Objective To investigate the relationship between preoperative mean daily step counts and pulmonary complications after thoracoscopic lobectomy in elderly patients. Methods From 2018 to 2021, the elderly patients with pulmonary complications after thoracoscopic lobectomy were included. A 1∶1 propensity score matching was performed with patients without pulmonary complications. The clinical data were compared between the two groups. ResultsTotally, 100 elderly patients with pulmonary complications were enrolled, including 78 males and 22 females, aged 66.4±4.5 years. And 100 patients without pulmonary complications were matched, including 71 males and 29 females aged 66.2±5.0 years. There was no significant difference in the preoperative data between the two groups (P>0.05). Compared to the patients with pulmonary complications, the ICU stay was shorter (8.1±4.4 h vs. 12.9±7.5 h, P＜0.001), the first out-of-bed activity time was earlier (8.8±4.5 h vs. 11.2±6.1 h, P=0.002), and the tube incubation time was shorter (19.3±9.2 h vs. 22.5±9.4 h, P=0.015) in the patients wihout pulmonary complications. There was no statistical difference in other perioperative data between the two groups (P>0.05). The mean daily step counts in the pulmonary complications group were significantly less than that in the non-pulmonary complications group (4 745.5±2 190.9 steps vs. 6 821.1±2 542.0 steps, P＜0.001). The daily step counts showed an upward trend for three consecutive days in the two groups, but the difference was not significant. Conclusion The decline of preoperative mean daily step counts is related to pulmonary complications after thoracoscopic lobectomy in elderly patients. Recording daily step counts can promote preoperative active exercise training for hospitalized patients.
Objective To clearly define and describe the difference of analgesic actions and side effects between dezocine and parecoxib sodium in video-assisted thoracic surgery (VATS) lobectomy. Methods Ninety patients underwent thoracotomy (lobectomy) and were hospitalized in the Department of Thoracic Surgery, West China Hospital, Sichuan University between August 2015 and January 2016. Patients were randomly divided into two groups including a parecoxib sodium group (a PG group, 43 patients) and a dezocine group (a DG group, 47 patients). We analyzed the occurrence of side effects in the two groups, as well as other outcomes including visual analogous scores and location of the pain et al. Results The occurrences of nausea, vomit and abdominal distention in the PG group (9.30%, 2.33%, 13.95%) were significantly lower than those of the DG group (25.53%, 17.02%, 40.43% , P=0.046, P=0.032, P=0.009) in the early period after operation. Pain scores at the postoperative 12 h, 24 h, 48 h and 72 h in the PG group (2.56±0.96, 2.47±0.96, 1.93±0.99, 0.98±1.24) were better than those of the DG group (4.00±1.60, 3.62±1.48, 3.36±1.55, 2.47±1.78,P=0.000, P=0.000, P=0.000, P=0.002). And the same results were found in the postoperative coughing VAS assessment. The mostly reported pain location was the chest drainage, incision site and chest wall in turn. Postoperative pain properties, in turn, were swelling, stabbing pain and numbness. Conclusion Postoperative pain after VATS lobectomy may be adequately controlled using parecoxib sodium. The low pain scores and decreased adverse effects are achieved.
