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1. Comparison of operative and postoperative characteristics and outcomes between thoracoscopic segmentectomy and lobectomy for non-small-cell lung cancer: a propensity score matching study from the Italian VATS Group Registry

Author

Dell'Amore, A., Lomangino, I., Cannone, G., Terzi, S., Pangoni, A., Lorenzoni, G., Nicotra, S., Schiavon, M., Zuin, A., Gregori, D., Crisci, R., Curcio, C., Rea, F., Mancuso, M., Pernazza, F., Refai, M., Bortolotti, L., Rizzardi, G., Solli, P., Brandolini, I., Perkmann, R., Zaraca, F., Benvenuti, M., Gavezzoli, D., Cherchi, R., Ferrari, P., Mucilli, F., Camplese, P., Melloni, G., Mazza, F., Cavallesco, G., Maniscalco, P., Voltolini, L., Gonfiotti, A., Stella, F., Argnani, D., Pariscenti, G. L., Iurilli, S., Surrente, C., Lopez, C., Droghett, A., Giovanardi, M., Breda, C., Lo Giudice, F., Alloisio, M., Bottoni, E., Spaggiari, L., Gasparri, R., Torre, M., Rinaldo, A., Nosotti, M., Rosso, L., Negri, G. P., Bandiera, A., Stefani, A., Natali, P., Scarci, M., Pirondini, E., Amore, D., Baietto, G., Casadio, C., Bertani, A., Russo, E., Ampollini, L., Carbognani, P., Puma, F., Vinci, D., Andreetti, C., Poggi, C., Cardillo, G., Margaritora, S., Meacci, E., Luzzi, L., Ghisalberti, M., Zaccagna, G., Lausi, P., Guerrera, F., Fontana, D., Della Beffa, V., Morelli, A., Londero, F., Imperatori, N., Rotolo, A., Terzi, A., Viti, A., Infante, M., and Benato, C.

Subjects
Segmentectomy, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Lung Neoplasms, medicine.medical_treatment, VATS lobectomy, Video-assisted thoracic surgery, Context (language use), Mastectomy, Segmental, Postoperative outcome, Postoperative Complications, Lobectomy, Non-small-cell lung cancer, Carcinoma, Non-Small-Cell Lung, Humans, Medicine, Registries, Thoracotomy, Pneumonectomy, Propensity Score, Lung cancer, Retrospective Studies, Thoracic Surgery, Video-Assisted, business.industry, Confounding, Postoperative complication, General Medicine, medicine.disease, Surgery, Propensity score matching, Non small cell, Cardiology and Cardiovascular Medicine, business
Abstract

OBJECTIVES Only few studies compared the surgical morbidity and mortality of thoracoscopic segmentectomy versus lobectomy for non-small-cell lung cancer, in particular, by relating the segmental resections with the corresponding anatomical lobes. METHODS We enrolled a total of 7487 patients who underwent VATS lobectomy (7269) or segmentectomy (218) from January 2014 to July 2019. A propensity score matching approach was used to account for potential confounding factors between the 2 groups. After matching, 349 lobectomies and 208 segmentectomies were included in the analysis. We analysed the operative and postoperative outcomes of video-assisted anatomical segmentectomy compared with video-assisted lobectomy and, in details, the results of segmentectomy with its corresponding lobectomy in a large cohort of patients from the Italian VATS Group Registry. RESULTS The overall conversion rate to thoracotomy was not statistically different between the groups (27 patients 8% vs 7 patients 3%, P = 0.1). The lobectomy group had a greater number of resected lymph nodes (median 11 vs 8, P = 0.006). No significant differences were detected in 30-day mortality (1.4%, 5 patients vs 0.9%, 2 patients), overall complications (18%, 62 patients vs 14%, 29 patients) and prolonged air leakage (31 patients, 9% vs 12 patients, 6%) between lobectomy and segmentectomy, respectively. No statistical differences were found regarding the median duration of drainage (3.2 days, P = 1) and the overall median length of hospital stay (6.4 days, P = 0.1) between the 2 groups. In the context of segmentectomy versus corresponding lobectomy, the right upper lobectomy compared with right upper segmentectomy showed a higher number of resected lymph nodes (P = 0.027). No statistical differences were reported in terms of conversion rate and postoperative complication and mortality. CONCLUSIONS Segmentectomy could be considered a safe procedure without significant differences compared to thoracoscopic lobectomy in terms of postoperative morbidity and mortality.

Published
2021

2. Uniportal and three-portal video-assisted thoracic surgery lobectomy: analysis of the Italian video-assisted thoracic surgery group database

