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Issard J, Brioude G, Mitilian D, Fabre D, Thomas de Montpreville V, Hanna A, Caramella C, Lepechoux C, Besse B, Mercier O, Fadel E. Outcomes of right sleeve lower lobectomy vs. lower bilobectomy for lung malignancies. Surg Oncol 2024; 56:102100. [PMID: 39024682 DOI: 10.1016/j.suronc.2024.102100] [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: 02/05/2024] [Revised: 06/09/2024] [Accepted: 06/28/2024] [Indexed: 07/20/2024]
Abstract
OBJECTIVES Lower bilobectomy (LBL) leaves a residual pleural space potentially associated with adverse postoperative outcomes. In selected patients, right sleeve lower lobectomy (RSLL) with anastomosis between the middle lobe bronchus and intermediate bronchus is feasible. The outcomes of RSLL and LBL have not been compared. The aim of this study was to compare post-operative and long-term outcomes of RSLL and LBL in patients with lung cancer. METHODS We retrospectively included patients managed by RSLL or LBL at our referral chest-surgery institution between 2001 and 2019. Post-operative complications and mortality were compared. Kaplan-Meier curves were plotted to compare overall and disease-free survival rates. RESULTS We identified 23 patients with RSLL and 96 with LBL. Postoperative mortality was 9 % after RSLL and 5 % after LBL (p = 0.41). Bronchial fistula developed in 3 (13 %) RSLL patients and 6 (6 %) LBL patients (p = 0.23). Pleural space complications were significantly less common after RSLL (4/23 [17 %] vs. 45/96 [47 %], p = 0.03). Long-term vital capacity was significantly higher in the RSLL group (91 % vs. 64 %, p < 0.01). Five-year survival did not differ significantly between groups (84 % vs. 72 %, p = 0.09). CONCLUSIONS RSLL was associated with similar postoperative mortality and long-term survival compared to LBL. However, pleural space complications were less common and lung function was better after RSLL than after LBL. When feasible, RSLL may deserve preference over LBL in patients with lung cancer managed at highly experienced centres.
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Affiliation(s)
- Justin Issard
- Department of Thoracic Surgery and Heart-lung Transplantation, Université Paris-Saclay, Marie Lannelongue Hospital, International Center for Thoracic Cancers, Le Plessis Robinson, France
| | - Geoffrey Brioude
- Department of Thoracic Surgery, CHU Hôpital Nord, Marseille, France
| | - Delphine Mitilian
- Department of Thoracic Surgery and Heart-lung Transplantation, Université Paris-Saclay, Marie Lannelongue Hospital, International Center for Thoracic Cancers, Le Plessis Robinson, France
| | - Dominique Fabre
- Department of Thoracic Surgery and Heart-lung Transplantation, Université Paris-Saclay, Marie Lannelongue Hospital, International Center for Thoracic Cancers, Le Plessis Robinson, France
| | - Vincent Thomas de Montpreville
- Department of Pathology, Marie Lannelongue Hospital, International Center for Thoracic Cancers, Le Plessis Robinson, France
| | - Amir Hanna
- Department of Thoracic Surgery and Heart-lung Transplantation, Université Paris-Saclay, Marie Lannelongue Hospital, International Center for Thoracic Cancers, Le Plessis Robinson, France
| | - Caroline Caramella
- Department of Radiology, Marie Lannelongue Hospital, International Center for Thoracic Cancers, Le Plessis Robinson, France
| | - Cécile Lepechoux
- Department of Radiation Therapy, Gustave Roussy, Université Paris-Saclay, International Center for Thoracic Cancers, Villejuif, France
| | - Benjamin Besse
- Department of Medical Oncology, Gustave Roussy, Université Paris-Saclay, International Center for Thoracic Cancers, Villejuif, France
| | - Olaf Mercier
- Department of Thoracic Surgery and Heart-lung Transplantation, Université Paris-Saclay, Marie Lannelongue Hospital, International Center for Thoracic Cancers, Le Plessis Robinson, France.
| | - Elie Fadel
- Department of Thoracic Surgery and Heart-lung Transplantation, Université Paris-Saclay, Marie Lannelongue Hospital, International Center for Thoracic Cancers, Le Plessis Robinson, France
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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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Duman S, Erdoğdu E, Özkan B. Double sleeve resections. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2023; 31:S29-S39. [PMID: 38344125 PMCID: PMC10852211 DOI: 10.5606/tgkdc.dergisi.2023.24754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 03/07/2023] [Indexed: 02/21/2024]
Abstract
Double sleeve lung resections are complex surgical procedures that require specialized surgical expertise and careful patient selection. These procedures allow for the preservation of lung tissue while still achieving complete tumor resection for central tumors. Although initially considered high-risk operations, double sleeve lung resections have become a viable option for central tumors. Recent studies have shown that double sleeve lung resections are associated with lower morbidity and mortality rates than pneumonectomy. Furthermore, double sleeve lung resections may be associated with similar or even better long-term oncological outcomes compared to pneumonectomy, with the added benefit of preserving lung parenchyma and reducing the incidence of postoperative complications.
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Affiliation(s)
- Salih Duman
- Department of Thoracic Surgery, Istanbul University Faculty of Medicine, Istanbul, Türkiye
| | - Eren Erdoğdu
- Department of Thoracic Surgery, Istanbul University Faculty of Medicine, Istanbul, Türkiye
| | - Berker Özkan
- Department of Thoracic Surgery, Istanbul University Faculty of Medicine, Istanbul, Türkiye
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Matsuo T, Imai K, Takashima S, Kurihara N, Kuriyama S, Iwai H, Tozawa K, Saito H, Nomura K, Minamiya Y. Outcomes and pulmonary function after sleeve lobectomy compared with pneumonectomy in patients with non-small cell lung cancer. Thorac Cancer 2023; 14:827-833. [PMID: 36727556 PMCID: PMC10040283 DOI: 10.1111/1759-7714.14813] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/14/2023] [Accepted: 01/17/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Sleeve lobectomy is recommended to avoid pneumonectomy and preserve pulmonary function in patients with central lung cancer. However, the relationship between postoperative pulmonary functional loss and resected lung parenchyma volume has not been fully characterized. The aim of this study was to evaluate the relationship between pulmonary function and lung volume in patients undergoing sleeve lobectomy or pneumonectomy. METHODS A total of 61 lung cancer patients who had undergone pneumonectomy or sleeve lobectomy were analyzed retrospectively. Among them, 20 patients performed pulmonary function tests, including vital capacity (VC) and forced expiratory volume in 1 s (FEV1) tests, preoperatively and then about 6 months after surgery. VC and FEV1 ratios were calculated (measured postoperative respiratory function/predicted postoperative respiratory function) as the standardized pulmonary functional loss ratio. RESULTS Thirty-day operation-related mortality was significantly lower after sleeve lobectomy (3.2%) than pneumonectomy (9.6%). The 5-year relapse-free survival rate was 46.67% versus 29.03%, and the 5-year overall survival rate was 63.33% versus 38.71% in patients receiving sleeve lobectomy versus pneumonectomy. The VC ratio in the pneumonectomy group was better than in the sleeve lobectomy group (1.003 ± 0.117 vs. 0.779 ± 0.12; p = 0.0008), as was the FEV1 ratio (1.132 ± 0.226 vs. 0.851 ± 0.063; p = 0.0038). CONCLUSIONS Both short-term and long-term outcomes were better with sleeve lobectomy than pneumonectomy. However, actual postoperative pulmonary function after pneumonectomy may be better than clinicians expect, and pneumonectomy should still be considered a treatment option for patients with sufficient pulmonary reserve and in whom sleeve lobectomy is less likely to be curative.
