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Goto H, Nakanishi K. Right upper lobectomy with mediastinal dissection under uniportal video-assisted thoracoscopic surgery for lung cancer in a patient with a right-sided aortic arch: a case report. J Cardiothorac Surg 2024; 19:136. [PMID: 38504342 PMCID: PMC10949794 DOI: 10.1186/s13019-024-02627-9] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 03/09/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND A right-sided aortic arch is a rare congenital vascular structure variation. Right lobectomy is not commonly performed on patients with such a condition. Further, there are no reports on lobectomy under uniportal video-assisted thoracoscopic surgery (VATS) in this patient group. CASE PRESENTATION A 67-year-old man with a right-sided aortic arch and Kommerell diverticulum underwent right upper lobectomy with mediastinal lymph node dissection under uniportal VATS for primary lung cancer. Due to the right descending aorta, which narrows the space of the dorsal hilum, handling of the stapler for stapling the right upper lobe bronchus from the uniport in the 6th intercostal space at the medial axillary line can be challenging. This issue was resolved by manipulating the staple over the azygos vein toward the inferior margin of the aortic arch. Via mediastinal lymphadenectomy, we found that the right recurrent laryngeal nerve branched from the right vagus nerve and hooked around the right-sided aortic arch. CONCLUSIONS Right lobectomy with mediastinal lymph node dissection under uniportal VATS can be performed for lung cancer in patients with a right-sided aortic arch.
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Affiliation(s)
- Hidenori Goto
- Department of General Thoracic Surgery, National Hospital Organization, Saitama Hospital, Suwa 2-1, Wako, Saitama, 351-0102, Japan.
| | - Kozo Nakanishi
- Department of General Thoracic Surgery, National Hospital Organization, Saitama Hospital, Suwa 2-1, Wako, Saitama, 351-0102, Japan
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Maniwa T, Ohue M, Kanzaki R, Shintani Y, Okami J. Metastatic pathways to the lower zone by segment in patients with clinical T1 lower lobe non-small cell lung cancer. Gen Thorac Cardiovasc Surg 2024:10.1007/s11748-024-02021-1. [PMID: 38498143 DOI: 10.1007/s11748-024-02021-1] [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] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/22/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVE Segmentectomy and mediastinal lymph node dissection (LND) may increasingly be used for non-small cell lung cancer (NSCLC). Lymph node metastasis (LNM) distribution varies by lower lobe segments; however, its segment-specific spread to the lower zone (#8, 9) (LZ) in lower lobe NSCLC is seldom reported. METHODS In total, 352 patients with clinical T1 lower lobe NSCLC who underwent lobectomy with systematic or lobe-specific LND were included for analysis between January 2006 and December 2018. RESULTS Fifty-eight (16.2%) patients had LNM (pN1: 24, pN2: 34), and nine (2.6%) had LZ metastasis. LZ metastasis was significantly more frequent in tumors with diameter > 2 cm, tumors without ground-glass opacity on radiological findings, left lung cancer, and basal segment lung cancer (respectively, p = 0.039, 0.006, 0.0177, 0.0024). None of the S6 NSCLC patients had LZ metastasis. Two patients with right basal segment NSCLC had LZ metastases (tumor on S10) as well as N1 lymph node and subcarinal zone metastasis. Seven (8.4%) patients with left basal segment NSCLC had LZ metastasis (tumor on S8: 3, tumor on S10: 4). Of them, three patients with left basal NSCLC had isolated LZ metastasis. CONCLUSIONS The LND of the LZ can be omitted for clinical T1 patients with S6 NSCLC. In addition, the LND of the LZ may be omitted in right basal NSCLC if intraoperative confirmation of negative N1 and subcarinal zone lymph nodes is obtained; however, it is necessary for left basal segment NSCLC.
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Affiliation(s)
- Tomohiro Maniwa
- Department of General Thoracic Surgery, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-Ku, Osaka, 541-8567, Japan.
- Department of Oncology, Graduate School of Medicine, Osaka University, Osaka, Japan.
