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Chen CY, Ding H, Wang SS. Effectiveness of Roy Adaptation Model-Based Cognitive Stimulation Therapy in Elderly Patients with Non-Small Cell Lung Cancer Undergoing Curative Resection. TOHOKU J EXP MED 2024; 263:27-34. [PMID: 38220169 DOI: 10.1620/tjem.2023.j108] [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] [Indexed: 01/16/2024]
Abstract
This study aimed to investigate the effects of a Roy adaptation model (RAM)-based cognitive stimulation therapy (CST) intervention on elderly patients diagnosed with primary non-small cell lung cancer (NSCLC) undergoing curative resection. A total of 280 patients diagnosed with primary NSCLC were randomized into RAM-based CST group and control group. Outcomes were assessed at three intervals: pre-surgery, discharge, and one-month post-discharge. Cognitive function was evaluated using Mini-Cognitive test. Postoperative delirium prevalence was determined within 48 hours post-surgery using Nursing Delirium Screening Scale. The Hospital Anxiety and Depression Scale evaluated anxiety and depression symptoms, while Quality of Life (QoL) was assessed via Short Form-36 (SF36) Health Survey. The RAM-based CST group demonstrated significantly higher Mini-Cog test scores than the control group upon discharge and post-intervention. Patients with RAM-based CST exhibited a decrease in postoperative delirium compared to the control group. The RAM-based CST intervention yielded an improvement in anxiety and depression at discharge and 1-month post-discharge compared to preoperative levels. Additionally, the RAM-based CST group exhibited substantial enhancements in SF36 subcategory scores at 1-month post-discharge compared to pre-surgery. At post-intervention, the RAM-based CST group demonstrated significantly higher scores than the control group across various health-related domains, including role limitations due to emotional problems, mental health, general health perception, bodily pain, and role limitations due to physical problems. The RAM-based CST intervention in elderly NSCLC patients undergoing curative resection yielded significant enhancements in cognitive function, reduced delirium incidence, improved emotional well-being, and better QoL postoperatively.
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Affiliation(s)
| | | | - Shang-Shang Wang
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine
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Tupper HI, Lawson BL, Kipnis P, Patel AR, Ashiku SK, Roubinian NH, Myers LC, Liu VX, Velotta JB. Video-Assisted vs Robotic-Assisted Lung Lobectomies for Operating Room Resource Utilization and Patient Outcomes. JAMA Netw Open 2024; 7:e248881. [PMID: 38700865 PMCID: PMC11069083 DOI: 10.1001/jamanetworkopen.2024.8881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/09/2024] [Indexed: 05/06/2024] Open
Abstract
Importance With increased use of robots, there is an inadequate understanding of minimally invasive modalities' time costs. This study evaluates the operative durations of robotic-assisted vs video-assisted lung lobectomies. Objective To compare resource utilization, specifically operative time, between video-assisted and robotic-assisted thoracoscopic lung lobectomies. Design, Setting, and Participants This retrospective cohort study evaluated patients aged 18 to 90 years who underwent minimally invasive (robotic-assisted or video-assisted) lung lobectomy from January 1, 2020, to December 31, 2022, with 90 days' follow-up after surgery. The study included multicenter electronic health record data from 21 hospitals within an integrated health care system in Northern California. Thoracic surgery was regionalized to 4 centers with 14 board-certified general thoracic surgeons. Exposures Robotic-assisted or video-assisted lung lobectomy. Main Outcomes and Measures The primary outcome was operative duration (cut to close) in minutes. Secondary outcomes were length of stay, 30-day readmission, and 90-day mortality. Comparisons between video-assisted and robotic-assisted lobectomies were generated using the Wilcoxon rank sum test for continuous variables and the χ2 test for categorical variables. The average treatment effects were estimated with augmented inverse probability treatment weighting (AIPTW). Patient and surgeon covariates were adjusted for and included patient demographics, comorbidities, and case complexity (age, sex, race and ethnicity, neighborhood deprivation index, body mass index, Charlson Comorbidity Index score, nonelective hospitalizations, emergency department visits, a validated laboratory derangement score, a validated institutional comorbidity score, a surgeon-designated complexity indicator, and a procedural code count), and a primary surgeon-specific indicator. Results The study included 1088 patients (median age, 70.1 years [IQR, 63.3-75.8 years]; 704 [64.7%] female), of whom 446 (41.0%) underwent robotic-assisted and 642 (59.0%) underwent video-assisted lobectomy. The median unadjusted operative duration was 172.0 minutes (IQR, 128.0-226.0 minutes). After AIPTW, there was less than a 10% difference in all covariates between groups, and operative duration was a median 20.6 minutes (95% CI, 12.9-28.2 minutes; P < .001) longer for robotic-assisted compared with video-assisted lobectomies. There was no difference in adjusted secondary patient outcomes, specifically for length of stay (0.3 days; 95% CI, -0.3 to 0.8 days; P = .11) or risk of 30-day readmission (adjusted odds ratio, 1.29; 95% CI, 0.84-1.98; P = .13). The unadjusted 90-day mortality rate (1.3% [n = 14]) was too low for the AIPTW modeling process. Conclusions and Relevance In this cohort study, there was no difference in patient outcomes between modalities, but operative duration was longer in robotic-assisted compared with video-assisted lung lobectomy. Given that this elevated operative duration is additive when applied systematically, increased consideration of appropriate patient selection for robotic-assisted lung lobectomy is needed to improve resource utilization.
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Affiliation(s)
- Haley I. Tupper
- Division of General Surgery, Department of Surgery, University of California, Los Angeles
| | - Brian L. Lawson
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Patricia Kipnis
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Ashish R. Patel
- Division of Thoracic Surgery, Department of Surgery, Kaiser Permanente Oakland, Oakland, California
| | - Simon K. Ashiku
- Division of Thoracic Surgery, Department of Surgery, Kaiser Permanente Oakland, Oakland, California
| | - Nareg H. Roubinian
- Division of Research, Kaiser Permanente Northern California, Oakland
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - Laura C. Myers
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Vincent X. Liu
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Jeffrey B. Velotta
- Division of Thoracic Surgery, Department of Surgery, Kaiser Permanente Oakland, Oakland, California
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
- Department of Surgery, University of California San Francisco School of Medicine
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Li W, Li X, Chen T, Deng X, Zhu J, Guo J, Li Y, Ye M. Factors affecting lung cancer patients' intention to perform early postoperative exercise: a qualitative study based on theory of planned behavior. Support Care Cancer 2023; 31:649. [PMID: 37864618 DOI: 10.1007/s00520-023-08107-5] [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: 07/06/2023] [Accepted: 10/06/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Early postoperative exercise is effective in improving the prognosis of postoperative lung cancer patients, but compliance was lower than expected. Factors affecting lung cancer patients' intention to perform early postoperative exercise were unclear. PURPOSE To discuss the factors affecting lung cancer patients' intention to perform early postoperative exercise based on the Theory of Planned Behavior. METHODS This was a qualitative study. Twenty-five lung cancer patients were recruited using purposive sampling, and semi-structured face-to-face interviews were performed. The reflexive intuitive thematic analysis method was used, and triangulation was employed to ensure the credibility of the study. RESULTS Results of this study identified 8 themes from 3 aspects. For behavioral attitudes, two themes emerged: (1) Aware of the benefits of postoperative exercise, (2) Underestimate the importance of postoperative exercise. For subjective norms, four themes emerged: (1) Influence of caregiver support on carrying out postoperative exercise, (2) Short-term supervision of medical staff, (3) Positive driving effect from other patients, and (4) Motivation due to family responsibility. For perceived behavior control, two themes and six sub-themes emerged: (1) Obstacles before actual exercise (Lack of adequate knowledge of postoperative pulmonary exercise, Less active in seeking related knowledge about rehabilitation exercise, and Misconceptions about rehabilitation exercise); (2) Unpleasant experiences during exercise (Physical discomfort, Limited space and depressive atmosphere, and Psychological burden). CONCLUSIONS Several factors could affect lung cancer patients' early postoperative exercise behavior. Healthcare professionals should fully understand these factors from patients' perspectives. Special interventions should be designed for the patients and their caregivers to correct cognitive bias, reduce obstacles, and promote compliance with exercise.
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Affiliation(s)
- Wei Li
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, 139 Renmin Middle Road, Changsha, 410011, Hunan, China
- Xiangya Nursing School of Central South University, Changsha, 410013, Hunan, China
| | - Xuting Li
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, 139 Renmin Middle Road, Changsha, 410011, Hunan, China
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Tian Chen
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, 139 Renmin Middle Road, Changsha, 410011, Hunan, China
- Xiangya Nursing School of Central South University, Changsha, 410013, Hunan, China
| | - Xianjiao Deng
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, 139 Renmin Middle Road, Changsha, 410011, Hunan, China
- Xiangya Nursing School of Central South University, Changsha, 410013, Hunan, China
| | - Jie Zhu
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, 139 Renmin Middle Road, Changsha, 410011, Hunan, China
- Xiangya Nursing School of Central South University, Changsha, 410013, Hunan, China
| | - Jiayi Guo
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, 139 Renmin Middle Road, Changsha, 410011, Hunan, China
- Xiangya Nursing School of Central South University, Changsha, 410013, Hunan, China
| | - Yamin Li
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, 139 Renmin Middle Road, Changsha, 410011, Hunan, China.
- Xiangya Nursing School of Central South University, Changsha, 410013, Hunan, China.
| | - Man Ye
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, 139 Renmin Middle Road, Changsha, 410011, Hunan, China.
- Xiangya Nursing School of Central South University, Changsha, 410013, Hunan, China.
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
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Huang Q, Rauniyar R, Yang J, Zhou C, Cai D, Chen-Yoshikawa TF, Yutaka Y, Orlandi R, Geraci TC, Lin J, Hu H, Jiang Z, Zhao G, Ye L. Risk stratification of postoperative pulmonary complications in elderly patients undergoing lung cancer resection: a propensity score-matched study. J Thorac Dis 2023; 15:3908-3918. [PMID: 37559604 PMCID: PMC10407502 DOI: 10.21037/jtd-23-923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/19/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND In China, lung cancer mainly affects the elderly population. Surgery remains the standard treatment for lung cancer in elderly patients, however, postoperative pulmonary complications (PPCs) are major contributors to morbidity and mortality following lung resection. This study aimed to identify perioperative predictors of PPCs among elderly patients undergoing pulmonary resection for lung cancer to provide evidence for better prevention and intervention for PPCs. METHODS A retrospective study was conducted with 456 patients (age >65 years) undergoing pulmonary resection for lung cancer in Yunnan, China from January 2016 to March 2019. Propensity score matching (PSM) was performed to compare preoperative data and clinical characteristics between the PPC and non-PPC groups, followed by binary logistic regression to evaluate predictors of PPCs. RESULTS Pulmonary complications occurred in 142/456 (31.1%) patients age >65 years, with pneumonia being the most common event (21.7%). Both PSM and binary logistic regression analysis identified American Society of Anesthesiologists (ASA) class CONCLUSIONS PPCs following lung cancer resection in elderly patients were associated with a higher ASA classification and open thoracotomy. An adequate and comprehensive evaluation of the operative strategies and enhanced recovery methods should be implemented among elderly patients undergoing lung resection with an ASA class > II or those undergoing an open thoracotomy to help prevent the occurrence of PPCs.
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Affiliation(s)
- Qiubo Huang
- Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ritika Rauniyar
- Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jiao Yang
- Department of Nursing, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Chen Zhou
- Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Dezhong Cai
- Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | | | - Yojiro Yutaka
- Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Riccardo Orlandi
- Department of Thoracic Surgery, IRCCS San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - Travis C. Geraci
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, USA
| | - Jules Lin
- Section of Thoracic Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Huilian Hu
- Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ziqi Jiang
- Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Guangqiang Zhao
- Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Lianhua Ye
- Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
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Panagopoulos N, Grapatsas K, Leivaditis V, Galanis M, Dougenis D. Are Extensive Open Lung Resections for Elderly Patients with Lung Cancer Justified? Curr Oncol 2023; 30:5470-5484. [PMID: 37366897 DOI: 10.3390/curroncol30060414] [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: 04/01/2023] [Revised: 05/29/2023] [Accepted: 06/03/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Older patients with malignancies are more comorbid than younger ones and are usually undertreated only because of their age. The aim of this study is to investigate the safety of open anatomical lung resections for lung cancer in elderly patients. METHODS We retrospectively analyzed all patients who underwent lung resection for lung cancer in our institution and categorized them into two groups: the elderly group (≥70 years old) and the control (<70). RESULTS In total, 135 patients were included in the elderly group and 375 in the control. Elderly patients were more frequently diagnosed with squamous cell carcinoma (59.3% vs. 51.5%, p = 0.037), higher differentiated tumors (12.6% vs. 6.4%, p = 0.014), and at an earlier stage (stage I: 55.6% for elderly vs. 36.6%, p = 0.002). Elderly patients were more vulnerable to postoperative pneumonia (3.7% vs. 0.8%, p = 0.034), lung atelectasis (7.4% vs. 2.9%, p = 0.040), and pleural empyema (3.2% vs. 0%, p = 0.042), however, with no increased 30-day-mortality (5.2% for elderly vs. 2.7%, p = 0.168). Survival was comparable in both groups (43.4 vs. 45.3 months, p = 0.579). CONCLUSIONS Elderly patients should not be excluded from open major lung resections as the survival benefit is not reduced in selected patients.
