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Fong AJ, Reich H, Mirocha J, Wong A, Imai TA. Disparities and Underutilization of Surgery for Early Stage Small Cell Lung Cancer. Ann Thorac Surg 2024; 117:1095-1102. [PMID: 38281575 DOI: 10.1016/j.athoracsur.2024.01.012] [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: 07/25/2023] [Revised: 12/03/2023] [Accepted: 01/04/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND The National Comprehensive Cancer Network recommends surgical resection for stage I small cell lung cancer (SCLC). Despite these recommendations and the curative potential of such surgery, many continue to underutilize surgery. Our aim is to investigate factors that contribute to underutilization of surgery for stage I SCLC. METHODS The National Cancer Database was queried to identify patients with SCLC stage I-IV from 2004 to 2018. Staging was defined by the American Joint Committee on Cancer guidelines. Cochran-Armitage analysis was performed to analyze trends in surgical treatment for patients diagnosed with stage I SCLC. Multivariable logistic regression assessed relationships between patient factors and surgical treatment. RESULTS A total of 296,583 patients were diagnosed with SCLC. Of the stage I patients (n = 13,003), only 29.4.% (n = 3823) underwent surgery. Trend analysis demonstrated increased frequency of surgical treatment for stage I SCLC over years 2004 to 2017, from 14.9% to 39.6% (P < .0001). Factors that were associated with underutilization of surgery for stage I SCLC include African American race, lower median income, nonprivate insurance or Medicare, community facility, and geographic regions other than the Northeast. CONCLUSIONS Surgical treatment for stage I SCLC remains underutilized and our study identifies notable associated factors. The recognition of these factors may help patients overcome barriers to receiving recommended treatments, improve guideline adherence, and overall quality of care for stage I SCLC patients.
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Affiliation(s)
- Abigail J Fong
- Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California
| | - Heidi Reich
- Central California Heart and Lung Surgery, Clovis, California
| | - James Mirocha
- Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California
| | - Amelia Wong
- John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Taryne A Imai
- Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California.
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2
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Hong Z, Liu Q, Li H, Cui B, Cheng T, Lu Y, Wu X, Jin D, Gou Y, Dong X. Effect of da Vinci robot versus thoracoscopic surgery on lung function and oxidative stress levels in NSCLC patients: a propensity score-matched study. Surg Endosc 2024; 38:706-712. [PMID: 38030797 DOI: 10.1007/s00464-023-10577-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND To evaluate the short-term efficacy, lung function, and oxidative stress levels between the robotic-assisted thoracoscopic surgery (RATS) and video-assisted thoracoscopic surgery group (VATS) for non-small cell lung cancer (NSCLC). METHODS We conducted a retrospective cohort study, selecting 248 NSCLC patients who underwent minimally invasive lobectomy at the Department of Thoracic Surgery, Gansu Provincial People's Hospital, from August 2019 to February 2023. There were 105 patients in the RATS group and 143 patients in the VATS group. The patients in the two groups were subjected to 1:1 propensity score matching analysis (PSM), and the perioperative indicators were recorded. The levels of oxidative stress factors (superoxide dismutase, SOD; malondialdehyde, MDA) and inflammatory factors were measured 1 day before surgery and 3 days after surgery, respectively. Pulmonary function and patient quality of life were measured at 1 day preoperatively and 3 months postoperatively. RESULTS There are 93 patients in each group after PSM. Compared to the VATS group, the RATS group had shorter operation time, less intraoperative blood loss, greater number and groups of lymph nodes cleared, and shorter postoperative hospital stay. The SOD level in the RATS group was higher and the MDA level was lower than that in the VATS group after surgery. Postoperative inflammatory cytokine levels were less elevated in the RATS group than in the VATS group. At 3 months postoperatively, FVC%, FEV1%, and GQOLI-74 scores were higher in the RATS group than in the VATS group. CONCLUSION Compared to VATS lobectomy, RATS lobectomy has the advantages of shorter operative time, lesser bleeding, more lymph node dissection, faster postoperative recovery, and lesser impact on postoperative lung function. It is also capable of reducing the postoperative oxidative stress and inflammatory response, which can improve patients' quality of life.
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Affiliation(s)
- Ziqiang Hong
- The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, 730000, Gansu, China
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, 730000, Gansu, China
| | - Qing Liu
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou, 730000, Gansu, China
| | - Hongchao Li
- The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, 730000, Gansu, China
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, 730000, Gansu, China
| | - Baiqiang Cui
- The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, 730000, Gansu, China
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, 730000, Gansu, China
| | - Tao Cheng
- The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, 730000, Gansu, China
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, 730000, Gansu, China
| | - Yingjie Lu
- The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, 730000, Gansu, China
| | - Xusheng Wu
- The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, 730000, Gansu, China
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, 730000, Gansu, China
| | - Dacheng Jin
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, 730000, Gansu, China
| | - Yunjiu Gou
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, 730000, Gansu, China.
| | - Xinchun Dong
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, 730000, Gansu, China.
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3
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Kendall F, Silva G, Drummond M, Viana P, Eusébio E, Pinho P, Oliveira J, Bastos PT. Predictors of prolonged hospital stay in patients undergoing lung resection. Disabil Rehabil 2024:1-7. [PMID: 38166526 DOI: 10.1080/09638288.2023.2297936] [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: 02/28/2023] [Accepted: 12/16/2023] [Indexed: 01/04/2024]
Abstract
PURPOSE To identify potential predictors of prolonged length of hospital stay in patients submitted to lung resection surgery. MATERIALS AND METHODS This is a cohort study, carried out in 105 patients with lung cancer, submitted to posterolateral thoracotomy pulmonary resection. Data collection included preoperative assessment of demographic, clinical, pulmonary function, respiratory muscle function, physical fitness, and behavioral habits. After surgery, length of hospital stay was documented, and the sample was divided into two groups according to the length of hospital stay (LOS): the normal hospital stay group (NLOS) until 8 days, and the prolonged hospital stay group (PLOS) with more than 8 days of hospital stay. Multiple linear regressions were performed between length of hospital stay and the studied variables, for the total sample and, specifically, for the PLOS group. RESULTS The multiple linear regression for the total sample, the most explanatory power variables were TLC, MIP, PEF, and BMI. When considering only the PLOS, the variables that mostly explained were the MIP%, MEP and TLC%. CONCLUSION Besides the classic outcomes used to calculate surgical risk, the body mass index, respiratory muscle strength, peak expiratory flow, and total lung capacity are predictors of the variation on length of hospital stay in patients submitted to lung resection.
