Outcomes Of Video-assisted Thoracoscopic Surgery Research Articles

Comparative outcomes of video-assisted thoracoscopic surgery versus open surgery for bronchogenic cysts in adults: a retrospective cohort study.

Open thoracotomy has been the traditional surgical approach for patients with bronchogenic cysts (BCs). This study aimed to evaluate the safety and efficacy of video-assisted thoracoscopic surgery (VATS) compared to open surgery for the treatment of BCs in adults. This single-institution, retrospective cohort study included 117 consecutive adult patients who underwent VATS (group A) or open surgery (group B) for BC resection between February 2019 and January 2023. Data regarding clinical history, operation duration, length of hospital stay, 30-day mortality, and recurrence during follow-up were collected and analyzed. Of the total cohort, 103 (88.0%) patients underwent VATS, while 14 (12.0%) patients underwent open surgery. Patients' age in group B were much older than group A (P=0.014), and no significant differences in other demographic and baseline clinical characteristics were observed between the groups. The VATS group had shorter median operation duration (96 vs. 149.5 min, P<0.001) and shorter mean length of hospital stay (5.0±5.5 vs. 8.6±4.0 days, P<0.001). One death occurred in the open surgery group. During a median follow-up of 34 (interquartile range, 20.8-42.5) months, no instances of BC recurrence were observed in either group. Compared to open surgery, VATS is also a safe and efficacious approach for treating BCs in adults. What's more, VATS offered shorter operative times and hospital stays. Considering the minimally invasive, VATS may be a better choice in most patients with bronchial cysts.

Role of Video Assisted Thoracoscopic Surgery (VATS) in the Management of Pulmonary Sequestration; A Meta-Analysis

Background: Pulmonary sequestration is a rare birth defect. It is a nonfunctioning dysplastic lung tissue without connection to the tracheobronchial tree, and its blood supply is from one or more aberrant systemic arteries. The aim of this study is to review the current literature regarding the role of video-assisted thoracic surgery (VATS) in the management of pulmonary sequestration. Objective: This review aims to assess the safety, efficacy, and outcomes of Video-Assisted Thoracoscopic Surgery (VATS) in managing pulmonary sequestration while considering patient characteristics, symptoms, arterial sources, surgical techniques, and postoperative advantages. Methods: The Web of Science, PubMed, MEDLINE, and Google Scholar were searched for articles published in English. Article titles containing the words “Video-Assisted Thoracoscopic Surgery for Pulmonary Sequestration and/or VATS” were filtered out of the search to exclude a large portion of irrelevant studies. The extracted data were analyzed. The data extracted were presented as frequencies and percentages. Results: After excluding the unrelated articles, 27 studies were identified for analysis; most of the studies (18) were case reports, with nine being case series, and the total number of patients who underwent pulmonary sequestration by VATS was 240. Both genders were equally affected (125, 52% were male and 115, 48% were female), the most common presenting symptom was coughing,and the descending thoracic aorta was the most common artery from which the feeders originated. About 149 patients (62.08%) underwent a lobectomy. Conclusion: Pulmonary sequestration can safely be treated by VATS at single or multiple ports with a shorter hospital stay, less postoperative pain, and fewer analgesic requirements.

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.

Results of video-assisted thoracoscopic surgery versus thoracotomy for lung cancer in a mixed practice medium-volume hospital: a propensity-matched study.

