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1.
Anticancer Res ; 39(12): 6835-6842, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31810950

RESUMO

BACKGROUND/AIM: Typical carcinoids (TC) and atypical carcinoids (AC) are rare diseases. A paucity of randomized studies and disagreements among various guidelines makes the management challenging. PATIENTS AND METHODS: Using codes for TC (8240) and AC (8249) in the National Cancer Database (NCDB), all surgically resected cases from 2004-2014 were included to evaluate the need for adjuvant chemotherapy. RESULTS: A total of 6,673 cases were included, 88% were TCs and 12% were ACs. From 2004 to 2014, the proportion of TCs went up from 1.3% to 1.8% and ACs from 0.1% to 0.3% of all lung malignancies. TC patients did well with surgery alone in all stages. AC patients with stage I [5-year overall survival (OS) - 84% vs. 52%; S vs. S+CT] and stage II disease (5-year OS - 81% vs. 55%; S vs. S+CT) showed better OS trend with surgery alone, while stage III patients showed some benefit with the use of adjuvant chemotherapy (5-year OS - 46% vs. 54%; S vs. S+CT). These results supported the National Comprehensive Cancer Network (NCCN) guidelines. CONCLUSION: No benefit was seen from adjuvant chemotherapy in TCs. While the adjuvant therapy may add benefit in stage III AC, the numbers are small and did not reach statistical significance.


Assuntos
Tumor Carcinoide/terapia , Quimioterapia Adjuvante/métodos , Neoplasias Pulmonares/terapia , Procedimentos Cirúrgicos Pulmonares/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Tumor Carcinoide/patologia , Feminino , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Análise de Sobrevida , Resultado do Tratamento , Adulto Jovem
2.
J Comput Assist Tomogr ; 43(6): 906-911, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31738213

RESUMO

The aim of this article was to review computed tomography angiography and magnetic resonance angiography of pulmonary atresia with ventricular septal defect. This disorder is a rare complex congenital heart disease. Preoperative imaging of pulmonary atresia with ventricular septal defect with computed tomography angiography and magnetic resonance angiography is important for complete anatomical delineation and planning for treatment. Preoperative imaging used for assessment of the main pulmonary artery (its size, valve, and confluence), aortopulmonary collaterals (its origin, insertion, course, and size), presence of patent ductus arteriosus, other sources of collaterals as bronchial and coronary arteries, and pattern of pulmonary arborization. Imaging can detect associated aortic, pulmonary venous and coronary anomalies, and other congenital heart disease. Postoperative imaging after unifocalization and stent is for assessment of patency, stenosis, and occlusion of stent or perivascular lesions as seroma.


Assuntos
Defeitos dos Septos Cardíacos/diagnóstico por imagem , Defeitos dos Septos Cardíacos/cirurgia , Atresia Pulmonar/diagnóstico por imagem , Atresia Pulmonar/cirurgia , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Cateterismo Cardíaco , Procedimentos Cirúrgicos Cardíacos , Angiografia por Tomografia Computadorizada , Humanos , Angiografia por Ressonância Magnética , Período Pós-Operatório , Período Pré-Operatório , Procedimentos Cirúrgicos Pulmonares
3.
Zentralbl Chir ; 144(S 01): S12-S19, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31291668

RESUMO

Arrhythmias are common after pulmonary resection. They often complicate the patient's recovery and can have an effect on the short-term and long-term prognosis. The aim of the following review is to give an overview of risk factors, prevention and therapy of arrhythmias following lung surgery.


Assuntos
Arritmias Cardíacas , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Pulmonares , Arritmias Cardíacas/etiologia , Humanos , Prognóstico , Procedimentos Cirúrgicos Pulmonares/efeitos adversos , Fatores de Risco
4.
Mycoses ; 62(10): 893-907, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31173415