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Affiliation(s)
| | - Konstantinos Grapatsas
- Department of Thoracic Surgery, University Medicine Essen-Ruhrlandklinik, 45239 Essen, Germany
| | - Vasileios Leivaditis
- Department of Cardiothoracic and Vascular Surgery, Westpfalz-Klinikum, 67655 Kaiserslautern, Germany
| | - Michail Galanis
- Department of Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, 3012 Bern, Switzerland
| | - Dimitrios Dougenis
- Department of Cardiothoracic Surgery, Attikon University Hospital of Athens, 12462 Athens, Greece
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A Clinical Prediction Model for Postoperative Pneumonia After Lung Cancer Surgery. J Surg Res 2023; 284:62-69. [PMID: 36549037 DOI: 10.1016/j.jss.2022.11.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 10/24/2022] [Accepted: 11/06/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Postoperative pneumonia (POP) is a common complication following lung cancer surgery and is associated with increased hospitalization costs and mortalities. We aimed to identify risk factors associated with POP and to develop a reliable predictive model. METHODS Patients who underwent lung cancer surgery between January 2015 and December 2021 in our hospital were enrolled. Least absolute shrinkage and selection operator regression analysis was used to select predictors of POP. Multivariable logistic regression was performed to construct the nomogram. Bootstrap resampling was conducted for internal validation. The performance of the model was evaluated by discrimination and calibration. RESULTS A total of 5269 consecutive patients were enrolled. POP occurred in 1.7% of patients (92/5269). Five independent predictors were identified: age, predicted forced expiratory volume in 1 s, predicted diffusing capacity of the lungs for carbon monoxide, tuberculosis history, and surgery duration. The multivariable regression model showed good discrimination (C-index: 0.821, 95% confidence interval, 0.783-0.859), which was well validated by internal validation. The calibration curve illustrated good agreement between the predicted probability and observed probability of POP. CONCLUSIONS Based on the easily available risk factors, our nomogram could predict the risk of POP with good discrimination and calibration. The model has good clinical practicability, enabling precise and targeted interventions to reduce the incidence of POP in high-risk patients.
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Lu Y, Liu X. Postoperative delirium and its influencing factors in elderly patients with lung cancer in the intensive care unit. J Thorac Dis 2023; 15:701-710. [PMID: 36910101 PMCID: PMC9992628 DOI: 10.21037/jtd-23-259] [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: 11/17/2022] [Accepted: 02/10/2023] [Indexed: 03/04/2023]
Abstract
Background In 2020, there were 2,206,771 new cases of lung cancer worldwide, ranking first in mortality rate postoperative delirium (POD) is a common surgical complication and typically occurs 1-3 days after surgery which leads to prolonged hospital stay. The currently available research on POD in elderly patients was mainly carried out in cardiac surgery, orthopedic, and gastroenterology departments. It is necessary to study the incidence and risk factors of delirium in intensive care unit (ICU) elderly patients after lung cancer surgery. Methods This study is a single-center and singe-arm observational study which examined the incidence of and factors affecting POD in elderly patients with lung cancer in ICU at our center from September 2019 to May 2020. 22 relevant variables including arterial oxygen partial pressure, postoperative sedative drug use, and other data were collected. The Confusion Assessment Method of Intensive Care Unit was used to assess the occurrence of POD, the Chinese version of the Richards-Campbell Sleep Questionnaire was used to assess patients' postoperative sleep quality, and the Mini-Mental State Examination was used to assess patients' preoperative cognitive level. Univariate and multivariate logistic regression analyses were conducted to identify the factors affecting POD in elderly ICU patients with lung cancer. Results Among the 208 elderly ICU patients who underwent surgery for lung cancer, 32 (15.38%) had POD. The results showed that postoperative blood oxygen level, preoperative cognitive level score and postoperative sleep quality score in delirium group were significantly lower than those in non-delirium group (P values were 0.002, 0.000, 0.000, respectively). The proportion of previous coronary heart disease and postoperative sedation use in delirium group was significantly higher than that in non-delirium group (P=0.008 and 0.008, respectively). Conclusions It was observed that the preoperative Mini-Mental State Examination (MMSE) score and postoperative Richards-Campbell Sleep Questionnaire (RCSQ) score of the delirium group were significantly lower than those of the non-delirium group, and this trend was still observed after adjusting for influencing factors. It is suggested that the difference of cognitive level in elderly lung cancer population has a significant effect on the occurrence of POD. In clinical work, we should pay more attention to patients with preoperative cognitive impairment, hypoxic state, and postoperative sleep disturbance.
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Affiliation(s)
- Yanna Lu
- Intensive Care Unit, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoxin Liu
- Intensive Care Unit, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Okamoto T, Matsuki Y, Ogata H, Okutani H, Ueki R, Kariya N, Tatara T, Hirose M. Association between averaged intraoperative nociceptive response index and postoperative complications after lung resection surgery. Interact Cardiovasc Thorac Surg 2022; 35:6754818. [PMID: 36214634 PMCID: PMC9725181 DOI: 10.1093/icvts/ivac258] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/12/2022] [Accepted: 10/06/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Since postoperative complications, defined as Clavien-Dindo grade ≥II, correlate with long-term survival after lung resection surgery in patients with primary lung cancer, identification of intraoperative risk factors for postoperative complications is crucial for better perioperative management. In the present study, we investigated the possible association between intraoperative variables for use in anaesthetic management and Clavien-Dindo grade ≥II. METHODS In this multi-institutional observational study, consecutive adult patients undergoing video-assisted thoracic surgery for primary lung cancer under general anaesthesia from March 2019 to April 2021 were enrolled. All patients were divided into 2 groups with Clavien-Dindo grade <II and ≥II. Uni- and multivariable analyses were performed to identify intraoperative risk factors. RESULTS After univariable analysis between patients with Clavien-Dindo grade <II (n = 415) and ≥II (n = 121), multivariable analysis revealed higher averaged nociceptive response (NR) index during surgery (mean NR), male sex, lower body mass index, longer duration of surgery, higher blood loss and lower urine volume, as independent risk factors for postoperative complications. In sensitivity analysis, based on the cut-off value of mean NR for postoperative complications, all patients were divided into high and low mean NR groups. The incidence of postoperative complications was significantly higher in patients with high mean NR (n = 332) than in patients with low mean NR (n = 204; P < 0.001). CONCLUSIONS Higher mean NR, as intraoperative variables for use in anaesthetic management, is associated with the higher incidence of postoperative complications after primary lung cancer surgery.
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Affiliation(s)
- Takuma Okamoto
- Department of Anaesthesiology and Pain Medicine, Hyogo Medical University School of Medicine, Nishinomiya, Japan
| | - Yuka Matsuki
- Department of Anaesthesiology and Reanimatology, Faculty of Medicine Sciences, University of Fukui, Fukui, Japan
| | - Hiroki Ogata
- Department of Anaesthesiology and Pain Medicine, Hyogo Medical University School of Medicine, Nishinomiya, Japan
| | - Hiroai Okutani
- Department of Anaesthesiology and Pain Medicine, Hyogo Medical University School of Medicine, Nishinomiya, Japan
| | - Ryusuke Ueki
- Department of Anaesthesiology and Pain Medicine, Hyogo Medical University School of Medicine, Nishinomiya, Japan
| | - Nobutaka Kariya
- Department of Anaesthesiology and Pain Medicine, Hyogo Medical University School of Medicine, Nishinomiya, Japan
| | - Tsuneo Tatara
- Department of Anaesthesiology and Pain Medicine, Hyogo Medical University School of Medicine, Nishinomiya, Japan
| | - Munetaka Hirose
- Corresponding author. Department of Anaesthesiology and Pain Medicine, Hyogo Medical University School of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 6638501, Japan. Tel: +81-798-45-6392; fax: +81-798-45-6393; e-mail: (M. Hirose)
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Fuzhi Y, Dongfang T, Wentao F, Jing W, Yingting W, Nianping M, Wen G, Xiaoyong S. Rapid Recovery of Postoperative Pulmonary Function in Patients With Lung Cancer and Influencing Factors. Front Oncol 2022; 12:927108. [PMID: 35898890 PMCID: PMC9309725 DOI: 10.3389/fonc.2022.927108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 06/13/2022] [Indexed: 12/24/2022] Open
Abstract
Among malignant tumors, lung cancer has the highest morbidity and mortality worldwide. Surgery is the first-line treatment for early-stage lung cancers, and has gradually advanced from conventional open-chest surgery to video-assisted thoracic surgery (VATS). Additionally, increasingly smaller surgical incisions and less surgical trauma have resulted in reduced pulmonary function damage. Previous studies have found that the level of pulmonary function loss and recovery is significantly correlated with postoperative complications and the quality of life. Thus, an accurate assessment of the preoperative pulmonary function and effective rehabilitation of postoperative pulmonary function are highly important for patients undergoing lung surgery. In addition, pulmonary function assessment after pulmonary rehabilitation serves as an objective indicator of the postoperative pulmonary rehabilitation status and is crucial to facilitating pulmonary function recovery. Furthermore, a complete preoperative assessment and effective rehabilitation are especially critical in elderly patients with pulmonary tumors, poor basic physiological functions, comorbid lung diseases, and other underlying diseases. In this review, we summarize the clinical significance of pulmonary function assessment in patients undergoing lung cancer surgery, postoperative changes in pulmonary function, effective pulmonary function rehabilitation, and the influencing factors of pulmonary function rehabilitation.
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Okada S, Shimomura M, Ishihara S, Ikebe S, Furuya T, Inoue M. Clinical significance of postoperative pulmonary complications in elderly patients with lung cancer. Interact Cardiovasc Thorac Surg 2022; 35:6595161. [PMID: 35640579 PMCID: PMC9297523 DOI: 10.1093/icvts/ivac153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 05/25/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Satoru Okada
- Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masanori Shimomura
- Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shunta Ishihara
- Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoshi Ikebe
- Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tatsuo Furuya
- Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masayoshi Inoue
- Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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11
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Ma H, Yao D, Cheng J, Wang W, Liu B, Yu Y, Xing W, Qin J. Older patients more likely to die from cancer-related diseases than younger with stage IA non-small cell lung cancer: a SEER database analysis. J Thorac Dis 2022; 14:2178-2186. [PMID: 35813764 PMCID: PMC9264095 DOI: 10.21037/jtd-22-505] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/27/2022] [Indexed: 11/10/2022]
Abstract
Background Various reports showed some conflicting data on survival at different ages. This study aimed to investigate the main cause of death in older patients with lung cancer and to perform a comparison with younger patients in order to observe the differences between these two cohorts. Methods Outcomes of patients with stage IA non-small cell lung cancer (NSCLC) ≤3 cm who underwent lobectomy without induction therapy in the Surveillance, Epidemiology, and End Results-18 (SEER-18; January 2004 to December 2016) database were evaluated using multivariable Cox proportional hazards modeling and propensity score-matched analysis. Results A total of 16,672 eligible NSCLC cases were found in the SEER database. The number of patients aged ≤60, 61–70, and ≥71 years was 3,930, 6,391, and 6,351, respectively. Among these patient groups, 527 (13.4%), 1,018 (15.9%), and 1,235 (19.4%) died of lung cancer during follow-up, while 357 (9.1%), 964 (15.1%) and 1,579 (25.2%) died of non-lung cancer diseases, respectively. The overall survival (OS) and lung cancer-specific survival (LCSS) rates of younger patients showed a significant survival advantage over older patients. After propensity-score matching (PSM) of patients aged ≤60 and ≥71 years using a ratio of 1:1, we found that 403 (12.9%) and 584 (18.7%) patients in the ≤60 and ≥71 years age groups died of lung cancer, respectively. The OS and LCSS rates of younger patients still exhibited a significant survival advantage over older patients. Conclusions Older patients with stage IA NSCLC have a worse prognosis compared with younger patients. Also, cancer-related causes were more frequent in older patients than non-cancer-related causes.
