scholarly journals Video-assisted thoracoscopic lobectomy versus open lobectomy in the treatment of large lung cancer: propensity-score matched analysis

2022 ◽  
Vol 17 (1) ◽  
Author(s):  
Jeonghee Yun ◽  
Junghee Lee ◽  
Sumin Shin ◽  
Hong Kwan Kim ◽  
Yong Soo Choi ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Propensity Score ◽  
Hospital Stay ◽  
Propensity Score Matching ◽  
Thoracoscopic Surgery ◽  
Perioperative Outcomes ◽  
Vats Lobectomy ◽  
Video Assisted ◽  
Increased Risk ◽  
Open Lobectomy

Abstract Background There are several concerns on thoracoscopic surgery for large tumors because of the increased risk of tumor cell spillage. This study aimed to compare perioperative outcomes and oncological validity between video-assisted thoracoscopic surgery (VATS) and open lobectomy for non-small cell lung cancer (NSCLC) with tumor size > 5 cm. Methods We retrospectively reviewed 355 patients who underwent lobectomy with clinical N0 NSCLC with solid tumor component diameter > 5 cm between January 2009 and December 2016. Patients with tumor invading adjacent structures were excluded. The patients were divided into the VATS group (n = 132) and thoracotomy group (n = 223). Propensity score matching (1:1) was applied. Results After propensity score matching, 204 patients were matched, and clinical characteristics of the two groups were well balanced. The VATS group was associated with a shorter length of hospital stay (6 days vs. 7 days; P < 0.001) than the thoracotomy group. There were no significant differences in the 5-year overall survival (71.5% in VATS vs. 64.4% in thoracotomy, P = 0.390) and 5-year recurrence-free survival (60.1% in VATS vs. 51.5% in thoracotomy, P = 0.210) between the two groups. The cumulative incidence of ipsilateral pleural recurrence was not significantly different between the two groups (12.0% in VATS vs. 7.9% in thoracotomy; P = 0.582). Conclusions In clinical N0 NSCLC larger than 5 cm, VATS lobectomy resulted in shorter hospital stay and similar survival outcome compared to open lobectomy. Based on these results, VATS lobectomy is a valuable option in this subset of patients.

Comparison of Subxiphoid and Intercostal Uniportal Thoracoscopic Thymectomy for Nonmyasthenic Early-Stage Thymoma: A Retrospective Single-Center Propensity-Score Matching Analysis

2020 ◽  
Author(s):  
Zhengcheng Liu ◽  
Rusong Yang
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Early Stage ◽  
Thoracoscopic Surgery ◽  
Disease Stage ◽  
Perioperative Outcomes ◽  
Control Group ◽  
Video Assisted ◽  
Drainage Time ◽  
Video Assisted Thoracoscopic Surgery

Abstract Objective The aim of this study was to compare early outcome between intercostal uniportal video-assisted thoracoscopic surgery (IU-VATS) versus subxiphoid uniportal video-assisted thoracoscopic surgery (SU-VATS) in thymectomy for non-myasthenic early-stage thymoma. Method Retrospective analysis of 76 cases completed in our hospital from May 2018 to September 2019 with subxiphoid uniportal thoracoscopic thymectomy; a single incision of ∼3 cm was made ∼1 cm under the xiphoid process. The control group included 213 patients who received intercostal uniportal thoracoscopic thymectomy from August 2015, and propensity score matching was conducted. All patients who were clinically diagnosed with thymic tumor before surgery were treated with thymectomy. Perioperative outcomes between SU-VATS (n = 76) and IU-VATS, n = 76 were compared. Result After propensity score matching, there were no statistically significant differences between the two groups in terms of age, gender, disease stage, maximal tumor size, or other baseline demographic and clinical variables. All operation was successfully completed; there were no significant differences in the operative time (88 vs. 81 minutes, p = 0.63), intraoperative blood loss (55 vs. 46 mL, p = 0.47), postoperative drainage time (2.2 vs. 2.5 days, p = 0.72), and postoperative hospital stay (3.2 vs. 3.4 days, p = 0.78) between the two groups. The visual analog scale (VAS) on postoperative days 1, 3, 7, and 30 was less in the SU-VATS group than that in the IU-VATS group. The VAS on days 60 and 180 did not differ significantly between the two groups. Conclusion Thymectomy using SU-VATS is a feasible procedure; it might reduce early postoperative pain and lead to faster recovery.

scholarly journals Comparison of postoperative pulmonary complications between sugammadex and neostigmine in lung cancer patients undergoing video-assisted thoracoscopic lobectomy: a prospective double-blinded randomized trial

2021 ◽  
Vol 16 (1) ◽  
pp. 60-67
Author(s):  
Tae Young Lee ◽  
Seong Yeop Jeong ◽  
Joon Ho Jeong ◽  
Jeong Ho Kim ◽  
So Ron Choi
Keyword(s):  
Hospital Stay ◽  
Thoracoscopic Surgery ◽  
Pulmonary Complications ◽  
Postoperative Pulmonary Complications ◽  
Vats Lobectomy ◽  
Reversal Agents ◽  
Duration Of Hospital Stay ◽  
Video Assisted ◽  
Increased Risk ◽  
Significant Difference

