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Cao J, Zhang C, Zhang X, Liu L, Li X, He J, Xu L, Fu X, Liu Y, Liu D, Hu J, Wang L. The Clinical Outcomes of Thoracoscopic Versus Open Lobectomy for Non-Small-Cell Lung Cancer After Neoadjuvant Therapy: A Multi-Center Retrospective Cohort Study. Clin Lung Cancer 2024; 25:e153-e160. [PMID: 38172025 DOI: 10.1016/j.cllc.2023.12.008] [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: 12/01/2022] [Revised: 10/15/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND The safety and efficacy of video-assisted thoracic surgical (VATS) versus open lobectomy for non-small-cell lung cancer (NSCLC) following neoadjuvant therapy remained controversial. The aim of this study was to compare the outcomes of VATS with those of open lobectomy for NSCLC after neoadjuvant therapy. METHODS Patients who had undergone VATS or open lobectomy for NSCLC following neoadjuvant therapy in nine hospitals in China from July 2014 to July 2020 were retrospectively reviewed. The clinical characteristics and overall survival (OS) of patients were analyzed using Cox regression models and propensity score matching. RESULTS We identified 685 patients, 436 (63.6%) who had undergone VATS lobectomy and 249 (36.4%) who had undergone open lobectomy. Patients who had undergone VATS lobectomy tended to have had fewer nodes removed than those who had undergone open lobectomy. However, compared with open group, the VATS group had a better perioperative outcome, such as smaller blood loss volumes and shorter postoperative stays. The groups had a similar operation durations and postoperative complications, and there was a nonsignificant difference between their 30-day mortality rates. After propensity score matching, there was no significant different between the OS of the groups, and only postoperative adjuvant therapy was associated with worse OS. CONCLUSION This multi-center analysis of patients with NSCLC who had undergone surgery subsequent to neoadjuvant therapy reveals that VATS lobectomy tended to have a better perioperative outcome, and have a similar OS compared to open lobectomy. These findings suggest that VATS lobectomy is appropriate for NSCLC following neoadjuvant therapy.
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Affiliation(s)
- Jinlin Cao
- Department of Thoracic surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chong Zhang
- Department of Thoracic surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xun Zhang
- Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin University, Tianjin, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaofei Li
- Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Jianxing He
- Department of Thoracic surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Lin Xu
- Department of Thoracic Surgery, Nanjing Medical University Affiliated Cancer Hospital, Cancer Institute of Jiangsu Province, Nanjing, China
| | - Xiangning Fu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yang Liu
- Department of Thoracic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Deruo Liu
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Jian Hu
- Department of Thoracic surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
| | - Luming Wang
- Department of Thoracic surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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Lucia F, Mievis C, Jansen N, Duysinx B, Cousin F, Louis T, Baiwir M, Ernst C, Wonner M, Hustinx R, Lovinfosse P, Coucke P. Predictive clinical and dosimetric parameters for risk of relapse in early-stage non-small cell lung cancer treated by SBRT: A large single institution experience. Clin Transl Radiat Oncol 2024; 45:100720. [PMID: 38288310 PMCID: PMC10823062 DOI: 10.1016/j.ctro.2023.100720] [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: 04/25/2023] [Revised: 11/30/2023] [Accepted: 12/30/2023] [Indexed: 01/31/2024] Open
Abstract
Purpose To evaluate the impact of dosimetric parameters on efficacy of stereotactic body radiation therapy (SBRT) in early-stage non-small cell lung cancer (ES-NSCLC), using Hypofractionated Treatment Effects in the Clinic (HyTEC) reporting standards. Methods From April 2010 to December 2020, 497 patients who received SBRT for ES-NSCLC at the University Hospital of Liège were retrospectively enrolled. A total dose of 40 to 60 Gy in 3-5 fractions (72-180 Gy biologically effective dose with an α/β ratio of 10 (BED10)) was prescribed to the 80 % isodose line of the PTV. Potential clinical and dosimetric predictors of recurrence, overall survival (OS) and disease specific survival (DSS) were evaluated using univariate and multivariate analyses. Results After a median follow-up of 32 months (range 3-143 months), the local control and disease-free survival (DFS) rates at 3 years were 91 % (95 % CI: 90 %-93 %) and 75 % (95 % CI: 73 %-77 %), respectively. The median OS was 41.6 months and the median DSS was not reached. On multivariate analysis, a higher gross tumor volume (GTV) Dmax (BED10) (cut-off 198 Gy) and a larger percent of the GTV receiving ≥110 % of the prescribed dose were predictive of a better local control, only GTV volume was correlated with DSS and no parameter was correlated with OS and regional or distant recurrences. Conclusion Lung SBRT for ES-NSCLC in 3 to 5 fractions resulted in high local control rates. A higher percent of GTV receiving ≥110 % of the prescribed dose and a higher GTV Dmax (BED10) seem to allow a better local control.
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Affiliation(s)
- François Lucia
- Radiation Oncology Department, University Hospital, Brest, France
- LaTIM, INSERM, UMR 1101, Univ Brest, Brest, France
- Division of Nuclear Medicine and Oncological Imaging, University Hospital of Liège, Liège, Belgium
| | - Carole Mievis
- Department of Radiotherapy Oncology, University Hospital of Liège, Liège, Belgium
| | - Nicolas Jansen
- Department of Radiotherapy Oncology, University Hospital of Liège, Liège, Belgium
| | | | - François Cousin
- Division of Nuclear Medicine and Oncological Imaging, University Hospital of Liège, Liège, Belgium
| | - Thomas Louis
- Division of Nuclear Medicine and Oncological Imaging, University Hospital of Liège, Liège, Belgium
| | - Manon Baiwir
- Department of Radiotherapy Oncology, University Hospital of Liège, Liège, Belgium
| | - Christelle Ernst
- Department of Radiotherapy Oncology, University Hospital of Liège, Liège, Belgium
| | - Michel Wonner
- Department of Radiotherapy Oncology, University Hospital of Liège, Liège, Belgium
| | - Roland Hustinx
- Division of Nuclear Medicine and Oncological Imaging, University Hospital of Liège, Liège, Belgium
| | - Pierre Lovinfosse
- Division of Nuclear Medicine and Oncological Imaging, University Hospital of Liège, Liège, Belgium
| | - Philippe Coucke
- Department of Radiotherapy Oncology, University Hospital of Liège, Liège, Belgium
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Chen T, Chan EG, Huang B, Bertolaccini L, Fernando HC, Tasoudis PT, Motas N, Pennathur A, Fang W, Zhang J. Outcomes following minimally invasive approaches vs. open extended lobectomy for non-small cell lung cancer: a propensity-matched analysis of the National Cancer Database. Transl Lung Cancer Res 2024; 13:334-344. [PMID: 38496690 PMCID: PMC10938095 DOI: 10.21037/tlcr-24-37] [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: 01/11/2024] [Accepted: 02/18/2024] [Indexed: 03/19/2024]
Abstract
Background Traditional thoracotomy, an invasive surgical procedure, has been the standard approach for extended lobectomy in treating non-small cell lung cancer (NSCLC). However, minimally invasive surgery (MIS) has gained traction with advancements in surgical techniques. Despite this, the outcomes of extended lobectomy via a minimally invasive approach remain largely uncharted. Using the comprehensive National Cancer Database (NCDB), our research aimed to clarify the safety, feasibility, and efficacy of minimally invasive extended lobectomy in patients diagnosed with NSCLC. Methods Our study encompassed a selection of patients with NSCLC who underwent extended lobectomy (defined as lobectomy or bilobectomy with chest wall, diaphragm or pericardial resection) between 2010 and 2014. Through propensity score matching (PSM), we ensured a balanced comparison between patients who underwent MIS and those who opted for the traditional open extended lobectomy. Both univariate and multivariate analyses were employed to discern whether the surgical approach had any significant impact on the prognosis of patients undergoing this specific procedure. Results Before PSM, our dataset included 3,934 patients. After 1:2 PSM, the MIS group included 683 cases, while the open group included 1,317 cases. One notable finding was the reduced average postoperative hospital stay for the MIS group at 7.15 days compared to the open group at 8.40 days (P<0.001). Furthermore, the 5-year survival rate was similar, with the MIS group at 53.1% and the open group at 51.3% (P=0.683). Conclusions The results of our study suggest that MIS for extended lobectomy not only is safe and feasible but also is oncologically effective. However, it is imperative to note that these encouraging findings necessitate further validation through prospective studies to ascertain the full scope of benefits and potential risks associated with MIS.
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Affiliation(s)
- Tangbing Chen
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ernest G. Chan
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Binhao Huang
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Gastric Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Luca Bertolaccini
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Hiran C. Fernando
- Department of Cardiothoracic Surgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Panagiotis T. Tasoudis
- Division of Cardiothoracic Surgery, Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Natalia Motas
- Department of Thoracic Surgery, Institute of Oncology Bucharest, Bucharest, Romania
- Clinic of Thoracic Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Thoracic Surgery, Memorial Hospital, Bucharest, Romania
| | - Arjun Pennathur
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Zhang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
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Makarov V, Yessentayeva S, Kadyrbayeva R, Irsaliev R, Novikov I. Modifications to the video-assisted thoracoscopic surgery technique reduce 1-year mortality and postoperative complications in intrathoracic tumors. Eur J Cancer Prev 2024; 33:53-61. [PMID: 37401484 DOI: 10.1097/cej.0000000000000825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
OBJECTIVE The purpose of the study is to analyze the immediate outcomes and results of video-assisted thoracoscopic lobectomy and lung resection performed in the surgical department of the AOC between 2014 and 2018. METHODS For the period from 2014 to 2018, 118 patients with peripheral lung cancer were operated on in the surgical department of the AOC. The following operations were performed: lobectomy in 92 cases (78%), of which: upper lobectomy, 44 (47.8%); average lobectomy, 13 (14.1%); lower lobectomy, 32 (35%); bilobectomy, 3 (3.3%). All patients underwent extensive lymphadenectomy on the side of the operation. In 22 patients, for various reasons, preservation of thoracotomy was performed. RESULTS The absence of N0 lymph node damage was observed in 82 patients (70%), the first-order lymph node damage N1 in 13 (11%), N2 in 13 (11%), N3 in 5 (4%), and NX in 5 (4%). Histological examination revealed: squamous cell carcinoma - 35.1%, adenocarcinoma - 28.5%, undifferentiated carcinoma - 8.3%, NSCLC - 5.6%, NEO - 4.6%, sarcoma - 1.8%. At the same time, in 12.7% of patients, mts was detected - lung damage, and in 3.4%, malignant cells were not detected. Most patients were activated on the first day after surgery. CONCLUSION An analysis of the direct results of the study allows us to conclude that video-assisted thoracoscopic surgery is a highly effective, minimally invasive, safe method for treating peripheral lung cancer, which allows us to recommend it for wider use in oncological practice.
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Affiliation(s)
- Valeriy Makarov
- Faculty of Medicine and Health Care, Al-Farabi Kazakh National University
- Department of Oncosurgery, Almaty Regional Multidisciplinary Clinic
| | | | - Rabiga Kadyrbayeva
- Department of Oncosurgery, Kazakh Research Institute of Oncology and Radiology
| | - Rustem Irsaliev
- Department of Oncosurgery, Almaty Oncology Center, Almaty, Republic of Kazakhstan
| | - Igor Novikov
- Department of Oncosurgery, Almaty Regional Multidisciplinary Clinic
- Department of Oncology and Mammology, Kazakh-Russian Medical University
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Niskakangas A, Mustonen O, Puro I, Karjula T, Helminen O, Yannopoulos F. Results of video-assisted thoracoscopic surgery versus thoracotomy for lung cancer in a mixed practice medium-volume hospital: a propensity-matched study. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2023; 37:ivad189. [PMID: 38011678 DOI: 10.1093/icvts/ivad189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/15/2023] [Accepted: 11/25/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVES The aim of this study was to compare the short- and long-term results of video-assisted thoracoscopic surgery (VATS) and thoracotomy for non-small-cell lung cancer in a medium-volume centre, where cardiothoracic surgeons perform both cardiac and general thoracic surgery. The primary outcome of interest was 5-year overall survival and disease-specific survival. Secondary outcomes were short-term postoperative complications, length of hospital stay and lymph node yield. METHODS This was a retrospective cohort study including 670 lung cancer patients undergoing VATS (n = 207) or open surgery (n = 463) with a curative intent in Oulu University Hospital between the years 2000-2020. Propensity score matching was implemented with surgical technique as the dependent and age, sex, Charlson comorbidity index, pulmonary function, pathological stage, histological type and the year of the operation as covariates resulting in 127 pairs. RESULTS In the propensity-matched cohort, 5-year overall survival was 64.3% after VATS and 63.2% after thoracotomy (P = 0.969). Five-year disease-specific survival was 71.6% vs 76.2% (P = 0.559). There were no differences in overall (34.6% vs 44.9%, p = 0.096) or major postoperative complications (8.7% vs 14.2%, P = 0.167) between the study groups. The average length of hospital stay was shorter (5.8 vs 6.6 days, P = 0.012) and the median lymph node yield was lower (4.0 vs 7.0, P < 0.001) in the VATS group compared to the thoracotomy group. CONCLUSIONS According to this study, the long-term results of lung cancer surgery in a mixed practice are comparable between VATS and open surgery.
