The " cut-in patch-out" technique for Pancoast tumor resections results in postoperative pain reduction

A case control study

Daniel J. Weber, Ikenna Okereke, Thomas J. Birdas, DuyKhanh P. Ceppa, Karen M. Rieger, Kenneth A. Kesler

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Since 2001 we have utilized a novel surgical approach for Pancoast tumors in which lobectomy and mediastinal lymph node dissection are performed directly though the chest wall defect. The defect is then patched at the completion of the procedure (" cut-in patch-out" ) thereby avoiding a separate thoracotomy with rib spreading. We undertook a study to compare outcomes of this novel " cut-in patch-out" technique with traditional thoracotomy for patients with Pancoast tumors.Methods: We retrospectively identified 41 patients undergoing surgical resection of Pancoast tumors requiring en-bloc removal of at least 3 ribs at our institution from 1999 to 2012. Surgery was accomplished by either a " cut-in patch-out" technique (n = 25) or traditional posterolateral thoracotomy and separate chest wall resection (n = 16). Multiple variables including patient demographics, neoadjuvant therapy, extent of resection, and pathology were analyzed with respect to outcomes from morbidity, narcotic use, and oncologic perspectives.Results: Baseline demographics, neoadjuvant therapy, and perioperative factors including extent of surgery, complete resections (R0), nodal status and lymph node number, morbidity, and mortality were similar between the two groups. The mean duration of out-patient narcotic use was significantly lower in the " cut-in patch-out" group compared to the thoracotomy group (80.6 days ± 62.4 vs. 158.2 days ± 119.2, p <0.01). Using multivariate regression analysis, the traditional thoracotomy technique (OR 7.72; p = 0.01) was independently associated with prolonged oral narcotic requirements (>100 days). Additionally, five year survival for the " cut-in patch-out" group was 48% versus the traditional group at 12.5% (p = 0.04).Conclusions: Compared with a traditional thoracotomy and separate chest wall resection approach for P-NSCLC, a " cut-in patch-out" technique offers an alternative approach that appears to have at least oncologic equivalence while decreasing pain. We have more recently adapted this technique to select patients with pulmonary neoplasms involving chest wall invasion and believe further investigation is warranted.

Original languageEnglish (US)
Article number163
JournalJournal of Cardiothoracic Surgery
Volume9
Issue number1
DOIs
StatePublished - Sep 30 2014
Externally publishedYes

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Pancoast Syndrome
Thoracotomy
Postoperative Pain
Case-Control Studies
Thoracic Wall
Neoadjuvant Therapy
Narcotics
Ribs
Demography
Morbidity
Lymph Node Excision
Lung Neoplasms
Outpatients
Lymph Nodes
Pathology
Pain
Survival
Mortality

Keywords

  • Chest wall
  • Lung cancer
  • Pain
  • Pancoast tumor

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

The " cut-in patch-out" technique for Pancoast tumor resections results in postoperative pain reduction : A case control study. / Weber, Daniel J.; Okereke, Ikenna; Birdas, Thomas J.; Ceppa, DuyKhanh P.; Rieger, Karen M.; Kesler, Kenneth A.

In: Journal of Cardiothoracic Surgery, Vol. 9, No. 1, 163, 30.09.2014.

Research output: Contribution to journalArticle

Weber, Daniel J. ; Okereke, Ikenna ; Birdas, Thomas J. ; Ceppa, DuyKhanh P. ; Rieger, Karen M. ; Kesler, Kenneth A. / The " cut-in patch-out" technique for Pancoast tumor resections results in postoperative pain reduction : A case control study. In: Journal of Cardiothoracic Surgery. 2014 ; Vol. 9, No. 1.
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abstract = "Background: Since 2001 we have utilized a novel surgical approach for Pancoast tumors in which lobectomy and mediastinal lymph node dissection are performed directly though the chest wall defect. The defect is then patched at the completion of the procedure ({"} cut-in patch-out{"} ) thereby avoiding a separate thoracotomy with rib spreading. We undertook a study to compare outcomes of this novel {"} cut-in patch-out{"} technique with traditional thoracotomy for patients with Pancoast tumors.Methods: We retrospectively identified 41 patients undergoing surgical resection of Pancoast tumors requiring en-bloc removal of at least 3 ribs at our institution from 1999 to 2012. Surgery was accomplished by either a {"} cut-in patch-out{"} technique (n = 25) or traditional posterolateral thoracotomy and separate chest wall resection (n = 16). Multiple variables including patient demographics, neoadjuvant therapy, extent of resection, and pathology were analyzed with respect to outcomes from morbidity, narcotic use, and oncologic perspectives.Results: Baseline demographics, neoadjuvant therapy, and perioperative factors including extent of surgery, complete resections (R0), nodal status and lymph node number, morbidity, and mortality were similar between the two groups. The mean duration of out-patient narcotic use was significantly lower in the {"} cut-in patch-out{"} group compared to the thoracotomy group (80.6 days ± 62.4 vs. 158.2 days ± 119.2, p <0.01). Using multivariate regression analysis, the traditional thoracotomy technique (OR 7.72; p = 0.01) was independently associated with prolonged oral narcotic requirements (>100 days). Additionally, five year survival for the {"} cut-in patch-out{"} group was 48{\%} versus the traditional group at 12.5{\%} (p = 0.04).Conclusions: Compared with a traditional thoracotomy and separate chest wall resection approach for P-NSCLC, a {"} cut-in patch-out{"} technique offers an alternative approach that appears to have at least oncologic equivalence while decreasing pain. We have more recently adapted this technique to select patients with pulmonary neoplasms involving chest wall invasion and believe further investigation is warranted.",
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AU - Okereke, Ikenna

