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He Y, Xu X, Wang C, Wu Z. Prognostic value of the early lung ultrasound B-line score for postoperative pulmonary insufficiency in patients undergoing thoracic surgery: an observational study. Eur J Med Res 2023; 28:160. [PMID: 37138303 PMCID: PMC10155320 DOI: 10.1186/s40001-023-01117-3] [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: 03/23/2022] [Accepted: 04/10/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Postoperative pulmonary insufficiency (PPI) is an important contributor to morbidity and mortality after thoracic surgery. Lung ultrasound is a reliable tool for assessing respiratory function. We sought to determine the clinical value of the early lung ultrasound B-line score for predicting changes in pulmonary function after thoracic surgery. METHODS Eighty-nine patients undergoing elective lung surgery were included in this study. The B-line score was determined 30 min after removal of the endotracheal tube, and the PaO2/FiO2 ratio was recorded 30 min after extubation and on the third postoperative day. Patients were divided into normal (PaO2/FiO2 ≥ 300) and PPI (PaO2/FiO2 < 300) groups according to their PaO2/FiO2 ratios. A multivariate logistic regression model was used to identify independent predictors of postoperative pulmonary insufficiency. Receiver operating characteristic (ROC) analysis was performed for significantly correlated variables. RESULTS Eighty-nine patients undergoing elective lung surgery were included in this study. We evaluated 69 patients in the normal group and 20 in the PPI group. Patients conforming to NYHA class 3 at administration were significantly more represented in the PPI group (5.8 and 55%; p < 0.001). B-line scores were significantly higher in the PPI group than in the normal group (16; IQR 13-21 vs. 7; IQR 5-10; p < 0.001). The B-line score was an independent risk factor (OR = 1.349 95% CI 1.154-1.578; p < 0.001), and its best cutoff value for predicting PPI was 12 (sensitivity: 77.5%; specificity: 66.7%). CONCLUSIONS Lung ultrasound B-line scores 30 min after extubation are effective in predicting early PPI in patients undergoing thoracic surgery. Trial registration This study was registered with the Chinese Clinical Trials Registry (ChiCTR2000040374).
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Affiliation(s)
- Yipeng He
- Department of Anesthesiology, Nanjing Medical University Affiliated, Changzhou No. 2 People's Hospital, Changzhou, 213003, China
| | - Xiaoxiao Xu
- Graduate School of Dalian Medical University, Liaoning, 116044, China
| | - Chenhao Wang
- Graduate School of Dalian Medical University, Liaoning, 116044, China
| | - Zhouquan Wu
- Department of Anesthesiology, Nanjing Medical University Affiliated, Changzhou No. 2 People's Hospital, Changzhou, 213003, China.
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Risk Factors for Postoperative Pulmonary Complications Leading to Increased In-Hospital Mortality in Patients Undergoing Thoracotomy for Primary Lung Cancer Resection: A Multicentre Retrospective Cohort Study of the German Thorax Registry. J Clin Med 2022; 11:jcm11195774. [PMID: 36233649 PMCID: PMC9572507 DOI: 10.3390/jcm11195774] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/24/2022] [Accepted: 09/26/2022] [Indexed: 11/16/2022] Open
Abstract
Postoperative pulmonary complications (PPCs) represent the most frequent complications after lung surgery, and they increase postoperative mortality. This study investigated the incidence of PPCs, in-hospital mortality rate, and risk factors leading to PPCs in patients undergoing open thoracotomy lung resections (OTLRs) for primary lung cancer. The data from 1426 patients in this multicentre retrospective study were extracted from the German Thorax Registry and presented after univariate and multivariate statistical processing. A total of 472 patients showed at least one PPC. The presence of two PPCs was associated with a significantly increased mortality rate of 7% (p < 0.001) compared to that of patients without or with a single PPC. Three or more PPCs increased the mortality rate to 33% (p < 0.001). Multivariate stepwise logistic regression analysis revealed male gender (OR 1.4), age > 60 years (OR 1.8), and current or previous smoking (OR 1.6), while the pre-operative risk factors were still CRP levels > 3 mg/dl (OR 1.7) and FEV1 < 60% (OR 1.4). Procedural independent risk factors for PPCs were: duration of surgery exceeding 195 min (OR 1.6), the amount of intraoperative blood loss (OR 1.6), partial ligation of the pulmonary artery (OR 1.5), continuing invasive ventilation after surgery (OR 2.9), and infusion of intraoperative crystalloids exceeding 6 mL/kg/h (OR 1.9). The incidence of PPCs was significantly lower in patients with continuous epidural or paravertebral analgesia (OR 0.7). Optimising perioperative management by implementing continuous neuroaxial techniques and optimised fluid therapy may reduce the incidence of PPCs and associated mortality.
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Sesma J, Bolufer S, García-Valentín A, Embún R, López ÍJ, Moreno-Mata N, Jiménez U, Trancho FH, Martín-Ucar AE, Gallar J. Thoracoscopic segmentectomy versus lobectomy: A propensity score–matched analysis. JTCVS OPEN 2022; 9:268-278. [PMID: 36003470 PMCID: PMC9390783 DOI: 10.1016/j.xjon.2022.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 01/12/2022] [Indexed: 11/30/2022]
Abstract
Objectives The aim of this study is to compare the postoperative complications, perioperative course, and survival among patients from the multicentric Spanish Video-assisted Thoracic Surgery Group database who received video-assisted thoracic surgery lobectomy or video-assisted thoracic surgery anatomic segmentectomy. Methods From December 2016 to March 2018, a total of 2250 patients were collected from 33 centers. Overall analysis (video-assisted thoracic surgery lobectomy = 2070; video-assisted thoracic surgery anatomic segmentectomy = 180) and propensity score–matched adjusted analysis (video-assisted thoracic surgery lobectomy = 97; video-assisted thoracic surgery anatomic segmentectomy = 97) were performed to compare postoperative results. Kaplan–Meier and competing risks method were used to compare survival. Results In the overall analysis, video-assisted thoracic surgery anatomic segmentectomy showed a lower incidence of respiratory complications (relative risk, 0.56; confidence interval, 0.37-0.83; P = .002), lower postoperative prolonged air leak (relative risk, 0.42; 95% confidence interval, 0.23-0.78; P = .003), and shorter median postoperative stay (4.8 vs 6.2 days; P = .004) than video-assisted thoracic surgery lobectomy. After propensity score–matched analysis, prolonged air leak remained significantly lower in video-assisted thoracic surgery anatomic segmentectomy (relative risk, 0.33; 95% confidence interval, 0.12-0.89; P = .02). Kaplan–Meier and competing risk curves showed no differences during the 3-year follow-up (median follow-up in months: 24.4; interquartile range, 20.8-28.3) in terms of overall survival (hazard ratio, 0.73; 95% confidence interval, 0.45-1.7; P = .2), tumor progression–related mortality (subdistribution hazard ratio, 0.41; 95% confidence interval, 0.11-1.57; P = .2), and disease-free survival (subdistribution hazard ratio, 0.73; 95% confidence interval, 0.35-1.51; P = .4) between groups. Conclusions Video-assisted thoracic surgery segmentectomy showed results similar to lobectomy in terms of postoperative outcomes and midterm survival. In addition, a lower incidence of prolonged air leak was found in patients who underwent video-assisted thoracic surgery anatomic segmentectomy.
