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2.
J Cardiothorac Surg ; 16(1): 187, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34215289

RESUMO

BACKGROUND: Open window thoracostomy (OWT) is indicated for patients with bronchopleural fistula (BPF) or trapped lung in the setting of empyema refractory to non-surgical interventions. We investigated the role of OWT in the era of minimally invasive surgeries, endobronchial valves and fibrinolytic therapy. METHODS: A retrospective chart review of all patients who underwent OWT at a single institution from 2010 to 2020 was performed. Indications for the procedure as well as operative details and morbidity and mortality were evaluated to determine patient outcomes for OWT. RESULTS: Eighteen patients were identified for the study. The most common indication for OWT was post-resectional BPF (n = 9). Prior to OWT, n = 11 patients failed other surgical or minimally invasive interventions. Patient comorbidities were quantified with the Charlson Comorbidity index (n = 11 score ≥ 5, 10-year survival ≤21%). Three (16.7%) patients died < 30 days post-operatively and 12 (66%) patients were deceased by the study's end (overall survival 24.0 ± 32.2 months). Mean number of ribs resected were 2.5 ± 1.2 (range 1-6) with one patient having 6 ribs removed. Patients were managed with negative pressure wound therapy (n = 9) or Kerlix packing (n = 9). Eleven patients (61.6%) underwent delayed closure (mean time from index surgery to closure 4.8 ± 6.7 months). CONCLUSIONS: Our study illustrates the significant comorbidities of patients undergoing OWT, the poor outcomes therein, and pitfalls associated with this procedure. We show that negative pressure wound therapy can be utilized as potential way to obliterate the pleural space and manage an open chest in the absence of an airleak; however, OWT procedures continue to be extremely morbid.


Assuntos
Fístula Brônquica/cirurgia , Empiema Pleural/cirurgia , Toracostomia , Adulto , Idoso , Fístula Brônquica/complicações , Comorbidade , Empiema Pleural/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Tratamento de Ferimentos com Pressão Negativa , Pneumonectomia/efeitos adversos , Reoperação , Estudos Retrospectivos , Costelas/cirurgia , Taxa de Sobrevida , Toracostomia/efeitos adversos , Toracostomia/métodos , Toracotomia/efeitos adversos , Terapia Trombolítica , Resultado do Tratamento
3.
Int J Chron Obstruct Pulmon Dis ; 16: 1957-1965, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34234426

RESUMO

Background: Since successful development of endobronchial valves (EBV) as treatment for severe emphysema, its main complication, pneumothorax, remains an important concern. Objective: We hypothesized that a two-step EBV implantation, during two distinct iterative procedures could lead to a more progressive target lobe volume reduction (TLVR) and thus ipsilateral lobe re-expansion, resulting in a significant decrease in the pneumothorax rate. Methods: This retrospective bi-center study carried out by Limoges and Toulouse University Hospitals included patients following the inclusion criteria established by the BLVR expert panel. All patients were treated by two distinct procedures: first, EBVs were placed in all but the most proximal segment or sub-segment. The remaining segment was treated subsequently. All patients had a complete evaluation before treatment, and 3 months after the second procedure. Results: Out of 58 patients included, only 4 pneumothoraxes (7%) occurred during the study. The other complications were pneumonia and severe COPD exacerbation (8.6% and 13.7% of patients, respectively). Significant improvement was found for FEV1 (+19.6 ± 25%), RV (-468 ± 960mL), 6MWD (30 ± 85m), BODE Index (-1.4 ± 1.8 point) and TLVR (50.6 ± 35.1%). Significant TLVR (MCID) was obtained in 74.1% of patients (43/58). Conclusion: This new approach using EBV could reduce the incidence of pneumothorax without increasing other complication rates. Clinical and physiological outcomes are similar to those reported in studies using the conventional single-step treatment.


