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Peeters M, Jansen Y, Daemen JHT, van Roozendaal LM, De Leyn P, Hulsewé KWE, Vissers YLJ, de Loos ER. The use of intravenous indocyanine green in minimally invasive segmental lung resections: a systematic review. Transl Lung Cancer Res 2024; 13:612-622. [PMID: 38601441 PMCID: PMC11002498 DOI: 10.21037/tlcr-23-807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/31/2024] [Indexed: 04/12/2024]
Abstract
Background To identify intersegmental planes (ISPs) in video/robot-assisted thoracoscopic segmentectomies, indocyanine green (ICG) is commonly used. The aim of this systematic review is to evaluate the efficacy of intravenous ICG in the identification of ISP. Methods A systematic search was performed. Studies evaluating patients who underwent a video/robot-assisted thoracoscopic segmentectomy using intravenous ICG were included. The primary outcome measure was the frequency and percentage of patients in whom the ISP was adequately visualized. Secondary outcomes encompassed the ICG dose, time to visualization, time to maximum ICG visualization, time to disappearance of ICG effect and adverse reactions to ICG. Results Eighteen studies were included for systematic review, enrolling a total of 1,090 patients. Irrespective of the injected dose, intravenous ICG identified the ISP in 94% of the cases (range, 30-100%). Overall, there was a considerable amount of heterogeneity regarding the injected dose of ICG (range, 5-25 mg or 0.05-0.5 mg/kg). The mean time before first effect of ICG was visible ranged from 10 to 40 seconds. The mean total time of ICG visibility ranged from 90 to 140 seconds after a bolus injection and was 170 seconds after continuous infusion. No adverse reactions were reported. Conclusions After administration of intravenous ICG, visualization of the ISP is successful in up to 94% of cases, even after administration of a low dose (0.05 mg/kg) of ICG. The use of intravenous ICG is safe with no reported adverse effects in the immediate peri-operative period.
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Affiliation(s)
- Maxim Peeters
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Division of Thoracic Surgery, Department of General Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Yanina Jansen
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Division of Thoracic Surgery, Department of General Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department CHROMETA, KU Leuven, Leuven, Belgium
| | - Jean H. T. Daemen
- Division of Thoracic Surgery, Department of General Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Lori M. van Roozendaal
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Division of Thoracic Surgery, Department of General Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Paul De Leyn
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department CHROMETA, KU Leuven, Leuven, Belgium
| | - Karel W. E. Hulsewé
- Division of Thoracic Surgery, Department of General Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Yvonne L. J. Vissers
- Division of Thoracic Surgery, Department of General Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Erik R. de Loos
- Division of Thoracic Surgery, Department of General Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
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Sayan M, Kankoc A, Valiyev E, Celik A. A novel technique proposition for determining the resection margins in lung resection by using a thermal camera. Gen Thorac Cardiovasc Surg 2024; 72:121-126. [PMID: 37278939 DOI: 10.1007/s11748-023-01948-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 05/29/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Determination of resection margins is very important in anatomical lung resections for both oncologic outcomes and postoperative complications. Absence of intersegmental plans naturally in segmentectomy surgeries and presence of incomplete fissure variationally in pulmonary lobectomy procedures constitute a challenge for surgeons in determining resection margins. Thoracic surgeons can prefer various techniques such as inflation deflation method, indocyanine green imaging, and three-dimensional segment modeling to cope with this problem. These techniques have some disadvantages such as high cost, the necessity of intravenous drug administration, need for an additional imaging system and ineffectiveness due to emphysema, anthracotic lung surface or interalveolar pores. Here we studied an alternative method for the solution of these disadvantages and aimed to demonstrate the correctness of a hypothesis based on detecting the cooling of the ischemic lung portion by a thermal camera after dividing the related pulmonary artery. METHODS We planned determining margins of resection with a thermal camera in patients scheduled for pulmonary lobectomy or segmentectomy. We made some measurements and mapping with a thermal camera before and after the dividing of pulmonary artery of related lobe or segment then processed the images taken with a software on the computer. RESULTS We detected a significant decrease in temperature in the ischemic lung area and demonstrated mapping the demarcation line between ischemic and perfused areas effectively by thermography in a total of 32 patients underwent lung resection. CONCLUSION Pulmonary resection margins can be detected effectively by thermography in patients.
