Value of preoperative evaluation of FEV1 in patients with destroyed lung undergoing pneumonectomy - a 20-year real-world study.

BACKGROUND: Clinical guidelines recommend a preoperative forced expiratory volume in one second (FEV1) of > 2 L as an indication for left or right pneumonectomy. This study compares the safety and long-term prognosis of pneumonectomy for destroyed lung (DL) patients with FEV1 ≤ 2 L or > 2 L. METHODS: A total of 123 DL patients who underwent pneumonectomy between November 2002 and February 2023 at the Department of Thoracic Surgery, Beijing Chest Hospital were included. Patients were sorted into two groups: the FEV1 > 2 L group (n = 30) or the FEV1 ≤ 2 L group (n = 96). Clinical characteristics and rates of mortality, complications within 30 days after surgery, long-term mortality, occurrence of residual lung infection/tuberculosis (TB), bronchopleural fistula/empyema, readmission by last follow-up visit, and modified Medical Research Council (mMRC) dyspnea scores were compared between groups. RESULTS: A total of 96.7% (119/123) of patients were successfully discharged, with 75.6% (93/123) in the FEV1 ≤ 2 L group. As compared to the FEV1 > 2 L group, the FEV1 ≤ 2 L group exhibited significantly lower proportions of males, patients with smoking histories, patients with lung cavities as revealed by chest imaging findings, and patients with lower forced vital capacity as a percentage of predicted values (FVC%pred) (P values of 0.001, 0.027, and 0.023, 0.003, respectively). No significant intergroup differences were observed in rates of mortality within 30 days after surgery, incidence of postoperative complications, long-term mortality, occurrence of residual lung infection/TB, bronchopleural fistula/empyema, mMRC ≥ 1 at the last follow-up visit, and postoperative readmission (P > 0.05). CONCLUSIONS: As most DL patients planning to undergo left/right pneumonectomy have a preoperative FEV1 ≤ 2 L, the procedure is generally safe with favourable short- and long-term prognoses for these patients. Consequently, the results of this study suggest that DL patient preoperative FEV1 > 2 L should not be utilised as an exclusion criterion for pneumonectomy.

Chemotherapy for advanced pulmonary sarcomatoid carcinoma: a population-based propensity score matching study.

OBJECTIVES: Pulmonary sarcomatoid carcinoma (PSC) is a rare histological type of non-small cell lung cancer (NSCLC). There are no specific treatment guidelines for PSC. For advanced PSC (stage II-IV), the role of chemotherapy is still controversial. The purpose of this study was to investigate the effect of chemotherapy on the prognosis of advanced PSC. METHODS: A total of 960 patients with advanced PSC from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2019 were enrolled in this study. To investigate the prognostic factors, the Cox proportional hazard regression model was conducted. A total of 642 cases were obtained after propensity score matching (PSM). The Kaplan‒Meier method was applied to compare overall survival (OS) and cancer-specific survival (CSS). RESULTS: For all 960 cases included in this study, the Cox proportional hazard model was applied for prognostic analysis. Univariate and multivariate analyses showed that stage, T stage, N stage, M stage, surgery, and chemotherapy were prognostic factors for OS and CSS (P < 0.05). A total of 642 cases were obtained after PSM, with no significant difference between the two groups for all variables. Kaplan‒Meier curves indicated that for OS and CSS, the prognosis was significantly better in the chemotherapy group than in the no-chemotherapy group. CONCLUSIONS: For advanced PSC, chemotherapy can significantly improve the OS and CSS of patients. Chemotherapy should be an important part of PSC treatment.

Risk factors for respiratory failure after tuberculosis-destroyed lung surgery and increased dyspnea score at 1-year follow-up.

Background: Although pneumonectomy is an important surgical treatment for tuberculosis-destroyed lung (TDL), few studies have investigated long-term postoperative TDL prognosis. Here, risk factors were determined for postoperative secondary respiratory failure and modified British Medical Research Council (mMRC ≥1) at discharge and at 1-year post-surgical follow-up. Methods: A two-way cohort study was conducted of 116 patients admitted to our thoracic surgery department for surgical TDL treatment from January 2001 to June 2020. General clinical data were collected then patient postoperative mMRC scores were monitored for 1 year. Dyspnea-associated factors (mMRC ≥1) were identified then risk factors for postoperative respiratory failure and compromised long-term respiratory function were identified using multivariate adjusted logistic regression analysis. Results: Of 116 patients, 27.6% (32/116) developed respiratory failure secondary to surgery. Multifactorial logistic regression analysis revealed that preoperative serum albumin of <30 g/L [adjusted odds ratios (aOR) 6.613, 95% confidence intervals (CI): 1.064-41.086] and intraoperative bleeding of >1,000 mL (aOR 6.876, 95% CI: 1.236-38.243) were risk factors for subsequent respiratory failure only in patients experiencing postoperative secondary respiratory failure. Sorting of patient mMRC dyspnea index scores into two groups (mMRC =0, mMRC ≥1) followed by logistic regression analysis revealed that risk factors for 1-year postoperative dyspnea included mMRC score ≥1 at discharge (aOR 14.446, 95% CI: 1.102-189.361) and postoperative respiratory failure occurrence (aOR 9.946, 95% CI: 1.063-93.034). Conclusions: TDL patient preoperative hypoalbuminemia and extensive intraoperative bleeding were risk factors for postoperative secondary respiratory failure. Postoperative secondary respiratory failure and high mMRC (≥1) at discharge were associated with reduced postoperative long-term recovery of respiratory function.

