Definitive surgery and intraoperative photodynamic therapy for locally advanced non-small cell lung cancer: a case report.

BACKGROUND: There are no guidelines for straightforwardly managing advanced lung cancer (T3 or T4). Although surgery has traditionally been regarded as the mainstay treatment and the only curative modality, it has limited relevance for patients with locally advanced non-small cell lung cancer (NSCLC). Photodynamic therapy (PDT) is a clinically approved cancer therapy; it is an established treatment modality with curative intent for early-stage and superficial endobronchial lesions. However, the efficacy of PDT in advanced lung cancer is controversial, and it has primarily been used in palliative care. CASE PRESENTATION: This case report describes a 70-year-old male who had right upper lung cancer and an endobronchial lesion that extended into the distal trachea. A biopsy specimen was obtained upon bronchoscopy, and the result confirmed squamous cell carcinoma. We performed a definitive sleeve lobectomy and intraoperative PDT. Gross total resection of the tumor was achieved, but the presence of microscopic residual tumors was inevitable. Complete anatomical resection of the primary tumor by pneumonectomy was not possible due to poor lung function and endobronchial extension to the distal trachea. We decided to apply intraoperative PDT to the lumen and outer wall of the bronchi and distal trachea for local tumor control. The patient is alive with no evidence of disease after 13 months of follow-up. CONCLUSIONS: This is the first report to describe the feasibility and efficacy of intraoperative PDT as part of multimodal therapy for locally advanced NSCLC.

Surgical outcomes of pulmonary metastasectomy in hepatocellular carcinoma patients according to approach method: thoracoscopic versus open approach.

BACKGROUND: The role of surgical intervention as a treatment for pulmonary metastasis (PM) from hepatocellular carcinoma (HCC) has not been established. In this study, we investigated the clinical outcomes of pulmonary metastasectomy. Using propensity score matching (PSM) analysis, we compared the results according to the surgical approach: video-assisted thoracic surgery (VATS) versus the open method. METHODS: A total of 134 patients (115 men) underwent pulmonary metastasectomy for isolated PM of HCC between January 1998 and December 2010 at Seoul Asan Medical Center. Of these, 84 underwent VATS (VATS group) and 50 underwent thoracotomy or sternotomy (open group). PSM analysis between the groups was used to match them based on the baseline characteristics of the patients. RESULTS: During the median follow-up period of 33.4 months (range, 1.8-112.0), 113 patients (84.3%) experienced recurrence, and 100 patients (74.6%) died of disease progression. There were no overall survival rate, disease-free survival rate, and pulmonary-specific disease-free survival rate differences between the VATS and the open groups (p = 0.521, 0.702, and 0.668, respectively). Multivariate analysis revealed local recurrence of HCC, history of liver cirrhosis, and preoperative alpha-fetoprotein level as independent prognostic factors for overall survival (hazard ratio, 1.729/2.495/2.632, 95% confidence interval 1.142-2.619/1.571-3.963/1.554-4.456; p = 0.010/< 0.001/< 0.001, respectively). CONCLUSIONS: Metastasectomy can be considered a potential alternative for selected patients. VATS metastasectomy had outcomes comparable to those of open metastasectomy.

Relationship Between the Size of Metastatic Lymph Nodes and Positron Emission Tomographic/Computer Tomographic Findings in Patients with Esophageal Squamous Cell Carcinoma.

