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Gioutsos K, Hayoz YJ, Dorn P. Clinical and Oncological Outcomes after Uniportal Anatomical Segmentectomy for Stage IA Non-Small Cell Lung Cancer. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1064. [PMID: 37374269 DOI: 10.3390/medicina59061064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/24/2023] [Accepted: 05/27/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: The existing literature comparing sublobar and lobar resection in the treatment of stage IA lung cancer highlights the trend and overall need for further evaluation of minimally invasive, parenchymal-sparing techniques. The role of uniportal minimally invasive segmentectomy in the oncological therapy of early-stage non-small cell lung cancer (NSCLC) remains controversial. The aim of this study was to evaluate the clinical and midterm oncological outcomes of patients who underwent uniportal video-assisted anatomical segmentectomy for pathological stage IA lung cancer. Materials and Methods: We retrospectively analyzed all patients with pathological stage IA lung cancer (8th edition UICC) who underwent uniportal minimally invasive anatomical segmentectomy at our institution from January 2015 to December 2018. Results: 85 patients, 54 of whom were men, were included. The median length of hospital stay was 3 days (1.-3. IQR 3-5), whereas 30-day morbidity was 15.3% (13 patients), and the in-hospital mortality rate was 1.2% (1 patient). The 3-year overall survival rate was 87.9% for the total population. It was 90.5% in the IA1 group, 93.3% in the IA2 group, and 70.1% in the IA3 group, respectively. Conclusions: There were satisfactory short-term clinical outcomes with low 30-day morbidity and mortality and promising midterm oncological survival results following uniportal minimally invasive anatomical segmentectomy for pathological stage IA non-small cell lung cancer.
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Affiliation(s)
- Konstantinos Gioutsos
- Department of Thoracic Surgery, Inselspital, University Hospital of Bern, 3010 Bern, Switzerland
| | - Yves J Hayoz
- Department of Thoracic Surgery, Inselspital, University Hospital of Bern, 3010 Bern, Switzerland
| | - Patrick Dorn
- Department of Thoracic Surgery, Inselspital, University Hospital of Bern, 3010 Bern, Switzerland
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Zhang C, Jiang D, Luo C, Yuan D, Shang G. Perioperative Effect of Single-Port Thoracoscopic Segmentectomy and Three-Port Thoracoscopic Segmentectomy in the Treatment of Early Non-Small-Cell Lung Cancer. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2023; 2023:7550317. [PMID: 36873790 PMCID: PMC9981298 DOI: 10.1155/2023/7550317] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/19/2022] [Accepted: 09/27/2022] [Indexed: 02/25/2023]
Abstract
Background Clinically, there were few reports on single-hole thoracoscopic segmental resection in non-small-cell lung cancer (NSCLC), and no report on the comparison of single-hole and three-hole thoracoscopic segmental resection. Hence, the purpose of the study was to explore the perioperative role of single-port thoracoscopic segmentectomy and three-port thoracoscopic segmentectomy for early-stage NSCLC. Methods The clinical data of 80 patients with early-stage NSCLC who were treated in our hospital from January 2021 to June 2022 were selected as the retrospective research subjects and divided into a comparison/research group with 40 cases in each group according to different surgical methods. Among them, the comparison group was received three-port thoracoscopic segmentectomy, and the research group was received single-port thoracoscopic segmentectomy. The surgical indicators, immune and tumor marker levels, as well as prognostic complications between two groups were compared. Results There was no remarkable diversity between the two groups in terms of operation time and the number of lymph nodes dissected during the operation (P > 0.05). The surgical blood loss in research group was lower than comparison group (P < 0.05). After treatment, the levels of CYFRA21-1, CA125, as well as VGEF in the research group were markedly lower than comparison group (P < 0.05). The differences in CD4+, CD3+, and CD4+/CD8+ after treatment were prominent, and the research group was higher than comparison group (P < 0.05). There was no statistical difference in postoperative complications between the two groups (P > 0.05). Conclusions Single-hole thoracoscopic lobectomy has obvious advantages in the treatment of NSCLC, which can reduce intraoperative bleeding, enhance the recovery of patients' immune function, and promote postoperative recovery.
