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Potter AL, Spasojevic A, Raman V, Hurd JC, Senthil P, Mathey-Andrews C, Schumacher LY, Yang CFJ. The Increasing Adoption of Minimally Invasive Lobectomy in the United States. Ann Thorac Surg 2023; 116:222-229. [PMID: 36223806 DOI: 10.1016/j.athoracsur.2022.09.032] [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: 01/07/2022] [Revised: 08/22/2022] [Accepted: 09/03/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND The objective of this study is to evaluate the trends of and outcomes associated with the use of minimally invasive lobectomy for stage I and II non-small cell lung cancer (NSCLC) in the United States. METHODS The use of and outcomes associated with open and minimally invasive lobectomy for clinical stage I and stage II NSCLC from 2010 to 2017 in the National Cancer Database were assessed by multivariable logistic regression and propensity score matching. RESULTS From 2010 to 2017, use of minimally invasive lobectomies increased for stage I NSCLC (multivariable-adjusted odds ratio [aOR] 4.52; 95% CI, 3.95-5.18; P < .001) and stage II NSCLC (aOR 4.38; 95% CI, 3.38-5.68; P < .001). In 2015, for the first time, more lobectomies for stage I NSCLC were performed by minimally invasive techniques (52.2%, n = 5647) than by thoracotomy (47.8%, n = 5164); and in 2017, more lobectomies for stage II NSCLC were performed by minimally invasive techniques (54.7%, n = 1620) than by thoracotomy (45.3%, n = 1,342). From 2010 to 2017, the conversion rates from minimally invasive to open lobectomy for stage I NSCLC decreased from 19.6% (n = 466) to 7.2% (n = 521; aOR 0.32; 95% CI, 0.23-0.43; P < .001). Similarly, from 2010 to 2017, the conversion rates from minimally invasive to open lobectomy for stage II NSCLC decreased from 20% (n = 114) to 11.5% (n = 186; aOR 0.39; 95% CI, 0.21-0.72; P = .002). CONCLUSIONS In the United States, for stage I and stage II NSCLC from 2010 to 2017, the use of minimally invasive lobectomy significantly increased while the conversion rate significantly decreased. By 2017, the minimally invasive approach had become the predominant approach for both stage I and stage II NSCLC.
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Affiliation(s)
- Alexandra L Potter
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Ana Spasojevic
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Vignesh Raman
- Division of Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Jacob C Hurd
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Priyanka Senthil
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Camille Mathey-Andrews
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Lana Y Schumacher
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Chi-Fu Jeffrey Yang
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts; Division of Thoracic Surgery, Wentworth-Douglass Hospital, Dover, New Hampshire.
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Luo X, Li D. Effects of epidural block anesthesia combined with general anesthesia on inflammatory factors, cognitive function and postoperative pain in patients with lung cancer after thoracoscopic surgery. Am J Transl Res 2021; 13:13024-13033. [PMID: 34956520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 08/19/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To investigate the effects of epidural block anesthesia combined with general anesthesia on inflammatory factors, cognitive function and postoperative pain in patients with lung cancer after thoracoscopic surgery. METHODS A total of 144 lung cancer patients admitted to the Department of Cardiothoracic Surgery of Ganzi Tibetan Autonomous Prefecture People's Hospital from October 2017 to October 2019 were included in this retrospective cohort study. The patients were divided into an observation group and a control group, with 72 cases in each group. Observation group was treated with epidural block anesthesia plus general anesthesia under thoracoscopic surgery, while control group was treated with general anesthesia alone. General information of both groups was compared. Tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) levels were measured by enzyme-linked immunosorbent assay before anesthesia (T0), before the end of operation (T1), 12 h after operation (T2) and 24 h after operation (T3). Calcium-binding protein (S-100β) content, mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) at T0, T3, the 3rd day after operation (T4), and the 5th day after operation (T5) were measured. And postoperative pain was recorded. RESULTS There were no significant differences in TNF-α, IL-6, MMSE and MoCA between the two groups at T0, and no significant differences were seen in S-100β between the two groups at T0 and T1 (all P>0.05). Compared with control group, observation group had lower TNF-α and IL-6 at T1, T2, T3, T4 and T5, and lower S-100β at T3, T4 and T5 (all P<0.001). Lower pain scores and higher MMSE and MoCA were found in the observation group at T3, T4 and T5 (all P<0.05). CONCLUSION Epidural block anesthesia combined with general anesthesia can effectively reduce levels of inflammatory factors, cognitive disorder and postoperative pain in patients with lung cancer after thoracoscopic surgery.
