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Xu X, Dai J, Jin K, Liu X, Yang Y, Ge T, Li Q, Jiang C, He W, Wang H, Zhang P, Jiang G. Surgery for bronchiectasis-destroyed lung: feasibility of video-assisted thoracoscopic surgery, and surgical outcomes. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivad175. [PMID: 37930040 DOI: 10.1093/icvts/ivad175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/12/2023] [Accepted: 10/30/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES To provide the experience of surgical treatment for bronchiectasis-destroyed lung (BDL) and evaluate the feasibility of video-assisted thoracoscopic surgery (VATS). METHODS BDL patients underwent surgical treatment between January 2013 and June 2018 were included. Logistic regression was performed to assess factors for major complications, and Cox's regression was performed to assess factors affected symptomatic outcome. RESULTS Totally, 143 patients were treated by VATS (n = 64) and thoracotomy (n = 79). Nine (14.1%) cases scheduled for VATS were converted to thoracotomy for dense adhesions (n = 6) and frozen hilum (n = 3). The VATS group had a median chest tube duration, hospitalization and a time of returning to full activity of 4 days, 5 days and 1.5 months, respectively. Major complications occurred in 28 (19.6%) of all patients, 50.0% after pneumonectomy and 13.4% after lobectomy/extensive lobectomy. Multivariable analysis identified pneumonectomy [odds ratio, 3.64; 95% confidence interval (CI), 1.18-11.21] as a significant predictor for major complications. Overall, 141 (98.6%) patients benefitted from surgery (completely asymptomatic, n = 109; acceptable alleviation, n = 32). Thirty-four patients experienced relapse of the disease, including 13 with productive cough, 11 with haemoptysis and 10 with recurrent infections. Pseudomonas aeruginosa infection [hazard ratio (HR), 3.07; 95% CI, 1.38-6.83] and extent of remanent bronchiectatic areas (HR, 1.03; 95% CI, 1.00-1.05) were independent risk factors for shorter relapse free interval. CONCLUSIONS VATS for BDL is feasible in well-selected patients. Pneumonectomy increased the risk of postoperative major complications. Removing all BDL lesions contributed to satisfactory prognosis.
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Affiliation(s)
- Xinnan Xu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Jie Dai
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Kaiqi Jin
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Xiaogang Liu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Yang Yang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Tao Ge
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Qiuyuan Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Chao Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Wenxin He
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Haifeng Wang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Peng Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
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Abstract
A destroyed lung pertains to the complete destruction of the lung. This is an irreversible condition and is an outcome of chronic or recurrent lung infections. Tuberculosis is widely reported to be a cause of destroyed lungs, and post-tubercular destroyed lung syndrome is a major issue, especially in countries with a high burden of tuberculosis. Herein, a case of destroyed lung syndrome in a 22-year-old Indian male is presented. He had a history of irregular treatment for tuberculosis and reported complaints of dry cough, fever, and dyspnea. A detailed clinical, radiological, and lab workup established the diagnosis of destroyed lung syndrome, and he was reinitiated on anti-tubercular treatment.
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Affiliation(s)
- Sankalp Yadav
- Medicine, Shri Madan Lal Khurana Chest Clinic, New Delhi, IND
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3
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Ruan H, Liu F, Li Y, Wang Y, Hou D, Yang X, Liu B, Ma T, Liu Z. Long-term follow-up of tuberculosis-destroyed lung patients after surgical treatment. BMC Pulm Med 2022; 22:346. [PMID: 36104786 PMCID: PMC9476694 DOI: 10.1186/s12890-022-02139-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/30/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
To monitor dypsnea and mortality at 5 and 10 years, respectively, after surgical treatment of tuberculosis-destroyed lung (TDL) patients.
Methods
TDL patients treated surgically at Beijing Chest Hospital from November 2007 to June 2019 were monitored in this observational study. Follow-up assessments of respiratory function indicators and survival conducted 5 and 10 years post-surgery led to patient grouping based on mMRC score into a dyspnea group (mMRC ≥ 1) and a non-dyspnea group (mMRC = 0). Cox regression analysis detected effects of patient demographics, clinical characteristics, surgical factors and respiratory function on 5 year post-surgical survival.
Results
By study completion (June 30, 2020), 32 of 104 patients were lost and 72 completed follow-up for a study total of 258.9 person-years. 45 patients (62.5%, 45/72) had mMRC scores of 0, while 12 (16.7%, 12/72), 21 (36.2%, 21/58) and 27 (60.0%, 27/45) patients exhibited dyspnea by 1, 3 and 5 years post-surgery, respectively. Low lung carbon monoxide diffusion score (DLCO% pred) and scoliosis contributed to dyspnea occurrence.
Conclusions
Most TDL patients lacked subjective dyspnea signs post-surgery, while dyspnea rates increased with time. Preoperative low lung diffusion function and Scoliosis were associated with factors for postoperative dyspnea. Surgical treatment increased TDL patient survival overall.
