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1.
Medicine (Baltimore) ; 99(5): e18959, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32000421

RESUMEN

The outcomes of minimally invasive thoracoscopic pulmonary segmentectomy for non-small cell lung cancer (NSCLC) still need to be defined. This study aimed to investigate the feasibility and effectiveness of thoracoscopic pulmonary segmentectomy in patients with early peripheral NSCLC.This was a retrospective study of patients with early peripheral NSCLC admitted between January 2013 and January 2017. Patients were divided into the segmentectomy and lobectomy groups (40/group), according to the surgery they underwent. Blood loss, operation time, removal of drainage tube time, inflammatory response after operation, postoperative complications, postoperative lung function, local recurrence, and survival were compared.Blood loss and removal of drainage tube time were not significantly different between the 2 groups (all P > .05). Operation time in the segmentectomy group was longer than in the lobectomy group (P < .001). The postoperative interleukin-6, procalcitonin, and C-reactive protein changes in the segmentectomy group were significantly lower than in the lobectomy group (all P < .001). The pulmonary function at 2 weeks was significantly reduced in the 2 groups (all P < .001), but it was better in the segmentectomy group than in the lobectomy group (all P < .05). The 1- and 3-year local recurrence disease-free, and overall survival rates were not significantly different between the 2 groups (P > .05). The multivariable analysis could not identify any factor associated with local recurrence or survival (all P > .05).Thoracoscopic pulmonary segmentectomy and lobectomy are both acceptable for the treatment of early peripheral NSCLC, but segmentectomy was associated with lower postoperative inflammation and better postoperative pulmonary function than lobectomy.


Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/cirugía , Neoplasias Pulmonares/cirugía , Neumonectomía/métodos , Toracoscopía , Adulto , Anciano , Biomarcadores de Tumor/sangre , Pérdida de Sangre Quirúrgica , Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Drenaje , Estudios de Factibilidad , Femenino , Humanos , Neoplasias Pulmonares/mortalidad , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Tempo Operativo , Complicaciones Posoperatorias , Pruebas de Función Respiratoria , Estudios Retrospectivos , Tasa de Supervivencia
3.
Zhonghua Er Ke Za Zhi ; 58(1): 19-24, 2020 Jan 02.
Artículo en Chino | MEDLINE | ID: mdl-31905471

RESUMEN

Objective: To summarize the diagnosis, clinical manifestations, treatment and prognosis of congenital cystic lung lesions. Methods: A retrospective study described the clinical course of 96 patients (46 female and 50 male) diagnosed with congenital cystic lung lesions treated at the Tianjin Children's Hospital from January 2010 to March 2019. The clinical findings, imaging examinations, pathological findings, treatment and follow-up were analyzed. Results: Totally 96 patients (aged from 4 days to 13 years) with congenital cystic lung lesions were included in this study. Eighty-six patients (90%) were diagnosed when they had cough and fever symptoms. Forty (42%) patients exhibited congenital cystic adenomatoid malformation, 30 underwent surgical excision, two were at emergency operations and one dead. There were 12 (13%) patients with pulmonary sequestration and four were surgical treated. Twelve (13%) patients with bronchogenic cyst were included and 4 were surgically treated. There were 3 (3%) patients with congenital lobar emphysema and one was surgically treated. Another patient with pneumothorax was operated in other hospital 2 months after discharge. Twenty-nine (30%) patients with unclassified congenital cystic lung lesions could not be definitively diagnosed by CT. Some of them were difficult to be distinguished from necrotizing pneumonia. Finally, 2 patients were diagnosed as necrotizing pneumonia after 6, 10 months follow-up. After operation 37 out of 39 patients recovered well. Conclusions: The diagnosis of congenital pulmonary cystic disease depend on imaging and pathological examination. Most patients are diagnosed when they have respiratory tract infection. The main clinical manifestations are cough and fever. The prognosis of operative management is good.


Asunto(s)
Quiste Broncogénico/diagnóstico , Quiste Broncogénico/cirugía , Malformación Adenomatoide Quística Congénita del Pulmón/diagnóstico , Enfisema Pulmonar/patología , Adolescente , Quiste Broncogénico/congénito , Secuestro Broncopulmonar/diagnóstico , Secuestro Broncopulmonar/cirugía , Niño , Preescolar , Malformación Adenomatoide Quística Congénita del Pulmón/cirugía , Femenino , Humanos , Lactante , Masculino , Neumonectomía , Enfisema Pulmonar/cirugía , Estudios Retrospectivos , Resultado del Tratamiento
4.
Zhonghua Wai Ke Za Zhi ; 58(1): 57-60, 2020 Jan 01.
Artículo en Chino | MEDLINE | ID: mdl-31902172

