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Girelli L, Bertolaccini L, Casiraghi M, Petrella F, Galetta D, Mazzella A, Donghi S, Lo Iacono G, Cara A, Guarize J, Spaggiari L. Anastomosis Complications after Bronchoplasty: Incidence, Risk Factors, and Treatment Options Reported by a Referral Cancer Center. Curr Oncol 2023; 30:10437-10449. [PMID: 38132394 PMCID: PMC10742568 DOI: 10.3390/curroncol30120760] [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: 11/14/2023] [Revised: 11/30/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Sleeve lobectomy with bronchoplasty is a safe surgical technique for the management of lung cancer and endobronchial localization of extrapulmonary cancers. However, anastomotic complications can occur, and treatment strategies are not standardized. METHODS Data from 280 patients subjected to bronchoplasty were retrospectively analyzed, focusing on surgical techniques, anastomotic complications, and their management. Multivariate analysis was performed, and Kaplan-Meier curves were used to determine survival. RESULTS Ninety percent of 280 surgeries were for lung cancer. Anastomotic complications occurred in 6.42% of patients: late stenosis in 3.92% and broncho-pleural fistula in 1.78%. The median survival was 65.90 months (95% CI = 41.76-90.97), with no difference (p = 0.375) for patients with (51.28 months) or without (71.03 months) anastomotic complications. Mortality at 30 days was higher with anastomotic complications (16.7% vs. 3%, p = 0.014). Multivariable analysis confirmed pathological stage (N+) as a risk factor for anastomotic complications (p = 0.016). Our mortality (3.93%) and morbidity rate (41.78%) corresponded to recent series results. CONCLUSIONS In our experience, surgery is preferred to avoid life-threatening complications in bronchopleural fistulas. Bronchoscopic balloon dilatation is preferred for benign strictures. The nodal stage is related to complications (p = 0.0014), reflecting the aggressiveness of surgery, which requires extended radical lymphadenectomy.
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Affiliation(s)
- Lara Girelli
- Division of Thoracic Surgery, IEO, European Institute of Oncology, IRCCS, 20141 Milan, Italy; (L.B.); (D.G.); (A.M.); (G.L.I.); (A.C.)
| | - Luca Bertolaccini
- Division of Thoracic Surgery, IEO, European Institute of Oncology, IRCCS, 20141 Milan, Italy; (L.B.); (D.G.); (A.M.); (G.L.I.); (A.C.)
| | - Monica Casiraghi
- Division of Thoracic Surgery, IEO, European Institute of Oncology, IRCCS, 20141 Milan, Italy; (L.B.); (D.G.); (A.M.); (G.L.I.); (A.C.)
- Department of Oncology and Hematology-Oncology, University of Milan, 20141 Milan, Italy
| | - Francesco Petrella
- Division of Thoracic Surgery, IEO, European Institute of Oncology, IRCCS, 20141 Milan, Italy; (L.B.); (D.G.); (A.M.); (G.L.I.); (A.C.)
- Department of Oncology and Hematology-Oncology, University of Milan, 20141 Milan, Italy
| | - Domenico Galetta
- Division of Thoracic Surgery, IEO, European Institute of Oncology, IRCCS, 20141 Milan, Italy; (L.B.); (D.G.); (A.M.); (G.L.I.); (A.C.)
- Department of Oncology and Hematology-Oncology, University of Milan, 20141 Milan, Italy
| | - Antonio Mazzella
- Division of Thoracic Surgery, IEO, European Institute of Oncology, IRCCS, 20141 Milan, Italy; (L.B.); (D.G.); (A.M.); (G.L.I.); (A.C.)
| | - Stefano Donghi
- Interventional Pneumology Unit, IEO, European Institute of Oncology, IRCCS, 20141 Milan, Italy; (S.D.); (J.G.)
| | - Giorgio Lo Iacono
- Division of Thoracic Surgery, IEO, European Institute of Oncology, IRCCS, 20141 Milan, Italy; (L.B.); (D.G.); (A.M.); (G.L.I.); (A.C.)
| | - Andrea Cara
- Division of Thoracic Surgery, IEO, European Institute of Oncology, IRCCS, 20141 Milan, Italy; (L.B.); (D.G.); (A.M.); (G.L.I.); (A.C.)
| | - Juliana Guarize
- Interventional Pneumology Unit, IEO, European Institute of Oncology, IRCCS, 20141 Milan, Italy; (S.D.); (J.G.)
| | - Lorenzo Spaggiari
- Division of Thoracic Surgery, IEO, European Institute of Oncology, IRCCS, 20141 Milan, Italy; (L.B.); (D.G.); (A.M.); (G.L.I.); (A.C.)
- Department of Oncology and Hematology-Oncology, University of Milan, 20141 Milan, Italy
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Kahya Y, Yüksel C. Pulmonary sleeve resection complications and management. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2023; 31:S54-S61. [PMID: 38344123 PMCID: PMC10852210 DOI: 10.5606/tgkdc.dergisi.2023.24898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 04/03/2023] [Indexed: 02/21/2024]
Abstract
In tumors involving the central airway or vascular structures, achieving local control and preserving pulmonary function can be possible with a pulmonary sleeve resection. In this section, complications and management of pulmonary sleeve resections are discussed.
