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Takamori S, Oizumi H, Suzuki J, Watanabe H, Sato K, Shiono S, Uchida T. Residual middle lobectomy after right upper or lower lobectomy: indications and outcome. Gen Thorac Cardiovasc Surg 2023; 71:525-533. [PMID: 36840840 DOI: 10.1007/s11748-023-01919-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/14/2023] [Indexed: 02/26/2023]
Abstract
OBJECTIVES Residual middle lobectomy after upper lobectomy and lower lobectomy differs in their indications and perioperative outcomes. Therefore, we aimed to evaluate the indications and perioperative outcomes of residual middle lobectomy after upper and lower lobectomy. METHODS The data of 14 patients who underwent residual middle lobectomy after upper or lower lobectomy between January 1997 and December 2021 were extracted and analyzed. RESULTS Overall, six patients underwent residual middle lobectomy after upper lobectomy. The indication was second primary lung cancer in five patients and local recurrence in the hilar lymph node between the middle and lower lobar bronchi in one patient. However, one patient was treated with the R2 operation. The remaining eight patients underwent residual middle lobectomy after lower lobectomy. The indication was second primary lung cancer and bronchopleural fistula or stenosis in two and six patients, respectively. No postoperative 90-day mortality was observed. CONCLUSIONS Residual middle lobectomy for second lung cancer after upper lobectomy is difficult because of severe hilar adhesions. Simultaneous resection of hilar structures or pulmonary artery and parenchyma might be an option. Residual middle lobectomy could be a treatment option for bronchopleural fistula or stenosis after lower lobectomy.
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Affiliation(s)
- Satoshi Takamori
- Department of Surgery II, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan.
- Department of General Thoracic Surgery, Higashiyamato Hospital, 1-13-12 Nangai, Higashiyamato, Tokyo, 207-0014, Japan.
| | - Hiroyuki Oizumi
- Department of General Thoracic Surgery, Higashiyamato Hospital, 1-13-12 Nangai, Higashiyamato, Tokyo, 207-0014, Japan
| | - Jun Suzuki
- Department of Surgery II, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Hikaru Watanabe
- Department of Surgery II, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Kaito Sato
- Department of Surgery II, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Satoshi Shiono
- Department of Surgery II, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Tetsuro Uchida
- Department of Surgery II, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
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Murakami J, Tanaka T, Hoshii Y, Hamano K. Microscopic feature of lymph node anthracosilicosis adherent with pulmonary artery: a case report. J Cardiothorac Surg 2023; 18:249. [PMID: 37605209 PMCID: PMC10441720 DOI: 10.1186/s13019-023-02348-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 08/09/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Although thoracic surgeons occasionally encounter dense adhesions of interlobar lymph node anthracosilicosis with the pulmonary artery, adhesiolysis may be challenging. Besides, characteristic microscopic features of the adherent lesion remain limited. CASE PRESENTATION During a thoracoscopic right upper lobectomy of a patient with stage IA3 primary lung adenocarcinoma, several interlobar lymph nodes adhered to the posterior ascending branch of the pulmonary artery to the right upper lobe were noted. After an unplanned conversion to a thoracotomy to avoid massive bleeding, the pulmonary artery branch was safely isolated. Microscopic examination revealed lymph node anthracosilicosis proximal to the peripheral pulmonary artery wall, with granulomatous inflammation. The adventitial stroma of the pulmonary artery developed into dense and borderless fibrous tissue with dust-laden macrophages. CONCLUSIONS Our pathological findings on lymph node anthracosilicosis provide substantial evidence that adhesions between lymph nodes and the pulmonary artery walls may develop into dense and borderless fibrous tissue. This finding would remind thoracic surgeons that adhesiolysis could cause injury to the pulmonary artery.
