1
|
Gattlen C, Frank KR, Marie DN, Trompette A, Chriqui LE, Hao Y, Abdelnour E, Gonzalez M, Krueger T, Dyson PJ, Siankevich S, von Garnier C, Ubags ND, Cavin S, Perentes JY. Use of a novel microbiome modulator improves anticancer immunity in a murine model of malignant pleural mesothelioma. JTCVS Open 2024; 18:324-344. [PMID: 38690424 PMCID: PMC11056478 DOI: 10.1016/j.xjon.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 01/30/2024] [Accepted: 02/05/2024] [Indexed: 05/02/2024]
Abstract
Objective Malignant pleural mesothelioma is a fatal disease and a clinical challenge, as few effective treatment modalities are available. Previous evidence links the gut microbiome to the host immunoreactivity to tumors. We thus evaluated the impact of a novel microbiome modulator compound (MMC) on the gut microbiota composition, tumor immune microenvironment, and cancer control in a model of malignant pleural mesothelioma. Methods Age- and weight-matched immunocompetent (n = 23) or athymic BALB/c mice (n = 15) were randomly assigned to MMC or no treatment (control) groups. MMC (31 ppm) was administered through the drinking water 14 days before AB12 malignant mesothelioma cell inoculation into the pleural cavity. The impact of MMC on tumor growth, animal survival, tumor-infiltrating leucocytes, gut microbiome, and fecal metabolome was evaluated and compared with those of control animals. Results The MMC delayed tumor growth and significantly prolonged the survival of immunocompetent animals (P = .0015) but not that of athymic mice. The improved tumor control in immunocompetent mice correlated with increased infiltration of CD3+CD8+GRZB+ cytotoxic T lymphocytes in tumors. Gut microbiota analyses indicated an enrichment in producers of short chain fatty acids in MMC-treated animals. Finally, we observed a positive correlation between the level of fecal short chain fatty acids and abundance of tumor-infiltrating cytotoxic T cells in malignant pleural mesothelioma. Conclusions MMC administration boosts antitumor immunity, which correlates with a change in gut microbiome and metabolome. MMC may represent a valuable treatment option to combine with immunotherapy in patients with cancer.
Collapse
Affiliation(s)
- Christophe Gattlen
- Division of Thoracic Surgery, Department of Surgery, CHUV, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Kirby R. Frank
- Division of Pulmonology, Department of Medicine, CHUV, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Damien N. Marie
- Division of Thoracic Surgery, Department of Surgery, CHUV, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Aurélien Trompette
- Division of Pulmonology, Department of Medicine, CHUV, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Louis-Emmanuel Chriqui
- Division of Thoracic Surgery, Department of Surgery, CHUV, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Yameng Hao
- Division of Thoracic Surgery, Department of Surgery, CHUV, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Institute of Chemical Sciences and Engineering, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Etienne Abdelnour
- Division of Thoracic Surgery, Department of Surgery, CHUV, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Michel Gonzalez
- Division of Thoracic Surgery, Department of Surgery, CHUV, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Thorsten Krueger
- Division of Thoracic Surgery, Department of Surgery, CHUV, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Paul J. Dyson
- Institute of Chemical Sciences and Engineering, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | | | - Christophe von Garnier
- Division of Pulmonology, Department of Medicine, CHUV, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Niki D.J. Ubags
- Division of Pulmonology, Department of Medicine, CHUV, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Sabrina Cavin
- Division of Thoracic Surgery, Department of Surgery, CHUV, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jean Y. Perentes
- Division of Thoracic Surgery, Department of Surgery, CHUV, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
2
|
Koliakos E, Abdelnour E, Hasenauer A, Forster C, Ojanguren A, Ris HB, Gonzalez M, Krueger T, Perentes JY. Objective improvement in dexterity for trainees undergoing a video-assisted thoracoscopic surgery simulation program, a prospective single center study. J Thorac Dis 2023; 15:6674-6686. [PMID: 38249899 PMCID: PMC10797410 DOI: 10.21037/jtd-23-1288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/03/2023] [Indexed: 01/23/2024]
Abstract
Background Video-assisted thoracoscopic surgery (VATS) is the recommended approach for the management of early-stage operable non-small cell lung carcinoma as well as for other pathologies of the thoracic cavity. Although VATS approaches have been largely adopted in Europe and North America, teaching the technique to novice thoracic surgery trainees remains challenging and non-standardized. Our objective was to assess the impact of a VATS simulation training program on the dexterity of thoracic surgery residents in a prospective single institution study. Methods We developed a 6-month VATS simulation training program on two different dry-lab simulators (Johnson & Johnson Ethicon Stupnik® lobectomy model; CK Surgical Simulation® Crabtree perfused lobectomy model) and assessed the skills of first year thoracic surgery residents (study group, n=7) before and after this program using three standardized exercises on the Surgical Science Simball® Box (peg placement on a board, rope insertion in loops, precision circle cutting). The results were compared to those of last-year medical students who performed the same Simball® Box exercises at a 6-month interval without undergoing a training program (control group, n=5). For each participant, the travel distances of instruments, operation time and absences of periods of extreme motion were assessed for each exercise by the use of the computer-based evaluation of the Simball® Box. Results After the 6-month VATS training program, all residents revealed a significant increase of their performance status with respect to instrument travel distances operation times and absence of periods of extreme motion in all three exercises performed. The performance of the control group was not different from the study group prior to the training program and remained unchanged 6 months later, for all exercises and parameters assessed. Conclusions Our results suggest that the implementation of a VATS simulation training program objectively increases the dexterity of thoracic surgery residents and could be an interesting training tool for their surgical education.
Collapse
Affiliation(s)
- Evangelos Koliakos
- Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Etienne Abdelnour
- Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Arpad Hasenauer
- Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Celine Forster
- Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Amaya Ojanguren
- Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Hans-Beat Ris
- Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Michel Gonzalez
- Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Thorsten Krueger
- Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Jean Y Perentes
- Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| |
Collapse
|
3
|
Bongard C, Rey Cobo J, Messe R, Noirez L, Lovis A, Krueger T, Peters S, Pozzessere C, Selby K, von Garnier C. [Lung cancer screening : towards the implementation of a pilot project in Switzerland]. Rev Med Suisse 2023; 19:2165-2171. [PMID: 37966148 DOI: 10.53738/revmed.2023.19.850.2165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
Lung cancer is responsible for one in five cancer-related deaths. Screening for lung cancer using low-dose chest CT (LDCT) is supported by several international studies targeting the at-risk population as part of an organised programme. Given the organisational challenges for the healthcare systems of the countries concerned, this involves setting up pilot screening projects. This requires close collaboration between the players involved, with a multidisciplinary approach structured around the participant, aiming to offer the expertise of the pulmonologist and the radiologist on the LDCT performed, interpreted with the help of artificial intelligence. Here we set out the elements needed to develop a screening programme, starting with the implementation of a pilot project.
Collapse
Affiliation(s)
- Cédric Bongard
- Service de pneumologie, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Juliana Rey Cobo
- Service de pneumologie, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Romain Messe
- Service de pneumologie, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Leslie Noirez
- Service de pneumologie, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Alban Lovis
- Service de pneumologie, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Thorsten Krueger
- Service de chirurgie thoracique, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Solange Peters
- Service d'oncologie, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Chiara Pozzessere
- Service de radiodiagnostique et radiologie interventionnelle, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Kevin Selby
- Département des policliniques, Unisanté, 1011 Lausanne
| | | |
Collapse
|
4
|
Ojanguren A, Parapanov R, Debonneville A, Lugrin J, Szabo C, Hasenauer A, Rosner L, Gonzalez M, Perentes JY, Krueger T, Liaudet L. Therapeutic reconditioning of damaged lungs by transient heat stress during ex vivo lung perfusion. Am J Transplant 2023; 23:1130-1144. [PMID: 37217006 DOI: 10.1016/j.ajt.2023.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/15/2023] [Accepted: 05/15/2023] [Indexed: 05/24/2023]
Abstract
Ex vivo lung perfusion (EVLP) may serve as a platform for the pharmacologic repair of lung grafts before transplantation (LTx). We hypothesized that EVLP could also permit nonpharmacologic repair through the induction of a heat shock response, which confers stress adaptation via the expression of heat shock proteins (HSPs). Therefore, we evaluated whether transient heat application during EVLP (thermal preconditioning [TP]) might recondition damaged lungs before LTx. TP was performed during EVLP (3 hours) of rat lungs damaged by warm ischemia by transiently heating (30 minutes, 41.5 °C) the EVLP perfusate, followed by LTx (2 hours) reperfusion. We also assessed the TP (30 minutes, 42 °C) during EVLP (4 hours) of swine lungs damaged by prolonged cold ischemia. In rat lungs, TP induced HSP expression, reduced nuclear factor κB and inflammasome activity, oxidative stress, epithelial injury, inflammatory cytokines, necroptotic death signaling, and the expression of genes involved in innate immune and cell death pathways. After LTx, heated lungs displayed reduced inflammation, edema, histologic damage, improved compliance, and unchanged oxygenation. In pig lungs, TP induced HSP expression, reduced oxidative stress, inflammation, epithelial damage, vascular resistance, and ameliorated compliance. Collectively, these data indicate that transient heat application during EVLP promotes significant reconditioning of damaged lungs and improves their outcomes after transplantation.
Collapse
Affiliation(s)
- Amaia Ojanguren
- Service of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland; Service of Thoracic Surgery, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - Roumen Parapanov
- Service of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland; Service of Adult Intensive Care Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Anne Debonneville
- Service of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland; Service of Adult Intensive Care Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Jérôme Lugrin
- Service of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland; Service of Adult Intensive Care Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Csaba Szabo
- Department of Pharmacology, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Arpad Hasenauer
- Service of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Lorenzo Rosner
- Service of Anesthesiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Michel Gonzalez
- Service of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Jean-Yannis Perentes
- Service of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Thorsten Krueger
- Service of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland.
| | - Lucas Liaudet
- Service of Adult Intensive Care Medicine, Lausanne University Hospital, Lausanne, Switzerland
| |
Collapse
|
5
|
Chriqui LE, Hao Y, Marie D, Gonzalez M, Krueger T, Meylan E, Joyce J, Cavin S, Perentes JY. Abstract 5152: Photodynamic therapy promotes immune infiltration and control of malignant pleural mesothelioma through NF-kB mediated upregulation of E-Selectin in the tumor vasculature. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-5152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Abstract
Introduction: Malignant pleural mesothelioma (MPM) is an aggressive cancer with limited treatment options. The application of photodynamic therapy (PDT) was shown to significantly improve patient survival. Previously, we found that low dose PDT (L-PDT) enhanced the immune infiltration of MPM and increased the impact of immune checkpoint inhibitors on tumor control. However, the mechanisms behind these observations are unknown. Here, in an orthotopic murine model of MPM, we show that L-PDT upregulates tumor vascular E-Selectin expression via NF-kB. This upregulation favors enhanced leukocyte trafficking and immune mediated MPM regression.
Methods: We analyzed adhesion molecules (E-Selectin, ICAM-1, VCAM-1) and canonical NF-kB activation (phosphorylated IκBα) protein levels in endothelial (ECRF-24) cells treated by L-PDT in the presence or absence of a NEMO/IKKγ siRNA in vitro. For in vivo validation, AB12-Luc MPM cells were grown in the pleural cavity of syngeneic BALB/c mice and treated with L-PDT (verteporfin 400 µg/kg, fluence 10 J/cm2, fluence rate 50 mW/cm2) alone or in presence of NF-kB or E-Selectin inhibitors (NEMO Binding Domain (NBD) peptide and E-Selectin blocking antibody respectively). For each treatment group, we determined the expression of endothelial adhesion molecules (E-Selectin, ICAM-1, VCAM-1) and the tumor immune infiltrate by immunohistochemistry and flow cytometry. In parallel, the impact of L-PDT on MPM growth and mouse survival were assessed in the presence of E-Selectin inhibition.
Results: L-PDT increased the levels of endothelial adhesion molecules E-Selectin, ICAM-1 and VCAM-1 9 to 24 hours after L-PDT treatment in vitro. This was preceded by an increase of IκBα phosphorylation. In the presence of NEMO siRNAs, the expression of NEMO/IKKγ was reduced and led to E-Selectin repression. In orthotopic MPM bearing mice, the treatment of MPM by L-PDT enhanced adhesion molecules expression in tumor vasculature at 24 hours. This correlated with increased infiltration of CD4+ and CD8+ granzyme B+ T-cells and improved tumor control and mouse survival. NF-kB inhibition impaired tumor vascular adhesion molecules upregulation and the recruitment of tumor infiltrating lymphocytes in MPM. The targeted inhibition of E-Selectin abrogated the immune infiltration and tumor regression of MPM following L-PDT, which ultimately decreased animal survival in our MPM model.
Conclusion: Low dose PDT relieves MPM tumor vascular anergy via NF-kB mediated adhesion molecules expression. Endothelial E-Selectin has been identified, in our MPM model, as a major determinant for L-PDT enhanced lymphocyte trafficking, tumor control and animal survival.
Citation Format: Louis-Emmanuel Chriqui, Yameng Hao, Damien Marie, Michel Gonzalez, Thorsten Krueger, Etienne Meylan, Johanna Joyce, Sabrina Cavin, Jean-Yannis Perentes. Photodynamic therapy promotes immune infiltration and control of malignant pleural mesothelioma through NF-kB mediated upregulation of E-Selectin in the tumor vasculature. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5152.
Collapse
Affiliation(s)
| | - Yameng Hao
- 2Ecole Polytechnique Fédérale de Lausanne, EPFL, Lausanne, Switzerland
| | - Damien Marie
- 1Lausanne University Hospital, Lausanne, Switzerland
| | | | | | | | | | - Sabrina Cavin
- 1Lausanne University Hospital, Lausanne, Switzerland
| | | |
Collapse
|
6
|
Hao Y, Gkasti A, Chriqui LE, Marie D, Gonzalez M, Krueger T, Peters S, Dyson PJ, Meylan E, Joyce J, Cavin S, Perentes JY. Abstract 6399: Hyperthermic intrathoracic chemotherapy (HITOC) improves malignant pleural mesothelioma control through a tumor specific cytotoxic immune response. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-6399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Abstract
Introduction: The management of malignant pleural mesothelioma (MPM) remains challenging with poor patient survival. Local therapies such as hyperthermic intrathoracic cisplatin (HITOC) have shown good tumor control in selected patients. HITOC was shown to increase MPM drug exposure while limiting systemic side effects but alternative mechanisms for HITOC are still lacking. Here, we hypothesized that HITOC induces an immune response directed against MPM which decreases cancer related mortality.
Methods: We implanted AB12-luc MPM cells in the pleural cavity of BALB/c mice. A chemotherapy perfusion circuit was downsized to administer cisplatin (80mg/m2 equivalent dose) in the thoracic cavity at normo (37°C, ITOC) or hyperthermic (39°C, HITOC) conditions for 30 minutes. Tumor growth (visualized by bioluminescence) and mouse survival were then assessed. We determined tumor platinum content and distribution by inductively coupled plasma mass spectrometry (ICP-MS) and by laser ablation ICP-MS (LA-ICP-MS) respectively. We also questioned the impact of (H)ITOC on the MPM immune microenvironment (innate and adaptive immune cells, activity and checkpoint expression) by 16-colour flow cytometry and immunohistochemistry. Finally, tumor response to (H)ITOC was assessed in BALB/c athymic mice implanted with AB12-luc cells.
