Objective To investigate the relationship between preoperative mean daily step counts and pulmonary complications after thoracoscopic lobectomy in elderly patients. Methods From 2018 to 2021, the elderly patients with pulmonary complications after thoracoscopic lobectomy were included. A 1∶1 propensity score matching was performed with patients without pulmonary complications. The clinical data were compared between the two groups. ResultsTotally, 100 elderly patients with pulmonary complications were enrolled, including 78 males and 22 females, aged 66.4±4.5 years. And 100 patients without pulmonary complications were matched, including 71 males and 29 females aged 66.2±5.0 years. There was no significant difference in the preoperative data between the two groups (P>0.05). Compared to the patients with pulmonary complications, the ICU stay was shorter (8.1±4.4 h vs. 12.9±7.5 h, P＜0.001), the first out-of-bed activity time was earlier (8.8±4.5 h vs. 11.2±6.1 h, P=0.002), and the tube incubation time was shorter (19.3±9.2 h vs. 22.5±9.4 h, P=0.015) in the patients wihout pulmonary complications. There was no statistical difference in other perioperative data between the two groups (P>0.05). The mean daily step counts in the pulmonary complications group were significantly less than that in the non-pulmonary complications group (4 745.5±2 190.9 steps vs. 6 821.1±2 542.0 steps, P＜0.001). The daily step counts showed an upward trend for three consecutive days in the two groups, but the difference was not significant. Conclusion The decline of preoperative mean daily step counts is related to pulmonary complications after thoracoscopic lobectomy in elderly patients. Recording daily step counts can promote preoperative active exercise training for hospitalized patients.
Objective To explore the advantages of postoperative chest drainage with 16F urinary catheter for video- assisted thoracoscopic surgery (VATS) lobectomy. Methods Data of 102 patients (October to December 2015) who under- went VATS lobectomy of lung disease with insertion of catheter (16 F urinary catheter or 28 F chest tube) were analyzed. The patients were divided into two groups including a 16F group (49 patients, with 16 F urinary catheter) and a 18F group (53 patients, with 18F chest drainage tube).The following post-operative data were evaluated: primary healing of tube inci- sion, chest X ray abnormalities (pneumothorax, pleural effusion, subcutaneous emphysema, and hematoma), drainage time, re-insert the drainage tube, and wound healing at the site of insertion. Results Both groups were similar in age, gender, co-morbidity and pathological evaluation of resected specimens. After adjustment, no statistically significant difference was found between the two groups in pulmonary complications (30.6% vs. 28.3%, P=0.102), subcutaneous emphysema (60.0% vs. 6.7%, P=0.011), required intervention (2.0% vs. 5.7%, P=0.048). The average total drainage volume in the 16F group (587.3±323.7 ml) was less than that of the 28 F group (824.1±444.3 ml, P=0.000). The rate of primary healing at the site of insertion in the 16 F group (100.0%) was higher than that in the 28F group (58.5%, P=0.014). A significant difference was found in the drainage time and post-operative length of stay between the two groups (54.2±28.6 h vs. 95.6±65.5 h，4.2±1.4 d vs. 6.5±3.0 d). Conclusion Since 16F urinary catheter has advantage in fast track rehabilitation and low risk of pulmonary complications, the use of 16F urinary catheter is appropriate after VATS pulmonary lobectomy.
