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1.
World J Surg Oncol ; 19(1): 234, 2021 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-34364369

RESUMO

BACKGROUND: To avoid the inconvenience of triangulation among various rigid operating instruments in mediastinoscopy-assisted esophagectomy, we invented a new technique: used a flexible endoscope to mobilize thoracic esophagus and dissected mediastinal lymph nodes through the left cervical incision. This technology has not been reported so far. In this study, we introduce our long-term experience and demonstrate this new technique. METHODS: Twenty-nine patients with early esophageal cancer underwent mediastinoscopy-assisted esophagectomy in our hospital from June 2018 to September 2020. Among them, 12 patients used flexible mediastinoscopy, and 17 patients used conventional rigid mediastinoscopy and instruments to observe their therapeutic effect. RESULTS: There were no significant differences between the two groups in gender, average age, body mass index, incidence of adverse reactions, bleeding volume, and postoperative hospital stay. The operation time of flexible mediastinoscopy group was significantly shorter than that of rigid mediastinoscopy group (192.9 ± 13.0 vs 246.8 ± 6.9 min, p < 0.01). The number of lymph nodes removed by flexible endoscopy was significantly more than that of rigid endoscopy (8.5 ± 0.6 vs 6.0 ± 0.3, P < 0.01). Postoperative follow-up was completed for all patients, and the average follow-up time was 11.6 ± 7.2 months. During the follow-up period, no recurrence or death was observed. CONCLUSIONS: Mediastinoscopy-assisted esophagectomy is an effective way to treat early esophageal cancer. The application of flexible mediastinoscopy provides more convenience and better stability. It can facilitate the operation of the surgeon and lymph node dissection, which proved to be a feasible technology.


Assuntos
Neoplasias Esofágicas , Esofagectomia , Neoplasias Esofágicas/cirurgia , Humanos , Excisão de Linfonodo , Mediastinoscopia , Recidiva Local de Neoplasia , Prognóstico , Tecnologia
2.
BMC Surg ; 21(1): 329, 2021 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-34407789

RESUMO

BACKGROUND: Mediastinal lymph node metastases (MLNM) are not rare in thyroid cancer, but their treatment has not been extensively studied. This study aimed to explore the preliminary application of video mediastinoscopy-assisted superior mediastinal dissection in the diagnosis and treatment of thyroid carcinoma with mediastinal lymphadenopathy. MATERIALS AND METHODS: We retrospectively reviewed the clinical pathologic data and short-term outcomes of thyroid cancer patients with suspicious MLNM treated with video mediastinoscopy-assisted mediastinal dissection at our institution from 2017 to 2020. RESULTS: Nineteen patients were included: 14 with medullary thyroid carcinoma and five with papillary thyroid carcinoma. Superior mediastinal nodes were positive in nine (64.3%) patients with medullary thyroid carcinoma and in four (80.0%) patients with papillary carcinoma. No fatal bleeding occurred. There were three cases of temporary recurrent laryngeal nerve (RLN) palsy postoperatively, one of which was bilateral. Four patients had temporary hypocalcemia requiring supplementation, one had a chyle fistula, and one developed wound infection after the procedure. Postoperative serum molecular markers decreased in all patients. One patient died of cancer while the other 18 patients remained disease-free, with a median follow-up of 33 months. CONCLUSION: Video mediastinoscopy-assisted superior mediastinal dissection can be performed relatively safely in patients with suspicious MLNM. This diagnostic and therapeutic approach may help control locoregional recurrences.


Assuntos
Linfadenopatia , Neoplasias da Glândula Tireoide , Dissecação , Humanos , Excisão de Linfonodo , Linfonodos/patologia , Mediastinoscopia , Esvaziamento Cervical , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia
3.
Lung Cancer ; 156: 122-128, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33931293

