Surgery Lobectomy For Lung Cancer Research Articles

Economic impact of powered stapler in video-assisted thoracic surgery lobectomy for lung Cancer in a Chinese tertiary hospital: a cost-minimization analysis

BackgroundTo assess the economic impact of powered stapler use in video-assisted thoracic surgery (VATS) lobectomy for lung cancer in a Chinese tertiary care hospital.MethodsThis study identified 388 patients who received VATS lobectomy using the ECHELON powered stapler (n = 296) or the ECHELON manual stapler (n = 92) for lung cancer in a Chinese tertiary hospital. Multiple generalized linear regression analyses were conducted using data on hospital costs and patient characteristics to develop predictive equations for hospital costs in a cost-minimization analysis (CMA) model comparing hospital costs associated with the ECHELON powered stapler and the ECHELON manual stapler. CMA model was used to conduct scenario analysis to compare the ECHELON powered stapler with another manual stapler (Victor Medical).ResultsThe multiple generalized linear regression analyses identified that using the ECHELON powered stapler in VATS lobectomy for lung cancer was associated with significantly lower drug costs than using the ECHELON manual stapler (coefficient − 0.256, 95% confidence interval: − 0.375 to − 0.139). The CMA model estimated that the ECHELON powered stapler could save hospital costs by ¥1653 when compared with the ECHELON manual stapler (¥65,531 vs. ¥67,184). The use of the ECHELON powered stapler also saved hospital costs by ¥4411 when compared with the Victor Medical manual stapler (¥65,531 vs. ¥69,942) in the scenario analysis.ConclusionsCompared to the two manual staplers used for VATS lobectomy for lung cancer in a Chinese tertiary hospital, the ECHELON powered stapler had 100% probability to save total hospital costs under present prices of the three staplers according to the CMA.

Clinical outcomes of powered and manual staplers in video-assisted thoracic surgery lobectomy for lung cancer.

Methods: This retrospective cohort study identified patients who underwent video-assisted thoracic surgery (VATS) lobectomy for lung cancer from January 2016 to December 2018 in a Chinese tertiary general hospital. The electronic hospital medical records associated with the VATS lobectomy for lung cancer were the data sources. Results: Based on the analysis of 433 patients with the utilization of staplers in their VATS lobectomy for lung cancer, using powered stapler was associated with significantly shorter operation time and postsurgery hospital stay length than using the manual stapler in the multivariable generalized linear regression analyses with the adjustment of patient characteristics. However, no other significant differences were observed for other clinical outcomes between the two staplers.

PCN25 Hospital Costs Associated with Powered and Manual Staplers in VIDEO-Assisted Thoracic Surgery Lobectomy for LUNG Cancer in a Chinese Teritary Care Hospital

PCN25 Hospital Costs Associated with Powered and Manual Staplers in VIDEO-Assisted Thoracic Surgery Lobectomy for LUNG Cancer in a Chinese Teritary Care Hospital

Prehabilitation in video-assisted thoracoscopic surgery lobectomy for lung cancer: current situation and future perspectives.

Prehabilitation in video-assisted thoracoscopic surgery lobectomy for lung cancer: current situation and future perspectives.

Routine intensive monitoring but not routine intensive care unit-based management is necessary in video-assisted thoracoscopic surgery lobectomy for lung cancer.

Evidence for immediate postoperative intensive care unit (ICU) care is still lacking in the era of minimally invasive video-assisted thoracic surgery (VATS). We evaluated the safety and feasibility of general ward (GW) care after VATS lobectomy for lung cancer. A total of 451 patients who underwent VATS lobectomy for lung cancer between June 2012 and August 2017 were retrospectively studied. The patients were divided into two groups (ICU 344 vs. GW 107). We compared the postoperative complications and mortality between the two groups after propensity score matching. Furthermore, we evaluated the clinical factors associated with complications, and stratified patients according to the risk for complications. Immediate complications (within 24 hours after surgery) occurred in 0.4%. Non-immediate complications occurred in 18.8%. There were no differences in the incidence of complications and mortality between the two groups, after propensity matching. However, the length of postoperative stay (12.6±10.0 vs. 10.3±4.1 days, P=0.041) was significantly higher in the ICU group than in the GW group. Multivariate regression analyses revealed that chronic obstructive pulmonary disease (COPD) [odds ratio (OR) =3.00, 95% confidence interval (CI): 1.51-5.97, P=0.002], non-stage I cancer (OR =2.54, 95% CI: 1.39-4.62, P=0.002), multi-port surgery (OR =3.75, 95% CI: 2.18-6.44, P<0.001), and age ≥60 years (OR =2.12, 95% CI: 1.03-4.37, P=0.042) were associated with complications. Immediate postoperative care in GW had no influence on complications. Immediate postoperative care after VATS lobectomy for lung cancer in GW was safe and feasible without poor outcomes. Therefore, selective intensive monitoring for high risk groups may offer cost-saving and efficient use of ICU resources.

