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Tiwari V, Wagh P. Left-Sided Destroyed Lung With Severe Pulmonary Arterial Hypertension as a Consequence of Recurrent Pulmonary Tuberculosis. Cureus 2024; 16:e56870. [PMID: 38659570 PMCID: PMC11040399 DOI: 10.7759/cureus.56870] [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: 03/03/2024] [Accepted: 03/24/2024] [Indexed: 04/26/2024] Open
Abstract
Pulmonary tuberculosis is an infection caused by Mycobacterium tuberculosis, which is an obligate aerobic microbe. Tuberculosis is a multisystemic disease that can attack the respiratory system, genitourinary system, central nervous system, gastrointestinal system, and the skeletal framework of the body. However, the most commonly affected system is the respiratory system (pulmonary tuberculosis). Tuberculosis is an ancient infection that affects millions of people every year, and even after adequate treatment, it is associated with significant morbidity and mortality, which can be attributed to reinfections, complications, extrapulmonary spread, and the long-term effects of tuberculosis on the lungs, leading to various restrictive and obstructive diseases. One of the most hazardous sequelae of pulmonary tuberculosis is the destroyed lung, which is predominately seen in the culminating stage of progressive disease or after reactivation of the disease. Here we present the case of a 46-year-old female patient who presented with complaints of breathlessness, cough with expectoration, and chest pain. With a history of recurrent tuberculosis infections and appropriate antituberculosis treatment for 30 years, the primary infection was recognized at 16 years of age. On examination, the patient was suspected to have developed fibrosis of the left lung, which, on radiological investigation, was confirmed to be a case of a destroyed left lung because of a recurrent tuberculosis infection. The patient was given symptomatic treatment along with broad-spectrum antibiotic therapy.
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Affiliation(s)
- Varun Tiwari
- Respiratory Medicine, Jawaharlal Nehru Medical College, Wardha, IND
| | - Pankaj Wagh
- Respiratory Medicine, Jawaharlal Nehru Medical College, Wardha, IND
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Bazhenov AV, Mariandyshev AO, Hinderaker SG, Heldal E, Motus IY, Vasilyeva IA. Prevention of bronchial fistulas after pneumonectomies for selected cavitary drug resistant lung tuberculosis. Front Surg 2023; 10:1151137. [PMID: 37065999 PMCID: PMC10097893 DOI: 10.3389/fsurg.2023.1151137] [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: 01/25/2023] [Accepted: 03/10/2023] [Indexed: 04/18/2023] Open
Abstract
Background The World Health Organization guidelines for management drug resistant tuberculosis include surgery as an additional method in selected cases. Pneumonectomies have higher risk of morbidity such as bronchial fistulas which may be prevented by bronchial stump covering. We compare two methods of bronchial stump reinforcement. Methods and materials A retrospective single center follow-up study was done in 52 patients who underwent pneumonectomy for drug resistant pulmonary tuberculosis. Between 2000 and 2017 we performed pneumonectomies with pericardial fat reinforcement of bronchial stump in group 1 (n = 42), and between 2017 and 2021 in group 2 with pedicled muscle flap reinforcement group 2 (n = 10). Results Bronchial fistulas occurred in 17/42 (41%) of patients group 1 and there was no fistula in group 2, and this was statistically different (Fisher's test p = 0.02). Post-operative complications were seen in 24/42 (57%) of the patients in Group 1, and 4/10 (40%) patients in Group 2 (Fischer's test p = 0.53). In group 1 positive bacteriology decreased from 74% to 24% just after surgery, and in group 2 it decreased from 90% to 10%, but this was not statistically different (Fisher's test p = 0.63). In group 1 no-one died the first month, but 8/42 (19%) died within a year; in group 2 one died within a month, and only this death (10%) within a year. This difference in case fatality was not statistically significant. Conclusions The use of pedicle muscle flap for bronchial stump coverage during the pneumonectomies for destructive drug resistant tuberculosis can prevent severe postoperative fistulas and improve postoperative life.
