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Caviezel C, Kostopanagiotou K, Puippe GD, Werner RS, Opitz I. ‘One-stop-shop’ diagnosis and stage-adapted surgical therapy for small nodules of early stage lung cancer in a hybrid operating room. Br J Surg 2022. [DOI: 10.1093/bjs/znac185.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Objective
Emergent lung cancer screening programs increased detection of small pulmonary nodules. Anatomical resection in case of early-stage lung cancer with only one intervention becomes increasingly desirable. Current literature lacks procedure data about both diagnosis and subsequent indicated resection. After starting our hybrid operating room program, we reviewed the efficacy of detection, diagnosis and therapy in one-step.
Methods
Undiagnosed pulmonary nodules suspicious of lung cancer, which were not detectable by conventional video-assisted thoracoscopic surgery (VATS) due to localization and size, were scheduled for a hybrid procedure consisting of a cone-beam CT-guided hookwire insertion and C-arm assisted thoracoscopic wedge resection for frozen section. All procedures were analyzed for perioperative outcomes including success rate of image-guided nodule resection and rate of concomitant correct anatomical resection.
Results
Between July 2020 and July 2021, 23 patients with 25 nodules underwent image-guided VATS (iVATS) in the hybrid room. Twenty-two nodules were successfully marked by hookwire, three nodules were detected by ultrasound in one case and palpation in two cases. In 16 patients (70%) wedge resection with frozen section showed malignancy. Five patients with previous history of operated lung cancer received only a diagnostic wedge, as frozen section could not differentiate between primary or metastatic lung cancer. Eleven patients (48%) had early-stage primary lung cancer (8 adenocarcinoma, one typical carcinoid, one small-cell lung cancer and one squamous-cell lung cancer). Ten of them (91%) received a synchronous completion anatomical resection (seven lobectomies, three segmentectomies). In one patient, malignancy was only confirmed in final histology.
Conclusion
One-stop-shop diagnosis and treatment by iVATS with frozen section and concomitant completion anatomical resection in a hybrid operating room for otherwise non-well approachable early stage lung cancer is patient-convenient for the increasingly detected small pulmonary nodules.
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Affiliation(s)
- C Caviezel
- Department of Thoracic Surgery, University Hospital Zurich , Zurich, Switzerland
| | - K Kostopanagiotou
- Department of Thoracic Surgery, Attikon University Hospital Athens-UHA , Athens, Greece
| | - G D Puippe
- Interventional Radiology Department, University Hospital Zurich , Zurich, Switzerland
| | - R S Werner
- Department of Thoracic Surgery, University Hospital Zurich , Zurich, Switzerland
| | - I Opitz
- Department of Thoracic Surgery, University Hospital Zurich , Zurich, Switzerland
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Hiltbrunner S, Britschgi C, Schuberth P, Bankel L, Nguyen-Kim T, Gulati P, Weder W, Opitz I, Lauk O, Caviezel C, Bachmann H, Tabor A, Schröder P, Knuth A, Münz C, Stahel R, Boyman O, Renner C, Petrausch U, Curioni-Fontecedro A. Local delivery of CAR T cells targeting fibroblast activation protein is safe in patients with pleural mesothelioma: first report of FAPME, a phase I clinical trial. Ann Oncol 2021; 32:120-121. [DOI: 10.1016/j.annonc.2020.10.474] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/07/2020] [Accepted: 10/12/2020] [Indexed: 10/23/2022] Open
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Collins CG, Spasojevic MJ, Alados CL, Aronson EL, Benavides JC, Cannone N, Caviezel C, Grau O, Guo H, Kudo G, Kuhn NJ, Müllerová J, Phillips ML, Pombubpa N, Reverchon F, Shulman HB, Stajich JE, Stokes A, Weber SE, Diez JM. Belowground impacts of alpine woody encroachment are determined by plant traits, local climate, and soil conditions. Glob Chang Biol 2020; 26:7112-7127. [PMID: 32902066 DOI: 10.1111/gcb.15340] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/22/2020] [Accepted: 08/26/2020] [Indexed: 05/17/2023]
Abstract
Global climate and land use change are causing woody plant encroachment in arctic, alpine, and arid/semi-arid ecosystems around the world, yet our understanding of the belowground impacts of this phenomenon is limited. We conducted a globally distributed field study of 13 alpine sites across four continents undergoing woody plant encroachment and sampled soils from both woody encroached and nearby herbaceous plant community types. We found that woody plant encroachment influenced soil microbial richness and community composition across sites based on multiple factors including woody plant traits, site level climate, and abiotic soil conditions. In particular, root symbiont type was a key determinant of belowground effects, as Nitrogen-fixing woody plants had higher soil fungal richness, while Ecto/Ericoid mycorrhizal species had higher soil bacterial richness and symbiont types had distinct soil microbial community composition. Woody plant leaf traits indirectly influenced soil microbes through their impact on soil abiotic conditions, primarily soil pH and C:N ratios. Finally, site-level climate affected the overall magnitude and direction of woody plant influence, as soil fungal and bacterial richness were either higher or lower in woody encroached versus herbaceous soils depending on mean annual temperature and precipitation. All together, these results document global impacts of woody plant encroachment on soil microbial communities, but highlight that multiple biotic and abiotic pathways must be considered to scale up globally from site- and species-level patterns. Considering both the aboveground and belowground effects of woody encroachment will be critical to predict future changes in alpine ecosystem structure and function and subsequent feedbacks to the global climate system.
