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Abstract
Pathologic diagnosis of thymic tumors (TTs) can be made by surgical or nonsurgical procedures. About 20% of TTs had been diagnosed by pretreatment biopsy methods while the rest had gone to surgery for diagnosis and treatment. However, in the last two decades there was an increase in pretreatment procedures for optimal management of locally advanced or metastatic TTs. Pretreatment tissue diagnosis of a noninvasive TT is not a standard option but is required if there is suspect or atypical clinical presentation and imaging, an invasive tumor requiring a nonsurgical approach or preoperative chemotherapy or chemo-radiotherapy, strong possibility of lymphoma or unclear differential diagnosis between lymphoma or other solid tumor by imaging studies, or suspicion of a metastatic lesion. In surgical diagnosis anterior mediastinotomy, video-assisted thoracic surgery or mediastinoscopy can be chosen for invasive TTs whereas total resection is performed for small, noninvasive tumors. Nonsurgical diagnosis can be made by transthoracic fine or core needle biopsies (TTFNA, TTCNB), conventional bronchoscopy, endobronchial ultrasonography-guided transbronchial needle aspiration (EBUS-TBNA), endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) or medical thoracoscopy depending on procedural amenability according to tumor extension. TTFNA and TTCNB have been the most frequently used nonsurgical methods. However, there is an upward trend in using conventional bronchoscopy, EBUS-TBNA, EUS-FNA and medical thoracoscopy recently. To increase the diagnostic performance of these procedures in TTs, recommendations are (I) obtaining histologic specimens, (II) combining smears or liquid based cytology preparations and cell blocks, (III) obtaining multiple sufficient samples, (IV) combining histologic and cytologic specimens, (V) performing morphologic, immunohistochemical and molecular analyses on all specimens, (VI) using rapid onsite evaluation for cytologic specimens, (VII) correlating pathologic, clinical and radiologic findings, (VIII) consulting experienced pathologists.
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Affiliation(s)
- Semra Bilaçeroğlu
- University of Health Sciences-Turkey, Izmir Dr. Suat Seren Training and Research Hospital for Thoracic Medicine and Surgery, Izmir, Turkey
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Kanesan N, Mohamad I, Mohamad Umbaik NA, Zawawi N. Carcinosarcoma of the Mediastinum: A Rare Cause of Vocal Cord Palsy and Progressive Dysphagia. Medeni Med J 2020; 35:166-169. [PMID: 32733767 PMCID: PMC7384507 DOI: 10.5222/mmj.2020.82956] [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: 02/26/2020] [Accepted: 04/13/2020] [Indexed: 11/05/2022] Open
Abstract
Carcinosarcoma is a rare type of malignant tumour that possess both the elements of carcinoma and sarcoma. They may occur in various locations such as the uterus, breast, thyroid, lung and gastrointestinal system. However, very few primary mediastinal carcinosarcomas have been reported. We are presenting a case of a 75-year-old male who presented with progressive dysphagia and hoarseness for 3 weeks. Contrast-enhanced computed tomography of the neck showed features of enlarged mediastinal necrotic nodes and the biopsy of this mass showed morphology and immunohistochemical profile that are consistent with carcinosarcoma. However, the patient succumbed to his illness soon after diagnosis.
