Publications by authors named "Pierre Benoit Pages"
Beyond Body Mass Index: The Impact of Height and Height-Normalised Weight on Overall Survival of Lung Cancer Undergoing Surgery.
J Cachexia Sarcopenia Muscle
August 2025
Introduction: Unlike most malignancies, increased adiposity, as expressed by a higher body mass index (BMI), is associated with improved prognosis after lung cancer surgery at the population level. Height, one of the determinants of BMI, is associated with better survival, independent of other confounders, even though BMI is calculated as weight divided by height squared. The association of weight with survival is difficult to assess because, at the individual level, weight is closely linked to height and does not directly reflect adiposity.
View Article and Find Full Text PDFObjective: To assess the predictive performance of Predicthor, an artificial intelligence model, for 30-day mortality and complications following major pulmonary resections.
Background: The significance of predicting postoperative complications in thoracic surgery lies in the impact on patient outcomes and the efficient allocation of healthcare resources. The longstanding use of the Thoracoscore for over 15 years in hospital settings emphasizes the opportune moment for an update, leveraging new artificial intelligence methodologies to enhance predictive precision and relevance.
The use of the robotic approach is rapidly increasing in thoracic surgery worldwide. Mastering this new technique is challenging and teaching robotic surgery is difficult. Nevertheless, to date, no academic certified training program including a standardized approach is available for robotic lobectomy and no objective assessment scale has been proposed.
View Article and Find Full Text PDFComparative short-term outcomes of robotic-assisted vs video-assisted thoracic surgery in lung cancer: a multicenter retrospective study from EPITHOR with a quality audit.
J Robot Surg
February 2025
Advancements in diagnostic imaging and surgical techniques have significantly evolved the treatment landscape of non-small cell lung cancer (NSCLC). The shift toward parenchymal-sparing approaches, such as segmentectomy for cT1a-bN0 tumors, is challenging the traditional lobectomy. This retrospective multicenter cohort study evaluates short-term outcomes of Video-Assisted Thoracoscopic Surgery (VATS) and Robotic-Assisted Thoracic Surgery (RATS) in NSCLC patients using data from the French EPITHOR registry, enhanced by an in-depth quality audit.
View Article and Find Full Text PDFBackground: Recent publications suggest that the threshold for validation of the learning curve is 25 procedures. The aim of this study was to evaluate this threshold using another rarely used method, based on a composite quality indicator.
Methods: We included all patients from the French medico-administrative database receiving robot-assisted surgery for lung cancer, with a focus on hospitals performing at least 25 procedures over the period 2019-2022.
Article Synopsis
- The study aimed to evaluate safety and survival outcomes of lobectomy, segmentectomy, and wedge resection for early-stage lung cancer using data from the French EPITHOR registry between 2016 and 2022.
- A total of 19,452 patients were analyzed, finding that lobectomy was the most common procedure (72.2%), and while short-term 90-day mortality rates were similar across the three methods, significant differences emerged in 5-year overall survival.
- The results indicated that wedge resection was linked to worse long-term survival compared to lobectomy, suggesting that all types of sublobar resections may not provide equal effectiveness in treating lung cancer.
Robotic-assisted thoracic surgery training in France: a nation-wide survey from young surgeons.
Interdiscip Cardiovasc Thorac Surg
July 2024
Article Synopsis
- A study was conducted to assess the training of thoracic surgeons-in-training in robotic-assisted thoracic surgery (RATS) across France, gathering responses from 101 participants.
- Over half of the trainees had access to robotic systems, with a significant number considering robotic training essential, though only a small percentage had performed a complete procedure independently.
- The findings suggest that training opportunities vary by institution, with higher exposure and performance among fellows at high-volume centers, highlighting the need for increased access and simulation training to improve skills in RATS.
Introduction: Unlike most malignancies, higher body mass index (BMI) is associated with a reduced risk of lung cancer and improved prognosis after surgery. However, it remains controversial whether height, one of determinants of BMI, is associated with survival independently of BMI and other confounders.
