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Hireche K, Canaud L, Peyron PA, Sakhri L, Serres I, Kamel S, Lounes Y, Gandet T, Alric P. Ex Vivo Comparison of the Elastic Properties of Vascular Substitutes Used for Pulmonary Artery Replacement. J Surg Res 2024; 295:222-230. [PMID: 38039727 DOI: 10.1016/j.jss.2023.10.022] [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: 12/16/2022] [Revised: 10/17/2023] [Accepted: 10/30/2023] [Indexed: 12/03/2023]
Abstract
INTRODUCTION Study aims were to evaluate the elastic properties of vascular substitutes frequently used for pulmonary artery (PA) replacement, and then to compare their compliance and stiffness indexes to those of human PA. METHODS A bench-test pulsatile flow experiment was developed to perfuse human cadaveric vascular substitutes (PA, thoracic aorta, human pericardial conduit), bovine pericardial conduit, and prosthetic vascular substitutes (polytetrafluorethylene and Dacron grafts) at a flow and low pulsed pressure mimicking pulmonary circulation. Intraluminal pressure was measured. An ultrasound system with an echo-tracking function was used to monitor vessel wall movements. The diameter, compliance, and stiffness index were calculated for each vascular substitute and compared to the human PA at mean pressures ranging from 10 to 50 mmHg. RESULTS The compliance of the PA and the thoracic aorta were similar at mean physiological pressures of 10 mmHg and 20 mmHg. The PA was significantly less compliant than the aorta at mean pressures above 30 mmHg (P = 0.017). However, there was no difference in stiffness index between the two substitutes over the entire pressure range. Compared to the PA, human pericardial conduit was less compliant at 10 mmHg (P = 0.033) and stiffer at 10 mmHg (P = 0.00038) and 20 mmHg (P = 0.026). Bovine pericardial conduit and synthetic prostheses were significantly less compliant and stiffer than the PA for mean pressures of 10, 20, and 30 mmHg. There were no differences at 40 and 50 mmHg. CONCLUSIONS Allogenic arterial grafts appear to be the most suitable vascular substitutes in terms of compliance and stiffness for PA replacement.
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Affiliation(s)
- Kheira Hireche
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve University Hospital, Montpellier, France; PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France.
| | - Ludovic Canaud
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve University Hospital, Montpellier, France; PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Pierre Antoine Peyron
- Department of Forensic Medicine, Lapeyronie University Hospital, Montpellier, France
| | - Linda Sakhri
- Groupe Hospitalier Mutualiste de grenoble, Daniel Hollard Cancer Institute, Grenoble, France
| | - Isabelle Serres
- Department of Anatomical Pathology, Gui De Chauliac Hospital, Montpellier, France
| | - Sanaa Kamel
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve University Hospital, Montpellier, France
| | - Youcef Lounes
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve University Hospital, Montpellier, France; PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Thomas Gandet
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve University Hospital, Montpellier, France
| | - Pierre Alric
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve University Hospital, Montpellier, France; PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
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Menna C, Rendina EA, D’Andrilli A. Parenchymal Sparing Surgery for Lung Cancer: Focus on Pulmonary Artery Reconstruction. Cancers (Basel) 2022; 14:cancers14194782. [PMID: 36230705 PMCID: PMC9563968 DOI: 10.3390/cancers14194782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/20/2022] [Accepted: 09/26/2022] [Indexed: 11/16/2022] Open
Abstract
Reconstruction of the pulmonary artery (PA) associated with lobectomy for the radical resection of lung cancer has been progressively gaining diffusion in lung cancer surgery as a safe and effective therapeutic option that may allow radical resection when lobectomy is not technically feasible, avoiding pneumonectomy. There are some controversial aspects concerning the intraoperative and perioperative management of a sleeve resection with PA reconstruction that may influence the outcome. In the present article, the authors have analyzed some of the main technical and oncological aspects to take stock of what they have learned from their lung-sparing operations experience over time. PA reconstruction may require prosthetic materials including different options with variable cost. A main concern in vascular reconstructive procedures is avoiding tension on the anastomosis. When PA reconstruction is required, appropriate anticoagulation management is crucial. Results from the main literature data confirm the reliability of lobectomy associated with PA reconstruction in terms of perioperative morbidity and long-term survival. Sleeve lobectomy and PA reconstruction can be performed safely and effectively even after induction therapy.