Background: Reversal of neuromuscular blockade (NMB) at the end of surgery is important for reducing postoperative residual NMB; this is associated with an increased risk of postoperative pulmonary complications (PPCs). Moreover, PPCs are associated with poor prognosis after video-assisted thoracoscopic surgery (VATS) for lobectomy. We compared the effects of two reversal agents, sugammadex and neostigmine, on the incidence of PPCs and duration of hospital stay in patients undergoing VATS lobectomy.Methods: After VATS lobectomy was completed under neuromuscular monitoring, the sugammadex group (n = 46) received sugammadex 2 mg/kg, while the neostigmine group (n = 47) received neostigmine 0.05 mg/kg with atropine 0.02 mg/kg after at least the third twitch in response to the train of four stimulation. The primary outcome was incidence of PPCs. The secondary outcomes were duration of hospital stay and intensive care unit (ICU) admission. Results: There was no significant difference in the incidence of PPCs for both the sugammadex and neostigmine groups (32.6% and 40.4%, respectively; risk difference = 0.08; 95% confidence interval = [−0.12, 0.27]; P = 0.434). The lengths of hospital (P = 0.431) and ICU (P = 0.964) stays were not significantly different between the two groups.Conclusions: The clinical use of sugammadex and neostigmine in NMB reversal for patients undergoing VATS lobectomy was not significantly different in the incidence of PPCs and duration of hospital and ICU stay.

Is a Chest Tube Necessary after Video-Assisted Thoracoscopic Mediastinal Tumor Resection?

2019 ◽  
Author(s):  
Yu-Wei Liu ◽  
Hao-Wei Chen ◽  
Jui-Ying Lee ◽  
Hung-Hsing Chiang ◽  
Hsien-Pin Li ◽  
...  
Keyword(s):  
Propensity Score ◽  
Hospital Stay ◽  
Propensity Score Matching ◽  
Mediastinal Tumor ◽  
Thoracoscopic Surgery ◽  
Lung Resection ◽  
Tumor Resection ◽  
Chest Drain ◽  
Video Assisted ◽  
Drain Group

Background The omission of chest tubes after thoracoscopic procedures such as sympathectomy, lung biopsy, and lung resection has proven efficacious in decreasing pain and length of hospital stay in some cases. However, its safety for mediastinal diseases remains unclear. This study evaluated the feasibility and outcome of eliminating chest drains after video-assisted thoracoscopic surgery (VATS) for mediastinal tumor resection. Methods We retrospectively investigated 70 patients receiving VATS mediastinal tumor resection in a single institution between January 2016 and November 2018. A total of 39 patients (drain group) received postoperative chest drains and 31 patients (no-drain group) did not. Group clinical outcomes and operation data were compared. A propensity score matching analysis was further performed to yield a fairer comparison. Results Before propensity score matching, the no-drain group had a higher prevalence of cystic lesions, a shorter operative time, and less blood loss compared with the drain group (p = 0.015, p = 0.018, and p < 0.001, respectively). After matching, the group differences in these perioperative variables lost significance (p = 0.095, 0.4, and 0.2, respectively). The no-drain group had lower postoperative day 2 pain scores and shorter postoperative hospital stays than the drain group, regardless of whether they were matched (pain: p = 0.028; hospital stay < 0.001) or not (pain: p = 0.003; hospital stay < 0.001). No major adverse events occurred in either group during hospitalization or follow-up period. Conclusion Eliminating chest drain placement after VATS mediastinal tumor resection may benefit some patients and decrease postoperative pain and hospital stay without increasing complications or compromising patient safety.

scholarly journals Cost and survival of video-assisted thoracoscopic lobectomy versus open lobectomy in lung cancer patients: a propensity score-matched study

2019 ◽  
Vol 57 (1) ◽  
pp. 92-99 ◽  
Author(s):  
Pavo Marijic ◽  
Julia Walter ◽  
Christian Schneider ◽  
Larissa Schwarzkopf
Keyword(s):  
Lung Cancer ◽  
Propensity Score ◽  
Hospital Stay ◽  
Propensity Score Matching ◽  
Cancer Patients ◽  
Economic Benefits ◽  
Wilcoxon Test ◽  
Lung Cancer Patients ◽  
Video Assisted ◽  
Patient Reported

Abstract OBJECTIVES A video-assisted thoracoscopic surgery (VATS) is an accepted alternative to open thoracotomy (OT) in lung cancer patients undergoing lobectomy, but evidence of the benefits of VATS remains inconsistent. The aim of this study was to compare VATS and OT regarding survival, costs and length of hospital stay (LOS). METHODS We identified lung cancer patients (incident 2013) undergoing VATS or OT from German insurance claims data and performed 1:2 propensity score matching. A 3-year survival was analysed using the Kaplan–Meier curves and a univariable Cox model. Group differences in the 3-year lung cancer-related costs and costs of hospital stay with lobectomy were compared via univariable generalized linear gamma models. LOS was compared using the Mann–Whitney–Wilcoxon test. RESULTS After propensity score matching, we compared 294 patients undergoing VATS and 588 receiving OT. We found no differences in the 3-year survival (VATS: 73.8%, OT: 69.2%, P = 0.131) or costs for hospital stay with lobectomy (VATS: €11 921, OT: €12 281, P = 0.573). However, VATS patients had significantly lower lung cancer-related costs (VATS: €20 828, OT: €23 723, P = 0.028) and median postoperative LOS (VATS: 9 days, OT: 11 days, P &lt; 0.001). CONCLUSIONS From a payer's perspective, extending the use of VATS is beneficial, as it shows economic benefits without affecting survival. However, for a more comprehensive assessment of the benefits of VATS from a society’s point of view, further aspects such as patient-reported outcomes and provider-related standby costs need to be investigated further.

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