P1.16-028 Is Video-Assisted Thoracic Surgery a Safer Procedure for Lung Cancer Patients?

Tsukazan, Maria Teresa Ruiz; Terra, Ricardo Mingarini; Vigo, Álvaro; Fortunato, Gustavo; Camargo, Spencer Marcantônio; Oliveira, Humberto; Filho, D. Pinto

doi:10.1016/j.jtho.2017.09.1082

Cited by 2 publications

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“…À semelhança do que foi publicado anteriormente, identificamos a necessidade de mais conversões cirúrgicas com a VATS, embora essa diferença não tenha sido estatisticamente significativa. (7,22,23) As medianas [IIQ] do tempo de drenagem não foram diferentes entre os grupos RATS e VATS (2 [1-2] dias vs. 2 [1][2][3][4] dias; p = 0,27). O mesmo ocorreu em relação ao tempo de internação hospitalar (3 [2-4] dias vs. 4 [2][3][4][5]; p = 0,55).…”

Section: Discussionunclassified

“…(7,22,23) As medianas [IIQ] do tempo de drenagem não foram diferentes entre os grupos RATS e VATS (2 [1-2] dias vs. 2 [1][2][3][4] dias; p = 0,27). O mesmo ocorreu em relação ao tempo de internação hospitalar (3 [2-4] dias vs. 4 [2][3][4][5]; p = 0,55). Esses achados são compatíveis com os da maioria dos estudos anteriores.…”

Section: Discussionunclassified

“…A lobectomia pulmonar é o tratamento padrão para o câncer de pulmão inicial e também é utilizada em pacientes selecionados com metástases pulmonares cujas características tornam as ressecções sublobares inadequadas (1) Vários estudos compararam a lobectomia por video-assisted thoracic surgery (VATS, cirurgia torácica videoassistida) com a toracotomia aberta e demonstraram redução da morbidade e do tempo de internação hospitalar em favor da técnica minimamente invasiva, sem comprometimento dos desfechos oncológicos. (2)(3)(4)(5) Apesar das claras vantagens da VATS e de ela ser fortemente recomendada pelas diretrizes, (1)(2)(3)(4)(5)(6) a toracotomia continua sendo a abordagem mais comum para lobectomias. (3)(4)(5)(6)(7) A visão bidimensional e o uso de instrumentos longos e inflexíveis podem promover uma dissecção imprecisa e uma longa e árdua curva de aprendizado.…”

Section: Introductionunclassified

“…(2)(3)(4)(5) Apesar das claras vantagens da VATS e de ela ser fortemente recomendada pelas diretrizes, (1)(2)(3)(4)(5)(6) a toracotomia continua sendo a abordagem mais comum para lobectomias. (3)(4)(5)(6)(7) A visão bidimensional e o uso de instrumentos longos e inflexíveis podem promover uma dissecção imprecisa e uma longa e árdua curva de aprendizado. Essas limitações podem ser responsáveis pela lenta implementação da lobectomia por VATS em todo o mundo.…”

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A Brazilian randomized study: Robotic-Assisted vs. Video-assisted lung lobectomy Outcomes (BRAVO trial)

et al. 2022

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Objective: To compare 90-day morbidity in patients undergoing lung lobectomy performed by either robotic-assisted thoracic surgery (RATS) or video-assisted thoracic surgery (VATS). Intraoperative complications, drainage time, length of hospital stay, postoperative pain, postoperative quality of life, and readmissions within 90 days were also compared. Methods: This was a two-arm randomized clinical trial including patients with lung lesions (primary lung cancer or lung metastasis) who were candidates for lung lobectomy. Patients with comorbidities that precluded surgical treatment were excluded. All patients followed the same postoperative protocol. Results: The overall sample comprised 76 patients (39 in the VATS group and 37 in the RATS group). The two groups were similar regarding gender, age, BMI, FEV1 in % of predicted, and comorbidities. Postoperative complications within 90 days tended to be more common in the VATS group than in the RATS group, but the difference was not significant (p = 0.12). However, when only major complications were analyzed, this tendency disappeared (p = 0.58). Regarding postoperative outcomes, the VATS group had a significantly higher number of readmissions within 90 days than did the RATS group (p = 0.029). No significant differences were found regarding intraoperative complications, drainage time, length of hospital stay, postoperative pain, and postoperative quality of life. Conclusions: RATS and VATS lobectomy had similar 90-day outcomes. However, RATS lobectomy was associated with a significant reduction in the 90-day hospital readmission rate. Larger studies are necessary to confirm such a finding. (ClinicalTrials.gov identifier: NCT02292914 [http://www.clinicaltrials.gov/])

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A Brazilian randomized study: Robotic-Assisted vs. Video-assisted lung lobectomy Outcomes (BRAVO trial)

et al. 2022

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Optimal Approach to Lobectomy for Non-Small Cell Lung Cancer: Systemic Review and Meta-Analysis

MacDonald

Gilbert

et al. 2019

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Objective Video-assisted thoracic surgery (VATS) lobectomy was introduced over 25 years ago. More recently, the technique has been modified from a multiport video-assisted thoracic surgery (mVATS) to uniportal (uVATS) and robotic (rVATS), with proponents for each approach. Additionally most lobectomies are still performed using an open approach. We sought to provide evidence-based recommendations to help define the optimal surgical approach to lobectomy for early stage non-small cell lung cancer. Methods Systematic review and meta-analysis of articles searched without limits from January 2000 to January 2018 comparing open, mVATS, uVATS, and rVATS using sources Medline, Embase, and Cochrane Library were considered for inclusion. Articles were individually scrutinized by ISMICS consensus conference members, and evidence-based statements were created and consensus processes were used to determine the ensuing recommendations. The ACC/AHA Clinical Practice Guideline Recommendation Classification system was used to assess the overall quality of evidence and the strength of recommendations. Results and recommendations One hundred and forty-five studies met the predefined inclusion criteria and were included in the meta-analysis. Comparisons were analyzed between VATS and open, and between different VATS approaches looking at oncological outcomes (survival, recurrence, lymph node evaluation), safety (adverse events), function (pain, quality of life, pulmonary function), and cost-effectiveness. Fifteen statements addressing these areas achieved consensus. The highest level of evidence suggested that mVATS is preferable to open lobectomy with lower adverse events (36% versus 42%; 88,460 patients) and less pain (IIa recommendation). Our meta-analysis suggested that overall survival was better (IIb) with mVATS compared with open (71.5% versus 66.7% 5-years; 16,200 patients). Different VATS approaches were similar for most outcomes, although uVATS may be associated with less pain and analgesic requirements (IIb). Conclusions This meta-analysis supports the role of VATS lobectomy for non-small cell lung cancer. Apart from potentially less pain and analgesic requirement with uVATS, different minimally invasive surgical approaches appear to have similar outcomes.

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P1.16-028 Is Video-Assisted Thoracic Surgery a Safer Procedure for Lung Cancer Patients?

Cited by 2 publications

References 0 publications

A Brazilian randomized study: Robotic-Assisted vs. Video-assisted lung lobectomy Outcomes (BRAVO trial)

A Brazilian randomized study: Robotic-Assisted vs. Video-assisted lung lobectomy Outcomes (BRAVO trial)

Optimal Approach to Lobectomy for Non-Small Cell Lung Cancer: Systemic Review and Meta-Analysis

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