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Bottet B, Piton N, Selim J, Sarsam M, Guisier F, Baste JM. Beyond the Frontline: A Triple-Line Approach of Thoracic Surgeons in Lung Cancer Management-State of the Art. Cancers (Basel) 2023; 15:4039. [PMID: 37627067 PMCID: PMC10452134 DOI: 10.3390/cancers15164039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 07/26/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
Non-small cell lung cancer (NSCLC) is now described as an extremely heterogeneous disease in its clinical presentation, histology, molecular characteristics, and patient conditions. Over the past 20 years, the management of lung cancer has evolved with positive results. Immune checkpoint inhibitors have revolutionized the treatment landscape for NSCLC in both metastatic and locally advanced stages. The identification of molecular alterations in NSCLC has also allowed the development of targeted therapies, which provide better outcomes than chemotherapy in selected patients. However, patients usually develop acquired resistance to these treatments. On the other hand, thoracic surgery has progressed thanks to minimally invasive procedures, pre-habilitation and enhanced recovery after surgery. Moreover, within thoracic surgery, precision surgery considers the patient and his/her disease in their entirety to offer the best oncologic strategy. Surgeons support patients from pre-operative rehabilitation to surgery and beyond. They are involved in post-treatment follow-up and lung cancer recurrence. When conventional therapies are no longer effective, salvage surgery can be performed on selected patients.
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Affiliation(s)
- Benjamin Bottet
- Department of General and Thoracic Surgery, Hospital Center University De Rouen, 1 Rue de Germont, F-76000 Rouen, France; (B.B.); (M.S.)
| | - Nicolas Piton
- Department of Pathology, UNIROUEN, INSERM U1245, CHU Rouen, Normandy University, F-76000 Rouen, France;
| | - Jean Selim
- Department of Anaesthesiology and Critical Care, CHU Rouen, F-76000 Rouen, France;
- INSERM EnVI UMR 1096, University of Rouen Normandy, F-76000 Rouen, France
| | - Matthieu Sarsam
- Department of General and Thoracic Surgery, Hospital Center University De Rouen, 1 Rue de Germont, F-76000 Rouen, France; (B.B.); (M.S.)
| | - Florian Guisier
- Department of Pneumology, CHU Rouen, 1 Rue de Germont, F-76000 Rouen, France;
- Clinical Investigation Center, Rouen University Hospital, CIC INSERM 1404, 1 Rue de Germont, F-76000 Rouen, France
| | - Jean-Marc Baste
- Department of General and Thoracic Surgery, Hospital Center University De Rouen, 1 Rue de Germont, F-76000 Rouen, France; (B.B.); (M.S.)
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Abstract
Background Despite implementation of enhanced recovery after surgery (ERAS) in lung surgery, potential barriers for improvements should be identified. The aim of this single-centre, prospective ERAS cohort study was to explore reasons for delayed patient discharge after video-assisted thoracoscopic surgery (VATS) lobectomy with a median length of hospital stay (LOS) of 2 days. Methods Consecutive patients referred for VATS lobectomy were consulted twice daily by an investigator for the primary reasons for continued hospitalization. The secondary outcomes were risk factors for delayed recovery using univariate and multivariate regression analyses. Results A total of 147 patients were included (69 with LOS more than 2 days and 78 with LOS of 2 days or less) from April 2020 to December 2020. Air leak (27.7 per cent), pneumonia (20.2 per cent), pain (15.3 per cent), urinary/renal factors (11.0 per cent), atrial fibrillation (7.0 per cent), respiratory failure (4.5 per cent), cognitive factors/delirium (4.3 per cent), gastrointestinal factors (3.8 per cent), oxygen dependency (2.7 per cent), social factors (2.0 per cent), and pleural effusion (1.4 per cent) were important factors for discharge more than 2 days after surgery. The 30-day readmission rate after discharge was 21 per cent for LOS of 2 days or less and 22 per cent for LOS more than 2 days (P = 0.856). On a multivariate regression model, age (per 5-year increase, odds ratio (OR) 1.29, 95 per cent c.i. 1.01 to 1.66, P = 0.043) and forced expiratory volume in 1 s (FEV1) per cent (per 5 per cent increase, OR 0.89, 95 per cent c.i. 0.81 to 0.98, P = 0.021) were significantly related to discharge after more than 2 days. Conclusion Despite a short median LOS of 2 days, air leak, pneumonia, and pain remain the most important challenges for further improvement of the ERAS programme. Age and FEV1 per cent were statistically significant risk factors for LOS longer than 2 days.
