A systematic review and meta-analysis of thoracoscopic versus thoracotomy sleeve lobectomy

Zhong, Yifan; Wang, Yang; Hu, Xuefei; Wang, Gege; She, Yunlang; Deng, Jiajun; Zhang, Lei; Qiao, Peng; Zhu, Yuming; Jiang, Gening; Yang, Minglei; Xie, Dong; Chang, Chen

doi:10.21037/jtd-20-1855

Cited by 12 publications

(15 citation statements)

References 41 publications

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“…Since we only performed sleeve resection or bronchoplasty only by VATS, we were not able to compare the clinical outcomes from 3D VATS group and those from 2D VATS group. Our data revealed number of lymph nodes of 27.4 ± 13.2, operation time of 216.8 ± 60.0 minutes, hospital stay of median 6 days, and complication rate of 5.6%, which can be considered comparable from the previously reported excellent clinical outcomes from the 2D VATS sleeve lobectomy [ 31 , 32 ]. Uniportal VATS is gaining popularity these days but is reported to have some early difficulty and require a certain amount of learning curve because there is only one utility incision to share for the operator and the assistants [ 33 – 36 ].…”

Section: Discussionsupporting

confidence: 85%

“…Regarding clinical outcomes from 2D VATS sleeve lobectomy versus sleeve lobectomy via thoracotomy, 2D VATS lobectomy revealed favorable clinical outcomes from many reports. Zhong et al reported from their systematic review and meta-analysis that 2D thoracoscopic sleeve lobectomy is a safe and efficient procedure with comparable clinical outcomes and oncologic results compared to thoracotomy sleeve lobectomy [ 31 ]. Deng et al reported from their recent meta-analysis that 2D VATS sleeve lobectomy yielded less surgical trauma than thoracotomy sleeve lobectomy and improved postoperative recovery without compromising oncological prognosis.…”

Section: Discussionmentioning

confidence: 99%

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Video-assisted thoracic surgery sleeve resection and bronchoplasty using 3D imaging system: its safety and efficacy

Seong

Jeon

Jang

et al. 2021

J Cardiothorac Surg

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Background Video-assisted thoracic surgery sleeve resection with bronchial anastomosis or bronchoplasty is a technically demanding procedure. Three-dimensional endoscopic surgery has been reported to be helpful in decreasing operation time and improving spatial perception with less surgical errors, but there have been rare reports about relatively difficult thoracoscopic procedures utilizing 3D thoracoscope. We performed this study to evaluate early clinical outcomes of thoracoscopic sleeve resection and bronchoplasty utilizing 3D thoracoscope. Methods Data from a total of 36 patients who underwent thoracoscopic sleeve lobectomy or bronchoplasty at our institution from December 2015 to October 2017 were retrospectively reviewed. Three-port approach with one utility incision was used with a 10 mm, 30° three-dimensional thoracoscope. Twenty-three patients (81%) were male, and mean age was 65.9 ± 9.4 years. Fourteen patients (38.9%) underwent sleeve resection with bronchial anastomosis, 22 (61.1%) underwent wedge or simple bronchoplasty, and one patient received concomitant PA procedure. Bronchial anastomosis sites were not covered with viable tissue flaps. Results There was no (0%) suture needle injury from spatial misperception during bronchoplasty or sleeve anastomosis. There was no (0%) operative mortality. The pathologic report revealed squamous cell carcinoma (63.9%), adenocarcinoma (19.4%), carcinoid (6.9%), adenosquamous carcinoma (3.4%), and sarcomatoid carcinoma (2.8%). One (2.8%) late mortality was due to systemic recurrence of sarcomatoid carcinoma. There was no (0.0%) anastomotic failure. The mean number of dissected lymph nodes were 27.4 ± 13.2, and mean operation time was 216.8 ± 60.0 min. Median postoperative 24-h drain amount was 315 mL. Median chest tube days and hospital days were 4 and 6, respectively. Two patients (5.6%) had complications greater than Clavien-Dindo grade II—one case of ARDS, and the other case of a delayed bronchopleural fistula. Conclusions Thoracoscopic sleeve resection and bronchoplasty utilizing HD 3D thoracoscope is a safe and effective procedure with excellent early clinical outcomes. Further investigation for long-term outcomes will be needed.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Video-assisted thoracic surgery sleeve resection and bronchoplasty using 3D imaging system: its safety and efficacy

