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1. Thoracoscopic segmentectomy versus lobectomy: A propensity score–matched analysisCentral MessagePerspective

Author

Julio Sesma, MD, Sergio Bolufer, MD, PhD, Antonio García-Valentín, MD, PhD, Raúl Embún, MD, PhD, Íker Javier López, MD, PhD, Nicolás Moreno-Mata, MD, PhD, Unai Jiménez, MD, Florentino Hernando Trancho, MD, PhD, Antonio Eduardo Martín-Ucar, MD, Juana Gallar, MD, PhD, Raul Embun, Iñigo Royo-Crespo, José Luis Recuero Díaz, Sergio Bolufer, Julio Sesma, Sergi Call, Miguel Congregado, David Gómez-de Antonio, Marcelo F. Jimenez, Nicolas Moreno-Mata, Borja Aguinagalde, Sergio Amor-Alonso, Miguel Jesús Arrarás, Ana Isabel Blanco Orozco, Marc Boada, Alberto Cabañero Sánchez, Isabel Cal Vázquez, Ángel Cilleruelo Ramos, Silvana Crowley Carrasco, Elena Fernández-Martín, Santiago García-Barajas, Maria Dolores García-Jiménez, Jose María García-Prim, Jose Alberto Garcia-Salcedo, Juan José Gelbenzu-Zazpe, Carlos Fernando Giraldo-Ospina, María Teresa Gómez Hernández, Jorge Hernández, Jennifer D. Illana Wolf, Alberto Jauregui Abularach, Unai Jiménez, Iker López Sanz, Néstor J. Martínez-Hernández, Elisabeth Martínez-Téllez, Lucía Milla Collado, Roberto Mongil Poce, Francisco Javier Moradiellos-Díez, Ramón Moreno-Balsalobre, Sergio B. Moreno Merino, Carme Obiols, Florencio Quero-Valenzuela, María Elena Ramírez-Gil, Ricard Ramos-Izquierdo, Eduardo Rivo, Alberto Rodríguez-Fuster, Rafael Rojo-Marcos, David Sanchez-Lorente, Laura Sanchez Moreno, Carlos Simón, Juan Carlos Trujillo-Reyes, and Florentino Hernando Trancho

Subjects
anatomic segmentectomy, lobectomy, lung cancer, sublobar resection, thoracoscopy, VATS, Diseases of the circulatory (Cardiovascular) system, RC666-701, Surgery, RD1-811
Abstract

Objectives: The aim of this study is to compare the postoperative complications, perioperative course, and survival among patients from the multicentric Spanish Video-assisted Thoracic Surgery Group database who received video-assisted thoracic surgery lobectomy or video-assisted thoracic surgery anatomic segmentectomy. Methods: From December 2016 to March 2018, a total of 2250 patients were collected from 33 centers. Overall analysis (video-assisted thoracic surgery lobectomy = 2070; video-assisted thoracic surgery anatomic segmentectomy = 180) and propensity score–matched adjusted analysis (video-assisted thoracic surgery lobectomy = 97; video-assisted thoracic surgery anatomic segmentectomy = 97) were performed to compare postoperative results. Kaplan–Meier and competing risks method were used to compare survival. Results: In the overall analysis, video-assisted thoracic surgery anatomic segmentectomy showed a lower incidence of respiratory complications (relative risk, 0.56; confidence interval, 0.37-0.83; P = .002), lower postoperative prolonged air leak (relative risk, 0.42; 95% confidence interval, 0.23-0.78; P = .003), and shorter median postoperative stay (4.8 vs 6.2 days; P = .004) than video-assisted thoracic surgery lobectomy. After propensity score–matched analysis, prolonged air leak remained significantly lower in video-assisted thoracic surgery anatomic segmentectomy (relative risk, 0.33; 95% confidence interval, 0.12-0.89; P = .02). Kaplan–Meier and competing risk curves showed no differences during the 3-year follow-up (median follow-up in months: 24.4; interquartile range, 20.8-28.3) in terms of overall survival (hazard ratio, 0.73; 95% confidence interval, 0.45-1.7; P = .2), tumor progression–related mortality (subdistribution hazard ratio, 0.41; 95% confidence interval, 0.11-1.57; P = .2), and disease-free survival (subdistribution hazard ratio, 0.73; 95% confidence interval, 0.35-1.51; P = .4) between groups. Conclusions: Video-assisted thoracic surgery segmentectomy showed results similar to lobectomy in terms of postoperative outcomes and midterm survival. In addition, a lower incidence of prolonged air leak was found in patients who underwent video-assisted thoracic surgery anatomic segmentectomy.

