1
|
Henschke P, Guglielmetti LC, Hillinger S, Monsch GM, Schneiter D, Opitz I, Lauk O. Risk factors influencing postoperative pleural empyema in patients with pleural mesothelioma: a retrospective single-centre analysis. Eur J Cardiothorac Surg 2024; 65:ezae137. [PMID: 38637940 PMCID: PMC11055398 DOI: 10.1093/ejcts/ezae137] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 03/14/2024] [Accepted: 04/17/2024] [Indexed: 04/20/2024] Open
Abstract
OBJECTIVES Postoperative empyema is a severe, potentially lethal complication also present, but poorly studied in patients undergoing surgery for pleural mesothelioma. We aimed to analyse which perioperative characteristics might be associated with an increased risk for postoperative empyema. METHODS From September 1999 to February 2023 a retrospective analysis of consecutive patients undergoing surgery for pleural mesothelioma at the University Hospital of Zurich was performed. Uni- and multivariable logistic regression was used to identify associated risk factors of postoperative empyema after surgery. RESULTS A total of 400 PM patients were included in the analysis, of which n = 50 patients developed empyema after surgery (12.5%). Baseline demographics were comparable between patients with (Eyes) and without empyema (Eno). 39% (n = 156) patients underwent extrapleural pneumonectomy (EPP), of whom 22% (n = 35) developed postoperative pleural empyema; 6% (n = 15) of the remaining 244 patients undergoing pleurectomy and decortication (n = 46), extended pleurectomy and decortication (n = 114), partial pleurectomy (n = 54) or explorative thoracotomy (n = 30) resulted in postoperative empyema. In multivariable logistic regression analysis, EPP (odds ratio 2.8, 95% confidence interval 1.5-5.4, P = 0.002) emerged as the only risk factor associated with postoperative empyema when controlled for smoking status. Median overall survival was significantly worse for Eyes (16 months, interquartile range 5-27 months) than for Eno (18 months, interquartile range 8-35 months). CONCLUSIONS Patients undergoing EPP had a significantly higher risk of developing postoperative pleural empyema compared to patients undergoing other surgery types. Survival of patients with empyema was significantly shorter.
Collapse
Affiliation(s)
- Peter Henschke
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | | | - Sven Hillinger
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Gian-Marco Monsch
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Didier Schneiter
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Olivia Lauk
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
2
|
Caviezel C, Rodriguez M, Sirotkin P, Held U, Opitz I, Schneiter D. Relevance of pleural adhesions for short- and long-term outcomes after lung volume reduction surgery. JTCVS Open 2023; 16:996-1003. [PMID: 38204661 PMCID: PMC10774947 DOI: 10.1016/j.xjon.2023.06.018] [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] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/14/2023] [Accepted: 06/20/2023] [Indexed: 01/12/2024]
Abstract
Objective Pleural adhesions (PLAs) have been shown to be a possible risk factor for air leak after lung volume reduction surgery (LVRS), but the relevance of PLA for lung function outcome remains unclear. We analyzed our LVRS cohort for the influence of PLA on short-term (ie, prolonged air leak) and long-term outcomes. Methods Retrospective observational cohort study with 187 consecutive patients who underwent LVRS from January 2016 to December 2019. PLA were defined as relevant if they were distributed extensively at the dorsal pleura; were present in at least at 2 areas, including the dorsal pleura; or present extensively at the mediastinal pleura. In patients with bilateral emphysema, bilateral LVRS was performed preferentially. The objectives were to quantify the association of PLA and rate of prolonged air leak (chest tube >7 days), and the association of PLA with postoperative exacerbations and with forced expiratory volume in 1 second 3 months postoperatively. The associations were quantified with odds ratios for binary outcomes, and with between-group differences for continuous outcomes. To account for missing observations, 100-fold multiple imputation was used. Results PLAs were found in 46 of 187 patients (24.6%). There was a 32.6% rate of prolonged air leak (n = 61), mean chest tube time was 7.84 days. A total of 94 (50.3%) LVRSs were unilateral and 93 were bilateral. There was evidence for an association between PLA and the rate of prolonged air leak (odds ratio, 2.83; 95% CI, 1.36 to 5.89; P = .006). There was no evidence for an association between PLA and postoperative exacerbations (odds ratio, 1.11; 95% CI, 0.5 to 2.45; P = .79). There was no evidence for an association between PLA and forced expiratory volume in 1 second (estimate -1.52; 95% CI -5.67 to 2.63; P = .47). Both unilateral and bilateral LVRS showed significant postoperative improvements in forced expiratory volume in 1 second by 27% (8.43 units; 95% CI, 3.66-13.12; P = .0006) and by 28% (7.87 units; 95% CI, 4.68-11.06; P < .0001) and a reduction in residual volume of 15% (-33.9 units; 95% CI, -56.37 to -11.42; P = .003) and 15% (-34.9 units; 95% CI, -52.57 to -17.22; P = .0001), respectively. Conclusions Patients should be aware of potential prolongation of hospitalization due to PLA. However, there might be no relevant influence of PLA on lung function outcomes.