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Affiliation(s)
- Anne Niskakangas
- Research Unit of Translational Medicine, Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Olli Mustonen
- Research Unit of Translational Medicine, Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Iiris Puro
- Research Unit of Translational Medicine, Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Topias Karjula
- Research Unit of Translational Medicine, Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Olli Helminen
- Research Unit of Translational Medicine, Medical Research Center Oulu, University of Oulu, Oulu, Finland
- Department of Gastrointestinal Surgery, Oulu University Hospital, Oulu, Finland
| | - Fredrik Yannopoulos
- Research Unit of Translational Medicine, Medical Research Center Oulu, University of Oulu, Oulu, Finland
- Department of Cardiothoracic Surgery, Oulu University Hospital, Oulu, Finland
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Ninety-Day Mortality of Thoracoscopic vs Open Lobectomy: A Large Multicenter Cohort Study. Ann Thorac Surg 2023; 115:693-699. [PMID: 35988738 DOI: 10.1016/j.athoracsur.2022.07.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 06/19/2022] [Accepted: 07/25/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Studies have demonstrated a lower incidence of complications after video-assisted thoracoscopic surgery (VATS) lobectomy compared with thoracotomy, but the data on in-hospital and 90-day mortality are inconclusive. This study analyzed whether surgical approach, VATS or thoracotomy, was related to early mortality of lobectomy in lung cancer and determined the differences between in-hospital and 90-day mortality. METHODS Data of all patients with non-small cell lung cancer who underwent lobectomy between January 1, 2007, and July 30, 2018, were retrieved from Polish National Lung Cancer Registry. Included were 31 433 patients who met all study criteria. After propensity score matching, 4946 patients in the VATS group were compared with 4946 patients in the thoracotomy group. RESULTS Compared with thoracotomy, VATS lobectomy was related to lower in-hospital (1.5% vs 0.9%, P = .004) and 90-day mortality (3.4% vs 1.8%, P < .001). Mortality at 90 days was twice as high as in-hospital mortality in both the VATS (1.8% vs 0.9%, P < .001) and thoracotomy groups (3.4% vs 1.5%, P < .001). Postoperative complications were less common after VATS compared with thoracotomy (23.6% vs 31.8%, P < .001). CONCLUSIONS VATS lobectomy is associated with lower in-hospital and 90-day mortality compared with thoracotomy and should be recommended for lung cancer treatment, if feasible. Patients should also be closely monitored after discharge from the hospital, because 90-day mortality is significant higher than in-hospital mortality.
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Li H, Wang Y, Chen Y, Zhong C, Fang W. Ground glass opacity resection extent assessment trial (GREAT): A study protocol of multi-institutional, prospective, open-label, randomized phase III trial of minimally invasive segmentectomy versus lobectomy for ground glass opacity (GGO)-containing early-stage invasive lung adenocarcinoma. Front Oncol 2023; 13:1052796. [PMID: 36741022 PMCID: PMC9892852 DOI: 10.3389/fonc.2023.1052796] [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: 09/24/2022] [Accepted: 01/04/2023] [Indexed: 01/20/2023] Open
Abstract
Background With widely use of computed tomography (CT) screening, an increasing number of early-stage lung cancers appearing as ground glass opacity (GGO) have been detected. Therefore, attempts have been made to investigate the feasibility of segmentectomy instead of lobectomy for those patients with GGO. However, the two recently released phase III trials failed to distinguish between GGO-containing lesions from pure solid nodules in the inclusion criteria, and the surgical methods did not distinguish between minimally invasive surgery and open thoracotomy. In addition, total lesion size≤ 2cm was taken as the inclusion criterion, instead of the solid part size recommended in the eighth edition of Union for International Cancer Control/International Association for the Study of Lung Cancer/American Joint Committee on Cancer (UICC/IASLC/AJCC) staging system. Hence, this present trial aims to figure out whether minimally invasive segmentectomy shows superiority in perioperative outcomes and non-inferiority in oncological prognosis over minimally invasive lobectomy among patients with GGO-containing clinical stage T1a-T1b lung invasive adenocarcinoma (IADC). Methods/design Sample sizes are 1024 patients, who will be randomized into minimally invasive segmentectomy and lobectomy groups . Patients will be collected from 19 hospitals in China. Patients with peripheral mixed ground glass opacity (mGGO) with 0.5cm<total lesion size ≤ 3cm and 0.5cm<solid component size ≤ 2cm in lung window on CT scan are enrolled. The primary endpoint is 5-year recurrence-free survival (RFS). The secondary endpoints are 5-year overall survival (OS), perioperative outcomes and pulmonary function preservation. Kaplan-Meier curves are plotted to compare the survival outcomes between the two arms. Subgroup analyses are also performed to investigate the benefit of segmentectomy among different clinical variables. Discussions If the primary endpoint shows at least non-inferiority in 5-year RFS of segmentectomy to lobectomy, minimally invasive segmentectomy can be recommended as an alternative to minimally invasive lobectomy. If second endpoints show non-inferior 5-year OS along with better perioperative outcomes and/or better pulmonary function preservation of segmentectomy compared with lobectomy after the primary endpoint has reached, minimally invasive segmentectomy may become a preferred procedure for patients with GGO-containing clinical stage T1a-T1b IADCs. Trial registration Chinese Clinical Trial Registry. Trial registration number: ChiCTR2000037065. Clinical trial registration https://www.chictr.org.cn/, identifier ChiCTR2000037065.
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Liu C, Ran R, Luo L, Li X, Liu G, Shao H, Li J. The three steps method for uniportal video-assisted thoracoscopic right upper lobectomy. J Cardiothorac Surg 2023; 18:12. [PMID: 36627665 PMCID: PMC9830912 DOI: 10.1186/s13019-023-02129-0] [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: 09/09/2022] [Accepted: 01/02/2023] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The uniportal video-assisted thoracoscopic right upper lobectomy (UVATRUL), as a common procedure for thoracic surgeons, is difficult to manipulate and has some inherent challenges. To solve both of problems, we summarized a series of techniques as the three steps method and investigated its feasibility on the patients of right upper lung cancer. METHODS Forty-eight patients with right upper lobe lung cancer who underwent the three steps method UVATRUL in our hospital from January 2020 to May 2022 were selected as the three steps method group. Forty-seven patients who underwent the traditional UVATRUL were selected as the traditional method group. The intraoperative condition and postoperative condition of the two groups were retrospectively analysed. Multiple linear regression analysis was carried out to analyze the relationship between positive results and surgical method. RESULTS All patients had successfully completed their surgeries. There was no significant difference between the two groups in respect of intraoperative blood loss, rate of conversion, day one thoracic drainage volume, chest tube indwelling time, incidence of postoperative complications, number of lymph node, and postoperative hospital stay (P > 0.05). Operative time of the three steps method group was significantly shorter than the traditional method group (P < 0.001), and number of reloads used was also significantly less than the traditional method group (P = 0.014). Multiple linear regression analysis showed that operative time (β = - 0.470, P < 0.001), and number of reloads (β = - 0.254, P = 0.007) correlated with surgical method. CONCLUSION Compared with the traditional UVATRUL, the three steps method trims the surgery procedures, shortens the operative time, and reduces the use of reloads which makes it an effective procedure for UVATRUL.
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Affiliation(s)
- Caiyang Liu
- Department of Cardiothoracic Surgery, The First People’s Hospital of Neijiang, No. 1866, West Section of Hanan Avenue, Shizhong District, Neijiang, 641000 Sichuan China
| | - Ran Ran
- grid.415880.00000 0004 1755 2258Breast Surgery Center of Sichuan Cancer Hospital, Chengdu, 610041 China
| | - Lei Luo
- Department of Cardiothoracic Surgery, The First People’s Hospital of Neijiang, No. 1866, West Section of Hanan Avenue, Shizhong District, Neijiang, 641000 Sichuan China
| | - Xiaoliang Li
- Department of Cardiothoracic Surgery, The First People’s Hospital of Neijiang, No. 1866, West Section of Hanan Avenue, Shizhong District, Neijiang, 641000 Sichuan China
| | - Gaohua Liu
- Department of Cardiothoracic Surgery, The First People’s Hospital of Neijiang, No. 1866, West Section of Hanan Avenue, Shizhong District, Neijiang, 641000 Sichuan China
| | - Hong Shao
- Department of Cardiothoracic Surgery, The First People’s Hospital of Neijiang, No. 1866, West Section of Hanan Avenue, Shizhong District, Neijiang, 641000 Sichuan China
| | - Ji Li
- Department of Cardiothoracic Surgery, The First People’s Hospital of Neijiang, No. 1866, West Section of Hanan Avenue, Shizhong District, Neijiang, 641000 Sichuan China
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Erwin PA, Lee AC, Ahmad U, Antonoff M, Arndt A, Backhus L, Berry M, Birdas T, Cassivi SD, Chang AC, Cooke DT, Crabtree T, DeCamp M, Donington J, Fernandez F, Force S, Gaissert H, Hofstetter W, Huang J, Kent M, Kim AW, Lin J, Martin LW, Meyerson S, Mitchell JD, Molena D, Odell D, Onaitis M, Puri V, Putnam JB, Reddy R, Schipper P, Seder CW, Shrager J, Tong B, Veeramachaneni N, Watson T, Whyte R, Ferguson MK. Consensus for Thoracoscopic Lower Lobectomy: Essential Components and Targets for Simulation. Ann Thorac Surg 2022; 114:1895-1901. [PMID: 34688617 DOI: 10.1016/j.athoracsur.2021.09.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/20/2021] [Accepted: 09/15/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Despite demonstration of its clear benefits relative to open approaches, a video-assisted thoracic surgery technique for pulmonary lobectomy has not been universally adopted. This study aims to overcome potential barriers by establishing the essential components of the operation and determining which steps are most useful for simulation training. METHODS After randomly selecting experienced thoracic surgeons to participate, an initial list of components to a lower lobectomy was distributed. Feedback was provided by the participants, and modifications were made based on anonymous responses in a Delphi process. Components were declared essential once at least 80% of participants came to an agreement. The steps were then rated based on cognitive and technical difficulty followed by listing the components most appropriate for simulation. RESULTS After 3 rounds of voting 18 components were identified as essential to performance of a video-assisted thoracic surgery for lower lobectomy. The components deemed the most difficult were isolation and division of the basilar and superior segmental branches of the pulmonary artery, isolation and division of the lower lobe bronchus, and dissection of lymphovascular tissue to expose the target bronchus. The steps determined to be most amenable for simulation were isolation and division of the branches of the pulmonary artery, the lower lobe bronchus, and the inferior pulmonary vein. CONCLUSIONS Using a Delphi process a list of essential components for a video-assisted thoracic surgery for lower lobectomy was established. Furthermore 3 components were identified as most appropriate for simulation-based training, providing insights for future simulation development.
