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Duan Q, Li R, Wang M, Cui Z, Zhu X, Chen F, Han F, Ma J. Exploring the anti-NSCLC mechanism of phillyrin targeting inhibition of the HSP90-AKT pathway. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024:10.1007/s00210-024-03481-1. [PMID: 39356318 DOI: 10.1007/s00210-024-03481-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2024] [Accepted: 09/21/2024] [Indexed: 10/03/2024]
Abstract
Phillyrin (PHN), derived from the dried fruit of Forsythia suspensa (Thunb.) Vahl, is a kind of Chinese herbal medicine with the effect of clearing heat, and has been used in China for thousands of years in treating various tumors. However, the mechanism of its main components on non-small cell lung cancer (NSCLC) remains unclear. PHN is a distinct component extracted from Forsythia suspensa with promising anti-cancer activity against various tumor types. This study sought to elucidate the promising effects of PHN on NSCLC. Based on network pharmacology results, we identified potential PHN targets and pathways for NSCLC treatment. CCK-8 assay, wound healing assay, apoptosis assay, western blot, and in vivo experiments verified the inhibitory effect of PHN on NSCLC. Network pharmacology identified 160 potential PHN targets, 955 NSCLC-related targets, and 54 common targets, along with 132 pathways and 2 core genes. Biological experiments demonstrated that PHN significantly inhibited the growth and migration of A549 and LLC cells while promoting their apoptosis. Western blot analysis revealed down-regulation of AKT, HSP90AA1, and CDC37 expression, suggesting that PHN inhibits A549 and LLC cell proliferation by down-regulating the HSP90-AKT pathway. In vivo experiments confirmed that PHN significantly inhibited NSCLC growth with low toxicity. This study, using network pharmacology and biological experiments, verified the effectiveness of PHN against NSCLC through the HSP90-AKT pathway. These findings provide a foundation for further research and analysis.
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Affiliation(s)
- Qiong Duan
- The Affiliated Lianyungang Municipal Oriental Hospital of Xuzhou Medical University, Lianyungang, 222042, China
| | - Ruochen Li
- Sichuan Integrative Medicine Hospital, Chengdu, 610000, China
| | - Mingxiao Wang
- Sichuan Integrative Medicine Hospital, Chengdu, 610000, China
| | - Zhenting Cui
- The Affiliated Lianyungang Municipal Oriental Hospital of Xuzhou Medical University, Lianyungang, 222042, China
| | - Xia Zhu
- The Affiliated Lianyungang Municipal Oriental Hospital of Xuzhou Medical University, Lianyungang, 222042, China
| | - Fanghong Chen
- The Affiliated Lianyungang Municipal Oriental Hospital of Xuzhou Medical University, Lianyungang, 222042, China
| | - Feng Han
- The Affiliated Lianyungang Municipal Oriental Hospital of Xuzhou Medical University, Lianyungang, 222042, China.
| | - Jianxin Ma
- The Affiliated Lianyungang Municipal Oriental Hospital of Xuzhou Medical University, Lianyungang, 222042, China.
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Bassiri A, Boutros C, Jiang B, Sinopoli J, Tapias Vargas L, Linden PA, Towe CW. Adoption of Minimally Invasive Lung Resection: A National Cancer Database Study. J Surg Res 2024; 302:166-174. [PMID: 39098115 DOI: 10.1016/j.jss.2024.07.036] [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: 03/01/2024] [Revised: 06/26/2024] [Accepted: 07/06/2024] [Indexed: 08/06/2024]
Abstract
INTRODUCTION Minimally invasive lung resection has been associated with improved outcomes; however, institutional characteristics associated with utilization are unclear. We hypothesized that the presence of surgical robots at institutions would be associated with increased utilization of minimally invasive techniques . METHODS Patients with cT1/2N0M0 non-small cell lung cancer who underwent lung lobectomy between 2010 and 2020 in the National Cancer Database were identified. Patients were categorized by operative approach as minimally invasive surgery (MIS) versus open. Institutions were categorized as "high utilizers" of MIS technique if their proportion of MIS lobectomies was >50%. Multivariate logistic regressions were used to determine factors associated with proportion of procedures performed minimally invasively. Further multivariate models were used to evaluate the association of proportion of MIS procedures with 90-d mortality, hospital length of stay, and hospital readmission. RESULTS In multivariate analysis, passage of time by year (odds ratio [OR] 1.26; confidence interval [CI] 1.22-1.30) and presence of a robot at the facility (OR 3.48; CI 2.84-4.24) were associated with high MIS-utilizing facilities. High utilizers of MIS were associated with lower 90-d mortality (OR 0.89; CI 0.83-0.97) and hospital length of stay (coeff -0.88; CI -1.03 to -0.72). Hospital readmission was similar between high and low MIS-utilizing facilities (compared to low MIS-utilizing facilities: OR 1.06; CI 0.95-1.09). CONCLUSIONS Passage of time and the presence of surgical robots were independently associated with increased utilization of MIS lobectomy. In addition to being associated with improved patient-level outcomes, robotic surgery is correlated with a higher proportion of procedures being performed minimally invasively.
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Affiliation(s)
- Aria Bassiri
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
| | - Christina Boutros
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Boxiang Jiang
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jillian Sinopoli
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Leonidas Tapias Vargas
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Philip A Linden
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Christopher W Towe
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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Chen S, Ding Y, Zhang X, Zhang X, Xiang J, Deng Y, Tao X, Cai W, Li Z, Chen J, Kong F, Li N. Efficacy of Transcutaneous Electrical Acupoint Stimulation on Chronic Postsurgical Pain After Video-Assisted Thoracoscopic Lobectomy: Study Protocol for a Prospective Randomized Controlled Trial. Pain Ther 2024; 13:269-280. [PMID: 38367159 DOI: 10.1007/s40122-024-00580-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/29/2024] [Indexed: 02/19/2024] Open
Abstract
INTRODUCTION Patients undergoing video-assisted thoracoscopic lobectomy (VATL) often experience chronic postsurgical pain (CPSP). Postoperative pain can affect the recovery of postoperative lung function, prolong postoperative recovery time, and increase patient hospitalization expenses. Transcutaneous electrical acupoint stimulation (TEAS) is an alternative therapy based on acupuncture that has shown promise in postoperative recovery and pain management across various medical fields. However, research specifically focused on the improvement of CPSP after VATL is currently lacking. The purpose of this study is to evaluate whether TEAS can effectively reduce the severity and occurrence of chronic postsurgical pain in patients undergoing VATL. By investigating the potential benefits of TEAS in mitigating CPSP after VATL, this study aims to provide valuable clinical evidence to support the integration of TEAS into postoperative care protocols for patients undergoing VATL. METHODS This study is a prospective, single-center, double-blinded, randomized controlled trial to be conducted at the 920th Hospital of Joint Logistics Support Force. Eighty patients undergoing VATL will be randomly divided into an experimental group (TEAS group) and a control group (sham group). The experimental group will receive TEAS at bilateral PC6, LI4, LR3, LU5, TE5, and LI11. The control group will not receive TEAS at the same acupoints. Both groups will receive TEAS or no TEAS before anesthesia induction and 1-7 days after surgery, with each session lasting 30 min. PLANNED OUTCOMES The primary outcome will be the incidence of CPSP at 3 months after surgery. Secondary outcomes will include the incidence of CPSP at 6 months after surgery, the numerical rating scale (NRS) scores at 3 and 6 months after surgery, as well as the NRS scores at 24, 48, and 72 h after surgery, remifentanil consumption during general anesthesia, demand for rescue analgesics, number and duration of indwelling chest tubes, incidence of postoperative nausea and vomiting, and changes of norepinephrine (NE), cortisol (Cor), tumor necrosis factor (TNF- α), and interleukin 6 (IL-6) in serum. TRIAL REGISTRATION ChiCTR2300069458. Registered on March 16, 2023.
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Affiliation(s)
- Shuang Chen
- Department of Anesthesiology, 920th Hospital of Joint Logistics Support Force, 212 Daguan Road, Xishan District, Kunming, Yunnan, China
- Kunming Medical University, Kunming, Yunnan, China
| | - Ying Ding
- Department of General Surgery, 920th Hospital of Joint Logistics Support Force, 212 Daguan Road, Xishan District, Kunming, Yunnan, China
| | - Xiaoming Zhang
- Department of Anesthesiology, 920th Hospital of Joint Logistics Support Force, 212 Daguan Road, Xishan District, Kunming, Yunnan, China
| | - Xue Zhang
- Department of Anesthesiology, 920th Hospital of Joint Logistics Support Force, 212 Daguan Road, Xishan District, Kunming, Yunnan, China
- Kunming Medical University, Kunming, Yunnan, China
| | - Jiajia Xiang
- Department of Anesthesiology, 920th Hospital of Joint Logistics Support Force, 212 Daguan Road, Xishan District, Kunming, Yunnan, China
- Kunming Medical University, Kunming, Yunnan, China
| | - Yiling Deng
- Kunming Medical University, Kunming, Yunnan, China
- Department of Orthopedics, The First People's Hospital of Yunnan Province, Xishan District, Kunming, Yunnan, China
| | - Xingran Tao
- Department of Anesthesiology, 920th Hospital of Joint Logistics Support Force, 212 Daguan Road, Xishan District, Kunming, Yunnan, China
| | - Wenke Cai
- Department of Cardiothoracic Surgery, 920th Hospital of Joint Logistics Support Force, 212 Daguan Road, Xishan District, Kunming, Yunnan, China
| | - Zhigui Li
- Department of Anesthesiology, 920th Hospital of Joint Logistics Support Force, 212 Daguan Road, Xishan District, Kunming, Yunnan, China
| | - Jiayu Chen
- Department of Orthopedics, The First People's Hospital of Yunnan Province, Xishan District, Kunming, Yunnan, China
| | - Fanyi Kong
- Department of Neurology, Affiliated Hospital of Yunnan University, 176 Qingnian Road, Wuhua District, Kunming, Yunnan, China
| | - Na Li
- Department of Anesthesiology, 920th Hospital of Joint Logistics Support Force, 212 Daguan Road, Xishan District, Kunming, Yunnan, China.
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Tong C, Niu Z, Zhu H, Li T, Xu Y, Yan Y, Miao Q, Jin R, Zheng J, Li H, Wu J. Development and external validation of a novel model for predicting new clinically important atrial fibrillation after thoracoscopic anatomical lung cancer surgery: a multicenter retrospective cohort study. Int J Surg 2024; 110:1645-1652. [PMID: 38181118 PMCID: PMC10942185 DOI: 10.1097/js9.0000000000001006] [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: 11/06/2023] [Accepted: 12/04/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND New clinically important postoperative atrial fibrillation (POAF) is the most common arrhythmia after thoracoscopic anatomical lung cancer surgery and is associated with increased morbidity and mortality. The full spectrum of predictors remains unclear, and effective assessment tools are lacking. This study aimed to develop and externally validate a novel model for predicting new clinically important POAF. METHODS This retrospective study included 14 074 consecutive patients who received thoracoscopic anatomical lung cancer surgery from January 2016 to December 2018 in Shanghai Chest Hospital. Based on the split date of 1 January 2018, we selected 8717 participants for the training cohort and 5357 participants for the testing cohort. For external validation, we pooled 2941 consecutive patients who received this surgical treatment from July 2016 to July 2021 in Shanghai Ruijin Hospital. Independent predictors were used to develop a model and internally validated using a bootstrap-resampling approach. The area under the receiver operating characteristic curves (AUROCs) and Brier score were performed to assess the model discrimination and calibration. The decision curve analysis (DCA) was used to evaluate clinical validity and net benefit. New clinically important POAF was defined as a new-onset of POAF that causes symptoms or requires treatment. RESULTS Multivariate analysis suggested that age, hypertension, preoperative treatment, clinical tumor stage, intraoperative arrhythmia and transfusion, and operative time were independent predictors of new clinically important POAF. These seven candidate predictors were used to develop a nomogram, which showed a concordance statistic (C-statistic) value of 0.740 and good calibration (Brier score; 0.025). Internal validation revealed similarly good discrimination (C-statistic, 0.736; 95% CI: 0.705-0.768) and calibration. The decision curve analysis showed positive net benefits with the threshold risk range of 0-100%. C-statistic value and Brier score were 0.717 and 0.028 in the testing cohort, and 0.768 and 0.012 in the external validation cohort, respectively. CONCLUSIONS This study identified seven predictors of new clinically important POAF, among which preoperative treatment, intraoperative arrhythmia, and operative time were rarely reported. The established and externally validated model has good performance and clinical usefulness, which may promote the application of prevention and treatment in high-risk patients, and reduce the development and related adverse outcomes of this event.
