Thoracoscopic Reduction Pneumoplasty for Severe Emphysema: Do Pleural Adhesions Affect Outcome?

Tc, Mineo; Pompeo, Eugenio; Rogliani, Paola; Villaschi, S; Pistolese, Chiara Adriana; Simonetti, Giovanni

doi:10.1055/s-2007-1013160

Cited by 11 publications

(9 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In our series, the presence of pleural adhesions was found in 26.0% of all enrolled VATS cases, which occupied a lower percentage than that in patients undergoing thoracotomy in the literature (6,9). The history of COPD and respiratory infections was more frequent in the patients with pleural adhesions, revealing a significant association between pleural adhesions and inflammatory responses of the chest.…”

Section: Interpretationsmentioning

confidence: 42%

“…However, the predictive roles of pleural adhesions for conversion to thoracotomy and other major morbidity are not well-understood according to the currently limited data (6). More importantly, the classifications of pleural adhesions still remain controversial in the literature (6,9). There is not any common grading system with clinical significance produced for the presence of pleural adhesions until now.…”

Section: Rationalementioning

confidence: 99%

“…It is commonly perceived that pleural adhesions may be more frequently encountered in the patients with a heavy smoking history and respiratory inflammations when entering the chest cavity, and meanwhile, predispose to the poor operative visualization, intraoperative bleeding, lung parenchymal damage and higher morbidity risks (6,9). Thus, a technically demanding operation will be highly expected for thoracic surgeons to get over this surgical difficulty.…”

Section: Interpretationsmentioning

confidence: 99%

“…There are ever some assessment tools that use the extent and macroscopic appearance to provide a common language for classification of adhesions among general surgeons but fail to be widely implemented (9,23). Nowadays, thoracic surgeons still report the pleural adhesions subjectively based on their own experience and capability.…”

Section: Generalizabilitymentioning

confidence: 99%

“…In this study, we tried to establish a modified classification system with reference to several assessment tools reported in previous studies and stratified the patients into five different degrees of pleural adhesions (6,9). But essentially, all of them were evaluated subjectively based on the surgeons' experience and capability.…”

Section: Limitationsmentioning

confidence: 99%

See 4 more Smart Citations

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

Li¹,

Zhou²,

Wu³

et al. 2018

J. Thorac. Dis.

View full text Add to dashboard Cite

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.

show abstract

Section: Interpretationsmentioning

confidence: 42%