1
|
Dai J, Sun F, Bao M, Cao J, Jin K, Zhang A, Zhou Y, Zhang P, Shi J, Jiang G. Pulmonary Function Recovery and Displacement Patterns After Anatomic Segmentectomy vs Lobectomy. Ann Thorac Surg 2024; 118:365-374. [PMID: 38309611 DOI: 10.1016/j.athoracsur.2024.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND The functional benefit of segmentectomy compared with lobectomy remains controversial. This ambispective study characterizes the changes in pulmonary function as correlated to displacement patterns of residual lung after segmentectomies vs lobectomies. METHODS Patients with normal preoperative pulmonary function and undergoing segmentectomy or lobectomy between 2017 and 2021 were considered. Pulmonary function testing was scheduled preoperatively and at least 3 months postoperatively. Differences in the proportions of the median forced expiratory volume in 1 second (FEV1) reduction between segmentectomy and lobectomy were calculated. Covariance analysis was used to estimate the adjusted postoperative FEV1 (apoFEV1) and compare the difference value (DV) in apoFEV1 between segmentectomy and lobectomy. RESULTS The study enrolled 634 patients (334 lobectomies and 300 segmentectomies). Median difference in the proportions of the FEV1 reduction between segmentectomy and lobectomy was 4.58%, with maximal difference observed in right S6 (9.08%) and minimal difference in left S1+2+3 (2.80%). For resections involving the upper lobe, apoFEV1 was significantly higher after segmentectomy than after lobectomy (DV, 0.15-0.22 L), except for left S3 and S1+2+3 segmentectomies (DV, 0.08 L and 0.06 L, respectively). Compared with a lower lobe lobectomy, S6 segmentectomy conferred a higher apoFEV1, whereas S7+8 and S9+10 had a similar apoFEV1 (DV, 0.16-0.18 L, 0.07 L, and 0.00-0.06 L, respectively). Functional recovery after segmentectomy was associated with the number of intersegment planes (P < .01) and the presence of an adjacent nonoperated on lobe (P = .03). CONCLUSIONS Basilar and left S3 segmentectomies did not preserve more pulmonary function compared with their corresponding lobectomies, possibly due to the presence of multiple intersegmental resection planes.
Collapse
Affiliation(s)
- Jie Dai
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Fenghuan Sun
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Minwei Bao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jingxue Cao
- Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Kaiqi Jin
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Aihong Zhang
- Department of Medical Statistics, Tongji University School of Medicine, Shanghai, China
| | - Yiming Zhou
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Peng Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jingyun Shi
- Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
| |
Collapse
|
2
|
Butson G, Edbrooke L, Ismail H, Denehy L. Exercise capacity prior to major cancer surgery: A cross-sectional observational study of the validity of the 6-minute walk and 30-second sit-to-stand tests. Asia Pac J Clin Oncol 2024; 20:497-506. [PMID: 38685578 DOI: 10.1111/ajco.14069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 02/26/2024] [Accepted: 04/06/2024] [Indexed: 05/02/2024]
Abstract
INTRODUCTION Cardiopulmonary exercise testing (CPET) is the gold standard for measuring exercise capacity, however, it is resource intensive and has limited availability. This study aimed to determine: 1) the association between the 6-min walk test (6MWT) and the 30-s sit-to-stand test (30STS) with CPET peak oxygen uptake (VO2peak) and anaerobic threshold (AT) and 2) 6MWT and 30STS cut points associated with a higher risk of postoperative complications. METHODS A cross-sectional study, retrospectively analyzing data collected from a tertiary cancer center over a 23-month period. Measures included CPET VO2peak and AT, 6MWT and 30STS test. Correlations were used to characterize relationships between variables. Receiver operating characteristic curve analyses determined 6MWT and 30STS cut points that aligned with CPET variable cut points. RESULTS Note that, 156 participants were included. The 6MWT and 30STS displayed moderate correlations with VO2peak, rho = 0.65, p = 0.01 and rho = 0.52, p < 0.005 respectively. Fair correlations were observed between AT and 6MWT (rho = 0.36, p = 0.01) and 30STS (rho = 0.41, p < 0.005). The optimal cut points to identify VO2peak < 15 mL/kg/min were 493.5 m on the 6MWT and 12.5 stands on the 30STS test and for AT < 11 mL/kg/min were 506.5 m on the 6MWT and 12.5 stands on the 30STS test. CONCLUSION Both the 6MWT and 30STS test could be used as alternative tools for measuring exercise capacity preoperatively in the cancer setting where CPET is not available. A range of 6MWT and 30STS cut points, according to sensitivity and specificity levels, may be used to evaluate risk of postoperative outcomes.
Collapse
Affiliation(s)
- Grace Butson
- Department of Physiotherapy, The Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Lara Edbrooke
- Department of Health Services Research, The Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
| | - Hilmy Ismail
- Department of Anesthesia, Perioperative and Pain Medicine, The Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Linda Denehy
- Department of Health Services Research, The Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
| |
Collapse
|
3
|
Garner JL, Shah PL, Herth F, Slebos DJ. ERJ Advances: interventional bronchoscopy. Eur Respir J 2024; 64:2301946. [PMID: 38991719 DOI: 10.1183/13993003.01946-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 05/14/2024] [Indexed: 07/13/2024]
Affiliation(s)
- Justin L Garner
- Department of Lung Cancer and Interventional Bronchoscopy, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Pallav L Shah
- Department of Lung Cancer and Interventional Bronchoscopy, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Felix Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik and Translational Lung Research Center, Universität Heidelberg, Heidelberg, Germany
| | - Dirk-Jan Slebos
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
4
|
[Chinese Expert Consensus on Day Surgery Management of Lung Cancer (2024 Edition)]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2024; 27:405-414. [PMID: 39026491 PMCID: PMC11258644 DOI: 10.3779/j.issn.1009-3419.2024.102.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Indexed: 07/20/2024]
Abstract
To alleviate the medical burden of lung cancer surgery and facilitate the implementation of the national hierarchical diagnosis and treatment policy, it is imperative to establish a hierarchical diagnosis and treatment system for day surgery of lung cancer. Identifying key quality control checkpoints in day surgery of lung cancer is essential to enhance medical quality, ensure safety, and improve the efficiency of medical services. These efforts aim to uphold a safe and well-structured progression of day surgery practices in China. The Chinese Expert Consensus Group on Day Surgery Management of Lung Cancer has convened national experts in relevant fields and integrated the latest research findings from both domestic and international sources to craft the Chinese Expert Consensus on Day Surgery Management of Lung Cancer (2024 Edition). This consensus is founded on the principles of holistic management of lung cancer surgery and comprehensive patient care throughout their medical journey. It encompasses preoperative assessments, anesthesia protocols, surgical procedures, postoperative care, hospital-community collaboration initiatives, and emergency response strategies. The primary objective of this expert consensus is to furnish research assistance and clinical recommendations to advance the practice of day surgery for lung cancer patients in China.
.
Collapse
|
5
|
Siddiquee T, Bhaskaran NA, Nathani K, Sawarkar SP. Empowering lung cancer treatment: Harnessing the potential of natural phytoconstituent-loaded nanoparticles. Phytother Res 2024. [PMID: 38806412 DOI: 10.1002/ptr.8241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 04/29/2024] [Accepted: 04/29/2024] [Indexed: 05/30/2024]
Abstract
Lung cancer, the second leading cause of cancer-related deaths, accounts for a substantial portion, representing 18.4% of all cancer fatalities. Despite advances in treatment modalities such as chemotherapy, surgery, and immunotherapy, significant challenges persist, including chemoresistance, non-specific targeting, and adverse effects. Consequently, there is an urgent need for innovative therapeutic approaches to overcome these limitations. Natural compounds, particularly phytoconstituents, have emerged as promising candidates due to their potent anticancer properties and relatively low incidence of adverse effects compared to conventional treatments. However, inherent challenges such as poor solubility, rapid metabolism, and enzymatic degradation hinder their clinical utility. To address these obstacles, researchers have increasingly turned to nanotechnology-based drug delivery systems (DDS). Nanocarriers offer several advantages, including enhanced drug stability, prolonged circulation time, and targeted delivery to tumor sites, thereby minimizing off-target effects. By encapsulating phytoconstituents within nanocarriers, researchers aim to optimize their bioavailability and therapeutic efficacy while reducing systemic toxicity. Moreover, the integration of nanotechnology with phytoconstituents allows for a nuanced understanding of the intricate molecular pathways involved in lung cancer pathogenesis. This integrated approach holds promise for modulating key cellular processes implicated in tumor growth and progression. Additionally, by leveraging the synergistic effects of phytoconstituents and nanocarriers, researchers seek to develop tailored therapeutic strategies that maximize efficacy while minimizing adverse effects. In conclusion, the integration of phytoconstituents with nanocarriers represents a promising avenue for advancing lung cancer treatment. This synergistic approach has the potential to revolutionize current therapeutic paradigms by offering targeted, efficient, and minimally toxic interventions. Continued research in this field holds the promise of improving patient outcomes and addressing unmet clinical needs in lung cancer management.
Collapse
Affiliation(s)
- Taufique Siddiquee
- Department of Pharmaceutics, SVKM's Dr. Bhanuben Nanavati College of Pharmacy, University of Mumbai, Mumbai, India
| | - Navya Ajitkumar Bhaskaran
- Department of Pharmaceutics, SVKM's Dr. Bhanuben Nanavati College of Pharmacy, University of Mumbai, Mumbai, India
| | - Khushali Nathani
- Department of Pharmaceutics, SVKM's Dr. Bhanuben Nanavati College of Pharmacy, University of Mumbai, Mumbai, India
| | - Sujata P Sawarkar
- Department of Pharmaceutics, SVKM's Dr. Bhanuben Nanavati College of Pharmacy, University of Mumbai, Mumbai, India
| |
Collapse
|
6
|
Tu DH, Yi C, Liu Q, Huang L, Yang G, Qu R. Longitudinal changes in the volume of residual lung lobes after lobectomy for lung cancer: a retrospective cohort study. Sci Rep 2024; 14:12055. [PMID: 38802642 PMCID: PMC11130117 DOI: 10.1038/s41598-024-63013-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 05/23/2024] [Indexed: 05/29/2024] Open
Abstract
It is unclear how the residual lobe volume changes over time after lobectomy. This study aims to clarify the temporal patterns of volume changes in each remaining lung lobe post-lobectomy. A retrospective review was conducted on patients who underwent lobectomy for lung cancer at Yueyang Central Hospital from January to December 2021. Lung CT images were reconstructed in three dimensions to calculate the volumes of each lung lobe preoperatively and at 1, 6, and 12 months postoperatively. A total of 182 patients were included. Postoperatively, the median total lung volume change rates relative to preoperative values were -20.1%, -9.3%, and -5.9% at 1, 6, and 12 months, respectively. Except for the right middle lobe in patients who underwent right upper lobectomy, the volumes of individual lung lobes exceeded preoperative values. The volume growth of the lung on the side of the resection was significantly more than that of the lung on the opposite side. For left lobectomy patients, the right lower lobe's volume change rate exceeded that of the right upper and middle lobes. Among right lobectomy patients, the left lower lobe and the relatively inferior lobe of right lung had higher volume change rates than the superior one. Right middle lobe change rate was more in patients with right lower lobectomy than right upper lobectomy. Six months postoperatively, FEV1% and right middle lobectomy were positively correlated with the overall volume change rate. One year postoperatively, only age was negatively correlated with the overall volume change rate. 75 patients had pulmonary function tests. Postoperative FEV1 change linearly correlated with 1-year lung volume change rate, but not with theoretical total lung volume change rate or segmental method calculated FEV1 change. Time-dependent compensatory volume changes occur in remaining lung lobe post-lobectomy, with stronger compensation observed in the relatively inferior lobe compared to the superior one(s). Preoperative lung function and age may affect compensation level.
Collapse
Affiliation(s)
- De-Hao Tu
- Department of Thoracic Surgery, Yueyang Central Hospital, Yueyang, Hunan, China
| | - Chong Yi
- Department of Pulmonary and Critical Care Medicine, Yueyang Central Hospital, Yueyang, Hunan, China
| | - Qianyun Liu
- Department of Medical Imaging, Yueyang Central Hospital, Yueyang, Hunan, China
| | - Lingmei Huang
- Department of Pulmonary and Critical Care Medicine, Yueyang Central Hospital, Yueyang, Hunan, China
| | - Guang Yang
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Wuhan, 430030, Hubei, China
| | - Rirong Qu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Wuhan, 430030, Hubei, China.
| |
Collapse
|
7
|
Verma S, Breadner D, Mittal A, Palma DA, Nayak R, Raphael J, Vincent M. An Updated Review of Management of Resectable Stage III NSCLC in the Era of Neoadjuvant Immunotherapy. Cancers (Basel) 2024; 16:1302. [PMID: 38610980 PMCID: PMC11010993 DOI: 10.3390/cancers16071302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 03/15/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Immune-checkpoint inhibitors (ICIs) have an established role in the treatment of locally advanced and metastatic non-small cell lung cancer (NSCLC). ICIs have now entered the paradigm of early-stage NSCLC. The recent evidence shows that the addition of ICI to neoadjuvant chemotherapy improves the pathological complete response (pCR) rate and survival rate in early-stage resectable NSCLC and is now a standard of care option in this setting. In this regard, stage III NSCLC merits special consideration, as it is heterogenous and requires a multidisciplinary approach to management. As the neoadjuvant approach is being adopted widely, new challenges have emerged and the boundaries for resectability are being re-examined. Consequently, it is ever more important to carefully individualize the treatment strategy for each patient with resectable stage III NSCLC. In this review, we discuss the recent literature in this field with particular focus on evolving definitions of resectability, T4 disease, N2 disease (single and multi-station), and nodal downstaging. We also highlight the controversy around adjuvant treatment in this setting and discuss the selection of patients for adjuvant treatment, options of salvage, and next line treatment in cases of progression on/after neoadjuvant treatment or after R2 resection. We will conclude with a brief discussion of predictive biomarkers, predictive models, ongoing studies, and directions for future research in this space.
Collapse
Affiliation(s)
- Saurav Verma
- Division of Medical Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada; (S.V.); (D.B.); (J.R.)
- London Regional Cancer Program, London Health Sciences Centre, London, ON N6A 5W9, Canada; (D.A.P.); (R.N.)
| | - Daniel Breadner
- Division of Medical Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada; (S.V.); (D.B.); (J.R.)