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Affiliation(s)
- Junichi Murakami
- Department of Surgery and Clinical Science, Division of Chest Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, 755-8505, Yamaguchi, Japan.
| | - Toshiki Tanaka
- Department of Surgery and Clinical Science, Division of Chest Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, 755-8505, Yamaguchi, Japan
| | - Yoshinobu Hoshii
- Department of Diagnostic Pathology, Yamaguchi University Hospital, Ube, 755-8505, Yamaguchi, Japan
| | - Kimikazu Hamano
- Department of Surgery and Clinical Science, Division of Chest Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, 755-8505, Yamaguchi, Japan
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Iijima Y, Ishikawa M, Iwai S, Yamagata A, Motono N, Yamada S, Uramoto H. An alternative posterior ascending pulmonary artery treatment in lobectomy with inflammatory lymph node infiltration. J Cardiothorac Surg 2022; 17:289. [PMID: 36384685 PMCID: PMC9670363 DOI: 10.1186/s13019-022-02033-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 11/05/2022] [Indexed: 11/18/2022] Open
Abstract
Background Lobectomy may be a challenging treatment option in lung cancer with inflammatory lymph node infiltration. Moreover, the en-masse lobectomy technique, which involves the simultaneous ligation or stapling of pulmonary vessels and bronchi at the hilar area, is controversial. Case presentation We report the case of a 75-year-old woman who presented with lung cancer and lymph node infiltration from the posterior ascending pulmonary artery (A2) to the superior pulmonary artery (A6). A nodule was observed in her right upper lobe on chest computed tomography while treating her for a myocardial infarction 3 months prior; hence, a radical lobectomy was planned. Her main pulmonary artery could be constricted using surgical tape, but this was not possible in the peripheral pulmonary artery of the ascending A2 due to widespread lymph node infiltration. Intraoperative frozen sections confirmed the absence of metastases in the hilar lymph nodes. Pulmonary angioplasty was aborted because the cardiac function had not fully recovered from the previous procedure. The ascending A2 and upper lobe bronchus were collectively treated using an auto-stapler. Two months postoperatively, computed tomography showed no pulmonary artery aneurysm.
Conclusions This report highlights that the en-masse technique may be recommended as an alternative for A2 treatment during lobectomy in cases with inflammatory lymph node infiltration. Surgeons should consider switching to thoracotomy, in such cases, to avoid fatal intraoperative complications.
Supplementary Information The online version contains supplementary material available at 10.1186/s13019-022-02033-z.
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A different approach in thoracic surgery: Guillotine lobectomy. TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2021; 29:520-526. [PMID: 35096450 PMCID: PMC8762912 DOI: 10.5606/tgkdc.dergisi.2021.20858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 03/31/2021] [Indexed: 11/24/2022]
Abstract
Background
In this study, we aimed to compare the surgical results of video-assisted thoracoscopic lobectomy with the guillotine technique to the results of conventional video-assisted thoracoscopic lobectomy.
Methods
Between January 2013 and December 2019, a total of 49 patients (20 males, 29 females; median age: 45 years; range, 11 to 73 years) who underwent video-assisted thoracoscopic lobectomy for benign lung pathologies were retrospectively analyzed. The patients were divided into two groups: the guillotine technique group (n=31) who had simultaneous cutting of the lobar artery and lobar bronchus with a single stapler, and the control group (n=18) who received conventional video-assisted thoracoscopic lobectomy. Demographic features of the patients, type of surgery, type of pulmonary resection, duration of the operation, postoperative length of hospital stay, postoperative pathological examination result, complications, and follow-up data were recorded.
Results
The median operation time was 142.5 (range, 60 to 237) min and 90 (range, 55 to 180) min in the control and the guillotine technique groups, respectively, indicating a statistically significant difference (p<0.05). Bronchiectasis was the most common histopathological diagnosis in both groups. No intraoperative complication, long-term complications or mortality were observed in any of the patients.
Conclusion
The guillotine lobectomy technique significantly reduces the duration of the operation. The adventitia and connective tissue around the lobar artery and lobar bronchus enable the closure of these structures with the supporting tissue and, therefore, reinforces the staples. The guillotine technique in video-assisted thoracoscopic lobectomy seems to be a cost-effective, reliable, and practical method that provides intraoperative convenience and shortens the operation time.
