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Wang H, Wang W, Zu P, Kocher GJ, Antonoff MB, Lopez-Pastorini A, Zhang C, Chen W, Liu H. Single-center clinical experience of extended sleeve lobectomy (ESL) versus standard sleeve lobectomy (SL). Transl Lung Cancer Res 2024; 13:1988-1999. [PMID: 39263034 PMCID: PMC11384477 DOI: 10.21037/tlcr-24-546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 08/17/2024] [Indexed: 09/13/2024]
Abstract
Background Sleeve lobectomy (SL) and extended SL (ESL), which aim to preserve pulmonary function and enhance the quality of life of patients while ensuring oncological outcomes, are valuable surgical options for the treatment of centrally located non-small cell lung cancer (NSCLC). This study aimed to compare perioperative adverse events and long-term survival between SL and ESL in NSCLC patients, providing a comprehensive review of surgical outcomes, complications, and survival to assess the roles of SL and ESL in thoracic oncology. Methods This single-center retrospective study assessed the outcomes of NSCLC patients who underwent SL or ESL from June 2014 to January 2022. The patients were selected based on specific inclusion criteria, and statistical analyses were conducted to examine the postoperative outcomes, overall survival (OS), and disease-free survival (DFS) of the patients. Results A total of 218 patients met the inclusion criteria. Among 218 patients, 33 underwent ESL and 185 underwent SL. Compared to SL, ESL was associated with longer operative times and higher R0 resection rates (93.9% vs. 78.8%, P=0.047). Despite the higher complexity of ESL compared to SL, there were no significant differences in the perioperative complications or mortality rates between the groups. Survival analysis was conducted on the propensity score matching (PSM) data, the results demonstrated superior OS and DFS in the ESL group compared to the SL group. Advanced age, more advanced nodal (N) status, and non-R0 resection were significant predictors of poorer prognosis. Conclusions ESL is a feasible and effective alternative for treating centrally located NSCLC, with better R0 resection rates and comparable survival outcomes to SL, without increasing the risk of grade III-IV complications. Further studies with larger cohorts need to be conducted to validate these findings and refine the surgical techniques.
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Affiliation(s)
- Haoyou Wang
- Department of Thoracic Surgery, Liaoning Cancer Hospital & Institute, Cancer Hospital of China Medical University, Shenyang, China
- Department of Thoracic Surgery, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Wei Wang
- Department of Thoracic Surgery, Liaoning Cancer Hospital & Institute, Cancer Hospital of China Medical University, Shenyang, China
- Department of Thoracic Surgery, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Peng Zu
- Department of Thoracic Surgery, Liaoning Cancer Hospital & Institute, Cancer Hospital of China Medical University, Shenyang, China
- Department of Thoracic Surgery, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Gregor J Kocher
- Department of Thoracic Surgery, Hirslanden Clinic Beau Site Bern and Lindenhof Hospital, Bern, Switzerland
- Division of Thoracic Surgery, University of Bern, Bern, Switzerland
| | - Mara B Antonoff
- Department of Thoracic & Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alberto Lopez-Pastorini
- Department of Thoracic Surgery, St. Hildegardis Hospital, Cologne, Germany
- Department of Thoracic Surgery, Witten/Herdecke University, Witten, Germany
| | - Chenlei Zhang
- Department of Thoracic Surgery, Liaoning Cancer Hospital & Institute, Cancer Hospital of China Medical University, Shenyang, China
- Department of Thoracic Surgery, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Wei Chen
- Department of Thoracic Surgery, Liaoning Cancer Hospital & Institute, Cancer Hospital of China Medical University, Shenyang, China
- Department of Thoracic Surgery, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Hongxu Liu
- Department of Thoracic Surgery, Liaoning Cancer Hospital & Institute, Cancer Hospital of China Medical University, Shenyang, China
- Department of Thoracic Surgery, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital & Institute, Shenyang, China
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Nitsche LJ, Jordan S, Demmy T, Dexter E, Hennon M, Nwogu C, Yendamuri S, Picone A. Analyzing the impact of minimally invasive surgical approaches on post-operative outcomes of pneumonectomy and sleeve lobectomy patients. J Thorac Dis 2023; 15:2497-2504. [PMID: 37324102 PMCID: PMC10267906 DOI: 10.21037/jtd-22-654] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 03/24/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Some patients with non-small cell lung cancer (NSCLC) have superior short- and long-term outcomes with sleeve lobectomy rather than pneumonectomy. Originally sleeve lobectomy was reserved for patients with limited pulmonary function, however, the reported superior results allowed sleeve lobectomy to be performed in expanded patient populations. In a further attempt to improve post-operative outcomes surgeons have adopted minimally invasive techniques Minimally invasive approaches have potential benefits to patients such as decreased morbidity and mortality while maintaining the same caliber of oncologic outcomes. METHODS We identified patients at our institution who underwent sleeve lobectomy