RESUMO

BACKGROUND: Mucormycosis portends a poor prognosis with mortality rates ranging from 50% to 70% in pulmonary mucormycosis (PM) and up to 95% in disseminated disease. However, detailed outcomes data have been lacking. It remains unknown how to identify patients who would benefit from surgical resection. OBJECTIVES: We present our experience with patients undergoing surgical resection for PM, including an analysis of factors affecting postoperative survival. We also describe a thoracic surgeon's approach through illustrative cases. PATIENTS/METHODS: We conducted a single-centre retrospective study of all adult patients with PM who received antifungal therapy and underwent surgical resection or who received antifungal therapy alone at Stanford between January 2004 and June 2018. RESULTS: Twelve patients received antifungal therapy and underwent surgical resection and 13 patients received antifungal therapy alone. From infection onset to death (or right-censoring if still alive), patients who underwent surgical resection had a median survival of 406 days (mean, 561.3; range, 22-2510), and patients who received antifungal therapy alone had a median survival of 28 days (mean, 66.7; range, 8-447). In patients who underwent surgical resection, median postoperative survival time was 154 days (range, 11-2495), in-hospital mortality was 16.7%, and 1-year mortality was 50.0%. Age, primary disease, ASA status, extrapulmonary dissemination, laterality, multilobar involvement, number of lesions, largest lesion size, platelet count, surgical approach, type of resection or extent of resection were not significantly associated with postoperative survival. CONCLUSIONS: Surgical resection significantly increases survival and should be strongly considered for selected patients with PM.


Assuntos
Pneumopatias Fúngicas/cirurgia , Mucormicose/cirurgia , Procedimentos Cirúrgicos Pulmonares/métodos , Adulto , Idoso , Antifúngicos/uso terapêutico , Terapia Combinada/métodos , Feminino , Humanos , Pneumopatias Fúngicas/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Mucormicose/tratamento farmacológico , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento , Adulto Jovem
5.
J Cardiothorac Surg ; 14(1): 89, 2019 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-31060627

RESUMO

BACKGROUND: One lung ventilation (OLV) is the technique used during lung resection surgery in order to facilitate optimal surgical conditions. OLV may result in hypoxemia due to the shunt created. Several techniques are used to overcome the hypoxemia, one of which is continuous positive airway pressure (CPAP) to the non-dependent lung. Another technique is ventilating the non-dependent lung with a minimal volume, thus creating differential lung ventilation (DLV). In this study we compared the efficacy of CPAP to DLV during video assisted thoracoscopic lung resection. PATIENTS AND METHOD: This is a prospective study of 30 adult patients undergoing elective video assisted thoracoscopic lung lobectomy. Each patient was ventilated in four modes: two lung ventilation, OLV, OLV + CPAP and OLV + DLV. Fifteen patients were ventilated with CPAP first and DLV next, and the other 15 were ventilated with DLV first and then CPAP. Five minutes separated each mode, during which the non-dependent lung was open to room air. We measured the patient's arterial blood gas during each mode of ventilation. The surgeons, who were blinded to the ventilation technique, were asked to assess the surgical conditions at each stage. RESULTS: Oxygenation during OLV+ CPAP was significantly lower that OLV + DLV (p = 0.018). There were insignificant alterations of pH, PCO2 and HCO3 during the different ventilating modes. The surgeons' assessments of interference in the field exposure between OLV + CPAP or OLV + DLV was found to be insignificant (p = 0.073). CONCLUSIONS: During OLV, DLV is superior to CPAP in improving patient's oxygenation, and may be used where CPAP failed. TRIAL REGISTRATION: ClinicalTrials.gov NCT03563612 . Registered 9 June 2018, retrospectively (due to clerical error).


Assuntos
Hipóxia/terapia , Ventilação Monopulmonar/métodos , Oxigênio/sangue , Procedimentos Cirúrgicos Pulmonares/métodos , Idoso , Gasometria , Pressão Positiva Contínua nas Vias Aéreas , Estudos Cross-Over , Feminino , Humanos , Hipóxia/sangue , Hipóxia/etiologia , Masculino , Pessoa de Meia-Idade , Pneumonectomia , Estudos Prospectivos , Método Simples-Cego , Cirurgia Torácica Vídeoassistida
6.
BMC Cancer ; 19(1): 444, 2019 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-31088404

