Search

Open in new tab Download slide OBJECTIVES There is a lack of evidence on whether perioperative outcomes differ in obese patients after video-assisted thoracic surgery (VATS) or open lobectomy. We queried the European Society of Thoracic Surgeons database to assess morbidity and postoperative length of hospital stay in obese patients submitted to VATS and open pulmonary lobectomy for non-small-cell lung cancer. METHODS We collected all consecutive patients from 2007 to 2021 submitted to lobectomy through VATS or thoracotomy with a body mass index greater than or equal to 30. An intention-to-treat analysis was carried out. Primary outcomes were morbidity rate, mortality and postoperative length of stay (LOS). Differences in outcomes were assessed through univariable, multivariable-adjusted and propensity score-matched analysis. RESULTS Out of a total of 78 018 patients submitted to lung lobectomy, 13 999 cases (17.9%) were considered in the analysis, including 5562 VATS lobectomies and 8437 thoracotomy lobectomies. The VATS group showed a lower complication rate (23.2% vs 30.2%, P  < 0.001), mortality (0.8% vs 1.5%, P  < 0.001) and postoperative LOS (median 5 vs 7 days, P  < 0.001). After propensity score matching, the VATS approach confirmed a lower complication rate (24.7% vs 29.7%, P  = 0.002) and postoperative LOS (median 5 vs 7 days, P  < 0.001). Moreover, these results were consistently observed when analyzing the severe obese subgroup (body mass index 35–39.9) and morbid obese subgroup (body mass index ≥40). CONCLUSIONS In obese patients with non-small cell lung cancer, VATS lobectomy was found to be associated with improved postoperative outcomes than open lobectomy. Consequently, it should be considered the approach of choice for the Obese population. [ABSTRACT FROM AUTHOR]

A frozen section on the segmental nodes should be performed in all cases (with the exception of pure GGO lesions or patient unfit for lobectomy), and in case of a positive node found at frozen section examination, the segmentectomy should be extended to lobectomy. Keywords: Segmentectomy; Sublobar resection; Non-small-cell lung cancer; Operative technique; Quality; Guidelines EN Segmentectomy Sublobar resection Non-small-cell lung cancer Operative technique Quality Guidelines 1 13 13 07/04/23 20230601 NES 230601 INTRODUCTION The recent findings from the JCOG0802 and CALGB randomized control trials [[1]] have corroborated previous observational reports series [[3], [5], [7]] showing favourable short-term and long-term results of segmentectomy in patients operated for peripheral (outer third of the lung), early-stage non-small-cell lung cancer (NSCLC) (2 cm or less). There was consensus among the panellists in this study to the statement: in case of unexpected positive station lymph nodes stations 10 or mediastinal lymph nodes node found only on the final pathological report, the patient should be referred to adjuvant chemotherapy and NOT for completion lobectomy with 79% and 89% agreement. Similarly, in a series of 1991 lepidic adenocarcinomas submitted to either lobectomy or segmentectomy, survival was significantly better after lobectomy, except in the sublobar resections subgroup associated with lymph node dissection [[50]]. In addition, some studies have shown that a larger number of sampled lymph nodes during segmentectomy is associated with a higher rate of metastatic lymph nodes (>6 nodes associated with 9.4% positive ones vs 6 or less nodes sampled associated with 1.5% positive nodes) and better survival at 5-year [[48]]. [Extracted from the article]

