Surgical Treatment Of Lung Cancer Research Articles

Introduction of uniportal VATS access when performing lobectomies

Aim. Analysis of surgical indices during monoport thoracoscopic lobectomies in Sakhalin Regional Clinical Oncological Dispensary at different stages of mastering the technique. Materials and methods. Case histories of 251 patients who underwent radical surgical treatment for lung cancer using monoport thoracoscopic access. Patients were divided into two groups: initial (109 patients) and advanced (142 patients). The average surgical time, number of complications and conversions were assessed. Results. Mastering the technique leads to a statistically significant reduction in surgical time. The difference in other parameters, such as the number of postoperative complications and the percentage of conversions at different stages, tends to decrease. Conclusion. Surgical indices improve as the team goes through the learning curve. The technique is adequate and reproducible for surgical treatment of patients with lung cancer.

EP.07A.15 Prognosis after Surgical Treatment of Lung Cancer with Multifocal Ground-Glass Nodules: The Effect of Nodule Characteristics

EP.07A.15 Prognosis after Surgical Treatment of Lung Cancer with Multifocal Ground-Glass Nodules: The Effect of Nodule Characteristics

Pattern of Clinical Presentation, Staging and Surgical Treatment of Lung cancer in 250 Consecutive Patients.

Introduction: GLOBOCAN 2022 showed lung cancer to be leading cancer in Nepal accounting for about 11% (2431) of all new cancer cases and about 15% (2207) of all cancer deaths. We reviewed the pattern, clinical presentation, stage and multimodality treatment of lung cancer results in Nepal. Methods: Two hundred fifty consecutive patients with clinical stages of I-IIIA, who were considered for lung resectional surgery were studied. Bronchoscopy and Computed Tomography were used for diagnosis and staging. Results: Surgery alone was done in 36% cases, rest of the patients (64%) underwent multimodality approach. Lobectomy, bilobectomy, pneumonectomy, sub lobar resection and sleeve resection were done in 85.6%, 4%, 6.4%, 2% and 2% respectively. Final histology revealed squamous cell carcinoma, adeno carcinoma, and others in 72.4%, 18.4%, 9.2% respectively. Final pathological report showed stage I, II, and III in 14.8%, 30% and 55.2% cases. Thirty-day mortality was observed in 1.6% of cases. Air leak was most common post operative complication (8.4%). Conclusion: Squamous cell carcinoma still remains the commonest pathological variant of lung cancer in Nepal. Lobectomy remains the most commonly performed surgical procedure

Risk factors and prognostic significance of early postoperative complications for patients who underwent pneumonectomy for lung cancer

BackgroundAlthough pneumonectomy has relatively high mortality and morbidity rates, it remains valid in the surgical treatment of lung cancer. This study aims to evaluate the prognostic significance of postoperative complications after pneumonectomy and demonstrate the risk factors related to early postoperative complications.MethodsPatients who underwent pneumonectomy for non-small cell lung cancer between January 2008 and May 2021 were included in the study. Factors related to the development of early postoperative complications and overall survival were evaluated by univariate and multivariate analyses.ResultsA total of 136 patients were included in the study. Early postoperative complications were seen in 33 (24.3%) patients and late postoperative complications in 7 (5.1%) patients. The amount of cigarette smoking, and the operation side were the independent variables that affect the development of early postoperative complications. In multivariate analysis, smoking amount and pericardial invasion were associated with the development of postoperative hemorrhage, and advanced age was associated with the development of postoperative pneumonia.ConclusionsEarly postoperative complications have a negative effect on the prognosis after pneumonectomy therefore careful patient selection and preoperative risk assessment are essential to minimize the occurrence of complications and improve patient outcomes.Trial registrationThis observational study was approved by the (Ethical Committee of Dr. Suat Seren Chest Diseases and Chest Surgery Education and Research Center) Institutional Review Board of our center (E-49109414-604.02.02-218625439).

Lobar or sublobar resection of peripheral stage I non-small cell lung cancer.

