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Rodney J Landreneau - One of the best experts on this subject based on the ideXlab platform.
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role of segmentectomy in treatment of early stage non small cell lung cancer
Annals of Surgical Oncology, 2018Co-Authors: Mark Hennon, Rodney J LandreneauAbstract:Purpose and Design Standard treatment for early-stage non–small cell lung cancer has traditionally involved Lobectomy. Historical data that demonstrates suboptimal results for sublobar resection compared to Lobectomy have been challenged in recent years with retrospective data for patients with T1a disease. For patients who are not candidates for Lobectomy, options for sublobar resection include wedge resection or anatomic segmentectomy. Segmentectomy has long been held to be a better cancer operation than wedge resection, and its role in treating early-stage lung cancer remains controversial in patients who are candidates for Lobectomy. A review of available literature involving segmentectomy and possible predictors of failure for segmentectomy was performed in an attempt to clarify the role of segmentectomy for early-stage lung cancer.
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anatomic segmentectomy for stage i non small cell lung cancer in the elderly
The Annals of Thoracic Surgery, 2009Co-Authors: Arman Kilic, Matthew J Schuchert, Brian L Pettiford, Arjun Pennathur, James R Landreneau, James D Luketich, Rodney J LandreneauAbstract:Background Anatomic segmentectomy for stage I non-small cell lung cancer (NSCLC) offers the potential of surgical cure with preservation of lung function. This may be of particular importance in elderly NSCLC patients with declining cardiopulmonary status and a limited life expectancy. Methods The study compared outcomes of 78 elderly patients (aged > 75 years) with stage I NSCLC undergoing segmentectomy and 106 undergoing Lobectomy for stage I NSCLC from 2002 to 2007. Primary outcome variables included perioperative morbidity and mortality, hospital course, recurrence patterns, and survival. Results Age, gender, tumor histology, and surgical approach were similar between groups. Comorbidities were similar except for a higher incidence of chronic obstructive pulmonary disease and diabetes in segmentectomy patients. The tumors in the Lobectomy group were significantly larger (3.5 vs 2.5 cm, p = 0.0001). Operative mortality was 1.3% for segmentectomy and 4.7% for Lobectomy. Segmentectomy patients had fewer major complications (11.5% vs 25.5%, p = 0.02). There were no differences in median hospitalization (7 vs 6 days). The estimated overall survival at 2, 3, and 5 years was 76%, 69%, and 46% for segmentectomy patients and 68%, 59%, and 47% for Lobectomy patients ( p = 0.28). The 5-year disease-free survival was equivalent (segmentectomy, 49.8%; Lobectomy, 45.5%; p = 0.80). Conclusions Anatomic segmentectomy can be performed safely in elderly patients with early-stage NSCLC. This approach is associated with reduced perioperative complications and comparable oncologic efficacy compared with Lobectomy in older patients with a limited life expectancy.
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outcomes of sublobar resection versus Lobectomy for stage i non small cell lung cancer a 13 year analysis
The Annals of Thoracic Surgery, 2006Co-Authors: Amgad Elsherif, Brian L Pettiford, James D Luketich, William E Gooding, Ricardo S Santos, Peter F Ferson, Hiran C Fernando, Susan J Urda, Rodney J LandreneauAbstract:Background The appropriate use of sublobar resection versus Lobectomy for stage I non–small cell lung cancer continues to be debated. A long-term analysis of the outcomes of these resections for stage I non–small cell lung cancer in a high-volume tertiary referral university hospital center was performed. Methods The outcomes of all stage I non–small cell lung cancer patients (n = 784) undergoing resection were analyzed from our lung cancer registry from 1990 to 2003. Lobectomy was the standard of care for patients with adequate cardiopulmonary reserve. Sublobar resection was reserved for patients with cardiopulmonary impairment prohibiting Lobectomy. Predictors of overall survival and disease-free survival were evaluated. Statistical analyses included Kaplan–Meier estimates of survival, log-rank tests of survival differences, and multivariate Cox proportional hazards models. Results Lobectomy was used for 577 patients and sublobar resection for 207 patients. The median age was 70 years (range, 31 to 107 years). The median follow-up of patients remaining alive was 31 months. Compared with Lobectomy, sublobar resection had no significant impact on disease-free survival, with a hazard ratio of 1.20 (95% confidence interval, 0.90 to 1.61; p = 0.24). Sublobar resection had a statistically significant association with overall survival when compared with Lobectomy, with an increased hazard ratio of 1.39 (95% confidence interval, 1.11 to 1.75; p = 0.004). Twenty-eight percent of Lobectomy patients experienced disease recurrence in that time compared with 29% of the sublobar patients. Seventy-two percent of the recurrences in the Lobectomy cohort were distant metastasis versus 52% of the sublobar group recurrences ( p = 0.0204). Conclusions Although sublobar resection is thought to be associated with increased incidence of local recurrence when compared with Lobectomy, we found no difference in disease-free survival between the two types of resection for stage IA patients but slightly worse disease-free survival for stage IB.
