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1.
Nihon Hoshasen Gijutsu Gakkai Zasshi ; 77(11): 1309-1316, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-34803111

RESUMO

This study aimed to determine the optimal image reconstruction method for preoperative computed tomography (CT) angiography for pulmonary segmentectomy. This study enrolled 20 patients who underwent contrast-enhanced CT examination for pulmonary segmentectomy. The optimal image reconstruction algorithm among four different reconstruction algorithms (filtered back projection, hybrid iterative reconstruction, model- based iterative reconstruction, and deep learning reconstruction [DLR]) was investigated by assessing the CT numbers, vessel extraction ratios, and misclassification ratios. The vessel extraction ratios for main and subsegment branches reconstructed using DLR were significantly higher than those using other reconstruction algorithms (96.7% and 90.8% for pulmonary artery and vein, respectively). The misclassification ratios at the right upper lobe pulmonary vessels (V1 and V2) were especially high because they were close to the superior vena cava, and their CT numbers were similar in all four reconstructions. In conclusion, the DLR allows a high extraction rate of pulmonary blood vessels and a low misclassification rate of automatic extraction.


Assuntos
Angiografia por Tomografia Computadorizada , Aprendizado Profundo , Algoritmos , Angiografia , Humanos , Imageamento Tridimensional , Pneumonectomia , Doses de Radiação , Interpretação de Imagem Radiográfica Assistida por Computador , Tomografia Computadorizada por Raios X , Veia Cava Superior
2.
Kyobu Geka ; 74(12): 1008-1011, 2021 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-34795143

RESUMO

A 70-year-old patient who survived about 40 years after left pneumonectomy for tuberculosis visited emergency hospital, because of dyspnea. She received suitable medical therapy for atirial fibrillation and severe mitral regurgitation and hesitated heart surgery because of anxiety for surgical risk. The computed-tomography showed mediastinal shift to left and right lung compensatory expansion. Respiratory function test after treatment of heart failure showed only mild restrictive disorder. And the blood-gas examination in room air was 101 mmHg of Pao2 and 37 mmHg of Paco2. The mitral valve replacement was performed via median sternotomy and using normal cardiopulmonary bypass. And she fully recoverd without any respiratory complications. Mediastinal shift did not obstract the surgical view and establishment of cardiopulmonary bypass in this case. It seemed that the key of surgical successs is the preserved function of healthy residual lung.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Mitral , Idoso , Ponte Cardiopulmonar , Feminino , Humanos , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/cirurgia , Pneumonectomia
3.
Kyobu Geka ; 74(12): 1039-1042, 2021 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-34795150

RESUMO

We present a case of a 54-year-old woman who had been performed video-assisted thoracic surgery (VATS) right upper lobectomy for stageⅡB adenocarcinoma. The patient had the recurrence of multiple lung metastases at 12 months after the surgery and was administrated gefitinib. The lung metastases disappeared at 3 months after the administration of gefitinib. A single metastasis in the left lower lung appearance again and VATS wedge left lung resection as salvage surgery was performed in postoperative 82 months. After salvage surgery, the patient has been followed up without additional treatment and is alive recurrence-free at 19 months.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Feminino , Gefitinibe/uso terapêutico , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/cirurgia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/tratamento farmacológico , Recidiva Local de Neoplasia/cirurgia , Pneumonectomia , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida
4.
Anticancer Res ; 41(11): 5499-5505, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34732420

RESUMO

BACKGROUND/AIM: Circulating tumor cells (CTCs) is one of the promising markers that predict dissemination and metastases. This study aimed to identify the relationship between CTCs in pulmonary vein (PuV) and spread through air space (STAS) in non-small cell lung cancers. MATERIALS AND METHODS: We applied a cytology-based microfluidic platform for rare cell isolation. Twenty-four patients were enrolled. RESULTS: The rate of CTC detection in PuV was 79.2%, and STAS was observed in 54.2% of the samples. When the definitive cut-off value was 1 CTC/1 ml, of the 14 CTC-PuV-high cases, 11 (78.6%) were STAS-positive, whereas 2 of the 10 (20.0%) CTC-PuV-low cases were STAS-positive, and the difference between the two groups was statistically significant (p=0.02). CTC-PuV-high exhibited a significantly poorer survival (p<0.01). CONCLUSION: The higher frequency of STAS is significantly associated with a higher number of CTCs in PuV, and the combination of STAS and CTC was significantly associated with poor prognosis.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/patologia , Movimento Celular , Neoplasias Pulmonares/patologia , Células Neoplásicas Circulantes/patologia , Veias Pulmonares/patologia , Idoso , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Separação Celular/métodos , Feminino , Humanos , Neoplasias Pulmonares/cirurgia , Masculino , Técnicas Analíticas Microfluídicas , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Pneumonectomia , Estudos Prospectivos
5.
Anticancer Res ; 41(11): 5549-5556, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34732425

