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      Effects of degree of pulmonary fissure completeness on major in-hospital outcomes after video-assisted thoracoscopic lung cancer lobectomy: a retrospective-cohort study

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          Abstract

          Background

          To evaluate the clinical significance of degree of pulmonary fissure completeness (PFC) on major in-hospital outcomes following video-assisted thoracoscopic (VATS) lobectomy for non-small-cell lung cancer (NSCLC).

          Materials and methods

          We carried out a single-center retrospective analysis on the prospectively maintained database at our unit between August 2014 and October 2015. Patients were divided into two groups based on their fissure sum average (FSA). Patients with FSA >1 (1< FSA ≤3) were considered to have incomplete pulmonary fissures (group A), while patients with FSA of 0–1 were considered to have complete pulmonary fissures (group B). Demographic differences in perioperative characteristics and surgical outcomes between these two groups were initially assessed. Then, a multivariate logistic-regression analysis was further conducted to identify the independent predictors for major in-hospital outcomes.

          Results

          A total of 563 patients undergoing VATS lobectomy for NSCLC were enrolled. There were 190 patients in group A and 373 patients in group B. The overall morbidity and mortality rates of our cohort were 30.6% and 0.5%, respectively. Group A patients had a significantly higher overall morbidity rate than group B patients (42.1% vs 24.7%, P<0.001). Both minor morbidity (40.5% vs 22%, P<0.001) and major morbidity (11.1% vs 5.6%, P=0.021) rates in group A patients were also significantly higher than group B patients. No significant difference was observed in mortality rate between these two groups (1.1% vs 0.3%, P=0.26). The incomplete degree of PFC was significantly correlated with length of stay and chest-tube duration (log-rank P<0.001) after surgery. Finally, the incomplete degree of PFC was found to be predictive of overall morbidity (OR 2.08, P<0.001), minor morbidity (OR 2.39, P<0.001), and major morbidity (OR 2.06, P=0.031) by multivariate logistic-regression analyses.

          Conclusion

          Degree of PFC is an excellent categorical predictor for both major and minor morbidity after VATS lobectomy for NSCLC.

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          Most cited references 30

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          A new concept of endoscopic lung cancer resection: Single-direction thoracoscopic lobectomy.

          Although video-assisted thoracoscopic surgery was introduced in the early 1990s, its use in the treatment of lung cancer has been limited. We examined the effectiveness of a simplified surgical method for thoracoscopic lobectomy in patients with lung cancer from May 2006 to October 2007. This novel single-direction thoracoscopic lobectomy was characterized by incisions convenient for the placement of instruments and the lobectomy proceeded progressively in a single direction from superficial to deep structures. The procedure was completed successfully in 26 of 28 patients, with no perioperative deaths. The average operation time was 135min (range, 100-200min), average blood loss was 125mL (range 10-500mL) and average number of lymph nodes dissected was 11.8 (range, 6-23). The average postoperative hospital stay was 7.4 days (range, 5-10 days). Single-direction thoracoscopic lobectomy is a simple, safe, and effective procedure for lobe resection with clear procedural steps. It overcomes the difficulty in manipulation of incomplete lung fissures and potentially extends the indications of thoracoscopic lobectomy.
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            Video-assisted thoracoscopic surgery lobectomy for lung cancer is associated with a lower 30-day morbidity compared with lobectomy by thoracotomy.

            Lung cancer is the most common cause of cancer-related deaths worldwide. Survival is highly dependent on surgery. Video-assisted thoracoscopic surgery (VATS) is increasingly chosen over open thoracotomy (OT) because of the possible benefits of the minimally invasive approach. Consequently, our aim was to compare the 30-day morbidity and mortality for lung cancer patients operated by VATS lobectomy or lobectomy by OT.
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              • Record: found
              • Abstract: found
              • Article: not found

              The effect of different comorbidities on survival of non-small cells lung cancer patients.

              Primary lung cancer is one of the most common types of cancers. Comorbidity has been shown to be a negative prognostic factor in the overall lung cancer population. The significance of the individual comorbidities is less well known. The purpose of this paper is to investigate the effect of each comorbid disease groups on survival.
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                Author and article information

                Journal
                Ther Clin Risk Manag
                Ther Clin Risk Manag
                Therapeutics and Clinical Risk Management
                Therapeutics and Clinical Risk Management
                Dove Medical Press
                1176-6336
                1178-203X
                2018
                02 March 2018
                : 14
                : 461-474
                Affiliations
                [1 ]Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu
                [2 ]Department of Thoracic Surgery, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing University, Chongqing China
                Author notes
                Correspondence: Guowei Che, Department of Thoracic Surgery, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, Sichuan 610041, China, Tel +86 189 8060 1890, Fax +86 28 8542 2494, Email guowei_che@ 123456foxmail.com
                [*]

                These authors contributed equally to this work

                Article
                tcrm-14-461
                10.2147/TCRM.S159632
                5841327
                © 2018 Li et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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                Original Research

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