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wedge resection versus Lobectomy for stage i t1 n0 m0 non small cell lung cancer
The Journal of Thoracic and Cardiovascular Surgery, 1997Co-Authors: Rodney J Landreneau, James D Luketich, David J. Sugarbaker, Michael J. Mack, Stephen R. Hazelrigg, Lynda S. Fetterman, Michael J. Liptay, Susan Bartley, Theresa M. Boley, Robert J. KeenanAbstract:Abstract Background: The role of nonanatomic wedge resection in the management of stage I (T1 N0 M0) non-small-cell lung cancer continues to be debated against the present gold standard of care—anatomic Lobectomy. Methods: We analyzed the results of 219 consecutive patients with pathologic stage I (T1 N0 M0) non-small-cell lung cancer who underwent open wedge resection ( n = 42), video-assisted wedge resection ( n = 60), and Lobectomy ( n = 117) to assess morbidity, recurrence, and survival differences between these approaches. Results: There were no differences among the three groups with regard to histologic tumor type. Analysis demonstrated the wedge resection groups to be significantly older and to have reduced pulmonary function despite a higher incidence of treatment for chronic obstructive pulmonary disease when compared with patients having Lobectomy. The mean hospital stay was significantly less in the wedge resection groups. There were no operative deaths among patients having wedge resection; however, a 3% operative mortality occurred among patients having Lobectomy ( p = 0.20). Kaplan-Meier survival curves were nearly identical at 1 year (open wedge resection, 94%; video-assisted wedge resection, 95%; Lobectomy, 91%). At 5 years survival was 58% for patients having open wedge resection, 65% for those having video-assisted wedge resection, and 70% for those having Lobectomy. Log rank testing demonstrated significant differences between the survival curves during the 5-year period of study ( p = 0.02). This difference was a result of a significantly greater non-cancer-related death rate by 5 years among patients having wedge resection (38% vs 18% for those having Lobectomy; p = 0.014). Conclusion: Wedge resection, done by open thoracotomy or video-assisted techniques, appears to be a viable "compromise" surgical treatment of stage I (T1 N0 M0) non-small-cell lung cancer for patients with cardiopulmonary physiologic impairment. Because of the increased risk for local recurrence, anatomic Lobectomy remains the surgical treatment of choice for patients with stage I non-small-cell lung cancer who have adequate physiologic reserve. (J Thorac Cardiovasc Surg 1997;113:691-700)
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Lobectomy video assisted thoracic surgery versus muscle sparing thoracotomy a randomized trial
The Journal of Thoracic and Cardiovascular Surgery, 1995Co-Authors: Thomas J Kirby, Rodney J Landreneau, Michael J. Mack, Thomas W RiceAbstract:Abstract Video-assisted thoracic surgery has been adopted by some thoracic surgeons as the preferred approach over thoracotomy for many benign and malignant diseases of the chest. However, little concrete evidence exists to support this technique as the superior approach. This randomized study was carried out to define the advantages of video-assisted Lobectomy over muscle-sparing thoracotomy and Lobectomy. Sixty-one patients with presumed clinical stage I non-small-cell lung cancer were entered into the study. Each patient was randomized to muscle-sparing thoracotomy and Lobectomy or video-assisted Lobectomy. Six patients were excluded from the study either because final pathologic results revealed nonmalignant disease (3 patients) or because an attempted video-assisted Lobectomy was converted to a thoracotomy. This left 30 patients in the thoracotomy group and 25 patients in the video-assisted group. No significant differences existed between the two groups in operating time, intraoperative blood loss, duration of chest tube drainage, or length of hospital stay. Significantly more postoperative complications occurred in the thoracotomy group ( p n = 2; video-assisted Lobectomy, n = 1). We conclude that video-assisted Lobectomy was not associated with a significant decrease in duration of chest tube drainage, length of hospital stay, postthoracotomy pain, or, in this group of patients, a faster recovery time and return to work. Video-assisted Lobectomy continues to expose the patient to the risk of a major pulmonary resection being done in an essentially closed chest. These results illustrate the need for critical evaluation of video-assisted thoracic surgery before the procedure is accepted as a superior approach based on presumed and thus far unproved advantages. (J THORAC CARDIOVASC SURG 1995; 109: 997-1002)
Thomas A Damico - One of the best experts on this subject based on the ideXlab platform.