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Affiliation(s)
- Cecilia Menna
- Correspondence: ; Tel.: +39-(0)6-3377-5155; Fax: +39-(0)6-3377-5578
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He J, Yang C, Suen HC, He J, Li S. A novel lung autotransplantation technique for treating central lung cancer: a case report. Transl Lung Cancer Res 2021; 10:2290-2297. [PMID: 34164276 PMCID: PMC8182719 DOI: 10.21037/tlcr-20-1242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Lung autotransplantation is an alternative technique in treating central non-small cell lung cancer (NSCLC) for patients who are not suitable to undergo pneumonectomy. We hereby report a novel lung autotransplantation technique for treating central lung cancer. Two cases of central NSCLC involving right main bronchus underwent right basal segment and right lower lobe autotransplantation after resection. The inferior pulmonary vein of graft was anastomosed to superior pulmonary venous stump in both cases to reduce the bronchial and pulmonary arterial gap created after extensive resection. One case had anastomosis of basal segment artery to the right upper lobe anterior segment artery stump while the other case had pulmonary artery angioplasty only without segmental arterial resection. Both procedures were performed in situ without graft perfusion. The airway reconstructions were completed using parachute principle via end-to-side anastomosis of graft bronchus and lateral wall of trachea instead of end-to-end anastomosis with main bronchial stump. Both patients received ICU care postoperatively for 4 days. Chest tubes were successfully removed within 7 days. They were discharged within 11 days postoperatively. No major complication, such as severe infection, anastomotic dehiscence, anastomotic stenosis, atelectasis, or pulmonary embolism was observed. There was no evidence of recurrence at 9-month follow-up.
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Affiliation(s)
- Jiaxi He
- Department of Thoracic Surgery, Guangzhou Medical University 1st Affiliated Hospital, Guangzhou, China
| | - Chao Yang
- Department of Thoracic Surgery, Guangzhou Medical University 1st Affiliated Hospital, Guangzhou, China
| | - Hon Chi Suen
- Cardio-thoracic Surgery Centre, Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong, China
| | - Jianxing He
- Department of Thoracic Surgery, Guangzhou Medical University 1st Affiliated Hospital, Guangzhou, China
| | - Shuben Li
- Department of Thoracic Surgery, Guangzhou Medical University 1st Affiliated Hospital, Guangzhou, China
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Madariaga MLL, Geller A, Lanuti M, Ott H, Allan JS, Donahue DM, Mathisen DJ, Wright CD, Gaissert HA. Pulmonary Artery Resection During Lung Resection for Malignancy. Ann Thorac Surg 2019; 108:1692-1700. [PMID: 31336066 DOI: 10.1016/j.athoracsur.2019.05.079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 05/17/2019] [Accepted: 05/20/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Complete resection of central tumors invading the main pulmonary artery (PA) requires arterial reconstruction to avoid pneumonectomy. Oncologic equivalence with pneumonectomy has been suggested. We review clinical selection and outcome for these uncommon procedures in the context of candidacy for pneumonectomy. METHODS From 2000 to 2018, 9 different surgeons performed 34 pulmonary arterial resections for primary or metastatic pulmonary malignancy, with independent determination of pneumonectomy candidacy and arterioplasty technique. Patients undergoing limited lateral stapled PA resection (n = 3) or resection for metastasis (n = 3) were excluded from survival analysis. RESULTS The PA was resected as a sleeve with primary anastomosis (14.7%) or noncircumferentially with primary (61.8%), stapled (8.8%), or patch (14.7%) closure. Arterial resections represented between 2.5% and 43% of each surgeon's pneumonectomy volume. Sixteen (47%) patients were candidates for pneumonectomy. There was no operative mortality and 1 death at 47 days. Postoperative complications occurred in 21 (61.8%) patients. No patient required completion pneumonectomy. Overall 5-year survival was 33% (95% confidence interval [CI], 12-53). Compared with pulmonary arterioplasty alone, patients undergoing bronchial sleeve resection and pulmonary arterioplasty had better disease-free 5-year survival (50% [95% CI, 18-82] vs 19% [95% CI, 5-43]; P = .04), higher complete resection rate (100% [95% CI, 83-100] vs 80% [95% CI, 56-94]; P = .23) and lower disease recurrence (8% [n = 1 of 13] vs 47% [n = 7 of 15]; P = .04); 80% of disease recurrence was distant. CONCLUSIONS Resection and reconstruction of the PA for malignant lung disease may be safely performed. In candidates for pneumonectomy, arterial resection offers low operative risk. Long-term survival is impaired by distant, not local, recurrence emphasizing the importance of systemic therapy.
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Affiliation(s)
| | - Abraham Geller
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Michael Lanuti
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Harald Ott
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - James S Allan
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Dean M Donahue
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Douglas J Mathisen
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Cameron D Wright
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Henning A Gaissert
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts.
