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Auliac JB, Greillier L, Martin E, Falcoz PE, Boisselier P, Ano S, Lefrançois M, Cortot A. Profiles, diagnostic process, and patterns of care of patients with stage III non-small cell lung cancer: A French national study. Respir Med Res 2024; 85:101087. [PMID: 38657298 DOI: 10.1016/j.resmer.2024.101087] [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: 09/04/2023] [Revised: 01/08/2024] [Accepted: 01/13/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND The management of stage III non-small-cell lung cancer (NSCLC) remains heterogeneous and complex, even after the approval of immune checkpoint inhibitors post-chemoradiotherapy (CRT). This observational study from France evaluated real-world practices in managing stage III NSCLC. METHODS Between 2020 and 2022, we conducted a physician practice survey in 41 medical centers across France, and retrospectively analyzed aggregated information from 417 consecutive charts of patients with stage III NSCLC. We collected information on diagnostic and staging procedures, biomarker testing, surgical and non-surgical treatments, and follow-up. RESULTS According to the physician survey, diagnostic workup of stage III NSCLC primarily relied on positron emission tomography/computed tomography and brain magnetic resonance imaging, performed for the majority of patients in 100 % and 78 % of centers, respectively. Of 417 patient charts, 414 were evaluable with 53 % of patients having stage IIIA disease, 37 % IIIB, and 10 % IIIC. The most common node involvement was N2 (59 %). Programmed death-ligand 1 testing was conducted for 98 % of patients. Invasive staging (mediastinoscopy or endobronchial ultrasound) was performed in 41 % of patients, of whom 83 % had N2 or N3 nodal involvement. Surgical resection was offered to 120 patients (29 %), with 85 % achieving R0 resection. In 292 charts of patients with unresectable stage III NSCLC, 190 patients (65 %) were offered CRT followed by consolidation immunotherapy. Within these patients, concurrent CRT was more frequently employed (52 %) than sequential CRT (13 %). CONCLUSIONS Diagnostic procedures and treatment modalities in French medical centers generally align with clinical guidelines for stage III NSCLC, except for invasive staging that was less commonly performed than expected.
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Affiliation(s)
- Jean-Bernard Auliac
- Pulmonary department, Centre Hospitalier Intercommunal de Créteil, 40 avenue de Verdun, 94010 Créteil cedex, France.
| | - Laurent Greillier
- Department of Multidisciplinary Oncology and Therapeutic Innovations, Aix-Marseille University, APHM, INSERM, CNRS, CRCM, Hôpital Nord, Chemin des Bourrely, 13015 Marseille, France
| | - Etienne Martin
- Department of Radiation Oncology, Centre Georges-François Leclerc, 1 Rue du Professeur Marion, 21000 Dijon, France
| | - Pierre-Emmanuel Falcoz
- Department of Thoracic Surgery, Strasbourg University Hospital, 1 place de l'hôpital, BP 426, 67091 Strasbourg cedex, France
| | - Pierre Boisselier
- Institut du Cancer de Montpellier, Parc Euromédecine, 208 Av. des Apothicaires, 34090 Montpellier, France
| | - Sabine Ano
- AstraZeneca Marketing Company, Tour Carpe Diem, 31 Pl. des Corolles, 92400 Courbevoie, France
| | | | - Alexis Cortot
- Université de Lille, CHU Lille, Thoracic Oncology Department, Centre National de la Recherche Scientifique, INSERM, Institut Pasteur de Lille, UMR9020-UMR-S 1277-Canther, 1, rue du Professeur Calmette, 59019 Lille cedex, France
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Bernard A, Cottenet J, Quantin C. Is the Validity of Logistic Regression Models Developed with a National Hospital Database Inferior to Models Developed from Clinical Databases to Analyze Surgical Lung Cancers? Cancers (Basel) 2024; 16:734. [PMID: 38398124 PMCID: PMC10886576 DOI: 10.3390/cancers16040734] [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: 09/29/2023] [Revised: 12/11/2023] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
In national hospital databases, certain prognostic factors cannot be taken into account. The main objective was to estimate the performance of two models based on two databases: the Epithor clinical database and the French hospital database. For each of the two databases, we randomly sampled a training dataset with 70% of the data and a validation dataset with 30%. The performance of the models was assessed with the Brier score, the area under the receiver operating characteristic (AUC ROC) curve and the calibration of the model. For Epithor and the hospital database, the training dataset included 10,516 patients (with resp. 227 (2.16%) and 283 (2.7%) deaths) and the validation dataset included 4507 patients (with resp. 93 (2%) and 119 (2.64%) deaths). A total of 15 predictors were selected in the models (including FEV1, body mass index, ASA score and TNM stage for Epithor). The Brier score values were similar in the models of the two databases. For validation data, the AUC ROC curve was 0.73 [0.68-0.78] for Epithor and 0.8 [0.76-0.84] for the hospital database. The slope of the calibration plot was less than 1 for the two databases. This work showed that the performance of a model developed from a national hospital database is nearly as good as a performance obtained with Epithor, but it lacks crucial clinical variables such as FEV1, ASA score, or TNM stage.
