1
|
López I, Aguinagalde B, Urreta I, Royo I, Bolufer S, Sánchez L, Zabaleta J, Fernández-Monge A, Embún R. Presurgical invasive mediastinal staging in lung cancer, unexpected N2 and long-term survival: a registry-based study with data from the Spanish group for video-assisted thoracic surgery. J Thorac Dis 2024; 16:2856-2865. [PMID: 38883688 PMCID: PMC11170386 DOI: 10.21037/jtd-23-1900] [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: 12/14/2023] [Accepted: 03/22/2024] [Indexed: 06/18/2024]
Abstract
Background Mediastinal lymph node staging is a key element in the diagnosis of lung cancer. The combination of computed tomography (CT) and positron emission tomography (PET) has improved staging but some circumstances are known to influence their negative predictive value. The objective of this study was to assess the impact on survival of avoiding invasive mediastinal staging in surgical lung cancer patients with negative mediastinum in CT and PET and intermediate risk of unexpected pN2. Methods Data were collected from the prospective cohort of the Spanish Group for Video-Assisted Thoracic Surgery (GEVATS), from December 2016 to March 2018. For this study, patients were selected if they had negative mediastinum in CT and PET findings but tumours >3 cm or located centrally, or with cN1 disease. Patients who did and did not undergo invasive staging [invasive group (IG) and non-invasive group (NIG)] were compared, analysing unexpected pN2 and survival with Kaplan-Meier curves and Cox regression. Results A total of 2,826 patients underwent surgery for primary lung cancer. We selected 1,247 patients who had tumours >3 cm, central tumours or cN1. Invasive staging was performed in 275 (22.1%) cases. The unexpected pN2 rate was 9.6% in the NIG and 13.8% in the IG, but half of them were discovered prior to surgery in the IG. Five-year overall survival (OS) was poorer in the IG (52.4% vs. 64%; P<0.001). In the Cox regression model, male sex, older age, diabetes, synchronous tumour, lower diffusing capacity for carbon monoxide, larger tumour size, higher pathological N-stage, and IG status were significant independent risk factors. Conclusions Invasive staging recommended by guidelines could be reduced with an appropriate selection in mediastinal CT- and PET-negative patients with risk factors for unexpected pN2, because rates of pN2 and survival did not worsen without invasive staging.
Collapse
Affiliation(s)
- Iker López
- Thoracic Surgery Department, University Hospital Donostia, San Sebastián-Donostia, Spain
- Biogipuzkoa Health Research Institute, San Sebastián-Donostia, Spain
| | - Borja Aguinagalde
- Thoracic Surgery Department, University Hospital Donostia, San Sebastián-Donostia, Spain
- Biogipuzkoa Health Research Institute, San Sebastián-Donostia, Spain
| | - Iratxe Urreta
- Biogipuzkoa Health Research Institute, San Sebastián-Donostia, Spain
- Osakidetza-Basque Health Service, Donostia University Hospital, Clinical Epidemiology Unit, San Sebastián-Donostia, Spain
- CIBER on Epidemiology and Public Health (CIBERESP), Spain
| | - Iñigo Royo
- Thoracic Surgery Department, University Hospital Miguel Servet and Lozano Blesa, Zaragoza, Spain
- Aragón Institute for Health Research (IIS Aragón), Zaragoza, Spain
| | - Sergio Bolufer
- Thoracic Surgery Department, University General Hospital of Alicante, Alicante, Spain
| | - Laura Sánchez
- Thoracic Surgery Department, University Hospital Marqués de Valdecilla, Santander, Spain
| | - Jon Zabaleta
- Thoracic Surgery Department, University Hospital Donostia, San Sebastián-Donostia, Spain
- Biogipuzkoa Health Research Institute, San Sebastián-Donostia, Spain
| | - Arantza Fernández-Monge
- Thoracic Surgery Department, University Hospital Donostia, San Sebastián-Donostia, Spain
- Biogipuzkoa Health Research Institute, San Sebastián-Donostia, Spain
| | - Raúl Embún
- Thoracic Surgery Department, University Hospital Miguel Servet and Lozano Blesa, Zaragoza, Spain
- Aragón Institute for Health Research (IIS Aragón), Zaragoza, Spain
| |
Collapse
|
2
|
Chiappetta M, Lococo F, Sperduti I, Tabacco D, Sassorossi C, Curcio C, Crisci R, Meacci E, Rea F, Margaritora S. Surgeon experience does not influence nodal upstaging during vats lobectomy: Results from a large prospective national database. Surgery 2024; 175:1408-1415. [PMID: 38302325 DOI: 10.1016/j.surg.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/12/2023] [Accepted: 12/14/2023] [Indexed: 02/03/2024]
Abstract