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Affiliation(s)
- Filipa Kendall
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), University of Porto, Porto, Portugal
- Department of Cardiothoracic Surgery, Centro Hospitalar São João, Porto, Portugal
- CESPU, Polytechnic Health Institute of the North, Gandra (PRD), Portugal
| | - Gustavo Silva
- Research Center in Sports Sciences, Health and Human Development (CIDESD), University of Maia (UMaia), Maia, Portugal
| | - Marta Drummond
- Pulmonology Department, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Paulo Viana
- Pulmonology Department, Centro Hospitalar São João, Porto, Portugal
- Health School, Polytechnic Institute of Porto, Porto, Portugal
| | | | - Paulo Pinho
- Department of Cardiothoracic Surgery, Centro Hospitalar São João, Porto, Portugal
| | - José Oliveira
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), University of Porto, Porto, Portugal
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4
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Yang D, Wei X, Hong Q, Zhao C, Mu J. Patient-Reported Outcome-Based Prediction for Postdischarge Complications after Lung Surgery. Thorac Cardiovasc Surg 2023; 71:671-679. [PMID: 37186190 DOI: 10.1055/s-0043-1768224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND Patients undergoing lung tumor surgery may experience various complications after discharge from the hospital. Using patient-reported outcomes (PROs), this study attempted to identify relevant indicators of postdischarge complications after lung tumor surgery and develop a predictive nomogram model to evaluate the risk for individual patients. METHODS Patients who underwent lung tumor surgery between December 2021 and June 2022 were included in this study. PROs were assessed using the Perioperative Symptom Assessment for Lung Surgery scale and were assessed preoperatively at baseline, on postoperative day 1 (POD1) 1 to POD4, and then weekly until the fourth week. A random forest machine learning prediction model was built to rank the importance of each PRO score of patients on POD1 to POD4. We then selected the top 10 variables in terms of importance for the multivariable logistic regression analysis. Finally, a nomogram was developed. RESULTS PROs, including coughing (POD3 and POD4), daily activity (POD1), and pain (POD1 and POD2), were associated with postdischarge complications in patients undergoing lung tumor surgery. The predictive model showed good performance in estimating the risk of postdischarge complications, with an area under the curve of 0.833 (95% confidence interval: 0.753-0.912), while maintaining good calibration and clinical value. CONCLUSION We found that PRO scores on POD1 to POD4 were associated with postdischarge complications after lung tumor surgery, and we developed a helpful nomogram model to predict the risk of postdischarge complications.
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Affiliation(s)
- Ding Yang
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xing Wei
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Qian Hong
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chenguang Zhao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Juwei Mu
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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5
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Zirafa CC, Romano G, Sicolo E, Bagalà E, Manfredini B, Alì G, Castaldi A, Morganti R, Davini F, Fontanini G, Melfi F. Robotic versus Open Surgery in Locally Advanced Non-Small Cell Lung Cancer: Evaluation of Surgical and Oncological Outcomes. Curr Oncol 2023; 30:9104-9115. [PMID: 37887558 PMCID: PMC10605396 DOI: 10.3390/curroncol30100658] [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: 08/31/2023] [Revised: 10/06/2023] [Accepted: 10/11/2023] [Indexed: 10/28/2023] Open
Abstract
Locally advanced non-small cell lung cancer (NSCLC) consists of a heterogeneous group, with different pulmonary extension and lymph nodal involvement. Robotic surgery can play a key role in these tumours thanks to its technological features, although open surgery is still considered the gold-standard approach. Our study aims to evaluate the surgical and oncological outcomes of locally advanced NSCLC patients who underwent robotic surgery in a high-volume centre. Data from consecutive patients with locally advanced NSCLC who underwent robotic lobectomy were retrospectively analysed and compared with patients treated with open surgery. Clinical characteristics and surgical and oncological information were evaluated. From 2010 to 2020, 131 patients underwent anatomical lung resection for locally advanced NSCLC. A total of 61 patients were treated with robotic surgery (46.6%); the median hospitalization time was 5.9 days (range 2-27) and the postoperative complication rate was 18%. Open surgery was performed in 70 patients (53.4%); the median length of stay was 9 days (range 4-48) and the postoperative complication rate was 22.9%. The median follow-up time was 70 months. The 5-year overall survival was 34% in the robotic group and 31% in the thoracotomy group. Robotic surgery can be considered safe and feasible not only for early stages but also for the treatment of locally advanced NSCLC.
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Affiliation(s)
- Carmelina C. Zirafa
- Minimally Invasive and Robotic Thoracic Surgery, Surgical, Medical, Molecular, and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy; (G.R.); (E.S.); (E.B.); (A.C.); (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; (G.R.); (E.S.); (E.B.); (A.C.); (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; (G.R.); (E.S.); (E.B.); (A.C.); (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; (G.R.); (E.S.); (E.B.); (A.C.); (F.D.); (F.M.)
| | - Beatrice Manfredini
- Division of Thoracic Surgery, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy;
| | - Greta Alì
- Pathological Anatomy, Surgical, Medical, Molecular, and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy; (G.A.); (G.F.)
| | - Andrea Castaldi
- Minimally Invasive and Robotic Thoracic Surgery, Surgical, Medical, Molecular, and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy; (G.R.); (E.S.); (E.B.); (A.C.); (F.D.); (F.M.)
| | - Riccardo Morganti
- Section of Statistics, 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; (G.R.); (E.S.); (E.B.); (A.C.); (F.D.); (F.M.)
| | - Gabriella Fontanini
- Pathological Anatomy, Surgical, Medical, Molecular, and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy; (G.A.); (G.F.)
| | - Franca Melfi
- Minimally Invasive and Robotic Thoracic Surgery, Surgical, Medical, Molecular, and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy; (G.R.); (E.S.); (E.B.); (A.C.); (F.D.); (F.M.)
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6
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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.
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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
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7
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Iida T, Shimada Y, Sato M. Management and mindset for air leak and intraoperative bleeding in thoracic surgery. J Thorac Dis 2023; 15:4137-4140. [PMID: 37691662 PMCID: PMC10482642 DOI: 10.21037/jtd-23-972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 07/13/2023] [Indexed: 09/12/2023]
Affiliation(s)
- Takahiro Iida
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Yoshihisa Shimada
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
- Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Masaaki Sato
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
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8
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Acar A, Ceylan KC, Mestan H, Yücel N. Complete videothoracoscopic en-bloc resection of lung cancer invading the diaphragm. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2023; 31:416-419. [PMID: 37664772 PMCID: PMC10472477 DOI: 10.5606/tgkdc.dergisi.2023.22052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/02/2021] [Indexed: 09/05/2023]
Abstract
Locally advanced non-small cell lung cancer invading the diaphragm is an infrequent clinical presentation. A 74-year-old male patient was operated using video-assisted thoracoscopic surgery in our clinic for a tumor originating from the right lower lobe. A right lower lobectomy with diaphragmatic resection was performed to the tumor with a diameter of 3 cm that invaded the diaphragm, and the resulting defect was repaired primarily with video-assisted thoracoscopic surgery. The patient did not develop complications in the postoperative period and was discharged on Day 6. In conclusion, patients with non-small cell lung cancer invasive to the diaphragm can be even safely operated with the video-assisted thoracoscopic surgery.