- London Regional Cancer Program, London Health Sciences Centre, London, ON N6A 5W9, Canada; (D.A.P.); (R.N.)
| | - Abhenil Mittal
- Division of Medical Oncology, Northeast Cancer Centre, Ramsey Lake Health Centre, Sudbury, ON P3E 5J1, Canada;
| | - David A. Palma
- London Regional Cancer Program, London Health Sciences Centre, London, ON N6A 5W9, Canada; (D.A.P.); (R.N.)
- Division of Radiation Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada
| | - Rahul Nayak
- London Regional Cancer Program, London Health Sciences Centre, London, ON N6A 5W9, Canada; (D.A.P.); (R.N.)
- Division of Thoracic Surgery, Department of Oncology, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada
| | - Jacques Raphael
- Division of Medical Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada; (S.V.); (D.B.); (J.R.)
- London Regional Cancer Program, London Health Sciences Centre, London, ON N6A 5W9, Canada; (D.A.P.); (R.N.)
| | - Mark Vincent
- Division of Medical Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada; (S.V.); (D.B.); (J.R.)
- London Regional Cancer Program, London Health Sciences Centre, London, ON N6A 5W9, Canada; (D.A.P.); (R.N.)
| |
Collapse
|
8
|
Kwon OB, Lee HU, Park HE, Choi JY, Kim JW, Lee SH, Yeo CD. Predicting Postoperative Lung Function in Patients with Lung Cancer Using Imaging Biomarkers. Diseases 2024; 12:65. [PMID: 38667523 PMCID: PMC11049658 DOI: 10.3390/diseases12040065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 03/19/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024] Open
Abstract
There have been previous studies conducted to predict postoperative lung function with pulmonary function tests (PFTs). Computing tomography (CT) can quantitatively measure small airway walls' thickness, lung volume, pulmonary vessel volume, and emphysema area, which reflect the severity of respiratory diseases. These measurements are considered imaging biomarkers. This study aimed to predict postoperative lung function with imaging biomarkers. A retrospective analysis of 79 patients with lung cancer who had undergone lung surgery was completed. Postoperative lung function measured by forced expiratory volume in one second (FEV1) was defined as an outcome. Preoperative clinico-pathological parameters and imaging biomarkers representing airway walls' thickness, severity of emphysema, total lung volume, and pulmonary vessel volume were measured quantitatively in chest CT by an automated segmentation software, AVIEW COPD. Pi1 was defined as the first percentile along the histogram of lung attenuation that represents the degree of emphysema. Wafw was defined as the airway thickness, which was calculated by the full-width at half-maximum method. Logistic and linear regressions were used to assess these variables. If the actual postoperative FEV1 was higher than the postoperative FEV1 projected by a formula, the group was considered to be preserved. Among the 79 patients, 16 of the patients were grouped as a non-preserved group, and 63 of them were grouped as a preserved group. The patients in the preserved FEV1 group had a higher vessel volume than the non-preserved group. Pi1 and Wafw were independent predictors of postoperative lung function. Imaging biomarkers can be considered significant variables in predicting postoperative lung function in patients with lung cancer.
Collapse
Affiliation(s)
- Oh-Beom Kwon
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (O.-B.K.); (J.-Y.C.); (J.-W.K.); (S.-H.L.)
- Department of Internal Medicine, Kangwon National University Hospital, Chuncheon 24289, Republic of Korea
| | - Hae-Ung Lee
- Coreline Soft Co., Ltd., Seoul 03991, Republic of Korea; (H.-U.L.); (H.-E.P.)
| | - Ha-Eun Park
- Coreline Soft Co., Ltd., Seoul 03991, Republic of Korea; (H.-U.L.); (H.-E.P.)
| | - Joon-Young Choi
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (O.-B.K.); (J.-Y.C.); (J.-W.K.); (S.-H.L.)
| | - Jin-Woo Kim
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (O.-B.K.); (J.-Y.C.); (J.-W.K.); (S.-H.L.)
| | - Sang-Haak Lee
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (O.-B.K.); (J.-Y.C.); (J.-W.K.); (S.-H.L.)
| | - Chang-Dong Yeo
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (O.-B.K.); (J.-Y.C.); (J.-W.K.); (S.-H.L.)
| |
Collapse
|
9
|
Li W, Zhao J, Gong C, Zhou R, Yan D, Ruan H, Liu F. Value of preoperative evaluation of FEV 1 in patients with destroyed lung undergoing pneumonectomy - a 20-year real-world study. BMC Pulm Med 2024; 24:39. [PMID: 38233903 PMCID: PMC10795229 DOI: 10.1186/s12890-024-02858-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/09/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Clinical guidelines recommend a preoperative forced expiratory volume in one second (FEV1) of > 2 L as an indication for left or right pneumonectomy. This study compares the safety and long-term prognosis of pneumonectomy for destroyed lung (DL) patients with FEV1 ≤ 2 L or > 2 L. METHODS A total of 123 DL patients who underwent pneumonectomy between November 2002 and February 2023 at the Department of Thoracic Surgery, Beijing Chest Hospital were included. Patients were sorted into two groups: the FEV1 > 2 L group (n = 30) or the FEV1 ≤ 2 L group (n = 96). Clinical characteristics and rates of mortality, complications within 30 days after surgery, long-term mortality, occurrence of residual lung infection/tuberculosis (TB), bronchopleural fistula/empyema, readmission by last follow-up visit, and modified Medical Research Council (mMRC) dyspnea scores were compared between groups. RESULTS A total of 96.7% (119/123) of patients were successfully discharged, with 75.6% (93/123) in the FEV1 ≤ 2 L group. As compared to the FEV1 > 2 L group, the FEV1 ≤ 2 L group exhibited significantly lower proportions of males, patients with smoking histories, patients with lung cavities as revealed by chest imaging findings, and patients with lower forced vital capacity as a percentage of predicted values (FVC%pred) (P values of 0.001, 0.027, and 0.023, 0.003, respectively). No significant intergroup differences were observed in rates of mortality within 30 days after surgery, incidence of postoperative complications, long-term mortality, occurrence of residual lung infection/TB, bronchopleural fistula/empyema, mMRC ≥ 1 at the last follow-up visit, and postoperative readmission (P > 0.05). CONCLUSIONS As most DL patients planning to undergo left/right pneumonectomy have a preoperative FEV1 ≤ 2 L, the procedure is generally safe with favourable short- and long-term prognoses for these patients. Consequently, the results of this study suggest that DL patient preoperative FEV1 > 2 L should not be utilised as an exclusion criterion for pneumonectomy.
Collapse
Affiliation(s)
- Wenbo Li
- Faculty of Health and Life Science, The University of Exeter, Exeter, UK
| | - Jing Zhao
- Department of Anesthesia, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, P. R. China
| | - Changfan Gong
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, No 9, Bei guan Street, Tong Zhou District, Beijing, 101149, P. R. China
| | - Ran Zhou
- Department of General Medicine, Qingdao Chest Hospital, Qingdao, P. R. China
| | - Dongjie Yan
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, No 9, Bei guan Street, Tong Zhou District, Beijing, 101149, P. R. China.
| | - Hongyun Ruan
- Department of Cellular and Molecular Biology, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, No 9, Bei guan Street, Tong Zhou District, Beijing, 101149, P. R. China.
| | - Fangchao Liu
- Department of Science and Technology, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, No 9, Bei guan Street, Tong Zhou District, Beijing, 101149, P. R. China.
| |
Collapse
|
10
|
Steiling K. Evaluating the Impact of Race-Neutral Interpretation of Preoperative Pulmonary Function. Ann Am Thorac Soc 2024; 21:32-34. [PMID: 38156898 PMCID: PMC10867907 DOI: 10.1513/annalsats.202309-834ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Affiliation(s)
- Katrina Steiling
- Division of Pulmonary, Allergy, and Critical Care Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| |
Collapse
|
11
|
Sheshadri A, Rajaram R, Baugh A, Castro M, Correa AM, Soto F, Daniel CR, Li L, Evans SE, Dickey BF, Vaporciyan AA, Ost DE. Association of Preoperative Lung Function with Complications after Lobectomy Using Race-Neutral and Race-Specific Normative Equations. Ann Am Thorac Soc 2024; 21:38-46. [PMID: 37796618 PMCID: PMC10867917 DOI: 10.1513/annalsats.202305-396oc] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 10/04/2023] [Indexed: 10/07/2023] Open
Abstract
Rationale: Pulmonary function testing (PFT) is performed to aid patient selection before surgical resection for non-small cell lung cancer (NSCLC). The interpretation of PFT data relies on normative equations, which vary by race, but the relative strength of association of lung function using race-specific or race-neutral normative equations with postoperative pulmonary complications is unknown. Objectives: To compare the strength of association of lung function, using race-neutral or race-specific equations, with surgical complications after lobectomy for NSCLC. Methods: We studied 3,311 patients who underwent lobectomy for NSCLC and underwent preoperative PFT from 2001 to 2021. We used Global Lung Function Initiative equations to generate race-specific and race-neutral normative equations to calculate percentage predicted forced expiratory volume in 1 second (FEV1%). The primary outcome of interest was the occurrence of postoperative pulmonary complications within 30 days of surgery. We used unadjusted and race-adjusted logistic regression models and least absolute shrinkage and selection operator analyses adjusted for relevant comorbidities to measure the association of race-specific and race-neutral FEV1% with pulmonary complications. Results: Thirty-one percent of patients who underwent surgery experienced pulmonary complications. Higher FEV1, whether measured with race-neutral (odds ratio [OR], 0.98 per 1% change in FEV1% [95% confidence interval (CI), 0.98-0.99]; P < 0.001) or race-specific (OR, 0.98 per 1% change in FEV1% [95% CI, 0.98-0.98]; P < 0.001) normative equations, was associated with fewer postoperative pulmonary complications. The area under the receiver operator curve for pulmonary complications was similar for race-adjusted race-neutral (0.60) and race-specific (0.60) models. Using least absolute shrinkage and selection operator regression, higher FEV1% was similarly associated with a lower rate of pulmonary complications in race-neutral (OR, 0.99 per 1% [95% CI, 0.98-0.99]) and race-specific (OR, 0.99 per 1%; 95% CI, 0.98-0.99) models. The marginal effect of race on pulmonary complications was attenuated in all race-specific models compared with all race-neutral models. Conclusions: The choice of race-specific or race-neutral normative PFT equations does not meaningfully affect the association of lung function with pulmonary complications after lobectomy for NSCLC, but the use of race-neutral equations unmasks additional effects of self-identified race on pulmonary complications.
Collapse
Affiliation(s)
| | | | - Aaron Baugh
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco, California; and
| | - Mario Castro
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Kansas Medical Center, Kansas City, Missouri
| | | | | | | | - Liang Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | | | | |
Collapse
|
12
|
Xu J, Li X, Zeng J, Zhou Y, Li Q, Bai Z, Zhang Y, Xiao J. Effect of Baduanjin qigong on postoperative pulmonary rehabilitation in patients with non-small cell lung cancer: a randomized controlled trial. Support Care Cancer 2023; 32:73. [PMID: 38158422 DOI: 10.1007/s00520-023-08194-4] [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: 03/23/2023] [Accepted: 11/19/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE The purpose of this study was to explore the effect of Baduanjin qigong on improving lung function and postoperative quality of life of patients with non-small cell lung cancer (NSCLC) and to find an effective home-based pulmonary rehabilitation method. METHODS A randomised controlled trial was carried out from July 2019 to October 2021, which included 216 NSCLC postoperative participants from Beijing China-Japan Friendship Hospital and Cancer Hospital of Chinese Academy of Medical Science. Participants were randomly divided into two groups, including the observation (n = 108) group and the control group (n = 108). The control group was given routine lung rehabilitation training, while the observation group was given Baduanjin qigong. Both groups were trained for 12 weeks.The patient's age, sex, smoking history, lung cancer stage, pathological type were recorded. Related indicators of lung function, 6-min walk distance(6MWD), Piper fatigue Scale, and Borg dyspnea score before and after intervention were recorded. RESULTS Compared with these indicators before indicators, lung function, 6MWD, Piper fatigue Scale score and Borg score were significantly better in the two groups after intervention (P < 0.05). There were no significant differences in FVC%, 6MWD and Borg score between the two groups (P > 0.05), whereas FEV1% and Piper fatigue Scale scores in the observation group were better than that in the control group (P < 0.05). CONCLUSION Both Baduanjin qigong and traditional pulmonary rehabilitation methods can improve the postoperative lung function and quality of life of patients with NSCLC; and compared with traditional pulmonary rehabilitation training, Baduanjin Qigong may have certain advantages in relieving cancer-related fatigue and FEV1%, and may be another new method of home-based pulmonary rehabilitation for patients with NSCLC. TRIAL REGISTRATION Clinical Trial No.: ChiCTR1900025121.
Collapse
Affiliation(s)
- Jilai Xu
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Xia Li
- Guangzhou Special Service Recuperation, Center PLA Rocket Force, Guangzhou, China
| | - Jing Zeng
- Guangzhou Special Service Recuperation, Center PLA Rocket Force, Guangzhou, China
| | - Yanfen Zhou
- Guangzhou Special Service Recuperation, Center PLA Rocket Force, Guangzhou, China
| | - Qiyan Li
- Guangzhou Special Service Recuperation, Center PLA Rocket Force, Guangzhou, China
| | - Zhenmin Bai
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Yuxuan Zhang
- Guangzhou Special Service Recuperation, Center PLA Rocket Force, Guangzhou, China.
| | - Jun Xiao
- Guangzhou Special Service Recuperation, Center PLA Rocket Force, Guangzhou, China.
| |
Collapse
|
13
|
Zirafa CC, Manfredini B, Romano G, Sicolo E, Castaldi A, Bagalà E, Morganti R, Cariello C, Davini F, Melfi F. Comparison of Robotic and Open Lobectomy for Lung Cancer in Marginal Pulmonary Function Patients: A Single-Centre Retrospective Study. Curr Oncol 2023; 31:132-144. [PMID: 38248094 PMCID: PMC10814225 DOI: 10.3390/curroncol31010009] [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: 10/23/2023] [Revised: 12/08/2023] [Accepted: 12/19/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND The treatment of non-small-cell lung cancer (NSCLC) patients with reduced respiratory function represents a challenge for thoracic surgeons. Minimally invasive surgery seems to be beneficial for these patients because it reduces tissue trauma and its impact on respiratory mechanics. Application of the robotic technique, the use of CO2 insufflation and longer surgical time are factors that could influence the outcomes of marginal pulmonary function patients. The objective of this study was to evaluate the impact of the robotic technique on the postoperative outcomes of patients with poor lung function. METHODS We retrospectively collected and analyzed data from consecutive marginal respiratory function patients who underwent robotic or open lobectomy for NSCLC. Data regarding clinical, operative and postoperative details were compared between the open and robotic approaches. RESULTS The outcomes of 100 patients with reduced respiratory function were evaluated, of whom 59 underwent open lobectomies and 41 underwent robotic lobectomies. Robotic lobectomy was characterized by a longer operative time, a reduced hospital stay and a lower incidence of postoperative complications (22% vs. 33.9%), when compared to the open approach. CONCLUSION Robotic lobectomy is a safe and feasible procedure for patients with marginal pulmonary function.
