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Ventura L, Fiorelli A, Rossi M, Gnetti L, Natale G, Wang Y, Carbognani P, Fang W, Waller D. Is Lobectomy Actually Worse Than Segmentectomy for All Stage I Non-Small Cell Lung Cancer? J Surg Res 2024; 300:298-308. [PMID: 38838427 DOI: 10.1016/j.jss.2024.04.041] [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: 04/22/2023] [Revised: 03/24/2024] [Accepted: 04/20/2024] [Indexed: 06/07/2024]
Abstract
INTRODUCTION The recent results of the JCOG 0802 and CALGB 140503 studies suggest that segmentectomy should be considered instead of lobectomy for patients with peripheral <2 cm node-negative non-small cell lung cancer (NSCLC). This study aimed to test this hypothesis in a retrospective analysis of a larger dataset of patients with stage I NSCLC recorded in the Surveillance, Epidemiology, and End Results database. METHODS Patients with all stage I NSCLC (≤4 cm in size) who underwent either segmentectomy or lobectomy from 2000 to 2017 were analyzed. The primary endpoints were overall survival and lung cancer-specific survival, while the secondary endpoints were the 30-day and 90-day mortality. RESULTS Overall, 32,673 patients treated by lobectomy and 2166 patients treated by segmentectomy were included in the initial data collection. After 1:1 propensity score matching (PSM), 2016 patients in each group were enrolled in the final analysis with well-balanced baseline characteristics. After PSM, there was no difference between segmentectomy and lobectomy for all stage IA NSCLC (≤3 cm in size) in both overall survival and lung cancer-specific survival (hazard ratio: 0.87 [0.74-1.02], P value: 0.09 and hazard ratio: 0.81 [0.4-1.03], P value: 0.09, respectively). Furthermore, lobectomy had higher 30-day mortality than segmentectomy: 1.1% versus 2.1%, P value: 0.01. However, this difference was not significant for 90-day mortality, even after PSM (3.9% versus 3.0%, P value: 0.17). CONCLUSIONS We found no evidence to support the use of lobectomy rather than segmentectomy in stage IA NSCLC in terms of either overall or lung cancer-specific long-term survival. The choice of lobectomy may also be detrimental to early postoperative recovery.
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Affiliation(s)
- Luigi Ventura
- Cardiothoracic Surgery Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK; School of Medicine and Population Health, The University of Sheffield, Sheffield, UK.
| | - Alfonso Fiorelli
- Thoracic Surgery Unit, Università della Campania "Luigi Vanvitelli", Naples, Italy
| | - Maurizio Rossi
- Department of Clinical and Experimental Medicine, University Hospital of Parma, Parma, Italy
| | - Letizia Gnetti
- Pathology Unit, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Giovanni Natale
- Thoracic Surgery Unit, Università della Campania "Luigi Vanvitelli", Naples, Italy
| | - Yiyang Wang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Jiaotong University Medical School, Shanghai, China
| | - Paolo Carbognani
- Thoracic Surgery Unit, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Jiaotong University Medical School, Shanghai, China
| | - David Waller
- Barts Thorax Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
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Wu B, Zhang X, Feng N, Hu Z, Wu J, Zhou W, Wei Y, Zhang W, Wang K. Treatment strategies for stage IA non-small cell lung cancer: A SEER-based population study. PLoS One 2024; 19:e0298470. [PMID: 38683794 PMCID: PMC11057715 DOI: 10.1371/journal.pone.0298470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/24/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND There are various therapeutic methods for treating stage IA (T1N0M0) non-small cell lung cancer (NSCLC), but no studies have systematically assessed multiple treatments to determine the most effective therapy. METHODS Stage IA NSCLC patient data collected between 2004 and 2018 were gathered from the Surveillance, Epidemiology, and End Results (SEER) database. Treatment modalities included observation, chemotherapy alone (CA), radiation alone (RA), radiation+chemotherapy (RC), surgery alone (SA), surgery+chemotherapy (SC), surgery+radiation (SR) and surgery+radiation+chemotherapy (SRC). Comparisons were made of overall survival (OS) and lung cancer-specific survival (LCSS) among patients based on different therapeutic methods by survival analysis. RESULTS Ultimately, 89147 patients with stage IA NSCLC between 2004 and 2018 were enrolled in this study. The order of multiple treatment modalities based on the hazard ratio (HR) for OS for the entire cohort revealed the following results: SA (HR: 0.20), SC (HR: 0.25), SR (HR: 0.42), SRC (HR: 0.46), RA (HR: 0.56), RC (HR: 0.72), CA (HR: 0.91) (P<0.001), and observation (HR: Ref). The SA group had the best OS and LCSS, and similar results were found in most subgroup analyses (all P<0.001). The order of surgical modalities based on the HR for OS for the entire cohort revealed the following results: lobectomy (HR: 0.32), segmentectomy (HR: 0.41), wedge resection (HR: 0.52) and local tumor destruction (HR: Ref). Lobectomy had the best effects on OS and LCSS, and similar results were found in all subgroup analyses (all P<0.001). CONCLUSION SA appeared to be the optimal treatment modality for patients with stage IA NSCLC, and lobectomy was associated with the best prognosis. There may be some indication and selection bias in our study, and the results of this study should be confirmed in a prospective study.
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Affiliation(s)
- Bo Wu
- Department of Thoracic Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Xiang Zhang
- Department of Thoracic Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Nan Feng
- Department of Thoracic Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Zhuozheng Hu
- Department of Thoracic Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Jiajun Wu
- Department of Thoracic Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Weijun Zhou
- Department of Thoracic Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Yiping Wei
- Department of Thoracic Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Wenxiong Zhang
- Department of Thoracic Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Kang Wang
- Department of Traditional Chinese Medicine, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
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Qiu B, Han J, Zhao J. Effect of thoracoscopic and thoracotomy on postoperative wound complications in patients with lung cancer: A meta-analysis. Int Wound J 2023; 20:4217-4226. [PMID: 37596788 PMCID: PMC10681477 DOI: 10.1111/iwj.14322] [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: 06/28/2023] [Revised: 07/08/2023] [Accepted: 07/10/2023] [Indexed: 08/20/2023] Open
Abstract
Because of the difficult surgical procedures, patients with lung cancer who have received thoracic surgery tend to have postoperative complications. It may lead to postoperative complications like wound infection, wound haematoma and pneumothorax. A lot of research has assessed the effect of various surgery methods on postoperative complications in pulmonary cancer. The purpose of this meta-analysis is to establish if thoracoscopic is superior to that of thoracotomy in the rate of post-operative complications. From the beginning to the end of June 2023, we performed an exhaustive search on four main databases for key words. The Hazard of Bias in Non-Randomized Interventional Studies (ROBINS-I) was evaluated in the literature. In the end, 13 trials that fulfilled the eligibility criteria underwent further statistical analyses. The results showed that thoracoscopic intervention decreased the risk of post operative wound infection (dominant ratio [OR], 3.00; 95% confidence margin [CI], 1.98, 4.55; p < 0.00001) and air-leakage after operation (OR, 1.30; 95% CI, 1.04, 1.63; p = 0.02). There was no statistically significant difference between the two groups in terms of the rate of haemorrhage after operation (OR, 0.10; 95% CI, 0.73, 1.66; p = 0.63). Our findings indicate that thoracoscopic is less likely to cause post operative infection and gas leakage than thoracotomy, and it does not decrease the risk of postoperative haemorrhage. As some of the chosen trials are too small to conduct meta-analyses, care must be taken when handling the data. In the future, a large number of randomized, controlled trials will be required to provide additional evidence for this research.
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Affiliation(s)
- Bin Qiu
- Department of Thoracic SurgeryAffiliated Hospital of Weifang Medical UniversityWeifangChina
| | - Jinlong Han
- Department of Interventional OncologyAffiliated Hospital of Weifang Medical UniversityWeifangChina
| | - Jin Zhao
- Department of Thoracic SurgeryAffiliated Hospital of Weifang Medical UniversityWeifangChina
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Jovanoski N, Abogunrin S, Di Maio D, Belleli R, Hudson P, Bhadti S, Jones LG. Systematic Literature Review to Identify Cost and Resource Use Data in Patients with Early-Stage Non-small Cell Lung Cancer (NSCLC). PHARMACOECONOMICS 2023; 41:1437-1452. [PMID: 37389802 PMCID: PMC10570243 DOI: 10.1007/s40273-023-01295-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/11/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Approximately 2 million new cases and 1.76 million deaths occur annually due to lung cancer, with the main histological subtype being non-small cell lung cancer (NSCLC). The costs and resource use associated with NSCLC are important considerations to understand the economic impact imposed by the disease on patients, caregivers and healthcare services. OBJECTIVE The objective of this systematic literature review (SLR) is to provide a comprehensive overview of the available direct medical costs, direct non-medical costs, indirect costs, cost drivers and resource use data available for patients with early-stage NSCLC. METHODS Electronic searches were conducted via the Ovid platform in March 2021 and June 2022 and were supplemented by grey literature searches. Eligible patients had early-stage (stage I-III) resectable NSCLC and received treatment in the neoadjuvant or adjuvant setting. There was no restriction on intervention or comparators. Publication date was restricted to 2011 onwards, and English language publications or non-English language publications with an English abstract were of primary interest. Due to the anticipation of many studies meeting the inclusion criteria, analyses were restricted to full publications from countries of primary interest (Australia, Brazil, Canada, China, France, Germany, Italy, Japan, South Korea, Spain, UK and the US) and those with > 200 patients. The Molinier checklist was applied to conduct quality assessment. RESULTS Forty-two full publications met the eligibility criteria and were included in this SLR. Early-stage NSCLC was associated with significant direct medical costs and healthcare utilisation, and the economic burden of the disease increased with its progression. Surgery was the primary cost driver in stage I patients, but as patients progressed to stage II and III, treatments such as chemotherapy and radiotherapy, and inpatient care became the main cost drivers. There was no significant difference in resource use between patients with early-stage disease. However, these data were heavily US-centric and there was a paucity of data relating to direct non-medical and indirect costs associated with early-stage NSCLC. CONCLUSIONS Preventing disease progression for patients with NSCLC could reduce the economic burden of NSCLC on patients, caregivers and healthcare systems. This review provides a comprehensive overview of the available cost and resource use data in this indication, which is important in guiding the decisions of policy makers regarding the allocation of resources. However, it also indicates a need for more studies comparing the economic impact of NSCLC in markets in addition to the US.
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Vedire Y, Nitsche L, Tiadjeri M, McCutcheon V, Hall J, Barbi J, Yendamuri S, Ray AD. Skeletal muscle index is associated with long term outcomes after lobectomy for non-small cell lung cancer. BMC Cancer 2023; 23:778. [PMID: 37598139 PMCID: PMC10439565 DOI: 10.1186/s12885-023-11210-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 07/23/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND Skeletal muscle indices have been associated with improved peri-operative outcomes after surgical resection of non-small-cell lung cancer (NSCLC). However, it is unclear if these indices can predict long term cancer specific outcomes. METHODS NSCLC patients undergoing lobectomy at our institute between 2009-2015 were included in this analysis (N = 492). Preoperative CT scans were used to quantify skeletal muscle index (SMI) at L4 using sliceOmatic software. Cox proportional modelling was performed for overall (OS) and recurrence free survival (RFS). RESULTS For all patients, median SMI was 45.7 cm2/m2 (IQR, 40-53.8). SMI was negatively associated with age (R = -0.2; p < 0.05) and positively associated with BMI (R = 0.46; P < 0.05). No association with either OS or RFS was seen with univariate cox modelling. However, multivariable modelling for SMI with patient age, gender, race, smoking status, DLCO and FEV1 (% predicted), American Society of Anesthesiology (ASA) score, tumor histology and stage, and postoperative neoadjuvant therapy showed improved OS (HR = 0.97; P = 0.0005) and RFS (HR = 0.97; P = 0.01) with SMI. Using sex specific median SMI as cutoff, a lower SMI was associated with poor OS (HR = 1.65, P = 0.001) and RFS (HR = 1.47, P = 0.03). CONCLUSIONS SMI is associated with improved outcomes after resection of NSCLC. Further studies are needed to understand the biological basis of this observation. This study provides additional rationale for designing and implementation of rehabilitation trials after surgical resection, to gain durable oncologic benefit.
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Affiliation(s)
- Yeshwanth Vedire
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, 14263, USA
| | - Lindsay Nitsche
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, 14263, USA
| | - Madeline Tiadjeri
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, 14263, USA
| | - Victor McCutcheon
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, 14263, USA
| | - Jack Hall
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, 14263, USA
- Department of Physical Therapy and Rehabilitation, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, 14263, USA
| | - Joseph Barbi
- Department of Immunology, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, Ny, 14263, USA
| | - Sai Yendamuri
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, 14263, USA.
| | - Andrew D Ray
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, 14263, USA.
- Department of Rehabilitation, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, 14263, USA.