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Affiliation(s)
- Tsubasa Matsuo
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Kazuhiro Imai
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Shinogu Takashima
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Nobuyasu Kurihara
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Shoji Kuriyama
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Hidenobu Iwai
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Kasumi Tozawa
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Hajime Saito
- Department of Thoracic Surgery, Iwate Medical University, Yahaba-cho, Japan
| | - Kyoko Nomura
- Department of Health Environmental Science and Public Health, Akita University Graduate School of Medicine, Akita, Japan
| | - Yoshihiro Minamiya
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
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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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7
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Duan J, Cai H, Huang W, Lin L, Wu L, Fan J. Bronchial Sleeve Resection with Complete Pulmonary Preservation: A Single-Center Experience. Cancer Manag Res 2020; 12:12975-12982. [PMID: 33364843 PMCID: PMC7751305 DOI: 10.2147/cmar.s286934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 12/06/2020] [Indexed: 11/29/2022] Open
Abstract
Purpose Bronchial sleeve resection with complete pulmonary preservation (BSRCPP) is a classic surgical method for the treatment of benign or low-grade bronchial tumors. For elderly patients and patients with poor cardiopulmonary function, BSRCPP is particularly advantageous because some of these patients may not tolerate lobectomy or pneumonectomy. We retrospectively reviewed the clinical data of 20 patients who underwent BSRCPP during the past 7 years. This report presents the experience with BSRCPP in our department. Patients and Methods We collected the data of 20 patients who underwent BSRCPP. Of these 20 patients, 17 underwent thoracotomy and 3 underwent video-assisted thoracoscopic surgery (VATS). The study cohort comprised 7 male and 13 female patients with an average age of 44 years (range, 4–71 years). All patients underwent a systematic preoperative examination to confirm the surgical indications and methods. Regular follow-up was conducted after the operation. Results All patients survived and remained clinically well. Two of the 20 patients (10%) were re-admitted to the hospital because of pulmonary air leakage, which was resolved after thoracic drainage. No patients developed tumor recurrence. Conclusion BSRCPP may be an effective treatment for selected patients with bronchial tumors. Notably, however, many technical key points require improvement, especially in VATS. Therefore, thoracoscopic minimally invasive treatment requires more practice and exploration.
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Affiliation(s)
- Jiangnan Duan
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Shanghai, People's Republic of China
| | - Haomin Cai
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Shanghai, People's Republic of China
| | - Wei Huang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Shanghai, People's Republic of China
| | - Lin Lin
- School of Medicine, Tongji University, Shanghai, People's Republic of China
| | - Liang Wu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Shanghai, People's Republic of China
| | - Jiang Fan
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Shanghai, People's Republic of China
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Li Z, Chen W, Xia M, Liu H, Liu Y, Inci I, Davoli F, Waseda R, Filosso PL, White A. Sleeve lobectomy compared with pneumonectomy for operable centrally located non-small cell lung cancer: a meta-analysis. Transl Lung Cancer Res 2019; 8:775-786. [PMID: 32010556 DOI: 10.21037/tlcr.2019.10.11] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background The purpose of this meta-analysis was to evaluate evidence comparing sleeve lobectomy (SL) and pneumonectomy (PN) in the treatment of non-small cell lung cancer (NSCLC). Methods The English literature search was undertaken in January 2018 and included studies dating back to 1996. Comparative studies were identified, evaluating survival, local recurrence, and distant recurrence rates, operative mortality, 30-day mortality, as well as complications. A pooled odds ratio (OR) and 95% confidence intervals (95% CI) were calculated with either the random or fixed-effect model. Results A total of 27 studies were identified, with publication dates between 1996 and 2018. These 27 studies included a total of 14,194 patients: 4,145 treated with SL and 10,049 treated with PN. The overall survival was significantly higher in the SL group compared to the PN one at 1, 3, 5 years. In patients with N0 and N1 disease, 5-year survival rates following SL exceeded those following PN. There was no statistically significant difference in the 3-, 5-year overall survival of N2 patients, according to the extent of surgery. The PN group had a higher rate of operative mortality, 30-day mortality and distant recurrence incidence. However, no statistical difference in complications and local recurrence between SL and PN were observed. Conclusions SL is an effective treatment option for hilar NSCLC with improved long-term survival compared to PN, with no increase of recurrence rate or postoperative complications. Furthermore, N2 disease is an important factor related to survival, and lymph node downstaging is a favorable prognostic factor.
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Affiliation(s)
- Zhengjun Li
- Department of Thoracic Surgery, Shenyang Chest Hospital, Shenyang 110044, China
| | - Wei Chen
- Department of Thoracic Surgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital, Shenyang 110042, China
| | - Mozhu Xia
- Department of Thoracic Surgery, The First Affiliated Hospital, China Medical University, Shenyang 110001, China
| | - Hongxu Liu
- Department of Thoracic Surgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital, Shenyang 110042, China
| | - Yongyu Liu
- Department of Thoracic Surgery, Shenyang Chest Hospital, Shenyang 110044, China
| | - Ilhan Inci
- Department of Thoracic Surgery, University Hospital, University of Zurich, Zurich, Switzerland
| | - Fabio Davoli
- Department of Thoracic Surgery, AUSL Romagna, S. Maria delle Croci Teaching Hospital, Ravenna, Italy
| | - Ryuichi Waseda
- Department of General Thoracic, Breast, and Pediatric Surgery, Fukuoka University, Fukuoka, Japan
| | - Pier Luigi Filosso
- Unit of Thoracic Surgery, Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Abby White
- Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
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Madariaga MLL, Geller A, Lanuti M, Ott H, Allan JS, Donahue DM, Mathisen DJ, Wright CD, Gaissert HA. Pulmonary Artery Resection During Lung Resection for Malignancy. Ann Thorac Surg 2019; 108:1692-1700. [PMID: 31336066 DOI: 10.1016/j.athoracsur.2019.05.079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 05/17/2019] [Accepted: 05/20/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Complete resection of central tumors invading the main pulmonary artery (PA) requires arterial reconstruction to avoid pneumonectomy. Oncologic equivalence with pneumonectomy has been suggested. We review clinical selection and outcome for these uncommon procedures in the context of candidacy for pneumonectomy. METHODS From 2000 to 2018, 9 different surgeons performed 34 pulmonary arterial resections for primary or metastatic pulmonary malignancy, with independent determination of pneumonectomy candidacy and arterioplasty technique. Patients undergoing limited lateral stapled PA resection (n = 3) or resection for metastasis (n = 3) were excluded from survival analysis. RESULTS The PA was resected as a sleeve with primary anastomosis (14.7%) or noncircumferentially with primary (61.8%), stapled (8.8%), or patch (14.7%) closure. Arterial resections represented between 2.5% and 43% of each surgeon's pneumonectomy volume. Sixteen (47%) patients were candidates for pneumonectomy. There was no operative mortality and 1 death at 47 days. Postoperative complications occurred in 21 (61.8%) patients. No patient required completion pneumonectomy. Overall 5-year survival was 33% (95% confidence interval [CI], 12-53). Compared with pulmonary arterioplasty alone, patients undergoing bronchial sleeve resection and pulmonary arterioplasty had better disease-free 5-year survival (50% [95% CI, 18-82] vs 19% [95% CI, 5-43]; P = .04), higher complete resection rate (100% [95% CI, 83-100] vs 80% [95% CI, 56-94]; P = .23) and lower disease recurrence (8% [n = 1 of 13] vs 47% [n = 7 of 15]; P = .04); 80% of disease recurrence was distant. CONCLUSIONS Resection and reconstruction of the PA for malignant lung disease may be safely performed. In candidates for pneumonectomy, arterial resection offers low operative risk. Long-term survival is impaired by distant, not local, recurrence emphasizing the importance of systemic therapy.