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5
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Yoshino M, Saitoh Y, Chiyo M, Hoshino H, Sekine Y, Wada H, Suzuki H, Yoshino I. Surgical outcome of pulmonary artery reconstruction using the expanded polytetrafluoroethylene patch in patients with lung cancer. Surg Today 2019; 49:778-784. [PMID: 30937633 DOI: 10.1007/s00595-019-01803-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 03/15/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Pulmonary artery reconstruction is sometimes utilized as an alternative to pneumonectomy in lung cancer surgery. We herein report our experience of pulmonary artery reconstruction using an expanded polytetrafluoroethylene (ePTFE) patch based on the surgical results and long-term outcome. METHODS Clinical records of lung cancer patients who underwent patch plasty were reviewed retrospectively. RESULTS Between 2003 and 2017, pulmonary artery patch plasty were performed in 21 patients [18 males, 3 females; mean age 65 (range 47-79) years]. Induction chemoradiotherapy was performed in three patients. Bronchoplasty was performed in five patients. The pathologic stages were stage I in 3 patients, stage II in 6 and stage III in 12. Pneumonectomy, lobectomy and segmentectomy were performed in 2, 18 and 1 patient, respectively. The left upper lobe was the most frequent origin of lung cancer (15 patients). There was no reconstruction-related morbidity or mortality. The overall survival rate at 5 years was 64.1% with a mean follow-up of 39.5 months, and the survival rates for N0-1 and N2-3 were 80.8% and 28.6%, respectively. CONCLUSION Patch angioplasty using the ePTFE sheet is a reliable procedure in radical surgery for lung cancer.
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Affiliation(s)
- Mitsuru Yoshino
- Department of Thoracic Surgery, National Hospital Organization Chiba Medical Center, 4-1-2 Tsubakimori, Chuo-ku, Chiba, 260-8606, Japan.
| | - Yukio Saitoh
- Department of Thoracic Surgery, National Hospital Organization Chiba Medical Center, 4-1-2 Tsubakimori, Chuo-ku, Chiba, 260-8606, Japan
| | - Masako Chiyo
- Department of Thoracic Surgery, National Hospital Organization Chiba Medical Center, 4-1-2 Tsubakimori, Chuo-ku, Chiba, 260-8606, Japan
| | - Hidehisa Hoshino
- Department of Thoracic Surgery, Tokyo Women's Medical University, Yachiyo Medical Center, 477-96 Owada-shinden, Yachiyo, Chiba, 276-8524, Japan
| | - Yasuo Sekine
- Department of Thoracic Surgery, Tokyo Women's Medical University, Yachiyo Medical Center, 477-96 Owada-shinden, Yachiyo, Chiba, 276-8524, Japan
| | - Hironobu Wada
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuoh-ku, Chiba, 260-8677, Japan
| | - Hidemi Suzuki
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuoh-ku, Chiba, 260-8677, Japan
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuoh-ku, Chiba, 260-8677, Japan
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Dartevelle PG, Mitilian D, Fadel E. Extended surgery for T4 lung cancer: a 30 years’ experience. Gen Thorac Cardiovasc Surg 2017; 65:321-328. [DOI: 10.1007/s11748-017-0752-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 01/11/2017] [Indexed: 12/14/2022]
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Venuta F, Diso D, Onorati I, Anile M, Mantovani S, Rendina EA. Lung cancer in elderly patients. J Thorac Dis 2016; 8:S908-S914. [PMID: 27942414 DOI: 10.21037/jtd.2016.05.20] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
There is a worldwide-accepted evidence of a population shift toward older ages. This shift favors an increased risk of developing lung cancer that is primarily a disease of older populations. Decision making is extremely difficult in elderly patients, since this group is under-represented in clinical trials with only 25% of them historically opening to patients older than 65 years. For all these reasons, a "customized" preoperative assessment to identify physiological or pathological frailty should be encouraged since standard tools may be less reliable. The work already done to improve patient selection for lung surgery in the elderly population clearly shows that surgical resection seems the treatment of choice for early stage lung cancer. Further studies are required to improve outcome by reducing postoperative morbidity and mortality.
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Affiliation(s)
- Federico Venuta
- Department of Thoracic Surgery, University of Rome Sapienza, Rome, Italy
| | - Daniele Diso
- Department of Thoracic Surgery, University of Rome Sapienza, Rome, Italy
| | - Ilaria Onorati
- Department of Thoracic Surgery, University of Rome Sapienza, Rome, Italy
| | - Marco Anile
- Department of Thoracic Surgery, University of Rome Sapienza, Rome, Italy
| | - Sara Mantovani
- Department of Thoracic Surgery, University of Rome Sapienza, Rome, Italy
| | - Erino A Rendina
- Department of Thoracic Surgery, University of Rome Sapienza, Rome, Italy
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8
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Maurizi G, D'Andrilli A, Venuta F, Rendina EA. Reconstruction of the bronchus and pulmonary artery. J Thorac Dis 2016; 8:S168-80. [PMID: 26981268 DOI: 10.3978/j.issn.2072-1439.2016.02.06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Bronchovascular reconstructive procedures employed in order to avoid pneumonectomy (PN) in patients functionally unsuitable have provided, over time, excellent results, similar or even better than those obtained by PN. In recent years, new successful techniques have been developed that pertain in particular the prevention of major complications and the reconstruction of the pulmonary artery (PA). Encouraging data from increasing number of published experiences support the choice of parenchymal sparing procedures for lung cancer also in patients with good functional reserve. This is even more true if considering trials published in the last 10 years, thus indicating that improved outcome can be achieved with increased experience in reconstructive techniques and perioperative management. This article discusses the main technical aspects and results of literature.
