Risk Factors and Impact of Conversion to Thoracotomy From 20,565 Cases of Thoracoscopic Lung Surgery

Tong, Chaoyang; Li, Tingting; Huang, Chengjie; Ji, Chunyu; Liu, Yuan; Wu, Jingxiang; Xu, Mengdan; Cao, Hui

doi:10.1016/j.athoracsur.2019.12.009

Cited by 37 publications

(59 citation statements)

References 23 publications

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“…The frequency of intrathoracic adhesion after lung resection is high and of great concern to surgeons when they perform ipsilateral lung resections for secondary lung malignancies. 1 , 2) This is because the risk of surgical complications, such as pulmonary fistula or unexpected intraoperative vascular damage associated with adhesion dissection, is higher in patients with intrathoracic adhesions than in those without adhesions. 1) Therefore, a surgery that does not require adhesion dissection reduces the surgeon’s stress as well as unnecessary tissue damage.…”

Section: Discussionmentioning

confidence: 99%

“… 1) In repeat ipsilateral lung surgery, the difficulty of the surgical procedure increases if intrathoracic adhesions are present. 1 , 2) Furthermore, there is no established method to prevent intrathoracic adhesions after lung resections. To this end, we introduce a new use for oxidized regenerated cellulose (ORC) sheets to prevent intrathoracic adhesion after lung resection.…”

Section: Introductionmentioning

confidence: 99%

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Oxidized Regenerated Cellulose Sheets in Postoperative Intrathoracic Adhesions

Hokka

Tanaka

Shimizu

et al. 2022

ATCS

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Adhesiolysis is often necessary in intrathoracic adhesion during ipsilateral repeat lung resection. This procedure has a risk of surgical complications, including unintentional intraoperative damage of the pulmonary vessels or lung parenchyma. We used an oxidized regenerated cellulose (ORC) sheet to prevent intrathoracic adhesion after lung resection in 55 patients. The sheet was placed on the surface of the resected region and on the lung surface under the wound. No major postoperative complications were observed. Three cases underwent ipsilateral thoracic surgery for the treatment of lung malignancies, and there were no intrathoracic adhesions around the ORC sheet-covered area.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Oxidized Regenerated Cellulose Sheets in Postoperative Intrathoracic Adhesions

Hokka

Tanaka

Shimizu

et al. 2022

ATCS

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“…Adhesiogenesis is a process that involves angiogenesis and associated cytokines 3‐6 . HIF‐1α and VEGF mediate important roles in adhesiogenesis, which include inflammation, vascular permeability and extravasation of fibrinogen, cellular migration, neovascularization, and fibrosis 3,7,45,49,74 .…”

Section: Discussionmentioning

confidence: 99%

“…Pleural adhesions have been associated with preoperative chemotherapy and reoperation and they have been identified as one of the most common causes of intraoperative conversion of video‐assisted thoracoscopic procedures to thoracotomy 6 . Pericardial adhesions affect the cardiac anatomy, impair the left ventricle function, and constitute an important cause of morbidity and mortality on cardiothoracic surgical patients 79 .…”

Section: Discussionmentioning

confidence: 99%

“…Peritoneal, pericardial, and pleural adhesions constitute one of the major problems in surgery, with many consequences in healthcare services utilization, increased risk of complications during reoperation, and impaired patient's quality of life 1,2 . Adhesiogenesis is the eventual result of increased fibrin formation and decreased fibrinolysis, overt angiogenesis, and collagen deposition that infiltrates the fibrin matrix 3‐6 . Tissue healing is a process mediated through the interaction of vascular endothelial cells, fibroblasts, platelets, and immune cells (neutrophils and macrophages).…”

Section: Introductionmentioning

confidence: 99%

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The anti‐adhesive effect of anti‐VEGF agents in experimental models: A systematic review

