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Abstract
Pulmonary resection of metastatic colorectal cancer is widely practiced in surgical oncology. However, only a highly selected subset of patients is eligible for resection, and the average recurrence rate is still high. We reviewed the recent literature on pulmonary metastasectomy for colorectal cancer and tried to address the issue of patient selection based on prognostic parameters associated with long-term survival. No randomized phase III trials are available, and data for this review were retrieved only from retrospective studies. We excluded papers reporting on patients earlier than 1990. In summary, there is a substantial body of evidence demonstrating that resection of pulmonary metastases can be performed safely and with a low mortality rate. For a subset of highly selected patients, the overall results of a 5-year actuarial survival rate after complete resection ranged between 40 and 68%. These outcomes exceed those normally associated with metastatic colorectal cancer. It is this perception that has encouraged surgeons and caused the practice to grow.
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202
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Staging of non-small cell lung cancer (NSCLC): a review. Respir Med 2010; 104:1767-74. [PMID: 20833010 DOI: 10.1016/j.rmed.2010.08.005] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Revised: 07/28/2010] [Accepted: 08/09/2010] [Indexed: 11/24/2022]
Abstract
Lung cancer remains the most common cause of cancer-related mortality in Scotland, accounting for 28.9% of all cancer deaths in 2007. (1) Current guidelines recommend assessment of patient fitness and operability by a multi-disciplinary team when selecting management options. (2-6) Two of the most important prognostic markers are the stage of disease and ECOG performance status. The most commonly used cancer staging system is the tumour, node, metastasis (TNM) staging system, which is maintained by the American Joint Committee on Cancer (AJCC) and the International Union Against Cancer (UICC). In 1998, the International Association for the Study of Lung Cancer (IASLC) established The Lung Cancer Staging Project, collecting data on over 100,000 patients diagnosed with lung cancer between 1990-2000 worldwide, in order to revise the 6th edition TNM staging system for non-small cell lung cancer (NSCLC).(7) The 7th edition was published in late 2009. This review of staging in NSCLC, includes a summary of the different staging techniques currently available and the 7th edition TNM staging system for NSCLC.(8).
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203
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Laack E, Sauter G, Bokemeyer C. Lessons learnt from gefitinib and erlotinib: Key insights into small-molecule EGFR-targeted kinase inhibitors in non-small cell lung cancer. Lung Cancer 2010; 69:259-64. [DOI: 10.1016/j.lungcan.2010.05.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2009] [Revised: 05/07/2010] [Accepted: 05/13/2010] [Indexed: 01/22/2023]
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204
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Brunelli A, Rocco G, Van Raemdonck D, Varela G, Dahan M. Lessons learned from the European thoracic surgery database: The composite performance score. Eur J Surg Oncol 2010; 36 Suppl 1:S93-9. [DOI: 10.1016/j.ejso.2010.06.023] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Accepted: 06/08/2010] [Indexed: 11/30/2022] Open
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205
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Abstract
Preoperative evaluation of patients undergoing lung resection remains an interdisciplinary challenge. Despite substantial progress in anesthesiology, intensive care medicine and surgery, mortality of patients undergoing pneumonectomy remains high at 5-9%. Guidelines were developed to identify patients with an increased perioperative risk for morbidity and mortality. These guidelines are focused around the forced expiratory capacity (FEV) measured by spirometry, following further investigations in patients with limited FEV(1). Extended testing includes measurement of the diffusion capacity, calculation of postoperative predicted values of lung function and spiroergometry to determine maximal oxygen uptake. In this article the methods to measure parameters of lung function and gas exchange are described and evaluated in the context of the current guidelines.
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206
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Lee SA, Sun JS, Park JH, Park KJ, Lee SS, Choi H, Sheen SS, Chung WY, Lee KS, Park KJ, Hwang SC. Emphysema as a risk factor for the outcome of surgical resection of lung cancer. J Korean Med Sci 2010; 25:1146-51. [PMID: 20676324 PMCID: PMC2908782 DOI: 10.3346/jkms.2010.25.8.1146] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Accepted: 01/19/2010] [Indexed: 12/28/2022] Open
Abstract
It is unclear whether emphysema, regardless of airflow limitation, is a predictive factor associated with survival after lung cancer resection. Therefore, we investigated whether emphysema was a risk factor associated with the outcome after resection for lung cancer. This study enrolled 237 patients with non small cell lung cancer with stage I or II who had surgical removal. Patient outcome was analyzed based on emphysema. Emphysema was found in 43.4% of all patients. Patients with emphysema were predominantly men and smokers, and had a lower body mass index than the patients without emphysema. The patients without emphysema (n=133) survived longer (mean 51.2+/-3.0 vs. 40.6+/-3.1 months, P=0.042) than those with emphysema (n=104). The univariate analysis showed a younger age, higher FEV(1)/FVC, higher body mass index, cancer stage I, and a lower emphysema score were significant predictors of better survival. The multivariate analysis revealed a younger age, higher body mass index, and cancer stage I were independent parameters associated with better survival, however, emphysema was not. This study suggests that unfavorable outcomes after surgical resection of lung cancer should not be attributed to emphysema itself.
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Affiliation(s)
- Sung Ah Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Joo Sung Sun
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Joo Hun Park
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Kyung Joo Park
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Sung Soo Lee
- Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Ho Choi
- Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Seung Soo Sheen
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Woo Young Chung
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Keu Sung Lee
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Kwang Joo Park
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Sung Chul Hwang
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, Korea
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207
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Reeves R, Denner A, Nel L. One-lobe ventilation during contralateral lung resection. Anaesthesia 2010; 65:756-7. [PMID: 20642534 DOI: 10.1111/j.1365-2044.2010.06400.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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208
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Affiliation(s)
- Clifford G Robinson
- Department of Radiation Oncology, Washington University School of Medicine. St. Louis, MO, USA.