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Affiliation(s)
- Giulio Maurizi
- 1 Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy ; 2 Department of Thoracic Surgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy ; 3 Lorillard Spencer Cenci Foundation, Rome, Italy
| | - Antonio D'Andrilli
- 1 Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy ; 2 Department of Thoracic Surgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy ; 3 Lorillard Spencer Cenci Foundation, Rome, Italy
| | - Federico Venuta
- 1 Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy ; 2 Department of Thoracic Surgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy ; 3 Lorillard Spencer Cenci Foundation, Rome, Italy
| | - Erino Angelo Rendina
- 1 Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy ; 2 Department of Thoracic Surgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy ; 3 Lorillard Spencer Cenci Foundation, Rome, Italy
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9
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Ibrahim M, Maurizi G, Venuta F, Rendina EA. Reconstruction of the bronchus and pulmonary artery. Thorac Surg Clin 2013; 23:337-47. [PMID: 23931017 DOI: 10.1016/j.thorsurg.2013.05.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Sleeve lobectomy (SL) (lobectomy associated with resection and reconstruction of the bronchus, the pulmonary artery, or both) has proved to be a suitable choice for the treatment of centrally sited non-small cell lung cancer. SL for lung cancer is indicated when a tumor or an N1 lymph node infiltrates the origin of a lobar bronchus, the origin of the lobar branches of the pulmonary artery, or both but not to the extent that a pneumonectomy is required. SL can be performed safely and effectively, even after induction therapy, without an increased complication rate.
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Affiliation(s)
- Mohsen Ibrahim
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Via di Grottarossa, 1035, Rome 00189, Italy.
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D'Andrilli A, Venuta F, Menna C, Rendina EA. Extensive resections: pancoast tumors, chest wall resections, en bloc vascular resections. Surg Oncol Clin N Am 2012; 20:733-56. [PMID: 21986269 DOI: 10.1016/j.soc.2011.07.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Infiltration by lung tumor of adjacent anatomic structures including major vessels, main bronchi, and chest wall not only influences the oncologic severity of the disease but also increases the technical complexity of surgery, requiring extended resections and demanding reconstructive procedures. Completeness of resection represents in every case one of the main factors influencing the long-term outcome of patients. Technical and oncologic aspects of extended operations, including resection of Pancoast tumors and chest wall, bronchovascular sleeve resections, and en bloc resections of major thoracic vessels, are reported in this article.
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Affiliation(s)
- Antonio D'Andrilli
- Department of Thoracic Surgery, Sant'Andrea Hospital, University LaSapienza, Via di Grottarossa 1035, 00189 Rome, Italy.
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Muralidaran A, Detterbeck FC, Boffa DJ, Wang Z, Kim AW. Long-term survival after lung resection for non–small cell lung cancer with circulatory bypass: A systematic review. J Thorac Cardiovasc Surg 2011; 142:1137-42. [DOI: 10.1016/j.jtcvs.2011.07.042] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 06/26/2011] [Accepted: 07/20/2011] [Indexed: 10/17/2022]
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Yıldızeli B, Dartevelle PG, Fadel E, Mussot S, Chapelier A. Results of Primary Surgery With T4 Non–Small Cell Lung Cancer During a 25-Year Period in a Single Center: The Benefit is Worth the Risk. Ann Thorac Surg 2008; 86:1065-75; discussion 1074-5. [PMID: 18805134 DOI: 10.1016/j.athoracsur.2008.07.004] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Revised: 07/01/2008] [Accepted: 07/02/2008] [Indexed: 10/21/2022]
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Lung Autotransplantation Technique in the Treatment for Central Lung Cancer of Upper Lobe. J Thorac Oncol 2008; 3:609-11. [DOI: 10.1097/jto.0b013e31817589a8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Sleeve resection and prosthetic reconstruction of the pulmonary artery have progressively gained acceptance as an alternative to pneumonectomy in lung cancer surgery. Previous concern was mainly related to technical difficulties, intraoperative and postoperative complications, lack of long-term survival, and impact on cardiopulmonary function. For this reason it was not until very recently that lobectomy associated with resection and reconstruction of the pulmonary artery, associated or not to a sleeve resection of the bronchus, has been demonstrated to be an advantageous alternative. The concern about an increased complication rate has been proven to be excessive; in fact, pulmonary artery reconstruction can be performed safely and effectively with the correct indications and technique. We hereby report our experience, along with a review of the indications, the surgical technique, and outcome of pulmonary artery reconstruction.
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Affiliation(s)
- Federico Venuta
- University of Rome La Sapienza, Department of Thoracic Surgery, Policlinico Umberto I, Rome, Italy.
