Postoperative Cardiopulmonary Complications Research Articles

Preoperative walking exercise to improve prognosis in patients with supratentorial brain tumours after craniotomy: protocol for a randomised controlled trial

IntroductionCardiopulmonary complications and cognitive impairment following craniotomy have a significantly impact on the general health of individuals with brain tumours. Observational research indicates that engaging in walking is linked to...

Surgical Apgar Score can help predict postoperative cardiopulmonary complication and reoperation in lung cancer resection

BackgroundBleeding due to lung resection increases the risk of cardiopulmonary complications and hospital stay. Surgical massive bleeding is associated with a high rate of mortality. In this study, our aim is to determine the effectiveness of Surgical Apgar Score in predicting complications and reoperation in the short term. Peroperative data of 405 patients aged 18–82 who underwent lung resection (pneumonectomy, lobectomy, wedge) and were operated consecutively were recorded.ResultsPulmonary complication developed in 38 (9.4%) of the patients, cardiac complication in 104 (25.7%), acute kidney failure in 8 (1.9%), and cerebrovascular accident in 1 (0.2%). Reoperation was performed in 24 (5.9%) patients due to bleeding. The Surgical Apgar Score was found to predict postoperative complications well for a value of < 6 (area under the curve = 0.745, 95%CI 0.710–0.7770, p < 0.001). When Surgical Apgar Score were evaluated together with receiver operating characteristic, the ability of Surgical Apgar Score to predict reoperation was found to be statistically significant (area under the curve = 0.777, 95%CI 0.671–0.883, p < 0.001. Accordingly, age, resection type, blood loss, heart rate, SAS score, intraoperative blood transfusion, and postoperative blood transfusion were independent risk factors affecting the development of complications. It was determined that the only independent risk factor affecting the development of mortality was postoperative blood transfusion. It was determined that the independent risk factors affecting ICU development were resection type, blood loss, SAS score, and postoperative blood transfusion.ConclusionIn our study, the Surgical Apgar Scoring System was found to be sufficient in predicting cardiac and respiratory complications. Patients with a low postoperative Surgical Apgar Score should be followed carefully in terms of postoperative complications and reoperation. Surgical Apgar Score can be a useful scoring method in predicting the prognosis of patients who underwent lung cancer resection in the postoperative period.

Therapeutic evaluation of postoperative chemotherapy and chemoradiotherapy on cardiopulmonary complications in patients with esophageal squamous cell carcinoma

Background: Postoperative chemotherapy (pCT), together with chemoradiotherapy (pCRT), is well used for the treatment of squamous cell carcinoma in the esophagus. However, these adjuvant therapies may cause serious adverse effects resulting in higher postoperative morbidity.&#x0D; Methods: In this study, we aim to assess and compare the postoperative cardiopulmonary complications as a result of pCT and pCRT in patients with esophageal cancer. PCT (n = 182) or pCRT (n = 153) was conducted to treat patients with esophageal cancer.&#x0D; Results: A significantly higher percentage of pneumonia was diagnosed in patients with the pCRT treatment compared with pCT group (P &lt; 0.01). In comparison to the pCT treated group, pCRT treatment patients showed significantly decreased early diastolic filling velocity (P &lt; 0.01) and higher plasma level of N-terminal pro-brain natriuretic peptide (NT-proBNP) (P &lt; 0.01). Moreover, pCRT treatment was associated with higher pneumonia risk and increased NT-proBNP level significantly by a multivariate analysis.&#x0D; Conclusion: pCRT treatment increased the percentage of cardiopulmonary complications in comparison with pCT treatment.

Interpretable prediction of cardiopulmonary complications after non-small cell lung cancer surgery based on machine learning and SHapley additive exPlanations

