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Lefetz O, Baste JM, Hamel JF, Mordojovich G, Lefevre-Scelles A, Coq JM. Robotic surgery and work-related stress: A systematic review. Appl Ergon 2024; 117:104188. [PMID: 38301320 DOI: 10.1016/j.apergo.2023.104188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 11/24/2023] [Accepted: 11/28/2023] [Indexed: 02/03/2024]
Abstract
Despite robot-assisted surgery (RAS) becoming increasingly common, little is known about the impact of the underlying work organization on the stress levels of members of the operating room (OR) team. To this end, assessing whether RAS may impact work-related stress, identifying associated stress factors and surveying relevant measurement methods seems critical. Using three databases (Scopus, Medline, Google Scholar), a systematic review was conducted leading to the analysis of 20 articles. Results regarding OR team stress levels and measurement methods were heterogeneous, which could be explained by differing research conditions (i.e., lab. vs. real-life). Relevant stressors such as (in)experience with RAS and quality of team communication were identified. Development of a common, more reliable methodology of stress assessment is required. Research should focus on real-life conditions in order to develop valid and actionable knowledge. Surgical teams would greatly benefit from discussing RAS-related stressors and developing team-specific strategies to handle them.
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Affiliation(s)
- Ophélie Lefetz
- Univ Rouen Normandie, CRFDP, UR 7475, F-76000, Rouen, France.
| | - Jean-Marc Baste
- Faculté de Médecine et de Pharmacie, Université de Rouen, 22 Boulevard Gambetta, CS, 76183, Rouen Cedex 1, France; Rouen University Hospital, Department of general and thoracic surgery, F-76000, Rouen, France; Normandie Univ, UNIROUEN, INSERM, U1096, Rouen University Hospital, Rouen, France
| | | | - Gerardo Mordojovich
- Clínica Alemana de Santiago, Av. Vitacura 5951, Vitacura, Región Metropolitana, Santiago, Chile; Hospital de la Fuerza Aérea de Chile, Santiago, Chile; Universidad Mayor de Santiago, Santiago, Chile
| | - Antoine Lefevre-Scelles
- Rouen University Hospital, Department of intensive care, anesthesia and perioperative medicine, F-76000, Rouen, France; Rouen University Hospital, Emergency Care Training Center (CESU-76A) of Emergency medical service (SAMU-76A), F-76000, Rouen, France
| | - Jean-Michel Coq
- Univ Rouen Normandie, CRFDP, UR 7475, F-76000, Rouen, France
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Gandhi S, Novoa Valentin NM, Brunelli A, Schmitt-Opitz I, Lugaresi M, Daddi N, Decaluwe H, Batirel H, Veronesi G, Baste JM, Lyberis P, Dunning J. Results of an exploratory survey within ESTS membership in 2022 on current trend of robotic-assisted thoracic surgery and its training perspectives. Interdiscip Cardiovasc Thorac Surg 2024; 38:ivae031. [PMID: 38441251 PMCID: PMC11014782 DOI: 10.1093/icvts/ivae031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 02/05/2024] [Accepted: 03/02/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVES Robotic-assisted thoracic surgery (RATS) is increasingly used in our specialty. We surveyed European Society of Thoracic Surgeons membership with the objective to determine current status of robotic thoracic surgery practice including training perspectives. METHODS A survey of 17 questions was rolled out with 1 surgeon per unit responses considered as acceptable. RESULTS A total of 174 responses were obtained; 56% (97) were board-certified thoracic surgeons; 28% (49) were unit heads. Most responses came from Italy (20); 22% (38) had no robot in their institutions, 31% (54) had limited access and only 17% (30) had full access including proctoring. Da Vinci Xi was the commonest system in 56% (96) centres, 25% (41) of them had dual console in all systems, whereas RATS simulator was available only in half (51.18% or 87). Video-assisted thoracic surgery (VATS) was the most commonly adopted surgical approach in 81% of centres (139), followed by thoracotomy in 67% (115) and RATS in 36% (62); 39% spent their training time on robotic simulator for training, 51% on robotic wet/dry lab, which being no significantly different to 46-59% who had training on VATS platform. There was indeed huge overlap between simulator models or varieties usage; 52% (90) reported of robotic surgery not a part of training curriculum with no plans to introduce it in future. Overall, 51.5% (89) responded of VATS experience being helpful in robotic training in view of familiarity with minimally invasive surgery anatomical views and dissection; 71% (124) reported that future thoracic surgeons should be proficient in both VATS and RATS. Half of the respondents found no difference in earlier chest drain removal with either approach (90), 35% (60) reported no difference in postoperative pain and 49% (84) found no difference in hospital stay; 52% (90) observed better lymph node harvest by RATS. CONCLUSIONS Survey concluded on a positive response with at least 71% (123) surgeons recommending to adopt robotics in future.
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Affiliation(s)
- Shilpa Gandhi
- Cardiac surgery unit, Department of Cardiothoracic Surgery, St Georges’ University Hospital NHS Foundation Trust, London, UK
| | | | | | | | - Marialuisa Lugaresi
- Department of Medical and Surgical Sciences, University of Bologna Medical School, Bologna, Italy
| | - Niccolò Daddi
- Division of Thoracic Surgery unit, IRCCS Azienda Ospedaliero-Universitaria, University of Bologna Medical School, Bologna, Italy
| | - Herbert Decaluwe
- Division of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
| | - Hasan Batirel
- Division of Thoracic Surgery, Biruni University School of Medicine, Istanbul, Turkey
| | - Giulia Veronesi
- Division of Thoracic Surgery, Universita Vita e Salute San Raffaele, Milan, Italy
| | - Jean-Marc Baste
- Cardiothoracic Department, Rouen University Hospital, Inserm U1096, UNIVRouen, Normandy, France
| | | | - Joel Dunning
- Division of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
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Prisciandaro E, Bertolaccini L, Fieuws S, Cara A, Spaggiari L, Huang L, Petersen RH, Ambrogi MC, Sicolo E, Barbarossa A, De Leyn P, Sporici D, Balsamo L, Donlagic A, Gonzalez M, Fuentes-Gago MG, Forcada-Barreda C, Congedo MT, Margaritora S, Belaroussi Y, Thumerel M, Tricard J, Felix P, Lebeda N, Opitz I, De Palma A, Marulli G, Braggio C, Thomas PA, Mbadinga F, Baste JM, Sayan B, Yildizeli B, Van Raemdonck DE, Weder W, Ceulemans LJ. Multicentre retrospective analysis on pulmonary metastasectomy: an European perspective. Eur J Cardiothorac Surg 2024; 65:ezae141. [PMID: 38579246 DOI: 10.1093/ejcts/ezae141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 03/27/2024] [Accepted: 04/03/2024] [Indexed: 04/07/2024] Open
Abstract
OBJECTIVES To assess the current practice of pulmonary metastasectomy at 15 European Centres. Short- and long-term outcomes were analysed. METHODS Retrospective analysis on patients ≥18 years who underwent curative-intent pulmonary metastasectomy (January 2010 to December 2018). Data were collected on a purpose-built database (REDCap). Exclusion criteria were: previous lung/extrapulmonary metastasectomy, pneumonectomy, non-curative intent and evidence of extrapulmonary recurrence at the time of lung surgery. RESULTS A total of 1647 patients [mean age 59.5 (standard deviation; SD = 13.1) years; 56.8% males] were included. The most common primary tumour was colorectal adenocarcinoma. The mean disease-free interval was 3.4 (SD = 3.9) years. Relevant comorbidities were observed in 53.8% patients, with a higher prevalence of metabolic disorders (32.3%). Video-assisted thoracic surgery was the chosen approach in 54.9% cases. Wedge resections were the most common operation (67.1%). Lymph node dissection was carried out in 41.4% cases. The median number of resected lesions was 1 (interquartile range 25-75% = 1-2), ranging from 1 to 57. The mean size of the metastases was 18.2 (SD = 14.1) mm, with a mean negative resection margin of 8.9 (SD = 9.4) mm. A R0 resection of all lung metastases was achieved in 95.7% cases. Thirty-day postoperative morbidity was 14.5%, with the most frequent complication being respiratory failure (5.6%). Thirty-day mortality was 0.4%. Five-year overall survival and recurrence-free survival were 62.0% and 29.6%, respectively. CONCLUSIONS Pulmonary metastasectomy is a low-risk procedure that provides satisfactory oncological outcomes and patient survival. Further research should aim at clarifying the many controversial aspects of its daily clinical practice.
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Affiliation(s)
- Elena Prisciandaro
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Leuven Intestinal Failure and Transplantation Centre (LIFT), University Hospitals Leuven, Leuven, Belgium
| | - Luca Bertolaccini
- Department of Thoracic Surgery, IEO European Institute of Oncology IRCCS, Milano, Italy
| | - Steffen Fieuws
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, KU Leuven-University of Leuven, Leuven, Belgium
| | - Andrea Cara
- Department of Thoracic Surgery, IEO European Institute of Oncology IRCCS, Milano, Italy
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IEO European Institute of Oncology IRCCS, Milano, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy
| | - Lin Huang
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - René H Petersen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Marcello C Ambrogi
- Division of Thoracic Surgery, Cardiac, Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Elisa Sicolo
- Division of Thoracic Surgery, Cardiac, Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Annalisa Barbarossa
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Leuven Intestinal Failure and Transplantation Centre (LIFT), University Hospitals Leuven, Leuven, Belgium
| | - Paul De Leyn
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Leuven Intestinal Failure and Transplantation Centre (LIFT), University Hospitals Leuven, Leuven, Belgium
| | - Diana Sporici
- Unit of Thoracic Surgery, Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Ludovica Balsamo
- Unit of Thoracic Surgery, Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Abid Donlagic
- Service of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Michel Gonzalez
- Service of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | | | | | - Maria T Congedo
- Unit of Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Stefano Margaritora
- Unit of Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Yaniss Belaroussi
- Department of Thoracic Surgery, University Hospital Bordeaux, Pessac, France
| | - Matthieu Thumerel
- Department of Thoracic Surgery, University Hospital Bordeaux, Pessac, France
| | - Jérémy Tricard
- Department of Cardiac and Thoracic Surgery, University Hospital Limoges, Limoges, France
| | - Pierre Felix
- Department of Cardiac and Thoracic Surgery, University Hospital Limoges, Limoges, France
| | - Nina Lebeda
- Department of Thoracic Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Angela De Palma
- Section of Thoracic Surgery, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari "Aldo Moro", Bari, Italy
| | - Giuseppe Marulli
- Section of Thoracic Surgery, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari "Aldo Moro", Bari, Italy
| | - Cesare Braggio
- Department of Thoracic Surgery, Lung Transplantation and Oesophageal Diseases, North Hospital, Marseille, France
| | - Pascal A Thomas
- Department of Thoracic Surgery, Lung Transplantation and Oesophageal Diseases, North Hospital, Marseille, France
| | - Frankie Mbadinga
- Department of General and Cardiothoracic Surgery, University Hospital Rouen, Rouen, France
| | - Jean-Marc Baste
- Department of General and Cardiothoracic Surgery, University Hospital Rouen, Rouen, France
| | - Bihter Sayan
- Department of Thoracic Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Bedrettin Yildizeli
- Department of Thoracic Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Dirk E Van Raemdonck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Leuven Intestinal Failure and Transplantation Centre (LIFT), University Hospitals Leuven, Leuven, Belgium
| | - Walter Weder
- Department of Thoracic Surgery, Bethanien Klinik, Zürich, Switzerland
| | - Laurens J Ceulemans
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Leuven Intestinal Failure and Transplantation Centre (LIFT), University Hospitals Leuven, Leuven, Belgium
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Etienne H, Pagès PB, Iquille J, Falcoz PE, Brouchet L, Berthet JP, Le Pimpec Barthes F, Jougon J, Filaire M, Baste JM, Anne V, Renaud S, D'Annoville T, Meunier JP, Jayle C, Dromer C, Seguin-Givelet A, Legras A, Rinieri P, Jaillard-Thery S, Margot V, Thomas PA, Dahan M, Mordant P. Impact of surgical approach on 90-day mortality after lung resection for nonsmall cell lung cancer in high-risk operable patients. ERJ Open Res 2024; 10:00653-2023. [PMID: 38259816 PMCID: PMC10801767 DOI: 10.1183/23120541.00653-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/15/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction Non-small cell lung cancer (NSCLC) is often associated with compromised lung function. Real-world data on the impact of surgical approach in NSCLC patients with compromised lung function are still lacking. The objective of this study is to assess the potential impact of minimally invasive surgery (MIS) on 90-day post-operative mortality after anatomic lung resection in high-risk operable NSCLC patients. Methods We conducted a retrospective multicentre study including all patients who underwent anatomic lung resection between January 2010 and October 2021 and registered in the Epithor database. High-risk patients were defined as those with a forced expiratory volume in 1 s (FEV1) or diffusing capacity of the lung for carbon monoxide (DLCO) value below 50%. Co-primary end-points were the impact of risk status on 90-day mortality and the impact of MIS on 90-day mortality in high-risk patients. Results Of the 46 909 patients who met the inclusion criteria, 42 214 patients (90%) with both preoperative FEV1 and DLCO above 50% were included in the low-risk group, and 4695 patients (10%) with preoperative FEV1 and/or preoperative DLCO below 50% were included in the high-risk group. The 90-day mortality rate was significantly higher in the high-risk group compared to the low-risk group (280 (5.96%) versus 1301 (3.18%); p<0.0001). In high-risk patients, MIS was associated with lower 90-day mortality compared to open surgery in univariate analysis (OR=0.04 (0.02-0.05), p<0.001) and in multivariable analysis after propensity score matching (OR=0.46 (0.30-0.69), p<0.001). High-risk patients operated through MIS had a similar 90-day mortality rate compared to low-risk patients in general (3.10% versus 3.18% respectively). Conclusion By examining the impact of surgical approaches on 90-day mortality using a nationwide database, we found that either preoperative FEV1 or DLCO below 50% is associated with higher 90-day mortality, which can be reduced by using minimally invasive surgical approaches. High-risk patients operated through MIS have a similar 90-day mortality rate as low-risk patients.
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Affiliation(s)
- Harry Etienne
- Department of Thoracic and Vascular Surgery, Hôpital Bichat, APHP, Paris, France
| | | | - Jules Iquille
- Department of Thoracic and Vascular Surgery, Hôpital Bichat, APHP, Paris, France
| | - Pierre Emmanuel Falcoz
- Department of Thoracic Surgery, Nouvel Hôpital Civil, CHU Strasbourg, Strasbourg, France
| | - Laurent Brouchet
- Department of Thoracic Surgery, Hôpital Larrey, CHU Toulouse, Toulouse, France
| | | | | | - Jacques Jougon
- Department of Thoracic Surgery, Hôpital Haut Lévêque, CHU Bordeaux, Bordeaux, France
| | - Marc Filaire
- Department of Thoracic Surgery, Centre Jean Perrin, Clermont-Ferrand, UK
| | - Jean-Marc Baste
- Department of Thoracic Surgery, Hôpital Charles-Nicolle, CHU Rouen, Rouen, France
- Department of Thoracic Surgery, Hôpital Robert Schuman, Vantoux, France
| | - Valentine Anne
- Department of Thoracic Surgery, Hôpital Arnault Tzanck, Mougins, France
| | - Stéphane Renaud
- Department of Thoracic Surgery, Hôpital Central, CHU Nancy, Nancy, France
| | - Thomas D'Annoville
- Department of Thoracic Surgery, Clinique du Millénaire, Montpellier, France
| | | | - Christophe Jayle
- Department of Thoracic Surgery, Hôpital La Mileterie, CHU Poitiers, Poitiers, France
| | - Christian Dromer
- Department of Thoracic Surgery, Polyclinique Nord-Aquitaine, Bordeaux, France
| | | | - Antoine Legras
- Department of Thoracic Surgery, Hôpital Trousseau, CHU Tours, Tours, France
| | - Philippe Rinieri
- Department of Thoracic Surgery, Clinique du Cèdre, Bois-Guillaume, France
| | | | | | | | - Marcel Dahan
- Department of Thoracic Surgery, Hôpital Larrey, CHU Toulouse, Toulouse, France
| | - Pierre Mordant
- Department of Thoracic and Vascular Surgery, Hôpital Bichat, APHP, Paris, France
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Haddad E, Bottet B, Thiebaut PA, Morin S, Dreyfus H, Vannier É, Vincent C, Marguet F, Lamy A, Sobol H, Baste JM, Guisier F, Sabourin JC, Piton N. Squamous Cell Carcinoma of the Lung With Microsatellite Instability in a Patient With Lynch Syndrome: A Case Report. JTO Clin Res Rep 2024; 5:100595. [PMID: 38229768 PMCID: PMC10788277 DOI: 10.1016/j.jtocrr.2023.100595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/09/2023] [Accepted: 10/14/2023] [Indexed: 01/18/2024] Open
Abstract
Lynch syndrome is the most common autosomal dominant inherited cancer predisposing syndrome, due to mutations in DNA mismatch repair genes. The key feature of cancers in Lynch syndrome is microsatellite instability and a high risk of developing mainly colorectal and uterine cancers. However, cancers with microsatellite instability outside this spectrum, for example, lung cancer, are extremely rare. Here, we report a case of squamous cell carcinoma of the lung with microsatellite instability in a patient with Lynch syndrome.
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Affiliation(s)
- Emna Haddad
- University of Rouen Normandy (UNIROUEN), Institut National de la Santé et de la Recherche Médicale (INSERM) U1245, Rouen, France
- Department of Pathology, Hospital Center University De Rouen (CHU Rouen), Rouen, France
| | - Benjamin Bottet
- Department of General and Thoracic Surgery, CHU Rouen, Rouen, France
| | - Pierre-Alain Thiebaut
- University of Rouen Normandy (UNIROUEN), Institut National de la Santé et de la Recherche Médicale (INSERM) U1245, Rouen, France
- Department of Pathology, Hospital Center University De Rouen (CHU Rouen), Rouen, France
| | | | | | | | - Colette Vincent
- Centre Hospitalier Intercommunal (CHI) Elbeuf Louviers Val de Reuil, Saint-Aubin-lès-Elbeuf, France
| | - Florent Marguet
- University of Rouen Normandy (UNIROUEN), Institut National de la Santé et de la Recherche Médicale (INSERM) U1245, Rouen, France
- Department of Pathology, Hospital Center University De Rouen (CHU Rouen), Rouen, France
| | - Aude Lamy
- University of Rouen Normandy (UNIROUEN), Institut National de la Santé et de la Recherche Médicale (INSERM) U1245, Rouen, France
- Department of Pathology, Hospital Center University De Rouen (CHU Rouen), Rouen, France
| | - Hagay Sobol
- Département de Biologie du Cancer, Institut Paloi-Calmettes, Marseille, France
- Faculté des Sciences Médicales et Paramédicales, Aix-Marseille University (AMU), Marseille, France
| | - Jean-Marc Baste
- Department of General and Thoracic Surgery, CHU Rouen, Rouen, France
| | | | - Jean-Christophe Sabourin
- University of Rouen Normandy (UNIROUEN), Institut National de la Santé et de la Recherche Médicale (INSERM) U1245, Rouen, France
- Department of Pathology, Hospital Center University De Rouen (CHU Rouen), Rouen, France
| | - Nicolas Piton
- University of Rouen Normandy (UNIROUEN), Institut National de la Santé et de la Recherche Médicale (INSERM) U1245, Rouen, France
- Department of Pathology, Hospital Center University De Rouen (CHU Rouen), Rouen, France
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Patel YS, Baste JM, Shargall Y, Waddell TK, Yasufuku K, Machuca TN, Xie F, Thabane L, Hanna WC. Robotic Lobectomy Is Cost-effective and Provides Comparable Health Utility Scores to Video-assisted Lobectomy: Early Results of the RAVAL Trial. Ann Surg 2023; 278:841-849. [PMID: 37551615 DOI: 10.1097/sla.0000000000006073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
OBJECTIVE The aim of this study was to determine if robotic-assisted lobectomy (RPL-4) is cost-effective and offers improved patient-reported health utility for patients with early-stage non-small cell lung cancer when compared with video-assisted thoracic surgery lobectomy (VATS-lobectomy). BACKGROUND Barriers against the adoption of RPL-4 in publicly funded health care include the paucity of high-quality prospective trials and the perceived high cost of robotic surgery. METHODS Patients were enrolled in a blinded, multicentered, randomized controlled trial in Canada, the United States, and France, and were randomized 1:1 to either RPL-4 or VATS-lobectomy. EuroQol 5 Dimension 5 Level (EQ-5D-5L) was administered at baseline and postoperative day 1; weeks 3, 7, 12; and months 6 and 12. Direct and indirect costs were tracked using standard methods. Seemingly Unrelated Regression was applied to estimate the cost effect, adjusting for baseline health utility. The incremental cost-effectiveness ratio was generated by 10,000 bootstrap samples with multivariate imputation by chained equations. RESULTS Of 406 patients screened, 186 were randomized, and 164 analyzed after the final eligibility review (RPL-4: n=81; VATS-lobectomy: n=83). Twelve-month follow-up was completed by 94.51% (155/164) of participants. The median age was 68 (60-74). There were no significant differences in body mass index, comorbidity, pulmonary function, smoking status, baseline health utility, or tumor characteristics between arms. The mean 12-week health utility score was 0.85 (0.10) for RPL-4 and 0.80 (0.19) for VATS-lobectomy ( P =0.02). Significantly more lymph nodes were sampled [10 (8-13) vs 8 (5-10); P =0.003] in the RPL-4 arm. The incremental cost/quality-adjusted life year of RPL-4 was $14,925.62 (95% CI: $6843.69, $23,007.56) at 12 months. CONCLUSION Early results of the RAVAL trial suggest that RPL-4 is cost-effective and associated with comparable short-term patient-reported health utility scores when compared with VATS-lobectomy.