RESUMEN

Minimally invasive surgery helps enhance postoperative recovery and improve quality of life of the patients by minimizing surgical trauma and decreasing incisional pain. Minimally invasive pulmonary resection, including both video-assisted thoracoscopic surgery and robotic surgery, is mainly used for surgical management of peripheral early stage lung cancers. Because of tumor location, lymph node involvement, and treatment modalities, surgery for central lung cancers is often technically demanding. Open thoracotomy is still the dominant approach for these tumors, especially when complex procedures such as sleeve lobectomy or pneumonectomy are needed. With the advent of surgical techniques, minimally invasive techniques have started to be tried in treatment of central lung cancers. Initial results have proven their feasibility and safety in sleeve lobectomy and pneumonectomy, showing a great potential of minimally invasive surgery in the future. Further study is necessary to prove its functionally superiority and oncological equivalence to open surgery, so that more lung cancer patients could benefit for minimally invasive surgery.


Asunto(s)
Neoplasias Pulmonares/cirugía , Neumonectomía/métodos , Cirugía Torácica Asistida por Video , Humanos , Procedimientos Quirúrgicos Mínimamente Invasivos
6.
Zhonghua Wai Ke Za Zhi ; 57(12): 956-960, 2019 Dec 01.
Artículo en Chino | MEDLINE | ID: mdl-31826603

RESUMEN

Lung cancer is the leading cause of death in malignant tumors. Surgery is one of the main treatments for early stage lung cancer. Idiopathic pulmonary fibrosis (IPF), one of the most common interstitial lung disease, is a chronic, progressive lung disease, characterized by insidious onset and progressive deterioration. It is reported that there are common pathways in idiopathic pulmonary fibrosis and lung cancer, and patients with IPF have a higher risk of lung cancer than the general population, whose prevalence was 3.34 times than that of the general population. The incidence of acute exacerbations of IPF and postoperative mortality was significantly higher in lung cancer patients complicated with IPF than those without IPF. The long-term outcomes of patients with IPF are dramatically worse than those without IPF. It was concluded that lobectomy has been still the standard surgical procedure for such patients, but sublobectomy should be taken as potential alternative choice for patients with high risk after preoperative evaluation. Moreover, further studies should be conducted on the prevention and treatment of acute exacerbation of IPF after surgery.


Asunto(s)
Fibrosis Pulmonar Idiopática/cirugía , Neoplasias Pulmonares/cirugía , Neumonectomía/métodos , Humanos , Fibrosis Pulmonar Idiopática/complicaciones , Fibrosis Pulmonar Idiopática/mortalidad , Pulmón/cirugía , Neoplasias Pulmonares/etiología , Neumonectomía/mortalidad
7.
Magy Seb ; 72(4): 149-160, 2019 Dec.
Artículo en Húngaro | MEDLINE | ID: mdl-31813241

RESUMEN

Introduction: Completion pneumonectomy (CP) means the removal of the entire residual lung tissue after previously performed lung resection. Mortality and morbidity of CP are higher when compared to those of standard pneumonectomy. In this article, we give an overview on indications and perioperative results of CP. Method: We analysed the perioperative results of CP performed during a period of 15 years in a retrospective manner, based on the patients' medical records, descriptions of surgeries and histological findings. We divided the indications into three groups: rescue surgery for complications in the early postoperative period (rescue: rCP), incomplete resection verified by histological results (pathological: pCP) and conventional surgeries performed in the late postoperative period (conventional: cCP). We classified the complications according to an international scale. Results: The overall surgery-related morbidity of 102 patients was 70.5% (minor: 36.27%, major: 34.23%), the mortality was 16.6%. There were no lethal complications during the surgical procedures. rCP: 24 patients (18 men, 6 women, 46-77 years, average 61.7 years). Intervals between operations: 10.87 days (0-32 days). Indications: necrosis or abscess formation (8 cases), bronchial fistula (5 cases), insufficient or blocked anastomosis (3 cases), massive haemoptysis (3 cases), intrathoracic bleeding (2 cases), non-expanding lung (3 cases). Overall morbidity: 79.19%. Nine patients died (37.5%). pCP: 7 patients (5 men, 2 women), 45-66 years (average: 56.3 years). Primary surgery: 6 lobectomies, 1 bilobectomy. Intervals between operations: 1-5 months (average: 2.84 months). Three patients did not develop complications, four had anaemia requiring blood transfusion, one empyema requiring fenestration, one died (14.28%) due to intrathoracic bleeding. There were no tumours in the removed lung tissues in cases of four patients. cCP: 71 patients (22 women, 44 men, 29-79 years (average: 60.3 years). Intervals between operations: 34 days - 40 years (average: 6.7 years). Histological findings of the previous surgeries: primary lung tumour (64 patients), metastases of tumours in other organs (1 patient), bronchiectasia (1 patient) and tuberculosis (5 patients). Indications of cCP: late bronchial fistula (2 patients), verified or suspected tumour (65 patients), other (4 patients). Histological findings with primary lung tumour in the patient's history: 32 new tumours, 15 local recurrences, 9 metastases, 2 metastases or recurrences, 7 non-malignant. Histological findings without malignancy in the patient's history: 3 new tumours, 1 tuberculosis and 2 chronic inflammations. Overall morbidity was 76.2%, mortality within 30 days or in the hospital 9.8%. Conclusions: Morbidity and mortality are the highest after rCP, but these patients usually do not have any other chance for healing. We have not performed repeat surgery for incomplete tumour resection in the last 10 years. Comparing our results to the international data, the morbidity after cCP is high, the mortality is similar.


