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Hekmat K, Bruns CJ. [Lobectomy vs. segmental resection of peripheral solid non-small cell lung cancer]. Chirurgie (Heidelb) 2024; 95:410-411. [PMID: 38587677 DOI: 10.1007/s00104-024-02073-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/08/2024] [Indexed: 04/09/2024]
Affiliation(s)
- Khosro Hekmat
- Klinik und Poliklinik für Herz- und Thoraxchirurgie, Universität zu Köln, Kerpener Straße 62, 50931, Köln, Deutschland.
| | - Christiane J Bruns
- Klinik und Poliklinik Allgemein‑, Viszeral- und Tumorchirurgie, Universität zu Köln, Kerpener Straße 62, 50931, Köln, Deutschland
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Munir MM, Woldesenbet S, Endo Y, Dillhoff M, Cloyd J, Ejaz A, Pawlik TM. Variation in Hospital Mortality After Complex Cancer Surgery: Patient, Volume, Hospital or Social Determinants? Ann Surg Oncol 2024; 31:2856-2866. [PMID: 38194046 PMCID: PMC10997543 DOI: 10.1245/s10434-023-14852-y] [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: 09/27/2023] [Accepted: 12/17/2023] [Indexed: 01/10/2024]
Abstract
INTRODUCTION We sought to define the individual contributions of patient characteristics (PCs), hospital characteristics (HCs), case volume (CV), and social determinants of health (SDoH) on in-hospital mortality (IHM) after complex cancer surgery. METHODS The California Department of Health Care Access and Information database identified patients who underwent esophagectomy (ES), pneumonectomy (PN), pancreatectomy (PD), or proctectomy (PR) for a malignant diagnosis between 2010 and 2020. Multi-level multivariable regression was performed to assess the proportion of variance explained by PCs, HCs, CV and SDoH on IHM. RESULTS A total of 52,838 patients underwent cancer surgery (ES: n = 2,700, 5.1%; PN: n = 30,822, 58.3%; PD: n = 7530, 14.3%; PR: n = 11,786, 22.3%) across 294 hospitals. The IHM for the overall cohort was 1.7% and varied from 4.4% for ES to 0.8% for PR. On multivariable regression, PCs contributed the most to the variance in IHM (overall: 32.0%; ES: 21.6%; PN: 28.0%; PD: 20.3%; PR: 39.9%). Among the overall cohort, CV contributed 2.4%, HCs contributed 1.3%, and SDoH contributed 1.2% to the variation in IHM. CV was the second highest contributor to IHM among ES (5.3%), PN (5.3%), and PD (5.9%); however, HCs were a more important contributor among patients who underwent PR (8.0%). The unexplained variance in IHM was highest among ES (72.4%), followed by the PD (67.5%) and PN (64.6%) patient groups. CONCLUSIONS PCs are the greatest underlying contributor to variations in IHM following cancer surgery. These data highlight the need to focus on optimizing patients and exploring unexplained sources of IHM to improve quality of surgical care.
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Affiliation(s)
- Muhammad Musaab Munir
- Department of Surgery, Wexner Medical Center and James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Selamawit Woldesenbet
- Department of Surgery, Wexner Medical Center and James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Yutaka Endo
- Department of Surgery, Wexner Medical Center and James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Mary Dillhoff
- Department of Surgery, Wexner Medical Center and James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Jordan Cloyd
- Department of Surgery, Wexner Medical Center and James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Aslam Ejaz
- Department of Surgery, Wexner Medical Center and James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, Wexner Medical Center and James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.
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Kazzi B, Mankuzhy NP, Swami N, Jain B, Patel TA, Chan JSK, Lam MB, Tian S, Dee EC. Surgical Resection Delays among Patients with Stage 1 Lung Cancer: A Study with Disaggregated Ethnic Groups. Ann Surg Oncol 2024; 31:2818-2823. [PMID: 38282026 DOI: 10.1245/s10434-024-14952-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 01/09/2024] [Indexed: 01/30/2024]
Affiliation(s)
- Bahaa Kazzi
- Hope Clinic of the Emory Vaccine Center, Emory University School of Medicine Decatur, Atlanta, GA, USA
| | - Nikhil P Mankuzhy
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nishwant Swami
- Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Bhav Jain
- Department of Health Policy, Stanford University School of Medicine, Stanford, CA, USA
| | - Tej A Patel
- Department of Healthcare Management and Policy, University of Pennsylvania, Philadelphia, PA, USA
| | - Jeffrey Shi Kai Chan
- Cardio-Oncology Research Unit, Cardiovascular Analytics Group, UK-China Collaboration, Hong Kong, China
| | - Miranda B Lam
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Sibo Tian
- Department of Radiation Oncology, Winship Cancer Institute, Atlanta, GA, USA
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Xia D, Cao W, Hu Y. A pulmonary artery was embolized in a patient with an occluded pulmonary vein to manage massive hemoptysis. BMC Pulm Med 2024; 24:192. [PMID: 38644505 PMCID: PMC11034142 DOI: 10.1186/s12890-024-02968-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/17/2024] [Indexed: 04/23/2024] Open
Abstract
BACKGROUND Stenosis and obliteration of the pulmonary vein can be developed by multiple diseases and might cause hemoptysis. Traditional therapy including surgical procedure and conservative treatments might be inappropriate choices to manage massive hemoptysis. CASE PRESENTATION A 64-year-old man, diagnosed with advanced stage IVA lung squamous cell carcinoma, presented with dyspnea and recurrent, massive hemoptysis. An initial contrast-enhanced computed tomography revealed a giant tumor in the left lung hilus and occlusion of the left superior pulmonary vein. Despite immediate selective bronchial artery embolization and simultaneous embolization of an anomalous branch of the internal thoracic artery, the massive hemoptysis continued. Subsequently, embolization of the left superior pulmonary artery was performed, achieving functional pulmonary lobectomy, which successfully treated the hemoptysis without relapse during a six-month follow-up. The patient continues to undergo cancer therapy and remains stable. CONCLUSIONS This case successfully managed massive hemoptysis associated with lung cancer invasion into the pulmonary vein through functional pulmonary lobectomy via embolization of the corresponding pulmonary artery.
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Affiliation(s)
- Dongping Xia
- Department of Respiratory and Critical Care Medicine, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Wuhan Clinical Research Center for Interventional Diagnosis and Treatment of Respiratory Diseases, Wuhan, China
| | - Wenhao Cao
- Department of Respiratory and Critical Care Medicine, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Wuhan Clinical Research Center for Interventional Diagnosis and Treatment of Respiratory Diseases, Wuhan, China
| | - Yi Hu
- Department of Respiratory and Critical Care Medicine, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
- Wuhan Clinical Research Center for Interventional Diagnosis and Treatment of Respiratory Diseases, Wuhan, China.
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Vandaele T, Van Slambrouck J, Schöffski P, Dumez H, Weynand B, Sciot R, Barbarossa A, Provoost AL, Van de Voorde K, Debaveye Y, Bouneb S, Nafteux P, Ceulemans LJ. Extensive surgical resections for rare pleural neoplasms: a single-center experience with a yolk sac tumor and synovial sarcoma. World J Surg Oncol 2024; 22:96. [PMID: 38622623 PMCID: PMC11021014 DOI: 10.1186/s12957-024-03367-9] [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: 12/12/2023] [Accepted: 03/28/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Pleural neoplasms are rare and can be subdivided into pleural metastasis and primary pleural neoplasms. Non-mesothelioma primary pleural neoplasms are a diverse group of extremely rare pathologies. CASE PRESENTATION In this case series, we describe the presentation and management of two rare primary pleural neoplasms. A first case describes a primary pleural yolk sac tumor treated with neoadjuvant chemotherapy, extended pleurectomy decortication, and hyperthermic intrathoracic chemotherapy. In a second case we describe the management of a primary pleural synovial sarcoma by neoadjuvant chemotherapy and extrapleural pneumonectomy. A complete resection was obtained in both cases and the post-operative course was uncomplicated. No signs of tumor recurrence were noted during follow-up in the first patient. In the second patient a local recurrence was diagnosed 6 months after surgery. CONCLUSION Neo-adjuvant chemotherapy followed by extensive thoracic surgery, including hyperthermic intrathoracic chemotherapy, is a feasible treatment strategy for non-mesothelioma primary pleural neoplasms, but careful follow-up is required.
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Affiliation(s)
- Tom Vandaele
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium.
| | - Jan Van Slambrouck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Patrick Schöffski
- Department of Oncology, University Hospitals Leuven, Leuven, Belgium
- Department of Oncology, Laboratory of experimental Oncology, KU Leuven, Leuven, Belgium
| | - Herlinde Dumez
- Department of Oncology, University Hospitals Leuven, Leuven, Belgium
- Department of Oncology, Laboratory of experimental Oncology, KU Leuven, Leuven, Belgium
| | - Birgit Weynand
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
- Department of Imaging and Pathology, Laboratory of translational cell and tissue research, KU Leuven, Leuven, Belgium
| | - Raf Sciot
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
- Department of Imaging and Pathology, Laboratory of translational cell and tissue research, KU Leuven, Leuven, Belgium
| | - Annalisa Barbarossa
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - An-Lies Provoost
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | | | - Yves Debaveye
- Department of Intensive care, University Hospitals Leuven, Leuven, Belgium
- Department of cellular and molecular medicine, Laboratory of Intensive care, KU Leuven, Leuven, Belgium
| | - Sofian Bouneb
- Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
- Department of cardiovascular science, Laboratory of anesthesiology and algology, KU Leuven, Leuven, Belgium
| | - Philippe Nafteux
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Laurens J Ceulemans
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
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Tran TN, Lee S, Kim HJ, Lee Y, Tu TM, Choi JH, Song JW, Cho H. Treatment-related cardiovascular events in patients with non-small cell lung cancer: Evidence from real-world data with a competing risks approach. Cancer 2024; 130:1303-1315. [PMID: 38103206 DOI: 10.1002/cncr.35143] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 09/25/2023] [Accepted: 11/08/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Understanding cancer treatment-related cardiovascular (CV) events is important for cancer care; however, comprehensive evaluation of CV events in patients with lung cancer is limited. This study aimed to assess the cumulative incidence and associated risks of various CV event types in patients with non-small cell lung cancer (NSCLC). METHODS A total of 7868 individuals aged 40 years and older, recently diagnosed with NSCLC (2007-2018), were assessed with data obtained from the National Cancer Center, Korea. This study included nine types of CV events. A 2-year cumulative incidence function (CIF) of CV events was estimated, with death as a competing event. The associated risks were assessed by subdistribution hazard ratio (sHR) in the Fine-Gray competing risks model. RESULTS CV events were observed in 7.8% of patients with NSCLC, with the most frequently observed types being atrial fibrillation and flutter (AF) (2.7%), venous thromboembolic disease (2.0%), and cerebrovascular disease (CeVD) (1.5%). Overall, all CV events were highest in the group treated with systemic therapy (CIF, 10.6%; 95% confidence interval [CI], 9.5%-11.8%), followed by those treated with surgery (CIF, 10.0%; 95% CI, 8.6%-11.6%); the incidence of AF (CIF, 5.7%; 95% CI, 4.6%-7.0%) was highest in patients treated with surgery. Individuals treated with systemic therapy were found to exhibit a higher CeVD risk than those treated with surgery (sHR, 4.12; 95% CI, 1.66-10.23). Among the patients who underwent surgery, those with lobectomy and pneumonectomy had a higher AF risk (vs. wedge resection/segmentectomy; sHR, 7.79; 95% CI, 1.87-32.42; sHR, 8.10; 95% CI, 1.60-40.89). CONCLUSIONS These findings revealed treatment-related CV event risks in patients with NSCLC, which suggests that the risk of AF in surgery and CeVD in systemic therapy should be paid more attention to achieve a better prognosis and improve cancer survivorship outcomes. PLAIN LANGUAGE SUMMARY Atrial fibrillation and flutter (AF) is the most common cardiovascular event, particularly at a high risk in patients with non-small cell lung cancer (NSCLC) undergoing surgery. Patients receiving surgery with poor performance status, diagnosed with regional stage, and undergoing lobectomy or pneumonectomy are at a high risk of AF. Systemic/radiotherapy is associated with cerebrovascular and ischemic heart disease in patients with NSCLC.
