Performance of a multidisciplinary robotic surgery program at a university hospital (2012-2022).

Robotic-assisted surgery has become widely adopted for its ability to expand the indications for minimally invasive procedures. This technology aims to improve precision, accuracy, and outcomes while reducing complications, blood loss, and recovery time. Successful implementation of a robotic surgery program requires careful initial design and a focus on maintenance and expansion to maximize its benefits. This article presents a comprehensive study conducted at a University Hospital on the robotic surgery program from December 2012 to December 2022. Data from hospital databases, including patient demographics, surgical department, surgical time, operating room occupancy, and primary diagnosis, were analyzed. The analysis covered various time periods (surgical sessions, weeks, months, and years) to assess the program's evolution over time. Over the 10-year period, a total of 1847 robotic-assisted interventions were performed across five surgical services. Urology accounted for 57% of the cases, general surgery 17%, gynecology 16%, otorhinolaryngology 6%, and thoracic surgery 4%. The most frequently performed procedures included robotic prostatectomies (643 cases), hysterectomies (261 cases), and colposacropexies (210 cases). The weekly volume of interventions showed a notable increase, rising from 2 cases per week in 2013-2014 cases in 2022. Moreover, the average surgical duration per intervention exhibited a progressive decrease from 275 min in 2013 to 184 min in 2022. This study highlights the potential of a well-managed robotic surgery program as a viable alternative to conventional surgical approaches. Effective coordination and resource utilization contribute to the program's efficiency. The findings underscore the successful integration of robotic-assisted surgery in diverse surgical specialties.

Implementation of an ERAS program in patients undergoing thoracic surgery at a third-level university hospital: an ambispective cohort study

Abstract Objective To analyze the effects of an ERAS program on complication rates, readmission, and length of stay in patients undergoing pulmonary resection in a tertiary university hospital. Methods Ambispective cohort study with a prospective arm of 50 patients undergoing thoracic surgery within an ERAS program (ERAS group) versus a retrospective arm of 50 patients undergoing surgery before the protocol was implemented (Standard group). The primary outcome was the number of patients with 30-day surgical complications. Secondary outcomes included ERAS adherence, non-surgical complications, mortality, readmission, reintervention rate, pain, and hospital length of stay. We performed a multivariate logistic analysis to study the correlation between outcomes and ERAS adherence. Results In the univariate analysis, we found no difference between the two groups in terms of surgical complications (Standard 18 [36%] vs. ERAS 12 [24%], p = 0.19). In the ERAS group, only the readmission rate was significantly lower (Standard 15 [30%] vs. ERAS 6 [12%], p = 0.03). In the multivariate analysis, ERAS adherence was the only factor associated with a reduction in surgical complications (OR [95% CI] = 0.02 [0.00, 0.59], p = 0.03) and length of stay (HR [95% CI] = 18.5 [4.39, 78.4], p < 0.001). Conclusions The ERAS program significantly reduced the readmission rate at our hospital. Adherence to the ERAS protocol reduced surgical complications and length of stay.

Implementation of an ERAS program in patients undergoing thoracic surgery at a third-level university hospital: an ambispective cohort study.

OBJECTIVE: To analyze the effects of an ERAS program on complication rates, readmission, and length of stay in patients undergoing pulmonary resection in a tertiary university hospital. METHODS: Ambispective cohort study with a prospective arm of 50 patients undergoing thoracic surgery within an ERAS program (ERAS group) versus a retrospective arm of 50 patients undergoing surgery before the protocol was implemented (Standard group). The primary outcome was the number of patients with 30-day surgical complications. Secondary outcomes included ERAS adherence, non-surgical complications, mortality, readmission, reintervention rate, pain, and hospital length of stay. We performed a multivariate logistic analysis to study the correlation between outcomes and ERAS adherence. RESULTS: In the univariate analysis, we found no difference between the two groups in terms of surgical complications (Standard 18 [36%] vs. ERAS 12 [24%], p=0.19). In the ERAS group, only the readmission rate was significantly lower (Standard 15 [30%] vs. ERAS 6 [12%], p=0.03). In the multivariate analysis, ERAS adherence was the only factor associated with a reduction in surgical complications (OR [95% CI]=0.02 [0.00, 0.59], p=0.03) and length of stay (HR [95% CI]=18.5 [4.39, 78.4], p<0.001). CONCLUSIONS: The ERAS program significantly reduced the readmission rate at our hospital. Adherence to the ERAS protocol reduced surgical complications and length of stay.

