Energy devices versus electrocoagulation in video-assisted thoracoscopic lobectomy: a propensity-match cohort study.

BACKGROUND: The aim of the study was to compare the effect on perioperative outcome of intraoperative use of different devices for tissue dissection (electrocoagulation [EC] or energy devices [ED]) in patients who underwent video-assisted thoracoscopic surgery (VATS) lobectomy for lung cancer. METHODS: We retrospectively reviewed 191 consecutive patients who underwent VATS lobectomy, divided into two cohorts: ED (117 patients), and EC (74 patients); after propensity score matching, 148 patients were extracted, 74 for each cohort. The primary endpoints considered were complication rate and 30-day mortality rate. The secondary endpoints considered were length of stay (LOS) and the number of lymph nodes harvested. RESULTS: The complication rate did not differ between the two cohorts (16.22% EC group, 19.66% ED group, P=0.549), before and after propensity matching (16.22% for both EC and ED group, P=1.000). The 30-day mortality rate was 1 in the overall population. Median LOS was 5 days for both groups, before and after propensity match, with the same interquartile range, (IQR: 4-8). ED group had a significantly higher median number of lymph nodes harvested (ED median: 18, IQR: 12-24; EC median: 10, IQR: 5-19; P=0.0002). The difference was confirmed after the propensity score matching (ED median: 17, IQR: 13-23; EC median: 10, IQR: 5-19; P=0.0008). CONCLUSIONS: ED dissection during VATS lobectomy did not lead to different complication rates, mortality rates, and LOS compared to EC tissue dissection. ED use led to a significantly higher number of intraoperative lymph nodes harvested compared to EC use.

Validation of a prognostic model including the number of harvested lymph-nodes in the setting of non-small cell lung cancer patients undergoing curative resection: a multicenter analysis.

BACKGROUND: The prognostic role of the extension of lymphadenectomy in non-small-cell lung cancer is still a debated and intriguing issue. The aim of this study is to validate a prognostic score including the number of resected lymph-nodes previously reported using a large multicenter dataset. METHODS: From 01/2002 to 12/2012, data on 4858 NSCLC patients undergoing curative-intent surgery in six institutions were retrospectively reviewed. To test the discriminative ability of the model, composed of a panel of high-risk, pathologic stage, nodal status, age, number of Resected Nodes and intermediate risk factors (gender, grading, histology), was determined. The Kaplan-Meier method was used to estimate overall (OS), cancer-specific (CSS) and disease-free survival (DFS) curves, and the log rank test was adopted to evaluate the differences between groups. RESULTS: Pathological stages were: 1) I in 46.5%, II in 24.1%, III in 27.8% and IV in 1.6% of cases. Overall, 5-year OS, CSS and DFS were 54.6%, 76.7% and 44.8%, respectively. Stratifying the sample of 3948 patients with complete data into low-risk (LR, #107), Intermediate-risk (IR, #1268) and High-Risk (HR, #2573) groups, the optimal prognostic discrimination power of this score was confirmed (C-statistics: 0.71, 95%CI 69-73). Specifically in LR, IR and HR, 5-year OS was 83.5%, 66.4% and 46.2% (P<0.0001), 5y-CSS was 95.8%, 89% and 69% (P<0.0001), and 5y-DFS was 74.7%, 59.1% and 35.5% (P<0.0001), respectively. CONCLUSIONS: Our study confirms the optimal prognostic discrimination power of the previous prognostic model including the number of harvested nodes.

Pulmonary metastasectomy for melanoma.

After primary tumor treatment, 30% of patients with malignant melanoma develop metastatic disease, usually associated with a poor prognosis. Effective chemotherapeutic regimens for metastatic melanoma are not currently available. Surgical treatment of pulmonary metastases remains controversial because of the dismal survival rates reported in several studies. However, for patients with good performance status, long disease-free interval, limited metastatic disease, and less aggressive tumor biology, it remains an option. The authors have analyzed their experience in 26 patients operated on between 2000 and 2008 alongside a review of the large series in the literature.