Video-assisted thoracoscopic surgery lobectomy for lung cancer: the state of art

Video-assisted thoracoscopic surgery (VATS) lobectomy represents, nowadays, the gold standard for the treatment of early-stage non-small cell lung cancer (NSCLC). This approach provides a viable alternative to open lobectomy, in terms of radical oncological surgery and of low incidence of complications, as a consequence of sustained innovations and improvements, due to the new available technology devices. Aim of the study was to evaluate the benefits and feasibility of such minimally invasive approaches throughout a careful review of the literature.

The long-term impact of postoperative pulmonary complications after video-assisted thoracic surgery lobectomy for lung cancer.

Pulmonary complications (PCs) may influence long-term survivor. We sought to determine the long-term impacts of major pulmonary complications (MPCs) and identify the independent risk factors in non-small cell lung cancer (NSCLC) patients. A retrospective study was conducted to analyze the PCs of 828 NSCLC patients who underwent video-assisted thoracic surgery (VATS) lobectomy in Peking University Hospital, the complications were graded according to TMM classification. The effects of PCs on the long-term prognosis were analyzed by using the Kaplan-Meier method. Multivariate logistic regression analysis was used to determine the risk factors of MPCs. Of 828 patients, 139 had PCs, including 66 (8%) MPCs, those patients who developed a PC had longer drainage time, hospital stay and higher perioperative mortality rate. Excluding perioperative deaths, those who develop a MPC had a reduced 3-year disease-free survival (DFS) and 5-year DFS (68.2% vs. 78.7%, 44.7% vs. 70.3%; P=0.001), as well as the reduced 3-year overall survival (OS) and 5-year OS (81.8% vs. 88.6%, 66.6% vs. 80.9%; P=0.023). MPCs were independent prognostic factors of patients with lung cancer. Multivariate logistic regression analysis showed that the independent risk factors for MPCs were age [P=0.007; hazard ratio (HR): 1.05, 95% confidence interval (CI): 1.01-1.08], male (P=0.001; HR: 3.33, 95% CI: 1.87-5.94) and American Society of Anesthesiologist (ASA) grade. MPC after VATS lobectomy is associated with a poorer long-time outcome. The independent risk factors for MPCs were age, male and ASA grade.

Video-assisted thoracoscopic surgery lobectomy for lung cancer versus thoracotomy: a less decrease in sVEGFR2 level after surgery.

Angiogenic and anti-angiogenic factors play an important role in tumor biology and tumor recurrence after surgical resection. Antiangiogenic factors such as vascular endothelial growth factor (VEGF)-receptor 1 (sVEGFR1) and sVEGFR2, two soluble form receptor proteins of VEGF, are critical for angiogenesis. VEGF can be sequestered by soluble forms of these receptors, which result in decreasing VEGF amount available to bind to its receptor on vascular endothelial cell surface. This study aimed to investigate the influences of video-assisted thoracoscopic surgery (VATS) lobectomy and open by thoracotomy for early stage non-small cell lung cancer (NSCLC) on postoperative circulating sVEGFR1 and sVEGFR2 levels. Forty-eight lung cancer patients underwent lobectomy through either VATS (n=26) or thoracotomy (n=22). Blood samples were collected from all patients preoperatively and postoperatively on days 1, 3 and 7. ELISA analysis was used to determine the plasma levels of sVEGFR1 and sVEGFR2. Data are reported as means and standard deviations, and were assessed with the Wilcoxon signed-Rank test (P<0.05). For all patients undergoing lobectomy, postoperative sVEGFR1 levels on days 1 and 3 were markedly increased, while postoperative sVEGFR2 levels on days 1 and 3 were significantly decreased. Moreover, VATS group had significantly higher plasma level of sVEGFR2 postoperative in comparison with open thoracotomy (OT) on day 1 (VATS 6,953±1,535 pg/mL; OT 5,874±1,328 pg/mL, P<0.05). Major pulmonary resection for early stage NSCLC resulted in the increased sVEGFR1 and decreased sVEGFR2 productions. VATS is associated with enhanced anti-angiogenic response with higher circulating sVEGFR2 levels compared with that with OT. Such differences in anti-angiogenic response may have an important effect on cancer biology and recurrence after surgery.

