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Qiu B, Han J, Zhao J. Effect of thoracoscopic and thoracotomy on postoperative wound complications in patients with lung cancer: A meta-analysis. Int Wound J 2023; 20:4217-4226. [PMID: 37596788 PMCID: PMC10681477 DOI: 10.1111/iwj.14322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/08/2023] [Accepted: 07/10/2023] [Indexed: 08/20/2023] Open
Abstract
Because of the difficult surgical procedures, patients with lung cancer who have received thoracic surgery tend to have postoperative complications. It may lead to postoperative complications like wound infection, wound haematoma and pneumothorax. A lot of research has assessed the effect of various surgery methods on postoperative complications in pulmonary cancer. The purpose of this meta-analysis is to establish if thoracoscopic is superior to that of thoracotomy in the rate of post-operative complications. From the beginning to the end of June 2023, we performed an exhaustive search on four main databases for key words. The Hazard of Bias in Non-Randomized Interventional Studies (ROBINS-I) was evaluated in the literature. In the end, 13 trials that fulfilled the eligibility criteria underwent further statistical analyses. The results showed that thoracoscopic intervention decreased the risk of post operative wound infection (dominant ratio [OR], 3.00; 95% confidence margin [CI], 1.98, 4.55; p < 0.00001) and air-leakage after operation (OR, 1.30; 95% CI, 1.04, 1.63; p = 0.02). There was no statistically significant difference between the two groups in terms of the rate of haemorrhage after operation (OR, 0.10; 95% CI, 0.73, 1.66; p = 0.63). Our findings indicate that thoracoscopic is less likely to cause post operative infection and gas leakage than thoracotomy, and it does not decrease the risk of postoperative haemorrhage. As some of the chosen trials are too small to conduct meta-analyses, care must be taken when handling the data. In the future, a large number of randomized, controlled trials will be required to provide additional evidence for this research.
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Affiliation(s)
- Bin Qiu
- Department of Thoracic SurgeryAffiliated Hospital of Weifang Medical UniversityWeifangChina
| | - Jinlong Han
- Department of Interventional OncologyAffiliated Hospital of Weifang Medical UniversityWeifangChina
| | - Jin Zhao
- Department of Thoracic SurgeryAffiliated Hospital of Weifang Medical UniversityWeifangChina
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2
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Nakane J, Honda N, Tsuchiya K. Computed tomography pulmonary angiography and venography with a low dose of contrast medium. Radiol Phys Technol 2018; 12:61-68. [PMID: 30536083 DOI: 10.1007/s12194-018-00492-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 11/28/2018] [Accepted: 11/28/2018] [Indexed: 11/24/2022]
Abstract
The authors developed a method to ensure sufficient opacification of pulmonary vasculature for separate depiction of arteries and veins in three-dimensional form with a small dose of contrast medium utilizing a test injection to determine optimal timing of computed tomography (CT) scanning. The dose was determined by a simulation based on a pharmacokinetic model. The contrast medium was administered at a rate of 5.0 mL/s for 3 s, followed by helical scanning at the timing determined by a dynamic CT scanning following the test injection. Images of 20 consecutive patients acquired with a 64-row CT scanner were evaluated. Quality of vessel depiction was assessed on the basis of the following: HU values at the main pulmonary artery (MPA) and left atrium (LA), distance between the pleural surface and the distal end of the pulmonary vessels on three-dimensional CT pulmonary arteriography and venography (3D-CTPAV), and subjective visual assessment of quality of the 3D-CTPAV images. Time to generate the 3D-CTPAV images was recorded. The mean ± standard deviation (SD) of the HU values at MPA/LA and the distances to the pleural surface for pulmonary arteries/veins were 448.0 ± 123.1/277.3 ± 60.85 HU and 9.21 ± 3.60/10.7 ± 5.45 mm, respectively. The image quality was visually rated as excellent for all of the patients. The mean time ± SD to generate 3D-CTPAV images was 13.6 ± 6.7 min. In conclusion, three-dimensional images of the pulmonary vasculature can be created using 21 mL (including 6 mL for the test injection) of contrast medium.
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Affiliation(s)
- Jun Nakane
- Radiology Service, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan.
| | - Norinari Honda
- Radiology Service, Division of Nuclear Medicine, Saitama Sekishinkai Hospital, 2-37-20, Irumagawa, Sayama, Saitama, 350-1305, Japan
| | - Kazuhiro Tsuchiya
- Department of Radiology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan
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Mafé JJ, Planelles B, Asensio S, Cerezal J, Inda MDM, Lacueva J, Esteban MD, Hernández L, Martín C, Baschwitz B, Peiró AM. Cost and effectiveness of lung lobectomy by video-assisted thoracic surgery for lung cancer. J Thorac Dis 2017; 9:2534-2543. [PMID: 28932560 DOI: 10.21037/jtd.2017.07.51] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Video-assisted thoracic surgery (VATS) emerged as a minimally invasive surgery for diseases in the field of thoracic surgery. We herein reviewed our experience on thoracoscopic lobectomy for early lung cancer and evaluated Health System use. METHODS A cost-effectiveness study was performed comparing VATS vs. open thoracic surgery (OPEN) for lung cancer patients. Demographic data, tumor localization, dynamic pulmonary function tests [forced vital capacity (FVC), forced expiratory volume in one second (FEV1), diffusion capacity (DLCO) and maximal oxygen uptake (VO2max)], surgical approach, postoperative details, and complications were recorded and analyzed. RESULTS One hundred seventeen patients underwent lung resection by VATS (n=42, 36%; age: 63±9 years old, 57% males) or OPEN (n=75, 64%; age: 61±11 years old, 73% males). Pulmonary function tests decreased just after surgery with a parallel increasing tendency during first 12 months. VATS group tended to recover FEV1 and FVC quicker with significantly less clinical and post-surgical complications (31% vs. 53%, P=0.015). Costs including surgery and associated hospital stay, complications and costs in the 12 months after surgery were significantly lower for VATS (P<0.05). CONCLUSIONS The VATS approach surgery allowed earlier recovery at a lower cost than OPEN with a better cost-effectiveness profile.
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Affiliation(s)
- Juan J Mafé
- Department of Thoracic Surgery, Department of Health of Alicante-General Hospital, Alicante, Spain
| | - Beatriz Planelles
- Neuropharmacology on Pain (NED), Research Unit, Department of Health of Alicante-General Hospital, ISABIAL, Spain
| | - Santos Asensio
- Department of Pneumology, Department of Health of Alicante-General Hospital, Alicante, Spain
| | - Jorge Cerezal
- Department of Thoracic Surgery, Department of Health of Alicante-General Hospital, Alicante, Spain
| | - María-Del-Mar Inda
- Neuropharmacology on Pain (NED), Research Unit, Department of Health of Alicante-General Hospital, ISABIAL, Spain
| | - Javier Lacueva
- Department of Thoracic Surgery, Department of Health of Alicante-General Hospital, Alicante, Spain
| | | | - Luis Hernández
- Department of Pneumology, Department of Health of Alicante-General Hospital, Alicante, Spain
| | - Concepción Martín
- Department of Pneumology, Department of Health of Alicante-General Hospital, Alicante, Spain
| | - Benno Baschwitz
- Department of Thoracic Surgery, Department of Health of Alicante-General Hospital, Alicante, Spain
| | - Ana M Peiró
- Neuropharmacology on Pain (NED), Research Unit, Department of Health of Alicante-General Hospital, ISABIAL, Spain.,Clinical Pharmacology Unit, Department of Health of Alicante-General Hospital, Alicante, Spain
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Smith DE, Dietrich A, Nicolas M, Da Lozzo A, Beveraggi E. Conversion during thoracoscopic lobectomy: related factors and learning curve impact. Updates Surg 2015; 67:427-32. [PMID: 26561493 DOI: 10.1007/s13304-015-0334-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 10/18/2015] [Indexed: 10/22/2022]
Abstract
Video-assisted thoracoscopic surgery (VATS) lobectomy has become a standard procedure for lung cancer treatment. Conversion-related factors and learning curve impacts, were poorly described. The aim of this study was to review the reasons and related factor for conversion in VATS lobectomy and the impact on this of the surgeon's learning curve. From June 2009 to May 2014, 154 patients who underwent a VATS lobectomy were included in our study. Patients' characteristics, pathology background, operative times, overall length of stay, overall morbidity and type of major complications were recorded for all patients and compared between non converted (n = 133) and converted (n = 21) patients. To evaluate surgeon's learning curve, we analyzed rates and causes of conversion in the first period (first 77 patients) and in the last period (78-154 patients). Patients characteristics were similar between converted and non-converted groups. Patients who were converted to open thoracotomy presented more frecuently tumors >3 cms (P = 0.02). The average of operative times and the length of stay were not significantly different between groups. Overall morbidity and major complications were also similar in both groups. There were no impact of surgeon's learning curve in overall rate conversion in both groups. Emergency conversion was always secondary to vascular accidents, all in the first group (p = 0.059). Surgeons should be expecting to perform a conversion to a thoracotomy in patients who present in preoperative studies, tumors greater than 3 cms. Learning curve only affected the emergency conversion, occurred all in the first half of our series.
