Video-Assisted Thoracic Surgery (VATS) Lobectomy: Focus on Technique

Background  

A clear definition of video-assisted thoracic surgery (VATS) lobectomy is lacking in the current peer-reviewed literature. Reported cases vary from four to six incisions in number, 4.0 to 10.0 cm in length, and with and without rib spreading; in addition, they include direct visualization through a utility incision. Described is a complete standardized three-incision thoracoscopic technique that maximizes the benefits of minimally invasive surgery without compromising oncologic principles.     

全胸腔镜联合非气腹腹腔镜辅助食管癌根治术与常规手术的对比研究

目的探讨全胸腔镜联合非气腹腹腔镜辅助食管癌根治术较常规开胸手术的优势。方法 2006年11月～2008年5月施行电视胸腔镜联合非气腹腹腔镜辅助食管癌根治术111例(研究组),同期施行常规开胸手术110例(对照组),比较2组患者临床疗效。结果研究组手术时间(272.3±57.9)min显著长于对照组(218.7±91.0)min(t=5.229,P=0.000);研究组术中出血量(219.7±194.4)ml显著少于对照组(590.0±324.4)ml(t=-10.304,P=0.000);研究组术后住院时间(9.6±1.7)d显著短于对照组(11.4±2.3)d(t=6.620,P=0.000)。研究组术后切口液化发生率为0,显著低于对照组6.3%(7/111)(P=0.007)。对照组清扫淋巴结(39.2±12.5)枚,显著少于研究组(44.3±21.0)枚(t=-2.191,P=0.029)。2组病人术后生存率无统计学差异(log-rank检验,χ2=0.348,P=0.555)。结论 全胸腔镜联合非气腹腹腔镜辅助食管癌根治术出血少、恢复快、并发症少、淋巴结清扫更彻底,尽管手术时间较常规手术长,但远期疗效与常规手术相同。     

Survival After Thoracoscopic Surgery or Open Lobectomy: Systematic Review and Meta-Analysis

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Long-Term Outcomes After Laparoscopic Surgery Versus Open Surgery for Rectal Cancer: A Propensity Score Analysis

Background

The aim of this study was to compare the long-term outcomes of laparoscopy-assisted surgery (LAP) with those for open surgery (OS) when excising nonmetastatic rectal cancers.

Methods

We reviewed the prospectively collected records of all patients (n = 1,009) undergoing OS or LAP from January 2000 to November 2008 at Kyungpook National University Hospital. We undertook propensity score analyses and compared outcomes for the OS and LAC groups in a 1:1 matched cohort. Covariates in the model for propensity scores included age, gender, preoperative tumor marker level, preoperative chemoradiation status, tumor height from the anal verge, and clinical tumor stage. Subgroup analysis was conducted to evaluate the oncologic safety of LAP in patients with extraperitoneal rectal cancers.

Results

There were no significant differences in mortality, morbidity, and pathological quality in the propensity-matched cohort (n = 812). The combined 3-year local recurrence rate for all tumor stages was 3.8 % (95 % confidence intervals [95 % CI], 1.9–5.7 %) in the LAP group and 5.9 % (95 % CI, 3.9–8.3 %) in the OS group (P = .089 by log-rank test). The combined 3-year disease-free survival for all stages was 80.5 % (95 % CI, 76.6–84.4 %) in the LAP group and 82.9 % (95 % CI 79.2–86.6 %) in the OS group (P = .516 by log-rank test). Similar results were confirmed for the subgroup of patients with extraperitoneal rectal cancers.

Conclusions

Laparoscopic rectal excision for rectal cancer is feasible and safe with acceptable oncologic outcomes. Further prospective multicenter trials are warranted before incorporating this technology into routine surgical care.     

Long-Term Survival After Complications Following Major Abdominal Surgery

Introduction

Postoperative complications have been associated with decreased long-term survival in cardiac, orthopedic, and vascular surgery. For major abdominal surgery research, conflicting evidence is reported in smaller studies. The aim of this study was to assess the effect of complications on long-term survival in major abdominal surgery.

Material and Methods

An observational cohort study was conducted of 861 consecutive patients that underwent major abdominal surgery between January 2009 and March 2014, with prospective assessment of the survival status. The effect of postoperative complications on survival was assessed.

Results

Postoperative complications were associated with decreased survival, even after applying correction for 30-day mortality (p?<?0.001). Stratified Cox regression analysis depicted postoperative complications to be an important predictor for survival in upper gastrointestinal and female hepatopancreaticobiliary patients. Correction was applied for age, gender, BMI, ASA classification, radicality, and positive lymph node status.

Conclusion

These results further indicate the importance of prevention and early diagnosis and treatment of complications. Etiological factors are believed to be both sustained levels of inflammatory markers, as well as attenuated immune response in malignancy with subsequent cancer cell seeding. Future research should aim to prevent and early diagnose postoperative complications to prevent morbidity and mortality not only in the early postoperative phase, but also in the long term.

     

Long-Term Outcomes of Reoperation for Bleeding After Cardiac Surgery

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