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Affiliation(s)
- Haibo Ma
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Di Yao
- Information Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jiwei Cheng
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Wei Wang
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Baoxing Liu
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Yongkui Yu
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Wenqun Xing
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Jianjun Qin
- Department of Thoracic Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China
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12
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Stabellini N, Bruno DS, Dmukauskas M, Barda AJ, Cao L, Shanahan J, Waite K, Montero AJ, Barnholtz-Sloan JS. Sex differences in lung cancer treatment and outcomes at a large hybrid academic-community practice. JTO Clin Res Rep 2022; 3:100307. [PMID: 35400080 PMCID: PMC8983352 DOI: 10.1016/j.jtocrr.2022.100307] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/28/2022] [Accepted: 03/04/2022] [Indexed: 11/02/2022] Open
Abstract
Introduction Methods Results Conclusions
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13
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Wei W, Zheng X, Gu Y, Fu W, Tang C, Yao Y. Effect of general anesthesia with thoracic paravertebral block on postoperative delirium in elderly patients undergoing thoracoscopic lobectomy: a randomized-controlled trial. BMC Anesthesiol 2022; 22:1. [PMID: 34979943 PMCID: PMC8722018 DOI: 10.1186/s12871-021-01532-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 11/29/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Postoperative delirium (POD) is characterized by acute brain dysfunction, especially in elderly patients. Postoperative pain is an important factor in the development of delirium, and effective pain management can reduce the risk of POD. Thoracic paravertebral block (TPVB) can effectively relieve postoperative pain and inhibit the perioperative stress and inflammatory response. We investigated whether the combination of TPVB with general anesthesia reduced the occurrence of POD following thoracoscopic lobectomy. METHODS A total of 338 elderly patients, aged 65-80 years, who underwent elective surgery for video-assisted thoracoscopic lobectomy (VATS) were randomly assigned to either a patient-controlled intravenous analgesia group (PIA) or a patient-controlled paravertebral-block analgesia group (PBA). POD was evaluated using the 3-min diagnostic confusion assessment method (3D-CAM). The postoperative quality of recovery (QoR) was assessed with Chinese version of QoR-40 scale. Pain intensity was measured using the visual analog scale (VAS) score. Tumor necrosis factor-α (TNF-α) and neurofilament light (NFL) levels were determined using enzyme-linked immunosorbent assay (ELISA) kits. RESULTS Delirium occurred in 47 (28%) of 168 cases in the PIA group and 28 (16.5%) of 170 cases in the PBA group (RR 1.7, p = 0.03). PBA was also associated with a higher rate of overall recovery quality at day 7 after surgery (27.1% vs. 17.3%, P = 0.013) compared with PIA. The incremental change in surgery-induced TNF-α and NFL was greater in the PIA group than PBA group (p < 0.05). CONCLUSION Thoracic paravertebral block analgesia is associated with lower incidence of postoperative delirium, probably due to its anti-neuroinflammatory effects. Furthermore, as a component of multimodal analgesia, TPVB provides not only superior analgesic but also opioid-sparing effects. TRIAL REGISTRATION The study was registered on the Chinese Clinical Trial Registry Center ( www.chictr.org.cn ; registration number: ChiCTR 2,000,033,238 ) on 25/05/2018.
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Affiliation(s)
- Wei Wei
- Department of anesthesiology, cancer hospital and institute of Guangzhou medical university, Guangzhuou, 510000, Guangdong, China
| | - Xi Zheng
- Department of anesthesiology, cancer hospital and institute of Guangzhou medical university, Guangzhuou, 510000, Guangdong, China
| | - Yu Gu
- Department of anesthesiology, cancer hospital and institute of Guangzhou medical university, Guangzhuou, 510000, Guangdong, China
| | - Wenting Fu
- Department of anesthesiology, cancer hospital and institute of Guangzhou medical university, Guangzhuou, 510000, Guangdong, China
| | - Chunlin Tang
- Department of anesthesiology, cancer hospital and institute of Guangzhou medical university, Guangzhuou, 510000, Guangdong, China
| | - Yonghua Yao
- Department of anesthesiology, cancer hospital and institute of Guangzhou medical university, Guangzhuou, 510000, Guangdong, China.
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14
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Song Y, Liu J, Lei M, Wang Y, Fu Q, Wang B, Guo Y, Mi W, Tong L. An External-Validated Algorithm to Predict Postoperative Pneumonia Among Elderly Patients With Lung Cancer After Video-Assisted Thoracoscopic Surgery. Front Oncol 2022; 11:777564. [PMID: 34970491 PMCID: PMC8712479 DOI: 10.3389/fonc.2021.777564] [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: 09/15/2021] [Accepted: 11/09/2021] [Indexed: 12/15/2022] Open
Abstract
The aim of the study was to develop an algorithm to predict postoperative pneumonia among elderly patients with lung cancer after video-assisted thoracoscopic surgery. We analyzed 3,009 patients from the Thoracic Perioperative Database for Geriatrics in our hospital and finally enrolled 1,585 elderly patients (age≧65 years) with lung cancer treated with video-assisted thoracoscopic surgery. The included patients were randomly divided into a training group (n = 793) and a validation group (n = 792). Patients in the training group were used to develop the algorithm after screening up to 30 potential risk factors, and patients in the validation group were used to internally validate the algorithm. External validation of the algorithm was achieved in the external validation dataset after enrolling 165 elderly patients with lung cancer treated with video-assisted thoracoscopic surgery from two hospitals in China. Of all included patients, 9.15% (145/1,585) of patients suffered from postoperative pneumonia in the Thoracic Perioperative Database for Geriatrics, and 10.30% (17/165) of patients had postoperative pneumonia in the external validation dataset. The algorithm consisted of seven variables, including sex, smoking, history of chronic obstructive pulmonary disease (COPD), surgery duration, leukocyte count, intraoperative injection of colloid, and intraoperative injection of hormone. The C-index from the receiver operating characteristic curve (AUROC) was 0.70 in the training group, 0.67 in the internal validation group, and 0.71 in the external validation dataset, and the corresponding calibration slopes were 0.88 (95% confident interval [CI]: 0.37–1.39), 0.90 (95% CI: 0.46–1.34), and 1.03 (95% CI: 0.24–1.83), respectively. The actual probabilities of postoperative pneumonia were 5.14% (53/1031) in the low-risk group, 15.07% (71/471) in the medium-risk group, and 25.30% (21/83) in the high-risk group (p < 0.001). The algorithm can be a useful prognostic tool to predict the risk of developing postoperative pneumonia among elderly patients with lung cancer after video-assisted thoracoscopic surgery.
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Affiliation(s)
- Yanping Song
- Anesthesia and Operation Center, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.,Department of Anesthesia, 922 Hospital of People's Liberation Army (PLA), Hengyang, China
| | - Jingjing Liu
- Anesthesia and Operation Center, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.,Department of Anesthesia, Beijing Corps Hospital of Chinese People's Armed Police Force, Beijing, China
| | - Mingxing Lei
- The National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.,Department of Orthopedic Surgery, Hainan Hospital of Chinese People's Liberation Army (PLA) General Hospital, Sanya, China.,Chinese People's Liberation Army (PLA) Medical School, Beijing, China
| | - Yanfeng Wang
- Department of Anesthesia, Xiangya Hospital, Central South University, Changsha, China
| | - Qiang Fu
- Anesthesia and Operation Center, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Bailin Wang
- Department of Thoracic Surgery, Hainan Hospital of Chinese People's Liberation Army (PLA) General Hospital, Sanya, China
| | - Yongxin Guo
- Anesthesia and Operation Center, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Weidong Mi
- Anesthesia and Operation Center, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Li Tong
- Anesthesia and Operation Center, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
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15
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Xu X, Cheung DST, Smith R, Lai AYK, Lin CC. The effectiveness of pre- and post-operative rehabilitation for lung cancer: A systematic review and meta-analysis on postoperative pulmonary complications and length of hospital stay. Clin Rehabil 2021; 36:172-189. [PMID: 34496658 DOI: 10.1177/02692155211043267] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To investigate the effects of rehabilitation either before or after operation for lung cancer on postoperative pulmonary complications and the length of hospital stay. DATA SOURCES MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, CINAHL Plus, SPORTDiscus, PsycInfo and Embase were searched from inception until June 2021. REVIEW METHODS Inclusion criteria were patients scheduled to undergo or had undergone operation for lung cancer, randomised controlled trials comparing rehabilitative interventions initiated before hospital discharge to usual care control. Two reviewers independently assessed eligibility, extracted data and risks of bias. Pooled odds ratios (ORs) or standardised mean differences (SMDs) with 95% Confidence Intervals (CI) were estimated using random-effects meta-analyses. RESULTS Twenty-three studies were included (12 preoperative, 10 postoperative and 1 perioperative), with 2068 participants. The pooled postoperative pulmonary complication risk and length of hospital stay were reduced after preoperative interventions (OR = 0.32; 95% CI = 0.22, 0.47; I2 = 0.0% and SMD = -1.68 days, 95% CI = -2.23, -1.13; I2 = 77.8%, respectively). Interventions delivered during the immediate postoperative period did not have any significant effects on either postoperative pulmonary complication or length of hospital stay (OR = 0.85; 95% CI = 0.56, 1.29; I2 = 0.0% and SMD = -0.23 days, 95% CI = -1.08, 0.63; I2 = 64.6%, respectively). Meta-regression showed an association between a higher number of supervised sessions and shorter hospital length of stay in preoperative studies (β = -0.17, 95% CI = -0.29, -0.05). CONCLUSION Preoperative rehabilitation is effective in reducing postoperative pulmonary complications and length of hospital stay associated with lung cancer surgery. Short-term postoperative rehabilitation in inpatient settings is probably ineffective.
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Affiliation(s)
- Xinyi Xu
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Denise Shuk Ting Cheung
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Robert Smith
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Agnes Yuen Kwan Lai
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Chia-Chin Lin
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong.,Alice Ho Miu Ling Nethersole Charity Foundation Professorship in Nursing, Hong Kong.,School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
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16
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Wang C, Wu D, Pang P, Kong H, Zhao J, Chen X, Ye J, Pan Z, Liang W, Liu J, He J. Spontaneous Ventilation Video-Assisted Thoracoscopic Surgery for Geriatric Patients With Non-Small-Cell Lung Cancer. J Cardiothorac Vasc Anesth 2021; 36:510-517. [PMID: 34419362 DOI: 10.1053/j.jvca.2021.07.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 07/18/2021] [Accepted: 07/23/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The aim of the present study was to compare the short-term outcomes between spontaneous ventilation video-assisted thoracic surgery (SV-VATS) and mechanical ventilation video-assisted thoracic surgery (MV-VATS) in the elderly. All patients included in the present study underwent lobectomy, segmentectomy, or wedge resection and lymph node dissection. DESIGN A retrospective cohor. SETTING The first affiliated hospital of Guangzhou Medical University, Guangzhou, China. PARTICIPANTS The present study included 799 elderly patients diagnosed with non-small-cell lung cancer undergoing SV-VATS or MV-VATS. After propensity score matching, 80 patients in the SV-VATS group and 80 patients in the MV-VATS group were analyzed. INTERVENTIONS Patients in the SV-VATS group received spontaneous-ventilation anesthesia, which was administered as follows: intravenous anesthesia + laryngeal mask airway + thoracic paravertebral block + visceral pleural surface anesthesia + thoracic vagus nerve block. Patients in the MV-VATS group received general endotracheal anesthesia. SV-VATS or MV-VATS was performed according to the preference of the patients. MEASUREMENTS AND MAIN RESULTS There were no significant differences in anesthesia time (226.3 ± 79.8 v 238.5 ± 66.2 min; p = 0.44), surgery time (166.2 ± 102.6 v 170.1 ± 83.4 min; p = 0.66), and number of dissected lymph nodes (5.3 ± 7.5 v 4.4 ± 7.4; p = 0.23) between the two groups. There were significant differences in intraoperative bleeding (61.5 ± 165.1 v 82.2 ± 116.9 mL; p < 0.001). After surgery, the two groups were statistically comparable in terms of hospitalization (17.6 ± 7.6 v 17.2 ± 6.9 days; p = 0.95) and incidence of complications (7.5% v 13.8%; p = 0.20), while there were significant differences in chest tube duration (6.1 ± 3.3 v 4.5 ± 1.2 days; p < 0.001). CONCLUSIONS SV-VATS is feasible and as safe as MV-VATS, and it could be considered as an alternative treatment for the elderly.
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Affiliation(s)
- Chuqiao Wang
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China; Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Donghong Wu
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China; Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Peilin Pang
- Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Han Kong
- Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Jieyi Zhao
- Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Xiaoying Chen
- Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Jingyi Ye
- Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Zhe Pan
- Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Wenhua Liang
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Jun Liu
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China.
| | - Jianxing He
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China.
