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Andreetti C, Ibrahim M, Gagliardi A, Poggi C, Maurizi G, Armillotta D, Peritone V, Teodonio L, Rendina EA, Venuta F, Anile M, Natale G, Santini M, Fiorelli A. Adjuvant chemotherapy, extent of resection, and immunoistochemical neuroendocrine markers as prognostic factors of early-stage large-cell neuroendocrine carcinoma. Thorac Cancer 2022; 13:900-912. [PMID: 35170859 PMCID: PMC8977171 DOI: 10.1111/1759-7714.14287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/05/2021] [Accepted: 12/06/2021] [Indexed: 01/25/2023] Open
Abstract
Background We investigated whether adjuvant chemotherapy, extent of resection, and immunoistochemical neuroendocrine markers affected survival of patients with the early stage of large‐cell neuroendocrine cancer. Methods This was a retrospective multicenter study including consecutive patients undergoing resection of node negative large‐cell neuroendocrine carcinoma. Five‐year survival and disease‐free survival rate were evaluated by the Kaplan–Meier method and the log‐rank test in relation to adjuvant chemotherapy, extent of resection, and immunoistochemical neuroendocrine markers (synaptophysin, chromogranin A, and neuron‐specific enolase). Results Our study population included 117 patients; 47 (40%) of these received adjuvant chemotherapy. Patients treated with adjuvant chemotherapy had better survival (74% vs. 45%, p = 0.002) and disease‐free survival (79% vs. 40%, p = 0.001) in all cases except patients with tumor <20 mm (79.5% vs. 57.4%, p = 0.43). Lobectomy compared to sublobar resection was associated with better survival (67% vs. 0.1%, p < 0.0001) and disease‐free survival (65% vs. 0.1%, p < 0.0001) also in patients with tumor <20 mm (79% vs. 28%, p = 0.001). Patients with triple‐positive neuroendocrine markers had better survival (79% vs. 35%, p = 0.0001) and disease‐free survival (69% vs. 42%, p = 0.0008). Regression analysis showed that tumor size <20 mm, lobectomy, adjuvant chemotherapy, and triple‐positive immunistochemical neuroendocrine markers were significant favorable prognostic factors for survival outcomes. Conclusions Lobectomy seems to be the management of choice in patients with large‐cell neuroendocrine cancer <20 mm while adjuvant chemotherapy should be administered only in patients with tumor >20 mm.
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Affiliation(s)
- Claudio Andreetti
- Thoracic Surgery Unit, Sant'Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Mohsen Ibrahim
- Thoracic Surgery Unit, Sant'Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Antonio Gagliardi
- Thoracic Surgery Unit, Sant'Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Camilla Poggi
- Thoracic Surgery Unit, Policlinico Hospital, University of Rome La Sapienza, Rome, Italy
| | - Giulio Maurizi
- Thoracic Surgery Unit, Sant'Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Domenico Armillotta
- Thoracic Surgery Unit, Sant'Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Valentina Peritone
- Thoracic Surgery Unit, Sant'Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Leonardo Teodonio
- Thoracic Surgery Unit, Sant'Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Erino Angelo Rendina
- Thoracic Surgery Unit, Sant'Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Federico Venuta
- Thoracic Surgery Unit, Policlinico Hospital, University of Rome La Sapienza, Rome, Italy
| | - Marco Anile
- Thoracic Surgery Unit, Policlinico Hospital, University of Rome La Sapienza, Rome, Italy
| | - Giovanni Natale
- Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Mario Santini
- Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Alfonso Fiorelli
- Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, Naples, Italy
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Fiorelli A, Forte S, Caronia FP, Ferrigno F, Santini M, Petersen RH, Fang W. Is video-assisted thoracoscopic lobectomy associated with higher overall costs compared with open surgery? Results of best evidence topic analysis. Thorac Cancer 2021; 12:567-579. [PMID: 33544445 PMCID: PMC7919127 DOI: 10.1111/1759-7714.13708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/02/2020] [Accepted: 10/02/2020] [Indexed: 11/28/2022] Open
Abstract
Thoracoscopic lobectomy has become the preferred approach for surgical management of early stage lung cancer, but the potential higher operative costs limit its widespread use. Theoretically, higher direct costs may be significantly counterbalanced by lower indirect costs, resulting in lower overall costs for thoracoscopic than for open lobectomy. To support this hypothesis, we reviewed the literature until May 2020, analyzing all papers comparing the cost of thoracoscopic versus open lobectomy.A total of 20 studies provided the most applicable evidence to evaluate this issue. In all the studies apart from one, thoracoscopic lobectomy was associated with higher operative costs due to the increased use of disposable instruments, and prolonged operative time. By contrast, in 17 studies the increased operative costs were significantly offset by indirect costs which were lower in thoracoscopic than in open lobectomy due to fewer postoperative complications, faster recovery, and lower readmission rates. It translated into lower overall costs for thoracoscopic than for open lobectomy in 10 studies, similar costs in seven, and higher in three, despite the lower hospitalization costs. The low bed fees and high prices of disposable instruments in these three studies may explain the discordance. The careful use of disposable instruments, and the minimizing hospitalization costs can reduce the total costs of thoracoscopic lobectomy to levels similar or to below those of open lobectomy. The worry that video‐assisted thoracoscopic surgery lobectomy (VATSL) might be associated with an increased overal cost is thus not warranted, and should not be used as an excuse against the use of VATS in surgery for early stage lung cancers.