Methods: We extracted data on all consecutive patients with resectable non-small cell lung cancer included in Epithor, the French Society of Thoracic and Cardiovascular Surgery database, over a 16-year period.
Article Synopsis
- Non-small cell lung cancer (NSCLC) often leads to compromised lung function, and this study focuses on the effects of surgical methods, specifically minimally invasive surgery (MIS), on 90-day post-operative mortality in high-risk patients.
- The research analyzed data from over 46,000 patients, identifying high-risk individuals with poor lung function, and found a significantly higher mortality rate in this group compared to low-risk patients.
- Results indicated that high-risk patients undergoing MIS had lower mortality rates than those undergoing traditional open surgery, even matching the mortality rates of low-risk patients.
Background: While much progress has been accomplished in the understanding of radiation-induced immune effects in tumors, little is known regarding the mechanisms involved at the tumor draining lymph node (TDLN) level. The objective of this retrospective study was to assess the immune and biological changes arising in non-involved TDLNs upon node sparing concurrent chemoradiotherapy (CRT) of non-small cell lung cancer (NSCLC) tumors.
Methods: Patients with proven localized (cN0M0) NSCLC, treated by radical surgery plus lymph node dissection with (CRT) or without (CRT) neoadjuvant chemoradiotherapy, whereby radiotherapy was targeted on the primary tumor with no significant incidental irradiation of the non-involved TDLN station (stations XI), were identified.
Article Synopsis
- The Lungsco01 study is the first to evaluate the effectiveness and economic impact of video-thoracoscopy compared to open thoracotomy for treating non-small cell lung cancer in France, involving 259 patients from 10 medical centers over a four-year period.
- Results indicated that the average costs for open thoracotomy were lower than for video-thoracoscopy at both 30 days and 3 months post-surgery, with video-thoracoscopy showing a higher incremental cost-utility ratio per additional quality-adjusted life-year (QALY) gained.
- The analysis revealed a 64% probability that video-thoracoscopy was cost-effective at the 30-day mark
Article Synopsis
- The study aimed to track changes in quality indicators, specifically 30-day mortality and failure-to-rescue rates, for lung cancer surgery in France over 15 years, while examining potential influencing factors.
- It analyzed data from over 157,000 patients who underwent pulmonary resection from 2005 to 2020, focusing on various patient demographics, surgical techniques, and hospital characteristics.
- Results showed a decline in 30-day mortality from 2005 to 2020, a drop in failure-to-rescue rates, and highlighted that less use of pneumonectomies and the adoption of advanced surgical techniques significantly contributed to improved outcomes.
Article Synopsis
- The minimally invasive approach (MIA) for lung cancer surgery has increased in use and is considered effective and safe across hospitals in France from 2013 to 2020.
- A total of 77,965 patients were analyzed, revealing a significant rise in MIA rates, reaching 50% by the 2019-2020 period, with some regional variability declining over time.
- Despite the overall increase in MIA adoption, variability remains notable between regions, with high-volume hospitals more likely to utilize this surgical technique compared to others.
Article Synopsis
- This study compared postoperative outcomes for lung cancer surgeries performed via open thoracotomy (OT), video-assisted (VATS), and robotic-assisted (RA) methods, using a large patient dataset from 2010 to 2020.
- VATS showed lower in-hospital mortality and major complications compared to OT, while both VATS and RA reduced occurrences of pneumonia and atelectasis compared to OT.
- Overall, both VATS and RA led to shorter hospital stays and improved outcomes compared to OT, with VATS showing the best results in reducing mortality.
Article Synopsis
- The study aimed to analyze lung cancer patients who had surgery for tumors invading the chest wall, comparing outcomes based on whether they received induction chemotherapy, induction radiochemotherapy, or no induction therapy.
- Out of 688 patients studied, those who received induction radiochemotherapy had the best long-term survival rates, while postoperative mortality and incomplete resection rates varied among the groups.
- The findings suggest that induction radiochemotherapy could improve survival outcomes, indicating a need for further research through a prospective randomized trial.