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17
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De León LE, Rochefort MM, Bravo-Iñiguez CE, Fox SW, Tarascio JN, Cardin K, DuMontier C, Frain LN, Jaklitsch MT. Opportunities for quality improvement in the morbidity pattern of older adults undergoing pulmonary lobectomy for cancer. J Geriatr Oncol 2021; 12:416-421. [PMID: 32980269 PMCID: PMC8011279 DOI: 10.1016/j.jgo.2020.09.016] [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: 03/02/2020] [Revised: 06/01/2020] [Accepted: 09/16/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is limited information on the frequency of complications among older adults after oncological thoracic surgery in the modern era. We hypothesized that morbidity and mortality in older adults with lung cancer undergoing lobectomy is low and different than that of younger patients undergoing thoracic surgery. METHODS All patients undergoing lobectomy at a large volume academic center between May 2016 and May 2019 were included. Patients were prospectively monitored to grade postoperative morbidity by organ system, based on the Clavien-Dindo classification. Patients were divided into two groups: Group 1 included patients 65-91 years of age, and Group 2 included those <65 years. RESULTS Of 680 lobectomies in 673 patients, 414(61%) were older than 65 years of age (group 1). Median age at surgery was 68 years (20-91). Median hospital stay was 4 days (1-38) and longer in older adults. Older adults experienced higher rates of grade II and IV complications, mostly driven by an increased incidence of delirium, atrial fibrillation, prolonged air leak, respiratory failure and urinary retention. In this modern cohort, there was only 1 stroke (0.1%), and delirium was reduced to 7%. Patients undergoing minimally invasive (MI) surgery had a lower rate of Grade IV life-threatening complications. Older adults were more likely to be discharged to a rehabilitation facility, however this difference also disappeared with MI surgical procedures. CONCLUSIONS Current morbidity of older adults undergoing lobectomy for cancer is low and is different than that of younger patients. Thoracotomy may be associated with postoperative complications in these patients. Our findings suggest the need to consider MI approaches and broad-based, geriatric-focused perioperative management of older adults undergoing lobectomy.
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Affiliation(s)
- Luis E De León
- Division of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Matthew M Rochefort
- Division of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Carlos E Bravo-Iñiguez
- Division of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sam W Fox
- Division of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jeffrey N Tarascio
- Division of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kristin Cardin
- Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Clark DuMontier
- Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Laura N Frain
- Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael T Jaklitsch
- Division of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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18
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Kaseda K, Hishida T, Masai K, Asakura K, Hayashi Y, Asamura H. Clinicopathological and prognostic features of operable non-small cell lung cancer patients with diabetes mellitus. J Surg Oncol 2020; 123:332-341. [PMID: 33002203 DOI: 10.1002/jso.26243] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 09/17/2020] [Accepted: 09/19/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND The aim of this study was to investigate the clinicopathological and prognostic features of operable non-small cell lung cancer (NSCLC) patients with diabetes mellitus (DM). METHODS A total of 1231 surgically resected NSCLC patients were retrospectively reviewed. Clinicopathological characteristics were compared between patients with DM (DM group, n = 139) and those without DM (non-DM group, n = 1092). The clinical factors associated with postoperative complications and prognostic factors were identified. RESULTS The DM group had distinct clinicopathological features. No significant differences in histological invasiveness or stage were found. The presence and control status of DM were independent predictors of postoperative complications. No significant differences in recurrence-free survival or cancer-specific survival were observed; however, the DM group had worse overall survival (OS). The DM group had a higher number of deaths from other diseases than the non-DM group, and these patients had significantly higher postoperative hemoglobin A1c levels than patients with cancer-related death. CONCLUSION The presence and control status of preoperative DM are useful predictors of both postoperative complications and OS in operable NSCLC patients. Concomitant diabetes-related complications have a negative effect on long-term survival in diabetic NSCLC patients, and long-term glycemic control is important to prolong OS.
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Affiliation(s)
- Kaoru Kaseda
- Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Tomoyuki Hishida
- Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kyohei Masai
- Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Keisuke Asakura
- Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan
| | | | - Hisao Asamura
- Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan
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Effective Gold Nanoparticle-Antibody-Mediated Drug Delivery for Photodynamic Therapy of Lung Cancer Stem Cells. Int J Mol Sci 2020; 21:ijms21113742. [PMID: 32466428 PMCID: PMC7311980 DOI: 10.3390/ijms21113742] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/19/2020] [Accepted: 05/21/2020] [Indexed: 12/12/2022] Open
Abstract
Cancer stem cells (CSCs) are a leading contributor to lung cancer mortality rates. CSCs are responsible for tumor growth and recurrence through inhibition of drug-induced cell death, decreasing the effect of traditional cancer therapy and photodynamic therapy (PDT). PDT can be improved to successfully treat lung cancer by using gold nanoparticles (AuNPs), due to their size and shape, which have been shown to facilitate drug delivery and retention, along with the targeted antibody (Ab) mediated selection of CSCs. In this study, a nanobioconjugate (NBC) was constructed, using a photosensitizer (PS) (AlPcS4Cl), AuNPs and Abs. The NBC was characterized, using spectroscopy techniques. Photodynamic effects of the NBC on lung CSCs was evaluated, using biochemical assays 24 h post-irradiation, in order to establish its anticancer effect. Results showed successful conjugation of the nanocomposite. Localization of the NBC was seen to be in integral organelles involved in cell homeostasis. Biochemical responses of lung CSCs treated using AlPcS4Cl-AuNP and AlPcS4Cl-AuNP-Ab showed significant cell toxicity and cell death, compared to free AlPcS4Cl. The PDT effects were enhanced when using the NBC, showing significant lung CSC destruction to the point of eradication.
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20
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Shi ZG, Mi WD. Application of dexmedetomidine for lung injury in elderly patients undergoing one-lung ventilation. Arch Med Sci 2020; 19:1262-1269. [PMID: 37732030 PMCID: PMC10507749 DOI: 10.5114/aoms.2020.94944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 10/01/2019] [Indexed: 09/22/2023] Open
Abstract
Introduction This study aimed to evaluate the effects of dexmedetomidine (DEX) on lung injury, the oxygenation index and perioperative pulmonary complications in elderly patients who underwent thoracotomy with one-lung ventilation (OLV). Material and methods A total of 120 elderly patients with lung cancer were included in the present study. According to the random number table method, these patients were randomly divided into two groups: group D and group C. Patients in group D were intravenously pumped with 0.5 μg/kg/h of DEX before anesthesia. The infusion was completed within 15 min, and anesthesia was induced by venous injection. Patients in group C were pumped with equal volumes of normal saline. Results At T2 and T3, compared with group C, group D had a significant decrease in cardiac index, mean arterial pressure and central venous pressure (p < 0.05). At T2, T3 and T4, compared with group C, group D had a significant increase in pH and PaO2 (p < 0.05). At T2, T3 and T4, compared with group C, group D had a significant decrease in Qs/Qt (p < 0.05). At T6, compared with group C, group D had a significant decrease in the supernatant of bronchoalveolar lavage fluid of tumor necrosis factor-α and interleukin 6 (p < 0.05). At T5, compared with group C, group D had a significant decrease in Visual Analogue Scale score (p < 0.05), and a significant increase in Ramsay Sedation Scale score (p < 0.05), and the number of respiratory and cardiovascular events also decreased (p < 0.05). Conclusions In elderly patients, dexmedetomidine can reduce Qs/Qt and increase PaO2 during OLV in surgery. It can reduce lung injury. Moreover, DEX reduced respiratory and cardiovascular complications in the perioperative period.
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Affiliation(s)
- Zhi-Guo Shi
- Department of Anesthesiology, Beijing Chest Hospital, Capital Medical University, China
| | - Wei-Dong Mi
- Department of Anesthesiology, Chinese PLA General Hospital, China
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21
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Wang Y, Hu X, Su MC, Wang YW, Che GW. Postoperative Elevations of Neutrophil-to-lymphocyte and Platelet-to-lymphocyte Ratios Predict Postoperative Pulmonary Complications in Non-small Cell Lung Cancer Patients: A Retrospective Cohort Study. Curr Med Sci 2020; 40:339-347. [PMID: 32337695 DOI: 10.1007/s11596-020-2189-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 12/06/2019] [Indexed: 02/05/2023]
Abstract
The neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) are found to increase in patients who develop postoperative complications (PCs). The aim of the present study was to explore the association of the perioperative changes of NLR (ΔNLR) and PLR (ΔPLR) with PCs in non-small cell lung cancer (NSCLC). Clinical data of 509 patients, who were diagnosed with NSCLC and underwent thoracoscopic radical resection between January 1, 2014 and July 31, 2016 at the Department of Thoracic Surgery, West China Hospital, were reviewed. Patients were divided into PC and non-PC groups, and clinical characteristics including ΔNLR and ΔPLR were compared between them. The optimal cut-off values of ΔNLR and ΔPLR were determined by receiver operating characteristics (ROC) curves and patients were assigned to high ΔNLR/ΔPLR and low ΔNLR/ΔPLR groups in terms of the cut-off values. Clinicopathologic characteristics and the incidence of different PCs were compared between the dichotomized groups. Univariate and multivariate logistic regression analyses were performed to identify the independent risk factors for PCs. The results showed that the ΔNLR and ΔPLR in the PC group were signifcantly higher than those in the non-PC group (P<0.001 for both). The optimal cutoff values of ΔNLR and ΔPLR were 6.6 and 49, respectively. Patients with ΔNLR>6.6 or ΔPLR>49 were more likely to experience postoperative pulmonary complications (PPCs) (P<0.001 for both). Multivariate logistic regression analysis demonstrated that smoking [odds ratio (OR): 2.450, 95% confdence interval (95% CI): 1.084-5.535, P=0.031)], tumor size (OR: 1.225, 95% CI: 1.047-1.433, P=0.011), ΔNLR>6.6 (OR: 2.453, 95% CI: 1.224-4.914, P=0.011) and ΔPLR>49 (OR: 2.231, 95% CI: 1.182-4.212, P=0.013) were predictive of PPCs. In conclusion, the ΔNLR and ΔPLR may act as novel predictors for PPCs in NSCLC patients undergoing thoracoscopic radical lung resection, and patients with ΔNLR>6.6 or ΔPLR>49 should be treated more actively to prevent or reduce PPCs.
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Affiliation(s)
- Yan Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xu Hu
- West China School of Medicine, Sichuan University, Chengdu, 610041, China
| | - Meng-Chan Su
- West China School of Medicine, Sichuan University, Chengdu, 610041, China
| | - Yan-Wen Wang
- West China School of Medicine, Sichuan University, Chengdu, 610041, China
| | - Guo-Wei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China.
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Ozdemir Y, Topkan E, Mertsoylu H, Selek U. Low Prognostic Nutritional Index Predicts Poor Clinical Outcomes in Patients with Stage IIIB Non-small-cell Lung Carcinoma Undergoing Chemoradiotherapy. Cancer Manag Res 2020; 12:1959-1967. [PMID: 32214853 PMCID: PMC7083637 DOI: 10.2147/cmar.s248034] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 03/06/2020] [Indexed: 12/12/2022] Open
Abstract
Purpose To investigate the prognostic utility of the prognostic nutritional index (PNI) in stage IIIB non-small-cell lung carcinoma (NSCLC) patients undergoing concurrent chemoradiotherapy (CRT). Methods A total of 358 stage IIIB NSCLC patients who received a total dose of 60–66 Gy (2 Gy/fraction) radiotherapy and ≥1 cycle(s) of platinum-based chemotherapy were analyzed. The receiver operating curve analysis was utilized to identify the optimal PNI cut-off value demonstrating a significant connection with the overall survival (OS), locoregional progression-free survival (LRPFS), and progression-free survival (PFS). Results At a median follow-up time of 22.5 months (range: 2.4–123.5), 30.2% and 14% of the patients were still alive and free of disease progression, respectively.The median OS, LRPFS, and PFS were 25.2 [95% confidence interval (CI): 36.3–46.6 months], 15.4 (95% CI: 26.6–35.3 months), and 10.7 (95% CI: 36.8–69.9 months), individually, for the whole study accomplice. The ROC analysis revealed an optimum rounded cut-off that associated meaningfully with each of the OS [area under the curve (AUC): 84.1%; sensitivity: 75.9%;72.4% specificity], LRPFS (AUC: 92.4%; sensitivity: 87.9%; 85.1% specificity), and PFS (AUC: 80.1%; sensitivity: 73.7%; 71.6% specificity) at a value of 40.5. Comparative analyses revealed that the patients presenting with PNI≤40.5 had significantly inferior OS (16.8 vs 36.7; P<0.001), LRPFS (11.5 vs 19.5; P<0.001), and PFS (8.6 vs 13.6; P<0.001) outcomes compared to patients with PNI>40.5. In univariate analyses, lower T-stage (1–2 vs 3–4; P< 0.001), lower N-stage (N2 vs N3; P< 0.001), anemia status (absent vs present; P< 0.001), weight loss status (<5% vs ≥5%; P< 0.001), and PNI group (≤40.5 vs >40.5; P<0.001) were the factors found to be associated with OS, LRPFS and PFS results. The results of multivariate analysis exhibited that the PNI was independently associated with each of the OS (P<0.001), LRPFS (P<0.001), and PFS (P<0.001) outcomes. Conclusion The pretreatment PNI appears to be a robust novel prognostic factor that stratifies patients with stage IIIB NSCLC into two significantly distinct survival groups after CRT.
