Extended Sleeve Lobectomy: One More Step Toward Avoiding Pneumonectomy in Centrally Located Lung Cancer

Berthet, Jean‐Philippe; Paradela, Marina; Jiménez, María José; Molins, Laureano; Gómez-Caro, Abel

doi:10.1016/j.athoracsur.2013.07.011

Cited by 54 publications

(63 citation statements)

References 21 publications

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“…In the current study, two (33%; 2/6) postoperative morbidities occurred, including one of anastomosis stenosis and the other of postoperative pneumonia. The complication rate was equivalent to that reported in other series (9,17,18). Both of the two patients with postoperative morbidity had comorbidities, including diabetes and end-stage renal disease with regular hemodialysis.…”

Section: Discussionsupporting

confidence: 63%

“…The variability of complication rates among different studies may depend on their different studied populations and postoperative management (9,17,18). In the current study, two (33%; 2/6) postoperative morbidities occurred, including one of anastomosis stenosis and the other of postoperative pneumonia.…”

Section: Discussionmentioning

confidence: 99%

“…Mahtabifard and his colleagues reported another series of 13 VATS sleeve lobectomies in 2008 (9), with a mean operation time of 167 (range, 90-300) minutes. Our experience suggests that RATS is a feasible procedure with an equivalent operation time and may offer some advantages over conventional thoracoscopic surgery in such difficult situations.Common complications after sleeve lobectomy include pneumonia, bronchial stenosis, atelectasis, prolonged air leakage, atrial fibrillation and wound infection, and the reported incidence of complication ranges from about 24-40% and 10-31% in open thoracotomy and VATS, respectively (9,17,18). The variability of complication rates among different studies may depend on their different studied populations and postoperative management (9,17,18).…”

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confidence: 99%

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Robotic-assisted thoracoscopic sleeve lobectomy for locally advanced lung cancer

et al. 2016

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Background: The Da Vinci robotic system has been used to enhance the surgeon's visualization and agility in lung cancer surgery, and thus facilitate refined dissection, knot tying and suturing. However, only a few case reports exist on performing a sleeve lobectomy with a robotic-assisted thoracoscopic surgery (RATS) technique. Here we describe our early experience performing RATS sleeve lobectomies. To our knowledge, this is the first study reporting a series of RATS sleeve lobectomies. Methods: The six consecutive NSCLC patients who underwent a RATS sleeve lobectomy betweenNovember 2013 and July 2015 at the National Taiwan University Hospital were enrolled in this study. The lobectomies were all performed by the same surgeon using a three-arm robotic system with an additional utility incision made for assistance and specimen retrieval.Results: Five patients were diagnosed with squamous cell carcinoma, while the sixth was diagnosed with a carcinoid tumor. The mean operation time was 436.7 [255-745] minutes. The mean postoperative intensive care unit (ICU) stay and hospital stay were 3.7 [1-11] and 11.3 [3-26] days, respectively. Two (33.3%; 2/6) morbidities were noted, including one pneumonia and one anastomosis stricture. There were no cases of mortality or of conversion to thoracotomy. Conclusions:Our experience performing a RATS sleeve lobectomy in the six patients demonstrated the feasibility of RATS in complex lung cancer surgeries. The three-dimensional vision and articulated joint instruments made robotic-assisted bronchial anastomosis easier under the endoscopic setting. Our experience suggests that RATS offers specific advantages with regard to accuracy and safety when performing sleeve lobectomies. endowrist technology. On the other hand, opponents of robotic surgery have cited the expensive cost, loss of haptic feedback, longer procedure times and concern regarding the management of accidental intraoperative bleeding (5-7). The impact of RATS lobectomy on clinical outcomes remains unclear. A few studies have reported on early experiences of using RATS for lung resection, and all have indicated similar outcomes in comparison with using VATS (5-7). Potential benefits may be postoperative pain reduction, early return to usual activity (5), and fewer conversions for uncontrolled bleeding (7). KeywordsCompared with standard lobectomy or wedge resection, the surgical technique of sleeve lobectomy is more complex, which has limited the usage of minimally invasive surgery in performing the procedure. VATS sleeve lobectomy or bronchoplasty has been reported, but its suitability is limited (8,9). The RATS platform may be superior to VATS for such complex thoracic surgeries because of its threedimensional viewing camera and articulated robotic forceps. However, there have been only three studies on the use of RATS for performing bronchoplasty or sleeve lobectomy (10-12). Here, we report our early experience conducting six RATS sleeve lobectomies for locally advanced lung cancer. This is the first series re...

