The Very Experienced Time-honoUred Surgeons (VETUS) project

Work in progress report of a multicentre retrospective observational study to evaluate the association between the airflows and the intrapleural pressures digitally recorded after video-assisted lobectomy

OBJECTIVES

Digital chest drainage systems allow real-time and continuous monitoring and recording of air leak flow rate and intrapleural pressure (IPP) from the immediate postoperative period to the chest drainage removal. A multicentre retrospective observational analysis of consecutive patients undergoing pulmonary lobectomy for lung cancer was performed to evaluate the association between the airflow and IPP digitally recorded during the immediate postoperative period after video-assisted thoracic surgery (VATS) lobectomy for lung cancer. Here, we present a work in progress report.

METHODS

All patients treated with VATS lobectomies for lung cancer were included. Multiple airflow measurements and minimum and maximum IPP through the chest tubes were digitally monitored and recorded using microelectronic mechanical sensor technology. The PALs were defined as an air leak lasting >5 days from the conclusion of the surgical procedure. The cessation of air leaks was defined as an airflow <10 ml/min during 6 consecutive hours.

RESULTS

This analysis comprised 76 patients who underwent VATS lobectomy for lung cancer. Nineteen patients (25%) showed prolonged air leaks (PAL) (≥5 days). The operative time was higher in the PAL group (mean difference = 44 min) without a statistically significant difference. Before the 7th postoperative hours, there were no statistically significant differences in IPPs.

CONCLUSIONS

Patients with PAL showed less negative IPP in the first 24 postoperative hours. Therefore, the 7th-24th postoperative hours were critical in PAL prediction since the mechanism for PAL seems to develop after the 7th postoperative hour.

An aggregate score to stratify the technical complexity of video-assisted thoracoscopic lobectomy

OBJECTIVES

The purpose of this study was to develop a score to predict the complexity of video-assisted thoracoscopic surgery (VATS) lobectomies preoperatively.

METHODS

One hundred and thirty-nine consecutive patients undergoing VATS lobectomy operated on by a single surgeon as the first operator were included. Complex operations were defined as: operation time >180 min (corresponding to the 75th percentile) or a conversion to thoracotomy. Several patient-related baseline and radiological variables were tested for a possible association with surgical complexity by logistic regression analysis. An aggregate score was created by weighing the regression estimates of the significant predictors. Patients were then grouped in classes of risk according to their scores. Finally, the score was validated in an external population of 154 VATS lobectomy patients.

RESULTS

Twenty-nine VATS lobectomies (21%) were classified as complex. The following variables were found to be significantly associated with a complex operation and were used to calculate the risk score in each patient (1 point each): male (P = 0.006), presence of thick pleura (P = 0.003), presence of emphysema (P = 0.001), enlarged hilar nodes (P = 0.003). Patients were grouped in 4 classes showing an incremental incidence of complex operations (P < 0.0001): score 0, 7.4%; score 1, 18%; score 2, 27%; score >2, 67%. In the external validation set, the score confirmed its association with the incidence of complex operations (P < 0.001): score 0, 7.3%; score 1, 10%; score 2, 16%; score >2 50%.

CONCLUSIONS

The complexity score appeared to be reproducible in an external setting and can be used to preoperatively identify appropriate candidates for VATS lobectomies to improve the efficiency and safety of the training phase.