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Sirakaya F, Calik Kutukcu E, Onur MR, Dikmen E, Kumbasar U, Uysal S, Dogan R. The Effects of Various Approaches to Lobectomies on Respiratory Muscle Strength, Diaphragm Thickness, and Exercise Capacity in Lung Cancer. Ann Surg Oncol 2024; 31:5738-5747. [PMID: 38679681 PMCID: PMC11300537 DOI: 10.1245/s10434-024-15312-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/01/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND The most common surgery for non-small cell lung cancer is lobectomy, which can be performed through either thoracotomy or video-assisted thoracic surgery (VATS). Insufficient research has examined respiratory muscle function and exercise capacity in lobectomy performed using conventional thoracotomy (CT), muscle-sparing thoracotomy (MST), or VATS. This study aimed to assess and compare respiratory muscle strength, diaphragm thickness, and exercise capacity in lobectomy using CT, MST, and VATS. METHODS The primary outcomes were changes in respiratory muscle strength, diaphragm thickness, and exercise capacity. Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were recorded for respiratory muscle strength. The 6-min walk test (6MWT) was used to assess functional exercise capacity. Diaphragm thickness was measured using B-mode ultrasound. RESULTS The study included 42 individuals with lung cancer who underwent lobectomy via CT (n = 14), MST (n = 14), or VATS (n = 14). Assessments were performed on the day before surgery and on postoperative day 20 (range 17-25 days). The decrease in MIP (p < 0.001), MEP (p = 0.003), 6MWT (p < 0.001) values were lower in the VATS group than in the CT group. The decrease in 6MWT distance was lower in the MST group than in the CT group (p = 0.012). No significant differences were found among the groups in terms of diaphragmatic muscle thickness (p > 0.05). CONCLUSION The VATS technique appears superior to the CT technique in terms of preserving respiratory muscle strength and functional exercise capacity. Thoracic surgeons should refer patients to physiotherapists before lobectomy, especially patients undergoing CT. If lobectomy with VATS will be technically difficult, MST may be an option preferable to CT because of its impact on exercise capacity.
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Affiliation(s)
- Funda Sirakaya
- Department of Thoracic Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| | - Ebru Calik Kutukcu
- Department of Cardiorespiratory Physiotherapy and Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Mehmet Ruhi Onur
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Erkan Dikmen
- Department of Thoracic Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ulas Kumbasar
- Department of Thoracic Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Serkan Uysal
- Department of Thoracic Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Riza Dogan
- Department of Thoracic Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Ju JW, Suh M, Choi H, Na KJ, Park S, Cheon GJ, Kim YT. Clinical Factors Affecting Discrepancy Between Predicted and Long-term Actual Lung Function Following Surgery. Clin Nucl Med 2024:00003072-990000000-01217. [PMID: 39010320 DOI: 10.1097/rlu.0000000000005395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/17/2024]
Abstract
PURPOSE Lung cancer surgery outcomes depend heavily on preoperative pulmonary reserve, with forced expiratory volume in 1 second (FEV1) being a critical preoperative evaluation factor. Our study investigates the discrepancies between predicted and long-term actual postoperative lung function, focusing on clinical factors affecting these outcomes. METHODS This retrospective observational study encompassed lung cancer patients who underwent preoperative lung perfusion SPECT/CT between 2015 and 2021. We evaluated preoperative and postoperative pulmonary function tests, considering factors such as surgery type, resected volume, and patient history including tuberculosis. Predicted postoperative lung function was calculated using SPECT/CT imaging. RESULTS From 216 patients (men:women, 150:66; age, 67.9 ± 8.7 years), predicted postoperative FEV1% (ppoFEV1%) showed significant correlation with actual postoperative FEV1% (r = 0.667; P < 0.001). Paired t test revealed that ppoFEV1% was significantly lower compared with actual postoperative FEV1% (P < 0.001). The study identified video-assisted thoracic surgery (VATS) (odds ratio [OR], 3.90; 95% confidence interval [CI], 1.98-7.69; P < 0.001) and higher percentage of resected volume (OR per 1% increase, 1.05; 95% CI, 1.01-1.09; P = 0.014) as significant predictors of postsurgical lung function improvement. Conversely, for the decline in lung function postsurgery, significant predictors included lower percentage of resected lung volume (OR per 1% increase, 0.92; 95% CI, 0.86-0.98; P = 0.011), higher preoperative FEV1% (OR, 1.03; 95% CI, 1.01-1.07; P = 0.009), and the presence of tuberculosis (OR, 5.19; 95% CI, 1.48-18.15; P = 0.010). Additionally, in a subgroup of patients with borderline lung function, VATS was related with improvement. CONCLUSIONS Our findings demonstrate that in more than half of the patients, actual postsurgical lung function exceeded predicted values, particularly following VATS and with higher volume of lung resection. It also identifies lower resected lung volume, higher preoperative FEV1%, and tuberculosis as factors associated with a postsurgical decline in lung function. The study underscores the need for precise preoperative lung function assessment and tailored postoperative management, with particular attention to patients with relevant clinical factors. Future research should focus on validation of clinical factors and exploring tailored approaches to lung cancer surgery and recovery.
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Affiliation(s)
- Jae-Woo Ju
- From the Departments of Anesthesiology and Pain Medicine
| | | | | | - Kwon Jooong Na
- Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Samina Park
- Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | | | - Young Tae Kim
- Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Kocjan J, Rydel M, Czyżewski D, Adamek M. Comparison of Early Postoperative Diaphragm Muscle Function after Lobectomy via VATS and Open Thoracotomy: A Sonographic Study. Life (Basel) 2024; 14:487. [PMID: 38672757 PMCID: PMC11051456 DOI: 10.3390/life14040487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/19/2024] [Accepted: 03/29/2024] [Indexed: 04/28/2024] Open
Abstract
Although a growing body of evidence emphasizes the superiority of VATS over conventional thoracotomy, little is still known about early postoperative diaphragm muscle function after lobectomy via these two approaches. To fill the gap in existing literature, we conducted a comparative study between VATS and conventional thoracotomy in terms of postoperative diaphragm muscle function, assessing its contractility, strength, the magnitude of effort and potential risk of dysfunction such as atrophy and paralysis. A total of 59 patients (30 after VATS), who underwent anatomical pulmonary resection at our institution, were enrolled in this study. The control group consisted of 28 health subjects without medical conditions that could contribute to diaphragm dysfunction. Diaphragm muscle was assessed before and after surgery using ultrasonography. We found that both surgical approaches were associated with postoperative impairment of diaphragm muscle function-compared to baseline data. Postoperative reduction in diaphragm contraction was demonstrated in most of the 59 patients. In the case of the control group, the differences between measurements were not observed. We noted that lobectomy via thoracotomy was linked with a greater percentage of patients with diaphragm paralysis and/or atrophy than VATS. Similar findings were observed in referring to diaphragm magnitude effort, as well as diaphragm contraction strength, where minimally invasive surgery was associated with better diaphragm function parameters-in comparison to thoracotomy. Disturbance of diaphragm work was reported both at the operated and non-operated side. Upper-right and left lobectomy were connected with greater diaphragm function impairment than other segments. In conclusion, the VATS technique seems to be less invasive than conventional thoracotomy providing a better postoperative function of the main respiratory muscle.
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Affiliation(s)
- Janusz Kocjan
- Department of Thoracic Surgery, Faculty of Medicine with Dentistry Division, Medical University of Silesia, 40-055 Katowice, Poland; (M.R.); (D.C.); (M.A.)
| | - Mateusz Rydel
- Department of Thoracic Surgery, Faculty of Medicine with Dentistry Division, Medical University of Silesia, 40-055 Katowice, Poland; (M.R.); (D.C.); (M.A.)
| | - Damian Czyżewski
- Department of Thoracic Surgery, Faculty of Medicine with Dentistry Division, Medical University of Silesia, 40-055 Katowice, Poland; (M.R.); (D.C.); (M.A.)
| | - Mariusz Adamek
- Department of Thoracic Surgery, Faculty of Medicine with Dentistry Division, Medical University of Silesia, 40-055 Katowice, Poland; (M.R.); (D.C.); (M.A.)
- Department of Radiology, Faculty of Health Sciences with Institute of Maritime and Tropical Medicine, Medical University of Gdansk, 80-210 Gdansk, Poland
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Kuo C, Malvar J, Chi Y, Kim ES, Shah R, Navid F, Stein JE, Mascarenhas L. Survival outcomes and surgical morbidity based on surgical approach to pulmonary metastasectomy in pediatric, adolescent and young adult patients with osteosarcoma. Cancer Med 2023; 12:20231-20241. [PMID: 37800658 PMCID: PMC10652329 DOI: 10.1002/cam4.6491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/03/2023] [Accepted: 08/23/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Thoracotomy is considered the standard surgical approach for the management of pulmonary metastases in osteosarcoma (OST). Several studies have identified the advantages of a thoracoscopic approach, however, the clinical significance of thoracotomy compared to thoracoscopy is yet to be evaluated in a randomized trial. AIMS The primary aim was to determine the survival outcomes in OST patients based on surgical approach for pulmonary metastasectomy (PM) and secondary aim was to assess the post-operative morbidities of OST PM through various surgical approaches. MATERIALS AND METHODS We conducted a single institution retrospective study to compare survival outcomes and surgical morbidity according to the surgical approach of the management of pulmonary metastases in patients with OST. RESULTS Sixty-one patients with OST underwent PM. Twenty-one patients were metastatic at diagnosis and underwent PM during primary treatment; nine had thoracotomy, six thoracoscopy, and six combined thoracoscopy with thoracotomy (CTT). Forty-three patients with first pulmonary relapse or progression underwent PM; 18 had thoracotomy, 16 thoracoscopy and nine CTT. There was no difference in survival between surgical approaches. There were significantly more postoperative morbidities associated with thoracotomy for initial PM (pain and postoperative chest tube placement), and for PM at first relapse (pneumothoraces, pain, Foley catheter use and prolonged hospitalizations). CONCLUSION Our study demonstrates that patients with OST pulmonary metastases have comparable poor outcomes despite varying surgical approaches for PM. There were significantly more postoperative morbidities associated with thoracotomy for PM. Surgical bias and other competing risks could not be assessed given the limitations of a retrospective study and may be addressed in a prospective trial evaluating surgical approach for PM in OST.
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Affiliation(s)
- Christopher Kuo
- Department of Pediatrics, Division of Hematology‐Oncology, Cancer and Blood Disease InstituteChildren's Hospital Los AngelesLos AngelesCaliforniaUSA
- Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Jemily Malvar
- Department of Pediatrics, Division of Hematology‐Oncology, Cancer and Blood Disease InstituteChildren's Hospital Los AngelesLos AngelesCaliforniaUSA
| | - Yueh‐Yun Chi
- Department of Pediatrics, Division of Hematology‐Oncology, Cancer and Blood Disease InstituteChildren's Hospital Los AngelesLos AngelesCaliforniaUSA
- Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Eugene S. Kim
- Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- Department of Surgery, Division of Pediatric SurgeryChildren's Hospital Los AngelesLos AngelesCaliforniaUSA
| | - Rachana Shah
- Department of Pediatrics, Division of Hematology‐Oncology, Cancer and Blood Disease InstituteChildren's Hospital Los AngelesLos AngelesCaliforniaUSA
- Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Fariba Navid
- Department of Pediatrics, Division of Hematology‐Oncology, Cancer and Blood Disease InstituteChildren's Hospital Los AngelesLos AngelesCaliforniaUSA
- Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - James E. Stein
- Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- Department of Surgery, Division of Pediatric SurgeryChildren's Hospital Los AngelesLos AngelesCaliforniaUSA
| | - Leo Mascarenhas
- Department of Pediatrics, Division of Hematology‐Oncology, Cancer and Blood Disease InstituteChildren's Hospital Los AngelesLos AngelesCaliforniaUSA
- Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
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Applications of Robotic Surgery in Thoracic Diseases. J Clin Med 2022; 11:jcm11144201. [PMID: 35887965 PMCID: PMC9317933 DOI: 10.3390/jcm11144201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 07/17/2022] [Indexed: 11/16/2022] Open
Abstract
With the ever-expanding implement of screening programs, as well as a raised awareness of patients about their own health, the number of cases of early-stage lung cancer is progressively increasing, leading surgeons to adapt their practice and to develop new surgical techniques that are less and less invasive [...]