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Affiliation(s)
- Yusuf Kahya
- Department of Thoracic Surgery, Ankara University Faculty of Medicine, Ankara, Türkiye
| | - Cabir Yüksel
- Department of Thoracic Surgery, Ankara University Faculty of Medicine, Ankara, Türkiye
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Ally SA, Foy M, Sood A, Gonzalez M. Preoperative risk factors for postoperative pneumonia following primary Total Hip and Knee Arthroplasty. J Orthop 2021; 27:17-22. [PMID: 34456526 PMCID: PMC8379351 DOI: 10.1016/j.jor.2021.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/15/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The purpose of this study is to evaluate risk factors for pneumonia following THA and TKA. METHODS Patients were identified from the American College of Surgeons National Quality Improvement Database (NSQIP) who experienced postoperative pneumonia after undergoing primary THA and TKA. RESULTS Many characteristics including old age, anemia, diabetes, cardiac comorbidities, dialysis, and smoking were independent risk factors for postoperative pneumonia after THA or TKA. CONCLUSION This analysis offers new evidence on risk factors associated with the development of pneumonia after THA and TKA. These risk factors can help guide clinicians in preventing postoperative pneumonia after THA and TKA.
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Affiliation(s)
- Syeda Akila Ally
- Department of Orthopaedic Surgery, University of Illinois, 835 S. Wolcott Avenue, Chicago, IL, 60612, United States
| | - Michael Foy
- Department of Orthopaedic Surgery, University of Illinois, 835 S. Wolcott Avenue, Chicago, IL, 60612, United States
| | - Anshum Sood
- Department of Orthopaedic Surgery, University of Illinois, 835 S. Wolcott Avenue, Chicago, IL, 60612, United States
| | - Mark Gonzalez
- Department of Orthopaedic Surgery, University of Illinois, 835 S. Wolcott Avenue, Chicago, IL, 60612, United States
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Ludwig C. Editorial comment on "Reimplantation of the upper lobe bronchus after lower sleeve lobectomy or bilobectomy: long-term results" by Maurizi et al.. J Thorac Dis 2019; 10:6427-6429. [PMID: 30746181 DOI: 10.21037/jtd.2018.12.32] [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)
- Corinna Ludwig
- Department of Thoracic Surgery, Florence Nightingale Hospital, Düsseldorf, Germany
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Abstract
PURPOSE OF REVIEW Both surgical workload and the age of those patients being considered for radial pulmonary resection are increasing. Enhanced recovery programmes are now well established in most surgical disciplines and are increasingly reported in thoracic procedures. This review will discuss the relevant principles of these programmes as applied to an increasing elderly population. RECENT FINDINGS Elderly patients undergoing less radial surgical resections without lymphadenectomy have comparable outcomes to those undergoing classical curative treatment. Patients require careful assessment and self-reported quality of life metrics or function may be a better marker of outcome than static measures such as lung function. Hypotension, low values for bispectral index and low anaesthetic gas mean alveolar concentration values are common and independent predictors of mortality in the elderly. Paravertebral blockade is preferred to epidural anaesthesia because of a more favourable side-effect profile and comparable efficacy. As yet no robust work has examined the efficacy of an integrated enhanced recovery programme in thoracic surgery. SUMMARY Elderly patients are suitable for enhanced recovery programmes but these must be tailored to individual circumstance. Further work is required to comprehensively assess their value in a modern healthcare setting.
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Abstract
In this chapter, we discuss the preoperative evaluation that is necessary prior to surgical resection, stage-specific surgical management of lung cancer, and the procedural steps as well as the indications to a variety of surgical approaches to lung resection.
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Affiliation(s)
- Osita I Onugha
- Thoracic surgery, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Jay M Lee
- Thoracic surgery, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
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Andersson SEM, Rauma VHS, Sihvo EI, Räsänen JV, Ilonen IK, Salo JA. Bronchial sleeve resection or pneumonectomy for non-small cell lung cancer: a propensity-matched analysis of long-term results, survival and quality of life. J Thorac Dis 2015; 7:1742-8. [PMID: 26623096 DOI: 10.3978/j.issn.2072-1439.2015.10.62] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND No randomized studies exist comparing pneumonectomy (PN) and sleeve lobectomy (SL). We evaluated surgical results and long-term quality of life in patients operated on for central non-small cell lung cancer (NSCLC) using either SL or PN. METHODS A total of 641 NSCLC patients underwent surgery 2000-2010. SL was performed in 40 (6.2%) and PN in 67 (10.5%). In 2011, all surviving patients were sent a 15D Quality of Life Questionnaire which 83% replied. Propensity-score-matching analysis was utilized to compare the groups. RESULTS Thirty-two bronchial (18 right/14 left), seven vasculobronchial (3 right/4 left), one right wedge SL, and 18 right and 22 left PN were performed. Preoperatively, the Charlson Comorbidity Index (CCI) score, forced expiratory volume in 1 s (FEV1) and diffusion capacity did not differ between groups. The perioperative complication rate and pattern were similar, but SL group had less major complications (P<0.027). One perioperative death (2.5%) occurred in SL group and four (6%) in PN. The 90-day mortality rate was 5% (n=2) for SL and 7.5% (n=5) for PN. In the follow-up total cancer recurrence did not differ (P=0.187). Quality of life measured by 15D showed no significant difference in separate dimensions or total score, except tendency to favor SL in moving or breathing. The 5-year survival did not differ between groups (P=0.458), but no deaths were observed in SL group after 5 years. CONCLUSIONS Due to less major operative complications and better long-term survival, we would advocate using SL when feasible, but in patients tolerating PN it should be considered if SL seems not to be oncologically sufficiently radical.
