Effects of degree of pulmonary fissure completeness on major in-hospital outcomes after video-assisted thoracoscopic lung cancer lobectomy: a retrospective-cohort study

Abstract

BackgroundTo evaluate the clinical significance of degree of pulmonary fissure completeness (PFC) on major in-hospital outcomes following video-assisted thoracoscopic (VATS) lobectomy for non-small-cell lung cancer (NSCLC).Materials and methodsWe carried out a single-center retrospective analysis on the prospectively maintained database at our unit between August 2014 and October 2015. Patients were divided into two groups based on their fissure sum average (FSA). Patients with FSA >1 (1< FSA ≤3) were considered to have incomplete pulmonary fissures (group A), while patients with FSA of 0–1 were considered to have complete pulmonary fissures (group B). Demographic differences in perioperative characteristics and surgical outcomes between these two groups were initially assessed. Then, a multivariate logistic-regression analysis was further conducted to identify the independent predictors for major in-hospital outcomes.ResultsA total of 563 patients undergoing VATS lobectomy for NSCLC were enrolled. There were 190 patients in group A and 373 patients in group B. The overall morbidity and mortality rates of our cohort were 30.6% and 0.5%, respectively. Group A patients had a significantly higher overall morbidity rate than group B patients (42.1% vs 24.7%, P<0.001). Both minor morbidity (40.5% vs 22%, P<0.001) and major morbidity (11.1% vs 5.6%, P=0.021) rates in group A patients were also significantly higher than group B patients. No significant difference was observed in mortality rate between these two groups (1.1% vs 0.3%, P=0.26). The incomplete degree of PFC was significantly correlated with length of stay and chest-tube duration (log-rank P<0.001) after surgery. Finally, the incomplete degree of PFC was found to be predictive of overall morbidity (OR 2.08, P<0.001), minor morbidity (OR 2.39, P<0.001), and major morbidity (OR 2.06, P=0.031) by multivariate logistic-regression analyses.ConclusionDegree of PFC is an excellent categorical predictor for both major and minor morbidity after VATS lobectomy for NSCLC.

Body surface area as a novel risk factor for chylothorax complicating video‐assisted thoracoscopic surgery lobectomy for non‐small cell lung cancer

“…We defined the PRI as the existence of one or more of the following preoperative infectious conditions: bacterial/viral/fungal respiratory tract infection, obstructive pneumonia, aspiration pneumonia, bronchiectasis, and lung abscess. Severe liver disease included hepatitis B and C, hepatocirrhosis, severe fatty liver, and hepatic parasitic infections …”

“…After surgery, patients were managed in compliance with a standardized clinical pathway. The institutional policies for intensive pulmonary rehabilitation, residual lung recruitment assessment, chest tube management, and discharge criteria, have been reported in our previous studies …”

“…Severe liver disease included hepatitis B and C, hepatocirrhosis, severe fatty liver, and hepatic parasitic infections. 6,12,13,[21][22][23] Multidisciplinary team meetings were held when necessary to discuss whether combined treatment modalities were required before surgery. Neoadjuvant/adjuvant therapy comprised cisplatin/paclitaxel-based chemotherapy or chemoradiotherapy with sustainable courses and dosages according to National Comprehensive Cancer Network Guidelines: China Edition.…”

“…The institutional policies for intensive pulmonary rehabilitation, residual lung recruitment assessment, chest tube management, and discharge criteria, have been reported in our previous studies. 6,12,13,[21][22][23][26][27][28][29] An algorithm of chylothorax management is shown in Figure 1. Once diagnosed with chylothorax, patients were initially managed with oral intake cessation (OIC) and total parenteral nutrition (TPN).…”

“…A frequency distribution histogram of BSA is presented in Figure 2. The mean BMI and BSA of the entire cohort were 23 The major characteristics of 26 chylothorax cases are summarized in Table 2. Twenty of these patients were initially managed with oral intake cessation plus total parenteral nutrition, and another six patients received a low-adipose diet.…”