Hannah Sidhu, Li Ding, Graeme M Rosenberg, Takashi Harano, Sean C Wightman, Scott M Atay, Anthony W Kim, Brooks V Udelsman
{"title":"微创肺叶下转移切除术治疗体弱患者的安全性。","authors":"Hannah Sidhu, Li Ding, Graeme M Rosenberg, Takashi Harano, Sean C Wightman, Scott M Atay, Anthony W Kim, Brooks V Udelsman","doi":"10.1002/jso.70078","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and objectives: </strong>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.</p><p><strong>Methods: </strong>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).</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>A MI sublobar resection significantly mitigates the risk of pulmonary metastasectomy in frail patients. Thoracotomy and lobectomy should be approached cautiously in this population.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":1.9000,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Safety of Minimally Invasive Sublobar Pulmonary Metastasectomy in the Frail Patient.\",\"authors\":\"Hannah Sidhu, Li Ding, Graeme M Rosenberg, Takashi Harano, Sean C Wightman, Scott M Atay, Anthony W Kim, Brooks V Udelsman\",\"doi\":\"10.1002/jso.70078\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and objectives: </strong>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.</p><p><strong>Methods: </strong>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).</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>A MI sublobar resection significantly mitigates the risk of pulmonary metastasectomy in frail patients. Thoracotomy and lobectomy should be approached cautiously in this population.</p>\",\"PeriodicalId\":17111,\"journal\":{\"name\":\"Journal of Surgical Oncology\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2025-09-05\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Surgical Oncology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1002/jso.70078\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Surgical Oncology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/jso.70078","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ONCOLOGY","Score":null,"Total":0}
Safety of Minimally Invasive Sublobar Pulmonary Metastasectomy in the Frail Patient.
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.
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.