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Duranti L, Tavecchio L. Major vascular reconstructions in thoracic oncological surgery. Updates Surg 2024:10.1007/s13304-024-01763-0. [PMID: 38421567 DOI: 10.1007/s13304-024-01763-0] [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: 11/03/2023] [Accepted: 01/16/2024] [Indexed: 03/02/2024]
Abstract
The replacement of the superior vena cava and thoracic outlet vessels for thoracic malignancies often becomes necessary for radical oncological surgery. The pulmonary artery can be directly infiltrated by the tumor or affected by metastatic hilar lymph nodes. In some cases, it must be resected and reconstructed to achieve oncological radicality and/or avoid pneumonectomy. This study reflects a single-surgeon, retrospective experience spanning 6 years (2017-2023). We reviewed data from patients undergoing early anticoagulant therapy after superior vena cava or thoracic outlet vessels bypass and from patients undergoing early antiaggregation therapy following pulmonary artery reconstruction or resection. This series comprises 41 patients treated by a single surgeon. Fourteen patients underwent superior vena cava and thoracic outlet vessel procedures. Among these, eight patients received superior vena cava replacement (six for thymic malignancies and two for lung cancer), and six patients underwent jugular and subclavian artery/vein resection or replacement (all six had sarcomas). There was one death due to respiratory failure, not associated with bleeding or bypass closure. Additionally, there was one graft closure in a patient with severe coagulopathy and three instances of hemothorax (two patients had undiagnosed complex coagulopathies not evident in pre-operative routine blood tests). Following bleeding incidents, anticoagulation was initiated the next day in one case and based on hematological indications in the two coagulopathic patients. In the pulmonary artery series, 27 patients were involved: 20 underwent direct suture after tangential resection, and 7 received pericardial patch reconstruction. Only one case experienced bleeding necessitating redo-surgery. All these patients received early and chronic antiaggregation therapy after pulmonary artery reconstruction. We conclude that major thoracic oncological vascular surgery is safe and feasible with appropriate technical skills. However, achieving optimal results requires integration with correct early anticoagulant therapy or antiaggregation to maintain the patency of bypasses/grafts and prevent life-threatening risks associated with closure of the "new vessels."
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Affiliation(s)
- Leonardo Duranti
- Thoracic Surgery Unit, IRCCS Istituto Nazionale dei Tumori Foundation, Via Venezian 1, 20133, Milan, Italy.
| | - Luca Tavecchio
- Thoracic Surgery Unit, IRCCS Istituto Nazionale dei Tumori Foundation, Via Venezian 1, 20133, Milan, Italy
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2
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Duman S, Erdoğdu E, Özkan B. Double sleeve resections. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2023; 31:S29-S39. [PMID: 38344125 PMCID: PMC10852211 DOI: 10.5606/tgkdc.dergisi.2023.24754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 03/07/2023] [Indexed: 02/21/2024]
Abstract
Double sleeve lung resections are complex surgical procedures that require specialized surgical expertise and careful patient selection. These procedures allow for the preservation of lung tissue while still achieving complete tumor resection for central tumors. Although initially considered high-risk operations, double sleeve lung resections have become a viable option for central tumors. Recent studies have shown that double sleeve lung resections are associated with lower morbidity and mortality rates than pneumonectomy. Furthermore, double sleeve lung resections may be associated with similar or even better long-term oncological outcomes compared to pneumonectomy, with the added benefit of preserving lung parenchyma and reducing the incidence of postoperative complications.