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Affiliation(s)
| | - Abraham Geller
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Michael Lanuti
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Harald Ott
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - James S Allan
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Dean M Donahue
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Douglas J Mathisen
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Cameron D Wright
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Henning A Gaissert
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts.
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10
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Ludwig C. [Surgical treatment of tracheopleural and bronchopleural fistulas after bronchoplastic resection (sleeve or bifurcation resection)]. Chirurg 2019; 90:704-709. [PMID: 31209516 DOI: 10.1007/s00104-019-0987-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The treatment of tracheopleural and bronchopleural fistulas at an anastomosis after sleeve resection is complex and fraught with complications. Morbidity and mortality are very high. Therefore, great care must be taken to avoid such complications. The clinical signs and the early diagnosis of a potentially critical anastomosis or anastomotic leakage as well as the treatment, including secondary pneumonectomy are presented.
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Affiliation(s)
- C Ludwig
- Klinik für Thoraxchirurgie, Florence Nightingale Krankenhaus, Akademisches Lehrkrankenhaus der Heinrich-Heine-Universität Düsseldorf, Kreuzbergstr. 79, 40489, Düsseldorf, Deutschland.
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11
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Soultanis KM, Chen Chao M, Chen J, Wu L, Yang C, Gonzalez-Rivas D, Abu Akar F, Jiang G, Jiang L. Technique and outcomes of 79 consecutive uniportal video-assisted sleeve lobectomies. Eur J Cardiothorac Surg 2019; 56:876-882. [PMID: 31180504 DOI: 10.1093/ejcts/ezz162] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 04/02/2019] [Accepted: 04/04/2019] [Indexed: 11/13/2022] Open
Abstract
AbstractOBJECTIVESUniportal video-assisted thoracic surgery (VATS) is well accepted by surgeons for anatomical major lung resections. However, large series evaluating the results, safety and efficacy of the technique for sleeve resections are still lacking. The aim of this study was to examine our experience with the use of uniportal VATS for sleeve resections.METHODSFrom September 2014 to January 2018, a total of 79 consecutive patients were offered uniportal VATS sleeve resection for centrally located tumours invading the orifice of the lobar bronchus or extending into the main stem bronchus by a single surgical team of the Thoracic Surgery Department of the Shanghai Pulmonary Hospital. Perioperative data were collected and analysed. Survival data were collected via telephone calls.RESULTSSixty-six of the 79 patients had a diagnosis of non-small-cell lung cancer, 47 of whom had squamous cell carcinoma. Twenty-one of the group with non-small-cell carcinoma were already at an advanced stage (III, IV) when operated on. The mean number of lymph node stations dissected was 5.5 ± 0.97 (4–8) and that of lymph nodes harvested was 13.7 ± 3.7 (5–23). A right upper lobectomy was the most common and time-consuming procedure. There was 1 conversion to a thoracotomy due to bleeding. No anastomotic-related complications were noted. The mean length of stay was 5.14 ± 1.56 (2–11) days. The 1- and 2-year survival rates were 98% and 80%, respectively.CONCLUSIONSUniportal VATS sleeve resection is a safe and efficient procedure for the treatment of centrally located tumours otherwise requiring a pneumonectomy.
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Affiliation(s)
- Konstantinos Marios Soultanis
- Department of Thoracic Surgery, Tongji University Affiliated Shanghai Pulmonary Hospital, Shanghai, China
- Department of Thoracic Surgery, 251 Hellenic Airforce General Hospital, Athens, Greece
| | - Ma Chen Chao
- Department of Thoracic Surgery, Tongji University Affiliated Shanghai Pulmonary Hospital, Shanghai, China
| | - Jian Chen
- Department of Thoracic Surgery, Tongji University Affiliated Shanghai Pulmonary Hospital, Shanghai, China
| | - Liang Wu
- Department of Thoracic Surgery, Tongji University Affiliated Shanghai Pulmonary Hospital, Shanghai, China
| | - Chenlu Yang
- Department of Thoracic Surgery, Tongji University Affiliated Shanghai Pulmonary Hospital, Shanghai, China
| | - Diego Gonzalez-Rivas
- Department of Thoracic Surgery, Tongji University Affiliated Shanghai Pulmonary Hospital, Shanghai, China
- Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruna Hospital, Coruna, Spain
| | - Firas Abu Akar
- Department of Cardiothoracic Surgery, Shaare Zedek Medical Center, Jerusalem, Israel
- Department of Cardiothoracic Surgery, Makassed Charitable Society, East Jerusalem, Israel
| | - Gening Jiang
- Department of Thoracic Surgery, Tongji University Affiliated Shanghai Pulmonary Hospital, Shanghai, China
| | - Lei Jiang
- Department of Thoracic Surgery, Tongji University Affiliated Shanghai Pulmonary Hospital, Shanghai, China
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Wood DE. Giants in Chest Medicine: Douglas J. Mathisen, MD. Chest 2018; 154:476-478. [PMID: 30195340 DOI: 10.1016/j.chest.2018.04.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 04/16/2018] [Indexed: 11/26/2022] Open
Affiliation(s)
- Douglas E Wood
- Douglas E. Wood is from the Department of Surgery, University of Washington, Seattle, WA.