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Affiliation(s)
- Muhammet Sayan
- Department of Thoracic Surgery, Gazi University, 06560, Ankara, Turkey.
| | - Aykut Kankoc
- Department of Thoracic Surgery, Gazi University, 06560, Ankara, Turkey
| | - Elgun Valiyev
- Department of Thoracic Surgery, Gazi University, 06560, Ankara, Turkey
| | - Ali Celik
- Department of Thoracic Surgery, Gazi University, 06560, Ankara, Turkey
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Liao W, Xu X, Li Z, Xu W, Xia Y, Cao X, Zhu Q, Wu W, Wang J, Chen L. Three-dimensional imaging anatomical research and clinical implications of V 1 +2 d in the left upper lung. Thorac Cancer 2024; 15:239-247. [PMID: 38083994 PMCID: PMC10803217 DOI: 10.1111/1759-7714.15186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/26/2023] [Accepted: 11/28/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND To investigate the distribution pattern of V1+2 d in the left superior pulmonary vein and its clinical significance. METHODS A retrospective analysis was conducted using three-dimensional computed tomographic bronchography and angiography (3D-CTBA) data from 500 lung cancer patients. Statistical analyses were performed to evaluate the incidence and drainage patterns of the three sub-branches of V1+2 d, namely V1+2 d1, V1+2 d2 and V1+2 d3. Furthermore, clinical data from 10 patients' lesions involving V1+2 d were reviewed to illustrate the impact of adjacency to V1+2 d on the surgical approach. RESULTS The incidences of V1+2 d1, V1+2 d2 and V1+2 d3 were 100%, 76.4% and 100% respectively. The relative interlobar distribution sizes of B3 a and B1+2 c and the left upper division (LUD) vein type influenced the incidence of V1+2 d2 (p < 0.05; p < 0.001). V1+2 d2 predominantly occurred in B3 a = B1+2 c and B1+2 c > B3 a patterns. V1+2 d2 was entirely absent in the B3 a > B1+2 c pattern. V1+2 d2 exhibited a higher incidence in both the central vein (CV) type and the noncentral vein (NCV) type when compared to the semi-central vein (SCV) type (100% vs. 100% vs. 64.8%). The most prevalent venous drainage pattern was the three sub-branches of V1+2 d constituting a major trunk to drain (41.2%). All 10 cases with lesions involving V1+2 d successfully underwent sublobar resection with no complications, and the surgical margin was ≥2 cm. CONCLUSIONS The three sub-branches of V1+2 d exhibit a high incidence with diverse distribution patterns, yet a discernible pattern exists. For inter- or multi-intersegmental nodules involving V1+2 d, combined segmentectomy and subsegmentectomy or combined subsegmentectomy can ensure the safe margin.