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Affiliation(s)
- Julio Sesma
- Thoracic Surgery Department, Hospital General Universitario de Alicante, Alicante, Spain
- Miguel Hernandez de Elche University, Alicante, Spain
- Address for reprints: Julio Sesma, MD, Pintor Baeza 12. 03013, Alicante, Spain.
| | - Sergio Bolufer
- Thoracic Surgery Department, Hospital General Universitario de Alicante, Alicante, Spain
- Miguel Hernandez de Elche University, Alicante, Spain
| | - Antonio García-Valentín
- Thoracic Surgery Department, Hospital General Universitario de Alicante, Alicante, Spain
- Miguel Hernandez de Elche University, Alicante, Spain
| | - Raúl Embún
- Cardiac Surgery Department, Hospital General Universitario de Alicante, Alicante, Spain
| | - Íker Javier López
- Thoracic Surgery Department, Hospital Universitario Miguel Servet and Hospital Clínico Universitario Lozano Blesa, IIS Aragón, Zaragoza, Spain
| | - Nicolás Moreno-Mata
- Thoracic Surgery Department, Hospital Universitario de Donostia, San Sebastián-Donostia, Spain
| | - Unai Jiménez
- Thoracic Surgery Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Antonio Eduardo Martín-Ucar
- Thoracic Surgery Department, Hospital Clínico San Carlos, Madrid, Spain
- Thoracic Surgery Department, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - Juana Gallar
- Miguel Hernandez de Elche University, Alicante, Spain
- Thoracic Surgery Department, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
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Wang X, Guo H, Hu Q, Ying Y, Chen B. Pulmonary function after segmentectomy versus lobectomy in patients with early-stage non-small-cell lung cancer: a meta-analysis. J Int Med Res 2021; 49:3000605211044204. [PMID: 34521244 PMCID: PMC8447102 DOI: 10.1177/03000605211044204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective Segmentectomy is widely performed for early-stage lung cancer. However, the
effects of segmentectomy versus lobectomy on pulmonary function remain
unclear. We performed a meta-analysis with the aim of comparing
segmentectomy and lobectomy in terms of preservation of pulmonary function
in patients with early-stage non-small-cell lung cancer (NSCLC). Methods We conducted a literature search of PubMed using the terms ‘pulmonary
function’ AND ‘segmentectomy’ AND ‘lobectomy’. The primary outcomes of
interest were the forced expiratory volume in 1 second (FEV1), FEV1 as
percent of predicted (%FEV1), change in FEV1 (Δ%FEV1), and the ratio of
postoperative to preoperative FEV1. Results Thirteen studies comprising 2027 patients met the inclusion and exclusion
criteria and were included for analysis, including 787 patients in the
segmentectomy group and 1240 patients in the lobectomy group. Patients in
the segmentectomy group showed significantly better preservation of FEV1 and
%FEV1 compared with the lobectomy group. The reduction in FEV1 after surgery
was significantly less in the segmentectomy group compared with the
lobectomy group, and Δ%FEV1 was significantly higher in the segmentectomy
group than in the lobectomy group. Conclusion Segmentectomy results in better preservation of pulmonary function compared
with lobectomy in patients with early-stage NSCLC.
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Affiliation(s)
- Xinxin Wang
- Department of Thoracic and Cardiovascular Surgery, Affiliated Taizhou Hospital of Wenzhou Medical University, Taizhou, China
| | - Haixie Guo
- Department of Thoracic and Cardiovascular Surgery, Affiliated Taizhou Hospital of Wenzhou Medical University, Taizhou, China
| | - Quanteng Hu
- Department of Thoracic and Cardiovascular Surgery, Affiliated Taizhou Hospital of Wenzhou Medical University, Taizhou, China
| | - Yongquan Ying
- Department of Thoracic and Cardiovascular Surgery, Affiliated Taizhou Hospital of Wenzhou Medical University, Taizhou, China
| | - Baofu Chen
- Department of Thoracic and Cardiovascular Surgery, Affiliated Taizhou Hospital of Wenzhou Medical University, Taizhou, China
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Kim HE, Yang YH, Lee CY. Video-Assisted Thoracic Surgery Segmentectomy. J Chest Surg 2021; 54:246-252. [PMID: 34353963 PMCID: PMC8350470 DOI: 10.5090/jcs.21.058] [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] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/19/2021] [Accepted: 07/27/2021] [Indexed: 11/16/2022] Open
Abstract
Although lobectomy remains the gold-standard surgical treatment for non-small-cell lung cancer, the frequency of thoracoscopic segmentectomy is increasing. Multiple factors must be considered in the choice of the procedure, ranging from adequate surgical planning or simulation, tumor localization, and identification of the intersegmental plane to severing the intersegmental plane to achieve an oncologically safe surgical margin with no or minimal manual palpation and different landmarks. In this article, we present an overview of methods for each procedural step of thoracoscopic segmentectomy, from preoperative planning to division of the intersegmental plane.
