The management of day surgery in minimally invasive surgery for 517 patients with early-stage lung cancer by enhanced recovery after surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XIE Dong ¹ , CHEN Chang ¹ , ZHU Yuming ¹ , LIN Weikang ¹ , SU Hang ¹ , CAO Weijun ^2,3 , CHEN Shanhao ³ , XU Xin ³ , SHE Yunlang ¹ , WANG Haifeng ¹ , HE Wenxin ¹ , JIANG Gening ¹ ,  AI Kaixing ¹

1. Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai, 200433, P.R. China;
2. Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, Shanghai, 200433, P.R. China;
3. Medical Department, Shanghai Pulmonary Hospital, Tongji University, Shanghai, 200433, P.R. China;

Corresponding?author：

AI Kaixing, Email: akxing8258@#edu.cn

Keywords：

Day surgery; enhanced recovery after surgery; early-stagy lung cancer; minimally invasive surgery

DOI：

10.7507/1007-4848.202012003

Video：

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Objective To evaluate the safety and effect of day surgery in minimally invasive surgical treatment of early-stage lung cancer by enhanced recovery after surgery (ERAS).Methods We included the patients discharged from the day surgery ward of thoracic surgery after surgery in Shanghai Pulmonary Hospital between June and November 2019. We retrospectively analyzed surgical indications of day surgery, management and perioperative medical history of the patients. A total of 517 patients were included, with 156 male and 361 female patients aged 46.4±10.9 years. A total of 45 patients underwent single port VATS segmentectomy and 472 patients underwent single port VATS wedge resection.Results The average operation duration was 33.7±18.5 min. The average intraoperative blood loss was 28.5±21.4 mL. There was no intraoperative blood transfusion or conversion to thoracotomy. Postoperative pain score was 2.1±0.2. The average hospitalization was 1.94±0.89 days. The total hospitalization cost of the patients was 34686.51±6228.09 Yuan, which was 29.93% lower than the same surgery methods in the general ward. A percentage of 98.2% patients were satisfied or very satisfied in the patient satisfaction survey.Conclusion Day surgery and ERAS are effective and safe in minimally invasive surgery of early-stage lung cancer. It can also speed up the postoperative recovery of patients, improve the occupancy efficiency of hospital beds and save the medical cost.

