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Kim AT, Ding L, Lee HB, Ashbrook MJ, Ashrafi A, Wightman SC, Atay SM, David EA, Harano T, Kim AW. Longer hospitalizations, more complications, and greater readmissions for patients with comorbid psychiatric disorders undergoing pulmonary lobectomy. J Thorac Cardiovasc Surg 2024; 167:1502-1511.e11. [PMID: 37245626 DOI: 10.1016/j.jtcvs.2023.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 05/16/2023] [Accepted: 05/20/2023] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To examine the influence of comorbid psychiatric disorders (PSYD) on postoperative outcomes in patients undergoing pulmonary lobectomy. METHODS A retrospective analysis of the Healthcare Cost and Utilization Project Nationwide Readmissions Database from 2016 to 2018 was performed. Patients with lung cancer with and without psychiatric comorbidities who underwent pulmonary lobectomy were collated and analyzed (International Classification of Diseases, 10th Revision, Clinical Modification Mental, Behavioral and Neurodevelopmental disorders [F01-99]). The association of PSYD with complications, length of stay, and readmissions was assessed using a multivariable regression analysis. Additional subgroup analyses were performed. RESULTS A total of 41,691 patients met inclusion criteria. Of these, 27.84% (11,605) of the patients had at least 1 PSYD. PSYD was associated with a significantly increased risk of postoperative complications (relative risk, 1.041; 95% CI, 1.015-1.068; P = .0018), pulmonary complications (relative risk, 1.125; 95% CI, 1.08-1.171; P < .0001), longer length of stay (PSYD mean, 6.79 days and non-PSYD mean, 5.68 days; P < .0001), higher 30-day readmission rate (9.2% vs 7.9%; P < .0001), and 90-day readmission rate (15.4% vs 12.9%; P < .007). Among patients with PSYD, those with cognitive disorders and psychotic disorders (eg, schizophrenia) appear to have the highest rates and risks of postoperative morbidity and in-hospital mortality. CONCLUSIONS Patients with lung cancer with comorbid psychiatric disorders undergoing lobectomy experience worse postoperative outcomes with longer hospitalization, increased rates of overall and pulmonary complications, and greater readmissions suggesting potential opportunities for improved psychiatric care during the perioperative period.
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Affiliation(s)
- Alexander T Kim
- Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Li Ding
- Division of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Hochang B Lee
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Matthew J Ashbrook
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Arman Ashrafi
- Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Sean C Wightman
- Division of Thoracic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Scott M Atay
- Division of Thoracic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Elizabeth A David
- Division of Thoracic Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colo
| | - Takashi Harano
- Division of Thoracic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Anthony W Kim
- Division of Thoracic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif.
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Schütte W, Gütz S, Nehls W, Blum TG, Brückl W, Buttmann-Schweiger N, Büttner R, Christopoulos P, Delis S, Deppermann KM, Dickgreber N, Eberhardt W, Eggeling S, Fleckenstein J, Flentje M, Frost N, Griesinger F, Grohé C, Gröschel A, Guckenberger M, Hecker E, Hoffmann H, Huber RM, Junker K, Kauczor HU, Kollmeier J, Kraywinkel K, Krüger M, Kugler C, Möller M, Nestle U, Passlick B, Pfannschmidt J, Reck M, Reinmuth N, Rübe C, Scheubel R, Schumann C, Sebastian M, Serke M, Stoelben E, Stuschke M, Thomas M, Tufman A, Vordermark D, Waller C, Wolf J, Wolf M, Wormanns D. [Prevention, Diagnosis, Therapy, and Follow-up of Lung Cancer - Interdisciplinary Guideline of the German Respiratory Society and the German Cancer Society - Abridged Version]. Pneumologie 2023; 77:671-813. [PMID: 37884003 DOI: 10.1055/a-2029-0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
The current S3 Lung Cancer Guidelines are edited with fundamental changes to the previous edition based on the dynamic influx of information to this field:The recommendations include de novo a mandatory case presentation for all patients with lung cancer in a multidisciplinary tumor board before initiation of treatment, furthermore CT-Screening for asymptomatic patients at risk (after federal approval), recommendations for incidental lung nodule management , molecular testing of all NSCLC independent of subtypes, EGFR-mutations in resectable early stage lung cancer in relapsed or recurrent disease, adjuvant TKI-therapy in the presence of common EGFR-mutations, adjuvant consolidation treatment with checkpoint inhibitors in resected lung cancer with PD-L1 ≥ 50%, obligatory evaluation of PD-L1-status, consolidation treatment with checkpoint inhibition after radiochemotherapy in patients with PD-L1-pos. tumor, adjuvant consolidation treatment with checkpoint inhibition in patients withPD-L1 ≥ 50% stage IIIA and treatment options in PD-L1 ≥ 50% tumors independent of PD-L1status and targeted therapy and treatment option immune chemotherapy in first line SCLC patients.Based on the current dynamic status of information in this field and the turnaround time required to implement new options, a transformation to a "living guideline" was proposed.
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Affiliation(s)
- Wolfgang Schütte
- Klinik für Innere Medizin II, Krankenhaus Martha Maria Halle-Dölau, Halle (Saale)
| | - Sylvia Gütz
- St. Elisabeth-Krankenhaus Leipzig, Abteilung für Innere Medizin I, Leipzig
| | - Wiebke Nehls
- Klinik für Palliativmedizin und Geriatrie, Helios Klinikum Emil von Behring
| | - Torsten Gerriet Blum
- Helios Klinikum Emil von Behring, Klinik für Pneumologie, Lungenklinik Heckeshorn, Berlin
| | - Wolfgang Brückl
- Klinik für Innere Medizin 3, Schwerpunkt Pneumologie, Klinikum Nürnberg Nord
| | | | - Reinhard Büttner
- Institut für Allgemeine Pathologie und Pathologische Anatomie, Uniklinik Köln, Berlin
| | | | - Sandra Delis
- Helios Klinikum Emil von Behring, Klinik für Pneumologie, Lungenklinik Heckeshorn, Berlin
| | | | - Nikolas Dickgreber
- Klinik für Pneumologie, Thoraxonkologie und Beatmungsmedizin, Klinikum Rheine
| | | | - Stephan Eggeling
- Vivantes Netzwerk für Gesundheit, Klinikum Neukölln, Klinik für Thoraxchirurgie, Berlin
| | - Jochen Fleckenstein
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg
| | - Michael Flentje
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Würzburg, Würzburg
| | - Nikolaj Frost
- Medizinische Klinik mit Schwerpunkt Infektiologie/Pneumologie, Charite Universitätsmedizin Berlin, Berlin
| | - Frank Griesinger
- Klinik für Hämatologie und Onkologie, Pius-Hospital Oldenburg, Oldenburg
| | | | - Andreas Gröschel
- Klinik für Pneumologie und Beatmungsmedizin, Clemenshospital, Münster
| | | | | | - Hans Hoffmann
- Klinikum Rechts der Isar, TU München, Sektion für Thoraxchirurgie, München
| | - Rudolf M Huber
- Medizinische Klinik und Poliklinik V, Thorakale Onkologie, LMU Klinikum Munchen
| | - Klaus Junker
- Klinikum Oststadt Bremen, Institut für Pathologie, Bremen
| | - Hans-Ulrich Kauczor
- Klinikum der Universität Heidelberg, Abteilung Diagnostische Radiologie, Heidelberg
| | - Jens Kollmeier
- Helios Klinikum Emil von Behring, Klinik für Pneumologie, Lungenklinik Heckeshorn, Berlin
| | | | - Marcus Krüger
- Klinik für Thoraxchirurgie, Krankenhaus Martha-Maria Halle-Dölau, Halle-Dölau
| | | | - Miriam Möller
- Krankenhaus Martha-Maria Halle-Dölau, Klinik für Innere Medizin II, Halle-Dölau
| | - Ursula Nestle
- Kliniken Maria Hilf, Klinik für Strahlentherapie, Mönchengladbach
| | | | - Joachim Pfannschmidt
- Klinik für Thoraxchirurgie, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin
| | - Martin Reck
- Lungeclinic Grosshansdorf, Pneumologisch-onkologische Abteilung, Grosshansdorf
| | - Niels Reinmuth
- Klinik für Pneumologie, Thorakale Onkologie, Asklepios Lungenklinik Gauting, Gauting
| | - Christian Rübe
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Homburg
| | | | | | - Martin Sebastian
- Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt
| | - Monika Serke
- Zentrum für Pneumologie und Thoraxchirurgie, Lungenklinik Hemer, Hemer
| | | | - Martin Stuschke
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Essen, Essen
| | - Michael Thomas
- Thoraxklinik am Univ.-Klinikum Heidelberg, Thorakale Onkologie, Heidelberg
| | - Amanda Tufman
- Medizinische Klinik und Poliklinik V, Thorakale Onkologie, LMU Klinikum München
| | - Dirk Vordermark
- Universitätsklinik und Poliklinik für Strahlentherapie, Universitätsklinikum Halle, Halle
| | - Cornelius Waller
- Klinik für Innere Medizin I, Universitätsklinikum Freiburg, Freiburg
| | | | - Martin Wolf
- Klinikum Kassel, Klinik für Onkologie und Hämatologie, Kassel
| | - Dag Wormanns
- Evangelische Lungenklinik, Radiologisches Institut, Berlin
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Robotic Surgery for Non-Small Cell Lung Cancer Treatment in High-Risk Patients. J Clin Med 2021; 10:jcm10194408. [PMID: 34640432 PMCID: PMC8509119 DOI: 10.3390/jcm10194408] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/16/2021] [Accepted: 09/23/2021] [Indexed: 11/16/2022] Open
Abstract
Robotic-assisted pulmonary resection has greatly increased over the last few years, yet data on the application of robotic surgery in high-risk patients are still lacking. The objective of this study is to evaluate the perioperative outcomes in ASA III-IV patients who underwent robotic-assisted lung resection for NSCLC. Between January 2010 and December 2017, we retrospectively collected the data of 148 high-risk patients who underwent lung resection for NSCLC via a robotic approach at our institution. For this study, the prediction of operative risk was based on the ASA-PS score, considering patients in ASA III and IV classes as high-risk patients: of the 148 high-risk patients identified, 146 patients were classified as ASA III (44.8%) and two as ASA IV (0.2%). Possible prognostic factors were also analysed. The average hospital stay was 6 days (8–30). Post-operative complications were observed in 87 (58.8%) patients. Patients with moderate/severe COPD developed in 33 (80.5%) cases post-operative complications, while elderly patients in 25 (55%) cases, with a greater incidence of high-grade complications. No difference was observed when comparing the data of obese and non-obese patients. Robotic surgery appears to be associated with satisfying post-operative results in ASA III-IV patients. Both marginal respiratory function and advanced age represent negative prognostic factors. Due to its safety and efficacy, robotic surgery can be considered the treatment of choice in high-risk patients.
