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Jiang D, Rao Y, Zhang C, Wang D, Jiang X, Wang H. Efficacy and safety of bevacizumab and platinum‑based chemotherapy as neoadjuvant regimen for stage‑IIIA non‑squamous non‑small cell lung cancer: A retrospective study. Oncol Lett 2024; 28:375. [PMID: 38910904 PMCID: PMC11190814 DOI: 10.3892/ol.2024.14508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 04/26/2024] [Indexed: 06/25/2024] Open
Abstract
Bevacizumab plus platinum-based chemotherapy provides modest benefits in non-squamous non-small cell lung cancer (NSCLC), while its application as a neoadjuvant regimen has yet to be validated. The present study aimed to assess the efficacy of neoadjuvant bevacizumab plus platinum-based chemotherapy in patients with stage-IIIA non-squamous NSCLC. Data from 110 patients with stage-IIIA non-squamous NSCLC with negative driver genes, who received neoadjuvant bevacizumab plus platinum-based chemotherapy (n=50) or neoadjuvant platinum-based chemotherapy alone (n=60), and tumor resection, were retrospectively reviewed in the current study. In addition, the data on pathological response, disease-free survival (DFS), overall survival (OS) and adverse events were obtained. The results demonstrated that neoadjuvant bevacizumab plus chemotherapy did not significantly increase the pathological complete response (pCR) rate in comparison with neoadjuvant chemotherapy alone (18.0 vs. 8.3%; P=0.130). However, neoadjuvant bevacizumab plus chemotherapy significantly increased the rates of DFS (P=0.007) and OS (P=0.049) compared with neoadjuvant chemotherapy alone. Adjustments were then performed using multivariate logistic or Cox regression analyses, which demonstrated that neoadjuvant bevacizumab plus chemotherapy in comparison with neoadjuvant chemotherapy alone only significantly independently prolonged DFS [hazard ratio (HR)=0.251; P=0.042], but did not significantly affect pCR (odds ratio=2.897; P=0.117) or OS (HR=0.297; P=0.158). Furthermore, no significant differences were demonstrated between the number of adverse events in patients receiving neoadjuvant bevacizumab plus chemotherapy in comparison with those receiving neoadjuvant chemotherapy alone (all P>0.05). In conclusion, neoadjuvant bevacizumab plus platinum-based chemotherapy was only associated with a significant improvement in the rate of DFS, but showed limited efficacy in improving pCR and OS rates in comparison with neoadjuvant chemotherapy alone in patients with stage-IIIA non-squamous NSCLC. Therefore, a larger sample size and randomized controlled studies are needed for further validation of the findings of the present study.
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Affiliation(s)
- Dexiong Jiang
- Pulmonary and Critical Care Medicine, Dazhou Central Hospital, Dazhou, Sichuan 635000, P.R. China
| | - Yao Rao
- Pulmonary and Critical Care Medicine, Dazhou Central Hospital, Dazhou, Sichuan 635000, P.R. China
| | - Chunxi Zhang
- Pulmonary and Critical Care Medicine, Dazhou Central Hospital, Dazhou, Sichuan 635000, P.R. China
| | - Dan Wang
- Pulmonary and Critical Care Medicine, Dazhou Central Hospital, Dazhou, Sichuan 635000, P.R. China
| | - Xu Jiang
- Pulmonary and Critical Care Medicine, Dazhou Central Hospital, Dazhou, Sichuan 635000, P.R. China
| | - Huachuan Wang
- Department of Thoracic Surgery, Dazhou Central Hospital, Dazhou, Sichuan 635000, P.R. China
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Andolfi M, Meacci E, Salati M, Xiumè F, Roncon A, Guiducci GM, Tiberi M, Nanto AC, Nachira D, Nocera A, Calabrese G, Congedo MT, Inchingolo R, Margaritora S, Refai M. Uniportal Video-Assisted Thoracoscopic Anatomic Lung Resection after Neoadjuvant Chemotherapy for Lung Cancer: A Case-Matched Analysis. Cancers (Basel) 2024; 16:2642. [PMID: 39123370 PMCID: PMC11311275 DOI: 10.3390/cancers16152642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 07/18/2024] [Accepted: 07/23/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND The advantages of video-assisted thoracic surgery (VATS) are well-recognized in several studies. However, in the cases of advanced lung cancer after neoadjuvant chemotherapy (nCT), the