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2.	張磊, 王小成, 趙曉燕, 等. 四川大學華西醫院日間手術臨床路徑管理基本規范. 華西醫學, 2019, 34(2): 150-154.
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15.	田博, 宋春鳳, 李輝, 等. Caprini 和 Rogers 風險評估模型聯合使用可以提高胸外科術后患者篩選靜脈血栓栓塞癥的準確性. 中華胸部外科電子雜志, 2017, 4(3): 186-189.
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22.	車國衛. 加速康復外科: 肺癌手術日間化現狀與策略. 中國肺癌雜志, 2020, 23(1): 1-4.
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1. 陳善豪, 趙昂, 江森, 等. 基于專科病種的日間介入手術模式探索與實踐. 現代醫院管理, 2019, 17(1): 29-31.
2. 張磊, 王小成, 趙曉燕, 等. 四川大學華西醫院日間手術臨床路徑管理基本規范. 華西醫學, 2019, 34(2): 150-154.
3. Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: A review. JAMA Surg, 2017, 152(3): 292-298.
4. 姜格寧, 陳昶, 朱余明等. 上海市肺科醫院磨玻璃結節早期肺腺癌的診療共識(第一版). 中國肺癌雜志, 2018, 21(3): 147-159.
5. Lee HW, Jin KN, Lee JK, et al. Long-term follow-up of ground-glass nodules after 5 years of stability. J Thorac Oncol, 2019, 14(8): 1370-1377.
6. Chiang XH, Hsu HH, Hsieh MS, et al. Propensity-matched analysis comparing survival after sublobar resection and lobectomy for ct1n0 lung adenocarcinoma. Ann Surg Oncol, 2019, 27(3): 703-715.
7. Zhu E, Xie H, Dai C, et al. Intraoperatively measured tumor size and frozen section results should be considered jointly to predict the final pathology for lung adenocarcinoma. Mod Pathol, 2018, 31(9): 1391-1399.
8. 朱泳樵, 黃佳, 林皓, 等. 機器人輔助下胸腔鏡手術(RATS)與傳統胸腔鏡手術(VATS)術后患者疼痛情況的比較研究. 中國胸心血管外科臨床雜志, 2015, 22(12): 1095-1099.
9. Fox JP, Vashi AA, Ross JS, et al. Hospital-based, acute care after ambulatory surgery center discharge. Surgery, 2014, 155(5): 743-753.
10. 中國日間手術合作聯盟. 直腸肛門日間手術臨床實踐指南(2019 版). 中國普通外科雜志, 2019, 28(11): 1322-1355.
11. 石天曉, 顧瀟怡, 于海峰, 等. 國內日間手術實踐成效與推廣建議. 現代醫院管理, 2017, 15(6): 46-48.
12. 嵇武, 劉亞萍, 戴瑋. 我國日間手術開展現狀與前景展望. 中國實用外科雜志, 2020, 40(2): 199-202.
13. Xie D, Wu J, Hu X, et al. Uniportal versus multiportal video-assisted thoracoscopic surgery does not compromise the outcome of segmentectomy. Eur J Cardio-thorac Surg, 2020: ezaa372.
14. Song C, Shargall Y, Li H, et al. Prevalence of venous thromboembolism after lung surgery in China: a single-centre, prospective cohort study involving patients undergoing lung resections without perioperative venous thromboembolism prophylaxis. Eur J Cardio-thorac Surg, 2019, 55(3): 455-460.
15. 田博, 宋春鳳, 李輝, 等. Caprini 和 Rogers 風險評估模型聯合使用可以提高胸外科術后患者篩選靜脈血栓栓塞癥的準確性. 中華胸部外科電子雜志, 2017, 4(3): 186-189.
16. Gould MK, Garcia DA, Wren SM, et al. Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 2012, 141(2 Suppl): e227S-e277S.
17. Bahl V, Hu HM, Henke PK, et al. A validation study of a retrospective venous thromboembolism risk scoring method. Ann Surg, 2010, 251(2): 344-350.
18. Pannucci CJ, Bailey SH, Dreszer G, et al. Validation of the caprini risk assessment model in plastic and reconstructive surgery patients. J Am Coll Sur, 2011, 212(1): 105-112.
19. 李輝, 姜格寧, 中國胸外科靜脈血栓栓塞癥研究協作組. 胸部惡性腫瘤圍術期靜脈血栓栓塞癥預防中國專家共識(2018 版). 中國肺癌雜志, 2018, 21(10): 739-752.
20. 李玉萍, 謝冬, 楊健, 等. 肺部磨玻璃結節術后急性肺動脈栓塞的防治策略. 中國胸心血管外科臨床雜志, 2020, 27(4): 465-470.
21. Farge D, Bounameaux H, Brenner B, et al. International clinical practice guidelines including guidance for direct oral anticoagulants in the treatment and prophylaxis of venous thromboembolism in patients with cancer. The Lancet Oncol, 2016, 17(10): e452-e466.
22. 車國衛. 加速康復外科: 肺癌手術日間化現狀與策略. 中國肺癌雜志, 2020, 23(1): 1-4.
23. Xie D, Wang H, Fei K, et al. Single-port video-assisted thoracic surgery in 1063 cases: a single-institution experiencedagger. Eur J Cardio-thorac Sur, 2016, 49(Suppl 1): i31-i36.
24. Meltzer MI. Introduction to health economics for physicians. Lancet, 2001, 358(9286): 993-998.
25. 沈誠, 常帥, 周坤, 等. 加速康復外科和日間手術模式在胸外科中的應用現狀及發展前景. 中國肺癌雜志, 2020, 23(9): 800-805.

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