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Affiliation(s)
- Nithya Kanesan
- Universiti Sains Malaysia, Health Campus, School of Medical Sciences, Department of Otorhinolaryngology-Head and Neck Surgery, Kelantan, Malaysia
| | - Irfan Mohamad
- Universiti Sains Malaysia Health Campus, School of Medical Sciences, Department of Otorhinolaryngology-Head and Neck Surgery, Kelantan, Malaysia
| | | | - Norzaliana Zawawi
- Universiti Sains Malaysia, Health Campus, School of Dental Sciences, Kelantan, Malaysia
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Santini M, Fiorelli A. Surgery: Recommendations for Surgeons. CURRENT CLINICAL PATHOLOGY 2018:43-64. [DOI: 10.1007/978-3-319-90368-2_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Terra RM. Thymic minimally invasive surgery: state of the art across the world: Central-South America. J Vis Surg 2017; 3:124. [PMID: 29078684 DOI: 10.21037/jovs.2017.07.13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 07/18/2017] [Indexed: 11/06/2022]
Abstract
Literature suggests that, for thymectomy in myasthenia or resection of thymic tumors, minimally invasive surgery is equivalent to open surgery with regard to long-term outcomes. However, it could bring some benefits in the immediate results as complication rate or length-of-stay. There are doubts about the worldwide adoption of the method, though. In Latin America, the implementation of video-assisted thoracic surgery (VATS) started in the 1990s, but it progressed slowly. The main barriers were associated costs and training. Thymic surgery poses a bigger challenge due to its rarity, so just a few reports mention the use of the method in the region. Nonetheless, in recent years we observe a faster dissemination of the method both in number and in complexity of the procedures performed. Confirming this fact, half of the patients registered in the Brazilian Society of Thoracic Surgery database in the last 2 years as undergoing resection of thymic tumors, underwent a minimally invasive procedure. Although promising, robotic surgery is still in its early days in Latin America.
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Terra RM, Araujo PHXND, Lauricella LL, Campos JRMD, Costa HF, Pego-Fernandes PM. Robotic pulmonary lobectomy for lung cancer treatment: program implementation and initial experience. J Bras Pneumol 2017; 42:185-90. [PMID: 27383931 PMCID: PMC5569613 DOI: 10.1590/s1806-37562015000000212] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 02/25/2016] [Indexed: 11/22/2022] Open
Abstract
Objective: To describe the implementation of a robotic thoracic surgery program at a public tertiary teaching hospital and to analyze its initial results. Methods: This was a planned interim analysis of a randomized clinical trial aimed at comparing video-assisted thoracoscopic surgery and robotic surgery in terms of the results obtained after pulmonary lobectomy. The robotic surgery program developed at the Instituto do Câncer do Estado de São Paulo, in the city of São Paulo, Brazil, is a multidisciplinary initiative involving various surgical specialties, as well as anesthesiology, nursing, and clinical engineering teams. In this analysis, we evaluated the patients included in the robotic lobectomy arm of the trial during its first three months (from April to June of 2015). Results: Ten patients were included in this analysis. There were eight women and two men. The mean age was 65.1 years. All of the patients presented with peripheral tumors. We performed right upper lobectomy in four patients, right lower lobectomy in four, and left upper lobectomy in two. Surgical time varied considerably (range, 135-435 min). Conversion to open surgery or video-assisted thoracoscopic surgery was not necessary in any of the cases. Intraoperative complications were not found. Only the first patient required postoperative transfer to the ICU. There were no deaths or readmissions within the first 30 days after discharge. The only postoperative complication was chest pain (grade 3), in two patients. Pathological examination revealed complete tumor resection in all cases. Conclusions: When there is integration and proper training of all of the teams involved, the implementation of a robotic thoracic surgery program is feasible and can reduce morbidity and mortality.