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Affiliation(s)
- Xiaoqin Luo
- Department of Anesthesiology, Ganzi Tibetan Autonomous Prefecture People's Hospital Kangding 626000, Sichuan Province, China
| | - Dong Li
- Department of Anesthesiology, Ganzi Tibetan Autonomous Prefecture People's Hospital Kangding 626000, Sichuan Province, China
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Vinh VH, Quang NVD, Thanh DDM, Van Le Phong T. Robotic video-assisted thoracoscopic surgery using multiport triangular trocar configuration: initial experience at a single center. J Cardiothorac Surg 2021; 16:77. [PMID: 33849581 PMCID: PMC8045230 DOI: 10.1186/s13019-021-01455-5] [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: 07/11/2020] [Accepted: 04/01/2021] [Indexed: 11/10/2022] Open
Abstract
Background Recent developments in robotic technology have brought significant changes in robotic video-assisted thoracoscopic surgery (r-VATS) worldwide, particularly including the treatment in the thorax for the mediastinal, esophagus, and pulmonary lesions. Currently, there are only a few reports describing the procedural experience and outcomes with r-VATS. The objective of this study is to provide our initial experience using r-VATS at a single center, with specific attention to safety, efficacy, and procedural details. Methods We retrospectively reviewed patients who underwent a newly modified r-VATS procedure for various surgical operations at the thoracic department of our hospital, from July 2018 to January 2020. Multiport trocars were placed in the classic triangular arrangement as in conventional VATS (c-VATS) but with modifications based on the type of surgery. The peri- and postoperative outcomes such as duration of surgery, complications, and duration of hospital stay for these patients were reported. Results Overall, 142 patients underwent r-VATS for lobectomy (66), wedge resection (15), thymectomy (22), mediastinal tumor resection (30), pneumonectomy (4), transthoracic esophagectomy (1), esophageal tumor resection or esophageal diverticulum repair (2), diaphragm plication (1), and mediastinal tumor resection plus thymectomy (1). For the entire cohort, the median operative time was 110 min, and the median length of hospital stay was 5 days. Conversion to open thoracic surgery was reported only in a total of 3 (2.1%) patients of pneumonectomy (1.4%) and mediastinal tumor resection (0.70%). All our patients were managed successfully with no postoperative complications and mortality. Conclusion Our method of r-VATS was found to be safe and effective and may be applied to different surgical operations. Adequate and proper training of thoracic surgeons is immediately needed for the transition from c-VATS to r-VATS. The utility and advantages of triangular trocar configuration for r-VATS require further refinement and research before it can be routinely adopted in clinical practice. Trial registration Retrospectively registered.
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Affiliation(s)
- Vu Huu Vinh
- Department of Thoracic Surgery, Choray Hospital, 202B Nguyen Chi Thanh Street, District No. 5, Hochiminh City, Vietnam.