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Affiliation(s)
- Wei Liao
- Department of Thoracic Surgery, Jiangsu Province HospitalThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Xinfeng Xu
- Department of Thoracic Surgery, Jiangsu Province HospitalThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Zhihua Li
- Department of Thoracic Surgery, Jiangsu Province HospitalThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Wenzheng Xu
- Department of Thoracic Surgery, Jiangsu Province HospitalThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Yang Xia
- Department of Thoracic Surgery, Jiangsu Province HospitalThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Xincen Cao
- Department of Thoracic Surgery, Jiangsu Province HospitalThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Quan Zhu
- Department of Thoracic Surgery, Jiangsu Province HospitalThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Weibing Wu
- Department of Thoracic Surgery, Jiangsu Province HospitalThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Jun Wang
- Department of Thoracic Surgery, Jiangsu Province HospitalThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Liang Chen
- Department of Thoracic Surgery, Jiangsu Province HospitalThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
- Department of Thoracic SurgeryThe Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine Nanjing Medical UniversityTaizhouChina
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Hao X, Xiaoyan C, Linyou Z. Robot-assisted segmentectomy with improved modified inflation-deflation combined with the intravenous indocyanine green method. J Robot Surg 2023; 17:2195-2203. [PMID: 37273113 DOI: 10.1007/s11701-023-01639-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 05/28/2023] [Indexed: 06/06/2023]
Abstract
To investigate the perioperative outcomes of patients who underwent robot-assisted thoracoscopic (RATS) segmentectomy for identifying the intersegmental plane (ISP) by improved modified inflation-deflation (MID) combined with near-infrared fluorescence imaging with the intravenous indocyanine green (ICG) method and to assess the feasibility of this method in a large-scale cohort according to the type of segmentectomy performed. We retrospectively analysed the perioperative data of a total of 155 consecutive patients who underwent RATS segmentectomy between April 2020 and December 2021. Data from the operation, including the demarcation status of the intersegmental plane, were analysed retrospectively. The mean operative time and estimated blood loss were 125.56 ± 36.32 min and 41.81 ± 49.18 mL, respectively. Good demarcation of the intersegmental plane was observed in 150 (96.77%) patients, with no correlation with the type of resected segments or the surgical method. Postoperative complications of Clavien-Dindo classification grade 3 or more were observed in 4 patients (2.58%), and no ICG-related adverse events were noted. Demarcation of the intersegmental plane by improved MID combined with ICG is feasible regardless of the type of segmentectomy and can be commonly applied in robot-assisted segmentectomy.
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Affiliation(s)
- Xu Hao
- Department of Thoracic Surgery, The Second Hospital Affiliated to Harbin Medical University, #148 Baojian Road, Harbin, 150001, China
| | - Chang Xiaoyan
- Department of Thoracic Surgery, The Second Hospital Affiliated to Harbin Medical University, #148 Baojian Road, Harbin, 150001, China
| | - Zhang Linyou
- Department of Thoracic Surgery, The Second Hospital Affiliated to Harbin Medical University, #148 Baojian Road, Harbin, 150001, China.
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Zhang L, Wang T, Feng Y, Chen Y, Feng C, Qin D, Han C. Clinical application of VATS combined with 3D-CTBA in anatomical basal segmentectomy. Front Oncol 2023; 13:1137620. [PMID: 36895493 PMCID: PMC9989288 DOI: 10.3389/fonc.2023.1137620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 02/06/2023] [Indexed: 02/23/2023] Open
Abstract
Objective This study aimed to summarize the clinical application experience of video-assisted thoracic surgery (VATS) combined with three-dimensional computed tomography-bronchography and angiography (3D-CTBA) in anatomical basal segmentectomy. Methods Clinical data of 42 patients who underwent bilateral lower sub-basal segmentectomy by VATS combined with 3D-CTBA in our hospital from January 2020 to June 2022 were retrospectively analyzed; the patients included 20 males and 22 females, with a median age of 48 (30-65) years. Combined with the preoperative enhanced CT and 3D-CTBA techniques to identify the altered bronchi, arteries, and veins during the operation, the anatomical resection of each basal segment of both lower lungs was completed through the fissure approach or inferior pulmonary vein approach. Results All operations were successfully completed without conversion to thoracotomy or lobectomy. The median operation time was 125 (90-176) min, the median intraoperative blood loss was 15 (10-50) mL, the median postoperative thoracic drainage time was 3 (2-17) days, and the median postoperative hospital stay was 5 (3-20) days. The median number of resected lymph nodes was 6 (5-8). There was no in-hospital death. Postoperative pulmonary infection occurred in 1 case, lower extremity deep vein thrombosis (DVT) in 3 cases, pulmonary embolism in 1 case, and persistent air leakage in the chest in 5 cases, all of which were improved by conservative treatment. Two cases of pleural effusion after discharge were improved after ultrasound guided drainage. Postoperative pathology showed 31 cases of minimally invasive adenocarcinoma, 6 cases of adenocarcinoma in situ (AIS), 3 cases of severe atypical adenomatous hyperplasia (AAH), and 2 cases of other benign nodules. All cases were lymph node-negative. Conclusion VATS combined with 3D-CTBA is safe and feasible in anatomical basal segmentectomy; consequently, this approach should be promoted and applied in clinical work.
