Video-assisted thoracoscopic surgery versus open lobectomy for primary non-small-cell lung cancer: a propensity-matched analysis of outcome from the European Society of Thoracic Surgeon database

Falcoz, Pierre‐Emmanuel; Puyraveau, Marc; Thomas, Philippe; Decaluwé, Herbert; Hürtgen, Martin; Petersen, René Horsleben; Hansen, Henrik Jessen; Brunelli, Alessandro

doi:10.1093/ejcts/ezv154

Cited by 371 publications

(211 citation statements)

References 17 publications

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“…Postoperative infections, cardiac events and respiratory failure are the main morbidities after thoracic surgery. The incidence of postoperative pneumonia, a dominating cause of death after pulmonary resection, has been reported as high as 25% (13) in the relevant series published in the years 2000-2016 (Table 6) (3,5,9,(13)(14)(15)(16)(17)(18)(19)(20)(21). Lower rates of postoperative pneumonia were recorded in a survey by the Society of Thoracic Surgeons (3.9%) (16) and in a large cooperative multi-institutional investigation in the USA (2.5%) (15).…”

Section: Discussionmentioning

confidence: 99%

Surgical site infections after lung resection: a prospective study of risk factors in 1,091 consecutive patients

Imperatori¹,

Nardecchia²,

Dominioni³

et al. 2017

J. Thorac. Dis.

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Background: To assess incidence and risk factors of surgical site infections (SSI) (wound infection, pneumonia, empyema) in a monocentric series of patients undergoing lung resection over a decade. Methods: All patients undergoing lung resection at our institution in 2006-2015 [wedge resection, n=579; lobectomy, n=472 (12% after chemo/radiotherapy); pneumonectomy, n=40 (47% after chemo/radiotherapy)], were prospectively enrolled. Perioperative SSI risk factors were recorded: age, gender, blood haemoglobin, Results: Of the 1,091 resected patients [median age, 65 (range, 13-91) years; male, 74%; malignancy, 65%], 124 (11.4%) developed one or more SSI. Wound infection, pneumonia and empyema rates were respectively 3.2%, 8.3% and 1.9%, stable through the decade. Overall infection rates after wedge resection, lobectomy and pneumonectomy were 4.8%, 17.4% and 35.0%, respectively. Thirty-day postoperative mortality was 0.6%; of the 7 deaths, 4 were causally related with SSI. Multivariable analysis showed that male gender, diabetes, preoperative steroids, induction chemo/radiotherapy, missed antibiotic prophylaxis and resection type were independent risk factors for overall SSI.Conclusions: SSI rates after lung resection were stable over the decade. The observed 11.4% frequency of SSI indicates that postoperative infections remain a relevant issue and a predominant cause of mortality after lung surgery. Focusing on SSI risk factors that are perioperatively modifiable may improve surgical results.

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Section: Discussionmentioning

confidence: 99%

Surgical site infections after lung resection: a prospective study of risk factors in 1,091 consecutive patients

Imperatori¹,

Nardecchia²,

Dominioni³

et al. 2017

J. Thorac. Dis.

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“…6 Despite this, the use of thoracoscopic lobectomy remains variable and it comprised less than 25% of all lobectomy procedures performed for NSCLC in Europe in 2013. [7][8][9] Concerns regarding the impact of intraoperative complications and subsequent conversion have hindered the widespread implementation of VATS lobectomy. The reported incidence of unplanned conversion to thoracotomy ranges from less than 5% to over 20%.…”

mentioning

confidence: 99%

The evolution of intraoperative conversion in video assisted thoracoscopic lobectomy

Vallance

Tcherveniakov

Bogdan

et al. 2017

annals

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INTRODUCTION Unplanned conversion to thoracotomy remains a major concern in video assisted thoracoscopic surgery (VATS) lobectomy. This study aimed to investigate the development of a VATS lobectomy programme over a five-year period, with a focus on the causes and consequences of unplanned conversions. METHODS A single centre retrospective review was performed of patients who underwent complete anatomical lung resection initiated by VATS between January 2010 and April 2015. RESULTS In total, 1,270 patients underwent a lobectomy in the study period and 684 (53.9%) of these were commenced thoracoscopically. There were 75 cases (10.9%) with unplanned conversion. The proportion of lobectomies started as VATS was significantly higher in the second half of the study period (2010-2012: 277/713 [38.8%], 2013-2015: 407/557 [73.1%], p<0.001). The conversion rate dropped initially from 20.4% (11/54) in 2010 to 9.9% (15/151) in 2013 and then remained consistently under 10% until 2015. Conversions were most commonly secondary to vascular injury (26/75, 34.7%). Patients undergoing unplanned conversion had a longer length of stay than VATS completed patients (9 vs 6 days, p<0.001). There was a higher incidence of respiratory failure (10/75 [14.1%] vs 23/607 [3.8%], p<0.001) and 30-day mortality (7/75 [9.3%] vs 6/607 [1.0%], p=0.003) in patients with unplanned conversion than in those with completed VATS. CONCLUSIONS As our VATS lobectomy programme developed, the unplanned conversion rate dropped initially and then remained constant at approximately 10%. With increasing unit experience, it is both safe and technically possible to complete the majority of lobectomy procedures thoracoscopically.

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“…When compared to lobectomy via thoracotomy, VATS has improved short-term outcomes: it is associated with a lower incidence of post-operative complications, shorter hospitalization, shorter duration of chest tube, and similar or lower rates of postoperative mortality (5)(6)(7)(8)(9)(10)(11)(12)(13)(14).…”

Section: Vatsmentioning

confidence: 99%

Surgical treatment for early stage non-small cell lung cancer

et al. 2018

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Video-assisted thoracoscopic surgery versus open lobectomy for primary non-small-cell lung cancer: a propensity-matched analysis of outcome from the European Society of Thoracic Surgeon database

Abstract: Data from the ESTS database confirmed that lobectomy performed through VATS is associated with a lower incidence of complications compared with thoracotomy.

Cited by 371 publications

References 17 publications

Surgical site infections after lung resection: a prospective study of risk factors in 1,091 consecutive patients

Surgical site infections after lung resection: a prospective study of risk factors in 1,091 consecutive patients

The evolution of intraoperative conversion in video assisted thoracoscopic lobectomy

Surgical treatment for early stage non-small cell lung cancer

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