Asunto(s)
Enfermedades Pulmonares , Neoplasias Pulmonares , Neumonectomía , Femenino , Humanos , Enfermedades Pulmonares/cirugía , Neoplasias Pulmonares/cirugía , Masculino , Recurrencia Local de Neoplasia , Complicaciones Posoperatorias , Estudios Retrospectivos , Resultado del Tratamiento
8.
Medicine (Baltimore) ; 98(49): e18282, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31804370

RESUMEN

RATIONALE: Fetal adenocarcinoma of the lung (FLAC) with fetal lung-like morphology is a rare entity of pulmonary adenocarcinoma. Well-differentiated fetal adenocarcinoma (WDFA) belongs to its the low-grade form, which possesses a relatively favorable prognosis. Tuberculosis (TB) is an aggressive infectious disease that has been ranked as one of the top 10 causes of death worldwide. There may be a connection between the 2 and attention should be paid to the differential diagnosis. PATIENT CONCERNS: A 28-year-old non-smoking female was admitted with signs of hemoptysis, and she had been coughing up phlegm for 5 years. The patient was previously diagnosed with TB in another hospital, and underwent an anti-TB regimen. DIAGNOSIS: The co-existence of WDFA and TB was confirmed via histopathological evaluation of postoperative samples. INTERVENTIONS: The patient was subjected to a right lower lobectomy together with a wedge resection of the right upper lobe using video-assisted thoracoscopic surgery, with systemic lymphadenectomy. OUTCOMES: The patient tolerated the surgical procedure well and underwent an uneventful postoperative course. LESSONS: To our knowledge, no previous reports exist of cases with WDFA accompanied by TB. The present case indicated that a prior diagnosis of TB might predispose to lung cancer regardless of smoking history. It is also essential to distinguish WDFA from TB because of the similarity in clinical features and sites of pathological changes. Patients with WDFA usually have a better prognosis and surgery is the preferred treatment.


Asunto(s)
Adenocarcinoma del Pulmón/complicaciones , Tuberculosis Pulmonar/complicaciones , Adenocarcinoma del Pulmón/diagnóstico por imagen , Adenocarcinoma del Pulmón/cirugía , Adulto , Antituberculosos/uso terapéutico , Femenino , Humanos , Biopsia Guiada por Imagen , Escisión del Ganglio Linfático , Neumonectomía , Cirugía Torácica Asistida por Video , Tomografía Computarizada por Rayos X , Tuberculosis Pulmonar/diagnóstico por imagen , Tuberculosis Pulmonar/tratamiento farmacológico
9.
Anticancer Res ; 39(12): 6829-6834, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31810949

RESUMEN

BACKGROUND/AIM: Circulating tumor cells (CTCs) are tumor cells shed from tumor sites and circulate in the peripheral blood. CTCs can be a surrogate biomarker of recurrence and prognosis. Because surgical manipulation could promote CTCs, it is important to reduce CTCs during surgery. This study aimed to evaluate the effectiveness of intraoperative wedge resection of the tumor site before lobectomy. PATIENTS AND METHODS: A total of 297 resected stage I lung adenocarcinoma patients were retrospectively reviewed. Patients were divided into two groups: Wedge and Non-Wedge. Recurrence-free survival (RFS) curves were plotted using the Kaplan-Meier method. Cox regression analyses were used to evaluate the hazard ratio (HR) with the endpoint RFS. RESULTS: The 5-year RFS rates were 92.9% and 85.5%, in Wedge and Non-Wedge groups, respectively (p=0.006). Wedge resection was an independent factor associated with RFS (HR=0.342, 95%CI=0.141-0.830, p=0.018). CONCLUSION: Wedge resection before lobectomy for lung adenocarcinoma patients can improve RFS rates.