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Detterbeck FC, Mase VJ, Li AX, Kumbasar U, Bade BC, Park HS, Decker RH, Madoff DC, Woodard GA, Brandt WS, Blasberg JD. A guide for managing patients with stage I NSCLC: deciding between lobectomy, segmentectomy, wedge, SBRT and ablation-part 2: systematic review of evidence regarding resection extent in generally healthy patients. J Thorac Dis 2022; 14:2357-2386. [PMID: 35813747 PMCID: PMC9264068 DOI: 10.21037/jtd-21-1824] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 05/05/2022] [Indexed: 11/06/2022]
Abstract
Background Clinical decision-making for patients with stage I lung cancer is complex. It involves multiple options (lobectomy, segmentectomy, wedge, stereotactic body radiotherapy, thermal ablation), weighing multiple outcomes (e.g., short-, intermediate-, long-term) and multiple aspects of each (e.g., magnitude of a difference, the degree of confidence in the evidence, and the applicability to the patient and setting at hand). A structure is needed to summarize the relevant evidence for an individual patient and to identify which outcomes have the greatest impact on the decision-making. Methods A PubMed systematic review from 2000-2021 of outcomes after lobectomy, segmentectomy and wedge resection in generally healthy patients is the focus of this paper. Evidence was abstracted from randomized trials and non-randomized comparisons with at least some adjustment for confounders. The analysis involved careful assessment, including characteristics of patients, settings, residual confounding etc. to expose degrees of uncertainty and applicability to individual patients. Evidence is summarized that provides an at-a-glance overall impression as well as the ability to delve into layers of details of the patients, settings and treatments involved. Results In healthy patients there is no short-term benefit to sublobar resection vs. lobectomy in randomized and non-randomized comparisons. A detriment in long-term outcomes is demonstrated by adjusted non-randomized comparisons, more marked for wedge than segmentectomy. Quality-of-life data is confounded by the use of video-assisted approaches; evidence suggests the approach has more impact than the resection extent. Differences in pulmonary function tests by resection extent are not clinically meaningful in healthy patients, especially for multi-segmentectomy vs. lobectomy. The margin distance is associated with the risk of recurrence. Conclusions A systematic, comprehensive summary of evidence regarding resection extent in healthy patients with attention to aspects of applicability, uncertainty and effect modifiers provides a foundation on which to build a framework for individualized clinical decision-making.
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Affiliation(s)
- Frank C. Detterbeck
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Vincent J. Mase
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Andrew X. Li
- Department of General Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Ulas Kumbasar
- Department of Thoracic Surgery, Hacettepe University School of Medicine, Ankara, Turkey
| | - Brett C. Bade
- Department of Pulmonary Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Henry S. Park
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Roy H. Decker
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - David C. Madoff
- Department of Radiology & Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Gavitt A. Woodard
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Whitney S. Brandt
- Department of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Justin D. Blasberg
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
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7
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Xu Y, Qin Y, Ma D, Liu H. The impact of segmentectomy versus lobectomy on pulmonary function in patients with non-small-cell lung cancer: a meta-analysis. J Cardiothorac Surg 2022; 17:107. [PMID: 35526006 PMCID: PMC9077940 DOI: 10.1186/s13019-022-01853-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 04/20/2022] [Indexed: 11/15/2022] Open
Abstract
Objective Segmentectomy has been reported as an alternative to lobectomy for small-sized NSCLC without detriment to survival. The long-term benefits of segmentectomy over lobectomy on pulmonary function have not been firmly established. This meta-analysis aims to compare postoperative changes in pulmonary function in NSCLC patients undergoing segmentectomy or lobectomy. Methods Medline, Embase, Web of Science and Scopus were searched through March 2021. Statistical comparisons were made when appropriate. Results Fourteen studies (2412 participants) out of 324 citations were included in this study. All selected studies were high quality, as indicated by the Newcastle–Ottawa scale for assessing the risk of bias. Clinical outcomes were compared between segmentectomy and lobectomy. ΔFEV1 [10 studies, P < 0.01, WMD = 0.40 (0.29, 0.51)], ΔFVC [4 studies, P < 0.01, WMD = 0.16 (0.07, 0.24)], ΔFVC% [4 studies, P < 0.01, WMD = 4.05 (2.32, 5.79)], ΔFEV1/FVC [2 studies, P < 0.01, WMD = 1.99 (0.90, 3.08)], and ΔDLCO [3 studies, P < 0.01, WMD = 1.30 (0.69, 1.90)] were significantly lower in the segmentectomy group than in the lobectomy group. Subgroup analysis showed that in stage IA patients, the ΔFEV1% [3 studies, P < 0.01, WMD = 0.26 (0.07, 0.46)] was significantly lower in the segmentectomy group. The ΔDLCO% and ΔMVV% were incomparable. Conclusion Segmentectomy preserves more lung function than lobectomy. There were significantly smaller decreases in FEV1, FVC, FVC%, FEV1/FVC and DLCO in the segmentectomy group than in the lobectomy group. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-022-01853-3.
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Affiliation(s)
- Yuan Xu
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yingzhi Qin
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Dongjie Ma
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Hongsheng Liu
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
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Prophylactic Penehyclidine Inhalation for Prevention of Postoperative Pulmonary Complications in High-risk Patients: A Double-blind Randomized Trial. Anesthesiology 2022; 136:551-566. [PMID: 35226725 DOI: 10.1097/aln.0000000000004159] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Postoperative pulmonary complications are common. Aging and respiratory disease provoke airway hyperresponsiveness, high-risk surgery induces diaphragmatic dysfunction, and general anesthesia contributes to atelectasis and peripheral airway injury. This study therefore tested the hypothesis that inhalation of penehyclidine, a long-acting muscarinic antagonist, reduces the incidence of pulmonary complications in high-risk patients over the initial 30 postoperative days. METHODS This single-center double-blind trial enrolled 864 patients age over 50 yr who were scheduled for major upper-abdominal or noncardiac thoracic surgery lasting 2 h or more and who had an Assess Respiratory Risk in Surgical Patients in Catalonia score of 45 or higher. The patients were randomly assigned to placebo or prophylactic penehyclidine inhalation from the night before surgery through postoperative day 2 at 12-h intervals. The primary outcome was the incidence of a composite of pulmonary complications within 30 postoperative days, including respiratory infection, respiratory failure, pleural effusion, atelectasis, pneumothorax, bronchospasm, and aspiration pneumonitis. RESULTS A total of 826 patients (mean age, 64 yr; 63% male) were included in the intention-to-treat analysis. A composite of pulmonary complications was less common in patients assigned to penehyclidine (18.9% [79 of 417]) than those receiving the placebo (26.4% [108 of 409]; relative risk, 0.72; 95% CI, 0.56 to 0.93; P = 0.010; number needed to treat, 13). Bronchospasm was less common in penehyclidine than placebo patients: 1.4% (6 of 417) versus 4.4% (18 of 409; relative risk, 0.327; 95% CI, 0.131 to 0.82; P = 0.011). None of the other individual pulmonary complications differed significantly. Peak airway pressures greater than 40 cm H2O were also less common in patients given penehyclidine: 1.9% (8 of 432) versus 4.9% (21 of 432; relative risk, 0.381; 95% CI, 0.171 to 0.85; P = 0.014). The incidence of other adverse events, including dry mouth and delirium, that were potentially related to penehyclidine inhalation did not differ between the groups. CONCLUSIONS In high-risk patients having major upper-abdominal or noncardiac thoracic surgery, prophylactic penehyclidine inhalation reduced the incidence of pulmonary complications without provoking complications. EDITOR’S PERSPECTIVE
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Mimae T, Miyata Y, Kumada T, Handa Y, Tsutani Y, Okada M. OUP accepted manuscript. Interact Cardiovasc Thorac Surg 2022; 34:753-759. [PMID: 35137092 PMCID: PMC9070519 DOI: 10.1093/icvts/ivac014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 01/13/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Takahiro Mimae
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Yoshihiro Miyata
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Takashi Kumada
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Yoshinori Handa
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Yasuhiro Tsutani
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
- Corresponding author. Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan. Tel: +81-82-257-5869; fax: +81-82-256-7109; e-mail: (M. Okada)
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10
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Wang X, Guo H, Hu Q, Ying Y, Chen B. Pulmonary function after segmentectomy versus lobectomy in patients with early-stage non-small-cell lung cancer: a meta-analysis. J Int Med Res 2021; 49:3000605211044204. [PMID: 34521244 PMCID: PMC8447102 DOI: 10.1177/03000605211044204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective Segmentectomy is widely performed for early-stage lung cancer. However, the
effects of segmentectomy versus lobectomy on pulmonary function remain
unclear. We performed a meta-analysis with the aim of comparing
segmentectomy and lobectomy in terms of preservation of pulmonary function
in patients with early-stage non-small-cell lung cancer (NSCLC). Methods We conducted a literature search of PubMed using the terms ‘pulmonary
function’ AND ‘segmentectomy’ AND ‘lobectomy’. The primary outcomes of
interest were the forced expiratory volume in 1 second (FEV1), FEV1 as
percent of predicted (%FEV1), change in FEV1 (Δ%FEV1), and the ratio of
postoperative to preoperative FEV1. Results Thirteen studies comprising 2027 patients met the inclusion and exclusion
criteria and were included for analysis, including 787 patients in the
segmentectomy group and 1240 patients in the lobectomy group. Patients in
the segmentectomy group showed significantly better preservation of FEV1 and
%FEV1 compared with the lobectomy group. The reduction in FEV1 after surgery
was significantly less in the segmentectomy group compared with the
lobectomy group, and Δ%FEV1 was significantly higher in the segmentectomy
group than in the lobectomy group. Conclusion Segmentectomy results in better preservation of pulmonary function compared
with lobectomy in patients with early-stage NSCLC.