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Affiliation(s)
- Courtney G Collins
- Institute of Arctic and Alpine Research, University of Colorado Boulder, Boulder, CO, USA
- Department of Botany and Plant Sciences, University of California Riverside, Riverside, CA, USA
| | - Marko J Spasojevic
- Department of Evolution, Ecology, and Organismal Biology, University of California Riverside, Riverside, CA, USA
| | | | - Emma L Aronson
- Department of Microbiology and Plant Pathology, University of California Riverside, Riverside, CA, USA
| | | | | | - Chatrina Caviezel
- Department of Environmental Sciences, Physical Geography and Environmental Change, University of Basel, Basel, Switzerland
| | - Oriol Grau
- Global Ecology Unit, Campus de Bellaterra (UAB), CREAF, Barcelona, Spain
- Cirad, UMR EcoFoG (AgroParisTech, CNRS, Inra, Univ Antilles, Univ Guyane), Kourou, French Guiana
| | - Hui Guo
- College of Resources and Environmental Sciences, Nanjing Agricultural University, Nanjing, China
| | - Gaku Kudo
- Environmental Earth Science, Hokkaido University, Sapporo, Japan
| | - Nikolas J Kuhn
- Department of Environmental Sciences, Physical Geography and Environmental Change, University of Basel, Basel, Switzerland
| | - Jana Müllerová
- Institute of Botany of the Czech Academy of Sciences, Průhonice, Czech Republic
| | - Michala L Phillips
- Department of Botany and Plant Sciences, University of California Riverside, Riverside, CA, USA
- US Geological Survey, Southwest Biological Science Center, Moab, UT, USA
| | - Nuttapon Pombubpa
- Department of Microbiology and Plant Pathology, University of California Riverside, Riverside, CA, USA
| | - Frédérique Reverchon
- Red de Estudios Moleculares Avanzados, Instituto de Ecología (INECOL), Pátzcuaro, Mexico
| | - Hannah B Shulman
- Department of Microbiology and Plant Pathology, University of California Riverside, Riverside, CA, USA
| | - Jason E Stajich
- Department of Microbiology and Plant Pathology, University of California Riverside, Riverside, CA, USA
| | - Alexia Stokes
- University Montpellier, AMAP, INRAE, CIRAD, IRD, CNRS, Montpellier, France
| | - Sören E Weber
- Department of Evolution, Ecology, and Organismal Biology, University of California Riverside, Riverside, CA, USA
- Institut für Evolutionsbiologie und Umweltwissenschaften, Universität Zürich, Zürich, Switzerland
| | - Jeffrey M Diez
- Department of Botany and Plant Sciences, University of California Riverside, Riverside, CA, USA
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Abstract
Lung volume reduction surgery (LVRS) offers improvement in lung function, quality of life and even survival in well selected patients with severe emphysema. Patients with all types of emphysema morphology can profit from LVRS when certain selection criteria are present. Hyperinflation plays a key role in qualifying for the procedure. Candidate selection should be performed at high volume centers with a multidisciplinary emphysema board. Qualified thoracic surgeons together with pulmonologists and radiologists identify the suitable patient considering emphysema morphology with its target areas for resection, lung function parameters and cardiac comorbidities. This review outlines candidate selection, technique and results of LVRS to inform referring physicians how to screen und inform their patients.
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Abstract
In a number of large case series in the mid-1990s, lung volume reduction surgery (LVRS) was shown to reduce dyspnoea and improve pulmonary function and quality of life in patients with advanced pulmonary emphysema. The large randomised National Emphysema Treatment Trial (NETT) confirmed this in the early 2000s and also demonstrated that selected patients live longer after surgery. Patient selection is crucial to the success of the procedure and should be performed at a specialised experienced centre with a multidisciplinary team approach on emphysema treatment. The upper-lobe predominant heterogeneous type of emphysema is the best indication, but there are other types of emphysema morphology that are also eligible for surgery, if ideally chosen. Nowadays there is also growing evidence for positive effects after different types of bronchoscopic lung volume reduction (BLVR) with increasing quality. These methods add to the range of multimodal emphysema treatment.
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Affiliation(s)
- C Caviezel
- Klinik für Thoraxchirurgie, UniversitätsSpital Zürich, Schweiz
| | - D Franzen
- Klinik für Pneumologie, UniversitätsSpital Zürich, Schweiz
| | - I Inci
- Klinik für Thoraxchirurgie, UniversitätsSpital Zürich, Schweiz
| | - W Weder
- Klinik für Thoraxchirurgie, UniversitätsSpital Zürich, Schweiz
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