Results: MPM tumor control and mouse survival were significantly improved by HITOC compared to controls (ITOC, saline 37 and 39°C). Tumor platinum content was significantly higher in HITOC compared to ITOC but was majorly located at the surface of tumors. HITOC enhanced MPM infiltration by CD8+Granzyme B+ T-cells and decreased the levels of MCHII−/CD80− (M2-like) macrophages compared to controls at day 7. Interestingly, immune checkpoint expression of PD1 and CTLA4 was significantly enhanced in CD8+ lymphocytes in HITOC treated MPM compared to controls at day 7. Finally, the lack of T lymphocytes (BALB/c athymic mice) abrogated the impact of HITOC on MPM control and mouse survival.
Conclusion: HITOC improves MPM control through a T lymphocyte immune mediated response. The enhanced immune checkpoint (PD1/CTLA4) expression in CD8+ lymphocytes opens perspectives for the combination of HITOC with immune checkpoint inhibitors.
Citation Format: Yameng Hao, Aspasia Gkasti, Louis-Emmanuel Chriqui, Damien Marie, Michel Gonzalez, Thorsten Krueger, Solange Peters, Paul J. Dyson, Etienne Meylan, Johanna Joyce, Sabrina Cavin, Jean Y. Perentes. Hyperthermic intrathoracic chemotherapy (HITOC) improves malignant pleural mesothelioma control through a tumor specific cytotoxic immune response. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 6399.
Collapse
Affiliation(s)
- Yameng Hao
- 1École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Aspasia Gkasti
- 1École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | | | - Damien Marie
- 2CHUV Lausanne University Hospital, Lausanne, Switzerland
| | | | | | - Solange Peters
- 2CHUV Lausanne University Hospital, Lausanne, Switzerland
| | - Paul J. Dyson
- 1École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | | | | | - Sabrina Cavin
- 2CHUV Lausanne University Hospital, Lausanne, Switzerland
| | | |
Collapse
|
7
|
Debonneville A, Parapanov R, Lugrin J, Gonzalez M, Perentes J, Liaudet L, Krueger T. Cell Death in Lung Transplantation. The Roles of Apoptosis, Necroptois, and Pyroptosis. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
|
8
|
Lugrin J, Parapanov R, Debonneville A, Arranz AO, Liaudet L, Krueger T. Thermal Preconditioning During EVLP Reduces T Lymphocytes and Increases Monocytes and Neutrophils Contents in the Perfusion Solution. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
|
9
|
Lugrin J, Parapanov R, Milano G, Cavin S, Debonneville A, Krueger T, Liaudet L. The systemic deletion of interleukin-1α reduces myocardial inflammation and attenuates ventricular remodeling in murine myocardial infarction. Sci Rep 2023; 13:4006. [PMID: 36899010 PMCID: PMC10006084 DOI: 10.1038/s41598-023-30662-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/27/2023] [Indexed: 03/12/2023] Open
Abstract
Myocardial inflammation following myocardial infarction (MI) is crucial for proper myocardial healing, yet, dysregulated inflammation may promote adverse ventricular remodeling and heart failure. IL-1 signaling contributes to these processes, as shown by dampened inflammation by inhibition of IL-1β or the IL-1 receptor. In contrast, the potential role of IL-1α in these mechanisms has received much less attention. Previously described as a myocardial-derived alarmin, IL-1α may also act as a systemically released inflammatory cytokine. We therefore investigated the effect of IL-1α deficiency on post-MI inflammation and ventricular remodeling in a murine model of permanent coronary occlusion. In the first week post-MI, global IL-1α deficiency (IL-1α KO mice) led to decreased myocardial expression of IL-6, MCP-1, VCAM-1, hypertrophic and pro-fibrotic genes, and reduced infiltration with inflammatory monocytes. These early changes were associated with an attenuation of delayed left ventricle (LV) remodeling and systolic dysfunction after extensive MI. In contrast to systemic Il1a-KO, conditional cardiomyocyte deletion of Il1a (CmIl1a-KO) did not reduce delayed LV remodeling and systolic dysfunction. In conclusion, systemic Il1a-KO, but not Cml1a-KO, protects against adverse cardiac remodeling after MI due to permanent coronary occlusion. Hence, anti-IL-1α therapies could be useful to attenuate the detrimental consequences of post-MI myocardial inflammation.
Collapse
Affiliation(s)
- J Lugrin
- Service of Adult Intensive Care Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
- Service of Thoracic Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
- Laboratoire de Chirurgie Thoracique, Centre des Laboratoires d'Epalinges, Chemin des Boveresses 155, 1066, Epalinges, Switzerland.
| | - R Parapanov
- Service of Adult Intensive Care Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Service of Thoracic Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - G Milano
- Department Coeur-Vaisseaux, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - S Cavin
- Service of Thoracic Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - A Debonneville
- Service of Thoracic Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - T Krueger
- Service of Thoracic Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - L Liaudet
- Service of Adult Intensive Care Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
10
|
Forster C, Abdelnour-Berchtold E, Bédat B, Perentes JY, Zellweger M, Sauvain MO, Christodoulou M, Triponez F, Karenovics W, Krueger T, Gonzalez M. Local control and short-term outcomes after video-assisted thoracoscopic surgery segmentectomy versus lobectomy for pT1c pN0 non-small-cell lung cancer. Interdiscip Cardiovasc Thorac Surg 2023; 36:7036337. [PMID: 36856745 PMCID: PMC9976754 DOI: 10.1093/icvts/ivad037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/19/2023] [Accepted: 02/10/2023] [Indexed: 02/15/2023]
Abstract
OBJECTIVES The aim of this study was to compare short-term outcomes and local control in pT1c pN0 non-small-cell lung cancer that were intentionally treated by video-assisted thoracoscopic surgery (VATS) lobectomy or segmentectomy. METHODS Multicentre retrospective study of consecutive patients undergoing VATS lobectomy (VL) or VATS segmentectomy (VS) for pT1c pN0 non-small-cell lung cancer from January 2014 to October 2021. Patients' characteristics, postoperative outcomes and survival were compared. RESULTS In total, 162 patients underwent VL (n = 81) or VS (n = 81). Except for age [median (interquartile range) 68 (60-73) vs 71 (65-76) years; P = 0.034] and past medical history of cancer (32% vs 48%; P = 0.038), there was no difference between VL and VS in terms of demographics and comorbidities. Overall 30-day postoperative morbidity was similar in both groups (34% vs 30%; P = 0.5). The median time for chest tube removal [3 (1-5) vs 2 (1-3) days; P = 0.002] and median postoperative length of stay [6 (4-9) vs 5 (3-7) days; P = 0.039] were in favour of the VS group. Significantly larger tumour size (mean ± standard deviation 25.1 ± 3.1 vs 23.6 ± 3.1 mm; P = 0.001) and an increased number of lymph nodes removal [median (interquartile range) 14 (9-23) vs 10 (6-15); P < 0.001] were found in the VL group. During the follow-up [median (interquartile range) 31 (14-48) months], no statistical difference was found for local and distant recurrence in VL groups (12.3%) and VS group (6.1%) (P = 0.183). Overall survival (80% vs 80%) was comparable between both groups (P = 0.166). CONCLUSIONS Despite a short follow-up, our preliminary data shows that local control is comparable for VL and VS.
Collapse
Affiliation(s)
- Céline Forster
- Department of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | | | - Benoît Bédat
- Department of Thoracic Surgery, University of Geneva (HUG), Geneva, Switzerland
| | - Jean Yannis Perentes
- Department of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Matthieu Zellweger
- Department of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Marc-Olivier Sauvain
- Department of General Surgery, Réseau Hospitalier Neuchâtelois (RHNe), Neuchâtel, Switzerland
| | - Michel Christodoulou
- Department of Thoracic Surgery, Réseau Santé du Valais Romand (RSVr), Sion, Switzerland
| | - Frédéric Triponez
- Department of Thoracic Surgery, University of Geneva (HUG), Geneva, Switzerland
| | - Wolfram Karenovics
- Department of Thoracic Surgery, University of Geneva (HUG), Geneva, Switzerland
| | - Thorsten Krueger
- Department of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Michel Gonzalez
- Corresponding author. Service of Thoracic Surgery, University Hospital of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland. Tel: +41-795563820; e-mail: (M. Gonzalez)
| |
Collapse
|
11
|
Le Reun E, Casutt A, Durham A, Bouchaab H, Romano E, Lovis A, Krueger T, Von Garnier C, Özsahin EM, Kinj R. Lung stereotactic radiation therapy: Intercomparison of irradiation devices in terms of outcome and predictive factors. Cancer Radiother 2023; 27:31-41. [PMID: 35965243 DOI: 10.1016/j.canrad.2022.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 04/07/2022] [Accepted: 05/17/2022] [Indexed: 02/06/2023]
Abstract
PURPOSE To compare three different radiotherapy devices able to perform pulmonary stereotactic radiotherapy: CyberKnife® (CK), Helical Tomotherapy® (HT), and volumetric modulated arc therapy (VMAT). This study aims to define the patients' outcome in terms of SBRT efficacy and toxicities depending of the device choice. MATERIALS AND METHODS We retrospectively analyzed the clinical, radiological, and dosimetric data of patients treated with lung SBRT between 2016 and 2020 at Lausanne University Hospital, using the Chi2 test for proportions, the t-test for means comparisons, the Kaplan-Meier method for survival, and the Log-rank test and Cox-regression for intergroups comparisons. RESULTS We identified 111 patients treated by either CK (59.9%), VMAT (38.0%), or HT (2.1%). Compared to other techniques, CK treated comparable gross tumor volume (GTV; 2.1 vs. 1.4cm3, P=0.84) with smaller planning treatment volume (PTV; 12.3 vs. 21.9cm3, P=0.013) and lower V5 (13.5 vs. 19.9cm3, P=0.002). Local control rates at 2years were not different whatever the irradiation device, respectively of 96.2% (range, 90.8-100) and 98.1% (range, 94.4-100), P=0.68. Toxicity incidence significantly increased with V5 value>17.2% (56.0 vs. 77.4%, P=0.021). CONCLUSION Compared to other SBRT techniques, CK treatments permitted to treat comparable GTV with reduced PTV and V5. Toxicity incidence was less frequent when reducing the V5. CK is particularly attractive in case of multiple courses of lung SBRT or lung reirradiation.
Collapse
Affiliation(s)
- E Le Reun
- Department of Radiation Oncology, University Hospital Center of Lausanne (CHUV), rue du Bugnon 46, 1011 Lausanne, Switzerland; Institut national de la santé et de la recherche médicale (Inserm), U1296 Research Unit « Radiations: Defense, Health and Environment », centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - A Casutt
- Division of Pulmonology, University Hospital Center of Lausanne (CHUV), rue du Bugnon 46, 1011 Lausanne, Switzerland; Lausanne University (UNIL), Lausanne, Switzerland
| | - A Durham
- Department of Radiation Oncology, University Hospital of Genève (HUG), rue Gabrielle-Perret-Gentil, 1205 Genève, Switzerland
| | - H Bouchaab
- Department of Medical Oncology, University Hospital Center of Lausanne (CHUV), rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - E Romano
- Department of Radiation Oncology, University Hospital Center of Lausanne (CHUV), rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - A Lovis
- Division of Pulmonology, University Hospital Center of Lausanne (CHUV), rue du Bugnon 46, 1011 Lausanne, Switzerland; Lausanne University (UNIL), Lausanne, Switzerland
| | - T Krueger
- Department of Thoracic Surgery, University Hospital Center of Lausanne (CHUV), rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - C Von Garnier
- Division of Pulmonology, University Hospital Center of Lausanne (CHUV), rue du Bugnon 46, 1011 Lausanne, Switzerland; Lausanne University (UNIL), Lausanne, Switzerland
| | - E M Özsahin
- Department of Radiation Oncology, University Hospital Center of Lausanne (CHUV), rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - R Kinj
- Department of Radiation Oncology, University Hospital Center of Lausanne (CHUV), rue du Bugnon 46, 1011 Lausanne, Switzerland.
| |
Collapse
|
12
|
Hasenauer A, Forster C, Hungerbühler J, Perentes JY, Abdelnour-Berchtold E, Koerfer J, Krueger T, Becce F, Gonzalez M. CT-Derived Sarcopenia and Outcomes after Thoracoscopic Pulmonary Resection for Non-Small Cell Lung Cancer. Cancers (Basel) 2023; 15:cancers15030790. [PMID: 36765748 PMCID: PMC9913444 DOI: 10.3390/cancers15030790] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023] Open
Abstract
We aimed to evaluate whether computed tomography (CT)-derived preoperative sarcopenia measures were associated with postoperative outcomes and survival after video-assisted thoracoscopic (VATS) anatomical pulmonary resection in patients with early-stage non-small cell lung cancer (NSCLC). We retrospectively reviewed all consecutive patients that underwent VATS anatomical pulmonary resection for NSCLC between 2012 and 2019. Skeletal muscle mass was measured at L3 vertebral level on preoperative CT or PET/CT scans to identify sarcopenic patients according to established threshold values. We compared postoperative outcomes and survival of sarcopenic vs. non-sarcopenic patients. A total of 401 patients underwent VATS anatomical pulmonary resection for NSCLC. Sarcopenia was identified in 92 patients (23%). Sarcopenic patients were predominantly males (75% vs. 25%; p < 0.001) and had a lower BMI (21.4 vs. 26.5 kg/m2; p < 0.001). The overall postoperative complication rate was significantly higher (53.2% vs. 39.2%; p = 0.017) in sarcopenic patients and the length of hospital stay was prolonged (8 vs. 6 days; p = 0.032). Two factors were associated with postoperative morbidity in multivariate analysis: BMI and American Society of Anesthesiologists score >2. Median overall survival was comparable between groups (41 vs. 46 months; p = 0.240). CT-derived sarcopenia appeared to have a small impact on early postoperative clinical outcomes, but no effect on overall survival after VATS anatomical lung resection for NSCLC.