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Affiliation(s)
- Lening Zhang
- Department of Thoracic Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Tuhui Wang
- Department of Thoracic Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yonggang Feng
- Department of emergency, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yizhao Chen
- Department of Thoracic Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Chong Feng
- Department of Thoracic Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Dongliang Qin
- Department of Thoracic Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Chunshan Han
- Department of Thoracic Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
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He H, Zhao H, Ma L, Fan K, Feng J, Zhao R, Wen X, Zhang J, Wu Q, Fu J, Zhang G. Identification of the intersegmental plane by arterial ligation method during thoracoscopic segmentectomy. J Cardiothorac Surg 2022; 17:281. [PMID: 36333814 PMCID: PMC9636693 DOI: 10.1186/s13019-022-02011-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 09/27/2022] [Indexed: 11/06/2022] Open
Abstract
Background Thoracoscopic segmentectomy is a common surgical procedure in thoracic surgery today. However, identifying the intersegmental plane is difficult in the surgical process. Therefore, we evaluated the feasibility of the arterial ligation method for determining the intersegmental plane and compared the demarcation status with the intravenous indocyanine green (ICG). Methods We retrospectively reviewed the records of 35 patients with peripheral small lung nodules who underwent thoracoscopic segmentectomy between May and December 2020. First, the preoperative three-dimensional reconstruction was performed to distinguish the location of lung nodules and the anatomical structures of targeted segmental arteries, veins, and bronchi. Second, the targeted segmental arteries were ligated, and the intersegmental plane was determined by the inflation-deflation technique. The waiting time for the appearance of the inflation-deflation line was recorded. Thirdly, the intersegmental plane was identified again using the ICG fluorescence method. Finally, the consistency of the two intersegmental planes was evaluated. Results The intersegmental planes were successfully observed in all patients using the arterial ligation method. Thirty-four patients underwent segmentectomy as planned, and one patient finally underwent lobectomy due to insufficient surgical margin. The waiting time for the appearance of the intersegmental plane by arterial ligation method was 13.7 ± 3.2 min (6–19 min). The intersegmental planes determined by the arterial ligation method and the ICG fluorescence method were comparable, with a maximum distance of no more than 5 mm between the two planes. The mean operative duration was 119.1 ± 34.9 min, and the mean blood loss was 76.9 ± 70.3 ml. No evident air leakage was found during the operation. Only one patient experienced a prolonged air leak (≥ 5 days) during the postoperative recovery. No atelectasis occurred in all cases. The chest tube duration was 3.1 ± 0.9 days. Conclusion The arterial ligation method can efficiently and accurately identify the intersegmental plane, comparable to the ICG fluorescence method.
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Size Measurement and Segmentectomy Resection Margin of Early-Stage Lung Adenocarcinoma Manifesting on Virtual 3D Imagery and Pathology: A Pilot Correlation Study. J Clin Med 2022; 11:jcm11206155. [PMID: 36294475 PMCID: PMC9605571 DOI: 10.3390/jcm11206155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/03/2022] [Accepted: 10/11/2022] [Indexed: 12/24/2022] Open
Abstract
Background: The objective of our study was to assess if 3D reconstructed images could be extrapolated to reflect pathologies, as evaluated by early-stage lung adenocarcinoma tumor size and simulated segmentectomy resection margin. Methods: Retrospectively selected patients (n = 18) who underwent segmentectomy at Changhua Christian Hospital between 2012 and 2018 and then had pulmonary 3D reconstruction using Ziostation2 were included in our study. Tumor size and simulated segmentectomy resection distance on a 3D model were measure and compared to pathology. Results: Both tumor size and segmentectomy resection margin showed positive correlations between 3D image measurements and pathological measurements. The resection margin showed a stronger correlation and was beneficial in pre-operative planning. Conclusions: A 3D reconstructed model aided understanding of pulmonary anatomy, prompting confidence in surgical approaches and ensured segmentectomy outcome success. Regardless of age and pulmonary function, 3D simulation can accurately mimic segmentectomy, making it a simple, effective and feasible pre-operative planning tool.
