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1.
Asian J Endosc Surg ; 17(3): e13356, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38965733

RESUMO

Tracheal injury during mediastinoscopic esophagectomy is a life-threatening complication that is challenging to manage. However, no precise treatment has been defined. An 80-year-old male patient with upper esophageal cancer underwent a mediastinoscopic esophagectomy and gastric tube reconstruction through the posterior mediastinal route. When the esophagus was separated from the trachea using a bipolar vessel sealing system, the left side of the membranous trachea incurred a 3-cm defect 7 cm below the sternal notch. We successfully repaired the tracheal injury not by directly suturing the defect but by reinforcing it with a pedicle sternocleidomastoid flap. The gastric tube was placed over the tracheal repair for esophageal reconstruction via a posterior mediastinal route. As a result, the patient recovered well and was discharged. A sternocleidomastoid flap might be another surgical option for reinforcement flaps in tracheal injuries.


Assuntos
Neoplasias Esofágicas , Esofagectomia , Mediastinoscopia , Retalhos Cirúrgicos , Traqueia , Humanos , Masculino , Idoso de 80 Anos ou mais , Neoplasias Esofágicas/cirurgia , Traqueia/cirurgia , Traqueia/lesões , Mediastinoscopia/métodos , Esofagectomia/métodos
2.
World J Surg ; 48(2): 427-436, 2024 02.
Artigo em Inglês | MEDLINE | ID: mdl-38686756

RESUMO

BACKGROUND: The McKeown minimally invasive esophagectomy (McMIE) procedure has various limitations, including surgical contraindications and a high rate of postoperative pulmonary complications. A novel mediastinoscopic esophagectomy procedure was described in this study by using esophageal invagination and a transhiatal and bilateral cervical approach (EITHBC). METHODS: According to the mode of operation, a total of 259 patients were divided into two groups, among which 106 underwent EITHBC and 153 underwent McMIE. The number of lymph nodes dissected, intraoperative outcomes, and postoperative outcomes were compared between the two groups of patients. RESULTS: The results revealed that the average number of resected lymph node in the EITHBC group was significantly higher in the recL106 and TbL106 stations (recL106: 1.75 vs. 1.51, p = 0.016, TbL106: 1.53 vs. 1.19, p = 0.016) and significantly lower in the 107 stations (1. 74 vs. 2. 07, p < 0.001) than in the McMIE group. The intraoperative blood loss in the EITHBC group was significantly lower than that in the McMIE group (63.30 vs. 80.45 mL, p < 0.001). The incidence of postoperative pulmonary complications in the EITHBC group was lower than that in the McMIE group (14.15% vs. 27.45%, p = 0.008). The incidence of recurrent laryngeal nerve paralysis in the EITHBC group was significantly higher than that in the McMIE group (26.41% vs. 10.46%, p = 0.003). CONCLUSION: Compared with the McMIE procedure, the EITHBC procedure has advantages in terms of removing the upper mediastinal lymph nodes and reducing postoperative pulmonary complications.


Assuntos
Neoplasias Esofágicas , Esofagectomia , Mediastinoscopia , Humanos , Esofagectomia/métodos , Feminino , Estudos Retrospectivos , Masculino , Mediastinoscopia/métodos , Pessoa de Meia-Idade , Neoplasias Esofágicas/cirurgia , Neoplasias Esofágicas/patologia , Idoso , Complicações Pós-Operatórias/epidemiologia , Excisão de Linfonodo/métodos , Resultado do Tratamento , Adulto , Estudos de Coortes
3.
Vet Surg ; 53(5): 834-843, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38686899

