Uniportal Video-Assisted Thoracoscopic Surgery Completion Lobectomy Long after Wedge Resection or Segmentectomy in the Same Lobe: A Bicenter Study.

Autor: Meacci E; Department of General Thoracic Surgery, Fondazione Policlinico Gemelli IRCCS, Catholic University of Sacred Heart of Rome, 00168 Rome, Italy., Refai M; Department of Thoracic Surgery, Ospedali Riuniti, 60126 Ancona, Italy., Nachira D; Department of General Thoracic Surgery, Fondazione Policlinico Gemelli IRCCS, Catholic University of Sacred Heart of Rome, 00168 Rome, Italy., Salati M; Department of Thoracic Surgery, Ospedali Riuniti, 60126 Ancona, Italy., Kuzmych K; Department of General Thoracic Surgery, Fondazione Policlinico Gemelli IRCCS, Catholic University of Sacred Heart of Rome, 00168 Rome, Italy., Tabacco D; Department of General Thoracic Surgery, Fondazione Policlinico Gemelli IRCCS, Catholic University of Sacred Heart of Rome, 00168 Rome, Italy., Zanfrini E; Service of Thoracic Surgery, University Hospital of Lausanne, 1005 Lausanne, Switzerland., Calabrese G; Department of General Thoracic Surgery, Fondazione Policlinico Gemelli IRCCS, Catholic University of Sacred Heart of Rome, 00168 Rome, Italy., Napolitano AG; Department of General Thoracic Surgery, Fondazione Policlinico Gemelli IRCCS, Catholic University of Sacred Heart of Rome, 00168 Rome, Italy., Congedo MT; Department of General Thoracic Surgery, Fondazione Policlinico Gemelli IRCCS, Catholic University of Sacred Heart of Rome, 00168 Rome, Italy., Chiappetta M; Department of General Thoracic Surgery, Fondazione Policlinico Gemelli IRCCS, Catholic University of Sacred Heart of Rome, 00168 Rome, Italy., Petracca-Ciavarella L; Department of General Thoracic Surgery, Fondazione Policlinico Gemelli IRCCS, Catholic University of Sacred Heart of Rome, 00168 Rome, Italy., Sassorossi C; Department of General Thoracic Surgery, Fondazione Policlinico Gemelli IRCCS, Catholic University of Sacred Heart of Rome, 00168 Rome, Italy., Andolfi M; Department of Thoracic Surgery, Ospedali Riuniti, 60126 Ancona, Italy., Xiumè F; Department of Thoracic Surgery, Ospedali Riuniti, 60126 Ancona, Italy., Tiberi M; Department of Thoracic Surgery, Ospedali Riuniti, 60126 Ancona, Italy., Guiducci GM; Department of Thoracic Surgery, Ospedali Riuniti, 60126 Ancona, Italy., Vita ML; Department of General Thoracic Surgery, Fondazione Policlinico Gemelli IRCCS, Catholic University of Sacred Heart of Rome, 00168 Rome, Italy., Roncon A; Department of Thoracic Surgery, Ospedali Riuniti, 60126 Ancona, Italy., Nanto AC; Department of Thoracic Surgery, Ospedali Riuniti, 60126 Ancona, Italy., Margaritora S; Department of General Thoracic Surgery, Fondazione Policlinico Gemelli IRCCS, Catholic University of Sacred Heart of Rome, 00168 Rome, Italy.
Jazyk: angličtina
Zdroj: Cancers [Cancers (Basel)] 2024 Mar 26; Vol. 16 (7). Date of Electronic Publication: 2024 Mar 26.
DOI: 10.3390/cancers16071286
Abstrakt: Background: Completion lobectomy (CL) following a prior resection in the same lobe may be complicated by severe pleural or hilar adhesions. The role of uniportal video-assisted thoracoscopic surgery (U-VATS) has never been evaluated in this setting.
Methods: Data were collected from two Italian centers. Between 2015 and 2022, 122 patients (60 men and 62 women, median age 67.7 ± 8.913) underwent U-VATS CL at least 4 weeks after previous lung surgery.
Results: Twenty-eight (22.9%) patients were affected by chronic obstructive pulmonary disease (COPD) and twenty-five (20.4%) were active smokers. Among the cohort, the initial surgery was performed using U-VATS in 103 (84.4%) patients, triportal-VATS in 8 (6.6%), and thoracotomy in 11 (9.0%). Anatomical segmentectomy was the initial surgery in 46 (37.7%) patients, while hilar lymphadenectomy was performed in 16 (13.1%) cases. CL was performed on 110 (90.2%) patients, segmentectomy on 10 (8.2%), and completion pneumonectomy on 2 (1.6%). Upon reoperation, moderate pleural adhesions were observed in 38 (31.1%) patients, with 2 (1.6%) exhibiting strong adhesions. Moderate hilar adhesions were found in 18 (14.8%) patients and strong adhesions in 11 (9.0%). The median operative time was 203.93 ± 74.4 min. In four (3.3%) patients, PA taping was performed. One patient experienced intraoperative bleeding that did not require conversion to thoracotomy. Conversion to thoracotomy was necessary in three (2.5%) patients. The median postoperative drainage stay and postoperative hospital stay were 5.67 ± 4.44 and 5.52 ± 2.66 days, respectively. Postoperative complications occurred in 34 (27.9%) patients. Thirty-day mortality was null. Histology was the only factor found to negatively influence intraoperative outcomes ( p = 0.000). Factors identified as negatively impacting postoperative outcomes at univariate analyses were male sex ( p = 0.003), age > 60 years ( p = 0.003), COPD ( p = 0.014), previous thoracotomy ( p = 0.000), previous S2 segmentectomy ( p = 0.001), previous S8 segmentectomy ( p = 0.008), and interval between operations > 5 weeks ( p = 0.005). In multivariate analysis, only COPD confirmed its role as an independent risk factor for postoperative complications (HR: 5.12, 95% CI (1.07-24.50), p = 0.04).
Conclusions: U-VATS CL seems feasible and safe after wedge resection and anatomical segmentectomy.
Databáze: MEDLINE
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