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Affiliation(s)
- Chaoyang Tong
- Department of Anesthesiology, Shanghai Chest Hospital
- Department of Anesthesiology, Shanghai Children’s Medical Center
| | - Zhenyi Niu
- Department of Thoracic Surgery, Ruijin Hospital
| | - Hongwei Zhu
- Department of Anesthesiology, Shanghai Chest Hospital
| | - Tingting Li
- Department of Anesthesiology, Shanghai Chest Hospital
| | - Yuanyuan Xu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, School of Medicine
| | - Yan Yan
- Department of Thoracic Surgery, Ruijin Hospital
| | - Qing Miao
- Department of Anesthesiology, Shanghai Chest Hospital
| | - Runsen Jin
- Department of Thoracic Surgery, Ruijin Hospital
| | - Jijian Zheng
- Department of Anesthesiology, Shanghai Children’s Medical Center
| | - Hecheng Li
- Department of Thoracic Surgery, Ruijin Hospital
| | - Jingxiang Wu
- Department of Anesthesiology, Shanghai Chest Hospital
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Hong Z, Liu Q, Li H, Cui B, Cheng T, Lu Y, Wu X, Jin D, Gou Y, Dong X. Effect of da Vinci robot versus thoracoscopic surgery on lung function and oxidative stress levels in NSCLC patients: a propensity score-matched study. Surg Endosc 2024; 38:706-712. [PMID: 38030797 DOI: 10.1007/s00464-023-10577-x] [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: 04/20/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND To evaluate the short-term efficacy, lung function, and oxidative stress levels between the robotic-assisted thoracoscopic surgery (RATS) and video-assisted thoracoscopic surgery group (VATS) for non-small cell lung cancer (NSCLC). METHODS We conducted a retrospective cohort study, selecting 248 NSCLC patients who underwent minimally invasive lobectomy at the Department of Thoracic Surgery, Gansu Provincial People's Hospital, from August 2019 to February 2023. There were 105 patients in the RATS group and 143 patients in the VATS group. The patients in the two groups were subjected to 1:1 propensity score matching analysis (PSM), and the perioperative indicators were recorded. The levels of oxidative stress factors (superoxide dismutase, SOD; malondialdehyde, MDA) and inflammatory factors were measured 1 day before surgery and 3 days after surgery, respectively. Pulmonary function and patient quality of life were measured at 1 day preoperatively and 3 months postoperatively. RESULTS There are 93 patients in each group after PSM. Compared to the VATS group, the RATS group had shorter operation time, less intraoperative blood loss, greater number and groups of lymph nodes cleared, and shorter postoperative hospital stay. The SOD level in the RATS group was higher and the MDA level was lower than that in the VATS group after surgery. Postoperative inflammatory cytokine levels were less elevated in the RATS group than in the VATS group. At 3 months postoperatively, FVC%, FEV1%, and GQOLI-74 scores were higher in the RATS group than in the VATS group. CONCLUSION Compared to VATS lobectomy, RATS lobectomy has the advantages of shorter operative time, lesser bleeding, more lymph node dissection, faster postoperative recovery, and lesser impact on postoperative lung function. It is also capable of reducing the postoperative oxidative stress and inflammatory response, which can improve patients' quality of life.
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Affiliation(s)
- Ziqiang Hong
- The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, 730000, Gansu, China
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, 730000, Gansu, China
| | - Qing Liu
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou, 730000, Gansu, China
| | - Hongchao Li
- The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, 730000, Gansu, China
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, 730000, Gansu, China
| | - Baiqiang Cui
- The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, 730000, Gansu, China
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, 730000, Gansu, China
| | - Tao Cheng
- The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, 730000, Gansu, China
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, 730000, Gansu, China
| | - Yingjie Lu
- The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, 730000, Gansu, China
| | - Xusheng Wu
- The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, 730000, Gansu, China
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, 730000, Gansu, China
| | - Dacheng Jin
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, 730000, Gansu, China
| | - Yunjiu Gou
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, 730000, Gansu, China.
| | - Xinchun Dong
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, 730000, Gansu, China.
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Huang S, Huang X, Huang Z, Luo R, Liang W. Comparison of robot-assisted thoracic surgery versus video-assisted thoracic surgery in the treatment of lung cancer: a systematic review and meta-analysis of prospective studies. Front Oncol 2023; 13:1271709. [PMID: 38023124 PMCID: PMC10646752 DOI: 10.3389/fonc.2023.1271709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/26/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Previous studies have compared robot-assisted thoracic surgery(RATS) with video-assisted thoracic surgery (VATS) in the treatment of patients with lung cancer, but results were conflicting. The present meta-analysis aimed to compare the clinical outcomes of RATS with VATS in the treatment of patients with lung cancer. Materials and methods Web of Science, PubMed, Cochrane Library and Embase were comprehensively searched for randomized controlled trials or prospective cohort studies comparing the clinical outcomes of RATS and VATS from inception to 22 July 2023. The Cochrane Risk of Bias tool was used to assess risk of bias. Meta-analyses of length of hospital stay, postoperative duration of drainage, postoperative complications, operative time, conversion, estimated blood loss, the number of dissected lymph nodes and stations, 30-day readmission and 30-day mortality were performed. Results In total 5 studies were included in the meta-analysis. A total of 614 patients were included, of which 299 patients were treated by RATS and 315 patients treated by VATS. Blood loss was significantly less in RATS group than that in VATS (MD = -17.14, 95% CI -29.96 ~ -4.33, P = 0.009). More nodes stations were dissected in RATS group compared with VATS group(MD= 1.07, 95% CI 0.79 ~ 1.36, P < 0.001). No significant difference occurred between RATS and VATS in length of hospital stay(MD= -0.19, 95% CI -0.98~0.61), readmission(OR=0.74, 95%CI 0.36~1.51, P=0.41), operative time(MD=11.43 95% CI -8.41~31.26, P=0.26), conversion(OR=0.58, 95% CI 0.29~1.17, P=0.13), number of dissected lymph nodes(MD=0.98, 95% CI -0.02~1.97, P=0.05), upstaging rate(OR =0.67, 95% CI 0.38 ~ 1.18, P =0.16, I2 = 0%), time of chest tube drainage (MD= -0.34, 95%CI -0.84~0.15, P=0.17), post-operative complications(OR=0.76, 95% CI 0.52~ 1.11, P=0.16) and total cost(MD = 3103.48, 95% CI -575.78 ~ 6782.74, P=0.1, I2 = 99%). Conclusion RATS is a feasible and safe treatment that can achieve better surgical outcomes compared with VATS in terms of short-term outcomes. Except of higher total cost, RATS has obvious advantage in lymphadenectomy and control of intraoperative bleeding. However, large sample and long follow-up randomized clinical trials comparing RATS with VATS are still necessary to better demonstrate the advantages of RATS for lung cancer. Systematic review registration https://www.crd.york.ac.uk/prospero/, Identifier CRD42023446653.
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Affiliation(s)
| | | | | | | | - Weiming Liang
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
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Bottet B, Piton N, Selim J, Sarsam M, Guisier F, Baste JM. Beyond the Frontline: A Triple-Line Approach of Thoracic Surgeons in Lung Cancer Management-State of the Art. Cancers (Basel) 2023; 15:4039. [PMID: 37627067 PMCID: PMC10452134 DOI: 10.3390/cancers15164039] [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: 07/07/2023] [Revised: 07/26/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
Non-small cell lung cancer (NSCLC) is now described as an extremely heterogeneous disease in its clinical presentation, histology, molecular characteristics, and patient conditions. Over the past 20 years, the management of lung cancer has evolved with positive results. Immune checkpoint inhibitors have revolutionized the treatment landscape for NSCLC in both metastatic and locally advanced stages. The identification of molecular alterations in NSCLC has also allowed the development of targeted therapies, which provide better outcomes than chemotherapy in selected patients. However, patients usually develop acquired resistance to these treatments. On the other hand, thoracic surgery has progressed thanks to minimally invasive procedures, pre-habilitation and enhanced recovery after surgery. Moreover, within thoracic surgery, precision surgery considers the patient and his/her disease in their entirety to offer the best oncologic strategy. Surgeons support patients from pre-operative rehabilitation to surgery and beyond. They are involved in post-treatment follow-up and lung cancer recurrence. When conventional therapies are no longer effective, salvage surgery can be performed on selected patients.
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Affiliation(s)
- Benjamin Bottet
- Department of General and Thoracic Surgery, Hospital Center University De Rouen, 1 Rue de Germont, F-76000 Rouen, France; (B.B.); (M.S.)
| | - Nicolas Piton
- Department of Pathology, UNIROUEN, INSERM U1245, CHU Rouen, Normandy University, F-76000 Rouen, France;
| | - Jean Selim
- Department of Anaesthesiology and Critical Care, CHU Rouen, F-76000 Rouen, France;
- INSERM EnVI UMR 1096, University of Rouen Normandy, F-76000 Rouen, France
| | - Matthieu Sarsam
- Department of General and Thoracic Surgery, Hospital Center University De Rouen, 1 Rue de Germont, F-76000 Rouen, France; (B.B.); (M.S.)
| | - Florian Guisier
- Department of Pneumology, CHU Rouen, 1 Rue de Germont, F-76000 Rouen, France;
- Clinical Investigation Center, Rouen University Hospital, CIC INSERM 1404, 1 Rue de Germont, F-76000 Rouen, France
| | - Jean-Marc Baste
- Department of General and Thoracic Surgery, Hospital Center University De Rouen, 1 Rue de Germont, F-76000 Rouen, France; (B.B.); (M.S.)
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Potter AL, Spasojevic A, Raman V, Hurd JC, Senthil P, Mathey-Andrews C, Schumacher LY, Yang CFJ. The Increasing Adoption of Minimally Invasive Lobectomy in the United States. Ann Thorac Surg 2023; 116:222-229. [PMID: 36223806 DOI: 10.1016/j.athoracsur.2022.09.032] [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: 01/07/2022] [Revised: 08/22/2022] [Accepted: 09/03/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND The objective of this study is to evaluate the trends of and outcomes associated with the use of minimally invasive lobectomy for stage I and II non-small cell lung cancer (NSCLC) in the United States. METHODS The use of and outcomes associated with open and minimally invasive lobectomy for clinical stage I and stage II NSCLC from 2010 to 2017 in the National Cancer Database were assessed by multivariable logistic regression and propensity score matching. RESULTS From 2010 to 2017, use of minimally invasive lobectomies increased for stage I NSCLC (multivariable-adjusted odds ratio [aOR] 4.52; 95% CI, 3.95-5.18; P < .001) and stage II NSCLC (aOR 4.38; 95% CI, 3.38-5.68; P < .001). In 2015, for the first time, more lobectomies for stage I NSCLC were performed by minimally invasive techniques (52.2%, n = 5647) than by thoracotomy (47.8%, n = 5164); and in 2017, more lobectomies for stage II NSCLC were performed by minimally invasive techniques (54.7%, n = 1620) than by thoracotomy (45.3%, n = 1,342). From 2010 to 2017, the conversion rates from minimally invasive to open lobectomy for stage I NSCLC decreased from 19.6% (n = 466) to 7.2% (n = 521; aOR 0.32; 95% CI, 0.23-0.43; P < .001). Similarly, from 2010 to 2017, the conversion rates from minimally invasive to open lobectomy for stage II NSCLC decreased from 20% (n = 114) to 11.5% (n = 186; aOR 0.39; 95% CI, 0.21-0.72; P = .002). CONCLUSIONS In the United States, for stage I and stage II NSCLC from 2010 to 2017, the use of minimally invasive lobectomy significantly increased while the conversion rate significantly decreased. By 2017, the minimally invasive approach had become the predominant approach for both stage I and stage II NSCLC.