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209
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Duggan M, Kavanagh BP. Perioperative modifications of respiratory function. Best Pract Res Clin Anaesthesiol 2010; 24:145-55. [DOI: 10.1016/j.bpa.2009.12.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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210
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Saif MW, Tzannou I, Makrilia N, Syrigos K. Role and cost effectiveness of PET/CT in management of patients with cancer. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2010; 83:53-65. [PMID: 20589185 PMCID: PMC2892773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
PET/CT is a relatively new imaging technology, whose undoubted advantages are valuable in clinical oncology as well as in all fields of diagnosis, staging, and treatment. The hardware combination of anatomy and function has been the true evolution in imaging. PET using 18F-fluorodeoxyglucose (FDG) is increasingly used for the staging of solid malignancies, including colon, lung, etc., but anatomic information is limited. Integrated PET/CT enables optimal anatomic delineation of PET findings and identification of FDG-negative lesions on computed tomography (CT) images and might improve preoperative staging. However, controversy still exists in relation to the application of PET/CT in clinical practice, mainly because of its high cost. It is evident that apart from additional costs, potential savings also are associated with PET/CT as a result of avoiding additional imaging examinations or invasive procedures and by helping clinicians make the optimum treatment decisions. The authors review the literature on the role of PET/CT in management of various tumors and discuss the medicoeconomic usefulness.
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Affiliation(s)
- Muhammad Wasif Saif
- Yale University School of Medicine, Section of Medical Oncology, New Haven, Connecticut,To whom all correspondence should be addressed: M. Wasif Saif, MD, Associate Professor, Division of Medical Oncology, 333 Cedar Street, FMP 116, New Haven, CT 06520; E-mail:
| | - Ifigenia Tzannou
- Oncology Unit, 3rd Department of Medicine, Athens Medical School, Sotiria General Hospital, Athens, Greece
| | - Nektaria Makrilia
- Oncology Unit, 3rd Department of Medicine, Athens Medical School, Sotiria General Hospital, Athens, Greece
| | - Kostas Syrigos
- Yale University School of Medicine, Section of Medical Oncology, New Haven, Connecticut,Oncology Unit, 3rd Department of Medicine, Athens Medical School, Sotiria General Hospital, Athens, Greece
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211
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Radiotherapy for lung cancer in the elderly. Lung Cancer 2010; 68:129-36. [DOI: 10.1016/j.lungcan.2009.12.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Revised: 11/30/2009] [Accepted: 12/07/2009] [Indexed: 12/25/2022]
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212
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Campione A, Terzi A, Bobbio M, Rosso GL, Scardovi AB, Feola M. Oxygen Pulse as a Predictor of Cardiopulmonary Events in Lung Resection. Asian Cardiovasc Thorac Ann 2010; 18:147-52. [DOI: 10.1177/0218492310361792] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Traditional algorithms suggest a stepwise approach to the functional evaluation of candidates for lung resection. A cardiopulmonary exercise test is incorporated as a supplementary test for patients with borderline pulmonary predicted values, and sometimes as a first screening test for cardiac risk evaluation. To assess the predictive weight of exercise tests in noncardiac thoracic surgery, we retrospectively analyzed 99 patients (80 males) aged 67.8 ± 8.1 years who underwent lung resection after a cardiopulmonary exercise test. During basal spirometry, the mean predicted forced expiratory volume in the first second was 69.9% ± 18.6%, and predicted carbon monoxide diffusing capacity was 71.6% ± 20.5%. Peak oxygen consumption was 11.1 ± 3.2 mL·kg−1·min−1, oxygen pulse was 9 ± 2.8 mL·beat−1, and minute ventilation/CO2 output was 45.2 ± 7.7. Mean hospital stay was 10.4 days, and intensive care unit stay was 0.3 days. Postoperative complications occurred in 20 (20%) patients. On multivariate analysis, body mass index, a high level of exercise achieved during the cardiopulmonary exercise test, lower heart rate at peak exercise, and oxygen pulse correlated significantly with better postoperative outcome. Cardiopulmonary exercise tests are helpful for stratifying patients undergoing thoracic surgery. Perioperative complications seem to be strongly related to left ventricular function and physical performance.
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Affiliation(s)
| | | | - Marco Bobbio
- Department of Cardiovascular Diseases Cuneo Hospital, Cuneo, Italy
| | - Gian Luca Rosso
- Department of Cardiovascular Diseases Cuneo Hospital, Cuneo, Italy
| | | | - Mauro Feola
- Department of Cardiovascular Diseases Cuneo Hospital, Cuneo, Italy
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213
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Stereotactic radiotherapy for stage I lung cancer: Current results and new developments. Cancer Radiother 2010; 14:115-8. [DOI: 10.1016/j.canrad.2009.11.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2009] [Revised: 11/04/2009] [Accepted: 11/19/2009] [Indexed: 12/25/2022]
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214
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Usuda J, Ichinose S, Ishizumi T, Hayashi H, Ohtani K, Maehara S, Ono S, Honda H, Kajiwara N, Uchida O, Tsutsui H, Ohira T, Kato H, Ikeda N. Outcome of photodynamic therapy using NPe6 for bronchogenic carcinomas in central airways >1.0 cm in diameter. Clin Cancer Res 2010; 16:2198-204. [PMID: 20332318 DOI: 10.1158/1078-0432.ccr-09-2520] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE Most centrally located early lung cancers (CLELC) <1.0 cm in diameter do not invade beyond the bronchial cartilage, and photodynamic therapy (PDT) with Photofrin is currently recommended as a treatment option for such lesions. NPe6 is a second-generation photosensitizer, and because it has a longer absorption band (664 nm) than Photofrin (630 nm), we hypothesized that NPe6-PDT would exert a strong antitumor effect against cancer lesions >1.0 cm in diameter, which are assumed to involve extracartilaginous invasion and to be unsuitable for treatment with Photofrin-PDT. EXPERIMENTAL DESIGN Between June 2004 and December 2008, 75 patients (91 lesions) with CLELC underwent NPe6-PDT after the extent of their tumors had been assessed by fluorescence bronchoscopy for photodynamic diagnosis and tumor depth had been assessed by optical coherence tomography. RESULTS Seventy cancer lesions < or =1.0 cm in diameter and 21 lesions >1.0 cm in diameter were identified, and the complete response rate was 94.0% (66 of 70) and 90.4% (19 of 21), respectively. After the mass of large tumors and deeply invasive tumors had been reduced by electrocautery, NPe6-PDT was capable of destroying the residual cancer lesions. CONCLUSION NPe6-PDT has a strong antitumor effect against CLELCs >1.0 cm in diameter that have invaded beyond the bronchial cartilage, thereby enabling the destruction of residual cancer lesions after mass reduction of large nodular- or polypoid-type lung cancers by electrocautery. The PDT guidelines for lung cancers should therefore be revised because use of NPe6-PDT will enable expansion of the clinical indications for PDT.
