VATS and Minimally Invasive Resection in Early-Stage NSCLC

Salfity, Hai; Tong, Betty C.

doi:10.1055/s-0039-3401991

Cited by 16 publications

(11 citation statements)

References 103 publications

(178 reference statements)

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“…VATS is an alternative approach for lung surgery which is considered to be less tissue trauma and shorter recovery [ 27 – 31 ]. VATS as a minimally invasive approach is expected to reduce postoperative pain; however, the relationship between VATS and CPTP is still ambiguous.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Influencing Factors of Chronic Postthoracotomy Pain in Lung Tumor Patients

Peng

Wang

et al. 2022

Journal of Healthcare Engineering

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Objectives. To estimate the incidence of chronic postthoracotomy pain (CPTP) in lung tumor patients and to explore the influencing factors of the intensity of CPTP. Methods. Lung tumor patients who underwent video-assisted thoracoscopic surgery (VATS) or thoracotomy were consecutively recruited from October 2016 to December 2017 at Yunnan Cancer Hospital. All the eligible patients were interviewed via telephone at the end of the third month after surgeries to identify the presence of CPTP. The potential influencing factors of CPTP, including pre-, intra-, and postoperative variables, were collected from medical records. A cumulative logit regression model was used to identify the independent influencing factors of the intensity of CPTP. Results. Three hundred and forty-three patients completed a telephone interview. The estimated overall incidence of CPTP was 67.6% (95% of confidence interval, 95% CI: 62.4%, 72.6%) in lung tumor patients; 70.8% (95% CI: 63.8%, 77.1%) in benign patients and 63.5% (95% CI: 55.2%, 71.3%) in malignant patients; and 78.1% (95% CI: 66.0%, 87.5%) in open chest and 65.2% (95% CI: 59.3%, 70.8%) in VATS. Cumulative logit regression models (intensity order, NRS, 0 ⟶ 1–3 ⟶ 4-) revealed independent influencing factors of CPTP to be patients with diabetes (OR = 0.32; 95% CI: 0.14, 0.76), usage of VATS (OR = 0.47; 95% CI: 027, 0.82), and the amount of intraoperative blood loss (OR = 1.09; 95% CI: 1.00, 1.19). Conclusions. A high incidence of CPTP is detected in lung tumor patients following the thoracic operation. Patients with diabetes and using VATS are the independent protective factors of the intensity of CPTP, and the increasing amount of intraoperative blood loss is an independent risk factor of the intensity of CPTP.

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Section: Discussionmentioning

confidence: 99%

Incidence and Influencing Factors of Chronic Postthoracotomy Pain in Lung Tumor Patients

Peng

Wang

et al. 2022

Journal of Healthcare Engineering

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“…In recent years, VATS has been widely applied and considered feasible and oncological effective in treating thoracic neoplasm, including NSCLC, mediastinal malignancies, and tracheal tumors. 11,14,15 Many studies have indicated that VATS exhibits superiority of less postoperative pains, faster recovery, and fewer postoperative complications and achieves comparable long-term outcomes when compared with traditional thoracotomy for lobectomy, segmentectomy, wedge resection, and bronchial sleeve resection in treating NSCLC. 16,17 However, because of the difficulty in carina resection and reconstruction, the application of VATS in NSCLC patients with the involved carina was quite reconstruction in treating locally advanced NSCLC, which showed that VATS achieved comparable perioperative outcomes and medium-term survival to thoracotomy for these patients.…”

Section: Discussionmentioning

confidence: 99%

Short‐ and medium‐term outcomes of video‐assisted thoracoscopic surgery versus thoracotomy for carinal lung resection combined with carina reconstruction in locally advanced non–small cell lung cancer patients