ObjectiveTo investigate the impact of chronic obstructive pulmonary disease (COPD) and surgical approach on postoperative fast track recovery and hospitalization cost of patients undergoing lung cancer resection, and explore clinical pathways and clinical value of fast track recovery. MethodClinical data of 129 consecutive patients undergoing lung cancer resection by one surgical group in West China Hospital from January 2010 to March 2011 were retrospectively analyzed. According to whether the patients had concomitant COPD, all the patients were divided into COPD group including 53 patients (39 males and 14 females) with their average age of 56.31±10.51 years, and non-COPD group including 76 patients (37 males and 39 females) with their average age of 65.92±7.85 years. According to different surgical approaches, all the patients were divided into complete video-assisted thoracoscopic surgery (VATS) group including 83 patients (44 males and 39 females) with their average age of 61.62±10.80 years, and routine thoracotomy group including 46 patients (32 males and 14 females) with their average age of 62.95±9.97 years. Postoperative morbidity, average hospital stay and hospitalization cost were compared between respective groups. ResultsThere was no statistical difference in postoperative morbidity (53% vs. 40%, P=0.134)or average hospital stay[(7.66±2.95) days vs. (7.36±2.74)days, P=0.539] between COPD group and non-COPD group. Postoperative morbidity (34% vs. 65%, P < 0.001)and average hospital stay[(6.67±2.52)days vs. (8.61±3.01) days, P < 0.001] of VATS group were significantly lower or shorter than those of routine thoracotomy group. Total hospitalization cost (￥44 542.26±11 447.50 yuan vs. ￥23 634.13±6 014.35 yuan, P < 0.001) and material cost (￥37 352.53±11 807.81 yuan vs. ￥12 763.08±7 124.76 yuan, P < 0.001) of VATS group were significantly higher than those of routine thoracotomy group. Average medication cost of VATS group was significantly lower than that of routine thoracotomy group (￥7 473.54±4 523.70 vs. ￥10 176.71±6 371.12, P < 0.001). There was no statistical difference in other cost between VATS group and routine thoracotomy group. ConclusionVATS lobectomy can promote postoperative fast track recovery of lung cancer patients, but also increase material cost of the surgery. COPD history does not influence postoperative fast track recovery or hospitalization cost.
ObjectiveTo evaluate the effectiveness and safety of a central venous catheter for thoracic drainage after video-assisted thoracoscopic lobectomy compared with a conventional chest tube.MethodsThis study collected 200 patients with lung cancer who underwent thoracoscopic lobectomy and systematic hilar and mediastinal lymph node dissection between January 2018 and September 2019 in our hospital. The patients were randomly divided into two groups, including a group A (left with 28F chest tubes postoperatively) and a group B (left with 12G central venous catheters postoperatively). Patients in both groups were left with 2 chest tubes after upper lobectomy and 1 chest tube after middle or lower lobectomy. Duration and total volume of drainage, length of hospital stay, maximum visual analogue scale score and so forth were compared between the two groups.ResultsFinally, 151 patients were included for analysis. There were 73 patients in the group A, including 26 males and 47 females, with an average age of 55.38±9.95 years, and 78 patients in the group B, including 37 males and 41 females, with an average age of 59.86±10.18 years. No statistical difference was found between the two groups in drainage volume on postoperative day 2, and proportion of prolonged air leaks, hemothorax, chylothorax or drain reinsertion (all P>0.05). There was a statistical difference in drainage volume on postoperative day 1 [200.0 (120.0, 280.0) mL vs. 57.5 (10.0, 157.5) mL, P=0.000], postoperative day 3 [155.0 (100.0, 210.0) mL vs. 150.0 (80.0, 215.0) mL, P=0.023], total volume of drainage [890.0 (597.5, 1 530.0) mL vs. 512.5 (302.5, 786.3) mL,P=0.000], maximum pain score (2.29±0.72 points vs. 2.09±0.51 points, P=0.013) and length of hospital stay [7 (7, 9) d vs. 5 (4, 7) d, P=0.000].ConclusionCompared with conventional chest tubes, central venous catheters for chest drainage in patients with lung cancer after thoracoscopic lobectomy shortens the length of hospital stay and reduces postoperative pain.
