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Gomes Neto A, Oliveira LCDE, Alves FM, Nogueira LFA, Oliveira VF, Medeiros IL, Mariani AW. Early and late outcomes of video thoracoscopic versus open approach for bronchiectasis lung resections. Rev Col Bras Cir 2024; 51:e20243748. [PMID: 39258626 DOI: 10.1590/0100-6991e-20243748-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 06/13/2024] [Indexed: 09/12/2024] Open
Abstract
OBJECTIVES To evaluate the early and late results of surgical treatment of patients with bronchiectasis, comparing the Video-Assisted Thoracic Surgery (VATS) vs. the open thoracotomy (OT). METHODS Observational retrospective study of patients who underwent surgery for bronchiectasis. Patients were divided into two groups according to surgical access OT/VATS. Variables collected included gender, age, preoperative symptoms, etiology, segments involved, FVC and FEV1, type of surgical resection, complications, mortality, and length of hospital stay. Late surgical results were classified as excellent, complete remission of symptoms; good, significative improvement; and poor, little/no improvement. RESULTS 108 surgical resections (103 patients). OT group 54 patients (52.4%) vs. VATS 49 (47.6%). A high percentage of complications was observed, but no difference between the OT (29.6%) and VATS (24.5%) groups was found. Post-operative hospital stay was shorter in the VATS group (5.4 days) vs. the OT group (8.7 days (p=0.029). 75% of the patients had a late follow-up; the results were considered excellent in 71.4%, good in 26%, and poor in 2.6%. Regarding bronchiectasis distribution, an excellent percentage was obtained at 82.1% in patients with localized bronchiectasis and 47.5% with non-localized bronchiectasis, p=0.003. CONCLUSIONS VATS leads to similar results regarding morbidity, compared to OT. However, VATS was related to shorter hospital stays, reflecting the early recovery. Late results were excellent in most patients, being better in patients with localized bronchiectasis. VATS should be considered a preferable approach for bronchiectasis lung resection whenever possible.
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Affiliation(s)
- Antero Gomes Neto
- - Universidade Federal do Ceará, Cirurgia Torácica - Fortaleza - CE - Brasil
- - Hospital De Messejana Dr. Carlos Alberto Studart Gomes, Cirurgia Torácica - Fortaleza - CE - Brasil
| | | | - Flávio Mendes Alves
- - Universidade Federal do Ceará, Cirurgia Torácica - Fortaleza - CE - Brasil
| | | | | | - Israel Lopes Medeiros
- - Hospital De Messejana Dr. Carlos Alberto Studart Gomes, Cirurgia Torácica - Fortaleza - CE - Brasil
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Huang WL, Chien ST, Yu MC, Chang BS, Yen YT, Wu MH, Tseng YL. Risk factor analysis of postoperative complications after adjunctive pulmonary resection in patients with multidrug-resistant tuberculosis: A multi-institutional study. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2023; 56:1064-1072. [PMID: 37586914 DOI: 10.1016/j.jmii.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/25/2023] [Accepted: 07/13/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND AND OBJECTIVE Multidrug-resistant tuberculosis (MDR-TB) requires extended treatment with regimens with multiple side effects, resulting in high treatment failure rates. Adjunctive lung resection combined with anti-tubercular agents improves outcomes. However, few studies have evaluated the potential harm from surgery and determined the optimal conditions for surgery. We aimed to analyze perioperative conditions to assess risk factors for postoperative complications in a multi-institutional setting. METHODS This retrospective study included 44 patients with MDR-TB who underwent adjunctive lung resection at three management groups of the Taiwan MDR-TB consortium between January 2007 and December 2020. Demographic data, clinical characteristics, radiological findings, sputum culture status before surgery, primary or acquired drug resistance, surgical procedure, complications, and treatment outcomes were collected and analyzed. Multivariate logistic regression was used to identify risk factors for postoperative complications. RESULTS Twenty-seven patients (61.4%) underwent lung resection using video-assisted thoracic surgery (VATS). The overall surgical complication rate was 20.5%, and the surgical mortality rate was 9.1%. Postsurgical hemothorax was the most common complication (11.4%). According to the univariate analysis, hilum involvement in images, positive preoperative sputum culture, and thoracotomy approach were unfavorable factors. VATS approach [adjusted OR, 0.088 (95% CI, 0.008-0.999)] was the only favorable factor identified by multivariate analysis. CONCLUSION The minimally invasive approach is a growing trend, and lobectomies and sublobar resections were the main procedures for MDR-TB. The VATS approach significantly reduced the surgical complication rate. Postsurgical hemothorax was noteworthy, and meticulous hemostasis of the chest wall and residual lung surface is critical for successful resections.
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Affiliation(s)
- Wei-Li Huang
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Chung University, Tainan, Taiwan.
| | - Shun-Tien Chien
- Chest Hospital, Ministry of Health and Welfare, Tainan, Taiwan.
| | - Ming-Chih Yu
- Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
| | - Bee-Song Chang
- Department of Cardiothoracic Surgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
| | - Yi-Ting Yen
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Chung University, Tainan, Taiwan.
| | - Ming-Ho Wu
- Division of Thoracic Surgery, Department of Surgery, Tainan Municipal Hospital, Tainan, Taiwan.
| | - Yau-Lin Tseng
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Chung University, Tainan, Taiwan.
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Lian KH, Liu WD, Lin MW, Hsu HH, Tsai TM, Tsou KC, Chen YC, Chen JS. Undiagnosed solitary caseating granulomas: Is lung resection surgery a feasible method for diagnosis and treatment? J Formos Med Assoc 2021; 121:896-902. [PMID: 34740492 DOI: 10.1016/j.jfma.2021.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 06/01/2021] [Accepted: 10/05/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND In many patients, low-dose computed tomography (CT) screening for lung cancer reveals asymptomatic pulmonary nodules. Lung resection surgery may be indicated in these patients; however, distinguishing malignancies from benign lesions preoperatively can be challenging. METHODS From 2013 to 2018, 4181 patients undergoing surgery for pulmonary nodules were reviewed at National Taiwan University Hospital, and 837 were diagnosed with benign pathologies. Only patients with pathological diagnosis as caseating granulomatous inflammation were included, sixty-nine patients were then analyzed for preoperative clinical and imaging characteristics, surgical methods and complications, pathogens, medical treatment and outcomes. Mycobacterial evidence was obtained from the culture of respiratory or surgical specimen. RESULTS Overall, 68% of the patients were asymptomatic before surgery. More than half of the nodules were in the upper lobes, and all patients underwent video-assisted thoracoscopic surgery (VATS). Some patients (14.5%) developed grade I complications, and the mean postoperative hospital stay was 4 days. The final pathology reports of 20% benign entities postoperatively, and caseating granulomatous inflammation accounted for a significant part. MTB and NTM were cultured from one-fourth of the patients respectively. All patients with confirmed MTB infection received antimycobacterial treatment, while the medical treatment in NTM-infected patients was decided by the infectious disease specialists. The mean follow-up period was 736 days, and no recurrence was found. CONCLUSION Lung resection surgery is an aggressive but safe and feasible method for diagnosing MTB- or NTM-associated pulmonary nodules, and, potentially, an effective therapeutic tool for patients with undiagnosed MTB- or NTM-associated pulmonary nodules.
