Video-assisted thoracic surgery versus open lobectomy for lung cancer: A secondary analysis of data from the American College of Surgeons Oncology Group Z0030 randomized clinical trial
Walter J. ScottMark S. AllenGail DarlingBryan F. MeyersPaul A. DeckerJoe B. PutnamRobert W. McKennaRodney LandrenauDavid R. JonesRichard InculetRichard Malthaner
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Keywords:
Thoracoscopy
VATS lobectomy
Video-assisted thoracoscopic surgery
Cardiothoracic surgery
Atelectasis
OBJECTIVESAlthough the standard video-assisted thoracoscopic surgery (VATS) approach is generally performed through two to four incisions, uniportal VATS pulmonary resection has recently been reported to be a promising, less invasive alternative. To evaluate the adequacy of uniportal VATS lobectomy as an alternative to conventional VATS lobectomy in lung cancer, we analysed and compared the outcomes of uniportal and conventional VATS lobectomies.
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In the past decade, many researchers focused on Robotic- Assisted Thoracoscopic Surgery (RATS), which has been introduced as an alternative minimally invasive approach, versus Video- Assisted Thoracoscopic Surgery (VATS) for lung lobectomy in patients with non-small cell lung cancer. However, the advantage of RVATS compared to VATS is still under investigation. The results are unclear.The aim of this study is to compare the efficacy and safety of Robot-assisted Thoracic Surgery (RATS) lobectomy versus Video-assisted Thoracic Surgery (VATS) for lobectomy in patients with Non- Small Cell Lung Cancer (NSCLC).A systematic electronic search of online electronic databases: Pubmed, Embase, Cochrane library updated in June 2017. The meta-analysis was performed including the studies are designed as randomized or non- randomized controlled.Twenty retrospective cohort studies met our inclusion criteria. The pooled analysis of mortality showed that RATS lobectomy significantly reduced the mortality rate when compared with VATS lobectomy (RR =0.53, 95% CI 0.37 - 0.76; P = 0.0005). With the pooled result of duration of surgery indicated that RATS has a tendency towards longer surgery time (SMD= 0.52, 95% CI 0.23- 0.81; P < 0.0004=). However, the meta-analysis on the median length of hospital stay (MD =0.00, 95% CI -0.03 - 0.03; P = 0.91), number of dissected lymph nodes station (SMD =0.39, 95% CI -0.60 - 1.38; P = 0.44), the number of removed lymph nodes (SMD =0.98, 95% CI -0.61 - 2.56; P = 0.23), mean duration of drainage (SMD =0.29, 95% CI -0.15 - 0.73; P = 0.20), prolonged air leak (RR =1.01, 95% CI 0.84 - 1.21; P = 0.93), arrhythmia (RR =1.06, 95% CI 0.88 - 1.26; P = 0.54) (P= 0.54), pneumonia (RR =0.89, 95% CI 0.69 - 1.13; P = 0.33), the incidence of conversion (RR =0.82, 95% CI 0.54 - 1.26; P = 0.37) and morbidity (RR =1.05, 95% CI 0.90 - 1.23; P = 0.055) all showed no significant differences between RATS and VATS lobectomy.RATS result in better mortality as compared with VATS. However, robotics seems to have longer operative time and higher hospital costs, without superior advantages in morbidity rates and oncologic efficiency. Since the advantages of RATS has been performed in some area, the continuation of a comparative investigation with VATS may be necessary. And some efforts need to be taken into consideration to reduce the operative time and cost.
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Video-assisted thoracic surgery (VATS) for lobectomy or segmentectomy is considered as a good alternative to thoracotomy because of its usefulness and safety; reducing postoperative pain, lowering morbidity, and shortening hospital stay. However, despite these advantages of VATS, it has been difficult to perform VATS pneumonectomy due to the high morbidity and mortality rate of pneumonectomy. Recently, as VATS technique has been developed and usefulness of VATS pneumonectomy has been continuously reported, VATS pneumonectomy is gradually increasing in large volume centers. This article describes VATS pneumonectomy with a focus on the surgical technique.
