Quality of Life and Outcomes after Nonintubated versus Intubated Video-Thoracoscopic Pleurodesis for Malignant Pleural Effusion: Comparison by a Case-Matched Study

Mineo, Tommaso Claudio; Sellitri, Francesco; Tacconi, Federico; Ambrogi, Vincenzo

doi:10.1089/jpm.2013.0617

Cited by 43 publications

(54 citation statements)

References 25 publications

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“…In another 1 to 1 matched study (29) morbidity rate was analyzed in a total of 462 patients who underwent either talc pleurodesis through NIVATS by local anesthesia (LA) or GAVATS. The authors found a significant decrease in postoperative complications as well as in many other perioperative outcome measures including quality of life scores and hospital stay.…”

Section: High-risk Patientsmentioning

confidence: 99%

Non-intubated video-assisted thoracic surgery: where does evidence stand?

Tacconi¹,

Pompeo²

2016

J. Thorac. Dis.

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In recent years, non-intubated video-assisted thoracic surgery (NIVATS) strategies are gaining popularity worldwide. The main goal of this surgical practice is to achieve an overall improvement of patients' management and outcome thanks to the avoidance of side-effects related to general anesthesia (GA) and one-lung ventilation. The spectrum of expected benefits is multifaceted and includes reduced postoperative morbidity, faster discharge, decreased hospital costs and a globally reduced perturbation of patients' well-being status. We have conducted a literature search to evaluate the available evidence on this topic. Meta-analysis of collected results was also done where appropriate. Despite some fragmentation of data and potential biases, the available data suggest that NIVATS operations can reduce operative morbidity and hospital stay when compared to equipollent procedures performed under GA. Larger, well designed prospective studies are thus warranted to assess the effectiveness of NIVATS as far as to investigate comprehensively the various outcomes. Multi-institutional and multidisciplinary cooperation will be welcome to establish uniform study protocols and to help address the questions that are to be answered yet.Keywords: Non-intubated thoracic surgery; video-assisted thoracic surgery (VATS); awake VATS; regional more dangerous in patients with pre-existing pulmonary disease. Other well-known side-effects of GA and one-lung ventilation include-but are not limited to-induction of cardiac arrhythmias (16), transient hypoxemia, injury to liver and kidney, cognitive deterioration, and impairment in perioperative immunosurveillance (17). Mechanical airway injury secondary to double-lumen tube insertion should be also taken into account, even though the estimated incidence of airway laceration is extremely low (18).The rationale of NIVATS is that avoidance of one-lung ventilation may help achieve a reduction in perioperative morbidity, particularly in subjects with poor cardiorespiratory performance. Accordingly, it is not surprising that most of the earliest NIVATS experiences consisted of small caseseries dealing with management of patients with chronic respiratory failure or other comorbidity.A paradigm shift is-however-being observed more recently and in some centers, adoption of NIVATS is being progressively extended to patients without any substantial risk factor for GA and one-lung ventilation.Indeed, in a recent survey from the European Society of Thoracic Surgeons, 70% of responders believed that ideal candidates for NIVATS are patients with multiple comorbidities although it is worth noting that 20% of them affirmed to be also favorable to the use of NIVATS regardless of patients ' comorbidity profile (19). This strategy appears to be justified when taking into account benefits other than protection from postoperative complications, which include reduced hospital stay, better quality of recovery and lower procedure-related costs. Furthermore, a lesser perturbation of immune and endocrine s...

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Section: High-risk Patientsmentioning

confidence: 99%

Non-intubated video-assisted thoracic surgery: where does evidence stand?

Tacconi¹,

Pompeo²

2016

J. Thorac. Dis.

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“…It is, to our knowledge, the first dedicated to nonintubated thoracic surgery in the literature. During more than a decade this program achieved a consistent amount of knowledge about the surgery in awake patients and produced a great number of scientific publications (68,69,81,84,(95)(96)(97)(98)(99)(100)(101)(102)(103)(104)(105). In our program we initially privileged anesthesia delivered through an epidural catheter with a fully awake and collaborative patient (96)(97)(98)(99).…”

Section: The Awake Anesthesia In Progressmentioning

confidence: 99%

A glance at the history of uniportal video-assisted thoracic surgery

Mineo¹,

Ambrogi²

2017

J. Vis. Surg.

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In the history of thoracic surgery, the advent of video-assisted thoracic surgery (VATS) had on effect equivalent to that provoked by a true revolution. VATS successfully allowed minor, major and complex procedures for various lung and mediastinal pathologies with small incision instead of the traditional accesses. These small incisions abolished ugly scars, generated less acute and chronic pain, reduced hospital stay and costs, allowed faster return to normal day life activities. Conventional VATS was initially performed

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“…The latter resulted in a shorter duration of hospital stay (p<0.014), in a lesser perioperative complication rate (5.2% vs. 9%, p=0.042), and in reduced costs, with a mean saving of 3000 Eurodollars a patients [2]. Furthermore, NITOS seems to achieve better results in terms of early postoperative quality of life [71], and did not show inferior efficacy in achieving and effective pleurodesis. All these findings highlights that NITOS could be a reliable means to take the advantage of a videothoracoscopic procedure, while avoiding the risks related to general anesthesia in these fragile patients.…”

Section: Malignant Pleural Effusionmentioning

confidence: 92%

“…Reported success rates for videothoracoscopic talc pleurodesis range from 84% to 95% [66][67][68][69][70][71][72]. These figures appear to be remarkably higher that those observed after bedside instillation of talc [68,70] or other agents [63,79].…”

Section: Malignant Pleural Effusionmentioning

confidence: 99%