Video-Assisted Thoracic Surgery (VATS) or Open Thoracotomy in Management of Pulmonary Hydatid cysts; A Randomized Controlled Trial

Video-Assisted Thoracic Surgery (VATS) or Open Thoracotomy in Management of Pulmonary Hydatid cysts; A Randomized Controlled Trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Video-Assisted Thoracic Surgery (VATS) or Open Thoracotomy in Management of Pulmonary Hydatid cysts; A Randomized Controlled Trial Fahmi Kakamad This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4093233/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: Pulmonary hydatid cysts, caused by Echinococcus Granulosus larvae, pose a significant health threat in livestock-raising regions, leading to respiratory symptoms. Surgical excision, involving open thoracotomy and video-assisted thoracoscopic surgery (VATS), is the primary treatment, yet their comparative effectiveness lacks robust evidence. The objective of this study is to compare outcomes of pulmonary hydatid cyst surgery using VATS and Thoracotomy Methods: We conducted a randomized controlled trial (RCT) with 50 patients to compare open thoracotomy and VATS for pulmonary hydatid cysts. Randomization was performed, and data collectors were blinded. Descriptive statistics and regression analysis were used to assess baseline characteristics and adjust for potential confounders. Results: Baseline characteristics were well-balanced between groups. VATS patients experienced reduced postoperative pain and a faster return to work compared to open thoracotomy. Correlation analysis revealed a moderate negative correlation between VATS and postoperative pain scores, as well as time to return to work. Age, gender, smoking, comorbidities, cyst number, and size showed limited correlations. Conclusion: This pilot RCT suggests VATS may offer advantages in reducing postoperative pain and hastening return to work. Larger studies are required for comprehensive clinical guidance. Health sciences/Cardiology/Cardiovascular biology Health sciences/Medical research/Study design Figures Figure 1 Introduction Pulmonary hydatid cysts, caused by the larval stage of the parasite Echinococcus granulosus ( 1 , 2 ), represent a significant health concern in regions where livestock is raised, such as South America, the Middle East, and Central Asia ( 2 , 3 ). The disease has a prolonged incubation period, which can last for several years until the hydatid cysts grow large enough to trigger clinical symptoms ( 2 ). These symptoms commonly include chronic cough, chest pain, and shortness of breath when the cysts affect the lungs ( 1 , 2 ). For accurate diagnosis, imaging studies like chest radiography, computed tomography (CT), and magnetic resonance imaging (MRI) are crucial ( 4 – 6 ). Chest radiography serves as the initial investigation for identifying pulmonary hydatid cysts, while CT is considered the primary tool for diagnosis ( 4 ). The cysts are typically visualized as solitary or multiple circumscribed or oval masses in imaging studies ( 2 , 7 ). However, it is worth noting that the detection of antibodies specific to echinococcal antigens may only be found in approximately half of the patients with pulmonary cysts ( 1 ). The mainstay of treatment for pulmonary hydatid cysts is surgical excision, whenever feasible. Various surgical options are available, including lobectomy, wedge resection, pericystectomy, intact endocystectomy, and capitonnage ( 8 ). Two common surgical techniques used for treating pulmonary hydatid cysts are open thoracotomy and video-assisted thoracoscopic surgery (VATS) ( 9 – 11 ). Open thoracotomy is a traditional approach involving a large incision in the chest wall, allowing direct access to the affected lung. The surgeon removes the cyst(s) and may perform additional lung tissue repairs as needed. On the other hand, VATS is a minimally invasive procedure that requires more or more small incisions in the chest ( 12 ). Surgical intervention is the preferred treatment, However, there is a notable lack of robust evidence comparing the efficacy and safety of open thoracotomy versus VATS as treatment options for this condition. To address this knowledge gap, we are conducting a pilot randomized controlled trial (RCT) that aims to compare the outcomes of open thoracotomy and VATS in the treatment of pulmonary hydatid cysts. Methods Setting: In this study, we conducted a randomized control trial to investigate the efficacy of two distinct surgical approaches (Thoracotomy vs VATS) for the treatment of pulmonary hydatid cysts. Randomization was carried out using a random number generator, with odd numbers assigned to the open surgical approach and even numbers allocated to the VATS approach. This method ensured the unbiased assignment of patients to their respective treatment groups. While the data collectors were blinded to the treatment allocation, the operating surgeons were not blinded due to the nature of the surgical procedures. The study was conducted during three years (March 2020 to March 2023). The primary outcomes were While the secondary outcomes were post operative pain control, hospital length of stay, presence of post operative complications and early return to work. Trial registry In accordance to the Declaration of Helsinki, the trial was registered in researchregistry, the registration number for this study is Research Registry 8813, with a registration date of April 4, 2023. The details can be found on Browse the Registry - Research Registry Sample size as the study was a pilot trial, the sample was kept small (50 consecutive cases) to assess the feasibility, safety and superiority of VATS in the management of pulmonary hydatid cyst. Inclusion criteria any case with suspected pulmonary hydatid cyst with the size at least 3 cm. Exclusion criteria simultaneous operation for other hydatid cysts like hepatic hydatid cyst, pulmonary hydatid cyst less than 3 cm. emergency presentation like tension pneumothorax, and sepsis. Preoperative diagnosis all suspected cases of hydatid cysts had complete blood count, chest x.ray and computed tomography (CT) scan with I.V contrast. When the diagnosis was in doubt, immunological studies for hydatid cysts were requested. Operative details the patients received single injection of antibiotic 2 hours before the intervention (ceftriaxone vial 1gm, iv). All procedures were performed under general anesthesia, in lateral position. For thoracotomy group, classical thoracotomy was performed through the fifth intercostal space centered at the posterior axillary line. For the VATS group, the 3–5 cm incision done in the same place. The cysts were located and removed after isolation and controlled evacuation for both group, the space was wiped by swap wetted with hypertonic saline and diluted povidone iodine (Fig. 1). Capitonnage was performed, hemo- and ero-stasis were done. The pleural cavity was irrigated by hypertonic saline. Chest tube was put for both groups in a separated incision. All of the procedures were performed by a single surgeon (the author). Postoperative care the patients were admitted to the ward, they were given I.V. antibiotics for the hospitalized period, the management of pain started by re-assurance, I.V. paracetamol, Ketorolac, if the patient still has pain, pethidine was given (50 mg subcutaneously). The criteria for chest tube removal were absence air leak and expanded lung both on clinical examination and chest.ray after removal of chest tubes, the patients were discharged home with oral antibiotic (ciprofloxacin 500 mg x2) and analgesic for further five days. All patients from both groups were put on albendazole 12 mg/kg, started directly after the operation continuing for six months, every month the drug was discontinued for one week (3 weeks/month