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Affiliation(s)
- Philip A Erwin
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - Andy C Lee
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - Usman Ahmad
- Department of Thoracic and Cardiovascular Surgery Cleveland Clinic, Cleveland, Ohio
| | - Mara Antonoff
- Department of Thoracic and Cardiovascular Surgery MD Anderson Cancer Center Houston, Texas
| | - Andrew Arndt
- Department of Surgery Northwestern University, Chicago, Illinois
| | - Leah Backhus
- Department of Cardiothoracic Surgery Stanford University, Stanford, California
| | - Mark Berry
- Department of Cardiothoracic Surgery Stanford University, Stanford, California
| | - Thomas Birdas
- Department of Surgery, Indiana University, Indianapolis, Indiana
| | | | - Andrew C Chang
- Department of Surgery, University of Michigan Ann Arbor, Michigan
| | - David T Cooke
- Department of Surgery, University of California, Davis Health, Sacramento, California
| | - Traves Crabtree
- Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Malcolm DeCamp
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | | | | | - Seth Force
- Department of Surgery, Emory University, Atlanta, Georgia
| | - Henning Gaissert
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Wayne Hofstetter
- Department of Thoracic and Cardiovascular Surgery MD Anderson Cancer Center Houston, Texas
| | - James Huang
- Department of Surgery, Memorial Sloan Kettering, New York, New York
| | - Michael Kent
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Anthony W Kim
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jules Lin
- Department of Surgery, University of Michigan Ann Arbor, Michigan
| | - Linda W Martin
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Shari Meyerson
- Department of Surgery, University of Kentucky, Lexington, Kentucky
| | - John D Mitchell
- Department of Surgery, University of Colorado Aurora, Colorado
| | - Daniela Molena
- Department of Surgery, Memorial Sloan Kettering, New York, New York
| | - David Odell
- Department of Surgery Northwestern University, Chicago, Illinois
| | - Mark Onaitis
- Department of Surgery, University of California-San Diego, La Jolla, California
| | - Varun Puri
- Department of Surgery, Washington University, St. Louis, Missouri
| | - Joe B Putnam
- Department of Surgery, Baptist MD Anderson Cancer Center, Jacksonville, Florida
| | - Rishindra Reddy
- Department of Surgery, University of Michigan Ann Arbor, Michigan
| | - Paul Schipper
- Department of Surgery, Oregon Health and Sciences University, Portland, Oregon
| | | | - Joseph Shrager
- Department of Cardiothoracic Surgery Stanford University, Stanford, California
| | - Betty Tong
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | | | - Thomas Watson
- Department of Surgery, Beaumont Health-Detroit, Royal Oak, Michigan
| | - Richard Whyte
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Mark K Ferguson
- Department of Surgery, University of Chicago, Chicago, Illinois.
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10
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Mitzman B, Chikwe J. Editors' Choice: Challenges of Randomized Trials of Cardiothoracic Surgery. Ann Thorac Surg 2022; 114:1531-1533. [PMID: 36284443 DOI: 10.1016/j.athoracsur.2022.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Indexed: 12/31/2022]
Affiliation(s)
- Brian Mitzman
- Division of Cardiothoracic Surgery, University of Utah Health, Salt Lake City Utah.
| | - Joanna Chikwe
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
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11
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Nath TS, Mohamed N, Gill PK, Khan S. A Comparative Analysis of Video-Assisted Thoracoscopic Surgery and Thoracotomy in Non-Small-Cell Lung Cancer in Terms of Their Oncological Efficacy in Resection: A Systematic Review. Cureus 2022; 14:e25443. [PMID: 35774656 PMCID: PMC9238107 DOI: 10.7759/cureus.25443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 05/29/2022] [Indexed: 12/24/2022] Open
Abstract
Video-assisted thoracoscopic surgery (VATS) is considered the standard procedure for surgical resection in non-small-cell lung cancer (NSCLC). However, there is still lingering speculation on its adequacy of lymph node (LN) dissection or sampling and the long-term survival benefits when compared to open thoracotomy. Given the above, we conducted a systematic review comparing VATS and thoracotomy in terms of their oncological effectiveness in resection. We explored major research literature databases and search engines such as MEDLINE, PubMed, PubMed Central, Google Scholar, and ResearchGate to find pertinent articles. After the meticulous screening, quality check, and applying relevant filters according to our eligibility criteria, we identified 16 studies relevant to our research question, out of which one was a randomized controlled trial, one meta-analysis, and 14 were observational studies. The study comprised 44,673 patients with NSCLC, out of whom 15,093 patients were operated by VATS and the remaining 29,580 patients by thoracotomy. The results indicate that VATS is equivalent to thoracotomy in total LNs (N1 + N2) and LN stations dissected. However, a thoracotomy may achieve slightly better mediastinal lymph node dissection (N2) in terms of assessing a greater number of mediastinal lymph nodes and nodal stations. This may be attributed to a better visual field during mediastinal nodal clearance by an open approach. Also, nodal upstaging was consistently more common with an open approach. In terms of long-term outcomes, both overall survival and disease-free survival rates were similar between the two groups, with VATS offering a slightly better survival benefit. Irrespective of the increased rates of nodal upstaging by an open approach, we conclude that VATS should be considered a highly efficient alternative to thoracotomy in both early and locally advanced NSCLC.
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12
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Montagne F, Chaari Z, Bottet B, Sarsam M, Mbadinga F, Selim J, Guisier F, Gillibert A, Baste JM. Long-Term Survival Following Minimally Invasive Lung Cancer Surgery: Comparing Robotic-Assisted and Video-Assisted Surgery. Cancers (Basel) 2022; 14:cancers14112611. [PMID: 35681593 PMCID: PMC9179652 DOI: 10.3390/cancers14112611] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/12/2022] [Accepted: 05/18/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS) are known to be safe and efficient surgical procedures to treat lung cancer. Both VATS and RATS allow anatomical resection associated with radical lymph node dissection. However, RATS, unlike VATS, allows the thoracic surgeon to mimic an open approach and to perform lung resection. We hypothesized that the technical advantages of RATS, compared with VATS, would allow more precise resection, with “better lymph node dissection” which could increase survival compared to VATS. Nevertheless, VATS, and RATS nodal up-staging are still debated, with conflicting results and in our study, as well as in the medical literature, RATS failed to show its superiority over VATS in resectable non-small cell lung cancer. Abstract Background: Nowadays, video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS) are known to be safe and efficient surgical procedures to treat early-stage non-small cell lung cancer (NSCLC). We assessed whether RATS increased disease-free survival (DFS) compared with VATS for lobectomy and segmentectomy. Methods: This retrospective cohort study included patients treated for resectable NSCLC performed by RATS or VATS, in our tertiary care center from 2012 to 2019. Patients’ data were prospectively recorded and reviewed in the French EPITHOR database. Primary outcomes were 5-year DFS for lobectomy and 3-year DFS for segmentectomy, compared by propensity-score adjusted difference of Kaplan–Meier estimates. Results: Among 844 lung resections, 436 VATS and 234 RATS lobectomies and 46 VATS and 128 RATS segmentectomies were performed. For lobectomy, the adjusted 5-year DFS was 60.9% (95% confidence interval (CI) 52.9–68.8%) for VATS and 52.7% (95%CI 41.7–63.7%) for RATS, with a difference estimated at −8.3% (−22.2–+4.9%, p = 0.24). For segmentectomy, the adjusted 3-year DFS was 84.6% (95%CI 69.8–99.0%) for VATS and 72.9% (95%CI 50.6–92.4%) for RATS, with a difference estimated at −11.7% (−38.7–+7.8%, p = 0.21). Conclusions: RATS failed to show its superiority over VATS for resectable NSCLC.
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Affiliation(s)
| | - Zied Chaari
- Department of Thoracic and Cardiovascular Surgery, University of Sfax, Habib Bourguiba University Hospital, Sfax 3029, Tunisia;
| | - Benjamin Bottet
- Department of General and Thoracic Surgery, Rouen University Hospital, 1 Rue de Germont, F-76000 Rouen, France; (B.B.); (M.S.); (F.M.)
| | - Matthieu Sarsam
- Department of General and Thoracic Surgery, Rouen University Hospital, 1 Rue de Germont, F-76000 Rouen, France; (B.B.); (M.S.); (F.M.)
| | - Frankie Mbadinga
- Department of General and Thoracic Surgery, Rouen University Hospital, 1 Rue de Germont, F-76000 Rouen, France; (B.B.); (M.S.); (F.M.)
| | - Jean Selim
- Department of Anesthesiology and Critical Care, CHU Rouen, F-76000 Rouen, France;
- Normandie University, University of Medicine and Pharmacy of Rouen, UNIROUEN, INSERM U1096, FHU REMOD-VHF, F-76183 Rouen, France
| | - Florian Guisier
- Thoracic Oncology and Respiratory Intensive Care Unit, Department of Pneumology, Rouen University Hospital, F-76000 Rouen, France;
- Normandie University, University of Medicine and Pharmacy of Rouen, UNIROUEN, EA4108 LITIS Lab, QuantiF Team and INSERM CIC-CRB 1404, F-76183 Rouen, France
| | - André Gillibert
- Department of Biostatistics, CHU Rouen, F-76000 Rouen, France;
| | - Jean-Marc Baste
- Department of General and Thoracic Surgery, Rouen University Hospital, 1 Rue de Germont, F-76000 Rouen, France; (B.B.); (M.S.); (F.M.)
- Normandie University, University of Medicine and Pharmacy of Rouen, UNIROUEN, INSERM U1096, FHU REMOD-VHF, F-76183 Rouen, France
- Correspondence: ; Tel.: +33-(2)-32888704
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13
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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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14
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Li H, Shen C, Chen Y, Wang Y, Zhong C, Fang W. What Do We Talk About Now When We Talk About Segmentectomy for GGO? Front Surg 2022; 9:831246. [PMID: 35242804 PMCID: PMC8887550 DOI: 10.3389/fsurg.2022.831246] [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: 12/08/2021] [Accepted: 01/13/2022] [Indexed: 11/29/2022] Open
Abstract
Segmentectomy has been considered as a compromised procedure in patients with early-stage lung cancer who could not tolerate standard lobectomy. By computed tomography (CT) screening, lung cancers are increasingly detected in earlier stages, especially those appearing as ground glass opacity (GGO)-containing lesions on CT scan. This has led to the revival of segmentectomy as an intentional procedure with the aim of curing selected patients, as GGO-containing lesions represent a special group of diseases that are relatively indolent in nature and seldom have lymphatic involvement. Limited resections, especially anatomical segmentectomy, may, thus, be helpful in reducing perioperative risks and preserving higher pulmonary function for patients while retaining similar oncological outcomes. However, clinical trials focusing specifically on the role of segmentectomy in the treatment of GGO-containing lung cancers are still lacking, especially in the minimally invasive surgery setting. Emerging evidence suggests that for such lesions, the oncological non-inferiority of segmentectomy to standard lobectomymay not be limited to lesions with a size ≤ 2 cm. More importantly, it is still unclear whether segmentectomy could indeed minimize perioperative risks and to what extent it could help preserve higher pulmonary function in good-risk patients with less extent of lung parenchyma resection. Hence, it is critical to reevaluate the efficacies of minimally invasive segmentectomy including not only oncological outcomes but also perioperative results and pulmonary function changes compared with lobectomy in good-risk patients with GGO-containing lung cancers. All these remain to be explored in future studies and robust evidence is still needed to prove that patients would indeed benefit from the combination of segmentectomy and minimally invasive surgery.
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15
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Sesti J, Decker J, Bell J, Nguyen A, Lackey A, Turner AL, Hilden P, Paul S. Long-term Outcomes After Lung Cancer Resection in Smokers: Analysis of the National Lung Screening Trial. World J Surg 2021; 46:265-271. [PMID: 34591149 DOI: 10.1007/s00268-021-06311-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Smoking is a known risk factor for perioperative complications after lung resection; however, little data exists looking at the impact of smoking status (current versus former) on long-term oncologic outcomes after lung cancer surgery. We sought to compare overall survival (OS), progression-free survival (PFS), and cancer-specific mortality (CSM) in current and former smokers using data from the National Lung Screening Trial (NLST). Additionally, we performed subset analysis in current smokers in order to evaluate the effect of modern surgical techniques on long-term outcomes. METHODS Patients with clinical stage IA or IB NSCLC who underwent upfront resection within 180 days of diagnosis were identified in the NLST database. Cox proportional hazard regression models were used to assess differences in patient and treatment characteristics with respect to OS and PFS, with a cause-specific hazard model used for CSM. RESULTS A total of 593 patients were included in the study (269 former smokers, 324 current smokers). Lobar resection (LR) was performed more often than sublobar resection (SLR) (481 vs. 112), and thoracotomy was performed more often than thoracoscopy (482 vs. 86). Comparison of current versus former smokers showed no difference in OS or PFS after resection. Higher CSM was seen in current smokers (p = 0.049). Subset analysis of current smokers revealed no difference in OS or PFS between sub-lobar and lobar resection or thoracotomy and thoracoscopy. Although higher CSM was associated with thoracoscopy versus thoracotomy in this group, this finding was limited by a relatively small thoracoscopy sample size of 44 patients (p = 0.026). CONCLUSION Our analysis of the NLST database shows no significant difference in OS and PFS when comparing current and former smokers undergoing resection for stage I NSCLC. Active smoking status was associated with higher CSM. Subset analysis of current smokers showed no difference in OS or PFS between sub-lobar and lobar resection or thoracotomy and thoracoscopy. Higher CSM was seen in current smokers who underwent thoracoscopy compared to thoracotomy; however, this finding was limited by a small sample size.