RESUMO

BACKGROUND: Selection of the best lymph node for dissection is a controversial topic in clinical stage-I non-small cell lung cancer (NSCLC). Here, we sought to identify the clinicopathologic predictors of regional lymph node metastasis in patients intraoperatively diagnosed with stage-I NSCLC. METHODS: A retrospective review of 595 patients intraoperatively diagnosed as stage I non-small-cell lung cancer who underwent lobectomy with complete lymph node dissection was performed. Univariate and multivariable logistic regression analysis was performed to determine the independent predictors of regional lymph node metastasis. RESULTS: Univariate logistic regression and multivariable analysis revealed three independent predictors of the presence of metastatic hilar lymph nodes, five independent predictors for lobe specific mediastinal lymph nodes, two independent predictors for lobe nonspecific mediastinal lymph nodes and two independent predictors for skipping mediastinal lymph nodes. CONCLUSIONS: A complete mediastinal lymph node dissection may be considered for patients suspected of nerve invasion and albumin (> 43.1 g/L) or nerve and vascular invasions. Lobe-specific lymph node dissection should probably be performed for patients suspected of pulmonary membrane invasion, vascular invasion, CEA (> 2.21 ng/mL), and tumor (> 1.6 cm) in the right lower lobe or mixed lobes. Hilar lymph node dissection should probably be performed for patients suspected of having bronchial mucosa and cartilage invasion, vascular invasion, and CEA (> 2.21 ng/mL).


Assuntos
Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/cirurgia , Metástase Linfática/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/patologia , Feminino , Humanos , Modelos Logísticos , Neoplasias Pulmonares/patologia , Excisão de Linfonodo , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Procedimentos Cirúrgicos Pulmonares , Estudos Retrospectivos
7.
Rev Bras Anestesiol ; 69(3): 242-252, 2019.
Artigo em Português | MEDLINE | ID: mdl-31133282

RESUMO

BACKGROUND AND OBJECTIVES: Patients undergoing lung resection surgery are at risk of developing postoperative acute kidney injury. Determination of cytokine levels allows the detection of an early inflammatory response. We investigated any temporal relationship among perioperative inflammatory status and development of acute kidney injury after lung resection surgery. Furthermore, we evaluated the impact of acute kidney injury on outcome and analyzed the feasibility of cytokines to predict acute kidney injury. METHODS: We prospectively analyzed 174 patients scheduled for elective lung resection surgery with intra-operative periods of one-lung ventilation. Fiberoptic broncho-alveolar lavage was performed in each lung before and after one-lung ventilation periods for cytokine analysis. As well, cytokine levels were measured from arterial blood samples at five time points. Acute kidney injury was diagnosed within 48h of surgery based estabilished criteria for its diagnosis. We analyzed the association between acute kidney injury and cardiopulmonary complications, length of intensive care unit and hospital stays, intensive care unit re-admission, and short-term and long-term mortality. RESULTS: The incidence of acute kidney injury in our study was 6.9% (12/174). Acute kidney injury patients showed higher plasma cytokine levels after surgery, but differences in alveolar cytokines were not detected. Although no patient required renal replacement therapy, acute kidney injury patients had higher incidence of cardiopulmonary complications and increased overall mortality. Plasma interleukin-6 at 6h was the most predictive cytokine of acute kidney injury (cut-off point at 4.89pg.mL-1). CONCLUSIONS: Increased postoperative plasma cytokine levels are associated with acute kidney injury after lung resection surgery in our study, which worsens the prognosis. Plasma interleukin-6 may be used as an early indicator for patients at risk of developing acute kidney injury after lung resection surgery.


Assuntos
Lesão Renal Aguda/diagnóstico , Citocinas/sangue , Complicações Pós-Operatórias/diagnóstico , Procedimentos Cirúrgicos Pulmonares/efeitos adversos , Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/etiologia , Idoso , Lavagem Broncoalveolar , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Ventilação Monopulmonar , Complicações Pós-Operatórias/epidemiologia , Valor Preditivo dos Testes , Estudos Prospectivos , Procedimentos Cirúrgicos Pulmonares/métodos
11.
BMC Cancer ; 19(1): 235, 2019 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-30876389

RESUMO

BACKGROUND: Perivascular Epithelioid Cell Tumors (PEComa) is an extraordinarily rare mesenchymal neoplasm especially the malignant type originating from the lung. To date, only 8 cases of malignant or malignant potential pulmonary PEComa had been documented. Firm diagnostic criteria for malignant pulmonary PEComa need urgently to be established. CASE PRESENTATION: We report a challenging case of malignant pulmonary PEComa combined with a primary adenocarcinoma in a 54-year-old man. The PEComa-like tumor showed strong Melan-A and weak transcription factor E3 (TFE3) protein expression but no TFE3 gene rearrangement. The carcinoma-like nodule was recognized as a poorly differentiated primary lung adenocarcinoma. DISCUSSION AND CONCLUSIONS: Our case report was the first case of malignant pulmonary PEComa synchronous with a primary adenocarcinoma and studied the dilemma of diagnosing benign versus malignant criteria for this uncommon tumor.