medication). The patient underwent CT scan of the chest once every six months for 2 years. The patients were followed up for a median duration of 2 years, ranging from 6 months to 3 years. For pain measurement, the pain scale score tool were used to quantity pain 0-no pain, 1- mild pain, 2- moderate pain, 3- severe pain. Data analysis Data analysis was performed using statistical methods to assess the outcomes of the two surgical approaches. Descriptive statistics, including median, interquartile range, and frequencies, were calculated for baseline characteristics. Additionally, regression analysis was conducted to adjust for potential confounding variables. All statistical analyses were carried out using a predetermined significance level (0.05), and the results were reported with corresponding confidence intervals. Results Overall, 59 patients were assessed for eligibility criteria, 7 patients were excluded because they underwent simultaneous operation for liver hydatid cysts, one patient was excluded as he presented with tension pneumothorax and another one excluded because he presented with sepsis and he needed emergency evacuation (Fig. 1). We enrolled 50 patients to undergo one of two surgical approaches for the treatment of pulmonary hydatid cysts: Open Thoracotomy and VATS. Both groups had a similar median age (around 44 years) and gender distribution. Comorbidities such as hypertension and diabetes mellitus were present in both groups. Most patients had a single cyst, with median cyst size around 6.5-7 cm. The two groups were comparable in the primary outcomes (completeness of cyst excision, presence of intraoperative cyst rupture, recurrence of disease and survival). Blood loss and hospital stay were comparable between the groups (median of 140–150 ml and 3 days, respectively). The VATS group showed a shorter time to return to work (median 18 days) and reported lower post-operative pain scores compared to the Open Thoracotomy group. Baseline characteristics of the cohort presented in Table 1 . No recurrence was found in either group. Table 1 Baseline characteristic of patients. Open Thoracotomy Video-Assisted Thoracoscopic Surgery (VATS) Number 25 25 Age in yrs; median (IQR) 45.5 (19–68) 43.5 (18–67) Gender Male n. (%) 11 (44) 10 (40) Female n. (%) 14 (54) 15 (60) Smoking n. (%) 11 (44) 10 (40) Comorbidities Hypertension n. (%) 4 ( 16 ) 3 ( 12 ) Diabetes Mellites n. (%) 6 (24) 5( 20 ) Chronic obstructive pulmonary disease 2( 8 ) 1 ( 4 ) Number of Hydatid Cysts 1 16 (64) 14 (56) 2 4( 16 ) 5 ( 20 ) ≥ 3 5 ( 20 ) 6 (24) Size of the largest cyst cm; median (IQR) 6.5 ( 3 – 13 ) 7 ( 3 – 12 ) Blood loss in ml; median (IQR) 150 (70–900) 140 (50–800) Hospital Stay in days; median (IQR) 3 ( 3 – 6 ) 3 ( 3 – 7 ) Time to return to work in days; median (IQR) 27 (19–34) 18 (18–23) Pain Score 1 1 ( 4 ) 5 ( 20 ) 2 12 (48) 15 (60) 3 12 (48) 5 ( 20 ) Table 2 Correlation Analysis Of Pain Score, Time To Return To Work, Length Of Hospitalization, And Amount Of Blood Loss In Pulmonary Hydatid Cyst operations. Pain Score Time To Return Work Correlation coefficient P-value LL UL Correlation coefficient P-value LL UL VATS -0.4601 0.001 -0.71973 -0.20047 -3.862104 0.001 -6.11181 -1.6124 Age 0.00153 0.745 -0.00782 0.010879 -0.0041707 0.919 -0.08518 0.076837 Female -0.08235 0.677 -0.47435 0.309657 -1.702109 0.321 -5.09883 1.694614 Non-smoker 0.140781 0.527 -0.30044 0.582005 3.771384 0.053 -0.05183 7.594601 Non-hypertensive 0.06472 0.804 -0.45439 0.583831 1.071598 0.636 -3.42652 5.569711 No DM -0.14319 0.48 -0.54555 0.259166 -0.5943762 0.735 -4.08081 2.892061 Number of Cysts 2 0.089166 0.618 -0.26584 0.444169 -1.290426 0.406 -4.36653 1.785679 3 -0.18006 0.383 -0.5888 0.228675 -1.290179 0.47 -4.83189 2.251534 4 -1.0466 0.001 -1.62971 -0.46349 -5.670534 0.028 -10.7232 -0.61787 5 0.28816 0.655 -0.99224 1.568557 -14.65888 0.01 -25.7536 -3.5642 6 -0.21938 0.736 -1.50938 1.070629 3.177247 0.573 -8.00068 14.35518 7 0.314175 0.622 -0.95185 1.580198 -1.729782 0.754 -12.6999 9.240349 Size of the cyst 2 0.263012 0.648 -0.88084 1.406862 6.102948 0.224 -3.80855 16.01445 3 0.06843 0.879 -0.8233 0.960156 1.028435 0.792 -6.6984 8.755272 4 -0.29393 0.512 -1.18357 0.595713 5.680062 0.146 -2.0287 13.38882 5 -0.18446 0.648 -0.98642 0.617505 0.0021429 1 -6.94689 6.951173 6 -0.21321 0.599 -1.01864 0.592226 2.548278 0.469 -4.43082 9.52738 7 0.033569 0.935 -0.78466 0.8518 1.23942 0.729 -5.85057 8.329411 8 0.153883 0.712 -0.67227 0.980038 2.566682 0.477 -4.59198 9.725345 9 0.147533 0.719 -0.66709 0.962158 1.521757 0.669 -5.53699 8.580508 10 -0.4542 0.377 -1.47286 0.564449 3.912754 0.38 -4.91391 12.73942 11 -0.36951 0.53 -1.53674 0.797725 6.7237 0.189 -3.39042 16.83782 12 -1.09616 0.166 -2.65673 0.464403 -1.215261 0.858 -14.7376 12.3071 13 -0.69945 0.362 -2.21855 0.819637 -5.671741 0.393 -18.8347 7.49123 Length Of Hospitalization Amount of Blood Loss VATS 0.163662 0.645 -0.54076 0.868084 4.721711 0.94 -128.97 119.5265 Age -0.00832 0.515 -0.03369 0.017041 4.883527 0.033 0.409581 9.357473 Female 0.141945 0.791 -0.92163 1.20552 -9.23343 0.922 -196.83 178.3634 Non-smoker 0.037672 0.95 -1.15945 1.234791 55.58424 0.601 -266.736 155.5673 Non-hypertensive -0.30632 0.666 -1.71476 1.102117 59.27005 0.636 -189.155 307.6953 No DM 0.321673 0.559 -0.76999 1.41334 124.5963 0.201 -67.9554 317.1479 Number of Cysts 2 -0.08585 0.86 -1.04903 0.877336 4.465518 0.958 -165.424 174.355 3 -0.07088 0.899 -1.17986 1.038091 43.0214 0.662 -152.583 238.6259 4 -0.78999 0.323 -2.37207 0.792093 77.76708 0.58 -356.82 201.2854 5 -1.48422 0.397 -4.95816 1.989728 220.4727 0.476 -833.218 392.2729 6 -0.71751 0.684 -4.21752 2.782502 332.3887 0.287 -949.732 284.9547 7 -1.62572 0.349 -5.06067 1.809228 98.45275 0.747 -704.32 507.4141 Size of the cyst 2 0.237679 0.879 -2.86579 3.341149 -9.0898 0.974 -556.49 538.3102 3 0.931311 0.446 -1.4881 3.350723 13.90449 0.948 -440.648 412.8392 4 0.949578 0.436 -1.46417 3.36333 25.07722 0.907 -400.668 450.8226 5 0.893545 0.416 -1.28232 3.069412 21.24684 0.912 -362.54 405.0332 6 0.74538 0.499 -1.4399 2.930662 153.8945 0.429 -231.553 539.3417 7 1.46349 0.193 -0.75651 3.683494 36.24613 0.854 -355.325 427.8176 8 1.958665 0.086 -0.28284 4.200172 12.58564 0.95 -407.95 382.7785 9 0.886795 0.427 -1.32343 3.097017 237.072 0.229 -152.774 626.9182 10 2.017611 0.15 -0.74618 4.7814 173.546 0.48 -313.94 661.0319 11 0.12144 0.939 -3.04547 3.288354 147.839 0.6 -410.752 706.4295 12 -0.15018 0.944 -4.38428 4.083912 168.8995 0.654 -915.723 577.9241 13 0.335151 0.872 -3.78641 4.456715 40.97506 0.911 -686 767.9499 Table 2 provides valuable insights into the correlation between various factors and surgical outcomes in the management of pulmonary hydatid cysts using two different approaches: Open Thoracotomy and VATS. The results indicate a moderate negative correlation between VATS and postoperative pain scores (correlation coefficient: -0.4601, p-value: 0.001), suggesting that VATS is associated with lower postoperative pain compared to Open Thoracotomy. Additionally, VATS shows a moderate negative correlation with the time taken for patients to return to work (correlation coefficient: -0.4601, p-value: 0.001), indicating that patients undergoing VATS may experience a shorter time to return to work compared to those undergoing Open Thoracotomy. Age, gender, smoking status, and comorbidities do not show significant correlations with surgical outcomes, suggesting that these factors may not have a substantial impact on postoperative pain, time to return to work, or other surgical measures in this context. Regarding the number of cysts, there is no consistent correlation with surgical outcomes. However, having four cysts is associated with a negative correlation with time to return to work (correlation coefficient: -1.0466, p-value: 