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Affiliation(s)
- Ha Eun Kim
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Ho Yang
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Young Lee
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Abstract
PURPOSE OF REVIEW Quantification and optimization of perioperative risk factors focusing on anesthesia-related strategies to reduce postoperative pulmonary complications (PPCs) after lung and esophageal surgery. RECENT FINDINGS There is an increasing amount of multimorbid patients undergoing thoracic surgery due to the demographic development and medical progress in perioperative medicine. Nevertheless, the rate of PPCs after thoracic surgery is still up to 30-50% with a significant influence on patients' outcome. PPCs are ranked first among the leading causes of early mortality after thoracic surgery. Although patients' risk factors are usually barely modifiable, current research focuses on procedural risk factors. From the surgical position, the minimal-invasive approach using video-assisted thoracoscopy and laparoscopy leads to a decreased rate of PPCs. The anesthesiological strategy to reduce the incidence of PPCs after thoracic surgery includes neuroaxial anesthesia, lung-protective ventilation, and goal-directed hemodynamic therapy. SUMMARY The main anesthesiological strategies to reduce PPCs after thoracic surgery include the use of epidural anesthesia, lung-protective ventilation: PEEP (positive end-expiratory pressure) of 5-8 mbar, tidal volume of 5 ml/kg BW (body weight) and goal-directed hemodynamics: CI (cardiac index) ≥ 2.5 l/min per m2, MAD (Mean arterial pressure) ≥ 70 mmHg, SVV (stroke volume variation) < 10% with a total amount of perioperative crystalloid fluids ≤ 6 ml/kg BW (body weight) per hour.
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Brunelli A, Decaluwe H, Gossot D, Guerrera F, Szanto Z, Falcoz PE. Perioperative outcomes of segmentectomies versus lobectomies in high-risk patients: an ESTS database analysis. Eur J Cardiothorac Surg 2020; 59:ezaa308. [PMID: 32929479 DOI: 10.1093/ejcts/ezaa308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 07/11/2020] [Accepted: 07/18/2020] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVES We queried the European Society of Thoracic Surgeons (ESTS) database with the aim to assess cardiopulmonary morbidity and 30-day mortality of segmentectomies and lobectomies in patients with a Eurolung-predicted mortality above the upper interquartile and classified as high risk. METHODS A total of 61 492 patients registered in the ESTS database (2007-2018) and submitted to lobectomy (55 353) or segmentectomy (6139) were divided into high risk or low risk according to a Eurolung-predicted mortality cut-off of 2.5% (corresponding in our population to the upper interquartile). Predicted versus observed mortalities were compared within each type of operation by using binomial test of proportion. Observed morbidity and mortality rates were compared between the 2 procedures using the χ2 test. RESULTS A total of 14 007 lobectomies and 1251 segmentectomies were classified as high risk. In the high-risk group, the cardiopulmonary morbidity and 30-day mortality rates observed in segmentectomies were lower than in lobectomies (morbidity: 12% vs 17%, P < 0.0001; mortality: 2.4% vs 3.7%, P = 0.018). In segmentectomy patients, the observed mortality rate was lower than the Eurolung-predicted one (2.4% vs 3.8%, P = 0.009), while in the lobectomy patients, there was no difference between observed and predicted mortality (3.7% vs 3.8%, P = 0.9). In the low-risk group, the cardiopulmonary morbidity and 30-day mortality rates observed in segmentectomies were lower than in lobectomies (morbidity: 4.5% vs 7.8%, P < 0.0001; mortality: 0.6% vs 1.0%, P = 0.01). In segmentectomy patients, the observed mortality rate was lower than the Eurolung-predicted one (0.6% vs 1.0%, P = 0.0003), while in the lobectomy patients, there was no difference between observed and predicted mortality (1.0% vs 1.1%, P = 0.06). CONCLUSIONS Segmentectomy was found associated with a 0.65 relative risk of mortality rate compared to lobectomy in patients deemed at higher surgical risk.
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Affiliation(s)
| | - Herbert Decaluwe
- Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
| | - Dominique Gossot
- Department of Thoracic Surgery, Institut du Thorax Curie-Montsouris - IMM, Paris, France
| | | | - Zalan Szanto
- Department of Thoracic Surgery, University of Pecs, Pecs, Hungary
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Gálvez C, Bolufer S, Gálvez E, Navarro-Martínez J, Galiana-Ivars M, Sesma J, Rivera-Cogollos MJ. Anatomic Segmentectomy in Nonintubated Video-Assisted Thoracoscopic Surgery. Thorac Surg Clin 2020; 30:61-72. [PMID: 31761285 DOI: 10.1016/j.thorsurg.2019.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Thoracic surgery has evolved into minimally invasive surgery, in terms of not only surgical approach but also less aggressive anesthesia protocols and lung-sparing resections. Nonintubated anatomic segmentectomies are challenging procedures but can be safely performed if some essentials are considered. Strict selection criteria, previous experience in minor procedures, multidisciplinary cooperation, and the 4 cornerstones (deep sedation, regional analgesia, oxygenation support and vagal blockade) should be followed. Better outcomes in postoperative recovery, including resumption of oral intake, chest tube duration, and hospital stay, and low complication and conversion rates, are encouraging but should be checked in larger multicenter prospective randomized trials.
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Affiliation(s)
- Carlos Gálvez
- Thoracic Surgery Department, Hospital General Universitario Alicante, C/Pintor Baeza, 12, Alicante 03010, Spain.