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Affiliation(s)
- Thi-Ngoc Tran
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea
| | - Sanghee Lee
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea
| | - Hak Jin Kim
- Division of Cardiology, Department of Internal Medicine, National Cancer Center, Goyang, Republic of Korea
- Department of Cardiology, Gumdan Top General Hospital, Incheon, Republic of Korea
| | - Youngjoo Lee
- Division of Hematology and Oncology, Department of Internal Medicine, National Cancer Center, Goyang, Republic of Korea
| | - Thao Minh Tu
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea
| | - Jin-Ho Choi
- Department of Thoracic Surgery, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Jae Won Song
- Department of Thoracic Surgery, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Hyunsoon Cho
- Department of Cancer AI and Digital Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea
- Integrated Biostatistics Branch, Division of Cancer Data Science, Research Institute, National Cancer Center, Goyang, Republic of Korea
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Fındık G, Çetin M, Nomenoğlu H, Türk İ, Acemoğlu S, Solak N, Can MA. A new technique for closure of pericardial defects: pericardial rug weave. BMC Surg 2024; 24:106. [PMID: 38614997 PMCID: PMC11015624 DOI: 10.1186/s12893-024-02368-5] [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: 08/21/2023] [Accepted: 02/21/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Pericardial defect that occurs after intrapericardial pneumonectomy can cause many fatal complications, and closing the defect with mesh is a widely used surgical method to prevent these complications. METHODS Data of patients who underwent intrapericardial pneumonectomy and pericardial resection in our clinic between October 2010 and June 2022 were retrospectively reviewed. Patients were divided into two groups, those who had prolene mesh used to close the pericardial defect and those who underwent the "Rug Weave" technique we proposed as an alternative, and the results were compared. RESULTS The study included 23 patients, one of whom was female. All patients underwent surgery due to malignancy. The vast majority of the patients had a diagnosis of squamous cell lung carcinoma (86.9%). Atrium was added to three patients and rib resection was added to one patient during intrapericardial pneumonectomy and pericardial resection. There was no significant difference between the two groups in terms of average age, gender, and length of hospital stay. There was no significant difference between the two groups in terms of complications, including atrial fibrillation, which is commonly seen in these patients (p = 0.795). The Rug Weave group had an average defect width of 23.96 cm2 and was found to be advantageous in terms of overall survival compared to the mesh group (p = 0.017). CONCLUSIONS The "Rug Weave" technique we proposed for closing pericardial defects after pneumonectomy can be used as a cheaper method safely and effectively that reduces complications as much as the traditional method of using mesh.
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Affiliation(s)
- Göktürk Fındık
- Department of Thoracic Surgery, Ataturk Sanatoryum Training and Research Hospital, Ankara, Turkey
| | - Mehmet Çetin
- Department of Thoracic Surgery, Omer Halisdemir University Training and Research Hospital, Niğde, Turkey.
| | - Hakan Nomenoğlu
- Department of Thoracic Surgery, Ataturk Sanatoryum Training and Research Hospital, Ankara, Turkey
| | - İlteriş Türk
- Department of Thoracic Surgery, Ataturk Sanatoryum Training and Research Hospital, Ankara, Turkey
| | - Serdar Acemoğlu
- Department of Thoracic Surgery, Ataturk Sanatoryum Training and Research Hospital, Ankara, Turkey
| | - Necati Solak
- Department of Thoracic Surgery, Sincan State Hospital, Ankara, Turkey
| | - Mehmet Ali Can
- Department of Radiology, Ataturk Sanatoryum Training and Research Hospital, Ankara, Turkey
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Niimi T, Samejima J, Wakabayashi M, Miyoshi T, Tane K, Aokage K, Taki T, Nakai T, Ishii G, Kikuchi A, Yoshioka E, Yokose T, Ito H, Tsuboi M. Ten-year follow-up outcomes of limited resection trial for radiologically less-invasive lung cancer. Jpn J Clin Oncol 2024; 54:479-488. [PMID: 38183216 DOI: 10.1093/jjco/hyad187] [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: 08/04/2023] [Accepted: 12/13/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND The JCOG0804/WJOG4507L single-arm confirmatory trial indicated a satisfactory 10-year prognosis for patients who underwent limited resection for radiologically less-invasive lung cancer. However, only one prospective trial has reported a 10-year prognosis. METHODS We conducted a multicenter prospective study coordinated by the National Cancer Center Hospital East and Kanagawa Cancer Center. We analyzed the long-term prognosis of 100 patients who underwent limited resection of a radiologically less-invasive lung cancer in the peripheral lung field. We defined radiologically less-invasive lung cancer as lung adenocarcinoma with a maximum tumor diameter of ≤2 cm, tumor disappearance ratio of ≥0.5 and cN0. The primary endpoint was the 10-year local recurrence-free survival. RESULTS Our patients, with a median age of 62 years, included 39 males. A total of 58 patients were non-smokers; 87 had undergone wide wedge resection and 9 underwent segmentectomy. A total of four cases were converted to lobectomy because of the presence of poorly differentiated components in the frozen specimen or insufficient margin with segmentectomy. The median follow-up duration was 120.9 months. The 10-year recurrence-free survival and overall survival rates of patients with lung cancer were both 96.0%. Following the 10-year long-term follow-up, two patients experienced recurrences at resection ends after wedge resection. CONCLUSIONS Limited resection imparted a satisfactory prognosis for patients with radiologically less-invasive lung cancer, except two cases of local recurrence >5 years after surgery. These findings suggest that patients with this condition who underwent limited resection may require continued follow-up >5 years after surgery.
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Affiliation(s)
- Takahiro Niimi
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Chiba
| | - Joji Samejima
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba
| | - Masashi Wakabayashi
- Biostatistics Division, Center for Research Administration and Support, National Cancer Center Hospital East, Kashiwa
| | - Tomohiro Miyoshi
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba
| | - Kenta Tane
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba
| | - Keiju Aokage
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba
| | - Tetsuro Taki
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Chiba
| | - Tokiko Nakai
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Chiba
| | - Genichiro Ishii
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Chiba
- Division of Innovative Pathology and Laboratory Medicine, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Kashiba, Chiba
| | - Akitomo Kikuchi
- Department of Pathology, Kanagawa Cancer Center, Yokohama, Kanagawa
| | - Emi Yoshioka
- Department of Pathology, Kanagawa Cancer Center, Yokohama, Kanagawa
| | - Tomoyuki Yokose
- Department of Pathology, Kanagawa Cancer Center, Yokohama, Kanagawa
| | - Hiroyuki Ito
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
| | - Masahiro Tsuboi
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba
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Torralba EJ, Fisher G, Fursmidt R, Gilbert M, Nystrom P, Malcom A, Mathis J, Short R. BPI24-013: Microwave Ablation Versus Resection Versus Stereotactic Body Radiation Therapy of Stage IA Non-Small Cell Lung Cancer in US Veterans. J Natl Compr Canc Netw 2024; 22:BPI24-013. [PMID: 38579882 DOI: 10.6004/jnccn.2023.7132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Affiliation(s)
| | - Garrett Fisher
- 1Wright State University Boonshoft School of Medicine, Dayton, OH
| | - Reid Fursmidt
- 1Wright State University Boonshoft School of Medicine, Dayton, OH
| | - Michael Gilbert
- 1Wright State University Boonshoft School of Medicine, Dayton, OH
| | - Perry Nystrom
- 1Wright State University Boonshoft School of Medicine, Dayton, OH
| | - Albert Malcom
- 1Wright State University Boonshoft School of Medicine, Dayton, OH
| | - John Mathis
- 1Wright State University Boonshoft School of Medicine, Dayton, OH
| | - Robert Short
- 2Dayton Veteran Affairs Medical Center, Dayton, OH
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Le UT, Hümmler N, Greiser F, Tullius-Modlmeier R, Benitz M, Passlick B. Hybrid (Digital/Water Seal) Chest Drainage System - An Innovative Device for Patients with Anticipated Air Leaks. Surg Innov 2024; 31:185-194. [PMID: 38403897 DOI: 10.1177/15533506241232618] [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] [Indexed: 02/27/2024]
Abstract
BACKGROUND To date, several chest drainage systems are available, such as digital drainage systems (DDS) and traditional systems with continuous suction or water seal. However, none of these systems were yet shown to be favorable in the treatment of complex situations such as persistent air leaks or residual spaces. We present in-vitro as well as clinical data of a novel hybrid drainage system consisting of an optimized digital drainage system (ODDS) and an underwater seal drainage system (UWSD). METHODS For in-vitro analysis, a DDS and an ODDS were connected to a pleural cavity simulator. Different air leaks were produced and data on intrapleural pressure and air flow were analyzed. Furthermore, we tested the hybrid drainage system in 10 patients with potential air leaks after pulmonary surgery. RESULTS In in-vitro analysis, we could show, that with advanced pump technology, pressure fluctuations caused by the drainage system when trying to maintain a set pressure level in patients with airleaks were much smaller when using an ODDS and could even be eliminated when using a fluid collection canister with sufficient buffer capacity. This minimized air leak boosts caused by the drainage system. Optimizing the auto-pressure regulation algorithms also led to a reduced airflow through the fistula and promoted rest. Switching to a passive UWSD also reduced the amount of airflow. Clinical application of the hybrid drainage system yielded promising results. CONCLUSION The novel hybrid drainage system shows promising results in the treatment of patients with complex clinical situations such as persistent air leaks.
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Affiliation(s)
- Uyen-Thao Le
- Department of Thoracic Surgery, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Nicolas Hümmler
- Department of Thoracic Surgery, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Frank Greiser
- ATMOS Medizintechnik GmbH & Co. KG, Lenzkirch, Germany
| | | | - Marion Benitz
- ATMOS Medizintechnik GmbH & Co. KG, Lenzkirch, Germany
| | - Bernward Passlick
- Department of Thoracic Surgery, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
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Yao F, Wang Z, Wu W, Zhu Q, Zhu Y, Chen L. Feasibility of thoracoscopic monosubsegmentectomy for small ground-glass opacity dominant lung cancer. Eur J Surg Oncol 2024; 50:108249. [PMID: 38479083 DOI: 10.1016/j.ejso.2024.108249] [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: 01/06/2024] [Revised: 02/25/2024] [Accepted: 03/03/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Monosubsegmentectomy (MSS) involves removal of less lung parenchyma than monosegmentectomy (MS) does. However, the clinical efficacy of MSS in lung cancer treatment remains unclear, with concerns regarding insufficient surgical margins and increased complications. METHODS Between February 2015 and December 2019, patients who underwent thoracoscopic MSS (n = 126) or MS (n = 678) for small ground-glass opacity (GGO) dominant lung cancer were examined. The primary endpoints were the procedure success rate (defined as resection with a surgical margin ≥2 cm or tumor size) and surgical margin. RESULTS There were no significant differences in age, sex, smoking history, or comorbidities between the groups. Both groups achieved a success rate of 100%. No significant group differences were observed in the number of lymph nodes removed (p = 0.060), overall complications (p = 0.147), or major complications (p = 0.450). The MSS group had a smaller surgical margin (median, 17 vs. 21mm, p < 0.001) and longer operative time (median, 138 vs. 130 min, p = 0.005) than the MS group did. Propensity score-matched analysis of 122 pairs of patients revealed consistent results. Surgical margins were further compared based on the number of resected subsegments. The 1 subsegment group had the smallest median surgical margin, followed by the 2 and 3 subsegments groups (17, 20, and 23 mm, p < 0.001). CONCLUSIONS Thoracoscopic MSS is an acceptable option for treating patients with small-sized GGO-dominant lung cancer. However, the close surgical margins and prolonged operative time should be considered.
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Affiliation(s)
- Fei Yao
- Department I of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, China; Department of Thoracic Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, China
| | - Zhibo Wang
- Department I of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, China
| | - Weibing Wu
- Department I of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, China
| | - Quan Zhu
- Department I of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, China
| | - Yining Zhu
- Department of Thoracic Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, China
| | - Liang Chen
- Department I of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, China.
