Multi‐center experience in an optimized right upper lobectomy surgical procedure in China. Issue 6 (25th December 2022)

• Record Type: Journal Article
• Authors: Mei, Long‐Yong; Liu, Wen‐Zhou; Xiu, Yu‐Chi; Tao, Shao‐Lin; Feng, Yong‐Geng; Tan, Qun‐You; Xu, Shi‐Guang; Xian, Lei; Deng, Bo
• Is Part Of: Thoracic cancer. Volume 14:Issue 6(2023)
• Page Start: 573
• Page End: 583
• Publication Date: 2022-12-25
• Subjects: lung cancer -- right upper lobectomy -- surgical technology; Chest -- Cancer -- Periodicals; Chest -- Cancer -- Treatment -- Periodicals; Chest -- Surgery -- Periodicals; 616.99494005
• DOI: 10.1111/1759-7714.14781
• Languages: English
• ISSNs: 1759-7706

Abstract

Abstract: Background: This multi‐center study was aimed at retrospectively evaluating the feasibility, safety, clinical outcomes, and surgical learning curve of an optimized procedure for right upper lobectomy (RUL), which is challenging because of the anatomical structures and features of this lobe. Methods: This study included 45 RUL cases of robot‐assisted thoracoscopy (RATS) in a pilot cohort and 187 RUL cases of video‐assisted thoracoscopy (VATS) in three cohorts. A total of 121 and 111 patients underwent traditional and optimized RUL, respectively. The optimized surgical procedure was performed to consecutively transect the superior arterial trunk and bronchus, and finally disconnect the pulmonary vein and posterior ascending artery with interlobar fissures. Clinical and radiological data were reviewed retrospectively. Results: Optimized RUL can be performed successfully by RATS or VATS. The optimized procedure yielded better clinical outcomes than the traditional procedure, including shorter operation times, less blood loss, fewer complications, shorter hospital times, lower costs, and a lower likelihood of postoperative intermedius bronchial kinking. Additionally, for calcified interlobar lymph nodes, the optimized VATS group was less likely to be converted to thoracotomy than the traditional group. The skills required to perform optimized VATS RUL can be gained by surgeons after 12 to 15 cases. The two RUL procedures in the pilot cohort showed similar disease‐free survival. Conclusions: The optimized RUL was safe, economical, and feasible, with a short learning curve and satisfactory disease‐free survival. Abstract : The optimized surgical procedure for right upper lobectomy by minimal invasive surgery was introduced, involving transection of interlobar fissures with the superior pulmonary vein and the ascending A2 artery simultaneously. Compared with the traditional method, this procedure achieved better clinical outcomes, including shorter operation times, fewer complications, less blood loss, shorter hospitalization times, and lower costs, while yielding similar disease‐free survival.