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16
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Liu JF, Wang QZ, Tian ZQ, Zhang YD. Bronchoplastic and pulmonary arterioplastic procedures in the treatment of bronchogenic carcinoma. Asian J Surg 2005; 27:192-6. [PMID: 15564159 DOI: 10.1016/s1015-9584(09)60031-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Bronchoplastic and pulmonary arterioplastic procedures have become increasingly popular in recent years as an alternative to pneumonectomy, especially for patients with compromised cardiopulmonary reserve. We reviewed our experience with the procedure to determine the operative technique, indication for the procedure and long-term results. METHODS From January 1981 to December 2000, 65 bronchoplasties, four pulmonary arterioplasties and three combined broncho-angioplasties were performed for bronchogenic carcinoma. RESULTS Of the 72 patients, 31 had stage I disease, 29 had stage II and 12 had stage III disease. One patient (1.4%) died of bilateral pneumonitis postoperatively. Atelectasis occurred in two patients (2.8%), empyema in one (1.4%), and bronchial fistula in one (1.4%). There were no bronchial stenoses after bronchoplastic procedures, and no vascular complications after angioplastic procedures. The 1-, 3- and 5-year survival rates for the entire group were 86.0%, 47.0% and 29.8%, respectively. The difference in survival was significant between stage I and II disease (p=0.0001) and between stage I and III disease (p<0.0001), but not between stage II and III disease (p=0.0779). CONCLUSIONS Bronchoplastic, pulmonary arterioplastic and broncho-angioplastic procedures can be performed safely. Bronchoplastic procedures offer patients with bronchogenic carcinoma a long-term result comparable to that with radical lung resection. Angioplastic and combined broncho-angioplastic procedures should only be used in patients who cannot tolerate pneumonectomy due to poor cardiopulmonary reserve.
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Affiliation(s)
- Jun-Feng Liu
- Department of Thoracic Surgery, Fourth Hospital, Hebei Medical University, Shijiazhuang, People's Republic of China.
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Byrne JG, Leacche M, Agnihotri AK, Paul S, Bueno R, Mathisen DJ, Sugarbaker DJ. The Use of Cardiopulmonary Bypass During Resection of Locally Advanced Thoracic Malignancies. Chest 2004; 125:1581-6. [PMID: 15078778 DOI: 10.1378/chest.125.4.1581] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
The use of cardiopulmonary bypass (CPB) for locally advanced thoracic malignancies is highly controversial. The purpose of this study was to document the techniques and results of CPB to facilitate the resection of complex thoracic malignancies and to identify common themes that provided for successful outcomes. This was a retrospective study that took place from January 1992 to September 2002. Fourteen consecutive patients (median age, 59 years; age range, 18 to 69 years; seven men and seven women) underwent CPB during the resection of locally advanced thoracic malignancies at two Boston hospitals. CPB was planned in 8 of 14 patients (57%) with centrally located tumors, while 6 of 14 patients (43%) required emergent institution of CPB due to injury of the superior vena cava (2 patients), inferior vena cava (2 patients), or pulmonary artery (2 patients). Complete microscopic resection was achieved in 12 of 14 patients (86%). The operative mortality rate was 1 of 14 patients (7%) due to pulmonary embolism (ie, the elective group). The median ICU and hospital lengths of stay were 5 and 9 days, respectively. The overall 1-year, 3-year, and 5-year survival rates were 57%, 36%, and 21%, respectively. The planned use of CPB to facilitate complete resection of thoracic malignancies should be considered only after careful patient selection. The availability of CPB also provides a safety net in the event of injury to vascular structures during tumor resection.
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Affiliation(s)
- John G Byrne
- The Division of Cardiac Surgery, Brigham & Women's Hospital, Boston, MA 02115, USA.
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18
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Bronchoplastic and pulmonary arterioplastic procedures in treatment of bronchogenic carcinoma. Chin J Cancer Res 2002. [DOI: 10.1007/s11670-002-0061-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Abstract
T4 lung cancers are a heterogeneous group of locally advanced lung cancers. Treatment is palliative for the majority of patients, ranging from supportive care to chemoradiotherapy. In certain patients, however, surgery is beneficial and may be curative. Patients with T4N0M0 cancers invading the distal trachea, carina, left atrium, aorta, superior vena cava, or vertebral bodies may be surgical candidates. Radical resections of these T4 lung cancers have potential for cure if no mediastinal lymph node metastases (N2 or N3) occur and if resection is complete. Increased postoperative mortality exists and extends beyond 30 days, as evidenced by a 30-day mortality of 8% and a 90-day mortality of 18%. Improved palliation (median survival of 19 months) and cure (31% five-year survival) are possible in patients who meet the criteria, who undergo radical resection, and who are followed by physicians in facilities with special interests in extended resections. The use of induction therapy and surgery in T4 patients may further increase survival and the number of T4 patients in whom radical resection is possible. Radical resections are contraindicated in patients with T4 lung cancers associated with malignant pleural effusions. Unfortunately, these patients have the worst prognosis. If surgical palliation is an option, only pulmonary resection with pleurectomy and not pleuropneumonectomy should be considered. In contrast, lung cancers with the best prognosis are those T4 tumors diagnosed because of a satellite tumor nodule within the same lobe. Because radical resections are usually not required, operative mortality is not increased. Five-year survival in patients with satellite intralobar tumor nodules without mediastinal nodal metastases is comparable to survival of highly selected T4N0M0 patients who undergo radical resection. These two extremes of T4 lung cancers, malignant pleural effusion and satellite intralobar tumor nodules, generally are not considered for or do not require radical resections. It is debatable that the definition of T4 should include these entities.