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use and outcomes of minimally invasive Lobectomy for stage i non small cell lung cancer in the national cancer data base
The Annals of Thoracic Surgery, 2016Co-Authors: Chifu Jeffrey Yang, David H Harpole, Mark W Onaitis, Matthew G Hartwig, Betty C Tong, Zhifei Sun, Paul J Speicher, Shakir M Saud, Brian C Gulack, Thomas A DamicoAbstract:Background Previous studies have raised concerns that video-assisted thoracoscopic (VATS) Lobectomy may compromise nodal evaluation. The advantages or limitations of robotic Lobectomy have not been thoroughly evaluated. Methods Perioperative outcomes and survival of patients who underwent open versus minimally-invasive surgery (MIS [VATS and robotic]) Lobectomy and VATS versus robotic Lobectomy for clinical T1-2, N0 non-small cell lung cancer from 2010 to 2012 in the National Cancer Data Base were evaluated using propensity score matching. Results Of 30,040 lobectomies, 7,824 were VATS and 2,025 were robotic. After propensity score matching, when compared with the open approach (n = 9,390), MIS (n = 9,390) was found to have increased 30-day readmission rates (5% versus 4%, p p p = 0.04). There were no significant differences in nodal upstaging and 30-day mortality between the two groups. After propensity score matching, when compared with the robotic group (n = 1,938), VATS (n = 1,938) was not significantly different from robotics with regard to nodal upstaging, 30-day mortality, and 2-year survival. Conclusions In this population-based analysis, MIS (VATS and robotic) Lobectomy was used in the minority of patients for stage I non-small cell lung cancer. MIS Lobectomy was associated with shorter length of hospital stay and was not associated with increased perioperative mortality, compromised nodal evaluation, or reduced short-term survival when compared with the open approach. These results suggest the need for broader implementation of MIS techniques.
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feasibility of hybrid thoracoscopic Lobectomy and en bloc chest wall resection
European Journal of Cardio-Thoracic Surgery, 2012Co-Authors: Mark F Berry, David H Harpole, Mark W Onaitis, Stafford S Balderson, Betty C Tong, Thomas A DamicoAbstract:OBJECTIVES: Lobectomy with an en-bloc chest wall resection is an effective but potentially morbid treatment of lung cancer invading the chest wall. Minimally invasive approaches to Lobectomy have reduced morbidity compared with thoracotomy for early stage lung cancer, but there is insufficient evidence regarding the feasibility of hybrid thoracoscopic Lobectomy chest wall resection. We reviewed our experience with an en-bloc chest wall resection and Lobectomy to evaluate the outcomes of a hybrid approach using thoracoscopic Lobectomy combined with the chest wall resection where rib spreading is avoided. METHODS: All patients who underwent Lobectomy and en-bloc chest wall resection with ribs for primary non-small cell lung cancer from January 2000 to July 2010 were reviewed. Starting in April 2003, a hybrid approach was introduced where thoracoscopic techniques were utilized to accomplish the pulmonary resection and a limited counter incision was used to perform the en-bloc resection of the chest wall, avoiding scapular mobilization and rib spreading. Preoperative, perioperative and outcome variables were assessed using the standard descriptive statistics. RESULTS: During the study period, 105 patients underwent en-bloc Lobectomy and chest wall resection, including 93 patients with resection via thoracotomy and 12 patients with resection via the hybrid thoracoscopic approach. Complete resection was achieved in all patients in both groups. Tumour size and the extent of resection were similar in the two groups. There were no conversions and no perioperative mortality in the hybrid group. Post-operative outcomes were similar, although patients who underwent the hybrid approach had a shorter length of stay (P= 0.03). CONCLUSIONS: A hybrid approach that combines thoracoscopic Lobectomy and chest wall resection is feasible and effective in selected patients. The use of a limited counter incision without rib spreading does not compromise oncologic efficacy. Further experience is needed to determine if this approach provides any advantage in outcomes, including post-operative morbidity.