| | - Masayuki Ohue
- Department of Oncology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Ryu Kanzaki
- Department of General Thoracic Surgery, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-Ku, Osaka, 541-8567, Japan
| | - Yasushi Shintani
- Department of General Thoracic Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Jiro Okami
- Department of General Thoracic Surgery, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-Ku, Osaka, 541-8567, Japan
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Niskakangas A, Mustonen O, Puro I, Karjula T, Helminen O, Yannopoulos F. Results of video-assisted thoracoscopic surgery versus thoracotomy for lung cancer in a mixed practice medium-volume hospital: a propensity-matched study. Interdiscip Cardiovasc Thorac Surg 2023; 37:ivad189. [PMID: 38011678 DOI: 10.1093/icvts/ivad189] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/15/2023] [Accepted: 11/25/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVES The aim of this study was to compare the short- and long-term results of video-assisted thoracoscopic surgery (VATS) and thoracotomy for non-small-cell lung cancer in a medium-volume centre, where cardiothoracic surgeons perform both cardiac and general thoracic surgery. The primary outcome of interest was 5-year overall survival and disease-specific survival. Secondary outcomes were short-term postoperative complications, length of hospital stay and lymph node yield. METHODS This was a retrospective cohort study including 670 lung cancer patients undergoing VATS (n = 207) or open surgery (n = 463) with a curative intent in Oulu University Hospital between the years 2000-2020. Propensity score matching was implemented with surgical technique as the dependent and age, sex, Charlson comorbidity index, pulmonary function, pathological stage, histological type and the year of the operation as covariates resulting in 127 pairs. RESULTS In the propensity-matched cohort, 5-year overall survival was 64.3% after VATS and 63.2% after thoracotomy (P = 0.969). Five-year disease-specific survival was 71.6% vs 76.2% (P = 0.559). There were no differences in overall (34.6% vs 44.9%, p = 0.096) or major postoperative complications (8.7% vs 14.2%, P = 0.167) between the study groups. The average length of hospital stay was shorter (5.8 vs 6.6 days, P = 0.012) and the median lymph node yield was lower (4.0 vs 7.0, P < 0.001) in the VATS group compared to the thoracotomy group. CONCLUSIONS According to this study, the long-term results of lung cancer surgery in a mixed practice are comparable between VATS and open surgery.
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Affiliation(s)
- Anne Niskakangas
- Research Unit of Translational Medicine, Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Olli Mustonen
- Research Unit of Translational Medicine, Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Iiris Puro
- Research Unit of Translational Medicine, Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Topias Karjula
- Research Unit of Translational Medicine, Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Olli Helminen
- Research Unit of Translational Medicine, Medical Research Center Oulu, University of Oulu, Oulu, Finland
- Department of Gastrointestinal Surgery, Oulu University Hospital, Oulu, Finland
| | - Fredrik Yannopoulos
- Research Unit of Translational Medicine, Medical Research Center Oulu, University of Oulu, Oulu, Finland
- Department of Cardiothoracic Surgery, Oulu University Hospital, Oulu, Finland
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Fujita T, Koyanagi A, Kishimoto K. Treatment outcomes of lobectomy with and without mediastinal lymph node dissection in older patients with clinical N0 non-small cell lung cancer. Asian Cardiovasc Thorac Ann 2023:2184923231180778. [PMID: 37291960 DOI: 10.1177/02184923231180778] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND To reduce surgical stress, we omit mediastinal lymph node dissection (MLND) in patients with non-small cell lung cancer aged ≥80 years without N1 metastasis, as confirmed via surgery. This study examined the effect of MLND omission on prognosis. METHODS Altogether, 212 eligible patients with clinical N0 non-small cell lung cancer underwent video-assisted thoracoscopic lobectomy between 2007 and 2017. Patients were classified into two groups as follows: patients aged 75-79 years who underwent MLND group, and patients aged ≥80 years in whom MLND was omitted (non-MLND group). Propensity score matching was performed between the two groups. RESULTS There were 86 patients after matching. The non-MLND group showed shorter operative time (237.5 min vs. 207.5 min, p = 0.018). No differences in postoperative complications were noted between the two groups. Between the MLND group and non-MLND group, the 5-year overall survival rates were 84.0% and 84.7% (p = 0.989), relapse-free survival rates were 69.8% and 74.7% (p = 0.855), and cancer-specific survival rates were 91.4% and 91.6% (p = 0.700), respectively. These results did not differ significantly. CONCLUSION This study demonstrated that MLND does not affect the prognosis of patients with non-small cell lung cancer aged ≥80 years. Lobectomy without MLND is one of the surgical treatment options in older patients with clinical N0 non-small cell lung cancer. Naturally, the clinical stage of patients must be carefully evaluated before surgery.
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Affiliation(s)
- Tomohiro Fujita
- National Hospital Organization Hamada Medical Center, Shimane University Hospital, Shimane, Japan
- Department of Thoracic Surgery, Shimane University Hospital, Shimane, Japan
| | - Akira Koyanagi
- National Hospital Organization Hamada Medical Center, Shimane University Hospital, Shimane, Japan
- Department of Thoracic Surgery, Shimane University Hospital, Shimane, Japan
| | - Koji Kishimoto
- National Hospital Organization Hamada Medical Center, Shimane University Hospital, Shimane, Japan
- Department of Thoracic Surgery, Shimane University Hospital, Shimane, Japan
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Hartert M, Huertgen M. Portrayal of video-assisted mediastinoscopic lymphadenectomy's range subsequent to its simultaneous use with uniportal VAT-lobectomy for left-sided NSCLC: a case-based perspective. J Cardiothorac Surg 2023; 18:152. [PMID: 37069572 PMCID: PMC10111845 DOI: 10.1186/s13019-023-02277-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/05/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Video-assisted mediastinoscopic lymphadenectomy (VAMLA) is the most precise approach combining staging and therapeutic interventions in non-small cell lung cancer (NSCLC). In the case of left-sided NSCLC, the likelihood of mediastinal lymph node metastases depends on the involvement of the left lung regional lymphatic network. As such, it appears obvious - at least for selected patients with mediastinal staging by either PET-CT or EBUS-TBNA ± EUS-FNA and with cN ≤ 2 - to merge VAMLA and left-sided video-assisted thoracoscopic (VAT) lobectomy for a single-stage therapeutical procedure. CASE PRESENTATION We present the clinical course of an 83-year-old patient following simultaneous VAMLA and VAT-lobectomy for invasive mucinous adenocarcinoma of the left upper lobe with a provisional cT3cN0cM0 stage. The patient developed a clinically relevant postoperative pneumothorax due to a persistent parenchymal air leak. CT scan revealed a substantial pneumomediastinum and showed the capability of VAMLAs range for mediastinal lymph node dissection in a unique way. Following the prompt insertion of a second chest tube, the situation was stabilized with an unremarkable further in-hospital stay. The patient remains free of tumor recurrence or distant metastases at a one-year follow-up. CONCLUSION Presenting this aperçu, we encourage reviving the debate on (1) precise mediastinal staging in general and (2) VAMLA's important role as a diagnostic and therapeutic tool.