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Feng Z, Hu B, Yu S, Guo C, Peng Z. Division of the intersegmental demarcation using the "modified hand-tearing method" is safe and feasible in thoracoscopic anatomical segmentectomy. Thorac Cancer 2022; 13:2732-2740. [PMID: 36184304 PMCID: PMC9527171 DOI: 10.1111/1759-7714.14607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 07/25/2022] [Accepted: 07/31/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The accurate and safe division of the intersegmental demarcation (ISD) is critical and challenging during thoracoscopic anatomical segmentectomy. Here, we provide an improved technique which emphasizes the application of an electric hook and blunt division of ISD. The technique is termed as the "modified hand-tearing method" (MHT method) with combined application of an electric hook and staplers. The study aimed to review the outcomes of patients who underwent thoracoscopic anatomical segmentectomy, with or without the MHT method in our institute and assess its feasibility and safety. In addition, we compared the feasibility between video-assisted thoracoscopic surgery (VATS) and robot-assisted thoracoscopic surgery (RATS) using the MHT method. METHODS From 2018 July to 2021 June, we retrospectively analyzed 701 patients who underwent segmentectomy. Using propensity score matching, data of two well-matched pairs of 276 cases in the MHT method and non-MHT method groups, and two well-matched pairs of 40 cases in the VATS and RATS subgroups were obtained. The clinical and perioperative characteristics of patients were compared between groups. RESULTS Compared with the non-MHT method group, the MHT method group had shorter operation time and shorter postoperative hospital stay. Period of chest tube drainage and postoperative total drainage and postoperative complications had no between-group difference. Compared with VATS, the RATS subgroup had less intraoperative bleeding and shorter postoperative hospital stay. CONCLUSION Division of ISD using the MHT method has advantages in precision and ease of operation, so it has the potential to become a feasible and effective method for thoracoscopic anatomical segmentectomy.
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Affiliation(s)
- Zhen Feng
- Department of Thoracic SurgeryShandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Benchuang Hu
- Department of Thoracic SurgeryShandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Shuliang Yu
- Department of OncologyThe First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan HospitalJinanChina
| | - Chenran Guo
- Department of Thoracic SurgeryShandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Zhongmin Peng
- Department of Thoracic SurgeryShandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinanChina
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Montagne F, Chaari Z, Bottet B, Sarsam M, Mbadinga F, Selim J, Guisier F, Gillibert A, Baste JM. Long-Term Survival Following Minimally Invasive Lung Cancer Surgery: Comparing Robotic-Assisted and Video-Assisted Surgery. Cancers (Basel) 2022; 14:cancers14112611. [PMID: 35681593 PMCID: PMC9179652 DOI: 10.3390/cancers14112611] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/12/2022] [Accepted: 05/18/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS) are known to be safe and efficient surgical procedures to treat lung cancer. Both VATS