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1.
Medicine (Baltimore) ; 99(41): e22485, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33031281

RESUMO

RATIONALE: Bronchopleural fistula (BPF) is a dreaded complication after lobectomy or pneumonectomy and is associated with high morbidity and mortality. Successful management remains challenging when this condition is combined with empyema, and the initial treatment is usually conservative and endoscopic, but operative intervention may be required in refractory cases. PATIENT CONCERNS: Two patients diagnosed with BPF with empyema were selected to undergo surgery in our hospital because they could not be cured by conservative and endoscopic therapy for 1 or more years. One was a 70-year-old man who had a 1-year history of fever and cough after he received a minimally invasive right lower lobectomy for intermediate lung adenocarcinoma and chemotherapy 2 years ago; the other was a 73-year-old man who had a 2-year history of cough and fever after he underwent a minimally invasive right upper lobectomy for early lung adenocarcinoma 3 years earlier. DIAGNOSIS: Both patients were diagnosed with BPF with empyema. INTERVENTIONS: After receiving conservative and endoscopic therapies, both patients underwent pedicled latissimus dorsi muscle flap transfers for complete filling of the empyema cavity. OUTCOMES: The patients recovered very well, with no recurrence of BPF and empyema during postoperative follow-up. LESSONS: It is crucial to not only completely control infection and occlude BPFs, but also obliterate the empyema cavity. Thus, pedicled latissimus dorsi muscle flap transfer associated with conservative and endoscopic therapies for BPF with empyema is a useful treatment option, offering feasible and efficient management with promising results.


Assuntos
Fístula Brônquica/cirurgia , Empiema Pleural/cirurgia , Fístula/cirurgia , Músculos Superficiais do Dorso/transplante , Idoso , Fístula Brônquica/etiologia , Empiema Pleural/etiologia , Fístula/etiologia , Humanos , Masculino , Pneumonectomia/efeitos adversos , Retalhos Cirúrgicos
2.
Orv Hetil ; 161(29): 1215-1220, 2020 07.
Artigo em Húngaro | MEDLINE | ID: mdl-32628621

RESUMO

INTRODUCTION: In our retrospective study, we examined changes in the histological results and types of metastatectomies of pulmonary metastases during the last 12 years, in two 5-year periods. AIM AND METHOD: There were 55 patients in the first group (2006-2010), 54.5% of the patients were male (n = 30), 45.5% were female (n = 25), the mean age was 57.9 years (24-80). The second group (2014-2018) consisted of 115 patients, with 60% male (n = 69) and 40% female (n = 46), the mean age was 62.2 years (26-82). RESULTS: During the first period, the primary tumor was found in the rectum 19.3% (n = 11), colon 17.5% (n = 10), or kidney 14% (n = 8), while during the second period, the primary tumor was in the colon in 23.1% (n = 31), in the rectum in 15.7% (n = 21), or in the kidney in 9% (n = 12). The following types of surgeries were performed: atypical resection: 38.6% (n = 22) and 46.3% (n = 62); lobectomy in 31.6% (n = 18) and 26.9% (n = 36); pulmonectomy in 10.5% (n = 6) and 1.5% (n = 2); segmentectomy in 7% (n = 4) and 9.7% (n = 13); and bilobectomy in 1.8% (n = 1) and 0.7% (n = 1) in the first and second group, respectively. The ratio of video-assisted thoracic surgery (VATS) was 5.3% (n = 3) during the first period, and this ratio increased to 64.9% (n = 87) during the second period. The mean disease-free survival between the surgery of the primary tumor and the removal of the pulmonary metastasis was 45.2 months (0-144) during the first period and 33.8 months (0-180) during the second period. The median survival was 39 months in the first period, and it increased to 59 months in the second group. The mean 5-year survival was 41% in both groups. CONCLUSION: During the last 12 years, there was a more than two-fold increase in the number of patients requiring surgery due to pulmonary metastases, and the ratio of VATS metastasectomy increased significantly as well (5.3% vs. 64.9%). No significant difference was found in the ratio of the types of the primary tumors. The median survival was slightly better in the second group. Orv Hetil; 161(29): 1215-1220.