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Affiliation(s)
- Alexander V. Bazhenov
- Department of Thoracic Surgery, Ural Research Institute for Phthisiopulmonology—a Branch “National Medical Research Center of Phthisiopulmonology and Infectious Diseases”, Ekaterinburg, Russia
| | - Andrei O. Mariandyshev
- Northern State Medical University, Arkhangelsk, Russia
- Northern Arctic Federal University, Arkhangelsk, Russia
| | - Sven G. Hinderaker
- University of Bergen, Bergen, Norway
- Correspondence: Sven Gudmund Hinderaker
| | | | - Igor Ya. Motus
- Department of Thoracic Surgery, Ural Research Institute for Phthisiopulmonology—a Branch “National Medical Research Center of Phthisiopulmonology and Infectious Diseases”, Ekaterinburg, Russia
| | - Irina A. Vasilyeva
- National Medical Research Center of Phthisiopulmonology and Infectious Diseases, Moscow, Russia
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D'Ambrosio PD, Mariani AW, Júnior ER, de Medeiros IL, Oliveira LCS, Neto AG, Terra RM, Pêgo-Fernandes PM. Current morbimortality and one-year survival after pneumonectomy for infectious diseases. Clinics (Sao Paulo) 2023; 78:100169. [PMID: 36805148 PMCID: PMC9957743 DOI: 10.1016/j.clinsp.2023.100169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/25/2022] [Accepted: 12/29/2022] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVE Identify the one-year survival rate and major complications in patients submitted to pneumonectomy for infectious disease. METHODS Retrospective data from all cases of infectious disease pneumonectomy over the past 10 years were collected from two reference centers. The authors analyzed: patient demographics, etiology, laterality, bronchial stump treatment, presence of previous pulmonary resection, postoperative complications in the first 30 days, the treatment used in pleural complications, and one-year survival rate. RESULTS 56 procedures were performed. The average age was 44 years, with female predominance (55%). 29 cases were operated on the left side (51%) and the most frequent etiology was post-tuberculosis (51.8%). The overall incidence of complications was 28.6% and the most common was empyema (19.2%). Among empyema cases, 36.3% required pleurostomy, 27.3% required pleuroscopy and 36.3% underwent thoracoplasty for treatment. Bronchial stump fistula was observed in 10.7% of cases. From all cases, 16.1% were completion pneumonectomies and 62.5% of these had some complication, a significantly higher incidence than patients without previous surgery (p = 0.0187). 30-day in-hospital mortality was (7.1%) with 52 cases (92.9%) and 1-year survival. The causes of death were massive postoperative bleeding (1 case) and sepsis (3 cases). CONCLUSIONS Pneumonectomy for benign disease is a high-risk procedure performed for a variety of indications. While morbidity is often significant, once the perioperative risk has passed, the one-year survival rate can be very satisfying in selected patients with benign disease.
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Affiliation(s)
- Paula Duarte D'Ambrosio
- Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil.
| | - Alessandro Wasum Mariani
- Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Eserval Rocha Júnior
- Instituto do Câncer, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | | | | | | | - Ricardo Mingarini Terra
- Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Paulo Manuel Pêgo-Fernandes
- Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
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Garrana SH, Buckley JR, Rosado-de-Christenson ML, Martínez-Jiménez S, Muñoz P, Borsa JJ. Multimodality Imaging of Focal and Diffuse Fibrosing Mediastinitis. Radiographics 2019; 39:651-667. [PMID: 30951437 DOI: 10.1148/rg.2019180143] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Fibrosing mediastinitis is a rare benign but potentially life-threatening process that occurs because of proliferation of fibrotic tissue in the mediastinum. The focal subtype is more common and typically is associated with an abnormal immunologic response to Histoplasma capsulatum infection. Affected patients are typically young at presentation, but a wide age range has been reported, without a predilection for either sex. The diffuse form may be idiopathic or associated with autoimmunity, usually affects middle-aged and/or elderly patients, and is more common in men. For both subtypes, patients present with signs and symptoms related to obstruction or compression of vital mediastinal structures. The most common presenting signs and symptoms are cough, dyspnea, recurrent pneumonia, hemoptysis, and pleuritic chest pain. Patients with the diffuse subtype may have additional extrathoracic symptoms depending on the other organ systems involved. Because symptom severity is variable, treatment should be individualized with therapies tailored to alleviate compression of the affected mediastinal structures. Characteristic imaging features of fibrosing mediastinitis include infiltrative mediastinal soft tissue (with or without calcification) with compression or obstruction of mediastinal vascular structures and/or the aerodigestive tract. When identified in the appropriate clinical setting, these characteristic features allow the radiologist to suggest the diagnosis of fibrosing mediastinitis. Careful assessment is crucial at initial and follow-up imaging for exclusion of underlying malignancy, assessment of disease progression, identification of complications, and evaluation of treatment response. Online supplemental material is available for this article. ©RSNA, 2019.