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Affiliation(s)
- Lin Huang
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Henrik Kehlet
- Correspondence to: Henrik Kehlet, Section of Surgical Pathophysiology, 7621, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark (e-mail: )
| | - René Horsleben Petersen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Montagne F, Guisier F, Venissac N, Baste JM. The Role of Surgery in Lung Cancer Treatment: Present Indications and Future Perspectives-State of the Art. Cancers (Basel) 2021; 13:3711. [PMID: 34359612 PMCID: PMC8345199 DOI: 10.3390/cancers13153711] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 07/14/2021] [Accepted: 07/20/2021] [Indexed: 12/25/2022] Open
Abstract
Non-small cell lung cancers (NSCLC) are different today, due to the increased use of screening programs and of innovative systemic therapies, leading to the diagnosis of earlier and pre-invasive tumors, and of more advanced and controlled metastatic tumors. Surgery for NSCLC remains the cornerstone treatment when it can be performed. The role of surgery and surgeons has also evolved because surgeons not only perform the initial curative lung cancer resection but they also accompany and follow-up patients from pre-operative rehabilitation, to treatment for recurrences. Surgery is personalized, according to cancer characteristics, including cancer extensions, from pre-invasive and local tumors to locally advanced, metastatic disease, or residual disease after medical treatment, anticipating recurrences, and patients' characteristics. Surgical management is constantly evolving to offer the best oncologic resection adapted to each NSCLC stage. Today, NSCLC can be considered as a chronic disease and surgery is a valuable tool for the diagnosis and treatment of recurrences, and in palliative conditions to relieve dyspnea and improve patients' comfort.
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Affiliation(s)
- François Montagne
- Department of Thoracic Surgery, Calmette Hospital, University Hospital of Lille, Boulevard du Pr. J Leclercq, F-59000 Lille, France; (F.M.); (N.V.)
| | - Florian Guisier
- Department of Pneumology, Rouen University Hospital, 1 rue de Germont, F-76000 Rouen, France;
- Clinical Investigation Center, Rouen University Hospital, CIC INSERM 1404, 1 rue de Germont, F-76000 Rouen, France
- Faculty of Medicine and Pharmacy of Rouen, Normandie University, LITIS QuantIF EA4108, 22 Boulevard Gambetta, F-76183 Rouen, France
| | - Nicolas Venissac
- Department of Thoracic Surgery, Calmette Hospital, University Hospital of Lille, Boulevard du Pr. J Leclercq, F-59000 Lille, France; (F.M.); (N.V.)
| | - Jean-Marc Baste
- Department of General and Thoracic Surgery, Rouen University Hospital, 1 rue de Germont, F-76000 Rouen, France
- Faculty of Medicine and Pharmacy of Rouen (UNIROUEN), Normandie University, INSERM U1096, 22 Boulevard Gambetta, F-76000 Rouen, France
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Minnella EM, Baldini G, Quang ATL, Bessissow A, Spicer J, Carli F. Prehabilitation in Thoracic Cancer Surgery: From Research to Standard of Care. J Cardiothorac Vasc Anesth 2021; 35:3255-3264. [PMID: 33752968 DOI: 10.1053/j.jvca.2021.02.049] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine whether personalized, stepped prehabilitation care is a feasible, safe, and effective implementation strategy. DESIGN Quality improvement project. Data collected prospectively from August 2018 to December 2019 were analyzed retrospectively to describe the clinical implementation of a prehabilitation care program for elective lung cancer surgery. SETTING Single center, tertiary university hospital. PARTICIPANTS Eighty-one consecutive adult patients living in the metropolitan area of Montreal were included if an elective resection of suspected or confirmed lung cancer was planned. INTERVENTIONS At the earliest contemplation of surgery, the whole cohort was screened for impaired physical, nutritional, and/or psychological status. Patients screened at higher risk received dedicated assessment and personalized prehabilitation care upon specific needs. MEASUREMENTS AND MAIN RESULTS Patients' specific needs and their access and flow through the different services were described. Prehabilitation effectiveness was evaluated using walking and exercise tests, and adverse events were monitored. Eighty-one patients were screened for functional impairments. Forty patients showed reduction of physical function, seven of them refused the specific assessment, one refused in-hospital exercise; 48 patients showed nutritional risk, eight of them refused or did not comply with nutritional therapy. Overall, 45 high-risk patients received a one-month personalized prehabilitation program: 16 partook in a trimodal program (exercise, nutrition, and psychological), and 22 received a program with both nutrition and exercise. No adverse events occurred during the study period. After prehabilitation, six-minute waking distance improved by 29.9 meters (standard deviation 47.3 m) (n = 35; p = 0.001) and the oxygen uptake at the anaerobic threshold improved by 1.6 (1.7) mL/kg/min (n = 13; p = 0.004). Length of hospital stay was two (interquartile range one-four) days in prehabilitated patients versus three (two-seven) days in the usual care group (p = 0.101). CONCLUSIONS A personalized, stepped prehabilitation program targeting high-risk patients undergoing elective lung cancer surgery was feasible, safe, and effective.