Published
2022
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2. Impact of neoadjuvant therapy on postoperative complications in non-small-cell lung cancer patients subjected to anatomic lung resection

Author

Alberto Cabañero Sánchez, Gemma María Muñoz Molina, Sara Fra Fernández, Alfonso Muriel García, Angel Cilleruelo Ramos, Néstor Martínez Hernández, Florentino Hernando Trancho, Nicolás Moreno Mata, Borja Aguinagalde de Valiente, Sergio Amor Alonso, Miguel Jesús Arrarás, Ana Isabel Blanco Orozco, Marc Boada Collado, Sergio Bolufer Nadal, Isabel Cal Vázquez, Sergi Call Caja, Ángel Cilleruelo Ramos, Miguel Congregado Loscertales, Silvana Crowley Carrasco, Raúl Embún Flor, Elena Fernández Martín, Juan José Fibla Alfara, Santiago García Barajas, Maria Dolores García Jiménez, Jose María García Prim, Jose Alberto García Salcedo, Carlos Fernando Giraldo Ospina, David Gómez de Antonio, María Teresa Gómez Hernández, Juan José Gelbenzu Zazpe, Jorge Henández Ferrández, Jennifer D. Illana Wolf, Alberto Jauregui Abularach, Marcelo Jiménez López, Unai Jiménez Maestre, Cipriano López García, Iker López Sanz, Elisabeth Martínez Téllez, Lucía Milla Collado, Roberto Mongil Poce, Francisco Javier Moradiellos Díez, Ramón Moreno Balsalobre, Sergio B. Moreno Merino, Carme Obiols Fornell, Florencio Quero Valenzuela, María Elena Ramírez Gil, Ricard Ramos Izquierdo, José Luis Recuero Díaz, Eduardo Rivo Vázquez, Alberto Rodríguez Fuster, Rafael Rojo Marcos, Iñigo Royo Crespo, David Sánchez Lorente, Laura Sanchez Moreno, Julio Sesma Romero, Carlos Simón Adiego, and Juan Carlos Trujillo Reyes

Subjects
Lung Neoplasms, Postoperative Complications, Treatment Outcome, Oncology, Carcinoma, Non-Small-Cell Lung, Humans, Surgery, Chemoradiotherapy, General Medicine, Pneumonectomy, Lung, Neoadjuvant Therapy
Abstract

To study the impact of neoadjuvant therapies on postoperative complications and mortality among non-small-cell lung cancer (NSCLC) patients subjected to anatomic lung resection and included in the Spanish cohort of the video-assisted thoracic surgery (GE-VATS) multicenter database.The study included a total of 3085 patients from 33 centers between December 2016 and March 2018. We performed a comparative analysis of the complications and mortality in patients who received neoadjuvant therapies (n = 263) versus those who did not (n = 2822). A propensity score-matched analysis was used to adjust for potential confounders. Association between exposure in two groups and outcomes were estimated by logistic regression weighted by inverse of probability of receiving the treatment that actually received.In the unadjusted analysis, the chemotherapy (CT) and chemoradiotherapy (CRT) group presented a higher frequency of ICU readmissions, reinterventions, empyema, cardiovascular complications, a greater frequency of atrial fibrillation, and an increased need for blood product transfusions. In the adjusted group, CT and CRT patients had a higher rate of cardiovascular complications (CT p = 0.002; OR 2.29; 95% CI 1.34-3.94 and CRT p = 0.001; OR 2.90; 95% CI 1.52-5-52), arrhythmias (CT p = 0.013; OR 2.23; 95% CI 1.18-4.20 and CRT p = 0.046; OR 2.22; 95% CI 1.01-4.90) and transfussions (CT p = 0.042; OR 2.95; 95% CI 1.04-8.35 and CRT p 0.001; OR 7.74; 95% CI 3.01-19-92).Based on our series, neoadjuvant CT and CRT were associated with a higher rate of cardiovascular complications, arrhythmias and transfussions in patients with NSCLC subjected to anatomic lung resection.