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Tanase BC, Burlacu AI, Nistor CE, Horvat T, Oancea C, Marc M, Tudorache E, Mateescu T, Manolescu D. A Retrospective Analysis Comparing VATS Cost Discrepancies and Outcomes in Primary Lung Cancer vs. Second Primary Lung Cancer Patients. Healthcare (Basel) 2023; 11:1745. [PMID: 37372863 DOI: 10.3390/healthcare11121745] [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: 05/05/2023] [Revised: 06/10/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
This study aimed to compare the outcomes and cost differences between primary lung cancer (PLC) and second primary lung cancer (SPLC) patients who underwent video-assisted thoracoscopic surgery (VATS). This was a retrospective analysis of 124 patients with lung cancer stages I, II, and III who underwent VATS between January 2018 and January 2023. The patients were divided into two groups based on their cancer status that was matched by age and gender: the PLC group (n = 62) and the SPLC group (n = 62). The results showed that there was no significant difference in the clinical characteristics between the 2 groups, except for the Charlson Comorbidity Index (CCI), with a score above 3 in 62.9% of PLC patients and 80.6% among SPLC patients (p = 0.028). Regarding the surgical outcomes, the operative time for the VATS intervention was significantly higher in the SPLC group, with a median of 300 min, compared with 260 min in the PLC group (p = 0.001), varying by the cancer staging as well. The average duration of hospitalization was significantly longer before and after surgery among patients with SPLC (6.1 days after surgery), compared with 4.2 days after surgery in the PLC group (0.006). Regarding the cost analysis, the total hospitalization cost was significantly higher in the SPLC group (15,400 RON vs. 12,800 RON; p = 0.007). Lastly, there was a significant difference in the survival probability between the two patient groups (log-rank p-value = 0.038). The 2-year survival was 41.9% among PLC patients and only 24.2% among those with SPLC. At the 5-year follow-up, there were only 1.6% survivors in the SPLC group, compared with 11.3% in the PLC group (p-value = 0.028). In conclusion, this study found that VATS is a safe and effective surgical approach for both PLC and SPLC patients. However, SPLC patients have a higher VATS operating time and require more healthcare resources than PLC patients, resulting in higher hospitalization costs. These findings suggest that careful pre-operative evaluation and individualized surgical planning are necessary to optimize the outcomes and cost-effectiveness of VATS for lung cancer patients. Nevertheless, the 5-year survival remains very low and concerning.
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Affiliation(s)
- Bogdan Cosmin Tanase
- Department of Thoracic Surgery, Oncology Institute "Alexandru Trestioreanu" of Bucharest, Fundeni Street 252, 022328 Bucharest, Romania
| | - Alin Ionut Burlacu
- Department of Thoracic Surgery, Oncology Institute "Alexandru Trestioreanu" of Bucharest, Fundeni Street 252, 022328 Bucharest, Romania
| | - Claudiu Eduard Nistor
- Department of Thoracic Surgery, Oncology Institute "Alexandru Trestioreanu" of Bucharest, Fundeni Street 252, 022328 Bucharest, Romania
| | - Teodor Horvat
- Department of Thoracic Surgery, Oncology Institute "Alexandru Trestioreanu" of Bucharest, Fundeni Street 252, 022328 Bucharest, Romania
| | - Cristian Oancea
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Monica Marc
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Emanuela Tudorache
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Tudor Mateescu
- Doctoral School, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Diana Manolescu
- Department of Radiology, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania
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Yang MZ, Tan ZH, Li JB, Xie CL, Sun TY, Long H, Fu JH, Zhang LJ, Lin P, Yang HX. Comparison of Short-Term Outcomes Between Robot-Assisted and Video-Assisted Segmentectomy for Small Pulmonary Nodules: A Propensity Score-Matching Study. Ann Surg Oncol 2023; 30:2757-2764. [PMID: 36774436 DOI: 10.1245/s10434-023-13179-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/02/2023] [Indexed: 02/13/2023]
Abstract
BACKGROUND Our study aimed to compare the short-term outcomes between robot-assisted segmentectomy (RAS) and video-assisted segmentectomy (VAS) for small pulmonary nodules. METHODS The study included of 299 segmentectomies (132 RAS and 167 VAS procedures) for small pulmonary nodules between June 2018 and November 2021. The patients were divided into two groups: the RAS group and the VAS group. Propensity score-matching (PSM) analysis was performed to minimize bias. A logistic regression model was performed to identify the independent risk factors associated with complications. RESULTS Before PSM, the following clinical variables were not balanced: age (P = 0.004), tumor size (P < 0.001), forced expiratory volume for 1 s (FEV1), and FEV1 percentage (P < 0.001). The patients with RAS had a shorter operative time (P = 0.014), less blood loss, a shorter postoperative hospital stay, less use of strong opioids, less drainage on postoperative day 1, and less postoperative total drainage, but more cost (all P < 0.001). Conversion to open surgery was performed for two patients in the VAS group but none in the RAS group. After PSM, 53 pairs were successfully matched. The data again suggested that the patients with RAS had less blood loss, a shorter postoperative hospital stay, and less use of strong opioids, but more cost (all P < 0.001). The operation time also was shorter in the RAS group, with a borderline statistically significant P value (0.053). CONCLUSIONS In our study, RAS had better short-term outcomes than VAS, indicating a safer and more efficient technique than VAS.
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Affiliation(s)
- Mu-Zi Yang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zi-Hui Tan
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Ji-Bin Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Department of Clinical Research, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Chu-Long Xie
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Tian-Yu Sun
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Hao Long
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jian-Hua Fu
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Lan-Jun Zhang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Peng Lin
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Hao-Xian Yang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China.
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.
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Huang JX, Chen Q, Hong SM, Hong JJ, Cao H. Single-direction thoracoscopic lobectomy for children with congenital lung malformation: initial experience. J Cardiothorac Surg 2023; 18:163. [PMID: 37118815 PMCID: PMC10148520 DOI: 10.1186/s13019-023-02192-7] [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: 07/05/2022] [Accepted: 03/29/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Thoracoscopic lobectomy is a common treatment for congenital lung malformation. Single-direction thoracoscopic lobectomy may be an effective and safe approach without the need to flip the lung over repeatedly, thus minimizing tissue trauma, but its use has not been reported in children. The purpose of this study was to evaluate the safety and efficacy of single-direction thoracoscopic lobectomy in children. METHODS A total of 91 patients who underwent thoracoscopic lobectomy in our hospital from January 2020 to December 2020 were retrospectively analysed. According to the inclusion criteria, 21 children were identified as the single-direction group. The details of the single-direction thoracoscopic lobectomy technique are described. Another 21 patients who underwent conventional thoracoscopic lobectomy in the same period were matched using the propensity score matching and set as the control group, the clinical outcomes between the two groups were compared. RESULTS The median age of the patients was 4.72 months (4.72 ± 0.90) with a mean body weight of 7.43 kg (7.43 ± 1.14). There were no significant differences in intraoperative blood loss (P = 0.549), operation time (P = 0.859), length of chest tube drainage (P = 0.102) and length of hospital stay (P = 0.636) between the 2 groups. No patients experienced bronchopleural fistula and conversion to thoracotomy in either group. All patients recovered well without respiratory symptoms or other complications after follow-up of more than 1 year. CONCLUSIONS Our preliminary experience presented a series of single-direction video-assisted thoracoscopic lobectomy for children with satisfactory perioperative results.
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Affiliation(s)
- Jin-Xi Huang
- Department of Cardiothoracic Surgery, Fujian Children's Hospital, Fuzhou, China.
- Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.
- College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.
- Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, 966 Hengyu Road, Fuzhou, Fujian Province, China.
| | - Qiang Chen
- Department of Cardiothoracic Surgery, Fujian Children's Hospital, Fuzhou, China
- Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China
- College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, 966 Hengyu Road, Fuzhou, Fujian Province, China
| | - Song-Ming Hong
- Department of Cardiothoracic Surgery, Fujian Children's Hospital, Fuzhou, China
- Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China
- College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, 966 Hengyu Road, Fuzhou, Fujian Province, China
| | - Jun-Jie Hong
- Department of Cardiothoracic Surgery, Fujian Children's Hospital, Fuzhou, China
- Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China
- College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, 966 Hengyu Road, Fuzhou, Fujian Province, China
| | - Hua Cao
- Department of Cardiothoracic Surgery, Fujian Children's Hospital, Fuzhou, China
- Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China
- College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, 966 Hengyu Road, Fuzhou, Fujian Province, China
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Sun D, Hu J, Li X, He J, Xu L, Fu X, Liu Y, Liu D, Chen P, Zhang X, Liu L. Real-world surgical treatment patterns and clinical outcomes in patients with stages IA-IIIA non-small cell lung cancer: a retrospective multicentric observational study involving 11,958 patients. J Cancer Res Clin Oncol 2023:10.1007/s00432-023-04729-8. [PMID: 37062036 DOI: 10.1007/s00432-023-04729-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 03/28/2023] [Indexed: 04/17/2023]
Abstract
PURPOSE Surgical resection is cornerstone treatment for early-stage non-small cell lung cancer (NSCLC) and offers a chance for cure. This study was conducted to determine current surgical treatment patterns and outcomes of Chinese patients with NSCLC. METHODS Data of patients with histologically confirmed NSCLC of stages IA-IIIA and who underwent surgery between July 2014 and July 2020 were retrospectively collected from 9 tertiary hospitals in China. Cox model was used for multivariate analyses. RESULTS This study included 11,958 patients, among whom 59.1%, 19.2%, and 21.7% were in stages I, II, and IIIA, respectively. Lobectomy was the most common operation method (78.4%), followed by wedge resection (8.2%), segmentectomy (5.4%), pneumonectomy (5.2%), and bronchial sleeve lobectomy (2.8%). Among patients who underwent wedge resection and segmentectomy, majority had stage I NSCLC (87.2% and 93.3%, respectively), and sublobectomy accounted for 20.7% of stage I operations. With a median follow-up time of 30.2 months, disease-free survival (DFS) and overall survival (OS) rates of entire population were 88.9% and 96.1% at 1 year, 75.2% and 85.1% at 3 years, and 65.3% and 77.0% at 5 years, respectively. The 5-year OS rates for stages IA, IB, IIA, IIB, and IIIA disease were 93.2%, 82.7%, 70.3%, 67.0%, and 52.1%, respectively. CONCLUSION This is the largest real-world cohort study of patients with NSCLC who underwent surgery in China, where we described characteristics of surgical treatment and survival outcomes. The results of our study provide insights into real-world surgical treatment status for surgeons and clinicians.
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Affiliation(s)
- Daqiang Sun
- Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin, 300051, China
| | - Jian Hu
- Department of Thoracic Surgery, The First Hospital Affiliated to Medical College of Zhejiang University, Hangzhou, 310003, China
| | - Xiaofei Li
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Military Medical University, Xi'an, 710038, China
| | - Jianxing He
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Lin Xu
- Department of Thoracic Surgery, Jiangsu Cancer Hospital, Nanjing, 210009, China
| | - Xiangning Fu
- Department of Thoracic Surgery, Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science & Technology, Wuhan, 430030, China
| | - Yang Liu
- Department of Thoracic Surgery, Chinese People's Liberation Army General Hospital, Beijing, 100853, China
| | - Deruo Liu
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Pingyan Chen
- Department of Biostatistics, Southern Medical University, Hainan Institute of Real World Data, Guangzhou, 510515, China
| | - Xun Zhang
- Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin, 300051, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China.
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Huang JX, Chen Q, Hong SM, Hong JJ, Cao H. Single-direction thoracoscopic lobectomy for incomplete pulmonary fissure in children with congenital pulmonary airway malformation: initial experience and propensity score-matched analysis. Pediatr Surg Int 2023; 39:174. [PMID: 37037920 DOI: 10.1007/s00383-023-05464-4] [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] [Accepted: 04/03/2023] [Indexed: 04/12/2023]
Abstract
PURPOSE To evaluate the safety and efficacy of single-direction lobectomy for congenital pulmonary airway malformation (CPAM), especially with incomplete pulmonary fissure (IPF). METHODS A total of 279 patients who underwent thoracoscopic lobectomy in our hospital from January 2019 to January 2022 were analyzed. Fifty-nine children were identified as the single-direction group, and the details of the surgical application are described. The degree of pulmonary fissure completeness was quantified intraoperatively. Propensity score matching was conducted and another 59 patients who underwent conventional lobectomy were matched as the control group. RESULTS The median age of the patients was 4.9 months and the mean body weight was 7.7 kg. For patients with complete pulmonary fissure, there were no statistical differences between two groups in terms of operative time, intraoperative blood loss, length of chest tube, and hospital stay. For patients with IPF, there were statistical differences between the single-direction group and the control group in terms of operative times (89.10 ± 7.97 min vs. 97.41 ± 7.51 min, P < 0.001), intraoperative blood loss (10.86 ± 5.36 mL vs. 14.14 ± 6.56 mL P = 0.042), and postoperative complications (P = 0.035). CONCLUSION IPF increases the operative difficulty of thoracoscopic lobectomy for CPAM, and the single-direction lobectomy technique is an effective and safe treatment for IPF.
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Affiliation(s)
- Jin-Xi Huang
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, 966 Hengyu Road, Fujian Province, Fuzhou City, China.
| | - Qiang Chen
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, 966 Hengyu Road, Fujian Province, Fuzhou City, China
| | - Song-Ming Hong
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, 966 Hengyu Road, Fujian Province, Fuzhou City, China
| | - Jun-Jie Hong
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, 966 Hengyu Road, Fujian Province, Fuzhou City, China
| | - Hua Cao
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, 966 Hengyu Road, Fujian Province, Fuzhou City, China
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11
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Deng J, Zeng Z, Liao Y, Zhong H, Zhang H. Cyanoacrylate glue foreign body after CT-guided localization of a pulmonary nodule during video-assisted thoracoscopic surgery: a case report. BMC Pulm Med 2023; 23:24. [PMID: 36653826 PMCID: PMC9847023 DOI: 10.1186/s12890-023-02321-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 01/10/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND A tracheal foreign body is a common airway aspiration that creates an emergency, which often causes unobserved respiratory problems and requires management. Iatrogenic tracheal foreign bodies are rarely observed, which results in tracheal obstruction. If the foreign body were removed from the tracheobronchial system, it would save lives. A similar case of a tracheal foreign body was focused on, which was caused by medical glue used during preoperative computed tomography localization of pulmonary nodules. CASE PRESENTATION The foreign body was deposited in the right upper bronchi, accidentally discovered after anesthesia when a double-lumen tube was located by fiber bronchoscopy. Following a video-assisted thoracoscopic surgery, the foreign body was removed using a respiratory endoscopy without subsequent adverse consequences for the patient. CONCLUSIONS There is a risk of complications from iatrogenic airway foreign bodies for preoperative localization of pulmonary nodules by injecting cyanoacrylate glue.