Key Factors Associated With Administration of Ventilator Support After Thymoma Resection.

INTRODUCTION: In clinical practice, some patients undergoing surgery for thymoma require post-surgical ventilator support, although, factors associated with administration of ventilator support are unclear. This study aimed to explore factors associated with incidence of post-surgical severe respiratory failure requiring ventilator support after thymoma resection. METHODS: Clinical data of patients who underwent thymoma re-section in our thoracic surgery department between January 2001 and February 2020 was retrospectively analyzed. Multiple logistic regression analysis was used to identify factors associated with patient need for post-surgical ventilator support after thymoma resection. RESULTS: Among 157 patients who underwent thymoma resection, 17.8% (28/157) required post-surgical ventilator support. Results of univariate analysis revealed that gender, myasthenia gravis (MG) grade, anti-MG medication use (neostigmine or prednisone), Masaoka thymoma stage, pulmonary function test index values, surgical approach, and intraoperative blood loss were associated with increased incidence of severe respiratory failure requiring post-operative ventilator support (P < 0.05). Results of multivariable logistic regression analysis revealed that median sternotomy, MG grade three status, and patient use of anti-MG drug treatments before thymoma resection surgery were associated with greater need for post-surgical ventilator support. CONCLUSIONS: Our data suggest that median sternotomy, MG grade three status, and preoperative use of anti-MG drugs are associated with greater incidence of severe respiratory failure requiring respiratory support after thymoma surgery. Therefore, patients with these risk factors should be closely monitored to reduce the incidence of severe postoperative respiratory failure.

Incidence and risk factors of postoperative complications in patients with tuberculosis-destroyed lung.

BACKGROUND: The purpose of this study was to determine risk factors of postoperative complications in tuberculosis-destroyed lung (TDL) patients. METHODS: We retrospectively analyzed the data from all consecutive TDL patients undergoing surgical treatment at the Beijing Chest Hospital from January 2001 to September 2019. RESULTS: Of 113 TDL cases experiencing surgery, 33 (29.2%) experienced postoperative complications. The patients with low BMI were more likely to have postoperative complications compared to those with normal BMI, whereas a significant lower rate of postoperative complications was noted in patients with BMI ≥ 25 kg/m2. In addition, significant increased risk was observed in patients with smoking history. We found that the patients with underlying infection, including aspergillus and nontuberculous mycobacteria (NTM), had significantly higher odds of having postoperative complications compared with those without underlying infection. The anaemia was another important independent factor associated with postoperative complication. Patients with blood transfusion above 1000 mL had a strongly increased frequency of postoperative complications than patients with blood transfusion below 1000 mL. CONCLUSION: In conclusion, our data demonstrate that approximate one third of TDL patients experience postoperative complications in our cohort. Patients with low BMI, anaemia, tobacco smoking, and coinfected aspergillus or NTM are at markedly higher risk to experience postoperative complications after pneumonectomy.

Risk factors associated with postoperative respiratory failure in tuberculous empyema patients.

ABSTRACT: Our objective was to identify independent risk factors for predicting which patients in the Chinese population would likely develop respiratory failure.A descriptive analysis was conducted of demographic and clinical data of patients with tuberculous empyema (TE) admitted to the Beijing Chest Hospital, Capital Medical University between January 2001 and January 2020. Risk factors associated with postsurgical respiratory failure in TE patients were identified based on results of analyses based on univariable and multivariable logistic regression models.A total of 139 TE patients who underwent surgical treatment in the Beijing Chest Hospital, Capital Medical University from January 2001 to January 2020 were enrolled in this study. Cases included 109 male and 30 female patients, with an overall mean age (range 17-73) of 39.3 years. Of 139 TE patients, 26 (18.7%) experienced respiratory failure after surgery. Among significant risk factors for postsurgical respiratory failure, intraoperative blood loss volume greater than 1000 mL had the highest odds ratio value of 6.452. In addition, a pathologic preoperative pulmonary function test result showing a high partial pressure of carbon dioxide level was an independent risk factor for respiratory failure. Moreover, the presence of tuberculosis lesions in the contralateral lung was another significant risk factor for respiratory failure, as determined using multivariate analysis.Respiratory failure is a predominant complication experienced by TE patients undergoing surgery. High intraoperative blood loss, high preoperative high partial pressure of carbon dioxide level, and tuberculosis lesion(s) in the contralateral lung of TE patients were associated with increased risk of postoperative respiratory failure.