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Affiliation(s)
- Arkın Acar
- Department of Thoracic Surgery, University of Health Sciences, Erzurum Regional Training and Research Hospital, Erzurum, Türkiye
| | - Kenan Can Ceylan
- Department of Thoracic Surgery, University of Health Sciences, Dr. Suat Seren Chest Diseases and Surgery SUAM, Izmir, Türkiye
| | - Hüseyin Mestan
- Department of Thoracic Surgery, University of Health Sciences, Dr. Suat Seren Chest Diseases and Surgery SUAM, Izmir, Türkiye
| | - Nur Yücel
- Department of Pathology, University of Health Sciences, Dr. Suat Seren Chest Diseases and Surgery SUAM, Izmir, Türkiye
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9
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Schreyer C, Eckermann C, Neudecker J, Becker L, Schulz-Drost S. [VATS in Thorax Trauma]. Zentralbl Chir 2023; 148:74-84. [PMID: 36470290 DOI: 10.1055/a-1957-5511] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Since the early 1990s, video-assisted thoracoscopy (VATS) has been increasingly established for a variety of indications in the treatment of patients with thoracic trauma. During this time, one premise for the use of thoracoscopy has not changed. Its use is consistently recommended only for trauma patients with stable circulation and respiration. To define the indications of VATS for use in thoracic trauma, the Pulmonary Injury Group - as part of the Working Committee for Thoracic Trauma of the German Society for Thoracic Surgery (DGT) and the German Society for Trauma Surgery (DGU) - has developed treatment recommendations based on a current literature review (based on the PRISMA Checklist/here: MEDLINE via PubMed from 1993 to 2022). In the present study, after reviewing the available literature, the indications for VATS in the care of thoracic trauma were identified, in order to formulate clinical recommendations for the use of VATS in thoracic trauma. The analysis of 1679 references identified a total of 4 randomised controlled trials (RCTs), 4 clinical trials, and 5 meta-analyses or systematic reviews and 39 reviews, which do not allow a higher level of recommendation than consensual recommendations, due to the low evidence of the available literature. Over the past 30 years, stabilisation options in the care of trauma patients have improved significantly, allowing expansion of indications for the use of VATS. Moreover, the recommendation for more than 50 years to thoracotomise trauma patients in case of an initial blood loss ≥ 1500 ml via the inserted chest drainage or in case of continuous blood loss ≥ 250 ml/h over 4 h is now only relative with today's better stabilisation measures. For unstable/non-stabilisable patients with a thoracic injury requiring emergency treatment, thoracotomy remains the method of choice, while VATS is recommended for a wide range of indications in the diagnosis and treatment of stable patients with a penetrating or blunt thoracic trauma. The indications for VATS are persistent haemothorax, treatment of injuries and haemorrhages to the lung, diaphragm, thoracic wall and other organ injuries, and in the secondary phase, treatment of thoracic sequelae of injury (empyema, persistent pulmonary fistula, infected atelectasis, etc.).
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Affiliation(s)
- Christof Schreyer
- Allgemein-, Viszeral- und Thoraxchirurgie, Bundeswehrzentralkrankenhaus, Koblenz, Deutschland
| | - Christoph Eckermann
- Allgemein-, Viszeral- und Thoraxchirurgie, Bundeswehrzentralkrankenhaus, Koblenz, Deutschland
| | - Jens Neudecker
- Klinik für Allgemein-, Viszeral-, Gefäß- und Thoraxchirurgie, Universitätsmedizin Berlin - Charité Campus Mitte, Berlin, Deutschland
| | - Lars Becker
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Essen, Essen, Deutschland
| | - Stefan Schulz-Drost
- Klinik für Unfallchirurgie und Traumatologie, HELIOS Kliniken Schwerin, Schwerin, Deutschland
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10
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Improvements in perioperative outcomes for non-small cell lung cancer: a decade-long analysis. Surg Endosc 2023; 37:172-179. [PMID: 35896840 DOI: 10.1007/s00464-022-09471-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/10/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Video-assisted thoracic surgery (VATS) procedures for non-small cell lung cancer (NSCLC) have steadily increased and have become the gold standard, but their prognostic advantage compared with thoracotomy has not been elucidated. This study retrospectively evaluated perioperative characteristics of VATS for NSCLC over time. METHODS We collected the clinical data of 760 patients with NSCLC who underwent pulmonary resection over the past decade, classifying patients into early (2011-2015) and late (2016-2020) periods. Changes in NSCLC patient characteristics, surgical approaches, perioperative factors, postoperative morbidities, and prognoses were analyzed. RESULTS Patients in the late period were older (p = 0.01), had more comorbidities (p = 0.01), and had earlier-stage cancer (p < 0.01) than those in the early period. The late period had significantly fewer surgical procedures for lobectomy or extended resection beyond lobectomy (p < 0.01), open thoracotomies (p < 0.01), postoperative (p = 0.02) and severe morbidities (p < 0.01), and a significantly shorter postoperative hospital stay than the early period. Surgical procedures of lobectomy or extended resection beyond lobectomy (p < 0.01) were significant risk factors for postoperative morbidity, and being in the early period (p < 0.01) and surgical procedures of lobectomy or extended resection beyond lobectomy (p < 0.01) were significant risk factors for severe postoperative morbidities. The overall survival prognosis significantly differed between the groups (p = 0.02) but progression-free survival did not (p = 0.89). CONCLUSIONS The incidence of postoperative morbidities decreased over time in older patients and patients with more comorbidities. The prognosis of patients with NSCLC did not change with increasing VATS or sublobar resection.