Assuntos
Adenocarcinoma de Pulmão/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Antígeno MART-1/metabolismo , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Neoplasias de Células Epitelioides Perivasculares/diagnóstico por imagem , Adenocarcinoma de Pulmão/genética , Adenocarcinoma de Pulmão/metabolismo , Adenocarcinoma de Pulmão/cirurgia , Fatores de Transcrição de Zíper de Leucina e Hélice-Alça-Hélix Básicos/genética , Regulação para Baixo , Humanos , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/metabolismo , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/genética , Neoplasias Primárias Múltiplas/metabolismo , Neoplasias Primárias Múltiplas/cirurgia , Neoplasias de Células Epitelioides Perivasculares/genética , Neoplasias de Células Epitelioides Perivasculares/metabolismo , Neoplasias de Células Epitelioides Perivasculares/cirurgia , Procedimentos Cirúrgicos Pulmonares , Tomografia Computadorizada por Raios X , Resultado do Tratamento
13.
Ann Diagn Pathol ; 39: 78-85, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30798075

RESUMO

Pulmonary malformations are rare disorders, with cystic and pseudocystic pulmonary malformations (CPPM) the most frequent, and constitute the first cause of lobectomy in children <1 year of age. Morphological overlap of congenital cystic pulmonary lesions might correspond to a spectrum of lesions in which bronchial atresia is a common etiopathogenetic mechanism. We aimed to report the frequency of CPPM resected in a tertiary-level hospital and to evaluate the degree of agreement between presurgical and anatomopathological diagnoses. We studied 44 surgical pieces with a diagnosis of CPPM received at the Pathology Service from 2009 to 2014, resected from 39 patients, 51.3 % males, with a median age of 16.8 months. Up to 69.2% of the patients had adenomatoid malformation of pulmonary airway (AMPA), with type 2 the most frequent (55.5%). Pulmonary sequestration was present in 15.4% of patients; in two cases the diagnosis was an incidental finding during surgery for the repair of a diaphragmatic hernia. Congenital lobar hyperinflation (CLH) occurred in 7.6% cases. Bronchogenic cyst (BC) was present in 7.6% cases. Presurgical and anatomopathological diagnoses in all patients coincided in 71.8% of cases. Kappa coefficient was 0.56 for global concordance in patients with AMPA, and 0.72, 0.64, 0.37 and 0.33 for CLH, BC, and types 1 and 2 AMPA, respectively. This relatively low interobserver agreement could reflect the low reproducibility of diagnoses used in the current nomenclature. Thus, the new nomenclature must be promoted in order to allow for better reproducibility and greater clinico-pathological concordance. The anatomopathological analysis must include the intentional search for bronchial atresia.


Assuntos
Procedimentos Cirúrgicos Pulmonares/métodos , Anormalidades do Sistema Respiratório/diagnóstico , Anormalidades do Sistema Respiratório/cirurgia , Adolescente , Cisto Broncogênico/diagnóstico , Cisto Broncogênico/patologia , Cisto Broncogênico/cirurgia , Sequestro Broncopulmonar/diagnóstico , Sequestro Broncopulmonar/patologia , Sequestro Broncopulmonar/cirurgia , Criança , Pré-Escolar , Estudos Transversais , Malformação Adenomatoide Cística Congênita do Pulmão/diagnóstico , Malformação Adenomatoide Cística Congênita do Pulmão/patologia , Malformação Adenomatoide Cística Congênita do Pulmão/cirurgia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Variações Dependentes do Observador , Enfisema Pulmonar/congênito , Enfisema Pulmonar/diagnóstico , Enfisema Pulmonar/patologia , Enfisema Pulmonar/cirurgia , Anormalidades do Sistema Respiratório/patologia , Estudos Retrospectivos , Centros de Atenção Terciária
14.
Gen Thorac Cardiovasc Surg ; 67(9): 773-781, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30725275