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Affiliation(s)
- Yurday Ozdemir
- Department of Radiation Oncology, Baskent University Medical Faculty, Adana, Turkey
| | - Erkan Topkan
- Department of Radiation Oncology, Baskent University Medical Faculty, Adana, Turkey
| | - Huseyin Mertsoylu
- Department of Medical Oncology, Baskent University Medical Faculty, Adana, Turkey
| | - Ugur Selek
- School of Medicine, Department of Radiation Oncology, Koc University, Istanbul, Turkey.,MD Anderson Cancer Center, Department of Radiation Oncology, The University of Texas, Houston, TX, USA
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Yang R, Du C, Xu J, Yao L, Zhang S, Wu Y. Excessive intravenous crystalloid infusion after video-assisted thoracoscopic surgery lobectomy is associated with postoperative pneumonia. J Cardiothorac Surg 2019; 14:209. [PMID: 31783886 PMCID: PMC6884861 DOI: 10.1186/s13019-019-1024-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 11/18/2019] [Indexed: 11/22/2022] Open
Abstract
Background Video-assisted thoracoscopic surgery has been widely used in thoracic surgery worldwide. Our goal was to identify the risk factors for postoperative pneumonia in patients undergoing video-assisted thoracoscopic surgery lobectomy. Methods A retrospective analysis of adult patients undergoing video-assisted thoracoscopic surgery lobectomy between 2016 and 05 and 2017–04 was performed. We used univariate analyses and multivariate analyses to examine risk factors for postoperative pneumonia after lobectomy. Results The incidence of postoperative pneumonia was 19.7% (n = 143/727). Patients with postoperative pneumonia had a higher postoperative length of stay and total hospital care costs when compared to those without postoperative pneumonia. Multivariate analysis showed that body mass index grading ≥24.0 kg/m2 (vs. <24.0 kg/m2: odds ratio 1.904, 95% confidence interval 1.294–2.802, P = 0.001) and right lung lobe surgery (vs. left lung lobe surgery: odds ratio 1.836, 95% confidence interval 1.216–2.771, P = 0.004) were independent risk factors of postoperative pneumonia. Total intravenous crystalloid infusion grading in the postoperative 24 h ≥ 1500 mL was also identified as the risk factors (vs. 1000 to < 1500 mL: odds ratio 2.060, 95% confidence interval 1.302–3.260, P = 0.002). Conclusions Major risk factors for postoperative pneumonia following video-assisted thoracoscopic surgery lobectomy are body mass index grading ≥24.0 kg/m2, right lung lobe surgery and total intravenous crystalloid infusion grading in the postoperative 24 h ≥ 1500 mL.
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Affiliation(s)
- Rong Yang
- Department of Radiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang Province, China
| | - Chengli Du
- Department of Thoracic Surgery, the First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, China
| | - Jinming Xu
- Department of Thoracic Surgery, the First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, China
| | - Linpeng Yao
- Department of Radiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang Province, China
| | - Siying Zhang
- Department of Radiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang Province, China
| | - Yihe Wu
- Department of Thoracic Surgery, the First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, China. .,Department of Thoracic Surgery, the First Division Hospital of Xinjiang Corps, Aksu City, 843000, Xinjiang Autonomous Region, China.
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Iwata E, Hasegawa T, Yamada SI, Kawashita Y, Yoshimatsu M, Mizutani T, Nakahara H, Mori K, Shibuya Y, Kurita H, Komori T. Effects of perioperative oral care on prevention of postoperative pneumonia after lung resection: Multicenter retrospective study with propensity score matching analysis. Surgery 2019; 165:1003-1007. [DOI: 10.1016/j.surg.2018.11.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 11/12/2018] [Accepted: 11/16/2018] [Indexed: 11/26/2022]
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Impact of enhanced recovery after surgery on outcomes of elderly patients undergoing open thoracic surgery. Gen Thorac Cardiovasc Surg 2019; 67:867-875. [PMID: 30929139 DOI: 10.1007/s11748-019-01099-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 02/26/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE An enhanced recovery after surgery (ERAS) program might be effective for postoperative recovery in elderly patients undergoing thoracic surgery. This study aimed to clarify the impact of ERAS on the post-operative recovery of elderly patients, with regard to shortening hospital stay and reducing complications after open thoracic surgery. METHODS We used a prospectively collected database and retrospectively accessed the data of patients who underwent lobectomies or segmentectomies for pulmonary malignancies from April 2013 to March 2018 and evaluated outcomes after implementation of ERAS. ERAS patients were those who completed an ERAS program. The control patients were those who underwent surgery before June 2015 and later operated patients who did not receive ERAS. Propensity score matching was performed to balance the characteristics of patients in both groups. Patients were also divided into the following three groups for evaluating the efficacy of ERAS: patients aged < 65 years, 65-74 years of age, and ≥ 75 years of age. RESULTS Before propensity score matching, the ERAS patients had shorter postoperative stay, shorter duration of chest tube drainage, and lower rate of postoperative complications than the patients without ERAS. The difference between readmission rates was not significant. After matching, the ERAS patients had shorter postoperative stay. The difference between readmission rates was not significant. After matching, the postoperative hospital stay was shorter in the patients aged ≥ 65 years. CONCLUSIONS ERAS shortened the length of postoperative hospital stay in patients aged ≥ 65 years and did not increase readmission rates.
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Tantraworasin A, Siwachat S, Tanatip N, Lertprasertsuke N, Kongkarnka S, Euathrongchit J, Wannasopha Y, Suksombooncharoen T, Chewaskulyong B, Taioli E, Saeteng S. Outcomes of pulmonary resection in non-small cell lung cancer patients older than 70 years old. Asian J Surg 2019; 43:154-165. [PMID: 30898491 DOI: 10.1016/j.asjsur.2019.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/23/2019] [Accepted: 03/05/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND An appropriate treatment of older lung cancer patients has become an important issue. The aim of this study is to evaluate the short and long-term surgical outcomes in lung cancer patients using 70 years as a cut-point, and to identify prognostic factors of cancer-specific mortality in patients older than 70 years. METHODS Medical records of non-small cell lung cancer (NSCLC) patients who underwent pulmonary resection at Chiang Mai University Hospital from January 2002 through December 2016 were retrospectively reviewed. Patients were divided into age less than 70 years (control group) and 70 years or more (study group). Primary outcomes were major post-operative complications and in-hospital death (POM); secondary outcome was long-term survival. Multivariable regression analysis was used. RESULTS This study included 583 patients, 167 for study group, and 416 for control group. There were no differences in POM, both at univariable and multivariable analyses, however, for long-term cancer-specific mortality, the study group was more likely to die (HRadj = 1.40, 95%CI = 1.03-1.89). Adverse prognostic factors for long-term mortality in study group were having universal coverage scheme (HRadj = 1.70, 95%CI = 1.03-2.79), the presence of intratumoral lymphatic invasion (HRadj = 2.83, 95%CI = 1.28-6.29), perineural invasion (HRadj = 2.80, 95%CI = 1.13-6.94), underwent lymph node sampling (HRadj = 2.23, 95%CI = 1.16-4.30) and higher stage of disease (HRadj = 2.02, 95%CI = 1.06-3.85 for stage III, HRadj = 3.40, 95%CI = 1.29-8.94 for stage IV). CONCLUSIONS In-hospital mortality and composite post-operative complications are acceptable in pulmonary resection for NSCLC patients older than 70 years. However, these patients had shorter long-term survival, especially who have some adverse prognostic factors. Further studies with larger sample size are warranted.
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Affiliation(s)
- Apichat Tantraworasin
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand; Clinical Epidemiology and Clinical Statistic Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | - Sophon Siwachat
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Clinical Epidemiology and Clinical Statistic Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Narumon Tanatip
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nirush Lertprasertsuke
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sarawut Kongkarnka
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Juntima Euathrongchit
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Yutthaphan Wannasopha
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Busayamas Chewaskulyong
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Emanuela Taioli
- Tisch Cancer Institute, Institute for Translational Epidemiology, Department of Population Health Science and Policy, Icahn Medical School at Mount Sinai, New York, NY, USA
| | - Somcharoen Saeteng
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Clinical Epidemiology and Clinical Statistic Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Shiono S. How can we reduce the incidence of postoperative mental disorders after thoracic surgery? J Thorac Dis 2019; 11:S207-S209. [PMID: 30997177 DOI: 10.21037/jtd.2019.02.22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Satoshi Shiono
- Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
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Jungraithmayr W. Lung cancer surgery in octogenarians revisited-risk factors and survival in a long lifespan population. J Thorac Dis 2019; 10:6423-6426. [PMID: 30746180 DOI: 10.21037/jtd.2018.12.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Kutluk AC, Akin H, Ceritoglu A, Kocaturk CI, Bilen S, Sonmezoglu Y, Karapinar K. Is the Outcome of Pulmonary Resections due to Non-Small Cell Lung Cancer in Octogenarian Patients Worse? Ann Thorac Cardiovasc Surg 2018; 25:95-101. [PMID: 30542000 PMCID: PMC6477457 DOI: 10.5761/atcs.oa.18-00206] [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: 11/16/2022] Open
Abstract
Purpose: Lung cancer is one of the major sources of mortality in the elderly. This study was undertaken to assess the early and long-term results of surgical resection in patients older than 70 years of age by comparing the results of patients aged 70–79 years (group 1) with patients older than 80 years of age (group 2). Methods: Data on patient age, gender, spirometry values, side, size, histology and stage of the tumor, surgical procedures, postoperative complications, Charlson comorbidity scores (CCS), and survival were collected. Results: After 1–2 propensity score matching group 1 (70–79 years) included 84 and group 2 (age over 80) 42 cases. The multivariate analysis showed that CCS was the only significant factor affecting the development of complications (p = 0.003). The overall median and 5-year survival of all patients were 55 months and 42.5%, respectively. Although the survival of the elderly group 2 was higher than the first group, the difference did not reach significance (50 vs. 49 months, respectively). Conclusion: The outcomes of surgery in terms of morbidity and mortality rates do not differ between the two age groups. The safety of pulmonary resections in the elderly group is comparable to patients under 70 years if the comorbidities are appropriately controlled. In addition, surgery provides satisfactory survival rates in both age groups.
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Affiliation(s)
- Ali Cevat Kutluk
- Department of Chest Surgery, Yedikule Chest Diseases and Surgery Training and Research Hospital, Istanbul, Turkey
| | - Hasan Akin
- Department of Chest Surgery, Yedikule Chest Diseases and Surgery Training and Research Hospital, Istanbul, Turkey
| | - Altan Ceritoglu
- Department of Chest Surgery, Yedikule Chest Diseases and Surgery Training and Research Hospital, Istanbul, Turkey
| | - Celalettin Ibrahim Kocaturk
- Department of Chest Surgery, Yedikule Chest Diseases and Surgery Training and Research Hospital, Istanbul, Turkey
| | - Salih Bilen
- Department of Chest Surgery, Yedikule Chest Diseases and Surgery Training and Research Hospital, Istanbul, Turkey
| | - Yasar Sonmezoglu
- Department of Chest Surgery, Yedikule Chest Diseases and Surgery Training and Research Hospital, Istanbul, Turkey
| | - Kemal Karapinar
- Department of Chest Surgery, Yedikule Chest Diseases and Surgery Training and Research Hospital, Istanbul, Turkey
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30
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Wang S, Sigua NL, Manchanda S, Gradney S, Khan SH, Perkins A, Kesler K, Khan B. Preoperative STOP-BANG Scores and Postoperative Delirium and Coma in Thoracic Surgery Patients. Ann Thorac Surg 2018; 106:966-972. [PMID: 30244705 DOI: 10.1016/j.athoracsur.2018.05.089] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 04/30/2018] [Accepted: 05/30/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is associated with higher rates of postoperative delirium. The relationship between preoperative OSA risk and postoperative delirium and coma in thoracic surgery patients hospitalized in the intensive care unit (ICU) is not well understood. This study tests the hypothesis that thoracic surgery patients hospitalized in ICU with a higher preoperative risk for OSA are more likely to develop postoperative delirium and coma, resulting in longer hospital stays. METHODS Preoperative OSA risk was measured using the STOP-BANG questionnaire. STOP-BANG scores of greater than or equal to 3 were defined as intermediate-high risk for OSA; 128 patients who underwent major thoracic surgery completed the STOP-BANG questionnaire preoperatively. The Richmond Agitation and Sedation Scale was used to assess level of consciousness. The Confusion Assessment Method for the ICU was used to assess for delirium. Linear regression was used to assess the relationship between risk of OSA and outcome measures. Results were adjusted for age, sex, body mass index, Charlson Comorbidity Index, instrumental activities of daily living, and surgery type. RESULTS A total of 96 of 128 patients (76%) were in the intermediate-high-risk OSA group. Adjusted analyses showed that the intermediate-high-risk OSA group had a longer duration of postoperative ICU delirium and coma compared with the low-risk OSA group (1.4 ± 1.3 days versus 0.9 ± 1.4 days; P = 0.04). Total number of hospital days was not significantly different. CONCLUSIONS Higher preoperative risk for OSA in thoracic surgery patients was associated with a longer duration of postoperative delirium and coma.
