Survival After Thoracoscopic Surgery or Open Lobectomy: Systematic Review and Meta-Analysis.

BACKGROUND: Video-assisted thoracoscopic surgery (VATS) has been shown to reduce hospital stays and pain compared with open lobectomy to treat non-small cell lung cancer. Because of the low rate of deaths, it is difficult to show differences in survival in individual studies. The objective of this study was to compare short- and long-term mortality by means of a systematic review and meta-analysis. METHODS: The reviewers systematically searched studies that compared VATS vs open lobectomy and provided data on 30-day mortality or long-term survival (>5 years). For long-term outcomes, studies included patients with the same cancer stage or, if several stages were included, the studies had to control for cancer stage in their propensity score model. A pooled odds ratio and hazard ratio (HR) was respectively calculated for short- and long-term outcomes. RESULTS: A total of 33 works were identified, comprising 61,633 patients. VATS led to lower postoperative mortality (odds ratio, 0.64; 95% confidence interval [CI], 0.56 to 0.73) and higher long-term survival (HR, .88; 95% CI, 0.81 to 0.96). Disease-free survival was similar in both groups (HR, 0.94; 95% CI, 0.80 to 1.10). CONCLUSIONS: For non-small cell lung cancer treated with lobectomy, VATS was associated with lower postoperative mortality and greater long-term survival compared with open lobectomy. Disease-free survival was similar between both groups.

Dynamic 3D printed titanium copy prosthesis: a novel design for large chest wall resection and reconstruction.

Due to high rates of complications, chest wall resection and reconstruction is a high risk procedure when large size of resection is required. Many different prosthetic materials have been used with similar results. Recently, thanks to the new advances in technology, personalized reconstruction have been possible with specific custom-made prosthesis. Nevertheless, they all generate certain amount of stiffness in thoracic motion because of his rigidity. In this report, we present a forward step in prosthesis design based on tridimensional titanium-printed technology. An exact copy of the resected chest wall was made, even endowing simulated sternochondral articulations, to achieve the most exact adaptation and best functional results, with a view to minimize postoperative complications. This novel design, may constitute an important step towards the improvement of the functional postoperative outcomes compared to the other prosthesis, on the hope, to reduce postoperative complications.

Clinical outcomes of CO2-less single-port video-assisted thoracoscopic thymectomy versus open thymectomy: comparative study.

BACKGROUND: Although video-assisted thoracoscopic surgery (VATS) for thymic disorders has been introduced, its oncological outcome and benefits over others open approaches remains unclear. Single-port VATS thymectomy using a flexible port and CO2 has been described. However, VATS thymectomy is possible by a single incision of 3 cm without CO2 insufflation or special port device avoiding objections related to CO2 insufflation and allowing instruments to move more freely making procedure easier and cheaper. Our institutional experience in open and CO2-less VATS single-port thymectomy was retrospectively reviewed to evaluate compared to sternotomy, the clinical and oncological outcomes with this novel approach. METHODS: A retrospective review consisting of 84 patients who underwent thymectomy because different thymic disorders especially thymoma was performed. Eighteen patients underwent CO2-less VATS single port thymectomy, while 66 underwent thymectomy through open sternotomy. Many clinical factors associated with the surgical and clinical outcomes, including tumor recurrence and clinical remission, were recorded. RESULTS: Non major postoperative complications were observed in any group. The median operative time and postoperative hospital stay of CO2-less VATS single port thymectomy were 95 min and 1 day, respectively and 120 min and 7 days for open sternotomy. The thymoma was the most common thymic disorder with 7 patients (38%) in VATS group and 28 patients (42.4%) for the open approach. The median lesion size was 2.6 cm in the VATS group and 3.2 cm in the open approach. No thymoma recurrence in patients undergoing VATS was observed during the follow-up time, while in the open surgery group 14.28% recurrence was observed, distributed as follows: loco-regional 75% and 25% at distance; free disease period of these patients was 8.3 months. Thymectomy associated with myasthenia gravis (MG) was observed in 6 (33%) patients in the VATS group and 32 (48%) patients for sternotomy; our results regarding thymectomy for the treatment of MG were established by the MG post-intervention status [complete stable remission (CSR), pharmacologic remission, minimal manifestations, improved, unchanged and worse exacerbation, and died of MG] and reflected similar results in both approaches. CONCLUSIONS: CO2-less VATS single-port thymectomy is a feasible and safe procedure. Oncologic outcomes are similar to open approaches. Complications, surgical time and hospital stay are shorter compared with sternotomy. This is an initial experience, further work is required to evaluate long-term results.

