1
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Li X, Teng J, Yuan H, Zhang Q. Comparing RATS with VATS and thoracotomy in bronchial sleeve lobectomy for NSCLC: A Bayesian network meta-analysis. Asian J Surg 2024; 47:2438-2440. [PMID: 38290945 DOI: 10.1016/j.asjsur.2024.01.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 01/19/2024] [Indexed: 02/01/2024] Open
Affiliation(s)
- Xuyang Li
- The Thoracic Surgery Department of Second Affiliated Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, 271016, PR China
| | - Jingyan Teng
- The Thoracic Surgery Department of Second Affiliated Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, 271016, PR China
| | - Hao Yuan
- The Thoracic Surgery Department of Second Affiliated Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, 271016, PR China
| | - Qiang Zhang
- The Thoracic Surgery Department of Second Affiliated Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, 271016, PR China.
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2
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Hireche K, Canaud L, Peyron PA, Sakhri L, Serres I, Kamel S, Lounes Y, Gandet T, Alric P. Ex Vivo Comparison of the Elastic Properties of Vascular Substitutes Used for Pulmonary Artery Replacement. J Surg Res 2024; 295:222-230. [PMID: 38039727 DOI: 10.1016/j.jss.2023.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 10/17/2023] [Accepted: 10/30/2023] [Indexed: 12/03/2023]
Abstract
INTRODUCTION Study aims were to evaluate the elastic properties of vascular substitutes frequently used for pulmonary artery (PA) replacement, and then to compare their compliance and stiffness indexes to those of human PA. METHODS A bench-test pulsatile flow experiment was developed to perfuse human cadaveric vascular substitutes (PA, thoracic aorta, human pericardial conduit), bovine pericardial conduit, and prosthetic vascular substitutes (polytetrafluorethylene and Dacron grafts) at a flow and low pulsed pressure mimicking pulmonary circulation. Intraluminal pressure was measured. An ultrasound system with an echo-tracking function was used to monitor vessel wall movements. The diameter, compliance, and stiffness index were calculated for each vascular substitute and compared to the human PA at mean pressures ranging from 10 to 50 mmHg. RESULTS The compliance of the PA and the thoracic aorta were similar at mean physiological pressures of 10 mmHg and 20 mmHg. The PA was significantly less compliant than the aorta at mean pressures above 30 mmHg (P = 0.017). However, there was no difference in stiffness index between the two substitutes over the entire pressure range. Compared to the PA, human pericardial conduit was less compliant at 10 mmHg (P = 0.033) and stiffer at 10 mmHg (P = 0.00038) and 20 mmHg (P = 0.026). Bovine pericardial conduit and synthetic prostheses were significantly less compliant and stiffer than the PA for mean pressures of 10, 20, and 30 mmHg. There were no differences at 40 and 50 mmHg. CONCLUSIONS Allogenic arterial grafts appear to be the most suitable vascular substitutes in terms of compliance and stiffness for PA replacement.
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Affiliation(s)
- Kheira Hireche
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve University Hospital, Montpellier, France; PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France.
| | - Ludovic Canaud
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve University Hospital, Montpellier, France; PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Pierre Antoine Peyron
- Department of Forensic Medicine, Lapeyronie University Hospital, Montpellier, France
| | - Linda Sakhri
- Groupe Hospitalier Mutualiste de grenoble, Daniel Hollard Cancer Institute, Grenoble, France
| | - Isabelle Serres
- Department of Anatomical Pathology, Gui De Chauliac Hospital, Montpellier, France
| | - Sanaa Kamel
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve University Hospital, Montpellier, France
| | - Youcef Lounes
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve University Hospital, Montpellier, France; PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Thomas Gandet
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve University Hospital, Montpellier, France
| | - Pierre Alric
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve University Hospital, Montpellier, France; PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
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3
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Girelli L, Bertolaccini L, Casiraghi M, Petrella F, Galetta D, Mazzella A, Donghi S, Lo Iacono G, Cara A, Guarize J, Spaggiari L. Anastomosis Complications after Bronchoplasty: Incidence, Risk Factors, and Treatment Options Reported by a Referral Cancer Center. Curr Oncol 2023; 30:10437-10449. [PMID: 38132394 PMCID: PMC10742568 DOI: 10.3390/curroncol30120760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 11/30/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Sleeve lobectomy with bronchoplasty is a safe surgical technique for the management of lung cancer and endobronchial localization of extrapulmonary cancers. However, anastomotic complications can occur, and treatment strategies are not standardized. METHODS Data from 280 patients subjected to bronchoplasty were retrospectively analyzed, focusing on surgical techniques, anastomotic complications, and their management. Multivariate analysis was performed, and Kaplan-Meier curves were used to determine survival. RESULTS Ninety percent of 280 surgeries were for lung cancer. Anastomotic complications occurred in 6.42% of patients: late stenosis in 3.92% and broncho-pleural fistula in 1.78%. The median survival was 65.90 months (95% CI = 41.76-90.97), with no difference (p = 0.375) for patients with (51.28 months) or without (71.03 months) anastomotic complications. Mortality at 30 days was higher with anastomotic complications (16.7% vs. 3%, p = 0.014). Multivariable analysis confirmed pathological stage (N+) as a risk factor for anastomotic complications (p = 0.016). Our mortality (3.93%) and morbidity rate (41.78%) corresponded to recent series results. CONCLUSIONS In our experience, surgery is preferred to avoid life-threatening complications in bronchopleural fistulas. Bronchoscopic balloon dilatation is preferred for benign strictures. The nodal stage is related to complications (p = 0.0014), reflecting the aggressiveness of surgery, which requires extended radical lymphadenectomy.