RESUMO

OBJECTIVE: To report technical feasibility and describe procedural details of a novel single incision minimally invasive approach to the mediastinum in cadaver dogs. STUDY DESIGN: Cadaveric study. ANIMALS: Large breed (25-40 kg) cadaver dogs (n = 10). METHODS: Three of 10 cadavers were used for preliminary technique development without data recording. Cadaver specimens underwent pre- and postoperative thoracic computed tomographic scans. Seven dogs were placed in dorsal recumbency and mediastinoscopy was performed via a SILS port placed cranial to the thoracic inlet with CO2 insufflation of the mediastinum at 2-4 mmHg. Retrieval of all CT and visually identified mediastinal lymph nodes (LN) was attempted; endoscopic compartmental and individual LN dissection times and subjective operative challenges were recorded. Procedural success scores for visualization and dissection as well as NASA-task force index scores were recorded per lymph node, per cadaver. RESULTS: Median time required for initial approach including SILS placement was 5 min (range 5-10 min). Individual LN retrieval times ranged from 2 to 32 min. Mediastinoscopic retrieval of LNs was most commonly successful for the left tracheobronchial LN (7/7), followed by the right tracheobronchial LN (4/7), the left and right sternal LNs (3/7 each), and the cranial mediastinal LNs (1/7). Post-procedure pleural gas was identified on CT in 4/7 cadavers. CONCLUSIONS: Mediastinoscopy as reported was feasible in large breed canine cadavers and retrieval or cup biopsy of a variety of lymph nodes is possible from the described approach. Application in living animals and its associated challenges should be further investigated. CLINICAL SIGNIFICANCE: Mediastinoscopy may provide a novel minimally invasive approach to the evaluation and oncologic staging of the cranial mediastinum in dogs.


Assuntos
Cadáver , Excisão de Linfonodo , Mediastinoscopia , Mediastino , Animais , Cães , Mediastinoscopia/veterinária , Mediastinoscopia/métodos , Excisão de Linfonodo/veterinária , Excisão de Linfonodo/métodos , Mediastino/cirurgia , Linfonodos/cirurgia , Linfonodos/anatomia & histologia
5.
Surg Oncol ; 53: 102042, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38330804

RESUMO

BACKGROUND: Transhiatal esophagectomy (THE) avoids thoracotomy but sacrifices mediastinal lymphadenectomy. Mediastinoscopy-assisted transhiatal esophagectomy (MATHE) allows for visualisation and en-bloc dissection of mediastinal lymph nodes while retaining the benefits of THE. However, given its novel inception, there is a paucity of literature. This study aimed to conduct the first meta-analysis to explore the efficacy of MATHE and clarify its role in the future of esophagectomy. METHODS: Four databases (PubMed, EMBASE, Scopus, and Cochrane Library) were searched from inception to May 1, 2023. Studies were included if they reported outcomes for patients with esophageal cancer who underwent MATHE. Meta-analyses of proportions and pooled means were performed for the outcomes of intraoperative blood loss, lymph node (LN) harvest, mean hospital length of stay (LOS), mean operative time, R0 resection, conversion rates, 30-day mortality rate, 5-year OS, and surgical complications (anastomotic leak, cardiovascular [CVS] and pulmonary complications, chyle leak and recurrent laryngeal nerve palsy [RLN]). Sensitivity analyses were performed for outcomes with substantial statistical heterogeneity. RESULTS: The search yielded 223 articles; 28 studies and 1128 patients were included in our analysis. Meta-analyses of proportions yielded proportion rates: 30-day mortality (0 %, 95 %CI 0-0), 5-year OS (60.5 %, 95 %CI 47.6-72.7), R0 resection (100 %, 95 %CI 99.3-100), conversion rate (0.1 %, 95 %CI 0-1.2). Among surgical complications, RLN palsy (14.6 %, 95 %CI 9.5-20.4) were most observed, followed by pulmonary complications (11.3 %, 95 %CI 7-16.2), anastomotic leak (9.7 %, 95 %CI 6.8-12.8), CVS complications (2.3 %, 95 %CI 0.9-4.1) and chyle leak (0.02 %, 95 %CI 0-0.8). Meta-analysis of pooled means yielded means: LN harvest (18.6, 95 %CI 14.3-22.9), intraoperative blood loss (247.1 ml, 95 %CI 173.6-320.6), hospital LOS (18.1 days, 95 %CI 14.4-21.8), and operative time (301.5 min, 95 %CI 238.4-364.6). There was moderate-to-high statistical heterogeneity. Findings were robust to sensitivity analyses. CONCLUSION: MATHE is associated with encouraging post-operative mortality and complication rates, while allowing for radical mediastinal lymphadenectomy with reasonable lymph node harvest.