Author

Tosi, D, Nosotti, M, Bonitta, G, Mazzucco, A, Righi, I, Mendogni, P, Rosso, L, Palleschi, A, Rocco, G, Crisci, R, Mancuso, M, Pernazza, F, Refai, M, Bortolotti, L, Rizzardi, G, Gargiulo, G, Dolci, Gp, Perkmann, R, Zaraca, F, Benvenuti, M, Gavezzoli, D, Cherchi, R, Ferrari, P, Mucilli, F, Camplese, P, Melloni, G, Mazza, F, Cavallesco, G, Maniscalco, P, Voltolini, L, Gonfiotti, A, Stella, F, Argnani, D, Pariscenti, Gl, Lurilli, Surrente, C, Lopez, C, Droghetti, A, Giovanardi, M, Breda, C, Lo Giudice, F, Alloisio, M, Bottoni, E, Spaggiari, L, Gasparri, R, Torre, M, Rinaldo, A, Negri, Gp, Bandiera, A, Stefani, A, Natali, P, Scarci, M, Pirondini, E, Curcio, C, Amore, D, Baietto, G, Casadio, C, Nicotra, S, Dell'Amore, A, Bertani, A, Russo, E, Ampollini, L, Carbognani, P, Puma, F, Vinci, D, Andreetti, C, Poggi, C, Cardillo, G, Margaritora, S, Meacci, Elisa, Luzzi, L, Ghisalberti, M, Zaccagna, G, Lausi, P, Guerrera, F, Fontana, D, Della Beffa, V, Morelli, A, Londero, F, Imperatori, A, Rotolo, N, Terzi, A, Viti, A, Infante, M, Benato, C, Tosi, D., Nosotti, M., Bonitta, G., Mazzucco, A., Righi, I., Mendogni, P., Rosso, L., Palleschi, A., Rocco, G., Crisci, R., Mancuso, M., Pernazza, F., Refai, M., Bortolotti, L., Rizzardi, G., Gargiulo, G., Dolci, G. P., Perkmann, R., Zaraca, F., Benvenuti, M., Gavezzoli, D., Cherchi, R., Ferrari, P., Mucilli, F., Camplese, P., Melloni, G., Mazza, F., Cavallesco, G., Maniscalco, P., Voltolini, L., Gonfiotti, A., Stella, F., Argnani, D., Pariscenti, G. L., Surrente, C., Lopez, C., Droghetti, A., Giovanardi, M., Breda, C., Lo Giudice, F., Alloisio, M., Bottoni, E., Spaggiari, L., Gasparri, R., Torre, M., Rinaldo, A., Negri, G, Bandiera, A., Stefani, A., Natali, P., Scarci, M., Pirondini, E., Curcio, C., Amore, D., Baietto, G., Casadio, C., Nicotra, S., Dell'Amore, A., Bertani, A., Russo, E., Ampollini, L., Carbognani, P., Puma, F., Vinci, D., Andreetti, C., Poggi, C., Cardillo, G., Margaritora, S., Meacci, E., Luzzi, L., Ghisalberti, M., Zaccagna, G., Lausi, P., Guerrera, F., Fontana, D., Della Beffa, V., Morelli, A., Londero, F., Imperatori, A., Rotolo, N., Terzi, A., Viti, A., Infante, M., Benato, C., Tosi D., Nosotti M., Bonitta G., Mazzucco A., Righi I., Mendogni P., Rosso L., Palleschi A., Rocco G., Crisci R., Mancuso M., Pernazza F., Refai M., Bortolotti L., Rizzardi G., Gargiulo G., Dolci G.P., Perkmann R., Zaraca F., Benvenuti M., Gavezzoli D., Cherchi R., Ferrari P., Mucilli F., Camplese P., Melloni G., Mazza F., Cavallesco G., Maniscalco P., Voltolini L., Gonfiotti A., Stella F., Argnani D., Pariscenti G.L., Surrente C., Lopez C., Droghetti A., Giovanardi M., Breda C., Lo Giudice F., Alloisio M., Bottoni E., Spaggiari L., Gasparri R., Torre M., Rinaldo A., Negri G.P., Bandiera A., Stefani A., Natali P., Scarci M., Pirondini E., Curcio C., Amore D., Baietto G., Casadio C., Nicotra S., Dell'amore A., Bertani A., Russo E., Ampollini L., Carbognani P., Puma F., Vinci D., Andreetti C., Poggi C., Cardillo G., Margaritora S., Meacci E., Luzzi L., Ghisalberti M., Zaccagna G., Lausi P., Guerrera F., Fontana D., Della Beffa V., Morelli A., Londero F., Imperatori A., Rotolo N., Terzi A., Viti A., Infante M., and Benato C.

Subjects
Male, Lung Neoplasms, Thoracic, Italian VATS Group, computer.software_genre, Postoperative pain, Settore MED/21 - CHIRURGIA TORACICA, Carcinoma, Non-Small-Cell Lung, Lobectomy, Three-portal, Uniportal, Video-assisted thoracic surgery, Aged, Equipment Design, Female, Humans, Neoplasm Staging, Operative Time, Pneumonectomy, Retrospective Studies, Thoracic Surgery, Video-Assisted, Tomography, X-Ray Computed, Stage (cooking), Non-Small-Cell Lung, Tomography, Database, Thoracic Surgery, X-Ray Computed, Cardiothoracic surgery, Cohort, Cardiology and Cardiovascular Medicine, Pulmonary and Respiratory Medicine, Italian VATS Group, Lobectomy, Postoperative pain, Three-portal, Uniportal, Video-assisted thoracic surgery, medicine.medical_specialty, VATS lobectomy, Video-Assisted, NO, medicine, Lung cancer, business.industry, Carcinoma, Odds ratio, medicine.disease, Confidence interval, Propensity score matching, Surgery, business, computer
Abstract

OBJECTIVES This study compares the uniportal with the 3-portal video-assisted thoracic surgery (VATS) by examining the data collected in the Italian VATS Group Database. The primary end point was early postoperative pain; secondary end points were intraoperative and postoperative complications, surgical time, number of dissected lymph nodes and length of stay. METHODS This was an observational, retrospective, cohort, multicentre study on data collected by 49 Italian thoracic units. Inclusion criteria were clinical stage I–II non-small-cell lung cancer, uniportal or 3-portal VATS lobectomy and R0 resection. Exclusion criteria were cT3 disease, previous thoracic malignancy, induction therapy, significant comorbidities and conversion to other techniques. The pain parameter was dichotomized: the numeric rating scale ≤3 described mild pain, whereas the numeric rating scale score >3 described moderate/severe pain. The propensity score-adjusted generalized estimating equation was used to compare the uniportal with 3-portal lobectomy. RESULTS Among 4338 patients enrolled from January 2014 to July 2017, 1980 met the inclusion criteria; 1808 patients underwent 3-portal lobectomy and 172 uniportal surgery. The adjusted generalized estimating equation regression model using the propensity score showed that over time pain decreased in both groups (P CONCLUSIONS Data from the Italian VATS Group Database showed that in clinical practice uniportal lobectomy seems to entail a higher risk of moderate/severe pain on second and third postoperative days.