Collapse
Affiliation(s)
- Carmelina Cristina Zirafa
- Minimally Invasive and Robotic Thoracic Surgery, Surgical, Medical, Molecular, and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy; (B.M.); (G.R.); (E.S.); (A.C.); (E.B.); (F.D.); (F.M.)
| | - Beatrice Manfredini
- Minimally Invasive and Robotic Thoracic Surgery, Surgical, Medical, Molecular, and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy; (B.M.); (G.R.); (E.S.); (A.C.); (E.B.); (F.D.); (F.M.)
| | - Gaetano Romano
- Minimally Invasive and Robotic Thoracic Surgery, Surgical, Medical, Molecular, and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy; (B.M.); (G.R.); (E.S.); (A.C.); (E.B.); (F.D.); (F.M.)
| | - Elisa Sicolo
- Minimally Invasive and Robotic Thoracic Surgery, Surgical, Medical, Molecular, and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy; (B.M.); (G.R.); (E.S.); (A.C.); (E.B.); (F.D.); (F.M.)
| | - Andrea Castaldi
- Minimally Invasive and Robotic Thoracic Surgery, Surgical, Medical, Molecular, and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy; (B.M.); (G.R.); (E.S.); (A.C.); (E.B.); (F.D.); (F.M.)
| | - Elena Bagalà
- Minimally Invasive and Robotic Thoracic Surgery, Surgical, Medical, Molecular, and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy; (B.M.); (G.R.); (E.S.); (A.C.); (E.B.); (F.D.); (F.M.)
| | - Riccardo Morganti
- Section of Statistics, University Hospital of Pisa, 56124 Pisa, Italy;
| | - Claudia Cariello
- Cardiothoracic and Vascular Anaesthesia and Intensive Care, Department of Anaesthesia and Critical Care Medicine, University Hospital of Pisa, 56124 Pisa, Italy;
| | - Federico Davini
- Minimally Invasive and Robotic Thoracic Surgery, Surgical, Medical, Molecular, and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy; (B.M.); (G.R.); (E.S.); (A.C.); (E.B.); (F.D.); (F.M.)
| | - Franca Melfi
- Minimally Invasive and Robotic Thoracic Surgery, Surgical, Medical, Molecular, and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy; (B.M.); (G.R.); (E.S.); (A.C.); (E.B.); (F.D.); (F.M.)
| |
Collapse
|
14
|
Arbee-Kalidas N, Moutlana HJ, Moodley Y, Kebalepile MM, Motshabi Chakane P. The association between cardiopulmonary exercise testing and postoperative outcomes in patients with lung cancer undergoing lung resection surgery: A systematic review and meta-analysis. PLoS One 2023; 18:e0295430. [PMID: 38060569 PMCID: PMC10703215 DOI: 10.1371/journal.pone.0295430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 11/22/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Exercise capacity should be determined in all patients undergoing lung resection for lung cancer surgery and cardiopulmonary exercise testing (CPET) remains the gold standard. The purpose of this study was to investigate associations between preoperative CPET and postoperative outcomes in patients undergoing lung resection surgery for lung cancer through a review of the existing literature. METHODS A search was conducted on PubMed, Scopus, Cochrane Library and CINAHL from inception until December 2022. Studies investigating associations between preoperative CPET and postoperative outcomes were included. Risk of bias was assessed using the QUIPS tool. A random effect model meta-analysis was performed. I2 > 40% indicated a high level of heterogeneity. RESULTS Thirty-seven studies were included with 6450 patients. Twenty-eight studies had low risk of bias. [Formula: see text] peak is the oxygen consumption at peak exercise and serves as a marker of cardiopulmonary fitness. Higher estimates of [Formula: see text] peak, measured and as a percentagege of predicted, showed significant associations with a lower risk of mortality [MD: 3.66, 95% CI: 0.88; 6.43 and MD: 16.49, 95% CI: 6.92; 26.07] and fewer complications [MD: 2.06, 95% CI: 1.12; 3.00 and MD: 9.82, 95% CI: 5.88; 13.76]. Using a previously defined cutoff value of > 15mL/kg/min for [Formula: see text] peak, showed evidence of decreased odds of mortality [OR: 0.55, 95% CI: 0.28-0.81] and but not decreased odds of postoperative morbidity [OR: 0.82, 95% CI: 0.64-1.00]. There was no relationship between [Formula: see text] slope, which depicts ventilatory efficiency, with mortality [MD: -9.60, 95% CI: -27.74; 8.54] however, patients without postoperative complications had a lower preoperative [Formula: see text] [MD: -2.36, 95% CI: -3.01; -1.71]. Exercise load and anaerobic threshold did not correlate with morbidity or mortality. There was significant heterogeneity between studies. CONCLUSIONS Estimates of cardiopulmonary fitness as evidenced by higher [Formula: see text] peak, measured and as a percentage of predicted, were associated with decreased morbidity and mortality. A cutoff value of [Formula: see text] peak > 15mL/kg/min was consistent with improved survival but not with fewer complications. Ventilatory efficiency was associated with decreased postoperative morbidity but not with improved survival. The heterogeneity in literature could be remedied with large scale, prospective, blinded, standardised research to improve preoperative risk stratification in patients with lung cancer scheduled for lung resection surgery.
Collapse
Affiliation(s)
- Nabeela Arbee-Kalidas
- Department of Anaesthesiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Hlamatsi Jacob Moutlana
- Department of Anaesthesiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Yoshan Moodley
- Department of Anaesthesiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Moses Mogakolodi Kebalepile
- Department of Anaesthesiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Palesa Motshabi Chakane
- Department of Anaesthesiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
15
|
King J, Taylor M, Booton R, Crosbie P, Shah D, Evison M, Ng C, Rammohan K, Shah R, Shackcloth M, Grant SW, Sinnott N. Safety of curative-intent lung cancer surgery in older patients (octogenarians): A contemporary multicentre cohort study. J Geriatr Oncol 2023; 14:101635. [PMID: 37812970 DOI: 10.1016/j.jgo.2023.101635] [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: 05/24/2023] [Revised: 09/01/2023] [Accepted: 09/18/2023] [Indexed: 10/11/2023]
Abstract
INTRODUCTION Despite octogenarians representing an ever-increasing proportion of patients with lung cancer, there is a paucity of evidence describing outcomes after lung resection for these patients. We aimed to evaluate short and mid-term outcomes for octogenarians after lung resection. MATERIALS AND METHODS A total of 5,470 consecutive patients undergoing lung resection for primary lung cancer from 2012-2019 in two UK centres were included. Primary outcomes were perioperative, 90-day, and one-year mortality in the octogenarian vs. non-octogenarian cohort. Appropriate statistical tests were used to compare outcomes between octogenarian and non-octogenarian patients. Secondary outcomes were post-operative complications and to validate the performance of the Thoracoscore model in the octogenarian cohort. RESULTS Overall, 9.4% (n=513) of patients were aged ≥80. The rates of 90-day mortality, one-year mortality, and post-operative atrial fibrillation were significantly higher for octogenarians. The one-year mortality rate for octogenarians fell significantly over time (2012-2015: 16.5% vs 2016-2019: 10.2%, p=0.034). Subgroup analysis (2016-2019 only) demonstrated no significant difference in peri-operative, 90-day, or one-year mortality between octogenarian and non-octogenarian patients. Validation of the Thoracoscore model demonstrated modest discrimination and acceptable calibration. DISCUSSION Mortality for octogenarians fell significantly over time in this study. Indeed, when confined to the most recent time period, comparable rates of both 90-day and one-year mortality for octogenarian and non-octogenarian patients were seen. Whilst preventative strategies to reduce the incidence of post-operative atrial fibrillation in octogenarians should be considered, these findings demonstrate that following appropriate patient selection, octogenarians can safely undergo lung resection for lung cancer.
Collapse
Affiliation(s)
- Jenny King
- Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK; Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK.
| | - Marcus Taylor
- Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Richard Booton
- Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK; Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
| | - Phil Crosbie
- Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK; Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
| | - Dinakshi Shah
- Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Matthew Evison
- Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Cassandra Ng
- Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK; Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
| | - Kandadai Rammohan
- Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Rajesh Shah
- Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Michael Shackcloth
- Department of Cardiothoracic Surgery, Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Stuart W Grant
- Division of Cardiovascular Sciences, University of Manchester, ERC, Manchester, UK
| | - Nicola Sinnott
- Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| |
Collapse
|
16
|
Lee HA, Yu W, Choi JD, Lee YS, Park JW, Jung YJ, Sheen SS, Jung J, Haam S, Kim SH, Park JE. Development of Machine Learning Model for VO 2max Estimation Using a Patch-Type Single-Lead ECG Monitoring Device in Lung Resection Candidates. Healthcare (Basel) 2023; 11:2863. [PMID: 37958007 PMCID: PMC10648477 DOI: 10.3390/healthcare11212863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/27/2023] [Accepted: 10/29/2023] [Indexed: 11/15/2023] Open
Abstract
A cardiopulmonary exercise test (CPET) is essential for lung resection. However, performing a CPET can be challenging. This study aimed to develop a machine learning model to estimate maximal oxygen consumption (VO2max) using data collected through a patch-type single-lead electrocardiogram (ECG) monitoring device in candidates for lung resection. This prospective, single-center study included 42 patients who underwent a CPET at a tertiary teaching hospital from October 2021 to July 2022. During the CPET, a single-lead ECG monitoring device was applied to all patients, and the results obtained from the machine-learning algorithm using the information extracted from the ECG patch were compared with the CPET results. According to the Bland-Altman plot of measured and estimated VO2max, the VO2max values obtained from the machine learning model and the FRIEND equation showed lower differences from the reference value (bias: -0.33 mL·kg-1·min-1, bias: 0.30 mL·kg-1·min-1, respectively). In subgroup analysis, the developed model demonstrated greater consistency when applied to different maximal stage levels and sexes. In conclusion, our model provides a closer estimation of VO2max values measured using a CPET than existing equations. This model may be a promising tool for estimating VO2max and assessing cardiopulmonary reserve in lung resection candidates when a CPET is not feasible.
Collapse
Affiliation(s)
- Hyun Ah Lee
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon 16499, Republic of Korea
| | - Woosik Yu
- Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine, Suwon 16499, Republic of Korea; (W.Y.)
| | - Jong Doo Choi
- Seers Technology Co., Seongnam-si 13558, Republic of Korea
| | - Young-sin Lee
- Seers Technology Co., Seongnam-si 13558, Republic of Korea
| | - Ji Won Park
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon 16499, Republic of Korea
| | - Yun Jung Jung
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon 16499, Republic of Korea
| | - Seung Soo Sheen
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon 16499, Republic of Korea
| | - Junho Jung
- Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine, Suwon 16499, Republic of Korea; (W.Y.)
| | - Seokjin Haam
- Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine, Suwon 16499, Republic of Korea; (W.Y.)
| | - Sang Hun Kim
- Department of Rehabilitation Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea
| | - Ji Eun Park
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon 16499, Republic of Korea
| |
Collapse
|
17
|
Schütte W, Gütz S, Nehls W, Blum TG, Brückl W, Buttmann-Schweiger N, Büttner R, Christopoulos P, Delis S, Deppermann KM, Dickgreber N, Eberhardt W, Eggeling S, Fleckenstein J, Flentje M, Frost N, Griesinger F, Grohé C, Gröschel A, Guckenberger M, Hecker E, Hoffmann H, Huber RM, Junker K, Kauczor HU, Kollmeier J, Kraywinkel K, Krüger M, Kugler C, Möller M, Nestle U, Passlick B, Pfannschmidt J, Reck M, Reinmuth N, Rübe C, Scheubel R, Schumann C, Sebastian M, Serke M, Stoelben E, Stuschke M, Thomas M, Tufman A, Vordermark D, Waller C, Wolf J, Wolf M, Wormanns D. [Prevention, Diagnosis, Therapy, and Follow-up of Lung Cancer - Interdisciplinary Guideline of the German Respiratory Society and the German Cancer Society - Abridged Version]. Pneumologie 2023; 77:671-813. [PMID: 37884003 DOI: 10.1055/a-2029-0134] [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: 10/28/2023]
Abstract
The current S3 Lung Cancer Guidelines are edited with fundamental changes to the previous edition based on the dynamic influx of information to this field:The recommendations include de novo a mandatory case presentation for all patients with lung cancer in a multidisciplinary tumor board before initiation of treatment, furthermore CT-Screening for asymptomatic patients at risk (after federal approval), recommendations for incidental lung nodule management , molecular testing of all NSCLC independent of subtypes, EGFR-mutations in resectable early stage lung cancer in relapsed or recurrent disease, adjuvant TKI-therapy in the presence of common EGFR-mutations, adjuvant consolidation treatment with checkpoint inhibitors in resected lung cancer with PD-L1 ≥ 50%, obligatory evaluation of PD-L1-status, consolidation treatment with checkpoint inhibition after radiochemotherapy in patients with PD-L1-pos. tumor, adjuvant consolidation treatment with checkpoint inhibition in patients withPD-L1 ≥ 50% stage IIIA and treatment options in PD-L1 ≥ 50% tumors independent of PD-L1status and targeted therapy and treatment option immune chemotherapy in first line SCLC patients.Based on the current dynamic status of information in this field and the turnaround time required to implement new options, a transformation to a "living guideline" was proposed.
