Objective To analyze the perioperative outcomes of uniportal thoracoscopic lobectomy compared with three-port thoracoscopic lobectomy. Methods Data were extracted from the Western China Lung Cancer Database, a prospectively maintained database at the Department of Thoracic Surgery, West China Hospital, Sichuan University. Perioperative outcomes of the patients who underwent uniportal or three-port thoracoscopic lobectomy for lung cancer during January 2014 through April 2021 were analyzed by using propensity score matching. Altogether 5 817 lung cancer patients were enrolled who underwent thoracoscopic lobectomy (uniportal: 530 patients; three-port: 5 287 patients). After matching, 529 patients of uniportal and 1 583 patients of three-port were included. There were 529 patients with 320 males and 209 females at median age of 58 (51, 65) years in the uniportal group and 1 583 patients with 915 males and 668 females at median age of 58 (51, 65) years in the three-port group. Results Uniportal thoracoscopic lobectomy was associated with less intraoperative blood loss (20 mL vs. 30 mL, P<0.001), longer operative time (115 min vs. 105 min, P<0.001) than three-port thoracoscopic lobectomy. No significant difference was found between the two groups regarding the number of lymph node dissected, rate of conversion to thoracotomy, incidence of postoperative complication, postoperative pain score within 3 postoperative days, length of hospital stay, or hospitalization expenses. Conclusion Uniportal video-assisted thoracoscopic lobectomy is safe and effective, and the overall perioperative outcomes are comparable between uniportal and three-port strategies, although the two groups show differences in intraoperative blood loss.
Objective To evaluate the survival outcomes of segmentectomy versus lobectomy for T1c non-small cell lung cancer (NSCLC). Methods We searched PubMed, EMbase, Cochrane Central Register of Controlled Trials (CENTRAL), CNKI (China National Knowledge Infrastructure), and Wanfang Data, with the search time limit set from the inception of the databases to February 2024. Three researchers independently screened the literature, extracted relevant information, and evaluated the risk of bias of the included literature according to the Newcastle-Ottawa Scale (NOS). Meta-analysis was conducted using STATA 15.1. Results A total of 8 retrospective cohort studies were included, involving 7 433 patients. The NOS scores of the included studies were all ≥7 points. Patients who underwent lobectomy had significantly higher five-year overall survival (OS) rates compared to those who underwent segmentectomy (adjusted HR=1.11, 95%CI 0.99-1.24, P=0.042). Compared with lobectomy, segmentectomy showed no significant difference in adjusted three-year OS rate (adjusted HR=0.88, 95%CI 0.62-1.24) and adjusted five-year lung cancer-specific survival (adjusted HR=1.10, 95%CI 0.80-1.51, P=0.556) of patients with T1c NSCLC. Moreover, there were no differences in the five-year adjusted relapse-free survival (adjusted HR=1.23, 95%CI 0.82-1.85, P=0.319), and adverse events (OR=0.57, 95%CI 0.37-0.90, P=0.015) in the segmentectomy group were significantly less than those in the lobectomy group. Subgroup analysis based on whether patients received neoadjuvant therapy showed that among studies that excluded patients who received neoadjuvant therapy, no significant difference in 5-year adjusted OS rate was observed between the segmentectomy group and lobectomy group (adjusted HR=1.02, 95%CI 0.81-1.28, P=0.870). Conclusion Segmentectomy and lobectomy show no significant difference in long-term survival in stage T1c NSCLC patients, with segmentectomy associated with fewer postoperative complications. Further high-quality research is needed to confirm the comparative efficacy and safety of lobectomy and segmentectomy for T1c NSCLC patients.
Abstract: Objective To summarize the clinical experiences of videoassisted thoracoscopic surgery (VATS) lobectomy performed on a series of 300 consecutive patients, and report the results of a 3year followup. Methods We retrospectively analyzed the clinical data of 300 consecutive patients who underwent VATS lobectomy from September 2006 to December 2009 in the Department of Thoracic Surgery, People’s Hospital of Peking University. Of the 300 patients, there were 159 males and 141 females with the age ranged from 18 to 86 years (58.30±13.90 years). Preoperative diagnosis showed that there were 266 patients of mass in the lung, 22 of bronchiectasis, 5 of cyst/abscess in the lung, 3 of pulmonary sequestration, 2 of fungus infection, and 2 of pneumothorax. We assessed the perioperative variables by standard descriptive statistics and estimated the 3year survival rate by KaplanMeier analyses. Results Sixtysix patients were diagnosed to have benign diseases and 234 patients were with malignancies. A percentage of 81.82% (54/66) of the benign patients had infectious diseases, and the majority of the malignancies was nonsmall cell lung cancer (213 patients), especially adenocarcinomas which comprised 73.08% (171/234) of all the malignancies. A total of 273 patients accomplished VATS lobectomy, of whom 27 patients required conversion to thoracotomy at a conversion rate of 9.00%(27/300). In the VATS lobectomy accomplished group, the mean operation time was 317±088 h, and the blood loss was 225.70±195.20 ml. Benign surgery took significantly less time (t=2.280, P=0.0032) and had shorter drainage time(t=1.392, P=0.0304) than those of malignancies. Dense adhesions between lymph nodes and blood vessels was the primary reason for conversion to thoracotomy in 17 patients at a percentage of 62.96%(17/27). Bleeding was the second reason for conversion in 5 patients at a percentage of 1852%. The patients in the upper lobe lobectomy group showed significantly higher risk of conversion compared with those in the nonupper lobe surgery group (χ2=6.131, P=0.013), while gender (χ2=1.182, P=0.277), pathology (χ2=0.210, P=0.647) and the tumor located in left or right side(χ2=2.933, P=0.087) didn’t influence the risk of conversion. The result of the 3year followup showed that there was no reoccurrence of symptoms in patients with benign diseases; Nonsmall cell lung cancer patients had a 3year survival rate of 0.87 with the 95% confidence interval (CI) from 0.77 to 0.96, and pathologic stage I patients at 0.91 with the 95%CI from 0.85 to 0.98. Conclusion VATS lobectomy is safe and effective. This research shows that domestic technologies of VATS lobectomy and its midterm results have reached the international standard.