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12
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Na KJ, Kim YT, Goo JM, Kim H. Clinical Utility of a CT-based AI Prognostic Model for Segmentectomy in Non-Small Cell Lung Cancer. Radiology 2024; 311:e231793. [PMID: 38625008 DOI: 10.1148/radiol.231793] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
Background Currently, no tool exists for risk stratification in patients undergoing segmentectomy for non-small cell lung cancer (NSCLC). Purpose To develop and validate a deep learning (DL) prognostic model using preoperative CT scans and clinical and radiologic information for risk stratification in patients with clinical stage IA NSCLC undergoing segmentectomy. Materials and Methods In this single-center retrospective study, transfer learning of a pretrained model was performed for survival prediction in patients with clinical stage IA NSCLC who underwent lobectomy from January 2008 to March 2017. The internal set was divided into training, validation, and testing sets based on the assignments from the pretraining set. The model was tested on an independent test set of patients with clinical stage IA NSCLC who underwent segmentectomy from January 2010 to December 2017. Its prognostic performance was analyzed using the time-dependent area under the receiver operating characteristic curve (AUC), sensitivity, and specificity for freedom from recurrence (FFR) at 2 and 4 years and lung cancer-specific survival and overall survival at 4 and 6 years. The model sensitivity and specificity were compared with those of the Japan Clinical Oncology Group (JCOG) eligibility criteria for sublobar resection. Results The pretraining set included 1756 patients. Transfer learning was performed in an internal set of 730 patients (median age, 63 years [IQR, 56-70 years]; 366 male), and the segmentectomy test set included 222 patients (median age, 65 years [IQR, 58-71 years]; 114 male). The model performance for 2-year FFR was as follows: AUC, 0.86 (95% CI: 0.76, 0.96); sensitivity, 87.4% (7.17 of 8.21 patients; 95% CI: 59.4, 100); and specificity, 66.7% (136 of 204 patients; 95% CI: 60.2, 72.8). The model showed higher sensitivity for FFR than the JCOG criteria (87.4% vs 37.6% [3.08 of 8.21 patients], P = .02), with similar specificity. Conclusion The CT-based DL model identified patients at high risk among those with clinical stage IA NSCLC who underwent segmentectomy, outperforming the JCOG criteria. © RSNA, 2024 Supplemental material is available for this article.
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Affiliation(s)
- Kwon Joong Na
- From the Department of Thoracic and Cardiovascular Surgery (K.J.N., Y.T.K.) and Department of Radiology (J.M.G., H.K.), Seoul National University Hospital and College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Seoul National University Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea (K.J.N., Y.T.K., J.M.G.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.G.)
| | - Young Tae Kim
- From the Department of Thoracic and Cardiovascular Surgery (K.J.N., Y.T.K.) and Department of Radiology (J.M.G., H.K.), Seoul National University Hospital and College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Seoul National University Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea (K.J.N., Y.T.K., J.M.G.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.G.)
| | - Jin Mo Goo
- From the Department of Thoracic and Cardiovascular Surgery (K.J.N., Y.T.K.) and Department of Radiology (J.M.G., H.K.), Seoul National University Hospital and College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Seoul National University Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea (K.J.N., Y.T.K., J.M.G.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.G.)
| | - Hyungjin Kim
- From the Department of Thoracic and Cardiovascular Surgery (K.J.N., Y.T.K.) and Department of Radiology (J.M.G., H.K.), Seoul National University Hospital and College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Seoul National University Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea (K.J.N., Y.T.K., J.M.G.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.G.)
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Nomura K, Inoue R, Narukawa T, Murakami M, Sekoguchi T, Inoue R, Hirano K, Maze Y, Tokui T, Kawaguchi T. [Complete Disruption of the Left Main Bronchus Treated with Extracorporeal Membrane Oxygenation Support and Pneumonectomy]. Kyobu Geka 2024; 77:256-261. [PMID: 38644171] [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: 04/23/2024]
Abstract
A 60-year old woman, sandwiched between two boats was brought to our hospital with severe respiratory failure. She was in pre-shock and there was extensive cutaneous emphysema from the face to abdomen. She required respirator support and bilateral chest tubes for hemopneumothorax. On the patient's 3rd hospital day, she received venovenous extracorporeal membrance oxgenation( ECMO) due to sudden ventilatory failure. The bronchofiberscopy revealed complete disruption of the left main bronchus and occlusion of the right one owing to blood clot and sputum. Because of significant destruction of the left main bronchus, we didn't attempt bronchoplasty, and performed left pneumonectomy under veno-venous (VV)-ECMO. The postoperative course was uneventful, and she was discharged after 30 days with satisfactory outcome.
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Affiliation(s)
- Kazuki Nomura
- Department of Thoracic Cardiovascular Surgery, Japanese Red Cross Ise Hospital, Ise, Japan
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Luna-Pardo C, Cruz-Chamorro DA, Martínez-Tomás R, Briones-Gómez A, Cases-Viedma E. Endoscopic Lung Volume Reduction With Vapor Ablation in Patients With Severe Emphysema. Arch Bronconeumol 2024; 60:244-245. [PMID: 38218694 DOI: 10.1016/j.arbres.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/22/2023] [Accepted: 12/26/2023] [Indexed: 01/15/2024]
Affiliation(s)
- Cristina Luna-Pardo
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
| | | | | | - Andrés Briones-Gómez
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Enrique Cases-Viedma
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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Isaka T, Nagashima T, Murakami K, Shigefuku S, Kikunishi N, Shigeta N, Ito H. Right S3 segmentectomy for lung cancer with partial anomalous pulmonary venous return in the right upper pulmonary vein: A case report. Thorac Cancer 2024; 15:852-856. [PMID: 38391040 PMCID: PMC10995714 DOI: 10.1111/1759-7714.15266] [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: 12/07/2023] [Revised: 02/09/2024] [Accepted: 02/10/2024] [Indexed: 02/24/2024] Open
Abstract
Partial anomalous pulmonary venous return (PAPVR) is a rare congenital malformation where the pulmonary vein partially refluxes into the venous system. Here, we present the first robotic-assisted right S3 segmentectomy in a 70-year-old male with early-stage lung cancer and PAPVR in the right upper pulmonary vein. The patient, with suspected primary lung cancer (11 mm diameter, pure solid appearance in right S3 segment), exhibited clinical stage T1bN0M0 stage IA2. Preoperative computed tomography revealed severe lung emphysema, and right V1-3 returned directly to the superior vena cava. However, no signs of right-sided heart failure were observed, and echocardiogram was normal with a pulmonary-to-systemic blood flow ratio of 1.4. Successful robot-assisted right S3 segmentectomy with hilar nodal dissection was performed, and the patient was discharged on the sixth postoperative day without complications. One year postoperatively, there has been no recurrence of lung cancer or respiratory/right-sided heart failure symptoms.
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Affiliation(s)
- Tetsuya Isaka
- Department of Thoracic SurgeryKanagawa Cancer CenterYokohamaJapan
| | - Takuya Nagashima
- Department of Thoracic SurgeryKanagawa Cancer CenterYokohamaJapan
| | - Kotaro Murakami
- Department of Thoracic SurgeryKanagawa Cancer CenterYokohamaJapan
| | | | | | - Naoko Shigeta
- Department of Thoracic SurgeryKanagawa Cancer CenterYokohamaJapan
| | - Hiroyuki Ito
- Department of Thoracic SurgeryKanagawa Cancer CenterYokohamaJapan
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Mulryan K, Sorensen J, Redmond K. Establishing an expert opinion framework for lung volume reduction in Ireland: a Delphi consensus technique. Ir J Med Sci 2024; 193:843-849. [PMID: 37550599 PMCID: PMC10961259 DOI: 10.1007/s11845-023-03467-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 07/15/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Lung volume reduction (LVR) is an effective treatment option offered to patients with emphysema. There is no formalised LVR referral network in Ireland. A rigorous approach to agreeing and implementing a LVR referral framework in an Irish context is required. A Delphi process was used to provide a basis for a framework of multi-disciplinary teams (MDTs) which can provide LVR as a management option. A Delphi process offers a framework for understanding variations and developing a consensus from expert opinion. AIM The aim of this study was to develop consensus on recommendations for LVR referral guidelines in an Irish context and provide a national scope based on current practice and evidence. DESIGN In accordance with Guidance on Conducting and Reporting Delphi Studies, a consensus-building Delphi study was performed. Thirty-three statements informed from review of research literature were identified and presented to participants. Evaluation of the statements was performed by an expert panel using a 5-point Likert scale. ≥ 70% agreement was defined as consensus and items with a consensus rating of < 70% were revised during the process. In total, Delphi questionnaires were distributed to 18 experts with a response rate of 78% (n = 14) and a follow-up response-rate of 50% (n = 7). SETTING/PARTICIPANTS The expert panel in Ireland consisted of representatives from respiratory medicine, cardiothoracic surgery and allied-health professionals with expertise in COPD care. RESULTS Of the initial 33 statements in five dimensions, there were consensus regarding 31 statements. CONCLUSIONS The 31 statements agreed through this Delphi study clarify a coherent direction for development of a LVR framework in Ireland. The Delphi study methodology described is a useful process to reach consensus among multi-disciplinary experts.
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Affiliation(s)
- Kathryn Mulryan
- Professor Eoin O'Malley National Thoracic and Transplant Centre, Mater Misericordiae University Hospital, Eccles St., Dublin, D07R2WY, Ireland.
- Beacon Court, Beacon Hospital, Bracken Rd, Sandyford Business Park, Dublin, Sandyford, Ireland.
- School of Postgraduate Studies, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Jan Sorensen
- Healthcare Outcomes Research Centre, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Karen Redmond
- Professor Eoin O'Malley National Thoracic and Transplant Centre, Mater Misericordiae University Hospital, Eccles St., Dublin, D07R2WY, Ireland
- Beacon Court, Beacon Hospital, Bracken Rd, Sandyford Business Park, Dublin, Sandyford, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
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Potter AL, Senthil P, Keshwani A, McCleery S, Haridas C, Kumar A, Mathey-Andrews C, Martin LW, Yang CFJ. Long-term Survival After Lung Cancer Resection in the National Lung Screening Trial. Ann Thorac Surg 2024; 117:734-742. [PMID: 38216080 DOI: 10.1016/j.athoracsur.2023.12.011] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 12/11/2023] [Accepted: 12/19/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND This study sought to evaluate the long-term survival and causes of death after surgery among patients with pathologic stage IA non-small cell lung cancer (NSCLC) in the National Lung Screening Trial (NLST). METHODS Patients who underwent surgery and who had a diagnosis of pathologic stage IA NSCLC in the NLST were identified for analysis. The 5- and 10-year overall survival and lung cancer-specific survival, stratified by operation type, were evaluated. Among patients who underwent lobectomy, the causes of death and the cumulative incidence of lung cancer death were assessed. RESULTS A total of 380 patients (n = 329, 86.6% lobectomy; n = 20, 5.3% segmentectomy; n = 31, 8.1% wedge resection) met inclusion criteria. Median follow-up time from the date of surgery was 7.8 years (interquartile range, 4.8-10.7 years). The 10-year overall survival rate was 58.3% (95% CI, 52.4%-63.8%) for lobectomy, 59.9% (95% CI, 33.2%-78.8%) for segmentectomy, and 45.2% (95% CI, 20.8%-66.9%) for wedge resection. The 10-year lung cancer-specific survival rate was 74.3% (95% CI, 68.6%-79.1%) for lobectomy, 81.3% (95% CI, 51.3%-93.8%) for segmentectomy, and 84.8% (95% CI, 64.0%-94.1%) for wedge resection. Lung cancer was the leading cause of death, accounting for 55.8% of deaths after lobectomy. The 10-year cumulative incidence of lung cancer death after lobectomy was 22.5% (95% CI, 18.3%-27.1%). CONCLUSIONS The 10-year overall survival rate after lobectomy among patients with pathologic stage IA NSCLC in the NLST was 58%. Lung cancer was the leading cause of death, accounting for more than 55% of deaths.
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Affiliation(s)
- Alexandra L Potter
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Priyanka Senthil
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Alisha Keshwani
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Spencer McCleery
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Chinmay Haridas
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Arvind Kumar
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Camille Mathey-Andrews
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Linda W Martin
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Chi-Fu Jeffrey Yang
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
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18
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Lee JD, Zheng R, Okusanya OT, Evans NR, Grenda TR. Association between surgical quality and long-term survival in lung cancer. Lung Cancer 2024; 190:107511. [PMID: 38417278 DOI: 10.1016/j.lungcan.2024.107511] [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: 07/27/2023] [Revised: 02/16/2024] [Accepted: 02/21/2024] [Indexed: 03/01/2024]
Abstract
OBJECTIVES There are significant variations in both perioperative and long-term outcomes after lung cancer resection. While perioperative outcomes are often used as comparative measures of quality, they are unreliable, and their association with long-term outcomes remain unclear. In this context, we evaluated whether historical perioperative mortality after lung cancer resection is associated with 5-year survival. PATIENTS AND METHODS The National Cancer Database (NCDB) was queried to identify patients diagnosed with non-small cell lung cancer (NSCLC) in 2010-2016 who underwent surgical resection (n = 234200). Hospital-level reliability-adjusted 90-day mortality rate quartiles for 2010-2013 was used as the independent variable to analyze 5-year survival for patients diagnosed in 2014-2016 (n = 85396). RESULTS There were 85,396 patients in the 2014-2016 cohort across 1,086 hospitals. Overall observed 90-day mortality rate was 3.2% (SD 17.6%) with 2.6% (SD 16.0%) for the historically best performing quartile vs. 3.9% (SD 19.4%) for the worst performing quartile (p < 0.0001). Patients who underwent resection at hospitals with the best historical mortality rate had significantly better 5-year survival across all stages compared to those treated at hospitals in the worst performing quartile in multivariate Cox regression analysis (all stages - HR 1.21 [95% CI 1.15-1.26]; stage I - HR 1.19 [95% CI 1.12-1.25]; stage II - HR 1.20 [95% CI 1.09-1.32]; stage III - HR 1.36 [95% CI 1.20-1.54]) and Kaplan-Meier survival estimates (all stages - p < 0.0001, stage I - p < 0.0001; stage II - p = 0.0004; stage III - p < 0.0001). CONCLUSION With expanded lung cancer screening criteria and likely increase in early-stage detection, profiling performance is paramount to ensuring mortality benefits. We found that episodes surrounding surgical resection may be used to profile long-term outcomes that likely reflect quality across a broader context of care. Evaluating lung cancer care quality using perioperative outcomes may be useful in profiling provider performance and guiding value-based payment policies.