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Affiliation(s)
- Cong Zhang
- Department of Thoracic Surgery, Chengdu Seventh People's Hospital, Chengdu, 610200 Sichuan, China
| | - Dexiong Jiang
- Department of Thoracic Surgery, Chengdu Seventh People's Hospital, Chengdu, 610200 Sichuan, China
| | - Cuilian Luo
- Department of Oncology, Chengdu Seventh People's Hospital, Chengdu, 610200 Sichuan, China
| | - Dongdong Yuan
- Department of Thoracic Surgery, Chengdu Seventh People's Hospital, Chengdu, 610200 Sichuan, China
| | - Guansheng Shang
- Department of Thoracic Surgery, Chengdu Seventh People's Hospital, Chengdu, 610200 Sichuan, China
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Romsa J, Imhoff RJ, Palli SR, Inculet R, Mehta S. SPECT/CT versus planar imaging to determine treatment strategy for non-small-cell lung cancer: a cost-effectiveness analysis. J Comp Eff Res 2022; 11:229-241. [PMID: 35006007 DOI: 10.2217/cer-2021-0139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: SPECT/CT has been found to improve predicted postoperative forced expiratory volume in one second (ppoFEV1) assessments in patients with non-small-cell lung cancer (NSCLC). Methods: An economic simulation was developed comparing the cost-effectiveness of SPECT/CT versus planar scintigraphy for a US payer. Clinical outcomes and cost data were obtained through review of the published literature. Results: SPECT/CT increased the accuracy ppoFEV1 assessment, changing the therapeutic decision for 1.3% of nonsurgical patients to a surgical option, while 3.3% of surgical patients shifted to more aggressive procedures. SPECT/CT led to an expected cost of $4694 per life year gained, well below typical thresholds. Conclusion: SPECT/CT resulted in substantially improved health outcomes and was found to be highly cost-effective.
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Affiliation(s)
- Jonathan Romsa
- Department of Medical Imaging, Division of Nuclear Medicine, University of Western Ontario, 800 Commissioners Rd E, London, ON N6A 5W9, Canada
| | - Ryan J Imhoff
- CTI Clinical Trial & Consulting Services, 100 E. RiverCenter Blvd, Covington, KY 41011, USA
| | - Swetha R Palli
- CTI Clinical Trial & Consulting Services, 100 E. RiverCenter Blvd, Covington, KY 41011, USA
| | - Richard Inculet
- Department of Surgery, Division of Thoracic Surgery, University of Western Ontario, 268 Grosvenor Street, St. Joseph's Hospital Rm. E3-117, London, ON N6A 4V2, Canada
| | - Sanjay Mehta
- Department of Medicine, Respirology Division, London Health Sciences Centre, University of Western Ontario, 800 Commissioners Rd E, London, ON N6A 5W9, Canada
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Chen YY, Huang WL, Chang CC, Yen YT, Tseng YL. Uniportal versus Multiportal Thoracoscopic Complex Segmentectomy: Propensity Matching Analysis. Ann Thorac Cardiovasc Surg 2020; 27:237-243. [PMID: 33239482 PMCID: PMC8374094 DOI: 10.5761/atcs.oa.20-00231] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: Uniportal video-assisted thoracoscopic surgery (VATS) complex segmentectomy has been challenging for thoracic surgeons. This study was designed to compare the perioperative outcomes between uniportal and multiportal VATS complex segmentectomy. Methods: Data on a total of 122 uniportal and 57 multiportal VATS complex segmentectomies were assessed. Propensity score (PS) matching yielded 56 patients in each group. A crude comparison and PS matching analyses, incorporating preoperative variables, were conducted to elucidate the short-term outcomes between uniportal and multiportal VATS complex segmentectomies. Results: The uniportal group had a significantly shorter operation time (173 min vs. 195 min, p = 0.004), pleural drainage duration (2.5 d vs. 3.5 d, p <0.001), and postoperative hospital stay (4.2 d vs. 5.3 d, p <0.001) before matching, and a significant difference was also observed after matching for pleural drainage duration (2.5 d vs. 3.6 d, p <0.001) and postoperative hospital stay (4.5 d vs. 5.2 d, p = 0.001). The numbers of dissected lymph nodes in N1 and N2 stations, the intraoperative and postoperative complication rates were not significantly different between these two groups. Conclusions: The uniportal VATS complex segmentectomy was not inferior to multiportal VATS in terms of perioperative outcomes and therefore should be considered as a viable surgical approach for treatment.