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Affiliation(s)
- Saana E M Andersson
- Department of General Thoracic and Esophageal Surgery, Helsinki University Hospital, Heart and Lung Center, Helsinki, Finland
| | - Ville H S Rauma
- Department of General Thoracic and Esophageal Surgery, Helsinki University Hospital, Heart and Lung Center, Helsinki, Finland
| | - Eero I Sihvo
- Department of General Thoracic and Esophageal Surgery, Helsinki University Hospital, Heart and Lung Center, Helsinki, Finland
| | - Jari V Räsänen
- Department of General Thoracic and Esophageal Surgery, Helsinki University Hospital, Heart and Lung Center, Helsinki, Finland
| | - Ilkka K Ilonen
- Department of General Thoracic and Esophageal Surgery, Helsinki University Hospital, Heart and Lung Center, Helsinki, Finland
| | - Jarmo A Salo
- Department of General Thoracic and Esophageal Surgery, Helsinki University Hospital, Heart and Lung Center, Helsinki, Finland
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Palade E, Holdt H, Passlick B. Bronchus anastomosis after sleeve resection for lung cancer: does the suture technique have an impact on postoperative complication rate? Interact Cardiovasc Thorac Surg 2015; 20:798-804. [PMID: 25810291 DOI: 10.1093/icvts/ivv058] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 02/19/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Bronchoplastic resections emerged as an alternative to pneumonectomy for patients with impaired pulmonary function and have gained popularity due to a marked decrease in morbidity and at least similar oncological outcome. Actual guidelines recommend sleeve resections whenever technically feasible, even in cases with adequate pulmonary reserve for pneumonectomy, in order to maximally preserve functional lung parenchyma. Various suture techniques were described; the existing evidence, however, is insufficient to recommend one of them as standard. The aim of this study was to compare two suture techniques for bronchus repair after sleeve resection. METHODS Two groups of patients from two separate institutions were retrospectively analysed. In Group A (n = 20), the anastomosis was performed with a running suture at the membranous part and an interrupted suture for the rest of the circumference. In Group B (n = 40), a telescoping continuous suture was used. Intra- and postoperative findings directly related to the anastomosis were compared. The parameters were assessed as absolute numbers and percentages; the statistical significance was determined using Pearson's χ(2) test for categorical variables and Student's t-test for continuous data (P < 0.05 considered as significant). RESULTS Other than tumour location and resection type (predominance of the right upper lobe for Group B), the groups were comparable regarding patient characteristics. The intraoperative anastomotic assessment revealed: patency 100% in both groups, initial air tightness (100 vs 82.5%; P = 0.047) and buttressing 85 vs 5%. No suture revision was necessary in both groups. The analysis of anastomosis-related morbidity revealed no significant difference: atelectasis (1 in Group A and 2 in Group B; P = 1), reversible anastomotic changes (0 vs 2; P = 0.309), early stenosis (0 vs 0), bronchopleural fistula (1 vs 0; P = 0.154), bronchovascular fistula (0 vs 0), late stenosis (1 vs 0; P = 0.119) and reoperations (15 vs 5%; P = 0.186). The operative mortality rate was similar (2 vs 3; P = 0.741) without intraoperative deaths. CONCLUSIONS Sleeve resections are technically challenging, especially concerning the tension in the suture and size mismatch. In our series, there was no significant difference between the two groups regarding parameters directly related to the anastomosis. The interrupted suture without telescoping is the most cited technique, can be performed in several variations and can universally be used with good ability to compensate size mismatch. The telescoping continuous anastomosis is less time- and material-consuming and is especially valuable for large-calibre bronchi and relevant size mismatch.