0.001), indicating that patients with four cysts may experience a longer time to return to work compared to those with a different number of cysts. Similarly, the size of the cyst does not consistently correlate with surgical outcomes, except for the presence of four cysts, which shows a negative correlation with time to return to work (correlation coefficient: -0.78999, p-value: 0.323). Discussion Open Thoracotomy involves a traditional approach with a large chest wall incision, providing direct access to the affected lung ( 13 ). The surgeon removes the cyst(s) and may perform additional lung tissue repairs as necessary. However, this procedure typically results in a longer hospital stay compared to VATS. In contrast, VATS is a minimally invasive procedure, utilizing several small chest incisions. VATS generally leads to a shorter hospital stay than open thoracotomy and is associated with lower postoperative pain scores ( 14 ). Numerous studies have supported the effectiveness and safety of VATS for managing both intact and ruptured solitary pulmonary hydatid cysts. Uniportal video-assisted thoracoscopy (u-VATS) has also been successfully applied in some cases, with favorable results ( 10 ). Based on the available literature, the blood loss for VATS for cyst removal in pulmonary hydatid disease ranges between 400 and 700 ml (15). VATS has been shown to have less perioperative bleeding compared to conventional thoracotomy ( 16 ). It is important to note that the amount of blood loss during surgery can vary depending on factors such as the size and location of the cyst, the surgical technique used, and the individual patient's characteristics (12,15,16). The specific blood loss for VATS cyst removal may vary in different studies and individual cases. Patients who underwent VATS reported experiencing less pain during the recovery period, attributed to its minimally invasive nature with smaller incisions, reduced tissue trauma, and pain ( 17 , 18 ). Additionally, VATS offers more favorable cosmetic outcomes with less noticeable scarring. The recurrence of hydatid cysts can occur after surgical removal, with varying rates depending on the approach. Open surgery typically has lower recurrence rates compared to VATS ins studies ( 19 ). Factors influencing recurrence include the completeness of cyst removal, the stage of the disease, surgical expertise, hygiene during surgery, and follow-up monitoring. Within the group of patients, there were no instances of recurrence observed with either of the surgical methods. SadriZadeh et al( 20 ). reported no significant association between the number of cysts and the length of hospital stay in patients undergoing surgery for pulmonary hydatid cysts, which is consistent with these findings. However, this study did identify a noteworthy result: having four cysts or more showed a negative correlation with the time taken to return to work (correlation coefficient: -1.0466, p-value: 0.001). This indicates that patients with four cysts or more may experience a longer duration before they can resume work compared to those with a different number of cysts. These findings provide valuable insights into the complex interplay of factors influencing postoperative recovery in pulmonary hydatid cyst surgery and warrant further investigation to better understand their implications. There are several limitations that should be acknowledged. First, the sample size of 50 patients may not fully represent the entire population of individuals undergoing pulmonary hydatid cyst surgery. A larger and more diverse sample would provide more robust and generalizable results. Secondly, this study was conducted at a single center, which may limit the generalizability of the findings to other institutions with different patient populations and surgical practices. Conclusion In conclusion, this study provides valuable insights into the surgical management of pulmonary hydatid cysts using VATS. VATS appears to be associated with lower postoperative pain scores and a shorter time to return to work compared to Open Thoracotomy. However, no significant correlations were observed between surgical outcomes and age, gender, smoking status, or comorbidities. The number and size of cysts did not consistently correlate with surgical outcomes, except for patients with four cysts and more, who showed a negative correlation with time to return to work. Declarations Acknowledgements : None Funding : Smart Health Tower Conflict of Interest : The authors declare that they have no competing interests. Consent For Publication : Written informed consent was obtained from the patient for publication. Data Availability Statement : The datasets generated and analyzed during the current study are available from the corresponding author on rea-sonable request Ethics approval and consent Ethical approval: The study was approved by the Sulaimani University Ethical Committee. Informed Consent patients: Written informed consent was obtained from the patient. References Morar R, Feldman C. Pulmonary echinococcosis. Eur Respir J [Internet]. 2003;21(6):1069 LP – 1077. Available from: http://erj.ersjournals.com/content/21/6/1069.abstract Rawat S, Kumar R, Raja J, Singh RS, Thingnam SKS. Pulmonary hydatid cyst: Review of literature. J Fam Med Prim care. 2019;8(9):2774–8. Sarkar M, Pathania R, Jhobta A, Thakur BR, Chopra R. Cystic pulmonary hydatidosis. Lung India. 2016;33(2):179–91. Abbasi B, Akhavan R, Ghamari Khameneh A, Darban Hosseini Amirkhiz G, Rezaei-Dalouei H, Tayebi S, et al. 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Pulmonary function, postoperative pain, and serum cytokine level after lobectomy: a comparison of VATS and conventional procedure. Ann Thorac Surg [Internet]. 2001;72(2):362–5. Available from: https://doi.org/10.1016/S0003-4975(01)02804-1 Bendixen M, Jørgensen OD, Kronborg C, Andersen C, Licht PB. Postoperative pain and quality of life after lobectomy via video-assisted thoracoscopic surgery or anterolateral thoracotomy for early stage lung cancer: a randomised controlled trial. Lancet Oncol. 2016;17(6):836–44. Prousalidis J, Kosmidis C, Anthimidis G, Kapoutzis K, Karamanlis E, Fachantidis E. Postoperative recurrence of cystic hydatidosis. Can J Surg. 2012;55(1):15–20. Sadrizadeh A, Haghi SZ, Masuom SHF, Bagheri R, Dalouee MN. Evaluation of the effect of pulmonary hydatid cyst location on the surgical technique approaches. Lung India. 2014;31(4):361–5. Additional Declarations No competing interests reported. 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The disease has a prolonged incubation period, which can last for several years until the hydatid cysts grow large enough to trigger clinical symptoms (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). These symptoms commonly include chronic cough, chest pain, and shortness of breath when the cysts affect the lungs (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFor accurate diagnosis, imaging studies like chest radiography, computed tomography (CT), and magnetic resonance imaging (MRI) are crucial (\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Chest radiography serves as the initial investigation for identifying pulmonary hydatid cysts, while CT is considered the primary tool for diagnosis (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). The cysts are typically visualized as solitary or multiple circumscribed or oval masses in imaging studies (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). However, it is worth noting that the detection of antibodies specific to echinococcal antigens may only be found in approximately half of the patients with pulmonary cysts (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe mainstay of treatment for pulmonary hydatid cysts is surgical excision, whenever feasible. Various surgical options are available, including lobectomy, wedge resection, pericystectomy, intact endocystectomy, and capitonnage (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Two common surgical techniques used for treating pulmonary hydatid cysts are open thoracotomy and video-assisted thoracoscopic surgery (VATS) (\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOpen thoracotomy is a traditional approach involving a large incision in the chest wall, allowing direct access to the affected lung. The surgeon removes the cyst(s) and may perform additional lung tissue repairs as needed. On the other hand, VATS is a minimally invasive procedure that requires more or more small incisions in the chest (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSurgical intervention is the preferred treatment, However, there is a notable lack of robust evidence comparing the efficacy and safety of open thoracotomy versus VATS as treatment options for this condition.