One-stage video-assisted thoracic surgery for bilateral multiple pulmonary nodules

Xu, Guoqiu; Fu, Xiangning

doi:10.21037/jtd.2019.01.10

Cited by 18 publications

(33 citation statements)

References 8 publications

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“…Although the trauma of one-stage operation is large and the need to remove more lung tissue, this may increase the potential perioperative risk, but its advantages are also obvious, it can solve the bilateral lesions in one operation, reduce the pain of the patient's secondary surgery, save medical resources, and more importantly, it can reduce the risk of tumor progression caused by staged surgery. Several studies [12][13][14] have shown that simultaneous bilateral VATS is safe and feasible, and does not increase the risk of perioperative surgery. In our study, there were no serious complications and deaths in perioperative period, all patients were discharged smoothly, except for the average operation time compared with unilateral surgery, intraoperative blood loss, postoperative thoracic drainage time and postoperative hospital stay days did not increase significantly, and the results were satisfactory.…”

Section: Discussionmentioning

confidence: 99%

Single-center experience of simultaneous bilateral uni-portal video-assisted thoracoscopic surgery for multiple ground-glass opacities

Zhang

et al. 2020

J Cardiothorac Surg

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Background: There is an increasing incidence rate of ground-glass opacity (GGO), especially for multiple GGOs (≥2). Whether it is safe and feasible to have bilateral simultaneous surgical resection remains unknown. The purpose of this study is to summarize the experience of surgical resection of patients with multiple GGOs in our Hospital in recent years, and to discuss the above questions. Methods: Clinical datas of patients who underwent one-stage bilateral uni-portal VATS resections of multiple pulmonary ground glass opacities and had routine pathological examination were collected from May 2016 to May 2019 in our hospital. Results: A total of 34 patients underwent simultaneous bilateral surgical resection of multiple GGO lesions, 28 were women,6 were men, the average age of total patients was 57.9 ± 6.7 years. All patients underwent bilateral uniportal video-assisted thoracoscopic surgery (Uni-portal VATS), the average intraoperative blood loss was 100.9 ± 67.7 ml, the average operation time was 140 ± 74.8 min, the average thoracic drainage time was 2.8 ± 3.1 days, and the average postoperative hospital stay was 4.2 ± 4.3 days. Postoperative complications including: 2 cases of infection, 3 cases of atrial fibrillation, and 5 cases of persistent air leakage for more than 3 days. All of them improved after treatment, and there were no serious complications and deaths in perioperative period. A total of 76 GGO lesions were resected, with a total malignancy rate of 81.6%, including 40 were pure GGO, of which 28 were malignant (70%), and the average diameter of them were 9.6 ± 3.8 mm; 36 were mixed GGO, of which 34 were malignant (94.4%), the average diameter of them were 15.6 ± 6.6 mm.Mean postoperative follow-up was 28.4 (range, 3-39) months. There was neither recurrence nor deaths at final follow-up. Conclusion: The malignancy rate of multiple GGOs is high. Therefore, when the lung function is allowed,one-stage bilateral uni-portal VATS can be considered. According to experience of main surgeon and the frozen biopsy, either sub-lobar resection or lobectomy was acceptable. The risk of postoperative complications and the prognosis were optimal.

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Section: Discussionmentioning

confidence: 99%

Single-center experience of simultaneous bilateral uni-portal video-assisted thoracoscopic surgery for multiple ground-glass opacities

Zhang

et al. 2020

J Cardiothorac Surg

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“…Although one‐stage surgical strategy for bSMPLCs could prevent patients from undergoing a second operation, reduce surgical trauma and hospitalization costs, minimize the risk of tumor progression during two operations and may provide better prognosis, there are still concerns about its perioperative safety. Several studies 6–10,20 have suggested simultaneous bilateral pulmonary resection by video‐assisted thoracoscopic surgery (VATS) is safe and feasible; however, most of those studies were retrospective of small sample size. Atrial fibrillation, pneumonia, persistent air leakage and transient respiratory insufficiency are common postoperative complications.…”

Section: Discussionmentioning

confidence: 99%

“…For BMPNs that need to be removed, most centers currently perform two‐stage bilateral pulmonary resection with intervals of weeks to months, and believe that perioperative risk of one‐stage surgery is significantly increased. Currently, the data of one‐stage surgical strategy is limited, and safety and effectiveness of simultaneous bilateral pulmonary resection are still controversial 5–10 . In this retrospective cohort study, we report our single‐center experience of simultaneous bilateral pulmonary resection for BMPNs and summarize its perioperative safety.…”

Section: Introductionmentioning

confidence: 98%

Simultaneous bilateral pulmonary resection via single‐utility port VATS for multiple pulmonary nodules: A single‐center experience of 16 cases