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Affiliation(s)
- Xinxin Wang
- Department of Thoracic and Cardiovascular Surgery, Affiliated Taizhou Hospital of Wenzhou Medical University, Taizhou, China
| | - Haixie Guo
- Department of Thoracic and Cardiovascular Surgery, Affiliated Taizhou Hospital of Wenzhou Medical University, Taizhou, China
| | - Quanteng Hu
- Department of Thoracic and Cardiovascular Surgery, Affiliated Taizhou Hospital of Wenzhou Medical University, Taizhou, China
| | - Yongquan Ying
- Department of Thoracic and Cardiovascular Surgery, Affiliated Taizhou Hospital of Wenzhou Medical University, Taizhou, China
| | - Baofu Chen
- Department of Thoracic and Cardiovascular Surgery, Affiliated Taizhou Hospital of Wenzhou Medical University, Taizhou, China
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11
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Falcoz PE, Olland A, Charloux A. Does functional evaluation before lung cancer surgery need reappraisal? Eur J Cardiothorac Surg 2021; 60:3-6. [PMID: 34113993 DOI: 10.1093/ejcts/ezab273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Pierre-Emmanuel Falcoz
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France.,Université de Strasbourg, Faculté de médecine et pharmacie, Strasbourg, France.,Hôpitaux Universitaire de Strasbourg, Service de chirurgie thoracique-Nouvel Hôpital Civil, Strasbourg, France.,Department of Thoracic Surgery, University Hospital, Strasbourg, France
| | - Anne Olland
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France.,Université de Strasbourg, Faculté de médecine et pharmacie, Strasbourg, France.,Hôpitaux Universitaire de Strasbourg, Service de chirurgie thoracique-Nouvel Hôpital Civil, Strasbourg, France.,Department of Thoracic Surgery, University Hospital, Strasbourg, France
| | - Anne Charloux
- Hôpitaux Universitaire de Strasbourg, Service de physiologie et explorations fonctionnelles-Nouvel Hôpital Civil, Strasbourg, France.,EA 3072, Federation of Translational Medicine, Strasbourg University, Strasbourg, France.,Physiology and Functional Explorations Dept, University Hospital, Strasbourg, France
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12
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Shibazaki T, Mori S, Harada E, Shigemori R, Kato D, Matsudaira H, Hirano J, Ohtsuka T. Measured versus predicted postoperative pulmonary function at repeated times up to 1 year after lobectomy. Interact Cardiovasc Thorac Surg 2021; 33:727-733. [PMID: 34115872 DOI: 10.1093/icvts/ivab168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/10/2021] [Accepted: 05/05/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Postoperative pulmonary function is difficult to predict accurately, because it changes from the time of the operation and is also affected by various factors. The objective of this study was to assess the accuracy of predicted postoperative forced expiratory volume in 1 s (FEV1) at different postoperative times after lobectomy. METHODS This retrospective study enrolled 104 patients who underwent lobectomy by video-assisted thoracic surgery. Pulmonary function tests were performed preoperatively and postoperatively at 3, 6 and 12 months. We investigated time-dependent changes in FEV1. In addition, the ratio of measured to predicted postoperative FEV1 calculated by the subsegmental method was evaluated to identify the factors associated with variations in postoperative FEV1. RESULTS Compared with the predicted postoperative FEV1, the measured postoperative FEV1 was 8% higher at 3 months, 11% higher at 6 months and 13% higher at 12 months. The measured postoperative FEV1 significantly increased from 3 to 6 months (P = 0.002) and from 6 to 12 months (P = 0.015) after lobectomy resected lobe, smoking history and body mass index were significant factors associated with the ratio of measured to predicted postoperative FEV1 at 12 months (P < 0.001, P = 0.036 and P = 0.025, respectively). CONCLUSIONS Postoperative FEV1 increased up to 12 months after lobectomy by video-assisted thoracic surgery. The predicted postoperative pulmonary function was underestimated after 3 months, particularly after lower lobectomy.
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Affiliation(s)
- Takamasa Shibazaki
- Department of Thoracic Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Shohei Mori
- Department of Thoracic Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Eriko Harada
- Department of Thoracic Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Rintaro Shigemori
- Department of Thoracic Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Daiki Kato
- Department of Thoracic Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Hideki Matsudaira
- Department of Thoracic Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Jun Hirano
- Department of Thoracic Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Takashi Ohtsuka
- Department of Thoracic Surgery, Jikei University School of Medicine, Tokyo, Japan
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13
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Quality of Life, Postoperative Pain, and Lymph Node Dissection in a Robotic Approach Compared to VATS and OPEN for Early Stage Lung Cancer. J Clin Med 2021; 10:jcm10081687. [PMID: 33920023 PMCID: PMC8071041 DOI: 10.3390/jcm10081687] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 04/11/2021] [Accepted: 04/12/2021] [Indexed: 11/17/2022] Open
Abstract
We compare the perioperative course, postoperative pain, and quality-of-life (QOL) in patients undergoing anatomic resections of early-stage lung cancer by means of robotic surgery (RATS), video-assisted thoracic surgery (VATS), or muscle-sparing thoracotomy (OPEN); 169 consecutive patients with known/suspected lung cancer, candidates to anatomic resection, were enrolled in a single-center prospective study from April 2016 to December 2018. EORTC QLQ-C30 and QLQ-LC13 scores were obtained preoperatively and, at three time points, postoperatively. RATS and VATS groups were matched for ASA scores, while RATS and open surgery were matched for gender, ASA score, cancer stage, and tumor size; 58 patients underwent open surgery, 58 had VATS, and 53 had RATS. Hospital stay was shorter after RATS than OPEN (median 4.5 versus 5; p = 0.047). Comparing matched RATS and VATS groups, the number of hilar lymph nodes and nodal stations removed was significantly higher in the former approach (p = 0.01 vs. p < 0.0001); conversely, pain at 2 weeks was slightly lower after VATS (p = 0.004). No significant difference was observed in conversions, complications, duration of surgery, and postoperative hospitalization. The robotic approach was superior to OPEN in terms of QOL, pain, and length of postoperative stay and showed improved lymph node dissection compared to VATS.
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14
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[Approaches to the pre-operative functional assessment of patients with lung cancer and preoperative rehabilitation]. Rev Mal Respir 2020; 37:800-810. [PMID: 33199069 DOI: 10.1016/j.rmr.2020.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/08/2020] [Indexed: 12/25/2022]
Abstract
Surgery is the best treatment for early lung cancer but requires a preoperative functional evaluation to identify patients who may be at a high risk of complications or death. Guideline algorithms include a cardiological evaluation, a cardiopulmonary assessment to calculate the predicted residual lung function, and identify patients needing exercise testing to complete the evaluation. According to most expert opinion, exercise tests have a very high predictive value of complications. However, since the publication of these guidelines, minimally-invasive surgery, sublobar resections, prehabilitation and enhanced recovery after surgery (ERAS) programmes have been developed. Implementation of these techniques and programs is associated with a decrease in postoperative mortality and complications. In addition, the current guidelines and the cut-off values they identified are based on early series of patients, and are designed to select patients before major lung resection (lobectomy-pneumonectomy) performed by thoracotomy. Therefore, after a review of the current guidelines and a brief update on prehabilitation (smoking cessation, exercise training and nutritional aspects), we will discuss the need to redefine functional criteria to select patients who will benefit from lung surgery.
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15
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Singer ES, Kneuertz PJ, Nishimura J, D'Souza DM, Diefenderfer E, Moffatt-Bruce SD, Merritt RE. Effect of operative approach on quality of life following anatomic lung cancer resection. J Thorac Dis 2020; 12:6913-6919. [PMID: 33282394 PMCID: PMC7711373 DOI: 10.21037/jtd.2020.01.05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Patient-reported outcomes (PRO) after lung cancer surgery are of increasing interest to patients and clinicians. A variety of studies have investigated the impact of the surgical approach on quality of life (QOL) after surgery for early non-small-cell lung cancer (NSCLC). Our aim is to review the current evidence on how minimally-invasive approaches, including video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS), versus open thoracotomy for lung cancer affect QOL. We conducted a systematic review of the literature of studies comparing QOL after VATS/RATS versus thoracotomy approach using studies published before 2019 on PubMed and Google Scholar. Studies were assessed for differences in QOL by domains. Fifteen studies met our inclusion criteria including 14 observational studies and one randomized trial. Survey instruments and timing of QOL assessments differed between all studies. A thoracoscopic (VATS or RATS) approach was associated with better general health (3/10 studies), physical functioning (9/14 studies), social functioning (1/12 studies), mental health (3/13 studies), emotional role functioning (4/12 studies), physical role functioning (7/12 studies), and bodily pain (7/12 studies) as compared to open surgery. The open thoracotomy approach was associated with better general health and mental health in one study each. Although QOL assessment in current studies is highly variable, the existing evidence suggests that a thoracoscopic approach is associated with improved QOL, particularly in the areas of physical functioning and pain as compared to open lung cancer surgery.
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Affiliation(s)
- Emily S Singer
- Thoracic Surgery Division, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Peter J Kneuertz
- Thoracic Surgery Division, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jennifer Nishimura
- Thoracic Surgery Division, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Desmond M D'Souza
- Thoracic Surgery Division, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ellen Diefenderfer
- Thoracic Surgery Division, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Susan D Moffatt-Bruce
- Thoracic Surgery Division, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Robert E Merritt
- Thoracic Surgery Division, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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16
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Lacroix V, Kahn D, Matte P, Pieters T, Noirhomme P, Poncelet A, Steyaert A. Robotic-Assisted Lobectomy Favors Early Lung Recovery versus Limited Thoracotomy. Thorac Cardiovasc Surg 2020; 69:557-563. [PMID: 33045756 DOI: 10.1055/s-0040-1715598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Postoperative pulmonary recovery after lobectomy has showed early benefits for the video-assisted thoracoscopic surgery and sparing open techniques over nonsparing techniques. Robotic-assisted procedures offer benefits in term of clinical outcomes, but their advantages on pulmonary recovery and quality of life have not yet been distinctly prospectively studied. METHODS Eighty-six patients undergoing lobectomy over a period of 29 months were prospectively studied for their pulmonary function recovery and pain score level during the in-hospital stay and at 1, 2, and 6 months. Quality of life was evaluated at 2 and 6 months. Forty-five patients were operated by posterolateral limited thoracotomy and 41 patients by robotic approach. The postoperative analgesia protocol differed for the two groups, being lighter for the robotic group. RESULTS The pulmonary tests were not significantly different during the in-hospital stay. At 1 month, the forced expiratory volume in 1 second, forced vital capacity, vital capacity, and maximal expiratory pressure were significantly better for the robotic group (p = 0.05, 0.04, 0.05, and 0.02, respectively). There was no significant difference left at 2 and 6 months. Pain intensity was equivalent during the in-hospital stay but was significantly lower for the robotic group at 1 month (p = 0.02). At 2 and 6 months, pain and quality of life were comparable. CONCLUSION Robotic technique can offer similar pulmonary and pain recovery during the in-hospital stay with a lighter analgesia protocol. It clearly favors the early term recovery compared with the open limited technique. The objective and subjective functional recovery becomes equivalent at 2 and 6 months.
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Affiliation(s)
- Valérie Lacroix
- Department of Cardiovascular and Thoracic Surgery, IREC, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
| | - David Kahn
- Department of Anesthesiology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
| | - Pascal Matte
- Department of Cardiovascular and Thoracic Surgery, IREC, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
| | - Thierry Pieters
- Department of Pulmonary Medicine, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
| | - Philippe Noirhomme
- Department of Cardiovascular and Thoracic Surgery, IREC, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
| | - Alain Poncelet
- Department of Cardiovascular and Thoracic Surgery, IREC, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
| | - Arnaud Steyaert
- Department of Anesthesiology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium.,Institute of Neuroscience, Université Catholique de Louvain, Bruxelles, Belgium
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17
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Furák J, Paróczai D, Burián K, Szabó Z, Zombori T. Oncological advantage of nonintubated thoracic surgery: Better compliance of adjuvant treatment after lung lobectomy. Thorac Cancer 2020; 11:3309-3316. [PMID: 32985138 PMCID: PMC7606006 DOI: 10.1111/1759-7714.13672] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/03/2020] [Accepted: 09/03/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Video-assisted thoracoscopic (VATS) surgery contributes to improved survival, adjuvant chemotherapy delivery and less postoperative complications. Nonintubated thoracic surgery (NITS) VATS procedures improves immunological responses in lung cancer patients; however, there is no data regarding adjuvant chemotherapy delivery effectiveness following NITS lobectomies. In this study, we aimed to compare protocol compliance and toxic complications during adjuvant chemotherapy after intubated and nonintubated VATS lobectomies in non-small cell lung cancer (NSCLC). METHODS We retrospectively reviewed the medical records of 66, stage IB-IIIB NSCLC patients who underwent intubated or nonintubated VATS lobectomy and received adjuvant chemotherapy. RESULTS A total of 38 patients (17 males, mean age 64 years) underwent conventional VATS and 28 (7 males; mean age 63 years) uniportal VATS NITS. Both groups had comparable demographic data, preoperative pulmonary function, and Eastern Cooperative Oncology Group (ECOG) status. Among the intubated and nonintubated patients, 82% and 75% were diagnosed with adenocarcinoma, respectively. The incidence of adenocarcinoma and squamous cell carcinoma cases were similar in both groups; however, the pathological staging showed significant differences, as 5 (18%) nonintubated patients had stage IB lung cancer, compared with the intubated group (P = 0.01). Further distribution of stages was similar between the groups. We observed significant differences in chest tube duration and operation time in the nonintubated group (P < 0.01). Among nonintubated patients, 92% completed the planned chemotherapy protocol, compared to 71% of the intubated group (P = 0.035). Grade 1/2 toxicity occurred significantly more often in the intubated group (16% vs. 0%, P = 0.03) and there was a lower incidence of grade 4 neutropenia in the nonintubated group (0% vs. 16%, P = 0.03). CONCLUSIONS Our results showed that the nonintubated procedure resulted in improved adjuvant chemotherapy compliance and lower toxicity rates after lobectomy. KEY POINTS SIGNIFICANT FINDINGS OF THE STUDY: Oncological advantage of the non-intubated thoracic surgery: better compliance with therapy protocol. What this study adds NITS lobectomies contribute to better administration of adjuvant chemotherapy with the planned cycle number and dosage.