or pneumonectomy to treat NSCLC from 2007 to 2017. We analyzed these groups in respect to 30- and 90-day mortality, complications, local recurrence, and median survival. We included multivariate analysis to determine the impact of a minimally invasive approach, sex, extent of resection, and histology. Differences in mortality were analyzed using the Kaplan-Meier method using the log-rank test to compare the groups. A two-tailed Z test for difference in proportions was done to analyze complications, local recurrence, 30-day and 90-day mortality. RESULTS A total of 108 patients underwent sleeve lobectomy (n=34) or pneumonectomy (n=74) for treatment of NSCLC with 18 undergoing open pneumonectomy, 56 undergoing video-assisted thoracoscopic surgery (VATS) pneumonectomy, 29 undergoing open sleeve lobectomy, and 5 undergoing VATS sleeve lobectomy. There was no significant difference in 30-day mortality (P=0.064) but there was a difference in 90-day (P=0.007). There was no difference in complication rates (P=0.234) or local recurrence rates (P=0.779). The pneumonectomy patients had a median survival of 23.6 months (95% CI: 3.8-43.4 months). The sleeve lobectomy group had a median survival of 60.7 months (95% CI: 43.3-78.2 months) (P=0.008). On multivariate analysis extent of resection (P<0.001) and tumor stage (P=0.036) were associated with survival. There was no significant difference between the VATS approach and the open surgical approach (P=0.053). CONCLUSIONS When considering patients undergoing surgery for NSCLC sleeve lobectomy resulted in lower 90-day mortality and better 3-year survival compared to patients undergoing PN. Having a sleeve lobectomy rather than a pneumonectomy and having earlier-stage disease lead to significantly improved survival on multivariate analysis. Having a VATS operation leads to a non-inferior post-operative outcome compared to open surgery.
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Affiliation(s)
- Lindsay J Nitsche
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, USA
| | - Sean Jordan
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, USA
| | - Todd Demmy
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, USA
| | - Elisabeth Dexter
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, USA
| | - Mark Hennon
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, USA
| | - Chukwumere Nwogu
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, USA
| | - Sai Yendamuri
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, USA
| | - Anthony Picone
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, USA
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Shaolin T, Yonggeng F, Poming K, Longyong M, Cheng S, Chunshu F, Licheng W, Qunyou T, Bo D. Comparison of Sleeve Lobectomy for Lung Cancer Using Mini-Thoracotomy and an Optimized Robot-Assisted Technique. Technol Cancer Res Treat 2021; 20:15330338211051547. [PMID: 34736363 PMCID: PMC8573479 DOI: 10.1177/15330338211051547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: To evaluate the clinical significance of an optimized approach to improve surgical field visualization and simplify anastomosis techniques using robotic-assisted sleeve lobectomy for lung or bronchial carcinoma. Method: A total of 26 consecutive patients who underwent sleeve lobectomy between January 2017 and April 2020 were enrolled in the study. The cohort included 11 cases of robotic-assisted surgery (RAS group) and 15 cases of mini-thoracotomy (MT group). RAS was performed via an exclusive optimized approach utilizing the "3 to 4-6 to 8/9" four-port technique. Retrieved demographical and clinical data included operation time, anastomosis time, blood loss, chest drainage time and volume, postoperative pain scores, complications, white blood cell (WBC) levels, and duration of hospital stay and follow-up. Results: No cases of perioperative death were recorded. Compared to MT group, the RAS group had a similar anastomosis time (30.82 ± 6.08 vs 33.20 ± 7.73 min, respectively, p > 0.05) and shorter operation time (189.73 ± 36.41 vs 225.33 ± 38.19 min, respectively, p < 0.05). The RAS group had lower pain scores (4.23 ± 0.26 vs 4.91 ± 0.51, p < 0.05), lower levels of WBC (p < 0.05), and no anastomotic complications postoperatively. The RAS and MT groups demonstrated a successful bronchus reconstruction with low risk of angulation (1/11 vs 1/15, p > 0.05) and satisfactory disease-free survival (eight cases, 72.73% and 12 cases, 80%, respectively). Conclusion: The optimized approach to RA sleeve lobectomy is convenient and efficient and provides satisfactory clinical outcomes. Further study with a large sample size and evaluation of long-term survival are warranted. Key points: (i) we present a novel, convenient, and efficient approach for robotic-assisted sleeve lobectomy, ie, "3 to 4-6 to 8/9" four-port technique. The optimized approach for RA sleeve lobectomy is convenient and efficient and provides satisfactory clinical outcomes; (ii) details for the "3 to 4-6 to 8/9" four-port method: the assistant port was located at the fourth intercostal space. The 1-cm camera port was inserted at the sixth intercostal space in the posterior axillary line. The 0.5-cm da Vinci ports of the instrument arms were placed at the third intercostal space in the anterior axillary line and the eighth or ninth intercostal space in the posterior axillary line. The patient cart was inserted from the back of the patient's head and shoulders at 75° to the longitudinal line.
