RESUMO
PURPOSE: Air leaks are common after pulmonary surgery. Prolonged air leaks (PALs) may persist through discharge and often are managed with one-way valve devices (OWD). We sought to determine the course and complications of patients discharged with OWDs, risk factors for complications, and to evaluate the utility of clamp trials before chest tube (CT) removal. METHODS: Single-institution, retrospective review of patients discharged with a OWD after pulmonary surgery between 2008 and 2022. Charts were examined for the presence of complications and CT duration. Differences in CT duration were compared by using the Wilcoxon rank-sum test. RESULT: Sixty-four of 1917 (3.3%) pulmonary surgeries resulted in OWD use. Twelve of 64 (19%) patients discharged with a OWD suffered a complication. Nine of 64 (14%) had a CT-related readmission, and seven of 64 (11%) required PAL intervention. Patients sustaining a complication demonstrated longer CT durations before complication compared with duration in patients without complications, with median days of 13 [IQR 6-21] vs. 7 [IQR 6-12], p = 0.04). Five (7.8%) OWD patients developed an empyema; only one (20%) occurred before a CT duration of 14 days. Sixteen of 64 (25%) patients underwent a clamp trial before CT removal. One of ten (10%) failed even with no air leak present, whereas one of six (17%) failed with a present/questionable air leak. CONCLUSIONS: One-way valve device use has a substantial complication rate, and chest tube duration is a risk factor. In-hospital interventions might benefit patients with larger leaks that likely require prolonged OWD use. Because clamp trials occasionally fail, we contend that a clamp trial is the safest course before CT removal.
Assuntos
Tubos Torácicos , Complicações Pós-Operatórias , Humanos , Estudos Retrospectivos , Masculino , Feminino , Complicações Pós-Operatórias/etiologia , Pessoa de Meia-Idade , Idoso , Seguimentos , Pneumotórax/etiologia , Pneumotórax/terapia , Prognóstico , Neoplasias Pulmonares/cirurgia , Fatores de Risco , Procedimentos Cirúrgicos Pulmonares/efeitos adversos , Procedimentos Cirúrgicos Pulmonares/métodos , Pacientes Ambulatoriais , Pneumonectomia/efeitos adversosRESUMO
BACKGROUND: The prognostic significance of ALK rearrangement is still contradictory. Here, we aimed to investigate the clinical characteristics and outcomes of lung adenocarcinoma patients with ALK rearrangement, and analyze whether these patients benefited from targeted therapy. METHODS: This was a retrospective cohort study of 80 ALK-rearranged lung adenocarcinoma patients who had undergone radical surgery and another 3031 ALK mutation-negative patients were retrospectively reviewed for inclusion in this case-controlled analyses. Overall survival (OS) was evaluated using the Kaplan--Meier method. Univariate analysis (UVA) and multivariate analysis (MVA) by the Cox proportional hazards regression identified risk factors that predicted OS. RESULTS: Compared to ALK-negative patients, the ALK rearranged patients were younger, with more non-smokers, more females, a larger primary tumor was demonstrated, and were a higher pathological stage. In particular, the risk of lymph node metastasis was higher. For patients with surgically-resected tumors, the prognosis was better for ALK rearranged patients (HR = 0.503; 95% CI: 0.259-0.974, p = 0.041). In addition, for stage II-III patients, targeted therapy was an independent prognostic factor of better OS (HR = 0.159; 95% CI: 0.032-0.801, p = 0.026). CONCLUSIONS: ALK rearranged lung adenocarcinoma patients who have undergone radical surgery have distinct clinical features. Patients with ALK rearrangement may have a favorable prognosis, and stage II-III patients may benefit from targeted treatment.
