Incidence, management, and outcomes of intraoperative catastrophes during robotic pulmonary resection Journal Article

Authors: Cao, C.; Cerfolio, R. J.; Louie, B. E.; Melfi, F.; Veronesi, G.; Razzak, R.; Romano, G.; Novellis, P.; Shah, S.; Ranganath, N.; Park, B. J.
Article Title: Incidence, management, and outcomes of intraoperative catastrophes during robotic pulmonary resection
Abstract: Background: Intraoperative catastrophes during robotic anatomical pulmonary resections are potentially devastating events. The present study aimed to assess the incidence, management, and outcomes of these intraoperative catastrophes for patients with primary lung cancers. Methods: This was a retrospective, multiinstitutional study that evaluated patients who underwent robotic anatomical pulmonary resections. Intraoperative catastrophes were defined as events necessitating emergency thoracotomy or requiring an additional unplanned major surgical procedure. Standardized data forms were collected from each institution, with questions on intraoperative management strategies of catastrophic events. Results: Overall, 1810 patients underwent robotic anatomical pulmonary resections, including 1566 (86.5%) lobectomies. Thirty-five patients (1.9%) experienced an intraoperative catastrophe. These patients were found to have significantly higher clinical TNM stage (P = .031) and lower forced expiratory volume in 1 second (81% vs 90%; P = .004). A higher proportion of patients who had a catastrophic event underwent preoperative radiotherapy (8.6% vs 2.3%; P = .048), and the surgical procedures performed differed significantly compared with noncatastrophic patients. Patients in the catastrophic group had higher perioperative mortality (5.7% vs 0.5%; P = .018), longer operative duration (195 minutes vs 170 minutes; P = .020), and higher estimated blood loss (225 mL vs 50 mL; P < .001). The most common catastrophic event was intraoperative hemorrhage from the pulmonary artery, followed by injury to the airway, pulmonary vein, and liver. Detailed management strategies were discussed. Conclusions: The incidence of catastrophic events during robotic anatomical pulmonary resections was low, and the most common complication was pulmonary arterial injury. Awareness of potential intraoperative catastrophes and their management strategies are critical to improving clinical outcomes. © 2019 The Society of Thoracic Surgeons
Keywords: adult; aged; primary tumor; surgical technique; major clinical study; conference paper; cancer staging; lung resection; thoracotomy; incidence; lung cancer; retrospective study; pneumonia; postoperative complication; multicenter study; operation duration; blood transfusion; surgical mortality; forced expiratory volume; empyema; lobectomy; liver injury; artery injury; pulmonary artery; peroperative complication; clinical outcome; preoperative radiotherapy; pulmonary vein; bilobectomy; emergency surgery; operative blood loss; human; male; female; priority journal; segmentectomy; robot assisted surgery; prolonged air leak; intraoperative hemorrhage; pulmonary vascular disease
Journal Title: Annals of Thoracic Surgery
Volume: 108
Issue: 5
ISSN: 0003-4975
Publisher: Elsevier Science, Inc.  
Date Published: 2019-11-01
Start Page: 1498
End Page: 1504
Language: English
DOI: 10.1016/j.athoracsur.2019.05.020
PUBMED: 31255610
PROVIDER: scopus
Notes: Conference Paper -- Export Date: 1 November 2019 -- Source: Scopus
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MSK Authors
  1. Bernard J Park
    160 Park
  2. Christopher Qian Cao
    6 Cao