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Dambaev GT, Shefer NA, Ena II, Kondaurov AG, Strezh VA. [ERAS protocol for perioperative management of patients with non-small cell lung cancer]. Khirurgiia (Mosk) 2020:52-58. [PMID: 33301254 DOI: 10.17116/hirurgia202012152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate an effectiveness of enhanced recovery program for perioperative support of patients with lung cancer. MATERIAL AND METHODS A prospective single-center study on effectiveness of ERAS protocol in perioperative support of patients with lung cancer was conducted at the Tomsk Regional Cancer Center. According to the study design, patients were divided into three groups. The first group included patients after VATS surgery followed by accelerated recovery. The second and the third groups comprised of patients after open interventions. In these groups, patients were randomized into traditional management or accelerated recovery management groups using the blind envelope method. Patients with indicated lobectomy or bilobectomy were included only. In postoperative period, we analyzed morbidity, pain syndrome and hospital-stay. RESULTS A total of 235 patients were treated. VATS surgery followed by enhanced recovery program was applied in 61 patients. Eighty-seven patients underwent open operations followed by accelerated recovery protocol and traditional management. ERAS protocol ensured less postoperative morbidity compared to traditional management (p<0.001). Pain syndrome was less pronounced after VATS surgery and did not require an appointment of narcotic analgesics. In the group of open surgery followed by accelerated recovery protocol, narcotic analgesics within 3 postoperative days were required in 38 (43.6%) cases, in the group of traditional management - in 63 (72.4%) patients. Mean postoperative hospital-stay after VATS operations was 6.4 days, after open interventions followed by ERAS protocol - 8.7 days. In patients after open surgery and traditional postoperative management, mean hospital-stay was 14.2 days. One patient died after open surgery followed by ERAS protocol and 3 patients died in the group of traditional management. CONCLUSION ERAS protocol ensures less postoperative morbidity, early activation of patients and reduced hospital-stay.
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Affiliation(s)
- G Ts Dambaev
- Siberian State Medical University, Tomsk, Russia
| | - N A Shefer
- Tomsk Regional Oncology Center, Tomsk, Russia
| | - I I Ena
- Tomsk Regional Oncology Center, Tomsk, Russia
| | | | - V A Strezh
- Tomsk Regional Oncology Center, Tomsk, Russia
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Beck N, van Brakel TJ, Smit HJM, van Klaveren D, Wouters MWJM, Schreurs WH. Pneumonectomy for Lung Cancer Treatment in The Netherlands: Between-Hospital Variation and Outcomes. World J Surg 2020; 44:285-294. [PMID: 31549204 DOI: 10.1007/s00268-019-05190-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pneumonectomy in lung cancer treatment is associated with considerable morbidity and mortality. Its use is reserved only for patients in whom a complete oncological resection by (sleeve) lobectomy is not possible. It is unclear whether a patients' risk of receiving a pneumonectomy is equally distributed. This study examined between-hospital variation of pneumonectomy use for primary lung cancer in the Netherlands. METHODS Data from the Dutch Lung Cancer Audit for Surgery from 2012 to 2016 were used to study the use of pneumonectomy for primary lung cancer in the Netherlands. Using multivariable logistic regression, factors associated with pneumonectomy use were identified and the expected number of pneumonectomies per hospital was determined. Subsequently, the observed/expected ratio (O/E ratio) per hospital was calculated to study between-hospital differences. RESULTS Of the 8446 included patients, 659 (7.8%) underwent a pneumonectomy with a mean postoperative mortality of 7.1% (n = 47). Factors associated with receiving a pneumonectomy were age, gender, cardiac and pulmonary comorbidities, tumor side, size and histopathology. The pneumonectomy use in the Netherlands varied considerably between hospitals (IQR 5.5-10.1%). Three hospitals out of 51 performed significantly less pneumonectomies than expected (O/E ratio < 0.5) and three significantly more (O/E ratio > 1.7). In the latter group, severe complications were more frequent, taking other influencing factors into account (OR 1.51, 95% CI 1.05-2.19). CONCLUSIONS There is a considerable between-hospital variation in pneumonectomy use in lung cancer treatment. To further optimize surgical lung cancer care, we suggest center-specific feedback on pneumonectomy use and the development of a risk-adjusted pneumonectomy indicator.
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Affiliation(s)
- Naomi Beck
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
- Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, 2333 AA, Leiden, The Netherlands.
| | - Thomas J van Brakel
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Hans J M Smit
- Department of Pulmonology, Rijnstate, Wagnerlaan 55, 6815 AD, Arnhem, The Netherlands
| | - David van Klaveren
- Medical Statistics, Department of Biomedical Data Sciences, Leiden University Medical Center, Einthovenweg 20, 2333 ZC, Leiden, The Netherlands
| | - Michel W J M Wouters
- Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, 2333 AA, Leiden, The Netherlands
- Department of Surgical Oncology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Wilhelmina H Schreurs
- Department of Surgery, North-West Clinics, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands
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Elgebaly AS, Anwar AG, Fathy SM, Sallam A, Elbarbary Y. The accuracy of electrical cardiometry for the noninvasive determination of cardiac output before and after lung surgeries compared to transthoracic echocardiography. Ann Card Anaesth 2020; 23:288-292. [PMID: 32687084 PMCID: PMC7559959 DOI: 10.4103/aca.aca_196_18] [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] [Indexed: 11/25/2022] Open
Abstract
Background: The anatomical changes associated with lung surgeries may decrease cardiac output and heart function. Therefore, monitoring of cardiac output (CO) is of significant value in these patients for clinical decision-making. Objective: This study is to evaluate the reliability of electrical cardiometry (EC) for the noninvasive continuous determination of CO after lobectomy or pneumonectomy compared to transthoracic echocardiography (TTE). Patients and Methods: This study was carried out on 60 patients, age ≥18 years scheduled for elective lung surgery (lobectomy or pneumonectomy). All patients underwent simultaneous measurement by EC using the ICON_ device and by TTE by measuring left ventricle outflow tract diameter (LVOT) and velocity time integral (VTI). Heart rate (HR), systolic and diastolic blood pressure (SBP and DBP), stroke volume (SV), stroke volume index (SVI), CO, and cardiac index (CI) were measured 1 day before the surgery and 7 days after the surgery. Results: There was no significant difference between TTE and EC regarding preoperative and postoperative HR, SV, SVI, CO, and CI. There was a strong positive correlation between TTE and EC as regard preoperative and postoperative HR, SV, SVI, CO, and CI. Bland and Altman analysis showed low bias with accepted limits of agreement of HR, SV, SVI, CO, and CI. Postoperative readings showed a significant increase in HR and a significant decrease in SV and CO (either by TTE or EC), SBP, and DBP as compared to preoperative reading. Conclusion: Compared to the TTE, EC provides accurate and reliable CO, SV, and HR measurements before and even after lung surgeries.
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Affiliation(s)
- Ahmed S Elgebaly
- Department of Anesthesiology, Surgical Intensive Care and Pain Medicine, Tanta University, Egypt
| | - Atteia G Anwar
- Department of Anesthesiology, Surgical Intensive Care and Pain Medicine, Tanta University, Egypt
| | - Sameh M Fathy
- Department of Anesthesiology, Surgical Intensive Care and Pain Medicine, Tanta University, Egypt
| | - Ayman Sallam
- Department of Cardio-thoracic Surgery, Surgical Intensive Care and Pain Medicine, Tanta University, Egypt
| | - Yaser Elbarbary
- Department of Cardiology, Faculty of Medicine, Surgical Intensive Care and Pain Medicine, Tanta University, Egypt
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Alcantud JCR, Varela G, Santos-Buitrago B, Santos-García G, Jiménez MF. Analysis of survival for lung cancer resections cases with fuzzy and soft set theory in surgical decision making. PLoS One 2019; 14:e0218283. [PMID: 31216304 PMCID: PMC6584012 DOI: 10.1371/journal.pone.0218283] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 05/29/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Lung cancer is the most common type of cancer around the world, and it represents the main cause of death in the USA. Surgical treatment is the optimal therapeutic strategy for resectable non-small cell lung cancer. The principal factor for long-term survival after complete resection is the anatomic extension of the neoplasm. However, other factors also have adverse effects on operative mortality, and influence long-term outcome. In this paper we propose an algorithmic solution for the estimation of 5-years survival rate in lung cancer patients undertaking pulmonary resection. MATERIALS AND METHODS We address the issue of survival analysis through decision-making techniques based on fuzzy and soft set theories. We develop an expert system based on clinical and functional data of lung cancer resections in patients with cancer that can be used to predict the survival of patients. RESULTS The evaluation of surgical risk in patients undertaking pulmonary resection is a primary target for thoracic surgeons. Lung cancer survival is influenced by many factors. The computational performance of our algorithm is critically analyzed by an experimental study. The correct survival classification is achieved with an accuracy of 79.0%. Our novel soft-set based criterion is an effective and precise diagnosis application for the determination of the survival rate.
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Affiliation(s)
- José Carlos R. Alcantud
- IME, University of Salamanca, Salamanca, Spain
- BORDA Research Unit, University of Salamanca, Salamanca, Spain
| | - Gonzalo Varela
- Salamanca University Hospital and Medical School, Salamanca, Spain
| | | | - Gustavo Santos-García
- IME, University of Salamanca, Salamanca, Spain
- FADoSS Research Unit, Universidad Complutense de Madrid, Madrid, Spain
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The Role of Intrapleural Lymphotropic Blockades in the Incidence of Respiratory Complications after Surgical Treatment of Lung Cancer. ACTA BIOMEDICA SCIENTIFICA 2019. [DOI: 10.29413/abs.2019-4.2.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The development of respiratory complications in patients after surgical treatment of lung cancer remains a serious problem, far from being resolved today. Pain remains the main factor that leads to a decrease in respiratory function in the postoperative period.The aim of this study is to evaluate the effect of intrapleural lymphotropic blockades on the incidence of respiratory complications in the postoperative period in patients undergoing surgical treatment of lung cancer.Materials and methods. 103 patients with operable forms of lung cancer, who underwent anatomical lung resection or pneumonectomy, were treated in the Oncology Department of the Tomsk Regional Oncology Center. The patients were divided in two groups. The first group included 52 patients, who were supplemented with intrapleural lymphotropic blockades. The second group consisted of 51 patients who received a standard multimodal scheme of analgesia in the postoperative period. In the postoperative period, we assessed severity of pain in patients, and the frequency and types of respiratory disorders.Results. The analysis of the results revealed a significant decrease in the intensity of pain syndrome the first 12 hours after surgery in the group of patients, who underwent lymphotropic blockade. The analysis of the frequency of respiratory disorders in the study groups also revealed significant reduction in the number of complications in patients in the group with lymphotropic blockade. Acute postoperative pain, that prevents full natural ventilation, plays one of the key roles in the pathogenesis of respiratory complications in patients after surgical treatment of lung cancer.Conclusion. The use of multimodal analgesia of intrapleural lymphotropic blockade in the complex allows to reduce the pain syndrome and provide psycho-emotional comfort of the patient in the early postoperative period, thereby reducing the risk of respiratory disorders.