Assuntos
Adenocarcinoma de Pulmão/genética , Adenocarcinoma de Pulmão/patologia , Quinase do Linfoma Anaplásico/genética , Rearranjo Gênico/genética , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/patologia , Adenocarcinoma de Pulmão/cirurgia , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Prognóstico , Procedimentos Cirúrgicos Pulmonares/métodos , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
BACKGROUND: Studies regarding the outcomes of salvage lung resections of epidermal growth factor receptor (EGFR)-mutant advanced lung adenocarcinomas (ALAs) following treatment with EGFR tyrosine kinase inhibitors (TKIs) are limited, hence the objective of this study was to investigate such outcomes. METHODS: A total of 29 patients with EGFR-mutant ALA who underwent salvage surgery after EGFR-TKI treatment from October 2013 through January 2019 were enrolled. The patients were divided into two groups according to the surgical indications. Their perioperative parameters and surgical outcomes, including progression-free survival (PFS) and overall survival (OS), were then analyzed. RESULTS: The initial stages of the patients were stage IIIB (seven patients), IVA (17 patients), and IVB (five patients). Their surgical indications included residual tumor (25 patients) and progressive disease (PD) (four patients). They all underwent surgery via minimally invasive approaches and the median follow-up was 33.9 months. Within that follow-up duration, the median PFS after surgery was 36.4 months, and the median OS was still not reached. There were no significant differences in PFS or OS according to the different EGFR-TKIs used, the different durations of EGFR-TKI treatment before surgery, or the different surgical indications. However, the patients presenting with pleural seeding before EGFR-TKI treatment had significantly poorer PFS and OS than the other patients (P < 0.001). CONCLUSIONS: Salvage surgery following EGFR-TKI treatment of ALAs is a safe procedure with acceptable intra- and postoperative results. However, studies involving more cases and longer follow-up periods are needed to clarify its benefits. KEY POINTS: Salvage surgery following EGFR-TKI treatment of ALAs is a safe procedure with acceptable intra- and postoperative results. Our results support the use of surgery following treatment with EGFR-TKIs such as afatinib in advanced lung cancer.
Assuntos
Adenocarcinoma de Pulmão/tratamento farmacológico , Adenocarcinoma de Pulmão/cirurgia , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/cirurgia , Inibidores de Proteínas Quinases/uso terapêutico , Procedimentos Cirúrgicos Pulmonares/métodos , Terapia de Salvação/métodos , Adenocarcinoma de Pulmão/genética , Adulto , Afatinib/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Receptores ErbB/genética , Feminino , Gefitinibe/uso terapêutico , Humanos , Neoplasias Pulmonares/genética , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND AND OBJECTIVES: Adoptive T-cell therapies (ACTs) using expansion of tumor-infiltrating lymphocyte (TIL) populations are of great interest for advanced malignancies, with promising response rates in trial settings. However, postoperative outcomes following pulmonary TIL harvest have not been widely documented, and surgeons may be hesitant to operate in the setting of widespread disease. METHODS: Patients who underwent pulmonary TIL harvest were identified, and postoperative outcomes were studied, including pulmonary, cardiovascular, infectious, and wound complications. RESULTS: 83 patients met inclusion criteria. Pulmonary TIL harvest was undertaken primarily via a thoracoscopy with a median operative blood loss and duration of 30 ml and 65 min, respectively. The median length of stay was 2 days. Postoperative events were rare, occurring in only five (6%) patients, including two discharged with a chest tube, one discharged with oxygen, one episode of urinary retention, and one blood transfusion. No reoperations occurred. The median time from TIL harvest to ACT infusion was 37 days. CONCLUSIONS: Pulmonary TIL harvest is safe and feasible, without major postoperative events in our cohort. All patients were able to receive intended ACT infusion without delays. Therefore, thoracic surgeons should actively participate in ongoing ACT trials and aggressively seek to enroll patients on these protocols.