role of VATS is still questionable, with concerns about safety, technical feasibility, and oncological completeness. The aim of this study was to assess the impact of nCT on patients who had undergone uniportal VATS (U-VATS) anatomic lung resections for lung cancer, by comparing the short-term outcomes of patients after nCT with case-matched counterparts (treated by surgery alone). METHODS We performed a retrospective, comparative study enrolling 927 patients (nCT: 60; non-nCT:867) who underwent U-VATS anatomic lung resections from 2014 to 2020 in two centers. Data were collected in a shared database with standardized variables' definition. Propensity score matching using 15 baseline preoperative patients' characteristics was performed in order to minimize selection-confounding factors between the two groups, which then were directly compared in terms of perioperative outcomes. RESULTS After propensity score matching, two groups of 60 patients had been defined. The nCT-group had a higher conversion rate compared to the control group (13.3% vs. 0%, p = 0.003) without an increase in operation time or cardiopulmonary complications. In addition, no differences between the two groups were recorded in terms of prolonged air leaks, length of stay, and readmission. CONCLUSIONS U-VATS after nCT is a feasible approach, showing a similar rate of cardiopulmonary complications and length of stay when compared with the control group. However, it remains a challenging surgery due to its great technical complexity as well as the clinical status of the patients.
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Affiliation(s)
- Marco Andolfi
- Department of Thoracic Surgery, AOU delle Marche, 60126 Ancona, Italy; (M.S.); (F.X.); (A.R.); (G.M.G.); (M.T.); (A.C.N.); (M.R.)
| | - Elisa Meacci
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario ‘A. Gemelli’ IRCCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (E.M.); (D.N.); (A.N.); (G.C.); (M.T.C.); (S.M.)
| | - Michele Salati
- Department of Thoracic Surgery, AOU delle Marche, 60126 Ancona, Italy; (M.S.); (F.X.); (A.R.); (G.M.G.); (M.T.); (A.C.N.); (M.R.)
| | - Francesco Xiumè
- Department of Thoracic Surgery, AOU delle Marche, 60126 Ancona, Italy; (M.S.); (F.X.); (A.R.); (G.M.G.); (M.T.); (A.C.N.); (M.R.)
| | - Alberto Roncon
- Department of Thoracic Surgery, AOU delle Marche, 60126 Ancona, Italy; (M.S.); (F.X.); (A.R.); (G.M.G.); (M.T.); (A.C.N.); (M.R.)
| | - Gian Marco Guiducci
- Department of Thoracic Surgery, AOU delle Marche, 60126 Ancona, Italy; (M.S.); (F.X.); (A.R.); (G.M.G.); (M.T.); (A.C.N.); (M.R.)
| | - Michela Tiberi
- Department of Thoracic Surgery, AOU delle Marche, 60126 Ancona, Italy; (M.S.); (F.X.); (A.R.); (G.M.G.); (M.T.); (A.C.N.); (M.R.)
| | - Anna Chiara Nanto
- Department of Thoracic Surgery, AOU delle Marche, 60126 Ancona, Italy; (M.S.); (F.X.); (A.R.); (G.M.G.); (M.T.); (A.C.N.); (M.R.)
| | - Dania Nachira
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario ‘A. Gemelli’ IRCCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (E.M.); (D.N.); (A.N.); (G.C.); (M.T.C.); (S.M.)
| | - Adriana Nocera
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario ‘A. Gemelli’ IRCCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (E.M.); (D.N.); (A.N.); (G.C.); (M.T.C.); (S.M.)
| | - Giuseppe Calabrese
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario ‘A. Gemelli’ IRCCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (E.M.); (D.N.); (A.N.); (G.C.); (M.T.C.); (S.M.)
| | - Maria Teresa Congedo
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario ‘A. Gemelli’ IRCCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (E.M.); (D.N.); (A.N.); (G.C.); (M.T.C.); (S.M.)
| | - Riccardo Inchingolo
- UOC Pneumologia, Dipartimento Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario ‘A. Gemelli’ IRCCS, 00168 Rome, Italy;
| | - Stefano Margaritora
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario ‘A. Gemelli’ IRCCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (E.M.); (D.N.); (A.N.); (G.C.); (M.T.C.); (S.M.)
| | - Majed Refai
- Department of Thoracic Surgery, AOU delle Marche, 60126 Ancona, Italy; (M.S.); (F.X.); (A.R.); (G.M.G.); (M.T.); (A.C.N.); (M.R.)