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Affiliation(s)
- Kuan-Hsun Lian
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei City, 100, Taiwan
| | - Wang-Da Liu
- Division of Infectious Diseases, Department of Internal Medicine, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Mong-Wei Lin
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei City, 100, Taiwan
| | - Hsao-Hsun Hsu
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei City, 100, Taiwan
| | - Tung-Ming Tsai
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Cancer Center, Taipei, Taiwan, No. 57, Ln. 155, Sec. 3, Keelung Rd., Da'an Dist., Taipei City, 106, Taiwan
| | - Kuan-Chuan Tsou
- National Taiwan University College of Medicine Graduate Institute of Clinical Medicine, No. 7, Chung-Shan South Road, Taipei, Taiwan; Department of Surgery, Taipei City Hospital, Zhongxiao Branch, No.145, Zhengzhou Rd., Datong Dist., Taipei, Taiwan.
| | - Yee-Chun Chen
- Center of Infection Control, National Taiwan University Hospital, Taipei, Taiwan, No. 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei City, 100, Taiwan
| | - Jin-Shing Chen
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Cancer Center, Taipei, Taiwan, No. 57, Ln. 155, Sec. 3, Keelung Rd., Da'an Dist., Taipei City, 106, Taiwan
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Wu CY, Chen YY, Chang CC, Yen YT, Lai WW, Huang WL, Tseng YL. Single-port thoracoscopic anatomic resection for chronic inflammatory lung disease. BMC Surg 2021; 21:244. [PMID: 34006253 PMCID: PMC8130153 DOI: 10.1186/s12893-021-01252-w] [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: 01/28/2021] [Accepted: 05/11/2021] [Indexed: 12/03/2022] Open
Abstract
Background It is challenging to proceed thoracoscopic anatomic resection when encountering severe pleural adhesion or calcified peribronchial lymphadenopathy. Compared with multiple-port video-assisted thoracoscopic surgery (MP-VATS), how to overcome these challenges in single-port (SP-) VATS is still an intractable problem. In the present study, we reported the surgical results of chronic inflammatory lung disease and shared some useful SP-VATS techniques. Methods We retrospectively assessed the surgical results of chronic inflammatory lung disease, primarily bronchiectasis, and mycobacterial infection, at our institution between 2010 and 2018. The patients who underwent SP-VATS anatomic resection were compared with those who underwent MP-VATS procedures. We analyzed the baseline characteristics, perioperative data, and postoperative outcomes, and illustrated four special techniques depending on the situation: flexible hook electrocautery, hilum-first technique, application of Satinsky vascular clamp, and staged closure of bronchial stump method. Results We classified 170 consecutive patients undergoing thoracoscopic anatomic resection into SP and MP groups, which had significant between-group differences in operation time and overall complication rate (P = 0.037 and 0.018, respectively). Compared to the MP-VATS group, the operation time of SP-VATS was shorter, and the conversion rate of SP-VATS was relatively lower (3.1% vs. 10.5%, P = 0.135). The most common complication was prolonged air leakage (SP-VATS, 10.8%; MP-VATS, 2.9%, P = 0.045). Conclusions For chronic inflammatory lung disease, certain surgical techniques render SP-VATS anatomic resection feasible and safe with a lower conversion rate.
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Affiliation(s)
- Chen-Yu Wu
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Chung University, 138 Sheng-Li Road, Tainan, 704, Taiwan
| | - Ying-Yuan Chen
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Chung University, 138 Sheng-Li Road, Tainan, 704, Taiwan.,Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chao-Chun Chang
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Chung University, 138 Sheng-Li Road, Tainan, 704, Taiwan
| | - Yi-Ting Yen
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Chung University, 138 Sheng-Li Road, Tainan, 704, Taiwan
| | - Wu-Wei Lai
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Chung University, 138 Sheng-Li Road, Tainan, 704, Taiwan
| | - Wei-Li Huang
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Chung University, 138 Sheng-Li Road, Tainan, 704, Taiwan. .,Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Yau-Lin Tseng
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Chung University, 138 Sheng-Li Road, Tainan, 704, Taiwan
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Leite PHC, Mariani AW, Araujo PHXNDE, Lima CET, Braga F, Haddad R, Campos JRMDE, Pego-Fernandes PM, Terra RM. Robotic thoracic surgery for inflammatory and infectious lung disease: initial experience in Brazil. Rev Col Bras Cir 2021; 48:e20202872. [PMID: 34008797 PMCID: PMC10683415 DOI: 10.1590/0100-6991e-20202872] [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: 10/19/2020] [Accepted: 03/08/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE in Latin America, especially Brazil, the use of a robotic platform for thoracic surgery is gradually increasing in recent years. However, despite tuberculosis and inflammatory pulmonary diseases are endemic in our country, there is a lack of studies describing the results of robotic surgical treatment of bronchiectasis. This study aims to evaluate the surgical outcomes of robotic surgery for inflammatory and infective diseases by determining the extent of resection, postoperative complications, operative time, and length of hospital stay. METHODS retrospective study from a database involving patients diagnosed with bronchiectasis and undergoing robotic thoracic surgery at three hospitals in Brazil between January of 2017 and January of 2020. RESULTS a total of 7 patients were included. The mean age was 47 + 18.3 years (range, 18-70 years). Most patients had non-cystic fibrosis bronchiectasis (n=5), followed by tuberculosis bronchiectasis (n=1) and lung abscess (n=1). The performed surgeries were lobectomy (n=3), anatomic segmentectomy (n=3), and bilobectomy (n=1). The median console time was 147 minutes (range 61-288 min.) and there was no need for conversion to open thoracotomy. There were no major complications. Postoperative complications occurred in one patient and it was a case of constipation with the need for an intestinal lavage. The median for chest tube time and hospital stay, in days, was 1 (range, 1-6 days) and 5 (range, 2-14 days) respectively. CONCLUSIONS robotic thoracic surgery for inflammatory and infective diseases is a feasible and safe procedure, with a low risk of complications and morbidity.
