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Jun Nakajima - One of the best experts on this subject based on the ideXlab platform.
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Long-Term Outcomes of Open and Video-Assisted Thoracoscopic Lung Lobectomy for the Treatment of Early Stage Non-small Cell Lung Cancer are Similar: A Propensity-Matched Study
World Journal of Surgery, 2015Co-Authors: Tomohiro Murakawa, Junji Ichinose, Haruaki Hino, Kentaro Kitano, Chihiro Konoeda, Jun NakajimaAbstract:Background Generally, in retrospective studies, favourable short- and long-term outcomes for patients after Lung Lobectomy for early stage non-small cell Lung cancer (NSCLC) using video-assisted thoracoscopic surgery (VATS) have been reported. However, the interpretation of Lung Lobectomy outcomes may be biased in retrospective settings. Methods We retrospectively reviewed patients who underwent Lung Lobectomy for cT1-2N0M0 NSCLC from 2001 to 2010. The outcomes of patients who underwent VATS Lobectomy were compared to those who underwent open Lobectomy before and after performing propensity score matching. Preoperative covariates were entered when developing the propensity score-matching model. Results This study reviewed the outcomes of 101 VATS patients and 184 open Lobectomy patients. Before propensity score matching, the VATS group had a higher mean age ( p
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Long-term outcomes of open and video-assisted thoracoscopic Lung Lobectomy for the treatment of early stage non-small cell Lung cancer are similar: a propensity-matched study.
World journal of surgery, 2015Co-Authors: Tomohiro Murakawa, Junji Ichinose, Haruaki Hino, Kentaro Kitano, Chihiro Konoeda, Jun NakajimaAbstract:Background Generally, in retrospective studies, favourable short- and long-term outcomes for patients after Lung Lobectomy for early stage non-small cell Lung cancer (NSCLC) using video-assisted thoracoscopic surgery (VATS) have been reported. However, the interpretation of Lung Lobectomy outcomes may be biased in retrospective settings.
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Lung Lobectomy in a patient with an implantable left ventricular assist device
Interactive cardiovascular and thoracic surgery, 2011Co-Authors: Tomohiro Murakawa, Jun Nakajima, Tomonori Murayama, Minoru OnoAbstract:Non-cardiac surgical procedures in patients with left ventricular assist devices (LVADs) pose a special challenge given the hemodynamic and hematologic considerations in these patients. During pulmonary procedures in patients with LVADs, special attention should be paid to hemodynamics because Lung resection surgery requires a lateral decubitus position, single-Lung ventilation and postoperative decrease in the pulmonary vascular bed, all of which may lead to inadequate preload to the LVAD. We present a case of lower Lobectomy of the left Lung for an adenocarcinoma found in a patient with an implantable continuous-flow LVAD.
Kimikazu Hamano - One of the best experts on this subject based on the ideXlab platform.
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Assessment of volume reduction effect after Lung Lobectomy for cancer
The Journal of surgical research, 2015Co-Authors: Kazuhiro Ueda, Junichi Murakami, Fumiho Sano, Masataro Hayashi, Taiga Kobayashi, Yoshie Kunihiro, Kimikazu HamanoAbstract:Abstract Background Lung Lobectomy results in an unexpected improvement of the remaining Lung function in some patients with moderate-to-severe emphysema. Because the Lung function is the main limiting factor for therapeutic decision making in patients with Lung cancer, it may be advantageous to identify patients who may benefit from the volume reduction effect, particularly those with a poor functional reserve. Methods We measured the regional distribution of the emphysematous Lung and normal Lung using quantitative computed tomography in 84 patients undergoing Lung Lobectomy for cancer between January 2010 and December 2012. The volume reduction effect was diagnosed using a combination of radiologic and spirometric parameters. Results Eight patients (10%) were favorably affected by the volume reduction effect. The forced expiratory volume in one second increased postoperatively in these eight patients, whereas the forced vital capacity was unchanged, thus resulting in an improvement of the airflow obstruction postoperatively. This improvement was not due to a compensatory expansion of the remaining Lung but was associated with a relative decrease in the forced end-expiratory Lung volume. According to a multivariate analysis, airflow obstruction and the forced end-expiratory Lung volume were independent predictors of the volume reduction effect. Conclusions A combined assessment using spirometry and quantitative computed tomography helped to characterize the respiratory dynamics underlying the volume reduction effect, thus leading to the identification of novel predictors of a volume reduction effect after Lobectomy for cancer. Verification of our results by a large-scale prospective study may help to extend the indications for Lobectomy in patients with oncologically resectable Lung cancer who have a marginal pulmonary function.