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Affiliation(s)
- James D Lee
- Division of Pulmonary, Allergy, and Critical Care, Penn Presbyterian Medical Center, Department of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
| | - Richard Zheng
- Division of Surgical Oncology, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Olugbenga T Okusanya
- Division of Thoracic Surgery, Department of Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Nathaniel R Evans
- Division of Thoracic Surgery, Department of Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Tyler R Grenda
- Division of Thoracic Surgery, Department of Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
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Forcada C, Iscan M, Gómez-Hernández MT, Rivas CE, Jiménez MF. Robotic segmentectomy for pulmonary sequestration complicated with aspergilloma. Cir Esp 2024; 102:233-235. [PMID: 38341092 DOI: 10.1016/j.cireng.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/20/2023] [Indexed: 02/12/2024]
Affiliation(s)
- Clara Forcada
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
| | - Mehlika Iscan
- Department of Thoracic Surgery, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - María Teresa Gómez-Hernández
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain; Salamanca Institute of Biomedical Research, Salamanca, Spain; University of Salamanca. Salamanca, Spain.
| | - Cristina E Rivas
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain; Salamanca Institute of Biomedical Research, Salamanca, Spain; University of Salamanca. Salamanca, Spain
| | - Marcelo F Jiménez
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain; Salamanca Institute of Biomedical Research, Salamanca, Spain; University of Salamanca. Salamanca, Spain
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Caso R, Watson TJ, Tefera E, Cerfolio R, Abbas AE, Lazar JF, Margolis M, Hwalek AE, Khaitan PG. Comparing Robotic, Thoracoscopic, and Open Segmentectomy: A National Cancer Database Analysis. J Surg Res 2024; 296:674-680. [PMID: 38359682 DOI: 10.1016/j.jss.2024.01.028] [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: 03/21/2023] [Revised: 01/08/2024] [Accepted: 01/17/2024] [Indexed: 02/17/2024]
Abstract
INTRODUCTION Minimally invasive approaches to lung resection have become widely acceptable and more recently, segmentectomy has demonstrated equivalent oncologic outcomes when compared to lobectomy for early-stage non-small cell lung cancer (NSCLC). However, studies comparing outcomes following segmentectomy by different surgical approaches are lacking. Our objective was to investigate the outcomes of patients undergoing robotic, video-assisted thoracoscopic surgery (VATS), or open segmentectomy for NSCLC using the National Cancer Database. METHODS NSCLC patients with clinical stage I who underwent segmentectomy from 2010 to 2016 were identified. After propensity-score matching (1:4:1), multivariate logistic regression analyses were performed to determine predictors of 30-d readmissions, 90-d mortality, and overall survival. RESULTS 22,792 patients met study inclusion. After matching, approaches included robotic (n = 2493; 17%), VATS (n = 9972; 66%), and open (n = 2493; 17%). An open approach was associated with higher 30-d readmissions (7% open versus 5.5% VATS versus 5.6% robot, P = 0.033) and 90-d mortality (4.4% open versus 2.2% VATS versus 2.5% robot, P < 0.001). A robotic approach was associated with improved 5-y survival (50% open versus 58% VATS versus 63% robot, P < 0.001). CONCLUSIONS For patients with clinical stage I NSCLC undergoing segmentectomy, compared to the open approach, a VATS approach was associated with lower 30-d readmission and 90-d mortality. A robotic approach was associated with improved 5-y survival compared to open and VATS approaches when matched. Additional studies are necessary to determine if unrecognized covariates contribute to these differences.
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Affiliation(s)
- Raul Caso
- Department of Surgery, Georgetown University School of Medicine, Medstar Washington Hospital Center, Washington, District of Columbia
| | - Thomas J Watson
- Division of Thoracic Surgery, Department of Surgery, Beaumont Health, Detroit, Michigan
| | - Eshetu Tefera
- Department of Biostatistics and Biomedical Informatics, Medstar Health Research Institute, Washington, District of Columbia
| | - Robert Cerfolio
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York
| | - Abbas E Abbas
- Division of Thoracic Surgery, Department of Surgery, Brown University, Providence, Rhode Island
| | - John F Lazar
- Department of Surgery, Georgetown University School of Medicine, Medstar Washington Hospital Center, Washington, District of Columbia; Division of Thoracic Surgery, Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia
| | - Marc Margolis
- Department of Surgery, Georgetown University School of Medicine, Medstar Washington Hospital Center, Washington, District of Columbia; Division of Thoracic Surgery, Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia
| | - Ann E Hwalek
- Department of Surgery, Georgetown University School of Medicine, Medstar Washington Hospital Center, Washington, District of Columbia; Division of Thoracic Surgery, Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia
| | - Puja Gaur Khaitan
- Department of Surgery, Georgetown University School of Medicine, Medstar Washington Hospital Center, Washington, District of Columbia; Division of Thoracic Surgery, Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia; Division of Thoracic Surgery, Department of Surgery, Sheikh Shakhbout Medical City, Khalifa University, Abu Dhabi, UAE.
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Blasberg JD, Li A. Evening the Odds: Making 1 + 1 = 2 for Bilobectomy. Ann Thorac Surg 2024; 117:874-875. [PMID: 38081495 DOI: 10.1016/j.athoracsur.2023.11.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 11/18/2023] [Indexed: 03/25/2024]
Affiliation(s)
- Justin D Blasberg
- Department of Surgery, Yale University, 330 Cedar St, BB205, New Haven, CT 06510.
| | - Andrew Li
- Department of Surgery, Yale University, 330 Cedar St, BB205, New Haven, CT 06510
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Brunelli A. Segmentectomy: lower surgical quality is associated with poorer outcomes. Eur J Cardiothorac Surg 2024; 65:ezae144. [PMID: 38579243 DOI: 10.1093/ejcts/ezae144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 04/04/2024] [Indexed: 04/07/2024] Open
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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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Sueyoshi K, Merlini M, Otsubo K, Kojima F, Bando T. Zero-leak prediction during major lung resection aiming for minimal chest drainage duration: a retrospective analysis. J Cardiothorac Surg 2024; 19:120. [PMID: 38481228 PMCID: PMC10935967 DOI: 10.1186/s13019-024-02620-2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 03/06/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Early chest tube removal should be considered to enhance recovery after surgery. The current study aimed to provide a predictive algorithm for air leak episodes (ALE) and to create a knowledge base for early chest tube removal. METHODS This retrospective study enrolled patients who underwent thoracoscopic anatomical pulmonary resections in our unit. We defined ALE as any airflow ≥ 10 mL/min recorded in the follow-up charts based on the digital thoracic drainage device. Multivariate regression analysis was used to control for preoperative and intraoperative confounding factors. The ALE prediction algorithm was constructed by combining an additive ALE risk-scoring system using the coefficients of the significant predictive factors with the intraoperative water-sealing test. RESULTS In 485 consecutive thoracoscopic major pulmonary resections, ALE developed in 209 (43%) patients. Statistically significant ALE-associated preoperative factors included male sex, lower body mass index, radiologically evident emphysema, lobectomy, and upper lobe surgery. Significant ALE-associated intraoperative factors were incomplete fissure and pleural adhesion. The ALE risk scoring demonstrated an average area under the receiver operating characteristic curve of 0.72 in the fivefold cross-validation test. The ALE prediction algorithm correctly predicted ALE-absent patients at a negative predictive value of 80%. CONCLUSIONS The algorithm may promote the optimization of the chest tube-dwelling duration by identifying potential ALE-absent patients for accelerated tube removal.
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Affiliation(s)
- Kuniyo Sueyoshi
- Department of Thoracic Surgery, St Luke's International Hospital, Akashi-Cho 9-1, Chuo-ku, Tokyo, 104-8560, Japan
| | - McAndrew Merlini
- Department of Thoracic Surgery, St Luke's International Hospital, Akashi-Cho 9-1, Chuo-ku, Tokyo, 104-8560, Japan
| | - Kosuke Otsubo
- Department of Thoracic Surgery, St Luke's International Hospital, Akashi-Cho 9-1, Chuo-ku, Tokyo, 104-8560, Japan
| | - Fumitsugu Kojima
- Department of Thoracic Surgery, St Luke's International Hospital, Akashi-Cho 9-1, Chuo-ku, Tokyo, 104-8560, Japan.
| | - Toru Bando
- Department of Thoracic Surgery, St Luke's International Hospital, Akashi-Cho 9-1, Chuo-ku, Tokyo, 104-8560, Japan
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Zhang Y, Shang K, Li J, Sun M, Gu X. Operative treatment of pulmonary primitive neuroectodermal tumor: a case report and literature review. J Cardiothorac Surg 2024; 19:109. [PMID: 38443970 PMCID: PMC10913649 DOI: 10.1186/s13019-024-02563-8] [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: 05/24/2023] [Accepted: 01/30/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Pulmonary primitive neuroectodermal tumor (PNET), a member of the Ewing sarcoma family of tumors, is a rare malignancy that is associated with a grim prognosis. To date, fewer than 30 cases of pulmonary PNET have been reported. In this case report, we present the clinical details of a 12-year-old girl with pulmonary PNET who underwent surgical treatment. We also conducted an analysis and summary of other relevant studies and the surgical outcomes. CASE PRESENTATION In May 2018, a 12-year-old girl was admitted with symptoms of cough and blood-tinged phlegm. A computed tomography scan revealed a large mass, measuring 12.9 cm × 8.1 cm, in the right middle and lower lungs. A percutaneous lung biopsy confirmed poorly differentiated tumor cells with a nested growth pattern. Immunohistochemical staining demonstrated positive expression of CD99, CD56, Vimentin, and Synaptophysin. The patient was diagnosed with pulmonary PNET. Following three cycles of neoadjuvant chemotherapy, a substantial reduction in tumor volume was observed. Subsequently, the patient underwent a surgical procedure involving pneumonectomy and partial resection of the left atrium with the assistance of cardiopulmonary bypass. The patient was discharged 37 days after surgery. During a three-year follow-up period, she exhibited no signs of tumor recurrence and has successfully returned to school. CONCLUSIONS This case highlights the successful management of an advanced PNET with neoadjuvant chemotherapy, pneumonectomy, and partial resection of the left atrium employing cardiopulmonary bypass. The patient remained disease-free after three years. Our analysis of surgically treated cases indicates that neoadjuvant chemotherapy can contribute to improved prognoses for PNET patients. It is crucial to emphasize that complete surgical excision remains the cornerstone of treatment, underscoring the importance of surgeons considering radical surgical approaches whenever feasible for patients with pulmonary PNETs.
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Affiliation(s)
- Yiyuan Zhang
- Department of Thoracic surgery, The First Hospital of Jilin University, Changchun, 130021, China
| | - Ke Shang
- Department of Anesthesiology, The First Hospital of Jilin University, Changchun, 130021, China
| | - Jialin Li
- Department of Thoracic surgery, The First Hospital of Jilin University, Changchun, 130021, China
| | - Mengyao Sun
- Department of Cardial Surgery, The First Hospital of Jilin University, Changchun, 130021, China
| | - Xiaoying Gu
- Department of Anesthesiology, The First Hospital of Jilin University, Changchun, 130021, China.