BACKGROUND Despite recent improvement in preoperative staging, nodal and mediastinal upstaging occur in about 5% to 15% of cN0 patients. Different clinical and tumor characteristics are associated with upstaging, whereas the role of the surgeon's experience is not well evaluated. This study aimed to investigate if operator experience might influence nodal upstaging during video-assisted thoracic surgery anatomical lung resection. METHODS Clinical and pathological data from the prospective video-assisted thoracic surgery Italian nationwide registry were reviewed and analyzed. Patients with incomplete data about tumor and surgical characteristics, ground glass opacities tumors, cN2 to 3, and M+ were excluded. Clinical data, tumor characteristics, and surgeon experience were correlated to nodal and mediastinal (N2) upstaging using Pearson's χ2 statistic or Fisher exact test for categorical variables and Mann-Whitney U and t tests for quantitative variables. A multivariable model was built using logistic regression analysis. Surgeon experience was categorized considering the number of video-assisted thoracic surgery major anatomical resections and years after residency. RESULTS Final analysis was conducted on 3,319 cN0 patients for nodal upstaging and 3,471 cN0N1 patients for N2 upstaging. Clinical tumor-nodes-metastasis stage was stage I in 2,846 (81.9%) patients, stage II in 533 (15.3%), and stage III (cT3N1) in 92 (2.8%). Nodal upstaging occurred in 489 (13.1%) patients, whereas N2 upstaging occurred in 229 (6.1%) patients. Years after residency (P = .60 for nodal, P = .13 for N2 upstaging) and a number of video-assisted thoracic surgery procedures(P = .49 for nodal, P = .72 for nodal upstaging) did not correlate with upstaging. Multivariable analysis confirmed cT-dimension (P = .001), solid nodules (P < .001), clinical tumor-nodes-metastasis (P < .001) and maximum standardized uptake values (P < .001) as factors independently correlated to nodal upstaging, whereas cT-dimension (P = .005), clinical tumor-nodes-metastasis (P < .001) and maximum standardized uptake values (P = .028) resulted independently correlated to N2 upstaging. CONCLUSION Our study showed that surgeon experience did not influence nodal and mediastinal upstaging during -assisted thoracic surgery anatomical resection, whereas cT-dimension, clinical tumor-nodes-metastasis, and maximum standardized uptake values resulted independently correlated to nodal and mediastinal upstaging.
Collapse
Affiliation(s)
- Marco Chiappetta
- Università Cattolica del Sacro Cuore, Rome, Italy; Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Filippo Lococo
- Università Cattolica del Sacro Cuore, Rome, Italy; Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Isabella Sperduti
- Biostatistics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Diomira Tabacco
- Università Cattolica del Sacro Cuore, Rome, Italy; Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carolina Sassorossi
- Università Cattolica del Sacro Cuore, Rome, Italy; Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Carlo Curcio
- Thoracic Surgery Unit, Division of Thoracic Surgery, Monaldi Hospital, Naples, Italy
| | - Roberto Crisci
- Department of Thoracic Surgery, University of L'Aquila, L'Aquila, Italy
| | - Elisa Meacci
- Università Cattolica del Sacro Cuore, Rome, Italy; Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Federico Rea
- Thoracic Surgery Division, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, Padova University Hospital, Padova, Italy
| | - Stefano Margaritora
- Università Cattolica del Sacro Cuore, Rome, Italy; Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| |
Collapse
|
3
|
Bertolaccini L, Prisciandaro E, Uslenghi C, Chiari M, Cara A, Mazzella A, Casiraghi M, Spaggiari L. The role of the surgical volume for clinical outcomes in VATS lobectomy for lung cancer: a national large database multicenter analysis. Updates Surg 2023:10.1007/s13304-023-01723-0. [PMID: 38103167 DOI: 10.1007/s13304-023-01723-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 11/29/2023] [Indexed: 12/17/2023]
Abstract
Improving the quality of lung cancer care at a cost that can be sustained is a hotly debated issue. High-risk, low-volume procedures (such as lung resections) are believed to improve significantly when centralised in high-volume centres. However, limited evidence exists to support volume requirements in lung cancer surgery. On the other hand, there was no evidence that the number of lung resections affected either the short-term perioperative results or the long-term cost. Using data from an extensive nationwide registry, this study investigated the correlations between surgical volumes and selected perioperative outcomes. A retrospective analysis of a prospectively filled national registry that follows stringent quality assurance and security procedures was conducted to ensure data accuracy and security. Patients who underwent VATS lobectomy from 2014 to 2019 at the participating centres were included. Selected perioperative outcomes were reported. Total direct hospital cost is measured at discharge for hospitalisations with a primary diagnosis of lung cancer, hospital stay costs, and postoperative length of hospital stay after lobectomy. After the propensity score matched, centres were divided into three groups according to the surgical volume of the unit where VATS lobectomies were performed (high-volume centre: > 500 lobectomies; medium-volume centre: 200-500 lobectomies; low-volume centre: < 200 lobectomies). 