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Advantages of applying digital chest drainage system for postoperative management of patients following pulmonary resection: a systematic review and meta-analysis of 12 randomized controlled trials. Gan To Kagaku Ryoho 2023; 71:1-11. [PMID: 36175611 DOI: 10.1007/s11748-022-01875-7] [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: 07/19/2022] [Accepted: 09/20/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES This meta-analysis aimed to evaluate the value of the chest digital drainage system for the postoperative management of patients who have undergone pulmonary resection. METHODS We searched the PubMed, EMBASE, the Cochrane Library, and Web of Science databases for included randomized controlled trials (RCTs) on the application of digital drainage systems versus the analog drainage system for patients with lung disease after pulmonary resection. Dichotomous variables were evaluated using risk ratios (RRs) and 95% confidence intervals (CIs), and mean and standardized mean differences (MDs and SMDs, respectively) with 95% CIs were used to calculate continuous variables. Statistical analyses were performed using Stata and RevMan software. RESULTS In total, 12 RCTs involving 2000 patients were analyzed. Significant differences in duration of chest tube placement (SMD = -0.49; 95% CI = -0.78 to -0.20), length of hospital stay (MD =-0.79 days; 95% CI = -1.24 to -0.34), and number of chest tube clamping tests (RR = 0.74; 95% CI = 0.36-1.49) were observed between the two groups, which did not significant differ in the occurrence of prolonged air leak or cardiopulmonary complication rate. CONCLUSIONS The digital chest drainage system is mainly advantageous in the duration of chest tube placement, length of hospital stay, and number of chest tube clamping tests. Future research should evaluate the requirements and economic impact of using digital system in routine clinical practice.
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Bevilacqua Filho CT, Schmidt AP, Felix EA, Bianchi F, Guerra FM, Andrade CF. Risk factors for postoperative pulmonary complications and prolonged hospital stay in pulmonary resection patients: a retrospective study. Braz J Anesthesiol 2021; 71:333-338. [PMID: 34229858 PMCID: PMC9373437 DOI: 10.1016/j.bjane.2021.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 08/08/2020] [Indexed: 12/25/2022] Open
Abstract
Background Postoperative pulmonary complications are the main cause of morbidity and mortality after pulmonary resection. This study was undertaken to determine the risk factors associated with postoperative pulmonary complications (PPCs) and length of hospital stay (LOS) in pulmonary resection patients in a tertiary teaching hospital in Brazil. Methods A retrospective data gathering from 196 patients who underwent pulmonary resection between 2012 and 2016 was conducted. Demographic and hospital admission data were collected from patients with complete medical records. Univariate analysis was performed, followed by Poisson’s regression for predicting the prevalence of postoperative pulmonary complications and length of hospital stay. Results Thirty-nine patients (20%) displayed pulmonary complications in the postoperative period. The risk factors associated with an increased prevalence of postoperative pulmonary complications in a multivariate analysis were: American Society of Anesthesiologists physical status (ASA) ≥ 3 (PR 4.77, p = 0.03, 95% CI: 1.17 to 19.46), predicted diffusion capacity of the lungs for carbon monoxide – corrected single breath (PR 0.98, p < 0.001, 95% CI: 0.96 to 0.99) and age of the patient (PR 1.04; p = 0.01; 95% CI: 1.01 to 1.06). Those associated with an increased prevalence of prolonged hospital stay were: duration of surgical procedure longer than five hours (PR 6.94, p = 0.01, 95% CI: 1.66 to 12.23), male sex (PR 5.72, p < 0.001, 95% CI: 1.87 to 9.58), and presence of postoperative pulmonary complications (PR 11.92, p < 0.001, 95% CI: 7.42 to 16.42). Conclusions The rate of postoperative pulmonary complications in the study population is in line with the world average. Recognizing risk factors for the development of PPCs may help optimize allocation resources and preventive efforts.
