Two-port robotic sleeve lobectomy using Stratafix sutures for central lung tumors.

OBJECTIVES: To explore the feasibility of two-port robotic sleeve lobectomy using Stratafix sutures for central lung tumors, and to summarize the surgical techniques and clinical outcomes. METHODS: We retrospectively evaluated 15 consecutive patients who underwent robotic bronchial sleeve lobectomy, performed by a single surgeon between March 2021 and September 2021. A half-continuous suture technique with two Stratafix sutures was used for bronchial anastomosis. The operative techniques and outcomes were analyzed. RESULTS: Complete resection was achieved in all patients undergoing different types of robotic bronchial sleeve lobectomy. There were no conversions to thoracotomy. The mean duration of surgery was 102.35 ± 46.31 min, mean time for bronchial anastomosis was 25.8 ± 15.2 min, mean blood loss was 64.71 ± 38.59 ml, and mean postoperative hospital stay was 4.76 ± 2.54 days. There was no death on follow-up within 90 days after surgery. CONCLUSIONS: Two-port robotic bronchial sleeve lobectomy and the novel anastomotic technique are both feasible and safe for selected patients.

Surgical techniques and outcome analysis of uniportal video-assisted thoracic surgery complex sleeve lung resection: a 20 case-series study.

BACKGROUND: Our study aims to explore the feasibility of uniportal video-assisted complex sleeve lung resection and summarize the surgical techniques and clinical outcomes. METHODS: From June 2016 to April 2020, a total of 20 complex sleeve pulmonary and distal tracheal resections were performed by the single surgical team at the Thoracic Surgery Department of the Shanghai Pulmonary Hospital. We defined cases as complex sleeve pulmonary resections if they required pulmonary segment sleeve resection, extended sleeve resection (lobectomy plus segmentectomy of the remaining lobe), sleeve pneumonectomy, lobectomy plus carinoplasty or neo-carina construction, pulmonary-sparing main bronchus resection plus carina reconstruction, and distal trachea resection with end to end anastomosis. RESULTS: The 20 cases comprised lung squamous cell carcinoma (n=11), lung adenocarcinoma (n=2), hamartoma (n=3), adenoid cystic carcinoma (n=2), carcinoid tumor (n=1), and pleomorphic carcinoma (n=1). The average blood loss during the operation was 250±126.17 mL (50-800 mL). The average operation time was 192.0±61.1 minutes. The average number of lymph node stations removed was 5.82±1.33, including station seven in all cases, and the median number of lymph nodes removed was 4.18±5.89. On the day of surgery, the drainage volume was 266±192.01 mL. The mean postoperative hospital stay was 5.37±1.86 days. Twelve of the 16 patients diagnosed with malignancy received postoperative chemotherapy. Granuloma formation at the anastomosis level led to stenosis in one case, and tumor recurrence occurred in one case. Broncho-esophageal fistula occurred in one patient after radiochemotherapy. The postoperative follow-up time was 15.6±10.7 months. The 30-day mortality was zero, and at one-year follow-up, only one patient had died of metastatic disease after the operation. CONCLUSIONS: Uniportal video-assisted complex sleeve pulmonary resections are feasible when conducted by experienced teams.

VATS Right Upper Lobe Anterior Segmentectomy in Post Left Pneumonectomy: Technique.

Lung resection following pneumonectomy for recurrent lung cancer is a challenging scenario. Peri-operative airway management and choice of surgical procedure are issues to be addressed by both the anesthesiologists and thoracic surgeons. We hereby report a case of anterior segmentectomy of the right upper for recurrent lung cancer, in a patient who had previously underwent pneumonectomy for primary lung cancer one year earlier. A modified conventional tracheal intubation and unique surgical techniques were applied for video-assisted thoracoscopic surgery (VATS) anterior segmentectomy of the right upper lobe in a patient with a notable mediastinal shift (following contralateral pneumonectomy), resulting in a good recovery and clinical outcome. The clinical experience is summarized in detail in this article.

Obesity and nonalcoholic fatty liver disease associated with adenocarcinoma in patients with lung cancer.