ObjectiveTo compare and analyze clinical effects of video-assisted thoracoscopic surgery (VATS) lobectomy and systematic lymph node harvests for peripheral non-small cell lung cancer (PNSCLC) patients between single-port (SP) and multi-port (MP) with a propensity-matched analysis. MethodsWe retrospectively analyzed the clinical data of 324 patients presented with PNSCLC and admitted in the Affiliated Hospital of Qingdao University from January 2013 through December 2015. Six-eight patients underwent single-port thoracoscopic lobectomy were as a SP group and 256 patients with multi-port thoracoscopic lobectomy. Another 68 patients were produced by a propensity-matched analysis in these 256 patients, to match with SP group as a MP group. There were 26 males and 42 females at age of 54-62 (59.3±10.3) years in the SP group. There were 32 males and 36 females at age of 50-66 (61.5±9.4) years in the MP group. Perioperative outcomes were compared between the two groups. ResultsAll operations were accomplished successfully, without conversion to thoracotomy. Most postoperative outcomes were similar in intraoperative blood loss (136.3±22.7 ml vs. 142.2±20.3 ml), conversion (4.4% vs. 7.4%), lymph node dissection number (19.9±3.5 vs. 20.0±3.0), station (7.9±2.3 vs. 8.3±2.1), postoperative drainage volume (761.4±182.3 ml vs. 736.9±176.4 ml), chest drainage duration (5.2±1.5 d vs. 5.8±1.8 d), length of hospital stay (5.5±2.0 d vs. 5.0±2.5 d), and postoperative complications (2.9% vs. 7.4%) between the two groups (P > 0.05). There were statistical differences in operation time (138.2±20.3 min vs. 126.4±22.4 min), downtrend of pain scores (P=0.03), and patients' satisfaction level (8.8±1.4 vs. 7.3±2.3, P < 0.05). Concision Single-port thoracoscopic lobectomy is not inferior to multi-port and is a safe and feasible surgical procedure for the management of PNSCLC.
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.
Objective To investigate the impact of complete video-assisted thoracoscopic lobectomy and open lobectomy on perioperative heart rate （HR） and blood oxygen saturation （SO2） of lung cancer patients，and explore whether minimally invasive surgery can enhance postoperative recovery of lung cancer patients. Methods A total of 138 lung cancer patients were chosen from 161 consecutive patients with pulmonary diseases who were admitted to West China Hospital of Sichuan University between September 2010 and December 2011. According to different surgical approach，all the 138 lung cancer patients were divided into routine thoracotomy group （thoracotomy group，70 patients including 53 males and 17 females with their average age of 56.1±9.7 years） and complete video-assisted thoracoscopic lobectomy group （VATS group，68 patients including 46 males and 22 females with their average age of 53.4±6.5 years）. There was no statistical difference in preoperative clinical characteristics between the 2 groups. Preoperative and postoperative （1st，3rd，7th and 30th day） numeric pain rating scale （NPRS），HR and SO2 were compared between the 2 groups. Results （1） There was no statistical difference in NPRS on the 1st and 3rd postoperative day between the 2 groups （3.83±0.79 vs. 3.93±0.67， 2.88±0.59 vs. 3.03±0.71，P＞0.05），but on the 7th and 30th postoperative day，NPRS of the thoracotomy group was signi- ficantly higher than that of VAST group （1.61±0.33 vs. 1.22±0.12，1.58±0.26 vs. 1.19±0.31，P＜0.05）. （2） Postop- erative sedentary HR of both VATS group and thoracotomy group were significantly higher than preoperative levels ［（84.13±17.21） / minute vs. （73.67±10.32）/minute， （86.13 ±19.67） / minute vs. （72.24±14.21） / minute， P＜0.05］. Postoperative HR of VATS group decreased to preoperative level on the 3rd postoperative day，while postoperative HR of the thoracotomy group decreased to preoperative level on the 7th postoperative day. （3） There was no statistical difference between preoperative and postoperative （all the time points） sedentary SO2 of both VATS group and thoracotomy group （96.34 %±2.11% vs. 97.12%±2.31%，95.33%±4.13% vs. 94.93% ±4.31%，P＞0.05）.（4） The changes of HR and SO2 before and after exercise of VATS group were significantly smaller than those of the thoracotomy group on the 3rd postoperative day ［（11.11±4.81）/minute vs. （18.23±6.17）/minute，3.1%±1.2% vs. 7.4 %±2.7%，P＜0.05］ . Conclusion The impact of complete video-assisted thoracoscopic lobectomy on cardiopulmonary function is comparatively smaller，which is helpful for postoperative fast-track recovery of lung cancer patients.