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Affiliation(s)
- Marc Hartert
- Department of Thoracic Surgery, Katholisches Klinikum Koblenz-Montabaur, Rudolf-Virchow-Str. 7-9, 56073, Koblenz, Germany.
| | - Martin Huertgen
- Department of Thoracic Surgery, Katholisches Klinikum Koblenz-Montabaur, Rudolf-Virchow-Str. 7-9, 56073, Koblenz, Germany
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Wang Z, Wang Y, Sun D. A retrospective and prospective study to establish a preoperative difficulty predicting model for video-assisted thoracoscopic lobectomy and mediastinal lymph node dissection. BMC Surg 2022; 22:135. [PMID: 35392865 PMCID: PMC8991718 DOI: 10.1186/s12893-022-01566-3] [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: 07/25/2021] [Accepted: 03/18/2022] [Indexed: 12/03/2022] Open
Abstract
Background In previous studies, the difficulty of surgery has rarely been used as a research object. Our study aimed to develop a predictive model to enable preoperative prediction of the technical difficulty of video-assisted thoracoscopic lobectomy and mediastinal lymph node dissection using retrospective data and to validate our findings prospectively. Methods Collected data according to the designed data table and took the operation time as the outcome variable. A nomogram to predict the difficulty of surgery was established through Lasso logistic regression. The prospective datasets were analyzed and the outcome was the operation time. Results This retrospective study enrolled 351 patients and 85 patients were included in the prospective datasets. The variables in the retrospective research were selected by Lasso logistic regression (only used for modeling and not screening), and four significantly related influencing factors were obtained: FEV1/FVC (forced expiratory volume in the first second/forced vital capacity) (p < 0.001, OR, odds ratio = 0.89, 95% CI, confidence interval = 0.84–0.94), FEV1/pred FEV1 (forced expiratory volume in the first second/forced expiratory volume in the first second in predicted) (p = 0.076, OR = 0.98, 95% CI = 0.95–1.00), history of lung disease (p = 0.027, OR = 4.00, 95% CI = 1.27–15.64), and mediastinal lymph node enlargement or calcification (p < 0.001, OR = 9.78, 95% CI = 5.10–19.69). We used ROC (receiver operating characteristic) curves to evaluate the model. The training set AUC (area under curve) value was 0.877, the test set’s AUC was 0.789, and the model had a good calibration curve. In a prospective study, the data obtained in the research cohort were brought into the model again for verification, and the AUC value was 0.772. Conclusion Our retrospective study identified four preoperative variables that are correlated with a longer surgical time and can be presumed to reflect more difficult surgical procedures. Our prospective study verified that the variables in the prediction model (including prior lung disease, FEV1/pred FEV1, FEV1/FVC, mediastinal lymph node enlargement or calcification) were related to the difficulty.
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Affiliation(s)
- Zixiao Wang
- Tianjin Medical University, Heping, Tianjin, 300070, People's Republic of China
| | - Yuhang Wang
- Tianjin Medical University, Heping, Tianjin, 300070, People's Republic of China
| | - Daqiang Sun
- Department of Thoracic Surgery, Tianjin Chest Hospital, Jinnan, Tianjin, 300222, People's Republic of China. .,Department of Thoracic Surgery, Tianjin Hospital of ITCWM Nankai Hospital, No. 6 Changjiang Road, Nankai, Tianjin, 300100, People's Republic of China.
