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Chiappetta M, Lococo F, Sperduti I, Tabacco D, Meacci E, Curcio C, Crisci R, Margaritora S. Type of lymphadenectomy does not influence survival in pIa NSCLC patients who underwent VATS lobectomy: Results from the national VATS group database. Lung Cancer 2022; 174:104-111. [PMID: 36370468 DOI: 10.1016/j.lungcan.2022.10.008] [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: 09/27/2022] [Accepted: 10/23/2022] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Stage Ia presents an optimal survival rate after surgical resection, but the type of lymphadenectomy to use in these patients is still debated. The aim of this study is evaluate if one type of lymphadenectomy adopted influences survival in patients who underwent VATS lobectomy for stage Ia NSCLC. METHODS Clinical and pathological data from pIa patients in the prospective VATS Italian nationwide registry were reviewed and analysed. Patients and tumour characteristics,type of lymphadenectomy (sampling or radical nodal dissection,MRLD), were collected and correlated to Overall Survival(OS) and Disease free Survival(DFS). The Kaplan-Meier product-limit method was used to estimate OS and DFS and the log-rank test was adopted to evaluate the differences between groups. A propensity match was performed to reduce bias due to the retrospective study design. RESULTS The final analysis was conducted on 2039 patients, 179 died during follow-up,recurrence rate was 13%. MRLD was performed in 1287(63.1%)patients. The univariable analysis identified as favourable prognostic factors for OS the female sex(p = 0.023), low ECOG-score(0.008),low SUVmax(p < 0.001), GGO appearance(p < 0.001), pT < 2 cm(p = 0.002) and low tumour grading(p = 0.002). The multivariable analysis confirmed as independent prognostic factors low ECOG-score(p = 0.012), low SUVmax(p < 0.001) and low tumour grading(p < 0.001). Analysing survival in patients with solid/sub-solid nodules and after propensity score matching for pTdimension and number of N2 resected lymphnodes, no OS differences were present comparing sampling vs MRLD. CONCLUSION Survival in pIa patients seems to be determined by patient and tumour characteristics such as performance status,grading and SUVmax. Type of lymphadnectomy did not seem to be correlated with OS in these patients.
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Affiliation(s)
- Marco Chiappetta
- Università Cattolica del Sacro Cuore, Rome, Italy; Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Filippo Lococo
- Università Cattolica del Sacro Cuore, Rome, Italy; Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Isabella Sperduti
- Università Cattolica del Sacro Cuore, Rome, Italy; Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Biostatistics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Diomira Tabacco
- Università Cattolica del Sacro Cuore, Rome, Italy; Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Elisa Meacci
- Università Cattolica del Sacro Cuore, Rome, Italy; Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carlo Curcio
- Thoracic Surgery Unit, Division of Thoracic Surgery, Monaldi Hospital, Naples, Italy
| | - Roberto Crisci
- Department of Thoracic Surgery, University of L'Aquila, L'Aquila, Italy
| | - Stefano Margaritora
- Università Cattolica del Sacro Cuore, Rome, Italy; Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Mao Y, Gao Z, Yin Y. Complete Video-Assisted Thoracoscopic Surgery and Traditional Open Surgery for Elderly Patients With NSCLC. Front Surg 2022; 9:863273. [PMID: 35372482 PMCID: PMC8971185 DOI: 10.3389/fsurg.2022.863273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 02/17/2022] [Indexed: 12/25/2022] Open
Abstract
Objective: To observe the efficacy of complete video-assisted thoracoscopic surgery (CVATS) and traditional open surgery (TOS) in the treatment of elderly patients with non-small cell lung cancer (NSCLC) and their influence on cardiopulmonary function. Methods A total of 120 elderly patients with primary NSCLC who were treated surgically in our hospital from January 2018 to January 2021 were selected and divided into the study group and the control group according to the different surgical procedures, 60 patients in each group. CVATS was used in the observation group and TOS in the control group. The surgical indexes and cardiopulmonary function indexes were observed and compared between the two groups. The serum C-reactive protein (CRP) level and visual analog scale's (VAS) score of the patients at different time points were detected. The incidence of postoperative complications was compared between the two groups. Results The perioperative indexes such as operation time were significantly different between the two groups (p < 0.05), but the number of lymph node dissection was not significantly different (p > 0.05). The serum CRP level and VAS score of the observation group were significantly lower than those of the control group on the 1st, 3rd, and 7th postoperative days (p < 0.05). There were significant differences in cardiopulmonary function between the two groups on the 7th postoperative day (p < 0.05). The incidence of adverse reactions in the observation group was significantly lower than that in the control group (p > 0.05). Conclusion CVATS is effective in the treatment of NSCLC. Compared with TOS therapy, CVATS has less damage to cardiopulmonary function and fewer complications, which is conducive to the rehabilitation of elderly patients. It is a safe and reliable scheme for the treatment of elderly patients with NSCLC.
