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PULMONER REZEKSİYONLARDA TORAKOTOMİ İLE UNİPORTAL VATS YÖNTEMLERİNİN KIYASLANMASI

Year 2023, Volume: 10 Issue: 1, 1 - 7, 23.06.2023

Abstract

Amaç: Küçük hücreli dışı akciğer kanserlerinde (KHDAK) hastalara önerilen altın standart tedavi cerrahi yöntemdir. Çalışmadaki amacımız torakotomi veya uniportal video yardımlı torakoskopik cerrahi (U-VATS) yapılan KHDAK hastalarında; cerrahinin sonuçlarının değerlendirilmesidir.
Gereç ve yöntem: 2018–2020 yılları süresinde kliniğimizde KHDAK sebebiyle pulmoner rezeksiyon planlanan 30 hasta prospektif incelendi. Uniportal video yardımlı torakoskopik cerrahi (U-VATS) ve kas koruyucu torakotomi (KKT) olarak iki grup oluşturuldu (n=15, n=15). Grupların parametreleri İstatistiksel olarak değerlendirildi.
Bulgular: Gruplar operasyon süresi, ameliyat esnasında kaydedilen kanama miktarı, çıkarılan lenf nodu sayısı açısından kıyaslandığında fark görülmedi. İnsizyonun boyu U-VATS’da KKT’ye göre anlamlı olarak düşük bulundu. Göğüs direni kalma süresi U-VATS grubunda, KKT’ye göre anlamlı olarak düşük tespit edildi. U-VATS yapılan grubun yattığı gün sayısı ortalama 5.8; Torakotomi grubunun ise gün sayısı 10.06 olarak kaydedildi. Ortalama göğüs direninin kaldığı günlerinin sayıları istatiksel açıdan U-VATS’da daha az olduğu tespit edildi. Grupların Visuel Analog Skalaları (VAS) skoru anlamlı düzeyde düşük bulundu.
Sonuç: U-VATS grubu KKT’ye göre karşılaştırılınca; insizyonun boyu, yattığı gün sayısı, göğüs direnli gün sayısı istatistiksel yönden düşük tespit edildi. Cerrahinin süresi, intraoperatif kanama miktarı, lenf nodlarının diseksiyon/örnekleme sayısı açısından kıyaslandığında istatistiksel olarak anlamlı farklılık bulunmadı. Pulmoner rezeksiyonlarda U-VATS yönteminin açık cerrahi tekniğiyle kıyaslayınca ağrı skorunun daha az olduğu kayda geçildi.

