Lobectomy For Primary Lung Cancer Research Articles

Pulmonary cyst newly formed after lobectomy in various underlying lung conditions

BackgroundIt has been recently recognized that pulmonary cyst may develop after pulmonary resection, causing various symptoms. Most previously reported cases were after upper lobectomy in patients with chronic obstructive lung disease (COPD).Case presentationCase 1 was a man in his 70 s with interstitial pneumonia (IP). Right lower lobectomy was performed for metastatic lung tumor using video-assisted thoracoscopic surgery (VATS). On postoperative day (POD) 19, computed tomography (CT) revealed a large cyst at the upper interlobular surface of the middle lobe, with pneumoderma and pneumomediastinum. The cyst was incised, polyglycolic acid (PGA) sheet and fibrin glue were applied, and the cyst was sutured. The sutured line was covered again with PGA sheet and fibrin glue. Case 2 was a man in his 70 s with COPD. Right upper lobectomy for primary lung cancer was performed using VATS. On POD 17, CT revealed a large pulmonary cyst at the apex of S6 and massive air leakage was observed. The same surgical procedure as that used in case 1 was performed. Cases 3 and 4 were healthy donors for living-donor lung transplantation. Two months after the right lower lobectomy in Case 3 and 3 months after the left lower lobectomy in Case 4, the patients had respiratory symptoms such as dyspnea and hemosputum. CT revealed a large cyst on the diaphragmatic surface of the right middle lobe in Case 3 and on the posterior mediastinal surface of the left upper lobe in Case 4. Cyst incision, soft coagulation, and application of PGA sheet with fibrin glue were performed in both cases. CT performed 1 year after surgery showed no development of a pulmonary cyst or air space in these four cases.ConclusionsPulmonary cysts newly formed after lobectomy can develop not only in COPD or IP but also in healthy lungs. Our findings suggest that incision of the cyst and application of fibrin glue and PGA sheet with or without suturing the cyst wall is effective for management.

Utility of 4K three-dimensional endoscopic system in performing video-assisted thoracoscopic surgery lobectomy: initial results of the first year after installation.

With the evolution of technology in the field of thoracoscopy, three-dimensional (3D) endoscopic systems with 4K resolution have recently come into use. This study aimed to determine perioperative outcomes of video-assisted thoracoscopic surgery (VATS) lobectomy performed a year after the 4K three-dimensional (3D) endoscopic system installation and compare them with those of the high-definition (HD) 3D endoscopic system. We included patients who underwent complete VATS (cVATS) lobectomy for primary lung cancer using an HD3D endoscopic system (HD3D group, June 2015-September 2021, n = 251) or 4K3D endoscopic system (4K3D group, October 2021-September 2022, n = 47). The perioperative outcomes were compared between the two groups. The operation time was significantly shorter in the 4K3D group (mean, 189.5min) than in the HD3D group (208.5min; p = 0.021), and the 4K3D group did not require conversion to thoracotomy or transfusion. The 4K3D group had less blood loss volume (4K3D group: mean, 24.0mL vs. HD3D group: 43.3mL; p = 0.105) and shorter chest drainage duration (4K3D group: mean, 2.3days vs. HD3D group: 3.1days; p = 0.115) and hospitalization period (4K3D group: mean, 7.9days vs. HD3D group:10.0days; p = 0.226) than the HD3D group, with no significant difference. No difference was observed in the incidence of ≥ Grade IIIa complications (p = 0.634). The 4K3D endoscopic system significantly shortened the duration of cVATS lobectomy. It is useful for lung resection and may replace other endoscopy systems.

Wedge resection versus lobectomy in T1 lung cancer patients: a propensity matched analysis.

