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Kim JY, Yun JK, Lee GD, Choi S, Kim HR, Kim YH, Park SI, Kim DK. Adjuvant surgical resection for nontuberculous mycobacterial pulmonary disease: Effectiveness and complications. Ann Thorac Med 2024; 19:131-138. [PMID: 38766373 PMCID: PMC11100472 DOI: 10.4103/atm.atm_237_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/16/2023] [Accepted: 11/16/2023] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Standard antibiotic treatment for nontuberculous mycobacteria pulmonary disease (NTMPD) has unsatisfactory success rates. Pulmonary resection is considered adjunctive therapy for patients with refractory disease or severe complications, but surgical indications and extent of resection remain unclear. We present surgical treatment outcomes for NTMPD and analyzes risk factors for unfavorable outcomes. METHODS We conducted a retrospective investigation of medical records for patients diagnosed with NTMPD who underwent surgical treatment at Asan Medical Center between 2007 and 2021. We analyzed clinical data including microbiological and surgical outcomes. RESULTS A total of 71 NTMPD patients underwent thoracic surgery. Negative conversion of acid-fast bacillus (AFB) culture following pulmonary resection was observed in 51 (73.9%) patients. In terms of long-term outcomes, negative conversion was sustained in 38 cases (55.1%). Mortality occurred in 7 patients who underwent pulmonary resections for NTMPD. Statistically significant associations with factors for recurrence or non-negative conversion of AFB culture were found in older age (odds ratio [OR] =1.093, 95% confidence interval [CI]: 1.029-1.161, P = 0.004), male sex (OR = 0.251, 95% CI: 0.071-0.892, P = 0.033), and extensive NTMPD lesions involving three lobes or more (OR = 5.362, 95% CI: 1.315-21.857, P = 0.019). Interstitial lung disease (OR = 13.111, 95% CI: 1.554-110.585, P = 0.018) and pneumonectomy (OR = 19.667, 95% CI: 2.017-191.797, P = 0.018) were statistically significant risk factors for postoperative mortality. CONCLUSION Pulmonary resection can be an effective adjuvant treatment option for NTMPD patients, with post-operative antibiotic treatment as the primary treatment. Careful patient selection is crucial, considering the associated risk factors and resectability due to complications and recurrence.
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Affiliation(s)
- Ji Yong Kim
- Department of Thoracic and Cardiovascular Surgery, Division of Thoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Kwang Yun
- Department of Thoracic and Cardiovascular Surgery, Division of Thoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Geon Dong Lee
- Department of Thoracic and Cardiovascular Surgery, Division of Thoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sehoon Choi
- Department of Thoracic and Cardiovascular Surgery, Division of Thoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyeong Ryul Kim
- Department of Thoracic and Cardiovascular Surgery, Division of Thoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yong-Hee Kim
- Department of Thoracic and Cardiovascular Surgery, Division of Thoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Il Park
- Department of Thoracic and Cardiovascular Surgery, Division of Thoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Division of Thoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Elkhayat H, Elsayed HH, Adel W, Elkhouly AG, Abdellateef A, Amin WAM, Abd El Hafiez AI, Beshir H, Elsayed YA, Elhamami MM, Wahby EAM, Gamil EE, Elminshawy A. Thoracic surgery in Egypt. J Thorac Dis 2022; 14:1282-1295. [PMID: 35572880 PMCID: PMC9096295 DOI: 10.21037/jtd-21-723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 10/18/2021] [Indexed: 11/13/2022]
Abstract
General thoracic surgery operations in Egypt are performed mainly by cardiothoracic surgeons and less oftenly by dedicated thoracic surgeons and general surgeons. This is mainly due to the relatively small number of thoracic surgeons in relation to population as only 210 cardiothoracic surgery specialists and 458 consultants are registered with the Egyptian Medical Syndicate (EMS) in a country with a population of more than 100 million people. Thoracic surgeons in Egypt are faced with a number of burdens, including the need to propagate the service to advanced technology infront of the obstacle of limited resources. Other burdens include higher incidence of TB, trauma and foreign body inhalation related to cultural backgrounds. More centres now are major video-assisted thoracic surgery (VATS) providing centres and others are specialized in more complex surgeries like complicated airway procedures and radical surgery for mesothelioma. As part of the international community, the COVID-19 pandemic has put more burdens on the thoracic surgery service as most centres have reduced their elective surgery workload to less than half of usual. Interestingly, the pandemic has allowed a self-referral screening programme with widespread Computed Tomography (CT) chest being performed among the population allowing thoracic surgeons to operate more on early stage lung cancer. The academic challenges for thoracic surgeons are even more with need for developing national databases. Nevertheless, thoracic surgeons in Egypt are optimistic regarding the future. The rising interest among the younger population will push training programs to meet the interests of enthusiastic junior surgeons. While the ancient history of thoracic surgery in Egypt seems to be extraordinary, the future perspectives promise to be more rewarding.