We aim to highlight two recent clinical trials that have altered the approach of the management of stage I nonsmall cell lung cancer. The JCOG 0802 and CALGB 140503 trials demonstrated that sublobar resection is noninferior to lobectomy for overall and disease-free survival in patients with stage I nonsmall cell lung cancer. Since 1962, lobectomy has been deemed the gold standard treatment for operable lung cancer. However, two recent clinical trials have demonstrated that, for select patients, sublobar resection is oncologically noninferior; results, which are leading us into a new era for the surgical management of lung cancer. Notwithstanding the progress made by these studies and the opportunities that have been put forth, questions remain. This review aims at reviewing the results of both trials and to discuss future perspectives for the surgical treatment of lung cancer.

Cervicothoracotomy for right upper sleeve lobectomy with carinal resection in the treatment of central lung cancer

We demonstrated successful treatment of patients with complicated central lung cancer, who underwent right upper sleeve lobectomy with carinal resection. We have used the following options for carinal reconstruction: anastomosis of trachea with the left main bronchus and anastomosis of intermediate bronchus with the left main bronchus (clinical case No. 1) or with trachea (clinical case No. 2). Cervicothoracotomy provided correct N-staging and mobilization of trachea with left main bronchus. This approach provided compliance with oncological principles of surgical treatment of lung cancer and significantly reduced tension of anastomosis. These aspects are important for satisfactory immediate functional and oncological results after right upper sleeve lobectomy with carinal resection.

Nomogram model combined thrombelastography for venous thromboembolism risk in patients undergoing lung cancer surgery.

Background: The aim of this study was to develop a nomogram model in combination with thromboelastography (TEG) to predict the development of venous thromboembolism (VTE) after lung cancer surgery. Methods: The data of 502 patients who underwent surgical treatment for lung cancer from December 2020 to December 2022 were retrospectively analyzed. Patients were then randomized into training and validation groups. Univariate and multivariate logistic regression analyses were carried out in the training group and independent risk factors were included in the nomogram to construct risk prediction models. The predictive capability of the model was assessed by the consistency index (C-index), receiver operating characteristic curves (ROC), the calibration plot and decision curve analysis (DCA). Results: The nomogram risk prediction model comprised of the following five independent risk factors: age, operation time, forced expiratory volume in one second and postoperative TEG parameters k value(K) and reaction time(R). The nomogram model demonstrated better predictive power than the modified Caprini model, with the C-index being greater. The calibration curve verified the consistency of nomogram between the two groups. Furthermore, DCA demonstrated the clinical value and potential for practical application of the nomogram. Conclusion: This study is the first to combine TEG and clinical risk factors to construct a nomogram to predict the occurrence of VTE in patients after lung cancer surgery. This model provides a simple and user-friendly method to assess the probability of VTE in postoperative lung cancer patients, enabling clinicians to develop individualized preventive anticoagulation strategies to reduce the incidence of such complications.

Sarcopenia and Mediastinal Adipose Tissue as a Prognostic Marker for Short- and Long-Term Outcomes after Primary Surgical Treatment for Lung Cancer