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Affiliation(s)
- Sophia Wang
- Department of Psychiatry, Indiana University School of Medicine, Indiana University Health Neuroscience Center, Indianapolis, Indiana; Sandra Eskenazi Center for Brain Care Innovation, Eskenazi Hospital, Indianapolis, Indiana.
| | - Ninotchka Liban Sigua
- Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Shalini Manchanda
- Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Steve Gradney
- Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Sikandar H Khan
- Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Indiana University Center for Aging Research, Regenstrief Institute, Indianapolis, Indiana
| | - Anthony Perkins
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Kenneth Kesler
- Department of Cardiothoracic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Babar Khan
- Sandra Eskenazi Center for Brain Care Innovation, Eskenazi Hospital, Indianapolis, Indiana; Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Indiana University Center for Aging Research, Regenstrief Institute, Indianapolis, Indiana
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Lai Y, Wang X, Li P, Li J, Zhou K, Che G. Preoperative peak expiratory flow (PEF) for predicting postoperative pulmonary complications after lung cancer lobectomy: a prospective study with 725 cases. J Thorac Dis 2018; 10:4293-4301. [PMID: 30174876 DOI: 10.21037/jtd.2018.07.02] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background The study aimed to investigate the correlation between peak expiratory flow (PEF) and postoperative pulmonary complications (PPCs) for lung cancer patients undergoing lobectomy. Methods Patients who were diagnosed with resected non-small cell lung cancer (NSCLC) (n=725) were prospectively analyzed and the relationship between the preoperative PEF and PPCs was evaluated based on patients' basic characteristics and clinical data in hospital. Results Among the 725 included patients, 144 of them were presented PPCs in 30 days after lobectomy, which were divided into PPCs group. PEF value (294.2±85.1 vs. 344.7±89.6 L/min; P<0.001) were found lower in PPCs group, compared with non-PPCs group; PEF (OR, 0.984, 95% CI: 0.980-0.987, P<0.001) was a significant independent predictor for the occurrence of PPCs; based on an receiver operating characteristic (ROC) curve, with the consideration of balancing the sensitivity and specificity, a cutoff value of 300 (L/min) (Youden index: 0.484, sensitivity: 69.4%, specificity: 79.0%) was selected and a PEF ≤300 L/min indicated a 8-fold increase in odds of having PPCs after lung surgery (OR, 8.551, 95% CI: 5.692-12.845, P<0.001). With regard to PPCs rate, patients with PEF value ≤300 L/min had high PPCs rate than those with PEF >300 L/min (45.0%, 100/222 vs. 8.7%, 44/503, P<0.001); Meanwhile, pneumonia (24.8%, 55/222 vs. 6.4%, 32/503, P<0.001), atelectasis (9.5%, 21/222 vs. 4.0%, 20/503, P=0.003) and mechanical ventilation >48 h (5.4%, 12/222 vs. 2.4%, 12/503, P=0.036) were higher in the group with PEF value ≤300 L/min. Conclusions The presented study revealed a significant correlation between a low PEF value and PPCs in surgical lung cancer patients receiving lobectomy, indicating the potential of a low PEF as an independent risk factor for the occurrence of PPCs and a PPC-guided (PEF value ≤300 L/min) risk assessment could be meaningful for the perioperative management of lung cancer candidates waiting for surgery.
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Affiliation(s)
- Yutian Lai
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xin Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Pengfei Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jue Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Kun Zhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
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Cheng H, Clymer JW, Po-Han Chen B, Sadeghirad B, Ferko NC, Cameron CG, Hinoul P. Prolonged operative duration is associated with complications: a systematic review and meta-analysis. J Surg Res 2018; 229:134-144. [PMID: 29936980 DOI: 10.1016/j.jss.2018.03.022] [Citation(s) in RCA: 383] [Impact Index Per Article: 63.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 02/27/2018] [Accepted: 03/14/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND The aim of this study was to systematically synthesize the large volume of literature reporting on the association between operative duration and complications across various surgical specialties and procedure types. METHODS An electronic search of PubMed, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews from January 2005 to January 2015 was conducted. Sixty-six observational studies met the inclusion criteria. RESULTS Pooled analyses showed that the likelihood of complications increased significantly with prolonged operative duration, approximately doubling with operative time thresholds exceeding 2 or more hours. Meta-analyses also demonstrated a 14% increase in the likelihood of complications for every 30 min of additional operating time. CONCLUSIONS Prolonged operative time is associated with an increase in the risk of complications. Given the adverse consequences of complications, decreased operative times should be a universal goal for surgeons, hospitals, and policy-makers. Future study is recommended on the evaluation of interventions targeted to reducing operating time.
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Scarci M, Crisci R, Minervini F. Lung surgery in elderly patients: are we doing enough? J Thorac Dis 2018; 10:693-694. [PMID: 29608186 DOI: 10.21037/jtd.2018.01.132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Marco Scarci
- Department of Thoracic Surgery, University College London Hospital, London, UK
| | - Roberto Crisci
- Department of Thoracic Surgery, University of L'Aquila, G. Mazzini Hospital, Teramo, Italy
| | - Fabrizio Minervini
- Department of Thoracic Surgery, McMaster University, Hamilton, Ontario, Canada
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Okada S, Shimada J, Teramukai S, Kato D, Tsunezuka H, Miyata N, Ishihara S, Furuya T, Nakazono C, Ishikawa N, Inoue M. Risk Stratification According to the Prognostic Nutritional Index for Predicting Postoperative Complications After Lung Cancer Surgery. Ann Surg Oncol 2018; 25:1254-1261. [DOI: 10.1245/s10434-018-6368-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Indexed: 12/30/2022]
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Zhou K, Su J, Lai Y, Li P, Li S, Che G. Short-term inpatient-based high-intensive pulmonary rehabilitation for lung cancer patients: is it feasible and effective? J Thorac Dis 2017; 9:4486-4493. [PMID: 29268518 DOI: 10.21037/jtd.2017.10.105] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background This study was conducted to develop a preoperative in-hospital short-term rehabilitation program for surgical lung cancer patients, and investigate its feasibility, potential cost benefit and effectiveness on outcome measures including reduction of postoperative pulmonary complications (PPCs) and postoperative length of stay. Methods A 7-day inpatient-based high-intensive rehabilitation regimen was performed between March 01, 2014 and June 30, 2015. It was combined with inspiratory muscles training (IMT) and aerobic endurance training and was tested in an enriched cohort study with 939 lung cancer patients undergoing lobectomy in a regional thoracic unit. Results Finally, 939 patients were divided into pulmonary rehabilitation (PR) group (n=197) and non-PR (NPR) group (n=742), according to whether they received the 7-day preoperative in-hospital systematic rehabilitation. The PR group had a shorter total length of stay (14.7±4.0 vs. 16.7±6.2 days, P<0.001) as well as postoperative length of stay (6.2±3.3 vs. 8.3±5.6 days, P<0.001) than the NPR group. Lower incidences of total PPCs (18.3%, 36/197 vs. 26.1%, 194/742, P=0.022), pneumonia (11.2%, 22/197 vs. 17.3%, 128/742, P=0.024) and atelectasis (6.6%, 13/197 vs. 12.3%, 91/742, P=0.038) were found in the PR group compared with NPR group. Meanwhile, a multivariable analysis of risk to PPCs, atelectasis and pneumonia, revealed that the PR intervention was the independent risk factor of the occurrence of the PPCs (OR =0.57, 95% CI: 0.47 to 0.93, P=0.033) and atelectasis (OR =0.49, 95% CI: 0.26 to 0.91, P=0.024). Conclusions The study showed the effectiveness of this systematic and high-intensive PR combining IMT and aerobic exercise in reductions of the length of stay and occurrence of PPCs without increase in in-hospital cost, suggesting the potential of this rehabilitation pattern as a practicable strategy performed preoperatively in surgical lung cancer patients.
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Affiliation(s)
- Kun Zhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jianhua Su
- Rehabilitation Department, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yutian Lai
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Pengfei Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Shuangjiang Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
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Huang J, Lai Y, Zhou X, Li S, Su J, Yang M, Che G. Short-term high-intensity rehabilitation in radically treated lung cancer: a three-armed randomized controlled trial. J Thorac Dis 2017; 9:1919-1929. [PMID: 28839990 DOI: 10.21037/jtd.2017.06.15] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The feasibility and practicality of preoperative rehabilitation (PR) programs remains quite controversial in the treatment of lung cancer (LC). This study explored whether a short-term high-intensity rehabilitation program could improve postoperative outcomes compared to those achieved with conventional inspiratory muscle training (IMT). METHODS A three-armed randomized controlled trial comparing the two training modalities and routine care was conducted in surgical LC patients. Patient groups received one of three treatment regimens: (I) high-intensity pulmonary rehabilitation (PR) that combined IMT with conventional resistance training (CRT) (combined PR group); (II) conventional PR (single IMT group); or (III) routine preoperative preparation (control group). The primary endpoint was a change in the occurrence of post-operative pulmonary complications (PPCs) that occurred within 30 days after surgery, while secondary endpoints included changes in length of hospital stay, quality of life (QoL) scores, 6-min walk distance (6-MWD) and peak expiratory flow (PEF). RESULTS A total of 90 enrolled patients were randomized into three groups with a computer-based 1:1:1 ratio. The intention-to-treat analysis of the study revealed that, compared with the Control Group, the Combined PR Group had a significant increase in ∆6-MWD (by 32.67 m, P=0.002), ∆PEF (by 14.3 L/min, P=0.001), ∆global scores (by 3.7, P=0.035); and a reduced ∆average total hospital stay (by 3.2 d, P=0.001) and ∆postoperative stay (by 3.6 d, P=0.001). With regard to PPC rate, the Combined PR Group had a somewhat lower PPC severity (grade II-V) compared to the Control Group. CONCLUSIONS This hospital-based short-term program of PR combining high-intensity IMT with CRT was significantly superior to the conventional IMT program, indicating that this approach would be a feasible strategy for treating LC patients, especially those waiting operations with surgery-related risk factors.
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Affiliation(s)
- Jian Huang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yutian Lai
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xudong Zhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Shuangjiang Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jianhua Su
- Rehabilitation Department, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Mei Yang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
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Yoo A, Ghosh SK, Danker W, Kassis E, Kalsekar I. Burden of air leak complications in thoracic surgery estimated using a national hospital billing database. CLINICOECONOMICS AND OUTCOMES RESEARCH 2017; 9:373-383. [PMID: 28721079 PMCID: PMC5498775 DOI: 10.2147/ceor.s133830] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background One of the most common outcomes of lung resections are parenchymal air leaks. These air leaks are most often self-limited and spontaneously resolve several days after surgery. Historically, only prolonged air leaks have been considered to have a significant effect on patient outcomes. This study aims to evaluate the impact of any air leak complications (aALCs) on resource utilization and mortality. Methods The Premier Perspective® database was used to identify all elective primary lobectomy, segmentectomy, and wedge resections performed from 2012 to 2014; aALC was defined as a composite of air leak and pneumothorax. Generalized estimating equation models were used to estimate the impact of aALCs on length of stay (LOS), operating room time (ORT), hospital costs, and mortality during index hospitalization. Results A total of 21,150 patients undergoing lung resection surgery were included in the analysis: lobectomy (n=10,946), segmentectomy (n=1,788), and wedge resection (n=8,416). The overall incidence of aALCs was 24.26% (95% CI [23.68, 24.83]). Identified risk factors included resection type, surgical approach, male gender, and presence of COPD. Patients with aALCs had a significantly higher economic burden (adjusted mean [standard error of mean, SE]: LOS=7.24 [SE=0.12] days; ORT=214.9 [SE=6.4] min; and hospital costs=$26,070 [SE=$1404]) compared to those without aALCs (adjusted mean [SE]: LOS=4.75 [SE=0.07] days; ORT=201.7 [SE=3.9] min; and hospital costs=$19,558 [SE=$399]). aALC was also associated with increased overall index hospitalization mortality (odds ratio=1.90, 95% CI [1.42, 2.55]). Conclusion This analysis showed that aALCs are not only frequent but also associated with significantly higher resource utilization and mortality.
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Affiliation(s)
- Andrew Yoo
- Medical Devices - Epidemiology, Johnson and Johnson, New Brunswick
| | - Sudip K Ghosh
- Global Health Economics and Market Access, Ethicon Inc., Somerville, NJ
| | - Walter Danker
- Global Health Economics and Market Access, Ethicon Inc., Somerville, NJ
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Li Y, Ma YL, Gao YY, Wang DD, Chen Q. Analysis of the risk factors of postoperative cardiopulmonary complications and ability to predicate the risk in patients after lung cancer surgery. J Thorac Dis 2017; 9:1565-1573. [PMID: 28740670 DOI: 10.21037/jtd.2017.05.42] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Postoperative cardiopulmonary complications might be fatal for patients with lung cancer after surgery. The aim of this study was to identify the risk factors of postoperative cardiopulmonary complications in lung cancer patients and get a fitting formula for predicting incidences of cardiopulmonary complications. METHODS We conducted a retrospective analysis of 653 patients with a diagnosis of lung cancer who underwent a surgery in the Tianjin Medical University Cancer Institute and Hospital (Tianjin, China) from January to December 2014. All patients received lung cancer surgeries. Clinical data was collected for the analysis of the influence factors of cardiopulmonary complication after lung cancer surgeries. The medical statistical analysis program R was used to calculate cardiopulmonary complication probability of classification of quantitative results. RESULTS Our work showed that ages, lymphocyte count, smoking history, chronic bronchitis history, operation mode and extubation time were significantly associated with lung infection both in univariate and multivariate survival analysis. And ages, smoking history, arrhythmia of electrocardiogram and operation mode were significantly associated with postoperative arrhythmia both in univariate and multivariate survival analysis. Multiple linear regressions were generated with risk factors by program R software. Finally, we got a fitting formula for predicting cardiopulmonary complications. Risk score for each patient could be obtained by this formula. CONCLUSIONS The incidences of pulmonary infection and arrhythmia were high for patients who underwent lung cancer surgery. It is important to discriminate risk factors for each patient for reducing the risk of heart and lung complications. Preoperative quantitative evaluation of cardiopulmonary complication after operation is beneficial to the risk control.