ObjectiveTo evaluate the feasibility and safety of improving chest drainage procedure by applying postoperative chest drainage with central venous catheter for uniportal video-assisted thoracoscopic surgery (VATS) lobectomy in fast track recovery. MethodsBetween July 2016 and March 2018, a total of 150 patients who underwent uniportal VATS lobectomy by the same chief surgeon were recruited. All patients were randomly divided into two groups including a trial group and a control group. In the trial group, there were 44 males and 28 females with an average age of 47±11 years. Central venous catheter and 26F silicone rubber tuber were used and chest tube was removed when drainage volume less than 300 ml/d. Chest X ray was conducted three days after discharge from hospital and the central venous catheter was removed after thoracentesis. In the control group, there were 40 males and 29 females with an average ages of 52±13 years, 26 F silicone rubber tuber and chest tube were removed when drainage volume less than 100 ml/d. The clinical effectiveness was compared between the two groups. ResultsNo statistically significant difference was observed between the trial group and the control group in the date of preoperative general information, the occurrence of postoperative complications and the visual analogue score on Day1 after the operation. However, the visual analogue score, intubation time, post-operative length of stay, the frequency of using tramadol were all significantly shorter or lower in the trial group when compared with the control group (P<0.05). Seven patients of the trial group suffered moderate pleural effusion after intubation, which was significantly more than that of the control group (P<0.05). Six patients recovered after thoracentes through central venous catheter. The average amount of pleural effusions before removing the central venous catheter was 74.8 ml. ConclusionThe use of central venous catheter and 26 F silicone rubber tuber after uniportal VATS lobectomy is safe and feasible for the early removal of chest tube. It is beneficial to fast track recovery.
Objective To investigate the risk factors of postoperative urinary retention of non-small cell lung cancer patients undergoing video-assisted thoracoscopic surgery (VATS) lobectomy without indwelling urinary catheterization. Methods In this prospective trial, we recruited 148 patients who were scheduled for lung cancer lobectomy under general anesthesia by VATS in Department of Thoracic Surgery in West China Hospital from July through December 2015. These patients were divided into two groups including a trial group and a control group. There was no indwelled urethral catheter in the trial group. And the patients in the control group were indwelled urethral catheter routinely. Postoperative urinary retention, urinary tract infection, the postoperative hospitalization duration and the clinical data were recorded. Results There was no significant difference between the trial group and the control group in postoperative urinary retention (9.46% vs. 6.76%, P=0.087). However, the ratios of the male patients and the patients with history of abdomen operation, and international prostate symptom score (IPSS) of the urinary retention patients (83.33%, 33.33%, 26.55±7.00) were statistically higher than those of the patients without urinary retention (56.62%, 0.00%, 15.31±8.31, P=0.017, P=0.000, P=0.031). Postoperative urinary tract infection rates in the trial group and the patients with urinary retention (4.05%，25%) were statistically higher than those in the control group and the patients without urinary retention (1.35%, 0.74%, P=0.049, P=0.048). Conclusion The risk factors of postoperative urinary retention patients with non-small cell lung cancer undergoing VATS lobectomy are male patients, history of abdomen operation, and moderate to severe hyperplasia of prostate.
ObjectiveTo compare and analyze clinical effects of video-assisted thoracoscopic surgery (VATS) lobectomy and systematic lymph node harvests for peripheral non-small cell lung cancer (PNSCLC) patients between single-port (SP) and multi-port (MP) with a propensity-matched analysis. MethodsWe retrospectively analyzed the clinical data of 324 patients presented with PNSCLC and admitted in the Affiliated Hospital of Qingdao University from January 2013 through December 2015. Six-eight patients underwent single-port thoracoscopic lobectomy were as a SP group and 256 patients with multi-port thoracoscopic lobectomy. Another 68 patients were produced by a propensity-matched analysis in these 256 patients, to match with SP group as a MP group. There were 26 males and 42 females at age of 54-62 (59.3±10.3) years in the SP group. There were 32 males and 36 females at age of 50-66 (61.5±9.4) years in the MP group. Perioperative outcomes were compared between the two groups. ResultsAll operations were accomplished successfully, without conversion to thoracotomy. Most postoperative outcomes were similar in intraoperative blood loss (136.3±22.7 ml vs. 142.2±20.3 ml), conversion (4.4% vs. 7.4%), lymph node dissection number (19.9±3.5 vs. 20.0±3.0), station (7.9±2.3 vs. 8.3±2.1), postoperative drainage volume (761.4±182.3 ml vs. 736.9±176.4 ml), chest drainage duration (5.2±1.5 d vs. 5.8±1.8 d), length of hospital stay (5.5±2.0 d vs. 5.0±2.5 d), and postoperative complications (2.9% vs. 7.4%) between the two groups (P > 0.05). There were statistical differences in operation time (138.2±20.3 min vs. 126.4±22.4 min), downtrend of pain scores (P=0.03), and patients' satisfaction level (8.8±1.4 vs. 7.3±2.3, P < 0.05). Concision Single-port thoracoscopic lobectomy is not inferior to multi-port and is a safe and feasible surgical procedure for the management of PNSCLC.