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Fu S, Niu Y, Yang H, Fang W. Minimally invasive surgery role in central squamous lung cancer after neoadjuvant chemoimmunotherapy. J Thorac Dis 2024; 16:285-295. [PMID: 38410551 PMCID: PMC10894389 DOI: 10.21037/jtd-23-1241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 12/01/2023] [Indexed: 02/28/2024]
Abstract
Background The present body of literature provides restricted evidence concerning the application of video-assisted thoracoscopic surgery (VATS) in individuals diagnosed with centrally located, locally advanced, and initially surgically challenging squamous cell lung carcinoma (SqCLC) following neoadjuvant chemoimmunotherapy (CIT). Further research is warranted to elucidate the role and potential benefits of VATS in this particular patient population. Methods We performed a retrospective analysis on individuals diagnosed with centrally located and locally advanced SqCLC who received preoperative CIT at a single institution. The study evaluated the percentage of VATS performed, conversion rates, and perioperative outcomes. Furthermore, survival outcomes related to the resection extent were compared between patients who underwent standard lobectomy (SL) and extended lobectomy (EL, e.g., sleeve, bilobectomy or pneumonectomy) after neoadjuvant CIT. Results A total of 27 cases of centrally located SqCLC underwent neoadjuvant CIT followed by VATS, with one case requiring conversion to thoracotomy due to adhesions. Comparison of perioperative outcomes and long-term cancer-specific mortality between the VATS group (N=24) and the thoracotomy group (N=13) did not yield any statistically significant differences. However, the VATS group exhibited a significantly higher frequency of SL (66.7% vs. 30.8%, P=0.046). Notably, within the VATS group, all three patients who experienced tumor relapse or died due to tumor recurrence were from the SL subgroup. Conclusions This study contributes valuable real-world evidence demonstrating the feasibility and safety of utilizing VATS in the management of patients with centrally located and locally advanced SqCLC following neoadjuvant CIT. However, careful consideration might be given to the extent of resection to optimize patient long-term outcomes.
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Affiliation(s)
- Shijie Fu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yongliang Niu
- Department of Respiratory and Critical Care Medicine, No. 2 People’s Hospital of Fuyang City, Fuyang Infectious Disease Clinical College of Anhui Medical University, Fuyang, China
| | - Haitang Yang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Sedighim S, Frank MI, Heutlinger O, Lee C, Hachey SJ, Keshava HB. A Systematic Review of Short-Term Outcomes of Minimally Invasive Thoracoscopic Surgery for Lung Cancer after Neoadjuvant Systemic Therapy. Cancers (Basel) 2023; 15:3908. [PMID: 37568725 PMCID: PMC10417737 DOI: 10.3390/cancers15153908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 07/25/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Minimally invasive surgeries for non-small cell lung cancers (NSCLCs) such as video-assisted thoracoscopic surgeries (VATSs) and robotic-assisted thoracoscopic surgeries (RATSs) have become standard of care for patients needing surgical resection in early stages. The role for neoadjuvant systemic therapy has increased with patients receiving neoadjuvant systemic chemotherapy and immunotherapy. However, there has been some equipoise over the intraoperative and overall outcomes for these patients. Here, we review the current data regarding outcomes of patients undergoing minimally invasive thoracic surgical resection after systemic chemotherapy, immunotherapy, or both. METHODS A systematic literature review of randomized controlled trials and observational studies presenting data on patients with NSCLC that underwent neoadjuvant systemic therapy followed by minimally invasive surgery was performed assessing complications, conversion rates, and lymph node yield. RESULTS Our search strategy and review of references resulted in 239 publications to screen with 88 full texts assessed and 21 studies included in our final review. VATS had a statistically significant higher lymph node yield in five studies. The reported conversion rates ranged from 0 to 54%. Dense adhesions, bleeding, and difficult anatomy were the most common reported reasons for conversion to open surgeries. The most common complications between both groups were prolonged air leak, arrythmia, and pneumonia. VATS was found to have significantly fewer complications in three papers. CONCLUSIONS The current literature supports VATS as safe and feasible for patients with NSCLC after neoadjuvant systemic treatment. Surgeons should remain prepared to convert to open surgeries in those patients with dense adhesions and bleeding risk.