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Affiliation(s)
- Yogita S Patel
- Department of Surgery, Division of Thoracic Surgery, McMaster University, Hamilton, ON, Canada
| | - Jean-Marc Baste
- Department of Surgery, Division of Thoracic Surgery, Rouen Normandy University, Rouen Cedex, France
| | - Yaron Shargall
- Department of Surgery, Division of Thoracic Surgery, McMaster University, Hamilton, ON, Canada
| | - Thomas K Waddell
- Department of Surgery, Division of Thoracic Surgery, University of Toronto, Toronto, ON, Canada
| | - Kazuhiro Yasufuku
- Department of Surgery, Division of Thoracic Surgery, University of Toronto, Toronto, ON, Canada
| | - Tiago N Machuca
- Department of Surgery, Division of Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, FL
| | - Feng Xie
- Department of Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Waël C Hanna
- Department of Surgery, Division of Thoracic Surgery, McMaster University, Hamilton, ON, Canada
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Lula Lukadi J, Mariolo AV, Ozgur EG, Gossot D, Baste JM, De Latour B, Seguin-Givelet A. Upstaged from cT1a-c to pT2a lung cancer, related to visceral pleural invasion patients, after segmentectomy: is it an indication to complete resection to lobectomy? Interdiscip Cardiovasc Thorac Surg 2023; 37:ivad102. [PMID: 37294828 PMCID: PMC10576639 DOI: 10.1093/icvts/ivad102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/09/2023] [Accepted: 06/08/2023] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Segmentectomy may be indicated for T1a-cN0 non-small-cell lung cancer. However, several patients are upstaged pT2a at final pathological examination due to visceral pleural invasion (VPI). As resection is usually not completed to lobectomy, this may raise issue of potential worse prognosis. The aim of this study is to compare prognosis of VPI upstaged cT1N0 patients operated on by segmentectomy or lobectomy. METHODS Data of patients from 3 centres were analysed. This was a retrospective study, of patients operated on from April 2007 to December 2019. Survival and recurrence were assessed by Kaplan-Meier method and cox regression analysis. RESULTS Lobectomy and segmentectomy were performed in 191 (75.4%) and in 62 (24.5%) patients, respectively. No difference in 5-year disease-free survival rate between lobectomy (70%) and segmentectomy (64.7%) was observed. There was no difference in loco-regional recurrence, nor in ipsilateral pleural recurrence. The distant recurrence rate was higher (P = 0.027) in the segmentectomy group. Five-year overall survival rate was similar for both lobectomy (73%) and segmentectomy (75.8%) groups. After propensity score matching, there was no difference in 5-year disease-free survival rate (P = 0.27) between lobectomy (85%) and segmentectomy (66.9%), and in 5-year overall survival rate (P = 0.42) between the 2 groups (lobectomy 76.3% vs segmentectomy 80.1%). Segmentectomy was not impacting neither recurrence, nor survival. CONCLUSIONS Detection of VPI (pT2a upstage) in patients who underwent segmentectomy for cT1a-c non-small-cell lung cancer does not seem to be an indication to extend resection to lobectomy.
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Affiliation(s)
- Joseph Lula Lukadi
- Thoracic Department, Curie-Montsouris Thoracic Institute, Institut Mutualiste Montsouris, Paris, France
| | - Alessio Vincenzo Mariolo
- Thoracic Department, Curie-Montsouris Thoracic Institute, Institut Mutualiste Montsouris, Paris, France
| | - Emrah Gokay Ozgur
- Faculty of Medicine, Department of Biostatistics, Marmara University, Istanbul, Turkey
| | - Dominique Gossot
- Thoracic Department, Curie-Montsouris Thoracic Institute, Institut Mutualiste Montsouris, Paris, France
| | - Jean-Marc Baste
- Thoracic Surgery Department, Rouen University Hospital, Rouen, France
- Normandie University UNIROUEN, Rouen, France
| | - Bertrand De Latour
- Thoracic and Cardiovascular Surgery Department, Rennes University Hospital, Rennes, France
| | - Agathe Seguin-Givelet
- Thoracic Department, Curie-Montsouris Thoracic Institute, Institut Mutualiste Montsouris, Paris, France
- Faculty of Medecine SMBH, Paris 13 University, Sorbonne Paris cité Bobiny, Bobigny, France
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8
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Soilly AL, Aho Glélé LS, Bernard A, Abou Hanna H, Filaire M, Magdaleinat P, Marty-Ané C, Tronc F, Grima R, Baste JM, Thomas PA, Richard De Latour B, Pforr A, Pagès PB. Medico-economic impact of thoracoscopy versus thoracotomy in lung cancer: multicentre randomised controlled trial (Lungsco01). BMC Health Serv Res 2023; 23:1004. [PMID: 37723516 PMCID: PMC10507914 DOI: 10.1186/s12913-023-09962-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/24/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Lungsco01 is the first study assessing the real benefits and the medico-economic impact of video-thoracoscopy versus open thoracotomy for non-small cell lung cancer in the French context. METHODS Two hundred and fifty nine adult patients from 10 French centres were randomised in this prospective multicentre randomised controlled trial, between July 29, 2016, and November 24, 2020. Survival from surgical intervention to day 30 and later was compared with the log-rank test. Total quality-adjusted-life-years (QALYs) were calculated using the EQ-5D-3L®. For medico-economic analyses at 30 days and at 3 months after surgery, resources consumed were valorised (€ 2018) from a hospital perspective. First, since mortality was infrequent and not different between the two arms, cost-minimisation analyses were performed considering only the cost differential. Second, based on complete cases on QALYs, cost-utility analyses were performed taking into account cost and QALY differential. Acceptability curves and the 95% confidence intervals for the incremental ratios were then obtained using the non-parametric bootstrap method (10,000 replications). Sensitivity analyses were performed using multiple imputations with the chained equation method. RESULTS The average cumulative costs of thoracotomy were lower than those of video-thoracoscopy at 30 days (€9,730 (SD = 3,597) vs. €11,290 (SD = 4,729)) and at 3 months (€9,863 (SD = 3,508) vs. €11,912 (SD = 5,159)). In the cost-utility analyses, the incremental cost-utility ratio was €19,162 per additional QALY gained at 30 days (€36,733 at 3 months). The acceptability curve revealed a 64% probability of efficiency at 30 days for video-thoracoscopy, at a widely-accepted willingness-to-pay threshold of €25,000 (34% at 3 months). Ratios increased after multiple imputations, implying a higher cost for video-thoracoscopy for an additional QALY gain (ratios: €26,015 at 30 days, €42,779 at 3 months). CONCLUSIONS Given our results, the economic efficiency of video-thoracoscopy at 30 days remains fragile at a willingness-to-pay threshold of €25,000/QALY. The economic efficiency is not established beyond that time horizon. The acceptability curves given will allow decision-makers to judge the probability of efficiency of this technology at other willingness-to-pay thresholds. TRIAL REGISTRATION NCT02502318.
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Affiliation(s)
- Anne-Laure Soilly
- Direction of Clinical Research and Innovation, Clinical Research Unit-Methodological Support Network, CHU Dijon-Bourgogne, 21000, Dijon, France.
| | | | - Alain Bernard
- Department of Thoracic and Cardiovascular Surgery, CHU Dijon, Dijon, France
| | - Halim Abou Hanna
- Department of Thoracic and Cardiovascular Surgery, CHU Dijon, Dijon, France
| | - Marc Filaire
- Department of Thoracic Surgery and Endocrine Surgery, Centre Jean Perrin, Clermont Auvergne University, Clermont-Ferrand, France
| | | | - Charles Marty-Ané
- Department of Thoracic and Cardiovascular Surgery, Hôpital Arnaud de Villeneuve, CHU Montpellier, Montpellier, France
| | - François Tronc
- Department of Thoracic Surgery, HCL, Hôpital Louis Pradel, Bron, France
| | - Renaud Grima
- Department of Thoracic Surgery, HCL, Hôpital Louis Pradel, Bron, France
| | | | - Pascal-Alexandre Thomas
- Department of Thoracic Surgery, North University Hospital, Aix-Marseille University & APHM, Marseille, France
| | | | - Arnaud Pforr
- Department of Thoracic and Vascular Surgery, Avignon, Avignon, CH, France
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9
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Bottet B, Piton N, Selim J, Sarsam M, Guisier F, Baste JM. Beyond the Frontline: A Triple-Line Approach of Thoracic Surgeons in Lung Cancer Management-State of the Art. Cancers (Basel) 2023; 15:4039. [PMID: 37627067 PMCID: PMC10452134 DOI: 10.3390/cancers15164039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 07/26/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
Non-small cell lung cancer (NSCLC) is now described as an extremely heterogeneous disease in its clinical presentation, histology, molecular characteristics, and patient conditions. Over the past 20 years, the management of lung cancer has evolved with positive results. Immune checkpoint inhibitors have revolutionized the treatment landscape for NSCLC in both metastatic and locally advanced stages. The identification of molecular alterations in NSCLC has also allowed the development of targeted therapies, which provide better outcomes than chemotherapy in selected patients. However, patients usually develop acquired resistance to these treatments. On the other hand, thoracic surgery has progressed thanks to minimally invasive procedures, pre-habilitation and enhanced recovery after surgery. Moreover, within thoracic surgery, precision surgery considers the patient and his/her disease in their entirety to offer the best oncologic strategy. Surgeons support patients from pre-operative rehabilitation to surgery and beyond. They are involved in post-treatment follow-up and lung cancer recurrence. When conventional therapies are no longer effective, salvage surgery can be performed on selected patients.
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Affiliation(s)
- Benjamin Bottet
- Department of General and Thoracic Surgery, Hospital Center University De Rouen, 1 Rue de Germont, F-76000 Rouen, France; (B.B.); (M.S.)
| | - Nicolas Piton
- Department of Pathology, UNIROUEN, INSERM U1245, CHU Rouen, Normandy University, F-76000 Rouen, France;
| | - Jean Selim
- Department of Anaesthesiology and Critical Care, CHU Rouen, F-76000 Rouen, France;
- INSERM EnVI UMR 1096, University of Rouen Normandy, F-76000 Rouen, France
| | - Matthieu Sarsam
- Department of General and Thoracic Surgery, Hospital Center University De Rouen, 1 Rue de Germont, F-76000 Rouen, France; (B.B.); (M.S.)
| | - Florian Guisier
- Department of Pneumology, CHU Rouen, 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
| | - Jean-Marc Baste
- Department of General and Thoracic Surgery, Hospital Center University De Rouen, 1 Rue de Germont, F-76000 Rouen, France; (B.B.); (M.S.)
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10
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Dusseaux MM, Grego V, Baste JM, Selim J. Paravertebral block combined with serratus anterior plane block after video-assisted thoracic surgery: a prospective randomized controlled trial-Response. Eur J Cardiothorac Surg 2023:ezad246. [PMID: 37410079 DOI: 10.1093/ejcts/ezad246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 07/05/2023] [Indexed: 07/07/2023] Open
Affiliation(s)
| | - Victor Grego
- Department of Anaesthesiology and Critical Care, CHU Rouen, F-76000, Rouen, France
| | - Jean-Marc Baste
- Univ Rouen Normandy INSERM EnVI UMR 1096, F-76000, Rouen, France
- Department of Thoracic Surgery, CHU Rouen, F-76000, Rouen, France
| | - Jean Selim
- Department of Anaesthesiology and Critical Care, CHU Rouen, F-76000, Rouen, France
- Univ Rouen Normandy INSERM EnVI UMR 1096, F-76000, Rouen, France
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11
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Madelaine L, Baste JM, Trousse D, Vidal R, Durand M, Pagès PB. Impact of robotic access on outcomes after lung cancer surgery in France: Analysis from the Epithor database. JTCVS Open 2023; 14:523-537. [PMID: 37425455 PMCID: PMC10328832 DOI: 10.1016/j.xjon.2023.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 01/30/2023] [Accepted: 02/06/2023] [Indexed: 07/11/2023]
Abstract
Introduction We aimed to compare postoperative outcomes after pulmonary resection for lung cancer after open thoracotomy (OT), video-assisted (VATS), and robotic-assisted (RA) thoracic surgery using a propensity score analysis. Methods From 2010 to 2020, 38,423 patients underwent resection for lung cancer. In total, 58.05% (n = 22,306) were operated by thoracotomy, 35.35% (n = 13,581) by VATS, and 6.6% (n = 2536) by RA. A propensity score was used to create balanced groups with weighting. End points were in-hospital mortality, postoperative complications, and length of hospital stay, reported by odds ratios (ORs) and 95% confidence intervals (CIs). Results VATS decreased in-hospital mortality compared with OT (OR, 0.64; 95% CI, 0.58-0.79; P < .0001) but not compared with RA (OR, 1.09; 95% CI, 0.77-1.52; P = .61). VATS reduced major postoperative complications compared with OT (OR, 0.83; 95% CI, 0.76-0.92; P < .0001) but not RA (OR, 1.01; 95% CI, 0.84-1.21; P = .17). VATS reduced prolonged air leaks rate compared with OT (OR, 0.9; 95% CI, 0.84-0.98; P = .015) but not RA (OR, 1.02; 95% CI, 0.88-1.18; P = .77). As compared with OT, VATS and RA decreased the incidence of atelectasis (respectively: OR, 0.57; 95% CI, 0.50-0.65; P < .0001 and OR, 0.75; 95% CI, 0.60-0.95; P = .016); the incidence of pneumonia (OR, 0.75; 95% CI, 0.67-0.83; P < .0001 and OR, 0.62; 95% CI, 0.50-0.78; P < .0001); and the number of postoperative arrhythmias (OR, 0.69; 95% CI, 0.61-0.78; P < .0001 and OR, 0.75; 95% CI, 0.59-0.96; P = .024). Both VATS and RA resulted in shorter hospital stays (-1.91 days [-2.24; -1.58]; P < .0001 and -2.73 days [-3.1; -2.36]; P < .0001, respectively). Conclusions RA appeared to decrease postoperative pulmonary complications as well as VATS compared with OT. VATS decreased postoperative mortality as compared with RA and OT.
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Affiliation(s)
- Leslie Madelaine
- Department of Thoracic Surgery, CHU Dijon, Bocage Central, Dijon, France
| | - Jean-Marc Baste
- Department of Thoracic Surgery, CHU Rouen, Hôpital Charles-Nicolle, Rouen, France
| | - Delphine Trousse
- Department of Thoracic Surgery and Esophageal, Hôpital Nord, CHU de Marseille, Marseille, France
| | - Renaud Vidal
- Department of Thoracic Surgery, Hôpital Européen, Marseille, France
| | - Marion Durand
- Department of Thoracic Surgery, Ramsay Santé, Hôpital Privé d’Antony, Antony, France
| | - Pierre-Benoit Pagès
- Department of Thoracic Surgery, CHU Dijon, Bocage Central, Dijon, France
- INSERM UMR 1231, CHU Dijon, University of Burgundy, Dijon, France
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12
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Dusseaux MM, Grego V, Baste JM, Besnier E, Boujibar F, Koscianski G, Ben Yahia MM, Compere V, Clavier T, Vannier M, Selim J. Paravertebral block combined with serratus anterior plane block after video-assisted thoracic surgery: a prospective randomized controlled trial. Eur J Cardiothorac Surg 2023:7140138. [PMID: 37094177 DOI: 10.1093/ejcts/ezad170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/27/2023] [Accepted: 04/23/2023] [Indexed: 04/26/2023] Open
Abstract
INTRODUCTION Adequate pain management after thoracoscopic surgery is a major issue in the prevention of respiratory complications. The combination of the paravertebral block (PVB) with the serratus anterior plane block (SAPB) may decrease postoperative pain. The objective of this study was to evaluate the impact of the combination of PVB and SAPB on the consumption of morphine and pain after video or robot-assisted thoracic surgery (VATS or RATS). METHODS The main objective of this randomized controlled trial was to compare the cumulative postoperative morphine consumption at 24-hr between a group having PVB (PVB group) and a group having PVB and SAPB (PV-SAPB group). Postoperative pain at 6-hr and 24-hr and morphine-related complications were also assessed. RESULTS 112 patients were included with 56 in each group. There was no difference in median cumulative morphine consumption at 24-hr between the 2 groups (p = 0.1640). At 6-hr, the median postoperative pain was higher in the PVB group compared to the PV-SAPB group (3 [0;4] vs. 2 [0;3], p = 0.0231). There were no differences between the 2 groups for pain at 24-hr and morphine related-complications. CONCLUSION We did not find any difference in morphine consumption between the two groups. Our results suggest that the combination of PVB and SAPB for VATS or RATS is safe effective and reliable and could be an alternative to PVB alone in certain indications.
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Affiliation(s)
| | - Victor Grego
- Department of Anaesthesiology and Critical Care, CHU Rouen, F-76000 Rouen, France
| | - Jean-Marc Baste
- Univ Rouen Normandy INSERM EnVI UMR 1096, F-76000 Rouen, France
- Department of Thoracic Surgery, CHU Rouen, F-76000, Rouen, France
| | - Emmanuel Besnier
- Department of Anaesthesiology and Critical Care, CHU Rouen, F-76000 Rouen, France
- Univ Rouen Normandy INSERM EnVI UMR 1096, F-76000 Rouen, France
| | - Fairuz Boujibar
- Univ Rouen Normandy INSERM EnVI UMR 1096, F-76000 Rouen, France
- Department of Thoracic Surgery, CHU Rouen, F-76000, Rouen, France
| | - Godefroy Koscianski
- Department of Anaesthesiology and Critical Care, CHU Rouen, F-76000 Rouen, France
| | | | - Vincent Compere
- Department of Anaesthesiology and Critical Care, CHU Rouen, F-76000 Rouen, France
| | - Thomas Clavier
- Department of Anaesthesiology and Critical Care, CHU Rouen, F-76000 Rouen, France
- Univ Rouen Normandy INSERM EnVI UMR 1096, F-76000 Rouen, France
| | - Margot Vannier
- Rouen University Hospital, Department of Biostatistics, F-76000 Rouen, France
| | - Jean Selim
- Department of Anaesthesiology and Critical Care, CHU Rouen, F-76000 Rouen, France
- Univ Rouen Normandy INSERM EnVI UMR 1096, F-76000 Rouen, France
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13
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Durey B, Djerada Z, Boujibar F, Besnier E, Montagne F, Baste JM, Dusseaux MM, Compere V, Clavier T, Selim J. Erector Spinae Plane Block versus Paravertebral Block after Thoracic Surgery for Lung Cancer: A Propensity Score Study. Cancers (Basel) 2023; 15:cancers15082306. [PMID: 37190233 DOI: 10.3390/cancers15082306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/13/2023] [Accepted: 04/13/2023] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION The prevention of respiratory complications is a major issue after thoracic surgery for lung cancer, and requires adequate post-operative pain management. The erector spinae plane block (ESPB) may decrease post-operative pain. The objective of this study was to evaluate the impact of ESPB on pain after video or robot-assisted thoracic surgery (VATS or RATS). METHODS The main outcome of this retrospective study with a propensity score analysis (PSA) was to compare the post-operative pain at 24 h at rest and at cough between a group that received ESPB and a group that received paravertebral block (PVB). Post-operative morphine consumption at 24 h and complications were also assessed. RESULTS One hundred and seven patients were included: 54 in the ESPB group and 53 in the PVB group. The post-operative median pain score at rest and cough was lower in the ESPB group compared to the PVB group at 24 h (respectively, at rest 2 [1; 3.5] vs. 2 [0; 4], p = 0.0181, with PSA; ESPB -0.80 [-1.50; -0.10], p = 0.0255, and at cough (4 [3; 6] vs. 5 [4; 6], p = 0.0261, with PSA; ESPB -1.48 [-2.65; -0.31], p = 0.0135). There were no differences between groups concerning post-operative morphine consumption at 24 h and respiratory complications. CONCLUSIONS Our results suggest that ESPB is associated with less post-operative pain at 24 h than PVB after VATS or RATS for lung cancer. Furthermore, ESPB is an acceptable and safe alternative compared to PVB.