ObjectiveTo evaluate the effectiveness and safety of a central venous catheter for thoracic drainage after video-assisted thoracoscopic lobectomy compared with a conventional chest tube.MethodsThis study collected 200 patients with lung cancer who underwent thoracoscopic lobectomy and systematic hilar and mediastinal lymph node dissection between January 2018 and September 2019 in our hospital. The patients were randomly divided into two groups, including a group A (left with 28F chest tubes postoperatively) and a group B (left with 12G central venous catheters postoperatively). Patients in both groups were left with 2 chest tubes after upper lobectomy and 1 chest tube after middle or lower lobectomy. Duration and total volume of drainage, length of hospital stay, maximum visual analogue scale score and so forth were compared between the two groups.ResultsFinally, 151 patients were included for analysis. There were 73 patients in the group A, including 26 males and 47 females, with an average age of 55.38±9.95 years, and 78 patients in the group B, including 37 males and 41 females, with an average age of 59.86±10.18 years. No statistical difference was found between the two groups in drainage volume on postoperative day 2, and proportion of prolonged air leaks, hemothorax, chylothorax or drain reinsertion (all P>0.05). There was a statistical difference in drainage volume on postoperative day 1 [200.0 (120.0, 280.0) mL vs. 57.5 (10.0, 157.5) mL, P=0.000], postoperative day 3 [155.0 (100.0, 210.0) mL vs. 150.0 (80.0, 215.0) mL, P=0.023], total volume of drainage [890.0 (597.5, 1 530.0) mL vs. 512.5 (302.5, 786.3) mL,P=0.000], maximum pain score (2.29±0.72 points vs. 2.09±0.51 points, P=0.013) and length of hospital stay [7 (7, 9) d vs. 5 (4, 7) d, P=0.000].ConclusionCompared with conventional chest tubes, central venous catheters for chest drainage in patients with lung cancer after thoracoscopic lobectomy shortens the length of hospital stay and reduces postoperative pain.
Abstract： Objective To investigate the effect of singledirection lobectomy plus systematic lymphnode dissection for primary nonsmall cell lung cancer (NSCLC) in the early stage by videoassisted thoracic surgery (VATS). Methods We retrospectively analyzed the clinical data of 89 patients who received VATS lobectomy plus systematic lymphnode dissection for earlystage primary NSCLC in the Second People’s Hospital of Chengdu between June 2006 and December 2009. Based on the operative approach, the patients were divided into two groups: VATSminithoracotomy group and singledirection lobectomy VATS group. In the former group, there were 46 patients, including 36 males and 10 females, with an age of 58.76±14.78 years. For patients in this group, minithoracotomy was carried out assisted by VATS. In the latter group, there were 43 patients, including 37 males and 6 females, with an age of 61.34±12.56 years, and singledirection lobectomy VATS was performed for patients in this group. Moreover, 42 patients undergoing routine posterior lateral open thoracotomy were chosen to form the control group (thoracotomy group, included 37 males and 5 females with an age of 56.30±15.59 years). The clinical features, such as operative time, operative blood loss, the number of systematic dissected lymph nodes, postoperative drainage quantity, postoperative complications and visual analogue scale (VAS) of chest pain were retrospectively analyzed to evaluate the early outcomes. Results No operative death occurred in all three groups. There were significant differences among the three groups in the postoperative drainage time (P=0.024), postoperative drainage quantity (P=0.019), operative blood loss (P=0.009), early outofbed activity time (P=0.031), and the incidence of cardiopulmonary complications (P=0.048). Compared with the VATSminithoracotomy group, the singledirection lobectomy VATS group was significantly