Surgical Lung Biopsy for Interstitial Lung Disease Safety and Feasibility at a Tertiary Referral Center
Surgical Lung Biopsy for Interstitial Lung Disease Safety and Feasibility at a Tertiary Referral Center
复制标题
DOI：
10.1513/annalsats.202006-759oc
复制
发表时间：
2021-03-01
影响因子：
8.3
通讯作者：
Nathan, Steven D.
中科院分区：
文献类型：
--
作者：
Pastre, Jean;Khandhar, Sandeep;Nathan, Steven D.
理由：当组织学被认为有必要时，电视胸腔镜手术（VATS）仍然是间质性肺疾病（ILD）特征的金标准。由于越来越多地依赖高分辨率计算机层析成像模式，以及对该程序潜在发病率和死亡率的担忧，VATS的使用正在减少。目的：本研究的目的是评估在三级护理中心转诊的广泛的ILD患者组中VATS的安全性和耐受性。方法：收集2012年12月至2019年9月在Inova Fairfax医院接受VATS肺活检的所有ILD患者的数据。整理临床、生理和功能参数以及术后结果，包括任何并发症、住院时间和死亡率。结果：在此期间进行了268例诊断性VATS活检。该队列的平均年龄为63±13岁，54%为男性，25%最终诊断为特发性肺纤维化。229例患者（85%，选择性VATS组），39例住院患者（15%）。择期组1个月并发症发生率为8%，严重并发症发生率为4%，无死亡病例。唯一的死亡发生在VATS前住院的组（4/39 =10%）。当三级转诊ILD团队要求进行VATS时，并发症较少。择期组87%的患者当天出院。结论：本报告证明了VATS肺活检作为现代当天手术的安全性、耐受性和可行性，特别是如果患者首先由具有ILD领域专业知识的团队进行审查。这些结果支持在需要进行ILD诊断的组织学检查时进行VATS活检的较低阈值。
Rationale: Video-assisted thoracoscopic surgery (VATS) remains the gold standard for interstitial lung disease (ILD) characterization when histology is deemed necessary. There is diminishing use of VATS owing to increased reliance on high-resolution computed tomographic patterns, as well as concerns regarding the potential morbidity and mortality of the procedure.Objectives: The goal of this study was to evaluate the safety and tolerability of VATS among a broad group of patients with ILD referred to a tertiary care center.Methods: Data for all patients with ILD who underwent VATS lung biopsies at Inova Fairfax hospital for the period from December 2012 to September 2019 were collected. Clinical, physiologic, and functional parameters as well as postoperative outcomes including any complications, hospital length of stay, and mortality were collated.Results: There were 268 diagnostic VATS biopsies performed during the period. The mean age of the cohort was 63 +/- 13 years, 54% were male, and 25% were ultimately diagnosed with idiopathic pulmonary fibrosis. Two hundred twenty-nine patients were scheduled (85%, Elective VATS group) whereas 39 were inpatients (15%). In the elective group, the 1-month complication rate was 8%, whereas 4% had a severe complication, and there were no deaths. The only mortalities were in the group who were hospitalized before the VATS (4/39 =10%). Complications were less frequent when VATS was requested by the tertiary referral ILD team. Of the elective group, 87% patients were discharged the same day.Conclusions: This report demonstrates the safety, tolerability, and feasibility of VATS lung biopsy as a same-day procedure in the modern era, especially if patients are first vetted by a team with expertise in the field of ILD. These results support a lower threshold to pursue a VATS biopsy when histology is required for an ILD diagnosis.