Comparison of short and long‐term results between sleeve resection and pneumonectomy in lung cancer patients over 70 years old: 10 years experience from a single institution in <scp>C</scp>hina

Pan, Xufeng; Tantai, Jicheng; Li, Gang; Ke-jian, Cao; Zhao, Heng

doi:10.1111/1759-7714.12116

Cited by 5 publications

(4 citation statements)

References 18 publications

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“…It could be speculated that younger patients undergo surgery despite decreased pulmonary reserve as they are often otherwise in good health and surgery is their best chance of survival [ 1 , 18 ]. Elderly patients on the other hand are evaluated more carefully to estimate whether surgery is justifiable in their health condition [ 19 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

A Modified Calculation Improves the Accuracy of Predicted Postoperative Lung Function Values in Lung Cancer Patients

Schlachtenberger

Doerr

Menghesha

et al. 2021

Lung

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Purpose Preoperative pulmonary function testing is mandatory for non-small cell lung cancer (NSCLC) surgery. The predicted postoperative FEV1 (ppoFEV1) is used for further risk stratification. We compared the ppoFEV1 with the postoperative FEV1 (postFEV1) in order to improve the calculation of the ppoFEV1. Methods 87 patients voluntarily received an FEV1 assessment 1 year after surgery. ppoFEV1 was calculated according to the Brunelli calculation. Baseline characteristics and surgical procedure were compared in a uni- and multivariate analysis between different accuracy levels of the ppoFEV1. Parameters which remained significant in the multinominal regression analysis were evaluated for a modification of the ppoFEV1 calculation. Results Independent factors for a more inaccurate ppoFEV1 were preoperative active smoking (odds ratio (OR) 4.1, confidence interval (CI) 3.6–6.41; p = 0.01), packyears (OR 4.1, CI 3.6–6.41; p = 0.008), younger age (OR 1.1, CI 1.01–1.12; p = 0.03), and patients undergoing pneumectomy (OR 5.55, CI 1.35–23.6; p = 0.01). For the customized ppoFEV1 we excluded pneumonectomies. For patients < 60 years, an additional lung segment was added to the calculation. ppoFEV1 = preFEV1 × $$1-\left(\frac{\text{Lung segments resected} + 1}{\text{Total number of segments}}\right)$$ 1 - Lung segments resected + 1 Total number of segments . For actively smoking patients with more than 30 packyears we subtracted one lung segment from the calculation ppoFEV1 = PreFEV1 × $$1-\left(\frac{\text{Lung segments resected} - 1}{\text{Total number of segments}}\right)$$ 1 - Lung segments resected - 1 Total number of segments . Conclusion We were able to enhance the predictability of the ppoFEV1 with modifications. The modified ppoFEV1 (1.828 l ± 0.479 l) closely approximates the postFEV1 of 1.823 l ± 0.476 l, (0.27%) while the original ppoFEV1 calculation is at 1.78 l ± 0.53 (2.19%). However, if patients require pneumectomy, more complex techniques to determine the ppoFEV1 should be included to stratify risk.

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Section: Discussionmentioning

confidence: 99%

A Modified Calculation Improves the Accuracy of Predicted Postoperative Lung Function Values in Lung Cancer Patients

Schlachtenberger

Doerr

Menghesha

et al. 2021

Lung

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“…Такого же мнения придерживаются в последние годы Z. Ma [4], T. Nagayasu [7], приво-дя данные о том, что бронхо-и ангиопластические операции дают хорошие результаты и при пораже-нии медиастинальных ЛУ. Другие авторы -Y. Kim, J. Schirren [11], X. Pan [10] -считают, что при на-личии метастазирования в медиастинальные ЛУ операция не показана. Несоответствие полученных нами данных с данными вышеуказанных авторов, возможно, связано с тем, что в нашем исследовании преимущественно наблюдались больные с оккульт-ными метастазами в ЛУ средостения, не выявляе-мыми при предоперационном обследовании.…”

Section: рисunclassified

“…местных осложнений и рецидивов онкологического процесса [10,11], а также сомнениями в адекватности этих операций при поражении лимфатических узлов (ЛУ) средостения [3,5].…”

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Broncho- And Angioplasty Lobectomy as an Alternative to Pneumonectomy in Treatment of Non-Small-Cell Lung Cancer