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Larsen KS, Skoffer B, Gregersen Oestergaard L, Van Tulder M, Petersen AK. The effects of various respiratory physiotherapies after lung resection: a systematic review. Physiother Theory Pract 2019; 36:1201-1219. [DOI: 10.1080/09593985.2018.1564095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Karoline Stentoft Larsen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital (AUH), Aarhus N., Denmark
- Centre of Research in Rehabilitation (CORIR), Institute of Clinical Medicine, Aarhus University and AUH, Aarhus N., Denmark
| | - Birgit Skoffer
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital (AUH), Aarhus N., Denmark
- Centre of Research in Rehabilitation (CORIR), Institute of Clinical Medicine, Aarhus University and AUH, Aarhus N., Denmark
| | - Lisa Gregersen Oestergaard
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital (AUH), Aarhus N., Denmark
- Centre of Research in Rehabilitation (CORIR), Institute of Clinical Medicine, Aarhus University and AUH, Aarhus N., Denmark
- Department of Public Health, Aarhus University, Aarhus N., Denmark
| | - Maurits Van Tulder
- Department of Health Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Annemette Krintel Petersen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital (AUH), Aarhus N., Denmark
- Centre of Research in Rehabilitation (CORIR), Institute of Clinical Medicine, Aarhus University and AUH, Aarhus N., Denmark
- Institute of Clinical Medicine, Aarhus University, Aarhus N., Denmark
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Beck N, Hoeijmakers F, van der Willik EM, Heineman DJ, Braun J, Tollenaar RA, Schreurs WH, Wouters MW. National Comparison of Hospital Performances in Lung Cancer Surgery: The Role of Case Mix Adjustment. Ann Thorac Surg 2018; 106:412-420. [DOI: 10.1016/j.athoracsur.2018.02.074] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 02/25/2018] [Accepted: 02/28/2018] [Indexed: 01/11/2023]
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Zhang Z, Mostofian F, Ivanovic J, Gilbert S, Maziak DE, Shamji FM, Sundaresan S, Villeneuve PJ, Seely AJE. All grades of severity of postoperative adverse events are associated with prolonged length of stay after lung cancer resection. J Thorac Cardiovasc Surg 2017; 155:798-807. [PMID: 29103816 DOI: 10.1016/j.jtcvs.2017.09.094] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 08/28/2017] [Accepted: 09/16/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine whether all grades of severity of postoperative adverse events are associated with prolonged length of stay in patients undergoing pulmonary cancer resection. METHODS This was a retrospective cohort study of all patients who underwent pulmonary resection with curative intent for malignancy at The Ottawa Hospital, Division of Thoracic Surgery (January 2008 to July 2015). Postoperative adverse events were collected prospectively with the Thoracic Morbidity & Mortality System, based on the Clavien-Dindo severity classification. Patient demographics, comorbidities, preoperative investigations, cardiopulmonary assessment, pathologic staging, operative characteristics, and length of stay were retrospectively reviewed. Prolonged hospital stay was defined as >75th percentile for each procedure performed (wedge resection 6 days, segmentectomy 6 days, lobectomy 7 days, extended lobectomy 8 days, pneumonectomy 10 days). Univariable and multivariable logistic regression analyses were conducted to identify factors associated with prolonged hospital stay. RESULTS Of 1041 patients, 579 (55.6%) were female, 610 (58.1%) were >65 years old, 232 (22.3%) experienced prolonged hospital stay, and 416 (40.0%) patients had ≥1 postoperative adverse event. Multivariable analyses identified significant (P < .05) factors associated with prolonged hospital stay to be (odds ratio; 95% confidence interval): lower diffusion capacity of the lung for carbon monoxide (0.99; 0.98-0.99), surgical approach: open thoracotomy (1.8; 1.3-2.5), and presence of any postoperative adverse event: Grade I (5.8; 3.3-10.2), Grade II (6.0; 4.0-8.9), Grade III (11.4; 7.0-18.7), and Grade IV (19.40; 7.1-55.18). CONCLUSIONS Lower diffusion capacity of the lung for carbon monoxide, open thoracotomy approach, and the development of any postoperative adverse event, including minor events that required no additional therapy, were factors associated with prolonged hospital stay.
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Affiliation(s)
- Zach Zhang
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Fargol Mostofian
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jelena Ivanovic
- School of Epidemiology, Public Health, and Preventative Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Sebastien Gilbert
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Division of Thoracic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Donna E Maziak
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; School of Epidemiology, Public Health, and Preventative Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Division of Thoracic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Farid M Shamji
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Division of Thoracic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Sudhir Sundaresan
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Division of Thoracic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Patrick J Villeneuve
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Division of Thoracic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Andrew J E Seely
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; School of Epidemiology, Public Health, and Preventative Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Division of Thoracic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.
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12
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Gu C, Wang R, Pan X, Huang Q, Luo J, Zheng J, Wang Y, Shi J, Chen H. Comprehensive study of prognostic risk factors of patients underwent pneumonectomy. J Cancer 2017; 8:2097-2103. [PMID: 28819411 PMCID: PMC5559972 DOI: 10.7150/jca.19454] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 04/01/2017] [Indexed: 11/17/2022] Open
Abstract
Introduction: To investigate postoperative complications and the prognostic risk factors of patients underwent pneumonectomy. Methods: Four hundred and six patients underwent pneumonectomy were subjected to the study. All the clinicopathologic data including age, gender, smoking history, surgical treatment, postoperative complications, tumor staging and the follow-up information were investigated. Results: The 30-day and 90-day mortality rates were 3.2% and 6.2%, respectively. Postoperative complications developed in 149 patients (36.7%), mainly included arrhythmia, transfusion, pulmonary infection, bronchopleural fistula and acute respiratory distress syndrome. During the follow-up, 189 patients experienced a relapse, consisting of 51 patients with local recurrence and 138 with distant recurrence. The median survival time was 24.4 months and the overall 1-year, 3-year and 5-year survival rates were 82.7%, 50.9% and 32.5%, respectively. Moreover, the overall 1-year, 3-year, 5-year survival rates for patients with non-small cell lung cancer (NSCLC) were 84.1%, 52.1% and 32.5%, respectively and patients with small cell lung cancer (SCLC) were 56.1%, 38.5% and 28.8%, respectively. Among NSCLCs, adenocarcinomas had a worse prognosis than squamous carcinomas. Compared to right pneumonectomy, patients with left pneumonectomy had a better prognosis. Multivariable analysis revealed ICU stay, disease stage, nodal stage and adjuvant chemotherapy were all significant predictors of overall survival (OS). Conclusions: Pneumonectomy is still a valuable and effective treatment option for patients with advanced lung cancer. Surgeons should be more cautious when patients had higher disease stage, adenocarcinoma and right-side lung cancer. Neoadjuvant chemotherapy did not affect the prognosis. Pneumonectomy could also achieve acceptable survival outcomes in well-selected SCLC patients.
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Affiliation(s)
- Chang Gu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Rui Wang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xufeng Pan
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Qingyuan Huang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jizhuang Luo
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jiajie Zheng
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yiyang Wang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jianxin Shi
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Haiquan Chen
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
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The impact of preoperative elevated serum C-reactive protein on postoperative morbidity and mortality after anatomic resection for lung cancer. Lung Cancer 2017; 109:68-73. [PMID: 28577953 DOI: 10.1016/j.lungcan.2017.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 04/11/2017] [Accepted: 05/02/2017] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The aim of this study was to determine whether preoperative elevated serum C-reactive protein (CRP) is an independent risk factor of postoperative morbidity and mortality after pulmonary resection for lung cancer. MATERIAL AND METHODS A retrospective analysis of prospectively collected data on 1414 consecutive patients that underwent an anatomic resection for lung cancer was performed. Patients' characteristics, operative procedures and the postoperative outcome were assessed with a standardised data entry form. Univariate and multivariate analyses were conducted to identify factors that affect morbidity and mortality. RESULTS Postoperative complications occurred in 35.5% of the patients. The mortality rate was 3.2%. Patients with preoperative C-reactive protein above 40mg/l showed more overall complications and a higher mortality than patients below this limit. Patients with a CRP level between 3mg/l and 40mg/l had no significant increase in morbidity and mortality compared to patients with values below the detection limit (< 3mg/l). CONCLUSIONS Preoperative serum C-reactive protein level is an independent and significant indicator for elevated morbidity and mortality after pulmonary resection. We propose the evaluation of CRP levels as a preoperative diagnostic modality of risk assessment in addition to standardised functional testing.
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14
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The effects of respiratory physiotherapy after lung resection: Protocol for a systematic review. Int J Surg Protoc 2017; 4:1-5. [PMID: 31851734 PMCID: PMC6913548 DOI: 10.1016/j.isjp.2017.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 03/29/2017] [Indexed: 12/17/2022] Open
Abstract
To investigate the effects of respiratory physiotherapy after lung resection surgery on mortality rate within 30 days after surgery. Postoperative pulmonary complications within 30 days after surgery. Length of stay in hospital postoperatively.
Background The main treatment of lung cancer (stage 1 and 2) is lung resection surgery. The risk of postoperative pulmonary complications is high and therefore standard postoperative care involves respiratory physiotherapy. The purpose of this systematic review is to create an overview of the evidence on respiratory physiotherapy after lung resection surgery on mortality rate (within 30 days) and postoperative pulmonary complications. Methods and analysis The review will include randomized or quasi-randomized controlled studies investigating the effect of all types of respiratory physiotherapy on mortality and postoperative pulmonary complications after lung resection surgery. Furthermore, the effect of respiratory physiotherapy is evaluated on secondary outcomes such as length of hospital stay, lung volumes and function, and adverse events. The method of the planned review is described in this paper. The literature search will include the databases PubMed, Cochrane (Central), Embase, Cinahl and PEDro. The literature search is being performed in 2017. If meta-analyses are not undertaken, a narrative synthesis of the available data will be provided. The protocol was registered in PROSPERO on the 10th of October 2016 (registration number CRD42016048956). Ethics and dissemination Conclusion of this systematic review is expected available in the second half of 2017.
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15
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Cañizares Carretero MÁ, García Fontán EM, Blanco Ramos M, Soro García J, Carrasco Rodríguez R, Peña González E, Cueto Ladrón de Guevara A. Is age a predisposing factor of postoperative complications after lung resection for primary pulmonary neoplasms? Cir Esp 2017; 95:160-166. [PMID: 28347487 DOI: 10.1016/j.ciresp.2017.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 02/05/2017] [Accepted: 02/19/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Age has been classically considered as a determining factor for the development of postoperative complications related to lung resection for bronchogenic carcinoma. The Postoperative Complications Study Group of the Spanish Society of Thoracic Surgery has promoted a registry to analyze this factor. METHODS A total of 3,307 patients who underwent any type of surgical resection for bronchogenic carcinoma have been systematically and prospectively recorded in any of the 24 units that are part of the group. Several variables related to comorbidity and age, as well as postoperative complications, were analyzed. RESULTS The mean age of patients was 65,44. Men were significantly more common than female. The most frequent complication was prolonged air leak, which was observed in more than one third of patients. In a univariant analysis, air leak presence and postsurgical atelectasis showed statistical association with patient age, when stratified in age groups. In a multivariate analysis, age was recognized as an independent prognostic factor in relation to air leak onset. However, this could not be confirmed for postoperative atelectasis. CONCLUSION Age is a predisposing factor for the development of postoperative complications after lung resection. Other associated factors also influence the occurrence of these complications.