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INTRODUCTION Unplanned conversion to thoracotomy remains a major concern in video assisted thoracoscopic surgery (VATS) lobectomy. This study aimed to investigate the development of a VATS lobectomy programme over a five-year period, with a focus on the causes and consequences of unplanned conversions. METHODS A single centre retrospective review was performed of patients who underwent complete anatomical lung resection initiated by VATS between January 2010 and April 2015. RESULTS In total, 1,270 patients underwent a lobectomy in the study period and 684 (53.9%) of these were commenced thoracoscopically. There were 75 cases (10.9%) with unplanned conversion. The proportion of lobectomies started as VATS was significantly higher in the second half of the study period (2010-2012: 277/713 [38.8%], 2013-2015: 407/557 [73.1%], p<0.001). The conversion rate dropped initially from 20.4% (11/54) in 2010 to 9.9% (15/151) in 2013 and then remained consistently under 10% until 2015. Conversions were most commonly secondary to vascular injury (26/75, 34.7%). Patients undergoing unplanned conversion had a longer length of stay than VATS completed patients (9 vs 6 days, p<0.001). There was a higher incidence of respiratory failure (10/75 [14.1%] vs 23/607 [3.8%], p<0.001) and 30-day mortality (7/75 [9.3%] vs 6/607 [1.0%], p=0.003) in patients with unplanned conversion than in those with completed VATS. CONCLUSIONS As our VATS lobectomy programme developed, the unplanned conversion rate dropped initially and then remained constant at approximately 10%. With increasing unit experience, it is both safe and technically possible to complete the majority of lobectomy procedures thoracoscopically.
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Background: Single-port video-assisted thoracoscopic surgery (VATS) have been performed in Southeast Asian countries for several years. However, the outcomes of the single-port VATS are still under investigation. Objective: To compare the surgical outcomes between single-port VATS and multi-port VATS in pulmonary lobectomy and to validate its efficacy and safety. Materials and Methods: The outcomes of 130 patients that underwent VATS at the Central Chest Institute of Thailand between January 2015 and May 2018, were reviewed. Patients were classified into two groups, single-port, and multi-port VATS with 68 as single-port and 62 as multi-port cases. Patient characteristics and perioperative outcomes were analyzed and compared. Results: There were no significant differences in patient characteristics between the two groups. The single-port group had a lower Pain Numeric Rating Scale at 24 hours (p=0.022) and shorter length of hospital stay (p=0.044) than the multi-port group. The number of N2 lymph nodes retrieved in the single-port group was significantly higher than in the multi-port group (p=0.022) while other surgical outcomes were not significantly different. There were no significant differences in intraoperative and post-operative complications (p=0.338 and p=0.142, respectively) and no perioperative mortality in both groups. Conclusion: The authors’ experience showed that single-port VATS is a practical technique and safe procedure when compared to multi-port VATS. Keywords: Video-assisted thoracoscopic surgery (VATS), lobectomy, minimally invasive surgery
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Video-assisted thoracoscopic surgery (VATS) has been recognized as a standard procedure, but whether uniport VATS (U-VATS) is a more effective and minimally invasive approach compared with multiport VATS (M-VATS) is controversial.The medical records of 184 patients in the M-VATS group and 69 patients in the U-VATS group who underwent anatomical lung resection from April 2017 to July 2020 at our institution were retrospectively reviewed. Postoperative outcomes were compared among U-VATS and M-VATS. Multivariate analysis was performed to identify factors that reduce postoperative pain.The mean operation time was significantly shorter in U-VATS than in M-VATS (172±43 min in M-VATS vs. 143±43 min in U-VATS, P<0.0001). Duration of postoperative drainage (2.2±1.2 days in M-VATS vs. 1.6±1.0 days in U-VATS, P=0.0002) and hospitalization (4.0±1.6 days in M-VATS vs. 3.1±1.6 days in U-VATS, P=0.0003) were significantly shorter in U-VATS than in M-VATS. The rate of postoperative complications was not significantly different between the groups (P=0.732). The number of analgesic prescriptions over 10 days postoperatively was significantly less in U-VATS than in M-VATS [68 (37.0%) in M-VATS vs. 8 (11.6%) in U-VATS, P<0.0001]. A multivariate logistic regression model showed that U-VATS was the only significant predictor for reduction of postoperative pain (odds ratio =0.204, P=0.0001).U-VATS shortened the operation time, postoperative drainage duration, and hospitalization compared with conventional M-VATS, and it significantly reduced the use of analgesics. There were no differences in perioperative results such as blood loss and the postoperative complication rate. U-VATS can be said to be a safe and minimally invasive surgical procedure.
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