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Affiliation(s)
- Alexandra L Potter
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Ana Spasojevic
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Vignesh Raman
- Division of Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Jacob C Hurd
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Priyanka Senthil
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Camille Mathey-Andrews
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Lana Y Schumacher
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Chi-Fu Jeffrey Yang
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts; Division of Thoracic Surgery, Wentworth-Douglass Hospital, Dover, New Hampshire.
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9
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Tang P, Sun D, Xu W, Li H, Chen L. Long non‑coding RNAs as potential therapeutic targets in non‑small cell lung cancer (Review). Int J Mol Med 2023; 52:68. [PMID: 37350412 PMCID: PMC10413047 DOI: 10.3892/ijmm.2023.5271] [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: 12/17/2022] [Accepted: 05/02/2023] [Indexed: 06/24/2023] Open
Abstract
Non‑small cell lung cancer (NSCLC) is one of the most common malignancies with a high morbidity and mortality rate. Long non‑coding RNAs (lncRNAs) have been reported to be closely associated with the occurrence and progression of NSCLC. In addition, lncRNAs have been documented to participate in the development of drug resistance and radiation sensitivity in patients with NSCLC. Due to their extensive functional characterization, high tissue specificity and sex specificity, lncRNAs have been proposed to be novel biomarkers and therapeutic targets for NSCLC. Therefore, in the current review, the functional classification of lncRNAs were presented, whilst the potential roles of lncRNAs in NSCLC were also summarized. Various physiological aspects, including proliferation, invasion and drug resistance, were all discussed. It is anticipated that the present review will provide a perspective on lncRNAs as potential diagnostic molecular biomarkers and therapeutic targets for NSCLC.
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Affiliation(s)
- Peiyu Tang
- Wuya College of Innovation, Key Laboratory of Structure-Based Drug Design and Discovery, Ministry of Education, Shenyang Pharmaceutical University, Shenyang, Liaoning 110016
| | - Dejuan Sun
- Wuya College of Innovation, Key Laboratory of Structure-Based Drug Design and Discovery, Ministry of Education, Shenyang Pharmaceutical University, Shenyang, Liaoning 110016
| | - Wei Xu
- Institute of Structural Pharmacology and TCM Chemical Biology, College of Pharmacy, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, P.R. China
| | - Hua Li
- Wuya College of Innovation, Key Laboratory of Structure-Based Drug Design and Discovery, Ministry of Education, Shenyang Pharmaceutical University, Shenyang, Liaoning 110016
- Institute of Structural Pharmacology and TCM Chemical Biology, College of Pharmacy, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, P.R. China
| | - Lixia Chen
- Wuya College of Innovation, Key Laboratory of Structure-Based Drug Design and Discovery, Ministry of Education, Shenyang Pharmaceutical University, Shenyang, Liaoning 110016
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Salimy S, Lanjanian H, Abbasi K, Salimi M, Najafi A, Tapak L, Masoudi-Nejad A. A deep learning-based framework for predicting survival-associated groups in colon cancer by integrating multi-omics and clinical data. Heliyon 2023; 9:e17653. [PMID: 37455955 PMCID: PMC10344710 DOI: 10.1016/j.heliyon.2023.e17653] [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: 04/30/2023] [Revised: 05/30/2023] [Accepted: 06/25/2023] [Indexed: 07/18/2023] Open
Abstract
Precise prognostic classification of patients and identifying survival subgroups and their associated genes can be important clinical references when designing treatment strategies for cancer patients. Multi-omics and data integration techniques are powerful tools to achieve this goal. This study aimed to introduce a machine learning method to integrate three types of biological data, and investigate the performance of two other methods, in identifying the survival dependency of patients. The data included TCGA RNA-seq gene expression, DNA methylation, and clinical data from 368 patients with colon cancer also we use an independent external validation data set, containing 232 samples. Three methods including, hyper-parameter optimized autoencoders (HPOAE), normal autoencoder, and penalized principal component analysis (PPCA) were used for simultaneous data integration and estimation under a COX hazards model. The HPOAE was thought to outperform other methods. The HPOAE had the Log Rank Mantel-Cox value of 14.27 ± 2, and a Breslow-Generalized Wilcoxon value of 13.13 ± 1. Ten miRNA, 11 methylated genes, and 28 mRNA all by (importance of marginal cutoff > 0.95) were identified. The study demonstrated that hsa-miR-485-5p targets both ZMYM1 and tp53, the latter of which has been previously associated with cancer in numerous studies. Furthermore, compared to other methods, the HPOAE exhibited a greater capacity for identifying survival subgroups and the genes associated with them in patients with colon cancer. However, all of the results were obtained by computational methods, and clinical and experimental studies are needed to validate these results.
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Affiliation(s)
- Siamak Salimy
- Laboratory of System Biology and Bioinformatics (LBB), Department of Bioinformatics, University of Tehran, Kish International Campus, Kish, Iran
| | - Hossein Lanjanian
- Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Karim Abbasi
- Laboratory of System Biology, Bioinformatics & Artificial Intelligent in Medicine (LBBai), Faculty of Mathematics and Computer Science, Kharazmi University, Tehran, Iran
| | - Mahdieh Salimi
- Department of Medical Genetics, Institute of Medical Biotechnology, National Institute of Genetic Engineering and Biotechnology (NIGEB), Tehran, Iran
| | - Ali Najafi
- Molecular Biology Research Center, Systems Biology and Poisonings Institute, Tehran, Iran
| | - Leili Tapak
- Department of Biostatistics, School of Public Health and Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ali Masoudi-Nejad
- Laboratory of System Biology and Bioinformatics (LBB), Department of Bioinformatics, University of Tehran, Kish International Campus, Kish, Iran
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Wang J, Li R, Chang J, Wang Y, Lai Y, Dong Y, Che G. Quality of life between home-based and outpatient pulmonary rehabilitation in patients after surgical resection for lung cancer: protocol for a prospective, single-blind, randomised controlled trial. BMJ Open 2023; 13:e067845. [PMID: 37156593 PMCID: PMC10174035 DOI: 10.1136/bmjopen-2022-067845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
INTRODUCTION Lung cancer remains a highly fatal disease. Surgical resection has been proven to be the most effective treatment for early-stage lung cancer. The conventional hospital-based pulmonary rehabilitation (PR) is shown to reduce symptoms, improve exercise capacity and impact the quality of life (QoL) for lung cancer patients. To date, scientific evidence on the effectiveness of home-based PR for patients with lung cancer following surgery is scarce. We aim to explore if home-based PR is non-inferior to outpatient PR for patients with lung cancer following surgical resection. METHODS AND ANALYSIS This study is a two-arm, parallel-group, assessor-blind, single-centre, randomised controlled trial. Participants will be recruited from West China Hospital, Sichuan University and randomly allocated to either an outpatient group or a home-based group at a ratio of 1:1. The PR programme involves self-management and exercises. The exercise includes warm-up (10 min), aerobic training (20 min), resistance training (15 min) and cool-down (10 min), lasting 4 weeks, with two sessions per week either at home or in the outpatient setting. The intensity will be adjusted according to the modified Borg rating of perceived exertion and heart rate before and after each exercise session. The primary outcome is QoL measured by EORTC QLQ-C30 & LC 13 after an intervention. Secondary outcomes include physical fitness measured by a 6 min walk test and stair-climbing test and symptom severity measured by patient-reported questionnaires and pulmonary function. The main hypothesis is that home-based PR is non-inferior to outpatient PR for patients with lung cancer following surgical resection. ETHICS AND DISSEMINATION The trial has been approved by the Ethical Committee of West China Hospital and is also registered with the Chinese Clinical Trial Registry. The results of this study will be disseminated through peer-reviewed publications and presentations at national and international conferences. TRIAL REGISTRATION NUMBER ChiCTR2100053714.
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Affiliation(s)
- Jiao Wang
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Ran Li
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, Sichuan University West China Hospital, Chengdu, Sichuan, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Junke Chang
- Department of Thoracic Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Yan Wang
- Department of Thoracic Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Yutian Lai
- Lung Cancer Center, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Yingxian Dong
- Department of Thoracic Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Guowei Che
- Department of Thoracic Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
- Lung Cancer Center, Sichuan University West China Hospital, Chengdu, Sichuan, China
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12
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Prevalence and Predictors of Chronic Postsurgical Pain After Video-Assisted Thoracoscopic Surgery: A Systematic Review and Meta-analysis. Pain Ther 2023; 12:117-139. [PMID: 36227420 PMCID: PMC9845490 DOI: 10.1007/s40122-022-00439-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 09/15/2022] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Determining the prevalence of chronic postsurgical pain (CPSP) after video-assisted thoracoscopic surgery (VATS) and identifying CPSP predictors should improve the prognosis of patients undergoing VATS. Although several studies have investigated predictors of CPSP after VATS, there were significant dissimilarities in the findings due to the confounding of predictors. METHODS PubMed, Cochrane, MEDLINE, Web of Science, Chinese Biomedical Literature, and China National Knowledge Infrastructure databases were comprehensively searched using the Medical Subject Headings terms "pain, postoperative," "thoracic surgery, video-assisted," and all related free terms from inception until March 27, 2022. The Stata metaprop package was used to comprehensively analyze the incidence of CPSP following VATS. Furthermore, the pooled odds ratios (OR) or the standardized mean differences (SMD) and their corresponding 95% confidence intervals (95% CI) were calculated, and qualitative analyses were performed for predictors that could not be assessed quantitatively to evaluate the effects of the included risk factors on the occurrence of CPSP. Unadjusted odds ratios were utilized to consider the impact of non-significant estimates if the original study did not report them. RESULTS Of the 4302 studies, 183 were considered eligible, and 17 were finally included in this study. The overall incidence of CPSP after VATS was 35.3% (95% CI 27.1-43.5%). The qualitative synthesis results revealed that female sex, age, and acute postoperative pain were definite predictors of CPSP after VATS. The number of ports, operation time, duration of drainage, and insufficient analgesia were also considered predictors. Consistent, quantitative synthesis results also showed that the aforementioned predictors were closely related to the occurrence of CPSP after VATS. Only by quantitative analysis, postoperative chemotherapy and an educational level less than junior school were also risk factors for CPSP. Other predictors displayed no evidence or unclear evidence of association with CPSP after VATS. CONCLUSION This study preliminarily determined the incidence of CPSP after VATS based on the existing literature. Female sex, age, and acute pain were identified as risk factors for CPSP after VATS, and other potential risk factors were also identified and analyzed. However, as a result of the inclusion of retrospective studies and inevitable limitations in this systematic review and meta-analysis, the results of this study still need to be verified by large-scale prospective clinical studies. TRIAL REGISTRATION CRD42022323179.
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Tong C, Shen Y, Zhu H, Zheng J, Xu Y, Wu J. Continuous Relationship of Operative Duration with Risk of Adverse Perioperative Outcomes and Early Discharge Undergoing Thoracoscopic Lung Cancer Surgery. Cancers (Basel) 2023; 15:cancers15020371. [PMID: 36672321 PMCID: PMC9856387 DOI: 10.3390/cancers15020371] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/20/2022] [Accepted: 12/28/2022] [Indexed: 01/08/2023] Open
Abstract
Background: For thoracoscopic lung cancer surgery, the continuous relationship and the trigger point of operative duration with a risk of adverse perioperative outcomes (APOs) and early discharge remain unknown. Methods: This study enrolled 12,392 patients who underwent this surgical treatment. Five groups were stratified by operative duration: <60 min, 60−120 min, 120−180 min, 180−240 min, and ≥240 min. APOs included intraoperative hypoxemia, delayed extubation, postoperative pulmonary complications (PPCs), prolonged air leakage (PAL), postoperative atrial fibrillation (POAF), and transfusion. A restricted cubic spline (RCS) plot was used to characterize the continuous relationship of operative duration with the risk of APOs and early discharge. Results: The risks of the aforementioned APOs increased with each additional hour after the first hour. A J-shaped association with APOs was observed, with a higher risk in those with prolonged operative duration compared with those with shorter values. However, the probability of early discharge decreased from 0.465 to 0.350, 0.217, and 0.227 for each additional hour of operative duration compared with counterparts (<60 min), showing an inverse J-shaped association. The 90 min procedure appears to be a tipping point for a sharp increase in APOs and a significant reduction in early discharge. Conclusions: Our findings have important and meaningful implications for risk predictions and clinical interventions, and early rehabilitation, for APOs.
