Dataset Information

Does Operative Duration of Lobectomy for Early Lung Cancer Increase Perioperative Morbidity?

ABSTRACT:

Background

Longer bariatric, colorectal, plastic, spine, and urologic operations increase complications and lengths of stay. We aimed to determine whether this is a risk factor for lung lobectomy morbidity.

Methods

The Society of Thoracic Surgeons General Thoracic Surgery Database was queried for early-stage non-small cell lung cancer lobectomy with surgical duration treated as a continuous variable. Univariate and multivariate analyses compared patient and clinical characteristics with perioperative outcomes and procedure durations. Robotic cases were combined with thoracoscopic cases for duration analyses into a minimally invasive group. All analyses were conducted in SAS v9.4 (SAS Institute, Cary, NC) at a significance level of .05.

Results

In 17,852 patients mean duration of thoracotomy, thoracoscopy, and robotic lobectomies were 178 ± 84, 185 ± 73, and 214 ± 82 minutes, respectively (P < .001). The most common complications were prolonged air leak (12.3%), atrial fibrillation (12%), pneumonia (4.4%), and atelectasis requiring bronchoscopy (4.1%). Procedure duration was associated with increased odds of intraoperative packed red blood cell transfusion (P < .001) and length of stay > 5 days (P < .001) for both thoracotomy and minimally invasive lobectomy. Increased odds of pneumonia (P < .001), atelectasis (P < .001), and unexpected intensive care unit admission (P = .006) for thoracotomy lobectomy were associated with longer procedure duration. Increased lobectomy duration was not associated with readmission (P = .549) or 30-day mortality (P = .208).

Conclusions

Longer early-stage lung cancer lobectomy durations are associated with postoperative morbidity and increased length of stay. Although the effects of protracted operation times on long-term survival are unknown, short-term mortality differences were not detected. Measures that decrease operative durations without sacrificing safety and oncologic outcome should be undertaken by surgeons and hospital systems.

SUBMITTER: Dexter E

PROVIDER: S-EPMC9381650 | biostudies-literature | 2022 Sep

REPOSITORIES: biostudies-literature

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Publications

Does Operative Duration of Lobectomy for Early Lung Cancer Increase Perioperative Morbidity?

Dexter Elisabeth E Attwood Kristopher K Demmy Todd T Yendamuri Sai S

The Annals of thoracic surgery 20220217 3

<h4>Background</h4>Longer bariatric, colorectal, plastic, spine, and urologic operations increase complications and lengths of stay. We aimed to determine whether this is a risk factor for lung lobectomy morbidity.<h4>Methods</h4>The Society of Thoracic Surgeons General Thoracic Surgery Database was queried for early-stage non-small cell lung cancer lobectomy with surgical duration treated as a continuous variable. Univariate and multivariate analyses compared patient and clinical characteristic ...[more]

PMID: 35183506

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Project description:ObjectivesCompare the differences in perioperative clinical characteristics of lung cancer patients of different genders who have undergone VATS lobectomy, and explore the impact of these differences on the short-term prognosis of patients.MethodsA total of 338 consecutive patients with lung cancer who underwent VATS lobectomy in our hospital from August 2021 to August 2022 were retrospectively analyzed, they were divided into male group and female group. The perioperative characteristics and short-term prognosis of different groups were compared. The multivariate binary logistic regression analysis was used to analyze the risk factors.ResultsThere were statistically significant differences between male and female patients in age of onset, body surface area (BSA), smoking rate, alcohol consumption rate, hypertension incidence, pulmonary function and clinical stage. There were statistically significant differences between male and female patients in operation time and lymph node dissection. The probability of postoperative complications, such as pulmonary infection, persistent air leakage and severe subcutaneous emphysema, in male patients was significantly higher than that in female patients. The average daily postoperative thoracic drainage volume in male patients was considerably higher than that in female patients, and the postoperative duration of thoracic drainage tube and hospital stay in male patients were significantly longer than those in female patients. After multiple regression analysis, low FEVI values in males was found to be an independent risk factor for postoperative complications.ConclusionsCompared with female patients, male patients with lung cancer are more likely to have unfavorable factors such as older age, higher smoking rate, poor pulmonary function and late clinical stage of tumors when they undergoing VATS surgery treatment. The appropriate thoracic drainage time can be selected according to gender differences to shorten the length of hospital stay. The incidence of postoperative complications is higher in male patients, especially those with poor pulmonary function, and active perioperative intervention is required to reduce the incidence of postoperative complications.