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Affiliation(s)
- David E Smith
- Hospital Italiano de Buenos Aires, Thoracic Surgery and Lung Transplant, Perón 4190, 1181, Buenos Aires, Argentina
| | - Agustin Dietrich
- Hospital Italiano de Buenos Aires, Thoracic Surgery and Lung Transplant, Perón 4190, 1181, Buenos Aires, Argentina.
| | - Matias Nicolas
- Hospital Italiano de Buenos Aires, Thoracic Surgery and Lung Transplant, Perón 4190, 1181, Buenos Aires, Argentina
| | - Alejandro Da Lozzo
- Hospital Italiano de Buenos Aires, Thoracic Surgery and Lung Transplant, Perón 4190, 1181, Buenos Aires, Argentina
| | - Enrique Beveraggi
- Hospital Italiano de Buenos Aires, Thoracic Surgery and Lung Transplant, Perón 4190, 1181, Buenos Aires, Argentina
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5
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Battoo A, Jahan A, Yang Z, Nwogu CE, Yendamuri SS, Dexter EU, Hennon MW, Picone AL, Demmy TL. Thoracoscopic Pneumonectomy. Chest 2014; 146:1300-1309. [DOI: 10.1378/chest.14-0058] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Abstract
Surgery serves an important role in the diagnosis, staging, and definitive management of non-small cell lung cancer (NSCLC). Resection is the primary mode of treatment for stage I and II NSCLC and an important component of the multimodality approach to stage IIIA disease. Standard resections include removal of the lobe involved with tumor and systematic evaluation of ipsilateral hilar and mediastinal lymph nodes. For early stage disease the evolving surgical treatment goals are aimed at decreasing morbidity and mortality through less invasive approaches including video-assisted thoracoscopic surgery and robotic approaches, and potentially decreasing the volume of lung removed for select patients with well-staged small peripheral tumors. For patients with locally advanced disease, ongoing research is focused on appropriately identifying patients who will most benefit from the addition of surgery to a multimodality regime and safely integrating resection with chemotherapy and radiotherapy.
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Affiliation(s)
- Adam Lackey
- Department of Cardiothoracic Surgery, NYU School of Medicine, New York, New York
| | - Jessica S Donington
- Department of Cardiothoracic Surgery, NYU School of Medicine, New York, New York
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7
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Mohiuddin K, Swanson SJ. Maximizing the benefit of minimally invasive surgery. J Surg Oncol 2013; 108:315-9. [DOI: 10.1002/jso.23398] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 07/12/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Kamran Mohiuddin
- Division of Thoracic Surgery; Brigham and Women's Hospital; Boston Massachusetts
| | - Scott J. Swanson
- Division of Thoracic Surgery; Brigham and Women's Hospital; Boston Massachusetts
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8
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Kim HK, Sung HK, Lee HJ, Choi YH. The feasibility of a Two-incision video-assisted thoracoscopic lobectomy. J Cardiothorac Surg 2013; 8:88. [PMID: 23587171 PMCID: PMC3660169 DOI: 10.1186/1749-8090-8-88] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Accepted: 04/12/2013] [Indexed: 11/28/2022] Open
Abstract
Background This study is to evaluate the feasibility and safety of video-assisted thoracoscopic (VATS) lobectomy with two incisions. Methods A total of 73 patients (male 47, female 26; mean age 61.2 ± 12.00 years old) who underwent major pulmonary resection, through VATS, using two incisions were included in this study. The thoracoscopy port was placed at the 7th or the 8th intercostal space in the mid-axillary line, and the working port, 3~5 cm long, at the 5th intercostal space, on the operator’s side. Results The preoperative diagnosis was benign lung disease in 8 patients (11.0%) and malignant lung disease in 65 (89.0%). Two patients (3.1%) needed a third port during surgery due to severe pleural adhesion, and conversion to thoracotomy was needed in 5 (6.8%), due to bleeding at pulmonary arterial branch (n = 3), anthracofibrotic lymph nodes around pulmonary artery (n = 1), and severe pleural adhesion (n = 1). The mean duration of the operation in the 66 patients, completed by a two-incision VATS lobectomy, was 163.4 ± 30.40 minutes. In 56 cases, which were completed by a two-incision VATS lobectomy for primary lung cancer, a total number of dissected lymph nodes per patient were 20.2 ± 11.2. The chest tube was removed on postoperative day 5.4 ± 2.8, and there was no occurrence of major perioperative morbidity and mortality. Conclusions Two-incision VATS lobectomy is applicable in the selected cases, and may obtain similar results with the conventional VATS lobectomy, through a certain period of learning curve.
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Affiliation(s)
- Hyun Koo Kim
- Departments of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, 97 Guro-donggil, Seoul, Guro-gu 152-703, Korea.
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Abstract
Non-small cell lung cancer remains one of the leading causes of cancer-related mortality worldwide. Despite recent advances in molecular characterization and targeted and adjuvant therapies, surgical resection remains the mainstay of curative treatment. Minimally invasive video-assisted thoracic surgery techniques, in particular video-assisted thoracic surgery lobectomy, are being increasingly utilized and championed over traditional thoracotomy approaches in the treatment of localized non-small cell lung cancer for the reported benefits of lower operative morbidity, accelerated postoperative recovery, and oncological equivalence. This article reviews the available literature comparing surgical outcomes of minimally invasive versus traditional open lobectomy with an emphasis on differences in surgical morbidity.
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10
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Video-Assisted Thoracic Surgery Lobectomy for Non-small Cell Lung Cancer in Patients with a Charlson Comorbidity Index Score of Two or More. J Thorac Oncol 2010; 5:56-61. [DOI: 10.1097/jto.0b013e3181c0a5ea] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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11
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Abstract
Minimally invasive thoracic surgery (MITS) has become part of the modern thoracic surgeon's armamentarium. Its applications include diagnostic and therapeutic procedures, and over the past one and a half decades, the scope of MITS has undergone rapid evolution. The role of MITS is well established in the management of pleural and mediastinal conditions, and it is beginning to move beyond diagnostic procedures for lung parenchyma conditions, to gain acceptance as a viable option for primary lung cancer treatment. However MITS poses technical challenges that are quite different from the conventional open surgical procedures. After a brief review of the history of MITS, an overview of the scope of MITS is given. Important examples of diagnostic and therapeutic indications are then discussed, with special emphasis on the potential complications specific to MITS, and their prevention and management.