Collapse
Affiliation(s)
- Wolfgang Schütte
- Klinik für Innere Medizin II, Krankenhaus Martha Maria Halle-Dölau, Halle (Saale)
| | - Sylvia Gütz
- St. Elisabeth-Krankenhaus Leipzig, Abteilung für Innere Medizin I, Leipzig
| | - Wiebke Nehls
- Klinik für Palliativmedizin und Geriatrie, Helios Klinikum Emil von Behring
| | - Torsten Gerriet Blum
- Helios Klinikum Emil von Behring, Klinik für Pneumologie, Lungenklinik Heckeshorn, Berlin
| | - Wolfgang Brückl
- Klinik für Innere Medizin 3, Schwerpunkt Pneumologie, Klinikum Nürnberg Nord
| | | | - Reinhard Büttner
- Institut für Allgemeine Pathologie und Pathologische Anatomie, Uniklinik Köln, Berlin
| | | | - Sandra Delis
- Helios Klinikum Emil von Behring, Klinik für Pneumologie, Lungenklinik Heckeshorn, Berlin
| | | | - Nikolas Dickgreber
- Klinik für Pneumologie, Thoraxonkologie und Beatmungsmedizin, Klinikum Rheine
| | | | - Stephan Eggeling
- Vivantes Netzwerk für Gesundheit, Klinikum Neukölln, Klinik für Thoraxchirurgie, Berlin
| | - Jochen Fleckenstein
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg
| | - Michael Flentje
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Würzburg, Würzburg
| | - Nikolaj Frost
- Medizinische Klinik mit Schwerpunkt Infektiologie/Pneumologie, Charite Universitätsmedizin Berlin, Berlin
| | - Frank Griesinger
- Klinik für Hämatologie und Onkologie, Pius-Hospital Oldenburg, Oldenburg
| | | | - Andreas Gröschel
- Klinik für Pneumologie und Beatmungsmedizin, Clemenshospital, Münster
| | | | | | - Hans Hoffmann
- Klinikum Rechts der Isar, TU München, Sektion für Thoraxchirurgie, München
| | - Rudolf M Huber
- Medizinische Klinik und Poliklinik V, Thorakale Onkologie, LMU Klinikum Munchen
| | - Klaus Junker
- Klinikum Oststadt Bremen, Institut für Pathologie, Bremen
| | - Hans-Ulrich Kauczor
- Klinikum der Universität Heidelberg, Abteilung Diagnostische Radiologie, Heidelberg
| | - Jens Kollmeier
- Helios Klinikum Emil von Behring, Klinik für Pneumologie, Lungenklinik Heckeshorn, Berlin
| | | | - Marcus Krüger
- Klinik für Thoraxchirurgie, Krankenhaus Martha-Maria Halle-Dölau, Halle-Dölau
| | | | - Miriam Möller
- Krankenhaus Martha-Maria Halle-Dölau, Klinik für Innere Medizin II, Halle-Dölau
| | - Ursula Nestle
- Kliniken Maria Hilf, Klinik für Strahlentherapie, Mönchengladbach
| | | | - Joachim Pfannschmidt
- Klinik für Thoraxchirurgie, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin
| | - Martin Reck
- Lungeclinic Grosshansdorf, Pneumologisch-onkologische Abteilung, Grosshansdorf
| | - Niels Reinmuth
- Klinik für Pneumologie, Thorakale Onkologie, Asklepios Lungenklinik Gauting, Gauting
| | - Christian Rübe
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Homburg
| | | | | | - Martin Sebastian
- Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt
| | - Monika Serke
- Zentrum für Pneumologie und Thoraxchirurgie, Lungenklinik Hemer, Hemer
| | | | - Martin Stuschke
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Essen, Essen
| | - Michael Thomas
- Thoraxklinik am Univ.-Klinikum Heidelberg, Thorakale Onkologie, Heidelberg
| | - Amanda Tufman
- Medizinische Klinik und Poliklinik V, Thorakale Onkologie, LMU Klinikum München
| | - Dirk Vordermark
- Universitätsklinik und Poliklinik für Strahlentherapie, Universitätsklinikum Halle, Halle
| | - Cornelius Waller
- Klinik für Innere Medizin I, Universitätsklinikum Freiburg, Freiburg
| | | | - Martin Wolf
- Klinikum Kassel, Klinik für Onkologie und Hämatologie, Kassel
| | - Dag Wormanns
- Evangelische Lungenklinik, Radiologisches Institut, Berlin
| |
Collapse
|
18
|
Collins ML, Whitehorn GL, Mack SJ, Till BM, Rshaidat H, Grenda TR, Evans NR, Okusanya OT. Is wedge a dirty word? Demographic and facility-level variables associated with high-quality wedge resection. JTCVS OPEN 2023; 15:481-488. [PMID: 37808043 PMCID: PMC10556949 DOI: 10.1016/j.xjon.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/16/2023] [Accepted: 07/05/2023] [Indexed: 10/10/2023]
Abstract
Objectives Although sublobar resections have gained traction, wedge resections vary widely in quality. We seek to characterize the demographic and facility-level variables associated with high-quality wedge resections. Methods The National Cancer Database was queried from 2010 to 2018. Patients with T1/T2 N0 M0 non-small cell lung cancer 2 cm or less who underwent wedge resection without neoadjuvant therapy were included. A wedge resection with no nodes sampled or with positive margins was categorized as a low-quality wedge. A wedge resection with 4 or more nodes sampled and negative margins was categorized as a high-quality wedge. Facility-specific variables were investigated via quartile analysis based on the overall volume and proportion of high-quality wedge or low-quality wedge resections performed. Results A total of 21,742 patients met inclusion criteria, 6390 (29.4%) of whom received a high-quality wedge resection. Factors associated with high-quality wedge resection included treatment at an academic center (3005 [47.0%] vs low-quality wedge 6279 [40.9%]; P < .001). The 30- and 90-day survivals were similar, but patients who received a high-quality wedge resection had improved 5-year survival (4902 [76.7%] vs 10,548 [68.7%]; P < .001). Facilities in the top quartile by volume of high-quality wedge resections performed 69% (4409) of all high-quality wedge resections, and facilities in the top quartile for low-quality wedge resections performed 67.6% (10,378) of all low-quality wedge resections. A total of 113 facilities were in the top quartile by volume for both high-quality wedge and low-quality wedge resections. Conclusions High-quality wedge resections are associated with improved 5-year survival when compared with low-quality wedge resections. By volume, high-quality wedge and low-quality wedge resections cluster to a minority of facilities, many of which overlap. There is discordance between best practice guidelines and current practice patterns that warrants additional study.
Collapse
Affiliation(s)
- Micaela L Collins
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa
- Division of Esophageal and Thoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pa
| | - Gregory L Whitehorn
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa
- Division of Esophageal and Thoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pa
| | - Shale J Mack
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa
- Division of Esophageal and Thoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pa
| | - Brian M Till
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa
- Division of Esophageal and Thoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pa
| | - Hamza Rshaidat
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa
- Division of Esophageal and Thoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pa
| | - Tyler R Grenda
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa
- Division of Esophageal and Thoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pa
| | - Nathaniel R Evans
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa
- Division of Esophageal and Thoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pa
| | - Olugbenga T Okusanya
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa
- Division of Esophageal and Thoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pa
| |
Collapse
|
19
|
Moon RJ, Taylor R, Miklavc P, Mehdi SB, Grant SW, Bittar MN. Wedge resection versus lobectomy in T1 lung cancer patients: a propensity matched analysis. J Cardiothorac Surg 2023; 18:252. [PMID: 37620956 PMCID: PMC10464042 DOI: 10.1186/s13019-023-02303-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/10/2023] [Indexed: 08/26/2023] Open
Abstract
OBJECTIVES Performing wedge resection rather than lobectomy for primary lung cancer remains controversial. Recent studies demonstrate no survival advantage for non-anatomical resection compared to lobectomy in patients with early-stage lung cancer. The objective of this study was to investigate whether in patients with T1 tumours, non-anatomical wedge resection is associated with equivalent survival to lobectomy. METHODS This was a retrospective cohort study of patients who underwent lung resection at the Lancashire Cardiac Centre between April 2005 and April 2018. Patients were subjected to multidisciplinary team discussion. The extent of resection was decided by the team based on British Thoracic Society guidelines. The primary outcome was overall survival. Propensity matching of patients with T1 tumours was also performed to determine whether differences in survival rates exist in a subset of these patients with balanced pre-operative characteristics. RESULTS There were 187 patients who underwent non-anatomical wedge resection and 431 patients who underwent lobectomy. Cox modelling demonstrated no survival difference between groups for the first 1.6 years then a risk of death 3-fold higher for wedge resection group after 1.6 years (HR 3.14, CI 1.98-4.79). Propensity matching yielded 152 pairs for which 5-year survival was 66.2% for the lobectomy group and 38.5% for the non-anatomical wedge group (SMD = 0.58, p = 0.003). CONCLUSIONS Non-anatomical wedge resection was associated with significantly reduced 5-year survival compared to lobectomy in matched patients. Lobectomy should remain the standard of care for patients with early-stage lung cancer who are fit enough to undergo surgical resection.
Collapse
Affiliation(s)
- Robert J Moon
- Department of Cardiothoracic Surgery, Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, UK.
| | - Rebecca Taylor
- Department of Cardiothoracic Surgery, Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, UK
| | - Pika Miklavc
- School of Science, Engineering and Environment, University of Salford, Manchester, UK
| | - Syed B Mehdi
- Department of Respiratory Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Stuart W Grant
- Department of Cardiothoracic Surgery, Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, UK
| | - Mohamad Nidal Bittar
- Department of Cardiothoracic Surgery, Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, UK
| |
Collapse
|
20
|
Etienne H, Kalt F, Park S, Opitz I. The oncologic efficacy of extended resections for lung cancer. J Surg Oncol 2023; 127:296-307. [PMID: 36630100 DOI: 10.1002/jso.27183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 01/12/2023]
Abstract
Extended lung resections for T3-T4 non-small-cell lung cancer remain challenging. Multimodal management is mandatory in multidisciplinary tumor boards, and here the determination of resectability is key. Long-term oncologic efficacy depends mostly on complete resection (R0) and the extent of N2 disease. The development of novel innovative treatments (targeted therapy and immune checkpoint inhibitors) sets interesting perspectives to reinforce current therapeutic options in the induction and adjuvant setting.
Collapse
Affiliation(s)
- Harry Etienne
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Fabian Kalt
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Samina Park
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
21
|
Paakkola NM, Lindqvist J, Jekunen A, Sihvo E, Johansson M, Andersén H. Impact of sex and age on adherence to guidelines in non-small cell lung cancer management. Cancer Treat Res Commun 2023; 34:100675. [PMID: 36566686 DOI: 10.1016/j.ctarc.2022.100675] [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: 10/10/2022] [Revised: 11/27/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Age-related disparities in non-small cell lung cancer (NSCLC) treatment are well known, but few studies have assessed the impact of sex on treatment disparities. Disparities in guideline-adherence may explain the superior survival in women with NSCLC. Therefore, we aimed to define patient- and tumor-related factors associated with non-adherence to guidelines in NSCLC management with a special focus on sex and age. PATIENTS AND METHODS Patients with NSCLC who received first-line treatment at the Vaasa Central Hospital between 2016 and 2020 were included in the study. The primary outcome was guideline adherence, defined as adherent, undertreatment, or overtreatment considering performance status. A binary logistic regression model was used to calculate the adjusted odds ratio (aOR) for non-adherence to treatment guidelines depending on patient- and tumor-related factors. RESULTS 321 patients were included in the study. Non-adherence was highest in ≥75-year-old women (41.3%), followed by ≥75-year-old men (32.6%), <75-year-old men (27.6%) and lowest in women <75-year-old (19.7%) (p = 0.035). Non-adherent care consisted more often of undertreatment in <75-year-old men than women (26.0% versus 12.1%) and overtreatment in <75-year-old women than men (7.6% versus 1.6%). Non-adherence was associated with stage III disease (aOR 2.21; 95% CI 1.07-4.59), poor pulmonary function (aOR 3.69, 95% CI 1.56-8.71), and Charlson Comorbidity Index 1-2 (aOR 2.09; 95% CI 1.09-4.01). CONCLUSION Sex- and age-related disparities in guideline adherence were observed in <75-year-old men and in ≥75-year-olds. Stage III NSCLC was associated with non-adherence.
Collapse
Affiliation(s)
- Nelly-Maria Paakkola
- Cancer Clinic, Vaasa Central Hospital, Vaasa, Finland; School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Jonatan Lindqvist
- Cancer Clinic, Vaasa Central Hospital, Vaasa, Finland; Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Antti Jekunen
- Cancer Clinic, Vaasa Central Hospital, Vaasa, Finland; Oncology Department, University of Turku, Turku, Finland
| | - Eero Sihvo
- Central Hospital of Central Finland, Jyväskylä, Finland
| | - Mikael Johansson
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Heidi Andersén
- Cancer Clinic, Vaasa Central Hospital, Vaasa, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| |
Collapse
|
22
|
Nakagawa T, Fukui T, Ohsumi Y, Miyamoto E, Gotoh M. Association between oxygen consumption and stepping exercise standardized with a triaxial accelerometer. Gen Thorac Cardiovasc Surg 2023; 71:27-32. [PMID: 35941402 DOI: 10.1007/s11748-022-01860-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 07/30/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE According to the current American College of Chest Physicians (ACCP) guideline, a cardiopulmonary exercise test (CPET) is indicated in patients with lung cancer being considered for lung surgery. The measurement of maximum oxygen consumption ([Formula: see text] max) is not sufficiently prevalent because it requires special technical equipment. Considering that stepping is a simple and common exercise, we aimed to establish a simple and reproducible test with standardization of exercise intensity using a triaxial accelerometer. METHODS Twenty healthy volunteers (10 male, 10 female) were included in the study. The subjects were obliged to step on the same spot at the rate of 80 and 110 counts for 1 min each and then step as quickly as possible for the last minute. Oxygen consumption ([Formula: see text]) (mL/kg/min) for every breath was continuously measured during the exercise. A triaxial accelerometer was attached to the hip of test subjects whereby metabolic equivalents (METs) at each test level were measured. RESULTS The mean age of the study subjects was 42.9 ± 11.4 (mean ± SD). The mean value of [Formula: see text] at each level increased linearly along with the stepping level in each individual but varied among subjects. Using METs instead of step counts minimized the difference in regression lines among subjects. A receiver operating characteristic analysis revealed the possibility of [Formula: see text] prediction for the critical values of 10 and 20 mL/kg/min using METs. CONCLUSION A simple and reproducible stepping test was suggested as applicable to standardizing the intensity of exercise using a triaxial accelerometer.
