Risk factors and prevention strategies for chronic cough after robotic versus video-assisted thoracic surgery in non-small cell lung cancer patients_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WU Ziheng ¹ , XU Wei ² , XU Shiguang ² , LIU Bo ² , DING Renquan ² , WANG Xilong ² , LIU Xingchi ² , LI Bo ² ,  WANG Shumin ²

1. The Graduate Training Base of Jinzhou Medical University, General Hospital of Northern Theater Command, Shenyang, 110016, P.R.China;
2. Department of Thoracic Surgery, General Hospital of Northern Theater Command, Shenyang, 110016, P.R.China;

Corresponding author：

WANG Shumin, Email: sureman2003congo@163.com

Keywords：

Da Vinci robot; postoperative chronic cough; non-small cell lung cancer; enhanced recovery after surgery; video-assisted thoracoscope

DOI：

10.7507/1007-4848.202006070

Video：

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Objective To analyze risk factors for chronic cough after minimally invasive resection of non-small cell lung cancer (NSCLC) and explore the possible prevention measures.Methods A total of 128 NSCLC patients who received minimally invasive resection in 2018 in our hospital were enrolled, including 63 males and 65 females with an average age of 60.82±9.89 years. The patients were allocated into two groups: a robot-assisted thoracic surgery (RATS) group (56 patients) and a video-assisted thoracic surgery (VATS) group (72 patients). Chronic cough was assessed by visual analogue scale (VAS), meanwhile, other perioperative indicators were compared between the two groups. Univariate and multivariate logistic regression analyses were performed to identify risk factors for postoperative chronic cough and explore the prevention strategies.Results Overall, 61 (47.7%) patients were diagnosed with chronic cough after surgery, including 25 (44.6%) patients in the RATS group and 36 (50.0%) patients in the VATS group, and the difference was not statistically significant (P>0.05). Compared with the VATS group, the RATS group got shorter endotracheal intubation time (P=0.009) and less blood loss (P<0.001). The univariate analysis showed that age (P=0.014), range of surgery (P=0.021), number of dissected lymph nodes (P=0.015), preoperative cough (P=0.006), endotracheal intubation time (P=0.004) were the influencing factors for postoperative chronic cough. The multivariate analysis showed that age <57 years (OR=3.006, 95%CI 1.294-6.986, P=0.011), preoperative cough (OR=3.944, 95%CI 4.548-10.048, P=0.004), endotracheal intubation time ≥172 min (OR=2.316, 95%CI 1.027-5.219, P=0.043), lobectomy (OR=2.651, 95%CI 1.052-6.681, P=0.039) were the independent risk factors for chronic cough.Conclusion There is no statistical difference in postoperative chronic cough between the RATS and VATS groups. The RATS group gets less blood loss and shorter endotracheal intubation time. Patients with younger age (<57 years), preoperative cough, lobectomy, and longer duration of endotracheal intubation (≥172 min) are more likely to have chronic cough after surgery.

Citation： WU Ziheng, XU Wei, XU Shiguang, LIU Bo, DING Renquan, WANG Xilong, LIU Xingchi, LI Bo, WANG Shumin. Risk factors and prevention strategies for chronic cough after robotic versus video-assisted thoracic surgery in non-small cell lung cancer patients. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(11): 1274-1280. doi: 10.7507/1007-4848.202006070 Copy