[Treatment of lung cancer with chest wall invasion]. / Tratamiento del cáncer de pulmón con invasión de la pared torácica.

The aim of this study was to analyze chest wall invasion, the indication and multidisciplinary nature of treatment, the methods used for parietal reconstruction and the technical problems posed by this procedure in patients with lung cancer and chest wall invasion. Chest wall invasion from adjacent malignancies affects 5% of patients with a bronchogenic carcinoma. Preoperative determination of parietal invasion aids the planning of an appropriate therapeutic approach. Positron emission tomography combined with computed tomography (PET/CT) improves the study of T-factor and metastatic nodal involvement and distant metastases. As a rule, surgical treatment should attempt complete tumoral resection: lobectomy, resection of the parietal pleura and/or of the chest wall--ensuring tumor-free margins--and hilar and mediastinal lymphadenectomy. We also analyzed the distinct prognostic factors for survival, as well as the indication for induction or adjuvant therapy. Chest wall reconstruction involves recreating the most anatomical and physiological conditions possible in the chest cavity and surrounding muscles. The ideal reconstruction would achieve adequate parietal stability and coverage to preserve functionality, with the cosmetic result being an important, but secondary, consideration. Many materials are available for reconstruction and the choice of material should be individualized in each patient. A multidisciplinary team able to plan and perform the resection and subsequent reconstruction, oversee postoperative management and treat complications early is essential.

Tratamiento del cáncer de pulmón con invasión de la pared torácica / Treatment of lung cancer with chest wall invasion

El objetivo de este trabajo es analizar en pacientes afectados de cáncer de pulmón con invasión de la paredtorácica, la indicación y el carácter multidisciplinar del tratamiento, y los métodos y problemas técnicos queplantea la reconstrucción parietal.La invasión de la pared torácica por contigüidad afecta al 5 % de los pacientes con un carcinoma broncogénico.Determinar de forma preoperatoria su existencia facilita el correcto planteamiento terapéutico. La tomografíapor emisión de positrones en combinación con las imágenes anatómicas (PET/TC) permite un mejor estudiodel factor T y de la extensión metastásica ganglionar y a distancia. Como norma, el tratamiento quirúrgicodebe intentar una exéresis tumoral completa: lobectomía, resección de pleura parietal y/o de la pared torácica,asegurando márgenes libres de tumor, y linfadenectomía hiliar y mediastínica. En relación con la supervivencia,se analizan distintos factores pronósticos. La indicación de un tratamiento oncológico de inducción oadyuvante también se considera.Reconstruir la pared torácica supone devolver la caja torácica y los músculos que la rodean a la situación másanatómica y fisiológica posible. La reconstrucción ideal ha de conseguir una adecuada estabilidad y coberturaparietales para preservar su funcionalidad, y es importante aunque secundario el resultado cosmético. Existenmuchos materiales disponibles para realizar la reparación, debiendo adecuarse su uso a cada caso enparticular. Resulta fundamental un equipo multidisciplinar capaz de planificar y llevar a cabo la resección yposterior reconstrucción, controlar el postoperatorio y tratar de forma precoz las complicaciones(AU)

The aim of this study was to analyze chest wall invasion, the indication and multidisciplinary nature oftreatment, the methods used for parietal reconstruction and the technical problems posed by this procedurein patients with lung cancer and chest wall invasion.Chest wall invasion from adjacent malignancies affects 5 % of patients with a bronchogenic carcinoma.Preoperative determination of parietal invasion aids the planning of an appropriate therapeutic approach.Positron emission tomography combined with computed tomography (PET/CT) improves the study of T-factorand metastatic nodal involvement and distant metastases. As a rule, surgical treatment should attemptcomplete tumoral resection: lobectomy, resection of the parietal pleura and/or of the chest wall —ensuringtumor-free margins— and hilar and mediastinal lymphadenectomy. We also analyzed the distinct prognosticfactors for survival, as well as the indication for induction or adjuvant therapy.Chest wall reconstruction involves recreating the most anatomical and physiological conditions possible inthe chest cavity and surrounding muscles. The ideal reconstruction would achieve adequate parietal stabilityand coverage to preserve functionality, with the cosmetic result being an important, but secondary,consideration. Many materials are available for reconstruction and the choice of material should beindividualized in each patient. A multidisciplinary team able to plan and perform the resection and subsequentreconstruction, oversee postoperative management and treat complications early is essential(AU)