RESUMO

BACKGROUND/AIM: LUCAS is a clinical lung cancer registry (ClinicalTrials.gov identifier is NCT04228237), prospectively collecting data from newly diagnosed lung cancer patients in seven pneumooncology centers in the Czech Republic, since June 1, 2018. The aim of the study was to assess the stage of the disease at the time of diagnosis, percentage of morphological types, survival, percentage of driving mutations, eligibility for radical surgery, and percentage of patients who undergo radical surgery, in the non-smoking population in comparison with smokers and former smokers. PATIENTS AND METHODS: The total number of patients in the registry at the time of the analysis was 2,743. Only 2,439 patients with complete records (smoking status, stage, and type of tumor) were included in this study. RESULTS: The analysis indicated that non-smokers are diagnosed at a later stage of the disease but they have a better survival rate than smokers. Fewer smokers with stage III disease who are eligible for radical surgery will undergo surgery compared to non-smokers with the same clinical stage. Driving mutations are more common in non-smokers, even after adjustment for the more frequent occurrence of adenocarcinoma in the group of non-smokers. CONCLUSION: The data from LUCAS registry are consistent with already known facts, suggesting that the LUCAS registry is a useful clinical tool.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/epidemiologia , Neoplasias Pulmonares/epidemiologia , não Fumantes , Carcinoma de Pequenas Células do Pulmão/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/genética , Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Carcinoma Pulmonar de Células não Pequenas/cirurgia , República Tcheca/epidemiologia , Ex-Fumantes , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Mutação , Estadiamento de Neoplasias , Pneumonectomia , Estudos Prospectivos , Sistema de Registros , Carcinoma de Pequenas Células do Pulmão/diagnóstico , Carcinoma de Pequenas Células do Pulmão/mortalidade , Carcinoma de Pequenas Células do Pulmão/terapia , Fumantes , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
6.
BMJ Case Rep ; 14(11)2021 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-34753722

RESUMO

Primary pulmonary angiosarcoma is a rare type of malignant vascular tumour with poor prognosis. Diagnosis is often late due to non-specific symptoms and low clinical suspicion for angiosarcoma. A 72-year-old man presented to hospital with a 6-month history of mild progressive dyspnoea, with associated cough, episodes of presyncope and weight loss. CT pulmonary angiogram (CTPA) was reported as a large saddle pulmonary embolism extending into both the right and left pulmonary arteries. Further Multidisciplinary team meeting (MDM) discussion, and review of CTPA and subsequent investigations revealed a large primary pulmonary artery sarcoma which was later confirmed histology. The patient was referred to the cardiothoracic surgeons and underwent left radical pneumonectomy.


Assuntos
Hemangiossarcoma , Embolia Pulmonar , Neoplasias Vasculares , Idoso , Hemangiossarcoma/diagnóstico por imagem , Hemangiossarcoma/cirurgia , Humanos , Pulmão , Masculino , Pneumonectomia , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia , Neoplasias Vasculares/diagnóstico por imagem , Neoplasias Vasculares/cirurgia
7.
Ann Acad Med Singap ; 50(10): 773-781, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34755171

