“Obesity paradox” has not an impact on minimally invasive anatomical lung resection

Objective Enhanced recovery pathways reduce length of stay and costs following lung resection. However, many fear that early discharge may lead to increased hospital readmissions. In this study, we aimed to determine whether early discharge was associated with increased readmission following anatomic lung resection. Methods Using the lung resection database approved by our institutional review board, we identified all patients undergoing minimally invasive lobectomy and segmentectomy between January 2010 and March 2017 at our institution, where an enhanced recovery pathway is well established. Thirty-day readmissions were compared between patients with short- and average length of stay, defined as 1 to 2 days and 3 to 5 days, respectively. Multivariable logistic regression analysis of patients matched by propensity scores was performed to determine odds of 30-day readmission for each group. Significance was set at P < 0.05. Results A total of 296 patients met inclusion criteria. Unadjusted analysis revealed a 3-fold increased rate of readmission in the group with average length of stay (9%, n = 12) versus the group with short length of stay (3%, n = 5; P < 0.01). At baseline, patients with average length of stay had increased rates of preoperative chemotherapy (13%, n = 18 vs. 4%, n = 6; P < 0.01) and radiation (12%, n = 16 vs. 3%, n = 5). Patients with average length of stay also had higher rates of lobectomy (95%, n = 127 vs. 86%, n = 140; P = 0.02) and postoperative complications (31%, n = 41 vs. 4%, n = 7; P < 0.01). On multivariable analysis, patients with average length of stay had a 2.3-fold greater odds of readmission, which was not statistically significant (OR = 2.33; 95% CI, 0.60 to 9.02; P = 0.22). Conclusions Early discharge following minimally invasive anatomic lung resection does not increase the risk of hospital readmission in patients treated within an enhanced recovery pathway.

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Computed tomography criteria for the use of advanced localization techniques in minimally invasive thoracoscopic lung resection

Journal of Thoracic Disease ◽

10.21037/jtd.2018.05.54 ◽

2018 ◽

Vol 10 (6) ◽

pp. 3390-3398

Author(s):

Min P. Kim ◽

Duc T. Nguyen ◽

Edward Y. Chan ◽

Leonora M. Meisenbach ◽

Lisa M. Kopas ◽

...

Keyword(s):

Computed Tomography ◽

Minimally Invasive ◽

Lung Resection

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When is a patient high risk for resection? A changing paradigm with minimally invasive lung surgery.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e20059 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e20059-e20059

Author(s):

Hiroko Nakahama ◽

Kostantinos Poulikidis ◽

James Lubawski ◽

Wickii T. Vigneswaran

Keyword(s):

Minimally Invasive Surgery ◽

Lung Function ◽

Minimally Invasive ◽

Invasive Surgery ◽

Chest Tube ◽

Lung Resection ◽

Invasive Technique ◽

Air Leak ◽

Tube Removal ◽

Predicted Values

e20059 Background: The predicted post-operative forced expiratory volume after 1 second (FEV1) and the diffusing capacity of the lung for carbon monoxide (DLCO) are predictors of postoperative complications and survival. Despite the benefits of minimally invasive surgery in patients with marginal lung function current practice guidelines advocates non-surgical approach for treatment from evidence derived from patients undergoing thoracotomy. It is necessary to define what should be minimum acceptable lung function for resection in the era of minimally invasive surgery. Methods: Single institution retrospective study of 61 patients with pre-operative predicted FEV1 and DLCO < 60% that underwent lung resection for pulmonary lung nodules suspected to be malignant between January 2017 to June 2018. Patient demographic and clinical data were collected and the 30-day or in-hospital morbidity and mortality were assessed. Results: 28 (46%) patients with pre-operative predicted FEV1 < 60% and 33 (54%) with DLCO < 60% were reviewed. 10 patients had both FEV1 and DLCO < 60%. There were 12 patients (28% in FEV1, 12% in DLCO group) who had < 40% of pre-operative predicted values. 15 (65%) of FEV1 group and 15 (45%) of DLCO group had anatomic lung resections with either a lobectomy or a segmentectomy. 24 (39%) of cases were done robotically and the remaining with VATS. 80% of patients had cancer in their final pathology. Patients were 68± 7 years old, 34 (56%) were male. Significant baseline clinical findings include high incidence of smoking (82% in FEV1, 97% in DLCO group), HTN (71% in FEV1, 81% in DLCO group), COPD (61% in FEV1, 48% in DLCO group), CAD (25% in FEV1, 30% in DLCO group), and a total of 2 patients suffered previous CVD. Most common complications included persistent air leak > 5 days (21% in FEV1 and DLCO group) and arrhythmia (14% in FEV1, 15% in DLCO group). Of those with an air leak, 50% in the FEV1 group and 29% in the DLCO group had predicted values < 40%. Three patients developed pneumothorax post chest tube removal necessitating chest tube replacement, all of whom had predicted values < 40%. One patient developed acute DVT and PE and another patient required mechanical ventilation for > 48 hours. There were no 30-day mortalities. Conclusions: Lung resection using minimally invasive technique had low rates of 30-day morbidity in patients with reduced pulmonary function. Majority of complications observed were minor. Minimally invasive lung resection is possible and may be extended to selected patients with pre-operative predicted DLCO or FEV1 < 40% suspected of malignancy.