et al. 2023

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Background: The application of video-assisted thoracoscopic surgery (VATS) for complex carina surgeries in treating non-small cell lung cancer (NSCLC) patients with involved carina is controversial. This study compared short-and medium-term outcomes of VATS versus thoracotomy for carinal lung resection with carina reconstruction in treating locally advanced NSCLC, aiming to assess the potential benefit of VATS over thoracotomy for these patients. Methods: A total of 37 consecutive NSCLC cases receiving VATS (n = 14) or thoracotomy (n = 23) for carinal lung resection with carina reconstruction from 2016 to 2021 were retrospectively identified. Baseline clinicopathological characteristics, perioperative outcomes, and survival profiles were investigated. Results: Patients in the VATS and thoracotomy groups had comparable baseline clinicopathological characteristics (all p > 0.050). VATS decreased postoperative drainage volume compared with thoracotomy (1280 [1170-1510] vs. 1795 [1510-1905] mL, p = 0.012). Regarding surgical-related pains, VATS reduced numeric rating scale scores on the postoperative day 1 (4 [3, 4] vs. 5 [4, 5], p = 0.021) and day 2 (3 [3, 4] vs. 5 [3-5], p = 0.023) than thoracotomy. No difference was found between the VATS and thoracotomy groups in other perioperative outcomes, postoperative complications, and assessment of lymph nodes (LNs) and LN stations (all p > 0.050). Moreover, patients in the two groups had comparable 3-year disease-free survival (DFS), overall survival (OS), and recurrence and mortality patterns. Further subgroup and Cox hazards regression analyses also observed no difference in DFS or OS between the two groups. Conclusions: VATS reduced postoperative drainage volume and ameliorated surgicalrelated pain, and achieved comparable medium-term survival compared to thoracotomy for carinal lung resection with carina reconstruction in treating locally advanced NSCLC.K E Y W O R D S carina reconstruction, medium-term survival, non-small cell lung cancer, perioperative outcomes, videoassisted thoracoscopic surgery Hanbo Pan, Ningyuan Zou, and Jia Huang contributed equally to this study.

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“…Then several studies demonstrated there was no differences in short-term outcomes or mortality between VATS and thoracotomy in T1 and T2 tumors and patients, especially elderly patients, with VATS had fewer postoperative complications. In Ceppa's study, VATS lobectomy had significantly fewer pulmonary complications compared with thoracotomy (P=0.023) (32,33). Compared with multiportal VATS, uniportal VATS shortened the operation time and postoperative drainage period and significantly reduced the use of analgesics (34) and may be a safer and less invasive surgical procedure.…”

Section: Discussion Of the Technical Issues Of Vatsmentioning

confidence: 99%

Anatomical segmentectomy under uniportal video-assisted thoracoscopic surgery for early staged non-small cell lung cancer: a case report

Wang¹,

Yu²,

Li³

et al. 2022

J Thorac Dis

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Background: Anatomical segmentectomy has become more and more universal in thoracic surgery because of the increasing detection of pulmonary nodules with ground-glass opacity (GGO), most of which proved early staged non-small cell lung cancer (NSCLC) postoperative. With the advantage of preservation of normal lung tissues, segmentectomy may be performed by surgeons when computed tomography (CT) scan shows pure GGO or multiple GGOs appearing. Especially when the patients with poor cardiopulmonary function or severe comorbidities or in the circumstance of bilateral pulmonary GGOs, segmentectomy can provide opportunities to radically resect all lesions. With the development of minimally invasive surgery technology, uniportal video-assisted thoracoscopic surgery (VATS) has become the regular operative route in many medical centers because it can provide less access trauma, less stress response, less pain, shorter hospital stays, and a lower postoperative complication rate and corresponds well with the idea of "minimally invasive". However, all of the procedures must be performed in one tiny portal, so uniportal VATS anatomical segmentectomy not only needs the skill and patience of surgeons but the effective cooperation of assistants, nurses and anesthetists, and plenty of details must be paid special attention.Case Description: Here we present a video of a patient undergoing S 1 segmentectomy of right upper lobectomy (RUL) under uniportal VATS. The chief complaints of the patients was that two pure GGOs in the bilateral upper lobe were found by physical examination for 26 months and he had no symptoms. We performed S 1 segmentectomy of RUL under uniportal first time and performed trisegmentectomy of left upper lobectomy (LUL) 3 months later. With routinely follow-up, no evidence of relapse and metastasis disease was found. Conclusions:We think anatomical segmentectomy under uniportal VATS can be a feasible and safe procedure that reduces trauma and has equivalent oncology outcomes to lobectomy in early-stage lung cancer but need a more experienced medical center to perform.

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VATS and Minimally Invasive Resection in Early-Stage NSCLC

Cited by 16 publications

References 103 publications

Incidence and Influencing Factors of Chronic Postthoracotomy Pain in Lung Tumor Patients

Incidence and Influencing Factors of Chronic Postthoracotomy Pain in Lung Tumor Patients

Short‐ and medium‐term outcomes of video‐assisted thoracoscopic surgery versus thoracotomy for carinal lung resection combined with carina reconstruction in locally advanced non–small cell lung cancer patients

Anatomical segmentectomy under uniportal video-assisted thoracoscopic surgery for early staged non-small cell lung cancer: a case report

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