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11
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Heiden BT, Subramanian MP, Liu J, Keith A, Engelhardt KE, Meyers BF, Puri V, Kozower BD. Long-term patient-reported outcomes after non-small cell lung cancer resection. J Thorac Cardiovasc Surg 2022; 164:615-626.e3. [PMID: 35430080 DOI: 10.1016/j.jtcvs.2021.11.100] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 10/07/2021] [Accepted: 11/13/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Patient-reported outcomes (PROs) are critical tools for evaluating patients before and after lung cancer resection. In this study, we assessed patient-reported pain, dyspnea, and functional status up to 1 year postoperatively. METHODS This study included patients who underwent surgery for non-small cell lung cancer at a single institution (2017-2020). We collected PROs using the National Institutes of Health Patient Reported Outcome Measurement Information System (PROMIS). Data were prospectively collected and merged with our institutional Society of Thoracic Surgeons data. Using multivariable linear mixed effect models, we compared PROMIS scores for preoperative and several postoperative visits. RESULTS From 2017 until 2020, 334 patients underwent lung cancer resection with completed PROMIS assessments. Pain interference, physical function, and dyspnea severity scores were worse 1 month after surgery (P < .001). Pain interference and physical function scores returned to baseline by 6 months after surgery. However, dyspnea severity scores remained persistently worse up to 1 year after surgery (1-month difference, 8.8 ± 1.9; 6-month difference, 3.6 ± 2.2; 1-year difference, 4.9 ± 2.8; P < .001). Patients who received a thoracotomy had worse physical function and pain interference scores 1 month after surgery compared with patients who received a minimally invasive operation; however, there were no differences in PROs by 6 months after surgery. CONCLUSIONS PROs are important metrics for assessing patients before and after lung cancer resection. Patients may report persistent dyspnea up to 1 year after resection. Additionally, patients undergoing thoracotomy initially report worse pain and physical function but these impairments improve by 6 months after surgery.
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Affiliation(s)
- Brendan T Heiden
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Mo; Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Mo
| | - Melanie P Subramanian
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Mo
| | - Jingxia Liu
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Mo
| | - Angela Keith
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Mo
| | - Kathryn E Engelhardt
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Mo
| | - Bryan F Meyers
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Mo
| | - Varun Puri
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Mo
| | - Benjamin D Kozower
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Mo.
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12
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Song Y, Liu J, Lei M, Wang Y, Fu Q, Wang B, Guo Y, Mi W, Tong L. An External-Validated Algorithm to Predict Postoperative Pneumonia Among Elderly Patients With Lung Cancer After Video-Assisted Thoracoscopic Surgery. Front Oncol 2022; 11:777564. [PMID: 34970491 PMCID: PMC8712479 DOI: 10.3389/fonc.2021.777564] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/09/2021] [Indexed: 12/15/2022] Open
Abstract
The aim of the study was to develop an algorithm to predict postoperative pneumonia among elderly patients with lung cancer after video-assisted thoracoscopic surgery. We analyzed 3,009 patients from the Thoracic Perioperative Database for Geriatrics in our hospital and finally enrolled 1,585 elderly patients (age≧65 years) with lung cancer treated with video-assisted thoracoscopic surgery. The included patients were randomly divided into a training group (n = 793) and a validation group (n = 792). Patients in the training group were used to develop the algorithm after screening up to 30 potential risk factors, and patients in the validation group were used to internally validate the algorithm. External validation of the algorithm was achieved in the external validation dataset after enrolling 165 elderly patients with lung cancer treated with video-assisted thoracoscopic surgery from two hospitals in China. Of all included patients, 9.15% (145/1,585) of patients suffered from postoperative pneumonia in the Thoracic Perioperative Database for Geriatrics, and 10.30% (17/165) of patients had postoperative pneumonia in the external validation dataset. The algorithm consisted of seven variables, including sex, smoking, history of chronic obstructive pulmonary disease (COPD), surgery duration, leukocyte count, intraoperative injection of colloid, and intraoperative injection of hormone. The C-index from the receiver operating characteristic curve (AUROC) was 0.70 in the training group, 0.67 in the internal validation group, and 0.71 in the external validation dataset, and the corresponding calibration slopes were 0.88 (95% confident interval [CI]: 0.37–1.39), 0.90 (95% CI: 0.46–1.34), and 1.03 (95% CI: 0.24–1.83), respectively. The actual probabilities of postoperative pneumonia were 5.14% (53/1031) in the low-risk group, 15.07% (71/471) in the medium-risk group, and 25.30% (21/83) in the high-risk group (p < 0.001). The algorithm can be a useful prognostic tool to predict the risk of developing postoperative pneumonia among elderly patients with lung cancer after video-assisted thoracoscopic surgery.
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Affiliation(s)
- Yanping Song
- Anesthesia and Operation Center, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.,Department of Anesthesia, 922 Hospital of People's Liberation Army (PLA), Hengyang, China
| | - Jingjing Liu
- Anesthesia and Operation Center, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.,Department of Anesthesia, Beijing Corps Hospital of Chinese People's Armed Police Force, Beijing, China
| | - Mingxing Lei
- The National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.,Department of Orthopedic Surgery, Hainan Hospital of Chinese People's Liberation Army (PLA) General Hospital, Sanya, China.,Chinese People's Liberation Army (PLA) Medical School, Beijing, China
| | - Yanfeng Wang
- Department of Anesthesia, Xiangya Hospital, Central South University, Changsha, China
| | - Qiang Fu
- Anesthesia and Operation Center, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Bailin Wang
- Department of Thoracic Surgery, Hainan Hospital of Chinese People's Liberation Army (PLA) General Hospital, Sanya, China
| | - Yongxin Guo
- Anesthesia and Operation Center, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Weidong Mi
- Anesthesia and Operation Center, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Li Tong
- Anesthesia and Operation Center, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
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13
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Qing B, Xia Z, Wang W, Gu L, Chen H, Yuan Y. A localization-independent approach for invisible and impalpable ground-glass opacity nodules detection in an in vitro lung specimen: two case reports. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1602. [PMID: 34790808 PMCID: PMC8576721 DOI: 10.21037/atm-21-4966] [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: 09/10/2021] [Accepted: 10/14/2021] [Indexed: 11/26/2022]
Abstract
A growing number of ground-glass opacity (GGO) nodules are screened out in lungs. Small GGOs are frequently neither visible nor palpable, thus undetectable during operation. Various nodule localization techniques have been developed to facilitate the intraoperative detection of GGO nodules; however, general localization techniques are infeasible or inappropriate in some cases. The detection of small GGO is a great challenge, even within a surgical specimen in the absence of preoperative localization. A localization-independent approach for GGO detection is urgently needed. Herein, we report two cases with invisible and impalpable small GGO which were not appropriate for preoperative localization. The lesions were anatomically resected under the guidance of three-dimensional (3D) reconstruction and got an adequate margin distance. A vessel (artery, vein, or bronchus) which had advanced into or immediately adjacent to the nodule was assigned as a reference vessel. By dissecting and tracing the reference vessel from proximal to distal, the GGO lesions were successfully detected in the surgical specimens, to the eventual obtainment of an accurate pathological diagnosis. Via the two case reports, we introduced an easily handled approach, namely dissecting and tracing a reference vessel, for GGO detection. The novel approach was first described. Combined with precise anatomical segmentectomy guided by 3D reconstruction, it provides an alternative scheme for GGO resection with no need for preoperative localization.