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Affiliation(s)
- Jingdan Deng
- grid.459766.fDepartment of Anesthesiology, Meizhou People’s Hospital, Meizhou City, 514031 Guangdong Province China
| | - Zhiwen Zeng
- grid.459766.fDepartment of Anesthesiology, Meizhou People’s Hospital, Meizhou City, 514031 Guangdong Province China
| | - Yilin Liao
- grid.459766.fDepartment of Anesthesiology, Meizhou People’s Hospital, Meizhou City, 514031 Guangdong Province China
| | - Haihui Zhong
- grid.459766.fDepartment of Thoracic Surgery, Meizhou People’s Hospital, Meizhou City, 514031 Guangdong Province China
| | - Huanrong Zhang
- grid.459766.fDepartment of Thoracic Surgery, Meizhou People’s Hospital, Meizhou City, 514031 Guangdong Province China
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Mei L, Liu W, Xiu Y, Tao S, Feng Y, Tan Q, Xu S, Xian L, Deng B. Multi-center experience in an optimized right upper lobectomy surgical procedure in China. Thorac Cancer 2022; 14:573-583. [PMID: 36567443 PMCID: PMC9968593 DOI: 10.1111/1759-7714.14781] [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: 11/20/2022] [Revised: 12/09/2022] [Accepted: 12/10/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND This multi-center study was aimed at retrospectively evaluating the feasibility, safety, clinical outcomes, and surgical learning curve of an optimized procedure for right upper lobectomy (RUL), which is challenging because of the anatomical structures and features of this lobe. METHODS This study included 45 RUL cases of robot-assisted thoracoscopy (RATS) in a pilot cohort and 187 RUL cases of video-assisted thoracoscopy (VATS) in three cohorts. A total of 121 and 111 patients underwent traditional and optimized RUL, respectively. The optimized surgical procedure was performed to consecutively transect the superior arterial trunk and bronchus, and finally disconnect the pulmonary vein and posterior ascending artery with interlobar fissures. Clinical and radiological data were reviewed retrospectively. RESULTS Optimized RUL can be performed successfully by RATS or VATS. The optimized procedure yielded better clinical outcomes than the traditional procedure, including shorter operation times, less blood loss, fewer complications, shorter hospital times, lower costs, and a lower likelihood of postoperative intermedius bronchial kinking. Additionally, for calcified interlobar lymph nodes, the optimized VATS group was less likely to be converted to thoracotomy than the traditional group. The skills required to perform optimized VATS RUL can be gained by surgeons after 12 to 15 cases. The two RUL procedures in the pilot cohort showed similar disease-free survival. CONCLUSIONS The optimized RUL was safe, economical, and feasible, with a short learning curve and satisfactory disease-free survival.
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Affiliation(s)
- Long‐Yong Mei
- Department of Thoracic Surgery, Institute of Surgery Research, Daping HospitalArmy Medical UniversityChongqingChina
| | - Wen‐Zhou Liu
- Department of Thoracic and Cardiovascular SurgeryThe Second Affiliated Hospital of Guangxi Medical UniversityNanningChina
| | - Yu‐Chi Xiu
- Department of Thoracic SurgeryGeneral Hospital of Northern Theater CommandShenyangChina
| | - Shao‐Lin Tao
- Department of Thoracic Surgery, Institute of Surgery Research, Daping HospitalArmy Medical UniversityChongqingChina
| | - Yong‐Geng Feng
- Department of Thoracic Surgery, Institute of Surgery Research, Daping HospitalArmy Medical UniversityChongqingChina
| | - Qun‐You Tan
- Department of Thoracic Surgery, Institute of Surgery Research, Daping HospitalArmy Medical UniversityChongqingChina
| | - Shi‐Guang Xu
- Department of Thoracic SurgeryGeneral Hospital of Northern Theater CommandShenyangChina
| | - Lei Xian
- Department of Thoracic and Cardiovascular SurgeryThe Second Affiliated Hospital of Guangxi Medical UniversityNanningChina
| | - Bo Deng
- Department of Thoracic Surgery, Institute of Surgery Research, Daping HospitalArmy Medical UniversityChongqingChina
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Wang JY, Pang QY, Yang YJ, Feng YM, Xiang YY, An R, Liu HL. Development and Validation of a Nomogram for Predicting Postoperative Pulmonary Infection in Patients Undergoing Lung Surgery. J Cardiothorac Vasc Anesth 2022; 36:4393-4402. [PMID: 36155718 DOI: 10.1053/j.jvca.2022.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/12/2022] [Accepted: 08/15/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To develop and validate a nomogram for predicting postoperative pulmonary infection (PPI) in patients undergoing lung surgery. DESIGN Single-center retrospective cohort analysis. SETTING A university-affiliated cancer hospital PARTICIPANTS: A total of 1,501 adult patients who underwent lung surgery from January 2018 to December 2020. INTERVENTIONS Observation for PPI within 7 days after lung surgery. MEASUREMENTS AND MAIN RESULTS A complete set of demographics, preoperative variables, and postoperative follow-up data was recorded. The primary outcome was PPI; a total of 125 (8.3%) out of 1,501 patients developed PPI. The variables with p < 0.1 in univariate logistic regression were included in the multivariate regression, and multivariate logistic regression analysis showed that surgical procedure, surgical duration, the inspired fraction of oxygen in one-lung ventilation, and postoperative pain were independent risk factors for PPI. A nomogram based on these factors was constructed in the development cohort (area under the curve: 0.794, 95% CI 0.744-0.845) and validated in the validation cohort (area under the curve: 0.849, 95% CI 0.786-0.912). The calibration slope was 1 in the development and validation cohorts. Decision curve analysis indicated that when the threshold probability was within a range of 0.02-to-0.58 and 0.02-to-0.42 for the development and validation cohorts, respectively, the nomogram model could provide a clinical net benefit. CONCLUSIONS The authors developed and validated a nomogram for predicting PPI in patients undergoing lung surgery. The prediction model can predict the development of PPI and identify high-risk groups.
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Affiliation(s)
- Jing-Yun Wang
- School of Medicine, Chongqing University, Chongqing, China; Department of Anaesthesia, Chongqing University Cancer Hospital, Chongqing, China
| | - Qian-Yun Pang
- Department of Anaesthesia, Chongqing University Cancer Hospital, Chongqing, China
| | - Ya-Jun Yang
- Department of Anaesthesia, Chongqing University Cancer Hospital, Chongqing, China
| | - Yu-Mei Feng
- Department of Anaesthesia, Chongqing University Cancer Hospital, Chongqing, China
| | - Ying-Ying Xiang
- Department of Anaesthesia, Chongqing University Cancer Hospital, Chongqing, China
| | - Ran An
- Department of Anaesthesia, Chongqing University Cancer Hospital, Chongqing, China
| | - Hong-Liang Liu
- Department of Anaesthesia, Chongqing University Cancer Hospital, Chongqing, China.
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Feng KP, Shen ZQ, Xu C, Ding C, Feng Y, Zhu XY, Pan B, Jia XY, Zhao J, Li C. Pulmonary function changes after sublobar resection in patients with peripheral non-subpleural nodules. BMC Surg 2022; 22:390. [DOI: 10.1186/s12893-022-01828-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 10/26/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In the treatment of peripheral early-staged lung cancer and benign lesions, segmentectomy and wedge resection are both reliable treatment methods. It is debatable that how much pulmonary function will be lost after different sublobar resection in the treatment of early-staged deep-located peripheral NSCLC (non-small cell lung cancer). The purpose of this study was to explore postoperative pulmonary function changes of sublobar resection in enrolled patients with non-subpleural peripheral nodules.
Methods
We collected clinical data of patients undergoing VATS (video-assisted thoracoscopic surgery) segmentectomy or wedge resection for single nodule. These nodules were confirmed as peripheral non-subpleural nodules by preoperative 3D imaging. Patients were divided into two groups according to the operation procedure. Demographic characteristics, pulmonary function, postoperative outcomes, and others were collected. All data was gathered at the First Affiliated Hospital of Soochow University. Outcomes after wedge resection were compared with those after segmentectomy resection.
Results
A total of 88 patients were included in this study, including 46 patients with VATS wedge resection and 42 patients with VATS segmentectomy. No difference was detected when comparing FEV1 (forced expiratory volume in 1 s) loss between these two groups (17.6 ± 2.1%, wedge resection vs. 19.4 ± 5.4%, segmentectomy, P = 0.176). FVC (forced vital capacity) loss (8.7 ± 2.3%, wedge resection vs. 17.1 ± 2.2%, segmentectomy, P < 0.001) and MVV (maximum ventilatory volume) loss (11.5 ± 3.1%, wedge resection vs. 20.6 ± 7.8%, segmentectomy, P < 0.001) in segmentectomy group was significantly higher than those in wedge resection group. Discrepancies were investigated when comparing duration of surgery (70 ± 22 min, wedge resection vs. 111 ± 52 min, segmentectomy, P = 0.0002), postoperative drainage (85 ± 45 mL, wedge resection vs. 287 ± 672 mL, segmentectomy, P = 0.0123), and treatment hospitalization expenses [35148 ± 889CNY, wedge resection vs. 52,502 (38,276–57,772) CNY, segmentectomy, P < 0.0002]. No significant difference was found between air leak time (1.7 ± 0.7 days, wedge resection vs. 2.5 ± 1.7 days, segmentectomy, P = 0.062) and hospitalization time (2.7 ± 0.7 days, wedge resection vs. 3.5 ± 1.7 days, segmentectomy, P = 0.051).
Conclusions
For patients with peripheral non-subpleural nodules, we observed that patients who underwent wedge resection had less lung function loss than those who underwent segmentectomy when their lung function was reviewed at the 6th month after surgery. Patients undergoing wedge resection had partial advantages over patients with segmental resection in terms of hospitalization cost, operation time and postoperative drainage, etc. Wedge resection, as a treatment for peripheral non-subpleural pulmonary nodules, seemed to have more advantages in preserving patients’ pulmonary function.
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15
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Chang WK, Li YS, Wu HL, Tai YH, Lin SP, Chang KY. Group-based trajectory analysis of postoperative pain in epidural analgesia for video-assisted thoracoscopic surgery and risk factors of rebound pain. J Chin Med Assoc 2022; 85:216-221. [PMID: 34698693 DOI: 10.1097/jcma.0000000000000647] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The current study aimed to investigate the patterns of postoperative pain trajectories over time and their associated risk factors in patients receiving video-assisted thoracoscopic surgery (VATS) and epidural analgesia (EA) for non-small cell lung cancer (NSCLC). METHODS This retrospective study was conducted at a tertiary medical center and included patients undergoing VATS for stage I NSCLC between 2011 and 2015. Maximal pain intensity was recorded daily during the first postoperative week. Group-based trajectory analysis was performed to categorize variations in pain scores over time. Associations between pain trajectory classification and amount of EA administered and length of hospital stay (LOS) after surgery were also evaluated. RESULTS A total of 635 patients with 4647 pain scores were included in the analysis, and 2 postoperative pain trajectory groups were identified: group 1, mild pain trajectory (78%); and group 2, rebound pain trajectory (22%). Risk factors for rebound pain trajectory were a surgical time longer than 3 hours (odds ratio [OR], 1.97; 95% CI, 1.27-3.07), female sex (OR, 1.62; 95% CI, 1.04-2.53), and higher pain score on postoperative day 0 (OR, 1.21; 95% CI, 1.08-1.36; linear effect). Although group 2 had a longer LOS (p < 0.001), they did not receive more EA than group 1 (p = 0.805). CONCLUSION Surgical time, sex, and pain intensity after surgery were major determinants of rebound pain trajectory, and more aggressive pain control strategies should be considered in high-risk patients.
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Affiliation(s)
- Wen-Kuei Chang
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yi-Shiuan Li
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Hsiang-Ling Wu
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Ying-Hsuan Tai
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan, ROC
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
| | - Shih-Pin Lin
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Kuang-Yi Chang
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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Zhang F, Qiu B, Ji Y, Guo W, Li N, Xue Q, Gao S, He J. Comparison of surgical difficulty in patients with resectable non-small cell lung cancer under different neoadjuvant treatment modes: a retrospective cohort study. J Thorac Dis 2021; 13:5604-5616. [PMID: 34795911 PMCID: PMC8575808 DOI: 10.21037/jtd-21-1007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/10/2021] [Indexed: 12/29/2022]
Abstract
Background Previous studies have reported on the efficacy and safety of neoadjuvant use of a programmed cell death 1 (PD-1) antibody, sintilimab, in patients with non-small cell lung cancer (NSCLC). This study aimed to further evaluate the difficulty of this surgery and the postoperative complication rates in patients with NSCLC receiving neoadjuvant sintilimab. Methods Patients who received neoadjuvant sintilimab (200 mg) in the Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital from March 2018 to March 2019 were enrolled in the neoadjuvant immunotherapy group (NI group). Another two cohorts who did not receive sintilimab were retrospectively selected by propensity score matching (PSM) at a ratio of 1:1 in the upfront surgery (M-US) and neoadjuvant chemotherapy (M-NC) groups. The postoperative complication rate, postoperative days (PODs), and other detailed objective indicators were compared by t-test or χ2 test. Results Thirty-seven patients were enrolled in each group. Postoperative complications were greater in the NI group (37.8%) than in the M-US (10.8%; P=0.013) or in the M-NC group (16.2%; P=0.036). The number of PODs (7) was greater in the NI group than in the M-US group (P=0.005). The total number of dissected lymph nodes was lower in the NI group than in the M-US group (P<0.001) or in the M-NC group (P<0.001). Lymph node dissection (LND) in the NI group was more difficult than in the M-US group (P=0.015), but intrathoracic adhesion, tumor invasion, and whole procedure difficulty were similar. Conclusions The administration of neoadjuvant sintilimab increased complications but did not increase the difficulty of surgery. Fewer lymph nodes were dissected in the NI group.