11,347 patients were included and matched (low-volume center = 2890; medium-volume center = 3147; high-volume center = 2907). The mean operative time density plot (Fig. 1A) showed no statistically significant difference (p = 0.67). In contrast, the density plot of the harvested lymph nodes (Fig. 1B) showed significantly higher values in the high-volume centres (p = 0.045), albeit without being clinically significant. The adjusted rates of any and significant complications were higher in the low-volume centre (p = 0.034) without significantly affecting the length of hospital stay (p = 0.57). VATS lobectomies for lung cancer in higher-volume centres seem associated with a statistically significantly higher number of harvested lymph nodes and lower perioperative complications, yet without any significant impact in terms of costs and resource consumption. These findings may advise the investigation of the learning curve effect in a complete economic evaluation of VATS lobectomy in lung cancer. Fig. 1 The mean operative time density plot showed no statistically significant difference (p = 0.67).
Collapse
Affiliation(s)
- Luca Bertolaccini
- Department of Thoracic Surgery, Division of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy.
| | - Elena Prisciandaro
- Department of Thoracic Surgery, Division of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Clarissa Uslenghi
- Department of Thoracic Surgery, Division of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Matteo Chiari
- Department of Thoracic Surgery, Division of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Andrea Cara
- Department of Thoracic Surgery, Division of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Antonio Mazzella
- Department of Thoracic Surgery, Division of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Monica Casiraghi
- Department of Thoracic Surgery, Division of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, Division of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| |
Collapse
|
4
|
Rate and Predictors of Unforeseen PN1/PN2-Disease in Surgically Treated cN0 NSCLC-Patients with Primary Tumor > 3 cm: Nationwide Results from Italian VATS-Group Database. J Clin Med 2023; 12:jcm12062345. [PMID: 36983345 PMCID: PMC10057948 DOI: 10.3390/jcm12062345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/07/2023] [Accepted: 03/15/2023] [Indexed: 03/19/2023] Open
Abstract
Background. Since no robust data are available on the real rate of unforeseen N1-N2 disease (uN) and the relative predictive factors in clinical-N0 NSCLC with peripheral tumours > 3 cm, the usefulness of performing a (mini)invasive mediastinal staging in this setting is debated. Herein, we investigated these issues in a nationwide database. Methods. From 01/2014 to 06/2020, 15,784 thoracoscopic major lung resections were prospectively recorded in the “Italian VATS-Group” database. Among them, 1982 clinical-N0 peripheral solid-type NSCLC > 3 cm were identified, and information was retrospectively reviewed. A mean comparison of more than two groups was made by ANOVA (Bonferroni correction for multiple comparisons), while associations between the categorical variables were estimated with a Chi-square test. The multivariate logistic regression model and Kaplan–Meyer method were used to identify the independent predictors of nodal upstaging and survival results, respectively. Results. At pathological staging, 229 patients had N1-involvement (11.6%), and 169 had uN2 disease (8.5%). Independent predictors of uN1 were SUVmax (OR: 1.98; CI 95: 1.44–2.73, p = 0.0001) and tumour-size (OR: 1.52; CI: 1.11–2.10, p = 0.01), while independent predictors of uN2 were age (OR: 0.98; CI 95: 0.96–0.99, p = 0.039), histology (OR: 0.48; CI 95: 0.30–0.78, p = 0.003), SUVmax (OR: 2.07; CI 95: 1.15–3.72, p = 0.015), and the number of resected lymph nodes (OR: 1.03; CI 95: 1.01–1.05, p = 0.002). Conclusions. The unforeseen N1-N2 disease in cN0/NSCLCs > 3 cm undergoing VATS resection is observable in between 12 and 8% of all cases. We have identified predictors that could guide physicians in selecting the best candidate for (mini)invasive mediastinal staging.
