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Nitsche LJ, Jordan S, Demmy T, Dexter E, Hennon M, Nwogu C, Yendamuri S, Picone A. Analyzing the impact of minimally invasive surgical approaches on post-operative outcomes of pneumonectomy and sleeve lobectomy patients. J Thorac Dis 2023; 15:2497-2504. [PMID: 37324102 PMCID: PMC10267906 DOI: 10.21037/jtd-22-654] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 03/24/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Some patients with non-small cell lung cancer (NSCLC) have superior short- and long-term outcomes with sleeve lobectomy rather than pneumonectomy. Originally sleeve lobectomy was reserved for patients with limited pulmonary function, however, the reported superior results allowed sleeve lobectomy to be performed in expanded patient populations. In a further attempt to improve post-operative outcomes surgeons have adopted minimally invasive techniques Minimally invasive approaches have potential benefits to patients such as decreased morbidity and mortality while maintaining the same caliber of oncologic outcomes. METHODS We identified patients at our institution who underwent sleeve lobectomy or pneumonectomy to treat NSCLC from 2007 to 2017. We analyzed these groups in respect to 30- and 90-day mortality, complications, local recurrence, and median survival. We included multivariate analysis to determine the impact of a minimally invasive approach, sex, extent of resection, and histology. Differences in mortality were analyzed using the Kaplan-Meier method using the log-rank test to compare the groups. A two-tailed Z test for difference in proportions was done to analyze complications, local recurrence, 30-day and 90-day mortality. RESULTS A total of 108 patients underwent sleeve lobectomy (n=34) or pneumonectomy (n=74) for treatment of NSCLC with 18 undergoing open pneumonectomy, 56 undergoing video-assisted thoracoscopic surgery (VATS) pneumonectomy, 29 undergoing open sleeve lobectomy, and 5 undergoing VATS sleeve lobectomy. There was no significant difference in 30-day mortality (P=0.064) but there was a difference in 90-day (P=0.007). There was no difference in complication rates (P=0.234) or local recurrence rates (P=0.779). The pneumonectomy patients had a median survival of 23.6 months (95% CI: 3.8-43.4 months). The sleeve lobectomy group had a median survival of 60.7 months (95% CI: 43.3-78.2 months) (P=0.008). On multivariate analysis extent of resection (P<0.001) and tumor stage (P=0.036) were associated with survival. There was no significant difference between the VATS approach and the open surgical approach (P=0.053). CONCLUSIONS When considering patients undergoing surgery for NSCLC sleeve lobectomy resulted in lower 90-day mortality and better 3-year survival compared to patients undergoing PN. Having a sleeve lobectomy rather than a pneumonectomy and having earlier-stage disease lead to significantly improved survival on multivariate analysis. Having a VATS operation leads to a non-inferior post-operative outcome compared to open surgery.
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Affiliation(s)
- Lindsay J Nitsche
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, USA
| | - Sean Jordan
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, USA
| | - Todd Demmy
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, USA
| | - Elisabeth Dexter
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, USA
| | - Mark Hennon
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, USA
| | - Chukwumere Nwogu
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, USA
| | - Sai Yendamuri
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, USA
| | - Anthony Picone
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, USA
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Effects of Neoadjuvant Radiotherapy on Survival in Patients with Stage IIIA-N2 Non-Small-Cell Lung Cancer Following Pneumonectomy. J Clin Med 2022; 11:jcm11237188. [PMID: 36498762 PMCID: PMC9738364 DOI: 10.3390/jcm11237188] [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: 10/25/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
Background: Pneumonectomy is a drastic but sometimes inevitable treatment option for patients with non-small-cell lung cancer (NSCLC) to improve their chances for long-term survival. However, the optimal adjuvant radiotherapy used for patients with N2 NSCLC following pneumonectomy remains unclear in the literature. Methods: T1-4N0-2M0 NSCLC patients registered in the Surveillance, Epidemiology, and End Results database were retrospectively analyzed. Propensity score matching was applied to balance the assignment of patients. Cox proportional hazards models and Kaplan−Meier analyses were used to identify the factors related to overall survival rates. Restricted cubic splines were used to detect the possible nonlinear dependency of the relationship between the risk of survival and age. Results: A total of 4308 NSCLC patients were enrolled in this study. In N2 patients, the long-term outcome of the chemotherapy and postoperative radiotherapy groups was the worst (p = 0.014). Subgroup analyses showed that the influence of age on survival outcome was confined to patients who received chemotherapy and neoadjuvant radiotherapy (p = 0.004). Meanwhile, patients >65 years of age who received chemotherapy and neoadjuvant radiotherapy had significantly worse prognoses than those in the chemotherapy group (p = 0.005). Conclusions: Our results show that neoadjuvant radiotherapy may have potential benefits in patients aged ≤ 65 years who are scheduled for pneumonectomy, but not in elderly patients.