Seong

Jeon

Jang

et al. 2021

J Cardiothorac Surg

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“…And as an echo of the "shift from pneumonectomy to lobectomy in the 50s", anatomical sleeve resection is a validated oncologic alternative not only to prevent the risk of residual tumor, but also to reduce post-operative mortality and to prevent a reduced QoL due to pneumonectomy [119][120][121][122][123]. Thoracotomy is the main approach for sleeve resection, but there is no absolute contraindication to using a minimally invasive approach as VATS or RATS, representing a validated oncologic and functional alternative to open sleeve lobectomy or pneumonectomy without compromising oncologic prognosis [124][125][126][127][128]. In a modern surgical era, these patients should also be proposed preoperative rehabilitation and ERAS protocols in order to reduce postoperative complications and to enhance recovery after surgery.…”

Section: Surgery For Ct4 Nsclcmentioning

confidence: 99%

The Role of Surgery in Lung Cancer Treatment: Present Indications and Future Perspectives—State of the Art

Montagne

Guisier

Vénissac

et al. 2021

Cancers

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Non-small cell lung cancers (NSCLC) are different today, due to the increased use of screening programs and of innovative systemic therapies, leading to the diagnosis of earlier and pre-invasive tumors, and of more advanced and controlled metastatic tumors. Surgery for NSCLC remains the cornerstone treatment when it can be performed. The role of surgery and surgeons has also evolved because surgeons not only perform the initial curative lung cancer resection but they also accompany and follow-up patients from pre-operative rehabilitation, to treatment for recurrences. Surgery is personalized, according to cancer characteristics, including cancer extensions, from pre-invasive and local tumors to locally advanced, metastatic disease, or residual disease after medical treatment, anticipating recurrences, and patients’ characteristics. Surgical management is constantly evolving to offer the best oncologic resection adapted to each NSCLC stage. Today, NSCLC can be considered as a chronic disease and surgery is a valuable tool for the diagnosis and treatment of recurrences, and in palliative conditions to relieve dyspnea and improve patients’ comfort.

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“…Video-assisted thoracic surgery (VATS) was first used for the surgical treatment of non-small cell lung cancer (NSCLC) in the early 1990s. After more than 30 years of development, VATS has demonstrated outcomes comparable to thoracotomy and is now the treatment of choice for early-stage NSCLC (1).…”

Section: Introductionmentioning

confidence: 99%

Surgical techniques and outcome analysis of uniportal video-assisted thoracic surgery complex sleeve lung resection: a 20 case-series study

Soultanis

Jiang

2021

J Thorac Dis

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Background: Our study aims to explore the feasibility of uniportal video-assisted complex sleeve lung resection and summarize the surgical techniques and clinical outcomes. Methods: From June 2016 to April 2020, a total of 20 complex sleeve pulmonary and distal tracheal resections were performed by the single surgical team at the Thoracic Surgery Department of the Shanghai Pulmonary Hospital. We defined cases as complex sleeve pulmonary resections if they required pulmonary segment sleeve resection, extended sleeve resection (lobectomy plus segmentectomy of the remaining lobe), sleeve pneumonectomy, lobectomy plus carinoplasty or neo-carina construction, pulmonary-sparing main bronchus resection plus carina reconstruction, and distal trachea resection with end to end anastomosis. Results: The 20 cases comprised lung squamous cell carcinoma (n=11), lung adenocarcinoma (n=2), hamartoma (n=3), adenoid cystic carcinoma (n=2), carcinoid tumor (n=1), and pleomorphic carcinoma (n=1).The average blood loss during the operation was 250±126.17 mL (50-800 mL). The average operation time was 192.0±61.1 minutes. The average number of lymph node stations removed was 5.82±1.33, including station seven in all cases, and the median number of lymph nodes removed was 4.18±5.89. On the day of surgery, the drainage volume was 266±192.01 mL. The mean postoperative hospital stay was 5.37±1.86 days.Twelve of the 16 patients diagnosed with malignancy received postoperative chemotherapy. Granuloma formation at the anastomosis level led to stenosis in one case, and tumor recurrence occurred in one case. Broncho-esophageal fistula occurred in one patient after radiochemotherapy. The postoperative follow-up time was 15.6±10.7 months. The 30-day mortality was zero, and at one-year follow-up, only one patient had died of metastatic disease after the operation. Conclusions: Uniportal video-assisted complex sleeve pulmonary resections are feasible when conducted by experienced teams.

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A systematic review and meta-analysis of thoracoscopic versus thoracotomy sleeve lobectomy

Cited by 12 publications

References 41 publications

Video-assisted thoracic surgery sleeve resection and bronchoplasty using 3D imaging system: its safety and efficacy

Video-assisted thoracic surgery sleeve resection and bronchoplasty using 3D imaging system: its safety and efficacy

The Role of Surgery in Lung Cancer Treatment: Present Indications and Future Perspectives—State of the Art

Surgical techniques and outcome analysis of uniportal video-assisted thoracic surgery complex sleeve lung resection: a 20 case-series study

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