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Physiological rehabilitation after video-assisted Lung Lobectomy for cancer: a prospective study of measuring daily exercise and oxygenation capacity
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 2006Co-Authors: Kazuhiro Ueda, Manabu Sudoh, Mitsutaka Jinbo, Kazuyoshi Suga, Kimikazu HamanoAbstract:Objective: Video-assisted thoracic surgery followed by fast-track rehabilitation has been claimed to accelerate physiological recovery after Lung Lobectomy for cancer; however, we are still uncertain when the exercise and oxygenation capacity recover and how to determine the rehabilitationtimerequiredbyeachpatient.Theaimofthisstudywastoevaluatetherehabilitationtimeafterthistypeofsurgeryanddetermine the best predictors of rehabilitation time. Methods: We measured exercise and oxygenation capacity daily during the perioperative period on a prospective series of 40 patients who had scheduled to undergo video-assisted Lung Lobectomy for cancer. Postoperative rehabilitation was confirmedwhenpatientshadregainedmorethan80%oftheirbaselineexercisecapacityandmorethan98%oftheirbaselineoxygenationcapacity without the use of routine tubes for oxygen supplementation, fluid transfusion, bladder catheterization, chest drainage, and epidural catheterization. The hypoxemia index, which we found to have correlated with early-postoperative oxygenation capacity, was calculated preoperatively using baseline arterial oxygen saturations and the severity of emphysema on computed tomography. Results: The median rehabilitation time was 3 days. Stepwise Cox regression analysis revealed that the postoperative predicted forced expiratory volume in 1 s (relative ratio 1.043, p < 0.01) and the hypoxemia index (relative ratio 1.343, p = 0.02) were the best independent determinants of the postoperative rehabilitation time. Conclusions: By conducting daily physiological assessments, we identified the rehabilitation time and its determinants in patients who underwent video-assisted Lung Lobectomy for cancer. Our results are valuable for planning patient-specific fasttrack surgery in the hospital setting.
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Role of quantitative CT in predicting hypoxemia and complications after Lung Lobectomy for cancer, with special reference to area of emphysema.
Chest, 2005Co-Authors: Kazuhiro Ueda, Manabu Sudoh, Kazuyoshi Suga, Yoshikazu Kaneda, Jinbo Mitsutaka, Nobuyuki Tanaka, Kimikazu HamanoAbstract:Study objectives: To determine the ability of quantitative CT, with special reference to area of emphysema, to predict early postoperative oxygenation capacity and outcome after Lung Lobectomy for cancer. Methods: Sixty-two consecutive patients scheduled to undergo Lung Lobectomy for cancer were enrolled in this study. The area of emphysema (< 910 Hounsfield units) was measured on a three-dimensional CT Lung model. Arterial oxygen saturation (SaO2) was calculated from PaO2 measured 1 day before and 1 day after surgery with patients at rest breathing room air. A patient was considered to have recovered at the completion of a standardized management regimen. Results: Postoperative SaO2 (postSaO2) was predicted by the baseline value and the area of emphysema with the use of a regression equation. Ten of the 62 patients (16%) had postoperative cardiopulmonary complications (CPCs). The median time to postoperative recovery was 3 days (range, 1 to 17 days). Predicted postSaO2 and predicted postoperative FEV1 were shown to be significant independent predictors of postoperative CPCs as well as postoperative recovery time. Conclusion: Determining the area of emphysema by quantitative CT is useful in predicting early postoperative oxygenation capacity. Predicted oxygenation capacity and predicted ventilatory capacity independently affect perioperative outcomes. Therefore, using quantitative CT in combination with spirometry may improve risk prediction in patients undergoing Lung Lobectomy for cancer. However, the role of quantitative CT in grading nonemphysematous Lung diseases, such as interstitial Lung diseases, must be investigated. (CHEST 2005; 128:3500–3506)
Thomas Schmid - One of the best experts on this subject based on the ideXlab platform.