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Affiliation(s)
- Shaina Sedighim
- Department of General Surgery, Irvine School of Medicine, University of California, 3800 Chapman Ave, Suite, 6200, Orange, CA 92868, USA
| | - Madelyn I. Frank
- Irvine School of Medicine, University of California, Orange, CA 92868, USA (O.H.)
| | - Olivia Heutlinger
- Irvine School of Medicine, University of California, Orange, CA 92868, USA (O.H.)
| | - Carlin Lee
- Department of General Surgery, Irvine School of Medicine, University of California, 3800 Chapman Ave, Suite, 6200, Orange, CA 92868, USA
| | - Stephanie J. Hachey
- Department of Molecular and Cell Biology, Irvine School of Biological Sciences, University of California, Orange, CA 92868, USA
| | - Hari B. Keshava
- Department of General Surgery, Irvine School of Medicine, University of California, 3800 Chapman Ave, Suite, 6200, Orange, CA 92868, USA
- Division of Thoracic Surgery, Irvine School of Medicine, University of California, Orange, CA 92868, USA
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Pan H, Zou N, Tian Y, Zhu H, Zhang J, Jin W, Gu Z, Ning J, Li Z, Kong W, Jiang L, Huang J, Luo Q. Short-term outcomes of robot-assisted versus video-assisted thoracoscopic surgery for non-small cell lung cancer patients with neoadjuvant immunochemotherapy: a single-center retrospective study. Front Immunol 2023; 14:1228451. [PMID: 37497221 PMCID: PMC10366598 DOI: 10.3389/fimmu.2023.1228451] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 06/27/2023] [Indexed: 07/28/2023] Open
Abstract
Background Neoadjuvant immunochemotherapy has been increasingly applied to treat non-small cell lung cancer (NSCLC). However, the comparison between robotic-assisted thoracoscopic surgery (RATS) and video-assisted thoracoscopic surgery (VATS) in the feasibility and oncological efficacy following neoadjuvant immunochemotherapy is scarce. This study aims to assess the superiorities of RATS over (VATS) concerning short-term outcomes in treating NSCLC patients with neoadjuvant immunochemotherapy. Methods NSCLC patients receiving RATS or VATS lobectomy following neoadjuvant immunochemotherapy at Shanghai Chest Hospital from 2019 to 2022 were retrospectively identified. Baseline clinical characteristics, perioperative outcomes, and survival profiles were analyzed. Results Forty-six NSCLC patients with neoadjuvant immunochemotherapy were included and divided into the RATS (n=15) and VATS (n=31) groups. The baseline clinical characteristics and induction-related adverse events were comparable between the two groups (all p>0.050). The 30-day mortality in the RATS and VATS groups were 0% and 3.23%, respectively (p=1.000). Patients undergoing RATS were associated with reduced surgical-related intensive unit care (ICU) stay than those receiving VATS (0.0 [0.0-0.0] vs. 0.0 [0.0-1.0] days, p=0.026). Moreover, RATS assessed more N1 LNs (6.27 ± 1.94 vs 4.90 ± 1.92, p=0.042) and LN stations (3.07 ± 1.03 vs 2.52 ± 0.57, p=0.038) compared with VATS. By comparison, no difference was found in surgical outcomes, pathological results, and postoperative complications between the RATS and VATS groups (all p>0.050). Finally, RATS and VATS achieved comparable one-year recurrence-free survival (82.96% vs. 85.23%, p=0.821) and the timing of central nervous system, LN, and bone recurrences (all p>0.050). Conclusion RATS is safe and feasible for NSCLC patients with neoadjuvant immunochemotherapy, reducing surgical-related ICU stay, assessing increased N1 LNs and stations, and achieving similar survival profiles to VATS.