Performing wedge resection rather than lobectomy for primary lung cancer remains controversial. Recent studies demonstrate no survival advantage for non-anatomical resection compared to lobectomy in patients with early-stage lung cancer. The objective of this study was to investigate whether in patients with T1 tumours, non-anatomical wedge resection is associated with equivalent survival to lobectomy. This was a retrospective cohort study of patients who underwent lung resection at the Lancashire Cardiac Centre between April 2005 and April 2018. Patients were subjected to multidisciplinary team discussion. The extent of resection was decided by the team based on British Thoracic Society guidelines. The primary outcome was overall survival. Propensity matching of patients with T1 tumours was also performed to determine whether differences in survival rates exist in a subset of these patients with balanced pre-operative characteristics. There were 187 patients who underwent non-anatomical wedge resection and 431 patients who underwent lobectomy. Cox modelling demonstrated no survival difference between groups for the first 1.6 years then a risk of death 3-fold higher for wedge resection group after 1.6 years (HR 3.14, CI 1.98-4.79). Propensity matching yielded 152 pairs for which 5-year survival was 66.2% for the lobectomy group and 38.5% for the non-anatomical wedge group (SMD = 0.58, p = 0.003). Non-anatomical wedge resection was associated with significantly reduced 5-year survival compared to lobectomy in matched patients. Lobectomy should remain the standard of care for patients with early-stage lung cancer who are fit enough to undergo surgical resection.

Effect of octogenarian status on outcomes after robotic-assisted pulmonary lobectomy for primary lung cancer

Effect of octogenarian status on outcomes after robotic-assisted pulmonary lobectomy for primary lung cancer

Impact of the Maryland Global Budget Revenue Program on Lobectomies for Lung Cancer

INTRODUCTION: In 2014, Maryland introduced a “Global Budget Revenue” (GBR) program in an effort to reduce hospital costs by prospectively capping annual hospital revenue at a predetermined amount, thereby incentivizing hospitals to reduce expenditures while maintaining quality. Our objective was to investigate the impact of the GBR model on thoracic surgery outcomes. METHODS: We used the Maryland Health Services Cost Review Commission (HSCRC) database to retrospectively review adult patients who underwent lobectomy for primary lung cancer between 2012 and 2018. Patients were dichotomized as “pre-GBR” if they underwent lobectomy prior to 2014, and “post-GBR” if they underwent lobectomy in 2014 or later. RESULTS: Baseline demographics between the two groups were comparable, although patients in the post-GBR group were less likely to be uninsured (0.2% vs 1.1%, p < 0.01). In-hospital mortality was similar between the two groups (1.0% vs 1.5%, p = 0.20), as was 30-day readmission rate (8.2% vs 7.9%, p = 0.80). On average, patients in the post-GBR era had a shorter length of stay (5.7 days vs 6.1 days, p = 0.02), but were more likely to be discharged with home health services (23.4% vs 19.5%, p = 0.01). CONCLUSION: These results suggest successful incentivization to reduce hospital length of stay with implementation of the GBR model, without evidence of inadvertent negative consequences such as increased mortality or need for readmission. The increased use of home health services suggest a multi-disciplinary approach will be integral to reducing overall health expenditures under this model, and demonstrates promise for use of the GBR model in thoracic surgery.

The Presence of a Cost-Volume Relationship in Robotic-assisted Thoracoscopic Lung Resections.

To characterize the relationship between institutional robotic-assisted pulmonary lobectomy volume and hospitalization costs. The high cost of robotic-assisted thoracoscopic surgery (RATS) is among several drivers of hesitation among nonadopters. Studies examining the impact of institutional experience on costs of RATS lobectomy are lacking. Adults undergoing RATS lobectomy for primary lung cancers were identified from the 2016 to 2018 Nationwide Readmissions Database. A multivariable regression to model hospitalization costs was developed with the inclusion of hospital RATS lobectomy volume as restricted cubic splines. The volume corresponding to the inflection point of the spline was used to categorize hospitals as high- (HVH) or low-volume (LVH). We subsequently examined the association of HVH status with adverse events, length of stay, costs, and 30-day, nonelective readmissions. An estimated 14,756 patients underwent RATS lobectomy during the study period, with median cost of $23,000. Upon adjustment for patient and operative characteristics, hospital RATS volume was inversely associated with costs. Although only 17.2% of centers were defined as HVH, 51.7% of patients were managed at these centers. Patients at HVH and LVH had similar age, sex, and distribution of comorbidities. Notably, patients at HVH had decreased risk-adjusted odds of adverse events (adjusted odds ratio: 0.62, P <0.001), as well as significantly reduced length of stay (-0.8d, P <0.001) and costs (-$3900, P <0.001). Increasing hospital RATS lobectomy volume was associated with reduced hospitalization costs. Our findings suggest the presence of streamlined care pathways at high-volume centers, which influence costs of care.

