Thoracoscopic Lobectomy Has Increasing Benefit in Patients With Poor Pulmonary Function

Ceppa, DuyKhanh P.; Kosinski, Andrzej S.; Berry, Mark F.; Tong, Betty C.; Harpole, David H.; Mitchell, John D.; D’Amico, Thomas A.; Onaitis, Mark W.

doi:10.1097/sla.0b013e318265819c

Cited by 221 publications

(173 citation statements)

References 35 publications

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“…It has become clear that VATS lobectomy has an advantage over thoracotomy in terms of morbidity, especially in patients with poor pulmonary function (14), and can be performed under sound oncological principles. VATS lobectomy has been demonstrated to have a lower incidence of arrhythmia, blood transfusion, renal failure, need for re-intubation, and shorter length of hospital stay and chest tube duration than open thoracotomy (8,15).…”

Section: Minimally Invasive Surgical Approachesmentioning

confidence: 99%

Selenium Protects Retinal Cells from Cisplatin Induced Alterations in Carbohydrate Residues

Akşit¹,

Yazıcı²,

Akşit³

et al. 2015

Balkan Med J

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Non-small cell lung cancer (NSCLC) remains the leading cause of cancer death worldwide. Approximately 15 to 20% of NSCLC patients present with early or localised disease; this figure is expected to grow with the increased use of low-dose computed tomography (CT) scans for screening (1). The standard treatment for operable stage I NSCLC is lobectomy or pneumonectomy with mediastinal lymphadenectomy. Five-year survival rates of early stage NSCLC patients range between 60 and 80% after surgical resection (2). Despite major developments in minimally-invasive surgical procedures, a substantial proportion of patients are not suitable for surgery due to their comorbidities. Stereotactic body radiation therapy (SBRT) or stereotactic ablative radiotherapy (SABR) has recently emerged as a benchmark of care for medically inoperable patients. SABR is a more concise and well-planned treatment procedure with enhanced local control and survival while minimising treatment cost against conventional radiotherapy.Cancer-specific outcomes of patients in SABR series are generally comparable to surgical series; however, overall survival results are usually reported to be superior in the surgical cohorts because of major differences in the two groups.Approximately one in every three patient dies as a result of comorbidity-related complications instead of cancer in SBRT series. As a result, in patients with operable stage I NSCLC, surgical operation continues to be the benchmark of care. In this review, we plan to summarise the published evidence for the treatment of early stage NSCLC with surgery and SABR. THE SURGICAL MANAGEMENT OF EARLY STAGE NSCLCSurgical resection remains the treatment of choice for patients with stage I or II NSCLC, since it provides the optimal likelihood of cure and long-term survival. Such an operation includes both complete anatomical resection of the tumour and mediastinal lymph node evaluation (3). PREOPERATIVE EVALUATIONPatients with NSCLC who are surgical candidates are often cigarette smokers, which makes them vulnerable to atheroThe management of early-stage Non-small Cell Lung Cancer (NSCLC) has improved recently due to advances in surgical and radiation modalities. Minimallyinvasive procedures like Video-assisted thoracoscopic surgery (VATS) lobectomy decreases the morbidity of surgery, while the numerous methods of staging the mediastinum such as endobronchial and endoscopic ultrasound-guided biopsies are helping to achieve the objectives much more effectively. Stereotactic Ablative Radiotherapy (SABR) has become the frontrunner as the standard of care in medically inoperable early stage NSCLC patients, and has also been branded as tolerable and highly effective. Ongoing researches using SABR are continuously validating the optimal dosing and fractionation schemes, while at the same time instituting its role for both inoperable and operable patients.