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Affiliation(s)
| | - Alessandro Wasum Mariani
- - Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, Departamento de Cirurgia Torácica - São Paulo - SP - Brasil
- - Rede D'Or - São Luiz, Serviço de Cirurgia Torácica - São Paulo - SP - Brasil
- - Hospital Sírio Libanês, Serviço de Cirurgia Torácica - São Paulo - SP - Brasil
| | - Pedro Henrique Xavier Nabuco DE Araujo
- - Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, Departamento de Cirurgia Torácica - São Paulo - SP - Brasil
- - Rede D'Or - São Luiz, Serviço de Cirurgia Torácica - São Paulo - SP - Brasil
- - Hospital Sírio Libanês, Serviço de Cirurgia Torácica - São Paulo - SP - Brasil
| | | | - Felipe Braga
- - Hospital Copa Star, Serviço de Cirurgia Torácica - Rio de Janeiro - RJ - Brasil
| | - Rui Haddad
- - Hospital Copa Star, Serviço de Cirurgia Torácica - Rio de Janeiro - RJ - Brasil
| | - José Ribas Milanez DE Campos
- - Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, Departamento de Cirurgia Torácica - São Paulo - SP - Brasil
| | - Paulo Manuel Pego-Fernandes
- - Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, Departamento de Cirurgia Torácica - São Paulo - SP - Brasil
- - Hospital Sírio Libanês, Serviço de Cirurgia Torácica - São Paulo - SP - Brasil
| | - Ricardo Mingarini Terra
- - Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, Departamento de Cirurgia Torácica - São Paulo - SP - Brasil
- - Rede D'Or - São Luiz, Serviço de Cirurgia Torácica - São Paulo - SP - Brasil
- - Hospital Sírio Libanês, Serviço de Cirurgia Torácica - São Paulo - SP - Brasil
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Pohnán R, Hytych V, Holmquist I, Boštíková V, Doležel R, Ryska M. Increasing incidence of tuberculosis diagnosed by surgery: a single centre analysis in low-incidence country. Cent Eur J Public Health 2020; 28:48-52. [PMID: 32228817 DOI: 10.21101/cejph.a5789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 03/27/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this study was to assess the incidence of thoracic tuberculosis (TB) in patients who underwent surgery for indeterminate lung nodules, mass and pleural effusions. METHODS A monocentric retrospective study was carried out from 2012 to 2018 in a high-volume thoracic surgery centre. All patients with finding of thoracic TB within surgery and/or confirmed post-surgery were studied. Demography, origin, TB related symptoms, immunosuppression, type of surgery, and complication of surgery were analyzed. RESULTS During the seven-year period TB was diagnosed in 71 cases, 58% were men. The mean age was 50 years. 21% of the cases had family history of TB or were successfully treated for TB in the past. 14% of patients had prior history of treatment for malignancy. Five patients (7%) received immunosuppressive therapy. The indication for surgery was indeterminate lung nodules and mass in 55 patients (77.5%) and indeterminate recurrent or persistent pleural effusions in 21 patients (22.5%). In five patients (7%) a lung carcinoma and a concomitant TB infection was detected. 63 of the cases (88.7%) had positive real-time PCR TBC test. Direct microscopic detection of Mycobacterium tuberculosis detected TB in five cases (7%). The microbiological diagnosis by culture was achieved in 19 patients (26.8%). Two patients (2.8%) were diagnosed with multidrug-resistant TB. Surgical procedure complications occurred in nine cases (12.7%). CONCLUSIONS Although the overall incidence of TB in the Czech Republic is low and constantly continues to decrease, the number of TB detected by surgical procedures is increasing. Surgery still remains an important tool in diagnostics of nonobvious cases of TB, especially in patients with a potential risk of malignancy.
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Affiliation(s)
- Radek Pohnán
- Department of Surgery, Second Faculty of Medicine, Charles University and Central Military Hospital, Prague, Czech Republic.,Thomayer Hospital, Prague, Czech Republic
| | | | - Ivana Holmquist
- Emory University Hospital Midtown, Atlanta, Georgia, USA.,Department of Epidemiology, Faculty of Health Sciences, University of Defence, Hradec Kralove, Czech Republic
| | - Vanda Boštíková
- Department of Epidemiology, Faculty of Health Sciences, University of Defence, Hradec Kralove, Czech Republic
| | - Radek Doležel
- Department of Surgery, Second Faculty of Medicine, Charles University and Central Military Hospital, Prague, Czech Republic
| | - Miroslav Ryska
- Department of Surgery, Second Faculty of Medicine, Charles University and Central Military Hospital, Prague, Czech Republic
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Molnar TF. Tuberculosis: mother of thoracic surgery then and now, past and prospectives: a review. J Thorac Dis 2018; 10:S2628-S2642. [PMID: 30345099 PMCID: PMC6178290 DOI: 10.21037/jtd.2018.04.131] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 04/19/2018] [Indexed: 11/06/2022]
Abstract
Knowledge on ontogenesis of thoracic surgery is essential not only for understanding present concepts and debates on surgery for tuberculosis, but it also contributes to the further developments in operative treatment of lung cancer. Both diseases have been the leading cause of death in their respective ages. History of tuberculosis follows the classic algorithm: diagnostic, casuistic and therapeutical stages. Villemin followed by Virchow, and, finally, Koch revealed the pathoanatomy and the cause of tuberculosis. The therapeutic phase of lung cancer has been reached without identified cause of the disease. Chest surgery, eradication of the macroscopic focus by physical interference with the involved tissue mass, in both diseases preceded medical treatment. Identification of phenotypes of lung cancer-if it is a single disease at all-does not contravene the concept: the tumor mass should been eliminated. However, causation is not an absolute sine qua non of an effective treatment, as the tuberculosis-lung cancer analogy also proves. Surgical approach of both diseases suffered from the same paraoxon: eradication without direct interference with the causative factor. While lung cancer seems to be controlled by an emerging array of new drugs, tuberculosis poses a new challenge, as multidrug resistant and extensively drug resistant Koch bacteria are emerging and fragile societies' immunity is weakening. Thoracic surgery has a significant share in the fight against tuberculosis, when drugs and/or society fail. Palliative and radical adjuvant surgery multiplies the chance of cure in those cases, where not much hope is left. The jury is still out in a series of questions, but it is obvious, that surgery is only an option and not a panacea where medicines and their providers fail. Deeper understanding of our past and present failures with tuberculosis and its surgery might contribute to new concepts in coping with lung cancer as well.
