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D'Andrilli A, Maurizi G, Ciccone AM, Ibrahim M, Andreetti C, De Benedictis I, Melina G, Venuta F, Rendina EA. Reconstruction of the heart and the aorta for radical resection of lung cancer. J Thorac Cardiovasc Surg 2024; 167:1481-1489. [PMID: 37541573 DOI: 10.1016/j.jtcvs.2023.07.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 07/03/2023] [Accepted: 07/24/2023] [Indexed: 08/06/2023]
Abstract
INTRODUCTION We report a single-center experience of resection and reconstruction of the heart and aorta infiltrated by lung cancer in order to prove that involvement of these structures is no longer a condition precluding surgery. METHODS Twenty-seven patients underwent surgery for lung cancer presenting full-thickness infiltration of the heart (n = 6) or the aorta (n = 18) and/or the supra-aortic branches (subclavian n = 3). Cardiac reconstruction was performed in 6 patients (5 atrium, 1 ventricle), with (n = 4) or without (n = 2) cardiopulmonary bypass, using a patch prosthesis (n = 4) or with deep clamping and direct suture (n = 2). Aortic or supra-aortic trunk reconstruction (n = 21) was performed using a heart-beating crossclamping technique in 14 cases (8 patch, 4 conduit, 2 direct suture), or without crossclamping by placing an endovascular prosthesis before resection in 7 (4 patch, 3 omental flap reconstruction). Neoadjuvant chemotherapy was administered in 13 patients, adjuvant therapy in 24. RESULTS All resections were complete (R0). Nodal staging of lung cancer was N0 in 14 cases, N1 in 10, N2 in 3. No intraoperative mortality occurred. Major complication rate was 14.8%. Thirty-day and 90-day mortality rate was 3.7%. Median follow-up duration was 22 months. Recurrence rate is 35.4% (9/26: 3 loco-regional, 6 distant). Overall 3- and 5-year survival is 60.9% and 40.6%, respectively. CONCLUSIONS Cardiac and aortic resection and reconstruction for full-thickness infiltration by lung cancer can be performed safely with or without cardiopulmonary bypass and may allow long-term survival of adequately selected patients.
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Affiliation(s)
- Antonio D'Andrilli
- Department of Thoracic Surgery, Sapienza University, Sant'Andrea Hospital, Rome, Italy.
| | - Giulio Maurizi
- Department of Thoracic Surgery, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Anna Maria Ciccone
- Department of Thoracic Surgery, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Mohsen Ibrahim
- Department of Thoracic Surgery, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Claudio Andreetti
- Department of Thoracic Surgery, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Ilaria De Benedictis
- Medical Statistics Unit, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Giovanni Melina
- Department of Cardiac Surgery, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Federico Venuta
- Department of Thoracic Surgery, Sapienza University, Policlinico Umberto I, Rome, Italy
| | - Erino A Rendina
- Department of Thoracic Surgery, Sapienza University, Sant'Andrea Hospital, Rome, Italy
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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: 5] [Impact Index Per Article: 2.5] [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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Kuckelman J, Debarros M, Bueno R. Extended Resections for Lung Cancer. Surg Clin North Am 2022; 102:345-363. [DOI: 10.1016/j.suc.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Gao HJ, Shi GD, Pan MJ, Liu XT, Wei YC. Autogenous pericardial angioplasty for thymic malignancies: a narrative review. MEDIASTINUM (HONG KONG, CHINA) 2021; 5:6. [PMID: 35118312 PMCID: PMC8794382 DOI: 10.21037/med-20-57] [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: 08/16/2020] [Accepted: 10/27/2020] [Indexed: 06/14/2023]
Abstract
Locally advanced thymic tumor usually invades adjacent great vessels, while the optimal treatment strategy for vessels resection and prosthetic replacement is still in controversial. We hereby present our series of patients undergoing autologous pericardial angioplasty for thymic malignancies. For invasive thymic tumors involving the superior vena cava (SVC), the replacement vessel was prepared by autologous pericardium and placed between the right atrium and distal left innominate vein stump to establish a SVC bypass. Then, the distal right innominate vein and proximal SVC were blocked, and the thymic tumor and involved vessel were completely resected, followed by SVC reconstruction using pericardium. We retrospectively analyzed the clinical characteristics and short-term outcomes of six related patients with autologous pericardial angioplasty. Due to the homologous advantages of autologous pericardial transplantation, those patients didn't need to receive anticoagulant therapy during the perioperative period, so as to avoid the occurrence of hemorrhage, embolism and other graft-related complications. There were no postoperative long-term thoracic drainage (>7 days), anastomotic bleeding, reconstructed vascular stenosis, embolism or even secondary thoracotomy and other related complications occurred in this case series. The application of autologous pericardium for the replacement of mediastinal great vessels in the surgery of locally advanced thymoma is a safe and effective technique. Compared with former artificial materials, such as polytetrafluoroethylene synthetic prosthesis, autologous pericardial transplantation avoids the occurrence of high risk graft-related complications such as postoperative hemorrhage and vascular stenosis, and its clinical application prospect is worth expecting.
