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Saeki Y, Goto Y, Kuroda K, Sato Y. Wedge extended bronchoplasty with caliber adjustment by membranous suture. Gen Thorac Cardiovasc Surg 2024:10.1007/s11748-024-02046-6. [PMID: 38802656 DOI: 10.1007/s11748-024-02046-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 05/23/2024] [Indexed: 05/29/2024]
Abstract
Extended bronchoplasty for the left lower lobe lung tumors with interlobar lymph node involvement is a useful surgical technique for avoiding pneumonectomy. Typically, sleeve bronchoplasty, in which the superior division bronchus and the left main bronchus are separated and anastomosed, is chosen due to the difference in caliber of the anastomosis; herein, we report a wedge extended bronchoplasty in which the superior division bronchus and the left main bronchus were not completely separated. The main point of this technique is to adjust the difference in caliber by suturing the main bronchial membranes.
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Affiliation(s)
- Yusuke Saeki
- Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yukinobu Goto
- Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Keisuke Kuroda
- Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yukio Sato
- Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
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Jiao Z, Tang Z, Yu J. Tracheal or bronchial wedge resection: Case report. Front Surg 2023; 10:1122075. [PMID: 36865625 PMCID: PMC9971566 DOI: 10.3389/fsurg.2023.1122075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 01/24/2023] [Indexed: 02/16/2023] Open
Abstract
Background Primary tracheal or bronchial tumors are relatively uncommon, whether benign or malignant. Sleeve resection is an excellent surgical technique for most primary tracheal or bronchial tumors. However, depending on the size and location of the tumor, thoracoscopic wedge resection of trachea or bronchus can be performed with the assistance of a fiberoptic bronchoscope for some malignant and benign tumors. Case Description We performed a single incision video-assisted bronchial wedge resection in a patient with a left main bronchial hamartoma with a size of 7 × 5 × 5 mm. The patient was discharged from the hospital six days after the surgery with no postoperative complications. There was no obvious discomfort during the 6-month postoperative follow-up, and the reexamination of fiberoptic bronchoscopy revealed no evident stenosis of the incision. Conclusions Through the detailed case study and literature review, we believe that tracheal or bronchial wedge resection is a significantly superior technique under the appropriate conditions. Video-assisted thoracoscopic wedge resection of trachea or bronchus should be a new and excellent development direction of minimally invasive bronchial surgery.
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Affiliation(s)
- Zhenhua Jiao
- Department of Thoracic Surgery, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Zhe Tang
- Department of Thoracic Surgery, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
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Zhang Z, Peng X, Ai B, Li K, Li Y, Abrão FC, Igai H, Terra RM, Xiao H, Huang Q, Liao Y. Feasibility and safety of pedicled autologous bronchial flap reconstruction airway instead of sleeve lobectomy in partial lung cancer surgery. Transl Lung Cancer Res 2022; 11:1019-1026. [PMID: 35832455 PMCID: PMC9271431 DOI: 10.21037/tlcr-22-347] [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: 11/02/2021] [Accepted: 06/16/2022] [Indexed: 11/06/2022]
Abstract
Background A sleeve lobectomy is a routine operation in thoracic surgery. However, sleeve lobectomy is not only a complex operation, but also has the risk of anastomotic leakage and stenosis. We used bronchial flap to reconstruct the airway instead of sleeve lobectomy. The above disadvantages can be avoided because the bronchial flap reconstruction airway has no anastomosis. This technique has not previously been reported. This paper discusses the feasibility and safety of reconstructing the bronchus with the pedicle autogenous bronchus flap in lung cancer surgery. Methods During the operation, when the tumor tissue had invaded ≤1/3 of the circumference of the lobar bronchus, the bronchus wall was removed at least 5 mm away from the tumor, but the contralateral healthy bronchus wall was preserved. The healthy bronchial wall was made into a "tongue-shaped" pedicled autogenous bronchial flap, approximately the size of the bronchial defect, and the flap was turned up or down to repair the root defect of the bronchus. The patients were examined every 3 months after surgery by chest computed tomography (CT) to observe the re-expansion of lung and reconstruction of the bronchus, and analyze the incidence of bronchus stenosis and local recurrence. Results The lobar bronchus was successfully reconstructed with the pedicled autologous bronchial flap in 45 patients; 36 males and 9 females with an average age of 56.5 years. The diameters of the tumors ranged from 3-12 cm. The pathological examination results showed that the margin of bronchus was negative. There was no perioperative death or bronchopleural fistula. The bronchoscopy showed that the reconstructed bronchus healed well, and no atelectasis or bronchostenosis was found in the follow-up period. Conclusions This is the first report on the application of the pedicled autogenous bronchial flap being used to reconstruct the airway instead of a sleeve lobectomy in lung cancer surgery. In the radical resection of lung cancer, the operation can simplify the operation process, and reduce the risk of anastomotic leakage or stenosis. The operation is safe and feasible, and should be more widely used.