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Affiliation(s)
- Fan Zhang
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bin Qiu
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Ji
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Guo
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning Li
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qi Xue
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shugeng Gao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie He
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Li S, Ding X, Zhao Y, Chen X, Huang J. Intravenous patient-controlled analgesia plus psychoeducational intervention for acute postoperative pain in patients with pulmonary nodules after thoracoscopic surgery: a retrospective cohort study. BMC Anesthesiol 2021; 21:281. [PMID: 34773972 PMCID: PMC8590357 DOI: 10.1186/s12871-021-01505-4] [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: 05/17/2021] [Accepted: 11/03/2021] [Indexed: 11/10/2022] Open
Abstract
Background The association of psychological factors with postoperative pain has been well documented. The incorporation of psychoeducational intervention into a standard analgesia protocol seems to be an attractive approach for the management of acute postoperative pain. Our study aimed to evaluate the impact of psychoeducational intervention on acute postoperative pain in pulmonary nodule (PN) patients treated with thoracoscopic surgery. Methods In this study, 76 PN patients treated with thoracoscopic surgery and intravenous patient-controlled analgesia (IV-PCA) plus psychoeducational evaluation and intervention were selected as the psychoeducational intervention group (PG). Another 76 PN patients receiving IV-PCA without psychoeducational intervention after thoracoscopic surgery, treated as the control group (CG), were identified from the hospital database and matched pairwise with PG patients according to age, sex, preoperative body mass index (BMI), opioid medications used for IV-PCA and the educational attainment of patients. Results The most common psychological disorders were anxiety and interpersonal sensitivity, which were recorded from 82.9% (63/76) and 63.2% (48/76) of PG patients. The numerical rating scale (NRS) pain scores of the PG patients were significantly lower than those of the CG patients at 2 and 24 h after surgery (P < 0.001). Total opioid consumption for acute postoperative pain in the PG was 52.1 mg of morphine equivalent, which was significantly lower than that (67.8 mg) in the CG (P = 0.038). PG patients had a significantly lower incidence of rescue analgesia than CG patients (28.9% vs. 44.7%, P = 0.044). Nausea/vomiting was the most common side effect of opioid medications, recorded for 3 (3.9%) PG patients and 10 (13.2%) CG patients (P = 0.042). In addition, no significant difference was observed between PG and CG patients in terms of grade 2 or higher postoperative complications (10.5% vs. 17.1%, P = 0.240). Conclusions Psychoeducational intervention for PN patients treated with thoracoscopic surgery resulted in reduced acute postoperative pain, less opioid consumption and fewer opioid-related side effects.
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Affiliation(s)
- Sha Li
- Department of Anesthesiology, Affiliated Hospital of Jiangnan University, 1000 Hefeng Road, Wuxi, 214125, Jiangsu, People's Republic of China
| | - Xian Ding
- Department of Anesthesiology, Affiliated Hospital of Jiangnan University, 1000 Hefeng Road, Wuxi, 214125, Jiangsu, People's Republic of China
| | - Yong Zhao
- Department of Thoracic and Cardiovascular Surgery, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - Xiao Chen
- Department of Anesthesiology, Affiliated Hospital of Jiangnan University, 1000 Hefeng Road, Wuxi, 214125, Jiangsu, People's Republic of China.
| | - Jianfeng Huang
- Department of Radiation Oncology, Affiliated Hospital of Jiangnan University, 1000 Hefeng Road, Wuxi, 214125, Jiangsu, People's Republic of China.
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Shi J, He J, He J, Li S. Electromagnetic navigation-guided preoperative localization: the learning curve analysis. J Thorac Dis 2021; 13:4339-4348. [PMID: 34422360 PMCID: PMC8339733 DOI: 10.21037/jtd-21-490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/19/2021] [Indexed: 12/11/2022]
Abstract
Background The electromagnetic navigation bronchoscopy (ENB) was increasingly used to mark small pulmonary nodules (PNs) for video-assisted thoracic surgery (VATS) resection due to high effectiveness and low risk. However, no study reports the learning curve of ENB-guided preoperative localization. In the study, we aimed to describe the learning curve of ENB-guided preoperative PNs localization initially. Methods Consecutive PNs cases that underwent ENB localizations between October 2018 and October 2019 by the same surgeon in our center were included in the study. The cumulative sum (CUSUM) method was used to analyze the learning curve of ENB localization. Results A total of 89 ENB localization from 64 patients were included in this study. The learning curve was divided into 3 phases: Phase I (the initial 11 cases), Phase II (the 12th to the 47th cases), and Phase III (the 47th to the 89th cases). The success rate of ENB localization has increased with the accumulation of operational experience in 3 phases (72.73%, 91.67%, and 97.62%, P=0.049). The distance from the ENB guide wire tip to the center of the lesion in Phase I was significantly longer than those in Phase II and Phase III (2.46±1.76 vs. 1.36±0.94 and 1.47±0.97 cm, P=0.014 and 0.027, respectively). Sex, bronchus sign, and learning curve phase were independent risk factors influencing operative time (OT) (OR =8.187, 18.847, and 13.920, respectively). Conclusions The technical competency, which is indicated by higher success rate, localization accuracy, and shorter OT, for ENB-guided preoperative PNs localization was achieved at the 47th operation.
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Affiliation(s)
- Jiang Shi
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,State Key Laboratory and National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Jiaxi He
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,State Key Laboratory and National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Jianxing He
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,State Key Laboratory and National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Shuben Li
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,State Key Laboratory and National Clinical Research Center for Respiratory Disease, Guangzhou, China
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19
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Wang Z, Guo F, Li J, Sun D. Safety and efficacy of lobectomy combined with off-pump coronary artery bypass grafting for lung cancer. J Thorac Dis 2021; 13:4438-4447. [PMID: 34422370 PMCID: PMC8339769 DOI: 10.21037/jtd-21-788] [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: 04/07/2021] [Accepted: 06/17/2021] [Indexed: 12/24/2022]
Abstract
Background This study sought to assess the safety and efficacy of a lobectomy combined with off-pump coronary artery bypass grafting (OPCABG) among patients with lung cancer. Methods Patients who underwent a simultaneous pulmonary lobectomy combined with OPCABG at Tianjin Chest Hospital from December 2010 to June 2019 and patients who underwent pulmonary lobectomy during the same period were selected at a ratio of 1:2 using a multi-factor propensity score for this study. The clinical data of each group during the operation and perioperative period were analyzed and compared, and the survival curves were drawn using the Kaplan-Meier method to compare the long-term survival of the patients. Results In the simultaneous-surgery group, no patients required a secondary thoracotomy for hemostasis and there were no perioperative deaths; however, 2 patients underwent a second intubation, 2 patients underwent a second debridement and suturing due to wound infection, 28 patients (76.3%) had pulmonary complications, and 10 patients (26.3%) had circulatory complications. The operation time, intraoperative blood loss, postoperative drainage volume, postoperative hospital stay, and complication rate were all higher in the simultaneous-surgery group than the lobectomy group. No significant difference was observed in the long-term survival rates between the 2 groups. Conclusions The simultaneous surgery was safe and effective. Some differences existed in the data between the 2 groups during the perioperative period; however, the risk of complications after surgery was controllable.
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Affiliation(s)
- Zheng Wang
- Department of Graduate School, Tianjin Medical University, Tianjin, China.,Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Fan Guo
- Department of Graduate School, Tianjin Medical University, Tianjin, China.,Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Jiuzhen Li
- Department of Graduate School, Tianjin Medical University, Tianjin, China.,Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Daqiang Sun
- Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin, China
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20
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Kim HK. Video-Assisted Thoracic Surgery Lobectomy. J Chest Surg 2021; 54:239-245. [PMID: 34353962 PMCID: PMC8350467 DOI: 10.5090/jcs.21.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/08/2021] [Accepted: 07/16/2021] [Indexed: 12/11/2022] Open
Abstract
Video-assisted thoracoscopic surgery (VATS) has been established as the surgical approach of choice for lobectomy in patients with early-stage non-small cell lung cancer (NSCLC). Patients with clinical stage I NSCLC with no lymph node metastasis are considered candidates for VATS lobectomy. To rule out the presence of metastasis to lymph nodes or distant organs, patients should undergo meticulous clinical staging. Assessing patients' functional status is required to ensure that there are no medical contraindications, such as impaired pulmonary function or cardiac comorbidities. Although various combinations of the number, size, and location of ports are available, finding the best method of port placement for each surgeon is fundamental to maximize the efficiency of the surgical procedure. When conducting VATS lobectomy, it is always necessary to comply with the following oncological principles: (1) the vessels and bronchus of the target lobe should be individually divided, (2) systematic lymph node dissection is mandatory, and (3) touching the lymph node itself and rupturing the capsule of the lymph node should be minimized. Most surgeons conduct the procedure in the following sequence: (1) dissection along the hilar structure, (2) fissure division, (3) perivascular and peribronchial dissection, (4) individual division of the vessels and bronchus, (5) specimen retrieval, and (6) mediastinal lymph node dissection. Surgeons should obtain experience in enhancing the exposure of the dissection target and facilitating dissection. This review article provides the basic principles of the surgical techniques and practical maneuvers for performing VATS lobectomy easily, safely, and efficiently.
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Affiliation(s)
- Hong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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21
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Shen H, Wang X, Nie Y, Zhang K, Wei Z, Yang F, Wang J, Chen K. Minimally invasive surgery versus thoracotomy for resectable stage II and III non-small-cell lung cancers: a systematic review and meta-analysis. Eur J Cardiothorac Surg 2021; 59:940-950. [PMID: 33370437 DOI: 10.1093/ejcts/ezaa437] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 10/23/2020] [Accepted: 11/04/2020] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES The study aimed to compare the long-term oncological efficacy and perioperative outcomes of patients with locally advanced non-small-cell lung cancers who underwent minimally invasive surgery (MIS) or thoracotomy. METHODS Cochrane Library, PubMed and EMBASE databases, ClinicalTrials.gov and reference lists were searched for relevant studies. Two reviewers independently assessed the quality of the studies. Recurrence-free survival (RFS) and overall survival (OS) and perioperative outcomes were synthesized. Random-effects models were used to summarize hazard ratios (HRs), relative risks and standardized mean differences (SMDs) with 95% confidence intervals (CIs). RESULTS Twenty-three retrospective cohort studies were reviewed with a total of 3281 patients, of whom 1376 (41.9%) received MIS and 1905 (58.1%) received thoracotomy. Meta-analysis showed no significant differences in both RFS (HR, 1.02; 95% CI, 0.89-1.17; P = 0.78) and OS (HR, 0.91; 95% CI, 0.80-1.03; P = 0.15) between MIS versus thoracotomy approaches. Similar results were observed in propensity score matched studies (RFS, HR, 0.94; 95% CI, 0.73-1.20; P = 0.62; OS, HR, 0.96; 95% CI, 0.72-1.30; P = 0.81). No significant difference was found in lymph node clearance and margin positivity. As for perioperative outcomes, MIS was associated with a significant reduction in postoperative complications (relative risk, 0.83; P = 0.01), intraoperative blood loss (standardized mean difference, -0.68; P = 0.007), chest tube drainage (standardized mean difference, -0.38; P = 0.03) and length of hospital stay (standardized mean difference, -0.79; P = 0.002) when compared with thoracotomy. CONCLUSIONS The use of MIS for resectable stage II and III non-small-cell lung cancers is an eligible alternative to conventional thoracotomy without compromising the long-term survival and short-term outcomes.
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Affiliation(s)
- Haifeng Shen
- Department of Thoracic Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - Xin Wang
- Department of Thoracic Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - Yuntao Nie
- Department of Thoracic Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - Kai Zhang
- Department of Thoracic Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - Zihan Wei
- Department of Thoracic Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - Fan Yang
- Department of Thoracic Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - Jun Wang
- Department of Thoracic Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - Kezhong Chen
- Department of Thoracic Surgery, Peking University People's Hospital, Peking University, Beijing, China
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22
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Zhu D, Li X, Gong H, Li J, Lu X, Xia H, Chen X, Ma L, Sun Z, Zhang X, Wang D. Effect and Mechanism of Transthyretin over-Expression on Proliferation and Cell Cycle of Lung Cancer A549 Cells. IRANIAN JOURNAL OF PUBLIC HEALTH 2021; 50:710-720. [PMID: 34183920 PMCID: PMC8219626 DOI: 10.18502/ijph.v50i4.5995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background The effects of transthyretin (TTR) over-expression on the proliferation and cell cycle of non-small cell lung cancer (NSCLC) A549 cells and its possible mechanism were verified. Methods A total of 196 LC patients and 20 healthy controls were enrolled at Tianjin Hospital, Tianjin, China between Apr 2017 and Oct 2017. The serum TTR content was detected by ELISA. Through lentiviral transfection method, NSCLC cells were divided into non-transfected group (group A), negative control group (group B) transfected with empty vector and experimental group (group C) transfected with TTR over-expression. Cell proliferation was detected by CCK-8 method, TTR mRNA expression was detected by real-time quantitative polymerase chain reaction (RT-qPCR), and TTR protein expression was tested by Western blot (WB). Cell cycle was detected by flow cytometry, Wnt3a/β-catenin protein expression was detected by WB, and mRNA expression was detected by RT-qPCR. Results The serum TTR content in early, middle and late LC group was remarkably lower than that in healthy group (P<0.05). Compared with late stage, TTR content in early and middle stages of LC group was higher, and the difference was statistically marked (P < 0.05). The absorbance value of group C was lower than that of groups A and B, indicating that the cell proliferation activity dramatically decreased, with statistically marked difference (P<0.05). LC A549 cells in group C were obviously blocked in G2M, with statistical significance (P<0.05). Conclusion TTR over-expression can inhibit the proliferation of NSCLC A549 cells, and the expression is related to Wnt3a/β-catenin pathway. TTR in serum of patients was helpful for diagnosing LC and has certain clinical value.