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Affiliation(s)
- Lara Girelli
- Division of Thoracic Surgery, IEO, European Institute of Oncology, IRCCS, 20141 Milan, Italy; (L.B.); (D.G.); (A.M.); (G.L.I.); (A.C.)
| | - Luca Bertolaccini
- Division of Thoracic Surgery, IEO, European Institute of Oncology, IRCCS, 20141 Milan, Italy; (L.B.); (D.G.); (A.M.); (G.L.I.); (A.C.)
| | - Monica Casiraghi
- Division of Thoracic Surgery, IEO, European Institute of Oncology, IRCCS, 20141 Milan, Italy; (L.B.); (D.G.); (A.M.); (G.L.I.); (A.C.)
- Department of Oncology and Hematology-Oncology, University of Milan, 20141 Milan, Italy
| | - Francesco Petrella
- Division of Thoracic Surgery, IEO, European Institute of Oncology, IRCCS, 20141 Milan, Italy; (L.B.); (D.G.); (A.M.); (G.L.I.); (A.C.)
- Department of Oncology and Hematology-Oncology, University of Milan, 20141 Milan, Italy
| | - Domenico Galetta
- Division of Thoracic Surgery, IEO, European Institute of Oncology, IRCCS, 20141 Milan, Italy; (L.B.); (D.G.); (A.M.); (G.L.I.); (A.C.)
- Department of Oncology and Hematology-Oncology, University of Milan, 20141 Milan, Italy
| | - Antonio Mazzella
- Division of Thoracic Surgery, IEO, European Institute of Oncology, IRCCS, 20141 Milan, Italy; (L.B.); (D.G.); (A.M.); (G.L.I.); (A.C.)
| | - Stefano Donghi
- Interventional Pneumology Unit, IEO, European Institute of Oncology, IRCCS, 20141 Milan, Italy; (S.D.); (J.G.)
| | - Giorgio Lo Iacono
- Division of Thoracic Surgery, IEO, European Institute of Oncology, IRCCS, 20141 Milan, Italy; (L.B.); (D.G.); (A.M.); (G.L.I.); (A.C.)
| | - Andrea Cara
- Division of Thoracic Surgery, IEO, European Institute of Oncology, IRCCS, 20141 Milan, Italy; (L.B.); (D.G.); (A.M.); (G.L.I.); (A.C.)
| | - Juliana Guarize
- Interventional Pneumology Unit, IEO, European Institute of Oncology, IRCCS, 20141 Milan, Italy; (S.D.); (J.G.)
| | - Lorenzo Spaggiari
- Division of Thoracic Surgery, IEO, European Institute of Oncology, IRCCS, 20141 Milan, Italy; (L.B.); (D.G.); (A.M.); (G.L.I.); (A.C.)
- Department of Oncology and Hematology-Oncology, University of Milan, 20141 Milan, Italy
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4
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Bourbonne V, Thureau S, Pradier O, Antoni D, Lucia F. Stereotactic radiotherapy for ultracentral lung tumours. Cancer Radiother 2023; 27:659-665. [PMID: 37516640 DOI: 10.1016/j.canrad.2023.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 06/19/2023] [Accepted: 06/22/2023] [Indexed: 07/31/2023]
Abstract
Ultracentral (UC) lung lesions are generally defined by the presence of the tumour or the Planning Target Volume (PTV) abutting proximal bronchial tree (PBT) or the esophagus. Initial reports rose awareness regarding the potential toxicity of stereotactic body radiotherapy (SBRT) when delivered to UC lesions. Major concerns include necrosis, stenosis, and bleeding of the PBT. Technological improvements now enable the delivery of more accurate treatments, possibly redefining the historical "no-fly zone". In this review, studies focusing on the treatment of UC lesions with SBRT are presented. The narrow therapeutic window requires a multidisciplinary approach.