Assuntos
Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/cirurgia , Metastasectomia/métodos , Pneumonectomia/métodos , Cirurgia Torácica Vídeoassistida/métodos , Toracotomia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/patologia , Neoplasias Colorretais/patologia , Feminino , Humanos , Neoplasias Renais/patologia , Masculino , Metastasectomia/efeitos adversos , Pessoa de Meia-Idade , Pneumonectomia/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
3.
Medicine (Baltimore) ; 99(26): e20768, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590754

RESUMO

BACKGROUND: The operation of lung cancer may squeeze the tumor and further promote the spread of tumor cells to the circulation, which may be one of the reasons for the metastasis and recurrence of lung cancer. The potential risk of tumor cell dissemination can theoretically be minimized if the effluent veins were ligated first (via the vein-first [V-first] technique), instead of having the artery ligated first (via the artery-first [A-first] technique). However, this technical concept has not yet been widely accepted as a standard of surgical oncology in current guidelines owing to a lack of sufficient evidence. This systematic review and meta-analysis will be performed to determine which technique during lobectomy will achieve longer patient survival and be more beneficial for patients. METHODS: We will search PubMed, Web of Science, EMBASE, Cancerlit, the Cochrane Central Register of Controlled Trials, and Google Scholar databases for relevant clinical trials published in any language before October 1, 2020. Randomized controlled trials (RCTs), quasi-RCTs, propensity score-matched comparative studies, and prospective cohort studies of interest, published or unpublished, that meet the inclusion criteria will be included. Subgroup analysis of the type of operation, tumor pathological stage, and ethnicity will be performed. INPLASY registration number: INPLASY202050060. RESULTS: The results of this study will be published in a peer-reviewed journal. CONCLUSION: As far as we know, this study will be the first meta-analysis to compare the efficacy of the vein-first and artery-first surgical technique of lobectomy for patients diagnosed with resectable non-small cell lung cancer. Due to the nature of the disease and intervention methods, randomized controlled trials may be inadequate, and we will carefully consider inclusion in high-quality, non-randomized controlled trials, but this may result in high heterogeneity and affect the reliability of the results.


Assuntos
Artérias/cirurgia , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Ligadura/métodos , Neoplasias Pulmonares/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Procedimentos Cirúrgicos Vasculares/métodos , Veias/cirurgia , Carcinoma Pulmonar de Células não Pequenas/patologia , Humanos , Neoplasias Pulmonares/patologia , Metanálise como Assunto , Inoculação de Neoplasia , Pneumonectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Projetos de Pesquisa , Revisões Sistemáticas como Assunto
4.
Pneumologie ; 74(6): 371-373, 2020 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-32557508

RESUMO

HISTORY: An 80-year old female was referred to our hospital with left internal carotid artery stenosis and a childhood history of hemoptysis. INVESTIGATIONS AND DIAGNOSIS: The ECG showed 2nd degree Mobitz atrio-ventricular block. The chest x-ray and computerized tomography identified a shift of the mediastinum and the heart to the left. The left lung was completely destroyed whilst the right lung was enlarged and crossed the midline. Pulmonary function tests revealed a moderate restrictive ventilation disorder. The diagnosis of autopneumonectomy was based on patient history together with radiological findings. TREATMENT AND COURSE: A pacemaker was implanted with two stimulation electrodes via a left cephalic venous cutdown. A carotid endarterectomy was also performed without any complication. CONCLUSION: After autopneumonectomy, postpneumonectomy like syndrome may occur in very rare cases, whereupon operative treatment is mandatory. Any respiratory infections should be treated with antibiotics. Pacemaker electrode placement via the subclavian vein is contraindicated due to the risk of a catastrophic pneumothorax.


Assuntos
Estenose das Carótidas , Pneumopatias , Marca-Passo Artificial , Pneumonectomia/efeitos adversos , Idoso de 80 Anos ou mais , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/cirurgia , Endarterectomia das Carótidas , Feminino , Hemoptise , Humanos , Pulmão , Pneumopatias/complicações , Pneumopatias/diagnóstico por imagem , Pneumopatias/fisiopatologia , Testes de Função Respiratória , Veia Subclávia , Resultado do Tratamento , Venostomia
5.
Lancet Oncol ; 21(6): 786-795, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32386568