RESUMO

OBJECTIVES: When induction therapy followed by surgery for locally advanced non-small cell lung cancer results in pathological complete response, the prognosis is excellent; however, relapses can occur. We analyzed the predictive factors for achieving pathological complete response and reviewed the clinicopathological features and surgical outcomes of locally advanced non-small cell lung cancer with pathological complete response. METHODS: Between March 2005 and January 2015, 145 resections after induction therapy for locally advanced non-small cell lung cancer were performed; 38 cases achieved pathological complete response. Predictive factors for achieving pathological complete response were analyzed, and the clinicopathological features and surgical outcomes of 38 cases with pathological complete response were retrospectively reviewed. RESULTS: Of 145 patients, 98 underwent induction chemoradiation and 47, induction chemotherapy. Squamous cell carcinoma occurred most frequently (n = 64), followed by adenocarcinoma (n = 53). Only squamous cell carcinoma was positively associated with achieving pathological complete response (p = 0.009). Of 38 patients with pathological complete response, 33 were men and the mean age was 67.0 ± 6.3 years; the clinical stages were IIA (n = 3), IIB (n = 2), IIIA (n = 26), and IIIB (n = 3). One patient died within 30 days post-surgery (2.6%). Eight recurrences occurred during the follow-up period; brain metastasis occurred most frequently. The 5-year overall and recurrence-free survival rates were 79.5% and 72.6%, respectively. CONCLUSIONS: Squamous cell carcinoma was identified as a positive predictive factor for achieving pathological complete response. Among patients undergoing lung cancer surgery after induction therapy with pathological complete response, brain metastasis occurred most frequently.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/cirurgia , Adenocarcinoma/cirurgia , Idoso , Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma de Células Escamosas/cirurgia , Quimiorradioterapia , Feminino , Humanos , Quimioterapia de Indução , Pulmão/patologia , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Estadiamento de Neoplasias , Prognóstico , Procedimentos Cirúrgicos Pulmonares , Estudos Retrospectivos , Resultado do Tratamento
15.
Clin Lab ; 65(1)2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-30775886

RESUMO

BACKGROUND: To report a case of broncholithiasis with recurrent hemoptysis and fever initially misdiagnosed as active tuberculosis. METHODS: The chest contrast-enhanced CT scan, electronic bronchoscope, and ultrathin bronchoscope were performed leading to the diagnosis of broncholithiasis, open lung lobectomy was done after thoracic surgery consultation. RESULTS: The chest contrast-enhanced CT scan showed a high-density intratracheal shadow and calcified lymph nodes. Ultrathin bronchoscopy manifested calcified lesions located at the distal portion of the right lower lobe bronchus. Histopathology of lobectomy showed lithiasis in the right lower lobe tracheobronchial tree. CONCLUSIONS: We should pay attention to calcified intratracheal lesions and make differential diagnosis with tuberculosis, especially when accompanied with calcified lymph nodes and fever.


Assuntos
Broncopatias/diagnóstico , Febre/complicações , Hemoptise/complicações , Litíase/diagnóstico , Tuberculose Pulmonar/diagnóstico , Tuberculose/diagnóstico , Adulto , Broncopatias/complicações , Diagnóstico Diferencial , Erros de Diagnóstico , Feminino , Febre/patologia , Hemoptise/patologia , Humanos , Litíase/complicações , Pulmão/diagnóstico por imagem , Pulmão/patologia , Pulmão/cirurgia , Procedimentos Cirúrgicos Pulmonares , Recidiva , Tomografia Computadorizada por Raios X
16.
BMJ Case Rep ; 12(1)2019 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-30665929

RESUMO

Pleuropulmonary blastomas (PPB) are rare aggressive paediatric lung malignancies associated with DICER1 variants. We present two cases, a 2-year-old girl with upper respiratory tract symptoms as well as a 6-month-old girl sibling undergoing screening due to family history of malignancy. Imaging of the 2-year-old girl revealed a large mass filling the right hemithorax which was determined to be a type II PPB after pathological examination. Imaging of the 6-month-old sibling demonstrated a small cystic lesion in the posterior basal segment of the right lower lobe which was determined to be a type 1r PPB after pathological examination. The 2-year-old girl received adjuvant chemotherapy while the baby sister underwent resection alone and both are alive and well at 12 months and 7 months, respectively. Sequence analysis in both cases confirmed the same DICER1 variation, c.2437-2A>G (likely pathogenic), which has not been previously described in the literature.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , RNA Helicases DEAD-box/genética , Mutação Puntual , Blastoma Pulmonar/terapia , Procedimentos Cirúrgicos Pulmonares/métodos , Ribonuclease III/genética , Quimioterapia Adjuvante , Pré-Escolar , Diagnóstico Diferencial , Feminino , Humanos , Lactente , Íntrons , Blastoma Pulmonar/diagnóstico por imagem , Blastoma Pulmonar/genética , Análise de Sequência de DNA , Irmãos , Resultado do Tratamento
17.
Ann Surg Oncol ; 26(1): 230-237, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30456673

