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Ruan Y, Cao W, Xue H, You M, Zhao Z. Long-term outcome of uniport vs. multiport video-assisted thoracoscopic lobectomy for lung cancer. Sci Rep 2024; 14:5316. [PMID: 38438473 PMCID: PMC10912317 DOI: 10.1038/s41598-024-55737-8] [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] [Received: 09/16/2023] [Accepted: 02/27/2024] [Indexed: 03/06/2024] Open
Abstract
This study aims to compare the perioperative outcomes and long-term survival of U-VATS lobectomy for NSCLC with multiportal VATS (M-VATS, involving two ports or more) lobectomy. A total of 339 patients who underwent intentional VATS lobectomy for lung cancer between 2012 and 2017 were included in the analysis. Perioperative outcomes and long-term survival were evaluated. Propensity score matching was utilized to minimize baseline characteristic differences between the two groups. Out of the total cases, 17 (5.01%) were converted to open thoracotomy. The conversion rates were 4.96% (7/141) in the U-VATS group and 5.05% (10/198) in the M-VATS group. A total of 322 consecutive patients underwent VATS lobectomy and mediastinal lymphadenectomy. After propensity matching, 106 pairs were obtained, consisting of 83 males and 129 females. Intraoperative bleeding volume, number of retrieved lymph nodes, explored nodal stations, drainage time and volume, and postoperative hospital stay were similar between the two groups. Both groups exhibited comparable morbidity and mortality rates. From the multivariable analysis, there was no significant difference observed in terms of overall survival (OS) and disease-free survival (DFS) between the two patient cohorts. U-VATS demonstrated comparable perioperative outcomes and long-term efficacy to M-VATS. However, further confirmation of these findings is required.
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Affiliation(s)
- Yingding Ruan
- Department of Thoracic Surgery, The First People's Hospital of Jiande, JianDe, 311699, China
| | - Wenjun Cao
- Department of Thoracic Surgery, Affiliated Zhongshan Hospital of Dalian University, 6 Jiefang Street, Zhongshan District, Dalian, 116044, China
| | - Hongsheng Xue
- Department of Thoracic Surgery, Affiliated Zhongshan Hospital of Dalian University, 6 Jiefang Street, Zhongshan District, Dalian, 116044, China
| | - Maoduan You
- Department of Thoracic Surgery, Affiliated Zhongshan Hospital of Dalian University, 6 Jiefang Street, Zhongshan District, Dalian, 116044, China
| | - Zhilong Zhao
- Department of Thoracic Surgery, Affiliated Zhongshan Hospital of Dalian University, 6 Jiefang Street, Zhongshan District, Dalian, 116044, China.
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Mi X, Dai Z, Liu C, Mei J, Zhu Y, Liu L, Pu Q. Perioperative outcomes of uniportal versus three-port video-assisted thoracoscopic surgery in lung cancer patients aged ≥ 75 years old: a cohort study. BMC Surg 2024; 24:32. [PMID: 38263042 PMCID: PMC10804747 DOI: 10.1186/s12893-024-02320-7] [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] [Received: 11/24/2023] [Accepted: 01/11/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Increasing attention has been raised on the surgical option for lung cancer patients aged ≥75 years, however, few studies have focused on whether uniportal video-assisted thoracoscopic surgery (VATS) is safe and feasible for these patients. This study aimed to evaluate short-term results of uniportal versus three-port VATS for the treatment of lung cancer patients aged ≥75 years. METHODS We retrospectively evaluated 582 lung cancer patients (≥75 years) who underwent uniportal or three-port VATS from August 2007 to August 2021 based on the Western China Lung Cancer Database. The baseline and perioperative outcomes between uniportal and three-port VATS were compared in the whole cohort (WC) and the patients undergoing lobectomy (lobectomy cohort, LC) respectively. Propensity score matching (PSM) was used to minimize confounding bias between the uniportal and three-port cohorts in WC and LC. RESULTS Intraoperative blood loss was significantly less in the uniportal than three-port LC (50 mL vs. 83 mL, P = 0.007) before PSM and relatively less in the uniportal than three-port LC (50 mL vs. 83 mL, P = 0.05) after PSM. Significantly more lymph nodes harvested (13 vs. 9, P = 0.007) were found in the uniportal than three-port LC after PSM. In addition, in WC and LC, there were no significant differences between uniportal and three-port cohorts in terms of operation time, the rate of conversion to thoracotomy during surgery, nodal treatments (dissection or sampling or not), the overall number of lymph node stations dissected, postoperative complications, volume and duration of postoperative thoracic drainage, hospital stay after operation and hospitalization expenses before and after PSM (P > 0.05). CONCLUSIONS There were no significant differences in short-term outcomes between uniportal and three-port VATS for lung cancer patients (≥75 years), except relatively less intraoperative blood loss (P < 0.05 before PSM and P = 0.05 after PSM) and significantly more lymph nodes harvested (P < 0.05 after PSM) were found in uniportal LC. It is reasonable to indicate that uniportal VATS is a safe, feasible and effective operation procedure for lung cancer patients aged ≥75 years.
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Affiliation(s)
- Xingqi Mi
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Zhangyi Dai
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Chengwu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Jiandong Mei
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Yunke Zhu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Qiang Pu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China.
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Lorange JP, Katz A, Tankel J, Huynh C, Spicer J. Comparing immediate postoperative outcomes of different VATS approaches for anatomical lung resection: a single-centre retrospective study. Can J Surg 2024; 67:E142-E148. [PMID: 38548299 PMCID: PMC10980531 DOI: 10.1503/cjs.010622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Video-assisted thoracic surgery (VATS) can be performed through 1 or more intercostal or subxiphoid ports. The aim of this study was to evaluate whether number and location of ports had an impact on early perioperative outcomes and postoperative pain after anatomical lung resection (ALR). METHODS A search of the departmental electronic database identified all patients who underwent VATS ALR between June 2018 and June 2019. We stratified patients according to the surgical approach: 2-port VATS, 3-port VATS, and subxiphoid VATS. We extracted demographic and clinicopathologic data. We used univariate analysis with unpaired t tests and χ2 tests to compare these variables between the subgroups. RESULTS We included 201 patients in the analysis. When patients were stratified by surgical approach, there was no difference in terms of age, disease load, length of surgery, postoperative complications, duration of pleural drainage, and length of hospital stay. Postoperative pain and morphine equivalent usage were also comparable between the groups. According to these results, number and location of VATS ports seemingly has no clinical impact on early postoperative outcomes. Limitations of the study include its retrospective nature, small sample size, and short follow-up interval. CONCLUSION Our results suggest that incision location and the number of VATS ports is not associated with differences in the incidence of perioperative complications or postoperative pain. Given the limitations described above, further studies with longer follow-up intervals are required to explore the lasting impact of this surgical approach on quality of life.
