Pulmonary open, robotic and thoracoscopic lobectomy (PORTaL) study: An analysis of 5,721 cases

Objective: The aim of this study was to analyze outcomes of open lobectomy (OL), video-assisted thoracoscopic lobectomy (VATS) and robotic-assisted lobectomy (RL). Summary background data: Robotic-assisted lobectomy has seen increasing adoption for treatment of early-stage lung cancer. Comparative data regarding these approaches is largely from single-institution case series or administrative datasets. Methods: Retrospective data was collected from 21 institutions from 2013-2019. All consecutive cases performed for clinical stage IA-IIIA lung cancer were included. Neoadjuvant cases were excluded. Propensity-score matching (1:1) was based on age, gender, race, smoking-status, FEV1%, Zubrod score, ASA score, tumor size and clinical T and N stage. Results: A total of 2,391 RL, 2,174 VATS, and 1,156 OL cases were included. After propensity-score matching there were 885 pairs of RL vs. OL, 1,711 pairs of RL vs. VATS, and 952 pairs of VATS vs. OL. Operative time for RL was shorter than VATS (p \u3c 0.0001) and OL (p = 0.0004). Compared to OL, RL and VATS had less overall postoperative complications, shorter hospital stay (LOS), and lower transfusion rates (all p \u3c 0.02). Compared to VATS, RL had lower conversion rate (p \u3c 0.0001), shorter hospital stay (p \u3c 0.0001) and a lower postoperative transfusion rate (p = 0.01). RL and VATS cohorts had comparable postoperative complication rates. In-hospital mortality was comparable between all groups. Conclusions: RL and VATS approaches were associated with favorable perioperative outcomes compared to OL. Robotic-assisted lobectomy was also associated with a reduced length of stay and decreased conversion rate when compared to VATS

Max Weber on the ethical irrationality of political leadership

This paper analyses the ethical basis of Max Weber's theory of political leadership. It (i) expounds the connection between the ethics of conviction and responsibility Weber outlines in Politics as a Vocation and the ideal-types of value and instrumental rationality he defines in Economy and Society, (ii) examines Weber's commitment to a practical reconciliation of these political ethics/action types, (iii) argues that, for Weber, this reconciliation ultimately is to proceed through the subordination of conviction to an ethic of responsibility