IntroductionLung cancer is a prevalent malignancy globally, with approximately 20% of patients developing cardiopulmonary complications after lobectomy. In order to prevent complications, an accurate and personalized method based on machine learning (ML) is required. MethodsDuring the period of 2017–2021, a retrospective analysis was conducted on the medical records of patients who had undergone lobectomy for non-small cell lung cancer (NSCLC). We performed logical regression, decision tree (DT), random forest (RF), gradient boost DT, and eXtreme gradient boosting analyses to establish an ML model. The ten-fold cross-validation was used to evaluate the performance of multiple ML models based on various evaluation metrics, including accuracy, precision, recall, F1 score, and area under the receiver operating (AUC). Additionally, we also calculated the Kappa value of these model. Each model used grid search to optimize hyper-parameters and then used the interpretability method to provide explanations for the model's Decisions. ResultsThe study included 718 eligible patients, among whom the incidence of postoperative cardiopulmonary complications was 20.89%. The RF model showed the best comprehensive performance among all models, and its ten-fold cross-validation accuracy, precision, recall, F1 score, and AUC were (OR and 95% confidence interval [CI]) 0.786 (0.738–0.834), 0.803 (0.735–0.872), 0.738 (0.678–0.797), 0.766 (0.714–0.818), 0.856 (0.815–0.898), respectively. The kappa value of the RF model was 0.696 (0.617–0.768). The SHAP method showed that gender, age, and intraoperative blood loss were closely associated with postoperative cardiopulmonary complications. ConclusionThe application of ML methods for predicting postoperative cardiopulmonary complications based on clinical data of patients with NSCLC showed a good performance. The results indicate that ML combined with the SHAP individualized interpretation method has practical clinical value.

Prediction of postoperative cardiopulmonary complications via assessment of heart rate recovery after submaximal exercise testing.

Prediction of postoperative cardiopulmonary complications via assessment of heart rate recovery after submaximal exercise testing.

Impact of regional anesthesia on outcomes of geriatric patients undergoing lower extremity revascularization: A propensity score-matched cohort study.

Lower extremity revascularization (LER) for peripheral artery disease in elderly patients is associated with a high risk of perioperative morbidity and mortality. This study aimed to a conduct retrospective review and propensity score matching analysis to determine whether the use of regional anesthesia (RA) instead of general anesthesia (GA) in geriatric patients undergoing LER for peripheral artery disease results in improved short-term mortality and health outcomes. We reviewed medical records of 1271 patients aged >65 years who underwent LER at our center between May 1998 and February 2016. According to the anesthesia method, patients were grouped in the GA and RA groups. The primary outcome was short-term mortality (7-day and 30-day). The secondary outcomes were 5-year survival rate, intraoperative events, postoperative morbidity, and postoperative length of stay. A propensity score-matched cohort design was used to control for potentially confounding factors including patient demographics, comorbidities, American Society of Anesthesiologists physical status, and preoperative medications. After propensity score matching, 722 patients that received LER under GA (n = 269) or RA (n = 453) were identified. Patients from the GA group showed significantly higher 7-day mortality than those from the RA group (5.6% vs 2.7% P = .048); however, there was no significant difference in 30-day mortality between the groups (GA vs RA: 6.3% vs 3.6%, P = .083). The 5-year survival rate and incidence of arterial and central venous catheter placement or intraoperative dopamine and epinephrine use were significantly higher in the GA group than in the RA group (P < .05). In addition, the frequency of immediate postoperative oxygen therapy or mechanical ventilation support was higher in the GA group (P < .05). However, there was no difference in the postoperative cardiopulmonary and cerebral complications between the 2 groups. These results suggest that RA can reduce intraoperative hemodynamic support and provide immediate postoperative respiratory intensive care. In addition, the use of RA may be associated with better short-term and 5-year survival rates in geriatric patients undergoing LER.

Proton Therapy With Concurrent Chemotherapy for Thoracic Esophageal Cancer: Toxicity, Disease Control, and Survival Outcomes.