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Affiliation(s)
- Justin-Pierre Lorange
- From the Faculty of Medicine, McGill University, Montréal, Que. (Lorange); the Division of Thoracic and Upper Gastrointestinal Surgery, Department of Surgery, McGill University, Montréal, Que. (Katz, Spicer); the Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, B.C. (Huynh)
| | - Amit Katz
- From the Faculty of Medicine, McGill University, Montréal, Que. (Lorange); the Division of Thoracic and Upper Gastrointestinal Surgery, Department of Surgery, McGill University, Montréal, Que. (Katz, Spicer); the Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, B.C. (Huynh)
| | - James Tankel
- From the Faculty of Medicine, McGill University, Montréal, Que. (Lorange); the Division of Thoracic and Upper Gastrointestinal Surgery, Department of Surgery, McGill University, Montréal, Que. (Katz, Spicer); the Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, B.C. (Huynh).
| | - Caroline Huynh
- From the Faculty of Medicine, McGill University, Montréal, Que. (Lorange); the Division of Thoracic and Upper Gastrointestinal Surgery, Department of Surgery, McGill University, Montréal, Que. (Katz, Spicer); the Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, B.C. (Huynh)
| | - Jonathan Spicer
- From the Faculty of Medicine, McGill University, Montréal, Que. (Lorange); the Division of Thoracic and Upper Gastrointestinal Surgery, Department of Surgery, McGill University, Montréal, Que. (Katz, Spicer); the Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, B.C. (Huynh)
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Qi K, Lin G, Liu H, Zhang X, Huang W, Chen Z, Li J. Safety and feasibility of preferential manual bronchoplasty in 2-3 cm single-port video-assisted thoracoscopic lobectomy. Thorac Cancer 2023; 14:2484-2492. [PMID: 37442784 PMCID: PMC10447174 DOI: 10.1111/1759-7714.15033] [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] [Received: 05/23/2023] [Revised: 06/24/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND This retrospective study aimed to compare preferential manual bronchoplasty (PMB) and mechanical stapler closure (MSC) of the bronchial stump after 2-3 cm single-port (SP) video-assisted thoracoscopic surgery (VATS) lobectomy in patients with pathological T1 (pT1) stage lung cancer. METHODS Between January 2019 and March 2022, patients with pulmonary neoplasms who underwent 2-3 cm SP VATS lobectomy were retrospectively screened. After propensity-matched analysis, we compared perioperative outcomes and analyzed the safety and feasibility of PMB and MSC of the bronchial stump while performing VATS lobectomy. RESULTS In this study, 280 and 832 patients were enrolled in the PMB and MSC groups, respectively. Propensity score matching produced 280 pairs. The operation time was shorter in the PMB group, whereas the average number of lymph nodes dissected was higher in the PMB group. The conversion rate was significantly lower in the PMB group. The following were similar between the PMB and MSC groups, respectively: average blood loss volume, postoperative hospital stay, and chest tube removal time. Postoperatively, the incidence of atelectasis was significantly higher in the MSC group. As per subgroup analyses, PMB was associated with a shorter operation time in left and right upper lobectomies. Particularly in left upper lobectomy, PMB had more lymph node dissections and less conversion to open and postoperative atelectasis. CONCLUSIONS In comparison with MSC of the bronchial stump, PMB showed better safety and feasibility in 2-3 cm SP VATS left and right superior lobectomies in patients with pT1 stage lung cancer.
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Affiliation(s)
- Kang Qi
- Department of Thoracic SurgeryPeking University First HospitalBeijingChina
| | - Gang Lin
- Department of Thoracic SurgeryPeking University First HospitalBeijingChina
| | - Haibo Liu
- Department of Thoracic SurgeryPeking University First HospitalBeijingChina
| | - Xining Zhang
- Department of Thoracic SurgeryPeking University First HospitalBeijingChina
| | - Weiming Huang
- Department of Thoracic SurgeryPeking University First HospitalBeijingChina
| | - Zhimao Chen
- Department of Precision Medicine in OncologyErasmus Medical Center Cancer InstituteRotterdamNetherlands
| | - Jian Li
- Department of Thoracic SurgeryPeking University First HospitalBeijingChina
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Han Y, Zhang Z, Feng H, Wen H, Su K, Xiao F, Liang C, Liu D. Uniportal video-assisted anatomical segmentectomy: an analysis of the learning curve. World J Surg Oncol 2023; 21:232. [PMID: 37516847 PMCID: PMC10386600 DOI: 10.1186/s12957-023-03086-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 06/28/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND This study aimed to demonstrate the learning curve of anatomical segmentectomy performed by uniportal video-assisted thoracoscopic surgery (U-VATS). METHOD We conducted a retrospective study of U-VATS segmentectomies performed by the same surgeon between September 2019 and August 2022. The learning curve was demonstrated using risk-adjusted cumulative sum (RA-CUSUM) analysis in terms of perioperative complications, which reflected surgical quality and technique proficiency. The surgical outcomes were also compared between different phases. RESULT The complication-based learning curve of U-VATS segmentectomy could be divided into two phases based on RA-CUSUM analysis: phase I, the initial learning phase (cases 1-50) and phase II, the proficiency phase (cases 51-141). Significantly higher complication rates (24.0 vs. 8.8%, p=0.013), longer surgical times (119.8±31.9 vs. 106.2±23.8 min, p=0.005), and more blood loss (20 [IQR, 20-30] vs. 20 [IQR, 10-20] ml, p=0.003) were observed in phase I than in phase II. CONCLUSION The learning curve of U-VATS segmentectomy consists of two phases, and at least 50 cases were required to gain technique proficiency and achieve high-quality surgical outcomes.