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Razafimanjato NNM, Ralaivao RA, Ravelomihary TDN, Hunald FA, Rakotovao JLH. Pneumonectomy in a child due to belated diagnosis of foreign body aspiration: a case report. J Med Case Rep 2021; 15:533. [PMID: 34670611 PMCID: PMC8529831 DOI: 10.1186/s13256-021-03015-w] [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: 04/16/2021] [Accepted: 07/15/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction With early diagnosis, fiberoptic or rigid bronchoscopy methods are the gold standard in the management of tracheobronchial foreign body. Otherwise, nonrecognized bronchial foreign bodies cause irreversible damage to the airways and lungs. The deficiency of the health system noted in many developing countries such as Madagascar, combined with the fundamental problem relating to children’s conditions, which are determined by social and educational factors, makes it almost impossible to provide early and appropriate management of the penetration syndrome. Case presentation An 11-year-old Malagasy female patient was referred to our hospital for an investigation of the etiology of the patient’s hemoptysis. The investigations revealed a localized bronchiectasis and atelectasis due to a foreign body obstructing the left main bronchus. Based on the hemoptysis and left lung almost destroyed by an occlusive lesion within, we decided to proceed with left pneumonectomy. A retrospective interrogation revealed a choking episode 4 years prior in elementary school after the child sucked on a pen cap and involuntarily aspirated it. Two years after the pneumonectomy, our patient was doing well and was asymptomatic. Conclusion In this case report, we describe a rare case of a late presentation of foreign body aspiration that resulted in a left pneumonectomy in a child. Despite our favorable results, pneumonectomy must be the preferred last option. Preventive actions remain the optimal approach.
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Affiliation(s)
- Narindra N M Razafimanjato
- Department of Surgery and Division of Thoracic Surgery, Faculty of Medecine, University Hospital of Joseph Ravoahangy Andrianavalona, University of Antananarivo, Antananarivo, Madagascar.
| | - Rindra A Ralaivao
- Department of Pathology, Faculty of Medecine, University Hospital of Joseph Ravoahangy Andrianavalona, University of Antananarivo, Antananarivo, Madagascar
| | - Tsiry D N Ravelomihary
- Department of Surgery and Division of Thoracic Surgery, Faculty of Medecine, University Hospital of Joseph Ravoahangy Andrianavalona, University of Antananarivo, Antananarivo, Madagascar
| | - Francis A Hunald
- Department of Surgery and Division of Pediatrics Surgery, Faculty of Medecine, University Hospital of Joseph Ravoahangy Andrianavalona, University of Antananarivo, Antananarivo, Madagascar
| | - Jean Louis H Rakotovao
- Department of Surgery and Division of Thoracic Surgery, Faculty of Medecine, University Hospital of Joseph Ravoahangy Andrianavalona, University of Antananarivo, Antananarivo, Madagascar
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Yoshiyasu N, Sato M, Konoeda C, Nakajima J. Pediatric living-donor lobar lung transplantation in postpneumonectomy-like anatomy caused by pulmonary hypoplasia with congenital diaphragmatic hernia. Am J Transplant 2021; 21:3461-3464. [PMID: 33934506 DOI: 10.1111/ajt.16626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 01/25/2023]
Abstract
When performing living-donor lobar lung transplantation on small children of height 100 cm or under, accommodation of an oversized adult lobar graft is problematic, sometimes necessitating single lobar transplantation in combination with contralateral pneumonectomy. We here report a unique case of living-donor lobar lung transplantation in a 9-year-old boy with congenital pulmonary hypoplasia. Although he was 104 cm tall, and the available adult lower lobe graft appeared to be oversized, his right lung was hypoplastic, resulting in his mediastinum being shifted to the right and thus already showing "postpneumonectomy-like" anatomy. His father's left lower lobe was successfully transplanted into the left thorax without performing a contralateral pneumonectomy. Three-dimensional reconstruction of computed tomography images and computed tomography volumetry were extremely helpful in matching the size of the graft and planning this unique surgery.
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Affiliation(s)
- Nobuyuki Yoshiyasu
- Department of Thoracic Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Masaaki Sato
- Department of Thoracic Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Chihiro Konoeda
- Department of Thoracic Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Jun Nakajima
- Department of Thoracic Surgery, The University of Tokyo Hospital, Tokyo, Japan
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Yang G, Wen Y, Chen T, Xu C, Yuan M, Li Y. Comparison of pediatric empyema secondary to tuberculosis or non-tuberculosis community-acquired pneumonia in those who underwent surgery in high TB burden areas. Pediatr Pulmonol 2021; 56:3321-3331. [PMID: 34289260 DOI: 10.1002/ppul.25591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 07/05/2021] [Accepted: 07/19/2021] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Tuberculous empyema (TE) in children is common in high-TB burden and medical resource-limited areas. However, studies that evaluate the characteristics of TE in children are sparse. This study aimed to analyze the clinical features of pediatric TE receiving surgical intervention. METHODS We performed a retrospective study of children with empyema secondary to community-acquired pneumonia who underwent surgery in our institution. The clinical characteristics were compared between TE and empyema secondary non-tuberculosis infection (non-tuberculosis empyema, NTE). RESULTS One hundred patients were included (27 with TE and 73 with NTE). Stage 3 empyema occupied 81.5% and 45.2% of TE and NTE in this study. The TE children had older age, longer duration of illness, and milder symptoms. Pleural fluid culture was positive for Mycobacterium tuberculosis in 7.4% of patients with TE. Lymph node enlargement, lymph node calcification, and pleural nodules presented in TE with high specificity (93.2%, 98.6%, and 98.5%) but low sensitivity (33.3%, 14.8%, and 29.6%) on CT scan. Thoracoscopy surgery was performed in 14 (51.9%) in TE and 39 (53.4%) in NTE. Postoperative chest-tube indwelling time was longer (7.85 ± 5.00 vs. 4.89 ± 1.81 days, p < .001), and more patients had incomplete lung expansion after 3 months in TE. CONCLUSION Tuberculosis infection should be screened in management of children with empyema in high-TB burden areas. Pediatric TE usually presented at older age and with milder respiratory symptoms. Pleural biopsy during surgery is often necessary to confirm the cause of infection. Thoracotomy is still required in some pediatric TE or NTE with delayed treatment in medical resource-limited area.