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Affiliation(s)
- Enrico Maria Minnella
- Department of Anesthesia, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milano, Italy.
| | - Gabriele Baldini
- Department of Anesthesia, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada
| | - Anh Thy Le Quang
- Department of Anesthesia, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada
| | - Amal Bessissow
- Department of Medicine, Division of Internal Medicine, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada
| | - Jonathan Spicer
- Department of Surgery, Division of Thoracic Surgery, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada
| | - Francesco Carli
- Department of Anesthesia, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada
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Seitlinger J, Wollbrett C, Mazzella A, Schmid S, Guerrera F, Banga Nkomo D, Hassan M, Brindel A, Ruuth-Praz J, Schmitt P, Clément-Duchêne C, Douiri N, Reeb J, Prisciandaro E, Siat J, Spaggiari L, Ruffini E, Filosso P, Ferri L, Santelmo N, Spicer J, Renaud S. Safety and Feasibility of Thoracic Malignancy Surgery During the COVID-19 Pandemic. Ann Thorac Surg 2020; 112:1870-1876. [PMID: 33333085 PMCID: PMC7834157 DOI: 10.1016/j.athoracsur.2020.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 11/26/2020] [Accepted: 12/01/2020] [Indexed: 12/11/2022]
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has decreased surgical activity, particularly in the field of oncology, because of the suspicion of a higher risk of COVID-19–related severe events. This study aimed to investigate the feasibility and safety of thoracic cancer surgery in the most severely affected European and Canadian regions during the COVID-19 pandemic. Methods The study investigators prospectively collected data on surgical procedures for malignant thoracic diseases from January 1 to April 30, 2020. The study included patients from 6 high-volume thoracic surgery departments: Nancy and Strasbourg (France), Freiburg (Germany), Milan and Turin (Italy), and Montreal (Canada). The centers involved in this research are all located in the most severely affected regions of those countries. An assessment of COVID-19–related symptoms, polymerase chain reaction (PCR)–confirmed COVID-19 infection, rates of hospital and intensive care unit admissions, and death was performed for each patient. Every deceased patient was tested for COVID-19 by PCR. Results In the study period, 731 patients who underwent 734 surgical procedures were included. In the whole cohort, 9 cases (1.2%) of COVID-19 were confirmed by PCR, including 5 in-hospital contaminants. Four patients (0.5%) needed readmission for oxygen requirements. In this subgroup, 2 patients (0.3%) needed intensive care unit and mechanical ventilatory support. The total number of deaths in the whole cohort was 22 (3%). A single death was related to COVID-19 (0.14%). Conclusions Maintaining surgical oncologic activity in the era of the COVID-19 pandemic seems safe and feasible, with very low postoperative morbidity or mortality. To continue to offer the best care to patients who do not have COVID-19, reports on other diseases are urgently needed.
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Affiliation(s)
- Joseph Seitlinger
- Department of Thoracic Surgery, Nancy Regional University Hospital, Nancy, France
| | - Christophe Wollbrett
- Department of Thoracic Surgery, Nancy Regional University Hospital, Nancy, France
| | - Antonio Mazzella
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Severin Schmid
- Department of Thoracic Surgery, University Hospital Freiburg, Freiburg, Germany; Department of Thoracic Surgery and Upper Gastrointestinal Surgery, McGill University, Montreal, Canada
| | | | - Douglas Banga Nkomo
- Department of Thoracic Surgery, Nancy Regional University Hospital, Nancy, France
| | - Mohamed Hassan
- Department of Thoracic Surgery, University Hospital Freiburg, Freiburg, Germany
| | - Aurélien Brindel
- Chest Department, Nancy Regional University Hospital, Nancy, France
| | - Julia Ruuth-Praz
- Chest Department, Nancy Regional University Hospital, Nancy, France
| | - Pierre Schmitt
- Chest Department, Sarreguemines Private Hospital, Sarreguemines, France
| | | | - Nawal Douiri
- Department of Internal Medicine and Infectious Disease, Rhena Private Hospital, Strasbourg, France
| | - Jérémie Reeb
- Department of Thoracic Surgery, Rhena Private Hospital, Strasbourg, France
| | - Elena Prisciandaro
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Joelle Siat
- Department of Thoracic Surgery, Nancy Regional University Hospital, Nancy, France
| | - Lorenzo Spaggiari
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Enrico Ruffini
- Thoracic Surgery Unit, University of Turin, Turin, Italy
| | | | - Lorenzo Ferri
- Department of Thoracic Surgery and Upper Gastrointestinal Surgery, McGill University, Montreal, Canada
| | - Nicola Santelmo
- Department of Thoracic Surgery, Rhena Private Hospital, Strasbourg, France
| | - Jonathan Spicer
- Department of Thoracic Surgery and Upper Gastrointestinal Surgery, McGill University, Montreal, Canada
| | - Stéphane Renaud
- Department of Thoracic Surgery, Nancy Regional University Hospital, Nancy, France.
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