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Affiliation(s)
- Michael K Y Hsin
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
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Akiba T, Marushima H, Harada J, Kobayashi S, Morikawa T. Importance of preoperative imaging with 64-row three-dimensional multidetector computed tomography for safer video-assisted thoracic surgery in lung cancer. Surg Today 2009; 39:844-7. [PMID: 19784721 DOI: 10.1007/s00595-009-3965-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2007] [Accepted: 03/09/2009] [Indexed: 11/30/2022]
Abstract
PURPOSE Video-assisted thoracic surgery (VATS) has recently been adopted for complicated anatomical lung resections. During these thoracoscopic procedures, surgeons view the operative field on a two-dimensional (2-D) video monitor and cannot palpate the organ directly, thus frequently encountering anatomical difficulties. This study aimed to estimate the usefulness of preoperative three-dimensional (3-D) imaging of thoracic organs. METHODS We compared the preoperative 64-row three-dimensional multidetector computed tomography (3DMDCT) findings of lung cancer-affected thoracic organs to the operative findings. RESULTS In comparison to the operative findings, the branches of pulmonary arteries, veins, and bronchi were well defined in the 3D-MDCT images of 27 patients. CONCLUSION 3D-MDCT imaging is useful for preoperatively understanding the individual thoracic anatomy in lung cancer surgery. This modality can therefore contribute to safer anatomical pulmonary operations, especially in VATS.
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Affiliation(s)
- Tadashi Akiba
- Department of Surgery, Jikei University Kashiwa Hospital, 163-1 Kashiwashita, Kashiwa, Chiba 277-8567, Japan
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Whitson BA, Groth SS, Duval SJ, Swanson SJ, Maddaus MA. Surgery for early-stage non-small cell lung cancer: a systematic review of the video-assisted thoracoscopic surgery versus thoracotomy approaches to lobectomy. Ann Thorac Surg 2009; 86:2008-16; discussion 2016-8. [PMID: 19022040 DOI: 10.1016/j.athoracsur.2008.07.009] [Citation(s) in RCA: 449] [Impact Index Per Article: 29.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2007] [Revised: 06/24/2008] [Accepted: 07/07/2008] [Indexed: 12/24/2022]
Abstract
Video-assisted thoracoscopic surgery (VATS) for lobectomy has been touted to provide superior outcomes, compared with thoracotomy, for patients with early-stage non-small-cell lung cancer (NSCLC). However, supporting data are limited to case series and small observational studies. We hypothesized that a systematic review of the literature would enable a more objective evaluation of the evidence in order to determine the potential superiority of the VATS approach, compared with thoracotomy, in terms of short-term morbidity and long-term survival. To identify relevant articles for inclusion in our analysis, we performed a systematic review of the MEDLINE database. We looked for randomized controlled trials, observational studies, and case series that reported outcomes after VATS or thoracotomy lobectomy for NSCLC. For statistical testing, we used a two-sided approach (alpha = 0.05) under the hypothesis that VATS lobectomy is superior to thoracotomy lobectomy. We screened 17,923 studies. After independent review of the abstracts by 2 reviewers, we included 39 studies (only one randomized controlled trial) in our analysis. In aggregate, these 39 studies involved 3256 thoracotomy and 3114 VATS patients. The characteristics of the two groups were not significantly different. Compared with thoracotomy, VATS lobectomy was associated with shorter chest tube duration, shorter length of hospital stay, and improved survival (at 4 years after resection), all statistically significant. Compared with lobectomy performed by thoracotomy, VATS lobectomy for patients with early-stage NSCLC is appears to favor lower morbidity and improved survival rates.
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Affiliation(s)
- Bryan A Whitson
- Department of Surgery, Division of Thoracic and Foregut Surgery, University of Minnesota, Minneapolis, Minnesota, USA
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Thoracoscopic lobectomy: Introduction of a new technique into a thoracic surgery training program. J Thorac Cardiovasc Surg 2008; 136:376-81. [DOI: 10.1016/j.jtcvs.2008.05.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2007] [Revised: 02/12/2008] [Accepted: 05/05/2008] [Indexed: 11/20/2022]
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16
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Nicastri DG, Wisnivesky JP, Litle VR, Yun J, Chin C, Dembitzer FR, Swanson SJ. Thoracoscopic lobectomy: Report on safety, discharge independence, pain, and chemotherapy tolerance. J Thorac Cardiovasc Surg 2008; 135:642-7. [DOI: 10.1016/j.jtcvs.2007.09.014] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2007] [Revised: 09/10/2007] [Accepted: 09/24/2007] [Indexed: 11/29/2022]
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17
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Schuchert MJ, Luketich JD, Fernando HC. Video-Assisted Thoracic Surgery. Surgery 2008. [DOI: 10.1007/978-0-387-68113-9_74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Lung Neoplasms. Surgery 2008. [DOI: 10.1007/978-0-387-68113-9_72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Gould MK, Fletcher J, Iannettoni MD, Lynch WR, Midthun DE, Naidich DP, Ost DE. Evaluation of patients with pulmonary nodules: when is it lung cancer?: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 2007; 132:108S-130S. [PMID: 17873164 DOI: 10.1378/chest.07-1353] [Citation(s) in RCA: 385] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Pulmonary nodules are spherical radiographic opacities that measure up to 30 mm in diameter. Nodules are extremely common in clinical practice and challenging to manage, especially small, "subcentimeter" nodules. Identification of malignant nodules is important because they represent a potentially curable form of lung cancer. METHODS We developed evidence-based clinical practice guidelines based on a systematic literature review and discussion with a large, multidisciplinary group of clinical experts and other stakeholders. RESULTS We generated a list of 29 recommendations for managing the solitary pulmonary nodule (SPN) that measures at least 8 to 10 mm in diameter; small, subcentimeter nodules that measure < 8 mm to 10 mm in diameter; and multiple nodules when they are detected incidentally during evaluation of the SPN. Recommendations stress the value of risk factor assessment, the utility of imaging tests (especially old films), the need to weigh the risks and benefits of various management strategies (biopsy, surgery, and observation with serial imaging tests), and the importance of eliciting patient preferences. CONCLUSION Patients with pulmonary nodules should be evaluated by estimation of the probability of malignancy, performance of imaging tests to characterize the lesion(s) better, evaluation of the risks associated with various management alternatives, and elicitation of patient preferences for treatment.
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Affiliation(s)
- Michael K Gould
- VA Palo Alto Health Care System, 3801 Miranda Ave (111P), Palo Alto, CA 94304, USA.
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Solaini L, Prusciano F, Bagioni P, di Francesco F, Solaini L, Poddie DB. Video-assisted thoracic surgery (VATS) of the lung. Surg Endosc 2007; 22:298-310. [DOI: 10.1007/s00464-007-9586-0] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2007] [Revised: 05/19/2007] [Accepted: 06/13/2007] [Indexed: 11/29/2022]
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21
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Indications and Developments of Video‐Assisted Thoracic Surgery in the Treatment of Lung Cancer. Oncologist 2007; 12:1205-14. [DOI: 10.1634/theoncologist.12-10-1205] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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22
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Mahtabifard A, DeArmond DT, Fuller CB, McKenna RJ. Video-assisted thoracoscopic surgery lobectomy for stage I lung cancer. Thorac Surg Clin 2007; 17:223-31. [PMID: 17626400 DOI: 10.1016/j.thorsurg.2007.03.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The literature shows that, in the hands of experienced thoracoscopic surgeons, VL is a safe operation that offers patients at least comparable complication and survival rates compared with lobectomy by thoracotomy. VL can be performed safely with proven advantages over conventional thoracotomy for lobectomy: smaller incisions, decreased postoperative pain, decreased LOS, decreased chest tube output and duration, decreased blood loss, better preservation of pulmonary function, and earlier return to normal activities. These results are obtained without sacrificing the oncologic principles of thoracic surgery, and, in fact, the evidence in the literature is mounting that VATS may offer reduced rates of complications and better survival.