References

  • De leyn, P., Dooms, C., Kuzdzal, J., Lardinois, D., Passlick, B., Rami-Porta, R., Turna, A., Schil, P. van, Venuta, F., Waller, D., Weder, W., & Zielinski, M. (2014). Revised ests guidelines for preoperative mediastinal lymph node staging for non-small-cell lung cancer. European Journal of Cardio-Thoracic Surgery, 45(5), 787–798. https://doi.org/10.1093/ejcts/ezu028
  • Fang, L., Wang, L., Wang, Y., Lv, W., & Hu, J. (2018a). Video assisted thoracic surgery vs. thoracotomy for locally advanced lung squamous cell carcinoma after neoadjuvant chemotherapy. Journal of Cardiothoracic Surgery, 13(1). https://doi.org/10.1186/s13019-018-0813-7
  • Flores, R. M., Ihekweazu, U. N., Rizk, N., Dycoco, J., Bains, M. S., Downey, R. J., Adusumilli, P., Finley, D. J., Huang, J., Rusch, V. W., Sarkaria, I., & Park, B. (2011). Patterns of recurrence and incidence of second primary tumors after lobectomy by means of video-assisted thoracoscopic surgery (VATS) versus thoracotomy for lung cancer. Journal of Thoracic and Cardiovascular Surgery, 141(1), 59–64.
  • Gonzalez-Rivas, D., Yang, Y., & Calvin, N. G. (2016). Advances in Uniportal Video-Assisted Thoracoscopic Surgery. Pushing the Envelope. In Thoracic Surgery Clinics (Vol. 26, Issue 2, pp. 187–201). W.B. Saunders. https://doi.org/10.1016/j.thorsurg.2015.12.007
  • Jutley, R. S., Khalil, M. W., & Rocco, G. (2005). Uniportal vs standard three-port VATS technique for spontaneous pneumothorax: Comparison of post-operative pain and residual paraesthesia. European Journal of Cardio-Thoracic Surgery, 28(1), 43–46. https://doi.org/10.1016/j.ejcts.2005.02.039
  • McElnay, P. J., Molyneux, M., Krishnadas, R., Batchelor, T. J. P., West, D., & Casali, G. (2015). Pain and recovery are comparable after either uniportal or multiport video-assisted thoracoscopic lobectomy: An observation study. European Journal of Cardio-Thoracic Surgery, 47(5), 912–915. https://doi.org/10.1093/ejcts/ezu324
  • Nomori, H., Cong, Y., & Sugimura, H. (2016). Limited thoracotomy for segmentectomy: a comparison of postoperative pain with thoracoscopic lobectomy. Surgery Today, 46(11), 1243–1248. https://doi.org/10.1007/s00595-015-1302-4
  • Nwogu, C. E., D’Cunha, J., Pang, H., Gu, L., Wang, X., Richards, W. G., Veit, L. J., Demmy, T. L., Sugarbaker, D. J., Kohman, L. J., & Swanson, S. J. (2015). VATS lobectomy has better perioperative outcomes than open lobectomy: CALGB 31001, an ancillary analysis of CALGB 140202 (Alliance). Annals of Thoracic Surgery, 99(2), 399–405. https://doi.org/10.1016/j.athoracsur.2014.09.018
  • Ochroch, E. A., Gottschalk, A., Augostides, J., Carson, K. A., Kent, L., Malayaman, N., Kaiser, L. R., & Aukburg, S. J. (2002). Pain And Regional Anesthesia Long-term Pain and Activity during Recovery from Major Thoracotomy Using Thoracic Epidural Analgesia. In Anesthesiology (Vol. 97). http://pubs.asahq.org/anesthesiology/article-pdf/97/5/1234/406164/0000542-200211000-00029.pdf
  • Sagawa, M., Sato, M., Sakurada, A., Matsumura, Y., Endo, C., Handa, M., & Kondo, T. (2002). A Prospective Trial of Systematic Nodal Dissection for Lung Cancer by Video-Assisted Thoracic Surgery: Can It Be Perfect?
  • Sakuraba, M., Miyamoto, H., Oh, S., Shiomi, K., Sonobe, S., Takahashi, N., Imashimizu, K., & Sakao, Y. (2007). Video-assisted thoracoscopic lobectomy vs. conventional lobectomy via open thoracotomy in patients with clinical stage IA non-small cell lung carcinoma. Interactive Cardiovascular and Thoracic Surgery, 6(5), 614–617. https://doi.org/10.1510/icvts.2007.157701
  • Sung Hyuna, Ferlay Jacques et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians 2021; 71(3):209-49
  • Toker, A., & Kaya, S. (2009). Türk Göğüs Kalp Damar Cer Türk Göğüs Kalp Damar Cerrahisi Dergisi Turkish Journal of Thoracic and Cardiovascular Surgery Akciğer kanserinde VATS ile lobektomi VATS Lobectomy for lung cancer Video Yardimli Torakoskopik Cerrahi İle Lobektomi Ne Demektir? In Göğüs Cerrahisi Anabilim Dalı (Vol. 17, Issue 2).
  • Watanabe, A., Koyanagi, T., Obama, T., Ohsawa, H., Mawatari, T., Takahashi, N., Ichimiya, Y., & Abe, T. (2005). Assessment of node dissection for clinical stage I primary lung cancer by VATS. European Journal of Cardio-Thoracic Surgery, 27(5), 745–752. https://doi.org/10.1016/j.ejcts.2005.02.007
  • Yang, J., Xia, Y., Yang, Y., Ni, Z. Z., He, W. X., Wang, H. F., Xu, X. X., Yang, Y. L., Fei, K., & Jiang, G. N. (2014). Risk factors for major adverse events of video-assisted thoracic surgery lobectomy for lung cancer. International Journal of Medical Sciences, 11(9), 863–869. https://doi.org/10.7150/ijms.8912
  • Yu, M. G., Jing, R., Mo, Y. J., Lin, F., Du, X. K., Ge, W. Y., Dai, H. J., Hu, Z. K., Zhang, S. S., Pan, L. H. (2019). Non-intubated anesthesia in patients undergoing video-assisted thoracoscopic surgery: a systematic review and meta-analysis. PLoS One, 14(11), 1-21.

