Simultaneous bilateral thoracoscopic lobectomy for synchronous bilateral multiple primary lung cancer-single center experience

Multidisciplinary expert consensus on diagnosis and treatment of multiple lung cancers

The rising incidence of multiple lung cancers (MLCs), encompassing multiple primary lung cancers (MPLCs) and intrapulmonary metastasis (IPM), poses two significant clinical challenges. First, distinguishing between MPLC and IPM remains difficult due to insufficiently accurate criteria and ambiguous integration of genetic testing. Second, standardized therapeutic protocols are still lacking. To address these issues, the Lung Cancer Expert Committee of China Anti-Cancer Association (CACA) assembled a multidisciplinary expert panel spanning thoracic surgery, pulmonary medicine, oncology, radiology, and pathology. Following a comprehensive literature review ending on October 23, 2024, the panel engaged in iterative discussions and conducted two rounds of expert voting, culminating in 25 evidence-based recommendations across five key domains: epidemiology, pre-treatment evaluation, definitive diagnostics, surgical treatment, and non-surgical treatment. This consensus provides clinicians with practical guidance to enhance diagnostic precision and therapeutic decision-making in MLC management while highlighting unmet needs to inform future guideline development.

One-stage versus two-stage video-assisted thoracic surgery for synchronous bilateral pulmonary nodules: protocol for a single center, non-randomized clinical trial (OTVATS-1)

BACKGROUND

Previous retrospective studies demonstrated both one-stage and two-stage video-assisted thoracic surgery (VATS) for bilateral pulmonary nodules were safe and feasible in selected patients. However, prospective data is still lacking. The purpose of this trial is to prospectively compare the prognostic and perioperative outcomes between one-stage and two-stage VATS for synchronous bilateral pulmonary nodules.

METHODS

We conduct a prospective clinical trial to investigate the surgical outcomes of one-stage and two-stage VATS for patients with synchronous bilateral pulmonary nodules. This trial plan to enroll 198 patients from a single institution during a period of 5 years. The primary outcome is 5-year overall survival. Secondary outcomes include 5-year disease free survival, 3-year overall survival, 3-year disease free survival, overall complications rate, 30-day mortality, pain score after surgery, surgical time, blood loss in the operation, duration of chest tube, length of stay, and quality of life score after surgery.

DISCUSSION

To our knowledge, this study is the first prospective registered clinical trials to compare the clinical outcomes after one-stage or two-stage VATS for synchronous bilateral non-small cell lung cancer.

TRAIL REGISTRATION

This study underwent review by the Ethics Committee of China-Japan Friendship Hospital under No. 2023-KY-061-1. It has been officially registered with the China Clinical Trial Registry, TRN: ChiCTR2300071198 and registration date is May. 8, 2023.

One-stage versus two-stage thoracoscopic surgery for synchronous bilateral pulmonary nodules: a propensity score-matched analysis

BACKGROUND

The aim of this study was to compare the surgical efficacy of one-stage and two-stage video-assisted thoracoscopic surgery (VATS) for bilateral multiple pulmonary nodules (BMPNs).

METHODS

A retrospective analysis was made of 156 patients, 84 who underwent one-stage and 72 who underwent two-stage VATS for BMPNs at our department between January 2019 and December 2022. Perioperative and long-term outcomes were compared between the two groups using propensity score-matched (PSM) analysis.

RESULTS

There were 48 patients in each group after PSM. No significant difference was observed in operation time, blood loss, rates of overall complications, and 3-year overall survival (p>0.05) between one-stage and two-stage groups. The one-stage procedure was associated with shorter length of stay (5 days [IQR 4-5.75 days] vs. 9 days [IQR 7-10 days]; p<0.001), as well as lower total cost (14626.3 ± 4149.4 vs. 18975.9 ± 3720.8 USD, p<0.001) compared to the two-stage procedure. The one-stage group was associated with better 3-year RFS compared with the two-stage group (90.7% vs. 75.3%, p = 0.039).