Operative Time is Associated With Postoperative Complications After Pulmonary Lobectomy.

To investigate the association between operative time and postoperative outcomes. The association between operative time and morbidity after pulmonary lobectomy has not been characterized fully. Patients who underwent pulmonary lobectomy for primary lung cancer at our institution from 2010 to 2018 were reviewed. Exclusion criteria included clinical stage ≥IIb disease, conversion to thoracotomy, and previous ipsilateral lung treatment. Operative time was measured from incision to closure. Relationships between operative time and outcomes were quantified using multivariable mixed-effects models with surgeon-level random effects. In total, 1651 patients were included. The median age was 68 years (interquartile range, 61-74), and 63% of patients were women. Median operative time was 3.2 hours (interquartile range, 2.7-3.8) for all cases, 3.0 hours for open procedures, 3.3 hours for video-assisted thoracoscopies, and 3.3 hours for robotic procedures ( P =0.0002). Overall, 488 patients (30%) experienced a complication; 77 patients (5%) had a major complication (grade ≥3), and 5 patients (0.3%) died within 30 days of discharge. On multivariable analysis, operative time was associated with higher odds of any complication [odds ratio per hour, 1.37; 95% confidence interval (CI), 1.20-1.57; P <0.0001] and major complication (odds ratio per hour, 1.41; 95% CI, 1.21-1.64; P <0.0001). Operative time was also associated with longer hospital length of stay (β, 1.09; 95% CI, 1.04-1.14; P =0.001). Longer operative time was associated with worse outcomes in patients who underwent lobectomy. Operative time is a potential risk factor to consider in the perioperative phase.

Prediction of Postoperative Respiratory Complications after Lobectomy in Lung Cancer Patients with COPD by Quantitative Image Analysis: A Historical Cohort Study.

We examined whether preoperative assessment of percentage of low attenuation area (LAA%) on the non-resected side can predict postoperative respiratory complications (PRC) after lobectomy. We conducted a historical cohort study of 217 smokers (175 males and 42 females) who underwent lobectomy for primary lung cancer at our hospital between January 2014 and March 2021. First, the relationship between LAA% and respiratory function parameters (RFPs) calculated for both the bilateral and non-resected sides was used to estimate the most effective patient group. Next, multivariate analyses of the relationship between LAA% of the non-resected side and PRC were performed using logistic regression analysis after adjusting for basic patient attributes and respiratory function. A correlation was found between LAA% and RFP in smoking males. Multivariate analysis showed a strong relationship between model 3, adjusted for basic patient attributes and lung function factors, and PRC (odds ratio, 2.43; 95% confidence interval, 1.05-5.63). LAA% of the non-resected side suggested that it may be able to predict the occurrence of PRC after lung cancer lobectomy.

Bronchial morphological changes are associated with postoperative intractable cough after right upper lobectomy in lung cancer patients.

To date, postoperative intractable cough (PIC) has not received adequate attention, and the complex perioperative factors when performing pulmonary resection often prevent researchers from addressing this issue. This study aimed to investigate the clinicopathological and radiographic indicators related to PIC in lung cancer patients. In all, 112 patients who had had right upper lobectomy for primary lung cancer from January 2019 to December 2020 were retrospectively reviewed. We collected data via the electronic medical database of our department. Bronchial morphological features were investigated comprehensively via three-dimensional chest computer tomography reconstruction images. During outpatient follow-up visits, 41 (36.6%) patients complained about persistent dry cough after surgery. Compared with the non-cough group, patients in the refractory cough group showed significant differences in smoking history, right upper lobe stump length, changes of right bronchus intermedius (RBI) diameter, changes of right lower lobe (RLL) basal bronchus diameter, changes of RBI/RLL bronchial angle, and bronchial kink. However, according to multivariable regression analysis, stump length, bronchial kink, and diameter change of the right lower lobe basal bronchus were independently associated with postoperative refractory cough. A nebulization drug was prescribed for the 41 patients diagnosed with PIC, and 33 (80.5%) patients had improved by the next visit. After right upper lobectomy, the morphology of the remaining bronchial tree in the residual lung changed significantly. The bronchial morphological alterations were independent risk factors for PIC.