| | - Sergio Bolufer
- Thoracic Surgery Department, Hospital General Universitario Alicante, C/Pintor Baeza, 12, Alicante 03010, Spain
| | - Elisa Gálvez
- Medical Oncology, Hospital General Universitario Elda, Ctra. Sax- La Torreta, S/N, Elda, Alicante 03600, Spain
| | - Jose Navarro-Martínez
- Anesthesiology and Surgical Critical Care Department, Hospital General Universitario Alicante, C/Pintor Baeza, 12, Alicante 03010, Spain
| | - Maria Galiana-Ivars
- Anesthesiology and Surgical Critical Care Department, Hospital General Universitario Alicante, C/Pintor Baeza, 12, Alicante 03010, Spain
| | - Julio Sesma
- Thoracic Surgery Department, Hospital General Universitario Alicante, C/Pintor Baeza, 12, Alicante 03010, Spain
| | - María Jesús Rivera-Cogollos
- Anesthesiology and Surgical Critical Care Department, Hospital General Universitario Alicante, C/Pintor Baeza, 12, Alicante 03010, Spain
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Tong C, Zhu H, Li B, Wu J, Xu M. Impact of paravertebral blockade use in geriatric patients undergoing thoracic surgery on postoperative adverse outcomes. J Thorac Dis 2019; 11:5169-5176. [PMID: 32030234 DOI: 10.21037/jtd.2019.12.13] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background While it is known that thoracic paravertebral blockade (TPVB) could reduce pain undergoing thoracic surgery, it has not been confirmed whether this reduction in pain reduces pulmonary complications in an elderly population. Methods We performed a monocentric retrospective analysis for a prospectively collected patients receiving thoracic surgery with or without intraoperative TPVB between November 7, 2018 and April 1, 2019, at Shanghai Chest Hospital. Whether or not to use TPVB depending on anesthesiologists' preference, the chances of harm and benefit of each patients after discussed with their anesthetist. Chest wall resection, bilateral lung resection, conversion to thoracotomy and ipsilateral reoperation were excluded. A total of 154 patients with lung operations were included in the final analysis, 34 of whom received general anesthesia combined with TPVB (GA-TPVB). The primary outcome was the incidence of postoperative pulmonary complications (PPCs). The secondary outcomes were the incidence of cardiovascular and other complications, required analgesia in post anesthesia care unit (PACU), patient controlled analgesia (PCA) pressing frequency in 24h, chest tube duration, ICU stay and the hospital length of stay (LOS). Results The incidence of PPCs undergoing thoracic surgery was about 21.4% (33/154). Compared with GA, GA-TPVB could reduce the incidence of PPCs (25% vs. 9%, P=0.042), mostly reduce postoperative atelectasis (19% vs. 3%, P=0.021). TPVB could reduce the rate of required analgesia in PACU, PCA pressing frequency in 24 h and chest tube duration. However, there were no significant differences on the rate of cardiovascular and other complications, ICU stay and LOS between the two groups (P>0.05). Multivariable logistic regression analysis identified preoperative DLCO% ≥92% (OR =0.293, P=0.006), duration of surgery <75 min (OR =0.278, P=0.008) and GA-TPVB (OR =0.270, P=0.048) was associated with fewer PPCs. Conclusions Our study shows that general anesthesia combined with TPVB may reduce PPCs by reducing postoperative pain in geriatric patients undergoing thoracic surgery compared with general anesthesia alone. Trial registration Chinese Clinical Trial Registry number, ChiCTR1800019526. Registered on Nov 7, 2018.
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Affiliation(s)
- Chaoyang Tong
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Hongwei Zhu
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Bin Li
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Jingxiang Wu
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Meiying Xu
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200025, China
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Bédat B, Abdelnour-Berchtold E, Krueger T, Perentes JY, Zellweger M, Triponez F, Karenovics W, Gonzalez M. Impact of complex segmentectomies by video-assisted thoracic surgery on peri-operative outcomes. J Thorac Dis 2019; 11:4109-4118. [PMID: 31737293 DOI: 10.21037/jtd.2019.10.07] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Pulmonary segmentectomies are generally classified into simple (tri-segmentectomy or lingulectomy as well as apical or basilar segmentectomy) and complex (individual or bi-segmentectomy of the upper, middle and lower lobes). Complex segmentectomies are technically feasible by video-assisted thoracic surgery (VATS) but remain challenging, and reports on post-operative outcomes are scarce. This study analyzes the differences between simple and complex VATS segmentectomy in terms of peri- and post-operative outcomes. Methods We retrospectively reviewed records of all patients who underwent anatomical pulmonary segmentectomy by VATS from 2014 to 2018 in two university hospitals. Results A total of 232 patients (114 men; median age 67 years; range, 29-87 years) underwent VATS segmentectomy for primary lung cancer (n=177), metastases (n=26) and benign lesions (n=29). The overall 30-day mortality and morbidity rates were 0.8% and 29.7%, respectively. The re-operation rate was 4.7%. Complex segmentectomy was realized in 111 patients including 86 (77.5%) upper lobe segmentectomies and 44 (39.6%) bi-segmentectomies. There was no statistical difference between complex and simple segmentectomy in terms of operative time (145 vs. 143 min, respectively; P=0.79) and chest tube duration [median: 1 (range, 0-33) vs. 2 (range, 1-19) days, respectively; P=0.95]. Post-operative overall complication rates were similar for both groups (30% vs. 30%, respectively; P=0.99) and were not correlated with the type of segmentectomy. However, complex segmentectomy patients had a shorter length of hospitalization compared to simple segmentectomy patients [median: 5 (range, 1-36) vs. 7 (range, 2-31) days; P=0.026]. Interestingly, complex segmentectomies were realized most frequently 2 years after implementation of VATS segmentectomy (23% vs. 77%; P=0.01). Conclusions In comparison with simple segmentectomy, complex segmentectomy by VATS seems to present similar post-operative complication rates. Learning curve and progressive increase in acceptance by surgeons seem to be key elements for successful implementation of complex segmentectomies and could explain the shorter length of stay we observed.
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Affiliation(s)
- Benoît Bédat
- Division of Thoracic and Endocrine Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | | | - Thortsen Krueger
- Service of Thoracic Surgery, University Hospital of Lausanne, Lausanne, Switzerland
| | - Jean Yannis Perentes
- Service of Thoracic Surgery, University Hospital of Lausanne, Lausanne, Switzerland
| | - Matthieu Zellweger
- Service of Thoracic Surgery, University Hospital of Lausanne, Lausanne, Switzerland
| | - Frédéric Triponez
- Division of Thoracic and Endocrine Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Wolfram Karenovics
- Division of Thoracic and Endocrine Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Michel Gonzalez
- Service of Thoracic Surgery, University Hospital of Lausanne, Lausanne, Switzerland
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Kaufmann KB, Loop T, Heinrich S. Risk factors for post-operative pulmonary complications in lung cancer patients after video-assisted thoracoscopic lung resection: Results of the German Thorax Registry. Acta Anaesthesiol Scand 2019; 63:1009-1018. [PMID: 31144301 DOI: 10.1111/aas.13388] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/28/2019] [Accepted: 04/30/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Post-operative pulmonary complications (PPCs) represent the most frequent complications after lung surgery. The aim of this study was to identify the modifiable risk factors for PPCs after video-assisted thoracoscopic surgery (VATS) in lung cancer patients. METHODS Data of this retrospective study were extracted from the German Thorax Registry, an interdisciplinary and multicenter database of the German Society of Anesthesiology and Intensive care medicine and the German Society of Thoracic Surgery. Univariate and multivariate stepwise logistic regression analysis of patient-specific and procedural risk factors for PPCs were conducted. RESULTS We analyzed 376 patients with lung cancer who underwent VATS bilobectomy (n = 2), lobectomy (n = 258) or segmentectomy (n = 116) in 2016 and 2017. One-hundred fourteen patients (114/376; 30%) developed PPCs. Two patients died within 30 days after surgery. In the univariate analysis, patients of the PPC group showed significantly more often a body mass index (BMI) ≤ 19 kg/m2 ; a pre-operative forced expiratory volume in 1 second (FEV1 ) ≤ 60%; a pre-operative arterial oxygen partial pressure (pa O2 ) ≤ 60 mm Hg; a higher rate of prolonged duration of surgery (≥2 hours [h]) and a higher frequency of intraoperative blood loss ≥500 mL. The multivariate stepwise logistic regression analysis revealed 4 independent risk factors: FEV1 ≤ 60% (1.9[1.1-3.4] OR [95% CI], P = 0.029); pa O2 ≤ 60 mm Hg (4.6[1.7-12.8] OR [95% CI], P = 0.003; duration of surgery ≥2 hours (2.7[1.5-4.7] OR [95% CI], P = 0.001) and intraoperative crystalloids ≥6 mL/kg/h (2.9[1.2-7.5] OR [95% CI], P = 0.023). CONCLUSION Intraoperative amount of crystalloid fluids should be kept below 6 mL/kg/h and duration of surgery should be below 2 hours to avoid an increased risk for PPCs.