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Affiliation(s)
- Alain Bernard
- Department of Thoracic and Cardiovascular Surgery, Dijon University Hospital, 21000 Dijon, France;
| | - Jonathan Cottenet
- Service de Biostatistiques et d’Information Médicale (DIM), CHU Dijon Bourgogne, Inserm, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, 21000 Dijon, France;
| | - Catherine Quantin
- Service de Biostatistiques et d’Information Médicale (DIM), CHU Dijon Bourgogne, Inserm, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, 21000 Dijon, France;
- CESP, Inserm, UVSQ, Université Paris-Saclay, 94807 Villejuif, France
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de Fréminville A, Saad M, Sage E, Pricopi C, Fischler M, Trillat B, Salze B, Pascreau T, Vasse M, Vallée A, Guen ML, Fessler J. Relationship Between Preoperative Inflammation Ratios Derived From Preoperative Blood Cell Count and Postoperative Pulmonary Complications in Patients Undergoing Lobectomy: A Single-Center Observational Study. J Cardiothorac Vasc Anesth 2024; 38:482-489. [PMID: 38016820 DOI: 10.1053/j.jvca.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/19/2023] [Accepted: 11/01/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVE Evaluation of the association of inflammatory cell ratios, especially neutrophil-to-lymphocyte ratio (NLR), based on preoperative complete blood counts, with postoperative complications in lobectomy surgery. DESIGN This was a retrospective monocentric cohort study. SETTING The study was conducted at Foch University Hospital in Suresnes, France. PARTICIPANTS Patients having undergone a scheduled lobectomy from January 2018 to September 2021. INTERVENTIONS There were no interventions. MEASUREMENTS AND MAIN RESULTS The authors studied 208 consecutive patients. Preoperative NLR, monocyte-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic inflammation index, systemic inflammation response index, and aggregate inflammation systemic index were calculated. Median and (IQR) of NLR was 2.67 (1.92-3.69). No statistically significant association was observed between any index and the occurrence of at least one major postoperative complication, which occurred in 37% of the patients. Median postoperative length of stay was 7 (5-10) days. None of the ratios was associated with prolonged length of stay (LOS), defined as a LOS above the 75th percentile. CONCLUSIONS The results suggested that simple available inflammatory ratios are not useful for the preoperative identification of patients at risk of postoperative major complications in elective lobectomy surgery.
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Affiliation(s)
- Amaury de Fréminville
- Department of Anesthesiology, Hôpital Foch, Suresnes, France, and Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France
| | - Mary Saad
- Department of Anesthesia, Institut Curie, PSL Research University, Saint Cloud, France, and PSL Research University, INSERM, Institut Curies, Saint Cloud, France
| | - Edouard Sage
- Department of Thoracic Surgery and Lung Transplantation, Hôpital Foch, Suresnes, France, and Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France
| | - Ciprian Pricopi
- Department of Thoracic Surgery and Lung Transplantation, Hôpital Foch, Suresnes, France, and Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France
| | - Marc Fischler
- Department of Anesthesiology, Hôpital Foch, Suresnes, France, and Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France.
| | - Bernard Trillat
- Department of Information Systems, Hôpital Foch, Suresnes, France
| | - Benjamin Salze
- Department of Anesthesiology, Hôpital Foch, Suresnes, France, and Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France
| | - Tiffany Pascreau
- Department of Clinical Biology, Hôpital Foch, Suresnes, France, and Department of Epidemiology-Data-Biostatistics, Delegation of Clinical Research and Innovation, Hôpital Foch, Suresnes, France
| | - Marc Vasse
- Department of Clinical Biology, Hôpital Foch, Suresnes, France, and Department of Epidemiology-Data-Biostatistics, Delegation of Clinical Research and Innovation, Hôpital Foch, Suresnes, France
| | - Alexandre Vallée
- Department of Epidemiology and Public Health, Hôpital Foch, Suresnes, France
| | - Morgan Le Guen
- Department of Anesthesiology, Hôpital Foch, Suresnes, France, and Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France
| | - Julien Fessler
- Department of Anesthesiology, Hôpital Foch, Suresnes, France, and Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France
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Etienne H, Pagès PB, Iquille J, Falcoz PE, Brouchet L, Berthet JP, Le Pimpec Barthes F, Jougon J, Filaire M, Baste JM, Anne V, Renaud S, D'Annoville T, Meunier JP, Jayle C, Dromer C, Seguin-Givelet A, Legras A, Rinieri P, Jaillard-Thery S, Margot V, Thomas PA, Dahan M, Mordant P. Impact of surgical approach on 90-day mortality after lung resection for nonsmall cell lung cancer in high-risk operable patients. ERJ Open Res 2024; 10:00653-2023. [PMID: 38259816 PMCID: PMC10801767 DOI: 10.1183/23120541.00653-2023] [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: 09/04/2023] [Accepted: 11/15/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction Non-small cell lung cancer (NSCLC) is often associated with compromised lung function. Real-world data on the impact of surgical approach in NSCLC patients with compromised lung function are still lacking. The objective of this study is to assess the potential impact of minimally invasive surgery (MIS) on 90-day post-operative mortality after anatomic lung resection in high-risk operable NSCLC patients. Methods We conducted a retrospective multicentre study including all patients who underwent anatomic lung resection between January 2010 and October 2021 and registered in the Epithor database. High-risk patients were defined as those with a forced expiratory volume in 1 s (FEV1) or diffusing capacity of the lung for carbon monoxide (DLCO) value below 50%. Co-primary end-points were the impact of risk status on 90-day mortality and the impact of MIS on 90-day mortality in high-risk patients. Results Of the 46 909 patients who met the inclusion criteria, 42 214 patients (90%) with both preoperative FEV1 and DLCO above 50% were included in the low-risk group, and 4695 patients (10%) with preoperative FEV1 and/or preoperative DLCO below 50% were included in the high-risk group. The 90-day mortality rate was significantly higher in the high-risk group compared to the low-risk group (280 (5.96%) versus 1301 (3.18%); p<0.0001). In high-risk patients, MIS was associated with lower 90-day mortality compared to open surgery in univariate analysis (OR=0.04 (0.02-0.05), p<0.001) and in multivariable analysis after propensity score matching (OR=0.46 (0.30-0.69), p<0.001). High-risk patients operated through MIS had a similar 90-day mortality rate compared to low-risk patients in general (3.10% versus 3.18% respectively). Conclusion By examining the impact of surgical approaches on 90-day mortality using a nationwide database, we found that either preoperative FEV1 or DLCO below 50% is associated with higher 90-day mortality, which can be reduced by using minimally invasive surgical approaches. High-risk patients operated through MIS have a similar 90-day mortality rate as low-risk patients.