\u003c/p\u003e \u003cp\u003eTo address this knowledge gap, we are conducting a pilot randomized controlled trial (RCT) that aims to compare the outcomes of open thoracotomy and VATS in the treatment of pulmonary hydatid cysts.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSetting:\u003c/h2\u003e \u003cp\u003eIn this study, we conducted a randomized control trial to investigate the efficacy of two distinct surgical approaches (Thoracotomy vs VATS) for the treatment of pulmonary hydatid cysts. Randomization was carried out using a random number generator, with odd numbers assigned to the open surgical approach and even numbers allocated to the VATS approach. This method ensured the unbiased assignment of patients to their respective treatment groups. While the data collectors were blinded to the treatment allocation, the operating surgeons were not blinded due to the nature of the surgical procedures. The study was conducted during three years (March 2020 to March 2023).\u003c/p\u003e \u003cp\u003eThe primary outcomes were While the secondary outcomes were post operative pain control, hospital length of stay, presence of post operative complications and early return to work.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eTrial registry\u003c/strong\u003e \u003cp\u003e In accordance to the Declaration of Helsinki, the trial was registered in researchregistry, the registration number for this study is Research Registry 8813, with a registration date of April 4, 2023. The details can be found on Browse the Registry - Research Registry\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eSample size\u003c/strong\u003e \u003cp\u003eas the study was a pilot trial, the sample was kept small (50 consecutive cases) to assess the feasibility, safety and superiority of VATS in the management of pulmonary hydatid cyst.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eInclusion criteria\u003c/strong\u003e \u003cp\u003eany case with suspected pulmonary hydatid cyst with the size at least 3 cm.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eExclusion criteria\u003c/strong\u003e \u003cp\u003esimultaneous operation for other hydatid cysts like hepatic hydatid cyst, pulmonary hydatid cyst less than 3 cm. emergency presentation like tension pneumothorax, and sepsis.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003ePreoperative diagnosis\u003c/strong\u003e \u003cp\u003eall suspected cases of hydatid cysts had complete blood count, chest x.ray and computed tomography (CT) scan with I.V contrast. When the diagnosis was in doubt, immunological studies for hydatid cysts were requested.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eOperative details\u003c/strong\u003e \u003cp\u003ethe patients received single injection of antibiotic 2 hours before the intervention (ceftriaxone vial 1gm, iv). All procedures were performed under general anesthesia, in lateral position. For thoracotomy group, classical thoracotomy was performed through the fifth intercostal space centered at the posterior axillary line. For the VATS group, the 3\u0026ndash;5 cm incision done in the same place. The cysts were located and removed after isolation and controlled evacuation for both group, the space was wiped by swap wetted with hypertonic saline and diluted povidone iodine (Fig.\u0026nbsp;1). Capitonnage was performed, hemo- and ero-stasis were done. The pleural cavity was irrigated by hypertonic saline. Chest tube was put for both groups in a separated incision. All of the procedures were performed by a single surgeon (the author).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003ePostoperative care\u003c/strong\u003e \u003cp\u003ethe patients were admitted to the ward, they were given I.V. antibiotics for the hospitalized period, the management of pain started by re-assurance, I.V. paracetamol, Ketorolac, if the patient still has pain, pethidine was given (50 mg subcutaneously). The criteria for chest tube removal were absence air leak and expanded lung both on clinical examination and chest.ray after removal of chest tubes, the patients were discharged home with oral antibiotic (ciprofloxacin 500 mg x2) and analgesic for further five days. All patients from both groups were put on albendazole 12 mg/kg, started directly after the operation continuing for six months, every month the drug was discontinued for one week (3 weeks/month medication). The patient underwent CT scan of the chest once every six months for 2 years. The patients were followed up for a median duration of 2 years, ranging from 6 months to 3 years.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eFor pain measurement, the pain scale score tool were used to quantity pain 0-no pain, 1- mild pain, 2- moderate pain, 3- severe pain.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eData analysis was performed using statistical methods to assess the outcomes of the two surgical approaches. Descriptive statistics, including median, interquartile range, and frequencies, were calculated for baseline characteristics. Additionally, regression analysis was conducted to adjust for potential confounding variables. All statistical analyses were carried out using a predetermined significance level (0.05), and the results were reported with corresponding confidence intervals.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eOverall, 59 patients were assessed for eligibility criteria, 7 patients were excluded because they underwent simultaneous operation for liver hydatid cysts, one patient was excluded as he presented with tension pneumothorax and another one excluded because he presented with sepsis and he needed emergency evacuation (Fig.\u0026nbsp;1). We enrolled 50 patients to undergo one of two surgical approaches for the treatment of pulmonary hydatid cysts: Open Thoracotomy and VATS. Both groups had a similar median age (around 44 years) and gender distribution. Comorbidities such as hypertension and diabetes mellitus were present in both groups. Most patients had a single cyst, with median cyst size around 6.5-7 cm. The two groups were comparable in the primary outcomes (completeness of cyst excision, presence of intraoperative cyst rupture, recurrence of disease and survival). Blood loss and hospital stay were comparable between the groups (median of 140\u0026ndash;150 ml and 3 days, respectively). The VATS group showed a shorter time to return to work (median 18 days) and reported lower post-operative pain scores compared to the Open Thoracotomy group. Baseline characteristics of the cohort presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. No recurrence was found in either group.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristic of patients.