RESUMO

BACKGROUND: Approximately 25% of all patients with non-small-cell lung cancer present with resectable stage IB-IIIA disease, and although perioperative chemotherapy is the standard of care, this treatment strategy provides only modest survival benefits. On the basis of the activity of immune checkpoint inhibitors in metastatic non-small-cell lung cancer, we designed a trial to test the activity of the PD-L1 inhibitor, atezolizumab, with carboplatin and nab-paclitaxel given as neoadjuvant treatment before surgical resection. METHODS: This open-label, multicentre, single-arm, phase 2 trial was done at three hospitals in the USA. Eligible patients were aged 18 years or older and had resectable American Joint Committee on Cancer-defined stage IB-IIIA non-small-cell lung cancer, an Eastern Cooperative Oncology Group performance status of 0-1, and a history of smoking exposure. Patients received neoadjuvant treatment with intravenous atezolizumab (1200 mg) on day 1, nab-paclitaxel (100 mg/m2) on days 1, 8, and 15, and carboplatin (area under the curve 5; 5 mg/mL per min) on day 1, of each 21-day cycle. Patients without disease progression after two cycles proceeded to receive two further cycles, which were then followed by surgical resection. The primary endpoint was major pathological response, defined as the presence of 10% or less residual viable tumour at the time of surgery. All analyses were intention to treat. This study is registered with ClinicalTrials.gov, NCT02716038, and is ongoing but no longer recruiting participants. FINDINGS: Between May 26, 2016, and March 1, 2019, we assessed 39 patients for eligibility, of whom 30 patients were enrolled. 23 (77%) of these patients had stage IIIA disease. 29 (97%) patients were taken into the operating theatre, and 26 (87%) underwent successful R0 resection. At the data cutoff (Aug 7, 2019), the median follow-up period was 12·9 months (IQR 6·2-22·9). 17 (57%; 95% CI 37-75) of 30 patients had a major pathological response. The most common treatment-related grade 3-4 adverse events were neutropenia (15 [50%] of 30 patients), increased alanine aminotransferase concentrations (two [7%] patients), increased aspartate aminotransferase concentration (two [7%] patients), and thrombocytopenia (two [7%] patients). Serious treatment-related adverse events included one (3%) patient with grade 3 febrile neutropenia, one (3%) patient with grade 4 hyperglycaemia, and one (3%) patient with grade 2 bronchopulmonary haemorrhage. There were no treatment-related deaths. INTERPRETATION: Atezolizumab plus carboplatin and nab-paclitaxel could be a potential neoadjuvant regimen for resectable non-small-cell lung cancer, with a high proportion of patients achieving a major pathological response, and manageable treatment-related toxic effects, which did not compromise surgical resection. FUNDING: Genentech and Celgene.


Assuntos
Anticorpos Monoclonais Humanizados/administração & dosagem , Antineoplásicos Imunológicos/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/terapia , Neoplasias Pulmonares/terapia , Terapia Neoadjuvante , Pneumonectomia , Receptor de Morte Celular Programada 1/antagonistas & inibidores , Idoso , Albuminas/administração & dosagem , Anticorpos Monoclonais Humanizados/efeitos adversos , Antineoplásicos Imunológicos/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Boston , Carboplatina/administração & dosagem , Carcinoma Pulmonar de Células não Pequenas/imunologia , Carcinoma Pulmonar de Células não Pequenas/patologia , Quimioterapia Adjuvante , Feminino , Humanos , Neoplasias Pulmonares/imunologia , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/efeitos adversos , Estadiamento de Neoplasias , Cidade de Nova Iorque , Paclitaxel/administração & dosagem , Pneumonectomia/efeitos adversos , Receptor de Morte Celular Programada 1/imunologia , Fatores de Tempo , Resultado do Tratamento
6.
J Surg Oncol ; 122(2): 328-335, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32436267

RESUMO

INTRODUCTION: Sleeve resection is an established oncological operative treatment for centrally located tumors with reduced complications compared to pneumonectomy. In cases of neoadjuvant chemoradiotherapy, the optimal timing of surgery for bronchial anastomotic healing has not been adequately explored. MATERIALS AND METHODS: Between 2006 and 2017, 584 tracheobronchial sleeve resections were retrospectively analyzed. We selected all patients (n = 88) after sleeve lobectomy or sleeve bilobectomy for lung cancer with fully completed neoadjuvant chemoradiotherapy. Bronchial healing was assessed by bronchoscopy on the 7th postoperative day using our earlier published classification from grades 1 to 5. RESULTS: The median interval to surgery was 50 days (interquartile range 46-53, mean 50.03 ± 3.72). Mean anastomotic grade was 2.05 ± 1.03 and in 29.5% of the patients a critical anastomosis (grade ≥3) was documented. Anastomotic healing showed optimal results (bronchoscopic grade mean value: 1.5 ± 0.70) between the 6th and 8th postchemoradiotherapy week (P = .001). All patients operated before (bronchoscopic grade mean value: 2.3 ± 1.02) or after the above period (bronchoscopic grade mean value: 2.5 ± 1.15) had an increased ratio of anastomotic healing complications. CONCLUSION: It is safer to perform sleeve-resections for non-small cell lung cancer after neoadjuvant trimodal treatment between the 6th and 8th week of completion of chemoradiotherapy.