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Affiliation(s)
- Chaoyang Tong
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200052, China
- Department of Anesthesiology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Yaofeng Shen
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200052, China
| | - Hongwei Zhu
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200052, China
| | - Jijian Zheng
- Department of Anesthesiology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
- Correspondence: (J.Z.); (J.W.)
| | - Yuanyuan Xu
- Department of Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Jingxiang Wu
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200052, China
- Correspondence: (J.Z.); (J.W.)
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14
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Chen WC, Zhang LH, Bai YY, Liu YB, Liang JW, He HF. Nomogram prediction of chronic postsurgical pain in patients with lung adenocarcinoma after video-assisted thoracoscopic surgery: A prospective study. Front Surg 2022; 9:1004205. [PMID: 36439523 PMCID: PMC9681821 DOI: 10.3389/fsurg.2022.1004205] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/24/2022] [Indexed: 09/13/2023] Open
Abstract
Chronic postsurgery pain (CPSP) refers to persistent or repeated pain around the incision after surgery. Different from acute postoperative pain, the persistence of CPSP seriously affects the quality of life of patients. CPSP has a considerable global impact due to large surgical volumes. Although the development of video-assisted thoracoscopy (VATS) has reduced the risk of CPSP, it still seriously affects patients' quality of life. Clinical recognition of CPSP at an early stage is limited; therefore, we aimed to develop and validate a nomogram to identify the significant predictive factors associated with CPSP after VATS in patients with lung adenocarcinoma. We screened 137 patients with invasive adenocarcinoma of the lung from among 312 patients undergoing VATS. In this prospective study, patients were divided into the CPSP (n = 52) and non-CPSP (n = 85) groups according to the occurrence of CPSP. Relevant information was collected 1 day before surgery and 1-3 days after surgery, and the occurrence of CPSP was followed up by telephone at 3 months after surgery. Data on clinical characteristics and peripheral blood leukocyte miRNAs were used to establish a nomogram for predicting CPSP using least absolute shrinkage and selection operator (LASSO) regression methods. The area under curve (AUC) was used to determine the recognition ability of the nomograms. The model was subjected to correction and decision curve analyses. Four variables-body mass index (BMI), history of chronic pain, miR 550a-3p, and visual analog scale (VAS) score on postoperative day 2 (VAS2d)-were selected according to LASSO regression to build the nomogram. The nomogram demonstrated adequate calibration and discrimination in the prediction model, with an AUC of 0.767 (95% confidence interval: 0.679-0.856). The calibration plot showed the best fit between model predictions and practical observations, suggesting that the use of the proposed nomogram to predict CPSP is beneficial. A nomogram consisting of BMI, history of chronic pain, miR 550a-3p, and VAS2d predicted the risk of CPSP after VATS in patients with lung adenocarcinoma.
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Affiliation(s)
| | | | | | | | - Jin-wei Liang
- Department of Anesthesiology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, China
| | - He-fan He
- Department of Anesthesiology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, China
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15
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Choi H, Hwang W. Perioperative Inflammatory Response and Cancer Recurrence in Lung Cancer Surgery: A Narrative Review. Front Surg 2022; 9:888630. [PMID: 35898583 PMCID: PMC9309428 DOI: 10.3389/fsurg.2022.888630] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 06/24/2022] [Indexed: 11/14/2022] Open
Abstract
While surgical resection is the gold standard treatment for solid tumors, cancer recurrence after surgery is common. Immunosurveillance of remnant tumor cells is an important protective mechanism. Therefore, maintenance of anti-tumor cell activity and proper levels of inflammatory mediators is crucial. An increasing body of evidence suggests that surgery itself and perioperative interventions could affect these pathophysiological responses. Various factors, such as the extent of tissue injury, perioperative medications such as anesthetics and analgesics, and perioperative management including transfusions and methods of mechanical ventilation, modulate the inflammatory response in lung cancer surgery. This narrative review summarizes the pathophysiological mechanisms involved in cancer recurrence after surgery and perioperative management related to cancer recurrence after lung cancer surgery.
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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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Mitzman B, Wang X, Haaland B, Varghese TK. Trends and factors affecting approach choice to pulmonary resection. J Surg Oncol 2022; 126:599-608. [DOI: 10.1002/jso.26923] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/28/2022] [Accepted: 05/05/2022] [Indexed: 01/26/2023]
Affiliation(s)
- Brian Mitzman
- Division of Cardiothoracic Surgery University of Utah Health Salt Lake City Utah USA
- Huntsman Cancer Institute Salt Lake City Utah USA
| | - Xuechen Wang
- Department of Population Health Sciences University of Utah Salt Lake City Utah USA
| | - Ben Haaland
- Huntsman Cancer Institute Salt Lake City Utah USA
- Department of Population Health Sciences University of Utah Salt Lake City Utah USA
| | - Thomas K. Varghese
- Division of Cardiothoracic Surgery University of Utah Health Salt Lake City Utah USA
- Huntsman Cancer Institute Salt Lake City Utah USA
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18
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Xu W, Dai W, Gao Z, Wang XS, Tang L, Pu Y, Yu Q, Yu H, Nie Y, Zhuang W, Qiao G, Cleeland CS, Shi Q. Establishment of Minimal Clinically Important Improvement for Patient-Reported Symptoms to Define Recovery After Video-Assisted Thoracoscopic Surgery. Ann Surg Oncol 2022; 29:5593-5604. [DOI: 10.1245/s10434-022-11629-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 01/25/2022] [Indexed: 12/15/2022]
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Tong C, Zheng J, Wu J. The effects of paravertebral blockade usage on pulmonary complications, atrial fibrillation and length of hospital stay following thoracoscopic lung cancer surgery. J Clin Anesth 2022; 79:110770. [PMID: 35334289 DOI: 10.1016/j.jclinane.2022.110770] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/03/2022] [Accepted: 03/16/2022] [Indexed: 11/25/2022]
Abstract
STUDY OBJECTIVE Although combined thoracic paravertebral blockade (TPVB)-general anesthesia (GA) could improve pain control compared to GA alone after thoracoscopic lung cancer surgery, it has not been established whether this improvement in pain control could reduce associated adverse outcomes. Thus, this study aimed to explore the association between TPVB usage and adverse outcomes after thoracoscopic lung cancer surgery. DESIGN Retrospective cohort study from a prospective database. SETTING A high-volume thoracic center in China. PATIENTS 13966 consecutive patients who received thoracoscopic lung cancer surgery from January 2016 to December 2018 in Shanghai Chest Hospital were enrolled. MEASUREMENTS With a 1:1 propensity score matching (PSM) analysis, adverse outcomes between GA alone and GA-TPVB were investigated. Multivariate and multiple linear regression analysis were used to identify factors and calculate odds radio (OR) for adverse outcomes. RESULTS The rate of TPVB usage was 14.8% (2070 out of 13,966). TPVB combined with GA was associated with lower rates of postoperative pulmonary complications (PPCs) (30.4% vs 33.5%, P = 0.005) and postoperative atrial fibrillation (POAF) (2.1% vs 2.9%, P = 0.041), and shorter length of hospital stay (LOS) (Median [IQR]; 5[4-5] vs 5[4-6]) days, P < 0.001) compared to GA alone. After a 1:1 PSM analysis, we investigated adverse outcomes in 2640 (1320 pairs) patients with or without TPVB usage, and this association remained existed, namely, the rates of PPCs (29.8% vs 34.2%, P = 0.014) and POAF (2.2% vs 3.6%, P = 0.028) were lower and LOS was shorter (5[4-5] vs 5[4-6] days, P < 0.001) in the GA-TPVB group. In multivariate analysis, the combination of GA plus TPVB was independent predictor for PPCs (OR = 0.879, 95%CI, 0.793-0.974, P = 0.014) and POAF (OR = 0.714, 95%CI, 0.516-0.988, P = 0.042), respectively. However, in multiple linear analysis, lower rates of PPCs and POAF associated with TPVB usage, rather than TPVB usage, were responsible for the reduced LOS. CONCLUSIONS The usage of TPVB may be a feasible and adjustable approach to reduce the rates of PPCs and POAF and associated LOS in thoracoscopic lung cancer surgery.
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Affiliation(s)
- Chaoyang Tong
- Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, China; Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, China
| | - Jijian Zheng
- Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, China
| | - Jingxiang Wu
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, China.
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20
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Moon DH, Park J, Park YG, Kim BJ, Woo W, Na H, Oh S, Lee HS, Lee S. Intramuscular stimulation as a new modality to control postthoracotomy pain: A randomized clinical trial. J Thorac Cardiovasc Surg 2022; 164:1236-1245. [PMID: 35410693 DOI: 10.1016/j.jtcvs.2022.02.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 02/18/2022] [Accepted: 02/25/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Postoperative pain after thoracic surgery primarily hinders patients' mobility, decreasing the quality of life. To date, various modalities have been suggested to improve postoperative pain. However, pain alleviation still remains a challenge, resulting in continued reliance on opioids. To tackle this problem, this study introduces a needle electrical twitch obtaining intramuscular stimulation (NETOIMS) as a new effective treatment modality for postoperative pain after thoracoscopic surgery. METHODS This randomized clinical trial analyzed patients receiving video-assisted thoracoscopic surgery pulmonary resection between March 2018 and June 2020 at a single institution. A total of 77 patients (NETOIMS, 36; intravenous patient-controlled analgesia, 41) were included. NETOIMS was conducted on the retracted intercostal muscle immediately following the main procedure, just before skin closure. Postoperative pain (numeric rating scale) and oral opioid morphine milligram equivalent were assessed daily until postoperative day 5. RESULTS The NETOIMS group had a significantly lower numeric rating scale score on postoperative day (POD) 0 (P < .01), POD2 (P < .001), POD4 (P < .001), and POD5 (P = .01). The predicted time to complete pain resolution was 6.15 days in the NETOIMS group and 20.7 days in the intravenous patient-controlled analgesia group. The oral opioid morphine milligram equivalent was significantly lower in the NETOIMS group on POD0 (P < .001) and POD1 (P < .001). CONCLUSIONS NETOIMS appears to be an effective modality in alleviating postoperative pain after thoracoscopic surgery, thereby reducing the reliance on opioid use.
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Affiliation(s)
- Duk Hwan Moon
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinyoung Park
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yoon Ghil Park
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Bong Jun Kim
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Wongi Woo
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hannah Na
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sunyoung Oh
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Department of Research Affairs, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sungsoo Lee
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Wang R, Wang Q, Jiang S, Chen C, Zheng J, Liu H, Liang X, Chen Z, Wang H, Guo Z, Liang W, He J, Liang H, Wang W. Spontaneous Ventilation Video-Assisted Thoracoscopic Surgery for Non-small-cell Lung Cancer Patients With Poor Lung Function: Short- and Long-Term Outcomes. Front Surg 2022; 9:800082. [PMID: 35310434 PMCID: PMC8928927 DOI: 10.3389/fsurg.2022.800082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThe goal of this study was to explore the feasibility and safety of spontaneous ventilation video-assisted thoracoscopic surgery (SV-VATS) for non-small-cell lung cancer (NSCLC) patients with poor lung function.MethodsNSCLC patients with poor lung function who underwent SV-VATS or mechanical ventilation VATS (MV-VATS) from 2011 to 2018 were analyzed. 1:2 Propensity score matching (PSM) was applied, and the short- and long-term outcomes between the SV-VATS group and the MV-VATS group were compared.ResultsAnesthesia time (226.18 ± 64.89 min vs. 248.27 ± 76.07 min; P = 0.03), operative time (140.85 ± 76.07 min vs. 163.12 ± 69.37 min; P = 0.01), days of postoperative hospitalization (7.29 ± 3.35 days vs. 8.40 ± 7.89 days; P = 0.04), and days of chest tube use (4.15 ± 2.89 days vs. 5.15 ± 3.54 days; P = 0.01), the number of N1 station lymph node dissection (2.94 ± 3.24 vs. 4.34 ± 4.15; P = 0.005) and systemic immune-inflammation index (3855.43 ± 3618.61 vs. 2908.11 ± 2933.89; P = 0.04) were lower in SV-VATS group. Overall survival and disease-free survival were not significantly different between the two groups (OS: HR 0.66, 95% CI: 0.41–1.07, P = 0.09; DFS: HR 0.78, 95% CI: 0.42–1.45, P = 0.43).ConclusionsComparable short-term and long-term outcomes indicated that SV-VATS is a feasible and safe method and might be an alternative to MV-VATS when managing NSCLC patients with poor lung function.