Asunto(s)
Adenocarcinoma del Pulmón/cirugía , Neoplasias Pulmonares/cirugía , Neumonectomía/métodos , Venas Pulmonares/cirugía , Adenocarcinoma del Pulmón/irrigación sanguínea , Adenocarcinoma del Pulmón/patología , Femenino , Humanos , Periodo Intraoperatorio , Neoplasias Pulmonares/irrigación sanguínea , Neoplasias Pulmonares/patología , Masculino , Estadificación de Neoplasias , Células Neoplásicas Circulantes/patología , Pronóstico , Estudios Retrospectivos , Análisis de Supervivencia , Cirugía Torácica Asistida por Video , Resultado del Tratamiento
10.
Medicine (Baltimore) ; 98(50): e18377, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31852149

RESUMEN

INTRODUCTION: Early recognition of VATS-related complications is crucial for early interventions, treatments and better outcomes PATIENT CONCERNS:: Patient presented with post-obstructive pneumonia like symptoms 1 week after VATS pulmonary resection. DIAGNOSIS: CT scan chest showed evidence of complete consolidation of the lobe where the pulmonary segmentectomy resection took place. INTERVENTIONS: Diagnostic bronchoscopy confirmed the erroneous transection of the Superior Segment (SS) of Right Lower Lobe (RLL). Patient was then taken back for completion lobectomy and found with necrotic SS of RLL. This finding potentially could have caused significant complication if not recognized and treated early OUTCOMES:: Patient recovered well after completion lobectomy and was discharged home several days later CONCLUSION:: Erroneous bronchial transection should be suspected early in patients presenting with post-obstructive pneumonia after VATS pulmonary resection. CT scan chest and diagnostic bronchoscopy are the 2 main diagnostic tests.


Asunto(s)
Broncoscopía/métodos , Errores Médicos/efectos adversos , Cirugía Torácica Asistida por Video/efectos adversos , Anciano , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Femenino , Humanos , Neoplasias Pulmonares/cirugía , Neumonectomía/métodos
11.
Medicine (Baltimore) ; 98(50): e18262, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31852095

RESUMEN

INTRODUCTION: Attaining lung isolation in the infant is a challenge for anesthesia care providers. Pulmonary lobe isolation is more challenging. We describe an approach to performing selective pulmonary lobe isolation using the pediatric endobronchial blocker in an infant in the absence of appropriate auxiliary guidance tool. PATIENT CONCERNS: An 8-month-old and 9.5 kg male infant was admitted because of repeated cough with fever for 3 months and a large cyst of his right lung for 2 weeks. He had been living in a pastoral area with his parents. DIAGNOSIS: Based on the chest computed tomography (CT) and his history about long-term residence in the pastoral area, this patient's diagnosis was considered as right middle lobe hydatid cyst. INTERVENTIONS: Guided by a fiberoptic bronchoscope, a cuffed 4.0-mm inside diameter (ID) endotracheal tube was successfully placed into the right main bronchus of this infant. Then, pediatric 5-French (Fr) endobronchial blocker was placed into the right middle and lower lobes through the endotracheal tube without navigation of fiberoptic bronchoscope. OUTCOMES: Lobe isolation was successfully achieved for right middle lobectomy. This approach allows clinicians to perform lobe isolation in the absence of fiberoptic bronchoscope with very small outer diameter. CONCLUSION: This technique is relatively easy to use and less dependent on equipment with small outer diameter in the selective pulmonary lobe isolation in infants and small children.


Asunto(s)
Anestesia/métodos , Broncoscopía/métodos , Quistes/cirugía , Intubación Intratraqueal/instrumentación , Enfermedades Pulmonares/cirugía , Neumonectomía/métodos , Respiración Artificial/métodos , Quistes/diagnóstico , Diseño de Equipo , Tecnología de Fibra Óptica , Humanos , Lactante , Enfermedades Pulmonares/diagnóstico , Masculino , Tomografía Computarizada por Rayos X
12.
Medicine (Baltimore) ; 98(50): e18316, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31852116