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Affiliation(s)
- Yu Han
- Department of General Thoracic Surgery, China-Japan Friendship Hospital, No. 2 Yinghua East Road, Chaoyang District, Beijing, 100029, China
- National Center for Respiratory Medicine, Beijing, People's Republic of China
| | - Zhenrong Zhang
- Department of General Thoracic Surgery, China-Japan Friendship Hospital, No. 2 Yinghua East Road, Chaoyang District, Beijing, 100029, China
- National Center for Respiratory Medicine, Beijing, People's Republic of China
| | - Hongxiang Feng
- Department of General Thoracic Surgery, China-Japan Friendship Hospital, No. 2 Yinghua East Road, Chaoyang District, Beijing, 100029, China
- National Center for Respiratory Medicine, Beijing, People's Republic of China
| | - Huanshun Wen
- Department of General Thoracic Surgery, China-Japan Friendship Hospital, No. 2 Yinghua East Road, Chaoyang District, Beijing, 100029, China
- National Center for Respiratory Medicine, Beijing, People's Republic of China
| | - Kunsong Su
- Department of General Thoracic Surgery, China-Japan Friendship Hospital, No. 2 Yinghua East Road, Chaoyang District, Beijing, 100029, China
- National Center for Respiratory Medicine, Beijing, People's Republic of China
| | - Fei Xiao
- Department of General Thoracic Surgery, China-Japan Friendship Hospital, No. 2 Yinghua East Road, Chaoyang District, Beijing, 100029, China.
- National Center for Respiratory Medicine, Beijing, People's Republic of China.
| | - Chaoyang Liang
- Department of General Thoracic Surgery, China-Japan Friendship Hospital, No. 2 Yinghua East Road, Chaoyang District, Beijing, 100029, China.
- National Center for Respiratory Medicine, Beijing, People's Republic of China.
| | - Deruo Liu
- Department of General Thoracic Surgery, China-Japan Friendship Hospital, No. 2 Yinghua East Road, Chaoyang District, Beijing, 100029, China
- National Center for Respiratory Medicine, Beijing, People's Republic of China
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Diaz-Gutierrez I, Menier CA, Savoie-White FH, Doyle JE, Wang Q, Andrade RS, Figueroa PU. Uniportal vs. multiportal thoracoscopic segmentectomy: a north American study. J Thorac Dis 2023; 15:335-347. [PMID: 36910108 PMCID: PMC9992592 DOI: 10.21037/jtd-22-780] [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: 06/06/2022] [Accepted: 12/09/2022] [Indexed: 02/15/2023]
Abstract
Background Uniportal video-assisted thoracoscopic surgery (VATS) segmentectomy is gaining worldwide acceptance, but experience in North America is still limited. We report a North American multicenter comparison of uniportal vs. multiportal VATS segmentectomy. Methods We performed an institutional review board-exempt retrospective chart review on prospectively collected databases at two North American centers, from January 2012 to December 2020. We included all VATS segmentectomy patients and excluded emergent cases (n=1), patients with incomplete records (n=2), and segmentectomy performed in conjunction with another type of lung resection (n=1). We recorded patient demographics, perioperative data, 30-day postoperative complications and compared outcomes between cohorts. We provided descriptive statistics for each group. We calculated propensity score matching and paired patients 1:1. We defined P values less than 0.05 as statistically significant. Results We performed a total of 423 VATS segmentectomies, 181 uniportal (42.7%) vs. 242 multiportal (57.2%). Indications for surgery were primary lung cancer (n=339), metastatic (n=41), benign disease (n=40), and other (n=3). We staged 85.1% of patients preoperatively with positron emission tomography-computed tomography (PET-CT) scan according to National Comprehensive Cancer Network (NCCN) guidelines. Propensity score matching generated 156 patients on each group. Operating time was significantly lower in the uniportal group compared to multiportal (130 vs. 161 min respectively, P<0.001). We found no difference in estimated blood loss, Clavien-Dindo class III-IV complications, conversion to thoracotomy, R0 resection rate, nodal upstaging, hospital length of stay, 30-day readmission or mortality. Conclusions Our experience from two North American centers indicates that, in experienced hands, postoperative outcomes after uniportal and multiportal VATS segmentectomy are comparable.
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Affiliation(s)
- Ilitch Diaz-Gutierrez
- Department of Surgery, Division of Thoracic and Foregut Surgery, University of Minnesota, Minneapolis, MN, USA
| | | | | | | | - Qi Wang
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA
| | - Rafael S. Andrade
- Department of Surgery and Chief, Division of Thoracic and Foregut Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Paula Ugalde Figueroa
- Division of Thoracic and Cardiac Surgery, Brigham and Women’s Hospital, Harvard University, Boston, MA, USA
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Kong L, Gao L, Zhang H, Wang X, Zhang J. Does Preoperative Hookwire Localization Influence Postoperative Acute and Chronic Pain After Video-Assisted Thoracoscopic Surgery: A Prospective Cohort Study. J Pain Res 2023; 16:21-32. [PMID: 36636265 PMCID: PMC9830704 DOI: 10.2147/jpr.s387543] [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: 08/25/2022] [Accepted: 12/24/2022] [Indexed: 01/05/2023] Open
Abstract
Purpose This study aimed to investigate whether preoperative computerized tomography-guided hookwire localization-associated pain could affect acute and chronic postsurgical pain (CPSP) in patients undergoing video-assisted thoracoscopic surgery (VATS). Methods We enrolled 161 adult patients who underwent elective VATS; sixty-nine patients experienced hookwire localization (Group A) and 69 did not (Group B). Group A was further subdivided into the multiple localization group (n=35, Group Amultiple) and the single localization group (n=34, Group Asingle) according to the number of hookwires. The numerical rating scale (NRS) was used preoperatively, during recovery at the post-anesthesia care unit (PACU), and the first two days, 3 and 6 months postoperatively. Furthermore, multivariate regression analysis was used to identify the risk factors associated with CPSP. The postoperative adverse events, length of hospital stay, and satisfaction in pain management were also recorded. Results The incidence and severity of acute postoperative pain were similar between Group A and Group B (p > 0.05). The incidence (56.5% vs 30.4%, p = 0.002) and the NRS scores (2.0 [2.0-3.0] vs 1.0 [1.0-2.0], p = 0.011) for CPSP were significantly higher in Group A than in Group B at 3 months postoperatively. On subgroup analysis, compared with Group Asingle, the intensity of CPSP (2.0 [2.0-3.0] vs 2.0 [1.0-2.0], p = 0.005) in Group Amultiple was slightly higher at 3 months postoperatively. Conversely, the CPSP incidence (60.0% vs 29.4%, p = 0.011) was significantly higher at 6 months postoperatively in Group Amultiple. The multivariate regression analysis further validated hookwire localization as a risk factor for CPSP (odds ratio: 6.199, 95% confidence interval 2.049-18.749, p = 0.001). Patient satisfaction relating to pain management at 3 months postoperatively was lower in Group A (p = 0.034). Conclusion The preoperative pain stress of hookwire localization increased the incidence and intensity of CPSP rather than acute pain at 3 months postoperatively, especially in patients with multiple hookwires.