Assuntos
Anastomose Cirúrgica/métodos , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/cirurgia , Pneumonectomia/métodos , Anastomose Cirúrgica/efeitos adversos , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Quimiorradioterapia Adjuvante , Feminino , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/radioterapia , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Pneumonectomia/efeitos adversos , Estudos Retrospectivos
7.
Kyobu Geka ; 73(2): 121-123, 2020 Feb.
Artigo em Japonês | MEDLINE | ID: mdl-32393719

RESUMO

The patient was a 78-year-old man who had undergone left lung segmentectomy (S6) with lymph node dissection for lung adenocarcinoma. One year and 5 months later, lung partial resection was performed for the lung cancer recurrence and the hematemesis was noted on the next day of surgery. Upper gastrointestinal endoscopy revealed extensive black necrosis on the mucosa of the esophagus, which was diagnosed as acute necrotizing esophagitis. To treat the bleeding, the exposed esophageal vessels were clipped via endoscopy several times. The endoscopy on the 64th post-operative day showed the mucosa recovered and he could be discharged on the 85th day. The exact etiology of acute necrotizing esophagitis is unknown in most cases.


Assuntos
Esofagite , Neoplasias Pulmonares , Pneumonectomia/efeitos adversos , Doença Aguda , Idoso , Esofagite/etiologia , Humanos , Neoplasias Pulmonares/cirurgia , Masculino , Necrose/etiologia , Recidiva Local de Neoplasia
9.
J Cardiothorac Surg ; 15(1): 110, 2020 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-32448399

RESUMO

BACKGROUND: The present study aimed to use an ex-vivo model to investigate whether a new method involving the use of fibrin glue and a polyglycolic acid (PGA) sheet under ventilation enhances the sealing effect after repair of the pleural defect. METHODS: Ex-vivo pig lungs were used in this study. We investigated the maximum pressure tolerance of pleural defects repaired using three methods: 1, directly spraying fibrin glue over a PGA sheet; 2, spreading fibrinogen on the site then sealing with a PGA sheet and spraying with fibrin glue; and 3, spreading fibrinogen while maintaining ventilation then sealing with a PGA sheet and spraying with fibrin glue. RESULTS: The maximum tolerable pressures were as follows (mean ± standard deviation, cmH2O): Method 1, 37.1 ± 13.6, Method 2, 71.4 ± 27.7, Method 3, 111.5 ± 8.8. Histological findings explained the difference in tolerable pressure at the repaired site between methods. Microscopic findings of lungs repaired using Method 3 indicated that the fibrinogen penetrated into deeper tissues to act as an anchor. CONCLUSIONS: Fibrin glue sealing under ventilation increases the anchoring effect of repairing air leakages due to pleural defect in an ex-vivo model. This method may have clinical application. For example, it may be useful to reduce severe air leakage in patients who undergo lung-sparing surgery for a pleural tumor.


Assuntos
Adesivo Tecidual de Fibrina/farmacologia , Pleura/cirurgia , Pneumonectomia/efeitos adversos , Complicações Pós-Operatórias/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Animais , Modelos Animais de Doenças , Pleura/patologia , Complicações Pós-Operatórias/etiologia , Suínos , Adesivos Teciduais/farmacologia
11.
J Thorac Cardiovasc Surg ; 160(1): 247-255.e5, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32249082