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Affiliation(s)
- Ricardo Mingarini Terra
- Disciplina de Cirurgia Torácica, Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | | | - Leticia Leone Lauricella
- Instituto do Câncer do Estado de São Paulo - ICESP - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - José Ribas Milanez de Campos
- Disciplina de Cirurgia Torácica, Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Herbert Felix Costa
- Instituto do Câncer do Estado de São Paulo - ICESP - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Paulo Manuel Pego-Fernandes
- Disciplina de Cirurgia Torácica, Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
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Terra RM, Kazantzis T, Pinto-Filho DR, Camargo SM, Martins-Neto F, Guimarães AN, Araújo CA, Losso LC, Ghefter MC, Lima NFD, Gomes-Neto A, Brito-Filho F, Haddad R, Saueressig MG, Lima AMR, Siqueira RPD, Pinho AJDME, Vannucci F. Anatomic pulmonary resection by video-assisted thoracoscopy: the Brazilian experience (VATS Brazil study). J Bras Pneumol 2017; 42:215-21. [PMID: 27383936 PMCID: PMC4984544 DOI: 10.1590/s1806-37562015000000337] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 04/06/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The objective of this study was to describe the results of anatomic pulmonary resections performed by video-assisted thoracoscopy in Brazil. METHODS Thoracic surgeons (members of the Brazilian Society of Thoracic Surgery) were invited, via e-mail, to participate in the study. Eighteen surgeons participated in the project by providing us with retrospective databases containing information related to anatomic pulmonary resections performed by video-assisted thoracoscopy. Demographic, surgical, and postoperative data were collected with a standardized instrument, after which they were compiled and analyzed. RESULTS The surgeons provided data related to a collective total of 786 patients (mean number of resections per surgeon, 43.6). However, 137 patients were excluded because some data were missing. Therefore, the study sample comprised 649 patients. The mean age of the patients was 61.7 years. Of the 649 patients, 295 (45.5%) were male. The majority-521 (89.8%)-had undergone surgery for neoplasia, which was most often classified as stage IA. The median duration of pleural drainage was 3 days, and the median hospital stay was 4 days. Of the 649 procedures evaluated, 598 (91.2%) were lobectomies. Conversion to thoracotomy was necessary in 30 cases (4.6%). Postoperative complications occurred in 124 patients (19.1%), the most common complications being pneumonia, prolonged air leaks, and atelectasis. The 30-day mortality rate was 2.0%, advanced age and diabetes being found to be predictors of mortality. CONCLUSIONS Our analysis of this representative sample of patients undergoing pulmonary resection by video-assisted thoracoscopy in Brazil showed that the procedure is practicable and safe, as well as being comparable to those performed in other countries. OBJETIVO O objetivo deste estudo foi descrever os resultados de ressecções pulmonares anatômicas por videotoracoscopia no Brasil. MÉTODOS Cirurgiões torácicos (membros da Sociedade Brasileira de Cirurgia Torácica) foram convidados, por correio eletrônico, a participar do estudo. Dezoito cirurgiões participaram do projeto enviando seus bancos de dados retrospectivos referentes a ressecções anatômicas de pulmão por videotoracoscopia. Dados demográficos, cirúrgicos e pós-operatórios foram coletados em um instrumento padronizado e posteriormente compilados e analisados. RESULTADOS Dados referentes a 786 pacientes foram encaminhados (média de 43,6 ressecções por cirurgião), sendo 137 excluídos por informações incompletas. Logo, 649 pacientes constituíram nossa população estudada. A média de idade dos pacientes foi de 61,7 anos, 295 eram homens (45,5%), e a maioria - 521 (89,8%) - foi submetida à cirurgia por neoplasia, mais frequentemente classificada como estádio IA. A mediana do tempo de drenagem pleural foi de 3 dias, e a do tempo de internação, 4 dias. Dos 649 procedimentos realizados, 598 (91,2%) foram lobectomias. A taxa de conversão para toracotomia foi de 4,6% (30 casos). Complicações pós-operatórias ocorreram em 124 pacientes (19,1%), sendo pneumonia, escape aéreo prolongado e atelectasia as mais frequentes. A mortalidade em 30 dias foi de 2,0%, tendo como preditores idade avançada e diabetes. CONCLUSÕES A casuística brasileira mostra que as ressecções pulmonares por cirurgia torácica videoassistida são factíveis e seguras, além de comparáveis àquelas de registros internacionais.