The aim of this study was to compare the short- and long-term results of video-assisted thoracoscopic surgery (VATS) and thoracotomy for non-small-cell lung cancer in a medium-volume centre, where cardiothoracic surgeons perform both cardiac and general thoracic surgery. The primary outcome of interest was 5-year overall survival and disease-specific survival. Secondary outcomes were short-term postoperative complications, length of hospital stay and lymph node yield. This was a retrospective cohort study including 670 lung cancer patients undergoing VATS (n = 207) or open surgery (n = 463) with a curative intent in Oulu University Hospital between the years 2000-2020. Propensity score matching was implemented with surgical technique as the dependent and age, sex, Charlson comorbidity index, pulmonary function, pathological stage, histological type and the year of the operation as covariates resulting in 127 pairs. In the propensity-matched cohort, 5-year overall survival was 64.3% after VATS and 63.2% after thoracotomy (P = 0.969). Five-year disease-specific survival was 71.6% vs 76.2% (P = 0.559). There were no differences in overall (34.6% vs 44.9%, p = 0.096) or major postoperative complications (8.7% vs 14.2%, P = 0.167) between the study groups. The average length of hospital stay was shorter (5.8 vs 6.6 days, P = 0.012) and the median lymph node yield was lower (4.0 vs 7.0, P < 0.001) in the VATS group compared to the thoracotomy group. According to this study, the long-term results of lung cancer surgery in a mixed practice are comparable between VATS and open surgery.

Video assisted thoracoscopic surgery vs thoracotomy in management of post traumatic retained hemothorax: a randomized study

BackgroundRetained hemothorax is a serious problem that can lead to empyema or fibro-thorax. Evacuation of the retained hemothorax is commonly performed via open thoracotomy. This randomized study was conducted to represent our center's expertise with this issue, we compared the outcomes of video-assisted thoracoscopic surgery (VATS) against open thoracotomy in managing post-traumatic retained clotted hemothorax.MethodsThis prospective randomized research was conducted on sixty cases with posttraumatic remaining clots of at least 500 ml or at least one-third of haemothorax that cannot be evacuated by a chest tube after 72 h of first intervention, as detected by computed tomography imaging who underwent open thoracotomy or VATS in the management of posttraumatic retained clotted hemothorax. Cases were allocated to equal groups; group A: cases who underwent VATS and group B: cases who underwent open thoracotomy.ResultsPreoperative intercostal chest tube (ICT) placement period was insignificantly different between the two groups. Group A had a significantly lesser post-operative amount of ICT drainage, and ICT was removed after significantly fewer days than in group B (P value < 0.001). Post-operatively, the numerical rating scale (NRS) was significantly higher at post-extubation and 6 h after extubation in group B than group A (P value < 0.05) and was insignificantly different between both groups the next morning, after chest tube removal and before discharge. group A had statistically better NRS versus group B (P value < 0.001). Wound infection incidence was significantly less in group A compared to group B (P value = 0.025); the incidence of air leak was insignificantly different between both groups. Group A has significantly shorter hospitalization than group B (P value < 0.001). Wound infection and empyema in outcases were insignificantly different between both groups (P value = 0.492). Cases in group A returned to normal activity earlier than group B (P value < 0.001).ConclusionsVATS in managing posttraumatic retained hemothorax was a more effective, well-tolerated, and reliable intervention that can be easily utilized for managing posttraumatic retained hemothorax in comparison to open thoracotomy.

Short- and medium-term outcomes of video-assisted thoracoscopic surgery versus thoracotomy for carinal lung resection combined with carina reconstruction in locally advanced non-small cell lung cancer patients.

The application of video-assisted thoracoscopic surgery (VATS) for complex carina surgeries in treating non-small cell lung cancer (NSCLC) patients with involved carina is controversial. This study compared short- and medium-term outcomes of VATS versus thoracotomy for carinal lung resection with carina reconstruction in treating locally advanced NSCLC, aiming to assess the potential benefit of VATS over thoracotomy for these patients. A total of 37 consecutive NSCLC cases receiving VATS (n = 14) or thoracotomy (n = 23) for carinal lung resection with carina reconstruction from 2016 to 2021 were retrospectively identified. Baseline clinicopathological characteristics, perioperative outcomes, and survival profiles were investigated. Patients in the VATS and thoracotomy groups had comparable baseline clinicopathological characteristics (all p > 0.050). VATS decreased postoperative drainage volume compared with thoracotomy (1280 [1170-1510] vs. 1795 [1510-1905] mL, p = 0.012). Regarding surgical-related pains, VATS reduced numeric rating scale scores on the postoperative day 1 (4 [3, 4] vs. 5 [4, 5], p = 0.021) and day 2 (3 [3, 4] vs. 5 [3-5], p = 0.023) than thoracotomy. No difference was found between the VATS and thoracotomy groups in other perioperative outcomes, postoperative complications, and assessment of lymph nodes (LNs) and LN stations (all p > 0.050). Moreover, patients in the two groups had comparable 3-year disease-free survival (DFS), overall survival (OS), and recurrence and mortality patterns. Further subgroup and Cox hazards regression analyses also observed no difference in DFS or OS between the two groups. VATS reduced postoperative drainage volume and ameliorated surgical-related pain, and achieved comparable medium-term survival compared to thoracotomy for carinal lung resection with carina reconstruction in treating locally advanced NSCLC.