Published
2022

3. VATS lobectomy morbidity and mortality is lower in patients with the same ppoDLCO: Analysis of the database of the Spanish Video-Assisted Thoracic Surgery Group

Author

Borja Aguinagalde, Asier Insausti, Iker Lopez, Laura Sanchez, Sergio Bolufer, Raul Embun, Iñigo Royo-Crespo, José Luis Recuero Díaz, Sergi Call, Miguel Congregado, David Gómez-de Antonio, Marcelo F. Jimenez, Nicolas Moreno-Mata, Sergio Amor-Alonso, Miguel Jesús Arrarás, Ana Isabel Blanco Orozco, Marc Boada, Alberto Cabañero Sánchez, Isabel Cal Vázquez, Ángel Cilleruelo Ramos, Silvana Crowley Carrasco, Elena Fernández-Martín, Santiago García-Barajas, Maria Dolores García-Jiménez, Jose María García-Prim, Jose Alberto Garcia-Salcedo, Juan José Gelbenzu-Zazpe, Carlos Fernando Giraldo-Ospina, María Teresa Gómez Hernández, Jorge Hernández, Jennifer D. Illana Wolf, Alberto Jauregui Abularach, Unai Jiménez, Iker López Sanz, Néstor J. Martínez-Hernández, Elisabeth Martínez-Téllez, Lucía Milla Collado, Roberto Mongil Poce, Francisco Javier Moradiellos-Díez, Ramón Moreno-Balsalobre, Sergio B. Moreno Merino, Carme Obiols, Florencio Quero-Valenzuela, María Elena Ramírez-Gil, Ricard Ramos-Izquierdo, Eduardo Rivo, Alberto Rodríguez-Fuster, Rafael Rojo-Marcos, David Sanchez-Lorente, Laura Sanchez Moreno, Carlos Simón, Juan Carlos Trujillo-Reyes, Florentino Hernando Trancho, Cipriano López, Juan José Fibla, and Julio Sesma

Subjects
Lung cancer surgery, medicine.medical_specialty, Lung Neoplasms, business.industry, Thoracic Surgery, Video-Assisted, medicine.medical_treatment, VATS lobectomy, General Medicine, medicine.disease, Surgery, Treatment Outcome, Thoracotomy, Cardiothoracic surgery, Relative risk, Propensity score matching, medicine, Risk of mortality, Humans, Morbidity, Lung cancer, business, Pneumonectomy, Retrospective Studies
Abstract

Measuring predicted post-operative diffusion capacity of the lung for carbon monoxide (ppoDLCO) is essential to determine patient operability and to stratify the risk of patients who are candidates for major lung cancer surgery. Studies that established surgical risk variables were based on open surgery series. The aim of our study was to analyze morbidity and mortality as a function of ppoDLCO and to compare its behavior in open and video-assisted thoracic surgery (VATS).We compared 90-day mortality and morbidity in patients undergoing open surgery versus VATS as a function of decline in ppoDLCO. Propensity score matching (using age, ASA, arterial vascular disease, BMI, gender, stage, ppoDLCO, and ppoFEVOf 2,530 patients with lung cancer and ppoDLCO values, a sample of 1,624 (812 per group) was obtained after score matching. The relative risk of mortality associated with thoracotomy in patients with ppoDLCO 60 is 2.66 (p 0.02) compared to VATS. The risk of thoracotomy in terms of overall and cardiac and respiratory morbidity is higher than that of VATS for almost all ppoDLCO values.Major resection by VATS shows lower morbidity and mortality in patients with the same ppoDLCO. A steady rise in the risk of mortality begins to occur at higher ppoDLCO values in thoracotomy (∼60) than in VATS (∼45).

Published
2020

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