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Discussion to: Overall survival in low-comorbidity patients with stage I non-small cell lung cancer who chose stereotactic body radiotherapy compared to surgery. J Thorac Cardiovasc Surg 2023; 167:834-5. [PMID: 37865894 DOI: 10.1016/j.jtcvs.2023.09.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Indexed: 10/23/2023]
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Kumar A, Kumar S, Gilja S, Mathey-Andrews CA, Potter AL, Jeffrey Yang CF, Auchincloss HG. Surgery for M1A Non-Small-Cell Lung Cancer With Additional Pulmonary Nodules in a Contralateral Lobe. J Surg Res 2024; 295:102-111. [PMID: 38006777 DOI: 10.1016/j.jss.2023.10.025] [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: 02/23/2023] [Revised: 09/06/2023] [Accepted: 10/27/2023] [Indexed: 11/27/2023]
Abstract
INTRODUCTION Limited consensus exists on the optimal treatment strategy for clinical M1a non-small-cell lung cancer (NSCLC) presenting as a primary tumor with additional intrapulmonary nodules in a contralateral lobe ("M1a-Contra"). This study sought to compare long-term survival of patients with M1a-Contra tumors receiving multimodal therapy with versus without thoracic surgery. METHODS Overall survival of patients with cT1-4, N0-3, M1a NSCLC with contralateral intrapulmonary nodules who received surgery as part of multimodal therapy ("Thoracic Surgery") versus systemic therapy with or without radiation ("No Thoracic Surgery") in the National Cancer Database from 2010 to 2015 was evaluated using Kaplan-Meier analysis, Cox proportional hazards modeling, and propensity score matching. RESULTS Of the 5042 patients who satisfied study inclusion criteria, 357 (7.1%) received multimodal therapy including surgery. In multivariable-adjusted analysis, the Thoracic Surgery cohort had better overall survival than the No Thoracic Surgery cohort (HR: 0.66, 95% CI: 0.56-0.79, P < 0.001). In a propensity score-matched analysis of 386 patients, well-balanced on 12 common prognostic covariates, the Thoracic Surgery group had better 5-year overall survival than the No Thoracic Surgery group (P = 0.020). In propensity score-matched analyses stratified by clinical N status, Thoracic Surgery was associated with better overall survival than No Thoracic Surgery for patients with cN0 disease and cN1-2 disease. CONCLUSIONS In this national analysis, multimodal treatment including surgery was associated with better overall survival than systemic therapy with or without radiation without surgery for patients with M1a-Contra tumors. These preliminary findings highlight the importance of further evaluation of surgery in a multidisciplinary treatment setting for M1a-Contra tumors.
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Affiliation(s)
- Arvind Kumar
- Department of Thoracic Surgery, Icahn School of Medicine at Mt. Sinai, New York, New York
| | - Sanjeevani Kumar
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Shivee Gilja
- Department of Thoracic Surgery, Icahn School of Medicine at Mt. Sinai, New York, New York
| | - Camille A Mathey-Andrews
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Alexandra L Potter
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Chi-Fu Jeffrey Yang
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Hugh G Auchincloss
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
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Rushwan A, Stefanou D, Tariq J, Drosos P, Chaudhuri N, Milton R, Tcherveniakov P, Papagiannopoulos K, Brunelli A. Increased minute ventilation-to-carbon dioxide slope during cardiopulmonary exercise test is associated with poor postoperative outcome following lung cancer resection. Eur J Cardiothorac Surg 2024; 65:ezad337. [PMID: 37812232 DOI: 10.1093/ejcts/ezad337] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/21/2023] [Accepted: 10/07/2023] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVES Ventilatory efficiency [minute ventilation-to-carbon dioxide output slope (VE/VCO2 slope)] can be measured at sub-maximal workload during cardiopulmonary exercise test. The aim of this study is to assess the association between VE/VCO2 slope and outcome after lung cancer resections. METHODS Retrospective, single-centre analysis on all patients undergoing lung resection for cancer (April 2014-August 2022) and with a preoperative cardiopulmonary exercise test. VE/VCO2 slope >40 was chosen as high-risk threshold. Logistic regression analysis was used to test the association of VE/VCO2 slope and several patient- and surgery-related factors with 90-day mortality. RESULTS A total of 552 patients were included (374 lobectomies, 81 segmentectomies, 55 pneumonectomies and 42 wedge resections). Seventy-four percent were minimally invasive procedures. Cardiopulmonary morbidity was 32%, in-hospital/30-day mortality 6.9% and 90-day mortality 8.9%. A total of 137 patients (25%) had a slope of >40. These patients were older (72 vs 70 years, P = 0.012), had more frequently coronary artery disease (17% vs 10%, P = 0.028), lower carbon monoxide lung diffusion capacity (57% vs 68%, P < 0.001), lower body mass index (25.4 vs 27.0 kg/m2, P = 0.001) and lower peak VO2 (14.9 vs 17.0 ml/kg/min, P < 0.001) than those with a lower slope. The cardiopulmonary morbidity among patients with a slope of >40 was 40% vs 29% in those with lower slope (P = 0.019). Ninety-day mortality was 15% vs 6.7% (P = 0.002). The 90-day mortality of elderly patients with slope >40 was 21% vs 7.8% (P = 0.001). After adjusting for peak VO2 value, extent of operation and other patient-related variables in a logistic regression analysis, VE/VCO2 slope retained a significant association with 90-day mortality. CONCLUSIONS VE/VCO2 slope was strongly associated with morbidity and mortality following lung resection and should be included in the functional algorithm to assess fitness for surgery.
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Affiliation(s)
- Amr Rushwan
- Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK
| | - Demetrios Stefanou
- Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK
| | - Javeria Tariq
- Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK
| | - Polivious Drosos
- Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK
| | - Nilanjan Chaudhuri
- Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK
| | - Richard Milton
- Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK
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Redolfi S, Straus C, Ninane V, Similowski T. Postural lung volume reduction, expiratory flow limitation, and orthopnoea in diaphragmatic weakness: Preliminary observations. Pulmonology 2024; 30:188-191. [PMID: 37741747 DOI: 10.1016/j.pulmoe.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 09/25/2023] Open
Affiliation(s)
- S Redolfi
- AP-HP, Groupe Hospitalier APHP-Sorbonne Université, Hôpital Pitié-Salpêtrière, Service des Pathologies du Sommeil (Département R3S), F-75013 Paris, France; Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, 09134 Cagliari, Italy
| | - C Straus
- AP-HP, Groupe Hospitalier APHP-Sorbonne Université, Hôpital Pitié-Salpêtrière, Service des Explorations Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée (Département R3S), F-75013 Paris, France; Sorbonne Université, Inserm, UMRS 1158, F-75013 Paris, France
| | - V Ninane
- Service de pneumologie, Hôpital Universitaire Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - T Similowski
- Sorbonne Université, Inserm, UMRS 1158, F-75013 Paris, France; AP-HP, Groupe Hospitalier APHP-Sorbonne Université, Hôpital Pitié-Salpêtrière, Département R3S, F-75013 Paris, France.
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Bernardi E, Diotti C, Bertolaccini L, Donghi SM, Di Tonno C, Spaggiari L, Guarize J. Mediastinal cellulose pack mimicking lung cancer relapsing after lobectomy. Eur J Cardiothorac Surg 2024; 65:ezae065. [PMID: 38400779 DOI: 10.1093/ejcts/ezae065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/01/2024] [Accepted: 02/21/2024] [Indexed: 02/26/2024] Open
Affiliation(s)
- Emanuele Bernardi
- Department of Emergency Medicine, Regina Montis Regalis Hospital, Mondovi (CN), Italy
| | - Cristina Diotti
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Luca Bertolaccini
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Stefano Maria Donghi
- Division of Interventional Pulmonology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Clementina Di Tonno
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Juliana Guarize
- Division of Interventional Pulmonology, IEO, European Institute of Oncology IRCCS, Milan, Italy
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Gonzalez M, Ojanguren A, Figueroa S, Bédat B. Segmentectomy for lung cancer: dig deeper. Eur J Cardiothorac Surg 2024; 65:ezae066. [PMID: 38402510 DOI: 10.1093/ejcts/ezae066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 02/22/2024] [Indexed: 02/26/2024] Open
Affiliation(s)
- Michel Gonzalez
- Department of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Amaia Ojanguren
- Department of Thoracic Surgery, Bellvitge University Hospital, Barcelona, Spain
| | - Santiago Figueroa
- Department of Thoracic Surgery, Clinical University Hospital of Valencia, Valencia, Spain
| | - Benoît Bédat
- Faculty of Medicine, Department of Thoracic and Endocrine Surgery, University Hospitals of Geneva, Geneva, Switzerland
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Pan H, Zou N, Tian Y, Shen Y, Chen H, Zhu H, Zhang J, Jin W, Gu Z, Ning J, Jiang L, Huang J, Luo Q. Robotic Versus Thoracoscopic Sub-lobar Resection for Octogenarians with Clinical Stage IA Non-small Cell Lung Cancer: A Propensity Score-Matched Real-World Study. Ann Surg Oncol 2024; 31:1568-1580. [PMID: 38071721 PMCID: PMC10838251 DOI: 10.1245/s10434-023-14689-5] [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: 07/26/2023] [Accepted: 11/16/2023] [Indexed: 02/06/2024]
Abstract
BACKGROUND Minimally invasive sub-lobectomy is sufficient in treating small early-stage non-small cell lung cancer (NSCLC). However, comparison of the feasibility and oncologic efficacy between robot-assisted thoracoscopic surgery (RATS) and video-assisted thoracoscopic surgery (VATS) in performing sub-lobectomy for early-stage NSCLC patients age 80 years or older is scarce. METHODS Octogenarians with clinical stage IA NSCLC (tumor size, ≤ 2 cm) undergoing minimally invasive wedge resection or segmentectomy at Shanghai Chest Hospital from 2011 to 2020 were retrospectively reviewed from a prospectively maintained database. Propensity score-matching (PSM) with a RATS versus VATS ratio of 1:4 was performed. Perioperative and long-term outcomes were analyzed. RESULTS The study identified 594 patients (48 RATS and 546 VATS patients), and PSM resulted in 45 cases in the RATS group and 180 cases in the VATS group. The RATS patients experienced less intraoperative bleeding (60 mL [interquartile range (IQR), 50-100 mL] vs. 80 mL [IQR, 50-100 mL]; P = 0.027) and a shorter postoperative hospital stay (4 days [IQR, 3-5 days] vs. 5 days [IQR, 4-6 days]; P = 0.041) than the VATS patients. The two surgical approaches were comparable concerning other perioperative outcomes and postoperative complications (20.00% vs. 26.11%; P = 0.396). Additionally, during a median follow-up period of 66 months, RATS and VATS achieved comparable 5-year overall survival (90.48% vs. 87.93%; P = 0.891), recurrence-free survival (83.37% vs. 83.18%; P = 0.782), and cumulative incidence of death. Further subgroup comparison also demonstrated comparable long-term outcomes between the two approaches. Finally, multivariate Cox analysis indicated that the surgical approach was not independently correlated with long-term outcomes. CONCLUSIONS The RATS approach shortened the postoperative hospital stay, reduced intraoperative bleeding by a statistically notable but clinically insignificant amount, and achieved long-term outcomes comparable with VATS in performing sub-lobectomy for octogenarians with early-stage small NSCLC.