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14.	Veronesi G, Galetta D, Maisonneuve P, et al. Four-arm robotic lobectomy for the treatment of early-stage lung cancer. J Thorac Cardiovasc Surg, 2010, 140(1): 19-25.
15.	徐宁, 汤磊, 陈浩, 等. 胸腔镜与开胸肺叶切除手术方式的比较. 临床肺科杂志, 2014, 19(4): 627-629.
16.	Kent M, Wang T, Whyte R, et al. Open, video-assisted thoracic surgery, and robotic lobectomy: review of a national database. Ann Thorac Surg, 2014, 97(1): 236-242.
17.	慕腾, 姜冠潮, 李晓, 等. 胸腔镜肺切除术后持续咳嗽的多因素分析. 中国微创外科杂志, 2017, 17(7): 577-580.
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20.	Minogue SC, Ralph J, Lampa MJ. Laryngotracheal topicalization with lidocaine before intubation decreases the incidence of coughing on emergence from general anesthesia. Anesth Analg, 2004, 99(4): 1253-1257.
21.	Widdicombe J. Airway receptors. Respir Physiol, 2001, 125(1-2): 3-15.
22.	Benjamin B. Laryngeal trauma from intubation: endoscopic valuation and classification. Otolaryng Head Neck, 1993, 109(3): 441-449.
23.	王天佑, 李单青, 崔永, 等. 胸外科围手术期肺保护中国专家共识(2019 版). 中国胸心血管外科临床杂志, 2019, 26(9): 835-842.
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1. Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2017. CA Cancer J Clin, 2017, 67(1): 7-30.
2. Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer, 2015, 136(5): E359-E386.
3. NCCN clinical practice guidelines in oncology non-small cell lung cancer guidelines. Version 5, 2020. URL: https://www.nccn.org/professionals/physician_gls/default.aspx.
4. Sawabata N, Maeda H, Takeda S, et al. Persistent cough following pulmonary resection: observational and empiric study of possible causes. Ann Thorac Surg, 2005, 79(1): 289-293.
5. Sarna L, Evangelista L, Tashkin D, et al. Impact of respiratory symptoms and pulmonary function on quality of life of long-term survivors of non-small cell lung cancer. Chest, 2004, 125(2): 439-445.
6. 胡坚, 吴益和. 胸外科 ERAS 多环节全程管理体系的建立与实践. 中国胸心血管外科临床杂志, 2017, 24(6): 413-416.
7. 邓城庆, 朱晓雷. 胸腔镜肺叶切除术后咳嗽的研究进展. 中国微创外科杂志, 2020, 20(4): 354-357.
8. 王述民. 达芬奇机器人在肺癌根治术中的应用现状及展望. 中国肿瘤, 2014, 23(9): 736-742.
9. 王述民, 许世广, 童向东, 等. 机器人肺叶切除术治疗非小细胞肺癌. 中国胸心血管外科临床杂志, 2013, 20(3): 308-311.
10. Liu L, Che G, Pu Q, et al. A new concept of endoscopic lung cancer resection: Single-direction thoracoscopic lobectomy. Surg Oncol, 2010, 19(2): e71-e77.
11. 中华医学会呼吸病学分会哮喘学组. 咳嗽的诊断与治疗指南(2015). 中华结核和呼吸杂志, 2016, 39(5): 323-354.
12. Lee KK, Matos S, Evans DH, et al. A longitudinal assessment of acute cough. Am J Respir Crit Care Med, 2013, 187(9): 991-997.
13. Molassiotis A, Smith JA, Mazzone P, et al. Symptomatic treatment of cough among adult patients with lung cancer: CHEST guideline and expert panel report. Chest, 2017, 151(4): 861-874.
14. Veronesi G, Galetta D, Maisonneuve P, et al. Four-arm robotic lobectomy for the treatment of early-stage lung cancer. J Thorac Cardiovasc Surg, 2010, 140(1): 19-25.
15. 徐宁, 汤磊, 陈浩, 等. 胸腔镜与开胸肺叶切除手术方式的比较. 临床肺科杂志, 2014, 19(4): 627-629.
16. Kent M, Wang T, Whyte R, et al. Open, video-assisted thoracic surgery, and robotic lobectomy: review of a national database. Ann Thorac Surg, 2014, 97(1): 236-242.
17. 慕腾, 姜冠潮, 李晓, 等. 胸腔镜肺切除术后持续咳嗽的多因素分析. 中国微创外科杂志, 2017, 17(7): 577-580.
18. Wu Yl, Huang ZF, Wang SY, et al. A randomized trial of systematic nodal dissection in resectable non-small cell lung cancer. Lung Cancer, 2002, 36(1): 1-6.
19. 车国卫, 吴齐飞, 邱源, 等. 多学科围手术期气道管理中国专家共识(2018 版). 中国胸心血管外科临床杂志, 2018, 25(7): 545-549.
20. Minogue SC, Ralph J, Lampa MJ. Laryngotracheal topicalization with lidocaine before intubation decreases the incidence of coughing on emergence from general anesthesia. Anesth Analg, 2004, 99(4): 1253-1257.
21. Widdicombe J. Airway receptors. Respir Physiol, 2001, 125(1-2): 3-15.
22. Benjamin B. Laryngeal trauma from intubation: endoscopic valuation and classification. Otolaryng Head Neck, 1993, 109(3): 441-449.
23. 王天佑, 李单青, 崔永, 等. 胸外科围手术期肺保护中国专家共识(2019 版). 中国胸心血管外科临床杂志, 2019, 26(9): 835-842.
24. Gillis C, Buhler K, Bresee L, et al. Effects of nutritional prehabilitation, with and without exercise, on outcomes of patients who undergo colorectal surgery: A systematic review and meta-analysis. Gastroenterology, 2018, 155(2): 391-410.

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Risk factors and prevention strategies for chronic cough after robotic versus video-assisted thoracic surgery in non-small cell lung cancer patients

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