Surgical Effectiveness of Uniportal-VATS Lobectomy Compared to Open Surgery in Early-Stage Lung Cancer

Nachira, Dania; Congedo, Maria Teresa; Tabacco, Diomira; Sassorossi, Carolina; Calabrese, Giuseppe; Ismail, Mahmoud; Vita, Maria Letizia; Petracca-Ciavarella, Leonardo; Margaritora, Stefano; Meacci, Elisa

doi:10.3389/fsurg.2022.840070

Cited by 9 publications

(11 citation statements)

References 31 publications

(42 reference statements)

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“…In recent years, numerous studies have shown that surgical treatment provides a remarkably improved 5-year survival rate for stage I or stage II lung cancer patients compared to those undergoing other treatments (17)(18)(19). Therefore, surgery could also be considered to be a promising treatment for some limited-stage lung cancers.…”

Section: Discussionmentioning

confidence: 99%

Surgery is a promising strategy for improving overall survival for stage III-N2 non-small cell lung cancer patients

Yang¹,

Jiang²,

Wang³

et al. 2023

J Thorac Dis

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Background: Surgery is commonly used to treat stage I lung cancer patients, whereas radiotherapy is applied to treat stage III lung cancer patients. However, few advanced-stage lung cancer patients benefit from surgery. This study aimed to investigate the efficacy of surgery for stage III-N2 non-small cell lung cancer (NSCLC) patients.Methods: A total of 204 patients with stage III-N2 NSCLC were included and divided into surgery (n=60) and radiotherapy (n=144) groups. The clinical characteristics [tumor node metastasis (TNM) stage, and adjuvant chemotherapy] and basic information (gender, age, and smoking/family history) of the included patients were evaluated. Furthermore, the patients' Eastern Cooperative Oncology Group (ECOG) scores and comorbidities were also evaluated, and the Kaplan-Meier approach was utilized to analyze their overall survival (OS). A multivariate Cox proportional hazards model was generated to analyze OS.Results: There was a significant difference in disease stages (IIIa and IIIb) between the surgery and radiotherapy groups (P<0.001). Compared with the surgery group, there were more patients with ECOG scores of 1 and 2 and fewer patients with ECOG scores of 0 in the radiotherapy group (P<0.001). Moreover, there was a significant difference in comorbidities between the stage III-N2 NSCLC patients in the two groups (P=0.011). The OS rate was higher significantly in stage III-N2 NSCLC patients in the surgery group compared to that in the radiotherapy group (P<0.05). Kaplan-Meier analysis demonstrated that the OS of III-N2 NSCLC was markedly better in the surgery group compared to the radiotherapy group (P<0.05).The multivariate proportional hazards model showed that age, T stage, surgery, disease stage, and adjuvant chemotherapy were independent prognostic predictors for OS in stage III-N2 NSCLC patients.Conclusions: Surgery is associated with improved OS in stage III-N2 NSCLC patients and is recommended to treat these patients.

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Section: Discussionmentioning

confidence: 99%

Surgery is a promising strategy for improving overall survival for stage III-N2 non-small cell lung cancer patients

Yang¹,

Jiang²,

Wang³

et al. 2023

J Thorac Dis

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“…Pain itself is multifactorial, and difficult to study and treat due to its subjective and unpredictable nature [ 27 ]. Minimally invasive surgery such as the uniportal VATS lobectomy for the treatment of early-stage lung cancer has led to less postoperative pain and shorter in-hospital stay [ 30 ]. However, even after minimally invasive thoracic operations, some patients suffer from chronic complaints, although they are less frequent and of lower intensity compared to thoracotomy [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Modified pericostal suture technique to reduce postoperative pain and provide optimum anatomic restoration after conversion of minimally invasive thoracic surgery to thoracotomy

Leivaditis,

Grapatsas,

Ehle

et al. 2023

kitp

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Minimally invasive thoracic techniques often need to be converted to open thoracotomy. Thoracotomy is associated with severe postoperative pain in 50% of the patients, and this situation can be maintained for a prolonged period. Many efforts have been made to avoid this complication. We propose an easy and fast thoracotomy closure technique to avoid nerve entrapment at the time of chest closure suitable for cases of conversion to thoracotomy after a minimally invasive attempt. The proposed method effectively avoids interference with the intercostal nerve, which remains intact and restores the anatomy of the intercostal space. Efforts to decrease postoperative pain are vital. Thoracic surgeons are the principal health professionals able to deal with operative factors and postoperative pain management. We believe that the use of this easy and fast technique can facilitate excellent anatomic repositioning of the ribs alongside nerve sparing.

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“…In the last 6 years, the VATS approach and, in particular, Uniportal-VATS has become the preferred technique for all major thoracic procedures in our department [ 14 ]; therefore, urgent mediastinal and pleural toilette in cases of DNM started to be performed through this approach.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors Associated with Post-Operative Complications in Multidisciplinary Treatment of Descending Necrotizing Mediastinitis

Congedo

Nachira

Pennisi

et al. 2022

JCM

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Background: Descending necrotizing mediastinitis (DNM) is a severe, life-threatening complication of oropharyngeal infections with cervical necrotizing fasciitis. In this study, we aimed to identify any possible factors that correlate with favorable outcomes. Methods: We retrospectively analyzed our series of 18 patients who underwent surgical treatment for DNM from a cervical abscess. Gender, age, symptoms, etiopathogenesis, comorbidities, time to surgery from diagnosis, degree of diffusion, identified microorganisms, surgical procedure, days in the intensive care unit, need for tracheostomy, complications, and surgical outcomes were reviewed. Results: The main type of surgery was thoracotomy + cervicotomy in eight cases (50.0%), followed by cervicotomy +VATS in four (22.2%). Seven patients (38.9%) had two or more surgeries; a bilateral operation was necessary for four patients. Evaluating the risk factors associated with post-operative complications, age ≥ 60 years (p:0.031), cervicotomy alone as surgical approach (p = 0.040), and the bilateral approach (p = 0.048) resulted in significance in terms of the univariate analysis; age ≥ 60 years (p = 0.04) and cervical approach (p = 0.05) maintained their significance in terms of the multivariate analysis. Conclusions: The low mortality of our series emphasizes the importance of an extensive and immediate surgical drainage of both the neck and the mediastinum. Mediastinal drainage from cervicotomy seems to be a risk factor for post-operative complications. Minimally invasive surgery on the chest cavity, such as with Uniportal-VATS, could be a good approach above all in elderly patients and all those cases where bilateral access is required.

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Surgical Effectiveness of Uniportal-VATS Lobectomy Compared to Open Surgery in Early-Stage Lung Cancer

Cited by 9 publications

References 31 publications

Surgery is a promising strategy for improving overall survival for stage III-N2 non-small cell lung cancer patients

Surgery is a promising strategy for improving overall survival for stage III-N2 non-small cell lung cancer patients

Modified pericostal suture technique to reduce postoperative pain and provide optimum anatomic restoration after conversion of minimally invasive thoracic surgery to thoracotomy

Risk Factors Associated with Post-Operative Complications in Multidisciplinary Treatment of Descending Necrotizing Mediastinitis

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