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Abstract
Background We report a case of bradycardia improved by surgical resection of the paratracheal lymph nodes, which has rarely been reported in the literature. Case presentation A 41-year-old male patient with pre-operative sinus bradycardia was diagnosed with right upper lobe adenocarcinoma. He planned to undergo VATS right upper lobectomy and mediastinal lymph node dissection. Consultation indicated that there was no need to place a temporary pacemaker. Severe sinus bradycardia occurred during induction of anesthesia and heart rate (HR) fell significantly from 52 to 28 bpm. There was no response to atropine. Isoproterenol was administered continuously for two hours at 0.01 µg per kg per minute to keep the patient’s HR around 50 bpm. During the operation, it was noted that the right upper mediastinal lymph nodes (group R2 and R4) were calcified and very close to the vagus nerve. After resection of the lymph nodes, the patient’s HR returned to 60–68 bpm without isoproterenol. There were no post-operative complications and the patient was discharged on the 5th post-operative day. The pathological findings indicated invasive adenocarcinoma with no lymph node metastases. One month after surgery, 24-h Holter monitoring revealed sinus rhythm without bradycardia. Six months after surgery no sinus bradycardia has occurred thus far. Conclusions Patients with persistent sinus bradycardia pre-operation caused by vagus nerve compression deserve attention. Guidelines on placement of temporary pacemakers and intraoperative anesthesia management may be improved by additional clinical experience.
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Affiliation(s)
- Jin Wei
- Department of Anesthesiology, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Ling Yu
- Department of Anesthesiology, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Nan Wu
- Department of Thoracic Surgery II, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Hongyu Tan
- Department of Anesthesiology, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, 100142, China.
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Martijn VD, Jelle Egbert B, Bart T, Christian D, Frank Jozef Christiaan VDB, Wilhelmina Hendrika S, Michel G, Geert K, David Jonathan H. Pulmonary metastasectomy with lymphadenectomy for colorectal pulmonary metastases: A systematic review. Eur J Surg Oncol 2021; 48:253-260. [PMID: 34656390 DOI: 10.1016/j.ejso.2021.09.020] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 09/19/2021] [Accepted: 09/27/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Routine lymphadenectomy during metastasectomy for pulmonary metastases of colorectal cancer has been recommended by several recent expert consensus meetings. However, evidence supporting lymphadenectomy is limited. The aim of this study was to perform a systematic review of the literature on the impact of simultaneous lymph node metastases on patient survival during metastasectomy for colorectal pulmonary metastases (CRPM). METHODS A systematic review was conducted according to the PRISMA guidelines of studies on lymphadenectomy during pulmonary metastasectomy for CRPM. Articles published between 2000 and 2020 were identified from Medline, Embase and the Cochrane Library without language restriction. Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to assess the risk of bias and applicability of included studies. Survival rates were assessed and compared for the presence and level of nodal involvement. RESULTS Following review of 8054 studies by paper and abstract, 27 studies comprising 3619 patients were included in the analysis. All patients included in these studies underwent lymphadenectomy during pulmonary metastasectomy for CRPM. A total of 690 patients (19.1%) had simultaneous lymph node metastases. Five-year overall survival for patients with and without lymph node metastases was 18.2% and 51.3%, respectively (p < .001). Median survival for patients with lymph node metastases was 27.9 months compared to 58.9 months in patients without lymph node metastases (p < .001). Five-year overall survival for patients with N1 and N2 lymph node metastases was 40.7% and 10.9%, respectively (p = .064). CONCLUSION Simultaneous lymph node metastases of CRPM have a detrimental impact on survival and this is most apparent for mediastinal lymph node metastases. Therefore, lymphadenectomy during pulmonary metastasectomy for CRPM can be advised to obtain important prognostic value.
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Affiliation(s)
- van Dorp Martijn
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Cancer Center Amsterdam, De Boelelaan, 1117, Amsterdam, the Netherlands.
| | | | - Torensma Bart
- Leiden University Medical Centre, Department of Anesthesiology, Albinusdreef 2, Leiden, the Netherlands
| | - Dickhoff Christian
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Cancer Center Amsterdam, De Boelelaan, 1117, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Cardiothoracic Surgery, Cancer Center Amsterdam, De Boelelaan, 1117, Amsterdam, the Netherlands
| | | | | | - Gonzalez Michel
- Centre Hospitalier Vaudois, Department of Thoracic Surgery, Rue du Bugnon 46, Lausanne, Switzerland
| | - Kazemier Geert
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Cancer Center Amsterdam, De Boelelaan, 1117, Amsterdam, the Netherlands
| | - Heineman David Jonathan
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Cancer Center Amsterdam, De Boelelaan, 1117, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Cardiothoracic Surgery, Cancer Center Amsterdam, De Boelelaan, 1117, Amsterdam, the Netherlands
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Maniwa T, Kimura T, Ohue M, Okami J. Mediastinal lymph node dissection in older patients with non-small cell lung cancer. Surg Today 2021. [PMID: 34524511 DOI: 10.1007/s00595-021-02373-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/15/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE We evaluated the impact of omitting mediastinal lymph node dissection (MLND) from the surgical treatment of non-small cell lung cancer (NSCLC) in older patients. METHODS We collected data retrospectively on 2475 patients who underwent pulmonary resection for NSCLC at our hospital between June, 2006 and December 2018. The subjects of this analysis were 209 patients aged ≥ 75 years who underwent lobectomy for cN0-1 NSCLC. The patients were divided into two groups based on whether they underwent MLND (ND2 group) or not (group ND0-1). RESULTS There were more patients aged ≥ 80 years in the ND0-1 group than in the ND2 group (p < 0.001). Patients in the ND0-1 group had clinically earlier stage lung cancers than those in the ND2 group (p = 0.053). We matched patient characteristics in the ND0-1 and ND2 groups by age, tumor diameter, cN, histology, and radiological findings. There were no significant differences in overall survival between the groups (p = 0.295). More patients in the ND2 group suffered complications (41.6% vs. 27.3%, p = 0.061) and arrhythmia episodes than those in the ND0-1 group (14.3% vs. 3.9%, p = 0.021). CONCLUSION MLND in older patients may not extend survival but it could lead to complications. Thus, the omission of MLND may be considered for patients of advanced age.