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOpen Thoracotomy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVideo-Assisted Thoracoscopic Surgery (VATS)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge in yrs; median (IQR)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45.5 (19\u0026ndash;68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43.5 (18\u0026ndash;67)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale n. (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (40)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale n. (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (60)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking n. (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (40)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComorbidities\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension n. (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e16\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes Mellites n. (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic obstructive pulmonary disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of Hydatid Cysts\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (56)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e16\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (24)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSize of the largest cyst cm; median (IQR)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.5 (\u003cspan additionalcitationids=\"CR4 CR5 CR6 CR7 CR8 CR9 CR10 CR11 CR12\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (\u003cspan additionalcitationids=\"CR4 CR5 CR6 CR7 CR8 CR9 CR10 CR11\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBlood loss in ml; median (IQR)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e150 (70\u0026ndash;900)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e140 (50\u0026ndash;800)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHospital Stay in days; median (IQR)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (\u003cspan additionalcitationids=\"CR4 CR5\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (\u003cspan additionalcitationids=\"CR4 CR5 CR6\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTime to return to work in days; median (IQR)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27 (19\u0026ndash;34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (18\u0026ndash;23)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePain Score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (60)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation Analysis Of Pain Score, Time To Return To Work, Length Of Hospitalization, And Amount Of Blood Loss In Pulmonary Hydatid Cyst operations.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003ePain Score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c9\" namest=\"c6\"\u003e \u003cp\u003eTime To Return Work\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCorrelation coefficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCorrelation coefficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eLL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eUL\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVATS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.4601\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.71973\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.20047\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-3.862104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-6.11181\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-1.6124\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.00153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.745\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.00782\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.010879\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.0041707\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.919\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.08518\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.076837\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFemale\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.08235\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.677\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.47435\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.309657\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-1.702109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.321\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-5.09883\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.694614\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNon-smoker\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.140781\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.527\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.30044\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.582005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.771384\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.053\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.05183\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e7.594601\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNon-hypertensive\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.06472\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.804\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.45439\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.583831\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.071598\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.636\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-3.42652\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e5.569711\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNo DM\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.14319\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.54555\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.259166\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.5943762\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.735\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-4.08081\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2.892061\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of Cysts\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.089166\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.618\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.26584\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.444169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-1.290426\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.406\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-4.36653\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.785679\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.18006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.383\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.5888\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.228675\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-1.290179\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.47\u003c/p\u003e \u003c/td\u003e 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colname=\"c2\"\u003e \u003cp\u003e0.147533\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.719\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.66709\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.962158\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.521757\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.669\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-5.53699\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e8.580508\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.4542\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.377\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1.47286\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.564449\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.912754\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-4.91391\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e12.73942\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.36951\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1.53674\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.797725\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6.7237\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.189\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-3.39042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e16.83782\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.09616\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.166\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-2.65673\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.464403\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-1.215261\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.858\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-14.7376\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e12.3071\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.69945\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.362\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-2.21855\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.819637\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-5.671741\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.393\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-18.8347\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e7.49123\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eLength Of Hospitalization\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c9\" namest=\"c6\"\u003e \u003cp\u003e\u003cb\u003eAmount of Blood Loss\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVATS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.163662\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.645\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.54076\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.868084\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.721711\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-128.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e119.5265\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.00832\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.515\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.03369\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.017041\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.883527\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.409581\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e9.357473\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFemale\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.141945\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.791\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.92163\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.20552\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-9.23343\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.922\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-196.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e178.3634\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNon-smoker\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.037672\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1.15945\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.234791\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e55.58424\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.601\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-266.736\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e155.5673\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNon-hypertensive\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.30632\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.666\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1.71476\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.102117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e59.27005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.636\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-189.155\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e307.6953\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNo DM\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.321673\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.559\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.76999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.41334\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e124.5963\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.201\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-67.9554\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e317.1479\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of Cysts\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.08585\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1.04903\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.877336\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.465518\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.958\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-165.424\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e174.355\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.07088\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.899\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1.17986\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.038091\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e43.0214\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.662\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-152.583\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e238.6259\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.78999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.323\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-2.37207\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.792093\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e77.76708\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-356.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e201.2854\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.48422\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.397\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-4.95816\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.989728\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e220.4727\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.476\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-833.218\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e392.2729\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.71751\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.684\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-4.21752\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.782502\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e332.3887\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.287\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-949.732\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e284.9547\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.62572\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.349\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-5.06067\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.809228\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e98.45275\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.747\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-704.