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Affiliation(s)
- V Bourbonne
- Radiation Oncology Department, centre hospitalier universitaire de Brest, Brest, France; Inserm, LaTim UMR 1101, université de Bretagne occidentale, Brest, France.
| | - S Thureau
- Radiation Oncology Department, centre Henri-Becquerel, Rouen, France; QuantIf-Litis EA4108, université de Rouen, Rouen, France
| | - O Pradier
- Radiation Oncology Department, centre hospitalier universitaire de Brest, Brest, France; Inserm, LaTim UMR 1101, université de Bretagne occidentale, Brest, France
| | - D Antoni
- Radiation Oncology Department, institut de cancérologie Strasbourg Europe, Strasbourg, France
| | - F Lucia
- Radiation Oncology Department, centre hospitalier universitaire de Brest, Brest, France; Inserm, LaTim UMR 1101, université de Bretagne occidentale, Brest, France
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Yost CC, Bhagat R, Blitzer D, Louis C, Han J, Wilder FG, Meguid RA. A primer for the student joining the general thoracic surgery service tomorrow: Primer 2 of 7. JTCVS OPEN 2023; 14:293-313. [PMID: 37425458 PMCID: PMC10328966 DOI: 10.1016/j.xjon.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 04/02/2023] [Accepted: 04/08/2023] [Indexed: 07/11/2023]
Affiliation(s)
- Colin C. Yost
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa
| | - Rohun Bhagat
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - David Blitzer
- Division of Cardiovascular Surgery, Columbia University, New York, NY
| | - Clauden Louis
- Division of Cardiothoracic Surgery, Brigham and Women’s Hospital, Boston, Mass
| | - Jason Han
- Division of Cardiothoracic Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Fatima G. Wilder
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Robert A. Meguid
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, Colo
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6
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Nitsche LJ, Jordan S, Demmy T, Dexter E, Hennon M, Nwogu C, Yendamuri S, Picone A. Analyzing the impact of minimally invasive surgical approaches on post-operative outcomes of pneumonectomy and sleeve lobectomy patients. J Thorac Dis 2023; 15:2497-2504. [PMID: 37324102 PMCID: PMC10267906 DOI: 10.21037/jtd-22-654] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 03/24/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Some patients with non-small cell lung cancer (NSCLC) have superior short- and long-term outcomes with sleeve lobectomy rather than pneumonectomy. Originally sleeve lobectomy was reserved for patients with limited pulmonary function, however, the reported superior results allowed sleeve lobectomy to be performed in expanded patient populations. In a further attempt to improve post-operative outcomes surgeons have adopted minimally invasive techniques Minimally invasive approaches have potential benefits to patients such as decreased morbidity and mortality while maintaining the same caliber of oncologic outcomes. METHODS We identified patients at our institution who underwent sleeve lobectomy or pneumonectomy to treat NSCLC from 2007 to 2017. We analyzed these groups in respect to 30- and 90-day mortality, complications, local recurrence, and median survival. We included multivariate analysis to determine the impact of a minimally invasive approach, sex, extent of resection, and histology. Differences in mortality were analyzed using the Kaplan-Meier method using the log-rank test to compare the groups. A two-tailed Z test for difference in proportions was done to analyze complications, local recurrence, 30-day and 90-day mortality. RESULTS A total of 108 patients underwent sleeve lobectomy (n=34) or pneumonectomy (n=74) for treatment of NSCLC with 18 undergoing open pneumonectomy, 56 undergoing video-assisted thoracoscopic surgery (VATS) pneumonectomy, 29 undergoing open sleeve lobectomy, and 5 undergoing VATS sleeve lobectomy. There was no significant difference in 30-day mortality (P=0.064) but there was a difference in 90-day (P=0.007). There was no difference in complication rates (P=0.234) or local recurrence rates (P=0.779). The pneumonectomy patients had a median survival of 23.6 months (95% CI: 3.8-43.4 months). The sleeve lobectomy group had a median survival of 60.7 months (95% CI: 43.3-78.2 months) (P=0.008). On multivariate analysis extent of resection (P<0.001) and tumor stage (P=0.036) were associated with survival. There was no significant difference between the VATS approach and the open surgical approach (P=0.053). CONCLUSIONS When considering patients undergoing surgery for NSCLC sleeve lobectomy resulted in lower 90-day mortality and better 3-year survival compared to patients undergoing PN. Having a sleeve lobectomy rather than a pneumonectomy and having earlier-stage disease lead to significantly improved survival on multivariate analysis. Having a VATS operation leads to a non-inferior post-operative outcome compared to open surgery.
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Affiliation(s)
- Lindsay J Nitsche
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, USA
| | - Sean Jordan
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, USA
| | - Todd Demmy
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, USA
| | - Elisabeth Dexter
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, USA
| | - Mark Hennon
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, USA
| | - Chukwumere Nwogu
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, USA
| | - Sai Yendamuri
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, USA
| | - Anthony Picone
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, USA
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7
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Eroğlu A, Aydın Y, Bilal Ulaş A. Overview of indications for pulmonary sleeve resection. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2023; 31:S1-S7. [PMID: 38344120 PMCID: PMC10852206 DOI: 10.5606/tgkdc.dergisi.2023.24752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 02/21/2024]
Abstract
Pulmonary sleeve resection is a complex lung resection and reconstruction surgery mostly performed in patients with centrally located locally invasive lung cancers which often penetrate into central airways and vasculature. This approach was initially used for patients unable to tolerate pneumonectomies, while it is currently also being preferred in patients whose tumors are anatomically suited. Today, thoracic sleeve resections include a wide range of procedures ranging from bronchial and tracheal sleeve resections to carinal sleeve pneumonectomies. In this review, we discuss indications for various types of sleeve resection in the light of current literature.