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Affiliation(s)
- Joanna Sesti
- Thoracic Surgical Services, RWJBarnabas Health, 101 Old Short Hills Road, West Orange, NJ, 07052, USA.
| | - Jonathan Decker
- Department of Surgery, Newark Beth Israel Medical Center, 201 Lyons Avenue, Newark, NJ, 07112, USA
| | - Jaimie Bell
- Thoracic Surgical Services, RWJBarnabas Health, 101 Old Short Hills Road, West Orange, NJ, 07052, USA
| | - Andrew Nguyen
- Thoracic Surgical Services, RWJBarnabas Health, 101 Old Short Hills Road, West Orange, NJ, 07052, USA
| | - Adam Lackey
- Thoracic Surgical Services, RWJBarnabas Health, 101 Old Short Hills Road, West Orange, NJ, 07052, USA
| | - Amber L Turner
- Department of Surgery, RWJBarnabas Health, 94 Old Short Hills Road, Livingston, NJ, 07039, USA
| | - Patrick Hilden
- Department of Biostatistics, Saint Barnabas Medical Center, 94 Old Short Hills Road, Livingston, NJ, 07039, USA
| | - Subroto Paul
- Thoracic Surgical Services, RWJBarnabas Health, 101 Old Short Hills Road, West Orange, NJ, 07052, USA
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16
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Kim HK. Video-Assisted Thoracic Surgery Lobectomy. J Chest Surg 2021; 54:239-245. [PMID: 34353962 PMCID: PMC8350467 DOI: 10.5090/jcs.21.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/08/2021] [Accepted: 07/16/2021] [Indexed: 12/11/2022] Open
Abstract
Video-assisted thoracoscopic surgery (VATS) has been established as the surgical approach of choice for lobectomy in patients with early-stage non-small cell lung cancer (NSCLC). Patients with clinical stage I NSCLC with no lymph node metastasis are considered candidates for VATS lobectomy. To rule out the presence of metastasis to lymph nodes or distant organs, patients should undergo meticulous clinical staging. Assessing patients' functional status is required to ensure that there are no medical contraindications, such as impaired pulmonary function or cardiac comorbidities. Although various combinations of the number, size, and location of ports are available, finding the best method of port placement for each surgeon is fundamental to maximize the efficiency of the surgical procedure. When conducting VATS lobectomy, it is always necessary to comply with the following oncological principles: (1) the vessels and bronchus of the target lobe should be individually divided, (2) systematic lymph node dissection is mandatory, and (3) touching the lymph node itself and rupturing the capsule of the lymph node should be minimized. Most surgeons conduct the procedure in the following sequence: (1) dissection along the hilar structure, (2) fissure division, (3) perivascular and peribronchial dissection, (4) individual division of the vessels and bronchus, (5) specimen retrieval, and (6) mediastinal lymph node dissection. Surgeons should obtain experience in enhancing the exposure of the dissection target and facilitating dissection. This review article provides the basic principles of the surgical techniques and practical maneuvers for performing VATS lobectomy easily, safely, and efficiently.
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Affiliation(s)
- Hong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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17
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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: 12] [Impact Index Per Article: 4.0] [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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18
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Nguyen Van N, Hung PN, Dung LT, Anh LV, Pho DC, Anh BDT, Hai VA. Short-Term and Mid-Term Outcomes of Video-Assisted Thoracic Surgery in Patients with Early-Stage Non-Small Cell Lung Cancer. OPEN ACCESS SURGERY 2021. [DOI: 10.2147/oas.s315389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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19
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Aeschbacher P, Nguyen TL, Dorn P, Kocher GJ, Lutz JA. Surgical Site Infections Are Associated With Higher Blood Loss and Open Access in General Thoracic Practice. Front Surg 2021; 8:656249. [PMID: 34250005 PMCID: PMC8267000 DOI: 10.3389/fsurg.2021.656249] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 05/18/2021] [Indexed: 12/23/2022] Open
Abstract
Background: Surgical site infections (SSIs) are the most costly and second most frequent healthcare-associated infections in the Western world. They are responsible for higher postoperative mortality and morbidity rates and longer hospital stays. The aim of this study is to analyze which factors are associated with SSI in a modern general thoracic practice. Methods: Data were collected from our department's quality database. Consecutive patients operated between January 2014 and December 2018 were included in this retrospective study. Results: A total of 2430 procedures were included. SSIs were reported in 37 cases (1.5%). The majority of operations were video-assisted (64.6%). We observed a shift toward video-assisted thoracic surgery in the subgroup of anatomical resections during the study period (2014: 26.7%, 2018: 69.3%). The multivariate regression analysis showed that blood loss >100 ml (p = 0.029, HR 2.70) and open surgery (p = 0.032, HR 2.37) are independent risk factors for SSI. The latter was higher in open surgery than in video-assisted thoracic procedures (p < 0.001). In the subgroup of anatomical resection, we found the same correlation (p = 0.043). SSIs are also associated with significantly longer mean hospital stays (17.7 vs. 7.8 days, p < 0.001). Conclusion: As SSIs represent higher postoperative morbidity and costs, efforts should be made to maintain their rate as low as possible. In terms of prevention of SSIs, video-assisted thoracic surgery should be favored over open surgery whenever possible.
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Affiliation(s)
- Pauline Aeschbacher
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thanh-Long Nguyen
- Department of Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Patrick Dorn
- Department of Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gregor Jan Kocher
- Department of Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jon Andri Lutz
- Department of Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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20
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Hennon MW, DeGraaff LH, Groman A, Demmy TL, Yendamuri S. The association of nodal upstaging with surgical approach and its impact on long-term survival after resection of non-small-cell lung cancer. Eur J Cardiothorac Surg 2021; 57:888-895. [PMID: 31764992 DOI: 10.1093/ejcts/ezz320] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 10/15/2019] [Accepted: 10/27/2019] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES Proponents of open thoracotomy (OPEN) and robot-assisted thoracic surgery (RATS) claim its oncological superiority over video-assisted thoracic surgery (VATS) in terms of the accuracy of lymph node staging. METHODS The National Cancer Database was queried for patients with non-small-cell lung cancer (NSCLC) undergoing lobectomy without neoadjuvant therapy from 2010 to 2014. Nodal upstaging rates were compared using a surgical approach. Overall survival adjusted for confounding variables was examined using the Cox proportional hazards model. RESULTS A total of 64 676 patients fulfilled the selection criteria. The number of patients who underwent lobectomy by RATS, VATS and OPEN approaches was 5470 (8.5%), 17 545 (27.1%) and 41 661 (64.4%), respectively. The mean number of lymph nodes examined for each of these approaches was 10.9, 11.3 and 10 (P < 0.01) and upstaging rates were 11.2%, 11.7% and 12.6% (P < 0.01), respectively. For patients with clinical stage I disease (N = 46 826; RATS = 4338, VATS = 13 416 and OPEN = 29 072), the mean lymph nodes examined were 10.6, 10.8 and 9.4 (P < 0.01), and upstaging rates were 10.8%, 11.1% and 12.1% (P < 0.01), respectively. A multivariable analysis suggested an association with improved survival with RATS and VATS compared with OPEN surgery [hazard ratio (HR) = 0.89 and 0.89, respectively; P < 0.01] for patients with all stages. In stage I disease, VATS but not RATS was associated with increased overall survival compared with the OPEN approach (HR = 0.81; P < 0.01). CONCLUSIONS RATS lobectomy is not superior to VATS lobectomy with respect to lymph node yield or upstaging of NSCLC. Increased nodal upstaging by the OPEN approach does not confer a survival advantage in any stage of NSCLC and may be associated with decreased overall survival.
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Affiliation(s)
- Mark W Hennon
- Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, NY, USA.,Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Luke H DeGraaff
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Adrienne Groman
- Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Todd L Demmy
- Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, NY, USA.,Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Sai Yendamuri
- Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, NY, USA.,Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
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21
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Geraci TC, Ng T. When Is It Safe to Operate for Lung Cancer? Selection of Fiscally Responsible Cardiopulmonary Function Tests for Limited Resection (Wedge Resection and Segmentectomy), Standard Lobectomy, Sleeve Lobectomy, and Pneumonectomy. Thorac Surg Clin 2021; 31:255-263. [PMID: 34304833 DOI: 10.1016/j.thorsurg.2021.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Pulmonary function testing remains the central determinant of candidacy for pulmonary resection and indicator of perioperative risk. For patients with borderline pulmonary function, exercise testing can help determine surgical candidacy either via stair climbing or by obtaining a maximum oxygen consumption. The Thoracic Revised Cardiac Risk Index should be used to select patients for further cardiac testing. Patient comorbidities, medications, functional limitations, and smoking status are also requisite assessments of the preoperative evaluation that influence perioperative outcomes. A minimally invasive approach to pulmonary resection reduces perioperative risk and may be of most benefit to patients with borderline pulmonary function.
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Affiliation(s)
- Travis C Geraci
- Department of Cardiothoracic Surgery, New York University Langone Health, 530 1st Avenue, Suite 9V, New York, NY 10016, USA
| | - Thomas Ng
- Division of Thoracic Surgery, University of Tennessee Health Science Center College of Medicine, 1325 Eastmoreland Avenue, Suite 460, Memphis, TN 38104, USA.
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22
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A National Analysis of Short-term Outcomes and Long-term Survival Following Thoracoscopic Versus Open Lobectomy for Clinical Stage II Non-Small-Cell Lung Cancer. Ann Surg 2021; 273:595-605. [PMID: 30946089 DOI: 10.1097/sla.0000000000003231] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To compare outcomes after open versus thoracoscopic (VATS) lobectomy for clinical stage II (cN1) non-small-cell lung cancer (NSCLC). BACKGROUND There have been no published studies evaluating the impact of a VATS approach to lobectomy for N1 NSCLC on short-term outcomes and survival. METHODS Outcomes of patients with clinical T1-2, N1, M0 NSCLC who underwent lobectomy without induction therapy in the National Cancer Data Base (2010-2012) were evaluated using multivariable Cox proportional hazards modeling and propensity score-matched analysis. RESULTS Median follow-up of 1559 lobectomies (1204 open and 355 VATS) was 43.2 months. The VATS approach was associated with a shorter median hospitalization (5 vs 6 d, P < 0.001) than the open approach. There were no significant differences between the VATS and open approach with regard to nodal upstaging (12.0% vs 10.5%, P = 0.41), 30-day mortality (2.3% vs 3.1%, P = 0.31), and overall survival (5-yr survival: 48.6% vs 48.7%, P = 0.76; multivariable-adjusted HR for VATS approach: 1.08, 95% CI: 0.90-1.30, P = 0.39). A propensity score-matched analysis of 334 open and 334 VATS patients who were well matched by 14 common prognostic covariates, including tumor size, and comorbidities, continued to show no significant differences in nodal upstaging, 30-day mortality, and 5-year survival between the VATS and open groups. CONCLUSION In this national analysis, VATS lobectomy was used in the minority of N1 NSCLC cases but was associated with shorter hospitalization and similar nodal upstaging rates, 30-day mortality, and long-term survival when compared to open lobectomy. These findings suggest thoracoscopic techniques are feasible for the treatment of stage II (cN1) NSCLC.