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Affiliation(s)
- Ricardo Mingarini Terra
- Departamento de Cardiopneumologia, Disciplina de Cirurgia Torácica, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Thamara Kazantzis
- Departamento de Cardiopneumologia, Disciplina de Cirurgia Torácica, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Darcy Ribeiro Pinto-Filho
- Serviço de Cirurgia Torácica, Hospital Geral de Caxias do Sul, Fundação Universidade de Caxias do Sul (RS) Brasil
| | - Spencer Marcantonio Camargo
- Serviço de Cirurgia Torácica, Pavilhão Pereira Filho, Complexo Hospitalar da Santa Casa de Porto Alegre, Porto Alegre (RS) Brasil
| | - Francisco Martins-Neto
- Hospital Monte Klinikum, Fortaleza (CE) Brasil.,Hospital de Messejana Doutor Carlos Alberto Studart Gomes, Fortaleza (CE) Brasil
| | | | | | | | | | | | - Antero Gomes-Neto
- Hospital de Messejana Doutor Carlos Alberto Studart Gomes, Fortaleza (CE) Brasil
| | | | - Rui Haddad
- Hospital Samaritano, Rio de Janeiro (RJ) Brasil
| | - Maurício Guidi Saueressig
- Serviço de Cirurgia Torácica, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre (RS) Brasil
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Wu CF, Gonzalez-Rivas D, Wen CT, Liu YH, Wu YC, Chao YK, Hsieh MJ, Wu CY, Chen WH. Comparative Short-Term Clinical Outcomes of Mediastinum Tumor Excision Performed by Conventional VATS and Single-Port VATS: Is It Worthwhile? Medicine (Baltimore) 2015; 94:e1975. [PMID: 26559275 PMCID: PMC4912269 DOI: 10.1097/md.0000000000001975] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 10/08/2015] [Accepted: 10/09/2015] [Indexed: 11/26/2022] Open
Abstract
Single-port video-assisted thoracoscopic surgery (VATS) has been widely applied recently. However, there are still only few reports describing its use in mediastinum tumor resection. We present the technique of single-port video-assisted thoracoscopic mediastinum tumor resection and compare it with conventional VATS with regard to short-term outcome.We retrospectively enrolled 105 patients who received mediastinum surgery in Chang Gung Memorial Hospital. Sixteen patients received sternotomy or thoracotomy, 29 patients received single-port VATS, and 60 patients received conventional VATS (3 ports). The operative time, blood loss, postoperation day 1 pain score, discharge day pain score, and postoperative hospital stay were compared. In order to establish a well balanced cohort study, we also use propensity scores match (1:1) to compare the short-term clinical outcome in 2 groups.No operative deaths occurred in this study. Single-port VATS was associated with shorter operative time, lower postoperation day 1 pain score, and shorter postoperation hospital stay in our cohort study (P = 0.001, <0.001, and 0.039), and propensity scores matched cohort study (P = 0.003, <0.001, and <0.001).Single-port VATS for mediastinum tumor appears to be a safe and promising technique with short-term outcome not inferior to conventional VATS in our cohort study. The long-term oncology outcome may require time and more enrolled patients to be further evaluated.
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Affiliation(s)
- Ching-Feng Wu
- From the Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung University Memorial Hospital, Taoyuan, Taiwan (CFW, CTW, YHL, YCW, YKC, MJH, CYW, WHC); and Minimally Invasive Thoracic Surgery Unit (UCTMI); Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain (GRD)
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Odaka M, Shibasaki T, Asano H, Marushima H, Yamashita M, Morikawa T. Feasibility of thoracoscopic thymectomy for treatment of early-stage thymoma. Asian J Endosc Surg 2015; 8:439-44. [PMID: 26094717 DOI: 10.1111/ases.12202] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 05/15/2015] [Accepted: 05/18/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The objective of this study was to evaluate the feasibility of thoracoscopic thymectomy (TT) for treatment of early-stage thymoma and to compare the outcomes with those after open thymectomy (OT). METHODS A retrospective review of 98 patients who underwent TT or OT of Masaoka stage I-II thymoma without thymic cancer between 1996 and 2013 was performed. RESULTS Thoracoscopic thymectomy was performed in 67 patients, and OT was performed in 31 patients. The intraoperative blood loss amounts differed significantly between the TT group and OT group (100 vs 185 mL, P = 0.0070). The postoperative hospital stay was significantly shorter in the TT group than in the OT group (4 vs 12 days, P < 0.0001). No patient in the TT group underwent conversion to open surgery, and no surgical complications, such as massive bleeding, were observed. Two patients experienced recurrence in the TT group during the median postoperative follow-up period of 65 months. No significant differences were found in the 5-year disease-free survival rates between the two groups. There were no significant differences in disease-free survival as classified by Masaoka stage, World Health Organization type, and the extent of resection of the thymus. CONCLUSION Our outcome showed that TT largely reduced the degree of invasiveness. The outcome was not inferior to that of OT. The results primarily demonstrated the feasibility of TT for treatment of early-stage thymoma.