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Affiliation(s)
- Atilla Eroğlu
- Department of Thoracic Surgery, Atatürk University Faculty of Medicine, Erzurum, Türkiye
| | - Yener Aydın
- Department of Thoracic Surgery, Atatürk University Faculty of Medicine, Erzurum, Türkiye
| | - Ali Bilal Ulaş
- Department of Thoracic Surgery, Atatürk University Faculty of Medicine, Erzurum, Türkiye
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8
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Menna C, Rendina EA, D’Andrilli A. Parenchymal Sparing Surgery for Lung Cancer: Focus on Pulmonary Artery Reconstruction. Cancers (Basel) 2022; 14:cancers14194782. [PMID: 36230705 PMCID: PMC9563968 DOI: 10.3390/cancers14194782] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/20/2022] [Accepted: 09/26/2022] [Indexed: 11/16/2022] Open
Abstract
Reconstruction of the pulmonary artery (PA) associated with lobectomy for the radical resection of lung cancer has been progressively gaining diffusion in lung cancer surgery as a safe and effective therapeutic option that may allow radical resection when lobectomy is not technically feasible, avoiding pneumonectomy. There are some controversial aspects concerning the intraoperative and perioperative management of a sleeve resection with PA reconstruction that may influence the outcome. In the present article, the authors have analyzed some of the main technical and oncological aspects to take stock of what they have learned from their lung-sparing operations experience over time. PA reconstruction may require prosthetic materials including different options with variable cost. A main concern in vascular reconstructive procedures is avoiding tension on the anastomosis. When PA reconstruction is required, appropriate anticoagulation management is crucial. Results from the main literature data confirm the reliability of lobectomy associated with PA reconstruction in terms of perioperative morbidity and long-term survival. Sleeve lobectomy and PA reconstruction can be performed safely and effectively even after induction therapy.
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Affiliation(s)
- Cecilia Menna
- Correspondence: ; Tel.: +39-(0)6-3377-5155; Fax: +39-(0)6-3377-5578
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9
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Gregoire J. Guiding Principles in the Management of Synchronous and Metachronous Primary Non-Small Cell Lung Cancer. Thorac Surg Clin 2021; 31:237-254. [PMID: 34304832 DOI: 10.1016/j.thorsurg.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Multiple lung cancers can be found simultaneously, with incidence ranging from 1% to 8%. Documentation of more than 1 pulmonary lesion can be challenging, because these solid, ground-glass, or mixed-density tumors may represent multicentric malignant disease or intrapulmonary metastases. If mediastinal nodal and distant deposits are excluded, surgery should be contemplated. After surgical treatment of lung cancer, patients should be followed closely for an undetermined period of time. Good clinical judgment is of outmost importance in deciding which individuals will benefit from those surgical interventions and which are candidates for alternate therapies. Every case should be discussed in a multidisciplinary meeting.
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Affiliation(s)
- Jocelyn Gregoire
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Chemin Sainte-Foy, Quebec, Quebec G1V 4G5, Canada.
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10
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Doyle J, Mhandu P. Late presentation of pulmonary artery pseudoaneurysm following bronchovascular sleeve resection of lung. BMJ Case Rep 2021; 14:14/7/e243294. [PMID: 34233867 DOI: 10.1136/bcr-2021-243294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 43-year-old man with a history of double sleeve right upper lobectomy for pulmonary sarcoma, presented with worsening haemoptysis. Bronchoscopic and positron emission tomography (PET)CT appearances were suspicious for disease recurrence; however, on attending for CT-guided biopsy, he was found to have a large pseudoaneurysm of his right pulmonary artery. The patient underwent placement of endovascular covered stent with fluoroscopic confirmation of pseudoaneurysm occlusion, and was discharged home on lifelong antiplatelet therapy. To our knowledge, this is the first reported case of pulmonary artery pseudoaneurysm following double (bronchovascular) sleeve resection of the lung, successfully treated by endovascular stenting.
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Affiliation(s)
- Joseph Doyle
- Cardiothoracic Surgery, Royal Victoria Hospital, Belfast, BT12 6BA, UK
| | - Peter Mhandu
- Cardiothoracic Surgery, Royal Victoria Hospital, Belfast, BT12 6BA, UK
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11
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Mantovani S, Gust L, D'Journo XB, Thomas PA. Left main bronchial sleeve resection with total lung parenchymal preservation: a tailored surgical approach. Eur J Cardiothorac Surg 2021; 57:596-597. [PMID: 31713596 DOI: 10.1093/ejcts/ezz300] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 09/15/2019] [Accepted: 09/23/2019] [Indexed: 12/13/2022] Open
Abstract
Bronchial sleeve resection is an uncommon thoracic surgical procedure. Under specific conditions, patients can be selected to undergo a sleeve resection of the main bronchus with complete parenchymal preservation. The left main bronchus is longer than the contralateral bronchus, therefore left endobronchial tumours can be localized at the proximal end of the bronchus or distally, near the secondary carina. Bronchial anastomosis in these 2 situations requires different approaches. We present the surgical technique of left main bronchus resection with complete preservation of lung parenchyma through a hemi-clamshell incision (proximal tumour) or posterolateral thoracotomy (distal tumour).
