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Kitazawa S, Wijesinghe AI, Maki N, Yanagihara T, Saeki Y, Kobayashi N, Kikuchi S, Goto Y, Ichimura H, Sato Y. Predicting Respiratory Complications Following Lobectomy Using Quantitative CT Measures of Emphysema. Int J Chron Obstruct Pulmon Dis 2021; 16:2523-2531. [PMID: 34511897 PMCID: PMC8428273 DOI: 10.2147/copd.s321541] [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: 05/27/2021] [Accepted: 08/02/2021] [Indexed: 12/25/2022] Open
Abstract
Purpose In performing surgery for lung cancer, emphysema is a risk factor related to postoperative respiratory complications (PRC). However, few studies have addressed the risk of radiological emphysematous volume affecting PRC. The aim of this study was to investigate the relationship between emphysematous volume as measured on 3-dimensional computed tomography and PRC. Patients and Methods We reviewed 342 lung cancer patients undergoing lobectomy between 2013 and 2018. The percentage of low attenuation area (LAA%) was defined as the percentage of the lung area showing attenuation of −950 Hounsfield units or lower. Preoperative factors including age, sex, body mass index, smoking index, respiratory function, tumour histology, and LAA% were evaluated. PRC included pneumonia, atelectasis, prolonged air leakage, empyema, hypoxia, ischemic bronchitis, bronchopleural fistula, and exacerbation of interstitial pneumonia. Uni- and multivariable analyses were performed to investigate the relationship between independent clinical variables and postoperative adverse events. Results Median LAA% was 5.0% (range, 0–40%) and PRC was observed in 50 patients (14.6%). Patients who presented with PRC showed significantly high LAA% compared to those without complications (median: 8.1% vs 3.8%; p < 0.001). Based on univariable analysis, age, sex, smoking index, percentage of forced expiratory volume in 1 s (FEV1.0%), histology, and LAA% were significant predictors for PRC. Multivariable analysis revealed higher LAA% as a significant risk factor for PRC (odds ratio = 1.040; 95% confidence interval, 1.001–1.080; p = 0.046). Conclusion In addition to respiratory function with spirometry, LAA% can be used as a predictor of PRC.
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Affiliation(s)
- Shinsuke Kitazawa
- Department of General Thoracic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Ashoka Indranatha Wijesinghe
- Department of General Thoracic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Naoki Maki
- Department of General Thoracic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Takahiro Yanagihara
- Department of General Thoracic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yusuke Saeki
- Department of General Thoracic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Naohiro Kobayashi
- Department of General Thoracic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Shinji Kikuchi
- Department of General Thoracic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yukinobu Goto
- Department of General Thoracic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Hideo Ichimura
- Department of General Thoracic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yukio Sato
- Department of General Thoracic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
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Infante MV, Benato C, Silva R, Rocco G, Bertani A, Bertolaccini L, Gonfiotti A, Giovannetti R, Bonadiman C, Lonardoni A, Canneto B, Falezza G, Gandini P, Curcio C, Crisci R. What counts more: the patient, the surgical technique, or the hospital? A multivariable analysis of factors affecting perioperative complications of pulmonary lobectomy by video-assisted thoracoscopic surgery from a large nationwide registry. Eur J Cardiothorac Surg 2020; 56:1097-1103. [PMID: 31408146 DOI: 10.1093/ejcts/ezz187] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 05/04/2019] [Accepted: 05/23/2019] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Inherent technical aspects of pulmonary lobectomy by video-assisted thoracoscopic surgery (VATS) may limit surgeons' ability to deal with factors predisposing to complications. We analysed complication rates after VATS lobectomy in a prospectively maintained nationwide registry. METHODS The registry was queried for all consecutive VATS lobectomy procedures from 49 Italian Thoracic Units. Baseline condition, tumour features, surgical techniques, devices, postoperative care, complications, conversions and the reasons thereof were detailed. Univariable and multivariable regressions were used to assess factors potentially linked to complications. RESULTS Four thousand one hundred and ninety-one VATS lobectomies in 4156 patients (2480 men, 1676 women) were analysed. The median age-adjusted Charlson index of the patients was 4 (interquartile range 3-6). Grade 1 and 2 and Grade 3-5 complications were observed in 20.1% and in 5.8%, respectively. Ninety-day mortality was 0.55%. The overall conversion rate was 9.2% and significantly higher in low-volume centres (<100 cases, P < 0.001), but there was no significant difference between intermediate- and high-volume centres under this aspect. Low-volume centres were significantly more likely to convert due to issues with difficult local anatomy, but not significantly so for bleeding. Conversion, lower case-volume, comorbidity burden, male gender, adhesions, blood loss, operative time, sealants and epidural analgesia were significantly associated with increased postoperative morbidity. CONCLUSIONS VATS lobectomy is a safe procedure even in medically compromised patients. An improved classification system for conversions is proposed and prevention strategies are suggested to reduce conversion rates and possibly complications in less-experienced centres.