RESUMO

OBJECTIVES: Mortality rates of 5% to 10% after pneumonectomy have remained constant during the last decade. To understand the patterns of outcomes after pneumonectomy, we investigated the time-varying risks of readmission and death during the first postoperative year and examined the contributions of specific causes to these patterns over time. METHODS: We retrospectively reviewed all pneumonectomies for lung cancer at our institution from 2000 to 2018. The time-varying instantaneous risk of all-cause readmission and mortality up to 1 year after pneumonectomy was estimated using parametric analyses and was repeated for each primary cause of readmission (oncologic, infectious, pulmonary, cardiac, or other) and death (oncologic or nononcologic). RESULTS: In our cohort of 355 patients who underwent pneumonectomy, risk of readmission was highest immediately after discharge and was halved by 14 days. This risk reached a nadir and remained constant from 4 to 8 months, after which it gradually increased. Pulmonary causes accounted for most readmissions within 90 days, after which oncologic causes predominated. Likewise, the overall risk of death was highest immediately after surgery, was halved by 7 days, reached a nadir at 90 days, and then increased throughout the remainder of the first year. All deaths during the first 90 days after surgery were due to nononcologic causes. CONCLUSIONS: Nononcologic causes of readmission and death predominate in the first 90 days after pneumonectomy, after which oncologic causes prevail. We also identify specific causes that pose the highest risk of readmission immediately after discharge. Efforts are warranted to define the effects of specific causes of readmission on overall mortality after pneumonectomy.


Assuntos
Readmissão do Paciente/estatística & dados numéricos , Pneumonectomia/efeitos adversos , Pneumonectomia/mortalidade , Idoso , Feminino , Humanos , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Estudos Retrospectivos , Resultado do Tratamento
12.
Ann Thorac Surg ; 110(1): 258-264, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32171731

RESUMO

BACKGROUND: The perioperative outcomes of the use of stapling devices versus electrocautery to dissect intersegmental planes in patients undergoing segmentectomy for small pulmonary lesions is still unclear. The aim of this randomized controlled trial was to compare the perioperative outcomes of these two methods. METHODS: A single-center, prospective, participant-blinded, randomized controlled trial (NCT03192904) was conducted with a preplanned sample size of 136. The primary outcome was the incidence of postoperative complications. Secondary outcomes included duration of operation, blood loss during operation, first-day drainage volume, duration of drainage, postoperative hospital stay, loss of lung function, and medical costs. RESULTS: The trial was stopped early as a result of a marked difference in the primary outcome between groups at a scheduled interim check of the data after recruiting 70 patients. The incidence of postoperative complications (eg, air leakage) was higher in the electrocautery group than in the stapler device group (11/32, 34.4% vs 2/33, 6.1%, P = .004). There were no differences in duration of operation, blood loss during operation, first-day drainage volume, duration of drainage, postoperative hospital stays, loss of lung function, or total medical cost, although the per-patient cost of medical materials was higher in the stapler device group (US$4214.6 ± 1185.4 vs $3260.1 ± 852.6, P < .001). CONCLUSIONS: Among patients undergoing segmentectomy, the use of stapler devices to divide intersegmental planes decreased postoperative complications without further compromising lung function or increasing economic burden.


Assuntos
Dissecação/métodos , Eletrocoagulação/efeitos adversos , Neoplasias Pulmonares/cirurgia , Pneumonectomia/métodos , Complicações Pós-Operatórias/epidemiologia , Grampeamento Cirúrgico/efeitos adversos , Adulto , Dissecação/efeitos adversos , Dissecação/instrumentação , Eletrocoagulação/instrumentação , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Pneumonectomia/efeitos adversos , Pneumonectomia/instrumentação , Estudos Prospectivos , Grampeadores Cirúrgicos
13.
Ann Thorac Surg ; 109(6): 1692-1699, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32057812

RESUMO

BACKGROUND: The choice between electrocautery or automatic suturing instruments for dissection of the lung parenchyma along the intersegmental plane during lung segmentectomy remains controversial. We hypothesized that a novel microwave surgical instrument (MSI) for dissecting the lung parenchyma could have excellent sealing effects. We examined the feasibility and safety of lung parenchymal dissection using a MSI during lung segmentectomy. METHODS: This was a prospective clinical study of lung segmentectomy involving dissection of the entire intersegmental plane using a MSI. Complications related to sealing of the lung parenchyma were evaluated and perioperative outcomes were compared to those of patients who underwent lung segmentectomy using automatic suturing instruments. Propensity score-matched comparisons were used to assess the potential impact of selection bias. RESULTS: Lung segmentectomy using a MSI was successfully performed in 30 patients. According to the propensity score matching analysis, intraoperative blood loss, length of hospital stay, and postoperative complications of the microwave group were significantly lesser (P = .019, .003, and .008, respectively) compared to those of the control group (n = 66). Prolonged air leakage was not observed. There were two cases of subcutaneous emphysema after removal of the chest tube, but no other grade 2 or higher complications were observed. No mortality occurred within 30 or 90 days postoperatively. CONCLUSIONS: The use of a MSI for lung parenchymal dissection was associated with lower blood loss during surgical procedures, reduced air leakage after the operation, and fewer postoperative complications.