Assuntos
Pneumotórax , Doença Pulmonar Obstrutiva Crônica , Enfisema Pulmonar , Broncoscopia , Volume Expiratório Forçado , Humanos , Pneumonectomia/efeitos adversos , Pneumotórax/diagnóstico por imagem , Pneumotórax/etiologia , Pneumotórax/prevenção & controle , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/cirurgia , Enfisema Pulmonar/diagnóstico por imagem , Enfisema Pulmonar/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
4.
Medicine (Baltimore) ; 100(19): e25338, 2021 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-34106585

RESUMO

ABSTRACT: This retrospective study investigated the effect of ultrasound-guided pulsed radiofrequency (UGPRF) on intercostal neuralgia (ICN) after lung cancer surgery (LCS).This retrospective observational study analyzed the outcome data of UGPRF on ICN in 80 patients with LCS. All those patients were allocated into a treatment group (n = 40) and a control group (n = 40). All patient data were collected between January 2018 and November 2019. The primary outcome was pain intensity (measured by numerical rating scale, NRS). The secondary outcomes were sleep quality (measured by Pittsburgh Sleep Quality Index, PSQI), anesthetic consumption, and treatment-related adverse events.After treatment, patients in the treatment group showed better outcomes in NRS (P < .01), PSQI (P < .01), and anesthetic consumption (P < .01), than patients in the control group. No treatment-related adverse events were documented in both groups in this study.The results of this study found that UGPRF may benefit patients for pain relief of ICN after LCS.


Assuntos
Nervos Intercostais , Neoplasias Pulmonares/cirurgia , Neuralgia/terapia , Dor Pós-Operatória/terapia , Pneumonectomia/efeitos adversos , Tratamento por Radiofrequência Pulsada , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuralgia/diagnóstico por imagem , Neuralgia/etiologia , Dor Pós-Operatória/diagnóstico por imagem , Dor Pós-Operatória/etiologia , Estudos Retrospectivos , Ultrassonografia de Intervenção
5.
BMC Cancer ; 21(1): 498, 2021 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-33941112

RESUMO

BACKGROUND: It remains no clear conclusion about which is better between robot-assisted thoracic surgery (RATS) and video-assisted thoracic surgery (VATS) for the treatment of patients with non-small cell lung cancer (NSCLC). Therefore, this meta-analysis aimed to compare the short-term and long-term efficacy between RATS and VATS for NSCLC. METHODS: Pubmed, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), Medline, and Web of Science databases were comprehensively searched for studies published before December 2020. The quality of the articles was evaluated using the Newcastle-Ottawa Scale (NOS) and the data analyzed using the Review Manager 5.3 software. Fixed or random effect models were applied according to heterogeneity. Subgroup analysis and sensitivity analysis were conducted. RESULTS: A total of 18 studies including 11,247 patients were included in the meta-analyses, of which 5114 patients were in the RATS group and 6133 in the VATS group. Compared with VATS, RATS was associated with less blood loss (WMD = - 50.40, 95% CI -90.32 ~ - 10.48, P = 0.010), lower conversion rate (OR = 0.50, 95% CI 0.43 ~ 0.60, P < 0.001), more harvested lymph nodes (WMD = 1.72, 95% CI 0.63 ~ 2.81, P = 0.002) and stations (WMD = 0.51, 95% CI 0.15 ~ 0.86, P = 0.005), shorter duration of postoperative chest tube drainage (WMD = - 0.61, 95% CI -0.78 ~ - 0.44, P < 0.001) and hospital stay (WMD = - 1.12, 95% CI -1.58 ~ - 0.66, P < 0.001), lower overall complication rate (OR = 0.90, 95% CI 0.83 ~ 0.99, P = 0.020), lower recurrence rate (OR = 0.51, 95% CI 0.36 ~ 0.72, P < 0.001), and higher cost (WMD = 3909.87 USD, 95% CI 3706.90 ~ 4112.84, P < 0.001). There was no significant difference between RATS and VATS in operative time, mortality, overall survival (OS), and disease-free survival (DFS). Sensitivity analysis showed that no significant differences were found between the two techniques in conversion rate, number of harvested lymph nodes and stations, and overall complication. CONCLUSIONS: The results revealed that RATS is a feasible and safe technique compared with VATS in terms of short-term and long-term outcomes. Moreover, more randomized controlled trials comparing the two techniques with rigorous study designs are still essential to evaluate the value of robotic surgery for NSCLC.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/cirurgia , Pneumonectomia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Cirurgia Torácica Vídeoassistida/métodos , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Tubos Torácicos , Conversão para Cirurgia Aberta/estatística & dados numéricos , Intervalo Livre de Doença , Drenagem/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Excisão de Linfonodo/estatística & dados numéricos , Recidiva Local de Neoplasia/epidemiologia , Pneumonectomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Viés de Publicação , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Cirurgia Torácica Vídeoassistida/efeitos adversos , Cirurgia Torácica Vídeoassistida/estatística & dados numéricos , Resultado do Tratamento
6.
J Cardiothorac Surg ; 16(1): 129, 2021 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-33985533