OBJECTIVES For centrally located lung tumours, sleeve lobectomy is preferred over pneumectomy. We report on the surgical practices and perioperative outcomes of sleeve resections based on data from the European Society of Thoracic Surgeons database. METHODS We retrieved data of patients undergoing sleeve lobectomy or bilobectomy from 2007 to 2021. We evaluated baseline characteristics, surgical approach, neoadjuvant treatments, morbidity and postoperative outcomes of open and video-assisted thoracoscopic surgery (VATS) procedures. RESULTS In total, 1652 patients (median age: 63 years; females/males: 446/1206) underwent sleeve lobectomy (n = 1536) or bilobectomy (n = 116) by open thoracotomy (n = 1491; 90.2%) or VATS (n = 161; 9.8%) with a thoracotomy conversion rate of 21.1% (n = 34); 398 (24.1%) patients received neoadjuvant treatment. Overall morbidity and 30-day mortality were 40.6% and 2.2%, respectively. Bronchial anastomotic complications occurred in 29 patients (1.8%) with conservative treatment in 6 cases (20.7%) and operative management in 23 (79.3%). On multivariable analysis, factors related to the elevated risk of cardiopulmonary complications were body mass index < 20 [odds ratio (OR): 2.26; P  < 0.001] and bilobectomy (OR : 2.28, P  < 0.001). Age <60 years (OR: 0.71, P  = 0.013), female sex (OR: 0.54, P  < 0.001) and VATS (0.64, P  < 0.001) were associated with decreased risk. Neoadjuvant treatment was not associated with increased risks of cardiopulmonary complications (OR: 1.05; P  = 0.664). Compared to open thoracotomy, VATS was associated with significantly decreased overall morbidity (30.4% vs 41.7%, P  = 0.006) and length of stay (median: 5 days vs 8 days; P  < 0.001). CONCLUSIONS Sleeve lobectomies can be safely performed after neoadjuvant treatment. The VATS approach fosters shorter length of stay and decreased morbidity. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide OBJECTIVES Intraoperative conversion from video-assisted thoracic surgery (VATS) to thoracotomy may occur during anatomical lung resection. The objectives of the present study were to identify risk factors for intraoperative conversion and to develop a predictive score. METHODS We performed a multicentre retrospective analysis of French thoracic surgery departments that contributed data on anatomical lung resections to the Epithor database over a 10-year period (from January-2010 to December-2019). Using univariate and multivariate logistic regression analyses, we determined risk factors for intraoperative conversion and elaborated the Epithor conversion score (ECS). The ECS was then validated in a cohort of patients operated on between January- and June-2020. RESULTS From January-2010 to December-2019, 210,037 patients had been registered in the Epithor database. Of these, 55,030 had undergone anatomical lung resection. We excluded patients who had upfront a thoracotomy or robotic-assisted thoracoscopic surgery (n = 40,293) and those with missing data (6,794). Hence, 7943 patients with intent-to-treat VATS were assessed: 7100 with a full VATS procedure and 843 patients with intraoperative conversion to thoracotomy (conversion rate: 10.6%). Thirteen potential risk factors were identified among patients' preoperative characteristics and planned surgical procedures and were weighted accordingly to give the ECS. The score showed acceptable discriminatory power (area under the curve: 0.62 in the development cohort and 0.64 in the validation cohort) and good calibration (P  = 0.23 in the development cohort and 0.30 in the validation cohort). CONCLUSIONS Thirteen potential preoperative risk factors were identified, enabling us to develop and validate the ECS—an easy-to-use, reproducible tool for estimating the risk of intraoperative conversion during VATS. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide Open in new tab Download slide OBJECTIVES We report an overview of surgical practices and outcomes in patients undergoing pulmonary metastasectomy based on data from the European Society of Thoracic Surgeons database. METHODS We retrieved data on resections performed for pulmonary metastases between July 2007 and July 2019. We evaluated baseline characteristics, surgical management and postoperative outcomes. Open and video-assisted thoracic surgery (VATS) procedures were compared in terms of surgical management, morbidity and mortality. RESULTS We selected 8868 patients [male/female 5031/3837; median age: 64 years (interquartile range 55–71)] who underwent pulmonary metastasectomy. Surgical approach consisted of open thoracotomy in 63.5% of cases (n  = 5627) and VATS in 36.5% (n  = 3241), with a conversion rate of 2.1% (n  = 69). Surgical resection was managed by wedge or local excision in 61% (n  = 5425) of cases and anatomical resection in 39% (n  = 3443); lobectomy: 26% (n  = 2307); segmentectomy: 11% (n  = 949); bilobectomy: 1% (n  = 95); pneumonectomy: 1% (n  = 92)). Lymph node assessment was realized in 58% (n  = 5097) [sampling: 21% (n  = 1832); complete dissection: 37% (n  = 3265)]. Overall morbidity and mortality rates were 15% (n  = 1308) and 0.8% (n  = 69), respectively. Median duration of stay was 6 days (interquartile range 4–8). The rate of VATS procedures increased from 15% in 2007 to 58% in 2018. When comparing VATS and Open surgery, there were significantly (P  < 0.001) fewer anatomical resections by VATS (24% vs 49%), lymph node assessments (36% vs 70%), less morbidity (9% vs 18%) and shorter durations of stay (median: 4 vs 7 days). CONCLUSIONS We report a good overview of current surgical practices in terms of resection extent and postoperative outcomes with a gradual acceptance of VATS. [ABSTRACT FROM AUTHOR]

In conclusion, this article may provide valuable data to improve the everyday clinical practice of any thoracic surgery centre by providing a low-cost technique that may reduce the negative impact of prolonged air leaks in the postoperative period of lung resection surgery. Nonpneumonectomy lung resection surgery always has had air leaks as its most significant limitation. Keywords: Air leaks; Prevention; Lung resection surgery EN Air leaks Prevention Lung resection surgery 1 2 2 06/06/23 20230501 NES 230501 Hironori Ishibashi I et al. i [[1]] present a manuscript on a novel method to avoid cough and prolonged air leak in the postoperative period after lung resection surgery. [Extracted from the article]

Background: Lobectomy for benign lung disease is renowned to be technically complex and to be subjected to an increased complication rate. The objective of this study was to evaluate whether the results obtained with video-assisted surgery (VATS) in benign disease are comparable to those obtained in oncologic surgery, where VATS has been validated.Methods: We have reviewed the files of 246 consecutive patients who underwent VATS lobectomy from January 2012 to August 2015. The cohort was divided into two groups according to pathology (benign or malignant). Outcome parameters on scrutiny were demographics, pathology, duration of air leak, drainage and hospital stay, conversion, and perioperative complication rate. Comparisons were made with the χ 2 test and Student's t test; any p value ≤0.05 was considered as significant.Results: Group 1 (36 patients) included patients who underwent lobectomy for benign disease and group 2 (210 patients) patients affected by lung cancer or pulmonary metastases. The two groups differed with reference to age (p < 0.001), history of cancer (p < 0.001), history of stroke (p = 0.05), and the presence of pleural adhesions (p = 0.03). There was no difference for duration of air leaks, chest tube drainage and hospital stay, conversion rate, and perioperative complication rate.Conclusions: We conclude that pathology did not impact on outcomes after VATS lobectomy. This study suggests that VATS is as a safe option in selected patients with benign disease requiring lobectomy, despite a more complex technical context. [ABSTRACT FROM AUTHOR]