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Affiliation(s)
- Ali Mahtabifard
- Section of Thoracic Surgery, Department of Cardiothoracic Surgery, Cedars-Sinai Medical Center, 8635 West Third Street, Suite 975W, Los Angeles, CA 90048, USA
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Onaitis MW, Petersen RP, Balderson SS, Toloza E, Burfeind WR, Harpole DH, D'Amico TA. Thoracoscopic lobectomy is a safe and versatile procedure: experience with 500 consecutive patients. Ann Surg 2006; 244:420-5. [PMID: 16926568 PMCID: PMC1856541 DOI: 10.1097/01.sla.0000234892.79056.63] [Citation(s) in RCA: 299] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Advantages of thoracoscopic lobectomy for early stage non-small cell lung cancer (NSCLC), as compared with lobectomy by conventional thoracotomy, include less postoperative pain and shorter length of hospitalization. The outcomes after thoracoscopic lobectomy in patients with more complex pulmonary conditions are analyzed to determine safety, efficacy, and versatility. METHODS A prospective database of 500 consecutive patients who underwent thoracoscopic lobectomy between June 1999 and January 2006 was queried. Demographic, histopathologic, perioperative, and outcome variables were assessed using standard descriptive statistics and Kaplan-Meier survival analyses. RESULTS Thoracoscopic lobectomy was successfully performed in 492 patients (conversion rate, 1.6%). Pathologic analysis included primary NSCLC in 416 patients (83.2%), centrally located secondary pulmonary malignancy in 37 patients (7.4%), and a variety of benign conditions in 45 patients (9%). Among the 416 patients with NSCLC, pathologic analysis demonstrated stage I in 330 patients (55.3%), stage II in 40 patients (9.6%), and stage III or greater NSCLC in 44 patients (10.6%). The operative and perioperative (30-day) mortality was 0% and 1%, respectively. The overall 2-year survival rate for the entire cohort was 80%, and the 2-year overall survival rates for stage I NSCLC, stage II or greater NSCLC, secondary pulmonary malignancy, and granulomatous disease patients were 85%, 77%, 73%, and 89%, respectively. CONCLUSIONS Thoracoscopic lobectomy is applicable to a spectrum of malignant and benign pulmonary disease and is associated with a low perioperative morbidity and mortality rate. Survival rates are comparable to those for lobectomy with thoracotomy.
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Affiliation(s)
- Mark W Onaitis
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
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Ng T, Ryder BA. Evolution to video-assisted thoracic surgery lobectomy after training: initial results of the first 30 patients. J Am Coll Surg 2006; 203:551-7. [PMID: 17000401 DOI: 10.1016/j.jamcollsurg.2006.06.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2006] [Revised: 06/03/2006] [Accepted: 06/05/2006] [Indexed: 11/26/2022]
Abstract
BACKGROUND In early-stage lung cancer, evidence is accumulating for the benefits of lobectomy by video-assisted thoracic surgery (VATS) over open lobectomy. Few thoracic training programs offer sufficient experience in this technically demanding procedure. This article describes the evolution of a new graduate's practice from open thoracotomy to VATS lobectomy. STUDY DESIGN Our model involves a transition in technique from posterolateral thoracotomy to muscle-sparing thoracotomy and, ultimately, to VATS lobectomy. This approach was evaluated by examining outcomes of open thoracotomy patients before VATS lobectomy and outcomes of the initial 30 VATS patients. Data were collected prospectively. RESULTS Before undertaking VATS lobectomy, 94 major pulmonary resections were performed by thoracotomy. Mortality was 1.2% for lobectomy and 0% for pneumonectomy. Use of the muscle-sparing thoracotomy increased from 17% of patients in the first half to 70% in the latter half of this group. For the first 30 VATS lobectomy patients, the mean operative time was 168 minutes. Median blood loss was 200 mL. Conversion rate to open thoracotomy was 13.3%. Mortality was 3.3% and morbidity was 26.7%. After short-term followup (mean followup 16 months), overall survival for stage I lung cancer was 96%. CONCLUSIONS With our approach, new graduates of thoracic surgery programs can safely transition to VATS lobectomy. Gaining experience with the lateral muscle-sparing thoracotomy is an important step in the transition, as it offers similar operative exposure. Longterm disease-free and overall survival data are needed to evaluate our oncologic efficacy with this approach.
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Affiliation(s)
- Thomas Ng
- Department of Surgery, Brown Medical School, 2 Dudley Street, Providence, RI 02905, USA.
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McKenna RJ, Houck W, Fuller CB. Video-assisted thoracic surgery lobectomy: experience with 1,100 cases. Ann Thorac Surg 2006; 81:421-5; discussion 425-6. [PMID: 16427825 DOI: 10.1016/j.athoracsur.2005.07.078] [Citation(s) in RCA: 659] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2005] [Revised: 07/20/2005] [Accepted: 07/25/2005] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although many video-assisted thoracic surgery (VATS) lobectomies have been performed over the 12 years since the first VATS lobectomy, controversies about the procedure remain regarding the safety and associated morbidity and mortality of that procedure. This series is reviewed to assess these issues. METHODS Between 1992 and 2004, we performed 1,100 VATS lobectomies in 595 women (54.1%) and 505 men (45.9%), with a mean age of 71.2 years. Diagnoses were as follows: benign disease (53), pulmonary metastases (27), lymphoma (5), and lung cancer (1,015). Of the primary lung cancers, 641 (63.1%) were adenocarcinoma. With visualization on a monitor, anatomic hilar dissection and lymph node sampling or dissection were performed, primarily through a 5-cm incision without spreading the ribs. RESULTS There were 9 deaths (0.8%), and none was intraoperative or due to bleeding; 932 patients had no postoperative complications (84.7%). Blood transfusion was required in 45 of 1,100 patients (4.1%). Length of stay was median 3 days (mean, 4.78). One hundred eighty patients (20%) were discharged on postoperative day 1 or 2. Conversion to a thoracotomy occurred in 28 patients (2.5%). Recurrence developed in the incisions in 5 patients (0.57%). In 2003, 89% of 224 lobectomies were performed with VATS. CONCLUSIONS VATS lobectomy with anatomic dissection can be performed with low morbidity and mortality rates. The risk of intraoperative bleeding or recurrence in an incision seems minimal.
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Abstract
Although modern techniques in anesthesia and surgery have reduced morbidity and mortality for pulmonary resection, some physicians still consider advanced age a contraindication to resection of lung cancer. We examined our experience with VATS lobectomy in octogenarians at Cedars-Sinai Medical Center over 12 years (1992–2004). There were 159 patients. Mean age was 83 years (range, 80–94 years) consisting of 61 males (38%) and 96 females (62%). Operations included 153 lobectomies (96%), 3 bilobectomies (2%), and 3 pneumonectomies (2%). Two operations were converted to thoracotomy (1%), one due to bleeding, and one due to poor visualization. Median hospital stay was 4.00 ± 6.39 days. One hundred thirty-one patients (82%) had no complications. The most common complication was arrhythmias occurring in 8/159 (5%) patients. There were three perioperative deaths (1.8%). Pathology revealed 104 adenocarcinomas (65%), 25 squamous cell carcinomas (16%), 5 adeno-squamous carcinomas (3%), 7 bronchoalveolar carcinomas (4%), 7 large cell carcinomas (4%), 4 carcinoid tumors (3%), 4 non-small cell lung cancer (NSCLC) (3%), 1 mucoepidermoid carcinoma (<1%), 1 lymphoma (<1%), and 1 pulmonary metastasis (<1%). Median follow-up was 29 months. The results of this series show that age alone is not a contraindication to the surgical treatment of lung cancer.