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Affiliation(s)
- Thomas W Rice
- Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, OH 44195, USA.
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Abstract
Contralateral pulmonary artery stenosis is a rare complication following pneumonectomy. When extensive intrapericardial dissection is warranted, one must be wary of this potential complication and take measures to avoid it. Postoperatively, a high index of suspicion must be maintained in a patient with a new onset of right-sided heart failure after intrapericardial pneumonectomy. We discuss intraoperative risk factors, postoperative clinical findings, and our strategy for repair.
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Affiliation(s)
- R M Flores
- Division of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Rendina EA, De Giacomo T, Venuta F, Ciccone AM, Coloni GF. Lung conservation techniques: bronchial sleeve resection and reconstruction of the pulmonary artery. SEMINARS IN SURGICAL ONCOLOGY 2000; 18:165-72. [PMID: 10657918 DOI: 10.1002/(sici)1098-2388(200003)18:2<165::aid-ssu10>3.0.co;2-m] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Bronchial and vascular reconstructive procedures are a technically feasible alternative to pneumonectomy and have the advantage of sparing functioning lung parenchyma. Between 1989 and 1999, we performed bronchovascular sleeve resection and reconstruction in 145 patients (109 men, 36 women; age range, 26 to 76 years, mean, 56 years) with non-small-cell lung cancer (NSCLCL). Forty-one patients had induction chemotherapy and 3 had pre-operative radiotherapy. Immediate and long-term postoperative evaluation included bronchoscopy, spirometry, electrocardiogram, Doppler echocardiography, and perfusion lung scans, computed tomography and, only recently, angio-magnetic resonance (MR) imaging. Follow-up ranged between 3 months and 10 years (mean, 3.7 years) and is complete for all patients. We report the results of this series and conclude that morbidity, mortality, and functional data indicate that bronchovascular reconstructions are equal to standard lobectomy in terms of pulmonary function. Long-term survival is comparable with that reported for standard resection (lobectomy-pneumonectomy). These findings suggest that even complex lung-sparing operations can be proposed as adequate procedures in the treatment of lung cancer as long as a complete anatomical resection is obtained.
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Affiliation(s)
- E A Rendina
- Department of Thoracic Surgery, University La Sapienza, Rome, Italy.
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Rendina EA, Venuta F, De Giacomo T, Ciccone AM, Moretti M, Ruvolo G, Coloni GF. Sleeve resection and prosthetic reconstruction of the pulmonary artery for lung cancer. Ann Thorac Surg 1999; 68:995-1001; discussion 1001-2. [PMID: 10509997 DOI: 10.1016/s0003-4975(99)00738-9] [Citation(s) in RCA: 93] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Lobectomy associated with reconstruction of the pulmonary artery (PA) is a technically feasible alternative to pneumonectomy in patients with lung cancer. However, concern about postoperative complications and long-term survival limited its acceptance so far. METHODS Between 1989 and 1996, we performed a PA reconstruction in 52 patients (41 men, 11 women; age range 35 to 75 years, mean 60 years) with lung cancer. Eleven patients had induction chemotherapy. We performed 15 PA sleeve resections, 34 PA reconstructions by a pericardial patch, and three PA reconstructions by a pericardial conduit, associated with a bronchial sleeve lobectomy or bilobectomy (33), or with standard lobectomy (19). Immediate and long-term postoperative evaluation included spirometry, echocardiography, perfusion lung scans, computed tomography, and PA angiography. The follow-up ranged between 27 and 96 months and is complete for all patients. RESULTS We had one specific postoperative complication (PA thrombosis) and no mortality. Perfusion scans and PA angiography were normal in all but the 1 patient having thrombosis. Mean forced expiratory volume (FEV) in 1 s and forced vital capacity (FVC) were, respectively, 72% and 80% preoperatively, 65% and 76% 1 month after surgery, and then they plateaued at 70% and 78% after 6 months. Echocardiography showed patterns in the normal range and normal estimates of PA pressures in all but 2 patients. Five-year survival was 38.3% for the entire group, 18.6% for stages IIIA and B, and 64.4% for stages I and II. CONCLUSIONS Morbidity, mortality, and functional data do not differ from what is currently reported for standard lobectomy. Long-term survival is in line with that reported for standard resection. These data support PA reconstruction as a viable option in the treatment of lung cancer.