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Affiliation(s)
- Salih Duman
- Department of Thoracic Surgery, Istanbul University Faculty of Medicine, Istanbul, Türkiye
| | - Eren Erdoğdu
- Department of Thoracic Surgery, Istanbul University Faculty of Medicine, Istanbul, Türkiye
| | - Berker Özkan
- Department of Thoracic Surgery, Istanbul University Faculty of Medicine, Istanbul, Türkiye
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3
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Amirkhosravi F, Kim MP. Complex Robotic Lung Resection. Thorac Surg Clin 2023; 33:51-60. [DOI: 10.1016/j.thorsurg.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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4
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Menna C, Rendina EA, D’Andrilli A. Parenchymal Sparing Surgery for Lung Cancer: Focus on Pulmonary Artery Reconstruction. Cancers (Basel) 2022; 14:cancers14194782. [PMID: 36230705 PMCID: PMC9563968 DOI: 10.3390/cancers14194782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/20/2022] [Accepted: 09/26/2022] [Indexed: 11/16/2022] Open
Abstract
Reconstruction of the pulmonary artery (PA) associated with lobectomy for the radical resection of lung cancer has been progressively gaining diffusion in lung cancer surgery as a safe and effective therapeutic option that may allow radical resection when lobectomy is not technically feasible, avoiding pneumonectomy. There are some controversial aspects concerning the intraoperative and perioperative management of a sleeve resection with PA reconstruction that may influence the outcome. In the present article, the authors have analyzed some of the main technical and oncological aspects to take stock of what they have learned from their lung-sparing operations experience over time. PA reconstruction may require prosthetic materials including different options with variable cost. A main concern in vascular reconstructive procedures is avoiding tension on the anastomosis. When PA reconstruction is required, appropriate anticoagulation management is crucial. Results from the main literature data confirm the reliability of lobectomy associated with PA reconstruction in terms of perioperative morbidity and long-term survival. Sleeve lobectomy and PA reconstruction can be performed safely and effectively even after induction therapy.
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Affiliation(s)
- Cecilia Menna
- Correspondence: ; Tel.: +39-(0)6-3377-5155; Fax: +39-(0)6-3377-5578
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5
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Watanabe I, Hattori A, Fukui M, Matsunaga T, Takamochi K, Suzuki K. Pulmonary artery reconstruction for non-small cell lung cancer: Surgical management and long-term outcomes. J Thorac Cardiovasc Surg 2022; 164:1200-1207. [DOI: 10.1016/j.jtcvs.2022.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/17/2021] [Accepted: 01/11/2022] [Indexed: 11/25/2022]
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PREOPERATIVE ENDOBRONCHIAL SANITATION AS PREPARATION FOR THORACIC INTERVENTIONS. EUREKA: HEALTH SCIENCES 2020. [DOI: 10.21303/2504-5679.2020.001188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The aim – to study the effectiveness of endoscopic photodynamic therapy as a preoperative preparation of the tracheobronchial tree in patients with lung cancer.
Materials and methods. The study included 181 patients with II-III stage of lung’s cancer. Diagnose of lung’s cancer was confirmed with a morphologically and concomitant endobronchitis. During the preoperative preparation, we used a technique developed by us introducing into the tracheobronchial tree an aqueous solution of brilliant green at concentration of 0.04 %, followed by irradiation of this solution with laser radiation with the wavelength of 0.63 μm (AFL-2 helium-neon laser) in an independent form and in combination with traditional anti-inflammatory therapy. Endoscopic endobronchial sanitation therapy was carried out by low-intensity radiation of the red part of the spectrum (λ=0.63–0.66 μm) in a pulsed mode, with a power of 12 mW.
Results. After 3–5 days of the start preoperative preparation and 1–2 sessions of endoscopic bronchosanation, the general state of patients was improved, the amount of sputum decreased and was changing from mucopurulent to mucous. To completely stop the clinical phenomena of endobronchitis, it was necessary to conduct 5-6 sessions of endoscopic photodynamic therapy according to our methodology, with the introduction of our method. In patients without pronounced clinical symptoms of concomitant chronic bronchitis, it was enough to complete only 3 sessions of bronchosanation.
Conclusion. Endoscopic photodynamic bronchosanation in the preoperative period in patients for correcting accompanying endobronchitis can significantly reduce or completely stop the clinical manifestations of endobronchitis in the shortest time and leads to a significant decrease in the number of endobronchial complications in surgical and combined treatment of lung cancer.