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Affiliation(s)
- Zheng Zhang
- Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Thoracic Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Xiaonu Peng
- Department of Thoracic Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Bo Ai
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kuo Li
- Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yang Li
- Department of Emergency, Xiangyang Central Hospital, Xiangyang, China
| | - Fernando C Abrão
- Thoracic Surgery Department, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Hitoshi Igai
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Ricardo Mingarini Terra
- Thoracic Surgery Division, Heart Institute (InCor) of the Hospital das Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Han Xiao
- Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Quanfu Huang
- Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yongde Liao
- Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Uniportal VATS for non-small cell lung cancer. Gen Thorac Cardiovasc Surg 2019; 68:707-715. [PMID: 31617147 DOI: 10.1007/s11748-019-01221-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 12/13/2022]
Abstract
The video-assisted thoracic surgery (VATS) technique has evolved from its multiport origins to even less invasive approaches grounded in its proven benefits over open surgery for the treatment of early stage lung cancer. In this evolution process, the Uniportal VATS (UniVATS) strategy emerged. This technique is giving some evidence of benefits when compared to the multiport VATS and has been embraced by the surgical community spreading its geographical and surgical boundaries. Moreover, UniVATS has proven its feasibility for numerous and more complex procedures for lung cancer diagnosis and treatment, which are reviewed in this document as well as its current and future development.
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Chichevatov D, Gorshenev A, Sinev E. Preventive Diaphragm Plasty after Pneumonectomy on Account of Lung Cancer. Asian Cardiovasc Thorac Ann 2016; 14:265-72. [PMID: 16868097 DOI: 10.1177/021849230601400401] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Experience is presented of 53 cases of diaphragm plasty of the bronchial stump, tracheobronchial anastomosis, pericardium, and esophagus wall after extended pneumonectomy on account of lung cancer. A pedicled diaphragm flap was used to prevent bronchopleural fistula in 53 patients, as well as heart dislocation after wide resection of the pericardium in 26, and esophagopleural fistula after resection of the muscle coat of the esophagus in 2. In all cases, there was a high risk of these complications. Dehiscence of the bronchial stump or tracheobronchial anastomosis occurred in 9 patients, but due to diaphragm plasty, a bronchopleural fistula formed in only 3. Restoration of the pericardium and the esophageal muscle coat was successful in all cases. Overall morbidity was 22.6%, 30-day mortality was 7.5%, hospital mortality was 11.3%. Causes of death were fulminant pneumonia of the single lung, cerebral hemorrhage, pulmonary embolism, heart failure, early tumor progression, and sepsis, in one case each. The results were compared with those in 49 patients who underwent other methods of bronchial stump or tracheobronchial anastomosis reinforcement. The analysis revealed that the diaphragm flap was highly efficacious as a multipurpose plastic material.
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Affiliation(s)
- Dmitry Chichevatov
- Department of Thoracic Surgery, Penza Regional Oncology Health Center, 37a Prospect Stroitelei, 440071 Penza, Russia.
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Gonzalez-Rivas D, Yang Y, Sekhniaidze D, Stupnik T, Fernandez R, Lei J, Zhu Y, Jiang G. Uniportal video-assisted thoracoscopic bronchoplastic and carinal sleeve procedures. J Thorac Dis 2016; 8:S210-22. [PMID: 26981273 DOI: 10.3978/j.issn.2072-1439.2016.01.76] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Despite of the recent advanced with the video-assisted thoracoscopic surgery (VATS), the most common approach for bronchial and carinal resection is still the open surgery. The technical difficulties, the steep learning curve and the concerns about performing an oncologic and safe reconstruction in advanced cases, are the main reasons for the low adoption of VATS for sleeve resections. Most of the authors use 3-4 incisions for thoracoscopic sleeve procedures. However these surgical techniques can be performed by a single incision approach by skilled uniportal VATS surgeons. The improvements of the surgical instruments, high definition cameras and recent 3D systems have greatly contributed to facilitate the adoption of uniportal VATS techniques for sleeve procedures. In this article we describe the technique of thoracoscopic bronchial sleeve, bronchovascular and carinal resections through a single incision approach.