Collapse
Affiliation(s)
- Claudio Caviezel
- Department of Thoracic Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Medea Rodriguez
- Department of Thoracic Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Pavel Sirotkin
- Epidemiology, Biostatistics, and Prevention Institute, University of Zürich, Zürich, Switzerland
| | - Ulrike Held
- Epidemiology, Biostatistics, and Prevention Institute, University of Zürich, Zürich, Switzerland
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Didier Schneiter
- Department of Thoracic Surgery, University Hospital Zürich, Zürich, Switzerland
| |
Collapse
|
3
|
Faccioli E, Lorenzoni G, Schneiter D, Dell’Amore A, Hillinger S, Schiavon M, Caviezel C, Gregori D, Rea F, Opitz I, Inci I. Validated Prognostic Scores to Predict Outcomes in ECLS-Bridged Patients to Lung Transplantation. Transpl Int 2023; 36:11609. [PMID: 37965627 PMCID: PMC10642624 DOI: 10.3389/ti.2023.11609] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 10/16/2023] [Indexed: 11/16/2023]
Abstract
Selection of patients who may benefit from extracorporeal life support (ECLS) as a bridge to lung transplant (LTx) is crucial. The aim was to assess if validated prognostic scores could help in selecting patients who may benefit from ECLS-bridging predicting their outcomes. Clinical data of patients successfully ECLS-bridged to LTx from 2009 to 2021 were collected from two European centers. For each patient, we calculated Sequential Organ Failure Assessment (SOFA), Simplified Acute Physiology Score III (SAPS III), Acute Physiology and Chronic Health Evaluation II (APACHE II), before placing ECLS support, and then correlated with outcome. Median values of SOFA, SAPS III, and APACHE II were 5 (IQR 3-9), 57 (IQR 47.5-65), and 21 (IQR 15-26). In-hospital, 30 and 90 days mortality were 21%, 14%, and 22%. SOFA, SAPS III, and APACHE II were analyzed as predictors of in-hospital, 30 and 90 days mortality (SOFA C-Index: 0.67, 0.78, 0.72; SAPS III C-index: 0.48, 0.45, 0.51; APACHE II C-Index: 0.49, 0.45, 0.52). For SOFA, the score with the best performance, a value ≥9 was identified to be the optimal cut-off for the prediction of the outcomes of interest. SOFA may be considered an adequate predictor in these patients, helping clinical decision-making. More specific and simplified scores for this population are necessary.
Collapse
Affiliation(s)
- Eleonora Faccioli
- Thoracic Surgery Unit, Department of Cardiac, Thoracic Vascular Sciences and Public Health, University Hospital of Padua, Padua, Italy
- Department of Thoracic Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic Vascular Sciences and Public Health University of Padua, Padua, Italy
| | - Didier Schneiter
- Department of Thoracic Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - Andrea Dell’Amore
- Thoracic Surgery Unit, Department of Cardiac, Thoracic Vascular Sciences and Public Health, University Hospital of Padua, Padua, Italy
| | - Sven Hillinger
- Department of Thoracic Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - Marco Schiavon
- Thoracic Surgery Unit, Department of Cardiac, Thoracic Vascular Sciences and Public Health, University Hospital of Padua, Padua, Italy
| | - Claudio Caviezel
- Department of Thoracic Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic Vascular Sciences and Public Health University of Padua, Padua, Italy
| | - Federico Rea
- Thoracic Surgery Unit, Department of Cardiac, Thoracic Vascular Sciences and Public Health, University Hospital of Padua, Padua, Italy
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - Ilhan Inci
- Department of Thoracic Surgery, University Hospital of Zurich, Zurich, Switzerland
| |
Collapse
|
4
|
Sarvan M, Etienne H, Bankel L, Brown ML, Schneiter D, Opitz I. Outcome Analysis of Treatment Modalities for Thoracic Sarcomas. Cancers (Basel) 2023; 15:5154. [PMID: 37958328 PMCID: PMC10649966 DOI: 10.3390/cancers15215154] [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: 09/30/2023] [Revised: 10/22/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Primary chest wall sarcomas are a rare and heterogeneous group of chest wall tumors that require multimodal oncologic and surgical therapy. The aim of this study was to review our experience regarding the surgical treatment of chest wall sarcomas, evaluating the short- and long-term results. METHODS In this retrospective single-center study, patients who underwent surgery for soft tissue and bone sarcoma of the chest wall between 1999 and 2018 were included. We analyzed the oncologic and surgical outcomes of chest wall resections and reconstructions, assessing overall and recurrence-free survival and the associated clinical factors. RESULTS In total, 44 patients underwent chest wall resection for primary chest wall sarcoma, of which 18 (41%) received surgery only, 10 (23%) received additional chemoradiotherapy, 7% (3) received surgery with chemotherapy, and 30% (13) received radiotherapy in addition to surgery. No perioperative mortality occurred. Five-year overall survival was 51.5% (CI 95%: 36.1-73.4%), and median overall survival was 1973 days (CI 95% 1461; -). As determined in the univariate analysis, the presence of metastasis upon admission and tumor grade were significantly associated with shorter survival (p = 0.037 and p < 0.01, respectively). Five-year recurrence-free survival was 71.5% (95% CI 57.6%; 88.7%). Tumor resection margins and metastatic disease upon diagnosis were significantly associated with recurrence-free survival (p < 0.01 and p < 0.01, respectively). CONCLUSION Surgical therapy is the cornerstone of the treatment of chest wall sarcomas and can be performed safely. Metastasis and high tumor grade have a negative influence on overall survival, while tumor margins and metastasis have a negative influence on local recurrence.