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Affiliation(s)
| | | | | | - José Soro García
- Servicio de Cirugía Torácica, Hospital Álvaro Cunqueiro, Vigo, España
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16
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Şentürk M, Orhan Sungur M. Pneumonia After Thoracic Surgery. POSTOPERATIVE CARE IN THORACIC SURGERY 2017. [PMCID: PMC7123947 DOI: 10.1007/978-3-319-19908-5_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Mert Şentürk
- Department of Anaesthesiology and Intensive Care, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Mukadder Orhan Sungur
- Department of Anaesthesiology and Intensive Care, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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17
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Glover JR, Velez-Cubian FO, Zhang WW, Toosi K, Tanvetyanon T, Ng EP, Moodie CC, Garrett JR, Fontaine JP, Toloza EM. Effect of gender on perioperative outcomes after robotic-assisted pulmonary lobectomy. J Thorac Dis 2016; 8:3614-3624. [PMID: 28149556 DOI: 10.21037/jtd.2016.12.11] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Female gender has been associated with worse outcomes after cardiovascular surgery and critical illness. We investigated the effect of gender on perioperative outcomes following robotic-assisted pulmonary lobectomy. METHODS We retrospectively analyzed 282 consecutive patients who underwent robotic-assisted pulmonary lobectomy by one surgeon over 53 months. Perioperative outcomes and clinically significant intraoperative and postoperative complications, including respiratory and cardiovascular events, were noted. Chi-Square (χ2), Fisher's exact test, Analysis of Variance (ANOVA), Student's t-test, and Kruskal-Wallis or Mood's median test were used to compare variables, with significance at P≤0.05. RESULTS There were 128 men (mean age, 68.8 yr) and 154 women (mean age, 65.9 yr; P=0.02). Women had higher preoperative forced expiratory volume in 1 second as percent of predicted (FEV1%; P=0.001). There were more former smokers in the male cohort (P=0.03) and more nonsmokers in the female cohort (P<0.001). Women had smaller tumors (3.0±0.1 vs. 3.5±0.2 cm, P=0.04), lower estimated blood loss (EBL) (150±34 vs. 250±44 mL, P<0.001), and shorter operative time (168±6 vs. 196±7 min, P=0.01). Rates of intraoperative complications (7.1% vs. 8.6%, P=0.65) and of conversion to open lobectomy (7.8% vs. 8.6%; P=0.81) were similar between genders. Postoperative complications were fewer in women (27.9% vs. 44.5%; P=0.004), the most common of which, in both women and men, were prolonged air leak for ≥7 days (13.0% vs. 22.7%, P=0.03), atrial fibrillation (7.1% vs. 14.8%, P=0.04), and pneumonia (7.8% vs. 10.2%, P=0.49). Hospital length of stay (LOS) (4±0.3 vs. 5±0.5 days) was also shorter for women (P=0.02). Despite the higher postoperative complication rate in men, in-hospital mortality did not differ between genders (P=0.23). Multivariable analyses did not identify female gender as an independent predictor of post-operative complications. CONCLUSIONS Female gender was associated with rates of intraoperative complications and of conversion to open lobectomy as low as those for men, but with better perioperative outcomes, lower risk of intraoperative bleeding, and fewer postoperative complications. Thus, robotic-assisted pulmonary lobectomy is feasible and safe for women.
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Affiliation(s)
- Jessica R Glover
- Morsani College of Medicine, University of South Florida Health, Tampa, FL, USA
| | - Frank O Velez-Cubian
- Department of Surgery, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA
| | - Wei Wei Zhang
- Department of Surgery, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA
| | - Kavian Toosi
- Morsani College of Medicine, University of South Florida Health, Tampa, FL, USA
| | - Tawee Tanvetyanon
- Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Emily P Ng
- Morsani College of Medicine, University of South Florida Health, Tampa, FL, USA
| | - Carla C Moodie
- Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Joseph R Garrett
- Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Jacques P Fontaine
- Department of Surgery, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA;; Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA;; Department of Oncologic Sciences, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA
| | - Eric M Toloza
- Department of Surgery, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA;; Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA;; Department of Oncologic Sciences, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA
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18
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Giubergia V, Alessandrini F, Barrias C, Giuseppucci C, Reusmann A, Barrenechea M, Castaños C. Risk factors for morbidities and mortality in children following pneumonectomy. Respirology 2016; 22:187-191. [PMID: 27511212 DOI: 10.1111/resp.12867] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 05/31/2016] [Accepted: 06/08/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE Pneumonectomy (PNE) is a procedure infrequently performed in children. A high morbidity/mortality rate associated with PNE has been described. Few series have been published in the last 15 years. Risk factors associated with morbidity/mortality after PNE were evaluated. Indications, course, survival and complications of PNE in children were also analized. METHODS In a case series of 51 children who underwent PNE, death within 30 days of surgery, pneumonia, empyema, sepsis, adult respiratory distress syndrome, bronchopleural fistula, bleeding, pneumothorax and post-PNE syndrome were considered major morbidities. Scoliosis, wound infection and atelectasis were considered minor morbidities. RESULTS Median age at PNE was 7.4 years; 45% were males. Indications of pneumonectomy were postinfectious bronchiectasis (61%), tumours (17%), pulmonary malformations (17%), aspiration syndrome (14%), cystic fibrosis (6%), immunodeficiency (4%) and trauma (2%). Mortality rate was 4% at 1 month. Major and minor morbidities were present in 23% and 27% of patients, respectively. Risk factors for development of morbidities after PNE were age ≤ 3 years (OR: 16.7; 95% CI: 2.4-117) and the need for mechanical ventilation for at least 4 days (OR: 8; 95% CI: 1.5-43.6). CONCLUSION Children are at high risk of death, major and minor morbidities following PNE. Caution is recommended for this group of patients.
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Affiliation(s)
- Verónica Giubergia
- Pulmonology Department, Prof. Dr. Juan P. Garrahan Pediatric Hospital, Buenos Aires, Argentina
| | - Florencia Alessandrini
- Pulmonology Department, Prof. Dr. Juan P. Garrahan Pediatric Hospital, Buenos Aires, Argentina
| | - Carolina Barrias
- Pulmonology Department, Prof. Dr. Juan P. Garrahan Pediatric Hospital, Buenos Aires, Argentina
| | - Carlos Giuseppucci
- General Surgery Department, Prof. Dr. Juan P. Garrahan Pediatric Hospital, Buenos Aires, Argentina
| | - Aixa Reusmann
- General Surgery Department, Prof. Dr. Juan P. Garrahan Pediatric Hospital, Buenos Aires, Argentina
| | - Marcelo Barrenechea
- General Surgery Department, Prof. Dr. Juan P. Garrahan Pediatric Hospital, Buenos Aires, Argentina
| | - Claudio Castaños
- Pulmonology Department, Prof. Dr. Juan P. Garrahan Pediatric Hospital, Buenos Aires, Argentina
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Bronchial colonization and complications after lung cancer surgery. Langenbecks Arch Surg 2016; 401:885-92. [PMID: 27485548 DOI: 10.1007/s00423-016-1487-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 07/21/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Infectious complications occur following pulmonary resections preceded or not by induction chemoradiotherapy. We aimed to investigate whether bacterial colonization of the bronchial tree at the time of surgery was associated with postoperative complications. PATIENTS AND METHODS A retrospective analysis of all patients who underwent open anatomical pulmonary resections for malignancies at a single center was performed. Demographical data of the included patients, intraoperative data, and data on the postoperative course of patients were collected. Outcome of patients with a positive intraoperative bronchial culture was compared to patients with a negative bronchial culture. Relations between the presence of potential bacterial pathogens in the bronchial tree and other possible risk factors for the development of postoperative infectious and non-infectious complications, were analyzed using uni- and multivariate analysis. RESULTS Between January 2010 and January 2012, a total of 121 consecutive patients underwent open anatomical pulmonary resections for malignancy, of whom 45 were preceded by induction chemoradiotherapy and 5 by induction chemotherapy. Intraoperative bronchial cultures were taken from 58 patients (48 %). Patients with a positive bronchial culture developed significantly more infectious (88 % vs. 20 %, p < 0.001) and non-infectious complications (63 % vs. 12 %, p = 0.001). Positive intraoperative bronchial cultures showed the strongest association with the development of infectious and non-infectious postoperative complications (OR 24.8 and 12.2, respectively). After multivariate analysis, only BMI less than 20 kg/m(2) and the presence of a positive intraoperative bronchial culture were found to be independent risk factors for the development of infectious complications. Chemoradiotherapy was not associated with postoperative complications in the present study. CONCLUSIONS Bacterial colonization of the bronchial tree assessed intraoperatively, appears to be associated with higher rates of infectious and non-infectious complications after pulmonary resection. Whether early starting of appropriate antibiotics based on intraoperative-taken culture findings will reduce the infectious complication rate in a subcategory of patients needs to be investigated.
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Jean RA, DeLuzio MR, Kraev AI, Wang G, Boffa DJ, Detterbeck FC, Wang Z, Kim A. Analyzing Risk Factors for Morbidity and Mortality after Lung Resection for Lung Cancer Using the NSQIP Database. J Am Coll Surg 2016; 222:992-1000.e1. [DOI: 10.1016/j.jamcollsurg.2016.02.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 02/19/2016] [Accepted: 02/22/2016] [Indexed: 10/22/2022]
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Brocki BC, Andreasen JJ, Langer D, Souza DSR, Westerdahl E. Postoperative inspiratory muscle training in addition to breathing exercises and early mobilization improves oxygenation in high-risk patients after lung cancer surgery: a randomized controlled trial. Eur J Cardiothorac Surg 2015; 49:1483-91. [PMID: 26489835 DOI: 10.1093/ejcts/ezv359] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 09/10/2015] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES The aim was to investigate whether 2 weeks of inspiratory muscle training (IMT) could preserve respiratory muscle strength in high-risk patients referred for pulmonary resection on the suspicion of or confirmed lung cancer. Secondarily, we investigated the effect of the intervention on the incidence of postoperative pulmonary complications. METHODS The study was a single-centre, parallel-group, randomized trial with assessor blinding and intention-to-treat analysis. The intervention group (IG, n = 34) underwent 2 weeks of postoperative IMT twice daily with 2 × 30 breaths on a target intensity of 30% of maximal inspiratory pressure, in addition to standard postoperative physiotherapy. Standard physiotherapy in the control group (CG, n = 34) consisted of breathing exercises, coughing techniques and early mobilization. We measured respiratory muscle strength (maximal inspiratory/expiratory pressure, MIP/MEP), functional performance (6-min walk test), spirometry and peripheral oxygen saturation (SpO2), assessed the day before surgery and again 3-5 days and 2 weeks postoperatively. Postoperative pulmonary complications were evaluated 2 weeks after surgery. RESULTS The mean age was 70 ± 8 years and 57.5% were males. Thoracotomy was performed in 48.5% (n = 33) of cases. No effect of the intervention was found regarding MIP, MEP, lung volumes or functional performance at any time point. The overall incidence of pneumonia was 13% (n = 9), with no significant difference between groups [IG 6% (n = 2), CG 21% (n = 7), P = 0.14]. An improved SpO2 was found in the IG on the third and fourth postoperative days (Day 3: IG 93.8 ± 3.4 vs CG 91.9 ± 4.1%, P = 0.058; Day 4: IG 93.5 ± 3.5 vs CG 91 ± 3.9%, P = 0.02). We found no association between surgical procedure (thoracotomy versus thoracoscopy) and respiratory muscle strength, which was recovered in both groups 2 weeks after surgery. CONCLUSIONS Two weeks of additional postoperative IMT, compared with standard physiotherapy alone, did not preserve respiratory muscle strength but improved oxygenation in high-risk patients after lung cancer surgery. Respiratory muscle strength recovered in both groups 2 weeks after surgery. CLINICAL TRIALSGOV ID NCT01793155.