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Affiliation(s)
- Emanuel Palade
- Department of Thoracic Surgery, Medical University Freiburg, Freiburg, Germany Clinic for Surgery, University of Schleswig-Holstein, Lübeck, Germany
| | - Holger Holdt
- Department of Thoracic Surgery, Lung Center Wangen, Wangen im Allgäu, Germany
| | - Bernward Passlick
- Department of Thoracic Surgery, Medical University Freiburg, Freiburg, Germany
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Pipanmekaporn T, Punjasawadwong Y, Charuluxananan S, Lapisatepun W, Bunburaphong P, Patumanond J, Saeteng S, Chandee T. Incidence of and Risk Factors for Cardiovascular Complications After Thoracic Surgery for Noncancerous Lesions. J Cardiothorac Vasc Anesth 2014; 28:948-53. [DOI: 10.1053/j.jvca.2014.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Indexed: 11/11/2022]
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Zhang L, Su Y, Wang C, Sha Y, Zhu H, Xie S, Kwauk S, Zhang J, Lin Y, Wang C. Assessing the nutritional status of elderly Chinese lung cancer patients using the Mini-Nutritional Assessment (MNA(®)) tool. Clin Interv Aging 2013; 8:287-91. [PMID: 23487488 PMCID: PMC3592510 DOI: 10.2147/cia.s41941] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE This study assessed the nutritional status of elderly Chinese lung cancer inpatients using a revised version of the Mini-Nutritional Assessment (MNA(®)) tool. PATIENTS AND METHODS The revised version of the MNA tool was used to assess the nutritional status of 180 elderly Chinese lung cancer inpatients prior to their scheduled surgery between June 2010 and July 2011. Patients' demographic data, anthropometric parameters, and biochemical markers were collected and analyzed. RESULTS Among the 180 inpatients who underwent the MNA, 9% were malnourished (MNA score < 19), 33% were at risk of malnutrition (MNA score 19-23), and 58% were well nourished (MNA score ≥ 24). There was significant correlation between the MNA scores of patients who were malnourished, at risk of malnutrition, and well nourished (P < 0.001), as well as between total MNA score and most MNA questions. The three patient groups with different nutritional statuses differed significantly in their responses to anthropometrics and global, diet, and subjective assessments. CONCLUSION Incidence rates of malnutrition prior to surgery are high among elderly Chinese lung cancer inpatients. The revised MNA is a valid and reliable tool that can be used to assess and prevent malnutrition among these inpatients.
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Affiliation(s)
- Lei Zhang
- Department of Thoracic Surgery,Tianjin Medical University Cancer Institute and Hospital, Tianjin
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Takenaka T, Katsura M, Shikada Y, Tsukamoto S, Takeo S. The impact of cardiovascular comorbidities on the outcome of surgery for non-small-cell lung cancer. Interact Cardiovasc Thorac Surg 2012; 16:270-4. [PMID: 23223675 DOI: 10.1093/icvts/ivs489] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The presence of cardiovascular comorbidity in non-small-cell lung cancer (NSCLC) patients increases with age. Therefore, the influence of cardiovascular comorbidity in NSCLC patients on their short- or long-term prognosis remains controversial. This study evaluated the possible risk factors related to the short-term and long-term survivals in NSCLC patients with cardiovascular comorbidity. METHODS One thousand one hundred and sixty-two consecutive patients with NSCLC who had undergone a surgical resection between 1984 and 2010 were enrolled in this study. A total of 360 (31%) patients with cardiovascular comorbidities were analysed to identify the risk factors for postoperative complications and prognostic factors. RESULTS The patients with cardiovascular comorbidity included 301 with hypertension, 28 with coronary artery disease, 35 with peripheral vascular disease, 23 with arrhythmia and 11 with abdominal aortic aneurysm. Eighty-three patients exhibited more than one type of comorbidity. The postoperative cardiovascular morbidity rates were 3.6% in the cardiovascular comorbidity patients and 3.3% among patients without cardiovascular comorbidity (P = 0.73). No correlation was observed between preoperative cardiovascular comorbidity and postoperative pulmonary complications (P = 0.52). The operative mortality rates were 1.0% for the cardiovascular comorbidity patients and 0.8% for the other patients (P = 0.51). No difference in the postoperative outcomes was observed between the patients with and without cardiovascular comorbidity. The 5-year survival rates were 62.5% in comparison with 65.4% among patients without cardiovascular comorbidity (P = 0.48). CONCLUSIONS Patients with cardiovascular comorbidity were not found to be at increased risk of mortality and morbidity following surgery for NSCLC. In addition, cardiovascular comorbidity did not influence the long-term outcomes of patients after a pulmonary resection for NSCLC.
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Affiliation(s)
- Tomoyoshi Takenaka
- Department of Thoracic Surgery, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan.
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Shintani Y, Ikeda N, Matsumoto T, Kadota Y, Okumura M, Ohno Y, Ohta M. Nutritional status of patients undergoing chemoradiotherapy for lung cancer. Asian Cardiovasc Thorac Ann 2012; 20:172-176. [DOI: 10.1177/0218492311435249] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Impaired nutrition is an important predictor of perioperative complications in lung cancer patients, and preoperative chemoradiotherapy increases the risk of such complications. The goal of this study was to assess the effect of an immune-enhancing diet on nutritional status in patients undergoing lung resection after chemoradiotherapy. We compared the preoperative nutritional status in 15 patients with lung cancer undergoing lung resection without chemoradiotherapy and 15 who had chemoradiotherapy. Body mass index and lymphocyte counts were lower in patients who had chemoradiotherapy. Although there was no difference in the rate of postoperative morbidity between groups, the chemoradiotherapy patients were more likely to have severe complications postoperatively. After chemoradiotherapy in 12 patients, 6 received oral Impact for 5 days, and 6 had a conventional diet before surgery. Oral intake of Impact for 5 days before surgery modified the decrease in transferrin and lymphocytes after the operation. Preoperative immunonutrition may improve the perioperative nutritional status after induction chemoradiotherapy in patients undergoing lung cancer surgery, and reduce the severity of postoperative complications. These potential benefits need to be confirmed in a randomized controlled trial.
