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Rodney J. Landreneau - One of the best experts on this subject based on the ideXlab platform.
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Intraoperative brachytherapy following thoracoscopic Wedge Resection of stage I lung cancer.
Chest, 1998Co-Authors: Thomas A. D'amato, Michael Galloway, Gary Szydlowski, Alex Chen, Rodney J. LandreneauAbstract:Study objectives Local recurrence is high when sublobar Resection is chosen as primary management of stage I non-small cell lung carcinoma. Postoperative external-beam radiotherapy may reduce this local recurrence problem. A technique of intraoperative brachyradiotherapy following thoracoscopic Wedge Resection is described as an alternative to adjuvant external-beam radiotherapy for high-risk patients who are not candidates for pulmonary lobectomy. Patients Fourteen patients with significant impairment in cardiopulmonary function having small peripheral solitary pulmonary nodules underwent video-assisted thoracoscopic (VATS) Wedge Resection and were found to have non-small cell cancer. Surgical margins were pathologically clear and mediastinal nodes were benign—stage I (TINO). Interventions A custom polyglyconate mesh (Vicryl) containing 125 I seeds was applied to pulmonary Resection margins following Wedge Resection of peripheral lung cancers. A total dose of 100 to 120 Gy at 1 cm was applied to the target area. Results All patients had histologically clear surgical margins. Postoperative dosimetry confirmed adequate Resection margin coverage. There was neither operative mortality nor morbidity related to the VATS Wedge Resection or the brachytherapy implants. Implants did not migrate, and there were no cases of significant radiation pneumonitis or local recurrence at mean follow-up of 7 months (range, 2 to 12 months). Conclusions Intraoperative brachytherapy appears to be a safe and efficient alternative to external-beam radiation therapy when adjuvant radiotherapy is considered following therapeutic Wedge Resection of stage I (TINO) lung cancers. The impact on local recurrence, disease-free interval, and survival will require additional follow-up.
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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, David J. Sugarbaker, Michael J. Mack, Stephen R. Hazelrigg, James D. Luketich, 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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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, David J. Sugarbaker, Michael J. Mack, Stephen R. Hazelrigg, James D. Luketich, Lynda S. Fetterman, Michael J. Liptay, Susan Bartley, Theresa M. Boley, Robert J. KeenanAbstract: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. 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. 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). 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.
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Cost analysis for thoracoscopy: thoracoscopic Wedge Resection.
The Annals of thoracic surgery, 1993Co-Authors: Stephen R. Hazelrigg, Rodney J. Landreneau, Michael J. Mack, Susan Nunchuck, Keith S. Naunheim, Paul E. Seifert, James E. AuerAbstract:Abstract Video-assisted thoracic surgery (VATS) procedures are now being performed with increasing frequency. The instrumentation and video equipment continue to evolve and much of this new technology is expensive. We reviewed our experience with VATS in our most recent 150 cases for the purpose of cost analysis. The costs incurred in patients undergoing VATS Wedge Resection for nodules (n = 45) were compared with those in similar patients having Wedge Resection using open techniques (n = 31). We found that patients who undergo open Resections were more likely to spend time in the intensive care unit after surgery. The anesthesia costs were similar in the two groups. Disposable instrument costs were $623 higher for VATS Resection; however, the operative time was shorter (101.4 minutes for VATS versus 122.5 minutes for the open procedure), making the total operating room costs comparable. The length of hospital stay was shorter after VATS Resection (4.4 days for VATS versus 6.5 days for the open procedure), resulting in lower total hospital changes in the VATS group; however, this difference was not statistically significant. The cost of a VATS Wedge Resection for removing peripheral nodules is competitive with that of open techniques. Additional benefits, such as reduced pain, shorter operating times, and decreased hospital stays, make thoracoscopy a valuable diagnostic tool. The length of hospital stay, operating room time, disposable instrument costs, complications, and patient acuity all have an impact on the total costs and vary for different procedures. The operative time has shortened and the use of disposable instrumentation has lessened as our experience with thoracoscopy has increased. These changes ultimately have a favorable impact on the overall costs.
Robert J. Keenan - One of the best experts on this subject based on the ideXlab platform.
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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, David J. Sugarbaker, Michael J. Mack, Stephen R. Hazelrigg, James D. Luketich, 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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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, David J. Sugarbaker, Michael J. Mack, Stephen R. Hazelrigg, James D. Luketich, Lynda S. Fetterman, Michael J. Liptay, Susan Bartley, Theresa M. Boley, Robert J. KeenanAbstract: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. 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. 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). 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.
Stephen R. Hazelrigg - One of the best experts on this subject based on the ideXlab platform.
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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, David J. Sugarbaker, Michael J. Mack, Stephen R. Hazelrigg, James D. Luketich, 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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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, David J. Sugarbaker, Michael J. Mack, Stephen R. Hazelrigg, James D. Luketich, Lynda S. Fetterman, Michael J. Liptay, Susan Bartley, Theresa M. Boley, Robert J. KeenanAbstract: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. 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. 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). 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.
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Cost analysis for thoracoscopy: thoracoscopic Wedge Resection.