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Affiliation(s)
- Diego Gonzalez-Rivas
- 1 Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospital, 15006 Coruña, Spain ; 2 Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China ; 3 Department of Thoracic Surgery, Regional Oncological Center, Tyumen, Russian Federation ; 4 Department of Thoracic Surgery, University Medical Center, Ljubljana, Slovenia
| | - Yang Yang
- 1 Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospital, 15006 Coruña, Spain ; 2 Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China ; 3 Department of Thoracic Surgery, Regional Oncological Center, Tyumen, Russian Federation ; 4 Department of Thoracic Surgery, University Medical Center, Ljubljana, Slovenia
| | - Dmitrii Sekhniaidze
- 1 Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospital, 15006 Coruña, Spain ; 2 Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China ; 3 Department of Thoracic Surgery, Regional Oncological Center, Tyumen, Russian Federation ; 4 Department of Thoracic Surgery, University Medical Center, Ljubljana, Slovenia
| | - Tomaz Stupnik
- 1 Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospital, 15006 Coruña, Spain ; 2 Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China ; 3 Department of Thoracic Surgery, Regional Oncological Center, Tyumen, Russian Federation ; 4 Department of Thoracic Surgery, University Medical Center, Ljubljana, Slovenia
| | - Ricardo Fernandez
- 1 Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospital, 15006 Coruña, Spain ; 2 Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China ; 3 Department of Thoracic Surgery, Regional Oncological Center, Tyumen, Russian Federation ; 4 Department of Thoracic Surgery, University Medical Center, Ljubljana, Slovenia
| | - Jiang Lei
- 1 Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospital, 15006 Coruña, Spain ; 2 Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China ; 3 Department of Thoracic Surgery, Regional Oncological Center, Tyumen, Russian Federation ; 4 Department of Thoracic Surgery, University Medical Center, Ljubljana, Slovenia
| | - Yuming Zhu
- 1 Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospital, 15006 Coruña, Spain ; 2 Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China ; 3 Department of Thoracic Surgery, Regional Oncological Center, Tyumen, Russian Federation ; 4 Department of Thoracic Surgery, University Medical Center, Ljubljana, Slovenia
| | - Gening Jiang
- 1 Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospital, 15006 Coruña, Spain ; 2 Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China ; 3 Department of Thoracic Surgery, Regional Oncological Center, Tyumen, Russian Federation ; 4 Department of Thoracic Surgery, University Medical Center, Ljubljana, Slovenia
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Gonzalez-Rivas D, Yang Y, Stupnik T, Sekhniaidze D, Fernandez R, Velasco C, Zhu Y, Jiang G. Uniportal video-assisted thoracoscopic bronchovascular, tracheal and carinal sleeve resections. Eur J Cardiothorac Surg 2015; 49 Suppl 1:i6-16. [DOI: 10.1093/ejcts/ezv410] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 10/25/2015] [Indexed: 12/17/2022] Open
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Pandey D, Ramanathan P, Khurse BB, Bharati SJ, Mishra S. Bronchoscopic debulking followed by bronchoplastic procedure helps in limiting lung resection in a bronchial carcinoid: a case report. Indian J Surg Oncol 2014; 5:214-6. [PMID: 25419070 DOI: 10.1007/s13193-014-0322-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 06/06/2014] [Indexed: 11/27/2022] Open
Abstract
Bronchoplasty is a conservative procedure in lung surgeries used in the past for patients with poor functional status but recently these procedures have been performed in low grade malignant tumors of lung avoiding extensive morbid procedure like pneumonectomy without compromising the oncologic outcome. We describe a case of bronchial carcinoid treated by bronchoscopic intervention followed by wedge bronchoplasty. The importance of bronchoscopic debulking of the tumor for accurate assessment of its extent has been highlighted. A parenchyma preserving pulmonary resection can then be performed with bronchoplastic technique, thus avoiding pneumonectomy.