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Waseda R, Iwasaki A. Extended sleeve lobectomy: its place in surgical therapy for centrally located non-small cell lung cancer and a review of technical aspects. J Thorac Dis 2018; 10:S3103-S3108. [PMID: 30430026 DOI: 10.21037/jtd.2018.07.40] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ryuichi Waseda
- Department of General Thoracic, Breast, and Pediatric Surgery, Fukuoka University, Fukuoka, Japan
| | - Akinori Iwasaki
- Department of General Thoracic, Breast, and Pediatric Surgery, Fukuoka University, Fukuoka, Japan
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Abstract
Standard sleeve resection refers to the circumferential removal of a segment of the main bronchus in continuity with a lobectomy in order to avoid pneumonectomy. By doing so, surgery can be carried out in patients with compromised pulmonary function while also benefiting those with more normal function. It is most often indicated for malignant tumors located at the origin of the right upper lobe bronchus. Operative mortality is low and in the range of 2% to 3%, and quality of life and long-term survival are better than what is observed after pneumonectomy.
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Maurizi G, Ciccone AM, Vanni C, D’Andrilli A, Ibrahim M, Andreetti C, Menna C, Tierno SM, Venuta F, Rendina EA. Reimplantation of the upper lobe bronchus after lower sleeve lobectomy or bilobectomy: long-term results†. Eur J Cardiothorac Surg 2018; 53:1180-1185. [DOI: 10.1093/ejcts/ezx494] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 12/02/2017] [Indexed: 11/15/2022] Open
Affiliation(s)
- Giulio Maurizi
- Department of Thoracic Surgery, Sant’Andrea Hospital, Sapienza University, Rome, Italy
| | - Anna Maria Ciccone
- Department of Thoracic Surgery, Sant’Andrea Hospital, Sapienza University, Rome, Italy
| | - Camilla Vanni
- Department of Thoracic Surgery, Sant’Andrea Hospital, Sapienza University, Rome, Italy
| | - Antonio D’Andrilli
- Department of Thoracic Surgery, Sant’Andrea Hospital, Sapienza University, Rome, Italy
| | - Mohsen Ibrahim
- Department of Thoracic Surgery, Sant’Andrea Hospital, Sapienza University, Rome, Italy
| | - Claudio Andreetti
- Department of Thoracic Surgery, Sant’Andrea Hospital, Sapienza University, Rome, Italy
| | - Cecilia Menna
- Department of Thoracic Surgery, Sant’Andrea Hospital, Sapienza University, Rome, Italy
| | - Simone M Tierno
- Department of Thoracic Surgery, Sant’Andrea Hospital, Sapienza University, Rome, Italy
| | - Federico Venuta
- Department of Thoracic Surgery, Policlinico Umberto I, Sapienza University, Rome, Italy
- Lorillard Spencer Cenci Foundation, Rome, Italy
| | - Erino A Rendina
- Department of Thoracic Surgery, Sant’Andrea Hospital, Sapienza University, Rome, Italy
- Lorillard Spencer Cenci Foundation, Rome, Italy
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Horan S, Battoo A, Yendamuri S. Sleeve lobectomy for lung cancer. Indian J Thorac Cardiovasc Surg 2017. [DOI: 10.1007/s12055-017-0581-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Abu Akar F, Yang C, Lin L, Min SJ, Jiang L. Intra-pericardial double sleeve uniportal video-assisted thoracoscopic surgery left upper lobectomy. J Vis Surg 2017; 3:51. [PMID: 29078614 DOI: 10.21037/jovs.2017.03.07] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 02/14/2017] [Indexed: 11/06/2022]
Abstract
The importance of parenchymal tissue preservation during lung resections is well realized in thoracic surgery. Technical refinement and anatomic insight have expanded indications for parenchymal -sparing surgeries. In thoracic surgery, it's reasonable to avoid pneumonectomy whenever it's possible, although challenging and technically more demanding than standard anatomic pulmonary resection, bronchial and/or vascular resection of a circumferential portion (sleeve resections) is a justified procedure due to its benefits of avoiding the complications of pneumonectomy in addition to preservation of pulmonary tissue and functions. In The era of video assisted thoracoscopic surgery's revolution and with the improvement of the surgical instruments and surgeon's experience, reports on multiportal and uniportal sleeve and double sleeve resections published recently in the literature. Here we present a video documented case of the Intra-pericardial double sleeve left upper lobectomy that demonstrates our technique in performing this surgery via uniportal approach.
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Affiliation(s)
- Firas Abu Akar
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China.,Department of Cardiothoracic Surgery, Shaare Zedek Medical Center (SZMC), Jerusalem, Israel.,Department of Cardiothoracic Surgery, Makassed Charitable Society Hospital, East Jerusalem
| | - Chenlu Yang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Lei Lin
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Shi Jia Min
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Lei Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
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Maurizi G, D'Andrilli A, Venuta F, Rendina EA. Bronchial and arterial sleeve resection for centrally-located lung cancers. J Thorac Dis 2016; 8:S872-S881. [PMID: 27942409 DOI: 10.21037/jtd.2016.06.48] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The use of bronchial and arterial sleeve resections for the treatment of centrally-located lung cancers, when available, has become the option of choice in comparison with pneumonectomy (PN). Technical expertise, in particular in vascular reconstruction, and perioperative management improved over time allowing excellent short-term and long-term results. This is even truer if considering literature data from the main experiences published in the last years. These evidences have given to such lung sparing reconstructive procedures more and more acceptance among the surgical community. This article focuses on the main technical aspects and literature data regarding bronchovascular sleeve resections.
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Affiliation(s)
- Giulio Maurizi
- Department of Thoracic Surgery, Sant'Andrea Hospital, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Antonio D'Andrilli
- Department of Thoracic Surgery, Sant'Andrea Hospital, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Federico Venuta
- Department of Thoracic Surgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy;; Lorillard Spencer-Cenci Foundation, Rome, Italy
| | - Erino Angelo Rendina
- Department of Thoracic Surgery, Sant'Andrea Hospital, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy;; Lorillard Spencer-Cenci Foundation, Rome, Italy
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Maurizi G, D'Andrilli A, Venuta F, Rendina EA. Reconstruction of the bronchus and pulmonary artery. J Thorac Dis 2016; 8:S168-80. [PMID: 26981268 DOI: 10.3978/j.issn.2072-1439.2016.02.06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Bronchovascular reconstructive procedures employed in order to avoid pneumonectomy (PN) in patients functionally unsuitable have provided, over time, excellent results, similar or even better than those obtained by PN. In recent years, new successful techniques have been developed that pertain in particular the prevention of major complications and the reconstruction of the pulmonary artery (PA). Encouraging data from increasing number of published experiences support the choice of parenchymal sparing procedures for lung cancer also in patients with good functional reserve. This is even more true if considering trials published in the last 10 years, thus indicating that improved outcome can be achieved with increased experience in reconstructive techniques and perioperative management. This article discusses the main technical aspects and results of literature.