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Affiliation(s)
- Lingchao Kong
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Lingling Gao
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Hong Zhang
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Xin Wang
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Jun Zhang
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China,Correspondence: Jun Zhang, Department of Anesthesiology, Shanghai Cancer Center, Fudan University and Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dong’An Road, Xuhui District, Shanghai, 200032, People’s Republic of China, Tel +86-21-64175590, Fax +86-21-64174774, Email
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Liu B, Li X, Yu MJ, Xie JB, Liao GL, Qiu ML. Application of single-port laparoscopic retrograde gastric mobilization during McKeown esophagectomy for esophageal cancer. Ann Thorac Med 2023; 18:39-44. [PMID: 36968329 PMCID: PMC10034825 DOI: 10.4103/atm.atm_205_22] [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: 05/29/2022] [Accepted: 11/05/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND As a novel alternative to the conventional minimally invasive esophagectomy (MIE) to treat esophageal cancer, single-port laparoscopic retrograde three-step gastric mobilization (SLRM) for esophageal reconstruction during MIE to treat esophageal cancer was attempted in our department. The aim of the present study was to explore the preliminary clinical outcomes and feasibility of this innovative surgery. METHODS From March 2020 to November 2021, patients undergoing SLRM combined with four-port thoracoscopic McKeown esophagectomy for their esophageal cancers were reviewed. Gastric mobilization with abdominal lymph node dissection was performed through SLRM. The clinical characteristics and short-term outcomes were analyzed retrospectively. RESULTS A total of 120 patients underwent R0 resection without conversion to open surgery. The mean times needed for the thoracic part, abdominal part, and total operation were 43 ± 6 min, 60 ± 18 min, and 230 ± 20 min, respectively. The numbers of mediastinal and abdominal lymph nodes harvested were 13.2 ± 2.7 and 10.2 ± 2.5, respectively. Postoperative pneumonia was encountered in 10 (8.3%) patients. Anastomotic leakage occurred in 3 (2.5%) cases. Temporary vocal cord paralysis was reported in 20 (16.6%) cases. The mean length of hospital stay was 8.5 ± 4.6 days. CONCLUSIONS The SLRM is a technically feasible and safe treatment for patients with esophageal cancer. It can be considered an alternative method for patients, especially for the ones with obesity and gastric distension.
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Affiliation(s)
- Bo Liu
- Department of Thoracic Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Xu Li
- Department of Thoracic Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Min-Jie Yu
- Department of Thoracic Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Jin-Bao Xie
- Department of Thoracic Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Guo-Liang Liao
- Department of Thoracic Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Ming-Lian Qiu
- Department of Thoracic Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
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Xu G, Wang G, Mei X, Wu M, Li T, Xie M. Sequential pulmonary resections by uniportal video-assisted thoracic surgery for bilateral multiple pulmonary nodules. Front Oncol 2022; 12:961812. [PMID: 36263215 PMCID: PMC9574321 DOI: 10.3389/fonc.2022.961812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 09/15/2022] [Indexed: 12/24/2022] Open
Abstract
Objective The aim of this study was to evaluate the effect of sequential pulmonary resections by uniportal video-assisted thoracoscopic surgery (VATS) for bilateral multiple pulmonary nodules (BMPNs). Methods A single-center, prospective, nonrandomized study was performed on patients who underwent one-stage or two-stage operations by uniportal VATS. The clinical, pathological and perioperative data were summarized and analyzed from January 2021 to December 2021. Results A total of 80 patients were included during the study period. Sequential pulmonary resection by uniportal VATS was underwent in 40 patients. There were no perioperative deaths and serious complications, 2 patients had postoperative pneumonia, 3 patients had transient atrial fibrillation, 1 patient had persistent severe air leakage, 1 patient occurred hemoptysis. The one-stage group had less operative time, surgical blood loss, pleural drainage, chest tube duration and postoperative admission duration(P<0.05). The results of pathological examination of pulmonary nodules revealed adenocarcinoma in situ (n=12), minimally invasive adenocarcinoma (n=24), invasive adenocarcinoma (n=42), squamous carcinoma (n=1),and benign nodules (n=10). The pathological diagnosis included multiple primary lung cancers (30/40, 75%), single primary lung cancer (6/40, 15%). The most advanced pathologic stage of the primary lung cancer was classified as IA (n=19), IB (n=5), II (n=3), and IIIA (n=2). Conclusion For patients with excellent pulmonary function, sequential pulmonary resection by uniportal VATS is a safe and feasible for BMPNs. Strict control of surgical indications, reasonable preoperative planning, accurate intraoperative operation, and standardized perioperative management can effectively reduce complications and maximize benefits for suitable patients.
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Affiliation(s)
| | | | | | | | - Tian Li
- *Correspondence: Mingran Xie, ; Tian Li,
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Hu CG, Yang XT, Zhao M, Zheng K, Li ZL, Liu GH, Zhao YL, Lian JH, Guo SP. Three-Dimensional Computed Tomography Bronchography and Angiography-Guided Thoracoscopic Segmentectomy for Pulmonary Nodules. Surg Innov 2021; 29:343-352. [PMID: 34559004 DOI: 10.1177/15533506211044389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Three-dimensional computed tomography bronchography and angiography (3D-CTBA) provides detailed imaging information for pulmonary segmentectomy. This study was performed to verify the feasibility of 3D-CTBA-guided thoracoscopic segmentectomy for the treatment of pulmonary nodules. METHODS A retrospective analysis was performed on all patients who underwent 3D-CTBA-guided uniport thoracoscopic segmentectomies or subsegmentectomies for pulmonary nodules in the period from May 2019 to May 2020. All of the information related to perioperative management and surgical operations was retrieved from the medical records and operating notes for detailed analysis. RESULTS A total of 104 eligible operations involving the resection of 110 nodules with diameters in the range of 5-20 mm were included. Under 3D-CTBA guidance, the pulmonary nodules were located with an accuracy of 100% (110/110) and the median resection margin was 24.3 mm (17-33 mm). Additionally, the segmental (subsegmental) bronchi, arteries, and veins were identified with accuracy rates of 100% (104/104), 96.2% (100/104), and 94.2% (98/104), respectively. The postoperative complications consisted of 3 cases of pulmonary infection (2.9%), 6 cases of arrhythmia (5.8%), 2 cases of hemoptysis (1.9%), 4 cases of air leak (3.8%), and 2 cases of subcutaneous emphysema (1.9%). No perioperative death occurred. CONCLUSION 3D-CTBA-guided thoracoscopic segmentectomy is an effective surgical approach for the management of pulmonary nodules.