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Affiliation(s)
- Alfonso Fiorelli
- Department of Translation Medicine, Thoracic Surgery Unit, Università della Campania "Luigi Vanvitelli", Naples, Italy
| | - Stefano Forte
- Istituto Oncologico del Mediterraneo (IOM), Catania, Italy
| | | | | | - Mario Santini
- Department of Translation Medicine, Thoracic Surgery Unit, Università della Campania "Luigi Vanvitelli", Naples, Italy
| | - René Horsleben Petersen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Jiao Tong University Medical School, Shanghai, China
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Malouf R, Marchal C, Paget-Bailly S, Westeel V, Bernard A. Limited resections versus lobectomy for stage I non-small cell lung cancer. Hippokratia 2020. [DOI: 10.1002/14651858.cd013728] [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)
- Reem Malouf
- National Perinatal Epidemiology Unit (NPEU); University of Oxford; Oxford UK
| | | | - Sophie Paget-Bailly
- Methodological and Quality of Life in Oncology Unit; University Hospital of Besançon; Besançon France
- Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR 1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique; Besançon France
| | - Virginie Westeel
- Methodological and Quality of Life in Oncology Unit; University Hospital of Besançon; Besançon France
- Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR 1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique; Besançon France
- Department of Thoracic Oncology; University Hospital of Besançon; Besançon France
| | - Alain Bernard
- Chirurgie Cardio-Vasculaire et Thoracique; CHU Dijon; Dijon Cedex France
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Smith D, Raices M, Diego C, Julián D, Montagne J, Dietrich A. Incidence of venous thromboembolism and bleeding after pulmonary lobectomy: evaluating the timing for thromboprophylaxis. J Thromb Thrombolysis 2020; 51:997-1004. [PMID: 32929687 DOI: 10.1007/s11239-020-02277-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2020] [Indexed: 12/24/2022]
Abstract
Venous thromboembolism (VTE) is an important postoperative complication after major lung cancer resective surgery, such as lobectomy. It is recommended to start chemical thromboprophylaxis within the first 12 h following the procedure. Postoperative bleeding is also a relevant complication in patients with predisposing conditions. However, the criterion for classifying a patient as "high risk of bleeding" is not standardized and is left to the expertise of the attending physician or surgeon. We aim to describe the incidence and risk factors for postoperative VTE and hemorrhage after pulmonary lobectomy; and to assess the impact of the timing of thromboprophylaxis on the incidence of postoperative thrombotic or hemorrhagic events. A retrospective observational study of 358 lobectomies performed in a single center was performed, analyzing the rates of postoperative thrombotic and hemorrhagic events and predisposing factors, including postoperative thromboprophylaxis management. Cumulative incidence of VTE was 3.07% (95% CI 1.54-5.43), and early postoperative bleeding was 10.05% (95% CI 7.14-13.64). Underlying pulmonary disease was associated with VTE (p = 0.001) and open approach was associated with hemorrhagic events (p = 0.01). The use of thromboprophylaxis and timing of its initiation were not associated with a higher incidence of events. VTE and postoperative hemorrhage are relevant complications following pulmonary lobectomy. Compliance with VTE prophylaxis guidelines is essential. Even so, a case-by-case risk evaluation of VTE and bleeding remains preferable and safe in order to decide on the most suitable timing of thromboprophylaxis.