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Affiliation(s)
- Clovis T Bevilacqua Filho
- Hospital de Clínicas de Porto Alegre, Serviço de Anestesia e Medicina Perioperatória, Porto Alegre, RS, Brazil.
| | - André P Schmidt
- Hospital de Clínicas de Porto Alegre, Serviço de Anestesia e Medicina Perioperatória, Porto Alegre, RS, Brazil
| | - Elaine A Felix
- Hospital de Clínicas de Porto Alegre, Serviço de Anestesia e Medicina Perioperatória, Porto Alegre, RS, Brazil
| | - Fabiana Bianchi
- Hospital de Clínicas de Porto Alegre, Serviço de Anestesia e Medicina Perioperatória, Porto Alegre, RS, Brazil
| | - Fernanda M Guerra
- Hospital de Clínicas de Porto Alegre, Serviço de Anestesia e Medicina Perioperatória, Porto Alegre, RS, Brazil
| | - Cristiano F Andrade
- Hospital de Clínicas de Porto Alegre, Serviço de Cirurgia Torácica, Porto Alegre, RS, Brazil
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Li S, Wang Z, Huang J, Fan J, Du H, Liu L, Che G. Systematic review of prognostic roles of body mass index for patients undergoing lung cancer surgery: does the 'obesity paradox' really exist? Eur J Cardiothorac Surg 2018; 51:817-828. [PMID: 28040677 DOI: 10.1093/ejcts/ezw386] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 10/26/2016] [Indexed: 01/11/2023] Open
Abstract
Summary The paradoxical benefit of obesity, the 'obesity paradox', has been recently identified in surgical populations. Our goal was to evaluate by a systematic review with meta-analysis the prognostic role of body mass index (BMI) and to identify whether the 'obesity paradox' exists in lung cancer surgery. Comprehensive literature retrieval was conducted in PubMed to identify the eligible articles. The odds ratios (OR) and hazard ratios (HR) with the corresponding 95% confidence intervals (CI) were used to synthesize in-hospital and long-term survival outcomes, respectively. The heterogeneity level and publication bias between studies were also estimated. Finally, 25 observational studies with 78 143 patients were included in this review. The pooled analyses showed a significantly better long-term survival rate in patients with higher BMI, but no significant benefit of increased BMI was found for in-hospital morbidity. The pooled analyses also showed that overall morbidity (OR: 0.84; 95% CI: 0.73-0.98; P = 0.025) and in-hospital mortality (OR: 0.78; 95% CI: 0.63-0.98; P = 0.031) were significantly decreased in obese patients. Obesity could be a strong predictor of the favourable long-term prognosis of lung cancer patients (HR: 0.69; 95% CI: 0.56-0.86; P = 0.001). The robustness of these pooled estimates was strong. No publication bias was detected. In summary, obesity has favourable effects on in-hospital outcomes and long-term survival of surgical patients with lung cancer. The 'obesity paradox' does have the potential to exist in lung cancer surgery.
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Araujo LH, Baldotto C, Castro GD, Katz A, Ferreira CG, Mathias C, Mascarenhas E, Lopes GDL, Carvalho H, Tabacof J, Martínez-Mesa J, Viana LDS, Cruz MDS, Zukin M, Marchi PD, Terra RM, Ribeiro RA, Lima VCCD, Werutsky G, Barrios CH. Lung cancer in Brazil. J Bras Pneumol 2018; 44:55-64. [PMID: 29538545 PMCID: PMC6104542 DOI: 10.1590/s1806-37562017000000135] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 07/10/2017] [Indexed: 11/22/2022] Open
Abstract
Lung cancer is one of the most incident types of cancer and a leading cause of cancer mortality in Brazil. We reviewed the current status of lung cancer by searching relevant data on prevention, diagnosis, and treatment in the country. This review highlights several issues that need to be addressed, including smoking control, patient lack of awareness, late diagnosis, and disparities in the access to cancer health care facilities in Brazil. We propose strategies to help overcome these limitations and challenge health care providers, as well as the society and governmental representatives, to work together and to take a step forward in fighting lung cancer.