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Affiliation(s)
- Barbara Cristina Brocki
- Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark Faculty of Medicine and Health, Surgery, Örebro University, Örebro, Sweden
| | - Jan Jesper Andreasen
- Department of Cardiothoracic Surgery, Aalborg University, Aalborg, Denmark Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Daniel Langer
- KU Leuven Faculty of Kinesiology and Rehabilitation Sciences, Leuven, Belgium Respiratory Rehabilitation and Respiratory Division, University Hospital Leuven, Leuven, Belgium
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Mei J, Liu L, Tang M, Xu N, Pu Q, Liu C, Ma L, Shi H, Che G. Airway bacterial colonization in patients with non-small cell lung cancer and the alterations during the perioperative period. J Thorac Dis 2014; 6:1200-8. [PMID: 25276361 DOI: 10.3978/j.issn.2072-1439.2014.07.07] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Accepted: 06/30/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND To observe the alterations in airway bacterial colonization during the perioperative period in patients with non-small cell lung cancer (NSCLC) and evaluate their clinical implications. METHODS Patients with resectable primary NSCLC were enrolled from October 2011 to April 2012. Airway secretions were harvested for microbiological study after admission, immediately after surgery, and before endotracheal extubation. Spontaneous sputum was collected when patients presented with signs of postoperative pneumonia (POP). Detailed data on the isolated pathogens were carefully recorded. Risk factors for airway colonization and POP were analyzed. RESULTS A total of 78 consecutive patients were enrolled. Fourteen patients (17.9%) had airway colonization at admission, including four cases of fungi and ten cases of Gram-negative bacilli (GNB). Five patients (6.4%) had colonized pathogens at the end of surgery, including three cases of GNB and two cases of Gram-positive cocci. Nine (11.5%) patients had positive culture of airway secretions collected before extubation, including seven cases of GNB and two cases of fungi. Eighteen patients (23.1%) had POP, of whom one suffered from bronchopleural fistula and one died of POP. Pathogens of POP were confirmed in 11 patients, including nine cases of GNB and two cases of fungi. Three patients had the same pathogens as preoperative colonization. The proportion of more antibiotic-resistant strains increased gradually. Advanced age [odds ratio (OR), 2.263; 95% confidence interval (95% CI), 1.030-4.970] and smoking (OR, 2.163; 95% CI, 1.059-4.429) were risk factors for airway colonization. Decreased diffusion capacity of the lung for carbon monoxide (OR, 5.838; 95% CI, 1.318-25.854), prolonged operation time (OR, 6.366; 95% CI, 1.349-30.033), and preoperative airway colonization (OR, 9.448; 95% CI, 2.206-40.465) were risk factors of POP. CONCLUSIONS Airway colonized pathogens altered and more antibiotic-resistant GNB emerged during the perioperative period. These pathogens played an important role in the presence of POP.
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Affiliation(s)
- Jiandong Mei
- 1 Department of Thoracic Surgery, 2 Intensive Care Unit of Cardiothoracic Surgery, 3 Operation Room, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Lunxu Liu
- 1 Department of Thoracic Surgery, 2 Intensive Care Unit of Cardiothoracic Surgery, 3 Operation Room, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Menglin Tang
- 1 Department of Thoracic Surgery, 2 Intensive Care Unit of Cardiothoracic Surgery, 3 Operation Room, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Ninghui Xu
- 1 Department of Thoracic Surgery, 2 Intensive Care Unit of Cardiothoracic Surgery, 3 Operation Room, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Qiang Pu
- 1 Department of Thoracic Surgery, 2 Intensive Care Unit of Cardiothoracic Surgery, 3 Operation Room, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Chengwu Liu
- 1 Department of Thoracic Surgery, 2 Intensive Care Unit of Cardiothoracic Surgery, 3 Operation Room, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Lin Ma
- 1 Department of Thoracic Surgery, 2 Intensive Care Unit of Cardiothoracic Surgery, 3 Operation Room, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Hui Shi
- 1 Department of Thoracic Surgery, 2 Intensive Care Unit of Cardiothoracic Surgery, 3 Operation Room, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Guowei Che
- 1 Department of Thoracic Surgery, 2 Intensive Care Unit of Cardiothoracic Surgery, 3 Operation Room, West China Hospital, Sichuan University, Chengdu 610041, China
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Galetta D, Borri A, Casiraghi M, Gasparri R, Petrella F, Tessitore A, Serra M, Guarize J, Spaggiari L. Outcome and prognostic factors of resected non-small-cell lung cancer invading the diaphragm. Interact Cardiovasc Thorac Surg 2014; 19:632-6; discussion 636. [DOI: 10.1093/icvts/ivu183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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24
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Balancing curability and unnecessary surgery in the context of computed tomography screening for lung cancer. J Thorac Cardiovasc Surg 2014; 147:1619-26. [DOI: 10.1016/j.jtcvs.2013.11.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 08/08/2013] [Accepted: 11/01/2013] [Indexed: 11/22/2022]
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25
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Speicher PJ, Ganapathi AM, Englum BR, Onaitis MW, D'Amico TA, Berry MF. Survival in the elderly after pneumonectomy for early-stage non-small cell lung cancer: a comparison with nonoperative management. J Am Coll Surg 2013; 218:439-49. [PMID: 24559956 DOI: 10.1016/j.jamcollsurg.2013.12.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 11/18/2013] [Accepted: 12/09/2013] [Indexed: 11/15/2022]
Abstract
BACKGROUND Short-term outcomes of morbidity, mortality, and quality of life after pneumonectomy worsen with increasing age. The impact of age on long-term outcomes has not been well described. The purpose of this study was to quantify the impact of patient age on long-term survival after pneumonectomy for early-stage non-small cell lung cancer. STUDY DESIGN Overall survival (OS) of patients who had a pneumonectomy for stage I to II non-small cell lung cancer in the Surveillance Epidemiology and End Results program registry from 1988 through 2010 was evaluated using multivariable and propensity score adjusted Cox proportional hazard models. Age was stratified as younger than 50 years, 50 to 69 years, 70 to 79 years, and 80 years and older. Pneumonectomy patients' OS was compared with matched patients who refused surgery and underwent radiation therapy (RT). RESULTS Pneumonectomies comprised 10.8% of non-small cell lung cancer resections in 1988, but only 2.9% in 2010. Overall, 5-year OS of 5,701 pneumonectomy patients was 49.8% (95% CI, 45.3-54.8%) for patients younger than 50 years, 40.5% (95% CI, 38.8-42.2%) for patients 50 to 69 years, 28.9% (95% CI, 26.6-31.5%) for patients 70 to 79 years, and 18.8% (95% CI, 14.2-24.8%) for patients 80 and older (p < 0.001). Increasing patient age was the most important predictor of worse OS (hazard ratio = 1.34 per decade; p < 0.001). For patients younger than 70 years, 5-year OS was 46.3% (95% CI, 36.2-59.2%) after pneumonectomy vs 18.4% (95% CI, 11.9-28.3%) for matched RT patients (p < 0.001). In matched groups of patients 70 years and older, 5-year OS for pneumonectomy was 25.8% (95% CI, 20.8-32.0%) vs 12.2% for RT (95% CI, 8.6-17.4%; p = 0.02). CONCLUSIONS Survival after pneumonectomy for stage I to II non-small cell lung cancer decreases steadily with patient age. The incremental benefit of pneumonectomy vs RT in matched patients is less in patients older than 70 years than in younger patients, although outcomes with pneumonectomy are superior to RT in all age groups. Patients should not be denied pneumonectomy based on age alone, but careful patient selection in elderly patients is essential to optimize survival.
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Affiliation(s)
- Paul J Speicher
- Department of Surgery, Duke University Medical Center, Durham, NC
| | | | - Brian R Englum
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Mark W Onaitis
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Thomas A D'Amico
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Mark F Berry
- Department of Surgery, Duke University Medical Center, Durham, NC.
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Lorut C, Lefebvre A, Planquette B, Quinquis L, Clavier H, Santelmo N, Hanna HA, Bellenot F, Regnard JF, Riquet M, Magdeleinat P, Meyer G, Roche N, Huchon G, Coste J, Rabbat A. Early postoperative prophylactic noninvasive ventilation after major lung resection in COPD patients: a randomized controlled trial. Intensive Care Med 2013; 40:220-227. [DOI: 10.1007/s00134-013-3150-2] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Accepted: 10/28/2013] [Indexed: 01/18/2023]
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Rocco G, Gatani T, Di Maio M, Meoli I, La Rocca A, Martucci N, La Manna C, Stefanelli F. The impact of decreasing cutoff values for maximal oxygen consumption (VO(2)max) in the decision-making process for candidates to lung cancer surgery. J Thorac Dis 2013; 5:12-8. [PMID: 23372945 DOI: 10.3978/j.issn.2072-1439.2012.12.04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Accepted: 12/18/2012] [Indexed: 11/14/2022]
Abstract
BACKGROUND Maximal oxygen consumption (VO(2)max) is considered a decisive test for risk prediction in patients with borderline cardiopulmonary reserve. Guidelines have adopted decreasing VO(2)max cut-off values to define operability within acceptable mortality and morbidity limits. We wanted to investigate how the adoption of decreasing VO(2)max cut-off-values assessment contributed to better select lung surgery candidates. METHODS One hundred and nineteen consecutive surgical candidates have been prospectively analyzed as a sample population. Preoperative work-up included spirometry and transfer factor (DLco); irrespective of the spirometric values, these patients were subjected to VO(2)max assessment. Surgical eligibility was decided by the same surgeon throughout the series. In the postoperative period, overall mortality and the occurrence of any, major or minor complications was recorded and graded according to the Common Terminology Criteria for Adverse Events v.4.3. RESULTS Three arbitrary cut-offs were introduced at 15, 14 and 12 mL(.)kg(-1) (.)min(-1). Notably, 15 and 12 mL(.)kg(-1) (.)min(-1) correlated with percentage VO(2)max values of 50% and 35% of predicted (P<0.0001 and 0.0079), respectively. Accordingly, the patients were subdivided into groups in which the prevalence of postoperative morbidity was recorded. The groups were homogeneous as to age, BMI, preoperative absolute and percentage FEV1 and DLco. In the Cox proportionate-hazards multivariate analysis, VO(2)max less than 35% (P=0.0017) and CTCAE >2 (P=0.0457) emerged as significant predictors of survival after surgery. Conversely on logistic regression analysis, age over 70 years (P=0.03) and pneumonectomy (P=0.001), but not VO(2)max cut-off values, were significant predictors of major (CTCAE >2) morbidity. CONCLUSIONS Since VO(2)max is increasingly used to contribute to risk prediction for the individual patient, surgeons need to be advised that the concept of a definitive, generalized cut-off value for VO(2)max is probably a contradiction in terms. Patient-specific VO(2)max values are more likely to contribute to risk assessment since they may reflect the primarily affected component among the determinants of maximal oxygen consumption. Whether patient-specific VO(2)max should be routinely used by surgeons to define operability for borderline patients needs further evaluation.