Assuntos
Imunoterapia Adotiva/métodos , Neoplasias Pulmonares/terapia , Linfócitos do Interstício Tumoral/imunologia , Melanoma/terapia , Procedimentos Cirúrgicos Pulmonares/métodos , Adulto , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Neoplasias Pulmonares/imunologia , Neoplasias Pulmonares/secundário , Masculino , Melanoma/imunologia , Melanoma/patologia , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Prognóstico , Estudos ProspectivosRESUMO
OBJECTIVE: This prospective study evaluated perioperative lung resection outcomes after implementation of a multidisciplinary, evidence-based Thoracic Enhanced Recovery After Surgery (ERAS) Program in an academic, quaternary-care center. BACKGROUND: ERAS programs have the potential to improve outcomes, but have not been widely utilized in thoracic surgery. METHODS: In all, 295 patients underwent elective lung resection for pulmonary malignancy from 2015 to 2019 PRE (n = 169) and POST (n = 126) implementation of an ERAS program containing all major ERAS Society guidelines. Propensity score-matched analysis, based upon patient, tumor, and surgical characteristics, was utilized to evaluate outcomes. RESULTS: After ERAS implementation, there was increased minimally invasive surgery (PRE 39.6%âPOST 62.7%), reduced intensive care unit utilization (PRE 70.4%âPOST 21.4%), improved chest tube (PRE 24.3%âPOST 54.8%) and urinary catheter (PRE 20.1%âPOST 65.1%) removal by postoperative day 1, and increased ambulation ≥3× on postoperative day 1 (PRE 46.8%âPOST 54.8%). Propensity score-matched analysis that accounted for minimally invasive surgery demonstrated that program implementation reduced length of stay by 1.2 days [95% confidence interval (CI) 0.3-2.0; PRE 4.4âPOST 3.2), morbidity by 12.0% (95% CI 1.6%-22.5%; PRE 32.0%âPOST 20.0%), opioid use by 19 oral morphine equivalents daily (95% CI 1-36; PRE 101âPOST 82), and the direct costs of surgery and hospitalization by $3500 (95% CI $1100-5900; PRE $23,000âPOST $19,500). Despite expedited discharge, readmission remained unchanged (PRE 6.3%âPOST 6.6%; P = 0.94). CONCLUSIONS: The Thoracic ERAS Program for lung resection reduced length of stay, morbidity, opioid use, and direct costs without change in readmission. This is the first external validation of the ERAS Society thoracic guidelines; adoption by other centers may show similar benefit.
Assuntos
Recuperação Pós-Cirúrgica Melhorada , Neoplasias Pulmonares/cirurgia , Procedimentos Cirúrgicos Pulmonares/métodos , Idoso , Analgésicos Opioides/uso terapêutico , Controle de Custos , Medicina Baseada em Evidências , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Neoplasias Pulmonares/mortalidade , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos , Readmissão do Paciente/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Pontuação de Propensão , Estudos Prospectivos , Procedimentos Cirúrgicos Pulmonares/mortalidadeRESUMO
BACKGROUND: Although thoracoscopic stapled bullectomy is a standard procedure for primary spontaneous pneumothorax (PSP), the postoperative recurrence rate is high. We investigated whether using a Vicryl (Ethicon, Somerville, NJ) mesh to cover the staple line after bullectomy reduces the postoperative recurrence rate. METHODS: Our single-blind, parallel-group, prospective, randomized controlled trial at 2 medical centers in Taiwan studied patients with PSP who were aged 15 to 50 years and required thoracoscopic bullectomy. On the day of operation, patients were randomly assigned (1:1) to receive Vicryl mesh (mesh group) or not (control group) after thoracoscopic bullectomy with linear stapling and mechanical apical pleural abrasion. Randomization was achieved using computer-generated random numbers in sealed envelopes. Our primary end point was the pneumothorax recurrence rate within 1 year after the operation (clinicaltrials.gov number, NCT01848860.) RESULTS: Between June 2013 and March 2016, 102 patients were assigned to the mesh group and 102 to the control group. Within 1 year after operation, recurrent pneumothorax was diagnosed in 3 patients (2.9%) in the mesh group compared with 16 (15.7%) in the control group (P = .005). The short-term postoperative results and hospitalization duration were comparable between the groups. CONCLUSIONS: For thoracoscopic bullectomy with linear stapling and mechanical apical pleural abrasion, the use of a Vicryl mesh to cover the staple line is effective for reducing the postoperative recurrence of pneumothorax. Vicryl mesh coverage can be considered an optimal adjunct to the standard surgical procedure for PSP.
Assuntos
Pneumotórax/cirurgia , Poliglactina 910 , Prevenção Secundária/instrumentação , Telas Cirúrgicas , Adolescente , Adulto , Feminino , Humanos , Masculino , Estudos Prospectivos , Procedimentos Cirúrgicos Pulmonares/métodos , Recidiva , Método Simples-Cego , Adulto JovemRESUMO
OBJECTIVES: There is an increasing interest in the quality of life (QoL) evaluation following video-assisted thoracoscopic anatomical lung resection or stereotactic ablative body radiotherapy for early-stage non-small-cell lung cancer (NSCLC). A qualitative interview study was conducted to gain insight into the optimal methods of assessing and discussing QoL in clinical practice. METHODS: A prospective observational longitudinal study of patients with early-stage NSCLC was conducted where repeated QoL measures were administered either online or on paper. A subset of participants was invited for qualitative interviews after the 6-month assessment or at the end of the study. The semi-structured interviews were transcribed verbatim and thematically analysed. RESULTS: Twenty-three patients were interviewed. Generally, patients were content with recruitment and data collection procedures. Most opted to complete the assessments on paper instead of online; this choice was influenced by the level of technology literacy. Some found the questionnaires too generic to reflect their experiences. Barriers to questionnaire completion were mostly practical, and many acknowledged benefits of QoL assessment including allowing them to express problems and health issues, and following changes over time. Generally, participants would like to discuss QoL results during clinical consultations, but reported this rarely happened. CONCLUSIONS: Lung cancer patient interviews confirm the acceptability of repeated QoL assessments, but online data capture is limited. Patients highlight the importance of discussing QoL aspects with their clinical team. Future strategies are needed to optimize the routine collection of patient-reported outcomes in clinical practice.