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Affiliation(s)
- Sherief H Garrana
- From the Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri in Kansas City, 4401 Wornall Rd, Kansas City, MO 64111 (S.H.G., J.R.B., M.L.R.d.C., S.M.J., J.J.B.); and Ameripath, Kansas City, Mo (P.M.)
| | - Jennifer R Buckley
- From the Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri in Kansas City, 4401 Wornall Rd, Kansas City, MO 64111 (S.H.G., J.R.B., M.L.R.d.C., S.M.J., J.J.B.); and Ameripath, Kansas City, Mo (P.M.)
| | - Melissa L Rosado-de-Christenson
- From the Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri in Kansas City, 4401 Wornall Rd, Kansas City, MO 64111 (S.H.G., J.R.B., M.L.R.d.C., S.M.J., J.J.B.); and Ameripath, Kansas City, Mo (P.M.)
| | - Santiago Martínez-Jiménez
- From the Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri in Kansas City, 4401 Wornall Rd, Kansas City, MO 64111 (S.H.G., J.R.B., M.L.R.d.C., S.M.J., J.J.B.); and Ameripath, Kansas City, Mo (P.M.)
| | - Phillip Muñoz
- From the Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri in Kansas City, 4401 Wornall Rd, Kansas City, MO 64111 (S.H.G., J.R.B., M.L.R.d.C., S.M.J., J.J.B.); and Ameripath, Kansas City, Mo (P.M.)
| | - John J Borsa
- From the Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri in Kansas City, 4401 Wornall Rd, Kansas City, MO 64111 (S.H.G., J.R.B., M.L.R.d.C., S.M.J., J.J.B.); and Ameripath, Kansas City, Mo (P.M.)
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Short-Term Outcome of Three-Dimensional Versus Two-Dimensional Video-Assisted Thoracic Surgery for Benign Pulmonary Diseases. Ann Thorac Surg 2016; 101:1297-302. [DOI: 10.1016/j.athoracsur.2015.10.042] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 08/25/2015] [Accepted: 10/13/2015] [Indexed: 01/10/2023]
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Gorospe L, Ayala-Carbonero AM, Fernández-Méndez MÁ, Arrieta P, Muñoz-Molina GM, Cabañero-Sánchez A, Mañas-Baena E. Idiopathic fibrosing mediastinitis: spectrum of imaging findings with emphasis on its association with IgG4-related disease. Clin Imaging 2015; 39:993-9. [DOI: 10.1016/j.clinimag.2015.07.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 07/06/2015] [Accepted: 07/10/2015] [Indexed: 12/19/2022]
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Yang L, Ding CL, Chang XJ, Li FG, Zhang TH, Wang ZT. Analysis of Pneumonectomy for Benign Disease: A Single Institution Retrospective Study on 59 Patients. Ann Thorac Cardiovasc Surg 2015; 21:440-5. [PMID: 26004112 DOI: 10.5761/atcs.oa.14-00361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Pneumonectomy is the only curative treatment for some benign diseases but the operation is a challenging procedure. Herein, we present our experiences of pneumonectomy for 59 patients. METHODS The medical records of 59 patients who undergone pneumonectomy for benign lung diseases from 2008 to 2013 at the Division of Thoracic Surgery in Beijing Chest Hospital were retrospectively reviewed. RESULTS There were 23 male and 36 female patients. Three procedures including pneumonectomy, pleuropneumonectomy and completion pneumonectomy were used. The operative time and intraoperative blood loss were statistically different in the patients who undergone different operations. The operative time of the patients with and without tuberculosis had no difference but the intraoperative blood loss was more in the patients with tuberculosis (P = 0.035). The operative type, age and operative blood loss were relevant with the morbidity, the P value were 0.024, 0.042 and 0.027 respectively. CONCLUSIONS Pneumonectomy for patients with benign disease may be more difficult than for patients with lung cancer, mean while pleuropneumonectomy and completion pneumonectomy may be greater challenges. But with careful patient selection and operative technique, it is a satisfactory treatment method for benign lung disease. The morbidity is acceptable and associated with operative type, age and operative blood loss.