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Affiliation(s)
- Jitsuo Usuda
- Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan.
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215
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Brunelli A. Risk Assessment for Pulmonary Resection. Semin Thorac Cardiovasc Surg 2010; 22:2-13. [DOI: 10.1053/j.semtcvs.2010.04.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2010] [Indexed: 12/20/2022]
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216
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Martin-Ucar AE, Medouye A, Deacon SE, Muhibullah N, Lau K, Bennett J, Annamaneni R. Systematic evaluation of quality of care provided to patients undergoing pulmonary surgery helps to identify areas for improvement☆. Interact Cardiovasc Thorac Surg 2010; 10:394-8. [DOI: 10.1510/icvts.2009.214221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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217
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Medford ARL, Bennett JA, Free CM, Agrawal S. Current status of medical pleuroscopy. Clin Chest Med 2010; 31:165-72, Table of Contents. [PMID: 20172442 DOI: 10.1016/j.ccm.2009.10.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Medical pleuroscopy (MP) offers a safe and minimally invasive tool for interventional pulmonologists. It allows diagnosis of unexplained effusion, while at the same time allowing drainage and pleurodesis. It can also help in the diagnosis of diffuse interstitial disease or associated peripheral lung abnormality in the presence of effusion. It can have a therapeutic role in pneumothorax and hyperhidrosis or chronic pancreatic pain. This article reviews the technical aspects and range of applications of MP.
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Affiliation(s)
- Andrew R L Medford
- Department of Respiratory Medicine, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester LE3 9QP, Leicestershire, UK.
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218
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Kim JB, Lee SW, Park SI, Kim YH, Kim DK. Risk factor analysis for postoperative acute respiratory distress syndrome and early mortality after pneumonectomy: the predictive value of preoperative lung perfusion distribution. J Thorac Cardiovasc Surg 2010; 140:26-31. [PMID: 20132949 DOI: 10.1016/j.jtcvs.2009.11.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2009] [Revised: 09/27/2009] [Accepted: 11/08/2009] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study aims to establish the preoperative risk factors in the development of acute respiratory distress syndrome (ARDS) and early mortality after pneumonectomy for lung cancer and to examine the influence of reduced pulmonary perfusion on outcomes. METHODS Between 1994 and 2009, of 425 patients who underwent simple pneumonectomy for primary lung cancer, 164 who were preoperatively evaluated with lung perfusion scanning formed the population of this study. RESULTS Of 30 (18.3%) patients who had major pulmonary complications, 17 (10.4%) progressed to ARDS, 15 of whom subsequently died. On multivariable logistic regression analyses, lower predicted postoperative forced expiratory volume in 1 second (ppo-FEV(1); relative risk of 0.93 [P = .020] for ARDS and 0.94 [P = .027] for mortality) and greater perfusion fraction of resected lung (relative risk of 1.10 [P = .003] for ARDS and 1.09 [P = .002] for mortality) were found to be independent factors associated with ARDS and early mortality. With a cut-off value of 35% for perfusion fraction of resected lung, patients with a perfusion fraction of greater than 35% had a greater incidence of ARDS (17.3% vs 3.3%, P = .005) and early mortality (19.8% vs 6.0%, P = .010) than those with a perfusion fraction of 35% or less. CONCLUSIONS Patients with a low ppo-FEV(1), a high perfusion fraction of resected lung, or both had a higher incidence of ARDS and early mortality after pneumonectomy. Therefore, although the ppo-FEV(1) appears to be within an acceptable limit for pneumonectomy, much attention should be given to patients with a high perfusion fraction of resected lung.
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Affiliation(s)
- Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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219
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Management of Multiple Primary Lung Cancer in Patients with Centrally Located Early Cancer Lesions. J Thorac Oncol 2010; 5:62-8. [DOI: 10.1097/jto.0b013e3181c42287] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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220
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Wittenberg M, Kaur N, Miller RF, Walker DA. The Challenges of HIV Disease in the Intensive Care Unit. J Intensive Care Soc 2010. [DOI: 10.1177/175114371001100108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
HIV/AIDS continues to be a significant world health issue. Patterns of referral to intensive care units (ICU) have changed in parallel with advances in treatment. Proven Pneumocystis therapy and the introduction of antiretroviral drugs have increased life expectancy. Lower respiratory tract infection predominates as a reason for ICU admission. Pneumocystis jirovecii, TB, fungi and bacterial infections rank highly as respiratory pathogens and should be considered potentially causative. Neurological pathology and severe sepsis commonly necessitate ICU admission in this population. The timing of highly active antiretroviral therapy (HARRT) remains controversial in critically ill patients. Therapy may be difficult due to associated drug interactions, lack of intravenous drug formulation and known toxic side effects. Improvement in survival may have resulted as much from general improvements in ICU care as from advances in highly active antiretroviral therapy, notably lung protective ventilation strategies and approaches to the early recognition and management of sepsis. HIV infection is now considered a chronic illness and should not be seen as a bar to ICU admission. Many HIV-positive patients present with non-HIV related illness and can be expected to make as good a recovery as non-infected patients.
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Affiliation(s)
- Marc Wittenberg
- Specialist Registrar in Anaesthesia
- University College London Hospitals
| | - Navkiran Kaur
- Clinical Fellow in Anaesthesia
- University College London Hospitals
| | - Rob F Miller
- Professor of Infectious Diseases, Dept of Infectious Diseases, University College London
- University College London Hospitals
| | - David A Walker
- Consultant in Anaesthesia & Critical Care Medicine
- University College London Hospitals
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221
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Abstract
Patients undergoing thoracic surgery are threatened by pulmonary complications such as pneumonia and atelectasis. Age, preoperative FEV(1), operative time and extent of resection are predictors for adverse outcome. Reported morbidity after lung resection is as high as 42% and mortality up to 7%. Fast track in thoracic surgery aims at reducing morbidity and mortality rates after lung resection by introducing specific measures into the pre-, intra- and postoperative periods. Basic fast track elements in thoracic surgery are smoking cessation, preoperative physiotherapy, micronutrient supplementation, high thoracic epidural anesthesia, fluid restriction, early mobilization and enteral feeding. The effectiveness of these individual measures has been proven of value in perioperative care, however, evidence on multimodal therapy regimens in thoracic surgery is limited. In particular it remains to be elucidated which patients should be fast tracked in order to improve outcomes.