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Affiliation(s)
- Tamas F. Molnar
- Department of Operational Medicine, Medical Humanities Unit, University of Pécs, Pécs, Hungary
- Department Surgery, St Sebastian Thoracic Surgery Unit, Petz A University Teaching Hospital, Győr, Hungary
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Lin TH, Huang WL, Chang CC, Yen YT, Lai WW, Tseng YL, Chen YY. Uniportal video-assisted thoracoscopic surgery lobectomy and segmentectomy for pulmonary sequestration. J Thorac Dis 2018; 10:3722-3728. [PMID: 30069370 DOI: 10.21037/jtd.2018.05.151] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background Pulmonary sequestration is a rare disease whose development begins in the embryonic stage. Surgery is the definitive treatment for eliminating respiratory symptoms and preventing complications. Reports of uniportal video-assisted thoracoscopic surgery (VATS) lobectomy and segmentectomy for pulmonary sequestration are limited in the literature. This study analyzes the perioperative results of the uniportal approach and compared them with those of the multiportal approach for pulmonary sequestration. Methods We collected a VATS series in a single institute from 2007 to 2017. Adult patients diagnosed with pulmonary sequestration and who had received surgical intervention were included. The use of uniportal VATS began from 2016. The perioperative outcomes for uniportal and multiportal approaches were compared. Results A total of 19 patients (7 in the uniportal group and 12 in the multiportal group) were included. VATS segmentectomy was performed significantly more in the uniportal group (P=0.033). Shorter operative time, less intraoperative blood loss, shorter pleural drainage time, and shorter postoperative hospital stay were found for the uniportal group; however, the differences compared with the multiportal group were not significant. There was also no significant difference in perioperative parameters among patients who underwent wedge resection, segmentectomy and lobectomy, respectively. All patients were symptom-free in the follow-up. Conclusions The perioperative results for a series of uniportal VATS anatomical resections for pulmonary sequestration were found to be better than those obtained with the multiportal approach. Although a challenging procedure, uniportal VATS segmentectomy can be performed safely for pulmonary sequestration to preserve more healthy pulmonary parenchyma.
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Affiliation(s)
- Tzu-Hung Lin
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Wei-Li Huang
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Chao-Chun Chang
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Yi-Ting Yen
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Wu-Wei Lai
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Yau-Lin Tseng
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Ying-Yuan Chen
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
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Tseng YL, Chang CC, Chen YY, Liu YS, Cheng L, Chang JM, Wu MH, Yen YT. From one incision to one port: The surgical technique and the evolution of segmentectomy in patients with pulmonary tuberculosis. PLoS One 2018; 13:e0197283. [PMID: 29763423 PMCID: PMC5953493 DOI: 10.1371/journal.pone.0197283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 04/29/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES We retrospectively reviewed the evolution of segmentectomy for pulmonary tuberculosis (TB) and the feasibility of multi- and single-incision video-assisted thoracoscopic segmentectomy. METHODS Of 348 patients undergoing surgery for TB, the medical records of 121 patients undergoing segmentectomy between January 1996 and November 2015 were reviewed. Clinical information and computed tomography (CT) image characteristics were investigated and analyzed. RESULTS Eighteen patients underwent direct or intended thoracotomy. Sixty-four underwent video-assisted thoracoscopic segmentectomy (VATS), including 53 multi-incision thoracoscopic segmentectomy (MITS), and 11 single-incision thoracoscopic segmentectomy (SITS). Thirty-nine were converted to thoracotomy. The intended thoracotomy group had more operative blood loss (p = 0.005) and hospital stay (p = 0.001) than the VATS group although the VATS group had higher grade of cavity (p = 0.007). The intended thoracotomy group did not differ from converted thoracotomy in operative time, blood loss, or hospital stay, and the grade of pleural thickening was higher in the converted thoracotomy group (p = 0.001). The converted thoracotomy group had more operative blood loss, hospital stay, and complication rate than the MITS group (p = 0.001, p<0.001, and p = 0.009, respectively). The MITS group had lower pleural thickening, peribronchial lymph node calcification, cavity, and tuberculoma grading than the converted thoracotomy group (p<0.001, p = 0.001, 0.001, and 0.017, respectively). The SITS group had lower grading in pleural thickening, peribronchial lymph node calcification, and aspergilloma grading than the converted thoracotomy group (p = 0.002, 0.010, and 0.031, respectively). Four patients in the intended thoracotomy group and seven in the converted thoracotomy group had complications compared with three patients in the MITS and two in the SITS group. Risk factors of conversion were pleural thickening and peribronchial lymph node calcification. CONCLUSION Although segmentectomy is technically challenging in patients with pulmonary TB, it could be safely performed using MITS or SITS and should be attempted in selected patients. Its efficacy for medical treatment failure needs investigation.
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Affiliation(s)
- Yau-Lin Tseng
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medical College, National Cheng Kung University, Tainan, Taiwan
| | - Chao-Chun Chang
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medical College, National Cheng Kung University, Tainan, Taiwan
| | - Ying-Yuan Chen
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medical College, National Cheng Kung University, Tainan, Taiwan
- Institute of Clinical Medicine, College of Medical College, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Sheng Liu
- Department of Diagnostic Radiology, National Cheng Kung University Hospital, College of Medical College, National Cheng Kung University, Tainan, Taiwan
| | - Lili Cheng
- Department of Diagnostic Radiology, National Cheng Kung University Hospital, College of Medical College, National Cheng Kung University, Tainan, Taiwan
| | - Jia-Ming Chang
- Institute of Clinical Medicine, College of Medical College, National Cheng Kung University, Tainan, Taiwan
- Division of Thoracic Surgery, Department of Surgery, Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Ming-Ho Wu
- Division of Thoracic Surgery, Department of Surgery, Tainan Municipal Hospital, Tainan, Taiwan
| | - Yi-Ting Yen
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medical College, National Cheng Kung University, Tainan, Taiwan
- Institute of Clinical Medicine, College of Medical College, National Cheng Kung University, Tainan, Taiwan
- Division of Trauma and Acute Care Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medical College, National Cheng Kung University, Tainan, Taiwan
- * E-mail:
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10
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Abstract
Modern thoracic surgery can now offer management of tuberculosis and its complications in selected patients with greater efficacy and less morbidity than ever before. Significantly, newer minimally invasive thoracic surgical approaches potentially lower thresholds for surgical candidacy, allowing more tuberculosis patients to receive operative treatment. This review aims to provide an overview of the role that modern thoracic surgery can play in diagnosing and managing patients with tuberculosis and its sequelae.