Surgical resection remains the gold standard of treatment for early-stage lung cancer. Several risk models exist to predict postoperative morbidity and mortality. Psoas muscle sarcopenia has already successfully been used for morbidity prediction in lung transplantation and is not yet included in the available risk scores for pulmonary resections. We hypothesized that the skeletal muscle index and mediastinal adipose tissue might also have an impact on postoperative outcomes after primary surgery for primary lung cancer. The institutional database was queried for patients with primary lung cancer who were treated with primary lobectomy or segmentectomy between February 2009 and November 2018. In total, 311 patients were included for analysis. Patients receiving neo-/adjuvant chemotherapy or with a positive nodal status were excluded to rule out any morbidity or mortality due to (neo-)adjuvant treatment. Sarcopenia was defined as a skeletal muscle index of <34.4 cm2/m2 for women and <45.4 cm2/m2 for men. Mediastinal adipose tissue was defined with a radiodensity of −150 to −30 Hounsfield units. Sarcopenia was diagnosed in 78 (25.1%) of the 311 patients. Male patients were significantly more likely to suffer from sarcopenia (31.5% vs. 18.1%, p = 0.009). Comorbidities, lung function, tumour histology, pathologic tumour staging, mediastinal adipose tissue and age did not differ between groups with or without sarcopenia. Sarcopenic patients had a significantly longer length of stay, with 13.0 days vs. 9.5 (p = 0.003), and a higher rate of any postoperative complications (59.0% vs. 44.6%, p = 0.036). There was no difference in recurrence rate. Five-year overall survival was significantly better in the patient cohort without sarcopenia (75.6% vs. 64.5%, p = 0.044). Mediastinal adipose tissue showed no significant impact on length of stay, postoperative complications, recurrence rate, morbidity or survival. Sarcopenia, quantified with the skeletal muscle index, is shown to be a risk factor for postoperative morbidity and reduced survival in primary lung cancer. Efforts should be taken to pre-emptively screen for sarcopenia and start countermeasures (e.g., physical prehabilitation, protein-rich nutrition, etc.) during the preoperative workup phase.

EP07.01-24 Surgical Treatment of Lung Cancer in Patients Over the Age of 75 Years: Single Cancer Centre Experience

EP07.01-24 Surgical Treatment of Lung Cancer in Patients Over the Age of 75 Years: Single Cancer Centre Experience

THE FIRST EXPERIENCE OF USING NON-INTUBATION VIDEO-ASSISTED THORACOSCOPIC RESECTIONS FOR LUNG CANCER IN THE REPUBLIC OF KAZAKHSTAN

Relevance:Several studies have shown that non-intubation surgical interventions, especially, have proven themselves well in patients with low reserve of the cardiovascular and respiratory systems, as well as in the diagnosis of interstitial lung diseases.
 The study aimed to describe the experience of introducing into clinical practice surgical interventions without intubation on spontaneous breathing for malignant neoplasms of the lungs and mediastinal organs.
 Methods: two clinical cases are described of the main points of the anesthesia and technical features of surgical intervention.
 Results: A surgery in two patients with peripheral lung cancer was performed. In the first case, the operation included NI-VATS on the right and the resection of the upper (S2) and lower lobe (S6, S9); in the second case – NI-VATS on the right, lower lobectomy, and lymph node dissection. Based on the results of histological examination, both patients were diagnosed with NSCLC in the initial stages. Postoperative chemoradiotherapy is not indicated. The patients were registered at the dispensary in clinical group III.
 Conclusion: As the literature data and our preliminary results of NI-VATS show, surgical interventions in the surgical treatment of lung cancer have places to be and should be widely introduced into clinical practice in oncothoracic departments of the Republic of Kazakhstan.

Surgical Treatment of Lung Cancer in Situs Inversus Totalis—A Case Report

Situs inversus totalis (SIT) is a congenital anomaly that involves the mirror rearrangement of the thoracic and abdominal internal organs. In this paper, we report a 56-year-old male patient with previously confirmed SIT, who was admitted to the hospital for the diagnosis and surgical treatment of non-small-cell lung cancer, located in the sixth right pulmonary segment. The patient underwent segmentectomy with mediastinal and hilar lymphadenectomy. Furthermore, we screened the PubMed and Embase databases for reports of the surgical treatment of patients with SIT and lung cancer. Articles describing inoperable and disseminated disease, as well as patients qualified for palliative treatment, were not included. Ultimately, we compared 21 articles (including the one described here). Data about the clinical condition, tumor characteristics, treatment, and histopathological examination were extracted and summarized.

The effectiveness of surgical treatment of lung cancer in Polish academic and nonacademic centers.