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Section: Minimally Invasive Surgical Approachesmentioning

confidence: 99%

Selenium Protects Retinal Cells from Cisplatin Induced Alterations in Carbohydrate Residues

Akşit¹,

Yazıcı²,

Akşit³

et al. 2015

Balkan Med J

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“…Although a large number of patients could not be offered surgery due to age or comorbidities in the past, the progress in thoracic anaesthesia, perioperative medicine and surgical techniques now allow octogenarians and patients with significant cardiopulmonary comorbidities to undergo lung resections routinely [31]. The estimation of in-hospital death and complications is of paramount importance to decide whether a patient should be offered surgery or not and to inform the patient in the best possible way.…”

Section: Assessment Of the Risk For Surgerymentioning

confidence: 99%

“…Therefore, lung resection should be considered even in patients with very poor pulmonary function, when the tumour is situated in the most emphysematous lobe [19]. Recently, an analysis of the STS database showed that thoracotomy had a markedly negative impact on complications compared with VATS lobectomy in patients with FEV1 ,60% predicted or DLCO ,60% predicted [31].…”

Section: Surgery In Patients With Impaired Pulmonary Functionmentioning

confidence: 99%

Surgery for nonsmall cell lung cancer

Lang-Lazdunski

2013

European Respiratory Review

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Surgery remains the best curative option in patients with early stage lung cancer (stage I and II). Developments in minimally invasive techniques now allow surgeons to perform lung resections on elderly patients, patients with poor pulmonary function or significant cardiopulmonary comorbidities. New techniques, such as stereotactic radiotherapy and ablative procedures, are being evaluated in early-stage lung cancer and may represent an alternative to surgery in patients unfit for lung resection. Perioperative mortality rates have dropped significantly at most institutions in the past two decades and complications are managed more efficiently. Progress in imaging and staging techniques have helped cut futile thoracotomy rates and offer patients the most adequate treatment options. Large randomised trials have helped clarify the role of neoadjuvant, induction and adjuvant chemotherapy, as well as radiotherapy. Surgery remains an essential step in the multimodality therapy of selected patients with advanced-stage lung cancer (stage III and IV). Interventional and endoscopic techniques have reduced the role of surgery in the diagnosis and staging of nonsmall cell lung cancer, but surgery remains an important tool in the palliation of advanced-stage lung cancer. Large national/international surgical databases have been developed and predictive risk-models for surgical mortality/morbidity published by learned surgical societies. Nonetheless, lung cancer overall survival rates remain deceptively low and it is hoped that early detection/screening, better understanding of tumour biology and development of biomarkers, and development of efficient targeted therapies will help improve the prognosis of lung cancer patients in the next decade. @ERSpublications Despite progress in surgical techniques, radiotherapy techniques and targeted therapy, lung cancer prognosis remains poor

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“…Video-assisted thoracic surgery (VATS), a minimally i n v a s i v e a p p r o a c h w i t h s e v e r a l a d v a n t a g e s o v e r thoracotomy for early stage lung cancer (1)(2)(3)(4)(5), its use is limited because of rigid instruments and poor 2-dimensional visualization. With technological innovations, robotic surgical systems appears to have several theoretical advantages over traditional VATS, including 3-dimensional field of view, improved greater dexterity due to more degrees of movement freedom of robotic arms and great comfort for the surgeon (6,7).…”

Section: Introductionmentioning

confidence: 99%

Comparison of robotic and video-assisted thoracic surgery for lung cancer: a propensity-matched analysis

Bao¹,

Zhang²,

Yang³

et al. 2016

J. Thorac. Dis.

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Background: Reports of comparison between robotic and thoracoscopic surgery for lung cancer are limited, we aimed to compare the perioperative outcomes of robotic and thoracoscopic anatomic pulmonary resection for lung cancer. 50.3±37.9 mL, P=0.531), morbidity rates (42.0% vs. 30.4%, P=0.157) were similar between the robotics and thoracoscopy. However, robotics was associated with higher cost ($12,067±1,610 vs. $8,328±1,004, P<0.001), and longer operative time (136±40 vs. 111±28 min, P<0.001). Conclusions: Robotics seems to have higher hospital costs and longer operative time, without superior advantages in morbidity rates and oncologic efficiency. Further prospective randomized clinical trials were needed to validate both of its short-and long-term oncologic efficiency.

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Thoracoscopic Lobectomy Has Increasing Benefit in Patients With Poor Pulmonary Function

Cited by 221 publications

References 35 publications

Selenium Protects Retinal Cells from Cisplatin Induced Alterations in Carbohydrate Residues

Selenium Protects Retinal Cells from Cisplatin Induced Alterations in Carbohydrate Residues

Surgery for nonsmall cell lung cancer

Comparison of robotic and video-assisted thoracic surgery for lung cancer: a propensity-matched analysis

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