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Terra RM, Kazantzis T, Pinto-Filho DR, Camargo SM, Martins-Neto F, Guimarães AN, Araújo CA, Losso LC, Ghefter MC, Lima NFD, Gomes-Neto A, Brito-Filho F, Haddad R, Saueressig MG, Lima AMR, Siqueira RPD, Pinho AJDME, Vannucci F. Anatomic pulmonary resection by video-assisted thoracoscopy: the Brazilian experience (VATS Brazil study). J Bras Pneumol 2017; 42:215-21. [PMID: 27383936 PMCID: PMC4984544 DOI: 10.1590/s1806-37562015000000337] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 04/06/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The objective of this study was to describe the results of anatomic pulmonary resections performed by video-assisted thoracoscopy in Brazil. METHODS Thoracic surgeons (members of the Brazilian Society of Thoracic Surgery) were invited, via e-mail, to participate in the study. Eighteen surgeons participated in the project by providing us with retrospective databases containing information related to anatomic pulmonary resections performed by video-assisted thoracoscopy. Demographic, surgical, and postoperative data were collected with a standardized instrument, after which they were compiled and analyzed. RESULTS The surgeons provided data related to a collective total of 786 patients (mean number of resections per surgeon, 43.6). However, 137 patients were excluded because some data were missing. Therefore, the study sample comprised 649 patients. The mean age of the patients was 61.7 years. Of the 649 patients, 295 (45.5%) were male. The majority-521 (89.8%)-had undergone surgery for neoplasia, which was most often classified as stage IA. The median duration of pleural drainage was 3 days, and the median hospital stay was 4 days. Of the 649 procedures evaluated, 598 (91.2%) were lobectomies. Conversion to thoracotomy was necessary in 30 cases (4.6%). Postoperative complications occurred in 124 patients (19.1%), the most common complications being pneumonia, prolonged air leaks, and atelectasis. The 30-day mortality rate was 2.0%, advanced age and diabetes being found to be predictors of mortality. CONCLUSIONS Our analysis of this representative sample of patients undergoing pulmonary resection by video-assisted thoracoscopy in Brazil showed that the procedure is practicable and safe, as well as being comparable to those performed in other countries. OBJETIVO O objetivo deste estudo foi descrever os resultados de ressecções pulmonares anatômicas por videotoracoscopia no Brasil. MÉTODOS Cirurgiões torácicos (membros da Sociedade Brasileira de Cirurgia Torácica) foram convidados, por correio eletrônico, a participar do estudo. Dezoito cirurgiões participaram do projeto enviando seus bancos de dados retrospectivos referentes a ressecções anatômicas de pulmão por videotoracoscopia. Dados demográficos, cirúrgicos e pós-operatórios foram coletados em um instrumento padronizado e posteriormente compilados e analisados. RESULTADOS Dados referentes a 786 pacientes foram encaminhados (média de 43,6 ressecções por cirurgião), sendo 137 excluídos por informações incompletas. Logo, 649 pacientes constituíram nossa população estudada. A média de idade dos pacientes foi de 61,7 anos, 295 eram homens (45,5%), e a maioria - 521 (89,8%) - foi submetida à cirurgia por neoplasia, mais frequentemente classificada como estádio IA. A mediana do tempo de drenagem pleural foi de 3 dias, e a do tempo de internação, 4 dias. Dos 649 procedimentos realizados, 598 (91,2%) foram lobectomias. A taxa de conversão para toracotomia foi de 4,6% (30 casos). Complicações pós-operatórias ocorreram em 124 pacientes (19,1%), sendo pneumonia, escape aéreo prolongado e atelectasia as mais frequentes. A mortalidade em 30 dias foi de 2,0%, tendo como preditores idade avançada e diabetes. CONCLUSÕES A casuística brasileira mostra que as ressecções pulmonares por cirurgia torácica videoassistida são factíveis e seguras, além de comparáveis àquelas de registros internacionais.
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Affiliation(s)
- Ricardo Mingarini Terra
- Departamento de Cardiopneumologia, Disciplina de Cirurgia Torácica, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Thamara Kazantzis
- Departamento de Cardiopneumologia, Disciplina de Cirurgia Torácica, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Darcy Ribeiro Pinto-Filho
- Serviço de Cirurgia Torácica, Hospital Geral de Caxias do Sul, Fundação Universidade de Caxias do Sul (RS) Brasil
| | - Spencer Marcantonio Camargo
- Serviço de Cirurgia Torácica, Pavilhão Pereira Filho, Complexo Hospitalar da Santa Casa de Porto Alegre, Porto Alegre (RS) Brasil
| | - Francisco Martins-Neto
- Hospital Monte Klinikum, Fortaleza (CE) Brasil.,Hospital de Messejana Doutor Carlos Alberto Studart Gomes, Fortaleza (CE) Brasil
| | | | | | | | | | | | - Antero Gomes-Neto
- Hospital de Messejana Doutor Carlos Alberto Studart Gomes, Fortaleza (CE) Brasil
| | | | - Rui Haddad
- Hospital Samaritano, Rio de Janeiro (RJ) Brasil
| | - Maurício Guidi Saueressig
- Serviço de Cirurgia Torácica, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre (RS) Brasil
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Vargas-Ábrego B, Ortega-García O, Arellano López P, Núñez-Perez Redondo C, López-Bochm K, Mendoza-Ramírez S, Cicero-Sabido R, Román-Bassaure E, Navarro-Reynoso F. VATS hybrid lobectomy in adenocarcinoma IIB. First case at the Hospital General de México. REVISTA MÉDICA DEL HOSPITAL GENERAL DE MÉXICO 2016. [DOI: 10.1016/j.hgmx.2016.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Scarci M, Pardolesi A, Caruana EJ, Petrella F, Solli P. Video-assisted thoracoscopic lobectomy: operative technique. Multimed Man Cardiothorac Surg 2015; 2015:mmv014. [PMID: 26173800 DOI: 10.1093/mmcts/mmv014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 06/17/2015] [Indexed: 11/14/2022]
Abstract
In this study, we present our technique for performing video-assisted lobectomy. This is presented in clear, easy-to-follow, sequential steps, noting variations on the most established technique and the rationale for this divergence. We also provide an instrument preference card, some operative tips and high-quality videos.
