Predicting a Prolonged Air Leak After Video-Assisted Thoracic Surgery, Is It Really Possible?

Pipitone, Marco; Feil, Birgit; Bertolaccini, Luca; Mancuso, Mauro; Pernazza, F.; Refai, Majed; Srella, F.; Argnani, Desideria; Marulli, Giuseppe; Palma, Angela De; Bortolotti, Luigi; Rizzardi, Giovanna; Solli, Piergiorgio; Dolci, Giampiero; Perkmann, Reinhold; Zaraca, Francesco; Benvenuti, Mauro Roberto; Gavezzoli, D; Cherchi, R.; Ferrari, Paolo Albino; Mucilli, Felice; Camplese, Pierpaolo; Melloni, Giulio; Mazza, Federico; Cavallesco, Giorgio; Maniscalco, Pio; Voltolini, Luca; Gonfiotti, Alessandro; Sollitto, Francesco; Ardò, Nicoletta Pia; Pariscenti, Gian Luca; Risso, C.; Surrente, Corrado; Lopez, Camillo; Droghetti, Andrea; Giovanardi, Michele; Breda, Cristiano; Giudice, Lo F.; Alloisio, Marco; Bottoni, Edoardo; Spaggiari, Lorenzo; Gasparri, Roberto; Torre, Massimo; Rinaldo, Alessandra; Nosotti, Mario; Tosi, Davide; Negri, Giampiero; Bandiera, Alessandro; Baisi, Alessandro; Raveglia, Federico; Stefani, A.; Natali, Pamela; Scarci, Marco; Pirondini, Emanuele; Curcio, Carlo; Amore, Dario; Rena, Ottavio; Nicotra, Samuele; Amore, Alfonso; Bertani, Alessandro; Tancredi, Giorgia; Ampollini, Luca; Carbognani, Paolo; Puma, Francesco; Vinci, Danilo; Cardillo, Giuseppe; Carleo, Francesco; Margaritora, Stefano; Meacci, Elisa; Luzzi, Luca; Ghisalberti, Marco; Crisci, Roberto; Divisi, Duilio; Lausi, Paolo Olivo; Guerrera, Francesco; Fontana, D.; Beffa, V. Della; Morelli, Alice; Londero, Francesco; Imperatori, Andrea; Rotolo, Nicola; Terzi, Alberto; Viti, Andrea; Infante, Maurizio; Benato, Cristiano

doi:10.1053/j.semtcvs.2020.08.012

Cited by 14 publications

(15 citation statements)

References 32 publications

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“…Converse unidirectional RATS usually starts with opening the fissure to dissecting the hilum, which requires the pulmonary lobe with preferable fissure. For the patients with dysplasia or incomplete fissure, the incidence of conversion to thoracotomy and continuous air leakage after the operation will increase due to the large wound area caused by the opening of the pulmonary fissure (19,20). Due to the different management order of hilum, the cut and closure of pulmonary fissure tissue was performed last, thus 4-port unidirectional VATS has low requirements for the development of the pulmonary fissure and relatively less postoperative air leakage.…”

Section: Discussionmentioning

confidence: 99%

Comparison of perioperative outcomes of robotic-assisted versus video-assisted thoracoscopic right upper lobectomy in non-small cell lung cancer

Huang¹,

Tian²,

Zhou³

et al. 2021

Transl Lung Cancer Res

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Background: Robotic-assisted thoracic surgery (RATS) has been widely used in the treatment of lung cancer.The perioperative outcomes of right upper lobectomy (RUL) using RATS and video-assisted thoracic surgery (VATS) were retrospectively investigated and compared. We aimed to summarize a single-center experience of RATS and 4-port unidirectional VATS in RUL, and to discuss the safety and the essentials of the surgery. Methods:We retrospectively analyzed the 685 with non-small cell lung cancer (NSCLC) patients who underwent minimally invasive RUL in our center by the same surgical group from January 2015 to December 2019. Both RATS and VATS were performed with three ports with utility incision. The 685 participants were divided into RATS (335 cases) and VATS (350 cases) groups according to surgical method. Baseline characteristics and perioperative outcomes including dissected lymph nodes, postoperative duration of drainage, postoperative hospital stay, and incidence of postoperative complications were compared between the groups.Results: In the 685 patients enrolled, the baseline characteristics were comparable, and no postoperative 30-day mortality or intraoperative blood transfusion were observed. Compared with VATS, RATS had less surgical duration (90.22±12.16 vs. 92.68±12.26 min, P<0.001), less length of stay (4.71±1.37 vs. 5.26±1.56 days, P<0.001), and decreased postoperative duration of drainage (3.49±1.15 vs. 4.09±1.57 days, P<0.001). No significant difference was observed in the lymph nodes dissection, blood loss, conversion rate and morbidities.