Published
2019

3. What counts more: The patient, the surgical technique, or the hospital? A multivariable analysis of factors affecting perioperative complications of pulmonary lobectomy by video-assisted thoracoscopic surgery from a large nationwide registry

Author

Infante, Maurizio V, Benato, Cristiano, Silva, Ronaldo, Rocco, Gaetano, Bertani, Alessandro, Bertolaccini, Luca, Gonfiotti, Alessandro, Giovannetti, Riccardo, Bonadiman, Cinzia, Lonardoni, Alessandro, Canneto, Barbara, Falezza, Giovanni, Gandini, Paola, Curcio, Carlo, Crisci, Roberto, Alloisio, M, Amore, D, Ampollini, L, Andreetti, C, Argnani, D, Baietto, G, Bandiera, A, Benato, C, Benvenuti, M, Bertani, A, Bertolaccini, L, Bortolotti, L, Bottoni, E, Breda, C, Camplese, P, Carbognani, P, Cardillo, G, Casadio, C, Cavallesco, G, Cherchi, R, Crisci, R, Curcio, C, Dell'Amore, A, Beffa, V, Dolci, G, Droghetti, A, Ferrari, Pa, Fontana, D, Gargiulo, G, Gasparri, R, Gavezzoli, D, Ghisalberti, M, Giovanardi, M, Gonfiotti, A, Guerrera, F, Imperatori, A, Infante, M, Iurilli, L, Lausi, P, Logiudice, F, Londero, F, Lopez, C, Luzzi, L, Mancuso, M, Maniscalco, P, Margaritora, S, Meacci, E, Melloni, G, Morelli, A, Mucilli, F, Natali, P, Negri, G, Nicotra, S, Nosotti, M, Pariscenti, G, Perkmann, R, Pernazza, F, Pirondini, E, Poggi, C, Puma, F, Refai, M, Rinaldo, A, Rizzardi, G, Rosso, L, Rotolo, N, Russo, E, Sabbatini, A, Scarci, M, Spaggiari, L, Stefani, A, Solli, P, Surrente, C, Terzi, A, Torre, M, Vinci, D, Viti, A, Voltolini, L, Zaccagna, G, Zaraca, F., Infante M.V., Benato C., Silva R., Rocco G., Bertani A., Bertolaccini L., Gonfiotti A., Giovannetti R., Bonadiman C., Lonardoni A., Canneto B., Falezza G., Gandini P., Curcio C., Crisci R., Zaraca F., Alloisio M., Amore D., Ampollini L., Andreetti C., Argnani D., Baietto G., Bandiera A., Benvenuti M., Bortolotti L., Bottoni E., Breda C., Camplese P., Carbognani P., Cardillo G., Casadio C., Cavallesco G., Cherchi R., Dell'Amore A., Beffa V., Dolci G., Droghetti A., Ferrari P.A., Fontana D., Gargiulo G., Gasparri R., Gavezzoli D., Ghisalberti M., Giovanardi M., Guerrera F., Imperatori A., Iurilli L., Lausi P., Lo Giudice F., Londero F., Lopez C., Luzzi L., Mancuso M., Maniscalco P., Margaritora S., Meacci E., Melloni G., Morelli A., Mucilli F., Natali P., Negri G., Nicotra S., Nosotti M., Pariscenti G., Perkmann R., Pernazza F., Pirondini E., Poggi C., Puma F., Refai M., Rinaldo A., Rizzardi G., Rosso L., Rotolo N., Russo E., Sabbatini A., Scarci M., Spaggiari L., Stefani A., Solli P., Surrente C., Terzi A., Torre M., Vinci D., Viti A., Voltolini L., Zaccagna G., Infante, M. V., Benato, C., Silva, R., Rocco, G., Bertani, A., Bertolaccini, L., Gonfiotti, A., Giovannetti, R., Bonadiman, C., Lonardoni, A., Canneto, B., Falezza, G., Gandini, P., Curcio, C., Crisci, R., the Italian VATS group, Member, and Negri, G.

Subjects
Male, Registrie, Conversion, Morbidity, Postoperative complications, Video-assisted thoracoscopic surgery lobectomy, Lung Neoplasms, Intraoperative Complication, Aged, Female, Hospitals, Humans, Intraoperative Complications, Lung, Middle Aged, Pneumonectomy, Postoperative Complications, Registries, Retrospective Studies, Risk Factors, Thoracic Surgery, Video-Assisted, medicine.medical_treatment, Interquartile range, Retrospective Studie, Settore MED/21 - CHIRURGIA TORACICA, Conversion, Morbidity, Postoperative complications, Video-assisted thoracoscopic surgery lobectomy, Thoracic Surgery, General Medicine, Video-assisted thoracoscopic surgery, Cardiology and Cardiovascular Medicine, Human, Pulmonary and Respiratory Medicine, medicine.medical_specialty, VATS lobectomy, Video-Assisted, NO, Hospital, medicine, business.industry, Risk Factor, Retrospective cohort study, Perioperative, medicine.disease, Comorbidity, Surgery, Postoperative complication, Lung Neoplasm, Complication, business
Abstract

OBJECTIVESInherent technical aspects of pulmonary lobectomy by video-assisted thoracoscopic surgery (VATS) may limit surgeons’ ability to deal with factors predisposing to complications. We analysed complication rates after VATS lobectomy in a prospectively maintained nationwide registry.METHODSThe registry was queried for all consecutive VATS lobectomy procedures from 49 Italian Thoracic Units. Baseline condition, tumour features, surgical techniques, devices, postoperative care, complications, conversions and the reasons thereof were detailed. Univariable and multivariable regressions were used to assess factors potentially linked to complications.RESULTSFour thousand one hundred and ninety-one VATS lobectomies in 4156 patients (2480 men, 1676 women) were analysed. The median age-adjusted Charlson index of the patients was 4 (interquartile range 3–6). Grade 1 and 2 and Grade 3–5 complications were observed in 20.1% and in 5.8%, respectively. Ninety-day mortality was 0.55%. The overall conversion rate was 9.2% and significantly higher in low-volume centres (CONCLUSIONSVATS lobectomy is a safe procedure even in medically compromised patients. An improved classification system for conversions is proposed and prevention strategies are suggested to reduce conversion rates and possibly complications in less-experienced centres.

