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Herrmann D, Starova U, Oggiano M, Luta LA, Hamouri S, Ewig S, Hecker E, Scheubel R. Pneumonectomy with Carinal Sleeve Resection in Patients with Non-Small-Cell Lung Cancer. Thorac Cardiovasc Surg 2024; 72:242-249. [PMID: 37884031 DOI: 10.1055/a-2199-2164] [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: 10/28/2023]
Abstract
BACKGROUND Carinal sleeve resection with pneumonectomy is one of the rarest procedures in thoracic surgery, but for locally advanced central lung cancer with infiltration of the carina, it is an option to achieve complete resection. Additionally, it might be the method of choice for patients with stump insufficiency after pneumonectomy or in the cases with anastomosis dehiscence after sleeve lobectomy. The aim of this study was to evaluate the morbidity and long-term survival of patients with non-small-cell lung cancer (NSCLC) who underwent sleeve pneumonectomy, either for curative intent or as an option to treat postoperative complications. METHODS All consecutive patients with NSCLC who underwent carinal sleeve pneumonectomy for the aforementioned indications in our department between December 2021 and September 2003 were included in this study. An analysis of demographic characteristics, perioperative variables, and long-term survival was carried out. Data were evaluated retrospectively. RESULTS Fifty patients underwent pneumonectomy with carina sleeve resection. Thirty-one cases for curative treatment of NSCLC (primary sleeve pneumonectomy [pSP]) and 19 patients were treated because of postpneumonectomy bronchial stump insufficiency or bronchial anastomosis dehiscence (secondary sleeve pneumonectomy [sSP]). Complications occurred in 30 patients (60%) and the 90-day mortality was 18% (n = 9). Patients with pSP had an estimated overall survival of 39.6 months, compared to estimated overall survival for patients after sSP of 24.5 months (p = 0.01). The N status did not appear to affect outcomes. CONCLUSION Carinal sleeve resection with pneumonectomy is a feasible procedure with limited morbidity and mortality. This procedure is a reasonable therapeutic option for patients with locally advanced central NSCLC after mandatory patient selection.
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Affiliation(s)
- Dominik Herrmann
- Department of Thoracic Surgery, Thoraxzentrum Ruhrgebiet, Herne, Germany
| | - Urim Starova
- Department of Thoracic Surgery, Thoraxzentrum Ruhrgebiet, Herne, Germany
| | - Melanie Oggiano
- Department of Thoracic Surgery, Thoraxzentrum Ruhrgebiet, Herne, Germany
| | | | - Shadi Hamouri
- Department of General Surgery and Urology, Jordan University of Science and Technology, Faculty of Medicine, Irbid, Jordan
| | - Santiago Ewig
- Department of Respiratory and Infectious Diseases, Thoraxzentrum Ruhrgebiet, Herne, Germany
| | - Erich Hecker
- Department of Thoracic Surgery, Thoraxzentrum Ruhrgebiet, Herne, Germany
| | - Robert Scheubel
- Clinic of Thoracic Surgery, Waldburg-Zeil Clinic, Wangen im Allgäu, Germany
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Dogru MV, Sezen CB, Aker C, Girgin O, Kilimci U, Erduhan S, Metin M. Evaluation of factors affecting morbidity and mortality in pneumonectomy patients. Acta Chir Belg 2021; 121:301-307. [PMID: 32254000 DOI: 10.1080/00015458.2020.1753147] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The aim of this study was to evaluate risk factors associated with morbidity and mortality after pneumonectomy in non-small cell lung cancer patients. METHODS The study included 107 patients who underwent pneumonectomy for non-small cell lung cancer between January 2013 and December 2018. Prognostic factors affecting mortality and morbidity were investigated. RESULTS The patient group included 10 women (9.3%) and 97 men (90.7%) with a mean age of 59.5 ± 8.5 years. Seventy-three patients (68.2%) underwent standard pneumonectomy and 34 (31.8%) underwent extended pneumonectomy. Nine patients (8.4%) received induction chemotherapy. Complications occurred in 33 patients (30.8%). Complications were classified as surgical, cardiovascular, pulmonary, or infectious. Charlson Comorbidity Index (CCI) > 3 and right-side resection were significant risk factors for the development of complications. The most common complication was atrial fibrillation. Eleven patients developed a bronchopleural fistula. The 30-day postoperative mortality rate was 6.5% (n = 7). Mortality was not associated with any demographic and surgical characteristics other than CCI > 3 (p = .05). CONCLUSION The results of this study indicate that our pneumonectomy outcomes are acceptable despite high morbidity and mortality rates. Appropriate patient selection for pneumonectomy is as important as complication management. High-comorbidity patients should undergo these procedures in experienced centers.