RESUMEN

To describe the characteristics of concomitant lung cancer and pulmonary cryptococcosis (PC) cases.A total of 8 patients with lung cancer and coexisting PC, who were admitted to Fuzhou Pulmonary Hospital of Fujian from 1st January 2009 to 31st December 2015 and whose diagnoses were confirmed by pathological examinations, were studied.One patient had a history of diabetes mellitus and 1 had a history of treated with surgery. The lesions in 7 cases manifested as nodular shadows; only 1 case showed the lesion of the 2 diseases mergedmixed together, and it manifested as a large flake-like infiltrated shadow in the same lobe. The histological type in all of the patients was lung adenocarcinoma. Lung cancer stage was advanced (III-IV) in 25.0% of the cases. The 5 patients who received surgery and drug treatment are presently healthy following resection. Recurrence and metastasis of lung cancer following surgery occurred in 2 patients in whom the tumor was controlled again after anti-tumor treatment. One patient with advanced lung cancer and PC was treated with antifungal therapy in combination with antineoplastic chemotherapy, but she failed to improve and died 10 months after symptom onset during the follow-up period.PC coexisting with pulmonary carcinoma is rare. PC can manifest as pulmonary nodules and mimic malignant lesions, so it must be considered during a differential diagnosis of pulmonary nodules, especially in immunosuppressed patients.


Asunto(s)
Adenocarcinoma del Pulmón/diagnóstico , Criptococosis/diagnóstico , Biopsia Guiada por Imagen/métodos , Enfermedades Pulmonares Fúngicas/diagnóstico , Neoplasias Pulmonares/diagnóstico , Adenocarcinoma del Pulmón/complicaciones , Adenocarcinoma del Pulmón/cirugía , Adulto , Anciano , Criptococosis/complicaciones , Criptococosis/cirugía , Femenino , Estudios de Seguimiento , Humanos , Enfermedades Pulmonares Fúngicas/complicaciones , Enfermedades Pulmonares Fúngicas/cirugía , Neoplasias Pulmonares/complicaciones , Neoplasias Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Neumonectomía/métodos , Estudios Retrospectivos , Cirugía Torácica Asistida por Video , Tomografía Computarizada por Rayos X
13.
Medicine (Baltimore) ; 98(47): e18088, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31764844

RESUMEN

The objective of this study is to compare the effects of paravertebral nerve block-propofol intravenous general anesthesia (PPA) and sevoflurane inhalation general anesthesia (SGA) on the expression of serum vascular endothelial growth factor (VEGF) and transforming growth factor beta (TGF-ß) in patients undergoing radical resection of lung cancer.Patients undergoing radical resection of lung cancer were divided into PPA group and SGA group. In PPA group, thoracic paraspinal nerve block was performed with 0.5% ropivacaine (2 mg/kg) before general anesthesia. Anesthesia was maintained with 2.5-3.5 µg/mL TCI of propofol. In SGA group, anesthesia was maintained with 1.0-1.5 MAC sevoflurane. The dosage of opioids during and 24 h after operation, the pain score at 2, 8, 24, 48, and 72 h after operation, and the concentrations of serum VEGF and TGF-ß before and 24 h after operation were observed in the two groups.The intraoperative dosage of remifentanil in PPA group was significantly less than that in SGA group (P < 0.05). The dosage of sufentanil in SGA group was significantly less than that in SGA group at 24 h after operation (P < 0.05). The VAS score at 2, 8, and 24 h after operation was significantly lower than that in SGA group (P < 0.05). The serum VEGF and TGF-ß concentration in PPA group was significantly lower than that in SGA group (P < 0.05).Thoracic paravertebral nerve block-propofol intravenous general anesthesia can reduce the dosage of opioids, improve the effect of postoperative analgesia, and reduce the serum concentration of tumor angiogenesis-related factors in patients undergoing radical resection of lung cancer.


Asunto(s)
Anestesia General/métodos , Anestésicos por Inhalación/administración & dosificación , Anestésicos Intravenosos/administración & dosificación , Neoplasias Pulmonares/cirugía , Neumonectomía , Propofol/administración & dosificación , Sevoflurano/administración & dosificación , Sevoflurano/farmacología , Factor de Crecimiento Transformador beta/efectos de los fármacos , Factor A de Crecimiento Endotelial Vascular/efectos de los fármacos , Anestesia por Inhalación , Anestesia Intravenosa , Anestésicos por Inhalación/farmacología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Músculos Paraespinales/inervación , Neumonectomía/métodos , Propofol/farmacología , Estudios Prospectivos , Tórax
14.
No Shinkei Geka ; 47(11): 1157-1163, 2019 Nov.
Artículo en Japonés | MEDLINE | ID: mdl-31761777

