Dataset Information

Efficacy, safety and patient satisfaction of two-stage versus single-stage computed tomography guided localization and resection of pulmonary nodules.

ABSTRACT:

Background

Low-dose computed tomography (CT) has been increasingly utilized for lung cancer screening. Localization of solitary pulmonary nodules (SPN) is crucial for resection. Two-stage localization method involves dye injection by radiologists prior to the operation. The significant interval between localization and resection is associated with a higher risk of marker failure, psychological distress and procedural complications. Single-stage localization and resection procedure under general anesthesia poses unique challenges. The aim of the study is to compare the safety, efficacy and patient satisfaction between the two methods.

Methods

This is a retrospective study comparing outcomes between two-stage and single-stage pre-operative localization of SPN. The primary study outcome was total operating time. Secondary outcomes included successful lesion localization, complication rate, 30-day readmission, mortality, patient satisfaction, and pain level.

Results

A total of 26 and 56 patients were included for the single and two-stage group respectively. Total operative time was significantly longer in the single-stage arm (mean: 188 min) than that of the two-stage arm (mean: 172 min, P<0.001) due to the additional time needed for intra-operative localization. Mean satisfaction score was significantly higher in the single-stage group than that of the two-stage group (92 vs. 52.69, P=0.004). Pain level assessed by numerical rating scales was better in the single-stage arm compared to the two-stage arm (mean: 8.8 vs. 4.85, P=0.007).

Conclusions

Single-stage localization and resection resulted in a minor increase in total operative time, higher patient satisfaction and less pain with comparable safety and efficacy to conventional two-stage approach.

SUBMITTER: Chen HYM

PROVIDER: S-EPMC11320263 | biostudies-literature | 2024 Jul

REPOSITORIES: biostudies-literature

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Publications

Efficacy, safety and patient satisfaction of two-stage versus single-stage computed tomography guided localization and resection of pulmonary nodules.

Chen Hei Yu Matthew HYM Wong Tsz Ho Andrew THA Li Ki Kwong KK Chan Ho Yan Howard HYH

Journal of thoracic disease 20240711 7

<h4>Background</h4>Low-dose computed tomography (CT) has been increasingly utilized for lung cancer screening. Localization of solitary pulmonary nodules (SPN) is crucial for resection. Two-stage localization method involves dye injection by radiologists prior to the operation. The significant interval between localization and resection is associated with a higher risk of marker failure, psychological distress and procedural complications. Single-stage localization and resection procedure under ...[more]

PMID: 39144360

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Project description:ObjectiveThis study aimed to investigate the safety and efficacy of the computed tomography (CT)-guided hook-wire localization technique in thoracoscopic surgery for small pulmonary nodules (≤ 10 mm) and to identify the risk factors for localization-related complications.MethodsThe medical records of 150 patients with small pulmonary nodules treated from January 2018 to June 2021 were retrospectively analyzed. According to preoperative hook-wire positioning status, they were divided into the localization group (50 cases) or the control group (100 cases). The operation time, intraoperative blood loss, hospital stay, and conversion rate to thoracotomy were recorded and compared between groups. Uni- and multivariate binary logistic regression analysis was used to identify the risk factors for localization-related complications.ResultsA total of 58 nodules were localized in 50 patients in the localization group, and the localization success rate was 98.3% (57/58). In one case, the positioning pin fell off before wedge resection was performed. The mean nodule diameter was 7.05 mm (range, 2.8-10.0 mm), while the mean depth from the pleura was 22.40 mm (range, 5.47-79.47 mm). There were 8 cases (16%) of asymptomatic pneumothorax, 2 (4%) of intrapulmonary hemorrhage, and 1 (2%) of pleural reaction.The mean operation time of the localization group (103.88 ± 41.74 min) was significantly shorter than that of the control group (133.30 ± 45.42 min) (P < 0.05). The mean intraoperative blood loss of the localization group (44.20 ± 34.17 mL) was significantly lower than that of the control group (112.30 ± 219.90 mL) (P < 0.05). The mean hospital stay of the localization group (7.96 ± 2.34 days) was significantly shorter than that of the control group (9.21 ± 3.25 days).Multivariate binary logistic analysis showed that localization times of small pulmonary nodules in the localization group was an independent risk factor for localization-related pneumothorax.ConclusionsOur results suggest that the CT-guided hook-wire localization technique is beneficial for localizing small pulmonary nodules. Specifically, it is helpful for the diagnosis and treatment of early lung cancer because it can accurately remove lesions, decrease intraoperative blood loss, shorten operation time and hospitalization stay, and reduce thoracotomy conversion rate. Simultaneous positioning of multiple nodules can easily lead to positioning-related pneumothorax.

