Presence of pleural adhesions can predict conversion to thoracotomy and postoperative surgical complications in patients undergoing video-assisted thoracoscopic lung cancer lobectomy

Abstract

Background:The purpose of our cohort study was to investigate the effects of pleural adhesions on perioperative outcomes in patients undergoing video-assisted thoracoscopic surgery (VATS) lobectomy for non-small-cell lung cancer (NSCLC). Methods: We performed a single-center retrospective analysis on the prospectively-maintained dataset at our unit from February 2014 to November 2015. Patients were divided into two groups (Group A: presence of pleural adhesions; Group B: absence of pleural adhesions) according to our grading system of pleural adhesions when entering the chest cavity. Demographic differences in perioperative outcomes between these two groups were initially estimated. A multivariate logistic-regression analysis was then performed to confirm the predictive value of the presence of pleural adhesions.Results: A total of 593 NSCLC patients undergoing VATS lobectomy were enrolled. The conversion and postoperative morbidity rates were 3.2% and 29.2%, respectively. There were 154 patients with pleural adhesions (Group A) and 439 patients without pleural adhesions (Group B). Group A patients had significantly higher rates of conversion to thoracotomy (9.1% vs. 1.1%; P<0.001) and surgical complications (24.0% vs. 14.4%; P=0.006) than those of Group B patients. No significant difference was found in the overall morbidity and cardiopulmonary complication rates between these two groups. The presence of pleural adhesions was also significantly associated with the prolonged length of chest tube drainage (logrank P<0.001) and length of stay (log-rank P=0.032). Finally, the presence of pleural adhesions was identified as an independent risk factor for conversion to thoracotomy [odds ratio (OR) =5.49; P=0.003] and surgical complications (OR =1.94; P=0.033) by multivariate logistic-regression analyses. Conclusions: Presence of pleural adhesions can predict conversion to thoracotomy and postoperative surgical complications in patients undergoing VATS lobectomy for NSCLC. Our study calls for an internationally accepted grading system for the presence of pleural adhesions to stratify the surgical risk.

Risk factors and cancer recurrence associated with postoperative complications after thoracoscopic lobectomy for clinical stage I non‐small cell lung cancer

“…Pleural adhesion is one of the main reasons for the conversion from a thoracoscopic approach to open thoracotomy, and many less experienced surgeons consider the VATS procedure to be contraindicated in cases of pleural adhesion. Pleural adhesion has been reported to be a statistically significant independent risk factor, not only for conversion to thoracotomy, but also for higher morbidity . Pleural adhesions can increase the incidence of prolonged air leak, pneumonia, and atelectasis, and can prolong postoperative hospitalization .…”

Body surface area as a novel risk factor for chylothorax complicating video‐assisted thoracoscopic surgery lobectomy for non‐small cell lung cancer

“…We defined the PRI as the existence of one or more of the following preoperative infectious conditions: bacterial/viral/fungal respiratory tract infection, obstructive pneumonia, aspiration pneumonia, bronchiectasis, and lung abscess. Severe liver disease included hepatitis B and C, hepatocirrhosis, severe fatty liver, and hepatic parasitic infections …”

“…After surgery, patients were managed in compliance with a standardized clinical pathway. The institutional policies for intensive pulmonary rehabilitation, residual lung recruitment assessment, chest tube management, and discharge criteria, have been reported in our previous studies …”

“…Severe liver disease included hepatitis B and C, hepatocirrhosis, severe fatty liver, and hepatic parasitic infections. 6,12,13,[21][22][23] Multidisciplinary team meetings were held when necessary to discuss whether combined treatment modalities were required before surgery. Neoadjuvant/adjuvant therapy comprised cisplatin/paclitaxel-based chemotherapy or chemoradiotherapy with sustainable courses and dosages according to National Comprehensive Cancer Network Guidelines: China Edition.…”

“…The institutional policies for intensive pulmonary rehabilitation, residual lung recruitment assessment, chest tube management, and discharge criteria, have been reported in our previous studies. 6,12,13,[21][22][23][26][27][28][29] An algorithm of chylothorax management is shown in Figure 1. Once diagnosed with chylothorax, patients were initially managed with oral intake cessation (OIC) and total parenteral nutrition (TPN).…”