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Affiliation(s)
- Gaetano Rocco
- Department of Thoracic Surgery and Oncology, Division of Thoracic Surgery and Service of Physiopathology, National Cancer Institute, Naples, Italy; ; Division of Respiratory Physiopathology, Monaldi Hospital, Naples, Italy
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Resection rate and outcome of pulmonary resections for non-small-cell lung cancer: a nationwide study from Iceland. J Thorac Oncol 2012; 7:1164-9. [PMID: 22592213 DOI: 10.1097/jto.0b013e318252d022] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The proportion of patients with non-small-cell lung cancer (NSCLC) who undergo surgery with curative intent is one measure of effectiveness in treating lung cancer. To the best of our knowledge, surgical resection rate (SRR) for a whole nation has never been reported before. We studied the SRR and surgical outcome of NSCLC patients in Iceland during a recent 15-year period. METHODS This was a retrospective study of all pulmonary resections performed with curative intent for NSCLC in Iceland from 1994 to 2008. Information was retrieved from medical records and from the Icelandic Cancer Registry. Patient demographics, postoperative tumor, node, metastasis stage, overall survival, and complication rates were compared over three 5-year periods. RESULTS Of 1530 confirmed cases of NSCLC, 404 were resected, giving an SRR of 26.4%, which did not change significantly during the study period. Minor and major complication rates were 37.4% and 8.7%, respectively. Operative mortality rates were 0.7% for lobectomy, 3.3% for pneumonectomy, and 0% for lesser resection. Five-year survival after all procedures was 40.7% and improved from the first to the last 5-year period (34.8% versus 43.8%, p = 0.04). Five-year survival for stages I and II together was 46.8%, with no significant change in stage distribution between periods. Five-year survival after pneumonectomy was 22.0%, which was significantly lower than for lobectomy (44.6%) and lesser resection (40.7%) (p < 0.005). Unoperated patients had a 5-year survival of 4.8%, as compared to 12.4% for all the NSCLC patients together. CONCLUSION Compared with most other published studies, the SRR of NSCLC in Iceland is high. Short-term outcome is good, with a low rate of major complications and an operative mortality of only 1.0%. Five-year survival improved significantly over the study period.
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Sharma A, Abtin F, Shepard JAO. Image-Guided Ablative Therapies for Lung Cancer. Radiol Clin North Am 2012; 50:975-99. [DOI: 10.1016/j.rcl.2012.06.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Galetta D, Solli P, Borri A, Gasparri R, Petrella F, Pardolesi A, Spaggiari L. Bronchovascular reconstruction for lung cancer: does induction chemotherapy influence the outcomes? Ann Thorac Surg 2012; 94:907-13; discussion 913. [PMID: 22776086 DOI: 10.1016/j.athoracsur.2012.05.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Revised: 05/07/2012] [Accepted: 05/11/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND Bronchoangioplastic interventions (BAIs) for lung cancer are challenging procedures associated with a high risk of postoperative morbidity and mortality. The role of induction chemotherapy (IC) in these patients is debated. METHODS We reviewed clinical records of patients who underwent a BAI between 1998 and 2009 using a prospective clinical and operative database. RESULTS Among 47 patients (39 men; mean age, 66 years) who underwent BAI, 26 (55.3%) received IC for N2 disease or for locally advanced lung cancer. We performed 35 pulmonary artery (PA) sleeve resections (31 partial and 4 circumferential), 10 PA reconstructions with a pericardial patch (8 autologous, and 2 heterologous), and 2 PA reconstructions using heterologous conduit. The 30-day mortality rate was 4.2% (n=2). Morbidity occurred in 19 (40.4%) patients; 5 patients (10.6%) had major complications (3 [6.4%] patients with fatal bronchovascular fistulas and 1 patient each with cardiac dislocation and acute respiratory distress syndrome) (2.2%). Fourteen patients (29.8%) had minor complications: 6 (12.7%) cardiac, 7 (14.9%) pulmonary, and 1 (2.2%) stroke. IC did not influence the complication rate. Overall 5-year survival and disease-free survival was 39.2% and 36.9%, respectively. Early pathologic stage and the absence of nodal involvement significantly influenced survival (p=0.005 and p=0.002, respectively). Patients receiving IC had a better prognosis (62.7% versus 10.7%; p=0.0003). At multivariate analysis, IC influenced long-term survival (p=0.003 [95% CI, 2.92-8.56]). CONCLUSIONS BAIs are feasible and effective surgical procedures with acceptable morbidity and mortality. IC does not influence morbidity and allows good long-term outcomes.
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Affiliation(s)
- Domenico Galetta
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy.
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Ichiki Y, Nagashima A, Chikaishi Y, Yasuda M. Pneumonectomy for non-small cell lung cancer. Surg Today 2012; 42:830-4. [PMID: 22484985 DOI: 10.1007/s00595-012-0174-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Accepted: 07/19/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the mortality, complications and major morbidity of pneumonectomy for non-small cell lung cancer (NSCLC) and to establish the importance of various prognostic factors. METHODS We reviewed retrospectively the hospital records of 71 consecutive patients who underwent pneumonectomy for NSCLC between 1992 and 2007 to evaluate the significance of risk factors for an adverse outcome. Patients were divided into two period groups according to the period when they were treated: early (1992-1999; n = 47) and late (2000-2007; n = 24). RESULTS Both the 30-day and the in-hospital mortality rates were 4.2 % (3/71). Complications developed in 31.3 % (22/71) and overall 5-year survival was 23.1 %. Pathological stage III or more, T3 or more, and N2 or more were risk factors of an adverse outcome. Survival was not significantly influenced by histological type, the side of surgery, or curability. The 5-year survival rates for the early and late periods were 19.6 and 32.9 %, respectively. There were more patients with clinical N2 or 3 disease in the early period than in the late period (66.0 vs. 33.3 %). CONCLUSIONS Pneumonectomy is associated with acceptable overall morbidity and mortality; however, patients with pathological stage III or more, T3 or more, and N2 or more disease require special consideration. Pneumonectomy should be performed only in selected patients.
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Affiliation(s)
- Yoshinobu Ichiki
- Department of Chest Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, Kitakyushu, 802-0077, Japan.
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Risk model of in-hospital mortality after pulmonary resection for cancer: A national database of the French Society of Thoracic and Cardiovascular Surgery (Epithor). J Thorac Cardiovasc Surg 2011; 141:449-58. [PMID: 20692003 DOI: 10.1016/j.jtcvs.2010.06.044] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Revised: 06/10/2010] [Accepted: 06/28/2010] [Indexed: 11/20/2022]
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Yamashita M, Komori E, Sawada S, Suehisa H, Nozaki I, Kurita A, Takashima S. Pulmonary angioplastic procedure for lung cancer surgery. Gen Thorac Cardiovasc Surg 2010; 58:19-24. [DOI: 10.1007/s11748-009-0462-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2008] [Accepted: 04/06/2009] [Indexed: 11/24/2022]
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Risk factors for early mortality and morbidity after pneumonectomy: a reappraisal. Ann Thorac Surg 2010; 88:1737-43. [PMID: 19932227 DOI: 10.1016/j.athoracsur.2009.07.016] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Revised: 07/12/2009] [Accepted: 07/15/2009] [Indexed: 01/02/2023]
Abstract
BACKGROUND Pneumonectomy remains a high-risk procedure. Comprehensive patient selection should be based on analysis of proven risk factors. METHODS The records of 323 pneumonectomy patients were retrospectively reviewed. Multiple demographic data were collected. End points were operative mortality at 30 and at 90 days, major procedurally related complications, and cardiovascular events. Univariate and multivariate statistical analyses were performed. RESULTS Smoking habits, chronic obstructive pulmonary disease (COPD) status, induction chemotherapy status, diabetes, and obesity had no statistical influence on short-term outcomes. After right pneumonectomy, 30-day mortality (p = 0.045) and the incidence of bronchopleural fistulas (p = 0.009) were increased. Multivariate analysis for postoperative bronchopleural fistulas discovered that right pneumonectomies are the sole risk factor (p = 0.015). Univariate analysis for postoperative atrial fibrillation showed that male gender, age 70 and older, hypertension, and dyslipidemia are risk factors. Multivariate analysis found no definite risk factor. Patients with coronary artery disease had more postoperative cardiovascular events (p = 0.003). Among patients free of coronary artery disease, COPD led to an increased 90-day mortality rate (p = 0.028). CONCLUSIONS Patients with right pneumonectomies are at increased risk. Postoperative cardiovascular events are more frequent in coronary artery disease patients. COPD is a risk factor in patients free of coronary disease.
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Abstract
Patients undergoing thoracic surgery are threatened by pulmonary complications such as pneumonia and atelectasis. Age, preoperative FEV(1), operative time and extent of resection are predictors for adverse outcome. Reported morbidity after lung resection is as high as 42% and mortality up to 7%. Fast track in thoracic surgery aims at reducing morbidity and mortality rates after lung resection by introducing specific measures into the pre-, intra- and postoperative periods. Basic fast track elements in thoracic surgery are smoking cessation, preoperative physiotherapy, micronutrient supplementation, high thoracic epidural anesthesia, fluid restriction, early mobilization and enteral feeding. The effectiveness of these individual measures has been proven of value in perioperative care, however, evidence on multimodal therapy regimens in thoracic surgery is limited. In particular it remains to be elucidated which patients should be fast tracked in order to improve outcomes.
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Affiliation(s)
- B Mühling
- Klinik für Thorax- und Gefässchirurgie, Universität Ulm, Steinhövelstrasse 9, Ulm, Germany.