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Affiliation(s)
- Runchen Wang
- State Key Laboratory of Respiratory Disease, Department of Thoracic Surgery and Oncology, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Qixia Wang
- State Key Laboratory of Respiratory Disease, Department of Thoracic Surgery and Oncology, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Shunjun Jiang
- State Key Laboratory of Respiratory Disease, Department of Thoracic Surgery and Oncology, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chao Chen
- State Key Laboratory of Respiratory Disease, Department of Thoracic Surgery and Oncology, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Jianqi Zheng
- State Key Laboratory of Respiratory Disease, Department of Thoracic Surgery and Oncology, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Hui Liu
- Department of Anesthesia, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xueqing Liang
- School of Public Health, Southern Medical University, Guangzhou, China
| | - Zhuxing Chen
- State Key Laboratory of Respiratory Disease, Department of Thoracic Surgery and Oncology, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Haixuan Wang
- State Key Laboratory of Respiratory Disease, Department of Thoracic Surgery and Oncology, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhuoxuan Guo
- State Key Laboratory of Respiratory Disease, Department of Thoracic Surgery and Oncology, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wenhua Liang
- State Key Laboratory of Respiratory Disease, Department of Thoracic Surgery and Oncology, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jianxing He
- State Key Laboratory of Respiratory Disease, Department of Thoracic Surgery and Oncology, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Hengrui Liang
- State Key Laboratory of Respiratory Disease, Department of Thoracic Surgery and Oncology, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- *Correspondence: Hengrui Liang
| | - Wei Wang
- State Key Laboratory of Respiratory Disease, Department of Thoracic Surgery and Oncology, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Wei Wang
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Yun J, Lee J, Shin S, Kim HK, Choi YS, Kim J, Zo JI, Shim YM, Cho JH. Video-assisted thoracoscopic lobectomy versus open lobectomy in the treatment of large lung cancer: propensity-score matched analysis. J Cardiothorac Surg 2022; 17:2. [PMID: 34996488 PMCID: PMC8742315 DOI: 10.1186/s13019-021-01749-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 12/28/2021] [Indexed: 12/25/2022] Open
Abstract
Background There are several concerns on thoracoscopic surgery for large tumors because of the increased risk of tumor cell spillage. This study aimed to compare perioperative outcomes and oncological validity between video-assisted thoracoscopic surgery (VATS) and open lobectomy for non-small cell lung cancer (NSCLC) with tumor size > 5 cm. Methods We retrospectively reviewed 355 patients who underwent lobectomy with clinical N0 NSCLC with solid tumor component diameter > 5 cm between January 2009 and December 2016. Patients with tumor invading adjacent structures were excluded. The patients were divided into the VATS group (n = 132) and thoracotomy group (n = 223). Propensity score matching (1:1) was applied. Results After propensity score matching, 204 patients were matched, and clinical characteristics of the two groups were well balanced. The VATS group was associated with a shorter length of hospital stay (6 days vs. 7 days; P < 0.001) than the thoracotomy group. There were no significant differences in the 5-year overall survival (71.5% in VATS vs. 64.4% in thoracotomy, P = 0.390) and 5-year recurrence-free survival (60.1% in VATS vs. 51.5% in thoracotomy, P = 0.210) between the two groups. The cumulative incidence of ipsilateral pleural recurrence was not significantly different between the two groups (12.0% in VATS vs. 7.9% in thoracotomy; P = 0.582). Conclusions In clinical N0 NSCLC larger than 5 cm, VATS lobectomy resulted in shorter hospital stay and similar survival outcome compared to open lobectomy. Based on these results, VATS lobectomy is a valuable option in this subset of patients. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-021-01749-8.
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Affiliation(s)
- Jeonghee Yun
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06531, South Korea
| | - Junghee Lee
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06531, South Korea
| | - Sumin Shin
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06531, South Korea
| | - Hong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06531, South Korea
| | - Yong Soo Choi
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06531, South Korea
| | - Jhingook Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06531, South Korea
| | - Jae Il Zo
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06531, South Korea
| | - Young Mog Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06531, South Korea
| | - Jong Ho Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06531, South Korea.
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OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6540689. [DOI: 10.1093/ejcts/ezac148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 02/05/2022] [Accepted: 02/18/2022] [Indexed: 01/12/2023] Open
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Zhao H, Wu Y, Zhang X, Feng Y. The Effect of Preoperative Serratus Anterior Muscle Plane Block on Persistent Postsurgical Pain After Video-assisted Thoracic Surgery: A Retrospective Cohort Study. Clin J Pain 2021; 37:759-765. [PMID: 34334692 DOI: 10.1097/ajp.0000000000000969] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 07/20/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Acute pain intensity is a strong indicator for the occurrence of persistent postsurgical pain (PPP) after video-assisted thoracic surgery (VATS). The effect of preoperative serratus anterior muscle plane block (SAPB) on PPP was investigated. MATERIALS AND METHODS In this retrospective cohort study, data of 148 patients who underwent VATS for lung nodules in 2019 were collected. Seventy-four patients received a single-shot of SAPB with 0.33% ropivacaine 30 mL after anesthesia induction and another 74 patients received intercostal blocks using 1% ropivacaine 10 mL at the fifth to seventh intercostal spaces after surgery. Postoperative analgesia was accomplished by continuous infusion of flurbiprofen (8 mg/h), and intravenous oxycodone rescue (1 mg) given on demand. Pain intensity was recorded at 24 and 48 hours after surgery and all patients were followed up 3 months after surgery investigating the occurrence of PPP. RESULTS Intraoperative sufentanil in the SAPB group was significantly decreased in comparison with Control group (0.34±0.09 vs. 0.43±0.14 ug/kg, P<0.001). The incidence of PPP was comparable between 2 groups (20.2% [15/74] vs. 14.8% [11/74], P=0.078). All patients who experienced PPP rated their PPP as mild, except 1 patient in Control group rated her pain as moderate. Multivariate logistic regression showed that pain score at 24 hours (odds ratio 1.646, 95% confidence interval [1.058, 2.560], P=0.027) and female (odds ratio 3.711, 95% confidence interval [1.274, 10.810], P=0.026) were independent risk factors for the development of PPP. DISCUSSION When SAPB was combined with continuous infusion of nonsteroidal anti-inflammatory drugs, no patient had moderate chronic pain. Pain score at 24 hours after surgery and female were risk factors for PPP after VATS.
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Affiliation(s)
- Hong Zhao
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China
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Takizawa H, Miyamoto N, Sakamoto S, Takashima M, Matsumoto D, Kawakita N, Toba H, Kawakami Y, Yoshida M, Kondo K, Tangoku A. Hypervascularized bronchial arteries as a risk factor for intraoperative bleeding and prolonged surgery. J Thorac Dis 2021; 13:4731-4741. [PMID: 34527314 PMCID: PMC8411168 DOI: 10.21037/jtd-21-616] [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: 04/08/2021] [Accepted: 06/19/2021] [Indexed: 11/19/2022]
Abstract
Background The present study investigated whether highly vascularized bronchial arteries affect the intraoperative blood loss and the operative time of video-assisted thoracic surgery (VATS) lobectomy for patients with non-small cell lung cancer. Results Among the 175 patients enrolled, risk factors for intraoperative blood loss >50 mL were being male (P=0.005), a history of smoking (P=0.01), percent forced expiratory volume in 1 s (FEV1.0%) <70% (P=0.012), squamous cell carcinoma (P=0.049), and a bronchial artery diameter >2.0 mm (P<0.001) in the unadjusted analysis, and a bronchial artery diameter >2.0 mm (P<0.001) in the multivariable analysis. Risk factors for an operative time >200 min were being male (P<0.001), a history of smoking (P=0.007), FEV1.0% <70% (P=0.011), squamous cell carcinoma (P=0.046), a bronchial artery diameter >2.0 mm (P<0.001), and experience of surgeon <10 years (P=0.011) in the unadjusted analysis, and being male (P=0.047), a bronchial artery diameter >2.0 mm (P=0.024), and experience of surgeon <10 years (P=0.047) in the multivariable analysis. Conclusions Bronchial artery diameter was the most important risk factor of intraoperative bleeding and prolonged operative time during VATS lobectomy.
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Affiliation(s)
- Hiromitsu Takizawa
- Department of Thoracic, Endocrine Surgery and Oncology, Tokushima University Graduate School of Biomedical Sciences, Kuramotocho, Tokushima, Japan
| | - Naoki Miyamoto
- Department of Thoracic, Endocrine Surgery and Oncology, Tokushima University Graduate School of Biomedical Sciences, Kuramotocho, Tokushima, Japan
| | - Shinichi Sakamoto
- Department of Thoracic, Endocrine Surgery and Oncology, Tokushima University Graduate School of Biomedical Sciences, Kuramotocho, Tokushima, Japan
| | - Mika Takashima
- Department of Thoracic, Endocrine Surgery and Oncology, Tokushima University Graduate School of Biomedical Sciences, Kuramotocho, Tokushima, Japan
| | - Daisuke Matsumoto
- Department of Thoracic, Endocrine Surgery and Oncology, Tokushima University Graduate School of Biomedical Sciences, Kuramotocho, Tokushima, Japan
| | - Naoya Kawakita
- Department of Thoracic, Endocrine Surgery and Oncology, Tokushima University Graduate School of Biomedical Sciences, Kuramotocho, Tokushima, Japan
| | - Hiroaki Toba
- Department of Thoracic, Endocrine Surgery and Oncology, Tokushima University Graduate School of Biomedical Sciences, Kuramotocho, Tokushima, Japan
| | - Yukikiyo Kawakami
- Department of Thoracic, Endocrine Surgery and Oncology, Tokushima University Graduate School of Biomedical Sciences, Kuramotocho, Tokushima, Japan
| | - Mitsuteru Yoshida
- Department of Thoracic, Endocrine Surgery and Oncology, Tokushima University Graduate School of Biomedical Sciences, Kuramotocho, Tokushima, Japan
| | - Kazuya Kondo
- Department of Oncological Medical Services, Tokushima University Graduate School of Biomedical Sciences, Kuramotocho, Tokushima, Japan
| | - Akira Tangoku
- Department of Thoracic, Endocrine Surgery and Oncology, Tokushima University Graduate School of Biomedical Sciences, Kuramotocho, Tokushima, Japan
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Montagne F, Guisier F, Venissac N, Baste JM. The Role of Surgery in Lung Cancer Treatment: Present Indications and Future Perspectives-State of the Art. Cancers (Basel) 2021; 13:3711. [PMID: 34359612 PMCID: PMC8345199 DOI: 10.3390/cancers13153711] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 07/14/2021] [Accepted: 07/20/2021] [Indexed: 12/25/2022] Open
Abstract
Non-small cell lung cancers (NSCLC) are different today, due to the increased use of screening programs and of innovative systemic therapies, leading to the diagnosis of earlier and pre-invasive tumors, and of more advanced and controlled metastatic tumors. Surgery for NSCLC remains the cornerstone treatment when it can be performed. The role of surgery and surgeons has also evolved because surgeons not only perform the initial curative lung cancer resection but they also accompany and follow-up patients from pre-operative rehabilitation, to treatment for recurrences. Surgery is personalized, according to cancer characteristics, including cancer extensions, from pre-invasive and local tumors to locally advanced, metastatic disease, or residual disease after medical treatment, anticipating recurrences, and patients' characteristics. Surgical management is constantly evolving to offer the best oncologic resection adapted to each NSCLC stage. Today, NSCLC can be considered as a chronic disease and surgery is a valuable tool for the diagnosis and treatment of recurrences, and in palliative conditions to relieve dyspnea and improve patients' comfort.
