Try a new search

Format these results:

Searched for:



Total Results:


Pulmonary Open, Robotic and Thoracoscopic Lobectomy (PORTaL) Study: Survival Analysis of 6,646 Cases

Kent, Michael S; Hartwig, Matthew G; Vallières, Eric; Abbas, Abbas E; Cerfolio, Robert J; Dylewski, Mark R; Fabian, Thomas; Herrera, Luis J; Jett, Kimble G; Lazzaro, Richard S; Meyers, Bryan; Reddy, Rishindra M; Reed, Michael F; Rice, David C; Ross, Patrick; Sarkaria, Inderpal S; Schumacher, Lana Y; Spier, Lawrence N; Tisol, William B; Wigle, Dennis A; Zervos, Michael
OBJECTIVE:The aim of this study was to analyze overall survival of robotic-assisted lobectomy (RL), video-assisted thoracoscopic lobectomy (VATS) and open lobectomy (OL) performed by experienced thoracic surgeons across multiple institutions. SUMMARY BACKGROUND DATA/BACKGROUND:Surgeons have increasingly adopted RL for resection of early-stage lung cancer. Comparative survival data following these approaches is largely from single-institution case series or administrative datasets. METHODS:Retrospective data was collected from 21 institutions from 2013-2019. Consecutive cases performed for clinical stage IA-IIIA lung cancer were included. Induction therapy patients were excluded. The propensity-score method of inverse-probability of treatment weighting (IPTW) was used to balance baseline characteristics. Overall survival (OS) was estimated using the Kaplan-Meier method. Multivariable Cox proportional hazard models were used to evaluate association among OS and relevant risk factors. RESULTS:A total of 2,789 RL, 2,661 VATS, and 1,196 OL cases were included. The unadjusted 5-year overall survival rate was highest for OL (84%) followed by RL (81%) and VATS (74%); P=0.008. Similar trends were also observed after IPTW adjustment (RL 81%; VATS 73%, OL 85%, P=0.001). Multivariable Cox regression analyses revealed that OL and RL were associated with significantly higher overall survival compared to VATS (OL vs. VATS: HR 0.64, P<0.001 and RL vs. VATS: HR 0.79; P=0.007). CONCLUSIONS:Our finding from this large multicenter study suggests that patients undergoing RL and OL have statistically similar OS, while the VATS group was associated with shorter OS. Further studies with longer follow-up are necessary to help evaluate these observations.
PMID: 36762564
ISSN: 1528-1140
CID: 5420972

Pulmonary Open, Robotic and Thoracoscopic Lobectomy (PORTaL) Study: An Analysis of 5,721 Cases

Kent, Michael S; Hartwig, Matthew G; Vallières, Eric; Abbas, Abbas E; Cerfolio, Robert J; Dylewski, Mark R; Fabian, Thomas; Herrera, Luis J; Jett, Kimble G; Lazzaro, Richard S; Meyers, Bryan; Mitzman, Brian A; Reddy, Rishindra M; Reed, Michael F; Rice, David C; Ross, Patrick; Sarkaria, Inderpal S; Schumacher, Lana Y; Tisol, William B; Wigle, Dennis A; Zervos, Michael
OBJECTIVE:The aim of this study was to analyze outcomes of open lobectomy (OL), video-assisted thoracoscopic lobectomy (VATS) and robotic-assisted lobectomy (RL). SUMMARY BACKGROUND DATA/BACKGROUND:Robotic-assisted lobectomy has seen increasing adoption for treatment of early-stage lung cancer. Comparative data regarding these approaches is largely from single-institution case series or administrative datasets. METHODS:Retrospective data was collected from 21 institutions from 2013-2019. All consecutive cases performed for clinical stage IA-IIIA lung cancer were included. Neoadjuvant cases were excluded. Propensity-score matching (1:1) was based on age, gender, race, smoking-status, FEV1%, Zubrod score, ASA score, tumor size and clinical T and N stage. RESULTS:A total of 2,391 RL, 2,174 VATS, and 1,156 OL cases were included. After propensity-score matching there were 885 pairs of RL vs. OL, 1,711 pairs of RL vs. VATS, and 952 pairs of VATS vs. OL. Operative time for RL was shorter than VATS (p < 0.0001) and OL (p = 0.0004). Compared to OL, RL and VATS had less overall postoperative complications, shorter hospital stay (LOS), and lower transfusion rates (all p < 0.02). Compared to VATS, RL had lower conversion rate (p < 0.0001), shorter hospital stay (p < 0.0001) and a lower postoperative transfusion rate (p = 0.01). RL and VATS cohorts had comparable postoperative complication rates. In-hospital mortality was comparable between all groups. CONCLUSIONS:RL and VATS approaches were associated with favorable perioperative outcomes compared to OL. Robotic-assisted lobectomy was also associated with a reduced length of stay and decreased conversion rate when compared to VATS.
PMID: 34534988
ISSN: 1528-1140
CID: 5044252