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Affiliation(s)
- Yasushi Shintani
- Department of Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
- Department of General Thoracic Surgery, Osaka Prefectural Medical Center for Respiratory and Allergic Disease, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Naoki Ikeda
- Department of General Thoracic Surgery, Osaka Prefectural Medical Center for Respiratory and Allergic Disease, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tomoshige Matsumoto
- Department of Clinical Research and Development, Osaka Prefectural Medical Center for Respiratory and Allergic Disease, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoshihisa Kadota
- Department of General Thoracic Surgery, Osaka Prefectural Medical Center for Respiratory and Allergic Disease, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Meinoshin Okumura
- Department of Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuko Ohno
- Department of Mathematical Health Science, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Mitsunori Ohta
- Department of General Thoracic Surgery, Osaka Prefectural Medical Center for Respiratory and Allergic Disease, Osaka University Graduate School of Medicine, Osaka, Japan
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Merritt RE, Mathisen DJ, Wain JC, Gaissert HA, Donahue D, Lanuti M, Allan JS, Morse CR, Wright CD. Long-term results of sleeve lobectomy in the management of non-small cell lung carcinoma and low-grade neoplasms. Ann Thorac Surg 2009; 88:1574-81; discussion 1581-2. [PMID: 19853115 DOI: 10.1016/j.athoracsur.2009.07.060] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Revised: 07/27/2009] [Accepted: 07/28/2009] [Indexed: 12/16/2022]
Abstract
BACKGROUND The objective of this study was to evaluate the operative mortality, morbidity, and long-term survival of sleeve lobectomy for non-small cell lung cancer and low-grade neoplasms. We evaluated the effects of neoadjuvant therapy on the bronchial anastomotic complication rate and determined whether sleeve lobectomy performed in patients with N1 disease resulted in decreased overall survival. METHODS This study is a retrospective review of 196 patients who underwent sleeve lobectomy. One hundred twenty-five patients had non-small cell lung cancer. There were 117 men (59.7%) and 79 women (40.3%) with a mean age of 54 years. Sixteen patients (13%) received neoadjuvant therapy. Fifty-six patients with N1 disease underwent sleeve lobectomy. RESULTS There were 4 (2.0%) postoperative deaths. The postoperative morbidity rate was 36.7%. Four patients (2.0%) experienced bronchopleural fistulas. Multivariate analysis demonstrated that age older than 70 years (p = 0.02) and the diagnosis of non-small cell lung cancer (p = 0.0002) were risk factors for postoperative complications. Multivariate analysis also demonstrated that neoadjuvant therapy predicted anastomotic complications (p = 0.01). For non-small cell lung cancer patients, the 5-year survival rate was 44%. The 5-year survival rates for patients with pathologic N0 disease and N1 disease were 52.6% versus 39.3%, respectively (p = 0.205). CONCLUSIONS Sleeve lobectomy can be performed with minimal bronchial anastomotic complications and low postoperative mortality. In our study, neoadjuvant therapy for non-small cell lung cancer adversely influenced the rate of anastomotic complications. Performing sleeve lobectomy for patients with N1 disease was not associated with decreased overall survival rates.
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Affiliation(s)
- Robert E Merritt
- General Thoracic Surgery Division, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
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Tewari N, Martin-Ucar AE, Black E, Beggs L, Beggs FD, Duffy JP, Morgan WE. Nutritional status affects long term survival after lobectomy for lung cancer. Lung Cancer 2007; 57:389-94. [PMID: 17481775 DOI: 10.1016/j.lungcan.2007.03.017] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2006] [Revised: 01/16/2007] [Accepted: 03/22/2007] [Indexed: 10/23/2022]
Abstract
STUDY OBJECTIVES Nutritional status has been reported as a predictor of complications following surgery for lung cancer. However, the impact of impaired nutrition in the long term has not been extensively studied. We have analysed our own experience after lobectomy for non-small cell lung cancer (NSCLC). PATIENTS Six hundred and forty-two consecutive patients undergoing lobectomy for primary lung cancer in a single centre between October 1991 and April 2004 were included in the study. STUDY DESIGN Impaired nutritional status was defined as any of low pre-operative albumin level (less than 30g/L), recent history of weight loss or low body mass index (BMI)--less than 18.5kg/m(2). There were 400 males and 242 females, median age 66 (range 32-89 years). Outcomes studied were hospital mortality and complications, and long term survival. RESULTS A high proportion of patients (185 of 642, 28%) were classed as having poor nutritional status. There were 12 hospital deaths (1.9%). Nutritional depletion had no significant impact on hospital mortality (1.3% versus 2.7%), cardiac (14.4% versus 16.8%), or respiratory (17.5% versus 18.9%) complications. The overall median survival was 48+/-6 months (standard error). On Cox multivariate analysis, impaired nutritional status, tumour stage and need for en bloc chest wall excision were all independent predictors of survival. CONCLUSIONS Nutritional status does not appear to significantly influence immediate outcomes following lobectomy for lung cancer. However, it is a predictor of survival in the long term independently of tumour extension and staging.