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Affiliation(s)
- Harry Etienne
- Department of Thoracic and Vascular Surgery, Hôpital Bichat, APHP, Paris, France
| | | | - Jules Iquille
- Department of Thoracic and Vascular Surgery, Hôpital Bichat, APHP, Paris, France
| | - Pierre Emmanuel Falcoz
- Department of Thoracic Surgery, Nouvel Hôpital Civil, CHU Strasbourg, Strasbourg, France
| | - Laurent Brouchet
- Department of Thoracic Surgery, Hôpital Larrey, CHU Toulouse, Toulouse, France
| | | | | | - Jacques Jougon
- Department of Thoracic Surgery, Hôpital Haut Lévêque, CHU Bordeaux, Bordeaux, France
| | - Marc Filaire
- Department of Thoracic Surgery, Centre Jean Perrin, Clermont-Ferrand, UK
| | - Jean-Marc Baste
- Department of Thoracic Surgery, Hôpital Charles-Nicolle, CHU Rouen, Rouen, France
- Department of Thoracic Surgery, Hôpital Robert Schuman, Vantoux, France
| | - Valentine Anne
- Department of Thoracic Surgery, Hôpital Arnault Tzanck, Mougins, France
| | - Stéphane Renaud
- Department of Thoracic Surgery, Hôpital Central, CHU Nancy, Nancy, France
| | - Thomas D'Annoville
- Department of Thoracic Surgery, Clinique du Millénaire, Montpellier, France
| | | | - Christophe Jayle
- Department of Thoracic Surgery, Hôpital La Mileterie, CHU Poitiers, Poitiers, France
| | - Christian Dromer
- Department of Thoracic Surgery, Polyclinique Nord-Aquitaine, Bordeaux, France
| | | | - Antoine Legras
- Department of Thoracic Surgery, Hôpital Trousseau, CHU Tours, Tours, France
| | - Philippe Rinieri
- Department of Thoracic Surgery, Clinique du Cèdre, Bois-Guillaume, France
| | | | | | | | - Marcel Dahan
- Department of Thoracic Surgery, Hôpital Larrey, CHU Toulouse, Toulouse, France
| | - Pierre Mordant
- Department of Thoracic and Vascular Surgery, Hôpital Bichat, APHP, Paris, France
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Bernard A, Cottenet J, Pagès PB, Quantin C. Mortality and failure-to-rescue major complication trends after lung cancer surgery between 2005 and 2020: a nationwide population-based study. BMJ Open 2023; 13:e075463. [PMID: 37699626 PMCID: PMC10503350 DOI: 10.1136/bmjopen-2023-075463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/30/2023] [Indexed: 09/14/2023] Open
Abstract
OBJECTIVES To estimate the evolution of quality indicators (30-day mortality and failure-to-rescue) inpatients who underwent lung cancer surgery in France over the past 15 years and to study the potential influencing factors. DESIGN Retrospective cohort study using data from the French hospital database (PMSI). SETTING Nationwide population-based study. PARTICIPANTS All patients who underwent pulmonary resection for lung cancer in France (2005-2020) were included (N=1 57 566). Characteristics of patients (age, gender, comorbidities), surgery (surgical approach, type of resection, extent of resection) and hospital (type of hospital, hospital volume for pulmonary resections) were retrieved. PRIMARY AND SECONDARY OUTCOME MEASURES We studied two outcome indicators: 30-day mortality and failure-to-rescue. We used regression-based techniques (including interrupted time-series) to assess the effects of patient and hospital characteristics on 30-day mortality and failure-to-rescue (number of deaths among patients with at least one major postoperative complication within the 30 days after surgery), adjusting for case mix. RESULTS The 30-day mortality rate increased from 3.8% in 2005 to 4.9% in 2010 and then decreased to 2.9% in 2020. The failure-to-rescue rate decreased from 12.2% in 2005 to 7.1% in 2020. The pneumonectomy rate decreased significantly over time (18.1% in 2005 to 4.8% in 2020) and had the greatest contribution on the reduction of mortality between two periods (2005-2010/2015-2020). The use of video-assisted thoracoscopic surgery or robot-assisted surgery had a great influence on the reduction of mortality (16% of the observed difference in mortality) between the two periods, as did hospital volume. CONCLUSIONS The change in surgical practices, particularly the reduction in pneumonectomies, could be one of the main reasons for reduction in postoperative mortality and failure-to-rescue in France since 2011. Hospital volume is another important factor in reducing postoperative mortality. Our study should encourage the use of technological or organisational innovation, such as changes in surgical practice and cancer surgery authorisations, to improve quality of care.
