Impact of complex segmentectomies by video-assisted thoracic surgery on peri-operative outcomes.

Details

Serval ID
serval:BIB_575E96770285
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Impact of complex segmentectomies by video-assisted thoracic surgery on peri-operative outcomes.
Journal
Journal of thoracic disease
Author(s)
Bédat B., Abdelnour-Berchtold E., Krueger T., Perentes J.Y., Zellweger M., Triponez F., Karenovics W., Gonzalez M.
ISSN
2072-1439 (Print)
ISSN-L
2072-1439
Publication state
Published
Issued date
10/2019
Peer-reviewed
Oui
Volume
11
Number
10
Pages
4109-4118
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
Pulmonary segmentectomies are generally classified into simple (tri-segmentectomy or lingulectomy as well as apical or basilar segmentectomy) and complex (individual or bi-segmentectomy of the upper, middle and lower lobes). Complex segmentectomies are technically feasible by video-assisted thoracic surgery (VATS) but remain challenging, and reports on post-operative outcomes are scarce. This study analyzes the differences between simple and complex VATS segmentectomy in terms of peri- and post-operative outcomes.
We retrospectively reviewed records of all patients who underwent anatomical pulmonary segmentectomy by VATS from 2014 to 2018 in two university hospitals.
A total of 232 patients (114 men; median age 67 years; range, 29-87 years) underwent VATS segmentectomy for primary lung cancer (n=177), metastases (n=26) and benign lesions (n=29). The overall 30-day mortality and morbidity rates were 0.8% and 29.7%, respectively. The re-operation rate was 4.7%. Complex segmentectomy was realized in 111 patients including 86 (77.5%) upper lobe segmentectomies and 44 (39.6%) bi-segmentectomies. There was no statistical difference between complex and simple segmentectomy in terms of operative time (145 vs. 143 min, respectively; P=0.79) and chest tube duration [median: 1 (range, 0-33) vs. 2 (range, 1-19) days, respectively; P=0.95]. Post-operative overall complication rates were similar for both groups (30% vs. 30%, respectively; P=0.99) and were not correlated with the type of segmentectomy. However, complex segmentectomy patients had a shorter length of hospitalization compared to simple segmentectomy patients [median: 5 (range, 1-36) vs. 7 (range, 2-31) days; P=0.026]. Interestingly, complex segmentectomies were realized most frequently 2 years after implementation of VATS segmentectomy (23% vs. 77%; P=0.01).
In comparison with simple segmentectomy, complex segmentectomy by VATS seems to present similar post-operative complication rates. Learning curve and progressive increase in acceptance by surgeons seem to be key elements for successful implementation of complex segmentectomies and could explain the shorter length of stay we observed.
Keywords
Video-assisted thoracic surgery (VATS), lung cancer, post-operative complication, segmentectomy
Pubmed
Web of science
Create date
21/11/2019 0:06
Last modification date
05/01/2020 7:18
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