The Efficacy and Safety of Surgical Treatment for Patients With Tuberculosis Destroyed Lung With or Without Chronic Pulmonary Aspergillosis.

BACKGROUND: To evaluate the efficacy and safety of surgical treatment of tuberculosis destroyed lung (TDL), and the influence of chronic pulmonary aspergillosis (CPA) on the outcomes of surgical treatment of TDL. METHODS: We performed a retrospective analysis of 113 patients with TDL who underwent surgical treatment from January 2005 to December 2019. Among them, 30 of these cases were complicated with CPA. The patients were divided into two groups: TDL group and TDL + CPA group. We analyzed the effectiveness and safety of surgical treatment of TDL, and further compared the effectiveness and safety of surgical treatment of TDL with or withoutthe presence of CPA. RESULTS: The TDL + CPA group had a significantly higher age (P=0.003), symptoms of hemoptysis (P=0.000), and a higher proportion of patients with preoperative serum albumin <30 g/L (P=0.014) as compared with TDL group. For all enrolled patients, the incidence of severe postoperative complications was 12.4% (14/113) and the postoperative mortality within 30 days after discharge was 4.4% (5/113). 86.7% (98/113) of the patients recovered and discharged, the incidence of severe postoperative complications in the TDA + CPA group was higher than that of TDL group (23.3% vs 8.4%, P = 0.034), although there was no difference in mortality between the two groups (P = 1.000). A binary logistic regression analysis showed that the independent risk factors for severe postoperative complications were male (OR 25.24, 95% CI 2.31-275.64; P = 0.008) and age ≥ 40 years (OR 10.34, 95% CI 1.56-68.65; P = 0.016). CONCLUSION: Surgical treatment for patients with TDL is effective with an acceptable mortality rate whether or not the disease is complicated with CPA. The independent risk factors identified for severe postoperative complications in patients with TDL were male and ≥ 40 years old. It implies that when treating patients with TDA + CPA, particular attention should be paid to these patients who have these independent risk factors to avoid a poor outcome.

The Necessity of Anti-Tuberculosis Therapy after Resection of Pulmonary Tuberculous Nodules: A Single Center Retrospective Study.

PURPOSE: To discuss the necessity of anti-tuberculosis therapy after resection of asymptomatic pulmonary tuberculous nodules: is postoperative anti-tuberculosis therapy is over-treatment? METHODS: This is a single-center retrospective study. Patients with solitary pulmonary nodule (SPN) and diagnosed as tuberculosis by pathology were included. Clinical features are collected. The primary end point is tuberculosis relapse and the secondary is adverse drug reactions. Patients are divided into two groups according to the acceptance of anti-tuberculosis treatment after operation (A: treated; B: untreated). Recurrence is diagnosed by multi-disciplinary discussion. The difference of recurrence rate will be compared and the incidence of adverse drug reactions in Group A will be calculated. RESULTS: A total of 98 patients were enrolled, 66 in Group A and 32 in Group B. No significant difference between two groups was found in the past history of tuberculosis, erythrocyte sedimentation rate (ESR), T-spot positive rate, and the uptake value of 18F-glucose. No relapse of tuberculosis was found in both groups. The incidence of adverse drug reactions in Group A was 61% (40/66), and the rate of severe adverse reaction was 14% (9/66). CONCLUSIONS: Postoperative recurrence of tuberculosis is rare, anti-tuberculosis treatment seems unnecessary for asymptomatic pulmonary tuberculous nodules. Adverse drug reactions should not be ignored.

Surgical treatment efficacy in 172 cases of tuberculosis-destroyed lungs.

OBJECTIVES: Compared to the use of anti-TB drugs for the treatment of tuberculosis (TB), surgery is destructive and is associated with higher risk. Whether surgery is needed for the treatment of TB-destroyed lungs (for short: destroyed lungs) is still controversial and unresolved in the clinic. METHODS: Retrospective analysis of treatment efficacy was performed on 172 cases of destroyed lungs (176 surgeries) in the Thoracic Surgery Department of our hospital from April 1992 to June 2010. RESULTS: A total of 83 male and 89 female patients was analyzed. The youngest patient was 7 years old, and the oldest was 72 years old, with a mean age of 38.4 years. A total of 120 cases had a preoperative cough, 31 cases had fever, and 42 cases had hemoptysis. A total of 49 cases was positive for Mycobacterium tuberculosis by sputum test before surgery, yielding a positive TB rate of 28.5% (49/172). A total of 116 patients had a destroyed left lung and 56 cases had a destroyed right lung. In all, 110 cases underwent total pneumonectomy, 37 pleuropneumonectomy, one lobectomy, 10 residual lobectomy, two total pneumonectomy and tracheoplasty, 11 cases bronchopleural fistula (BPF) repair and other surgeries, and one case underwent thoracoplasty. A total of four patients underwent thoracoplasty 30 days after surgery due to a thoracic cavity infection or empyema. The overall perioperative mortality rate was 2.9% (5/172). The surgical complication rate was 18.6% (32/172). The sputum negative conversion rate was 87.8% (43/49), and the clinical cure rate was 91.9% (158/172). CONCLUSIONS: Our findings suggested that surgical treatment efficacy in destroyed lungs was satisfactory with strict surgical indications, standard preoperative anti-TB treatment, adequate preoperative preparation, and careful intraoperative operations.

