scholarly journals Perioperative outcomes of combined heart surgery and lung tumor resection: A systematic review and meta-analysis

2020 ◽  
Author(s):  
Shizhao Cheng ◽  
Yiyao Jiang ◽  
Xin Li ◽  
Xike Lu ◽  
Xun Zhang ◽  
...  
Keyword(s):  
Complication Rate ◽  
Subgroup Analysis ◽  
Heart Surgery ◽  
Lung Tumor ◽  
Meta Analysis ◽  
Tumor Resection ◽  
Perioperative Outcomes ◽  
Off Pump ◽  
Lung Cancer Patients ◽  
Pump Cabg

Abstract Objective: The coexistence of concomitant lesions of the heart and lungs needed surgical intervention is increasing. Simultaneous cardiac surgery with pulmonary resection can solve the lesions at the same time, thus avoiding the second operation. However, concern exists regarding the potentially increased mortality and complication rate of simultaneous surgery and the adequacy of lung exposure during heart surgery. Therefore, we performed a meta-analysis to evaluate the perioperative mortality and complication rate of combined heart surgery and lung tumor resection.Methods: A comprehensive literature search was performed in July 2020. PubMed, Embase and Web of Science databases were searched to collect studies reported the perioperative outcomes of combined heart surgery and lung tumor resection. Two reviewers independently screened literatures, extracted data and assessed the risk of bias of included studies. Pooled proportion and its 95% confidence intervals (95% CI) was performed by R version 3.6.1 using the meta package.Results: A total of 536 patients from 29 studies were included in this analysis. Overall, the results of this meta-analysis showed that the pooled proportion of operative mortality was 0.01 (95% CI: 0.00, 0.03) and the pooled proportion of postoperative complications was 0.40 (95% CI: 0.24, 0.57) for patients underwent combined cardiothoracic surgery. Subgroup analysis by lung pathology revealed that, for lung cancer patients, the pooled proportion of anatomical lung resection was 0.99 (95% CI: 0.95, 1.00), and the pooled proportion of systematic lymph node dissection or sampling was 1.00 (95% CI: 1.00, 1.00). Subgroup analysis by heart surgery procedures found that the pooled proportion of postoperative complications of coronary artery bypass grafting (CABG) patients using off-pump method was 0.17 (95% CI: 0.01, 0.43), while the pooled proportion of on-pump method was 0.61 (95% CI: 0.38, 0.82).Conclusion: This study presented that combined heart surgery and lung tumor resection had a low mortality rate and an acceptable complication rate. Subgroup analysis revealed most lung cancer patients underwent uncompromised anatomical resection and mediastinal lymph node sampling or dissection during combined cardiothoracic surgery, and showed off-pump CABG could potentially reduce the complication rate compared with on-pump CABG. While further researches are still needed.

scholarly journals Perioperative outcomes of combined heart surgery and lung tumor resection: a systematic review and meta-analysis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Shizhao Cheng ◽  
Yiyao Jiang ◽  
Xin Li ◽  
Xike Lu ◽  
Xun Zhang ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Lymph Node ◽  
Heart Surgery ◽  
Lung Tumor ◽  
Meta Analysis ◽  
Tumor Resection ◽  
Perioperative Outcomes ◽  
Complication Rates ◽  
Off Pump ◽  
Pump Cabg

Abstract Objective The prevalence of patients with concomitant heart and lung lesions requiring surgical intervention is increasing. Simultaneous cardiac surgery and pulmonary resection avoids the need for a second operation. However, there are concerns regarding the potentially increased mortality and complication rates of simultaneous surgery and the adequacy of lung exposure during heart surgery. Therefore, we performed a meta-analysis to evaluate the perioperative mortality and complication rates of combined heart surgery and lung tumor resection. Methods A comprehensive literature search was performed in July 2020. The PubMed, Embase, and Web of Science databases were searched to identify studies that reported the perioperative outcomes of combined heart surgery and lung tumor resection. Two reviewers independently screened the studies, extracted data, and assessed the risk of bias of included studies. Pooled proportions and 95% confidence intervals (95% CI) were calculated by R version 3.6.1 using the meta package. Results A total of 536 patients from 29 studies were included. Overall, the pooled proportion of operative mortality was 0.01 (95% CI: 0.00, 0.03) and the pooled proportion of postoperative complications was 0.40 (95% CI: 0.24, 0.57) for patients who underwent combined cardiothoracic surgery. Subgroup analysis by lung pathology revealed that, for patients with lung cancer, the pooled proportion of anatomical lung resection was 0.99 (95% CI: 0.95, 1.00) and the pooled proportion of systematic lymph node dissection or sampling was 1.00 (95% CI: 1.00, 1.00). Subgroup analysis by heart surgery procedure found that the pooled proportion of postoperative complications of patients who underwent coronary artery bypass grafting (CABG) patients using the off-pump method was 0.17 (95% CI: 0.01, 0.43), while the pooled proportion of complications after CABG using the on-pump method was 0.61 (95% CI: 0.38, 0.82). Conclusion Combined heart surgery and lung tumor resection had a low mortality rate and an acceptable complication rate. Subgroup analyses revealed that most patients with lung cancer underwent uncompromised anatomical resection and mediastinal lymph node sampling or dissection during combined cardiothoracic surgery, and showed off-pump CABG may reduce the complication rate compared with on-pump CABG. Further researches are still needed to verify these findings.