AU - Birdas, Thomas J.

AU - Ceppa, DuyKhanh P.

AU - Rieger, Karen M.

AU - Kesler, Kenneth A.

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N2 - Background: Since 2001 we have utilized a novel surgical approach for Pancoast tumors in which lobectomy and mediastinal lymph node dissection are performed directly though the chest wall defect. The defect is then patched at the completion of the procedure (" cut-in patch-out" ) thereby avoiding a separate thoracotomy with rib spreading. We undertook a study to compare outcomes of this novel " cut-in patch-out" technique with traditional thoracotomy for patients with Pancoast tumors.Methods: We retrospectively identified 41 patients undergoing surgical resection of Pancoast tumors requiring en-bloc removal of at least 3 ribs at our institution from 1999 to 2012. Surgery was accomplished by either a " cut-in patch-out" technique (n = 25) or traditional posterolateral thoracotomy and separate chest wall resection (n = 16). Multiple variables including patient demographics, neoadjuvant therapy, extent of resection, and pathology were analyzed with respect to outcomes from morbidity, narcotic use, and oncologic perspectives.Results: Baseline demographics, neoadjuvant therapy, and perioperative factors including extent of surgery, complete resections (R0), nodal status and lymph node number, morbidity, and mortality were similar between the two groups. The mean duration of out-patient narcotic use was significantly lower in the " cut-in patch-out" group compared to the thoracotomy group (80.6 days ± 62.4 vs. 158.2 days ± 119.2, p <0.01). Using multivariate regression analysis, the traditional thoracotomy technique (OR 7.72; p = 0.01) was independently associated with prolonged oral narcotic requirements (>100 days). Additionally, five year survival for the " cut-in patch-out" group was 48% versus the traditional group at 12.5% (p = 0.04).Conclusions: Compared with a traditional thoracotomy and separate chest wall resection approach for P-NSCLC, a " cut-in patch-out" technique offers an alternative approach that appears to have at least oncologic equivalence while decreasing pain. We have more recently adapted this technique to select patients with pulmonary neoplasms involving chest wall invasion and believe further investigation is warranted.

AB - Background: Since 2001 we have utilized a novel surgical approach for Pancoast tumors in which lobectomy and mediastinal lymph node dissection are performed directly though the chest wall defect. The defect is then patched at the completion of the procedure (" cut-in patch-out" ) thereby avoiding a separate thoracotomy with rib spreading. We undertook a study to compare outcomes of this novel " cut-in patch-out" technique with traditional thoracotomy for patients with Pancoast tumors.Methods: We retrospectively identified 41 patients undergoing surgical resection of Pancoast tumors requiring en-bloc removal of at least 3 ribs at our institution from 1999 to 2012. Surgery was accomplished by either a " cut-in patch-out" technique (n = 25) or traditional posterolateral thoracotomy and separate chest wall resection (n = 16). Multiple variables including patient demographics, neoadjuvant therapy, extent of resection, and pathology were analyzed with respect to outcomes from morbidity, narcotic use, and oncologic perspectives.Results: Baseline demographics, neoadjuvant therapy, and perioperative factors including extent of surgery, complete resections (R0), nodal status and lymph node number, morbidity, and mortality were similar between the two groups. The mean duration of out-patient narcotic use was significantly lower in the " cut-in patch-out" group compared to the thoracotomy group (80.6 days ± 62.4 vs. 158.2 days ± 119.2, p <0.01). Using multivariate regression analysis, the traditional thoracotomy technique (OR 7.72; p = 0.01) was independently associated with prolonged oral narcotic requirements (>100 days). Additionally, five year survival for the " cut-in patch-out" group was 48% versus the traditional group at 12.5% (p = 0.04).Conclusions: Compared with a traditional thoracotomy and separate chest wall resection approach for P-NSCLC, a " cut-in patch-out" technique offers an alternative approach that appears to have at least oncologic equivalence while decreasing pain. We have more recently adapted this technique to select patients with pulmonary neoplasms involving chest wall invasion and believe further investigation is warranted.

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