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Affiliation(s)
- B Mühling
- Klinik für Thorax- und Gefässchirurgie, Universität Ulm, Steinhövelstrasse 9, Ulm, Germany.
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222
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Heunks LMA, de Bruin CJR, van der Hoeven JG, van der Heijden HFM. Non-invasive mechanical ventilation for diagnostic bronchoscopy using a new face mask: an observational feasibility study. Intensive Care Med 2009; 36:143-7. [PMID: 19774365 PMCID: PMC2807591 DOI: 10.1007/s00134-009-1662-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2009] [Accepted: 09/01/2009] [Indexed: 11/07/2022]
Abstract
Purpose Bronchoscopy is an indispensable tool for invasive pulmonary evaluation with high diagnostic yield and low incidence of major complications. However, hypoxemia increases the risk of complications, in particular after bronchoalveolar lavage. Non-invasive positive pressure ventilation may prevent hypoxemia associated with bronchoalveolar lavage. The purpose of this study is to present a modified total face mask to aid bronchoscopy during non-invasive positive pressure ventilation. Methods A commercially available full face mask was modified to allow introduction of the bronchoscope without interfering with the ventilator circuit. Bronchoscopy with bronchoalveolar lavage was performed in 12 hypoxemic non-ICU patients during non-invasive positive pressure ventilation in the ICU. Results Patients had severely impaired oxygen uptake as indicated by PaO2/FiO2 ratio 192 ± 23 mmHg before bronchoscopy. Oxygenation improved after initiation of non-invasive positive pressure ventilation. In all patients the procedure could be completed without subsequent complications, although in one patient SpO2 decreased until 86% during bronchoscopy. A microbiological diagnosis could be established in 8 of 12 patients with suspected for infection. Conclusions Our modified face mask for non-invasive positive pressure ventilation is a valuable tool to aid diagnostic bronchoscopy in hypoxemic patients.
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Affiliation(s)
- Leo M A Heunks
- Department of Intensive Care Medicine (551), Radboud University Medical Centre, Postbox 9101, 6500 HB Nijmegen, The Netherlands.
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223
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Charloux A, Brunelli A, Bolliger CT, Rocco G, Sculier JP, Varela G, Licker M, Ferguson MK, Faivre-Finn C, Huber RM, Clini EM, Win T, De Ruysscher D, Goldman L. Lung function evaluation before surgery in lung cancer patients: how are recent advances put into practice? A survey among members of the European Society of Thoracic Surgeons (ESTS) and of the Thoracic Oncology Section of the European Respiratory Society (ERS). Interact Cardiovasc Thorac Surg 2009; 9:925-31. [PMID: 19752152 DOI: 10.1510/icvts.2009.211219] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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224
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Kashiwabara K, Sasaki JI, Mori T, Nomori H, Fujii K, Kohrogi H. Relationship Between Functional Preservation after Segmentectomy and Volume-Reduction Effects after Lobectomy in Stage I Non-small Cell Lung Cancer Patients with Emphysema. J Thorac Oncol 2009; 4:1111-6. [DOI: 10.1097/jto.0b013e3181ae59e2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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225
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Pallis AG, Gridelli C, van Meerbeeck JP, Greillier L, Wedding U, Lacombe D, Welch J, Belani CP, Aapro M. EORTC Elderly Task Force and Lung Cancer Group and International Society for Geriatric Oncology (SIOG) experts' opinion for the treatment of non-small-cell lung cancer in an elderly population. Ann Oncol 2009; 21:692-706. [PMID: 19717538 DOI: 10.1093/annonc/mdp360] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Non-small-cell lung cancer (NSCLC) represents a common health issue in the elderly population. Nevertheless, the paucity of large, well-conducted prospective trials makes it difficult to provide evidence-based clinical recommendations for these patients. The present paper reviews the currently available evidence regarding treatment of all stages of NSCLC in elderly patients. Surgery remains the standard for early-stage disease, though pneumonectomy is associated with higher incidence of postoperative mortality in elderly patients. Given the lack of demonstrated benefit for the use of adjuvant radiotherapy, it is also not recommended in elderly patients. Elderly patients seem to derive the same benefit from adjuvant chemotherapy as younger patients do, with no significant increase in toxicity. For locally advanced NSCLC, concurrent chemoradiotherapy may be offered to selected elderly patients as there is a higher risk for toxicity reported in the elderly population. Third-generation single-agent treatment is considered the standard of care for patients with advanced/metastatic disease. Platinum-based combination chemotherapy needs to be evaluated in prospective trials. Unfortunately, with the exception of advanced/metastatic NSCLC, prospective elderly-specific NSCLC trials are lacking and the majority of recommendations made are based on retrospective data, which might suffer from selection bias. Prospective elderly-specific trials are needed.
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Affiliation(s)
- A G Pallis
- EORTC Headquarters, EORTC-ETF, Brussels, Belgium.