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Affiliation(s)
- József Furák
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - Dóra Paróczai
- Department of Pulmonology, University of Szeged, Deszk, Hungary.,Department of Medical Microbiology and Immunobiology, University of Szeged, Szeged, Hungary
| | - Katalin Burián
- Department of Medical Microbiology and Immunobiology, University of Szeged, Szeged, Hungary
| | - Zsolt Szabó
- Department of Anaesthesiology and Intensive Therapy, University of Szeged, Szeged, Hungary
| | - Tamás Zombori
- Department of Pathology, University of Szeged, Szeged, Hungary
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18
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Le Gac C, Gondé H, Gillibert A, Laurent M, Selim J, Bottet B, Varin R, Baste JM. Medico-economic impact of robot-assisted lung segmentectomy: what is the cost of the learning curve? Interact Cardiovasc Thorac Surg 2020; 30:255-262. [PMID: 31605110 DOI: 10.1093/icvts/ivz246] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 09/10/2019] [Accepted: 09/11/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The objective of this study was to assess the learning curve (LC) of robot-assisted lung segmentectomy and to evaluate hospital-related costs. METHODS We conducted a retrospective study of Robot-assisted thoracic surgery (RATS) segmentectomies performed by 1 surgeon during 5 years. Perioperative and medical device data were collected. The LC, based on operating time, was assessed by Cumulative SUM analysis and an exponential model. Cost of care was estimated using the French National Cost Study method. RESULTS One hundred and two RATS segmentectomies were included. The LC was completed at ∼30 procedures according to both models without significant difference in patients' characteristics before or after the LC. Mean operative time decreased from 136 min [95% confidence intervals (CI) 124-149] for the first 30 procedures to 97 min (95% CI 88-107) for the last 30 procedures. Mean length of stay decreased non-significantly (P = 0.10 for linear trend) from 8.1 days (95% CI 6.1-11.0) to 6.2 days (95% CI 4.9-7.9). The overall costs for the last 30 procedures as compared with the first 30 did not significantly decrease in the primary economic analysis but significantly decreased (P = 0.02) by €1271 (95% CI -2688 to +108, P = 0.02 for linear trend) after exclusion of 1 outlier (hospitalization-related costs > €10 000). After exclusion of this outlier, costs related to EndoWrist® instruments significantly decreased by €-135 (95% CI -220 to -35, P = 0.004), whereas costs related to clips decreased non-significantly (P = 0.28). CONCLUSIONS The LC was completed at ∼30 procedures. Inexperienced surgeons may have higher procedure costs, related to consumable medical devices and operating time.
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Affiliation(s)
- Constance Le Gac
- Department of Pharmacy, Rouen University Hospital, Rouen, France
| | - Henri Gondé
- Department of Pharmacy, UNIROUEN, Inserm U1234, Rouen University Hospital, Normandie University, Rouen, France
| | - André Gillibert
- Department of Biostatistics, Rouen University Hospital, Rouen, France
| | - Marc Laurent
- Department of Pharmacy, Rouen University Hospital, Rouen, France
| | - Jean Selim
- Department of Anesthesiology, UNIROUEN, Inserm U1096, Rouen University Hospital, Normandie University, Rouen, France
| | - Benjamin Bottet
- Department of General and Thoracic Surgery, Rouen University Hospital, Rouen, France
| | - Rémi Varin
- Department of Pharmacy, UNIROUEN, Inserm U1234, Rouen University Hospital, Normandie University, Rouen, France
| | - Jean-Marc Baste
- Department of General and Thoracic Surgery, UNIROUEN, Inserm U1096, Rouen University Hospital, Normandie University, Rouen, France
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19
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Sihoe ADL. Video-assisted thoracoscopic surgery as the gold standard for lung cancer surgery. Respirology 2020; 25 Suppl 2:49-60. [PMID: 32734596 DOI: 10.1111/resp.13920] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 06/20/2020] [Accepted: 07/07/2020] [Indexed: 12/25/2022]
Abstract
Surgical resection remains the only effective means of cure in the vast majority of patients with early-stage lung cancer. It can be performed via a traditional open approach (particularly thoracotomy) or a minimally invasive approach. VATS is 'keyhole' surgery in the chest, and was first used for lung cancer resection in the early 1990s. Since then, a large volume of evolving clinical evidence has confirmed that VATS lung cancer resection offered proven safety and feasibility, better patient-reported post-operative outcomes, less surgical trauma as quantified by objective outcome measures and equivalent or better survival than open surgery. This has firmly established VATS as the surgical approach of choice for early-stage lung cancer today. Although impressive new non-surgical lung cancer therapies have emerged in recent years, VATS is also being constantly rejuvenated by the development of 'next generation' VATS techniques, the refinement of VATS sublobar resection for selected patients, the utilization of bespoke post-operative recovery programmes for VATS and the synthesis of VATS into multi-modality lung cancer therapy. There is little doubt that VATS will remain as the gold standard for lung cancer surgery for the foreseeable future.
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Affiliation(s)
- Alan D L Sihoe
- Gleneagles Hong Kong Hospital, Hong Kong SAR, China.,International Medical Centre, Hong Kong SAR, China
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20
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Tukanova K, Papi E, Jamel S, Hanna GB, McGregor AH, Markar SR. Assessment of chest wall movement following thoracotomy: a systematic review. J Thorac Dis 2020; 12:1031-1040. [PMID: 32274172 PMCID: PMC7139064 DOI: 10.21037/jtd.2019.12.93] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Thoracotomy is a major cause of respiratory impairment, increasing the risk of postoperative pulmonary complications (PPC). Systems assessing ribcage kinematics may detect changes in chest expansion following thoracotomy and may thus aid in the development of patient-tailored chest physiotherapy. Hence, we aimed to identify studies assessing changes in chest wall movement following thoracotomy using objective measures. The Cochrane library, MEDLINE, EMBASE, Scopus and Web of Science databases were searched to find relevant articles providing an objective assessment of chest wall movement following thoracotomy. Methodological quality of included studies concerning chest wall movement following thoracotomy was assessed by use of QUADAS-2 tool. A total of 12 articles were included for the assessment of chest wall changes following thoracotomy using objective measures. Four studies measured changes in the cross-sectional area of the ribcage and abdomen using the respiratory inductive plethysmography (RIP), 1 study computed the chest wall compliance by monitoring the intra-pleural pressure, 3 studies measured changes in chest circumference with a simple tape measure and 4 articles performed a compartmental analysis of the chest wall volume by means of an optoelectronic plethysmography (OEP). There was no delay in the collection of data of the index test and reference standard, resulting in a low risk of bias for the flow and timing domain. Across all studies, participants underwent the same reference standard, resulting in a low risk of verification bias. Several objective measures were able to detect changes in chest wall displacement following thoracotomy and differed in the practical use and invasive nature. OEP allows a compartmental analysis of the chest wall volume. Hence, this system allows to assess chest wall movement changes following thoracotomy and the impact of different types of surgical approach. Furthermore, it could aid in the development of tailored physiotherapy.
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Affiliation(s)
- Karina Tukanova
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Enrica Papi
- Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Bioengineering, Imperial College London, London, UK
| | - Sara Jamel
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - George B Hanna
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Alison H McGregor
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Sheraz R Markar
- Department of Surgery and Cancer, Imperial College London, London, UK
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21
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Uchida T, Tanaka Y, Shimizu N, Kuroda S, Doi T, Hokka D, Okita Y, Maniwa Y. Diaphragmatic plication for iatrogenic respiratory insufficiency after cardiothoracic surgery. J Thorac Dis 2019; 11:3704-3711. [PMID: 31656642 DOI: 10.21037/jtd.2019.09.34] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The efficacy of diaphragmatic plication (DP) has been proven in many studies. However, there are few reports on DP for patients with severe respiratory conditions requiring mechanical ventilation. The study aim was to demonstrate the efficacy of DP for patients with severe respiratory insufficiency after cardiothoracic surgeries. Methods We retrospectively reviewed 10 patients who underwent DP for severe respiratory insufficiency due to postoperative diaphragmatic paralysis; eight of them required mechanical ventilation, and two needed high-flow oxygen therapy prior to DP. The symptoms, lung function, and elevation of the diaphragm were assessed before and after DP. Results All patients were successfully withdrawn from mechanical ventilation after DP and discharged without the need for oxygen therapy. The mean perioperative Medical Research Council (MRC) dyspnea scale (ATS/ERS 2004) score improved in 30 days (from 4 to 1.8) and in 90 days (from 4 to 0.6) after DP. Lung dynamic compliance was also ameliorated (mean improvement: 41.9 to 60.7 mL/cmH2O). Radiography revealed improved elevation of the diaphragm (mean improvement of 1.8 intercostal spaces, range, 1-2). Mean hospital stay after DP was 65.5 days (range, 25-187 days). One patient who underwent DP with endostapler-only suturing required re-operation because of staple line ruptures. Conclusions DP was found to be an effective form of treatment for patients with severe respiratory insufficiency after cardiothoracic surgery.
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Affiliation(s)
- Takahiro Uchida
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yugo Tanaka
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Nahoko Shimizu
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Sanae Kuroda
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takefumi Doi
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Daisuke Hokka
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yutaka Okita
- Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshimasa Maniwa
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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22
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Liu CJ, Tsai WC, Chu CC, Muo CH, Chung WS. Is incentive spirometry beneficial for patients with lung cancer receiving video-assisted thoracic surgery? BMC Pulm Med 2019; 19:121. [PMID: 31286923 PMCID: PMC6615301 DOI: 10.1186/s12890-019-0885-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 06/24/2019] [Indexed: 02/01/2023] Open
Abstract
Background The effectiveness of Incentive spirometry (IS) in patients undergoing video-assisted thoracic surgery (VATS) remains lacking. We conducted a population-based study to investigate the effectiveness of IS on patients with lung cancers following VATS. Methods We identified patients newly diagnosed with lung cancer who underwent surgical resection by VATS or thoracotomy from the years 2000 to 2008 in the Longitudinal Health Insurance Database. Exposure variable was the use of IS during admission for surgical resection by VATS or thoracotomy. Primary outcomes included hospitalization cost, incidence of pneumonia, and length of hospital stay. Secondary outcomes included the frequency of emergency department (ED) visits and hospitalizations at 3-month, 6-month, and 12-month follow-ups after thoracic surgery. Results We analyzed 7549 patients with lung cancer undergoing surgical resection by VATS and thoracotomy. The proportion of patients who were subjected to IS was significantly higher in those who underwent thoracotomy than in those who underwent VATS (68.4% vs. 53.1%, P < 0.0001). After we controlled for potential covariates, the IS group significantly reduced hospitalization costs (− 524.5 USD, 95% confidence interval [CI] = − 982.6 USD – -66.4 USD) and the risk of pneumonia (odds ratio = 0.55, 95% CI = 0.32–0.95) compared to the non-IS group following VATS. No difference in ED visit frequency and hospitalization frequency at 3-month, 6-month, and 1-year follow-up was noted between the IS and the non-IS groups following VATS. Conclusions The use of IS in patients with lung cancers undergoing VATS may reduce hospitalization cost and the risk of pneumonia.