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Affiliation(s)
- Sara Mantovani
- Department of Thoracic Surgery, North Hospital, Aix-Marseille University, Marseille, France
| | - Lucile Gust
- Department of Thoracic Surgery, North Hospital, Aix-Marseille University, Marseille, France
| | - Xavier Benoit D'Journo
- Department of Thoracic Surgery, North Hospital, Aix-Marseille University, Marseille, France
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12
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Andruska N, Stowe HB, Crockett C, Liu W, Palma D, Faivre-Finn C, Badiyan SN. Stereotactic Radiation for Lung Cancer: A Practical Approach to Challenging Scenarios. J Thorac Oncol 2021; 16:1075-1085. [PMID: 33901637 DOI: 10.1016/j.jtho.2021.04.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/02/2021] [Accepted: 04/07/2021] [Indexed: 12/18/2022]
Abstract
Stereotactic body radiation therapy (SBRT) is an effective and well-tolerated treatment for medically inoperable patients with early stage NSCLC. SBRT is a noninvasive treatment involving the delivery of ablative radiation doses with high precision in the course of a few treatments. Relative to conventionally fractionated radiation, SBRT achieves superior local control and survival. SBRT use has increased dramatically in the past 15 years and is currently considered the standard of care in cases of inoperable early stage NSCLC. It is being increasingly applied to more complex patient populations at higher risk of treatment-related toxicity. In these more complex patients, there is an increasing need to balance patient and treatment factors in selecting the optimal patients for SBRT. Here, we review several challenging clinical scenarios often encountered in thoracic multidisciplinary tumor boards.
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Affiliation(s)
- Neal Andruska
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St Louis, Missouri
| | - Hayley B Stowe
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St Louis, Missouri
| | - Cathryn Crockett
- Division of Cancer Sciences, University of Manchester and The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Wei Liu
- Division of Radiation Oncology, Western University, London, Ontario, Canada
| | - David Palma
- Division of Radiation Oncology, Western University, London, Ontario, Canada; Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Corinne Faivre-Finn
- Division of Cancer Sciences, University of Manchester and The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Shahed N Badiyan
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St Louis, Missouri.
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13
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Scheinerman JA, Jiang J, Chang SH, Geraci TC, Cerfolio RJ. Extended Robotic Pulmonary Resections. Front Surg 2021; 8:597416. [PMID: 33693026 PMCID: PMC7937914 DOI: 10.3389/fsurg.2021.597416] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 01/05/2021] [Indexed: 11/13/2022] Open
Abstract
While lung cancer remains the most common cause of cancer-related mortality in the United States, surgery for curative intent continues to be a mainstay of therapy. The robotic platform for pulmonary resection for non-small cell lung cancer (NSCLC) has been utilized for more than a decade now. With respect to more localized resections, such as wedge resection or lobectomy, considerable data exist demonstrating shorter length of stay, decreased postoperative pain, improved lymph node dissection, and overall lower complication rate. There are a multitude of technical advantages the robotic approach offers, such as improved optics, natural movement of the operator's hands to control the instruments, and precise identification of tissue planes leading to a more ergonomic and safe dissection. Due to the advantages, the scope of robotic resections is expanding. In this review, we will look at the existing data on extended robotic pulmonary resections, specifically post-induction therapy resection, sleeve lobectomy, and pneumonectomy. Additionally, this review will examine the indications for these more complex resections, as well as review the data and outcomes from other institutions' experience with performing them. Lastly, we will share the strategy and outlook of our own institution with respect to these three types of extended pulmonary resections. Though some controversy remains regarding the use and safety of robotic surgery in these complex pulmonary resections, we hope to shed some light on the existing evidence and evaluate the efficacy and safety for patients with NSCLC.
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Affiliation(s)
- Joshua A Scheinerman
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, United States
| | - Jeffrey Jiang
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, United States
| | - Stephanie H Chang
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, United States
| | - Travis C Geraci
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, United States
| | - Robert J Cerfolio
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, United States
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Collaud S, Alnajdawi Y, Stork T, Plönes T, Stefani D, Tokuishi K, Valdivia D, Zaatar M, Hegedüs B, Umutlu L, Hautzel H, Aigner C. Preoperative chest computed tomography evaluation for predicting intraoperative lung resection strongly depends on interpreters experience. Lung Cancer 2021; 154:23-28. [PMID: 33611223 DOI: 10.1016/j.lungcan.2021.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 10/25/2020] [Accepted: 02/03/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Preoperative planning of lung resection extent is decisive for preoperative functional work-up and selection for multimodal treatment. It is mainly based on preoperative chest CT. We aimed at evaluating chest CT adequacy to predict the extent of lung resection and hypothesized a relation with CT interpreters' level of experience. MATERIALS AND METHODS A pseudonymized CT library was built from patients who had curative intent lung resection for centrally located NSCLC. CT library was interpreted by 20 thoracic surgery residents or attendings. Interpreters were blinded to intraoperative findings and scored one point when lung resection was adequately planned. Points were summed up in a score from 0 to 20. Interpreters' experience was evaluated through nine variables: age, position (resident vs. attending), years of experience in evaluating chest CTs, number of anatomic resections and sleeve resections attended as first assistant or performed as surgeon in presence of a teaching assistant or as main surgeon/teaching assistant. Variables characterizing interpreters' experience were divided into equal sized groups. Independent sample T-test and one-way ANOVA/Tukey post hoc tests were used to compare scores between groups. RESULTS CT library included 20 patients. Lung resections were lobectomy (n = 7, 35 %), sleeve lobectomy (n = 10, 50 %), sleeve bilobectomy (n = 2, 10 %), pneumonectomy (n = 1, 5%). Twenty interpreters scored a median of 10 (4-14). Attending surgeons had significantly higher mean scores (11.2 ± 1.3) compared to residents (7.7 ± 2.3, p = 0.001). All scores were significantly different between groups related to interpreters' levels of experience, except for interpreters'age. CONCLUSION Preoperative CT evaluation for predicting intraoperative lung resection for centrally located NSCLC strongly depends on interpreters' experience.