Use of a novel digital drainage system after pulmonary resection

Geraci, Travis C; Sorensen, Audrey; James, Les; Chen, Stacey; El Zaeedi, Mohamed; Cerfolio, Robert J; Zervos, Michael
BACKGROUND/UNASSIGNED:The Thoraguard Surgical Drainage System is a novel device for drainage of air and fluid after cardiothoracic surgery. METHODS/UNASSIGNED:A three-part study was conducted: a prospective observational safety and feasibility study, a retrospective comparison of patients managed with an analogue drainage system, and a clinician user-feedback survey. RESULTS/UNASSIGNED:2.8 days (IQR 1-3) (P=0.004). Compared to an analogue system, the Thoraguard system had superior user-reported ability to detect air-leaks (17/23, 74%), better ease of patient ambulation (14/23, 61%), and better display of clinically relevant information (22/23, 96%). CONCLUSIONS/UNASSIGNED:The Thoraguard Surgical Drainage System provides safe and effective drainage post pulmonary resection. Compared to an analogue system, the Thoraguard system detected a higher number of air leaks and was associated with decreased chest tube duration and hospital length of stay. User survey data reported superior air leak detection, display of clinical data, and ease of use of the Thoraguard system.
PMID: 36245636
ISSN: 2072-1439
CID: 5387372

Incidence, Management, and Outcomes of Patients With COVID-19 and Pneumothorax

Geraci, Travis C; Williams, David; Chen, Stacey; Grossi, Eugene; Chang, Stephanie; Cerfolio, Robert J; Bizekis, Costas; Zervos, Michael
BACKGROUND:Our objective was to report the incidence, management, and outcomes of patients who developed a secondary pneumothorax while admitted for coronavirus disease 2019 (COVID-19). METHODS:A single-institution, retrospective review of patients admitted for COVID-19 with a diagnosis of pneumothorax between March 1, 2020, and April 30, 2020, was performed. The primary assessment was the incidence of pneumothorax. Secondarily, we analyzed clinical outcomes of patients requiring tube thoracostomy, including those requiring operative intervention. RESULTS:From March 1, 2020, to April 30, 2020, 118 of 1595 patients (7.4%) admitted for COVID-19 developed a pneumothorax. Of these, 92 (5.8%) required tube thoracostomy drainage for a median of 12 days (interquartile range 5-25 days). The majority of patients (95 of 118, 80.5%) were on mechanical ventilation at the time of pneumothorax, 17 (14.4%) were iatrogenic, and 25 patients (21.2%) demonstrated tension physiology. Placement of a large-bore chest tube (20 F or greater) was associated with fewer tube-related complications than a small-bore tube (14 F or less) (14 vs 26 events, P = .011). Six patients with pneumothorax (5.1%) required operative management for a persistent alveolar-pleural fistula. In patients with pneumothorax, median hospital stay was 36 days (interquartile range 20-63 days) and in-hospital mortality was significantly higher than for those without pneumothorax (58% vs 13%, P < .001). CONCLUSIONS:The incidence of secondary pneumothorax in patients admitted for COVID-19 is 7.4%, most commonly occurring in patients requiring mechanical ventilation, and is associated with an in-hospital mortality rate of 58%. Placement of large-bore chest tubes is associated with fewer complications than small-bore tubes.
PMID: 34481799
ISSN: 1552-6259
CID: 5067052