Collapse
Affiliation(s)
- Arpad Hasenauer
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland
| | - Céline Forster
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland
| | - Johan Hungerbühler
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland
| | - Jean Yannis Perentes
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne (UNIL), 1011 Lausanne, Switzerland
| | | | - Joachim Koerfer
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland
| | - Thorsten Krueger
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne (UNIL), 1011 Lausanne, Switzerland
| | - Fabio Becce
- Faculty of Biology and Medicine, University of Lausanne (UNIL), 1011 Lausanne, Switzerland
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland
| | - Michel Gonzalez
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne (UNIL), 1011 Lausanne, Switzerland
- Correspondence: ; Tel.: +41-795-563-820; Fax: +41-213-142-358
| |
Collapse
|
13
|
Marro M, Leiva-Juárez MM, D'Ovidio F, Chan J, Van Raemdonck D, Ceulemans LJ, Moreno P, Kindelan AA, Krueger T, Koutsokera A, Ehrsam JP, Inci I, Yazicioglu A, Yekeler E, Boffini M, Brioude G, Thomas PA, Pizanis N, Aigner C, Schiavon M, Rea F, Anile M, Venuta F, Keshavjee S. Lung Transplantation for Primary Ciliary Dyskinesia and Kartagener Syndrome: A Multicenter Study. Transpl Int 2023; 36:10819. [PMID: 36865666 PMCID: PMC9970992 DOI: 10.3389/ti.2023.10819] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 02/02/2023] [Indexed: 02/16/2023]
Abstract
Primary ciliary dyskinesia, with or without situs abnormalities, is a rare lung disease that can lead to an irreversible lung damage that may progress to respiratory failure. Lung transplant can be considered in end-stage disease. This study describes the outcomes of the largest lung transplant population for PCD and for PCD with situs abnormalities, also identified as Kartagener's syndrome. Retrospectively collected data of 36 patients who underwent lung transplantation for PCD from 1995 to 2020 with or without SA as part of the European Society of Thoracic Surgeons Lung Transplantation Working Group on rare diseases. Primary outcomes of interest included survival and freedom from chronic lung allograft dysfunction. Secondary outcomes included primary graft dysfunction within 72 h and the rate of rejection ≥A2 within the first year. Among PCD recipients with and without SA, the mean overall and CLAD-free survival were 5.9 and 5.2 years with no significant differences between groups in terms of time to CLAD (HR: 0.92, 95% CI: 0.27-3.14, p = 0.894) or mortality (HR: 0.45, 95% CI: 0.14-1.43, p = 0.178). Postoperative rates of PGD were comparable between groups; rejection grades ≥A2 on first biopsy or within the first year was more common in patients with SA. This study provides a valuable insight on international practices of lung transplantation in patients with PCD. Lung transplantation is an acceptable treatment option in this population.
Collapse
Affiliation(s)
- Matteo Marro
- Division of Cardiac Surgery, University of Turin, Turin, Italy
| | - Miguel M Leiva-Juárez
- Division of Thoracic Surgery, Columbia University Medical Center, New York, NY, United States
| | - Frank D'Ovidio
- Division of Thoracic Surgery, Columbia University Medical Center, New York, NY, United States
| | - Justin Chan
- Toronto Lung Transplant Program, University Health Network, Toronto, ON, Canada
| | - Dirk Van Raemdonck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | | | - Paula Moreno
- Thoracic Surgery and Lung Transplantation Unit, University Hospital Reina Sofia, Cordoba, Spain
| | | | - Thorsten Krueger
- Division of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Angela Koutsokera
- Division of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Jonas Peter Ehrsam
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Ilhan Inci
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Alkin Yazicioglu
- Department of Thoracic Surgery, University of Health Sciences, Ankara, Türkiye
| | - Erdal Yekeler
- Department of Thoracic Surgery, University of Health Sciences, Ankara, Türkiye
| | - Massimo Boffini
- Division of Cardiac Surgery, University of Turin, Turin, Italy
| | - Geoffrey Brioude
- Division of Thoracic Surgery, University of Marseilles, Marseille, France
| | | | - Nikolaus Pizanis
- Department of Thoracic Surgery, University Hospital Essen, Essen, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery, University Hospital Essen, Essen, Germany
| | - Marco Schiavon
- Department of Cardio-Thoracic Surgery, Padua University Hospital, Padua, Italy
| | - Federico Rea
- Department of Cardio-Thoracic Surgery, Padua University Hospital, Padua, Italy
| | - Marco Anile
- Division of Thoracic Surgery, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Federico Venuta
- Division of Thoracic Surgery, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Shaf Keshavjee
- Toronto Lung Transplant Program, University Health Network, Toronto, ON, Canada
| |
Collapse
|
14
|
Ioakeim F, Mazza T, Casutt A, Balmpouzis Z, Lechartier B, Krueger T, Aubert JD, Berra G, Koutsokera A. [When to consider lung transplantation?]. Rev Med Suisse 2022; 18:2143-2149. [PMID: 36382974 DOI: 10.53738/revmed.2022.18.804.2143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Pulmonary transplantation remains the ultimate therapeutic option for selected patients with an advanced pulmonary disease and terminal respiratory insufficiency when all other therapeutic options have been exhausted. The optimal time-frame to proceed to a first discussion and evaluation about lung transplantation may be difficult to determine. This article describes the pathway of a patient towards lung transplantation and summarizes the criteria, which may help to timely identify eligibility for this therapeutic modality. We will focus mainly on the 2021 update of the International Society for Heart and Lung Transplantation (ISHLT) recommendations for the selection of lung transplant candidates.
Collapse
Affiliation(s)
- Foteini Ioakeim
- Service de pneumologie, Unité de transplantation pulmonaire, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Tina Mazza
- Service de médecine interne, Hôpitaux universitaires de Genève, 1211 Genève 14
- Service de pneumologie, Programme de transplantation pulmonaire, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Alessio Casutt
- Service de pneumologie, Unité de transplantation pulmonaire, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Zisis Balmpouzis
- Service de pneumologie, Unité de transplantation pulmonaire, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
- Unité de mucoviscidose adulte et CFTR-related disorders, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Benoit Lechartier
- Service de pneumologie, Unité de transplantation pulmonaire, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
- Consultation d'hypertension pulmonaire, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Thorsten Krueger
- Service de chirurgie thoracique, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - John-David Aubert
- Service de pneumologie, Unité de transplantation pulmonaire, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
- Consultation d'hypertension pulmonaire, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
- Centre de transplantation d'organes, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Gregory Berra
- Service de pneumologie, Programme de transplantation pulmonaire, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Angela Koutsokera
- Service de pneumologie, Unité de transplantation pulmonaire, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
- Unité de mucoviscidose adulte et CFTR-related disorders, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| |
Collapse
|
15
|
Perentes JY, Christodoulou M, Abdelnour-Berchtold E, Karenovics W, Gayet-Ageron A, Gonzalez M, Krueger T, Triponez F, Terrier P, Bédat B. Effectiveness of rib fixation compared to pain medication alone on pain control in patients with uncomplicated rib fractures: study protocol of a pragmatic multicenter randomized controlled trial-the PAROS study (Pain After Rib OSteosynthesis). Trials 2022; 23:732. [PMID: 36056421 PMCID: PMC9438257 DOI: 10.1186/s13063-022-06509-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 07/05/2022] [Indexed: 11/24/2022] Open
Abstract
Background Persistent pain and disability following rib fractures result in a large psycho-socio-economic impact for health-care system. Benefits of rib osteosynthesis are well documented in patients with flail chest that necessitates invasive ventilation. In patients with uncomplicated and simple rib fractures, indication for rib osteosynthesis is not clear. The aim of this trial is to compare pain at 2 months after rib osteosynthesis versus medical therapy. Methods This trial is a pragmatic multicenter, randomized, superiority, controlled, two-arm, not-blinded, trial that compares pain evolution between rib fixation and standard pain medication versus standard pain medication alone in patients with uncomplicated rib fractures. The study takes place in three hospitals of Thoracic Surgery of Western Switzerland. Primary outcome is pain measured by the brief pain inventory (BPI) questionnaire at 2 months post-surgery. The study includes follow-up assessments at 1, 2, 3, 6, and 12 months after discharge. To be able to detect at least 2 point-difference on the BPI between both groups (standard deviation 2) with 90% power and two-sided 5% type I error, 46 patients per group are required. Adjusting for 10% drop-outs leads to 51 patients per group. Discussion Uncomplicated rib fractures have a significant medico-economic impact. Surgical treatment with rib fixation could result in better clinical recovery of patients with uncomplicated rib fractures. These improved outcomes could include less acute and chronic pain, improved pulmonary function and quality of life, and shorter return to work. Finally, surgical treatment could then result in less financial costs. Trial registration ClinicalTrials.govNCT04745520. Registered on 8 February 2021.
Collapse
Affiliation(s)
- Jean Yaniss Perentes
- Unit of Thoracic and Endocrine Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | | | - Wolfram Karenovics
- Unit of Thoracic and Endocrine Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Angèle Gayet-Ageron
- CRC & Division of Clinical-Epidemiology, Department of Health and Community Medicine, University of Geneva & University Hospitals of Geneva, Geneva, Switzerland
| | - Michel Gonzalez
- Unit of Thoracic and Endocrine Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Thorsten Krueger
- Unit of Thoracic and Endocrine Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Frédéric Triponez
- Unit of Thoracic and Endocrine Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Philippe Terrier
- Unit of Thoracic and Endocrine Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland. .,Haute-Ecole Arc Santé, HES-SO University of Applied Sciences and Arts Western Switzerland, Neuchâtel, Switzerland.
| | - Benoît Bédat
- Unit of Thoracic and Endocrine Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| |
Collapse
|
16
|
Hasenauer A, Hungerbühler J, Perentes J, Abdelnour E, Koerfer J, Forster C, Krueger T, Becce F, Gonzalez M. CT-based sarcopenia and outcomes in patients undergoing VATS anatomical resection for NSCLC. Br J Surg 2022. [DOI: 10.1093/bjs/znac185.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Objective
Sarcopenia is defined by a progressive loss of skeletal muscle mass and strength, combined with muscle fatty infiltration. Lung cancer patients frequently suffer from sarcopenia which may be associated with poorer post-operative outcomes. The aim of this study is to evaluate whether preoperative CT-based sarcopenia was associated with postoperative outcomes and survival after VATS resections in patients with early-stage non-small cell lung cancer (NSCLC).
Methods
We retrospectively reviewed all consecutive patients that underwent anatomical resection for NSCLC between 2012 and 2019. The skeletal muscle index (SMI) and muscle quality (SMRA and IMAT) were measured at the L3 vertebral level on preoperative CT or PET/CT scans. We used the following SMI cut-off values for sarcopenia: 52.4 cm2 /m2 for men and 38.5 cm2 /m2 for women.
Results
In total, 401 patients (sex ratio F/M: 173/228, mean age: 67 +/- 9.3 years) underwent VATS lobectomies (n=304) and segmentectomies (n=97) for NSCLC. Overall morbidity and mortality were 42.4% and 0.2%, respectively. The median length of stay was 7 days (IQR: 4–10). Sarcopenia was identified in 92 patients (23%). Patients with sarcopenia were predominantly males (75% vs 25%, p<0.001) and had lower BMI (21.4 vs 26.5, p<0.001). Patients with sarcopenia presented significantly increased morbidity (53.2% vs 39.2%, p=0.017) and had longer lengths of stay (6 vs 8 days, p=0.032). However, only lower BMI and ASA score >2 remained associated with increased morbidity on multivariate analysis. The median overall survival was comparable between patients with sarcopenia and those without sarcopenia (41 vs. 46 months, p=0.240).
Conclusion
Based on CT assessment alone, preoperative sarcopenia appeared to have little impact on postoperative clinical outcomes or overall survival in patients undergoing VATS pulmonary resection. Further studies should also consider muscle strength and physical performance, in addition to CT imaging, for preoperative risk assessment.
Collapse
Affiliation(s)
- A Hasenauer
- Department of Thoracic Surgery, Lausanne University Hospital , Lausanne, Switzerland
| | - J Hungerbühler
- Department of Thoracic Surgery, Lausanne University Hospital , Lausanne, Switzerland
| | - J Perentes
- Department of Thoracic Surgery, Lausanne University Hospital , Lausanne, Switzerland
| | - E Abdelnour
- Department of Thoracic Surgery, Lausanne University Hospital , Lausanne, Switzerland
| | - J Koerfer
- Department of Radiology, Lausanne University Hospital , Lausanne, Switzerland
| | - C Forster
- Department of Thoracic Surgery, Lausanne University Hospital , Lausanne, Switzerland
| | - T Krueger
- Department of Thoracic Surgery, Lausanne University Hospital , Lausanne, Switzerland
| | - F Becce
- Department of Radiology, Lausanne University Hospital , Lausanne, Switzerland
| | - M Gonzalez
- Department of Thoracic Surgery, Lausanne University Hospital , Lausanne, Switzerland
| |
Collapse
|
17
|
Forster C, Hasenauer A, Perentes JY, Abdelnour-Berchtold E, Zellweger M, Krueger T, Gonzalez M. Is faster better? Impact of operative time on postoperative outcomes after VATS anatomical pulmonary resection. J Thorac Dis 2022; 14:1980-1989. [PMID: 35813729 PMCID: PMC9264101 DOI: 10.21037/jtd-21-1774] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 04/21/2022] [Indexed: 12/03/2022]
Abstract
Background Video-assisted thoracic surgery (VATS) is now the preferred approach for standard anatomical pulmonary resections. This study evaluates the impact of operative time (OT) on post-operative outcomes after VATS anatomical pulmonary resection for non-small cell lung cancer (NSCLC). Methods We retrospectively reviewed all consecutive patients undergoing VATS lobectomy or segmentectomy for NSCLC between November 2010 and December 2019. Postoperative outcomes were compared between short (<150 minutes) and long (≥150 minutes) OT groups. A multivariable analysis was performed to identify predictors of long OT and overall post-operative complications. Results A total of 670 patients underwent lobectomy (n=496, 74%) or segmentectomy (n=174, 26%) for NSCLC. Mediastinal lymph node dissection was performed in 621 patients (92.7%). The median OT was 141 minutes (SD: 47 minutes) and 387 patients (57.8%) were operated within 150 minutes. Neoadjuvant chemotherapy was given in 25 patients (3.7%). Conversion thoracotomy was realized in 40 patients (6%). Shorter OT was significantly associated with decreased post-operative overall complication rate (30% vs. 41%; P=0.003), shorter median length of drainage (3 vs. 4 days; P<0.001) and shorter median length of hospital stay (6 vs. 7 days; P<0.001). On multivariable analysis, long OT (≥150 minutes) (OR 1.64, P=0.006), ASA score >2 (OR 1.87, P=0.001), FEV1 <80% (OR 1.47, P=0.046) and DLCO <80% (OR 1.5, P=0.045) were significantly associated with postoperative complications. Two predictors of long OT were identified: neoadjuvant chemotherapy (OR 3.11, P=0.01) and lobectomy (OR 1.5, P=0.032). Conclusions A prolonged OT is significantly associated with postoperative complications in our collective of patients undergoing VATS anatomical pulmonary resection.
Collapse
Affiliation(s)
- Céline Forster
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Arpad Hasenauer
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Jean Yannis Perentes
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
| | | | - Matthieu Zellweger
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Thorsten Krueger
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Michel Gonzalez
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
| |
Collapse
|
18
|
Forster C, Abdelnour-Berchtold E, Bédat B, Perentes JY, Sauvain MO, Christodoulou M, Triponez F, Karenovics W, Krueger T, Gonzalez M. Local control and short-term outcomes after VATS segmentectomy vs lobectomy for pT1c pN0 NSCLC (2–3 cm). Br J Surg 2022. [DOI: 10.1093/bjs/znac185.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Objective
Pulmonary segmentectomy has shown comparable oncological results to lobectomy for non-small cell lung cancers (NSCLC) of less than 2 cm. However, controversy remains for tumors of larger size. The aim of this study was to compare short-term outcomes and local control in pT1c pN0 NSCLC that were intentionally treated by VATS segmentectomy or lobectomy.
Methods
Multicenter retrospective study from January 2014 to October 2021 of 162 consecutive patients undergoing complete (R0) anatomical resections for pT1c pN0 NSCLC. Two groups, VATS lobectomy (VL) or VATS segmentectomy (VS) were defined according to the extension of the resection. Patients’ characteristics, postoperative outcomes and survival were compared.