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Affiliation(s)
- Maurizio V Infante
- Thoracic Surgery Department, University and Hospital Trust, Ospedale Borgo Trento, Verona, Italy
| | - Cristiano Benato
- Thoracic Surgery Department, University and Hospital Trust, Ospedale Borgo Trento, Verona, Italy
| | - Ronaldo Silva
- Clinical Research Unit, University and Hospital Trust, Ospedale Borgo Trento, Verona, Italy
| | - Gaetano Rocco
- Thoracic Surgery Department, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alessandro Bertani
- Division of Thoracic Surgery and Lung Transplantation, IRCCS ISMETT - UPMC, Palermo, Italy
| | - Luca Bertolaccini
- Department of Thoracic Surgery, Maggiore Teaching Hospital, Bologna, Italy
| | | | - Riccardo Giovannetti
- Thoracic Surgery Department, University and Hospital Trust, Ospedale Borgo Trento, Verona, Italy
| | - Cinzia Bonadiman
- Thoracic Surgery Department, University and Hospital Trust, Ospedale Borgo Trento, Verona, Italy
| | - Alessandro Lonardoni
- Thoracic Surgery Department, University and Hospital Trust, Ospedale Borgo Trento, Verona, Italy
| | - Barbara Canneto
- Thoracic Surgery Department, University and Hospital Trust, Ospedale Borgo Trento, Verona, Italy
| | - Giovanni Falezza
- Thoracic Surgery Department, University and Hospital Trust, Ospedale Borgo Trento, Verona, Italy
| | - Paola Gandini
- Thoracic Surgery Department, University and Hospital Trust, Ospedale Borgo Trento, Verona, Italy
| | - Carlo Curcio
- Department of Thoracic Surgery, Monaldi Hospital, Naples, Italy
| | - Roberto Crisci
- Department of Thoracic Surgery, University Hospital "Mazzini", Teramo, Italy
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Aloud A, Berdine G, Nugent K. Single lung ventilation in patients undergoing lobectomy. J Thorac Dis 2019; 10:6383-6387. [PMID: 30746170 DOI: 10.21037/jtd.2018.11.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Abdurahim Aloud
- Department of Internal Medicine at Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Gilbert Berdine
- Department of Internal Medicine at Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Kenneth Nugent
- Department of Internal Medicine at Texas Tech University Health Sciences Center, Lubbock, TX, USA
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Julliard W, Krupnick AS. Improving pain after video-assisted thoracoscopic lobectomy-advantages of a wound retractor camera port. J Thorac Dis 2019; 11:341-344. [PMID: 30962968 DOI: 10.21037/jtd.2018.11.42] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Walker Julliard
- Thoracic and Cardiovascular Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Alexander S Krupnick
- Thoracic and Cardiovascular Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
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Dexter EU, Yendamuri S. ASO Author Reflections: To Med or Not to Med? That is the Question. Ann Surg Oncol 2018; 25:966-967. [PMID: 30421051 DOI: 10.1245/s10434-018-7040-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Indexed: 11/18/2022]
Affiliation(s)
- E U Dexter
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.,Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - S Yendamuri
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA. .,Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA.
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Li Y, Shang Y, Wang W, Ning S, Chen H. Lung Cancer and Pulmonary Embolism: What Is the Relationship? A Review. J Cancer 2018; 9:3046-3057. [PMID: 30210627 PMCID: PMC6134828 DOI: 10.7150/jca.26008] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 06/08/2018] [Indexed: 11/11/2022] Open
Abstract
Pulmonary embolism (PE) is gradually considered to be the third most common disease in the vascular disease category. Lung cancer is the most frequently diagnosed cancer and the leading cause of cancer death among males worldwide. Although initially appearing as distinct entities, lung cancer is a great risk factor for the development of PE. Pulmonary embolism is common in lung cancer patients, with a pooled incidence of 3.7%, and unsuspected pulmonary embolism (UPE) is also non-negligible with a rough rate ranging from 29.4% to 63%. Many risk factors of PE have been detected and could be classified into three categories: lung cancer-related, patient-related, and treatment-related factors. Decreased mean survival time could be significantly observed in lung cancer patients with PE or UPE compared to those only, but suspected PE has higher mortality than UPE. Prophylactic anticoagulant therapy benefit might be highest in patients with stage IV non-small cell lung cancer (NSCLC) or limited small cell lung cancer (SCLC), and heparin seems superior to warfarin for thrombotic prophylaxis. Periodically reassessing the risk-benefit ratio of anticoagulant treatment will be an efficient treatment strategy in lung cancer patients with PE.