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Affiliation(s)
- Hui-Jiang Gao
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Guo-Dong Shi
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Mao-Jie Pan
- Department of Thoracic Surgery, Linyi People’s Hospital, Linyi, China
| | - Xiao-Tong Liu
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yu-Cheng Wei
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
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Yu Z, Yu L, Yu T, Yang XG, Zhang BX, Du X. Surgical feasibility and long-term outcome of superior vena cava replacement for advanced thymoma in patients undergoing preoperative chemotherapy or chemoradiotherapy. Thorac Cancer 2021; 12:1074-1083. [PMID: 33569912 PMCID: PMC8017250 DOI: 10.1111/1759-7714.13872] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/14/2021] [Accepted: 01/14/2021] [Indexed: 12/24/2022] Open
Abstract
Background The aim of this study was to investigate the long‐term outcome of superior vena cava (SVC) replacement after chemotherapy or chemoradiotherapy for advanced thymoma. Methods The medical information of patients with advanced thymoma who underwent thymoma resection and SVC replacement in Beijing Tongren Hospital from 2002 to 2017 were reviewed. We compared surgical outcomes, postoperative complications and long‐term prognosis in the chemoradiotherapy + surgery group (CRT + surgery group, 19 cases) and the surgery group (26 cases). Results The operation time (486.05 ± 148.01 vs. 370.77 ± 124.32 min; p = 0.007) and intraoperative blood loss (1400 ml [IQR 1125–2105 ml] vs. 855 ml [IQR 555–1682.5 ml], p = 0.036), poor wound healing (three cases [15.79%] vs. zero cases [0.0%], p = 0.036) in the CRT + surgery group were significantly higher than those of the surgery group. There was no significant difference between the CRT + surgery group and the surgery group in postoperative chest tube drainage time, hospitalization time, postoperative arrhythmia and incidence of pneumonia. Kaplan Meier analysis showed that the recurrence‐free survival (RFS) curves of the CRT + surgery group patients were better than those of the surgery group (p = 0.031). However, overall survival (OS) between the two groups was not significantly different (p = 0.069). Conclusions Thymoma resection and SVC replacement is feasible for patients undergoing preoperative induction chemotherapy or chemoradiotherapy for advanced thymoma. Although patients in the CRT + surgery group had a longer operation time and increased intraoperative bleeding, the RFS rate seemed to be better than that in the surgery group.