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Affiliation(s)
- François Montagne
- Department of Thoracic Surgery, Calmette Hospital, University Hospital of Lille, Boulevard du Pr. J Leclercq, F-59000 Lille, France; (F.M.); (N.V.)
| | - Florian Guisier
- Department of Pneumology, Rouen University Hospital, 1 rue de Germont, F-76000 Rouen, France;
- Clinical Investigation Center, Rouen University Hospital, CIC INSERM 1404, 1 rue de Germont, F-76000 Rouen, France
- Faculty of Medicine and Pharmacy of Rouen, Normandie University, LITIS QuantIF EA4108, 22 Boulevard Gambetta, F-76183 Rouen, France
| | - Nicolas Venissac
- Department of Thoracic Surgery, Calmette Hospital, University Hospital of Lille, Boulevard du Pr. J Leclercq, F-59000 Lille, France; (F.M.); (N.V.)
| | - Jean-Marc Baste
- Department of General and Thoracic Surgery, Rouen University Hospital, 1 rue de Germont, F-76000 Rouen, France
- Faculty of Medicine and Pharmacy of Rouen (UNIROUEN), Normandie University, INSERM U1096, 22 Boulevard Gambetta, F-76000 Rouen, France
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Song Y, Zheng C, Zhou S, Cui H, Wang J, Wang J, Wang W, Liu L, Liu J. The application analysis of 8F ultrafine chest drainage tube for thoracoscopic lobectomy of lung cancer. J Cardiothorac Surg 2021; 16:104. [PMID: 33882980 PMCID: PMC8059218 DOI: 10.1186/s13019-021-01479-x] [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: 11/04/2020] [Accepted: 04/05/2021] [Indexed: 11/17/2022] Open
Abstract
Background Currently, thoracoscopic lobectomy is widely used in clinical practice, and postoperative placement of ultrafine drainage tube has advantages of reducing postoperative pain and accelerating postoperative recovery in patients. This study aimed to investigate the feasibility and safety of placement of 8F ultrafine chest drainage tube after thoracoscopic lobectomy and its superiority over traditional 24F chest drainage tube. Methods A retrospective data analysis was conducted in 169 patients who underwent placement of 8F ultrafine chest drainage tube or 24F chest drainage tube with thoracoscopic lobectomy for lung cancer from January 2018 to December 2019. Propensity score matching (PSM) was used to reduce bias between the experimental group and the control group. After PSM, 134 patients (67 per group) were enrolled. The drainage time, the total drainage volume, postoperative hospital stay, postoperative pain score and postoperative complication of both groups were analyzed and compared. Results Compared to group B, group A had lower pain scores on postoperative days 1, 2 and 3 (3.72 ± 0.65point vs 3.94 ± 0.67point, P = 0.027; 2.72 ± 0.93point vs 3.13 ± 1.04point, P = 0.016; and 1.87 ± 0.65point vs 2.39 ± 1.22point, P = 0.005), shorter drainage time (4.25 ± 1.79d vs 6.04 ± 1.96d, P = 0.000), fewer drainage volume (1100.42 ± 701.57 ml vs 1369.39 ± 624.25 ml, P = 0.021); and shorter postoperative hospital stay (8.46 ± 2.48d vs 9.37 ± 1.70d, P = 0.014). Postoperative complications such as subcutaneous emphysema, pulmonary infection, atelectasis, chest tube reinsertion and intrathoracic hemorrhage showed no differences between both groups (P > 0.05). Conclusion Compared with 24F chest drainage tube, the application of an 8F ultrafine chest drainage tube after thoracoscopic lobectomy has significantly shortened the drainage time, reduced the total drainage volume, reduced the postoperative pain degree, shortened the hospital day, and effectively detected postoperative intrathoracic hemorrhage. So, it is considered as an effective, safe and reliable drainage method.
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Affiliation(s)
- Yongbin Song
- Graduate School, Hebei Medical University, 361 Zhongshan East Road, Shijiazhuang, 050051, Hebei Province, People's Republic of China.,Department of Thoracic Surgery, Hebei General Hospital, 348 West He-Ping Road, Shijiazhuang, 050051, Hebei Province, People's Republic of China
| | - Chong Zheng
- Department of Thoracic Surgery, Hebei General Hospital, 348 West He-Ping Road, Shijiazhuang, 050051, Hebei Province, People's Republic of China.,Graduate School, Hebei North University, 11 Diamond South Road, High-tech Zone, Zhangjiakou, 075000, Hebei Province, People's Republic of China
| | - Shaohui Zhou
- Department of Thoracic Surgery, Hebei General Hospital, 348 West He-Ping Road, Shijiazhuang, 050051, Hebei Province, People's Republic of China
| | - Hongshang Cui
- Department of Thoracic Surgery, Hebei General Hospital, 348 West He-Ping Road, Shijiazhuang, 050051, Hebei Province, People's Republic of China
| | - Jincong Wang
- Ningbo University Medical School, 818 Fenghua Road, Jiangbei District, Ningbo, 315000, Zhejiang Province, People's Republic of China
| | - Jianxun Wang
- Department of Thoracic Surgery, Hebei General Hospital, 348 West He-Ping Road, Shijiazhuang, 050051, Hebei Province, People's Republic of China.,Graduate School, Hebei North University, 11 Diamond South Road, High-tech Zone, Zhangjiakou, 075000, Hebei Province, People's Republic of China
| | - Wenhao Wang
- Department of Thoracic Surgery, Hebei General Hospital, 348 West He-Ping Road, Shijiazhuang, 050051, Hebei Province, People's Republic of China
| | - Lijun Liu
- Department of Thoracic Surgery, Hebei General Hospital, 348 West He-Ping Road, Shijiazhuang, 050051, Hebei Province, People's Republic of China
| | - Junfeng Liu
- Department of Thoracic Surgery, Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital, 12 Jiankang Road, Shijiazhuang, Hebei Province, 050011, People's Republic of China.
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Xu J, Ni H, Wu Y, Cao J, Han X, Liu L, Fu X, Li Y, Li X, Xu L, Liu Y, Zhao H, Liu D, Peng X, Hu J. Perioperative comparison of video-assisted thoracic surgery and open lobectomy for pT1-stage non-small cell lung cancer patients in China: a multi-center propensity score-matched analysis. Transl Lung Cancer Res 2021; 10:402-414. [PMID: 33569322 PMCID: PMC7867771 DOI: 10.21037/tlcr-20-1132] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Compared with open surgery, video-assisted thoracic surgery (VATS) has innovated the concept of the minimally invasive approach for non-small cell lung cancer (NSCLC) patients in past decades. This present study aimed to compare the perioperative and lymph node dissection outcomes between VATS lobectomy and open lobectomy for pathological stage T1 (pT1) NSCLC patients from both surgical and oncologic perspectives. Methods This was a retrospective multicenter study. Patients who underwent surgical resection for pT1 NSCLC between January 2014 and September 2017 were retrospectively reviewed from 10 thoracic surgery centers in China. Perioperative and lymph node dissection outcomes of pT1 NSCLC patients who accepted VATS or open lobectomies were compared by propensity score matching (PSM) analysis. Results Of the 11,360 patients who underwent surgery for pT1 NSCLC, 7,726 were enrolled based on the selection criteria, including 1,222 cases of open lobectomies and 6,504 cases of VATS lobectomies. PSM resulted in 1,184 cases of open lobectomies and 1,184 cases of VATS lobectomies being well matched by common prognostic variables, including age, sex, and surgical side. VATS lobectomy led to better perioperative outcomes, including less blood loss (133.5±200.1 vs. 233.3±318.4, P<0.001), lower blood transfusion rate (2.4% vs. 6.4%, P<0.001), shorter postoperative hospital stay (8.6±5.7 vs. 10.1±5.1, P<0.001), less chest drainage volume (1,109.5±854.0 vs. 1,324.1±948.8, P<0.001), and less postoperative complications (4.9% vs. 8.2%, P<0.001). However, open lobectomy had better lymph node dissection outcomes than VATS, with increased lymph node dissection numbers (16.1±9.4 vs. 13.7±7.7, P<0.001) and more positive lymph nodes being dissected (1.5±3.9 vs. 1.1±2.5, P=0.002). Compared with VATS, open lobectomy harvested more lymph node stations (5.5±1.9 vs. 5.2±1.8, P=0.001), including more pathological N2 (pN2) lymph node stations (3.4±1.4 vs. 3.1±1.3, P<0.001). Conclusions VATS lobectomy was associated with better perioperative outcomes, such as less blood loss, lower blood transfusion rate, shorter postoperative hospital stay, less chest drainage volume and less postoperative complications. Open lobectomy has improved lymph node dissection outcomes, as more lymph nodes and positive lymph nodes were dissected for pT1 NSCLC patients during surgery.
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Affiliation(s)
- Jinming Xu
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Heng Ni
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yihe Wu
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jinlin Cao
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xingpeng Han
- Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiangning Fu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yin Li
- Department of Thoracic Surgery, Henan Cancer Hospital, Zhengzhou, China
| | - Xiaofei Li
- Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Lin Xu
- Department of Thoracic Surgery, Nanjing Medical University Affiliated Cancer Hospital, Cancer Institute of Jiangsu Province, Nanjing, China.,Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Cancer Institute of Jiangsu Province, Nanjing, China
| | - Yang Liu
- Department of Thoracic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Heng Zhao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai, China
| | - Deruo Liu
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Xin Peng
- Medical Affairs, Linkdoc Technology Co. Ltd., Beijing, China
| | - Jian Hu
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Inequalities in access to minimally invasive general surgery: a comprehensive nationwide analysis across 20 years. Surg Endosc 2020; 35:6227-6243. [PMID: 33206242 PMCID: PMC8523463 DOI: 10.1007/s00464-020-08123-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 10/21/2020] [Indexed: 12/18/2022]
Abstract
Background Minimally invasive surgery (MIS) has profoundly changed standards of care and lowered perioperative morbidity, but its temporal implementation and factors favoring MIS access remain elusive. We aimed to comprehensibly investigate MIS adoption across different surgical procedures over 20 years, identify predictors for MIS amenability and compare propensity score-matched outcomes among MIS and open surgery. Methods Nationwide retrospective analysis of all hospitalizations in Switzerland between 1998 and 2017. Appendectomies (n = 186,929), cholecystectomies (n = 57,788), oncological right (n = 9138) and left hemicolectomies (n = 21,580), rectal resections (n = 13,989) and gastrectomies for carcinoma (n = 6606) were included. Endpoints were assessment of temporal MIS implementation, identification of predictors for MIS access and comparison of propensity score-matched outcomes among MIS and open surgery. Results The rates of MIS increased for all procedures during the study period (p ≤ 0.001). While half of all appendectomies were performed laparoscopically by 2005, minimally invasive oncological colorectal resections reached 50% only by 2016. Multivariate analyses identified older age (p ≤ 0.02, except gastrectomy), higher comorbidities (p ≤ 0.001, except rectal resections), lack of private insurance (p ≤ 0.01) as well as rural residence (p ≤ 0.01) with impaired access to MIS. Rural residence correlated with low income regions (p ≤ 0.001), which themselves were associated with decreased MIS access. Geographical mapping confirmed strong disparities for rural and low-income areas in MIS access. Matched outcome analyses revealed benefits of MIS for length of stay, decreased surgical site infection rates for MIS appendectomies and cholecystectomies and higher mortality for open cholecystectomies. No consistent morbidity or mortality benefit for MIS compared to open colorectal resections was observed. Conclusion Unequal access to MIS exists in disfavor of older and more comorbid patients and those lacking private insurance, living in rural areas, and having lower income. Efforts should be made to ensure equal MIS access regardless of socioeconomic or geographical factors. Electronic supplementary material The online version of this article (10.1007/s00464-020-08123-0) contains supplementary material, which is available to authorized users.