RESUMEN

A 76-year-old man underwent a left upper lobectomy due to lung cancer. On postoperative day 3, he developed a cerebral infarction(NIHSS:17). MR and right carotid angiography demonstrated a right internal carotid artery occlusion. The patient underwent an endovascular thrombectomy without intravenous administration of recombinant tissue plasminogen activator. Complete recanalization was achieved and the symptoms almost disappeared except for a slight dysarthria. The patient subsequently continued cancer treatment by administration of edoxaban. Reports of cerebral emboli due to a thrombus migrating from the stump of the pulmonary vein after a left upper lobectomy are increasing. Several reports indicate that left upper lobectomy carries a high risk of thromboembolism. The current prospective study demonstrates that a mechanical thrombectomy can significantly improve both neurological and cognitive functions of patients after acute ischemic stroke. Endovascular neurosurgeons should prepare for and await an opportunity for thrombectomy for patients undergoing pulmonary resection.


Asunto(s)
Isquemia Encefálica , Procedimientos Endovasculares , Neoplasias Pulmonares , Accidente Cerebrovascular , Trombectomía , Tromboembolia , Anciano , Arteria Carótida Interna , Humanos , Neoplasias Pulmonares/cirugía , Masculino , Neumonectomía , Estudios Prospectivos , Activador de Tejido Plasminógeno , Resultado del Tratamiento
15.
J Cardiothorac Surg ; 14(1): 183, 2019 Nov 04.
Artículo en Inglés | MEDLINE | ID: mdl-31684981

RESUMEN

BACKGROUND: The prognosis of patients who undergo unilateral pneumonectomy and subsequently develop a contralateral pulmonary tumor can be improved by tumor resection. Thus, surgery is a treatment option if the patient's pulmonary function and performance status are satisfactory. To date, there have been only few cases reporting thoracoscopic lung resection for pulmonary tumor after contralateral pneumonectomy because of the difficulty in respiratory management during surgery. Thoracoscopic surgery requires the maintenance of the operative field to allow the lung to collapse, and in partial lung resection we need to identify tumor localization. The identification of a tumor lesion just inferior to the pleura is easy; however, the identification of a tumor lesion in the deep parts is difficult. The tumor in the deep part of the lung segments can be easily located if the tumor-affected lobe is allowed to completely collapse. Therefore, ventilation technique should be modified according to the tumor localization. CASE PRESENTATION: Here, we report three cases of thoracoscopic partial lung resections for pulmonary tumors that developed after contralateral pneumonectomy. Intermittent manual ventilation using a tracheal tube was performed in two cases with a lesion just inferior of the pleura. The tumors in both patients were resected using automatic suturing devices while arresting manual ventilation. The affected lobe was allowed to collapse using a bronchial blocker in one of the cases with a lesion in the deep part. Furthermore, she had contralateral pneumothorax with bullae on the right upper and lower lobes of the lung. The tumor in the deep part of the lung segment and ruptured bullae were easily located and resected using automatic suturing devices. The hemodynamic status of the patients was stable, and the intra- and postoperative courses were uneventful. CONCLUSIONS: Our cases demonstrate that thoracoscopic lung resection after contralateral pneumonectomy can be performed if intermittent manual ventilation is utilized when the tumor is located just inferior to the pleura and if selective double ventilation using an intrabronchial blocker is utilized when the tumor is located in the deep part.


Asunto(s)
Carcinoma Adenoide Quístico/cirugía , Neoplasias Pulmonares/cirugía , Neumonectomía , Adulto , Anciano , Carcinoma Adenoide Quístico/diagnóstico por imagen , Carcinoma Adenoide Quístico/secundario , Femenino , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/secundario , Masculino , Metástasis de la Neoplasia , Toracoscopía , Tomografía Computarizada por Rayos X
16.
J Cardiothorac Surg ; 14(1): 189, 2019 Nov 07.
Artículo en Inglés | MEDLINE | ID: mdl-31699121