When treating esophageal cancer with radiation therapy, it is critical to limit the dose to surrounding structures, such as the lung and/or heart, as much as possible. Proton radiation therapy allows a reduced radiation dose to both the heart and lungs, potentially reducing the risk of cardiopulmonary toxicity. Here, we report disease control, survival, and toxicity outcomes among patients with esophageal cancer treated with proton radiation therapy and concurrent chemotherapy (chemoradiation therapy; CRT) with or without surgery. We enrolled 17 patients with thoracic esophageal carcinoma on a prospective registry between 2010 and 2021. Patients received proton therapy to a median dose of 50.4-GyRBE (range, 50.4-64.8) in 1.8-Gy fractions.Acute and late toxicities were graded per the Common Terminology Criteria for Adverse Events, version 4.0 (US National Cancer Institute, Bethesda, Maryland). In addition, disease control, patterns of failure, and survival outcomes were collected. Nine patients received preoperative CRT, and 8 received definitive CRT. Overall, 88% of patients had adenocarcinoma, and 12% had squamous cell carcinoma. With a median follow-up of 2.1 years (range, 0.5-9.4), the 3-year local progression-free, disease-free, and overall survival rates were 85%, 66%, and 55%, respectively. Two patients (1 with adenocarcinoma and 1 with squamous cell carcinoma) recurred at the primary site after refusing surgery after a complete clinical response to CRT. The most common acute nonhematologic and hematologic toxicities, respectively, were grades 1 to 3 esophagitis and grades 1 to 4 leukopenia, both affecting 82% of patients. No acute cardiopulmonary toxicities were observed in the absence of surgical resection. Reagarding surgical complications, 3 postoperative cardiopulmonary complications occurred as follows: 1 grade 1 pleural effusion, 1 grade 3 pleural effusion, and 1 grade 2 anastomotic leak. Two severe late CRT toxicities occurred: 1 grade 5 tracheoesophageal fistula and 1 grade 3 esophageal stenosis requiring a feeding tube. Proton radiation therapy is a safe, effective treatment for esophageal cancer with increasing evidence supporting its role in reducing cardiopulmonary toxicity.

Exercise oxygen desaturation is a predictor of cardiopulmonary complications after lung resection

BackgroundTo investigate whether oxygen desaturation during low technology tests was associated with complications after lung resection.MethodsA retrospective cohort study was conducted on 1097 candidates for pulmonary resection; seven metabolic equivalents...

ASO Visual Abstract: Clinical and Dosimetric Predictors for Postoperative Cardiopulmonary Complications in Patients with Esophageal Squamous Cell Carcinoma Receiving Neoadjuvant Chemoradiotherapy and Surgery.

ASO Visual Abstract: Clinical and Dosimetric Predictors for Postoperative Cardiopulmonary Complications in Patients with Esophageal Squamous Cell Carcinoma Receiving Neoadjuvant Chemoradiotherapy and Surgery.

ASO Author Reflections: The Prophets of Postoperative Cardiopulmonary Complications in Esophageal Squamous Cell Carcinoma Patients Receiving Trimodality Therapy.

ASO Author Reflections: The Prophets of Postoperative Cardiopulmonary Complications in Esophageal Squamous Cell Carcinoma Patients Receiving Trimodality Therapy.

Prediction of postoperative cardiopulmonary complications after lung resection in a Chinese population: A machine learning-based study.

BackgroundApproximately 20% of patients with lung cancer would experience postoperative cardiopulmonary complications after anatomic lung resection. Current prediction models for postoperative complications were not suitable for Chinese patients. This study aimed to develop and validate novel prediction models based on machine learning algorithms in a Chinese population.MethodsPatients with lung cancer receiving anatomic lung resection and no neoadjuvant therapies from September 1, 2018 to August 31, 2019 were enrolled. The dataset was split into two cohorts at a 7:3 ratio. The logistic regression, random forest, and extreme gradient boosting were applied to construct models in the derivation cohort with 5-fold cross validation. The validation cohort accessed the model performance. The area under the curves measured the model discrimination, while the Spiegelhalter z test evaluated the model calibration.ResultsA total of 1085 patients were included, and 760 were assigned to the derivation cohort. 8.4% and 8.0% of patients experienced postoperative cardiopulmonary complications in the two cohorts. All baseline characteristics were balanced. The values of the area under the curve were 0.728, 0.721, and 0.767 for the logistic, random forest and extreme gradient boosting models, respectively. No significant differences existed among them. They all showed good calibration (p > 0.05). The logistic model consisted of male, arrhythmia, cerebrovascular disease, the percentage of predicted postoperative forced expiratory volume in one second, and the ratio of forced expiratory volume in one second to forced vital capacity. The last two variables, the percentage of forced vital capacity and age ranked in the top five important variables for novel machine learning models. A nomogram was plotted for the logistic model.ConclusionThree models were developed and validated for predicting postoperative cardiopulmonary complications among Chinese patients with lung cancer. They all exerted good discrimination and calibration. The percentage of predicted postoperative forced expiratory volume in one second and the ratio of forced expiratory volume in one second to forced vital capacity might be the most important variables. Further validation in different scenarios is still warranted.