Results
In total, 162 patients underwent VL (n=81) or VS (n=81). Except for age (median of 68 vs 71 years, p=0.034) and past medical history of cancer (32% vs 48%, p=0.038), there was no difference between VL and VS in terms of demographics and comorbidities (table1). Segmentectomies were performed in upper lobes in 68% and single segments represented 46% of all cases. Conversion thoracotomy rate was 5% in both groups. Morbidity were similar in both groups (34% vs 30%, p=0.5). The median time for chest tube removal (3 vs 2 days, p=0.002) and median LOS (6 vs 5 days, p=0.039) were in favor of the VS group. Significantly larger tumor (25 mm vs 23.5 mm p=0.001) and an increased number of lymph nodes removal (median 14 vs 10, p<0.001) were found in the VL group. During the follow-up (median: 31 months), no statistical difference was found for local and distant recurrence in VL groups (12.3%) and VS group (6.2%) (p=0.414). Overall survival was comparable in-between both groups (p=0.166).
Conclusion
Despite a short follow-up, our preliminary data shows that local control is comparable for VATS lobectomy and VATS segmentectomy. Further prospective randomized trials are needed to corroborate these results.
Collapse
Affiliation(s)
- C Forster
- Lausanne University Hospital Department of Thoracic Surgery, , Lausanne, Switzerland
| | - E Abdelnour-Berchtold
- Lausanne University Hospital Department of Thoracic Surgery, , Lausanne, Switzerland
| | - B Bédat
- Geneva University Hospital Department of Thoracic Surgery, , Geneva, Switzerland
| | - J Y Perentes
- Lausanne University Hospital Department of Thoracic Surgery, , Lausanne, Switzerland
| | - M-O Sauvain
- Hospital of Neuchâtel Department of General Surgery, , Neuchâtel, Switzerland
| | - M Christodoulou
- Hospital of Sion Department of General Surgery, , Sion, Switzerland
| | - F Triponez
- Geneva University Hospital Department of Thoracic Surgery, , Geneva, Switzerland
| | - W Karenovics
- Geneva University Hospital Department of Thoracic Surgery, , Geneva, Switzerland
| | - T Krueger
- Lausanne University Hospital Department of Thoracic Surgery, , Lausanne, Switzerland
| | - M Gonzalez
- Lausanne University Hospital Department of Thoracic Surgery, , Lausanne, Switzerland
| |
Collapse
|
19
|
Gattlen C, Chriqui LE, Hao Y, Gonzalez M, Krueger T, Siankevich S, Dyson P, Cavin S, Perentes JY. The Prembion® pre-biotic improves the impact of anti-CTLA4 immune checkpoint inhibitor in a murine model of malignant pleural mesothelioma. Br J Surg 2022. [DOI: 10.1093/bjs/znac185.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Objective
Immune checkpoint inhibition (ICI) therapy has revolutionized the outcome of certain cancers such as malignant pleural mesothelioma (MPM). However, patient responsiveness to this treatment remains unpredictable. Recently, a role for the gut microbiota composition has emerged for patients to generate a robust immune response against their tumors, following immunotherapy. Here, we studied the impact of Prembion®, a pre-biotic and modulator of the gut microbiota, on tumor control and lymphocyte infiltration in a murine MPM model treated by ICI.
Methods
Prembion® (diluted into drinking water) was administrated to BALBc mice for 14 days. These animals were then inoculated orthotopically with a syngeneic MPM cell line (AB12-luc cells injected in the pleura) and followed by bioluminescence imaging. We determined the tumor growth and mouse survival in different groups: untreated control, Prembion®, IgG control, anti-PDL-1, anti-CTLA4, Prembion®+anti-PDL-1 and Prembion®+anti-CTLA4. A correlation between tumor response/animal survival and MPM infiltration with CD8+ lymphocytes was also performed by immunohistochemistry.
Results
Prembion® was well tolerated and did not affect animal weight or activity. Interestingly, Prembion® was as effective as anti-PDL1 and anti-CTLA4 monotherapy on tumor control, prolonging survival by 4.0 ± 1.1 days compared to controls (p<0.05). Moreover Prembion® potentiated anti-CTLA4 efficacy with a significant improvement in mouse survival of the Prembion®+anti-CTLA4 compared to controls (3.6 ± 1.1 days, p<0.05). Additionally, this finding correlated with enhanced MPM infiltration by CD8+ lymphocytes compared to controls (p<0.05).
Conclusion
Prembion® positively regulated the adaptive immune response against MPM and helped to improve the impact of anti-CTLA4 ICI on MPM. Further work focusing on the gut microbiome changes induced by Prembion® are ongoing to better understand the mechanisms involved.
Collapse
Affiliation(s)
- C Gattlen
- Department of Thoracic Surgery, Lausanne University Hospital , Lausanne, Switzerland
| | - L-E Chriqui
- Department of Thoracic Surgery, Lausanne University Hospital , Lausanne, Switzerland
| | - Y Hao
- Institute of Chemical Sciences and Engineering , Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - M Gonzalez
- Department of Thoracic Surgery, Lausanne University Hospital , Lausanne, Switzerland
| | - T Krueger
- Department of Thoracic Surgery, Lausanne University Hospital , Lausanne, Switzerland
| | - S Siankevich
- Embion Technologies, Embion Technologies , Etoy, Switzerland
| | - P Dyson
- Institute of Chemical Sciences and Engineering , Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - S Cavin
- Department of Thoracic Surgery, Lausanne University Hospital , Lausanne, Switzerland
| | - J-Y Perentes
- Department of Thoracic Surgery, Lausanne University Hospital , Lausanne, Switzerland
| |
Collapse
|
20
|
Lugrin J, Debonneville A, Ojanguren A, Hasenauer A, Parapanov R, Gonzalez M, Perentes J, Liaudet L, Krueger T. Cell death in lung transplantation. The roles of apoptosis, necroptois, and pyroptosis. Br J Surg 2022. [DOI: 10.1093/bjs/znac176.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Objective
For patients with end stage lung disease, lung transplantation (Ltx) is the unique treatment option. Nevertheless, a large number of lung allografts fail, because of acute or chronic rejection. Innate immune responses following Ltx play a critical role in the development of primary graft dysfunction, and ultimately promote the development of chronic lung allograft dysfunction, leading to increased mortality after lung transplantation. Here, we focus on the mechanisms responsible for disruption of the cells membranes integrity, resulting in the release of Damage Associated Molecular Patterns (DAMPs) and activation of cell death pathways triggering cell injury in lungs with different preservation status.
Methods
Rat lungs were exposed to cold ischemia (CI group, n=9) or warm ischemia (WI group, n=9). In CI group, after Perfadex flushing, and hypothermic preservation (4 h) left lung was transplanted. In WI group, after 1 h of in situ WI, flashing and 3 h cold preservation the left lung was transplanted. Lung mechanics were determined during reperfusion. Recipients were sacrificed at 30, 60 and 120 min after Ltx. Bronchoalveolar lavage (BAL) was performed on the grafts to measure markers of cellular injury, and cytokines. Cell death markers were determined in graft tissue. Biological samples were kept at -80°C for additional analysis.
Results
Compared to CI, WI group displayed significantly decreased graft function associated with increased activation of pyroptotic cell death (NLRP3, caspase1, IL-1β) pathway, whereas apoptotic (caspas3 and caspase7) and necroptotic (RIP1, RIP3, MLKL) cell death pathways activation were similar in both groups. WI group showed more important cellular damage with DAMPs release (LDH, sRAGE, HMGB) and inflammation (CXCL1, IL1-β, IL-33).
Conclusion
Our results suggest that pyroptosis could play a critical role in the development of early graft dysfunction in lungs subjected to warm ischemia. Inhibition of pyroptotic pathway could be a strategy to improve damaged donor lungs.
Collapse
Affiliation(s)
- J Lugrin
- Department of Thoracic Surgery, Lausanne University Hospital , Lausanne, Switzerland
| | - A Debonneville
- Department of Thoracic Surgery, Lausanne University Hospital , Lausanne, Switzerland
| | - A Ojanguren
- Department of Thoracic Surgery, Lausanne University Hospital , Lausanne, Switzerland
| | - A Hasenauer
- Department of Thoracic Surgery, Lausanne University Hospital , Lausanne, Switzerland
| | - R Parapanov
- Department of Thoracic Surgery, Lausanne University Hospital , Lausanne, Switzerland
| | - M Gonzalez
- Department of Thoracic Surgery, Lausanne University Hospital , Lausanne, Switzerland
| | - J Perentes
- Department of Thoracic Surgery, Lausanne University Hospital , Lausanne, Switzerland
| | - L Liaudet
- Department of Adult intensive care medicine, Lausanne University Hospital , Lausanne, Switzerland
| | - T Krueger
- Department of Thoracic Surgery, Lausanne University Hospital , Lausanne, Switzerland
| |
Collapse
|
21
|
Chriqui LE, Hao Y, Ortolini ME, Gattlen C, Gonzalez M, Krueger T, Perentes JY, Cavin S. Photodynamique therapy relieves tumor vascular anergy and promotes immune cell trafficking in an orthotopic mouse model of malignant pleural mesothelioma. Br J Surg 2022. [DOI: 10.1093/bjs/znac185.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Objective
Malignant pleural mesothelioma (MPM) is a deadly disease with limited treatment options. Recently, dual immune checkpoint inhibition therapy (ICI) showed improved patient survival. However, only a fraction of patients were responsive to immunotherapy. One potential mechanism of MPM resistance to ICIs could be their endothelial anergy that hampers leukocyte trafficking to the tumor bulk. Here, we hypothesized that vascular-targeted low dose photodynamic therapy (L-PDT), treatment of MPM could relieve tumor endothelial anergy and improve immunotherapy efficacy.
Methods
Using an orthotopic syngeneic MPM murine model (AB12 cells injected in the pleura of BALB/c mice), we determined the impact of L-PDT on the endothelial expression of E-Selectin, a key molecule involved in leukocyte diapedesis by immunohistochemistry. Furthermore, to confirm the role of E-selectin, we determined the extravasation of effector T cells (CD8+/CD4+) by immunostaining in L-PDT treated tumors in the presence or absence of an E-selectin blocking antibody. Finally, we assessed tumor growth/survival of our MPM murine model treated with L-PDT alone or combined to ICIs.
Results
L-PDT pre-treatment enhanced MPM endothelial E-Selectin expression in vivo. The latter was associated with increased CD4+ and CD8+ lymphocyte infiltration of MPM following L-PDT which did not occur after E-Selectin blockade. Also, L-PDT pre-treatment of MPM influenced favorably tumor control, mouse survival and the impact of ICIs compared to controls.
Conclusion
L-PDT pre-treatment relieves endothelial anergy in MPM which improves antitumor immunity and response to ICI. This approach could constitute a promising pre-treatment option, in combination with ICIs, for the management of this deadly disease.
Collapse
Affiliation(s)
- L E Chriqui
- Department of Thoracic Surgery, Lausanne University Hospital , Lausanne, Switzerland
| | - Y Hao
- Institute of Chemical Sciences and Engineering , Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - M E Ortolini
- Department of Thoracic Surgery, Lausanne University Hospital , Lausanne, Switzerland
| | - C Gattlen
- Department of Thoracic Surgery, Lausanne University Hospital , Lausanne, Switzerland
| | - M Gonzalez
- Department of Thoracic Surgery, Lausanne University Hospital , Lausanne, Switzerland
| | - T Krueger
- Department of Thoracic Surgery, Lausanne University Hospital , Lausanne, Switzerland
| | - J-Y Perentes
- Department of Thoracic Surgery, Lausanne University Hospital , Lausanne, Switzerland
| | - S Cavin
- Department of Thoracic Surgery, Lausanne University Hospital , Lausanne, Switzerland
| |
Collapse
|
22
|
Nosotti M, Leiva-Juarez M, D'Ovidio F, Van Raemdonck D, Ceulemans L, Keshavjee S, Rackauskas M, Paladini P, Luzzi L, Casado PM, Alvarez A, Inci I, Ehrsam J, Krueger T, Roth A, Rea F, Schiavon M, Rosso L. Survival After Lung Transplantation for Chronic Hypersensitivity Pneumonitis: Results From a Large International Cohort Study. Transpl Int 2022; 35:10450. [PMID: 35431638 PMCID: PMC9008138 DOI: 10.3389/ti.2022.10450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 03/03/2022] [Indexed: 11/13/2022]
Abstract
Repeated exposure to antigens via inhalation is the primary cause of hypersensitivity pneumonitis, a form of interstitial pneumonia. The chronic form of hypersensitivity pneumonitis leads to progressive loss of respiratory function; lung transplantation is the only therapeutic option for chronically ill patients. The ESTS Lung Transplantation Working Group conducted a retrospective multicentred cohort study to increase the body of knowledge available on this rare indication for lung transplantation. Data were collected for every patient who underwent lung transplant for hypersensitivity pneumonitis in participating centres between December 1996 and October 2019. Primary outcome was overall survival; secondary outcome was freedom from chronic lung allograft dysfunction. A total of 114 patients were enrolled from 9 centres. Almost 90% of patients were diagnosed with hypersensitivity pneumonitis before transplantation, yet the antigen responsible for the infection was identified in only 25% of cases. Eighty per cent of the recipients received induction therapy. Survival at 1, 3, and 5 years was 85%, 75%, and 70%, respectively. 85% of the patients who survived 90 days after transplantation were free from chronic lung allograft dysfunction after 3 years. The given study presents a large cohort of HP patients who underwent lung transplants. Overall survival rate is higher in transplanted hypersensitivity pneumonitis patients than in those suffering from any other interstitial lung diseases. Hypersensitivity pneumonitis patients are good candidates for lung transplantation.