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thoracoscopic Lobectomy the gold standard for early stage lung cancer
The Annals of Thoracic Surgery, 2010Co-Authors: Matthew G Hartwig, Thomas A DamicoAbstract:Primary lung cancers remain the most lethal of all the malignancies, predicted to account for nearly 160,000 deaths and 220,000 new diagnoses in 2009. The cornerstone of therapy for early-stage lung cancer is surgical resection by Lobectomy with concomitant removal of the draining nodal basin. Minimally invasive Lobectomy with the use of a thoracoscope has been established as an alternative to standard thoracotomy approaches. Thoracoscopic Lobectomy provides advantages over a traditional thoracotomy, including less pain, shorter hospitalization, decreased overall costs, superior chemotherapy compliance, and fewer overall complications. In light of these advantages and with evidence of oncologic equivalence, thoracoscopic Lobectomy should be considered the gold standard for the treatment of early-stage lung cancer. This article details the technical strategies for performing thoracoscopic Lobectomy and highlights the published evidence demonstrating its advantages over a traditional thoracotomy approach.
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thoracoscopic Lobectomy is associated with lower morbidity than open Lobectomy a propensity matched analysis from the sts database
The Journal of Thoracic and Cardiovascular Surgery, 2010Co-Authors: Subroto Paul, Jeffrey L Port, Brendon M Stiles, Nasser K Altorki, David H Harpole, Mark W Onaitis, Shubin Sheng, Thomas A DamicoAbstract:Background Several single-institution series have demonstrated that compared with open thoracotomy, video-assisted thoracoscopic Lobectomy may be associated with fewer postoperative complications. In the absence of randomized trials, we queried the Society of Thoracic Surgeons database to compare postoperative mortality and morbidity following open and video-assisted thoracoscopic Lobectomy. A propensity-matched analysis using a large national database may enable a more comprehensive comparison of postoperative outcomes. Methods All patients having Lobectomy as the primary procedure via thoracoscopy or thoracotomy were identified in the Society of Thoracic Surgeons database from 2002 to 2007. After exclusions, 6323 patients were identified: 5042 having thoracotomy, 1281 having thoracoscopy. A propensity analysis was performed, incorporating preoperative variables, and the incidence of postoperative complications was compared. Results Matching based on propensity scores produced 1281 patients in each group for analysis of postoperative outcomes. After video-assisted thoracoscopic Lobectomy, 945 patients (73.8%) had no complications, compared with 847 patients (65.3%) who had Lobectomy via thoracotomy ( P P = .0004], reintubation [n = 18 (1.4%) vs 40 (3.1%); P = .0046], and blood transfusion [n = 31 (2.4%) vs n=60 (4.7%); P = .0028], as well as a shorter length of stay (4.0 vs 6.0 days; P P Conclusions Video-assisted thoracoscopic Lobectomy is associated with a lower incidence of complications compared with Lobectomy via thoracotomy. For appropriate candidates, video-assisted thoracoscopic Lobectomy may be the preferred strategy for appropriately selected patients with lung cancer.
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thoracoscopic Lobectomy is associated with lower morbidity compared with thoracotomy
The Journal of Thoracic and Cardiovascular Surgery, 2009Co-Authors: Nestor Villamizar, William R Burfeind, Rebecca P Petersen, Eric M Toloza, David H Harpole, Marcus D Darrabie, Mark W Onaitis, Thomas A DamicoAbstract:Objectives Advantages of thoracoscopic Lobectomy include less postoperative pain, shorter hospitalization, and improved delivery of adjuvant chemotherapy. The incidence of postoperative complications has not been thoroughly assessed. This study analyzes morbidity after Lobectomy to compare the thoracoscopic approach and thoracotomy. Methods By using a prospective database, the outcomes of patients who underwent Lobectomy from 1999–2009 were analyzed with respect to postoperative complications. Propensity-matched groups were analyzed based on preoperative variables and stage. Results Of the 1079 patients in the study, 697 underwent thoracoscopic Lobectomy, and 382 underwent Lobectomy by means of thoracotomy. In the overall analysis thoracoscopic Lobectomy was associated with a lower incidence of atrial fibrillation ( P = .01), atelectasis ( P = .0001), prolonged air leak ( P = .0004), transfusion ( P = .0001), pneumonia ( P = .001), sepsis ( P = .008), renal failure ( P = .003), and death ( P = .003). In the propensity-matched analysis based on preoperative variables, when comparing 284 patients in each group, 196 (69%) patients who underwent thoracoscopic Lobectomy had no complications versus 144 (51%) patients who underwent thoracotomy ( P = .0001). In addition, thoracoscopic Lobectomy was associated with a lower incidence of atrial fibrillation (13% vs 21%, P = .01), less atelectasis (5% vs 12%, P = .006), fewer prolonged air leaks (13% vs 19%, P = .05), fewer transfusions (4% vs 13%, P = .002), less pneumonia (5% vs 10%, P = .05), less renal failure (1.4% vs 5%, P = .02), shorter chest tube duration (median of 3 vs 4 days, P P Conclusions Thoracoscopic Lobectomy is associated with a lower incidence of major complications, including atrial fibrillation, compared with Lobectomy by means of thoracotomy. The underlying factors responsible for this advantage should be analyzed to improve the safety and outcomes of other thoracic procedures.