and RATS allow anatomical resection associated with radical lymph node dissection. However, RATS, unlike VATS, allows the thoracic surgeon to mimic an open approach and to perform lung resection. We hypothesized that the technical advantages of RATS, compared with VATS, would allow more precise resection, with “better lymph node dissection” which could increase survival compared to VATS. Nevertheless, VATS, and RATS nodal up-staging are still debated, with conflicting results and in our study, as well as in the medical literature, RATS failed to show its superiority over VATS in resectable non-small cell lung cancer. Abstract Background: Nowadays, video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS) are known to be safe and efficient surgical procedures to treat early-stage non-small cell lung cancer (NSCLC). We assessed whether RATS increased disease-free survival (DFS) compared with VATS for lobectomy and segmentectomy. Methods: This retrospective cohort study included patients treated for resectable NSCLC performed by RATS or VATS, in our tertiary care center from 2012 to 2019. Patients’ data were prospectively recorded and reviewed in the French EPITHOR database. Primary outcomes were 5-year DFS for lobectomy and 3-year DFS for segmentectomy, compared by propensity-score adjusted difference of Kaplan–Meier estimates. Results: Among 844 lung resections, 436 VATS and 234 RATS lobectomies and 46 VATS and 128 RATS segmentectomies were performed. For lobectomy, the adjusted 5-year DFS was 60.9% (95% confidence interval (CI) 52.9–68.8%) for VATS and 52.7% (95%CI 41.7–63.7%) for RATS, with a difference estimated at −8.3% (−22.2–+4.9%, p = 0.24). For segmentectomy, the adjusted 3-year DFS was 84.6% (95%CI 69.8–99.0%) for VATS and 72.9% (95%CI 50.6–92.4%) for RATS, with a difference estimated at −11.7% (−38.7–+7.8%, p = 0.21). Conclusions: RATS failed to show its superiority over VATS for resectable NSCLC.
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Affiliation(s)
| | - Zied Chaari
- Department of Thoracic and Cardiovascular Surgery, University of Sfax, Habib Bourguiba University Hospital, Sfax 3029, Tunisia;
| | - Benjamin Bottet
- Department of General and Thoracic Surgery, Rouen University Hospital, 1 Rue de Germont, F-76000 Rouen, France; (B.B.); (M.S.); (F.M.)
| | - Matthieu Sarsam
- Department of General and Thoracic Surgery, Rouen University Hospital, 1 Rue de Germont, F-76000 Rouen, France; (B.B.); (M.S.); (F.M.)
| | - Frankie Mbadinga
- Department of General and Thoracic Surgery, Rouen University Hospital, 1 Rue de Germont, F-76000 Rouen, France; (B.B.); (M.S.); (F.M.)
| | - Jean Selim
- Department of Anesthesiology and Critical Care, CHU Rouen, F-76000 Rouen, France;
- Normandie University, University of Medicine and Pharmacy of Rouen, UNIROUEN, INSERM U1096, FHU REMOD-VHF, F-76183 Rouen, France
| | - Florian Guisier
- Thoracic Oncology and Respiratory Intensive Care Unit, Department of Pneumology, Rouen University Hospital, F-76000 Rouen, France;
- Normandie University, University of Medicine and Pharmacy of Rouen, UNIROUEN, EA4108 LITIS Lab, QuantiF Team and INSERM CIC-CRB 1404, F-76183 Rouen, France
| | - André Gillibert
- Department of Biostatistics, CHU Rouen, F-76000 Rouen, France;
| | - Jean-Marc Baste
- Department of General and Thoracic Surgery, Rouen University Hospital, 1 Rue de Germont, F-76000 Rouen, France; (B.B.); (M.S.); (F.M.)