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7
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Andreetti C, Poggi C, Ibrahim M, D'Andrilli A, Maurizi G, Tiracorrendo M, Peritore V, Rendina EA, Venuta F, Anile M, Pagini A, Natale G, Santini M, Fiorelli A. Surgical treatment of lung cancer with adjacent lobe invasion in relation to fissure integrity. Thorac Cancer 2019; 11:232-242. [PMID: 31851771 PMCID: PMC6996991 DOI: 10.1111/1759-7714.13217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 09/21/2019] [Accepted: 09/22/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Tumor with adjacent lobe invasion (T-ALI) is an uncommon condition. Controversy still exists regarding the optimal resection of adjacent lobe invasion, and the prognostic value in relation to fissure integrity at the tumor invasion point. The aims of this paper were to evaluate the prognosis of T-ALI with regard to fissure integrity, and type of resection. METHODS This was a retrospective multicenter study which included all consecutive patients with T-ALI undergoing surgical treatment. Based on radiological, intraoperative and histological findings, T-ALI patients were differentiated into two groups based on whether the fissure was complete (T-ALI-A group) or incomplete (T-ALI-D Group) at the level of tumor invasion point. Clinico-pathological features and survival of two study groups were analyzed and compared. RESULTS Study population included 135 patients, of these 98 (72%) were included into T-ALI-A group, and 37 (38%) into T-ALI-D Group. T-ALI-D patients had better overall survival than T-ALI-A patients (63.9 ± 7.0 vs. 48.9 ± 3.9; respectively, P = 0.01) who presented with a higher incidence of lymph node involvement (35% vs. 4%; P = 0.004), and recurrence rate (43% vs. 16%; P = 0.01). At multivariable analysis, T-ALI-D (P = 0.01), pN0 stage (P = 0.0002), and pT≤5 cm (P = 0.0001) were favorable survival prognostic factors. CONCLUSIONS T-ALI-D presented a better prognosis than T-ALI-A while extent of resection had no effect on survival. Thus, in patients with small T-ALI-D and without lymph node involvement, sublobar resection of adjacent lobe rather than lobectomy could be indicated. KEY POINTS The extent of resection of adjacent lobe had no effect on survival while T-ALI-D, pN0 stage, and pT≤5 cm were significant prognostic factors. In patients with small T-ALI-D and without lymph node involvement, sublobar resection of adjacent lobe could be indicated as an alternative to lobectomy.
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Affiliation(s)
- Claudio Andreetti
- Division of Thoracic Surgery, Sant'Andrea Hospital, Faculty of Medicine and Psychology, University of Rome 'Sapienza', Rome, Italy
| | - Camilla Poggi
- Division of Thoracic Surgery, Policlinico Umberto I, Faculty of Pharmacy and Medicine, University of Rome 'Sapienza', Rome, Italy
| | - Mohsen Ibrahim
- Division of Thoracic Surgery, Sant'Andrea Hospital, Faculty of Medicine and Psychology, University of Rome 'Sapienza', Rome, Italy
| | - Antonio D'Andrilli
- Division of Thoracic Surgery, Sant'Andrea Hospital, Faculty of Medicine and Psychology, University of Rome 'Sapienza', Rome, Italy
| | - Giulio Maurizi
- Division of Thoracic Surgery, Sant'Andrea Hospital, Faculty of Medicine and Psychology, University of Rome 'Sapienza', Rome, Italy
| | - Matteo Tiracorrendo
- Division of Thoracic Surgery, Sant'Andrea Hospital, Faculty of Medicine and Psychology, University of Rome 'Sapienza', Rome, Italy
| | - Valentina Peritore
- Division of Thoracic Surgery, Sant'Andrea Hospital, Faculty of Medicine and Psychology, University of Rome 'Sapienza', Rome, Italy
| | - Erino Angelo Rendina
- Division of Thoracic Surgery, Sant'Andrea Hospital, Faculty of Medicine and Psychology, University of Rome 'Sapienza', Rome, Italy.,Fondazione Eleonora Lorillard Spencer Cenci, Rome, Italy
| | - Federico Venuta
- Division of Thoracic Surgery, Policlinico Umberto I, Faculty of Pharmacy and Medicine, University of Rome 'Sapienza', Rome, Italy.,Fondazione Eleonora Lorillard Spencer Cenci, Rome, Italy
| | - Marco Anile
- Division of Thoracic Surgery, Policlinico Umberto I, Faculty of Pharmacy and Medicine, University of Rome 'Sapienza', Rome, Italy
| | - Andreina Pagini
- Division of Thoracic Surgery, Policlinico Umberto I, Faculty of Pharmacy and Medicine, University of Rome 'Sapienza', Rome, Italy
| | - Giovanni Natale
- Division of Thoracic Surgery, UniversitàdegliStudidella Campania "Luigi Vanvitelli", Naples, Italy
| | - Mario Santini