BACKGROUND: We measured the sizes of metastatic lymph nodes and the relationships thereof by (18)F-fluorodeoxyglucose positron emission tomography/computer tomography (PET/CT). We identified risk factors for nodal upstaging in patients with esophageal squamous cell carcinoma (ESCC). METHODS: Eighty-five patients with ESCC who underwent esophagectomy with extensive mediastinal lymphadenectomy were assessed. Two radiologists blinded to pathology data reviewed PET/CT scans, evaluating both primary tumors and lymph node involvement. A pathologist examined all metastatic lymph nodes in terms of maximal diameter (LNmax), the size of the metastatic focus (Fmax), and the metastasis occupation ratio (MOR = Fmax/LNmax). RESULTS: The maximal tumor length averaged 2.9 ± 0.2 cm and the mean SUVmax of the primary lesion 5.3 ± 0.5. On PET/CT scans, 26 (30.6 %) patients exhibited nodal metastasis and 59 (69.4 %) did not. Pathology grades of pN0, pN1, pN2, and pN3 were assigned to 45 (52.9 %), 24 (28.2 %), 13 (15.3 %), and 3 (3.5 %) patients, respectively. Nodal upstaging was evident in 29 (34.1 %) cases. In 123 metastatic nodes of 4212 nodes dissected, the LNmax was 6.60 ± 0.39 mm, the Fmax 4.47 ± 0.35 mm, and the MOR 0.68 ± 0.03. Of 123 nodes, 85 (69.1 %) were retrieved from PET-negative stations, and the LNmax and Fmax values of these nodes were 5.88 ± 0.42 and 3.75 ± 0.31 mm, respectively. Upon multivariate analysis, tumor length (OR 1.666, p = 0.019) and lymphovascular invasion (OR 41.038, p < 0.001) were risk factors for nodal upstaging. CONCLUSION: A significant proportion of nodal metastases were too small to detect via PET/CT imaging. Therefore, meticulous lymph node dissection might be helpful in ESCC patients.

Thermal conductivity characteristics of dewatered sewage sludge by thermal hydrolysis reaction.

The purpose of this study is to quantify the thermal conductivity of sewage sludge related to reaction temperature for the optimal design of a thermal hydrolysis reactor. We continuously quantified the thermal conductivity of dewatered sludge related to the reaction temperature. As the reaction temperature increased, the dewatered sludge is thermally liquefied under high temperature and pressure by the thermal hydrolysis reaction. Therefore, the bound water in the sludge cells comes out as free water, which changes the dewatered sludge from a solid phase to slurry in a liquid phase. As a result, the thermal conductivity of the sludge was more than 2.64 times lower than that of the water at 20. However, above 200, it became 0.704 W/m* degrees C, which is about 4% higher than that of water. As a result, the change in physical properties due to thermal hydrolysis appears to be an important factor for heat transfer efficiency. Implications: The thermal conductivity of dewatered sludge is an important factor the optimal design of a thermal hydrolysis reactor. The dewatered sludge is thermally liquefied under high temperature and pressure by the thermal hydrolysis reaction. The liquid phase slurry has a higher thermal conductivity than pure water.

Chlortetracycline degradation by photocatalytic ozonation in the aqueous phase: mineralization and the effects on biodegradability.

Chlortetracycline (CTC) is a hazardous material in aquatic environments. This study was focused on optimization of photocatalytic ozonation processes for removal of CTC from wastewater at pH 2.2 and 7.0. In this study, the tested processes for CTC removal were arranged from the least efficient to the most efficient as: UV, UV/TiO2, O3, O3/UV and O3/UV/TiO2. Ozonation efficiency was due to ozone affinity for electron-rich sites on the CTC molecule. In the O3/UV and O3/UV/TiO2 processes, efficiency was increased by the photolysis of CTC and generation of *OH. At pH 7.0, all the processes were more efficient for CTC degradation than at pH 2.2 due to CTC speciation, ozone decay to *OH and the attractions between ionized CTC and TiO2 particles. UV/O3 at pH 7.0 showed an additive effect while other combination processes showed a synergistic effect that resulted in higher rates of reactions than the sums of individual reaction rates. The TOC removal ranged from 8% to 41% after one hour of reaction, with the above-mentioned order of efficiency. The biodegradability increased rapidly during the early minutes of the reaction. A reaction time of 10-15 min was sufficient for near maximum biodegradability, making these processes good pretreatments for the biological processes.

Intraoperative photodynamic therapy for tracheal mass in non-small cell lung cancer: A case report.

