Erratum to nodal management and upstaging of disease. Initial results from the Italian VATS Lobectomy Registry

[This corrects the article DOI: 10.21037/jtd.2017.06.12.]

Kαρδιοαναπνευστική δοκιμασία άσκησης στην προεγχειρητική εκτίμηση ασθενών με μη μικροκυτταρικό καρκίνο πνεύμονα

Εισαγωγή. Τρέχουσες κατευθυντήριες οδηγίες συστήνουν καρδιοαναπνευστική δoκιμασία άσκησης (CPET) μόνο σε ασθενείς με υπολογιζόμενη μετεγχειρητική FEV1 ή/και DLCO<40%pred. Κατά πόσο η συστηματική εξέταση με CPET, μπορεί να βελτιώσει την εκτίμηση του περιεγχειρητικού κινδύνου δεν έχει μελετηθεί επαρκώς. Σκοπός. Στόχος της μελέτης ήταν η συσχέτιση προ-εγχειρητικών εργομετρικών παραμέτρων με την μετεγχειρητική έκβαση ασθενών με μη μικροκυτταρικό καρκίνο πνεύμονα (ΜΜΚΠ). Μέθοδος. Στην μελέτη εντάχθηκαν 50 ασθενείς με ΜΜΚΠ, σταδίου Ι-ΙΙα. Στα πλαίσια της προ-εγχειρητικής εκτίμησης καταγράφονταν οι σπιρομετρικές παράμετροι, η διαχυτική ικανότητα (DLCO) και υπολογιζόταν η μετεγχειρητική FEV1 (ppoFEV1%pred). Επιπλέον όλοι οι ασθενείς υποβάλλονταν σε «μέγιστη» δοκιμασία άσκησης (CPET), με κυλιόμενο διάδρομο, σύμφωνα με το πρωτόκολλο Bruce. Οι ασθενείς κρίνονταν κατάλληλοι για λοβεκτομή-πνευμονεκτομή ή σφηνοειδή εκτομή σύμφωνα με τις διεθνείς κατευθυντήριες οδηγίες. Κατά τις πρώτες 30 μετεγχειρητικές ημέρες καταγράφονταν όλες οι καρδιο- αναπνευστικές επιπλοκές και η θνησιμότητα Αποτελέσματα. Μέγιστη κατανάλωση οξυγόνου (VO2max)<10ml/kg/min και VO2%pred<40 σχετίζονταν με σημαντικά υψηλότερες συχνότητα επιπλοκών (80% vs 2,5% και 77,7% vs 4,8%, p<0,001) και θνησιμότητα (20% vs 0%, p<0,001). Η συχνότητα επιπλοκών ήταν: 15,7% (όλοι με VO2max<10ml/kg/min) στους ασθενείς με προ-εγχειρητικές FEV1 και DLCO>80%, 19,35% (5/6 με VO2max<10ml/kg/min) στους ασθενείς με προ- εγχειρητικές FEV1 και DLCO<80% και ppoFEV1>40% και 33,3% (όλοι με VO2max<10ml/kg/min) στους ασθενείς με προ-εγχειρητικές FEV1 και DLCO<80% και ppoFEV1<40%. Συμπέρασμα. Τα αποτελέσματα της μελέτης υποστηρίζουν την πιο ελεύθερη χρήση της CPET στην προ-εγχειρητική εκτίμηση ασθενών με ΜΜΚΠ, σε σχέση με τις τρέχουσες κατευθυντήριες οδηγίες.Introduction. Current guidelines recommend cardiopulmonary exercise testing (CPET) only in very select patients (postoperative FEV1 or DLCO <40%predicted). Whether systematic CPET can add to preoperative risk stratification has never been fully assessed. Aim. Objective of this investigation was to assess the association of pre-operative ergometric parameters with postoperative outcome in a prospective cohort of patients with operable (stage I-IIa) non small cell lung cancer (NSCLC). Methods. 50 patients with NSCLC were finally enrolled. During preoperative stratification of surgical risk, actual spirometric parameters diffusing capacity (DLCO) and post-operative FEV1%pred were assessed. A maximal (according to standard criteria) CPET by Bruce-protocol, was also performed in all patients, using an ergometric treadmill. Patients were stratified as appropriate for major or minor lung resection in accordance to current guidelines. The rate of cardio-pulmonary complications and mortality during the immediate 30 postoperative days, were associated with preoperative spirometric and ergometric parameters, in different groups of patients subdivided according to their cardiorespiratory status. Results. Maxiimal oxygen consumption (VO2max) <10ml/kg/min and VO2%pred <40 were associated with significantly higher complications rate (80% vs 2,5% and 77,7% vs 4,8%, p<0,001) and mortality (20% vs 0%, p<0,001). VO2max <10ml/kg/min, was associated with both respiratory (50% vs 0% p<0,001) and cardiac (30% vs 2,5% p<0,001) complications. The complication rate was: 15,7% (all pts with VO2max<10 ml/kg/min) in patients with preoperative FEV1 and DLCO>80%, 19,35% (5/6 pts with VO2max<10ml/kg/min) in patients with preoperative FEV1 and DLCO<80% and ppoFEV1>40% and 33,3% (all pts with VO2max<10ml/kg/min) in patients with preoperative FEV1 and DLCO<80% and ppoFEV1<40%. Conclusions. The results of the current study support a more liberal use of CPET before lung resection compared with current guidelines, since this test improves the stratification of the surgical risk guiding the perioperative care

