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Bai G, Chen X, Peng Y, Ji Y, Bie F, Liu Y, Yang Z, Gao S. Surgery challenges and postoperative complications of lung cancer after neoadjuvant immunotherapy. Thorac Cancer 2024; 15:1138-1148. [PMID: 38572774 DOI: 10.1111/1759-7714.15297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/11/2024] [Accepted: 03/13/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND In China, real-world data on surgical challenges and postoperative complications after neoadjuvant immunotherapy of lung cancer are limited. METHODS Patients were retrospectively enrolled from January 2018 to January 2023, and their clinical and pathological characters were subsequently analyzed. Surgical difficulty was categorized into a binary classification according to surgical duration: challenging or routine. Postoperative complications were graded using Clavien-Dindo grades. Logistic regression was used to identify risk factors affecting the duration of surgery and postoperative complications greater than Clavien-Dindo grade 2. RESULTS In total, 261 patients were included. Of these, stage III patients accounted for 62.5% (163/261) at initial diagnosis, with 25.3% (66/261) at stage IIIB. Central-type non-small-cell lung cancer accounted for 61.7% (161/261). One hundred and forty patients underwent video-assisted thoracoscopic surgery and lobectomy accounted for 53.3% (139/261) of patients. Surgical time over average duration was defined as challenging surgeries, accounting for 43.7%. The postoperative complications rate of 261 patients was only 22.2%. Smoking history (odds ratio [OR] = 9.96, 95% [CI] 1.15-86.01, p = 0.03), chemoimmunotherapy (OR = 2.89, 95% CI 1.22-6.86, p = 0.02), and conversion to open surgery (OR = 11.3, 95% CI 1.38-92.9, p = 0.02) were identified as independent risk factors for challenging surgeries, while pneumonectomy (OR = 0.36, 95% CI 0.15-0.86, p= 0.02) was a protective factor. Meanwhile, pneumonectomy (OR = 7.51, 95% CI 2.40-23.51, p < 0.01) and challenging surgeries (OR = 5.53, 95% CI 1.50-20.62, p = 0.01) were found to be risk factors for postoperative complications greater than Clavien-Dindo grade 2. CONCLUSIONS Compared to immunotherapy alone or in combination with apatinib, neoadjuvant chemoimmunotherapy could increase the difficulty of surgery while the incidence of postoperative complications remained acceptable. The conversion to open surgery and pneumonectomy after neoadjuvant immunotherapy should be reduced.
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Affiliation(s)
- Guangyu Bai
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaowei Chen
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue Peng
- Department of Thoracic Surgery, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Ying Ji
- Department of Thoracic Surgery, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Fenglong Bie
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yang Liu
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhenlin Yang
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shugeng Gao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Zini J, Dayan G, Têtu M, Kfouri T, Maqueda LB, Abdulnour E, Ferraro P, Ghosn P, Lafontaine E, Martin J, Nasir B, Liberman M. Intersurgeon variations in postoperative length of stay after video-assisted thoracoscopic surgery lobectomy. JTCVS OPEN 2024; 18:253-260. [PMID: 38690406 PMCID: PMC11056473 DOI: 10.1016/j.xjon.2024.01.003] [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: 05/06/2023] [Revised: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 05/02/2024]
Abstract
Objectives To identify factors associated with prolonged postoperative length of stay (LOS) after VATS lobectomy (VATS-L), explore potential intersurgeon variation in LOS and ascertain whether or not early discharge influences hospital readmission rates. Methods We conducted a retrospective analysis of patients who underwent VATS-L at a single academic center between 2018 and 2021. Each VATS lobectomy procedure was performed by 1 of 7 experienced thoracic surgeons. The primary end point of interest was prolonged LOS, defined as an index LOS >3 days. Results Among 1006 patients who underwent VATS lobectomy, 632 (63%) had a prolonged LOS. On multivariate analysis, the factors independently associated with prolonged LOS were: surgeon (P < .001), patient age (odds ratio [OR], 1.03; 95% CI, 1.02-1.06), operation time (OR, 1.01; 95% CI, 1.01-1.01), postoperative complication (OR, 3.60; 95% CI, 2.45-5.29), and prolonged air leak (OR, 8.95; 95% CI, 4.17-19.23). There was no significant association between LOS and gender, body mass index, coronary artery disease, prior atrial fibrillation, American Society of Anesthesiologists score >3, and prior ipsilateral thoracic surgery or sternotomy. There was no association between LOS ≤3 days and hospital readmission (20 [5.3%] vs 39 [5.9%]; OR, 0.88; 95% CI, 0.50-1.53). Conclusions An intersurgeon variation in postoperative LOS after VATS-L exists and is independent of patient baseline characteristics or perioperative complications. This variation seems to be more closely related to differences in postoperative management and discharge practices rather than to surgical quality. Postoperative discharge within 3 days is safe and does not increase hospital readmissions.