RESUMO

INTRODUCTION: Surgical resection of the primary and metastatic tumour is increasingly recommended in suitable patients with metastatic colorectal cancer (CRC). While the role of metastasectomy is well studied and established in colorectal liver metastasis, evidence remains limited in pulmonary metastases. This systematic review was conducted to examine the current evidence on the role of lung metastasectomy (LUM) in CRC. METHODS: Three databases were systematically searched, to identify studies that compared survival outcomes of LUM, and factors that affected decision for LUM. RESULTS: From a total of 5,477 records, 6 studies were eventually identified. Two papers reported findings from one randomised controlled trial and 4 were retrospective reviews. There was no clear survival benefit in patients who underwent LUM compared to those who did not. When compared against patients who underwent liver metastasectomy, there was also no clear survival benefit. Patients who underwent LUM were also more likely to have a single pulmonary tumour, and metachronous disease. CONCLUSION: The evidence suggests a role for LUM, but is limited by inherent selection bias in retrospective reviews, and the single randomised clinical trial performed was not completed. More prospective studies are required to understand the true effect of LUM on outcomes in metastatic CRC.


Assuntos
Neoplasias Colorretais , Neoplasias Hepáticas , Neoplasias Pulmonares , Metastasectomia , Neoplasias Colorretais/cirurgia , Humanos , Neoplasias Hepáticas/cirurgia , Neoplasias Pulmonares/cirurgia , Pneumonectomia , Prognóstico , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Taxa de Sobrevida
8.
Anticancer Res ; 41(10): 5117-5122, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34593462

RESUMO

AIM: The aim of this study was to evaluate the utility of selected tumor markers for the detection of lung cancer recurrence during follow-up. PATIENTS AND METHODS: The study group consisted of 109 patients and 109 healthy controls. The following biomarkers were selected: Carcinoembryonic antigen; cytokeratin fragment 19; neuron-specific enolase; tissue polypeptide-specific antigen; cytokeratin fragments 8, 18 and 19; insulin-like growth factor 1; pro-gastrin-releasing peptide; and 25-hydroxyvitamin D. The biomarkers were assessed individually or using a multivariate analysis. RESULTS: Carcinoembryonic antigen [area under the receiver operating characteristics curve (AUC)=0.6857, p<0.0001] and cytokeratin fragment 19 (AUC=0.6882, p<0.0001) proved best in detecting relapse. The multivariate model indicated insulin-like growth factor 1 (p=0.0006, AUC=0.6225) as the third most useful biomarker. The multivariate model using these three markers achieved the best AUC value of 0.7730 (p=0.0050). CONCLUSION: We demonstrated that carcinoembryonic antigen and cytokeratin fragment 19 play a key role in the detection of lung cancer recurrence. A multivariate approach can increase the effectiveness of detection.


Assuntos
Adenocarcinoma de Pulmão/patologia , Biomarcadores Tumorais/sangue , Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma de Células Escamosas/patologia , Neoplasias Pulmonares/patologia , Pneumonectomia/mortalidade , Adenocarcinoma de Pulmão/sangue , Adenocarcinoma de Pulmão/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/sangue , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Carcinoma de Células Escamosas/sangue , Carcinoma de Células Escamosas/cirurgia , Feminino , Seguimentos , Humanos , Neoplasias Pulmonares/sangue , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Taxa de Sobrevida
9.
J Med Case Rep ; 15(1): 533, 2021 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-34670611

RESUMO

INTRODUCTION: With early diagnosis, fiberoptic or rigid bronchoscopy methods are the gold standard in the management of tracheobronchial foreign body. Otherwise, nonrecognized bronchial foreign bodies cause irreversible damage to the airways and lungs. The deficiency of the health system noted in many developing countries such as Madagascar, combined with the fundamental problem relating to children's conditions, which are determined by social and educational factors, makes it almost impossible to provide early and appropriate management of the penetration syndrome. CASE PRESENTATION: An 11-year-old Malagasy female patient was referred to our hospital for an investigation of the etiology of the patient's hemoptysis. The investigations revealed a localized bronchiectasis and atelectasis due to a foreign body obstructing the left main bronchus. Based on the hemoptysis and left lung almost destroyed by an occlusive lesion within, we decided to proceed with left pneumonectomy. A retrospective interrogation revealed a choking episode 4 years prior in elementary school after the child sucked on a pen cap and involuntarily aspirated it. Two years after the pneumonectomy, our patient was doing well and was asymptomatic. CONCLUSION: In this case report, we describe a rare case of a late presentation of foreign body aspiration that resulted in a left pneumonectomy in a child. Despite our favorable results, pneumonectomy must be the preferred last option. Preventive actions remain the optimal approach.


