Surgery Performed At Night Contributes To A Higher Incidence Of Intraoperative Complications In Video-assisted Thoracoscopic Pulmonary Resection

PART Ⅰ Night-time surgery performed by continuously working surgeons contributes to a higher incidence of intraoperative complications in video-assisted thoracoscopic pulmonary resection-A large monocentric retrospective studyObjectives: To assess the influence of working hours and night time on intraoperative complications when conducting video-assisted pulmonary resection.Methods: Patients underwent video-assisted thoracoscopic surgery(VATS)in Shanghai Chest Hospital were all identified from January 2015 to April 2017.Univariable and Multivariable logistic analyses were used to analyze independent risk factors of the intraoperative complications,through which nomograms were performed to visualize the risk of the occurrence of the intraoperative complications.A 1:4 propensity score matching(PSM)analysis was conducted to verify those results.Results: A total of 15767 patients underwent VATS pulmonary resection were included in this study.Among them,15280 patients(96.1%)received surgeries during working hours and 487(3.1%)at night time.203(1.3%)intraoperative complications occurred.Vascular injury was the main cause of intraoperative complications,accounting for 92.1%(187/203).Multivariable logistic regression indicated that age(OR=1.68,95%Cl: 1.43-1.98,P<0.001),gender(OR=1.71,95%CI: 1.26-2.32,P=0.001),surgical experience(OR=2.07,95%CI: 1.56-2.75,P<0.001),type of surgery(OR=0.31,95%CI: 0.20-0.49,P<0.001)and surgical periods(OR=2.69,95%CI: 1.61-4.86,P<0.001)were independent predictors for intraoperative complications.The incidence of intraoperative complications in night-time surgery was significantly higher than that during working hours.A 1:4 PSM-based results verification shown that night-time surgery was still an independent risk factor after PSM(OR=2.76,95%CI: 1.47-5.15,P=0.002).Conclusion: The incidence of intraoperative complications of VATS pulmonary resection during night hours was significantly higher than that during working hours.In the present labor environment,thoracic surgeons should avoid nighttime surgery whenever possible.PART Ⅱ Choice of the surgical approach for patients with stage I lung squamous cell carcinoma ≤3 cmBackground: We tried to explore the surgical procedures for stage I squamous cell carcinoma(SCC)with a size of ≤3 cm by using the Surveillance,Epidemiology,and End Results(SEER)database.Furthermore,we investigated the relationships between the chosen surgical option and the size of SCC.Methods: In total,1,147 patient data sets were collected from 2010 to 2011 using the SEER database.Afterwards,849 patients with a p T1–2a N0M0 SCC with a size of ≤3 cm after a lobectomy or sublobectomy procedure were identified.Kaplan-Meier curves were conducted to compare the overall survival(OS)rates and the lung cancer-specific survival(LCSS)rates between the two surgical approaches.Cox proportional hazards regressions were performed to discover the independent risk factors for both the OS and LCSS rates.Lastly,subgroup analysis was stratified by the size of the SCC and then classified by the 8th edition T category.Results: The sublobectomy procedure did not demonstrate a difference for the OS rate.Additionally,it demonstrated a worse LCSS rate when compared with a lobectomy for stage I SCC.In the subgroup analysis,a lobectomy was shown to have a better survival outcome only when the SCC was >2 and ≤3 cm.Multivariable analysis showed that a size of >2 to ≤3 cm,and an age of >60 were independently associated with poorer OS while the sublobectomy procedure and pleural invasions(PI)were related with a poorer LCSS rate.In the stratification of data for the tumor size,the cox proportional analysis still confirmed the protective effects of the lobectomy in subgroups of SCCs with sizes between >2 to ≤3 cm as well as the T1 c category.Conclusions: The choice of the SCC surgery can be recommended based on the tumor size.A lobectomy procedure demonstrated a better LCSS against the sublobectomy in stage I SCC.SCC with sizes of >2 to ≤3 cm could become a pretty good indicator for lobectomy,while a sublobectomy may be an adequate substitute when the SCC size is ≤2 cm,especially for patients who cannot tolerate a lobectomy.T1 c category can also suggest a lobectomy instead of sublobectomy for stage I SCC patients.