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Katsumata S, Tane K, Suzuki J, Miyoshi T, Samejima J, Aokage K, Ishii G, Tsuboi M. Mediastinal lymph node dissection for the elderly with clinical stage I non-small cell lung cancer. Gen Thorac Cardiovasc Surg 2021. [PMID: 34050889 DOI: 10.1007/s11748-021-01656-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/22/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES We aimed to compare the differences in prognosis and perioperative complications between patients with and without mediastinal lymph node dissection (MLND) among elderly patients with clinical stage I non-small cell lung cancer (NSCLC). METHODS We analysed 439 patients ≥ 75 years of age with NSCLC classified as clinical stage I who underwent complete resection with lobectomy. We divided the patients into two groups. Those with MLND were included in the MLND group (n = 365), and those without MLND or adequate systematic mediastinal lymph node sampling were included in the non-MLND group (n = 74). To reduce selection bias, a propensity score matching method (3:1) was implemented. We compared survival and the incidence of perioperative complications. RESULTS After matching, we compared 171 patients in the MLND group to 57 patients in the non-MLND group. There were no significant differences in clinicopathological characteristics between the groups. The non-MLND group did not show a significantly better prognosis than the MLND group in overall survival and cancer-specific survival (p = 0.246 and 0.150, respectively). The cumulative incidence of recurrence was similar in the two groups. MLND did not affect chest drain duration or hospitalization. The numbers of patients with perioperative complications ≥ grade 2 or ≥ grade 3 did not differ between the groups (p = 0.312 and > 0.999, respectively). CONCLUSIONS Anatomical pulmonary resection without MLND might be a treatment option for elderly patients with clinical stage I NSCLC. Further investigation is needed to clarify the value of MLND, especially for vulnerable elderly individuals.
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Pan L, Mo R, Zhu L, Yu W, Lv W, Hu J. Time trend of mediastinal lymph node dissection in stage IA non-small cell lung cancer patient who undergo lobectomy: a retrospective study of surveillance, epidemiology, and end results (SEER) database. J Cardiothorac Surg 2020; 15:207. [PMID: 32738925 PMCID: PMC7395351 DOI: 10.1186/s13019-020-01215-x] [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: 02/26/2020] [Accepted: 07/07/2020] [Indexed: 12/25/2022] Open
Abstract
Background Although lobectomy with mediastinal lymph node dissection (MLND) is the first option for early-stage non-small cell lung cancer (NSCLC) patients, the time trends of MLND in stage IA NSCLC patients who undergo a lobectomy are not clear still. Methods We included stage IA NSCLC patients who underwent lobectomy or lobectomy with MLND between 2003 and 2013 in the SEER database. The time trend of MLND was compared among patients who underwent a lobectomy. Results For stage T1a patients, the lobectomy group and lobectomy with MLND group had no differences in postoperative overall survival (OS) (P = 0.34) or lung-cancer specific survival (LCSS) (P = 0.18) between 2003 and 2013. For stage T1b patients, the OS (P = 0.01) and LCSS (P = 0.01) were different between the lobectomy group and the lobectomy with MLND group in the period from 2003 to 2009; however, only OS (P = 0.04), not LCSS (P = 0.14), was different between the lobectomy group and the lobectomy with MLND group between 2009 and 2013. For T1c patients, the OS (P = 0.01) and LCSS (P = 0.02) were different between the two groups between 2003 and 2009 but not between 2009 and 2013 (P = 0.60; P = 0.39). From the Cox regression analysis, we found that the factors affecting OS/LCSS in T1b and T1c patients were age, sex, year of diagnosis, histology, and grade, in which year of diagnosis was the obvious factor (HR = 0.79, CI = 0.71–0.87; HR = 0.73, CI = 0.64–0.84). Conclusions There was a time trend in prognosis differences between the lobectomy group and lobectomy with MLND group for T1b and T1c stage NSCLC patients.
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Affiliation(s)
- Liang Pan
- Department of thoracic surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, China
| | - Ran Mo
- Department of thoracic surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, China
| | - Linhai Zhu
- Department of thoracic surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, China
| | - Wenfeng Yu
- Department of thoracic surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, China
| | - Wang Lv
- Department of thoracic surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, China
| | - Jian Hu
- Department of thoracic surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, China.