Abstract: Objective To investigate the feasibility of videoassisted thoracoscopic surgery (VATS) ronchial sleeve lobectomy for lung cancer, and to describe this treatment method. Methods Between December 2010 and April 2011, three patients in our hospital underwent VATS bronchial sleeve lobectomy as treatment for right upper lobe nonsmall cell lung cancer. The patients were one female and two males, aged 61, 65, and 62 years. Surgical incisions were the same as for singledirection VATS right upper lobectomy. The right superior pulmonary vein was firstly transected, followed by the first branch of the pulmonary artery. Then, the lung fissure was transected and the mediastinal lymph nodes, including the subcarinal nodes, were also dissected to achieve sufficient exposure of the right main bronchus. The bronchus was transected via the utility incision, and the anastomosis was accomplished by continuous suture with 30 Prolene stitches. Another 0.5 cm port in the 7th intercostal space at the posterior axillary line was added in the third operation for handling of a pair of forceps to help hold the needle during anastomosis. A sealing test was performed to confirm that there was no leakage after completion of the anastomosis, and the stoma was covered with biological material. Bronchoscopy was performed to clear airway secretions and to confirm that there was no stenosis on postoperative day (POD) 1. Results The lobectomy and lymph node dissection was finished in 5158 minutes (averaging 54.7), and the time needed foranastomosis was 4055 minutes (averaging 45.7). Total blood loss was 55230 ml (averaging 155.0 ml). Number of dissected lymph nodes was 1821 (averaging 19.3). One patient was diagnosed with adenocarcinoma of the right upper lobe with metastatic hilar lymph node invasive to the right upper lobar bronchus. The other two patients were both diagnosed with centrally located squamous cell carcinoma of the right upper lobe, and all the patients achieved microscopically negative margins. There was no stenosis of the anastomosis stoma, and the postoperative course was uneventful. These patients were discharged on POD 810 (averaging 8.7 days), and they recovered well during the followup period, which lasted 2 to 6 months. [WTHZ]Conclusion [WTBZ]For experienced skillful thoracoscopic surgeons, VATS bronchial sleeve lobectomy is safe and feasible. Making the incisions of a singledirection VATS lobectomy with an additional miniport may be an ideal approach for this procedure.
Objective To explore the risk factors and short-term clinical effect of conversion to open thoracotomy during thoracoscopic lobectomy for lung cancer patients. Methods We retrospectively analyzed the clinical data of 423 lung cancer patients who were scheduled for thoracoscopic lobectomy between March 2011 and November 2015.There were 252 males and 171 females at median age of 60 (24-83) years. According to the patients who were and were not converted to thoracotomy, they were divided into a conversion group (378 patients) and a video-assisted thoracic surgery group (a VATS group, 45 patients). Then, clinical data of two groups were compared, and the risk factors and short-term clinical effect of unplanned conversions to thoracotomy were analyzed. Results Lymph nodes of hilar or/and interlobar fissure closely adhered to adjacent vessels and bronchi was the most common cause of unexpected conversions to thoracotomy in 15 patients (33.3%), followed by sleeve lobectomy in 11(24.4%) patients, uncontrolled hemorrhage caused by intraoperative vessel injury in 8 patients, tumor invasion or extension in 5 patients, difficulty of exposing bronchi in 3 patients, close adhesion of pleural in 2 patients, incomplete interlobar fissure in 1 patient. Conversion did translate into higher overall postoperative complication rate (P=0.030), longer operation time (P<0.001), more intraoperative blood loss (P<0.001). In the univariable analysis, the type of operation, the anatomical site of lung cancer, the lymph node enlargement of hilar in CT and the low diffusion capacity for carbon monoxide (DLCO) were related to conversion. Logistic regression analysis showed that the independent risk factors for conversion were sleeve lobectomy (OR=5.675, 95%CI 2.310–13.944, P<0.001), the lymph node enlargement of hilar in CT (OR=3.732, 95%CI 1.347–10.341, P=0.011) and DLCO≤5.16 mmol/(min·kPa)(OR=3.665, 95%CI 1.868–7.190, P<0.001). Conclusions Conversion to open thoracotomy during video-assisted thoracic surgery lobectomy for lung cancer does not increase mortality, and it is a measure of reducing the risk of surgery. Therefore, with high-risk patients who may conversion to thoracotomy, the surgeon should be careful selection for VATS candidate. And, if necessary, the decision to convert must be made promptly to reduce short-term adverse outcome.