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Affiliation(s)
- Nilanjana Tewari
- Department of Thoracic Surgery, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, United Kingdom.
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Diemel KD, Branscheid D. [Intensive care treatment following thoracic surgery]. Chirurg 2006; 77:674-81. [PMID: 16868772 DOI: 10.1007/s00104-006-1213-4] [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: 10/24/2022]
Abstract
Intensive care in thoracic surgery requires highly specialised abilities and knowledge in addition to usual intensive care standards. The operative chest intensivist must be experienced in special surgical methods, interventional bronchology, and tube management. Cooperating with chest physicians and anaesthesiologists, he takes the central position in intensive therapy. This is described in detail and explained by examples. Furthermore, aspects of education in this specialty will be emphasised.
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Affiliation(s)
- K D Diemel
- Thoraxchirurgische Abteilung, Krankenhaus Grosshansdorf, Zentrum für Pneumologie und Thoraxchirurgie, Wöhrendamm 80, 22927 Grosshansdorf.
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Yildizeli B, Fadel E, Mussot S, Fabre D, Chataigner O, Dartevelle PG. Morbidity, mortality, and long-term survival after sleeve lobectomy for non-small cell lung cancer. Eur J Cardiothorac Surg 2006; 31:95-102. [PMID: 17126556 DOI: 10.1016/j.ejcts.2006.10.031] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2006] [Revised: 10/11/2006] [Accepted: 10/23/2006] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Sleeve lobectomy is a widely accepted procedure for central tumors for which the alternative is pneumonectomy. The purpose of this study is to assess operative mortality, morbidity, and long-term results of sleeve lobectomies performed for non-small cell lung carcinoma (NSCLC). METHODS A retrospective review of 218 patients who underwent sleeve lobectomy for NSCLC between 1981 and 2005 was undertaken. There were 186 (85%) men and 32 women with a mean age of 61.9 years (range, 19-82 years). Eighty patients (36.6%) had a preoperative contraindication to pneumonectomy. Right upper lobectomy was the most common operation (45.4%). Vascular sleeve resection was performed in 28 patients (12.8%) and was commonly associated with left upper lobectomy (n=20; 9.1%; p=0.0001). The histologic type was predominantly squamous cell carcinoma (n=164; 75%), followed by adenocarcinoma (n=46; 21%). Resection was incomplete in nine (4.1%) patients. RESULTS There were nine operative deaths; the operative mortality and the morbidity rates were 4.1% and 22.9%, respectively. A total of 14 (6.4%) patients presented with bronchial anastomotic complications: two were fatal postoperatively, seven patients required reoperation, three required a stent insertion, and two were managed conservatively. Multivariate analysis showed that compromised patients (p=0.001), current smoking (p=0.01), right sided resections (p=0.003), bilobectomy (p=0.03), squamous cell carcinoma (p=0.03), and presence of N1 or N2 disease (p=0.01) were risk factors for mortality and morbidity. Follow-up was complete in 208 patients (95.4%). Overall 5-year and 10-year survival rates were 53% and 28.6%, respectively. After complete resection, recurrence was local in 10 patients, mediastinal in 20, and distant in 25. By multivariate analysis, two factors significantly and independently influenced survival: nodal status (N0-N1 vs N2; p=0.01) and the stage of the lung cancer (stage I-II vs III, p=0.02). CONCLUSIONS For patients with NSCLC, sleeve lobectomy achieves local tumor control, even in patients with preoperative contraindication to pneumonectomy and is associated with low mortality and bronchial anastomotic complication rates. Postoperative complications are higher in compromised patients, smokers, N disease, right sided resections, bilobectomies, and squamous cell cancers. The presence of N2 disease and stage III significantly worsen the prognosis.
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Affiliation(s)
- Bedrettin Yildizeli
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie-Lannelongue, Paris-Sud University, Le Plessis Robinson, France.
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Abstract
Airway complications following pulmonary resection remain a challenging problem. A high degree of clinical suspicion, contrasted CT imaging, and early reoperation are crucial in preserving viable lung parenchyma following the anatomic compromise of lobar torsion. Likewise, early recognition and expeditious drainage of the pleural space in the setting of bronchial dehiscence may help prevent the aspiration pneumonia and consequent respiratory failure that is the leading cause of death in this patient population; A variety of interventions to manage stump dehiscence are possible, but successful management still remains difficult and requires an individualized approach. Attention to technical details and avoidance of extensive dissection and tension should yield acceptably low rates of postoperative stenosis following bronchoplastic resection. These common themes of precise surgical technique, vigilance in the perioperative period, and classic sound judgment in addressing problems effectively and expeditiously remain pivotal in the minimization of sequelae from morbid airway complications.