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e507.4141\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSize of the cyst\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.237679\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.879\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-2.86579\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.341149\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-9.0898\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.974\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-556.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e538.3102\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.931311\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.446\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1.4881\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.350723\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13.90449\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.948\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-440.648\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e412.8392\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.949578\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.436\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1.46417\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.36333\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25.07722\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.907\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-400.668\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e450.8226\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.893545\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.416\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1.28232\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.069412\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e21.24684\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.912\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-362.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e405.0332\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.74538\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.499\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1.4399\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.930662\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e153.8945\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.429\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-231.553\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e539.3417\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.46349\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.193\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.75651\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.683494\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e36.24613\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.854\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-355.325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e427.8176\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.958665\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.086\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.28284\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.200172\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12.58564\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-407.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e382.7785\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.886795\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.427\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1.32343\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.097017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e237.072\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.229\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-152.774\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e626.9182\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.017611\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.74618\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.7814\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e173.546\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-313.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e661.0319\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.12144\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.939\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-3.04547\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.288354\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e147.839\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-410.752\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e706.4295\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.15018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.944\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-4.38428\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.083912\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e168.8995\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.654\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-915.723\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e577.9241\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.335151\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.872\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-3.78641\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.456715\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e40.97506\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.911\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-686\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e767.9499\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e provides valuable insights into the correlation between various factors and surgical outcomes in the management of pulmonary hydatid cysts using two different approaches: Open Thoracotomy and VATS. The results indicate a moderate negative correlation between VATS and postoperative pain scores (correlation coefficient: -0.4601, p-value: 0.001), suggesting that VATS is associated with lower postoperative pain compared to Open Thoracotomy. Additionally, VATS shows a moderate negative correlation with the time taken for patients to return to work (correlation coefficient: -0.4601, p-value: 0.001), indicating that patients undergoing VATS may experience a shorter time to return to work compared to those undergoing Open Thoracotomy.\u003c/p\u003e \u003cp\u003eAge, gender, smoking status, and comorbidities do not show significant correlations with surgical outcomes, suggesting that these factors may not have a substantial impact on postoperative pain, time to return to work, or other surgical measures in this context.\u003c/p\u003e \u003cp\u003eRegarding the number of cysts, there is no consistent correlation with surgical outcomes. However, having four cysts is associated with a negative correlation with time to return to work (correlation coefficient: -1.0466, p-value: 0.001), indicating that patients with four cysts may experience a longer time to return to work compared to those with a different number of cysts.\u003c/p\u003e \u003cp\u003eSimilarly, the size of the cyst does not consistently correlate with surgical outcomes, except for the presence of four cysts, which shows a negative correlation with time to return to work (correlation coefficient: -0.78999, p-value: 0.323).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOpen Thoracotomy involves a traditional approach with a large chest wall incision, providing direct access to the affected lung (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). The surgeon removes the cyst(s) and may perform additional lung tissue repairs as necessary. However, this procedure typically results in a longer hospital stay compared to VATS.