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Lim E, Harris RA, Batchelor T, Casali G, Krishnadas R, Begum S, Jordan S, Dunning J, Paul I, Shackcloth M, Feeney S, Anikin V, Mcgonigle N, Fallouh H, Hernandez L, Di Chiara F, Stavroulias D, Loubani M, Qadri S, Zamvar V, Marshall L, Kaur S, Rogers CA. Outcomes of single- versus multi-port video-assisted thoracoscopic surgery: Data from a multicenter randomized controlled trial of video-assisted thoracoscopic surgery versus thoracotomy for lung cancer. JTCVS OPEN 2024; 19:296-308. [PMID: 39015471 PMCID: PMC11247214 DOI: 10.1016/j.xjon.2024.02.025] [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: 04/27/2023] [Revised: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 07/18/2024]
Abstract
Objectives Surgery through a single port may be less painful because access is supplied by 1 intercostal nerve or more painful because multiple instruments are used in 1 port. We analyzed data collected from the video-assisted thoracoscopic surgery group of a randomized controlled trial to compare differences in pain up to 1 year. Methods Groups were compared in a prespecified exploratory analysis using direct (regression) and indirect comparison (difference with respect to thoracotomy). In-hospital visual analogue scale pain scores were used, and analgesic ratios were calculated. After discharge, pain was evaluated using European Organization for Research and Treatment of Cancer Quality of Life Questionnaires-Core 30 scores up to 1 year. Results From July 2015 to February 2019, we randomized 503 participants. After excluding 50 participants who did not receive lobectomy, surgery was performed using a single port in 42 participants (predominately by a single surgeon), multiple ports in 166 participants, and thoracotomy in 245 participants. No differences were observed in-hospital between single- and multiple-port video-assisted thoracoscopic surgery when modeled using a direct comparison, mean difference of -0.24 (95% CI, -1.06 to 0.58) or indirect comparison, mean difference of -0.33 (-1.16 to 0.51). Mean analgesic ratio (single/multiple port) was 0.75 (0.64 to 0.87) for direct comparison and 0.90 (0.64 to 1.25) for indirect comparison. After discharge, pain for single-port video-assisted thoracoscopic surgery was lower than for multiple-port video-assisted thoracoscopic surgery (first 3 months), and corresponding physical function was higher up to 12 months. Conclusions There were no consistent differences for in-hospital pain when lobectomy was undertaken using 1 or multiple ports. However, better pain scores and physical function were observed for single-port surgery after discharge.
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Affiliation(s)
- Eric Lim
- Royal Brompton and Harefield Hospitals, Part of Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Rosie A. Harris
- Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | | | - Gianluca Casali
- University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Rakesh Krishnadas
- University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Sofina Begum
- Royal Brompton and Harefield Hospitals, Part of Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Simon Jordan
- Royal Brompton and Harefield Hospitals, Part of Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Joel Dunning
- The James Cook University Hospital, Middlesbrough, United Kingdom
| | - Ian Paul
- The James Cook University Hospital, Middlesbrough, United Kingdom
| | | | - Sarah Feeney
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Vladimir Anikin
- Royal Brompton and Harefield Hospitals, Part of Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | | | - Hazem Fallouh
- Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Luis Hernandez
- Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | | | | | | | - Syed Qadri
- Castle Hill Hospital, Hull, United Kingdom
| | - Vipin Zamvar
- Edinburgh Royal Infirmary, Edinburgh, United Kingdom
| | - Lucy Marshall
- Edinburgh Royal Infirmary, Edinburgh, United Kingdom
| | - Surinder Kaur
- Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Chris A. Rogers
- Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - VIOLET Trialists
- Royal Brompton and Harefield Hospitals, Part of Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- St Bartholomew's Hospital, London, United Kingdom
- University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
- The James Cook University Hospital, Middlesbrough, United Kingdom
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
- Belfast Trust Hospitals, Belfast, United Kingdom
- Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- Castle Hill Hospital, Hull, United Kingdom
- Edinburgh Royal Infirmary, Edinburgh, United Kingdom
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Nakagawa K, Yoshida Y, Yotsukura M, Watanabe SI. Minimally invasive open surgery (MIOS) for clinical stage I lung cancer: diversity in minimally invasive procedures. Jpn J Clin Oncol 2021; 51:1649-1655. [PMID: 34373902 DOI: 10.1093/jjco/hyab128] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/23/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Many thoracic surgeons have tried to make lung cancer surgery less invasive. Among the minimally invasive approaches that are currently available, it is controversial which is optimal. Minimally invasive open surgery, i.e. hybrid video-assisted thoracic surgery, has been adopted for lung cancer surgery at our institute. The objective of this study was to evaluate minimally invasive open surgery in terms of perioperative outcomes over the most recent 5 years. METHODS Between 2015 and 2019, 2738 patients underwent pulmonary resection for lung cancer at National Cancer Center Hospital, Japan. Among them, 2174 patients with clinical stage I lung cancer who underwent minimally invasive open surgery were included. Several perioperative parameters were evaluated. RESULTS The patients consisted of 1092 men (50.2%) and 1082 women (49.8%). Lobectomy was performed in 1255 patients (57.7%), segmentectomy in 603 (27.7%) and wide wedge resection in 316 (14.5%). Median blood loss was 30 ml (interquartile range: 15-57 ml) for lobectomy, 17 ml (interquartile range: 10-31 ml) for segmentectomy and 5 ml (interquartile range: 2-10 ml) for wide wedge resection. Median operative time was 120 min (interquartile range: 104-139 min) for lobectomy, 109 min (interquartile range: 98-123 min) for segmentectomy and 59 min (interquartile range: 48-76 min) for wide wedge resection. Median length of postoperative hospital stay was 4 days (interquartile range: 3-5 days). The 30-day mortality rate was 0.08% for lobectomy, 0.17% for segmentectomy and 0.00% for wide wedge resection. CONCLUSIONS Minimally invasive open surgery for clinical stage I lung cancer is a feasible approach with a low mortality and a short hospital stay. Oncological outcomes need to be investigated.