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Affiliation(s)
- Bei Qing
- Department of Thoracic Surgery, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhenkun Xia
- Department of Thoracic Surgery, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Wei Wang
- Department of Thoracic Surgery, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Linguo Gu
- Department of Thoracic Surgery, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Hongzuo Chen
- Department of Thoracic Surgery, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Yunchang Yuan
- Department of Thoracic Surgery, the Second Xiangya Hospital, Central South University, Changsha, China
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14
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Pickering O, Pucher PH, De'Ath H, Abuawwad M, Kelly J, Underwood TJ, Noble F, Byrne JP. Minimally Invasive Approach in Boerhaave's Syndrome: Case Series and Systematic Review. J Laparoendosc Adv Surg Tech A 2021; 31:1254-1261. [PMID: 33400893 DOI: 10.1089/lap.2020.0751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Boerhaave's syndrome is a life-threatening spontaneous perforation of the esophagus associated with significant morbidity and mortality. Historically, thoracotomy has been the mainstay of treatment, but is associated with high morbidity and pain. Minimally invasive approaches provide alternative treatment possibilities. This systematic review together with inclusion of a case series from a tertiary esophagogastric unit assesses current evidence focused on minimally invasive surgical management of this condition. Methods: A systematic review was conducted in line with MOOSE (Meta-analyses Of Observational Studies in Epidemiology) guidelines. Electronic databases PubMed, MEDLINE, and Cochrane Library were searched, and articles focusing on the minimally invasive management of Boerhaave's syndrome were identified and scrutinized. We also report demographics and outcomes for a consecutive case series of patients with acute Boerhaave's syndrome managed via thoracoscopy. Results: Fifteen studies were included comprising 5 retrospective cohort studies and 10 case reports. Management strategies were divided into three categories: thoracoscopic, endoscopic, and laparoscopic. Overall mortality rates for each treatment modality were 2%, 13%, and 33%, and treatment success rates 98%, 38%, and 67%, respectively. Postoperative infective complications were seen in 79% of patients, with only 2 patients requiring salvage thoracotomy. In our local case series, we report 4 consecutive patients managed with thoracoscopy, with a 100% treatment success rate. Conclusion: Minimally invasive approaches in the management of Boerhaave's syndrome are safe and effective. We propose a selective management algorithm involving a minimally invasive approach to management of this life-threatening condition. Registered with local clinical outcomes team as service evaluation. (Approval number sev/0171).
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Affiliation(s)
- Oliver Pickering
- Department of General Surgery, St Mary's Hospital, Isle of Wight, Newport, United Kingdom
- Department of General Surgery, Southampton General Hospital, Southampton, United Kingdom
| | - Philip H Pucher
- Department of General Surgery, Southampton General Hospital, Southampton, United Kingdom
| | - Henry De'Ath
- Department of General Surgery, Southampton General Hospital, Southampton, United Kingdom
- Department of General Surgery, Frimley Park Hospital, Frimley, United Kingdom
| | - Mahmoud Abuawwad
- Department of General Surgery, Southampton General Hospital, Southampton, United Kingdom
| | - Jamie Kelly
- Department of General Surgery, Southampton General Hospital, Southampton, United Kingdom
| | - Timothy J Underwood
- Department of General Surgery, Southampton General Hospital, Southampton, United Kingdom
- School of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Fergus Noble
- Department of General Surgery, Southampton General Hospital, Southampton, United Kingdom
| | - James P Byrne
- Department of General Surgery, Southampton General Hospital, Southampton, United Kingdom
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15
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Nakagawa K, Yoshida Y, Yotsukura M, Watanabe SI. Minimally invasive open surgery (MIOS) for clinical stage I lung cancer: diversity in minimally invasive procedures. Jpn J Clin Oncol 2021; 51:1649-1655. [PMID: 34373902 DOI: 10.1093/jjco/hyab128] [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: 04/30/2021] [Accepted: 07/23/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Many thoracic surgeons have tried to make lung cancer surgery less invasive. Among the minimally invasive approaches that are currently available, it is controversial which is optimal. Minimally invasive open surgery, i.e. hybrid video-assisted thoracic surgery, has been adopted for lung cancer surgery at our institute. The objective of this study was to evaluate minimally invasive open surgery in terms of perioperative outcomes over the most recent 5 years. METHODS Between 2015 and 2019, 2738 patients underwent pulmonary resection for lung cancer at National Cancer Center Hospital, Japan. Among them, 2174 patients with clinical stage I lung cancer who underwent minimally invasive open surgery were included. Several perioperative parameters were evaluated. RESULTS The patients consisted of 1092 men (50.2%) and 1082 women (49.8%). Lobectomy was performed in 1255 patients (57.7%), segmentectomy in 603 (27.7%) and wide wedge resection in 316 (14.5%). Median blood loss was 30 ml (interquartile range: 15-57 ml) for lobectomy, 17 ml (interquartile range: 10-31 ml) for segmentectomy and 5 ml (interquartile range: 2-10 ml) for wide wedge resection. Median operative time was 120 min (interquartile range: 104-139 min) for lobectomy, 109 min (interquartile range: 98-123 min) for segmentectomy and 59 min (interquartile range: 48-76 min) for wide wedge resection. Median length of postoperative hospital stay was 4 days (interquartile range: 3-5 days). The 30-day mortality rate was 0.08% for lobectomy, 0.17% for segmentectomy and 0.00% for wide wedge resection. CONCLUSIONS Minimally invasive open surgery for clinical stage I lung cancer is a feasible approach with a low mortality and a short hospital stay. Oncological outcomes need to be investigated.