BACKGROUND: Tracheal neoplasms represent less than 0.1% of all malignancies and have no established treatment guidelines. Surgical resection with reconstruction is the primary treatment. This study demonstrates successful treatment of concurrent lung and tracheal tumors using surgical excision and intraoperative photodynamic therapy (PDT), highlighting the effectiveness and safety of this approach. CASE SUMMARY: A 74-year-old male with a history of smoking and chronic obstructive pulmonary disease was diagnosed with tracheal squamous cell carcinoma and right lower lobe adenocarcinoma. A multidisciplinary team created a treatment plan involving tumor resection and PDT. The tracheal tumor was removed through a tracheal incision and this was followed by intraluminal PDT. The trachea was repaired and a right lower lobectomy was performed. The patient received a second PDT treatment postoperatively and was discharged 10 d after the tracheal surgery, without complications. He then underwent platinum-based chemotherapy for lymphovascular invasion of lung cancer. Three-month postoperative bronchoscopy revealed normal tracheal mucosa with a scar at the resection site and no evidence of tumor recurrence in the trachea or lung. CONCLUSION: Our case of concurrent tracheal and lung cancers was successfully treated with surgical excision and intraoperative PDT which proved safe and effective in this patient.

Simultaneous Viscum pleurodesis and video-assisted thoracic surgery (VATS) bullectomy in patients with primary spontaneous pneumothorax.

Although surgery is the gold standard for treatment of primary spontaneous pneumothorax (PSP), recurrence after surgery remains a concern. This study sought to evaluate the efficacy of simultaneous pleurodesis using Viscum album (VA) extract and video-assisted thoracic surgery (VATS) bullectomy for the treatment of PSP. From March 2016 to June 2020, 175 patients with PSP underwent bullectomy and intraoperative pleurodesis with VA extract at a single institution. All operations were performed through thoracoscopy by one surgeon. Upon completion of bullectomy, a polyglycolic acid sheet was used to cover the stapler lines, and 40 mg of VA extract was instilled over the entire chest wall before chest tube placement. The median operating time was 20 min (interquartile ranges, 15-30) and the median indwelling time of chest drainage was 2 days (interquartile ranges, 2-3). There were no postoperative complications over grade 3. During the median follow-up period of 38 months (interquartile ranges, 15-48), no recurrence of pneumothorax was observed. The results of this study demonstrated that simultaneous Viscum pleurodesis and VATS bullectomy provides a feasible and effective treatment option for preventing postoperative pneumothorax in patients with PSP.

Alternative Surgical Methods in Patients with Recurrent Palmar Hyperhidrosis and Compensatory Hyperhidrosis.

Recurrent hyperhidrosis after thoracic sympathectomy is an uncomfortable condition, and compensatory hyperhidrosis (CH) is one of the most troublesome side effects. Here, we describe two patients with recurrent palmar hyperhidrosis (PH) and CH over the whole body simultaneously. They were treated with bilateral T4 sympathetic clipping and reconstruction of the sympathetic nerve from a T5 to T8 sympathetic nerve graft, which was transferred to the resected T3 sympathetic bed site. They reported improvements in sweating and were fully satisfied with the results. Our method can be considered as an alternative approach for patients with recurrent PH and CH.

Validation of the T descriptor in the new 8th TNM classification for non-small cell lung cancer.

BACKGROUND: To validate new proposals for the revision of T descriptors and to compare the prognostic value of the seventh and forthcoming eighth edition of the tumor, node and metastasis (TNM) classification for lung cancer. METHODS: A retrospective analysis was conducted of 1,316 patients with non-small lung cancer who underwent pulmonary resection between 1999 and 2012. Patients who had a positive nodal status or distant metastasis were excluded. We classified these patients according to the seventh and eighth edition of the TNM system, and analyzed differences in stage specific survival. Harrell's concordance (C)-index and Heagerty's integrated area under the curve (iAUC) were used to assess the overall predictive ability of the different TNM versions. RESULTS: There were no significant survival differences between each stage based on the T stage criteria of the eighth edition, most notably between T1a and T1b (P=0.752), and T1c, T2a, and T2b (P=0.832). The C-indices of the classification based on the seventh and eighth edition were 0.681 and 0.675, respectively. There was no significant difference in the C-indices between the seventh and eighth edition. The iAUC value for overall survival of the seventh and eighth staging editions was 0.637 and 0.631, respectively. The differences in iAUC between the seventh and eighth editions were also not statistically significant. CONCLUSIONS: The newly proposed T descriptors in the eighth TNM classification system did not allow a more accurate prediction of prognosis compared with the current seventh edition in our population.