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Yablonskii P, Kudriashov G, Vasilev I, Avetisyan A, Sokolova O. Robot-assisted surgery in complex treatment of the pulmonary tuberculosis. J Vis Surg 2017; 3:18. [PMID: 29078581 DOI: 10.21037/jovs.2016.12.09] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 12/02/2016] [Indexed: 11/06/2022]
Abstract
Surgery of pulmonary tuberculosis associated with open thoracotomy due to dense pleural and vascular adhesions. These reasons limited the use of video-assisted thoracoscopic surgery (VATS) in these cases. Robotic surgical system aimed to performing successfully minimally invasive operations for pulmonary tuberculosis. This paper showed 3-year experience of one chest center in this area. The results of this work are recommendations that facilitate the implementation of robot-assisted lung resection in complex treatment of pulmonary tuberculosis.
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Affiliation(s)
- Piotr Yablonskii
- Department of Thoracic Surgery, St. Petersburg State Research Institute of Phthisiopulmonology, St. Petersburg, Russian.,Medical Faculty, St. Petersburg, Russian
| | - Grigorii Kudriashov
- Department of Thoracic Surgery, St. Petersburg State Research Institute of Phthisiopulmonology, St. Petersburg, Russian
| | - Igor Vasilev
- Department of Thoracic Surgery, St. Petersburg State Research Institute of Phthisiopulmonology, St. Petersburg, Russian
| | - Armen Avetisyan
- Department of Thoracic Surgery, St. Petersburg State Research Institute of Phthisiopulmonology, St. Petersburg, Russian
| | - Olga Sokolova
- Department of Thoracic Surgery, St. Petersburg State Research Institute of Phthisiopulmonology, St. Petersburg, Russian
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12
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Reichert M, Kerber S, Pösentrup B, Bender J, Schneck E, Augustin F, Öfner D, Padberg W, Bodner J. Anatomic lung resections for benign pulmonary diseases by video-assisted thoracoscopic surgery (VATS). Langenbecks Arch Surg 2016; 401:867-75. [PMID: 27456676 DOI: 10.1007/s00423-016-1478-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 07/07/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE Based on increasing evidence of its benefits regarding perioperative and oncologic outcome, video-assisted thoracoscopic surgery (VATS) has gained increasing acceptance in the surgical treatment of early stage non-small cell lung cancer (NSCLC). However, the evidence for a VATS approach in anatomic lung resection for benign pulmonary diseases is still limited. METHODS Between March 2011 and May 2014, data from 33 and 63 patients who received VATS anatomic lung resection for benign diseases (VATS-B) and early stage NSCLC (VATS-N), respectively, were analyzed retrospectively. For subgroup analyses, VATS-B was subdivided by operation time and underlying diseases. Subgroups were compared to VATS-N. RESULTS Three patients from VATS-B and four from VATS-N experienced conversion to open surgery. Causes of conversion in VATS-B were intraoperative complications, whereas conversions in VATS-N were elective for oncological concerns (p < 0.05). Operation time and duration of postoperative mechanical ventilation were longer by tendency; postoperative stay on intensive care unit and chest tube duration were significantly longer in VATS-B. Subgroup analyses showed a longer operation time as a predictor for worse perioperative outcome regarding postoperative mechanical ventilation, postoperative stay on intensive care unit, chest tube duration, and length of hospital stay. Patients with longer operation time suffered from more postoperative complications. Differences in perioperative outcome data were not significantly dependent on the underlying benign diseases compared to VATS-N. CONCLUSIONS VATS is feasible and safe in anatomic lung resection for benign pulmonary diseases. Not the underlying disease, but a longer operation time is a factor for worse postoperative outcome.
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Affiliation(s)
- Martin Reichert
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, 35392, Giessen, Germany.
| | - Stefanie Kerber
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, 35392, Giessen, Germany
| | - Bernd Pösentrup
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, 35392, Giessen, Germany
| | - Julia Bender
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, 35392, Giessen, Germany
| | - Emmanuel Schneck
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, 35392, Giessen, Germany
| | - Florian Augustin
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Dietmar Öfner
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Winfried Padberg
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, 35392, Giessen, Germany
| | - Johannes Bodner
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, 35392, Giessen, Germany.,Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria.,Department of Thoracic Surgery, Klinikum Bogenhausen, Englschalkinger Strasse 77, 81925, Munich, Germany
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Tseng YL, Chang JM, Liu YS, Cheng L, Chen YY, Wu MH, Lu CL, Yen YT. The Role of Video-Assisted Thoracoscopic Therapeutic Resection for Medically Failed Pulmonary Tuberculosis. Medicine (Baltimore) 2016; 95:e3511. [PMID: 27149451 PMCID: PMC4863768 DOI: 10.1097/md.0000000000003511] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
There are few reports regarding video-assisted thoracoscopic therapeutic resection for medically failed pulmonary tuberculosis (TB). We reviewed our surgical results of video-assisted thoracoscopic surgery (VATS) therapeutic resection for pulmonary TB with medical failure, and its correlation with image characteristics on chest computed tomography (CT) scan.Between January 2007 and December 2012, among the 203 patients who had surgery for TB, the medical records of 89 patients undergoing therapeutic resection for medically failed pulmonary TB were reviewed. Clinical information and the image characteristics of CT scan were investigated and analyzed.Forty-six of the 89 patients undergoing successful VATS therapeutic resection had significantly lower grading in pleural thickening (P < 0.001), peribronchial lymph node calcification (P < 0.001), tuberculoma (P = 0.015), cavity (P = 0.006), and aspergilloma (P = 0.038); they had less operative blood loss (171.0 ± 218.7 vs 542.8 ± 622.8 mL; P < 0.001) and shorter hospital stay (5.2 ± 2.2 vs 15.6 ± 15.6 days; P < 0.001). They also had a lower percentage of anatomic resection (73.9% vs 93.0%; P = 0.016), a higher percentage of sublobar resection (56.5% vs 32.6%; P = 0.023), and a lower disease relapse rate (4.3% vs 23.3%; P = 0.009). Eighteen of the 38 patients with multi-drug resistant pulmonary tuberculosis (MDRTB) who successfully underwent VATS had significantly lower grading in pleural thickening (P = 0.001), peribronchial lymph node calcification (P = 0.019), and cavity (P = 0.017). They were preoperatively medicated for a shorter period of time (221.6 ± 90.8 vs 596.1 ± 432.5 days; P = 0.001), and had more sublobar resection (44.4% vs 10%), less blood loss (165.3 ± 148.3 vs 468.0 ± 439.9 mL; P = 0.009), and shorter hospital stay (5.4 ± 2.6 vs 11.8 ± 6.9 days; P = 0.001).Without multiple cavities, peribronchial lymph node calcification, and extensive pleural thickening, VATS therapeutic resection could be safely performed in selected patients with medically failed pulmonary TB as an effective adjunct with satisfactory results.