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Affiliation(s)
- Marco Scarci
- Department of Thoracic Surgery, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | | | - Edward Joseph Caruana
- Department of Thoracic Surgery, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Francesco Petrella
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Piergiorgio Solli
- Department of Thoracic Surgery, Papworth Hospital NHS Foundation Trust, Cambridge, UK
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Liu C, Li Z, Bai C, Wang L, Shi X, Song Y. Video-assisted thoracoscopic surgery and thoracotomy during lobectomy for clinical stage I non-small-cell lung cancer have equivalent oncological outcomes: A single-center experience of 212 consecutive resections. Oncol Lett 2014; 9:1364-1372. [PMID: 25663914 PMCID: PMC4315067 DOI: 10.3892/ol.2014.2804] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Accepted: 08/22/2014] [Indexed: 12/24/2022] Open
Abstract
The aim of the present study was to compare the oncological outcomes following lobectomy using either video-assisted thoracoscopic surgery (VATS) or thoracotomy in clinical stage I non-small cell lung cancer (NSCLC) patients. Short- and long-term data from 212 consecutive patients who underwent lobectomy for clinical stage I NSCLC via VATS or thoracotomy between February 2003 and July 2013 were retrospectively reviewed. The primary endpoints were mediastinal lymph node staging, disease-free survival time and overall survival time. A total of 212 lobectomies for clinical stage I NSCLC were performed, 123 by VATS and 89 by thoracotomy. Patients’ demographic data, pathological stage and residual tumor were similar in the two groups. Reduced blood loss, less post-operative analgesia required and earlier hospital discharge were recorded for the VATS group, as compared with the thoracotomy group. The overall morbidity was similar in the two groups. However, the rate of major complications was higher following thoracotomy than following VATS. No 30-day mortality occurred subsequent to either thoracotomy or VATS lobectomy. The overall survival and disease-free survival times were comparable between the two groups. In the univariate analysis, the treatment approach was not associated with the overall five-year survival or the disease-free survival times. Multivariate Cox regression analysis of survival times revealed that significant predictors of shorter survival times were advanced pathological T3 stage, pathological N1 or N2 disease and poor cancer differentiation. In conclusion, it is reasonable to conclude from the present study that VATS lobectomy performed by specialist thoracic surgeons is safe and may achieve similar long-term survival times to the open surgery approach. However, further prospective randomized multi-center trials are warranted prior to incorporating VATS into clinical routine.
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Affiliation(s)
- Chunhua Liu
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu 210002, P.R. China
| | - Zhongdong Li
- Department of Cardiothoracic Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu 210002, P.R. China
| | - Cuiqing Bai
- Department of Respiratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Li Wang
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu 210002, P.R. China
| | - Xuefei Shi
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu 210002, P.R. China
| | - Yong Song
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu 210002, P.R. China
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Who Performs Complex Noncardiac Thoracic Surgery in United States Academic Medical Centers? Ann Thorac Surg 2012; 94:1060-4. [DOI: 10.1016/j.athoracsur.2012.04.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 04/03/2012] [Accepted: 04/05/2012] [Indexed: 11/21/2022]
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Wright GM. Video-assisted thoracoscopic pulmonary resections - The Melbourne experience. Ann Cardiothorac Surg 2012; 1:11-5. [PMID: 23977458 DOI: 10.3978/j.issn.2225-319x.2012.04.01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 04/23/2012] [Indexed: 11/14/2022]
Abstract
BACKGROUND Despite its privileged economic and educational place in the world, Melbourne was relatively slow to embrace video-assisted thoracic surgery (VATS) for lobectomy. The initial driver of this was Professor C Peter Clarke at the Austin Hospital at the beginning of the new millennium. His legacy was carried on by his apprentice, but at St Vincent's Hospital. After a period of slow development, it became the procedure of choice from 2005, and began to filter sporadically to other hospitals from 2010. METHODS This paper details the historical development, techniques and results of 343 VATS pulmonary resections (including lobectomies, sub-lobar anatomical resections, sleeve resections, bi-lobectomies and pneumonectomies). RESULTS In-hospital and 30-day mortality was 2.0% and 5-year survival for all stages of NSCLC was 70%. Over 36% of patients were stage II-III using the new 7(th) revision TNM staging system. The conversion to thoracotomy rate was 4.7%. The estimated learning curve for this experience VATS lobectomy appears to be in the range of 15-20 cases. In this series, the same lymph node dissection or sampling was attempted and usually achieved as would have occurred at thoracotomy. CONCLUSIONS The results confirm the findings of other large case series that the benefits of a minimally invasive approach are achieved without compromising the long-term survival.