Collapse
Affiliation(s)
- Tatsuo Nakagawa
- Department of Thoracic Surgery, Tenri Hospital, 200 Mishima, Nara, Tenri, 632-8552, Japan.
| | - Takamasa Fukui
- Department of Thoracic Surgery, Tenri Hospital, 200 Mishima, Nara, Tenri, 632-8552, Japan
| | - Yuki Ohsumi
- Department of Thoracic Surgery, Tenri Hospital, 200 Mishima, Nara, Tenri, 632-8552, Japan
| | - Ei Miyamoto
- Department of Thoracic Surgery, Tenri Hospital, 200 Mishima, Nara, Tenri, 632-8552, Japan
| | - Masashi Gotoh
- Department of Thoracic Surgery, Tenri Hospital, 200 Mishima, Nara, Tenri, 632-8552, Japan
| |
Collapse
|
23
|
Tao X, Zhao J, Wei W, Shan Z, Zheng H, Pan T. The feasibility and safety of simultaneous bilateral video-assisted thoracic surgery for the treatment of bilateral pulmonary lesions. Front Oncol 2022; 12:975259. [DOI: 10.3389/fonc.2022.975259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/13/2022] [Indexed: 11/17/2022] Open
Abstract
BackgroundThe aim of this study was to evaluate the feasibility and safety of simultaneous bilateral video-assisted thoracic surgery (VATS) for the treatment of bilateral pulmonary lesions.MethodsThe data of 11 patients who received simultaneous bilateral pulmonary surgery using VATS in the Department of Thoracic Surgery of The Third Affiliated Hospital of Naval Medical University between January 2016 and August 2021 were retrospectively analyzed.ResultsThe cases of four male and seven female patients, with a mean age of 57.54 ± 8.37 years (range, 44-67 years), were reviewed. Nonanatomic wedge resection, pulmonary segmentectomy or lobectomy via VATS were performed depending on each patient’s situation. Mean 1 second forced expiratory volume (FEV1) was 2.55 ± 0.66 L(range, 1.49-3.88 L), mean intraoperative bleeding volume was 91.81 ± 49.56 mL(range, 30-150 mL), mean operating time was 273.72 ± 68.98 min(range, 132-390 min), and mean drainage duration was 5.27 ± 3.60 days(range, 2-14 days), with a mean total drainage volume of 1,515.90 ± 772.75 mL(range, 530-3,225 mL). Only one postoperative complication (air leakage) occurred, with an overall complication rate of 9.09%. The mean postoperative hospital stay was 8.81 ± 3.60 days (range, 5-18 days), and the mean total cost of hospitalization was 67,054.53 ± 20,896.49 RMB (range, 47,578.45-123,530.8 RMB).ConclusionsSimultaneous bilateral pulmonary surgery using VATS for the treatment of bilateral pulmonary lesions is safe and feasible and can therefore be considered after strict preoperative evaluation of the patient.
Collapse
|
24
|
Nieves-Alonso JM, Méndez Hernández RM, Ramasco Rueda F, Planas Roca A. Estimated metabolic equivalents of task do not correlate with the maximal oxygen consumption of patients undergoing lung resection surgery. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2022; 69:437-441. [PMID: 35869005 DOI: 10.1016/j.redare.2021.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/05/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Metabolic equivalent of task (MET) is a physiological measure that represents the metabolic cost of an activity of daily living. One MET is equivalent to the resting metabolic rate. METs can be estimated by questionnaires or calculated by measuring maximal oxygen uptake (VO2max). The aim of this study is to determine whether METs estimated in the pre-consultation (METse) correlates with METs calculated from VO2max (METsVO2). PATIENTS AND METHODS Retrospective observational study in patients scheduled for lung resection surgery. The estimation of METs was obtained in the pre-consultation according to the 2014 European and American guidelines for preoperative cardiovascular assessment in non-cardiac surgery. VO2max was calculated in the ergometry laboratory. RESULTS A total of 104 patients were included in the study, of whom 25 (24%) were female. The mean age was 65.1 years (±9.8). In 26 patients (25%), the METse classification correlated with METsVO2 (κ = -0.107 P = .02). In the remaining patients, METse overestimated functional capacity measured by ergometry (METse > METsVO2). CONCLUSIONS Subjective assessment overestimates functional capacity and should not replace objective testing in patients scheduled for lung resection surgery.
Collapse
Affiliation(s)
- J M Nieves-Alonso
- Servicio de Anestesiología y Reanimación, Hospital Universitario de La Princesa, Madrid, Spain.
| | - R M Méndez Hernández
- Servicio de Anestesiología y Reanimación, Hospital Universitario de La Princesa, Madrid, Spain
| | - F Ramasco Rueda
- Servicio de Anestesiología y Reanimación, Hospital Universitario de La Princesa, Madrid, Spain
| | - A Planas Roca
- Servicio de Anestesiología y Reanimación, Hospital Universitario de La Princesa, Madrid, Spain
| |
Collapse
|
25
|
Pons A, De Sousa P, Proli C, Booth SA, Palmares A, Leung M, Alshammari A, Vlastos D, Raubenheimer H, Devbhandari M, Patel A, Lim E. Impact of society and national guidelines on patient selection for lung cancer surgery in the United Kingdom. EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY : OFFICIAL JOURNAL OF THE EUROPEAN ASSOCIATION FOR CARDIO-THORACIC SURGERY 2022; 62:6619559. [PMID: 35766817 DOI: 10.1093/ejcts/ezac362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/01/2022] [Accepted: 06/27/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVES We sought to evaluate the impact of different national clinical guidelines (with consistent and conflicting recommendations) on clinician's practice in the UK. METHODS In this cohort study, we analysed data from National Lung Cancer Audit comprising all patients diagnosed with lung cancer between 2008 and 2013 within England and Wales for consistent (British Thoracic Society and National Institute of Clinical Excellence) recommendations for lower/more permissive lung function but opposing stage (N2) selection parameters for surgery. RESULTS From 2008 to 2013, data from 167 192 patients with primary lung cancers were included. The proportion of patients undergoing surgery for lung cancer increased from 9.5% to 20.5% in 2013 (P < 0.001) as the number of general thoracic surgeons in the UK increased from 40 to 81 in the corresponding timeframe. Mean forced expiratory volume in 1 s of surgical patients increased from 76% (22) to 81% (22) in 2013 (P < 0.001). Of the patients undergoing surgery, the proportion of patients with N2 disease across the 6-year interval was broadly consistent between 8% and 11% without any evidence of trend (P = 0.125). CONCLUSIONS Within 3 years of new clinical guideline recommendations, we did not observe any overall change suggesting greater selection for surgery on lower levels of lung function. When presented with conflicting recommendation, no observable change in selection was noted on surgery for N2 disease. The observed increase in surgical resection rates is more likely due to greater access to surgery (by increasing number of surgeons) rather than any impact of guideline recommendations.
Collapse
Affiliation(s)
- Aina Pons
- Academic Division of Thoracic Surgery, Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Paulo De Sousa
- Academic Division of Thoracic Surgery, Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Chiara Proli
- Academic Division of Thoracic Surgery, Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Sarah A Booth
- Academic Division of Thoracic Surgery, Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Abigail Palmares
- Academic Division of Thoracic Surgery, Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Maria Leung
- Academic Division of Thoracic Surgery, Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Abdullah Alshammari
- Academic Division of Thoracic Surgery, Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Dimitrios Vlastos
- Academic Division of Thoracic Surgery, Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Hilgardt Raubenheimer
- Academic Division of Thoracic Surgery, Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Mohan Devbhandari
- Academic Division of Thoracic Surgery, Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Anant Patel
- Department of Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - Eric Lim
- Academic Division of Thoracic Surgery, Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas NHS Foundation Trust, London, UK
- Imperial College London, London, UK
| |
Collapse
|
26
|
Carr JA, NeCamp T. Results of emergency colectomy in nonagenarians and octogenarians previously labeled as prohibitive surgical risk. Eur J Trauma Emerg Surg 2022; 48:4927-4933. [PMID: 35759007 DOI: 10.1007/s00068-022-02030-w] [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: 05/06/2022] [Accepted: 05/30/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE There are no standardized criteria for what constitutes prohibitive risk for emergency abdominal surgery. METHODS A retrospective review was performed comparing two groups of patients having emergent colectomy. One group had previously been labeled as being prohibitive surgical risk and the other was a contemporary, non-prohibitive risk group also requiring emergency colectomy. All operations were performed by a single surgeon. RESULTS There were 27 prohibitive risk patients and 81 non-prohibitive risk (control group) patients. The average age of the prohibitive risk group was 85 years (range 78-99) compared to the control group mean age of 52 years (18-79, p < 0.00001). Prohibitive risk was due to extremes of age combined with congestive heart failure in 44%, followed by chronic obstructive pulmonary disease combined with heart failure in 19%. The groups were closely matched by the type of colectomy performed. The total complication rate was much higher in the prohibitive risk group compared to the non-prohibitive risk patients (81% versus 48%, p 0.005). But the 30-day mortality rate was similar between groups (7% versus 4%, p 0.6). CONCLUSION Patients who are labeled as prohibitive surgical risk may be inaccurately assessed in the majority of cases. Additional research will need to be performed to evaluate the presence of quantifiable high-risk physiological conditions, and not just comorbidities, that place a patient at high risk of death after abdominal surgery. Until then, elderly patients should not be denied colectomy based upon comorbidities alone.
Collapse
Affiliation(s)
- John Alfred Carr
- ProMedica Health System, 100 Madison Avenue, Toledo, OH, 43606, USA.
| | - Timothy NeCamp
- Data Bloom Statistical Consultants, 104 Fieldstone Drive, Terrace Park, OH, 45174, USA
| |
Collapse
|
27
|
Xia Y, Zha J, Curull V, Sánchez-Font A, Guitart M, Rodríguez-Fuster A, Aguiló R, Barreiro E. Gene expression profile of epithelial-mesenchymal transition in tumors of patients with nsclc: the influence of COPD. ERJ Open Res 2022; 8:00105-2022. [PMID: 35854873 PMCID: PMC9289374 DOI: 10.1183/23120541.00105-2022] [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: 02/25/2022] [Accepted: 05/10/2022] [Indexed: 11/28/2022] Open
Abstract
Epithelial–mesenchymal transition (EMT) is involved in the pathophysiology of lung cancer (LC) and COPD, and the latter is an important risk factor for LC. We hypothesised that the EMT gene expression profile and signalling cascade may differ in LC patients with COPD from those with no respiratory diseases. In lung tumour specimens obtained through video-assisted thoracoscopic surgery from LC (n=20, control group) and LC-COPD patients (n=30), gene expression (quantitative real-time PCR amplification) of EMT markers SMAD3, SMAD4, ZEB2, TWIST1, SNAI1, ICAM1, VIM, CDH2, MMP1 and MMP9 was detected. In lung tumours of LC-COPD compared to LC patients, gene expression of SMAD3, SMAD4, ZEB2 and CDH2 significantly declined, while no significant differences were detected for the other analysed markers. A significant correlation was found between pack-years (smoking burden) and SMAD3 gene expression among LC-COPD patients. LC-COPD patients exhibited mild-to-moderate airway obstruction and a significant reduction in diffusion capacity compared to LC patients. In lung tumour samples of patients with COPD, several markers of EMT expression, namely SMAD3, SMAD4, ZEB2 and CDH2, were differentially expressed suggesting that these markers are likely to play a role in the regulation of EMT in patients with this respiratory disease. Cigarette smoke did not seem to influence the expression of EMT markers in this study. These results have potential clinical implications in the management of patients with LC, particularly in those with underlying respiratory diseases. The downregulation of the epithelial–mesenchymal transition repressor SMAD pathway may favour a pro-tumoural micro-environment in patients with chronic airway diseases, namely COPD, which could be targeted therapeuticallyhttps://bit.ly/39oXnoG
Collapse
|
28
|
Xu Y, Qin Y, Ma D, Liu H. The impact of segmentectomy versus lobectomy on pulmonary function in patients with non-small-cell lung cancer: a meta-analysis. J Cardiothorac Surg 2022; 17:107. [PMID: 35526006 PMCID: PMC9077940 DOI: 10.1186/s13019-022-01853-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 04/20/2022] [Indexed: 11/15/2022] Open
Abstract
Objective Segmentectomy has been reported as an alternative to lobectomy for small-sized NSCLC without detriment to survival. The long-term benefits of segmentectomy over lobectomy on pulmonary function have not been firmly established. This meta-analysis aims to compare postoperative changes in pulmonary function in NSCLC patients undergoing segmentectomy or lobectomy. Methods Medline, Embase, Web of Science and Scopus were searched through March 2021. Statistical comparisons were made when appropriate. Results Fourteen studies (2412 participants) out of 324 citations were included in this study. All selected studies were high quality, as indicated by the Newcastle–Ottawa scale for assessing the risk of bias. Clinical outcomes were compared between segmentectomy and lobectomy. ΔFEV1 [10 studies, P < 0.01, WMD = 0.40 (0.29, 0.51)], ΔFVC [4 studies, P < 0.01, WMD = 0.16 (0.07, 0.24)], ΔFVC% [4 studies, P < 0.01, WMD = 4.05 (2.32, 5.79)], ΔFEV1/FVC [2 studies, P < 0.01, WMD = 1.99 (0.90, 3.08)], and ΔDLCO [3 studies, P < 0.01, WMD = 1.30 (0.69, 1.90)] were significantly lower in the segmentectomy group than in the lobectomy group. Subgroup analysis showed that in stage IA patients, the ΔFEV1% [3 studies, P < 0.01, WMD = 0.26 (0.07, 0.46)] was significantly lower in the segmentectomy group. The ΔDLCO% and ΔMVV% were incomparable. Conclusion Segmentectomy preserves more lung function than lobectomy. There were significantly smaller decreases in FEV1, FVC, FVC%, FEV1/FVC and DLCO in the segmentectomy group than in the lobectomy group. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-022-01853-3.