Thomas W Rice - One of the best experts on this subject based on the ideXlab platform.
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Lobectomy video assisted thoracic surgery versus muscle sparing thoracotomy a randomized trial
The Journal of Thoracic and Cardiovascular Surgery, 1995Co-Authors: Thomas J Kirby, Rodney J Landreneau, Michael J. Mack, Thomas W RiceAbstract:Abstract Video-assisted thoracic surgery has been adopted by some thoracic surgeons as the preferred approach over thoracotomy for many benign and malignant diseases of the chest. However, little concrete evidence exists to support this technique as the superior approach. This randomized study was carried out to define the advantages of video-assisted Lobectomy over muscle-sparing thoracotomy and Lobectomy. Sixty-one patients with presumed clinical stage I non-small-cell lung cancer were entered into the study. Each patient was randomized to muscle-sparing thoracotomy and Lobectomy or video-assisted Lobectomy. Six patients were excluded from the study either because final pathologic results revealed nonmalignant disease (3 patients) or because an attempted video-assisted Lobectomy was converted to a thoracotomy. This left 30 patients in the thoracotomy group and 25 patients in the video-assisted group. No significant differences existed between the two groups in operating time, intraoperative blood loss, duration of chest tube drainage, or length of hospital stay. Significantly more postoperative complications occurred in the thoracotomy group ( p n = 2; video-assisted Lobectomy, n = 1). We conclude that video-assisted Lobectomy was not associated with a significant decrease in duration of chest tube drainage, length of hospital stay, postthoracotomy pain, or, in this group of patients, a faster recovery time and return to work. Video-assisted Lobectomy continues to expose the patient to the risk of a major pulmonary resection being done in an essentially closed chest. These results illustrate the need for critical evaluation of video-assisted thoracic surgery before the procedure is accepted as a superior approach based on presumed and thus far unproved advantages. (J THORAC CARDIOVASC SURG 1995; 109: 997-1002)
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Lobectomy video assisted thoracic surgery versus muscle sparing thoracotomy a randomized trial
The Journal of Thoracic and Cardiovascular Surgery, 1995Co-Authors: Thomas J Kirby, Rodney J Landreneau, Michael J. Mack, Thomas W RiceAbstract:Video-assisted thoracic surgery has been adopted by some thoracic surgeons as the preferred approach over thoracotomy for many benign and malignant diseases of the chest. However, little concrete evidence exists to support this technique as the superior approach. This randomized study was carried out to define the advantages of video-assisted Lobectomy over muscle-sparing thoracotomy and Lobectomy. Sixty-one patients with presumed clinical stage I non-small-cell lung cancer were entered into the study. Each patient was randomized to muscle-sparing thoracotomy and Lobectomy or video-assisted Lobectomy. Six patients were excluded from the study either because final pathologic results revealed nonmalignant disease (3 patients) or because an attempted video-assisted Lobectomy was converted to a thoracotomy. This left 30 patients in the thoracotomy group and 25 patients in the video-assisted group. No significant differences existed between the two groups in operating time, intraoperative blood loss, duration of chest tube drainage, or length of hospital stay. Significantly more postoperative complications occurred in the thoracotomy group (p < 0.5), the majority of which were prolonged air leaks. Return to work time was not an issue because the majority of the patients were either retired or not working at the time of the operation. Only three patients had persistent postthoracotomy pain (thoracotomy, n = 2; video-assisted Lobectomy, n = 1). We conclude that video-assisted Lobectomy was not associated with a significant decrease in duration of chest tube drainage, length of hospital stay, postthoracotomy pain, or, in this group of patients, a faster recovery time and return to work. Video-assisted Lobectomy continues to expose the patient to the risk of a major pulmonary resection being done in an essentially closed chest. These results illustrate the need for critical evaluation of video-assisted thoracic surgery before the procedure is accepted as a superior approach based on presumed and thus far unproved advantages.