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Affiliation(s)
- Giulio Maurizi
- 1 Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy ; 2 Department of Thoracic Surgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy ; 3 Lorillard Spencer Cenci Foundation, Rome, Italy
| | - Antonio D'Andrilli
- 1 Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy ; 2 Department of Thoracic Surgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy ; 3 Lorillard Spencer Cenci Foundation, Rome, Italy
| | - Federico Venuta
- 1 Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy ; 2 Department of Thoracic Surgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy ; 3 Lorillard Spencer Cenci Foundation, Rome, Italy
| | - Erino Angelo Rendina
- 1 Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy ; 2 Department of Thoracic Surgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy ; 3 Lorillard Spencer Cenci Foundation, Rome, Italy
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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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22
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Luciano G, Stella F, Dell’Amore A, Dolci G, Domenico G, Bini A. Tracheo-bronchoplastic Procedures for NSCLC: Single-centre Experience. Heart Lung Circ 2015; 24:1027-32. [DOI: 10.1016/j.hlc.2015.04.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 02/15/2015] [Accepted: 04/04/2015] [Indexed: 10/23/2022]
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23
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Zhou S, Pei G, Han Y, Yu D, Song X, Li Y, Xiao N, Liu S, Liu Z, Xu S. Sleeve lobectomy by video-assisted thoracic surgery versus thoracotomy for non-small cell lung cancer. J Cardiothorac Surg 2015; 10:116. [PMID: 26357875 PMCID: PMC4564953 DOI: 10.1186/s13019-015-0318-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 08/24/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Both video-assisted thoracic surgery (VATS) and thoracotomy are used for sleeve lobectomy for patients with non-small cell lung cancer (NSCLC). This retrospective study aimed to assess the safety and efficacy of VATS sleeve lobectomy for NSCLC patients. METHODS Between May 2009 and May 2013, 51 sleeve lobectomies (10 by VATS and 41 by thoracotomy) were performed for patients with NSCLC. Operative characteristics and postoperative course were compared between two groups. RESULTS Patient demographics were similar between the two groups. Thoracotomy patients had larger tumors compared with VATS patients (p = 0.02). VATS patients had a longer operating time (p < 0.001) but a shorter length of postoperative hospital stay (p = 0.009). The two groups did not differ in pathologic stage, histologic results, blood loss, ICU stay, amount of chest drainage, duration of chest drainage, numbers and distributions of dissected lymph nodes and the occurrence of complications. There were no perioperative deaths in the VATS group, whereas there was one death (2.4 %) in the thoracotomy group. There were no conversions to thoracotomy in the VATS group. The overall median survival between the two groups was similar (3.2 years VATS versus 3.2 years thoracotomy, log-rank p = 0.58). CONCLUSIONS VATS sleeve lobectomy for the treatment of NSCLC is technically feasible and safe and is associated with comparable complication rates and survival compared with thoracotomy approach, but it deserves further investigation in large series.
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Affiliation(s)
- Shijie Zhou
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University, Machang 97, Tongzhou District, Beijing, 101149, China
| | - Guotian Pei
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University, Machang 97, Tongzhou District, Beijing, 101149, China
| | - Yi Han
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University, Machang 97, Tongzhou District, Beijing, 101149, China
| | - Daping Yu
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University, Machang 97, Tongzhou District, Beijing, 101149, China
| | - Xiaoyun Song
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University, Machang 97, Tongzhou District, Beijing, 101149, China
| | - Yunsong Li
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University, Machang 97, Tongzhou District, Beijing, 101149, China
| | - Ning Xiao
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University, Machang 97, Tongzhou District, Beijing, 101149, China
| | - Shuku Liu
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University, Machang 97, Tongzhou District, Beijing, 101149, China
| | - Zhidong Liu
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University, Machang 97, Tongzhou District, Beijing, 101149, China.
| | - Shaofa Xu
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University, Machang 97, Tongzhou District, Beijing, 101149, China.
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Bylicki O, Vandemoortele T, Orsini B, Laroumagne S, D’Journo XB, Astoul P, Thomas PA, Dutau H. Incidence and Management of Anastomotic Complications After Bronchial Resection: A Retrospective Study. Ann Thorac Surg 2014; 98:1961-7. [DOI: 10.1016/j.athoracsur.2014.07.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Revised: 06/16/2014] [Accepted: 07/07/2014] [Indexed: 10/24/2022]
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Carinal Resection and Reconstruction for Locally Advanced Primary Lung Cancer: Institutional Report. ACTA ACUST UNITED AC 2014. [DOI: 10.1155/2014/692590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Carinal resection and reconstruction for lung cancer, termed carinaplasty, is a rare operation, and the procedure remains challenging and few reports have been presented. We analyzed complications, local control, and manner of recurrence in patients who underwent a carinaplasty and compared the results to those who underwent an ordinary bronchoplasty. Among 766 patients who underwent surgery for primary lung cancer at our institutions, 82 bronchoplasty procedures were performed, while 6 of those who received a bronchoplasty underwent a carinaplasty. Three of 6 patients who received a carinaplasty underwent the montage method, and other 3 patients underwent the one-stoma method. There were no operative deaths in patients who underwent a carinaplasty, while there was 1 operative death in the group of patients who underwent an ordinary bronchoplasty. Complications in the anastomotic site were observed in 33% in the carinaplasty group and 5.3% in the ordinary bronchoplasty group (P=0.011). There was no significant difference in regard to local recurrence between the groups (P=0.620). In conclusion, our results show that a carinaplasty is a technically demanding but useful procedure to avoid a pneumonectomy in patients with locally advanced lung cancer.
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Ibrahim M, Maurizi G, Venuta F, Rendina EA. Reconstruction of the bronchus and pulmonary artery. Thorac Surg Clin 2013; 23:337-47. [PMID: 23931017 DOI: 10.1016/j.thorsurg.2013.05.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Sleeve lobectomy (SL) (lobectomy associated with resection and reconstruction of the bronchus, the pulmonary artery, or both) has proved to be a suitable choice for the treatment of centrally sited non-small cell lung cancer. SL for lung cancer is indicated when a tumor or an N1 lymph node infiltrates the origin of a lobar bronchus, the origin of the lobar branches of the pulmonary artery, or both but not to the extent that a pneumonectomy is required. SL can be performed safely and effectively, even after induction therapy, without an increased complication rate.
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Affiliation(s)
- Mohsen Ibrahim
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Via di Grottarossa, 1035, Rome 00189, Italy.
