Impact of the Video-Assisted Lobectomy Approach on Maximal Oxygen Consumption, Pulmonary Function and Quality of Life of Lung Cancer Patients

Nowadays video-assisted lobectomy could be considered an appropriate treatment option for early stage lung cancer patients, as obtaining similar or even better early outcomes when compared to open standard lobectomy. This study was aimed at verifying the long-term impact (three months after surgery) of VATS-lobectomy technique on physical and mental status of patients undergoing lung resection for lung cancer and to compare the physical variation to the one registered after open approach. We enrolled patients treated by VATS-lobectomy at our institution since June 2012 to June 2015, comparing the preoperative physical evaluation (in terms of FEV1, DLCO and VO2max) and perceived quality of life (measured using the EORTC questionnaire) to the postoperative values. Moreover we performed a propensity score matching analysis to verify if the physical variation registered after VATS-lobectomy differed from that after open resection. We found a three months postoperative reduction of the physical indicators in comparison to the preoperative values (FEV1-variation: -8.3%, DLCO-variation: -12.4%, VO2max-variation: -6.6%). A similar negative trend was found for the psychological indicators, but the only parameter with a significative worsening was the perceived physical functioning (variation: -6.2%). The propensity score procedure yielded 83 well-matched open and VATS-lobectomy patients. The reductions in FEV1, DLCO and VO2max were similar in both groups (open patients’ reduction: FEV1 -10%, DLCO -11.9%, VO2max -5.5%; VATS patients’ reduction: FEV1 -7.2%, DLCO -10.6%, VO2max -6.9%), with a Cohen effect size < 0.2 for all the comparisons. In conclusion, VATS-lobectomy influences a reduction of the preoperative functional status three months after the operation, without affecting the postoperative perceived quality of life. Moreover VATS-lobectomy doesn’t offer any advantage in terms of FEV1, DLCO and exercise capacity recovery in comparison to the open approach

A model for the internal evaluation of the quality of care after lung resection in the elderly

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Risk-adjusted econometric model to estimate postoperative costs: An additional instrument for monitoring performance after major lung resection

ObjectivesThe objectives of this study were to develop a risk-adjusted model to estimate individual postoperative costs after major lung resection and to use it for internal economic audit.MethodsVariable and fixed hospital costs were collected for 679 consecutive patients who underwent major lung resection from January 2000 through October 2006 at our unit. Several preoperative variables were used to develop a risk-adjusted econometric model from all patients operated on during the period 2000 through 2003 by a stepwise multiple regression analysis (validated by bootstrap). The model was then used to estimate the postoperative costs in the patients operated on during the 3 subsequent periods (years 2004, 2005, and 2006). Observed and predicted costs were then compared within each period by the Wilcoxon signed rank test.ResultsMultiple regression and bootstrap analysis yielded the following model predicting postoperative cost: 11,078 + 1340.3X (age > 70 years) + 1927.8X cardiac comorbidity − 95X ppoFEV1%. No differences between predicted and observed costs were noted in the first 2 periods analyzed (year 2004, $6188.40 vs$6241.40, P = .3; year 2005, $6308.60 vs$6483.60, P = .4), whereas in the most recent period (2006) observed costs were significantly lower than the predicted ones ($3457.30 vs$6162.70, P < .0001).ConclusionsGreater precision in predicting outcome and costs after therapy may assist clinicians in the optimization of clinical pathways and allocation of resources. Our economic model may be used as a methodologic template for economic audit in our specialty and complement more traditional outcome measures in the assessment of performance

Development of a patient-centered aggregate score to predict survival after lung resection for non–small cell lung cancer