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Affiliation(s)
- Yue Li
- Department of Cardiopulmonary Function, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China.,Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Yin-Lu Ma
- Department of Cardiopulmonary Function, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China.,Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Yong-Yin Gao
- Department of Cardiopulmonary Function, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China.,Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Dan-Dan Wang
- Department of Cardiopulmonary Function, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China.,Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Qing Chen
- Department of Cardiopulmonary Function, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China.,Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
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Jeong SS, Choi PJ, Yi JH, Yoon SS. Impact of Lifestyle Diseases on Postoperative Complications and Survival in Elderly Patients with Stage I Non-Small Cell Lung Cancer. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2017; 50:86-93. [PMID: 28382266 PMCID: PMC5380200 DOI: 10.5090/kjtcs.2017.50.2.86] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 12/15/2016] [Accepted: 12/21/2016] [Indexed: 12/04/2022]
Abstract
Background The influence of lifestyle diseases on postoperative complications and long-term survival in patients with non-small cell lung cancer (NSCLC) is unclear. The aim of this study was to determine whether lifestyle diseases were significant risk factors of perioperative and long-term surgical outcomes in elderly patients with stage I NSCLC. Methods Between December 1995 and November 2013, 110 patients aged 65 years or older who underwent surgical resection of stage I NSCLC at Dong-A University Hospital were retrospectively studied. We assessed the presence of the following lifestyle diseases as risk factors for postoperative complications and long-term mortality: diabetes, hypertension, chronic obstructive pulmonary disease, stroke, and ischemic heart disease. Results The mean age of the patients was 71 years (range, 65 to 82 years). Forty-six patients (41.8%) had hypertension, making it the most common lifestyle disease, followed by diabetes (n=23, 20.9%). The in-hospital mortality rate was 0.9% (n=1). The 3-year and 5-year survival rates were 78% and 64%, respectively. Postoperative complications developed in 32 patients (29.1%), including 7 (6.4%) with prolonged air leakage, 6 (5.5%) with atrial fibrillation, 5 (4.5%) with delirium and atelectasis, and 3 (2.7%) with acute kidney injury and pneumonia. Univariate and multivariate analyses showed that the presence of a lifestyle disease was the only independent risk factor for postoperative complications. In survival analysis, univariate analysis showed that age, smoking, body mass index, extent of resection, and pathologic stage were associated with impaired survival. Multivariate analysis revealed that resection type (hazard ratio [HR], 2.20; 95% confidence interval [CI], 1.08 to 4.49; p=0.030) and pathologic stage (HR, 1.89; 95% CI, 1.02 to 3.49; p=0.043) had independent adverse impacts on survival. Conclusion This study demonstrated that the presence of a lifestyle disease was a significant prognostic factor for postoperative complications, but not of survival, in elderly patients with stage I NSCLC. Therefore, postoperative complications may be influenced by the presence of a lifestyle disease.
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Affiliation(s)
- Sang Seok Jeong
- Department of Thoracic and Cardiovascular Surgery, Dong-A University College of Medicine
| | - Pil Jo Choi
- Department of Thoracic and Cardiovascular Surgery, Dong-A University College of Medicine
| | - Jung Hoon Yi
- Department of Thoracic and Cardiovascular Surgery, Dong-A University College of Medicine
| | - Sung Sil Yoon
- Department of Thoracic and Cardiovascular Surgery, Dong-A University College of Medicine
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Huang J, Lai Y, Gao K, Wang Y, Du H, Su J, Che G, Zhou X. Surfactant Protein-D: A sensitive predictor for efficiency of preoperative pulmonary rehabilitation. Int J Surg 2017; 41:136-142. [PMID: 28385654 DOI: 10.1016/j.ijsu.2017.03.084] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 03/20/2017] [Accepted: 03/31/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Surfactant Protein D (SP-D) as a lung-derived biomarker for inflammatory lung disease is being studied in depth. Meanwhile, the Pre-operative Rehabilitation Program (PRP) has been proposed as an effective treatment to reduce the incidence of Post-operative Pulmonary Complications (PPCs) and further improve quality of life. However, the relationship between serum SP-D levels and PRP remains unclear. This study aimed to explore the correlation between these two phenomena and validate the feasibility of using preoperative serum SP-D levels to predict or assess the effectiveness of PRP. METHODS A prospective study with a total of 80 lung cancer patients with risk factors for PPCs was conducted; subjects were randomly divided into an Intervention Group (IG, n = 36) and a Control Group (CG, n = 44). The IG was treated with one week of PRP, and the CG was treated for the same duration with routine preoperative preparation before the lobectomy. Peripheral venous blood samples were collected at five time points and serum SP-D levels were measured by enzyme-linked immunosorbent assay (ELISA). We analysed the serum level changes of SP-D as well as the PPCs occurred between the two groups. RESULTS Both groups were comparable at baseline. The average levels of SP-D in both groups showed a decline trend with time, and levels before the day of surgery revealed a significant decline range in the IG compared with the CG (6.56 ± 5.30 vs. 1.05 ± 2.79 ng/ml, P < 0.001). The incidence of PPCs in the IG was significantly lower than in the CG (2/36 vs. 10/44, p = 0.032), as were the PPC person-times occurring from postoperative days 1-4 (POD 1-4) (5/36 vs. 15/44, p = 0.038) and the total person-times (5/36 vs. 19/44, p = 0.004). The overall SP-D levels on the day before surgery in patients with PPCs were significantly higher than those without PPCs (34.07 ± 4.32 vs. 30.30 ± 6.52 ng/ml, p = 0.005); furthermore, the overall SP-D levels on admission day in CG patients with PPCs were also significantly higher than those without PPCs (34.93 ± 4.15 vs. 29.81 ± 7.47 ng/ml, p = 0.045). CONCLUSIONS The Preoperative Intensity Rehabilitation Program could positively decrease the serum SP-D levels in lung cancer patients with PPC risk factors, and higher preoperative serum SP-D levels may related to a higher incidence of PPCs. Serum SP-D may be a potential predictor for evaluating the efficiency of PRPs and the risk of PPC occurrence.
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Affiliation(s)
- Jian Huang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, PR China; Department of Thoracic Surgery, Wuxi People's Hospital, Nanjing Medical University, Wuxi, 214000, PR China
| | - Yutian Lai
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, PR China
| | - Ke Gao
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, PR China
| | - Yifan Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, PR China
| | - Heng Du
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, PR China
| | - Jianhua Su
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, PR China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, PR China.
| | - Xudong Zhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, PR China
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Tutic-Horn M, Gambazzi F, Rocco G, Mosimann M, Schneiter D, Opitz I, Martucci N, Hillinger S, Weder W, Jungraithmayr W. Curative resection for lung cancer in octogenarians is justified. J Thorac Dis 2017; 9:296-302. [PMID: 28275477 DOI: 10.21037/jtd.2017.02.22] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Due to an increased life expectancy in a healthy aging population and a progressive incidence of lung cancer, curative pulmonary resections can be performed even in octogenarians. The present study aims to investigate whether surgery is justified in patients reaching the age of 80 years and older who undergo resection for non-small cell lung cancer (NSCLC). METHODS In this retrospective multi-centre analysis, the morbidity, mortality and long-term survival of 88 patients (24 females) aged ≥80 who underwent complete resection for lung cancer between 2000 and 2013 were analysed. Only fit patients with few comorbidities, low cardiopulmonary risk, good quality of life and a life expectancy of at least 5 years were included. RESULTS Curative resections from three thoracic surgery centres included 61 lobectomies, 9 bilobectomies, 6 pneumonectomies and 12 segmentectomies or wide wedge resections with additional systematic mediastinal lymphadenectomy in all cases. Final histology revealed squamous cell carcinoma [33], adenocarcinoma [41], large cell carcinoma [5] or other histological types [9]. Lung cancer stage distribution was 0 [1], I [53], II [17] and IIIA [14]. The overall 90-day mortality was 1.1%. The median hospitalisation and chest drainage times were 10 days (range, 5-27 days) and 5 days (range, 0-17 days), respectively. Thirty-six patients were complication-free (41%). In particular, pulmonary complications occurred in 25 patients (28%). In addition, 23 patients (26%) developed cardiovascular complications requiring medical intervention, while 24 patients (27%) had cerebrovascular complications, urinary tract infection and others. The median survival time was 51 months (range, 1-110 months), and the 5-year overall survival reached 45% without significance between tumour stages. CONCLUSIONS Curative lung resections in selected octogenarians can be safely performed up to pneumonectomy for all tumour stages with a perioperative mortality, morbidity, and 5-year survival rate comparable to younger cohorts.
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Affiliation(s)
- Michaela Tutic-Horn
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Franco Gambazzi
- Division of Thoracic Surgery, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Gaetano Rocco
- Division of Thoracic Surgery, University Hospital Naples, Naples, Italy
| | - Monique Mosimann
- Division of Thoracic Surgery, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Didier Schneiter
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Nono Martucci
- Division of Thoracic Surgery, University Hospital Naples, Naples, Italy
| | - Sven Hillinger
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Walter Weder
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Wolfgang Jungraithmayr
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland;; Department of Thoracic Surgery, Medical University Brandenburg, Germany
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Abstract
Thoracic surgery represents a special challenge for anesthesia and requires a high level of human and material resources. Accurate knowledge of the pathophysiology is essential for selection of the anesthetic procedure, the separation of the lungs, monitoring and treatment of hemodynamics as well as for postoperative follow-up care. The increasing number of thoracic interventions and patients who are often suffering from complex diseases require close interdisciplinary cooperation between surgeons, anesthesiologists and intensive care specialists. In addition to the anesthetic techniques particular attention must be paid to the prevention of perioperative complications that can have a relevant effect on patient outcome. In particular hypoxemia during one-lung ventilation influences postoperative morbidity and mortality. Protective pulmonary ventilation strategies play an important role in prevention of postoperative acute lung injury.
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Affiliation(s)
- T Kammerer
- Klinik für Anaesthesiologie, Klinikum Großhadern, Ludwig-Maximilians-Universität, Marchioninistr.15, 81377, München, Deutschland.
| | - E Speck
- Klinik für Anaesthesiologie, Klinikum Großhadern, Ludwig-Maximilians-Universität, Marchioninistr.15, 81377, München, Deutschland
| | - V von Dossow
- Klinik für Anaesthesiologie, Klinikum Großhadern, Ludwig-Maximilians-Universität, Marchioninistr.15, 81377, München, Deutschland
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Liu Y, Gao Y, Zhang H, Cheng Y, Chang R, Zhang W, Zhang C. Video-assisted versus conventional thoracotomy pneumonectomy: a comparison of perioperative outcomes and short-term measures of convalescence. J Thorac Dis 2016; 8:3537-3542. [PMID: 28149547 DOI: 10.21037/jtd.2016.12.24] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Pneumonectomy is a proven treatment for lung diseases. We sought to present a comparison between video-assisted thoracic surgery pneumonectomy (VATS-P) and conventional thoracotomy pneumonectomy (CP) on perioperative outcomes and short-term measures of convalescence. METHODS A retrospective cohort study was performed to assess perioperative outcomes among patients underwent VATS-P and CP. A total of 32 patients undergoing VATS-P were matched 2:1 about comorbidity, surgical indication, tumour size and lesion location to a previous cohort of 64 patients who underwent CP. Demographic and perioperative data were obtained. Statistical analysis was performed. RESULTS Mean patient age was 55.4 years for both groups, with equal sex distribution. Pneumonectomy for malignant and benign lesion patients was evaluated individually. For malignant tumour patients, median tumour size was 3.9 cm for both groups. There was no difference between VATS-P and CP cases in transfusion rates (2% vs. 10%, P=0.50), dissected lymph node numbers (11.9 vs. 14.2, P=0.26), dissected lymph node stations (5.0 vs. 4.9, P=0.75), estimated blood loss (226.0 vs. 261.3 mL, P=0.40), complication rate (20.0% vs. 22.5%, P=0.82), postoperative drainage time (5.9 vs. 6.2, P=0.50) or length of hospital stay (7.5 vs. 8.1, P=0.50). Operation time in VATS-P was higher than conventional groups (187.5 vs. 146.3 min, P=0.00) but the mean pain score was significantly less. For benign patients, over 1,000 mL blood losing (1,033.3 vs. 1,233.3 mL, P=0.78) and 180 minutes (186.6 vs. 105.8, P=0.73) OR time was found in both groups. The Length of stay (7.6 vs. 6.3 d, P=0.57), transfusion rates (66.7% vs. 33.3%), complications rates (zero in both group) and length of drainage (6.7 vs. 6.7 d, P=1.0) between two groups are identical. CONCLUSIONS Complete video-assisted thoracic surgery (VATS) pneumonectomy is feasible and safe technique and can be recommended as a surgical treatment for lung cancer patients. However, long-term benefits need to be evaluated by further studies and large sample tests.