OBJECTIVES: There are no guidelines regarding the surgical approach for spontaneous pneumothorax. It has been reported, however, that the risk of recurrence following video-assisted thoracic surgery is higher than that following open thoracotomy (OT). The objective of this study was to determine whether this higher risk of recurrence following video-assisted thoracic surgery could be attributable to differences in intraoperative parenchymal resection and the pleurodesis technique. METHODS: Data for 7647 patients operated on for primary or secondary spontaneous pneumothorax between 1 January 2005 and 31 December 2012 were extracted from Epithor®, the French national database. The type of pleurodesis and parenchymal resection was collected. Outcomes were (i) bleeding, defined as postoperative pleural bleeding; (ii) pulmonary and pleural complications, defined as atelectasis, pneumonia, empyema, prolonged ventilation, acute respiratory distress syndrome and prolonged air leaks; (iii) in-hospital length of stay and (iv) recurrence, defined as chest drainage or surgery for a second pneumothorax. RESULTS: Of note, 6643 patients underwent videothoracoscopy and 1004 patients underwent OT. When compared with the thoracotomy group, the videothoracoscopy group was associated with more parenchymal resections (62.4 vs 80%, P = 0.01), fewer mechanical pleurodesis procedures (93 vs 77.5%, P < 10-3), fewer postoperative respiratory complications (12 vs 8.2%, P = 0.01), fewer cases of postoperative pleural bleeding (2.3 vs 1.4%, P = 0.04) and shorter hospital lengths of stay (16 vs 9 days, P = 0.01). The recurrence rate was 1.8% (n = 18) in the thoracotomy group versus 3.8% (n = 254) in the videothoracoscopy group (P = 0.01). The median time between surgery and recurrence was 3 months (range: 1-76 months). CONCLUSIONS: In the surgical management of spontaneous pneumothorax, videothoracoscopy is associated with a higher rate of recurrence than OT. This difference might be attributable to differences in the pleurodesis technique rather than differences in the parenchymal resection. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Video-assisted thoracoscopic anatomical resections are increasingly used in Europe to manage primary lung cancer. The purpose of this study was to compare the outcome following thoracoscopic versus open lobectomy in case-matched groups of patients from the European Society of Thoracic Surgeon (ESTS) database. METHODS: All patients having lobectomy as the primary procedure via thoracoscopy [video-assisted thoracoscopic surgery (VATS)-L)] or thoracotomy (TH-L) were identified in the ESTS database ( January 2007 to December 2013). A propensity score was constructed using several patients’ baseline characteristics. The matching using the propensity score was responsible for the minimization of selection bias. A propensity score-matched analysis was performed to compare the incidence of postoperative major complications (according to the ESTS database definitions) and mortality at hospital discharge between the matched groups. After exclusions, 28 771 patients were identified: 26 050 having thoracotomy and 2721 having thoracoscopy. Propensity score yielded two well-matched groups of 2721 patients. Numeric variables were compared by Student’s t-tests and categorical variables were compared by McNemar’s tests. RESULTS: Compared with TH-L, VATS-L was associated with a lower incidence of total complications [n = 792 (29.1%) vs 863 (31.7%), P = 0.0357], major cardiopulmonary complications [n = 316 (15.9%) vs 435 (19.6%), P = 0.0094], atelectasis requiring bronchoscopy [n = 65 (2.4%) vs 150 (5.5%), P < 0.0001], initial ventilation >48 h [n = 18 (0.7%) vs 38 (1.4%), P = 0.0075] and wound infection [n = 6 (0.2%) vs 17 (0.6%), P = 0.0218]. There was no difference in the incidence of postoperative atrial fibrillation between the two groups (P = 0.14). Postoperative hospital stay was 2 days shorter in the VATS-L patients (mean: 7.8 vs 9.8 days; P = 0.0003). In terms of outcome at hospital discharge, there were 27 deaths in the VATS-L group (1%) versus 50 in the TH-L group (1.9%, P = 0.0201). CONCLUSIONS: Data from the ESTS database confirmed that lobectomy performed through VATS is associated with a lower incidence of complications compared with thoracotomy. [ABSTRACT FROM AUTHOR]

An editorial is presented on the comparison of the outcomes of video-assisted thoracic surgery (VATS) and thoracotomy for anatomical lung resection. Also includes data released by Brazilian Society of Thoracic Surgery database, process performed by surgeons for surgeries, and role of epidemiology, research and international collaboration in making databases.