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Section: Discussionsupporting

confidence: 63%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Robotic-assisted thoracoscopic sleeve lobectomy for locally advanced lung cancer

et al. 2016

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“…In this study, endobronchial metastasis was defined as grades 2 or 3 invasions in central bronchial anatomic regions in patients with lung adenocarcinoma. Since lobectomy is more difficult in cases with tumor invading lobar bronchus opening or adjacent principal bronchus [6], the sleeved protocol is superior in increasing the length of bronchial incision [7]. When metastatic tumors are observable by bronchoscopy, there may be a high possibility of positive stump after simple lobectomy [8–10].…”

Section: Discussionmentioning

confidence: 99%

Relationship between EGFR gene mutation and local metastasis of resectable lung adenocarcinoma

Nie

Gao

et al. 2017

World J Surg Onc

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BackgroundResectable lung adenocarcinoma is dominated by peripheral distribution, and surgical resection is the main treatment protocol. However, high recurrence rate remains after surgery. Lung adenocarcinoma with epidermal growth factor receptor (EGFR) mutation has strong invasion ability, but the effects of this mutation on local invasion in early lung adenocarcinoma have been rarely studied. This study aimed to assess the effects of EGFR mutation on local invasion in resectable lung adenocarcinoma.MethodsA retrospective analysis of 103 patients clinically diagnosed with peripheral lung adenocarcinoma was included. They underwent preoperative bronchoscopy, which indicated grades 2 or 3 bronchial involvement (lumen of the lobe or segment). The associations of EGFR mutation with pleural invasion, endobronchial metastasis, and lymph node metastasis were analyzed according to pathologies of pleural invasion and lymph node metastasis, as well as EGFR gene mutation detected by postoperative pathological specimens. Statistical analyses were performed by unpaired Chi-square test using the SPSS16.0 software.ResultsIn patients with EGFR mutation, pleural invasion, endobronchial metastasis, and lymph node metastasis rates were 62.5, 39.1, and 34.4%, respectively, indicating statistically significant differences (p = 0.003). Meanwhile, the pleural invasion rate in patients with wild-type EGFR was 43.6%, significantly reduced compared with patients with mutated EGFR (62.5%; p = 0.018). In addition, the endobronchial metastasis rate in patients with wild-type EGFR was 17.9%, significantly lower than in patients with EGFR mutation (39.1%; p = 0.005). However, lymph node metastasis rates were similar between EGFR mutated and wild-type patients (34.4 vs 25.6%, respectively, p > 0.05).ConclusionsEarly resectable lung adenocarcinoma patients with EGFR mutation showed a higher rate of local invasion compared with those harboring wild-type EGFR. This finding provides a basis for improved therapy.Trial registrationThis study was supported by Project of Medical and Health Science Technology in Shandong Province (2015WS0376)

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“…The procedure should be reserved for centrally located tumors, synchronous tumors in the same lung or smaller tumors involving central structures (7). When possible, a sleeve lobectomy should be performed (8). In the reported case the mentioned criteria have been met.…”

Section: Discussionmentioning

confidence: 99%

Single-port video-assisted thoracoscopic surgery (VATS) right pneumonectomy: a case report

2017

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Abstract:When it comes to surgical treatment of non-small cell lung cancer (NSCLC), modern principles dictate that every possible effort should be made to avoid pneumonectomy, its debilitating consequences and a higher rate of complications. In marginal cases where video-assisted thoracoscopic surgery (VATS) sleeve or double sleeve lobectomy cannot be performed a conversion to open sleeve lobectomy is always preferred over a VATS pneumonectomy. We present a case of a 64-year-old male patient with two synchronous tumors of the right lung, both centrally located in the right upper and the right lower lobe. A single-port VATS right pneumonectomy was performed. The patient was discharged on the post-operative day 5 in good general condition.

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Extended Sleeve Lobectomy: One More Step Toward Avoiding Pneumonectomy in Centrally Located Lung Cancer

Cited by 54 publications

References 21 publications

Robotic-assisted thoracoscopic sleeve lobectomy for locally advanced lung cancer

Robotic-assisted thoracoscopic sleeve lobectomy for locally advanced lung cancer

Relationship between EGFR gene mutation and local metastasis of resectable lung adenocarcinoma

Single-port video-assisted thoracoscopic surgery (VATS) right pneumonectomy: a case report

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