- Division of Thoracic Surgery, UniversitàdegliStudidella Campania "Luigi Vanvitelli", Naples, Italy
| | - Alfonso Fiorelli
- Division of Thoracic Surgery, UniversitàdegliStudidella Campania "Luigi Vanvitelli", Naples, Italy
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8
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Maurizi G, Vanni C, Rendina EA. Pushing the limits in order to avoid pneumonectomy. J Thorac Dis 2019; 11:E144-E145. [PMID: 31559088 DOI: 10.21037/jtd.2019.07.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Giulio Maurizi
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Camilla Vanni
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Erino Angelo Rendina
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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9
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Maurizi G, Ciccone AM, Rendina EA. The advantage of sleeve lobectomy over pneumonectomy. J Thorac Dis 2019; 11:E103-E104. [PMID: 31463158 DOI: 10.21037/jtd.2019.06.70] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Giulio Maurizi
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Anna Maria Ciccone
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Erino Angelo Rendina
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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10
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Pulmonary artery reconstruction using an autologous pulmonary vein patch in pulmonary resection. Gen Thorac Cardiovasc Surg 2019; 67:569-571. [PMID: 30604239 DOI: 10.1007/s11748-018-1028-5] [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: 07/19/2018] [Accepted: 10/28/2018] [Indexed: 10/27/2022]
Abstract
Pulmonary artery (PA) reconstruction has been accepted to avoid pneumonectomy in locally advanced lung cancer surgery because of its satisfactory outcomes with regard to long-term survival and its low postoperative morbidity and mortality rates. Several techniques of PA reconstruction have been documented. However, the availability of PA reconstruction using an autologous pulmonary vein (PV) patch is unclear. Here, we present a patient who successfully underwent PA reconstruction using an autologous PV patch during resection of a lung adenocarcinoma (cT2aN1M0: stage IIB) in the left upper lobe with hilar extension and left main PA invasion.
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11
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Abstract
The bronchoplastic procedure is feasible for lung cancer. However, in modern thoracic surgery, the numbers of the procedure are decreasing. To avoid pneumonectomy, thoracic surgeons should be familiar with sleeve resection and vascular reconstruction for thoracic malignancy. Extended sleeve resection is the resection of more than one lobe with the bronchoplastic procedure, which was reported in 1999. Extended sleeve resection is technically demanding, but the procedure should be one of the options to preserve lung function.
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Affiliation(s)
- Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, 1-3, Hongo 3 chome, Bunkyoku, Tokyo 113-8431, Japan.
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12
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Vannucci J, Matricardi A, Potenza R, Ragusa M, Puma F, Cagini L. Lobectomy with angioplasty: which is the best technique for pulmonary artery reconstruction? J Thorac Dis 2018; 10:S1892-S1898. [PMID: 30026976 DOI: 10.21037/jtd.2018.05.174] [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] [Indexed: 11/06/2022]
Abstract
Lobectomies with bronchial and/or vascular reconstruction are conservative procedures aimed at managing locally advanced lung cancer, avoiding a pneumonectomy. Considering morbidity, mortality and the functional consequences of a pneumonectomy, such procedures must be in the technical armamentarium of every thoracic surgeon. Vascular reconstruction of the pulmonary artery (PA) is seldom performed with or without the bronchial sleeve resection. Both functional and oncologic outcomes have been reported to be better than after a pneumonectomy. Different technical options are now available but some aspects and technical details are not standardized. Indications, possible complications, planning and even definitions need to be more solid to allow for definitive improvement in such procedures. This analysis is aimed at assessing the acquired technical data with special emphasis on the PA reconstruction with autologous tissues.