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Sleeve lobectomy compared with pneumonectomy after induction therapy for non-small-cell lung cancer. J Thorac Oncol 2013; 8:637-43. [PMID: 23584296 DOI: 10.1097/jto.0b013e318286d145] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND We compared morbidity, mortality, and oncological results of bronchial and/or vascular sleeve lobectomy (SL) with those of pneumonectomy (PN) after induction therapy for lung cancer. METHODS Between 1998 and 2011, 82 patients receiving induction therapy (chemo or chemo-radiotherapy) for non-small-cell-lung-cancer underwent sleeve lobectomy (n = 39) or pneumonectomy (n= 43). Only patients undergoing preoperative chemotherapy (39 in the SL group and 39 in the PN group) were included in the study. SL was bronchial in 21, vascular in 12, and broncho-vascular in six cases, respectively. Clinical stage before induction therapy was IIb in seven patients (1 in PN group; 6 in SL group), IIIa in 66 (36 in PN group; 30 in SL group), and IIIb in five patients (2 in PN group; 3 in SL group), respectively. N3 patients were not included in this series. RESULTS The rate of downstaged patients (pathological complete response and stage I-II) was 79.5% in the SL group and 53.8% in the PN group (p = 0.01).Postpneumonectomy mortality rate was 2.6 %. There was no postoperative mortality after SL. Complications occurred in 12 patients (30.8%) after PN and in 11 patients (28.2%) after SL (p = 0.6). Three-year and 5-year survival rates were 68 ± 3% and 64 ± 8% in the SL group; and 59.5 ± 5% and 34.5 ± 8% in the PN group (p = 0.02). The difference in terms of recurrence rate (locoregional and distant) between the two groups was not significant (p = 0.2). CONCLUSIONS SL represents a valid therapeutic option even after induction chemotherapy, providing better long-term survival than PN, with no increase of postoperative complications or recurrence rate. Pathological downstaging is a favorable prognostic factor.
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Shi W, Zhang W, Sun H, Shao Y. Sleeve lobectomy versus pneumonectomy for non-small cell lung cancer: a meta-analysis. World J Surg Oncol 2012; 10:265. [PMID: 23231962 PMCID: PMC3543213 DOI: 10.1186/1477-7819-10-265] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 11/26/2012] [Indexed: 11/25/2022] Open
Abstract
Aim It is controversial that whether sleeve lobectomy (SL) should be promoted more worthy than pneumonectomy (PN) in suitable patients. Methods We searched all studies that had been published in English from PUBMED and Embase which compared the short-term and long-term outcomes of SL and pneumonectomy (PN) in patients with non-small cell lung cancer (NSCLC). Results Nineteen studies met our criteria with a combined total of 3878 subjects, of which 1316 (33.9%) underwent SL and 2562 (66.1%) underwent PN. The odds ratio was 0.50 (95% CI: 0.34-0.72) for postoperative mortality, 1.17 (95% CI: 0.82-1.67) for postoperative complications, 0.78 (95% CI: 0.47-1.29) for locoregional recurrences. The risk difference for 1-, 3-, 5- year was 0.11 (95% CI: 0.07-0.14), 0.15 (95% CI: 0.06-0.24), 0.15 (95% CI: 0.09-0.20),respectively. The pooled hazard ratio was 0.63 (95% CI: 0.56-0.71) in favor of SL group. Conclusion SL is more worthy to be done than PN in suitable patients with less mortality and better long-term survival.
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Affiliation(s)
- Woda Shi
- Department of Cardio-Thoracic Surgery, the third People’s hospital, Yancheng, China
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Abstract
A bronchial sleeve resection can be considered for lesions arising from a lobar bronchus so as to preclude a standard lobectomy, yet without enough distal involvement as to warrant a pneumonectomy. Limited bronchial resection allows maximal conservation of pulmonary function in patients with benign or malignant disease, without compromising oncologic outcome. This article defines the indications and preoperative management of candidate patients and discusses key anesthetic considerations and surgical techniques for this complex airway reconstruction. The essential component of a successful operation is a tension-free bronchial anastomosis. Open communication and careful discussion of airway management between anesthesiologist and surgeon will help ensure a good outcome.
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Affiliation(s)
- Jessica A. Yu
- University of Colorado Denver School of Medicine, Aurora, CO, USA
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Galetta D, Solli P, Borri A, Gasparri R, Petrella F, Pardolesi A, Spaggiari L. Bronchovascular reconstruction for lung cancer: does induction chemotherapy influence the outcomes? Ann Thorac Surg 2012; 94:907-13; discussion 913. [PMID: 22776086 DOI: 10.1016/j.athoracsur.2012.05.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Revised: 05/07/2012] [Accepted: 05/11/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND Bronchoangioplastic interventions (BAIs) for lung cancer are challenging procedures associated with a high risk of postoperative morbidity and mortality. The role of induction chemotherapy (IC) in these patients is debated. METHODS We reviewed clinical records of patients who underwent a BAI between 1998 and 2009 using a prospective clinical and operative database. RESULTS Among 47 patients (39 men; mean age, 66 years) who underwent BAI, 26 (55.3%) received IC for N2 disease or for locally advanced lung cancer. We performed 35 pulmonary artery (PA) sleeve resections (31 partial and 4 circumferential), 10 PA reconstructions with a pericardial patch (8 autologous, and 2 heterologous), and 2 PA reconstructions using heterologous conduit. The 30-day mortality rate was 4.2% (n=2). Morbidity occurred in 19 (40.4%) patients; 5 patients (10.6%) had major complications (3 [6.4%] patients with fatal bronchovascular fistulas and 1 patient each with cardiac dislocation and acute respiratory distress syndrome) (2.2%). Fourteen patients (29.8%) had minor complications: 6 (12.7%) cardiac, 7 (14.9%) pulmonary, and 1 (2.2%) stroke. IC did not influence the complication rate. Overall 5-year survival and disease-free survival was 39.2% and 36.9%, respectively. Early pathologic stage and the absence of nodal involvement significantly influenced survival (p=0.005 and p=0.002, respectively). Patients receiving IC had a better prognosis (62.7% versus 10.7%; p=0.0003). At multivariate analysis, IC influenced long-term survival (p=0.003 [95% CI, 2.92-8.56]). CONCLUSIONS BAIs are feasible and effective surgical procedures with acceptable morbidity and mortality. IC does not influence morbidity and allows good long-term outcomes.
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Affiliation(s)
- Domenico Galetta
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy.
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Lee HK, Lee HS, Kim KI, Shin HS, Lee JW, Kim HS, Cho SW. Outcomes of Sleeve Lobectomy versus Pneumonectomy for Lung Cancer. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2012; 44:413-7. [PMID: 22324026 PMCID: PMC3270283 DOI: 10.5090/kjtcs.2011.44.6.413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 10/20/2011] [Accepted: 10/22/2011] [Indexed: 11/23/2022]
Abstract
Background Sleeve lobectomy for lung cancer in close proximity to or involving the carina is widely accepted. Operative morbidity and mortality rates, recurrence, and survival rates have varied considerably across studies. Materials and Methods From March of 2005 to July of 2010, sleeve lobectomy was performed in 19 patients and pneumonectomy was performed in 20 patients. In this paper, the results of sleeve lobectomy and pneumonectomy for patients with lung cancer will be compared and evaluated. Results There were no postoperative complications in either group, but there was one mortality in the pneumonectomy group. There was better preservation of pulmonary function in the sleeve lobectomy group than the pneumonectomy group (p=0.066 in FVC, p=0.019 in FEV1). The 3-year survival rates were 46.7% in the sleeve lobectomy group and 54.5% in the pneumonectomy group (p=0.505). The 3-year disease-free survival rates were 38% in the sleeve lobectomy group and 45.8% in the pneumonectomy group (p=0.200). Conclusion Sleeve lobectomy for lung cancer showed low mortality, low bronchial anastomotic complication rates, and good preservation of pulmonary function.