Objective To compare the efficacy of the single tube (ST) and double tube (DT) for closed thoracic drainage after lobectomy. Methods The PubMed, Medline, EMbase, Web of Science, CNKI, Wanfang Database, VIP database and CBMdisc from inception to March 30, 2018 were searched by computer to identify randomized controlled trial (RCT) about ST and DT drainage after lobectomy. Based on inclusion and exclusion criteria the literature was screened. Meta-analysis was performed using RevMan 5.3 software. Results Twelve RCTs were enrolled in this meta-analysis, including 1 442 patients. Compared with the patients using DT after lobectomy, the patients using ST had significantly less postoperative pain (MD=–0.64, 95%CI –0.71 to –0.56, P<0.000 01) and shorter duration of drainage (MD=–0.62, 95%CI –0.78 to –0.46, P<0.000 01) and hospital stay (MD=–0.55, 95%CI –0.80 to –0.29, P<0.000 1). Besides, there was no significant difference in postoperative complications (RR=1.11, 95%CI 0.83 to 1.49, P=0.49), air leaks (RD=0.03, 95%CI –0.02 to 0.08, P=0.19) and the redrainage rate (RR=0.89, 95%CI 0.51 to 1.54, P=0.67). ConclusionST drainage after lobectomy is effective, which reduces postoperative pain and duration of hospital stay and drainage, and moreover, does not increase the postoperative complications and redrainage rate.
ObjectiveTo explore the application effect of the individualized preoperative visit to the da Vinci Robotic lobectomy patients. MethodSixty lobectomy patients with 34 males and 26 females at age of 29 to 78 (58.4±12.4) years were divided into two groups according to the order of their medical treatment in our hospital between June 2014 and December 2014. In the control group we used conventional reoperative visit method, while in the observation group we used individualized preoperative visit method. And the rehabilitation effects of the two groups were compared. ResultsPostoperative drainage tube time (6.17±1.34 d vs. 7.13±1.17 d, P=0.004) and length of hospital stay (7.13±1.17 d vs. 8.37±1.92 d, P=0.004) were significantly shorter in the observation group than those in the control group. Postoperative pain score was significantly lower in the observation group than that in the control group (0.87±0.73 points vs. 2.60±0.81 points, P=0.000). Also in the observation group the patients had a higher degree of satisfaction with a statistical difference (P<0.05). ConclusionIndividualized preoperative visit relieves patients' concern of the effect of the robotic operation, effectively reduces the psychological pressure of patients, strengthens the confidence of patients to overcome the disease, so that patients can actively cooperate with the operation, which promote postoperative rehabilitation.
Objective To explore the advantages of postoperative chest drainage with 16F urinary catheter for video- assisted thoracoscopic surgery (VATS) lobectomy. Methods Data of 102 patients (October to December 2015) who under- went VATS lobectomy of lung disease with insertion of catheter (16 F urinary catheter or 28 F chest tube) were analyzed. The patients were divided into two groups including a 16F group (49 patients, with 16 F urinary catheter) and a 18F group (53 patients, with 18F chest drainage tube).The following post-operative data were evaluated: primary healing of tube inci- sion, chest X ray abnormalities (pneumothorax, pleural effusion, subcutaneous emphysema, and hematoma), drainage time, re-insert the drainage tube, and wound healing at the site of insertion. Results Both groups were similar in age, gender, co-morbidity and pathological evaluation of resected specimens. After adjustment, no statistically significant difference was found between the two groups in pulmonary complications (30.6% vs. 28.3%, P=0.102), subcutaneous emphysema (60.0% vs. 6.7%, P=0.011), required intervention (2.0% vs. 5.7%, P=0.048). The average total drainage volume in the 16F group (587.3±323.7 ml) was less than that of the 28 F group (824.1±444.3 ml, P=0.000). The rate of primary healing at the site of insertion in the 16 F group (100.0%) was higher than that in the 28F group (58.5%, P=0.014). A significant difference was found in the drainage time and post-operative length of stay between the two groups (54.2±28.6 h vs. 95.6±65.5 h，4.2±1.4 d vs. 6.5±3.0 d). Conclusion Since 16F urinary catheter has advantage in fast track rehabilitation and low risk of pulmonary complications, the use of 16F urinary catheter is appropriate after VATS pulmonary lobectomy.