RESUMO
Video-assisted thoracoscopic surgery (VATS) has showed benefits in terms of pain, hospital stay and accomplishment of adjuvancy therapy versus open surgery in early stage of non-small-cell lung cancer. Over the last years, the indication of VATS technique has been expanded to advanced lung cancer. In this article, we discuss the definition of VATS and advanced lung cancer, and the safety and feasibility of VATS technique for the resection of advanced tumors.
Assuntos
Neoplasias Pulmonares/cirurgia , Pneumonectomia/métodos , Complicações Pós-Operatórias/epidemiologia , Cirurgia Torácica Vídeoassistida/métodos , Conversão para Cirurgia Aberta/estatística & dados numéricos , Estudos de Viabilidade , Humanos , Tempo de Internação/estatística & dados numéricos , Pulmão/patologia , Pulmão/cirurgia , Neoplasias Pulmonares/patologia , Estadiamento de Neoplasias , Seleção de Pacientes , Pneumonectomia/efeitos adversos , Pneumonectomia/tendências , Complicações Pós-Operatórias/etiologia , Cirurgia Torácica Vídeoassistida/efeitos adversos , Cirurgia Torácica Vídeoassistida/tendências , Toracotomia/efeitos adversos , Toracotomia/métodos , Resultado do TratamentoRESUMO
The correct treatment for patients with non-small-cell lung cancer and ipsilateral mediastinal involvement (N2) remains a challenge. The heterogeneity of this group of patients has been shown, as well as many different prognostic factors, that will determine a specific management to each of them. Although the standard treatment is based on a multimodality therapy consisting of chemotherapy, radiotherapy and surgery, surgery is not always indicated. The selection of patients who are going to be operated, reminds being a key point of the treatment of this disease. Recent reports on operable N2 disease have been reviewed by our group in order to discuss surgery indications and when to bring it about, with the possibility to go straight to surgery.
Assuntos
Carcinoma Pulmonar de Células não Pequenas/terapia , Neoplasias Pulmonares/terapia , Neoplasias do Mediastino/terapia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Pneumonectomia/métodos , Carcinoma Pulmonar de Células não Pequenas/secundário , Quimiorradioterapia/métodos , Terapia Combinada/métodos , Terapia Combinada/tendências , Humanos , Imunoterapia/métodos , Pulmão/patologia , Pulmão/cirurgia , Neoplasias Pulmonares/patologia , Excisão de Linfonodo/métodos , Linfonodos/patologia , Neoplasias do Mediastino/secundário , Mediastino/patologia , Mediastino/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/normas , Procedimentos Cirúrgicos Minimamente Invasivos/tendências , Estadiamento de Neoplasias , Seleção de Pacientes , Pneumonectomia/tendências , Prognóstico , Resultado do TratamentoRESUMO
BACKGROUND: To evaluate the clinical efficacy and identify the predictors of outcome of intercostal arterial embolization for hemothorax caused by intercostal artery (ICA) injuries. METHODS: A retrospective multi-institutional study was conducted. Outcomes were analyzed in 30 consecutive patients presenting with hemothorax caused by active ICA hemorrhage undergoing transcatheter arterial embolization (TAE). Clinical and procedural parameters were compared between outcomes groups. RESULTS: Overall technical success rate was 87% (n=26). Among the 4 failed cases, 2 underwent repeated TAE and 2 underwent additional surgery. Overall 30-day mortality rate was 23%. Low haemoglobin levels and haematocrit, hepatic comorbidities and more than one artery undergoing embolization increased technical failure rate significantly. Survival was poorer in patients with massive bleeding. CONCLUSIONS: ICA embolization was found to be a safe and effective method in treating hemothorax caused by active ICA haemorrhage. Careful pre-embolization evaluation may be required for patient with low haemoglobin levels and haematocrit, hepatic comorbidities and active haemorrhage from more than one artery.