Assuntos
Carcinoma Pulmonar de Células não Pequenas/psicologia , Neoplasias Pulmonares/psicologia , Estadiamento de Neoplasias , Qualidade de Vida , Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Seguimentos , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/cirurgia , Estudos Prospectivos , Procedimentos Cirúrgicos Pulmonares/métodos , Inquéritos e Questionários , Fatores de TempoAssuntos
Infecções por Coronavirus/economia , Infecções por Coronavirus/prevenção & controle , Neoplasias Pulmonares/economia , Neoplasias Pulmonares/cirurgia , Pandemias/economia , Pandemias/prevenção & controle , Pneumonia Viral/economia , Pneumonia Viral/prevenção & controle , Betacoronavirus/isolamento & purificação , COVID-19 , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Atenção à Saúde/economia , Grécia/epidemiologia , Humanos , Controle de Infecções/economia , Controle de Infecções/métodos , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/virologia , Programas Nacionais de Saúde/economia , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Procedimentos Cirúrgicos Pulmonares/economia , Procedimentos Cirúrgicos Pulmonares/métodos , SARS-CoV-2RESUMO
The resection of lung parenchyma for thoracic trauma is uncommon. Different surgical procedures with a wide range of complexities have been described depending on the severity of trauma and the presence of associated injuries. The aim of this study was to analyze outcomes of wedge resection, lobectomy, and pneumonectomy. Data for this study were obtained from an eight-year retrospective National Trauma Data Bank study (2007-2015). Adult patients who sustained severe chest trauma (Abbreviated Injury Scale > 3) that required any type of lung resection were included. Propensity score (PS) analysis was adopted. Overall, 3107 patients were included. Wedge resection was performed in 54.3 per cent, lobectomy in 38.2 per cent, and pneumonectomy in 7.5 per cent of patients. Longer in-hospital length of stay (P = 0.01), ICU length of stay (P = 0.002), and mechanical ventilation days (P = 0.038) were found in case of major resections. The overall morbidity and mortality were 32 per cent and 27.5 per cent, respectively. A stepwise increase in mortality occurred when comparing wedge (20.3%), lobectomy (30.8%), and pneumonectomy (63.4%) (P < 0.001). After PS analysis, lobectomy and pneumonectomy were associated with higher mortality compared with wedge resection (odds ratio [OR] 1.42; 95% confidence interval 1.26-1.71 and OR 4.16; 95% confidence interval 2.84-6.07, respectively). Similarly, after PS analysis, lobectomy and pneumonectomy were associated with higher overall complications compared with wedge resection (OR 1.21 and OR 1.56, respectively). Comparable results were found in the subgroup analysis of patients with isolated lung injury. After PS matching, lobectomy and pneumonectomy were associated with significantly higher morbidity and mortality compared with nonanatomical wedge resection.
Assuntos
Causas de Morte , Tempo de Internação , Lesão Pulmonar/mortalidade , Lesão Pulmonar/cirurgia , Pneumonectomia/métodos , Adulto , Idoso , Intervalos de Confiança , Bases de Dados Factuais , Feminino , Humanos , Escala de Gravidade do Ferimento , Lesão Pulmonar/diagnóstico , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Pneumonectomia/mortalidade , Prognóstico , Pontuação de Propensão , Procedimentos Cirúrgicos Pulmonares/métodos , Procedimentos Cirúrgicos Pulmonares/mortalidade , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida , Resultado do TratamentoRESUMO
Enhanced recovery after surgery (ERAS) is a multiprofessional, multidisciplinary and evidence-based program that aims to reduce complications, improve overall prognosis, shorten hospital stays, and promote fast recovery following major surgery. Nurses play a crucial role in the successful implementation of the ERAS program. Therefore, this research focuses on the trajectory optimized and acquired by nurses in the enhanced recovery of elderly patients undergoing radical surgery for lung cancer. This study concludes that the implementation of the proposed ERAS preoperative point-of-care trajectory is highly beneficial for improved outcomes and enhanced recovery of geriatric patients following lung surgery.