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Affiliation(s)
- Kai B. Kaufmann
- Faculty of Medicine, Department of Anesthesiology and Critical Care Medicine Medical Center ‐ University of Freiburg Freiburg Germany
| | - Torsten Loop
- Faculty of Medicine, Department of Anesthesiology and Critical Care Medicine Medical Center ‐ University of Freiburg Freiburg Germany
| | - Sebastian Heinrich
- Faculty of Medicine, Department of Anesthesiology and Critical Care Medicine Medical Center ‐ University of Freiburg Freiburg Germany
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12
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Gossot D. Comparing open and closed chest surgery for early-stage lung cancer: still relevant? J Thorac Dis 2019; 11:S1307-S1309. [PMID: 31245117 DOI: 10.21037/jtd.2019.04.74] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Dominique Gossot
- Thoracic Department, Curie-Montsouris Thoracic Institute, Institut Mutualiste Montsouris, Paris, France
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Sato M, Murayama T, Nakajima J. Concepts and techniques: how to determine and identify the appropriate target segment in anatomical pulmonary segmentectomy? J Thorac Dis 2019; 11:972-986. [PMID: 31019788 DOI: 10.21037/jtd.2019.02.83] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Anatomical segmentectomy is gathering increasing interest among thoracic surgeons because of increased detection of pulmonary nodules with ground-glass opacity (GGO) as well as an increase in the number of compromised patients. Accurate determination of intersegmental planes is a challenge in anatomical segmentectomy, and multiple methods have been proposed including developing inflation/deflation lines and injecting indocyanine green either intravenously or intrabronchially. Considering resection margins, adding a localization technique to conventional methods, or conducting virtual-assisted lung mapping (bronchoscopic multi-spot dye marking) may be an optional approach for optimal anatomical segmentectomy to identify intersegmental planes and obtain adequate resection margins. To determine optimal resection lines in anatomical segmentectomy, surgeons must also consider oncological validity such as venous and lymph drainage, resection margins, and lung anatomy to avoid complications such as venous congestion, infarction, and air leakage. Although anatomical segmentectomy is an attractive approach to resect small early-stage lung cancer and some metastatic lung tumors, caution is needed to optimally perform this technically demanding surgery.
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Affiliation(s)
- Masaaki Sato
- Department of Thoracic Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Tomonori Murayama
- Department of Thoracic Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Jun Nakajima
- Department of Thoracic Surgery, The University of Tokyo Hospital, Tokyo, Japan
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Bédat B, Abdelnour-Berchtold E, Krueger T, Perentes JY, Ris HB, Triponez F, Licker MJ, Karenovics W, Gonzalez M. Clinical outcome and risk factors for complications after pulmonary segmentectomy by video-assisted thoracoscopic surgery: results of an initial experience. J Thorac Dis 2018; 10:5023-5029. [PMID: 30233876 DOI: 10.21037/jtd.2018.07.42] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background Pulmonary anatomical segmentectomies are increasingly being done via video-assisted thoracoscopic surgery (VATS). We analyzed clinical outcomes and risk factors for post-operative complications after pulmonary segmentectomy by VATS was introduced in two institutions. Methods We retrospectively reviewed records of all patients who underwent anatomical pulmonary segmentectomy by VATS from 2014 to 2016 at the university hospitals of Geneva and Lausanne in Switzerland. Results One hundred twenty-nine patients (64 men; median age 68 years, range, 29-85 years) underwent anatomical VATS segmentectomy for primary lung tumors (n=100), metastases (n=16) and benign lesions (n=13). The overall 30-day mortality and morbidity rates were 0.8% and 31%, respectively. The reoperation rate was 4.7% [indications: hemothorax 2, prolonged air leak (PAL) 2, segmental torsion 1, empyema 1]. Chest drainage lasted for a median of 2 days (range, 1-33 days) and patients were discharged from the hospital after a median of 6 days (range, 2-37 days). Postoperative complications were mainly associated with chronic obstructive pulmonary disease (COPD) [odds ratio (OR) 2.54 and 95% confidence interval (95% CI), 1.18-5.47], and smoking pack-years >50 units (OR 5.27; 95% CI, 1.68-16.55). Nine patients (9%) presented with distant recurrences. Nodule size >2 cm was associated with decreased disease-free survival (DFS) (P=0.04). There was no association between surgical experience in VATS segmentectomy and DFS or postoperative complications. Conclusions Segmentectomies can be safely performed by VATS in an initial experience and result in favorable clinical outcome. COPD and smoking pack-years are associated with an increased risk of complications.
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Affiliation(s)
- Benoît Bédat
- Service of Thoracic Surgery, Hopitaux Universitaires de Genève, Genève, Switzerland
| | | | - Thorsten Krueger
- Service of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Jean Yannis Perentes
- Service of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Hans-Beat Ris
- Service of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Frédéric Triponez
- Service of Thoracic Surgery, Hopitaux Universitaires de Genève, Genève, Switzerland
| | - Marc-Joseph Licker
- Service of Anesthesiology, Hopitaux Universitaires de Genève, Genève, Switzerland
| | - Wolfram Karenovics
- Service of Thoracic Surgery, Hopitaux Universitaires de Genève, Genève, Switzerland
| | - Michel Gonzalez
- Service of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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15
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Affiliation(s)
- Dominique Gossot
- Thoracic Department, Curie-Montsouris Thoracic Institute, IMM, Paris, France.