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Affiliation(s)
- Lei Yang
- Thoracic Department, Beijing Chest Hospital, Capital Medical University, Beijing, China
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8
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Arame A, Rivera C, Mordant P, Pricopi C, Foucault C, Badia A, Le Pimpec Barthes F, Riquet M. [Pneumonectomy for benign disease: indication and factors affecting the postoperative course]. REVUE DE PNEUMOLOGIE CLINIQUE 2015; 71:1-4. [PMID: 25131368 DOI: 10.1016/j.pneumo.2014.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 03/28/2014] [Accepted: 04/02/2014] [Indexed: 06/03/2023]
Abstract
Pneumonectomy for benign disease is rare but may generate more postoperative morbimortality than when performed for lung cancer. We questioned this assessment and retrospectively reviewed 1436 pneumonectomies and 54 completions of which 82 and 10 performed for benign disease (5.7% and 18.5%, respectively): left n=65 and right n=27. Indications were: post-tuberculosis destroyed lung (n=37), aspergilloma (n=18), bronchiectasis (n=19), infection (n=5), congenital malformations (n=5), inflammatory pseudotumor (n=3), trauma (n=2), post-radiation (n=2) and mucormycosis (n=1). Pneumonectomy consisted of 48 standard and 44 pleuro-pneumonectomies. Stump coverage by flaps was performed in 66.3% (61/92). Complications occurred in 21.7% (20/92) and postoperative deaths in 7.6% (7/92, of which 5 with fungal infections), which was not different than what was observed in lung cancer. There was no difference in fistula formation and mortality regarding the side, the type of resection and the protective role of stump coverage. Considering patients with fungal infections versus others, mortality was 26.3% (n=5/19) and 2.7% (n=2/74), respectively (P=0.0028). Pneumonectomy for benign disease achieves cure with acceptable mortality and morbidity. However, presence of fungal infection should raise the attention for possibility of increased postoperative risks.
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Affiliation(s)
- A Arame
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, Paris Descartes université, 20-40, rue Leblanc, 75015 Paris, France
| | - C Rivera
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, Paris Descartes université, 20-40, rue Leblanc, 75015 Paris, France
| | - P Mordant
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, Paris Descartes université, 20-40, rue Leblanc, 75015 Paris, France
| | - C Pricopi
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, Paris Descartes université, 20-40, rue Leblanc, 75015 Paris, France
| | - C Foucault
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, Paris Descartes université, 20-40, rue Leblanc, 75015 Paris, France
| | - A Badia
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, Paris Descartes université, 20-40, rue Leblanc, 75015 Paris, France
| | - F Le Pimpec Barthes
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, Paris Descartes université, 20-40, rue Leblanc, 75015 Paris, France
| | - M Riquet
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, Paris Descartes université, 20-40, rue Leblanc, 75015 Paris, France.