A Fully Automated Deep Learning Pipeline for Multi-Vertebral Level Quantification and Characterization of Muscle and Adipose Tissue on Chest CT Scans.

Body composition on chest CT scans encompasses a set of important imaging biomarkers. This study developed and validated a fully automated analysis pipeline for multi-vertebral level assessment of muscle and adipose tissue on routine chest CT scans. This study retrospectively trained two convolutional neural networks on 629 chest CT scans from 629 patients (55% women; mean age, 67 years ± 10 [standard deviation]) obtained between 2014 and 2017 prior to lobectomy for primary lung cancer at three institutions. A slice-selection network was developed to identify an axial image at the level of the fifth, eighth, and 10th thoracic vertebral bodies. A segmentation network (U-Net) was trained to segment muscle and adipose tissue on an axial image. Radiologist-guided manual-level selection and segmentation generated ground truth. The authors then assessed the predictive performance of their approach for cross-sectional area (CSA) (in centimeters squared) and attenuation (in Hounsfield units) on an independent test set. For the pipeline, median absolute error and intraclass correlation coefficients for both tissues were 3.6% (interquartile range, 1.3%-7.0%) and 0.959-0.998 for the CSA and 1.0 HU (interquartile range, 0.0-2.0 HU) and 0.95-0.99 for median attenuation. This study demonstrates accurate and reliable fully automated multi-vertebral level quantification and characterization of muscle and adipose tissue on routine chest CT scans. Keywords: Skeletal Muscle, Adipose Tissue, CT, Chest, Body Composition Analysis, Convolutional Neural Network (CNN), Supervised Learning Supplemental material is available for this article. © RSNA, 2022.

Selection of preoperative stress electrocardiography test for appropriate patients with non-small cell lung cancer.

Lobectomy is an established surgical procedure for treating non-small cell lung cancer; however, it significantly impacts postoperative cardiac function. The stress electrocardiography test is relatively easy to perform and is used to confirm the presence of coronary artery stenotic lesions. However, it has a low pre-test probability and may yield many false positives. We examined the factors that would enable the appropriate selection of patients for stress electrocardiography as a preoperative cardiovascular examination preceding lobectomy for non-small cell lung cancer. From June 2016 to July 2018, 240 patients at our institution who underwent stress electrocardiography before lobectomy for primary lung cancer were included in this study. Clinical information was extracted from electronic medical records and evaluated retrospectively. Smoking history, diabetes, hypertension, dyslipidemia, and ischemic heart disease were considered risk factors for coronary artery stenosis. We determined the coronary risk factors that were applicable to each participant and calculated the total number of coronary risk factors as a risk score. Patients with coronary risk factor scores of ≥ 3 were significantly more likely to have abnormal stress electrocardiography results. In addition, these patients also underwent more comprehensive examinations to identify coronary diseases. There were no patients with complications that could be attributed to ischemic heart disease. Stress electrocardiography may be more useful before lobectomy in non-small cell lung cancer patients if the patients are appropriately selected, with the test utilized mainly in patients with coronary risk factor scores of ≥ 3.