Assuntos
Corpos Estranhos , Pneumonectomia , Brônquios/diagnóstico por imagem , Brônquios/cirurgia , Broncoscopia , Criança , Feminino , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/cirurgia , Humanos , Estudos Retrospectivos
10.
BMC Surg ; 21(1): 368, 2021 Oct 18.
Artigo em Inglês | MEDLINE | ID: mdl-34663287

RESUMO

BACKGROUND: Primary lung acinic cell carcinoma is very rare. Here we report a young female patient who suffered the largest primary lung acinic cell carcinoma with severe mediastinal deviation which has never been reported before. We also reviewed data and features of 20 previously reported cases of primary lung acinic cell carcinoma who underwent lobectomy. CASE PRESENTATION: A 27-year-old female patient presented with recurrent coughing and hemoptysis for more than 10 years came to our hospital. A chest computed tomography (CT) showed a giant space-occupying lesion in the hilum of right lung. After a thorough and detailed preoperative examination, the patient then was performed a radical right pneumonectomy with mediastinal lymph node dissection. The size of the tumor was about 8.6 × 4.5 × 4.4 cm. The pathological results demonstrated a primary acinic cell carcinoma of right lung. The immunohistochemistry of the tumor showed AE1/AE3 (+), Ki-67 (2% +), CK7 (+), Vimentin (+), CK19 (+), α1-ACT (+), AB-PAS (+), S-100 (-), TTF-1 (-). The patient was discharged less than 2 weeks after the operation. So far, the patient has been followed-up for 2 years, and no evidence of tumor recurrence or metastasis was observed. CONCLUSIONS: The primary acinic cell carcinoma of lung in this case is the biggest one ever reported and also the first case treated with radical right pneumonectomy. In addition, the patient had a very rare condition of severe mediastinal deviation at the same time. After surgical treatment, the patient recovered uneventfully and had stable disease without recurrence and metastasis after 2 years of follow-up. This case together with the reported case indicate that primary acinic cell carcinoma of lung is of low malignancy, the prognosis and therapy effect of surgical treatment are relatively satisfactory.


Assuntos
Carcinoma de Células Acinares , Neoplasias Pulmonares , Adulto , Carcinoma de Células Acinares/cirurgia , Feminino , Humanos , Neoplasias Pulmonares/cirurgia , Excisão de Linfonodo , Recidiva Local de Neoplasia , Pneumonectomia
11.
J Prim Health Care ; 13(2): 186-188, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34620301

RESUMO

Pulmonary herniation is defined as protrusion of lung parenchyma through thoracic wall weakness. We present a case of a 69-year-old male who presented to a rural hospital with a 4-day history of cough, right-sided chest pain and exertional shortness of breath. His past medical history included right lung adenocarcinoma treated with right upper lobe lobectomy via video-assisted thorascopic surgery (VATS) 3 years prior. Chest inspection revealed decreased chest wall movements on the right side with no visible chest bulge and on palpation non-tender chest bilaterally with palpable crepitus of the right anterior chest. Chest expansion was reduced on the right side associated with hyper-resonant percussion. Auscultation revealed diffuse bilateral rhonchi. A CT of the chest showed herniation of the right lung through a post-operative defect in the thoracic wall. The patient was initiated on codeine linctus for cough suppression and remained haemodynamically stable for his 3-day admission. He remained asymptomatic at his 4-week follow up with complete resolution of surgical emphysema. We could find no other case reports of VATS lobectomy where lung herniation presented years after surgery.


Assuntos
Adenocarcinoma , Neoplasias Pulmonares , Adenocarcinoma/cirurgia , Idoso , Humanos , Pulmão , Neoplasias Pulmonares/cirurgia , Masculino , Pneumonectomia/efeitos adversos , Cirurgia Torácica Vídeoassistida
12.
J Laparoendosc Adv Surg Tech A ; 31(10): 1157-1161, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34609926

RESUMO

Indications for pulmonary lobectomy in infants and children include cystic pulmonary adenomatoid malformation, congenital lobar emphysema, chronic infection, and malignancy. These procedures can now all be done thoracoscopically avoiding the short- and long-term morbidity of an open thoracotomy. In this article we describe the technique of thoracoscopic lobectomy as well as the preoperative and postoperative care.