Four years' experience in uniportal video-assisted thoracoscopic surgery for major lung resections: influence of silicosis in clinical outcomes.

BACKGROUND: Crystalline silica (CS) is one of the most common minerals and a common particulate air pollutant in both working and living environments. Lung cancer is considered one of the serious consequences of silica exposure. This paper gives an overview of the role of silicosis in results of perioperative and postoperative of lung resection surgery performed by the most up to date video-assisted thoracoscopic surgery (VATS) approach: the uniportal VATS. METHODS: In January 2012 a program of video-assisted thoracoscopic anatomic pulmonary resections through a uniportal approach (no rib spreading) was started in our institution by a single surgeon experienced in postero-lateral open major resections and in other VATS procedures except lobectomies. We have retrospectively reviewed our first 4 years of experience in which 128 consecutive patients had undergone this approach, setting as a variable comparison of the results the presence of silicosis. RESULTS: Between January 2012 to December 2015, 128 anatomical resections where attempted. Of these attempted major resections, 115 (90%) were successfully completed. Out of 128 patients 21 (16%) had a diagnosis of complex silicosis. The most frequent resection was left upper lobectomy. The mean surgical time was 178±65 min. The median postoperative chest drain time was 3 days and the median postoperative hospital stay time was 3 days. There were 25 (19%) minor complications 17 (68%) of them in the first year of experience, and 3 (2.3%) had major complications. Preoperative forced expiratory volume in one second (FEV1) less than 60%, diagnosis of chronic obstructive pulmonary disease (COPD) and silicosis have been predictive of postoperative minor complications. CONCLUSIONS: The uniportal VATS for major anatomic lung resections is reproducible and safe with good results when performed by surgeons experienced in both open major resections (anterior or postero-lateral thoracotomy), and multiport VATS minor procedures, even in highly complex cases such as patients with silicosis. Presence of silicosis should be taken into account as a predictive factor for postoperative complications. Therefore, overestimation of the benefits of the procedure in the patient selection process especially in the initial part of the experience must be avoided.

From open surgery to uniportal VATS: asturias experience.

OBJECTIVE: Uniportal video-assisted thoracic surgery (VATS) resections are of increasing interest in many thoracic surgery departments. This study shows our initial experience in uniportal VATS anatomical resections in direct transition from posterolateral thoracotomy. PATIENTS AND METHODS: We retrospectively reviewed the 82 files of patients on whom anatomical pulmonary resection via uniportal VATS was attempted in our department by a single surgeon experienced in VATS for almost all purposes except major pulmonary resections. Demographic data of patients, smoking habits, chronic obstructive pulmonary disease (COPD), presence of cardiopulmonary comorbidities, general characteristics of pulmonary lesions, preoperative FEV1, intraoperative findings, operative time, postoperative-drain-time, hospital-stay-time, successfully completed or converted to thoracotomy, intraoperative and postoperative complications and 30-day mortality were recorded. The patients were chronologically divided into two groups for analysis (A: operated on in the first year; B: operated on after the first year). We compare our results with the largest published experience in anatomical resections by uniportal VATS started from multiport technique and anterior thoracotomy in order to identify the feasibility of this transition. RESULTS: From January 2012 to January 2014, 82 uniportal VATS anatomical pulmonary resections were attempted. Of these 82 resections attempted, 74 (90.2%) were completely carried out. The median drain-time and hospital-stay-time were 3 days, and 4 days for the first year of experience and 2 and 3 days for the second year of experience respectively. The most frequent intraoperative complication was bleeding in 10 (12.1%), of these 8 occurred in the first year of experience (group A). In 8 (9.75%) cases conversion to thoracotomy widening the incision was needed for different reasons, of these 6 occurred in group A. The most frequent minor complication was chest tube reinsertion in 12 (14.6%) patients. There were no major complications or mortality in the first year of experience (group A). Two cases of mortality in the 8(th) and 15(th) postoperative day respectively occurred in group B in two patients with serious comorbidities. CONCLUSIONS: Uniportal VATS for anatomical resections is a feasible and safe technique with good results even if experience is started in direct transition from open surgery, on condition that general recommendations for an initial VATS program were observed. Specific training courses with experts are also necessary. Patient selection is crucial. The number of procedures necessary to obtain appropriate experience may be similar to those reported for transition from open surgery to multiport technique.