Article Synopsis
- The study assesses the quality of thoracic surgery for lung cancer in France by analyzing 30-day post-operative mortality rates across different hospitals and regions from 2013 to 2020.
- Data from over 87,000 patients revealed a 2.91% mortality rate, with significant variability in standardized mortality ratios (SMRs) among 199 hospitals, particularly in high-volume regions.
- The findings indicate that while regional differences in mortality exist, the volume of surgeries performed at hospitals greatly influences the likelihood of post-operative death, highlighting the importance of hospital experience in surgical outcomes.
Prognostic score and sex-specific nomograms to predict survival in resectable lung cancer: A French nationwide study from the Epithor cohort database.
Lancet Reg Health Eur
March 2023
Article Synopsis
- The study aims to create a user-friendly nomogram to predict long-term outcomes for patients with resectable non-small cell lung cancer (NSCLC), helping to identify those at high risk during cancer treatment planning.
- Researchers analyzed clinical data from over 62,000 patients treated between 2003 and 2020, utilizing Cox modeling to identify key prognostic factors, leading to the development of sex-specific nomograms.
- Results showed a median survival of 9.2 years, with significant differences in overall survival rates based on the prognostic scoring system, confirming that this composite score can effectively predict survival after NSCLC surgery.
Article Synopsis
- The study investigates the effects of the SARS-CoV-2 epidemic on lung cancer surgery outcomes in France, comparing data from 2020 to 2018-2019.
- It found a slight decrease in lung cancer resections in 2020, particularly during the height of the pandemic, but surgery remained feasible.
- SARS-CoV-2 was linked to increased in-hospital mortality and severe complications after surgery, indicating a significant impact on patient outcomes.
The Reality of Lung Cancer Paradox: The Impact of Body Mass Index on Long-Term Survival of Resected Lung Cancer. A French Nationwide Analysis from the Epithor Database.
Cancers (Basel)
September 2021
Article Synopsis
- A study of 54,631 lung cancer patients found that obesity might actually improve survival rates for those undergoing surgery for non-small cell lung cancer (NSCLC).
- Patients were categorized by body mass index (BMI), revealing that underweight individuals had the lowest survival rates, while overweight and obese patients showed better outcomes.
- After adjusting for various factors, underweight patients had a higher risk of poor survival (HR 1.51), while those overweight (HR 0.84) and obese (HR 0.80) had a significantly lower risk, emphasizing that BMI is an important survival predictor in lung cancer surgery.
Article Synopsis
- Anatomical segmentectomy offers a potential alternative to lobectomy for early-stage lung cancer, particularly for patients at higher risk.
- A study using data from the French National Epithor database compared the morbidity and mortality of both procedures, finding segmentectomies resulted in significantly fewer postoperative complications.
- While segmentectomies lowered the risk of issues like atelectasis and pneumonia, there was no significant difference in 30, 60, or 90-day mortality rates compared to lobectomies.
Guidelines on enhanced recovery after pulmonary lobectomy.
Anaesth Crit Care Pain Med
February 2021
Article Synopsis
- The objective of the study was to create recommendations for optimizing the management of patients having pulmonary lobectomy, focusing on Enhanced Recovery After Surgery (ERAS).
- A consensus committee of 13 experts collaborated without industry funding, adhering to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to assess evidence quality.
- The committee established 32 recommendations across five areas related to patient management and recovery, achieving a strong consensus on 31 of them, with some backed by high-quality evidence.
Article Synopsis
- Exosomes, tiny vesicles released by cells found in blood, can serve as potential cancer biomarkers by distinguishing between tumor-derived and non-tumor exosomes, particularly focusing on the presence of Heat Shock Protein-70 (HSP70) in cancer cells.
- A clinical study investigated HSP70 exosomes in breast and lung cancer patients, revealing that levels in the blood were indicative of the HSP70 levels in tumor biopsies and varied significantly between metastatic and non-metastatic patients.
- The findings suggest that monitoring circulating HSP70 exosomes could be a more sensitive method for predicting tumor spread and treatment response, indicating their potential utility in assessing patient outcomes.