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Affiliation(s)
- Zhen Yu
- Department of Thoracic Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Lei Yu
- Department of Thoracic Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Tao Yu
- Department of Thoracic Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xing-Guo Yang
- Department of Thoracic Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Bao-Xun Zhang
- Department of Thoracic Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xin Du
- Department of Thoracic Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Radvansky B, Hunt ML, Augoustides JG, Shah RM, Valentine EA, Kucharczuk JC, Ibrahim R, Sanders J, Kumar N, Capdeville M. Perioperative Approaches to the Anterior Mediastinal Mass-Principles and Pearls From a Ten-Year Experience at an Experienced Referral Center. J Cardiothorac Vasc Anesth 2021; 35:2503-2512. [PMID: 33676802 DOI: 10.1053/j.jvca.2021.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 12/17/2022]
Affiliation(s)
| | - Mallory L Hunt
- Division of Cardiovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - John G Augoustides
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Ronak M Shah
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Elizabeth A Valentine
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - John C Kucharczuk
- Division of Thoracic Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Philadelphia, PA
| | - Rowaa Ibrahim
- Department of Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Health Systems, Detroit, MI
| | - Joseph Sanders
- Department of Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Health Systems, Detroit, MI
| | - Nikhil Kumar
- Department of Cardiothoracic Anesthesia, Lerner College of Medicine, Cleveland Clinic, Cleveland, OH
| | - Michelle Capdeville
- Department of Cardiothoracic Anesthesia, Lerner College of Medicine, Cleveland Clinic, Cleveland, OH
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Eguchi T, Hamanaka K, Shimizu K. Thymic Malignancy Still Needs Aggressive Surgery: Safety and Oncologic Feasibility of Superior Vena Cava Resection. Ann Thorac Surg 2020; 112:277-278. [PMID: 33212025 DOI: 10.1016/j.athoracsur.2020.08.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 08/20/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Takashi Eguchi
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Japan 390-8621
| | - Kazutoshi Hamanaka
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Japan 390-8621
| | - Kimihiro Shimizu
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Japan 390-8621.
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D'Andrilli A, Maurizi G, Venuta F, Rendina EA. Mediastinal staging: when and how? Gen Thorac Cardiovasc Surg 2019; 68:725-732. [PMID: 31797211 DOI: 10.1007/s11748-019-01263-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 11/21/2019] [Indexed: 12/19/2022]
Abstract
Mediastinal staging for lung cancer includes both the assessment of mediastinal lymph nodes status before treatment and the postoperative pathological staging obtained by lymph-node removal performed during surgery. In patients with early stage NSCLC, the aim is to exclude with the highest certainty and the lowest morbidity the presence of mediastinal node involvement. Before treatment, mediastinal staging is based on imaging techniques, endoscopic techniques, and surgical procedures. Final pathological staging is based on lymph-node removal performed with lung resection according with different modalities (sampling, systematic dissection, etc.) and various approaches (thoracotomy, VATS, robotic). Data and indications from literature evidences are reported and discussed.
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Affiliation(s)
- Antonio D'Andrilli
- Department of Thoracic Surgery, Sapienza University, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189, Rome, Italy.
| | - Giulio Maurizi
- Department of Thoracic Surgery, Sapienza University, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189, Rome, Italy
| | - Federico Venuta
- Department of Thoracic Surgery, Sapienza University, Policlinico Umberto I, Rome, Italy
| | - Erino A Rendina
- Department of Thoracic Surgery, Sapienza University, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189, Rome, Italy
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Maurizi G, D'Andrilli A, Vanni C, Ciccone AM, Ibrahim M, Andreetti C, Menna C, Poggi C, Venuta F, Rendina EA. Salvage resection of advanced mediastinal tumors. J Thorac Dis 2019; 11:S1653-S1661. [PMID: 31516738 DOI: 10.21037/jtd.2019.07.09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The surgical treatment of locally advanced mediastinal tumors invading the great vessels and other nearby structures still represent a tricky question, principally due to the technical complexity of the resective phase, the contingent need to carry out viable vascular reconstructions and, therefore, the proper management of pathophysiologic issues. Published large-number series providing oncologic outcomes of patients who have undergone extended radical surgery for invasive mediastinal masses are just a few. Furthermore, the wide variety of different histologies included in some of these studies, as well as the heterogeneity of chemo and radiation therapies employed, did not allow for the development of clear oncologic guidelines. Usually in the past, surgical resections of large masses along with the neighbouring structures were not offered to patients because of related morbidity and mortality and limited information available on the prognostic advantage for long term. However, in the last decades, advances in surgical technique and perioperative management, as well as increased oncologic experience in this field, have allowed radical exeresis in selected patients with invasive tumors requiring resections extended to the surrounding structures and complex vascular reconstructions. Such aggressive surgical treatment has been proposed in association or not with adjuvant chemo- or radiotherapy regimens, achieving encouraging oncologic results with limited morbidity and mortality in experienced institutions. Congestive heart failure or impending cardiovascular collapse due to the compression by the large mass are the most frequent immediately life-threatening problems that some of these patients can experience. In this setting, medical palliation is usually ineffective and an aggressive salvage surgical treatment may remain the only therapeutic option.