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Affiliation(s)
- Hanbo Pan
- Department of Thoracic Surgical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ningyuan Zou
- Department of Thoracic Surgical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Tian
- Department of Thoracic Surgical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hongda Zhu
- Department of Thoracic Surgical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiaqi Zhang
- Department of Thoracic Surgical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weiqiu Jin
- Department of Thoracic Surgical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zenan Gu
- Department of Thoracic Surgical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junwei Ning
- Department of Thoracic Surgical Oncology, 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
| | - Ziming Li
- Department of Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weicheng Kong
- Department of Thoracic Surgical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Thoracic Surgery, Putuo District People’s Hospital, Zhejiang, China
| | - Long Jiang
- Department of Thoracic Surgical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jia Huang
- Department of Thoracic Surgical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qingquan Luo
- Department of Thoracic Surgical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Wang YF, Deng HY, Huang W, Zhou Q. Is video-assisted thoracoscopic surgery comparable with thoracotomy in perioperative and long-term survival outcomes for non-small-cell lung cancer after neoadjuvant treatment? Interact Cardiovasc Thorac Surg 2022; 35:6835421. [PMID: 36409029 PMCID: PMC9686345 DOI: 10.1093/icvts/ivac271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/13/2022] [Indexed: 11/23/2022] Open
Abstract
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was 'Is video-assisted thoracoscopic surgery comparable with thoracotomy in perioperative and long-term survival outcomes for patients with non-small cell lung cancer following neoadjuvant therapy intended for anatomical lung resection?'. Altogether 655 papers were found using the reported search, of which 12 studies represented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type and relevant outcomes and results of these papers are tabulated. Almost all of the enrolled cohort studies reported that video-assisted thoracoscopic surgery (VATS) was comparable with thoracotomy in negative surgical margin rate, postoperative mortality, complication rate, overall survival and disease-free survival. Moreover, 7 studies found patients in the VATS group had a significantly shorter hospital stay. Furthermore, in these well-matched cohort studies (6 studies), it still held true that VATS was comparable with thoracotomy in long-term prognosis with enhanced recovery. However, the issue regarding surgical radicality and intraoperative conversion to thoracotomy still should be noted carefully among these patients receiving VATS surgery because all the current available evidence was retrospective based on relatively small sample sizes. Nevertheless, thoracic surgeons should not consider VATS inferior to thoracotomy for patients after neoadjuvant treatment. VATS surgery could be an alternative for selected patients with locally advanced but relatively small, peripheral, fewer positive N2 lymph nodes and non-squamous NSCLC intended for anatomic lung resection.
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Affiliation(s)
| | - Han-Yu Deng
- Corresponding authors. Lung Cancer Center, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu 610041, China. Tel: +86-1820-0295-920; e-mail: (H.-Y. Deng); Lung Cancer Center, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu 610041, China. Tel: +86-1898-0606-202; fax: +86-28-862-981-39; e-mail: (Q. Zhou)
| | - Weijia Huang
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Qinghua Zhou
- Corresponding authors. Lung Cancer Center, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu 610041, China. Tel: +86-1820-0295-920; e-mail: (H.-Y. Deng); Lung Cancer Center, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu 610041, China. Tel: +86-1898-0606-202; fax: +86-28-862-981-39; e-mail: (Q. Zhou)
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Wang L, Ge L, Fu N, Ren Y. Would the width of a metal rib spreader affect postoperative pain in patients who undergo video-assisted mini-thoracotomy (VAMT)? Front Oncol 2022; 12:1039737. [PMID: 36387252 PMCID: PMC9643404 DOI: 10.3389/fonc.2022.1039737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/12/2022] [Indexed: 11/25/2022] Open
Abstract
Background Hitherto, no study has evaluated postoperative pain in patients with non-small cell lung cancer (NSCLC) treated with video-assisted mini-thoracotomy (VAMT). In this study, we aimed to assess postoperative pain related to the width of the metal rib spreader in patients who underwent lobectomy using VAMT. Methods We retrospectively analysed the data of 94 consecutive patients with NSCLC who underwent lobectomy using VAMT at our institution between March 2019 and May 2022. We divided the patients into groups according to the width ratio of the rib spreader to that of a single intercostal space. Patients with width ratios ≤ 2.5 times were assigned to group A, and those with width ratios > 2.5 times were assigned to group B. Pre-, intra-, and postoperative data were collected and reviewed. Results We successfully performed VAMT in 94 patients with NSCLC. Forty-five patients were in group A, and 49 were in group B. There were no intraoperative mortalities, although one patient, due to respiratory failure, experienced 30-day mortality. There were no significant differences between the two groups in terms of the blood loss volume, operative time, drainage time, postoperative complications, length of hospital stay, or number of lymph node stations explored and retrieved. The drainage volumes (Day 1–Day 3) were higher in group B than in group A (P < 0.05). The postoperative visual analogue scale (VAS) pain scores were significantly lower in Group A than in Group B at 12, 24, and 48 h (P < 0.05), although there was no significant difference in the VAS scores between the two groups at 72 h and 1 week postoperatively (P > 0.05). Conclusion The smaller the width of the metal rib spreader used in surgery, the less pain experienced by the patient and the faster the recovery. Multicentre, randomised, controlled trials should be conducted in the future.