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Affiliation(s)
| | - Jonathan Cottenet
- Service de Biostatistiques et d'Information Médicale (DIM) ; INSERM, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, CHU Dijon, Dijon, France
| | | | - Catherine Quantin
- Service de Biostatistiques et d'Information Médicale (DIM) ; INSERM, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, CHU Dijon, Dijon, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Villejuif, France
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Bernard A, Cottenet J, Pages PB, Quantin C. Diffusion of Minimally Invasive Approach for Lung Cancer Surgery in France: A Nationwide, Population-Based Retrospective Cohort Study. Cancers (Basel) 2023; 15:3283. [PMID: 37444392 DOI: 10.3390/cancers15133283] [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: 05/15/2023] [Revised: 06/20/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND The minimally invasive approach (MIA) has gained popularity thanks to its efficacy and safety. Our work consisted of evaluating the diffusion of the MIA in hospitals and the variability of this approach (within and between regions). METHODS All patients who underwent limited resection or lobectomy for lung cancer in France were included from the national hospital administrative database (2013-2020). We described between-hospital differences in the MIA rate over four periods (2013-2014, 2015-2016, 2017-2018, and 2019-2020). The potential influence of the hospital volume, hospital type, and period on the adjusted MIA rate was estimated by a multilevel linear regression. RESULTS From 2013 to 2020, 77,965 patients underwent a lobectomy or limited resection for lung cancer. The rate of the MIA increased significantly over the four periods (50% in 2019-2020). Variability decreased over time in 7/12 regions. The variables included in the multilevel model were significantly related to the adjusted rate of the MIA. Variability between regions was considerable since 18% of the variance was due to systematic differences between regions. CONCLUSIONS We confirm that the MIA is part of the surgical techniques used on a daily basis for the treatment of lung cancer. However, this technology is mostly used by surgeons in high volume institutions.
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Affiliation(s)
- Alain Bernard
- Department of Thoracic and Cardiovascular Surgery, Dijon University Hospital, 21000 Dijon, France
| | - Jonathan Cottenet
- Service de Biostatistiques et d'Information Médicale (DIM), CHU Dijon Bourgogne, Inserm, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, 21000 Dijon, France
| | - Pierre-Benoit Pages
- Department of Thoracic and Cardiovascular Surgery, Dijon University Hospital, 21000 Dijon, France
| | - Catherine Quantin
- Service de Biostatistiques et d'Information Médicale (DIM), CHU Dijon Bourgogne, Inserm, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, 21000 Dijon, France
- Inserm, High-Dimensional Biostatistics for Drug Safety and Genomics, Le Centre de Recherche en Epidémiologie et Santé des Populations (CESP), Université Paris-Saclay (UVSQ), 94800 Villejuif, France
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Madelaine L, Baste JM, Trousse D, Vidal R, Durand M, Pagès PB. Impact of robotic access on outcomes after lung cancer surgery in France: Analysis from the Epithor database. JTCVS OPEN 2023; 14:523-537. [PMID: 37425455 PMCID: PMC10328832 DOI: 10.1016/j.xjon.2023.02.018] [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: 01/14/2022] [Revised: 01/30/2023] [Accepted: 02/06/2023] [Indexed: 07/11/2023]
Abstract
Introduction We aimed to compare postoperative outcomes after pulmonary resection for lung cancer after open thoracotomy (OT), video-assisted (VATS), and robotic-assisted (RA) thoracic surgery using a propensity score analysis. Methods From 2010 to 2020, 38,423 patients underwent resection for lung cancer. In total, 58.05% (n = 22,306) were operated by thoracotomy, 35.35% (n = 13,581) by VATS, and 6.6% (n = 2536) by RA. A propensity score was used to create balanced groups with weighting. End points were in-hospital mortality, postoperative complications, and length of hospital stay, reported by odds ratios (ORs) and 95% confidence intervals (CIs). Results VATS decreased in-hospital mortality compared with OT (OR, 0.64; 95% CI, 0.58-0.79; P < .0001) but not compared with RA (OR, 1.09; 95% CI, 0.77-1.52; P = .61). VATS reduced major postoperative complications compared with OT (OR, 0.83; 95% CI, 0.76-0.92; P < .0001) but not RA (OR, 1.01; 95% CI, 0.84-1.21; P = .17). VATS reduced prolonged air leaks rate compared with OT (OR, 0.9; 95% CI, 0.84-0.98; P = .015) but not RA (OR, 1.02; 95% CI, 0.88-1.18; P = .77). As compared with OT, VATS and RA decreased the incidence of atelectasis (respectively: OR, 0.57; 95% CI, 0.50-0.65; P < .0001 and OR, 0.75; 95% CI, 0.60-0.95; P = .016); the incidence of pneumonia (OR, 0.75; 95% CI, 0.67-0.83; P < .0001 and OR, 0.62; 95% CI, 0.50-0.78; P < .0001); and the number of postoperative arrhythmias (OR, 0.69; 95% CI, 0.61-0.78; P < .0001 and OR, 0.75; 95% CI, 0.59-0.96; P = .024). Both VATS and RA resulted in shorter hospital stays (-1.91 days [-2.24; -1.58]; P < .0001 and -2.73 days [-3.1; -2.36]; P < .0001, respectively). Conclusions RA appeared to decrease postoperative pulmonary complications as well as VATS compared with OT. VATS decreased postoperative mortality as compared with RA and OT.