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Affiliation(s)
- Deqing Zhu
- Department of Cardio-Thoracic Surgery, Tianjin Hospital, Tianjin 300211, China
| | - Xuan Li
- Institute of Clinical Orthopedics, Tianjin Medical University, Tianjin 300070, China
| | - Hao Gong
- Department of Cardio-Thoracic Surgery, Tianjin Hospital, Tianjin 300211, China
| | - Jing Li
- Tianjin Medical College, Tianjin 300222, China
| | - Xike Lu
- Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin 300051, China
| | - Honggang Xia
- Department of Cardio-Thoracic Surgery, Tianjin Hospital, Tianjin 300211, China
| | - Xia Chen
- Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin 300051, China
| | - Lan Ma
- Department of Cardio-Thoracic Surgery, Tianjin Hospital, Tianjin 300211, China
| | - Zhongyi Sun
- Department of Cardio-Thoracic Surgery, Tianjin Hospital, Tianjin 300211, China
| | - Xun Zhang
- Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin 300051, China
| | - Dongbin Wang
- Department of Cardio-Thoracic Surgery, Tianjin Hospital, Tianjin 300211, China
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23
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Luan TMB, Bang HT, Vuong NL, Dung LT, Tin NT, Tien TQ, Nam NH. Long-term outcomes of video-assisted lobectomy in non-small cell lung cancer. Asian Cardiovasc Thorac Ann 2021; 29:318-326. [PMID: 33631956 DOI: 10.1177/0218492321997380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Video-assisted thoracoscopic surgery lobectomy combined with lymphadenectomy is widely utilized worldwide for treating non-small cell lung cancer. We evaluated the long-term survival outcomes of this approach and determined the prognostic factors of overall survival. METHODS This prospective observational study was performed in patients with non-small cell lung cancer who were subjected to video-assisted lobectomy and lymphadenectomy from 2012 to 2016. Independent prognostic factors were determined via uni- and multivariable Cox models. RESULTS There were 109 patients with the mean age of 59.2 years and males accounted for 54.1%. Postoperative staging determined 22.9% of stage IA, 31.2% of stage IB, 16.5% of stage IIA and 29.4% of stage IIIA. Median follow-up time was 27 months. The overall survival rate after 1, 2, 3, 4 and 5 years was 100%, 85.9%, 65.3%, 55.9% and 55.9%, respectively. In univariable analysis, smoking (hazard ratio (HR) [95% confidence interval (CI)]: 2.50 [1.18-5.31]), Tumor--nodes--metastases (TNM) stage (IIA: 7.60 [1.57-36.9]; IIIA: 14.3 [3.28-62.7] compared to IA), histological differentiation (moderately differentiated: 4.91 [1.04-23.2]; poorly differentiated: 8.25 [1.91-35.6] compared to well differentiated), lymph node size ≥1 cm (8.22 [3.11-21.7]), tumour size ≥3 cm (4.24 [1.01-17.9]), radical lymphadenectomy (6.67 [3.14-14.2]) were identified as prognostic factors of the long-term survival. In multivariable analysis, only radical lymphadenectomy was an independent prognostic factor (HR [95% CI]: 3.94 [1.41-11.0]). CONCLUSION Video-assisted thoracoscopic lobectomy combined with lymphadenectomy is feasible, safe and effective for the treatment of non-small cell lung cancer. The long-term outcomes of this method are favourable, especially at the early stage of cancer.
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Affiliation(s)
- Tran Minh Bao Luan
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.,Thoracic and Vascular Department, University Medical Center HCMC, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Ho Tat Bang
- Thoracic and Vascular Department, University Medical Center HCMC, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.,Department of Health Organization and Management, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Nguyen Lam Vuong
- Department of Medical Statistics and Informatics, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Le Tien Dung
- Pham Ngoc Thach Hospital, Ho Chi Minh City, Vietnam
| | - Nguyen Trung Tin
- Department of General Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Tran Quyet Tien
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Nguyen Hoai Nam
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
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24
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Huang KL, Deng HY, Fan M, Zheng Q, Lin S, Zhu D, Zhou Q. The sequence of pulmonary vessels ligation during lobectomy for non-small cell lung cancer: A systematic review and meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2021; 47:1535-1540. [PMID: 33632591 DOI: 10.1016/j.ejso.2021.02.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 12/12/2020] [Accepted: 02/08/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The effects of ligating the pulmonary vein first or pulmonary artery first during lobectomy on the long-term survival of patients with non-small cell lung cancer (NSCLC) remain controversial. We conducted the first systematic review and meta-analysis to determine the association between different sequences of vessel ligation during lobectomy and the prognosis of patients with NSCLC. METHODS Literature retrieval was performed by systematically searching Embase, PubMed and Web of Science to identify relevant articles published from the inception of each database to November 2020. The overall survival (OS) and disease-free survival (DFS) of patients treated with vein-first ligation versus those treated with artery-first ligation during lobectomy were analyzed. A standard fixed-effect model test (Mantel-Haenszel method) was used to calculate pooled hazard ratios (HRs) and 95% confidence intervals (CIs). Heterogeneity was assessed using the Q-test and I2-test. Sensitivity analysis was performed to further examine the stability of pooled HRs. RESULTS Five studies with a total of 1109 patients receiving lobectomy, including one randomized controlled trial and four retrospective studies, were included in this meta-analysis. The results showed that patients with vein-first ligation had a significantly better OS (HR 1.25, 95% CI 1.03-1.50; P = 0.02) and DFS (HR 1.54, 95% CI 1.16-2.04; P = 0.003) than those with artery-first ligation during lobectomy. Significant heterogeneity and publication bias were not observed during analysis. CONCLUSION Our meta-analysis indicates that vein-first ligation may improve the prognosis of NSCLC patients receiving lobectomy. Therefore, vein-first ligation is recommended during lobectomy for patients with non-small cell lung cancer whenever possible.
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Affiliation(s)
- Kai-Li Huang
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Han-Yu Deng
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Mingyu Fan
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Qiangqiang Zheng
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Shanyu Lin
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Daxing Zhu
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Qinghua Zhou
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041, China.
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25
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Zhao L, Li S, Ju J, Zhou H, Wang H, Che G. Gamma-Glutamyl Transpeptidase to Platelet Ratio Is a Novel and Independent Prognostic Marker for Resectable Lung Cancer: A Propensity Score Matching Study. Ann Thorac Cardiovasc Surg 2021; 27:151-163. [PMID: 33536389 PMCID: PMC8343033 DOI: 10.5761/atcs.oa.20-00247] [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] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND We report this propensity score matching (PSM) analysis to assess prognostic roles of preoperative gamma-glutamyl transpeptidase to platelet ratio (GPR) in video-assisted thoracoscopic (VATS) lobectomy for stage I-II non-small-cell lung cancer (NSCLC). METHODS The PSM-based study conducted on our single-center prospectively collected database from January 2014 to August 2015 provided Kaplan-Meier survival analyses using the log-rank test to discriminate differences in overall survival (OS) and disease-free survival (DFS) between patients stratified by preoperative GPR. RESULTS Our study includes 379 patients diagnosed with operable primary stage I-II NSCLC. A GPR value at 0.16 was recognized as the optimal cutoff point for prognostic prediction. Both OS and DFS of patients with GPR ≥0.16 were significantly shortened when compared to those of patients with GPR <0.16. Patients with GPR ≥0.16 had significantly lower 5-year rates of OS and DFS than those of patients with GPR <0.16 (P <0.001). Significant associations between GPR and unfavorable survival still are validated in the PSM analysis. Multivariable Cox regression models on both the entire cohort and the PSM cohort consistently demonstrated that an elevated preoperative GPR could be an independent prognostic marker for both OS and DFS of resectable NSCLC. CONCLUSIONS GPR may be an effective and noninvasive prognostic biomarker in VATS lobectomy for surgically resectable NSCLC.
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Affiliation(s)
- Liang Zhao
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,Division of General Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Shuangjiang Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,Division of General Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Juan Ju
- Department of Radiology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, China
| | - Haining Zhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,Department of Thoracic Surgery, Suining Central Hospital, Suining, China
| | - Hongyu Wang
- Department of Thoracic and Cardiovascular Surgery, Affiliated Dongfeng Hospital, Hubei University of Medicine, Shiyan, China.,Department of Thoracic and Cardiovascular Surgery, Sino-Pharm Dongfeng General Hospital, Shiyan, China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
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26
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Berna P, Quesnel C, Assouad J, Bagan P, Etienne H, Fourdrain A, Le Guen M, Leone M, Lorne E, Nguyen YNL, Pages PB, Roz H, Garnier M. Guidelines on enhanced recovery after pulmonary lobectomy. Anaesth Crit Care Pain Med 2021; 40:100791. [PMID: 33451912 DOI: 10.1016/j.accpm.2020.100791] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To establish recommendations for optimisation of the management of patients undergoing pulmonary lobectomy, particularly Enhanced Recovery After Surgery (ERAS). DESIGN A consensus committee of 13 experts from the French Society of Anaesthesia and Intensive Care Medicine (Soci,t, franOaise d'anesth,sie et de r,animation, SFAR) and the French Society of Thoracic and Cardiovascular Surgery (Soci,t, franOaise de chirurgie thoracique et cardiovasculaire, SFCTCV) was convened. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independently of any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence. METHODS Five domains were defined: 1) patient pathway and patient information; 2) preoperative management and rehabilitation; 3) anaesthesia and analgesia for lobectomy; 4) surgical strategy for lobectomy; and 5) enhanced recovery after surgery. For each domain, the objective of the recommendations was to address a number of questions formulated according to the PICO model (Population, Intervention, Comparison, Outcome). An extensive literature search on these questions was carried out and analysed using the GRADE® methodology. Recommendations were formulated according to the GRADE® methodology, and were then voted by all experts according to the GRADE grid method. RESULTS The SFAR/SFCTCV guideline panel provided 32 recommendations on the management of patients undergoing pulmonary lobectomy. After two voting rounds and several amendments, a strong consensus was reached for 31 of the 32 recommendations and a moderate consensus was reached for the last recommendation. Seven of these recommendations present a high level of evidence (GRADE 1+), 23 have a moderate level of evidence (18 GRADE 2+ and 5 GRADE 2-), and 2 correspond to expert opinions. Finally, no recommendation was provided for 2 of the questions. CONCLUSIONS A strong consensus was expressed by the experts to provide recommendations to optimise the whole perioperative management of patients undergoing pulmonary lobectomy.
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Affiliation(s)
- Pascal Berna
- Department of Thoracic Surgery, Amiens University Hospital, 80000 Amiens, France
| | - Christophe Quesnel
- Sorbonne Universit,, APHP, DMU DREAM, Service d'Anesth,sie-R,animation et M,decine P,riop,ratoire, H"pital Tenon, 75020 Paris, France
| | - Jalal Assouad
- Department of Thoracic Surgery, Tenon University Hospital, Sorbonne Universit,, 75020 Paris, France
| | - Patrick Bagan
- Department of Thoracic and Vascular Surgery, Victor Dupouy Hospital, 95100 Argenteuil, France
| | - Harry Etienne
- Department of Thoracic Surgery, Tenon University Hospital, Sorbonne Universit,, 75020 Paris, France
| | - Alex Fourdrain
- Department of Thoracic Surgery, Amiens University Hospital, 80000 Amiens, France
| | - Morgan Le Guen
- D,partement d'Anesth,sie, H"pital Foch, Universit, Versailles Saint Quentin, 92150 Suresnes, France; INRA UMR 892 VIM, 78350 Jouy-en-Josas, France
| | - Marc Leone
- Aix Marseille Universit, - Assistance Publique H"pitaux de Marseille - Service d'Anesth,sie et de R,animation - H"pital Nord - 13005 Marseille, France
| | - Emmanuel Lorne
- Departement d'Anesth,sie-R,animation, Clinique du Mill,naire, 34000 Montpellier, France
| | - Y N-Lan Nguyen
- Anaesthesiology and Critical Care Department, APHP Centre, Paris University, 75000 Paris, France
| | - Pierre-Benoit Pages
- Department of Thoracic Surgery, Dijon Burgundy University Hospital, 21000 Dijon, France; INSERM UMR 1231, Dijon Burgundy University Hospital, University of Burgundy, 21000 Dijon, France
| | - Hadrien Roz
- Unit, d'Anesth,sie R,animation Thoracique, H"pital Haut Leveque, CHU de Bordeaux, 33000 Bordeaux, France
| | - Marc Garnier
- Sorbonne Universit,, APHP, DMU DREAM, Service d'Anesth,sie-R,animation et M,decine P,riop,ratoire, H"pital Tenon, 75020 Paris, France.