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Affiliation(s)
- Cheng-Guang Hu
- Department of Thoracic Surgery, ShanXi Cancer Hospital (the Affiliated Cancer Hospital of Shanxi Medical University), Taiyuan, China
| | - Xiao-Tang Yang
- Department of Computed Tomography and Magnetic Resonance, ShanXi Cancer Hospital (the Affiliated Cancer Hospital of Shanxi Medical University), Taiyuan, China
| | - Ming Zhao
- Department of Positron Emission Computed Tomography, ShanXi Cancer Hospital (the Affiliated Cancer Hospital of Shanxi Medical University), Taiyuan, China
| | - Kang Zheng
- Department of Thoracic Surgery, ShanXi Cancer Hospital (the Affiliated Cancer Hospital of Shanxi Medical University), Taiyuan, China
| | - Zhi-Long Li
- Department of Thoracic Surgery, ShanXi Cancer Hospital (the Affiliated Cancer Hospital of Shanxi Medical University), Taiyuan, China
| | - Guan-Hua Liu
- Department of Thoracic Surgery, ShanXi Cancer Hospital (the Affiliated Cancer Hospital of Shanxi Medical University), Taiyuan, China
| | - Yan-Li Zhao
- Department of Thoracic Surgery, ShanXi Cancer Hospital (the Affiliated Cancer Hospital of Shanxi Medical University), Taiyuan, China
| | - Jian-Hong Lian
- Department of Thoracic Surgery, ShanXi Cancer Hospital (the Affiliated Cancer Hospital of Shanxi Medical University), Taiyuan, China
| | - Shi-Ping Guo
- Department of Thoracic Surgery, ShanXi Cancer Hospital (the Affiliated Cancer Hospital of Shanxi Medical University), Taiyuan, China
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11
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Sano Y, Okazaki M, Shigematsu H, Yamashita N, Sugimoto R, Sakao N, Mori Y, Yukumi S, Izutani H. Quality of life after partial lung resection with uniportal versus 3-port video-assisted thoracoscopic surgery: a prospective randomized controlled study. Surg Today 2021; 51:1755-1763. [PMID: 34013428 DOI: 10.1007/s00595-021-02294-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 02/09/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The effect of uniportal video-assisted thoracoscopic surgery (uni-VATS) versus that of conventional VATS on postoperative quality of life (QOL) is unclear. This prospective randomized controlled study compared uni-VATS and conventional 3-port VATS in terms of QOL and patient satisfaction. METHODS The subjects of this study were 84 patients with pulmonary nodules or bullous formation, randomized to undergo uniportal or conventional 3-port video-assisted thoracoscopic partial lung resection. The primary endpoint was postoperative pain, assessed using a numeric rating scale on postoperative day (POD) 1. RESULTS No differences were found in the numeric rating scale on POD 1 after uni-VATS and conventional 3-port VATS. There were also no differences in blood loss, operative time, complication rate, surgical margin, analgesic requirement, vital capacity (VC), forced expiratory volume in 1 s (FEV1), the 6-min walk test (6MWT), C-reactive protein (CRP) levels, white blood cell count (WBC), or duration of chest tube drainage and hospital stay. Differences were found in the numeric rating scale on days 2, 3, 5, and 10 and in the patient satisfaction score on PODs 5 and 10. CONCLUSIONS Uni-VATS is associated with less chest pain and better patient satisfaction in the short term but without differences in complication rates or surgical margins from the lesions. CLINICAL TRIAL REGISTRY NUMBER University Hospital Medical Information Network Clinical Trial Registry (UMIN000015340 http://www.umin.ac.jp/english/ ).
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Affiliation(s)
- Yoshifumi Sano
- Department of Cardiovascular and Thoracic Surgery, Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon City, 791-0295, Japan.
| | - Mikio Okazaki
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama City, Japan
| | - Hisayuki Shigematsu
- Department of Thoracic Surgery, National Hospital Organization Shikoku Cancer Center, Matsuyama City, Japan
| | - Natsumi Yamashita
- Division of Clinical Biostatistics, Section of Cancer Prevention and Epidemiology, Clinical Research Center, National Hospital Organization Shikoku Cancer Center, Matsuyama City, Japan
| | - Ryujiro Sugimoto
- Department of Cardiovascular and Thoracic Surgery, Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon City, 791-0295, Japan
| | - Nobuhiko Sakao
- Department of Cardiovascular and Thoracic Surgery, Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon City, 791-0295, Japan
| | - Yu Mori
- Department of Cardiovascular and Thoracic Surgery, Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon City, 791-0295, Japan
| | - Shungo Yukumi
- Department of Surgery, National Hospital Organization Ehime Medical Center, Toon City, Japan
| | - Hironori Izutani
- Department of Cardiovascular and Thoracic Surgery, Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon City, 791-0295, Japan
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12
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Xie D, Wu J, Hu X, Gonzalez-Rivas D, She Y, Chen Q, Zhu Y, Jiang G, Chen C. Uniportal versus multiportal video-assisted thoracoscopic surgery does not compromise the outcome of segmentectomy. Eur J Cardiothorac Surg 2020; 59:650-657. [PMID: 33230524 DOI: 10.1093/ejcts/ezaa372] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/07/2020] [Accepted: 08/29/2020] [Indexed: 12/12/2022] Open
Abstract
Abstract
OBJECTIVES
The goal of this study was to compare the feasibility and safety of uniportal thoracoscopic segmentectomy (UTS) with that of multiportal thoracoscopic segmentectomy (MTS).
METHODS
From January 2014 to December 2015, a total of 1056 patients who underwent thoracoscopic segmentectomy were identified, including 375 and 681 who had simple and complex segmentectomies, respectively. A propensity matched analysis was applied to compare perioperative indicators. Survival outcomes, which included disease-free survival and overall survival, were assessed by Kaplan–Meier estimates and Cox hazards regression analysis.