RESUMO

BACKGROUND: Our goal was to discuss the treatment for rupture of contralateral mainstem bronchus during uniportal video-assisted thoracoscopy surgery (uniportal VATS) lobectomy. CASE PRESENTATION: We analyzed clinical data of 3 cases of rupture of contralateral mainstem bronchus during uniportal VATS. Surgical repair was performed immediately under an uniportal VATS during operation, as a result, 3 cases of bronchial rupture all were repaired successfully, and we continued to complete lobectomy and systemic lymph node dissection. Reexamination was performed after 1 week, and no fistula was found in trachea and bronchi through a fiberoptic bronchoscopy. The time range for indwelling the chest tube is 6-9 days, and the hospital stay is 8-10 days. No abnormality was observed on chest radiography when the 3 patients returned to the hospital 1 month after the operation for the second reexamination. CONCLUSIONS: Instant surgical repair is recommended to the treatment of bronchial rupture in thoracic surgery. It is safe and feasible to repair bronchial tear with uniportal VATS.


Assuntos
Brônquios/lesões , Complicações Intraoperatórias/cirurgia , Intubação Intratraqueal/efeitos adversos , Pneumonectomia/efeitos adversos , Ruptura/cirurgia , Cirurgia Torácica Vídeoassistida/efeitos adversos , Idoso , Brônquios/cirurgia , Feminino , Humanos , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/etiologia , Pessoa de Meia-Idade , Pneumonectomia/métodos , Fatores de Risco , Ruptura/etiologia , Cirurgia Torácica Vídeoassistida/métodos
7.
J Cardiothorac Surg ; 16(1): 149, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34049583

RESUMO

BACKGROUND: To retrospectively assess the efficacy of hypertonic glucose pleurodesis for treatment of chylothorax after pulmonary resection. METHODS: Out of a total of 8252 patients who underwent pulmonary resection (at least lobectomy) at department of thoracic surgery, between June 2008 and December 2015, 58 patients (0.7%) developed postoperative chylothorax. All patients received conservative treatment, including thoracic closed drainage, oral fasting, and total parenteral nutrition. RESULTS: Conservative treatment was successful in 50 (86.2%) patients, while eight patients [mean age: 58.0 years (range, 45-75)] were treated with hypertonic glucose pleurodesis. All eight patients had undergone operation for lung cancer (four squamous cell carcinomas and four adenocarcinomas). The bronchial stump was covered by pleural flap in three patients. After pleurodesis, three patients developed fever but without empyema; thoracentesis was performed in two patients. The mean time interval between pleurodesis and operation was 4.3 days (range,3-5) days. The average length of stay was 23.1 days (range, 18-31). No recurrent pleural effusion was observed over a mean follow-up duration of 28 months. CONCLUSION: Hypertonic glucose pleurodesis performed via the chest drainage tube is a viable treatment option for chylothorax after lung resection, prior to resorting to a thoracoscopic or thoracotomic ductus thoracicus ligation of the thoracic duct leak. It is a simple, safe and efficient modality associated with rapid recovery and less pain.


Assuntos
Quilotórax/terapia , Solução Hipertônica de Glucose/administração & dosagem , Neoplasias Pulmonares/cirurgia , Pleurodese/métodos , Pneumonectomia/efeitos adversos , Complicações Pós-Operatórias/terapia , Adenocarcinoma/cirurgia , Adulto , Carcinoma de Células Escamosas/cirurgia , Tubos Torácicos , Quilotórax/diagnóstico por imagem , Quilotórax/etiologia , Drenagem , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Pulmonares/efeitos adversos , Radiografia , Estudos Retrospectivos , Ducto Torácico/cirurgia
8.
World J Surg Oncol ; 19(1): 158, 2021 May 26.
Artigo em Inglês | MEDLINE | ID: mdl-34039365