Assuntos
Malformação Adenomatoide Cística Congênita do Pulmão , Enfisema Pulmonar , Criança , Malformação Adenomatoide Cística Congênita do Pulmão/cirurgia , Humanos , Lactente , Pulmão/cirurgia , Pneumonectomia , Enfisema Pulmonar/cirurgia , Toracotomia , Resultado do Tratamento
13.
Medicine (Baltimore) ; 100(40): e27461, 2021 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-34622872

RESUMO

INTRODUCTION: Video-assisted thoracoscopic lobectomy is the prior recommended treatment for non-small cell lung cancer (NSCLC), with the advantages of small trauma, less postoperative pain, and quick recovery. However, a large number of patients may suffer chronic postsurgical pain (CPSP), which makes the patients unwilling to practice pulmonary exercises, and it would directly affect patient's cough, sputum expectoration, and mobility. Opioids could greatly improve the quality of postoperative analgesia and the quality of life after surgery, but it is accompanied with obvious side effects. A number of clinical studies have proved that acupuncture could improve postoperative pain and reduce opioid use. In this study, we try to conduct a randomized controlled study to evaluate the efficacy and safety of plum-blossom needle acupuncture combined with Tramadol in improving CPSP after lobectomy in NSCLC patients. METHODS: Patients will be randomly divided into treatment group (acupuncture plus Tramadol) and control group (sham acupuncture plus Tramadol) with a random number table in 1:1 ratio. The patients, outcome assessor, and statistician will be blinded. The outcomes are changes of numerical rating scale, Karnofsky performance score, brief pain inventory, blood routine, liver and kidney function. The data will be analyzed by SPSS 22.0. CONCLUSIONS: The results will help to evaluate the efficacy and safety of plum-blossom needle acupuncture in improving CPSP after lobectomy in NSCLC patients.


Assuntos
Terapia por Acupuntura/métodos , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/cirurgia , Dor Pós-Operatória/terapia , Projetos de Pesquisa , Adulto , Idoso , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/tratamento farmacológico , Pneumonectomia/efeitos adversos , Cirurgia Torácica Vídeoassistida/efeitos adversos , Tramadol/administração & dosagem , Tramadol/uso terapêutico
14.
Khirurgiia (Mosk) ; (10): 68-74, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34608782

RESUMO

OBJECTIVE: To present an experience of adapting the accelerated rehabilitation protocol at the thoracic surgery department of the Moscow City Clinical Oncology Hospital No. 1. MATERIAL AND METHODS: An effectiveness of the accelerated rehabilitation program in the city oncology hospital was retrospectively analyzed for the period from February to December 2019. Lung resections were performed in 252 patients with median age 66 (59; 71) years and an equal ratio of men and women (124/128). Primary non-small cell lung cancer was noted in 194 (77%) patients, secondary malignant neoplasms of lungs - in 58 (23%) cases. ASA grading system of anesthetic risk was applied (American Society of Anesthesiologists): grade II - 56 (22.2%) patients, grade III - 203 (75.2%) patients, grade IV - 7 (2.8%) patients. RESULTS: Lobectomy was performed in 147 patients, segmentectomy - in 32, bilobectomy, pneumonectomy and marginal resection - in 1, 3 and 69 cases, respectively. Endoscopic operations made up 13.6% (n=20), 12.5% (n=4) and 78% (n=54). Postoperative 30-day complications occurred in 19 (7.5%) out of 252 patients (95% CI 4.9-11.5). Postoperative 30-day mortality was 1.98% (5 out of 252 patients, 95% CI 0.9-4.6). Median postoperative hospital-stay was 7 (6; 8) days. CONCLUSION: Implementation of fast track protocol requires time and the first results can be assessed after 6-12 months. Continuous monitoring of implementation of the protocol elements by all members of multidisciplinary team, analysis of complications and long-term results are required to realize all potential benefits of this program.


