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Forster C, Abdelnour-Berchtold E, Bédat B, Perentes JY, Sauvain MO, Christodoulou M, Triponez F, Karenovics W, Krueger T, Gonzalez M. Local control and short-term outcomes after VATS segmentectomy vs lobectomy for pT1c pN0 NSCLC (2–3 cm). Br J Surg 2022. [DOI: 10.1093/bjs/znac185.004] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Objective
Pulmonary segmentectomy has shown comparable oncological results to lobectomy for non-small cell lung cancers (NSCLC) of less than 2 cm. However, controversy remains for tumors of larger size. The aim of this study was to compare short-term outcomes and local control in pT1c pN0 NSCLC that were intentionally treated by VATS segmentectomy or lobectomy.
Methods
Multicenter retrospective study from January 2014 to October 2021 of 162 consecutive patients undergoing complete (R0) anatomical resections for pT1c pN0 NSCLC. Two groups, VATS lobectomy (VL) or VATS segmentectomy (VS) were defined according to the extension of the resection. Patients’ characteristics, postoperative outcomes and survival were compared.
Results
In total, 162 patients underwent VL (n=81) or VS (n=81). Except for age (median of 68 vs 71 years, p=0.034) and past medical history of cancer (32% vs 48%, p=0.038), there was no difference between VL and VS in terms of demographics and comorbidities (table1). Segmentectomies were performed in upper lobes in 68% and single segments represented 46% of all cases. Conversion thoracotomy rate was 5% in both groups. Morbidity were similar in both groups (34% vs 30%, p=0.5). The median time for chest tube removal (3 vs 2 days, p=0.002) and median LOS (6 vs 5 days, p=0.039) were in favor of the VS group. Significantly larger tumor (25 mm vs 23.5 mm p=0.001) and an increased number of lymph nodes removal (median 14 vs 10, p<0.001) were found in the VL group. During the follow-up (median: 31 months), no statistical difference was found for local and distant recurrence in VL groups (12.3%) and VS group (6.2%) (p=0.414). Overall survival was comparable in-between both groups (p=0.166).
Conclusion
Despite a short follow-up, our preliminary data shows that local control is comparable for VATS lobectomy and VATS segmentectomy. Further prospective randomized trials are needed to corroborate these results.
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Affiliation(s)
- C Forster
- Lausanne University Hospital Department of Thoracic Surgery, , Lausanne, Switzerland
| | - E Abdelnour-Berchtold
- Lausanne University Hospital Department of Thoracic Surgery, , Lausanne, Switzerland
| | - B Bédat
- Geneva University Hospital Department of Thoracic Surgery, , Geneva, Switzerland
| | - J Y Perentes
- Lausanne University Hospital Department of Thoracic Surgery, , Lausanne, Switzerland
| | - M-O Sauvain
- Hospital of Neuchâtel Department of General Surgery, , Neuchâtel, Switzerland
| | - M Christodoulou
- Hospital of Sion Department of General Surgery, , Sion, Switzerland
| | - F Triponez
- Geneva University Hospital Department of Thoracic Surgery, , Geneva, Switzerland
| | - W Karenovics
- Geneva University Hospital Department of Thoracic Surgery, , Geneva, Switzerland
| | - T Krueger
- Lausanne University Hospital Department of Thoracic Surgery, , Lausanne, Switzerland
| | - M Gonzalez
- Lausanne University Hospital Department of Thoracic Surgery, , Lausanne, Switzerland
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2
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Forster C, Ojanguren A, Perentes JY, Zellweger M, Krueger T, Gonzalez M. Is faster better? Impact of operative time on postoperative outcomes after VATS anatomical pulmonary resection. Br J Surg 2021. [DOI: 10.1093/bjs/znab202.075] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Objective
Video-Assisted Thoracic Surgery (VATS) is now the preferred approach for standard anatomical pulmonary resections. However, operative time (OT) for this technique is correlated to many aspects, such as the surgical complexity or the surgeon’s experience and skills. The aim of this study was to identify the factors associated with prolonged OTs and to assess the impact of OT on the development of post-operative complications after VATS anatomical pulmonary resections.
Methods
Retrospective monocentric study including all consecutive patients undergoing a VATS anatomical pulmonary resection for benign or malignant lesions between January 2010 and December 2019. Postoperative outcomes were compared between short (<150 minutes) and long (≥150 minutes) OTs. A multivariate analysis was carried out to identify predictors of longer OTs and post-operative complications.
Results
A total of 836 patients underwent a VATS anatomical pulmonary resection for malignant (n = 767, 91.7%) or benign (n = 69, 8.3%) lesions. Lobectomies were performed in 555 (66.4%), segmentectomies in 250 (29.9%), sleeve lobectomies in 16 (1.9%), bilobectomies in 11 (1.3%) and pneumonectomy in 4 (0.5%) patients. The conversion rate to thoracotomy was 7.7%. Of those 836 patients, 495 (59.2%) were operated within 150 minutes. During the 30-postoperative day period, the overall morbidity was significantly lower in the short OT group (29.1% vs. 40.5%; p = 0.001). Both the duration of drainage (3 vs. 4 days; p < 0.00001) and the length of hospital stay (6 vs. 7 days; p < 0.00001) were significantly reduced in the short OT group. Two predictors of long OT were identified on multivariate analysis: male sex (OR 1.41, p = 0.04) and neoadjuvant chemotherapy (OR 3.46, p = 0.003). A long OT was identified as an individual predictor of postoperative complications (OR 1.84, p < 0.0001).