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Affiliation(s)
- Emily A Farkas
- Division of Thoracic Surgery, Yale University School of Medicine, 330 Cedar Street, New Haven, CT 06520-8062, USA
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Schussler O, Alifano M, Dermine H, Strano S, Casetta A, Sepulveda S, Chafik A, Coignard S, Rabbat A, Regnard JF. Postoperative Pneumonia after Major Lung Resection. Am J Respir Crit Care Med 2006; 173:1161-9. [PMID: 16474029 DOI: 10.1164/rccm.200510-1556oc] [Citation(s) in RCA: 144] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Postoperative pneumonia (POP) is a life-threatening complication of lung resection. The incidence, causative bacteria, predisposing factors, and outcome are poorly understood. DESIGN Prospective observational study. METHODS A prospective study of all patients undergoing major lung resections for noninfectious disease was performed over a 6-mo period. Culture of intraoperative bronchial aspirates was systematically performed. All patients with suspicion of pneumonia underwent bronchoscopic sampling and culture before antibiotherapy. RESULTS One hundred and sixty-eight patients were included in the study. Bronchial colonization was identified in 31 of 136 patients (22.8%) on analysis of intraoperative samples. The incidence of POP was 25% (42 of 168). Microbiologically documented and nondocumented pneumonias were recorded in 24 and 18 cases, respectively. Haemophilus species, Streptococcus species, and, to a much lesser extent, Pseudomonas and Serratia species were the most frequently identified pathogens. Among colonized and noncolonized patients, POP occurred in 15 of 31 and 20 of 105 cases, respectively (p = 0.0010; relative risk, 2.54). Death occurred in 8 of 42 patients who developed POP and in 3 of 126 of patients who did not (p = 0.0012). Patients with POP required noninvasive ventilation or reintubation more frequently than patients who did not develop POP (p < 0.0000001 and p = 0.00075, respectively). POP was associated with longer intensive care unit and hospital stay (p < 0.0000001 and p = 0.0000005, respectively). Multivariate analysis showed that chronic obstructive pulmonary disease, extent of resection, presence of intraoperative bronchial colonization, and male sex were independent risk factors for POP. CONCLUSIONS Pneumonia acquired in-hospital represents a relatively frequent complication of lung resections, associated with an important percentage of postoperative morbidity and mortality.
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Affiliation(s)
- Olivier Schussler
- Unité de Chirurgie Thoracique, Hôpital Hôtel-Dieu, 1 Place Parvis de Nôtre Dame, 75004 Paris, France
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Kozian A, Schilling T, Strang C, Hachenberg T. Anesthetic considerations in patients with previous thoracic surgery. Curr Opin Anaesthesiol 2006; 19:26-33. [PMID: 16547430 DOI: 10.1097/01.aco.0000192782.40021.88] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF THE REVIEW This review presents an overview of the different problems and challenges after thoracic surgery. It covers the pathophysiological changes that may occur regularly in the early and late period following surgery. In addition, surgical complications with anesthesiological implications for diagnosis, treatment and prevention are discussed, and consequences for anesthesia in further major and thoracic surgical procedures are shown. RECENT FINDINGS During the last decade, complications in the early period following surgery after thoracotomy have increasingly moved into the focus caused by their high morbidity and mortality. These problems, such as hemorrhagia and bronchopleural fistulas, are important because they call for a prompt revision or even an emergency operation. The therapy of acute bleeding follows general anesthesiological guidelines whereas the bronchopleural fistula demands methods to prevent aspiration pneumonia as a first priority. In the late period following surgery, typical cardiac and pulmonary modifications can be described that persist and have anesthesiological implications in the case of further surgery. Recent literature, however, lacks clear recommendations regarding anesthesiological management and practice for these cases. SUMMARY Current literature presents no general recommendations on how to manage patients after recent thoracic surgery. Therefore it is necessary to find an individual strategy to handle possible complications and well known pathophysiological changes. Knowledge and understanding of the etiology, the pathophysiology and the risk factors of the perioperative period, allows prevention and target intervention aimed at reducing morbidity and mortality following surgery.
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Affiliation(s)
- Alf Kozian
- Department of Anesthesiology and Intensive Care Medicine, Otto-von-Guericke-University, Magdeburg, Germany.
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Safdar Z, O'Sullivan M, Shapiro JM. Emergent bullectomy for acute respiratory failure in Ehlers-Danlos syndrome. J Intensive Care Med 2005; 19:349-51. [PMID: 15523121 DOI: 10.1177/0885066604269645] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A 49-year-old man with Ehlers-Danlos syndrome developed acute respiratory failure requiring mechanical ventilation. Chest computed tomography demonstrated giant right bulla extending into the contralateral hemithorax with mediastinal shift. Surgical bullectomy with pleurodesis relieved tension effects and allowed weaning.
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Affiliation(s)
- Zeenat Safdar
- Division of Pulmonary-Critical Care Medicine, Columbia University of Physicians & Surgeons, St. Luke's-Roosevelt Hospital Center, 432 W. 58th Street, Rm 520, New York, NY 10019, USA.