Primary Spontaneous Pneumothorax: Open Thoracotomy vs. Video-assisted Thoracoscopic Surgery: A Single-center Retrospective Cohort Study.

Primary spontaneous pneumothorax (PSP) is a spontaneous pneumothorax without underlying lung disease. The main goals of this study were to compare the outcomes of video-assisted thoracoscopic surgery (VATS) and open thoracotomy in patients with PSP. The current study is a retrospective cohort study of patients who were admitted to the emergency department or general surgery ward at Dr. Masih Daneshvari Hospital (Tehran, Iran) with the diagnosis of PSP and underwent surgery by open or VATS approach from 2006 to 2012. The groups were compared in terms of the length of operation, the length of hospitalization, recurrence, and postoperative complications. Data were analyzed using SPSS version 18.0, and Student's t test, analysis of variance (ANOVA), Chi square, and Fisher's exact test were employed. P values less than 0.05 were considered statistically significant. PSP was diagnosed in 90 patients who underwent surgery. Open thoracotomy and VATS procedures were performed in 65 (72.2%) and 25 (27.8%) patients, respectively. VATS was converted to open in seven cases (7.7%). Recurrent pneumothorax was the most common surgical indication for PSP. There was no significant difference between the two groups in terms of mean age, sex, smoking, side of the involved lung, previous pneumothorax history, mean length of hospitalization for recurrence, post-operation bleeding, and failure of lung expansion. However, the length of surgery (P=0.011) and air leakage (P=0.048) significantly differed between the two groups. When compared to open thoracotomy, VATS could be the primary treatment option in the surgical treatment of PSP due to the shorter length of surgery and decreased complications such as air leakage.

VATS in complicated COVID-19 patients: case series.

Common complications of coronavirus disease 2019 (COVID-19) related ARDS and ventilation are barotrauma-induced pneumothorax, pneumatocele and/or empyema. We analysed indications and results of video-assisted thoracoscopic surgery (VATS) in complicated COVID-19 patients. This is a retrospective single-institution study analysing a case series of patients treated by VATS for secondary spontaneous pneumothorax (SSP), pneumatocele and empyema complicating COVID-19, not responding to drainage in Lodi Maggiore Hospital between February 2020 and May 2021. Out of 2076 patients hospitalized in Lodi Maggiore Hospital with COVID-19, nine Males (0,43%; mean age 58,1-33-81) were treated by VATS for complications of pneumonia (6 SSP and 3 empyema; 1 case complicated by haemothorax). 7 patients (77%) had CPAP before surgery for 21.3days mean (4-38). Mean Operative time was 80.9min (38-154). Conversion rate was 0%. 3 (33%) patients were admitted to ICU before VATS. Treatments were: bullectomy in six patients (66%), drainage of the pleural space in all patients, pleural decortication and fluid aspiration in five cases (55%). two patients (22%) needed surgery interruption and bilateral ventilation to restore adequate oxygenation. Mortality was 1/9 (11%) due to respiratory failure for persistent pneumonia. In one patient (11%) redo surgery was performed for bleeding. Mean postop Length of Stay (LOS) was 37.9days (10-77). Our report shows that VATS can be considered an extreme, but effective treatment for COVID-19 patients with SSP, pneumatocele or empyema, for patients who can tolerate general anaesthesia. Attention must be paid to the aerosol-generation of infected droplets.