RESUMEN

BACKGROUND: Compared to lobectomy by video-assisted thoracic surgery (VATS), segmentectomy by VATS has a potential higher risk of postoperative atelectasis and air leakage. We compared postoperative complications between these two procedures, and analyzed their risk factors. METHODS: We reviewed the records of all patients who underwent anatomical pulmonary resections by VATS from January 2014 to March 2018 in two Swiss university hospitals. All complications were reported. A logistic regression model was used to compare the risks of complications for the two interventions. Adjustment for patient characteristics was performed using a propensity score, and by including risk factors separately. RESULTS: Among 690 patients reviewed, the major indication for lung resection was primary lung cancer (86.4%) followed by metastasis resection (5.8%), benign lesion (3.9%), infection (3.2%) and emphysema (0.7%). Postoperatively, there were 80 instances (33.3%) of complications in 240 segmentectomies, and 171 instances (38.0%) of complications in 450 lobectomies (P = 0.73). After adjustment for the patient's propensity to be treated by segmentectomy rather than lobectomy, the risks of a complication remained comparable for the two techniques (odds ratio for segmentectomy 0.91 (0.61-1.30), p = 0.59). Length of hospital stay and drainage duration were shorter after segmentectomy. On multivariate analysis, an American Society of Anesthesiologists score above 2 and a forced expiratory volume in one second below 80% of predicted value were significantly associated with the occurrence of complications. CONCLUSIONS: The rate of complications and their grade were similar between segmentectomy and lobectomy by VATS.


Asunto(s)
Neumonectomía/métodos , Complicaciones Posoperatorias/etiología , Cirugía Torácica Asistida por Video/métodos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Incidencia , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/epidemiología , Puntaje de Propensión , Estudios Retrospectivos , Factores de Riesgo
17.
Anticancer Res ; 39(11): 6241-6247, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31704853

RESUMEN

BACKGROUND/AIM: We performed multimodality therapy comprising preoperative chemotherapy, extrapleural pneumonectomy (EPP), and radiation therapy for patients with malignant pleural mesothelioma (MPM). Although multimodality therapy resulted in good prognosis, further improvement is required. Therefore, herein, we analysed the prognostic factors using surgical specimens and searched for suitable molecular targets to improve the prognosis after multidisciplinary treatment. PATIENTS AND METHODS: Forty-six patients with MPM underwent multimodality therapy. Paraffin-embedded surgical samples were used for immunohistochemistry to evaluate the expression of phosphorylated (p-) AKT, extracellular signal-regulated kinase (ERK), mammalian target of rapamycin (mTOR), mitogen-activated protein kinase (MAPK), eukaryotic translation initiation factor 4E-binding protein 1 (4E-BP1), and S6 ribosomal protein (S6RP). RESULTS: On univariate and multivariate analyses, significant differences were observed according to the histological type, pathological stage, and p-mTOR expression rate. CONCLUSION: The prognosis of MPM is affected by p-mTOR expression, suggesting that molecular-targeted treatment might be used during multimodal therapy for MPM.


Asunto(s)
Biomarcadores de Tumor/análisis , Neoplasias Pulmonares/enzimología , Mesotelioma/enzimología , Proteína Quinasa 1 Activada por Mitógenos/análisis , Neoplasias Pleurales/enzimología , Serina-Treonina Quinasas TOR/análisis , Adulto , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Biomarcadores de Tumor/metabolismo , Cisplatino/administración & dosificación , Terapia Combinada/métodos , Femenino , Humanos , Inmunohistoquímica , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/terapia , Masculino , Mesotelioma/mortalidad , Mesotelioma/terapia , Persona de Mediana Edad , Proteína Quinasa 1 Activada por Mitógenos/metabolismo , Terapia Molecular Dirigida , Pemetrexed/administración & dosificación , Neoplasias Pleurales/mortalidad , Neoplasias Pleurales/terapia , Neumonectomía , Pronóstico , Proteínas Serina-Treonina Quinasas/análisis , Proteínas Serina-Treonina Quinasas/metabolismo , Serina-Treonina Quinasas TOR/metabolismo
18.
J Cardiothorac Surg ; 14(1): 196, 2019 Nov 12.
Artículo en Inglés | MEDLINE | ID: mdl-31718656

RESUMEN

BACKGROUND: Primary thrombosis of the pulmonary vasculatures without extra-pulmonary sources of embolism are uncommon. Here, we report 2 cases of thrombosis of the stump of the remnant pulmonary vasculatures after lung resection complicated by embolic events with review of the literature. CASE PRESENTATION: A 75-year-old female was consulted to evaluate cardiac source of embolism for acute cerebral infarction. The patient underwent left upper lobectomy because of lung cancer 2 years ago. Cardiovascular imaging revealed about 1.6 cm × 1.4 cm sized thrombus within the remnant stump of the left superior pulmonary vein. The patient was treated by anticoagulation with warfarin, because the patients refused surgical removal of thrombus. A 57-year-old female who had a history of right pneumonectomy 10 years ago presented with dyspnea. Cardiovascular imaging revealed 1.7 × 1.5 cm sized thrombus in the right pulmonary artery stump and small pulmonary embolism in the left lower segmental pulmonary artery. The patient was treated by long-term anticoagulation with warfarin, and the thrombus and pulmonary embolism were resolved. CONCLUSION: The present cases demonstrated that very late thrombosis of the remnant pulmonary vascular structures and subsequent fatal embolic complications can develope even several years later after lung resection. Therefore, the dead space of the remnant vascular structures should be minimized during lung resection surgery, and the developement of delayed thromboembolic complications associated with vascular stump thrombosis should be carefully monitored.