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Bédat B, Koliakos E, Demarchi MS, Perentes J, Licker MJ, Triponez F, Krueger T, Karenovics W, Gonzalez M. OUP accepted manuscript. Interact Cardiovasc Thorac Surg 2022; 35:6528414. [PMID: 35157073 PMCID: PMC9252121 DOI: 10.1093/icvts/ivac039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 01/31/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Benoît Bédat
- Service of Thoracic Surgery, University Hospital of Lausanne, Lausanne, Switzerland
- Division of Thoracic and Endocrine Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
- Corresponding author. Division of thoracic and endocrine surgery, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland. Tel: 079553-04-42; e-mail: (B. Bédat)
| | - Evangelos Koliakos
- Service of Thoracic Surgery, University Hospital of Lausanne, Lausanne, Switzerland
| | - Marco S Demarchi
- Division of Thoracic and Endocrine Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Jean Perentes
- Service of Thoracic Surgery, University Hospital of Lausanne, Lausanne, Switzerland
| | - Marc-Joseph Licker
- Division of Anesthesiology, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Frédéric Triponez
- Division of Thoracic and Endocrine Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Thorsten Krueger
- Service of Thoracic Surgery, University Hospital of Lausanne, Lausanne, Switzerland
| | - Wolfram Karenovics
- Division of Thoracic and Endocrine Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Michel Gonzalez
- Service of Thoracic Surgery, University Hospital of Lausanne, Lausanne, Switzerland
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Aguinagalde B, Insausti A, Lopez I, Sanchez L, Bolufer S, Embun R. VATS lobectomy morbidity and mortality is lower in patients with the same ppoDLCO: Analysis of the database of the Spanish Video-Assisted Thoracic Surgery Group. Arch Bronconeumol 2021; 57:750-756. [PMID: 35698981 DOI: 10.1016/j.arbr.2021.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/25/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Measuring predicted post-operative diffusion capacity of the lung for carbon monoxide (ppoDLCO) is essential to determine patient operability and to stratify the risk of patients who are candidates for major lung cancer surgery. Studies that established surgical risk variables were based on open surgery series. The aim of our study was to analyze morbidity and mortality as a function of ppoDLCO and to compare its behavior in open and video-assisted thoracic surgery (VATS). METHODS We compared 90-day mortality and morbidity in patients undergoing open surgery versus VATS as a function of decline in ppoDLCO. Propensity score matching (using age, ASA, arterial vascular disease, BMI, gender, stage, ppoDLCO, and ppoFEV1) was applied to create comparable open surgery and VATS groups. RESULTS Of 2,530 patients with lung cancer and ppoDLCO values, a sample of 1,624 (812 per group) was obtained after score matching. The relative risk of mortality associated with thoracotomy in patients with ppoDLCO < 60 is 2.66 (p < 0.02) compared to VATS. The risk of thoracotomy in terms of overall and cardiac and respiratory morbidity is higher than that of VATS for almost all ppoDLCO values. CONCLUSIONS Major resection by VATS shows lower morbidity and mortality in patients with the same ppoDLCO. A steady rise in the risk of mortality begins to occur at higher ppoDLCO values in thoracotomy (∼60) than in VATS (∼45).
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Affiliation(s)
- Borja Aguinagalde
- Servicio de Cirugía Torácica, Hospital Universitario Donostia, Donostia, Guipúzcoa, Spain.