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Affiliation(s)
- Gang Yang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yang Wen
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Ting Chen
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Chang Xu
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Miao Yuan
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuan Li
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Laboratory of Digestive Surgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Hameury F, Marec-Berard P, Eymery M, Wijnen MHW, van der Kaaij N, Mure PY, Tronc F, Chotel F, Libbrecht C, van Boven WJP, Haveman LM. Pleuropneumonectomy as Salvage Therapy in Children Suffering from Primary or Metastatic Sarcomas with Pleural Localizations. Cancers (Basel) 2021; 13:cancers13153655. [PMID: 34359557 PMCID: PMC8345037 DOI: 10.3390/cancers13153655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/16/2021] [Accepted: 07/19/2021] [Indexed: 12/05/2022] Open
Abstract
Simple Summary Pediatric sarcoma patients with pleuropulmonary lesions have a dismal prognosis because the impossibility to achieve local control. Local therapy with radiotherapy, whether in combination with chemotherapy, appears to be insufficient to eliminate the tumor cells. The aim of this study was to determine if pleuropneumonectomy (PP) could be a therapeutic option. We retrospectively reviewed nine patients who underwent PP for pleuropulmonary localization of primary localized sarcoma or metastatic recurrence. Surgery and complications were analyzed, pulmonary function tests were conducted, and quality of life was determined. Outcome is variable, four patients died within 14 months after PP, one patient suffered from local recurrence, and four patients are in long-lasting remission. This extended operation is quite well tolerated. Lung function seems preserved, and quality of life is generally good. Because it gives improvement of survival in patients with pleural lesions, PP can be considered as effective salvage therapy in selected patients. Abstract Pediatric sarcoma patients with pleuropulmonary lesions have a dismal prognosis because the impossibility to obtain local control. The aim of this study was to determine if pleuropneumonectomy (PP) could be a therapeutic option. We retrospectively reviewed nine patients who underwent salvage PP for pleuropulmonary localization of primary localized sarcoma or metastatic recurrence. Surgery and complications were analyzed, pulmonary function tests were conducted, and quality of life was determined with EORTC-QLQ-C30 questionnaire. At the time of PP age was between 9–17 years. Underlying disease included metastatic osteosarcoma (n = 5), Ewing sarcoma (two metastatic, one primary), and one primary undifferentiated sarcoma. Early complications occurred in three patients. Mean postoperative hospitalization stay was 14.5 days. Pulmonary function test showed 19–66% reduction of total lung capacity which led to mild exercise intolerance but did not affect daily life. Four patients died of multi-metastatic relapse <14 months after PP, one patient had a local recurrence, and four patients are in complete remission between 1.5 and 12 years after PP. In conclusion, in this small patient group treated with a pleuropneumonectomy for primary or metastatic lesions, outcome is variable; however, this extended surgical technique was generally quite well tolerated. Postoperative lung function seems well preserved, and it seems to lead to at least an extension of life with good quality and therefor can be considered as salvage therapy.
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Affiliation(s)
- Frédéric Hameury
- Department of Pediatric Surgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Claude Bernard University, 69677 Bron, France; (F.H.); (P.-Y.M.); (F.T.); (F.C.)
| | - Perrine Marec-Berard
- Institute of Hematology and Pediatric Oncology, 69008 Lyon, France; (P.M.-B.); (M.E.); (C.L.)
| | - Mathilde Eymery
- Institute of Hematology and Pediatric Oncology, 69008 Lyon, France; (P.M.-B.); (M.E.); (C.L.)
| | - Marc H. W. Wijnen
- Princess Maxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands;
| | - Niels van der Kaaij
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands;
| | - Pierre-Yves Mure
- Department of Pediatric Surgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Claude Bernard University, 69677 Bron, France; (F.H.); (P.-Y.M.); (F.T.); (F.C.)
| | - François Tronc
- Department of Pediatric Surgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Claude Bernard University, 69677 Bron, France; (F.H.); (P.-Y.M.); (F.T.); (F.C.)
| | - Franck Chotel
- Department of Pediatric Surgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Claude Bernard University, 69677 Bron, France; (F.H.); (P.-Y.M.); (F.T.); (F.C.)
| | - Clara Libbrecht
- Institute of Hematology and Pediatric Oncology, 69008 Lyon, France; (P.M.-B.); (M.E.); (C.L.)
| | - Wim Jan P. van Boven
- Department of Cardiothoracic Surgery, Amsterdam University Center, Location AMC, 1105 AZ Amsterdam, The Netherlands;
| | - Lianne M. Haveman
- Princess Maxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands;
- Correspondence: ; Tel.: +31-88-972-7272; Fax: +31-88-972-5009
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Lung destruction secondary to intrapulmonary migration of a ventriculoperitoneal shunt catheter: report of an unusual case and literature review. Childs Nerv Syst 2021; 37:989-993. [PMID: 32514761 DOI: 10.1007/s00381-020-04716-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 05/28/2020] [Indexed: 10/24/2022]
Abstract
Ventriculoperitoneal shunt placement for the treatment of hydrocephalus is one of the most common pediatric neurosurgical procedures. Complications, including infections, catheter obstruction, shunt breakdown, and hemorrhage, have been described in the literature. Occasionally, however, uncommon and devastating complications occur. We report a case of a 10-year-old female patient who at birth underwent surgical closure of lumbar myelomeningocele and placement of a CSF shunt at another center. Her neurosurgical follow-up was poor. She presented at our institution with a history of recurrent pneumonia. Control chest X-rays showed a right pulmonary infiltrate with lung retraction and mediastinal shift. Chest and brain CT scans confirmed the intrapulmonary location of the distal catheter tip and ventricular dilation. Surgical shunt revision was performed with removal of the intrapulmonary catheter and placement of a new intraperitoneal catheter. Subsequently, right pneumonectomy was performed with good postoperative recovery of the patient. Intrathoracic migration of the distal catheter of the CSF shunt is an extremely rare complication that may produce severe morbidity. To our knowledge, there have been no previous reports on extensive lung destruction secondary to intrathoracic and intrapulmonary ventriculoperitoneal shunt migration. In patients with CSF shunts and pulmonary symptoms, intrapulmonary catheter migration should be considered.