Assuntos
Pneumonectomia/instrumentação , Pneumonectomia/métodos , Idoso , Idoso de 80 Anos ou mais , Dissecação/métodos , Desenho de Equipamento , Estudos de Viabilidade , Feminino , Humanos , Pulmão/cirurgia , Masculino , Micro-Ondas/uso terapêutico , Pessoa de Meia-Idade , Tecido Parenquimatoso/cirurgia , Pneumonectomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Ablação por Radiofrequência , Técnicas de Sutura/instrumentação , Resultado do Tratamento
14.
Zhongguo Fei Ai Za Zhi ; 23(1): 50-54, 2020 Jan 20.
Artigo em Chinês | MEDLINE | ID: mdl-31948538

RESUMO

BACKGROUND: Da Vinci robotic system is currently widely used in thoracic surgery. The ports employment and procedures vary in different medical center in China. Usually, a small incision was used for assistant. METHODS: Based on clinical practice, we summarized domestic and foreign experience, combined with the characteristics of the Chinese body anatomy, employ portal technique and artificial pneumothorax, summarized a set of simplified and easier surgical method. RESULTS: Port-only artificial pneumothorax robot-assisted lobectomy has further improvement in anatomical safety, hemostatic effect and aesthetic appearance of the wound. CONCLUSIONS: This study optimizes the procedure of port-only artificial pneumothorax robot-assisted lobectomy in order to serve lung cancer patients better.


Assuntos
Pneumonectomia/métodos , Pneumotórax Artificial/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Humanos , Neoplasias Pulmonares/cirurgia , Pneumonectomia/efeitos adversos , Pneumotórax Artificial/efeitos adversos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Segurança
15.
Ann Thorac Surg ; 109(4): 1104-1111, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31891695

RESUMO

BACKGROUND: Current knowledge about sex-related differences states that pain is generally more frequent and intense in women. Because severe postthoracotomy pain is associated with complications, sufficient pain control is essential. Data on sex-related aspects in the context of pain after thoracotomy are scarce. The study attempted to determine whether sex significantly affects pain and pain treatment after thoracotomy. METHODS: This retrospective study assessed visual analogue scale (VAS) scores and analgesic consumption (opioids and diclofenac) during the first 5 days after surgery and the point in time when analgesics were changed from the intravenous to the oral route in patients who had open lung surgery. The influences of sex, PCEA (patient-controlled epidural analgesia), age, and surgical factors were evaluated with mixed-model analysis. RESULTS: The study was able to include 344 patients (130 female, 214 male). The VAS scores model did not consider sex as relevant. The opioid model showed a PCEA-time-sex interaction with increasing opioid demand after day 3 that predominantly affected male patients (P < .001). Diclofenac doses where significantly higher in an interaction of female sex and small extent of surgery (P = .007). Posterolateral thoracotomy led to significantly higher VAS scores (P < .001) and higher demand for opioids (P = .007) and diclofenac (P = .012). CONCLUSIONS: The study concluded that there are no general sex-related differences in pain intensity and analgesic requirement after thoracotomy. Anterolateral thoracotomy was the less painful surgical approach. PCEA had favorable results, although there seemed to a rebound pain phenomenon after epidural catheter removal on postoperative day 3 that mainly affected male patients.


