Minimally Invasive Lung Resection After Induction Therapy: Is There Evidence?

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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Major Pathologic Response after Induction Therapy Has a Long-Term Impact on Survival and Tumor Recurrence in Stage IIIA/B Locally Advanced NSCLC

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0039-1679884 ◽

2019 ◽

Vol 68 (07) ◽

pp. 639-645

Author(s):

Waldemar Schreiner ◽

Wojciech Dudek ◽

Ralf Joachim Rieker ◽

Sebastian Lettmaier ◽

Rainer Fietkau ◽

...

Keyword(s):

Induction Therapy ◽

Lung Resection ◽

Locally Advanced ◽

Prognostic Significance ◽

Pathologic Response ◽

Perioperative Morbidity ◽

Platinum Based Chemotherapy ◽

Impact On Survival ◽

Long Term Impact

Abstract Background Major pathologic response (MPR) determines favorable outcome in locally advanced non-small cell lung cancer after induction therapy (IT) followed by lung resection. The aim of this retrospective study was to identify the prognostic relevance of MPR in long-term interval. Methods In 55 patients, the survival rate according to MPR and non-MPR was estimated by Kaplan–Meier method and compared using log-rank, Breslow, and Tarone–Ware tests. Results The IT included chemoradiation with 50.4 Gy (range: 45–56.4 Gy) combined with platinum-based chemotherapy in 52 patients (94.5%) and platinum-based chemotherapy in 3 patients (5.5%). Perioperative morbidity and 30-day mortality were 36 and 3.6%, respectively. The estimated 5-year postoperative and progressive-free survivals were statistically significantly improved in MPR versus non-MPR with 53.5 versus 18% and 49.4 versus 18.5%, respectively. According to the log-rank, Breslow, and Tarone–Ware tests, the MPR demonstrates prognostic significance in early, long-term, and whole postoperative interval. Conclusion MPR is associated with a robust correlation to long-term postoperative and recurrence-free survival improvement, and can potentially simplify the multidisciplinary debate and allow further stratification of adjuvant treatment in multimodality therapy.

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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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VATS Versus Thoracotomy for Major Lung Resection After Induction Therapy

Difficult Decisions in Thoracic Surgery ◽

10.1007/978-1-84996-492-0_15 ◽

2010 ◽

pp. 145-153

Author(s):

Mark F. Berry ◽

Thomas A. D’Amico

Keyword(s):

Induction Therapy ◽

Lung Resection

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P-391 Preliminary survival analysis of patients with non-small cell lung cancer after induction therapy followed by surgical restaging and lung resection or palliative treatment

Lung Cancer ◽

10.1016/s0169-5002(03)92359-2 ◽

2003 ◽

Vol 41 ◽

pp. S190 ◽

Cited By ~ 2

Author(s):

Miguel Mateu-Navarro ◽

Ramon Rami-Porta ◽

Mireia Serra-Mitjans

Keyword(s):

Lung Cancer ◽

Survival Analysis ◽

Small Cell Lung Cancer ◽

Induction Therapy ◽

Cell Lung Cancer ◽

Palliative Treatment ◽

Lung Resection ◽

Small Cell ◽

Small Cell Lung

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Picrosirius red staining assessment of collagen after dermal roller application: A minimally invasive percutaneous collagen induction therapy

Indian Journal of Dermatopathology and Diagnostic Dermatology ◽

10.4103/2349-6029.147289 ◽

2014 ◽

Vol 1 (2) ◽

pp. 68 ◽

Cited By ~ 2

Author(s):

Fatma El-ZahraaSalah El-Deen Yassin ◽

RehamEzz El-Dawela ◽

MohammadAbel Kerim

Keyword(s):

Minimally Invasive ◽

Induction Therapy ◽

Picrosirius Red

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Female gender is an independent predictor of superior perioperative survival following non-small cell lung cancer (NSCLC) resection

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.7150 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 7150-7150

Author(s):

B. J. Park ◽

N. Rizk ◽

R. M. Flores ◽

R. Downey ◽

M. S. Bains ◽

...

Keyword(s):

Lung Cancer ◽

Hospital Mortality ◽

Surgical Resection ◽

Induction Therapy ◽

Independent Predictor ◽

Lung Resection ◽

Female Gender ◽

Extent Of Resection ◽

Diffusion Capacity ◽

Co Morbidity

7150 Background: Selecting patients who will benefit from surgical resection of NSCLC, especially following induction therapy, can be challenging. We analyzed our modern experience to determine factors associated with superior operative outcomes. Methods: A retrospective review of a prospectively maintained database of consecutive NSCLC patients who underwent surgical exploration for resection from January 1999 through June 2005 was performed. Factors evaluated included age, sex, co-morbidities, use of induction therapy, previous thoracic operations, extent of lung resection, and in-hospital mortality. Associations between categorical variables were evaluated with a chi-squared test and for continuous variables with an analysis of variance. Multivariate analysis was done with a logistic regression model. Results: A total of 2,524 patients underwent attempt at surgical resection, 1,398 of whom were female (55.4%). One hundred and four (4.1%) patients had exploration only. The majority of patients underwent lobectomy (1,692/2,524, 67.1%), and 6.1% (154/2,524) had a pneumonectomy. Induction therapy was given in 492 patients (19.5%). Univariate analysis showed that male gender (2.4% vs 0.93%, respectively, p = 0.003), presence of cardiac co-morbidity (p = 0.05), poor diffusion capacity (p = 0.003), and greater extent of resection (p = 0.01) were associated with increased in-hospital mortality. Multivariate analysis controlling for gender, age, diffusion capacity, cardiac, and diabetic co-morbidity, as well as prior lung cancer operation, extent of resection and use of induction therapy demonstrated that increased age, decreased diffusion capacity and greater anatomic lung resection were risk factors for higher in-hospital mortality. However, female sex was an independent predictor of lower in-hospital mortality (OR 0.41, p = 0.01). Conclusions: In addition to other previously described predictors of poor surgical outcome, such as advanced age, poor lung function and greater extent of lung removal, we observed that female gender appears to be associated with better in-hospital survival following surgical resection of NSCLC. No significant financial relationships to disclose.

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