Exercise testing and postoperative complications after minimally invasive lung resection: A cohort study

Background: Peak oxygen uptake () during cardiospulmonary exercise testing (CPET) is used to stratify postoperative risk following lung cancer resection but peak thresholds to predict post-operative mortality and morbidity were derived mostly from patients who underwent thoracotomy. Objectives: We evaluated whether peak or other CPET-derived variables predict post-operative mortality and cardiopulmonary morbidity after minimally invasive video-assisted thoracoscopic surgery (VATS) for lung cancer resection. Methods: A retrospective analysis of patients who underwent VATS lung resection between 2002 and 2019 and in whom CPET was performed. Logistic regression models were used to determine predictors of postoperative outcomes until 30 days after surgery. The ability of peak to discriminate between patients with and without post-operative complications was evaluated using Receiver operating characteristic (ROC) analysis. Results: Among the 593 patients, postoperative cardiopulmonary complications occurred in 92 (15.5%) individuals, including three deaths. Mean peak was 18.8 ml⋅kg−1⋅min−1, ranging from 7.0 to 36.4 ml⋅kg−1⋅min−1. Best predictors of postoperative morbidity and mortality were peripheral arterial disease, bilobectomy or pneumonectomy (versus sublobar resection), preoperative FEV1, peak , and peak . The proportion of patients with peak of < 15 ml⋅kg−1⋅min−1, 15 to < 20 ml⋅kg−1⋅min−1 and ≥ 20 ml⋅kg−1⋅min−1 experiencing at least one postoperative complication was 23.8, 16.3 and 10.4%, respectively. The area under the ROC curve for peak was 0.63 (95% CI: 0.57–0.69). Conclusion: Although lower peak was a predictor of postoperative complications following VATS lung cancer resection, its ability to discriminate patients with or without complications was limited.

Clinical and Dosimetric Predictors for Postoperative Cardiopulmonary Complications in Esophageal Squamous Cell Carcinoma Patients Receiving Neoadjuvant Chemoradiotherapy and Surgery.

Neoadjuvant chemoradiotherapy followed by esophagectomy is the standard treatment for patients with locally advanced esophageal squamous cell carcinoma (ESCC). This study explored correlations of clinical factors and dose-volume histogram (DVH) parameters with postoperative cardiopulmonary complications and predicted their risk by establishing a nomogram model. Clinical and DVH parameters of ESCC patients who underwent trimodality treatment from 2002 to 2020 were collected. Postoperative cardiopulmonary complications were recorded. Logistic regression analysis was applied, and a nomogram model was constructed. Area under the receiver operating characteristic (AUC) curve, calibration curve, and decision curve analyses were performed to evaluate the performance of the nomogram. Of the 307 ESCC patients enrolled in this study, 65 (21.2%) experienced pulmonary complications and 57 (18.6%) experienced cardiac complications. The following six risk factors were identified as independent risk factors for pulmonary complications by multivariate logistic regression analyses in the integrated model: male sex (odds ratio [OR], 3.26; 95% confidence interval [CI], 1.27-9.70; P = 0.021), post-radiation therapy (RT) forced expiratory volume in 1 s (FEV1) (OR, 0.51; 95% CI 0.28-0.90; P = 0.023), mean lung dose (MLD) (OR, 1.13; 95% CI 1.01-1.28; P = 0.041), and pre-RT monocyte (OR, 8.36; 95% CI 1.23-11.7; P = 0.03). The AUC of this integrated model was 0.705 (95% CI 0.64-0.77). The paclitaxel and cisplatin (TP) concurrent chemotherapy regimen was the independent predictor of cardiac complication (OR, 2.50; 95% CI 1.22-5.55; P = 0.016). For ESCC patients who underwent trimodality treatment, male sex, post-RT FEV1, MLD, and pre-RT monocyte were confirmed as significant predictors of postoperative pulmonary complications. A nomogram model including six risk factors was further established. The independent predictor of cardiac complication was TP concurrent chemotherapy.

Performance of prolonged air leak scoring systems in patients undergoing video-assisted thoracoscopic surgery segmentectomy.