[Management of short-term complications after pneumonectomy for pulmonary tuberculosis].

OBJECTIVE: To explore the diagnosis and management of short-term complications after pneumonectomy for pulmonary tuberculosis. METHODS: The clinical data and management of short-term complications in patients with pulmonary tuberculosis after pneumonectomy were retrospectively reviewed and analyzed. RESULTS: From September 2000 to September 2010, 206 patients with pulmonary tuberculosis underwent pneumonectomy, of whom 26 experienced complications shortly after the surgery. Postoperative acute type II respiratory failure occurred in 5 within 14 months post-operation, acute respiratory distress syndrome (ARDS) in 2 within 3 months post-operation, chest hemorrhage in 7 within 20 days post-operation, empyema in 8 within 4 years post-operation, and bronchopleural fistula in 4 cases within 50 days post-operation. Of the 7 cases with chest hemorrhage, 2 were cured and 5 dead. All the 8 cases with empyema were cured. Of the patients with bronchopleural fistula, 2 were cured, 1 failed, and 1 was dead. CONCLUSIONS: Pneumonectomy for pulmonary tuberculosis carries a higher risk of developing serious complications such as chest hemorrhage, acute type II respiratory failure and bronchopleural fistula. Most complications can be managed successfully if diagnosed and treated early.

[Clinical analysis of treating 174 cases with pulmonary tuberculosis by pneumonectomy].

OBJECTIVE: To evaluate the efficacy and indication of pneumonectomy in patients with pulmonary tuberculosis. METHODS: From January 1992 to the end of 2008, 174 patients with pulmonary tuberculosis underwent pneumonectomy. According to the classification of pulmonary tuberculosis, there were tuberculous destroyed lungs (n = 106), chronic fibro-cavernous pulmonary tuberculosis (n = 27), cavernous pulmonary tuberculosis with aspergilloma (n = 5), tuberculous tracheobronchial stenosis (n = 16), pulmonary tuberculosis with encapsulated empyema (n = 5), tuberculous empyema with broncho pleural fistula (n = 4) and massive hemoptysis (n = 11). RESULTS: The surgical approaches were pneumonectomy (n = 146), pleuropneumonectomy (n = 21), chlorine pneumonectomy (n = 3), pneumonectomy with thoracoplasty (n = 1) and pneumonectomy with tracheoplasty (n = 3). The overall clinical cure rate was 93.0%, the rate of complications 11.5% and the operative mortality 2.3%. There were 3 dead cases resulting from operations in six months. CONCLUSION: Tuberculosis chemotherapy is an important modality for pulmonary tuberculosis, but surgical therapy remains essential for some patients. Pneumonectomy may increase the cure rates of severe pulmonary and multiple drug resistant tuberculosis.

[Preoperative chemotherapy for long-term results of small cell lung cancer].

OBJECTIVE: To reveal the pre-operative chemotherapy for long-term of small cell lung cancer. METHODS: From January 1994 to January 2005, 263 patients with small cell lung cancer underwent combined therapy. The comparison of long-term survival rates was made between pre-operative chemotherapy group (n = 111) (group A) and post-operative chemotherapy (n = 96) (group B). RESULTS: The analyses disclosed that the overall 5-year survival rate was 42.16%. The 5-year survival rate of group A was 38.25% while in group B it was 46.57%. 5-year survival rate of group A for N0-1 and N2 was 40.12% and 39.22%, that for stage I, II, IIIa, IIIb, IV was 60.15%, 35.70%, 40.16%, 14.29% and 0 respectively. 5-year survival rate of group B for N0-1 and N2 was 51.91% and 42.69%, that for stage I, II, IIIa, IIIb, IV was 61.1%, 50.23%, 42.32%, 26.47% and 0 respectively. CONCLUSION: The comparison of the survival rate between patients with the pre-operative chemotherapy and those with chemotherapy post-operatively revealed trend of variation. Operation plus post-operative chemotherapy mode is indispensable for better prognosis of small cell lung cancer.