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27
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Xu J, Ni H, Wu Y, Cao J, Han X, Liu L, Fu X, Li Y, Li X, Xu L, Liu Y, Zhao H, Liu D, Peng X, Hu J. Perioperative comparison of video-assisted thoracic surgery and open lobectomy for pT1-stage non-small cell lung cancer patients in China: a multi-center propensity score-matched analysis. Transl Lung Cancer Res 2021; 10:402-414. [PMID: 33569322 PMCID: PMC7867771 DOI: 10.21037/tlcr-20-1132] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Compared with open surgery, video-assisted thoracic surgery (VATS) has innovated the concept of the minimally invasive approach for non-small cell lung cancer (NSCLC) patients in past decades. This present study aimed to compare the perioperative and lymph node dissection outcomes between VATS lobectomy and open lobectomy for pathological stage T1 (pT1) NSCLC patients from both surgical and oncologic perspectives. Methods This was a retrospective multicenter study. Patients who underwent surgical resection for pT1 NSCLC between January 2014 and September 2017 were retrospectively reviewed from 10 thoracic surgery centers in China. Perioperative and lymph node dissection outcomes of pT1 NSCLC patients who accepted VATS or open lobectomies were compared by propensity score matching (PSM) analysis. Results Of the 11,360 patients who underwent surgery for pT1 NSCLC, 7,726 were enrolled based on the selection criteria, including 1,222 cases of open lobectomies and 6,504 cases of VATS lobectomies. PSM resulted in 1,184 cases of open lobectomies and 1,184 cases of VATS lobectomies being well matched by common prognostic variables, including age, sex, and surgical side. VATS lobectomy led to better perioperative outcomes, including less blood loss (133.5±200.1 vs. 233.3±318.4, P<0.001), lower blood transfusion rate (2.4% vs. 6.4%, P<0.001), shorter postoperative hospital stay (8.6±5.7 vs. 10.1±5.1, P<0.001), less chest drainage volume (1,109.5±854.0 vs. 1,324.1±948.8, P<0.001), and less postoperative complications (4.9% vs. 8.2%, P<0.001). However, open lobectomy had better lymph node dissection outcomes than VATS, with increased lymph node dissection numbers (16.1±9.4 vs. 13.7±7.7, P<0.001) and more positive lymph nodes being dissected (1.5±3.9 vs. 1.1±2.5, P=0.002). Compared with VATS, open lobectomy harvested more lymph node stations (5.5±1.9 vs. 5.2±1.8, P=0.001), including more pathological N2 (pN2) lymph node stations (3.4±1.4 vs. 3.1±1.3, P<0.001). Conclusions VATS lobectomy was associated with better perioperative outcomes, such as less blood loss, lower blood transfusion rate, shorter postoperative hospital stay, less chest drainage volume and less postoperative complications. Open lobectomy has improved lymph node dissection outcomes, as more lymph nodes and positive lymph nodes were dissected for pT1 NSCLC patients during surgery.
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Affiliation(s)
- Jinming Xu
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Heng Ni
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yihe Wu
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jinlin Cao
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xingpeng Han
- Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiangning Fu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yin Li
- Department of Thoracic Surgery, Henan Cancer Hospital, Zhengzhou, China
| | - Xiaofei Li
- Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Lin Xu
- Department of Thoracic Surgery, Nanjing Medical University Affiliated Cancer Hospital, Cancer Institute of Jiangsu Province, Nanjing, China.,Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Cancer Institute of Jiangsu Province, Nanjing, China
| | - Yang Liu
- Department of Thoracic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Heng Zhao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai, China
| | - Deruo Liu
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Xin Peng
- Medical Affairs, Linkdoc Technology Co. Ltd., Beijing, China
| | - Jian Hu
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Weder W, Furrer K, Opitz I. Robotic-assisted thoracoscopic surgery for clinically stage IIIA (c-N2) NSCLC-is it justified? Transl Lung Cancer Res 2021; 10:1-4. [PMID: 33569286 PMCID: PMC7867792 DOI: 10.21037/tlcr-20-647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Walter Weder
- Thoracic Surgery, Klinik Bethanien, Zürich, Switzerland
| | - Katarzyna Furrer
- Department of Thoracic Surgery, University Hospital Zurich, Zürich, Switzerland
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zürich, Switzerland
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Prinzi N, Rossi RE, Proto C, Leuzzi G, Raimondi A, Torchio M, Milione M, Corti F, Colombo E, Prisciandaro M, Cascella T, Spreafico C, Beninato T, Coppa J, Lo Russo G, Di Bartolomeo M, de Braud F, Pusceddu S. Recent Advances in the Management of Typical and Atypical Lung Carcinoids. Clin Lung Cancer 2020; 22:161-169. [PMID: 33618994 DOI: 10.1016/j.cllc.2020.12.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/30/2020] [Accepted: 12/10/2020] [Indexed: 11/17/2022]
Abstract
Neuroendocrine neoplasms of the lung represent about 20% to 30% of all neuroendocrine tumors. On the basis of clinical and pathologic characteristics, 2 different categories of tumors may be defined: poorly differentiated neuroendocrine neoplasms, characterized by a high rate of recurrences and poor prognosis, and well-differentiated neuroendocrine neoplasms (typical carcinoids and atypical carcinoids), which generally display an indolent course. Lung carcinoids represent only 1% to 5% of all lung malignancies, but their incidence has significantly increased over the past 30 years. Surgery is the reference standard of treatment for lung carcinoids with locoregional disease. For advanced or unresectable lung carcinoids, several therapeutic options are available, but the choice should be shared within a multidisciplinary team to ensure optimal therapeutic outcomes. We describe the current management of these rare neoplasms.
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Affiliation(s)
| | - Roberta Elisa Rossi
- Gastrointestinal Surgery and Liver Transplantation Unit; Department of Pathophysiology and Organ Transplant, Università degli Studi di Milano, Milan, Italy
| | | | | | | | | | - Massimo Milione
- Diagnostic Pathology and Laboratory Medicine Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | | | | | - Tommaso Cascella
- Radiology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carlo Spreafico
- Radiology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | | | | | | | - Filippo de Braud
- Department of Medical Oncology; Oncology and Hemato-oncology Department, Università degli Studi di Milano, Milan, Italy
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30
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Gustave Roussy Immune Score based on a three-category risk assessment scale serves as a novel and effective prognostic indicator for surgically resectable early-stage non-small-cell lung cancer: A propensity score matching retrospective cohort study. Int J Surg 2020; 84:25-40. [DOI: 10.1016/j.ijsu.2020.10.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/13/2020] [Indexed: 02/07/2023]
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31
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Ventura L, Zhao W, Chen T, Wang Z, Feng J, Gu Z, Ji C, Fang W. Significant diaphragm elevation suggestive of phrenic nerve injury after thoracoscopic lobectomy for lung cancer: an underestimated problem. Transl Lung Cancer Res 2020; 9:1822-1831. [PMID: 33209604 PMCID: PMC7653126 DOI: 10.21037/tlcr-20-540] [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] [Indexed: 11/06/2022]
Abstract
Background Phrenic nerve injury (PNI) during lung cancer surgery, without apparent nerve section or damage, is still not well-studied. The aim of our study is to find an easy and objective way to evaluate a significant diaphragm elevation (SDE) suggestive of inadvertent PNI and its incidence and impact on lung cancer patients undergone video-assisted thoracoscopic surgery (VATS) lobectomy. Methods Extent of diaphragm elevation was first examined on chest X-ray in a cohort of patients with invasive thymoma in whom phrenic nerve was intentionally transected. The result was then used as the criterion to diagnose a SDE suggestive of PNI in another cohort of VATS lobectomy patients. Fluoroscopy test was used to validate the results. Spirometry test was repeated to evaluate pulmonary function loss after surgery. Results Diaphragm elevation was 24.24%±6.2% in 22 invasive thymoma-patients, with 30% elevation adopted as the criterion to diagnose SDE suggestive of PNI. In 753 VATS lobectomy patients, 56 (7.4%) were diagnosed of SDE. On Fluoroscopy test, diaphragm movement was significantly less in patients with diaphragm elevation >30% than those without (5.0 vs. 11.0 mm, P=0.003), together with a significantly smaller diaphragm movement ratio on the operation (OP) side than on the contralateral side (17% vs. 42%, P=0.018). Although no difference in postoperative complications was found, reduction in FEV1, FVC, and DLCO was significantly greater in patients with a SDE than those without (P=0.009). Conclusions Patients with more than 30% diaphragm elevation after VATS lobectomy is highly likely to have PNI and should undergo fluoroscopic validation. Inadvertent PNI during VATS lobectomy is an underestimated phenomenon and is associated with significantly greater loss of pulmonary function.
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Affiliation(s)
- Luigi Ventura
- Department of Thoracic Surgery, Shanghai Chest Hospital, Jiaotong University Medical School, Shanghai, China.,Thoracic Surgery, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Weigang Zhao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Jiaotong University Medical School, Shanghai, China.,Department of Thoracic Surgery, the Sixth People's Hospital, Jiaotong University Medical School, Shanghai, China
| | - Tangbing Chen
- Department of Thoracic Surgery, Shanghai Chest Hospital, Jiaotong University Medical School, Shanghai, China
| | - Zhexin Wang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Jiaotong University Medical School, Shanghai, China
| | - Jian Feng
- Department of Thoracic Surgery, Shanghai Chest Hospital, Jiaotong University Medical School, Shanghai, China
| | - Zhitao Gu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Jiaotong University Medical School, Shanghai, China
| | - Chunyu Ji
- Department of Thoracic Surgery, Shanghai Chest Hospital, Jiaotong University Medical School, Shanghai, China
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Jiaotong University Medical School, Shanghai, China
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Kong J, Guo J, Zhang H, Li Y, Wang G, Zhang Y. CT-guided localization techniques of small pulmonary nodules: a prospective non-randomized controlled study on pulmonary nodule localization needle and methylene blue staining with surgical glue. J Thorac Dis 2020; 12:6826-6835. [PMID: 33282384 PMCID: PMC7711370 DOI: 10.21037/jtd-20-3147] [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] [Indexed: 12/18/2022]
Abstract
Background Thoracoscopic resection of small pulmonary nodules (SPNs) is challenging. Accurate preoperative computed tomography-guided localization of SPNs is key to successful rection. The aim of the present study was to evaluate the clinical value of a novel localization needle and methylene blue staining combined with surgical glue (MBSG) and to explore the risk factors for post-localization complications. Methods This prospective, non-randomized controlled study was conducted on 110 patients who received either MBSG or novel needle localization prior to video-assisted thoracoscopic surgery (VATS) from January 2019 to December 2019 at Shenzhen People’s Hospital. The primary endpoints were the safety and the success rates of the 2 localization techniques. The secondary endpoints were operative time and feasibility. Results The 110 patients were categorized into 2 groups: the MBSG group (n=84) and the pulmonary nodule localization needle group (n=26). The success rate of pre-VATS localization was 100% in both groups. No deaths or serious complications occurred during localization. The rates of pneumothorax, pulmonary hemorrhage, and localization-induced cough were 38.1%, 25%, and 7.14%, respectively, in the MBSG group, and 26.92%, 19.23%, and 0%, respectively, in the pulmonary nodule localization needle group. Differences between the 2 groups were not statistically significant (P>0.05). Total complication rate and the incidence of pain were significantly lower in the pulmonary nodule localization needle group (χ2=4.441 and 4.295, respectively; P<0.05). The difference in operative time between the 2 groups was not statistically significant (P>0.05). Dye diffusion occurred in 2 patients in the MBSG group; however, it had no impact on VATS or on the pathological analysis. Neither displacement nor dislocation was observed in the pulmonary nodule localization needle group. Logistic regression analysis showed that the localization technique was an independent risk factor for total complications (odds ratio: 2.634, 95% confidence interval: 1.022–6.789, P<0.05). Conclusions Both techniques can localize SPNs effectively prior to VATS. The pulmonary nodule localization needle technique has a lower incidence of complications.
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Affiliation(s)
- Jian Kong
- Department of Interventional Radiology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Jianxi Guo
- Department of Interventional Radiology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Hua Zhang
- Department of Interventional Radiology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Yong Li
- Department of Interventional Radiology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Guangsuo Wang
- Department of Thoracic Surgery, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Yanfang Zhang
- Department of Interventional Radiology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
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Zhang C, Yu Z, Li J, Zu P, Yu P, Wang G, Miyazaki T, Waseda R, Caso R, Maurizi G, Liu H. Hybrid video-assisted thoracoscopic surgery sleeve lobectomy for non-small cell lung cancer: a case report. J Thorac Dis 2020; 12:6836-6846. [PMID: 33282385 PMCID: PMC7711411 DOI: 10.21037/jtd-20-2679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Chenlei Zhang
- Department of Thoracic Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Zhanwu Yu
- Department of Thoracic Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Jijia Li
- Department of Thoracic Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Peng Zu
- Department of Thoracic Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Pingwen Yu
- Department of Thoracic Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Gebang Wang
- Department of Thoracic Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Takuro Miyazaki
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ryuichi Waseda
- Department of General Thoracic, Breast, and Pediatric Surgery, Fukuoka University, Fukuoka, Japan
| | - Raul Caso
- Department of Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Giulio Maurizi
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Hongxu Liu
- Department of Thoracic Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
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Lin SF, Zheng YZ, Li XQ, Xu HP, Wang JJ, Wang W, Huang QY, Wu D, Zhong CX, Fu SS, Yuan LX, Wang SC, Luo RX, Zhai WY, Yu BT, Zhu KS. Impact of treatment modality on long-term survival of stage IA small-cell lung cancer patients: a cohort study of the U.S. SEER database. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1292. [PMID: 33209872 PMCID: PMC7661878 DOI: 10.21037/atm-20-5525] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background The optimal treatment modality for patients with stage IA (T1N0M0) small-cell lung cancer (SCLC) is still unclear. Methods Patients who received surgical resection or chemo-radiotherapy (CRT) between January 2004 and December 2014 were identified from The Surveillance, Epidemiology and End Results (SEER) database. Surgical resection included lobectomy, wedge resection, segmentectomy with lymphadenectomy [examined lymph node (ELN) ≥1]. Propensity score match analysis was utilized to balance the baseline characteristics. Results A total of 686 stage IA SCLC cases were included: 337 patients underwent surgery and 349 patients were treated by CRT alone. Surgery achieved a better outcome than CRT alone, with an adjusted hazard ratio (HR) of 0.495. Patients who underwent lobectomy demonstrated a longer overall survival (OS), compared to those who received sublobectomy (crude cohort, median OS, 69 vs. 38 months; match cohort, median OS, 67 vs. 38 months). Patients with ELN >7 presented with longer OS than those with ELN ≤7 (crude cohort, median OS, 91 vs. 49 months; matched cohort, median OS, 91 vs. 54 months). The additional efficacy of chemotherapy or radiotherapy in patients receiving lobectomy was observed. The best prognosis was achieved in the lobectomy plus CRT cohort, with a 5-year survival rate of 73.5%. Conclusions The prolonged survival associated with lobectomy and chemotherapy or radiotherapy presents a viable treatment option in the management of patients with stage IA SCLC.