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Affiliation(s)
- Carie L. Mcvay
- From Cedars-Sinai Medical Center, Los Angeles, California
| | - Allan Pickens
- From Cedars-Sinai Medical Center, Los Angeles, California
| | - Clark Fuller
- From Cedars-Sinai Medical Center, Los Angeles, California
| | - Ward Houck
- From Cedars-Sinai Medical Center, Los Angeles, California
| | - Robert Mckenna
- From Cedars-Sinai Medical Center, Los Angeles, California
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Abstract
PURPOSE OF REVIEW The momentum for minimally invasive thoracic surgery has been growing. Thousands of video-assisted thoracoscopic surgery lobectomies have been performed since the first video-assisted thoracoscopic surgery lobectomy was performed in 1992, but currently most lobectomies are still performed via a thoracotomy. Although most lobectomies could be performed with video-assisted thoracoscopic surgery, less than 5% are currently performed that way. Compared with a thoracotomy, video-assisted thoracoscopic surgery offers patients a shorter length of stay, less pain, and a quicker recovery, without compromising the adequacy of the operation. The purpose of this review is to identify the current uses for minimally invasive procedures in thoracic surgery and to present the current data regarding these procedures. RECENT FINDINGS Complete anatomic resections and node dissections are routinely being performed at several centers internationally. The median length of stay after video-assisted thoracoscopic surgery lobectomy is 3 days, and 84.7% of patients had no complications. Studies comparing video-assisted thoracoscopic surgery and thoracotomy suggest that minimally invasive surgery causes less pain, has a smaller impact on postoperative pulmonary function, and provides a quicker return to regular activity, with at least comparable survival for cancer patients. SUMMARY Current data suggest that, compared with a thoracotomy, video-assisted thoracoscopic surgery has advantages for anatomic pulmonary resections.
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Affiliation(s)
- Robert J McKenna
- Center for Chest Diseases, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
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Hosaka N, Kameko M, Nishimura H, Hosaka S. Prevalence of tuberculosis in small pulmonary nodules obtained by video-assisted thoracoscopic surgery. Respir Med 2005; 100:238-43. [PMID: 15964180 DOI: 10.1016/j.rmed.2005.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2005] [Accepted: 05/03/2005] [Indexed: 10/25/2022]
Abstract
The prevalence of tuberculosis in small solitary lesions of the lung obtained by video-assisted thoracoscopic surgery (VATS) is still unclear. Of 103 lung lesions resected by VATS in 98 patients (47 men, 51 women), 19 were identified macroscopically as inflammatory changes, 78 were neoplastic, and 6 were undefined. Presumptive diagnosis based on microscopic analysis of fresh specimen smears treated with Papanicolaou stain was performed in 19 lesions. Of these, 11 lesions had epithelioid cells, granulomas with caseous necrosis and Langerhans-type giant cells. The 6 undefined lesions were non-inflammatory benign changes. Isolation and identification of tuberculosis were based on microscopic findings of fresh material smears and sections of fixed specimens stained with Ziehl-Neelsen's dye, cultivation using egg-based Ogawa medium, and in situ hybridization between polymerase chain reaction (PCR) products of each of the 11 lesions and specific DNA sequences for Mycobacterium tuberculosis, M. avium, and M. intracellulare. Of these 11 lesions, M. tuberculosis was confirmed in one (0.96%) by PCR and M. avium was confirmed in four by culture and PCR. Of the 78 malignant lesions, final pathologies were primary lung cancer (n=59, 70.2%) and pulmonary metastatic cancer (n=19, 22.6%). The most frequent primary malignant cancer was adenocarcinoma, which was found in 19 men and 28 women in the present study. Eight lesions in 8 men were squamous cell carcinomas. The results of the present study suggested that even though the prevalence of lung tuberculosis is low, attention should be paid to the presence of M. tuberculosis in specimens obtained by VATS.
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Affiliation(s)
- Noriko Hosaka
- Division of Clinical Pathology, Nagano Municipal Hospital, Nagano, Japan
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Abstract
UNLABELLED VATS lobectomies have now been performed for 12 years since the first VATS lobectomy. Although some controversies remain regarding the safety, morbidity, and mortality of that procedure, the procedure is clearly gaining momentum. The purpose of this paper is to review the current literature about the procedure. MATERIALS AND METHODS Between 1992-2004, we performed 1100 VATS lobectomies in 595 (54.1%) women and 505 men (45.9%), mean age=71.2 years. Diagnoses were as follows: benign disease (53), pulmonary met (27), Lymphoma (5) and lung cancer (1015). 641 (63.1%) of the primary lung cancers were adenocarcinoma. With visualization on a monitor, anatomic hilar dissection and lymph node sampling or dissection were performed, primarily through a 5 cm incision without spreading the ribs. RESULTS There were 9 deaths (0.8%)-none were intra-operative or due to bleeding. 932 patients had no postoperative complications (84.7%). Blood transfusion was required in 45/1100 (4.1%). Length of stay was median 3 days, mean 4.78 days. 180 patients were discharged on POD 1 or 2 (20%). Conversion to a thoracotomy occurred in 28 patients (2.5%). 5 patients developed recurrence in the incisions (0.57%). In 2003, 89% of 224 lobectomies were performed with VATS. CONCLUSIONS VATS lobectomy with anatomic dissection can be performed with low morbidity and mortality. The risk of intraoperative bleeding or recurrence in an incision seems minimal.
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Affiliation(s)
- Robert J McKenna
- Department of Cardiothoracic Surgery, Cedars-Sinai Health System, Los Angeles, California 90048, USA.
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Roviaro G, Varoli F, Vergani C, Maciocco M, Nucca O, Pagano C. Video-assisted thoracoscopic major pulmonary resections. Surg Endosc 2004. [DOI: 10.1007/bf02637119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Roviaro G, Varoli F, Vergani C, Maciocco M, Nucca O, Pagano C. Video-assisted thoracoscopic major pulmonary resections: technical aspects, personal series of 259 patients, and review of the literature. Surg Endosc 2004; 18:1551-8. [PMID: 15931484 DOI: 10.1007/s00464-004-6006-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2004] [Accepted: 07/08/2004] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although more than 10 years have passed since the first video-assisted thoracoscopic lobectomies, these procedures have not gained widespread acceptance. We discuss the technical aspects and major problems associated with these operations, focusing on their present status and future perspectives. The results of our clinical series are presented and the relevant literature is reviewed. METHODS From October 1991 to June 2003, 344 patients were submitted to surgery for an intended video major pulmonary resection. RESULTS Of the 344 patients, seven (2.0%) were deemed inoperable at video exploration; 78 (23.1%) required conversion, either for technical reasons (n = 3), anatomical problems (n = 49), oncological conditions (n = 20), or intraoperative complications (n = 6). We carried out 253 video-assisted lobectomies and six pneumonectomies (209 for primary lung tumor, 43 for benign disease, and seven for metastases). There were no intraoperative deaths. Two patients died postoperatively. Complications occurred in 20 patients (7.7%). Global survival at 3 and 5 years was 83.24% (+/-6.9) and 68.87% (+/-9.7), respectively. Patients with T1 N0 cancer had a better survival rate at 3 and 5 years (87.13 +/- 8.3% and 75.12 +/- 12.2%) than those with T2 N0 cancer (78.49 +/- 11.2% and 61.2 +/- 15%). CONCLUSIONS Based on our experience and a review of the literature, we conclude that video-assisted thoracoscopic lobectomies offer less postoperative pain, a more rapid recovery, and better cosmetic results than their conventional counterpart. The results at 3- and 5-year follow-up for cancer are attractive. However, because no randomized study has yet proved these benefits definitively, further studies are still needed.