CONCLUSION

One-stage and two-stage VATS for BMPNs are both safe and feasible in selected patients. One-stage procedure possess potential advantages in reducing hospital stay and cost, as well as preventing tumor progression.

Simultaneous bilateral video-assisted thoracic surgery is safe and feasible for multiple primary lung cancers

BACKGROUND

The treatment for bilateral synchronous multiple primary lung cancers (MPLC) remains challenging. Simultaneous bilateral video-assisted thoracic surgery (VATS) may be an optimal treatment with curative intent, but its safety and feasibility are controversial.

METHODS

One hundred and fifty-eight patients who underwent simultaneous bilateral VATS (simultaneous group) and 79 who underwent two-staged bilateral VATS (two-staged group) were included in this study. Their medical records were retrospectively reviewed and analyzed.

RESULTS

The majority of patients were female and non-smokers. The most common surgical plan was lobectomy and contralateral wedge resection in both groups. There was no significant difference in the postoperative complication rate between the simultaneous groups and two-staged group (13.3% vs. 11.4%, p = 0.73). Patients who underwent simultaneous bilateral resection had shorter hospital stays, shorter anesthesia time and less chest drainage compared with those who underwent two-staged resection. Advanced TNM stage, complicated surgical plan and aggressive lymph node resection were risk factors for postoperative complications in simultaneous bilateral VATS. Patients in two groups had similar overall survival and disease free survival (p = 0.2).

CONCLUSIONS

Simultaneous bilateral VATS for bilateral lung nodule resection is as safe and feasible as two-staged bilateral VATS. Patients who underwent simultaneous bilateral resection had similar or even better outcomes compared to that of the two-staged group. Simultaneous bilateral VATS is potentially an optimal treatment option for patients with erarly cTNM stage and good physical condition.

Lobectomy Versus Sublobar Resection in Simultaneous Bilateral Thoracoscopic Lung Resection

BACKGROUND

Simultaneous bilateral thoracoscopic lung resection (SBTLR) has been shown to be a feasible and efficacious approach for a wide range of pulmonary conditions. Our aim was to evaluate the impact of different procedures on surgical outcomes in patients receiving SBTLR.

METHODS

Between 2012 and 2021, 207 patients with bilateral lung neoplasms who underwent SBTLR were retrospectively reviewed. Fifty-one patients received ipsilateral plus contralateral lobectomy or sublobectomy (lobar group), whilst 156 patients received bilateral sublobectomy (sublobar group). Propensity scores were calculated and matched. Perioperative and clinicopathologic outcomes were compared.

RESULTS

The lobar group had a greater mean age (64.5 vs. 60.0 years, p = 0.008), longer operative time (254 vs. 205 min, p < 0.001), and more blood loss (74 vs. 46 ml, p < 0.001). The sublobar group had fewer complications (6.4 vs. 19.6%, p = 0.006), shorter hospital stay (4.8 vs. 7.4 days, p < 0.001), and lower hospital costs (p = 0.03). Among 50 pairs of matched groups, significant differences were found only in operative time, hospital stay, and costs. Maximum tumor size and pathological features differed significantly before and after matching (all p < 0.05), with the lobar group consistently demonstrating a larger main tumor (median, 2.5 cm) and a higher percentage of primary lung cancer (84%). Multivariate logistic regression analysis showed that a longer operative time was the factor associated with more complications (OR: 1.01; 95% CI 1.00-1.02, p = 0.002).

CONCLUSIONS

With regard to SBTLR, our data suggests that sublobectomy may reduce the prolonged recovery, hospital costs, and complications incurred by lobectomy, without compromising oncological outcomes.