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Affiliation(s)
- Luiz Henrique Araujo
- . Instituto Nacional de Câncer José Alencar Gomes da Silva - INCA - Rio de Janeiro (RJ) Brasil
- . Instituto COI de Educação e Pesquisa, Rio de Janeiro (RJ) Brasil
| | - Clarissa Baldotto
- . Instituto Nacional de Câncer José Alencar Gomes da Silva - INCA - Rio de Janeiro (RJ) Brasil
- . Instituto COI de Educação e Pesquisa, Rio de Janeiro (RJ) Brasil
| | - Gilberto de Castro
- . Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira - Icesp - São Paulo (SP) Brasil
- . Centro de Oncologia, Hospital Sírio-Libanês, São Paulo (SP) Brasil
| | - Artur Katz
- . Centro de Oncologia, Hospital Sírio-Libanês, São Paulo (SP) Brasil
| | - Carlos Gil Ferreira
- . Instituto D'Or de Pesquisa e Ensino, Rio de Janeiro (RJ) Brasil
- . Fundação do Câncer, Rio de Janeiro (RJ) Brasil
| | | | | | | | - Heloisa Carvalho
- . Centro de Oncologia, Hospital Sírio-Libanês, São Paulo (SP) Brasil
- . Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | | | | | | | | | - Mauro Zukin
- . Instituto Nacional de Câncer José Alencar Gomes da Silva - INCA - Rio de Janeiro (RJ) Brasil
- . Instituto COI de Educação e Pesquisa, Rio de Janeiro (RJ) Brasil
| | | | - Ricardo Mingarini Terra
- . Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira - Icesp - São Paulo (SP) Brasil
| | | | | | - Gustavo Werutsky
- . Latin American Cooperative Oncology Group - LACOG - Porto Alegre (RS) 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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Stanzani F, Paisani DDM, Oliveira AD, Souza RCD, Perfeito JAJ, Faresin SM. Morbidity, mortality, and categorization of the risk of perioperative complications in lung cancer patients. ACTA ACUST UNITED AC 2014; 40:21-9. [PMID: 24626266 PMCID: PMC4075917 DOI: 10.1590/s1806-37132014000100004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 10/28/2013] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To determine morbidity and mortality rates by risk category in accordance with the American College of Chest Physicians guidelines, to determine what role pulmonary function tests play in this categorization process, and to identify risk factors for perioperative complications (PCs). METHODS This was a historical cohort study based on preoperative and postoperative data collected for cases of lung cancer diagnosed or suspected between 2001 and 2010. RESULTS Of the 239 patients evaluated, only 13 (5.4%) were classified as being at high risk of PCs. Predicted postoperative FEV1 (FEV1ppo) was sufficient to define the risk level in 156 patients (65.3%); however, cardiopulmonary exercise testing (CPET) was necessary for identifying those at high risk. Lung resection was performed in 145 patients. Overall morbidity and mortality rates were similar to those reported in other studies. However, morbidity and mortality rates for patients at an acceptable risk of PCs were 31.6% and 4.3%, respectively, whereas those for patients at high risk were 83.3% and 33.3%. Advanced age, COPD, lobe resection, and lower FEV1ppo were correlated with PCs. CONCLUSIONS Although spirometry was sufficient for risk assessment in the majority of the population studied, CPET played a key role in the identification of high-risk patients, among whom the mortality rate was seven times higher than was that observed for those at an acceptable risk of PCs. The risk factors related to PCs coincided with those reported in previous studies.