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Affiliation(s)
- Makoto Odaka
- Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Takamasa Shibasaki
- Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Hisatoshi Asano
- Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Hideki Marushima
- Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Makoto Yamashita
- Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Toshiaki Morikawa
- Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
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Malkan AD, Loh AH, Fernandez-Pineda I, Sandoval JA. The Role of Thoracoscopic Surgery in Pediatric Oncology. J Laparoendosc Adv Surg Tech A 2014; 24:819-26. [DOI: 10.1089/lap.2014.0252] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alpin D. Malkan
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Amos H.P. Loh
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | - John A. Sandoval
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee
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Chao YK, Liu YH, Hsieh MJ, Wu YC, Chen TP, Lu MS, Lu HI, Liu HP. Long-Term Outcomes After Thoracoscopic Resection of Stage I and II Thymoma: A Propensity-Matched Study. Ann Surg Oncol 2014; 22:1371-6. [DOI: 10.1245/s10434-014-4068-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Indexed: 11/18/2022]
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Yuan ZY, Cheng GY, Sun KL, Mao YS, Li J, Wang YG, Wang DL, Gao SG, Xue Q, Huang JF, Mu JW. Comparative study of video-assisted thoracic surgery versus open thymectomy for thymoma in one single center. J Thorac Dis 2014; 6:726-33. [PMID: 24976996 DOI: 10.3978/j.issn.2072-1439.2014.04.08] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Accepted: 03/17/2014] [Indexed: 01/09/2023]
Abstract
BACKGROUND Due to the popularity of video-assisted thoracic surgery (VATS) techniques in clinical, thymoma patients via VATS thymectomy are increasing rapidly. However, compared with open thymectomy, the potential superiorities and defects of VATS thymectomy remain controversial. METHODS A number of 129 patients who underwent thymectomy of early stage thymoma (Masaoka stage I and stage II) in one single center from January 2007 to September 2013 were selected in this retrospective study. Of those patients, 38 thymoma patients underwent VATS thymectomy (VATS group) and 91 underwent open thymectomy (open group) via either transsternal [44] or transthoracic approach [47] in the same period. The postoperative variables, which included postoperative hospital length of stay (LOS), the intensive care unit (ICU) LOS, the entire resection ratio, the number of thoracic drainage tubes, the quantity of output and duration of drainage, were analyzed. Meanwhile, the operation time and blood loss were considered as intraoperative variables. RESULTS All thymoma patients in the analysis included 19 thymoma patients with myasthenia gravis, among which five patients via VATS thymectomy and 14 patients via open thymectomy respectively. There was no death or morbidity due to the surgical procedures perioperatively. The ICU LOS, operation time, entire resection ratio, and the number of chest tubes were not significantly different in two groups. The postoperative hospital LOS of VATS thymectomy was shorter than that of open thymectomy (5.26 versus 8.32 days, P<0.001). The blood loss of VATS thymectomy was less than open thymectomy (114.74 versus 194.51 mL, P=0.002). Postoperatively, the quantity of chest tubes output in VATS group was less than that in open thymectomy group (617.86 versus 850.08 mL, P=0.007) and duration of drainage in VATS group was shorter than that in open thymectomy group (3.87 versus 5.22 days, P<0.001). CONCLUSIONS VATS thymectomy is a safe and practicable treatment for early-stage thymoma patients. Thymoma according with Masaoka staging I-II without evident invading seems to be performed through VATS approach appropriately, which has shorter postoperative hospital LOS, less blood loss and less restrictions to activities, hence patients will recover sooner.
