TY - JOUR
T1 - Safety of lymphadenectomy during video-assisted thoracic surgery lobectomy
T2 - Analysis from a national database
AU - Italian VATSGroup
AU - Gonfiotti, Alessandro
AU - Bertani, Alessandro
AU - Nosotti, Mario
AU - Viggiano, Domenico
AU - Bongiolatti, Stefano
AU - Bertolaccini, Luca
AU - Droghetti, Andrea
AU - Solli, Piergiorgio
AU - Crisci, Roberto
AU - Voltolini, Luca
AU - Curcio, Carlo
AU - Amore, Dario
AU - Marulli, Giuseppe
AU - Nicotra, Samuele
AU - De Negri, Andrea
AU - Maineri, Paola
AU - Di Rienzo, Gaetano
AU - Lopez, Camillo
AU - Divisi, Duilio
AU - Morelli, Angelo
AU - Russo, Emanuele
AU - Londero, Francesco
AU - Rosso, Lorenzo
AU - Spaggiari, Lorenzo
AU - Gasparri, Roberto
AU - Baietto, Guido
AU - Casadio, Caterina
AU - Infante, Maurizio
AU - Benato, Cristiano
AU - Alloisio, Marco
AU - Bottoni, Edoardo
AU - Giovanardi, Andrea
AU - Cardillo, Giuseppe
AU - Carleo, Francesco
AU - Stella, Franco
AU - Dolci, Giampiero
AU - Puma, Francesco
AU - Vinci, Damiano
AU - Cavallesco, Giorgio
AU - Maniscalco, Pio
AU - Argnani, Desideria
AU - Ampollini, Luca
AU - Carbognani, Paolo
AU - Terzi, Alberto
AU - Viti, Andrea
AU - Negri, Giampiero
AU - Bandiera, Alessandro
AU - Perkmann, Reinhold
AU - Zaraca, Francesco
AU - Ibrahim, Mohsen
N1 - Publisher Copyright:
© The Author(s) 2018. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
PY - 2018/10/1
Y1 - 2018/10/1
N2 - OBJECTIVES The Italian VATS Group database was accessed to evaluate whether preoperative and intraoperative factors may affect the safety of lymphadenectomy (LA) during video-assisted thoracic surgery lobectomy. METHODS All video-assisted thoracic surgery lobectomy procedures performed between 1 January 2014 and 30 March 2017 for non-small-cell lung cancer with cN0 or cN1 disease were identified in the database. LA safety was evaluated based on intraoperative (operative time, bleeding and conversion rate) and postoperative (30-day morbidity and mortality, chest drain duration and length of stay) outcomes and was correlated with the number of resected lymph nodes and the rates of nodal upstaging. Continuous variables were presented as mean ± standard deviation and compared using the unpaired t-test; the X 2 test was used for categorical variables. Univariable analysis was performed on selected variables. Significant variables (P < 0.30) were entered into a Cox multivariable logistic regression model, using the overall and specific occurrence of complications as dependent variables. The Spearman's rank correlation coefficient was applied as needed. RESULTS A total of 3181 cases (2077 men, 65.3%; mean age of 69 years) met the enrolment criteria. Final pathology was consistent with adenocarcinoma (n = 2262, 67.5%), squamous cell (n = 520, 15.5%), typical (n = 184, 5.5%) and atypical carcinoid (n = 48, 1.4%) and other (n = 335, 10%). The mean number of resected lymph nodes was 13.42 ± 8.24; nodal upstaging occurred in 308 of 3181 (9.68%) cases. Six hundred and fifty-five complications were recorded in 404 (12.7%) patients; in this series, no mortality was observed. Univariable and multivariable analyses did not show any association between the extension of LA and intraoperative or postoperative outcomes. The number of resected lymph nodes and nodal upstagings showed a minimal correlation with intraoperative outcomes and a moderate correlation with postoperative air leak (p = 0.35 and p = 0.48, respectively), arrhythmia (p = 0.29 and p = 0.35, respectively), chest drain duration (p = 0.35 and p = 0.51, respectively) and length of stay (p = 0.35). CONCLUSIONS Based on the VATS Group data, video-assisted thoracic surgery LA proved to be safe and displayed good outcomes even when performed with an extended approach.
AB - OBJECTIVES The Italian VATS Group database was accessed to evaluate whether preoperative and intraoperative factors may affect the safety of lymphadenectomy (LA) during video-assisted thoracic surgery lobectomy. METHODS All video-assisted thoracic surgery lobectomy procedures performed between 1 January 2014 and 30 March 2017 for non-small-cell lung cancer with cN0 or cN1 disease were identified in the database. LA safety was evaluated based on intraoperative (operative time, bleeding and conversion rate) and postoperative (30-day morbidity and mortality, chest drain duration and length of stay) outcomes and was correlated with the number of resected lymph nodes and the rates of nodal upstaging. Continuous variables were presented as mean ± standard deviation and compared using the unpaired t-test; the X 2 test was used for categorical variables. Univariable analysis was performed on selected variables. Significant variables (P < 0.30) were entered into a Cox multivariable logistic regression model, using the overall and specific occurrence of complications as dependent variables. The Spearman's rank correlation coefficient was applied as needed. RESULTS A total of 3181 cases (2077 men, 65.3%; mean age of 69 years) met the enrolment criteria. Final pathology was consistent with adenocarcinoma (n = 2262, 67.5%), squamous cell (n = 520, 15.5%), typical (n = 184, 5.5%) and atypical carcinoid (n = 48, 1.4%) and other (n = 335, 10%). The mean number of resected lymph nodes was 13.42 ± 8.24; nodal upstaging occurred in 308 of 3181 (9.68%) cases. Six hundred and fifty-five complications were recorded in 404 (12.7%) patients; in this series, no mortality was observed. Univariable and multivariable analyses did not show any association between the extension of LA and intraoperative or postoperative outcomes. The number of resected lymph nodes and nodal upstagings showed a minimal correlation with intraoperative outcomes and a moderate correlation with postoperative air leak (p = 0.35 and p = 0.48, respectively), arrhythmia (p = 0.29 and p = 0.35, respectively), chest drain duration (p = 0.35 and p = 0.51, respectively) and length of stay (p = 0.35). CONCLUSIONS Based on the VATS Group data, video-assisted thoracic surgery LA proved to be safe and displayed good outcomes even when performed with an extended approach.
KW - Lobectomy
KW - Lung cancer
KW - Video-assisted thoracic surgery
UR - http://www.scopus.com/inward/record.url?scp=85049259253&partnerID=8YFLogxK
U2 - 10.1093/ejcts/ezy098
DO - 10.1093/ejcts/ezy098
M3 - Article
C2 - 29579185
AN - SCOPUS:85049259253
SN - 1010-7940
VL - 54
SP - 664
EP - 670
JO - European Journal of Cardio-thoracic Surgery
JF - European Journal of Cardio-thoracic Surgery
IS - 4
ER -