RESUMO

BACKGROUND: Bronchopleural fistula (BPF) refers to an abnormal channel between the pleural space and the bronchial tree. It is a potentially fatal postoperative complication after pulmonary resection and a complex challenge for thoracic surgeons because many patients with BPF ultimately develop refractory empyema, which is difficult to manage and has a major impact on quality of life and survival. Therefore, an operative intervention combined with conservative and endoscopic therapies may be required to control infection completely, to occlude BPF, and to obliterate the empyema cavity during treatment periods. CASE PRESENTATION: Two patients who suffered from BPF complicated with chronic empyema after lobectomy were treated in other hospitals for a long time and did not recover. In our department, we performed staged surgery and creatively combined an Amplatzer Septal Occluder (ASO) device (AGA Medical Corp, Golden Valley, MN, USA) with pedicled muscle flap transposition. First, open-window thoracostomy (OWT), or effective drainage, was performed according to the degree of contamination in the empyema cavity after the local infection was controlled. Second, Amplatzer device implantation and pedicled muscle flap transposition was performed at the same time, which achieved the purpose of obliterating the infection, closing the fistula, and tamponading the residual cavity. The patients recovered without complications and were discharged with short hospitalization stays. CONCLUSIONS: We believe that the union of the Amplatzer device and pedicle muscle flap transposition seems to be a safe and effective treatment for BPF with chronic empyema and can shorten the length of the related hospital stay.


Assuntos
Fístula Brônquica , Empiema Pleural , Fístula Brônquica/etiologia , Fístula Brônquica/cirurgia , Empiema Pleural/etiologia , Empiema Pleural/cirurgia , Humanos , Músculos , Pneumonectomia/efeitos adversos , Prognóstico , Qualidade de Vida
9.
Khirurgiia (Mosk) ; (5): 32-41, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33977696

RESUMO

OBJECTIVE: To analyze the anatomometric characteristics of post-pneumonectomy cavity and their changes at various times after surgery. MATERIAL AND METHODS: The study included 47 patients aged 39-75 years after pneumonectomy (right-sided - 23 cases, left-sided - 24 cases). Computed tomography was performed prior to surgery, in 10-12 days, 6 and 12 months after intervention. Transverse, anteroposterior dimensions, height and volume of pleural cavity were evaluated using CT scans and 3D models. RESULTS: Post-pneumonectomy cavity decreases and changes own shape in postoperative period. Reduction is mainly caused by decrease in its height. The volume of post-pneumonectomy cavity was decreased in early postoperative period by 1.8 times compared to preoperative values (from 3351.5±150.0 cm3 to 2112.1±152.6 cm3 on the right side and from 2674.3±125.2 cm3 to 1460.1±84.1 cm3 on the left side). After 12 months, this value was reduced by 3.68 times compared to early postoperative period (714.3±100.7 cm3 on the right and 401.5±42.5 cm3 on the left). The shape changes consist of flattening and sinus depth reduction. Exudate density was similar throughout a year. The capsule was formed in 74.1% of patients after 12 months. There was no correlation between the cavity reduction and patient constitution. CONCLUSION: Post-pneumonectomy cavity is a dynamically changing anatomical formation participating in the mechanisms of compensation for changes after pneumonectomy. The most significant collapse of post-pneumonectomy cavity occurs in early postoperative period. Cavity reduction degree does not depend on individual characteristics of patients.


Assuntos
Cavidade Pleural , Pneumonectomia , Adulto , Idoso , Humanos , Pessoa de Meia-Idade , Cavidade Pleural/diagnóstico por imagem , Pneumonectomia/efeitos adversos , Período Pós-Operatório , Tomografia Computadorizada por Raios X
10.
Gen Thorac Cardiovasc Surg ; 69(9): 1291-1302, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33895938