Trends of utilization and perioperative outcomes of robotic and video-assisted thoracoscopic surgery in patients with lung cancer undergoing minimally invasive resection in the United States

ObjectiveThe objective of this study was to evaluate utilization and perioperative outcomes of video-assisted thoracoscopic surgery (VATS) or robotic-assisted thoracoscopic surgery (RATS) for lung cancer in the United States using a nationally representative database. MethodsHospital admissions for lobectomy or sublobar resection (segmentectomy or wedge resection) using VATS or RATS in patients with nonmetastatic lung cancer from October 2015 through December 2018 in the National Inpatient Sample were studied. Patient and hospital characteristics, perioperative complications and mortality, length of stay (LOS), and total hospital cost were compared. Logistic regression was used to assess whether the surgical approach was independently associated with adverse outcomes. ResultsThere were 83,105 patients who had VATS (n = 65,375) or RATS (n = 17,710) for lobectomy (72.7% VATS) or sublobar resection (84.2% VATS). Utilization of RATS for lobectomy and sublobar resection increased from 19.2% to 34% and 7.3% to 22%, respectively. Mortality, LOS, and conversion rates were comparable. The cost was higher for RATS (P <.01). Multivariate analyses showed comparable RATS and VATS complications with no independent association between the minimally invasive surgery approach used and adverse surgical outcomes, except for a decreased risk of pneumonia with RATS, relative to VATS sublobar resection (P <.01). Thoracic complication rates and LOS decreased after RATS lobectomy in 2018, compared with previous years (P <.005). ConclusionsThe utilization of robotic-assisted lung resection for cancer has increased in the United States between 2015 and 2018 for sublobar resection and lobectomy. In adjusted regression analysis, compared with VATS, patients who underwent RATS had similar complication rates and LOS. The robotic approach was associated with increased total hospital cost. LOS and thoracic complication rates trended down after RATS lobectomy.

Video-Assisted Thoracoscopic Surgery versus Open Decortication in Chronic Pleural Empyema

Background: The role of video-assisted thoracoscopic surgery (VATS) for managing organized empyema is still limited. This study compared VATS versus open decortication in patients with chronic pleural empyema.&#x0D; Methods: This randomized controlled trial included 58 patients with stage III empyema. Patients were divided into two groups. Group A (n= 30) included patients who had decortication through an open thoracotomy, and Group B (n= 28) included VATS decortication patients. Two patients in the VATS group were converted to the open approach and were excluded from the analysis.&#x0D; Results: The mean age in Group A was 48.23 ± 8.44 years and 49.79 ± 7.85 years Group B (p= 0.47). There were 16 males (53.3%) in Group A and 15 (63.6%) in Group B (p= 0.99). The operative time was 336.0 ± 67.60 min in Group A and 291.07 ± 56.66 min in Group B (p= 0.01). There was no difference in intraoperative complications between groups. Postoperative hospital stay (p= 0.23) and ICU admission (p= 0.24) did not differ between groups. In Group A, the pain scale was 8 (6- 8), and it was 4 (2- 4) in Group B (p˂ 0.001). No difference was recorded in the postoperative complications between groups.&#x0D; Conclusion: The outcomes of VATS in managing stage III empyema are comparable to the open approach. VATS has the advantage of lower postoperative pain. VATS could be an alternative to open decortication in patients with stage III pleural empyema.