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Affiliation(s)
- Benjamin Durey
- Department of Anaesthesiology and Critical Care, CHU Rouen, 76000 Rouen, France
| | - Zoubir Djerada
- Department of Medical Pharmacology, University of Reims Champagne-Ardenne, EA3801, SFR CAP-Santé, 51000 Reims, France
| | - Fairuz Boujibar
- Univ Rouen Normandie, INSERM EnVI UMR 1096, 76000 Rouen, France
- Department of Thoracic Surgery, Rouen University Hospital, 76000 Rouen, France
| | - Emmanuel Besnier
- Department of Anaesthesiology and Critical Care, CHU Rouen, 76000 Rouen, France
- Univ Rouen Normandie, INSERM EnVI UMR 1096, 76000 Rouen, France
| | - François Montagne
- Department of Thoracic Surgery, Rouen University Hospital, 76000 Rouen, France
| | - Jean-Marc Baste
- Univ Rouen Normandie, INSERM EnVI UMR 1096, 76000 Rouen, France
- Department of Thoracic Surgery, Rouen University Hospital, 76000 Rouen, France
| | | | - Vincent Compere
- Department of Anaesthesiology and Critical Care, CHU Rouen, 76000 Rouen, France
| | - Thomas Clavier
- Department of Anaesthesiology and Critical Care, CHU Rouen, 76000 Rouen, France
- Univ Rouen Normandie, INSERM EnVI UMR 1096, 76000 Rouen, France
| | - Jean Selim
- Department of Anaesthesiology and Critical Care, CHU Rouen, 76000 Rouen, France
- Univ Rouen Normandie, INSERM EnVI UMR 1096, 76000 Rouen, France
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14
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El Husseini K, Baste JM, Bouyeure-Petit AC, Lhuillier E, Cuvelier A, Decazes P, Vera P, Similowski T, Patout M. Respiratory muscle metabolic activity on PET/CT correlates with obstructive ventilatory defect severity and prognosis in patients undergoing lung cancer surgery. Respirology 2023; 28:551-560. [PMID: 36855939 DOI: 10.1111/resp.14475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 01/24/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND AND OBJECTIVE Respiratory muscle activity is increased in patients with chronic respiratory disease. 18 F-FDG-PET/CT can assess respiratory muscle activity. We hypothesized that respiratory muscles metabolism was correlated to lung function impairment and was associated to prognosis in patients undergoing lung cancer surgery based on the research question whether respiratory muscle metabolism quantitatively correlates with the severity of lung function impairment in patients? Does respiratory muscle hypermetabolism have prognostic value? METHODS Patients undergoing 18 F-FDG-PET/CT and pulmonary function tests prior to lung cancer surgery were identified. Maximum Standardized Uptake Value (SUVm) were measured in each respiratory muscle group (sternocleidomastoid, scalene, intercostal, diaphragm), normalized against deltoid SUVm. Respiratory muscle hypermetabolism was defined as SUVm >90th centile in any respiratory muscle group. Clinical outcomes were collected from a prospective cohort. RESULTS One hundred fifty-six patients were included, mostly male [110 (71%)], 53 (34%) with previous diagnosis of COPD. Respiratory muscle SUVm were: scalene: 1.84 [1.51-2.25], sternocleidomastoid 1.64 [1.34-1.95], intercostal 1.01 [0.84-1.16], diaphragm 1.79 [1.41-2.27]. Tracer uptake was inversely correlated to FEV1 for the scalene (r = -0.29, p < 0.001) and SCM (r = -0.17, p = 0.03) respiratory muscle groups and positively correlated to TLC for the scalene (r = 0.17, p = 0.04). Respiratory muscle hypermetabolism was found in 45 patients (28.8%), who had a lower VO2 max (15.4 [14.2-17.5] vs. 17.2 mL/kg/min [15.2-21.1], p = 0.07) and poorer overall survival when adjusting to FEV1% (p < 0.01). CONCLUSION Our findings show respiratory muscle hypermetabolism is associated with lung function impairment and has prognostic significance. 18 F-FDG/PET-CT should be considered as a tool for assessing respiratory muscle activity and to identify high-risk patients.
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Affiliation(s)
- Kinan El Husseini
- Service de Pneumologie, Oncologie Thoracique et Soins Intensifs Respiratoires, CHU Rouen, Rouen, France.,Inserm UMRS1152 Physiopathologie et épidémiologie des maladies respiratoires, Université Paris-Cité, Paris, France.,Service de Pneumologie A, Hôpital Bichat, FHU APOLLO, AP-HP, Paris, France
| | | | | | - Elodie Lhuillier
- Unité de recherche clinique, Centre Henri Becquerel, Rouen, France
| | - Antoine Cuvelier
- Service de Pneumologie, Oncologie Thoracique et Soins Intensifs Respiratoires, CHU Rouen, Rouen, France.,EA3830-GRHV, Institute for Research and Innovation in Biomedicine (IRIB), Normandie Université, UNIRouen, Rouen, France
| | - Pierre Decazes
- Service de Médecine Nucléaire, Centre Henri Becquerel, Rouen, France
| | - Pierre Vera
- Service de Médecine Nucléaire, Centre Henri Becquerel, Rouen, France
| | - Thomas Similowski
- Département R3S (Respiration, Réanimation, Réhabilitation respiratoire, Sommeil), AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Paris, France.,Inserm UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Paris, France
| | - Maxime Patout
- Inserm UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Paris, France.,AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service des Pathologies du Sommeil (Département R3S), Paris, France
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15
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Gravier FE, Buekers J, Smondack P, Boujibar F, Prieur G, Medrinal C, Combret Y, Muir JF, Baste JM, Cuvelier A, Debeaumont D, Bonnevie T. Oxygen Uptake and Heart Rate On-Kinetics during Prehabilitation in Patients with Scheduled Non-Small Cell Lung Cancer Resection. Respiration 2023; 102:173-181. [PMID: 36634636 DOI: 10.1159/000528718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 12/06/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Oxygen uptake (V̇O2) and heart rate (HR) kinetics during a constant work-rate test (CWRT) are used to evaluate the response to exercise in healthy subjects as well as subjects with various pathologies. OBJECTIVES This study aimed to explore the feasibility of these measures and their responsiveness to a prehabilitation program in patients with non-small cell lung cancer (NSCLC). METHOD This study is preregistered (NCT04041297) ancillary analysis of a subgroup of individuals with NSCLC included in the Preo-Dens study (NCT03936764). Thirty individuals performed a moderate-CWRT before and after a 15-session prehabilitation program between July 2019 and April 2021. V̇O2 and HR on-kinetics were extracted from the first 240 s of breath-by-breath data using Box-Jenkins transfer functions. RESULTS Pre/post V̇O2 on-kinetic feature values were reliable for 25/30 participants, and pre/post HR kinetic feature values were reliable for 19/30. V̇O2 time constant (τ) and mean response time reduced from pre-post prehabilitation (mean difference -7.8 s; 95% CI: -14.6 to -1.0, and -8.4 s; 95% CI: -14.7 to -2.0, respectively). For HR on-kinetics, τ did not change from pre-post prehabilitation (median difference -4.0 s; 95% CI: -36.0 to +11.0). V̇O2 and HR response amplitudes reduced significatively from pre-post prehabilitation (mean difference -38.6 mL/min; 95% CI: -73.3 to -3.9, and -3.1 beats/min; 95% CI: -6.4 to -0.2, respectively). CONCLUSION V̇O2 on-kinetic analysis during moderate-CWRT is feasible in individuals with scheduled NSCLC resection, and results are responsive to prehabilitation. These results support a true speeding of the adaptation of aerobic metabolism after a 15-session prehabilitation program.
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Affiliation(s)
- Francis-Edouard Gravier
- ADIR Association, Rouen University Hospital, Rouen, France
- Normandie Rouen university, Institute for Research and Innovation in Biomedicine, UR 3830 GRHVN, Rouen, France
| | - Joren Buekers
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Pauline Smondack
- ADIR Association, Rouen University Hospital, Rouen, France
- Department of Rehabilitation (P3R), Rouen Normandy University Hospital, Rouen, France
| | - Fairuz Boujibar
- Department of Thoracic Surgery, Rouen University Hospital, Rouen, France
- Normandie Rouen university, Institute for Research and Innovation in Biomedicine, INSERM U1096, Rouen, France
| | - Guillaume Prieur
- Normandie Rouen university, Institute for Research and Innovation in Biomedicine, UR 3830 GRHVN, Rouen, France
- Intensive Care Unit Department, Le Havre Hospital, Le Havre, France
| | - Clément Medrinal
- Intensive Care Unit Department, Le Havre Hospital, Le Havre, France
- Université Paris-Saclay, UVSQ, Erphan, Versailles, France
- IFMK Saint Michel, Paris, France
| | - Yann Combret
- Intensive Care Unit Department, Le Havre Hospital, Le Havre, France
| | - Jean-François Muir
- ADIR Association, Rouen University Hospital, Rouen, France
- Normandie Rouen university, Institute for Research and Innovation in Biomedicine, UR 3830 GRHVN, Rouen, France
| | - Jean-Marc Baste
- Department of Thoracic Surgery, Rouen University Hospital, Rouen, France
- Normandie Rouen university, Institute for Research and Innovation in Biomedicine, INSERM U1096, Rouen, France
| | - Antoine Cuvelier
- Normandie Rouen university, Institute for Research and Innovation in Biomedicine, UR 3830 GRHVN, Rouen, France
- Pulmonary, Thoracic Oncology and Respiratory Intensive Care Department, Rouen University Hospital, Rouen, France
| | - David Debeaumont
- Department of Respiratory and Exercise Physiology and CIC-CRB 1404, Rouen University Hospital, Rouen, France
| | - Tristan Bonnevie
- ADIR Association, Rouen University Hospital, Rouen, France
- Normandie Rouen university, Institute for Research and Innovation in Biomedicine, UR 3830 GRHVN, Rouen, France
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Kluge A, Baste JM. Editorial: Imaging for lung surgery. Front Surg 2022; 9:1087973. [PMID: 36582966 PMCID: PMC9794179 DOI: 10.3389/fsurg.2022.1087973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 11/17/2022] [Indexed: 12/14/2022] Open
Affiliation(s)
- Alexander Kluge
- Institute of Diagnostic and Interventional Radiology, Pius-Hospital Oldenburg, Oldenburg, Germany,Correspondence: Alexander Kluge
| | - Jean-Marc Baste
- General and Cardiothoracic Surgery, University Hospital Center Rouen, Rouen, France
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Selim Y, Di Lena É, Abu-Omar N, Baig Z, Verhoeff K, La J, Purich K, Albacete S, Valji R, Purich K, Safar A, Schellenberg M, Schellenberg M, Schellenberg M, Schellenberg M, Schellenberg M, Schellenberg M, Daza J, Glass LT, Verhoeff K, Johnson G, Guidolin K, Glass LT, Balvardi S, Gawad N, McKechnie T, McKechnie T, Purich K, Henley J, Imbert E, Li C, Skinner S, Lenet T, Lenet T, Metz J, Ahn H(S, Do U, Rouhi A, Greenberg B, Muaddi H, Park L, Vogt K, Bradley N, Deng SX, Murphy P, Alhabboubi M, Lie J, Laplante S, Lie J, Drung J, Nixon T, Allard-Coutu A, Mansouri S, Lee A, Tweedy J, D’Elia MA, Hopkins B, Srivastava A, Alibhai K, Lee C, Moon J(J, How N, Spoyalo K, Lalande A, Baig Z, Schweitzer C, Keogh J, Huo B, Patel YS, Patel YS, Jogiat U, McGuire AL, Jogiat U, Lee Y, Barber E, Akhtar-Danesh GG, Bondzi-Simpson A, Bowker R, Ahmadi N, Abdul SA, Patel P, Harrison L, Shi G, Shi G, Alaichi JA, Kidane B, Qu LC, Alaichi J, Mackay E, Lee J, Purich K, Castelo M, Caycedo-Marulanda A, Caycedo-Marulanda A, Brennan K, Brennan K, Brennan K, Garfinkle R, Sharma S, Candy S, Patel S, LeGal G, Spadafora S, Maclellan S, Trottier D, Jonker D, Asmis T, Mallick R, Ramsay T, Carrier M, McKechnie T, Shojaei D, Motamedi A, Ghuman A, Karimuddin A, Raval M, Brown C, Shojaei D, Wang H, Buie D, Wang H, McKechnie T, Buie D, Al Busaidi N, Rajabiyazdi F, Demian M, Boutros M, Farooq A, Brown C, Phang T, Ghuman A, Karimuddin A, McKechnie T, Raval M, Udwadia F, Marinescu D, Alqahtani M, Pang A, Vasilevsky CA, Boutros M, Oviedo SC, McFadden N, Spence R, Lee L, Hirsch G, Neumann K, Neumann K, Spence R, Johnson G, Singh H, Helewa R, Yilbas A, Netto FS, Katz J, Robitaille S, Sharma B, Khan U, Selzner M, Mocanu V, Dang J, Wilson H, Switzer N, Birch D, Karmali S, Mocanu V, Robitaille S, Jogiat U, Forbes H, Switzer N, Birch D, Karmali S, Verhoeff K, Mocanu V, Kung J, Purich K, Switzer N, Sadri H, Birch D, Karmali S, Tassé N, Tchernof A, Nadeau M, Dawe P, Beckett A, Biertho L, Lin A, Verhoeff K, Selznick S, Mocanu V, Kung JY, Birch DW, Karmali S, Switzer NJ, Fowler-Woods M, Fowler-Woods A, Shingoose G, Hatala A, Daeninck F, Wiseman V, Vergis A, Hardy K, Clouston K, Debru E, Sun W, Dang J, Switzer N, Birch D, Karmali S, De Gara C, Wiseman V, Halasz J, Dang J, Switzer N, Kanji A, Birch D, Modi R, Karmali S, Gu J, Jarrar A, Kolozsvari N, Wiseman V, Samarasinghe Y, Chen L, Hapugall A, Javidan A, McKechnie T, Doumouras A, Hong D, Laplante S, Stogryn S, Maeda A, Brennan K, Jackson T, Okrainec A, Birch D, Karmali S, Kanji A, Switzer N, Balas M, Gee D, Hutter M, Meireles O, Baker L, Jung J, Vergis A, Hardy K, Boudreau V, Hong D, Anvari M, Iranmanesh P, Barlow K, Cookson T, Bolis R, Ichhpuniani S, Shanthanna H, Shiroky J, Deghan S, Zevin B, Cloutier Z, Cookson T, Barlow K, Boudreau V, Anvari M, Brodie J, Johnson G, O’Brien E, Tedman-Aucoin K, Lawlor D, Murphy R, Twells L, Pace D, Ellsmere J, Evans B, Zhang T, Deehan E, Zhang L, Kao D, Hotte N, Birch D, Karmali S, Samarasinghe K, Walter J, Madsen K, Williams E, Kong W, Fundytus A, Holden J, Booth C, Patel S, Caycedo-Marulanda A, Chung W, Nanji S, Merchant S, Hansen B, Paszat L, Baxter N, Scheer A, Moon J(J, Ghezeljeh TN, Lapointe-Gagner M, Nguyen-Powanda P, Elhaj H, Rajabiyazdi F, Lee L, Feldman LS, Fiore J, Sutradhar R, Haas B, Moon J(J, Guttman M, Eskander A, Coburn N, Chesney T, Tillman B, Zuk V, Mahar A, Hsu A, Chan W, Hallet J, Moon J(J, Guidolin K, Servidio-Italiano F, Quereshy F, Sapisochin G, Prisman E, Mitmaker E, Walker R, Wu J, Nguyen A, Wiseman S, Moon J(J, Hong D, Gupta M, Pasternak J, Vergara-Fernandez O, Brar A, Conner J, Kirsch R, Brar M, Kennedy E, Govindarajan A, Paradis T, Gryfe R, MacRae H, Cohen Z, McLeod R, Swallow C, Ghasemi F, Delisle M, Stacey D, Abou-Khalil J, Balaa F, Bayat Z, Bertens K, Dingley B, Martel G, McAlpine K, Nessim C, Tadros S, Carrier M, Auer R, Lim D, Eskander A, Patel S, Coburn N, Sutradhar R, Chan W, Hallet J, Pickard F, Mathieson A, Hogan M, Seal M, Acidi B, Johnston W, Maalouf MF, Callegaro D, Brar S, Gladdy R, Chung P, Catton C, Khalili K, Honore C, Swallow C, Fu N, Kazazian K, Wachtel A, Pacholczyk K, Ng D, Swett-Cosentino J, Savage P, Shibahara Y, Kalimuthu S, Espin-Garcia O, Conner J, Yeung J, Darling G, Baronas V, Swallow C, Mercier F, Barabash V, Law C, Coburn N, Singh S, Myrehaug S, Chan W, Hallet J, Auer RC, Wiseman V, Muhn N, Heller B, Lovrics P, Ng D, Koerber D, Al-Sukhni E, Cyr D, Kazazian K, Swallow C, Apte S, Lie J, Nessim C, Ban J, Chen L, McKevitt E, Warburton R, Pao JS, Dingee C, Kuusk U, Bazzarelli A, Hong NL, Hajjar R, Gagliardi A, Nyhof B, Marfil-Garza B, Sandha G, Cooper D, Dajani K, Bigam D, Anderson B, Kin T, Lam A, Ehlebracht A, O’Gorman D, Senior P, Ricordi C, Shapiro AJ, Moser M, Lam H, Flemming J, Jalink D, Nanji S, Bennett S, Caminsky N, Zhang B, Tywonek K, Meyers B, Serrano P, Lenet T, Shorr R, Abou-Khalil J, Bertens K, Balaa F, Martel G, Caminsky N, Jayaraman S, Wei A, Mahar A, Kaliwal Y, Martel G, Coburn N, Hallet J, Williams P, Claasen M, Ivanics T, Gilbert R, Englesakis M, Gallinger S, Hansen B, Sapisochin G, Ivanics T, Claasen M, Gallinger S, Hansen B, Sapisochin G, Lenet T, Morin G, Abou-Khalil J, Balaa F, Martel G, Brind’Amour A, Bertens K, Balaa F, Bertens K, Martel G, Abou-Khalil J, Collin Y, Auer RC, Ivanics T, Toso C, Adam R, Ijzermans J, Sapisochin G, Polak W, Léveillé M, Lawson C, Collin Y, Tai LH, Phang T, Greene B, Jayaraman S, Tsang M, Al-Arnawoot A, Rajendran L, Lamb T, Turner A, Reid M, Rekman J, Mimeault R, Hopkins J, Abou-Khalil J, Bertens K, Martel G, Balaa F, Zhang C, Lemke M, Glinka J, Leslie K, Skaro A, Tang E, Hopkins J, Greene B, Tsang M, Jayaraman S, Bubis L, Jayaraman S, Tsang ME, Ganescu O, Vanounou T, Pelletier JS, Greene B, Levin Y, Tsang M, Jayaraman S, Ganescu O, Pelletier JS, Vanounou T, Choi WJ, Muaddi H, Ivanics T, Classen MP, Sapisochin G, Alam A, Caminsky N, Mansouri S, Lagace P, Lagace P, El-Kefraoui C, Mainprize M, Melland-Smith M, Verhoeff K, Verhoeff K, Nasser K, Mailloux O, Purich K, Whyte M, Li T, Ahmad MS, Sun W, Ahn H(S, Lee Y, Roach E, Chow A, Trac J, He W, Ramji K, Kouzmina E, Koziak C, Hossain I, Mocanu V, Hanna N, Castelo M, Pook M, Zuckerman J, Choi WJ, Watanabe A, Saravana-Bawan B, Cyr D, Brackstone M, Ivankovic V, Nair AG, Hirpara D, Stockley C, Ng D, Luu S, Meloche-Dumas L, D’Elia MA, Eom A, Tang K, Khan S, Schmitz E, Chen KT, Newman-Bremang J, Verhoeff K, Jette N, Mir Z, Griffiths C, Rajendran L, Zuckerman J, Choi WJ, Choi WJ, Gilbert R, Lenet T, Amhis N, Claasen M, Mansouri S, Workewych A, Lee A, Waugh E, Zhu A, Nabavian H, Roldan J, Lagrotteria A, Roldan J, Rajendran L, Safa N, Rahman S, Kaneva P, Feldman L, Baig Z, Ginther N, Gill D, Sarwar Z, Verdiales C, Moser M, Mocanu V, Fang B, Dang J, Sun W, Switzer N, Birch D, Karmali S, Alqaydi A, Wei X, Digby G, Brogly S, Merchant S, Verhoeff K, Miles A, Kung JY, Shapiro AJ, Bigam DL, Matkin A, Dumestre D, Peiris L, Turner S, Verhoeff K, Mador B, McLennan S, Jastaniah A, Owattanapanich N, Grigorian A, Lam L, Nahmias J, Inaba K, Liasidis P, Inaba K, Demetriades D, Benjamin ER, Cowan S, Owattanapanich N, Wong MD, Inaba K, Demetriades D, Owattanapanich N, Emigh B, Karavites L, Clark DH, Lam L, Inaba K, Benjamin ER, Owattanapanich N, Inaba K, Demetriades D, Anderson GA, Owattanapanich N, Cheng V, Lam L, Inaba K, Myers L, Cuthbertson B, Myles P, Shulman M, Wijeysundera D, Murphy PB, Allen L, Minkhorst K, Bowker D, Tang ES, Leslie K, Hawel JE, Ma O, Purich K, Skinner S, Dhaliwal R, Strickland M, Park J, Vergis A, Gillman L, Rivard J, Lin J, Zorigtbaatar A, Nadeem M, Ibrahim T, Neilson Z, Kim KY(P, Rajendran L, Chadi S, Quereshy F, Davidson M, Friedrich E, Champion C, Semsar-Kazerooni K, Kaneva P, Mueller C, Vassiliou M, Al Mahroos M, Fiore J, Schwartzman K, Feldman L, Purich K, Verhoeff K, Anderson B, Daniel R, Kruse C, Levin M, Lee Y, Doumouras A, Hong D, Eskicioglu C, Povolo C, Lee J, Lee Y, Park L, Doumouras A, Hong D, Bhandari M, Eskicioglu C, Lee E, Verhoeff K, Sydora D, Turner S, Strickland M, Boone D, Roberts S, McGrouther D, Manuel P, Dykstra M, Wang H, Snelgrove R, Verhoeff K, Purich K, Perry T, Strickland M, Dhaliwal R, Skanes S, Tropiano J, McIsaac D, Tinmouth A, Hallet J, Nicholls S, Fergusson D, Martel G, Tropiano J, Skanes S, Ivankovic V, McIsaac D, Tinmouth A, Patey A, Fergusson D, Martel G, Naqvi R, Noppens R, Hawel J, Elnahas A, Schlachta C, Alkhamesi N, Lenet T, Gilbert R, Mallick R, Shaw J, McIsaac D, Martel G, Pook M, Najafi T, Rajabiyazdi F, El-Kefraoui C, Balvardi S, Barone N, Elhaj H, Nguyen-Powanda P, Lee L, Baldini G, Feldman L, Fiore J, Purich K, Jogiat U, Mapiour D, Kim M, Nadler A, Stukel T, De Mestral C, Nathens A, Pautler S, Shayegan B, Hanna W, Schlachta C, Breau R, Hopkins L, Jackson T, Karanicolas P, Griffiths C, Ali S, Archer V, Cloutier Z, Choi D, McKechnie T, Serrano P, McClure JA, Jones P, Mrkobrada M, Flier S, Welk B, Dubois L, Khwaja K, Allen L, Tung L, Hameed M, Spoyalo K, Lampron J, Garcia-Ochoa C, Jastaniah A, Engels P, Talwar G, Cloutier Z, Minor S, Moffat B, Parry N, Vogt K, Ebeye T, Sharma BT, Samman A, Zulfiqar A, Purzner RH, Greene B, Tsang M, Jayaraman S, Allen L, Ball CG, Hameed M, Engels P, Nenshi R, Widder S, Minor S, Parry N, Bradley