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Section: Discussionmentioning

confidence: 99%

Comparison of perioperative outcomes of robotic-assisted versus video-assisted thoracoscopic right upper lobectomy in non-small cell lung cancer

Huang¹,

Tian²,

Zhou³

et al. 2021

Transl Lung Cancer Res

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“…These include lower body mass index, presence of pleural adhesions, surgeon experience and higher early postoperative air leak flow (ml/min) as measured on a digital chest drainage system [ 10 , 12 ]. However, in practice, previous PAL scores based on preoperative factors remain limited, with high risk of false positives and low-positive predictive value [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Risk factors for prolonged air leak and need for intervention following lung resection

Dezube

Dolan

Mazzola

et al. 2021

Interactive CardioVascular and Thoracic Surgery

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OBJECTIVES Prolonged air leak (PAL; >5 days) following lung resection is associated with postoperative morbidity. We investigated factors associated with PAL and PAL requiring intervention. METHODS Retrospective review of all patients undergoing lobectomy, segmentectomy or wedge resection from 2016 to 2019 at our institution. Bronchoplastic reconstructions and lung-volume reduction surgeries were excluded. Incidence and risk factors for PAL and PAL requiring intervention were evaluated. RESULTS In total, 2384 patients were included. PAL incidence was 5.4% (129/2384); 22.5% (29/129) required intervention. PAL patients were more commonly male (56.6% vs 39.7%), older (mean age 69 vs 65 years) and underwent lobectomy or thoracotomy (all P < 0.001). Patients with PAL had longer length of stay (9 vs 3 days), more discharge needs and increased odds of complication (all P < 0.050). Twenty-nine patients required intervention (9 chest tubes; 4 percutaneous drains; 16 operations). In 50% of operative interventions, an air leak source was identified; however, the median time from intervention to resolution was 13 days. Patients requiring intervention had increased steroid use, lower diffusion capacity for carbon monoxide and twice the length of stay versus PAL patients (all P < 0.050). On univariable analysis, forced expiratory volume in 1 s (FEV1) <40%, diffusion capacity for carbon monoxide <50%, steroid use and albumin <3 had increased odds of intervention (P < 0.050). CONCLUSIONS Age, gender and operative technique were related to PAL development. Patients with worse forced expiratory volume in 1 s or diffusion capacity for carbon monoxide, steroid use or poor nutrition were less likely to heal on their own, indicating a population that could benefit from earlier intervention.

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“…Both models were well calibrated as shown in the calibration plots (Figure 5), and according to the low values of Emax and Eavg (Table 2), C statistics was 0.68 (0.66-0.70) when the optimal model was tested in the training cohort, while it dropped to 0.63 (0.57-0.67) when tested in the internal validation cohort. The discriminative ability among the models is far from acceptable in clinical practice, as explained in our previous study (13).…”

Section: Model Performancementioning

confidence: 81%

“…Many algorithms to risk-stratify patients undergoing lung resection for PAL have been reported from different study groups (5)(6)(7)(8). Nevertheless, current risk models in the literature, even if they have many cases, a long period of enrollment and are scientifically relevant, do not have sufficient discriminatory capacity to be used in common clinical practice (13).…”

Section: Introductionmentioning

confidence: 99%

Prolonged air leak after video-assisted thoracic anatomical pulmonary resections: a clinical predicting model based on data from the Italian VATS group registry, a machine learning approach

Divisi¹,

Pipitone²,

Perkmann³

et al. 2023

J Thorac Dis

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Background: Prolonged air leak (PAL) is a frequent complication after lung resection surgery and has a high clinical and economic impact. A useful risk predictor model can help recognize those patients who might benefit from additional preventive procedures. Currently, no risk model has sufficient discriminatory capacity to be used in common clinical practice. The aim of this study is to identify predictive risk factors for PAL after video-assisted thoracoscopic surgery (VATS) anatomical resections in the Italian VATS group database and to evaluate their clinical and statistical performance. Methods:We processed data collected in the second edition of the Italian VATS group registry. It includes patients that underwent a thoracoscopic anatomical resection for benign or malignant diseases, between November 2015 and December 2020. We used recursive feature elimination (RFE), using a backward selection process, to find the optimal combination of predictors. The study population was randomly split based on the outcome into a derivation (80%) and an internal validation cohort (20%). Discrimination of the model was measured using the area under the curve, or C-statistic. Calibration was displayed using a calibration plot and was measured using Emax and Eavg, the maximum and the average difference in predicted versus loess calibrated probabilities.Results: A cohort of 6,236 patients was eligible for the study after application of the exclusion criteria.Five-day PAL rate in this patient cohort was 11.3%. For the construction of our predictive model, we used both preoperative and intraoperative variables, with a total of 320 variables. The presence of variables with missing values greater than 5% led to 120 remaining predictors. RFE algorithm recommended 8 features for the model that are relevant in predicting the target variable. Conclusions:We confirmed significant prognostic risk factors for the prediction of PAL: decreased DLCO/VA ratio, longer duration of surgery, male sex, the need for adhesiolysis, COPD, and right side. We identified middle lobe resections and ground glass opacity as protective factors. After internal validation, a C statistic of 0.63 was revealed, which is too low to generate a reliable score in clinical practice.

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Predicting a Prolonged Air Leak After Video-Assisted Thoracic Surgery, Is It Really Possible?

Cited by 14 publications

References 32 publications

Comparison of perioperative outcomes of robotic-assisted versus video-assisted thoracoscopic right upper lobectomy in non-small cell lung cancer

Comparison of perioperative outcomes of robotic-assisted versus video-assisted thoracoscopic right upper lobectomy in non-small cell lung cancer

Risk factors for prolonged air leak and need for intervention following lung resection

Prolonged air leak after video-assisted thoracic anatomical pulmonary resections: a clinical predicting model based on data from the Italian VATS group registry, a machine learning approach

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