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. 2018 Jan;10(1):416-431.
doi: 10.21037/jtd.2017.12.70.

Presence of pleural adhesions can predict conversion to thoracotomy and postoperative surgical complications in patients undergoing video-assisted thoracoscopic lung cancer lobectomy

Shuang-Jiang Li  1 , Kun Zhou  1 , Yan-Ming Wu  1 , Ming-Ming Wang  1 , Cheng Shen  1 , Zhi-Qiang Wang  2 , Guo-Wei Che  1 , Lun-Xu Liu  1
Affiliations

Presence of pleural adhesions can predict conversion to thoracotomy and postoperative surgical complications in patients undergoing video-assisted thoracoscopic lung cancer lobectomy

Shuang-Jiang Li et al. J Thorac Dis. 2018 Jan.

Abstract

Background: The purpose of our cohort study was to investigate the effects of pleural adhesions on perioperative outcomes in patients undergoing video-assisted thoracoscopic surgery (VATS) lobectomy for non-small-cell lung cancer (NSCLC).

Methods: We performed a single-center retrospective analysis on the prospectively-maintained dataset at our unit from February 2014 to November 2015. Patients were divided into two groups (Group A: presence of pleural adhesions; Group B: absence of pleural adhesions) according to our grading system of pleural adhesions when entering the chest cavity. Demographic differences in perioperative outcomes between these two groups were initially estimated. A multivariate logistic-regression analysis was then performed to confirm the predictive value of the presence of pleural adhesions.

Results: A total of 593 NSCLC patients undergoing VATS lobectomy were enrolled. The conversion and postoperative morbidity rates were 3.2% and 29.2%, respectively. There were 154 patients with pleural adhesions (Group A) and 439 patients without pleural adhesions (Group B). Group A patients had significantly higher rates of conversion to thoracotomy (9.1% vs. 1.1%; P<0.001) and surgical complications (24.0% vs. 14.4%; P=0.006) than those of Group B patients. No significant difference was found in the overall morbidity and cardiopulmonary complication rates between these two groups. The presence of pleural adhesions was also significantly associated with the prolonged length of chest tube drainage (log-rank P<0.001) and length of stay (log-rank P=0.032). Finally, the presence of pleural adhesions was identified as an independent risk factor for conversion to thoracotomy [odds ratio (OR) =5.49; P=0.003] and surgical complications (OR =1.94; P=0.033) by multivariate logistic-regression analyses.

Conclusions: Presence of pleural adhesions can predict conversion to thoracotomy and postoperative surgical complications in patients undergoing VATS lobectomy for NSCLC. Our study calls for an internationally accepted grading system for the presence of pleural adhesions to stratify the surgical risk.

Keywords: Pleural adhesions; lobectomy; non-small cell lung cancer (NSCLC); video-assisted thoracoscopic surgery (VATS).

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Classifications of the pleural adhesions. SDense%, percentage of the area of dense pleural adhesions requiring sharp dissections with the electrocautery or energy device over the inner surface of the pleural cavity; SOverall%, percentage of the area of overall pleural adhesions (both ‘dense’ and ‘loose’) over the inner surface of the pleural cavity.
Figure 2
Figure 2
Histogram revealing the proportions of different degrees of pleural adhesions.
Figure 3
Figure 3
Tendency of major perioperative events with the increasing severity of pleural adhesions.
Figure 4
Figure 4
Kaplan-Meier curve for the length of chest tube drainage between patients with and without pleural adhesions.
Figure 5
Figure 5
Kaplan-Meier curve for the length of stay between patients with and without pleural adhesions.
See this image and copyright information in PMC

References

    1. Li S, Wang Z, Huang J, et al. Systematic review of prognostic roles of body mass index for patients undergoing lung cancer surgery: does the 'obesity paradox' really exist? Eur J Cardiothorac Surg 2017;51:817-28. - PubMed
    1. Li S, Zhou K, Du H, et al. Body surface area is a novel predictor for surgical complications following video-assisted thoracoscopic surgery for lung adenocarcinoma: a retrospective cohort study. BMC Surg 2017;17:69. 10.1186/s12893-017-0264-4 - DOI - PMC - PubMed
    1. Laursen LØ, Petersen RH, Hansen HJ, et al. Video-assisted thoracoscopic surgery lobectomy for lung cancer is associated with a lower 30-day morbidity compared with lobectomy by thoracotomy. Eur J Cardiothorac Surg 2016;49:870-5. 10.1093/ejcts/ezv205 - DOI - PubMed
    1. Li S, Zhou K, Wang M, et al. Degree of pulmonary fissure completeness can predict postoperative cardiopulmonary complications and length of hospital stay in patients undergoing video-assisted thoracoscopic lobectomy for early-stage lung cancer. Interact Cardiovasc Thorac Surg 2018;26:25-33. 10.1093/icvts/ivx261 - DOI - PubMed
    1. Li SJ, Zhou K, Shen C, et al. Body surface area: a novel predictor for conversion to thoracotomy in patients undergoing video-assisted thoracoscopic lung cancer lobectomy. J Thorac Dis 2017;9:2383-96. 10.21037/jtd.2017.07.53 - DOI - PMC - PubMed

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