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Affiliation(s)
- Kazuo Nakagawa
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Yukihiro Yoshida
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Masaya Yotsukura
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Shun-Ichi Watanabe
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
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Andreetti C, Peritore V, Ibrahim M, Gagliardi A, Argento G, Maurizi G, Teodonio L, Serra N, Rendina EA, Santini M, Fiorelli A. Subxifoid versus transthoracic thoracoscopic lobectomy: Results of a retrospective analysis before and after matching analysis. Thorac Cancer 2021; 12:1279-1290. [PMID: 33689213 PMCID: PMC8088929 DOI: 10.1111/1759-7714.13778] [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: 09/07/2020] [Revised: 11/25/2020] [Accepted: 11/25/2020] [Indexed: 11/28/2022] Open
Abstract
Background Here, we report our initial experience with subxifoid video‐assisted thoracoscopic surgery (SVATS) lobectomy for the management of primary lung cancer, and compared the outcomes of SVATS with those of conventional transthoracic VATS (CVATS) lobectomies to validate its feasibility and usefulness. Methods The clinical data of consecutive patients undergoing VATS lobectomy via SVATS or CVATS for lung cancer were retrospectively compared. The endpoints were to evaluate the statistical differences in surgical results, postoperative pain (measured with visual analog scale [VAS] scores at 8 hours, Day 1, Day 2, Day 3, at discharge, one month and three months after surgery) and paresthesia (measured at one‐ month, and three months after surgery). The two groups were compared before and after matching analysis. Results Our study population included 223 patients: 84 in the SVATS and 139 in the CVATS group. The two groups were not comparable for sex (P = 0.001), preoperative comorbidity as cardiopathy (P = 0.007), BMI value (P = 0.003), left‐sided procedure (P = 0.04), tumor stage (P = 0.04), and tumor size (P = 0.002). These differences were overcome by propensity score matching (PSM) analysis that yielded two well‐matched groups which included 61 patients in each group. Surgical outcomes including blood loss, hospital stay and complications were similar before and after matching analysis, but SVATS compared to CVATS was associated with longer operative time before (159 ± 13 vs. 126 ± 6.3, P < 0.0001), and after matching analysis (161 ± 23 vs. 119 ± 8.3; P < 0.0001) and significant reduction of postoperative pain during the different time‐points (P < 0.001), and paresthesia at one (P = 0.001), and three months (P < 0.0001). Conclusions SVATS lobectomy is a feasible and safe strategy with surgical outcomes similar to CVATS lobectomy but with less postoperative pain and paresthesia. Key points Significant findings of the study Subxifoid thoracoscopic lobectomy is a feasible and safe procedure, with potential benefits in terms of postoperative pain and paresthesia compared to conventional thoracoscopic lobectomy Our results showed that surgical outcomes including blood loss, hospital stay, morbidity and mortality are similar but subxifoid thoracoscopy was associated with significant reduction of postoperative pain and paresthesia.
What this study adds Subxifoid thoracoscopy is a safe procedure; compared to conventional transthoracic thoracoscopy, it avoids intercostal incisions, and spares nerve trauma, resulting in a reduction of postoperative pain and paresthesia.
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Affiliation(s)
- Claudio Andreetti
- Thoracic Surgery Unit, Sant'Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Valentina Peritore
- Thoracic Surgery Unit, Sant'Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Mohsen Ibrahim
- Thoracic Surgery Unit, Sant'Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Antonio Gagliardi
- Thoracic Surgery Unit, Sant'Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Giacomo Argento
- Thoracic Surgery Unit, Sant'Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Giulio Maurizi
- Thoracic Surgery Unit, Sant'Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Leonardo Teodonio
- Thoracic Surgery Unit, Sant'Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Nicola Serra
- Department of Molecular Medicine and Medical Biotechnology, University Federico II of Naples, Naples, Italy
| | - Erino Angelo Rendina
- Thoracic Surgery Unit, Sant'Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Mario Santini
- Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Alfonso Fiorelli
- Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, Naples, Italy
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Santambrogio L, Musso V. VATS lobectomy: does surgical heterogeneity prevent evidence on pain control? J Thorac Dis 2018; 10:S1029-S1031. [PMID: 29849215 DOI: 10.21037/jtd.2018.03.189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Luigi Santambrogio
- Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico of Milan, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Valeria Musso
- Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico of Milan, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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