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Affiliation(s)
- Leslie Madelaine
- Department of Thoracic Surgery, CHU Dijon, Bocage Central, Dijon, France
| | - Jean-Marc Baste
- Department of Thoracic Surgery, CHU Rouen, Hôpital Charles-Nicolle, Rouen, France
| | - Delphine Trousse
- Department of Thoracic Surgery and Esophageal, Hôpital Nord, CHU de Marseille, Marseille, France
| | - Renaud Vidal
- Department of Thoracic Surgery, Hôpital Européen, Marseille, France
| | - Marion Durand
- Department of Thoracic Surgery, Ramsay Santé, Hôpital Privé d’Antony, Antony, France
| | - Pierre-Benoit Pagès
- Department of Thoracic Surgery, CHU Dijon, Bocage Central, Dijon, France
- INSERM UMR 1231, CHU Dijon, University of Burgundy, Dijon, France
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Is the Evaluation of Robot-Assisted Surgery Based on Sufficient Scientific Evidence? J Clin Med 2023; 12:jcm12020422. [PMID: 36675350 PMCID: PMC9863293 DOI: 10.3390/jcm12020422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 12/31/2022] [Indexed: 01/07/2023] Open
Abstract
Robot-assisted surgery is becoming an increasingly common approach for lung cancer resection [...].
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Armand E, Boulate D, Fourdrain A, Nguyen NAT, Resseguier N, Brioude G, Trousse D, Doddoli C, D'journo XB, Thomas PA. Benignant and malignant epidemiology among surgical resections for suspicious solitary lung cancer without preoperative tissue diagnosis. EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY : OFFICIAL JOURNAL OF THE EUROPEAN ASSOCIATION FOR CARDIO-THORACIC SURGERY 2022; 63:6971845. [PMID: 36610992 DOI: 10.1093/ejcts/ezac590] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 12/19/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The aim of this study was to describe the epidemiology of patients undergoing diagnostic and/or curative surgical pulmonary resections for lung opacities suspected of being localized primary lung cancers without preoperative tissue confirmation. METHODS We performed a single-centre retrospective study of a prospectively implemented institutional database of all patients who underwent pulmonary resection between January 2010 and December 2020. Patients were selected when surgery complied with the Fleischner society guidelines. We performed a multivariable logistic regression to determine the preoperative variables associated with malignancy. RESULTS Among 1392 patients, 213 (15.3%) had a final diagnosis of benignancy. We quantified futile parenchymal resections in 29 (2.1%) patients defined by an anatomical resection of >2 lung segments for benign lesions that did not modified the clinical management. Compared with patients with malignancies, patients with benignancies were younger (57.5 vs 63.9 years, P < 0.001), had lower preoperative risk profile (thoracoscore 0.4 vs 2.1, P < 0.001), had a higher proportion of wedge resection (50.7% vs 12.2%, P < 0.01) and experienced a lower burden of postoperative complication (Clavien-Dindo IV or V, 0.4% vs 5.6%, P < 0.001). Preoperative independent variables associated with malignancy were (adjusted odd ratio [95% confident interval]) age 1.02 [1.00; 1.04], smoking (year-pack) 1.005 (1.00; 1.01), history of cardiovascular disease 2.06 [1.30; 3.30], history of controlled cancer 2.74 [1.30; 6.88] and clinical N involvement 4.20 [1.11; 37.44]. CONCLUSIONS Futile parenchymal lung resection for suspicious opacities without preoperative tissue diagnosis is rare (2.1%) while surgery for benign lesions represented 15.3% and has a satisfactory safety profile with very low postoperative morbi-mortality.
