Surgeon experience is associated with prolonged air leak after robotic-assisted pulmonary lobectomy

Risk factors and clinical impact of prolonged air leak following video-assisted thoracoscopic surgery: a retrospective cohort study

Objective

This study aims to reveal the incidence and risk factors of prolonged air leak (PAL) following video-assisted thoracoscopic surgery (VATS) and to evaluate its impact on postoperative outcomes.

Methods

A retrospective analysis was performed on the clinical data of all pulmonary surgery patients who underwent VATS at the Department of Hospital Surgery No.2 at Sechenov University, from September 2023 to September 2024. Patients were categorized into two groups based on the presence of PAL (defined as prolonged air leak lasting ≥ 5 days): the PAL group and the non-PAL group. Risk factors for PAL and its effects on postoperative recovery were assessed.

Results

A total of 110 patients were included in the study, with an incidence of PAL of 26.3%. Multivariate analysis identified chronic obstructive pulmonary disease (COPD) (OR = 9.023, P = 0.003) and pleural adhesions (OR = 3.404, P = 0.013) as independent risk factors for the development of PAL. Significant differences were found between the PAL and non-PAL groups in terms of length of hospital stay (P < 0.001) and chest tube removal time (P < 0.001). The PAL group had a higher overall complication rate than the non-PAL group, with significantly more postoperative pneumonia (P = 0.003), postoperative empyema (P = 0.023), and postoperative wound infections (P = 0.005).

Conclusion

Chronic obstructive pulmonary disease and pleural adhesions were identified as independent risk factors for PAL after VATS. Patients with PAL experienced more postoperative complications and longer hospital stays.

The Correlation between Metal Mixed Exposure and Lung Function in Different Ages of the Population

Herein, we explored the overall association between metal mixtures and lung functions in populations of varying ages and the relationship among the associated components. The 2007-2012 National Health and Nutrition Examination Survey data of 4382 American participants was analyzed, and generalized linear, elastic net, quantile g-computation, and Bayesian kernel machine regression models were used to evaluate the relationship between exposure to the metal mixture and lung function at various ages. The results of barium exposure at distinct stages revealed that children and adolescents exhibited greater lung function changes than those in adults and the elderly. Additionally, compared with children and adolescents, cadmium- and arsenic-containing metabolites contributed to nonconductive lung function changes in adults and the elderly exposed to metal mixtures. The results showed that the effects of exposure to metal mixtures on lung function in children and adolescents were predominantly caused by lead and barium. Altogether, children and adolescents were found to be more susceptible to metal-exposure-mediated lung function changes than adults and the elderly.

Trends of utilization and perioperative outcomes of robotic and video-assisted thoracoscopic surgery in patients with lung cancer undergoing minimally invasive resection in the United States

OBJECTIVE

The objective of this study was to evaluate utilization and perioperative outcomes of video-assisted thoracoscopic surgery (VATS) or robotic-assisted thoracoscopic surgery (RATS) for lung cancer in the United States using a nationally representative database.

METHODS

Hospital admissions for lobectomy or sublobar resection (segmentectomy or wedge resection) using VATS or RATS in patients with nonmetastatic lung cancer from October 2015 through December 2018 in the National Inpatient Sample were studied. Patient and hospital characteristics, perioperative complications and mortality, length of stay (LOS), and total hospital cost were compared. Logistic regression was used to assess whether the surgical approach was independently associated with adverse outcomes.

RESULTS

There were 83,105 patients who had VATS (n = 65,375) or RATS (n = 17,710) for lobectomy (72.7% VATS) or sublobar resection (84.2% VATS). Utilization of RATS for lobectomy and sublobar resection increased from 19.2% to 34% and 7.3% to 22%, respectively. Mortality, LOS, and conversion rates were comparable. The cost was higher for RATS (P <.01). Multivariate analyses showed comparable RATS and VATS complications with no independent association between the minimally invasive surgery approach used and adverse surgical outcomes, except for a decreased risk of pneumonia with RATS, relative to VATS sublobar resection (P <.01). Thoracic complication rates and LOS decreased after RATS lobectomy in 2018, compared with previous years (P <.005).

CONCLUSIONS

The utilization of robotic-assisted lung resection for cancer has increased in the United States between 2015 and 2018 for sublobar resection and lobectomy. In adjusted regression analysis, compared with VATS, patients who underwent RATS had similar complication rates and LOS. The robotic approach was associated with increased total hospital cost. LOS and thoracic complication rates trended down after RATS lobectomy.