Is faster better? Impact of operative time on postoperative outcomes after VATS anatomical pulmonary resection

Abstract

Background: Video-assisted thoracic surgery (VATS) is now the preferred approach for standard anatomical pulmonary resections. This study evaluates the impact of operative time (OT) on post-operative outcomes after VATS anatomical pulmonary resection for non-small cell lung cancer (NSCLC). Methods:We retrospectively reviewed all consecutive patients undergoing VATS lobectomy or segmentectomy for NSCLC between November 2010 and December 2019. Postoperative outcomes were compared between short (<150 minutes) and long (≥150 minutes) OT groups. A multivariable analysis was performed to identify predictors of long OT and overall post-operative complications.Results: A total of 670 patients underwent lobectomy (n=496, 74%) or segmentectomy (n=174, 26%) for NSCLC. Mediastinal lymph node dissection was performed in 621 patients (92.7%). The median OT was 141 minutes (SD: 47 minutes) and 387 patients (57.8%) were operated within 150 minutes. Neoadjuvant chemotherapy was given in 25 patients (3.7%). Conversion thoracotomy was realized in 40 patients (6%).Shorter OT was significantly associated with decreased post-operative overall complication rate (30% vs. 41%; P=0.003), shorter median length of drainage (3 vs. 4 days; P<0.001) and shorter median length of hospital stay (6 vs. 7 days; P<0.001). On multivariable analysis, long OT (≥150 minutes) (OR 1.64, P=0.006), ASA score >2 (OR 1.87, P=0.001), FEV 1 <80% (OR 1.47, P=0.046) and DLCO <80% (OR 1.5, P=0.045) were significantly associated with postoperative complications. Two predictors of long OT were identified: neoadjuvant chemotherapy (OR 3.11, P=0.01) and lobectomy (OR 1.5, P=0.032).Conclusions: A prolonged OT is significantly associated with postoperative complications in our collective of patients undergoing VATS anatomical pulmonary resection.

Surgery challenges and postoperative complications of lung cancer after neoadjuvant immunotherapy

“…However, left pneumonectomy might also bring about postoperative complications. Table 5 suggests that pneumonectomy and longer surgical time (challenging surgery) are independent risk factors for postoperative complications, which is consistent with the results of previous studies 31,32 . Foster et al 31 believe that a surgical duration greater than 150 min significantly increases the complications of the surgery, similar to the threshold of 148.6 min used for surgical difficulty appraisal in the present study.…”

“…Table 5 suggests that pneumonectomy and longer surgical time (challenging surgery) are independent risk factors for postoperative complications, which is consistent with the results of previous studies 31,32 . Foster et al 31 believe that a surgical duration greater than 150 min significantly increases the complications of the surgery, similar to the threshold of 148.6 min used for surgical difficulty appraisal in the present study. Jiang et al 32 reckon that, compared to sleeve resection, pneumonectomy has a higher 30‐ and 90‐day mortality rates, and the overall incidence of postoperative complications, inclusive of bronchopleural fistula and acute respiratory distress syndrome, is significantly increased.…”

Surgery Challenges and Postoperative Complications of Lung Cancer after Neoadjuvant Immunotherapy: A Cohort Study

“…However, left pneumonectomy might also bring about postoperative complications. Table 5 suggests that pneumonectomy and longer surgical time (challenging surgery) are independent risk factors for postoperative complications, which is consistent with the results of preceding studies [30,31]. Foster et al [30] believe that a surgical duration greater than 150 minutes signi cantly increases the complications of the surgery, similar to the threshold of 144.5 minutes used for surgical di culty appraisal in the present study.…”

Outside the Cage Subcostal RATS Lobectomy: Technical Aspects and Results of the First Series of a Novel Approach to Pulmonary Lobectomy

“…Prolonged operative time in MIS pulmonary resections has been reported to be associated with increased postoperative complications. [16][17][18] In this series, the mean operative time was 132.6 (98 to 223) min, which is lower than the threshold proposed by the cited authors at which complications are more frequently observed. In addition, a 25% decrease (mean 99.4 min) was observed in the second half of cases.…”