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Han WH, Eom BW, Yoon HM, Reim D, Kim YW, Kim MS, Lee JM, Ryu KW. The optimal extent of lymph node dissection in gastroesophageal junctional cancer: retrospective case control study. BMC Cancer 2019; 19:719. [PMID: 31331305 PMCID: PMC6647315 DOI: 10.1186/s12885-019-5922-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 08/22/2018] [Accepted: 07/11/2019] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Recently, the incidence of gastroesophageal junction (GEJ) cancer has been increasing in Eastern countries. Mediastinal lymph node (MLN) metastasis rates among patients with GEJ cancer are reported to be 5-25%. However, survival benefits associated with MLN dissection in GEJ cancer has been a controversial issue, especially in Eastern countries, due to its rarity and potential morbidity. METHODS We retrospectively reviewed 290 patients who underwent surgery for GEJ cancer at the National Cancer Center in Korea from June 2001 to December 2015. Clinicopathologic characteristics and surgical outcomes were compared between patients without MLN dissection (Group A) and patients with MLN dissection (Group B). Prognostic factors associated with the survival rate were identified in a multivariate analysis. RESULTS Twenty-nine (10%) patients underwent MLN dissection (Group B). Three of 29 patients (10.3%) showed a metastatic MLN in Group B. For abdominal LNs, the 5-year disease-free survival rate was 79.5% in Group A and 33.9% in Group B (P < 0.001). The multivariate analysis revealed that abdominal LN dissection, pT category, and pN category were statistically significant prognostic factors. LNs were the most common site for recurrence in both groups. CONCLUSION Abdominal LN dissection and pathologic stage are the important prognostic factors for type II and III GEJ cancer rather than mediastinal lymph node dissection.
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Affiliation(s)
- Won Ho Han
- Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, 410-769, Republic of Korea
| | - Bang Wool Eom
- Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, 410-769, Republic of Korea
| | - Hong Man Yoon
- Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, 410-769, Republic of Korea
| | - Daniel Reim
- Department of Surgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, Munich, Germany
| | - Young-Woo Kim
- Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, 410-769, Republic of Korea
| | - Moon Soo Kim
- Center for Lung Cancer, Research Institute & Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, 410-769, Republic of Korea
| | - Jong Mog Lee
- Center for Lung Cancer, Research Institute & Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, 410-769, Republic of Korea
| | - Keun Won Ryu
- Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, 410-769, Republic of Korea.
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Allakhverdiev A, Davydov M, Akhmedov P. Thoracoscopic lobectomy with mediastinal lymph node dissection as a standard surgery for T1-2N0M0 non-small cell lung cancer (>300 surgeries experience). Ann Med Surg (Lond) 2018; 35:169-172. [PMID: 30319774 PMCID: PMC6180294 DOI: 10.1016/j.amsu.2018.09.022] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 09/01/2018] [Accepted: 09/18/2018] [Indexed: 01/05/2023] Open
Abstract
Background A lot of clinics worldwide in recent years recommend the use of minimally invasive surgical procedures in the early stages of lung cancer claiming that this technique helps reduce the number of postoperative complications, shortens the period of social rehabilitation of patients, without significantly affecting the long-term results of treatment. In this study we evaluate immediate and long-term results of surgical treatment of patients with early stages of non-small cell lung cancer (NSCLC) after video-assisted thoracoscopic lobectomy (VATS) with mediastinal lymph node dissection. Materials and methods Since 2008 317 patients with T1-2N0M0 NSCLC over 20 (median age was 65.3 ± 2.5) years underwent VATS with mediastinal lymphadenectomy. Total number of men was 186 (58.7%), women - 131 (41.3%). Histologically verified adenocarcinoma was in 278 (87, 7%), Squamous cell carcinoma in 39 (12.3%). A group of patients who underwent thoracotomy lobectomy (n = 189) was taken to compare immediate and long-term results. Median age in this group was 66.5 ± 1.7. Total number of men was 115, women - 74. Histologically verified adenocarcinoma was in 154 (82.4%), Squamous cell carcinoma in 35 (17.6%). Results Conversion to thoracotomy during VATS was in 14.3% of surgeries. There was no postoperative mortality in VATS group, whereas in open surgeries this happened in 2.6%. The 3 and 5-year overall survival (OS) rate was 94.0% and 94.0% in the VATS group respectively, 83.0% and 78.0% in the thoracotomy group for clinical stage T1N0M0 NSCLC (p = 0.04554). Conclusion Considering the results of our research and the literature review we made sure that VATS lobectomy with mediastinal lymph node dissection is an alternative procedure to open approaches: it is much safer, reduce the frequency of post-operative complications and the rehabilitation period. We believe that complete VATS lobectomy with mediastinal lymph node dissection must be taken as a standard in surgical treatment of patients with early stages of non-small cell lung cancer.