Collapse
|
5
|
Swanson SJ, White A. Sublobar resections for lung cancer: Finally, some answers and some more questions? J Surg Oncol 2023; 127:269-274. [PMID: 36630096 DOI: 10.1002/jso.27163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 01/12/2023]
Abstract
The Lung Cancer Study Group Trial, published in 1995, set the tone for lobectomy as the standard of care for early-stage nonsmall cell lung cancer. Twenty-seven years and two randomized trials later, does the thoracic oncology community have clarity regarding the choice type of resection, or more questions?
Collapse
Affiliation(s)
- Scott J Swanson
- Division of Thoracic and Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Abby White
- Division of Thoracic and Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
6
|
Choi JS, Lee J, Moon YK, Moon SW, Park JK, Moon MH. Nodal Outcomes of Uniportal versus Multiportal Video-Assisted Thoracoscopic Surgery for Clinical Stage I Lung Cancer. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 53:104-113. [PMID: 32551290 PMCID: PMC7287225 DOI: 10.5090/kjtcs.2020.53.3.104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/18/2019] [Accepted: 10/30/2019] [Indexed: 12/19/2022]
Abstract
Background Accurate intraoperative assessment of mediastinal lymph nodes is a critical aspect of lung cancer surgery. The efficacy and potential for upstaging implicit in these dissections must therefore be revisited in the current era of uniportal video-assisted thoracoscopic surgery (VATS). Methods A retrospective study was conducted in which 544 patients with stage I (T1abc–T2a, N0, M0) primary lung cancer were analyzed. To assess risk factors for nodal upstaging and to limit any imbalance imposed by surgical choices, we constructed an inverse probability of treatment-weighted (IPTW) logistic regression model (in addition to non-weighted logistic models). We also evaluated risk factors for early locoregional recurrence using IPTW logistic regression analysis. Results In the comparison of uniportal and multiportal VATS, the resected lymph node count (14.03±8.02 vs. 14.41±7.41, respectively; p=0.48) and rate of nodal upstaging (6.5% vs. 8.7%, respectively; p=0.51) appeared similar. Predictors of nodal upstaging included tumor size (odds ratio [OR], 1.74; 95% confidence interval [CI], 1.12–2.70), carcinoembryonic antigen level (OR, 1.11; 95% CI, 1.04–1.18), and histologically confirmed pleural invasion (OR, 3.97; 95% CI, 1.89–8.34). The risk factors for locoregional recurrence within 1 year were found to be number of resected N2 nodes, age, and nodal upstaging. Conclusion Uniportal and multiportal VATS appear similar with regard to accuracy and thoroughness, showing no significant difference in the extent of nodal dissection.
Collapse
Affiliation(s)
- Jung Suk Choi
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jiyun Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Kyu Moon
- Department of Thoracic and Cardiovascular Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seok Whan Moon
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Kil Park
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Mi Hyoung Moon
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|
7
|
Marulli G, Faccioli E, Mammana M, Nicotra S, Comacchio G, Verderi E, De Palma A, Rea F. Predictors of nodal upstaging in patients with cT1-3N0 non-small cell lung cancer (NSCLC): results from the Italian VATS Group Registry. Surg Today 2019; 50:711-718. [PMID: 31873770 DOI: 10.1007/s00595-019-01939-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 11/29/2019] [Indexed: 12/26/2022]
Abstract
PURPOSE Accurate staging of early non-small cell lung cancer is fundamental for selecting the best treatment. The aim of this study was to identify risk factors for nodal upstaging after video-assisted thoracoscopic lobectomy for clinical T1-3N0 tumors. METHODS From 2014 to 2017, 3276 thoracoscopic lobectomies were recorded in the prospective database "Italian VATS Group". Linear and multiple logistic regression models were adapted to identify independent predictors of nodal upstaging and factors associated with progression in postoperative N status. RESULTS Nodal upstaging was found in 417 cases (12.7%), including 206 cases (6.2%) of N1-positive nodes, 81 cases of N2 nodes (2.4%), and 130 cases (4%) of involvement of both N1 + N2 nodes. A total of 241 (7.3%) patients had single-station nodal involvement, whereas 176 (5.3%) had multiple-station involvement. In the final regression model, the tumor grade, histology, pathologic T status, and > 12 resected nodes were independent predictors of nodal upstaging. CONCLUSIONS The number of resected lymph nodes seems to predict nodal upstaging better than the type of intraoperative lymph node management. Other preoperative risk factors correspond to those for which the current guidelines of the European Society of Thoracic Surgery recommend more extensive preoperative mediastinal staging.