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Affiliation(s)
- Hussein Elkhayat
- Department of Cardiothoracic Surgery, Faculty of Medicine, Assiut University Heart Hospital, Assiut, Egypt
| | - Hany Hasan Elsayed
- Department of Cardiothoracic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Waleed Adel
- Department of Cardiothoracic Surgery, Kasr Alainy Faculty of medicine, Cairo University, Cairo, Egypt
| | - Ahmed Gamal Elkhouly
- Department of Cardiothoracic Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Amr Abdellateef
- Department of Cardiothoracic Surgery, Faculty of Medicine, Mansoura University, Nile Delta, Egypt
| | | | | | - Hatem Beshir
- Department of Cardiothoracic Surgery, Faculty of Medicine, Mansoura University, Nile Delta, Egypt
- Department of Cardiothoracic Surgery, Egypt Ministry of Health and Population, Alexandria, Egypt
| | | | | | | | | | - Ahmed Elminshawy
- Department of Cardiothoracic Surgery, Faculty of Medicine, Assiut, Egypt
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Wu CY, Chen YY, Chang CC, Yen YT, Lai WW, Huang WL, Tseng YL. Single-port thoracoscopic anatomic resection for chronic inflammatory lung disease. BMC Surg 2021; 21:244. [PMID: 34006253 PMCID: PMC8130153 DOI: 10.1186/s12893-021-01252-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/11/2021] [Indexed: 12/03/2022] Open
Abstract
Background It is challenging to proceed thoracoscopic anatomic resection when encountering severe pleural adhesion or calcified peribronchial lymphadenopathy. Compared with multiple-port video-assisted thoracoscopic surgery (MP-VATS), how to overcome these challenges in single-port (SP-) VATS is still an intractable problem. In the present study, we reported the surgical results of chronic inflammatory lung disease and shared some useful SP-VATS techniques. Methods We retrospectively assessed the surgical results of chronic inflammatory lung disease, primarily bronchiectasis, and mycobacterial infection, at our institution between 2010 and 2018. The patients who underwent SP-VATS anatomic resection were compared with those who underwent MP-VATS procedures. We analyzed the baseline characteristics, perioperative data, and postoperative outcomes, and illustrated four special techniques depending on the situation: flexible hook electrocautery, hilum-first technique, application of Satinsky vascular clamp, and staged closure of bronchial stump method. Results We classified 170 consecutive patients undergoing thoracoscopic anatomic resection into SP and MP groups, which had significant between-group differences in operation time and overall complication rate (P = 0.037 and 0.018, respectively). Compared to the MP-VATS group, the operation time of SP-VATS was shorter, and the conversion rate of SP-VATS was relatively lower (3.1% vs. 10.5%, P = 0.135). The most common complication was prolonged air leakage (SP-VATS, 10.8%; MP-VATS, 2.9%, P = 0.045). Conclusions For chronic inflammatory lung disease, certain surgical techniques render SP-VATS anatomic resection feasible and safe with a lower conversion rate.