Project description:RATIONALE:Video-assisted thoracoscopic surgery (VATS) and open lobectomy are both standard of care for the treatment of early-stage non-small cell lung cancer (NSCLC) because of equivalent long-term survival. OBJECTIVES:To evaluate whether the improved perioperative outcomes associated with VATS lobectomy are explained by surgeon characteristics, including case volume and specialty training. METHODS:We analyzed the Surveillance, Epidemiology, and End Results-Medicare-linked registry to identify stage I-II NSCLC in patients above 65 years of age. We used a propensity score model to adjust for differences in patient characteristics undergoing VATS versus open lobectomy. Perioperative complications, extended length of stay, and perioperative mortality among patients were compared after adjustment for surgeon's volume and specialty using linear mixed models. We compared survival using a Cox model with robust standard errors. RESULTS:We identified 9,508 patients in the registry who underwent lobectomy for early-stage NSCLC. VATS lobectomies were more commonly performed by high-volume surgeons (P < 0.001) and thoracic surgeons (P = 0.01). VATS lobectomy was associated with decreased adjusted odds of cardiovascular complications (odds ratio [OR] = 0.65; 95% confidence interval [CI] = 0.47-0.90), thromboembolic complications (OR = 0.47; 95% CI = 0.38-0.58), extrapulmonary infections (OR = 0.75; 95% CI = 0.61-0.94), extended length of stay (OR = 0.47; 95% CI = 0.40-0.56), and perioperative mortality (OR = 0.33; 95% CI = 0.23-0.48) even after controlling for differences in surgeon volume and specialty. Long-term survival was equivalent for VATS and open lobectomy (hazard ratio = 0.95; 95% CI = 0.85-1.08) after controlling for patient and tumor characteristics, surgeon volume, and specialization. CONCLUSIONS:VATS lobectomy for NSCLC is associated with better postoperative outcomes, but similar long-term survival, compared with open lobectomy among older adults, even after controlling for surgeon experience.

Project description:BackgroundRobotic-assisted thoracic surgery (RATS) is a safe and efficient minimally invasive thoracic approach compared to thoracotomy. Today, almost all thoracic procedures can be performed by RATS. In recent years, the Chinese government has issued some policies to support the development of domestic surgical robots, leading to the development of the Toumai® surgical robot system. This study aimed to explore the application of the Toumai® surgical robot in performing lobectomy for early-stage non-small cell lung cancer (NSCLC), and to compare its safety, surgical effect, and advantages or disadvantages compared with the mature da Vinci robotic surgical system.MethodsPatients with early-stage NSCLC undergoing robotic-assisted lobectomy in our center between November 2021 and December 2021 were enrolled in the study; Surgeries were performed through the Toumai® surgical robot and the da Vinci robotic system. Anatomical lobectomy and systematic lymph node (LN) dissection were conducted in all patients. Baseline and perioperative outcomes were analyzed to compare the two methods.ResultsThe combined 19 patients from the Toumai® group (n=9) and the da Vinci group (n=10) were enrolled and eligible for analyses. They had similar baseline characteristics, tumor characteristics, clinical stage, and pathological stage. Conversion to thoracotomy was not observed, and the operation time {95 minutes [interquartile range (IQR), 86.5-136.5 minutes] vs. 86 minutes (IQR, 81-102 minutes), P=0.178} and other perioperative outcomes were comparable in the two groups. There was no significant difference in the number of dissected LNs and lymphatic stations between both groups.ConclusionsThe application of Toumai® surgical robot in lobectomy was preliminarily shown to be safe and effective. Compared with the mature da Vinci robotic surgery system, Toumai® surgical robot had similar technical and surgical advantages, highlighting its suitability as an optional method for the new generation of robotic-assisted thoracoscopic surgery.

Dataset Information

Does Operative Duration of Lobectomy for Early Lung Cancer Increase Perioperative Morbidity?

Background

Methods

Results

Conclusions

Publications

Does Operative Duration of Lobectomy for Early Lung Cancer Increase Perioperative Morbidity?

Similar Datasets

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