Index of prolonged air leak score validation in case of video-assisted thoracoscopic surgery anatomical lung resection: results of a nationwide study based on the French national thoracic database, EPITHOR

Orsini, Bastien; Baste, Jean Marc; Gossot, Dominique; Berthet, J; Assouad, Jalal; Dahan, M.; Bernard, Alain; Thomas, Philippe

doi:10.1093/ejcts/ezu505

Cited by 38 publications

(30 citation statements)

References 21 publications

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“…They identified numerous preoperative variables linked with PAL, demonstrating their multifactorial etiology. We focused on two models, which has been specifically developed for VATS lobectomy . ESTS identifies three main factors affecting the risk of PAL: male gender, FEV1 < 80%, and body mass index less than 18.5 kg/m 2 .…”

Section: Discussionmentioning

confidence: 99%

“…IPAL score = gender (female = 0, male = 4) − (BMI‐24) + (2 × MRC) + type of resection (in this case 7 for lobectomy) + location (upper = 4, middle or lower = 0) + adhesions (yes = 4).…”

Section: Methodsmentioning

confidence: 99%

“…In 2015, Orsini et al validated the index of PAL (IPAL score), originally developed from the French national general thoracic surgery database (EPITHOR), showing that IPAL is a valid tool for the estimation of air leaks after VATS lobectomy. 5,6 More recently, the European Society of Thoracic Surgery (ESTS) elaborated another risk model for VATS lobectomy, which incorporates three preoperative indicators to provide a readily usable aggregate score. 7 Concurrently, dedicated intraoperative and postoperative strategies have been demonstrated to curb the incidence of PAL.…”

mentioning

confidence: 99%

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The everlasting issue of prolonged air leaks after lobectomy for non‐small cell lung cancer: A data‐driven prevention planning model in the era of minimally invasive approaches

Viti

Socci

Congregado

et al. 2018

Journal of Surgical Oncology

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Background and Objectives Prolonged air leaks (PAL) are the most frequent complication after lobectomy for non–small cell lung cancer, even in case of minimally invasive approaches. We developed a novel score to identify high‐risk patients for PAL during minimally invasive lobectomy. Methods A dedicated database was created. We investigated preoperative candidate features and specific intraoperative variables. Univariate and subsequent logistic regression analysis with bootstrap resampling have been used. Model performance has been assessed by reckoning the area under the receiver operating characteristics curve and the Hosmer‐Lemeshow goodness of fit. Results PAL (>5 days) occurred in 72 (15.69%) patients. Five variables emerged from the model. Each one was assigned a score to provide a cumulative scoring system: forced expiratory volume in 1 second below 86% (P = 0.004, 1.5 points), body mass index <24 ( P = 0.002, 1 point), active smoking ( P = 0.001, 1.5 points), incomplete fissures ( P = 0.004, 1.5 points), and adhesions ( P = 0.0001, 1 point). The new score provided a stratification into four risk classes. Conclusions The risk score incorporates either general or more specific variables, providing a risk stratification that could be readily applied intra‐ and postoperatively. Henceforth, specific technical and management measures could be properly allocated to curb PAL.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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The everlasting issue of prolonged air leaks after lobectomy for non‐small cell lung cancer: A data‐driven prevention planning model in the era of minimally invasive approaches

Viti

Socci

Congregado

et al. 2018

Journal of Surgical Oncology

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“…The incidence of prolonged air leak (PAL) is a common complication after pulmonary major surgeries, which incidences reported 7.6-10% in several studies (1)(2)(3)(4).…”

Section: Introductionmentioning

confidence: 99%

The efficacy of thoracoscopic fissureless lobectomy in patients with dense fissures