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Affiliation(s)
- Fabiana Stanzani
- Federal University of São Paulo, Department of Medicine, São Paulo, Brazil, Physician. Pulmonology Section, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Denise de Moraes Paisani
- Arnaldo Vieira de Carvalho Cancer Institute, São Paulo, Brazil, Thoracic Surgeon. Arnaldo Vieira de Carvalho Cancer Institute, São Paulo, Brazil
| | - Anderson de Oliveira
- Federal University of São Paulo, Department of Medicine, São Paulo, Brazil, Thoracic Surgeon. Thoracic Surgeon Section, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Rodrigo Caetano de Souza
- Federal University of São Paulo, Department of Medicine, São Paulo, Brazil, Thoracic Surgeon. Thoracic Surgeon Section, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - João Aléssio Juliano Perfeito
- Federal University of São Paulo, Department of Medicine, São Paulo, Brazil, Affiliate Professor. Pulmonology Section, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
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de Leon Martini S, Müller CB, Meurer RT, Fernandes MDC, Mariano R, Barbachan E Silva M, Klamt F, Andrade CF. The potential role of extracellular regulatory kinase in the survival of patients with early stage adenocarcinoma. J Thorac Dis 2014; 6:930-6. [PMID: 25093089 DOI: 10.3978/j.issn.2072-1439.2014.07.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 06/10/2014] [Indexed: 01/15/2023]
Abstract
BACKGROUND Lung cancer is among the most common types of neoplasias, and adenocarcinoma is the most frequent histological type. There is currently an extensive search for prognostic biomarkers of nonsmall cell lung cancer (NSCLC). METHODS We analyzed the correlation of clinical data and patient survival with the levels of activated extracellular regulatory kinase (ERK) in histological samples of surgically resected early stage lung adenocarcinoma. We randomly selected 36 patients with stage I or II lung adenocarcinoma who underwent pulmonary lobectomy between 1998 and 2004. Patients were divided into the following two groups according to immunohistochemical profile: a group with <15% ERK-positive tumor cells and a group with ≥15% ERK-positive tumor cells. For data comparison, an enrichment analysis of a microarray database was performed (GSE29016, n=72). RESULTS Activated ERK levels were ≥15% and <15% in 21 (58%) and 15 (42%) patients, respectively. There were no statistically significant differences in age, sex, smoking history, and body mass index (BMI) among the groups stratified by ERK levels. The survival rate was lower in the ERK ≥15% group than in the ERK <15% group (P=0.045). Enrichment analyses showed no correlation between variations in gene expression of ERK in patients with adenocarcinoma and survival rates in patients with stage I and combined stage II + III disease. CONCLUSIONS Our findings suggest that high ERK positivity in cells from biological samples of lung adenocarcinoma is related with tumor aggressiveness and a poorer prognosis.
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Affiliation(s)
- Simone de Leon Martini
- 1 Programa de Pós-graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul (UFRGS), 90035-903 Porto Alegre (RS), Brazil ; 2 Laboratório de Pulmão e Vias Aéreas, Hospital de Clínicas de Porto Alegre (HCPA), 90035-903, Porto Alegre (RS), Brazil ; 3 Laboratório de Bioquímica Celular, Departamento de Bioquímica, ICBS/UFRGS, 90035-003 Porto Alegre (RS), Brazil ; 4 Laboratório de Pesquisa em Patologia, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), 90050-170 Porto Alegre (RS), Brazil ; 5 Instituto Nacional de Ciência e Tecnologia-Translational em Medicina (INCT-TM), 90035-903 Porto Alegre (RS), Brazil ; 6 Departamento de Cirurgia Torácica, Hospital de Clínicas de Porto Alegre (HCPA), 90035-903, Porto Alegre (RS), Brazil ; 7 Hospital da Criança Santo Antônio, Santa Casa de Misericórdia de Porto Alegre, 90020-090 Porto Alegre (RS), Brazil
| | - Carolina Beatriz Müller