RESUMO

BACKGROUND: Postoperative complications are reportedly related to poor prognosis following lung cancer surgery; however, the difference in the prognostic impact according to immune-nutritional status is unknown. METHODS: In 411 patients with completely resected non-small cell lung cancer, the relationship between severe postoperative complications (SPCs; Clavien-Dindo grade III or higher) and survival was retrospectively analyzed, with special reference to preoperative immune-nutritional status based on the prognostic nutritional index (PNI), which was calculated using serum albumin level and total lymphocyte count. RESULTS: A total of 52 (12.7%) patients had SPCs. The most common SPC was air leak (n = 39), atelectasis/sputum (n = 4), pneumonia (n = 2), pyothorax (n = 2), and bleeding (n = 2). The 5-year overall survival (OS) rates in patients with and without SPCs were 63.8% and 80.1%, respectively (p = 0.007). A multivariate Cox proportional hazard model revealed SPCs had a negative prognostic impact on patients with preserved immune-nutritional status (PNI ≥ 48.3; first to third quartile), but not on those with poor immune-nutritional status (PNI < 48.3; fourth quartile), with statistically significant interaction. Further analysis focused on 309 patients with preserved immune-nutritional status. The OS and relapse-free survival (RFS) rates were significantly worse in patients with SPCs than in those without (p < 0.001). After controlling for potential confounders, SPCs remained significantly associated with worse OS (adjusted hazard ratio [HR] 2.49, 95% confidence interval [CI] 1.21-4.83; p = 0.015) and RFS (adjusted HR 2.02, 95% CI 1.10-3.53; p = 0.025). CONCLUSION: Severe complications following lung cancer surgery could negatively impact prognosis, particularly in patients with preserved immune-nutritional status.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/cirurgia , Avaliação Nutricional , Estado Nutricional , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Pulmonares/efeitos adversos , Idoso , Carcinoma Pulmonar de Células não Pequenas/patologia , Feminino , Seguimentos , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida
18.
Ann Surg Oncol ; 26(1): 217-229, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30456676

RESUMO

BACKGROUND: Pulmonary peripheral-type squamous cell carcinoma (p-SqCC) has been increasing in incidence. However, little is known about the clinicopathologic features of p-SqCC. This study aimed to investigate the clinicopathologic characteristics and clinical outcomes of p-SqCC compared with central-type SqCC (c-SqCC) in a large cohort of surgically resected lung SqCC patients with long-term follow-up results. METHODS: The study included 268 patients with SqCC who underwent surgical resection at the authors' institute from January 1990 to September 2013. The mean follow-up period was 67.1 months. The clinicopathologic and genetic characteristics were investigated in relation to their association with progression-free survival (PFS) and overall survival (OS) based on tumor location. RESULTS: The study cohort included 120 patients with p-SqCC and 148 patients with c-SqCC. Compared with c-SqCC, p-SqCC was correlated with older age (p = 0.002), female sex (p = 0.033), better performance status (p < 0.001), smaller tumor (p = 0.004), less lymph node metastasis (p < 0.001), and an earlier pathologic stage (p < 0.001). Despite the clinicopathologic differences, tumor location was not significantly correlated with clinical outcomes. For the p-SqCC patients, the multivariate analysis showed a significant correlation of lymphovascular invasion (PFS, p < 0.001; OS, p < 0.001) and lymph node metastasis (p = 0.007; OS, p = 0.022) with poor PFS and OS, but a significant correlation of incomplete tumor resection (PFS, p = 0.009) only with poor PFS. CONCLUSIONS: The clinicopathologic features differed between the p-SqCC and c-SqCC patients. Lymphovascular invasion and lymph node metastasis were independent prognostic factors of p-SqCC. These prognostic factors may be potentially used as indicators for adjuvant therapies to be used with patients who have p-SqCC.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma de Células Escamosas/patologia , Neoplasias Pulmonares/patologia , Procedimentos Cirúrgicos Pulmonares/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Carcinoma de Células Escamosas/cirurgia , Estudos de Coortes , Feminino , Seguimentos , Humanos , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Prognóstico , Taxa de Sobrevida
19.
Eur J Cardiothorac Surg ; 55(1): 91-115, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30304509