et al. 2016

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Background: Prolonged air leakage after a lobectomy remains a frequent complication in patients with dense fissures. To avoid postoperative air leakage, we used the "thoracoscopic fissureless technique" for patients with dense fissures. A thoracoscopic approach is useful for the fissureless technique because it gives a good operative view from various angles without dividing the fissure. In this study, we compared the perior intraoperative results of thoracoscopic fissureless lobectomies to traditional lobectomies with fissure dissection for pulmonary artery (PA) exposure in order to identify the efficacy of thoracoscopic fissureless lobectomy.Methods: Between April 2012 and November 2015, 175 patients underwent a thoracoscopic lobectomy with three or four ports, of whom 14 underwent a fissureless lobectomy because of dense fissures. We compared the characteristics and perioperative outcomes of the patients who underwent the fissureless technique (fissureless technique group, n=14) and the traditional fissure dissection technique for PA exposure (traditional technique group, n=161). In our department, fissureless lobectomy is indicated for patients with a fused fissure (fissural grade III or IV as proposed by Craig in 1997) or inflammation makes it difficult to expose the PA, while the traditional technique is used for other patients.Results: Although the fissureless technique group had longer operation time than the traditional technique group (P=0.0045), there was no significant inter-group difference about blood loss (P=0.85), occurrence rate of intraoperative massive bleeding (P=0.6) or conversion rate to thoracotomy (P=0.31). According to postoperative results, there was no significant inter-group difference in duration of chest tube drainage (P=0.56), length of postoperative hospital stay (P=0.14), or morbidity rate (P=0.16). No mortality occurred in either group.Conclusions: A thoracoscopic fissureless lobectomy is feasible and safe, and useful to avoid postoperative air-leakage in patients with dense fissures.

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“…PALs is one of the most common postoperative complication in patients that have undergone VAT pulmonary resections and is a main factor leading to prolonged hospitalizations; 13 the PAL incidence has been reported to be 6-15% after lobectomy surgeries. 14,15 PAL risk factors include male sex, 16 preoperative pulmonary dysfunction, presence of pleural adhesions, and poorly developed fissures; whether an association exists between the PALs and the endoscopic stapler used is unclear.…”

Section: Discussionmentioning

confidence: 99%

<p>Clinical Outcomes And Cost-Effectiveness Of Different Staplers For Lung Lobectomy With Video-Assisted Thoracic Surgery</p>

Xiao

Chang

Gao

2019

CMAR

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The aim of this study was to compare intra-operative adverse events (AE), postoperative outcomes, and costs of three different types of Echelon staplers (manual activated SC45A and electrical power-activated PSE45A & PSEE60A) used during video-assisted thoracic surgery (VATS) for lung lobectomy. Patients and methods: We carried out a retrospective chart review of patients undergoing VATS lobectomies using one of three staplers (SC45A, PSE45A, or PSEE60A) during a 2year period at our institution. We compared intra-operative AEs, post-operative outcomes (drainage volume, chest tube duration, prolonged air leaks [PALs]), endoscopic product costs [ECs], and hospitalization costs [HCs]) amongst the three stapler groups. Results: In all 204 peripheral lung cancer patients were included in the study (95 in the SC45A group, 72 in the PSE45A group, and 37 in the PSEE60A group). We observed intraoperative AEs in 6 patients of the SC45A group, in 4 of the PSE45A group, and in 1 of the PSEE60A group (P>0.05). Drainage volumes among the three groups were similar. The mean chest tube duration was shorter]st in the PSE45A group followed by those in the PSEE60A and SC45A groups (P<0.05). PALs were lowest in the PSE45A group and highest in the SC45A group (P<0.05). The mean EC in the PSEE60A group was significantly higher than those in the other two groups (P<0.05). We found no statistically significant differences in terms of HCs among groups. Conclusion: The three endoscopic staplers had similar incidences of intra-operative AEs when used for lobectomy with VATS. Use of the PSE45A stapler was associated with the shortest chest tube duration and least PALs, while use of the PSEE60A resulted in the highest EC rate.

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Index of prolonged air leak score validation in case of video-assisted thoracoscopic surgery anatomical lung resection: results of a nationwide study based on the French national thoracic database, EPITHOR

Abstract: The IPAL score is valid for the estimation of the predictive risk of PAL after VATS lung resections. It may thus a priori be used to characterize any surgical population submitted to potential preventive measures.

Cited by 38 publications

References 21 publications

The everlasting issue of prolonged air leaks after lobectomy for non‐small cell lung cancer: A data‐driven prevention planning model in the era of minimally invasive approaches

The everlasting issue of prolonged air leaks after lobectomy for non‐small cell lung cancer: A data‐driven prevention planning model in the era of minimally invasive approaches

The efficacy of thoracoscopic fissureless lobectomy in patients with dense fissures

<p>Clinical Outcomes And Cost-Effectiveness Of Different Staplers For Lung Lobectomy With Video-Assisted Thoracic Surgery</p>

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