Assuntos
Recuperação Pós-Cirúrgica Melhorada/normas , Tempo de Internação/estatística & dados numéricos , Neoplasias Pulmonares/enfermagem , Neoplasias Pulmonares/cirurgia , Assistência Perioperatória , Procedimentos Cirúrgicos Pulmonares/métodos , Projetos de Pesquisa , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos RetrospectivosRESUMO
BACKGROUND/AIM: Typical carcinoids (TC) and atypical carcinoids (AC) are rare diseases. A paucity of randomized studies and disagreements among various guidelines makes the management challenging. PATIENTS AND METHODS: Using codes for TC (8240) and AC (8249) in the National Cancer Database (NCDB), all surgically resected cases from 2004-2014 were included to evaluate the need for adjuvant chemotherapy. RESULTS: A total of 6,673 cases were included, 88% were TCs and 12% were ACs. From 2004 to 2014, the proportion of TCs went up from 1.3% to 1.8% and ACs from 0.1% to 0.3% of all lung malignancies. TC patients did well with surgery alone in all stages. AC patients with stage I [5-year overall survival (OS) - 84% vs. 52%; S vs. S+CT] and stage II disease (5-year OS - 81% vs. 55%; S vs. S+CT) showed better OS trend with surgery alone, while stage III patients showed some benefit with the use of adjuvant chemotherapy (5-year OS - 46% vs. 54%; S vs. S+CT). These results supported the National Comprehensive Cancer Network (NCCN) guidelines. CONCLUSION: No benefit was seen from adjuvant chemotherapy in TCs. While the adjuvant therapy may add benefit in stage III AC, the numbers are small and did not reach statistical significance.
Assuntos
Tumor Carcinoide/terapia , Quimioterapia Adjuvante/métodos , Neoplasias Pulmonares/terapia , Procedimentos Cirúrgicos Pulmonares/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Tumor Carcinoide/patologia , Feminino , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Análise de Sobrevida , Resultado do Tratamento , Adulto JovemRESUMO
Pulmonary alveolar proteinosis (PAP) is an uncommon lung disease characterized by excessive accumulation of pulmonary surfactant that usually requires treatment with whole-lung lavage. A 47-year-old female presented with history of dry cough and breathlessness for past 6months. Chest radiograph demonstrated bilateral alveolar shadows and high resolution computerized tomography thorax showed crazy paving pattern. Broncho-alveolar lavage (BAL) and transbronchial lung biopsy confirmed a diagnosis of PAP. Due to worsening hypoxemia and respiratory failure, wholelung lavage was planned and performed. Anaesthetic management involved integrated use of pre-oxygenation, complete lung isolation, one-lung ventilation with optimal positive end-expiratory pressure, vigilant use of positional manoeuvres, and use of recruitment manoeuvres for the lavaged lung. We have discussed valuable strategies for the anaesthetic management of patients undergoing this multifaceted procedure in a case of severe PAP. FUNDING: None declared.