Huang

Sun

et al. 2020

Thoracic Cancer

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Background The detection rate of bilateral multiple pulmonary nodules (BMPNs) is increasing due to widespread use of chest computed tomography (CT) screening. However, there is no consensus on the treatment options for BMPNs and whether simultaneous bilateral pulmonary resection is safe remains controversial. The purpose of this study was to evaluate the feasibility and safety of simultaneous bilateral pulmonary resection for BMPNs. Methods A total of 16 consecutive patients with BMPNs who underwent simultaneous bilateral pulmonary resection in Beijing Hospital from June 2013 to July 2020 were enrolled in this study. Clinical characteristics, imaging and pathological features, and perioperative outcomes were retrospectively reviewed. Results There were 10 males and six females included in the study with a mean age of 61.9 (range: 39–78) years. A total of 35 nodules were resected in 16 patients including 12 patients with bilateral primary lung cancer, three patients with primary lung cancer on one side and a benign nodule on the contralateral side, and one patient with bilateral benign nodules. All patients underwent bilateral pulmonary resection via single‐utility port video‐assisted thoracoscopic surgery (VATS). Nine, four, two, and one patients underwent lobectomy with contralateral segmentectomy or wedge resection, segmentectomy with contralateral wedge resection, bilateral segmentectomy and bilateral wedge resection, respectively. All operations were accomplished successfully without intraoperative blood transfusion, conversion to thoracotomy, major complication and postoperative 90‐day death. The mean operation time was 220.1 ± 65.6 minutes, median thoracic drainage duration was four days (range: 2–8 days), mean pleural drainage was 1387.5 ± 694.7 mL, and median postoperative hospital stay was seven days (range: 5–18 days). There were three cases (18.8%) of minor complications, including one case of pulmonary air leakage, one case of atrial fibrillation, and one case of poor healing of surgical site. A total of 50% (8/16) of the patients had severe postoperative pain and required additional analgesia. Conclusions For selected patients, simultaneous bilateral pulmonary resection via single‐utility port VATS is a safe and feasible minimally invasive procedure for BMPNs. Adequate postoperative analgesia via a multimodal analgesia strategy should be used to prevent postoperative pain. Key points Significant findings of the study The incidence of major complication after minimally invasive bilateral pulmonary resection is low for patients with good pulmonary function, but there is a relatively high incidence of minor complications and pain at the surgical site. Adequate postoperative analgesia via multimodal analgesia strategy should be used to prevent postoperative pain. What this study adds For the treatment of bilateral multiple pulmonary nodules, simultaneous bilateral pulmonary resection via single‐utility port video‐assisted thoracoscopic surgery is safe and feasible for selected patients.

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“… 6 , 19 Theoretically, single-stage bilateral pulmonary resection also decreases the risk of disease progression, especially in patients with bilateral malignant tumors; shortens the patients’ total hospitalization time; and decreases postoperative complications. 11 – 13 , 20 Our study indicated that the incidence of unstable hemodynamics may increase in patients undergoing single-stage sequential bilateral VATS if these patients have a lower percent predicted forced vital capacity, longer surgical time, or higher preoperative neutrophil count. Therefore, the preoperative evaluation should be rigorous for patients who are scheduled for single-stage sequential bilateral thoracic surgery.…”

Section: Discussionmentioning

confidence: 83%

“…However, lobectomy and two combined procedures were more frequently performed among patients who underwent two-stage VATS because the patients could recover their pulmonary function after a few months. 13,22 Several published articles comparing different procedures have reported conflicting results, making it difficult to achieve a consensus on which procedure is the best for small pulmonary nodules. 23,24 Our study showed no difference in tumor size, pathologic classification, preoperative chemotherapy, or surgical site in our study.…”

Section: Discussionmentioning

confidence: 99%

Comparison of single-stage and two-stage bilateral video-assisted thoracic surgery

et al. 2020

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Objective Single-stage sequential bilateral video-assisted thoracoscopic surgery (VATS) is a controversial procedure. In the present study, we retrospectively compared the outcomes of single-stage and two-stage VATS. Methods This study involved patients who underwent single-stage sequential bilateral VATS (SS-VATS group) or two-stage VATS at a 3-month interval (TS-VATS group) for treatment of non-small cell lung cancer from 2010 to 2018. The major outcome was the comparison of intraoperative changes. Results The inspiratory peak pressure was higher, the incidences of intraoperative hypoxia and unstable hemodynamics were higher, the surgical time was longer, and the durations of the intensive care unit stay and postoperative hospitalization were longer in the SS-VATS group than in the TS-VATS group. However, the chest tube duration, incidence of postoperative mechanical ventilation, and clinical complications were not different between the two groups. Conclusions Compared with two-stage VATS, single-stage sequential bilateral VATS can be performed for successful treatment of bilateral pulmonary lesions with a shorter total time and higher cost-effectiveness in terms of anesthesia and hospitalization but with a higher incidence of intraoperative adverse effects and a longer hospital stay.

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One-stage video-assisted thoracic surgery for bilateral multiple pulmonary nodules

Cited by 18 publications

References 8 publications

Single-center experience of simultaneous bilateral uni-portal video-assisted thoracoscopic surgery for multiple ground-glass opacities

Single-center experience of simultaneous bilateral uni-portal video-assisted thoracoscopic surgery for multiple ground-glass opacities

Simultaneous bilateral pulmonary resection via single‐utility port VATS for multiple pulmonary nodules: A single‐center experience of 16 cases

Comparison of single-stage and two-stage bilateral video-assisted thoracic surgery

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