Asunto(s)
Neoplasias Pulmonares/cirugía , Neumonectomía/efectos adversos , Embolia Pulmonar/etiología , Venas Pulmonares/diagnóstico por imagen , Trombosis de la Vena/etiología , Anciano , Infarto Encefálico/etiología , Disnea/etiología , Femenino , Humanos , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Arteria Pulmonar/diagnóstico por imagen , Arteria Pulmonar/cirugía , Embolia Pulmonar/diagnóstico por imagen , Venas Pulmonares/cirugía , Tomografía Computarizada por Rayos X , Trombosis de la Vena/diagnóstico por imagen
19.
J Cardiothorac Surg ; 14(1): 197, 2019 Nov 13.
Artículo en Inglés | MEDLINE | ID: mdl-31722726

RESUMEN

OBJECTIVE: Whether segmentectomy can be used to treat radiologically determined pure solid or solid-dominant lung cancer remains controversial owing to the invasive pathologic characteristics of these tumors despite their small size. This meta-analysis compared the oncologic outcomes after lobectomy and segmentectomy regarding relapse-free survival (RFS) and overall survival (OS) in patients with radiologically determined pure solid or solid-dominant clinical stage IA non-small cell lung cancer (NSCLC). METHODS: A literature search was performed in the MEDLINE, EMBASE, and Cochrane Central databases for information from the date of database inception to March 2019. Studies were selected according to predefined eligibility criteria. The hazard ratio (HR) and associated 95% confidence interval (CI) were extracted or calculated as the outcome measure for data combining. RESULTS: Seven eligible studies published between 2014 and 2018 enrolling 1428 patients were included in the current meta-analysis. Compared with lobectomy, segmentectomy had a significant benefit on the RFS of radiologically determined pure solid or solid-dominant clinical stage IA NSCLC patients (combined HR: 1.46; 95% CI, 1.05-2.03; P = 0.024) and there were no significant differences on the OS of these patients (HR: 1.52; 95% CI, 0.95-2.43; P = 0.08). CONCLUSIONS: Segmentectomy leads to lower survival than lobectomy for clinical stage IA NSCLC patients with radiologically determined pure solid or solid-dominant tumors. Moreover, applying lobectomy to clinical stage IA NSCLC patients with radiologically determined pure solid or solid-dominant tumors (≤2 cm) could lead to an even bigger survival advantage. However, there are some limitations in the present study, and more evidence is needed to support the conclusion.


Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/cirugía , Neoplasias Pulmonares/cirugía , Recurrencia Local de Neoplasia , Neumonectomía/métodos , Carcinoma de Pulmón de Células no Pequeñas/diagnóstico por imagen , Carcinoma de Pulmón de Células no Pequeñas/patología , Supervivencia sin Enfermedad , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/patología , Recurrencia Local de Neoplasia/diagnóstico por imagen , Estadificación de Neoplasias , Neumonectomía/mortalidad , Tasa de Supervivencia
20.
Eur. j. anat ; 23(6): 465-468, nov. 2019. ilus
Artículo en Inglés | IBECS | ID: ibc-185090

RESUMEN

Anatomical variation of pulmonary fissures and lobes is common, and may be a source of confusion in the interpretation of signs seen on chest imaging. We report a very rare case of three pulmonary fissures in a plastinated specimen of a left lung, producing a unique lobar pattern consisting of four lobes. To our knowledge, this is the first report of three complete fissures dividing the left lung into four distinct lobes. A left minor fissure courses obliquely across the upper lobe, distinguishing the lingula from the rest of the upper lobe while an inferior accessory fissure demarcates the anteromedial basal segment from the other bronchopulmonary segments of the lower lobe . Recognising the existence of such rare variants is crucial for surgeons performing lobectomies or surgical resection of the lungs. It is also of great clinical significance to radiologists interpreting chest radio-graphs and computerised tomography (CT) scans to identify and diagnose lung lesions


No disponible


Asunto(s)
Humanos , Pulmón/anatomía & histología , Variación Anatómica , Lesión Pulmonar/diagnóstico por imagen , Pulmón/anomalías , Neumonectomía , Radiografía Torácica , Tomografía Computarizada de Emisión
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