Video-assisted thoracoscopic surgery for primary pulmonary cryptococcosis

The surgical outcome for primary pulmonary cryptococcosis remains unclear. In this study, we investigated the clinical characteristics, treatment, and outcomes of video-assisted thoracoscopic surgery (VATS) for primary pulmonary cryptococcosis. We retrospectively reviewed the medical records of 49 patients with confirmed pulmonary cryptococcosis who underwent VATS for pulmonary nodules at the National Taiwan University Hospital between May 2013 and March 2019. Serum cryptococcal antigen (CryAg)-positive and CryAg-negative patients were compared. The diagnosis of pulmonary cryptococcosis was confirmed using histopathology or tissue swab culture. The mean age of the patients was 56.0±12.2 years, and 27 patients (55.1%) were male. Most patients were asymptomatic (67.3%) and admitted following the detection of pulmonary lesions on a computed tomography scan of the chest. A greater proportion of patients in the CryAg-positive group (62.5%) underwent lobectomy compared with those in the CryAg-negative group (7.3%, P<0.001). Three patients (6.1%) had neurological symptoms (headache or dizziness) and all were serum CryAg-positive. One patient with Cryptococcus gattii developed fluctuating serum CryAg titers after a 12-month antifungal treatment. No relapse occurred in the remaining 48 patients, irrespective of postoperative antifungal treatment. In patients with primary pulmonary cryptococcosis, serum CryAg detection rate is low, and VATS was an effective and safe diagnostic and therapeutic tool.

Efficacy of video-assisted thoracoscopic surgery versus intrapleural streptokinase for treatment of parapneumonic empyema with multiloculation and septation.

IntroductionEffective treatment of parapneumonic empyema with multiloculation and septation has been a challenge for clinicians for many years.AimThis study compared the clinical outcomes of video-assisted thoracoscopic surgery (VATS) and intrapleural streptokinase in patients with stage II empyema.Material and methodsThis is a retrospective study of 46 patients with parapneumonic empyema with multiloculation and septation in the pleural cavity treated with VATS or streptokinase in Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran, between January 2018 and January 2021. The main outcome measures of this study were hospital stay, febrile period, days with drainage, and treatment failure.ResultsA total of 46 patients were included in this study. Of these, 28 were treated with VATS deloculation, and 18 were treated with streptokinase. The average hospital stay was 2.8 ±1.7 days for the VATS group and 7.5 ±3.5 days for the streptokinase group (p < 0.001). The average days with fever were 1.9 ±0.7 days for the VATS group and 3.0 ±1.64 days for the streptokinase group (p = 0.017). The average days with drainage were 3.0 ±1.6 days for the VATS group and 7.5 ±4.4 days for the streptokinase group (p < 0.001). The success rate was 92.9% for the VATS group and 66.7% for the streptokinase group, which was significantly higher in the VATS group compared to the streptokinase group (p = 0.042). No cases of perioperative mortality occurred. The frequency of adverse events did not differ between study groups (p > 0.05).ConclusionsOur results demonstrated that treatment of empyema with VATS is superior to streptokinase therapy.

Three-dimensional reconstruction facilitates thoracoscopic anatomical partial lobectomy by an inexperienced surgeon: a single-institution retrospective review.

BackgroundThis study aimed to evaluate the effect of three-dimensional (3D) interactive quantitative surgical planning on the outcome of video-assisted thoracoscopic surgery (VATS) anatomical partial lobectomy (APL), and to investigate the learning curve of 3D reconstruction-assisted VATS APL assisted.MethodsWe retrospectively analyzed 156 cases of solitary pulmonary ground-glass opacity (GGO) lesions in patients who underwent 3D interactive quantitative VATS APL. Digital imaging and communications in medicine data were recorded for each patient. We used Materialise 3-Matic software to make 3D reconstructed images. All surgeries were performed by the same thoracic surgeon at the Cardiothoracic Surgery Department of Yichang Central People’s Hospital between February 28, 2018, and April 20, 2020. The learning curve was evaluated using operative time and the cumulative sum (CUSUM) value of operative time in all cases.ResultsVATS APL was performed in every patient successfully, and there were no conversions to thoracotomy or lobectomy. The median surgical margin distance was 2.2 (range, 2.0–2.8) cm. All patients had an R0 complete cancer resection on histology. The histological subtypes of the segmental lesions included 69 cases of minimally invasive adenocarcinoma (MIA), 61 cases of adenocarcinoma, one case of squamous cell carcinoma, 16 cases of adenocarcinoma in situ (AIS), and nine cases of atypical adenomatous hyperplasia (AAH). The median operation time was 119 (range, 57–245) min, and median intraoperative blood loss was 37 (range, 15–247) mL. The median duration of thoracic drainage tube insertion was 2.3 (range, 1–23) days after surgery. The median length of postoperative hospital stay was 3.7 (range, 3–25) days. There were no cases of perioperative death. During the median postoperative follow-up period of 11 (range, 2–26) months, no tumor recurrence or postoperative death was observed. 3D interactive quantitative surgical planning facilitates safe and efficient VATS APL with a learning curve of 30 cases.Conclusions3D interactive quantitative surgical planning for VATS APL is a feasible option for inexperienced surgeons, with acceptable safety and complications.