Objective To investigate the risk factors of postoperative urinary retention of non-small cell lung cancer patients undergoing video-assisted thoracoscopic surgery (VATS) lobectomy without indwelling urinary catheterization. Methods In this prospective trial, we recruited 148 patients who were scheduled for lung cancer lobectomy under general anesthesia by VATS in Department of Thoracic Surgery in West China Hospital from July through December 2015. These patients were divided into two groups including a trial group and a control group. There was no indwelled urethral catheter in the trial group. And the patients in the control group were indwelled urethral catheter routinely. Postoperative urinary retention, urinary tract infection, the postoperative hospitalization duration and the clinical data were recorded. Results There was no significant difference between the trial group and the control group in postoperative urinary retention (9.46% vs. 6.76%, P=0.087). However, the ratios of the male patients and the patients with history of abdomen operation, and international prostate symptom score (IPSS) of the urinary retention patients (83.33%, 33.33%, 26.55±7.00) were statistically higher than those of the patients without urinary retention (56.62%, 0.00%, 15.31±8.31, P=0.017, P=0.000, P=0.031). Postoperative urinary tract infection rates in the trial group and the patients with urinary retention (4.05%，25%) were statistically higher than those in the control group and the patients without urinary retention (1.35%, 0.74%, P=0.049, P=0.048). Conclusion The risk factors of postoperative urinary retention patients with non-small cell lung cancer undergoing VATS lobectomy are male patients, history of abdomen operation, and moderate to severe hyperplasia of prostate.
Objective To explore the effect of early short-term use of low-dose steroids on early acute lung injury (EALI) after video-assisted thoracoscopic lobectomy. Methods Patients who underwent video-assisted thoracoscopic lobectomy in our department from January 2019 to January 2022 were selected for this retrospective cohort study. They were divided into an early steroid treatment group and a control group based on whether steroids were used in the early postoperative period. In the early steroid treatment group, in addition to routine postoperative treatment, low-dose methylprednisolone was administered intravenously, at 80-120 mg/d for 3 consecutive days. In the control group, routine postoperative treatment was given, but no steroids were used in the first 3 days. A chest computed tomography (CT) scan was performed on postoperative day (POD) 1, and POD3 or POD4 to assess lung injury. Chest CT scores, the EALI incidence, the length of hospital stay, and the incidence of poor incision healing were recorded. ResultsA total of 521 patients were included, consisting of 255 males and 266 females, aged 11-80 years. There were 203 patients in the early steroid treatment group and 318 patients in the control group. On POD1, the incidence of EALI was 16.0% in the control group and 13.8% in the steroid group, with no significant difference between the two groups (P>0.05). There was also no significant difference in the CT scores of patients with EALI in the two groups (P>0.05). On POD3/4, the incidence of EALI was 33.6% in the control group and 22.7% in the steroid group, showing a significant difference (P=0.007). When comparing the CT scores of patients with EALI in both groups, the scores were lower in the steroid group, but the difference was not significant (P>0.05). The overall incidence of EALI on POD1-4 was 37.4% in the control group and 26.1% in the steroid group, showing a significant difference (P=0.007). Of these, 28.9% of patients in the control group showed radiological progression, which means new EALI occurred or existing EALI progressed, while the progression rate was 14.8% in the steroid group (P<0.001). The length of hospital stay was significantly shorter in the steroid group compared to the control group (P<0.001), but the incidence of poor incision healing was not (P>0.05). Conclusion Early use of corticosteroids cannot reduce the incidence and severity of EALI on POD1, but it can reduce the incidence of EALI on POD3/4 and decrease the risk of radiological progression, and also lower the overall risk of EALI after surgery, without extended postoperative hospital stays or increased incidence of poor incision healing. Therefore, early postoperative use of low-dose corticosteroids can help to inhibit the occurrence and progression of EALI. It is suggested to use as early as possible especially in patients with high risks of postoperative EALI.