Three-dimensional CT Angiography Facilitates Uniportal Thoracoscopic Anatomic Lung Resection for Pulmonary Sequestration

BackgroundPulmonary sequestration (PS) is a rare lesion with independent blood supply from an anomalous systemic artery. A timely resection is considered the best treatment for PS, but the optimal approach is controversial. Three-dimensional computed tomography angiography (3D-CTA) has been widely utilized for precise thoracic surgery. This study aimed to investigate the safety of uniportal video-assisted thoracoscopic surgery (VATS) for PS assisted with preoperative 3D-CTA. MethodsThe data of patents with PS who underwent VATS anatomic lung resection between April 2011 and May 2021 in a single centre were retrospectively reviewed. They were divided into uniportal and tow-port groups according to the initial surgical plan. The perioperative parameters including the incidence of conversion to open thoracotomy, operation time, blood loss, complications and chest tube duration were analyzed. ResultsTwenty consecutive patients (9 in uniportal group and 11 in two-port group) underwent VATS for PS, including 12 female and 8 male patients, with a mean age of 45 years old (range, 24-60 years). Nine cases demonstrated recurrent febrile, cough, or hemoptysis; whereas the other 11 patients were asymptomatic. The 3D-CTA was utilized for all patients in the uniportal group and 1 patient in the two-port group. Eighteen (90.0%) intralobar and 2 extralobar PS were confirmed; and 18 (90.0%) lesions were located in the left thorax. The feeding vessels originated from the thoracic aorta in 16 patients (80.0%), the abdominal aorta in 3 (15.0%) and the inferior phrenic artery in 1 patient (5.0%). Thirteen lobectomies, 5 segmentectomies and 2 mass excisions were performed. There was no major bleeding or 30-day mortality. No conversion was needed in the uniportal group; whereas 6 (54.5%) conversions (4 to multiple-port and 2 to thoracotomy) occurred in the two-port group, indicating a significant difference (P=0.008). In addition, the operation time in the uniportal VATS group was significantly shorter than those in the two-port VATS group ([110.6 ± 25.5] min vs. [148.6 ± 42.1] min, P = 0.029). The other perioperative variables were similar between the two groups. During the follow-up of 5-75 months, no recurrence of hemoptysis was recorded. ConclusionPreoperative 3D-CTA facilitates the safe performance of uniportal VATS anatomic lung resection for PS, which might be associated with shorter operation time and lower conversion to thoracotomy.

Low Embolic Risk from Short Duration Atrial Fibrillation following Anatomic Lung Resection

Objectives There is no consensus regarding the merits of anticoagulation following short duration atrial arrhythmia and anatomic lung resection. We hypothesized that the risk of embolic event following episodes of atrial fibrillation (AF) lasting less than 48 hours is low and even with an elevated CHA2DS2-VASC score should not incur the risk of long-term full dose anticoagulation contrary to recommendations. Design & Intervention A retrospective review was performed of a prospectively maintained database of all patients undergoing anatomic lung resection at a single institution from 2014 to 2019. Patients who had new onset post-operative atrial fibrillation (POAF) were queried as to their co-morbidities, the length of arrhythmia, discharge with anticoagulation, and any post-operative embolic events. Main Outcome Measures There were 565 patients who underwent anatomic lung resection. 40 patients (7.1%) developed new POAF that lasted a median of one day. In 32 patients (80%), POAF lasted for less than 48 hours. There were 28 males and 12 females, median age of 73 years. These patients underwent segmentectomy (2/40), lobectomy (24/40) and pneumonectomy (14/40). Twenty-nine patients were discharged home without anticoagulation. Median follow-up was 22 month (range 1.3 – 62.8 month). Two patients had embolic events and these two were discharged home without anticoagulation. The overall incidence rate of thromboembolic events was 3.2% per person year. Conclusions Our data suggest that the risk of arterial embolic events is low in patients with new, short duration atrial fibrillation post anatomical lung resection. Anticoagulation may not be necessary in these patients and can be given selectively.

Long-term and short-term outcomes of robot- versus video-assisted anatomic lung resection in lung cancer: a systematic review and meta-analysis

OBJECTIVES Minimally invasive thoracic surgery has evolved with the introduction of robotic platforms. This study aimed to compare the long-term and short-term outcomes of the robot-assisted thoracic surgery (RATS) and video-assisted thoracic surgery (VATS) for anatomic lung resection. METHODS We searched published studies that investigated RATS and VATS in anatomic lung resection. Long-term outcomes (disease-free survival and overall survival) and short-term outcomes (30-day mortality, postoperative complications, conversion rate to open surgery and lymph node upstaging) were extracted. The features were compared and tested as hazard ratios (HRs) and odds ratios (ORs) at a 95% confidence interval (CI). RESULTS Twenty-five studies with 50 404 patients (7135 for RATS and 43 269 for VATS) were included. The RATS group had a longer disease-free survival than the VATS group (HR: 0.76; 95% CI: 0.59–0.97; P = 0.03), and the overall survival showed a similar trend but was not statistically significant (HR: 0.77; 95% CI: 0.57–1.05; P = 0.10). The RATS group showed a significantly lower 30-day mortality (OR: 0.55; 95% CI: 0.38–0.81; P = 0.002). No significant difference was found in postoperative complications (OR: 1.01; 95% CI: 0.87–1.16; P = 0.94), the conversion rate to open surgery (OR: 0.92; 95% CI: 0.56–1.52; P = 0.75) and lymph node upstaging (OR: 0.89; 95% CI: 0.52–1.54; P = 0.68). CONCLUSIONS RATS has comparable short-term outcomes and potential long-term survival benefits for anatomic lung resection compared with VATS.