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Grapatsas K, Menghesha H, Dörr F, Baldes N, Schuler M, Stuschke M, Darwiche K, Taube C, Bölükbas S. Pneumonectomy for Primary Lung Tumors and Pulmonary Metastases: A Comprehensive Study of Postoperative Morbidity, Early Mortality, and Preoperative Clinical Prognostic Factors. Curr Oncol 2023; 30:9458-9474. [PMID: 37999105 PMCID: PMC10670891 DOI: 10.3390/curroncol30110685] [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: 09/26/2023] [Revised: 10/14/2023] [Accepted: 10/23/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Pneumonectomy is a major surgical resection that still remains a high-risk operation. The current study aims to investigate perioperative risk factors for postoperative morbidity and early mortality after pneumonectomy for thoracic malignancies. METHODS We retrospectively analyzed all patients who underwent pneumonectomy for thoracic malignancies at our institution between 2014 and 2022. Complications were assessed up to 30 days after the operation. Mortality for any reason was recorded after 30 days and 90 days. RESULTS A total of 145 out of 169 patients undergoing pneumonectomy were included in this study. The postoperative 30-day complication rate was 41.4%. The 30-day-mortality was 8.3%, and 90-day-mortality 17.2%. The presence of cardiovascular comorbidities was a risk factor for major cardiopulmonary complications (54.2% vs. 13.2%, p < 0.01). Postoperative bronchus stump insufficiency (OR: 11.883, 95% CI: 1.288-109.591, p = 0.029) and American Society of Anesthesiologists (ASA) score 4 (OR: 3.023, 95% CI: 1.028-8.892, p = 0.044) were independent factors for early mortality. CONCLUSION Pneumonectomy for thoracic malignancies remains a high-risk major lung resection with significant postoperative morbidity and mortality. Attention should be paid to the preoperative selection of patients.
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Affiliation(s)
- Konstantinos Grapatsas
- Department of Thoracic Surgery, West German Cancer Center, Medical Faculty, University Hospital Essen, Ruhrlandklinik, Tueschner Weg 40, 45239 Essen, Germany; (H.M.); (F.D.); (N.B.); (S.B.)
| | - Hruy Menghesha
- Department of Thoracic Surgery, West German Cancer Center, Medical Faculty, University Hospital Essen, Ruhrlandklinik, Tueschner Weg 40, 45239 Essen, Germany; (H.M.); (F.D.); (N.B.); (S.B.)
| | - Fabian Dörr
- Department of Thoracic Surgery, West German Cancer Center, Medical Faculty, University Hospital Essen, Ruhrlandklinik, Tueschner Weg 40, 45239 Essen, Germany; (H.M.); (F.D.); (N.B.); (S.B.)
| | - Natalie Baldes
- Department of Thoracic Surgery, West German Cancer Center, Medical Faculty, University Hospital Essen, Ruhrlandklinik, Tueschner Weg 40, 45239 Essen, Germany; (H.M.); (F.D.); (N.B.); (S.B.)
| | - Martin Schuler
- Department of Medical Oncology, West German Cancer Center, Medical Faculty, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany;
| | - Martin Stuschke
- Department of Radiation Oncology, West German Cancer Center, Medical Faculty, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany;
| | - Kaid Darwiche
- Department of Pneumology, Medical Faculty, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany; (K.D.); (C.T.)
| | - Christian Taube
- Department of Pneumology, Medical Faculty, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany; (K.D.); (C.T.)
| | - Servet Bölükbas
- Department of Thoracic Surgery, West German Cancer Center, Medical Faculty, University Hospital Essen, Ruhrlandklinik, Tueschner Weg 40, 45239 Essen, Germany; (H.M.); (F.D.); (N.B.); (S.B.)