Preoperative Cumulative Smoking Dose on Lung Cancer Surgery in a Japanese Nationwide Database

BackgroundSmoking is a known risk factor for postoperative mortality and morbidity. However, the significance of cumulative smoking dose in preoperative risk assessment has not been established. We examined the influence of preoperative cumulative smoking dose on surgical outcomes after lobectomy for primary lung cancer. MethodsA total of 80,989 patients with primary lung cancer undergoing lobectomy from 2014 to 2016 were enrolled. Preoperative cumulative smoking dose was categorized by pack-years (PY): nonsmokers, PY = 0; light smokers, 0 < PY < 10; moderate smokers, 10 ≤ PY < 30; and heavy smokers, 30 ≤ PY. The risk of short-term outcomes was assessed according to PY by multivariable analysis adjusted for other covariates. ResultsPostoperative 30-day mortality, as well as pulmonary, cardiovascular, and infectious complications, increased with preoperative PY. Multivariable analysis revealed that the odds ratios (ORs) for postoperative mortality compared with nonsmokers were 1.76 for light smokers (P = .044), 1.60 for moderate smokers (P = .026), and 1.73 for heavy smokers (P = .003). The ORs for pulmonary complications compared with nonsmokers were 1.20 for light smokers (P = .022), 1.40 for moderate smokers (P < .001), and 1.72 for heavy smokers (P < .001). Heavy smokers had a significantly increased risk of postoperative cardiovascular (OR, 1.26; P = .002) and infectious (OR, 1.39; P = .007) complications compared with nonsmokers. ConclusionsThe risk of mortality and morbidity after lung resection could be predicted according to preoperative cumulative smoking dose. These findings contribute to the development of strategies in perioperative management of lung resection patients.

Retrosternal goiter in thoracic surgical practice

To evaluate and optimize surgical approaches to the management of retrosternal goiter. A cohort retrospective single-center study included 56 patients aged 68.3±9.8 years with retrosternal goiter who underwent surgery between 2004 and 2019. Right-sided goiter was diagnosed in 16 cases, left-sided goiter in 21 patients, bilateral goiter in 19 patients. Palpable neck mass was found in 17 (30.4%), stridor in 16 (28.6%), thyrotoxicosis in 4 (7.1%) and recurrent laryngeal nerve palsy in 2 (3.6%) cases. X-ray signs of tracheal compression were detected in 43 (76.8%) patients, deviation in 26 (46.4%) patients. Resection through cervical collar incision was performed in 40 (71.4%) patients. Additional sternotomy was required in 11 (19.6%) patients, 1 (1.8%) patient required collar incision and right anterior mediastinotomy. Right-sided posterolateral thoracotomy without collar incision was performed in 1 (1.8%) patient with a suspected mediastinal teratoma. Three patients underwent median sternotomy only because of preoperative diagnosis of teratoma in one and thymoma in two patients. There was no perioperative mortality. Transient vocal changes occurred in 3 (5.4%) patients, recurrent laryngeal nerve palsy in 3 (5.4%), atrial fibrillation in 2 (3.6%), wound complications in 2 (3.6%), left phrenic nerve palsy in 1 (1.8%), transient hypocalcaemia in 1 (1.8%) and persistent hypothyroidism in 1 (1.8%) patient. Hospital-stay ranged from 2 to 12 (5.5±2.0) days. Multinodular goiter was found in 53 (94.6%) patients, diffuse goiter in 1 (1.8%), ectopic thyroid in 1 (1.8%) and oncocytic tumor in 1 (1.8%) patient. One (1.8%) patient underwent simultaneous resection of RSG via a collar incision and right-sided VATS upper lobectomy for primary lung cancer. One (1.8%) patient also underwent simultaneous resection of RSG via collar incision and right-sided VATS subcarinal lymph node biopsy for coexistent lymphoma. Mean vertical length of goiter in the collar incision group was 7.6 cm compared to 10.6 cm in the sternotomy group. Mean weight of specimens was 162.3 g in patients with collar incisions and 312.5 g in the sternotomy group. Sternotomy was required in 14 (25%) patients. Resection of retrosternal goiter is more commonly performed via cervical collar incision with mandatory availability of sternotomy. Radiological measurement of craniocaudal length may predict the need for sternotomy. Surgical outcomes are not affected by surgical approach. Simultaneous thoracic interventions for a coexistent pathology in patients with RSG may be considered. Further research of minimally invasive interventions for RSG resection is required.