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Affiliation(s)
- Chin-Jung Liu
- Department of Health Services Administration, China Medical University, Taichung, Taiwan.,Department of Public Health, China Medical University, Taichung, Taiwan.,Department of Respiratory Therapy, China Medical University, Taichung, Taiwan.,Division of Respiratory Therapy, China Medical University Hospital, Taichung, Taiwan
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, Taichung, Taiwan.,Department of Public Health, China Medical University, Taichung, Taiwan
| | - Chia-Chen Chu
- Department of Respiratory Therapy, China Medical University, Taichung, Taiwan.,Division of Respiratory Therapy, China Medical University Hospital, Taichung, Taiwan.,Department of Biomedical Engineering, Chung Yuan Christian University, Jhongli, Taiwan
| | - Chih-Hsin Muo
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Wei-Sheng Chung
- Department of Health Services Administration, China Medical University, Taichung, Taiwan. .,Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, No. 199, Section 1, San-Min Road, Taichung City, 40343, Taiwan. .,Department of Healthcare Administration, Central Taiwan University of Science and Technology, Taichung, Taiwan.
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23
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Veronesi G, Park B, Cerfolio R, Dylewski M, Toker A, Fontaine JP, Hanna WC, Morenghi E, Novellis P, Velez-Cubian FO, Amaral MH, Dieci E, Alloisio M, Toloza EM. Robotic resection of Stage III lung cancer: an international retrospective study. Eur J Cardiothorac Surg 2019; 54:912-919. [PMID: 29718155 DOI: 10.1093/ejcts/ezy166] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 03/25/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Minimally invasive surgery is accepted for early-stage lung cancer, but its role in locally advanced disease is controversial, especially using a robotic platform. The aim of this retrospective study was to assess the safety and effectiveness of robot-assisted resection in patients with Stage IIIA non-small-cell lung cancer (NSCLC) or carcinoid tumours in the series as a whole and in different subgroups according to adjuvant treatment. METHODS This was a retrospective multicentre study of consecutive patients with clinically evident or occult N2 disease (210 NSCLC and 13 carcinoid) who, in 2007-2016, underwent robot-assisted resection at 7 high-volume centres. Perioperative outcomes, recurrences and overall survival were assessed. RESULTS N2 disease was diagnosed preoperatively in 72 (32%) patients and intraoperatively in 151 (68%) patients. Surgical margins were negative in 98.4% of cases with available data. Thirty-four (15.2%) patients received neoadjuvant treatment, 140 (63%) patients received postoperative treatment, and 49 (22%) patients underwent surgery only. There were 22 (9.9%) conversions to thoracotomy, 23 (10.3%) had serious (Grades III-IV) postoperative morbidity and the mean hospital stay was 5.3 days. Complications and outcomes did not differ significantly between treatment groups. Of the 34 patients who were given neoadjuvant chemotherapy, all had R0 resection, 5 (15%) patients required conversion but none required conversion because of bleeding and 4 (12%) patients had Grade III or IV postoperative complications. After a median of 18 (interquartile range 8-33) months, 3-year overall survival in NSCLC patients was 61.2% and 60.3% (P = 0.6) of patients in the subgroup were given induction treatment. However, overall survival was significantly better (P = 0.012) in NSCLC patients with ≤2 positive nodes (vs >2). Nineteen (8.5%) patients developed local recurrence. CONCLUSIONS Robot-assisted lobectomy is safe and effective in patients with Stage III NSCLC or carcinoid tumours with low conversions and complications. Among patients with NSCLC, including those who were given induction chemotherapy, survival was similar to that reported for open surgery.
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Affiliation(s)
- Giulia Veronesi
- Division of Thoracic Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Bernard Park
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert Cerfolio
- Thoracic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mark Dylewski
- Department of Cardiothoracic Surgery, Baptist Health South Florida-South Miami Hospital, South Miami, FL, USA
| | - Alpert Toker
- Department of Thoracic Surgery, Group Florence Nightingale Hospitals, Istanbul, Turkey
| | - Jacques P Fontaine
- Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA.,Department of Surgery, Morsani College of Medicine, University of South Florida Health, Tampa, FL, USA.,Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida Health, Tampa, FL, USA
| | - Wael C Hanna
- Department of Surgery, Division of Thoracic Surgery, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Emanuela Morenghi
- Biostatistics Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.,Department of Biomedical Science, Humanitas University, Rozzano, Milan, Italy
| | - Pierluigi Novellis
- Division of Thoracic Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Frank O Velez-Cubian
- Department of Surgery, Morsani College of Medicine, University of South Florida Health, Tampa, FL, USA
| | - Marisa H Amaral
- Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Elisa Dieci
- Division of Thoracic Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Marco Alloisio
- Division of Thoracic Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.,Department of Biomedical Science, Humanitas University, Rozzano, Milan, Italy
| | - Eric M Toloza
- Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA.,Department of Surgery, Morsani College of Medicine, University of South Florida Health, Tampa, FL, USA.,Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida Health, Tampa, FL, USA
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Deol PS, Sipko J, Kumar A, Tsalatsanis A, Moodie CC, Garrett JR, Fontaine JP, Toloza EM. Effect of insurance type on perioperative outcomes after robotic-assisted pulmonary lobectomy for lung cancer. Surgery 2019; 166:211-217. [PMID: 31202473 DOI: 10.1016/j.surg.2019.04.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/07/2019] [Accepted: 04/13/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Insurance type has been reported to be an independent predictor of overall survival in lung cancer patients. We studied the effect of insurance type on patient outcomes after minimally invasive pulmonary lobectomy for lung cancer. METHODS We retrospectively analyzed 433 consecutive patients who underwent robotic-assisted pulmonary lobectomy by one surgeon during an 80-month period. Perioperative outcomes and intraoperative and postoperative complications were noted. Disposition at discharge after surgery (favorable, eg, transfer to home with self-care or with home health nursing and/or physical therapy, versus unfavorable, eg, long-term acute care or rehabilitation facility, hospice, or death) and 5-year overall survival (5-years OS) were also recorded. We used Pearson χ2, analysis of variance (ANOVA), and Kruskal-Wallis test to compare variables and Cox regression for survival analysis. RESULTS There were 107 patients (mean age 57.5 years) with private insurance, 118 (mean age 70.3 years) with public insurance (Medicare or Medicaid), 196 (mean age 71.8 year; P < .001) with combination insurance plans (Medicare plus a privately supplied supplemental), and 12 patients with no insurance (excluded owing to low sample size). There were more current smokers in the public insurance group, more former smokers in the combination insurance group, and more nonsmokers in the private insurance group (P = .03). There were more comorbidities in the public and combination insurance groups versus the private insurance group, including gastroesophageal reflux disease (P = .003), hypertension (P = .01), and hyperlipidemia (P < .001). The groups had no differences in tumor size or pathologic stage. There were higher numbers of intraoperative conversions to open lobectomy in the private and public insurance groups versus the combination insurance group (P = .001). Also, the private and combination insurance groups had more cases of favorable disposition at discharge after surgery compared with the public insurance group (P < .001). Multivariable regression analyses identified private insurance type as an independent predictor of favorable disposition at discharge (public versus private plan; odds ratio, 0.43; 95% confidence interval [CI], 0.22-0.85, P = .02) and 5-year OS (combination versus private plan; hazard ratio, 2.68; 95% CI, 1.26-5.67, P = .01; public versus private plan; HR, 2.84; 95% CI, 1.37-5.89; P = .01). CONCLUSION Although public or combination insurance type was associated with greater risk of all-cause mortality, and public insurance type was associated with less favorable disposition at discharge after surgery and overall conversion to open lobectomy, insurance type was not associated with increased intraoperative complications, hospital duration of stay, or in-hospital mortality after minimally invasive robotic-assisted pulmonary lobectomy.
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Affiliation(s)
- Pavit S Deol
- SELECT Program, University of South Florida Health Morsani College of Medicine, Tampa, FL
| | - Joseph Sipko
- SELECT Program, University of South Florida Health Morsani College of Medicine, Tampa, FL
| | - Ambuj Kumar
- Office of Research, University of South Florida Health Morsani College of Medicine, Tampa, FL
| | - Athanasios Tsalatsanis
- Office of Research, University of South Florida Health Morsani College of Medicine, Tampa, FL
| | - Carla C Moodie
- Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL
| | - Joseph R Garrett
- Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL
| | - Jacques P Fontaine
- Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL; Department of Surgery, University of South Florida Health Morsani College of Medicine, Tampa, FL; Department of Oncologic Sciences, University of South Florida Health Morsani College of Medicine, Tampa, FL
| | - Eric M Toloza
- Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL; Department of Surgery, University of South Florida Health Morsani College of Medicine, Tampa, FL; Department of Oncologic Sciences, University of South Florida Health Morsani College of Medicine, Tampa, FL.
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Minimally Invasive Anterior Thoracotomy for Routine Lung Cancer Resection. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2019; 2:76-83. [DOI: 10.1097/imi.0b013e31804bfb7e] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objectives A 7-year experience with a minimally invasive approach to routine lung cancer resection is compared with standard lateral open thoracotomy. Methods All patients undergoing lung resection with curative intent for primary lung cancer between July 1998 and November 2005 by a single surgical team were registered. Surgical access was obtained through a mini 5- to 6-cm anterior thoracotomy with video assistance; direct visualization was also used extensively. Results Patients (n = 167) underwent major pulmonary resection for primary lung cancer. The minimally invasive group (MI), 137 patients, included 12 fully endoscopic or robotic approaches. The open lateral (OL) approach included 30 patients (18%). Both groups included pneumonectomies (8 MI, 3 OL), sleeve resections (3 MI, 2 OL), chest wall resections (2 MI, 5 OL), and pancoasts (3 MI, 0 OL) and had full lymph node resections. The Kaplan-Meier estimated overall mean survival was 64.5 months (95% CL, 58 to 71 months). Mean estimate survivals were stage 1a, 66%; stage 1b, 65%; stage 2a, 61%; stage 2b, 55%; stage 3a, 52%; stage 3b, 45%. Mean survival in the MI group was 64.3 months versus 59.3 with standard open access (OL) (X2 = 0.003 Mantel-Cox; significance, 0.959). In-hospital mortality rate was 2.2%; conversion from a mini to open procedure was 1.5%. Avoidance of rib spreading (soft tissue retractor) and small incisions appeared to have reduced pain and improved early recovery. Conclusions Kaplan-Meier survival for routine unselected lung cancer resection through a minimal access approach was not significantly different from the open approach and reflects published survival curves.
