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@#Objective To explore the safety and feasibility of preferential manual bronchoplasty in single-port video-assisted thoracoscopic surgery (VATS) upper lobectomy. Methods The clinical data of 457 patients with non-small cell lung cancer who underwent single-port VATS lobectomy in the Department of Thoracic Surgery of Peking University First Hospital from March 2020 to March 2022 were retrospectively analyzed. The patients were divided into a preferential manual bronchoplasty group and a traditional single-port VATS lobectomy group with a 1 : 1 propensity score matching for further research. Results A total of 204 patients were matched, and there were 102 patients in each group. There were 50 males and 52 females aged 62.2±10.1 years in the preferential bronchoplasty group, and 49 males and 53 females aged 61.2±10.7 years in the traditional single-port VATS group. The preferential bronchoplasty group had shorter surgical time (154.4±37.0 min vs. 221.2±68.9 min, P<0.01), less bleeding (66.5±116.9 mL vs. 288.6±754.5 mL, P=0.02), more lymph node dissection (19.8±7.5 vs. 15.2±4.7, P<0.01), and a lower conversion rate to multi-port or open surgery (2.3% vs. 13.8%, P=0.04) in left upper lobe resection. In the right upper lobe resection surgery, there was no statistical difference in postoperative results between two groups. There was no perioperative death or occurrence of bronchopleural fistula in both groups. Conclusion Compared with traditional single-port VATS upper lobectomy, preferential bronchoplasty has similar safety and feasibility. In addition, priority bronchoplasty in left upper lobectomy has the advantages of shorter surgical time, less bleeding, more lymph node dissection, and lower conversion rate to multi-port or open surgery.
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@#Objective To evaluate the effectiveness and safety of a central venous catheter for thoracic drainage after video-assisted thoracoscopic lobectomy compared with a conventional chest tube. Methods This study collected 200 patients with lung cancer who underwent thoracoscopic lobectomy and systematic hilar and mediastinal lymph node dissection between January 2018 and September 2019 in our hospital. The patients were randomly divided into two groups, including a group A (left with 28F chest tubes postoperatively) and a group B (left with 12G central venous catheters postoperatively). Patients in both groups were left with 2 chest tubes after upper lobectomy and 1 chest tube after middle or lower lobectomy. Duration and total volume of drainage, length of hospital stay, maximum visual analogue scale score and so forth were compared between the two groups. Results Finally, 151 patients were included for analysis. There were 73 patients in the group A, including 26 males and 47 females, with an average age of 55.38±9.95 years, and 78 patients in the group B, including 37 males and 41 females, with an average age of 59.86±10.18 years. No statistical difference was found between the two groups in drainage volume on postoperative day 2, and proportion of prolonged air leaks, hemothorax, chylothorax or drain reinsertion (all P>0.05). There was a statistical difference in drainage volume on postoperative day 1 [200.0 (120.0, 280.0) mL vs. 57.5 (10.0, 157.5) mL, P=0.000], postoperative day 3 [155.0 (100.0, 210.0) mL vs. 150.0 (80.0, 215.0) mL, P=0.023], total volume of drainage [890.0 (597.5, 1 530.0) mL vs. 512.5 (302.5, 786.3) mL, P=0.000], maximum pain score (2.29±0.72 points vs. 2.09±0.51 points, P=0.013) and length of hospital stay [7 (7, 9) d vs. 5 (4, 7) d, P=0.000]. Conclusion Compared with conventional chest tubes, central venous catheters for chest drainage in patients with lung cancer after thoracoscopic lobectomy shortens the length of hospital stay and reduces postoperative pain.
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Introduction: Despite the increasing use of video-assisted thoracoscopic lobectomy, this surgical approach is still controversial in certain aspects. The purpose of this study is to compare the surgical results of video-assisted thoracoscopic pulmonary lobectomy to pulmonary lobectomy via thoracotomy. Materials and Methods: Between 2008 and 2017, 153 patients (n = 89 males) had surgery at the Hospital Universitario Fundación Favaloro. Results: 39/89 patients underwent video-assisted thoracoscopic lobectomy. Patients who had video-assisted thoracoscopy and were diagnosed with lung cancer mostly had stage I tumors (25/39 patients). Postoperative complications and mortality rates were similar in both groups. Video-assisted thoracoscopy patients had a significantly shorter pleural drainage time (4 vs. 3 days, p = 0.004) and a shorter length of hospital stay (6 vs. 4 days of stay, p = 0.03). The number of lymph node stations sampled during surgery was higher in the patients operated via thoracotomy (4 vs. 3.5 lymph node stations, p < 0.001). Conclusion: Video-assisted thoracoscopic lobectomy was at least equivalent to surgery by means of thoracotomy in terms of postoperative complications. The main benefits of the video-assisted thoracoscopy approach were shorter pleural drainage time and length of hospital stay. Special attention should be paid to nodal sampling when the surgery is performed via video-assisted thoracoscopy.
Sujets)
Pneumonectomie , ThoracotomieRésumé
Objective To investigate the difference of curative effects between the complete video assisted thoracic surgery (C-VATS)and traditional open surgery in the treatment of elderly patients with lung cancer,and to clarify the specially curative effect of C-VATS.Methods 80 patients with lung cancer without diabetes mellitus,chronic brouchitis and heart diseases aged over 65 years were enrolled in the study.They were divided into C-VATS group and open surgery for lobectomy (OPEN)group (n=40)according their wishes.The operation time,number of lymph nodes removed,amount of intraoperative blood loss,postoperative thoracic drainage,chest tube duration, postoperative hospitalized time, postoperative pain degree, incidence of postoperative complications, preoperative and postoperative sedentary heart rate (HR)of the patients in two groups were compared.Results The operation time in C-VATS group(193.12 min±59.06 min)was longer than that in OPEN group(167.17 min±54.01 min) (P0.05).The postoperative pain degree in C-VATS group(2.54 ± 0.12)was lower than that in OPEN group(4.61 ± 0.10)(P0.05).The postoperative sedentary HR in C-VATS group and OPEN group were significantly higher than preoperative;the postoperative sedentary HR recovered to the preoperative level 3 d after operation in C-VATS group and it recovered to the preoperative level 7 d after operation in OPEN group. Conclusion Compared with traditional open thoracic surgery, C-VATS owns the characteristics such as less trauma, less pain, less hospital stay and better postoperative recovery in the aged patients with lung cancer.