DSpace Collection:https://hdl.handle.net/10171/188942024-03-29T15:05:56Z2024-03-29T15:05:56ZImpact of Neoadjuvant Chemoradiation on Adverse Events After Bronchial Sleeve Resectionhttps://hdl.handle.net/10171/690522024-02-12T06:09:49Z2021-01-01T00:00:00ZTitle: Impact of Neoadjuvant Chemoradiation on Adverse Events After Bronchial Sleeve Resection
Abstract: Background. We analyzed the association between
neoadjuvant chemoradiation in patients undergoing
bronchial sleeve resection with the incidence of postoperative pulmonary and airway complications.
Methods. After instructional review board approval we
performed a retrospective review of a prospectively
maintained database of 136 patients who underwent
sleeve resection in our institution between January 1998
and December 2016. Administration of neoadjuvant chemoradiation treatment was the studied exposure. Outcomes of interest were rates of postoperative pulmonary
and airway complications. Nonparametric testing of demographic, surgical, and pathologic characteristics and
morbidity was performed. Logistic regression models
evaluated postoperative pulmonary complications and
airway complications. Analysis was performed using
Stata/IC 15.
Results. We analyzed 136 patients (18 underwent neoadjuvant chemoradiation), 77 (57%) of whom had nonsmall cell lung cancer. Postoperative pulmonary complications were observed in 44 of 136 patients (32%).
Incidences of pulmonary complications were higher in
the neoadjuvant chemoradiation group compared with
the non–neoadjuvant radiation group (15/18 patients
[83%] vs 29/118 patients [25%], respectively; P < .001).
Likewise, rates of pneumonia, atelectasis, respiratory
insufficiency, bronchial stenosis, prolonged air leak,
bronchopleural fistula, and completion pneumonectomy
(2/18 [11%]) were higher in the neoadjuvant chemoradiation group, reaching statistical significance in all
cases except bronchial stenosis and prolonged air leak.
Only neoadjuvant chemoradiation therapy remained
significant for postoperative pulmonary and airway
complications on logistic regression (both P < .05)
Conclusions. Patients who undergo neoadjuvant chemoradiation before sleeve resection are at an increased
risk of pulmonary and airway complications.2021-01-01T00:00:00ZPre-COVID-19 National Mortality Trends in Open and Video-Assisted Lobectomy for Non-Small Cell Lung Cancerhttps://hdl.handle.net/10171/690492024-02-12T06:09:47Z2022-01-01T00:00:00ZTitle: Pre-COVID-19 National Mortality Trends in Open and Video-Assisted Lobectomy for Non-Small Cell Lung Cancer
Abstract: Introduction
In the current era of episode-based hospital reimbursements, it is important to determine the impact of hospital size on contemporary national trends in surgical technique and outcomes of lobectomy.
Methods
Patients aged >18 y undergoing open and video-assisted thoracoscopic surgery (VATS) lobectomy from 2008 to 2014 were identified using insurance claims data from the National Inpatient Sample. The impact of hospital size on surgical approach and outcomes for both open and VATS lobectomy were analyzed.
Results
Over the 7-y period, 202,668 lobectomies were performed nationally, including 71,638 VATS and 131,030 open. Although the overall number of lobectomies decreased (30,058 in 2008 versus 27,340 in 2014, P < 0.01), the proportion of VATS lobectomies increased (24.0% versus 46.9%), and open lobectomies decreased (76.0% versus 53.0%, all P < 0.01). When stratified by hospital size, small hospitals had a significant increase in the proportion of open lobectomies (6.4%-12.2%; P = 0.01) and trend toward increased number of VATS lobectomies (2.7%-12.2%). Annual mortality rates for VATS (range: 1.0%-1.9%) and open (range: 1.9%-2.4%) lobectomy did not significantly differ over time (all P > 0.05) but did decrease among small hospitals (4.1%-1.3% and 5.1%-1.1% for VATS and open, respectively; both P < 0.05). After adjusting for confounders, hospital bed size was not a predictor of in-hospital mortality.
Conclusions
Utilization of VATS lobectomies has increased over time, more so among small hospitals. Mortality rates for open lobectomy remain consistently higher than VATS lobectomy (range 0.4%-1.4%) but did not significantly differ over time. This data can help benchmark hospital performance in the future.2022-01-01T00:00:00ZPrognostic impact of lung adenocarcinoma second predominant pattern from a large European databasehttps://hdl.handle.net/10171/690462024-02-12T06:09:46Z2020-01-01T00:00:00ZTitle: Prognostic impact of lung adenocarcinoma second predominant pattern from a large European database
Abstract: Background and Objectives: Adenocarcinoma patterns could be grouped based on
clinical behaviors: low‐ (lepidic), intermediate‐ (papillary or acinar), and high‐grade
(micropapillary and solid). We analyzed the impact of the second predominant
pattern (SPP) on disease‐free survival (DFS).
Methods: We retrospectively collected data of surgically resected stage I and II
adenocarcinoma. Selection criteria: anatomical resection with lymphadenectomy
and pathological N0. Pure adenocarcinomas and mucinous subtypes were excluded. Recurrence rate and factors affecting DFS were analyzed according to the SPP
focusing on intermediate‐grade predominant pattern adenocarcinomas.
Results: Among 270 patients, 55% were male. The mean age was 68.3 years. SPP
pattern appeared as follows: lepidic 43.0%, papillary 23.0%, solid 14.4%, acinar
11.9%, and micropapillary 7.8%. The recurrence rate was 21.5% and 5‐year DFS was
71.1%. No difference in DFS was found according to SPP (p = .522).
In patients with high‐grade SPP, the percentage of SPP, age, and tumor size significantly influenced DFS (p = .016). In patients with lepidic SPP, size, male gender,
and lymph‐node sampling (p = .005; p = .014; p = .038, respectively) significantly influenced DFS.
Conclusions: The impact of SPP on DFS is not homogeneous in a subset of patients
with the intermediate‐grade predominant patterns. The influence of high‐grade SPP
on DFS is related to its proportion in the tumor.2020-01-01T00:00:00ZThe need for structured thoracic robotic training: the perspective of an American Association for Thoracic Surgery surgical robotic fellowhttps://hdl.handle.net/10171/662282023-05-22T05:12:29Z2020-01-01T00:00:00ZTitle: The need for structured thoracic robotic training: the perspective of an American Association for Thoracic Surgery surgical robotic fellow
Abstract: Since the initial experiences with robotic platforms in
thoracic surgery (1), the number of procedures performed
with this technique have continued to increase (2). Not
only have newer trainees demonstrated interest in the field,
but former open and VATS surgeons have also become
aware of the advantages that the robotic platform provides
(1,3). However, although some authors have implemented
robotic thoracic surgery safely (4,5) others still consider it
inefficient, citing the increased operative time (related to
the learning curve), the initial instrument cost, and the lack
of appropriate directed training (3).2020-01-01T00:00:00Z