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Affiliation(s)
- Linlin Wang
- Department of Thoracic Surgery, Shenyang Chest Hospital & Tenth People’s Hospital, Shenyang, Liaoning, China
| | - Lihui Ge
- Department of Health Management, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Ninghua Fu
- Department of Thoracic Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Yi Ren
- Department of Thoracic Surgery, Shenyang Chest Hospital & Tenth People’s Hospital, Shenyang, Liaoning, China
- *Correspondence: Yi Ren,
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Li G, Zhang C, Wang C, Xiao L. Acupuncture against chronic postsurgical pain in non-small cell lung cancer patients: A protocol of randomized controlled trial. Medicine (Baltimore) 2021; 100:e27461. [PMID: 34622872 PMCID: PMC8500646 DOI: 10.1097/md.0000000000027461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 09/22/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Video-assisted thoracoscopic lobectomy is the prior recommended treatment for non-small cell lung cancer (NSCLC), with the advantages of small trauma, less postoperative pain, and quick recovery. However, a large number of patients may suffer chronic postsurgical pain (CPSP), which makes the patients unwilling to practice pulmonary exercises, and it would directly affect patient's cough, sputum expectoration, and mobility. Opioids could greatly improve the quality of postoperative analgesia and the quality of life after surgery, but it is accompanied with obvious side effects. A number of clinical studies have proved that acupuncture could improve postoperative pain and reduce opioid use. In this study, we try to conduct a randomized controlled study to evaluate the efficacy and safety of plum-blossom needle acupuncture combined with Tramadol in improving CPSP after lobectomy in NSCLC patients. METHODS Patients will be randomly divided into treatment group (acupuncture plus Tramadol) and control group (sham acupuncture plus Tramadol) with a random number table in 1:1 ratio. The patients, outcome assessor, and statistician will be blinded. The outcomes are changes of numerical rating scale, Karnofsky performance score, brief pain inventory, blood routine, liver and kidney function. The data will be analyzed by SPSS 22.0. CONCLUSIONS The results will help to evaluate the efficacy and safety of plum-blossom needle acupuncture in improving CPSP after lobectomy in NSCLC patients.
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Kim HK. Video-Assisted Thoracic Surgery Lobectomy. J Chest Surg 2021; 54:239-245. [PMID: 34353962 PMCID: PMC8350467 DOI: 10.5090/jcs.21.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/08/2021] [Accepted: 07/16/2021] [Indexed: 12/11/2022] Open
Abstract
Video-assisted thoracoscopic surgery (VATS) has been established as the surgical approach of choice for lobectomy in patients with early-stage non-small cell lung cancer (NSCLC). Patients with clinical stage I NSCLC with no lymph node metastasis are considered candidates for VATS lobectomy. To rule out the presence of metastasis to lymph nodes or distant organs, patients should undergo meticulous clinical staging. Assessing patients' functional status is required to ensure that there are no medical contraindications, such as impaired pulmonary function or cardiac comorbidities. Although various combinations of the number, size, and location of ports are available, finding the best method of port placement for each surgeon is fundamental to maximize the efficiency of the surgical procedure. When conducting VATS lobectomy, it is always necessary to comply with the following oncological principles: (1) the vessels and bronchus of the target lobe should be individually divided, (2) systematic lymph node dissection is mandatory, and (3) touching the lymph node itself and rupturing the capsule of the lymph node should be minimized. Most surgeons conduct the procedure in the following sequence: (1) dissection along the hilar structure, (2) fissure division, (3) perivascular and peribronchial dissection, (4) individual division of the vessels and bronchus, (5) specimen retrieval, and (6) mediastinal lymph node dissection. Surgeons should obtain experience in enhancing the exposure of the dissection target and facilitating dissection. This review article provides the basic principles of the surgical techniques and practical maneuvers for performing VATS lobectomy easily, safely, and efficiently.
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Affiliation(s)
- Hong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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