Conclusion
A prolonged OT is an individual risk factor for postoperative complications in patients undergoing VATS anatomical pulmonary resection.
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Affiliation(s)
- C Forster
- Department of Thoracic Surgery, Hospital of Sion, Sion, Switzerland
| | - A Ojanguren
- Department of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - J Y Perentes
- Department of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - M Zellweger
- Department of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - T Krueger
- Department of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - M Gonzalez
- Department of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
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Koliakos E, Bedat B, Caput B, Hasenauer A, Federici S, Ojanguren-Arranz A, Gonzalez M, Krueger T, Perentes JY. Objective performance assessment on trainees of a VATS simulation program: A prospective single center study. Br J Surg 2021. [DOI: 10.1093/bjs/znab202.074] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Objective
A prospective single center study to assess the objective impact on motion performance of a VATS simulation program on thoracic surgery trainees.
Methods
We developed a 6-month VATS simulation training program including exercises of progressive complexity on 3 different black box simulators: a 2D and 3D lobectomy model (Stupnik®) and a 3D perfused lobectomy model (Crabtree®). Between November 2019 and 2020, all consecutive thoracic surgery residents (study group) were prospectively enrolled in this weekly training program that was supervised by a board certified thoracic surgeon. We compared an objective performance evaluation of the study group before and after the training program by assessing movement parameters (distance in cm, time in sec) and absence of shock/extreme motion (%) on 3 simple standardized thoracoscopic exercises (peg placement on a board, rope insertion in loops and precision circle cutting) using the Simball®. Also, we determined the objective performance 6 months apart of 5 final year medical students (unexperienced controls) that were not trained.
Results
There were 7 residents (2 female and 5 male, median age: 29 [range: 26-34] years) who completed the 6-month VATS simulation training program. Five residents were in their first year while two had >3 year experience. The study group's objective performance improved significantly for all three movement parameters in all standardized exercises (Figure 1) after the training program. The objective performance of the unexperienced control group was comparable to the study group before training, but it remained unchanged at 6 months (p > 0.05). When comparing unexperienced and advanced residents, we observed that the training program had more impact on improving the performance for unexperienced residents (p < 0.05).
Conclusion
This study suggests that the implementation of a VATS simulation training program improves the objective performance of trainees compared to controls. Such programs could be interesting adjuncts for residents.
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Affiliation(s)
- E Koliakos
- Department of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - B Bedat
- Department of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - B Caput
- Department of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - A Hasenauer
- Department of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - S Federici
- Department of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - A Ojanguren-Arranz
- Department of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - M Gonzalez
- Department of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - T Krueger
- Department of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - J Y Perentes
- Department of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
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4
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de Perrot M, Wu L, Cabanero M, Perentes JY, McKee TD, Donahoe L, Bradbury P, Kohno M, Chan ML, Murakami J, Keshavjee S, Tsao MS, Cho BCJ. Prognostic influence of tumor microenvironment after hypofractionated radiation and surgery for mesothelioma. J Thorac Cardiovasc Surg 2019; 159:2082-2091.e1. [PMID: 31866087 DOI: 10.1016/j.jtcvs.2019.10.122] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 10/20/2019] [Accepted: 10/21/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Cytotoxic CD8+ tumor infiltrating lymphocytes (TILs) can contribute to the benefit of hypofractionated radiation, but programmed cell death pathways (programmed cell death 1 and programmed cell death ligand 1 [PD-1/PD-L1]) may provide a mechanism of tumor immune escape. We therefore reviewed the influence of PD-1/PD-L1 and CD8+ TILs on survival after accelerated hypofractionated hemithoracic radiation followed by extrapleural pneumonectomy for malignant pleural mesothelioma (MPM). METHODS Sixty-nine consecutive patients undergoing the protocol of Surgery for Mesothelioma after Radiation Therapy (SMART) between November 2008 and February 2016 were analyzed for the presence of PD-L1 on tumor cells, PD-1 on inflammatory cells, and CD8+ TILs. Comparison was made with a cohort of patients undergoing extrapleural pneumonectomy after induction chemotherapy (n = 14) and no induction (n = 2) between March 2005 and October 2008. PD-L1 expression on tumor cells ≥1% was considered positive. CD8+ TILs and PD-1 expression were scored as a percentage of positive cells. RESULTS PD-L1 was negative in 75% of MPM after completion of SMART. CD8+ TILs ranged between 0.24% and 8.47% (median 2%). CD8+ TILs ≥2% was associated with significantly better survival in epithelioid MPM (median survival 3.7 years vs 2.3 years in CD8+ TILs <2%; P = .02). PD-L1 positivity was associated with worse survival in biphasic MPM (median survival, 0.4 years vs 1.5 years in biphasic PD-L1 negative tumors; P = .07) after SMART. Multivariate analysis demonstrated that epithelioid MPM, nodal disease, and CD8+ TILs were independent predictors of survival after SMART. CONCLUSIONS The influence of tumor microenvironment on survival differs between epithelioid and nonepithelioid MPM. CD8+ TILs is an independent factor associated with better survival in epithelioid MPM treated with SMART.