lower or shorter (Plt;0.05) in postoperative drainage quantity (208.33±50.39 ml vs. 245.98±45.32 ml), operative blood loss (78.79±24.23 ml vs. 112.63±64.32 ml), and the early outofbed activity time (2.31±0.27 d vs. 3.56±0.31 d). The rate of using Dolantin in the control group was significantly higher than the other two groups (P=0.046, 0.007). The change of VAS score among the three groups after operation was also statistically significant (F=5.796, P=0.002). A total of 109 patients (37 in the VATSminithoracotomy group, 37 in the singledirection lobectomy VATS group, and 35 in the control group) were followed up after operation with a period of 2 to 48 months. Twentytwo patients were lost in the followup. There were 10, 9, and 8 deaths during the followup in the three groups respectively, and the median survival time was 40 months, 37 months, and 37 months respectively. There was no significant difference among the three groups in survival time (P=0.848). Conclusion VATS, especially VATS assisted single direction lobectomy and systematic lymphnode dissection for primary NSCLC in the early stage has the same surgical efficacy as the traditional open thoracotomy, and is minimally invasive, which contributes to a quick recovery. Consequently, it is a reliable approach for lung cancer in the early stage.
Objective To investigate the impact of complete video-assisted thoracoscopic lobectomy and open lobectomy on perioperative heart rate （HR） and blood oxygen saturation （SO2） of lung cancer patients，and explore whether minimally invasive surgery can enhance postoperative recovery of lung cancer patients. Methods A total of 138 lung cancer patients were chosen from 161 consecutive patients with pulmonary diseases who were admitted to West China Hospital of Sichuan University between September 2010 and December 2011. According to different surgical approach，all the 138 lung cancer patients were divided into routine thoracotomy group （thoracotomy group，70 patients including 53 males and 17 females with their average age of 56.1±9.7 years） and complete video-assisted thoracoscopic lobectomy group （VATS group，68 patients including 46 males and 22 females with their average age of 53.4±6.5 years）. There was no statistical difference in preoperative clinical characteristics between the 2 groups. Preoperative and postoperative （1st，3rd，7th and 30th day） numeric pain rating scale （NPRS），HR and SO2 were compared between the 2 groups. Results （1） There was no statistical difference in NPRS on the 1st and 3rd postoperative day between the 2 groups （3.83±0.79 vs. 3.93±0.67， 2.88±0.59 vs. 3.03±0.71，P＞0.05），but on the 7th and 30th postoperative day，NPRS of the thoracotomy group was signi- ficantly higher than that of VAST group （1.61±0.33 vs. 1.22±0.12，1.58±0.26 vs. 1.19±0.31，P＜0.05）. （2） Postop- erative sedentary HR of both VATS group and thoracotomy group were significantly higher than preoperative levels ［（84.13±17.21） / minute vs. （73.67±10.32）/minute， （86.13 ±19.67） / minute vs. （72.24±14.21） / minute， P＜0.05］. Postoperative HR of VATS group decreased to preoperative level on the 3rd postoperative day，while postoperative HR of the thoracotomy group decreased to preoperative level on the 7th postoperative day. （3） There was no statistical difference between preoperative and postoperative （all the time points） sedentary SO2 of both VATS group and thoracotomy group （96.34 %±2.11% vs. 97.12%±2.31%，95.33%±4.13% vs. 94.93% ±4.31%，P＞0.05）.（4） The changes of HR and SO2 before and after exercise of VATS group were significantly smaller than those of the thoracotomy group on the 3rd postoperative day ［（11.11±4.81）/minute vs. （18.23±6.17）/minute，3.1%±1.2% vs. 7.4 %±2.7%，P＜0.05］ . Conclusion The impact of complete video-assisted thoracoscopic lobectomy on cardiopulmonary function is comparatively smaller，which is helpful for postoperative fast-track recovery of lung cancer patients.