We assessed the accuracy of 3 validated lobectomy scoring systems to predict prolonged air leak (PAL) in patients undergoing video-assisted thoracoscopic surgery (VATS) segmentectomy. We reviewed all consecutive patients who had a VATS segmentectomy between January 2016 and October 2020. We determined PALs on postoperative day 5. These findings were correlated with the calculated Brunelli (gender, age, body mass index [BMI], forced expiratory volume in 1 s < 80 and pleural adhesion), Epithor (gender, location, dyspnoea score, BMI, type of resection and pleural adhesion) and European Society of Thoracic Surgeons (ESTS) (gender, BMI and forced expiratory volume in 1 s) scores of each patient. A total of 453 patients (mean age: 66.5 years, female/male sex ratio: 226/227) underwent a VATS segmentectomy for malignant (n = 400) and non-malignant (n = 53) disease. Postoperative cardiopulmonary complications and in-hospital mortality rates were 19.6% and 0.4%, respectively. Median chest tube drainage duration and hospital stay were 2 (interquartile range: 1-4) and 4 (interquartile range: 3-7) days, respectively. On day 5, the prevalence of PAL was 14.1%. The ESTS, Brunelli and Epithor scores for the treated population were, respectively, class A (6.8%), class B (3.2%), class C (10.8%) and class D (28.2%); very low and low (0%), moderate (5%), high (6.3%) and very high (21%); and class A (7%), class B (13.2%), class C (24%) and class D (27.8%). All scores correlated with PAL (p ≤ 0.001). The areas under the receiver operating characteristic (ROC) curve were 0.686, 0.680 and 0.644, respectively. All 3 scoring systems were correlated with PAL > 5 days following the VATS segmentectomies. ESTS scores seem easier to introduce in clinical practice, but validation by a multicentre cohort is mandatory.

Ventilatory efficiency slope is associated with cardiopulmonary complications after thoracoscopic anatomical lung resection.

OBJECTIVESThe aim of this study was to identify whether steeper V.E/V. CO2 slope was associated with cardiopulmonary complications (CPC) after anatomical resection by video-assisted thoracic surgery. Long-term survival was analysed as secondary outcome.METHODSWe reviewed the files of all consecutive patients who underwent pulmonary anatomical resections by video-assisted thoracic surgery between January 2010 and October 2020 at the Centre for Thoracic Surgery of Western Switzerland. Logistic regression was used to investigate the risk of CPC associated with the V.E/V.CO2 slope and other possible confounders. Survival was analysed with Kaplan–Meier curves. Risk factors associated with survival were analysed with a Cox proportional hazards model.RESULTSThe V.E/V.CO2 slope data were available for 145 patients [F/M: 66/79; mean age (standard deviation): 65.8 (8.9)], which were included in the analysis. Patients underwent anatomical resection [lobectomy (71%) or segmentectomy (29%)] mainly for lung cancer (96%). CPC and all-cause 90-day mortality were 29% and 1%, respectively. The mean (standard deviation) percentage of the predicted O2peak was 70% (17). Maximum effort during cardiopulmonary exercise test was reached in only 31% of patients. The V.E/V.CO2 slope (standard deviation) was not different if the maximum effort was reached or not [39 (6) vs 37 (7), P = 0.21]. V.E/V.CO2 slope >35 was associated with an increased risk of CPC (odds ratio 2.9, 95% confidence interval 1.2, 7.2, P = 0.020). V.E/V.CO2 slope >35 was not associated with shorter survival censored for lung cancer-related death.CONCLUSIONS E/CO2 slope >35 is significantly associated with postoperative CPC after anatomical resections by video-assisted thoracic surgery.Clinical registration number CER-VD (Switzerland)Project ID: 2021-00620.

