Incidence Risk and Independent Predictors of Prolonged Air Leak in 269 Consecutive Pulmonary Resection Patients over Nine Months: A Single-Center Retrospective Cohort Study

Introduction: Prolonged air leak (PAL) is a common complication following pulmonary resection. It is associated with pneumonia, empyema, increased length of hospital stay and health-care costs. Intraoperative techniques have been developed to mitigate the risk of developing a PAL, but for their use to be efficient, identification of patients at risk for PAL is necessary. Aim: To determine the incidence of PAL following lobectomy and lesser pulmonary resections, risk factors for development of PALs, and the impact of PAL on hospital stay and readmission rates. Methods: The following variables were analyzed as PAL risk factors: patient characteristics of age, sex, body mass index (BMI), forced minute expiratory volume and capacity ratio (FEV1 and FEV1/FVC), diffusion capacity (DCLO), and transplant recipient status. Validated scoring systems included the Charlson Comorbidity Index (CCI), Medical Research Council (MRC) dyspnea score, and Eastern Cooperative Oncology Group (EGOC) score. Surgical factors included surgical technique, unplanned conversion from video-assisted thoracoscopic surgery (VATS) to thoracotomy, location and extent of resection, presence of adhesions, completeness of fissures, and method of fissure completion. Length of hospital stay and readmission rates were analyzed. Statistical tests performed on the data include univariate and multivariate logistic regression analyses. Results: Over the 9-month study duration there were 269 lung resections, of which 31 (11.52%) had an air leak lasting longer than 5 days. Mean length of stay in hospital was significantly longer in patients with PAL compared to the control group (13 vs 5 days, P P = 0.009), right upper lobectomy (P = 0.001), and unplanned conversion from video-assisted thoracoscopic surgery (VATS) to thoracotomy (P = 0.023). Conclusion: The incidence of PAL in our study population is similar to that found in previous studies. PAL prolongs hospital length of stay. Normal BMI, right upper lobectomy, and unplanned conversion from VATS to thoracotomy are risk factors for PAL.

Risk factors of morbidity after pulmonary resection for lung cancer in patients older than 70 years

Objective This study is to analyse the clinical feature and risk factors of morbidity after pulmonary resection for lung cancer in patients older than 70 years. Methods The clinical records of 222 patients older than 70 years who had undergone pulmonary resection for their lung cancer were reviewed. The patients were divided into 3 groups,group I including the patients who had

Adjuvant chemotherapy for isolated resectable colorectal lung metastasis: A retrospective study using inverse probability treatment weighting propensity analysis

BACKGROUND The benefit of adjuvant chemotherapy(ACT)for patients with no evidence of disease after pulmonary metastasis resection(PM)from colorectal cancer(CRC)remains controversial.AIM To assess the efficacy of ACT in patients after PM resection for CRC.METHODS This study included 96 patients who underwent pulmonary metastasectomy for CRC at a single institution between April 2008 and July 2023.The primary end-point was overall survival(OS);secondary endpoints included cancer-specific survival(CSS)and disease-free survival(DFS).An inverse probability of treat-ment-weighting(IPTW)analysis was conducted to address indication bias.Sur-vival outcomes compared using Kaplan-Meier curves,log-rank test,Cox regre-ssion and confirmed by propensity score-matching(PSM).RESULTS With a median follow-up of 27.5 months(range,18.3-50.4 months),the 5-year OS,CSS and DFS were 72.0%,74.4%and 51.3%,respectively.ACT had no significant effect on OS after PM resection from CRC[original cohort:P=0.08;IPTW:P=0.15].No differences were observed for CSS(P=0.12)and DFS(P=0.68)between the ACT and non-ACT groups.Multivariate analysis showed no association of ACT with better survival,while sublobar resection(HR=0.45;95%CI:0.20-1.00,P=0.049)and longer disease-free interval(HR=0.45;95%CI:0.20-0.98,P=0.044)were associated with improved survival.CONCLUSION ACT does not improve survival after PM resection for CRC.Further well-designed randomized controlled trials are needed to determine the optimal ACT regimen and duration.

An Exploration of the Treatment of Spontaneous Progressive Hemopneumothorax in Young People

Objective:To explore an effective treatment for spontaneous progressive hemopneumothorax in young people.Methods:Thirty-four young patients with spontaneous progressive hemopneumothorax from January 2018 to December 2019 were selected to be included in the control group for retrospective analysis;from January 2020 to December 2021,69 young patients with spontaneous progressive hemopneumothorax were selected to be included in the study group.The control group was treated with double-port thoracoscopic bullectomy,whereas the study group was treated with single-port thoracoscopic bullectomy.The intraoperative blood loss,operation time,tube retention time,VAS score,postoperative air leakage,and 1-year recurrence of the patients in the two groups were observed and analyzed.Results:The perioperative conditions of the patients in the study group,including intraoperative bleeding loss,operation time,tube retention time,and VAS scores,were 15.12±1.36,54.69±18.78,2.14±0.98,and 3.25±0.14,respectively.The perioperative conditions of the patients in the control group,including intraoperative bleeding loss,operation time,tube retention time,and VAS scores,were 22.69±2.01,55.36±19.01,4.21±1.01,and 5.36±0.45,respectively;other than the operation time,the differences in intraoperative blood loss,tube retention time,and VAS scores between the two groups were statistically significant(p<0.05);after the surgery,two patients in the study group had postoperative air leakage,accounting for 2.90%and another two patients had recurrence one year after the surgery,accounting for 2.90%;on the other hand,three patients in the control group had postoperative air leakage,accounting for 8.82%,and two patients had recurrence one year after the surgery,accounting for 5.88%.However,χ^(2) test showed that p>0.05.Conclusion:Treatment of spontaneous progressive hemopneumothorax in young people is better with single-port thoracoscopic bullectomy than with two-port thoracoscopic bullectomy,which effectively reduces intraoperative bleeding.The pain level is significantly better with single-port thoracoscopic bullectomy than with two-port thoracoscopic bullectomy,and the prognosis of patients is good with a low probability of recurrence for both,single-and twoport thoracoscopic bullectomy.