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Affiliation(s)
- Hong-Kyu Lee
- Department of Thoracic and Cardiovascular Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Korea
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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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Fehér C, Agócs L, Kocsis A, Heiler Z, Vágvölgyi A, Csekeo A, Vadász P. [Isolated bronchial resection for tumor]. Magy Seb 2011; 64:122-4. [PMID: 21672683 DOI: 10.1556/maseb.64.2011.3.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Tumors that are confined to specific areas of the airway (e.g. left main stem bronchus or the bronchus intermedius) can be removed with resections of the bronchus only and preservation of the parenchyma. During the period of January 2004 to February 2009 five patients underwent isolated bronchial resection for lung tumor with curative intent. In this study we analyzed the data of five men with a median age of 47.6 years (range 29–68 years). In four cases resection of the intermediate bronchus was performed, and in one case left main bronchus was removed. Intraoperative frozen section revealed negative bronchial resection margins in all cases. Four patients had carcinoid tumors, while one was diagnosed with chemodectoma. Minor postoperative complications were observed in two patients only. Isolated bronchial resection for lung tumor is associated with low morbidity and mortality. Lung sparing procedures are preferable in the above cases but sufficient experience and conditions are mandatory to achieve adequate results.
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Affiliation(s)
- Csaba Fehér
- Országos Korányi Tbc és Pulmonológiai Intézet és Semmelweis Egyetem Mellkassebészet 1529 Budapest Pihenő u. 1.
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Gezer S, Oz G, Findik G, Türüt H, Altinok T, Sirmali M, Gülhan E, Ağaçkiran Y, Kaya S, Taştepe I. Sleeve resections for squamous cell carcinoma of the lung. Heart Lung Circ 2011; 19:549-54. [PMID: 20434399 DOI: 10.1016/j.hlc.2010.02.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Revised: 02/09/2010] [Accepted: 02/21/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Sleeve resection is an advanced technique that was developed as an alternative to pneumonectomy. This study evaluated our cases of sleeve resection for squamous cell carcinoma of the lung and compared the outcomes with the literature reports. METHODS In total, 26 bronchial, 5 bronchovascular, and 3 vascular sleeve lobectomies were performed between January 2000 and July 2005 in our clinic. Age, gender, operations, postoperative diagnosis and staging, and postoperative morbidity and mortality were evaluated. RESULTS Sleeve resections were performed in 34 patients. All patients were male, with a mean age of 59.4 years. The operations consisted of 16 right upper, 14 left upper, and 1 left lower sleeve lobectomies and 3 superior sleeve bilobectomies. The most common postoperative pathological staging group was stage IIb (32.3%). Operative mortality was 5.9% (n=2). Postoperative morbidity was 20.5% (n=7), including 4 prolonged air leaks plus empyema, 1 prolonged air leak, 1 postoperative bleeding needing revision, and 1 severe bronchostenosis; of these, 6 had persistent atelectasis. The local tumour recurrence rate was 11.7% (n=4). The median survival time and 5-year survival were 36 months and 42%, respectively. CONCLUSIONS Sleeve resection proved to be good therapy for lung cancer and has a lower morbidity and mortality than standard pneumonectomies and results in better lung function and quality of life. The anastomosis-related complications are experience-related technical complications and training thoracic surgeons to perform SRs at experienced centres will reduce the morbidity associated with SRs.
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Affiliation(s)
- Suat Gezer
- Faculty of Medicine, Clinic of Thoracic Surgery, Düzce University, Düzce, Turkey.
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Long-term outcome of hybrid surgical approach of video-assisted minithoracotomy sleeve lobectomy for non-small-cell lung cancer. Surg Endosc 2011; 25:2509-15. [PMID: 21298520 DOI: 10.1007/s00464-011-1576-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 12/13/2010] [Indexed: 12/21/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the technical feasibility and safety of a hybrid surgical approach of video-assisted minithoracotomy (hybrid VATS) sleeve lobectomy for non-small-cell lung cancer (NSCLC), using success rate as the primary end point. METHODS Between February 1996 and December 2006, patients with bronchogenic tumors were prospectively registered to undergo hybrid VATS sleeve resection in a single institution. Hybrid VATS involved performing the main procedures via rib spreading and minithoracotomy using a monitor and direct vision. A successful procedure was defined as a patient who had a sleeve lobectomy via hybrid VATS without conversion to thoracotomy and without significant perioperative morbidity or mortality. RESULTS A total of 148 patients (108 men and 40 women; median age = 58 years) who underwent hybrid VATS sleeve lobectomy for NSCLC were identified in our database. The median duration of the successfully completed procedures was 190 min (range = 145-305 min). The median length of time of chest tube in place was 3 days (range = 1-12 days). Hybrid VATS sleeve lobectomy was performed successfully in 134 of 148 patients for a success rate of 90.5%. The median follow-up period was 65.1 months (range = 34.5-154.8 months). The overall 5-year disease-free survival and overall survival of all patients were 36.7% (95% CI = 27.9-45.5%) and 54.2% (95% CI = 44.8-63.6%), respectively. CONCLUSION Hybrid VATS sleeve lobectomy is feasible for selected patients with NSCLC in specialized centers.
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Stallard J, Loberg A, Dunning J, Dark J. Is a sleeve lobectomy significantly better than a pneumonectomy? Interact Cardiovasc Thorac Surg 2010; 11:660-6. [PMID: 20724429 DOI: 10.1510/icvts.2010.245506] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A best evidence topic was written according to a structured protocol. The question addressed was 'whether a sleeve lobectomy results in a better survival rate than a pneumonectomy in suitable patients?' Altogether, more than 327 papers were found using the reported search, of which 15 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude in the biggest meta-analysis of nearly 3000 patients, the five-year survival was 50% for sleeve lobectomy compared to 30% for pneumonectomy. Operative mortality was 3% vs. 6% for pneumonectomy, and locoregional recurrence was 17% vs. 30%. These results are broadly consistent across all the 13 cohort studies presented here many of which document a 20-year single centre experience or more. There are significant issues in all cohort studies on this subject as, due to their non-randomized nature, the reason for not performing a sleeve resection may well have been more advanced disease, which would necessarily mean that the pneumonectomy patients would have a lower expected survival and higher local recurrence. In addition, there have been many large cohort studies to date and thus no more are required, as future studies are unlikely to resolve this issue. Thus, the only study that would adequately correct for this issue would be a randomized trial, but to prove a 10% increase in five-year survival a 300 patient study would be needed. This is bigger than any study ever done in this area and as some centres took 30 years to collect these numbers of potential sleeve patients an RCT is not a realistic possibility. Therefore, we conclude that no more cohort studies should be performed, as the results will be consistent with the meta-analyses and an RCT to eliminate their bias is unattainable, and thus no more research should be done on this topic and surgeons should use the figures presented above and in more detail in this best evidence topic to govern their management in the future.
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Affiliation(s)
- Joseph Stallard
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK.