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Affiliation(s)
- Yupeng Li
- Department of Respiration, Second Affiliated Hospital of Harbin Medical University, Harbin 150081, China.,Drs Yupeng Li and Yu Shang contribute equally to this article
| | - Yu Shang
- Department of Respiration, First Hospital of Harbin, Harbin 150081, China.,Drs Yupeng Li and Yu Shang contribute equally to this article
| | - Wenwen Wang
- Department of Respiration, Second Affiliated Hospital of Harbin Medical University, Harbin 150081, China
| | - Shangwei Ning
- College of Bioinformatics Science and Technology, Harbin Medical University, Harbin 150081, China
| | - Hong Chen
- Department of Respiration, Second Affiliated Hospital of Harbin Medical University, Harbin 150081, China
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Yendamuri S, Battoo A, Attwood K, Dhillon SS, Dy GK, Hennon M, Picone A, Nwogu C, Demmy T, Dexter E. Concomitant Mediastinoscopy Increases the Risk of Postoperative Pneumonia After Pulmonary Lobectomy. Ann Surg Oncol 2018; 25:1269-1276. [PMID: 29488189 DOI: 10.1245/s10434-018-6397-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Mediastinoscopy is considered the gold standard for preresectional staging of lung cancer. We sought to examine the effect of concomitant mediastinoscopy on postoperative pneumonia (POP) in patients undergoing lobectomy. METHODS All patients in our institutional database (2008-2015) undergoing lobectomy who did not receive neoadjuvant therapy were included in our study. The relationship between mediastinoscopy and POP was examined using univariate (Chi square) and multivariate analyses (binary logistic regression). In order to validate our institutional findings, lobectomy data in the National Surgical Quality Improvement Program (NSQIP) from 2005 to 2014 were analyzed for these associations. RESULTS Of 810 patients who underwent a lobectomy at our institution, 741 (91.5%) surgeries were performed by video-assisted thoracic surgery (VATS) and 487 (60.1%) patients underwent concomitant mediastinoscopy. Univariate analysis demonstrated an association between mediastinoscopy and POP in patients undergoing VATS [odds ratio (OR) 1.80; p = 0.003], but not open lobectomy. Multivariate analysis retained mediastinoscopy as a variable, although the relationship showed only a trend (OR 1.64; p = 0.1). In the NSQIP cohort (N = 12,562), concomitant mediastinoscopy was performed in 9.0% of patients, with 44.5% of all the lobectomies performed by VATS. Mediastinoscopy was associated with POP in patients having both open (OR1.69; p < 0.001) and VATS lobectomy (OR 1.72; p = 0.002). This effect remained in multivariate analysis in both the open and VATS lobectomy groups (OR 1.46, p = 0.003; and 1.53, p = 0.02, respectively). CONCLUSIONS Mediastinoscopy may be associated with an increased risk of POP after pulmonary lobectomy. This observation should be examined in other datasets as it potentially impacts preresectional staging algorithms for patients with lung cancer.
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Affiliation(s)
- Sai Yendamuri
- Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, NY, USA. .,Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA.
| | - Athar Battoo
- Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Kris Attwood
- Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, NY, USA
| | | | - Grace K Dy
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Mark Hennon
- Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, NY, USA.,Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Anthony Picone
- Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, NY, USA.,Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Chukwumere Nwogu
- Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, NY, USA.,Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Todd Demmy
- Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, NY, USA.,Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Elisabeth Dexter
- Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, NY, USA.,Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
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Tacconi F, Pompeo E. Non-intubated video-assisted thoracic surgery: where does evidence stand? J Thorac Dis 2016; 8:S364-75. [PMID: 27195134 DOI: 10.21037/jtd.2016.04.39] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In recent years, non-intubated video-assisted thoracic surgery (NIVATS) strategies are gaining popularity worldwide. The main goal of this surgical practice is to achieve an overall improvement of patients' management and outcome thanks to the avoidance of side-effects related to general anesthesia (GA) and one-lung ventilation. The spectrum of expected benefits is multifaceted and includes reduced postoperative morbidity, faster discharge, decreased hospital costs and a globally reduced perturbation of patients' well-being status. We have conducted a literature search to evaluate the available evidence on this topic. Meta-analysis of collected results was also done where appropriate. Despite some fragmentation of data and potential biases, the available data suggest that NIVATS operations can reduce operative morbidity and hospital stay when compared to equipollent procedures performed under GA. Larger, well designed prospective studies are thus warranted to assess the effectiveness of NIVATS as far as to investigate comprehensively the various outcomes. Multi-institutional and multidisciplinary cooperation will be welcome to establish uniform study protocols and to help address the questions that are to be answered yet.
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Affiliation(s)
- Federico Tacconi
- Department of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy
| | - Eugenio Pompeo
- Department of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy
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Falcoz PE. Editorial comment on: "Major morbidity after video-assisted thoracic surgery lung resections: a comparison between the European Society of Thoracic Surgeons definition and the Thoracic Morbidity and Mortality system" by Sandri A, et al. J Thorac Dis 2015; 7:E329-31. [PMID: 26543622 DOI: 10.3978/j.issn.2072-1439.2015.09.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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