- Normandie University, University of Medicine and Pharmacy of Rouen, UNIROUEN, INSERM U1096, FHU REMOD-VHF, F-76183 Rouen, France
- Correspondence: ; Tel.: +33-(2)-32888704
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Bie M, Zhao X, Zhang M, Fu G, Ge M. A novel localization technique for peripheral ground glass opacity using geometric parameters measured on CT images. BMC Surg 2021; 21:345. [PMID: 34537024 PMCID: PMC8449907 DOI: 10.1186/s12893-021-01343-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 09/15/2021] [Indexed: 11/20/2022] Open
Abstract
Background Currently no optimal localization technique has been established for localization of ground glass opacity (GGO). We aimed to introduce a localization technique using geometric localization for peripheral GGO. Methods We delineated the location of pulmonary GGO using geometric method which was similar with localization of a point in a spatial coordinate system. The localization technique was based on the anatomical landmarkers (ribs or intercostal spaces, capitulum costae and sternocostal joints). The geometric parameters were measured on preoperative CT images and the targeted GGO could be identified intraoperatively according to the parameters. We retrospectively collected the data of the patients with peripheral GGOs which were localized using this method and were wedge resected between June 2019 and July 2020. The efficacy and feasibility of the localization technique were assessed. Results There were 93 patients (male 34, median = 55 years) with 108 peripheral GGOs in the study. All the targeted GGOs were successfully wedge resected in the operative field with negative surgical margin at the first attempt. For each GGO, the localization parameters could be measured in 2–4 min (median = 3 min) on CT images before operation, and surgical resection could be completed in 5–10 min (median = 7 min). A total of 106 (98.15%) GGOs achieved sufficient resection margin. No complications and deaths occurred related to the localization and surgical procedure. Conclusions The localization technique can achieve satisfactory localization success rate and good safety profile. It can provide an easy-to-use alternative to localize peripheral GGO.
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Affiliation(s)
- Mengjun Bie
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xuemin Zhao
- Department of Cardiology, The First Branch Hospital, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400015, China
| | - Min Zhang
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Guang Fu
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Mingjian Ge
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Montagne F, Guisier F, Venissac N, Baste JM. The Role of Surgery in Lung Cancer Treatment: Present Indications and Future Perspectives-State of the Art. Cancers (Basel) 2021; 13:3711. [PMID: 34359612 PMCID: PMC8345199 DOI: 10.3390/cancers13153711] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 07/14/2021] [Accepted: 07/20/2021] [Indexed: 12/25/2022] Open
Abstract
Non-small cell lung cancers (NSCLC) are different today, due to the increased use of screening programs and of innovative systemic therapies, leading to the diagnosis of earlier and pre-invasive tumors, and of more advanced and controlled metastatic tumors. Surgery for NSCLC remains the cornerstone treatment when it can be performed. The role of surgery and surgeons has also evolved because surgeons not only perform the initial curative lung cancer resection but they also accompany and follow-up patients from pre-operative rehabilitation, to treatment for recurrences. Surgery is personalized, according to cancer characteristics, including cancer extensions, from pre-invasive and local tumors to locally advanced, metastatic disease, or residual disease after medical treatment, anticipating recurrences, and patients' characteristics. Surgical management is constantly evolving to offer the best oncologic resection adapted to each NSCLC stage. Today, NSCLC can be considered as a chronic disease and surgery is a valuable tool for the diagnosis and treatment of recurrences, and in palliative conditions to relieve dyspnea and improve patients' comfort.
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Affiliation(s)
- François Montagne
- Department of Thoracic Surgery, Calmette Hospital, University Hospital of Lille, Boulevard du Pr. J Leclercq, F-59000 Lille, France; (F.M.); (N.V.)
| | - Florian Guisier
- Department of Pneumology, Rouen University Hospital, 1 rue de Germont, F-76000 Rouen, France;
- Clinical Investigation Center, Rouen University Hospital, CIC INSERM 1404, 1 rue de Germont, F-76000 Rouen, France
- Faculty of Medicine and Pharmacy of Rouen, Normandie University, LITIS QuantIF EA4108, 22 Boulevard Gambetta, F-76183 Rouen, France
| | - Nicolas Venissac
- Department of Thoracic Surgery, Calmette Hospital, University Hospital of Lille, Boulevard du Pr. J Leclercq, F-59000 Lille, France; (F.M.); (N.V.)
| | - Jean-Marc Baste
- Department of General and Thoracic Surgery, Rouen University Hospital, 1 rue de Germont, F-76000 Rouen, France
- Faculty of Medicine and Pharmacy of Rouen (UNIROUEN), Normandie University, INSERM U1096, 22 Boulevard Gambetta, F-76000 Rouen, France
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