The theoretical advantage of academic hospitals over nonacademic are: more qualified surgeons, adequate diagnostic facilities and infrastructure, including intensive care units. The aim of the study was to compare the effectiveness of surgical lung cancer treatment in academic (ACA) and nonacademic (non-ACA) centers. This was a retrospective analysis of data from 31,777 patients surgically-treated for lung cancer during the period from 2007 to 2020 in 9 ACA and 21 non-ACA centers. The analysis considered the clinical data of patients, the effectiveness of preoperative diagnostics, the type of procedures performed, the complications, the postoperative mortality and the long-term survival. The median number of anatomical lung resection procedures was 1,218 for ACA and 550 for non-ACA centers. In the ACA group, resection using the video-assisted thoracic surgery (VATS) technique was performed significantly more often than in the non-ACA group (23.6% vs. 14.2%, P<0.001). The pN feature analysis showed significantly lower proportions of pNX (9.2%) in the ACA group than those in the non-ACA group (17.1%) (P<0.001). The rates of postoperative complications in the ACA and non-ACA groups were 30.7% and 33.8%, respectively (P<0.001). There were no significant differences in 5-year survival between the ACA and non-ACA groups (56% and 56%, respectively) (P=0.2). The present study showed that ACA centers are characterized by better preoperative diagnostics, a higher percentage of VATS lobectomies, a lower percentage of postoperative complications and a shorter hospitalization period than non-ACA centers, but there was no impact on 5-year survival.

Identification of Factors Related to the Quality of Lymphadenectomy for Lung Cancer: Secondary Analysis of Prospective Randomized Trial Data.

The outcomes of non-small cell lung cancer surgery are influenced by the quality of lymphadenectomy. This study aimed to evaluate the impact of different energy devices on lymphadenectomy quality and identify additional influencing factors. This secondary analysis of the prospective randomized trial data (clinicaltrials.gov: NCT03125798) compared patients who underwent thoracoscopic lobectomy with the LigaSure device (study group, n = 96) and monopolar device (control group, n = 94). The primary endpoint was the lobe-specific mediastinal lymphadenectomy. Lobe-specific mediastinal lymphadenectomy criteria were met in 60.4% and 38.3% of patients in the study and control groups, respectively (p = 0.002). In addition, in the study group, the median number of mediastinal lymph node stations removed was higher (4 vs. 3, p = 0.017), and complete resection was more often achieved (91.7% vs. 80.9%, p = 0.030). Logistic regression analysis indicated that lymphadenectomy quality was positively associated with the use of the LigaSure device (OR, 2.729; 95% CI, 1.446 to 5.152; p = 0.002) and female sex (OR, 2.012; 95% CI, 1.058 to 3.829; p = 0.033), but negatively associated with a higher Charlson Comorbidity Index (OR, 0.781; 95% CI, 0.620 to 0.986; p = 0.037), left lower lobectomy (OR, 0.263; 95% CI, 0.096 to 0.726; p = 0.010) and middle lobectomy (OR, 0.136; 95% CI, 0.031 to 0.606, p = 0.009). This study found that using the LigaSure device can improve the quality of lymphadenectomy in lung cancer patients and also identified other factors that affect the quality of lymphadenectomy. These findings contribute to improving lung cancer surgical treatment outcomes and provide valuable insights for clinical practice.

Consensus of Chinese Experts on Surgical Treatment of Lung Cancer in the Elderly (2022 Edition)

Lung cancer ranked the highest incidence rate and mortality among people over 60 years old in China. With the increasing social population and incidence of lung cancer, the treatment of elderly lung cancer patients has become a major concern. Due to the improvement of surgical techniques and the application of enhanced recovery after surgery in thoracic surgery, more elderly patients could tolerate surgical treatment. At the same time, with the improvement of health awareness and the popularization of early diagnosis and screening, more lung cancer can be detected at the early stage. However, considering the organ dysfunction, various complications, physical weakness and other factors of elderly patients, it is important to provide individualized surgical treatment for the elderly. Therefore, based on the latest research progress worldwide, the experts in relevant fields have developed this consensus which contributes to guide the preoperative evaluation, surgical strategy, intraoperative anesthesia management, and postoperative management for elderly patients of lung cancer. .

Disparities in localized malignant lung cancer surgical treatment: A population-based cancer registry analysis.