\u003c/p\u003e \u003cp\u003eIn contrast, VATS is a minimally invasive procedure, utilizing several small chest incisions. VATS generally leads to a shorter hospital stay than open thoracotomy and is associated with lower postoperative pain scores (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eNumerous studies have supported the effectiveness and safety of VATS for managing both intact and ruptured solitary pulmonary hydatid cysts. Uniportal video-assisted thoracoscopy (u-VATS) has also been successfully applied in some cases, with favorable results (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eBased on the available literature, the blood loss for VATS for cyst removal in pulmonary hydatid disease ranges between 400 and 700 ml (15). VATS has been shown to have less perioperative bleeding compared to conventional thoracotomy (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e16\u003c/span\u003e). It is important to note that the amount of blood loss during surgery can vary depending on factors such as the size and location of the cyst, the surgical technique used, and the individual patient's characteristics (12,15,16). The specific blood loss for VATS cyst removal may vary in different studies and individual cases.\u003c/p\u003e \u003cp\u003ePatients who underwent VATS reported experiencing less pain during the recovery period, attributed to its minimally invasive nature with smaller incisions, reduced tissue trauma, and pain (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Additionally, VATS offers more favorable cosmetic outcomes with less noticeable scarring.\u003c/p\u003e \u003cp\u003eThe recurrence of hydatid cysts can occur after surgical removal, with varying rates depending on the approach. Open surgery typically has lower recurrence rates compared to VATS ins studies (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Factors influencing recurrence include the completeness of cyst removal, the stage of the disease, surgical expertise, hygiene during surgery, and follow-up monitoring. Within the group of patients, there were no instances of recurrence observed with either of the surgical methods.\u003c/p\u003e \u003cp\u003eSadriZadeh et al(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e20\u003c/span\u003e). reported no significant association between the number of cysts and the length of hospital stay in patients undergoing surgery for pulmonary hydatid cysts, which is consistent with these findings. However, this study did identify a noteworthy result: having four cysts or more showed a negative correlation with the time taken to return to work (correlation coefficient: -1.0466, p-value: 0.001). This indicates that patients with four cysts or more may experience a longer duration before they can resume work compared to those with a different number of cysts. These findings provide valuable insights into the complex interplay of factors influencing postoperative recovery in pulmonary hydatid cyst surgery and warrant further investigation to better understand their implications.\u003c/p\u003e \u003cp\u003eThere are several limitations that should be acknowledged. First, the sample size of 50 patients may not fully represent the entire population of individuals undergoing pulmonary hydatid cyst surgery. A larger and more diverse sample would provide more robust and generalizable results. Secondly, this study was conducted at a single center, which may limit the generalizability of the findings to other institutions with different patient populations and surgical practices.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, this study provides valuable insights into the surgical management of pulmonary hydatid cysts using VATS. VATS appears to be associated with lower postoperative pain scores and a shorter time to return to work compared to Open Thoracotomy. However, no significant correlations were observed between surgical outcomes and age, gender, smoking status, or comorbidities. The number and size of cysts did not consistently correlate with surgical outcomes, except for patients with four cysts and more, who showed a negative correlation with time to return to work.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e: None\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: Smart Health Tower\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest\u003c/strong\u003e:\u0026nbsp;The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent For Publication\u003c/strong\u003e: Written informed consent was obtained from the patient for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e: The datasets generated and analyzed during the current study are available from the corresponding author on rea-sonable request\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval:\u0026nbsp;The study was approved by the Sulaimani University Ethical Committee.\u003c/p\u003e\n\u003cp\u003eInformed Consent patients: Written informed consent was obtained from the patient.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMorar R, Feldman C. 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Lung India. 2014;31(4):361\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-4093233/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4093233/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eIntroduction:\u003c/b\u003e\u003c/p\u003e \u003cp\u003ePulmonary hydatid cysts, caused by Echinococcus Granulosus larvae, pose a significant health threat in livestock-raising regions, leading to respiratory symptoms. Surgical excision, involving open thoracotomy and video-assisted thoracoscopic surgery (VATS), is the primary treatment, yet their comparative effectiveness lacks robust evidence. The objective of this study is to compare outcomes of pulmonary hydatid cyst surgery using VATS and Thoracotomy\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods:\u003c/b\u003e\u003c/p\u003e \u003cp\u003eWe conducted a randomized controlled trial (RCT) with 50 patients to compare open thoracotomy and VATS for pulmonary hydatid cysts. Randomization was performed, and data collectors were blinded. Descriptive statistics and regression analysis were used to assess baseline characteristics and adjust for potential confounders.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults:\u003c/b\u003e\u003c/p\u003e \u003cp\u003eBaseline characteristics were well-balanced between groups. VATS patients experienced reduced postoperative pain and a faster return to work compared to open thoracotomy. Correlation analysis revealed a moderate negative correlation between VATS and postoperative pain scores, as well as time to return to work. Age, gender, smoking, comorbidities, cyst number, and size showed limited correlations.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion:\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThis pilot RCT suggests VATS may offer advantages in reducing postoperative pain and hastening return to work. Larger studies are required for comprehensive clinical guidance.\u003c/p\u003e","manuscriptTitle":"Video-Assisted Thoracic Surgery (VATS) or Open Thoracotomy in Management of Pulmonary Hydatid cysts; A Randomized Controlled Trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-29 18:39:42","doi":"10.21203/rs.3.rs-4093233/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"671bc37a-bf03-4ff3-9710-d50b241d533d","owner":[],"postedDate":"March 29th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":29859411,"name":"Health sciences/Cardiology/Cardiovascular biology"},{"id":29859412,"name":"Health sciences/Medical research/Study design"}],"tags":[],"updatedAt":"2024-05-06T06:07:05+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-29 18:39:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4093233","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4093233","identity":"rs-4093233","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}