Giannis

Geropoulos

Ziogas

et al. 2020

Wound Repair Regeneration

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Adhesions constitute a major problem in abdominal‐pelvic and thoracic surgery with significant impact in the postoperative quality of life and healthcare services utilization. Adhesiogenesis is the result of increased fibrin formation, impaired fibrinolysis, angiogenesis, and fibrosis. Despite the recent advancements, the ideal anti‐adhesive agent remains to be determined. To this end, we performed a comprehensive literature search in PubMed, EMBASE, and Scopus databases to identify studies investigating the antiadhesive role of anti‐VEGF agents in peritoneal, pleural, and pericardial experimental adhesion models. Fifteen studies were eligible for inclusion with a total population of 602 animals (334 rats, 180 rabbits, and 88 mice). The majority of included studies (11/15) used bevacizumab, while three studies used other anti‐VEGF antibodies and one study used an anti‐VEGFR‐antibody. A rat model was used in nine studies, while rabbit (n = 3) or mouse (n = 3) models were used less frequently. Eleven studies used peritoneal models, three studies used pleural models, and one study used a pericardial model. The scales (n = 12) and interval (Range: 1‐42 days) used for the evaluation of adhesions varied between the studies. All studies demonstrated a significant decrease in adhesion scores between the anti‐VEGF and control groups up to 42 days postprocedure. VEGF blockade resulted in decreased fibrosis in four out of five studies that used peritoneal models, while the effect on pleural models depended on the pleurodesis agent and was significant between 7 and 28 days. The effect of anti‐VEGF agents on anastomosis integrity depends on the dose and the model that is used (inconclusive results).Current data support the anti‐adhesive role of Anti‐VEGF agents in all three serosal surfaces up to 6 weeks postprocedure. Further studies are needed to confirm the anti‐adhesive role of anti‐VEGF agents in pleural and pericardial adhesion experimental models and investigate any effect on anastomosis integrity in peritoneal models.

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Impact of body mass index on perioperative and oncological outcomes in elderly patients undergoing minimally invasive McKeown esophagectomy for esophageal squamous cell carcinoma

Tong

Zhu

et al. 2022

Cancer Medicine

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Background The association between elevated body mass index (BMI) and perioperative and oncological outcomes among elderly patients undergoing minimally invasive McKeown esophagectomy (MIE) remains unclear. Methods We performed a single‐center retrospective analysis of 526 consecutive patients aged 65 years or older who underwent MIE for esophageal squamous cell carcinoma (SCC) between January 2016 and December 2019. Two groups were stratified by BMI: normal (18.5 ≤ BMI < 24 kg/m2) and elevated groups (BMI ≥ 24 kg/m2). A 1:1 propensity score matching (PSM) analysis was used to compare perioperative and oncological outcomes between the two groups. Results A total of 480 elderly patients were eventually enrolled, with a mean age of 70.2 years (range: 65–87), and 185 patients were eligible for elevated BMI, with a mean BMI of 26.3 ± 1.9 kg/m2. Compared with the normal BMI group, the elevated BMI group had prolonged operation time (261.7 ± 57.2 vs. 278.9 ± 62.7 mins, p = 0.002) and increased incidence of intraoperative hypoxemia (12.2% vs. 21.6%, p = 0.006). The differences in intraoperative estimated blood loss, transfusion, new‐onset arrhythmia, and conversion rates and postoperative outcomes regarding pulmonary and surgical complications, intensive care unit and 30‐day readmissions, the length of hospital stay, and oncological outcomes regarding R0 dissection, and the number of dissected lymph nodes between two groups were comparable. After a 1:1 PSM analysis, there was no significant difference in both perioperative and oncological outcomes between two groups. Conclusions Among elderly patients undergoing MIE for esophageal SCC, there was insufficient evidence to demonstrate that elevated BMI could increase perioperative and oncological adverse outcomes.

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Risk Factors and Impact of Conversion to Thoracotomy From 20,565 Cases of Thoracoscopic Lung Surgery

Cited by 37 publications

References 23 publications

Oxidized Regenerated Cellulose Sheets in Postoperative Intrathoracic Adhesions

Oxidized Regenerated Cellulose Sheets in Postoperative Intrathoracic Adhesions

The anti‐adhesive effect of anti‐VEGF agents in experimental models: A systematic review

Impact of body mass index on perioperative and oncological outcomes in elderly patients undergoing minimally invasive McKeown esophagectomy for esophageal squamous cell carcinoma

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