| | - Nguyen Viet Dang Quang
- Department of Thoracic Surgery, Choray Hospital, 202B Nguyen Chi Thanh Street, District No. 5, Hochiminh City, Vietnam
| | - Dang Dinh Minh Thanh
- Department of Thoracic Surgery, Choray Hospital, 202B Nguyen Chi Thanh Street, District No. 5, Hochiminh City, Vietnam
| | - Truong Van Le Phong
- Department of Thoracic Surgery, Choray Hospital, 202B Nguyen Chi Thanh Street, District No. 5, Hochiminh City, Vietnam
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Hu J, Chen Y, Dai J, Zhu X, Gonzalez-Rivas D, Jiang G, Li H, Zhang P. Perioperative outcomes of robot-assisted vs video-assisted and traditional open thoracic surgery for lung cancer: A systematic review and network meta-analysis. Int J Med Robot 2020; 16:1-14. [PMID: 32400946 DOI: 10.1002/rcs.2123] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 05/06/2020] [Accepted: 05/08/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND The superiority of robot-assisted thoracic surgery (RATS) over video-assisted thoracic surgery (VATS) and thoracotomy remains controversial for lung cancer. METHODS A network meta-analysis (NMA) and pairwise meta-analysis (PMA) were performed to evaluate the perioperative outcomes using five databases. RESULTS Thirty-two studies involving 6593 patients were included for analysis. The NMA showed that RATS had similar operative time, conversion rate to thoracotomy, number of lymph node, postoperative morbidity, and length of hospital stay with VATS, except for lower 30-day mortality. Compared with thoracotomy, longer operative time and shorter hospital stay were observed in RATS, but no significant difference was observed in number of lymph node, postoperative morbidity, and 30-day mortality in both NMA and PMA. In lobectomy/segmentectomy subgroup, all outcomes, except for operative time of RATS vs VATS and number of lymph node, were similar with overall analyses. CONCLUSIONS RATS had comparable perioperative outcomes with VATS and open surgery.
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Affiliation(s)
- Junjie Hu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yan Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jie Dai
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xinsheng Zhu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Diego Gonzalez-Rivas
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.,Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hua Li
- Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Peng Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
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O'Sullivan KE, Kreaden US, Hebert AE, Eaton D, Redmond KC. A systematic review and meta-analysis of robotic versus open and video-assisted thoracoscopic surgery approaches for lobectomy. Interact Cardiovasc Thorac Surg 2019; 28:526-534. [PMID: 30496420 DOI: 10.1093/icvts/ivy315] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 10/08/2018] [Accepted: 10/14/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES A number of meta-analytical and database studies have sought to compare open, video-assisted thoracoscopic surgery (VATS) and robotic operative approaches to lobectomy, often with conflicting results. Our objective was to perform a comprehensive review of these meta-analytical and database studies published to date. METHODS A systematic review was conducted in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines using the PubMed and Scopus databases. Primary outcome was short-term mortality, and secondary outcomes were operative time, blood loss or transfusion rate, hospital stay, conversions, lymph node yield and complications. Meta-analyses of the primary and secondary outcomes were performed. RESULTS Robotic lobectomy is a valid alternative to the VATS approach and is superior to the open approach with respect to complications [OR 0.67, 95% CI 0.58-0.76, P < 0.00001] and duration of hospital stay (WMD -1.4, 95% CI -1.96-0.85, P < 0.00001). It is inferior to both VATS and open with respect to operative duration (robotic vs. VATS; WMD 4.98, 95% CI 2.61-7.36, P < 0.001, robotic vs. open WMD 65.56, 95% CI 53.66-77.46, P < 0.00001). Robotic approach is superior with respect to 30-day mortality compared to VATS (OR 0.61, 95% CI 0.45-0.83, P = 0.001 and open approaches (OR 0.53, 95% CI 0.33-0.85, P = 0.008). CONCLUSIONS This is the largest published systematic review and meta-analysis to date qualifying the robotic lobectomy as a reasonable alternative to VATS and open surgery. Short-term survival is superior in the robotic cohorts. No definitive conclusions on long-term outcomes can be drawn until a randomized controlled trial comparing approaches is conducted.
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Affiliation(s)
- Katie E O'Sullivan
- Department of Thoracic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Usha S Kreaden
- Department of Clinical Affairs, Intuitive Surgial Inc., Sunnyvale, CA, USA
| | - April E Hebert
- Department of Clinical Affairs, Intuitive Surgial Inc., Sunnyvale, CA, USA
| | - Donna Eaton
- Department of Thoracic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Karen C Redmond
- Department of Thoracic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
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Li C, Li H. Robotic-assisted thoracoscopic segmentectomy: there is a long way to go. J Thorac Dis 2017; 9:E968-E970. [PMID: 29268448 DOI: 10.21037/jtd.2017.10.81] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Chengqiang Li
- Department of Thoracic Surgery, Ruijin Hospital Shanghai Jiao Tong University, School of Medicine, Shanghai 200025, China
| | - Hecheng Li
- Department of Thoracic Surgery, Ruijin Hospital Shanghai Jiao Tong University, School of Medicine, Shanghai 200025, China
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