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Affiliation(s)
- Mustafa Vedat Dogru
- Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Celal Buğra Sezen
- Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Cemal Aker
- Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Oğuz Girgin
- Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Umut Kilimci
- Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Semih Erduhan
- Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Muzaffer Metin
- Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
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Evaluation of prognostic factors in lung cancers with surgical complete response after induction treatment. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2021; 29:201-211. [PMID: 34104514 PMCID: PMC8167474 DOI: 10.5606/tgkdc.dergisi.2021.19956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/13/2020] [Indexed: 11/22/2022]
Abstract
Background
This study aims to evaluate long-term results of induction treatment and to investigate prognostic factors affecting survival in non-small cell lung cancer patients with a pathological complete response.
Methods
Between January 2010 and December 2017, a total of 39 patients (38 males, 1 female; mean age: 56.2±8.3 years; range, 38 to 77 years) having locally advanced (IIIA-IIIB) non-small cell lung cancer who were given induction treatment and underwent surgery after induction treatment and had a pathological complete response were retrospectively analyzed. Survival rates of the patients and prognostic factors of survival were analyzed.
Results
Clinical staging before induction treatment revealed Stage IIB, IIIA, and IIIB disease in three (7.7%), 26 (66.7%), and 10 (25.6%) patients, respectively. The five-year overall survival rate was 61.2%, and the disease-free survival rate was 55.1%. In nine (23.1%) patients, local and distant recurrences were detected in the postoperative period.
Conclusion
In patients with locally advanced non-small cell lung cancer undergoing surgery after induction treatment, the rates of pathological complete response are at considerable levels. In these patients, the five-year overall survival is quite satisfactory and the most important prognostic factor affecting overall survival is the presence of single-station N2.
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Herrmann D, Oggiano M, Gencheva-Bozhkova P, Braun M, Neuhaus G, Ewig S, Hecker E. Carinal sleeve resection: last exit for bronchial insufficiency-a 17-year, single-centre experience. Interact Cardiovasc Thorac Surg 2021; 32:921-927. [PMID: 33772313 DOI: 10.1093/icvts/ivab031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/12/2020] [Accepted: 01/20/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Bronchopleural fistula after pneumonectomy and dehiscence of an anastomosis after sleeve lobectomy are severe complications. Several established therapeutic options are available. Conservative treatment is recommended for a small fistula without pleural infection. In patients with a bronchopleural fistula and subsequent pleural empyema, surgical management is the mainstay. Overall, the associated morbidity and mortality are high. Carinal sleeve resection is the last resort for patients with a short stump after pneumonectomy or anastomotic dehiscence after sleeve resection near the carina. METHODS All patients with bronchopleural fistula after pneumonectomy or sleeve resection who underwent secondary carinal sleeve resection between 2003 and 2019 in our institution were evaluated retrospectively. Patients with anastomotic dehiscence after sleeve lobectomy underwent a completion pneumonectomy. The surgical approach was an anterolateral thoracotomy; the anastomosis was covered with muscle flap, pericardial fat or omentum majus. In case of empyema, povidone-iodine-soaked towels were introduced into the cavity and changed at least twice. RESULTS A total of 17 patients with an initial sleeve lobectomy in 12 patients and pneumonectomy in 5 patients were treated with carinal sleeve resection in our department. Morbidity was 64.7% and 30-day survival was 82.4% (n = 14). A total of 70.6% of the patients survived 90 days (n = 12). Median hospitalization was 17 days and the median stay in the intensive care unit was 12 days. CONCLUSIONS Carinal sleeve resection is a feasible option in patients with a post-pneumonectomy fistula or anastomotic insufficiency following sleeve lobectomy in the absence of alternative therapeutic strategies. Nevertheless, postoperative morbidity is high, including prolonged intensive care unit stay.