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MESH Headings
- Adult
- Antitubercular Agents/therapeutic use
- Calcinosis/diagnosis
- Calcinosis/etiology
- Female
- Humans
- Lymph Nodes/diagnostic imaging
- Lymph Nodes/pathology
- Male
- Middle Aged
- Outcome and Process Assessment, Health Care
- Pleura/diagnostic imaging
- Pleura/pathology
- Pneumonectomy/adverse effects
- Pneumonectomy/methods
- Predictive Value of Tests
- Prognosis
- Taiwan/epidemiology
- Thoracic Surgery, Video-Assisted/adverse effects
- Thoracic Surgery, Video-Assisted/methods
- Thoracic Surgery, Video-Assisted/statistics & numerical data
- Tuberculosis, Multidrug-Resistant/complications
- Tuberculosis, Multidrug-Resistant/diagnosis
- Tuberculosis, Multidrug-Resistant/surgery
- Tuberculosis, Pleural/diagnosis
- Tuberculosis, Pleural/etiology
- Tuberculosis, Pulmonary/complications
- Tuberculosis, Pulmonary/diagnosis
- Tuberculosis, Pulmonary/epidemiology
- Tuberculosis, Pulmonary/surgery
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Affiliation(s)
- Yau-Lin Tseng
- From the Department of Surgery, Division of Thoracic Surgery, National Cheng Kung University Hospital, College of Medical College, National Cheng Kung University, Tainan (Y-LT, Y-YC, Y-TY); Department of Surgery, Division of Thoracic Surgery, Chia-Yi Christian Hospital, Chia-Yi (J-MC); Graduate Institute of Medical Sciences, Collage of Health Science, Chang Jung Christian University, Tainan (J-MC); Department of Diagnostic Radiology, National Cheng Kung University Hospital, College of Medical College, National Cheng Kung University (Y-SL, LC); Department of Surgery, Division of Thoracic Surgery, Tainan Municipal Hospital (M-HW); Center for Infection Control, National Cheng Kung University Hospital (C-LL); and Institute of Clinical Medicine, College of Medical College (J-MC, Y-TY), National Cheng Kung University, Tainan, Taiwan
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14
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Pishchik VG, Zinchenko EI, Obornev AD, Kovalenko AI. [Video-assisted thoracoscopic anatomic lung resection: experience of 246 operations]. Khirurgiia (Mosk) 2016:10-15. [PMID: 26977763 DOI: 10.17116/hirurgia20161210-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM To present one of the largest materials of video-assisted thoracoscopic (VATS) anatomic lung resections in Russia. MATERIAL AND METHODS It is a retrospective analysis of treatment of 246 patients who underwent VATS anatomic lung resection for the period from 2010 to 2014 at the Center for Thoracic Surgery of St. Petersburg Clinical Hospital №122. One surgical team has operated 125 men and 121 women aged from 20 to 85 years (58.8±13.4 years). There were 216 (87.8%) lobectomies, 4 (1.6%) bilobectomies, 9 (3.7%) pneumonectomies, 10 (4.1%) segmentectomies and 7 (2.8%) trisegmentectomies. Upper right-side lobectomy was the most frequent in this group (87 (40.3%)). Most of operations was performed via 2 approaches (119 patients). Average length of the longest incision was 4.3±0.93 cm (range 2-6 cm). All patients were examined according to a single plan. FEV1 less than 70% was observed in 26% of patients; comorbidity index was 5 scores or more in 24% of cases; 23.2% of patients were older than 70 years. RESULTS Non-small cell lung cancer (NSCLC) was diagnosed in 168 patients (68.3%), pulmonary tuberculosis - in 27 (11%), chronic suppurative lung disease - in 27 (11%) cases. Furthermore there were 9 cases of pulmonary metastases, 11 cases of carcinoid, 1 - MALT-lymphoma, 1 - leiomyoma, 2 - small cell lung cancer, as well as one case of IgG-associated pseudotumor. Among 168 cases of NSCLC operations were performed in 87 (51.8%) cases for cancer stage I, in 46 (27.3%) patients for stage II, in 27 patients for stage III (including 16 cases of stage IIIA and 11 cases of stage IIIB). 8 patients (4.7%) with lung cancer stage IV have been operated in radical surgery for solitary metastasis. Mean duration of surgery was 202.1±58.2 minutes (range 100-380). On the average 12.8±5.6 (range 9-32) mediastinal lymph nodes were excised during lymph node dissection in cancer patients. Mean number of nodes groups was 4.1±1.1. In 11 (4.5%) patients conversion to open surgery was made due to intraoperative bleeding (3 cases) and technical difficulties (8 cases). Mean duration of postoperative pleural drainage and hospital-stay were 5.1±4.3 (median - 3 days) and 7.9±4.7 days (median - 6 days) respectively. Complications which were not associated with perioperative deaths were observed in 66 patients (26.8%). Prolonged air vent was the most common complication. CONCLUSION VATS anatomical lung resections are safe and effective in most of pulmonary surgical diseases. Such interventions may be recommended for wider introduction at the Thoracic Departments of Russia because of small number of complications and rapid rehabilitation. Bleeding or its risk associated with fibrotic changes in pulmonary root are the most frequent causes of conversion to open access.
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Affiliation(s)
- V G Pishchik
- L.G. Sokolov Clinical Hospital #122, FMBA of Russia, St. Petersburg, Russia; Medical Faculty of St. Petersburg State University, St. Petersburg, Russia
| | - E I Zinchenko
- L.G. Sokolov Clinical Hospital #122, FMBA of Russia, St. Petersburg, Russia; Medical Faculty of St. Petersburg State University, St. Petersburg, Russia
| | - A D Obornev
- L.G. Sokolov Clinical Hospital #122, FMBA of Russia, St. Petersburg, Russia; Medical Faculty of St. Petersburg State University, St. Petersburg, Russia
| | - A I Kovalenko
- Medical Faculty of St. Petersburg State University, St. Petersburg, Russia
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15
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Han Y, Zhen D, Liu Z, Xu S, Liu S, Qin M, Zhou S, Yu D, Song X, Li Y, Xiao N, Su C, Shi K. Surgical treatment for pulmonary tuberculosis: is video-assisted thoracic surgery "better" than thoracotomy? J Thorac Dis 2015; 7:1452-8. [PMID: 26380771 DOI: 10.3978/j.issn.2072-1439.2015.08.08] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 03/16/2015] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To compare video-assisted thoracoscopic surgery (VATS) lobectomy and conventional open lobectomy in patients with pulmonary tuberculosis (TB) who require surgery. METHODS Forty patients with pulmonary TB who required lobectomy were randomized to receive either VATS or open lobectomy. Patient demographic, pulmonary function, operative, and postoperative data were compared between the groups. RESULTS There were 20 patients who received VATS lobectomy (median age 31.5 years, range 19-67 years) and 20 that received open lobectomy (median age 33.5 years, range 16-60 years). The two groups were similar with respect to gender, age and pulmonary function (all, P>0.05). Lobectomy was completed by VATS in 19 of 20 patients (95%), and by thoracoscope-assisted mini-incision lobectomy in 1 patient. The median intraoperative blood loss was 345 mL (range, 100-800 mL), and the median duration of pleural cavity closed drainage was 5 days (range, 3-7 days). All open lobectomies were completed successfully, and the median intraoperative blood loss was 445 mL (range, 150-950 mL) and the median duration of pleural cavity closed drainage was 5 days (range, 3-9 days). No statistically significant differences were found between the groups with respect to operation completion rates, type of lung resection, intraoperative blood loss, closed pleural drainage duration and volume of postoperative chest drainage. The operation time, number of postoperative complications, postoperative pain index at 24 hours after surgery and postoperative hospital stay were all significantly less in the VATS group. With a median follow-up duration of 14 months (range, 8-18 months) no positive sputum examination results were found in either group. CONCLUSIONS VATS lobectomy is an effective and minimally invasive method for treating patients with pulmonary TB.