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Affiliation(s)
- Arif Allakhverdiev
- Department of Thoracic Surgery, N.N. Blokhin Cancer Research Center, Kashirskoe Road 23, 115478, Moscow, Russian Federation
| | - Mikhail Davydov
- Department of Thoracic Surgery, N.N. Blokhin Cancer Research Center, Kashirskoe Road 23, 115478, Moscow, Russian Federation
| | - Parvin Akhmedov
- Department of Thoracic Surgery, N.N. Blokhin Cancer Research Center, Kashirskoe Road 23, 115478, Moscow, Russian Federation
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Huang C, Xu X, Chen Q, Lin S. Video-assisted thoracoscopic right upper lobectomy in a patient with a right-sided aortic arch and Kommerell diverticulum. World J Surg Oncol 2018; 16:178. [PMID: 30165866 PMCID: PMC6117877 DOI: 10.1186/s12957-018-1477-4] [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: 04/29/2018] [Accepted: 08/21/2018] [Indexed: 11/30/2022] Open
Abstract
Background It is a very rare condition for a patient to have right lung cancer and a right-sided aortic arch simultaneously. Right lobectomy under video-assisted thoracoscopic surgery (VATS) in such a patient is a challenging procedure that is seldom reported. We successfully performed a VATS right upper lobectomy in a 77-year-old female with a right-sided aortic arch and Kommerell diverticulum. Case presentation A 77-year-old woman was referred to our division for a mixed ground-glass opacity lesion in the right upper lung. A right-sided aortic arch with Kommerell diverticulum was identified by preoperative 3D CT reconstruction. A VATS right upper lobectomy with radical mediastinal lymph node dissection was performed, and the final histological staging was Ia3 (pT1cN0M0). The patient was discharged without any complications. Conclusions We conclude that the video-assisted thoracic surgery can be safely performed in such conditions. It is difficult to determine the extent of upper mediastinal lymph node dissection in such cases.
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Affiliation(s)
- Chen Huang
- Department of Thoracic Surgery, Fujian Provincial Hospital, Provincial Clinical College of Fujian Medical University, No. 134 East St., Fuzhou, 350001, Fujian, China
| | - Xunyu Xu
- Department of Thoracic Surgery, Fujian Provincial Hospital, Provincial Clinical College of Fujian Medical University, No. 134 East St., Fuzhou, 350001, Fujian, China.
| | - Qianshun Chen
- Department of Thoracic Surgery, Fujian Provincial Hospital, Provincial Clinical College of Fujian Medical University, No. 134 East St., Fuzhou, 350001, Fujian, China
| | - Shengmei Lin
- Department of Radiology, Fujian Provincial Hospital, Fuzhou, 350001, China
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15
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Kim HK, Lee K, Han KN, Eo JS, Kim S, Choi YH. The predictive accuracy of sentinel nodes mapping in the setting of pulmonary metastasectomy. Clin Exp Metastasis 2017; 34:125-31. [PMID: 28062976 DOI: 10.1007/s10585-016-9834-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 12/28/2016] [Indexed: 02/07/2023]
Abstract
This is the first study to evaluate the feasibility of mediastinal lymph node dissection (MLND) based on sentinel lymph node (SLN) status during pulmonary metastasectomy. A total of 22 patients (16 men, 6 women; age 63.3 ± 7.01 years) who were candidates for metastasectomy through segmentectomy or lobectomy with MLND owing to cancers metastatic to the lung were enrolled in this study. Radiotracer was administered at the peritumoral region before surgery or soon after initiating surgery. During the operation, the radioactivity of the lymph nodes (ex vivo) was counted with a handheld gamma probe after MLND. Lobectomy was performed in 17 patients, and segmentectomy, in 5 patients. The number of dissected lymph nodes per patient was 14.4 ± 8.69 (range, 5–36). In all patients, the SLN could be detected, and the number of SLNs identified was 2.0 ± 1.15 (range, 1–5) per patient. Lymph node metastasis was identified in 3 of the 22 patients (13.6%), and none of the 3 patients with N1 or N2 disease had false-negative SLNs. SLN identification might be an indicator of whether or not MLND should be performed during pulmonary metastasectomy. However, further large-volume and multi-institutional studies are needed.
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Hikage M, Kamei T, Nakano T, Abe S, Katsura K, Taniyama Y, Sakurai T, Teshima J, Ito S, Niizuma N, Okamoto H, Fukutomi T, Yamada M, Maruyama S, Ohuchi N. Impact of routine recurrent laryngeal nerve monitoring in prone esophagectomy with mediastinal lymph node dissection. Surg Endosc 2016; 31:2986-2996. [PMID: 27826777 DOI: 10.1007/s00464-016-5317-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [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: 04/07/2016] [Accepted: 10/25/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND The problem of recurrent laryngeal nerve (RLN) paralysis (RLNP) after radical esophagectomy remains unresolved. Several studies have confirmed that intraoperative nerve monitoring (IONM) of the RLN during thyroid surgery substantially decreases the incidence of RLN damage. This study tried to determine the feasibility and effectiveness of IONM of the RLN during thoracoscopic esophagectomy in the prone position for esophageal cancer. METHODS All 108 patients who underwent prone esophagectomy at Tohoku University Hospital between July 2012 and March 2015 were included in this study. We divided patients into two groups: a control group (No-Monitoring group, surgery without IONM; n = 54) and a study group (Monitoring group, surgery with IONM; n = 54). In Monitoring group, neural stimulation was performed for both RLNs before and after dissection in the thoracic procedure, then for RLNs and vagus nerves (VNs) in the cervical procedure. The feasibility of IONM in Monitoring group and early surgical outcomes were retrospectively compared with those in No-Monitoring group. RESULTS IONM could be performed for 47 cases (87.0%) in Monitoring group. Reasons for discontinuation were use of muscle relaxants (3 patients), change in thoracotomy procedure (2 patients), past rib bone fracture (1 patient), and allergic shock by transfusion (1 patient). Right RLNPs were identified postoperatively in 4 patients, and left RLNPs in 23 patients. IONM sensitivities were 92.7 and 88.0% for the right and left VNs, respectively. Incidences of postoperative RLNP, aspiration, and primary pneumonia did not differ significantly between groups. CONCLUSIONS This study confirmed the feasibility and safety of IONM of the RLN for thoracoscopic esophagectomy in the prone position. No significant differences in postoperative outcomes were seen between esophagectomy with and without IONM.