Does T1- and diffusion-weighted magnetic resonance imaging give value-added than bone scintigraphy in the follow-up of vertebral metastasis of prostate cancer?

PURPOSE: To evaluate the effectiveness of limited Magnetic Resonance (MR) images including T1- and diffusion-weighted image (DWI) for monitoring vertebral metastasis in patients with prostate cancer. MATERIALS AND METHODS: From July 2014 to November 2016, patients diagnosed with spinal metastasis from prostate cancer using 99mTc bone scintigraphy were enrolled. Regardless of the primary local therapy, the changes in spinal metastasis were followed up using bone scan and biparametric MR (T1+DWI). All tests were followed up for more than 3 months. RESULTS: Among the 14 follow-ups of 10 patients, 6 and 10 (including all progressed cases on bone scan) follow-ups were determined to show progressive disease using bone scan and biparametric MR, respectively. Otherwise, we could have predicted neurologic sequela earlier using biparametric MR. Examination time for biparametric MR was 15 minutes, and it was 4 hours for bone scan, respectively. CONCLUSIONS: Although bone scan has been considered the standard test for bony metastasis in men with prostate cancer, limited MR including T1 and DWI has an additional benefit in monitoring spinal metastasis in patients who are already diagnosed as having spinal metastasis. The limited MR is more sensitive in detecting progressive disease. In addition, it can reduce neurologic complications caused by spinal metastasis.

Three-Dimensional Ground Glass Opacity Ratio in CT Images Can Predict Tumor Invasiveness of Stage IA Lung Cancer.

PURPOSE: We investigated the relationship between various parameters, including volumetric parameters, and tumor invasiveness according to the International Association for the Study of Lung Cancer (IASLC)/American Thoracic Society (ATS)/European Respiratory Society (ERS) classification. MATERIALS AND METHODS: We retrospectively reviewed 99 patients with completely resected stage IA lung adenocarcinoma. The correlation between several parameters [one-dimensional ground glass opacity (1D GGO) ratio, two-dimensional (2D) GGO ratio, three-dimensional (3D) GGO ratio, 1D solid size, 2D solid size, and 3D solid size] and tumor invasiveness according to IASLC/ATS/ERS classification was investigated using receiver operating characteristic (ROC) analysis. Adenocarcinoma in situ and minimally invasive adenocarcinoma were referred to as noninvasive adenocarcinoma. RESULTS: The areas under the curve (AUC) to predict invasive adenocarcinoma for the 1D, 2D, and 3D GGO ratios were 0.962, 0.967, and 0.971, respectively. The optimal cut-off values for the 1D, 2D, and 3D GGO ratios were 38%, 62%, and 74%, respectively. The AUC values for 1D, 2D, and 3D solid sizes to predict invasive adenocarcinoma were 0.933, 0.944, and 0.903, respectively. The optimal cut-off values for 1D, 2D, and 3D solid sizes were 1.2 cm, 1.5 cm², and 0.7 cm³, respectively. The difference in the ROC curves for 3D GGO ratio and 3D solid size was significant (p=0.01). CONCLUSION: Computed tomography image-related parameters based on GGO were well correlated with and predictive of invasiveness according to IASLC/ATS/ERS classification. 3D GGO ratio was more strongly correlated with pathologic invasiveness than 3D solid size.

Tumor perimeter and lobulation as predictors of pleural recurrence in patients with resected thymoma.