Assuntos
Anestésicos , Lavagem Broncoalveolar , Proteinose Alveolar Pulmonar , Procedimentos Cirúrgicos Pulmonares , Feminino , Humanos , Pessoa de Meia-Idade , Anestésicos/administração & dosagem , Lavagem Broncoalveolar/métodos , Proteinose Alveolar Pulmonar/cirurgia , Procedimentos Cirúrgicos Pulmonares/métodosRESUMO
Background/aim: The increasing number of lung diseases and particularly pulmonary malignancies has intensified the need for diverse interventions in the field of interventional pulmonology. In recent years we have seen many new developments and expanding applications in the field of interventional pulmonology. This has resulted in an increased number and variety of performed procedures and differing approaches. The purpose of the present study is to provide information on patient characteristics, range of interventions, complication rates, and the evolving approach of an experienced center for interventional pulmonology. Materials and methods: We retrospectively examined the records of 1307 patients who underwent a total of 2029 interventional procedures in our interventional pulmonology department between January 2008 and December 2017. Results: About half of the interventional procedures (47.2%) were performed on patients with airway stenosis due to malignant disease. Among patients with benign airway stenosis, the most frequent reason for intervention was postintubation tracheal stenosis. The number of patients who developed complications was 81 (6.2%), and the most common complication was hemorrhage (n = 31, 2.99%); 94.9% (n = 1240) of interventional procedures were performed under general anesthesia, without complications or deaths associated with anesthesia. Only one death (0.076%) occurred in the perioperative period. A total of 18 patients (1.38%) died in the 30-day perioperative and postoperative period. None of the patients with benign airway stenosis died. Conclusion: Interventional bronchoscopy is an invasive but considerably safe and efficient procedure for selected cases and effective treatment modality for airway obstructions, massive hemoptysis, and foreign body aspiration. Interventional pulmonology is a field of pulmonary medicine that needs effort to progress and provide an opportunity to witness relevant developments, and increase the number of competent physicians and centers.
Assuntos
Pneumopatias/terapia , Neoplasias Pulmonares/cirurgia , Procedimentos Cirúrgicos Pulmonares/métodos , Procedimentos Cirúrgicos Pulmonares/tendências , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos RetrospectivosRESUMO
OBJECTIVES: Our study aimed to investigate the independent prognostic values of consolidation-to-tumor ratio (CTR) and tumor disappearance ratio (TDR) after adjustment for the conventional prognostic factors and the eighth edition clinical T category for patients with resected lung adenocarcinomas. MATERIALS AND METHODS: This retrospective study included 691 patients (281 men and 410 women; median age, 63 years) with resected lung adenocarcinomas (clinical T1N0M0). The prognostic implications for disease-free survival (DFS) of CTR and TDR in continuous and categorical forms were analyzed using multivariable-adjusted Cox regression analysis, including multiple clinico-radiological prognostic factors and the clinical T category based on the solid portion measurement. Analysis was performed for the total study population and for two part-solid nodule subgroups (cT1mi/cT1a to cT1c and cT1mi/cT1a to cT1b, respectively). RESULTS: For the total study population, CTR and TDR were not selected in the multivariable Cox regression models, which indicated that these are not independent prognostic factors. Age (adjusted HR: 1.026; P = 0.022) and clinical T category (adjusted HR for cT1b: 3.475; P = 0.019; adjusted HR for cT1c: 9.938; P < 0.001) were independently associated with DFS. For the part-solid nodule subgroups, multivariable-adjusted HRs for CTR and TDR were not statistically significant (all P > 0.05). CONCLUSION: CTR and TDR were not independent prognostic factors. Preoperative prognostication based on clinical T category would be sufficient without further stratification according to CTR or TDR.
Assuntos
Adenocarcinoma de Pulmão/patologia , Neoplasias Pulmonares/patologia , Procedimentos Cirúrgicos Pulmonares/métodos , Tomografia Computadorizada por Raios X/métodos , Adenocarcinoma de Pulmão/diagnóstico por imagem , Adenocarcinoma de Pulmão/cirurgia , Idoso , Feminino , Seguimentos , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos RetrospectivosRESUMO
OBJECTIVES: Organization and governance of national healthcare might play an important role in decision-making and outcomes in patients with lung cancer. Both Denmark and the Netherlands have a high level of healthcare but a different financial coverage, governance and level of centralization. By using both national databases we analyzed the consequences of these differences on patterns of care and outcomes with a focus on morbidity, mortality and clinical staging. MATERIALS AND METHODS: General numbers on both healthcare systems were requested. All patients who had surgery for lung cancer from 2013 to 2016 were included. Mortality, morbidity and clinical staging were analyzed for patients with NSCLC without metastases, only one operation and no neo-adjuvant therapy. RESULTS: In 2016 annual budget as share of gross national product was 10.4% for both countries. In Denmark 4 hospitals performed lung surgery in 2016, compared to 43 hospitals in the Netherlands. We included 4030 Danish and 8286 Dutch patients. In the subgroup 30-day mortality was 1.5% in Denmark compared to 1.9% in the Netherlands. The percentage of patients with a complicated course was 24.4% and 34.8% respectively (p < 0.05). Accuracy between cTNM and pTNM was 53.0% in Denmark and 52.9% in the Netherlands. CONCLUSION: Surgery for lung cancer is at a high level in both countries, reflected by low mortality-rates. Centralization has been implemented successfully in Denmark, which might explain the lower rate of patients with a complicated post-operative course, although different definitions preclude firm conclusions. In both countries correct clinical staging of lung cancer remains a challenge.