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Affiliation(s)
- Makoto Hikage
- Department of Surgery, Division of Organ Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.
| | - Takashi Kamei
- Department of Surgery, Division of Organ Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Toru Nakano
- Department of Surgery, Division of Organ Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Shigeo Abe
- Department of Surgery, Division of Organ Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Kazunori Katsura
- Department of Surgery, Division of Organ Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Yusuke Taniyama
- Department of Surgery, Division of Organ Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Tadashi Sakurai
- Department of Surgery, Division of Organ Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Jin Teshima
- Department of Surgery, Division of Organ Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Soichi Ito
- Department of Surgery, Division of Organ Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Nobuchika Niizuma
- Department of Surgery, Division of Organ Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Hiroshi Okamoto
- Department of Surgery, Division of Organ Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Toshiaki Fukutomi
- Department of Surgery, Division of Organ Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Masato Yamada
- Department of Surgery, Division of Organ Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Shota Maruyama
- Department of Surgery, Division of Organ Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Noriaki Ohuchi
- Department of Surgical Oncology, Graduate School of Medicine, Tohoku University, Sendai, Japan
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Toishi M, Yoshida K, Agatsuma H, Sakaizawa T, Eguchi T, Saito G, Hashizume M, Hamanaka K, Shiina T. Usefulness of vessel-sealing devices for ≤7 mm diameter vessels: a randomized controlled trial for human thoracoscopic lobectomy in primary lung cancer. Interact Cardiovasc Thorac Surg 2014; 19:448-55. [PMID: 24893872 DOI: 10.1093/icvts/ivu176] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Vessel-sealing devices (VSDs) are widely used for various surgical procedures, including thoracoscopic surgery, but very few reports have compared their safety and usefulness with human thoracoscopic lobectomy procedures not employing VSDs. METHODS Primary lung cancer patients for whom a thoracoscopic lobectomy involving mediastinal lymph node dissection was planned in our department from April 2011 to March 2013 were recruited for the study. Patients were randomly allocated to a control group (n = 14) or a VSD group (n = 44), which comprised three sub-groups, namely EnSeal (n = 17), LigaSure (n = 15) and Harmonic (n = 12). The control group comprised patients undergoing surgery solely with ligation and conventional electrocautery. EnSeal, LigaSure and Harmonic were chosen because they are the three most popular disposable VSDs used in Japan. In the VSD groups, the proximal side of pulmonary artery stumps (≤7 mm diameter) were ligated and then treated with respective devices. Primary end-points were burst pressure of the pulmonary artery stump (measured using resected specimens), operative time, intraoperative blood loss, instances of endostapler use, intraoperative surgeon stress (assessed by visual analogue scale) and postoperative drainage volume and duration. As a secondary objective, the individual VSD groups were also compared with each other. RESULTS The burst pressure of ligation-treated pulmonary artery stumps was higher than that of VSD-treated stumps (P <0.0001). The burst pressure of <5-mm-wide VSD-treated stumps was higher than that of ≥5-mm-wide stumps (P = 0.0421). However, the burst pressure for all groups and all vessel diameters was sufficient to withstand the physiological pulmonary artery pressure. The VSD group demonstrated reduced intraoperative blood loss (P = 0.0241), surgeon stress (P = 0.0002), postoperative drainage volume (P = 0.0358) and shortened postoperative drainage duration (P = 0.0449). Operative time and the instances of endostapler use did not significantly differ. Comparison between each of the VSD groups revealed no significant differences. None of the patients experienced serious perioperative complications or died because of surgery. CONCLUSION VSD is simple and safe to use in thoracoscopic lobectomy involving mediastinal lymph node dissection for primary lung cancer. Furthermore, none of the VSDs used in this study presented any observable differences in quality that could lead to clinical problems.
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Affiliation(s)
- Masayuki Toishi
- Department of Thoracic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kazuo Yoshida
- Department of Thoracic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hiroyuki Agatsuma
- Department of Thoracic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takao Sakaizawa
- Department of Thoracic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takashi Eguchi
- Department of Thoracic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Gaku Saito
- Department of Thoracic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Masahiro Hashizume
- Department of Thoracic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kazutoshi Hamanaka
- Department of Thoracic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takayuki Shiina
- Department of Thoracic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
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