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Dziedzic DA, Zbytniewski M, Gryszko GM, Cackowski MM, Langfort R, Orlowski TM. Video-assisted versus open thoracotomy lobectomy: comparison on lymphadenectomy and survival in early stage of lung cancer. J Thorac Dis 2021; 13:101-112. [PMID: 33569190 PMCID: PMC7867811 DOI: 10.21037/jtd-20-2251] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Video-assisted thoracic surgery (VATS) is increasingly used in the surgical treatment of early lung cancer, but the oncological benefits are still controversial. We aimed to compare video-assisted lobectomy and open thoracotomy lobectomy in terms of lymphadenectomy and long-term survival depending on the location of lobectomy. Methods A retrospective, multicenter study was based on the Polish Lung Cancer Study Group and included patients with stage I lung cancer who were surgically treated between 2007 and 2015. We included 1410 patients after video-assisted lobectomy and 4,855 after open thoracotomy. Results The average number of lymph nodes removed in video-assisted lobectomy was 10.9 and in open thoracotomy lobectomy was 12.9 (P<0.001). The 5-year survival was better in the video-assisted lobectomy group (78.6%) compared to open thoracotomy (73.8%) (P=0.002). Significant differences were found in the case of left lower lobe and left upper lobe lobectomies. Multivariable analysis showed that the prognostic factors for open thoracotomy relative to video-assisted lobectomy are: age over 60 [HR (95% CI): 1.55 (1.17-2.05), P=0.002], female [HR (95% CI): 1.57 (1.07-2.29), P=0.02], squamous cell carcinoma [HR (95% CI): 1.63 (1.12-2.37), P=0.011], left lower lobe [HR (95% CI): 2.69 (1.37-5.27), P=0.004] and left upper lobe [HR (95% CI): 1.53 (1.01-2.33), P=0.047]. Conclusions The study showed that the number of lymph nodes removed during video-assisted lobectomy is significantly lower than in the open thoracotomy group. The long-term video-assisted lobectomy results were significantly better compared to open thoracotomy. Better long-term results were achieved on the left side of lobectomy.
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Affiliation(s)
- Dariusz A Dziedzic
- Department of Thoracic Surgery, National Research Institute of Chest Diseases, Warsaw, Poland
| | - Marcin Zbytniewski
- Department of Thoracic Surgery, National Research Institute of Chest Diseases, Warsaw, Poland
| | - Grzegorz M Gryszko
- Department of Thoracic Surgery, National Research Institute of Chest Diseases, Warsaw, Poland
| | - Marcin M Cackowski
- Department of Thoracic Surgery, National Research Institute of Chest Diseases, Warsaw, Poland
| | - Renata Langfort
- Department of Pathomorphology, National Research Institute of Chest Diseases, Warsaw, Poland
| | - Tadeusz M Orlowski
- Department of Thoracic Surgery, National Research Institute of Chest Diseases, Warsaw, Poland
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Weder W, Furrer K, Opitz I. Robotic-assisted thoracoscopic surgery for clinically stage IIIA (c-N2) NSCLC-is it justified? Transl Lung Cancer Res 2021; 10:1-4. [PMID: 33569286 PMCID: PMC7867792 DOI: 10.21037/tlcr-20-647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Walter Weder
- Thoracic Surgery, Klinik Bethanien, Zürich, Switzerland
| | - Katarzyna Furrer
- Department of Thoracic Surgery, University Hospital Zurich, Zürich, Switzerland
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zürich, Switzerland
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25
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Pu CY, Rodwin S, Nelson B, Fayyaz N, Scott N, Bouchard RJ, Groman A, Hennon M, Yendamuri S. Approach to Resectable N1 Non-Small Cell Lung Cancer: An Analysis of the National Cancer Database. J Surg Res 2020; 259:145-153. [PMID: 33279840 DOI: 10.1016/j.jss.2020.11.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/28/2020] [Accepted: 11/02/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND In patients with clinical N1 disease, minimally invasive surgery (MIS) has potentially better perioperative outcome compared to open thoracotomy. Additionally, whether adjuvant or neoadjuvant chemotherapy produces the best long-term survival is still debatable. METHODS We queried The National Cancer Database for patients with clinical N1 NSCLC who underwent surgical resection between 2010 and 2014. Comparison between patients receiving MIS and patients who underwent open thoracotomy was done using an intention-to-treat analysis. Comparison was also done among neoadjuvant, adjuvant chemotherapy, and only surgery. Proportional hazard models were used to evaluate the effects of surgical approach and timing of chemotherapy on overall survival. RESULTS A total of 1440 and 3942 patients underwent MIS and open thoracotomy respectively. MIS achieved better surgical margins (90.0% versus 88.6%) and shorter length of stay (6.5 ± 6.5 versus 7.3 ± 6.4 d, P ≤ 0.01) compared to open thoracotomy. There were no differences in 30-day and 90-day mortality, nor readmission rates. Neoadjuvant and adjuvant chemotherapy were administered to 13.5% and 57.2% of patients respectively. There was no significant difference in the 5-year overall survival between MIS and open thoracotomy (46% versus 46% P = 0.08). There was significantly better 5-year overall survival in neoadjuvant and adjuvant chemotherapy versus only surgery, but no difference between neoadjuvant and adjuvant chemotherapy (48% versus 47% versus 44%, P < 0.01). CONCLUSIONS In clinical N1 NSCLC, MIS does not compromise oncological quality or overall survival when compared to open thoracotomy. Overall survival improved in patients treated with chemotherapy but there is no difference when given as neoadjuvant versus adjuvant chemotherapy.
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Affiliation(s)
- Chan Y Pu
- Pulmonary, Critical Care and Sleep Division, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York.
| | | | | | | | | | | | - Adrienne Groman
- Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, New York
| | - Mark Hennon
- Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, New York; Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York
| | - Sai Yendamuri
- Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, New York; Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York
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26
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Dong B, Zhu X, Shu Z, Ji Y, Lu F, Wang J, Chen M. Video-Assisted Thoracoscopic Lobectomy Versus Stereotactic Body Radiotherapy Treatment for Early-Stage Non-Small Cell Lung Cancer: A Propensity Score-Matching Analysis. Front Oncol 2020; 10:585709. [PMID: 33244457 PMCID: PMC7683774 DOI: 10.3389/fonc.2020.585709] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/19/2020] [Indexed: 12/25/2022] Open
Abstract
Background Compared the overall outcomes of video-assisted thoracoscopic surgery (VATS) versus stereotactic body radiotherapy (SBRT) for stage I-II non-small cell lung cancer (NSCLC). Methods We retrospectively compared overall survival (OS), cancer-specific survival (CSS), locoregional control (LRC), and disease-free survival (DFS) at our institution between January 2012 and December 2016. Propensity score-matching was performed to reduce patient selection bias based on age, gender, Karnofsky performance score, Charlson comorbidity index, pulmonary function, and tumor diameter. Results A total of 567 patients treated with SBRT (n = 109) or surgery (n = 458) were included. Of those, 104 patients were matched for further analyses. Median follow-up was 44 months. At 3 and 5 years, OS was 88.6 and 79.9% for SBRT, and 94.2 and 91.6% for surgery (p = 0.097). There were no differences noted in 5-year CSS (83.7 vs. 91.6%, respectively; p = 0.270). The cumulative incidence of LRC at 3 and 5 years was comparable (93.5 and 93.5% vs. 94.0 and 85.9%, respectively; p = 0.621). Differences in the rates of disease-free survival at 5 years were not statistically significant (79.0 and 80.5%, respectively; p = 0.624). Conclusions This propensity score-matching analysis suggests that SBRT can be an alternative option to VATS lobectomy for stage I-II NSCLC.
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Affiliation(s)
- Baiqiang Dong
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, China.,Department of Radiation Oncology, Zhejiang Key Laboratory of Radiobiology, Hangzhou, China
| | - Xuan Zhu
- Department of Radiation Oncology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Zekai Shu
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, China.,Department of Radiation Oncology, Zhejiang Key Laboratory of Radiobiology, Hangzhou, China
| | - Yongling Ji
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, China.,Department of Radiation Oncology, Zhejiang Key Laboratory of Radiobiology, Hangzhou, China
| | - Fangxiao Lu
- Department of X-ray, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, China
| | - Jin Wang
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, China.,Department of Radiation Oncology, Zhejiang Key Laboratory of Radiobiology, Hangzhou, China
| | - Ming Chen
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, China.,Department of Radiation Oncology, Zhejiang Key Laboratory of Radiobiology, Hangzhou, China
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Cowper PA, Feng L, Kosinski AS, Tong BC, Habib RH, Putnam JB, Onaitis MW, Furnary AP, Wright CD, Jacobs JP, Fernandez FG. Initial and Longitudinal Cost of Surgical Resection for Lung Cancer. Ann Thorac Surg 2020; 111:1827-1833. [PMID: 33031776 DOI: 10.1016/j.athoracsur.2020.07.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 07/18/2020] [Accepted: 07/30/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND The longitudinal cost of treating patients with non-small cell lung cancer (NSCLC) undergoing surgical resection has not been evaluated. We describe initial and 4-year resource use and cost for NSCLC patients aged 65 years of age or greater who were treated surgically between 2008 and 2013. METHODS Using clinical data for NSCLC resections from The Society of Thoracic Surgeons General Thoracic Surgery Database linked to Medicare claims, resource use and cost of preoperative staging, surgery, and subsequent care through 4 years were examined ($2017). Cost of hospital-based care was estimated using cost-to-charge ratios; professional services and care in other settings were valued using reimbursements. Inverse probability weighting was used to account for administrative censoring. Outcomes were stratified by pathologic stage and by surgical approach for stage I lobectomy patients. RESULTS Resection hospitalizations averaged 6 days and cost $31,900. In the first 90 days, costs increased with stage ($12,430 for stage I to $26,350 for stage IV). Costs then declined toward quarterly means more similar among stages. Cumulative costs ranged from $131,032 (stage I) to $205,368 (stage IV). In the stage I lobectomy cohort, patients selected for minimally invasive procedures had lower 4-year costs than did thoracotomy patients ($120,346 versus $136,250). CONCLUSIONS The 4-year cost of surgical resection for NSCLC was substantial and increased with pathologic stage. Among stage I lobectomy patients, those selected for minimally invasive surgery had lower costs, particularly through 90 days. Potential avenues for improving the value of surgical resection include judicious use of postoperative intensive care and earlier detection and treatment of disease.
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Affiliation(s)
| | | | | | - Betty C Tong
- Division of Thoracic and Cardiovascular Surgery, Duke University Medical Center, Durham, North Carolina
| | - Robert H Habib
- The Society of Thoracic Surgeons Research Center, Chicago, Illinois
| | - Joe B Putnam
- Baptist MD Anderson Cancer Center, Jacksonville, Florida
| | - Mark W Onaitis
- Division of Cardiothoracic Surgery, University of California, San Diego, La Jolla, California
| | | | - Cameron D Wright
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Felix G Fernandez
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
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28
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A Comparative Analysis of Long-Term Survival of Robotic Versus Thoracoscopic Lobectomy. Ann Thorac Surg 2020; 110:1139-1146. [DOI: 10.1016/j.athoracsur.2020.03.085] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 02/25/2020] [Accepted: 03/24/2020] [Indexed: 02/07/2023]
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29
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Comparison of the Video-assisted Thoracoscopic Lobectomy versus Open Thoracotomy for Primary Non-Small Cell Lung Cancer: Single Cohort Study with 269 Cases. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2020; 54:291-296. [PMID: 33312025 PMCID: PMC7729729 DOI: 10.14744/semb.2020.60963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/27/2020] [Indexed: 11/20/2022]
Abstract
Objectives: This study aims to compare the outcomes of video-assisted thoracoscopic surgery (VATS) lobectomy with open thoracotomy lobectomy in patients with non-small cell lung cancer (NSCLC). Methods: There were 269 cases with NSCLC who underwent lobectomy between 2017-2019; these cases were retrospectively studied. VATS lobectomy (VATS Group) and open thoracotomy lobectomy (Thoracotomy Group) patients’ results were compared according to the length of hospitalizations, early postoperative complications and tumor size and stages. Results: VATS lobectomy was performed in 89 (33%) of these patients, whereas 180 (67%) patients underwent lobectomy using open thoracotomy for NSCLC. The findings showed that the average length of hospitalization was shorter in the VATS Group compared to the Thoracotomy Group (4 vs. 5.5 days) (p<0.05). It was found that the mean size of the tumour was smaller in the VATS Group when compared to the Thoracotomy Group (2.66 cm vs 3.97 cm) (p<0.001). Early postoperative complications were lower in the VATS Group (n=15, 16.8% vs n=58, 32.2%; p<0.021). Conclusion: In VATS lobectomy cases, postoperative complications are less, and the length of hospitalization is shorter. VATS lobectomy is mostly preferred smaller than 3 cm tumor size.