N, Moffat B, Vogt K, Liberman S, Wong E, Chughtai T, Turner J, Wiseman S, Li J, Mak N, Namazi B, Kiani P, Hashimoto D, Alseidi A, Pasten M, Brunt LM, Gill S, Davis B, Bloom M, Pernar L, Okrainec A, Madani A, Hamilton T, Nabata K, Zhang JW, Zhao D, Dawe P, Hameed M, Allen L, Leslie K, Drung J, Purich K, Verhoeff K, Skinner S, Dhaliwal R, Strickland M, Heller B, Wright V, Cho W, Wong M, Singh K, Comeau É, Collin Y, Oviedo SC, Rajendran L, Lamb T, Reid M, Turner A, Bertens K, Rekman J, Balaa F, Neumann K, Porter G, Teo I, Forse CL, Musselman R, Grozman L, Alshawan N, Fraser S, Bergman S, Pelletier JS, Vanounou T, Wong EG, Nolan B, Qiao L, Jung J, Raîche I, McDonald H, Gawad N, Cheifetz R, Hawley P, Rehany Z, Bakhshi M, Razek T, Grushka J, Boulanger N, Watt L, Vivier A, Clark G, Fata P, Deckelbaum D, Khwaja K, Jastaniah A, Wong E, Ren K, Qiu Y, Hamann K, Lalande A, MacNeill A, Park J, Alexis S, Spoyalo K, Patterson K, Gadhari N, Zhao J, MacNeill A, Ahmed R, Farooq A, Karimuddin A, Wiseman S, Chhor A, Begum H, Akhtar-Danesh N, Finley C, Manos D, Xu Z, Matheson K, Chun S, Fris J, Wallace A, French D, Baste JM, Shargall Y, Waddell TK, Yasufuku K, Machuca TN, Xie F, Thabane L, Hanna WC, Beauchamp MK, Wald J, Mbuagbaw L, Key BL, Green SM, Hanna WC, Behzadi A, Donahoe L, Nasralla A, Poon J, Safieddine N, Seyednejad N, Tavakoli I, Turner S, Sharma S, Hilzenrat RA, McConechy M, Frank I, Hughsman C, Yip S, Choi JJ, Yee J, Sasewich H, Turner S, Baracos V, Eurich D, Filafilo H, Bedard E, Samarasinghe Y, Patel J, Khondker A, McKechnie T, Samarasinghe N, Finley C, Hanna W, Shargall Y, Agzarian J, Whidden M, Aguirre F, Graham A, Chhor A, Begum H, Ewusie J, Mbuagbaw L, Yaron S, Keshishi M, Ademe Y, Tizazu A, Rose M, Uddin S, Ko M, Ddamba J, French D, Wallace A, Safieddine N, Gazala S, Simone C, Wright F, Finley C, Villeneuve PJ, Gilbert S, Sundaresan S, Seely AJ, Maziak DE, Manos D, Wallace A, Plourde M, Turner D, Ringash J, Manuel D, Kidane B, Gupta V, Decker K, Davis L, Darling G, Compton C, Coburn N, Boyes R, Pugliese M, Mahar A, Hsu A, Kokavec A, Ho E, Waterman R, Wang E, Harnden K, Malthaner R, Nayak R, Qiabi M, Malthaner R, Nayak R, Qiabi M, Patel Y, Farrokhyar F, Simunovic M, Hanna WC, Gowing S, Liu R, Srinathan S, Tan L, Malthaner R, Malik P, Patel Y, Hanna W, Fahim U, Hafizi A, Ashrafi AS, McKechnie T, Amin N, Doumouras A, Hong D, Eskicioglu C, Streu C, Wong C, Schiller D, Sue-Chue-Lam C, Paszat L, Scheer A, Hansen B, Kishibe T, Baxter N, Neary E, Ibrahim T, Verschoor C, Patel S, Merchant S, Chadi S, Romagnolo L, Verschoor C, Brown C, Karimuddin A, Raval M, Phang T, Vikis E, Melich G, Patel S, Patel S, Caycedo-Marulanda A, Merchant S, Booth C, Kong W, McClintock C, Bankhead C, Heneghan C, Patel S, McClintock C, Merchant S, Caycedo-Marulanda A, Booth C, Bankhead C, Heneghan C, Zhang L, Flemming J, Djerboua M, Nanji S, Caycedo-Marulanda A, Merchant S, Patel S, Demian M, Sabboobeh S, Moon J, Hulme-Moir M, Liberman AS, Feinberg S, Hayden DM, Chadi SA, Demyttenaere S, Samuel L, Hotakorzian N, Quintin L, Morin N, Ghitulescu G, Faria J, Vasilevsky CA, Boutros M, Mckechnie T, Khamar J, Ichhpuniani S, Eskicioglu C, Patel S, Merchant S, Caycedo-Marulanda A, Bankhead C, Heneghan C, Govind S, Lee J, Lee Y, Hong D, Eskicioglu C, Lu J, Khamar J, Lee Y, Amin N, Hong D, Eskicioglu C, Cardenas L, Schep D, Doumouras A, Hong D, Wong R, Levine O, Eskicioglu C, Mueller C, Stein B, Charlebois P, Liberman S, Fried G, Feldman L, Wang A, Liberman S, Charlebois P, Stein B, Fiore JF, Feldman L, Lee L, Wang A, Liberman S, Charlebois P, Stein B, Fiore JF, Feldman L, Lee L, Barkun A, Levy J, Bogdan R, Hawel J, Elnahas A, Alkhamesi NA, Schlachta CM, Caycedo-Marulanda A, Iaboni N, Hurlbut D, Kaufmann M, Ren KYM, Jamzad A, Mousavi P, Fichtinger G, Nicol CJ, Rudan JF, Brennan K, Caycedo-Marulanda A, Merchant S, McClintock C, Patel SV, McClintock C, Bankhead C, Merchant S, Caycedo-Marulanda A, Booth C, Heneghan C, Zhang L, Huo B, Donaldson A, Flemming J, Nanji S, Caycedo-Marulanda A, Merchant S, Brogly S, Patel S, Lenet T, Park L, Murthy S, Musselman R, McKechnie T, Lee J, Biro J, Lee Y, Park L, Doumouras A, Hong D, Eskicioglu C, Singh H, Helewa R, Reynolds K, Sibley K, Doupe M, Brennan K, Flemming J, Nanji S, Merchant S, Djerboua M, Caycedo-Marulanda A, Patel S, Johnson G, Hochman D, Helewa R, Garfinkle R, Dell’Aniello S, Zelkowitz P, Vasilevsky CA, Brassard P, Boutros M, Zoughlami A, Abibula W, Amar A, Ghitulescu G, Vasilevsky CA, Brassard P, Boutros M, Araji T, Pang A, Vasilevsky CA, Boutros M, Ehlebracht A, Faria J, Ghitulescu G, Morin N, Pang A, Vasilevsky CA, Boutros M, Robitaille S, Oliver M, Charlebois P, Stein B, Liberman S, Feldman LS, Lee L, Kennedy E, Victor C, Govindarajan A, Zhang L, Brennan K, Djerboua M, Nanji S, Merchant SJ, Caycedo-Marulanda A, Flemming J, Robitaille S, Penta R, Pook M, Fiore JF, Feldman L, Lee L, Wong-Chong N, Marinescu D, Bhatnagar S, Morin N, Ghitulescu G, Vasilevsky CA, Faria J, Boutros M, Arif A, Ladua G, Bhang E, Brown C, Donellan F, Stuart H, Loree J, Patel S, Zhang L, MacDonald PH, Merchant S, Barnett KW, Caycedo-Marulanda A, Brown C, Karimuddin A, Stuart H, Ghuman A, Phang T, Raval M, Yoon HM, Fragoso G, Oliero M, Calvé A, Rendos HV, Gonzalez E, Brereton NJ, Cuisiniere T, Gerkins C, Djediai S, Annabi B, Diop K, Routy B, Laplante P, Cailhier JF, Taleb N, Alratrout H, Dagbert F, Loungnarath R, Sebajang H, Schwenter F, Wassef R, Ratelle R, Debroux E, Richard C, Santos MM, Hamad D, Alsulaim H, Monton O, Marinescu D, Pang A, Vasilevsky CA, Boutros M, Marinescu D, Alqahtani M, Pang A, Ghitulescu G, Vasilevsky CA, Boutros M, Marinescu D, Garfinkle R, Boutros M, Zwiep T, Greenberg J, Lenet T, Musselman R, Williams L, Raiche I, McIsaac D, Thavorn K, Fergusson D, Moloo H, Charbonneau J, Paré X, Frigault J, Letarte F, Ott M, Karanicolas P, Brackstone M, Ashmalla S, Weaver J, Tagalakis V, Boutros M, Stotland P, Caycedo-Marulanda A, Moloo H, Jayaraman S. 2022 Canadian Surgery Forum Sept. 15–17, 202201. Operative classification of ventral abdominal hernias: new and practical classification02. Watchful waiting for large primary splenic cysts03. Transversus abdominis plane (TAP) blocks with and without dexamethasone in colorectal surgery04. What factors determine publication of resident research day projects?05. Characterization of near-infrared imaging and indocyanine green use amongst general surgeons06. Variation in opioid prescribing after outpatient breast surgery: Time for a streamlined approach?07. Trends in graduate degree types and research output for Canadian academic general surgeons08. Would you prefer to undergo breast-conserving therapy or a mastectomy for early breast cancer? Comparison of perceptions of general and plastic surgeons09. Lack of representation of women and BIPOC individuals in Canadian academic surgery10. Medical student interest and perspectives on pursuing surgical careers: a multicentre survey evaluating 5-year trends11. Difficult cholecystectomy with cholecystogastric fistula12. Surviving nonsurvivable injuries: patients who elude the “lethal” Abbreviated Injury Scale (AIS) score of six13. Gunshot wounds sustained during legal intervention v. those inflicted by civilians: a comparative analysis14. The impact of delayed time to first head CT on functional outcomes after blunt head trauma with moderately depressed GCS15. Contemporary utility of diagnostic peritoneal aspiration in trauma16. Impact of delayed time to first head CT in traumatic brain injury17. Radiologic predictors of in-hospital mortality after traumatic craniocervical dissociation18. Measurement properties of a patient-reported instrument to evaluate functional status after major surgery19. The safety of venous thromboembolism chemoprophylaxis use in endoscopic retrograde cholangiopancreatography20. Characterizing Canadian rural surgeons: trends over time and 10-year replacement needs21. Contextual interference for skills development and transfer in laparoscopic surgery: a randomized controlled trial22. Evaluating the accuracy and design of visual backgrounds in academic surgical journals23. Defining rural surgery in Canada24. Validity of video-based general and procedure-specific self-assessment tools for surgical trainees in laparoscopic cholecystectomy25. Examining the equity and diversity characteristics of academic general surgeons in Canada26. Video-based coaching for surgical residents: a systematic review and meta-analysis27. Very-low-energy diets prior to nonbariatric surgery: a systematic review and meta-analysis28. Factors associated with resident research success: a descriptive analysis of Canadian general surgery trainees29. Global surgery pilot curriculum in Canadian undergraduate medical education: a novel approach30. How useful is ultrasound in predicting surgical findings of “mild cholecystitis”?31. Implementing a colorectal surgery “virtual hospital”: description of a novel outpatient care pathway to advance surgical care32. Trends in training and workforce planning for Canadian pediatric surgeons: a 10-year model33. Patient perspectives on intraoperative blood transfusion: results of semistructured interviews with perioperative patients34. Understanding intraoperative transfusion decision-making variability: a qualitative study using the Theoretical Domains Framework35. Effectiveness of preoperative oscillating positive expiratory pressure (OPEP) therapy in reduction of postoperative respiratory morbidity in patients undergoing surgery: a systematic review37. Accuracy of point-of-care testing devices for hemoglobin in the operating room: a systematic review and meta-analysis38. Opioid-free analgesia after outpatient general surgery: a qualitative study focused on the perspectives of patients and clinicians involved in a pilot trial39. The impact of the COVID-19 pandemic on general surgery residency: an analysis of operative volumes by residents at a Canadian general surgery residency program40. Postoperative care protocols for elderly emergency surgical patients: a quality improvement initiative42. Adverse events following robotic compared to laparoscopic and open surgery: a population-based analysis43. Is accrual higher for patients randomized to pragmatic v. exploratory randomized clinical trials? A systematic review and meta-analysis44. Effect of preoperative proton-pump inhibitor use on postoperative infectious and renal complications after elective general surgery45. The early burden of COVID-19 in emergency general surgery care across Canada46. Laparoscopic subtotal cholecystectomy for the difficult gallbladder: evolution of technique at a single teaching hospital and retrospective review47. The demand for emergency general surgery in Canada: a public health crisis48. Attitudes of Canadian general surgery staff and residents toward point-of-care ultrasound49. Psychological impact of COVID-19 on Canadian surgical residents50. Validation of an artificial intelligence platform for the guidance of safe laparoscopic cholecystectomy51. Predictors of recurrent appendicitis after nonoperative management: a prospective cohort study52. The effect of the first wave of the COVID-19 pandemic on colorectal and hepatobiliary oncologic outcomes at a tertiary care centre53. Trends in training and workforce representation for Canadian general surgeons working in critical care: a descriptive study54. White presentation: teaching safe opioid prescription and opioid use disorder management in Canadian universities56. How bad is really bad, eh? Impact of the first wave of the COVID-19 pandemic on residents’ operative volume: the experience of a Canadian general surgery program57. Surgeon-specific encounters within a multidisciplinary care pathway: Is there a role for shared care models in surgery?59. A pan-Canadian analysis of approach to treatment for acute appendicitis60. Appendix neoplasm stratified by age: understanding the best treatment for appendicitis61. Predicting acute cholecystitis on final pathology to prioritize surgical urgency: an evaluation of the Tokyo criteria and development of a novel predictive score62. Obesity is an independent predictor of acute renal failure after surgery64. Validation of a clinical decision-making assessment tool in general surgery65. Moral distress in the provision of palliative care delivery for surgical patients in British Columbia: lessons learned from the perspectives of general surgeons66. Delays in presentation and severity of illness predict adverse surgical outcomes among patients transferred from rural Indigenous communities for acute care surgery67. Remote video-based suturing education with smartphones (REVISE): a randomized controlled trial68. Modified Delphi consensus on appropriate use of laboratory investigations in acute care surgery patients72. Impacts of inpatient food at a tertiary care centre on patient satisfaction, nutrition and planetary health73. Racial disparities in health outcomes for oncological surgery in Canada75. Risk of recurrent laryngeal nerve injury from thyroidectomy is lower when intraoperative nerve monitoring (IONM) is used: an analysis of 17 688 patients from the NSQIP database01. The impact of the COVID-19 pandemic on non-smallcell lung cancer pathologic stage and presentation02. Screening criteria evaluation for expansion in pulmonary neoplasias (screen)03. Robotic-assisted lobectomy for early-stage lung cancer provides better patient-reported quality of life than video-assisted lobectomy: early results of the RAVAL trial04. Breathe Anew: designing and testing the feasibility of a novel intervention for lung cancer survivorship05. Learning objectives for thoracic surgery: developing a national standard for undergraduate medical education06. Plasma cell-free DNA as a point-of-care well-being biomarker for early-stage non-small-cell lung cancer patients07. Sarcopenia determined by skeletal muscle index predicts overall survival, disease-free survival and postoperative complications in resectable esophageal cancer: a systematic review and meta-analysis08. The short- and long-term effects of open v. minimally invasive thymectomy in myasthenia gravis patients: a systematic review and meta-analysis09. Optimizing opioid prescribing practices following minimally invasive lung resections through a structured quality improvement process10. Effects of virtual postoperative postdischarge care in patients undergoing lung resection during the COVID-19 pandemic11. Initiating Ethiopia’s first minimally invasive surgery program: a novel approach for collaborations in global surgical education12. Patient outcomes following salvage lung cancer surgery after definitive chemotherapy or radiation13. Replacing chest X-rays after chest tube removal with clinical assessment in postoperative thoracic surgery patients14. Updating the practice of thoracic surgery in Canada: a survey of the Canadian Association of Thoracic Surgeons15. The impact of COVID-19 on the diagnosis and treatment of lung cancer16. Development of a prediction model for survival time in esophageal cancer patients treated with resection17. The development and validation of a mixed reality thoracic surgical anatomy atlas18. Routine placement of feeding tubes should be avoided in esophageal cancer patients undergoing surgery19. Nodal count is no different during robotic segmentectomy compared with robotic lobectomy20. Point-of-care ultrasound-guided percutaneous biopsy of solid masses in the thoracic outpatient clinic: a safe, high-yield procedure to accelerate tissue diagnosis for patients with advanced thoracic malignancy21. Sarcopenia and modified frailty index are not associated with adverse outcomes after esophagectomy for esophageal cancer: a retrospective cohort study22. Near-infrared-guided segmental resection for lung cancer: an analysis of the learning curve23. Routine use of feeding jejunostomy tubes in patients undergoing esophagectomy for esophageal malignancy is safe and associated with low complication rates01. Ghost ileostomy versus loop ileostomy following total mesorectal excision for rectal cancer: a systematic review and meta-analysis02. Analysis of 100 consecutive colorectal cancers presenting at a Canadian tertiary care centre: delayed diagnosis and advanced disease03. Clinical delays and comparative outcomes in younger and older adults with colorectal cancer: a systematic review04. Recurrence rates of rectal cancer after transanal total mesorectal excision (taTME): a systematic review and meta-analysis05. Transanal total mesorectal excision for abdominoperineal resection (taTME-APR) is associated with poor oncological outcomes in rectal cancer patients: a word of caution from a multicentric Canadian cohort study06. Association between survival and receipt of recommended and timely treatment in locally advanced rectal cancer: a population-based study07. Trends and the impact of incomplete preoperative staging in rectal cancer08. Postoperative outcomes after elective colorectal surgery in patients with cirrhosis09. Bowel stimulation before loop ileostomy closure to reduce postoperative ileus: a multicentre, single-blinded, randomized controlled trial10. Recurrence following perineal rectosigmoidectomy ( Altemeier) with levatorplasty: a systematic review and meta-analysis11. Nonmodifiable risk factors and receipt of surveillance investigations following treatment of rectal cancer12. Safety and effectiveness of endoscopic full-thickness resection for the management of colorectal lesions: a systematic review and meta-analysis13. Impact of preoperative carbohydrate loading before colectomy: a systematic review and meta-analysis of randomized controlled trials14. Statin therapy in patients undergoing short-course neoadjuvant radiotherapy for rectal cancer15. Feasibility of targeted lymphadenectomy during complete mesocolic excision for colon cancer using indocyanine green immunofluorescence lymphatic mapping16. Feasibility of expanding an ambulatory colectomy protocol: a retrospective analysis of early discharge following minimally invasive colectomy in an enhanced recovery pathway17. Impact of rectal cancer on bowel dysfunction before treatment and its relationship with post-treatment function18. Canadian cost–utility analysis of artificial-intelligence-assisted colonoscopy for adenoma detection in fecal immunochemical-based colorectal cancer screening19. A comparison of outcomes following intracorporeal and extracorporeal anastomotic techniques in laparoscopic right colectomies20. Assessment of metabolic signatures using desorption electrospray ionization mass spectrometry (DESI) and rapid evaporative ionization mass spectrometry (REIMS) of rectal cancer samples to assist in determining treatment response21. The association between hospital characteristics and minimally invasive rectal cancer surgery: a population-based study22. Cancer centre level designation and the impact on treatment and outcomes in those with rectal cancer: a population-based study23. Oncological outcomes after colorectal cancer in patients with liver cirrhosis: a systematic review and meta-analysis24. Optimal preoperative nutrition for penetrating Crohn disease: a systematic review and meta-analysis25. Lymph node ratio as a predictor of survival for colon cancer: a systematic review and meta-analysis26. Barriers and facilitators for use of new recommendations for optimal endoscopic localization of colorectal neoplasms according to gastroenterologists and surgeons27. Emergency colorectal surgery in patients with cirrhosis: a population-based