Assuntos
Atenção à Saúde/organização & administração , Pessoal de Saúde , Neoplasias Pulmonares/epidemiologia , Procedimentos Cirúrgicos Pulmonares , Terapia Combinada , Dinamarca/epidemiologia , Gerenciamento Clínico , Feminino , Humanos , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/cirurgia , Masculino , Países Baixos/epidemiologia , Avaliação de Resultados em Cuidados de Saúde , Procedimentos Cirúrgicos Pulmonares/métodos , Procedimentos Cirúrgicos Pulmonares/estatística & dados numéricos , Fatores SocioeconômicosRESUMO
In this article we report two cases of left lower lobe lung cancer undergoing a surgical procedure that allowed the preservation of lung parenchyma and avoided pneumonectomy. The first case concerned a left lower lobe non-small cell lung cancer with extracapsular spread in a metastatic interlobar lymph node and the second a left lower lobe lung cancer with invasion of the pulmonary artery at the origin of lobar branches to the lower lobe. In both cases, a lung-sparing surgical treatment was preferred and a left lower lobectomy was performed with division of lingular arteries and the interlobar artery, preserving the remaining arterial branches to the upper lobe.
Assuntos
Adenocarcinoma de Pulmão/cirurgia , Neoplasias Pulmonares/cirurgia , Artéria Pulmonar/cirurgia , Procedimentos Cirúrgicos Pulmonares/métodos , Procedimentos Cirúrgicos Pulmonares/normas , Veias Pulmonares/cirurgia , Adenocarcinoma de Pulmão/patologia , Idoso , Feminino , Humanos , Neoplasias Pulmonares/patologia , Masculino , Prognóstico , Artéria Pulmonar/patologia , Veias Pulmonares/patologiaRESUMO
OBJECTIVES: Surgical treatment is the gold standard for the treatment of early-stage non-small-cell lung cancer. However, minimally invasive tumour ablation can be an alternative treatment for patients not eligible for surgery due to comorbidities. The aim of this study was to evaluate the efficacy of photothermal ablation therapy using low-power near-infrared laser and topical injection of indocyanine green (ICG), a photosensitizer, in a preclinical study using a rabbit VX2 lung cancer model. METHODS: Six New Zealand white rabbits were used. Five hundred microlitres of a suspension containing 0.5 × 107 VX2 cancer cells with growth factor-reduced Matrigel was inoculated into the right lung using an ultrathin bronchoscope. Three rabbits were treated with laser ablation therapy with topical injection of ICG, whereas another 3 rabbits were treated with laser ablation alone. All tumours were irradiated with a laser with 500-mW output at 808 nm for 15 min. The tumours were examined histopathologically to assess the state of ablation. RESULTS: The maximum tumour surface temperatures in rabbits treated using ICG/laser and laser alone were higher than 58°C and lower than 40°C, respectively. The ablated areas in the rabbits treated with ICG/laser were significantly larger than those in the rabbits treated with laser alone (0.49 ± 0.27 vs 0.02 ± 0.002 cm2, respectively) (P < 0.05). CONCLUSIONS: The photothermal treatment using the combination of low-power near-infrared laser and topical injection of ICG can ablate a larger tumour area than laser treatment alone.
Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Verde de Indocianina/administração & dosagem , Terapia a Laser/métodos , Neoplasias Pulmonares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Neoplasias Experimentais , Procedimentos Cirúrgicos Pulmonares/métodos , Animais , Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Corantes/administração & dosagem , Injeções , Neoplasias Pulmonares/diagnóstico , CoelhosRESUMO
OBJECTIVES: We prospectively investigate the accuracy of frozen sections for diagnosing visceral pleural invasion (VPI) by autofluorescence and evaluated its usefulness in sublobar resection. METHODS: We included patients with lung adenocarcinoma 2 cm or less to evaluate the diagnostic performance of autofluorescence for VPI in frozen sections via a fluorescence microscope. Furthermore, the impact of VPI on patients treated with sublobar resection was assessed in another cohort. RESULTS: A total of 112 patients were enrolled. The accuracy, sensitivity, and specificity of autofluorescence for VPI diagnosis was 95.5%, 86.8%, and 100%, respectively. Sublobar resection was an independent risk factor for recurrence in patients with lung adenocarcinomas 2 cm or less with VPI positivity (hazard ratio, 3.30; P = .023), whereas it was not in those with VPI negativity. CONCLUSIONS: Using autofluorescence in frozen sections appears to be an accurate method for diagnosing VPI, which is helpful for surgical decision making.