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Affiliation(s)
- G Roviaro
- Department of Surgical Sciences, University of Milan, Ospedale Maggiore Policlinico, 20122 Milan, Italy.
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Roviaro G, Varoli F, Vergani C, Nucca O, Maciocco M, Grignani F. Long-term Survival After Videothoracoscopic Lobectomy for Stage I Lung Cancer. Chest 2004; 126:725-32. [PMID: 15364748 DOI: 10.1378/chest.126.3.725] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES The aim of this study was to evaluate our personal experience and survival curves after video-assisted thoracic surgery (VATS) lobectomies for stage I lung cancer, in comparison with the results reported in existing literature. DESIGN Retrospective analysis of our experience and an overview of literature. SETTING Department of Surgery, San Giuseppe Hospital, University of Milan. PATIENTS From October 1991 to December 2001, of 257 patients with clinical stage I lung cancer, 193 patients underwent VATS lobectomy, 7 patients were declared inoperable at thoracoscopic exploration, and 57 patients were converted (18 patients for oncologic reasons and 39 patients for technical reasons). RESULTS We observed no intraoperative mortality and no recurrence. Survival data were analyzed with the Kaplan-Meier method along with a log-rank test for statistical significance. The global survival rates at 3 years and 5 years were 77.7% and 63.64%, respectively. T1N0 patients had a better survival curve at 3 years and 5 years (83.50% and 70.21%, respectively) compared to T2N0 patients (71.13% and 56.12%). Patients < 70 years of age had better 3-year and 5-year survival rates (82.37% and 73.32%, respectively) than those > 70 years of age (57.49% and 37.09%). This difference was statistically significant (p < 0.01). CONCLUSIONS Our results after the VATS approach match the "best" results reported in literature following conventional surgery. Minimally invasive surgery seems to imply reduced tissue damage and decreased impairment of immunologic function. VATS lobectomy permits radical oncology as accurately as lobectomy by thoracotomy, provided that long-established standards are respected. In spite of technical difficulties, it could therefore become a valid alternative in treating stage I lung cancer.
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MESH Headings
- Adolescent
- Adult
- Aged
- Carcinoma, Bronchogenic/mortality
- Carcinoma, Bronchogenic/pathology
- Carcinoma, Bronchogenic/surgery
- Carcinoma, Non-Small-Cell Lung/mortality
- Carcinoma, Non-Small-Cell Lung/pathology
- Carcinoma, Non-Small-Cell Lung/surgery
- Carcinoma, Small Cell/mortality
- Carcinoma, Small Cell/pathology
- Carcinoma, Small Cell/surgery
- Child
- Female
- Follow-Up Studies
- Humans
- Lung/pathology
- Lung Neoplasms/mortality
- Lung Neoplasms/pathology
- Lung Neoplasms/surgery
- Lymph Node Excision
- Lymph Nodes/pathology
- Male
- Middle Aged
- Neoplasm Staging
- Postoperative Complications/mortality
- Postoperative Complications/pathology
- Survival Analysis
- Survivors/statistics & numerical data
- Thoracic Surgery, Video-Assisted
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Affiliation(s)
- Giancarlo Roviaro
- University of Milan, Ospedale Maggiore Policlinico IRCCS, Milan, Pad. Zonda, Via Francesco Sforza, 35, 20122 Milan, Italy.
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Ohtsuka T, Nomori H, Horio H, Naruke T, Suemasu K. Is Major Pulmonary Resection by Video-Assisted Thoracic Surgery an Adequate Procedure in Clinical Stage I Lung Cancer? Chest 2004; 125:1742-6. [PMID: 15136385 DOI: 10.1378/chest.125.5.1742] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE Although several studies have shown that video-assisted thoracic surgery (VATS) for major pulmonary resection is less invasive than open thoracotomy, VATS for lung cancer has been performed in only a limited number of institutions. We aimed to review our experience of VATS for major pulmonary resections, and to determine its safety and adequacy in stage I lung cancer. METHODS Between August 1999 and March 2003, we performed major pulmonary resection by VATS in 106 patients with lung cancer and preoperatively determined clinical stage I disease. We evaluated the number of procedures converted to open thoracotomy and the reasons for conversion, the intraoperative blood loss, interval between surgery and chest tube removal, length of postoperative hospital stay, postoperative complications, mortality rate, prognoses, and patterns of recurrence. RESULTS We successfully performed VATS in 95 patients, whereas in another 11 patients (10%) conversion to open thoracotomy was required. The operative procedures were lobectomy in 86 patients, segmentectomy in 8 patients, and bilobectomy in 1 patient. In 95 patients who underwent VATS, postoperative complications developed in 9 patients (9%), and 1 patient (1%) died from pneumonia. In the 86 patients without complications, the mean postoperative hospital stay was 7.6 days (range, 4 to 15 days). In a mean follow-up period of 25 months (range, 6 to 48 months) in patients with non-small cell lung cancer (NSCLC), including the one perioperative death, the 3-year survival rate was 93% in 82 patients with clinical stage I disease, and 97% in 68 patients with pathologic stage I disease. The 3-year disease-free survival rate was 79% in patients with clinical stage I disease, and 89% in patients with pathologic stage I disease. Local recurrence was observed in six patients (6%): recurrence in mediastinal lymph nodes in five patients, and in the bronchial stump in one patient. CONCLUSIONS Major pulmonary resection by VATS is acceptable in view of its low perioperative mortality and morbidity, and is an adequate procedure for the achievement of local control and good prognosis in patients with clinical stage I NSCLC.
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Affiliation(s)
- Takashi Ohtsuka
- Department of Thoracic Surgery, Saiseikai Central Hospital, Tokyo, Japan.
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Haraguchi S, Koizumi K, Hatori N, Hioki M, Yamashita K, Akiyama H, Hirata T, Hirai K, Mikami I, Kubokura H, Tanaka S. Postoperative Respiratory Complications of Video-assisted Thoracic Surgery for Lung Cancer. J NIPPON MED SCH 2004; 71:30-4. [PMID: 15129593 DOI: 10.1272/jnms.71.30] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE We analyzed the risk factors predisposing patients to develop postoperative respiratory complications (PRCs) in VATS lobectomy and segmentectomy for lung cancer, retrospectively. METHODS Both univariate and multivariate analyses of PRCs were performed in seventy-five patients who had undergone VATS lobectomy and segmentectomy for lung cancer from November 1994 to December 2000. RESULTS Univariate analysis of the development of PRCs revealed that the significant risk factors were age, ppo%VC, ppo%FEV, ppoFEV, poor pulmonary function, and duration of surgery. Multivariate logistic regression test in regard to the development of PRCs revealed that duration of surgery was the most significant risk factor. On the basis of the receiver operator characteristic analysis, duration of surgery more than 297 min had a sensitivity of 70% and a specificity of 66% for the development of PRCs. CONCLUSIONS The duration of surgery should be less than five hours not to lose advantages of VATS lobectomy and segmentectomy. Therefore, if the duration of surgery is more than five hours for any reasons, conversion to limited thoracotomy or muscle-sparing methods is recommended.
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Affiliation(s)
- Shuji Haraguchi
- Department of Surgery, Nippon Medical School Second Hospital, 1-396 Kosugi-cho, Nakahara-ku, Kawasaki-shi, Kanagawa 211-8533, Japan.