Assuntos
Neoplasias Esofágicas , Mediastinoscopia , Humanos , Mediastinoscopia/efeitos adversos , Perda Sanguínea Cirúrgica , Esofagectomia/efeitos adversos , Fístula Anastomótica , Resultado do Tratamento , Excisão de Linfonodo , Neoplasias Esofágicas/patologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos
6.
Surg Endosc ; 38(3): 1617-1625, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38321335

RESUMO

BACKGROUND: Thoracic esophageal cancer resection through the neck approach has recently been reported as mediastinoscopic surgery. We present the first report of a new minimally invasive technique for thoracic esophageal cancer: robot-assisted transcervical esophagectomy with a bilateral cervical approach. METHODS: Ten cases of robot-assisted bilateral transcervical esophagectomy performed at the National Cancer Center Hospital East, Japan, from February 2023 to August 2023 were reviewed. The short-term surgical outcomes were presented, and the feasibility and efficacy of this procedure were discussed. RESULTS: The mean operation time for the cervical procedure was 184.2 ± 23.6 min. The total time for the whole procedure was 472.7 ± 28.4 min, and total intraoperative blood loss was 162.2 ± 40.0 ml. Among the 10 cases, one patient developed recurrent nerve paralysis, one patient developed pulmonary complications, and no patients developed postoperative pneumonia. The median postoperative hospital stay was 22 (range: 12-43) days. No patients developed severe postoperative surgical complications, which were graded as Clavien-Dindo ≥ III. The total number of surgically harvested mediastinal lymph nodes was 37.2 ± 11.2. CONCLUSIONS: Robot-assisted bilateral transcervical esophagectomy, a novel procedure for thoracic esophageal cancer, was safe and feasible. Using this procedure, the incidence of recurrent nerve palsy, which is a problem with transcervical esophagectomy and mediastinoscopic esophagectomy, is expected to decrease.


Assuntos
Neoplasias Esofágicas , Robótica , Humanos , Excisão de Linfonodo/métodos , Esofagectomia/métodos , Mediastinoscopia/efeitos adversos , Mediastinoscopia/métodos , Neoplasias Esofágicas/cirurgia , Neoplasias Esofágicas/complicações , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
7.
J Coll Physicians Surg Pak ; 33(9): 1062-1066, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-37691371

RESUMO

OBJECTIVE: To determine the yield of cervical mediastinoscopy in determining causes of mediastinal lymph node enlargement. STUDY DESIGN: Observational study. Place and Duration of the Study: CMH Rawalpindi, Lahore and Multan, from January 2010 to December 2021. METHODOLOGY: Patients who underwent lymph node biopsy through cervical mediastinoscopy approach were included. Record of the patients including age, gender, clinical presentation, and findings on CT scan chest were noted along with the record of preoperative complications and duration of surgery. Histopathology report was also recorded. RESULTS: Out of 398 patients, 259 (65%) were males and 139 (35%) were females. Out of 338 patients who were operated for diagnostic purpose, 157 (46%) had tuberculosis and 34 (10.1%) had sarcoidosis. Fifty-two (15.3%) were diagnosed to have malignancy including non-small cell lung cancer (NSCLC), small cell lung cancer (SCLC), and metastatic carcinoma of unspecified origin. Amongst staging group (n=60), 33 (55%) patients had negative mediastinal disease. Complication rate was 3.8%, including hoarseness of voice in three patients while 2 patients had wound infection requiring intervention. CONCLUSION: Cervical mediastinoscopy is a safe and efficacious means of diagnosis in indeterminate mediastinal lymphadenopathy and staging of lung malignancy. KEY WORDS: Mediastinoscopy, Lymph nodes, Tuberculosis, Lung cancer, Staging.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Linfadenopatia , Feminino , Masculino , Humanos , Mediastinoscopia , Linfadenopatia/diagnóstico , Linfonodos
9.
Surg Laparosc Endosc Percutan Tech ; 33(4): 420-427, 2023 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-37505923