RESUMO

INTRODUCTION: Endobronchial Ultrasonography (EBUS) and mediastinoscopy are used for mediastinal lymph node staging in patients with suspected non-small cell lung carcinoma (NSCLC). In our hospital, confirmatory mediastinoscopy has been largely abandoned, which may reduce the number of surgical interventions and health care costs. This study provides insight into EBUS and mediastinoscopy performance in patients with proven NSCLC from January 2007 until January 2019. METHODS: This is a single-centre, retrospective study, evaluating unforeseen N2 rates, negative predictive value and survival, providing insight into the diagnostic yield of EBUS and mediastinoscopy. Surgical lung resection with lymph node dissection was used as reference. RESULTS: A total of 418 patients with proven NSCLC after lung resection (mean age: 66 years; 61 % male) and 118 patients who underwent mediastinoscopy, have been included in the study. The overall prevalence of N2 metastases after lung resection was 10.5 %. The percentage of unforeseen N2 cases after negative EBUS was 14.5 %, and 14.3 % after negative mediastinoscopy. Over the past nine years, none of the confirmatory mediastinoscopies were tumor positive after negative EBUS results. The median survival in patients with surgically confirmed N2 metastases was 33 months, compared to 23 months in patients with EBUS/mediastinoscopy-proven N2 metastases. CONCLUSION: Despite optimisation of mediastinal staging procedures, it remains difficult to identify all patients with N2 metastases in the workup of NSCLC. In our institute, confirmatory mediastinoscopy has no added value after tumor-negative EBUS procedures, and has been abandoned as standard procedure.


Assuntos
Neoplasias Pulmonares , Mediastinoscopia , Idoso , Endossonografia , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/patologia , Linfonodos/patologia , Metástase Linfática , Masculino , Mediastino/patologia , Estadiamento de Neoplasias , Estudos Retrospectivos
4.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 46(1): 60-68, 2021 Jan 28.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-33678638

RESUMO

OBJECTIVES: To compare the short-, mid-, and long-term outcomes in patients with esophageal cancer between minimally invasive esophagectomy via Sweet approach in combination with cervical mediastinoscopy (MIE-SM) and minimally invasive esophagectomy via McKeown approach (MIE-MC), and to evaluate the value of MIE-SM in the surgical treatment of esophageal cancer. METHODS: A prospective, nonrandomized study was adopted. A total of 65 esophageal cancer patients after MIE-SM and MIE-MC from June 2014 to May 2016 were included. Among them, 33 patients underwent MIE-SM and 32 patients underwent MIE-MC. Short-term outcomes (including the duration of surgery, intraoperative blood loss volume, ICU stay time, postoperative complications, postoperative hospital stay, reoperation, open surgery, number of dissected lymph nodes, and 30-day mortality), mid-term outcomes, [including Quality of Life Core Questionnaire (QLQ-C30) and the esophageal site-specific module (QLQ-OES18)], long-term outcomes [including overall survival and disease-free survival] were compared between the 2 groups. RESULTS: Radical resection (R0) were achieved in all patients. There were no significant differences in the duration of surgery, intraoperative blood loss volume, ICU stay time, postoperative complications, and postoperative hospital stay between the 2 groups (all P>0.05). More lymph nodes were dissected in the MIE-SM group (24.1±7.3) than those in the MIE-MC group (17.8±5.0, P<0.001). The emotional function, global health status scale scores in QLQ-C30 scale in the MIE-SM group were significantly higher than those in the MIE-MC group (P=0.025, P<0.001, respectively), and the pain score in the MIE-SM group was significantly lower than that in the MIE-MC group (P=0.013). QLQ-OES18 results showed that the pain score in the MIE-SM group was significantly lower than that in the MIE-MC group (P=0.021). Survival analysis showed that the overall survival and disease-free survival were similar between the 2 groups. CONCLUSIONS: MIE-SM appears to be a safe surgical approach, which may get better quality of life, suffer less pain, and can achieve the same therapeutic effect as MIE-MC. Therefore, MIE-SM should be considered as a valuable approach for the treatment of middle and lower esophageal cancer.


Assuntos
Neoplasias Esofágicas , Laparoscopia , Neoplasias Esofágicas/cirurgia , Esofagectomia , Humanos , Mediastinoscopia , Procedimentos Cirúrgicos Minimamente Invasivos , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Qualidade de Vida , Estudos Retrospectivos , Resultado do Tratamento
5.
Trials ; 22(1): 168, 2021 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-33639999