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Yun JK, Park I, Kim HR, Choi YS, Lee GD, Choi S, Kim YH, Kim DK, Park SI, Cho JH, Shin S, Kim HK, Kim J, Zo JI, Kim K, Shim YM. Long-term outcomes of video-assisted thoracoscopic lobectomy for clinical N1 non-small cell lung cancer: A propensity score-weighted comparison with open thoracotomy. Lung Cancer 2020; 150:201-208. [PMID: 33197685 DOI: 10.1016/j.lungcan.2020.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/28/2020] [Accepted: 10/18/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Although the video-assisted thoracic surgery (VATS) approach has been accepted as a safe and effective alternative to lobectomy, its advantage remains unclear in advanced-stage lung cancer. This study is aimed to evaluate the feasibility and long-term outcomes of VATS in lung cancer with clinical N1 (cN1) disease. MATERIALS AND METHODS We retrospectively reviewed the records of 1149 consecutive patients who underwent lobectomy for cN1 disease from 2006 to 2016. Perioperative outcomes and long-term survival rates were compared using a propensity score-based inverse probability of treatment weighting (IPTW) technique. RESULTS We performed VATS and open thoracotomy for 500 and 649 patients, respectively. All preoperative characteristics became similar between the two groups after IPTW adjustment. Compared to thoracotomy, VATS was associated with shorter hospitalization (7.7 days vs. 9.2 days, p < 0.001), earlier adjuvant chemotherapy (41.7 days vs. 46.6 days, p = 0.028), similar complete resection rates (95.2 % vs. 94.0 %, p = 0.583), and equivalent dissected lymph nodes (27.5 vs. 27.8, p = 0.704). On IPTW-adjusted analysis, overall survival (OS) (59.4 % vs. 60.3 %, p = 0.588) and recurrence-free survival (RFS) (59.2 % vs. 56.9 %, p = 0.651) at 5 years were also similar between the two groups. Multivariable Cox analysis revealed that VATS was not a significant prognostic factor for cN1 disease (p = 0.764 for OS and p = 0.879 for RFS). CONCLUSIONS VATS lobectomy is feasible for patients with cN1 disease, providing comparable perioperative outcomes, oncologic efficacy, and long-term outcomes as open thoracotomy.
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Affiliation(s)
- Jae Kwang Yun
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
| | - Ilkun Park
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyeong Ryul Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea.
| | - Yong Soo Choi
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Geun Dong Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
| | - Sehoon Choi
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
| | - Yong-Hee Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
| | - Dong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
| | - Seung-Il Park
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
| | - Jong Ho Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sumin Shin
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jhingook Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Il Zo
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kwhanmien Kim
- Department of Thoracic and Cardiovascular Surgery, Bundang Hospital, Seoul National University School of Medicine, Seoul, Republic of Korea
| | - Young Mog Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Aiolfi A, Nosotti M, Micheletto G, Khor D, Bonitta G, Perali C, Marin J, Biraghi T, Bona D. Pulmonary lobectomy for cancer: Systematic review and network meta-analysis comparing open, video-assisted thoracic surgery, and robotic approach. Surgery 2020; 169:436-446. [PMID: 33097244 DOI: 10.1016/j.surg.2020.09.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/25/2020] [Accepted: 09/12/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Although minimally invasive lobectomy has gained worldwide interest, there has been debate on perioperative and oncological outcomes. The purpose of this study was to compare outcomes among open lobectomy, video-assisted thoracic surgery lobectomy, and robotic lobectomy. METHODS PubMed, EMBASE, and Web of Science databases were consulted. A fully Bayesian network meta-analysis was performed. RESULTS Thirty-four studies (183,426 patients) were included; 88,865 (48.4%) underwent open lobectomy, 79,171 (43.2%) video-assisted thoracic surgery lobectomy, and 15,390 (8.4%) robotic lobectomy. Compared with open lobectomy, video-assisted thoracic surgery, lobectomy and robotic lobectomy had significantly reduced 30-day mortality (risk ratio = 0.53; 95% credible intervals, 0.40-0.66 and risk ratio = 0.51; 95% credible intervals, 0.36-0.71), pulmonary complications (risk ratio = 0.70; 95% credible intervals, 0.51-0.92 and risk ratio = 0.69; 95% credible intervals, 0.51-0.88), and overall complications (risk ratio = 0.77; 95% credible intervals, 0.68-0.85 and risk ratio = 0.79; 95% credible intervals, 0.67-0.91). Compared with video-assisted thoracic surgery lobectomy, open lobectomy, and robotic lobectomy had a significantly higher total number of harvested lymph nodes (mean difference = 1.46; 95% credible intervals, 0.30, 2.64 and mean difference = 2.18; 95% credible intervals, 0.52-3.92) and lymph nodes stations (mean difference = 0.37; 95% credible intervals, 0.08-0.65 and mean difference = 0.93; 95% credible intervals, 0.47-1.40). Positive resection margin and 5-year overall survival were similar across treatments. Intraoperative blood loss, postoperative transfusion, hospital length of stay, and 30-day readmission were significantly reduced for minimally invasive approaches. CONCLUSION Compared with open lobectomy, video-assisted thoracic surgery lobectomy, and robotic lobectomy seem safer with reduced 30-day mortality, pulmonary, and overall complications with equivalent oncologic outcomes and 5-year overall survival. Minimally invasive techniques may improve outcomes and surgeons should be encouraged, when feasible, to adopt video-assisted thoracic surgery lobectomy, or robotic lobectomy in the treatment of lung cancer.
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Affiliation(s)
- Alberto Aiolfi
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istitituto Clinico Sant'Ambrogio, Milan, Italy.
| | - Mario Nosotti
- Department of Pathophysiology and Transplantation, Thoracic Surgery and Lung Transplant Unit Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Giancarlo Micheletto
- Department of Pathophysiology and Transplantation, INCO and Department of General Surgery, University of Milan, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Desmond Khor
- University of Maryland Medical Center, Baltimore, MD
| | - Gianluca Bonitta
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istitituto Clinico Sant'Ambrogio, Milan, Italy
| | - Carolina Perali
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istitituto Clinico Sant'Ambrogio, Milan, Italy
| | - Jacopo Marin
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istitituto Clinico Sant'Ambrogio, Milan, Italy
| | - Tullio Biraghi
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istitituto Clinico Sant'Ambrogio, Milan, Italy
| | - Davide Bona
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istitituto Clinico Sant'Ambrogio, Milan, Italy
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Sun W, Su H, Liu J, Zhang L, Li M, Xie H, Xu L, Zhao S, She Y, Tang H, Wu C, Ke H, Chen C. Impact of histological components on selecting limited lymphadenectomy for lung adenocarcinoma ≤ 2 cm. Lung Cancer 2020; 150:36-43. [PMID: 33059150 DOI: 10.1016/j.lungcan.2020.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/05/2020] [Accepted: 09/22/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES There is still some dispute regarding the performance of limited mediastinal lymphadenectomy (LML) even for lung adenocarcinoma ≤ 2 cm. We aimed to recognize the potential candidates who can benefit from LML based on the percentage of histological components (PHC). METHODS We analyzed 1160 surgical patients with invasive lung adenocarcinoma ≤ 2 cm from seven institutions between January 2012 and December 2015. All histological subtypes were listed in 5% increments by pathological slices. To test the accuracy of frozen section in judging PHC, frozen section slides from 140 cases were reviewed by three pathologists. RESULTS There were 882 patients with systematic mediastinal lymphadenectomy (SML) and 278 with LML. Multivariable analysis indicated that, the total percentage of micropapillary and solid components (PHCMIP+S) > 5 % was the independent predictor of N2 metastasis (P < 0.001). Overall, recurrence-free survival (RFS) and overall survival (OS) favored SML compared with LML, but the subgroup analysis revealed LML and SML had similar prognosis in the group of PHCMIP+S ≤ 5 %. Moreover, multivariable Cox analysis showed LML (vs. SML) was independently associated with worse prognosis for patients with PHCMIP+S > 5 % (RFS, HR = 2.143, P < 0.001; OS, HR=1.963, P < 0.001), but not for those with PHCMIP+S ≤ 5 % (RFS, P = 0.398; OS, P = 0.298). The sensitivity and specificity of frozen section to intraoperatively identify PHCMIP+S ≤ 5 % were 97.6 % and 84.2 %, respectively. CONCLUSIONS PHCMIP+S showed the predictive value for N2 metastasis and procedure-specific outcome (LML vs. SML). It may serve as a feasible indicator for identifying proper candidates of LML by using intraoperative frozen section.
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Affiliation(s)
- Weiyan Sun
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Hang Su
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Jinshi Liu
- Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China
| | - Lei Zhang
- Department of Thoracic Surgery, The First People's Hospital of Changzhou, Changzhou, People's Republic of China
| | - Ming Li
- Department of Thoracic Surgery, Jiangsu Cancer Hospital, Nanjing, People's Republic of China
| | - Huikang Xie
- Department of Pathology, Shanghai Pulmonary Hospital, TongjiUniversity School of Medicine, Shanghai, People's Republic of China
| | - Long Xu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Shengnan Zhao
- Department of Pathology, Shanghai Pulmonary Hospital, TongjiUniversity School of Medicine, Shanghai, People's Republic of China
| | - Yunlang She
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Hai Tang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Chunyan Wu
- Department of Pathology, Shanghai Pulmonary Hospital, TongjiUniversity School of Medicine, Shanghai, People's Republic of China
| | - Honggang Ke
- Department of Thoracic Surgery, Affiliated Hospital of Nantong University, Nantong, People's Republic of China.
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
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Yun JK, Lee GD, Choi S, Kim HR, Kim YH, Park SI, Kim DK. Video-assisted thoracoscopic lobectomy is feasible for selected patients with clinical N2 non-small cell lung cancer. Sci Rep 2020; 10:15217. [PMID: 32939008 PMCID: PMC7495470 DOI: 10.1038/s41598-020-72272-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/28/2020] [Indexed: 12/17/2022] Open
Abstract
Few studies have evaluated the usefulness of video-assisted thoracoscopic surgery (VATS) for advanced-stage lung cancer. We aimed to evaluate the feasibility of VATS for treating clinical N2 (cN2) lung cancer. A retrospective cohort analysis was performed with data from 268 patients who underwent lobectomy for cN2 disease from 2007 to 2016. Using propensity score-based inverse probability of treatment weighting (IPTW), perioperative and long-term survival outcomes were compared. We performed VATS and open thoracotomy on 121 and 147 patients, respectively. Overall, VATS was preferred for patients with peripherally located tumors (p < 0.001). After IPTW-adjustment, all preoperative information became similar between the groups. Compared to thoracotomy, VATS was associated with shorter hospitalization (7.7 days vs. 9.1 days, p = 0.028), despite equivalent complete resection rates (92.6% vs. 90.5%, p = 0.488) and dissected lymph nodes (mean, 31.9 vs. 29.4, p = 0.100). On IPTW-adjusted analysis, overall survival (50.5% vs. 48.4%, p = 0.127) and recurrence-free survival (60.5% vs 44.6%, p = 0.069) at 5 years were also similar between the groups. Among selected patients with resectable cN2 disease and peripherally located tumors, VATS is feasible, associated with shorter hospitalization and comparable perioperative and long-term survival outcomes, compared with open thoracotomy.