COMPARİSON OF THORACOTOMY AND UNİPORTAL VATS TECHNİQUES İN PULMONARY RESECTİONS

Year 2023, Volume: 10 Issue: 1, 1 - 7, 23.06.2023

Abstract

Objective: In non-small cell lung cancers(NSCLC), surgery is the gold standard treatment recommended for patients. Our aim is to evaluate the results of surgery in NSCLC patients who underwent thoracotomy or uniportal video-assisted thoracoscopic surgery(U-VATS).
Method: During 2018–2020, 30 patients planned pulmonary resection NSCLC in our clinic were prospectively analyzed. Two groups were divided into uniportal video-assisted thoracoscopic surgery(U-VATS) and muscle-sparing thoracotomy(KKT)(n=15, n=15). The group’s parameters were evaluated statistically.
Results: o differences in the groups were compared in operation time, the amount of bleeding recorded, and the number of lymph nodes removed. The length of the incision was found to be significantly lower in U-VATS compared to KKT. The length of stay of the chest tube was found to be significantly lower in the U-VATS group compared to KKT. The average number of days spent in the hospital U-VATS group was 5.8; The number of days in the thoracotomy group was recorded as 10.06. The number of days of average chest tube stay was statistically less in U-VATS. Visual Analogue Scales(VAS) was found to be significantly lower in U-VATS.
Conclusion: When the U-VATS group compared to KKT; the length of the incision, the number of days hospitalized, and the number of days with chest-tube were found to be statistically low. No statistically significant difference when the duration of surgery intraoperative bleeding, the number of lymph nodes dissection/sampling were compared. It was noted that the pain score was lower the U-VATS method was compared with the open surgery technique.