Effect of perioperative treatment with ambroxol on lung cancer patients after video-assisted thoracic surgery lobectomy

To evaluate the influence of perioperative intravenous administration of ambroxol on pulmonary function, postoperative complications, postoperative hospital stay, and cost after video-assisted thoracic surgery lobectomy for lung cancer. Sixty patients who underwent video-assisted thoracic surgery lobectomy for lung cancer in Xiangya Hospital, Central South University between May 2011 and May 2012 were randomly assigned into 2 groups: An ambroxol group (n=30) and a control group (n=30). In the ambroxol group, patients were given ambroxol (1 000 mg/d) on the day of operation and on the first 3 postoperative days. In control group, placebo was given. The pulmonary function tests, arterial blood gases, incidence of perioperative morbidity, postoperative mechanical ventilation time, duration of ICU stay, length and costs of postoperative hospital stay were compared between the 2 groups. The 2 groups were well matched for demographics and operative variables. The ambroxol group showed better the percent predicted forced expiratory volume in 1 second (FEV1%), the ratio of forced expiratory volume in 1 second to forced vital capacity (FEV1/FVC%), the percent predicted diffusing capacity of the lung for carbon monoxide (DLCO%) and arterial oxygen pressure than the control group. The postoperative pulmonary complications was significantly reduced, the duration of mechanical ventilation and the length of ICU stay were shortened, and the length and costs of postoperative hospital stay were significantly decreased in the ambroxol group compared with the control group (all P<0.05). Perioperative intravenous administration of ambroxol can improve the postoperative lung function, reduce the incidence of pulmonary complications, shorten the length of postoperative hospital stay, and lower the total cost of hospitalization after video-assisted thoracic surgery lobectomy for lung cancer.

Video-Assisted Thoracic Surgery Lobectomy for Lung Cancer with Displaced B1+2

A 52-year-old man was diagnosed with lung adenocarcinoma in the left upper lobe (c-T1bN0M0). Preoperative bronchoscopy revealed a displaced anomalous B(1+2) arising from the left main bronchus. Multiplanar reconstruction computed tomography showed that the displaced B(1+2) was located behind the left main pulmonary artery, and the interlobar fissure was largely fused. Video-assisted thoracic surgery (VATS) left upper lobectomy was performed successfully. The "no-touch fissure" technique was efficient not only for avoiding accidental cutting of the displaced bronchus but also post-operative air leakage. This is the first reported case of VATS lobectomy for lung cancer associated with a displaced B(1+2).

Risk factors for major adverse events of video-assisted thoracic surgery lobectomy for lung cancer.

Aims: The purpose of this study was to identify the risk factors for major adverse events of VATS (Video-Assisted Thoracic Surgery) lobectomy for primary lung cancer.Methods: 1806 Patients (1032 males, 57.1%) planned to undergo VATS lobectomy for stage IA-IIIA lung cancer from July 2007 to June 2012. The Thoracic Morbidity and Mortality Classification TM&M system was used to evaluate the presence and severity of complications. Postoperative complications were observed during a 30-day follow up. Univariate and multivariate analysis were used to analyze the independent risk factors for major adverse events.Results: Successful rate of VATS lobectomy was 97.6% (1763/1806). Major complications occurred in 129 patients (7.3%), with a mortality of 0.3% (5/1763). Pulmonary complications contribute up to 90.7% of the major complications and 80% of mortality. Logistic regression indicated that comorbidities, elder age ≥70y, operative time ≥240min and hybrid VATS were predictors for major adverse events (P<0.05). Hybrid and converted VATS lobectomy result in higher major adverse events compared with complete VATS, 15.1%, 20.9% and 7.4% respectively (P=0.013).Conclusions: The overall complication rate and mortality of VATS lobectomy are low, while major complications sometimes occur. Pulmonary complications are the most common major complications and cause of mortality. Age ≥70y, comorbidities, operative time ≥240min and Hybrid VATS are predictors of major adverse events.