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Affiliation(s)
- David Smith
- Department of Thoracic Surgery. Hospital Italiano de Buenos Aires. Juan D. Perón, 4190. C1199ABD, Buenos Aires, Argentina
| | - Micaela Raices
- Department of General Surgery. Hospital Italiano de Buenos Aires. Juan D. Perón, 4190. C1199ABD, Buenos Aires, Argentina.
| | - Carolina Diego
- Department of General Surgery. Hospital Italiano de Buenos Aires. Juan D. Perón, 4190. C1199ABD, Buenos Aires, Argentina
| | - Drago Julián
- Department of General Surgery. Hospital Italiano de Buenos Aires. Juan D. Perón, 4190. C1199ABD, Buenos Aires, Argentina
| | - Juan Montagne
- Department of Thoracic Surgery. Hospital Italiano de Buenos Aires. Juan D. Perón, 4190. C1199ABD, Buenos Aires, Argentina
| | - Agustín Dietrich
- Department of Thoracic Surgery. Hospital Italiano de Buenos Aires. Juan D. Perón, 4190. C1199ABD, Buenos Aires, Argentina
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Rispoli M, Salvi R, Cennamo A, Di Natale D, Natale G, Meoli I, Gioia MR, Esposito M, Nespoli MR, De Finis M, Buono S, Corcione A, Lavoretano S, Bianco A, Fiorelli A, Curcio C, Perrotta F. Effectiveness of home-based preoperative pulmonary rehabilitation in COPD patients undergoing lung cancer resection. TUMORI JOURNAL 2020; 106:300891619900808. [PMID: 32090715 DOI: 10.1177/0300891619900808] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate the effectiveness of a home-based preoperative rehabilitation program for improving preoperative lung function and surgical outcome of patients with chronic obstructive pulmonary disease (COPD) undergoing lobectomy for cancer. METHODS This was a prospective, observational, single-center study including 59 patients with mild COPD who underwent lobectomy for lung cancer. All patients attended a home-based preoperative rehabilitation program including a minimum of 3 sessions each week for 4 weeks. Each session included aerobic and anaerobic exercises. Participants recorded the frequency and the duration of exercise performed in a diary. The primary end point was to evaluate changes in lung function including predicted postoperative (PPO) forced expiratory volume in 1 second (FEV1), 6-minute walking distance test (6MWD), PPO diffusing capacity for carbon monoxide (DLCO) %, and blood gas analysis values before and after the rehabilitation program. Postoperative pulmonary complications were recorded and multivariable analysis was used to identify independent prognostic factors (secondary end point). RESULTS All patients completed the 4-week rehabilitation program. Thirteen of 59 (22%) patients (Group A) performed <3 sessions per week (mean sessions per week: 2.3±1.3); 46 of 59 (78%) patients (Group B) performed ⩾3 sessions per week (mean sessions per week: 3.5±1.6). The comparison of PPO FEV1% and 6MWD before and after rehabilitation showed a significant improvement only in Group B. No significant changes in PPO DLCO% or in blood gas analysis values were seen. Nine patients presented postoperative pulmonary complications, including atelectasis (n = 6), pneumonia (n = 1), respiratory failure (n = 1), and pulmonary embolism (n = 1). Group A presented higher number of postoperative pulmonary complications than Group B (6 vs 3; p = 0.0005). Multivariate analysis showed that the number of weekly rehabilitation sessions was the only independent predictive factor (p = 0.001). CONCLUSIONS Our simple and low-cost rehabilitation program could improve preoperative clinical function in patients with mild to moderate COPD undergoing lobectomy and reduce postoperative pulmonary complications. All patients should be motivated to complete at least 3 rehabilitation sessions per week in order to obtain significant clinical benefits. Our preliminary results should be confirmed by larger prospective studies.