Assuntos
Dor Pós-Operatória/epidemiologia , Toracotomia/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Analgesia Controlada pelo Paciente , Analgésicos/uso terapêutico , Feminino , Humanos , Pneumopatias/patologia , Pneumopatias/cirurgia , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/tratamento farmacológico , Pneumonectomia/efeitos adversos , Estudos Retrospectivos , Fatores Sexuais , Adulto Jovem
17.
Ann Thorac Surg ; 109(4): 1040-1046, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31926158

RESUMO

BACKGROUND: Patients undergoing thoracic lung wedge resection could benefit from tubeless strategies. However, postoperative pneumothorax is a primary limiting factor for such strategies. Accordingly, we evaluated the safety and efficacy of the prophylactic use of an air-extraction catheter as an improved drainage strategy and compared the findings with those for chest tube drainage in patients undergoing thoracic wedge resection. METHODS: Patients undergoing thoracic wedge resection between August 2017 and October 2018 were enrolled in this single-center, randomized, open-label, noninferiority trial. Patients who received an improved drainage strategy involving the use of a prophylactic air-extraction catheter were randomized to the intervention group, whereas those who underwent routine chest tube drainage were assigned to the control group. Analysis was based on the per-protocol population. The primary outcome was the incidence of pneumothorax on postoperative day 1. Secondary outcomes included patient recovery and related complications, including pleural effusion, lung infection, numeric rating scale score for pain, postoperative chest tube or catheter removal, postoperative hospitalization, and chest tube reinsertion. RESULTS: A total of 96 patients were randomized. Baseline demographic and clinical characteristics were similar between groups. The incidence of pneumothorax in the intervention and control groups was 10.0% and 9.1%, respectively (noninferiority, P = 1.00). In addition, there were no significant between-group differences in secondary outcomes. A significantly lower pain score was observed in the intervention group (P = .001). CONCLUSIONS: The improved drainage strategy is not inferior to standard chest tube drainage after thoracic wedge resection and should be popularized.


Assuntos
Drenagem/métodos , Pneumopatias/cirurgia , Pneumonectomia/efeitos adversos , Pneumotórax/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Toracoscopia/efeitos adversos , Adulto , Idoso , Tubos Torácicos , Feminino , Humanos , Incidência , Pneumopatias/complicações , Masculino , Pessoa de Meia-Idade , Pneumotórax/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos
18.
J Thorac Cardiovasc Surg ; 159(6): 2469-2483.e4, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31928821

RESUMO

OBJECTIVE: Conversion to lobectomy is typically performed when positive lymph nodes are found during intentional segmentectomy. Our objective was to evaluate survival after lobectomy and segmentectomy in patients with unsuspected nodal metastases. METHODS: The National Cancer Database was queried for patients with clinical T1N0, pathological N1/N2 non-small cell lung cancer (NSCLC) who underwent either lobectomy or segmentectomy. Survival differences between the 2 groups were evaluated using a propensity score model. Cox regression analysis was used to evaluate predictors of overall survival, including adjuvant treatment. Statistical analysis was done using SPSS version 21.0 (IBM Corp, Armonk, NY). RESULTS: Between 2004 and 2015, unsuspected pathological N1 disease for clinical T1N0M0 NSCLC was found in 2.5% (228/9118) and 6.7% (8915/132,604) of patients who underwent segmentectomy and lobectomy, respectively. The incidence of unsuspected pathological N2 disease for clinical T1N0M0 NSCLC was 2.4% (224/9118) after segmentectomy and 3.9% (5192/132,604) after lobectomy. Using propensity matched pairs (227 pairs for N1 and 215 for N2), segmentectomy showed equivalent 5-year survival compared with lobectomy for the N1 group (41.9% vs 44.3%; P = .35), and N2 group (41.6% vs 37.2%; P = .99). In a multivariable model, adjuvant chemotherapy was associated with better survival of patients with unsuspected N1 (hazard ratio, 0.613; 95% confidence interval, 0.536-0.700; P < .001) and N2 (hazard ratio, 0.684; 95% confidence interval, 0.583-0.802; P < .001) nodal metastases. CONCLUSIONS: Survival is similar between lobectomy and segmentectomy for clinical T1N0 and unsuspected pathological N1/N2 nodal metastases. The use of adjuvant chemotherapy significantly improves survival in patients with lymph node metastasis (N1/N2) independent of the type of anatomic lung resection.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/cirurgia , Pneumonectomia/mortalidade , Idoso , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Carcinoma Pulmonar de Células não Pequenas/secundário , Quimioterapia Adjuvante/mortalidade , Bases de Dados Factuais , Progressão da Doença , Feminino , Humanos , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Metástase Linfática , Masculino , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Pneumonectomia/efeitos adversos , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
19.
Ann Thorac Surg ; 109(5): 1591-1597, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31953045