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30
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Meng S, Liu G, Wang S, Yang F, Wang J. Nodal Involvement Pattern in Clinical Stage IA Non-Small Cell Lung Cancer According to Tumor Location. Cancer Manag Res 2020; 12:7875-7880. [PMID: 32904622 PMCID: PMC7457550 DOI: 10.2147/cmar.s262623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/30/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The purpose of this study was to investigate lymph node involvement pattern in clinical stage IA non-small cell lung cancer (NSCLC). PATIENTS AND METHODS Clinical stage ⅠA NSCLC patients who underwent lobectomy and lymph node resection were included in this retrospective study. Mediastinal lymph node involvement was distinguished by different lobes and tumor size. RESULTS From 2000 to 2015, a total of 759 patients were identified: 282 (37.2%) with tumors in the right upper lobe (RUL), 183 (24.1%) in the left upper lobe (LUL), 124 (16.3%) in the right lower lobe (RLL), 103 (13.6%) in the left lower lobe (LLL), and 67 (8.8%) in the right middle lobe (RML). Patients with tumor size ≤1 cm accounted for 19.6%, >1 and ≤2 cm for 47.8%, >2 and ≤3 cm for 32.5%. Patients with pN1 accounted for 8.2%, and pN2 for 12.5%. Among patients with pN2, the inferior mediastinum was involved in 9.7% of RULs and 17.4% of LULs; the superior mediastinum was involved in 52.2% of RLLs and 36.4% of LLLs. Mediastinal lymph node metastasis was found in 13.2% of patients with size >1 and ≤2 cm, and 19.0% of >2 and ≤3 cm. Patients with tumors ≤1 cm had no N2 lymph node involved. CONCLUSION Selective lymph node dissection based on tumor location is not recommended in clinical stage ⅠA NSCLC, and systemic lymph node dissection should be performed for NSCLC with size >1 cm.
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Affiliation(s)
- Shushi Meng
- Department of Thoracic Surgery, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Ganwei Liu
- Department of Thoracic Surgery, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Shaodong Wang
- Department of Thoracic Surgery, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Fan Yang
- Department of Thoracic Surgery, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Jun Wang
- Department of Thoracic Surgery, Peking University People’s Hospital, Beijing, People’s Republic of China
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31
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Ijsseldijk MA, Shoni M, Siegert C, Wiering B, van Engelenburg AKC, Tsai TC, Ten Broek RPG, Lebenthal A. Oncologic Outcomes of Surgery Versus SBRT for Non-Small-Cell Lung Carcinoma: A Systematic Review and Meta-analysis. Clin Lung Cancer 2020; 22:e235-e292. [PMID: 32912754 DOI: 10.1016/j.cllc.2020.04.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/21/2020] [Accepted: 04/25/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The optimal treatment of stage I non-small-cell lung carcinoma is subject to debate. The aim of this study was to compare overall survival and oncologic outcomes of lobar resection (LR), sublobar resection (SR), and stereotactic body radiotherapy (SBRT). METHODS A systematic review and meta-analysis of oncologic outcomes of propensity matched comparative and noncomparative cohort studies was performed. Outcomes of interest were overall survival and disease-free survival. The inverse variance method and the random-effects method for meta-analysis were utilized to assess the pooled estimates. RESULTS A total of 100 studies with patients treated for clinical stage I non-small-cell lung carcinoma were included. Long-term overall and disease-free survival after LR was superior over SBRT in all comparisons, and for most comparisons, SR was superior to SBRT. Noncomparative studies showed superior long-term overall and disease-free survival for both LR and SR over SBRT. Although the papers were heterogeneous and of low quality, results remained essentially the same throughout a large number of stratifications and sensitivity analyses. CONCLUSION Results of this systematic review and meta-analysis showed that LR has superior outcomes compared to SBRT for cI non-small-cell lung carcinoma. New trials are underway evaluating long-term results of SBRT in potentially operable patients.
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Affiliation(s)
- Michiel A Ijsseldijk
- Division of Surgery, Slingeland Ziekenhuis, Doetinchem, The Netherlands; Division of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Melina Shoni
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Charles Siegert
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA; Division of Thoracic Surgery, West Roxbury Veterans Administration, West Roxbury, MA
| | - Bastiaan Wiering
- Division of Surgery, Slingeland Ziekenhuis, Doetinchem, The Netherlands
| | | | - Thomas C Tsai
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Richard P G Ten Broek
- Division of Surgery, Slingeland Ziekenhuis, Doetinchem, The Netherlands; Division of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Abraham Lebenthal
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA; Division of Thoracic Surgery, West Roxbury Veterans Administration, West Roxbury, MA; Harvard Medical School, Boston, MA
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Study of Long-Term Follow-up of Exercise Levels Following Participation in a Prehabilitation Program in Esophagogastric Cancer. REHABILITATION ONCOLOGY 2020. [DOI: 10.1097/01.reo.0000000000000205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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33
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Zhang YH, Lu Y, Lu H, Zhou YM. Development of a Survival Prognostic Model for Non-small Cell Lung Cancer. Front Oncol 2020; 10:362. [PMID: 32266143 PMCID: PMC7098984 DOI: 10.3389/fonc.2020.00362] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 03/02/2020] [Indexed: 12/12/2022] Open
Abstract
Lung cancer is a leading cause of cancer-related death, and >80% of lung cancer diagnoses are non-small-cell lung cancer (NSCLC). However, when using current staging and prognostic indices, the prognosis can vary significantly. In the present study, we calculated a prognostic index for predicting overall survival (OS) in NSCLC patients. The data of 545 NSCLC patients were retrospectively reviewed. Univariate and multivariate Cox proportional hazards regression analyses were performed to evaluate the prognostic value of clinicopathological factors. Age (hazard ratio [HR] = 1.25, 95% confidence interval [CI] = 1.02–1.54), TNM stage (III, HR = 1.64, 95% CI = 1.08–2.48; IV, HR = 2.33, 95% CI = 1.48–3.69), lung lobectomy (HR = 1.96, 95% CI = 1.45–2.66), chemotherapy (HR = 1.42, 95% CI = 1.15–1.74), and pretreatment hemoglobin level (HR = 1.61, 95% CI = 1.28–2.02) were independent prognosticators. A prognostic index for NSCLC (PInscl, 0–6 points) was calculated based on age (≥65 years, 1 point), tumor-node-metastasis (TNM) stage (III, 1 point; IV, 2 points), lung lobectomy (no, 1 point), chemotherapy (no, 1 point), and pretreatment hemoglobin level (low, 1 point). In comparison with the “PInscl = 0” subgroup (survival time = 2.71 ± 1.86 years), the “PInscl = 2” subgroup (survival time = 1.86 ± 1.24 years), “PInscl = 3” subgroup (survival time = 1.45 ± 1.07 years), “PInscl = 4” subgroup (survival time = 1.17 ± 1.06 years), “PInscl = 5” subgroup (survival time = 0.81 ± 0.78 years), and “PInscl = 6” subgroup (survival time = 0.65 ± 0.56 years) exhibited significantly shorter survival times. Kaplan-Meier survival analysis showed that patients with higher PInscl scores had poorer OS than those with lower scores (log-rank test: χ2 = 155.82, P < 0.0001). The area under the curve of PInscl for predicting the 1-year OS was 0.73 (95 % CI = 0.69–0.77, P < 0.001), and the PInscl had a better diagnostic performance than the Karnofsky performance status or TNM stage (P < 0.01). In conclusion, the PInscl, which is calculated from age, TNM stage, lung lobectomy, chemotherapy, and pretreatment hemoglobin level, significantly predicted OS in NSCLC patients.
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Affiliation(s)
- Yue-Hua Zhang
- Department of Oncology, The First Affiliated Hospital of Henan University, Kaifeng, China.,Department of Oncology, Huaihe Hospital of Henan University, Kaifeng, China
| | - Yuquan Lu
- International Joint Research Laboratory for Cell Medical Engineering of Henan, Huaihe Hospital of Henan University, Kaifeng, China
| | - Hong Lu
- Department of Oncology, Huaihe Hospital of Henan University, Kaifeng, China
| | - Yue-Min Zhou
- International Joint Research Laboratory for Cell Medical Engineering of Henan, Huaihe Hospital of Henan University, Kaifeng, China
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Geraci TC, Ng T. Commentary: Overreliance of propensity-score matched studies in thoracic surgery. J Thorac Cardiovasc Surg 2020; 161:417-418. [PMID: 32173105 DOI: 10.1016/j.jtcvs.2020.02.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 02/15/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Travis C Geraci
- Department of Cardiothoracic Surgery, New York University-Langone Health, New York, NY
| | - Thomas Ng
- Department of Surgery, Warren Alpert Medical School of Brown University, Providence, RI.
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35
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Comparison of medium-term survival outcomes between robot-assisted thoracoscopic surgery and video-assisted thoracoscopic surgery in treating primary lung cancer. Gen Thorac Cardiovasc Surg 2020; 68:984-992. [DOI: 10.1007/s11748-020-01312-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 02/01/2020] [Indexed: 10/25/2022]
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36
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Zeltsman M, Dozier J, Vaghjiani RG, Poch A, Eguchi T, Pedoto A, Jones DR, Adusumilli PS. Decreasing use of epidural analgesia with increasing minimally invasive lobectomy: Impact on postoperative morbidity. Lung Cancer 2020; 139:68-72. [PMID: 31743888 PMCID: PMC7171549 DOI: 10.1016/j.lungcan.2019.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/17/2019] [Accepted: 11/01/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The goal of this study is to investigate the use of EA and its impact on the postoperative short-term outcomes of patients with non-small cell lung cancer (NSCLC) who received a lobectomy by either minimally invasive surgery (MIS) or thoracotomy. MATERIALS AND METHODS We investigated 793 patients who underwent lobectomy for pathological stage I-III NSCLC without induction therapy during two time periods, an early-time period (2009-2010: MIS, n = 204 [53%]; and thoracotomy, n = 182 [47%]) and a late-period (2014-2015: MIS, n = 308 [76%]; and thoracotomy, n = 99 [24%]). Patient characteristics, including pulmonary function tests, comorbidities, and use of EA, as well as short-term outcomes, including length of stay, morbidity, and mortality were assessed and compared between early-and late-time periods. We also compared patients who received EA (n = 150) with patients who did not receive EA (n = 158) following MIS lobectomy in the late-time period. RESULTS The use of MIS lobectomy increased during the late-time period compared to the early-time period (p < 0.001). In patients who underwent MIS lobectomy, the use of EA significantly decreased in the late-time period compared to the early-time period (2009-2010 vs. 2014-2015, 95% vs. 51%; p < 0.001). There was no difference in postoperative morbidity and mortality between the two time periods in both MIS and thoracotomy. In the late-time period MIS group, the length of stay in the no EA group (n = 150) was shorter than that in the EA group (n = 158) (3 vs. 4 days, p = 0.038). There was no difference in morbidity and mortality between the EA and no EA groups. CONCLUSION In our study cohort, the observed decrease in the use of EA with the increasing rate of MIS lobectomy did not negatively affect postoperative short-term outcomes.
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Affiliation(s)
- Masha Zeltsman
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, USA
| | - Jordan Dozier
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, USA
| | - Raj G Vaghjiani
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, USA
| | - Alexandra Poch
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, USA
| | - Takashi Eguchi
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, USA
| | - Alessia Pedoto
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, USA
| | - David R Jones
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, USA
| | - Prasad S Adusumilli
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, USA; Center for Cell Engineering, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, USA.
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Lutz JA, Seguin-Givelet A, Grigoroiu M, Brian E, Girard P, Gossot D. Oncological results of full thoracoscopic major pulmonary resections for clinical Stage I non-small-cell lung cancer. Eur J Cardiothorac Surg 2019; 55:263-270. [PMID: 30052990 DOI: 10.1093/ejcts/ezy245] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 06/07/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The full thoracoscopic approach to major pulmonary resections is considered challenging and controversial as it might compromise oncological outcomes. The aim of this work was to analyse the results of a full thoracoscopic technique in terms of nodal upstaging and survival in patients with non-small-cell lung carcinoma (NSCLC). METHODS All patients who underwent a full thoracoscopic major pulmonary resection for NSCLC between 2007 and August 2016 were analysed from an 'intent-to-treat' prospective database. Overall survival and disease-free survival were estimated using the Kaplan-Meier curves and comparisons in survival using the log-rank test. RESULTS A total of 648 patients met the inclusion criteria, of whom 621 patients had clinical Stage I and 27 had higher stages (16 oligometastatic patients were excluded from the analysis, 11 cT3 or cT4). The mean follow-up was 34.5 months. There were 40 conversions to thoracotomy (6.3%). Thirty-day or in-hospital mortality was 0.95%. Complications occurred in 29.3% of patients. On pathological examination, 22.5% of clinical Stage I patients were upstaged. Nodal upstaging to N1 or N2 was observed in 15.8% of clinical Stage I patients. Five-year overall survival of the whole cohort was 75% and was significantly different between clinical Stages IA (76%) and IB (70.9%). For tumours <2 cm, no significant difference in overall survival was found for the segmentectomy group compared to the lobectomy group: 74% versus 78.9% (P = 0.634). CONCLUSIONS Long-term survival is not compromised by a full thoracoscopic approach. Our results compared favourably with those of video-assisted techniques.