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Affiliation(s)
- Stephane Collaud
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Yazan Alnajdawi
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Theresa Stork
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Till Plönes
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Dirk Stefani
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Keita Tokuishi
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Daniel Valdivia
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Mohamed Zaatar
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Balazs Hegedüs
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Lale Umutlu
- Department of Radiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Hubertus Hautzel
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany.
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15
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Zalepugas D, Koryllos A, Stoelben E, Ludwig C. Sleeve lobectomy versus lobectomy for primary treatment of non-small-cell lung cancer: A single-center retrospective analysis. J Surg Oncol 2020; 123:553-559. [PMID: 33159352 DOI: 10.1002/jso.26286] [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: 09/05/2020] [Accepted: 10/20/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVES It is unclear how much additional perioperative risk a sleeve lobectomy could pose in comparison to lobectomy. The objective of this analysis was to compare the complication rate, 30-day mortality, and overall survival between lobectomy and sleeve lobectomy without prior neoadjuvant treatment in non-small-cell lung cancer (NSCLC). METHODS This is a retrospective study using our prospective database for quality assurance in our hospital. Inclusion criteria for our study was a completed lobectomy or sleeve lobectomy for primary treatment of NSCLC. RESULTS In 506 patients, the tumor was treated by means of standard lobectomy. In 252 patients with central tumor localization, sleeve lobectomy was performed. Postoperative complications occurred in n:148 (29.24%) patients of the lobectomy group and in n = 76 (30.15%) of the sleeve group. The mortality rate difference between the two groups was statistically significant and favored the lobectomy group (0.78% vs. 4.76%, p = .007). Five year survival was 69.97% for the lobectomy and 65.59% for the sleeve group (p = .829). CONCLUSION Sleeve lobectomy for primary surgical treatment of NSCLC has comparable perioperative complications with lobectomy. Sleeve lobectomy does not seem to negatively influence survival. Postoperative mortality was higher in the sleeve group.
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Affiliation(s)
- Donatas Zalepugas
- Department of Thoracic Surgery, Malteser Hospital Seliger Gerhard Bonn/Rhein-Sieg, Bonn, Germany
| | - Aris Koryllos
- Lung Clinic, Cologne-Merheim Hospital, Witten/Herdecke University, Cologne, Germany
| | - Erich Stoelben
- Lung Clinic, Cologne-Merheim Hospital, Witten/Herdecke University, Cologne, Germany
| | - Corinna Ludwig
- Department of Thoracic Surgery, Florence Nightingale Hospital, Düsseldorf, Germany
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16
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Li X, Deng H, Zheng X, Zhu D, Zhou Q, Tang X. [Clinical Effect of Pedicled Pericardial Fat Flap in Prevention of Bronchial Pleural Fistula in Bronchial Sleeve Lobectomy]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2020; 23:360-364. [PMID: 32429637 PMCID: PMC7260383 DOI: 10.3779/j.issn.1009-3419.2020.104.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
背景与目的 支气管袖式肺叶切除是中心型肺癌重要的手术方式,它是最能体现“最大程度切除肿瘤,同时最大程度保留肺功能”的肺癌手术原则。支气管胸膜瘘是支气管袖式肺叶切除最严重的手术并发症,严重威胁患者的生命安全。本文将总结带蒂心包脂肪垫包裹支气管吻合口在预防支气管袖式肺叶切除术后支气管吻合口瘘的临床效果。 方法 回顾性分析四川大学华西医院肺癌中心2016年1月-2019年5月期间行支气管袖式肺叶切除术,并用带蒂心包脂肪垫包裹支气管吻合口的39例中心型肺癌患者临床资料,观察该组患者术后并发症,尤其是支气管吻合口相关并发症发生情况。 结果 该组患者手术后恢复良好,均于术后6 d-14 d内出院;30 d内无支气管胸膜瘘发生,无因胸腔内出血再次行手术病例,无严重心律失常,无严重肺部感染及呼吸衰竭发生;术后继续随访期间,术后6个月发生重度吻合口狭窄导致术侧残余肺不张1例。 结论 支气管袖式肺叶切除的肺癌患者,术中用带蒂心包脂肪垫包裹支气管吻合口,可有效预防术后吻合口瘘相关并发症的发生,从而提高手术安全性。
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Affiliation(s)
- Xiaoyun Li
- Southwest Medical University, Luzhou 646000, China
| | - Hanyu Deng
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 611135, China
| | - Xi Zheng
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 611135, China
| | - Daxing Zhu
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 611135, China
| | - Qinghua Zhou
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 611135, China
| | - Xiaojun Tang
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 611135, China
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17
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An antiquated contraindication for minimally invasive lung surgery: No place to staple the bronchus. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 27:521-525. [PMID: 32082920 DOI: 10.5606/tgkdc.dergisi.2019.17315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 12/12/2018] [Indexed: 01/31/2023]
Abstract