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Affiliation(s)
- Giulio Maurizi
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Antonio D'Andrilli
- 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
| | - Anna Maria Ciccone
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Mohsen Ibrahim
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Claudio Andreetti
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Cecilia Menna
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Camilla Poggi
- Department of Thoracic Surgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Federico Venuta
- Department of Thoracic Surgery, Policlinico Umberto I, 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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Maurizi G, Poggi C, D’Andrilli A, Vanni C, Ciccone AM, Ibrahim M, Andreetti C, Tierno SM, Venuta F, Rendina EA. Superior Vena Cava Replacement for Thymic Malignancies. Ann Thorac Surg 2019; 107:386-392. [DOI: 10.1016/j.athoracsur.2018.08.060] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 08/25/2018] [Accepted: 08/28/2018] [Indexed: 10/28/2022]
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Quint LE, Reddy RM, Lin J, Arenberg DA, Speers C, Hayman JA, Kong FP, Orringer MB, Kalemkerian GP. Imaging in thoracic oncology: case studies from Multidisciplinary Thoracic Tumor Board: (part 2 of 2 part series). Cancer Imaging 2013; 13:440-7. [PMID: 24325879 PMCID: PMC3858864 DOI: 10.1102/1470-7330.2013.0030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Multidisciplinary tumor board conferences foster collaboration among health care providers from a variety of specialties and help to facilitate optimal patient care. Generally, the clinical questions revolve around the best options for establishing a diagnosis, staging the disease and directing treatment. This article describes and illustrates the clinical scenarios of three patients who were presented at our thoracic Tumor Board, focusing on management issues and the role of imaging. These patients had invasive thymoma; concurrent small cell lung cancer and non-small cell lung cancer; and esophageal cancer with celiac lymph node metastases, respectively.
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Affiliation(s)
- Leslie E Quint
- Department of Radiology, Department of Surgery (Section of Thoracic Surgery)
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12
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D'Andrilli A, De Cecco CN, Maurizi G, Muscogiuri G, Baldini R, David V, Venuta F, Rendina EA. Reconstruction of the superior vena cava by biologic conduit: assessment of long-term patency by magnetic resonance imaging. Ann Thorac Surg 2013; 96:1039-45. [PMID: 23791160 DOI: 10.1016/j.athoracsur.2013.04.062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Revised: 04/16/2013] [Accepted: 04/22/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND To assess the long-term patency of the biologic prosthetic conduit used for reconstruction of the superior vena cava (SVC) by magnetic resonance imaging (MRI). METHODS Patients undergoing oncologic resection and reconstruction of the SVC by a bovine pericardial prosthesis (January 2003 to April 2010) have been studied after 1 year (if surviving) by MRI for the assessment of the conduit long-term patency. Results were compared with those of a control group of patients with normal SVC. Blood flow and area of lumen section at 3 different levels (proximal, middle, distal) were analyzed. RESULTS Sixteen consecutive patients surviving after 1 year from surgery out of 17 (9 lung cancer, 8 mediastinal malignancy) undergoing SVC reconstruction were included. One patient died postoperatively and was not included. Sixteen patients with similar demographic characteristics were studied in the control group. Mean blood flow was 18.4±3.5 mL/sec (range 14.3 to 25.7) in patients with reconstructed SVC and 20.8±4.1 mL/sec (range 15.3 to 27.7) in the control group. Mean area of the conduit lumen section was 2.2±0.6 cm2 (range 1.6 to 3.6) at proximal level, 2.9±1.3 cm2 at middle level (range 1.3 to 5.7), and 2.1±0.9 cm2 (range 0.5 to 4) at distal level in the reconstructed group, and 2.6±0.7 cm2 (range 1.8 to 4.2), 2.7±0.7 cm2 (range 1.9 to 4.3), and 2.4±0.3 cm2 (range 1.8 to 3.1), respectively, at proximal, middle, and distal levels in the control group. Differences between the 2 groups were not significant (p>0.05). CONCLUSIONS The MRI assessment in terms of blood flow and area of lumen section at 3 different levels confirms that bovine pericardial conduit used for SVC replacement shows an optimal patency over the long term.