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Ota H, Matsumoto H. Impact of the crural diaphragm thickness on pulmonary function after lobectomy. Asian Cardiovasc Thorac Ann 2019; 27:388-393. [PMID: 31088110 DOI: 10.1177/0218492319851393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective The crural diaphragm is responsible for pulmonary ventilation in the early period after lobectomy. However, the role of its thickness in pulmonary ventilation remains unclear. We investigated the impact of crural diaphragm thickness on pulmonary oxygenation and gas exchange early after lobectomy. Methods We enrolled 32 patients with non-small-cell lung cancer who underwent video-assisted thoracoscopic lobectomy. Crural diaphragm thickness was defined as the average of the maximum thicknesses of the right and left crural diaphragm at the level of the median arcuate ligament on computed tomography. Pulmonary oxygenation and gas exchange were evaluated by the ratio of arterial oxygen tension/fraction of inspiratory oxygen and alveolar-arterial oxygen difference on the second postoperative day. Results Crural diaphragm thickness of 7.0 ± 1.7 mm was associated with vital capacity. After lobectomy, arterial oxygen tension/fraction of inspiratory oxygen decreased significantly and alveolar-arterial oxygen difference increased significantly. Five patients with oxygen saturation via pulse oximetry ≤92% had a lower arterial oxygen tension/fraction of inspiratory oxygen and higher alveolar-arterial oxygen difference than the others. Crural diaphragm thickness in these patients was less than in the others (5.5 ± 1.9 vs. 7.3 ± 1.5 mm, p = 0.033). In multivariate analysis, crural diaphragm thickness remained an independent factor affecting arterial oxygen tension/fraction of inspiratory oxygen and alveolar-arterial oxygen difference ( p = 0.044, p = 0.049). Crural diaphragm thickness was positively associated with arterial oxygen tension/fraction of inspiratory oxygen and negatively associated with alveolar-arterial oxygen difference. Conclusion Crural diaphragm thickness affects pulmonary ventilation early after lobectomy.
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Affiliation(s)
- Hideki Ota
- Department of Surgery, Yamagata Prefecture Shinjo Hospital, Shinjo, Yamagata, Japan
| | - Hidekazu Matsumoto
- Department of Surgery, Yamagata Prefecture Shinjo Hospital, Shinjo, Yamagata, Japan
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Giang NT, Van Nam N, Trung NN, Anh LV, Cuong NM, Van Dinh N, Pho DC, Geiger P, Kien NT. Patient-controlled paravertebral analgesia for video-assisted thoracoscopic surgery lobectomy. Local Reg Anesth 2018; 11:115-121. [PMID: 30538541 PMCID: PMC6255283 DOI: 10.2147/lra.s184589] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Paravertebral block has been proven to be an efficient method to provide post-thoracotomy pain management. This study aimed to compare patient-controlled paravertebral analgesia (PCPA) and intravenous patient-controlled analgesia (IVPCA) in terms of analgesic efficiency, respiratory function, and adverse effects after video-assisted thoracoscopic surgery (VATS) lobectomy. Patients and methods The prospective randomized trial study was carried out on 60 patients who underwent VATS lobectomy (randomly allocated 30 patients in each group). In the PCPA group, an initial dose of 0.3 mL/kg of 0.125% bupivacaine with fentanyl 2 µg/mL was administered, followed by a 3 mL/h continuous infusion with patient-controlled analgesia (2 mL bolus, 10-minute lockout interval, 25 mL/4 h limit). In the IVPCA group with morphine 1 mg/mL solution, an infusion device was programmed to deliver a 1.0 mL demand bolus with no basal infusion rate, with a 10-minute lockout interval and a maximum of 20 mL/4 h period. Postoperative pain was assessed by visual analog scale at rest and on coughing. Arterial blood gas and spirometry were monitored and recorded for the first 3 postoperative days. Side effects to include were also recorded. Results The PCPA group had statistically significant lower pain scores (P<0.0001) at rest at all times. Lower pain scores on coughing were statistically significant in PCPA group in the first 4 hours. Postoperative spirometry showed that both the groups had comparable recovery trajectories for their pulmonary function. Arterial blood gas analysis showed pH and PaCO2 were in a normal range in both the groups. The incidence of headache was higher in the IVPCA group (13.3% vs 0%; P=0.038). Conclusion PCPA effectively managed pain after VATS lobectomy, with lower pain scores, similar respiratory function, and fewer side effects than standard IVPCA treatment.
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Affiliation(s)
- Nguyen Truong Giang
- Department of Cardiothoracic Surgery, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| | - Nguyen Van Nam
- Department of Cardiothoracic Surgery, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| | - Nguyen Ngoc Trung
- Department of Cardiothoracic Surgery, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| | - Le Viet Anh
- Department of Cardiothoracic Surgery, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| | - Nguyen Manh Cuong
- Department of Anesthesia and Pain Medicine, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam,
| | - Ngo Van Dinh
- Department of Anesthesia and Pain Medicine, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam,
| | - Dinh Cong Pho
- Department of Anesthesia and Pain Medicine, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam,
| | - Phillip Geiger
- Department of Anesthesiology, Perioperative, and Pain Medicine, Naval Medical Center Portsmouth, Portsmouth, VA, USA
| | - Nguyen Trung Kien
- Department of Anesthesia and Pain Medicine, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam,
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Video-assisted thoracic surgery in hemothorax evacuation after cardiac surgery or cardiac interventions. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2017; 14:154-157. [PMID: 29181041 PMCID: PMC5701590 DOI: 10.5114/kitp.2017.70528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 08/09/2017] [Indexed: 12/02/2022]
Abstract
Introduction Cardiac surgery and cardiac interventions are associated with the risk of iatrogenic complications, including hemothorax. Minimally invasive methods of evacuating hemothorax include video-assisted thoracic surgery (VATS). Aim This paper presents this method and provides its detailed analysis. Material and methods The VATS procedures were used to evacuate hemothorax in 8 patients (7 after cardiac surgery and 1 after a cardiac intervention). Complete three-port VATS was performed in 7 patients, while 1 patient underwent assisted VATS due to a large number of adhesions. Results On average, the repeat procedures were performed on the 20th postoperative day (10th–58th postoperative day). In 6 (75%) cases the VATS intervention was the third surgical intervention performed. One patient, operated on 12 days after the original procedure, was diagnosed with active arterial bleeding, which required conversion to a classic procedure using median sternotomy. No postoperative wound infection was noted. Complete hemothorax removal was achieved in all patients. Conclusions Classic median sternotomy is the standard approach for hemothorax evacuation. However, it may sometimes be burdened with a high perioperative risk due to massive mediastinal adhesions in the late postoperative period. Additionally, access through the postoperative wound appears to be associated with a higher risk of local infection and sternal instability. Hemodynamically stable patients in the late postoperative period, with stable sternums and healed postoperative wounds, are good candidates for VATS aiming to evacuate hemothorax. The VATS is an effective procedure for evacuating hemothorax.
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Kocher GJ, Gioutsos KP, Ahler M, Funke-Chambour M, Ott SR, Dorn P, Lutz J, Schmid RA. Perioperative Lung Function Monitoring for Anatomic Lung Resections. Ann Thorac Surg 2017; 104:1725-1732. [DOI: 10.1016/j.athoracsur.2017.06.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 05/17/2017] [Accepted: 06/05/2017] [Indexed: 10/18/2022]
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Charloux A, Quoix E. Lung segmentectomy: does it offer a real functional benefit over lobectomy? Eur Respir Rev 2017; 26:26/146/170079. [DOI: 10.1183/16000617.0079-2017] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 08/03/2017] [Indexed: 12/23/2022] Open
Abstract
Anatomical segmentectomy has been developed to offer better pulmonary function preservation than lobectomy, in stage IA lung cancer. Despite the retrospective nature of most of the studies and the lack of randomised studies, a substantial body of literature today allows us to evaluate to what extent lung function decreases after segmentectomy and whether segmentectomy offers a real functional benefit over lobectomy. From the available series, it emerges that the mean decrease in forced expiratory volume in 1 s (FEV1) is low, ranging from −9% to −24% of the initial value within 2 months and −3 to −13% 12 months after segmentectomy. This reduction in lung function is significantly lower than that induced by lobectomy, but saves only a few per cent of pre-operative FEV1. Moreover, the published results do not firmly establish the functional benefit of segmentectomy over lobectomy in patients with poor lung function. Some issues remain to be addressed, including whether video-assisted thoracic surgery (VATS) segmentectomy may preserve lung function better than VATS lobectomy in patients with poor lung function, especially within the early days after surgery, and whether this may translate to lowering the functional limit for surgery. Eventually, trials comparing stereotactic ablative body radiotherapy, radiofrequency ablation and segmentectomy functional consequences are warranted.
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Veronesi G, Novellis P, Difrancesco O, Dylewski M. Robotic assisted lobectomy for locally advanced lung cancer. J Vis Surg 2017; 3:78. [PMID: 29078641 DOI: 10.21037/jovs.2017.04.03] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 04/11/2017] [Indexed: 11/06/2022]
Abstract
Some series report the use of video-assisted thoracic surgery (VATS) in patients with locally advanced non-small cell lung cancer (NSCLC) but, few studies describe the use of the robotic approach specifically for locally advanced disease. One potential advantage of the robotic approach over traditional VATS is the increased radicality. While the benefit of the robotic approach over open thoracotomy is directly related to reduced surgical trauma and the improved tolerability in fragile patients that have received induction treatment. In case of occult N2 disease, robotic assisted surgery can translate into a quicker recovery with improved compliance with adjuvant treatments following surgery. Technical details are reported and described. The robotic instrument technology allows sharp and controlled dissection compared to the typical blunt sweeping methods used in most VATS lobectomy techniques. The authors believe that robotic technology favors a more radical resection in the case of complex locally advanced tumors. Robotic technology has some limitations that have affected adoption such as significant capital and maintenance costs, reduced operating room efficiencies, and a steep learning curve.
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Affiliation(s)
- Giulia Veronesi
- Division of Thoracic Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Pierluigi Novellis
- Division of Thoracic Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Orazio Difrancesco
- Department of Anesthesia and Intensive Care Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Mark Dylewski
- Thoracic and Robotic Surgery, Baptist Health of South Florida, Miami, Florida, USA
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Kouritas V, Milton R. The lobar vs. sublobar "limited" resection respiratory function preservation debate: learning to speak the same language. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:169. [PMID: 28480205 PMCID: PMC5401685 DOI: 10.21037/atm.2017.03.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 02/06/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Vasileios Kouritas
- Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK
| | - Richard Milton
- Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK
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Salati M, Brunelli A, Xiumè F, Monteverde M, Sabbatini A, Tiberi M, Pompili C, Palloni R, Refai M. Video-assisted thoracic surgery lobectomy does not offer any functional recovery advantage in comparison to the open approach 3 months after the operation: a case matched analysis†. Eur J Cardiothorac Surg 2017; 51:1177-1182. [DOI: 10.1093/ejcts/ezx013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 01/03/2017] [Indexed: 11/13/2022] Open
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Kobayashi N, Kobayashi K, Kikuchi S, Goto Y, Ichimura H, Endo K, Sato Y. Long-term pulmonary function after surgery for lung cancer. Interact Cardiovasc Thorac Surg 2017; 24:727-732. [DOI: 10.1093/icvts/ivw414] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 11/17/2016] [Indexed: 11/13/2022] Open
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Video-Assisted Thoracic Surgery in Patients with Previous Sternotomy and Cardiac Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017; 12:15-20. [DOI: 10.1097/imi.0000000000000344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective Although video-assisted thoracic surgery (VATS) lobectomy has become a standard approach for early-stage 1 lung cancer, concerns exist regarding potential damage to the heart or bypass grafts when VATS is performed after cardiac surgery via median sternotomy. We could find only case reports regarding VATS lobectomy after sternotomy for cardiac surgery. Therefore, we reviewed our series of patients who underwent VATS anatomic resections after sternotomy for cardiac surgery. Methods Between 1996 and 2010, there were 87 patients who underwent 88 pulmonary resections after sternotomy for coronary artery bypass grafting (64), valve replacement or repair (12), coronary artery bypass graft and valve replacement (6), and transplant (5). There were 10 women (11.5%) and 77 men (88.5%) with a mean age of 76.2 years. Diagnoses included lung cancer (83), pulmonary metastases (4), and benign disease (1). Results Dense adhesions between the lung and the mediastinum sometimes occur after cardiac surgery. Compared with the total series of 2684 VATS lobectomies, operations after sternotomy are associated with greater mortality (12, 0.4% vs 5, 5.7%), myocardial infarction (13, 0.5% vs 2, 2.3%), transfusion (45, 1.7% vs 12, 13.6), conversion to thoracotomy (188, 7% vs 14, 15.9%). Injury occurred to the left main pulmonary artery (1, 1%) and internal mammary artery graft (1, 1%). There were no intraoperative deaths. Conclusions Previous sternotomy for cardiac surgery does increase the risk for VATS lobectomy. Conversion to thoracotomy should be considered if dense adhesions are found. Techniques to reduce the risk for the heart are discussed.