RESUMO

BACKGROUND: The objective of the current study was to investigate the safety and feasibility of mediastinoscopy-assisted esophagectomy (MAE). METHODS: A meta-analysis was conducted between MAE and traditional transthoracic esophagectomy (TTE). For a comparative analysis of MAE and TTE, we searched PubMed, the Cochrane Library, Embase, and Web of Science databases. We identified the relevant literature and extracted the relevant data. Finally, RevMan 5.3 software was applied to conduct a meta-analysis of the data. RESULTS: A total of 1256 people were enrolled in 16 studies, comprising 575 patients with MAE and 681 with TTE. The findings revealed that the pulmonary complications, cardiac complications, and postoperative hospital stay in the MAE group were significantly better than those in the TTE group. No significant differences were found between the 2 groups in postoperative chylothorax, anastomotic fistula, and postoperative mortality. But the incidence of recurrent laryngeal nerve injury in the MAE group was higher than that in the TTE group (odds ratio=1.64, 95% CI, 1.15 to 2.35, P =0.006). The MAE group had less lymph node dissection than the TTE group (mean difference=-4.62, 95% CI, -5.97 to 3.45, P <0.00001). CONCLUSIONS: This meta-analysis presented that MAE was safe and feasible, reduced postoperative pulmonary and cardiac complications, and shortened hospital stay, but lymph node dissection was less, recurrent laryngeal nerve injury was higher, and the impact of long-term survival prognosis required more randomized controlled trials.


Assuntos
Neoplasias Esofágicas , Traumatismos do Nervo Laríngeo Recorrente , Humanos , Mediastinoscopia/efeitos adversos , Esofagectomia/efeitos adversos , Estudos de Viabilidade , Neoplasias Esofágicas/cirurgia , Neoplasias Esofágicas/patologia , Excisão de Linfonodo , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia
11.
J Clin Oncol ; 41(22): 3785-3790, 2023 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-37267507

RESUMO

The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice.Accurate staging of the mediastinal lymph nodes in resectable non-small-cell lung cancer (NSCLC) is critically important to determine the overall stage of the tumor and guide subsequent management. The staging process typically begins with positron emission tomography (PET) or computed tomography imaging; however, imaging alone is inadequate, and tissue acquisition is required for confirmation of nodal disease. Mediastinoscopy was long considered the gold standard for staging of mediastinal lymph nodes, but, recently, endobronchial ultrasound-guided (EBUS) fine-needle aspiration (FNA) has become the standard of care. EBUS-FNA, in combination with supplementary technologies, such as intranodal forceps biopsy and esophageal ultrasonography, has a high sensitivity and specificity for the diagnosis of nodal metastases. EBUS-FNA is also capable of assessing N1 disease and obtaining adequate tissue for tumor genomic analysis to help guide treatment. In the case of negative findings on EBUS, a confirmatory video mediastinoscopy is still recommended by the European Society of Thoracic Surgeons guidelines. However, whether confirmatory mediastinoscopy is necessary is a matter of debate, and it is not commonly performed in North America. To address this question, Bousema and colleagues performed a randomized noninferiority trial to determine rates of unforeseen nodal metastases after EBUS alone versus EBUS with confirmatory mediastinoscopy in patients with resectable NSCLC. The authors concluded that EBUS alone is noninferior to EBUS with confirmatory mediastinoscopy. These findings affirm our current practice to forgo confirmatory mediastinoscopy after negative findings on EBUS.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Humanos , Carcinoma Pulmonar de Células não Pequenas/patologia , Mediastinoscopia/métodos , Neoplasias Pulmonares/patologia , Estadiamento de Neoplasias , Mediastino/diagnóstico por imagem , Mediastino/patologia , Endossonografia/métodos , Linfonodos/diagnóstico por imagem , Linfonodos/patologia
12.
Asian Cardiovasc Thorac Ann ; 31(5): 426-430, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-37225669

RESUMO

BACKGROUND: The aim was to compare transhiatal esophagectomy via mediastinoscopy (TEM) with Sweet procedure for patients with T2 midpiece and distal esophageal squamous cell carcinoma (ESCC). MATERIALS AND METHODS: By virtue of propensity score matching, 42 T2 ESCC patients who underwent TEM (n = 21) and Sweet procedure (n = 21) were included. Both the short-term and long-term outcomes of these patients were observed. RESULTS: Compared with the Sweet procedure, the TEM procedure showed less operation time (133.8 ± 30.4 vs 171.2 ± 30.3 min, p = 0.038), reduced drainage volume in 24 h (83.8 ± 142.3 vs 665.2 ± 220.0 mL, p < 0.001), shorter reserving time of chest tube (26.2 ± 26.3 vs 82.8 ± 49.8 h, p < 0.001) and less dissected lymph nodes (12.4 ± 6.1 vs 17.0 ± 6.5, p = 0.041). The average survival period was 62.6 months for TEM group and 62.5 months for Sweet group (p = 0.753). The COX regression showed that the nodal staging could be regarded as an independent prognostic factor (p = 0.013), not the surgical method (p = 0. 754). CONCLUSIONS: The TEM procedure could reduce operative trauma compared with the Sweet procedure. The long-term survival rate of TEM group was acceptable. The lymph node resection was a major disadvantage of TEM procedure. The TEM procedure might be an alternate choice for T2 midpiece and distal ESCC patients, especially for patients who cannot tolerate transthoracic esophagectomy.