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Affiliation(s)
- Yi Han
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
| | - Dezhi Zhen
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
| | - Zhidong Liu
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
| | - Shaofa Xu
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
| | - Shuku Liu
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
| | - Ming Qin
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
| | - Shijie Zhou
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
| | - Daping Yu
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
| | - Xiaoyun Song
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
| | - Yunsong Li
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
| | - Ning Xiao
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
| | - Chongyu Su
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
| | - Kang Shi
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
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16
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Single-incision versus multiple-incision thoracoscopic lobectomy and segmentectomy: a propensity-matched analysis. Ann Surg 2015; 261:793-9. [PMID: 24836148 DOI: 10.1097/sla.0000000000000712] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To compare the perioperative outcomes of single-incision and multiple-incision thoracoscopic lobectomy and segmentectomy. BACKGROUND Reports of single-incision thoracoscopic lobectomy and segmentectomy for lung cancer are limited, and a comparison between single-incision and multiple-incision thoracoscopic lobectomy or segmentectomy for lung cancer has not been previously reported. METHODS From January 2005 to June 2013, a total of 233 patients with lung cancer underwent thoracoscopic lobectomy or segmentectomy via a single-incision or multiple-incision technique. A propensity-matched analysis, incorporating preoperative variables, was used to compare the short-term outcomes between single-incision and multiple-incision thoracoscopic lobectomy and segmentectomy. RESULTS Overall, 50 patients underwent single-incision thoracoscopic pulmonary resections, including 35 lobectomies and 15 segmentectomies, and 183 patients underwent multiple-incision thoracoscopic lobectomy or segmentectomy between January 2005 and December 2011. Propensity matching produced 46 patients in each group. The length of hospital stay and the complication rate were not significantly different between the 2 groups. Single-incision thoracoscopic lobectomy and segmentectomy were associated with shorter operative time (P = 0.029), more numbers of lymph nodes (P = 0.032), and less intraoperative blood loss (P = 0.017) than with the multiple-incision approach. No in-hospital mortality occurred in either group. CONCLUSIONS Single-incision thoracoscopic lobectomy and segmentectomy are feasible, and perioperative outcomes are comparable with those of the multiple-incision approach.
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17
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Kilani T, Boudaya MS, Zribi H, Ouerghi S, Marghli A, Mestiri T, Mezni F. [Surgery for thoracic tuberculosis]. REVUE DE PNEUMOLOGIE CLINIQUE 2015; 71:140-158. [PMID: 24894967 DOI: 10.1016/j.pneumo.2014.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 03/25/2014] [Accepted: 03/26/2014] [Indexed: 06/03/2023]
Abstract
Tuberculosis is mainly a medical disease. Surgery has been the unique therapeutic tool for a long time before the advent of specific antituberculous drugs, and the role of surgery was then confined to the treatment of the sequelae of tuberculosis and their complications. The resurgence of tuberculosis and the emergence of multidrug-resistant TB combined to immunosuppressed patients represent a new challenge for tuberculosis surgery. Surgery may be indicated for a diagnostic purpose in patients with pulmonary, pleural, mediastinal or thoracic wall involvement, or with a therapeutic purpose (drainage, resection, residual cavity obliteration). Modern imaging techniques and the advent of video-assisted thoracic surgery allowed a new approach of this pathology; the majority of diagnostic interventions and selected cases requiring lung resection can be performed through a mini-invasive approach. Patients proposed for aggressive surgery may be treated with the best results thanks to a good evaluation of the thoracic lesions, of the patients' nutritional, infectious and general status combined with a good coordination between the specialized medical team for an optimal preparation to surgery.
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Affiliation(s)
- T Kilani
- Hôpital Abderrahmane Mami, université Tunis El Manar, Ariana, Tunisie.
| | - M S Boudaya
- Hôpital Abderrahmane Mami, université Tunis El Manar, Ariana, Tunisie
| | - H Zribi
- Hôpital Abderrahmane Mami, université Tunis El Manar, Ariana, Tunisie
| | - S Ouerghi
- Hôpital Abderrahmane Mami, université Tunis El Manar, Ariana, Tunisie
| | - A Marghli
- Hôpital Abderrahmane Mami, université Tunis El Manar, Ariana, Tunisie
| | - T Mestiri
- Hôpital Abderrahmane Mami, université Tunis El Manar, Ariana, Tunisie
| | - F Mezni
- Hôpital Abderrahmane Mami, université Tunis El Manar, Ariana, Tunisie
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Pischik VG. Technical difficulties and extending the indications for VATS lobectomy. J Thorac Dis 2014; 6:S623-30. [PMID: 25379200 DOI: 10.3978/j.issn.2072-1439.2014.10.11] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 09/02/2014] [Indexed: 11/14/2022]
Abstract
BACKGROUND Data on advantages of video-assisted thoracoscopic surgery (VATS) lobectomies has been accumulated during the last 10 years then number of thoracoscopic anatomic pulmonary resections rapidly increased. But still there is no agreement about limitations of the method. The most popular "technical contraindications" for VATS anatomic pulmonary resections are: dense pleural adhesions, incompleteness of interlobar fissure, previous chemo- or/and radiotherapy, perivascular or/and peribronchial fibrosis, tumor larger than 5 cm, chest wall involvement, centrally located tumor, severe comorbidity, advanced age, severe COPD and emphysema. Extending of indications for the VATS anatomic pulmonary resection and its influence on the immediate outcomes was investigated. METHODS Ninety two consecutive cases of VATS anatomic pulmonary resection performed by the single surgeon from January 2012 till December 2013 at the Federal University Hospital #122 in Saint Petersburg, Russia were retrospectively analyzed. Forty three males and 49 females at the age from 21 to 87 years old (mean age 59±7.2). The most of the cases were comprised by lung cancer of I-III stage together with bronchiectasis and tuberculomas. Conversion rate was 3.2% mostly due to perivascular calcification and/or fibrosis. There were no cases of 30-days mortality and readmission. All those patients retrospectively divided into two groups: with standard and extended indications for the VATS lobectomy. Inclusion in "extended" group was made if patients had one or more technical challenges among following: size of the lesion 5 cm and more; strong pleural adhesions and/or "bad fissure"; adjacent structures involvement; hilar or mediastinal lymph nodes enlargement or involvement; centrally located tumors; previous chemo- or chemoradiotherapy or previous thoracic surgery. RESULTS According to these criteria, 45 standard (S) and 47 extended (E) patients were pair-matched with no statistically significant differences between the groups in common patients' characteristics. Postoperative comparison of "standard" and "expanded" groups revealed some differences in average operation time (152 vs. 189 min), in number of resected mediastinal lymph nodes (10.2 vs. 13.1), and in the mean time before removal of the chest tube (3.9 vs. 5.2 days). But the blood loss, morbidity and the length of hospital stay were almost the same in the two groups. CONCLUSIONS Extension of indications to VATS lobectomy does not compromise the short-term results. Incompleteness of interlobar fissures, pleural adhesions, preoperative chemotherapy, big size of lesion, and some cases of centrally located tumors are not supposed to be the contraindications for VATS lobectomy. Peribronchial and perivascular lymph node calcification may complicate and even preclude lobectomy by VATS.