Long-term survival associated with complete resection after induction chemotherapy in stage IIIA (N2) and IIIB (T4N0-1) non small-cell lung cancer patients: the Spanish Lung Cancer Group Trial 9901.

PURPOSE: To assess the activity of induction chemotherapy followed by surgery in stage IIIA and selected stage IIIB non-small-cell lung cancer patients. PATIENTS AND METHODS: Mediastinoscopy proof of either positive N2 (IIIA) or T4N0-1 (IIIB) disease was required. Induction therapy was three cycles of cisplatin/gemcitabine/docetaxel, followed by surgery. RESULTS: From December 1999 to March 2003, 136 patients were entered onto the study; the clinical response rate in 129 assessable patients was 56%. The overall complete resection rate was 68.9% of patients eligible for surgery (72% of stage IIIA patients and 66% of stage IIIB patients) and 48% of all assessable patients. Eight (12.9%) of 62 completely resected patients had a pathologic complete response. Seven patients (7.8%) died during the postoperative period. The median overall survival time was 15.9 months, 3-year survival rate was 36.8%, and 5-year survival rate was 21.1%, with no significant differences in survival between stage IIIA and stage IIIB patients. Median survival time was 48.5 months for 62 completely resected patients, 12.9 months for 13 incompletely resected patients, and 16.8 months for 15 nonresected patients (P = .005). Three- and 5-year survival rates were 60.1% and 41.4% for completely resected patients, 23.1% and 11.5% for incompletely resected patients, and 31.1% and 0% for nonresected patients, respectively. In the multivariate analysis, complete resection (hazard ratio [HR] = 0.35; P < .0001), clinical response (HR = 0.32; P < .0001), and age younger than 60 years (HR = 0.64; P = .027) were the most powerful prognostic factors. CONCLUSION: Induction chemotherapy followed by surgery is effective in stage IIIA and in selected stage IIIB patients attaining complete resection.

Typical and atypical carcinoid tumours: analysis of the experience of the Spanish Multi-centric Study of Neuroendocrine Tumours of the Lung.

BACKGROUND: This study examines the experience of the Spanish Multi-centric Study of Neuroendocrine Tumours of the Lung with patients treated surgically for typical and atypical carcinoid tumours. METHODS: From 1980 to 2002, 661 patients were treated surgically for 569 typical carcinoid tumours and 92 atypical carcinoid tumours. Three hundred and four cases were studied retrospectively from 1980 to 1997 (261 typical carcinoid and 43 atypical carcinoid tumours); the other 357 new cases (308 typical carcinoid and 49 atypical carcinoid tumours) were collected prospectively from 1998 to 2002. Tumours were classified according the 1999 classification from the WHO and the International Association for the Study of Lung Cancer (IASLC). Several variables were reviewed in all patients. Univariate and multivariate statistical analyses were performed in order to determine whether clinical characteristics were associated with significant differences in survival. RESULTS: In the total of the patients, 5-year survival for different tumours was as follows: typical carcinoid: overall survival 97%; with nodal involvement 100%; atypical carcinoid: overall 78%; with nodal involvement 60%. A significant difference in survival was found between patients in the retrospective and prospective groups with atypical carcinoid and nodal involvement. The comparative analysis of several factors in typical and atypical carcinoid tumours showed a significant difference for mean age, tumour size, nodal involvement and distant metastases. CONCLUSION: Nodal involvement and histological sub-type appear as the most important factors influencing the prognosis. Adequate lung resection and systematic radical mediastinal lymphadenectomy should always be performed. Sleeve resection could be performed in central typical and atypical carcinoid tumours, avoiding pneumonectomy.