Surgical Procedures and Perioperative Management for Non-small Cell Lung Cancer Complicated with Left Atrial Tumor Thrombus / 中国肺癌杂志

BACKGROUND@#Non-small cell lung cancer with left atrial tumor thrombus accounts for a small proportion of local advanced lung cancer. Whether surgery could bring benefits, as well as surgical options are still controversial, and have always been hot spots in surgical research. We report a single center experience of surgical treatment to non-small cell lung cancer with left atrial tumor thrombus, aim to figure out more reasonable treatment strategy.@*METHODS@#From August 2006 to July 2017, a total of 11 cases of non-small cell lung cancer with left atrial tumor thrombus underwent surgery in Thoracic Surgery Department of China-Japan Friendship Hospital. Clinical data, treatment options, pathological types and prognosis of these patients were collected to perform a retrospective study.@*RESULTS@#Of the 11 patients (mean age of 57.9), 7 were men and 4 were women. Six of them received neoadjuvant radiotherapy and/or chemotherapy. All patients underwent smooth operation, including 3 cases with cardiopulmonary bypass, 1 case of posterolateral approach under extracorporeal membrane oxygenation, 6 cases of conventional posterolateral approach and 1 case of video-assisted minithoracotomy. Nine patients were evaluated as R0 resection while 2 cases were evaluated as R1 resection. The Surgeries cost an average of 292 min (210 min-380 min), with an average of 436 mL (100 mL-1,600 mL) blood loss. One patient (9.1%) died within 90 days after surgery, and another 4 cases (36.4%) suffered postoperative complications such as arrhythmia, cerebral infarction or hypoxemia. Six cases of squamous cell carcinoma, 4 cases of adenocarcinoma and 1 case of sarcomatoid carcinoma were identified by pathology. Seven cases were staged as pT4N0M0 while 4 cases were staged as pT4N1M0. Nine patients underwent adjuvant chemotherapy, and two patients underwent radiotherapy during follow-up. The overall follow-up time was 2 to 53 months, the 3-year disease-free survival rate was 30.7%, the median disease-free survival time was 31 months, the 3-year overall survival rate was 49.1% and the median overall survival time was 33 months.@*CONCLUSIONS@#For selected patients of non-small cell lung cancer complicated with left atrial tumor thrombus, choose a reasonable surgical approach to resect both the tumor and the thrombus, strengthen the perioperative management and apply neoadjuvant/adjuvant radiotherapy and/or chemotherapy, might obtain satisfying prognosis.

Simple and Easy Techniques for Mitral Valve Exposure with a Single Retractor / 日本心臓血管外科学会雑誌

Adequate exposure is crucial for successful mitral valve surgery. We report simple techniques for optimizing mitral valve exposure via conventional left atriotomy. The right side of the pericardium is sutured to the chest wall after medial sternotomy and pericardiotomy. We mobilize both the superior and inferior vena cava by dissecting the pericardium on their right side. Tourniquets are placed around both venae cavae and hitched up to the left after bicaval cannulation. Then the right side of the left atrium is lifted up and exposed. A longitudinal incision of the left atrium allows excellent exposure of the mitral valve using a single retractor. We adopted these procedures for 38 consecutive patients for mitral valve plasty, and additional incisions were not required. Simple mitral plasty procedure in 18 cases required 212±32 min for operation, 120±22 min for extracorporeal circulation and 88±18 min for aortic cross clamp. We conclude that this method is simple and does not lengthen the procedure.

Clinical Study of 80 Cases of Mitral Valve Operations Via Extended Transseptal Approach / 대한흉부외과학회지

BACKGROUND: Among the various techniques for the adequate exposure of the mitral valve, the extended transseptal approach is the essential prerequisite for accurate repair or replacement of the mitral apparatus. But the efficacy and safty of the extended transseptal approach has not determined in Korea yet. MATERIALS AND METHODS: Retrospective data of 80 consecutive patients, operated from September 1992 to July 1997 were reviewed. Seventy- eight patients underwent mitral valve replacement and 2 patients underwent excision of left atrial myxoma. Thirty-eight of 78 patients had other concomitant procedures such as aortic valve replacement (n=22), tricuspid annulopasty (n=14), coronary artery bypass graft (n=1) and closure of ventricular septal defect (n=1). Mean follow up was 23.3+/-15.0 months and total follow up was 1792 patient-months. RESULTS: The hospital mortality rate was 3.8% (3 patients). Two deaths were due to low cardiac output and one due to postoperative bleeding of coagulopathy. Among the 46 patients who had atrial fibrillation preoperatively, 45 had atrial fibrillation postoperatively and 1 converted to sinus rhythm. All 34 patients who were in normal sinus rhythm preoperatively remained in sinus rhythm after the operation. Mean aortic cross clamping time was 62 minutes for isolated mitral procedure and 90 minutes for concomitant procedures. There were no specific complications related to this approach. CONCLUSIONS: We suggest that the extended transseptal approach is an easy and good method for mitral valve surgery, especially in patients with small sized left atrium.