Extended post-ex vivo lung perfusion cold preservation predicts primary graft dysfunction and mortality: Results from a multicentric study.

BACKGROUND: Ex vivo lung perfusion (EVLP) allows for a reassessment of lung grafts initially deemed unsuitable for transplantation, increasing the available donor pool; however, this requires a pre- and post-EVLP period of cold ischemic time (CIT). Paucity of data exists on how the sequence of cold normothermic-cold preservations affect outcomes. METHODS: A total of 110 patients were retrospectively analyzed. Duration of 3 preservation phases was measured: cold pre-EVLP, EVLP, and cold post-EVLP. The donor and recipient clinical data were collected. Primary graft dysfunction (PGD) and survival were monitored. Risk of mortality or PGD was calculated using Cox proportional hazards and logistic regression models to adjust for baseline characteristics. RESULTS: Using the highest quartile, patients were stratified into extended vs non-extended pre-EVLP (<264 vs ≥264 minutes) and post-EVLP (<287 vs ≥287 minutes) CIT. The rates of 1-year mortality (8.4% vs 29.6%, p = 0.013), PGD 2-3 (20.5% vs 52%, p = 0.002), and PGD 3 (8.4% vs 29.6%, p = 0.005) at 72 hours were increased in the extended post-EVLP CIT group. After adjusting for baseline risk factors, the extended group remained an independent predictor of PGD ≥2 (odd ratio: 6.18, 95% CI: 1.88-20.3, p = 0.003) and PGD 3 (odd ratio: 20.4, 95% CI: 2.56-161.9, p = 0.004) at 72 hours and 1-year mortality (hazard ratio: 17.9, 95% CI: 3.36-95.3, p = 0.001). Cold pre-EVLP was not a significant predictor of primary outcomes. CONCLUSIONS: Extended cold post-EVLP preservation is associated with a risk for PGD and 1-year mortality. Pre-EVLP CIT does not increase mortality or high-grade PGD. These findings from a multicenter trial should caution on the implementation of extended cold preservation after EVLP.

Resección toracoscópica de un bocio ectópico mediastínico por puerto único / Single-port thoracoscopic access for a mediastinal ectopic goiter

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¿Es una buena opción terapéutica la cirugía pulmonar en pacientes mayores de 80 años? / Is lung surgery a good option for octogenarians?

INTRODUCCIÓN: El número de pacientes geriátricos con cáncer de pulmón se espera que aumente en las próximas décadas, especialmente por encima de los 80 años de edad, por tanto es importante conocer los límites terapéuticos. ¿Es una buena opción terapéutica la cirugía pulmonar en mayores de 80 años?. OBJETIVO: Mostrar nuestros resultados en las resecciones pulmonares realizadas a mayores de 80 años para evaluar la seguridad y el pronóstico a corto plazo en estos pacientes. MATERIAL Y MÉTODOS: Estudio retrospectivo de 21 pacientes sometidos a resección pulmonar entre octubre de 1999 a octubre de 2011. RESULTADOS: De 21 pacientes con edad de 82 ± 2 años, en los que se realizó 13 lobectomías, 5 resecciones transegmentarias, 2 segmentectomías regladas y una neumonectomía, las complicaciones postoperatorias (28,6%) fueron: 66,6% respiratorias, 16,7% cardíacas y 16,7% digestivas. La mortalidad perioperatoria fue del 9,5% (2). Observamos significación estadística entre la mortalidad postoperatoria y la edad (p = 0,023), o la realización de neumonectomía (p = 0,002). Estudiamos la EPOC como factor de riesgo de mortalidad apreciando significación estadística con la necesidad de UCI (p < 0,007) y la aparición de complicaciones (p < 0,044). CONCLUSIONES: La cirugía de resección pulmonar en mayores de 80 años es una buena opción terapéutica en pacientes seleccionados. En nuestra experiencia el carcinoma broncogénico epidermoide fue el más frecuente. La cirugía de elección fue la lobectomía, que demuestra ser una técnica segura con una baja tasa de complicaciones postoperatorias en pacientes añosos. La neumonectomía debe evitarse en estos pacientes, ya que hemos observado una asociación significativa con la mortalidad perioperatoria

INTRODUCTION: The number of geriatric patients with lung cancer is expected to increase in the next few years, especially patients over 80, and therefore it is important to know where the therapeutic limits should be drawn. Is surgery a good option in patients over 80? OBJECTIVE: To show the results of lung resection in patients over 80 years of age to evaluate the safety and short-term results. MATERIAL AND METHODS: Retrospective study of 21 patients who underwent lung resection between October 1999 and October 2011. RESULTS: The mean age of the patients was 82 ± 2; 13 lobectomies were performed,5 transegmental resections, 2 segmentectomies, and 1 pneumonectomy. Postoperative complications (28.6%) were: respiratory 66.6%, cardiological 16.7% and digestive 16,7%. Perioperative mortality was 9,5% (2). There was a significant association between mortality and age (P = .023), or pneumonectomy (P = .002). We studied COPD as a risk factor for mortality and found a statistically significant relation with the need for ICU (P < .007), and the appearance of complications (P < .044). CONCLUSIONS: Resective lung surgery is feasible and safe in selected patients over 80 years of age. In our experience, squamous cell carcinoma was the most frequent tumor. The most common procedure was lobectomy which is a safe technique with a low complicaction rate in elderly patients. Pneumonectomy s hould be avoided, as we have found a significant association with perioperative mortality

Periareolar approach for thoracoscopic lobectomy.