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Affiliation(s)
- Jacopo Vannucci
- Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy
| | - Alberto Matricardi
- Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy
| | - Rossella Potenza
- Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy
| | - Mark Ragusa
- Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy
| | - Francesco Puma
- Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy
| | - Lucio Cagini
- Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy
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13
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D’Andrilli A, Maurizi G, Ciccone AM, Andreetti C, Ibrahim M, Menna C, Vanni C, Venuta F, Rendina EA. Long-segment pulmonary artery resection to avoid pneumonectomy: long-term results after prosthetic replacement. Eur J Cardiothorac Surg 2017; 53:331-335. [DOI: 10.1093/ejcts/ezx353] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 08/02/2017] [Accepted: 08/23/2017] [Indexed: 11/13/2022] Open
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14
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Pulmonary artery reconstruction with a tailor-made bovine pericardial conduit following sleeve resection of a long segmental pulmonary artery for the treatment of lung cancer: technical details of the dog-ear method for adjusting diameter during vascular anastomosis. Gen Thorac Cardiovasc Surg 2016; 65:304-307. [PMID: 27796918 DOI: 10.1007/s11748-016-0725-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 10/21/2016] [Indexed: 10/20/2022]
Abstract
Sleeve resection of the pulmonary artery (PA) is always required for lung-sparing operations in which half or more of the vessel circumference is infiltrated by the primary tumor or metastatic hilar nodes. Following sleeve resection, conduit reconstruction may be indicated if there is excessive distance between the two vascular stumps, because there is a high degree of tension when repaired by direct anastomosis. We herein present a case of PA reconstruction using a tailor-made bovine pericardial conduit after sleeve resection of PA during lung cancer surgery. The length of resection was longer than 3 cm, and the difference in diameter between the conduit and peripheral PA stump was larger than 0.5 cm. We describe the surgical and oncological merits of a bovine pericardial conduit, and provide details of our reconstruction technique, focusing on adjustment of diameter between the conduit and peripheral PA (dog-ear method).
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15
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Maurizi G, D'Andrilli A, Venuta F, Rendina EA. Bronchial and arterial sleeve resection for centrally-located lung cancers. J Thorac Dis 2016; 8:S872-S881. [PMID: 27942409 DOI: 10.21037/jtd.2016.06.48] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The use of bronchial and arterial sleeve resections for the treatment of centrally-located lung cancers, when available, has become the option of choice in comparison with pneumonectomy (PN). Technical expertise, in particular in vascular reconstruction, and perioperative management improved over time allowing excellent short-term and long-term results. This is even truer if considering literature data from the main experiences published in the last years. These evidences have given to such lung sparing reconstructive procedures more and more acceptance among the surgical community. This article focuses on the main technical aspects and literature data regarding bronchovascular sleeve resections.
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Affiliation(s)
- Giulio Maurizi
- Department of Thoracic Surgery, Sant'Andrea Hospital, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Antonio D'Andrilli
- Department of Thoracic Surgery, Sant'Andrea Hospital, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Federico Venuta
- Department of Thoracic Surgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy;; Lorillard Spencer-Cenci Foundation, Rome, Italy
| | - Erino Angelo Rendina
- Department of Thoracic Surgery, Sant'Andrea Hospital, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy;; Lorillard Spencer-Cenci Foundation, Rome, Italy
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16
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Hirai A, Shinohara S, Kuwata T, Takenaka M, Chikaishi Y, Oka S, Kuroda K, Imanishi N, Tanaka F. Pulmonary artery reconstruction using autologous pulmonary vein for surgical treatment of locally advanced lung cancer: a case report. Surg Case Rep 2016; 2:46. [PMID: 27215225 PMCID: PMC4877334 DOI: 10.1186/s40792-016-0174-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 05/21/2016] [Indexed: 11/10/2022] Open
Abstract
Background Resection and reconstruction of the pulmonary artery during lobectomy is a safe and effective procedure for centrally located lung cancer. We usually choose a pericardial conduit to repair a large defect of the pulmonary artery. The use of an autologous pulmonary vein conduit for reconstruction was first described in 2009. Case presentation A 64-year-old woman with left upper lung adenocarcinoma with mediastinal and hilar adenopathy was referred to our hospital. Hilar nodes had extensively infiltrated the pulmonary artery. We interposed an autologous superior pulmonary vein between the cut ends of the pulmonary artery. She was discharged without any complication on the ninth postoperative day. Conclusions A pulmonary vein conduit is a good option for reconstruction of the pulmonary artery. We report the successful use of an autologous pulmonary vein conduit.