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Affiliation(s)
- Elsa Armand
- Department of Thoracic Surgery, Lung Transplantation and Esophageal Diseases, Hôpital Nord, Marseille, France
| | - David Boulate
- Department of Thoracic Surgery, Lung Transplantation and Esophageal Diseases, Hôpital Nord, Marseille, France
| | - Alex Fourdrain
- Department of Thoracic Surgery, Lung Transplantation and Esophageal Diseases, Hôpital Nord, Marseille, France
| | | | - Noémie Resseguier
- Department of Epidemiology and Health Economics, APHM, Marseille, France
| | - Geoffrey Brioude
- Department of Thoracic Surgery, Lung Transplantation and Esophageal Diseases, Hôpital Nord, Marseille, France
| | - Delphine Trousse
- Department of Thoracic Surgery, Lung Transplantation and Esophageal Diseases, Hôpital Nord, Marseille, France
| | - Christophe Doddoli
- Department of Thoracic Surgery, Lung Transplantation and Esophageal Diseases, Hôpital Nord, Marseille, France
| | - Xavier-Benoit D'journo
- Department of Thoracic Surgery, Lung Transplantation and Esophageal Diseases, Hôpital Nord, Marseille, France
| | - Pascal-Alexandre Thomas
- Department of Thoracic Surgery, Lung Transplantation and Esophageal Diseases, Hôpital Nord, Marseille, France
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Boujibar F, Elkins MR. Perioperative physiotherapy. J Physiother 2022; 68:218-219. [PMID: 36244959 DOI: 10.1016/j.jphys.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 09/27/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
- Fairuz Boujibar
- Department of Thoracic Surgery, Rouen University Hospital, Rouen, France
| | - Mark R Elkins
- Editor, Journal of Physiotherapy; Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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11
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Bertolaccini L, Spaggiari L. Commentary: Brutus, Cassius, the Stars, and the Lung Cancer Screening Criteria. Semin Thorac Cardiovasc Surg 2022; 35:781-782. [PMID: 35987440 DOI: 10.1053/j.semtcvs.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 08/08/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Luca Bertolaccini
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy.
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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12
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Boujibar F, Gillibert A, Bonnevie T, Rinieri P, Montagne F, Selim J, Cuvelier A, Gravier FE, Baste JM. The 6-minute stepper test and the sit-to-stand test predict complications after major pulmonary resection via minimally invasive surgery: a prospective inception cohort study. J Physiother 2022; 68:130-135. [PMID: 35396177 DOI: 10.1016/j.jphys.2022.03.001] [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: 02/19/2021] [Revised: 02/02/2022] [Accepted: 03/07/2022] [Indexed: 11/27/2022] Open
Abstract
QUESTIONS How well do the 6-minute stepper test (6MST) and sit-to-stand test (STST) predict complications after minimally invasive lung cancer resection? Do the 6MST and STST provide supplementary information on the risk of postoperative complications in addition to the prognostic variables that are currently used, such as age and the American Society of Anesthesiology (ASA) score? DESIGN Prospective inception cohort study with follow-up for 90 days. PARTICIPANTS Consecutive sample of adults undergoing major lung resection with video-assisted thoracic surgery (VATS) or robot-assisted thoracic surgery (RATS). OUTCOME MEASURES Patients had a preoperative functional evaluation with the 6MST and STST. The number of steps, heart rate change, saturation and dyspnoea during the 6MST and the number of lifts during the STST were recorded. Complications graded ≥ 2 on the Clavien-Dindo classification were recorded for 90 days after surgery. RESULTS Between November 2018 and November 2019, 118 patients with a mean age of 65 years (SD 9) were included and analysed. Their surgeries were via VATS in 88 (75%) and via RATS in 30 (25%). For predicting a postoperative complication graded ≥ 2 on the Clavien-Dindo classification, the area under the Receiver Operating Characteristic curve was: 0.82 (95% CI 0.75 to 0.90) for the number of steps during the 6MST, with an optimum cut-off of 140 steps; and 0.85 (95% CI 0.77 to 0.93) for the number of lifts during the STST, with an optimum cut-off of 20 lifts. CONCLUSION The 6MST and STST predicted morbidity and mortality after lung cancer resection via minimally invasive surgery. The preoperative use of these exercise tests in clinical practice may be useful for risk stratification. REGISTRATION NCT03824977.
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Affiliation(s)
- Fairuz Boujibar
- Department of Thoracic Surgery, Rouen University Hospital, Rouen, France; Normandie University, UNIROUEN, INSERM U1096, Haute Normandie Research and Biomedical Innovation, Rouen, France.