Erratum: Nodal management and upstaging of disease: Initial results from the Italian VATS Lobectomy Registry [J Thorac Dis, 9, (2017), (2061-2070)] DOI: 10.21037/jtd.2017.06.12

In the article that appeared on page 2061-2070, Vol 9, No 7 (July 2017) Issue of the Journal of Thoracic Disease (1), there are some mistakes in the presented authors information. In the list of collaborators of the Italian VATS Group are not included the following author names: Alessandro Bertani, Alessandro Gonfiotti, Mario Nosotti, Paolo Albino Ferrari, Lavinia De Monte, Emanuele Russo, Gioacchino Di Paola, Piergiorgio Solli, Andrea Droghetti, Luca Bertolaccini, Roberto Crisci. The correct list of collaborators of the Italian VATS Group should have been shown as below. Alessandro Bertani, MD (IRCCS ISMETT, Palermo); Alessandro Gonfiotti, MD (Careggi Hospital, Firenze); Mario Nosotti, MD (Policlinico Ca'Granda, Milano); Paolo Albino Ferrari, MD (IRCCS ISMETT, Palermo); Lavinia De Monte, MD (IRCCS ISMETT, Palermo); Emanuele Russo, MD (IRCCS ISMETT, Palermo); Gioacchino Di Paola, MD (IRCCS ISMETT, Palermo); Piergiorgio Solli, MD PhD (AUSL Romagna Teaching Hospital, Forlì); Andrea Droghetti, MD (ASST Mantova-Cremona, Mantova); Luca Bertolaccini, MD PhD (AUSL Romagna Teaching Hospital, Forlì); Roberto Crisci, MD PhD (Università dell'Aquila, L'Aquila); Carlo Curcio, MD (Monaldi Hospital, Napoli); Dario Amore, MD (Monaldi Hospital, Napoli); Giuseppe Marulli, MD (University of Padova); Samuele Nicotra, MD (University of Padova); Andrea De Negri, MD (San Martino Hospital, Genova); Paola Maineri, MD (San Martino Hospital, Genova); Gaetano di Rienzo (Vito Fazzi Hospital, Lecce); Camillo Lopez, MD (Vito Fazzi Hospital, Lecce); Angelo Morelli, MD (S. Maria delle Misericordia Hospital, Udine); Francesco Londero, MD (S. Maria delle Misericordia Hospital, Udine); Lorenzo Spaggiari, MD (IEO Hospital, Milano); Roberto Gasparri, MD (IEO Hospital, Milano); Guido Baietto, MD (Maggiore della Carità Hospital, Novara); Caterina Casadio, MD (Maggiore della Carità Hospital, Novara); Maurizio Infante, MD (Borgo Trento Hospital, Verona); Cristiano Benato, MD (Borgo Trento Hospital, Verona); Marco Alloisio, MD (IRCCS Humanitas, Milano); Edoardo Bottoni, MD (IRCCS Humanitas, Milano); Giuseppe Cardillo, MD (Forlanini Hospital, Roma); Francesco Carleo, MD (Forlanini Hospital, Roma); Franco Stella, MD (S. Orsola Hospital, Bologna); Giampiero Dolci, MD (S. Orsola Hospital, Bologna); Francesco Puma, MD (University of Perugia); Damiano Vinci, MD (University of Perugia); Giorgio Cavallesco, MD (University of Ferrara); Pio Maniscalco, MD (University of Ferrara); Luca Ampollini, MD (University of Parma); Paolo Carbognani, MD (University of Parma); Alberto Terzi, MD (Negrar Hospital, Verona); Andrea Viti, MD (Negrar Hospital, Verona); Giampiero Negri, MD (S. Raffaele Hospital, Milano); Alessandro Bandiera, MD (S. Raffaele Hospital, Milano); Reinhold Perkmann, MD (Bolzano Hospital, Bolzano); Francesco Zaraca, MD (Bolzano Hospital, Bolzano); Claudio Andretti, MD (S. Andrea Hospital, Roma); Camilla Poggi, MD (S. Andrea Hospital, Roma); Felice Mucilli, MD (S. Maria Annunziata Hospital, Chieti); Pierpaolo Camplese, MD (S. Maria Annunziata Hospital, Chieti); Luca Luzzi, MD (University of Siena); Marco Ghisalberti, MD (University of Siena); Andrea Imperatori, MD (University of Varese); Nicola Rotolo, MD (University of Varese); Luigi Bortolotti, MD (Humanitas Gavazzeni Hospital, Bergamo); Giovanna Rizzardi, MD (Humanitas Gavazzeni Hospital, Bergamo); Massimo Torre, MD (Niguarda Hospital, Milano); Alessandro Rinaldo, MD (Niguarda Hospital, Milano); Armando Sabbatini, MD (Ospedali Riuniti, Ancona); Majed Refai, MD (Ospedali Riuniti, Ancona); Mauro Roberto Benvenuti, MD (Spedali Civili, Brescia); Diego Benetti, MD (Spedali Civili, Brescia); Alessandro Stefani, MD (Ospedale Policlinico, Modena); Pamela Natali, MD (Ospedale Policlinico, Modena); Paolo Lausi, MD (Ospedale Molinette, Torino); Francesco Guerrera, MD (Ospedale Molinette, Torino)