Lung cancer has become the leading cause of cancer-related deaths around the world. In addition to genetic risk factors and smoking, the metabolic risk factors remain to be elusive.To evaluate the associations between obesity, nonalcoholic fatty liver disease (NAFLD) and pulmonary adenocarcinoma in patients with lung cancer.Consecutive operation-proven lung cancer patients with assessment of metabolic disorders and liver ultrasound in 2009 and 2013 were retrospectively enrolled. T-test and multivariate logistic regression were applied to evaluate the contribution of individual factors to lung adenocarcinoma, as well as the synergistic effects between these factors.Among 3664 lung cancer patients with ultrasound examination, 2844 cases were enrolled for further analysis. Of them, 1053 (37.0%) were females, 1242 (43.7%) were cigarette smokers, 1658 (58.3%) were diagnosed as lung adenocarcinoma, 744 (26.2%) had obesity, and 614 (21.6%) had NAFLD. Proportion of female gender, nonsmoker, obesity, NAFLD, and serum lipid levels in patients with adenocarcinoma were significantly higher than those in other subtypes of lung cancer, and in 2013 than in 2009 (all P < .01). NAFLD and obesity were shown as independent factors and positively associated with pulmonary adenocarcinoma, along with female gender and nonsmoking, higher serum levels of cholesterol. NAFLD and other contributing factors exhibited no synergistic effects on adenocarcinoma.Obesity and NAFLD might increase the risk for pulmonary adenocarcinoma, especially in nonsmoking females, and underscore the need for further study into carcinogenic mechanisms and preventive interventions.

Clinical features and mutation status of EGFR, KRAS, BRAF, EML4-ALK and ROS1 between surgical resection samples and non surgical resection samples in lung cancer.

BACKGROUND: Target therapy is the first-line treatment in lung cancer. The testing of driver gene mutations is crucial for decision of treatment. Many lung cancer patients are in advanced grade, and lose the chance of operation. METHODS: The tissue used to perform mutation testing is only from biopsy. In order to analysis the difference between surgical resection samples (SRSs) and non-surgical resection samples (NSRSs), 1,357 surgical tissues and 145 biopsy samples histopathologically diagnosed with lung cancer were collected to detect the mutation status of EGFR, KRAS, BRAF, EML4-ALK and ROS1 in this study. RESULTS: There were no significant differences of age, gender, and histological type between the two group patients we collected; however, the significant difference was present in grade. More early stage patients were in the surgical group, but more advanced stage lung cancer patients were in non surgical group. In the mutation analysis, we also found no significant differences in all driver genes we detected between the two groups. CONCLUSIONS: Both surgical resection samples and biopsy samples could be used to perform the testing the driver gene mutation.

Progressive chest wall bleeding caused by bronchial stump nails after lobectomy.

BACKGROUND: Postoperative intrathoracic active bleeding is a serious complication after general thoracic surgery. Yet, progressive chest wall bleeding caused by a bronchial stump nail after lobectomy has rarely been reported. The purpose of this report was to review the causes, surgical treatment, and prevention of progressive chest wall bleeding caused by a bronchial stump nail in patients after lobectomy. METHODS: Between January 2011 and February 2013, approximately 5,000 patients underwent lobectomies for various thoracic diseases in the Department of Thoracic Surgery of Shanghai Pulmonary Disease Hospital in China. Among the 5,000 patients, four required reexploration for progressive postoperative chest wall bleeding caused by bronchial stump nails. RESULTS: Staples were used without covers for the bronchial stumps in these patients. At the time of reoperation, we noted that the main site of bleeding was the pleura corresponding to the bronchial stump. The bleeding pleura sites were coagulated and sutured, and complete hemostasis of the pleura was achieved. The nails on the staple that may have caused the bleeding were removed. Then, muscle or hemostatic material was applied to separate the bronchial stump and corresponding pleura. CONCLUSIONS: Performing surgery carefully and understanding the risk from bronchial stump nails are keys to preventing progressive postoperative bleeding.