Video-assisted thoracic surgery lobectomy for lung cancer in a patient with complete situs inversus

Complete situs inversus is a rare abnormality of autosomal recessive inheritance; it requires particular care during surgery, because the viscus anatomy is a mirror image of the normal anatomy. Reports of surgery for lung cancer in cases of complete situs inversus are very rare. Here, we report a case of lobectomy for lung cancer of the right lower lobe performed using video-assisted thoracic surgery (VATS) in a patient with complete situs inversus. We emphasize the importance of careful examination of the relationship between the bronchus, pulmonary artery, and pulmonary vein in the hilum of the lung in cases of complete situs inversus requiring lung resection for cancer; this is even more necessary when VATS is performed.

Lung cancer associated with an azygos lobe successfully treated with video‐assisted thoracoscopic surgery

Primary lung cancer associated with an azygos lobe is extremely rare. Herein, we report the case of a 64-year-old woman with lung adenocarcinoma arising in the right upper lobe with an azygos lobe. The patient underwent a right upper lobectomy and lymph node dissection with video-assisted thoracoscopic surgery. Video-assisted thoracoscopic surgery lobectomy for lung cancer of this variant has yet to be reported. We demonstrate the intraoperative findings and the resected pulmonary lobe. This is the first case of primary lung cancer associated with the azygos lobe treated by lobectomy with video-assisted thoracoscopic surgery.

Comparison of the Early Robot-Assisted Lobectomy Experience to Video-Assisted Thoracic Surgery Lobectomy for Lung Cancer a Single-Institution Case Series Matching Study

: Robotic surgery has evolved in urology, gynecology, and general surgery and seems to be an oncologically sound surgical approach. Robotic surgery has been infrequently reported for pulmonary lobectomy. The aim of this study is to compare the outcomes of our early experience in performing robot-assisted lobectomy (RAL) with video-assisted thoracic surgery (VATS) for the treatment of non-small cell lung cancer. : Between February and October 2009, 40 patients underwent RAL for resectable non-small cell lung cancer. The dissection and anatomic isolation of the hilar structures were performed using two arms of the da Vinci S system. A retrospective comparison with two VATS groups was performed, our initial 40 VATS patients (between January 2006 and February 2007) and our most recent 40 VATS patients (between June 2008 and September 2009). The entire experience with VATS lobectomy is 163 cases. : In the RAL group, the mean age was 64 years, and there were 23 male patients. Adenocarcinoma was diagnosed in 29 patients with a mean tumor size of 3.5 cm. There were no conversions to open thoracotomy. Among the patients in our initial and recent VATS lobectomy groups, the conversion rate was 3 (8%) and 2 (5%) patients, respectively. The operative time for the RAL (240 ± 62 minutes) and the initial VATS lobectomy groups (257 ± 57 minutes) were similar but was longer than the recent VATS lobectomy group (161 ± 39 minutes, P < 0.001). However, the rate of postoperative complications in the RAL group (n = 4, 10%) was significantly lower than that of the initial VATS group (n = 13, 32.5%, P = 0.027) and similar to that of the recent VATS group (n = 7, 17.5%, P = 0.755). Intraoperative bleeding was reduced in the RAL group compared with the initial VATS group (219 mL vs 374 mL P = 0.017), and the median length of postoperative stay was significantly shorter for the RAL group compared with the initial VATS group (6 vs 9 days, P < 0.001). : The outcomes of our early RAL experience was comparable to the our outcomes achieved with VATS lobectomy, whether performed early or late.

Comparison of the Early Robot-Assisted Lobectomy Experience to Video-Assisted Thoracic Surgery Lobectomy for Lung Cancer a Single-Institution Case Series Matching Study

Comparison of the Early Robot-Assisted Lobectomy Experience to Video-Assisted Thoracic Surgery Lobectomy for Lung Cancer a Single-Institution Case Series Matching Study

Video-assisted thoracic surgery lobectomy for lung cancer: the point at issue

Among the four subjects addressed in this article, the definition of video-assisted thoracic surgery (VATS) lobectomy is fundamentally the point at issue, which leads to various obstacles for upcoming clinical trials. It is strongly expected that VATS lobectomy will be identified as a standard operation for primary lung cancer with confirmed clinical evidence. Standard surgical procedure with a certain oncological validity for lung cancer should be minimally invasive, safe, and technically simple for general thoracic surgeons. In conclusion, most patients with resectable lung cancer will be able to benefit from a validated painless VATS lobectomy in the near future.

