Minimally Invasive Lung Cancer Surgery Performed by Thoracic Surgeons as Effective as Thoracotomy

2018 ◽  
Vol 36 (23) ◽  
pp. 2378-2385 ◽  
Author(s):  
Daniel J. Boffa ◽  
Andrzej S. Kosinski ◽  
Anthony P. Furnary ◽  
Sunghee Kim ◽  
Mark W. Onaitis ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Minimally Invasive ◽  
Thoracic Surgery ◽  
Lung Cancer Surgery ◽  
Hazard Ratio ◽  
Cancer Surgery ◽  
Stage I ◽  
Invasive Approach ◽  
Longitudinal Outcome ◽  
Stage I Lung Cancer

Purpose The prevalence of minimally invasive lung cancer surgery using video-assisted thoracic surgery (VATS) has increased dramatically over the past decade, yet recent studies have suggested that the lymph node evaluation during VATS lobectomy is inadequate. We hypothesized that the minimally invasive approach to lobectomy for stage I lung cancer resulted in a longitudinal outcome that was not inferior to thoracotomy. Patients and Methods Patients > 65 years of age who had undergone lobectomy for stage I lung cancer between 2002 and 2013 were analyzed within the Society of Thoracic Surgeons General Thoracic Surgery Database, which had been linked to Medicare data, as part of a retrospective-cohort, noninferiority study. Results A total of 10,597 patients with clinical stage I lung cancer who underwent lobectomy were evaluated (4,448 patients underwent thoracotomy, and 6,149 underwent VATS). VATS patients had a more favorable distribution of all health-related variables, including pulmonary function (59% of VATS patients had intact spirometry v 51% of thoracotomy patients; P < .001). Cox proportional hazards models were performed over two eras to account for an evolving practice standard. The mortality risk associated with the VATS approach was not greater than thoracotomy in either the earlier era (2002 to 2008; hazard ratio, 0.97; 95% CI, 0.87 to 1.09; P = .62) or the more recent era (2009 to 2013; hazard ratio, 0.84; 95% CI, 0.75 to 0.93; P < .001). Kaplan-Meier survival estimates of 2,901 propensity-matched VATS-thoracotomy pairs demonstrated that the 4-year survival associated with VATS (68.6%) was modestly superior to thoracotomy (64.8%; P = .003). The analyses detailed above were replicated in a separate cohort of pathologic stage I patients with similar findings. Conclusion The long-term efficacy of lobectomy for stage I lung cancer performed using the VATS approach by board-certified thoracic surgeons does not seem to be inferior to that of thoracotomy.

scholarly journals Centralization of lung cancer surgery in the Netherlands: differences in care and survival of patients with stage I non-small cell lung cancer between hospitals with and without in-house lung cancer surgery

2020 ◽  
Vol 59 (4) ◽  
pp. 384-387
Author(s):  
Julianne Cynthia de Ruiter ◽  
David Jonathan Heineman ◽  
Adrianus Johannes de Langen ◽  
Max Dahele ◽  
Ronald Alphons Maria Damhuis ◽  
...  
Keyword(s):  
Lung Cancer ◽  
The Netherlands ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Lung Cancer Surgery ◽  
Small Cell ◽  
Cancer Surgery ◽  
Stage I ◽  
Small Cell Lung

scholarly journals Epidural Anesthesia–Analgesia and Recurrence-free Survival after Lung Cancer Surgery: A Randomized Trial

2021 ◽  
Author(s):  
Zhen-Zhen Xu ◽  
Huai-Jin Li ◽  
Mu-Han Li ◽  
Si-Ming Huang ◽  
Xue Li ◽  
...  
Keyword(s):  
Lung Cancer ◽  
General Anesthesia ◽  
Survival Time ◽  
Epidural Anesthesia ◽  
Lung Cancer Surgery ◽  
Hazard Ratio ◽  
Cancer Surgery ◽  
Recurrence Free Survival ◽  
Cancer Specific Survival ◽  
Free Survival

Background Regional anesthesia and analgesia reduce the stress response to surgery and decrease the need for volatile anesthesia and opioids, thereby preserving cancer-specific immune defenses. This study therefore tested the primary hypothesis that combining epidural anesthesia–analgesia with general anesthesia improves recurrence-free survival after lung cancer surgery. Methods Adults scheduled for video-assisted thoracoscopic lung cancer resections were randomized 1:1 to general anesthesia and intravenous opioid analgesia or combined epidural–general anesthesia and epidural analgesia. The primary outcome was recurrence-free survival (time from surgery to the earliest date of recurrence/metastasis or all-cause death). Secondary outcomes included overall survival (time from surgery to all-cause death) and cancer-specific survival (time from surgery to cancer-specific death). Long-term outcome assessors were blinded to treatment. Results Between May 2015 and November 2017, 400 patients were enrolled and randomized to general anesthesia alone (n = 200) or combined epidural–general anesthesia (n = 200). All were included in the analysis. The median follow-up duration was 32 months (interquartile range, 24 to 48). Recurrence-free survival was similar in each group, with 54 events (27%) with general anesthesia alone versus 48 events (24%) with combined epidural–general anesthesia (adjusted hazard ratio, 0.90; 95% CI, 0.60 to 1.35; P = 0.608). Overall survival was also similar with 25 events (13%) versus 31 (16%; adjusted hazard ratio, 1.12; 95% CI, 0.64 to 1.96; P = 0.697). There was also no significant difference in cancer-specific survival with 24 events (12%) versus 29 (15%; adjusted hazard ratio, 1.08; 95% CI, 0.61 to 1.91; P = 0.802). Patients assigned to combined epidural–general had more intraoperative hypotension: 94 patients (47%) versus 121 (61%; relative risk, 1.29; 95% CI, 1.07 to 1.55; P = 0.007). Conclusions Epidural anesthesia–analgesia for major lung cancer surgery did not improve recurrence-free, overall, or cancer-specific survival compared with general anesthesia alone, although the CI included both substantial benefit and harm. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Multicentre review of readmission rates within 30 days of discharge following lung cancer surgery

2019 ◽  
Vol 28 (17) ◽  
pp. S16-S22
Author(s):  
Maureen King ◽  
Amy Kerr ◽  
Sandra Dixon ◽  
Sarah Taylor ◽  
Alison Smith ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Postoperative Complications ◽  
Thoracic Surgery ◽  
Primary Lung Cancer ◽  
Lung Cancer Surgery ◽  
Cancer Surgery ◽  
Limited Data ◽  
Readmission Rates ◽  
Surgery Group ◽  
The Uk

Postoperative complications following curative lung cancer surgery are well recognised, but there is limited data on 30-day readmission rates. The UK Thoracic Surgery Group conducted a multicentre review over a 3-month period to assess readmission rates. Overall readmission among the 268 patients who had undergone primary lung cancer surgery was 30 (11%); 14/30 of readmissions occurred within 7 days of discharge, with 13/30 patients readmitted to a hospital that had not performed the surgery. The causes of readmission were mainly pulmonary related (16/30). Readmission was associated with being discharged with a pleural drain 11/30 (P<0.01), having two or more postoperative complications 11/30 (P<0.01) and a patient's readiness for discharge 9/30 (P=0.001). There was a trend toward an association with smoking 13/30 (P=0.18). The authors suggest that a greater focus on patients presenting with characteristics associated with readmission, and incorporating a patient's readiness for discharge, may reduce readmission, although more studies are needed.

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