Collapse
Affiliation(s)
- Yuan Xu
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yingzhi Qin
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Dongjie Ma
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Hongsheng Liu
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
| |
Collapse
|
29
|
Functional analysis of the airways after pulmonary lobectomy through computational fluid dynamics. Sci Rep 2022; 12:3321. [PMID: 35228582 PMCID: PMC8885819 DOI: 10.1038/s41598-022-06852-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 12/14/2021] [Indexed: 12/25/2022] Open
Abstract
Pulmonary lobectomy, which consists of the partial or complete resection of a lung lobe, is the gold standard intervention for lung cancer removal. The removal of functional tissue during the surgery and the re-adaptation of the remaining thoracic structures decrease the patient's post-operative pulmonary function. Residual functionality is evaluated through pulmonary function tests, which account for the number of resected segments without considering local structural alterations and provide an average at-the-mouth estimation. Computational Fluid Dynamics (CFD) has been demonstrated to provide patient-specific, quantitative, and local information about airways airflow dynamics. A CFD investigation was performed on image-based airway trees reconstructed before and after the surgery for twelve patients who underwent lobectomy at different lobes. The geometrical alterations and the variations in fluid dynamics parameters and in lobar ventilation between the pre and post-operative conditions were evaluated. The post-operative function was estimated and compared with current clinical algorithms and with actual clinical data. The post-operative configuration revealed a high intersubject variability: regardless of the lobectomy site, an increment of global velocity, wall pressure, and wall shear stress was observed. Local flow disturbances also emerged at, and downstream of, the resection site. The analysis of lobar ventilation showed severe variations in the volume flow rate distribution, highlighting the compensatory effects in the contralateral lung with an increment of inflow. The estimation of post-operative function through CFD was comparable with the current clinical algorithm and the actual spirometric measurements. The results confirmed that CFD could provide additional information to support the current clinical approaches both in the operability assessment and in the prescription of personalized respiratory rehabilitation.
Collapse
|
30
|
Iwai K, Hanaoka J. Pulmonary Rehabilitation of a Case With Worsening Dyspnea Due to Acute Exacerbation of Interstitial Pneumonia After Video-Assisted Thoracic Surgery. Cureus 2022; 14:e22545. [PMID: 35345724 PMCID: PMC8956513 DOI: 10.7759/cureus.22545] [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] [Accepted: 02/21/2022] [Indexed: 11/18/2022] Open
Abstract
We report a case of acute exacerbation of interstitial pneumonia after video-assisted thoracic surgery. The case was a 69-year-old man with left upper lobe lung cancer. Acute exacerbation was suspected on postoperative day 6 due to worsening dyspnea and frosted shadows on computed tomography. High-dose corticosteroids and low-to-moderate-dose corticosteroids were administered. Step-by-step rehabilitation with oxygen administration commenced as soon as possible, and the patient was able to be discharged. However, dyspnea, knee extension strength, and exercise capacity were significantly worse than before surgery. Eighteen months later, pulmonary function and knee extension strength showed improvements, but exercise capacity was unchanged from the time of discharge. Continued follow-up will be necessary.
Collapse
|
31
|
Nakahama H, Jaradeh M, Abdelsattar ZM, Lubawski J, Vigneswaran WT. The impact of marginal lung function on outcomes in the era of minimally invasive thoracic surgery. J Thorac Dis 2022; 13:6800-6809. [PMID: 35070364 PMCID: PMC8743406 DOI: 10.21037/jtd-21-1382] [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: 08/21/2021] [Accepted: 10/28/2021] [Indexed: 11/24/2022]
Abstract
Background The effect of marginal lung function on outcomes after lung resection has traditionally been studied in the context of open thoracic surgery. Its impact on postoperative outcomes in the era of minimally invasive lung resection is unclear. Methods In this retrospective cohort study, we included adult patients who underwent minimally invasive lung resection at our institution between January 2017 and May 2020 for known malignancy or lung nodule. Marginal lung function was defined as pre-operative forced expiratory volume in 1 second (FEV1) and/or diffusion lung capacity of carbon monoxide <60% of predicted. Our outcomes included a composite outcome of pulmonary morbidity and/or 30- and 90-day mortality, and hospital length of stay. We used multivariable logistic and Poisson regression models to identify associations with outcomes, and Kaplan-Meier and Cox models to estimate survival. Results Of 300 patients, 88 (29%) had marginal lung function. Patients in the marginal group were more likely to be female (69% vs. 56%; P=0.028), and more likely to have: hypertension (HTN) (83% vs. 71%; P=0.028), chronic obstructive pulmonary disease (COPD) (38% vs. 12%; P<0.001), interstitial lung disease (ILD) (9% vs. 3%; P<0.019), and ischemic heart disease (28% vs. 18%; P=0.033). Patients were similar in terms of age (68±8 vs. 68±10 years; P=0.932), and other comorbidities. Anatomic lung resection comprised 56.8% of the marginal group vs. 74% in the non-marginal group (P=0.003). The most common complication was prolonged air leak (18.2% vs. 11.8%; P=0.479). Marginal lung function had a trend toward increased composite respiratory complications (22.7% vs. 15.1%; P=0.112) and 90-day mortality (5.7% vs. 4.2%; P=0.591), although they did not reach statistical significance. There was a statistically significant 1-day average increase in length of stay in the marginal lung function cohort (4.6 vs. 3.4 days; P<0.015) with a stronger association with diffusion lung capacity of carbon monoxide than FEV1. Survival was similar (marginal function HR =1.0; P=0.994). Conclusions In the era of minimally invasive thoracic surgery, lung resection in patients with marginal lung function may be considered in select patients. These findings aid in the selection consideration and counseling of this patient population.
Collapse
Affiliation(s)
- Hiroko Nakahama
- Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Mark Jaradeh
- Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Zaid M Abdelsattar
- Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - James Lubawski
- Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Wickii T Vigneswaran
- Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL, USA
| |
Collapse
|
32
|
Choi JW, Jeong H, Ahn HJ, Yang M, Kim JA, Kim DK, Lee SH, Kim K, Choi J. The impact of pulmonary function tests on early postoperative complications in open lung resection surgery: an observational cohort study. Sci Rep 2022; 12:1277. [PMID: 35075198 PMCID: PMC8786949 DOI: 10.1038/s41598-022-05279-8] [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: 07/27/2021] [Accepted: 01/10/2022] [Indexed: 11/09/2022] Open
Abstract
We investigated whether pulmonary function tests (PFTs) can predict pulmonary complications and if they are, to find new cutoff values in current open lung resection surgery. In this observational study, patients underwent open lung resection surgery at a tertiary hospital were analyzed (n = 1544). Various PFTs were tested by area under the receiver-operating characteristic curve (AUCROC) to predict pulmonary complications until 30 days postoperatively. In results, PFTs were generally not effective to predict pulmonary complications (AUCROC: 0.58-0.66). Therefore, we could not determine new cutoff values, and used previously reported cutoffs for post-hoc analysis [predicted postoperative forced expiratory volume in one second (ppoFEV1) < 40%, predicted postoperative diffusing capacity for carbon monoxide (ppoDLCO) < 40%]. In multivariable analysis, old age, male sex, current smoker, intraoperative transfusion and use of inotropes were independent risk factors for pulmonary complications (model 1: AUCROC 0.737). Addition of ppoFEV1 or ppoDLCO < 40% to model 1 did not significantly increase predictive capability (model 2: AUCROC 0.751, P = 0.065). In propensity score-matched subgroups, patients with ppoFEV1 or ppoDLCO < 40% showed higher rates of pulmonary complications [13% (21/160) vs. 24% (38/160), P = 0.014], but no difference in in-hospital mortality [3% (8/241) vs. 6% (14/241), P = 0.210] or mean survival duration [61 (95% CI 57-66) vs. 65 (95% CI 60-70) months, P = 0.830] compared to patients with both > 40%. In conclusion, PFTs themselves were not effective predictors of pulmonary complications. Decision to proceed with surgical resection of lung cancer should be made on an individual basis considering other risk factors and the patient's goals.
Collapse
Affiliation(s)
- Ji Won Choi
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Heejoon Jeong
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Hyun Joo Ahn
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
| | - Mikyung Yang
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Jie Ae Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Duk Kyung Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Sang Hyun Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Keoungah Kim
- Department of Anesthesiology, School of Dentistry, Dankook University, Cheonan, South Korea
| | - Jisun Choi
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| |
Collapse
|
33
|
Pulmonary Risk Assessment. Perioper Med (Lond) 2022. [DOI: 10.1016/b978-0-323-56724-4.00009-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
34
|
Varghese TK. General Thoracic Surgery. Perioper Med (Lond) 2022. [DOI: 10.1016/b978-0-323-56724-4.00032-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
35
|
Murray-Torres TM, Winch PD, Naguib AN, Tobias JD. Anesthesia for thoracic surgery in infants and children. Saudi J Anaesth 2021; 15:283-299. [PMID: 34764836 PMCID: PMC8579498 DOI: 10.4103/sja.sja_350_20] [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: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 11/19/2022] Open
Abstract
The management of infants and children presenting for thoracic surgery poses a variety of challenges for anesthesiologists. A thorough understanding of the implications of developmental changes in cardiopulmonary anatomy and physiology, associated comorbid conditions, and the proposed surgical intervention is essential in order to provide safe and effective clinical care. This narrative review discusses the perioperative anesthetic management of pediatric patients undergoing noncardiac thoracic surgery, beginning with the preoperative assessment. The considerations for the implementation and management of one-lung ventilation (OLV) will be reviewed, and as will the anesthetic implications of different surgical procedures including bronchoscopy, mediastinoscopy, thoracotomy, and thoracoscopy. We will also discuss pediatric-specific disease processes presenting in neonates, infants, and children, with an emphasis on those with unique impact on anesthetic management.
Collapse
Affiliation(s)
- Teresa M Murray-Torres
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, Missouri, USA.,Department of Anesthesiology, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Peter D Winch
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, Missouri, USA.,Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Aymen N Naguib
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, Missouri, USA.,Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Joseph D Tobias
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, Missouri, USA.,Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| |
Collapse
|
36
|
Iwai K, Komada R, Ohshio Y, Hanaoka J. Evaluation of predictive factors related to the presence or absence of supplemental oxygen therapy and comparison of physical functions after video-assisted thoracic surgery. NAGOYA JOURNAL OF MEDICAL SCIENCE 2021; 83:801-810. [PMID: 34916723 PMCID: PMC8648526 DOI: 10.18999/nagjms.83.4.801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/06/2021] [Indexed: 11/06/2022]
Abstract
We performed a retrospective study of 102 individuals to evaluate predictive factors for needing supplemental oxygen therapy following video-assisted thoracic surgery (VATS) and to compare patients' physical functions before and after surgery. Prior to surgery, we evaluated quadriceps torque, 6-minute walk distance (6MWD), timed up and go test, and grip strength. During the 6MWD, patients' oxygen saturation was recorded every minute. Quadriceps torque and 6MWD were evaluated again following surgery. The indication for supplemental oxygen therapy was determined based on desaturation (<85%) during the 6MWD in room air. A total of 14 patients needed oxygen therapy at discharge (group A), while 88 patients did not need oxygen therapy (group B). In group A, the postoperative 6MWD was repeated with supplemental oxygen. Compared with the same parameters in group B, in group A the percentage diffusing capacity for carbon monoxide was significantly lower (p=0.011), while a history of smoking (p=0.016), exercise-induced hypoxemia (EIH, p<0.001), chronic obstructive pulmonary disease (p<0.001), and interstitial pneumonia (p=0.008) were significantly higher. Logistic regression analysis showed that EIH was an independent risk factor for requiring supplemental oxygen therapy following surgery (odds ratio: 46.2, 95% CI: 9-237.1; p<0.001). In group A, patients' minimum oxygen saturation was significantly improved by oxygen administration (83.4±3.4 vs. 87.7±3.3, p=0.002), but there was no difference in walking distance (359.5±64.2 vs. 353.6±41.6, p=0.482). Our data indicate that patients should be preoperatively evaluated to predict postoperative hypoxemia and that this evaluation could complement the prediction of postoperative need for oxygen therapy.
Collapse
Affiliation(s)
- Kohji Iwai
- Division of Physical Therapy, Rehabilitation Units, Shiga University of Medical Science, Otsu, Japan
| | - Ryo Komada
- Division of Physical Therapy, Rehabilitation Units, Shiga University of Medical Science, Otsu, Japan
| | - Yasuhiko Ohshio
- Department of Thoracic Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Jun Hanaoka
- Department of Thoracic Surgery, Shiga University of Medical Science, Otsu, Japan
| |
Collapse
|
37
|
GCC2 as a New Early Diagnostic Biomarker for Non-Small Cell Lung Cancer. Cancers (Basel) 2021; 13:cancers13215482. [PMID: 34771645 PMCID: PMC8582534 DOI: 10.3390/cancers13215482] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/28/2021] [Accepted: 10/28/2021] [Indexed: 01/08/2023] Open
Abstract
Simple Summary Lung cancer, including non-small cell lung cancer, is the leading cause of cancer-related death worldwide. A better prognosis is associated with early diagnosis of lung cancer patients. Although annual screening guidelines for lung cancer are recommended, using various tools such as chest X-ray, low-dose computed tomography, and positron emission tomography, these screening procedures are expensive and difficult to repeat. They are also invasive and have a high risk of radiation exposure. Therefore, a low-risk, convenient diagnostic method using liquid biopsy and biomarkers is required for the early diagnosis of lung cancer. The newly proposed biomarker GCC2 was identified through proteomic analysis of exosomes secreted from lung cancer cell lines. GCC2 expression levels in peripheral blood of the patients showed high specificity and sensitivity in early lung cancer, demonstrating that our novel exosomal biomarker GCC2 can greatly contribute to improving the diagnosis of lung cancer patients, even though it has been tested in only a few pilot studies. Abstract No specific markers have been identified to detect non-small cell lung cancer (NSCLC) cell-derived exosomes circulating in the blood. Here, we report a new biomarker that distinguishes between cancer and non-cancer cell-derived exosomes. Exosomes isolated from patient plasmas at various pathological stages of NSCLC, NSCLC cell lines, and human pulmonary alveolar epithelial cells isolated using size exclusion chromatography were characterized. The GRIP and coiled-coil domain-containing 2 (GCC2) protein, involved in endosome-to-Golgi transport, was identified by proteomics analysis of NSCLC cell line-derived exosomes. GCC2 protein levels in the exosomes derived from early-stage NSCLC patients were higher than those from healthy controls. Receiver operating characteristic curve analysis revealed the diagnostic sensitivity and specificity of exosomal GCC2 to be 90% and 75%, respectively. A high area under the curve, 0.844, confirmed that GCC2 levels could effectively distinguish between the exosomes. These results demonstrate GCC2 as a promising early diagnostic biomarker for NSCLC.