In recent years advances in video-assisted thoracoscopic surgery have been aimed at reducing the number of video surgery ports, and especially major lung resections pose the greatest challenge. We describe a new minimally invasive as well as aesthetic approach for thoracoscopic lobectomy. The technique poses no difficulty for the surgeon and has certain advantages over other videothoracoscopic approaches.

Is lung surgery a good option for octogenarians?

INTRODUCTION: The number of geriatric patients with lung cancer is expected to increase in the next few years, especially patients over 80, and therefore it is important to know where the therapeutic limits should be drawn. Is surgery a good option in patients over 80? OBJECTIVE: To show the results of lung resection in patients over 80 years of age to evaluate the safety and short-term results. MATERIAL AND METHODS: Retrospective study of 21 patients who underwent lung resection between October 1999 and October 2011. RESULTS: The mean age of the patients was 82 ± 2; 13 lobectomies were performed,5 transegmental resections, 2 segmentectomies, and 1 pneumonectomy. Postoperative complications (28.6%) were: respiratory 66.6%, cardiological 16.7% and digestive 16,7%. Perioperative mortality was 9,5% (2). There was a significant association between mortality and age (P=.023), or pneumonectomy (P=.002). We studied COPD as a risk factor for mortality and found a statistically significant relation with the need for ICU (P<.007), and the appearance of complications (P<.044). CONCLUSIONS: Resective lung surgery is feasible and safe in selected patients over 80 years of age. In our experience, squamous cell carcinoma was the most frequent tumor. The most common procedure was lobectomy which is a safe technique with a low complication rate in elderly patients. Pneumonectomy should be avoided, as we have found a significant association with perioperative mortality.

Reconstrucción torácica con prótesis de metacrilato en el síndrome de Poland / Chest Wall Reconstruction With Methacrylate Prosthesis in Poland Syndrome

El síndrome de Poland es una malformación congénita infrecuente. Se trata de una anomalía descrita en 1841 por Alfred Poland en el Guy's Hospital de Londres, caracterizada por hipoplasia de la mama y el pezón, escasez de tejido subcutáneo y ausencia de la porción costoesternal del músculo pectoral mayor, que se asocia a alteraciones de los dedos de la mano del mismo lado. La corrección de las anormalidades del tórax y los tejidos blandos en el síndrome de Poland varía según el autor. Presentamos el caso de una adolescente de 17 años en el que se elige una prótesis de metilmetacrilato para la reconstrucción de la pared torácica. Este procedimiento quirúrgico está recomendado en grandes defectos de la parte anterior del tórax e impide el movimiento paradójico de la misma. Además nos permite una remodelación individual del defecto de acuerdo con la forma del tórax (AU)

Poland syndrome is a rare congenital malformation. This syndrome was described in 1841 by Alfred Poland at Guy's Hospital in London. It is characterized by hypoplasia of the breast and nipple, subcutaneous tissue shortages, lack of the costosternal portion of the pectoralis major muscle and associated alterations of the fingers on the same side. Corrective treatment of the chest and soft tissue abnormalities in Poland syndrome varies according to different authors. We report the case of a 17-year-old adolescent who underwent chest wall reconstruction with a methyl methacrylate prosthesis. This surgical procedure is recommended for large anterior chest wall defects, and it prevents paradoxical movement. Moreover it provides for individual remodeling of the defect depending on the shape of the patient's chest (AU)

Chest wall reconstruction with methacrylate prosthesis in Poland syndrome.

Poland syndrome is a rare congenital malformation. This syndrome was described in 1841 by Alfred Poland at Guy's Hospital in London. It is characterized by hypoplasia of the breast and nipple, subcutaneous tissue shortages, lack of the costosternal portion of the pectoralis major muscle and associated alterations of the fingers on the same side. Corrective treatment of the chest and soft tissue abnormalities in Poland syndrome varies according to different authors. We report the case of a 17-year-old adolescent who underwent chest wall reconstruction with a methyl methacrylate prosthesis. This surgical procedure is recommended for large anterior chest wall defects, and it prevents paradoxical movement. Moreover it provides for individual remodeling of the defect depending on the shape of the patient's chest.

Bronchiectasis due to pulmonary artery aneurysm.

Pulmonary artery aneurysm (PAA) is a rare entity. We report what we believe to be the first case of bronchiectasis resulting from a PAA, which in turn developed after a previous Senning procedure for transposition of the great vessels during infancy. The patient had bronchiectasis secondary to compression of the left main bronchus because of a PAA. Bronchiectasis is a condition indicating lung resection. Despite the patient receiving medical therapy to treat recurrent pneumonia, lobectomy was necessary to prevent this and other possible complications.