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Abstract
OBJECTIVE The objective of this study was to confirm the safety and feasibility of video-assisted thoracic surgery (VATS) for primary lung cancer and to compare prognoses with that of conventional procedures, and then to examine whether VATS would supplant a conventional thoracotomy for stage I lung cancer. METHODS From September 1995 through March 2002, 144 patients with primary lung cancer, included 118 patients with postoperative stage I, underwent VATS lobectomy. We reviewed the previous cases whether they could be candidates for VATS lobectomy according to present indications. 166 cases were supposed to be candidates for VATS, and 121 cases of postoperative stage I disease were recruited into the "conventional thoracotomy" group. RESULTS There was no mortality or major complication except one case, and mean follow-up was 31.8 months in VATS. The number of removed lymph nodes was not significantly less than the number by conventional thoracotomy (p=0.061). Five-year survival for patients with pathological stage IA adenocarcinoma was 92.4% (n=66) in VATS and 86.9% (n=50) in conventional thoracotomy, and a statistical significance could not be recognized (p=0.980). The length of hospital stay was significantly short in VATS lobectomy (p<0.0001). CONCLUSIONS VATS lobectomy for stage I lung cancer can be performed safely with minimal morbidity, satisfying survival comparable with that of lobectomy through conventional thoracotomy. VATS approach is a feasible surgical technique for patients with stage I lung cancer.
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Affiliation(s)
- Akitoshi Tatsumi
- Department of General Thoracic Surgery, Kochi Municipal Hospital, Kochi, Japan
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Halstead JC, Screaton N, Ritchie AJ. The surgical treatment of bronchial carcinoma. HOSPITAL MEDICINE (LONDON, ENGLAND : 1998) 2003; 64:136-43. [PMID: 12669479 DOI: 10.12968/hosp.2003.64.3.1795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article considers the current place of surgery in the treatment of bronchial carcinoma. Aspects of the diagnosis of this condition will be covered, but the main focus falls on the surgical procedures, their complications and the outlook for these patients according to tumour stage.
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Affiliation(s)
- James C Halstead
- Department of Thoracic Surgery, Papworth Hospital, Cambridge CB3 8RE
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Watanabe SI, Arai K, Watanabe T, Koda W, Urayama H. Use of three-dimensional computed tomographic angiography of pulmonary vessels for lung resections. Ann Thorac Surg 2003; 75:388-92; discussion 392. [PMID: 12607645 DOI: 10.1016/s0003-4975(02)04375-8] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Identification and appropriate treatment of the pulmonary artery (PA) is a key to successful anatomic resection of the lung. Preoperative identification of branching pattern of the PA seems to make pulmonary resection easier and safer especially when there is severe adhesion or incomplete fissure between the lobes. With the development of the multidetector row spiral computed tomography (MDCT), three-dimensional (3D) CT angiography can be obtained easily and can provide very useful information about various organs. We studied the usefulness of 3D-CT pulmonary angiography (3D-CTPA) in evaluating the PA branching pattern before anatomic pulmonary resection. METHODS Fourteen patients with primary lung cancer undergoing anatomic pulmonary resections were the subjects of this study. The 3D-CTPA images were obtained using MDCT. The obtained images of the PA branching pattern were compared with intraoperative findings in each case at the time of thoracotomy. RESULTS MDCT scanning required approximately 15 seconds per patient during a single respiratory pause and the 3D images were processed within 10 minutes after scannning. According to intraoperative findings, 98% (84 of 86) of PA branches were revealed to be successfully identified on preoperative 3D-CTPA. Two missed branches on 3D-CTPA were small vessels, which were less than 1.5 mm in actual diameter. Pulmonary vessels were clearly identified even when contrast medium was not administered intravenously. CONCLUSIONS Obtaining 3D-CTPA using MDCT is noninvasive yet it provides precise preoperative information regarding pulmonary vessels. This technique is a far less invasive and an easier investigation than conventional pulmonary angiography. The 3D-CTPA navigation may have the potential to increase the safety of surgical procedure and to reduce surgical morbidity in anatomic lung resection.
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Affiliation(s)
- Shun-ichi Watanabe
- Department of Thoracic and Vascular Surgery, Kurobe City Hospital, Kurobe, Japan.
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Abstract
The application of video-assisted thoracoscopic surgery (VATS) in major pulmonary resections has remained infrequent, despite earlier demonstration of its technical feasibility. The early postoperative benefits of this approach to patients are now well documented. The intermediate to long-term clinical results of VATS major resections for primary cancer are now available and appear extremely encouraging. There are few, detailed descriptions of this technique in the literature. This article reviews the current status of VATS major resection with emphasis on its controversies, techniques, and results.
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Affiliation(s)
- Anthony P C Yim
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, China.
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Roviaro GC, Varoli F, Vergani C, Maciocco M. State of the art in thoracospic surgery: a personal experience of 2000 videothoracoscopic procedures and an overview of the literature. Surg Endosc 2002; 16:881-92. [PMID: 12163949 DOI: 10.1007/s00464-001-8153-3] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2001] [Accepted: 05/16/2001] [Indexed: 11/29/2022]
Abstract
BACKGROUND Herein we compare our personal experience with a series of > 2000 videothoracoscopic procedures with those reported in the literature to identify the procedures now accepted as the gold standard, those still regarded as investigational, and those considered unacceptable. METHODS Between June 1991 and December 2000, we performed 2068 videothoracoscopic procedures, including lung cancer staging (n = 910), wedge resections (n = 261), lobectomies (n = 221), pneumonectomies (n = 6), the diagnosis and treatment of pleural diseases (n = 200), the treatment of pneumothorax (n = 170), giant bullae (n = 57), lung volume reduction surgery (LVRS) for emphysema (n = 41), the diagnosis and treatment of mediastinal diseases (n = 133), the treatment of esophageal diseases (n = 39), and 30 other miscellaneous procedures. RESULTS A review of the literature indicates that videothoracoscopy is usually considered the preferred approach for the treatment of spontaneous pneumothorax, the diagnosis of indeterminate pleural effusions, the treatment of malignant pleural effusions, sympathectomy, and the diagnosis and treatment of benign esophageal or mediastinal diseases. The videoendoscopic approach to LVRS for emphysema is still under evaluation. Videothoracoscopic wedge resections for the diagnosis of indeterminate nodules and the treatment of primary lung cancer, metastases, and other malignancies are still controversial due to oncologic concerns. Videoendoscopic major pulmonary resections are usually considered investigational or even unacceptable due to oncologic concerns, technical difficulties, and the risk of complications. CONCLUSIONS Although we generally agree with the foregoing recommendations, we consider videoendoscopy the best approach for LVRS and particularly useful for the staging of lung cancer, where we always perform it as the first step of the operation. We widely perform videoendoscopic major pulmonary resections, but we believe that these procedures should only be used in strictly selected cases and at specialized centers.
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Affiliation(s)
- G C Roviaro
- Department of Surgery, S. Giuseppe Hospital Fbf, A.Fa. R., University of Milan, 12 via San Vittore, 20123 Milan, Italy.
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40
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Abstract
VATS is a relatively new technology that has become the standard of care for basic procedures such as drainage of pleural effusion and blebectomy. VATS anatomic lung resection is more controversial. Published studies demonstrate several advantages of VATS over a standard posterolateral thoracotomy. A minimally invasive approach causes less inflammatory reaction. Acute and chronic pain are diminished. As a result, the length of hospitalization is shorter. Early and late shoulder dysfunction is less and return to work time is shorter. Taken together, these factors suggest a better overall outcome using a VATS approach. From an oncologic standpoint, lymph node dissection can be accomplished and locoregional recurrence is low. The validity of VATS for lung cancer will be determined by long-term data. A phase III national (intergroup) protocol is being drafted and will help to answer these questions.
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Affiliation(s)
- Scott J Swanson
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA.