Treatment of Bronchiectasis in the Era of Minimally Invasive Surgery: 10-Year Experience in a Single Center

Bronchiectasis is a chronic pulmonary disease characterized by permanent enlargement of the bronchi and bronchioles. Anatomic resection of the affected lung part is still the most valid treatment option in localized disease. Despite the promising results of video-assisted thoracoscopic surgery (VATS) in patients with early-stage lung cancer, VATS is still controversial in bronchiectasis. In this study, we aim to present our surgical experience in patients with bronchiectasis by comparing the results of VATS and thoracotomy groups. We reviewed the medical records of patients who underwent anatomic lung resection via VATS and thoracotomy for the treatment of bronchiectasis between January 2009 and December 2019. Between January 2009 and December 2019, 50 patients with bronchiectasis were surgically treated in our department. Among them, 20 patients underwent attempted VATS lung resection, and 30 patients underwent thoracotomy. There was no difference in the intraoperative and postoperative complications, but postoperative pain scores were lower in the VATS group. Video-assisted thoracoscopic surgery is a safe and feasible technique in the surgical treatment of bronchiectasis.

Comparing the outcomes of video-assisted thoracoscopic surgery and rethoracotomy in the management of postoperative hemorrhage

Comparing the outcomes of video-assisted thoracoscopic surgery and rethoracotomy in the management of postoperative hemorrhage

Prognostic Factors and Long-Term Results in Patients Who Underwent Videothoracoscopic Bronchogenic Cyst Excision.

Background: Our aim in this study was to compare the results of video-assisted thoracoscopic surgery with those of open surgery regarding efficacy, morbidity, and long-term recurrence of bronchogenic cysts in light of the literature.Methods: This study comprises the data of 51 patients whose pathological diagnosis revealed bronchogenic cyst after surgical excision between January 2010 and December 2016. There were two groups according to the type of resection: video-assisted thoracoscopic surgery (VATS) and thoracotomy.Results: Of the patients included in the study, 25 (49%) were male and 26 (51%) were female. Their average age was 41.7 ± 14.1 years. While 14 patients (27.5%) were asymptomatic in the preoperative period, 37 patients (72.5%) had symptoms. The Charlson Comorbidity Index was 0 in 35 patients (68.6%) and 1 and above in 16 patients (31.4%). While 22 (43.1%) patients underwent cyst excision via VATS, 29 (56.9%) patients underwent thoracotomy. The average length of hospital stay was 1.77 ± 0.68 days for patients who had VATS, whereas it was 3.82 ± 3.3 days for patients who had thoracotomy (p <0.001).Conclusion: VATS procedure is a safe method in the surgical treatment of bronchogenic cysts, with less hospitalization and similar recurrence rates.

Video-Assisted Thoracoscopic Lobectomy Versus Stereotactic Body Radiotherapy Treatment for Early-Stage Non-Small Cell Lung Cancer: A Propensity Score-Matching Analysis.