P39 Impact of Pulmonary Function on Pulmonary Complications After Robotic Assisted Thoracoscopic Lobectomy

Percentage predicted FEV1 and DLCO, and their predicted postoperative (ppo) values are established prognostic factors for postoperative pulmonary complications after thoracotomy. However, their predictive value for minimally-invasive pulmonary resections remains controversial. This study assessed the incidence of pulmonary complications after robotic lobectomy for primary lung cancer and analysed the predictive significance of FEV1 and DLCO.

Intermediate bronchial kinking after right upper lobectomy for lung cancer.

Bronchial kinking after lung lobectomy is likely, whereas that of the intermediate bronchus after right upper lobectomy is often not recognized. The aim of this study was to examine the clinical implications of this condition. One-hundred cases of right upper lobectomy for primary lung cancer were reviewed. The cases were divided into groups with intermediate (group A) and non-intermediate (group B) bronchial kinking, and the patient characteristics and postoperative outcomes were compared. The remaining lower lobe deformation was also evaluated using the angle formed by the intrathoracic tracheal line and posterior fissure on reconstructed sagittal computed tomography. There were 23 cases in group A which had a higher rate of bronchial calcification, older age, and female sex, whereas and smoking and pulmonary emphysema were less frequent. Three cases in group A had respiratory symptoms such as wheezing and respiratory noise, while only one case of middle lobe atelectasis was found in group B. In multivariate analysis, upper mediastinal lymph node dissection was an independent factor for non-intermediate bronchial kinking. The lower lobe was significantly more expanded in group A than in group B. Intermediate bronchial kinking correlates with postoperative respiratory symptoms and was less likely after upper mediastinal lymph node dissection.

Evaluation of prognosis after thoracoscopic lobectomy for primary lung cancer.

Thoracoscopic lobectomy for primary lung cancer is performed at many institutions. However, few reports are available on postoperative prognosis for progressive stages. In 2004, we adopted lobectomy by video-assisted thoracoscopic surgery (VATS), which would be applicable to the clinical stages up to stage IIIA. This study reports long-term outcomes of surgery for primary lung cancer at several stages, including IIIA. We compared the long-term outcomes of 315 VATS cases with those of 159 open thoracotomy cases. The overall 5-year survival rate was 78.1% for the VATS group and 61.9% for the open thoracotomy group. A statistically significant difference between the survival curves of the two groups was observed (P = .001). When analyzing the survival curves for both groups by pathological (p) stage, significant differences were observed for p-stages IB and IIIA, with the VATS group producing better results than the open thoracotomy group. The long-term outcomes of patients with primary lung cancer at our institution were more favorable in the group undergoing VATS lobectomy than in the group undergoing open thoracotomy.

VATS right upper lobectomy for primary lung cancer after esophagectomy: Report of a case

VATS right upper lobectomy for primary lung cancer after esophagectomy: Report of a case

Postoperative opioid use after lobectomy for primary lung cancer: A propensity-matched analysis of Premier hospital data

ObjectiveTo evaluate opioid administration after robotic lobectomy (RL) compared with video-assisted thoracic surgery (VATS) and open lobectomy in patients with lung cancer. MethodsPatients undergoing lobectomy for primary lung cancer between January 1, 2013, and September 30, 2015, were identified from the US Premier Hospital Perspective Database. The primary outcome was the average daily dose of opioids received from postoperative day (POD) 1 until discharge. Opioid doses were converted to morphine equivalent daily doses (MEDDs). Propensity score matching was performed to balance patient, hospital, and surgeon characteristics when comparing opioid administration by surgical approach. ResultsThe open versus RL cohort included 2061 matched pairs, and the VATS versus RL cohort included 2142 matched pairs. From POD 1 until discharge, the patients undergoing open lobectomy had a higher rate of opioid use compared with those undergoing RL (94.8% vs 87.2%; P < .001), with a higher total dose (median MEDD, 225.0 vs 100.0; P < .001) and average daily dose (median MEDD, 41.3 vs 30.0; P < .001). Similarly, from POD 1 until discharge, patients undergoing VATS lobectomy had a slightly higher rate of opioid use compared with those undergoing RL (89.6% vs 87.0%; P = .008), with a higher total dose (median MEDD, 130.0 vs 100.0; P < .001) and average daily dose (median MEDD, 33.8 vs 28.8; P < .001). ConclusionsPatients undergoing RL for primary lung cancer received opioids less frequently, and with lower total and average daily doses, compared with those undergoing VATS and open lobectomy. Studies are needed to determine whether early opioid dosage reductions translate into less chronic opioid use.