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Affiliation(s)
- Ying-Yuan Chen
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Li Huang
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chao-Chun Chang
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Ting Yen
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yau-Lin Tseng
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Nonintubated Versus Intubated Uniportal Thoracoscopic Segmentectomy for Lung Tumors. Ann Thorac Surg 2020; 111:1182-1189. [PMID: 32857994 DOI: 10.1016/j.athoracsur.2020.06.058] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 05/20/2020] [Accepted: 06/15/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Although the use of the uniportal thoracoscopic technique has spread exponentially recently, a comparison of nonintubated and intubated uniportal thoracoscopic segmentectomies for lung tumors has not been reported. We aimed to compare the feasibility, safety, and short-term postoperative outcomes between the 2 methods. METHODS From January 2014 to June 2019 we retrospectively reviewed 185 consecutive patients with lung tumors who underwent uniportal thoracoscopic segmentectomy at our institute. A body mass index of ≥25 kg/m2 was considered a contraindication for the nonintubated anesthetic approach. For the remaining cases the anesthetic approach was made at the discretion of each individual anesthesiologist. A propensity-matched analysis incorporating sex and body mass index was used to compare the clinical outcomes of the nonintubated and intubated groups. RESULTS Fifty patients (27.0%) underwent the procedure with the nonintubated anesthetic approach. The nonintubated group was more likely to be female (P < .001) and with a lower body mass index (P < .001). Other clinical features showed no significant difference. There was no significant difference between the 2 groups in the type of segmentectomy according to the difficulty classification system. After propensity matching 43 matched patients in each group were included. Anesthetic induction duration (12.0 vs 15.3 minutes, P = .014) was shorter in the nonintubated group. No other significant differences in perioperative, postoperative, and anesthetic results were noted between the 2 matched groups. CONCLUSIONS The nonintubated anesthetic approach can be a safe and feasible alternative to intubated uniportal thoracoscopic segmentectomy.
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Shi Q, Diao Y, Qian J. [Application of Single-hole Thoracoscopic Surgery Combined with ERAS Concept for Respiratory Function Exercise in Perioperative Period of Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2020; 23:667-672. [PMID: 32434296 PMCID: PMC7467983 DOI: 10.3779/j.issn.1009-3419.2020.101.26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
背景和目的 肺癌是当前国内和国外发病率和死亡率均排名前列的恶性肿瘤, 手术治疗为肺癌治疗的主要治疗方案。本研究旨在探讨快速康复外科(enhanced recovery after surgery, ERAS)理念的呼吸功能锻炼联合单孔胸腔镜手术对肺癌患者术后肺部并发症、术后疼痛、下床时间、拔管时间以及住院时间的影响。 方法 选择2017年10月-2019年10月在扬州大学附属医院和盐城市第一人民医院行胸腔镜肺癌手术的240例患者, 随机分为四组, 每组60例。A组患者采用单孔胸腔镜手术, 术前进行ERAS理念宣教和呼吸功能锻炼; B组采用常规3孔胸腔镜手术, 术前进行ERAS理念宣教和呼吸功能锻炼; C组采用常规3孔胸腔镜手术, 进行常规入院宣教和护理指导, 常规的呼吸功能锻炼, 无术前ERAS理念宣教; D组采用单孔胸腔镜手术, 进行常规入院宣教和护理指导以及常规的呼吸功能锻炼, 无术前ERAS理念宣教。记录四组患者术后肺部并发症的发生数量、术后疼痛、下次时间、拔管时间及住院时间。 结果 A组分别与B组、C组、D组三组比较, 肺部并发症发生率明显降低, 下床时间、拔管时间和住院时间明显缩短; 与B组、C组两组比较, 术后疼痛明显减轻; B组与C组比较, B组肺部并发症显著降低, 下床时间、拔管时间和住院时间明显缩短, 差异均有统计学意义(P < 0.05)。术后疼痛在A组和D组比较以及B组和C组比较中均未见明显差异(P > 0.05)。 结论 对于单孔胸腔镜肺癌手术患者, ERAS理念指导可有效降低肺部并发症的发生率和术后疼痛, 缩短下床时间、拔管时间以及住院时间。
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Affiliation(s)
- Qingtong Shi
- Department of Thoracic Surgery, the Affiliated Hospital of Yangzhou University, Yangzhou 225000, China
| | - Yali Diao
- Department of Thoracic Surgery, the Affiliated Hospital of Yangzhou University, Yangzhou 225000, China
| | - Jun Qian
- Department of Thoracic Surgery, Yancheng First People's Hospital, Yancheng 224000, China
