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Mei LY, Feng YG, Tao SL, Jiang B, Dai FQ, Zhou JH, Shen C, Guo W, Tan QY, Deng B. Analysis of the unplanned reoperation following surgical treatment of pulmonary tumor. J Cardiothorac Surg 2022; 17:306. [PMID: 36510224 PMCID: PMC9746151 DOI: 10.1186/s13019-022-02064-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In this study, we aimed to summarize the extremely important lesson and experience in the whole process of surgical treatments of lung tumors for the benefit of steps taken to prevent against unplanned reoperation. METHODS Demographical and clinical information of 7732 patients were retrospectively retrieved and reviewed, who were diagnosed with pulmonary tumor and underwent surgical treatments from January 2016 to March 2021. Those patients who underwent unplanned reoperation for the treatment of severe complications were focused carefully and analyzed meticulously. RESULTS A total of forty-one patients (41/7732) received 44 unplanned reoperations. Among them, eight and thirty-three patients were diagnosed with benign and malignant tumor, respectively. The incidence of unplanned reoperations seemed to be similar on both sides (Left vs. Right: 12/3231 vs. 29/4501, p = 0.103). Lobectomy plus segmentectomy is prone to reoperation (2/16, 12.5%) as compared to the other types of surgery. The complications leading to reoperation was hemothorax, including active hemorrhage (23/44, 52.3%) and clotted hemothorax (6/44, 13.6%), chylothorax (8/44, 18.2%), and the others (7/44, 15.9%) including bronchopleural fistula, torsion, or injury of right middle bronchus and pulmonary bulla rupture. The morbidity and mortality after unplanned reoperation were 17.1% (7/41) and 12.2% (5/41), respectively. CONCLUSIONS Bronchi or vessel stumps, the surgical edges of the lung parenchyma, and pleural adhesions should be checked to avoid postoperative bleeding. Prophylactic ligation of the thoracic duct should be recommended in case of the suspected oily-like exudation in the lymph node bed. Smooth expansion of the middle lobe is important to avoid narrowing and torsion before transection of the bronchus.
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Affiliation(s)
- Long-Yong Mei
- grid.414048.d0000 0004 1799 2720Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St,10#, Yuzhong District, Chongqing City, 400042 China
| | - Yong-Geng Feng
- grid.414048.d0000 0004 1799 2720Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St,10#, Yuzhong District, Chongqing City, 400042 China
| | - Shao-Lin Tao
- grid.414048.d0000 0004 1799 2720Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St,10#, Yuzhong District, Chongqing City, 400042 China
| | - Bin Jiang
- grid.414048.d0000 0004 1799 2720Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St,10#, Yuzhong District, Chongqing City, 400042 China
| | - Fu-Qiang Dai
- grid.414048.d0000 0004 1799 2720Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St,10#, Yuzhong District, Chongqing City, 400042 China
| | - Jing-Hai Zhou
- grid.414048.d0000 0004 1799 2720Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St,10#, Yuzhong District, Chongqing City, 400042 China
| | - Cheng Shen
- grid.414048.d0000 0004 1799 2720Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St,10#, Yuzhong District, Chongqing City, 400042 China
| | - Wei Guo
- grid.414048.d0000 0004 1799 2720Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St,10#, Yuzhong District, Chongqing City, 400042 China
| | - Qun-You Tan
- grid.414048.d0000 0004 1799 2720Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St,10#, Yuzhong District, Chongqing City, 400042 China
| | - Bo Deng
- grid.414048.d0000 0004 1799 2720Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St,10#, Yuzhong District, Chongqing City, 400042 China
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Kurihara N, Imai K, Takashima S, Nanjo H, Hiroshima Y, Ito S, Nomura K, Saito H, Minamiya Y. Stapler-lavage cytology using a new rapid immunocytochemistry for evaluating surgical margin status after pulmonary sublobar resection. Gen Thorac Cardiovasc Surg 2021; 70:359-365. [PMID: 34784004 DOI: 10.1007/s11748-021-01733-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/03/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Sublobar resection is considered the gold standard for selected patients with pulmonary metastasis or who are compromised in some way. However, an unfavorable outcome after sublobar resection is local/margin recurrence. The aim of this study was to evaluate the clinical reliability of a new rapid-stapler lavage immunocytochemistry (ICC) technique for assessing margin malignancy. The method uses non-contact alternating current (AC) mixing to achieve more stable staining. METHODS Twenty-one patients who underwent sublobar resection, including 16 wedge resections, for pulmonary metastasis or lung cancer in a compromised host between September 2016 and December 2017 were retrospectively reviewed. All margin specimens were intraoperatively evaluated with HE staining of frozen sections and stapler lavage cytology using Papanicolaou staining and rapid-ICC. RESULTS Rapid-stapler lavage ICC can be used to diagnose surgically safe margins within 20 min during sublobar resections. Although in all cases margins were diagnosed as cancer free based on HE staining of frozen sections, two of four patients diagnosed with malignant-positive margins based on rapid ICC experienced local/margin recurrence. CONCLUSIONS Rapid-stapler lavage ICC with AC mixing could potentially serve as a clinical tool for prompt determination of margin malignant status after pulmonary sublobar resection.