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Yavuzer Ş, Yüksel C, Kutlay H. Segmental Bronchial Sleeve Resection: Preserving All Lung Parenchyma for Benign/Low-Grade Neoplasms. Ann Thorac Surg 2010; 89:1737-43. [DOI: 10.1016/j.athoracsur.2010.02.060] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Revised: 02/16/2010] [Accepted: 02/18/2010] [Indexed: 11/15/2022]
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Sleeve Lobectomy as an Alternative Procedure to Pneumonectomy for Non-small Cell Lung Cancer. J Thorac Oncol 2010; 5:517-20. [DOI: 10.1097/jto.0b013e3181d0a44b] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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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Ludwig C, Morand P, Schnell J, Stoelben E. Preserving middle lobe to improve lung function in non-small-cell lung cancer. Asian Cardiovasc Thorac Ann 2009; 17:153-6. [PMID: 19592545 DOI: 10.1177/0218492309103296] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
When a lung tumor arises in segment 6, the close anatomical relationship to the middle lobe bronchus may make a lower bilobectomy necessary. Sleeve lobectomy may be an alternative. These procedures were compared retrospectively in 36 patients operated on between January 2005 and December 2006 with non-small-cell lung cancer (stage I-IIIB) of the right lower lobe. Sleeve lobectomy was performed in 21 patients and bilobectomy in 15 (41%). Preoperative lung function was comparable in both groups. Radical resection was achieved in 34/36 patients. Operation time was 121 min for sleeve lobectomy and 144 min for bilobectomy. Chest tubes were removed after 5 days in both groups. Postoperative lung function was better after sleeve lobectomy than bilobectomy (forced expiratory volume in 1st sec: 78% vs. 69%). Preservation of the middle lobe by sleeve lobectomy is feasible. There was no evidence that this resection was less radical, and complication rates were similar in both groups.
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Affiliation(s)
- Corinna Ludwig
- Thoracic Surgery, Lungenklinik Merheim, Kliniken der Stadt Köln gGmbH, Cologne, Germany.
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Gaissert HA, Keum DY, Wright CD, Ancukiewicz M, Monroe E, Donahue DM, Wain JC, Lanuti M, Allan JS, Choi NC, Mathisen DJ. POINT: Operative risk of pneumonectomy—Influence of preoperative induction therapy. J Thorac Cardiovasc Surg 2009; 138:289-94. [PMID: 19619768 DOI: 10.1016/j.jtcvs.2008.11.069] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2008] [Revised: 10/01/2008] [Accepted: 11/15/2008] [Indexed: 02/06/2023]
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Parissis H, Leotsinidis M, Hughes A, McGovern E, Luke D, Young V. Comparative Analysis and Outcomes of Sleeve Resection versus Pneumonectomy. Asian Cardiovasc Thorac Ann 2009; 17:175-82. [DOI: 10.1177/0218492309103309] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To compare the outcome of sleeve resection or complex sleeve resection versus (Vs) pneumonectomy for lung cancer in a single unit. Between 1998 and 2006, 664 lung resections were carried out. There were 129 (19.4%) pneumonectomies and 79 (11.9%) sleeve resections; Twenty one patients (26.5%) underwent a complex sleeve resection. Operative mortality for the sleeve resections (SR) was 2.5% and for the pneumonectomies 8.53%. Overall 5-year survival after SR was 46.8% and after pneumonectomy 37.1%. The survival curves for the 2 procedures after adjusting for risk factors are different. The area under the curve is higher for the SR (Hazard ratio 1.78 C.I.: 0,92-3,46). The 5-year survival for early stages favors SR. The survival for the complex SR was not influenced by the complexity of the procedure but from the TNM stage of each individual case. Multivariate analysis of risk factors affecting survival after surgery showed: male sex Hazard ratio (HR) 1.19, 0.63–2.27(95%CI), Age >63 1.38(HR), 0.78–2.48, Pneumonectomy 1.78(HR), 0.92–3.46 and stage III 4.44(HR), 1.94–10.16(95% CI). For comparative stages survival appears to be better after sleeves, moreover male sex, sleeve resection, age younger that 63 and early TNM stage are positive predictors for survival.
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Affiliation(s)
- Harry Parissis
- Department of Statistics and Epidemiology University of Patras Medical School Patras, Greece
| | - Michael Leotsinidis
- Department of Statistics and Epidemiology University of Patras Medical School Patras, Greece
| | - Ann Hughes
- Department of Statistics and Epidemiology University of Patras Medical School Patras, Greece
| | - Eilish McGovern
- Department of Statistics and Epidemiology University of Patras Medical School Patras, Greece
| | - David Luke
- Department of Statistics and Epidemiology University of Patras Medical School Patras, Greece
| | - Vincent Young
- Department of Statistics and Epidemiology University of Patras Medical School Patras, Greece
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Extended sleeve lobectomy for locally advanced lung cancer. Ann Thorac Surg 2009; 87:900-5. [PMID: 19231416 DOI: 10.1016/j.athoracsur.2008.12.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Revised: 12/02/2008] [Accepted: 12/05/2008] [Indexed: 11/24/2022]
Abstract
BACKGROUND The risk of perioperative mortality is greater for patients undergoing a pneumonectomy than for a sleeve lobectomy. At our institution, we perform an extended sleeve lobectomy, an atypical sleeve resection of more than one lobe, to avoid a pneumonectomy in patients with locally advanced lung cancer. The purpose of this study was to analyze the risks of complications and local control in patients who underwent an extended sleeve lobectomy procedure. METHODS Patients who underwent an extended sleeve lobectomy procedure were retrospectively analyzed in regard to operative mortality, complications, and local recurrence. RESULTS A total of 23 patients underwent an extended sleeve lobectomy: one lobe + segment in 15, two lobes in 7, and two lobes + segment in 1. There were no operative deaths within 30 days or hospital deaths. Two (8.7%) of the 23 patients had complications at the anastomosis site, a stricture in 1 and bronchopleural fistula in 1, whereas 2 (8.7%) others had local control failure, relapse at the anastomosis site in 1 and staple line relapse in 1. Long-term survival was similar to that of those who underwent a pneumonectomy during the same period. CONCLUSIONS Our extended sleeve lobectomy procedure is useful to avoid a pneumonectomy in patients with locally advanced lung cancer.
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History and current status of bronchoplastic surgery for lung cancer. Gen Thorac Cardiovasc Surg 2009; 57:3-9. [DOI: 10.1007/s11748-008-0316-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Indexed: 11/25/2022]
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Quality of Life after Lung Cancer Surgery: A Prospective Pilot Study comparing Bronchial Sleeve Lobectomy with Pneumonectomy. J Thorac Oncol 2008; 3:604-8. [DOI: 10.1097/jto.0b013e318170fca4] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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What to do with “Surprise” N2?: Intraoperative Management of Patients with Non-small Cell Lung Cancer. J Thorac Oncol 2008; 3:289-302. [DOI: 10.1097/jto.0b013e3181630ebd] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lung Neoplasms. Surgery 2008. [DOI: 10.1007/978-0-387-68113-9_72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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