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Robotic-assisted minimally invasive vs. thoracoscopic Lung Lobectomy: comparison of perioperative results in a learning curve setting
Langenbeck's archives of surgery, 2013Co-Authors: Florian Augustin, Johannes Bodner, Herbert Maier, Christoph Schwinghammer, Burkhard Pichler, Paolo Lucciarini, Johann Pratschke, Thomas SchmidAbstract:Purpose Minimally invasive Lung Lobectomy was introduced in the late 1990s. Since that time, various different approaches have been described. At our institution, two different minimally invasive approaches, a robotic and a conventional thoracoscopic one, were performed for pulmonary lobectomies. This study compares perioperative outcome of the two different techniques in a learning curve setting.
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Video-assisted thoracoscopic pneumonectomy: a minimally invasive approach for a rare inidication
memo - Magazine of European Medical Oncology, 2013Co-Authors: Herbert Maier, Paolo Lucciarini, Thomas Schmid, Florian AugustinAbstract:Minimally invasive video-assisted thoracoscopic surgery (VATS) is considered as an alternative to thoracotomy for early stage Lung cancer. Since 2009, we use a VATS approach for all early stage Lung tumors as well as benign indications for Lung Lobectomy. As experience with the technique is growing, indications are expanded. Here, we report our first minimally invasive pneumonectomies of two patients with non-small cell Lung cancer (NSCLC). Case 1: A 60-year-old man was diagnosed with a centrally located tumor of the right Lung invading all three lobes without any obvious lymph node metastasis in the preoperative work-up. The patient was scheduled for a right-sided VATS pneumonectomy. Case 2: A 62-year-old woman was diagnosed with a centrally located tumor of the left Lung with an ipsilateral positron emission tomography (PET) positive lymph node (aortopulmonary window). After neoadjuvant treatment, the patient was scheduled for a left-sided pneumonectomy. Written informed consent was given in both cases. The procedures were completed using three incisions. A complete mediastinal lymph node dissection was performed. The postoperative courses were uneventful. VATS pneumonectomy is feasible in highly selected cases. It offers all advantages known from minimally invasive Lung Lobectomy with less pain and faster rehabilitation, which might facilitate the delivery of adjuvant treatment.
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Perioperative results of robotic Lung Lobectomy: summary of literature.
Surgical endoscopy, 2011Co-Authors: Florian Augustin, Johannes Bodner, Christoph Schwinghammer, H. Wykypiel, Thomas SchmidAbstract:Dear Editor, We appreciate the interest in our manuscript [1] by Takagi and colleagues, resulting in a detailed analysis of the current literature [2]. After its introduction in cardiac surgery, thoracic surgeons were eager to adopt the robotic technique for minimally invasive thoracic surgery. While the technique offers benefits in mediastinal tumor resections [3] and has become the standard technique for minimally invasive thymectomies in many centers [4], studies comparing robotic and conventional minimally invasive Lung resections do not show any clear advantage for a robotic approach, as shown by Takagi and colleagues. Reports on larger series of robotic Lung Lobectomy and oncologic longterm outcomes are still missing. Only a few centers perform robotic Lobectomy regularly; fellowships in robotic thoracic surgery are rare. Furthermore, high acquisition and maintenance costs of the robotic system hinder its broad availability. In contrast, video-assisted thoracoscopic surgery (VATS) lobectomies have been performed since the early 1990s in numerous institutions, and fellowships in minimally invasive thoracic surgery are offered in many of them. Various case series and randomized and nonrandomized trials have been published documenting its feasibility and oncologic safety [5]. Takagi and colleagues conclude that median length of stay (LOS) of robotic patients is only half of that of VATS lobectomies (and open lobectomies), when compared to results of a meta-analysis of Yan and colleagues [6]. However, LOS is not only affected by recovery of patients, but also by different social systems. The results on median LOS in this meta-analysis are based on seven Japanese papers with median LOS of 15.4 days and six manuscripts from other countries (USA: 4; France 1; China: 1) with median LOS of 6.9 days. This highlights the regional differences in LOS. In our opinion, results of a comparison of median LOS with the meta-analysis from Yan et al. should be interpreted with caution, since none of the robotic lobectomies included in the pooled data of Takagi et al. were performed in Japan. Ideally, comparative studies should be performed within a single center to overcome regional differences in patient management. We recently performed a retrospective analysis of our own VATS Lobectomy patients and compared them with the robotic group; the manuscript summarizing this study is currently in progress. We agree with Takagi et al. that randomized studies are needed to finally answer the question of whether a robotic approach is superior to conventional minimally invasive Lobectomy. We share the authors’ enthusiasm for robotic thoracic surgery; however, it needs to be proven that superior perioperative and oncologic outcome warrant the higher procedural costs of a robotic approach.