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Waguaf S, Boubia S, Idelhaj N, Fatene A, Ridai M. Video-assisted thoracoscopic pneumonectomy for destroyed lung. Asian Cardiovasc Thorac Ann 2020; 29:111-115. [PMID: 33175560 DOI: 10.1177/0218492320974516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM Destroyed lung refers to destruction of a large portion of a lung induced by chronic or recurrent lung infections. The aim of this single-center retrospective review was to evaluate patients with a diagnosis of destroyed lung undergoing pneumonectomy via video-assisted thoracoscopic surgery, in terms of surgical technique, postoperative morbidity and mortality, and long-term outcomes. METHODS Data of 15 patients who underwent video-assisted thoracoscopic pneumonectomy for destroyed lung during a 4-year period were analyzed retrospectively. There were 9 (60%) males and 6 (40%) females with a median age of 33.87 years (range 8-52 years). Bronchiectasis (n = 7), tuberculosis (n = 5), and fungal infection (n = 3) were the main etiologies. Hemoptysis was the most common presenting symptom (n = 8, 53.3%). Destroyed lung was detected on the left side in 13 (86.7%) patients and on the right side in 2 (13.3%). Seven patients showed narrowing or thickening of the main bronchus. RESULTS Video-assisted thoracoscopic pneumonectomy was attempted in all patients but 5 (33.3%) were converted to a thoracotomy. The mean operative time was 273.8 min. The postoperative morbidity rate was 13.3%. The mortality rate was 6.67%. The median length of hospital stay was 3.5 days. The mean follow-up period was 23.7 months. Significant improvement was observed in inflammatory symptoms and quality of life in all patients. The overall 1-year survival was 93.3%. CONCLUSION Video-assisted thoracoscopic pneumonectomy for destroyed lung is a safe and feasible option in selected patients, which can be used as an alternative to thoracotomy.
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Affiliation(s)
- Sara Waguaf
- Department of Thoracic Surgery, CHU Ibn Rochd, Hassan II University, Casablanca, Morocco
| | - Souheil Boubia
- Department of Thoracic Surgery, CHU Ibn Rochd, Hassan II University, Casablanca, Morocco
| | - Najat Idelhaj
- Department of Thoracic Surgery, CHU Ibn Rochd, Hassan II University, Casablanca, Morocco
| | - Abdellah Fatene
- Department of Thoracic Surgery, CHU Ibn Rochd, Hassan II University, Casablanca, Morocco
| | - Mohamed Ridai
- Department of Thoracic Surgery, CHU Ibn Rochd, Hassan II University, Casablanca, Morocco
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Pneumonectomy for Pediatric Tumors-a Pediatric Surgical Oncology Research Collaborative Study. Ann Surg 2020; 274:e605-e609. [PMID: 32209902 DOI: 10.1097/sla.0000000000003795] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe utilization and long-term outcomes of pneumonectomy in children and adolescents with cancer. SUMMARY BACKGROUND DATA Pneumonectomy in adults is associated with significant morbidity and mortality. Little is known about the indications and outcomes of pneumonectomy for pediatric tumors. METHODS The Pediatric Surgical Oncology Research Collaborative (PSORC) identified pediatric patients <21 years of age who underwent pneumonectomy from 1990 to 2017 for primary or metastatic tumors at 12 institutions. Clinical information was collected; outcomes included operative complications, long-term function, recurrence, and survival. Univariate log rank, and multivariable Cox analyses determined factors associated with survival. RESULTS Thirty-eight patients (mean 12 ± 6 yrs) were identified; median (IQR) follow-up was 19 (5-38) months. Twenty-six patients (68%) underwent pneumonectomy for primary tumors and 12 (32%) for metastases. The most frequent histologies were osteosarcoma (n = 6), inflammatory myofibroblastic tumors (IMT; n = 6), and pleuropulmonary blastoma (n = 5). Median postoperative ventilator days were 0 (0-1), intensive care 2 (1-3), and hospital 8 (5-16). Early postoperative complications occurred in 10 patients including 1 death. Of 25 (66%) patients alive at 1 year, 15 reported return to preoperative pulmonary status. All IMT patients survived while all osteosarcoma patients died during follow-up. On multivariable analysis, metastatic indications were associated with nonsurvival (HR = 3.37, P = 0.045) CONCLUSION:: This is the largest review of children who underwent pneumonectomy for cancer. There is decreased procedure-related morbidity and mortality than reported for adults. Survival is worse with preoperative metastatic disease, especially osteosarcoma.