descriptive study28. Local recurrence rates and associated risk factors after transanal endoscopic microsurgery for benign polyps and adenocarcinomas29. Bowel dysfunction impacts mental health after restorative proctectomy for rectal cancer30. Evolution of psychological morbidity following restorative proctectomy for rectal cancer: a systematic review and meta-analysis31. Frailty predicts LARS and quality of life in rectal cancer survivors after restorative proctectomy32. Low anterior resection syndrome in a reference North American population: prevalence and predictive factors33. The evolution of enhanced recovery: same day discharge after laparoscopic colectomy34. Effect of ERAS protocols on length of stay after colorectal surgery: an interrupted time series analysis35. Practice patterns and outcomes in individuals with cirrhosis and colorectal cancer: a population-based study36. Understanding the impact of bowel function on quality of life after rectal cancer surgery37. Right-sided colectomies for diverticulitis have worse outcomes compared with left-sided colectomies38. Symptom burden and time from symptom onset to cancer diagnosis in patients with early-onset colorectal cancer39. The impact of access to robotic rectal surgery at a tertiary care centre: a Canadian perspective40. Management of rectal neuroendocrine tumours by transanal endoscopic microsurgery41. The gut microbiota modulates colorectal anastomotic healing in patients undergoing surgery for colorectal cancer42. Is there added risk of complications for concomitant procedures during an ileocolic resection for Crohn disease?43. Cost of stoma-related hospital readmissions for rectal cancer patients following restorative proctectomy with a diverting loop ileostomy: a nationwide readmissions database analysis44. Older age associated with quality of rectal cancer care: an ACS-NSQIP database study45. Outcomes of patients undergoing elective bowel resection before and after implementation of an anemia screening and treatment program47. Loop ileostomy closure as a 23-hour stay procedure: a randomized controlled trial48. Extended duration perioperative thromboprophylaxis with low-molecular-weight heparin to improve disease-free survival following surgical resection of colorectal cancer: a multicentre randomized controlled trial (PERIOP-01 Trial)49. Three-stage versus modified 2-stage ileal pouch anal anastomosis: perioperative outcomes, function and quality of life50. Compliance with extended venous thromboembolism prophylaxis in rectal cancer51. Extended-duration venous thromboembolism prophylaxis after diversion in rectal cancer52. Financial and occupational impact of low anterior resection syndrome: a qualitative study53. Nonoperative management for rectal cancer: patient perspectives54. Trends in ileostomy-related emergency department visits for rectal cancer patients55. Long-term implications of treatment of fecal incontinence: a single Canadian centre’s retrospective cohort study: a 17-year follow-up56. Externally benchmarking colorectal resection outcomes in our province against the ACS NSQIP risk calculator: identifying opportunities for improvement57. Externally benchmarking our provincial colectomy outcomes against the ACS NSQIP using the Codman Score: to identify possible opportunities for improvement of outcomes58. Rural v. urban documentation of recommended practices for optimal endoscopic colorectal lesion localization01. Incidence of in-hospital opioid use and pain after inguinal hernia repair02. Ventral hernia repair following liver transplantation: outcome of repair techniques and risk factors for recurrence01. Impact of the COVID-19 pandemic on bariatric surgery in North America: a retrospective analysis of 834 647 patients02. Patient selection and 30-day outcomes of SADI-S compared to RYGB: a retrospective cohort study of 47 375 patients03. New persistent opioid use following bariatric surgery: a systematic review and pooled proportion meta-analysis04. Bariatric surgery should be offered to active-duty military personnel: a retrospective study of the Canadian Armed Forces experience05. Opioid prescribing practices and use following bariatric surgery: a systematic review and pooled summary of data06. Sacred sharing circles: urban Indigenous Manitobans’ experiences with bariatric surgery07. Gastrogastric hernia after laparoscopic gastric great curve plication: a video presentation08. Characterization of comorbidities predictive of bariatric surgery09. Efficacy of preoperative high-dose liraglutide in patients with superobesity10. The effect of linear stapled gastrojejunostomy size in Roux-en-Y gastric bypass11. Fragility of statistically significant outcomes in randomized trials comparing bariatric surgeries12. Weight loss outcomes for patients undergoing conversion to Roux-en-Y gastric bypass after sleeve gastrectomy13. Are long waiting lists for bariatric surgery detrimental to patients? A single-centre experience14. Does upper gastrointestinal swallow study after bariatric surgery lead to earlier detection of leak?15. Pharmaceutical utilization before and after bariatric surgery16. Same-day discharge Roux-en-Y gastric bypass at a Canadian bariatric centre: pathway implementation and early experiences17. Safety and efficiency of performing primary bariatric surgery at an ambulatory site of a tertiary care hospital: a 5-year experience18. Impact of psychiatric diagnosis on weight loss outcomes 3 years after bariatric surgery19. Ursodeoxycholic acid (UDCA) for prevention of gallstone disease after laparoscopic sleeve gastrectomy (LSG): an Atlantic Canada perspective20. Fecal microbial transplantation and fibre supplementation in patients with severe obesity and metabolic syndrome: a randomized double-blind, placebo-controlled phase 2 trial01. Incidence, timing and outcomes of venous thromboembolism in patients undergoing surgery for esophagogastric cancer: a population-based cohort study04. Omission of axillary staging and survival in elderly women with early-stage breast cancer: a population-based cohort study05. Patients’ experiences receiving cancer surgery during the COVID-19 pandemic: a qualitative study06. Cancer surgery outcomes are better at high-volume centres07. Attitudes of Canadian colorectal cancer care providers toward liver transplantation for colorectal liver metastases: a national survey08. Quality of narrative central and lateral neck dissection reports for thyroid cancer treatment suggests need for a national standardized synoptic operative template09. Transoral endoscopic thyroidectomy vestibular approach (TOETVA): indications and technique10. Temporal trends in lymph node assessment as a quality indicator in colorectal cancer patients treated at a high-volume Canadian centre11. Molecular landscape of early-stage breast cancer with nodal metastasis12. Beta testing of a risk-stratified patient decision aid to facilitate shared decision making for postoperative extended thromboprophylaxis in patients undergoing major abdominal surgery for cancer13. Breast reconstruction use and impact on oncologic outcomes among inflammatory breast cancer patients: a systematic review14. Association between patient-reported symptoms and health care resource utilization: a first step to develop patient-centred value measures in cancer care15. Complications after colorectal liver metastases resection in Newfoundland and Labrador16. Why do patients with nonmetastatic primary retroperitoneal sarcoma not undergo resection?17. Loss of FAM46Cexpression predicts inferior postresection survival and induces ion channelopathy in gastric adenocarcinoma18. Liver-directed therapy of neuroendocrine liver metastases19. Neoadjuvant pembrolizumab use in microsatellite instability high (MSI-H) rectal cancer: benefits of its use in lynch syndrome20. MOLLI for excision of nonpalpable breast lesions: a case series22. Patients awaiting mastectomy report increased depression, anxiety, and decreased quality of life compared with patients awaiting lumpectomy for treatment of breast cancer23. Is microscopic margin status important in retroperitoneal sarcoma (RPS) resection? A systematic review and meta-analysis24. Absence of benefit of routine surveillance in very-low-risk and low-risk gastric gastrointestinal stromal tumors25. Effect of intraoperative in-room specimen radiography on margin status in breast-conserving surgery26. Active surveillance for DCIS of the breast: qualitative interviews with patients and physicians01 Outcomes following extrahepatic and intraportal pancreatic islet transplantation: a comparative cohort study02. Cholang-funga-gitis03. Evaluating the effect of a low-calorie prehepatectomy diet on perioperative outcomes: a systematic review and meta-analysis04. Toxicity profiles of systemic therapy for advanced hepatocellular carcinoma: a systematic review to guide neoadjuvant trials05. Should cell salvage be used in liver resection and transplantation? A systematic review and meta-analysis06. The association between surgeon and hospital variation in use of laparoscopic liver resection and short-term outcomes07. Systematic review and meta-analysis of prognostic factors for early recurrence in intrahepatic cholangiocarcinoma after curative-intent resection08. Impact of neoadjuvant chemotherapy on postoperative outcomes of patients undergoing hepatectomy for intrahepatic cholangiocarcinoma: ACS-NSQIP propensity-matched analysis09. The impact of prophylactic negative pressure wound therapy on surgical site infections in pancreatic resection: a systematic review and meta-analysis10. Does hepatic pedicle clamping increase the risk of colonic anastomotic leak after combined hepatectomy and colectomy? Analysis of the ACS NSQIP database11. Development of a culture process to grow a full-liver tissue substitute12. Liver transplantation for fibrolamellar hepatocellular carcinoma: an analysis of the European Liver Transplant Registry13. Arming beneficial viruses to treat pancreatic cancer14. Hepaticoduodenostomy versus hepaticojenunostomy for biliary reconstruction: a retrospective review of a single-centre experience15. Feasibility and safety of a “shared care” model in complex hepatopancreatobiliary surgery: a 5-year analysis of pancreaticoduodenectomy16. Laparoscopic v. open pancreaticoduodenectomy: initial institutional experience and NSQIP-matched analysis17. Laparoscopic spleen-preserving distal pancreatectomy: Why not do a Warshaw?18. The impact of COVID-19 on pancreaticoduodenectomy outcomes in a high-volume hepatopancreatobiliary centre19. Transitioning from open to minimally invasive pancreaticoduodenectomy: the learning curve factor in an academic centre20. Closed-incision negative-pressure wound therapy following pancreaticoduodenectomy for prevention of surgical site infections in high-risk patients21. Robotic Appleby procedure for recurrent pancreatic cancer22. The influence of viral hepatitis status on posthepatectomy complications in patients with hepatocellular carcinoma: a NSQIP analysis. Can J Surg 2022. [DOI: 10.1503/cjs.014322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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Sarsam M, Baste JM, Thiberville L, Salaun M, Lachkar S. How Bronchoscopic Dye Marking Can Help Minimally Invasive Lung Surgery. J Clin Med 2022; 11:jcm11113246. [PMID: 35683630 PMCID: PMC9181781 DOI: 10.3390/jcm11113246] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/18/2022] [Accepted: 05/30/2022] [Indexed: 02/04/2023] Open
Abstract
In the era of increasing availability of high-resolution chest computed tomography, the diagnosis and management of solitary pulmonary nodules (SPNs) has become a common challenging clinical problem. Meanwhile, surgical techniques have improved, and minimally invasive approaches such as robot- and video-assisted surgery are becoming standard, rendering the palpation of such lesions more difficult, not to mention pure ground-glass opacities, which cannot be felt even in open surgery. In this article, we explore the role of bronchoscopy in helping surgeons achieve successful minimally invasive resections in such cases.
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Affiliation(s)
- Matthieu Sarsam
- Department of General and Thoracic Surgery, CHU Rouen, F-76000 Rouen, France; (M.S.); (J.-M.B.)
| | - Jean-Marc Baste
- Department of General and Thoracic Surgery, CHU Rouen, F-76000 Rouen, France; (M.S.); (J.-M.B.)
- Normandie University, University of Medicine and Pharmacy of Rouen, UNIROUEN, INSERM U1096, FHU REMOD-VHF, F-76183 Rouen, France
| | - Luc Thiberville
- Department of Pulmonology, CHU Rouen, F-76000 Rouen, France; (L.T.); (M.S.)
| | - Mathieu Salaun
- Department of Pulmonology, CHU Rouen, F-76000 Rouen, France; (L.T.); (M.S.)
- QuantIF Team, LITIS Lab EA4108, UNIROUEN, Normandie University, F-76000 Rouen, France
| | - Samy Lachkar
- Department of Pulmonology, CHU Rouen, F-76000 Rouen, France; (L.T.); (M.S.)
- Correspondence:
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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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Boujibar F, Gillibert A, Bonnevie T, Rinieri P, Montagne F, Selim J, Cuvelier A, Gravier FE, Baste JM. The 6-minute stepper test and the sit-to-stand test predict complications after major pulmonary resection via minimally invasive surgery: a prospective inception cohort study. J Physiother 2022; 68:130-135. [PMID: 35396177 DOI: 10.1016/j.jphys.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 02/02/2022] [Accepted: 03/07/2022] [Indexed: 11/27/2022] Open
Abstract
QUESTIONS How well do the 6-minute stepper test (6MST) and sit-to-stand test (STST) predict complications after minimally invasive lung cancer resection? Do the 6MST and STST provide supplementary information on the risk of postoperative complications in addition to the prognostic variables that are currently used, such as age and the American Society of Anesthesiology (ASA) score? DESIGN Prospective inception cohort study with follow-up for 90 days. PARTICIPANTS Consecutive sample of adults undergoing major lung resection with video-assisted thoracic surgery (VATS) or robot-assisted thoracic surgery (RATS). OUTCOME MEASURES Patients had a preoperative functional evaluation with the 6MST and STST. The number of steps, heart rate change, saturation and dyspnoea during the 6MST and the number of lifts during the STST were recorded. Complications graded ≥ 2 on the Clavien-Dindo classification were recorded for 90 days after surgery. RESULTS Between November 2018 and November 2019, 118 patients with a mean age of 65 years (SD 9) were included and analysed. Their surgeries were via VATS in 88 (75%) and via RATS in 30 (25%). For predicting a postoperative complication graded ≥ 2 on the Clavien-Dindo classification, the area under the Receiver Operating Characteristic curve was: 0.82 (95% CI 0.75 to 0.90) for the number of steps during the 6MST, with an optimum cut-off of 140 steps; and 0.85 (95% CI 0.77 to 0.93) for the number of lifts during the STST, with an optimum cut-off of 20 lifts. CONCLUSION The 6MST and STST predicted morbidity and mortality after lung cancer resection via minimally invasive surgery. The preoperative use of these exercise tests in clinical practice may be useful for risk stratification. REGISTRATION NCT03824977.
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Affiliation(s)
- Fairuz Boujibar
- Department of Thoracic Surgery, Rouen University Hospital, Rouen, France; Normandie University, UNIROUEN, INSERM U1096, Haute Normandie Research and Biomedical Innovation, Rouen, France.
| | - André Gillibert
- Department of Biostatistics, Rouen University Hospital, Rouen, France
| | - Tristan Bonnevie
- Normandie University, UNIROUEN, INSERM U1096, Haute Normandie Research and Biomedical Innovation, Rouen, France; ADIR Association, Rouen University Hospital, Rouen, France
| | - Philippe Rinieri
- Department of Thoracic Surgery, Centre Médico-chirurgical du Cèdre, Bois-Guillaume, France
| | - François Montagne
- Department of Thoracic Surgery, University Hospital of Lille, Lille, France
| | - Jean Selim
- Normandie University, UNIROUEN, INSERM U1096, Haute Normandie Research and Biomedical Innovation, Rouen, France; Department of Anaesthesiology and Critical Care, Rouen University Hospital, Rouen, France
| | - Antoine Cuvelier
- Normandie University, UNIROUEN, INSERM U1096, Haute Normandie Research and Biomedical Innovation, Rouen, France; Pulmonary, Thoracic Oncology and Respiratory Intensive Care Department, Rouen University Hospital, Rouen, France
| | - Francis-Edouard Gravier
- Normandie University, UNIROUEN, INSERM U1096, Haute Normandie Research and Biomedical Innovation, Rouen, France; ADIR Association, Rouen University Hospital, Rouen, France
| | - Jean-Marc Baste
- Department of Thoracic Surgery, Rouen University Hospital, Rouen, France; Normandie University, UNIROUEN, INSERM U1096, Haute Normandie Research and Biomedical Innovation, Rouen, France
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Chevalier L, Selim J, Castro C, Cuvilly F, Baste JM, Richard V, Pareige P, Bellien J. Combined Electron Microscopy Approaches for Arterial Glycocalyx Visualization. Front Cardiovasc Med 2022; 9:840689. [PMID: 35355969 PMCID: PMC8959549 DOI: 10.3389/fcvm.2022.840689] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
Mainly constituted of glycosaminoglycans and proteoglycans, the glycocalyx is anchored in the plasma membrane, covering, in particular, the extracellular face of the arterial endothelium. Due to its complex three-dimensional (3D) architecture, the glycocalyx interacts with a wide variety of proteins, contributing to vascular permeability, the flow of mechanotransduction, and the modulation of local inflammatory processes. Alterations of glycocalyx structure mediate the endothelial dysfunction and contribute to the aggravation of peripheral vascular diseases. Therefore, the exploration of its ultrastructure becomes a priority to evaluate the degree of injury under physiopathological conditions and to assess the impact of therapeutic approaches. The objective of this study was to develop innovative approaches in electron microscopy to visualize the glycocalyx at the subcellular scale. Intravenous perfusion on rats with a fixing solution containing aldehyde fixatives enriched with lanthanum ions was performed to prepare arterial samples. The addition of lanthanum nitrate in the fixing solution allowed the enhancement of the staining of the glycocalyx for transmission electron microscopy (TEM) and to detect elastic and inelastic scattered electrons, providing complementary qualitative information. The strength of scanning electron microscopy (SEM) was used on resin-embedded serial sections, allowing rapid and efficient large field imaging and previous correlative TEM observations for ultrastructural fine details. To demonstrate the dynamic feature of the glycocalyx, 3D tomography was provided by dual-beam focus-ion-beam-SEM (FIB-SEM). These approaches allowed us to visualize and characterize the ultrastructure of the pulmonary artery glycocalyx under physiological conditions and in a rat pulmonary ischemia-reperfusion model, known to induce endothelial dysfunction. This study demonstrates the feasibility of combined SEM, TEM, and FIB-SEM tomography approaches on the same sample as the multiscale visualization and the identification of structural indicators of arterial endothelial glycocalyx integrity.