Early Experience of Cardiac Surgery in the Maldives

2019 ◽  
Vol 41 (1) ◽  
pp. 52-66
Author(s):  
Ranjan Sapkota ◽  
Mohamed Shafiu ◽  
Dusooma A Razzag ◽  
Priyanka B Patil ◽  
Haytham M Y Sadoon ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Heart Surgery ◽  
Perioperative Management ◽  
Length Of Hospital Stay ◽  
Early Experience ◽  
Current Level ◽  
Chest Tubes ◽  
Fatal Complication ◽  
Off Pump ◽  
Pump Cabg

Introduction:From stitching a heart wound to the current level of sophistication, cardiac surgery has come a long way as a discipline. Heart surgery in South Asia has advanced tremendously; both, quantitatively and qualitatively. This is a report of the first fifteen surgeries done in the Maldives where cardiac surgery has started as an organized program. Methods: Data on the first fifteen consecutive cardiac surgeries done in our hospital, over a period of 7 months, was analyzed. We briefly describe our usual perioperative management, and the pretext of the beginning of the cardiac surgery program. Results: Fifteen patients, 13 males, aged 59.9±13.8 years, with a EuroScore of 0.9±0.4%, were operated. Eleven underwent CABG; and four had a valve replacement. Nine out of 11 had TVD, including 6 who had an LMCA disease. The first surgery was an off-pump CABG. The CABG group had a total of 2-5 grafts. Pump and cross-clamp times were 239.6 (± 56.1) min and 154.2 (± 45) min respectively. Five (33.3%) had at least one non-fatal complication. Two (13.2%) required re-exploration for mediastinal bleeding. The length of hospital stay was 16.5 days (±6.9 days). The chest tubes stayed for an average of 4.8 (±0.7) days. There was no in-hospital, 30-day and 90-day mortality recorded. Conclusion: Cardiac surgery has begun in the Maldives. It is safe and feasible to sustain cardiac surgery program in the country, provided continued national support and international collaboration is ensured.

scholarly journals Uniportal versus multiportal video-assisted thoracoscopic anatomical resection for NSCLC: a meta-analysis

2020 ◽  
Author(s):  
Yueren Yan ◽  
Qingyuan Huang ◽  
Han Han ◽  
Yang Zhang ◽  
Haiquan Chen
Keyword(s):  
Blood Loss ◽  
Lymph Nodes ◽  
Subgroup Analysis ◽  
Operative Time ◽  
Pulmonary Resection ◽  
Meta Analysis ◽  
Perioperative Outcomes ◽  
Categorical Variables ◽  
Postoperative Stay ◽  
Video Assisted

Abstract Background Uniportal video-assisted thoracoscopic surgery (U-VATS) has recently emerged as an alternative procedure for non-small cell lung cancer (NSCLC); however, whether U-VATS has advantages over multiportal VATS (M-VATS) remains unknown. Methods We performed a systematic review of two databases (Pubmed and Web of Science) to search comparative studies of U-VATS and M-VATS anatomical pulmonary resection for NSCLC. Parameters of continuous variables (operative time, blood loss, number of resected lymph nodes, drainage duration, length of postoperative stay and pain in postoperative day 1(POD1)) or categorical variables (conversion rates) were retrieved to estimate the comparitiveoutcomes. A subgroup analysis stratified by study type (propensity-matched analysis& randomized-controlled trial versus non-propensity matched analysis) was performed. Result A total of 19 studies with 3809 patients were included in this meta-analysis. U-VATS was performed on 1747 patients, whereas the other 2062 patients underwent M-VATS. This meta-analysis showed that there was no significant difference in operative time (U-VATS: 146.48±55.07min versus M-VATS: 171.70±79.40min, P=0.81), blood loss (74.49±109.03mL versus 95.48±133.67mL, P=0.18), resected lymph nodes (17.28±9.46 versus 18.31±10.17, P=0.62), conversion rate (6.18% versus 4.34%, P=0.14), drainage duration (3.90±2.94 days versus 4.44±3.12 days, p=0.09), length of postoperative stay (6.16±4.40 days versus 6.45±4.80 days, P=0.22), and pain in POD1 (3.94±1.68 versus 3.59±2.76, p=0.07). Subgroup analysis showed the value of PSM&RCT group consistency with overall value. Conclusion This up-to-date meta-analysis shows that the perioperative outcomes of U-VATS and M-VATS anatomical pulmonary resection are equivalent. In addition, the differences in long-term outcomes of these two approaches are still unclear. Thoracic surgeons should pay more emphasize on providing high-quality and personalized surgical care for patients, to improve the survival ultimately.