RESUMO

Enhanced recovery after surgery is well established in specialties such as colorectal surgery. It is achieved through the introduction of multiple evidence-based perioperative measures that aim to diminish postoperative organ dysfunction while facilitating recovery. This review aims to present consensus recommendations for the optimal perioperative management of patients undergoing thoracic surgery (principally lung resection). A systematic review of meta-analyses, randomized controlled trials, large non-randomized studies and reviews was conducted for each protocol element. Smaller prospective and retrospective cohort studies were considered only when higher-level evidence was unavailable. The quality of the evidence base was graded by the authors and used to form consensus recommendations for each topic. Development of these recommendations was endorsed by the Enhanced Recovery after Surgery Society and the European Society for Thoracic Surgery. Recommendations were developed for a total of 45 enhanced recovery items covering topics related to preadmission, admission, intraoperative care and postoperative care. Most are based on good-quality studies. In some instances, good-quality data were not available, and subsequent recommendations are generic or based on data extrapolated from other specialties. In other cases, no recommendation can currently be made because either equipoise exists or there is a lack of available evidence. Recommendations are based not only on the quality of the evidence but also on the balance between desirable and undesirable effects. Key recommendations include preoperative counselling, nutritional screening, smoking cessation, prehabilitation for high-risk patients, avoidance of fasting, carbohydrate loading, avoidance of preoperative sedatives, venous thromboembolism prophylaxis, prevention of hypothermia, short-acting anaesthetics to facilitate early emergence, regional anaesthesia, nausea and vomiting control, opioid-sparing analgesia, euvolemic fluid management, minimally invasive surgery, early chest drain removal, avoidance of urinary catheters and early mobilization after surgery. These guidelines outline recommendations for the perioperative management of patients undergoing lung surgery based on the best available evidence. As the recommendation grade for most of the elements is strong, the use of a systematic perioperative care pathway has the potential to improve outcomes after surgery.


Assuntos
Cuidados Pós-Operatórios/normas , Guias de Prática Clínica como Assunto , Procedimentos Cirúrgicos Pulmonares , Recuperação de Função Fisiológica , Sociedades Médicas , Cirurgia Torácica , Europa (Continente) , Humanos
20.
Thorax ; 74(1): 51-59, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30100577

RESUMO

INTRODUCTION: We investigated socioeconomic disparities and the role of the main prognostic factors in receiving major surgical treatment in patients with lung cancer in England. METHODS: Our study comprised 31 351 patients diagnosed with non-small cell lung cancer in England in 2012. Data from the national population-based cancer registry were linked to Hospital Episode Statistics and National Lung Cancer Audit data to obtain information on stage, performance status and comorbidities, and to identify patients receiving major surgical treatment. To describe the association between prognostic factors and surgery, we performed two different analyses: one using multivariable logistic regression and one estimating cause-specific hazards for death and surgery. In both analyses, we used multiple imputation to deal with missing data. RESULTS: We showed strong evidence that the comorbidities 'congestive heart failure', 'cerebrovascular disease' and 'chronic obstructive pulmonary disease' reduced the receipt of surgery in early stage patients. We also observed gender differences and substantial age differences in the receipt of surgery. Despite accounting for sex, age at diagnosis, comorbidities, stage at diagnosis, performance status and indication of having had a PET-CT scan, the socioeconomic differences persisted in both analyses: more deprived people had lower odds and lower rates of receiving surgery in early stage lung cancer. DISCUSSION: Comorbidities play an important role in whether patients undergo surgery, but do not completely explain the socioeconomic difference observed in early stage patients. Future work investigating access to and distance from specialist hospitals, as well as patient perceptions and patient choice in receiving surgery, could help disentangle these persistent socioeconomic inequalities.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/epidemiologia , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Disparidades em Assistência à Saúde , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/cirurgia , Pobreza , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Carcinoma Pulmonar de Células não Pequenas/patologia , Transtornos Cerebrovasculares/epidemiologia , Comorbidade , Inglaterra/epidemiologia , Feminino , Nível de Saúde , Insuficiência Cardíaca/epidemiologia , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/secundário , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/estatística & dados numéricos , Prognóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Procedimentos Cirúrgicos Pulmonares/estatística & dados numéricos , Fatores Sexuais
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