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Affiliation(s)
- Hanbo Pan
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ningyuan Zou
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Tian
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yaofeng Shen
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hang Chen
- Department of Cardiothoracic Surgery, The Affiliated Lihuili Hospital of Ningbo University, Zhejiang, China
| | - Hongda Zhu
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiaqi Zhang
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weiqiu Jin
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zenan Gu
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junwei Ning
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Thoracic Surgery, Shanghai Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Long Jiang
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jia Huang
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Qingquan Luo
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Tsikis ST, Hirsch TI, Klouda T, Fligor SC, Pan A, Joiner MM, Wang SZ, Quigley M, Devietro A, Mitchell PD, Kishikawa H, Yuan K, Puder M. Direct thrombin inhibitors fail to reverse the negative effects of heparin on lung growth and function after murine left pneumonectomy. Am J Physiol Lung Cell Mol Physiol 2024; 326:L213-L225. [PMID: 38113296 DOI: 10.1152/ajplung.00096.2023] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 12/18/2023] [Indexed: 12/21/2023] Open
Abstract
Neonates with congenital diaphragmatic hernia (CDH) frequently require cardiopulmonary bypass and systemic anticoagulation. We previously demonstrated that even subtherapeutic heparin impairs lung growth and function in a murine model of compensatory lung growth (CLG). The direct thrombin inhibitors (DTIs) bivalirudin and argatroban preserved growth in this model. Although DTIs are increasingly used for systemic anticoagulation clinically, patients with CDH may still receive heparin. In this experiment, lung endothelial cell proliferation was assessed following treatment with heparin-alone or mixed with increasing concentrations of bivalirudin or argatroban. The effects of subtherapeutic heparin with or without DTIs in the CLG model were also investigated. C57BL/6J mice underwent left pneumonectomy and subcutaneous implantation of osmotic pumps. Pumps were preloaded with normal saline, bivalirudin, or argatroban; treated animals received daily intraperitoneal low-dose heparin. In vitro, heparin-alone decreased endothelial cell proliferation and increased apoptosis. The effect of heparin on proliferation, but not apoptosis, was reversed by the addition of bivalirudin and argatroban. In vivo, low-dose heparin decreased lung volume compared with saline-treated controls. All three groups that received heparin demonstrated decreased lung function on pulmonary function testing and impaired exercise performance on treadmill tolerance testing. These findings correlated with decreases in alveolarization, vascularization, angiogenic signaling, and gene expression in the heparin-exposed groups. Together, these data suggest that bivalirudin and argatroban fail to reverse the inhibitory effects of subtherapeutic heparin on lung growth and function. Clinical studies on the impact of low-dose heparin with DTIs on CDH outcomes are warranted.NEW & NOTEWORTHY Infants with pulmonary hypoplasia frequently require cardiopulmonary bypass and systemic anticoagulation. We investigate the effects of simultaneous exposure to heparin and direct thrombin inhibitors (DTIs) on lung growth and pulmonary function in a murine model of compensatory lung growth (CGL). Our data suggest that DTIs fail to reverse the inhibitory effects of subtherapeutic heparin on lung growth and function. Clinical studies on the impact of heparin with DTIs on clinical outcomes are thus warranted.
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Affiliation(s)
- Savas T Tsikis
- Vascular Biology Program, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, United States
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Thomas I Hirsch
- Vascular Biology Program, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, United States
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Timothy Klouda
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts, United States
| | - Scott C Fligor
- Vascular Biology Program, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, United States
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Amy Pan
- Vascular Biology Program, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, United States
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Malachi M Joiner
- Vascular Biology Program, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, United States
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Sarah Z Wang
- Vascular Biology Program, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, United States
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Mikayla Quigley
- Vascular Biology Program, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, United States
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Angela Devietro
- Vascular Biology Program, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, United States
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Paul D Mitchell
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, Massachusetts, United States
| | - Hiroko Kishikawa
- Vascular Biology Program, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Ke Yuan
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts, United States
| | - Mark Puder
- Vascular Biology Program, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, United States
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, United States
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Pan H, Huang J, Luo Q. ASO Author Reflections: Should We Prefer Robotic over Thoracoscopic Surgery for Sublobar Resection in Octogenarians with Pulmonary Nodules ≤ 2 cm? Ann Surg Oncol 2024; 31:1585-1586. [PMID: 38057626 DOI: 10.1245/s10434-023-14728-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 11/20/2023] [Indexed: 12/08/2023]
Affiliation(s)
- Hanbo Pan
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jia Huang
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Qingquan Luo
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Takamori S, Nakagami C, Nakatsuka M, Watanabe H, Suzuki J, Endo M, Shiono S. [Educational Impact of Using Three-dimentional Models for Preoperative Simulation of Segmentectomy for Medical Students]. Kyobu Geka 2024; 77:169-172. [PMID: 38465487] [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: 03/12/2024]
Abstract
BACKGROUND Lung segment anatomy is complex and difficult for medical students to comprehend, so education is a challenging issue. Three-dimensional (3D) models may be a more effective teaching tool for medical students. We evaluated the usefulness of 3D models in education for segmentectomy. METHODS Sixty-six students who participated in clinical training for thoracic surgery from November 2020 to March 2022 were included in the study. Computed tomography (CT) images, 3D-CT images, and 3D models were used to investigate students' level of understanding for each lung segment. Levels of understanding were assessed using a questionnaire administered using the interview method. The results of the questionnaire were tabulated and analyzed using the Kruskal-Wallis test. RESULTS The response rate was 100%. Comprehension scores for all questions were highest for 3D models, followed by 3D-CT and CT. These results suggest that use of a 3D entity model may have a high educational effect. CONCLUSION Although it is unclear whether students' comprehension was directly related to their understanding of correct anatomy, our results suggest that 3D models may be an effective way for medical students to understand lung segmentectomy.
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Affiliation(s)
- Satoshi Takamori
- Department of General Thoracic Surgery, Yamagata Prefectural Hospital, Yamagata, Japan
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Tsolaki F, Tagarakis GI, Tagarakis I. When to anatomically excise a benign lung tumor-correspondence regarding the article: "large mesenchymal cystic and chondroid pulmonary hamartoma mimicking lung cancer: case report". J Cardiothorac Surg 2024; 19:82. [PMID: 38336782 PMCID: PMC10858531 DOI: 10.1186/s13019-024-02554-9] [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: 10/15/2023] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
The decision of whether to perform a large anatomic resection for a lung mass that is not definitely malignant comes often forward in the everyday practice of the thoracic surgeon. The general characteristics of the tumor as well as of the patient and the instinct and experience of the surgeon are the ones that dictate the final choice. Such a decision was made in the case of a large pulmonary hamartoma where a right middle lobectomy was performed with the postoperative course justifying the surgeons' choice.
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Affiliation(s)
- Fani Tsolaki
- Aristotle University of Thessaloniki, University Campus, Thessaloniki, 54124, Greece
| | - Georgios I Tagarakis
- Department of Cardiothoracic Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, 54636, Greece.
| | - Ioannis Tagarakis
- Aristotle University of Thessaloniki, University Campus, Thessaloniki, 54124, Greece
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Busti M, Zarfati A, Valfre L, Conforti A, Bagolan P. Respiratory and Musculoskeletal Long-Term Outcomes after Surgical Resection of Congenital Cystic Adenomatoid Malformation of the Lung in Newborns, Infants, and Toddlers. Eur J Pediatr Surg 2024; 34:63-68. [PMID: 37459887 DOI: 10.1055/a-2130-2564] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
INTRODUCTION The long-term outcomes of children who underwent surgery for congenital cystic adenomatoid malformation of the lung (CCAML) are not well documented, particularly regarding orthopaedic and respiratory follow-up (FU). The aim of this study was to assess the long-term pulmonary and orthopaedic outcomes of surgically treated CCAML in newborns, infants, and toddlers. MATERIALS AND METHODS Retrospective examination of prospectively recorded data of consecutive patients with CCAML who underwent surgery at our tertiary referral institution from January 2000 to December 2015 (newborns, infants, and toddlers). Clinical, radiological, and surgical data, as well as FU data were revised. A multidisciplinary team followed the patients after discharge at scheduled time points. RESULTS Seventy-seven patients were included. After surgery, patients were followed for a median of 8 years (range: 1-19 years) until they reached a median age of 8 years (range: 2-19 years). Thirty patients (39%) developed wheezing and 21 (27%) had lower respiratory tract infections (LRTIs) within 4 years of age. However, more than 50% of patients with respiratory symptoms underwent complete remission in the following 4 years. Thirty-one patients (40%) developed at least one minimal musculoskeletal deformity. Eighteen (23%) had scoliosis, 17 (22%) thoracic asymmetry, 10 (12%) pectus excavatum, and 5 (6%) winged scapula. CONCLUSIONS Patients operated for CCAML had good overall outcomes despite pulmonary symptoms and musculoskeletal sequelae. Even though these issues are frequently paucisymptomatic, trying to use less-invasive procedures (such as minimally axillary open "muscle-sparing" thoracotomy or thoracoscopy) may reduce this burden. A structured multidisciplinary FU is required.
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Affiliation(s)
- Matteo Busti
- Newborn Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Department of Systems Medicine, University of "Tor Vergata," Rome, Italy
| | - Angelo Zarfati
- Newborn Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Department of Systems Medicine, University of "Tor Vergata," Rome, Italy
| | - Laura Valfre
- Newborn Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Andrea Conforti
- Newborn Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Pietro Bagolan
- Newborn Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Department of Systems Medicine, University of "Tor Vergata," Rome, Italy
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Maeda R, Shien T, Takahashi M, Kawada K, Kajiwara Y, Kubo S, Takabatake D, Ohtani S, Matsuoka K, Hikino H, Ogasawara Y, Taira N, Osumi S, Ikeda M, Doihara H. Lung Oligometastasis of Breast Cancer: Prospective Cohort Study of Treatment Strategies (SBP-06). Acta Med Okayama 2024; 78:15-20. [PMID: 38419310 DOI: 10.18926/amo/66666] [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] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
While local treatment of metastases is considered to be unrelated to prognosis, previous studies have suggested that local treatment of isolated lung metastases may have positive prognostic impact. We designed this prospective cohort study to investigate the clinical situation and its outcomes. We enrolled patients with fewer than 3 lung nodules suspected of being oligometastases after curative breast cancer surgery. Treatments, including local and systemic therapy, were selected by the physician and patient in consultation. The primary outcome was overall survival (OS); secondary outcomes were the efficacy and the safety of the surgery for lung oligometastases. Between May 2015 and May 2019, 14 patients were enrolled. Resection of lung nodules (metastasectomy) was performed in 11 (78.6%) of 14 patients, and one of these cases was diagnosed as primary lung cancer. Metastasectomies were all performed employing video-assisted thoracic surgery (VATS) without perioperative complications. Systemic therapies were administered to all patients except one. The respective 3-year and 5-year OS rates of patients with lung oligometastases were 91.6% and 81.5%, respectively. Progression occurred in 6 patients: 3 of the 10 with metastasectomy and all 3 without this surgical procedure. Lung metastasectomy was worthwhile as a diagnostic evaluation and may provide long-term benefit in some patients.
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Affiliation(s)
- Reina Maeda
- Department of Breast and Endocrine Surgery, Okayama University Hospital
- Department of Breast Surgery, Hiroshima City Hiroshima Citizens Hospital
| | - Tadahiko Shien
- Department of Breast and Endocrine Surgery, Okayama University Hospital
| | - Mina Takahashi
- Department of Breast Oncology, NHO Shikoku Cancer Center
| | - Kengo Kawada
- Department of Breast and Endocrine Surgery, Kagawa Prefectural Central Hospital
| | - Yukiko Kajiwara
- Department of Breast Surgery, Hiroshima City Hiroshima Citizens Hospital
| | - Shinichiro Kubo
- Department of Breast and Thyroid Surgery, Fukuyama City Hospital
| | | | - Shoichiro Ohtani
- Department of Breast Surgery, Hiroshima City Hiroshima Citizens Hospital
| | - Kinya Matsuoka
- Department of Breast and Thyroid Surgery, Ehime Prefectural Central Hospital
| | - Hajime Hikino
- Department of Breast Surgery, Matsue Red Cross Hospital
| | - Yutaka Ogasawara
- Department of Breast and Endocrine Surgery, Kagawa Prefectural Central Hospital
| | - Naruto Taira
- Department of Breast and Thyroid Surgery, Kawasaki Medical School
| | - Shozo Osumi
- Department of Breast Oncology, NHO Shikoku Cancer Center
| | - Masahiko Ikeda
- Department of Breast and Thyroid Surgery, Fukuyama City Hospital
| | - Hiroyoshi Doihara
- Department of Breast and Endocrine Surgery, Okayama University Hospital
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Brunelli A, Decaluwe H, Gonzalez M, Gossot D, Petersen RH. Which extent of surgical resection thoracic surgeons would choose if they were diagnosed with an early-stage lung cancer: a European survey. Eur J Cardiothorac Surg 2024; 65:ezae015. [PMID: 38327176 DOI: 10.1093/ejcts/ezae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/03/2024] [Accepted: 01/11/2024] [Indexed: 02/09/2024] Open
Affiliation(s)
| | - Herbert Decaluwe
- Department of Thoracovascular Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Michel Gonzalez
- Department of Thoracic Surgery, University Hospital of Lausanne, Lausanne, Switzerland
| | - Dominique Gossot
- Department of Thoracic Surgery, IMM-Curie-Montsouris Thoracic Institute, Paris, France
| | - Rene Horsleben Petersen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Tsai PC, Liu C, Yeh YC, Hsu PK, Huang CS, Hsieh CC, Hsu HS. Prognostic factors for recurrence-free survival in resected pathologic N2-stage III non-small cell lung cancer treated with upfront surgery. J Chin Med Assoc 2024; 87:212-218. [PMID: 38156883 DOI: 10.1097/jcma.0000000000001050] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND The standard treatment for pathological N2 (pN2) non-small-cell lung cancer (NSCLC) patients is definitive chemoradiation. Surgery might be beneficial for resectable pN2 disease, so we investigated the recurrence-free interval of upfront surgery for selected patients with resectable pN2 disease. METHODS The clinicopathologic characteristics of patients with pN2 NSCLC who underwent upfront anatomical resection at Taipei Veterans General Hospital from 2011 January to 2019 December were retrospectively reviewed. A Cox regression model was used to identify prognostic factors of recurrence-free survival (RFS). RESULTS In total, 84 patients after curative lung anatomic resection were analyzed, with a 44-month median survival. The 1-, 3-, and 5-year RFS rates were 63.1%, 31.3%, and 19.9%, respectively, with a median RFS of 18.9 months. Multivariable cox regression analysis identified that the significant predictor for RFS was a tumor size of more than 3 cm (hazard ratio [HR] = 1.74, 95% CI, 1.07-2.83, p = 0.027). Visceral pleural invasion, LN harvest number, tumor stage, and N2 status including single zone (N2a) or multiple zones (N2b) were not prognostic factors in this study. CONCLUSION Upfront surgery for resectable N2 disease achieved favorable outcomes in selected patients, especially better recurrence control with limited tumor size. Therapeutic advances might encourage surgeons to aggressive intervention.