CLC059 ORAL Combined heart surgery and lung tumor resection

Lung Cancer ◽  
2007 ◽  
Vol 55 ◽  
pp. S14-S15 ◽  
Author(s):  
Chr. Prokakis ◽  
N. Panagopoulos ◽  
E. Koletsis ◽  
D. Tselikos ◽  
K. Filos ◽  
...  
Keyword(s):  
Heart Surgery ◽  
Lung Tumor ◽  
Tumor Resection

scholarly journals Uniportal versus multiportal video-assisted thoracoscopic anatomical resection for NSCLC: a meta-analysis

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Yueren Yan ◽  
Qingyuan Huang ◽  
Han Han ◽  
Yang Zhang ◽  
Haiquan Chen
Keyword(s):  
Blood Loss ◽  
Lymph Nodes ◽  
Subgroup Analysis ◽  
Operative Time ◽  
Pulmonary Resection ◽  
Meta Analysis ◽  
Perioperative Outcomes ◽  
Postoperative Stay ◽  
Video Assisted ◽  
Significant Difference

Abstract Background Uniportal video-assisted thoracoscopic surgery (U-VATS) has recently emerged as an alternative procedure for non-small cell lung cancer (NSCLC); however, whether U-VATS has advantages over multiportal VATS (M-VATS) remains unknown. Methods We performed a systematic review of two databases (Pubmed and Web of Science) to search comparative studies of U-VATS and M-VATS anatomical pulmonary resection for NSCLC. Operative time, blood loss, number of resected lymph nodes, drainage duration, length of postoperative stay, pain in postoperative day 1(POD1) and conversion rates were retrieved to estimate the comparison of outcomes. A subgroup analysis stratified by study type (propensity-matched analysis and randomized-controlled trial versus non-propensity matched analysis) was performed. Result A total of 20 studies with 4142 patients were included in this meta-analysis. U-VATS was performed on 1869 patients, whereas the other 2173 patients underwent M-VATS. This meta-analysis showed that there was no significant difference in operative time (U-VATS: 146.48 ± 55.07 min versus M-VATS: 171.70 ± 79.40 min, P = 0.81), blood loss (74.49 ± 109.03 mL versus 95.48 ± 133.67 mL, P = 0.18), resected lymph nodes (17.28 ± 9.46 versus 18.31 ± 10.17, P = 0.62), conversion rate (6.18% versus 4.34%, P = 0.14), drainage duration (3.90 ± 2.94 days versus 4.44 ± 3.12 days, p = 0.09), length of postoperative stay (6.16 ± 4.40 days versus 6.45 ± 4.80 days, P = 0.22), and pain in POD1 (3.94 ± 1.68 versus 3.59 ± 2.76, p = 0.07). Subgroup analysis showed the value of PSM and RCT group consistency with overall value. Conclusion This up-to-date meta-analysis shows that the perioperative outcomes of U-VATS and M-VATS anatomical pulmonary resection are equivalent. In addition, the differences in long-term outcomes of these two approaches are still unclear. Thoracic surgeons should pay more emphasize on providing high-quality and personalized surgical care for patients, to improve the survival ultimately.

scholarly journals Efficacy of Laparoscopic Hepatectomy versus Open Surgery for Hepatocellular Carcinoma With Cirrhosis: A Meta-analysis of Case-Matched Studies

2021 ◽  
Vol 11 ◽  
Author(s):  
Yu Pan ◽  
Shunjie Xia ◽  
Jiaqin Cai ◽  
Ke Chen ◽  
Xiujun Cai
Keyword(s):  
Hepatocellular Carcinoma ◽  
Complication Rate ◽  
Subgroup Analysis ◽  
Meta Analysis ◽  
Laparoscopic Hepatectomy ◽  
Operation Time ◽  
Cochrane Library ◽  
Oncological Outcomes ◽  
Major Resection