RESUMO

BACKGROUND: Invasive mediastinal nodal staging is recommended by guidelines in selected patients with resectable non-small cell lung cancer (NSCLC). Endosonography is recommended as initial staging technique, followed by confirmatory mediastinoscopy in case of negative N2 or N3 cytology after endosonography. Confirmatory mediastinoscopy however is under debate owing its limited additional diagnostic value, its associated morbidity and its delay in the start of lung cancer treatment. The MEDIASTrial examines whether confirmatory mediastinoscopy can be safely omitted after negative endosonography in mediastinal nodal staging of NSCLC. The present work is the proposed statistical analysis plan of the clinical consequences of omitting mediastinoscopy, which is submitted before closure of the MEDIASTrial and before knowledge of any results was done to enhance transparency of scientific behaviour. METHODS: The primary outcome measure of this non-inferiority trial will be unforeseen N2 disease resulting from lobe-specific mediastinal lymph node dissection. For non-inferiority, the upper limit of the 95% confidence interval of the unforeseen N2 rate in the group without mediastinoscopy should not exceed 14.3% in order to probably have no negative impact on survival. Since this is a non-inferiority trial, both an intention to treat (ITT) and a per protocol (PP) analyses will be done. The ITT and the PP analyses should both indicate non-inferiority before the diagnostic strategy omitting mediastinoscopy will be interpreted as non-inferior to the strategy with mediastinoscopy. Secondary outcome measures include 30-day major morbidity and mortality, the total number of days of hospital care, overall and disease free 2-year survival, generic and disease-specific health related quality of life and cost-effectiveness and cost-utility of staging strategies with and without mediastinoscopy. DISCUSSION: The MEDIASTrial will determine if confirmatory mediastinoscopy can be omitted after tumour negative systematic endosonography in invasive mediastinal staging of patients with resectable NSCLC. TRIAL REGISTRATION: Netherlands Trial Register NL6344/NTR6528 . Registered on 2017 July 06.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Endossonografia , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Linfonodos/patologia , Mediastinoscopia , Estadiamento de Neoplasias , Países Baixos , Qualidade de Vida
6.
Thorac Cardiovasc Surg ; 69(2): 189-193, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-32634834

RESUMO

BACKGROUND: Video-assisted mediastinoscopy (VAM) is a valuable method in the investigation of diseases with mediastinal lymphadenopathy or those localized in the mediastinum. The aim of this study was to determine the diagnostic value of VAM in the investigation of mediastinal involvement of nonlung cancer diseases and to describe our institutional surgical experience. METHODS: Clinical parameters such as age, sex, histological diagnosis, morbidity, and mortality of all patients who underwent VAM for the investigation of mediastinal involvement of diseases except lung cancer between January 2006 and July 2018 were retrospectively reviewed, and the diagnostic efficacy of VAM was determined statistically. RESULTS: During the study period, 388 patients underwent VAM, and 536 lymph nodes were sampled for histopathological evaluation of mediastinum due to mediastinal lymphadenopathy or paratracheal lesions. The most common diagnoses were sarcoidosis (n = 178 [45.9%]), tuberculous lymphadenitis (n = 108 [27.8%]), lymphadenitis with anthracosis (n = 72 [18.6%]), and lymphoma (n = 15 [3.9%]). CONCLUSION: The results of the study show that VAM should be used because of its high diagnostic benefit in mediastinal lymphadenopathies, which are difficult to diagnose, or mediastinal lesions located in the paratracheal region. Despite the increase in the number of new diagnostic modalities, VAM is still the most effective method and a gold standard.


Assuntos
Linfadenopatia/patologia , Doenças do Mediastino/patologia , Mediastinoscopia , Cirurgia Torácica Vídeoassistida , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Linfadenite/patologia , Linfadenopatia/terapia , Linfoma/patologia , Masculino , Doenças do Mediastino/terapia , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Sarcoidose Pulmonar/patologia , Tuberculose dos Linfonodos/patologia , Adulto Jovem
7.
Asian Cardiovasc Thorac Ann ; 29(1): 33-37, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32998523

RESUMO

BACKGROUND: This study aimed to evaluate the results of transhiatal esophagectomy using a mediastinoscope in comparison with conventional transhiatal esophagectomy. METHODS: Sixty-two esophageal cancer patients who were referred to our thoracic surgery clinic between April 2015 and March 2017, and met the inclusion criteria, were randomly divided into two groups of 31 each. In the first group, patients were operated on by conventional transhiatal esophagectomy. In the second group, only release of the thoracic esophagus through a neck incision (mediastinal esophagolysis) was performed using a mediastinoscope. The other surgical procedures were similar to those in the first group. RESULTS: The mean age of the patients was almost the same in both groups (57.7 years in the first group versus 56.7 years in the second group). There was no significant difference in sex ratio. The mean volume of blood loss during the operation, mean operative time, and intensive care unit stay as well as cardiopulmonary complications and early postoperative complications were lower in the group that had esophagectomy using a mediastinoscope, and the number of resected mediastinal lymph nodes was greater. CONCLUSION: Based on the results of this study, it can be expected that use of a video mediastinoscope for esophagolysis of the thoracic esophagus in a transhiatal esophagectomy procedure is safe and it will reduce the morbidity and mortality in these patients.