Meta-analysis of the association between obstructive sleep apnea and postoperative complications

ObjectiveTo clarify the association between obstructive sleep apnea (OSA) and postoperative outcomes, investigate whether preoperative diagnosis and continuous positive airway pressure (CPAP) therapy reduce the risks and examine the impact of OSA severity on postoperative outcomes. MethodsThe PubMed, Cochrane Library and Embase databases were searched from inception until April 2021 for studies evaluating the association between OSA and postoperative adverse events. A random effects model was used to calculate the pooled outcome. Sensitivity analysis and publication bias were conducted to verify the robustness and reliability of the results. ResultsIn total, 46 studies were eligible for further analysis. OSA was significantly associated with higher risks of postoperative respiratory complications (OR = 1.91; 95% CI = 1.54 to 2.36) and cardiac complications (OR = 1.74; 95% CI = 1.25 to 2.42), and the risks increased with OSA severity. OSA also increased the risk of intensive care unit (ICU) transfer (OR = 1.92; 95% CI = 1.32 to 2.80), increased the risk of postoperative delirium (OR = 1.83; 95% CI = 1.26 to 2.66) and prolonged the length of hospital stay (WMD = 0.48; 95% CI = 0.15 to 0.82). Subgroup analysis indicated that preoperative diagnosis and use of CPAP decrease the risk of postoperative respiratory complications (OR = 1.87; 95% CI = 1.43 to 2.43) and cardiac complications (OR = 1.17; 95% CI = 0.91 to 1.51). ConclusionsPatients with OSA have a higher risk of postoperative cardiopulmonary complications, ICU transfer, delirium, pneumonia, bleeding and prolonged length of hospital stay. OSA severity is an important risk modifier for postoperative complications, preoperative diagnosis and CPAP therapy may attenuate the occurrence of postoperative complications. The conclusions need to be interpreted with caution due to the limitations in the data, despite this, the results indicate and inform the need for further and larger trials. ProsperoCRD42021254374.

External validation of five predictive models for postoperative cardiopulmonary morbidity in a Chinese population receiving lung resection.

BackgroundNo postoperative cardiopulmonary morbidity models have been developed or validated in Chinese patients with lung resection. This study aims to externally validate five predictive models, including Eurolung models, the Brunelli model and the Age-adjusted Charlson Comorbidity Index, in a Chinese population.MethodsPatients with lung cancer who underwent anatomic lung resection between 2018/09/01 and 2019/08/31 in our center were involved. Model discrimination was assessed by the area under the receiver operating characteristic curve. Model calibration was evaluated by the Hosmer–Lemeshow test. Calibration curves were plotted. Specificity, sensitivity, negative predictive value, positive predictive value and accuracy were calculated. Model updating was achieved by re-estimating the intercept and/or the slope of the linear predictor and re-estimating all coefficients.ResultsAmong 1085 patients, 91 patients had postoperative cardiopulmonary complications defined by the European Society of Thoracic Surgeons. For original models, only parsimonious Eurolung1 had acceptable discrimination (area under the receiver operating characteristic curve = 0.688, 95% confidence interval 0.630–0.745) and calibration (p = 0.23 > 0.05) abilities simultaneously. Its sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 0.700, 0.649, 0.153, 0.960 and 0.653, respectively. In the secondary analysis, increased pleural effusion (n = 94), which was nonchylous and nonpurulent, was labeled as a kind of postoperative complication. The area under the receiver operating characteristic curve of the models increased slightly, but all models were miscalibrated. The original Eurolung1 model had the highest discrimination ability but poor calibration, and thus it was updated by three methods. After model updating, new models showed good calibration and small improvements in discrimination. The discrimination ability was still merely acceptable.ConclusionsOverall, none of the models performed well on postoperative cardiopulmonary morbidity prediction in this Chinese population. The original parsimonious Eurolung1 and the updated Eurolung1 were the best-performing models on morbidity prediction, but their discrimination ability only achieved an acceptable level. A multicenter study with more relevant variables and sophisticated statistical methods is warranted to develop new models among Chinese patients in the future.

Surgical resection of Masaoka stage III thymic epithelial tumours with great vessels involvement: a retrospective multicentric analysis from the European Society of Thoracic Surgeons thymic database.