BackgroundThe role of laparoscopic hepatectomy (LH) in hepatocellular carcinoma (HCC) with cirrhosis remains controversial and needs to be further assessed. The present meta-analysis aimed to compare the surgical and oncological outcomes of LH with those of open hepatectomy (OH) for HCC with cirrhosis.MethodsThe PubMed, Embase, and Cochrane Library databases were searched for studies comparing LH and OH until Mar 2021. Weighted mean differences (WMDs), odds ratios (ORs), and hazard ratios (HRs) were calculated for continuous, dichotomous, and long-term variables, respectively, with 95% confidence intervals (CIs). Subgroup analysis was performed according to different resection types: major resection and minor resection. The meta-analysis was performed using the STATA 12.0.ResultsA total of 16 case-matched studies (784 patients in the LH group and 1,191 patients in the OH group.) were included in this meta-analysis. In terms of primary outcomes, LH was associated with decreased overall complication rate (OR 0.57; 95% CI 0.46 to 0.71; P <0.01), major complication rate (OR 0.52; 95% CI 0.33 to 0.82; P < 0.01), postoperative mortality (OR 0.27; 95% CI 0.11 to 0.66; P  <0.01), 1-y overall survival (OS) rate (HR 0.48; 95% CI 0.31 to 0.73; P <0.01), 2-y OS (HR 0.61; 95% CI 0.45 to 0.83; P < 0.01), and 5-y OS (0.67; 95% CI 0.53 to 0.85; P < 0.01). With respect to secondary outcomes, blood loss (WMD −69.16; 95% CI −101.72 to −36.61; P < 0.01), length of hospitalization (LOH) (WMD −2.65; 95% CI −3.41 to −1.89; P < 0.01), minor complication rate (OR 0.70; 95% CI 0.53 to 0.94; P = 0.02), postoperative liver failure (OR 0.60; 95% CI 0.38 to 0.95; P = 0.03), and postoperative ascites (OR 0.44; 95% CI 0.28 to 0.72; P < 0.01) was lower in LH than in OH. No significant differences in operation time (P = 0.07), transfusion rate (P = 0.05), 1-, 2-, and 5-year DFS rate (1-year, P = 0.08; 2-year, P = 0.08; 5-year, P = 0.23) were noted between LH and OH. Subgroup analysis based on minor resection revealed that LH had similar favored outcomes in comparison with those in the overall pooled analysis. However, LH had a longer operation time than OH in the setting of major resection (P < 0.01).ConclusionLH is technically feasible and safe for selected HCC patients with cirrhosis. LH can achieve favored short-term and long-term oncological outcomes in minor liver resection. Laparoscopic major hepatectomy (LMH) seems to offer some advantages over the open approach; however concerns about surgical and oncological safety remain. More evidence on LMH is warranted before expanding its indication to patients with cirrhosis.

scholarly journals Prognostic significance of mean platelet volume in lung cancer patients: A meta-analysis

2021 ◽  
Author(s):  
Sanjeev Kharel ◽  
Suraj Shrestha ◽  
Prafulla Shakya ◽  
Rohit Rawat ◽  
Ramila Shilpakar
Keyword(s):  
Lung Cancer ◽  
Cancer Patients ◽  
Subgroup Analysis ◽  
Mean Platelet Volume ◽  
Meta Analysis ◽  
Prognostic Significance ◽  
Platelet Volume ◽  
Free Survival ◽  
Lung Cancer Patients ◽  
Platelet Size

Abstract Background Lung cancer is the most prevalent cancer globally with a grim prognosis alongside a very high number of cancer-related deaths. Mean platelet volume (MPV) is the measure of platelet size and is considered a surrogate marker of platelet activation. Low MPV indicates exhausted platelets causing worse outcomes in cancer patients. As the correlation between platelet count/platelet size and lung cancer prognosis still remains a topic of debate, this meta-analysis was done to comprehensively evaluate the prognostic significance of MPV among lung cancer patients.Methods A systematic search of electronic databases PubMed, Embase, and Google scholar and additional sources for relevant studies were done with no language restrictions from inception to 7th May 2021. Overall Survival (OS) and Disease-Free Survival (DFS)/Progression-Free Survival (PFS) and hazard ratio (HR) with 95% Confidence Interval (CI) were pooled to evaluate the relation of MPV with OS/DFS. Subgroup analysis based on cancer type, clinical stage, sample size, median age, cut-off value, and study region was done to identify the cause of significant heterogeneity.Results Eleven studies with 2421 lung cancer patients were included in our analysis. Our analysis showed no significant association between MPV levels with OS (H.R.:1.07, 95%C.I.:0.84–1.35, p = 0.60) and DFS/PFS (HR:1.04, 95%C.I.:0.68–1.60, p = 0.84). Under subgroup analysis, studies conducted in countries other than China (HR:1.53, 95% C.I.=1.14–2.03, p < 0.001, I2 = 42.11%) and studies with advanced-stage lung cancer patients (HR: 1.84, 95% C.I.=1.19–2.82, p-value = 0.01, I2 = 0%) showed significant association between MPV levels and worse DFS/PFS.Conclusion Pretreatment MPV levels did not show prognostic significance except in advanced lung cancer cases. Large multicentric studies with large samples and long follow-up times are necessary.

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