Lung cancer (LC) continues to be the leading cause of cancer deaths in the United States. Surgical treatment has proven to offera favorable prognosis and a better 5-year relative survival for patients with early or localized tumors. This novel study investigates the factors associated with the odds of receiving surgical treatment for localized malignant LCin Tennessee. Population-based data of 9679 localized malignant LC patients from the Tennessee Cancer Registry (2005-2015) were utilized to examine the factors associated with receiving surgical treatment for localized malignant LC. Bivariate and multivariate logistic regression analyses, cross-tabulation, and Chi-Square ( 2 ) tests were conducted to assessthese factors. Patients with localized malignant LC who initiated treatment after 2.7 weeks were 46% less likely to receive surgery (adjusted odds ratio [AOR]=0.54; 95% confidence interval [CI]=0.50-0.59; p < 0.0001). Females had a greater likelihood (AOR=1.14; CI=1.03-1.24) of receiving surgical treatment compared to men. Blacks had lower odds (AOR=0.76; CI=0.65-0.98) of receiving surgical treatment compared to Whites.All marital groups had higher odds of receiving surgical treatment compared to those who were single/never married. Patients living in Appalachian county had lower odds of receiving surgical treatment (AOR=0.65; CI=0.59-0.71) compared with those in the non-Appalachian county. Patients with private (AOR=2.09; CI=1.55-2.820) or public (AOR=1.42; CI=1.06-1.91) insurance coverage were more likely to receive surgical treatment compared to self-pay/uninsured patients. Overall, the likelihood of patients receiving surgical treatment for localized malignant LC decreases with age. Disparities exist in the receipt of surgical treatment among patients with localized malignant LC in Tennessee. Health policies should target reducing these disparities to improve the survival of these patients.

Adequate lung cancer surgery lymphadenectomy within a statewide quality collaborative: Quality improvement in action

ObjectivesIn January 2016, our statewide quality improvement collaborative focused on 3 metrics of adequate lymph node harvest during lung cancer surgery: (1) rates of pathologic examination of 10 lymph nodes or more; (2) sampling 5 or more lymph node stations or more within the hilum or mediastinum; and (3) pathologic nodal upstaging (pathologic nodal stage higher than clinical nodal stage). Unblinded, hospital-level outcomes were presented at biannual meetings, and opportunities for education or improvement were discussed. We set out to describe this quality improvement initiative and the subsequent impact on surgical lymphadenectomies statewide. MethodsWe retrospectively reviewed patients undergoing lobectomy for stage IA to IIIA non–small-cell lung cancer from July 2015 to December 2020 at the 16 participating centers. ResultsThe study cohort included 3753 patients. The rates of examining 10 lymph nodes or more statewide increased from 215 lobectomies (44.0%) in 2015 to 522 lobectomies (78.9%) in 2020 (P < .001). Similar trends were noted statewide for 5 lymph node stations or more, which increased from 193 lobectomies (39.6%) to 531 lobectomies (80.3%) in 2020 (P < .001). The overall rate of nodal upstaging was more variable year to year and generally declined over time (P = .004). ConclusionsOur statewide quality improvement initiative improved rates of appropriate lymph node staging for surgically treated non–small cell lung cancer compared with national rates. This work demonstrates the power that a “community of practice” philosophy can have on surgical treatment of lung cancer. Quality improvement interventions including transparent data-driven discussions and collaboration can help guide future quality improvement initiatives and should be readily transferrable to other clinical domains.

State of the art and new perspectives in surgical treatment of lung cancer: a narrative review.

Lung cancer is the leading cause of cancer-related deaths worldwide, and its incidence has increased over the past two decades. The standard care for stage I, stage II, and selected cases of stage IIIA non-small cell lung cancer (NSCLC) is surgical resection; in some cases, patients may be offered adjuvant systemic therapy after surgical resection. Patients with lung cancer presenting with distant metastases belong to stage IV: in this setting, some carefully selected patients may benefit from surgery within a multimodality approach. We performed a comprehensive, non-systematic review of the latest literature to define the present role of surgery in lung cancer treatment. The literature review disclosed a pivotal role of surgery in early stage lung cancer and a complimentary role in locally advanced lung cancer; in very selected cases, surgery might be considered in oligometastatic disease. Surgical treatment of lung cancer still plays a pivotal role in early stages of the disease while, in locally advanced stages, it may contribute to improve overall survival in combination with medical treatments and radiotherapy. More recently, an effective role of surgery has been advocated in carefully selected oligometastatic patients with encouraging initial results.