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Affiliation(s)
- Ayako Hirai
- Department of Thoracic Surgery, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyusyu-shi, Fukuoka, 807-8555, Japan.
| | - Shuichi Shinohara
- Department of Thoracic Surgery, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyusyu-shi, Fukuoka, 807-8555, Japan
| | - Taiji Kuwata
- Department of Thoracic Surgery, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyusyu-shi, Fukuoka, 807-8555, Japan
| | - Masaru Takenaka
- Department of Thoracic Surgery, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyusyu-shi, Fukuoka, 807-8555, Japan
| | - Yasuhiro Chikaishi
- Department of Thoracic Surgery, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyusyu-shi, Fukuoka, 807-8555, Japan
| | - Soichi Oka
- Department of Thoracic Surgery, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyusyu-shi, Fukuoka, 807-8555, Japan
| | - Koji Kuroda
- Department of Thoracic Surgery, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyusyu-shi, Fukuoka, 807-8555, Japan
| | - Naoko Imanishi
- Department of Thoracic Surgery, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyusyu-shi, Fukuoka, 807-8555, Japan
| | - Fumihiro Tanaka
- Department of Thoracic Surgery, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyusyu-shi, Fukuoka, 807-8555, Japan
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17
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Maurizi G, D'Andrilli A, Venuta F, Rendina EA. Reconstruction of the bronchus and pulmonary artery. J Thorac Dis 2016; 8:S168-80. [PMID: 26981268 DOI: 10.3978/j.issn.2072-1439.2016.02.06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Bronchovascular reconstructive procedures employed in order to avoid pneumonectomy (PN) in patients functionally unsuitable have provided, over time, excellent results, similar or even better than those obtained by PN. In recent years, new successful techniques have been developed that pertain in particular the prevention of major complications and the reconstruction of the pulmonary artery (PA). Encouraging data from increasing number of published experiences support the choice of parenchymal sparing procedures for lung cancer also in patients with good functional reserve. This is even more true if considering trials published in the last 10 years, thus indicating that improved outcome can be achieved with increased experience in reconstructive techniques and perioperative management. This article discusses the main technical aspects and results of literature.
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Affiliation(s)
- Giulio Maurizi
- 1 Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy ; 2 Department of Thoracic Surgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy ; 3 Lorillard Spencer Cenci Foundation, Rome, Italy
| | - Antonio D'Andrilli
- 1 Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy ; 2 Department of Thoracic Surgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy ; 3 Lorillard Spencer Cenci Foundation, Rome, Italy
| | - Federico Venuta
- 1 Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy ; 2 Department of Thoracic Surgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy ; 3 Lorillard Spencer Cenci Foundation, Rome, Italy
| | - Erino Angelo Rendina
- 1 Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy ; 2 Department of Thoracic Surgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy ; 3 Lorillard Spencer Cenci Foundation, Rome, Italy
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18
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D'Andrilli A, Maurizi G, Andreetti C, Ciccone AM, Ibrahim M, Piraino A, Mariotta S, Venuta F, Rendina EA. Sleeve Lobectomy Versus Standard Lobectomy for Lung Cancer: Functional and Oncologic Evaluation. Ann Thorac Surg 2016; 101:1936-42. [PMID: 26912305 DOI: 10.1016/j.athoracsur.2015.11.057] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 11/19/2015] [Accepted: 11/23/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND The purpose of this study was to compare functional and oncologic outcome of sleeve lobectomy (SL) with that of standard lobectomy (STL) in patients with non-small cell lung cancer. METHODS Between January 2009 and April 2013, 44 consecutive patients undergoing upper SL (29 right side, 15 left side) were prospectively enrolled to be compared with 44 patients with the same side distribution who were randomly selected from patients undergoing upper STL during the study period. Functional and oncologic results of the two groups were compared. RESULTS Pathologic tumor stage ranged between I and IIIa with similar patient distribution between the two groups. Postoperative complication rates were 20.5% in the SL group and 16% in the STL group. There was no postoperative mortality in either group. Mean postoperative decrease in forced expiratory volume in 1 second at 3 months postoperatively was 17.5% ± 6.2% in the SL group and 19% ± 14.8% in the STL group (p = 0.52). There also was no significant difference (p = 0.15) in mean postoperative decrease in 6-minute walk test (64.3 ± 2.5 m versus 69.1 ± 21.4 m) between the two groups. Evaluation of postoperative changes in quality of life at 3 and 6 months based on a standardized questionnaire (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core Questionnaire) did not show significant differences between the SL group and the STL group (p > 0.05) in terms of global health status, physical functioning, and fatigue. Actuarial survival rates at 3 and 5 years, respectively, were 85.3% and 60.1% in the SL group and 88.7% and 58.2% in the STL group, without significant difference (p = 0.68). CONCLUSIONS Functional and oncologic results of SL are comparable to those of STL in patients with non-small cell lung cancer.