Published
2019

4. Predictors of nodal upstaging in patients with cT1-3N0 non-small cell lung cancer (NSCLC): results from the Italian VATS Group Registry

Author

Marulli, G., Faccioli, E., Mammana, M., Nicotra, S., Comacchio, G., Verderi, E., De Palma, A., Curcio, C., Rea, F., Bertani, A., Russo, E., Voltolini, L., Gonfiotti, A., Nosotti, M., Rosso, L., Muriana, G., Droghetti, A., Crisci, R., Zaccagna, G., Amore, D., di Rienzo, G., Lopez, C., Morelli, A., Londero, F., Spaggiari, L., Gasparri, R., Baietto, G., Casadio, C., Infante, M., Benato, C, Alloisio, M., Bottoni, E, Cardillo, G., Carleo, F., Stella, F., Dolci, G., Puma, F., Vinci, D., Cavallesco, G., Maniscalco, P., Ampollini, L., Carbognani, P., Terzi, A., Viti, A, Negri, G., Bandiera, A., Perkmann, R., Zaraca, F., Andreetti, C., Poggi, C., Mucilli, F., Camplese, P., Luzzi, L., Ghisalberti, M., Imperatori, A., Rotolo, N., Bortolotti, L., Rizzardi, G., Torre, M., Rinaldo, A., Sabbatini, A., Refai, M., Benvenuti, M. R., Benetti, D., Stefani, A., Natali, P., Lausi, P., Guerrera, F., Melloni, G., Mazza, F., Argnani, D., Sanna, S., Fontana, D., Beffa, V. D., Meda, S., Pernazza, F. a, and Italian VATS Group

Subjects
Oncology, Male, Lung Neoplasms, medicine.medical_treatment, non-small cell lung cancer (NSCLC), Nodal upstaging, VATS lobectomy, 0302 clinical medicine, Risk Factors, Carcinoma, Non-Small-Cell Lung, 80 and over, Registries, Non-Small-Cell Lung, Child, Pneumonectomy, GeneralLiterature_REFERENCE(e.g.,dictionaries,encyclopedias,glossaries), Aged, 80 and over, Thoracic Surgery, Video-Assisted, Thoracic Surgery, General Medicine, Middle Aged, Lymph node dissection, Mediastinal staging, Predictive risk factors, Adolescent, Adult, Aged, Disease Progression, Female, Humans, Italy, Lymph Node Excision, Neoplasm Staging, Predictive Value of Tests, Young Adult, 030220 oncology & carcinogenesis, Predictive value of tests, 030211 gastroenterology & hepatology, Lymph node dissection, Mediastinal staging, Nodal upstaging, Predictive risk factors, VATS lobectomy, medicine.medical_specialty, Video-Assisted, NO, 03 medical and health sciences, Internal medicine, medicine, In patient, business.industry, Disease progression, Carcinoma, medicine.disease, Surgery, Neoplasm staging, business
Abstract

Accurate staging of early non-small cell lung cancer is fundamental for selecting the best treatment. The aim of this study was to identify risk factors for nodal upstaging after video-assisted thoracoscopic lobectomy for clinical T1-3N0 tumors.From 2014 to 2017, 3276 thoracoscopic lobectomies were recorded in the prospective database "Italian VATS Group". Linear and multiple logistic regression models were adapted to identify independent predictors of nodal upstaging and factors associated with progression in postoperative N status.Nodal upstaging was found in 417 cases (12.7%), including 206 cases (6.2%) of N1-positive nodes, 81 cases of N2 nodes (2.4%), and 130 cases (4%) of involvement of both N1 + N2 nodes. A total of 241 (7.3%) patients had single-station nodal involvement, whereas 176 (5.3%) had multiple-station involvement. In the final regression model, the tumor grade, histology, pathologic T status, and 12 resected nodes were independent predictors of nodal upstaging.The number of resected lymph nodes seems to predict nodal upstaging better than the type of intraoperative lymph node management. Other preoperative risk factors correspond to those for which the current guidelines of the European Society of Thoracic Surgery recommend more extensive preoperative mediastinal staging.

Published
2020

5. National adoption of video-assisted thoracoscopic surgery (VATS) lobectomy: The Italian VATS register evaluation

Author

Divisi D., Bertolaccini L., Barone M., Amore D., Argnani D., Zaccagna G., Solli P., Di Rienzo G., Curcio C., Crisci R., Ampollini L., Alloisio M., Andreetti C., Baietto G., Bandiera A., Benato C., Benetti D., Benvenuti M., Bertani A., Bortolotti L., Bottoni E., Camplese P., Carbognani P., Cardillo G., Carleo F., Casadio C., Cavallesco G., Negri A. D., Dolci G., Droghetti A., Gasparri R., Ghisalberti M., Gonfiotti A., Guerrera F., Imperatori A., Infante M., Lausi P., Londero F., Lopez C., Luzzi L., Maineri P., Maniscalco P., Marulli G., Monteverde M., Morelli A., Mucilli F., Natali P., Negri G., Nicotra S., Nosotti M., Perkmann R., Poggi C., Puma F., Refai M., Rinaldo A., Rizzardi G., Rosso L., Rotolo N., Russo E., Sabatini A., Spaggiari L., Stefani A., Stella F., Terzi A., Torre M., Vinci D., Viti A., Voltolini L., Zaraca F., Divisi D., Bertolaccini L., Barone M., Amore D., Argnani D., Zaccagna G., Solli P., Di Rienzo G., Curcio C., Crisci R., Ampollini L., Alloisio M., Andreetti C., Baietto G., Bandiera A., Benato C., Benetti D., Benvenuti M., Bertani A., Bortolotti L., Bottoni E., Camplese P., Carbognani P., Cardillo G., Carleo F., Casadio C., Cavallesco G., Negri A.D., Dolci G., Droghetti A., Gasparri R., Ghisalberti M., Gonfiotti A., Guerrera F., Imperatori A., Infante M., Lausi P., Londero F., Lopez C., Luzzi L., Maineri P., Maniscalco P., Marulli G., Monteverde M., Morelli A., Mucilli F., Natali P., Negri G., Nicotra S., Nosotti M., Perkmann R., Poggi C., Puma F., Refai M., Rinaldo A., Rizzardi G., Rosso L., Rotolo N., Russo E., Sabatini A., Spaggiari L., Stefani A., Stella F., Terzi A., Torre M., Vinci D., Viti A., Voltolini L., Zaraca F., Divisi, Duilio, Bertolaccini, Luca, Barone, Mirko, Amore, Dario, Argnani, Desideria, Zaccagna, Gino, Solli, Piergiorgio, Di Rienzo, Gaetano, Curcio, Carlo, Crisci, Roberto, Italian VATS, Group, and Negri, G