| | - André Gillibert
- Department of Biostatistics, Rouen University Hospital, Rouen, France
| | - Tristan Bonnevie
- Normandie University, UNIROUEN, INSERM U1096, Haute Normandie Research and Biomedical Innovation, Rouen, France; ADIR Association, Rouen University Hospital, Rouen, France
| | - Philippe Rinieri
- Department of Thoracic Surgery, Centre Médico-chirurgical du Cèdre, Bois-Guillaume, France
| | - François Montagne
- Department of Thoracic Surgery, University Hospital of Lille, Lille, France
| | - Jean Selim
- Normandie University, UNIROUEN, INSERM U1096, Haute Normandie Research and Biomedical Innovation, Rouen, France; Department of Anaesthesiology and Critical Care, Rouen University Hospital, Rouen, France
| | - Antoine Cuvelier
- Normandie University, UNIROUEN, INSERM U1096, Haute Normandie Research and Biomedical Innovation, Rouen, France; Pulmonary, Thoracic Oncology and Respiratory Intensive Care Department, Rouen University Hospital, Rouen, France
| | - Francis-Edouard Gravier
- Normandie University, UNIROUEN, INSERM U1096, Haute Normandie Research and Biomedical Innovation, Rouen, France; ADIR Association, Rouen University Hospital, Rouen, France
| | - Jean-Marc Baste
- Department of Thoracic Surgery, Rouen University Hospital, Rouen, France; Normandie University, UNIROUEN, INSERM U1096, Haute Normandie Research and Biomedical Innovation, Rouen, France
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13
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Pages PB, Cottenet J, Bonniaud P, Tubert-Bitter P, Piroth L, Cadranel J, Bernard A, Quantin C. Impact of the SARS-CoV-2 Epidemic on Lung Cancer Surgery in France: A Nationwide Study. Cancers (Basel) 2021; 13:cancers13246277. [PMID: 34944896 PMCID: PMC8699699 DOI: 10.3390/cancers13246277] [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: 09/30/2021] [Revised: 11/30/2021] [Accepted: 12/10/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary Few studies have investigated the link between SARS-CoV-2 and health restrictions and its effects on the health of lung cancer (LC) patients. This study aimed to assess the impact of SARS-CoV-2 on activity volume, postoperative complications and in-hospital mortality (IHM) for LC resections in 2020 at the national level in France. Our study shows a decrease in the volume of LC resections, especially during the first lockdown. We also show that only 0.43% of patients hospitalized for LC surgery during 2020 developed a SARS-CoV-2 infection, but this low rate is counterbalanced by a high IHM (21%) in these 51 patients. Our findings suggest that, even if the IHM is high, LC surgery is feasible during a pandemic provided that the general guidance protocols edited by the surgical societies are respected. Therefore, this study provides further arguments to encourage teams to test for COVID-19 prior to surgery and patients to be vaccinated. Abstract Few studies have investigated the link between SARS-CoV-2 and health restrictions and its effects on the health of lung cancer (LC) patients. The aim of this study was to assess the impact of the SARS-CoV-2 epidemic on surgical activity volume, postoperative complications and in-hospital mortality (IHM) for LC resections in France. All data for adult patients who underwent pulmonary resection for LC in France in 2020, collected from the national administrative database, were compared to 2018–2019. The effect of SARS-CoV-2 on the risk of IHM and severe complications within 30 days among LC surgery patients was examined using a logistic regression analysis adjusted for age, sex, comorbidities and type of resection. There was a slight decrease in the volume of LC resections in 2020 (n = 11,634), as compared to 2018 (n = 12,153) and 2019 (n = 12,227), with a noticeable decrease in April 2020 (the peak of the first wave of epidemic in France). We found that SARS-CoV-2 (0.43% of 2020 resections) was associated with IHM and severe complications, with, respectively, a sevenfold (aOR = 7.17 (3.30–15.55)) and almost a fivefold (aOR = 4.76 (2.31–9.80)) increase in risk. Our study suggests that LC surgery is feasible even during a pandemic, provided that general guidance protocols edited by the surgical societies are respected.
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Affiliation(s)
- Pierre-Benoit Pages
- Department of Thoracic Surgery, Centre Hospitalier Universitaire Dijon, Bocage Central, 21079 Dijon, France; (P.-B.P.); (A.B.)
- INSERM UMR 1231, Centre Hospitalier Universitaire Bocage, University of Burgundy, 21079 Dijon, France
| | - Jonathan Cottenet
- Biostatistics and Bioinformatics (DIM), Dijon University Hospital, University of Burgundy Franche-Comté, BP 77908, 21079 Dijon, France;
| | - Philippe Bonniaud
- Faculty of Medicine, University of Bourgogne-Franche-Comté, 21000 Dijon, France; (P.B.); (L.P.)
- Reference Center for Rare Pulmonary Diseases, Pulmonary Medicine and Intensive Care Unit Department, Dijon University Hospital, BP 77908, 21079 Dijon, France
| | - Pascale Tubert-Bitter
- High-Dimensional Biostatistics for Drug Safety and Genomics, Paris-Saclay University, UVSQ, Inserm, CESP, 94800 Villejuif, France;
| | - Lionel Piroth
- Faculty of Medicine, University of Bourgogne-Franche-Comté, 21000 Dijon, France; (P.B.); (L.P.)
- Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, Dijon University Hospital, 21079 Dijon, France
- Infectious Diseases Department, Dijon University Hospital, BP 77908, 21079 Dijon, France
| | - Jacques Cadranel
- Chest Department and Constitutive Center for Rare Pulmonary Disease, Hôpital Tenon, AP-HP, Inflammation-Immunopathology-Biotherapy Department (DHU i2B) and Sorbonne University, 75020 Paris, France;
| | - Alain Bernard
- Department of Thoracic Surgery, Centre Hospitalier Universitaire Dijon, Bocage Central, 21079 Dijon, France; (P.-B.P.); (A.B.)
| | - Catherine Quantin
- Biostatistics and Bioinformatics (DIM), Dijon University Hospital, University of Burgundy Franche-Comté, BP 77908, 21079 Dijon, France;
- High-Dimensional Biostatistics for Drug Safety and Genomics, Paris-Saclay University, UVSQ, Inserm, CESP, 94800 Villejuif, France;
- Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, Dijon University Hospital, 21079 Dijon, France
- Correspondence: ; Tel.: +(33)-3-80-29-34-65; Fax: +(33)-3-80-29-39-73
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Pujol JL, Thomas PA, Giraud P, Denis MG, Tretarre B, Roch B, Bommart S. Lung Cancer in France. J Thorac Oncol 2021; 16:21-29. [PMID: 33384058 DOI: 10.1016/j.jtho.2020.09.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 09/15/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Jean-Louis Pujol
- Thoracic Oncology Unit, University Hospital of Montpellier, Arnaud de Villeneuve Hospital, Montpellier, France; Cancerology Research Institute of Montpellier (IRCM), Institut national de la santé et de la recherche médicale (INSERM) unit U1194, Montpellier, France.
| | | | - Philippe Giraud
- Service d'oncologie radiothérapie, Hôpital Européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Marc G Denis
- Department of Biochemistry and INSERM U1232, Nantes University Hospital, Nantes, France
| | - Brigitte Tretarre
- Herault Department Register, French National Network of Cancer Registers, Montpellier, France
| | - Benoît Roch
- Thoracic Oncology Unit, University Hospital of Montpellier, Arnaud de Villeneuve Hospital, Montpellier, France; Cancerology Research Institute of Montpellier (IRCM), Institut national de la santé et de la recherche médicale (INSERM) unit U1194, Montpellier, France
| | - Sebastien Bommart
- Department of Medical Imaging, University Hospital of Montpellier, Arnaud de Villeneuve Hospital, Montpellier, France; PhyMedExp, INSERM U1046, Centre national de la recherche scientifique Unité mixte de recherche 9214, University of Montpellier, Montpellier, France
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15
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Affiliation(s)
- M Dahan
- CNP de chirurgie thoracique et cardio-vasculaire, 56, boulevard Vincent-Auriol, 75013 Paris, France.
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Die Loucou J, Pagès PB, Falcoz PE, Thomas PA, Rivera C, Brouchet L, Baste JM, Puyraveau M, Bernard A, Dahan M. Validation and update of the thoracic surgery scoring system (Thoracoscore) risk model. Eur J Cardiothorac Surg 2020; 58:350-356. [DOI: 10.1093/ejcts/ezaa056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 01/20/2020] [Accepted: 01/31/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
OBJECTIVES
The performance of prediction models tends to deteriorate over time. The purpose of this study was to update the Thoracoscore risk prediction model with recent data from the Epithor nationwide thoracic surgery database.
METHODS
From January 2016 to December 2017, a total of 56 279 patients were operated on for mediastinal, pleural, chest wall or lung disease. We used 3 recommended methods to update the Thoracoscore prediction model and then proceeded to develop a new risk model. Thirty-day hospital mortality included patients who died within the first 30 days of the operation and those who died later during the same hospital stay.
RESULTS
We compared the baseline patient characteristics in the original data used to develop the Thoracoscore prediction model and the validation data. The age distribution was different, with specifically more patients older than 65 years in the validation group. Video-assisted thoracoscopy accounted for 47% of surgeries in the validation group compared but only 18% in the original data. The calibration curve used to update the Thoracoscore confirmed the overfitting of the 3 methods. The Hosmer–Lemeshow goodness-of-fit test was significant for the 3 updated models. Some coefficients were overfitted (American Society of Anesthesiologists score, performance status and procedure class) in the validation data. The new risk model has a correct calibration as indicated by the Hosmer–Lemeshow goodness-of-fit test, which was non-significant. The C-index was strong for the new risk model (0.84), confirming the ability of the new risk model to differentiate patients with and without the outcome. Internal validation shows no overfitting for the new model
CONCLUSIONS
The new Thoracoscore risk model has improved performance and good calibration, making it appropriate for use in current clinical practice.
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Affiliation(s)
- Julien Die Loucou
- Department of Thoracic Surgery, Dijon University Hospital, Dijon, France
| | - Pierre-Benoit Pagès
- Department of Thoracic Surgery, Dijon University Hospital, Dijon, France
- INSERM UMR 1231, Dijon University Hospital, University of Burgundy, Dijon, France
| | | | - Pascal-Alexandre Thomas
- Department of Thoracic Surgery, Hopital-Nord-APHM, Aix-Marseille University, Marseille, France
| | - Caroline Rivera
- Department of Thoracic Surgery, Bayonne Hospital, Bayonne, France
| | - Laurent Brouchet
- Department of Thoracic Surgery, Hopital Larrey, CHU Toulouse, Toulouse, France
| | | | - Marc Puyraveau
- Department of Biostatistics and Epidemiology, CHU Besançon, Besançon, France
| | - Alain Bernard
- Department of Thoracic Surgery, Dijon University Hospital, Dijon, France
| | - Marcel Dahan
- Department of Thoracic Surgery, Bayonne Hospital, Bayonne, France
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