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16
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Traitement chirurgical des cancers bronchiques non à petites cellules (CBNPC) de stade précoce par segmentectomie à thorax fermé : résultats préliminaires. Rev Mal Respir 2018; 35:521-530. [DOI: 10.1016/j.rmr.2018.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 08/27/2017] [Indexed: 11/19/2022]
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Seguin-Givelet A, Grigoroiu M, Brian E, Gossot D. Planning and marking for thoracoscopic anatomical segmentectomies. J Thorac Dis 2018; 10:S1187-S1194. [PMID: 29785293 DOI: 10.21037/jtd.2018.02.21] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Although sublobar resection (SLR) for treating non-small cell lung carcinoma (NSCLC) is still controversial, thoracoscopic segmentectomy is rising. Performing it by closed chest surgery is complex as it means confirming the location of the lesion, identifying vascular and bronchial structures, preserving venous drainage of adjacent segments, severing the intersegmental plane and ensuring an oncological safety margin with no manual palpation and different landmarks. Accurate planning is mandatory. We discuss in this article the interest of 3D reconstruction and mapping technics to enhance safety and reliability of these procedures.
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Affiliation(s)
- Agathe Seguin-Givelet
- Thoracic Department, Curie-Montsouris Thorax Institute, Institut Mutualiste Montsouris, Paris, France.,Paris 13 University, Sorbonne Paris Cité, Faculty of Medicine SMBH, Bobigny, France
| | - Madalina Grigoroiu
- Thoracic Department, Curie-Montsouris Thorax Institute, Institut Mutualiste Montsouris, Paris, France
| | - Emmanuel Brian
- Thoracic Department, Curie-Montsouris Thorax Institute, Institut Mutualiste Montsouris, Paris, France
| | - Dominique Gossot
- Thoracic Department, Curie-Montsouris Thorax Institute, Institut Mutualiste Montsouris, Paris, France
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18
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Traibi A, Seguin-Givelet A, Brian E, Grigoroiu M, Gossot D. Adult pulmonary intralobar sequestrations: changes in the surgical management. J Vis Surg 2018; 4:62. [PMID: 29682472 DOI: 10.21037/jovs.2018.02.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 02/09/2018] [Indexed: 11/06/2022]
Abstract
Background Until now, the traditional procedure to treat intralobar pulmonary sequestration (ILS) in adults has been a lobectomy performed by open chest surgery. We have reviewed our data to determine whether the surgical management of these lesions has evolved over the last years. Methods We retrospectively reviewed the records of patients who were operated on for an ILS by either posterolateral thoracotomy (PLT group), or by thoracoscopy (TS group) between 2000 and 2016. Results Eighteen patients were operated on for a ILS during this period. Before 2011, all resections were performed by thoracotomy (n=6) and after 2011 the approach was either a thoracotomy (n=5) or a thoracoscopy (n=7). There was one conversion because of dense pleural adhesions and this patient was integrated in the PLT group for further analysis. ILS presented more frequently on the left side (n=12, 66.7%) than on the right one (n=6, 33.3%) and exclusively in the lower lobes. All the PLT group patients underwent a lobectomy. In the TS group, five patients underwent a sublobar resection (2 segmentectomies S9+10, 1 basilar segmentectomy and 2 atypical resections). There was no mortality. In the PLT group, 5 patients (45%) had complications versus one patient (14%) in the TS group. The mean hospital stay was 7.4 days in the PLT group versus 5.4 days in the TS group. Conclusions These data confirm that ILS can be safely treated by a sublobar resection that should be performed, whenever possible, without opening the chest.
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Affiliation(s)
- Akram Traibi
- Thoracic Department, Institut du Thorax Curie-Montsouris, Institut Mutualiste Montsouris, Paris, France
| | - Agathe Seguin-Givelet
- Thoracic Department, Institut du Thorax Curie-Montsouris, Institut Mutualiste Montsouris, Paris, France.,Paris 13 University, Sorbonne Paris Cité, Faculty of Medicine SMBH, Bobigny, France
| | - Emmanuel Brian
- Thoracic Department, Institut du Thorax Curie-Montsouris, Institut Mutualiste Montsouris, Paris, France
| | - Madalina Grigoroiu
- Thoracic Department, Institut du Thorax Curie-Montsouris, Institut Mutualiste Montsouris, Paris, France
| | - Dominique Gossot
- Thoracic Department, Institut du Thorax Curie-Montsouris, Institut Mutualiste Montsouris, Paris, France
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19
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Wolf A, Liu B, Leoncini E, Nicastri D, Lee DS, Taioli E, Flores R. Outcomes for Thoracoscopy Versus Thoracotomy Not Just Technique Dependent: A Study of 9,787 Patients. Ann Thorac Surg 2018; 105:886-891. [DOI: 10.1016/j.athoracsur.2017.09.059] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 09/20/2017] [Accepted: 09/25/2017] [Indexed: 01/23/2023]
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20
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Charloux A, Quoix E. Lung segmentectomy: does it offer a real functional benefit over lobectomy? Eur Respir Rev 2017; 26:26/146/170079. [DOI: 10.1183/16000617.0079-2017] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 08/03/2017] [Indexed: 12/23/2022] Open
Abstract
Anatomical segmentectomy has been developed to offer better pulmonary function preservation than lobectomy, in stage IA lung cancer. Despite the retrospective nature of most of the studies and the lack of randomised studies, a substantial body of literature today allows us to evaluate to what extent lung function decreases after segmentectomy and whether segmentectomy offers a real functional benefit over lobectomy. From the available series, it emerges that the mean decrease in forced expiratory volume in 1 s (FEV1) is low, ranging from −9% to −24% of the initial value within 2 months and −3 to −13% 12 months after segmentectomy. This reduction in lung function is significantly lower than that induced by lobectomy, but saves only a few per cent of pre-operative FEV1. Moreover, the published results do not firmly establish the functional benefit of segmentectomy over lobectomy in patients with poor lung function. Some issues remain to be addressed, including whether video-assisted thoracic surgery (VATS) segmentectomy may preserve lung function better than VATS lobectomy in patients with poor lung function, especially within the early days after surgery, and whether this may translate to lowering the functional limit for surgery. Eventually, trials comparing stereotactic ablative body radiotherapy, radiofrequency ablation and segmentectomy functional consequences are warranted.