BackgroundCompared the overall outcomes of video-assisted thoracoscopic surgery (VATS) versus stereotactic body radiotherapy (SBRT) for stage I-II non-small cell lung cancer (NSCLC).MethodsWe retrospectively compared overall survival (OS), cancer-specific survival (CSS), locoregional control (LRC), and disease-free survival (DFS) at our institution between January 2012 and December 2016. Propensity score-matching was performed to reduce patient selection bias based on age, gender, Karnofsky performance score, Charlson comorbidity index, pulmonary function, and tumor diameter.ResultsA total of 567 patients treated with SBRT (n = 109) or surgery (n = 458) were included. Of those, 104 patients were matched for further analyses. Median follow-up was 44 months. At 3 and 5 years, OS was 88.6 and 79.9% for SBRT, and 94.2 and 91.6% for surgery (p = 0.097). There were no differences noted in 5-year CSS (83.7 vs. 91.6%, respectively; p = 0.270). The cumulative incidence of LRC at 3 and 5 years was comparable (93.5 and 93.5% vs. 94.0 and 85.9%, respectively; p = 0.621). Differences in the rates of disease-free survival at 5 years were not statistically significant (79.0 and 80.5%, respectively; p = 0.624).ConclusionsThis propensity score-matching analysis suggests that SBRT can be an alternative option to VATS lobectomy for stage I-II NSCLC.

Nhận xét chỉ định, đánh giá kết quả ứng dụng phẫu thuật soi điều trị mủ màng phổi

Tóm tắt Mục tiêu: Nhận xét chỉ định và kết quả ứng dụng phẫu thuật nội soi (PTNS) trong điều trị mủ màng phổi. Đối tượng và phương pháp: 44 người bệnh mủ màng phổi giai đoạn bán cấp và mạn tính được PTNS điều trị tại khoa phẫu thuật lồng ngực - Bệnh viện Quân Y 103, thời gian từ 01/2017 đến 04/2019. Nghiên cứu tiến cứu, mô tả và theo dõi dọc. Kết quả: Tuối trung bình 54,6 ± 14,2; tỷ lệ nam/nữ là 21/1; điểm Karnofsky 68,6 ± 6,9; bệnh lý kết hợp gồm: đái tháo đường (36,4%), suy thận giai đoạn cuối (2,3%), xơ gan (2,3%). Cấy khuẩn mủ màng phổi xác định được vi khuẩn gây bệnh ở 12/44 trường hợp (tỷ lệ 27,3%); PTNS điều trị mủ màng phổi giai đoạn bán cấp tính chiếm 77,3%, mạn tính 22,7%. Phương pháp xử lý gồm: bóc vỏ phổi (56,8%) và gỡ dính, hút mủ, rửa màng phổi, dẫn lưu kín (43,2%); Biến chứng sau mổ 9,1%. Kết quả tốt tại thời điểm 1 và 3 tháng sau phẫu thuật lần lượt là 43,2% và 81,8%. Kết luận: Ứng dụng PTNS điều trị mủ màng phổi (MMP) giai đoạn bán cấp và đầu mạn tính khả thi. Biến chứng tỷ lệ thấp (9,1%). Kết quả tốt khả quan tại thời điểm tháng thứ 3 sau phẫu thuật (81,8%). Abstract Objectives: Remarks on indication and results of Video - Assisted - Thoracoscopic Surgery (VATS) for management of empyema. Materials and Methods: 44 patients with fibrinopurulent and empyema phases were treated by VATS at the Department of thoracic surgery of Military Hospital 103, from 01/2017 to 04/2019. Descriptive, longitudinal and prospective study. Results: The mean of age was 54.6 ± 14.2; male/female was 21/1; Karnofsky score was 68.6 ± 6.9; Comorbidity diseases include: diabetes (36.4%), end-stage renal failure (2.3%), cirrhosis (2.3%). Results of pleural pus culture with 12/44 (27,3%) were identified pathogenic bacteria. VATS performed for fibrinopurulent and chronic empyema (77.3% and 22.7%, respectively). The techniques performed were: decortication (56.8%) and empyemectomy and debridement (43.2%). The rate of postoperative complication was relative low (9.1%). The good results at the 1st and 3rd month after surgery were 43.2% and 81.8%, respectively. Conclusion: Application of VATS for fibrinopurulent and chronic empyema was feasibility. Low-rate of complication was only 9,1%. The good results at the 3rd month after surgery was as high as 81,8%. Keywords: Empyema; Video-Assisted-Thoracoscopic Surgery