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Affiliation(s)
- Durgatosh Pandey
- Department of Surgical Oncology, Institute of Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India 110029
| | - Palaniappan Ramanathan
- Department of Surgical Oncology, Institute of Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India 110029
| | - Bharat Bhushan Khurse
- Department of Surgical Oncology, Institute of Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India 110029
| | - Sachidanand Jee Bharati
- Department of Anaesthesiology, Institute of Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India 110029
| | - Seema Mishra
- Department of Anaesthesiology, Institute of Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India 110029
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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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Left main bronchus resection and reconstruction. A single institution experience. J Cardiothorac Surg 2012; 7:29. [PMID: 22490234 PMCID: PMC3348089 DOI: 10.1186/1749-8090-7-29] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Accepted: 04/10/2012] [Indexed: 11/10/2022] Open
Abstract
Background Left main bronchus resection and reconstruction (LMBRR) is a complex surgical procedure indicated for management of inflammatory, benign and low grade malignant lesions. Its application provides maximal parenchymal sparing. Methods Out of 98 bronchoplastic procedures performed at the Authors' Institution in the 1995-2011 period, 4 were LMBRR. Indications were bronchial carcinoid in 2 cases, inflammatory pseudotumor in 1 case, TBC stricture in 1 case. All patients underwent preoperatively a rigid bronchoscopy to restore the airway lumen patency. At surgery a negative resection margin was confirmed by frozen section in the neoplastic patients. In all patients an end-to-end bronchial anastomosis was constructed according to Grillo. Results There were neither mortality nor major complications. Airway lumen was optimal in 3 patients, good in 1. Conclusion LMBRR is a valuable option for the thoracic surgeon. It maximizes the parenchyma-sparing philosophy, broadening the spectrum of potential candidates for cure. It remains a technically demanding procedure, to be carried out by an experienced surgical team. Correct surgical planning affords excellent results, both in the short and long term.
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Park SY, Lee HS, Jang HJ, Joo J, Kim MS, Lee JM, Zo JI. Wedge bronchoplastic lobectomy for non–small cell lung cancer as an alternative to sleeve lobectomy. J Thorac Cardiovasc Surg 2012; 143:825-831.e3. [DOI: 10.1016/j.jtcvs.2011.10.057] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Revised: 09/14/2011] [Accepted: 10/21/2011] [Indexed: 10/15/2022]
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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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13
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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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Abstract
Ischemia is the primary risk factor for airway complications in double lung transplantation using tracheal anastomosis and in tracheal transplantation. Many treatment options as to revascularization for the trachea were herein described and reviewed. They include direct revascularization (using a conduit such as artery or vein), revascularization with tissue wrapping (using omentum, muscle, internal thoracic artery pedicle, pleura, or pericardial fat pad), and with drug administration (using corticosteroid hormone, prostaglandin, or angiogenic factor). As there are few organized reports including new information on revascularization for the trachea these days, this review article would help thoracic surgeons who get engaged transplantation.
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Affiliation(s)
- Ryoichi Nakanishi
- Department of Thoracic Surgery, Shin-Kokura Hospital, Federation of National Public Service Personnel Mutual Aid Associations, Kokurakita-ku, Kitakyushu, Japan.
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Lucchi M, Melfi F, Ribechini A, Dini P, Duranti L, Fontanini G, Mussi A. Sleeve and wedge parenchyma-sparing bronchial resections in low-grade neoplasms of the bronchial airway. J Thorac Cardiovasc Surg 2007; 134:373-7. [PMID: 17662775 DOI: 10.1016/j.jtcvs.2007.03.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2007] [Revised: 02/19/2007] [Accepted: 03/16/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Sleeve and wedge bronchial resections without parenchymal resection may represent a surgical option in selected cases of low-grade neoplasms of the airway. We reviewed our experience analyzing the indications, the operative technique, and the results of such operations. METHODS From 1980 to 2006, we performed 248 bronchoplastic procedures, and 26 of those were bronchoplastic procedures without parenchymal resection for low-grade neoplasms of the airway. There were 17 men and 9 women with a mean age of 49.4 years (range 19-74 years). All patients underwent a preoperative bronchoscopic study, which gave indication for such a procedure, and an intraoperative bronchoscopic examination confirming the feasibility and the good quality of the bronchial suture. The bronchial resection involved the trachea and the carina (n = 5), the main bronchi (n = 7), the intermediate bronchus (n = 2), the bronchial corner (n = 6), and the lobar bronchus (n = 6). RESULTS The resection margins were always tumor free. There was no operative mortality. The mean hospital stay was 6.7 days (range 4-16 days). One minimal dehiscence and no stenosis of the anastomosis were observed. In 1 case we experienced a granulation that required an endoscopic treatment. The histologic type was carcinoid (n = 18), mucoepidermoid (n = 2), adenoid cystic (n = 1), chondroma (n = 2), hamartoma (n = 1), melanoma endobronchial metastasis (n = 1), and glomic tumor (n = 1). The mean follow-up was 134 months and no local relapse occurred. CONCLUSION Bronchoplastic procedures without resection of the lung parenchyma are a suitable and fascinating technique for selected cases of low-grade endobronchial neoplasms.