Assuntos
Neoplasias Esofágicas/cirurgia , Esofagectomia/instrumentação , Mediastinoscópios , Mediastinoscopia/instrumentação , Idoso , Neoplasias Esofágicas/patologia , Esofagectomia/efeitos adversos , Feminino , Humanos , Irã (Geográfico) , Masculino , Mediastinoscopia/efeitos adversos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento
8.
Kyobu Geka ; 73(10): 870-875, 2020 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-33130782

RESUMO

According to the aging of society, elderly patients with esophageal cancer have been increasing in Japan. A multimodality treatment strategy is required to achieve long-term survival in patients with advanced-stage esophageal cancer. However, in elderly patients with impaired organ functions, the highly invasive treatment strategy is often difficult to be indicated. Esophagectomy remains the mainstay of treatment even in the elderly. Indication for esophagectomy in the elderly should be determined comprehensively, based on the physical status, life expectancy, tumor staging, and patients' desires. To predict the risk of postoperative complications, some scoring systems, such as estimation of physiology ability and surgical stress( E-PASS) and controlling nutritional status(CONUT), and the risk calculator provided by the National Clinical Database in Japan should be appropriately used. For patients with impaired organ functions, surgical procedures to reduce the surgical invasiveness, such as 2-stage operation, transhiatal esophagectomy, and mediastinoscopic esophagectomy, should be considered as an alternative to conventional transthoracic esophagectomy and reconstruction. Depending on the situations, preservation of the bronchial artery, thoracic duct, and azygos arch should be considered. A care bundle by a multidisciplinary perioperative management team may decrease postoperative morbidity and mortality rates in elderly patients undergoing esophagectomy.


Assuntos
Neoplasias Esofágicas , Esofagectomia , Idoso , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/cirurgia , Humanos , Japão , Mediastinoscopia , Estadiamento de Neoplasias , Complicações Pós-Operatórias
9.
J Bras Pneumol ; 46(6): e20190221, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33111752

RESUMO

OBJECTIVE: Lung cancer (LC) is one of the leading causes of death worldwide. Accurate mediastinal staging is mandatory in order to assess prognosis and to select patients for surgical treatment. EBUS-TBNA is a minimally invasive procedure that allows sampling of mediastinal lymph nodes (LNs). Some studies have suggested that EBUS-TBNA is preferable to surgical mediastinoscopy for mediastinal staging of LC. The objective of this systematic review and meta-analysis was to compare EBUS-TBNA and mediastinoscopy in terms of their effectiveness for mediastinal LN staging in potentially operable non-small cell lung cancer (NSCLC). METHODS: This was a systematic review and meta-analysis, in which we searched various databases. We included studies comparing the accuracy of EBUS-TBNA with that of mediastinoscopy for mediastinal LN staging in patients with NSCLC. In the meta-analysis, we calculated sensitivity, specificity, positive likelihood ratios, and negative likelihood ratios. We also analyzed the risk difference for the reported complications associated with each procedure. RESULTS: The search identified 4,201 articles, 5 of which (with a combined total of 532 patients) were selected for inclusion in the meta-analysis. There were no statistically significant differences between EBUS-TBNA and mediastinoscopy in terms of the sensitivity (81% vs. 75%), specificity (100% for both), positive likelihood ratio (101.03 vs. 95.70), or negative likelihood ratio (0.21 vs. 0.23). The area under the summary ROC curve was 0.9881 and 0.9895 for EBUS-TBNA and mediastinoscopy, respectively. Although the number of complications was higher for mediastinoscopy, the difference was not significant (risk difference: -0.03; 95% CI: -0.07 to 0.01; I2 = 76%). CONCLUSIONS: EBUS-TBNA and mediastinoscopy produced similar results for mediastinal staging of NSCLC. EBUS-TBNA can be the procedure of first choice for LN staging in patients with NSCLC.