The aim of this study was to analyse the outcomes of an international cohort of patients affected by Masaoka stage III thymic epithelial tumours with vascular involvement and treated by surgery. Study design was the observational multicentre retrospective cohort study. Data were extracted from the European Society of Thoracic Surgeons thymic database; additional variables were collected. Inclusion criteria were as follows: stage III (Masaoka-Koga) thymic epithelial tumours; surgery with radical intention; clinical or pathological great vessels involvement; and radiologically suspected or diagnosed intraoperatively. Outcome items were analysed. Sixty-five patients submitted to surgery from 2001 to 2017 fulfilled inclusion criteria. Thymoma and thymic carcinoma patients did not differ for demographics and clinical characteristics. The majority of great vessel treated were superior vena cava or innominate veins (72.3%). Eleven patients (16.9%) had postoperative cardiopulmonary complications; vascular stenosis was observed in 3 patients (4.6%). The multivariable Cox analysis for disease-free survival showed an increased hazard of recurrence for thymic carcinoma (hazard ratio = 3.59; 95% confidence interval: 1.66-7.78, P = 0.001). The 1-, 3-, 5- and 10-year overall survival rates were 0.86, 0.84, 0.81, and 0.53, respectively. There was no significant difference in overall survival according to resection status or between thymoma and thimic carcinoma. The univariable Cox regression model did not show an increased hazard of death for myasthenic patients considering all resection status and for patients who received neoadjuvant therapy. We observed that clinical outcomes of patients treated for stage III thymic epithelial tumours with vascular involvement are satisfactory suggesting to increase the confidence in dealing with these complex surgeries. Complete resection should be achieved, even though extensive vascular reconstructions are required.

Impact of enhanced pathway of care in uniportal video-assisted thoracoscopic surgery.

Enhanced Recovery After Surgery (E.R.A.S.) is a multimodal, evidence-based and patient-centered pathway designed to minimize surgical stress, enhancing recovery and improving perioperative outcomes. However, considering that the potential clinical implication of E.R.A.S. on patients undergoing video-assisted thoracic surgery (V.A.T.S.) has not properly defined, we proposed to implement our minimally invasive program with a specific clinical pathway able to enhance recovery after lung resection. Aim of this study was to assess the impact of this integrated program of Enhanced Pathway of Care (E.P.C.) in Uniportal V.A.T.S. patients undergoing lung resection, in terms of efficiency and safety. We conductedaretrospective, observational study enrolling patients undergoing uniportal V.A.T.S. resections from January 2015 to May 2020. Two groups were created: pre-E.P.C. and E.P.C. Propensity score matching analysis was performed to evaluate length of stay (LOS), postoperative cardiopulmonary complications (CPC)and readmission rate (READM). We analyzed 1167 patients (E.P.C. group: 182; pre-E.P.C. group: 985). E.P.C. group has a mean LOS shorter compared to pre-E.P.C. group (3.13 vs 4.19days, p < 0.0001) without increasing on CPC (E.P.C. 12% vs pre-E.P.C. 11%, p = 0.74) and READM rate (E.P.C. 1.6% vs pre-E.P.C. 4.9%, p = 0.07). In particular, the LOS was shortened in the E.P.C. patients submitted to lobectomy, segmentectomy and wedge resection. Moreover, the three subgroups had similar CPC and READM rates for E.P.C. and control patients. In conclusion, this study demonstrated the benefits and safety of E.P.C. program showing a reduction of LOS for patients undergoing uniportal V.A.T.S. resection.

The Predictive Value of Stair Climbing Test on Postoperative Complications in Lung Cancer Patients with Limited Pulmonary Function.

To evaluate the predictive value of stair climbing test (SCT) on postoperative complications in lung cancer patients with limited pulmonary function. A total of 727 hospitalized lung cancer patients with limited pulmonary function were retrospectively reviewed. Included in the cohort were 424 patients who underwent SCT preoperatively. Patients were grouped according to general condition, past medical history, surgical approach, pulmonary function test, and SCT results. Comparison of the postoperative cardiopulmonary complication rates was made and independent risk factors were identified. A total of 89 cardiopulmonary-related complications occurred in 69 cases, accounting for 16.3% of the entire cohort. The postoperative cardiopulmonary complication rates were significantly different between groups stratified by smoking index, percentage of forced expiratory volume in one second, percentage of diffusion capacity for carbon monoxide, SCT results, excision extension, and anesthetic duration (p <0.05). Multivariate analysis showed that only height achieved (p <0.001), changes in heart rate (∆HR; p <0.001), and excision extension (p = 0.006) were independent risk factors for postoperative cardiopulmonary complications. The SCT could be used as a preoperative screening method for lung cancer patients with limited pulmonary function. For those patients who could only climb less than 6 floors or had ∆HR >30 bpm in the test, sublobar resection should be selected to reduce the postoperative cardiopulmonary complication rate.