RESULTS
Propensity matching generated 454 paired patients for the UTS and MTS cohorts; the perioperative results were comparable. Survival analysis indicated that the surgical approach (UTS versus MTS) was not an independent risk factor in either disease-free survival (P = 0.247) or overall survival (P = 0.870) of patients with invasive adenocarcinoma. A shorter operative time was observed in patients who had a UTS (P < 0.001) or an MTS (P = 0.011) via a simple segmentectomy compared with those who had a complex segmentectomy. Moreover, 147 and 266 corresponding cases were selected to compare the UTS and MTS in the simple and complex segmentectomy groups, respectively. MTS showed slightly longer operative times (119 vs 108 min; P = 0.007) and drainage duration (P = 0.010) in the simple segmentectomy group. In contrast, UTS was associated with statistically longer operative times (141 vs 133 min; P = 0.016) in the complex segmentectomy group.
CONCLUSIONS
Although minor differences could be found in the simple and complex segmentectomy groups, respectively, these results were clinically irrelevant. Our study supports UTS as a feasible and safe surgical technique.
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Affiliation(s)
- Dong Xie
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Junqi Wu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xuefei Hu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Diego Gonzalez-Rivas
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain
| | - Yunlang She
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qiankun Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yuming Zhu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
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13
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Hu CG, Zheng K, Liu GH, Li ZL, Zhao YL, Lian JH, Guo SP. Effectiveness and postoperative pain level of single-port versus two-port thoracoscopic lobectomy for lung cancer: a retrospective cohort study. Gen Thorac Cardiovasc Surg 2020; 69:318-325. [PMID: 32897502 PMCID: PMC7868319 DOI: 10.1007/s11748-020-01479-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/29/2020] [Indexed: 12/24/2022]
Abstract
Objectives Single-port thoracoscopic lobectomy is a new therapeutic technique for patients with lung cancer; however, insufficient data are available regarding its clinical outcomes. We therefore compared the clinical outcomes of single-port and two-port thoracoscopic lobectomies for lung cancer. Methods We retrospectively analyzed and compared the data of 204 and 368 patients with lung cancer who underwent single-port or two-port thoracoscopic lobectomy, respectively, between October 2014 and October 2017 at our institution. Patients in both groups underwent 1:1 propensity score matching, and 400 patients (200 patients in each group) were included. Perioperative clinical indicators were analyzed, including operation time, lymph node dissection stations and numbers, incidence of postoperative complications, and pain scores at 24 h, 72 h, and 1 week after surgery. Results No perioperative deaths occurred in either group. The operation time, intraoperative blood loss, chest drainage duration, duration of postoperative hospital stay, lymph node dissection station and number, rate of conversion to open surgery, number of ruptured intraoperative pulmonary vessel, and incidence of postoperative complications were not significantly different between the groups (all P > 0.05). However, analysis of the 24-h (P = 0.005), 72-h (P = 0.011), and 1-week (P = 0.034) visual analog scale score after surgery revealed that the postoperative pain levels were significantly lower in the single-port than in the two-port group. Conclusions Single-port and two-port thoracoscopic lobectomies had similar perioperative outcomes, although the postoperative pain was lower after single-port than two-port thoracoscopic lobectomy. Hence, we concluded that single-port thoracoscopic lobectomy is an effective, minimally invasive, and promising surgical procedure.
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Affiliation(s)
- Cheng-Guang Hu
- Department of Thoracic Surgery, ShanXi Cancer Hospital, the Affiliated Cancer Hospital of Shanxi Medical University, No. 3 Kaixuan Street, Xinghualing District, Taiyuan, 030013, China.
| | - Kang Zheng
- Department of Thoracic Surgery, ShanXi Cancer Hospital, the Affiliated Cancer Hospital of Shanxi Medical University, No. 3 Kaixuan Street, Xinghualing District, Taiyuan, 030013, China
| | - Guan-Hua Liu
- Department of Thoracic Surgery, ShanXi Cancer Hospital, the Affiliated Cancer Hospital of Shanxi Medical University, No. 3 Kaixuan Street, Xinghualing District, Taiyuan, 030013, China
| | - Zhi-Long Li
- Department of Thoracic Surgery, ShanXi Cancer Hospital, the Affiliated Cancer Hospital of Shanxi Medical University, No. 3 Kaixuan Street, Xinghualing District, Taiyuan, 030013, China
| | - Yan-Li Zhao
- Department of Thoracic Surgery, ShanXi Cancer Hospital, the Affiliated Cancer Hospital of Shanxi Medical University, No. 3 Kaixuan Street, Xinghualing District, Taiyuan, 030013, China
| | - Jian-Hong Lian
- Department of Thoracic Surgery, ShanXi Cancer Hospital, the Affiliated Cancer Hospital of Shanxi Medical University, No. 3 Kaixuan Street, Xinghualing District, Taiyuan, 030013, China
| | - Shi-Ping Guo
- Department of Thoracic Surgery, ShanXi Cancer Hospital, the Affiliated Cancer Hospital of Shanxi Medical University, No. 3 Kaixuan Street, Xinghualing District, Taiyuan, 030013, China
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14
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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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15
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Tosi D, Nosotti M, Bonitta G, Mazzucco A, Righi I, Mendogni P, Rosso L, Palleschi A, Rocco G, Crisci R. Uniportal and three-portal video-assisted thoracic surgery lobectomy: analysis of the Italian video-assisted thoracic surgery group database. Interact Cardiovasc Thorac Surg 2020; 29:714-721. [PMID: 31363760 DOI: 10.1093/icvts/ivz153] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 05/06/2019] [Accepted: 05/19/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES This study compares the uniportal with the 3-portal video-assisted thoracic surgery (VATS) by examining the data collected in the Italian VATS Group Database. The primary end point was early postoperative pain; secondary end points were intraoperative and postoperative complications, surgical time, number of dissected lymph nodes and length of stay. METHODS This was an observational, retrospective, cohort, multicentre study on data collected by 49 Italian thoracic units. Inclusion criteria were clinical stage I-II non-small-cell lung cancer, uniportal or 3-portal VATS lobectomy and R0 resection. Exclusion criteria were cT3 disease, previous thoracic malignancy, induction therapy, significant comorbidities and conversion to other techniques. The pain parameter was dichotomized: the numeric rating scale ≤3 described mild pain, whereas the numeric rating scale score >3 described moderate/severe pain. The propensity score-adjusted generalized estimating equation was used to compare the uniportal with 3-portal lobectomy. RESULTS Among 4338 patients enrolled from January 2014 to July 2017, 1980 met the inclusion criteria; 1808 patients underwent 3-portal lobectomy and 172 uniportal surgery. The adjusted generalized estimating equation regression model using the propensity score showed that over time pain decreased in both groups (P < 0.001). There was a statistical difference on the second and third postoperative days; odds ratio (OR) 2.28 [95% confidence interval (CI) 1.62-3.21; P < 0.001] and OR 2.58 (95% CI 1.74-3.83; P < 0.001), respectively. The uniportal-VATS group had higher operative time (P < 0.001), shorter chest drain permanence (P < 0.001) and shorter length of stay (P < 0.001). CONCLUSIONS Data from the Italian VATS Group Database showed that in clinical practice uniportal lobectomy seems to entail a higher risk of moderate/severe pain on second and third postoperative days.
