Analysis of risk factors for complications after robot-assisted segmentectomy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CAO Yuqin , ZHANG Yajie ,  LI Hecheng

Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P.R.China;

Corresponding author：

LI Hecheng, Email: lihecheng2000@hotmail.com

Keywords：

Robotic surgery; lung neoplasms; segmentectomy; complications; risk factors

DOI：

10.7507/1007-4848.202008002

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To analyze the risk factors for complications after robotic segmentectomy.Methods Clinical data of 207 patients undergoing robot-assisted anatomical segmentectomy in our hospital from June 2015 to July 2019 were retrospectively analyzed, including 69 males and 138 females with a median age of 54.0 years. The relationship between clinicopathological factors and prolonged air leakage, pleural effusion, and pulmonary infection after surgery was analyzed.Results After robot-assisted segmentectomy, 20 (9.7%) patients developed prolonged air leakage (>5 d), 17 (8.2%) patients developed pleural effusion, and 4 (1.9%) patients developed pulmonary infection. Univariate logistic regression showed that body mass index (BMI, P=0.018), FEV1% (P=0.024), number of N1 lymph nodes resection (P=0.008) were related to prolonged air leakage after robot-assisted segmentectomy. Benign lesion was a risk factor for pleural effusion (P=0.013). The number of lymph node sampling stations was significantly related to the incidence of pulmonary infection (P=0.035). Multivariate logistic analysis showed that the BMI (OR=0.73, P=0.012) and N1 lymph node sampling (OR=1.38, P=0.001) had a negative and positive relationship with prolonged air leakage after robot-assisted segmentectomy, respectively.Conclusion The incidence of pulmonary complications after robot-assisted segmentectomy is low. The lower BMI and more N1 lymph node sampling is, the greater probability of prolonged air leakage is. Benign lesions and more lymph node sampling stations are risk factors for pleural effusion and lung infection, respectively. Attention should be paid to the prevention and treatment of perioperative complications for patients with such risk factors.

Citation： CAO Yuqin, ZHANG Yajie, LI Hecheng. Analysis of risk factors for complications after robot-assisted segmentectomy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(11): 1281-1286. doi: 10.7507/1007-4848.202008002 Copy

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14.	张树亮, 郑斌, 徐国兵, 等. 联合降维法在达芬奇机器人辅助精准肺段切除术中的应用. 中华胸部外科电子杂志, 2019, 6(2): 139-140.
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18.	Lee L, Hanley SC, Robineau C, et al. Estimating the risk of prolonged air leak after pulmonary resection using a simple scoring system. J Am Coll Surg, 2011, 212(6): 1027-1032.
19.	Rivera C, Bernard A, Falcoz PE, et al. Characterization and prediction of prolonged air leak after pulmonary resection: a nationwide study setting up the index of prolonged air leak. Ann Thorac Surg, 2011, 92(3): 1062-1068.
20.	Goldstraw P, Chansky K, Crowley J, et al. The IASLC Lung Cancer Staging Project: Proposals for revision of the TNM stage groupings in the forthcoming (eighth) edition of the TNM classification for lung cancer. J Thorac Oncol, 2016, 11(1): 39-51.
21.	Asamura H, Chansky K, Crowley J, et al. The International Association for the Study of Lung Cancer Lung Cancer Staging Project: Proposals for the revision of the N descriptors in the forthcoming 8th edition of the TNM classification for lung cancer. J Thorac Oncol, 2015, 10(12): 1675-1684.
22.	Ray MA, Smeltzer MP, Faris NR, et al. Survival after mediastinal node dissection, systematic sampling, or neither for early stage NSCLC. J Thorac Oncol, 2020. [Epub ahead of print].