Project description:BackgroundThe early surgical intervention for pulmonary ground-glass nodules (GGNs) has become increasingly important, but accurate identification of these nodules during thoracoscopic surgery poses challenges due to the need for sublobar resections and reliance on visual and tactile perception alone. The prognosis of the procedure is closely tied to the use of precise positioning technology. Thus, it is crucial to develop an accurate positioning technology that can improve patient prognosis.MethodsClinical data from the cardiothoracic department of a tertiary hospital in Shanghai were collected and analyzed between January 2020 and December 2021. The patients were categorized into 2 groups: an indocyanine green (ICG) group and a hook-wire group. Outcome measures including success rate, complications, procedure time, localization-related pain, and interval time were assessed. Adverse events and reactions were reported and compared between the 2 groups.ResultsA total of 62 patients (17 males and 45 females, aged 50.5±13.2 years) were in the ICG group, while 66 patients (23 males and 43 females, aged 48.4±12.9 years) were localized in the hook-wire group. The success rate was comparable between the 2 groups. However, the ICG group showed significant advantages over the hook-wire group in terms of procedure time (22.6±4.4 vs. 24.1±4.9 min; P=0.012), localization-related pain (P<0.001), and interval time [median and interquartile range (IQR): 3 (0.7, 104.9) vs. 1.2 (0.5, 3.3) h; P<0.001]. In the ICG group, there were 11 cases of pneumothorax, 4 cases of hemothorax, and 2 cases of ICG diffusion. In the hook-wire group, there were 24 cases of pneumothorax, 25 cases of hemothorax, and 2 cases of dislodgement. The ICG group had fewer complications, including pneumothorax (P=0.018) and hemothorax (P=0.007), compared to the hook-wire group.ConclusionsComputed tomography (CT)-guided intrapulmonary injection of ICG for preoperative localization of peripheral pulmonary GGNs is a practical and safe technique. It offers advantages in terms of reduced procedure time, localization-related pain, and interval time compared to the hook-wire method. Moreover, the ICG technique results in fewer complications, making it a valuable preoperative localization technique worthy of popularization.

Project description:BackgroundThe necessity of localization of pulmonary nodules lies in ensuring the ability to locate the nodule quickly and accurately during surgery, thereby improving the success rate of the operation. The accuracy and risk of preoperative localization of pulmonary nodules need further exploration. Therefore, the purpose of this study was to investigate the factors of accuracy and safety of computed tomography (CT)-guided localization of pulmonary nodules using a flexible wire hook positioner.MethodsIn this retrospective cross-sectional analysis, 281 patients with a single pulmonary nodule underwent video-assisted thoracoscopic surgery (VATS) following localization with a soft hook-wire guided by CT scan from January 2021 to July 2022 at Nanjing Drum Tower Hospital. The patients underwent VATS to remove pulmonary nodules within 24 hours after localization. The demographic, pulmonary nodule, and technical factors were analyzed retrospectively. Univariate and multivariate analysis were used to analyze the identified factors that influence pulmonary nodule localization accuracy and complications.ResultsLocalization was successfully performed in 280 patients, with only 1 patient being excluded due to a displaced positioner and the hook wire failing to enter the lung parenchyma as a result of pneumothorax. Out of the total cases, 191 (68.2%) were accurately positioned in group G0, whereas 89 cases (31.7%) were inaccurately positioned in group G1. Hemorrhage and self-limited hemoptysis were observed in 64 patients (22.8%), whereas pneumothorax was observed in 84 patients (29.9%). There were no serious complications such as air embolism or death. The accuracy of localization was found to be influenced by both the depth of pulmonary nodules [odds ratio (OR) =22.610, 95% confidence interval (CI): 10.351-49.391, P=0.001] and the depth of the needle used (OR =0.322, 95% CI: 0.136-0.765, P=0.010). Additionally, postoperative hemorrhage was found to be affected by several important factors, including the diameter (P=0.036) and depth of the nodule (P=0.011), as well as the thickness of the chest wall (P=0.043) and the depth of the needle used (P=0.005).ConclusionsThe CT-guided flexible wire hook positioner has been found to be a safe and effective device for locating pulmonary nodules. The depth of pulmonary nodules and needle penetration are key factors affecting the accuracy of lung nodule localization under CT guidance and are important factors affecting postoperative bleeding.

Dataset Information

Efficacy, safety and patient satisfaction of two-stage versus single-stage computed tomography guided localization and resection of pulmonary nodules.

Background

Methods

Results

Conclusions

Publications

Efficacy, safety and patient satisfaction of two-stage versus single-stage computed tomography guided localization and resection of pulmonary nodules.

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