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Rivera C, Arame A, Pricopi C, Riquet M, Mangiameli G, Abdennadher M, Dahan M, Le Pimpec Barthes F. Pneumonectomy for benign disease: indications and postoperative outcomes, a nationwide study. Eur J Cardiothorac Surg 2014; 48:435-40; discussion 440. [PMID: 25414429 DOI: 10.1093/ejcts/ezu439] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 10/13/2014] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Pneumonectomy for benign disease is rare but is thought to have a higher more postoperative morbidity and mortality than when performed for lung cancer. We questioned this by assessing and analysing indications and postoperative outcomes of patients who underwent this type of resection. METHODS We used Epithor, the French national thoracic database including 91 public and private institutions with more than 220 000 procedures. We prospectively collected data of 5975 patients who underwent pneumonectomy between January 2003 and June 2013. The 321 patients (5.4%) who underwent pneumonectomy (n = 201) or completion pneumonectomy (n = 120) for benign disease were compared with those treated for malignant disease. RESULTS The patients' mean age was 55.2 years (53.5; 56.8) for benign indications vs 61.6 years (61.4; 61.9) for malignant disease; the sex ratio was 1.8 (207 males) and 4 (4543 males), respectively; 53% of patients (n = 169) had an American Society of Anesthesiologist (ASA) score of ≥3 vs 29% (n = 1598) for malignant disease. For benign disease, most frequent indications were infection or abscess (n = 114, 37.1%), post-tuberculosis destroyed lung (n = 47, 15.3%), aspergillosis or aspergilloma (n = 33, 10.7%), bronchiectasis (n = 41, 13.3%), haemorrhage (n = 26, 8.5%) and benign tumour (n = 20, 6.5%). Complications occurred in 53% (n = 170) of patients and the postoperative in-hospital mortality rate was 22.1% (n = 71). These results were significantly worse than those for malignant indications: 38.9% (n = 2198) of morbidity (P < 0.0001) and 5.1% (n = 288) of in-hospital mortality (P < 0.0001). For benign disease, there was no difference in fistula formation regarding side (P = 0.07) or type of resection (P = 0.6). Morbidity was higher for completion pneumonectomy: 62.5 vs 47.3% (P = 0.008). Mortality was significantly higher in case of resection for infection or abscess (P = 0.01) and for haemorrhage (P = 0.002). Emergency procedures were associated with worse postoperative outcomes (P < 0.0001). CONCLUSIONS Pneumonectomy for benign disease achieves cure with very high levels of morbidity and mortality. This type of surgical treatment should be considered as a salvage procedure.
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Affiliation(s)
- Caroline Rivera
- General Thoracic Surgery, Georges Pompidou European Hospital, Paris Descartes University, Paris, France EPITHOR Group, French Society of Thoracic and Cardiovascular Surgery, Paris, France
| | - Alex Arame
- General Thoracic Surgery, Georges Pompidou European Hospital, Paris Descartes University, Paris, France
| | - Ciprian Pricopi
- General Thoracic Surgery, Georges Pompidou European Hospital, Paris Descartes University, Paris, France
| | - Marc Riquet
- General Thoracic Surgery, Georges Pompidou European Hospital, Paris Descartes University, Paris, France
| | - Giuseppe Mangiameli
- General Thoracic Surgery, Georges Pompidou European Hospital, Paris Descartes University, Paris, France
| | - Mahdi Abdennadher
- General Thoracic Surgery, Georges Pompidou European Hospital, Paris Descartes University, Paris, France
| | - Marcel Dahan
- EPITHOR Group, French Society of Thoracic and Cardiovascular Surgery, Paris, France
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Newington DF, Ismail S. Laparoscopic cholecystectomy in a patient with previous pneumonectomy: a case report and discussion of anaesthetic considerations. Case Rep Anesthesiol 2014; 2014:582078. [PMID: 25431680 PMCID: PMC4241691 DOI: 10.1155/2014/582078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 10/16/2014] [Indexed: 11/18/2022] Open
Abstract
Increasing numbers of patients require cholecystectomy after previous pneumonectomy, but there are little data to guide anaesthetic management. A laparoscopic approach is associated with less postoperative respiratory compromise than open cholecystectomy but may be relatively contraindicated due to the undesirable effects of pneumoperitoneum on respiratory function. We describe the case of a 72-year-old patient who successfully underwent elective laparoscopic cholecystectomy 23 years after left pneumonectomy. An understanding of the combined physiological consequences of pneumonectomy and pneumoperitoneum facilitated the provision of safe and uneventful anaesthesia. We propose that laparoscopic cholecystectomy is feasible and safe to perform in patients with a single lung.