Assuntos
Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Linfonodos/cirurgia , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/patologia , Mediastinoscopia/métodos , Mediastino/diagnóstico por imagem , Broncoscopia , Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Endoscopia , Humanos , Neoplasias Pulmonares/cirurgia , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Neoplasias do Mediastino/cirurgia , Mediastino/cirurgia , Estadiamento de Neoplasias , Sensibilidade e Especificidade
10.
Interact Cardiovasc Thorac Surg ; 31(4): 527-535, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33091932

RESUMO

OBJECTIVES: The objective of this study was to define the learning process of video-assisted mediastinoscopic lymphadenectomy (VAMLA) by the assessment of consecutive procedural metrics. METHODS: We conducted a single-centre retrospective observational study of all consecutive VAMLAs performed between 2011 and 2018 for the staging of non-small-cell lung carcinoma. Learning curves were assessed using non-risk adjusted cumulative observed minus expected (CUSUM) failure charts of complications. Boundary lines were defined by the acceptable and unacceptable complication rates of 4.5% and 15.0%. The Kruskal-Wallis test with post hoc analysis was used to assess trends in operation time and blood loss. RESULTS: Two-hundred-thirty-six unique VAMLAs by 4 surgeons performing their first procedures were evaluated. CUSUM charts of surgeons A and B showed a typical learning curve with an initial incline, followed by a turning point towards lower complications rates after 16-17 cases, whereas surgeons C and D showed an average performance. The median time between consecutive VAMLAs was shorter for surgeons A and B (13.0 vs 28.5-38.0 days for surgeons C and D). Overcoming the learning curve, complication rates of surgeons A and B decreased from 19% to 3% and from 18% to 5%, respectively. Operation time and blood loss showed a significant improvement after, respectively, 81-100 and 61-80 procedures compared to the first 20 procedures. CONCLUSIONS: VAMLA is a safe procedure to adopt and perform with acceptable complication rates from the first operation onward, regardless of the caseload. To overcome its learning curve, 16-17 cases are required, preferably at least 1 per 2 weeks.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Curva de Aprendizado , Neoplasias Pulmonares/cirurgia , Excisão de Linfonodo/métodos , Mediastinoscopia/métodos , Estadiamento de Neoplasias/métodos , Cirurgia Torácica Vídeoassistida/métodos , Idoso , Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Carcinoma Pulmonar de Células não Pequenas/secundário , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico , Linfonodos/patologia , Linfonodos/cirurgia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos
11.
Vnitr Lek ; 66(2): 53-57, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32942888

RESUMO

Various types of tumors (either benign or malignant) can be found in mediastinum. Early diagnosis and treatment may help to improve survival and quality if life in these patients. Compared to direct mediastinoscopy, used for obtaining a specimen for histological analysis in previous decades, modern imaging methods, specifically the CT navigated biopsy, represent an effective and less invasive approach to the diagnosis. In our publication, we present a patient with thymoma, rather rare type of anterior mediastinum tumor.


Assuntos
Neoplasias do Mediastino , Timoma , Neoplasias do Timo , Humanos , Mediastinoscopia , Timoma/diagnóstico por imagem , Neoplasias do Timo/diagnóstico por imagem , Tomografia Computadorizada por Raios X
13.
PLoS One ; 15(6): e0235479, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32603376

RESUMO

INTRODUCTION: The emergence of endobronchial ultrasound (EBUS) changed the approach to staging lung cancer. As a new method being incorporated, the use of EBUS may lead to a shift in clinical and costs outcomes. OBJECTIVE: The aim of this systematic review is to gather information to better understand the economic impact of implementing EBUS. METHODS: This review is reported according to the PRISMA statement and registered on PROSPERO (CRD42019107901). Search keywords were elaborated considering descriptors of terms related to the disease (lung cancer / mediastinal staging of lung cancer) and the technologies of interest (EBUS and mediastinoscopy) combined with a specific economic filter. The literature search was performed in MEDLINE, EMBASE, LILACS, Cochrane Library of Trials, Web of Science, Scopus and National Health System Economic Evaluation Database (NHS EED) of the Center for Reviews and Dissemination (CRD). Screening, selection of articles, data extraction and quality assessment were carried out by two reviewers. RESULTS: Seven hundred and seventy publications were identified through the database searches. Eight articles were included in this review. All publications are full economic evaluation studies, one cost-effectiveness, three cost-utility, and four cost-minimization analyses. The costs of strategies using EBUS-TBNA were lower than the ones using mediastinoscopy in all studies analyzed. Two of the best quality scored studies demonstrate that the mediastinoscopy strategy is dominated by the EBUS-TBNA strategy. CONCLUSION: Information gathered in the eight studies of this systematic review suggest that EBUS is cost-effective compared to mediastinoscopy for mediastinal staging of lung cancer.