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Affiliation(s)
- Ping-Chung Tsai
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chia Liu
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yi-Chen Yeh
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Po-Kuei Hsu
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chien-Sheng Huang
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chih-Cheng Hsieh
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Han-Shui Hsu
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Lyberis P, Guerrera F, Balsamo L, Cristofori RC, Della Beffa E, Lausi PO, Rosboch GL, Filosso PL, Ruffini E, Femia F. Energy devices versus electrocoagulation in video-assisted thoracoscopic lobectomy: a propensity-match cohort study. Minerva Surg 2024; 79:21-27. [PMID: 37218141 DOI: 10.23736/s2724-5691.23.09944-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND The aim of the study was to compare the effect on perioperative outcome of intraoperative use of different devices for tissue dissection (electrocoagulation [EC] or energy devices [ED]) in patients who underwent video-assisted thoracoscopic surgery (VATS) lobectomy for lung cancer. METHODS We retrospectively reviewed 191 consecutive patients who underwent VATS lobectomy, divided into two cohorts: ED (117 patients), and EC (74 patients); after propensity score matching, 148 patients were extracted, 74 for each cohort. The primary endpoints considered were complication rate and 30-day mortality rate. The secondary endpoints considered were length of stay (LOS) and the number of lymph nodes harvested. RESULTS The complication rate did not differ between the two cohorts (16.22% EC group, 19.66% ED group, P=0.549), before and after propensity matching (16.22% for both EC and ED group, P=1.000). The 30-day mortality rate was 1 in the overall population. Median LOS was 5 days for both groups, before and after propensity match, with the same interquartile range, (IQR: 4-8). ED group had a significantly higher median number of lymph nodes harvested (ED median: 18, IQR: 12-24; EC median: 10, IQR: 5-19; P=0.0002). The difference was confirmed after the propensity score matching (ED median: 17, IQR: 13-23; EC median: 10, IQR: 5-19; P=0.0008). CONCLUSIONS ED dissection during VATS lobectomy did not lead to different complication rates, mortality rates, and LOS compared to EC tissue dissection. ED use led to a significantly higher number of intraoperative lymph nodes harvested compared to EC use.
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Affiliation(s)
- Paraskevas Lyberis
- Department of Thoracic Surgery, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Francesco Guerrera
- Department of Thoracic Surgery, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Ludovica Balsamo
- Department of Thoracic Surgery, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Riccardo C Cristofori
- Department of Thoracic Surgery, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Eleonora Della Beffa
- Department of Thoracic Surgery, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Paolo O Lausi
- Department of Thoracic Surgery, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Giulio L Rosboch
- Department of Anesthesia, Intensive Care and Emergency, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Pier L Filosso
- Department of Thoracic Surgery, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Enrico Ruffini
- Department of Surgical Sciences, University of Turin, Turin, Italy
- Department of Anesthesia, Intensive Care and Emergency, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Federico Femia
- Department of Thoracic Surgery, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy -
- Department of Surgical Sciences, University of Turin, Turin, Italy
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Hong Z, Liu Q, Li H, Cui B, Cheng T, Lu Y, Wu X, Jin D, Gou Y, Dong X. Effect of da Vinci robot versus thoracoscopic surgery on lung function and oxidative stress levels in NSCLC patients: a propensity score-matched study. Surg Endosc 2024; 38:706-712. [PMID: 38030797 DOI: 10.1007/s00464-023-10577-x] [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: 04/20/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND To evaluate the short-term efficacy, lung function, and oxidative stress levels between the robotic-assisted thoracoscopic surgery (RATS) and video-assisted thoracoscopic surgery group (VATS) for non-small cell lung cancer (NSCLC). METHODS We conducted a retrospective cohort study, selecting 248 NSCLC patients who underwent minimally invasive lobectomy at the Department of Thoracic Surgery, Gansu Provincial People's Hospital, from August 2019 to February 2023. There were 105 patients in the RATS group and 143 patients in the VATS group. The patients in the two groups were subjected to 1:1 propensity score matching analysis (PSM), and the perioperative indicators were recorded. The levels of oxidative stress factors (superoxide dismutase, SOD; malondialdehyde, MDA) and inflammatory factors were measured 1 day before surgery and 3 days after surgery, respectively. Pulmonary function and patient quality of life were measured at 1 day preoperatively and 3 months postoperatively. RESULTS There are 93 patients in each group after PSM. Compared to the VATS group, the RATS group had shorter operation time, less intraoperative blood loss, greater number and groups of lymph nodes cleared, and shorter postoperative hospital stay. The SOD level in the RATS group was higher and the MDA level was lower than that in the VATS group after surgery. Postoperative inflammatory cytokine levels were less elevated in the RATS group than in the VATS group. At 3 months postoperatively, FVC%, FEV1%, and GQOLI-74 scores were higher in the RATS group than in the VATS group. CONCLUSION Compared to VATS lobectomy, RATS lobectomy has the advantages of shorter operative time, lesser bleeding, more lymph node dissection, faster postoperative recovery, and lesser impact on postoperative lung function. It is also capable of reducing the postoperative oxidative stress and inflammatory response, which can improve patients' quality of life.
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Affiliation(s)
- Ziqiang Hong
- The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, 730000, Gansu, China
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, 730000, Gansu, China
| | - Qing Liu
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou, 730000, Gansu, China
| | - Hongchao Li
- The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, 730000, Gansu, China
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, 730000, Gansu, China
| | - Baiqiang Cui
- The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, 730000, Gansu, China
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, 730000, Gansu, China
| | - Tao Cheng
- The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, 730000, Gansu, China
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, 730000, Gansu, China
| | - Yingjie Lu
- The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, 730000, Gansu, China
| | - Xusheng Wu
- The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, 730000, Gansu, China
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, 730000, Gansu, China
| | - Dacheng Jin
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, 730000, Gansu, China
| | - Yunjiu Gou
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, 730000, Gansu, China.
| | - Xinchun Dong
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, 730000, Gansu, China.
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Serhal M, Dadrass F, Kim E, Lewandowski RJ. Radiation Segmentectomy for Hepatocellular Carcinoma. Curr Oncol 2024; 31:617-628. [PMID: 38392039 PMCID: PMC10888093 DOI: 10.3390/curroncol31020045] [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: 12/28/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/24/2024] Open
Abstract
The application of trans-arterial radioembolization (TARE) with Yttrium-90, historically a palliative treatment option for patients with advanced hepatocellular carcinoma (HCC), is evolving. Radiation segmentectomy (RADSEG), the segmental delivery of an ablative radiation dose, is a treatment option for patients with earlier-stage HCC. This review presents an in-depth exploration of RADSEG, emphasizing its technical considerations, dosimetry advancements, and patient selection. The integration of RADSEG into the Barcelona Clinic Liver Cancer (BCLC) paradigm will be highlighted. RADSEG outcomes concerning safety and efficacy will be explored and compared with traditional locoregional cancer treatments like trans-arterial chemoembolization (TACE), percutaneous thermal ablation, and surgical resection, with an eye on future directions and considerations.
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Affiliation(s)
- Muhamad Serhal
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA;
| | - Farnaz Dadrass
- Department of Radiology, Mount Sinai Health System, New York, NY 10029, USA; (F.D.); (E.K.)
| | - Edward Kim
- Department of Radiology, Mount Sinai Health System, New York, NY 10029, USA; (F.D.); (E.K.)
| | - Robert J. Lewandowski
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA;
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Ravishankar R, Hussain A, Arif S, Khan T, Gooseman M, Tentzeris V, Cowen M, Qadri S. An analysis of long-term survival after pneumonectomy for lung cancer: A retrospective study of 20 years. Asian Cardiovasc Thorac Ann 2024; 32:11-18. [PMID: 38043931 DOI: 10.1177/02184923231212657] [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] [Indexed: 12/05/2023]
Abstract
INTRODUCTION The incidence of pneumonectomy for lung cancer in the UK is continuing to decline in the era of minimally invasive thoracic surgery totalling approximately 3.5% of lung cancer resections annually. Literature is lacking for long-term survival of pneumonectomies. This study updates our previous results. Between 1998 and 2008, 206 patients underwent pneumonectomy compared to 98 patients between 2009 and 2018. METHODS From January 1998 until December 2018, 304 patients underwent pneumonectomy. This was a retrospective study; data was analysed for age, gender, laterality, histology and time period. RESULTS Operative mortality was 4.3% overall which was lower than the national average of 5.8%. In the last five years, there were no in-hospital, operative or 30-day mortality. During this period, 90-day mortality was 9.2%. Left-sided pneumonectomies had significantly better overall survival (3.00 vs. 2.03 years; p = 0.0015), squamous cell carcinoma (3.23 vs. 1.54 years; p = 0.00012) as well as those aged less than 70 (2.79 vs. 2.13 years; p = 0.011). There was no significant difference in survival between gender (p = 0.48). Intervention from 1998 to 2008 had significantly greater survival compared to the latter 10 years (2.68 vs. 2.46 years; p = 0.031). The Cox model shows that laterality, age, histology and time period remain significant with multivariate testing. No patient survived after 16 years. DISCUSSION Our updated retrospective study has built on our previous results by reinforcing the success of pneumonectomies. The incidence of pneumonectomies is likely to decrease with the deployment of nation-wide lung cancer screening in the UK due to earlier detection.
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Affiliation(s)
| | - Azar Hussain
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Cottingham, UK
| | - Salman Arif
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Cottingham, UK
| | - Tanveer Khan
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Cottingham, UK
| | - Michael Gooseman
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Cottingham, UK
| | | | - Michael Cowen
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Cottingham, UK
| | - Syed Qadri
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Cottingham, UK
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Kim S, Kim J, Jeong U, Oh YJ, Park SG, Lee HY. Robust imaging approach for precise prediction of postoperative lung function in lung cancer patients prior to curative operation. Thorac Cancer 2024; 15:35-43. [PMID: 37967873 PMCID: PMC10761624 DOI: 10.1111/1759-7714.15153] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 10/25/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND To create a combined variable integrating both ventilation and perfusion as measured by preoperative dual-energy computed tomography (DECT), compare the results with predicted postoperative (PPO) lung function as estimated using conventional methods, and assess agreement with actual postoperative lung function. METHODS A total of 33 patients with lung cancer who underwent curative surgery after DECT and perfusion scan were selected. Ventilation and perfusion values were generated from DECT data. In the "combined variable method," these two variables and clinical variables were linearly regressed to estimate PPO lung function. Six PPO lung function parameters (segment counting, perfusion scan, volume analysis, ventilation map, perfusion map, and combined variable) were compared with actual postoperative lung function using an intraclass correlation coefficient (ICC). RESULTS The segment counting method produced the highest ICC for forced vital capacity (FVC) at 0.93 (p < 0.05), while the segment counting and perfusion map methods produced the highest ICC for forced expiratory volume in 1 second (FEV1 ; both 0.89, p < 0.05). The highest ICC value when using the combined variable method was for FEV1 /FVC (0.75, p < 0.05) and diffusing capacity of the lung for carbon monoxide (DLco; 0.80, p < 0.05) when using the perfusion map method. Overall, the perfusion map and ventilation map provided the best performance, followed by volume analysis, segment counting, perfusion scan, and the combined variable. CONCLUSIONS Use of DECT image processing to predict postoperative lung function produced better agreement with actual postoperative lung function than conventional methods. The combined variable method produced ICC values of 0.8 or greater for FVC and FEV1 .