Collapse
Affiliation(s)
- Mario Nosotti
- Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Miguel Leiva-Juarez
- Department of Surgery, Columbia University Medical Center, New York, NY, United States
| | - Frank D'Ovidio
- Department of Surgery, Columbia University Medical Center, New York, NY, United States
| | - Dirk Van Raemdonck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Laurens Ceulemans
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Shaf Keshavjee
- Toronto Lung Transplant Program, University Health Network, Toronto, ON, Canada
| | | | - Piero Paladini
- Thoracic Surgery, University Hospital of Siena (AOUS), Siena, Italy
| | - Luca Luzzi
- Thoracic Surgery, University Hospital of Siena (AOUS), Siena, Italy
| | - Paula Moreno Casado
- Division of Thoracic Surgery and Lung Transplantation, Reina Sofia University Hospital, Córdoba, Spain
| | - Antonio Alvarez
- Division of Thoracic Surgery and Lung Transplantation, Reina Sofia University Hospital, Córdoba, Spain
| | - Ilhan Inci
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Jonas Ehrsam
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Thorsten Krueger
- Department of Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Andrey Roth
- Department of Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Federico Rea
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital, Padova, Italy
| | - Marco Schiavon
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital, Padova, Italy
| | - Lorenzo Rosso
- Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| |
Collapse
|
23
|
Debonneville A, Parapanov R, Lugrin J, Ojanguren A, Letovanec I, Gonzalez M, Perentes J, Liaudet L, Krueger T. Lung Function and Inflammatory Profiling of Damaged Rat Donor Lungs Following EVLP Thermal Preconditioning. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
24
|
Furrer K, Weder W, Eboulet EI, Betticher D, Pless M, Stupp R, Krueger T, Perentes JY, Schmid RA, Lardinois D, Furrer M, Früh M, Peters S, Curioni-Fontecedro A, Stahel RA, Rothschild SI, Hayoz S, Opitz I. Extended resection for potentially operable stage III NSCLC patients after neoadjuvant treatment. J Thorac Cardiovasc Surg 2022; 164:1587-1602.e5. [DOI: 10.1016/j.jtcvs.2022.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 03/01/2022] [Accepted: 03/12/2022] [Indexed: 11/16/2022]
|
25
|
Debonneville A, Parapanov R, Lugrin J, Ojanguren A, Letovanec I, Gonzalez M, Perentes J, Liaudet L, Krueger T. Lung Function and Inflammatory Profiling of Damaged Rat Donor Lungs Following EVLP Heat Stress with Different Temperatures. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
26
|
Federici S, Bédat B, Hayau J, Gonzalez M, Triponez F, Krueger T, Karenovics W, Perentes JY. Outcome of parapneumonic empyema managed surgically or by fibrinolysis: a multicenter study. J Thorac Dis 2022; 13:6381-6389. [PMID: 34992818 PMCID: PMC8662487 DOI: 10.21037/jtd-21-1083] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/16/2021] [Indexed: 11/21/2022]
Abstract
Background Parapneumonic empyema (PPE) management remains debated. Here we present the outcome of a comparable population with PPE treated over a 4-year period in two Thoracic Surgery University Centers with different approaches: one with an early “surgical” and the other with a “fibrinolytic” approach. Methods All operable patients with PPE managed in both centers between January 2014 and January 2018 were reviewed. Patients with persistent pleural effusion/loculations following drainage were managed by a “surgical” approach in one center and by “fibrinolytic” approach in the other. For each patient, we recorded the age, sex, hospital stay, morbidity/mortality and change in pleural opacity on chest X-ray before and at the end of the treatment. Results During the study period, 66 and 93 patients underwent PPE management in the “surgical” and “fibrinolytic” centers respectively. The population characteristics were comparable. Infection was controlled in all patients. In the “fibrinolytic” group, 20 patients (21.5%) underwent an additional drain placement while 12 patients (12.9%) required surgery to correct PPE. In the “surgical” group, 4 patients (6.1%) developed postoperative arrhythmia while 2 patients (3%) underwent a second surgery to evacuate a hemothorax. Median drainage {3 [2–4] vs. 5 [4–7] days} and hospital {7 [5–10] vs. 11 [7–19] days} durations were significantly lower in the “surgical” compared to the “fibrinolytic” center. Pleural opacity regression with therapy was significantly more important in the “surgical” compared to the “fibrinolytic” group (−22%±18% vs. −16%±17%, P=0.035). Conclusions Surgical management of PPE was associated with shorter chest tube and hospital duration and better pleural space control. Prospective randomized studies are mandatory.
Collapse
Affiliation(s)
- Sara Federici
- Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.,University Center of Thoracic Surgery of Western Switzerland, Switzerland
| | - Benoit Bédat
- University Center of Thoracic Surgery of Western Switzerland, Switzerland.,Division of Thoracic and Endocrine Surgery, University Hospital of Geneva, Geneva, Switzerland
| | - Justine Hayau
- Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.,University Center of Thoracic Surgery of Western Switzerland, Switzerland
| | - Michel Gonzalez
- Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.,University Center of Thoracic Surgery of Western Switzerland, Switzerland
| | - Frederic Triponez
- University Center of Thoracic Surgery of Western Switzerland, Switzerland.,Division of Thoracic and Endocrine Surgery, University Hospital of Geneva, Geneva, Switzerland
| | - Thorsten Krueger
- Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.,University Center of Thoracic Surgery of Western Switzerland, Switzerland
| | - Wolfram Karenovics
- University Center of Thoracic Surgery of Western Switzerland, Switzerland.,Division of Thoracic and Endocrine Surgery, University Hospital of Geneva, Geneva, Switzerland
| | - Jean Y Perentes
- Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.,University Center of Thoracic Surgery of Western Switzerland, Switzerland
| |
Collapse
|
27
|
Bédat B, Koliakos E, Demarchi MS, Perentes J, Licker MJ, Triponez F, Krueger T, Karenovics W, Gonzalez M. OUP accepted manuscript. Interact Cardiovasc Thorac Surg 2022; 35:6528414. [PMID: 35157073 PMCID: PMC9252121 DOI: 10.1093/icvts/ivac039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 01/31/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Benoît Bédat
- Service of Thoracic Surgery, University Hospital of Lausanne, Lausanne, Switzerland
- Division of Thoracic and Endocrine Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
- Corresponding author. Division of thoracic and endocrine surgery, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland. Tel: 079553-04-42; e-mail: (B. Bédat)
| | - Evangelos Koliakos
- Service of Thoracic Surgery, University Hospital of Lausanne, Lausanne, Switzerland
| | - Marco S Demarchi
- Division of Thoracic and Endocrine Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Jean Perentes
- Service of Thoracic Surgery, University Hospital of Lausanne, Lausanne, Switzerland
| | - Marc-Joseph Licker
- Division of Anesthesiology, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Frédéric Triponez
- Division of Thoracic and Endocrine Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Thorsten Krueger
- Service of Thoracic Surgery, University Hospital of Lausanne, Lausanne, Switzerland
| | - Wolfram Karenovics
- Division of Thoracic and Endocrine Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Michel Gonzalez
- Service of Thoracic Surgery, University Hospital of Lausanne, Lausanne, Switzerland
| |
Collapse
|
28
|
Forster C, Ojanguren A, Perentes JY, Zellweger M, Krueger T, Abdelnour-Berchtold E, Gonzalez M. Survival prognostic and recurrence risk factors after single pulmonary metastasectomy. J Cardiothorac Surg 2021; 16:357. [PMID: 34961544 PMCID: PMC8713404 DOI: 10.1186/s13019-021-01740-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 12/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background Identification of the prognostic factors of recurrence and survival after single pulmonary metastasectomy (PM). Methods Retrospective analysis of all consecutive patients who underwent PM for a single lung metastasis between 2003 and 2018. Results A total of 162 patients with a median age of 64 years underwent single PM. Video-Assisted Thoracic Surgery (VATS) was performed in 83.9% of cases. Surgical resection was achieved by wedge in 73.5%, segmentectomy in 7.4%, lobectomy in 17.9% and pneumonectomy in 1.2% of cases. The median durations of hospital stay and of drainage were 4 days (IQR 3–7) and 1 day (IQR 1–2), respectively. During the follow-up (median 31 months; IQR 15–58), 93 patients (57.4%) presented recurrences and repeated PM could be realized in 35 patients (21.6%) achieved by VATS in 77.1%. Non-colorectal tumour (HR 1.84), age < 70 years (HR 1.77) and previous extra-thoracic metastases (HR 1.61) were identified as prognostic factors of recurrence. Overall survival at 5-year was estimated at 67%. Non-colorectal tumour (HR 2.40) and mediastinal lymph nodes involvement (HR 3.42) were significantly associated with an increased risk of death. Conclusions Despite high recurrence rates after PM, surgical resection shows low morbidity rate and acceptable long-term survival, thus should remain the standard treatment for single pulmonary metastases. Trial registration: The Local Ethics Committee approved the study (No. 2019–02,474) and individual consent was waived.
Collapse
Affiliation(s)
- Céline Forster
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Amaya Ojanguren
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Jean Yannis Perentes
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Rue du Bugnon 21, 1011, Lausanne, Switzerland
| | - Matthieu Zellweger
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Thorsten Krueger
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Rue du Bugnon 21, 1011, Lausanne, Switzerland
| | - Etienne Abdelnour-Berchtold
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Michel Gonzalez
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland. .,Faculty of Biology and Medicine, University of Lausanne (UNIL), Rue du Bugnon 21, 1011, Lausanne, Switzerland.
| |
Collapse
|
29
|
Chriqui LE, Forster C, Lovis A, Bouchaab H, Krueger T, Perentes JY, Gonzalez M. Is sleeve lobectomy safe after induction therapy?-a systematic review and meta-analysis. J Thorac Dis 2021; 13:5887-5898. [PMID: 34795937 PMCID: PMC8575812 DOI: 10.21037/jtd-21-939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/06/2021] [Indexed: 11/06/2022]
Abstract
Background Sleeve lobectomy (SL) is a lung-sparing procedure, which is accepted as a valid operation for centrally-located advanced tumors. These tumors often require induction treatment by chemotherapy and/or radiotherapy to downstage the disease and thus facilitate subsequent surgery. However, induction therapy may potentially increase the risk of bronchial anastomotic complications and related morbidity. This meta-analysis aims to determine the impact of induction therapy on the outcomes of pulmonary SL. Methods We compared studies of patients undergoing SL or bilobectomy for non-small cell lung cancer (NSCLC) with and without induction therapy. Outcomes of interest were in-hospital mortality, morbidity, anastomosis complication and 5-year survival. Odds ratio (OR) were computed following the Mantel-Haenszel method. Results Ten studies were included for a total of 1,204 patients. There was no statistical difference for between patients who underwent induction therapy followed by surgery and patients who underwent surgery alone in term of post-operative mortality (OR: 1.80, 95% confidence interval (CI): 0.76-4.25, P value =0.19) and morbidity (OR: 1.17, 95% CI: 0.90-1.52, P value =0.237). Anastomosis related complications rate were 5.2% and appears increased after induction therapy with a statistical difference close to the significance (OR: 1.65, 95% CI: 0.97-2.83, P value =0.06). Patients undergoing surgery alone showed better survival at 5 years (OR: 1.52, 95% CI: 1.15-2.00, P value =0.003). Conclusions SL following induction therapy can be safely performed with no increase of mortality and morbidity. However, the need for induction therapy before surgery is associated with increased anastomotic complications and poorer survival prognosis at 5 years.
Collapse
Affiliation(s)
- Louis-Emmanuel Chriqui
- Service of Thoracic Surgery. University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Céline Forster
- Service of Thoracic Surgery. University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Alban Lovis
- Service of Pneumology. University Hospital of Lausanne (CHUV), Lausanne, Switzerland.,University of Lausanne, Lausanne, Switzerland
| | - Hasna Bouchaab
- Service of Oncology University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Thorsten Krueger
- Service of Thoracic Surgery. University Hospital of Lausanne (CHUV), Lausanne, Switzerland.,University of Lausanne, Lausanne, Switzerland
| | - Jean Yannis Perentes
- Service of Thoracic Surgery. University Hospital of Lausanne (CHUV), Lausanne, Switzerland.,University of Lausanne, Lausanne, Switzerland
| | - Michel Gonzalez
- Service of Thoracic Surgery. University Hospital of Lausanne (CHUV), Lausanne, Switzerland.,University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
30
|
Furrer K, Weder W, Eboulet E, Betticher D, Pless M, Stupp R, Krueger T, Perentes J, Schmid R, Lardinois D, Furrer M, Fruh M, Peters S, Curioni-Fontecedro A, Stahel R, Rothschild S, Hayoz S, Thierstein S, Biaggi C, Opitz I. P30.01 Extended Resections for Advanced Stages T3/T4 NSCLC After Neoadjuvant Treatment: Conclusions of SAKK Pooled Analysis (16/96, 16/00, 16/01). J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
31
|
Caudron de Coquereaumont G, Couchepin J, Perentes JY, Krueger T, Lovis A, Rotman S, Lamoth F. Limited Index of Clinical Suspicion and Underdiagnosis of Histopathologically Documented Invasive Mold Infections. Open Forum Infect Dis 2021; 8:ofab174. [PMID: 34549073 PMCID: PMC8446918 DOI: 10.1093/ofid/ofab174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/31/2021] [Indexed: 11/14/2022] Open
Abstract
Invasive mold infections (IMIs) are difficult to diagnose. This analysis of histopathologically proven IMIs at our institution (2010-2019) showed that 11/41 (27%) of them were not suspected at the time of biopsy/autopsy (9/17, 53% among autopsies). The rate of missed diagnosis was particularly high (8/16, 50%) among nonhematologic cancer patients.
Collapse
Affiliation(s)
| | - Jade Couchepin
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jean Y Perentes
- Service of Thoracic Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Thorsten Krueger
- Service of Thoracic Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alban Lovis
- Service of Pulmonology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Samuel Rotman
- Service of Clinical Pathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Frederic Lamoth
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Institute of Microbiology, Department of Laboratories, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
32
|
Bracher J, Wolffram D, Deuschel J, Görgen K, Ketterer JL, Ullrich A, Abbott S, Barbarossa MV, Bertsimas D, Bhatia S, Bodych M, Bosse NI, Burgard JP, Castro L, Fairchild G, Fuhrmann J, Funk S, Gogolewski K, Gu Q, Heyder S, Hotz T, Kheifetz Y, Kirsten H, Krueger T, Krymova E, Li ML, Meinke JH, Michaud IJ, Niedzielewski K, Ożański T, Rakowski F, Scholz M, Soni S, Srivastava A, Zieliński J, Zou D, Gneiting T, Schienle M. A pre-registered short-term forecasting study of COVID-19 in Germany and Poland during the second wave. Nat Commun 2021; 12:5173. [PMID: 34453047 PMCID: PMC8397791 DOI: 10.1038/s41467-021-25207-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 07/28/2021] [Indexed: 12/31/2022] Open
Abstract
Disease modelling has had considerable policy impact during the ongoing COVID-19 pandemic, and it is increasingly acknowledged that combining multiple models can improve the reliability of outputs. Here we report insights from ten weeks of collaborative short-term forecasting of COVID-19 in Germany and Poland (12 October-19 December 2020). The study period covers the onset of the second wave in both countries, with tightening non-pharmaceutical interventions (NPIs) and subsequently a decay (Poland) or plateau and renewed increase (Germany) in reported cases. Thirteen independent teams provided probabilistic real-time forecasts of COVID-19 cases and deaths. These were reported for lead times of one to four weeks, with evaluation focused on one- and two-week horizons, which are less affected by changing NPIs. Heterogeneity between forecasts was considerable both in terms of point predictions and forecast spread. Ensemble forecasts showed good relative performance, in particular in terms of coverage, but did not clearly dominate single-model predictions. The study was preregistered and will be followed up in future phases of the pandemic.
Collapse
Affiliation(s)
- J Bracher
- Chair of Statistics and Econometrics, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany.