Collapse
|
38
|
Shamji FM. Controversies in Lung Cancer: When to Resect with Compromised Pulmonary Function. Thorac Surg Clin 2021; 31:485-495. [PMID: 34696861 DOI: 10.1016/j.thorsurg.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Lung cancer is the most common cause of cancer-related death worldwide among both men and women. Patients with lung cancer frequently have impaired pulmonary function, usually secondary to smoking-related chronic obstructive lung disease. Numerous techniques have been used to evaluate the postsurgical risk. These techniques include preoperative pulmonary function test, 6-minute walk test, stage 1 cardiopulmonary exercise test, 2D echocardiography, and quantitative ventilation-perfusion scintigraphy.
Collapse
Affiliation(s)
- Farid M Shamji
- University of Ottawa, General Campus, Ottawa Hospital, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada.
| |
Collapse
|
39
|
Abstract
Lung cancer is a lethal disease, and chronic cigarette smoking is the most common cause. The selection of treatment is based on the histologic cell type, accurate staging, and adequacy of cardiopulmonary functional reserve. The risk for surgery is highest in patients over the age of 80 years.
Collapse
Affiliation(s)
- Farid M Shamji
- University of Ottawa, General Campus, Ottawa Hospital, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada.
| | - Gilles Beauchamp
- Thoracic Surgery Unit, Department of Surgery, Maisonneuve-Rosemount Hospital, University of Montreal, 5415 L'Assomption Boulevard, Montreal, Quebec H1T 2M4, Canada
| |
Collapse
|
40
|
Delays in Managing Lung Cancer: The Importance of Fast-Tracking in the Clinical Care. Thorac Surg Clin 2021; 31:417-427. [PMID: 34696854 DOI: 10.1016/j.thorsurg.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Early diagnosis in lung cancer is desirable, because surgical resection offers the only hope of cure. In the face of suggestive symptoms, a normal plain chest radiograph does not exclude the diagnosis, and investigation is essential. The various imaging changes seen on computerized tomography and PET scan provide strong suggestive evidence of lung cancer, but proof of diagnosis rests on histologic examination, material that may be obtained by one of the following diagnostic procedures: bronchoscopy, mediastinoscopy, fine needle aspiration biopsy, thoracentesis and pleural biopsy, lymph node biopsy, and exploratory thoracotomy.
Collapse
|
41
|
Kwon OB, Yeo CD, Lee HY, Kang HS, Kim SK, Kim JS, Park CK, Lee SH, Kim SJ, Kim JW. The Value of Residual Volume/Total Lung Capacity as an Indicator for Predicting Postoperative Lung Function in Non-Small Lung Cancer. J Clin Med 2021; 10:jcm10184159. [PMID: 34575273 PMCID: PMC8470520 DOI: 10.3390/jcm10184159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/09/2021] [Accepted: 09/13/2021] [Indexed: 12/25/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is one of the most frequently occurring concomitant diseases in patients with non-small cell lung cancer (NSCLC). It is characterized by small airways and the hyperinflation of the lung. Patients with hyperinflated lung tend to have more reserved lung function than conventionally predicted after lung cancer surgery. The aim of this study was to identify other indicators in predicting postoperative lung function after lung resection for lung cancer. Patients with NSCLC who underwent curative lobectomy with mediastinal lymph node dissection from 2017 to 2019 were included. Predicted postoperative FEV1 (ppoFEV1) was calculated using the formula: preoperative FEV1 × (19 segments-the number of segments to be removed) ÷ 19. The difference between the measured postoperative FEV1 and ppoFEV1 was defined as an outcome. Patients were categorized into two groups: preserved FEV1 if the difference was positive and non-preserved FEV1, if otherwise. In total, 238 patients were included: 74 (31.1%) in the FEV1 non-preserved group and 164 (68.9%) in the FEV1 preserved group. The proportion of preoperative residual volume (RV)/total lung capacity (TLC) ≥ 40% in the FEV1 non-preserved group (21.4%) was lower than in the preserved group (36.1%) (p = 0.03). In logistic regression analysis, preoperative RV/TLC ≥ 40% was related to postoperative FEV1 preservation. (adjusted OR, 2.02, p = 0.041). Linear regression analysis suggested that preoperative RV/TLC was positively correlated with a significant difference. (p = 0.004) Preoperative RV/TLC ≥ 40% was an independent predictor of preserved lung function in patients undergoing curative lobectomy with mediastinal lymph node dissection. Preoperative RV/TLC is positively correlated with postoperative lung function.
Collapse
Affiliation(s)
- Oh-Beom Kwon
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (O.-B.K.); (C.-D.Y.); (H.-S.K.); (S.-K.K.); (J.-S.K.); (C.-K.P.); (S.-H.L.); (S.-J.K.)
| | - Chang-Dong Yeo
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (O.-B.K.); (C.-D.Y.); (H.-S.K.); (S.-K.K.); (J.-S.K.); (C.-K.P.); (S.-H.L.); (S.-J.K.)
| | - Hwa-Young Lee
- Division of Allergy, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
| | - Hye-Seon Kang
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (O.-B.K.); (C.-D.Y.); (H.-S.K.); (S.-K.K.); (J.-S.K.); (C.-K.P.); (S.-H.L.); (S.-J.K.)
| | - Sung-Kyoung Kim
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (O.-B.K.); (C.-D.Y.); (H.-S.K.); (S.-K.K.); (J.-S.K.); (C.-K.P.); (S.-H.L.); (S.-J.K.)
| | - Ju-Sang Kim
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (O.-B.K.); (C.-D.Y.); (H.-S.K.); (S.-K.K.); (J.-S.K.); (C.-K.P.); (S.-H.L.); (S.-J.K.)
| | - Chan-Kwon Park
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (O.-B.K.); (C.-D.Y.); (H.-S.K.); (S.-K.K.); (J.-S.K.); (C.-K.P.); (S.-H.L.); (S.-J.K.)
| | - Sang-Haak Lee
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (O.-B.K.); (C.-D.Y.); (H.-S.K.); (S.-K.K.); (J.-S.K.); (C.-K.P.); (S.-H.L.); (S.-J.K.)
- Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Seung-Joon Kim
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (O.-B.K.); (C.-D.Y.); (H.-S.K.); (S.-K.K.); (J.-S.K.); (C.-K.P.); (S.-H.L.); (S.-J.K.)
- Division of Pulmonology, Department of Internal Medicine, Seoul St. Mary’s Hospital, Seoul 06591, Korea
- Postech-Catholic Biomedical Engineering Institute, Songeui Multiplex Hall, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Jin-Woo Kim
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (O.-B.K.); (C.-D.Y.); (H.-S.K.); (S.-K.K.); (J.-S.K.); (C.-K.P.); (S.-H.L.); (S.-J.K.)
- Correspondence:
| |
Collapse
|
42
|
Suehs CM, Solovei L, Hireche K, Vachier I, Mariano Goulart D, Gamon L, Charriot J, Serre I, Molinari N, Bourdin A, Bommart S. Complication and lung function impairment prediction using perfusion and computed tomography air trapping (CLIPPCAIR): protocol for the development and validation of a novel multivariable model for the prediction of post-resection lung function. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1092. [PMID: 34423004 PMCID: PMC8339869 DOI: 10.21037/atm-21-214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/21/2021] [Indexed: 12/24/2022]
Abstract
Background Recent advancements in computed tomography (CT) scanning and post processing have provided new means of assessing factors affecting respiratory function. For lung cancer patients requiring resection, and especially those with respiratory comorbidities such as chronic obstructive pulmonary disease (COPD), the ability to predict post-operative lung function is a crucial step in the lung cancer operability assessment. The primary objective of the CLIPPCAIR study is to use novel CT data to develop and validate an algorithm for the prediction of lung function remaining after pneumectomy/lobectomy. Methods Two sequential cohorts of non-small cell lung cancer patients requiring a pre-resection CT scan will be recruited at the Montpellier University Hospital, France: a test population (N=60) on which predictive models will be developed, and a further model validation population (N=100). Enrolment will occur during routine pre-surgical consults and follow-up visits will occur 1 and 6 months after pneumectomy/lobectomy. The primary outcome to be predicted is forced expiratory volume in 1 second (FEV1) six months after lung resection. The baseline CT variables that will be used to develop the primary multivariable regression model are: expiratory to inspiratory ratios of mean lung density (MLDe/i for the total lung and resected volume), the percentage of voxels attenuating at less than ‒950 HU (PVOX‒950 for the total lung and resected volume) and the ratio of iodine concentrations for the resected volume over that of the total lung. The correlation between predicted and real values will be compared to (and is expected to improve upon) that of previously published methods. Secondary analyses will include the prediction of transfer factor for carbon monoxide (TLCO) and complications in a similar fashion. The option to explore further variables as predictors of post-resection lung function or complications is kept open. Discussion Current methods for estimating post-resection lung function are imperfect and can add assessments (such as scintigraphy) to the pre-surgical workup. By using CT imaging data in a novel fashion, the results of the CLIPPCAIR study may not only improve such estimates, it may also simplify patient pathways. Trial registration Clinicaltrials.gov (NCT03885765).
Collapse
Affiliation(s)
- Carey Meredith Suehs
- Department of Respiratory Diseases, The University of Montpellier, CHU Montpellier, Montpellier, France
| | - Laurence Solovei
- Department of Thoracic Surgery, The University of Montpellier, CHU Montpellier, Montpellier, France
| | - Kheira Hireche
- Department of Thoracic Surgery, The University of Montpellier, CHU Montpellier, Montpellier, France
| | - Isabelle Vachier
- Department of Respiratory Diseases, The University of Montpellier, CHU Montpellier, Montpellier, France
| | - Denis Mariano Goulart
- Department of Nuclear Medicine, The University of Montpellier, CHU Montpellier, Montpellier, France.,PhyMedExp, CNRS, INSERM, The University of Montpellier, CHU Montpellier, Montpellier, France
| | - Lucie Gamon
- Department of Medical Information, The University of Montpellier, CHU Montpellier, Montpellier, France
| | - Jérémy Charriot
- Department of Respiratory Diseases, The University of Montpellier, CHU Montpellier, Montpellier, France
| | - Isabelle Serre
- Department of Pathology, The University of Montpellier, CHU Montpellier, Montpellier, France
| | - Nicolas Molinari
- IMAG, CNRS, The University of Montpellier, CHU Montpellier, Montpellier, France
| | - Arnaud Bourdin
- Department of Respiratory Diseases, The University of Montpellier, CHU Montpellier, Montpellier, France.,PhyMedExp, CNRS, INSERM, The University of Montpellier, CHU Montpellier, Montpellier, France
| | - Sébastien Bommart
- PhyMedExp, CNRS, INSERM, The University of Montpellier, CHU Montpellier, Montpellier, France.,Department of Radiology, The University of Montpellier, CHU Montpellier, Montpellier, France
| |
Collapse
|
43
|
Melzer AC, Begnaud A, Lindgren BR, Schertz K, Fu SS, Vock DM, Rothman AJ, Joseph AM. Self-reported exercise capacity among current smokers eligible for lung cancer screening: Distribution and association with key comorbidities. Cancer Treat Res Commun 2021; 28:100443. [PMID: 34371253 PMCID: PMC8405582 DOI: 10.1016/j.ctarc.2021.100443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/22/2021] [Accepted: 07/23/2021] [Indexed: 06/13/2023]
Abstract
ONE CONCERN: as lung cancer screening (LCS) is implemented is that patients will be screened who are too ill to benefit. Poor exercise capacity (EC) predicts adverse outcomes following lung resection. OBJECTIVE Describe the distribution of EC among smokers eligible for LCS and examine associations with comorbidities. METHODS Cross-sectional analysis of baseline data from a randomized controlled trial of tobacco treatment in the context of LCS. Participants responded regarding limitations in moderate activities, ability to climb stairs, and frequency of dyspnea on a scale from never/almost never to all or most of the time. Responses were assigned a numeric score and summed to categorize exercise limitation. Associations between poor EC and key comorbidities were examined using adjusted logistic regression. RESULTS 660 participants completed a survey with the following characteristics: 64.4% male, 89.5% white, mean age 64.5. Overall EC categories were: good 39.0%, intermediate 41.6%, and poor 19.4%. Prevalence of poor EC was higher among patients with COPD (OR 4.62 95%CI 3.05-7.02), heart failure (OR 3.07 95%CI 1.62-5.82) and cardiovascular disease (OR 2.24, 95%CI 1.45-3.47), and was highest among patients with multimorbidity. Among patients with COPD and heart failure, 57% had poor and 0% had good EC. In adjusted logistic regression, only COPD and Charlson comorbidity index remained significantly associated with poor EC. CONCLUSIONS Many patients eligible for LCS reported poor EC, with increased odds of poor EC among patients with comorbidities. More research is needed to determine how to best integrate EC and comorbidity into eligibility and shared decision-making conversations.
Collapse
Affiliation(s)
- Anne C Melzer
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, United States; Division of Pulmonary, Allergy, Critical Care and Sleep, University of Minnesota Medical School, United States.
| | - Abbie Begnaud
- Division of Pulmonary, Allergy, Critical Care and Sleep, University of Minnesota Medical School, United States
| | | | - Kelsey Schertz
- Department of Medicine, University of Minnesota Medical School, United States
| | - Steven S Fu
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, United States; Department of Medicine, University of Minnesota Medical School, United States
| | - David M Vock
- Division of Biostatistics, School of Public Health, University of Minnesota, United States
| | | | - Anne M Joseph
- Masonic Cancer Center, University of Minnesota, United States; Department of Medicine, University of Minnesota Medical School, United States
| |
Collapse
|
44
|
Abstract
Nontuberculous mycobacteria (NTM) are ubiquitous in the environment and 193 species of NTM have been discovered thus far. NTM species vary in virulence from benign environmental organisms to difficult-to-treat human pathogens. Pulmonary infections remain the most common manifestation of NTM disease in humans and bronchiectasis continues to be a major risk factor for NTM pulmonary disease (NTM PD). This article will provide a useful introduction and framework for clinicians involved in the management of bronchiectasis and NTM. It includes an overview of the epidemiology, pathogenesis, diagnosis, and management of NTM PD. We will address the challenges faced in the diagnosis of NTM PD and the importance of subspeciation in guiding treatment and follow-up, especially in Mycobacterium abscessus infections. The treatment of both Mycobacterium avium complex and M. abscessus, the two most common NTM species known to cause disease, will be discussed in detail. Elements of the recent ATS/ERS/ESCMID/IDSA NTM guidelines published in 2020 will also be reviewed.