Comparison of the Short- and Long-term Outcomes of Video-assisted Thoracoscopic Surgery versus Open Thoracotomy Bronchial Sleeve Lobectomy for Central Lung Cancer: A Retrospective Propensity Score Matched Cohort Study.

The purpose of this study was to evaluate the short- and long-term outcomes of video-assisted thoracoscopic surgery (VATS) versus open thoracotomy bronchial sleeve lobectomy (BSL) for patients with central lung cancer. This is a retrospective cohort study. Perioperative outcomes and long-term survival of patients who underwent VATS versus open thoracotomy BSL for central lung cancer from June 2010 and June 2018 in the Western China Lung Cancer Database were compared using propensity score matching (PSM) between the two surgical approaches. The retrospective study included 187 patients who divided into VATS group (n = 44) and open group (n = 143) according to surgical approach, and PSM resulted in 43 patients in each group, which were well matched by 11 potential prognostic factors. The VATS group was associated with lower overall incidence of postoperative complications (20.3% vs. 30.2%, P = 0.029), less postoperative drainage (875ml [250-3960] vs. 1280ml [100-4890], P = 0.039). The 5-year overall survival (OS) and disease-free survival (DFS) were comparable between the VATS and open groups (55.9% vs. 65.2% P = 0.836 and 54.1% vs. 60.2% P = 0.391, respectively) after matching. Multivariable adjusted analysis demonstrated that the surgical approach was not an independent favorable prognostic factor for OS (hazard ratio [HR] = 0.922; 95% confidence interval [CI], 0.427-1.993; P = 0.836) but just the pTNM stage (HR = 2.003; 95% CI 1.187-3.382; P = 0.009). VATS BSL may achieve equivalent long-term outcomes for central lung cancer patients when comparing with open thoracotomy. Although slightly longer duration of surgery, VATS approach may be a feasible option for lung cancer patients requiring BSL.

Thoracoscopic lobectomy for non-small-cell lung cancer in patients with impaired pulmonary function: analysis from a national database.

The objective of this retrospective multi-institutional study was to evaluate the postoperative outcomes of video-assisted thoracoscopic surgery (VATS)-lobectomy (VATS-L) for non-small-cell lung cancer (NSCLC) in patients with impaired lung function. The second end point was to illustrate the effective role of forced expiratory volume in 1 s (FEV1%) and the diffusing capacity of the lung for carbon monoxide (DLCO%) in predicting complications in this population. Data from patients who underwent VATS-L at participating centres were analysed and divided into 2 groups: group A comprised patients with FEV1% and/or DLCO% >60% and group B included patients with impaired lung function defined as FEV1% and/or DLCO% ≤60%. To define clinical predictors of death and complications, we performed univariate and multivariable regression analyses. A total of 5562 patients underwent VATS-L, 809 (14.5%) of whom had impaired lung function. The postoperative mortality rate did not differ between the 2 groups (2.3% vs 3.2%; P = 0.77). The percentage of patients who had any complication (21.4% vs 34.2%; P ≤ 0.001), the complication rate (28% vs 49.8%; P ≤ 0.001) and the length of hospital stay (P ≤ 0.001) were higher for patients with limited pulmonary function. Impaired lung function was a strong predictor of overall and pulmonary complications at multivariable analysis. VATS-L for NSCLC can be performed in patients with impaired lung function without increased risk of postoperative death and with an acceptable incidence of overall and respiratory complications. Our analysis suggested that FEV1% and DLCO% play a substantial role in estimating the risk of complications after VATS-L, but their role was less reliable for estimating the mortality.