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Abdellateef A, Ma X, Qiao W, Chen Z, Wu L, Cai J, Jiang L. Subxiphoid uniportal video-assisted thoracoscopic pulmonary segmentectomy: effect of learning curve and future perspectives. Eur J Cardiothorac Surg 2020; 58:i50-i57. [PMID: 32613248 DOI: 10.1093/ejcts/ezaa101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/11/2020] [Accepted: 02/04/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Subxiphoid uniportal video-assisted thoracoscopic segmentectomy (SU-VATs) has been widely adopted because it is associated with better postoperative pain scores. Nevertheless, it also has had some limitations that have gradually been decreasing. Therefore, our goal was to evaluate the change in perioperative results with SU-VATs as the learning curve developed to outline the current status and the points that should be of future concern. METHODS Three hundred patients who underwent SU-VATs from September 2014 to May 2018 were divided chronologically into 2 groups; group 1 comprised the first 150 cases and group 2 comprised the last 150 cases. Different perioperative variables were analysed and compared between the 2 groups. In addition, the cumulative sum analysis and multivariable logistic regression were conducted to identify the cut-off point and predictors of significant improvement in operative time. RESULTS The cumulative sum analysis showed significant improvement in the operative time after the 148th case. Group 2 showed a statistically significant decrease in operative time (104.3 ± 36.7 vs 132 ± 43.1 min; P < 0.001), amount of operative blood loss [50 (80 ml) vs 100 (50 ml); P < 0.001], chest drain duration (2.6 ± 1.6 vs 3.2 ± 1.4 days; P = 0.004) and hospital stay (3.7 ± 1.7 vs 4.2 ± 1.7 days; P = 0.008). The number of dissected lymph nodes was significantly higher in the second group [11 (4) vs 9 (4); P < 0.001]. CONCLUSIONS Limitations of SU-VATs are being overcome by the improvement in the learning curve and in the expertise of the surgeons. Our future concerns should focus on examining the long-term survival rate, the oncological efficacy and the effect on quality of life.
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Affiliation(s)
- Amr Abdellateef
- Department of Cardiothoracic Surgery, Mansoura University Hospital, Mansoura University School of Medicine, Mansoura, Egypt.,Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaoyu Ma
- Thoracic Surgery Department, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Wenxiang Qiao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhigang Chen
- Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Liang Wu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jianqiao Cai
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lei Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
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Meacci E, Nachira D, Zanfrini E, Triumbari EKA, Iaffaldano AG, Congedo MT, Petracca Ciavarella L, Pogliani L, Chiappetta M, Porziella V, Gonzalez-Rivas D, Vita ML, Margaritora S. Uniportal VATS approach to sub-lobar anatomic resections: literature review and personal experience. J Thorac Dis 2020; 12:3376-3389. [PMID: 32642263 PMCID: PMC7330759 DOI: 10.21037/jtd.2020.01.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Surgical scientific literature contains relatively little information regarding the surgical outcomes of anatomic sublobar resections performed with the uniportal video-assisted thoracoscopic surgery (U-VATS) technique. This paper attempts to evaluate the role of U-VATS segmentectomies in the landscape of a minimally invasive approach to the treatment of early stage non small cell lung cancer (NSCLC).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Diego Gonzalez-Rivas
- Thoracic Surgery Department, Tongji University Affiliated Shanghai Pulmonary Hospital, Shanghai 200433, China
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Fu HH, Feng Z, Li M, Wang H, Ren WG, Peng ZM. The arterial-ligation-alone method for identifying the intersegmental plane during thoracoscopic anatomic segmentectomy. J Thorac Dis 2020; 12:2343-2351. [PMID: 32642139 PMCID: PMC7330350 DOI: 10.21037/jtd.2020.03.83] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Currently, methods for identifying the intersegmental plane during anatomical segmentectomy can be classified into 2 categories: the bronchial method and the vascular method. One of the vascular methods, the arterial-ligation-alone method, has not yet been validated or objectively evaluated in a large case series. We thus aimed to confirm that the arterial-ligation-alone method could effectively and accurately identify the intersegmental plane. Methods We retrospectively reviewed the records of 104 patients who were scheduled for thoracoscopic anatomic segmentectomy. Preoperative three-dimensional (3D) reconstruction was performed on all the affected lungs to distinguish the targeted segmental arteries, veins and bronchi. The procedure was as follows: first, based on the 3D reconstruction of the lung, the targeted segmental arteries were distinguished and ligated. Second, bilateral pulmonary ventilation was performed with pure oxygen. When the affected lung had completely inflated, contralateral pulmonary ventilation