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Affiliation(s)
- Dominik Herrmann
- Department of Thoracic Surgery, Thoraxzentrum Ruhrgebiet, Evangelisches Krankenhaus, Herne, Germany
| | - Melanie Oggiano
- Department of Thoracic Surgery, Thoraxzentrum Ruhrgebiet, Evangelisches Krankenhaus, Herne, Germany
| | | | - Monique Braun
- Department of Thoracic Surgery, Thoraxzentrum Ruhrgebiet, Evangelisches Krankenhaus, Herne, Germany
| | - Gerd Neuhaus
- Department of Thoracic Surgery, Thoraxzentrum Ruhrgebiet, Evangelisches Krankenhaus, Herne, Germany
| | - Santiago Ewig
- Department of Respiratory and Infectious Diseases, Thoraxzentrum Ruhrgebiet, Evangelisches Krankenhaus, Herne, Germany
| | - Erich Hecker
- Department of Thoracic Surgery, Thoraxzentrum Ruhrgebiet, Evangelisches Krankenhaus, Herne, Germany
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Spaggiari L, Sedda G, Petrella F, Venturino M, Rossi F, Guarize J, Galetta D, Casiraghi M, Iacono GL, Bertolaccini L, Alamanni F. Preliminary Results of Extracorporeal Membrane Oxygenation Assisted Tracheal Sleeve Pneumonectomy for Cancer. Thorac Cardiovasc Surg 2020; 69:240-245. [PMID: 32814351 DOI: 10.1055/s-0040-1714071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Tracheal sleeve pneumonectomy is a challenge in lung cancer management and in achieving long-term oncological results. In November 2018, we started a prospective study on the role of extracorporeal membrane oxygenation (ECMO) in tracheal sleeve pneumonectomy. We aim to present our preliminary results. METHODS From November 2018 to November 2019, six patients (three men and three women; median age: 61 years) were eligible for tracheal sleeve pneumonectomy for lung cancer employing the veno-venous ECMO during tracheobronchial anastomosis. RESULTS Only in one patient, an intrapericardial pneumonectomy without ECMO support was performed, but cannulas were maintained during surgery. The median length of surgery was 201 minutes (range: 162-292 minutes), and the average duration of the apneic phase was 38 minutes (range: 31-45 minutes). No complications correlated to the positioning of the cannulas were recorded. There was only one major postoperative complication (hemothorax). At the time of follow-up, all patients were alive; one patient alive with bone metastasis was being treated with radiotherapy. CONCLUSION ECMO-assisted oncological surgery was rarely described, and its advantages include hemodynamic stability with low bleeding complications and a clean operating field. As suggested by our preliminary data, ECMO-assisted could be a useful alternative strategy in select lung cancer patients.
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Affiliation(s)
- Lorenzo Spaggiari
- Department of Thoracic Surgery, IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy
| | - Giulia Sedda
- Department of Thoracic Surgery, IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Francesco Petrella
- Department of Thoracic Surgery, IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy
| | - Marco Venturino
- Department of Anesthesiology, IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Fabiana Rossi
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino IRCCS, Milano, Italy
| | - Juliana Guarize
- Department of Thoracic Surgery, IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Domenico Galetta
- Department of Thoracic Surgery, IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Monica Casiraghi
- Department of Thoracic Surgery, IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Giorgio Lo Iacono
- Department of Thoracic Surgery, IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Luca Bertolaccini
- Department of Thoracic Surgery, IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Francesco Alamanni
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino IRCCS, Milano, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy
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Carinal surgery: A single-institution experience spanning 2 decades. J Thorac Cardiovasc Surg 2019; 157:2073-2083.e1. [DOI: 10.1016/j.jtcvs.2018.11.130] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 11/14/2018] [Accepted: 11/17/2018] [Indexed: 11/22/2022]
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