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Affiliation(s)
- Zu-Yang Yuan
- Department of Thoracic Surgical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Gui-Yu Cheng
- Department of Thoracic Surgical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Ke-Lin Sun
- Department of Thoracic Surgical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - You-Sheng Mao
- Department of Thoracic Surgical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Jian Li
- Department of Thoracic Surgical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yong-Gang Wang
- Department of Thoracic Surgical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Da-Li Wang
- Department of Thoracic Surgical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Shu-Geng Gao
- Department of Thoracic Surgical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Qi Xue
- Department of Thoracic Surgical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Jin-Feng Huang
- Department of Thoracic Surgical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Ju-Wei Mu
- Department of Thoracic Surgical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Drummond M, Robalo Cordeiro C, Hespanhol V, Marques Gomes M, Bugalho de Almeida A, Parente B, Pinto P. Revista Portuguesa de Pneumologia: Ano em Revisão 2009. REVISTA PORTUGUESA DE PNEUMOLOGIA 2010. [DOI: 10.1016/s0873-2159(15)31252-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Pompeo E, Tacconi F, Mineo TC. Awake Video-Assisted Thoracoscopic Biopsy in Complex Anterior Mediastinal Masses. Thorac Surg Clin 2010; 20:225-33. [DOI: 10.1016/j.thorsurg.2010.01.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Alternative choices of total and partial thymectomy in video-assisted resection of noninvasive thymomas. Surg Endosc 2007; 22:1272-7. [PMID: 17943356 DOI: 10.1007/s00464-007-9606-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2007] [Revised: 07/24/2007] [Accepted: 08/29/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND The purpose of this report is to discuss the appropriate choice of procedures for video-assisted resection of thymoma according to factors such as the presence of myasthenia gravis or location of the tumor. METHODS We evaluated the short-term results of thoracoscopic surgery for 30 consecutive cases of noninvasive thymoma. Unilateral thoracoscopic partial (or subtotal) thymectomy (UTPT) was employed in patients with nonmyasthenic thymoma localized to the unilateral mediastinum, and extended (or total) thymectomy by an infrasternal mediastinal approach (ETIS) in myasthenic cases or those in which total thymectomy was considered inevitable. RESULTS UTPT was performed on 11 nonmyasthenic patients, and ETIS on 19 (13 myasthenics and six nonmyasthenics). Three patients in the ETIS group underwent conversion to sternotomy because of pericardial dissemination, pleural adhesion, and vascular injury, respectively. The mean surgical duration was 163 min and 224 min and mean blood loss was 123 g versus 149 g for UTPT and ETIS, respectively. Post-thymomectomy myasthenia occurred in a patient after UTPT who made an excellent recovery to remission after the re-UTPT. There has not been any recurrence detected for 48 months of mean postoperative follow-up. CONCLUSIONS Our trial regarding the choice of total or partial thymectomy in thoracoscopic surgery for thymomas yielded acceptable results that warrant further investigations into long-term survival and recurrence after longer-term observation of patients undergoing these procedures.
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Khraim FM. The Wider Scope of Video-Assisted Thoracoscopic Surgery. AORN J 2007; 85:1199-1208; quiz 1209-12. [PMID: 17560858 DOI: 10.1016/j.aorn.2007.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2007] [Indexed: 11/15/2022]
Abstract
In the past, rudimentary devices were used to look closely into the chest; currently, advanced video technology, computers, and high-tech electronics are being used to perform many surgical procedures that formerly required a large, open incision. The goal of video-assisted thoracoscopic surgery (VATS) is the same as for comparable open procedures, but it is accomplished with less pain, less patient morbidity, and a shorter hospital stay. In addition to evaluating and treating thoracic injuries, VATS has demonstrated effectiveness in detecting and managing many other conditions, such as pleural disease, interstitial lung disease, and thoracic malignancies.