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Affiliation(s)
- Marco Lucchi
- Division of Thoracic Surgery, University of Pisa, Pisa, Italy.
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Chang JW, Choi YS, Kim K, Shim YM, Lee KS, Kim HJ, Kim J. Main bronchial reconstruction with sparing of pulmonary parenchyma for benign diseases. J Korean Med Sci 2006; 21:1017-20. [PMID: 17179679 PMCID: PMC2721921 DOI: 10.3346/jkms.2006.21.6.1017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Main bronchial reconstruction is anatomically suitable for benign main bronchial stenosis. But, it has been hardly recommended for operative mortality and morbidity. This study was aimed at providing validity and the proper clinical information of bronchoplasty for benign main bronchial stenosis by reviewing the results we obtained over the last ten years for main bronchial reconstruction operations. We retrospectively reviewed admission and office records. Twenty eight consecutive patients who underwent main bronchoplasty were included. Enrolled patients underwent main bronchial reconstruction for benign disease (tuberculosis in 21, trauma in 4, endobronchial mass in 3). Concomitant procedures with main stem bronchoplasty were performed in 19 patients. There were no incidences of postoperative mortality and significant morbidity. There were 2 cases of retained secretions, and these problems were resolved by bronchoscopy or intubation. All of the patients are still alive without obstructive airway problem. Bronchoplasty should be considered as one of the primary treatment modalities, if it is anatomically feasible.
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Affiliation(s)
- Jee Won Chang
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Yong Soo Choi
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Kwanmien Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Young Mog Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Kyung Soo Lee
- Department of Imaging Medicine, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Ho Joong Kim
- Department of Respiratory Medicine, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Jhingook Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
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Varela-Simó G, Barberà-Mir JA, Cordovilla-Pérez R, Duque-Medina JL, López-Encuentra A, Puente-Maestu L. [Guidelines for the evaluation of surgical risk in bronchogenic carcinoma]. Arch Bronconeumol 2006; 41:686-97. [PMID: 16373045 DOI: 10.1016/s1579-2129(06)60336-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- G Varela-Simó
- Servicio de Cirugía Torácica, Hospital Universitario, Salamanca, Spain.
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Varela-Simó G, Barberà-Mir J, Cordovilla-Pérez R, Duque-Medina J, López-Encuentra A, Puente-Maestu L. Normativa sobre valoración del riesgo quirúrgico en el carcinoma broncogénico. Arch Bronconeumol 2005. [DOI: 10.1016/s0300-2896(05)70724-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ludwig C, Stoelben E, Olschewski M, Hasse J. Comparison of Morbidity, 30-Day Mortality, and Long-Term Survival After Pneumonectomy and Sleeve Lobectomy For Non–Small Cell Lung Carcinoma. Ann Thorac Surg 2005; 79:968-73. [PMID: 15734415 DOI: 10.1016/j.athoracsur.2004.08.062] [Citation(s) in RCA: 133] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/10/2004] [Indexed: 11/18/2022]
Abstract
BACKGROUND The advantage of sleeve lobectomy as an alternative to pneumonectomy for preserving lung function is obvious and among other arguments allows operating on patients with lung cancer who would not tolerate pneumonectomy. The purpose of this retrospective, nonrandomized study is to compare the early (30-day mortality) and late (5-year survival) outcomes of both procedures. METHODS The charts of 310 patients who underwent either pneumonectomy or sleeve lobectomy for lung cancer stages I to IIIA from 1987 to 1997 were reviewed. One hundred ninety-four patients underwent pneumonectomy, and 116 patients underwent sleeve lobectomy. Specific operative complications, i.e., anastomotic leakage versus stump dehiscence, perioperative complications, 30-day or in-hospital mortality, and 5-year survival were registered for comparison of the immediate risk of the respective procedures. RESULTS In the bronchial sleeve lobectomy group, the incidence of anastomotic leakage was 6.9% (8 of 116 patients) and the operative mortality was 4.3%. The incidence of bronchial stump fistulas after pneumonectomy was 3.6% (7 of 194 patients), and early mortality was 4.6%. All but 6 patients (98%) had a complete resection. Overall 5-year survival after sleeve lobectomy was 39% and after pneumonectomy, 27%. The distribution of 5-year survival stage by stage in either group is presented. Sleeve lobectomy, age younger than 65 years, pN0, and stage I are positive prognostic factors for long-term survival. In the multivariate analysis, pneumonectomy is a negative prognostic factor. CONCLUSIONS The indication for pneumonectomy versus sleeve lobectomy depends on the localization of the primary tumor on the one hand, and on cardiorespiratory function, which might be more often distinctly impaired in the sleeve group, on the other hand. This could explain why the mortality in the sleeve lobectomy group was identical with that in the pneumonectomy group. However, both techniques are appropriate treatment modalities of advanced lung cancer or patients with critical functional reserve. Therefore, whenever possible, sleeve lobectomy should be performed.