Richard Inculet - One of the best experts on this subject based on the ideXlab platform.
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video assisted thoracic surgery versus open Lobectomy for lung cancer a secondary analysis of data from the american college of surgeons oncology group z0030 randomized clinical trial
The Journal of Thoracic and Cardiovascular Surgery, 2010Co-Authors: Walter J Scott, Mark S Allen, Gail Darling, Bryan F Meyers, Paul A Decker, Joe B Putnam, Robert W Mckenna, Rodney Landrenau, David R Jones, Richard InculetAbstract:Objective Video-assisted thoracoscopic Lobectomy remains controversial. We compared outcomes from participants in a randomized study comparing lymph node sampling versus dissection for early-stage lung cancer who underwent either video-assisted thoracoscopic or open Lobectomy. Methods Data from 964 participants in the American College of Surgeons Oncology Group Z0030 trial were used to construct propensity scores for video-assisted thoracoscopic versus open Lobectomy (based on age, gender, histology, performance status, tumor location, and T1 vs T2). Propensity scores were used to estimate the adjusted risks of short-term outcomes of surgery. Patients were classified into 5 equal-sized groups and compared using conditional logistic regression or repeated measures analysis of variance. Results A total of 752 patients (66 video-assisted and 686 open procedures) were analyzed on the basis of propensity score stratification. Median operative time was shorter for video-assisted thoracoscopic Lobectomy (video-assisted thoracoscopy 117.5 minutes vs open 171.5 minutes; P Conclusion Patients undergoing video-assisted Lobectomy had fewer respiratory complications and shorter length of stay. These data suggest video-assisted thoracoscopic Lobectomy is safe in patients with resectable lung cancer. Longer follow-up is needed to determine the oncologic equivalency of video-assisted versus open Lobectomy.
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video assisted thoracic surgery versus open Lobectomy for lung cancer a secondary analysis of data from the american college of surgeons oncology group z0030 randomized clinical trial
The Journal of Thoracic and Cardiovascular Surgery, 2010Co-Authors: Walter J Scott, Mark S Allen, Gail Darling, Bryan F Meyers, Paul A Decker, Joe B Putnam, Robert W Mckenna, Rodney Landrenau, David R Jones, Richard InculetAbstract:Objective Video-assisted thoracoscopic Lobectomy remains controversial. We compared outcomes from participants in a randomized study comparing lymph node sampling versus dissection for early-stage lung cancer who underwent either video-assisted thoracoscopic or open Lobectomy. Methods Data from 964 participants in the American College of Surgeons Oncology Group Z0030 trial were used to construct propensity scores for video-assisted thoracoscopic versus open Lobectomy (based on age, gender, histology, performance status, tumor location, and T1 vs T2). Propensity scores were used to estimate the adjusted risks of short-term outcomes of surgery. Patients were classified into 5 equal-sized groups and compared using conditional logistic regression or repeated measures analysis of variance. Results A total of 752 patients (66 video-assisted and 686 open procedures) were analyzed on the basis of propensity score stratification. Median operative time was shorter for video-assisted thoracoscopic Lobectomy (video-assisted thoracoscopy 117.5 minutes vs open 171.5 minutes; P P = .147), as were instances of R1/R2 resection (video-assisted thoracoscopy 0% vs open 2.3%; P = .368). Patients undergoing video-assisted thoracoscopic Lobectomy had less atelectasis requiring bronchoscopy (0% vs 6.3%, P = .035), fewer chest tubes draining greater than 7 days (1.5% vs 10.8%; P = .029), and shorter median length of stay (5 days vs 7 days; P P = 1.0). Conclusion Patients undergoing video-assisted Lobectomy had fewer respiratory complications and shorter length of stay. These data suggest video-assisted thoracoscopic Lobectomy is safe in patients with resectable lung cancer. Longer follow-up is needed to determine the oncologic equivalency of video-assisted versus open Lobectomy.
Morihito Okada - One of the best experts on this subject based on the ideXlab platform.