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Affiliation(s)
- Fadi M Khraim
- University of New York at Buffalo, School of Nursing, USA
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Abstract
Paediatric haematopoietic cell transplantation has experienced significant advances in the last few decades. However, pulmonary complications are an important limitation to the efficacy of this intervention, contributing to post-transplantation morbidity and mortality. Such complications persist even in experienced centres and occur in adult and paediatric recipients. This review identifies the paediatric pulmonary complications that are commonly seen following haematopoietic cell transplantation and addresses both infectious and non-infectious aetiologies and their clinical manifestations, evaluation, and potential therapy. Ultimately, improvement in outcomes will require attention to immunosuppression as well as traditional diagnostic procedures and treatment. This article aims to review the current state of pulmonary complications post-transplantation, to examine the impact of our recent advances and changes in treatment, and to identify potential future therapies and hypothesise what role these might have on long-term survival.
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Abstract
Esophageal duplication is a rare congenital esophageal disorder. Surgical excision is the standard treatment for symptomatic esophageal duplication cysts. Traditionally, the resection is accomplished via thoracotomy; however, a minimally invasive approach is possible, avoiding the long hospital stay, the discomfort and the long recovery time due to a thoracotomy. The authors describe two cases of esophageal duplication resected via a left thoracoscopic approach.
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Affiliation(s)
- F A M Herbella
- Departments of Surgery and Medicine, University of California, San Francisco, CA 94143-0790, USA
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18
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Ríos Zambudio A, Torres Lanzas J, Roca Calvo MJ, Galindo Fernández PJ, Parrilla Paricio P. Tratamiento quirúrgico de los quistes mediastínicos no neoplásicos. Cir Esp 2002. [DOI: 10.1016/s0009-739x(02)72044-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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19
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Partrick DA, Rothenberg SS. Thoracoscopic resection of mediastinal masses in infants and children: an evaluation of technique and results. J Pediatr Surg 2001; 36:1165-7. [PMID: 11479848 DOI: 10.1053/jpsu.2001.25740] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Thoracoscopy has been accepted as a technique in pediatric surgery for diagnosis of thoracic pathology, but there has been little experience using it as a therapeutic modality as well. The purpose of this report is to describe and critically evaluate a 7-year experience with thoracoscopic diagnosis and resection of mediastinal masses in infants and children. METHODS From February 1993 to June 2000, 39 patients presented with mediastinal masses and no tissue diagnosis. Age ranged from 5 months to 18 years old and weight from 3.6 to 110 kg. Twelve children had anterior mediastinal masses, 27 posterior. The patients were positioned in a modified prone or supine position, and single lung ventilation was performed on the contralateral side. Three or 4 valved trocars were utilized with 3 and 5 mm instrumentation. RESULTS A total of 38 of 39 procedures were completed successfully endoscopically. The procedure in 1 patient with a sarcoma was converted to thoracotomy because of extensive disease. Operating times ranged from 20 to 185 minutes. Diagnosis was obtained in all cases, and complete excision was performed in 33. All children were extubated in the operating room; 8 chest tubes were placed but removed within 24 hours. Hospital stay ranged from 12 hours to 4 days. Pathology included 12 foregut duplications, 7 ganglioneuromas, 6 neuroblastomas, 6 lymphomas, 3 teratomas, 2 sarcomas, and 3 other lesions. CONCLUSION Thoracoscopy is a safe and effective method to evaluate, biopsy, and in most cases resect lesions of the anterior and posterior mediastinum in infants and children.
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Affiliation(s)
- D A Partrick
- Department of Pediatric Surgery, Hospital for Infants and Children, Presbyterian/St Luke's Medical Center and The Children's Hospital, University of Colorado, Denver, CO, USA
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20
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Abstract
Mediastinal tumors are comprised of various benign and malignant neoplasms that share the same anatomic location within the thorax. The mediastinum is traditionally divided into three compartments: the anterior, middle, and posterior mediastinum. This division, based on lateral chest radiographs, helps clinicians establish appropriate differential diagnoses and plan further imaging, diagnostic, and treatment strategies. With the continued and complex advances in imaging, medical treatment, and surgery, we recommend a multidisciplinary approach to the management of mediastinal tumors. This discussion is intended to guide the pulmonary specialist through this potentially complex approach.
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Affiliation(s)
- K Y Yoneda
- University of California, Davis, School of Medicine, Sacramento, California, USA.
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