Assuntos
Neoplasias Esofágicas , Carcinoma de Células Escamosas do Esôfago , Humanos , Carcinoma de Células Escamosas do Esôfago/cirurgia , Carcinoma de Células Escamosas do Esôfago/etiologia , Neoplasias Esofágicas/patologia , Mediastinoscopia/efeitos adversos , Esofagectomia/métodos , Resultado do Tratamento , Excisão de Linfonodo/efeitos adversos , Estudos Retrospectivos , Complicações Pós-Operatórias/etiologia
13.
J Clin Oncol ; 41(22): 3805-3815, 2023 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-37018653

RESUMO

PURPOSE: Resectable non-small-cell lung cancer (NSCLC) with a high probability of mediastinal nodal involvement requires mediastinal staging by endosonography and, in the absence of nodal metastases, confirmatory mediastinoscopy according to current guidelines. However, randomized data regarding immediate lung tumor resection after systematic endosonography versus additional confirmatory mediastinoscopy before resection are lacking. METHODS: Patients with (suspected) resectable NSCLC and an indication for mediastinal staging after negative systematic endosonography were randomly assigned to immediate lung tumor resection or confirmatory mediastinoscopy followed by tumor resection. The primary outcome in this noninferiority trial (noninferiority margin of 8% that previously showed to not compromise survival, Pnoninferior < .0250) was the presence of unforeseen N2 disease after tumor resection with lymph node dissection. Secondary outcomes were 30-day major morbidity and mortality. RESULTS: Between July 17, 2017, and October 5, 2020, 360 patients were randomly assigned, 178 to immediate lung tumor resection (seven dropouts) and 182 to confirmatory mediastinoscopy first (seven dropouts before and six after mediastinoscopy). Mediastinoscopy detected metastases in 8.0% (14/175; 95% CI, 4.8 to 13.0) of patients. Unforeseen N2 rate after immediate resection (8.8%) was noninferior compared with mediastinoscopy first (7.7%) in both intention-to-treat (Δ, 1.03%; UL 95% CIΔ, 7.2%; Pnoninferior = .0144) and per-protocol analyses (Δ, 0.83%; UL 95% CIΔ, 7.3%; Pnoninferior = .0157). Major morbidity and 30-day mortality was 12.9% after immediate resection versus 15.4% after mediastinoscopy first (P = .4940). CONCLUSION: On the basis of our chosen noninferiority margin in the rate of unforeseen N2, confirmatory mediastinoscopy after negative systematic endosonography can be omitted in patients with resectable NSCLC and an indication for mediastinal staging.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/cirurgia , Neoplasias Pulmonares/patologia , Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Carcinoma Pulmonar de Células não Pequenas/patologia , Mediastinoscopia/métodos , Endossonografia/métodos , Estadiamento de Neoplasias , Linfonodos/diagnóstico por imagem , Linfonodos/cirurgia , Linfonodos/patologia
15.
Pneumologie ; 77(3): 162-167, 2023 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-36731497

RESUMO

We present the case of a patient with severe complications from mediastinal bleeding after endosonographically guided transbronchial cryobiopsy (EBUS-TBKB) with suspected advanced lymphoma. The EBUS-TBKB is a new effective examination method in interventional pneumology for the diagnosis of diseases with mediastinal lymph node enlargement and intrathoracic tumors, with which large tissue cylinders in the mediastinum can be obtained. Due to the high diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for the clarification of lymphadenopathy, the examination should not be carried out as a routine application. Indications for a primary EBUS-TBKB arise when there is a suspicion of intrathoracic malignant lymphomas or other rare tumors in which extensive unfragmented tissue material is required for diagnosis. A rare complication that has not yet been described in the literature is a hematomediastinum, so that a careful risk assessment of possible bleeding complications should be carried out before intervention and the more invasive mediastinoscopy can be a safer examination method.