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Serna-Gallegos DR, Merry HE, McKenna RJ. Video-Assisted Thoracic Surgery in Patients with Previous Sternotomy and Cardiac Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017. [DOI: 10.1177/155698451701200104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Heather E. Merry
- Department of Cardiothoracic Surgery, Providence Health and Services, Portland, OR USA
| | - Robert J. McKenna
- Department of Cardiothoracic Surgery, Saint John's Health Center, Santa Monica, CA USA
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Usuda K, Maeda S, Motomo N, Tanaka M, Ueno M, Machida Y, Sagawa M, Uramoto H. Pulmonary Function After Lobectomy: Video-Assisted Thoracoscopic Surgery Versus Muscle-Sparing Mini-thoracotomy. Indian J Surg 2016; 79:504-509. [PMID: 29217900 DOI: 10.1007/s12262-016-1510-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 05/26/2016] [Indexed: 11/29/2022] Open
Abstract
Although pulmonary function was better after video-assisted thoracoscopic surgery (VATS) lobectomy than after open thoracotomy lobectomy, it is unclear whether postoperative pulmonary function after VATS lobectomy is better than that after mini-thoracotomy lobectomy. The aim of this study is to determine whether the former is better than the latter. VATS lobectomies were performed using endoscopic techniques through a 3-4-cm skin incision spread by a silicon rubber retractor and two or three trocars. Mini-thoracotomy lobectomies were performed through a 7-12-cm skin incision spread by rib retractors made of metal and one or two trocars. Pulmonary function tests were performed a week before surgery and 3 months after surgery. There were 14 males and 11 females in VATS lobectomy and 32 males and 30 females in mini-thoracotomy lobectomy. For lobe location (right upper/right lower/left upper/left lower), there were 12/1/8/4 in VATS lobectomy and 16/19/13/14 in mini-thoracotomy lobectomy, respectively. The percent predicted postoperative forced vital capacity (FVC) (postoperative FVC/predicted postoperative FVC × 100) (110 ± 15 %) of VATS lobectomy was significantly higher than that (101 ± 16 %) of mini-thoracotomy lobectomy (P = 0.0124). The percent predicted postoperative forced expiratory volume in 1 s (FEV1) (postoperative FEV1/predicted postoperative FEV1 × 100) (110 ± 15 %) of VATS lobectomy was not significantly higher than that (104 ± 15 %) of mini-thoracotomy lobectomy (P = 0.091). Multiple regression analysis revealed that operative procedure (VATS lobectomy or mini-thoracotomy lobectomy) was the only significant variable contributing to percent predicted postoperative FVC (P = 0.0073) and percent predicted postoperative FEV1 (P = 0.0180). Postoperative FVC after VATS lobectomy is better than after mini-thoracotomy lobectomy.
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Affiliation(s)
- Katsuo Usuda
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293 Japan
| | - Sumiko Maeda
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293 Japan
| | - Nozomu Motomo
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293 Japan
| | - Makoto Tanaka
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293 Japan
| | - Masakatsu Ueno
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293 Japan
| | - Yuichiro Machida
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293 Japan
| | - Motoyasu Sagawa
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293 Japan
| | - Hidetaka Uramoto
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293 Japan
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Louie BE, Wilson JL, Kim S, Cerfolio RJ, Park BJ, Farivar AS, Vallières E, Aye RW, Burfeind WR, Block MI. Comparison of Video-Assisted Thoracoscopic Surgery and Robotic Approaches for Clinical Stage I and Stage II Non-Small Cell Lung Cancer Using The Society of Thoracic Surgeons Database. Ann Thorac Surg 2016; 102:917-924. [PMID: 27209613 DOI: 10.1016/j.athoracsur.2016.03.032] [Citation(s) in RCA: 155] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 01/25/2016] [Accepted: 03/08/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Data from selected centers show that robotic lobectomy is safe and effective and has 30-day mortality comparable to that of video-assisted thoracoscopic surgery (VATS). However, widespread adoption of robotic lobectomy is controversial. We used The Society of Thoracic Surgeons General Thoracic Surgery (STS-GTS) Database to evaluate quality metrics for these 2 minimally invasive lobectomy techniques. METHODS A database query for primary clinical stage I or stage II non-small cell lung cancer (NSCLC) at high-volume centers from 2009 to 2013 identified 1,220 robotic lobectomies and 12,378 VATS procedures. Quality metrics evaluated included operative morbidity, 30-day mortality, and nodal upstaging, defined as cN0 to pN1. Multivariable logistic regression was used to evaluate nodal upstaging. RESULTS Patients undergoing robotic lobectomy were older, less active, and less likely to be an ever smoker and had higher body mass index (BMI) (all p < 0.05). They were also more likely to have coronary heart disease or hypertension (all p < 0.001) and to have had preoperative mediastinal staging (p < 0.0001). Robotic lobectomy operative times were longer (median 186 versus 173 minutes; p < 0.001); all other operative measurements were similar. All postoperative outcomes were similar, including complications and 30-day mortality (robotic lobectomy, 0.6% versus VATS, 0.8%; p = 0.4). Median length of stay was 4 days for both, but a higher proportion of patients undergoing robotic lobectomy had hospital stays less than 4 days (48% versus 39%; p < 0.001). Nodal upstaging overall was similar (p = 0.6) but with trends favoring VATS in the cT1b group and robotic lobectomy in the cT2a group. CONCLUSIONS Patients undergoing robotic lobectomy had more comorbidities and robotic lobectomy operative times were longer, but quality outcome measures, including complications, hospital stay, 30-day mortality, and nodal upstaging, suggest that robotic lobectomy and VATS are equivalent.
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Affiliation(s)
- Brian E Louie
- Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, Washington.
| | - Jennifer L Wilson
- Division of Thoracic Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Sunghee Kim
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Robert J Cerfolio
- Department of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Bernard J Park
- Division of Thoracic Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | | | - Eric Vallières
- Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, Washington
| | - Ralph W Aye
- Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, Washington
| | - William R Burfeind
- Division of Thoracic Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania
| | - Mark I Block
- Division of Thoracic Surgery, Memorial Healthcare System, Hollywood, Florida
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Park TY, Park YS. Long-term respiratory function recovery in patients with stage I lung cancer receiving video-assisted thoracic surgery versus thoracotomy. J Thorac Dis 2016; 8:161-8. [PMID: 26904225 DOI: 10.3978/j.issn.2072-1439.2016.01.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Video-assisted thoracic surgery (VATS) and thoracotomy are standard treatment methods for early lung cancer. We compared their effects on the long-term recovery of pulmonary function in patients with stage I non-small cell lung cancer (NSCLC). METHODS We retrospectively reviewed 203 patients with early NSCLC who underwent VATS or thoracotomy at Seoul University Hospital from January 2005 to December 2010. Two matched groups (VATS and thoracotomy) each consisting of 60 patients were created via propensity score matching according to TNM stage, age, sex, smoking history, lung disease history, and preoperative pulmonary function. RESULTS There were no significant differences in the recovery of forced expiratory volume in 1 second, the forced vital capacity (FVC), or the peak flow rate (PFR), presented as the postoperative value/predicted value, between the VATS and thoracotomy groups during the 12-month follow-up period. The standardized functional loss ratio [(measured postoperative value - predicted postoperative value)/(predicted postoperative value × 100)] did not differ between the two groups at 6 and 12 months. In an intragroup analysis, the postoperative FVC in the thoracotomy group remained below predicted postoperative value during the follow-up period and did not reach the predicted postoperative FVC (6 months/12 months: -6.58%/-2.43%). The analgesic requirements and pain procedures were similar in the VATS and thoracotomy groups during the 12-month follow-up period. CONCLUSIONS There were no significant differences in pulmonary function recovery during the late postoperative period in NSCLC patients receiving VATS versus thoracotomy. We suggest that the volume of the resected lung and preoperative lung function are the main determinants of late recovery, rather than postoperative pain.
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Affiliation(s)
- Tae Yun Park
- 1 Division of Critical Care Medicine, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea ; 2 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young Sik Park
- 1 Division of Critical Care Medicine, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea ; 2 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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Abstract
In this chapter, we discuss the preoperative evaluation that is necessary prior to surgical resection, stage-specific surgical management of lung cancer, and the procedural steps as well as the indications to a variety of surgical approaches to lung resection.
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Affiliation(s)
- Osita I Onugha
- Thoracic surgery, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Jay M Lee
- Thoracic surgery, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
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Smith DE, Dietrich A, Nicolas M, Da Lozzo A, Beveraggi E. Conversion during thoracoscopic lobectomy: related factors and learning curve impact. Updates Surg 2015; 67:427-32. [PMID: 26561493 DOI: 10.1007/s13304-015-0334-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 10/18/2015] [Indexed: 10/22/2022]
Abstract
Video-assisted thoracoscopic surgery (VATS) lobectomy has become a standard procedure for lung cancer treatment. Conversion-related factors and learning curve impacts, were poorly described. The aim of this study was to review the reasons and related factor for conversion in VATS lobectomy and the impact on this of the surgeon's learning curve. From June 2009 to May 2014, 154 patients who underwent a VATS lobectomy were included in our study. Patients' characteristics, pathology background, operative times, overall length of stay, overall morbidity and type of major complications were recorded for all patients and compared between non converted (n = 133) and converted (n = 21) patients. To evaluate surgeon's learning curve, we analyzed rates and causes of conversion in the first period (first 77 patients) and in the last period (78-154 patients). Patients characteristics were similar between converted and non-converted groups. Patients who were converted to open thoracotomy presented more frecuently tumors >3 cms (P = 0.02). The average of operative times and the length of stay were not significantly different between groups. Overall morbidity and major complications were also similar in both groups. There were no impact of surgeon's learning curve in overall rate conversion in both groups. Emergency conversion was always secondary to vascular accidents, all in the first group (p = 0.059). Surgeons should be expecting to perform a conversion to a thoracotomy in patients who present in preoperative studies, tumors greater than 3 cms. Learning curve only affected the emergency conversion, occurred all in the first half of our series.
