PubMed Posts

Background: The aim of this study was to evaluate the technical feasibility and safety of a hybrid surgical approach of video-assisted minithoracotomy (hybrid VATS) sleeve lobectomy for non-small-cell lung cancer (NSCLC), using success rate as the primary end point.

Methods: Between February 1996 and December 2006, patients with bronchogenic tumors were prospectively registered to undergo hybrid VATS sleeve resection in a single institution. Hybrid VATS involved performing the main procedures via rib spreading and minithoracotomy using a monitor and direct vision. A successful procedure was defined as a patient who had a sleeve lobectomy via hybrid VATS without conversion to thoracotomy and without significant perioperative morbidity or mortality.

Results: A total of 148 patients (108 men and 40 women; median age = 58 years) who underwent hybrid VATS sleeve lobectomy for NSCLC were identified in our database. The median duration of the successfully completed procedures was 190 min (range = 145-305 min). The median length of time of chest tube in place was 3 days (range = 1-12 days). Hybrid VATS sleeve lobectomy was performed successfully in 134 of 148 patients for a success rate of 90.5%. The median follow-up period was 65.1 months (range = 34.5-154.8 months). The overall 5-year disease-free survival and overall survival of all patients were 36.7% (95% CI = 27.9-45.5%) and 54.2% (95% CI = 44.8-63.6%), respectively.

Conclusion: Hybrid VATS sleeve lobectomy is feasible for selected patients with NSCLC in specialized centers.

Background: To compare the outcomes and costs of two methods of video-assisted thoracoscopic surgery (VATS) major pulmonary resection in patients with clinically resectable non-small cell lung cancer (NSCLC).

Methods: Between January 2000 and December 2007, 1,058 patients with proven stages I-IIIA NSCLC underwent complete VATS (c-VATS) or assisted VATS (a-VATS) major pulmonary resection together with a systematic nodal dissection.

Results: The study cohort consisted of 736 men and 322 women. Mean operative time was shorter for the a-VATS cohort compared with the c-VATS group (P = 0.038). Overall survival (OS) at 5 years based on Kaplan-Meier analysis was 55.3% (95%CI, 50.6-60.0%) for those who underwent c-VATS and 47.7% (95%CI, 41.2-54.2%) for those who underwent a-VATS (P = 0.404). Gender, final pathology, TNM stage, and pT status were significant predictive factors for OS according to multivariate analysis. The total cost of a-VATS lobectomy was lower than that of c-VATS lobectomy.

Conclusions: c-VATS and a-VATS yield similar results in patients with clinically resectable NSCLC. a-VATS, however, may be less expensive and easier to adopt, making it a particularly attractive option for thoracic surgeons in developing countries.

Background: Patients with liver metastases from pancreatic adenocarcinomas have a dismal prognosis. Surgical resection remains the only curative option but is appropriate for only a minority of patients as a treatment option. This is the first study to examine the safety and efficacy of radioembolization with yttirum-90 microspheres for these patients.

Patients and methods: All patients with histologically proven pancreatic carcinoma liver metastases referred to a single institution from 2006-2009 were included in the study. After radioembolization, follow-up abdominal computed tomography scans were performed to assess response according to the Response Criteria in Solid Tumors guidelines.

Results: Seven patients were identified from our prospectively collected data base. Of the five patients with available computed tomography follow-up, 2 patients achieved a partial response and 1 patient had stable disease. One patient with partial response survived for nearly 15 months after radioembolization therapy. No patient experienced major post-radioembolization complications.

Conclusions: Radioembolization with yttrium-90 microspheres may have a useful role in treating patients with pancreatic carcinoma liver metastases in a multimodality setting. Results of the current study warrant further investigation of this novel treatment.

Background: The purpose of the present study was to assess the value of matrix metalloproteinase (MMP)-2 and MMP-9 expression and other potential prognostic factors in predicting the clinical outcome of patients after definitive surgery for pathologic stage IA non-small cell lung cancer (NSCLC).

Methods: One hundred and forty-six consecutive and non-selected patients who underwent definitive surgery for stage IA NSCLC were included in this study. Formalin-fixed paraffin-embedded specimens were stained for MMP-2 and MMP-9, which were statistically evaluated for their prognostic value and other clinicopathological parameters.

Results: Of the 146 patients studied, 102 (69.9%) cases were classified as having high expression for MMP-2. A total of 89 carcinomas (61.0%) had high expression for MMP-9. MMP-9 expression correlated with Eastern Cooperative Oncology Group (ECOG) performance status, pT stage, and differentiation (P = 0.005, <0.001, and <0.001, respectively). Vessel invasion, pT stage, and MMP-9 expression maintained their independent prognostic influence on overall survival (P = 0.037, <0.001, and <0.001, respectively).