Assuntos
Neoplasias Pulmonares , Linfadenopatia , Linfoma , Humanos , Idoso , Neoplasias Pulmonares/patologia , Mediastino/patologia , Linfoma/patologia , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/efeitos adversos , Mediastinoscopia , Broncoscopia/efeitos adversos , Broncoscopia/métodos , Estudos Retrospectivos
16.
Thorac Cardiovasc Surg ; 71(1): 76-78, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36216329

RESUMO

The coexistence of pleural and pericardial effusions in frail patients with or without confirmed neoplasia necessitates the use of a minimally invasive technique that has a minor impact on the patient's general status and allows for fast fluid evacuation and biopsy sampling if necessary. We present a subxiphoid mediastinoscopic autonomous (simultaneous noncommunicating) double fenestration approach for these patients with both diagnostic and therapeutic advantages in selected cases. Using the mediastinoscope alone through the subxiphoid incision can considerably reduce the duration of operation, allow for fluid evacuation, and significantly alleviate the patient's symptoms. This method enables the sampling of pleural and pericardial fluids and targeted tissue, if necessary.


Assuntos
Mediastinoscópios , Derrame Pericárdico , Humanos , Resultado do Tratamento , Derrame Pericárdico/diagnóstico por imagem , Derrame Pericárdico/etiologia , Derrame Pericárdico/cirurgia , Mediastinoscopia , Biópsia
17.
Med Arch ; 77(6): 477-481, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-38313110

RESUMO

Background: Since its introduction in 1959 by Carlens (1), Mediastinoscopy has been, for long, used for assessment of the mediastinum (superior and middle) for establishing a histological diagnosis of mediastinal masses of undefined cause, and for Lung carcinomas staging. The use of Mediastinoscopy has been decreasing lately due to the introduction of other less invasive techniques (e.g., endoscopic ultrasound-directed fine needle aspiration cytology), however, it is still a cheap and effective tool that can be utilized in underprivileged centers. Objective: To emphasize how does Mediastinoscopy plays an important role in confirming the clinical diagnosis of isolated mediastinal lymphadenopathy and reviewing its utility. Methods: These are a retrospective analysis of medical charts for patients who underwent diagnostic cervical mediastinoscopy during (2012 - 2018) at a University hospital in Saudi Arabia. The included patients are presented with an isolated mediastinal lymph node enlargement, in the absence of underlying cause and was found to be significant (>1cm in its short axis) by computed tomography. The patient who had a known cause (e.g., Sarcoidosis) or were diagnosed via other tools, was excluded. Results: Mediastinoscopy was performed on 56 patients, 38 of them were males (68%) and 18 females (32%), with a mean age of (37.5 ± 10 years). The patients' most common presenting symptoms were persistent cough (49%), fever of unknown origin (38%) and weight loss (36%) with an average of 2 symptoms per patient, while in 4 patients (7%) lymphadenopathy was discovered incidentally during the CT scan for other reasons. In addition, the histopathological examination of specimens obtained confirmed the most common diagnoses, Sarcoidosis in 17 patients (30%), lymphoma in 12 patients (21%) and TB in 10 patients (18%). The mean hospital stay (calculated from the day of the procedure) was (2.5 ± 4 days) including work up, with only one mortality (2%) and 3 patients (5%) had experienced post-operative complications. Conclusion: The diagnostic Mediastinoscopy is both safe and efficient in the diagnosis of patients with isolated mediastinal lymphadenopathy, requiring a minimal surgical setup and is considered cost-effective. Therefore, it is a valid choice of investigating such cases in other underprivileged centers, as it reaches a tissue-based diagnosis, while other techniques are used for staging purposes.