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Clinical analysis of pneumonectomy for destroyed lung: a retrospective study of 32 patients. Gen Thorac Cardiovasc Surg 2019; 67:530-536. [DOI: 10.1007/s11748-018-01055-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 12/19/2018] [Indexed: 11/27/2022]
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Factors affecting complication rates of pneumonectomy in destroyed lung. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 26:272-278. [PMID: 32082745 DOI: 10.5606/tgkdc.dergisi.2018.14635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 07/04/2017] [Indexed: 11/21/2022]
Abstract
Background This study aims to investigate the relationship between characteristics of patients who were performed pneumonectomy for destroyed lung and their surgical procedures with postoperative complications. Methods Thirty-nine patients (19 males, 20 females; mean age 35 years; range, 6 to 71 years) who were performed pneumonectomy with a diagnosis of destroyed lung between February 2007 and October 2014 were retrospectively evaluated. Patients were divided into two as those who did not develop any postoperative complication (group 1) and those who developed a postoperative complication (group 2). Patients' characteristics and details of the surgical procedures were compared between the two groups. Results Twenty-nine patients (74%) were performed left pneumonectomy. Mean duration of hospital stay was nine days. During the postoperative three-month follow-up period, morbidity and mortality were reported for 13 patients (33.3%) and one patient (2.6%), respectively. No significant difference was found between groups 1 and 2 in terms of age, gender, concomitant diseases, spirometric findings, blood transfusion status, surgical resection width or methods of bronchial stump closure. Conclusion Low albumin levels increased the risk of developing postoperative complications in patients who were performed surgical resection for destroyed lung. Postpneumonectomy morbidity and mortality rates were at acceptable levels. Pneumonectomy should not be avoided as surgical treatment in eligible patients with destroyed lung.
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Yarmus L, Nguyen PT, Montemayor K, Jennings M, Bade B, Shafiq M, Silvestri G, Steinfort D. Year in review 2017: Interventional pulmonology, lung cancer, pleural disease and respiratory infections. Respirology 2018; 23:628-635. [PMID: 29641840 DOI: 10.1111/resp.13306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 03/21/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Lonny Yarmus
- Division of Pulmonary and Critical Care, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Phan T Nguyen
- The University of Adelaide, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Kristina Montemayor
- Division of Pulmonary and Critical Care, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mark Jennings
- Division of Pulmonary and Critical Care, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Brett Bade
- Division of Pulmonary and Critical Care Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Majid Shafiq
- Division of Pulmonary and Critical Care, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gerard Silvestri
- Division of Pulmonary, Critical Care, and Sleep Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Daniel Steinfort
- Department of Respiratory Medicine, Royal Melbourne Hospital, VIC, Australia
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Varona Porres D, Persiva O, Pallisa E, Andreu J. Radiological findings of unilateral tuberculous lung destruction. Insights Imaging 2017; 8:271-277. [PMID: 28197882 PMCID: PMC5359149 DOI: 10.1007/s13244-017-0547-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 01/26/2017] [Accepted: 02/01/2017] [Indexed: 01/15/2023] Open
Abstract
Objectives The aim of this report is to identify the radiological findings of unilateral tuberculous lung destruction (UTLD). Materials and methods Thirteen patients with (UTLD) were reviewed from 1999 to 2014. Only patients with radiological evidence of absence of pulmonary parenchyma preserved were included. Clinical and demographic data were obtained and radiological studies (chest radiograph and CT) were retrospectively reviewed. Results The left lung was more commonly involved (85%). The following radiological findings were found in all cases: a decrease in the diameter of the pulmonary vessels of the affected lung, herniation of the contralateral lung and hypertrophy of the ribs and/or thickening of extrapleural fat. Two radiological patterns were identified: UTLD with cystic bronchiectasis (85%) and UTLD without residual cystic bronchiectasis (15%). Forty-six per cent of cases had respiratory infection symptoms with presence of air-fluid levels in the affected lung as the most common finding in these patients. Conclusions Total unilateral post-tuberculous lung destruction is an irreversible complication with the following main radiological features: predominantly left-sided location, decreases in the diameter of the ipsilateral pulmonary vessels, herniation of the contralateral lung and hypertrophy of the ribs and/or thickening of extrapleural fat. Teaching Points • Unilateral tuberculous lung destruction is an irreversible complication of tuberculosis. • Left-side predominance and herniation of the contralateral lung are characteristic. • Decreased diameter of the ipsilateral pulmonary vessels occurred in all patients. • The pattern with residual cystic bronchiectasis is the most frequent. • Superimposed non-tuberculous infections may affect the destroyed lung.
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Affiliation(s)
- Diego Varona Porres
- Hospital Vall d´Hebrón. Radiology department, Passeig Vall d´Hebrón 119, 08035, Barcelona, Spain.