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Affiliation(s)
- Gavin M Wright
- Director of Surgical Oncology, St Vincent's Hospital, Melbourne, Australia; ; Clinical Associate Professor, University of Melbourne Department of Surgery, St Vincent's Hospital, Melbourne, Australia; ; Thoracic Surgical Lead, Division of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
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Jheon S, Yang HC, Cho S. Video-assisted thoracic surgery for lung cancer. Gen Thorac Cardiovasc Surg 2012; 60:255-60. [PMID: 22453533 DOI: 10.1007/s11748-011-0898-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Indexed: 02/08/2023]
Abstract
Video-assisted thoracic surgery (VATS) lobectomy is currently accepted as an appropriate procedure for selected patients with early-stage non-small-cell lung cancer (NSCLC). Evidence has demonstrated that VATS lobectomy is not only a safe and feasible technique, it provides better functional recovery and oncological efficacy similar to that achieved with conventional thoracotomy. However, there are still ongoing issues concerning VATS in terms of terminology, oncological efficacy, functional recovery, benefit of screening detected lung cancer, and its role in limited resection. As the number of VATS procedures are increasing and VATS is becoming a dominant procedural choice, it would be wise to collect evidence and come to a consensus to justify the expansion of surgical indications for VATS.
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Affiliation(s)
- Sanghoon Jheon
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, 166 Gumiro, Bundang, Seungnam, Gyeonggi, 463-707, Korea.
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Veronesi G, Agoglia BG, Melfi F, Maisonneuve P, Bertolotti R, Bianchi PP, Rocco B, Borri A, Gasparri R, Spaggiari L. Experience with Robotic Lobectomy for Lung Cancer. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2011. [DOI: 10.1177/155698451100600603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Giulia Veronesi
- Thoracic Surgery Division, European Institute of Oncology, Milan, Italy
| | | | - Franca Melfi
- Division of Thoracic Surgery, Cisanello Hospital, Pisa, Italy
| | - Patrick Maisonneuve
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
| | | | - Paolo P. Bianchi
- Unit of Minimally Invasive Surgery, Division of General Surgery, European Institute of Oncology, Milan, Italy
| | - Bernardo Rocco
- Institute of Urology, University of Milan, Fondazione Ca’ Granda Policlinico, Mangiagalli, Regina Elena, Milan, Italy
| | - Alessandro Borri
- Thoracic Surgery Division, European Institute of Oncology, Milan, Italy
| | - Roberto Gasparri
- Thoracic Surgery Division, European Institute of Oncology, Milan, Italy
| | - Lorenzo Spaggiari
- Thoracic Surgery Division, European Institute of Oncology, Milan, Italy
- University of Milan, Milan, Italy
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Experience with Robotic Lobectomy for Lung Cancer. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2011; 6:355-60. [DOI: 10.1097/imi.0b013e3182490093] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective In this study, we analyze our experience so far with robotic pulmonary lobectomy, compare it with published data, and suggest a learning curve for the operation. Methods Ninety-one patients with suspected or proven clinical stage I–III lung cancer underwent robotic lobectomy. Selection criteria included lesion ≤5 cm and normal respiratory function. One surgeon performed the operations using the da Vinci system with three ports and a 3-cm utility thoracotomy. Results Median duration of operation was 239 (range 85–411) minutes, 260 minutes in the first 18 patients and 221 minutes in the remaining 73 cases (P = 0.01). Median hospitalization declined from 6 days in the first 18 cases to 5 days in the remaining cases (P = 0.002). Conversion rate and number of complications reduced nonsignificantly from the initial to later series. Major complications occurred in 11% of the first 18 cases and 4% of the later cases. The number of lymph nodes removed did not change over the two series. There was no 30-day postoperative mortality. After a median follow-up of 24 months, 80 of 91 patients were alive with no sign of disease. Conclusions Our data suggest that about 20 operations are required to achieve surgical competence. Robotic lobectomy appears safe, oncologically radical, and associated with shorter postoperative hospitalization than open surgery.
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Cooke DT, Gelfand GA, Broghammer JA. Billing, Coding, and Credentialing in the Thoracic Surgery Practice. Thorac Surg Clin 2011; 21:349-58. [DOI: 10.1016/j.thorsurg.2011.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Zhao H, Bu L, Yang F, Li J, Li Y, Wang J. Video-Assisted Thoracoscopic Surgery Lobectomy for Lung Cancer: The Learning Curve. World J Surg 2010; 34:2368-72. [DOI: 10.1007/s00268-010-0661-7] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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