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Affiliation(s)
- Laurence Chevalier
- Université Rouen Normandie, CNRS, INSA Rouen Normandie- Normandie Université- GPM-UMR 6634, Rouen, France
- *Correspondence: Laurence Chevalier
| | - Jean Selim
- Université Rouen Normandie, INSERM, Normandie Université, ENVI- U1096, Rouen, France
- Rouen University Hospital, Department of Anaesthesia and Critical Care, Rouen, France
| | - Celia Castro
- Université Rouen Normandie, CNRS, INSA Rouen Normandie- Normandie Université- GPM-UMR 6634, Rouen, France
| | - Fabien Cuvilly
- Université Rouen Normandie, CNRS, INSA Rouen Normandie- Normandie Université- GPM-UMR 6634, Rouen, France
| | - Jean-Marc Baste
- Université Rouen Normandie, INSERM, Normandie Université, ENVI- U1096, Rouen, France
- Rouen University Hospital, Department of Thoracic Surgery, Rouen, France
| | - Vincent Richard
- Université Rouen Normandie, INSERM, Normandie Université, ENVI- U1096, Rouen, France
- Rouen University Hospital, Department of Pharmacology, Rouen, France
| | - Philippe Pareige
- Université Rouen Normandie, CNRS, INSA Rouen Normandie- Normandie Université- GPM-UMR 6634, Rouen, France
| | - Jeremy Bellien
- Université Rouen Normandie, INSERM, Normandie Université, ENVI- U1096, Rouen, France
- Rouen University Hospital, Department of Pharmacology, Rouen, France
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Patel YS, Hanna WC, Fahim C, Shargall Y, Waddell TK, Yasufuku K, Machuca TN, Pipkin M, Baste JM, Xie F, Shiwcharan A, Foster G, Thabane L. RAVAL trial: Protocol of an international, multi-centered, blinded, randomized controlled trial comparing robotic-assisted versus video-assisted lobectomy for early-stage lung cancer. PLoS One 2022; 17:e0261767. [PMID: 35108265 PMCID: PMC8809527 DOI: 10.1371/journal.pone.0261767] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 11/06/2021] [Indexed: 11/19/2022] Open
Abstract
Background Retrospective data demonstrates that robotic-assisted thoracoscopic surgery provides many benefits, such as decreased postoperative pain, lower mortality, shorter length of stay, shorter chest tube duration, and reductions in the incidence of common postoperative pulmonary complications, when compared to video-assisted thoracoscopic surgery. Despite the potential benefits of robotic surgery, there are two major barriers against its widespread adoption in thoracic surgery: lack of high-quality prospective data, and the perceived higher cost of it. Therefore, in the face of these barriers, a prospective randomized controlled trial comparing robotic- to video-assisted thoracoscopic surgery is needed. The RAVAL trial is a two-phase, international, multi-centered, blinded, parallel, randomized controlled trial that is comparing robotic- to video-assisted lobectomy for early-stage non-small cell lung cancer that has been enrolling patients since 2016. Methods The RAVAL trial will be conducted in two phases: Phase A will enroll 186 early-stage non-small cell lung cancer patients who are candidates for minimally invasive pulmonary lobectomy; while Phase B will continue to recruit until 592 patients are enrolled. After consent, participants will be randomized in a 1:1 ratio to either robotic- or video-assisted lobectomy, and blinded to the type of surgery they are allocated to. Health-related quality of life questionnaires will be administered at baseline, postoperative day 1, weeks 3, 7, 12, months 6, 12, 18, 24, and years 3, 4, 5. The primary objective of the RAVAL trial is to determine the difference in patient-reported health-related quality of life outcomes between the robotic- and video-assisted lobectomy groups at 12 weeks. Secondary objectives include determining the differences in cost-effectiveness, and in the 5-year survival data between the two arms. The results of the primary objective will be reported once Phase A has completed accrual and the 12-month follow-ups are completed. The results of the secondary objectives will be reported once Phase B has completed accrual and the 5-year follow-ups are completed. Discussion If successfully completed, the RAVAL Trial will have studied patient-reported outcomes, cost-effectiveness, and survival of robotic- versus video-assisted lobectomy in a prospective, randomized, blinded fashion in an international setting. Trial registration ClinicalTrials.gov, NCT02617186. Registered 22-September-2015. https://clinicaltrials.gov/ct2/show/NCT02617186
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Affiliation(s)
- Yogita S. Patel
- Division of Thoracic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- * E-mail:
| | - Waël C. Hanna
- Division of Thoracic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Christine Fahim
- Division of Thoracic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Yaron Shargall
- Division of Thoracic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Thomas K. Waddell
- Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kazuhiro Yasufuku
- Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Tiago N. Machuca
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida, United States of America
| | - Mauricio Pipkin
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida, United States of America
| | - Jean-Marc Baste
- Division of Thoracic Surgery, Department of Surgery, Rouen Normandy University, Rouen Cedex, France
| | - Feng Xie
- Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Andrea Shiwcharan
- Funding Reform and Case Costing, St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Gary Foster
- Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
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23
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Gravier FE, Smondack P, Boujibar F, Prieur G, Medrinal C, Combret Y, Muir JF, Baste JM, Cuvelier A, Debeaumont D, Bonnevie T. Prehabilitation sessions can be provided more frequently in a shortened regimen with similar or better efficacy in people with non-small cell lung cancer: a randomised trial. J Physiother 2022; 68:43-50. [PMID: 34952813 DOI: 10.1016/j.jphys.2021.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/24/2021] [Accepted: 12/09/2021] [Indexed: 12/24/2022] Open
Abstract
QUESTION In people with non-small cell lung cancer, what is the effect of condensing 15 prehabilitation sessions into a 3-week regimen compared with a 5-week regimen? DESIGN Randomised controlled trial with concealed allocation, intention-to-treat analysis and blinded assessment of the primary outcome. PARTICIPANTS People with diagnosed or suspected non-small cell lung cancer and moderate-to-high risk of postoperative complications. INTERVENTION Fifteen supervised prehabilitation sessions delivered with either a dense regimen of five sessions/week for 3 weeks (experimental group) or a non-dense regimen of three sessions/week for 5 weeks (control group). OUTCOME MEASURES The primary outcome was the change in cardiorespiratory fitness measured by the V̇O2peak in ml/kg/min. The secondary outcomes were the change in other variables of interest measured during cardiopulmonary exercise testing, non-invasive nutritional markers, quadriceps maximal voluntary isometric contractions, maximal inspiratory pressure, quality of life, adherence and postoperative complications. RESULTS Changes with the experimental regimen were similar to or better than changes with the control regimen for: V̇O2peak (MD 1.2 ml/kg/min, 95% CI -0.1 to 2.6); V̇E/V̇CO2 slope (MD -3.6 points, 95% CI -8.7 to 1.5); and work rate at ventilatory threshold (MD 3.7 W, 95% CI -5.6 to 13.0). The two regimens had similar effects on: peak work rate (MD 1.3 W, 95% CI -6.4 to 9.0), V̇O2 at ventilatory threshold (MD 0.0 ml/kg/min, 95% CI -1.4 to 1.4); body mass index (MD -0.2 kg/m2, 95% CI -0.5 to 0.1); and maximal inspiratory pressure (MD -0.7 cmH2O, 95% CI -9.8 to 8.4). The relative effect was uncertain for quadriceps maximal voluntary isometric contractions, quality of life and complications. CONCLUSION Condensing prehabilitation sessions led to similar or better improvement in cardiorespiratory fitness and did not decrease adherence or increase adverse events. This could increase the number of patients who can be referred for prehabilitation, despite short presurgical periods. TRIAL REGISTRATION NCT03936764.
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Affiliation(s)
- Francis-Edouard Gravier
- ADIR Association, Rouen University Hospital, Rouen, France; Normandie University, UNIROUEN, UPRES EA 3830, Haute Normandie Research and Biomedical Innovation, Rouen, France.
| | | | - Fairuz Boujibar
- Department of Thoracic Surgery, Rouen University Hospital, Rouen, France; Normandie University, UNIROUEN, INSERM U1096, Haute Normandie Research and Biomedical Innovation, Rouen, France
| | - Guillaume Prieur
- Normandie University, UNIROUEN, UPRES EA 3830, Haute Normandie Research and Biomedical Innovation, Rouen, France; Intensive Care Unit Department, Le Havre Hospital, Le Havre, France
| | - Clément Medrinal
- Intensive Care Unit Department, Le Havre Hospital, Le Havre, France; Université Paris-Saclay, UVSQ, UR 20201 ERPHAN, Versailles, France; IFMK Saint Michel, Paris, France
| | - Yann Combret
- Physiotherapy Department, Le Havre Hospital, Le Havre, France
| | - Jean-François Muir
- ADIR Association, Rouen University Hospital, Rouen, France; Normandie University, UNIROUEN, UPRES EA 3830, Haute Normandie Research and Biomedical Innovation, Rouen, France
| | - Jean-Marc Baste
- Department of Thoracic Surgery, Rouen University Hospital, Rouen, France; Normandie University, UNIROUEN, INSERM U1096, Haute Normandie Research and Biomedical Innovation, Rouen, France
| | - Antoine Cuvelier
- Normandie University, UNIROUEN, UPRES EA 3830, Haute Normandie Research and Biomedical Innovation, Rouen, France; Pulmonary, Thoracic Oncology and Respiratory Intensive Care Department, Rouen University Hospital, Rouen, France
| | - David Debeaumont
- Department of Respiratory and Exercise Physiology and CIC-CRB 1404, Rouen University Hospital, Rouen, France
| | - Tristan Bonnevie
- ADIR Association, Rouen University Hospital, Rouen, France; Normandie University, UNIROUEN, UPRES EA 3830, Haute Normandie Research and Biomedical Innovation, Rouen, France
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24
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Bottet B, Rivera C, Dahan M, Falcoz PE, Jaillard S, Baste JM, Seguin-Givelet A, de la Tour RB, Bellenot F, Rind A, Gossot D, Thomas PA, D’Journo XB. OUP accepted manuscript. Interact Cardiovasc Thorac Surg 2022; 35:6584014. [PMID: 35543477 PMCID: PMC9419675 DOI: 10.1093/icvts/ivac129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/10/2022] [Accepted: 05/04/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Benjamin Bottet
- Department of General and Thoracic Surgery, Rouen University Hospital, Rouen, France
| | - Caroline Rivera
- Department of Thoracic Surgery, Bayonne Hospital, Bayonne, France
| | - Marcel Dahan
- Department of Thoracic Surgery, Larrey Hospital, CHU Toulouse, Toulouse, France
| | | | - Sophie Jaillard
- Department of Thoracic surgery, Hopital Privé le Bois, Lille, France
| | - Jean-Marc Baste
- Department of General and Thoracic Surgery, Rouen University Hospital, Rouen, France
| | - Agathe Seguin-Givelet
- Department of Thoracic Surgery, Curie-Montsouris Thorax Institute, Institut Mutualiste Montsouris, Paris, France
- Paris 13 University, Sorbonne Paris Cité, Faculty of Medecine SMBH, Bobigny, France
| | | | | | - Alain Rind
- Organisme d’Accréditation (OA)-CTCV, SFCTCV, Paris, France
| | - Dominique Gossot
- Department of Thoracic Surgery, Curie-Montsouris Thorax Institute, Institut Mutualiste Montsouris, Paris, France
| | - Pascal-Alexandre Thomas
- Department of Thoracic Surgery, Hopital Nord-APHM, Aix-Marseille University, Marseille, France
| | - Xavier Benoit D’Journo
- Department of Thoracic Surgery, Hopital Nord-APHM, Aix-Marseille University, Marseille, France
- Corresponding author. Department of Thoracic Surgery, Hopital Nord-APHM, Aix-Marseille University, Chemin des Bourrely, 13015 Marseille, France. Tel: +33-4-91-96-60-01; fax: +33-4-91-96-60-04; e-mail: (X.B. D’Journo)
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25
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Kostic M, Sarsam M, Bottet B, Baste JM. Post-immunotherapy combined operative technique with an anterior surgical approach and robot-assisted lobectomy for an anterior superior sulcus tumor—case report. J Vis Surg 2022. [DOI: 10.21037/jovs-20-95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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26
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Pagès PB, Gutierrez I, Baste JM. Pulmonary artery repair during robotic lung resection: narrative review and management. J Vis Surg 2022. [DOI: 10.21037/jovs-20-147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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27
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Lim E, Baste JM, Shackcloth M. Clinical outcomes of pre-attached reinforced stapler reloads in thoracic surgery: a prospective case series. J Thorac Dis 2022; 14:2864-2873. [PMID: 36071754 PMCID: PMC9442509 DOI: 10.21037/jtd-22-220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/11/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Eric Lim
- Imperial College and The Royal Brompton Hospital, London, UK
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28
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Seder CW, Farrokhyar F, Nayak R, Baste JM, Patel Y, Agzarian J, Finley CJ, Shargall Y, Thomas PA, Dahan M, Verhoye JP, Mbadinga F, Hanna WC. Robotic vs. Thoracoscopic Anatomic Lung Resection in Obese Patients: A Propensity Adjusted Analysis. Ann Thorac Surg 2021; 114:1879-1885. [PMID: 34742733 DOI: 10.1016/j.athoracsur.2021.09.061] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/16/2021] [Accepted: 09/23/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Minimally-invasive lung resections can be particularly challenging in obese patients. We hypothesized robotic surgery (RTS) is associated with less conversion to thoracotomy than thoracoscopic surgery (VATS) in obese populations. METHODS The STS GTSD, Epithor French National Database, and McMaster University Database were queried for obese (BMI≥30 kg/m2) patients who underwent VATS or RTS lobectomy or segmentectomy for clinical T1-2, N0-1 NSCLC between 2015-2019. Propensity score adjusted logistic regression analysis was used to compare the rate of conversion to thoracotomy between the VATS and RTS cohorts. RESULTS Overall, 8,108 patients (STS GTSD: n=7,473; Epithor: n=572; McMaster: n=63) met inclusion criteria with a mean age of 66.6 years (SD 9 years) and BMI of 34.7 kg/m2 (SD 4.5 kg/m2). After propensity score adjusted multivariable analysis, patients who underwent VATS were over 5 times more likely to experience conversion to thoracotomy than those who underwent RTS (OR=5.33; 95% CI 4.14, 6.81, p<0.001). There was a linear association between degree of obesity and odds ratio of VATS conversion to thoracotomy compared to RTS. The VATS cohort had a longer mean length of stay (5.0 vs. 4.3 days, p<0.001), higher rate of respiratory failure (2.8% [168/5975] vs. 1.8% [39/2133], p=0.026), and were less likely to be discharged to their home (92.5% [5,525/5,975] vs. 94.3% [2,012/2,133]; p=0.013) compared to RTS patients. CONCLUSIONS In obese patients, RTS anatomic lung resection is associated with a lower rate of conversion to thoracotomy than VATS.
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Affiliation(s)
- Christopher W Seder
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, IL, USA.
| | - Forough Farrokhyar
- The Office of Surgical Research Services, Department of Surgery, McMaster University, Hamilton, ON, Canada; Department of Health, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Rahul Nayak
- Division of Thoracic Surgery, McMaster University, Hamilton, ON, Canada
| | - Jean-Marc Baste
- Departement de Chirurgie Thoracique, Centre Hospitalier Universitaire de Rouen, Rouen, France
| | - Yogita Patel
- Division of Thoracic Surgery, McMaster University, Hamilton, ON, Canada
| | - John Agzarian
- Division of Thoracic Surgery, McMaster University, Hamilton, ON, Canada
| | | | - Yaron Shargall
- Division of Thoracic Surgery, McMaster University, Hamilton, ON, Canada
| | - Pascal-Alexandre Thomas
- Departement de Chirurgie Thoracique, Hopitaux Universitaires de Marseille, Marseille, France
| | - Marcel Dahan
- Departement de Chirurgie Thoracique, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Jean-Philippe Verhoye
- Departement de Chirurgie Thoracique, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Frankie Mbadinga
- Departement de Chirurgie Thoracique, Centre Hospitalier Universitaire de Rouen, Rouen, France
| | - Waël C Hanna
- Division of Thoracic Surgery, McMaster University, Hamilton, ON, Canada
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29
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Bouabdallah I, Baste JM. Robotic assisted thoracic surgery: advanced procedures in lung and mediastinum. J Vis Surg 2021. [DOI: 10.21037/jovs-21-44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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30
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Amoedo ND, Sarlak S, Obre E, Esteves P, Bégueret H, Kieffer Y, Rousseau B, Dupis A, Izotte J, Bellance N, Dard L, Redonnet-Vernhet I, Punzi G, Rodrigues MF, Dumon E, Mafhouf W, Guyonnet-Dupérat V, Gales L, Palama T, Bellvert F, Dugot-Senan N, Claverol S, Baste JM, Lacombe D, Rezvani HR, Pierri CL, Mechta-Grigoriou F, Thumerel M, Rossignol R. Targeting the mitochondrial trifunctional protein restrains tumor growth in oxidative lung carcinomas. J Clin Invest 2021; 131:133081. [PMID: 33393495 DOI: 10.1172/jci133081] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 10/21/2020] [Indexed: 12/15/2022] Open
Abstract
Metabolic reprogramming is a common hallmark of cancer, but a large variability in tumor bioenergetics exists between patients. Using high-resolution respirometry on fresh biopsies of human lung adenocarcinoma, we identified 2 subgroups reflected in the histologically normal, paired, cancer-adjacent tissue: high (OX+) mitochondrial respiration and low (OX-) mitochondrial respiration. The OX+ tumors poorly incorporated [18F]fluorodeoxy-glucose and showed increased expression of the mitochondrial trifunctional fatty acid oxidation enzyme (MTP; HADHA) compared with the paired adjacent tissue. Genetic inhibition of MTP altered OX+ tumor growth in vivo. Trimetazidine, an approved drug inhibitor of MTP used in cardiology, also reduced tumor growth and induced disruption of the physical interaction between the MTP and respiratory chain complex I, leading to a cellular redox and energy crisis. MTP expression in tumors was assessed using histology scoring methods and varied in negative correlation with [18F]fluorodeoxy-glucose incorporation. These findings provide proof-of-concept data for preclinical, precision, bioenergetic medicine in oxidative lung carcinomas.