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Affiliation(s)
- Dash Faith Newington
- Department of Anaesthesia, Launceston General Hospital, Charles Street, Launceston, TAS 7250, Australia
| | - Sanaa Ismail
- Department of Anaesthesia, Dubbo Base Hospital, Myall Street, Dubbo, NSW 2830, Australia
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Pipanmekaporn T, Punjasawadwong Y, Charuluxananan S, Lapisatepun W, Bunburaphong P, Patumanond J, Saeteng S, Chandee T. Incidence of and Risk Factors for Cardiovascular Complications After Thoracic Surgery for Noncancerous Lesions. J Cardiothorac Vasc Anesth 2014; 28:948-53. [DOI: 10.1053/j.jvca.2014.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Indexed: 11/11/2022]
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Pipanmekaporn T, Punjasawadwong Y, Charuluxananan S, Lapisatepun W, Bunburaphong P, Saeteng S. Association of positive fluid balance and cardiovascular complications after thoracotomy for noncancer lesions. Risk Manag Healthc Policy 2014; 7:121-9. [PMID: 25050079 PMCID: PMC4090221 DOI: 10.2147/rmhp.s64585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Objective The purpose of this study was to explore the influence of positive fluid balance on cardiovascular complications after thoracotomy for noncancer lesions. Methods After approval from an institutional review board, a retrospective cohort study was conducted. All consecutive patients undergoing thoracotomy between January 1, 2005 and December 31, 2011 in a single medical center were recruited. The primary outcome of the study was the incidence of cardiovascular complications, which were defined as cardiac arrhythmia, cardiac arrest, heart failure, myocardial ischemia, and pulmonary embolism. Univariable and multivariable risk regression analyses were used to evaluate the association between positive fluid balance and cardiovascular complications. Results A total of 720 patients were included in this study. The incidence of cardiovascular complications after thoracotomy for noncancer lesions was 6.7% (48 of 720). Patients with positive fluid balance >2,000 mL had a significantly higher incidence of cardiovascular complications than those with positive fluid balance ≤2,000 mL (22.2% versus 7.0%, P=0.005). Cardiac arrhythmias were the most common complication. Univariable risk regression showed that positive fluid balance >2,000 mL was a significant risk factor (risk ratio =3.15, 95% confident interval [CI] =1.44–6.90, P-value =0.004). After adjustment for all potential confounding variables during multivariable risk regression analysis, positive fluid balance >2,000 mL remained a strong risk factor for cardiovascular complications (risk ratio =2.18, 95% CI =1.36–3.51, P-value =0.001). Causes of positive fluid balance >2,000 mL included excessive hemorrhage (48%), hypotension without excessive hemorrhage (29.6%), and liberal fluid administration (22.4%). Conclusion Positive fluid balance was a significant risk factor for cardiovascular complications. Strategies to minimize positive fluid balance during surgery for patients at high risk of cardiovascular complications include preparing adequate blood and blood products, considering appropriate hemoglobin level as a transfusion trigger, and adjusting the optimal dose of local anesthetic for intraoperative thoracic epidural analgesia.