| | - Oscar Persiva
- Hospital Vall d´Hebrón. Radiology department, Passeig Vall d´Hebrón 119, 08035, Barcelona, Spain
| | - Esther Pallisa
- Hospital Vall d´Hebrón. Radiology department, Passeig Vall d´Hebrón 119, 08035, Barcelona, Spain
| | - Jordi Andreu
- Hospital Vall d´Hebrón. Radiology department, Passeig Vall d´Hebrón 119, 08035, Barcelona, Spain
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Liew Z, Mallikarjuna S, Hasan A, Gould FK, Bunn S, Thomas MF, Lordan JL, O'Brien C, Brodlie M. Successful outcome following pneumonectomy in a teenage boy with cystic fibrosis: a case report. BMC Pulm Med 2017; 17:17. [PMID: 28086849 PMCID: PMC5237202 DOI: 10.1186/s12890-016-0350-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 12/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cystic fibrosis lung disease is generally a diffuse process however rarely one lung may become particularly damaged through chronic collapse and consolidation resulting in end-stage bronchiectasis with relative sparing of the contralateral lung. This clinical situation is sometimes referred to as "destroyed lung". Lung resection surgery is seldom indicated in cystic fibrosis and the associated medical literature is relatively sparse. CASE PRESENTATION A 14 year old boy was referred to our centre for lung transplantation assessment. He had a chronic history of complete collapse and consolidation of his entire right lung. This was causing severe morbidity in terms of a continuous requirement for intravenous antibiotics over the last year, poor exercise tolerance with forced expiratory volume in 1 s of 35-40% predicted and need for home tuition. He also had significant nutritional problems and gastrointestinal symptoms following a Nissen's fundoplication operation a year earlier. His nutritional status was firstly improved by the institution of jejunal feeding, which also greatly improved his distressing symptoms of nausea and wretching. After thorough multidisciplinary assessment the therapeutic option of performing a right pneumonectomy was considered due to relative sparing of the left lung, which demonstrated only mild bronchiectasis on computed tomography scan. This was performed uneventfully with a smooth peri-operative course. Targeted antimicrobials were used to treat the multiresistant organisms colonising his airways. Subsequently his quality of life, nutritional status and lung function all improved significantly and requirement for lung transplantation has been delayed. CONCLUSIONS We report a successful outcome following pneumonectomy in a teenage boy with cystic fibrosis referred to our centre for lung transplantation assessment with chronic unilateral collapse and consolidation of his right lung. We believe that improvement of nutritional status pre-operatively and targeted antimicrobial therapy, all contributed to the smooth peri-operative course. Pneumonectomy can be a feasible option in this clinical situation in cystic fibrosis but the associated risks must be considered carefully on a case-by-case basis.
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Affiliation(s)
- Zheyi Liew
- Department of Paediatric Respiratory Medicine, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Santosh Mallikarjuna
- Department of Paediatric Respiratory Medicine, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Asif Hasan
- Department of Paediatric Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, UK
| | - F Kate Gould
- Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK
| | - Su Bunn
- Department of Paediatric Gastroenterology, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Matthew F Thomas
- Department of Paediatric Respiratory Medicine, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Jim L Lordan
- Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK
| | - Christopher O'Brien
- Department of Paediatric Respiratory Medicine, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Malcolm Brodlie
- Institute of Cellular Medicine, Newcastle University and Department of Paediatric Respiratory Medicine, Great North Children's Hospital, Level 3 Clinical Resource Building, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK.
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Liu Y, Gao Y, Zhang H, Cheng Y, Chang R, Zhang W, Zhang C. Video-assisted versus conventional thoracotomy pneumonectomy: a comparison of perioperative outcomes and short-term measures of convalescence. J Thorac Dis 2016; 8:3537-3542. [PMID: 28149547 DOI: 10.21037/jtd.2016.12.24] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Pneumonectomy is a proven treatment for lung diseases. We sought to present a comparison between video-assisted thoracic surgery pneumonectomy (VATS-P) and conventional thoracotomy pneumonectomy (CP) on perioperative outcomes and short-term measures of convalescence. METHODS A retrospective cohort study was performed to assess perioperative outcomes among patients underwent VATS-P and CP. A total of 32 patients undergoing VATS-P were matched 2:1 about comorbidity, surgical indication, tumour size and lesion location to a previous cohort of 64 patients who underwent CP. Demographic and perioperative data were obtained. Statistical analysis was performed. RESULTS Mean patient age was 55.4 years for both groups, with equal sex distribution. Pneumonectomy for malignant and benign lesion patients was evaluated individually. For malignant tumour patients, median tumour size was 3.9 cm for both groups. There was no difference between VATS-P and CP cases in transfusion rates (2% vs. 10%, P=0.50), dissected lymph node numbers (11.9 vs. 14.2, P=0.26), dissected lymph node stations (5.0 vs. 4.9, P=0.75), estimated blood loss (226.0 vs. 261.3 mL, P=0.40), complication rate (20.0% vs. 22.5%, P=0.82), postoperative drainage time (5.9 vs. 6.2, P=0.50) or length of hospital stay (7.5 vs. 8.1, P=0.50). Operation time in VATS-P was higher than conventional groups (187.5 vs. 146.3 min, P=0.00) but the mean pain score was significantly less. For benign patients, over 1,000 mL blood losing (1,033.3 vs. 1,233.3 mL, P=0.78) and 180 minutes (186.6 vs. 105.8, P=0.73) OR time was found in both groups. The Length of stay (7.6 vs. 6.3 d, P=0.57), transfusion rates (66.7% vs. 33.3%), complications rates (zero in both group) and length of drainage (6.7 vs. 6.7 d, P=1.0) between two groups are identical. CONCLUSIONS Complete video-assisted thoracic surgery (VATS) pneumonectomy is feasible and safe technique and can be recommended as a surgical treatment for lung cancer patients. However, long-term benefits need to be evaluated by further studies and large sample tests.