Evaluation of the efficacy of paravertebral blockade as a component of combined anesthesia in the surgical treatment of pulmonary cancer

The aim. The paper evaluates the effectiveness of implemented combined anaesthesia (inhalation with paravertebral blockade) in comparison with inhalation anaesthesia (IA) and total intravenous anaesthesia (TVA) at the stages of surgery and the early postoperative period in the surgical treatment of cancer lungs.&#x0D; Methods. The study involved 60 patients with an average age of 55±5.6 years, physical status ASA II–III, who underwent open surgical interventions in the scope of frontal or pneumonectomy or resection of part of the lung. Patients were divided into 3 groups depending on the method of anaesthetic support at the stage of anaesthesia maintenance: I (n=20) – combined anaesthesia was used; II (n=20) – IA with sevoflurane; III (n=20) – TVA. In addition, the leading indicators of central hemodynamics were studied; oxygen saturation (SaO2), CO2 ET (concentration of CO2 in exhaled air), cortisol level, and indicators of acid-base status were determined. The effectiveness of analgesia in the early postoperative period was assessed using a visual analogue scale (VAS) at 10 control stages. Fasting intensity was recorded after waking up, after extubation, after 1 h. after surgery, on the first day after surgery every 3 h. and once a day from the 2nd day for 5-6 days.&#x0D; Results. The studied clinical and laboratory indicators indicated an adequate course of the applied type of anaesthesia. In the dynamics of pain syndrome (PS) in the postoperative period, a gradual subjective increase of pain syndrome was noted until the 3rd day, including a decrease in pain on the 4th - 6th day. It was established that when using combined anaesthesia, a less significant level of PS, according to VAS, was noted compared to inhalation anaesthesia and the use of TVA.&#x0D; Conclusions. Combined anaesthesia (inhalation with PVB) can more effectively prevent the development of post-thoracotomy pain syndrome (PTPS) compared to TVA and IA in the surgical treatment of lung cancer

Outcomes of lung cancer surgery in patients with COVID-19 history: a single center cohort study

ObjectivesCoronavirus disease 2019 (COVID-19) can irreversibly damage the lungs and could possibly increase the risk of surgical treatment of lung cancer. The study aimed to assess the relationship between preoperative COVID-19 and complications and early outcomes of lung cancer surgery.MethodsThis single-center cohort study included 444 patients who underwent lobectomy or segmentectomy for primary lung cancer from January 1, 2019 to December 31, 2021. The exclusion criteria were pneumonectomy, extended resection, and wedge resection. The groups of patients with (n = 72) and without (n = 372) the history of COVID-19 prior to surgery were compared. The groups were similar in terms of distribution of baseline, surgical and histopathological characteristics. The primary endpoint was the incidence of postoperative complications. Secondary endpoints were outcomes at discharge and at 90 days.ResultsThe incidence of postoperative complications did not differ between the groups of patients with and without COVID-19 history (30.6% vs 29.3%, p = 0.831). Outcomes at discharge and at 90 days after surgery did not differ between the groups. Among the patients with and without prior COVID-19, 97.2 and 99.5% were alive at discharge (p = 0.125), and 97.2% and 98.1% ninety days after surgery (p = 0.644), respectively. Patients with COVID-19 history more often required re-drainage (6.9% v 2.2%, p = 0.044) and reoperation (5.6 v 1.3%, p = 0.042).ConclusionsCOVID-19 history is not related to the general incidence of complications, outcomes at discharge from the hospital, and at 90-days after surgery.

EP06.01-016 Nationwide Activity of Lung Cancer Surgery Before and During the COVID-19 Pandemic

EP06.01-016 Nationwide Activity of Lung Cancer Surgery Before and During the COVID-19 Pandemic