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Affiliation(s)
- Corinna Ludwig
- Department of Thoracic Surgery, University of Freiburg, Freiburg, Germany.
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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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Hollaus PH, Wilfing G, Wurnig PN, Pridun NS. Risk factors for the development of postoperative complications after bronchial sleeve resection for malignancy: a univariate and multivariate analysis. Ann Thorac Surg 2003; 75:966-72. [PMID: 12645725 DOI: 10.1016/s0003-4975(02)04542-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND This study was designed to identify risk factors responsible for postoperative complications after bronchoplastic procedures. METHODS Excluding sleeve pneumonectomies between January 1994 and December 2001, 108 patients underwent bronchoplastic procedures for bronchial malignancy. Prospectively documented data were age, gender, side, type of bronchial reconstruction, extended resection, histology, TNM stage, diseased lobe, and bronchial tumour occlusion. Cardiovascular (CV) risk factors included heart disease, arterial hypertension, cerebro-occlusive disease, peripheral artery disease of the lower extremities, diabetes mellitus, and abdominal aortic aneurysm. Patients were grouped according to the presence/absence of any CV risk factor and the absolute number of CV risk factors present (zero to four). Non-CV risk factors included neoadjuvant chemotherapy, alcoholism, lung disease, sleep apnea, history of recent pneumococcal sepsis, and repeat thoracotomy. Groups were assembled according to the presence or absence of any non-CV risk factor, neoadjuvant chemotherapy, and alcoholism. Respiratory risk factors included lung function and blood gas analysis. Groups were assembled according to the absolute number of respiratory risk factors in each person (zero to three) and the combination of respiratory and CV risk factors. Complications were defined as septic (pneumonia, empyema, brochopleural fistula, colitis) and aseptic. For univariate statistical analysis, t test, cross-tabulation, and chi2 test were used. All factors with a significance of p < 0.1 were entered into a binary backwards-stepwise logistic regression model. RESULTS The combination of respiratory and CV risk factors (p = 0.012, OR = 0.165) was predictive for overall complications. Coronary artery disease (p = 0.02, OR = 0.062) and the combination of two respiratory risk factors (p = 0.008, OR = 0.062) were predictive for septic complications. Peripheral artery disease (p = 0.024, OR = 0.28), moderate (p = 0.01, OR = 0.13) and severe chronic obstructive pulmonary disease (p = 0.018, OR = 0.11), and extended resections (p = 0.003, OR = 0.017.) were predictive for aseptic complications. CONCLUSIONS Comorbidity significantly influences the postoperative complication rate and is therefore crucial for evaluation of patients for bronchoplastic procedures. Different risk factors are responsible for the occurrence of septic and aseptic complications after bronchoplastic procedures.
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Affiliation(s)
- Peter H Hollaus
- Department of Thoracic Surgery, Otto Wagner Hospital, Vienna, Austria.
