A comparison of efficacy and safety of preoperative versus intraoperative computed tomography-guided thoracoscopic lung resection.
J Thorac Cardiovasc Surg
; 156(5): 1974-1983.e1, 2018 11.
Article
em En
| MEDLINE
| ID: mdl-30119900
ABSTRACT
BACKGROUND:
The efficacy and safety of intraoperative computed tomography (IOCT)-guided lung tumor localization and resection performed in a hybrid operating room (OR) compared with the conventional 2-stage preoperative CT (POCT)-guided approach for the treatment of small and deep solitary pulmonary nodules (SPNs) remains unknown.METHODS:
We compared IOCT-guided (IOCT group) and POCT-guided (POCT group) thoracoscopic resections in 64 consecutive patients with SPNs. The main outcome measures included efficacy, safety, and radiation exposure.RESULTS:
The IOCT (n = 34) and POCT (n = 30) groups had a similar SPN depth-to-size ratio. All SPNs were successfully localized and removed using a minimally invasive approach. There were no significant intergroup differences in localization procedural time (mean, 17.68 [IOCT] vs 19.63 minutes [POCT]; P = .257) and radiation exposure (median, 3.65 [IOCT] vs 6.88 mSv [POCT]; P = .506). The use of a hybrid operating room (OR) for tumor localization significantly reduced the patient time at risk (ie, the interval from completion of localization to skin incision; mean, 215.83 [POCT] vs 13.06 minutes [IOCT]; P < .001). However, the IOCT-guided approach significantly increased the time under general anesthesia (mean, 120.61 [POCT] vs 163.1 minutes [IOCT]; P < .001) and the total OR utilization time (mean, 168.68 [POCT] vs 227.41 minutes [IOCT]; P < .001).CONCLUSIONS:
Compared with the POCT-guided approach, the IOCT-guided approach decreased the time at risk, despite a significant increase in the global OR utilization time. Because no significant outcome differences were evident, the choice between the 2 approaches should be based on the most readily available approach at a surgeon's specific facility.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Pneumonectomia
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Cuidados Pré-Operatórios
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Tomografia Computadorizada por Raios X
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Nódulo Pulmonar Solitário
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Cirurgia Torácica Vídeoassistida
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Cuidados Intraoperatórios
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Neoplasias Pulmonares
Tipo de estudo:
Etiology_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
J Thorac Cardiovasc Surg
Ano de publicação:
2018
Tipo de documento:
Article
País de publicação:
EEUU
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ESTADOS UNIDOS
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ESTADOS UNIDOS DA AMERICA
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EUA
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UNITED STATES
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UNITED STATES OF AMERICA
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US
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USA