Assuntos
Neoplasias Pulmonares , Cirurgia Torácica , Idoso , Feminino , Humanos , Tempo de Internação , Neoplasias Pulmonares/cirurgia , Masculino , Pneumonectomia , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida
15.
Khirurgiia (Mosk) ; (10): 52-58, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34608780

RESUMO

Lung surgeries following pneumonectomy using veno-venous extracorporeal membrane oxygenation (V-V ECMO) are described in the literature. The authors report a 62-year-old man with bilateral metachronous primary multiple lung cancer after previous extended lower lobectomy combined with sublobar resection of the upper lobe for squamous cell carcinoma of the left lung. Despite satisfactory functional status and heart function, the patient had poor lung function. Therefore, we decided to increase safety of resection using extracorporeal respiratory support. Extended right lower lobectomy was carried out under V-V ECMO. Surgery was followed by intrapleural bleeding that required urgent surgical hemostasis with completion of perioperative V-V ECMO. Postoperative ventilation lasted for 33 days but the patient was discharged later in a satisfactory condition.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Oxigenação por Membrana Extracorpórea , Neoplasias Pulmonares , Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Humanos , Pulmão , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Pneumonectomia
16.
J Cardiothorac Surg ; 16(1): 302, 2021 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-34656152

RESUMO

BACKGROUND: Video-assisted thoracic surgery sleeve resection with bronchial anastomosis or bronchoplasty is a technically demanding procedure. Three-dimensional endoscopic surgery has been reported to be helpful in decreasing operation time and improving spatial perception with less surgical errors, but there have been rare reports about relatively difficult thoracoscopic procedures utilizing 3D thoracoscope. We performed this study to evaluate early clinical outcomes of thoracoscopic sleeve resection and bronchoplasty utilizing 3D thoracoscope. METHODS: Data from a total of 36 patients who underwent thoracoscopic sleeve lobectomy or bronchoplasty at our institution from December 2015 to October 2017 were retrospectively reviewed. Three-port approach with one utility incision was used with a 10 mm, 30° three-dimensional thoracoscope. Twenty-three patients (81%) were male, and mean age was 65.9 ± 9.4 years. Fourteen patients (38.9%) underwent sleeve resection with bronchial anastomosis, 22 (61.1%) underwent wedge or simple bronchoplasty, and one patient received concomitant PA procedure. Bronchial anastomosis sites were not covered with viable tissue flaps. RESULTS: There was no (0%) suture needle injury from spatial misperception during bronchoplasty or sleeve anastomosis. There was no (0%) operative mortality. The pathologic report revealed squamous cell carcinoma (63.9%), adenocarcinoma (19.4%), carcinoid (6.9%), adenosquamous carcinoma (3.4%), and sarcomatoid carcinoma (2.8%). One (2.8%) late mortality was due to systemic recurrence of sarcomatoid carcinoma. There was no (0.0%) anastomotic failure. The mean number of dissected lymph nodes were 27.4 ± 13.2, and mean operation time was 216.8 ± 60.0 min. Median postoperative 24-h drain amount was 315 mL. Median chest tube days and hospital days were 4 and 6, respectively. Two patients (5.6%) had complications greater than Clavien-Dindo grade II-one case of ARDS, and the other case of a delayed bronchopleural fistula. CONCLUSIONS: Thoracoscopic sleeve resection and bronchoplasty utilizing HD 3D thoracoscope is a safe and effective procedure with excellent early clinical outcomes. Further investigation for long-term outcomes will be needed.


Assuntos
Neoplasias Pulmonares , Cirurgia Torácica Vídeoassistida , Idoso , Humanos , Imageamento Tridimensional , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Pneumonectomia/efeitos adversos , Estudos Retrospectivos
17.
J Cardiothorac Surg ; 16(1): 305, 2021 Oct 18.
Artigo em Inglês | MEDLINE | ID: mdl-34663384

RESUMO

A novel surgical energy device with high sealing ability using microwave technology has been developed. This novel microwave surgical instrument (MSI) is capable of sealing and dissecting a vessel ≤ 5 mm in diameter. The high sealing ability of the MSI enables fine dissection of the lung parenchyma by a scissor-type blade. This device is particularly useful in situations wherein the use of an automatic suturing instrument is difficult. Here, we describe the dissection of the lung parenchyma using this device in three patients (cases 1-3). This device was used for wedge resection of a tumor located close to the pulmonary hilum, for subsegmentectomy, and for dividing incomplete interlobar fissure (cases 1-3, respectively). In all the cases, the postoperative course was uneventful. This MSI is effective for resection of the lung parenchyma, allowing fine tissue dissection and excellent tissue sealing. This technique could assist surgeons in various lung resection cases.