RESUMO

OBJECTIVES: Uniportal (U-VATS) pneumonectomy in lung cancer patients remains disputed in terms of oncological outcomes, and has not been compared to open approaches previously. We evaluated U-VATS versus open pneumonectomy at a high-volume centre. METHODS: Patients undergoing pneumonectomy for lung cancer between 2014 and 2018 were retrospectively reviewed and divided into two groups based on surgical approach. Propensity-score matching was performed (1:1), and intention-to-treat analysis applied. Overall survival, operative time, intraoperative blood loss, hospital-stay and readmission, pain, time to adjuvant therapy, morbidity and mortality were tested. Statistical analysis was performed using SAS version 9.4 (SAS Institute Inc. NC) RESULTS: 341 patients underwent pneumonectomy; 23 patients with small-cell lung cancer were excluded, thus 318 patients were submitted to surgery by either U-VATS (n = 54) or open (n = 264). After matching, 52 patients were selected from each group. Five patients (9.2%) in the uniportal group required conversion. There was no significant difference in intraoperative outcomes, complication rates, readmission rates or mortality. The U-VATS group experienced significantly shorter hospital stay (mean ± SD; 6.7 ± 2.7 vs 9.1 ± 2.3 days, p < 0.001) and reported less pain postoperatively (p < 0.0001). Adjuvant chemotherapy was initiated sooner after U-VATS (38.1 ± 8.4 vs 50.8 ± 11.5 days, p < 0.0001). Overall survival appeared to be superior in U-VATS when pathology stage was aligned (p = 0.001). CONCLUSIONS: Uniportal VATS is a safe and effective alternative approach to open surgery for pneumonectomy in lung cancer. Complications and oncologic outcomes were comparatively similar. U-VATS showed lower postoperative pain, shorter hospital stay and superior overall survival. The study is a preliminary analysis.


Assuntos
Neoplasias Pulmonares , Pneumonectomia , Humanos , Neoplasias Pulmonares/cirurgia , Pneumonectomia/efeitos adversos , Pontuação de Propensão , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida/efeitos adversos
11.
Int J Chron Obstruct Pulmon Dis ; 16: 1127-1136, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33911858

RESUMO

Background: Endobronchial valve (EBV) treatment is an effective treatment for patients with severe emphysema. Revision bronchoscopies after endobronchial valve treatment can be essential to prolong the effect of treatment or address long-term complications. Purpose: To evaluate the indications, endoscopic findings and outcomes of revision bronchoscopies and investigate if any predictors for granulation tissue formation, after EBV treatment, can be identified. Patients and Methods: Patients who underwent EBV treatment between 2016 and 2019 in our hospital, as routine care, were included. If a patient underwent a revision bronchoscopy, data regarding revision bronchoscopies, including indication, finding, intervention and pulmonary function testing (PFT) after revision bronchoscopy were analysed. Results: One hundred seventy-nine patients were included of which 41% required at least one revision bronchoscopy. In 43% of the revision bronchoscopy patients, the indication was loss of initial treatment effect. In 53% of the revision bronchoscopy patients, granulation tissue was found to be the underlying cause. Valve replacement(s) were performed in 51% of the revision bronchoscopy cases. Permanent valve removal was required in 13% of all patients. Overall, revision bronchoscopies led to improvements in PFT outcomes for patients experiencing no or a loss of initial treatment effect. No clinically relevant predictors for granulation tissue formation were identified. Conclusion: Performing a revision bronchoscopy after EBV treatment is a useful procedure leading to an improved treatment effect in most patients. Granulation tissue formation, causing valve dysfunction, is the most common cause of longer term problems.


Assuntos
Enfisema , Doença Pulmonar Obstrutiva Crônica , Enfisema Pulmonar , Broncoscopia/efeitos adversos , Humanos , Pneumonectomia/efeitos adversos , Doença Pulmonar Obstrutiva Crônica/cirurgia , Enfisema Pulmonar/diagnóstico por imagem , Enfisema Pulmonar/cirurgia , Resultado do Tratamento
12.
A A Pract ; 15(4): e01454, 2021 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-33905387

RESUMO

A 75-year-old woman with a history of right-upper lobectomy for adenocarcinoma presented for a right completion pneumonectomy due to 2 new fluorodeoxyglucose-avid densities on the remaining lung. After uneventful anesthetic induction and surgical resection with modest blood loss, the patient developed refractory hypoxemia on emergence without significant hemodynamic changes. Despite delivery of fraction of inspired oxygen (Fio2) = 1.0, confirmed position of the double-lumen tube, and exclusion of common causes of hypoxemia, hypoxemia persisted. An emergent transesophageal echocardiogram revealed a significant intracardiac shunt due to a patent foramen ovale. Specific cardiorespiratory management to achieve a positive left-right heart pressure gradient resulted in prompt normoxemia and successful extubation.