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Affiliation(s)
- Kazuo Nakagawa
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Yukihiro Yoshida
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Masaya Yotsukura
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Shun-Ichi Watanabe
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
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16
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Forster C, Perentes JY, Ojanguren A, Abdelnour-Berchtold E, Zellweger M, Bouchaab H, Peters S, Krueger T, Gonzalez M. Early discharge after thoracoscopic anatomical pulmonary resection for non-small-cell lung cancer. Interact Cardiovasc Thorac Surg 2021; 33:892-898. [PMID: 34279040 DOI: 10.1093/icvts/ivab187] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 04/13/2021] [Accepted: 06/03/2021] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Although video-assisted thoracic surgery (VATS) has shortened hospitalization duration for non-small-cell lung cancer (NSCLC) patients, the factors associated with early discharge remain unclear. This study aimed to identify patients eligible for a 72-h stay after VATS anatomical resection. METHODS Monocentric retrospective study including all consecutive patients undergoing VATS anatomical resection for NSCLC between February 2010 and December 2019. Two groups were defined according to the discharge: 'early discharge' (within 72 postoperative hours) and 'routine discharge' (at >72 postoperative hours). RESULTS A total of 660 patients with a median age of 66.5 years (interquartile range 60-73 years) (female/male: 321/339) underwent VATS anatomical pulmonary resection for NSCLC [segmentectomy in 169 (25.6%), lobectomy in 481 (72.9%), bilobectomy in 8 (1.2%) and pneumonectomy in 2 (0.3%) patients]. The cardiopulmonary and Clavien-Dindo III-IV postoperative complication rates were 32.6% and 7.7%, respectively. The median postoperative length of stay was 6 days (interquartile range 4-10 days). In total, 119 patients (18%) could be discharged within 72 h of surgery. On multivariable analysis, the factors significantly associated with an increased likelihood of early discharge were: body mass index >20 kg/m2 [odds ratio (OR) 2.37], absence of prior cardiopathy (OR 2), diffusing capacity of the lung for carbon monoxide >60% (OR 1.82), inclusion in an enhanced recovery after surgery protocol (OR 2.23), use of a single chest tube (OR 5.73) and postoperative transfer to the ward (OR 4.84). Factors significantly associated with a decreased likelihood of early discharge were: age >60 years (OR 0.53), American Society of Anaesthesiologists score >2 (OR 0.46) and use of an epidural catheter (OR 0.41). Readmission rates were not statistically different between both groups (5.9% vs 3.1%; P = 0.17). CONCLUSIONS Age, pulmonary functions and comorbidities may influence discharge after VATS anatomical resection. The early discharge does not increase readmission rates.
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Affiliation(s)
- Céline Forster
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Jean Yannis Perentes
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Amaya Ojanguren
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | | | - Matthieu Zellweger
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Hasna Bouchaab
- Service of Oncology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Solange Peters
- Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland.,Service of Oncology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Thorsten Krueger
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Michel Gonzalez
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
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17
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Aeschbacher P, Nguyen TL, Dorn P, Kocher GJ, Lutz JA. Surgical Site Infections Are Associated With Higher Blood Loss and Open Access in General Thoracic Practice. Front Surg 2021; 8:656249. [PMID: 34250005 PMCID: PMC8267000 DOI: 10.3389/fsurg.2021.656249] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 05/18/2021] [Indexed: 12/23/2022] Open
Abstract
Background: Surgical site infections (SSIs) are the most costly and second most frequent healthcare-associated infections in the Western world. They are responsible for higher postoperative mortality and morbidity rates and longer hospital stays. The aim of this study is to analyze which factors are associated with SSI in a modern general thoracic practice. Methods: Data were collected from our department's quality database. Consecutive patients operated between January 2014 and December 2018 were included in this retrospective study. Results: A total of 2430 procedures were included. SSIs were reported in 37 cases (1.5%). The majority of operations were video-assisted (64.6%). We observed a shift toward video-assisted thoracic surgery in the subgroup of anatomical resections during the study period (2014: 26.7%, 2018: 69.3%). The multivariate regression analysis showed that blood loss >100 ml (p = 0.029, HR 2.70) and open surgery (p = 0.032, HR 2.37) are independent risk factors for SSI. The latter was higher in open surgery than in video-assisted thoracic procedures (p < 0.001). In the subgroup of anatomical resection, we found the same correlation (p = 0.043). SSIs are also associated with significantly longer mean hospital stays (17.7 vs. 7.8 days, p < 0.001). Conclusion: As SSIs represent higher postoperative morbidity and costs, efforts should be made to maintain their rate as low as possible. In terms of prevention of SSIs, video-assisted thoracic surgery should be favored over open surgery whenever possible.
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Affiliation(s)
- Pauline Aeschbacher
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thanh-Long Nguyen
- Department of Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Patrick Dorn
- Department of Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gregor Jan Kocher
- Department of Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jon Andri Lutz
- Department of Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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18
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Wei X, Yu H, Dai W, Mu Y, Wang Y, Liao J, Peng L, Han Y, Li Q, Shi Q. Patient-Reported Outcomes of Video-Assisted Thoracoscopic Surgery Versus Thoracotomy for Locally Advanced Lung Cancer: A Longitudinal Cohort Study. Ann Surg Oncol 2021; 28:8358-8371. [PMID: 33880671 DOI: 10.1245/s10434-021-09981-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/24/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The effects of video-assisted thoracoscopic surgery (VATS) and traditional thoracotomy with respect to patient-reported outcomes (PROs) have only been assessed for early-stage lung cancer. This study was a longitudinal PRO assessment to compare the effects of these surgeries for locally advanced (stage II and III) lung cancer from the patients' perspective. METHODS We investigated lung cancer patients from a previous prospective, multicentre study. Longitudinal data of clinical characteristics and PROs were collected. PROs were obtained preoperatively, daily in the hospital postoperatively, and weekly up to 4 weeks after discharge or the beginning of postoperative adjuvant therapy. Symptoms and impact on daily functioning and quality of life (QOL) were assessed by using the MD Anderson Symptom Inventory for lung cancer and a single-item QOL scale. Trajectories of PROs over the investigation period were compared. RESULTS Overall, 117 primary lung cancer patients (stage II or III), including 63 and 54 patients who underwent VATS and traditional thoracotomy, respectively, were included. During postoperative hospitalization, VATS patients reported milder disturbed sleep (p = 0.048), drowsiness (p = 0.008), and interference with activity (p = 0.001), as well as better work ability (p < 0.0001), walking ability (p < 0.0001), and life enjoyment (p = 0.004). Post-discharge, VATS patients had less distress (p = 0.039), milder pain (p = 0.006), better work ability (p = 0.001), and better QOL (p = 0.047). CONCLUSIONS Locally advanced lung cancer patients who underwent VATS had lower postoperative symptom burden, less daily function interference, and better QOL than those who underwent thoracotomy.