Subjects
Database, Learning curve, Learning tools, Non-small cell lung cancer, Training, Video-assisted thoracoscopic surgery lobectomy (VATS lobectomy), Pulmonary and Respiratory Medicine, medicine.medical_specialty, medicine.medical_treatment, VATS lobectomy, Air leak, NO, 03 medical and health sciences, 0302 clinical medicine, Learning tool, database, learning curve, learning tools, non-small cell lung cancer, training, medicine, Thoracotomy, business.industry, General surgery, Database, Learning curve, Learning tools, Non-small cell lung cancer, Training, Video-assisted thoracoscopic surgery lobectomy (VATS lobectomy), 030228 respiratory system, Cardiothoracic surgery, 030220 oncology & carcinogenesis, Video-assisted thoracoscopic surgery, Operative time, Original Article, business
Abstract

Background: The expertise curve of video-assisted thoracoscopic surgery (VATS) lobectomies still stirs debate and controversy both because of the number of procedures to carry out and of the evaluation of the learning threshold. The purpose of our study was the examination of the variables related to the learning curve of the video-assisted approach, to establish what may be an expression of the technical maturity of the surgeon. Methods: The National Register for VATS lobectomy built in 2013 was used to collect data from 65 Thoracic Surgery Units. Out of more than 3,700 patients enrolled, only information from Units with ≥100 VATS lobectomies were retrospectively analysed. Unpaired Student’s t-tests, Fisher’s exact tests, Pearson’s χ 2 were applied as needed. Cumulative summative analysis and one-way ANOVA were used to identify the expertise curve of VATS lobectomy. Results: Ten institutions contributed a total of 1,679 patients, who were divided into three uniform groups according to the chronological sequence of surgery. The length of utility incision, the number of dissected lymph nodes and the operative time were not statistically significant (P=0.999, P=0.972 and P=0.307, respectively) among groups. Conversion to thoracotomy and postoperative air leaks occurred in 125 (7.44%) and 109 (6.49%) patients, gradually declined in Group 3 with statistical signi cance (P=0.048 and P=0.00086). Conclusions: The conversion rate and the percentage of air leaks seem to de ne the expertise of VATS lobectomy, being linked to the ability to manage more complicated surgical cases or intraoperative adverse events.

Published
2018

6. Corrigendum to: What counts more: The patient, the surgical technique, or the hospital? A multivariable analysis of factors affecting perioperative complications of pulmonary lobectomy by video-assisted thoracoscopic surgery from a large nationwide registry (European Journal of Cardio-thoracic Surgery (2019) DOI: 10.1093/ejcts/ezz187)

Author

Infante, M. V., Benato, C., Silva, R., Rocco, G., Bertani, A., Bertolaccini, L., Gonfiotti, A., Giovannetti, R., Bonadiman, C., Lonardoni, A., Canneto, B., Falezza, G., Gandini, P., Curcio, C., Crisci, R., Zaraca, F., Alloisio, M., Amore, D., Ampollini, L., Andreetti, C., Argnani, D., Baietto, G., Bandiera, A., Benvenuti, M., Bortolotti, L., Bottoni, E., Breda, C., Camplese, P., Carbognani, P., Cardillo, G., Casadio, C., Cavallesco, G., Cherchi, R., Dell'Amore, A., Beffa, V., Dolci, G, Droghetti, A, Ferrari, P. A., Fontana, D., Gargiulo, G., Gasparri, R., Gavezzoli, D., Ghisalberti, M., Giovanardi, M., Guerrera, F., Imperatori, A., Iurilli, L., Lausi, P., Lo Giudice, F., Londero, F., Lopez, C., Luzzi, L., Mancuso, M., Maniscalco, P., Margaritora, S., Meacci, E., Melloni, G., Morelli, A., Mucilli, F., Natali, P., Negri, G., Nicotra, S., Nosotti, M., Pariscenti, G., Perkmann, R., Pernazza, F., Pirondini, E., Poggi, C., Puma, F., Refai, M., Rinaldo, A., Rizzardi, G, Rosso, L., Rotolo, N., Russo, E., Sabbatini, A., Scarci, M., Spaggiari, L., Stefani, A., Solli, P., Surrente, C., Terzi, A., Torre, M., Vinci, D., Viti, A., Voltolini, L., Zaccagna, G., and the Italian VATS group members

Subjects
Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Lung Neoplasms, Thoracic, medicine.medical_treatment, MEDLINE, NO, Postoperative Complications, Risk Factors, Pulmonary lobectomy, Humans, Medicine, Registries, Intraoperative Complications, Pneumonectomy, Lung, Aged, Retrospective Studies, Thoracic Surgery, Video-Assisted, business.industry, General surgery, General Medicine, Perioperative, Middle Aged, Corrigenda, Hospitals, Video-assisted thoracoscopic surgery, Female, Surgery, Cardiology and Cardiovascular Medicine, business
Abstract

OBJECTIVES: Inherent technical aspects of pulmonary lobectomy by video-assisted thoracoscopic surgery (VATS) may limit surgeons’ ability to deal with factors predisposing to complications. We analysed complication rates after VATS lobectomy in a prospectively maintained nationwide registry. METHODS: The registry was queried for all consecutive VATS lobectomy procedures from 49 Italian Thoracic Units. Baseline condition, tumour features, surgical techniques, devices, postoperative care, complications, conversions and the reasons thereof were detailed. Univariable and multivariable regressions were used to assess factors potentially linked to complications. RESULTS: Four thousand one hundred and ninety-one VATS lobectomies in 4156 patients (2480 men, 1676 women) were analysed. The median age-adjusted Charlson index of the patients was 4 (interquartile range 3–6). Grade 1 and 2 and Grade 3–5 complications were observed in 20.1% and in 5.8%, respectively. Ninety-day mortality was 0.55%. The overall conversion rate was 9.2% and significantly higher in low-volume centres (