1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
2. 郑荣寿, 孙可欣, 张思维, 等. 2015 年中国恶性肿瘤流行情况分析. 中华肿瘤杂志, 2019, 41(1): 19-28.
3. NCCN clinical practice guidelines in oncology - lung cancer screening (Version 1.2020). URL: https://www.nccn.org/professionals/physician_gls/pdf/lung_screening.pdf.
4. Cerfolio RJ, Bass CS, Pask AH, et al. Predictors and treatment of persistent air leaks. Ann Thorac Surg, 2002, 73(6): 1727-1730.
5. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg, 2004, 240(2): 205-213.
6. Tsubokawa N, Harada H, Takenaka C, et al. Comparison of postoperative pain after different thoracic surgery approaches as measured by electrical stimulation. Thorac Cardiovasc Surg, 2015, 63(6): 519-525.
7. Ghaly G, Kamel M, Nasar A, et al. Video-assisted thoracoscopic surgery is a safe and effective alternative to thoracotomy for anatomical segmentectomy in patients with clinical stageⅠnon-small cell lung cancer. Ann Thorac Surg, 2016, 101(2): 465-472.
8. 谢博恒, 隋天一, 秦毅, 等. 机器人辅助与电视辅助胸腔镜肺段切除术治疗早期非小细胞肺癌短期效果比较. 中国肺癌杂志, 2019, 22(12): 767-771.
9. Zhang Y, Chen C, Hu J, et al. Early outcomes of robotic versus thoracoscopic segmentectomy for early-stage lung cancer: A multi-institutional propensity score-matched analysis. J Thorac Cardiovasc Surg, 2020. [Epub ahead of print].
10. Harada H, Okada M, Sakamoto T, et al. Functional advantage after radical segmentectomy versus lobectomy for lung cancer. Ann Thorac Surg, 2005, 80(6): 2041-2045.
11. Saito H, Nakagawa T, Ito M, et al. Pulmonary function after lobectomy versus segmentectomy in patients with stageⅠnon-small cell lung cancer. World J Surg, 2014, 38(8): 2025-2031.
12. El-Sherif A, Gooding WE, Santos R, et al. Outcomes of sublobar resection versus lobectomy for stageⅠnon-small cell lung cancer: a 13-year analysis. Ann Thorac Surg, 2006, 82(2): 408-415.
13. 陈凯, 张亚杰, 项捷, 等. CT 三维重建辅助达芬奇机器人解剖性肺段切除术的临床应用. 中华解剖与临床杂志, 2020, 25(3): 260-264.
14. 张树亮, 郑斌, 徐国兵, 等. 联合降维法在达芬奇机器人辅助精准肺段切除术中的应用. 中华胸部外科电子杂志, 2019, 6(2): 139-140.
15. Brunelli A, Varela G, Refai M, et al. A scoring system to predict the risk of prolonged air leak after lobectomy. Ann Thorac Surg, 2010, 90(1): 204-209.
16. Attaar A, Winger DG, Luketich JD, et al. A clinical prediction model for prolonged air leak after pulmonary resection. J Thorac Cardiovasc Surg, 2017, 153(3): 690-699.
17. Gilbert S, Maghera S, Seely AJ, et al. Identifying patients at higher risk of prolonged air leak after lung resection. Ann Thorac Surg, 2016, 102(5): 1674-1679.
18. Lee L, Hanley SC, Robineau C, et al. Estimating the risk of prolonged air leak after pulmonary resection using a simple scoring system. J Am Coll Surg, 2011, 212(6): 1027-1032.
19. Rivera C, Bernard A, Falcoz PE, et al. Characterization and prediction of prolonged air leak after pulmonary resection: a nationwide study setting up the index of prolonged air leak. Ann Thorac Surg, 2011, 92(3): 1062-1068.
20. Goldstraw P, Chansky K, Crowley J, et al. The IASLC Lung Cancer Staging Project: Proposals for revision of the TNM stage groupings in the forthcoming (eighth) edition of the TNM classification for lung cancer. J Thorac Oncol, 2016, 11(1): 39-51.
21. Asamura H, Chansky K, Crowley J, et al. The International Association for the Study of Lung Cancer Lung Cancer Staging Project: Proposals for the revision of the N descriptors in the forthcoming 8th edition of the TNM classification for lung cancer. J Thorac Oncol, 2015, 10(12): 1675-1684.
22. Ray MA, Smeltzer MP, Faris NR, et al. Survival after mediastinal node dissection, systematic sampling, or neither for early stage NSCLC. J Thorac Oncol, 2020. [Epub ahead of print].

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Analysis of risk factors for complications after robot-assisted segmentectomy

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