OBJECTIVES: Recurrence of resected thymoma frequently occurs during follow-up, with pleural recurrence as the most common type. The aim of our study was to identify risk factors for pleural recurrence after complete resection of thymoma by investigating clinical, radiological, surgical, and pathological findings. MATERIALS AND METHODS: Retrospective study was performed with 309 patients who had undergone complete resection of thymoma between January 2000 and December 2013. Among these cases, the patients were divided into the no pleural recurrence group (n=285) and the pleural recurrence group (n=24). Radiologic parameters such as maximum tumor diameter, tumor perimeter that contacted the lung (TPCL) and lobulated tumor contour were measured based on computed tomography. A multivariate analysis was performed to estimate risk factors for pleural recurrence including maximum tumor diameter, TPCL, lobulated tumor contour, World Health Organization (WHO) histologic classification, and Masaoka-Koga (M-K) stage. RESULTS: The median follow-up period was 62 months. The pleural recurrence rate was 7.8% (24/309). After univariate analysis, longer maximum tumor diameter (p<0.001), longer TPCL (p<0.001), lobulated tumor contour (p=0.001), WHO histologic type B2, B3 (p=0.002), and M-K stage III/IV (p<0.001) demonstrated significant differences with risk factors of pleural recurrence. Multivariate analysis revealed that TPCL (per 1cm increase: hazard ratio [HR]: 1.040, 95% confidence interval [CI]: 1.019-1.061, p<0.001), lobulated tumor contour (HR: 5.883, CI: 1.201-28.824, p=0.029), WHO histologic classification B2/B3 (HR: 5.331, CI: 1.453-19.558, p=0.012) and advanced M-K stage (HR: 3.900, CI: 1.579-9.632, p=0.003) were significantly associated with pleural recurrence. CONCLUSION: TPCL and lobulated tumor contour as well as WHO histologic classification and M-K stage were independent predictors of pleural recurrence after thymoma resection. Our study demonstrated that radiologic parameters could be useful predictor of pleural recurrence in patients with resected thymoma.

Combined Bilateral Lung Transplantation and Off-Pump Coronary Artery Bypass.

Coronary artery disease has historically been a contraindication to lung transplantation. We report a successful combined bilateral lung transplantation and off-pump coronary artery bypass in a 62-year-old man. The patient had a progressive decline in lung function due to idiopathic pulmonary fibrosis and a history of severe occlusive coronary artery disease.

Transition to routine use of venoarterial extracorporeal oxygenation during lung transplantation could improve early outcomes.

BACKGROUND: The study objective was to compare the outcomes of intraoperative routine use of venoarterial (VA) extracorporeal membrane oxygenation (ECMO) versus selective use of cardiopulmonary bypass (CPB). METHODS: Between January 2010 and February 2013, 41 lung transplantations (LTx) were performed, and CPB was used as a primary cardiopulmonary support modality by selective basis (group A). Between March 2013 and December 2014, 41 LTx were performed, and ECMO was used routinely (group B). The two groups were compared retrospectively. RESULTS: The operative time was significantly longer in group A (group A, 458 min; group B, 420 min; P=0.041). Postoperatively, patients in group B had less fresh frozen plasma (FFP) transfusion (P=0.030). Complications were not different between the two groups. The 30- and 90-day survival rates were better in group B (30-day survival: group A, 75.6%; group B, 95.1%, P=0.012; 90-day survival: group A, 68.3%; group B, 87.8%, P=0.033). The 1-year survival showed better trends in group B, but it was not significant. Forced vital capacity (FVC) at 1, 3, and 6 months after LTx was better in group B than in group A (1 month: group A, 43.8%; group B, 52.9%, P=0.043; 3 months: group A, 45.5%; group B, 59.0%, P=0.005; 6 months: group A, 51.5%; group B, 65.2%, P=0.020). Forced expiratory volume in 1 second (FEV1) at 3 months after LTx was better in patients in group B than that in patient in group A (group A, 53.3%; group B, 67.5%, P=0.017). CONCLUSIONS: Routine use of ECMO during LTx could improve early outcome and postoperative lung function without increased extracorporeal-related complication such as vascular and neurologic complications.

Early outcomes of lung transplantation for bronchiolitis obliterans syndrome after allogeneic haematopoietic stem cell transplantation: a single-centre experience.