Thoracic surgery outcomes for patients with Coronavirus Disease 2019

Chang, Stephanie H; Chen, David; Paone, Darien; Geraci, Travis C; Scheinerman, Joshua; Bizekis, Costas; Zervos, Michael; Cerfolio, Robert J
OBJECTIVE:As the Coronavirus Disease 2019 pandemic continues, appropriate management of thoracic complications from Coronavirus Disease 2019 needs to be determined. Our objective is to evaluate which complications occurring in patients with Coronavirus Disease 2019 require thoracic surgery and to report the early outcomes. METHODS:This study is a single-institution retrospective case series at New York University Langone Health Manhattan campus evaluating patients with confirmed Coronavirus Disease 2019 infection who were hospitalized and required thoracic surgery from March 13 to July 18, 2020. RESULTS:From March 13 to August 8, 2020, 1954 patients were admitted to New York University Langone Health for Coronavirus Disease 2019. Of these patients, 13 (0.7%) required thoracic surgery. Two patients (15%) required surgery for complicated pneumothoraces, 5 patients (38%) underwent pneumatocele resection, 1 patient (8%) had an empyema requiring decortication, and 5 patients (38%) developed a hemothorax that required surgery. Three patients (23%) died after surgery, 9 patients (69%) were discharged, and 1 patient (8%) remains in the hospital. No healthcare providers were positive for Coronavirus Disease 2019 after the surgeries. CONCLUSIONS:Given the 77% survival, with a majority of patients already discharged from the hospital, thoracic surgery is feasible for the small percent of patients hospitalized with Coronavirus Disease 2019 who underwent surgery for complex pneumothorax, pneumatocele, empyema, or hemothorax. Our experience also supports the safety of surgical intervention for healthcare providers who operate on patients with Coronavirus Disease 2019.
PMID: 33642100
ISSN: 1097-685x
CID: 4801032

Beyond the learning curve: a review of complex cases in robotic thoracic surgery

Geraci, Travis C; Scheinerman, Joshua; Chen, David; Kent, Amie; Bizekis, Costas; Cerfolio, Robert J; Zervos, Michael D
The number of thoracic surgery cases performed on the robotic platform has increased steadily over the last two decades. An increasing number of surgeons are training on the robotic system, which like any new technique or technology, has a progressive learning curve. Central to establishing a successful robotic program is the development of a dedicated thoracic robotic team that involves anesthesiologists, nurses, and bed-side assistants. With an additional surgeon console, the robot is an excellent platform for teaching. Compared to current methods of video-assisted thoracoscopic surgery (VATS), the robot offers improved wristed motion, a magnified, high definition three-dimensional vision, and greater surgeon control of the operation. These advantages are paired with integrated adjunctive technology such as infrared imaging. For pulmonary resection, these advantages of the robotic platform have translated into several clinical benefits, such as fewer overall complications, reduced pain, shorter length of stay, better postoperative pulmonary function, lower operative blood loss, and a lower 30-day mortality rate compared to open thoracotomy. With increased experience, cases of greater complexity are being performed. This review article details the process of becoming an experienced robotic thoracic surgeon and discusses a series of challenging cases in robotic thoracic surgery that a surgeon may encounter "beyond the learning curve". Nearly all thoracic surgery can now be approached robotically, including sleeve lobectomy, pneumonectomy, resection of large pulmonary and mediastinal masses, decortication, thoracic duct ligation, rib resection, and pulmonary resection after prior chest surgery and/or chemoradiation.
PMID: 34795964
ISSN: 2072-1439
CID: 5049642

Clinical and Economic Outcomes of Using Robotic Versus Hand-Held Staplers During Robotic Lobectomy

Zervos, Michael; Song, Alfred; Li, Yanli; Lee, Shih Hao; Oh, Daniel S
OBJECTIVE:During robotic lobectomy (RL), the surgeon can elect to use either robotic staplers or hand-held laparoscopic staplers. It is assumed that either will result in similar outcomes, while robotic staplers increase cost. We sought to compare perioperative outcomes and costs between RL cases that utilized robotic staplers versus hand-held staplers in real-world clinical practice. METHODS:Patients who underwent an elective RL between October 2015 and December 2017 were identified in the Premier Hospital Perspective Database. Propensity score matching (PSM) analysis was performed to compare perioperative outcomes, healthcare resource utilization, and costs between cases using robotic staplers and hand-held staplers during RL. RESULTS:= 0.22). CONCLUSIONS:Among RL cases, utilization of robotic staplers was associated with significantly lower risks of perioperative bleeding, conversion, and possibly air leak and overall complications compared to RL cases utilizing hand-held staplers. The choice of stapler may have an impact on outcomes and robotic staplers do not increase total costs.
PMID: 34488486
ISSN: 1559-0879
CID: 4998462

Outcomes of robotic surgery in patients with pulmonary nontuberculous mycobacterial disease [Meeting Abstract]