Published
2019

7. First italian consensus conference on VATS lobectomy for NSCLC

Author

Nosotti, Mario, Droghetti, Andrea, Luzzi, Luca, Solli, Piergiorgio, Crisci, Roberto, VATS Group Italia, Alloisio, M, Amore, D, Ampollini, D, Andreetti, C, Aresu, Argnani, D, Baletto, G, Bandiera, A, Benato, C, Bertani, A, Bertolaccini, L, Bortolotti, L, Camplese, P, Carbognani, P, Cardillo, G, Carleo, F, Cavallesco, G, Curcio, C, Dell’Amore, D, De Monte, L, Denegri, A, De Vico, A, Di Rienzo, G, Divisi, D, Dolci, Gp, Ghisalberti, M, Giovanardi, M, Gonfiotti, A, Gotti, G, Imperatori, A, Infante, M, Lo faso, F, Lopez, C, Magnanelli, G, Maineri, P, Mancuso, M, Maniscalco, P, Marulli, G, Morelli, A, Mucilli, F, Muriana, G, Negri, Gp, Nicotra, S, Palleschi, A, Perkmann, R, Pernazza, F, Poggi, C, Puma, F, Rinaldo, A, Rizzardi, G, Roncon, A, Rosso, L, Rotolo, N, Solaini, L, Stella, F, Terzi, A, Torre, M, Vinci, D, Voltolini, L, and Zaraca, F

Subjects
medicine.medical_specialty, Surgical strategy, medicine, consensus conference, medicine.medical_treatment, VATS lobectomy, practical recommendations, thoracotomy, 030204 cardiovascular system & hematology, carcinoma, lung neoplasms, 03 medical and health sciences, 0302 clinical medicine, Carcinoma, Non-Small-Cell Lung, Medicine, Thoracotomy, lung cancer, non-small-cell lung, humans, Italy, thoracic surgery, video-assisted, oncology, cancer research, video-assisted, Perioperative management, business.industry, Thoracic Surgery, Video-Assisted, General surgery, Consensus conference, General Medicine, thoracic surgery, 030228 respiratory system, Cardiothoracic surgery, business
Abstract

Purpose Video-assisted thoracoscopic surgery (VATS) lobectomy has become an accepted procedure for the treatment of selected cases of lung cancer. The aim of this project was to establish national practical recommendations for the management of patients suitable for VATS lobectomy. Methods The Scientific Committee of the VATS Lobectomy Group (a branch of the Italian Society of Thoracic Surgery) identified the consensus conference as an appropriate tool for a national debate. The consensus conference was organized following indications of the Italian Department of Health: a panel of experts reviewed the literature, the jury board revised the experts’ reports, and the national conference discussed and voted on statements. The strength of recommendation for a statement was classified as weak, fair, or high when the total score ranged between 51% and 67%, 68% and 84%, or 85% and 100%, respectively. Results Eighty-six Italian thoracic surgeons attended the 1st Italian Consensus Conference on VATS lobectomy in Giulianova, Italy, on October 29-30, 2015. Thirty-three topics were discussed: indications, surgical strategy, perioperative management, and training were the main topics. Consensus was reached on 24 statements that were consequently recommended. Conclusions The Italian Consensus Conference is the first attempt to discuss VATS lobectomy-related issues in a national scientific community. Such experience determined an improvement in epistemic knowledge among the Italian thoracic surgeons and could be a suggestion for other national communities.

Published
2017

8. Risk factors and impact of conversion from VATS to open lobectomy: analysis from a national database

Author

Bongiolatti, Stefano, Gonfiotti, Alessandro, Viggiano, Domenico, Borgianni, Sara, Politi, Leonardo, Crisci, Roberto, Curcio, Carlo, Voltolini, Luca, Italian Vats Group, Carlo, Curcio, Dario, Amore, Giuseppe, Marulli, Samuele, Nicotra, Andrea De Negri, Paola, Maineri, Gaetano Di Rienzo, Camillo, Lopez, Roberto, Crisci, Duilio, Divisi, Angelo, Morelli, Alessandro, Bertani, Francesco, Londero, Lorenzo, Rosso, Lorenzo, Spaggiari, Roberto, Gasparri, Guido, Baietto, Caterina, Casadio, Maurizio, Infante, Cristiano, Benato, Marco, Alloisio, Edoardo, Bottoni, Andrea, Droghetti, Andrea, Giovanardi, Giuseppe, Cardillo, Francesco, Carleo, Luca, Bertolaccini, Piergiorgio, Solli, Franco, Stella, Giampiero, Dolci, Francesco, Puma, Damiano, Vinci, Giorgio Cavallesco Pio Maniscalco, Desideria, Argnani, Luca, Ampollini, Paolo, Carbognani, Alberto, Terzi, Andrea, Viti, Giampiero, Negri, Alessandro, Bandiera, Reinhold, Perkmann, Francesco, Zaraca, Ibrahim, Mohsen, Poggi, Camilla, Felice, Mucilli, Pierpaolo, Camplese, Luca, Luzzi, Marco, Ghisalberti, Andrea, Imperatori, Nicola, Rotolo, Luigi, Bortolotti, Giovanna, Rizzardi, Massimo, Torre, Alessandro, Rinaldo, Armando, Sabbatini, Majed, Refai, Mauro Roberto Benvenuti, Diego, Benetti, Alessandro, Stefani, Pamela, Natali, Paolo, Lausi, Francesco, Guerrera, Bongiolatti S., Gonfiotti A., Viggiano D., Borgianni S., Politi L., Crisci R., Curcio C., Voltolini L., Amore D., Marulli G., Nicotra S., De Negri A., Maineri P., DiRienzo G., Lopez C., Divisi D., Morelli A., Bertani A., Russo E., Londero F., Rosso L., Spaggiari L., Gasparri R., Baietto G., Casadio C., Infante M., Benato C., Alloisio M., Bottoni E., Droghetti A., Giovanardi A., Cardillo G., Carleo F., Bertolaccini L., Solli P., Stella F., Dolci G., Puma F., Vinci D., Cavallesco G., Maniscalco P., Argnani D., Ampollini L., Carbognani P., Terzi A., Viti A., Negri G., Bandiera A., Perkmann R., Zaraca F., Ibrahim M., Poggi C., Mucilli F., Camplese P., Luzzi L., Ghisalberti M., Imperatori A., Rotolo N., Bortolotti L., Rizzardi G., Torre M., Rinaldo A., Sabbatini A., Refai M., Benvenuti M.R., Benetti D., Stefani A., Natali P., Lausi P., Guerrera F., Bongiolatti, S., Gonfiotti, A., Viggiano, D., Borgianni, S., Politi, L., Crisci, R., Curcio, C., Voltolini, L., Amore, D., Marulli, G., Nicotra, S., De Negri, A., Maineri, P., Dirienzo, G., Lopez, C., Divisi, D., Morelli, A., Bertani, A., Russo, E., Londero, F., Rosso, L., Spaggiari, L., Gasparri, R., Baietto, G., Casadio, C., Infante, M., Benato, C., Alloisio, M., Bottoni, E., Droghetti, A., Giovanardi, A., Cardillo, G., Carleo, F., Bertolaccini, L., Solli, P., Stella, F., Dolci, G., Puma, F., Vinci, D., Cavallesco, G., Maniscalco, P., Argnani, D., Ampollini, L., Carbognani, P., Terzi, A., Viti, A., Negri, G., Bandiera, A., Perkmann, R., Zaraca, F., Ibrahim, M., Poggi, C., Mucilli, F., Camplese, P., Luzzi, L., Ghisalberti, M., Imperatori, A., Rotolo, N., Bortolotti, L., Rizzardi, G., Torre, M., Rinaldo, A., Sabbatini, A., Refai, M., Benvenuti, M. R., Benetti, D., Stefani, A., Natali, P., Lausi, P., and Guerrera, F.