Background This study aims to evaluate the feasibility and outcomes of lobectomy operations without using a stapler for bronchial closure. Methods Between December 2014 and August 2018, a total of 108 patients (72 males, 36 females; mean age 62.1±9.8 years; range, 19 to 83 years) with primary lung cancer who underwent lobar resection with robot-assisted thoracoscopic surgery were included in this study. Primary bronchial closure (n=7) and sleeve anastomosis (n=9) were performed in some cases. These 16 patients were compared with other lobectomy cases (n=92) who had bronchial stapling for bronchial closure. Results There was no statistically significant difference in the mean duration of operation, amount of intraoperative bleeding, length of postoperative stay in the hospital, and morbidity and readmission rates between the two groups (p=0.3, p=0.5, p=0.06, p=0.4, and p=0.63, respectively). No bronchial fistula developed in any of the patients. Conclusion Primary bronchial closure and sleeve anastomosis can be safely performed with robot-assisted thoracoscopic surgery without conversion to thoracotomy, or a larger assistance incision with a similar success rate of the stapled bronchus.
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18
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Maurizi G, Vanni C, Rendina EA. Pushing the limits in order to avoid pneumonectomy. J Thorac Dis 2019; 11:E144-E145. [PMID: 31559088 DOI: 10.21037/jtd.2019.07.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Giulio Maurizi
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Camilla Vanni
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Erino Angelo Rendina
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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19
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Maurizi G, Marinucci BT, Rendina EA. Upper lobe preservation is not a challenge. J Thorac Dis 2019; 11:E98-E99. [PMID: 31463156 DOI: 10.21037/jtd.2019.06.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Giulio Maurizi
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Erino Angelo Rendina
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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20
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Soultanis KM, Gonzalez-Rivas D. Uniportal video-assisted sleeve resections: how to deal with specific challenges. J Thorac Dis 2019; 11:S1670-S1677. [PMID: 31516740 DOI: 10.21037/jtd.2019.06.52] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Diego Gonzalez-Rivas
- Thoracic Surgery Department, Tongji University Affiliated Shanghai Pulmonary Hospital, Shanghai 200433, China.,Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain
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21
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Maurizi G, Ciccone AM, Rendina EA. The advantage of sleeve lobectomy over pneumonectomy. J Thorac Dis 2019; 11:E103-E104. [PMID: 31463158 DOI: 10.21037/jtd.2019.06.70] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Giulio Maurizi
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Anna Maria Ciccone
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Erino Angelo Rendina
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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22
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Cohen C, Pop D, Benkirane T, Mouroux J, Berthet JP. Upper lobe preservation in the treatment of centrally located NSCLC: one more challenge in lung-sparing surgery? J Thorac Dis 2019; 10:6418-6422. [PMID: 30746179 DOI: 10.21037/jtd.2018.11.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Charlotte Cohen
- Department of Thoracic Surgery, University Hospital of Nice, Nice, France
| | - Daniel Pop
- Department of Thoracic Surgery, University Hospital of Nice, Nice, France
| | - Taib Benkirane
- Department of Thoracic Surgery, University Hospital of Nice, Nice, France
| | - Jérôme Mouroux
- Department of Thoracic Surgery, University Hospital of Nice, Nice, France
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23
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Vannucci J, Matricardi A, Potenza R, Ragusa M, Puma F, Cagini L. Lobectomy with angioplasty: which is the best technique for pulmonary artery reconstruction? J Thorac Dis 2018; 10:S1892-S1898. [PMID: 30026976 DOI: 10.21037/jtd.2018.05.174] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Lobectomies with bronchial and/or vascular reconstruction are conservative procedures aimed at managing locally advanced lung cancer, avoiding a pneumonectomy. Considering morbidity, mortality and the functional consequences of a pneumonectomy, such procedures must be in the technical armamentarium of every thoracic surgeon. Vascular reconstruction of the pulmonary artery (PA) is seldom performed with or without the bronchial sleeve resection. Both functional and oncologic outcomes have been reported to be better than after a pneumonectomy. Different technical options are now available but some aspects and technical details are not standardized. Indications, possible complications, planning and even definitions need to be more solid to allow for definitive improvement in such procedures. This analysis is aimed at assessing the acquired technical data with special emphasis on the PA reconstruction with autologous tissues.