OBJECTIVES: Bronchiolitis obliterans syndrome (BOS) is a serious late complication following allogeneic haematopoietic stem cell transplantation (allo-HSCT) and is associated with chronic graft-versus-host disease. However, the outcome of medical treatment for BOS, mainly immunosuppressive therapy, is disappointing. This study evaluated the early outcomes of lung transplantation (LTx) as a treatment option for severe BOS. METHODS: Between January 2010 and December 2014, we retrospectively reviewed the medical records and postoperative outcomes of 9 patients who underwent LTx for BOS after allo-HSCT at a single institution. RESULTS: The median age of patients at the time of LTx was 21 years, and the median interval from the diagnosis of BOS to LTx was 17.1 months. At the time of LTx, 5 patients were receiving oxygen therapy via nasal prongs, whereas the remaining 4 were receiving mechanical ventilation supports, 2 of whom requiring extracorporeal lung support. All patients underwent bilateral lung transplantation. During a median follow-up of 17 months after LTx, 2 patients died: one of intra-cranial haemorrhage and pneumonia during hospitalization and another patient of pneumonia and septic shock after discharge. Although the follow-up was short, the remaining 7 patients are currently healthy and active except one who developed BOS 45.3 months after LTx; he is on the waiting list for retransplantation. One patient experienced acute rejection that resolved after steroid pulse therapy. There was no relapse of the haematological disease after LTx. CONCLUSIONS: LTx could be a reasonable therapeutic option in selected patients with refractory BOS not responsive to conventional therapy.

Sarcopenia of thoracic muscle mass is not a risk factor for survival in lung transplant recipients.

BACKGROUND: In lung transplantation (LTx), patients with thoracic muscle sarcopenia may have to require longer to recovery. We measured thoracic muscle volume by using the cross sectional area (CSA) and assessed its effect on early outcomes after LTx. METHODS: A retrospective analysis was conducted to evaluate the effect of thoracic sarcopenia in patients undergoing LTx between January 2010 and July 2015. The lowest CSA quartile (Q1) was defined as sarcopenia. RESULTS: In total, 109 patients were enrolled. The mean CSA was 58.24±15.82 cm(2). Patients in the highest CSA quartile were more likely to be male (92.6% vs. 17.9%, P<0.001), older (55.2±10.1 vs. 43.2±14.9 years, P=0.001), to have a higher body mass index (BMI) (22.3±4.0 vs. 19.4±3.7 kg/m(2), P=0.007), and to have pulmonary fibrosis (85.2% vs. 35.7%, P=0.003) compared with the lowest CSA quartile. Early outcomes including ventilator support duration [32.9±49.2 vs. 24.5±39.9 days, P= not significant (ns)], intensive care unit (ICU) stay duration (28.4±43.7 vs. 24.4±35.9 days, P= ns) and hospital stay duration (61.4±48.2 vs. 50.8±37.2 days, P= ns) tended to be longer in Q1 than Q4, but the difference was not significant. However, the 1-year survival rate was better in Q1 compared with Q4 (66.6% vs. 46.0%, P=0.04). CONCLUSIONS: Although patients with thoracic sarcopenia seem to require a longer post-operative recovery time after LTx, this does not compromise their early outcomes. By contrast, patients with larger thoracic muscle volume (Q4) showed poorer survival times.

Limited thymectomy as a potential alternative treatment option for early-stage thymoma: A multi-institutional propensity-matched study.

OBJECTIVES: For early-stage thymoma, complete thymectomy has classically been regarded as the standard treatment protocol. However, several studies have shown that limited thymectomy may be an alternative treatment option for thymoma. This study compared perioperative outcomes, survival, and recurrence rates between patients undergoing limited thymectomy and complete thymectomy. MATERIALS AND METHODS: Between January 2000 and December 2013, a total of 762 patients underwent thymectomy for stage I or II thymomas at four institutions participating in the Korean Association for Research on the Thymus. Patients were divided into two groups: limited thymectomy group (n=295) and complete thymectomy group (n=467). Comparative clinicopathological, surgical, and oncological features were reviewed retrospectively. RESULTS: The median follow-up time was 49 months (range: 0.2-189 months). A propensity score-matching analysis, based on seven variables (age, sex, surgical approach, tumor size, WHO histological type, Masaoka-Koga stage, and adjuvant radiotherapy), was performed using 141 patients selected from each group. The 5- and 10-year freedom-from-recurrence rates in the limited thymectomy group were 96.3% and 89.7%, respectively, and those in the complete thymectomy group were 97.0% and 85.0%, respectively. No significant differences in these rates were observed between groups (p=0.86). A multivariate Cox regression analysis showed that overall survival and freedom-from-recurrence rates did not significantly differ by surgery extent (p=0.27, 0.66, respectively). Perioperative outcomes were better in the limited thymectomy group. CONCLUSION: Limited thymectomy was not inferior to complete thymectomy with respect to recurrence, and had better perioperative outcomes. Limited thymectomy may be a viable treatment option for early-stage thymoma.