Subjects
Male, Lung Neoplasms, Complications, Databases, Factual, medicine.medical_treatment, Sex Factor, Conversion, Lobectomy, Lung cancer, Video-assisted thoracic surgery, 0302 clinical medicine, Risk Factors, Retrospective Studie, Carcinoma, Non-Small-Cell Lung, Age Factor, Thoracotomy, Non-Small-Cell Lung, Pneumonectomy, Thoracic Surgery, Video-Assisted, Mortality rate, Age Factors, Thoracic Surgery, Middle Aged, Conversion to Open Surgery, Lymphatic Metastasis, 030220 oncology & carcinogenesis, Female, 030211 gastroenterology & hepatology, Human, medicine.medical_specialty, VATS lobectomy, Video-Assisted, NO, Databases, 03 medical and health sciences, Sex Factors, Internal medicine, medicine, Humans, Factual, Retrospective Studies, Aged, Complications, Conversion, Lobectomy, Lung cancer, Video-assisted thoracic surgery, business.industry, Risk Factor, Carcinoma, Lymphatic Metastasi, Retrospective cohort study, Video-assisted thoracic surgery · Lobectomy · Lung cancer · Conversion · Complications, Lung Neoplasm, Chest tube, Surgery, Complication, business, Abdominal surgery
Abstract

Objective: The objective of the study is to analyse the causes and impact of conversion from VATS to thoracotomy identifying any possible pre-operative risk factors and related consequences. Methods: Data from patient who underwent VATS lobectomy (VATS-L) for NSCLC at VATS Group participating centres were retrospectively analysed and divided in two groups: patients treated with VATS-L and patients who suffered from conversion. Predictors of conversion were assessed with univariate and multivariable exact logistic regression. Complications were evaluated as dependent variables of conversion in a Cox multivariable logistic regression model. Results: A total of 4629 patients underwent planned VATS-L for NSCLC and of these, 432 (9.3%) required conversion; the most frequent causes were bleeding (30.4%) and fibro-calcified hilar lymph nodes (23.9%). The independent risk factors at multivariable analysis model were sex male (OR 1.458, p < 0.01), age older than 70years (OR 1.248, p = 0.036) and the clinically node-positive disease (OR 2.258, p < 0.01). The mortality rate was similar, but the percentage of patients who suffered from any complication (41.7% vs 24.4%, p < 0.01), the complication rate (65% vs 32.2%, p < 0.01), chest tube duration (p < 0.01) and the hospitalisation rate (p < 0.01) were higher for patients converted. Atrial fibrillation (OR 1.471, p = 0.019), prolonged air leak (OR 1.403, p = 0.043), blood transfusions (OR 4.820, p < 0.01), sputum retention (OR 1.80, p = 0.027) and acute kidney failure (OR 2.758, p = 0.03) were significantly associated with conversion at multivariable analysis. Conclusions: Conversion is associated with increased surgical morbidity, blood loss and hospital stay. Sex male, old age and the clinical involvement of lymph nodes were the strongest predictors of conversion.

Published
2019

9. Conversion due to vascular injury during video-assisted thoracic surgery lobectomy: A multicentre retrospective analysis from the Italian video-assisted thoracic surgery group registry