Conclusions: From results of our relatively large database, MMP-9 may be considered as a viable biomarker that can be used in conjunction with other prognostic factors such as vessel invasion and pT stage to predict the prognosis of patients with completely resected pathologic stage IA NSCLC

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This review aims to evaluate systematically the safety and efficacy of percutaneous left atrial appendage occlusion (PLAAO) in stroke prevention for patients with atrial fibrillation (AF). A systematic review of peer-reviewed journals on PLAAO before June 2011 was performed on three electronic databases. Fourteen studies were identified for evaluation. Overall, implantation was successful in 93% of all cases. Periprocedural mortality and stroke rates were 1.1% and 0.6%, respectively. The incidences of pericardial effusion/cardiac tamponade and device embolisation were 4% and 0.7%, respectively. At the time of the latest follow-up (up to 40 months), the overall incidence of stroke among all studies was 1.4% per annum. Existing evidence suggests that PLAAO is a relatively safe treatment for patients with AF. However, there is a need for further evaluation of its efficacy in the form of large and well-designed randomised controlled trials.

Objectives: This meta-analysis aimed to compare the perioperative outcomes of video-assisted thoracic surgery (VATS) with open thoracotomy for propensity score-matched patients with early-stage non-small cell lung cancer (NSCLC).

Methods: Four relevant studies with propensity score-matched patients were identified from six electronic databases. Endpoints included perioperative mortality and morbidity, individual postoperative complications and duration of hospitalization.

Results: Results indicate that all-cause perioperative mortality was similar between VATS and open thoracotomy. However, patients who underwent VATS were found to have significantly fewer overall complications, and significantly lower rates of prolonged air leak, pneumonia, atrial arrhythmias and renal failure. In addition, patients who underwent VATS had a significantly shorter length of hospitalization compared with those who underwent open thoracotomy.

Conclusions: In view of a paucity of high-level clinical evidence in the form of large, well-designed randomized controlled trials, propensity score matching may provide the highest level of evidence to compare VATS with open thoracotomy for patients with NSCLC. The present meta-analysis demonstrated superior perioperative outcomes for patients who underwent VATS, including overall complication rates and duration of hospitalization.

Introduction: Pleurectomy/decortication (P/D) in the treatment of malignant pleural mesothelioma includes a number of procedures with different clinical indications and therapeutic intents. To unify the nomenclature, IMIG and IASLC recently defined P/D-related procedures according to surgical technique, including ‘extended P/D’, ‘P/D’ and ‘partial pleurectomy’. The present systematic review aimed to assess the safety and efficacy of these techniques.

Methods: A systematic review of relevant studies was performed by electronic search of five online databases from 1985 to 2012 by two independent reviewers according to predefined selection criteria.

Results: Thirty-four studies involving 1916 patients who underwent pleurectomy were included for quantitative analysis. These included 12 studies on ‘extended P/D’, 8 studies on ‘P/D’ and 14 studies on ‘partial pleurectomy’. Perioperative mortality ranged from 0% to 11% and perioperative morbidity ranged from 13% to 43%. Median overall survival ranged from 7.1 to 31.7 months and disease-free survival ranged from 6 to 16 months. One study reported on quality-of-life outcomes using a standardized questionnaire suggesting superior outcomes for ‘extended P/D’ compared to extrapleural pneumonectomy.

Conclusions: Results of the present systematic review suggested similar perioperative mortality outcomes between different P/D techniques but a trend towards higher morbidity and length of hospitalization for patients who underwent ‘extended P/D’. However, overall and disease-free survival appeared to favour ‘extended P/D’ compared to less aggressive techniques. Future studies on P/D should adhere to recent definitions to enable accurate analysis of similar procedures. Direct comparisons of pleurectomy to extrapleural pneumonectomy remain challenging, and should be restricted to ‘extended P/D’ procedures only.

Objectives: Comparative long-term survival and oncological outcomes for patients with non-small-cell lung cancer (NSCLC) who undergo video-assisted thoracic surgery (VATS) or conventional open lobectomy remain uncertain. We conducted a multi-institutional propensity-matched study to stratify potential differences in these outcomes.

Methods: We established a multi-institutional registry for 4312 patients with NSCLC who underwent lobectomy between 2001 and 2008 from eight institutions in the People’s Republic of China. Age, gender, histological type and tumour staging were entered into a non-parsimonious multivariable logistic regression model to assess long-term survival outcomes. The predicted probability derived from the logistic equation was used as the propensity score for each individual. Based on similar propensity scores, we matched 1458 of the 1700 patients who underwent VATS lobectomy with 1458 of the 2612 patients who underwent open lobectomy and compared their long-term survival outcomes.

Results: The mean age of the 2916 matched patients was 59 (standard deviation = 11) years. After propensity-matching, VATS and open lobectomy patients were similar in regards to important prognostic variables. Three prognostic factors were independently associated with improved survival in the multivariate analysis: age < 60 (P < 0.001), female gender (P = 0.013) and pathological staging (P < 0.001). Patients who underwent VATS vs open lobectomy had similar long-term survival (P = 0.07).

Conclusions: The current propensity score analysis suggests that well-matched patients with NSCLC who underwent standardized VATS lobectomy had similar long-term survival outcomes when compared with those who underwent open lobectomy.