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Initial experience with robotic Lung Lobectomy: report of two different approaches
Surgical endoscopy, 2010Co-Authors: Florian Augustin, Johannes Bodner, Christoph Schwinghammer, H. Wykypiel, Thomas SchmidAbstract:Background Surgical resection is the gold standard for treatment of early-stage Lung tumors. Different minimally invasive approaches are currently under investigation: In addition to conventional video-assisted thoracoscopic surgery (VATS), robotic technology with the da Vinci System has emerged over the past 10 years.
Yang Gao - One of the best experts on this subject based on the ideXlab platform.
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Clinical Outcomes And Cost-Effectiveness Of Different Staplers For Lung Lobectomy With Video-Assisted Thoracic Surgery.
Cancer management and research, 2019Co-Authors: Xiaoxiong Xiao, Chang Ruimin, Yang GaoAbstract:Purpose The aim of this study was to compare intra-operative adverse events (AE), post-operative outcomes, and costs of three different types of Echelon staplers (manual activated SC45A and electrical power-activated PSE45A & PSEE60A) used during video-assisted thoracic surgery (VATS) for Lung Lobectomy. Patients and methods We carried out a retrospective chart review of patients undergoing VATS lobectomies using one of three staplers (SC45A, PSE45A, or PSEE60A) during a 2-year period at our institution. We compared intra-operative AEs, post-operative outcomes (drainage volume, chest tube duration, prolonged air leaks [PALs]), endoscopic product costs [ECs], and hospitalization costs [HCs]) amongst the three stapler groups. Results In all 204 peripheral Lung cancer patients were included in the study (95 in the SC45A group, 72 in the PSE45A group, and 37 in the PSEE60A group). We observed intra-operative AEs in 6 patients of the SC45A group, in 4 of the PSE45A group, and in 1 of the PSEE60A group (P>0.05). Drainage volumes among the three groups were similar. The mean chest tube duration was shorter]st in the PSE45A group followed by those in the PSEE60A and SC45A groups (P
Florian Augustin - One of the best experts on this subject based on the ideXlab platform.
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Robotic-assisted minimally invasive vs. thoracoscopic Lung Lobectomy: comparison of perioperative results in a learning curve setting
Langenbeck's archives of surgery, 2013Co-Authors: Florian Augustin, Johannes Bodner, Herbert Maier, Christoph Schwinghammer, Burkhard Pichler, Paolo Lucciarini, Johann Pratschke, Thomas SchmidAbstract:Purpose Minimally invasive Lung Lobectomy was introduced in the late 1990s. Since that time, various different approaches have been described. At our institution, two different minimally invasive approaches, a robotic and a conventional thoracoscopic one, were performed for pulmonary lobectomies. This study compares perioperative outcome of the two different techniques in a learning curve setting.