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Comparison of Pulmonary Segmentectomy and Lobectomy: Safety Results of a Randomized Trial
The Journal of thoracic and cardiovascular surgery, 2019Co-Authors: Kenji Suzuki, Hisashi Saji, Keiju Aokage, Shun-ichi Watanabe, Morihito Okada, Junki Mizusawa, Ryu Nakajima, Masahiro Tsuboi, Shinichiro Nakamura, Kenichi NakamuraAbstract:Abstract Background No definitive comparisons of surgical morbidity between segmentectomy and Lobectomy for non–small cell lung cancer have been reported. Methods We conducted a randomized controlled trial to confirm the noninferiority of segmentectomy to Lobectomy in regard to prognosis (trial No. JCOG0802/WJOG4607L). Patients with invasive peripheral non–small cell lung cancer tumor of a diameter ≤2 cm were randomized to undergo either Lobectomy or segmentectomy. The primary end point was overall survival. Here, we have focused on morbidity and mortality. Predictors of surgical morbidity were evaluated by the mode of surgery. Segmentectomy was categorized into simple and complex. Simple segmentectomy was defined as segmental resection of the right or left segment 6, left superior, or lingular segment. Complex segmentectomy was resection of the other segment. This trial is registered with the University Hospital Medical Information Network--Clinical Trial Registry (UMIN000002317). Results Between August 10, 2009, and October 21, 2014, 1106 patients (Lobectomy n = 554 and segmentectomy n = 552) were enrolled. No mortality was noted. Complications (grade ≥ 2) occurred in 26.2% and 27.4% in the Lobectomy and segmentectomy arms (P = .68), respectively. Fistula/pulmonary-lung (air leak) was detected in 21 (3.8%) and 36 (6.5%) patients in the Lobectomy and segmentectomy arms (P = .04), respectively. Multivariable analysis revealed that predictors of pulmonary complications, including air leak and empyema (grade ≥ 2) were complex segmentectomy (vs Lobectomy) (odds ratio, 2.07; 95% confidence interval, 1.11-3.88; P = .023), and > 20 pack-years of smoking (odds ratio, 2.61; 95% confidence interval, 1.14-5.97; P = .023). Conclusions There was no difference in almost any postoperative measure of intraoperative and postoperative complication in segmentectomy and Lobectomy patients, except more air leakage was observed in the segmentectomy arm. Segmentectomy will be a standard treatment if the superior pulmonary function and noninferiority in overall survival are confirmed.
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bronchoplasty for lung cancer
Nihon Geka Gakkai zasshi, 2016Co-Authors: Morihito OkadaAbstract:Bronchoplasty for patients with lung cancer is basically designed to achieve radical cure with the preservation of lung function. Functional lung parenchyma can be preserved, and the reimplanted lobes contribute to postoperative quality of life. Pneumonectomy is associated with a higher occurrence of postoperative complications, poor quality of life, and cardiopulmonary dysfunction as compared with Lobectomy. In addition, long-term complications (i.e., late pulmonary hypertension, respiratory failure, or so-called postpneumonectomy syndrome) are sometimes seen after pneumonectomy but seldom after Lobectomy. Thus pneumonectomy itself is considered a disease. Sleeve Lobectomy, or Lobectomy with bronchoplasty, which allows the preservation of functional lung parenchyma with the possible advantages of lower mortality and morbidity rates, is a valid alternative to pneumonectomy and has recently been accepted as a standard treatment in noncompromised patients with lung cancer. Atypical bronchoplasties such as double-sleeve and extended-sleeve Lobectomy, and sleeve segmentectomy are also performed at present. This article describes the surgical techniques for bronchoplastic procedures and compares the surgical outcomes of sleeve Lobectomy with those of pneumonectomy reported in the literature.
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segmentectomy versus Lobectomy for clinical stage ia lung adenocarcinoma
Annals of cardiothoracic surgery, 2014Co-Authors: Morihito Okada, Masahiro Yoshimura, Yasuhiro Tsutani, Haruhiko Nakayama, Sakae Okumura, Takahiro Mimae, Yoshihiro MiyataAbstract:Background: Despite the increasingly prevalent early discovery of small-sized non-small cell lung cancers (NSCLCs), particularly adenocarcinoma, sublobar resection has not yet gained acceptance for patients who can tolerate Lobectomy. Methods: We compared the outcomes of segmentectomy (n=155) and Lobectomy (n=479) in 634 consecutive patients with clinical stage IA lung adenocarcinoma and in propensity score-matched pairs. Those who had undergone wedge resection were excluded. Results: The 30-day postoperative mortality rate in this population was zero. Patients with large or rightsided tumors, high maximum standardized uptake value (SUVmax), pathologically invasive tumors (with lymphatic, vascular, or pleural invasion), and lymph node metastasis underwent Lobectomy significantly more often. Three-year recurrence-free survival (RFS) was significantly higher after segmentectomy compared to Lobectomy (92.7% vs. 86.9%, P=0.0394), whereas three-year overall survival (OS) did not significantly differ (95.7% vs. 94.1%, P=0.162). Multivariate analyses of RFS and OS revealed age and SUVmax as significant independent prognostic factors, whereas gender, tumor size and procedure (segmentectomy vs. Lobectomy) were not. In 100 propensity score-matched pairs with variables adjusted for age, gender, tumor size, SUVmax, tumor location, the three-year RFS (90.2% vs. 91.5%) and OS (94.8% vs. 93.3%) after segmentectomy and Lobectomy respectively were comparable. Conclusions: Segmentectomy with reference to SUVmax should be considered as an alternative for clinical stage IA adenocarcinoma, even for low-risk patients.