Collapse
Affiliation(s)
- Giuseppe Marulli
- Thoracic Surgery Unit, Department of Emergency and Organ Transplantation (DETO), University Hospital of Bari, Piazza Giulio Cesare, 11, 70124, Bari, Italy.
| | - Eleonora Faccioli
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital of Padova, Padova, Italy
| | - Marco Mammana
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital of Padova, Padova, Italy
| | - Samuele Nicotra
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital of Padova, Padova, Italy
| | - Giovanni Comacchio
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital of Padova, Padova, Italy
| | - Enrico Verderi
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital of Padova, Padova, Italy
| | - Angela De Palma
- Thoracic Surgery Unit, Department of Emergency and Organ Transplantation (DETO), University Hospital of Bari, Piazza Giulio Cesare, 11, 70124, Bari, Italy
| | - Federico Rea
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital of Padova, Padova, Italy
| |
Collapse
|
8
|
Lopez-Pastorini A, Stoelben E, Koryllos A. Editorial on "Trans-inferior-pulmonary-ligament VATS basal segmentectomy: application of single-direction strategy in segmentectomy of left S9+10". J Thorac Dis 2019; 11:S283-S285. [PMID: 30997198 DOI: 10.21037/jtd.2019.01.59] [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)
- Alberto Lopez-Pastorini
- Department of Thoracic Surgery, Lung Clinic, Hospital of the City of Cologne, University of Witten-Herdecke, Cologne, Germany
| | - Erich Stoelben
- Department of Thoracic Surgery, Lung Clinic, Hospital of the City of Cologne, University of Witten-Herdecke, Cologne, Germany
| | - Aris Koryllos
- Department of Thoracic Surgery, Lung Clinic, Hospital of the City of Cologne, University of Witten-Herdecke, Cologne, Germany
| |
Collapse
|
9
|
Harris JP, Nwachukwu C, Qian Y, Pollom E, Loo BW, Das M, Diehn M. Invasive nodal evaluation prior to stereotactic ablative radiation for non-small cell lung cancer. Lung Cancer 2018; 124:76-85. [DOI: 10.1016/j.lungcan.2018.07.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/04/2018] [Accepted: 07/22/2018] [Indexed: 12/25/2022]
|
10
|
Solli P, Bertolaccini L, Droghetti A, Bertani A, Gonfiotti A, Nosotti M, Migliore M, Crisci R, VATS Group I. 2016 Annual report from the Italian VATS Group. Future Oncol 2018; 14:23-28. [DOI: 10.2217/fon-2017-0423] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
This report highlights the results of the Italian video-assisted thoracoscopic surgery (VATS) Group, launched in mid 2013, which now has a website and an established database with over 4000 VATS lobectomy cases recruited from 67 thoracic surgery units across Italy. The year 2016 has been crucial for the following steps: inclusion of a dedicated biostatistician and a ‘Survey Analysis & Data Quality Check’; the First Consensus Meeting with statements consequently adopted as Recommendations for the Italian Thoracic Surgery Society and published in a peer-reviewed journal; two papers published under the logo Italian VATS Group and seven abstracts accepted at annual international meetings (European Society of Thoracic Surgeons, European Association of Cardio-Thoracic Surgeons, European Lung Cancer Conference and European Respiratory Society); the institution of a Master Course on VATS lobectomy; the partnership with AME Publishing Company.