| | | | - Iker Lopez
- Servicio de Cirugía Torácica, Hospital Universitario Donostia, Donostia, Guipúzcoa, Spain
| | - Laura Sanchez
- Servicio de Cirugía Torácica, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Sergio Bolufer
- Servicio de Cirugía Torácica, Hospital General Universitario de Alicante, Alicante, Spain
| | - Raul Embun
- Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet, IIS Aragón, Zaragoza, Spain; Servicio de Cirugía Torácica, Hospital Clínico Universitario Lozano Blesa, IIS Aragón, Zaragoza, Spain
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Aguinagalde B, Insausti A, Lopez I, Sanchez L, Bolufer S, Embun R. VATS Lobectomy Morbidity and Mortality is Lower in Patients with the Same ppoDLCO: Analysis of the Database of the Spanish Video-Assisted Thoracic Surgery Group. Arch Bronconeumol 2021; 57:S0300-2896(21)00055-7. [PMID: 33715848 DOI: 10.1016/j.arbres.2021.01.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/08/2021] [Accepted: 01/25/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Measuring predicted post-operative diffusion capacity of the lung for carbon monoxide (ppoDLCO) is essential to determine patient operability and to stratify the risk of patients who are candidates for major lung cancer surgery. Studies that established surgical risk variables were based on open surgery series. The aim of our study was to analyze morbidity and mortality as a function of ppoDLCO and to compare its behavior in open and video-assisted thoracic surgery (VATS). METHODS We compared 90-day mortality and morbidity in patients undergoing open surgery versus VATS as a function of decline in ppoDLCO. Propensity score matching (using age, ASA, arterial vascular disease, BMI, sexo, stage, ppoDLCO, and ppoFEV1) was applied to create comparable open surgery and VATS groups. RESULTS Of 2,530 patients with lung cancer and ppoDLCO values, a sample of 1,624 (812 per group) was obtained after score matching. The relative risk of mortality associated with thoracotomy in patients with ppoDLCO<60 is 2.66 (P<.02) compared to VATS. The risk of thoracotomy in terms of overall and cardiac and respiratory morbidity is higher than that of VATS for almost all ppoDLCO values. CONCLUSIONS Major resection by VATS shows lower morbidity and mortality in patients with the same ppoDLCO. A steady rise in the risk of mortality begins to occur at higher ppoDLCO values in thoracotomy (∼60) than in VATS (∼45).
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Affiliation(s)
- Borja Aguinagalde
- Servicio de Cirugía Torácica, Hospital Universitario Donostia, Donostia, Guipúzcoa, España.
| | | | - Iker Lopez
- Servicio de Cirugía Torácica, Hospital Universitario Donostia, Donostia, Guipúzcoa, España
| | - Laura Sanchez
- Servicio de Cirugía Torácica, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Sergio Bolufer
- Servicio de Cirugía Torácica, Hospital General Universitario de Alicante, Alicante, España
| | - Raul Embun
- Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet, IIS Aragón, Zaragoza, España; Servicio de Cirugía Torácica, Hospital Clínico Universitario Lozano Blesa, IIS Aragón, Zaragoza, España
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Post-operative outcomes and quality of life assessment after thoracoscopic lobectomy for Non-small-cell lung cancer in octogenarians: Analysis from a national database. Surg Oncol 2021; 37:101530. [PMID: 33548589 DOI: 10.1016/j.suronc.2021.101530] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 12/27/2020] [Accepted: 01/25/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Thoracoscopic lobectomy (VATS-L) for non-small-cell lung cancer (NSCLC) is a well-established option for early stage NSCLC, but the evidences are limited for octogenarians. OBJECTIVE The objectives of this multi-institutional study were to evaluate the post-operative outcomes of VATS-L in octogenarians and to estimate the post-operative quality of life (QoL) using a validated questionnaire (EuroQoL5D). METHODS Data from patients underwent VATS-L between 2014 and 2019 were analysed and divided into two groups: Group A (younger patients) and Group B (octogenarians). To define predictors for complications, univariate and multivariable logistic regression analysis were performed. RESULTS 7023 patients underwent VATS-L and 329 (4.6%) were octogenarians. 30-day and 90-day post-operative mortality were similar (0.95% vs 0.91%, p = 0.84 and 1.3% vs 1.2%, p = 0.58), whereas the percentage of patients who suffered from any complication (25.5% vs 31.9%, p = 0.012) and the complication rate (31.6% vs 45.2%, p=<0.01) were higher for octogenarians. At discharge, the values of EuroQoL5D were worse in group B, but after one month these levels became similar. Age >80 years had a significant influence on morbidity on both univariate and multivariable analyses (p = 0.025). CONCLUSIONS VATS-L for NSCLC can be performed in selected octogenarians without increased risk of post-operative death, acceptable not-life-threatening complications and a moderate impact on QoL.
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