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Affiliation(s)
- Chen-Yu Wu
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Chung University, 138 Sheng-Li Road, Tainan, 704, Taiwan
| | - Ying-Yuan Chen
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Chung University, 138 Sheng-Li Road, Tainan, 704, Taiwan.,Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chao-Chun Chang
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Chung University, 138 Sheng-Li Road, Tainan, 704, Taiwan
| | - Yi-Ting Yen
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Chung University, 138 Sheng-Li Road, Tainan, 704, Taiwan
| | - Wu-Wei Lai
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Chung University, 138 Sheng-Li Road, Tainan, 704, Taiwan
| | - Wei-Li Huang
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Chung University, 138 Sheng-Li Road, Tainan, 704, Taiwan. .,Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Yau-Lin Tseng
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Chung University, 138 Sheng-Li Road, Tainan, 704, Taiwan
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Yun JS, Song SY, Na KJ, Kim S, Jang KH, Jeong IS, Oh SG. Surgery for hemoptysis in patients with benign lung disease. J Thorac Dis 2018; 10:3532-3538. [PMID: 30069350 DOI: 10.21037/jtd.2018.05.122] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Hemoptysis can be a life-threatening condition that requires urgent treatment. Surgery still plays an important role in managing this critical situation, although previous reports have reported high postoperative morbidity and mortality rates. We report our experience with surgical resection for hemoptysis caused by benign lung diseases. Methods We reviewed the retrospectively collected data from 94 patients undergoing pulmonary resection for various benign lung diseases with hemoptysis at a single institution from 2010 to 2016. Baseline characteristics, surgical factors, and postoperative outcomes (morbidity and mortality rates) were analyzed. Results The ratio of male to female patients was 1:1, and the mean age was 58.2±11.1 (range, 29-79) years. The etiology of hemoptysis included aspergilloma in 58 patients (61.7%), bronchiectasis in 10, tuberculosis in 7, necrotizing bronchiolitis in 6, and other inflammatory disease in 13. A total of 21 patients (22.3%) underwent emergency operation, and 73 (77.7%) had an elective operation. Pulmonary resection was performed by thoracotomy (n=53, 56.4%) and video-assisted thoracoscopic surgery (VATS) (n=41, 43.6%). Sublobar resection (n=50, 53.2%, segmentectomy in 19 and wedge resection in 31) was performed more often than lobectomy (n=35, 37.2%). Pneumonectomy was performed in 7 patients, and bilobectomy was performed in 2. Postoperative morbidity occurred in 23 patients (24.5%), with prolonged air leak being the most frequent complication (n=14, 14.9%). The in-hospital mortality rate was 3.2% (n=3). Complications were less frequent in patients undergoing an elective operation, VATS, and sublobar resection. Multivariate analysis showed that patients treated with VATS had a decreased risk of postoperative complications (odds ratio, 12.8; 95% confidence interval, 1.29-127.9; P=0.03). Conclusions Surgical resection for hemoptysis in patients with benign lung diseases is the mainstay of effective treatment with acceptable morbidity and mortality rates. If applicable, we recommend elective (planned) sublobar resection using VATS in order to improve postoperative outcomes.