- Computational Statistics Group, Heidelberg Institute for Theoretical Studies (HITS), Heidelberg, Germany.
| | - D Wolffram
- Chair of Statistics and Econometrics, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
- Computational Statistics Group, Heidelberg Institute for Theoretical Studies (HITS), Heidelberg, Germany
| | - J Deuschel
- Chair of Statistics and Econometrics, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - K Görgen
- Chair of Statistics and Econometrics, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - J L Ketterer
- Chair of Statistics and Econometrics, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - A Ullrich
- Robert Koch Institute (RKI), Berlin, Germany
| | - S Abbott
- London School of Hygiene and Tropical Medicine, London, UK
| | - M V Barbarossa
- Frankfurt Institute for Advanced Studies, Frankfurt, Germany
| | - D Bertsimas
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - S Bhatia
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), Imperial College London, London, UK
| | - M Bodych
- Wroclaw University of Science and Technology, Wroclaw, Poland
| | - N I Bosse
- London School of Hygiene and Tropical Medicine, London, UK
| | - J P Burgard
- Economic and Social Statistics Department, University of Trier, Trier, Germany
| | - L Castro
- Information Systems and Modeling, Los Alamos National Laboratory, Los Alamos, NM, USA
| | - G Fairchild
- Information Systems and Modeling, Los Alamos National Laboratory, Los Alamos, NM, USA
| | - J Fuhrmann
- Frankfurt Institute for Advanced Studies, Frankfurt, Germany
- Jülich Supercomputing Centre, Forschungszentrum Jülich, Jülich, Germany
| | - S Funk
- London School of Hygiene and Tropical Medicine, London, UK
| | - K Gogolewski
- Institute of Informatics, University of Warsaw, Warsaw, Poland
| | - Q Gu
- Department of Computer Science, University of California, Los Angeles, CA, USA
| | - S Heyder
- Institute of Mathematics, Technische Universität Ilmenau, Ilmenau, Germany
| | - T Hotz
- Institute of Mathematics, Technische Universität Ilmenau, Ilmenau, Germany
| | - Y Kheifetz
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - H Kirsten
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - T Krueger
- Wroclaw University of Science and Technology, Wroclaw, Poland
| | - E Krymova
- Swiss Data Science Center, ETH Zurich and EPFL, Lausanne, Switzerland
| | - M L Li
- Operations Research Center, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - J H Meinke
- Jülich Supercomputing Centre, Forschungszentrum Jülich, Jülich, Germany
| | - I J Michaud
- Statistical Sciences Group, Los Alamos National Laboratory, Los Alamos, NM, USA
| | - K Niedzielewski
- Interdisciplinary Centre for Mathematical and Computational Modeling, University of Warsaw, Warsaw, Poland
| | - T Ożański
- Wroclaw University of Science and Technology, Wroclaw, Poland
| | - F Rakowski
- Interdisciplinary Centre for Mathematical and Computational Modeling, University of Warsaw, Warsaw, Poland
| | - M Scholz
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - S Soni
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - A Srivastava
- Ming Hsieh Department of Computer and Electrical Engineering, University of Southern California, Los Angeles, CA, USA
| | - J Zieliński
- Interdisciplinary Centre for Mathematical and Computational Modeling, University of Warsaw, Warsaw, Poland
| | - D Zou
- Department of Computer Science, University of California, Los Angeles, CA, USA
| | - T Gneiting
- Computational Statistics Group, Heidelberg Institute for Theoretical Studies (HITS), Heidelberg, Germany
- Institute for Stochastics, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - M Schienle
- Chair of Statistics and Econometrics, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany.
| |
Collapse
|
33
|
Forster C, Perentes JY, Ojanguren A, Abdelnour-Berchtold E, Zellweger M, Bouchaab H, Peters S, Krueger T, Gonzalez M. Early discharge after thoracoscopic anatomical pulmonary resection for non-small-cell lung cancer. Interact Cardiovasc Thorac Surg 2021; 33:892-898. [PMID: 34279040 DOI: 10.1093/icvts/ivab187] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 04/13/2021] [Accepted: 06/03/2021] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Although video-assisted thoracic surgery (VATS) has shortened hospitalization duration for non-small-cell lung cancer (NSCLC) patients, the factors associated with early discharge remain unclear. This study aimed to identify patients eligible for a 72-h stay after VATS anatomical resection. METHODS Monocentric retrospective study including all consecutive patients undergoing VATS anatomical resection for NSCLC between February 2010 and December 2019. Two groups were defined according to the discharge: 'early discharge' (within 72 postoperative hours) and 'routine discharge' (at >72 postoperative hours). RESULTS A total of 660 patients with a median age of 66.5 years (interquartile range 60-73 years) (female/male: 321/339) underwent VATS anatomical pulmonary resection for NSCLC [segmentectomy in 169 (25.6%), lobectomy in 481 (72.9%), bilobectomy in 8 (1.2%) and pneumonectomy in 2 (0.3%) patients]. The cardiopulmonary and Clavien-Dindo III-IV postoperative complication rates were 32.6% and 7.7%, respectively. The median postoperative length of stay was 6 days (interquartile range 4-10 days). In total, 119 patients (18%) could be discharged within 72 h of surgery. On multivariable analysis, the factors significantly associated with an increased likelihood of early discharge were: body mass index >20 kg/m2 [odds ratio (OR) 2.37], absence of prior cardiopathy (OR 2), diffusing capacity of the lung for carbon monoxide >60% (OR 1.82), inclusion in an enhanced recovery after surgery protocol (OR 2.23), use of a single chest tube (OR 5.73) and postoperative transfer to the ward (OR 4.84). Factors significantly associated with a decreased likelihood of early discharge were: age >60 years (OR 0.53), American Society of Anaesthesiologists score >2 (OR 0.46) and use of an epidural catheter (OR 0.41). Readmission rates were not statistically different between both groups (5.9% vs 3.1%; P = 0.17). CONCLUSIONS Age, pulmonary functions and comorbidities may influence discharge after VATS anatomical resection. The early discharge does not increase readmission rates.
Collapse
Affiliation(s)
- Céline Forster
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Jean Yannis Perentes
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Amaya Ojanguren
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | | | - Matthieu Zellweger
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Hasna Bouchaab
- Service of Oncology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Solange Peters
- Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland.,Service of Oncology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Thorsten Krueger
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Michel Gonzalez
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
| |
Collapse
|
34
|
Opitz I, Patella M, Payrard L, Perentes JY, Inderbitzi R, Gelpke H, Schulte S, Diezi M, Gonzalez M, Krueger T, Weder W. Prognostic factors of oligometastatic non-small-cell lung cancer following radical therapy: a multicentre analysis. Eur J Cardiothorac Surg 2021; 57:1166-1172. [PMID: 32011665 DOI: 10.1093/ejcts/ezz384] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/30/2019] [Accepted: 12/09/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Patients with oligometastatic non-small-cell lung cancer (NSCLC) may benefit from therapy with curative intent. Our goal was to identify prognostic factors related to better prognosis in a multicentre analysis of patients who underwent surgery of primary tumours in combination with radical treatment of all metastatic sites. METHODS We retrospectively reviewed the records of oligometastatic patients who underwent resection of primary tumours at 4 centres (August 2001-February 2018). Oligometastasis was defined as ≤5 synchronous metastases in ≤2 organs. Radical metastatic treatment was surgery, radiotherapy or a combination. The Cox proportional hazards model was used for identification of prognostic factors on overall survival. RESULTS We treated 124 patients; 72 (58%) were men, mean age 60 ± 9.8 years, with 87 (70%) adenocarcinoma. Sixty-seven (54%) patients had positive pathologic-N stage (pN). Brain metastases were most common (n = 76; 61%) followed by adrenal (n = 13; 10%) and bone (n = 12; 10%). Systemic therapy was administered in 101 (82%) patients. Median follow-up was 60 months [95% confidence interval (CI) 41-86]. Thirty- and 90-day mortality rates were 0 and 2.4%, respectively. One-, 2-, and 5-year overall survival were 80%, 58% and 36%, respectively. Cox regression analysis showed that patients ≤60 years [hazard ratio (HR) 0.41, 95% CI 0.24, 0.69; P = 0.001] and patients with pN0 (HR 0.38, 95% CI 0.21-0.69; P = 0.002) had a significant survival benefit. The presence of bone metastases negatively affected survival (HR 2.53, 95% CI 1.05-6.09; P = 0.04). CONCLUSIONS Treatment with curative intent of selected oligometastatic NSCLC, including resection of the primary tumour, can be performed safely and with excellent 5-year survival rates, especially in younger patients with pN0 disease.
Collapse
Affiliation(s)
- Isabelle Opitz
- Department of Thoracic Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - Miriam Patella
- Department of Thoracic Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - Loic Payrard
- Department of Thoracic Surgery, University Hospital of Vaudois, Lausanne, Switzerland
| | - Jean Yannis Perentes
- Department of Thoracic Surgery, University Hospital of Vaudois, Lausanne, Switzerland
| | - Rolf Inderbitzi
- Department of Thoracic Surgery, San Giovanni Hospital, Bellinzona, Switzerland
| | - Hans Gelpke
- Department of Thoracic and Visceral Surgery, Cantonal Hospital, Winterthur, Switzerland
| | - Sandra Schulte
- Department of Thoracic and Visceral Surgery, Cantonal Hospital, Winterthur, Switzerland
| | - Maja Diezi
- Department of Thoracic Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - Michel Gonzalez
- Department of Thoracic Surgery, University Hospital of Vaudois, Lausanne, Switzerland
| | - Thorsten Krueger
- Department of Thoracic Surgery, University Hospital of Vaudois, Lausanne, Switzerland
| | - Walter Weder
- Department of Thoracic Surgery, University Hospital of Zurich, Zurich, Switzerland
| |
Collapse
|
35
|
Cavin S, Gkasti A, Faget J, Hao Y, Letovanec I, Reichenbach M, Gonzalez M, Krueger T, Dyson PJ, Meylan E, Perentes JY. Low-dose photodynamic therapy promotes a cytotoxic immunological response in a murine model of pleural mesothelioma. Eur J Cardiothorac Surg 2021; 58:783-791. [PMID: 32372095 DOI: 10.1093/ejcts/ezaa145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 03/10/2020] [Accepted: 03/24/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Malignant pleural mesothelioma (MPM) is a deadly disease with limited treatment options. Approaches to enhance patient immunity against MPM have been tested but shown variable results. Previously, we have demonstrated interesting vascular modulating properties of low-dose photodynamic therapy (L-PDT) on MPM. Here, we hypothesized that L-PDT vascular modulation could favour immune cell extravasation in MPM and improve tumour control in combination with immune checkpoint inhibitors. METHODS First, we assessed the impact of L-PDT on vascular endothelial E-selectin expression, a key molecule for immune cell extravasation, in vitro and in a syngeneic murine model of MPM. Second, we characterized the tumour immune cell infiltrate by 15-colour flow cytometry analysis 2 and 7 days after L-PDT treatment of the murine MPM model. Third, we determined how L-PDT combined with immune checkpoint inhibitor anti-CTLA4 affected tumour growth in a murine MPM model. RESULTS L-PDT significantly enhanced E-selectin expression by endothelial cells in vitro and in vivo. This correlated with increased CD8+ T cells and activated antigen-presenting cells (CD11b+ dendritic cells and macrophages) infiltration in MPM. Also, compared to anti-CTLA4 that only affects tumour growth, the combination of L-PDT with anti-CTLA4 caused complete MPM regression in 37.5% of animals. CONCLUSIONS L-PDT enhances E-selectin expression in the MPM endothelium, which favours immune infiltration of tumours. The combination of L-PDT with immune checkpoint inhibitor anti-CTLA4 allows best tumour control and regression.
Collapse
Affiliation(s)
- Sabrina Cavin
- Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Aspasia Gkasti
- Swiss Institute for Experimental Cancer Research, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Julien Faget
- Swiss Institute for Experimental Cancer Research, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Yameng Hao
- Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.,Institute of Chemical Sciences and Engineering, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Igor Letovanec
- Institute of Pathology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Maxime Reichenbach
- Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Michel Gonzalez
- Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Thorsten Krueger
- Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Paul J Dyson
- Institute of Chemical Sciences and Engineering, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Etienne Meylan
- Swiss Institute for Experimental Cancer Research, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Jean Y Perentes
- Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| |
Collapse
|
36
|
Hasenauer A, Bédat B, Parapanov R, Lugrin J, Debonneville A, Abdelnour-Berchtold E, Gonzalez M, Perentes JY, Piquilloud L, Szabo C, Krueger T, Liaudet L. Effects of cold or warm ischemia and ex-vivo lung perfusion on the release of damage associated molecular patterns and inflammatory cytokines in experimental lung transplantation. J Heart Lung Transplant 2021; 40:905-916. [PMID: 34193360 DOI: 10.1016/j.healun.2021.05.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 05/14/2021] [Accepted: 05/24/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Lung transplantation (LTx) is associated with sterile inflammation, possibly related to the release of damage associated molecular patterns (DAMPs) by injured allograft cells. We have measured cellular damage and the release of DAMPs and cytokines in an experimental model of LTx after cold or warm ischemia and examined the effect of pretreatment with ex-vivo lung perfusion (EVLP). METHODS Rat lungs were exposed to cold ischemia alone (CI group) or with 3h EVLP (CI-E group), warm ischemia alone (WI group) or with 3 hour EVLP (WI-E group), followed by LTx (2 hour). Bronchoalveolar lavage (BAL) was performed before (right lung) or after (left lung) LTx to measure LDH (marker of cellular injury), the DAMPs HMGB1, IL-33, HSP-70 and S100A8, and the cytokines IL-1β, IL-6, TNFα, and CXCL-1. Graft oxygenation capacity and static compliance after LTx were also determined. RESULTS Compared to CI, WI displayed cellular damage and inflammation without any increase of DAMPs after ischemia alone, but with a significant increase of HMGB1 and functional impairment after LTx. EVLP promoted significant inflammation in both cold (CI-E) and warm (WI-E) groups, which was not associated with cell death or DAMP release at the end of EVLP, but with the release of S100A8 after LTx. EVLP reduced graft damage and dysfunction in warm ischemic, but not cold ischemic, lungs. CONCLUSIONS The pathomechanisms of sterile lung inflammation during LTx are significantly dependent on the conditions. The release of HMGB1 (in the absence of EVLP) and S100A8 (following EVLP) may be important factors in the pathogenesis of LTx.
Collapse
Affiliation(s)
- Arpad Hasenauer
- Service of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Benoît Bédat
- Service of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Roumen Parapanov
- Service of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland; Service of Thoracic Surgery and Department of Adult Intensive Care Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Jérôme Lugrin
- Service of Thoracic Surgery and Department of Adult Intensive Care Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Anne Debonneville
- Service of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Michel Gonzalez
- Service of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Jean Y Perentes
- Service of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Lise Piquilloud
- Department of Adult Intensive Care Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Csaba Szabo
- Department of Pharmacology, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Thorsten Krueger
- Service of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Lucas Liaudet
- Department of Adult Intensive Care Medicine, Lausanne University Hospital, Lausanne, Switzerland.
| |
Collapse
|
37
|
Forster C, Ojanguren A, Perentes JY, Zellweger M, Krueger T, Gonzalez M. Is faster better? Impact of operative time on postoperative outcomes after VATS anatomical pulmonary resection. Br J Surg 2021. [DOI: 10.1093/bjs/znab202.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Objective
Video-Assisted Thoracic Surgery (VATS) is now the preferred approach for standard anatomical pulmonary resections. However, operative time (OT) for this technique is correlated to many aspects, such as the surgical complexity or the surgeon’s experience and skills. The aim of this study was to identify the factors associated with prolonged OTs and to assess the impact of OT on the development of post-operative complications after VATS anatomical pulmonary resections.
Methods
Retrospective monocentric study including all consecutive patients undergoing a VATS anatomical pulmonary resection for benign or malignant lesions between January 2010 and December 2019. Postoperative outcomes were compared between short (<150 minutes) and long (≥150 minutes) OTs. A multivariate analysis was carried out to identify predictors of longer OTs and post-operative complications.