Assuntos
Neoplasias Pulmonares , Linfadenopatia , Sarcoidose , Masculino , Feminino , Humanos , Adulto , Pessoa de Meia-Idade , Mediastinoscopia/métodos , Estudos Retrospectivos , Mediastino/patologia , Linfadenopatia/diagnóstico por imagem , Linfadenopatia/patologia , Neoplasias Pulmonares/patologia , Sarcoidose/patologia , Estadiamento de Neoplasias
18.
Medicine (Baltimore) ; 101(46): e31619, 2022 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-36401468

RESUMO

RATIONALE: It is often difficult to perform transthoracic esophagectomy (TTE) in patients with chest deformities, as these patients may be lost to surgery for non-oncological reasons. PATIENT CONCERNS: In this case, we had a patient with esophageal squamous cell carcinoma (ESCC) who was not suitable for TTE because of extensive thoracic adhesions caused by the left pneumonectomy 8 years ago. DIAGNOSES: ESCC. INTERVENTIONS: Based on Professor Fujiwara's surgical method, we further improved it by proposing a single-port inflatable mediastinoscopy combined with laparoscopic-assisted esophagectomy. OUTCOMES: At the time of this writing, computed tomography and gastroscopy revealed no stenosis of anastomosis, and no evidence of disease recurrence. LESSONS: To the best of our knowledge, the present case is the first single-port inflatable mediastinoscopic esophagectomy performed on a patient undergoing pneumonectomy.


Assuntos
Neoplasias Esofágicas , Carcinoma de Células Escamosas do Esôfago , Humanos , Esofagectomia/métodos , Neoplasias Esofágicas/cirurgia , Neoplasias Esofágicas/patologia , Mediastinoscopia/métodos , Carcinoma de Células Escamosas do Esôfago/cirurgia , Recidiva Local de Neoplasia/cirurgia
19.
J R Coll Physicians Edinb ; 52(1): 46-47, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-36146976

RESUMO

We describe the case of a 70-year-old never smoker with chronic lymphocytic leukaemia, treated with single agent ibrutinib therapy. Chest imaging noted nodular change and mediastinal lymphadenopathy, which showed avid uptake on positron emission tomography and guided subsequent biopsies (bronchoscopy using endobronchial ultrasound, mediastinoscopy). Despite negative aspergillus blood immunology tests, he was found to have invasive aspergillosis, which is a known risk with ibrutinib therapy. He has since been successfully treated with antifungal therapy.


Assuntos
Neoplasias Pulmonares , Adenina/análogos & derivados , Idoso , Antifúngicos , Broncoscopia/métodos , Humanos , Neoplasias Pulmonares/patologia , Macrófagos/patologia , Masculino , Mediastinoscopia/métodos , Mediastino/patologia , Estadiamento de Neoplasias , Piperidinas
20.
J Cardiothorac Surg ; 17(1): 161, 2022 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-35717369

RESUMO

BACKGROUND: Vocal cord palsy after cervical mediastinoscopy is usually reported at less than 1%. However, its incidence might be underestimated and no follow-up studies are available. Our study aimed to evaluate the incidence of voice changes after cervical mediastinoscopy and report on long-term outcomes, including quality of life, after at least one-year follow-up. METHODS: A retrospective cohort study was performed, considering all patients who underwent cervical mediastinoscopy in our center between January 2011 and April 2016. Patients with pre-existing voice changes, voice changes only after pulmonary resection and patients who underwent neoadjuvant chemo(radio)therapy were excluded. Voice changes with full recovery within 14 days were attributed to intubation-related causes. Follow-up questionnaires, including the standardized Voice Handicap Index, were sent to patients with documented voice changes. RESULTS: Of 270 patients who were included for final analysis, 17 (6.3%) experienced voice changes after cervical mediastinoscopy, which persisted > 2 years in 4 patients (1.5%), causing mild to moderate disabilities in daily living. Twelve patients (out of 17, 71%) were referred for otolaryngology consultation, and paresis of the left vocal cord suggesting recurrent laryngeal nerve injury was confirmed in 10 (3.7% of our total study group). Additionally, 83% of the patients who were referred for otolaryngology consultation received voice treatment. Recovery rate after vocal exercises therapy and injection laryngoplasty was respectively 71% and 33%. CONCLUSIONS: Voice changes after cervical mediastinoscopy is an underreported complication, with an incidence of at least 6.3% in our retrospective study, with persisting complaints in at least 1.5% of patients, leading to mild to moderate disabilities in daily living. These findings highlight the need for appropriate patient education for this underestimated complication, as well as the exploration of possible preventive measures.


Assuntos
Mediastinoscopia , Qualidade da Voz , Seguimentos , Humanos , Mediastinoscopia/efeitos adversos , Qualidade de Vida , Estudos Retrospectivos
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