| | - C Gridelli
- Division of Medical Oncology, "S.G. Moscati" Hospital, Avellino, Italy
| | - J P van Meerbeeck
- Department of Respiratory Medicine & Thoracic Oncology, Ghent University Hospital, Gent, Belgium; EORTC Lung Cancer Group, Brussels, Belgium
| | - L Greillier
- EORTC Lung Cancer Group, Brussels, Belgium; Department of Thoracic Oncology, Assistance Publique-Hôpitaux de Marseille, Faculté de Médecine, Université de la Méditerranée, Marseille, France
| | - U Wedding
- Department of Hematology, Oncology, Palliative Care, University Hospital Jena, Jena, Germany
| | - D Lacombe
- EORTC Headquarters, EORTC-ETF, Brussels, Belgium
| | - J Welch
- EORTC Headquarters, EORTC Lung Cancer Group, Brussels, Belgium
| | - C P Belani
- Department of Medicine, Penn State Cancer Hershey Institute, Hershey, USA
| | - M Aapro
- IMO Clinique de Genolier, Genolier, Switzerland
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Benzo RP, Sciurba FC. Oxygen consumption, shuttle walking test and the evaluation of lung resection. ACTA ACUST UNITED AC 2009; 80:19-23. [PMID: 19672050 DOI: 10.1159/000235543] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2009] [Accepted: 06/04/2009] [Indexed: 11/19/2022]
Abstract
BACKGROUND Assessment of peak oxygen uptake (VO(2)) is recommended in the evaluation of patients with borderline pulmonary function as VO(2) is the strongest independent predictor of postoperative pulmonary complications. However, the measurement of VO(2) requires expensive equipment not available in many medical facilities. The shuttle walking test (SWT) has been proposed to be used as a screening tool prior to performing a cardiopulmonary exercise test. Although an association exists between SWT distance and VO(2), only one small study directly measured VO(2) during the SWT. OBJECTIVES The aim of this study was to further validate the VO(2)-SWT association by directly measuring VO(2) during SWT in a larger cohort of patients with stable chronic obstructive pulmonary disease (COPD). METHODS Fifty stable COPD patients with mild/severe disease were studied. Each patient performed an SWT while wearing a validated portable metabolic monitor. RESULTS Mean VO(2) (ml/kg/min) measured after each finalized minute of the SWT was (95% confidence interval): 6 (5-7), 9 (8-10), 11 (10-12), 13 (11-14), 15 (14-16), 18 (16-20) and 21 (18-26) for minutes 1-7, respectively. Patients that completed the British Thoracic Society-recommended 25 shuttles (5 min or 250 m) in the SWT had a mean VO(2) of 15 (14-16). The positive predictive value for walking 25 shuttles (predicting a VO(2) of >or=15ml/kg/min) was 90% and the negative predictive value was 90%. CONCLUSIONS Our findings validate the association between VO(2) and SWT distance and facilitate the interpretation of the test in general practice, particularly when deciding the candidacy of a patient for surgical resection.
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Affiliation(s)
- Roberto P Benzo
- Divisions of Pulmonary and Critical Care Medicine at Mayo Clinic, Rochester, MN 55905, USA.
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Outcome for Patients with Malignant Pleural Mesothelioma Referred for Trimodality Therapy in Western Australia. J Thorac Oncol 2009; 4:1010-6. [DOI: 10.1097/jto.0b013e3181ae25bf] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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228
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Jaklitsch M, Billmeier S. Preoperative Evaluation and Risk Assessment for Elderly Thoracic Surgery Patients. Thorac Surg Clin 2009; 19:301-12. [DOI: 10.1016/j.thorsurg.2009.07.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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229
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Powell ES, Pearce AC, Cook D, Davies P, Bishay E, Bowler GMR, Gao F. UK pneumonectomy outcome study (UKPOS): a prospective observational study of pneumonectomy outcome. J Cardiothorac Surg 2009; 4:41. [PMID: 19643006 PMCID: PMC2726136 DOI: 10.1186/1749-8090-4-41] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2009] [Accepted: 07/30/2009] [Indexed: 01/02/2023] Open
Abstract
Background In order to assess the short term risks of pneumonectomy for lung cancer in contemporary practice a one year prospective observational study of pneumonectomy outcome was made. Current UK practice for pneumonectomy was observed to note patient and treatment factors associated with major complications. Methods A multicentre, prospective, observational cohort study was performed. All 35 UK thoracic surgical centres were invited to submit data to the study. All adult patients undergoing pneumonectomy for lung cancer between 1 January and 31 December 2005 were included. Patients undergoing pleuropneumonectomy, extended pneumonectomy, completion pneumonectomy following previous lobectomy and pneumonectomy for benign disease, were excluded from the study. The main outcome measure was suffering a major complication. Major complications were defined as: death within 30 days of surgery; treated cardiac arrhythmia or hypotension; unplanned intensive care admission; further surgery or inotrope usage. Results 312 pneumonectomies from 28 participating centres were entered. The major complication incidence was: 30-day mortality 5.4%; treated cardiac arrhythmia 19.9%; unplanned intensive care unit admission 9.3%; further surgery 4.8%; inotrope usage 3.5%. Age, American Society of Anesthesiologists physical status ≥ P3, pre-operative diffusing capacity for carbon monoxide (DLCO) and epidural analgesia were collectively the strongest risk factors for major complications. Major complications prolonged median hospital stay by 2 days. Conclusion The 30 day mortality rate was less than 8%, in agreement with the British Thoracic Society guidelines. Pneumonectomy was associated with a high rate of major complications. Age, ASA physical status, DLCO and epidural analgesia appeared collectively most associated with major complications.
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Li JY, Yong TY, Jurisevic CA, Russ GR, Grove DI, Coates PTH, Disney AP. Successful Treatment of Pulmonary Mucormycosis in a Renal Transplant Recipient with Limited Pulmonary Reserve by Combined Medical and Surgical Therapy. Heart Lung Circ 2009; 18:226-8. [DOI: 10.1016/j.hlc.2007.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2007] [Accepted: 12/22/2007] [Indexed: 10/22/2022]
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Balduyck B, Hendriks J, Lauwers P, Nia PS, Van Schil P. Quality of life evolution after lung cancer surgery in septuagenarians: a prospective study. Eur J Cardiothorac Surg 2009; 35:1070-5; discussion 1075. [DOI: 10.1016/j.ejcts.2009.01.050] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2008] [Revised: 01/27/2009] [Accepted: 01/30/2009] [Indexed: 01/22/2023] Open
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Abstract
PURPOSE OF REVIEW Pneumonectomy has the highest perioperative risk among common pulmonary resections. The purpose of this review is to update clinicians on the importance of anesthetic management for these patients. RECENT FINDINGS Two complications associated with increased perioperative mortality are relevant to anesthetic management: postoperative arrhythmias and acute lung injury. The geriatric population is particularly at risk for arrhythmias. Adequate preoperative cardiac assessment and drug prophylaxis may decrease this risk. Patients with decreased respiratory function are at increased risk for acute lung injury. The use of large tidal-volume ventilation during anesthesia may increase this risk. There is a trend to better outcomes in centers with larger surgical volumes. SUMMARY Patients should have a preoperative assessment of their respiratory function in three areas: lung mechanical function, pulmonary parenchymal function and cardiopulmonary reserve. Interventions that have been shown to decrease the incidence of respiratory complications include cessation of smoking, physiotherapy and thoracic epidural analgesia. Extrapleural pneumonectomy and sleeve pneumonectomy are surgical variations that place specific increased demands on the anesthesiologist. The rare but treatable complication of cardiac herniation must always be remembered as a potential cause of life-threatening hemodynamic instability in the early postoperative period.
