Protocol of an iterative qualitative study to develop a molecular testing decision aid for shared decision-making in patients with lung cancer after surgery

Xing, Wei; Liu, Yangjun; Yu, Hongfan; Dai, Wei; Yang, Ding; Zhang, Kunpeng; Sun, Jing; Xu, Wei; Gong, Ruoyan; Yu, Qingsong; Pu, Yang; Wang, Yaqin; Liao, Jia‐Feng; Mu, Yunfei; Zhang, Yuanqiang; Feng, Wenhong; Pan, Qi; Li, Qiang; Shi, Qiuling

doi:10.1136/bmjopen-2022-061367

Cited by 6 publications

(3 citation statements)

References 37 publications

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“…Although some reports have been published, this anomaly is exceptional [ 1 ]. These unforeseen changes underscore the necessity of surgical adaptability and the importance of intraoperative decision-making [ 6 ]. Our case reinforces these well-known principles in the context of robotic-assisted thoracic surgery, providing a practical example of their application [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Robotic-assisted right upper lobectomy with systemic pulmonary vein anomaly: a case report

Liu,

Xie,

Zhang

et al. 2024

J Cardiothorac Surg

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Background While the role of low-dose computed tomography (CT) in lung cancer screening is established, its limitations in detailing pulmonary vascular variations are less emphasized. Three-dimensional reconstruction technology allows surgeons to reconstruct a patient’s bronchial and pulmonary vascular structures using CT scan results. However, low-dose CT may not provide the same level of clarity as enhanced CT in displaying pulmonary vascular details. This limitation can be unfavorable for preoperative detection of potential pulmonary vascular variations, especially in cases involving planned segmentectomy. Case Presentation We report a case of a 58-year-old female with lung cancer, initially planned for Da Vinci robot-assisted thoracoscopic segmentectomy. Unexpectedly, during surgery, a pulmonary vein variation in the right upper lobe was discovered, leading to a change in the surgical method to a lobectomy. The patient had four variant right upper lobe veins draining into the superior vena cava and one into the left atrium. The surgery was complicated by significant bleeding and postoperative pulmonary congestion. Postoperative pathology confirmed adenocarcinoma. Conclusions This case highlights the importance of meticulous intraoperative exploration, particularly in cases involving planned segmentectomy, as unexpected pulmonary vein variations can significantly affect surgical decision-making. While three-dimensional reconstruction based on preoperative CT data is a valuable tool, it may not capture the full complexity of the anatomical variations. We discuss potential preoperative imaging techniques, including contrast-enhanced CT and CT angiography, as methods to better identify these variations. The enhanced visualization provided by robot-assisted surgery plays a crucial role in identifying and adapting to these variations, underscoring the advantages of this surgical approach. Our report contributes to the existing literature by providing a detailed account of how these principles were applied in a real-world scenario, reinforcing the need for surgical adaptability and awareness of the limitations of low-dose CT in complex cases.

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Section: Discussionmentioning

confidence: 99%

Robotic-assisted right upper lobectomy with systemic pulmonary vein anomaly: a case report

Liu,

Xie,

Zhang

et al. 2024

J Cardiothorac Surg

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“…We could establish PRO-based perioperative symptom management, evaluate the benefits and drawbacks of different lung surgeries, and analyze trends in patients’ postoperative symptoms and functional recovery with the use of PSA-Lung. Additionally, PSA can allow surgeons and patients to understand symptoms and functions based on data, which may improve shared decision-making [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Postoperative Patient-Reported Outcomes after Uniportal Video-Assisted Thoracoscopic Surgery Using the Perioperative Symptom Assessment for Lung Surgery Scale

et al. 2022

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This study aimed to use a new special inventory for lung surgery patients to evaluate postoperative symptoms and functional status and to identify factors that may affect these after uniportal video-assisted thoracoscopic surgery (VATS). In this single-center longitudinal cohort observational study, we used a new scale, the perioperative symptom assessment for lung surgery (PSA-Lung), to evaluate the recovery from symptoms and the functional status of patients undergoing uniportal VATS. We divided patients into two groups, according to patients’ symptom scores, and compared the clinical characteristics between the two groups under each item. Then, we conducted a qualitative interview regarding coughing in postoperative week 4. Exactly 104 patients were enrolled in this study. The two highest-scoring patient-reported outcome (PRO) items were “shortness of breath” and “coughing” in the fourth week after surgery. Thirty-one patients reported that “coughing” severely influenced their lives in postoperative week 4. Using the PSA-Lung inventory, we found that “shortness of breath” was the worst symptom in postoperative week 4. Although “coughing” was not the most important symptom in the early postoperative period, it affected some patients’ lives in postoperative week 4. Therefore, further research is required to determine the optimal cut-off point for coughing.

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“…The thoracic surgery experts noted that minimally invasive surgery would be challenging and risky; therefore, open surgery was advised [ 6 , 7 ]. After a comprehensive discussion encompassing the MDT team’s recommendations, a detailed explanation of the planned surgical approach and an inclusive shared decision-making process involving the patient and his family, the patient provided informed consent and opted to proceed with the surgery [ 8 ].…”

Section: Case Reportmentioning

confidence: 99%

Multidisciplinary management and surgical resection of a rare posterior mediastinal haemangioma

Zhang,

Dai,

et al. 2024

Journal of Surgical Case Reports

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Mediastinal haemangiomas pose diagnostic and therapeutic challenges owing to their rarity and complex anatomy. A 36-year-old man, with a history of smoking and drinking, presented with a posterior mediastinal mass with back pain. Initial investigations suggested a lymphangioma. However, owing to persistent symptoms and complex pathology, we performed surgical intervention involving open resection of the tumour, which was closely associated with the descending aorta and extended into the right posterior mediastinum. The surgical approach was influenced by the proximity of the tumour to vital structures, necessitating an open procedure. Postoperative complications included chylothorax, managed with a fat-free diet. The final pathological diagnosis was consistent with a benign vascular tumour with a low proliferative rate. Two months post-surgery, computed tomography revealed no complications, and the patient’s pain had decreased. A multidisciplinary approach and surgical intervention played important roles in the diagnosis and treatment of this posterior mediastinal haemangioma.

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Protocol of an iterative qualitative study to develop a molecular testing decision aid for shared decision-making in patients with lung cancer after surgery

Cited by 6 publications

References 37 publications

Robotic-assisted right upper lobectomy with systemic pulmonary vein anomaly: a case report

Robotic-assisted right upper lobectomy with systemic pulmonary vein anomaly: a case report

Postoperative Patient-Reported Outcomes after Uniportal Video-Assisted Thoracoscopic Surgery Using the Perioperative Symptom Assessment for Lung Surgery Scale

Multidisciplinary management and surgical resection of a rare posterior mediastinal haemangioma

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