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Amore D, Casazza D, Saglia A, Imitazione P, Caterino U, Curcio C. How to avoid "en masse" lobectomy using VATS technique in presence of hilar fibrosis. Monaldi Arch Chest Dis 2021; 91. [PMID: 33794597 DOI: 10.4081/monaldi.2021.1633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/17/2021] [Indexed: 11/23/2022] Open
Abstract
Perivascular fibrosis is technically one of the most challenging issue to manage during thoracoscopic lobectomy and it is associated with increased risk of hemorrhagic injury. Here we report a case of thoracoscopic right lower lobectomy performed with individual dissection of segmental arteries due to dense adventitial fibrosis around the right lower lobe pulmonary artery. This approach may be considered as an alternative to the so-called "en masse" lobectomy and a way to avoid conversion to thoracotomy.
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Affiliation(s)
- Dario Amore
- Department of Thoracic Surgery, Monaldi Hospital, Naples.
| | - Dino Casazza
- Department of Thoracic Surgery, Monaldi Hospital, Naples.
| | | | | | | | - Carlo Curcio
- Department of Thoracic Surgery, Monaldi Hospital, Naples.
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Guedes RL, Höglund OV, Brum JS, Borg N, Dornbusch PT. Resorbable Self-Locking Implant for Lung Lobectomy Through Video-Assisted Thoracoscopic Surgery: First Live Animal Application. Surg Innov 2018; 25:158-164. [DOI: 10.1177/1553350617751293] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Rogério Luizari Guedes
- Federal University of Paraná, Curitiba, Paraná, Brazil
- Tuiuti University of Paraná, Curitiba, Paraná, Brazil
| | - Odd Viking Höglund
- Swedish University of Agricultural Sciences, Uppsala, Sweden
- Resorbable Devices AB, Uppsala, Sweden
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Kamiyoshihara M, Ibe T, Kawatani N, Ohsawa F, Yoshikawa R. Successful treatment of a bronchopleural fistula after en masse lobectomy. J Thorac Dis 2016; 8:E689-92. [PMID: 27621901 DOI: 10.21037/jtd.2016.06.63] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A 72-year-old man underwent en masse lobectomy of the lower left lobe because of continued hemoptysis. We chose en masse lobectomy as a last resort because the patient had cardiopulmonary problems including chronic obstructive pulmonary disease (COPD), pulmonary hypertension, and continued hemoptysis. The patient developed a bronchopleural fistula 2 weeks later, so the Clagett window procedure was performed. After gauze exchange and cleaning of the pleural space, the Clagett window was closed using a latissimus dorsi muscle flap. He was discharged about 3 months after the initial operation. One of the most critical complications after en masse lobectomy is a bronchopleural fistula because the bronchial stump and vessel are too close to each other. The space between the bronchus and vessel can fill with tissue, such as pulmonary parenchyma or lymph nodes, which cover the fistula.
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Affiliation(s)
| | - Takashi Ibe
- Department of General Thoracic Surgery, Maebashi Red Cross Hospital, Maebashi, Japan
| | - Natsuko Kawatani
- Department of General Thoracic Surgery, Maebashi Red Cross Hospital, Maebashi, Japan
| | - Fumi Ohsawa
- Department of General Thoracic Surgery, Maebashi Red Cross Hospital, Maebashi, Japan
| | - Ryohei Yoshikawa
- Department of General Thoracic Surgery, Maebashi Red Cross Hospital, Maebashi, Japan
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Qiang G, Nakajima J. Simultaneous stapling of pulmonary vein and bronchus in video-assisted thoracic surgery lobectomy. Ann Thorac Cardiovasc Surg 2014; 21:78-80. [PMID: 24835920 DOI: 10.5761/atcs.cr.14-00072] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We present the case of a 66-year-old female who had undergone pulmonary wedge resection for diagnosis and followed by a radical lobectomy for the treatment of the primary lung cancer. We performed a left upper lobectomy through Video-Assisted Thoracic Surgery (VATS), we successfully adapted simultaneous stapling technique to division of both pulmonary vein and lobar bronchus which were densely adhered each other because of the previous surgery.
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Affiliation(s)
- Guangliang Qiang
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, China; Department of Thoracic Surgery, The University of Tokyo Hospital, Tokyo, Japan
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