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233
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Kobayashi S, Suzuki S, Niikawa H, Sugawara T, Yanai M. Preoperative use of inhaled tiotropium in lung cancer patients with untreated COPD. Respirology 2009; 14:675-9. [PMID: 19476597 DOI: 10.1111/j.1440-1843.2009.01543.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVE Lung cancer patients with COPD are at high risk during surgery. Tiotropium, a long-acting bronchodilator, is a preferred maintenance therapy for COPD, but its efficacy in the perioperative period has not been clarified. METHODS A retrospective review was performed of the medical records of 102 patients with primary lung cancer and COPD, who underwent scheduled surgery. Twenty-one lung cancer patients with untreated mild-to-severe COPD received tiotropium preoperatively. Spirometry was performed prior to and after 2 weeks of treatment with tiotropium, and at 3 months after surgery. RESULTS Two-week preoperative treatment with tiotropium significantly improved respiratory symptoms and pulmonary function as reflected by FVC (median 3.43 L pretreatment vs 3.52 L post-treatment), FEV(1) (median 2.06 L vs 2.32 L) and FEV(1)% (73.2% vs 81.0%) (all P < 0.001). Postoperative FEV(1)% was significantly increased from a median of 56.0% (interquartile range 51.6-60.3) to 63.4% (60.8-66.0) (P < 0.001). The increase in FEV(1) was inversely associated with severity of COPD (r = -0.59, P < 0.005). Lung resections were successfully accomplished without complications. The postoperative FEV(1) predicted prior to tiotropium treatment was underestimated (median predicted postoperative FEV(1) 1.65 L vs median measured postoperative FEV(1) 1.96 L, P < 0.001). CONCLUSIONS Preoperative treatment with tiotropium may facilitate surgical treatment for lung cancer patients with COPD. This is encouraging for COPD patients who may require curative lung resections.
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Affiliation(s)
- Seiichi Kobayashi
- Department of Respiratory Medicine, Japanese Red Cross Ishinomaki Hospital, 71 Nishimichishita, Hebita, Ishinomaki 986-8522, Japan.
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Voltolini L, Rapicetta C, Ligabue T, Luzzi L, Scala V, Gotti G. Short- and Long-Term Results of Lung Resection for Cancer in Octogenarians. Asian Cardiovasc Thorac Ann 2009; 17:147-52. [DOI: 10.1177/0218492309103295] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To analyze short- and long-term results of surgery in octogenarians, we reviewed data of 96 consecutive patients aged 80 years or more who were operated on for non-small-cell lung carcinoma from 1990 to 2005. Risk factors for complications, perioperative mortality, and long-term survival were assessed by univariate and multivariate analysis. Major complications developed in 17 (17.7%) patients, leading to death in 9 (9.4%) of them. Resection of more than 1 lobe, cardiorespiratory comorbidity, PaO2 < 75 mm Hg, and CO diffusion capacity <60% were predictive of major complications; extended resection was also predictive of 30-day mortality. The overall 5-year survival rate was 38%, with a significant difference between stage I/II and stage III. In multivariate analysis only pathological stage was related to long-term survival. Surgery is feasible for octogenarians, and even patients in stage II can achieve remarkable survival.
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Affiliation(s)
| | | | - Tommaso Ligabue
- Thoracic Surgery Unit, Spedali Civili Riuniti, Brescia, Italy
| | - Luca Luzzi
- Thoracic Surgery Unit, Spedali Civili Riuniti, Brescia, Italy
| | - Valerio Scala
- Thoracic Surgery Unit, Spedali Civili Riuniti, Brescia, Italy
| | - Giuseppe Gotti
- Thoracic Surgery Unit, Spedali Civili Riuniti, Brescia, Italy
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236
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Extended sleeve lobectomy for locally advanced lung cancer. Ann Thorac Surg 2009; 87:900-5. [PMID: 19231416 DOI: 10.1016/j.athoracsur.2008.12.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Revised: 12/02/2008] [Accepted: 12/05/2008] [Indexed: 11/24/2022]
Abstract
BACKGROUND The risk of perioperative mortality is greater for patients undergoing a pneumonectomy than for a sleeve lobectomy. At our institution, we perform an extended sleeve lobectomy, an atypical sleeve resection of more than one lobe, to avoid a pneumonectomy in patients with locally advanced lung cancer. The purpose of this study was to analyze the risks of complications and local control in patients who underwent an extended sleeve lobectomy procedure. METHODS Patients who underwent an extended sleeve lobectomy procedure were retrospectively analyzed in regard to operative mortality, complications, and local recurrence. RESULTS A total of 23 patients underwent an extended sleeve lobectomy: one lobe + segment in 15, two lobes in 7, and two lobes + segment in 1. There were no operative deaths within 30 days or hospital deaths. Two (8.7%) of the 23 patients had complications at the anastomosis site, a stricture in 1 and bronchopleural fistula in 1, whereas 2 (8.7%) others had local control failure, relapse at the anastomosis site in 1 and staple line relapse in 1. Long-term survival was similar to that of those who underwent a pneumonectomy during the same period. CONCLUSIONS Our extended sleeve lobectomy procedure is useful to avoid a pneumonectomy in patients with locally advanced lung cancer.
