Electromagnetic Navigation Bronchoscopy Localization Versus Percutaneous CT-Guided Localization for Lung Resection via Video-Assisted Thoracoscopic Surgery: A Propensity-Matched Study.

BACKGROUND: An ideal preoperative localization method is essential for the resection of small and deep-seated pulmonary nodules by video-assisted thoracoscopic surgery (VATS) in the era of low-dose computed tomography (CT) screening. This study describes a new localization method using electromagnetic navigation bronchoscopy (ENB) and compares it against conventional percutaneous CT-guided methods. METHODS: Between January 2016 and May 2018, 18 consecutive patients with a total of 27 pulmonary nodules underwent ENB localization using patent blue vital dye before thoracoscopy for lung resection at the National Taiwan University Hospital. Over the same period, 268 patients had a total of 325 pulmonary nodules localized by a CT-guided method. Propensity analysis was applied to minimize bias during comparison. RESULTS: Patients were selected using a propensity-score based process, matched for potential risk factors for localization failure, to ensure equal potential prognostic factors in both groups. After matching, the ENB group had 15 patients with a total of 24 pulmonary nodules, and the CT group had 30 patients with 48 pulmonary nodules. No major procedure-related complications occurred in either group. The target pulmonary nodule was not successfully localized for one patient in the ENB group and three in the CT group. The lesions were fully excised after conversion to mini-thoracotomy. Pathological examination confirmed the accuracy of the dye staining. Analysis found a non-significant difference in the success rate of these two localization methods. However, the following parameters were significantly different: interval between localization to surgery, global time, and rate of pneumothorax (p <0.05). CONCLUSIONS: In the era of minimally invasive surgery, surgeons need an efficient one-step way to manage pulmonary nodules. Patent blue vital injection with ENB guidance in the operating room is a new, effective approach to localize small, deep-seated and non-palpable pulmonary lesions, comparable with CT-guided localization.

Comparison of single- and multi-incision minimally invasive esophagectomy (MIE) for treating esophageal cancer: a propensity-matched study.

OBJECTIVE: To compare the perioperative outcome of minimally invasive (MIE) esophagectomy performed with a single- or a multi-incision in treating esophageal cancer. METHOD: Patients with esophageal cancer who underwent MIE from 2006 to 2016 were evaluated. A 3-4-cm incision was created in both the thoracoscopic and the laparoscopic phases during the single-incision MIE procedures. A propensity-matched comparison was made between the two groups of patients. RESULTS: We analyzed a total of 48 pairs of patients with propensity-matched from the cohort of 360 patients undergoing MIE during 2006-2015. There is no statistical difference in terms of postoperative ICU and hospital stay, number of dissected lymph nodes and presence of major surgical complications (anastomotic leakage and pulmonary complications) between the two groups of patients. The pain score one week after surgery was significantly lower in the single-incision group (p < 0.05). There was no surgical mortality in the single-incision MIE group. CONCLUSION: Minimally invasive esophagectomy performed with a single-incision approach is feasible for treating patients with esophageal cancer, with a comparable perioperative outcome with that of multi-incision approaches. The postoperative pain one week after surgery was significantly reduced in patients undergoing single-incision MIE.

Pleural Photodynamic Therapy and Surgery in Lung Cancer and Thymoma Patients with Pleural Spread.

Pleural spread is difficult to treat in malignancies, especially in lung cancer and thymoma. Monotherapy with surgery fails to have a better survival benefit than palliative chemotherapy, the currently accepted treatment. Photodynamic therapy utilizes a photosensitizer to target the tumor site, and the tumor is exposed to light after performing a pleurectomy and tumor resection. However, the benefits of this procedure to lung cancer or thymoma patients are unknown. We retrospectively reviewed the clinical characteristics and treatment outcomes of patients with lung cancer or thymoma with pleural seeding who underwent pleural photodynamic therapy and surgery between 2005 and 2013. Eighteen patients enrolled in this study. The mean patient age was 52.9 ± 12.2 years. Lung cancer was the inciting cancer of pleural dissemination in 10 patients (55.6%), and thymoma in 8 (44.4%). There was no procedure-related mortality. Using Kaplan-Meier survival analysis, the 3-year survival rate and the 5-year survival rate were 68.9% and 57.4%, respectively. We compared the PDT lung cancer patients with those receiving chemotherapy or target therapy (n = 51) and found that the PDT group had better survival than non-PDT patients (mean survival time: 39.0 versus 17.6 months; P = .047). With proper patient selection, radical surgical resection combined with intrapleural photodynamic therapy for pleural spread in patients with non-small cell lung cancer or thymoma is feasible and may provide a survival benefit.