Ching Feng Wu1,2,3, Torre de la Mercedes1,2, Ricardo Fernandez1,2, Maria Delgado1,2, Eva Fieira1,2, Ching Yang Wu3, Ming Ju Hsieh3, Marina Paradela1,2, Yun Hen Liu3, Yin Kai Chao3, Diego Gonzalez-Rivas4,5,6. 1. Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain. 2. Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain. 3. Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan. 4. Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain. diego.gonzalez.rivas@sergas.es. 5. Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain. diego.gonzalez.rivas@sergas.es. 6. Coruña University Hospital, Xubias 84, 15006, Coruña, Spain. diego.gonzalez.rivas@sergas.es.
Abstract
BACKGROUND: Our objective is to report on two centers' experience of intra-operative management of major vascular injury during single-port video-assisted thoracoscopic (SPVATS) anatomic resections, including bleeding control techniques, incidence, results, and risk factor analysis. METHODS: Consecutive patients (n = 442) who received SPVATS anatomic lung resections in two centers were enrolled. The different clinical parameters studied included age, previous thoracic surgery, obesity (BMI > 30), tumor location, neoadjuvant therapy, and pleural symphysis. In addition, peri-operative outcomes were compared between the groups, with or without vessel injury. RESULTS: There were no intra-operative deaths in our study. Overall major bleeding incidence was 4.5%, whereby 70% of major bleeding episodes could be managed with SPVATS techniques. In order to determine risk factors possibly related to intra-operative bleeding, we used case control matching to homogenize our study population. After case control matching, pleural symphysis was significantly related in the univariate (p = 0.005, Odds ratio 4.415, 95% CI 1.424-13.685) and multivariate analysis (p = 0.006, Odds ratio 4.926, 95% CI 1.577-15.384). Operative time (p < 0.001), blood loss (p < 0.001), and post-operative hospital stay (p = 0.012) were longer in patients with major vascular injury. There were no differences in 30-day mortality and 90-day morbidity. CONCLUSIONS: In summary, major intra-operative bleeding episodes during SPVATS anatomic lung resections are acceptable and most such bleeding episodes can be safely managed with SPVATS techniques.
BACKGROUND: Our objective is to report on two centers' experience of intra-operative management of major vascular injury during single-port video-assisted thoracoscopic (SPVATS) anatomic resections, including bleeding control techniques, incidence, results, and risk factor analysis. METHODS: Consecutive patients (n = 442) who received SPVATS anatomic lung resections in two centers were enrolled. The different clinical parameters studied included age, previous thoracic surgery, obesity (BMI > 30), tumor location, neoadjuvant therapy, and pleural symphysis. In addition, peri-operative outcomes were compared between the groups, with or without vessel injury. RESULTS: There were no intra-operative deaths in our study. Overall major bleeding incidence was 4.5%, whereby 70% of major bleeding episodes could be managed with SPVATS techniques. In order to determine risk factors possibly related to intra-operative bleeding, we used case control matching to homogenize our study population. After case control matching, pleural symphysis was significantly related in the univariate (p = 0.005, Odds ratio 4.415, 95% CI 1.424-13.685) and multivariate analysis (p = 0.006, Odds ratio 4.926, 95% CI 1.577-15.384). Operative time (p < 0.001), blood loss (p < 0.001), and post-operative hospital stay (p = 0.012) were longer in patients with major vascular injury. There were no differences in 30-day mortality and 90-day morbidity. CONCLUSIONS: In summary, major intra-operative bleeding episodes during SPVATS anatomic lung resections are acceptable and most such bleeding episodes can be safely managed with SPVATS techniques.
Authors: Ching Feng Wu; Marina Paradela; Ching Yang Wu; de la Torre Mercedes; Ricardo Fernandez; Maria Delgado; Eva Fieira; Ming Ju Hsieh; Yin Kai Chao; Lan Yan Yang; Yu Bin Pan; Diego Gonzalez-Rivas Journal: Medicine (Baltimore) Date: 2020-03 Impact factor: 1.817