Application of small-bore pigtail catheter to improve pleural drainage after single-incision thoracoscopic lobectomy for lung cancer.

In order to overcome the problems associated with the drainage of single-incision thoracoscopic surgery, we investigated the efficiency of applying an 8-Fr pigtail catheter in addition to the conventional 26-Fr chest tube. This prospective study includes 88 consecutive patients who underwent single-incision thoracoscopic lobectomy between July 2017 and March 2018. Patients were treated either with (smaller pigtail group) or without (larger drain group) 8-Fr pigtail catheter in addition to conventional 26-Fr chest tube. Post-operative recovery was assessed by analysing the post-operative drainage volume on the first 2 days, the duration (days) of drainage, re-intubation after 2 weeks, air leak time, length of stay, subcutaneous emphysema, pleural effusion after 2 weeks and pain score. The patients in the pigtail tube group had a significantly shorter drainage time and higher drainage volume on the first 2 days than those in the larger drain group. The percentage of patients that developed pleural effusion after 2 weeks was 4.54% in the smaller pigtail group and 25% in the larger drain group (P = 0.007). The pain score in the smaller pigtail tube group decreased significantly on the third day after surgery compared with larger drain group (P < 0.001). There were no significant differences between the two groups in the air leak time, subcutaneous emphysema, wound healing and pain score on the first day. Application of 8-Fr pigtail catheter after single-incision thoracoscopic lobectomy for primary lung cancer can accelerate the post-operative recovery of patients.

Impact of pulmonary function on pulmonary complications after robotic-assisted thoracoscopic lobectomy.

Percentage-predicted forced expiratory volume in 1 s (FEV1) and diffusing capacity for carbon monoxide (DLCO), and their predicted postoperative (ppo) values are established prognostic factors for postoperative pulmonary complications after thoracotomy. However, their predictive value for minimally invasive pulmonary resections remains controversial. This study assessed the incidence of pulmonary complications after robotic lobectomy for primary lung cancer and analysed the predictive significance of FEV1 and DLCO. This was a retrospective analysis of patients who underwent robotic lobectomy from 4 institutions. Descriptive and comparative analyses were performed for patients who experienced pulmonary complications versus patients who did not, in relation to FEV1 and DLCO values. To identify thresholds for increased complications, patients were categorized into groups of 10% incremental increases in FEV1 and DLCO, and their ppo values. From November 2002 to April 2018, 1088 patients underwent robotic lobectomy. Overall, 169 postoperative pulmonary complications occurred in 141 patients. Male gender and Eastern Cooperative Oncology Group grade ≥1 were associated with increased pulmonary complications on univariable analysis. Patients who experienced pulmonary complications had increased mortality (2.1% vs 0.2%, P = 0.017) and longer hospitalizations (9 vs 4 days, P < 0.001). Pulmonary complications were associated when FEV1 ≤60% and DLCO ≤50%, and when ppo FEV1 or DLCO was ≤50%; ppo FEV1 ≤50% (P < 0.001) and ppo DLCO ≤50% (P = 0.031) remained statistically significant on multivariable analysis. Both FEV1 and DLCO were shown to be significant predictors of pulmonary complications. Furthermore, thresholds of percentage-predicted and ppo FEV1 and DLCO values were identified, below which pulmonary complications occurred significantly more frequently, suggesting their predictive values are particularly useful in patients with poorer pulmonary function.