ObjectiveThe objective of this analysis was to develop a survival aggregate score (SAS), including objective and subjective patient-based parameters, and assess its prognostic role after major anatomic resection for non–small cell lung cancer.MethodsA total of 245 patients underwent major lung resections for non–small cell lung cancer with preoperative evaluation of quality of life (Short-Form 36v2 survey) and complete follow-up. The Cox multivariable regression and bootstrap analyses were used to identify prognostic factors of overall servival, which were weighted to construct the scoring system and summed to generate the SAS.ResultsCox regression analysis showed that the factors negatively associated with overall survival and used to construct the score were 36-item short-form health survey physical component summary score less than 50 (hazard ratio [HR], 1.7; P = .008), aged older than 70 years (HR, 1.9; P = .002), and carbon monoxide lung diffusion capacity less than 70% (HR, 1.7; P = .01). Patients were grouped into 4 risk classes according to their SAS. The 5-year overall survival was 78% in class SAS0, 59% in class SAS1, 42% in class SAS2, and 14% in class SAS3 (log-rank test, P < .0001). SAS maintained its association with overall survival in patients with stages pT1 (log-rank test, P = .01), pT2 (log-rank test, P = .02), or pT3-4 (log-rank test, P = .001), and in those with stages pN0 (log-rank test, P = .0005) or pN1-2 (log-rank test, P = .02). The 5-year cancer-specific survival was 83% in class SAS0, 71% in class SAS1, 63% in class SAS2, and 17% in class SAS3 (log-rank test, P < .0001).ConclusionsThis system may be used to refine stratification of prognosis for clinical and research purposes

Outcome after video-assisted thoracoscopic surgery and open pulmonary lobectomy in patients with low VO_{2 max}: a case-matched analysis from the ESTS database

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Peak Oxygen Consumption Measured during the Stair-Climbing Test in Lung Resection Candidates

Background: The stair-climbing test is commonly used in the preoperative evaluation of lung resection candidates, but it is difficult to standardize and provides little physiologic information on the performance. Objective: To verify the association between the altitude and the VO2peak measured during the stair-climbing test. Methods: 109 consecutive candidates for lung resection performed a symptom-limited stair-climbing test with direct breath-by-breath measurement of VO2peak by a portable gas analyzer. Stepwise logistic regression and bootstrap analyses were used to verify the association of several perioperative variables with a VO2peak O2peak from stair-climbing parameters and other patient-related variables. Results: 56% of patients climbing O2peak 22 m had a VO2peak >15 ml/kg/min. The altitude reached at stair-climbing test resulted in the only significant predictor of a VO2peak O2peak factoring altitude (p Conclusions: There was an association between altitude and VO2peak measured during the stair-climbing test. Most of the patients climbing more than 22 m are able to generate high values of VO2peak and can proceed to surgery without any additional tests. All others need to be referred for a formal cardiopulmonary exercise test. In addition, we were able to generate an equation to estimate VO2peak, which could assist in streamlining the preoperative workup and could be used across different settings to standardize this test

Surgery or Locoregional Approaches for Hepatic Oligometastatic Pancreatic Cancer: Myth, Hope, or Reality?

Despite extensive research, pancreatic ductal adenocarcinoma (PDAC) remains a difficult-to-treat cancer associated with poor survival. Due to the known aggressive disease biology, palliative chemotherapy is the only routinely recommended treatment in the metastatic setting in patients with adequate performance status. However, in a subset of patients with oligometastatic disease, multimodality treatment with surgery and/or locoregional approaches may provide long-term disease control and prolong survival. In fact, in highly selected cases, median overall survival has been reported to extend to 56 months in patients treated with surgery. In particular, liver and extraregional nodal resections may provide long-term tumor control with acceptable morbidity. Current guidelines do not recommend surgery for patients with metastatic PDAC and, in the case of PDAC with oligometastases, there are no published randomized controlled trials regarding locoregional or surgical approaches. Here we review the literature on surgical and locoregional approaches including radiofrequency ablation, irreversible electroporation, and stereotactic body radiation, and focus on patients with hepatic oligometastatic pancreatic cancer. We provide a summary regarding survival outcomes, morbidity and mortality and discuss selection criteria that may be useful to predict the best outcomes for such strategies

Visualization of bronchoalveolar fistula as the presenting sign of lung cancer

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Measured FEV1 in the first postoperative day, and not ppoFEV1, is the best predictor of cardio-respiratory morbidity after lung resection☆

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Short-term perioperative treatment with ambroxol reduces pulmonary complications and hospital costs after pulmonary lobectomy: a randomized trial☆

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