was performed. After waiting for some time, the first intersegmental plane could be obtained, and the time was recorded as T1, with an electric coagulation hook being used for marking. Thirdly, when the targeted segmental veins and bronchi had been ligated, the second intersegmental plane could be obtained by the inflation-deflation method as before, with the waiting time being recorded as T2. The differences between the 2 intersegmental planes were evaluated by 2 experienced chief thoracic surgeons. Result In a total of 99 (95.2%) patients, the intersegmental planes were successfully and accurately identified by the arterial-ligation-alone method. Ultimately, 85 (81.7%) patients underwent thoracoscopic anatomic segmentectomy. The results for evaluating the differences between the 2 planes were as follows: completely consistent (94 cases, 94.9%), basically consistent (5 cases, 5.1%), and discrepant (0 cases, 0%). The mean T1 was 13.6±2.7 minutes (range, 8–25 minutes), and the mean T2 was 13.0±2.6 minutes (range, 8–23 minutes), with P=0.100 (95% CI). For 99 patients, the mean nodule size was 1.1±0.34 cm. In the 85 patients who underwent segmentectomy, the mean margin width was 2.84±0.51 cm, the mean operative duration was 165.6±18.3 minutes, the mean operative hemorrhage was 52.1±20.2 mL, and the mean duration of chest tube drainage was 3.9±1.3 days. Postoperative complications related to operative procedures occurred in 2 cases. Conclusions The arterial-ligation-only method can effectively, accurately and inexpensively identify the intersegmental plane, and is especially suitable for the patients whose veins or bronchi are difficult to anatomize. Whether the target bronchus is ligated has no effect on the intersegmental plane.
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Affiliation(s)
- Hong-Hao Fu
- Department of General Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
| | - Zhen Feng
- Department of General Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
| | - Meng Li
- Department of General Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
| | - Hui Wang
- Department of General Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
| | - Wan-Gang Ren
- Department of General Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
| | - Zhong-Min Peng
- Department of General Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
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Bédat B, Abdelnour-Berchtold E, Perneger T, Licker MJ, Stefani A, Krull M, Perentes JY, Krueger T, Triponez F, Karenovics W, Gonzalez M. Comparison of postoperative complications between segmentectomy and lobectomy by video-assisted thoracic surgery: a multicenter study. J Cardiothorac Surg 2019; 14:189. [PMID: 31699121 PMCID: PMC6836384 DOI: 10.1186/s13019-019-1021-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 10/28/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Compared to lobectomy by video-assisted thoracic surgery (VATS), segmentectomy by VATS has a potential higher risk of postoperative atelectasis and air leakage. We compared postoperative complications between these two procedures, and analyzed their risk factors. METHODS We reviewed the records of all patients who underwent anatomical pulmonary resections by VATS from January 2014 to March 2018 in two Swiss university hospitals. All complications were reported. A logistic regression model was used to compare the risks of complications for the two interventions. Adjustment for patient characteristics was performed using a propensity score, and by including risk factors separately. RESULTS Among 690 patients reviewed, the major indication for lung resection was primary lung cancer (86.4%) followed by metastasis resection (5.8%), benign lesion (3.9%), infection (3.2%) and emphysema (0.7%). Postoperatively, there were 80 instances (33.3%) of complications in 240 segmentectomies, and 171 instances (38.0%) of complications in 450 lobectomies (P = 0.73). After adjustment for the patient's propensity to be treated by segmentectomy rather than lobectomy, the risks of a complication remained comparable for the two techniques (odds ratio for segmentectomy 0.91 (0.61-1.30), p = 0.59). Length of hospital stay and drainage duration were shorter after segmentectomy. On multivariate analysis, an American Society of Anesthesiologists score above 2 and a forced expiratory volume in one second below 80% of predicted value were significantly associated with the occurrence of complications. CONCLUSIONS The rate of complications and their grade were similar between segmentectomy and lobectomy by VATS.