- 1 Programa de Pós-graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul (UFRGS), 90035-903 Porto Alegre (RS), Brazil ; 2 Laboratório de Pulmão e Vias Aéreas, Hospital de Clínicas de Porto Alegre (HCPA), 90035-903, Porto Alegre (RS), Brazil ; 3 Laboratório de Bioquímica Celular, Departamento de Bioquímica, ICBS/UFRGS, 90035-003 Porto Alegre (RS), Brazil ; 4 Laboratório de Pesquisa em Patologia, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), 90050-170 Porto Alegre (RS), Brazil ; 5 Instituto Nacional de Ciência e Tecnologia-Translational em Medicina (INCT-TM), 90035-903 Porto Alegre (RS), Brazil ; 6 Departamento de Cirurgia Torácica, Hospital de Clínicas de Porto Alegre (HCPA), 90035-903, Porto Alegre (RS), Brazil ; 7 Hospital da Criança Santo Antônio, Santa Casa de Misericórdia de Porto Alegre, 90020-090 Porto Alegre (RS), Brazil
| | - Rosalva Thereza Meurer
- 1 Programa de Pós-graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul (UFRGS), 90035-903 Porto Alegre (RS), Brazil ; 2 Laboratório de Pulmão e Vias Aéreas, Hospital de Clínicas de Porto Alegre (HCPA), 90035-903, Porto Alegre (RS), Brazil ; 3 Laboratório de Bioquímica Celular, Departamento de Bioquímica, ICBS/UFRGS, 90035-003 Porto Alegre (RS), Brazil ; 4 Laboratório de Pesquisa em Patologia, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), 90050-170 Porto Alegre (RS), Brazil ; 5 Instituto Nacional de Ciência e Tecnologia-Translational em Medicina (INCT-TM), 90035-903 Porto Alegre (RS), Brazil ; 6 Departamento de Cirurgia Torácica, Hospital de Clínicas de Porto Alegre (HCPA), 90035-903, Porto Alegre (RS), Brazil ; 7 Hospital da Criança Santo Antônio, Santa Casa de Misericórdia de Porto Alegre, 90020-090 Porto Alegre (RS), Brazil
| | - Marilda da Cruz Fernandes
- 1 Programa de Pós-graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul (UFRGS), 90035-903 Porto Alegre (RS), Brazil ; 2 Laboratório de Pulmão e Vias Aéreas, Hospital de Clínicas de Porto Alegre (HCPA), 90035-903, Porto Alegre (RS), Brazil ; 3 Laboratório de Bioquímica Celular, Departamento de Bioquímica, ICBS/UFRGS, 90035-003 Porto Alegre (RS), Brazil ; 4 Laboratório de Pesquisa em Patologia, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), 90050-170 Porto Alegre (RS), Brazil ; 5 Instituto Nacional de Ciência e Tecnologia-Translational em Medicina (INCT-TM), 90035-903 Porto Alegre (RS), Brazil ; 6 Departamento de Cirurgia Torácica, Hospital de Clínicas de Porto Alegre (HCPA), 90035-903, Porto Alegre (RS), Brazil ; 7 Hospital da Criança Santo Antônio, Santa Casa de Misericórdia de Porto Alegre, 90020-090 Porto Alegre (RS), Brazil
| | - Rodrigo Mariano
- 1 Programa de Pós-graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul (UFRGS), 90035-903 Porto Alegre (RS), Brazil ; 2 Laboratório de Pulmão e Vias Aéreas, Hospital de Clínicas de Porto Alegre (HCPA), 90035-903, Porto Alegre (RS), Brazil ; 3 Laboratório de Bioquímica Celular, Departamento de Bioquímica, ICBS/UFRGS, 90035-003 Porto Alegre (RS), Brazil ; 4 Laboratório de Pesquisa em Patologia, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), 90050-170 Porto Alegre (RS), Brazil ; 5 Instituto Nacional de Ciência e Tecnologia-Translational em Medicina (INCT-TM), 90035-903 Porto Alegre (RS), Brazil ; 6 Departamento de Cirurgia Torácica, Hospital de Clínicas de Porto Alegre (HCPA), 90035-903, Porto Alegre (RS), Brazil ; 7 Hospital da Criança Santo Antônio, Santa Casa de Misericórdia de Porto Alegre, 90020-090 Porto Alegre (RS), Brazil
| | - Mariel Barbachan E Silva
- 1 Programa de Pós-graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul (UFRGS), 90035-903 Porto Alegre (RS), Brazil ; 2 Laboratório de Pulmão e Vias Aéreas, Hospital de Clínicas de Porto Alegre (HCPA), 90035-903, Porto Alegre (RS), Brazil ; 3 Laboratório de Bioquímica Celular, Departamento de Bioquímica, ICBS/UFRGS, 90035-003 Porto Alegre (RS), Brazil ; 4 Laboratório de Pesquisa em Patologia, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), 90050-170 Porto Alegre (RS), Brazil ; 5 Instituto Nacional de Ciência e Tecnologia-Translational em Medicina (INCT-TM), 90035-903 Porto Alegre (RS), Brazil ; 6 Departamento de Cirurgia Torácica, Hospital de Clínicas de Porto Alegre (HCPA), 90035-903, Porto Alegre (RS), Brazil ; 7 Hospital da Criança Santo Antônio, Santa Casa de Misericórdia de Porto Alegre, 90020-090 Porto Alegre (RS), Brazil