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Affiliation(s)
- Antonio D'Andrilli
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University, Rome, Italy.
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Mordant P, Bagan P, Le Pimpec Barthes F, Riquet M. Traitement chirurgical des tumeurs du médiastin. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/s1241-8226(12)39116-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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D'Andrilli A, Venuta F, Menna C, Rendina EA. Extensive resections: pancoast tumors, chest wall resections, en bloc vascular resections. Surg Oncol Clin N Am 2012; 20:733-56. [PMID: 21986269 DOI: 10.1016/j.soc.2011.07.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Infiltration by lung tumor of adjacent anatomic structures including major vessels, main bronchi, and chest wall not only influences the oncologic severity of the disease but also increases the technical complexity of surgery, requiring extended resections and demanding reconstructive procedures. Completeness of resection represents in every case one of the main factors influencing the long-term outcome of patients. Technical and oncologic aspects of extended operations, including resection of Pancoast tumors and chest wall, bronchovascular sleeve resections, and en bloc resections of major thoracic vessels, are reported in this article.
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Affiliation(s)
- Antonio D'Andrilli
- Department of Thoracic Surgery, Sant'Andrea Hospital, University LaSapienza, Via di Grottarossa 1035, 00189 Rome, Italy.
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Long-term patency of the stapled bovine pericardial conduit for replacement of the superior vena cava. Eur J Cardiothorac Surg 2011; 40:1487-91; discussion 1491. [PMID: 21530293 DOI: 10.1016/j.ejcts.2011.03.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Revised: 02/28/2011] [Accepted: 03/02/2011] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Artificial prosthesis of the superior vena cava (SVC) may occlude with time. For this reason, we proposed in 2003 the use of a biological material (bovine pericardium) and devised an original technique to construct the prosthetic conduit. We hereby report the long-term results in 15 patients. METHODS The SVC prosthetic conduit is realized by wrapping a bovine pericardial leaflet around a 5 or 10 cm(3) syringe and stapling it on the side by a 60-80 linear stapler. This procedure is carried out intra-operatively after the size of the patient's SVC has been ascertained; the conduit is then cut to the appropriate length. We have employed this technique in 15 patients with lung (eight) or mediastinal (seven) tumors; after a minimum follow-up of 1 year, all patients underwent computed tomographic-volume rendering (CT-VR) studies of the SVC. RESULTS Technically, the stapled pericardial conduit has several advantages: (1) it is simple and expeditious; (2) it allows an even and regular suture line, which cannot be achieved by hand suturing; (3)'one size fits all': with one single pericardial leaflet, conduits of all sizes can be realized; this is important for an operation which is performed only few times per year; (4) patency is granted by the intrinsic rigidity of the pericardium and staple line, without the need for any reinforcement; (5) different calibers at the two extremities can be obtained by simply placing the stapler obliquely; and (6) the staple line is excellent for the orientation of the conduit while suturing. In our patients, SVC clamping time ranged between 18 and 50 min (mean 29 min); one patient needed cardiopulmonary bypass. Intra-operative anticoagulation (1.500-2.500 units of heparin) was continued postoperatively subcutaneously for 7 days and then shifted to oral anticoagulation for 6 months. One patient died postoperatively of heart failure (mortality 6%). One to 5 years after surgery, CT-VR showed full patency of the pericardial conduit, no clots or thrombus formation, and absence of collateral venous circulation in all 14 patients. One- and 5-year survival was 93% and 73%, respectively (Kaplan-Meier). CONCLUSIONS The stapled bovine pericardial conduit is a simple, expeditious, and economic solution to SVC replacement, and offers reliable long-term patency without permanent anticoagulation.
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Standardtechniken in der Thoraxchirurgie. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2010. [DOI: 10.1007/s00398-010-0799-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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