Reshetov¹,

Елькин²,

Николаев³

et al. 2018

VESTNIK KHIRURGII IMENI I.I.GREKOVA

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В в е д е н и е. Хирургическое удаление опухоли с лимфодиссекцией до настоящего времени оста-ется одним из основных методов радикального лечения немелкоклеточного рака легкого (НМРЛ). В качестве операций используют анатомические ре-зекции легких, позволяющие убрать вместе с опу-холевым очагом регионарные сосудистые и лимфа-тические коллекторы. Если при периферическом расположении опухоли операцией выбора, как пра-вило, является лобэктомия, то при централизации опухолевого процесса пневмонэктомия занимает одну из ведущих позиций. По данным J. Deslauriers [1], пневмонэктомия при центральном раке легко-го остается одной из основных операций выбора.Как альтернатива пневмонэктомии еще в конце XX в. в практику внедряются бронхопластические и ангиопластические операции, позволяющие уда-лить не все легкое, а его часть. Изначально эти опе-рации использовали у больных старшего возраста с сопутствующими заболеваниями, не позволяющи-ми выполнить пневмонэктомию [2,3]. Впоследствии они стали выполняться более широко [4,5]. Их сто-ронники утверждали, что отдаленные результаты не уступают таковым, полученным при выполнении пневмонэктомии [6][7][8], а качество жизни значительно лучше [9]. Однако существуют и возражения против альтернативного использования бронхо-и ангиопла-стических операций, связанные с возрастанием числа The OBJECTIVE of the study is to substantiate the applying of broncho-and angioplasty lobectomy as an alternative to pneumonectomy in NSCLC. MATERIAL AND METHODS. The results of treatment of two comparable groups of patients with NSCLC were presented. In one group, patients underwent broncho-or angioplasty lobectomies (group A), in another -pneumonectomy (group B). The number of complications, overall and disease-free survival in both groups, as well as the factors affected the results were analyzed. RESULTS. The number of postoperative complications in group A and group B was 12.5 % and 15.6 %, respectively. The median of disease-free survival and overall survival in both groups did not differ meaningfully, consisting of 20 months and 48 months in group A, and 19 months and 25 months in group B (p=0.91) and (p=0.97). The results of treatment were meaningfully affected only by the stage of the disease (p=0.017) and multidisciplinary treatment (p=0.007), including chemotherapy and radiation therapy. CONCLUSIONS. Performing of broncho-and angioplasty lobectomies can be justified as an alternative to lung removal in NSCLC within the multidisciplinary treatment.

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“…Abdelsattar et al showed that when analyzing national databases including 23,964 patients, including 1,713 SL patients, there was improved longterm survival and decreased mortality in the SL group (11). The improved outcomes were shown to remain in patients above 70 years old (12,13). The results also hold following induction therapy (14).…”

Section: Introductionmentioning

confidence: 99%

Analyzing the impact of minimally invasive surgical approaches on post-operative outcomes of pneumonectomy and sleeve lobectomy patients

Nitsche¹,

Jordan²,

Demmy³

et al. 2023

J Thorac Dis

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Background: Some patients with non-small cell lung cancer (NSCLC) have superior short-and long-term outcomes with sleeve lobectomy rather than pneumonectomy. Originally sleeve lobectomy was reserved for patients with limited pulmonary function, however, the reported superior results allowed sleeve lobectomy to be performed in expanded patient populations. In a further attempt to improve post-operative outcomes surgeons have adopted minimally invasive techniques Minimally invasive approaches have potential benefits to patients such as decreased morbidity and mortality while maintaining the same caliber of oncologic outcomes. Methods:We identified patients at our institution who underwent sleeve lobectomy or pneumonectomy to treat NSCLC from 2007 to 2017. We analyzed these groups in respect to 30-and 90-day mortality, complications, local recurrence, and median survival. We included multivariate analysis to determine the impact of a minimally invasive approach, sex, extent of resection, and histology. Differences in mortality were analyzed using the Kaplan-Meier method using the log-rank test to compare the groups. A two-tailed Z test for difference in proportions was done to analyze complications, local recurrence, 30-day and 90-day mortality.Results: A total of 108 patients underwent sleeve lobectomy (n=34) or pneumonectomy (n=74) for treatment of NSCLC with 18 undergoing open pneumonectomy, 56 undergoing video-assisted thoracoscopic surgery (VATS) pneumonectomy, 29 undergoing open sleeve lobectomy, and 5 undergoing VATS sleeve lobectomy. There was no significant difference in 30-day mortality (P=0.064) but there was a difference in 90-day (P=0.007). There was no difference in complication rates (P=0.234) or local recurrence rates (P=0.779).The pneumonectomy patients had a median survival of 23.6 months (95% CI: 3.8-43.4 months). The sleeve lobectomy group had a median survival of 60.7 months (95% CI: 43.3-78.2 months) (P=0.008). On multivariate analysis extent of resection (P<0.001) and tumor stage (P=0.036) were associated with survival.There was no significant difference between the VATS approach and the open surgical approach (P=0.053).Conclusions: When considering patients undergoing surgery for NSCLC sleeve lobectomy resulted in lower 90-day mortality and better 3-year survival compared to patients undergoing PN. Having a sleeve lobectomy rather than a pneumonectomy and having earlier-stage disease lead to significantly improved survival on multivariate analysis. Having a VATS operation leads to a non-inferior post-operative outcome compared to open surgery.

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Comparison of short and long‐term results between sleeve resection and pneumonectomy in lung cancer patients over 70 years old: 10 years experience from a single institution in China

Cited by 5 publications

References 18 publications

A Modified Calculation Improves the Accuracy of Predicted Postoperative Lung Function Values in Lung Cancer Patients

A Modified Calculation Improves the Accuracy of Predicted Postoperative Lung Function Values in Lung Cancer Patients

Broncho- And Angioplasty Lobectomy as an Alternative to Pneumonectomy in Treatment of Non-Small-Cell Lung Cancer

Analyzing the impact of minimally invasive surgical approaches on post-operative outcomes of pneumonectomy and sleeve lobectomy patients

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