Results
A total of 836 patients underwent a VATS anatomical pulmonary resection for malignant (n = 767, 91.7%) or benign (n = 69, 8.3%) lesions. Lobectomies were performed in 555 (66.4%), segmentectomies in 250 (29.9%), sleeve lobectomies in 16 (1.9%), bilobectomies in 11 (1.3%) and pneumonectomy in 4 (0.5%) patients. The conversion rate to thoracotomy was 7.7%. Of those 836 patients, 495 (59.2%) were operated within 150 minutes. During the 30-postoperative day period, the overall morbidity was significantly lower in the short OT group (29.1% vs. 40.5%; p = 0.001). Both the duration of drainage (3 vs. 4 days; p < 0.00001) and the length of hospital stay (6 vs. 7 days; p < 0.00001) were significantly reduced in the short OT group. Two predictors of long OT were identified on multivariate analysis: male sex (OR 1.41, p = 0.04) and neoadjuvant chemotherapy (OR 3.46, p = 0.003). A long OT was identified as an individual predictor of postoperative complications (OR 1.84, p < 0.0001).
Conclusion
A prolonged OT is an individual risk factor for postoperative complications in patients undergoing VATS anatomical pulmonary resection.
Collapse
Affiliation(s)
- C Forster
- Department of Thoracic Surgery, Hospital of Sion, Sion, Switzerland
| | - A Ojanguren
- Department of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - J Y Perentes
- Department of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - M Zellweger
- Department of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - T Krueger
- Department of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - M Gonzalez
- Department of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| |
Collapse
|
38
|
Hao Y, Chriqui LE, Gattlen C, Gonzalez M, Krueger T, Krueger T, Dyson P, Cavin S, Perentes J. Intrapleural hyperthermic chemotherapy induces pro-immunogenic e-selectin expression in the vasculature of malignant pleural mesothelioma. Br J Surg 2021. [DOI: 10.1093/bjs/znab202.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Objective
Malignant pleural mesothelioma (MPM) is a deadly disease with dismal prognosis. Prior studies combining surgery with intrapleural hyperthermic chemotherapy (IPHC) have shown improved survivals in selected patients with MPM. However, the mechanisms by which IPHC acts on MPM and its microenvironment remains unknown. Here we focus on tumor endothelial adhesion molecule expression patterns.
Methods
First, we determined the impact of IPHC on MPM tumor and vascular compartments in vitro using a novel bioincubater for hyperthermic cell culture. The cytotoxicity of normo (37 °C) / hyperthermic (42 °C for 60 minutes) cisplatin/carboplatin therapies were evaluated on four MPM (MSTO211H, H-Meso, AE17 and AB12) and one endothelial (EC-RF24) cell lines at a minimum of 24 hours using a presto-blue assay. Second, we treated endothelial cells with IPHC (60 min, 42 °C at optimized cytotoxic concentrations) and determined its impact on pro-immunogenic adhesion molecule (E-selectin, VE-cadherin, VCAM and Connexin-43) expression at 24 hours by Western blot.
Results
Tumor and endothelial cell viability decreased with increasing doses of both chemotherapeutics but was not affected by hyperthermia (IC50 with or without hyperthermia of each cell line at 24 hours reported in Figure 1A). Interestingly, endothelial cell line IC50 was much higher than that of MPM tumor cells for both chemotherapeutics (Figure 1A). Pro-immunogenic adhesion molecule E-Selectin was increased at 24 hours by IPHC with both chemotherapeutics while VE-Cadherin, VCAM and Connexin-43 were not affected (Figure 1B).
Conclusion
Hyperthermia adds no cytotoxicity to intrapleural chemotherapy. However, IPHC favors pro-immunogenic endothelial E-selectin expression. The latter could help induce patient immunity against their MPM and improve survival. Confirmation of these findings in vivo is mandatory.
Collapse
Affiliation(s)
- Y Hao
- Institute of Chemical Sciences & Engineering, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
- Department of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - L -E Chriqui
- Department of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - C Gattlen
- Department of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - M Gonzalez
- Department of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - T Krueger
- Department of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - T Krueger
- Department of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - P Dyson
- Institute of Chemical Sciences & Engineering, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - S Cavin
- Department of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - J Perentes
- Department of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| |
Collapse
|
39
|
Koliakos E, Bedat B, Caput B, Hasenauer A, Federici S, Ojanguren-Arranz A, Gonzalez M, Krueger T, Perentes JY. Objective performance assessment on trainees of a VATS simulation program: A prospective single center study. Br J Surg 2021. [DOI: 10.1093/bjs/znab202.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Objective
A prospective single center study to assess the objective impact on motion performance of a VATS simulation program on thoracic surgery trainees.
Methods
We developed a 6-month VATS simulation training program including exercises of progressive complexity on 3 different black box simulators: a 2D and 3D lobectomy model (Stupnik®) and a 3D perfused lobectomy model (Crabtree®). Between November 2019 and 2020, all consecutive thoracic surgery residents (study group) were prospectively enrolled in this weekly training program that was supervised by a board certified thoracic surgeon. We compared an objective performance evaluation of the study group before and after the training program by assessing movement parameters (distance in cm, time in sec) and absence of shock/extreme motion (%) on 3 simple standardized thoracoscopic exercises (peg placement on a board, rope insertion in loops and precision circle cutting) using the Simball®. Also, we determined the objective performance 6 months apart of 5 final year medical students (unexperienced controls) that were not trained.
Results
There were 7 residents (2 female and 5 male, median age: 29 [range: 26-34] years) who completed the 6-month VATS simulation training program. Five residents were in their first year while two had >3 year experience. The study group's objective performance improved significantly for all three movement parameters in all standardized exercises (Figure 1) after the training program. The objective performance of the unexperienced control group was comparable to the study group before training, but it remained unchanged at 6 months (p > 0.05). When comparing unexperienced and advanced residents, we observed that the training program had more impact on improving the performance for unexperienced residents (p < 0.05).
Conclusion
This study suggests that the implementation of a VATS simulation training program improves the objective performance of trainees compared to controls. Such programs could be interesting adjuncts for residents.
Collapse
Affiliation(s)
- E Koliakos
- Department of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - B Bedat
- Department of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - B Caput
- Department of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - A Hasenauer
- Department of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - S Federici
- Department of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - A Ojanguren-Arranz
- Department of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - M Gonzalez
- Department of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - T Krueger
- Department of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - J Y Perentes
- Department of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| |
Collapse
|
40
|
Bédat B, Koliakos E, Licker MJ, Demarchi M, Perentes J, Triponez F, Krueger T, Karenovics W, Gonzalez M. VE/VCO2 slope predicts short- and long-term outcome after anatomical pulmonary resection by VATS. Br J Surg 2021. [DOI: 10.1093/bjs/znab202.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Objective
The ventilation-to-carbon dioxide output (VE/VCO2) slope could predict morbidity and mortality after lung resection. The aim of the study was to identify whether VE/VCO2 slope obtained from cardiopulmonary exercise test (CPET) was an independent predictor of cardiopulmonary complications after anatomical pulmonary resection by video-assisted thoracic surgery (VATS).
Methods
We reviewed the files of all consecutive patients that underwent pulmonary anatomical resections by VATS between January 2010 and October 2020. The data were extracted from the registry of the Centre for Thoracic Surgery of Western Switzerland. Pneumonectomies were excluded from the study. We used a multivariable Cox regression to investigate the risk of cardiopulmonary complications associated with the VE/VCO2 slope and other possible confounders, including the Charlson Comorbidity Index (CCI), the CPET data and pulmonary functions.
Results
In total, 1392 patients (mean age: 66±11 years; ratio female: 47%) underwent anatomical resection by VATS. CPET was performed in 204 patients (15%). However, the VE/VCO2 slope data were available in 145 patients, which were included for the analysis. Patients underwent segmentectomies (N = 42) and lobectomies (N = 101) mainly for lung cancer (96%). The average percentage of the predicted VO2max was of 70±17%. Maximal effort during the CPET (respiratory coefficient ratio >1.1) was not reached in 30% of patients, without impact on the VE/VCO2 slope (39±6 vs 37±7, P = 0.21). Cardiopulmonary complications appeared in 32% of patients with no mortality at 90 days. In the multivariate analysis, VE/VCO2 slope >35 was correlated with cardiopulmonary complications (OR 3.5, 95% CI [1.3-9.3], P = 0.012). CCI, pulmonary functions, peak VO2 and the extension of the anatomical resection was not associated with cardiopulmonary complications.
Conclusion
VE/VCO2 slope above 35 predicts postoperative cardiopulmonary complications in anatomical resections by VATS. The VE/VCO2 slope is independent of the intensity of effort during the CPET. The impact of prehabilitation on the slope should be determined.
Collapse
Affiliation(s)
- B Bédat
- Department of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - E Koliakos
- Department of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - M -J Licker
- Department of Anaesthesiology, Geneva University Hospital, Geneva, Switzerland
| | - M Demarchi
- Department of Thoracic Surgery, Geneva University Hospital, Geneva, Switzerland
| | - J Perentes
- Department of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - F Triponez
- Department of Thoracic Surgery, Geneva University Hospital, Geneva, Switzerland
| | - T Krueger
- Department of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - W Karenovics
- Department of Thoracic Surgery, Geneva University Hospital, Geneva, Switzerland
| | - M Gonzalez
- Department of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| |
Collapse
|
41
|
Glatzer M, Leskow P, Caparrotti F, Elicin O, Furrer M, Gambazzi F, Dutly A, Gelpke H, Guckenberger M, Heuberger J, Inderbitzi R, Cafarotti S, Karenovics W, Kestenholz P, Kocher GJ, Kraxner P, Krueger T, Martucci F, Oehler C, Ozsahin M, Papachristofilou A, Wagnetz D, Zaugg K, Zwahlen D, Opitz I, Putora PM. Stage III N2 non-small cell lung cancer treatment: decision-making among surgeons and radiation oncologists. Transl Lung Cancer Res 2021; 10:1960-1968. [PMID: 34012806 PMCID: PMC8107728 DOI: 10.21037/tlcr-20-1210] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Stage III N2 non-small cell lung cancer (NSCLC) is a very heterogeneous disease associated with a poor prognosis. A number of therapeutic options are available for patients with Stage III N2 NSCLC, including surgery [with neoadjuvant or adjuvant chemotherapy (CTx)/neoadjuvant chemoradiotherapy (CRT)] or CRT potentially followed by adjuvant immunotherapy. We have no clear evidence demonstrating a significant survival benefit for either of these approaches, the selection between treatments is not always straightforward and can come down to physician and patient preference. The very heterogeneous definition of resectability of N2 disease makes the decision-making process even more complex. Methods We evaluated the treatment strategies for preoperatively diagnosed stage III cN2 NSCLC among Swiss thoracic surgeons and radiation oncologists. Treatment strategies were converted into decision trees and analysed for consensus and discrepancies. We analysed factors relevant to decision-making within these recommendations. Results For resectable “non-bulky” mediastinal lymph node involvement, there was a trend towards surgery. Numerous participants recommend a surgical approach outside existing guidelines as long as the disease was resectable, even in multilevel N2. With increasing extent of mediastinal nodal disease, multimodal treatment based on radiotherapy was more common. Conclusions Both, surgery- or radiotherapy-based treatment regimens are feasible options in the management of Stage III N2 NSCLC. The different opinions reflected in the results of this manuscript reinforce the importance of a multidisciplinary setting and the importance of shared decision-making with the patient.
Collapse
Affiliation(s)
- Markus Glatzer
- Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Pawel Leskow
- Department of Thoracic Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Francesca Caparrotti
- Department of Radiation Oncology, University Hospital Geneva, Geneva, Switzerland
| | - Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Markus Furrer
- Department of Vascular and Thoracic Surgery, Kantonsspital Chur, Chur, Switzerland
| | - Franco Gambazzi
- Department of Thoracic Surgery, Kantonsspital Aarau, Aarau, Switzerland
| | - André Dutly
- Department of Thoracic Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Hans Gelpke
- Department of Thoracic Surgery, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jürg Heuberger
- Department of Radiation Oncology, Kantonsspital Aarau, Aarau, Switzerland
| | - Rolf Inderbitzi
- Department of Thoracic Surgery, Ente Ospedaliero Cantonale, Belinzona, Switzerland
| | - Stefano Cafarotti
- Department of Thoracic Surgery, Ente Ospedaliero Cantonale, Belinzona, Switzerland
| | - Wolfram Karenovics
- Department of Thoracic Surgery, University Hospital Geneva, Geneva, Switzerland
| | - Peter Kestenholz
- Department of Thoracic Surgery, Kantonsspital Luzern, Luzern, Switzerland
| | - Gregor Jan Kocher
- Department of Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Peter Kraxner
- Department of Radiation Oncology, Kantonsspital Luzern, Luzern, Switzerland.,Department of Radiation Oncology, Kantonsspital Chur, Chur, Switzerland
| | - Thorsten Krueger
- Department of Thoracic Surgery, University Hospital Lausanne, Lausanne, Switzerland
| | - Francesco Martucci
- Radiation Oncology Clinic, Oncology Institute of Southern Switzerland, Bellinzona-Lugano, Switzerland
| | - Christoph Oehler
- Department of Radiation Oncology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Mahmut Ozsahin
- Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | - Dirk Wagnetz
- Department of Visceral-Vascular and Thoracic Surgery, City Hospital Waid and Triemli, Zurich, Switzerland
| | - Kathrin Zaugg
- Department of Radiation Oncology, City Hospital Waid and Triemli, Zurich, Switzerland
| | - Daniel Zwahlen
- Department of Radiation Oncology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Paul Martin Putora
- Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland.,Department of Radiation Oncology, University of Bern, Bern, Switzerland
| |
Collapse
|
42
|
Tavernari D, Battistello E, Dheilly E, Petruzzella AS, Mina M, Sordet-Dessimoz J, Peters S, Krueger T, Gfeller D, Riggi N, Oricchio E, Letovanec I, Ciriello G. Nongenetic Evolution Drives Lung Adenocarcinoma Spatial Heterogeneity and Progression. Cancer Discov 2021; 11:1490-1507. [PMID: 33563664 DOI: 10.1158/2159-8290.cd-20-1274] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/21/2020] [Accepted: 01/22/2021] [Indexed: 11/16/2022]
Abstract
Cancer evolution determines molecular and morphologic intratumor heterogeneity and challenges the design of effective treatments. In lung adenocarcinoma, disease progression and prognosis are associated with the appearance of morphologically diverse tumor regions, termed histologic patterns. However, the link between molecular and histologic features remains elusive. Here, we generated multiomics and spatially resolved molecular profiles of histologic patterns from primary lung adenocarcinoma, which we integrated with molecular data from >2,000 patients. The transition from indolent to aggressive patterns was not driven by genetic alterations but by epigenetic and transcriptional reprogramming reshaping cancer cell identity. A signature quantifying this transition was an independent predictor of patient prognosis in multiple human cohorts. Within individual tumors, highly multiplexed protein spatial profiling revealed coexistence of immune desert, inflamed, and excluded regions, which matched histologic pattern composition. Our results provide a detailed molecular map of lung adenocarcinoma intratumor spatial heterogeneity, tracing nongenetic routes of cancer evolution. SIGNIFICANCE: Lung adenocarcinomas are classified based on histologic pattern prevalence. However, individual tumors exhibit multiple patterns with unknown molecular features. We characterized nongenetic mechanisms underlying intratumor patterns and molecular markers predicting patient prognosis. Intratumor patterns determined diverse immune microenvironments, warranting their study in the context of current immunotherapies.This article is highlighted in the In This Issue feature, p. 1307.