The Annals of thoracic surgery, 1993Co-Authors: Stephen R. Hazelrigg, Rodney J. Landreneau, Michael J. Mack, Susan Nunchuck, Keith S. Naunheim, Paul E. Seifert, James E. AuerAbstract:Abstract Video-assisted thoracic surgery (VATS) procedures are now being performed with increasing frequency. The instrumentation and video equipment continue to evolve and much of this new technology is expensive. We reviewed our experience with VATS in our most recent 150 cases for the purpose of cost analysis. The costs incurred in patients undergoing VATS Wedge Resection for nodules (n = 45) were compared with those in similar patients having Wedge Resection using open techniques (n = 31). We found that patients who undergo open Resections were more likely to spend time in the intensive care unit after surgery. The anesthesia costs were similar in the two groups. Disposable instrument costs were $623 higher for VATS Resection; however, the operative time was shorter (101.4 minutes for VATS versus 122.5 minutes for the open procedure), making the total operating room costs comparable. The length of hospital stay was shorter after VATS Resection (4.4 days for VATS versus 6.5 days for the open procedure), resulting in lower total hospital changes in the VATS group; however, this difference was not statistically significant. The cost of a VATS Wedge Resection for removing peripheral nodules is competitive with that of open techniques. Additional benefits, such as reduced pain, shorter operating times, and decreased hospital stays, make thoracoscopy a valuable diagnostic tool. The length of hospital stay, operating room time, disposable instrument costs, complications, and patient acuity all have an impact on the total costs and vary for different procedures. The operative time has shortened and the use of disposable instrumentation has lessened as our experience with thoracoscopy has increased. These changes ultimately have a favorable impact on the overall costs.
Michael J. Mack - One of the best experts on this subject based on the ideXlab platform.
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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, David J. Sugarbaker, Michael J. Mack, Stephen R. Hazelrigg, James D. Luketich, 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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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, David J. Sugarbaker, Michael J. Mack, Stephen R. Hazelrigg, James D. Luketich, Lynda S. Fetterman, Michael J. Liptay, Susan Bartley, Theresa M. Boley, Robert J. KeenanAbstract: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. 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. 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). 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.
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Cost analysis for thoracoscopy: thoracoscopic Wedge Resection.
The Annals of thoracic surgery, 1993Co-Authors: Stephen R. Hazelrigg, Rodney J. Landreneau, Michael J. Mack, Susan Nunchuck, Keith S. Naunheim, Paul E. Seifert, James E. AuerAbstract:Abstract Video-assisted thoracic surgery (VATS) procedures are now being performed with increasing frequency. The instrumentation and video equipment continue to evolve and much of this new technology is expensive. We reviewed our experience with VATS in our most recent 150 cases for the purpose of cost analysis. The costs incurred in patients undergoing VATS Wedge Resection for nodules (n = 45) were compared with those in similar patients having Wedge Resection using open techniques (n = 31). We found that patients who undergo open Resections were more likely to spend time in the intensive care unit after surgery. The anesthesia costs were similar in the two groups. Disposable instrument costs were $623 higher for VATS Resection; however, the operative time was shorter (101.4 minutes for VATS versus 122.5 minutes for the open procedure), making the total operating room costs comparable. The length of hospital stay was shorter after VATS Resection (4.4 days for VATS versus 6.5 days for the open procedure), resulting in lower total hospital changes in the VATS group; however, this difference was not statistically significant. The cost of a VATS Wedge Resection for removing peripheral nodules is competitive with that of open techniques. Additional benefits, such as reduced pain, shorter operating times, and decreased hospital stays, make thoracoscopy a valuable diagnostic tool. The length of hospital stay, operating room time, disposable instrument costs, complications, and patient acuity all have an impact on the total costs and vary for different procedures. The operative time has shortened and the use of disposable instrumentation has lessened as our experience with thoracoscopy has increased. These changes ultimately have a favorable impact on the overall costs.
Reza J Mehran - One of the best experts on this subject based on the ideXlab platform.
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local failure after stereotactic body radiation therapy or Wedge Resection for colorectal pulmonary metastases
The Journal of Thoracic and Cardiovascular Surgery, 2019Co-Authors: David B Nelson, Nabihah Tayob, Quynh Nhu Nguyen, Jeremy J Erasmus, Kyle G Mitchell, Wayne L Hofstetter, Boris Sepesi, Mara B Antonoff, Reza J MehranAbstract:Abstract Objective Several options are available for the local treatment of colorectal pulmonary metastases; however, the efficacy of each treatment has not been well characterized. We compared the risk of local recurrence after Wedge Resection or stereotactic body radiation therapy for pulmonary metastases of colorectal origin. Methods We retrospectively reviewed records of patients treated for pulmonary colorectal metastases with stereotactic body radiation therapy or Wedge Resection from 2006 to 2016 at a single institution. Local recurrence was defined as an enlarging nodule either adjacent to the staple line or within the radiation field on computed tomography. Matching weights using the propensity score with death as a competing event was used to estimate the risk of local recurrence for each metastatic nodule. Results A total of 381 patients underwent 762 Wedge Resections and 64 courses of stereotactic body radiation therapy for definitive treatment of 826 pulmonary nodules. The risk of local recurrence was increased with stereotactic body radiation therapy (hazard ratio, 3.28; 95% confidence interval, 1.53-7.04; P = .002) and larger tumor size (hazard ratio, 1.38 per additional centimeter; 95% confidence interval, 1.01-1.87; P = .042). After reweighting with matching weights, the marginal 2-year risk of local recurrence for each nodule was 14.1% (95% confidence interval, 9.8-18.5) after Wedge Resection and 29.4% (95% confidence interval, 13.8-45.0) after stereotactic body radiation therapy (P = .023). Conclusions Pulmonary colorectal metastases treated with stereotactic body radiation therapy have a higher risk of local recurrence than those treated with Wedge Resection. Stereotactic body radiation therapy should be reserved for patients with comorbidities precluding surgical Resection.