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Sagawa M, Sato M, Sakurada A, Matsumura Y, Endo C, Handa M, Kondo T. A prospective trial of systematic nodal dissection for lung cancer by video-assisted thoracic surgery: can it be perfect? Ann Thorac Surg 2002; 73:900-4. [PMID: 11899198 DOI: 10.1016/s0003-4975(01)03409-9] [Citation(s) in RCA: 139] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND There have been no reports evaluating the completeness of systematic nodal dissection with video-assisted thoracic surgery (VATS). In order to elucidate the completeness of the dissection, we have conducted a prospective trial with patients having primary lung cancer. METHODS Patients with clinical stage I lung cancer were the candidates for this study. Thoracotomy was performed with a small skin incision of 7 cm to 8 cm in length. Through these small wounds and two trocars, pulmonary resection was performed and then hilar and mediastinal lymph nodes were dissected. After that, a standard thoracotomy was carried out by another surgeon to complete systematic nodal dissection. RESULTS Video-assisted thoracic surgery lobectomy with lymph node dissection was accomplished in 17 right lung cancer patients and 12 left lung cancer patients. On the right side, the average numbers of resected lymph nodes by VATS and remnant lymph nodes were 40.3 and 1.2, respectively. The average weights of dissected tissues by VATS and remnant tissues were 10.0 g and 0.2 g, respectively. On the left side, there were 37.1 and 1.2 lymph nodes and 8.3 g and 0.2 g of weight of dissected tissues. No nodal involvement was observed in the remnant lymph nodes. CONCLUSIONS The lymph node dissection with VATS was technically feasible and the remnant ("missed" by VATS) lymph nodes and tissues were 2% to 3%, which seems acceptable for clinical stage I lung cancer.
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Affiliation(s)
- Motoyasu Sagawa
- Department of Thoracic Surgery, Institute of Development Aging and Cancer, Tohoku University, Sendai, Japan.
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Kaseda S, Aoki T, Hangai N, Shimizu K. Pulmonary function and prognosis: VATS versus thoracotomy: Reply. Ann Thorac Surg 2001. [DOI: 10.1016/s0003-4975(01)02573-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kaseda S, Aoki T, Hangai N, Shimizu K, Kiguchi H. One hundred consecutive treatments with holmium: YAG laser for pulmonary bullae: especially in conjunction with gelatin-resorcinol formaldehyde-glutaraldehyde glue adhesion. Lasers Surg Med 2001; 28:255-8. [PMID: 11295761 DOI: 10.1002/lsm.1047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVE We have widely used a Ho:YAG laser to treat bullae thoracoscopically. STUDY DESIGN/MATERIALS AND METHODS Bullae with broad necks were treated with a Ho:YAG laser thoracoscopically. Because one patient relapsed after application of fibrin glue in the early period, a DEXON (polyglycolic acid) mesh patch soaked in fibrin glue was used through a 2-cm opening in the subsequent cases. Lastly, gelatin-resorcinol formaldehyde-glutaraldehyde (GRFG) glue was applied through a 5-mm opening instead of a DEXON mesh after coagulation. RESULTS In the 38 patients patched with DEXON mesh soaked in fibrin glue and 56 patched with GRFG glue after coagulation, none relapsed. CONCLUSION Combined uses of fibrin glue plus DEXON mesh or GRFG glue were effective when bullae were treated with the Ho:YAG laser. However, the wound was smaller and more cosmetic in the GRFG glue group than in the DEXON mesh plus fibrin glue group.
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Affiliation(s)
- S Kaseda
- Department of Thoracic Surgery, Saiseikai Kanagawa-ken Hospital, Yokohama 221-8601, Japan.
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Kaseda S, Aoki T, Hangai N, Shimizu K. Better pulmonary function and prognosis with video-assisted thoracic surgery than with thoracotomy. Ann Thorac Surg 2000; 70:1644-6. [PMID: 11093502 DOI: 10.1016/s0003-4975(00)01909-3] [Citation(s) in RCA: 254] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Data regarding pulmonary function and prognosis after video-assisted thoracic surgery lobectomy are limited. METHODS From September 1992 to April 2000, 204 video-assisted thoracic surgery lobectomies were performed, and their preoperative and postoperative pulmonary function test results and prognoses were evaluated. RESULTS The postoperative to preoperative ratio of pulmonary function tests (vital capacity and forced expiratory volume in 1 s) were better in video-assisted thoracic surgery lobectomy than in open thoracotomy (p < 0.0001). Furthermore, the 5-year survival rate of pathologic stage I lung cancers after video-assisted thoracic surgery was 97.0%, whereas that after open thoracotomy was 78.5% (p = 0.0173; Mantel-Cox). CONCLUSIONS Pulmonary function and prognosis were far better after video-assisted thoracic surgery lobectomy than after open thoracotomy.
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Affiliation(s)
- S Kaseda
- Department of Thoracic Surgery, Saiseikai Kanagawa-ken Hospital, Yokohama, Japan.
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Abstract
VATS wedge resection and lobectomy can be performed with reasonable morbidity and mortality. A cautious approach is appropriate for VATS lobectomy with proper patient selection, and the completeness of the cancer surgery should not be compromised. Only surgeons with the VATS skills that allow them to perform complex procedures should perform the procedure.
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Affiliation(s)
- R J McKenna
- Section of Thoracic Surgery, Cedars Sinai Medical Center, Los Angeles, Californa 90048, USA
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Alpard SK, Duarte AG, Bidani A, Zwischenberger JB. Pathogenesis and management of respiratory insufficiency following pulmonary resection. SEMINARS IN SURGICAL ONCOLOGY 2000; 18:183-96. [PMID: 10657920 DOI: 10.1002/(sici)1098-2388(200003)18:2<183::aid-ssu12>3.0.co;2-c] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The underlying principle of the surgical treatment of non-small-cell lung cancer (NSCLC) is complete removal of the local/regional disease within the thorax. Pulmonary resection should be as conservative as possible without compromising the adequacy of tumor removal. A multitude of factors influence the incidence and severity of complications following pulmonary resection including the pre-operative physical and psychological status of the patient, the pathologic process requiring resection, the physiologic impact of the procedure, and the addition of pre-operative or postoperative adjuvant therapy. The insidious onset of interstitial changes on chest X-ray (CXR) 1 to 2 days after pulmonary resection forewarns of respiratory distress; however, the pathophysiology of adult respiratory distress syndrome (ARDS) with progression to respiratory failure requiring mechanical ventilation and advanced critical care often unfolds. Management of patients with severe respiratory failure remains primarily supportive. "Good critical care" is the mainstay of therapy: this includes gentle mechanical ventilation to avoid ventilator-induced barotrauma and over-extension of remaining functional alveoli, diuresis, infection identification and management, and nutritional support. New therapeutic strategies that may impact on outcomes in the adult population include pressure-limited ventilation (permissive hypercapnia), inverse ratio ventilation, high-frequency jet ventilation, high-frequency oscillatory ventilation, intratracheal pulmonary ventilation, and prone position ventilation. In addition, alternative therapies such as partial liquid ventilation, inhaled nitric oxide, and extracorporeal techniques including extracorporeal membrane oxygenation (ECMO), extracorporeal carbon dioxide removal (ECCO(2)R), intravascular oxygenation (IVOX), and arteriovenous carbon dioxide removal (AVCO(2)R), provide additional modalities. A component of some or all of these strategies is finding a role in clinical practice.
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Affiliation(s)
- S K Alpard
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, Texas 77555-0528, USA
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Kaseda S, Aoki T, Yamamoto S, Nagashima A, Ukai I, Satoh K. Successful simultaneously stapled lobectomy for a stab wound to the lung with massive hemorrhage: case report. THE JOURNAL OF TRAUMA 1999; 46:1140-1. [PMID: 10372643 DOI: 10.1097/00005373-199906000-00036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- S Kaseda
- Department of Thoracic Surgery, Saiseikai Kanagawa-ken Hospital, Yokohama, Japan.
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