Collapse
Affiliation(s)
- Daniele Tavernari
- Swiss Cancer Center Leman, Lausanne, Switzerland.,Department of Computational Biology, University of Lausanne (UNIL), Lausanne, Switzerland.,Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Elena Battistello
- Swiss Cancer Center Leman, Lausanne, Switzerland.,Department of Computational Biology, University of Lausanne (UNIL), Lausanne, Switzerland.,Swiss Institute of Bioinformatics, Lausanne, Switzerland.,Swiss Institute for Experimental Cancer Research (ISREC), EPFL, Lausanne, Switzerland
| | - Elie Dheilly
- Swiss Cancer Center Leman, Lausanne, Switzerland.,Swiss Institute for Experimental Cancer Research (ISREC), EPFL, Lausanne, Switzerland
| | - Aaron S Petruzzella
- Swiss Cancer Center Leman, Lausanne, Switzerland.,Swiss Institute for Experimental Cancer Research (ISREC), EPFL, Lausanne, Switzerland
| | - Marco Mina
- Swiss Cancer Center Leman, Lausanne, Switzerland.,Department of Computational Biology, University of Lausanne (UNIL), Lausanne, Switzerland.,Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | | | - Solange Peters
- Swiss Cancer Center Leman, Lausanne, Switzerland.,Department of Oncology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Thorsten Krueger
- Division of Thoracic Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - David Gfeller
- Swiss Cancer Center Leman, Lausanne, Switzerland.,Department of Oncology, Ludwig Institute for Cancer Research, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Nicolo Riggi
- Swiss Cancer Center Leman, Lausanne, Switzerland.,Institute of Pathology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Elisa Oricchio
- Swiss Cancer Center Leman, Lausanne, Switzerland.,Swiss Institute for Experimental Cancer Research (ISREC), EPFL, Lausanne, Switzerland
| | - Igor Letovanec
- Swiss Cancer Center Leman, Lausanne, Switzerland. .,Institute of Pathology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.,Department of Pathology, Central Institute, Hôpital du Valais, Sion, Switzerland
| | - Giovanni Ciriello
- Swiss Cancer Center Leman, Lausanne, Switzerland. .,Department of Computational Biology, University of Lausanne (UNIL), Lausanne, Switzerland.,Swiss Institute of Bioinformatics, Lausanne, Switzerland
| |
Collapse
|
43
|
Elahi L, Zellweger M, Abdelnour-Berchtold E, Gonzalez M, Ris HB, Krueger T, Raffoul W, Perentes JY. The size and sternal involvement of chest wall resections for malignant disease predict postoperative morbidity. Transl Cancer Res 2021; 11:1162-1172. [PMID: 35706797 PMCID: PMC9189217 DOI: 10.21037/tcr-21-2143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 01/20/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Leslie Elahi
- Department of Thoracic Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Matthieu Zellweger
- Department of Thoracic Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | | | - Michel Gonzalez
- Department of Thoracic Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Hans-Beat Ris
- Department of Thoracic Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Thorsten Krueger
- Department of Thoracic Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Wassim Raffoul
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Jean Yannis Perentes
- Department of Thoracic Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| |
Collapse
|
44
|
Forster C, Doucet V, Perentes JY, Abdelnour-Berchtold E, Zellweger M, Faouzi M, Bouchaab H, Peters S, Marcucci C, Krueger T, Rosner L, Gonzalez M. Impact of an enhanced recovery after surgery pathway on thoracoscopic lobectomy outcomes in non-small cell lung cancer patients: a propensity score-matched study. Transl Lung Cancer Res 2021; 10:93-103. [PMID: 33569296 PMCID: PMC7867780 DOI: 10.21037/tlcr-20-891] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background This study evaluates the effect of enhanced recovery after surgery (ERAS) pathways on postoperative outcomes of non-small cell lung cancer (NSCLC) patients undergoing video-assisted thoracic surgery (VATS) lobectomy. Methods We retrospectively reviewed all consecutive patients undergoing VATS lobectomy for NSCLC between January 2014 and October 2019 and assigned them to the relevant group (“pre-ERAS” or “ERAS”). Length of stay, readmissions and complications within 30 days were compared between both groups. A propensity score-matched analysis was performed based on sex, age, type of operation, comorbidities, American Society of Anesthesiologists (ASA) score and preoperative pulmonary functions. Results A total of 307 records (164 male/143 female; 140 ERAS/167 pre-ERAS; median age: 67) were reviewed. There was no statistical difference in patient’s characteristics. Overall ERAS compliance was 81%. The ERAS group presented significantly shorter length of stay (median 5 vs. 7 days; P=0.004) without significant difference in cardiopulmonary complication rate (27.1% vs. 35.9%; P=0.1). Readmission (3.6% vs. 5.4%; P=0.75) and duration of drainage (median 2 vs. 3 days; P=0.14) were similar between groups. The propensity score-matched analysis showed that the length of hospital stay was reduced by 1.4 days (P=0.034) and the postoperative cardiopulmonary complication rate by 13% (P=0.044) in the ERAS group. Conclusions Adoption of an ERAS pathway for VATS lobectomies in NSCLC patients has decreased the length of hospital stay and the cardiopulmonary complication rate without affecting the readmission rate.
Collapse
Affiliation(s)
- Céline Forster
- Service of Thoracic Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Valérie Doucet
- Service of Thoracic Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Jean Yannis Perentes
- Service of Thoracic Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.,University of Lausanne, Lausanne, Switzerland
| | | | - Matthieu Zellweger
- Service of Thoracic Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Mohamed Faouzi
- Division of Biostatistics, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Hasna Bouchaab
- Service of Medical Oncology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Solange Peters
- University of Lausanne, Lausanne, Switzerland.,Service of Medical Oncology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Carlo Marcucci
- University of Lausanne, Lausanne, Switzerland.,Service of Anesthesiology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Thorsten Krueger
- Service of Thoracic Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.,University of Lausanne, Lausanne, Switzerland
| | - Lorenzo Rosner
- Service of Anesthesiology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Michel Gonzalez
- Service of Thoracic Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.,University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
45
|
Koliakos E, Pal M, Gonzalez M, Krueger T, Perentes JY. Learning of VATS right lower lobe anterior-basal segmentectomy (S8) on a 3D printed simulator. J Vis Surg 2021. [DOI: 10.21037/jovs-21-67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
46
|
Darras M, Ojanguren A, Forster C, Zellweger M, Perentes JY, Krueger T, Gonzalez M. Short-term local control after VATS segmentectomy and lobectomy for solid NSCLC of less than 2 cm. Thorac Cancer 2020; 12:453-461. [PMID: 33270380 PMCID: PMC7882390 DOI: 10.1111/1759-7714.13766] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/15/2020] [Accepted: 11/17/2020] [Indexed: 12/25/2022] Open
Abstract
Introduction VATS pulmonary segmentectomy is increasingly proposed as a parenchyma‐sparing resection for tumors smaller than 2 cm in diameter. The aim of this study was to compare short‐term oncological results and local control in solid non‐small cell lung cancers (NSCLCs) <2 cm surgically treated by intentional VATS segmentectomy or lobectomy. Methods This study was a single center retrospective study of consecutive patients undergoing VATS lobectomy (VL) or segmentectomy (VS) for solid <2 cm NSCLC from January 2014 to October 2019. Results In total, 188 patients with a median age of 65 years (male/female: 99/89) underwent VS (n = 96) or VL (n = 92). Segmentectomies in the upper lobes were performed in 57% and as a single segment in 55% of cases. There was no statistically significant difference between VS and VL in terms of demographics, comorbidities, postoperative outcomes, dissected lymph node stations (2.89 ± 0.95 vs. 2.93 ± 1, P = 0.58), rate of pN1 (2.2% vs. 2.1%, P = 0.96) or pN2 upstaging (1.09% vs. 1.06%, P = 0.98). Adjuvant chemotherapy was given in 15% of patients in the VL and 11% in the VS group. During follow‐up (median: 23 months), no patients presented with local nodal recurrence or on the stapler line (VS group). Three patients on VL and two in VS groups presented with recurrence on the remnant operated lung. New primary pulmonary tumors were diagnosed in 3.3% and 6.3% of patients in the VL and VS groups, respectively. Conclusions Despite the short follow‐up, our preliminary data shows that local control is comparable for VATS lobectomy and VATS segmentectomy for patients with NSCLC <2 cm.
Collapse
Affiliation(s)
- Marc Darras
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Amaya Ojanguren
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Céline Forster
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Matthieu Zellweger
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Jean Yannis Perentes
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Thorsten Krueger
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Michel Gonzalez
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
| |
Collapse
|
47
|
Koliakos E, Chiriatti E, Durham A, Gonzalez M, Krueger T, Grange JC, Delay D, Gex G, Christodoulou M, Perentes JY. Metachronous lung cancer resection on extracorporeal membrane oxygenation in a pneumonectomized and mediastinum irradiated patient. Video-assist Thorac Surg 2020. [DOI: 10.21037/vats-2020-lm-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
48
|
Casutt A, Lovis A, Selby K, Noirez L, Peters S, Beigelman-Aubry C, Krueger T, Soccal PM, Von Garnier C. [Lung cancer screening in Switzerland : Who ? How ? When ?]. Rev Med Suisse 2020; 16:2224-2226. [PMID: 33206480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Professional societies encourage the establishment of coordinated national screening programs for lung cancer by « low-dose » chest CT scans. The interdisciplinary Swiss Lung Cancer Screening Implementation Group (CH-LSIG) is exploring the feasibility of such a project. However, several questions still remain unanswered, namely the -financing of such a program, the ideal « number-needed to screen », the definition and follow-up of « positive cases », as well as the role of smoking cessation measures. The key points to discuss in the future with patients requesting screening are based on the « shared -decision-making » approach. Pilot projects guided by the CH-LSIG could help to identify the optimal strategy for establishing a national screening program based on the best available scientific evidence.
Collapse
Affiliation(s)
| | | | - Kevin Selby
- Département des policliniques, Unisanté, 1011 Lausanne
| | | | | | | | | | | | | |
Collapse
|
49
|
Selby K, Gubelmann R, Lovis A, Bulliard JL, Beigelman-Aubry C, Casutt A, Peters S, Krueger T, Von Garnier C, Cornuz J. [Lung cancer screening: what can we tell our patients while we await a screening program ?]. Rev Med Suisse 2020; 16:2086-2091. [PMID: 33146956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The NLST study in the United States showed, in 2011, that low-dose lung CT scans can reduce lung cancer mortality but was limited in its routine recommendation by 96% of false positive screening results. The European NELSON trial, published in 2020, confirmed a 24% decrease in lung cancer mortality and, by using lung nodule volume and volume doubling time, decreased false positive results to 56% of positive tests. The implementation of screening programs is now expected in Europe, including Switzerland. In anticipation, we have developed a decision aid to present patients with the benefits (decreased lung cancer mortality), risks (false positives and indeterminate results), and uncertainties (incidental findings) of lung cancer screening.
Collapse
Affiliation(s)
- Kevin Selby
- Département des policliniques, Département formation, recherche et innovation, Unisanté, 1011 Lausanne
| | | | | | - Jean-Luc Bulliard
- Département épidémiologie et systèmes de santé, Unisanté, 1011 Lausanne
| | | | | | | | | | | | | |
Collapse
|
50
|
Nosotti M, D'Ovidio F, Leiva-Juarez M, Keshavjee S, Rackauskas M, Van Raemdonck D, Ceulemans LJ, Krueger T, Koutsokera A, Schiavon M, Rea F, Iskender I, Moreno P, Alvarez A, Luzzi L, Paladini P, Rosso L, Bertani A, Venuta F, Pecoraro Y, Al-Kattan K, Kubisa B, Inci I. Rare indications for a lung transplant. A European Society of Thoracic Surgeons survey. Interact Cardiovasc Thorac Surg 2020; 31:638-643. [PMID: 33057713 DOI: 10.1093/icvts/ivaa165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 06/04/2020] [Accepted: 07/09/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The European Society of Thoracic Surgeons Lung Transplantation Working Group promoted a survey to evaluate overall survival in a large cohort of patients receiving lung transplants for rare pulmonary diseases. METHODS We conducted a retrospective multicentre study. The primary end point was overall survival; secondary end points were survival of patients with the most common diagnoses in the context of rare pulmonary diseases and chronic lung allograft dysfunction (CLAD)-free survival. Finally, we analysed risk factors for overall survival and CLAD-free survival. RESULTS Clinical records of 674 patients were extracted and collected from 13 lung transplant centres; diagnoses included 46 rare pulmonary diseases. Patients were followed for a median of 3.1 years. The median survival after a lung transplant was 8.5 years. The median CLAD-free survival was 8 years. The multivariable analysis for mortality identified CLAD as a strong negative predictor [hazard ratio (HR) 6.73)], whereas induction therapy was a protective factor (HR 0.68). The multivariable analysis for CLAD occurrence identified induction therapy as a protective factor (HR 0.51). When we stratified patients by CLAD occurrence in a Kaplan-Meier plot, the survival curves diverged significantly (log-rank test: P < 0.001). Patients with rare diseases who received transplants had chronic rejection rates similar to those of the general population who received transplants. CONCLUSIONS We observed that overall survival and CLAD-free survival were excellent. We support the practice of allocating lungs to patients with rare pulmonary diseases because a lung transplant is both effective and ethically acceptable.
Collapse
Affiliation(s)
- Mario Nosotti
- Thoracic Surgery and Lung Transplantation Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Frank D'Ovidio
- Division of Thoracic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Miguel Leiva-Juarez
- Division of Thoracic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Shaf Keshavjee
- Toronto Lung Transplant Program, University Health Network, Toronto, ON, Canada
| | | | - Dirk Van Raemdonck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Laurens J Ceulemans
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Thorsten Krueger
- Division of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Angela Koutsokera
- Lung Transplant Program, Division of Pulmonology, University Hospital of Lausanne, Switzerland
| | - Marco Schiavon
- Department of Cardio-Thoracic Surgery, Padua University Hospital, Padua, Italy
| | - Federico Rea
- Department of Cardio-Thoracic Surgery, Padua University Hospital, Padua, Italy
| | - Ilker Iskender
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Paula Moreno
- Thoracic Surgery and Lung Transplantation Unit, University Hospital Reina Sofia, Cordoba, Spain
| | - Antonio Alvarez
- Thoracic Surgery and Lung Transplantation Unit, University Hospital Reina Sofia, Cordoba, Spain
| | - Luca Luzzi
- Thoracic Surgery, University Hospital of Siena, Siena, Italy
| | - Piero Paladini
- Thoracic Surgery, University Hospital of Siena, Siena, Italy
| | - Lorenzo Rosso
- Thoracic Surgery and Lung Transplantation Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandro Bertani
- Thoracic Surgery and Lung Transplantation Unit, IRCCS - ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Federico Venuta
- Division of Thoracic Surgery, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Ylenia Pecoraro
- Division of Thoracic Surgery, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Khaled Al-Kattan
- Department of Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Bartosz Kubisa
- Department of Thoracic Surgery and Transplantation, Pomeranian Medical University, Szczecin, Poland
| | - Ilhan Inci
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|