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One Stage Minimally Invasive Thoracoscopic Lung Resection and Transphrenic Adrenalectomy: Surgical Technique

Thoracic Surgery ◽

10.1007/978-3-030-40679-0_74 ◽

2020 ◽

pp. 829-832

Author(s):

Patrick Bagan ◽

Bassel Dakhil ◽

Rym Zaimi ◽

Mahine Kashi-dakhil

Keyword(s):

Surgical Technique ◽

Minimally Invasive ◽

Lung Resection ◽

One Stage

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Feasibility and Complications in Concomitant Lung Resection With Minimally Invasive Repair of Pectus Excavatum

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2014.09.084 ◽

2015 ◽

Vol 100 (2) ◽

pp. 707-709 ◽

Cited By ~ 3

Author(s):

Zeynep Bilgi ◽

Nezih Onur Ermerak ◽

Korkut Bostancı ◽

Bülent Saçak ◽

Hasan Fevzi Batırel ◽

...

Keyword(s):

Minimally Invasive ◽

Pectus Excavatum ◽

Lung Resection

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Ist die Adipositas ein Risikofaktor für postoperative Komplikationen nach Lungenlappenresektion?

Karger Kompass Pneumologie ◽

10.1159/000500586 ◽

2019 ◽

Vol 7 (4) ◽

pp. 200-201

Author(s):

Thomas Lesser

Keyword(s):

Postoperative Complications ◽

Intraoperative Complications ◽

Lung Resection ◽

Postoperative Mortality ◽

Obesity Paradox ◽

P Value ◽

Obese Patients ◽

Short Term ◽

Lung Lobectomy ◽

The Impact

Background: The aim of the present study was to evaluate the impact of BMI on the short-term outcomes of patients undergoing lung lobectomy. Methods: This was a retrospective clinical cohort study conducted in a single institution to assess the short-term outcomes of obese patients undergoing lung resection. Intraoperative and postoperative parameters were compared between the two study subgroups: obese (BMI ≥30 kg/m2) and non-obese patients (BMI <30 kg/m2). Results: In total, 203 patients were enrolled in the study (70 obese and 133 non-obese patients). Both study subgroups were comparable with regards to demographics, clinical data and surgical approach (thoracoscopy vs. thoracotomy). The surgery time was significantly longer in obese patients (p = 0.048). There was no difference in the frequency of intraoperative complications between the study subgroups (p = 0.635). The postoperative hospital stay was similar in both study subgroups (p = 0.366). A 30-day postoperative morbidity was higher in a subgroup of non-obese patients (33.8% vs. 21.7%), but the difference was not significant (p = 0.249). In the subgroup of non-obese patients, a higher frequency of mild and severe postoperative complications was observed. However, the differences between the study subgroups were not statistically significant due to the borderline p-value (p = 0.053). The 30-day postoperative mortality was comparable between obese and non-obese patients (p = 0.167). Conclusions: Obesity does not increase the incidence and severity of intraoperative and postoperative complications after lung lobectomy. Slightly better outcomes in obese patients indicate that obesity paradox might be a reality in patients undergoing lung resection.

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Cotton-Derived Oxidized Cellulose in Minimally Invasive Thoracic Surgery

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0b013e3182a6afcf ◽

2013 ◽

Vol 8 (4) ◽

pp. 296-301 ◽

Cited By ~ 2

Author(s):

Biruta Witte ◽

Stefan M. Kroeber ◽

Hubertus Hillebrand ◽

Michael Wolf ◽

Martin Huertgen

Keyword(s):

Adverse Events ◽

Minimally Invasive ◽

Thoracic Surgery ◽

Lung Carcinoma ◽

Large Scale ◽

Lung Resection ◽

Implantation Site ◽

Oxidized Cellulose ◽

Fluid Collections

Objective The aim of this study was to identify resorption, clinical performance, and safety of cotton-derived oxidized cellulose gauze applied as a hemostat in minimally invasive oncologic thoracic surgery. Methods This is a pilot prospective noncomparative observational human in vivo study. A piece of cotton-derived oxidized cellulose gauze measuring 5 × 20 cm was inserted into the subcarinal space of patients with potentially resectable lung carcinoma at the time of video-assisted mediastinoscopic lymphadenectomy and reexamined several days later for macroscopic and histologic evaluation at the time of subsequent lung resection. The primary endpoint was the local situation at the implantation site described by cellulose remnants, fluid collections, and adhesions. The secondary endpoint was safety, described by the number of adverse events and surgical reinterventions. Results Twenty-five consecutive eligible patients with potentially resectable lung carcinoma were included. The desired hemostatic effect was achieved in all cases. No adverse events were observed. At re-exploration 10.5 (5–28) days later, the cellulose gauze was found to lose its solid structure from the fifth day on. Remnants were last detected 14 days after insertion. The implantation site exhibited no inflammatory changes and a remarkable small amount of fluid collections and adhesions. Conclusions Mediastinal application of cotton-derived oxidized cellulose is safe and effective. A piece of gauze measuring 5 × 20 cm seems to be absorbed completely within 15 days, thus precluding any interference with oncologic restaging and follow-up. The absence of relevant adhesions facilitates further surgical procedures. Larger comparative confirmatory studies are required. For large-scale resorption studies, our clinical model should be translated into a porcine model.

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