Mcguire, E L; Saini, S; Luoma, K; Zervos, M; Cerfolio, R J; Addrizzo-Harris, D J
Rationale: Treatment for patients with pulmonary nontuberculous mycobacterial (NTM) disease includes long, multi-drug, and toxic medication regimens. Despite medical therapy, the rate of sputum culture conversion is low. Surgical resection is an alternative treatment for patients with localized or refractory NTM infection. Traditionally, resection of the affected lung was achieved via open thoracotomy. Robot-assisted surgery is less invasive and similarly effective, but has not been used routinely in this population. To our knowledge, this is the first report of robotic surgery for patients with complex NTM disease.
Method(s): Using the electronic medical record we identified patients with NTM disease that underwent robotic anatomic pulmonary resection by an experienced surgeon. All surgeries were done at NYU Langone Medical Center between August 2017 and February 2020. We collected data on demographics, NTM species, antibiotic course, pre- and post-operative sputum cultures, and surgical complications.
Result(s): We identified 8 patients that met the criteria. 100% of the patients were female and 88% were white. Mean age at time of surgery was 53 years. The most common indication for surgery was cavitary disease, followed by failure of medical therapy, and hemoptysis. All of the patients had pre-operative sputum cultures positive Mycobacterium avium complex. Prior to surgery, 63% of patients required IV antibiotics. Lobectomy was the most common operation performed and none of the surgeries were converted to open thoracotomy. There were no post-operative bleeds requiring transfusion, pneumonias, pneumothoraces, or bronchopleural fistulas. One patient had an air leak > 5 days. None of the patients required an ICU stay and the median length of hospital stay was 2.5 days. There were no deaths. Patients were considered cured if they had sputum culture conversion or no longer required antibiotics. Partial cure was defined as symptom improvement or de-escalation of medical regimen. Six of the patients were completely cured, one patient was partially cured, and one patient was lost to follow-up.
Conclusion(s): Surgical resection for patients with complex NTM disease can be performed using minimally invasive, robotic techniques safely and without the need for conversion to open thoracotomy, blood transfusions, or ICU stay. In this small cohort of patients, robotic surgery had a high rate of cure, few post-operative complications, and a short length of hospital stay. Larger studies can assist with validating robotic surgery as the preferred approach in these patients
ISSN: 1535-4970
CID: 4915762

Safety and Efficacy of Bronchoscopy in Critically Ill Patients with COVID-19

Chang, Stephanie H; Jiang, Jeffrey; Kon, Zachary N; Williams, David M; Geraci, Travis; Smith, Deane E; Cerfolio, Robert J; Zervos, Michael; Bizekis, Costas
PMID: 33039461
ISSN: 1931-3543
CID: 4632252

Safety of patients and providers in lung cancer surgery during the COVID-19 pandemic

Chang, Stephanie H; Zervos, Michael; Kent, Amie; Chachoua, Abraham; Bizekis, Costas; Pass, Harvey; Cerfolio, Robert J
OBJECTIVES/OBJECTIVE:The coronavirus disease 2019 (COVID-19) pandemic has resulted in patient reluctance to seek care due to fear of contracting the virus, especially in New York City which was the epicentre during the surge. The primary objectives of this study are to evaluate the safety of patients who have undergone pulmonary resection for lung cancer as well as provider safety, using COVID-19 testing, symptoms and early patient outcomes. METHODS:Patients with confirmed or suspected pulmonary malignancy who underwent resection from 13 March to 4 May 2020 were retrospectively reviewed. RESULTS:Between 13 March and 4 May 2020, 2087 COVID-19 patients were admitted, with a median daily census of 299, to one of our Manhattan campuses (80% of hospital capacity). During this time, 21 patients (median age 72 years) out of 45 eligible surgical candidates underwent pulmonary resection-13 lobectomies, 6 segmentectomies and 2 pneumonectomies were performed by the same providers who were caring for COVID-19 patients. None of the patients developed major complications, 5 had minor complications, and the median length of hospital stay was 2 days. No previously COVID-19-negative patient (n = 20/21) or healthcare provider (n = 9: 3 surgeons, 3 surgical assistants, 3 anaesthesiologists) developed symptoms of or tested positive for COVID-19. CONCLUSIONS:Pulmonary resection for lung cancer is safe in selected patients, even when performed by providers who care for COVID-19 patients in a hospital with a large COVID-19 census. None of our patients or providers developed symptoms of COVID-19 and no patient experienced major morbidity or mortality.
PMID: 33150417
ISSN: 1873-734x
CID: 4656112