Assuntos
Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/economia , Mediastinoscopia/economia , Estadiamento de Neoplasias/métodos , Broncoscopia/economia , Broncoscopia/métodos , Análise Custo-Benefício , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Feminino , Humanos , Biópsia Guiada por Imagem/economia , Biópsia Guiada por Imagem/métodos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/patologia , Masculino , Mediastinoscopia/métodos , Mediastino/diagnóstico por imagem , Mediastino/cirurgia , Estadiamento de Neoplasias/economia
14.
Respirology ; 25 Suppl 2: 37-48, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32656946

RESUMO

Mediastinal staging is a crucial step in the management of patients with NSCLC. With the recent development of novel techniques, mediastinal staging has evolved from an activity of interest mainly for thoracic surgeons to a joint effort carried out by many specialists. In this regard, the debate of cases in MDT sessions is crucial for optimal management of patients. Current evidence-based clinical guidelines for preoperative NSCLC staging recommend that mediastinal staging should be performed with increasing invasiveness. Image-based techniques are the first approach, although they have limited accuracy and findings must be confirmed by pathology in almost all cases. In this setting, the advent of radiomics is promising. Invasive staging depends on procedural factors rather than diagnostic performance. The choice between endoscopy-based or surgical procedures should depend on the local expertise of each centre. As the extension of mediastinal disease in terms of number of involved lymph nodes and nodal stations affects prognosis and the choice of treatment, systematic samplings are preferred over random targeted samplings. Following this approach, a diagnosis of single mediastinal nodal involvement can be unreliable if all reachable mediastinal nodal stations have not been assessed. The performance of confirmatory mediastinoscopy after a negative endoscopy-based procedure is controversial but currently recommended. Current indications of invasive staging in patients with radiologically normal mediastinum have to be re-evaluated, especially for central tumour location.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/secundário , Neoplasias Pulmonares/patologia , Linfonodos/patologia , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Humanos , Neoplasias Pulmonares/cirurgia , Linfonodos/diagnóstico por imagem , Metástase Linfática , Mediastinoscopia , Mediastino , Estadiamento de Neoplasias , Equipe de Assistência ao Paciente , Período Pré-Operatório , Prognóstico
15.
Curr Oncol ; 27(3): e313-e317, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32669938

RESUMO

Background: The emergence of covid-19 has the potential to change the way in which the health care system can accommodate various patient populations and might affect patients with non-covid-19 problems. The Quebec Lung Cancer Network, which oversees thoracic oncology services in the province of Quebec under the direction of the Ministère de la Santé et des Services sociaux, convened to develop recommendations to deal with the potential disruption of services in thoracic oncology in the province of Quebec. The summary provided here has been adapted from the original document posted on the Programme québécois du cancer Web site at: https://www.msss.gouv.qc.ca/professionnels/documents/coronavirus-2019-ncov/PJ1_Recommandations_oncologie-thoracique-200415.pdf. Methods: Plans to optimize the health care system and potentially to prioritize services were discussed with respect to various levels of activity. For each level-of-activity scenario, suggestions were made for the services and treatments to prioritize and for those that might have to be postponed, as well as for potential alternatives to care. Results: The principal recommendation is that the cancer centre executive committee and the multidisciplinary tumour board always try to find a solution to maintain standard-of-care therapy for all patients with thoracic tumours, using novel approaches to treatment and the adoption of a network approach to care, as needed. Conclusions: The effect of the covid-19 pandemic on the health care system remains unpredictable and requires that cancer teams unite and offer the most efficient and innovative therapies to all patients under the various conditions that might be forced upon them.