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Affiliation(s)
- Ju Sik Yun
- Department of Thoracic and Cardiovascular Surgery, Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Jeollanamdo, South Korea
| | - Sang Yun Song
- Department of Thoracic and Cardiovascular Surgery, Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Jeollanamdo, South Korea
| | - Kook Joo Na
- Department of Thoracic and Cardiovascular Surgery, Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Jeollanamdo, South Korea
| | - Seok Kim
- Department of Thoracic and Cardiovascular Surgery, Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Jeollanamdo, South Korea
| | - Keun-Ho Jang
- Department of Occupational and Environmental Medicine, Mokpo Christian Hospital, Jeollanamdo, South Korea
| | - In Seok Jeong
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Gwang-ju, South Korea
| | - Sang Gi Oh
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Gwang-ju, South Korea
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Mazzella A, Olland A, Garelli E, Renaud S, Reeb J, Santelmo N, Falcoz PE, Massard G. Video-assisted thoracoscopic surgery is a safe option for benign lung diseases requiring lobectomy. Surg Endosc 2016; 31:1250-1256. [PMID: 27405483 DOI: 10.1007/s00464-016-5099-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 07/06/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Lobectomy for benign lung disease is renowned to be technically complex and to be subjected to an increased complication rate. The objective of this study was to evaluate whether the results obtained with video-assisted surgery (VATS) in benign disease are comparable to those obtained in oncologic surgery, where VATS has been validated. METHODS We have reviewed the files of 246 consecutive patients who underwent VATS lobectomy from January 2012 to August 2015. The cohort was divided into two groups according to pathology (benign or malignant). Outcome parameters on scrutiny were demographics, pathology, duration of air leak, drainage and hospital stay, conversion, and perioperative complication rate. Comparisons were made with the χ 2 test and Student's t test; any p value ≤0.05 was considered as significant. RESULTS Group 1 (36 patients) included patients who underwent lobectomy for benign disease and group 2 (210 patients) patients affected by lung cancer or pulmonary metastases. The two groups differed with reference to age (p < 0.001), history of cancer (p < 0.001), history of stroke (p = 0.05), and the presence of pleural adhesions (p = 0.03). There was no difference for duration of air leaks, chest tube drainage and hospital stay, conversion rate, and perioperative complication rate. CONCLUSIONS We conclude that pathology did not impact on outcomes after VATS lobectomy. This study suggests that VATS is as a safe option in selected patients with benign disease requiring lobectomy, despite a more complex technical context.
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Affiliation(s)
- Antonio Mazzella
- Department of thoracic surgery, Hôpitaux universitaires de Strasbourg, Nouvel Hôpital Civil, 1 Place de l'Hôpital, BP 426, 67091, Strasbourg Cedex, France
| | - Anne Olland
- Department of thoracic surgery, Hôpitaux universitaires de Strasbourg, Nouvel Hôpital Civil, 1 Place de l'Hôpital, BP 426, 67091, Strasbourg Cedex, France
- E.A. 7213 stress vasculaire et tissulaire en transplantation, Strasbourg, France
| | - Elena Garelli
- Department of thoracic surgery, Hôpitaux universitaires de Strasbourg, Nouvel Hôpital Civil, 1 Place de l'Hôpital, BP 426, 67091, Strasbourg Cedex, France
| | - Stephane Renaud
- Department of thoracic surgery, Hôpitaux universitaires de Strasbourg, Nouvel Hôpital Civil, 1 Place de l'Hôpital, BP 426, 67091, Strasbourg Cedex, France
- EA 3430: Progression tumorale et micro-environnement. Approches translationnelles et épidémiologie, Strasbourg, France
| | - Jeremie Reeb
- Department of thoracic surgery, Hôpitaux universitaires de Strasbourg, Nouvel Hôpital Civil, 1 Place de l'Hôpital, BP 426, 67091, Strasbourg Cedex, France
| | - Nicola Santelmo
- Department of thoracic surgery, Hôpitaux universitaires de Strasbourg, Nouvel Hôpital Civil, 1 Place de l'Hôpital, BP 426, 67091, Strasbourg Cedex, France
| | - Pierre Emmanuel Falcoz
- Department of thoracic surgery, Hôpitaux universitaires de Strasbourg, Nouvel Hôpital Civil, 1 Place de l'Hôpital, BP 426, 67091, Strasbourg Cedex, France
| | - Gilbert Massard
- Department of thoracic surgery, Hôpitaux universitaires de Strasbourg, Nouvel Hôpital Civil, 1 Place de l'Hôpital, BP 426, 67091, Strasbourg Cedex, France.
- E.A. 7213 stress vasculaire et tissulaire en transplantation, Strasbourg, France.
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