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36
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Berry MF, Hanna J, Tong BC, Burfeind WR, Harpole DH, D'Amico TA, Onaitis MW. Risk factors for morbidity after lobectomy for lung cancer in elderly patients. Ann Thorac Surg 2009; 88:1093-9. [PMID: 19766786 DOI: 10.1016/j.athoracsur.2009.06.012] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2009] [Revised: 05/31/2009] [Accepted: 06/04/2009] [Indexed: 01/18/2023]
Abstract
BACKGROUND Studies evaluating risk factors for complications after lobectomy in elderly patients have not adequately analyzed the effect of using minimally invasive approaches. METHODS A model for morbidity including published preoperative risk factors and surgical approach was developed by multivariable logistic regression. All patients aged 70 years or older who underwent lobectomy for primary lung cancer without chest wall resection or airway procedure between December 1999 and October 2007 at a single institution were reviewed. Preoperative, histopathologic, perioperative, and outcome variables were assessed using standard descriptive statistics. Morbidity was measured as a patient having any perioperative complication. The impact of bias in the selection of surgical approach was assessed using propensity scoring. RESULTS During the study period, 338 patients older than 70 years (mean age, 75.7 +/- 0.2) underwent lobectomy (219 thoracoscopy, 119 thoracotomy). Operative mortality was 3.8% (13 patients) and morbidity was 47% (159 patients). Patients with at least one complication had increased length of stay (8.3 +/- 0.6 versus 3.8 +/- 0.1 days; p < 0.0001) and mortality (6.9% [11 of 159] versus 1.1% [2 of 179]; p = 0.008). Significant predictors of morbidity by multivariable analysis included age (odds ratio, 1.09 per year; p = 0.01) and thoracotomy as surgical approach (odds ratio, 2.21; p = 0.004). Thoracotomy remained a significant predictor of morbidity when the propensity to undergo thoracoscopy was considered (odds ratio, 4.9; p= 0.002). CONCLUSIONS Patients older than 70 years of age can undergo lobectomy for lung cancer with low morbidity and mortality. Advanced age and the use of a thoracotomy increased the risk of complications in this patient population.
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Affiliation(s)
- Mark F Berry
- Department of Surgery, Division of Thoracic Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA
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37
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Villamizar NR, Darrabie MD, Burfeind WR, Petersen RP, Onaitis MW, Toloza E, Harpole DH, D'Amico TA. Thoracoscopic lobectomy is associated with lower morbidity compared with thoracotomy. J Thorac Cardiovasc Surg 2009; 138:419-25. [PMID: 19619789 DOI: 10.1016/j.jtcvs.2009.04.026] [Citation(s) in RCA: 273] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Revised: 04/07/2009] [Accepted: 04/24/2009] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Advantages of thoracoscopic lobectomy include less postoperative pain, shorter hospitalization, and improved delivery of adjuvant chemotherapy. The incidence of postoperative complications has not been thoroughly assessed. This study analyzes morbidity after lobectomy to compare the thoracoscopic approach and thoracotomy. METHODS By using a prospective database, the outcomes of patients who underwent lobectomy from 1999-2009 were analyzed with respect to postoperative complications. Propensity-matched groups were analyzed based on preoperative variables and stage. RESULTS Of the 1079 patients in the study, 697 underwent thoracoscopic lobectomy, and 382 underwent lobectomy by means of thoracotomy. In the overall analysis thoracoscopic lobectomy was associated with a lower incidence of atrial fibrillation (P = .01), atelectasis (P = .0001), prolonged air leak (P = .0004), transfusion (P = .0001), pneumonia (P = .001), sepsis (P = .008), renal failure (P = .003), and death (P = .003). In the propensity-matched analysis based on preoperative variables, when comparing 284 patients in each group, 196 (69%) patients who underwent thoracoscopic lobectomy had no complications versus 144 (51%) patients who underwent thoracotomy (P = .0001). In addition, thoracoscopic lobectomy was associated with a lower incidence of atrial fibrillation (13% vs 21%, P = .01), less atelectasis (5% vs 12%, P = .006), fewer prolonged air leaks (13% vs 19%, P = .05), fewer transfusions (4% vs 13%, P = .002), less pneumonia (5% vs 10%, P = .05), less renal failure (1.4% vs 5%, P = .02), shorter chest tube duration (median of 3 vs 4 days, P < .0001), and shorter length of hospital stay (median of 4 vs 5 days, P < .0001). CONCLUSIONS Thoracoscopic lobectomy is associated with a lower incidence of major complications, including atrial fibrillation, compared with lobectomy by means of thoracotomy. The underlying factors responsible for this advantage should be analyzed to improve the safety and outcomes of other thoracic procedures.
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Affiliation(s)
- Nestor R Villamizar
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
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Should We Change Antibiotic Prophylaxis for Lung Surgery? Postoperative Pneumonia Is the Critical Issue. Ann Thorac Surg 2008; 86:1727-33. [DOI: 10.1016/j.athoracsur.2008.08.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2008] [Revised: 08/01/2008] [Accepted: 08/04/2008] [Indexed: 11/22/2022]
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Roth K, Nilsen TIL, Hatlen E, Sørensen KS, Hole T, Haaverstad R. Predictors of long time survival after lung cancer surgery: a retrospective cohort study. BMC Pulm Med 2008; 8:22. [PMID: 18954454 PMCID: PMC2614408 DOI: 10.1186/1471-2466-8-22] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Accepted: 10/27/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There have been few reports regarding long time survival after lung cancer surgery. The influence of age and pulmonary function on long time survival is still not fully discovered. Some reports suggest that hospitals with a high surgical volume have better results. The aim of this study was to evaluate lung cancer surgery performed in a county hospital in terms of 30 days mortality, complications and predictors of long time survival. METHODS All patients operated with non-small cell lung cancer in the period 1993-2006 were reviewed, and 148 patients were included in the study. 30 days mortality and complications were analyzed by univariate analysis. Kaplan Meier plots were performed to display some of the univariate variables. Cox regression analysis was performed to find Hazard Ratios (HR) that predicted long time survival in univariate and multivariate analysis. RESULTS The overall 30 days mortality rate was 2.7%, whereas 36.3% had one or more complications after surgery. The median survival time was 3.4 years. In multivariate Cox regression analysis advanced preoperative stage predicted reduced long time survival with HR (95%CI) 1.63 (0.92, 2.89) and 4.16 (1.92, 9.05) for patients in stage IB and II-IV respectively, when compared to patients in stage IA. Age >or= 70 years and FEV1<80% predicted reduced long time survival with HR (95%CI) 2.23 (1.41, 3.54) and 1.93 (1.14, 3.28) respectively, compared to age<70 years and FEV1 >or= 80%. CONCLUSION Thirty days mortality and complication rate showed that lung cancer surgery can be performed safely in a county hospital with experienced thoracic surgeons. Early preoperative stage, age below 70 years and normal pulmonary function predicted long time survival.
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Affiliation(s)
- Kjetil Roth
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway.
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Wright CD, Gaissert HA, Grab JD, O'Brien SM, Peterson ED, Allen MS. Predictors of Prolonged Length of Stay after Lobectomy for Lung Cancer: A Society of Thoracic Surgeons General Thoracic Surgery Database Risk-Adjustment Model. Ann Thorac Surg 2008; 85:1857-65; discussion 1865. [DOI: 10.1016/j.athoracsur.2008.03.024] [Citation(s) in RCA: 136] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Revised: 03/06/2008] [Accepted: 03/10/2008] [Indexed: 10/22/2022]
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Radu DM, Jauréguy F, Seguin A, Foulon C, Destable MD, Azorin J, Martinod E. Postoperative Pneumonia After Major Pulmonary Resections: An Unsolved Problem in Thoracic Surgery. Ann Thorac Surg 2007; 84:1669-73. [DOI: 10.1016/j.athoracsur.2007.05.059] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2007] [Revised: 05/19/2007] [Accepted: 05/22/2007] [Indexed: 10/22/2022]
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Weinstein H, Bates AT, Spaltro BE, Thaler HT, Steingart RM. Influence of preoperative exercise capacity on length of stay after thoracic cancer surgery. Ann Thorac Surg 2007; 84:197-202. [PMID: 17588411 DOI: 10.1016/j.athoracsur.2007.02.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2005] [Revised: 01/29/2007] [Accepted: 02/02/2007] [Indexed: 11/17/2022]
Abstract
BACKGROUND Stress testing is frequently used to assess cardiac risk before thoracic surgery. However, the relationship between treadmill exercise capacity and length of stay (LOS) has not been investigated. We hypothesized that exercise capacity, a strong predictor of long-term prognosis, can also predict LOS after thoracic cancer surgery. METHODS Accordingly, 191 consecutive patients who had exercise stress testing before major thoracic cancer surgery were retrospectively grouped by poor (<4 metabolic equivalents [METs], n = 31), fair (4 to 7 METs, n = 107), good (7 to 10 METs, n = 30), and excellent (>10 METs, n = 23) exercise capacity. The relationship between exercise capacity and LOS was then determined. RESULTS Average LOS was inversely related to exercise capacity, with a nearly twofold increase in LOS between the excellent and poor exercise groups (4.8 versus 9.2 days). This relationship remained significant even after controlling for operation type, history of dyspnea, sex, and smoking history in analysis of covariance. Prolonged hospital stay (10 days or more) was strongly predicted by exercise capacity. Failure to exceed 4 METs was associated with a high risk of prolonged stay (9 of 31, 39%), whereas none of the 23 patients who exceeded 10 METs had a prolonged stay. CONCLUSIONS Treadmill exercise capacity has independent predictive value for LOS and risk of prolonged stay after thoracic cancer surgery. These findings have important implications for risk assessment and cost, suggesting that preoperative programs designed to improve exercise capacity may favorably influence LOS and associated costs.
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Affiliation(s)
- Howard Weinstein
- Department of Medicine, Division of Cardiology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
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Strand TE, Rostad H, Damhuis RAM, Norstein J. Risk factors for 30-day mortality after resection of lung cancer and prediction of their magnitude. Thorax 2007; 62:991-7. [PMID: 17573442 PMCID: PMC2117132 DOI: 10.1136/thx.2007.079145] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND There is considerable variability in reported postoperative mortality and risk factors for mortality after surgery for lung cancer. Population-based data provide unbiased estimates and may aid in treatment selection. METHODS All patients diagnosed with lung cancer in Norway from 1993 to the end of 2005 were reported to the Cancer Registry of Norway (n = 26 665). A total of 4395 patients underwent surgical resection and were included in the analysis. Data on demographics, tumour characteristics and treatment were registered. A subset of 1844 patients was scored according to the Charlson co-morbidity index. Potential factors influencing 30-day mortality were analysed by logistic regression. RESULTS The overall postoperative mortality rate was 4.4% within 30 days with a declining trend in the period. Male sex (OR 1.76), older age (OR 3.38 for age band 70-79 years), right-sided tumours (OR 1.73) and extensive procedures (OR 4.54 for pneumonectomy) were identified as risk factors for postoperative mortality in multivariate analysis. Postoperative mortality at high-volume hospitals (> or = 20 procedures/year) was lower (OR 0.76, p = 0.076). Adjusted ORs for postoperative mortality at individual hospitals ranged from 0.32 to 2.28. The Charlson co-morbidity index was identified as an independent risk factor for postoperative mortality (p = 0.017). A prediction model for postoperative mortality is presented. CONCLUSIONS Even though improvements in postoperative mortality have been observed in recent years, these findings indicate a further potential to optimise the surgical treatment of lung cancer. Hospital treatment results varied but a significant volume effect was not observed. Prognostic models may identify patients requiring intensive postoperative care.