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Chaturvedi G, Barreto E. Cubital fossa defect- our reconstructive experience with pedicle flaps. J Orthop 2022; 32:7-12. [DOI: 10.1016/j.jor.2022.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/15/2022] [Accepted: 04/26/2022] [Indexed: 11/29/2022] Open
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Chim H, Cohen-Shohet R, McLaughlin MM, Ehanire T. Function-Sparing Free Split Latissimus Dorsi Flap for Lower-Extremity Reconstruction: Five-Year Consecutive Single-Surgeon Series. J Bone Joint Surg Am 2020; 102:1714-1723. [PMID: 32598120 DOI: 10.2106/jbjs.20.00022] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The free split latissimus dorsi flap for lower-extremity reconstruction has some advantages over the traditional latissimus dorsi flap. The flap is harvested with the patient in the supine position and is associated with minimal morbidity as the function of the remaining latissimus dorsi muscle is preserved through the posterior division of the thoracodorsal nerve. METHODS A consecutive single-surgeon 5-year series of free split latissimus dorsi muscle flaps for lower-extremity reconstruction (n = 42) was evaluated. Donor site morbidity was evaluated through assessment of the strength of the remaining latissimus dorsi at least 1 month after surgery. Shoulder function was evaluated postoperatively using the Disabilities of the Arm, Shoulder and Hand (DASH) score, American Shoulder and Elbow Surgeons (ASES) score, and Shoulder Pain and Disability Index (SPADI). RESULTS The mean age of the 42 patients was 40.7 years. The mean length and width of the flaps were 17.9 cm and 8.6 cm. The majority (71%) of the wounds were due to acute trauma. Of the 42 flap procedures performed, 95% (40) were successful. Assessment of remaining latissimus dorsi strength at least 1 month postoperatively, during 3 activities, showed a Medical Research Council (MRC) grade of 5 in all patients. The mean and median scores were 6.4 and 0 according to the DASH, 6.0/6.4 and 0/0 on the SPADI pain/disability scales, and 90.7 and 100 on the ASES. CONCLUSIONS The free split latissimus dorsi flap is a large reliable muscle flap with negligible donor site morbidity that is particularly advantageous for lower-extremity resurfacing following trauma. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Harvey Chim
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida
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Subotic D, Hojski A, Wiese M, Lardinois D. Use of staplers and adverse events in thoracic surgery. J Thorac Dis 2019; 11:S1216-S1221. [PMID: 31245090 DOI: 10.21037/jtd.2019.03.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Dragan Subotic
- Clinic for Thoracic Surgery, University Hospital Basel, Basel, Switzerland
| | - Aljaz Hojski
- Clinic for Thoracic Surgery, University Hospital Basel, Basel, Switzerland
| | - Mark Wiese
- Clinic for Thoracic Surgery, University Hospital Basel, Basel, Switzerland
| | - Didier Lardinois
- Clinic for Thoracic Surgery, University Hospital Basel, Basel, Switzerland
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Terzi A, Bertolaccini L, Gorla A, Viti A. Surgery for the treatment of the tuberculosis-destroyed lung: to protect or not to protect the bronchial stump? Eur J Cardiothorac Surg 2012; 43:201. [PMID: 22564811 DOI: 10.1093/ejcts/ezs259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Sawabata N, Nojiri T, Okumura M. Successful muscle prombage for directly nonclosable extremely calcified bronchial stump. Gen Thorac Cardiovasc Surg 2011; 59:48-51. [PMID: 21225402 DOI: 10.1007/s11748-010-0589-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Accepted: 01/24/2010] [Indexed: 11/28/2022]
Abstract
Severe diffuse chronic calcification can cause an unsuccessful closure of the bronchial stump. An opened stump must be closed with a tissue flap without fixation using the bronchial wall. We performed successful volume double-layered dressing using a technique whereby we divided the latissimus dorsi muscle above and below the left pulmonary artery over the open stump of a severely calcified bronchus.
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Affiliation(s)
- Noriyoshi Sawabata
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, 2-2 L5 Yamada-oka, Suita, Osaka 565-0871, Japan.
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Intramuscular innervations of muscle flaps that are commonly used in clinical settings. Surg Radiol Anat 2010; 32:637-46. [DOI: 10.1007/s00276-010-0644-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Accepted: 02/23/2010] [Indexed: 11/25/2022]
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