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Affiliation(s)
- Jon A Lutz
- Thoracic Department, Institut du Thorax Curie-Montsouris, Institut Mutualiste Montsouris, Paris, France.,Division of General Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Agathe Seguin-Givelet
- Thoracic Department, Institut du Thorax Curie-Montsouris, Institut Mutualiste Montsouris, Paris, France.,Paris 13 University, Sorbonne Paris Cité, Faculty of Medicine SMBH, Bobigny, France
| | - Madalina Grigoroiu
- Thoracic Department, Institut du Thorax Curie-Montsouris, Institut Mutualiste Montsouris, Paris, France
| | - Emmanuel Brian
- Thoracic Department, Institut du Thorax Curie-Montsouris, Institut Mutualiste Montsouris, Paris, France
| | - Philippe Girard
- Thoracic Department, Institut du Thorax Curie-Montsouris, Institut Mutualiste Montsouris, Paris, France
| | - Dominique Gossot
- Thoracic Department, Institut du Thorax Curie-Montsouris, Institut Mutualiste Montsouris, Paris, France
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Al-Ameri M, Sachs E, Sartipy U, Jackson V. Uniportal versus multiportal video-assisted thoracic surgery for lung cancer. J Thorac Dis 2019; 11:5152-5161. [PMID: 32030232 DOI: 10.21037/jtd.2019.12.01] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Video-assisted thoracic surgery (VATS) lobectomy is the recommended surgical approach for patients with stage I lung cancer. Whether a multiportal or a uniportal approach is preferable remains unclear. The aim of this study was to evaluate the safety of implementing uniportal VATS lobectomy into the treatment program of lung cancer patients. Methods We used the national quality register for general thoracic surgery in Sweden and included all patients who underwent VATS lobectomy for lung cancer at the Karolinska University Hospital between 2016-2018. Early postoperative complications were compared in patients undergoing uniportal (n=122) and multiportal (n=211) VATS lobectomy for lung cancer. Inverse probability of treatment weighting and standardized mean differences were used to limit differences in baseline characteristics and to assess balance after weighting. Results The proportion of uniportal VATS lobectomies increased during the study period and the conversion rates declined significantly. Baseline characteristics were similar in the two groups with the exception of a higher percentage of patients without any comorbidity in the uniportal group (59.8% vs. 44.5%, P=0.010). After inverse probability of treatment weighting the groups were well balanced. Postoperative complications were rare regardless of surgical approach, 94% in both groups had no complications. The 30-day mortality and overall survival at 1 year was 0% and 97% in the uniportal group, and 0.5% and 98% in the multiportal group (P=0.71). Patients undergoing uniportal VATS lobectomy were discharged directly to home to a higher extent than multiportal VATS patients (76.2% vs. 62.1%, P=0.008). Conclusions We found that uniportal VATS lobectomy was feasible and safe, and might entail advantages in terms of a faster recovery after surgery as compared to multiportal VATS lobectomy in patients with lung cancer.
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Affiliation(s)
- Mamdoh Al-Ameri
- Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Erik Sachs
- Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Ulrik Sartipy
- Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Veronica Jackson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Hristov B, Eguchi T, Bains S, Dycoco J, Tan KS, Isbell JM, Park BJ, Jones DR, Adusumilli PS. Minimally Invasive Lobectomy Is Associated With Lower Noncancer-specific Mortality in Elderly Patients: A Propensity Score Matched Competing Risks Analysis. Ann Surg 2019; 270:1161-1169. [PMID: 29672399 PMCID: PMC7421837 DOI: 10.1097/sla.0000000000002772] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To investigate cancer- and noncancer-specific mortality following lobectomy by minimally invasive surgery (MIS) versus open thoracotomy in elderly patients with nonsmall cell lung cancer (NSCLC). BACKGROUND Two-thirds of patients with NSCLC are ≥65 years of age. As age increases, the risk of competing events, such as noncancer death, also increases. METHODS Elderly patients (≥65 yrs of age) who have undergone curative-intent lobectomy for stage I-III NSCLC without induction therapy (2002-2013) were included (n=1,303). Of those, 607 patients had undergone MIS and 696 had undergone thoracotomy. Propensity-score matching was performed to identify pairs of thoracotomy and MIS patients with comparable clinical characteristics (eg, year of surgery, comorbidities, and pulmonary function). Association between surgical approach (MIS vs thoracotomy) and lung cancer-specific and noncancer-specific cumulative incidence of death (CID) was analyzed using competing risks approach. RESULTS Following propensity score matching of patients who had undergone thoracotomy (n=338) versus MIS (n=338), MIS was associated with shorter length of stay (P <0.001), lower noncancer-specific 1-year mortality (P=0.027), and lower noncancer-specific CID (P=0.014) compared with thoracotomy; there was no difference in lung cancer-specific CID between surgical approaches. On multivariable analysis, thoracotomy was a significant risk factor for noncancer-specific death (subhazard ratio 2.45, 95% CI 1.18-5.06, P=0.016) independent of age, sex, and diffusion capacity of the lungs for carbon monoxide. CONCLUSION In a propensity score-matched cohort, multivariable analysis has indicated that lobectomy performed by MIS is associated with lower incidence of noncancer-specific mortality compared with lobectomy performed by open thoracotomy in elderly patients with NSCLC.
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Affiliation(s)
- Boris Hristov
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Takashi Eguchi
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Division of Thoracic Surgery, Department of Surgery, Shinshu University, Matsumoto, Japan
| | - Sarina Bains
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joe Dycoco
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kay See Tan
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - James M. Isbell
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bernard J. Park
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David R. Jones
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Prasad S. Adusumilli
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Center for Cell Engineering, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Guerrera F, Olland A, Ruffini E, Falcoz PE. VATS lobectomy vs. open lobectomy for early-stage lung cancer: an endless question-are we close to a definite answer? J Thorac Dis 2019; 11:5616-5618. [PMID: 32030283 DOI: 10.21037/jtd.2019.12.19] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Francesco Guerrera
- Department of Surgical Science, University of Torino, Turin, Italy.,Department of Thoracic Surgery, A.O.U. Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Anne Olland
- Department of Thoracic Surgery, Strasbourg University Hospital, Strasbourg, France.,INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France.,Faculty of Pharmacy and Medicine, University of Strasbourg, Strasbourg, France
| | - Enrico Ruffini
- Department of Surgical Science, University of Torino, Turin, Italy.,Department of Thoracic Surgery, A.O.U. Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Pierre-Emmanuel Falcoz
- Department of Thoracic Surgery, Strasbourg University Hospital, Strasbourg, France.,INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France.,Faculty of Pharmacy and Medicine, University of Strasbourg, Strasbourg, France
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Liu L, Mei J, He J, Demmy TL, Gao S, Li S, He J, Liu Y, Huang Y, Xu S, Hu J, Chen L, Zhu Y, Luo Q, Mao W, Tan Q, Chen C, Li X, Zhang Z, Jiang G, Xu L, Zhang L, Fu J, Li H, Wang Q, Liu D, Tan L, Zhou Q, Fu X, Jiang Z, Chen H, Fang W, Zhang X, Li Y, Tong T, Yu Z, Liu Y, Zhi X, Yan T, Zhang X, Pu Q, Che G, Lin Y, Ma L, Embun R, Aragón J, Evman S, Kocher GJ, Bertolaccini L, Brunelli A, Gonzalez-Rivas D, Dunning J, Liu HP, Swanson SJ, Borisovich RA, Sarkaria IS, Sihoe ADL, Nagayasu T, Miyazaki T, Chida M, Kohno T, Thirugnanam A, Soukiasian HJ, Onaitis MW, Liu CC. International expert consensus on the management of bleeding during VATS lung surgery. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:712. [PMID: 32042728 DOI: 10.21037/atm.2019.11.142] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Intraoperative bleeding is the most crucial safety concern of video-assisted thoracic surgery (VATS) for a major pulmonary resection. Despite the advances in surgical techniques and devices, intraoperative bleeding is still not rare and remains the most common and potentially fatal cause of conversion from VATS to open thoracotomy. Therefore, to guide the clinical practice of VATS lung surgery, we proposed the International Interest Group on Bleeding during VATS Lung Surgery with 65 experts from 10 countries in the field to develop this consensus document. The consensus was developed based on the literature reports and expert experience from different countries. The causes and incidence of intraoperative bleeding were summarised first. Seven situations of intraoperative bleeding were collected based on clinical practice, including the bleeding from massive vessel injuries, bronchial arteries, vessel stumps, and bronchial stumps, lung parenchyma, lymph nodes, incisions, and the chest wall. The technical consensus for the management of intraoperative bleeding was achieved on these seven surgical situations by six rounds of repeated revision. Following expert consensus statements were achieved: (I) Bleeding from major vascular injuries: direct compression with suction, retracted lung, or rolled gauze is useful for bleeding control. The size and location of the vascular laceration are evaluated to decide whether the bleeding can be stopped by direct compression or by ligation. If suturing is needed, the suction-compressing angiorrhaphy technique (SCAT) is recommended. Timely conversion to thoracotomy with direct compression is required if the operator lacks experience in thoracoscopic angiorrhaphy. (II) Bronchial artery bleeding: pre-emptive clipping of bronchial artery before bronchial dissection or lymph node dissection can reduce the incidence of bleeding. Bronchial artery bleeding can be stopped by compression with the suction tip, followed by the handling of the vascular stump with energy devices or clips. (III) Bleeding from large vessel stumps and bronchial stumps: bronchial stump bleeding mostly comes from accompanying bronchial artery, which can be clipped for hemostasis. Compression for hemostasis is usually effective for bleeding at the vascular stump. Otherwise, additional use of hemostatic materials, re-staple or a suture may be necessary. (IV) Bleeding from the lung parenchyma: coagulation hemostasis is the first choice. For wounds with visible air leakage or an insufficient hemostatic effect of coagulation, suturing may be necessary. (V) Bleeding during lymph node dissection: non-grasping en-bloc lymph node dissection is recommended for the nourishing vessels of the lymph node are addressed first with this technique. If bleeding occurs at the site of lymph node dissection, energy devices can be used for hemostasis, sometimes in combination with hemostatic materials. (VI) Bleeding from chest wall incisions: the chest wall incision(s) should always be made along the upper edge of the rib(s), with good hemostasis layer by layer. Recheck the incision for hemostasis before closing the chest is recommended. (VII) Internal chest wall bleeding: it can usually be managed with electrocoagulation. For diffuse capillary bleeding with the undefined bleeding site, compression of the wound with gauze may be helpful.
