Safety of Minimally Invasive Sublobar Pulmonary Metastasectomy in the Frail Patient.

IF 1.9 3区 医学 Q3 ONCOLOGY
Hannah Sidhu, Li Ding, Graeme M Rosenberg, Takashi Harano, Sean C Wightman, Scott M Atay, Anthony W Kim, Brooks V Udelsman
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引用次数: 0

Abstract

Background and objectives: Minimally invasive (MI) pulmonary metastasectomy may improve access in frail patients who are at high-risk for complications after thoracotomy. We compared postoperative complications among frail and non-frail patients undergoing pulmonary metastasectomy.

Methods: The Nationwide Readmissions Database (2017-2019) identified adult patients who underwent pulmonary metastasectomy. Frailty was determined using Johns Hopkins Adjusted Clinical Groups indicator. Independent propensity-score matches were performed for the open and MI cohorts. Odds ratio (OR) and incidence rate (IRR) were used to compare morbidity and length of stay (LOS).

Results: A total of 8778 patients underwent pulmonary metastasectomy, of which 3.1% (270/8778) were frail. In the open cohort after propensity-score matching (98-matched pairs), frail patients had more complications (OR 2.1; p < 0.0001) and increased LOS (IRR 2.6; p < 0.0001), both of which did not improve with a sublobar resection. In the MI cohort (167-matched pairs), frailty was associated with increased morbidity (OR 2.6; p < 0.001) and increased LOS (IRR 2.8; p < 0.001), but both were mitigated by sublobar resection (morbidity OR 0.44; p = 0.005; LOS IRR 0.66; p < 0.001).

Conclusions: A MI sublobar resection significantly mitigates the risk of pulmonary metastasectomy in frail patients. Thoracotomy and lobectomy should be approached cautiously in this population.

微创肺叶下转移切除术治疗体弱患者的安全性。
背景和目的:微创(MI)肺转移切除术可以改善开胸术后并发症高危体弱患者的手术通路。我们比较了接受肺转移切除术的虚弱和非虚弱患者的术后并发症。方法:全国再入院数据库(2017-2019)确定了接受肺转移切除术的成年患者。虚弱程度采用约翰霍普金斯调整临床组指标测定。对开放组和心肌梗死组进行独立倾向评分匹配。使用优势比(OR)和发病率(IRR)比较发病率和住院时间(LOS)。结果:共8778例患者行肺转移切除术,其中3.1%(270/8778)虚弱。在倾向评分匹配后的开放队列中(98对配对),体弱患者有更多的并发症(OR 2.1; p)。结论:心肌梗死叶下切除术可显著降低体弱患者肺转移切除术的风险。在这一人群中应谨慎进行开胸和肺叶切除术。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
4.70
自引率
4.00%
发文量
367
审稿时长
2 months
期刊介绍: The Journal of Surgical Oncology offers peer-reviewed, original papers in the field of surgical oncology and broadly related surgical sciences, including reports on experimental and laboratory studies. As an international journal, the editors encourage participation from leading surgeons around the world. The JSO is the representative journal for the World Federation of Surgical Oncology Societies. Publishing 16 issues in 2 volumes each year, the journal accepts Research Articles, in-depth Reviews of timely interest, Letters to the Editor, and invited Editorials. Guest Editors from the JSO Editorial Board oversee multiple special Seminars issues each year. These Seminars include multifaceted Reviews on a particular topic or current issue in surgical oncology, which are invited from experts in the field.
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