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Affiliation(s)
- Benoît Bédat
- Division of Thoracic and Endocrine Surgery, University Hospitals of Geneva, Geneva, Switzerland.
| | | | - Thomas Perneger
- Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland
| | - Marc-Joseph Licker
- Division of Anesthesiology, University Hospitals of Geneva, Geneva, Switzerland
| | - Alexandra Stefani
- Division of Thoracic and Endocrine Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Matthieu Krull
- Division of Thoracic and Endocrine Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Jean Yannis Perentes
- Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Thorsten Krueger
- Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Frédéric Triponez
- Division of Thoracic and Endocrine Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Wolfram Karenovics
- Division of Thoracic and Endocrine Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Michel Gonzalez
- Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Abstract
This article addresses technical details of uniportal VATS segmentectomy by lung segments, suggesting available techniques for lesion localization and identification of the intersegmental plane. Long-term results and superiority have not yet been characterized in standard VATS for lung malignancy. Indications include almost all thoracic procedures currently performed by conventional multiport VATS. We review our experience and published literature on the feasibility of uniportal VATS segmentectomy.
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Affiliation(s)
- Hyun Koo Kim
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea.
| | - Kook Nam Han
- Department of Thoracic and Cardiovascular Surgery, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
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Nakazawa S, Shimizu K, Mogi A, Kuwano H. VATS segmentectomy: past, present, and future. Gen Thorac Cardiovasc Surg 2017; 66:81-90. [PMID: 29255967 DOI: 10.1007/s11748-017-0878-6] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 12/05/2017] [Indexed: 12/12/2022]
Abstract
Video-assisted thoracoscopic surgery (VATS) has gradually been implemented in thoracic surgery, and the VATS approach has now been extended to technically challenging procedures, such as segmentectomy. The definition of VATS segmentectomy is changing over time, and the repertoire of segmentectomy is getting wider with increasing reports on atypical segmentectomy. VATS segmentectomy bears surgical, oncological, and technical advantages; however, there are still areas of controversy, particularly regarding oncological outcomes. The indication of VATS segmentectomy is diverse and is used for treating lung cancer, metastatic lung tumors, or a variety of nonmalignant diseases. It is particularly valuable for the lung-sparing resection of deeply located small nodules or repeated surgery for multiple lung lesions. VATS segmentectomy requires a thorough analysis of segmental anatomy and a tailored preoperative planning with the assessment of surgical margins. Technical challenges include intraoperative navigation, methods to identify and dissect the intersegmental plane, and the prevention of air leakage. This review will discuss the present state of VATS segmentectomy, with a focus on past studies, current indications and techniques, and future view.
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Affiliation(s)
- Seshiru Nakazawa
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Kimihiro Shimizu
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan.
| | - Akira Mogi
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Hiroyuki Kuwano
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
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Jiménez MF, Gómez Hernández MT. A greater quality of clinical evidence is needed. J Thorac Dis 2017; 9:E274-E276. [PMID: 28449518 DOI: 10.21037/jtd.2017.03.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Marcelo F Jiménez
- Service of Thoracic Surgery. Salamanca University Hospital. Salamanca, Spain
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