| | - Fábio Klamt
- 1 Programa de Pós-graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul (UFRGS), 90035-903 Porto Alegre (RS), Brazil ; 2 Laboratório de Pulmão e Vias Aéreas, Hospital de Clínicas de Porto Alegre (HCPA), 90035-903, Porto Alegre (RS), Brazil ; 3 Laboratório de Bioquímica Celular, Departamento de Bioquímica, ICBS/UFRGS, 90035-003 Porto Alegre (RS), Brazil ; 4 Laboratório de Pesquisa em Patologia, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), 90050-170 Porto Alegre (RS), Brazil ; 5 Instituto Nacional de Ciência e Tecnologia-Translational em Medicina (INCT-TM), 90035-903 Porto Alegre (RS), Brazil ; 6 Departamento de Cirurgia Torácica, Hospital de Clínicas de Porto Alegre (HCPA), 90035-903, Porto Alegre (RS), Brazil ; 7 Hospital da Criança Santo Antônio, Santa Casa de Misericórdia de Porto Alegre, 90020-090 Porto Alegre (RS), Brazil
| | - Cristiano Feijó Andrade
- 1 Programa de Pós-graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul (UFRGS), 90035-903 Porto Alegre (RS), Brazil ; 2 Laboratório de Pulmão e Vias Aéreas, Hospital de Clínicas de Porto Alegre (HCPA), 90035-903, Porto Alegre (RS), Brazil ; 3 Laboratório de Bioquímica Celular, Departamento de Bioquímica, ICBS/UFRGS, 90035-003 Porto Alegre (RS), Brazil ; 4 Laboratório de Pesquisa em Patologia, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), 90050-170 Porto Alegre (RS), Brazil ; 5 Instituto Nacional de Ciência e Tecnologia-Translational em Medicina (INCT-TM), 90035-903 Porto Alegre (RS), Brazil ; 6 Departamento de Cirurgia Torácica, Hospital de Clínicas de Porto Alegre (HCPA), 90035-903, Porto Alegre (RS), Brazil ; 7 Hospital da Criança Santo Antônio, Santa Casa de Misericórdia de Porto Alegre, 90020-090 Porto Alegre (RS), Brazil
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Mueller MR, Marzluf BA. The anticipation and management of air leaks and residual spaces post lung resection. J Thorac Dis 2014; 6:271-84. [PMID: 24624291 DOI: 10.3978/j.issn.2072-1439.2013.11.29] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 11/27/2013] [Indexed: 11/14/2022]
Abstract
The incidence of any kind of air leaks after lung resections is reportedly around 50% of patients. The majority of these leaks doesn't require any specific intervention and ceases within a few hours or days. The recent literature defines a prolonged air leak (PAL) as an air leak lasting beyond postoperative day 5. PAL is associated with a generally worse outcome with a more complicated postoperative course anxd prolonged hospital stay and increased costs. Some authors therefore consider any PAL as surgical complication. PAL is the most prevalent postoperative complication following lung resection and the most important determinant of postoperative length of hospital stay. A low predicted postoperative forced expiratory volume in 1 second (ppoFEV1) and upper lobe disease have been identified as significant risk factors involved in developing air leaks. Infectious conditions have also been reported to increase the risk of PAL. In contrast to the problem of PAL, there is only limited information from the literature regarding apical spaces after lung resection, probably because this common finding rarely leads to clinical consequences. This article addresses the pathogenesis of PAL and apical spaces, their prediction, prevention and treatment with a special focus on surgery for infectious conditions. Different predictive models to identify patients at higher risk for the development of PAL are provided. The discussion of surgical treatment options includes the use of pneumoperitoneum, blood patch, intrabronchial valves (IBV) and the flutter valve, and addresses the old question, whether or not to apply suction to chest tubes. The discussed prophylactic armentarium comprises of pleural tenting, prophylactic intraoperative pneumoperitoneum, sealing of the lung, buttressing of staple lines, capitonnage after resection of hydatid cysts, and plastic surgical options.