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237
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Kasikcioglu E, Toker A, Tanju S, Arzuman P, Kayserilioglu A, Dilege S, Kalayci G. Oxygen uptake kinetics during cardiopulmonary exercise testing and postoperative complications in patients with lung cancer. Lung Cancer 2009; 66:85-8. [PMID: 19185383 DOI: 10.1016/j.lungcan.2008.12.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2008] [Revised: 11/07/2008] [Accepted: 12/24/2008] [Indexed: 11/18/2022]
Abstract
It is accepted that cardiopulmonary exercise testing is one of the most valuable parameters, especially peak oxygen uptake (VO(2)), for the evaluation of risk assessment in lung cancer surgery. It therefore represents an attractive way of identifying a patient at high risk for postoperative complications. However, many patients do not achieve the maximal or predictive level during an incremental exercise testing. The purpose of the current investigation was to study the value of the oxygen uptake efficiency slope (OUES), which shows exercise capacity during submaximal testing, in predicting postoperative mortality in patients with bronchogenic carcinoma scheduled for lung resection. Forty-nine patients with bronchogenic carcinoma participated in studies with exercise tests as a preoperative evaluation. The peak VO(2) was calculated for each subject by averaging values obtained during the final 10s of exercise. The following equation was used to determine OUES: VO(2)/log(10)VE. Peak VO(2) without postoperative complication was 22.8+/-3.3 ml/(kg min), however, peak VO(2) in patients with present complications was 19.1+/-4.2 ml/(kg min) (p=0.001). In addition, although the mean OUES in patients with present complications was 11.1+/-1.2, the mean OUES in the absent group was 13.3+/-2.1 (p<0.001). Although peak VO(2) is useful in evaluating selected patients with bronchogenic carcinoma, OUES is also a beneficial parameter and should be calculated and recorded with peak VO(2), a better predictor of poor surgical outcome than absolute values, and should be integrated into preoperative decision making.
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Affiliation(s)
- Erdem Kasikcioglu
- Istanbul University, Istanbul Faculty of Medicine, Department of Sports Medicine, Istanbul, Turkey.
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238
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Bernstein WK, Deshpande S. Preoperative evaluation for thoracic surgery. Semin Cardiothorac Vasc Anesth 2009; 12:109-21. [PMID: 18635562 DOI: 10.1177/1089253208319868] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The goal of the preoperative evaluation for thoracic surgery is to assess and implement measures to decrease perioperative complications and prepare high-risk patients for surgery. Major respiratory complications, such as atelectasis, pneumonia, and respiratory failure, occur in 15% to 20% of patients and account for most of the 3% to 4% mortality rate. Development of pulmonary complications has been associated with higher postoperative mortality rates. Strategies aimed at preventing postoperative difficulties have the potential to reduce morbidity and mortality, decrease hospital stay, and improve resource use. One lung ventilation leads to a significant derangement of gas exchange, and hypoxemia can develop due to increased intrapulmonary shunting. Recent advances in anesthetic management, monitoring devices, improved lung isolation techniques, and improved critical care management have increased the number of patients who were previously considered inoperable. In addition, there is a growing tendency to offer surgery to patients with significant lung function impairment; hence a higher incidence of intraoperative gas-exchange abnormalities can be expected. The anesthesiologist must also consider the risks of denying or postponing a potentially curative operation in patients with lung cancer. Detailed consideration of the information provided by preoperative testing is essential to successful outcomes following thoracic surgery.
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Affiliation(s)
- Wendy K Bernstein
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
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Abstract
Pulmonary metastases are common in patients following resection for soft tissue sarcoma. Pulmonary resection of metastatic soft tissue sarcomas is widely practiced in surgical oncology. No randomized phase III trials are available, and data for this review were retrieved only from retrospective studies. This article addresses the issues of patient selection, surgical technique, and adjuvant chemotherapy, and provides the surgical oncologist with a current review of pulmonary metastasectomy in metastatic soft tissue sarcoma. In summary, there is a substantial body of evidence demonstrating that resection of soft tissue pulmonary metastases can be performed safely and with a low mortality rate. For a subset of highly selected patients, the overall results of a 5-year actuarial survival rate ranged between 25% and 37.6%. These outcomes exceed those normally associated with metastatic soft tissue sarcoma and are well comparable with surgical resection for other malignancies.
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240
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Cheung MC, Hamilton K, Sherman R, Byrne MM, Nguyen DM, Franceschi D, Koniaris LG. Impact of Teaching Facility Status and High-Volume Centers on Outcomes for Lung Cancer Resection: An Examination of 13,469 Surgical Patients. Ann Surg Oncol 2009; 16:3-13. [DOI: 10.1245/s10434-008-0025-9] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2008] [Revised: 05/17/2008] [Accepted: 05/18/2008] [Indexed: 01/01/2023]
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241
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Fu X, Zhang N, Li Y, Sun W. Application of pulmonary venoplasty in the surgical treatment of lung cancer. ACTA ACUST UNITED AC 2008; 28:681-2. [DOI: 10.1007/s11596-008-0615-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Indexed: 11/27/2022]
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242
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Struthers R, Erasmus P, Holmes K, Warman P, Collingwood A, Sneyd J. Assessing fitness for surgery: a comparison of questionnaire, incremental shuttle walk, and cardiopulmonary exercise testing in general surgical patients † †This article is accompanied by the Editorial. Br J Anaesth 2008; 101:774-80. [DOI: 10.1093/bja/aen310] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Brunelli A, Belardinelli R, Refai M, Salati M, Socci L, Pompili C, Sabbatini A. Peak oxygen consumption during cardiopulmonary exercise test improves risk stratification in candidates to major lung resection. Chest 2008; 135:1260-1267. [PMID: 19029436 DOI: 10.1378/chest.08-2059] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The objective of this investigation was to assess the association of peak oxygen consumption (Vo(2)) with postoperative outcome in a prospective cohort of patients undergoing major lung resection for the treatment of lung cancer. METHODS Preoperative symptom-limited cardiopulmonary exercise testing (CPET) performed using cycle ergometry was conducted in 204 consecutive patients who had undergone pulmonary lobectomy or pneumonectomy. Peak Vo(2) was tested for possible association with postoperative cardiopulmonary complications and mortality. Logistic regression analysis, validated by a bootstrap analysis, was used to adjust for the effect of other perioperative factors. The role of peak Vo(2) in stratifying the surgical risk was further assessed in different groups of patients subdivided according to their cardiorespiratory status. RESULTS Logistic regression showed that peak Vo(2) was an independent and reliable predictor of pulmonary complications (p = 0.04). All six deaths occurred in patients with a peak Vo(2) of < 20 mL/kg/min (four deaths in patients with a peak Vo(2) of < 12 mL/kg/min). The mortality rate in this high-risk group was 10-fold higher (4 of 30 patients; 13%) compared to those with higher peak Vo(2) (p = 0.006). Compared to patients with a peak Vo(2) of > 20 mL/kg/min, those with a peak Vo(2) of < 12 mL/kg/min had 5-fold, 8-fold, 5-fold, and 13-fold higher rates, respectively, of total cardiopulmonary complications pulmonary complications, cardiac complications, and mortality. CONCLUSIONS The present study supports a more liberal use of CPET before lung resection compared to the current guidelines since this test can help in stratifying the surgical risk and optimizing perioperative care.