Assuntos
Forame Oval Patente , Pneumonectomia , Idoso , Ecocardiografia Transesofagiana , Feminino , Forame Oval Patente/diagnóstico por imagem , Forame Oval Patente/cirurgia , Humanos , Hipóxia/etiologia , Pulmão , Pneumonectomia/efeitos adversos
13.
J Cardiothorac Surg ; 16(1): 67, 2021 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-33789704

RESUMO

INTRODUCTION: Cardiac herniation is a rare complication after pulmonary surgery, and there are only a few reports about it. We now report a case of cardiac herniation presenting as superior vena cava obstruction after pneumonectomy. CASE PRESENTATION: A-52-years old woman diagnosed right pulmonary squamous cell carcinoma was carried out right pneumonectomy, the pulmonary artery and right superior pulmonary vein were dissected and ligated intrapericardial. The patient developed tachycardia arrhythmias, hypotension, followed by loss of consciousness at about 18 h after operation. After resuscitation, the patient was conscious but developed cyanosis of the superior vena cava drainage area, uropenia, and hypotension (80/30 mmHg). Bedside-echocardiography showed that the SVC was obstructed due to thrombus formation. Chest radiography a shift of the heart into right hemithorax. Rethoracotomy was performed and the herniated heart was replaced into the pericardium, and the pericardium was repaired with Gore Tex patch. The patient recovered smoothly after the second surgery. CONCLUSION: Cardiac herniation is a rare and fatally complication after thoracic surgery, and the prompt recognition with timely intervention is life-saving. Cardiac herniation is a rare but fatal complication of pneumonectomy. The increasing frequency of surgical resection for locally advanced thoracic carcinoma has led to a renewed emphasis regarding early diagnosis and treatment for cardiac herniation. Here we discuss a case of cardiac herniation presented with acute superior vena cava obstruction syndrome and hemodynamic instability after intrapericradial right pneumonectomy.


Assuntos
Carcinoma de Células Escamosas/cirurgia , Cardiopatias/etiologia , Hérnia/etiologia , Neoplasias Pulmonares/cirurgia , Pneumonectomia/efeitos adversos , Síndrome da Veia Cava Superior/etiologia , Feminino , Cardiopatias/diagnóstico , Cardiopatias/cirurgia , Hérnia/diagnóstico , Herniorrafia , Humanos , Pessoa de Meia-Idade , Pericárdio/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/cirurgia , Radiografia Torácica , Síndrome da Veia Cava Superior/cirurgia , Tomografia Computadorizada por Raios X , Veia Cava Superior/cirurgia
14.
Thorac Surg Clin ; 31(2): 139-160, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33926668

RESUMO

Chronic obstructive pulmonary usually is subcategorized into 2 groups: chronic bronchitis and emphysema. The main cause of chronic bronchitis and emphysema is smoking; however, alpha1-antitrypsin also has been seen to cause emphysema in patients who are deficient. As symptoms and lung function decline, treatment modalities, such as lung volume reduction surgery, have been used in individuals with chronic obstructive pulmonary disease and upper lobe predominant emphysema. This article analyzes multiple published series where lung volume reduction surgery has been used in individuals with alpha1-antitrypsin deficiency and their overall outcomes.


Assuntos
Pneumonectomia/métodos , Doença Pulmonar Obstrutiva Crônica/complicações , Enfisema Pulmonar/complicações , Deficiência de alfa 1-Antitripsina/complicações , Deficiência de alfa 1-Antitripsina/cirurgia , Idoso , Anti-Inflamatórios/uso terapêutico , Broncodilatadores/uso terapêutico , Dispneia/cirurgia , Endoscopia , Feminino , Volume Expiratório Forçado , Humanos , Pulmão , Masculino , Pessoa de Meia-Idade , Oxigênio/uso terapêutico , Pneumonectomia/efeitos adversos , Prognóstico , Doença Pulmonar Obstrutiva Crônica/cirurgia , Enfisema Pulmonar/cirurgia , Risco , Fumar/efeitos adversos , Abandono do Hábito de Fumar , Fatores de Tempo , alfa 1-Antitripsina/metabolismo , Deficiência de alfa 1-Antitripsina/diagnóstico
15.
Thorac Surg Clin ; 31(2): 161-169, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33926669