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Fujimura T, Kawaguchi AT, Ishibashi-Ueda H, Bergsland J, Koide S, Batista RJ. Partial left ventriculectomy for patients with ischemic cardiomyopathy. J Card Surg 2001; 16:145-52. [PMID: 11766833 DOI: 10.1111/j.1540-8191.2001.tb00500.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Partial left ventriculectomy (PLV) has been performed in patients with dilated cardiomyopathy (DCM), but improved myocardial energetics may make PLV useful also for ischemic cardiomyopathy (ICM) unamenable to conventional treatment. METHODS Of 262 patients undergoing PLV, 94 patients with ICM as the underlying pathology were analyzed and compared with 168 patients with DCM. RESULTS ICM patients were older (57.3 years vs 50.9 years, p = 0.0001) and heavier (69.7 kg vs 65.9 kg, p = 0.039) than those with DCM, but ventricular end-diastolic and end-systolic dimensions were similar with comparably depressed fractional shortening (16% vs 15%, p = 0.294) and equally severe functional limitation [New York Heart Association (NYHA) Class 3.7 vs 3.6, p = 0.734]. A majority of patients in both groups underwent lateral PLV (76% vs 74%, p = 0.883) with myocardium excised between papillary muscles and simultaneous mitral valvuloplasty (41% vs 74%, p < 0.0001). Because ICM patients required coronary artery bypass grafting (CABG) more frequently (79% vs 0.6%, p < 0.0001), operation was more extensive in terms of bypass time (74 minutes vs 47 minutes, p < 0.0001), percentage requiring cardiac arrest (43% vs 19%, p < 0.0001), and arrest duration (34 minutes vs 28 minutes, p = 0.280), but all had similar resection and postoperative ventricular dimensions. Nonetheless, ICM patients required shorter intensive care unit (ICU) time (4.4 days vs 5.9 days, p = 0.048) and similar postoperative hospital stays, resulting in similar hospital survival rates (69% vs 71%, p = 0.778) and functional capacity in long-term follow-up. CONCLUSIONS Results suggest that PLV can be performed in patients with ICM with comparable risks and benefits as in DCM. Relative efficacy of CABG and mitral repair as compared to volume reduction remains to be studied.
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Affiliation(s)
- T Fujimura
- Department of Cardiovascular Surgery and Transplantation, Tokai University, Bohseidai, Isehara, Japan
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Pezzella AT, Adebonojo SA, Hooker SG, Mabogunje OA, Conlan AA. Complications of general thoracic surgery. Curr Probl Surg 2000; 37:733-858. [PMID: 11082724 DOI: 10.1016/s0011-3840(00)80009-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- A T Pezzella
- Department of Surgery, University of Massachusetts Medical Center, Worcester, USA
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Lausberg HF, Graeter TP, Wendler O, Demertzis S, Ukena D, Schäfers HJ. Bronchial and bronchovascular sleeve resection for treatment of central lung tumors. Ann Thorac Surg 2000; 70:367-71; discussion 371-2. [PMID: 10969646 DOI: 10.1016/s0003-4975(00)01725-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND To improve postoperative pulmonary reserve, we have employed parenchyma-sparing resections for central lung tumors irrespective of pulmonary function. The results of lobectomy, pneumonectomy, and sleeve resection were analyzed retrospectively. METHODS From October 1995 to June 1999, 422 typical lung resections were performed for lung cancer. Of these, 301 were lobectomies (group I), 81 were sleeve resections (group II), and 40 were pneumonectomies (group III). RESULTS Operative mortality was 2% in group I, 1.2% in group II, and 7.5% in group III (group I and II vs. group III, p<0.03). Mean time of intubation was 1.0+/-4.1 days in group I, 0.9+/-1.3 days in group II, and 3.6+/-11.2 days in group III (groups I and II vs. group III, p<0.01). The incidence of bronchial complications was 1.3% in group I, none in group II, and 7.5% in group III (group I and II vs group III, p<0.001). After 2 years, survival was 64% in group I, 61.9% in group II, and 56.1% in group III (p = NS). Freedom from local disease recurrence was 92.1% in group I, 95.7% in group II, and 90.9% in group III after 2 years (p = NS). CONCLUSIONS Sleeve resection is a useful surgical option for the treatment of central lung tumors, thus avoiding pneumonectomy with its associated risks. Morbidity, early mortality, long-term survival, and recurrence of disease after sleeve resection are similar to those seen after lobectomy.
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Affiliation(s)
- H F Lausberg
- Department of Thoracic and Cardiovascular Surgery, University Hospitals Homburg, Homburg/Saar, Germany
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