Ultrasound-Guided Bilateral Sequential Thoracic Paravertebral Block for Simultaneous Bilateral Uniportal Video-Assisted Thoracoscopic Surgery: Study Protocol for a Randomized Controlled Trial

Purpose

Simultaneous bilateral pulmonary resection via uniportal video-assisted thoracoscopic surgery (UVATS) was safe and feasible for the treatment of bilateral multiple pulmonary nodules. But, it should be noted that considerable postoperative pain at the bilateral surgical site was a crucial issue. The safety and efficacy of bilateral thoracic paravertebral block (TPVB) have been reported for postoperative analgesia. But, whether bilateral sequential TPVB can be safely and effectively used in simultaneous bilateral UVATS remains unknown. Therefore, this study aimed to determine the analgesic efficacy and safety of bilateral sequential TPVB after simultaneous bilateral UVATS.

Study Design and Methods

In this study, 80 participants scheduled for UVATS will be randomly allocated to the bilateral sequential TPVB group (G2) and the control group (G1). The patient of G2 will be performed bilateral TPVB at 2 time-points: before the start of the first side of pulmonary resection and before the start of the contralateral pulmonary resection. G1 will only receive standard analgesia protocol. The primary outcome is the numeric rating scale score during coughing at 24 h postoperatively. The secondary outcomes include the Prince Henry Pain Score scores, sufentanil consumption, postoperative nausea and vomiting, levels of inflammatory factors, and the Quality of Recovery-40 scores at different time points, as well as chronic pain at postoperative day (POD) 90.

Discussion

This is the first prospective trial to determine the safety and effectiveness of ultrasound-guided bilateral sequential TPVB for postoperative analgesia following simultaneous bilateral UVATS. This study also intended to evaluate the effect of this intervention on postoperative quality of recovery and inflammation levels. The final results will provide clinical evidence related to bilateral sequential TPVB, and promote the application of that acting as a more appropriate analgesic method for simultaneous bilateral UVATS.

The feasibility and safety of simultaneous bilateral video-assisted thoracic surgery for the treatment of bilateral pulmonary lesions

Background

The aim of this study was to evaluate the feasibility and safety of simultaneous bilateral video-assisted thoracic surgery (VATS) for the treatment of bilateral pulmonary lesions.

Methods

The data of 11 patients who received simultaneous bilateral pulmonary surgery using VATS in the Department of Thoracic Surgery of The Third Affiliated Hospital of Naval Medical University between January 2016 and August 2021 were retrospectively analyzed.

Results

The cases of four male and seven female patients, with a mean age of 57.54 ± 8.37 years (range, 44-67 years), were reviewed. Nonanatomic wedge resection, pulmonary segmentectomy or lobectomy via VATS were performed depending on each patient’s situation. Mean 1 second forced expiratory volume (FEV1) was 2.55 ± 0.66 L(range, 1.49-3.88 L), mean intraoperative bleeding volume was 91.81 ± 49.56 mL(range, 30-150 mL), mean operating time was 273.72 ± 68.98 min(range, 132-390 min), and mean drainage duration was 5.27 ± 3.60 days(range, 2-14 days), with a mean total drainage volume of 1,515.90 ± 772.75 mL(range, 530-3,225 mL). Only one postoperative complication (air leakage) occurred, with an overall complication rate of 9.09%. The mean postoperative hospital stay was 8.81 ± 3.60 days (range, 5-18 days), and the mean total cost of hospitalization was 67,054.53 ± 20,896.49 RMB (range, 47,578.45-123,530.8 RMB).

Conclusions

Simultaneous bilateral pulmonary surgery using VATS for the treatment of bilateral pulmonary lesions is safe and feasible and can therefore be considered after strict preoperative evaluation of the patient.

Application of bilateral simultaneous sequential single-incision video-assisted thoracic surgery in multiple nodules both lungs: a single-center experience of 10 cases

Objective

To discuss the application of bilateral simultaneous sequential single-incision video-assisted thoracic surgery in multiple nodules in both lungs.