RESUMO

Postoperative air leak is one of the most common complications after pulmonary resection and contributes to postoperative pain, complications, and increased hospital length of stay. Several risk factors, including both patient and surgical characteristics, increase the frequency of air leaks. Appropriate intraoperative tissue handling is the most important surgical technique to reduce air leaks. Digital drainage systems have improved the management of postoperative air leak via objective data, portability, and ease of use in the outpatient setting. Several treatment strategies have been used to address prolonged air leak, including pleurodesis, blood patch, placement of endobronchial valves, and reoperative surgery.


Assuntos
Pulmão/cirurgia , Pleurodese/efeitos adversos , Pleurodese/métodos , Pneumonectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Próteses e Implantes , Idoso , Tubos Torácicos , Drenagem , Feminino , Volume Expiratório Forçado , Humanos , Período Intraoperatório , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pneumonectomia/métodos , Período Pós-Operatório , Fatores de Risco , Esteroides/uso terapêutico , Resultado do Tratamento
16.
Thorac Surg Clin ; 31(2): 177-188, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33926671

RESUMO

Lung volume reduction surgery (LVRS) patient selection guidelines are based on the National Emphysema Treatment Trial. Because of increased mortality and poor improvement in functional outcomes, patients with non-upper lobe emphysema and low baseline exercise capacity are determined as poor candidates for LVRS. In well-selected patients with heterogeneous emphysema, LVRS has a durable long-term outcome at up to 5-years of follow-up. Five-year survival rates in patients range between 63% and 78%. LVRS seems a durable alternative for end-stage heterogeneous emphysema in patients not eligible for lung transplantation. Future studies will help identify eligible patients with homogeneous emphysema for LVRS.


Assuntos
Expectativa de Vida , Pulmão/cirurgia , Pneumonectomia/efeitos adversos , Pneumonectomia/métodos , Enfisema Pulmonar/cirurgia , Idoso , Ensaios Clínicos como Assunto , Feminino , Guias como Assunto , Humanos , Estimativa de Kaplan-Meier , Transplante de Pulmão , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Enfisema Pulmonar/mortalidade , Enfisema Pulmonar/fisiopatologia , Taxa de Sobrevida , Resultado do Tratamento
17.
Thorac Surg Clin ; 31(2): 189-201, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33926672

RESUMO

Endobronchial valve therapy has evolved over the past decade, with demonstration of significant improvements in pulmonary function, 6-minute walk distance, and quality of life in patients with end-stage chronic obstructive lung disease. Appropriate patient selection is crucial, with identification of the most diseased lobe and of a target lobe with minimal to no collateral ventilation. Endobronchial valve therapy typically is utilized in patients with heterogeneous disease but may be indicated in select patients with homogeneous disease. Morbidity and mortality have been lower than historically reported with lung volume reduction surgery, but complications related to pneumothoraces remain a challenge.


Assuntos
Broncoscopia/métodos , Pneumonectomia/métodos , Doença Pulmonar Obstrutiva Crônica/cirurgia , Enfisema Pulmonar/cirurgia , Cateteres/efeitos adversos , Volume Expiratório Forçado , Humanos , Pulmão , Seleção de Pacientes , Pneumonectomia/efeitos adversos , Pneumotórax/cirurgia , Próteses e Implantes , Enfisema Pulmonar/etiologia , Enfisema Pulmonar/fisiopatologia , Qualidade de Vida
18.
Eur J Cardiothorac Surg ; 59(3): 633-640, 2021 04 13.
Artigo em Inglês | MEDLINE | ID: mdl-33849065