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Affiliation(s)
| | | | - Majed Refai
- Division of Thoracic Surgery, Umberto I Regional Hospital, Ancona, Italy
| | - Michele Salati
- Division of Thoracic Surgery, Umberto I Regional Hospital, Ancona, Italy
| | - Laura Socci
- Division of Thoracic Surgery, Umberto I Regional Hospital, Ancona, Italy
| | - Cecilia Pompili
- Division of Thoracic Surgery, Umberto I Regional Hospital, Ancona, Italy
| | - Armando Sabbatini
- Division of Thoracic Surgery, Umberto I Regional Hospital, Ancona, Italy
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Gonzalez-Aragoneses F, Moreno-Mata N, Simon-Adiego C, Peñalver-Pascual R, Gonzalez-Casaurran G, Perea LA. Lung cancer surgery in the elderly. Crit Rev Oncol Hematol 2008; 71:266-71. [PMID: 18996718 DOI: 10.1016/j.critrevonc.2008.09.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2008] [Revised: 07/19/2008] [Accepted: 09/17/2008] [Indexed: 10/21/2022] Open
Abstract
Non-small cell lung cancer (NSCLC) is a typical disease of the elderly, and is becoming increasingly more common as a result of the gradual aging of the population. Although patient age is known to be an independent prognostic factor of postoperative survival, lung resection should not be denied on the basis of age alone. In patients of this kind, careful evaluation and selection is very important. In early-stage NSCLC, surgery is the treatment of choice. In the advanced stages of the disease treatment usually comprises primary radiotherapy or combined radio-chemotherapy. Preoperative preparation and postoperative care are very important in chest surgery, and particularly in elderly patients. The 5-year survival rate in octogenarians exceeds 40%, but is much lower in pneumonectomized patients (close to 10%). In conclusion, elderly patients should be offered the best treatment possible, bearing in mind that surgery offers the best results when the disease is resectable.
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245
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Induction chemotherapy followed by parenchyma-sparing surgery in medically inoperable NSCLC—Results of a feasibility study. Lung Cancer 2008; 62:228-35. [DOI: 10.1016/j.lungcan.2008.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2008] [Revised: 03/03/2008] [Accepted: 03/08/2008] [Indexed: 12/26/2022]
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Place de la chimiothérapie. Rev Mal Respir 2008. [DOI: 10.1016/s0761-8425(08)82015-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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247
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Costa F, J Barata F. [Treatment of non-small cell lung cancer in elderly patients]. REVISTA PORTUGUESA DE PNEUMOLOGIA 2008; 13:841-54. [PMID: 18183333 DOI: 10.1016/s0873-2159(15)30379-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Lung cancer is the most common cause of cancer death. With the aging of the population, more than 50% of patients with non-small cell lung cancer (NSCLC) are older than 65 years. Until recently, there was some scepticism regarding treatment of patients in this age group, prevailing the notion that whatever treatment was given, the balance between the benefits and the side effects was unfavourable. The organ failure dependent of age, the comorbidities, the polimedication and the fragility of elderly people, were responsible for this generalized opinion. In the last few years, this nihilistic approach has changed radically. When deciding what treatment strategy should be used in these patients, the biological age (based on performance status: PS and comorbidities) rather than the chronological age should be taken into account, and the modification of standard treatment plans should only be made when there is a valid reason. This applies equally to surgery, chemotherapy, radiotherapy and the new targeted agents, the therapeutic weapons available to treat this disease. Recently published studies, that specifically analysed elderly patients, proved that if treated adequately, elderly patients with a good PS and without major comorbidities have the same survival rates and quality of life as younger patients. The rising number of elderly patients with lung cancer led the authors to do a review of the literature on this topic.
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Affiliation(s)
- Filipa Costa
- Serviço de Pneumologia, Centro Hospitalar de Coimbra
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249
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Brunelli A, Refai M, Xiumé F, Salati M, Sciarra V, Socci L, Sabbatini A. Performance at symptom-limited stair-climbing test is associated with increased cardiopulmonary complications, mortality, and costs after major lung resection. Ann Thorac Surg 2008; 86:240-7; discussion 247-8. [PMID: 18573431 DOI: 10.1016/j.athoracsur.2008.03.025] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2008] [Revised: 03/09/2008] [Accepted: 03/14/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Exercise tests are increasingly used during preoperative evaluation before lung resection. This study assessed the association between performance at the symptom-limited stair-climbing test and postoperative cardiopulmonary morbidity, mortality, and costs after major lung resections. METHODS As part of their routine preoperative evaluation, 640 patients who had lobectomy (n = 533) or pneumonectomy (n = 107) for lung cancer from January 2000 through April 2007 performed a preoperative symptom-limited stair-climbing test. Sensitivity/specificity analysis was used to identify the best cutoff values of altitude climbed (number of steps x height of the step in m) associated with outcome. Univariate and multivariate regression analyses (validated by bootstrap) were used to test associations between preoperative and operative factors and postoperative cardiopulmonary complications, mortality, and postoperative costs. RESULTS The altitude reached at the stair-climbing test was reliably associated with increased cardiopulmonary complications (p = 0.04), mortality (p = 0.02), and costs (p < 0.0001). In patients who climbed less than 12 m, cardiopulmonary complications, mortality, and costs were 2-fold (p < 0.0001), 13-fold (p < 0.0001), and 2.5-fold higher, respectively, than in patients who climbed more than 22 m. CONCLUSIONS Performance at a maximal stair-climbing test was reliably associated with postoperative morbidity and mortality. We recommend the use of this simple and economic test in all lung resection candidates. Patients who perform poorly at the stair-climbing test should undergo a formal cardiopulmonary exercise test with measurement of oxygen consumption to optimize their perioperative management.
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Brunelli A, Salati M. Preoperative evaluation of lung cancer: predicting the impact of surgery on physiology and quality of life. Curr Opin Pulm Med 2008; 14:275-81. [DOI: 10.1097/mcp.0b013e328300caac] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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