Assuntos
Micro-Ondas , Pneumonectomia , Humanos , Pulmão/diagnóstico por imagem , Pulmão/cirurgia , Artéria Pulmonar , Instrumentos Cirúrgicos
18.
BMJ Case Rep ; 14(10)2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34598972

RESUMO

A 62-year-old man presents with breathlessness 6 months following right pneumonectomy for lung adenocarcinoma. Previous investigations had not yielded a diagnosis and his symptoms were progressing. The patient described worsened symptoms when stood up (platypnoea), with profound hypoxia until laid supine (orthodeoxia). Platypnoea-orthodeoxia syndrome due to a right-to-left interatrial shunt was diagnosed on contrast-enhanced transoesophageal echocardiography with the patient undergoing successful percutaneous patent foramen ovale closure. Patent foramen ovale is often asymptomatic with a population prevalence of around 20%-30%. Anatomical shifts postpneumonectomy can open, or worsen a previously closed interatrial communication leading to right-to-left shunting of blood. Platypnoea-orthodeoxia is under-recognised, impairing quality of life and patient outcome. Investigations can be falsely reassuring, or poorly sensitive for the causative pathology. Percutaneous closure is safe with high success rates and this case highlights the need for a high index of suspicion for shunts, particularly in postpneumonectomy patients.


Assuntos
Neoplasias Pulmonares , Pneumonectomia , Dispneia/etiologia , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Síndrome
19.
Int J Chron Obstruct Pulmon Dis ; 16: 2809-2815, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34675505

RESUMO

Background: Lung volume reduction with endobronchial coils treatment (ECT), for patients with severe emphysema, has shown modest improvement in exercise capacity and lung functions in clinical trials, yet the benefit of this procedure is still unclear. Methods: We conducted a multicenter retrospective cohort study including all patients who underwent ECT in Israel and a propensity score matched control group of patients with chronic obstructive pulmonary disease (COPD) that were treated with usual care. The primary outcome was six-minute walk test distance (6MWTD), secondary outcomes were lung function tests and patient survival. Results: Overall, 46 patients were included in the ECT group. Their mean 6MWTD at baseline and at 6 and at 24 months post procedure was 331.0±101.4, 372.9±76.8 and 338.8±104.8, respectively (overall P=0.04, pairwise comparison: baseline to 6 months (P=0.1), baseline to 24 months (P=1.0)). Mean FEV1 values at baseline and at 6 and at 24 months post procedure were 0.86±0.38, 0.92±0.37 and 0.82±0.36 liters, respectively (overall P=0.003, pairwise comparison: baseline to 6 months (P=0.04), baseline to 24 months (P=0.75)). The median 6MWTD for the ECT and control groups at 24 months were 333.0 (262.5-390) and 280 (210-405), respectively (P=0.16). There was no difference in overall survival (P=0.84). Heterogenous emphysema was a significant predictor of treatment success in univariate analysis (p=0.004). Conclusion: Lung volume reduction with endobronchial coils may improve the exercise capacity and FEV1 of COPD patients. However, the majority of the effect was diminished after 24 months. The current state of evidence does not support regulatory approval of ECT and warrant its use only after consideration of the benefit-harm ratio in a highly selected patient population.


Assuntos
Enfisema , Doença Pulmonar Obstrutiva Crônica , Enfisema Pulmonar , Broncoscopia , Tolerância ao Exercício , Volume Expiratório Forçado , Humanos , Pulmão , Pneumonectomia , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/terapia , Enfisema Pulmonar/cirurgia , Enfisema Pulmonar/terapia , Estudos Retrospectivos , Resultado do Tratamento
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