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Affiliation(s)
- Davide Tosi
- Thoracic Surgery and Lung Transplant Unit, Fondazione Irccs Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mario Nosotti
- Thoracic Surgery and Lung Transplant Unit, Fondazione Irccs Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gianluca Bonitta
- Thoracic Surgery and Lung Transplant Unit, Fondazione Irccs Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandra Mazzucco
- Thoracic Surgery and Lung Transplant Unit, Fondazione Irccs Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ilaria Righi
- Thoracic Surgery and Lung Transplant Unit, Fondazione Irccs Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Mendogni
- Thoracic Surgery and Lung Transplant Unit, Fondazione Irccs Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lorenzo Rosso
- Thoracic Surgery and Lung Transplant Unit, Fondazione Irccs Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandro Palleschi
- Thoracic Surgery and Lung Transplant Unit, Fondazione Irccs Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gaetano Rocco
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Roberto Crisci
- Thoracic Surgery Unit, University of L'Aquila, "G. Mazzini" Hospital, Teramo, Italy
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16
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Xu GW, Xie MR, Wu HR, Xiong R, Li CW, Xu SB, Xu MQ, Li T. A prospective study examining the impact of uniportal video-assisted thoracic surgery on the short-term quality of life in patients with lung cancer. Thorac Cancer 2020; 11:612-618. [PMID: 31967724 PMCID: PMC7049482 DOI: 10.1111/1759-7714.13305] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 12/16/2019] [Accepted: 12/25/2019] [Indexed: 02/02/2023] Open
Abstract
Background The aim of this study was to evaluate the effect of uniportal and three‐portal VATS in lung cancer patients on the postoperative short‐term quality of life (QOL). Methods A single‐center, prospective, nonrandomized study was performed on patients who underwent uniportal or three‐portal video‐assisted thoracoscopic surgery (VATS) lobectomy and systemic mediastinal lymph node dissection. QOL was measured before surgery at baseline and at one, two, four, and eight weeks after the operation. The measured data of normal distribution were indicated by the mean ± standard deviation, the independent sample t‐test was used among the groups, and the χ2 test was used to compare the counting. Non‐normal distribution of the measurement data was carried out using the Mann‐Whitney test. Results Preoperative functional areas, symptom areas and overall health scores were similar in the two groups. The physical, role, emotional and social functions and overall health status of the uniportal group were significantly higher than those of the three‐portal group in postoperative time. The score of symptom field was higher in one week after operation, the score of two, four and eight weeks decreased gradually, but it was still above the preoperative level, and the fatigue and pain of the uniportal group were significantly lower than that of the three‐portal group. Conclusion The advantages of uniportal VATS include a shorter hospital stay, more rapid recovery and superior cosmetic results compared to three‐portal VATS. Additionally, uniportal VATS is superior to three‐portal thoracoscopic surgery in terms of the immediate postoperative short‐term QOL.
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Affiliation(s)
- Guang-Wen Xu
- Department of Thoracic Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Ming-Ran Xie
- Department of Thoracic Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Han-Ran Wu
- Department of Thoracic Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Ran Xiong
- Department of Thoracic Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Cai-Wei Li
- Department of Thoracic Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Shi-Bin Xu
- Department of Thoracic Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Mei-Qing Xu
- Department of Thoracic Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Tian Li
- Department of Thoracic Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
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Zhang J, Zhao H, Lv L, Yuan J, Sun Y. Uniportal thoracoscopic pulmonary lobectomy in the treatment of Lung Cancer. Pak J Med Sci 2020; 36:182-186. [PMID: 32063956 PMCID: PMC6994905 DOI: 10.12669/pjms.36.2.793] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 11/09/2019] [Accepted: 11/11/2019] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To investigate the clinical efficacy of uniportal thoracoscopic pulmonary lobectomy in the treatment of lung cancer. METHODS One hundred and ten patients with lung cancer who were admitted to our hospital from February 2017 to June 2018 were enrolled and they were divided into the control group (55 patients) and observation group (55 patients) according to the random number table method. The patients in the observation group received uniportal thoracoscopic pulmonary lobectomy, and patients in the control group underwent triportal thoracoscopic pulmonary lobectomy. The surgical condition, postoperative pulmonary functions, postoperative complication incidence, and postoperative quality of life were compared between the two groups. RESULTS The intraoperative blood loss and number of dissected lymph nodes of the observation group were (125.31±12.63) mL and (13.91±2.41) respectively, which were not significantly different with (127.54±13.60) mL and (13.96±2.69) of the control group (P>0.05). The incision length of the observation group was (4.22±0.31) cm, shorter than (6.97±0.42) cm of the control group, the postoperative pain score was (2.87±0.69) points, lower than (4.31±1.09) points of the control group, and the operation time was (195.21±19.42) minutes, longer than (162.68±18.52) min of the control group; the differences were significantly different (P<0.05). The postoperative forced vital capacity (FVC), Maximum Ventilatory Volume (MVV) and Forced Expiratory Volume in 1s (FEV1) in the observation group were (1.90±0.75) L, (54.59±16.03) L/minutes and (1.60±0.53) L respectively, larger than (1.06±0.28) L, (38.41±15.59) L/min and (1.02±0.15) L respectively (P<0.05). The scores of Short Form 36-item Health Survey (SF-36) of patients in the observation group was observed one month after surgery, significantly higher than those in the control group, and the difference was statistically significant (P<0.05). The incidence of complications of the postoperative complication of the observation group was 12.7%, which was not significantly different with 14.5% of the control group (P>0.05). CONCLUSION Patients who receive uniportal video-assisted thoracoscopic pulmonary lobectomy have milder trauma, which is beneficial to the lung functions and postoperative recovery. Moreover, the number of dissected lymph nodes in uniportal thoracoscopic pulmonary lobectomy is equivalent with that in triportal thoracoscopic pulmonary lobectomy. Hence it is worth clinical promotion.