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Affiliation(s)
- Yuanqi Liu
- Department of Thoracic Surgery, Xiangya Hospital Central South University, Changsha 410000, China
| | - Yang Gao
- Department of Thoracic Surgery, Xiangya Hospital Central South University, Changsha 410000, China
| | - Huajun Zhang
- Department of Thoracic Surgery, Xiangya Hospital Central South University, Changsha 410000, China
| | - Yuanda Cheng
- Department of Thoracic Surgery, Xiangya Hospital Central South University, Changsha 410000, China
| | - Ruimin Chang
- Department of Thoracic Surgery, Xiangya Hospital Central South University, Changsha 410000, China
| | - Weixing Zhang
- Department of Thoracic Surgery, Xiangya Hospital Central South University, Changsha 410000, China
| | - Chunfang Zhang
- Department of Thoracic Surgery, Xiangya Hospital Central South University, Changsha 410000, China
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Giubergia V, Alessandrini F, Barrias C, Giuseppucci C, Reusmann A, Barrenechea M, Castaños C. Risk factors for morbidities and mortality in children following pneumonectomy. Respirology 2016; 22:187-191. [PMID: 27511212 DOI: 10.1111/resp.12867] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 05/31/2016] [Accepted: 06/08/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE Pneumonectomy (PNE) is a procedure infrequently performed in children. A high morbidity/mortality rate associated with PNE has been described. Few series have been published in the last 15 years. Risk factors associated with morbidity/mortality after PNE were evaluated. Indications, course, survival and complications of PNE in children were also analized. METHODS In a case series of 51 children who underwent PNE, death within 30 days of surgery, pneumonia, empyema, sepsis, adult respiratory distress syndrome, bronchopleural fistula, bleeding, pneumothorax and post-PNE syndrome were considered major morbidities. Scoliosis, wound infection and atelectasis were considered minor morbidities. RESULTS Median age at PNE was 7.4 years; 45% were males. Indications of pneumonectomy were postinfectious bronchiectasis (61%), tumours (17%), pulmonary malformations (17%), aspiration syndrome (14%), cystic fibrosis (6%), immunodeficiency (4%) and trauma (2%). Mortality rate was 4% at 1 month. Major and minor morbidities were present in 23% and 27% of patients, respectively. Risk factors for development of morbidities after PNE were age ≤ 3 years (OR: 16.7; 95% CI: 2.4-117) and the need for mechanical ventilation for at least 4 days (OR: 8; 95% CI: 1.5-43.6). CONCLUSION Children are at high risk of death, major and minor morbidities following PNE. Caution is recommended for this group of patients.
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Affiliation(s)
- Verónica Giubergia
- Pulmonology Department, Prof. Dr. Juan P. Garrahan Pediatric Hospital, Buenos Aires, Argentina
| | - Florencia Alessandrini
- Pulmonology Department, Prof. Dr. Juan P. Garrahan Pediatric Hospital, Buenos Aires, Argentina
| | - Carolina Barrias
- Pulmonology Department, Prof. Dr. Juan P. Garrahan Pediatric Hospital, Buenos Aires, Argentina
| | - Carlos Giuseppucci
- General Surgery Department, Prof. Dr. Juan P. Garrahan Pediatric Hospital, Buenos Aires, Argentina
| | - Aixa Reusmann
- General Surgery Department, Prof. Dr. Juan P. Garrahan Pediatric Hospital, Buenos Aires, Argentina
| | - Marcelo Barrenechea
- General Surgery Department, Prof. Dr. Juan P. Garrahan Pediatric Hospital, Buenos Aires, Argentina
| | - Claudio Castaños
- Pulmonology Department, Prof. Dr. Juan P. Garrahan Pediatric Hospital, Buenos Aires, Argentina
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Fan X, Deng Y, Chen W, Li W, Cai Y, Xu Q, Fu S, Fu X, Ni Z. Use of lung-preserving surgery in left inflammatory bronchial occlusion and distal atelectasis: preliminary results. Interact Cardiovasc Thorac Surg 2014; 19:644-9. [PMID: 25009308 DOI: 10.1093/icvts/ivu214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Lung-preserving surgery was proved to be effective and safe to treat patients with benign bronchial strictures. However, this surgical treatment has been rarely reported in patients with complete occlusion in the left main bronchus. The aim of this study was to assess the value of this procedure and report our experience in the treatment of these patients with left atelectasis caused by inflammatory bronchial occlusion. METHODS We reviewed and analysed the medical records of 8 patients who had undergone left main bronchus sleeve resection for symptomatic left atelectasis caused by inflammatory bronchial occlusion from May 2007 to April 2011. RESULTS Eight patients (3 men and 5 women) with a medical history of active pulmonary tuberculosis were involved in this study. The median age was 23 years. Parenchyma-sparing left main bronchus resection was performed in 4 patients, 1 of whom received partial wedge resection in the lingual lobe. Left main bronchus sleeve resection plus superior lobectomy was performed in 2 patients and left main bronchus sleeve resection plus left inferior lobectomy in 2 patients, 1 of whom received additional partial wedge resection of the lingual lobe. The procedure was completed successfully in all 8 patients without postoperative deaths. The mean follow-up time was 49.3 months, ranging from 23 to 69 months. No major complications, including stenosis and atelectasis, were observed during the follow-up period. The symptoms of pulmonary atelectasis disappeared and pulmonary ventilation function improved significantly. CONCLUSIONS In symptomatic patients with left atelectasis caused by inflammatory bronchial occlusion, lung-preserving surgery is an effective and safe surgical treatment.