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Affiliation(s)
- Shao-Feng Lin
- Department of Thoracic Surgery, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital& Fujian Provincial Key Laboratory of Tumor Biotherapy, Fuzhou, China
| | - Yu-Zhen Zheng
- Department of Thoracic Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiao-Qiang Li
- Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen, China
| | - Hai-Peng Xu
- Department of Thoracic Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Jun-Jie Wang
- Department of Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Wei Wang
- S. Arthur Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, NY, USA
| | - Qing-Yuan Huang
- Department of Thoracic Surgery, Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Da Wu
- Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen, China
| | - Chen-Xi Zhong
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Shen-Shen Fu
- Department of Ultrasonography, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Lian-Xiong Yuan
- Office of Research Service, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangzhou, China
| | - Si-Chao Wang
- Department of Thoracic Surgery, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Rui-Xing Luo
- Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen, China
| | - Wen-Yu Zhai
- Department of Thoracic Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation, Guangzhou, China
| | - Ben-Tong Yu
- Department of Thoracic Surgery, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Kun-Shou Zhu
- Department of Thoracic Surgery, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital& Fujian Provincial Key Laboratory of Tumor Biotherapy, Fuzhou, China
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Naples Prognostic Score as a novel prognostic prediction tool in video-assisted thoracoscopic surgery for early-stage lung cancer: a propensity score matching study. Surg Endosc 2020; 35:3679-3697. [PMID: 32748268 DOI: 10.1007/s00464-020-07851-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 07/24/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUNDS The Naples Prognostic Score (NPS) emerges as a novel prognostic scoring system in surgical oncology. We aim to assess the prognostic significance of preoperative NPS in patients undergoing completely video-assisted thoracoscopic surgery (VATS) lobectomy for early-stage non-small cell lung cancer (NSCLC) by propensity score matching (PSM) analysis. METHODS The present study was conducted on our single-center prospectively maintained database between January 2014 and December 2015. A Kaplan-Meier survival analysis using the log-rank test was used to distinguish differences in both overall survival (OS) and disease-free survival (DFS) between the patients stratified by preoperative NPS. Finally, multivariable Cox-proportional hazards regression analysis and PSM analysis were carried out to determine the independent prognostic factors for both OS and DFS. RESULTS There were 457 patients with operable primary stage I-II NSCLC included. Per 1-point increase in NPS was found to be significantly associated with unfavorable OS and DFS of NSCLC. Both OS and DFS were significantly shortened along with each number increase in the NPS group, showing a step-wise fashion. Such strong correlations between preoperative NPS and survival outcomes still remained validated after PSM analysis. In addition, NPS held the best discriminatory power for predicting both OS and DFS when compared to the other peripheral biomarkers. Multivariable analyses on the entire cohort and the PSM cohort demonstrated that preoperative NPS could be an independent prognostic indicator for both OS and DFS. CONCLUSIONS The NPS scoring system can serve as a novel risk stratification tool to refine prognostic prediction after VATS lobectomy for surgically resected NSCLC.
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Survival After Thoracoscopic Surgery or Open Lobectomy: Systematic Review and Meta-Analysis. Ann Thorac Surg 2020; 111:302-313. [PMID: 32730840 DOI: 10.1016/j.athoracsur.2020.05.144] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/10/2020] [Accepted: 05/18/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Video-assisted thoracoscopic surgery (VATS) has been shown to reduce hospital stays and pain compared with open lobectomy to treat non-small cell lung cancer. Because of the low rate of deaths, it is difficult to show differences in survival in individual studies. The objective of this study was to compare short- and long-term mortality by means of a systematic review and meta-analysis. METHODS The reviewers systematically searched studies that compared VATS vs open lobectomy and provided data on 30-day mortality or long-term survival (>5 years). For long-term outcomes, studies included patients with the same cancer stage or, if several stages were included, the studies had to control for cancer stage in their propensity score model. A pooled odds ratio and hazard ratio (HR) was respectively calculated for short- and long-term outcomes. RESULTS A total of 33 works were identified, comprising 61,633 patients. VATS led to lower postoperative mortality (odds ratio, 0.64; 95% confidence interval [CI], 0.56 to 0.73) and higher long-term survival (HR, .88; 95% CI, 0.81 to 0.96). Disease-free survival was similar in both groups (HR, 0.94; 95% CI, 0.80 to 1.10). CONCLUSIONS For non-small cell lung cancer treated with lobectomy, VATS was associated with lower postoperative mortality and greater long-term survival compared with open lobectomy. Disease-free survival was similar between both groups.
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Xu W, Xu C, Ding C, Chen J, Wang W, Zhao J, Li C. [Comparison of the Clinical Effect of Uniportal Video-assisted Thoracoscopic Lobectomy and Biportal Video-assisted Thoracoscopic Lobectomy in the Treatment of Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2020; 23:561-567. [PMID: 32455516 PMCID: PMC7406445 DOI: 10.3779/j.issn.1009-3419.2020.101.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
背景与目的 近年来单孔胸腔镜肺癌根治术逐渐兴起,作为一种新的手术方式,其可行性及安全性尚未得到普遍认可。本研究拟探讨单孔胸腔镜肺癌根治术在治疗Ⅰ期至部分Ⅲa期肺癌病例中的可行性及安全性。 方法 回顾性分析苏州大学附属第一医院胸外科同一治疗组在2018年5月-2019年3月连续进行的胸腔镜肺癌根治术患者的临床资料。排除部分不符合要求的病例后,根据手术方式分为单孔组(55例)和单操作孔组(87例),共142例。分析两组患者的临床数据,进行统计学分析。 结果 142例患者均行肺叶切除+淋巴结清扫术,术后顺利出院,未有围手术期死亡。单孔组和单操作孔组比较,年龄、肿瘤位置、术后病理类型、肿瘤大小、肿瘤的病理性原发灶-淋巴结-转移(pathological tumor-node-metastasis, pTNM)分期的差异均无统计学意义(P > 0.05)。单孔组手术时间更短[(167.65±43.85) min vs (181.71±51.28) min],术中出血量更少[(57.45±50.19) mL vs (87.47±132.54) mL],术后引流管留置时间[(4.82±2.82) d vs (5.84±3.43) d]及术后住院天数[(6.91±3.88) d vs (7.74±3.87) d]更短,但差异无统计学意义(P > 0.05)。单孔组的术后总引流量显著低于单操作孔组[(1, 064.82±776.38) mL vs (1, 658.71±1, 722.38) mL],术后24 h及72 h视觉疼痛评分明显更低[(4.73±0.73)分vs(5.25±0.74)分;(2.16±0.71)分vs(2.55±0.86)分],差异有统计学意义(P < 0.05)。 结论 在Ⅰ期至部分Ⅲa期肺癌病例中,单孔胸腔镜肺癌根治术安全可行。
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Affiliation(s)
- Weifeng Xu
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou 215006, China.,Department of Thoracic Surgery, Wuxi Xishan People's Hospital, Wuxi 214105, China
| | - Chun Xu
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Cheng Ding
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Jun Chen
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Wenyi Wang
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Jun Zhao
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Chang Li
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
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Yang Y, Mei J, Lin F, Pu Q, Ma L, Liu C, Zhu Y, Guo C, Xia L, Liu L. Comparison of the Short- and Long-term Outcomes of Video-assisted Thoracoscopic Surgery versus Open Thoracotomy Bronchial Sleeve Lobectomy for Central Lung Cancer: A Retrospective Propensity Score Matched Cohort Study. Ann Surg Oncol 2020; 27:4384-4393. [PMID: 32642997 DOI: 10.1245/s10434-020-08805-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 05/25/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the short- and long-term outcomes of video-assisted thoracoscopic surgery (VATS) versus open thoracotomy bronchial sleeve lobectomy (BSL) for patients with central lung cancer. METHODS This is a retrospective cohort study. Perioperative outcomes and long-term survival of patients who underwent VATS versus open thoracotomy BSL for central lung cancer from June 2010 and June 2018 in the Western China Lung Cancer Database were compared using propensity score matching (PSM) between the two surgical approaches. RESULTS The retrospective study included 187 patients who divided into VATS group (n = 44) and open group (n = 143) according to surgical approach, and PSM resulted in 43 patients in each group, which were well matched by 11 potential prognostic factors. The VATS group was associated with lower overall incidence of postoperative complications (20.3% vs. 30.2%, P = 0.029), less postoperative drainage (875 ml [250-3960] vs. 1280 ml [100-4890], P = 0.039). The 5-year overall survival (OS) and disease-free survival (DFS) were comparable between the VATS and open groups (55.9% vs. 65.2% P = 0.836 and 54.1% vs. 60.2% P = 0.391, respectively) after matching. Multivariable adjusted analysis demonstrated that the surgical approach was not an independent favorable prognostic factor for OS (hazard ratio [HR] = 0.922; 95% confidence interval [CI], 0.427-1.993; P = 0.836) but just the pTNM stage (HR = 2.003; 95% CI 1.187-3.382; P = 0.009). CONCLUSIONS VATS BSL may achieve equivalent long-term outcomes for central lung cancer patients when comparing with open thoracotomy. Although slightly longer duration of surgery, VATS approach may be a feasible option for lung cancer patients requiring BSL.
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Affiliation(s)
- Yanbo Yang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, 610041, People's Republic of China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Jiandong Mei
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, 610041, People's Republic of China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Feng Lin
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, 610041, People's Republic of China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Qiang Pu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, 610041, People's Republic of China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Lin Ma
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, 610041, People's Republic of China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Chengwu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, 610041, People's Republic of China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Yunke Zhu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, 610041, People's Republic of China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Chenglin Guo
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, 610041, People's Republic of China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Liang Xia
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, 610041, People's Republic of China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, 610041, People's Republic of China.
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Zhou Q, Huang J, Pan F, Li J, Liu Y, Hou Y, Song W, Luo Q. Operative outcomes and long-term survival of robotic-assisted segmentectomy for stage IA lung cancer compared with video-assisted thoracoscopic segmentectomy. Transl Lung Cancer Res 2020; 9:306-315. [PMID: 32420070 PMCID: PMC7225141 DOI: 10.21037/tlcr-20-533] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Robotic anatomic segmentectomy (RATS) for early-stage lung cancer is being increasingly performed in spite of limited published evidence. To evaluate its safety and oncologic efficacy, we compared the outcomes of both RATS and video-assisted thoracoscopic (VATS) segmentectomy in patients with small-sized (<2 cm) peripheral stage IA lung cancer. Methods From November 2011 to January 2018, a total of 130 patients with resected stage IA non-small cell lung cancer (NSCLC) who underwent RATS (n=50) and VATS (n=80) pulmonary segmentectomy were included. Clinicopathologic data, recurrence rate, and survival were recorded. Results The demographics, pulmonary function, comorbidity, and tumor size were similar between RATS segmentectomy and VATS segmentectomy. The surgery time, intensive care unit stay, hospital stay, and blood loss were reduced in the RATS group compared to the VATS group. The number of totally dissected lymph nodes and postoperative complications were similar between the 2 groups. There was no operative mortality. The intensity of narcotic use during hospital stay and the time to return to routine daily activities were also reduced in the RATS group. There was no recurrence observed in the RATS group during the median 38-month follow-up period; meanwhile, during a median 85-month follow-up period in the VATS group, local recurrence and distant recurrence was observed in 2 patients (2.5%) and 3 patients (3.75%) respectively. There was no significant difference in the 5-year recurrence-free survival between the RATS and VATS groups (100% vs. 93.75%; P>0.05). Conclusions RATS can be performed safely and effectively in patients with early-stage NSCLC. The reduced narcotic use and earlier return to routine daily activities of RATS patients might reflect its less traumatic nature as compared to VATS. For stage IA disease with small tumors (<2 cm), segmentectomy performed by RATS has better oncologic efficacy when compared to VATS, although in this study, this difference did not reach statistical difference.