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Affiliation(s)
- Jinying Zhang
- Jinying Zhang, Department of Cardiothoracic Surgery (B), Binzhou People’s Hospital, Shandong, 256610, China
| | - Haixia Zhao
- Haixia Zhao, Department of Breast Surgery, Binzhou People’s Hospital, Shandong, 256610, China
| | - Lingmei Lv
- Lingmei Lv, Department of Neurology (B), Binzhou People’s Hospital, Shandong, 256610, China
| | - Jiang Yuan
- Jiang Yuan, Department of Cardiothoracic Surgery (B), Binzhou People’s Hospital, Shandong, 256610, China
| | - Yuzhen Sun
- Yuzhen Sun, Department of Neurosurgery (A), Binzhou People’s Hospital, Shandong, 256610, China
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Simplified synchronous disconnection of pulmonary arteries and veins for right upper lobectomy. Surg Endosc 2019; 33:2015-2023. [PMID: 30617423 DOI: 10.1007/s00464-018-06659-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 12/24/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Video-assisted thoracoscopic lobectomy with lymphadenectomy is considered one of the most effective treatments for early non-small cell lung cancer. We developed a novel approach for lobectomy in patients with right upper lung cancer through simplified synchronous disconnection of pulmonary arteries and veins. This study aimed to evaluate the feasibility, efficacy, safety, and cost-effectiveness of this minimally invasive technique in managing right upper lobectomy. PATIENTS AND METHODS From March 2016 to September 2017, 62 patients with right upper lung cancer underwent lobectomy via simplified synchronous disconnection of pulmonary arteriovenous by video-assisted thoracoscopic surgery. All patients were followed up for 6-12 months after the procedure through clinic visits or telephone/e-mail interviews. RESULTS Of the 62 patients (mean age, 57.2 ± 8.7 years), 28 were men (45.2%) and 34 (54.8%) were women. All procedures were successfully performed by thoracoscopy, with a mean operating time of 66.2 ± 9.0 min. The mean blood loss was 40.3 ± 19.5 mL. Only 1 (1.61%) patient required blood transfusion. The mean number of endoscopic linear stapling devices used was 2.6 ± 0.7. The mean number of lymph nodes harvested was 16.0 ± 1.6. Postoperative pneumonia was encountered in 4 (6.45%) patients. There was no postoperative mortality. The mean length of hospital stay was 5.3 ± 1.3 days. Six-month follow-up revealed an excellent clinical result and degree of satisfaction. CONCLUSIONS Simplified synchronous disconnection of pulmonary arteries and veins is a feasible, economical, safe, and effective therapeutic procedure for right upper lung carcinoma. This novel procedure shows promise as a viable surgical approach for right upper lobectomy.
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Li C, Xu M, Xu G, Xiong R, Wu H, Xie M. [A Comparative Study of Acute and Chronic Pain between Single Port and Triple Port Video-assisted Thoracic Surgery for Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018; 21:279-284. [PMID: 29587906 PMCID: PMC5973348 DOI: 10.3779/j.issn.1009-3419.2018.04.09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Through the comparative analysis of the acute and chronic pain postoperative between the single port and triple port video-assisted thoracic surgery to seek the better method which can reduce the incidence of acute and chronic pain in patients with lung cancer. METHODS Data of 232 patients who underwent single port -VATS (n=131) or triple port VATS (n=101) for non-small cell lung cancer (NSCLC) on January 1, 2016 to June 30, 2017 in our hospital were analyzed. The clinical and operative data were assessed, numeric rating scale (NRS) was used to evaluate the mean pain score on the 1th, 2th, 3th, 7th, 14th days, 3th months and 6th months postoperative. RESULTS Both groups were similar in clinical characteristics, there were no perioperative death in two groups. In the 1th, 2th, 7th, 14th days and 3th, 6th months postoperative, the NRS score of the single port group was superior, and the difference was significant compared with the triple port (P<0.05). There was no statistically significant difference between the two groups in operative time, blood loss, postoperative hospitalization time, duration of chest tube, the NRS scores in the 3 d (P>0.05). Univariate and multivariate analysis of the occurrence on the chronic pain showed that the operation time, surgical procedure and the 14th NRS score were risk factors for chronic pain (P<0.05). CONCLUSIONS The single port thoracoscopic surgery has an advantage in the incidence of acute and chronic pain in patients with non-small cell lung cancer. Shorter operative time can reduce the occurrence of chronic pain. The 14th day NRS score is a risk factor for chronic pain postoperative.
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Affiliation(s)
- Caiwei Li
- Department of Thoracic Surgery, The First Affiliated Hospital of USTC (Anhui Provincial Hospital), Hefei 230001, China
| | - Meiqing Xu
- Department of Thoracic Surgery, The First Affiliated Hospital of USTC (Anhui Provincial Hospital), Hefei 230001, China
| | - Guangwen Xu
- Department of Thoracic Surgery, The First Affiliated Hospital of USTC (Anhui Provincial Hospital), Hefei 230001, China
| | - Ran Xiong
- Department of Thoracic Surgery, The First Affiliated Hospital of USTC (Anhui Provincial Hospital), Hefei 230001, China
| | - Hanran Wu
- Department of Thoracic Surgery, The First Affiliated Hospital of USTC (Anhui Provincial Hospital), Hefei 230001, China
| | - Mingran Xie
- Department of Thoracic Surgery, The First Affiliated Hospital of USTC (Anhui Provincial Hospital), Hefei 230001, China
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Qin J. [Is Uniportal Less Invasive Than Multi--Portal Regarding VATS Lobectomy?]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018; 21:300-302. [PMID: 29587910 PMCID: PMC5973336 DOI: 10.3779/j.issn.1009-3419.2018.04.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jianjun Qin
- Department of Thoracic Surgery, Cancer Hospital Affiliated to Zhengzhou University & Henan Tumor Hospital
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