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Affiliation(s)
- Xing Wei
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Hongfan Yu
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Wei Dai
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Yunfei Mu
- Department of Thoracic Surgery, Chengdu Third People's Hospital, Chengdu, Sichuan, China
| | - Yaqin Wang
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Jia Liao
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Lin Peng
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Yongtao Han
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Qiang Li
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Qiuling Shi
- School of Public Health and Management, Chongqing Medical University, Chongqing, China. .,Center for Cancer Prevention Research, Sichuan Cancer Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China.
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19
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Gullo R, Gagliardo CM, Palazzolo M, Porrello C, Gulotta L, Lo Faso F, Gulotta G. Postoperative outcomes, lymph node dissection and effects on costs among thoracotomy, video-assisted and robotic-assisted lobectomy for clinical stage I non-small cell lung cancer. Minerva Surg 2021; 76:80-89. [PMID: 33754591 DOI: 10.23736/s2724-5691.20.08395-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Thoracotomy, video-assisted thoracoscopic surgery (VATS) and robotic assisted thoracoscopic surgery (RATS)-lobectomy are widely accepted procedures for the surgical treatment of clinical (c)stage I non- small cell lung cancer (NSCLC). In the current literature which procedure gives more benefits is still debated. We present a comparison between these three procedures in term of advantages and postoperative outcomes. METHODS A multicentric study about 259 lobectomies from 2013 to 2019: 128 patients underwent TL, 96 VATS and 35 RATS. Different variables were retrospectively analyzed among these three cohorts of patients with diagnosis of cStage I NSCLC. RESULTS Rate of major complications comparable in VATS, RATS and TL; Advantages for RATS in minor complications (TL 34.4% vs. VATS 18.75% vs. RATS 8.57%. P=0.0015), postoperative days in Intensive Care Unit, days to chest tube removal, length of postoperative hospitalization (P<0.0001) and number of lymph nodes dissected (P=0.0257). Operating times are shorter in VATS than RATS (P<0.05). Pain (NRS Scale) is comparable. CONCLUSIONS TL remains the conventional approach for stage II-IIIA(N2) NSCLC. RATS showed great advantages, but its higher operating time and costs, mostly, today don't justify its adoption as gold standard for the surgical treatment of cStage I NSCLC, instead of VATS.
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Affiliation(s)
- Roberto Gullo
- Department of Thoracic Surgery, Paolo Giaccone University Hospital, Palermo, Italy
| | - Carola M Gagliardo
- Department of Surgical, Oncological and Stomatological Sciences, Paolo Giaccone University Hospital, Palermo, Italy -
| | - Manuela Palazzolo
- Department of Thoracic Surgery, Paolo Giaccone University Hospital, Palermo, Italy
| | - Calogero Porrello
- Department of Thoracic Surgery, Paolo Giaccone University Hospital, Palermo, Italy
| | - Leonardo Gulotta
- Department of General and Oncologic Surgery, Gaetano Martino University Hospital, Messina, Italy
| | - Felice Lo Faso
- Department of Thoracic Surgery, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Gaspare Gulotta
- Department of General and Emergency Surgery, Paolo Giaccone University Hospital, Palermo, Italy
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20
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Abstract
Locally advanced lung cancer, defined by nodal involvement in upper mediastinal stations (N2) (stage IIIA–N2), includes a wide spectrum of patients with multiple therapeutic alternatives. Such heterogeneity is explained, at least in part, by tumor size and magnitude of mediastinal nodal involvement. In this setting, many variants can influence the prognosis, such as the specific nodal stations compromised, the burden of mediastinal disease, and the presence of skip metastasis. In the surgical field, the advent of minimally invasive techniques, including video-assisted thoracoscopic and robotic surgery, have revolutionized the management of early-stage lung cancer, but implementations of these approaches in the locally advanced setting have been erratic. This review attempts to highlight the most relevant scientific data of the surgical management of locally advanced lung cancer patients, analyzing not only the medical evidence but also the cost-effectiveness and accessibility.
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Affiliation(s)
- Ana Karina Patané
- Department of Thoracic Surgery, Hospital de Rehabilitación Respiratoria María Ferrer, Buenos Aires, Argentina
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21
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Xu J, Ni H, Wu Y, Cao J, Han X, Liu L, Fu X, Li Y, Li X, Xu L, Liu Y, Zhao H, Liu D, Peng X, Hu J. Perioperative comparison of video-assisted thoracic surgery and open lobectomy for pT1-stage non-small cell lung cancer patients in China: a multi-center propensity score-matched analysis. Transl Lung Cancer Res 2021; 10:402-414. [PMID: 33569322 PMCID: PMC7867771 DOI: 10.21037/tlcr-20-1132] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Compared with open surgery, video-assisted thoracic surgery (VATS) has innovated the concept of the minimally invasive approach for non-small cell lung cancer (NSCLC) patients in past decades. This present study aimed to compare the perioperative and lymph node dissection outcomes between VATS lobectomy and open lobectomy for pathological stage T1 (pT1) NSCLC patients from both surgical and oncologic perspectives. Methods This was a retrospective multicenter study. Patients who underwent surgical resection for pT1 NSCLC between January 2014 and September 2017 were retrospectively reviewed from 10 thoracic surgery centers in China. Perioperative and lymph node dissection outcomes of pT1 NSCLC patients who accepted VATS or open lobectomies were compared by propensity score matching (PSM) analysis. Results Of the 11,360 patients who underwent surgery for pT1 NSCLC, 7,726 were enrolled based on the selection criteria, including 1,222 cases of open lobectomies and 6,504 cases of VATS lobectomies. PSM resulted in 1,184 cases of open lobectomies and 1,184 cases of VATS lobectomies being well matched by common prognostic variables, including age, sex, and surgical side. VATS lobectomy led to better perioperative outcomes, including less blood loss (133.5±200.1 vs. 233.3±318.4, P<0.001), lower blood transfusion rate (2.4% vs. 6.4%, P<0.001), shorter postoperative hospital stay (8.6±5.7 vs. 10.1±5.1, P<0.001), less chest drainage volume (1,109.5±854.0 vs. 1,324.1±948.8, P<0.001), and less postoperative complications (4.9% vs. 8.2%, P<0.001). However, open lobectomy had better lymph node dissection outcomes than VATS, with increased lymph node dissection numbers (16.1±9.4 vs. 13.7±7.7, P<0.001) and more positive lymph nodes being dissected (1.5±3.9 vs. 1.1±2.5, P=0.002). Compared with VATS, open lobectomy harvested more lymph node stations (5.5±1.9 vs. 5.2±1.8, P=0.001), including more pathological N2 (pN2) lymph node stations (3.4±1.4 vs. 3.1±1.3, P<0.001). Conclusions VATS lobectomy was associated with better perioperative outcomes, such as less blood loss, lower blood transfusion rate, shorter postoperative hospital stay, less chest drainage volume and less postoperative complications. Open lobectomy has improved lymph node dissection outcomes, as more lymph nodes and positive lymph nodes were dissected for pT1 NSCLC patients during surgery.