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21
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Gossot D, Lutz JA, Grigoroiu M, Brian E, Seguin-Givelet A. Unplanned Procedures During Thoracoscopic Segmentectomies. Ann Thorac Surg 2017; 104:1710-1717. [PMID: 28969898 DOI: 10.1016/j.athoracsur.2017.05.081] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 05/26/2017] [Accepted: 05/30/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Thoracoscopic sublobar resections (TSLRs) are gaining popularity, but are challenging. However, despite technical difficulties, the reported rate of adverse events, complications, and unplanned procedures is low. To understand this paradox, we have studied our series of TSLRs. METHODS We reviewed our prospective and intention-to-treat database on videothoracoscopic anatomical resections and extracted all planned thoracoscopic segmentectomies from January 2007 to July 2016. Intraoperative and postoperative data were analyzed. Unplanned procedures were defined as a conversion into thoracotomy or an unplanned additional pulmonary resection. RESULTS During the study period 284 thoracoscopic anatomical segmentectomies were performed in 280 patients. There were 124 men and 156 women with a mean age of 64 years (range, 18 to 86 years). Indication for segmentectomy was a proven or suspected non-small cell lung carcinoma in 184 patients, suspected metastasis in 51 patients, and benign lesion in 49 patients. In total, 23 patients had an unplanned procedure (8%). There were 10 unplanned thoracotomies (9 conversions and 1 reoperation; 3.1%) mainly for vascular injuries, and 15 unplanned additional resections (5.1%) distributed among oncological reasons (n = 7), per operative technical issues (n = 6) and postoperative adverse events (lingular ischemia, n = 2). Considering only the 235 patients operated on for cancer, the unplanned additional pulmonary resection rate for an oncological reason was 3%. CONCLUSIONS Although lower than for thoracoscopic lobectomies, the rate of unplanned procedure during TSLRs is of concern. It could most likely be reduced by technical refinements, such as a better preoperative planning.
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Affiliation(s)
- Dominique Gossot
- Thoracic Department, Institut du Thorax Curie-Montsouris, Institut Mutualiste Montsouris, Paris, France.
| | - Jon Andri Lutz
- Thoracic Department, Institut du Thorax Curie-Montsouris, Institut Mutualiste Montsouris, Paris, France; Division of General Thoracic Surgery, University Hospital Bern, Bern, Switzerland
| | - Madalina Grigoroiu
- Thoracic Department, Institut du Thorax Curie-Montsouris, Institut Mutualiste Montsouris, Paris, France
| | - Emmanuel Brian
- Thoracic Department, Institut du Thorax Curie-Montsouris, Institut Mutualiste Montsouris, Paris, France
| | - Agathe Seguin-Givelet
- Thoracic Department, Institut du Thorax Curie-Montsouris, Institut Mutualiste Montsouris, Paris, France; Paris 13 University, Sorbonne Paris Cité, Faculty of Medicine SMBH, Bobigny, France
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22
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Omasa M, Date H, Takamochi K, Suzuki K, Miyata Y, Okada M. Completion lobectomy after radical segmentectomy for pulmonary malignancies. Asian Cardiovasc Thorac Ann 2017; 24:450-4. [PMID: 27207503 DOI: 10.1177/0218492316648863] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Completion lobectomy after radical segmentectomy is relatively rare, with no systematic evaluation of this challenging procedure. We aimed to clarify the details of this operation performed in 3 Japanese institutions. METHODS Completion lobectomy after segmentectomy in the same lobe was performed in 11 patients (9 lung cancers and 2 metastatic lung tumors) between 2007 and 2013. Surgical outcomes were analyzed retrospectively. RESULTS The 11 patients accounted for 1.37% of the 805 segmentectomies performed in the 3 institutions. The reasons for completion lobectomy were postoperative complications in the remaining lobe (n = 3), positive pathological lymph node metastasis found by permanent section (n = 3), and malignancy in the remaining lobe (n = 5). The patients were divided into two groups according the interval between segmentectomy and completion lobectomy: group A (3-35 days, n = 5) and group B (56-1470 days, n = 6). There was a tendency for more severe adhesions around the hilum (p = 0.061) in group B, resulting in increased operative bleeding (p = 0.055), more usage of fibrin glue (p = 0.080), and significantly longer operative time (p = 0.036). Injury to the pulmonary arteries was experienced only in group B (3/6 cases). There was no operation-related mortality. CONCLUSIONS Completion lobectomy may become more difficult approximately 5 weeks after segmentectomy, due to severe adhesions, but it can be performed safely with careful manipulation.
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Affiliation(s)
- Mitsugu Omasa
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazuya Takamochi
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Yoshihiro Miyata
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
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23
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Gossot D, Lutz J, Grigoroiu M, Brian E, Seguin-Givelet A. Thoracoscopic anatomic segmentectomies for lung cancer: technical aspects. J Vis Surg 2016; 2:171. [PMID: 29078556 DOI: 10.21037/jovs.2016.10.04] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 10/01/2016] [Indexed: 11/06/2022]
Abstract
Although the interest for thoracoscopic sublobar resections (TSLR) is rising, its use for treating non-small cell lung carcinoma (NSCLC) is still controversial because publications dealing with survival and recurrence rate provide contradictory results. If applied to the resection of lung cancer, thoracoscopic segmentectomies must be performed according to oncological criteria. The aim of this technical paper is to give some technical details on thoracoscopic segmentectomies for the treatment of malignancies. Our experience is based on 235 thoracoscopic anatomical segmentectomies performed in 232 patients for a malignant lesion between January 2007 and July 2016. Indication for segmentectomy was a proven or suspected NSCLC in 184 and suspected metastasis in 51 patients. Intraoperative and postoperative data were recorded in a prospective manner. There were eight conversions into a posterolateral thoracotomy (3.4%) and seven unplanned additional pulmonary resections for an oncological reason (3%). We discuss some technical refinements that could minimize these adverse events and make thoracoscopic segmentectomy a safe and reliable procedure.