Collapse
Affiliation(s)
- Piergiorgio Solli
- Department of Thoracic Surgery, Maggiore & Bellaria Teaching Hospitals, Bologna 40133, Italy
| | - Luca Bertolaccini
- Department of Thoracic Surgery, AUSL Romagna Teaching Hospital, Ravenna 48121, Italy
| | - Andrea Droghetti
- Department of Thoracic Surgery, ASST Mantova, Mantova 46100, Italy
| | - Alessandro Bertani
- Department of Thoracic Surgery, IRCCS ISMETT-UPMC, University of Pittsburgh, Palermo 90127, Italy
| | - Alessandro Gonfiotti
- Department of Thoracic Surgery, University Hospital Careggi, Firenze 50134, Italy
| | - Mario Nosotti
- Thoracic Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan 20122, Italy
| | - Marcello Migliore
- Section of Thoracic Surgery, Department of Surgery, Policlinico University Hospital, Catania 95125, Italy
| | - Roberto Crisci
- Department of Thoracic Surgery, University of L'Aquila, L'Aquila 67100, Italy
| | | |
Collapse
|
11
|
Vannucci J, Costi S, Matricardi A, Scarnecchia E, Droghetti A. VATS Group ERAS Registry. J Thorac Dis 2018; 10:S571-S577. [PMID: 29629204 DOI: 10.21037/jtd.2018.02.56] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Enhanced recovery after surgery (ERAS) is a multimodal, polyhedral approach to surgical management for patients undergoing surgical therapy. Since ERAS is not a specific procedure, these protocols are not exclusively created for particular clinical settings but they are prone to be adapted to a large variety of healthcare programs after surgery. ERAS Society was the platform in which a new multidisciplinary methodology to promote a fast recovery, a considerable patient involvement and resource optimization has been developed. ERAS Society has also produced guidelines for different surgical specialties and has already generated some evidence regarding preoperative, intraoperative and postoperative practice. ERAS in Thoracic Surgery has had a slow-growing development but some hints suggest that introducing ERAS methodology in pulmonary resections for cancer could be feasible and effective with potential tangible benefits for patients, families, caregivers and welfare. There is no evidence yet concerning ERAS principles in Thoracic Surgery; for this reason, a new possibility for prospective data collection and analysis is created using the VATS Group Web Registry in which additional records, documents and facts have now the possibility to be registered and eventually explored to possibly adjust the ERAS protocols to major pulmonary resections.
Collapse
Affiliation(s)
- Jacopo Vannucci
- Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy
| | | | - Alberto Matricardi
- Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy
| | - Elisa Scarnecchia
- Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy.,Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Policlinico Sant'Orsola Malpighi, Bologna, Italy
| | - Andrea Droghetti
- Division of Thoracic Surgery, Carlo Poma Hospital, Mantova, Italy
| |
Collapse
|
12
|
Bertani A, Gonfiotti A, Nosotti M, Ferrari PA, De Monte L, Russo E, Di Paola G, Solli P, Droghetti A, Bertolaccini L, Crisci R. Erratum to nodal management and upstaging of disease: initial results from the Italian VATS Lobectomy Registry. J Thorac Dis 2017; 9:E976-E977. [PMID: 29268451 DOI: 10.21037/jtd.2017.09.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
[This corrects the article DOI: 10.21037/jtd.2017.06.12.].
Collapse
Affiliation(s)
- Alessandro Bertani
- Division of Thoracic Surgery and Lung Transplantation, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS ISMETT, Palermo, Italy
| | | | - Mario Nosotti
- Division of Thoracic Surgery, Policlinico Ca'Granda, Milano, Italy
| | - Paolo Albino Ferrari
- Division of Thoracic Surgery and Lung Transplantation, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS ISMETT, Palermo, Italy
| | - Lavinia De Monte
- Division of Thoracic Surgery and Lung Transplantation, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS ISMETT, Palermo, Italy
| | - Emanuele Russo
- Division of Thoracic Surgery and Lung Transplantation, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS ISMETT, Palermo, Italy
| | - Gioacchino Di Paola
- Division of Thoracic Surgery and Lung Transplantation, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS ISMETT, Palermo, Italy
| | - Piero Solli
- Department of Thoracic Surgery, AUSL Romagna Teaching Hospital, Forlì, Italy
| | - Andrea Droghetti
- Division of Thoracic Surgery, ASST Mantova-Cremona, Mantova, Italy
| | - Luca Bertolaccini
- Department of Thoracic Surgery, AUSL Romagna Teaching Hospital, Forlì, Italy
| | - Roberto Crisci
- Division of Thoracic Surgery, Università dell'Aquila, L'Aquila, Italy
| | | |
Collapse
|