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Affiliation(s)
- Xiaowu Fan
- Department of Thoracic Surgery, TongJi Hospital, TongJi Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Deng
- Department of Thoracic Surgery, TongJi Hospital, TongJi Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenshu Chen
- Department of Thoracic Surgery, TongJi Hospital, TongJi Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weina Li
- Department of Infectious Disease, TongJi Hospital, TongJi Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yixin Cai
- Department of Thoracic Surgery, TongJi Hospital, TongJi Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qinzi Xu
- Department of Thoracic Surgery, TongJi Hospital, TongJi Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shengling Fu
- Department of Thoracic Surgery, TongJi Hospital, TongJi Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiangning Fu
- Department of Thoracic Surgery, TongJi Hospital, TongJi Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhang Ni
- Department of General Thoracic Surgery, TongJi Hospital, TongJi Medical College, Huazhong University of Science and Technology, Wuhan, China
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19
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Andrade CF, Melo IA, Holand ARR, Silva ÉF, Fischer GB, Felicetii JC. Surgical treatment of non-cystic fibrosis bronchiectasis in Brazilian children. Pediatr Surg Int 2014; 30:63-9. [PMID: 24105331 DOI: 10.1007/s00383-013-3420-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2013] [Indexed: 01/31/2023]
Abstract
PURPOSE To determine the clinical characteristics of patients submitted to surgical treatment for non-cystic fibrosis (CF) bronchiectasis, the indications for surgery, and the results obtained at a referral facility for pediatric thoracic surgery. METHODS Between January 1998 and December 2009, we retrospectively reviewed the medical charts of 109 pediatric patients with non-CF bronchiectasis who underwent surgical treatment. These findings were subsequently analyzed by focusing on postoperative complications and long-term results. RESULTS Of the 109 patients undergoing pulmonary resection, the mean age was 7.6 years (ranging from 1 to 15.5 y-o) with male predominance (59 %). The most common procedure was segmentectomy (43 %) followed by left lower lobectomy (38 %). Minor postoperative complications occurred in 36 % of the patients; the most common was transient atelectasis (26 %), followed by air leak (6 %), and postoperative pain (4 %). There was one death within the 30-day postoperative period, but it was unrelated to the procedure. Eighty-three children were followed after discharge, with a mean follow-up period of 667 days. Sixty-five (76 %) patients showed improvement of clinical symptoms after surgery. CONCLUSIONS Lung resection for the treatment of non-CF bronchiectasis in children is a safe procedure, with no life-treating morbidity and low mortality. This procedure also leads to significant improvements in symptoms and quality of life.
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Affiliation(s)
- Cristiano Feijó Andrade
- Postgraduate Program in Pulmonary Sciences, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil,
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20
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Alifano M, Gaucher S, Rabbat A, Brandolini J, Guinet C, Damotte D, Regnard JF. Alternatives to resectional surgery for infectious disease of the lung: from embolization to thoracoplasty. Thorac Surg Clin 2013; 22:413-29. [PMID: 22789603 DOI: 10.1016/j.thorsurg.2012.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Surgical treatment of lung diseases is based on removal of the affected lung tissue, achieved by atypical or anatomic lung resection. Infectious lung diseases are generally treated by medical therapy, including medications, chest physiotherapy, bronchoscopic toilet, and respiratory rehabilitation. Surgical management of infectious disease of the lung is integrated in the multispecialty care. This article focuses exclusively on nonresectional surgery and other alternatives to lung resection and addresses bacterial infection and fungal disease of the lung.
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Affiliation(s)
- Marco Alifano
- Department of Thoracic Surgery, Hôtel-Dieu Hospital, Paris Descartes University, 1 Place du Parvis Notre Dame, 75181 Paris, France
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21
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Massard G, Olland A, Santelmo N, Falcoz PE. Surgery for the Sequelae of Postprimary Tuberculosis. Thorac Surg Clin 2012; 22:287-300. [DOI: 10.1016/j.thorsurg.2012.05.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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22
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Ballouhey Q, Lau S, Accadbled F, Wahn U, Kaiser D, Rothe K, Magdorf K. Miliary tuberculosis complicated by pulmonary cavitations and pneumothorax in a 14-month old boy. Ann Thorac Cardiovasc Surg 2012; 18:355-8. [PMID: 22293307 DOI: 10.5761/atcs.cr.11.01732] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Surgical management of tuberculosis is uncommon in children. We report a case of a 14-month-old boy with miliary tuberculosis and recurrent pneumothorax due to cavities in the left lung. This boy had no previous medical history and was referred to our hospital for a severe pneumonia. Initial chest radiograph showed bilateral miliary pattern. Direct microscopy of gastric lavage showed the presence of tubercle bacilli, providing definitive diagnosis. In spite of effective medication, his status rapidly worsened. A cardiac resuscitation was followed by intubation, and he required high-pressure ventilation for four weeks. He developed left pneumothorax, for which several drainages were performed. Computed tomography revealed a huge cavern system involving the entire lingula and surrounded by the left pneumothorax. Eventually, a massive enlargement of the initial cavity necessitated a thoracotomy and wedge resection.
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Affiliation(s)
- Quentin Ballouhey
- Department of Pediatric Surgery, Children's Hospital, Toulouse Cedex, France.
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Consunji-Araneta R, Higgins R, Qing G, Bouhasan L. Tuberculous damaged lung in a child. Pediatr Pulmonol 2011; 46:1247-50. [PMID: 21815276 DOI: 10.1002/ppul.21503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Accepted: 06/23/2011] [Indexed: 11/07/2022]
Abstract
Tuberculosis (TB) remains the "great pretender." We report the case of a 10-year-old female, who presented with a mass in the left chest that was suspected initially to be a tumor. This was later confirmed to be tuberculous in nature, with dissemination to the liver. A large granuloma eventually replaced the left lung, leaving her with "tuberculous destroyed lung" (TDL), an extremely rare, life-threatening sequela of the disease. We review the pathophysiology, radiologic findings, and management options, which includes pneumonectomy, for this seldom seen but preventable condition.
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Affiliation(s)
- Raquel Consunji-Araneta
- Department of Pediatrics and Child Health, Pediatric Respirology, University of Manitoba, Winnipeg, Manitoba, Canada.
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