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Affiliation(s)
- Vadim G Pischik
- Thoracic Surgery Department, Federal Hospital #122, Saint Petersburg, Russia ; Faculty of Medicine, Saint Petersburg State University, Saint Petersburg, Russia
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19
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Baste JM, Orsini B, Rinieri P, Melki J, Peillon C. Résections pulmonaires majeures par vidéothoracoscopie : 20ans après les premières réalisations. Rev Mal Respir 2014; 31:323-35. [DOI: 10.1016/j.rmr.2013.10.650] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Accepted: 10/07/2013] [Indexed: 11/27/2022]
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20
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Calligaro GL, Moodley L, Symons G, Dheda K. The medical and surgical treatment of drug-resistant tuberculosis. J Thorac Dis 2014; 6:186-95. [PMID: 24624282 PMCID: PMC3949182 DOI: 10.3978/j.issn.2072-1439.2013.11.11] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 11/20/2013] [Indexed: 11/14/2022]
Abstract
Multi drug-resistant tuberculosis (MDR-TB) and extensively drug-resistant TB (XDR-TB) are burgeoning global problems with high mortality which threaten to destabilise TB control programs in several parts of the world. Of alarming concern is the emergence, in large numbers, of patients with resistance beyond XDR-TB (totally drug-resistant TB; TDR-TB or extremely drug resistant TB; XXDR-TB). Given the burgeoning global phenomenon of MDR-TB, XDR-TB and TDR-TB, and increasing international migration and travel, healthcare workers, researchers, and policy makers in TB endemic and non-endemic countries should familiarise themselves with issues relevant to the management of these patients. Given the lack of novel TB drugs and limited access to existing drugs such as linezolid and bedaquiline in TB endemic countries, significant numbers of therapeutic failures are emerging from the ranks of those with XDR-TB. Given the lack of appropriate facilities in resource-limited settings, such patients are being discharged back into the community where there is likely ongoing disease spread. In the absence of effective drug regimens, in appropriate patients, surgery is a critical part of management. Here we review the diagnosis, medical and surgical management of MDR-TB and XDR-TB.
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Chen QK, Chen C, Chen XF, Jiang GN. Video-Assisted Thoracic Surgery for Pulmonary Aspergilloma: A Safe and Effective Procedure. Ann Thorac Surg 2014; 97:218-23. [DOI: 10.1016/j.athoracsur.2013.08.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 08/05/2013] [Accepted: 08/07/2013] [Indexed: 12/01/2022]
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Bouchikh M, Achir A, Caidi M, El Aziz S, Benosman A. [Role of pulmonary resections in management of multidrug-resistant tuberculosis. A monocentric series of 29 patients]. REVUE DE PNEUMOLOGIE CLINIQUE 2013; 69:326-330. [PMID: 24210152 DOI: 10.1016/j.pneumo.2013.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 07/25/2013] [Accepted: 09/13/2013] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Multidrug-resistant tuberculosis (MDR-TB) is a worldwide health problem. Surgery is often used as an adjuvent therapy with anti-tuberculosis agents. The aim of this study is to present our results of pulmonary resections in the treatment of MDR-TB. MATERIAL AND METHODS [corrected] This is a retrospective monocentric study of 29 patients operated on between 1995 and 2010 for MDR-TB. RESULTS Tuberculosis was evolving from 9 to 108 months with a median of 34.77±19.88 months. The average number of tuberculosis relapses was 2.73 per patient. All patients had a destroyed and/or cavitary parenchyma and 17 had bacilli in sputum at the time of surgery. Lobectomy (51.17%) and pneumonectomy (41.37%) were the main interventions carried out. The operative mortality was 3.44%. Complications such prolonged air leaking and empyema had occurred in 9 patients. The rate of postoperative microbiological conversion was 88.23%. One patient had a relapse 5 months after surgery. CONCLUSION Surgery associated with medical treatment provides a high cure rate to the detriment of an acceptable morbidity and mortality.
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Affiliation(s)
- M Bouchikh
- Service de chirurgie thoracique, CHU Ibn-Sina, BP 353, 10001 Rabat, Maroc; Unité de pédagogie et de recherche en chirurgie thoracique, faculté de médecine, Rabat, Maroc.
| | - A Achir
- Service de chirurgie thoracique, CHU Ibn-Sina, BP 353, 10001 Rabat, Maroc; Unité de pédagogie et de recherche en chirurgie thoracique, faculté de médecine, Rabat, Maroc
| | - M Caidi
- Service de chirurgie thoracique, CHU Ibn-Sina, BP 353, 10001 Rabat, Maroc
| | - S El Aziz
- Service de chirurgie thoracique, CHU Ibn-Sina, BP 353, 10001 Rabat, Maroc
| | - A Benosman
- Service de chirurgie thoracique, CHU Ibn-Sina, BP 353, 10001 Rabat, Maroc; Unité de pédagogie et de recherche en chirurgie thoracique, faculté de médecine, Rabat, Maroc
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