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Affiliation(s)
- Nivea Dias Amoedo
- CELLOMET, Bordeaux, France.,INSERM U1211, Bordeaux, France.,Bordeaux University, Bordeaux, France
| | - Saharnaz Sarlak
- INSERM U1211, Bordeaux, France.,Bordeaux University, Bordeaux, France
| | - Emilie Obre
- INSERM U1211, Bordeaux, France.,Bordeaux University, Bordeaux, France
| | - Pauline Esteves
- INSERM U1211, Bordeaux, France.,Bordeaux University, Bordeaux, France
| | - Hugues Bégueret
- Bordeaux University, Bordeaux, France.,Pathology Department, Haut-Lévèque Hospital, CHU Bordeaux, Bordeaux, France
| | - Yann Kieffer
- Stress and Cancer Laboratory, Curie Institute - INSERM U830, Paris, France
| | - Benoît Rousseau
- INSERM U1211, Bordeaux, France.,Transgenic Animal Facility A2, University of Bordeaux, Bordeaux, France
| | - Alexis Dupis
- INSERM U1211, Bordeaux, France.,Bordeaux University, Bordeaux, France
| | - Julien Izotte
- INSERM U1211, Bordeaux, France.,Transgenic Animal Facility A2, University of Bordeaux, Bordeaux, France
| | - Nadège Bellance
- INSERM U1211, Bordeaux, France.,Bordeaux University, Bordeaux, France
| | - Laetitia Dard
- CELLOMET, Bordeaux, France.,INSERM U1211, Bordeaux, France.,Bordeaux University, Bordeaux, France
| | - Isabelle Redonnet-Vernhet
- CELLOMET, Bordeaux, France.,INSERM U1211, Bordeaux, France.,Biochemistry Department, Pellegrin Hospital, CHU Bordeaux, Bordeaux, France
| | - Giuseppe Punzi
- Laboratory of Biochemistry and Molecular Biology, University of Bari,Bari, Italy
| | | | - Elodie Dumon
- INSERM U1211, Bordeaux, France.,Bordeaux University, Bordeaux, France
| | - Walid Mafhouf
- Bordeaux University, Bordeaux, France.,INSERM U1035, Bordeaux, France
| | | | - Lara Gales
- Laboratoire d'Ingénierie des Systèmes Biologiques et des Procédés (LISBP), Institut National des Sciences Appliquées (INSA)/CNRS 5504 - UMR INSA/Institut National de la Recherche Agronomique (INRA) 792, Toulouse, France
| | - Tony Palama
- Laboratoire d'Ingénierie des Systèmes Biologiques et des Procédés (LISBP), Institut National des Sciences Appliquées (INSA)/CNRS 5504 - UMR INSA/Institut National de la Recherche Agronomique (INRA) 792, Toulouse, France
| | - Floriant Bellvert
- Laboratoire d'Ingénierie des Systèmes Biologiques et des Procédés (LISBP), Institut National des Sciences Appliquées (INSA)/CNRS 5504 - UMR INSA/Institut National de la Recherche Agronomique (INRA) 792, Toulouse, France
| | | | - Stéphane Claverol
- Bordeaux University, Bordeaux, France.,Functional Genomics Center (CGFB), Proteomics Facility, Bordeaux, France
| | - Jean-Marc Baste
- Thoracic Surgery, Haut-Lévèque Hospital, CHU Bordeaux, Bordeaux, France
| | - Didier Lacombe
- INSERM U1211, Bordeaux, France.,Bordeaux University, Bordeaux, France
| | | | - Ciro Leonardo Pierri
- Laboratory of Biochemistry and Molecular Biology, University of Bari,Bari, Italy
| | | | - Matthieu Thumerel
- Thoracic Surgery, Haut-Lévèque Hospital, CHU Bordeaux, Bordeaux, France
| | - Rodrigue Rossignol
- CELLOMET, Bordeaux, France.,INSERM U1211, Bordeaux, France.,Bordeaux University, Bordeaux, France
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31
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Baste JM, Bottet B, Selim J, Sarsam M, Lefevre-Scelles A, Dusseaux MM, Franchina S, Palenzuela AS, Chagraoui A, Peillon C, Thouroude A, Henry JP, Coq JMM, Sibert L, Damm C. Implementation of simulation-based crisis training in robotic thoracic surgery: how to improve safety and performance? J Thorac Dis 2021; 13:S26-S34. [PMID: 34447589 PMCID: PMC8371544 DOI: 10.21037/jtd-2020-epts-03] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/14/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Jean-Marc Baste
- Department of General and Thoracic Surgery, UNIROUEN, Inserm U1096, Rouen University Hospital, Normandie University, Rouen, France.,MTC (Medical Training Center) Rouen, Normandie, France
| | - Benjamin Bottet
- Department of General and Thoracic Surgery, UNIROUEN, Inserm U1096, Rouen University Hospital, Normandie University, Rouen, France
| | - Jean Selim
- Department of Anesthesia and Critical Care Medicine, UNIROUEN, Rouen University Hospital, Normandie University, Rouen, France
| | - Matthieu Sarsam
- Department of General and Thoracic Surgery, UNIROUEN, Inserm U1096, Rouen University Hospital, Normandie University, Rouen, France
| | - Antoine Lefevre-Scelles
- MTC (Medical Training Center) Rouen, Normandie, France.,Department of Anesthesia and Critical Care Medicine, UNIROUEN, Rouen University Hospital, Normandie University, Rouen, France
| | - Marie-Melody Dusseaux
- Department of Anesthesia and Critical Care Medicine, UNIROUEN, Rouen University Hospital, Normandie University, Rouen, France
| | - Sébastien Franchina
- Department of Anesthesia and Critical Care Medicine, UNIROUEN, Rouen University Hospital, Normandie University, Rouen, France
| | - Anne-Sophie Palenzuela
- Department of General and Thoracic Surgery, UNIROUEN, Inserm U1096, Rouen University Hospital, Normandie University, Rouen, France
| | - Abdeslam Chagraoui
- INSERM, U1239, Department of Medical Biochemistry, Rouen University Hospital, Normandie University, Rouen, France
| | - Christophe Peillon
- Department of General and Thoracic Surgery, UNIROUEN, Inserm U1096, Rouen University Hospital, Normandie University, Rouen, France
| | | | - Jean-Pierre Henry
- Department of Anesthesia and Critical Care Medicine, UNIROUEN, Rouen University Hospital, Normandie University, Rouen, France
| | - Jean-Michel M Coq
- MTC (Medical Training Center) Rouen, Normandie, France.,Psychology Department, UFR Human and Social Sciences, EA 7475, Normandie University, Rouen, France
| | - Louis Sibert
- MTC (Medical Training Center) Rouen, Normandie, France
| | - Cédric Damm
- Department of Anesthesia and Critical Care Medicine, UNIROUEN, Rouen University Hospital, Normandie University, Rouen, France
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32
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Gravier FE, Smondack P, Prieur G, Medrinal C, Combret Y, Muir JF, Baste JM, Cuvelier A, Boujibar F, Bonnevie T. Effects of exercise training in people with non-small cell lung cancer before lung resection: a systematic review and meta-analysis. Thorax 2021; 77:486-496. [PMID: 34429375 DOI: 10.1136/thoraxjnl-2021-217242] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/23/2021] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Exercise training before lung resection for non-small cell lung cancer is believed to decrease postoperative complications (POC) by improving cardiorespiratory fitness. However, this intervention lacks a strong evidence base. AIM To assess the effectiveness of preoperative exercise training compared with usual care on POC and other secondary outcomes in patients with scheduled lung resection. METHODS A systematic search of randomised trials was conducted by two authors. Meta-analysis was performed, and the effect of exercise training was estimated by risk ratios (RR) and mean differences, with their CIs. Clinical usefulness was estimated according to minimal important difference values (MID). RESULTS Fourteen studies involving 791 participants were included. Compared with usual care, exercise training reduced overall POC (10 studies, 617 participants, RR 0.58, 95% CI 0.45 to 0.75) and clinically relevant POC (4 studies, 302 participants, Clavien-Dindo score ≥2 RR 0.42, 95% CI 0.25 to 0.69). The estimate of the effect of exercise training on mortality was very imprecise (6 studies, 456 participants, RR 0.66, 95% CI 0.20 to 2.22). The main risks of bias were a lack of participant blinding and selective reporting. Exercise training appeared to improve exercise capacity, pulmonary function and also quality of life and depression, although the clinical usefulness of the changes was unclear. The quality of the evidence was graded for each outcome. CONCLUSION Preoperative exercise training leads to a worthwhile reduction in postoperative complications. These estimates were both accurate and large enough to make recommendations for clinical practice.
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Affiliation(s)
- Francis-Edouard Gravier
- ADIR Association, University Hospital Centre Rouen, Rouen, France .,UPRES EA 3830, Haute Normandie Research and Biomedical Innovation, Rouen University, Rouen, France
| | - Pauline Smondack
- ADIR Association, University Hospital Centre Rouen, Rouen, France
| | - Guillaume Prieur
- UPRES EA 3830, Haute Normandie Research and Biomedical Innovation, Rouen University, Rouen, France.,Intensive Care Unit Department, Groupe Hospitalier du Havre, Le Havre, France
| | - Clement Medrinal
- Intensive Care Unit Department, Groupe Hospitalier du Havre, Le Havre, France.,IFMK Saint-Michel, Paris, France.,Equipe de Recherche Paramédicale sur le HAndicap Neuromoteur (ERPHAN), Université Paris-Saclay, Versailles, France
| | - Yann Combret
- Intensive Care Unit Department, Groupe Hospitalier du Havre, Le Havre, France
| | - Jean-François Muir
- ADIR Association, University Hospital Centre Rouen, Rouen, France.,UPRES EA 3830, Haute Normandie Research and Biomedical Innovation, Rouen University, Rouen, France
| | - Jean-Marc Baste
- Thoracic Surgery Department, University Hospital Centre Rouen, Rouen, France.,INSERM U1096, Haute Normandie Research and Biomedical Innovation, Rouen University, Rouen, France
| | - Antoine Cuvelier
- UPRES EA 3830, Haute Normandie Research and Biomedical Innovation, Rouen University, Rouen, France.,Pulmonary, Thoracic Oncology and Respiratory Intensive Care Department, University Hospital Centre Rouen, Rouen, France
| | - Fairuz Boujibar
- Thoracic Surgery Department, University Hospital Centre Rouen, Rouen, France.,INSERM U1096, Haute Normandie Research and Biomedical Innovation, Rouen University, Rouen, France
| | - Tristan Bonnevie
- ADIR Association, University Hospital Centre Rouen, Rouen, France.,UPRES EA 3830, Haute Normandie Research and Biomedical Innovation, Rouen University, Rouen, France
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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: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Selim J, Hamzaoui M, Boukhalfa I, Djerada Z, Chevalier L, Piton N, Genty D, Besnier E, Clavier T, Dumesnil A, Renet S, Mulder P, Doguet F, Tamion F, Veber B, Richard V, Baste JM. Cardiopulmonary bypass increases endothelial dysfunction after pulmonary ischaemia-reperfusion in an animal model. Eur J Cardiothorac Surg 2021; 59:1037-1047. [PMID: 33276375 DOI: 10.1093/ejcts/ezaa412] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 10/06/2020] [Accepted: 10/18/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Endothelial dysfunction during ischaemia-reperfusion (IR) is a major cause of primary graft dysfunction during lung transplantation. The routine use of cardiopulmonary bypass (CPB) during lung transplantation remains controversial. However, the contribution of CPB to pulmonary endothelial dysfunction remains unclear. The objective was to investigate the impact of CPB on endothelial dysfunction in a lung IR rat model. METHODS Rats were allocated to 4 groups: (i) Sham, (ii) IR, (iii) CPB and (iv) IR-CPB. The primary outcome was the study of pulmonary vascular reactivity by wire myograph. We also assessed glycocalyx degradation by enzyme-linked immunosorbent assay and electron microscopy and both systemic and pulmonary inflammation by enzyme-linked immunosorbent assay and immunohistochemistry. Rats were exposed to 45 min of CPB and IR. We used a CPB model allowing femoro-femoral support with left pulmonary hilum ischaemia for IR. RESULTS Pulmonary endothelium-dependent relaxation to acetylcholine was markedly reduced in the IR-CPB group (10.7 ± 9.1%) compared to the IR group (50.5 ± 5.2%, P < 0.001), the CPB group (54.1 ± 4.7%, P < 0.001) and the sham group (80.8 ± 6.7%, P < 0.001), suggesting that the association of pulmonary IR and CPB increases endothelial dysfunction. In IR-CPB, IR and CPB groups, vasorelaxation was completely abolished when inhibiting nitric oxide synthase, suggesting that this relaxation process was mainly mediated by nitric oxide. We observed higher syndecan-1 plasma levels in the IR-CPB group in comparison with the other groups, reflecting an increased degradation of glycocalyx. We also observed higher systemic inflammation in the IR-CPB group as shown by the increased plasma levels of IL-1β, IL-10. CONCLUSIONS CPB significantly increased the IR-mediated effects on pulmonary endothelial dysfunction. Therefore, the use of CPB during lung transplantation could be deleterious, by increasing endothelial dysfunction.
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Affiliation(s)
- Jean Selim
- Normandie Univ, UNIVROUEN, INSERM U1096, Rouen, France.,Rouen University Hospital, Department of Anaesthesia and Critical Care, Rouen, France
| | | | | | | | | | - Nicolas Piton
- Rouen University Hospital, Department of Pathology, Rouen, France
| | - Damien Genty
- Rouen University Hospital, Department of Pathology, Rouen, France
| | - Emmanuel Besnier
- Normandie Univ, UNIVROUEN, INSERM U1096, Rouen, France.,Rouen University Hospital, Department of Anaesthesia and Critical Care, Rouen, France
| | - Thomas Clavier
- Normandie Univ, UNIVROUEN, INSERM U1096, Rouen, France.,Rouen University Hospital, Department of Anaesthesia and Critical Care, Rouen, France
| | | | | | - Paul Mulder
- Normandie Univ, UNIVROUEN, INSERM U1096, Rouen, France
| | - Fabien Doguet
- Normandie Univ, UNIVROUEN, INSERM U1096, Rouen, France
| | | | - Benoît Veber
- Rouen University Hospital, Department of Anaesthesia and Critical Care, Rouen, France
| | | | - Jean-Marc Baste
- Normandie Univ, UNIVROUEN, INSERM U1096, Rouen, France.,Rouen University Hospital, Department of Thoracic Surgery, Rouen, France
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Berg E, Madelaine L, Baste JM, Dahan M, Thomas P, Falcoz PE, Martinod E, Bernard A, Pagès PB. Interest of anatomical segmentectomy over lobectomy for lung cancer: a nationwide study. J Thorac Dis 2021; 13:3587-3596. [PMID: 34277052 PMCID: PMC8264688 DOI: 10.21037/jtd-20-2203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 03/25/2021] [Indexed: 11/25/2022]
Abstract
Background Anatomical segmentectomy is an alternative to lobectomy for early-stage lung cancer (LC) or in patients at high risk. The main objective of this study was to compare the morbidity and mortality associated with these two types of pulmonary resection using data from the French National Epithor database. Methods All patients who underwent lobectomy or segmentectomy for early-stage LC from January 1st 2014 to December 31st 2016 were identified in the Epithor database. The primary endpoint was morbidity; the secondary endpoint was postoperative mortality. Propensity score matching was implemented and used to balance groups. The results were reported as odds ratios (OR) and 95% confidence intervals (CI). Results During the study period, 1,604 segmentectomies (9.78%) and 14,786 lobectomies (90.22%) were performed. After matching, the segmentectomy group experienced significantly less atelectasis (OR 0.54; 95% CI: 0.4–0.75, P<0.0001), pneumonia (OR 0.72; 95% CI: 0.55–0.95, P=0.02), prolonged air leaks (OR 0.75; 95% CI: 0.64–0.89, P=0.001) or bronchopleural fistula (OR 0.35; 95% CI: 0.14–0.83, P=0.017), and fewer patients had at least one complication (OR 0.7; 95% CI: 0.62–0.78, P<0.0001). According to the Clavien-Dindo classification, postoperative complications were significantly less severe in the segmentectomy group (OR 0.52; 95% CI: 0.37–0.74, P<0.0001). There was no significant difference in postoperative mortality at 30 days (OR 0.67; 95% CI: 0.38–1.20, P=0.18), 60 days (OR 0.78; 95% CI: 0.42–1.47, P=0.4), or 90 days (OR 0.77; 95% CI: 0.45–1.34, P=0.36). Conclusions Anatomical segmentectomy is an alternative surgical approach that could reduce postoperative morbidity, but it does not appear to affect mortality.
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Affiliation(s)
- Elodie Berg
- CHU Dijon Bourgogne, Hôpital François Mitterrand, Dijon, France
| | | | | | | | | | | | | | - Alain Bernard
- CHU Dijon Bourgogne, Hôpital François Mitterrand, Dijon, France
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Montagne F, Delacour D, Fommarty M, Chaari Z, Papet E, Baste JM. Robotic radical thymothymectomy for thymomatous myasthenia gravis in the elderly: case report and mini-review. J Vis Surg 2021. [DOI: 10.21037/jovs-20-128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Sarsam M, Lachkar S, Baste JM. Creation of multi-images for assistance in surgery for robotic segmentectomies. Video-assist Thorac Surg 2021. [DOI: 10.21037/vats-20-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Yu X, Zhang R, Zhang M, Lin Y, Zhang X, Wen Y, Yang L, Huang Z, Wang G, Zhao D, Gonzalez M, Baste JM, Petersen RH, Ng CSH, Brunelli A, Zheng L, Zhang L. Segmental resection is associated with decreased survival in patients with stage IA non-small cell lung cancer with a tumor size of 21-30 mm. Transl Lung Cancer Res 2021; 10:900-913. [PMID: 33718031 PMCID: PMC7947415 DOI: 10.21037/tlcr-20-1217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The feasibility of segmental resection for early-stage non-small cell lung cancer (NSCLC) is still controversial. This study aimed to compare survival outcomes following lobectomy and segmental resection in patients with pathological T1cN0M0 (tumor size 21-30 mm) NSCLC. Methods Patients diagnosed between 1998 and 2016 with pathological stage IA NSCLC and with tumors measuring 21-30 mm were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. The observational outcomes were cancer-specific survival (CSS) and overall survival (OS) at 5 years. Univariate survival analysis was carried out to identify potential prognostic factors of prolonged survival. Cox proportional hazards model was used to adjust for confounding factors. Additionally, pairwise comparisons were conducted between lobectomy and segmental resection for CSS and OS, and forest plots were drawn. Results Of the 9,580 patients analyzed, 400 patients (4.2%) underwent segmental resections. Patients with older age (P<0.001), smaller tumors (P<0.001), and left-sided tumors (P=0.002) were more likely to receive segmental resection. No difference was found in the operative mortality rates between the segmental resection group and the lobectomy group (1.0% vs. 1.2%, P=0.707). The CSS (HR, 1.429; 95% CI, 1.166-1.752; P=0.001) and OS (HR, 1.348; 95% CI, 1.176-1.544; P<0.001) in the segmental resection group were significantly worse than those in the lobectomy group. Subgroup analyses by age, year of diagnosis, sex, tumor size, histology, grade, and the number of dissected lymph nodes also confirmed that lobectomy was associated with improved CSS and OS. Conclusions Lobectomy and thorough removal of lymph nodes should continue to be the recommended standard of care for patients with surgically resectable stage IA NSCLC with tumor size of 21-30 mm.
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Affiliation(s)
- Xiangyang Yu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Rusi Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Mengqi Zhang
- Department of Pathology, Shenzhen Maternity and Child Healthcare Hospital, Shenzhen, China
| | - Yongbin Lin
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xuewen Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Anesthesiology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yingsheng Wen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Longjun Yang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zirui Huang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Gongming Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Dechang Zhao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Michel Gonzalez
- Service of Thoracic Surgery, University Hospital of Lausanne, University of Lausanne, Lausanne, Switzerland
| | - Jean-Marc Baste
- Department of General and Thoracic Surgery, Rouen University Hospital, Rouen, France
| | - Rene Horsleben Petersen
- Department of Cardiothoracic Surgery, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Calvin S H Ng
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China
| | | | - Lie Zheng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Medical Imaging, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Lanjun Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
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Boujibar F, Gravier FE, Selim J, Baste JM. Preoperative assessment for minimally invasive lung surgery: Need an update? Thorac Cancer 2020; 12:3-4. [PMID: 33210472 PMCID: PMC7779197 DOI: 10.1111/1759-7714.13753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 11/07/2020] [Indexed: 12/25/2022] Open
Affiliation(s)
- Fairuz Boujibar
- Department of General and Thoracic Surgery, CHU Rouen, Rouen, France.,INSERM U1096, CHU Rouen, Rouen, France
| | | | - Jean Selim
- INSERM U1096, CHU Rouen, Rouen, France.,Department of Anesthesiology and Critical Care, Rouen University Hospital, Rouen, France
| | - Jean-Marc Baste
- Department of General and Thoracic Surgery, CHU Rouen, Rouen, France.,INSERM U1096, CHU Rouen, Rouen, France
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Gravier FE, Bonnevie T, Boujibar F, Médrinal C, Prieur G, Combret Y, Muir JF, Baste JM, Debeaumont D, Cuvelier A. Cardiopulmonary exercise testing in patients with non-small cell lung cancer: trust the V ˙ O 2peak? J Thorac Dis 2020; 12:5313-5323. [PMID: 33209365 PMCID: PMC7656379 DOI: 10.21037/jtd-20-1528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Maximal oxygen consumption (V˙ O2max) is the most frequently used variable to determine postoperative risk in patients with non-small cell lung cancer (NSCLC), however patients frequently cannot provide the necessary maximum effort to ensure the validity of the V˙ O2 measurements. The aim of this observational study was to assess exercise-limiting factors and the rate of achievement of the currently recommended maximality criteria in patients with NSCLC who had been routinely referred for cardiopulmonary exercise testing (CPET) to assess their postoperative risk. Methods Patient data, including peak exercise variables and markers used to designate the exercise test as maximal, were retrospectively analysed from 203 preoperative CPET assessments that were performed at Rouen University Hospital from January 2014 until July 2019. Results Ventilatory limitation was the most common physiological cause of exercise cessation. A total of 62 patients (or 30.5%) achieved either one, or no, markers of maximality. The mean duration of the incremental phase (after the 3-minute warm-up) was 5.1±2 minutes. Conclusions About 30% of the patients in this study did not generate maximum effort during CPET. As a result, it is likely that their V˙ O2peak was underestimated and that their post-operative risk was overestimated. It is therefore important to incorporate strategies to verify V˙ O2peak results for patients with values close to the risk threshold.