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Affiliation(s)
- Trond-Eirik Strand
- Cancer Registry of Norway, Department of Clinical and Registry-based Research, 0310 Oslo, Norway.
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Tewari N, Martin-Ucar AE, Black E, Beggs L, Beggs FD, Duffy JP, Morgan WE. Nutritional status affects long term survival after lobectomy for lung cancer. Lung Cancer 2007; 57:389-94. [PMID: 17481775 DOI: 10.1016/j.lungcan.2007.03.017] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2006] [Revised: 01/16/2007] [Accepted: 03/22/2007] [Indexed: 10/23/2022]
Abstract
STUDY OBJECTIVES Nutritional status has been reported as a predictor of complications following surgery for lung cancer. However, the impact of impaired nutrition in the long term has not been extensively studied. We have analysed our own experience after lobectomy for non-small cell lung cancer (NSCLC). PATIENTS Six hundred and forty-two consecutive patients undergoing lobectomy for primary lung cancer in a single centre between October 1991 and April 2004 were included in the study. STUDY DESIGN Impaired nutritional status was defined as any of low pre-operative albumin level (less than 30g/L), recent history of weight loss or low body mass index (BMI)--less than 18.5kg/m(2). There were 400 males and 242 females, median age 66 (range 32-89 years). Outcomes studied were hospital mortality and complications, and long term survival. RESULTS A high proportion of patients (185 of 642, 28%) were classed as having poor nutritional status. There were 12 hospital deaths (1.9%). Nutritional depletion had no significant impact on hospital mortality (1.3% versus 2.7%), cardiac (14.4% versus 16.8%), or respiratory (17.5% versus 18.9%) complications. The overall median survival was 48+/-6 months (standard error). On Cox multivariate analysis, impaired nutritional status, tumour stage and need for en bloc chest wall excision were all independent predictors of survival. CONCLUSIONS Nutritional status does not appear to significantly influence immediate outcomes following lobectomy for lung cancer. However, it is a predictor of survival in the long term independently of tumour extension and staging.
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Affiliation(s)
- Nilanjana Tewari
- Department of Thoracic Surgery, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, United Kingdom.
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Duque JL, Rami-Porta R, Almaraz A, Castanedo M, Freixinet J, Fernández de Rota A, López Encuentra A. [Risk factors in bronchogenic carcinoma surgery]. Arch Bronconeumol 2007; 43:143-9. [PMID: 17386190 DOI: 10.1016/s1579-2129(07)60038-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To analyze the factors that determine the risk of morbidity and mortality associated with lung resection in patients with bronchogenic carcinoma. PATIENTS AND METHODS Prospective multicenter study conducted between October 1, 1993 and September 30, 1997 in the 19 hospitals that make up the Bronchogenic Carcinoma Cooperative Group. During the study period, 2994 patients with bronchogenic carcinoma underwent surgery. The morbidity and mortality data at 30 days from all centers were recorded in a single registry. RESULTS Major resection was performed in 2491 patients, whereas 212 underwent minor resection. The resection had to be extended in 296 and exploratory thoracotomy was carried out in 291. Postoperative complications were reported in 1057 patients (35.2%). Complications directly related to surgery were the most common (22.9%), followed by respiratory (19.5%) and cardiovascular (10.7%) complications. Of the patients with complications, 654 patients (21.8%) had only 1, whereas 403 (13.4%) had more than 1. After classification of complications, 21% were found to be minor and 14.2% were major. Mortality at 30 days was 6.8% (204 patients), and strongly linked to the presentation of major complications--40.8% of those with such complications died. CONCLUSIONS Surgical treatment of bronchogenic carcinoma in Spain is associated with high morbidity and mortality. The morbidity reported in the present study lies in the middle of the ranges found in the literature, whereas mortality lies at the high end of the range. The presence of major complications and/or multiple complications should be considered as strong risk factors.
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Affiliation(s)
- José Luis Duque
- Servicio de Cirugía Torácica, Hospital Universitario, Valladolid, España.
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Shaw A. Genetics of postoperative complications following thoracic surgery. Semin Cardiothorac Vasc Anesth 2007; 10:327-45. [PMID: 17200090 DOI: 10.1177/1089253206294368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The field of complex trait-gene interaction research has expanded exponentially in recent years, and new insights into the ways patients respond to surgical stimuli have arisen from this body of work. From a physiological systems perspective, thoracic surgical procedures (thoracotomy in particular) represent a massive input stimulus, and it is, therefore, not surprising that approximately 30% of these patients experience an adverse postoperative event. The best risk prediction models have typically explained about 60% to 70% of the risk, leaving a large residual component unaccounted for. It is quite possible that there is a genetic (heritable) component to this residual risk. This article explores some of the concepts underlying gene-disease interactions, the preliminary work that has been done to date in this area, and finally discusses some of the more important methodological issues involved in complex trait association study design.
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Affiliation(s)
- Andrew Shaw
- Division of Cardiothoracic Anesthesia and Critical Care Medicine, Duke University Medical Center, Durham, NC 27710, USA.
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Duque JL, Rami-Porta R, Almaraz A, Castanedo M, Freixinet J, de Rota AF. Parámetros de riesgo en la cirugía del carcinoma broncogénico. Arch Bronconeumol 2007. [DOI: 10.1157/13099530] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Sánchez PG, Vendrame GS, Madke GR, Pilla ES, Camargo JDJP, Andrade CF, Felicetti JC, Cardoso PFG. Lobectomia por carcinoma brônquico: análise das co-morbidades e seu impacto na morbimortalidade pós-operatória. J Bras Pneumol 2006; 32:495-504. [PMID: 17435899 DOI: 10.1590/s1806-37132006000600005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2005] [Accepted: 03/24/2006] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Analisar o impacto das co-morbidades no desempenho pós-operatório de lobectomia por carcinoma brônquico. MÉTODOS: Estudaram-se retrospectivamente 493 pacientes submetidos a lobectomia por carcinoma brônquico e 305 preencheram os critérios de inclusão. A técnica cirúrgica foi sempre semelhante. Analisaram-se as co-morbidades categorizando-se os pacientes nas escalas de Torrington-Henderson e de Charlson, estabelecendo-se grupos de risco para complicações e óbito. RESULTADOS: A mortalidade operatória foi de 2,9% e o índice de complicações de 44%. O escape aéreo prolongado foi a complicação mais freqüente (20,6%). A análise univariada mostrou que sexo, idade, tabagismo, terapia neo-adjuvante e diabetes apresentaram impacto significativo na incidência de complicações. O índice de massa corporal (23,8 ± 4,4 kg/m²), volume expiratório forçado no primeiro segundo (74,1 ± 24%) e relação entre volume expiratório forçado no primeiro segundo e capacidade vital forçada (0,65 ± 0,1) foram fatores preditivos da ocorrência de complicações. As escalas foram eficazes na identificação de grupos de risco e na relação com a morbimortalidade (p = 0,001 e p < 0,001). A análise multivariada identificou que o índice de massa corporal e o índice de Charlson foram os principais determinantes de complicações; o escape aéreo prolongado foi o principal fator envolvido na mortalidade (p = 0,01). CONCLUSÃO: Valores reduzidos de volume expiratório forçado no primeiro segundo, relação entre volume expiratório forçado no primeiro segundo e capacidade vital forçada, índice de massa corporal e graus 3-4 de Charlson e 3 de PORT associaram-se a mais complicações após lobectomias por carcinoma brônquico. O escape aéreo persistente associou-se fortemente à mortalidade.
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Birim O, Kappetein AP, Waleboer M, Puvimanasinghe JPA, Eijkemans MJC, Steyerberg EW, Versteegh MIM, Bogers AJJC. Long-term survival after non–small cell lung cancer surgery: Development and validation of a prognostic model with a preoperative and postoperative mode. J Thorac Cardiovasc Surg 2006; 132:491-8. [PMID: 16935100 DOI: 10.1016/j.jtcvs.2006.04.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2005] [Revised: 02/26/2006] [Accepted: 04/11/2006] [Indexed: 01/23/2023]
Abstract
OBJECTIVE At present, there is no prognostic model that is specific for prediction of survival after non-small cell lung cancer surgery. We aimed to develop a prognostic model that can be used to estimate the postoperative survival of individual patients. METHODS A total of 766 patients underwent resection for primary non-small cell lung cancer. Comorbid conditions were scaled according to the Charlson comorbidity index (CCI). Cox proportional hazard analyses were used to determine risk factors for survival. A prognostic model for survival with a preoperative and postoperative mode was established. Performance of the prognostic model, the CCI, and pathologic tumor stage were quantified by a concordance statistic to indicate discriminative ability. RESULTS The factors associated with an impaired survival were male sex, age, chronic obstructive pulmonary disease, congestive heart failure, any prior tumor, moderate-to-severe renal disease (preoperative and postoperative mode), clinical tumor stage (preoperative mode), type of resection, and pathologic tumor stage (postoperative mode). The discriminative performance was poor for the CCI (c = 0.55), better for pathologic tumor stage (c = 0.60) and for the preoperative mode (c = 0.61), and best for the postoperative mode (c = 0.65). The discriminative performance of the postoperative mode was better than the discriminative performance of the CCI (P < .0001), the preoperative mode (P < .0002), and pathologic tumor stage (P < .0001). The discriminative performance of the preoperative mode was better than the discriminative performance of the CCI (P < .0001) and similar (P = .90) to a model that only included pathologic tumor stage. CONCLUSIONS The prognostic model, particularly the postoperative mode, successfully estimates long-term survival of individual patients and could help clinicians in clinical decision-making and treatment tailoring.
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Affiliation(s)
- Ozcan Birim
- Department of Cardio-Thoracic Surgery, Erasmus MC, Rotterdam, The Netherlands.
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Varela-Simó G, Barberà-Mir JA, Cordovilla-Pérez R, Duque-Medina JL, López-Encuentra A, Puente-Maestu L. [Guidelines for the evaluation of surgical risk in bronchogenic carcinoma]. Arch Bronconeumol 2006; 41:686-97. [PMID: 16373045 DOI: 10.1016/s1579-2129(06)60336-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- G Varela-Simó
- Servicio de Cirugía Torácica, Hospital Universitario, Salamanca, Spain.
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