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Video-assisted thoracoscopic pneumonectomy: a minimally invasive approach for a rare inidication
memo - Magazine of European Medical Oncology, 2013Co-Authors: Herbert Maier, Paolo Lucciarini, Thomas Schmid, Florian AugustinAbstract:Minimally invasive video-assisted thoracoscopic surgery (VATS) is considered as an alternative to thoracotomy for early stage Lung cancer. Since 2009, we use a VATS approach for all early stage Lung tumors as well as benign indications for Lung Lobectomy. As experience with the technique is growing, indications are expanded. Here, we report our first minimally invasive pneumonectomies of two patients with non-small cell Lung cancer (NSCLC). Case 1: A 60-year-old man was diagnosed with a centrally located tumor of the right Lung invading all three lobes without any obvious lymph node metastasis in the preoperative work-up. The patient was scheduled for a right-sided VATS pneumonectomy. Case 2: A 62-year-old woman was diagnosed with a centrally located tumor of the left Lung with an ipsilateral positron emission tomography (PET) positive lymph node (aortopulmonary window). After neoadjuvant treatment, the patient was scheduled for a left-sided pneumonectomy. Written informed consent was given in both cases. The procedures were completed using three incisions. A complete mediastinal lymph node dissection was performed. The postoperative courses were uneventful. VATS pneumonectomy is feasible in highly selected cases. It offers all advantages known from minimally invasive Lung Lobectomy with less pain and faster rehabilitation, which might facilitate the delivery of adjuvant treatment.
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Perioperative results of robotic Lung Lobectomy: summary of literature.
Surgical endoscopy, 2011Co-Authors: Florian Augustin, Johannes Bodner, Christoph Schwinghammer, H. Wykypiel, Thomas SchmidAbstract:Dear Editor, We appreciate the interest in our manuscript [1] by Takagi and colleagues, resulting in a detailed analysis of the current literature [2]. After its introduction in cardiac surgery, thoracic surgeons were eager to adopt the robotic technique for minimally invasive thoracic surgery. While the technique offers benefits in mediastinal tumor resections [3] and has become the standard technique for minimally invasive thymectomies in many centers [4], studies comparing robotic and conventional minimally invasive Lung resections do not show any clear advantage for a robotic approach, as shown by Takagi and colleagues. Reports on larger series of robotic Lung Lobectomy and oncologic longterm outcomes are still missing. Only a few centers perform robotic Lobectomy regularly; fellowships in robotic thoracic surgery are rare. Furthermore, high acquisition and maintenance costs of the robotic system hinder its broad availability. In contrast, video-assisted thoracoscopic surgery (VATS) lobectomies have been performed since the early 1990s in numerous institutions, and fellowships in minimally invasive thoracic surgery are offered in many of them. Various case series and randomized and nonrandomized trials have been published documenting its feasibility and oncologic safety [5]. Takagi and colleagues conclude that median length of stay (LOS) of robotic patients is only half of that of VATS lobectomies (and open lobectomies), when compared to results of a meta-analysis of Yan and colleagues [6]. However, LOS is not only affected by recovery of patients, but also by different social systems. The results on median LOS in this meta-analysis are based on seven Japanese papers with median LOS of 15.4 days and six manuscripts from other countries (USA: 4; France 1; China: 1) with median LOS of 6.9 days. This highlights the regional differences in LOS. In our opinion, results of a comparison of median LOS with the meta-analysis from Yan et al. should be interpreted with caution, since none of the robotic lobectomies included in the pooled data of Takagi et al. were performed in Japan. Ideally, comparative studies should be performed within a single center to overcome regional differences in patient management. We recently performed a retrospective analysis of our own VATS Lobectomy patients and compared them with the robotic group; the manuscript summarizing this study is currently in progress. We agree with Takagi et al. that randomized studies are needed to finally answer the question of whether a robotic approach is superior to conventional minimally invasive Lobectomy. We share the authors’ enthusiasm for robotic thoracic surgery; however, it needs to be proven that superior perioperative and oncologic outcome warrant the higher procedural costs of a robotic approach.
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Initial experience with robotic Lung Lobectomy: report of two different approaches
Surgical endoscopy, 2010Co-Authors: Florian Augustin, Johannes Bodner, Christoph Schwinghammer, H. Wykypiel, Thomas SchmidAbstract:Background Surgical resection is the gold standard for treatment of early-stage Lung tumors. Different minimally invasive approaches are currently under investigation: In addition to conventional video-assisted thoracoscopic surgery (VATS), robotic technology with the da Vinci System has emerged over the past 10 years.