RESUMO

OBJECTIVES: With improvements in the outcome of treatment for non-small-cell lung cancer (NSCLC), other diseases may account for a high death rate after surgery in patients with stage I NSCLC. In the present study, we analysed the associations between the clinical factors and non-cancer death after surgery in these patients. METHODS: The records of 514 patients with stage I NSCLC who underwent surgery were retrospectively reviewed; a proportional hazards model for the subdistribution of a competing risk was conducted to define the risk factors for non-cancer death. RESULTS: The mean patient age was 67 years. A total of 367 patients (71%) underwent bilobectomy or lobectomy while 147 (29%) underwent sublobar resection. The pathological stage was IA in 386 (75%) and IB in 128 (25%) patients. Three patients (0.6%) died within 90 days after surgery, and 108 (21%) experienced postoperative complications. Until the time of writing this report, 83 patients had died during the follow-up. The cause of death was primary lung cancer in 38 (46%) patients and other diseases in 45 (54%) patients, including non-cancer causes in 29 patients, such as pneumonia, cardiac death and cerebral stroke. According to a multivariable competing risk analysis for non-cancer death age (≥70 years), sex (male), body mass index (BMI <18.5), postoperative complications and % forced expiratory volume in 1 s (<80) were identified as risk factors for postoperative non-cancer death. CONCLUSIONS: Advanced age (≥70 years), male sex, low BMI (<18.5), postoperative complications and low preoperative % forced expiratory volume in 1 s (<80) were found to be the risk factors for postoperative non-cancer death after surgery in patients with stage I NSCLC.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Idoso , Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Humanos , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Masculino , Estadiamento de Neoplasias , Pneumonectomia/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
19.
J Med Case Rep ; 15(1): 205, 2021 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-33906689

RESUMO

BACKGROUND: The median sternotomy approach in sleeve pneumonectomy enables diseased lung ventilation in selected cases, which may reduce the difficulty in achieving anastomosis under intubation of the left main bronchus. However, with median sternotomy, the ascending aorta requires repeated mobilization to expose the operative field for anastomosis, which can cause an aortogenic embolic stroke. CASE PRESENTATION: A 70-year-old Asian man presenting 6 months after developing hemoptysis was diagnosed with right upper lobe lung cancer (stage T4N0M0), invading the lower trachea and basal bronchus. Preoperative computed tomography revealed ascending aorta calcification. Right sleeve pneumonectomy was performed using median sternotomy with diseased lung ventilation. The ascending aorta was repeatedly mobilized to adequately expose the tracheobronchial bifurcation. Surgery was uneventful, but he did not recover complete consciousness even after termination of anesthesia. Mild paralysis of both upper extremities was observed. Head magnetic resonance imaging on postoperative day 1 revealed multiple small acute infarctions in the brain, possibly caused by mobilization of the aorta. He received anticoagulation therapy and rehabilitation and was discharged on postoperative day 30. CONCLUSION: The median sternotomy approach in sleeve pneumonectomy enables diseased lung ventilation. However, the possibility of aortogenic embolic stroke should be considered when calcification of the ascending aorta is observed on preoperative computed tomography.


Assuntos
AVC Embólico/etiologia , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/cirurgia , Pneumonectomia/efeitos adversos , Esternotomia/efeitos adversos , Idoso , Brônquios , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Masculino , Recidiva Local de Neoplasia
20.
Anticancer Res ; 41(4): 2165-2169, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33813428

RESUMO

BACKGROUND/AIM: In centrally-located lung cancer treatment, it is difficult to attain a sufficient resection margin. It is important to investigate recurrent styles in centrally-located lung cancer patients. PATIENTS AND METHODS: Primary lung cancer located at the hilar area that requires pneumonectomy or sleeve lobectomy is defined as centrally-located lung cancer. Early recurrence was defined as that within 1 year after surgery. RESULTS: This study included 43 centrally-located lung cancer patients. Ten patients underwent pneumonectomy and 33 underwent sleeve lobectomy. Eleven patients experienced early recurrence. Non-squamous cell carcinoma (p=0.012), tumor size>64 mm (p<0.001) and pathological N2 (p=0.012) were significant predictors for early recurrence by univariate analysis. Also, tumor size >64 mm (p=0.006) and pathological N2 (p=0.019) were independent predictors by multivariate analysis. CONCLUSION: Non-squamous cell carcinoma, tumor size and pathological N2 were significant predictors of early recurrence in centrally-located lung cancer. The type of surgical procedure did not affect recurrence development.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/cirurgia , Linfonodos/patologia , Carga Tumoral/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/patologia , Feminino , Seguimentos , Humanos , Neoplasias Pulmonares/patologia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Pneumonectomia/efeitos adversos , Pneumonectomia/métodos , Período Pós-Operatório , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
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