RESUMO

BACKGROUND: There is still controversy whether full lung palpation is required for patients undergoing pulmonary metastasectomy. We aimed to compare pulmonary ipsilateral recurrence (IR) after video-assisted thoracic surgery (VATS) or open surgery. METHODS: A retrospective study of all patients who underwent surgery for colorectal cancer lung metastases between 2003 and 2012 was performed. IR rate was compared between the 2 groups after adjusting for a propensity score matching based on age, sex, disease-free interval, number of metastases, type of resection, presence of a cardiovascular risk factor, presence of a respiratory risk factor, as well as the interaction between the number of metastases and the disease-free interval. The propensity score was used for matched and weighted comparisons of VATS and open patients. RESULTS: A total of 211 patients underwent surgery for colorectal cancer lung metastases. Of these, 75 (35.5%) were performed via VATS and 136 (64.5%) via open surgery. Before matching, 118 (55.9%) were male and the median age at the time of metastases diagnosis was 61 (range, 49.8-72.2) years. Median disease free-interval was 20 (19.7 ± 28.3) months; 22 (21.6 ± 28.5) months in VATS and 19 (19.0 ± 28.3) months in open surgery. In total, 19 (25.3%) developed IR in VATS, and 39 (28.7%) in open surgery. Five-year overall survival was 53.1% (61.9% VATS; 49.2% open). In the matched sample, IR was 23.6% in VATS vs 26.2% in open surgery (95% confidence interval for risk reduction with VATS: -22.6% to 17.5%; P = .80). CONCLUSIONS: No significant difference was observed in IR rates between VATS and open surgery in the treatment of colorectal cancer lung metastases.


Assuntos
Neoplasias Colorretais/patologia , Neoplasias Pulmonares/cirurgia , Metastasectomia/efeitos adversos , Recidiva Local de Neoplasia/epidemiologia , Pneumonectomia/efeitos adversos , Cirurgia Torácica Vídeoassistida/efeitos adversos , Toracotomia/efeitos adversos , Feminino , Seguimentos , Humanos , Incidência , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/secundário , Masculino , Metastasectomia/métodos , Pessoa de Meia-Idade , Metástase Neoplásica , Ontário/epidemiologia , Pneumonectomia/métodos , Estudos Retrospectivos
20.
World J Surg Oncol ; 18(1): 5, 2020 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-31901232

RESUMO

BACKGROUND: The necessity of the inferior pulmonary ligament (IPL) dissection after an upper lobectomy remains controversial. This meta-analysis aimed to evaluate whether this accessional procedure could reduce the postoperative complications and improve outcomes. METHODS: PubMed, Embase, Ovid, Cochrane Library, CBM, and CNKI databases were searched for the relevant studies which compared the dissection with preservation of IPL during the upper lobectomy. The Review Manager 5.3 software was used for this meta-analysis. RESULTS: Three RCTs and five CCTs were included in this meta-analysis. These studies contained a total of 610 patients, in which 315 patients received a pulmonary ligament dissection (group D) after the upper lobectomy, while the other 295 patients preserved the pulmonary ligament (group P). No significant difference was demonstrated between the group D and group P in terms of drainage time after surgery (MD 0.14, 95%CI - 0.05 to 0.33, P = 0.15), rate of postoperative dead space (OR 1.33, 95%CI 0.72 to 2.46, P = 0.36), rate of postoperative complications (OR 1.20, 95%CI 0.66 to 2.19, P = 0.56). However, the pooled comparison revealed a greater change of the right main bronchial angle (MD 5.00, 95%CI 1.68 to 8.33, P = 0.003) in group D compared with group P, indicated that the dissection of IPL may lead to a greater distortion of bronchus. CONCLUSIONS: This meta-analysis confirmed that the dissection of IPL do not effectively reduce the postoperative complications and improve the prognosis. Therefore, it is not necessary to dissect the IPL after an upper lobectomy.


Assuntos
Ligamentos/cirurgia , Neoplasias Pulmonares/cirurgia , Tratamentos com Preservação do Órgão/métodos , Pneumonectomia/métodos , Dissecação/efeitos adversos , Dissecação/métodos , Humanos , Ligamentos/patologia , Neoplasias Pulmonares/patologia , Tratamentos com Preservação do Órgão/efeitos adversos , Pneumonectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Prognóstico , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos
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