Yin-Kai Chao1, Kuang-Tse Pan2, Chih-Tsung Wen3, Hsin-Yueh Fang3, Ming-Ju Hsieh3. 1. Division of Thoracic Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan. Electronic address: chaoyk@cgmh.org.tw. 2. Department of Medical Imaging and Intervention, College of Medicine, Chang Gung University, Taoyuan, Taiwan. 3. Division of Thoracic Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Abstract
BACKGROUND: The efficacy and safety of intraoperative computed tomography (IOCT)-guided lung tumor localization and resection performed in a hybrid operating room (OR) compared with the conventional 2-stage preoperative CT (POCT)-guided approach for the treatment of small and deep solitary pulmonary nodules (SPNs) remains unknown. METHODS: We compared IOCT-guided (IOCT group) and POCT-guided (POCT group) thoracoscopic resections in 64 consecutive patients with SPNs. The main outcome measures included efficacy, safety, and radiation exposure. RESULTS: The IOCT (n = 34) and POCT (n = 30) groups had a similar SPN depth-to-size ratio. All SPNs were successfully localized and removed using a minimally invasive approach. There were no significant intergroup differences in localization procedural time (mean, 17.68 [IOCT] vs 19.63 minutes [POCT]; P = .257) and radiation exposure (median, 3.65 [IOCT] vs 6.88 mSv [POCT]; P = .506). The use of a hybrid operating room (OR) for tumor localization significantly reduced the patient time at risk (ie, the interval from completion of localization to skin incision; mean, 215.83 [POCT] vs 13.06 minutes [IOCT]; P < .001). However, the IOCT-guided approach significantly increased the time under general anesthesia (mean, 120.61 [POCT] vs 163.1 minutes [IOCT]; P < .001) and the total OR utilization time (mean, 168.68 [POCT] vs 227.41 minutes [IOCT]; P < .001). CONCLUSIONS: Compared with the POCT-guided approach, the IOCT-guided approach decreased the time at risk, despite a significant increase in the global OR utilization time. Because no significant outcome differences were evident, the choice between the 2 approaches should be based on the most readily available approach at a surgeon's specific facility.
BACKGROUND: The efficacy and safety of intraoperative computed tomography (IOCT)-guided lung tumor localization and resection performed in a hybrid operating room (OR) compared with the conventional 2-stage preoperative CT (POCT)-guided approach for the treatment of small and deep solitary pulmonary nodules (SPNs) remains unknown. METHODS: We compared IOCT-guided (IOCT group) and POCT-guided (POCT group) thoracoscopic resections in 64 consecutive patients with SPNs. The main outcome measures included efficacy, safety, and radiation exposure. RESULTS: The IOCT (n = 34) and POCT (n = 30) groups had a similar SPN depth-to-size ratio. All SPNs were successfully localized and removed using a minimally invasive approach. There were no significant intergroup differences in localization procedural time (mean, 17.68 [IOCT] vs 19.63 minutes [POCT]; P = .257) and radiation exposure (median, 3.65 [IOCT] vs 6.88 mSv [POCT]; P = .506). The use of a hybrid operating room (OR) for tumor localization significantly reduced the patient time at risk (ie, the interval from completion of localization to skin incision; mean, 215.83 [POCT] vs 13.06 minutes [IOCT]; P < .001). However, the IOCT-guided approach significantly increased the time under general anesthesia (mean, 120.61 [POCT] vs 163.1 minutes [IOCT]; P < .001) and the total OR utilization time (mean, 168.68 [POCT] vs 227.41 minutes [IOCT]; P < .001). CONCLUSIONS: Compared with the POCT-guided approach, the IOCT-guided approach decreased the time at risk, despite a significant increase in the global OR utilization time. Because no significant outcome differences were evident, the choice between the 2 approaches should be based on the most readily available approach at a surgeon's specific facility.
Authors: Pablo Alvarez; Simon Rouzé; Michael I Miga; Yohan Payan; Jean-Louis Dillenseger; Matthieu Chabanas Journal: Med Image Anal Date: 2021-01-30 Impact factor: 13.828