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Affiliation(s)
- Marco Rispoli
- Anesthesia and Intensive Care, Ospedale dei Colli Vincenzo Monaldi Hospital, Napoli, Italy
| | - Rosario Salvi
- Thoracic Surgery Unit, Ospedale dei Colli, Vincenzo Monaldi Hospital, Napoli, Italy
| | - Antonio Cennamo
- Department of Cardio-Thoracic and Respiratory Sciences, University of Campania "L. Vanvitelli," Naples, Italy
| | - Davide Di Natale
- Thoracic Surgery Unit, Ospedale dei Colli, Vincenzo Monaldi Hospital, Napoli, Italy
| | - Giovanni Natale
- Thoracic Surgery Unit, Ospedale dei Colli, Vincenzo Monaldi Hospital, Napoli, Italy
| | - Ilernando Meoli
- Department of Medicine and Health Sciences "V. Tiberio," University of Molise, Campobasso, Italy
| | - Maria Rosaria Gioia
- Department of Cardio-Thoracic and Respiratory Sciences, University of Campania "L. Vanvitelli," Naples, Italy
| | - Marianna Esposito
- Anesthesia and Intensive Care, Ospedale dei Colli Vincenzo Monaldi Hospital, Napoli, Italy
| | - Moana Rossella Nespoli
- Anesthesia and Intensive Care, Ospedale dei Colli Vincenzo Monaldi Hospital, Napoli, Italy
| | - Mario De Finis
- Anesthesia and Intensive Care, Ospedale dei Colli Vincenzo Monaldi Hospital, Napoli, Italy
| | - Salvatore Buono
- Anesthesia and Intensive Care, Ospedale dei Colli Vincenzo Monaldi Hospital, Napoli, Italy
| | - Antonio Corcione
- Anesthesia and Intensive Care, Ospedale dei Colli Vincenzo Monaldi Hospital, Napoli, Italy
| | - Sabrina Lavoretano
- Department of Cardio-Thoracic and Respiratory Sciences, University of Campania "L. Vanvitelli," Naples, Italy
| | - Andrea Bianco
- Department of Cardio-Thoracic and Respiratory Sciences, University of Campania "L. Vanvitelli," Naples, Italy
| | - Alfonso Fiorelli
- Department of Cardio-Thoracic and Respiratory Sciences, University of Campania "L. Vanvitelli," Naples, Italy
- Thoracic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli," Naples, Italy
| | - Carlo Curcio
- Thoracic Surgery Unit, Ospedale dei Colli, Vincenzo Monaldi Hospital, Napoli, Italy
| | - Fabio Perrotta
- Department of Medicine and Health Sciences "V. Tiberio," University of Molise, Campobasso, Italy
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Dalwadi SM, Zhang J, Bernicker EH, Butler EB, Teh BS, Farach AM. Socioeconomic Factors Associated with Lack of Treatment in Early Stage Non-Small Cell Lung Cancer. Cancer Invest 2019; 37:506-511. [PMID: 31530035 DOI: 10.1080/07357907.2019.1666136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
With modern radiotherapy, stage I non-small cell lung cancer (S1NSCLC) cure is extended to nonsurgical candidates. Despite this, some S1NSCLC remains untreated. We aim to identify factors associated with no treatment. 62,213 S1NSCLC cases were identified (SEER: 2004-2012). Demographics were compared using Chi-squared. Multivariate analysis was performed using COX proportional HR. 11.9% of the 7373 patients lacked treatment. No insurance, Medicaid-dependence, unmarried status, advancing age, lower income, African American and Asian/Pacific Islander race, and male sex are associated with no treatment (p < .0001). No treatment portends a worse cancer-specific survival (21% vs 66% at 5Y, p < .0001) and OS (10% vs 50% at 5Y, p < .0001).
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Affiliation(s)
| | - Jun Zhang
- Houston Methodist Hospital , Houston , TX , USA
| | | | | | - Bin S Teh
- Houston Methodist Hospital , Houston , TX , USA
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Hutchinson BD, Shroff GS, Truong MT, Ko JP. Spectrum of Lung Adenocarcinoma. Semin Ultrasound CT MR 2019; 40:255-264. [DOI: 10.1053/j.sult.2018.11.009] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Dziedzic R, Rzyman W. Lobectomy versus segmentectomy and wedge resection in the treatment of stage I non-small cell lung cancer. J Thorac Dis 2018; 10:E234-E235. [PMID: 29708140 DOI: 10.21037/jtd.2018.03.30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Robert Dziedzic
- Department of Thoracic Surgery, Medical University of Gdansk, Poland
| | - Witold Rzyman
- Department of Thoracic Surgery, Medical University of Gdansk, Poland
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