完全内臓逆位に合併した原発性肺癌に対し完全胸腔鏡下に左上葉切除を施行した１例

完全内臓逆位に合併した肺癌に対する胸腔鏡下切除術を経験したので報告する．症例は58歳男性．検診の胸部X線で左上肺野に異常陰影を指摘された．胸腹部CTで胸腹部内臓の完全逆位を認めており，さらに左肺上葉に2cm大の結節影を認めた．手術は腫瘍を胸腔鏡下に部分切除を行い，迅速病理検査で腺癌と診断されたため完全胸腔鏡下に左上葉切除を施行した．左肺は上中下葉の3葉に分葉し，肺動静脈は正常の鏡像を呈しており，その切除手技は通常の右肺上葉切除術の手順とまったくの鏡像での手順となった．

Video-assisted thoracic surgery lobectomy for lung cancer is associated with less immunochemokine disturbances than thoracotomy

Major surgery is immunosuppressive and could have an impact on postoperative tumor immunosurveillance and recurrence in cancer patients. Low circulating levels of insulin growth factor binding protein (IGFBP)-3 have been linked to advance prostate and the development of colonic cancers. This prospective study examined the early postoperative circulating levels of IGFBP-3, matrix metalloproteinase (MMP)-9, and tissue inhibitor of metalloproteinase (TIMP)-1 in early stage non-small cell lung cancer (NSCLC) patients undergoing major lung resection by VATS versus thoracotomy. Forty-two consecutive patients with resectable primary NSCLC were assigned to VATS or thoracotomy approach over a 7-month-period. Blood samples were collected preoperatively and postoperatively on days (POD) 1 and 3 for enzyme linked immunosorbent assay determination of IGFBP-3, MMP-9 and TIMP-1 levels in the serum. There were no demographic differences between the two groups. VATS lung resection was associated with lower levels of MMP-9 and TIMP-1 on POD1 (median 628 vs 1311ng/ml, p=0.009; and 131 vs 211ng/ml, p=0.004, respectively) but higher levels of IGFBP-3 on POD3 (1366 vs 1144ng/ml, p=0.02), when compared with the thoracotomy approach. There was no perioperative mortality. VATS major lung resection for NSCLC is associated with higher circulating levels of IGFBP-3, and lower levels of MMP-9 and TIMP-1, compared to the thoracotomy approach. The clinical relevance of these postoperative changes on tumor biology following lung resection for cancer warrants further investigation.

Video-Assisted Thoracoscopic Surgery Lobectomy for c-T1N0M0 Primary Lung Cancer: Its Impact on Locoregional Control

The outcomes of a video-assisted thoracoscopic surgery lobectomy for lung cancer, with a special focus on its locoregional control, were compared with a conventional lobectomy. We performed a retrospective review of 160 patients who had undergone a lobectomy either by means of thoracoscopic surgery (n = 81) or a standard thoracotomy (n = 79) for clinical T1N0M0 nonsmall-cell lung cancer. The overall, disease-free, and locoregional recurrence-free survival were compared. In a separate multivariate analysis, the ability of numerous clinical and surgical factors, including the surgical approach, to predict locoregional recurrence was investigated. The total recurrence of the primary disease occurred in 28 cases (12 locoregional and 14 distant). In the 12 documented local recurrences, 8 belonged to the thoracoscopic surgery group and 4 were in the standard thoracotomy group, without significant differences (p = 0.229). The overall 5-year survival rates associated with the thoracoscopic and standard procedure were 89.1% and 77.7%, respectively (p = 0.149). No significant differences in the disease-free or locoregional recurrence-free survivals were observed between the groups. The results of a multivariate analysis for the incidence of total and locoregional recurrence demonstrated that two covariates, lymph node metastasis and the surgical side (right or left lung), were significant factors for both total and locoregional recurrence. No significant relationship was found between thoracoscopic surgery or standard thoracotomy, and the incidence of locoregional recurrence. Our findings suggest that thoracoscopic surgery is not inferior regarding its ability to achieve locoregional control in comparison with the standard procedure.