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Affiliation(s)
- Jonathan Zini
- Division of Thoracic Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Québec, Canada
| | - Gabriel Dayan
- Division of Thoracic Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Québec, Canada
| | - Maxime Têtu
- Division of Thoracic Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Québec, Canada
| | - Toni Kfouri
- Division of Thoracic Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Québec, Canada
| | - Luciano Bulgarelli Maqueda
- Division of Thoracic Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Québec, Canada
| | - Elias Abdulnour
- Division of Thoracic Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Québec, Canada
| | - Pasquale Ferraro
- Division of Thoracic Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Québec, Canada
| | - Pierre Ghosn
- Division of Thoracic Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Québec, Canada
| | - Edwin Lafontaine
- Division of Thoracic Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Québec, Canada
| | - Jocelyne Martin
- Division of Thoracic Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Québec, Canada
| | - Basil Nasir
- Division of Thoracic Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Québec, Canada
| | - Moishe Liberman
- Division of Thoracic Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Québec, Canada
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Bulgarelli Maqueda L, Têtu M, Guimarães Rocha Lima P, Abu-Reida F, Alashgar O, Dayan G, Nasir B, Ferraro P, Liberman M. Outside the Cage Subcostal RATS Lobectomy: Technical Aspects and Results of the First Series of a Novel Approach to Pulmonary Lobectomy. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2023; 18:519-524. [PMID: 38073258 PMCID: PMC10757067 DOI: 10.1177/15569845231217257] [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] [Indexed: 12/18/2023]
Abstract
OBJECTIVE The goal of minimally invasive surgery is to reduce trauma to patients and improve their postoperative outcomes. In this context, the utilization of robot-assisted thoracic surgery (RATS) in the treatment of lung cancer has increased worldwide. The feasibility of single-incision major pulmonary resections by RATS was recently reported, with the objective of minimizing the surgical trauma of the traditional multiportal RATS approach. However, both techniques require intercostal incisions, potentially causing immediate and chronic pain resulting from intercostal nerve injury. To reduce postoperative pain resulting from intercostal approaches, we developed a nonintercostal, outside the thoracic cage (OTC) approach for RATS lobectomy, avoiding intercostal instrumentation. This report aims to describe the results of the first reported series of OTC subcostal RATS lobectomies. METHODS Retrospective analysis of a series of the first consecutive patients operated on using the novel OTC subcostal RATS lobectomy technique. RESULTS Between August and December 2022, a total of 10 consecutive cases were analyzed. The median age was 63 (55 to 84) years, the mean body mass index was 29 (24 to 45) kg/m2, and the median American Society of Anesthesiologists score was III (II to IV). No serious adverse events were observed, and there was no conversion of the surgical technique. The mean operative time was 132.6 (98 to 223) min. The median length of stay was 2 days. No pain-related complications, readmissions, or 30-day mortality were observed. CONCLUSIONS This series demonstrates that OTC RATS lobectomy is feasible and safe. A phase I clinical trial is currently underway to prospectively assess the safety of the technique as well as its clinical relevance.