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Affiliation(s)
- Jinming Xu
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Heng Ni
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yihe Wu
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jinlin Cao
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xingpeng Han
- Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiangning Fu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yin Li
- Department of Thoracic Surgery, Henan Cancer Hospital, Zhengzhou, China
| | - Xiaofei Li
- Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Lin Xu
- Department of Thoracic Surgery, Nanjing Medical University Affiliated Cancer Hospital, Cancer Institute of Jiangsu Province, Nanjing, China.,Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Cancer Institute of Jiangsu Province, Nanjing, China
| | - Yang Liu
- Department of Thoracic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Heng Zhao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai, China
| | - Deruo Liu
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Xin Peng
- Medical Affairs, Linkdoc Technology Co. Ltd., Beijing, China
| | - Jian Hu
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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22
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Aiolfi A, Nosotti M, Micheletto G, Khor D, Bonitta G, Perali C, Marin J, Biraghi T, Bona D. Pulmonary lobectomy for cancer: Systematic review and network meta-analysis comparing open, video-assisted thoracic surgery, and robotic approach. Surgery 2020; 169:436-446. [PMID: 33097244 DOI: 10.1016/j.surg.2020.09.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/25/2020] [Accepted: 09/12/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Although minimally invasive lobectomy has gained worldwide interest, there has been debate on perioperative and oncological outcomes. The purpose of this study was to compare outcomes among open lobectomy, video-assisted thoracic surgery lobectomy, and robotic lobectomy. METHODS PubMed, EMBASE, and Web of Science databases were consulted. A fully Bayesian network meta-analysis was performed. RESULTS Thirty-four studies (183,426 patients) were included; 88,865 (48.4%) underwent open lobectomy, 79,171 (43.2%) video-assisted thoracic surgery lobectomy, and 15,390 (8.4%) robotic lobectomy. Compared with open lobectomy, video-assisted thoracic surgery, lobectomy and robotic lobectomy had significantly reduced 30-day mortality (risk ratio = 0.53; 95% credible intervals, 0.40-0.66 and risk ratio = 0.51; 95% credible intervals, 0.36-0.71), pulmonary complications (risk ratio = 0.70; 95% credible intervals, 0.51-0.92 and risk ratio = 0.69; 95% credible intervals, 0.51-0.88), and overall complications (risk ratio = 0.77; 95% credible intervals, 0.68-0.85 and risk ratio = 0.79; 95% credible intervals, 0.67-0.91). Compared with video-assisted thoracic surgery lobectomy, open lobectomy, and robotic lobectomy had a significantly higher total number of harvested lymph nodes (mean difference = 1.46; 95% credible intervals, 0.30, 2.64 and mean difference = 2.18; 95% credible intervals, 0.52-3.92) and lymph nodes stations (mean difference = 0.37; 95% credible intervals, 0.08-0.65 and mean difference = 0.93; 95% credible intervals, 0.47-1.40). Positive resection margin and 5-year overall survival were similar across treatments. Intraoperative blood loss, postoperative transfusion, hospital length of stay, and 30-day readmission were significantly reduced for minimally invasive approaches. CONCLUSION Compared with open lobectomy, video-assisted thoracic surgery lobectomy, and robotic lobectomy seem safer with reduced 30-day mortality, pulmonary, and overall complications with equivalent oncologic outcomes and 5-year overall survival. Minimally invasive techniques may improve outcomes and surgeons should be encouraged, when feasible, to adopt video-assisted thoracic surgery lobectomy, or robotic lobectomy in the treatment of lung cancer.
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Affiliation(s)
- Alberto Aiolfi
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istitituto Clinico Sant'Ambrogio, Milan, Italy.
| | - Mario Nosotti
- Department of Pathophysiology and Transplantation, Thoracic Surgery and Lung Transplant Unit Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Giancarlo Micheletto
- Department of Pathophysiology and Transplantation, INCO and Department of General Surgery, University of Milan, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Desmond Khor
- University of Maryland Medical Center, Baltimore, MD
| | - Gianluca Bonitta
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istitituto Clinico Sant'Ambrogio, Milan, Italy
| | - Carolina Perali
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istitituto Clinico Sant'Ambrogio, Milan, Italy
| | - Jacopo Marin
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istitituto Clinico Sant'Ambrogio, Milan, Italy
| | - Tullio Biraghi
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istitituto Clinico Sant'Ambrogio, Milan, Italy
| | - Davide Bona
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istitituto Clinico Sant'Ambrogio, Milan, Italy
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23
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Evaluation of effects of perioperative oral care intervention on hospitalization stay and postoperative infection in patients undergoing lung cancer intervention. Support Care Cancer 2020; 29:135-143. [PMID: 32323001 DOI: 10.1007/s00520-020-05450-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 04/01/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE This retrospective study investigated the effect of perioperative oral care intervention on postoperative outcomes in patients undergoing lung cancer resection, in terms of the length of postoperative hospital stay and the incidence of postoperative respiratory infections. METHODS In total, 585 patients underwent lung resection for lung cancer, 397 received perioperative oral care intervention, whereas the remaining 188 did not. This study retrospectively investigated the demographic and clinical characteristics (including postoperative complications and postoperative hospital stay) of each group. To determine whether perioperative oral care intervention was independently associated with either postoperative hospital stay or postoperative respiratory infections, multivariate analysis, multiple regression analysis, and multivariate logistic regression analysis were conducted. RESULTS Parameters significantly associated with a prolonged postoperative hospital stay in lung cancer surgery patients were older age, postoperative complications, increased intraoperative bleeding, more invasive operative approach (e.g., open surgery), and lack of perioperative oral care intervention (standard partial regression coefficient (ß) = 0.083, p = 0.027). Furthermore, older age and longer operative time were significant independent risk factors for the occurrence of postoperative respiratory infections. Lack of perioperative oral care intervention was a potential risk factor for the occurrence of postoperative respiratory infections, although not statistically significant (odds ratio = 2.448, 95% confidence interval = 0.966-6.204, p = 0.059). CONCLUSION These results highlight the importance of perioperative oral care intervention prior to lung cancer surgery, in order to shorten postoperative hospital stay and reduce the risk of postoperative respiratory infections.
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