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Affiliation(s)
- Suho Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea
| | - Jonghoon Kim
- Department of Health Sciences and Technology, SAIHSTSungkyunkwan UniversitySeoulSouth Korea
| | - Uichan Jeong
- Department of Radiology and Center for Imaging Science, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea
| | - You Jin Oh
- Department of Radiology and Center for Imaging Science, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea
- Department of Health Sciences and Technology, SAIHSTSungkyunkwan UniversitySeoulSouth Korea
| | - Sung Goo Park
- Department of Radiology and Center for Imaging Science, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea
| | - Ho Yun Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea
- Department of Health Sciences and Technology, SAIHSTSungkyunkwan UniversitySeoulSouth Korea
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Huang C, Tong H. Two-stage minimally invasive pulmonary resections with intraoperative localization technique for bilateral multiple primary lung cancers: A case report. Thorac Cancer 2024; 15:192-197. [PMID: 38018514 PMCID: PMC10788464 DOI: 10.1111/1759-7714.15183] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/18/2023] [Accepted: 11/20/2023] [Indexed: 11/30/2023] Open
Abstract
Multiple primary lung cancers (MPLCs) are becoming more and more common and these patients can benefit from minimally invasive surgery. Here, we report a case of a patient diagnosed with synchronous MPLCs who underwent bilateral thoracoscopic pulmonary resections in a two-stage strategy, and achieved a good surgical outcome and high quality of life. A 66-year-old female was found to have one major ground-glass nodule (GGN) in the right upper lobe and eight minor GGNs in the left upper and lower lobes. The patient underwent right upper lobe resection and systematic mediastinal lymph node dissection via single-utility port thoracoscopic surgery in September 2018. Pathology was lepidic predominant adenocarcinoma pT1bN0M0, IA2. Regular high-resolution computed tomography examination during 36 months after right upper lobectomy showed gradually increasing diameter and solid component of multiple GGNs in left lung. The patient underwent thoracoscopic multiple pulmonary resections using an intraoperative localization technique in a hybrid operating room in October 2021 and all eight nodules in the left lung were resected. Two segmentectomies and four wedge resections were performed, and the pathological results of the eight nodules included four adenocarcinomas, three adenocarcinomas in situ, and one alveolar epithelial hyperplasia. The two operations were successful with no intra- or postoperative 90-day complications. During more than 20 months of follow-up after the second operation, the patient had well recovered pulmonary function and physical status with a Karnofsky performance status score of 90 and no local recurrence or metastasis. A two-stage surgical strategy for synchronous MPLCs is therefore feasible. The surgical strategy, timing of intervention, and extent of pulmonary resection should be individually designed according to the location and characteristics of each nodule. Intraoperative localization of small GGNs is very important to ensure that all nodules are completely and accurately resected during the operation.
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Affiliation(s)
- Chuan Huang
- Department of Thoracic Surgery, Beijing Hospital, National Center of GerontologyInstitute of Geriatric Medicine, Chinese Academy of Medical SciencesBeijingChina
| | - Hong‐Feng Tong
- Department of Thoracic Surgery, Beijing Hospital, National Center of GerontologyInstitute of Geriatric Medicine, Chinese Academy of Medical SciencesBeijingChina
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Ugalde Figueroa PA, Marques E, Cilento VJ, Giroux DJ, Nishimura KK, Detterbeck FC, Van Schil P, Bertoglio P, Jeffrey Yang CF, Fang W. Completeness of Resection and Long-Term Survival of Patients Undergoing Resection for Pathologic T3 NSCLC: An International Association for the Study of Lung Cancer Analysis. J Thorac Oncol 2024; 19:141-152. [PMID: 37717854 DOI: 10.1016/j.jtho.2023.09.277] [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: 04/16/2023] [Revised: 08/20/2023] [Accepted: 09/07/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION Currently, tumors with different histopathologic characteristics and oncologic outcomes comprise the T3 category of the eight edition TNM classification for lung cancers. To better understand the T3 category, we evaluated completeness of resection and long-term survival in patients undergoing resection for T3 NSCLC. METHODS The International Association for the Study of Lung Cancer 1999 to 2010 database was queried for patients with pathologic T3N0M0 NSCLC who underwent lobectomy or pneumonectomy. The primary outcome evaluated was overall survival (OS) stratified by T3 descriptors and completeness of resection. RESULTS Of 1448 patients with T3N0M0 tumors, 1187 (82.0%) had a single descriptor defining them as T3. T3 tumors with chest wall infiltration (CWI) or parietal pleura infiltration (PL3) had the highest rates of incomplete resection (9.8% and 8.4%, respectively), and those classified as T3 by size only had the lowest rate of incomplete resection (2.9%). Individual T3 descriptors were associated with significant differences in OS (p = 0.005). When tumors with similar survival and complete resection rates were grouped, patients with T3 tumors characterized by size or the presence of a separate nodule (SN) in the same lobe had better 5-year OS than patients with tumors characterized by PL3 or CWI (size/SN 60% versus CWI/PL3 53%, p = 0.017) independent of completeness of resection. CONCLUSIONS Significant differences in 5-year OS were associated with size, SN, PL3, or CWI T3 descriptors. Subdividing pathologic T3N0M0 tumors according to the presence or absence of CWI or PL3 may increase the prognostic accuracy of tumor staging.
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Affiliation(s)
- Paula A Ugalde Figueroa
- Division of Thoracic and Cardiac Surgery, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts.
| | - Edouard Marques
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec, Quebec, Canada
| | | | | | | | - Frank C Detterbeck
- Division of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Paul Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital and Antwerp University, Edegem (Antwerp), Belgium
| | - Pietro Bertoglio
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Chi-Fu Jeffrey Yang
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Jiao Tong University Medical School, Shanghai, People's Republic of China
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Streit A, Lampridis S, Seitlinger J, Renaud S, Routledge T, Bille A. Resectability versus Operability in Early-Stage Non-Small Cell Lung Cancer. Curr Oncol Rep 2024; 26:55-64. [PMID: 38133722 DOI: 10.1007/s11912-023-01477-3] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE OF REVIEW With increased detection of early-stage non-small cell lung cancer (NSCLC) owing to screening, determining optimal management increasingly hinges on assessing resectability and operability. Resectability refers to the feasibility of achieving microscopically negative margins based on tumour size, location and degree of local invasion and achieving an anatomical lobar resection. Operability reflects the patient's tolerance for resection based on comorbidities, cardiopulmonary reserve and frailty. Standardized criteria help guide these assessments, but application variability contributes to practice inconsistencies. This review synthesizes a strategic approach to evaluating resectability and operability in contemporary practice. Standardization promises reduced care variability and optimized patient selection to maximize curative outcomes in this new era of early detection. RECENT FINDINGS Recent pivotal trials demonstrate equivalency of sublobar resection to lobectomy for small, peripheral, node-negative NSCLC, expanding options for parenchymal preservation in borderline surgical candidates. Furthermore, recent phase 3 trials have highlighted the benefit of chemoimmunotherapy as a neoadjuvant treatment with an excellent pathological response and a down staging of the tumour, improving the resectability of the early-stage NSCLC. A good assessment of the operability and resectability is paramount in order to offer the best course of treatment for our patients. European and American societies have issued recommendations to help clinicians assess the cardiopulmonary function and predict the extension of pulmonary resection that could afford the patient. This operability assessment is closely linked with the evaluated tumour resectability which will determine the extension of pulmonary resection that is needed for the patient in order to achieve a good oncological outcome. Some major progresses have been done recently to improve the operability and resectability of patients. For instance, prehabilitation program allows better postoperative morbidity. Some studies have shown a potential good oncological outcome with sublobar resection expending access to surgery for patient with reduced lung function. Some others have identified the neoadjuvant immunochemotherapy as a potential solution for downstaging tumours. Work-up of early-stage NSCLC is a key moment and has to be done thoroughly and in full knowledge of the recent findings in order to propose the most appropriate treatment for the patient.
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Affiliation(s)
- Arthur Streit
- Department of Thoracic Surgery, Great Maze Pond, Guy's and St Thomas' NHS Trust Foundation, London, SE19RT, UK.
- Department of Thoracic Surgery, University Hospital of Nancy, Nancy, France.
| | - Savvas Lampridis
- Department of Thoracic Surgery, Great Maze Pond, Guy's and St Thomas' NHS Trust Foundation, London, SE19RT, UK
| | - Joseph Seitlinger
- Department of Thoracic Surgery, University Hospital of Nancy, Nancy, France
| | - Stéphane Renaud
- Department of Thoracic Surgery, University Hospital of Nancy, Nancy, France
| | - Tom Routledge
- Department of Thoracic Surgery, Great Maze Pond, Guy's and St Thomas' NHS Trust Foundation, London, SE19RT, UK
| | - Andrea Bille
- Department of Thoracic Surgery, Great Maze Pond, Guy's and St Thomas' NHS Trust Foundation, London, SE19RT, UK
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Sarnaik KS, Bassiri A, Poston LM, Gasnick A, Sinopoli JN, Tapias Vargas L, Linden PA, Towe CW. Lymph Node Yield in Lung Cancer Resection is Associated With Demographic and Institutional Factors. J Surg Res 2024; 293:175-186. [PMID: 37776720 DOI: 10.1016/j.jss.2023.09.007] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 08/09/2023] [Accepted: 09/01/2023] [Indexed: 10/02/2023]
Abstract
INTRODUCTION Lymphadenectomy is routinely performed during surgical resection of nonsmall cell lung cancer (NSCLC). Lymph node yield and number of nodal stations sampled are important prognostic markers viewed as surrogates of surgical quality. The purpose of this study was to identify factors associated with these quality metrics after resection of NSCLC. MATERIALS AND METHODS We identified NSCLC patients undergoing resection at a single institution from 2010 to 2021. Cases were matched to detailed pathologist reports, which included lymph node yield and number of stations sampled. Demographic and clinical characteristics were analyzed individually using unadjusted linear regression to identify factors associated with lymph node yield and number of stations sampled. Multivariable linear regression analyses were performed to evaluate the same end points, using covariates determined through stepwise-backwards selection. RESULTS The study cohort included 836 patients. Multivariable regression demonstrated that male sex, history of cardiothoracic surgery, and individual pathologist were independently associated with lymph node yield. Among 18 pathologists, interpathologist coefficients with respect to lymph node yield varied from -5.61 to 11.25. Multivariable regression demonstrated White race and history of cardiothoracic surgery to be independently associated with number of nodal stations sampled, as well as individual surgeon and pathologist. CONCLUSIONS Lymph node yield and number of nodal stations sampled after NSCLC resection may vary based on patient demographic and clinical characteristics, as well as institutional factors. These factors should be accounted for when using these metrics as markers of surgical quality and prognosis of NSCLC.
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Affiliation(s)
- Kunaal S Sarnaik
- Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Aria Bassiri
- Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio; Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Lauren M Poston
- Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Allison Gasnick
- Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jillian N Sinopoli
- Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio; Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Leonidas Tapias Vargas
- Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio; Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Philip A Linden
- Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio; Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Christopher W Towe
- Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio; Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
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Kolařík J, Tavandžis J, Novysedlák R, Vachtenheim J, Švorcová M, Pozniak J, Šimonek J, Schützner J, Lischke R. Biportal robotic pulmonary lobectomy, initial experience - case report. Rozhl Chir 2024; 102:430-432. [PMID: 38290819 DOI: 10.33699/pis.2023.102.11.430-432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
INTRODUCTION Thanks to perfect visualization and high maneuverability of instruments, the robotic technique is a preferable type of lung resection, even though the number of required incisions is usually higher compared to the video-assisted approach. This case report presents our initial experience with the reduced-port approach in performing robotic biportal lobectomy. CASE REPORT The 72-years-old female, examined for hemoptysis, was diagnosed with a carcinoid tumor of the left lower lobe bronchus based on bronchoscopy. The patient underwent a biportal fully robotic left lower lobectomy. The time of operation was 235 minutes, longer compared to the average time of multiportal procedures, i.e. 190±52 minutes, and the blood loss of 100 mL was higher compared to 43±54 mL. The patient was discharged without complications on the third postoperative day. Histological analysis confirmed the diagnosis of a typical carcinoid with tumor free margins and seven tumor free lymph nodes. The patient continues to be followed at the Department of Pneumology, showing no signs of disease recurrence for eight months. CONCLUSION The robotic biportal approach offers a reduction in chest wall traumatization while maintaining oncological radicality. Although this approach is safe and feasible, limitations in instrument movements necessitate specific training.
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