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Affiliation(s)
- Qianjun Zhou
- Department of Thoracic Surgical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine (SJTUSM), Shanghai 200030, China
| | - Jia Huang
- Department of Thoracic Surgical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine (SJTUSM), Shanghai 200030, China
| | - Feng Pan
- Department of Respiratory Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine (SJTUSM), Shanghai 200030, China
| | - Jiantao Li
- Department of Thoracic Surgical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine (SJTUSM), Shanghai 200030, China
| | - Yuan Liu
- Department of Statistics Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine (SJTUSM), Shanghai 200030, China
| | - Yucheng Hou
- Department of Thoracic Surgical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine (SJTUSM), Shanghai 200030, China
| | - Weijian Song
- Department of Thoracic Surgical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine (SJTUSM), Shanghai 200030, China
| | - Qingquan Luo
- Department of Thoracic Surgical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine (SJTUSM), Shanghai 200030, China
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Yang Z, Li S, Zhao L, Lv W, Ju J, Zhang W, Li J, Che G. Serum uric acid to lymphocyte ratio: A novel prognostic biomarker for surgically resected early-stage lung cancer. A propensity score matching analysis. Clin Chim Acta 2020; 503:35-44. [DOI: 10.1016/j.cca.2020.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 12/29/2019] [Accepted: 01/08/2020] [Indexed: 12/14/2022]
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Chan JWY, Yu PSY, Yang JH, Yuan EQ, Jia H, Peng J, Lau RWH, Ng CSH. Surgical access trauma following minimally invasive thoracic surgery. Eur J Cardiothorac Surg 2020; 58:i6-i13. [PMID: 32061088 DOI: 10.1093/ejcts/ezaa025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 12/05/2019] [Accepted: 12/22/2019] [Indexed: 12/11/2022] Open
Abstract
SummarySurgical access trauma has important detrimental implications for immunological status, organ function and clinical recovery. Thoracic surgery has rapidly evolved through the decades, with the advantages of minimally invasive surgery becoming more and more apparent. The clinical benefits of enhanced recovery after video-assisted thoracoscopic surgery (VATS) may be, at least in part, the result of better-preserved cellular immunity and cytokine profile, attenuated stress hormone release and improved preservation of pulmonary and shoulder function. Parameters of postoperative pain, chest drain duration, hospital stay and even long-term survival are also indirect reflections of the advantages of reduced access trauma. With innovations of surgical instruments, optical devices and operative platform, uniportal VATS, robotic thoracic surgery and non-intubated anaesthesia represent the latest frontiers in minimizing trauma from surgical access.
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Affiliation(s)
- Joyce W Y Chan
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Peter S Y Yu
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jack Hong Yang
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Evan Qize Yuan
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Hao Jia
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jia Peng
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Rainbow W H Lau
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Calvin S H Ng
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
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Liu L, Mei J, He J, Demmy TL, Gao S, Li S, He J, Liu Y, Huang Y, Xu S, Hu J, Chen L, Zhu Y, Luo Q, Mao W, Tan Q, Chen C, Li X, Zhang Z, Jiang G, Xu L, Zhang L, Fu J, Li H, Wang Q, Liu D, Tan L, Zhou Q, Fu X, Jiang Z, Chen H, Fang W, Zhang X, Li Y, Tong T, Yu Z, Liu Y, Zhi X, Yan T, Zhang X, Pu Q, Che G, Lin Y, Ma L, Embun R, Aragón J, Evman S, Kocher GJ, Bertolaccini L, Brunelli A, Gonzalez-Rivas D, Dunning J, Liu HP, Swanson SJ, Borisovich RA, Sarkaria IS, Sihoe ADL, Nagayasu T, Miyazaki T, Chida M, Kohno T, Thirugnanam A, Soukiasian HJ, Onaitis MW, Liu CC. International expert consensus on the management of bleeding during VATS lung surgery. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:712. [PMID: 32042728 DOI: 10.21037/atm.2019.11.142] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Intraoperative bleeding is the most crucial safety concern of video-assisted thoracic surgery (VATS) for a major pulmonary resection. Despite the advances in surgical techniques and devices, intraoperative bleeding is still not rare and remains the most common and potentially fatal cause of conversion from VATS to open thoracotomy. Therefore, to guide the clinical practice of VATS lung surgery, we proposed the International Interest Group on Bleeding during VATS Lung Surgery with 65 experts from 10 countries in the field to develop this consensus document. The consensus was developed based on the literature reports and expert experience from different countries. The causes and incidence of intraoperative bleeding were summarised first. Seven situations of intraoperative bleeding were collected based on clinical practice, including the bleeding from massive vessel injuries, bronchial arteries, vessel stumps, and bronchial stumps, lung parenchyma, lymph nodes, incisions, and the chest wall. The technical consensus for the management of intraoperative bleeding was achieved on these seven surgical situations by six rounds of repeated revision. Following expert consensus statements were achieved: (I) Bleeding from major vascular injuries: direct compression with suction, retracted lung, or rolled gauze is useful for bleeding control. The size and location of the vascular laceration are evaluated to decide whether the bleeding can be stopped by direct compression or by ligation. If suturing is needed, the suction-compressing angiorrhaphy technique (SCAT) is recommended. Timely conversion to thoracotomy with direct compression is required if the operator lacks experience in thoracoscopic angiorrhaphy. (II) Bronchial artery bleeding: pre-emptive clipping of bronchial artery before bronchial dissection or lymph node dissection can reduce the incidence of bleeding. Bronchial artery bleeding can be stopped by compression with the suction tip, followed by the handling of the vascular stump with energy devices or clips. (III) Bleeding from large vessel stumps and bronchial stumps: bronchial stump bleeding mostly comes from accompanying bronchial artery, which can be clipped for hemostasis. Compression for hemostasis is usually effective for bleeding at the vascular stump. Otherwise, additional use of hemostatic materials, re-staple or a suture may be necessary. (IV) Bleeding from the lung parenchyma: coagulation hemostasis is the first choice. For wounds with visible air leakage or an insufficient hemostatic effect of coagulation, suturing may be necessary. (V) Bleeding during lymph node dissection: non-grasping en-bloc lymph node dissection is recommended for the nourishing vessels of the lymph node are addressed first with this technique. If bleeding occurs at the site of lymph node dissection, energy devices can be used for hemostasis, sometimes in combination with hemostatic materials. (VI) Bleeding from chest wall incisions: the chest wall incision(s) should always be made along the upper edge of the rib(s), with good hemostasis layer by layer. Recheck the incision for hemostasis before closing the chest is recommended. (VII) Internal chest wall bleeding: it can usually be managed with electrocoagulation. For diffuse capillary bleeding with the undefined bleeding site, compression of the wound with gauze may be helpful.
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Affiliation(s)
- Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jiandong Mei
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jie He
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Todd L Demmy
- Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Shugeng Gao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Shanqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medicine, Beijing 100032, China
| | - Jianxing He
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Yang Liu
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Yunchao Huang
- Department of Thoracic and Cardiovascular Surgery, The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital), Kunming 650106, China
| | - Shidong Xu
- Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, Harbin 150086, China
| | - Jian Hu
- Department of Thoracic Surgery, First Hospital Affiliated to Medical College of Zhejiang University, Hangzhou 310003, China
| | - Liang Chen
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yuming Zhu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200003, China
| | - Qingquan Luo
- Shanghai Lung Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Weimin Mao
- Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Qunyou Tan
- Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing 400042, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Xiaofei Li
- Department of Thoracic Surgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an 710038, China
| | - Zhu Zhang
- Department of Thoracic Surgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200003, China
| | - Lin Xu
- Department of Thoracic Surgery, Nanjing Medical University Affiliated Cancer Hospital, Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Cancer Institute of Jiangsu Province, Nanjing 210009, China
| | - Lanjun Zhang
- Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China
| | - Jianhua Fu
- Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China
| | - Hui Li
- Department of Thoracic Surgery, Beijing Chao-Yang Hospital, Beijing 100043, China
| | - Qun Wang
- Department of Thoracic Surgery, Shanghai Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Deruo Liu
- Department of Thoracic Surgery, China and Japan Friendship Hospital, Beijing 100029, China
| | - Lijie Tan
- Department of Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Qinghua Zhou
- Department of Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xiangning Fu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zhongmin Jiang
- Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan 250014, China
| | - Haiquan Chen
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Jiao Tong University, Shanghai 200032, China
| | - Xun Zhang
- Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin 300051, China
| | - Yin Li
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Ti Tong
- Department of Thoracic Surgery, Second Hospital of Jilin University, Changchun 130041, China
| | - Zhentao Yu
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - Yongyu Liu
- Department of Thoracic Surgery, Liaoning Cancer Hospital and Institute, Shenyang 110042, China
| | - Xiuyi Zhi
- Department of Thoracic Surgery, Xuanwu Hospital of Capital Medical University, Beijing 100053, China
| | - Tiansheng Yan
- Department of Thoracic Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Xingyi Zhang
- Department of Thoracic Surgery, The Second Hospital of Jilin University, Changchun 130041, China
| | - Qiang Pu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yidan Lin
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Lin Ma
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Raul Embun
- Thoracic Surgery Department, Hospital Universitario Miguel Servet, IIS Aragón, Zaragoza, Spain
| | - Javier Aragón
- Department of Thoracic Surgery, Asturias University Central Hospital, Oviedo, Spain
| | - Serdar Evman
- Department of Thoracic Surgery, University of Health Sciences, Sureyyapasa Training and Research Hospital, Istanbul, Turkey
| | - Gregor J Kocher
- Division of Thoracic Surgery, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Luca Bertolaccini
- Department of Thoracic Surgery, Maggiore Teaching Hospital, Bologna, Italy
| | | | - Diego Gonzalez-Rivas
- Department of Thoracic Surgery, Coruña University Hospital and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain
| | - Joel Dunning
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| | - Hui-Ping Liu
- Department of Thoracic Surgery, Chang Gung Memorial Hospital (Linkou), Taiwan, China
| | - Scott J Swanson
- Department of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Inderpal S Sarkaria
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Alan Dart Loon Sihoe
- Honorary Consultant in Cardio-Thoracic Surgery, Gleneagles Hong Kong Hospital, Hong Kong, China
| | - Takeshi Nagayasu
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takuro Miyazaki
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Masayuki Chida
- Department of General Thoracic Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Tadasu Kohno
- Department of Thoracic Surgery, Thoracoscopic Surgery Center, New Tokyo Hospital, Chiba, Japan
| | - Agasthian Thirugnanam
- Agasthian Thoracic Surgery Pte Ltd. 3 Mount Elizabeth #14-12 Mount Elizabeth Medical Centre, Singapore
| | - Harmic J Soukiasian
- Division of Thoracic Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Mark W Onaitis
- Moores Cancer Center, UC San Diego Health - La Jolla, Moores Cancer Center, La Jolla, USA
| | - Chia-Chuan Liu
- Division of Thoracic Surgery, Sun Yat-Sen Cancer Center, Taipei, Taiwan, China
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Albumin-to-alkaline phosphatase ratio as a novel prognostic indicator for patients undergoing minimally invasive lung cancer surgery: Propensity score matching analysis using a prospective database. Int J Surg 2019; 69:32-42. [PMID: 31319230 DOI: 10.1016/j.ijsu.2019.07.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/22/2019] [Accepted: 07/06/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To evaluate prognostic significance of albumin-to-alkaline phosphatase ratio (AAPR) for patients undergoing video-assisted thoracoscopic surgery (VATS) lobectomy for non-small-cell lung cancer (NSCLC) by a propensity score-matching (PSM) analysis. METHODS This PSM study was conducted on the prospectively-maintained database in our institution between December 2013 and March 2015. Overall survival analyses and further subgroup analyses were both performed to distinguish the differences in postoperative survival between patients stratified by an optimal cutoff of AAPR. Multivariable Cox proportional hazards regression models were established to determine the independent prognostic factors. RESULTS There were 390 patients with operable NSCLCs included. An AAPR of 0.57 was identified as the optimal cutoff regarding to postoperative survival. Both overall survival (OS) and disease-free survival (DFS) in patients with AAPR≤0.57 were significantly shortened compared to those in patient with AAPR>0.57 (Log-rank P < 0.001). Patients with AAPR≤0.57 had significantly lower rates of OS and DFS than those of patients with AAPR>0.57 (P < 0.001). These differences still remained significant after subgroup analyses and PSM analyses. Multivariate analyses on the entire cohort and the PSM cohort commonly indicated that low preoperative AAPR could be an independent prognostic factor for unfavorable OS and DFS of resected NSCLCs. CONCLUSIONS AAPR can serve as a novel risk stratification tool to refine prognostic prediction for surgical NSCLC. It may help surgeons to screen high-surgical-risk patients and further formulate individualized treatment schemes.
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Li S, Zhang W, Yang Z, Li Y, Du H, Che G. Systemic Inflammation Score as a Novel Prognostic Indicator for Patients Undergoing Video-Assisted Thoracoscopic Surgery Lobectomy for Non-Small-Cell Lung Cancer. J INVEST SURG 2019; 34:428-440. [PMID: 31304810 DOI: 10.1080/08941939.2019.1641169] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND To evaluate the prognostic significance of systemic inflammation score (SIS) for patients undergoing video-assisted thoracoscopic surgery (VATS) lobectomy for non-small-cell lung cancers (NSCLCs). Methods: This retrospective cohort study was conducted on the prospectively maintained database in our institution during the study period. Preoperative SIS comprising serum albumin (sALB) and lymphocyte-to-monocyte ratio (LMR) was graded into 0, 1 and 2. Survival analysis was performed to distinguish differences in postoperative survival between three groups of SIS. Finally, multivariate Cox proportional hazards regression analyses were conducted to determine independent prognostic factors. Results: There were 390 patients with operable NSCLCs included. We applied sALB at 40 g/L and our median LMR at 3.91 as the cutoffs for modified SIS scoring criteria. Both overall survival (OS) and disease-free survival (DFS) were significantly shortened in a step-wise fashion with each 1-point increase in SIS (Log-rank p < .001). There was a significant step-wise decline in both OS and DFS rates in proportion to SIS (p < .001). No difference was found in postoperative complications between three groups of SIS. Multivariate analyses finally demonstrated that both SIS = 1 and SIS = 2 could be independent prognostic factors for unfavorable OS and DFS of NSCLCs. Conclusions: SIS can serve as a novel risk stratification tool to refine the prognostic prediction for surgical NSCLCs.
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Affiliation(s)
- Shuangjiang Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Wenbiao Zhang
- Department of Radiology, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Sun Yat-Sen University, Guangzhou, PR China
| | - Zhang Yang
- Division of General Thoracic Surgery, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Yongjiang Li
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Heng Du
- Division of Pulmonary Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, PR China
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