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Bölükbas S, Baldes N, Bergmann T, Eberlein M, Beqiri S. Standard and extended sleeve resections of the tracheobronchial tree. J Thorac Dis 2020; 12:6163-6172. [PMID: 33209454 PMCID: PMC7656394 DOI: 10.21037/jtd.2020.02.65] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Anatomic resections with bronchial and/or vascular resections and reconstruction, so called sleeve resections were originally performed in patients with impaired cardio-pulmonary reserves. Nowadays, sleeve resections are established surgical procedures of first choice for tracheobronchial pathologies, whenever anatomically and oncologically feasible. Experienced thoracic surgeons have a broad surgical armentarium to avoid a pneumonectomy and the morbidity and mortality associated with it. Sleeve resections are associated with better outcomes in all aspects. Thus, sleeve resection is not an alternative for pneumonectomy and vice versa. In this review article we set out to provide a contemporary overview on this topic.
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Affiliation(s)
- Servet Bölükbas
- Department of Thoracic Surgery, Kliniken Essen-Mitte, Essen, Germany
| | - Natalie Baldes
- Department of Thoracic Surgery, Kliniken Essen-Mitte, Essen, Germany
| | - Thomas Bergmann
- Department of Thoracic Surgery, Kliniken Essen-Mitte, Essen, Germany
| | - Michael Eberlein
- Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Safet Beqiri
- Department of Thoracic Surgery, Kerckhoff-Klinik, Bad Nauheim, Germany
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Liao Y, Yin G, Fan X. The Positive Lymph Node Ratio Predicts Survival in T 1-4N 1-3M 0 Non-Small Cell Lung Cancer: A Nomogram Using the SEER Database. Front Oncol 2020; 10:1356. [PMID: 32903785 PMCID: PMC7438846 DOI: 10.3389/fonc.2020.01356] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 06/29/2020] [Indexed: 12/14/2022] Open
Abstract
Background: An increasing number of studies have shown that the positive lymph node ratio (pLNR) can be used to evaluate the prognosis of non-small cell lung cancer (NSCLC) patients. To determine the predictive value of the pLNR, we collected data from the Surveillance, Epidemiology, and End Results (SEER) database and performed a retrospective analysis. Methods: We collected survival and clinical information on patients with T1-4N1-3M0 NSCLC diagnosed between 2010 and 2016 from the SEER database and screened them according to inclusion and exclusion criteria. X-tile software was used to obtain the best cut-off value for the pLNR. Then, we randomly divided patients into a training set and a validation set at a ratio of 7:3. Pearson's correlation coefficient, tolerance and the variance inflation factor (VIF) were used to detect collinearity between variables. Univariate and multivariate Cox regression analyses were used to identify significant prognostic factors, and nomograms was constructed to visualize the results. The concordance index (C-index), calibration curves, and decision curve analysis (DCA) were used to assess the predictive ability of the nomogram. We divided the patient scores into four groups according to the interquartile interval and constructed a survival curve using Kaplan-Meier analysis. Results: A total of 6,245 patients were initially enrolled. The best cut-off value for the pLNR was determined to be 0.55. The nomogram contained 13 prognostic factors, including the pLNR. The pLNR was identified as an independent prognostic factor for both overall survival (OS) and cancer-specific survival (CSS). The C-index was 0.703 (95% CI, 0.695-0.711) in the training set and 0.711 (95% CI, 0.699-0.723) in the validation set. The calibration curves and DCA also indicated the good predictability of the nomogram. Risk stratification revealed a statistically significant difference among the four groups of patients divided according to quartiles of risk score. Conclusion: The nomogram containing the pLNR can accurately predict survival in patients with T1-4N1-3M0 NSCLC.