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Affiliation(s)
- Jae Kwang Yun
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Geun Dong Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Sehoon Choi
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Hyeong Ryul Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Yong-Hee Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Seung-Il Park
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Dong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
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Elkhouly AG, Sorge R, Rogliani P, Cristino B, Wahby E, Serag A, Liang H, He J, Pompeo E. Ergonomical Assessment of Three-Dimensional Versus Two-Dimensional Thoracoscopic Lobectomy. Semin Thorac Cardiovasc Surg 2020; 32:1089-1096. [PMID: 32450215 DOI: 10.1053/j.semtcvs.2020.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/15/2020] [Indexed: 11/11/2022]
Abstract
In this study. we compared ergonomical domains characteristics of three-dimensional (3D) versus two-dimensional (2D) video-systems in thoracoscopic lobectomy using a scoring-scale-based assessment. Seventy patients (mean age, 69 ± 6.9 years, 43 males and 27 females) with early stage lung cancer were randomized to undergo thoracoscopic lobectomy by either 3D (N = 35) or 2D (N = 35) video-systems. All operations were divided into 5 standardized surgical steps (vein, artery, bronchus, fissure, and lymph nodes), which were evaluated by 4 thoracic surgeons using a scoring scale (score range from 1, unsatisfactory to 3,excellent) entailing assessment of 3 ergonomical domains: exposure, instrumentation and maneuvering. Primary outcome was a difference ≥10% in the maneuvering domain steps. At intergroup comparisons, there was no difference in demographics. The 3D system results were better for maneuvering domain total score and particularly for the artery and bronchus steps scores (score ≥10%, P ≤ 0.006). Other significant differences included exposure of the vein, artery and bronchus (P ≤ 0.03). Results favoring the 2D system included maneuvering, exposure and instrumentation of the fissure (P = 0.001). Inter-rater concordance of ergonomics scoring was satisfactory (Cronbach's α range, 0.85-0.88). Operative time was significantly shorter in the 3D group (127 ± 19 min vs 143±18 min, P = 0.001) whereas there was no difference in hospital stay (3.4 ± 1.2 vs 4.1 ± 1.6 days, P = 0.07). In this study comparison of ergonomic domains scoring in 3D versus 2D thoracoscopic lobectomy favored the 3D system for the maneuvering total score, which proved inversely correlated with operative times possibly due to a better perception of depth and more precise surgical maneuvering.
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Affiliation(s)
- Ahmed G Elkhouly
- Department of Cardiothoracic Surgery, Tanta University, Tanta, Egypt
| | - Roberto Sorge
- Department of Biostatistics, Policlinico Tor Vergata University, Rome, Italy
| | - Paola Rogliani
- Department of Respiratory Medicine, Policlinico Tor Vergata University, Rome, Italy
| | - Benedetto Cristino
- Department of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy
| | - Ehab Wahby
- Department of Cardiothoracic Surgery, Tanta University, Tanta, Egypt
| | - Amro Serag
- Department of Cardiothoracic Surgery, Tanta University, Tanta, Egypt
| | - Hengrui 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
| | - 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
| | - Eugenio Pompeo
- Department of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy.
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Results of video-assisted thoracic surgery versus thoracotomy in surgical resection of pN2 non-small cell lung cancer in a Chinese high-volume Center. Surg Endosc 2020; 35:2186-2197. [PMID: 32394172 DOI: 10.1007/s00464-020-07624-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 05/02/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE To investigate the short-term outcomes and long-term oncological efficacy of video-assisted thoracic surgery (VATS) for surgical treatment of pN2 non-small cell lung cancer (NSCLC) compared with open thoracotomy (OT). PATIENTS AND METHODS We retrospectively collected data from 1034 patients who underwent pulmonary resection and systemic lymph node dissection for pathological N2 NSCLC from September 2005 to December 2017 (536 patients in VATS group and 498 patients in OT group). Propensity score matching was applied to reduce the confounding effects. Factors affecting survival were assessed by Kaplan-Meier estimates and Cox regression analysis. RESULTS The VATS procedure was associated with shorter operative time compared with the OT procedure (147.96 ± 58.91 min vs. 165.34 ± 58.91 min, P < 0.001). No significant difference was identified between the two groups in the number of dissected mediastinal lymph nodes (MLNs) and number of dissected MLNs stations. More patients after VATS procedure received postoperative adjuvant therapy (83.4% vs. 75.5%, P = 0.002). At a median follow-up of 36 (range 4-150) months, comparing VATS procedure and OT procedure, no significant differences were noted in 5-year DFS (20.7% vs. 22.5%, P = 0.89) and 5-year OS (30.7% vs. 34.5%, P = 0.821). The VATS procedure was not found to be an independent predictor of DFS (hazard ratio, 0.986; 95% CI, 0.809 to 1.202) or OS (hazard ratio, 0.977; 95% CI 0.802 to 1.191). CONCLUSION In this large propensity-matched comparison, the VATS procedure offered comparable short-term outcomes and long-term oncological efficacy for patients with pN2 NSCLC when compared with OT procedure.
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Cui Y, Grogan EL, Deppen SA, Wang F, Massion PP, Bailey CE, Zheng W, Cai H, Shu XO. Mortality for Robotic- vs Video-Assisted Lobectomy-Treated Stage I Non-Small Cell Lung Cancer Patients. JNCI Cancer Spectr 2020; 4:pkaa028. [PMID: 33215060 PMCID: PMC7660043 DOI: 10.1093/jncics/pkaa028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 02/03/2020] [Accepted: 04/07/2020] [Indexed: 12/24/2022] Open
Abstract
Background To address the US Food and Drug Administration’s recent safety concern on robotic surgery procedures, we compared short- and long-term mortality for stage I non-small cell lung cancer (NSCLC) patients treated by robotic-assisted thoracoscopic surgical lobectomy (RATS-L) vs video-assisted thoracoscopic surgical lobectomy (VATS-L). Methods From the National Cancer Database, we identified 18 908 stage I NSCLC patients who underwent RATS-L or VATS-L as the primary operation from 2010 to 2014. Cox proportional hazards models were used to estimate hazard ratios (HRs) for short- and long-term mortality using unmatched and propensity score–matched analyses. All statistical tests were 2-sided. Results Patients treated by RATS-L had higher 90-day mortality than those with VATS-L (6.6% vs 3.8%, P = .03) if conversion to open thoracotomy occurred. After excluding first-year observation, multiple regression analyses showed RATS-L was associated with increased long-term mortality, compared with VATS-L, in cases with tumor size 20 mm or less: hazard ratio (HR) = 1.33 (95% confidence interval [CI] = 1.15 to 1.55), HR = 1.36 (95% CI = 1.17 to 1.58), and HR = 1.33 (95% CI = 1.11 to 1.61) for unmatched, N:1 matched, and 1:1 matched analyses, respectively, in the intention-to-treat analysis. Among patients without conversion to an open thoracotomy, the respective hazard ratios were 1.19 (95% CI = 1.10 to 1.29), 1.19 (95% CI = 1.10 to 1.29), and 1.17 (95% CI = 1.06 to 1.29). Similar associations were observed when follow-up time started 18 or 24 months postsurgery. No statistically significant mortality difference was found for patients with tumor size of greater than 20 mm. These associations were not related to case volume of VATS-L or RATS-L performed at treatment institutes. Conclusions Patients with small (≤20 mm) stage I NSCLC treated with RATS-L had statistically significantly higher long-term mortality risk than VATS-L after 1 year postsurgery.
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Affiliation(s)
- Yong Cui
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Eric L Grogan
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Stephen A Deppen
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Fei Wang
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA.,Department of Breast Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Pierre P Massion
- Division of Allergy, Pulmonary & Critical Care Medicine, Vanderbilt University Medical Center, Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Christina E Bailey
- Division of Surgical Oncology & Endocrine Surgery, Department of Surgery, Vanderbilt University Medical Center, Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Hui Cai
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Xiao-Ou Shu
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA
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Liu Y, Tian J, Qin D, Liu J, Xie Y. AKIP1 expression in tumor tissue as a new biomarker for disease monitoring and prognosis in non-small cell lung cancer: Results of a retrospective study. J Clin Lab Anal 2019; 34:e23128. [PMID: 31782840 PMCID: PMC7171317 DOI: 10.1002/jcla.23128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/18/2019] [Accepted: 11/11/2019] [Indexed: 12/24/2022] Open
Abstract
Background A‐kinase–interacting protein 1 (AKIP1) has been reported as an oncogenetic factor in multiple cancers; however, no study has reported its role in non‐small cell lung cancer (NSCLC) yet. This study aimed to evaluate the expression of AKIP1, and its correlation with tumor characteristics as well as prognosis in patients with NSCLC. Methods Four hundred and ninety patients with NSCLC who underwent resection were reviewed, and baseline clinical data were collected. AKIP1 expression in tumor tissue/paired adjacent tissue was detected by immunohistochemistry. Disease‐free survival (DFS) and overall survival (OS) were calculated. Results A‐kinase–interacting protein 1 expression was elevated in tumor tissue compared with paired adjacent tissue (P < .001), and high AKIP1 tumor tissue expression was correlated with poor pathological differentiation (P < .001), tumor size >5 cm (P = .001), lymph node metastasis (P = .016), higher TNM stages (P < .001), and abnormal CEA level (>5 ng/mL) (P = .035). DFS was worse in patients with tumor tissue AKIP1 high expression compared with patients who had AKIP1 low expression in total patients (P < .001), TNM stage I (P < .001) and TNM stage III (P < .001) patients. And the OS was also decreased in patients with AKIP1 high expression in total patients (P < .001), TNM stage I patients (P = .001) and TNM stage III patients (P = .004). Moreover, multivariate Cox's proportional hazards regression model analysis revealed that AKIP1 high expression was an independent predictive factor for worse DFS (P < .001) and OS (P < .001). Conclusion Tumor tissue AKIP1 expression may have the potential to be a biomarker assisting in disease monitoring and prognosis in NSCLC.
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Affiliation(s)
- Yingchao Liu
- Department of Clinical Laboratory, The Second People's Hospital of Liaocheng, The Second Hospital of Liaocheng Affiliated to Shandong First Medical University, Linqing, China
| | - Jia Tian
- Pathology Department, The Second People's Hospital of Liaocheng, The Second Hospital of Liaocheng Affiliated to Shandong First Medical University, Linqing, China
| | - Dongrui Qin
- Pathology Department, The Second People's Hospital of Liaocheng, The Second Hospital of Liaocheng Affiliated to Shandong First Medical University, Linqing, China
| | - Jiaqi Liu
- Pathology Department, Baoding Maternal and Child Health Hospital, Baoding, China
| | - Yaozeng Xie
- Lung Cancer Screening Division, The Second People's Hospital of Liaocheng, The Second Hospital of Liaocheng Affiliated to Shandong First Medical University, Linqing, China
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Rolli L, Duranti L, Leuzzi G. Treatment of anaemia in the "ERAS" era: how far can we go? J Thorac Dis 2019; 11:3692-3695. [PMID: 31656640 DOI: 10.21037/jtd.2019.09.21] [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]
Affiliation(s)
- Luigi Rolli
- Division of Thoracic Surgery, IRCCS Istituto Nazionale dei Tumori Foundation, Milan, Italy
| | - Leonardo Duranti
- Division of Thoracic Surgery, IRCCS Istituto Nazionale dei Tumori Foundation, Milan, Italy
| | - Giovanni Leuzzi
- Division of Thoracic Surgery, IRCCS Istituto Nazionale dei Tumori Foundation, Milan, Italy
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Uniportal VATS for non-small cell lung cancer. Gen Thorac Cardiovasc Surg 2019; 68:707-715. [PMID: 31617147 DOI: 10.1007/s11748-019-01221-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 12/13/2022]
Abstract
The video-assisted thoracic surgery (VATS) technique has evolved from its multiport origins to even less invasive approaches grounded in its proven benefits over open surgery for the treatment of early stage lung cancer. In this evolution process, the Uniportal VATS (UniVATS) strategy emerged. This technique is giving some evidence of benefits when compared to the multiport VATS and has been embraced by the surgical community spreading its geographical and surgical boundaries. Moreover, UniVATS has proven its feasibility for numerous and more complex procedures for lung cancer diagnosis and treatment, which are reviewed in this document as well as its current and future development.
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Nachira D, Meacci E, Margaritora S, Ismail M. Level of evidence on long-term results after VATS lobectomy: state of the art. J Thorac Dis 2019; 11:2192-2194. [PMID: 31372249 DOI: 10.21037/jtd.2019.06.19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Dania Nachira
- Department of Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elisa Meacci
- Department of Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano Margaritora
- Department of Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mahmoud Ismail
- Department of Thoracic Surgery, Klinikum Ernst von Bergmann Potsdam, Academic Hospital of the Charité - Universitätsmedizin Humboldt University Berlin, Germany
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