Assuntos
Antineoplásicos/administração & dosagem , Carcinoma Pulmonar de Células não Pequenas/terapia , Infecções por Coronavirus/epidemiologia , Neoplasias Pulmonares/terapia , Pneumonia Viral/epidemiologia , Radioterapia , Carcinoma de Pequenas Células do Pulmão/terapia , Procedimentos Cirúrgicos Torácicos , Triagem , Administração Oral , Antineoplásicos/uso terapêutico , Betacoronavirus , COVID-19 , Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Gerenciamento Clínico , Humanos , Neoplasias Pulmonares/diagnóstico , Mediastinoscopia , Oncologia , Técnicas de Diagnóstico Molecular , Estadiamento de Neoplasias , Pandemias , Quebeque/epidemiologia , Radiocirurgia , SARS-CoV-2 , Carcinoma de Pequenas Células do Pulmão/diagnóstico , Toracoscopia
16.
J Cardiothorac Surg ; 15(1): 125, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32503651

RESUMO

BACKGROUND: Transthoracic esophagectomy is a crucial independent risk factor for the incidence of postoperative cardiopulmonary complications in elderly or comorbid patients. To reduce postoperative cardiopulmonary complications and promote postoperative recovery. We made an attempt to adopt the single-port inflatable mediastinoscopy combined with laparoscopy for radical esophagectomy in esophageal cancer to observe the clinical application and effect. METHOD: Data of patients with esophageal carcinoma were collected in the Hebei General Hospital from May 2018 to November 2019. The operation time, surgical blood loss, the number of dissected lymph nodes, duration of drainage tube, duration of time on the ventilator, the length of stay in ICU, postoperative complications, the length of postoperative hospital stay were collected to assess the safety and feasibility of the single-port inflatable mediastinoscopy combined with laparoscopy for radical esophagectomy in esophageal cancer. RESULTS: A total of 22 patients with esophageal cancer were analyzed in our research. There were no cases of conversion to thoracotomy、perioperative death or postoperative cardiopulmonary complications. The average operation time of all enrolled patients was 4.26 ± 0.52 h、The surgical blood loss was 142 ± 36.50 ml、The amount of dissected lymph nodes were 21.6 ± 4.2、The duration of drainage tube was 5.8 ± 2.5 days、The duration of time on the ventilator was 6.5 ± 3.4 h、The length of stay in ICU was 1.2 ± 0.4 days、The postoperative hospital stay was 12.6 ± 2.5 days. Among all the enrolled patients, one patient (4.5%) developed anastomotic fistula on the third day after surgery. Anastomotic stricture was found in 5 patients (22.7%). Pleural effusion was found in 4 cases (18.2%). Recurrent laryngeal nerve injury caused hoarseness or cough after drinking water in 3 cases (13.6%).There was one patient (4.5%) of conversion to laparotomy as the patient had serious peritoneal adhesion. All of the patients were discharged successfully. CONCLUSION: Our results showed that this surgery of single-port inflatable mediastinoscopy combined with laparoscopy for radical esophagectomy in esophageal squamous cell carcinoma is safe and feasible. The feasibility and safety could be further and better investigated with a RCT to achieve more conclusive results.


Assuntos
Neoplasias Esofágicas/cirurgia , Carcinoma de Células Escamosas do Esôfago/cirurgia , Esofagectomia/métodos , Laparoscopia/métodos , Mediastinoscopia/métodos , Complicações Pós-Operatórias/epidemiologia , Idoso , Perda Sanguínea Cirúrgica , Constrição Patológica/epidemiologia , Drenagem , Feminino , Humanos , Tempo de Internação , Excisão de Linfonodo/métodos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Traumatismos do Nervo Laríngeo Recorrente/epidemiologia , Toracotomia
17.
Rev. cuba. cir ; 59(2): e917, abr.-jun. 2020. graf
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1126418