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oncologic outcomes of segmentectomy compared with Lobectomy for clinical stage ia lung adenocarcinoma propensity score matched analysis in a multicenter study
The Journal of Thoracic and Cardiovascular Surgery, 2013Co-Authors: Yasuhiro Tsutani, Masahiro Yoshimura, Yoshihiro Miyata, Haruhiko Nakayama, Sakae Okumura, Shuji Adachi, Morihito OkadaAbstract:Objective Our objective was to compare the oncologic outcomes of Lobectomy and segmentectomy for clinical stage IA lung adenocarcinoma. Methods We examined 481 of 618 consecutive patients with clinical stage IA lung adenocarcinoma who underwent Lobectomy or segmentectomy after preoperative high-resolution computed tomography and F-18-fluorodeoxyglucose positron emission tomography/computed tomography. Patients (n = 137) who underwent wedge resection were excluded. Lobectomy (n = 383) and segmentectomy (n = 98) as well as surgical results were analyzed for all patients and their propensity score–matched pairs. Results Recurrence-free survival (RFS) and overall survival (OS) were not significantly different between patients undergoing Lobectomy (3-year RFS, 87.3%; 3-year OS, 94.1%) and segmentectomy (3-year RFS, 91.4%; hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.27-1.20; P = .14; 3-year OS, 96.9%; HR, 0.49; 95% CI, 0.17-1.38; P = .18). Significant differences in clinical factors such as solid tumor size ( P P P = .005; lobe, P = .001) were observed between both treatment groups. In 81 propensity score–matched pairs including variables such as age, gender, solid tumor size, SUVmax, side, and lobe, RFS and OS were similar between patients undergoing Lobectomy (3-year RFS, 92.9%, 3-year OS, 93.2%) and segmentectomy (3-year RFS, 90.9%; 3-year OS, 95.7%). Conclusions Segmentectomy is suitable for clinical stage IA lung adenocarcinoma, with survivals equivalent to those of standard Lobectomy.
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functional advantage after radical segmentectomy versus Lobectomy for lung cancer
The Annals of Thoracic Surgery, 2005Co-Authors: Hiroaki Harada, Morihito Okada, Toshihiko Sakamoto, Hidehito Matsuoka, Noriaki TsubotaAbstract:Background Although several reports have recently demonstrated that segmentectomy for small-sized N0 lung cancer leads to recurrence and survival rates equivalent to those associated with Lobectomy, controversy regarding the postoperative functional advantage in the former over the latter still persists. The purpose of this study was to evaluate the degree of postoperative functional loss in patients undergoing segmentectomy or Lobectomy for lung cancer. Methods We analyzed patients able to tolerate Lobectomy, who underwent radical segmentectomy (n = 38) or Lobectomy (n = 45) for non–small-cell lung cancer. Functional testing included forced vital capacity, forced expiratory volume in 1 second, and anaerobic threshold measured preoperatively and at 2 and 6 months after surgery. Results Preoperative function tests showed no differences between segmentectomy and Lobectomy patients. A positive and significant correlation was found between the number of resected segments versus loss of forced vital capacity ( r = 0.518, p r = 0.604, p r = 0.492, p r = 0.512, p p = 0.0006) and forced expiratory volume in 1 second ( p = 0.0007) was significantly less in the segmentectomy group; however, a marginally significant benefit was observed in this group for anaerobic threshold ( p = 0.0616). Conclusions The extent of removed lung parenchyma directly affected that of postoperative functional loss even at 6 months after surgery, and segmentectomy offered significantly better functional preservation compared with Lobectomy. These results indicate the importance of segmentectomy for early staged lung cancer.