Author

Luca Bertolaccini, Fabio Davoli, Alessandro Pardolesi, Jury Brandolini, Desideria Argnani, Alessandro Bertani, Andrea Droghetti, Alessandro Gonfiotti, Duilio Divisi, Roberto Crisci, Piergiorgio Solli, Mario Nosotti, Carlo Curcio, Dario Amore, Giuseppe Marulli, Samuele Nicotra, Andrea De Negri, Paola Maineri, Gaetano di Rienzo, Camillo Lopez, Angelo Morelli, Francesco Londero, Lorenzo Spaggiari, Roberto Gasparri, Guido Baietto, Caterina Casadio, Maurizio Infante, Cristiano Benato, Marco Alloisio, Edoardo Bottoni, Giuseppe Cardillo, Francesco Carleo, Franco Stella, Giampiero Dolci, Francesco Puma, Damiano Vinci, Giorgio Cavallesco, Pio Maniscalco, Luca Ampollini, Paolo Carbognani, Alberto Terzi, Andrea Viti, Giampiero Negri, Alessandro Bandiera, Reinhold Perkmann, Francesco Zaraca, Claudio Andretti, Camilla Poggi, Felice Mucilli, Pierpaolo Camplese, Luca Luzzi, Marco Ghisalberti, Andrea Imperatori, Nicola Rotolo, Luigi Bortolotti, Giovanna Rizzardi, Massimo Torre, Alessandro Rinaldo, Armando Sabbatini, Majed Refai, Mauro Roberto Benvenuti, Diego Benetti, Alessandro Stefani, Pamela Natali, Paolo Lausi, Francesco Guerrera, Bertolaccini, Luca, Davoli, Fabio, Pardolesi, Alessandro, Brandolini, Jury, Argnani, Desideria, Bertani, Alessandro, Droghetti, Andrea, Gonfiotti, Alessandro, Divisi, Duilio, Crisci, Roberto, Solli, Piergiorgio, Nosotti, Mario, Curcio, Carlo, Amore, Dario, Marulli, Giuseppe, Nicotra, Samuele, De Negri, Andrea, Maineri, Paola, di Rienzo, Gaetano, Lopez, Camillo, Morelli, Angelo, Londero, Francesco, Spaggiari, Lorenzo, Gasparri, Roberto, Baietto, Guido, Casadio, Caterina, Infante, Maurizio, Benato, Cristiano, Alloisio, Marco, Bottoni, Edoardo, Cardillo, Giuseppe, Carleo, Francesco, Stella, Franco, Dolci, Giampiero, Puma, Francesco, Vinci, Damiano, Cavallesco, Giorgio, Maniscalco, Pio, Ampollini, Luca, Carbognani, Paolo, Terzi, Alberto, Viti, Andrea, Negri, Giampiero, Bandiera, Alessandro, Perkmann, Reinhold, Zaraca, Francesco, Andretti, Claudio, Poggi, Camilla, Mucilli, Felice, Camplese, Pierpaolo, Luzzi, Luca, Ghisalberti, Marco, Imperatori, Andrea, Rotolo, Nicola, Bortolotti, Luigi, Rizzardi, Giovanna, Torre, Massimo, Rinaldo, Alessandro, Sabbatini, Armando, Refai, Majed, Benvenuti, Mauro Roberto, Benetti, Diego, Stefani, Alessandro, Natali, Pamela, Lausi, Paolo, Guerrera, Francesco, Bertolaccini L., Davoli F., Pardolesi A., Brandolini J., Argnani D., Bertani A., Droghetti A., Gonfiotti A., Divisi D., Crisci R., Solli P., Nosotti M., Curcio C., Amore D., Marulli G., Nicotra S., De Negri A., Maineri P., di Rienzo G., Lopez C., Morelli A., Londero F., Spaggiari L., Gasparri R., Baietto G., Casadio C., Infante M., Benato C., Alloisio M., Bottoni E., Cardillo G., Carleo F., Stella F., Dolci G., Puma F., Vinci D., Cavallesco G., Maniscalco P., Ampollini L., Carbognani P., Terzi A., Viti A., Negri G., Bandiera A., Perkmann R., Zaraca F., Andretti C., Poggi C., Mucilli F., Camplese P., Luzzi L., Ghisalberti M., Imperatori A., Rotolo N., Bortolotti L., Rizzardi G., Torre M., Rinaldo A., Sabbatini A., Refai M., Benvenuti M.R., Benetti D., Stefani A., Natali P., Lausi P., and Guerrera F.

Subjects
Registrie, Male, Complications, Lung Neoplasms, medicine.medical_treatment, Iatrogenic Disease, 030204 cardiovascular system & hematology, 0302 clinical medicine, Retrospective Studie, Risk Factors, Thoracotomy, Registries, Pneumonectomy, Video-assisted thoracic surgery lobectomy, Univariate analysis, Thoracic Surgery, Video-Assisted, Thoracic Surgery, General Medicine, Treatment Outcome, Oncology, Italy, Cardiothoracic surgery, Female, Lung cancer, Human, medicine.medical_specialty, Complications, Conversion, Lung cancer, Lymph nodes dissection, Vascular injury, Video-assisted thoracic surgery lobectomy, VATS lobectomy, Video-Assisted, Vascular injury, NO, 03 medical and health sciences, medicine, Conversion, Lymph nodes dissection, Aged, Humans, Retrospective Studies, Vascular System Injuries, business.industry, Risk Factor, nutritional and metabolic diseases, Retrospective cohort study, medicine.disease, Surgery, Lung Neoplasm, 030228 respiratory system, business, Complication
Abstract

Objectives Vascular injuries are among the most severe causes of unplanned conversion during VATS lobectomies. The study aimed to analyse the incidence of vascular injuries and their risk factors during VATS lobectomy. Methods The Italian VATS lobectomy Registry was used to collect data from 66 Thoracic Surgery Units. From 2013 to October 2016 (out of more than 3,700 patients enrolled) only information from Units with an enrollment >100 VATS lobectomies were retrospectively analysed. Logistic regression analysis was performed on selected variables of the univariate analysis. Results Ten institutions contributed a total of 1,679 patients. Vascular injuries leading to conversion occurred in 44 (2.6%) patients. Years of experiences were inversely related to the risk of vascular injuries. Univariate analysis showed age, gender, surgical activity, Charlson Index Score and number of resected lymph nodes like significantly associated variables. Multivariate analysis revealed that number of resected lymph nodes, VATS experience ratio (number of VATS lobectomies/total lobectomies performed in the same year at same centre), and surgical activity of the centre were significantly associated with the risk of conversion. Unplanned thoracotomy was correlated with postoperative morbidity. Conclusion Vascular injuries in VATS lobectomies represented a rare complication which could directly affect the postoperative outcomes. The predictive factors for conversion were multifactorial and depended on characteristics of centres and surgeons’ seniority. Minimally invasive VATS lobectomy approaches did not influence the risk of vascular damages.

Published
2019

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