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Affiliation(s)
- Michael Rolf Mueller
- Otto Wagner Hospital, Department of Thoracic Surgery, Baumgartner Hoehe 1, A-1145 Vienna, Austria
| | - Beatrice A Marzluf
- Otto Wagner Hospital, Department of Thoracic Surgery, Baumgartner Hoehe 1, A-1145 Vienna, Austria
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Imbalance in redox status is associated with tumor aggressiveness and poor outcome in lung adenocarcinoma patients. J Cancer Res Clin Oncol 2014; 140:461-70. [PMID: 24449404 DOI: 10.1007/s00432-014-1586-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 01/12/2014] [Indexed: 12/23/2022]
Abstract
PURPOSE The expression levels of human antioxidant genes (HAGs) and oxidative markers were investigated in light of lung adenocarcinoma aggressiveness and patient outcome. METHODS We assayed in vitro the tumoral invasiveness and multidrug resistance in human lung adenocarcinoma (AdC) cell lines (EKVX and A549). Data were associated with several redox parameters and differential expression levels of HAG network. The clinicopathological significance of these findings was investigated using microarray analysis of tumor tissue and by immunohistochemistry in archival collection of biopsies. RESULTS An overall increased activity (expression) of selected HAG components in the most aggressive cell line (EKVX cells) was observed by bootstrap and gene set enrichment analysis (GSEA). In vitro validation of oxidative markers revealed that EKVX cells had high levels of oxidative stress markers. In AdC cohorts, GSEA of microarray datasets showed significantly high levels of HAG components in lung AdC samples in comparison with normal tissue, in advanced stage compared with early stage and in patients with poor outcome. Cox multivariate regression analysis in a cohort of early pathologic (p)-stage of AdC cases showed that patients with moderate levels of 4-hydroxynonenal, a specific and stable end product of lipid peroxidation, had a significantly less survival rate (hazard ratio of 8.87) (P < 0.05). CONCLUSIONS High levels of oxidative markers are related to tumor aggressiveness and can predict poor outcome of early-stage lung adenocarcinoma patients.
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Asai N, Ohkuni Y, Shoji K, Kaneko N. Efficacy of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in evaluating lung cancer recurrence. J Bras Pneumol 2013; 39:242-4. [PMID: 23670511 PMCID: PMC4075821 DOI: 10.1590/s1806-37132013000200017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Santoro IL, Ramos RP, Franceschini J, Jamnik S, Fernandes ALG. Non-small cell lung cancer in never smokers: a clinical entity to be identified. Clinics (Sao Paulo) 2011; 66:1873-7. [PMID: 22086516 PMCID: PMC3203958 DOI: 10.1590/s1807-59322011001100005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Accepted: 07/12/2011] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES It has been recognized that patients with non-small cell lung cancer who are lifelong never-smokers constitute a distinct clinical entity. The aim of this study was to assess clinical risk factors for survival among never-smokers with non-small cell lung cancer. METHODS All consecutive non-small cell lung cancer patients diagnosed (n = 285) between May 2005 and May 2009 were included. The clinical characteristics of never-smokers and ever-smokers (former and current) were compared using chi-squared or Student's t tests. Survival curves were calculated using the Kaplan-Meier method, and log-rank tests were used for survival comparisons. A Cox proportional hazards regression analysis was evaluated by adjusting for age (continuous variable), gender (female vs. male), smoking status (never- vs. ever-smoker), the Karnofsky Performance Status Scale (continuous variable), histological type (adenocarcinoma vs. non-adenocarcinoma), AJCC staging (early vs. advanced staging), and treatment (chemotherapy and/or radiotherapy vs. the best treatment support). RESULTS Of the 285 non-small cell lung cancer patients, 56 patients were never-smokers. Univariate analyses indicated that the never-smoker patients were more likely to be female (68% vs. 32%) and have adenocarcinoma (70% vs. 51%). Overall median survival was 15.7 months (95% CI: 13.2 to 18.2). The never-smoker patients had a better survival rate than their counterpart, the ever-smokers. Never-smoker status, higher Karnofsky Performance Status, early staging, and treatment were independent and favorable prognostic factors for survival after adjusting for age, gender, and adenocarcinoma in multivariate analysis. CONCLUSIONS Epidemiological differences exist between never- and ever-smokers with lung cancer. Overall survival among never-smokers was found to be higher and independent of gender and histological type.
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Affiliation(s)
- Ilka Lopes Santoro
- Respiratory Division, Federal University of São Paulo, São Paulo, SP, Brazil.
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