Assuntos
Adenocarcinoma de Pulmão/patologia , Secções Congeladas , Invasividade Neoplásica/patologia , Imagem Óptica , Pleura/patologia , Adenocarcinoma de Pulmão/cirurgia , Adulto , Idoso , Feminino , Humanos , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/etiologia , Prognóstico , Estudos Prospectivos , Procedimentos Cirúrgicos Pulmonares/efeitos adversos , Procedimentos Cirúrgicos Pulmonares/métodos , Reprodutibilidade dos Testes , Fatores de Risco , Sensibilidade e EspecificidadeRESUMO
PURPOSE: Our aims were to evaluate the prevalence of preoperative acute sleep disruption in the hospital and to assess perioperative sleep quality and the effects of acute sleep disruption on postoperative functional recovery in a surgical setting. METHODS: This prospective observational study included 24 patients aged ≥ 20 years who underwent video-assisted thoracoscopic surgical lobectomy for lung cancer under general anesthesia at a tertiary hospital in Japan between October 2016 and May 2017. Actigraphy was performed for 7 days in the hospital, including the night before surgery. We defined acute sleep disturbance as less than 85% preoperative sleep efficiency and analyzed its effect on postoperative functional disability using the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) and Mann-Whitney U testing. The perioperative change in sleep efficiency was compared using a Dunn analysis. A high score on the WHODAS 2.0 is indicative of impaired function. RESULTS: Nineteen (79.1%) patients had low sleep efficiency in the hospital prior to surgery. Three months after surgery, the 12-item WHODAS 2.0 score was higher in patients with acute sleep disturbance than in those without it (38.8 versus 33.3, p = 0.02, effect size 0.5). Sleep efficiency decreased significantly on the 5th postoperative day in patients with acute sleep disturbance. CONCLUSIONS: Our results showed a high prevalence of acute sleep disturbance. Patients with acute sleep disruption had low postoperative sleep efficiency and impaired functional ability three months after surgery.
Assuntos
Anestesia Geral/métodos , Neoplasias Pulmonares/cirurgia , Procedimentos Cirúrgicos Pulmonares/métodos , Transtornos do Sono-Vigília/epidemiologia , Atividades Cotidianas , Idoso , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Prevalência , Estudos Prospectivos , Recuperação de Função FisiológicaRESUMO
BACKGROUND: Mucormycosis portends a poor prognosis with mortality rates ranging from 50% to 70% in pulmonary mucormycosis (PM) and up to 95% in disseminated disease. However, detailed outcomes data have been lacking. It remains unknown how to identify patients who would benefit from surgical resection. OBJECTIVES: We present our experience with patients undergoing surgical resection for PM, including an analysis of factors affecting postoperative survival. We also describe a thoracic surgeon's approach through illustrative cases. PATIENTS/METHODS: We conducted a single-centre retrospective study of all adult patients with PM who received antifungal therapy and underwent surgical resection or who received antifungal therapy alone at Stanford between January 2004 and June 2018. RESULTS: Twelve patients received antifungal therapy and underwent surgical resection and 13 patients received antifungal therapy alone. From infection onset to death (or right-censoring if still alive), patients who underwent surgical resection had a median survival of 406 days (mean, 561.3; range, 22-2510), and patients who received antifungal therapy alone had a median survival of 28 days (mean, 66.7; range, 8-447). In patients who underwent surgical resection, median postoperative survival time was 154 days (range, 11-2495), in-hospital mortality was 16.7%, and 1-year mortality was 50.0%. Age, primary disease, ASA status, extrapulmonary dissemination, laterality, multilobar involvement, number of lesions, largest lesion size, platelet count, surgical approach, type of resection or extent of resection were not significantly associated with postoperative survival. CONCLUSIONS: Surgical resection significantly increases survival and should be strongly considered for selected patients with PM.