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Affiliation(s)
- David E Smith
- Hospital Italiano de Buenos Aires, Thoracic Surgery and Lung Transplant, Perón 4190, 1181, Buenos Aires, Argentina
| | - Agustin Dietrich
- Hospital Italiano de Buenos Aires, Thoracic Surgery and Lung Transplant, Perón 4190, 1181, Buenos Aires, Argentina.
| | - Matias Nicolas
- Hospital Italiano de Buenos Aires, Thoracic Surgery and Lung Transplant, Perón 4190, 1181, Buenos Aires, Argentina
| | - Alejandro Da Lozzo
- Hospital Italiano de Buenos Aires, Thoracic Surgery and Lung Transplant, Perón 4190, 1181, Buenos Aires, Argentina
| | - Enrique Beveraggi
- Hospital Italiano de Buenos Aires, Thoracic Surgery and Lung Transplant, Perón 4190, 1181, Buenos Aires, Argentina
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Park S, Kang CH, Hwang Y, Seong YW, Lee HJ, Park IK, Kim YT. Risk factors for postoperative anxiety and depression after surgical treatment for lung cancer†. Eur J Cardiothorac Surg 2015; 49:e16-21. [PMID: 26410631 DOI: 10.1093/ejcts/ezv336] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 08/25/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Psychological distress associated with cancer treatment is an emerging issue in the management of cancer patients. The aim of this study was to identify the prevalence of postoperative anxiety and depression after surgical treatment for lung cancer, and to assess the risk factors associated with these phenomena. METHODS Patients who underwent curative surgical resection for primary lung cancer were included in this study. Patients with complex treatment histories (recurrent or metastatic lung cancer or neoadjuvant treatment) and those taking psychiatric medication were excluded. We prospectively evaluated the degrees of pre- and postoperative anxiety and depression using a Hospital Anxiety Depression Scale questionnaire. The relationships between clinical and patient factors and anxiety and depression after surgical treatment for lung cancer were assessed. RESULTS A total of 278 patients were enrolled. The mean age was 62 years. Thoracoscopic resection was performed in 246 patients (89%). The prevalence rates of preoperative anxiety and depression were 8% (n = 22) and 12% (n = 32), and changed to 9% (n = 26) and 19% (n = 54) postoperatively (P = 0.37 and <0.001, respectively). Gender, age, marital status, advanced clinical stage, alcohol abuse, smoking status, length of hospital stay, pulmonary function and preoperative comorbidities were not associated with postoperative anxiety and depression. Multivariate analysis revealed that thoracotomy was a risk factor for postoperative anxiety after adjusting for preoperative anxiety (odds ratio [OR] = 4.5, P = 0.002). Thoracotomy (OR = 3.4, P = 0.009), postoperative dyspnoea (OR = 4.8, P < 0.001), severe pain (OR = 3.9, P = 0.001) and diabetes mellitus (OR = 3.0, P = 0.012) were identified as risk factors for postoperative depression after adjusting for preoperative depression. Twenty-four patients were referred to mental health professionals and provided with supportive psychotherapy or pharmacological intervention. Of these, 14 patients (56%) were diagnosed with an adjustment disorder. CONCLUSIONS Postoperative psychological distress and, in particular, depression increased after surgical treatment for lung cancer. Postoperative anxiety and depression were aggravated by residual symptoms after surgery. Careful psychological evaluation and appropriate management are required to improve patients' quality of life after lung cancer surgery.
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Affiliation(s)
- Samina Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Chang Hyun Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Yoohwa Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Yong Won Seong
- Department of Thoracic and Cardiovascular Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyun Joo Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - In Kyu Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Young Tae Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
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Kim SJ, Ahn S, Lee YJ, Park JS, Cho YJ, Cho S, Yoon HI, Kim K, Lee JH, Jheon S, Lee CT. Factors associated with preserved pulmonary function in non-small-cell lung cancer patients after video-assisted thoracic surgery. Eur J Cardiothorac Surg 2015; 49:1084-90. [DOI: 10.1093/ejcts/ezv325] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 06/30/2015] [Indexed: 11/14/2022] Open
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Fumimoto S, Ochi K, Ichihashi Y, Sato K, Morita T, Hanaoka N, Katsumata T. Right intra lobar pulmonary sequestration with feeding artery arising from abdominal aorta: a case report. J Cardiothorac Surg 2015; 10:86. [PMID: 26109198 PMCID: PMC4479071 DOI: 10.1186/s13019-015-0290-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 05/29/2015] [Indexed: 11/11/2022] Open
Abstract
Pulmonary sequestration (PS) is a rare congenital malformation. Right intra lobar PS with a feeding artery arising from the abdominal aorta is extremely rare. This case report describes a 30-year-old man with a history of mental deficiency and repeated pneumonia who was referred to our hospital for further work-up of PS. Three-dimensional enhanced computed tomography of the chest and aorta revealed right intra lobar PS with an aberrant systemic artery from the abdominal aorta. We resected the PS using lower lobectomy by video-assisted thoracic surgery (VATS). The patient was discharged 10 days later without complications.
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Affiliation(s)
- Satoshi Fumimoto
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, Osaka, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan.
| | - Kaoru Ochi
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, Osaka, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan.
| | - Yoshio Ichihashi
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, Osaka, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan.
| | - Kiyoshi Sato
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, Osaka, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan.
| | - Takuya Morita
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, Osaka, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan.
| | - Nobuharu Hanaoka
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, Osaka, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan.
| | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, Osaka, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan.
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Robotic anatomic lung resections: the initial experience and description of learning in 102 cases. Surg Endosc 2015; 30:676-683. [DOI: 10.1007/s00464-015-4259-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 05/13/2015] [Indexed: 10/23/2022]
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Kumar A, Asaf BB, Cerfolio RJ, Sood J, Kumar R. Robotic lobectomy: The first Indian report. J Minim Access Surg 2015; 11:94-8. [PMID: 25598607 PMCID: PMC4290127 DOI: 10.4103/0972-9941.147758] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Accepted: 09/24/2014] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Even today, open lobectomy involves significant morbidity. Video-assisted thoracic surgery (VATS) lobectomy results in lesser blood loss, pain, and hospital stay compared to lobectomy by thoracotomy. Despite being an excellent procedure in expert hands, VATS lobectomy is associated with a longer learning curve because of its inherent basic limitations. The da Vinci surgical system was developed essentially to overcome these limitations. In this study, we report our initial experience with robotic pulmonary resections using the Completely Portal approach with four arms. To the best of our knowledge this is the first series of robotic lobectomy reported from India. MATERIAL AND METHODS Data on patient characteristics, operative details, complications, and postoperative recovery were collected in a prospective manner for patients who underwent Robotic Lung resection at our institution between March 2012 and April 2014 for various indications including both benign and malignant cases. RESULTS Between March 2012 to April 2014, a total of 13 patients were taken up for Robotic Lobectomy with a median age of 57 years. The median operative time was 210 min with a blood loss of 33 ml. R0 clearance was achieved in all patients with malignant disease. The median lymph node yield in nine patients with malignant disease was 19 (range 11-40). There was one intra-operative complication and two postoperative complications. The median hospital stay was 7 days with median duration to chest tube removal being 3 days. CONCLUSION Robotic lobectomy is feasible and safe. It appears to be oncologically sound surgical treatment for early-stage lung cancer. Comparable benefits over VATS needs to be further evaluated by long-term studies.
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Affiliation(s)
- Arvind Kumar
- Department of Thoracic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Belal Bin Asaf
- Department of Thoracic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Robert James Cerfolio
- Section of Thoracic Surgery, Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jayshree Sood
- Department of Anaesthsiology and Pain Management, Sir Ganga Ram Hospital, New Delhi, India
| | - Reena Kumar
- Additional Director, Medical Services, Sir Ganga Ram Hospital, New Delhi, India
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Abstract
The advent of MIS or VATS techniques, better perioperative anesthesia management, and better postoperative care enables thoracic surgeons to operate on marginal patients, with less risk than previously established. Careful preoperative decision making in a multidisciplinary setting should insure that all patients are given the best potential curative option.
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Affiliation(s)
- Naveed Zeb Alam
- Department of Surgery, St Vincent's Hospital, University of Melbourne, 55 Victoria Parade, Melbourne, Victoria 3065, Australia.
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Kim SJ, Lee YJ, Park JS, Cho YJ, Cho S, Yoon HI, Kim K, Lee JH, Jheon S, Lee CT. Changes in pulmonary function in lung cancer patients after video-assisted thoracic surgery. Ann Thorac Surg 2014; 99:210-7. [PMID: 25440275 DOI: 10.1016/j.athoracsur.2014.07.066] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 07/22/2014] [Accepted: 07/23/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Video-assisted thoracoscopic surgery (VATS) is widely performed in patients with resectable non-small cell lung cancer. However, it is unknown whether VATS sublobar resection has advantages compared with VATS lobectomy in preserving pulmonary function. METHODS Three hundred patients with non-small cell lung cancer who underwent VATS were enrolled. Pulmonary function tests were performed three times: preoperatively, and at 3 and 12 months postoperatively. Pulmonary function was compared between the VATS lobectomy group (n = 227) and the VATS sublobar resection group (n = 73). RESULTS The VATS sublobar resection group had greater preserved pulmonary function than the VATS lobectomy group at 3 and 12 months postoperatively (p < 0.001). However, a VATS lobectomy of the right upper or right middle lobe revealed no difference in forced vital capacity (-1.21% versus -1.45%; p = 0.88) or the diffusion capacity of carbon monoxide (-3.99% versus -2.45%; p = 0.61) compared with VATS sublobar resection after 12 months. In those who underwent VATS of the right lower lobe, forced expiratory volume in 1 second (-8.60% versus -3.69%; p = 0.12) was not different between the two groups after 12 months. Video-assisted thoracoscopic surgery lobectomy of the left upper or left lower lobe resulted in lower pulmonary function than VATS sublobar resection (p < 0.05). CONCLUSIONS Patients with non-small cell lung cancer who underwent VATS sublobar resection demonstrated greater pulmonary function than those who underwent VATS lobectomy. However, in right-side VATS lobectomy, some differences dissipated at 1 year.
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Affiliation(s)
- Se Joong Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Yeon Joo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Jong Sun Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Young-Jae Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Sukki Cho
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Ho Il Yoon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Kwhanmien Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Jae Ho Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Sanghoon Jheon
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Choon-Taek Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea.
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Shen H, Wang J, Li W, Yi W, Wang W. Assessment of health-related quality of life of patients with esophageal squamous cell carcinoma following esophagectomy using EORTC quality of life questionnaires. Mol Clin Oncol 2014; 3:133-138. [PMID: 25469283 DOI: 10.3892/mco.2014.434] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 09/03/2014] [Indexed: 11/06/2022] Open
Abstract
Esophageal cancer is one of the leading causes of cancer-related mortality and surgery is currently the main treatment modality for resectable esophageal cancer. To assess health-related quality of life (HRQL) of patients with esophageal squamous cell carcinoma (ESCC) following esophagectomy, 62 consecutive patients with middle ESCC were randomly assigned into hand video-assisted thoracoscopic surgery (HVATS) (n=33) and Ivor-Lewis surgery (ILS) (n=29) groups. Quality of life questionnaires (QLQ)-C30 and QLQ-OES18, published by the European Organization for Research and Treatment of Cancer, were used prior to treatment and at regular intervals until 6 months following surgery. The results of QLQ-C30 and QLQ-OES18 demonstrated that i) patients with comorbidities and advanced tumor stage (III-IV) exhibited increased risk of poor HRQL, while their gender, age, body mass index and anastomosis location were not associated with HRQL at 6 months after surgery; ii) all the patients had worse functional, symptom and global scores within 6 months after surgery; iii) patients in the HVATS group had similar baseline functional and symptom scores to those of patients in the ILS group; however, their functional and global scores were higher and their symptom scores were lower compared to those of patients in the ILS group; iv) the HRQL of patients in the HVATS group returned to preoperative levels within a shorter time period compared to patients in the ILS group. There were significant differences in global health, physical functioning, fatigue and pain scales between the two groups. In QLQ-OES18, the dysphagia and gastroesophageal reflux scales were improved in both the HVATS and ILS groups, but no significant differences were observed between the two groups. In addition, the overall survival rate was similar in the two groups. Taken together, our findings indicated that HVATS is a safe procedure, associated with less disturbance to short-term HRQL compared to ILS. Therefore, it appears reasonable to select HVATS for patients with early-stage middle esophageal cancer.
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Affiliation(s)
- Hongchang Shen
- Departments of Chemotherapy and Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Jue Wang
- Departments of Breast and Thyroid Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Wenhuan Li
- Departments of Chemotherapy and Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Weiwei Yi
- Departments of Chemotherapy and Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Weibo Wang
- Departments of Chemotherapy and Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
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Yamasaki M, Suzuki M, Misumi H, Abe K, Ito J, Kawazoe K. Hybrid Surgery for Intralobar Pulmonary Sequestration With Aortic Aneurysm. Ann Thorac Surg 2014; 98:e11-3. [DOI: 10.1016/j.athoracsur.2014.04.054] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 02/12/2014] [Accepted: 04/04/2014] [Indexed: 11/24/2022]
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