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Affiliation(s)
- Yi Liao
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Inflammation & Allergic Diseases Research Unit, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Guofang Yin
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Inflammation & Allergic Diseases Research Unit, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xianming Fan
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Inflammation & Allergic Diseases Research Unit, The Affiliated Hospital of Southwest Medical University, Luzhou, China
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Li Z, Chen W, Xia M, Liu H, Liu Y, Inci I, Davoli F, Waseda R, Filosso PL, White A. Sleeve lobectomy compared with pneumonectomy for operable centrally located non-small cell lung cancer: a meta-analysis. Transl Lung Cancer Res 2019; 8:775-786. [PMID: 32010556 DOI: 10.21037/tlcr.2019.10.11] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background The purpose of this meta-analysis was to evaluate evidence comparing sleeve lobectomy (SL) and pneumonectomy (PN) in the treatment of non-small cell lung cancer (NSCLC). Methods The English literature search was undertaken in January 2018 and included studies dating back to 1996. Comparative studies were identified, evaluating survival, local recurrence, and distant recurrence rates, operative mortality, 30-day mortality, as well as complications. A pooled odds ratio (OR) and 95% confidence intervals (95% CI) were calculated with either the random or fixed-effect model. Results A total of 27 studies were identified, with publication dates between 1996 and 2018. These 27 studies included a total of 14,194 patients: 4,145 treated with SL and 10,049 treated with PN. The overall survival was significantly higher in the SL group compared to the PN one at 1, 3, 5 years. In patients with N0 and N1 disease, 5-year survival rates following SL exceeded those following PN. There was no statistically significant difference in the 3-, 5-year overall survival of N2 patients, according to the extent of surgery. The PN group had a higher rate of operative mortality, 30-day mortality and distant recurrence incidence. However, no statistical difference in complications and local recurrence between SL and PN were observed. Conclusions SL is an effective treatment option for hilar NSCLC with improved long-term survival compared to PN, with no increase of recurrence rate or postoperative complications. Furthermore, N2 disease is an important factor related to survival, and lymph node downstaging is a favorable prognostic factor.
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Affiliation(s)
- Zhengjun Li
- Department of Thoracic Surgery, Shenyang Chest Hospital, Shenyang 110044, China
| | - Wei Chen
- Department of Thoracic Surgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital, Shenyang 110042, China
| | - Mozhu Xia
- Department of Thoracic Surgery, The First Affiliated Hospital, China Medical University, Shenyang 110001, China
| | - Hongxu Liu
- Department of Thoracic Surgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital, Shenyang 110042, China
| | - Yongyu Liu
- Department of Thoracic Surgery, Shenyang Chest Hospital, Shenyang 110044, China
| | - Ilhan Inci
- Department of Thoracic Surgery, University Hospital, University of Zurich, Zurich, Switzerland
| | - Fabio Davoli
- Department of Thoracic Surgery, AUSL Romagna, S. Maria delle Croci Teaching Hospital, Ravenna, Italy
| | - Ryuichi Waseda
- Department of General Thoracic, Breast, and Pediatric Surgery, Fukuoka University, Fukuoka, Japan
| | - Pier Luigi Filosso
- Unit of Thoracic Surgery, Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Abby White
- Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
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Skrzypczak PJ, Roszak M, Kasprzyk M, Kopczyńska A, Gabryel P, Dyszkiewicz W. Pneumonectomy - permanent injury or still effective method of treatment? Early and long-term results and quality of life after pneumonectomy due to non-small cell lung cancer. KARDIOCHIRURGIA I TORAKOCHIRURGIA POLSKA = POLISH JOURNAL OF CARDIO-THORACIC SURGERY 2019; 16:7-12. [PMID: 31043969 PMCID: PMC6491376 DOI: 10.5114/kitp.2019.82966] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 01/31/2019] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Despite the constant decrease of performed pneumonectomies (PN) in recent years, it is still necessary for 15-20% of patients with non-small cell lung cancer (NSCLC) to undergo total lung resection due to the local progression of the disease. AIM To assess the frequency and type of postoperative complications, quality of life, and the early and long-term results after PN performed due to NSCLC. MATERIAL AND METHODS In the total group of 1160 patients, operated on in 2008-2011 due to NSCLC, 192 of them underwent PN (16.6%). The quality of life was analysed using EORTC-QLQ-C30 questionnaire. RESULTS Perioperative mortality after PN was 4%. Five-year survival reached 45%. The factors that significantly affected the 5-year survival in multivariate analysis were: pTNM stage, pN stage, intrapericardial resection, and additional extrapulmonary structures resection. The mean Global Quality of Life was 50.8. The Symptom Scale ranged from 7 to 54.3, the Functional Scale from 58.2 to 76.3 and the rate for NSCLC symptoms ranged from 2.2 to 48.1. CONCLUSIONS Pneumonectomies in patients with NSCLC is associated with higher risk of postoperative complications but it does not significantly increase the perioperative mortality. Long-term results in this group of patients are encouraging. According to the questionnaire, the quality of life is favourable. Low intensity of typical NSCLC symptoms was observed. The appropriate qualification for right-sided PN and exclusion of metastasis in N2 nodes are crucial.