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Affiliation(s)
- E A Rendina
- Department of Thoracic Surgery La Sapienza University of Rome, Italy
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Rendina EA, Venuta F, De Giacomo T, Ciccone AM, Ruvolo G, Coloni GF, Ricci C. Induction chemotherapy for T4 centrally located non-small cell lung cancer. J Thorac Cardiovasc Surg 1999; 117:225-33. [PMID: 9918961 DOI: 10.1016/s0022-5223(99)70416-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE We used induction chemotherapy in a prospective, single-institution clinical trial intended to achieve resectability in patients with centrally located, unresectable T4 non-small cell lung cancer. Other types of IIIB disease were excluded. METHODS Between January 1990 and April 1996, we enrolled 57 patients with histologically confirmed non-small cell lung cancer. Eligibility criteria for T4 were clinical (superior vena cava syndrome, 9 patients), vocal cord paralysis (6 patients), dysphagia from esophageal involvement (1 patient), radiologic (computed tomography and magnetic resonance evidence of infiltration, 10 patients), bronchoscopic (tracheal infiltration, 11 patients), and thoracoscopic (histologically proven mediastinal infiltration, 20 patients). After 3 cycles of cisplatin (120 mg/m2), vinblastine (4 mg/m2), and mitomycin (2 mg/m2), patients were reevaluated. RESULTS Forty-two patients (73%; 36 men, 6 women; age range, 42-75 years; mean, 58 years) responded to therapy and underwent thoracotomy; 11 patients did not respond, and 4 patients had major toxicity. Thirty-six patients (63% of the entire group) had complete resection. We performed 4 exploratory thoracotomies, 6 pneumonectomies, 32 lobectomies (20 procedures were associated with reconstruction of hilar-mediastinal structures). Overall, 4 patients had no histologic evidence of disease. We had 2 bronchopleural fistulas with 1 death and 5 other major complications. Overall survival at 1 and 4 years is 61.4% and 19.5%, respectively. Forty-two patients (73%) underwent exploratory operation, with a 4-year survival of 25.9%; 36 patients (63%) had complete resection, with a 4-year survival of 30.5%. CONCLUSIONS Induction chemotherapy is effective for downstaging and surgical reconversion of centrally located T4 non-small cell lung cancer. Survival is promising, especially in patients whose disease becomes resectable.
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MESH Headings
- Adenocarcinoma/diagnosis
- Adenocarcinoma/drug therapy
- Adenocarcinoma/mortality
- Adenocarcinoma/pathology
- Adenocarcinoma/surgery
- Adult
- Aged
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Carcinoma, Non-Small-Cell Lung/diagnosis
- Carcinoma, Non-Small-Cell Lung/drug therapy
- Carcinoma, Non-Small-Cell Lung/mortality
- Carcinoma, Non-Small-Cell Lung/pathology
- Carcinoma, Non-Small-Cell Lung/surgery
- Carcinoma, Squamous Cell/diagnosis
- Carcinoma, Squamous Cell/drug therapy
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/surgery
- Chemotherapy, Adjuvant
- Cisplatin/administration & dosage
- Cisplatin/adverse effects
- Female
- Humans
- Lung Neoplasms/diagnosis
- Lung Neoplasms/drug therapy
- Lung Neoplasms/mortality
- Lung Neoplasms/pathology
- Lung Neoplasms/surgery
- Lymph Node Excision
- Male
- Middle Aged
- Mitomycin/administration & dosage
- Mitomycin/adverse effects
- Neoplasm Staging
- Pneumonectomy
- Preoperative Care/methods
- Prospective Studies
- Vindesine/administration & dosage
- Vindesine/adverse effects
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Affiliation(s)
- E A Rendina
- Department of Thoracic Surgery, University La Sapienza, Rome, Italy
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Rendina EA, Venuta F, De Giacomo T, Flaishman I, Fazi P, Ricci C. Safety and efficacy of bronchovascular reconstruction after induction chemotherapy for lung cancer. J Thorac Cardiovasc Surg 1997; 114:830-5; discussion 835-7. [PMID: 9375614 DOI: 10.1016/s0022-5223(97)70088-6] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The aim of this study was to ascertain the safety and efficacy of bronchial sleeve resection and reconstruction of the pulmonary artery in patients who had undergone induction chemotherapy for lung cancer. METHODS Between January 1991 and July 1996, we operated on 68 patients who had received three cycles of cisplatin-based induction chemotherapy. In 27 of these cases, we performed a lobectomy (n = 25) or bilobectomy (n = 2) associated with reconstruction of the bronchus, the pulmonary artery, or both. In only five additional patients, pneumonectomy had to be carried out. Before chemotherapy, 14 patients were in stage IIIA and 13 were in stage IIIB. All patients in stage IIIB had T4 disease; no N3 cases were included. At thoracotomy, one patient had no evidence of tumor, six were in stage I, 13 were in stage II, six were in stage IIIA, and one was in stage IIIB. Sixteen patients had epidermoid carcinoma and 11 had adenocarcinoma. RESULTS Sixteen patients underwent bronchial sleeve resection; 11 had various types of pulmonary artery reconstruction, associated with the bronchial sleeve in eight cases. In 26 patients, resection was radical with histologically negative margins. Neither bronchial complications nor deaths occurred. One patient had empyema and two had wound infections. Mean chest tube duration was 6 days. After a postoperative follow-up of 4 to 69 months (mean 25 months), 14 patients are alive and free of disease, one is alive with disease, and 12 have died. There were no local recurrences. The 1- and 4-year survival rates are 78% and 39%, respectively. CONCLUSIONS Although it is technically demanding, lobectomy associated with bronchovascular reconstruction is feasible, with good immediate and long-term results, after induction chemotherapy.