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Affiliation(s)
- Antonio D'Andrilli
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University, Rome, Italy.
| | - Giulio Maurizi
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Claudio Andreetti
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Anna Maria Ciccone
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Mohsen Ibrahim
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Alessio Piraino
- Department of Pulmonology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Salvatore Mariotta
- Department of Pulmonology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Federico Venuta
- Department of Thoracic Surgery, Policlinico Umberto I, Sapienza University, Rome, Italy; Lorillard Spencer Cenci Foundation, Rome, Italy
| | - Erino Angelo Rendina
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University, Rome, Italy; Lorillard Spencer Cenci Foundation, Rome, Italy
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Maeda H, Kanzaki M, Sakamoto K, Kikkawa T, Isaka T, Oyama K, Murasugi M, Fuchinoue S, Tanabe K, Onuki T. Video-assisted thoracoscopic surgery after renal transplantation: A single-institution experience. Asian J Endosc Surg 2016; 9:37-43. [PMID: 26486097 PMCID: PMC5057336 DOI: 10.1111/ases.12248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 09/09/2015] [Accepted: 09/10/2015] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The number of renal transplantations performed for patients with chronic kidney disease has increased in Japan, but little is known about the outcomes in those who subsequently undergo video-assisted thoracoscopic surgery (VATS). We therefore investigated the outcomes of consecutive patients requiring VATS after renal transplantation at our institute. METHODS We retrospectively collected the clinical data for patients undergoing VATS after renal transplantation between January 2003 and September 2014. Specifically, we compared the serum creatinine level and estimated glomerular filtration rate preoperatively and postoperatively, and investigated the postoperative complications. RESULTS In total, 12 patients underwent VATS after renal transplantation during the study period. All patients received two or three immunosuppressive agents. Operative methods used included VATS wedge resection (n = 4), segmentectomy (n = 4), lobectomy (n = 2), mediastinal tumor resection (n = 1), and chest wall tumor resection (n = 1). No patients required perioperative hemodialysis. There were no intraoperative complications, but one patient developed postoperative hemorrhagic cystitis and another developed pneumonia. One patient developed pneumocystis pneumonia 2 months after left lower lobectomy and required hemodialysis. No further hemodialysis was required by any patient. Of note, no statistically significant differences were observed between the preoperative and postoperative serum creatinine level (P = 0.666) and estimated glomerular filtration rate (P = 0.388). There were no in-hospital deaths. Univariate analysis revealed no significant risk factors for postoperative complications. CONCLUSION This report showed favorable results for VATS after renal transplantation. However, clinicians must remain vigilant for complications because transplant recipients remain permanently immunocompromised.
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Affiliation(s)
- Hideyuki Maeda
- Department of Surgery ITokyo Women's Medical UniversityTokyoJapan
| | - Masato Kanzaki
- Department of Surgery ITokyo Women's Medical UniversityTokyoJapan
| | - Kei Sakamoto
- Department of Surgery ITokyo Women's Medical UniversityTokyoJapan
| | - Takuma Kikkawa
- Department of Surgery ITokyo Women's Medical UniversityTokyoJapan
| | - Tamami Isaka
- Department of Surgery ITokyo Women's Medical UniversityTokyoJapan
| | - Kunihiro Oyama
- Department of Surgery ITokyo Women's Medical UniversityTokyoJapan
| | | | - Shohei Fuchinoue
- Department of Surgery IIITokyo Women's Medical UniversityTokyoJapan
| | - Kazunari Tanabe
- Department of UrologyTokyo Women's Medical UniversityTokyoJapan
| | - Takamasa Onuki
- Department of Surgery ITokyo Women's Medical UniversityTokyoJapan
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20
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Maurizi G, Rendina EA. Bronchovascular reconstructions for lung cancer: improvements over time. Eur J Cardiothorac Surg 2015; 49:306-7. [PMID: 25769462 DOI: 10.1093/ejcts/ezv101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Giulio Maurizi
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Erino Angelo Rendina
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy Spencer-Cenci Lorillard Foundation, Rome, Italy
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