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Affiliation(s)
- Jacopo Vannucci
- Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy
| | - Alberto Matricardi
- Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy
| | - Rossella Potenza
- Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy
| | - Mark Ragusa
- Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy
| | - Francesco Puma
- Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy
| | - Lucio Cagini
- Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy
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24
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Maurizi G, Ciccone AM, Vanni C, D’Andrilli A, Ibrahim M, Andreetti C, Menna C, Tierno SM, Venuta F, Rendina EA. Reimplantation of the upper lobe bronchus after lower sleeve lobectomy or bilobectomy: long-term results†. Eur J Cardiothorac Surg 2018; 53:1180-1185. [DOI: 10.1093/ejcts/ezx494] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 12/02/2017] [Indexed: 11/15/2022] Open
Affiliation(s)
- Giulio Maurizi
- Department of Thoracic Surgery, Sant’Andrea Hospital, Sapienza University, Rome, Italy
| | - Anna Maria Ciccone
- Department of Thoracic Surgery, Sant’Andrea Hospital, Sapienza University, Rome, Italy
| | - Camilla Vanni
- Department of Thoracic Surgery, Sant’Andrea Hospital, Sapienza University, Rome, Italy
| | - Antonio D’Andrilli
- Department of Thoracic Surgery, Sant’Andrea Hospital, Sapienza University, Rome, Italy
| | - Mohsen Ibrahim
- Department of Thoracic Surgery, Sant’Andrea Hospital, Sapienza University, Rome, Italy
| | - Claudio Andreetti
- Department of Thoracic Surgery, Sant’Andrea Hospital, Sapienza University, Rome, Italy
| | - Cecilia Menna
- Department of Thoracic Surgery, Sant’Andrea Hospital, Sapienza University, Rome, Italy
| | - Simone M Tierno
- Department of Thoracic Surgery, Sant’Andrea Hospital, Sapienza University, Rome, Italy
| | - Federico Venuta
- Department of Thoracic Surgery, Policlinico Umberto I, Sapienza University, Rome, Italy
- Lorillard Spencer Cenci Foundation, Rome, Italy
| | - Erino A Rendina
- Department of Thoracic Surgery, Sant’Andrea Hospital, Sapienza University, Rome, Italy
- Lorillard Spencer Cenci Foundation, Rome, Italy
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25
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Horan S, Battoo A, Yendamuri S. Sleeve lobectomy for lung cancer. Indian J Thorac Cardiovasc Surg 2017. [DOI: 10.1007/s12055-017-0581-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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26
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D’Andrilli A, Maurizi G, Ciccone AM, Andreetti C, Ibrahim M, Menna C, Vanni C, Venuta F, Rendina EA. Long-segment pulmonary artery resection to avoid pneumonectomy: long-term results after prosthetic replacement. Eur J Cardiothorac Surg 2017; 53:331-335. [DOI: 10.1093/ejcts/ezx353] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 08/02/2017] [Accepted: 08/23/2017] [Indexed: 11/13/2022] Open
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27
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Plenzig S, Soriano M, Held H, Verhoff MA. Post-operative fatal blood aspiration after routine lung surgery. Forensic Sci Int 2017; 277:e11-e15. [PMID: 28592376 DOI: 10.1016/j.forsciint.2017.05.017] [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: 04/05/2017] [Revised: 05/16/2017] [Accepted: 05/17/2017] [Indexed: 11/30/2022]
Abstract
A routine question encountered in medicolegal practice is whether the death of a patient in proximity to a surgical procedure is due to medical malpractice. The case of a 62-year-old man who died two weeks after undergoing a VATS sleeve resection of the upper right lung lobe in conjunction with radical lymphadenectomy, a routine surgical procedure, is reported. To address the issue of medical malpractice, a forensic autopsy was ordered by the investigative authority. During the autopsy, the lungs were removed as a whole and fixed in formalin and were later dissected in cooperation with a thoracic surgeon. In the course of this dissection, a bronchovascular fistula, which had led to the occlusion of the bronchial system with clotted blood, was discovered. Bronchovascular fistulas are a rare complication of bronchial sleeve resections. Because this surgical complication is essentially always fatal, it is highly pertinent to medicolegal practice. The presented case report also lists other important complications associated with bronchial anastomosis and elucidates a pragmatic approach to obtaining an expert clinical assessment of possible medical malpractice after operations through the example of a dissection performed in cooperation with a thoracic surgeon.
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Affiliation(s)
- Stefanie Plenzig
- University Hospital Frankfurt, Institute of Legal Medicine, Kennedyallee 104, 60596 Frankfurt am Main, Germany.
| | - Mauricio Soriano
- University Hospital Frankfurt, Department of Cardiac, Thoracic and Cardiovascular Surgery, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Hannelore Held
- University Hospital Frankfurt, Institute of Legal Medicine, Kennedyallee 104, 60596 Frankfurt am Main, Germany
| | - Marcel A Verhoff
- University Hospital Frankfurt, Institute of Legal Medicine, Kennedyallee 104, 60596 Frankfurt am Main, Germany
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