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Affiliation(s)
- Dominique Gossot
- Department of Thoracic, Institute Mutualiste Montsouris, Paris, France
| | - Jon Lutz
- Department of Thoracic, Institute Mutualiste Montsouris, Paris, France
| | | | - Emmanuel Brian
- Department of Thoracic, Institute Mutualiste Montsouris, Paris, France
| | - Agathe Seguin-Givelet
- Department of Thoracic, Institute Mutualiste Montsouris, Paris, France.,Paris 13 University, Sorbonne Paris Cité, Faculty of Medicine SMBH, Bobigny, France
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24
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Ojanguren A, Gossot D, Seguin-Givelet A. Division of the intersegmental plane during thoracoscopic segmentectomy: is stapling an issue? J Thorac Dis 2016; 8:2158-64. [PMID: 27621872 DOI: 10.21037/jtd.2016.07.47] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Stapling is becoming the method of choice for dividing the intersegmental plane during thoracoscopic segmentectomies. The technique however is controversial as it can impair re-expansion of preserved segments. We have analyzed the morbidity and lung re-expansion on a series of 175 thoracoscopic segmentectomies. METHODS A total of 175 patients underwent a thoracoscopic anatomic segmentectomy. Ten patients were excluded due to conversion into thoracotomy. There were 89 females (54%) and 76 males (46%). Mean age was 63 years (range, 18-83 years). Indications for segmentectomy were as follows: primary lung cancer (n=100, 61%), metastases (n=27, 16%), benign non-infectious lesions (n=20, 12%) and benign infectious lesions (n=18, 11%). The intersegmental plane was divided with an endostapler in all patients. Lung re-expansion assessment included chest roentgenograms at discharge and at one-month consultation. RESULTS The overall complication rate was 17%. There were 0.6% major complications and 16% minor complications. The average duration of drainage was 3 days (range, 1-13 days) and average length of stay was 5.7 days (range, 2-22 days). At discharge and at 1-month follow-up chest radiography, incomplete lung re-expansion was observed in 12 (7.4%) and 4 patients (2.8%) respectively. Patients who underwent upper lobe segmentectomy had significantly more incomplete re-expansion at discharge and at 1-month follow-up. On univariate analysis, mean drainage duration was significantly longer in patients who underwent upper segmentectomy (mean 3.7 days; range, 1-13) than those who underwent lower segmentectomy (mean 2.7 days; range, 1-5). CONCLUSIONS Although stapling of the intersegmental plane most likely slightly impairs lung re-expansion, clinical and radiological consequences are minimal.
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Affiliation(s)
- Amaia Ojanguren
- Thoracic Department, Institut Mutualiste Montsouris, Paris, France
| | - Dominique Gossot
- Thoracic Department, Institut Mutualiste Montsouris, Paris, France
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25
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Brunswicker A, Farid S, Van Tornout F. Infarction of the lingula following left upper lobe trisegmentectomy. Asian Cardiovasc Thorac Ann 2015; 24:107-9. [DOI: 10.1177/0218492315610224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Anatomical segmentectomy has emerged as the procedure of choice for early-stage non-small-cell lung cancer, especially in the presence of poor cardiopulmonary reserve. The most common postoperative complications are pneumonia, persistent air leak, and rarely, vascular compromise of the remaining lobe. We report the case of a 74-year-old woman who underwent thoracotomy and left upper lobe trisegmentectomy for T1bN0Mo squamous cell carcinoma and subsequently developed infarction and hepatization of the remaining lingula. A completion left upper lobectomy was performed and the patient made a full recovery.
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Affiliation(s)
- Annemarie Brunswicker
- Department of Thoracic Surgery, Norfolk and Norwich University Hospital, Norwich, UK
| | - Shakil Farid
- Department of Thoracic Surgery, Norfolk and Norwich University Hospital, Norwich, UK
| | - Filip Van Tornout
- Department of Thoracic Surgery, Norfolk and Norwich University Hospital, Norwich, UK
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26
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Łochowski MP, Kozak J. Video-assisted thoracic surgery complications. Wideochir Inne Tech Maloinwazyjne 2014; 9:495-500. [PMID: 25561984 PMCID: PMC4280410 DOI: 10.5114/wiitm.2014.44250] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 04/12/2014] [Accepted: 05/02/2014] [Indexed: 12/04/2022] Open
Abstract
Video-assisted thoracic surgery (VATS) is a miniinvasive technique commonly applied worldwide. Indications for VATS are very broad and include the diagnosis of mediastinal, lung and pleural diseases, as well as large resection procedures such as pneumonectomy. The most frequent complication is prolonged postoperative air leak. The other significant complications are bleeding, infections, postoperative pain and recurrence at the port site. Different complications of VATS procedures can occur with variable frequency in various diseases. Despite the large number of their types, such complications are rare and can be avoided through the proper selection of patients and an appropriate surgical technique.
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Affiliation(s)
| | - Józef Kozak
- Department of Thoracic Surgery, Medical University of Lodz, Lodz, Poland
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27
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Caronia FP, Fiorelli A, Ruffini E, Nicolosi M, Santini M, Lo Monte AI. A comparative analysis of Pancoast tumour resection performed via video-assisted thoracic surgery versus standard open approaches. Interact Cardiovasc Thorac Surg 2014; 19:426-35. [DOI: 10.1093/icvts/ivu115] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Alfonso Fiorelli
- Unità Operativa di Chirurgia Toracica, Seconda Università di Napoli, Napoli, Italy
| | - Enrico Ruffini
- Unità Operativa di Chirurgia Toracica, Università di Torino, Torino, Italy
| | | | - Mario Santini
- Unità Operativa di Chirurgia Toracica, Seconda Università di Napoli, Napoli, Italy
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28
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Yang CFJ, D'Amico TA. Open, thoracoscopic and robotic segmentectomy for lung cancer. Ann Cardiothorac Surg 2014; 3:142-52. [PMID: 24790837 DOI: 10.3978/j.issn.2225-319x.2014.02.05] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Accepted: 01/21/2014] [Indexed: 11/14/2022]
Abstract
While lobectomy is the standard procedure for early stage lung cancer, the role of sublobar resection is currently under investigation for selected patients with small tumors. In this review, studies reporting outcomes on open, thoracoscopic and robotic segmentectomy were analyzed. In patients with stage I lung cancer, with tumors <2 cm in diameter and within segmental anatomic boundaries, segmentectomy appears to have equivalent rates of morbidity, recurrence and survival when compared to lobectomy. Segmentectomy also resulted in greater preservation of lung function and exercise capacity than lobectomy. It appears reasonable to consider segmentectomy for patients with stage I lung cancer (particularly in air-containing tumors with ground glass opacities) where tumors are <2 cm in diameter and acceptable segmental margins are obtainable, especially in patients with advanced age, poor performance status, or poor cardiopulmonary reserve. The results of two ongoing randomized controlled trials (CALGB 140503 and JCOG0802/WJOG4607L) and additional well-designed studies on open, thoracoscopic, and robotic segmentectomy will be important for clarifying the role of segmentectomy for lung cancer.
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Affiliation(s)
- Chi-Fu Jeffrey Yang
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Thomas A D'Amico
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
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