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Früh- und Spätergebnisse nach Pneumonektomie und Manschettenlobektomie nicht kleinzelliger Bronchialkarzinome im Stadium I–IIIa. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2004. [DOI: 10.1007/s00398-004-0466-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Paull DE, Updyke GM, Davis CA, Adebonojo SA. Complications and long-term survival for alcoholic patients with resectable lung cancer. Am J Surg 2004; 188:553-9. [PMID: 15546569 DOI: 10.1016/j.amjsurg.2004.07.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2004] [Revised: 07/03/2004] [Indexed: 01/30/2023]
Abstract
BACKGROUND The aim of this study was to determine the surgical risks and long-term survival in alcoholic patients undergoing resection for non-small-cell lung cancer. METHODS Nineteen resected patients comprising the alcoholic group were identified by either a Diagnostic and Statistical Manual of Mental Disorders-IV diagnosis of alcohol dependence/abuse, or an alcohol consumption of 60 oz/d or more. Alcoholic patients were compared with 37 nonalcoholic patients undergoing resection. RESULTS Alcoholic patients had an increase in major infectious complications (37% [7 of 19] versus 5% [2 of 37], P = 0.005), respiratory failure (42% [8 of 19] versus 5% [2 of 37], P </=0.001), and costs ($49,526 +/- $17,525 versus $18,385 +/- $3,260, P = 0.01). Alcohol abuse was the best predictor of perioperative respiratory and infectious complications (P = 0.002, B = 2.86, odds ratio = 17.5). Stage of disease (P = 0.03, B = 1.19, hazard ratio = 3.29) was a better predictor of long-term survival. CONCLUSIONS Alcohol abuse significantly increases the risk and cost of lung cancer resection. For alcoholic patients surviving the perioperative period, long-term survival appears similar to non-alcohol-abusing patients.
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Affiliation(s)
- Douglas E Paull
- Department of Surgery, Wright State University School of Medicine, Veterans Administration Medical Center, 4100 W. Third St., Dayton, OH 45428, USA.
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Ludwig C, Behrend M, Hoffarth U, Schüttler W, Stoelben E. [Resistance to pressure of bronchial closures. Comparison of pressure resistance of manual and stapler bronchial closures depending on the angle to the cartilaginous rings]. Chirurg 2004; 75:896-9. [PMID: 15138658 DOI: 10.1007/s00104-004-0832-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND This study was aimed to determine the resistance to pressure of manual and stapled bronchial closures under ideal conditions (90 degrees to the bronchial tree) and parallel to the trachea (45 degrees). MATERIAL AND METHODS An experimental study was done on 60 explanted pig tracheae which were alternatively closed with either double-layer, running sutures angled 90 degrees to the cartilaginous rings or an automatic stapling device. The closure line was placed exactly 90 degrees to the bronchial tree in 30 cases and parallel to the trachea (45 degrees) in 30. The sutures were placed under pressure until air leakage was observed. The leakage pressure was digitally recorded. RESULTS A statistically significant difference existed between the two groups. Mechanical sutures proved more resistant to pressure (P=0.011). CONCLUSIONS Under ideal conditions, the resistance to pressure of mechanical sutures is equal to if not better than that of manual sutures.
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Affiliation(s)
- C Ludwig
- Abteilung Thoraxchirurgie, Universitätsklinikum Freiburg, 79106 Freiburg, Germany.
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Pramesh CS. Does neoadjuvant chemotherapy cause increased morbidity after lung surgery? THE JAPANESE JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2004; 52:276; author reply 276-7. [PMID: 15195754 DOI: 10.1007/s11748-004-0125-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hollaus PH, Wurnig PN, Pridun NS. The natural history of recurrence after bronchoplastic procedures for non-small cell lung cancer. Ann Thorac Surg 2003; 76:363-9. [PMID: 12902065 DOI: 10.1016/s0003-4975(03)00337-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND The natural course of recurrence after bronchoplastic procedures for non-small cell lung cancer (NSCLC) has not been described. METHODS Sex, age, tnm-stage, histology, neoadjuvant chemotherapy, disease-free interval (months), exact localisation of tumour recurrence, time between first and second recurrence (months), survival after first and second recurrence (months), causes of death were retrospectively recorded in 83 patients operated between December 1993 and July 2001. RESULTS One patient was lost to follow-up, five resections were nonradical. Survivors' follow-up lasted 5 to 100.7 months (mean 43.3). Fourteen patients (14.4%) died tumor free. Eleven (13.2%) distant recurrences were diagnosed 1 to 42 months (mean 10.6) postoperatively, eight (9.6%) died 0 to 17 months (mean 7.55) after diagnosis. Nine local recurrences (10.8%)-5 unifocal, 4 multifocal-occurred 2 to 35 months (mean 17.3) postoperatively, eight died 0 to 8 months (mean 2.13) after diagnosis. Nine mixed recurrences (10.8%)-1 synchronous, 8 metachronous-were found (14.8%) 2 to 21 months postoperatively (mean 8.3). All died 4 to 41 months (mean 17.83) after diagnosis. Fourteen mediastinal lymph node recurrences occurred, ten as a primary recurrence and four as secondary. Lymph nodes were involved in all multifocal recurrences. Intrabronchial recurrence was observed in five patients and was always a result of progressive regional lymph node recurrence. CONCLUSIONS The pattern and natural history of recurrence cannot be sufficiently explained by stage and surgical radicality and suggest different genetic characteristics of the primary tumor. In case of reoperation due to intrabronchial recurrence adjuvant mediastinal irradiation should be considered.
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Affiliation(s)
- Peter H Hollaus
- Department of Thoracic Surgery, Otto Wagner Hospital, Vienna, Austria
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