Surgical Treatment of Postpneumonectomy Syndrome with Tissue Expanders in Children.

Postpneumonectomy syndrome (PPS) is a rare late complication of pneumonectomy. It occurs more often in children than in adults, and is characterized by respiratory failure resulting from bronchial compression caused by severe mediastinal shift. Various methods have been used to treat PPS, including aortopexy and the insertion of plastic balls, silastic implants, and saline-filled breast prostheses. We describe two cases of PPS corrected with tissue expanders after right pneumonectomy in patients with esophageal atresia.

Clinical feasibility and efficacy of video-assisted thoracic surgery (VATS) anatomical resection in patients with central lung cancer: a comparison with thoracotomy.

BACKGROUND: The aim of this study is to evaluate the clinical feasibility and efficacy of video-assisted thoracoscopic surgery (VATS) anatomical pulmonary resection in patients with central lung cancer. METHODS: Between July 2004 and December 2011, 465 patients underwent anatomical pulmonary resection and systematic mediastinal lymph node sampling or dissection for central lung cancer. Because patients were not randomized to receive VATS, clinical outcomes were compared using a propensity score matching design, giving 88 patients in each group. RESULTS: A lobectomy was attempted in 69 patients of the thoracotomy group and 64 of the VATS group, bilobectomy in 19 patients of the thoracotomy group and 21 of the VATS group, and segmentectomy in 3 patients of the VATS group. There were no differences in the anatomical distribution of pulmonary resections between the two groups. There was no operation related in-hospital mortality. There were 34 postoperative complications in 30 patients, without significant differences between the two groups. The median hospital stay and chest tube indwelling period of the VATS group were shorter than those of the thoracotomy group by 2 days and 1 day, respectively (P<0.05). During a median follow-up of 32.5 months (range, 0.5-95.8 months), there was no difference between the two groups in 3-year recurrence-free or overall survivals (OS). CONCLUSIONS: VATS anatomical pulmonary resection is safe and feasible for central lung cancer, providing a low operative mortality and favorable outcomes in selected patients. Further case studies with long-term outcome data are necessary to verify our conclusions.

Safety of thoracoscopic surgery for lung cancer without interruption of anti-platelet agents.

BACKGROUND: Perioperative bleeding concerns have led to the general recommendation that antiplatelet agents (APAs) be discontinued 7-10 days preoperatively, but this could increase the risk of perioperative cardiovascular events. This retrospective study aimed to evaluate the safety of APA continuation during thoracoscopic surgery for lung cancer. METHODS: Between January 2009 and February 2015, 164 patients taking APAs underwent curative resection. Comparisons were conducted between two groups: preoperatively interrupted APA administration (group I, n=106) and continued APA administration (group N, n=58). RESULTS: Group N had a significantly higher revised cardiac risk index (rCRI) (P=0.001). Lobectomy was performed in the majority of patients [95 (89.6%) in group I; 52 (89.7%) in group N]. There were no significant differences in intraoperative outcomes, such as the thoracotomy conversion rate, operating time, intraoperative transfusion, and amount of blood loss during the operation, or postoperative outcomes, such as postoperative bleeding and thrombotic complications, postoperative transfusions, and operative mortality. Within group N, the patients taking aspirin + clopidogrel (n=11) had significantly greater postoperative bleeding (P=0.005), and more postoperative transfusions (P=0.003) and chest tube drainage over a 3-day period (P=0.049) compared with other antiplatelet regimens. CONCLUSIONS: Continued use of APAs during thoracoscopic surgery for lung cancer could be safely done in patients at high risk of cardiac or thrombotic events. However, in patients administered aspirin + clopidogrel, it may be the best to continue aspirin only because of an increased risk of postoperative bleeding and transfusion requirements.