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Affiliation(s)
- E A Rendina
- Department of Thoracic Surgery, University of Rome La Sapienza, Italy
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Noriyuki T, Ohdan H, Yoshioka S, Miyata Y, Asahara T, Dohi K. Near-infrared spectroscopic method for assessing the tissue oxygenation state of living lung. Am J Respir Crit Care Med 1997; 156:1656-61. [PMID: 9372690 DOI: 10.1164/ajrccm.156.5.97-01112] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
To quantify changes in tissue oxygenation of pathologic lungs, we applied a novel method using near-infrared spectroscopy (NIRs). In in vitro experiments, we assayed the effect of photon scattering on the absorption spectra of an in vitro system simulating structures of lung, which consists of test tube containing air in hematocrit tubes and red blood cell suspension with various predetermined hemoglobin concentrations. It was determined that photon scattering of the tissue containing air did not affect the absorption in the NIR region. In in vivo experiments, we tested the applicability of the NIRs technique in rat lungs under the following conditions: (1) hypoxic loading; (2) administration of an inhibitor (NaCN) of the mitochondrial respiratory chain; (3) hemorrhagic shock. We found that: (1) Changes in hemoglobin oxygenation state in the lung measured by NIRs depended on inspired oxygen concentrations; (2) NaCN-induced reduction of cytochrome oxidase a,a3 in the lung was observed; and (3) Total hemoglobin levels in the lung decreased after bleeding. Changes in the hemoglobin oxygenation state and cytochrome oxidase redox state in the lung were determined using the least-square-curve fitting for NIR absorption spectra. Our NIRs technique was capable of assessing the hemoglobin oxygenation and cytochrome oxidase redox state in the lung.
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Affiliation(s)
- T Noriyuki
- Second Department of Surgery, Hiroshima University School of Medicine, Japan
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Casillas Pajuelo M, Rodríguez Paniagua J, García Sánchez-Girón J, Díaz-Agero Álvarez P, Gil Alonso J, Mafé Madueño J, de la Cruz Lozano F. Broncoplastias en tumores broncopulmonares. Revisión de cincuenta casos. Arch Bronconeumol 1996. [DOI: 10.1016/s0300-2896(15)30721-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Gillinov AM, Greene PS, Stuart RS, Heitmiller RF. Cardiopulmonary bypass as an adjunct to pulmonary surgery. Chest 1996; 110:571-4. [PMID: 8697872 DOI: 10.1378/chest.110.2.571] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Although performance of concomitant open heart and pulmonary operations has been described, there is general reluctance to perform pulmonary procedures in patients receiving cardiopulmonary bypass (CPB). Reasons for this include fear of excess bleeding caused by systemic heparinization, limited exposure afforded by median sternolomy, and alterations in the immune system caused by CPB that might lead to dissemination of lung cancer or infection. We have used CPB to facilitate operations on the lung in four patients who did not require concomitant cardiac surgery. In each case, lesions involving central pulmonary vessels precluded safe operation by conventional techniques. There were no complications related to the use of CPB. We believe that CPB can be a valuable adjunct in the surgical treatment of selected tumors and vascular malformations that involve large or central pulmonary vessels.
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Affiliation(s)
- A M Gillinov
- Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA
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Bronchoplastische und angioplastische Operationen beim Bronchialkarzinom. Eur Surg 1996. [DOI: 10.1007/bf02602603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rendina EA, Venuta F, De Giacomo T, Vizza DC, Ricci C. Reconstruction of the pulmonary artery by a conduit of autologous pericardium. J Thorac Cardiovasc Surg 1995; 110:867-8. [PMID: 7564463 DOI: 10.1016/s0022-5223(95)70128-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- E A Rendina
- Department of Thoracic Surgery, University of Rome La Sapienza, Italy
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