Simultaneous Uniportal video-assisted thoracic surgery of bilateral pulmonary nodules

Abstract

Background Surgical resection is an appropriate treatment option for synchronous bilateral pulmonary nodules with ground-glass opacities. The applicability of simultaneous uniportal video-assisted thoracic surgery is not fully understood. We evaluated the feasibility and safety of performing such surgeries at our hospital. Methods Clinical data of 35 patients who underwent simultaneous bilateral pulmonary resection with uniportal video-assisted thoracic surgery at our hospital were reviewed retrospectively. Results Simultaneous bilateral pulmonary resection with uniportal video-assisted thoracic surgery was performed for 35 patients (15 men, 20 women); 97 nodules were operated on, and the average nodule diameter was 11.4 mm (range, 1–38 mm). Computerized tomography showed that most nodules had ground-glass opacity (52/97, 53.6%); solid nodules (24/97, 24.7%) and nodules with mixed ground-glass opacity (21/97, 21.7%) were noted. Surgical resection included lobar-sublobar resection (11/35, 31.4%) and sublobar-sublobar resection (24/35, 68.6%). Wound infection and postoperative 30-day mortality were not observed. Pneumonia was the major postoperative complication, with a higher incidence in the lobar-sublobar group (6/10, 60%) than in the sublobar-sublobar group (4/25, 16%; P = 0.016). Pneumonia did not correlate with operative time (mean, 262.3 ± 108.1 vs. 261.9 ± 87.5 min, P = 0.991), duration of chest drainage (mean, 7.0 ± 4.0 vs 5.4 ± 2.1 days, P = 0.124), and postoperative hospital stay (mean, 10.2 ± 3.6 vs 10.2 ± 6.4 days, P = 0.978). The mean follow-up time was 8 (range, 3–22) months. Recurrence of primary lung cancer or mortality was not noted at the final follow-up. Conclusions Simultaneous bilateral pulmonary resection with uniportal video-assisted thoracic surgery is feasible and safe for appropriate patients. Simultaneous lobar-sublobar pulmonary resection for bilateral nodules can increase the risk of developing pneumonia.

Lobectomy Versus Sublobar Resection in Simultaneous Bilateral Thoracoscopic Lung Resection

“…This study is one of very few to have investigated simultaneous bilateral lung resection using VATS for indeterminate lung neoplasms. While several studies have shown the feasibility and safety of simultaneous bilateral VATS resection, such as comparisons between one-stage versus two-stage, or intercostal versus subxiphoid bilateral procedures [5][6][7][8][9][10], none have commented on the difference regarding the extent of resection in one-stage operations. In our study over a 10-year period, we assessed the clinicopathologic outcome and perioperative context of 207 patients with bilateral lung neoplasms undergoing SBTLR.…”

“…In conclusion, one-stage surgery for managing a wide array of thoracic diseases is proven to be safe and efficacious [1][2][3][4][5][6][7][8][9][10]15], and its advantages include circumventing the risk of contralateral tumor progression, comparable wound pain when compared with unilateral-side surgery, decreased medical cost, and decreased psychological burden. In our study, SBTLR allowed clear pathological discrimination in patients with indeterminate lung neoplasms and produced a perioperative course with a comparable safety profile.…”

“…Simultaneous bilateral pulmonary surgery has been proven to be a safe and efficacious approach for a wide array of thoracic diseases, including but not limited to primary spontaneous pneumothorax (PSP), bilateral pulmonary metastases, and bilateral multifocal ground glass opacities (GGOs) suggestive of early primary lung cancer [1][2][3][4][5][6][7][8][9][10]. There has been increased interest in the feasibility of this treatment strategy when performed with video-assisted thoracoscopic surgery (VATS).…”

“…VATS has been associated with less postoperative pain, fewer postoperative complications, faster recovery, and better quality of life compared to open thoracotomy for primary lung cancer, and may improve the safety and outcomes of this aggressive surgical approach [11][12][13]. However, few retrospective studies have reported on the use of thoracoscopic techniques for simultaneous bilateral pulmonary neoplasms, with data from only a small number of patients [5][6][7][8][9][10].…”

The feasibility and safety of simultaneous bilateral video-assisted thoracic surgery for the treatment of bilateral pulmonary lesions

“…Therefore, evaluating pulmonary function inpatients who will undergo simultaneous bilateral pulmonary surgery is crucial. Previous research has demonstrated that pneumonectomy is safe if FEV1 is greater than 2L and that lobectomy is safe if it is greater than 1.5 L or if its predicted value is more than 80% ( 16 , 17 ).For simultaneous bilateral pulmonary surgery, anFEV1/forced vital capacity of more than 75% is recommended ( 18 ).It is interesting to note that female patient shave been found to have better outcomes than male patients after pulmonary surgery, which may be caused by their smaller vital capacity ( 19 ).…”