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Affiliation(s)
- Nobuyasu Kurihara
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Kazuhiro Imai
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
| | - Shinogu Takashima
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Hiroshi Nanjo
- Department of Pathology, Akita University Graduate School of Medicine, Akita, Japan
| | - Yuko Hiroshima
- Department of Pathology, Akita University Graduate School of Medicine, Akita, Japan
| | - Satoru Ito
- Department of Pathology, Akita University Graduate School of Medicine, Akita, Japan
| | - Kyoko Nomura
- Department of Health Environmental Science and Public Health, Akita University Graduate School of Medicine, Akita, Japan
| | - Hajime Saito
- Department of Chest Surgery, Iwate Medical University, Yahaba, Japan
| | - Yoshihiro Minamiya
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
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Han XY, Wang YY, Wei HQ, Yang GZ, Wang J, Jia YZ, Ao WQ. Multifocal neuroendocrine cell hyperplasia accompanied by tumorlet formation and pulmonary sclerosing pneumocytoma: A case report. World J Clin Cases 2020; 8:3583-3590. [PMID: 32913868 PMCID: PMC7457093 DOI: 10.12998/wjcc.v8.i16.3583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 07/06/2020] [Accepted: 07/16/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pulmonary tumorlets are nodular hyperplastic neuroendocrine cells (NECs) that extend beyond the basement membrane. They often coexist with other lung diseases such as fibrosis and bronchiectasis, but rarely accompanied by pulmonary sclerosing pneumocytoma (PSP), which has not been reported in the literature.
CASE SUMMARY A 54-year-old woman was admitted to the hospital because she had symptoms of bloody sputum for more than 4 mo and hemoptysis for 1 wk. Computed tomography images showed atrophy accompanied by infections in the middle lobe of her right lung. Moreover, numerous nodules were identified in the middle lobe of the right lung. The patient underwent thoracoscopic pneumonectomy of the middle lobe of the right lung, and the resected mass was pathologically confirmed to have bronchiectasis, multifocal NEC hyperplasia accompanied by tumorlet, and PSP.
CONCLUSION Our report presents a rare clinical case of bronchiectasis complicated with multifocal NEC hyperplasia, tumorlet, and PSP.
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Affiliation(s)
- Xiao-Yu Han
- Department of Pathology, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang Province, China
| | - Yuan-Yuan Wang
- Department of Pathology, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang Province, China
| | - Hong-Quan Wei
- Department of Pathology, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang Province, China
| | - Guang-Zhao Yang
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang Province, China
| | - Jian Wang
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang Province, China
| | - Yu-Zhu Jia
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang Province, China
| | - Wei-Qun Ao
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang Province, China
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Yabuki K, Matsuyama A, Obara K, Takenaka M, Tanaka F, Nakatani Y, Hisaoka M. A unique case of a huge mixed squamous cell and glandular papilloma of non-endobronchial origin with a peripheral growth. Respir Med Case Rep 2018; 24:108-112. [PMID: 29977775 PMCID: PMC6010628 DOI: 10.1016/j.rmcr.2018.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 05/02/2018] [Indexed: 12/21/2022] Open
Abstract
We report a case of a huge solitary non-endobronchial pulmonary tumor in a 76-year-old male smoker. The tumor measured 11 × 10 × 8 cm. It was ill-defined, and it was located periphery of the right lower lobe with the subpleural cystic spaces. He underwent right lower lobectomy with mediastinal lymph node dissection and is free from tumor 30 months after surgery. Microscopically, it was composed of a proliferation of squamous and ciliated columnar epithelial cells with a few mucous cells. These cells were arranged in a papillary growth fashion extending along the fibrously thickened alveolar septa together with metaplastic bronchiolar and squamous epithelia displaying an usual interstitial pneumonia-pattern. Although the histologic features of the tumor were that of a mixed squamous cell and glandular papilloma (MSCGP), it was peripherally located and showed a lepidic growth, and it was much larger than previously reported MSCGPs. It is possible that the tumor developed in association with bronchial metaplasia in the periphery of the lung, and then extended along the surface of the reconstructed air spaces, which resulted in its unique histologic appearance. Further investigations of respiratory papilloma are needed to clarify the pathogenesis of these lesions.
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Affiliation(s)
- Kei Yabuki
- Departments of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Atsuji Matsuyama
- Departments of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Kosho Obara
- Department of Surgical Pathology, University Hospital of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Masaru Takenaka
- Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Fumihiro Tanaka
- Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Yukio Nakatani
- Department of Diagnostic Pathology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Masanori Hisaoka
- Departments of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
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Huang L, Wang L, Zhu W, Han R, Tang H, Cao Z, Zhou J, Hu D, Wang C, Xia L. Area--a consistent method to evaluate pulmonary tumor size on multidetector CT imaging: an intraobserver and interobserver agreement study. Clin Imaging 2013; 37:1006-10. [PMID: 23993800 DOI: 10.1016/j.clinimag.2013.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 05/20/2013] [Accepted: 06/25/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To evaluate the agreements of unidimensional, bidimensional, area and volume measurements of pulmonary tumors on multidetector computed tomography (MDCT), and to determine which method is the most reliable one. MATERIALS AND METHODS Thirty patients with pulmonary tumors were enrolled in this study, which referred to undergo thoracic MDCT in our hospital. Four radiologists evaluated dimensions of pulmonary tumor independently, including length, width, height, area and volume. The intraclass correlation coefficient (ICC) and concordance correlation coefficient (CCC) were both used to evaluate the variability between the repeat readings of the same scan. RESULTS The ICCs and CCCs of the intraobserver were both higher than interobserver's (ICC intra vs. inter: 0.984 vs. 0.947 and CCC intra vs. inter: 0.993 vs. 0.943). Area of intraobserver ICC (ICC=0.992, P<.001) and CCC (CCC=0.997, P<.001) both had the best agreements of the six methods. Among the interobserver ICCs and CCCs, area (ICC=0.981, P<.001 and CCC=0.982, P<.001) was also the best of the six methods. CONCLUSIONS Area measurement on MDCT is the most reproducible method that measures tumor dimension accurately.
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Affiliation(s)
- Lu Huang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095# Jiefang Ave, Wuhan, Hubei, 430030,PR China
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