Collapse
Affiliation(s)
- Shera Tan
- Tuberculosis Control Unit, Tan Tock Seng Hospital, Singapore, Singapore
| | - Shannon Kasperbauer
- Division of Mycobacterial and Respiratory Infections, National Jewish Health, Denver, Colorado
| |
Collapse
|
45
|
Mariani AW, Vallilo CC, de Albuquerque ALP, Salge JM, Augusto MC, Suesada MM, Pêgo-Fernandes PM, Terra RM. Preoperative evaluation for lung resection in patients with bronchiectasis: should we rely on standard lung function evaluation? Eur J Cardiothorac Surg 2021; 59:1272-1278. [PMID: 33491053 DOI: 10.1093/ejcts/ezaa454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/24/2020] [Accepted: 11/04/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The scant data about non-cystic fibrosis bronchiectasis, including tuberculosis sequelae and impairment of lung function, can bias the preoperative physiological assessment. Our goal was to evaluate the changes in lung function and exercise capacity following pulmonary resection in these patients; we also looked for outcome predictors. METHODS We performed a non-randomized prospective study evaluating lung function changes in patients with non-cystic fibrosis bronchiectasis treated with pulmonary resection. Patients performed lung function tests and cardiopulmonary exercise tests preoperatively and 3 and 9 months after the operation. Demographic data, comorbidities, surgical data and complications were collected. RESULTS Forty-four patients were evaluated for lung function. After resection, the patients had slightly lower values for spirometry: forced expiratory volume in 1 s preoperatively: 2.21 l ± 0.8; at 3 months: 1.9 l ± 0.8 and at 9 months: 2.0 l ± 0.8, but the relationship between the forced expiratory volume in 1 s and the forced vital capacity remained. The gas diffusion measured by diffusing capacity for carbon monoxide did not change: preoperative value: 23.2 ml/min/mmHg ± 7.4; at 3 months: 21.5 ml/min/mmHg ± 5.6; and at 9 months: 21.7 ml/min/mmHg ± 8.2. The performance of general exercise did not change; peak oxygen consumption preoperatively was 20.9 ml/kg/min ± 7.4; at 3 months: 19.3 ml/kg/min ± 6.4; and at 9 months: 20.2 ml/kg/min ± 8.0. Forty-six patients were included for analysis of complications. We had 13 complications with 2 deaths. To test the capacity of the predicted postoperative (PPO) values to forecast complications, we performed several multivariate and univariate analyses; none of them was a significant predictor of complications. When we analysed other variables, only bronchoalveolar lavage with positive culture was significant for postoperative complications (P = 0.0023). Patients who had a pneumonectomy had a longer stay in the intensive care unit (P = 0.0348). CONCLUSIONS The calculated PPO forced expiratory volume in 1 s had an excellent correlation with the measurements at 3 and 9 months; but the calculated PPO capacity for carbon monoxide and the PPO peak oxygen consumption slightly underestimated the 3- and 9-month values. However, none of them was a predictor for complications. Better tools to predict postoperative complications for patients with bronchiectasis who are candidates for lung resection are needed. CLINICAL TRIAL REGISTRATION NUMBER Clinicaltrials.gov: NCT01268475.
Collapse
Affiliation(s)
- Alessandro Wasum Mariani
- Thoracic Surgery Department, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Camilla Carlini Vallilo
- Thoracic Surgery Department, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - André Luís Pereira de Albuquerque
- Pneumology Department, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - João Marcos Salge
- Pneumology Department, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Marcia Cristina Augusto
- Thoracic Surgery Department, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Milena Mako Suesada
- Thoracic Surgery Department, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Paulo Manuel Pêgo-Fernandes
- Thoracic Surgery Department, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ricardo Mingarini Terra
- Thoracic Surgery Department, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| |
Collapse
|
46
|
Shibazaki T, Mori S, Harada E, Shigemori R, Kato D, Matsudaira H, Hirano J, Ohtsuka T. Measured versus predicted postoperative pulmonary function at repeated times up to 1 year after lobectomy. Interact Cardiovasc Thorac Surg 2021; 33:727-733. [PMID: 34115872 DOI: 10.1093/icvts/ivab168] [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: 01/24/2021] [Revised: 04/10/2021] [Accepted: 05/05/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Postoperative pulmonary function is difficult to predict accurately, because it changes from the time of the operation and is also affected by various factors. The objective of this study was to assess the accuracy of predicted postoperative forced expiratory volume in 1 s (FEV1) at different postoperative times after lobectomy. METHODS This retrospective study enrolled 104 patients who underwent lobectomy by video-assisted thoracic surgery. Pulmonary function tests were performed preoperatively and postoperatively at 3, 6 and 12 months. We investigated time-dependent changes in FEV1. In addition, the ratio of measured to predicted postoperative FEV1 calculated by the subsegmental method was evaluated to identify the factors associated with variations in postoperative FEV1. RESULTS Compared with the predicted postoperative FEV1, the measured postoperative FEV1 was 8% higher at 3 months, 11% higher at 6 months and 13% higher at 12 months. The measured postoperative FEV1 significantly increased from 3 to 6 months (P = 0.002) and from 6 to 12 months (P = 0.015) after lobectomy resected lobe, smoking history and body mass index were significant factors associated with the ratio of measured to predicted postoperative FEV1 at 12 months (P < 0.001, P = 0.036 and P = 0.025, respectively). CONCLUSIONS Postoperative FEV1 increased up to 12 months after lobectomy by video-assisted thoracic surgery. The predicted postoperative pulmonary function was underestimated after 3 months, particularly after lower lobectomy.
Collapse
Affiliation(s)
- Takamasa Shibazaki
- Department of Thoracic Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Shohei Mori
- Department of Thoracic Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Eriko Harada
- Department of Thoracic Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Rintaro Shigemori
- Department of Thoracic Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Daiki Kato
- Department of Thoracic Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Hideki Matsudaira
- Department of Thoracic Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Jun Hirano
- Department of Thoracic Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Takashi Ohtsuka
- Department of Thoracic Surgery, Jikei University School of Medicine, Tokyo, Japan
| |
Collapse
|
47
|
Elsayed HH, Moharram AA. Tailored anaesthesia for thoracoscopic surgery promoting enhanced recovery: The state of the art. Anaesth Crit Care Pain Med 2021; 40:100846. [PMID: 33774262 DOI: 10.1016/j.accpm.2021.100846] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 11/30/2020] [Accepted: 12/20/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE OF THE REVIEW The current review focuses on precise anaesthesia for video-assisted thoracoscopic surgery (VATS) with the goal of enhanced recovery. The main aim of an enhanced recovery program after thoracic surgery is to reduce postoperative stress response, protect from postoperative pulmonary complications, give hospitals a better financial option and improve overall patient outcome. This can ultimately reduce hospital stay and increase patient satisfaction. With advances in endoscopic, robotic and endovascular techniques, video-assisted thoracoscopic surgery (VATS) can be performed in a minimally invasive way in managing most pulmonary, pleural and mediastinal diseases. As a minimally invasive technique, video-assisted thoracoscopic surgery (VATS) represents an important element of enhanced recovery program in thoracic surgery as it can achieve most of its goals. Anaesthetic management during preoperative, intraoperative and postoperative period is essential for the establishment of a successful enhanced recovery program. In the era of enhanced recovery protocols, non-intubated thoracoscopic procedures present a step forward. This article focuses on the key anaesthetic elements of the enhanced recovery program during all phases of thoracoscopic surgery. Having reviewed recent literature, a systematic review of literature will highlight successful ERAS protocols published for thoracoscopic surgery.
Collapse
Affiliation(s)
| | - Assem Adel Moharram
- Department of Anaesthesia, Intensive Care and Pain Management, Ain Shams University, Cairo, Egypt
| |
Collapse
|
48
|
Zheng H, Peng Q, Xie D, Duan L, Zhao D, Jiang G, Zhu Y, Chen C. Simultaneous bilateral thoracoscopic lobectomy for synchronous bilateral multiple primary lung cancer-single center experience. J Thorac Dis 2021; 13:1717-1727. [PMID: 33841962 PMCID: PMC8024796 DOI: 10.21037/jtd-20-3325] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The aim of this study was to investigate the feasibility and safety of simultaneous bilateral thoracoscopic lobectomy and compare perioperative and late outcomes between simultaneous and staged bilateral thoracoscopic lobectomy. Methods Between January 2013 and December 2017, the medical records of patients who underwent bilateral thoracoscopic lobectomy for synchronous bilateral multiple primary lung cancer (SPLC) were reviewed retrospectively. Univariate analysis was used to examine the factors associated with morbidity. Survival was estimated with the Kaplan-Meier method. Results In the simultaneous resection group (n=41) and the staged groups (n=66), 11 and 16 patients underwent postoperative complication, respectively, whereas no significant differences existed between two groups (P=0.850). Univariate analysis showed that preoperative comorbidities (P=0.009), FEV1 <2 L (P=0.001), FEV1% <80% (P=0.036), and the number of pulmonary segments resected ≥9 (P=0.014) were the risk factors to increased simultaneous resection postoperative complication. In addition, simultaneous resection could significantly reduce total cost compared to staged resection (10,854.6±1,998.8 vs. 16,241.4±2,972.8 USD, P<0.001). In long-time outcomes, the patients with simultaneous resection showed better disease-free survival (DFS) than patients with staged resection at 5 years (67.7% vs. 45.9%, P=0.039). In subgroup analysis, simultaneous resection also had a significantly better survival than staged resection in patients with bilateral pure solid lesions or the biggest tumor size >3 cm. Conclusions Bilateral thoracoscopic lobectomy could be a feasible option for SPLC based on appropriate patient selection and careful perioperative management. Meanwhile, simultaneous resection has significantly advantaged in reducing the cost, preventing tumor progression compare to staged resection.
Collapse
Affiliation(s)
- Hui Zheng
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qiao Peng
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Dong Xie
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Liang Duan
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Deping Zhao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yuming Zhu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| |
Collapse
|
49
|
Aguinagalde B, Insausti A, Lopez I, Sanchez L, Bolufer S, Embun R. VATS Lobectomy Morbidity and Mortality is Lower in Patients with the Same ppoDLCO: Analysis of the Database of the Spanish Video-Assisted Thoracic Surgery Group. Arch Bronconeumol 2021; 57:S0300-2896(21)00055-7. [PMID: 33715848 DOI: 10.1016/j.arbres.2021.01.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/08/2021] [Accepted: 01/25/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Measuring predicted post-operative diffusion capacity of the lung for carbon monoxide (ppoDLCO) is essential to determine patient operability and to stratify the risk of patients who are candidates for major lung cancer surgery. Studies that established surgical risk variables were based on open surgery series. The aim of our study was to analyze morbidity and mortality as a function of ppoDLCO and to compare its behavior in open and video-assisted thoracic surgery (VATS). METHODS We compared 90-day mortality and morbidity in patients undergoing open surgery versus VATS as a function of decline in ppoDLCO. Propensity score matching (using age, ASA, arterial vascular disease, BMI, sexo, stage, ppoDLCO, and ppoFEV1) was applied to create comparable open surgery and VATS groups. RESULTS Of 2,530 patients with lung cancer and ppoDLCO values, a sample of 1,624 (812 per group) was obtained after score matching. The relative risk of mortality associated with thoracotomy in patients with ppoDLCO<60 is 2.66 (P<.02) compared to VATS. The risk of thoracotomy in terms of overall and cardiac and respiratory morbidity is higher than that of VATS for almost all ppoDLCO values. CONCLUSIONS Major resection by VATS shows lower morbidity and mortality in patients with the same ppoDLCO. A steady rise in the risk of mortality begins to occur at higher ppoDLCO values in thoracotomy (∼60) than in VATS (∼45).
Collapse
Affiliation(s)
- Borja Aguinagalde
- Servicio de Cirugía Torácica, Hospital Universitario Donostia, Donostia, Guipúzcoa, España.
| | | | - Iker Lopez
- Servicio de Cirugía Torácica, Hospital Universitario Donostia, Donostia, Guipúzcoa, España
| | - Laura Sanchez
- Servicio de Cirugía Torácica, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Sergio Bolufer
- Servicio de Cirugía Torácica, Hospital General Universitario de Alicante, Alicante, España
| | - Raul Embun
- Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet, IIS Aragón, Zaragoza, España; Servicio de Cirugía Torácica, Hospital Clínico Universitario Lozano Blesa, IIS Aragón, Zaragoza, España
| |
Collapse
|
50
|
Conibear J. Rationale for concurrent chemoradiotherapy for patients with stage III non-small-cell lung cancer. Br J Cancer 2020; 123:10-17. [PMID: 33293671 PMCID: PMC7735212 DOI: 10.1038/s41416-020-01070-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
When treating patients with unresectable stage III non-small-cell lung cancer (NSCLC), those with a good performance status and disease measured within a radical treatment volume should be considered for definitive concurrent chemoradiotherapy (cCRT). This guidance is based on key scientific rationale from two large Phase 3 randomised studies and meta-analyses demonstrating the superiority of cCRT over sequential (sCRT). However, the efficacy of cCRT comes at the cost of increased acute toxicity versus sequential treatment. Currently, there are several documented approaches that are addressing this drawback, which this paper outlines. At the point of diagnosis, a multidisciplinary team (MDT) approach can enable accurate assessment of patients, to determine the optimal treatment strategy to minimise risks. In addition, reviewing the Advisory Committee on Radiation Oncology Practice (ACROP) guidelines can provide clinical oncologists with additional recommendations for outlining target volume and organ-at-risk delineation for standard clinical scenarios in definitive cCRT (and adjuvant radiotherapy). Furthermore, modern advances in radiotherapy treatment planning software and treatment delivery mean that radiation oncologists can safely treat substantially larger lung tumours with higher radiotherapy doses, with greater accuracy, whilst minimising the radiotherapy dose to the surrounding healthy tissues. The combination of these advances in cCRT may assist in creating comprehensive strategies to allow patients to receive potentially curative benefits from treatments such as immunotherapy, as well as minimising treatment-related risks.
Collapse
Affiliation(s)
- John Conibear
- Department of Clinical Oncology, St. Bartholomew's Hospital, London, UK.
| |
Collapse
|