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Affiliation(s)
- Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jiandong Mei
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jie He
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Todd L Demmy
- Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Shugeng Gao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Shanqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medicine, Beijing 100032, China
| | - Jianxing He
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Yang Liu
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Yunchao Huang
- Department of Thoracic and Cardiovascular Surgery, The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital), Kunming 650106, China
| | - Shidong Xu
- Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, Harbin 150086, China
| | - Jian Hu
- Department of Thoracic Surgery, First Hospital Affiliated to Medical College of Zhejiang University, Hangzhou 310003, China
| | - Liang Chen
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yuming Zhu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200003, China
| | - Qingquan Luo
- Shanghai Lung Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Weimin Mao
- Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Qunyou Tan
- Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing 400042, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Xiaofei Li
- Department of Thoracic Surgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an 710038, China
| | - Zhu Zhang
- Department of Thoracic Surgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200003, China
| | - Lin Xu
- Department of Thoracic Surgery, Nanjing Medical University Affiliated Cancer Hospital, Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Cancer Institute of Jiangsu Province, Nanjing 210009, China
| | - Lanjun Zhang
- Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China
| | - Jianhua Fu
- Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China
| | - Hui Li
- Department of Thoracic Surgery, Beijing Chao-Yang Hospital, Beijing 100043, China
| | - Qun Wang
- Department of Thoracic Surgery, Shanghai Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Deruo Liu
- Department of Thoracic Surgery, China and Japan Friendship Hospital, Beijing 100029, China
| | - Lijie Tan
- Department of Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Qinghua Zhou
- Department of Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xiangning Fu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zhongmin Jiang
- Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan 250014, China
| | - Haiquan Chen
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Jiao Tong University, Shanghai 200032, China
| | - Xun Zhang
- Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin 300051, China
| | - Yin Li
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Ti Tong
- Department of Thoracic Surgery, Second Hospital of Jilin University, Changchun 130041, China
| | - Zhentao Yu
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - Yongyu Liu
- Department of Thoracic Surgery, Liaoning Cancer Hospital and Institute, Shenyang 110042, China
| | - Xiuyi Zhi
- Department of Thoracic Surgery, Xuanwu Hospital of Capital Medical University, Beijing 100053, China
| | - Tiansheng Yan
- Department of Thoracic Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Xingyi Zhang
- Department of Thoracic Surgery, The Second Hospital of Jilin University, Changchun 130041, China
| | - Qiang Pu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yidan Lin
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Lin Ma
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Raul Embun
- Thoracic Surgery Department, Hospital Universitario Miguel Servet, IIS Aragón, Zaragoza, Spain
| | - Javier Aragón
- Department of Thoracic Surgery, Asturias University Central Hospital, Oviedo, Spain
| | - Serdar Evman
- Department of Thoracic Surgery, University of Health Sciences, Sureyyapasa Training and Research Hospital, Istanbul, Turkey
| | - Gregor J Kocher
- Division of Thoracic Surgery, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Luca Bertolaccini
- Department of Thoracic Surgery, Maggiore Teaching Hospital, Bologna, Italy
| | | | - Diego Gonzalez-Rivas
- Department of Thoracic Surgery, Coruña University Hospital and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain
| | - Joel Dunning
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| | - Hui-Ping Liu
- Department of Thoracic Surgery, Chang Gung Memorial Hospital (Linkou), Taiwan, China
| | - Scott J Swanson
- Department of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Inderpal S Sarkaria
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Alan Dart Loon Sihoe
- Honorary Consultant in Cardio-Thoracic Surgery, Gleneagles Hong Kong Hospital, Hong Kong, China
| | - Takeshi Nagayasu
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takuro Miyazaki
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Masayuki Chida
- Department of General Thoracic Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Tadasu Kohno
- Department of Thoracic Surgery, Thoracoscopic Surgery Center, New Tokyo Hospital, Chiba, Japan
| | - Agasthian Thirugnanam
- Agasthian Thoracic Surgery Pte Ltd. 3 Mount Elizabeth #14-12 Mount Elizabeth Medical Centre, Singapore
| | - Harmic J Soukiasian
- Division of Thoracic Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Mark W Onaitis
- Moores Cancer Center, UC San Diego Health - La Jolla, Moores Cancer Center, La Jolla, USA
| | - Chia-Chuan Liu
- Division of Thoracic Surgery, Sun Yat-Sen Cancer Center, Taipei, Taiwan, China
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Pregernig A, Beck-Schimmer B. Which Anesthesia Regimen Should Be Used for Lung
Surgery? CURRENT ANESTHESIOLOGY REPORTS 2019. [DOI: 10.1007/s40140-019-00356-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Toste PA, Lee JM. VATS lobectomy for early lung cancer: long-term outcomes. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S235. [PMID: 31656814 DOI: 10.21037/atm.2019.08.32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Paul A Toste
- Division of Thoracic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jay M Lee
- Division of Thoracic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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44
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Saito T, Murakawa T. Searching for an arrow hitting two targets: the time to evaluate long-term outcomes of video-assisted thoracoscopic surgery lobectomy for early-stage lung cancer. J Thorac Dis 2019; 11:S1995-S1998. [PMID: 31632808 PMCID: PMC6783771 DOI: 10.21037/jtd.2019.06.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 06/26/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Tomohito Saito
- Department of Thoracic Surgery, Kansai Medical University, Osaka, Japan
| | - Tomohiro Murakawa
- Department of Thoracic Surgery, Kansai Medical University, Osaka, Japan
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Khan T, Usman Y, Abdo T, Chaudry F, Keddissi JI, Youness HA. Diagnosis and management of peripheral lung nodule. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:348. [PMID: 31516894 DOI: 10.21037/atm.2019.03.59] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A solitary pulmonary nodule (SPN) is a well-defined radiographic opacity up to 3 cm in diameter that is surrounded by unaltered aerated lung. Frequently, it is an incidental finding on chest radiographs and chest CT scans. Determining the probability of malignancy is the first step in the evaluation of SPN. This can be done by looking at specific risk factors and the rate of radiographic progression. Subsequent management is guided by the type of the nodule. Patients with solid nodules and low pretest probability can be followed radiographically; those with high probability, who are good surgical candidates, can be referred for surgical resection. When the pretest probability is in the intermediate range additional testing such as biopsy should be done. Various modalities are now available to obtain tissue diagnosis. These modalities differ in their yield and complication rate. Patients with SPN should be well informed of each approach's risks and benefits and should be able to make an informed decision regarding the different diagnostic and therapeutic modalities.
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Affiliation(s)
- Taha Khan
- Interventional Pulmonary Program, Section of Pulmonary, Critical Care and Sleep Medicine, The Oklahoma City VA Health Care System and The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Yasir Usman
- Interventional Pulmonary Program, Section of Pulmonary, Critical Care and Sleep Medicine, The Oklahoma City VA Health Care System and The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Tony Abdo
- Interventional Pulmonary Program, Section of Pulmonary, Critical Care and Sleep Medicine, The Oklahoma City VA Health Care System and The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Fawad Chaudry
- Interventional Pulmonary Program, Section of Pulmonary, Critical Care and Sleep Medicine, The Oklahoma City VA Health Care System and The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Jean I Keddissi
- Interventional Pulmonary Program, Section of Pulmonary, Critical Care and Sleep Medicine, The Oklahoma City VA Health Care System and The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Houssein A Youness
- Interventional Pulmonary Program, Section of Pulmonary, Critical Care and Sleep Medicine, The Oklahoma City VA Health Care System and The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Affiliation(s)
- Richard D Neal
- Academic Unit of Primary Care, Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9NL, UK
| | - Fei Sun
- Leeds Teaching Hospitals Trust, St James's Hospital, Leeds LS9 7TF, UK
| | - Jon D Emery
- Centre for Cancer Research and Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victorian Comprehensive Cancer Centre, Victoria 3000, Australia
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47
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Ujiie H, Gregor A, Yasufuku K. Minimally invasive surgical approaches for lung cancer. Expert Rev Respir Med 2019; 13:571-578. [DOI: 10.1080/17476348.2019.1610399] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Hideki Ujiie
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Alexander Gregor
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Kazuhiro Yasufuku
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
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Gossot D. Comparing open and closed chest surgery for early-stage lung cancer: still relevant? J Thorac Dis 2019; 11:S1307-S1309. [PMID: 31245117 DOI: 10.21037/jtd.2019.04.74] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Dominique Gossot
- Thoracic Department, Curie-Montsouris Thoracic Institute, Institut Mutualiste Montsouris, Paris, France
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Ng CS, MacDonald JK, Gilbert S, Khan AZ, Kim YT, Louie BE, Blair Marshall M, Santos RS, Scarci M, Shargal Y, Fernando HC. Optimal Approach to Lobectomy for Non-Small Cell Lung Cancer: Systemic Review and Meta-Analysis. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2019; 14:90-116. [DOI: 10.1177/1556984519837027] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective Video-assisted thoracic surgery (VATS) lobectomy was introduced over 25 years ago. More recently, the technique has been modified from a multiport video-assisted thoracic surgery (mVATS) to uniportal (uVATS) and robotic (rVATS), with proponents for each approach. Additionally most lobectomies are still performed using an open approach. We sought to provide evidence-based recommendations to help define the optimal surgical approach to lobectomy for early stage non-small cell lung cancer. Methods Systematic review and meta-analysis of articles searched without limits from January 2000 to January 2018 comparing open, mVATS, uVATS, and rVATS using sources Medline, Embase, and Cochrane Library were considered for inclusion. Articles were individually scrutinized by ISMICS consensus conference members, and evidence-based statements were created and consensus processes were used to determine the ensuing recommendations. The ACC/AHA Clinical Practice Guideline Recommendation Classification system was used to assess the overall quality of evidence and the strength of recommendations. Results and recommendations One hundred and forty-five studies met the predefined inclusion criteria and were included in the meta-analysis. Comparisons were analyzed between VATS and open, and between different VATS approaches looking at oncological outcomes (survival, recurrence, lymph node evaluation), safety (adverse events), function (pain, quality of life, pulmonary function), and cost-effectiveness. Fifteen statements addressing these areas achieved consensus. The highest level of evidence suggested that mVATS is preferable to open lobectomy with lower adverse events (36% versus 42%; 88,460 patients) and less pain (IIa recommendation). Our meta-analysis suggested that overall survival was better (IIb) with mVATS compared with open (71.5% versus 66.7% 5-years; 16,200 patients). Different VATS approaches were similar for most outcomes, although uVATS may be associated with less pain and analgesic requirements (IIb). Conclusions This meta-analysis supports the role of VATS lobectomy for non-small cell lung cancer. Apart from potentially less pain and analgesic requirement with uVATS, different minimally invasive surgical approaches appear to have similar outcomes.
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Affiliation(s)
| | | | | | | | - Young T. Kim
- Seoul National University Hospital, Chongro-Ku, South Korea
| | - Brian E. Louie
- Swedish Cancer Institute and Medical Center, Seattle, WA, USA
| | | | | | | | - Yaron Shargal
- St Joseph’s Healthcare, MacMaster University, Hamilton, ON, Canada
| | - Hiran C. Fernando
- Inova Fairfax Medical Campus, Virginia Commonwealth University, Falls Church, Richmond, VA, USA
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Outcomes after Video-assisted Thoracoscopic Lobectomy versus Open Lobectomy for Early-Stage Lung Cancer in Older Adults. Ann Am Thorac Soc 2019; 15:76-82. [PMID: 29121474 DOI: 10.1513/annalsats.201612-980oc] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
RATIONALE Video-assisted thoracoscopic surgery (VATS) and open lobectomy are both standard of care for the treatment of early-stage non-small cell lung cancer (NSCLC) because of equivalent long-term survival. OBJECTIVES To evaluate whether the improved perioperative outcomes associated with VATS lobectomy are explained by surgeon characteristics, including case volume and specialty training. METHODS We analyzed the Surveillance, Epidemiology, and End Results-Medicare-linked registry to identify stage I-II NSCLC in patients above 65 years of age. We used a propensity score model to adjust for differences in patient characteristics undergoing VATS versus open lobectomy. Perioperative complications, extended length of stay, and perioperative mortality among patients were compared after adjustment for surgeon's volume and specialty using linear mixed models. We compared survival using a Cox model with robust standard errors. RESULTS We identified 9,508 patients in the registry who underwent lobectomy for early-stage NSCLC. VATS lobectomies were more commonly performed by high-volume surgeons (P < 0.001) and thoracic surgeons (P = 0.01). VATS lobectomy was associated with decreased adjusted odds of cardiovascular complications (odds ratio [OR] = 0.65; 95% confidence interval [CI] = 0.47-0.90), thromboembolic complications (OR = 0.47; 95% CI = 0.38-0.58), extrapulmonary infections (OR = 0.75; 95% CI = 0.61-0.94), extended length of stay (OR = 0.47; 95% CI = 0.40-0.56), and perioperative mortality (OR = 0.33; 95% CI = 0.23-0.48) even after controlling for differences in surgeon volume and specialty. Long-term survival was equivalent for VATS and open lobectomy (hazard ratio = 0.95; 95% CI = 0.85-1.08) after controlling for patient and tumor characteristics, surgeon volume, and specialization. CONCLUSIONS VATS lobectomy for NSCLC is associated with better postoperative outcomes, but similar long-term survival, compared with open lobectomy among older adults, even after controlling for surgeon experience.
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