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Affiliation(s)
- Luciano Bulgarelli Maqueda
- Department of Thoracic Surgery, CHUM
Endoscopic Tracheobronchial and Oesophageal Center (CETOC), Centre Hospitalier de
l’Université de Montréal (CHUM), University of Montréal, QC, Canada
- Centre de Recherche de Centre
Hospitalier de l’Université de Montréal (CR-CHUM), QC, Canada
| | - Maxime Têtu
- Centre de Recherche de Centre
Hospitalier de l’Université de Montréal (CR-CHUM), QC, Canada
| | - Pedro Guimarães Rocha Lima
- Department of Thoracic Surgery, CHUM
Endoscopic Tracheobronchial and Oesophageal Center (CETOC), Centre Hospitalier de
l’Université de Montréal (CHUM), University of Montréal, QC, Canada
- Centre de Recherche de Centre
Hospitalier de l’Université de Montréal (CR-CHUM), QC, Canada
| | - Feras Abu-Reida
- Department of Thoracic Surgery, CHUM
Endoscopic Tracheobronchial and Oesophageal Center (CETOC), Centre Hospitalier de
l’Université de Montréal (CHUM), University of Montréal, QC, Canada
- Centre de Recherche de Centre
Hospitalier de l’Université de Montréal (CR-CHUM), QC, Canada
| | - Omniyah Alashgar
- Department of Thoracic Surgery, CHUM
Endoscopic Tracheobronchial and Oesophageal Center (CETOC), Centre Hospitalier de
l’Université de Montréal (CHUM), University of Montréal, QC, Canada
| | - Gabriel Dayan
- Centre de Recherche de Centre
Hospitalier de l’Université de Montréal (CR-CHUM), QC, Canada
| | - Basil Nasir
- Department of Thoracic Surgery, CHUM
Endoscopic Tracheobronchial and Oesophageal Center (CETOC), Centre Hospitalier de
l’Université de Montréal (CHUM), University of Montréal, QC, Canada
- Centre de Recherche de Centre
Hospitalier de l’Université de Montréal (CR-CHUM), QC, Canada
| | - Pasquale Ferraro
- Department of Thoracic Surgery, CHUM
Endoscopic Tracheobronchial and Oesophageal Center (CETOC), Centre Hospitalier de
l’Université de Montréal (CHUM), University of Montréal, QC, Canada
- Centre de Recherche de Centre
Hospitalier de l’Université de Montréal (CR-CHUM), QC, Canada
| | - Moishe Liberman
- Department of Thoracic Surgery, CHUM
Endoscopic Tracheobronchial and Oesophageal Center (CETOC), Centre Hospitalier de
l’Université de Montréal (CHUM), University of Montréal, QC, Canada
- Centre de Recherche de Centre
Hospitalier de l’Université de Montréal (CR-CHUM), QC, Canada
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Semmelmann A, Baar W, Haude H, Moneke I, Loop T. Risk Factors for Postoperative Pulmonary Complications Leading to Increased Morbidity and Mortality in Patients Undergoing Thoracic Surgery for Pleural Empyema. J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00252-5. [PMID: 37236839 DOI: 10.1053/j.jvca.2023.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/04/2023] [Accepted: 04/14/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVES Surgery for pleural empyema carries a high burden of morbidity and mortality. The authors investigated the incidence of postoperative pulmonary complications (PPCs) and their effects on perioperative morbidity and mortality. Patient-specific, preoperative, procedural, and postoperative risk factors for PPCs were analyzed. DESIGN Retrospective observational study. SETTING A single, large university hospital. PARTICIPANTS A total of 250 adult patients were included who underwent thoracic surgery for pleural empyema between January 2017 and December 2021. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 250 patients with pleural empyema underwent thoracic surgery by video-assisted thoracoscopic surgery (49%; n = 122) or open thoracotomy (51%; n = 128). A proportion (42% [105]) of patients had ≥1 PPCs; 28% (n = 70) had to undergo resurgery; and 10% (n = 25) were re-admitted unexpectedly to the ICU. Preoperative respiratory failure (odds ratio [OR]: 5.8, 95% CI: 2.4-13.1), general anesthesia without regional analgesia techniques (OR: 2.9, 95% CI: 1.4-5.8), open thoracotomy and subsequent resurgery (OR: 3.9, 95% CI 1.5-9.9), surgery outside the regular working hours (OR: 3.1, 95% CI 1.2-8.2), and postoperative sepsis (OR: 2.6, 95% CI 1.1-6.8) were identified as independent risk factors for PPCs. Postoperative pulmonary complications were independent factors for unplanned intensive care unit admission (OR: 10.5, 95% CI 2.1-51 for >1 PPC), death within 360 days (OR: 4.5, 95% CI 2.2-12.3 for ≥2 PPCs), and death within 30 days for ≥1 PPCs (OR: 1.2, 95% CI 1.1-1.3). CONCLUSIONS The incidence of PPCs is a significant risk factor for morbidity and mortality after surgery for pleural empyema. Targeting the risk factors identified in this study could improve patient outcomes.
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Affiliation(s)
- Axel Semmelmann
- Department of Anesthesiology and Critical Care, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Wolfgang Baar
- Department of Anesthesiology and Critical Care, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Haron Haude
- Department of Anesthesiology and Critical Care, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Isabelle Moneke
- Department of Thoracic Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Torsten Loop
- Department of Anesthesiology and Critical Care, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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