Methods

A retrospective analysis of 10 patients in Zhengzhou People’s Hospital who underwent single-incision thoracoscopic surgery to treat multiple nodules in both lungs at the same time from September 2019 to January 2021, and analyze the perioperative indicators (general condition, smoking history, family history, follow-up time of pulmonary nodules, size, location, height and weight, pulmonary function, intraoperative blood loss, operation time, color and volume of drainage fluid, catheterization time, perioperative complications, length of stay, pathology, patient satisfaction, etc.).

Results

All 10 patients used single-incision thoracoscopy to complete bilateral simultaneous sequential operations, aged 32 to 70 years, 8 female patients, 2 male patients, preoperative follow-up time ranging from 1 day to 2 years, a total of 23 lung nodules were removed except for the benign lesions in one nodule in the 2 patients, the other nodules were tumorous lesions (91.3%). The average total hospital stay was 10.5 days (8–14 days), and the average operation time was 194.5 min (145–292 min). The blood loss ranged from 10 to 280 ml, all patients had no serious complications during the perioperative period, and they recovered well and were discharged smoothly, and the satisfaction reached 100%.

Conclusion

Single-incision bilateral simultaneous sequential thoracoscopy have certain advantages in the treatment of patients with multiple nodules in both lungs, conforms to the concept of rapid recovery, and is a feasible choice in the shared decision making of doctors and patients.

Thoracoscopic Lobectomy versus Segmentectomy in the Treatment of Patients with Early-Stage Lung Cancer

Objective

To assess the clinical efficacy of thoracoscopic lobectomy and segmentectomy in the treatment of patients with early-stage lung cancer.

Methods

A total of 70 patients with early-stage non-small cell lung cancer who were treated in our hospital from April 2018 to May 2020 were recruited and assigned at a ratio of 1 : 1 to receive either segmentectomy (observation group) or lobectomy (control group). Outcome measures included clinical efficacy, surgery-related indicators, pulmonary function indicators (forced vital capacity (FVC) and forced expiratory volume in one second (FEV1)), postoperative complications, and recurrence and metastasis.

Results

There was no significant difference in the clinical efficacy between the two groups (P > 0.05). Segmentectomy was associated with a longer operation time and shorter hospital stay compared to lobectomy (P < 0.05). There was no statistical significance in the amount of intraoperative blood loss and the number of lymph nodes dissected (P > 0.05). Segmentectomy resulted in significantly higher FVC and FEV1 levels in patients compared to lobectomy (P < 0.05). There was no significant difference in the incidence of postoperative complications between the two groups (P > 0.05). The two groups of patients were followed up for 12 months after the operation, and there was no recurrence or metastasis in either group.

Conclusion

The two surgical methods have similar efficacy and safety profiles, but for the treatment of patients with early-stage lung cancer, thoracoscopic segmentectomy is associated with a shorter hospital stay and better protection of the lung function of patients compared to lobectomy.

Uniportal video-assisted thoracic surgery approach for simultaneous lung cancer and thymic carcinoma: Case report and literature review

Thymic carcinoma is an epithelial tumor derived from thymic epithelial cells. Thymic tumors may be associated with other simultaneous and/or metachronous extra‐thymic tumors (e.g., lung cancer). Here, we report a case of simultaneous surgical management of lung and mediastinal neoplasm together with a review of the literature. During radiological follow‐up for prostate and colorectal cancer, an 82‐year‐old man was diagnosed with lung cancer with simultaneous mediastinal suspected neoplasm. Both were surgically removed with a single intervention performed via a uniportal video‐assisted thoracic surgery (uni‐VATS) approach. The literature emphasizes how extra‐thymic cancer can be diagnosed before, concurrently and consecutively with thymic neoplasia. The surgical treatment of such simultaneous cancer is challenging. We succeeded in the excision of both neoplasia with a mini‐invasive surgical technique. This report highlights the feasibility of uniportal VATS in a patient with very unusual clinical and oncological history.