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Affiliation(s)
- Marc de Perrot
- Division of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada; Latner Thoracic Surgery Laboratories, University Health Network, University of Toronto, Toronto, Ontario, Canada; Department of Immunology, University of Toronto, Toronto, Ontario, Canada.
| | - Licun Wu
- Latner Thoracic Surgery Laboratories, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Michael Cabanero
- Department of Pathology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - J Yannis Perentes
- Division of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Trevor D McKee
- STTARR Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Laura Donahoe
- Division of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Penelope Bradbury
- Division of Medical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Mikihiro Kohno
- Latner Thoracic Surgery Laboratories, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Mei-Lin Chan
- Latner Thoracic Surgery Laboratories, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Junichi Murakami
- Latner Thoracic Surgery Laboratories, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Shaf Keshavjee
- Division of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada; Latner Thoracic Surgery Laboratories, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ming-Sound Tsao
- Department of Pathology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - B C John Cho
- Department of Radiation Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Lovis A, Krueger T, Perentes JY, Ris HB, Egger B, Beigelman C, Nicod L, Aubert JD, Gonzalez M. [Lung volume reduction (LVR) in severe emphysema: a multidisciplinary approach]. Rev Med Suisse 2014; 10:1337-1342. [PMID: 25051596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Most cases of emphysema are managed conservatively. However, in severe symptomatic emphysema associated with hyperinflation, lung volume reduction (LVR) may be proposed to improve dyspnea, exercice capacity, pulmonary functions, walk distance and to decrease long-term mortality. LVR may be achieved either surgically (LVRS) or endoscopically (EVLR by valves or coils) according to specific clinical criteria. Currently, the optimal approach is discussed in a multidisciplinary setting. The latter permits a personalized evaluation the patient's clinical status and allows the best possible therapeutic intervention to be proposed to the patient.
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Krueger T, Perentes JY, Peters S, Ris HB, Gonzalez M. [VATS lobectomy for early-stage primary lung cancer]. Rev Med Suisse 2012; 8:1337-1341. [PMID: 22792599] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Lobectomy via video-assisted thoracoscopic surgery (VATS) is now considered as a valid alternative to conventional thoracotomy for early-stage primary lung cancer. Various studies have reported that VATS lobectomy is a safe technique associated with fewer postoperative complications and better post-operative recovery than open thoracotomy. Furthermore, studies suggest oncological equivalence between VATS and open lobectomy.
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Affiliation(s)
- T Krueger
- Service de chirurgies thoracique et vasculaire, CHUV, 1011 Lausanne.
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7
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Cheng C, Wang Y, Haouala A, Debefve E, Andrejevic Blant S, Krueger T, Gonzalez M, Ballini JP, Peters S, Decosterd L, van den Bergh H, Ris HB, Perentes JY. Photodynamic therapy enhances liposomal doxorubicin distribution in tumors during isolated perfusion of rodent lungs. Eur Surg Res 2011; 47:196-204. [PMID: 21986386 DOI: 10.1159/000330744] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Accepted: 06/17/2011] [Indexed: 12/15/2022]
Abstract
BACKGROUND Photodynamic therapy (PDT) at low drug-light conditions can enhance the transport of intravenously injected macromolecular therapeutics through the tumor vasculature. Here we determined the impact of PDT on the distribution of liposomal doxorubicin (Liporubicin™) administered by isolated lung perfusion (ILP) in sarcomas grown on rodent lungs. METHODS A syngeneic methylcholanthrene-induced sarcoma cell line was implanted subpleurally in the left lung of Fischer rats. Treatment schemes consisted in ILP alone (400 μg of Liporubicin), low-dose (0.0625 mg/kg Visudyne®, 10 J/cm(2) and 35 mW/cm(2)) and high-dose left lung PDT (0.125 mg/kg Visudyne, 10 J/cm(2) and 35 mW/cm(2)) followed by ILP (400 μg of Liporubicin). The uptake and distribution of Liporubicin in tumor and lung tissues were determined by high-performance liquid chromatography and fluorescence microscopy in each group. RESULTS Low-dose PDT significantly improved the distribution of Liporubicin in tumors compared to high-dose PDT (p < 0.05) and ILP alone (p < 0.05). However, both PDT pretreatments did not result in a higher overall drug uptake in tumors or a higher tumor-to-lung drug ratio compared to ILP alone. CONCLUSIONS Intraoperative low-dose Visudyne-mediated PDT enhances liposomal doxorubicin distribution administered by ILP in sarcomas grown on rodent lungs which is predicted to improve tumor control by ILP.
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Affiliation(s)
- C Cheng
- Division of Thoracic and Vascular Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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