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Affiliation(s)
- Tanyong Pipanmekaporn
- Clinical Epidemiology Program, Chiang Mai University, Chiang Mai, Thailand ; Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Yodying Punjasawadwong
- Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Somrat Charuluxananan
- Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Worawut Lapisatepun
- Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pavena Bunburaphong
- Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Somchareon Saeteng
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Hamaji M, Keegan MT, Cassivi SD, Shen KR, Wigle DA, Allen MS, Nichols FC, Deschamps C. Outcomes in patients requiring mechanical ventilation following pneumonectomy. Eur J Cardiothorac Surg 2014; 46:e14-9. [DOI: 10.1093/ejcts/ezu208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Martin J, Ferraris VA, Saha SP. Pneumonectomy for nonmalignant disease. Asian Cardiovasc Thorac Ann 2014; 22:824-8. [DOI: 10.1177/0218492314521824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Pneumonectomy for nonmalignant disease is unusual. We wondered about the incidence, predisposing risks, and outcomes of this entity. Methods We interrogated the Society of Thoracic Surgeons General Thoracic Surgery Database to compare patients undergoing pneumonectomy for benign or malignant indications between 2006 and 2010. Results 309 of 3081 (10%) patients underwent pneumonectomy for nonmalignant conditions. The benign group were younger (56 vs. 62 years), more likely to be on steroid therapy (11.3% vs. 2.7%), and less likely to be current smokers (14.4% vs. 20.1%). Both groups had an equal incidence of comorbidities. Preoperative pulmonary function was decreased in the nonmalignant group: forced expiratory volume in 1 s 61% vs. 74% of predicted; carbon monoxide diffusion in the lung 61% vs. 71% of predicted. The most common nonmalignant etiologies requiring pneumonectomy were lung and pleural infections. The benign group had increased postoperative bleeding, infections, and lung-related complications. Conclusions Approximately 10% of patients undergoing pneumonectomy have nonmalignant disease. In these cases, careful patient selection with detailed preoperative preparation including improvement in nutrition and functional status are indicated. Technical aspects of pneumonectomy, which minimize perioperative bleeding and infectious complications, are particularly important when this surgery is performed for nonmalignant conditions.
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Affiliation(s)
- Jeremiah Martin
- Department of Surgery, University of Kentucky, Lexington, Kentucky, USA
| | - Victor A Ferraris
- Department of Surgery, University of Kentucky, Lexington, Kentucky, USA
| | - Sibu P Saha
- Department of Surgery, University of Kentucky, Lexington, Kentucky, USA
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Hu XF, Duan L, Jiang GN, Wang H, Liu HC, Chen C. Risk Factors for Early Postoperative Complications After Pneumonectomy for Benign Lung Disease. Ann Thorac Surg 2013; 95:1899-904. [DOI: 10.1016/j.athoracsur.2013.03.051] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Revised: 03/18/2013] [Accepted: 03/22/2013] [Indexed: 11/24/2022]
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Puri V, Tran A, Bell JM, Crabtree TD, Kreisel D, Krupnick AS, Patterson GA, Meyers BF. Completion pneumonectomy: outcomes for benign and malignant indications. Ann Thorac Surg 2013; 95:1885-90; discussion 1890-1. [PMID: 23647859 DOI: 10.1016/j.athoracsur.2013.04.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 04/02/2013] [Accepted: 04/05/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Past series have identified completion pneumonectomy (CP) as a high-risk operation. We evaluated factors affecting outcomes of CP with a selective approach to offering this operation. METHODS We analyzed a prospective institutional database and abstracted information on patients undergoing pneumonectomy. Patients undergoing CP were compared with those undergoing primary pneumonectomy (PP). RESULTS Between January 2000 and February 2011, 211 patients underwent pneumonectomy, of which 35 (17%) were CPs. Ten of 35 (29%) CPs were for benign disease and 25 of 35 (71%) for cancer. Major perioperative morbidity was seen in 21 of 35 (60%) with 4 (11%) perioperative deaths. In univariate analysis, postoperative bronchopleural fistula (p = 0.05) and benign diagnosis (p = 0.07) tended to be associated with perioperative mortality. All 10 patients undergoing CP for benign disease developed a major complication compared with 11 of 25 (44%) with malignancy, p = 0.002. A bronchopleural fistula (4 of 35, 11%) was more likely to occur in patients undergoing CP shortly after the primary operation (interval between lobectomy and CP; 0.28 vs 4.5 years; p = 0.018) with a trend toward a benign indication for operation (p = 0.07). Median survival after CP for benign and malignant indications was 24.3 months and 36.5 months, respectively. Comparing CP patients to those undergoing PP (n = 176), CP patients were more likely to undergo an operation for benign disease (10 of 35, 29% vs 14 of 176, 8%, p = 0.001). Perioperative mortality for PP was 10 of 176 (5.7%), and was statistically similar to CP (11%). CONCLUSIONS Despite a selective approach, CP remains a morbid operation, particularly for benign indications. Rigorous preoperative optimization, ruling out contraindications to operation and attention to technical detail, are recommended.
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Affiliation(s)
- Varun Puri
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
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