RESUMO

RESUMEN La exploración mediastinal comienza desde la época de Galeno. Su desarrollo se alcanzó en la segunda mitad del siglo XX, utilizada para el estudio de los ganglios y tumores mediastinales. En la actualidad su uso se ha ampliado no solo como diagnóstico, sino con fines terapéuticos, al lograr realizar resecciones pulmonares. El objetivo es realizar una revisión actualizada de la literatura, acerca del uso de la mediastinoscopia en el diagnóstico del cáncer pulmonar. Se realizó una revisión de la literatura médica donde se utilizaron las bases de datos Scopus, Medline y Cochrane bajo los criterios de sus revisores. Se emplearon las palabras claves en idioma español e inglés. El método de análisis y síntesis se usó para la interpretación de la bibliografía. Se revisaron 173 artículos, de los cuales, se escogieron 58, que cumplían con los criterios de selección, entre ellos, 6 meta análisis, 11 artículos de revisión y 41 artículos originales. La videomediastinoscopía constituye una herramienta válida para el diagnóstico, así como para el estadiamiento de enfermedades dentro y fuera de la cavidad torácica y mediastino. Por otra parte, permite el tratamiento de algunas enfermedades(AU)


ABSTRACT The mediastinal exploration begins from the time of Galen. Its development was reached in the second half of the 20th century, used for the study of lymph nodes and mediastinal tumors. At present its use has been expanded not only as a diagnosis, but also for therapeutic purposes, by achieving lung resections. The objective is to carry out an updated review of the literature on the use of mediastinoscopy in the diagnosis of lung cancer. A review of the medical literature was carried out where the Scopus, Medline and Cochrane databases were used under the criteria of their reviewers. The keywords in Spanish and English were used. The method of analysis and synthesis was used for the interpretation of the bibliography. 173 articles were reviewed, of which 58 were chosen, which met the selection criteria, including 6 meta-analyzes, 11 review articles, and 41 original articles. Videomediastinoscopy is a valid tool for diagnosis, as well as for the staging of diseases inside and outside the thoracic cavity and mediastinum. On the other hand, it allows the treatment of some diseases(AU)


Assuntos
Humanos , Endossonografia/métodos , Cirurgia Torácica Vídeoassistida/métodos , Neoplasias Pulmonares/diagnóstico por imagem , Mediastinoscopia/métodos , Literatura de Revisão como Assunto
18.
BMC Surg ; 20(1): 86, 2020 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-32366237

RESUMO

BACKGROUND: Double aortic arch (DAA) is a congenital anomaly of the aorta. Esophageal cancer with DAA is rare, and consequently, the appropriate surgical approach has not been standardized. Herein, we report the utilization of intraoperative neurological monitoring (IONM) system to preserve the function of the recurrent laryngeal nerve. CASE PRESENTATION: A 79-year-old man with esophageal cancer was diagnosed with DAA incidentally. The descending aorta was located on the right side of the thoracic vertebrae. Safe dissection of the mediastinal lymph nodes was difficult using the right transthoracic approach because of the anatomical abnormalities. During surgery, we used cervical mediastinoscopy combined with the IONM system to preserve the bilateral recurrent laryngeal nerves. Severe complications, including recurrent nerve palsy, were not observed postoperatively. CONCLUSION: IONM may be useful for evaluation of the function of the recurrent laryngeal nerve, and it would be suitable for atypical cases of esophageal cancer.


Assuntos
Neoplasias Esofágicas/cirurgia , Monitorização Intraoperatória/métodos , Anel Vascular/diagnóstico , Idoso , Aorta/anormalidades , Aorta Torácica/anormalidades , Humanos , Linfonodos/patologia , Masculino , Mediastinoscopia , Nervo Laríngeo Recorrente/fisiologia
19.
Gen Thorac Cardiovasc Surg ; 68(7): 716-724, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32266699

RESUMO

Lymph node assessment is an essential component of the treatment of lung cancer. Identification of the correct "N" stage is important for staging which in turn determines treatment. Assessment of lymph nodes may be accomplished using imaging with CT scan and PET-CT, invasive techniques such as mediastinoscopy, endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) or endoscopic ultrasound fine needle aspiration (EUS-FNA). Ultimately, regardless of any pre-resection assessment, lymph nodes must be assessed at the time of resection. The question to be addressed in this report is the role of mediastinal lymph node dissection versus lymph node sampling. However, the issues surrounding lymph node assessment in NSCLC are complex, depending on clinical stage, imaging and histology.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/cirurgia , Mediastino/patologia , Biópsia por Agulha Fina , Endossonografia , Humanos , Excisão de Linfonodo , Linfonodos/patologia , Metástase Linfática , Mediastinoscopia , Mediastino/cirurgia , Estadiamento de Neoplasias , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X
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