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Affiliation(s)
- Francis-Edouard Gravier
- ADIR Association, Rouen University Hospital, Rouen, France.,Normandy University UNIROUEN, UPRES EA 3830, Haute Normandie Research and Biomedical Innovation, Rouen, France
| | - Tristan Bonnevie
- ADIR Association, Rouen University Hospital, Rouen, France.,Normandy University UNIROUEN, UPRES EA 3830, Haute Normandie Research and Biomedical Innovation, Rouen, France
| | - Fairuz Boujibar
- Department of Thoracic Surgery, Rouen University Hospital, Rouen, France.,Normandy University UNIROUEN, INSERM U1096, Haute Normandie Research and Biomedical Innovation, Rouen, France
| | - Clément Médrinal
- Normandy University UNIROUEN, UPRES EA 3830, Haute Normandie Research and Biomedical Innovation, Rouen, France.,Medico-surgical Intensive Care Unit, Jacques Monod Hospital, Le Havre, France
| | - Guillaume Prieur
- Normandy University UNIROUEN, UPRES EA 3830, Haute Normandie Research and Biomedical Innovation, Rouen, France.,Medico-surgical Intensive Care Unit, Jacques Monod Hospital, Le Havre, France
| | - Yann Combret
- Medico-surgical Intensive Care Unit, Jacques Monod Hospital, Le Havre, France.,Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL and Dermatologie, Université Catholique de Louvain, Brussels 1200, Belgium
| | - Jean-François Muir
- ADIR Association, Rouen University Hospital, Rouen, France.,Normandy University UNIROUEN, UPRES EA 3830, Haute Normandie Research and Biomedical Innovation, Rouen, France
| | - Jean-Marc Baste
- Department of Thoracic Surgery, Rouen University Hospital, Rouen, France.,Normandy University UNIROUEN, INSERM U1096, Haute Normandie Research and Biomedical Innovation, Rouen, France
| | - David Debeaumont
- Department of Respiratory and Exercise Physiology and CIC-CRB 1404, Rouen University Hospital, Rouen, France
| | - Antoine Cuvelier
- Normandy University UNIROUEN, UPRES EA 3830, Haute Normandie Research and Biomedical Innovation, Rouen, France.,Pulmonary, Thoracic Oncology and Respiratory Intensive Care Department, Rouen University Hospital, Rouen, France
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Gravier FE, Bonnevie T, Boujibar F, Medrinal C, Prieur G, Combret Y, Muir JF, Baste JM, Debeaumont D, Cuvelier A. Cardiopulmonary exercise testing in patients with non-small cell lung cancer: maximality criteria analysis. Lung Cancer 2020. [DOI: 10.1183/13993003.congress-2020.1628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Le Gac C, Gondé H, Gillibert A, Laurent M, Selim J, Bottet B, Varin R, Baste JM. Medico-economic impact of robot-assisted lung segmentectomy: what is the cost of the learning curve? Interact Cardiovasc Thorac Surg 2020; 30:255-262. [PMID: 31605110 DOI: 10.1093/icvts/ivz246] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 09/10/2019] [Accepted: 09/11/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The objective of this study was to assess the learning curve (LC) of robot-assisted lung segmentectomy and to evaluate hospital-related costs. METHODS We conducted a retrospective study of Robot-assisted thoracic surgery (RATS) segmentectomies performed by 1 surgeon during 5 years. Perioperative and medical device data were collected. The LC, based on operating time, was assessed by Cumulative SUM analysis and an exponential model. Cost of care was estimated using the French National Cost Study method. RESULTS One hundred and two RATS segmentectomies were included. The LC was completed at ∼30 procedures according to both models without significant difference in patients' characteristics before or after the LC. Mean operative time decreased from 136 min [95% confidence intervals (CI) 124-149] for the first 30 procedures to 97 min (95% CI 88-107) for the last 30 procedures. Mean length of stay decreased non-significantly (P = 0.10 for linear trend) from 8.1 days (95% CI 6.1-11.0) to 6.2 days (95% CI 4.9-7.9). The overall costs for the last 30 procedures as compared with the first 30 did not significantly decrease in the primary economic analysis but significantly decreased (P = 0.02) by €1271 (95% CI -2688 to +108, P = 0.02 for linear trend) after exclusion of 1 outlier (hospitalization-related costs > €10 000). After exclusion of this outlier, costs related to EndoWrist® instruments significantly decreased by €-135 (95% CI -220 to -35, P = 0.004), whereas costs related to clips decreased non-significantly (P = 0.28). CONCLUSIONS The LC was completed at ∼30 procedures. Inexperienced surgeons may have higher procedure costs, related to consumable medical devices and operating time.
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Affiliation(s)
- Constance Le Gac
- Department of Pharmacy, Rouen University Hospital, Rouen, France
| | - Henri Gondé
- Department of Pharmacy, UNIROUEN, Inserm U1234, Rouen University Hospital, Normandie University, Rouen, France
| | - André Gillibert
- Department of Biostatistics, Rouen University Hospital, Rouen, France
| | - Marc Laurent
- Department of Pharmacy, Rouen University Hospital, Rouen, France
| | - Jean Selim
- Department of Anesthesiology, UNIROUEN, Inserm U1096, Rouen University Hospital, Normandie University, Rouen, France
| | - Benjamin Bottet
- Department of General and Thoracic Surgery, Rouen University Hospital, Rouen, France
| | - Rémi Varin
- Department of Pharmacy, UNIROUEN, Inserm U1234, Rouen University Hospital, Normandie University, Rouen, France
| | - Jean-Marc Baste
- Department of General and Thoracic Surgery, UNIROUEN, Inserm U1096, Rouen University Hospital, Normandie University, Rouen, France
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Rinieri P, Selim J, Le Guillou V, Baste JM. Crisis checklist (Code Red) for the management of cardiac arrest during minimally invasive thoracic surgery: case report. J Cardiothorac Surg 2020; 15:173. [PMID: 32677971 PMCID: PMC7367320 DOI: 10.1186/s13019-020-01200-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 06/22/2020] [Indexed: 11/15/2022] Open
Abstract
Background The management of cardiac arrest during video assisted thoracic surgery is challenging. Checklist use improve the management of operating-room crises. Case presentation: Cardiac arrest (asystole) occurred during anatomical pulmonary resection by minimally invasive surgery. Conversion to thoracotomy was decided (thoracic surgeon and anesthesiologist conjointly) to check for absence of cardiac bleeding and to start cardiac massage (4 min no-flow). After few minutes, ventricular fibrillation occurred and persisted despite shocks. Extracorporeal life support with veno-arterial extracorporeal membrane oxygenation allowed a return of spontaneous circulation (45 min low-flow). Conclusions The patient survived without central neurologic deficit due to perfect team work process using a crisis check-list (strengthened by a comprehensive simulation program with crisis resource management).
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Affiliation(s)
- Philippe Rinieri
- Department of General and Thoracic Surgery, Rouen University Hospital, Charles Nicolle Hospital, 1 rue de Germont, 76031, Rouen, France.
| | - Jean Selim
- Department of Anaesthesiology and Intensive Care, Rouen University Hospital, Rouen, France
| | | | - Jean-Marc Baste
- Department of General and Thoracic Surgery, Rouen University Hospital, Charles Nicolle Hospital, 1 rue de Germont, 76031, Rouen, France
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Montagne F, Baste JM. Should we keep on doing robotic surgery to treat lung cancer in 2020? Ann Transl Med 2020; 8:775. [PMID: 32647700 PMCID: PMC7333151 DOI: 10.21037/atm.2020.02.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- François Montagne
- Department of General and Thoracic Surgery, Rouen University Hospital, Rouen, France
| | - Jean-Marc Baste
- Department of General and Thoracic Surgery, Rouen University Hospital, Normandie University, Rouen, France
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Boujibar F, Gillibert A, Gravier FE, Gillot T, Bonnevie T, Cuvelier A, Baste JM. Performance at stair-climbing test is associated with postoperative complications after lung resection: a systematic review and meta-analysis. Thorax 2020; 75:791-797. [PMID: 32651199 PMCID: PMC7476257 DOI: 10.1136/thoraxjnl-2019-214019] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 05/15/2020] [Accepted: 06/05/2020] [Indexed: 12/25/2022]
Abstract
Background Thoracic surgery is the optimal treatment for early-stage lung cancer, but there is a high risk of postoperative morbidity. Therefore, it is necessary to evaluate patients’ preoperative general condition and cardiorespiratory capacity to determine the risk of postoperative complications. The objective of this study was to assess whether the stair-climbing test could be used in the preoperative evaluation of lung resection patients to predict postoperative morbidity following thoracic surgery. Methods We performed a systematic review and a meta-analysis on the association between stair-climbing test result and morbidity/mortality after thoracic surgery. We analysed all articles published until May 2020 in the following databases: Pubmed/Medline, Pedro, The Cochrane library, Embase and CINAHL. The risk of bias was assessed using the Quality in Prognosis Studies tool. This meta-analysis is registered as PROSPERO CRD42019121348. Results 13 articles were included in the systematic review for a total of 2038 patients and 6 in the meta-analysis. There were multiple test evaluation criteria: rise time, height, desaturation and heart rate change. For the meta-analysis, we were able to pool data on the height of rise at a variable threshold: risk ratio 2.34 (95% CI 1.59 to 3.43) with I²=53% (p=0.06). The threshold for occurrence of complications was estimated at a 10 m climb. Conclusions Our results indicate that the stair-climbing test could be used as a first-line functional screening test to predict postoperative morbidity following thoracic surgery and that patients with a poor test result (<10 m) should be referred to formal cardiopulmonary exercise testing.
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Affiliation(s)
- Fairuz Boujibar
- Department of General and Thoracic Surgery, CHU Rouen, Rouen, France .,Normandie University UNIROUEN, INSERM U1096, Rouen, France
| | | | - Francis Edouard Gravier
- ADIR Association, Bois Guillaume, France.,Normandie University, UNIROUEN, UPRES EA 3830, Rouen University Hospital, Haute Normandie Research and Biomedical Innovation, Rouen, France
| | - Timothée Gillot
- CETAPS EA 3832, Mont Saint Aignan, France.,ERFPS, CHU Rouen, Rouen, France
| | - Tristan Bonnevie
- ADIR Association, Bois Guillaume, France.,Normandie University, UNIROUEN, UPRES EA 3830, Rouen University Hospital, Haute Normandie Research and Biomedical Innovation, Rouen, France
| | - Antoine Cuvelier
- Normandie University, UNIROUEN, UPRES EA 3830, Rouen University Hospital, Haute Normandie Research and Biomedical Innovation, Rouen, France.,Pulmonary & Respiratory Intensive Care Department, CHU Rouen, Rouen, Normandie, France
| | - Jean-Marc Baste
- Department of General and Thoracic Surgery, CHU Rouen, Rouen, France.,Normandie University UNIROUEN, INSERM U1096, Rouen, France
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Die Loucou J, Pagès PB, Falcoz PE, Thomas PA, Rivera C, Brouchet L, Baste JM, Puyraveau M, Bernard A, Dahan M. Validation and update of the thoracic surgery scoring system (Thoracoscore) risk model. Eur J Cardiothorac Surg 2020; 58:350-356. [DOI: 10.1093/ejcts/ezaa056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 01/20/2020] [Accepted: 01/31/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
OBJECTIVES
The performance of prediction models tends to deteriorate over time. The purpose of this study was to update the Thoracoscore risk prediction model with recent data from the Epithor nationwide thoracic surgery database.
METHODS
From January 2016 to December 2017, a total of 56 279 patients were operated on for mediastinal, pleural, chest wall or lung disease. We used 3 recommended methods to update the Thoracoscore prediction model and then proceeded to develop a new risk model. Thirty-day hospital mortality included patients who died within the first 30 days of the operation and those who died later during the same hospital stay.
RESULTS
We compared the baseline patient characteristics in the original data used to develop the Thoracoscore prediction model and the validation data. The age distribution was different, with specifically more patients older than 65 years in the validation group. Video-assisted thoracoscopy accounted for 47% of surgeries in the validation group compared but only 18% in the original data. The calibration curve used to update the Thoracoscore confirmed the overfitting of the 3 methods. The Hosmer–Lemeshow goodness-of-fit test was significant for the 3 updated models. Some coefficients were overfitted (American Society of Anesthesiologists score, performance status and procedure class) in the validation data. The new risk model has a correct calibration as indicated by the Hosmer–Lemeshow goodness-of-fit test, which was non-significant. The C-index was strong for the new risk model (0.84), confirming the ability of the new risk model to differentiate patients with and without the outcome. Internal validation shows no overfitting for the new model
CONCLUSIONS
The new Thoracoscore risk model has improved performance and good calibration, making it appropriate for use in current clinical practice.
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Affiliation(s)
- Julien Die Loucou
- Department of Thoracic Surgery, Dijon University Hospital, Dijon, France
| | - Pierre-Benoit Pagès
- Department of Thoracic Surgery, Dijon University Hospital, Dijon, France
- INSERM UMR 1231, Dijon University Hospital, University of Burgundy, Dijon, France
| | | | - Pascal-Alexandre Thomas
- Department of Thoracic Surgery, Hopital-Nord-APHM, Aix-Marseille University, Marseille, France
| | - Caroline Rivera
- Department of Thoracic Surgery, Bayonne Hospital, Bayonne, France
| | - Laurent Brouchet
- Department of Thoracic Surgery, Hopital Larrey, CHU Toulouse, Toulouse, France
| | | | - Marc Puyraveau
- Department of Biostatistics and Epidemiology, CHU Besançon, Besançon, France
| | - Alain Bernard
- Department of Thoracic Surgery, Dijon University Hospital, Dijon, France
| | - Marcel Dahan
- Department of Thoracic Surgery, Bayonne Hospital, Bayonne, France
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Decaluwé H, Petersen RH, Brunelli A, Pompili C, Seguin-Givelet A, Gust L, Aigner C, Falcoz PE, Rinieri P, Augustin F, Sokolow Y, Verhagen A, Depypere L, Papagiannopoulos K, Gossot D, D'Journo XB, Guerrera F, Baste JM, Schmid T, Stanzi A, Van Raemdonck D, Bardet J, Thomas PA, Massard G, Fieuws S, Moons J, Dooms C, De Leyn P, Hansen HJ. Multicentric evaluation of the impact of central tumour location when comparing rates of N1 upstaging in patients undergoing video-assisted and open surgery for clinical Stage I non-small-cell lung cancer†. Eur J Cardiothorac Surg 2019; 53:359-365. [PMID: 29029062 DOI: 10.1093/ejcts/ezx338] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 07/12/2017] [Accepted: 07/30/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Large retrospective series have indicated lower rates of cN0 to pN1 nodal upstaging after video-assisted thoracic surgery (VATS) compared with open resections for Stage I non-small-cell lung cancer (NSCLC). The objective of our multicentre study was to investigate whether the presumed lower rate of N1 upstaging after VATS disappears after correction for central tumour location in a multivariable analysis. METHODS Consecutive patients operated for PET-CT based clinical Stage I NSCLC were selected from prospectively managed surgical databases in 11 European centres. Central tumour location was defined as contact with bronchovascular structures on computer tomography and/or visibility on standard bronchoscopy. RESULTS Eight hundred and ninety-five patients underwent pulmonary resection by VATS (n = 699, 9% conversions) or an open technique (n = 196) in 2014. Incidence of nodal pN1 and pN2 upstaging was 8% and 7% after VATS and 15% and 6% after open surgery, respectively. pN1 was found in 27% of patients with central tumours. Less central tumours were operated on by VATS compared with the open technique (12% vs 28%, P < 0.001). Logistic regression analysis showed that only tumour location had a significant impact on N1 upstaging (OR 6.2, confidence interval 3.6-10.8; P < 0.001) and that the effect of surgical technique (VATS versus open surgery) was no longer significant when accounting for tumour location. CONCLUSIONS A quarter of patients with central clinical Stage I NSCLC was upstaged to pN1 at resection. Central tumour location was the only independent factor associated with N1 upstaging, undermining the evidence for lower N1 upstaging after VATS resections. Studies investigating N1 upstaging after VATS compared with open surgery should be interpreted with caution due to possible selection bias, i.e. relatively more central tumours in the open group with a higher chance of N1 upstaging.
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Affiliation(s)
- Herbert Decaluwé
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - René Horsleben Petersen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Alex Brunelli
- Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK
| | - Cecilia Pompili
- Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK
| | | | - Lucile Gust
- Department of Thoracic Surgery, Lung Transplantation and Diseases of the Esophagus, North University Hospital, Marseille, France
| | - Clemens Aigner
- Department of Thoracic Surgery and Thoracic Endoscopy, University Medicine Essen, Essen, Germany
| | - Pierre-Emmanuel Falcoz
- Department of Thoracic Surgery, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Philippe Rinieri
- Department of Thoracic Surgery, University Hospital of Rouen, Rouen, France
| | - Florian Augustin
- Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Youri Sokolow
- Department of Thoracic Surgery, Université Libre de Bruxelles, Brussels, Belgium
| | - Ad Verhagen
- Department of Cardiothoracic Surgery, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Lieven Depypere
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | | | - Dominique Gossot
- Department of Thoracic Surgery, Institut Mutualiste Montsouris, Paris, France
| | - Xavier Benoit D'Journo
- Department of Thoracic Surgery, Lung Transplantation and Diseases of the Esophagus, North University Hospital, Marseille, France
| | - Francesco Guerrera
- Department of Thoracic Surgery, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Jean-Marc Baste
- Department of Thoracic Surgery, University Hospital of Rouen, Rouen, France
| | - Thomas Schmid
- Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Alessia Stanzi
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Dirk Van Raemdonck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Jeremy Bardet
- Department of Thoracic Surgery, Institut Mutualiste Montsouris, Paris, France
| | - Pascal-Alexandre Thomas
- Department of Thoracic Surgery, Lung Transplantation and Diseases of the Esophagus, North University Hospital, Marseille, France
| | - Gilbert Massard
- Department of Thoracic Surgery, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Steffen Fieuws
- Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), Leuven, Belgium
| | - Johnny Moons
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Christophe Dooms
- Department of Pneumology, University Hospitals Leuven, Leuven, Belgium
| | - Paul De Leyn
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Henrik Jessen Hansen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Aludaat C, Sarsam M, Doguet F, Baste JM. Autopsy and clinical discrepancies in patients undergoing extracorporeal membrane oxygenation: a case series-a step towards understanding "Why"? J Thorac Dis 2019; 11:S1865-S1868. [PMID: 31632770 DOI: 10.21037/jtd.2019.08.121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Chadi Aludaat
- Department of Thoracic and Cardiovascular Surgery, University Hospital of Rouen, Rouen, France
| | - Matthieu Sarsam
- Department of Thoracic and Cardiovascular Surgery, University Hospital of Rouen, Rouen, France.,Department of General and Thoracic Surgery, University Hospital of Rouen, Rouen, France
| | - Fabien Doguet
- Department of Thoracic and Cardiovascular Surgery, University Hospital of Rouen, Rouen, France
| | - Jean-Marc Baste
- Department of General and Thoracic Surgery, University Hospital of Rouen, Rouen, France
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Gondé H, Le Gac C, Gillibert A, Bottet B, Laurent M, Sarsam M, Hervouët C, Varin R, Baste JM. Feedback on the use of three surgical sealants for preventing prolonged air leak after robot-assisted anatomical lung resection. J Thorac Dis 2019; 11:2705-2714. [PMID: 31463097 DOI: 10.21037/jtd.2019.06.43] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Prolonged air leak (PAL) is the most common complication after lung resection. Several surgical sealants have been developed to reduce PAL, including fibrin-based (FS), polyethylene glycol-based (PEGS) and polyglycolic acid-based (PGAS) sealants. In this work we report our experience of surgical sealant use after robot-assisted lung resection. Methods A 7-year retrospective study was conducted, including patients who had robot-assisted lobectomy or segmentectomy. Data were collected using a prospective national database. The use of surgical sealants was recorded in traceability sheets. Results PAL occurred in 60 of the 299 patients included. American Society of Anesthesiologists score (ASA) and index of prolonged air leak (IPAL) were higher for patients with sealants. In this group, operative time, chest drain duration and length of stay were significantly longer. PAL occurrence was significantly associated to sealant in univariate analysis (odds ratio =1.88, 95% CI: 1.07 to 3.36, P=0.03) but the association was slightly decreased when adjusting on IPAL and ASA score (Odds ratio =1.70, 95% CI: 0.94 to 3.10, P=0.08). Comparing sealants, more segmentectomies were performed in patients with PGAS (P=0.0013) and their operative time was shorter (P=0.0002). PAL occurrences were not different. Length of stay (P=0.0045) and operative time (P=0.0002) were longer in patients with PEGS who had more postoperative complications (P=0.024). Conclusions This study did not identify a positive effect of surgical sealants for preventing PAL. However it highlighted the need to rationalize their use.
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Affiliation(s)
- Henri Gondé
- Department of Pharmacy, Rouen University Hospital, Normandie Univ, UNIROUEN, U1234, F 76000 Rouen, France
| | - Constance Le Gac
- Department of Pharmacy, Rouen University Hospital, F 76000 Rouen, France
| | - André Gillibert
- Department of Biostatistics, Rouen University Hospital, Normandie Univ, UNIROUEN, F 76000 Rouen, France
| | - Benjamin Bottet
- Department of General and Thoracic Surgery, Rouen University Hospital, F 76000 Rouen, France
| | - Marc Laurent
- Department of Pharmacy, Rouen University Hospital, F 76000 Rouen, France
| | - Matthieu Sarsam
- Department of General and Thoracic Surgery, Rouen University Hospital, F 76000 Rouen, France
| | - Charles Hervouët
- Department of Pharmacy, Rouen University Hospital, F 76000 Rouen, France
| | - Rémi Varin
- Department of Pharmacy, Rouen University Hospital, Normandie Univ, UNIROUEN, U1234, F 76000 Rouen, France
| | - Jean-Marc Baste
- Department of General and Thoracic Surgery, Rouen University Hospital, Normandie Univ, UNIROUEN, U1096, F 76000 Rouen, France
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