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Affiliation(s)
- Tao Shaolin
- Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, 12525Army Medical University, Chongqing 400042, China
| | - Feng Yonggeng
- Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, 12525Army Medical University, Chongqing 400042, China
| | - Kang Poming
- Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, 12525Army Medical University, Chongqing 400042, China
| | - Mei Longyong
- Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, 12525Army Medical University, Chongqing 400042, China
| | - Shen Cheng
- Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, 12525Army Medical University, Chongqing 400042, China
| | - Fang Chunshu
- Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, 12525Army Medical University, Chongqing 400042, China
| | - Wu Licheng
- Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, 12525Army Medical University, Chongqing 400042, China
| | - Tan Qunyou
- Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, 12525Army Medical University, Chongqing 400042, China
| | - Deng Bo
- Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, 12525Army Medical University, Chongqing 400042, China
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Jeon YJ, Yun J, Choi YS, Kim MS, Choi JW. Feasibility of video-assisted thoracoscopic sleeve lobectomy for non-small cell lung cancer. PRECISION AND FUTURE MEDICINE 2021. [DOI: 10.23838/pfm.2020.00184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Wang Z, Li M, Teng F, Kong L, Yu J. Primary tumor location is an important predictor of survival in pulmonary adenocarcinoma. Cancer Manag Res 2019; 11:2269-2280. [PMID: 30962716 PMCID: PMC6432898 DOI: 10.2147/cmar.s192828] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose The prognostic value of tumor location in pulmonary adenocarcinoma (ADC) is controversial. We compared the prognosis and relevant data between central-type ADC (CT-ADC) and peripheral-type ADC (PT-ADC) in order to identify the reasons for the different outcomes between them and to improve the treatment strategy and prognosis of these two types. Patients and methods Data of 256 patients with pathologically diagnosed ADC were retrospectively reviewed. The prognostic factors for disease-free survival (DFS), progression-free survival (PFS), and overall survival (OS) were analyzed using univariate and multivariate analyses. Results A total of 124 and 132 patients had CT-ADC and PT-ADC, respectively. CT-ADC was associated with an earlier age, poorer Karnofsky Performance Status (KPS), higher rates of advanced stage, bone metastasis, contralateral pulmonary metastasis, and pleural effusion. Besides, CT-ADC showed a trend toward lower rate of EGFR mutation. Patients with CT-ADC had a significantly shorter PFS/DFS and OS than did those with PT-ADC. Multivariate analysis revealed that advanced stage, central-type location, EGFR wild-type, no surgery, presence of COPD, and interstitial lung disease (ILD) were independent poor prognostic factors for OS. The rate of surgery was significantly lower in patients with CT-ADC. Among patients with ILD or COPD, OS is shorter in patients with central- than peripheral-type tumors. Conclusion CT-ADC is associated with poorer survival than PT-ADC and the lower rate of surgery in patients with CT-ADC is an important reason for this. Tumor location of pulmonary ADC plays a critical role in predicting prognosis and choosing therapeutic strategies.
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Affiliation(s)
- Zhe Wang
- School of Medicine, Shandong University, Jinan, Shandong, China.,Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, China, ;
| | - Minghuan Li
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, China, ;
| | - Feifei Teng
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, China, ;
| | - Li Kong
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, China, ;
| | - Jinming Yu
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, China, ;
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Guido-Guerrero W, Bolaños-Cubillo A, González-Rivas D. Single-port video-assisted thoracic surgery (VATS)-advanced procedures & update. J Thorac Dis 2018; 10:S1652-S1661. [PMID: 30034831 DOI: 10.21037/jtd.2018.05.43] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The uniportal approach for major pulmonary resections began in 2010, with the first case being reported by D González-Rivas and colleagues in La Coruña, Spain. Since then, in different countries, thoracic surgeons had been performing hundreds of cases, with more advanced and complex procedures. Nowadays, there are reports of uniportal tracheal resection and reconstruction, carinal resection, bronchoplastic procedures, lobectomies with en bloc chest wall excision, and vascular reconstruction with optimal outcomes. The development of technologies and the potential benefits of a direct view, anatomic instrumentation, better cosmesis, and, potentially, less postoperative pain have led uniportal video-assisted thoracic surgery to grow exponentially worldwide.
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Affiliation(s)
- William Guido-Guerrero
- Department of Thoracic Surgery, Rafael Angel Calderón Guardia Hospital, San José, Costa Rica
| | - Albert Bolaños-Cubillo
- Department of Thoracic Surgery, Rafael Angel Calderón Guardia Hospital, San José, Costa Rica
| | - Diego González-Rivas
- Department of Thoracic Surgery, Coruña University Hospital and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain.,Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
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