References

  • De leyn, P., Dooms, C., Kuzdzal, J., Lardinois, D., Passlick, B., Rami-Porta, R., Turna, A., Schil, P. van, Venuta, F., Waller, D., Weder, W., & Zielinski, M. (2014). Revised ests guidelines for preoperative mediastinal lymph node staging for non-small-cell lung cancer. European Journal of Cardio-Thoracic Surgery, 45(5), 787–798. https://doi.org/10.1093/ejcts/ezu028
  • Fang, L., Wang, L., Wang, Y., Lv, W., & Hu, J. (2018a). Video assisted thoracic surgery vs. thoracotomy for locally advanced lung squamous cell carcinoma after neoadjuvant chemotherapy. Journal of Cardiothoracic Surgery, 13(1). https://doi.org/10.1186/s13019-018-0813-7
  • Flores, R. M., Ihekweazu, U. N., Rizk, N., Dycoco, J., Bains, M. S., Downey, R. J., Adusumilli, P., Finley, D. J., Huang, J., Rusch, V. W., Sarkaria, I., & Park, B. (2011). Patterns of recurrence and incidence of second primary tumors after lobectomy by means of video-assisted thoracoscopic surgery (VATS) versus thoracotomy for lung cancer. Journal of Thoracic and Cardiovascular Surgery, 141(1), 59–64.
  • Gonzalez-Rivas, D., Yang, Y., & Calvin, N. G. (2016). Advances in Uniportal Video-Assisted Thoracoscopic Surgery. Pushing the Envelope. In Thoracic Surgery Clinics (Vol. 26, Issue 2, pp. 187–201). W.B. Saunders. https://doi.org/10.1016/j.thorsurg.2015.12.007
  • Jutley, R. S., Khalil, M. W., & Rocco, G. (2005). Uniportal vs standard three-port VATS technique for spontaneous pneumothorax: Comparison of post-operative pain and residual paraesthesia. European Journal of Cardio-Thoracic Surgery, 28(1), 43–46. https://doi.org/10.1016/j.ejcts.2005.02.039
  • McElnay, P. J., Molyneux, M., Krishnadas, R., Batchelor, T. J. P., West, D., & Casali, G. (2015). Pain and recovery are comparable after either uniportal or multiport video-assisted thoracoscopic lobectomy: An observation study. European Journal of Cardio-Thoracic Surgery, 47(5), 912–915. https://doi.org/10.1093/ejcts/ezu324
  • Nomori, H., Cong, Y., & Sugimura, H. (2016). Limited thoracotomy for segmentectomy: a comparison of postoperative pain with thoracoscopic lobectomy. Surgery Today, 46(11), 1243–1248. https://doi.org/10.1007/s00595-015-1302-4
  • Nwogu, C. E., D’Cunha, J., Pang, H., Gu, L., Wang, X., Richards, W. G., Veit, L. J., Demmy, T. L., Sugarbaker, D. J., Kohman, L. J., & Swanson, S. J. (2015). VATS lobectomy has better perioperative outcomes than open lobectomy: CALGB 31001, an ancillary analysis of CALGB 140202 (Alliance). Annals of Thoracic Surgery, 99(2), 399–405. https://doi.org/10.1016/j.athoracsur.2014.09.018
  • Ochroch, E. A., Gottschalk, A., Augostides, J., Carson, K. A., Kent, L., Malayaman, N., Kaiser, L. R., & Aukburg, S. J. (2002). Pain And Regional Anesthesia Long-term Pain and Activity during Recovery from Major Thoracotomy Using Thoracic Epidural Analgesia. In Anesthesiology (Vol. 97). http://pubs.asahq.org/anesthesiology/article-pdf/97/5/1234/406164/0000542-200211000-00029.pdf
  • Sagawa, M., Sato, M., Sakurada, A., Matsumura, Y., Endo, C., Handa, M., & Kondo, T. (2002). A Prospective Trial of Systematic Nodal Dissection for Lung Cancer by Video-Assisted Thoracic Surgery: Can It Be Perfect?
  • Sakuraba, M., Miyamoto, H., Oh, S., Shiomi, K., Sonobe, S., Takahashi, N., Imashimizu, K., & Sakao, Y. (2007). Video-assisted thoracoscopic lobectomy vs. conventional lobectomy via open thoracotomy in patients with clinical stage IA non-small cell lung carcinoma. Interactive Cardiovascular and Thoracic Surgery, 6(5), 614–617. https://doi.org/10.1510/icvts.2007.157701
  • Sung Hyuna, Ferlay Jacques et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians 2021; 71(3):209-49
  • Toker, A., & Kaya, S. (2009). Türk Göğüs Kalp Damar Cer Türk Göğüs Kalp Damar Cerrahisi Dergisi Turkish Journal of Thoracic and Cardiovascular Surgery Akciğer kanserinde VATS ile lobektomi VATS Lobectomy for lung cancer Video Yardimli Torakoskopik Cerrahi İle Lobektomi Ne Demektir? In Göğüs Cerrahisi Anabilim Dalı (Vol. 17, Issue 2).
  • Watanabe, A., Koyanagi, T., Obama, T., Ohsawa, H., Mawatari, T., Takahashi, N., Ichimiya, Y., & Abe, T. (2005). Assessment of node dissection for clinical stage I primary lung cancer by VATS. European Journal of Cardio-Thoracic Surgery, 27(5), 745–752. https://doi.org/10.1016/j.ejcts.2005.02.007
  • Yang, J., Xia, Y., Yang, Y., Ni, Z. Z., He, W. X., Wang, H. F., Xu, X. X., Yang, Y. L., Fei, K., & Jiang, G. N. (2014). Risk factors for major adverse events of video-assisted thoracic surgery lobectomy for lung cancer. International Journal of Medical Sciences, 11(9), 863–869. https://doi.org/10.7150/ijms.8912
  • Yu, M. G., Jing, R., Mo, Y. J., Lin, F., Du, X. K., Ge, W. Y., Dai, H. J., Hu, Z. K., Zhang, S. S., Pan, L. H. (2019). Non-intubated anesthesia in patients undergoing video-assisted thoracoscopic surgery: a systematic review and meta-analysis. PLoS One, 14(11), 1-21.
There are 16 citations in total.

Details

Primary Language Turkish
Subjects Surgery
Journal Section Araştırma Makalesi Bölümü
Authors

Suzan Temiz Bekce 0000-0003-1247-8485

Ömer Önal 0000-0002-9971-7401

Publication Date June 23, 2023
Submission Date December 9, 2022
Published in Issue Year 2023 Volume: 10 Issue: 1

Cite

APA Temiz Bekce, S., & Önal, Ö. (2023). PULMONER REZEKSİYONLARDA TORAKOTOMİ İLE UNİPORTAL VATS YÖNTEMLERİNİN KIYASLANMASI. ERÜ Sağlık Bilimleri Fakültesi Dergisi, 10(1), 1-7.