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Affiliation(s)
- Yuanqi Liu
- Department of Thoracic Surgery, Xiangya Hospital Central South University, Changsha 410000, China
| | - Yang Gao
- Department of Thoracic Surgery, Xiangya Hospital Central South University, Changsha 410000, China
| | - Huajun Zhang
- Department of Thoracic Surgery, Xiangya Hospital Central South University, Changsha 410000, China
| | - Yuanda Cheng
- Department of Thoracic Surgery, Xiangya Hospital Central South University, Changsha 410000, China
| | - Ruimin Chang
- Department of Thoracic Surgery, Xiangya Hospital Central South University, Changsha 410000, China
| | - Weixing Zhang
- Department of Thoracic Surgery, Xiangya Hospital Central South University, Changsha 410000, China
| | - Chunfang Zhang
- Department of Thoracic Surgery, Xiangya Hospital Central South University, Changsha 410000, China
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Simplified comorbidity score for elderly patients undergoing thoracoscopic surgery for lung cancer. Surg Today 2016; 47:718-725. [DOI: 10.1007/s00595-016-1427-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 09/06/2016] [Indexed: 10/20/2022]
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Seven-day intensive preoperative rehabilitation for elderly patients with lung cancer: a randomized controlled trial. J Surg Res 2016; 209:30-36. [PMID: 28032568 DOI: 10.1016/j.jss.2016.09.033] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 09/04/2016] [Accepted: 09/21/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND As a newly developed treatment, preoperative pulmonary rehabilitation (PR) has been studied in depth. However, few studies have assessed the relationship between advanced age and a shorter term intensive pattern of preoperative PR in patients with lung cancer (LC) and especially those patients waiting for therapeutic LC surgeries. This study investigated short-term preoperative PR combined with inspiratory muscle training (IMT) and aerobic endurance training in elderly patients scheduled to undergo LC lobectomy. METHODS A prospective randomized controlled trial with a total of 60 subjects aged ≥70 y was conducted. The intervention group (PR group) was treated for 1 wk with systematic and highly intensive preoperative PR training before lobectomy, and the control group (NPR group) was treated with conventional preoperative respiratory management. We analyzed the 6-min walking distance (6-MWD), the peak expiratory flow (PEF), and quality-of-life scores before and after the rehabilitation regimen as well as the incidence of postoperative pulmonary complications (PPCs). RESULTS In total, 30 patients (PR group) completely executed the 7-d intensive preoperative PR, and 30 patients (NPR group) served as the control group. The two groups were comparable at baseline. During the preoperative PR, a significantly longer 6-MWD (increase: 28.6 ± 18.2 versus 9.4 ± 27.0 m; between-groups difference: 19.2 m, P = 0.029) and an increased PEF (increase: 26.2 ± 22.5 versus 8.2 ± 10.3 L/min; between-groups difference: 18.0 L/min, P < 0.001) were noted in the PR group compared with the NPR group. After LC surgery, the mean postoperative length of stay (6.9 ± 4.4 versus 10.7 ± 6.4 d, P = 0.010) and total hospital stay (16.0 ± 4.5 versus 19.7 ± 6.5 d, P = 0.012) were significantly reduced in the PR group. Thirty-day PPCs were noted in four (13.3%) patients in the PR group and 11 (36.7%) patients in the NPR group, with a significant difference between the two groups (P = 0.037). CONCLUSIONS For elderly LC patients scheduled to undergo surgery in China, a 7-d intensive pattern of preoperative PR combined with IMT and aerobic endurance training may be a feasible rehabilitation strategy with positive physical and psychological effects.
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Miyata R, Omasa M, Fujimoto R, Ishikawa H, Aoki M. Efficacy of Ramelteon for delirium after lung cancer surgery. Interact Cardiovasc Thorac Surg 2016; 24:8-12. [DOI: 10.1093/icvts/ivw297] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 07/24/2016] [Accepted: 08/04/2016] [Indexed: 11/12/2022] Open
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Simonsen DF, Søgaard M, Bozi I, Horsburgh CR, Thomsen RW. Risk factors for postoperative pneumonia after lung cancer surgery and impact of pneumonia on survival. Respir Med 2015. [PMID: 26209227 DOI: 10.1016/j.rmed.2015.07.008] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Little is known about risk factors and prognosis for postoperative pneumonia (POP) in patients undergoing therapeutic lung cancer (LC) surgery. METHODS We followed a nationwide population-based cohort of 7479 patients with LC surgery in Denmark 1995-2011. We used logistic regression analysis to examine risk factors for POP within 30 days after surgery. Subsequent survival in patients with POP was analyzed with Cox regression. RESULTS We identified 268 (3.6%) patients with POP. Important risk factors included advanced age (age ≥80 years: (adjusted odds ratio [aOR] = 3.64; 95% CI: 2.17-6.12) as compared to patients aged 50-59 years), previous pneumonia (aOR = 2.68; 95% CI: 2.02-3.56), obesity (aOR = 1.91; 95% CI: 0.99-3.69), chronic pulmonary disease (aOR = 1.90; 95% CI: 1.40-2.57), alcoholism (aOR = 1.56; 95% CI: 0.81-3.01), and atrial fibrillation (aOR = 1.42; 95% CI: 0.82-2.45). Overall thoracoscopic surgery halved the risk of POP and the highest risk of POP was seen in pneumonectomy performed in open thoracotomy. Among patients surviving the 30-day postoperative period, 31-365 day mortality was 21.6% in POP patients vs. 16.8% in non-POP patients, and 1-5-year mortality was 62.2% vs. 53.0%. Adjusted 31-365 day hazard ratio (HR) of death with POP was 1.31 (95% CI: 1.00-1.73), and 1-5 year HR was 1.22 (95% CI 0.98-1.53). CONCLUSION Major risk factors for POP following LC surgery are advanced age, previous pneumonia, obesity, chronic pulmonary disease, alcoholism, and atrial fibrillation. POP is a clinical marker for decreased LC survival.
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Affiliation(s)
- Dennis F Simonsen
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
| | - Mette Søgaard
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Imre Bozi
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Charles R Horsburgh
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Reimar W Thomsen
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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48
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Wang Z, Cai XJ, Shi L, Li FY, Lin NM. Risk factors of postoperative nosocomial pneumonia in stage I-IIIa lung cancer patients. Asian Pac J Cancer Prev 2015; 15:3071-4. [PMID: 24815449 DOI: 10.7314/apjcp.2014.15.7.3071] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate the related risk factors of postoperative nosocomial pneumonia (POP) in patients with I-IIIa lung cancer. METHODS Medical records of 511 patients who underwent resection for lung cancer between January 2012 to December 2012 were retrospectively reviewed. Risk factors of postoperative pneumonia were identified and evaluated by univariate and multivariate analyses. RESULTS The incidence of postoperative pneumonia in these lung cancer patients was 2.9% (15 cases). Compared with 496 patients who had no pneumonia infection after operation, older age (>60), histopathological type of squamous cell carcinoma and longer surgery time (>3h) were significant risk factors by univariate analysis. Other potential risk factors such as alcohol consumption, history of smoking, hypersensitivity, hypertension, diabetes mellitus and so on were not showed such significance in this study. Further, the multivariate analysis revealed that old age (>60 years) (OR 5.813, p=0.018) and histopathological type of squamous cell carcinoma (OR 5.831, p<0.001) were also statistically significant independent risk factors for postoperative pneumonia. CONCLUSIONS This study demonstrated that being old aged (>60 years) and having squamous cell carcinoma histopathological type might be important factors in determining the risk of postoperative pneumonia in lung cancer patients after surgery.
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Affiliation(s)
- Zeng Wang
- Department of pharmacy, Zhejiang cancer hospital, Hangzhou, China E-mail :
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49
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Gao K, Yu PM, Su JH, He CQ, Liu LX, Zhou YB, Pu Q, Che GW. Cardiopulmonary exercise testing screening and pre-operative pulmonary rehabilitation reduce postoperative complications and improve fast-track recovery after lung cancer surgery: A study for 342 cases. Thorac Cancer 2014; 6:443-9. [PMID: 26273399 PMCID: PMC4511322 DOI: 10.1111/1759-7714.12199] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Accepted: 10/27/2014] [Indexed: 02/05/2023] Open
Abstract
Background An evaluation of cardiopulmonary exercise testing (CPET) screening and pre-operative pulmonary rehabilitation in reducing postoperative complications and improving fast-track recovery in high-risk patients who undergo resection for lung cancer. Methods Of 342 potential lung cancer cases, 142 high-risk patients were finally divided into two groups: group R (n = 71) underwent an intensive pre-operative pulmonary rehabilitation program (PRP), followed by lobectomy; group S (n = 71) underwent only lobectomy with conventional management. Postoperative complications, average days in hospital, postoperative days in hospital, and cost were analyzed. Results The 142 high-risk patients were screened by smoking history and CPET. Sixty-eight patients had bronchial hyperresponsiveness (BHR) and 47 patients had peak expiratory flow <250 L/minute by CPET. The rate of postoperative total complications in group R (16.90%) was significantly lower than in group S (83.31%) (P = 0.00), as was the rate of postoperative pulmonary complications PPC: group R (12.81%) versus S (13.55%) (P = 0.009); the PPC in the left lung (17.9%) was higher than in the right lung (2.3%) (P = 0.00). The average days in hospital in group S was significantly higher than in group R (P = 0.03). There was no difference between groups in average hospital cost (P = 0.304). Conclusion Pre-operative screening using CPET is conducive to identifying high-risk patients for lung resection. Pre-operative pulmonary rehabilitation is helpful to reduce postoperative complications and improve fast-track recovery.
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Affiliation(s)
- Ke Gao
- Department of Thoracic Surgery, West China Hospital, Sichuan University Chengdu, China ; Department of Thoracic Surgery, The No. 2 Hospital of Chengdu Chengdu, China
| | - Peng-Ming Yu
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University Chengdu, China
| | - Jian-Hua Su
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University Chengdu, China
| | - Cheng-Qi He
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University Chengdu, China
| | - Lun-Xu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University Chengdu, China
| | - Yu-Bin Zhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University Chengdu, China
| | - Qiang Pu
- Department of Thoracic Surgery, West China Hospital, Sichuan University Chengdu, China
| | - Guo-Wei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University Chengdu, China
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50
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Blanco R, Maestu I, de la Torre MG, Cassinello A, Nuñez I. A review of the management of elderly patients with non-small-cell lung cancer. Ann Oncol 2014; 26:451-63. [PMID: 25060421 DOI: 10.1093/annonc/mdu268] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Most patients with non-small-cell lung cancer (NSCLC) are elderly but evidence to guide appropriate treatment decisions for this age group is generally scant. Careful evaluation of the elderly should be undertaken to ensure that treatment appropriate for the stage of the tumour is guided by patient characteristics and not by age. The Comprehensive Geriatric Assessment (CGA) remains the preferred option, but briefer tools may be appropriate to select patients for further evaluation. The predicted outcome should be used to guide management decisions together with a reappraisal of polypharmacy. Patient expectations should also be taken into account. Management recommendations are generally similar to those of general guidelines for the NSCLC population, although the risks of surgery and toxicity of chemotherapy and radiotherapy are often increased in the elderly compared with younger patients; therefore, patients should be closely scrutinised and subjected to a CGA to ensure suitability of the planned treatment. If surgery is indicated, then lobectomy is generally the preferred option, although limited resection may be more feasible for some. Radiotherapy with curative intent is an alternative, with stereotactic body radiotherapy the most likely preferred modality. Adjuvant chemotherapy is also an appropriate approach, whereas adjuvant radiotherapy is generally not recommended. Concurrent chemoradiotherapy should be considered for elderly patients with inoperable locally advanced disease and chemotherapy for advanced/metastatic disease. Efforts should also be made to increase participation of elderly patients with NSCLC in clinical trials, thereby enhancing evidence-based treatment decisions for this majority group. This will require overcoming barriers relating to trial design and to physician and patient awareness and attitudes.
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Affiliation(s)
- R Blanco
- Oncology Service, Consorci Sanitari de Terrassa, Ctra. de Torrebonica sn, Terrassa
| | - I Maestu
- Department of Oncology, Hospital Universitario Dr Peset, Avenida de Gaspar Aguilar, Valencia and
| | | | - A Cassinello
- Medical Department, Lilly Spain, Alcobendas, Spain
| | - I Nuñez
- Medical Department, Lilly Spain, Alcobendas, Spain
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