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Affiliation(s)
- Piotr J. Skrzypczak
- Department of Thoracic Surgery, Wielkopolska Centre for Pulmonology and Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Magdalena Roszak
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, Poznan, Poland
| | - Mariusz Kasprzyk
- Department of Thoracic Surgery, Wielkopolska Centre for Pulmonology and Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Anna Kopczyńska
- Department of Oncology, University Hospital of Lord’s Transfiguration, Poznan University of Medical Sciences, Poznan, Poland
| | - Piotr Gabryel
- Department of Thoracic Surgery, Wielkopolska Centre for Pulmonology and Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Wojciech Dyszkiewicz
- Department of Thoracic Surgery, Wielkopolska Centre for Pulmonology and Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland
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Wang L, Pei Y, Li S, Zhang S, Yang Y. Left sleeve lobectomy versus left pneumonectomy for the management of patients with non-small cell lung cancer. Thorac Cancer 2018; 9:348-352. [PMID: 29341464 PMCID: PMC5832469 DOI: 10.1111/1759-7714.12583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 11/30/2017] [Accepted: 12/01/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The study was conducted to compare the outcomes of sleeve lobectomy (SL) and pneumonectomy (PN) for management of the left lung in patients with non-small cell lung cancer (NSCLC). METHODS One hundred and thirty-five patients who underwent left SL (n = 87) or left PN (n = 48) for NSCLC from January 2006 to December 2011 were enrolled in this retrospective study. Left SL was performed when technically possible. The clinicopathological features and treatment outcomes in both groups were compared. Survival was evaluated using the Kaplan-Meier method, and significant differences were calculated using the log-rank test. Multivariate analysis was conducted using the Cox proportional hazards model to analyze significant variables associated with the outcomes of left SL. RESULTS There were no significant differences in general clinicopathological features (age, gender, lymph node metastasis, pathological stage, and complications of bronchial fistula) between patients who underwent left SL and left PN. The operation duration was markedly longer and the extent of bleeding was greater for left SL than left PN; however patients who underwent left SL achieved significantly longer overall survival than patients who underwent left PN. The outcomes of left SL were only associated with pathological stage. CONCLUSIONS Our results indicate that left SL may offer superior survival than left PN in selected patients. If anatomically feasible, left SL may be a preferred alternative to left PN for NSCLC patients. Pathological stage is an important factor to determine the outcome of SL.
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Affiliation(s)
- Liang Wang
- Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education)Peking University Cancer Hospital and InstituteBeijingChina
| | - YuQuan Pei
- Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education)Peking University Cancer Hospital and InstituteBeijingChina
| | - ShaoLei Li
- Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education)Peking University Cancer Hospital and InstituteBeijingChina
| | - ShanYuan Zhang
- Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education)Peking University Cancer Hospital and InstituteBeijingChina
| | - Yue Yang
- Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education)Peking University Cancer Hospital and InstituteBeijingChina
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Maurizi G, D'Andrilli A, Venuta F, Rendina EA. Bronchial and arterial sleeve resection for centrally-located lung cancers. J Thorac Dis 2016; 8:S872-S881. [PMID: 27942409 DOI: 10.21037/jtd.2016.06.48] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The use of bronchial and arterial sleeve resections for the treatment of centrally-located lung cancers, when available, has become the option of choice in comparison with pneumonectomy (PN). Technical expertise, in particular in vascular reconstruction, and perioperative management improved over time allowing excellent short-term and long-term results. This is even truer if considering literature data from the main experiences published in the last years. These evidences have given to such lung sparing reconstructive procedures more and more acceptance among the surgical community. This article focuses on the main technical aspects and literature data regarding bronchovascular sleeve resections.
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Affiliation(s)
- Giulio Maurizi
- Department of Thoracic Surgery, Sant'Andrea Hospital, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Antonio D'Andrilli
- Department of Thoracic Surgery, Sant'Andrea Hospital, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Federico Venuta
- Department of Thoracic Surgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy;; Lorillard Spencer-Cenci Foundation, Rome, Italy
| | - Erino Angelo Rendina
- Department of Thoracic Surgery, Sant'Andrea Hospital, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy;; Lorillard Spencer-Cenci Foundation, Rome, Italy
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