Collapse
Affiliation(s)
- Milos Sarvan
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, 8091 Zurich, Switzerland;
| | - Harry Etienne
- Department of Thoracic Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (H.E.); (D.S.)
| | - Lorenz Bankel
- Department of Medical Oncology, University Hospital Zurich, 8091 Zurich, Switzerland;
| | - Michelle L. Brown
- Department of Radiation Oncology, University Hospital Zurich, 8091 Zurich, Switzerland;
| | - Didier Schneiter
- Department of Thoracic Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (H.E.); (D.S.)
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (H.E.); (D.S.)
| |
Collapse
|
5
|
Caviezel C, Steinack C, Schneiter D, Gaisl T, Schmitt-Opitz I. [Surgical or bronchoscopic lung volume reduction for emphysema therapy]. Zentralbl Chir 2023; 148:S51-S70. [PMID: 37604145 DOI: 10.1055/a-1990-4810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
More than 20 years ago, surgical lung volume reduction (LVRS) was already established in patients with advanced emphysema as a palliative therapy option that reduces respiratory distress and improves lung function and quality of life. In addition, bronchoscopic procedures (BLVR) aimed at volume reduction have existed for just over 10 years. The advantages and disadvantages of LVRS and BLVR are discussed in this article.
Collapse
|
6
|
Brunelli A, Decaluwe H, Gonzalez M, Gossot D, Petersen RH, Augustin F, Assouad J, Baste JM, Batirel H, Falcoz PE, Almanzar SF, Furak J, Gomez-Hernandez MT, de Antonio DG, Hansen H, Jimenez M, Koryllos A, Meacci E, Opitz I, Pages PB, Piwkowski C, Ruffini E, Schneiter D, Stupnik T, Szanto Z, Thomas P, Toker A, Tosi D, Veronesi G. European Society of Thoracic Surgeons expert consensus recommendations on technical standards of segmentectomy for primary lung cancer. Eur J Cardiothorac Surg 2023; 63:ezad224. [PMID: 37267148 DOI: 10.1093/ejcts/ezad224] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/18/2023] [Accepted: 05/31/2023] [Indexed: 06/04/2023] Open
Affiliation(s)
| | - Herbert Decaluwe
- Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
| | - Michel Gonzalez
- Department of Thoracic Surgery, University Hospital of Lausanne, Lausanne, Switzerland
| | - Dominique Gossot
- Department of Thoracic Surgery, IMM-Curie-Montsouris Thoracic Institute, Paris, France
| | - Rene Horsleben Petersen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Florian Augustin
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Jalal Assouad
- Department of Thoracic Surgery. Tenon Hospital, Sorbonne University-Assistance Publique Hôpitaux de Paris, Paris, France
| | - Jean Marc Baste
- Department of Cardio-Thoracic Surgery, University Hospital of Rouen, Rouen, France
| | - Hasan Batirel
- Department of Thoracic Surgery, Faculty of Medicine, Biruni University, Istanbul, Turkey
| | | | | | - Jozsef Furak
- Department of Surgery, University of Szeged, Szeged, Hungary
| | | | - David Gomez de Antonio
- Department of Thoracic Surgery, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Henrik Hansen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Marcelo Jimenez
- Department of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
| | - Aris Koryllos
- Department of Thoracic Surgery, Florence Nightingale Hospital, Duesseldorf, Germany
| | - Elisa Meacci
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Catholic University of Sacred Hearth, Rome, Italy
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | | | - Cezary Piwkowski
- Thoracic Surgery Department, Poznan University of Medical Sciences, Poznan, Poland
| | - Enrico Ruffini
- Division of Thoracic Surgery, University of Torino, Turin, Italy
| | - Didier Schneiter
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Tomaz Stupnik
- Department of Thoracic Surgery, Ljubljana University Medical Centre, Ljubljana, Slovenia
| | - Zalan Szanto
- Department of Thoracic Surgery, Medical School, University of Pécs, Pécs, Hungary
| | - Pascal Thomas
- Department of Thoracic Surgery, North Hospital, APHM/Aix-Marseille University, Marseille, France
| | - Alper Toker
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV, USA
| | - Davide Tosi
- Thoracic Surgery and Lung Transplantation Unit, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Veronesi
- Department of Thoracic Surgery, IRCCS San Raffaele Scientific Institute, and Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
7
|
Werner R, Furrer K, Lauk O, Caviezel C, Hillinger S, Schneiter D, Britschgi C, Guckenberger M, Opitz I. 115P Salvage surgery in patients with locally advanced or metastatic non-small cell lung cancer. J Thorac Oncol 2023. [DOI: 10.1016/s1556-0864(23)00370-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
|
8
|
Furrer K, Schuurmans M, Schneiter D, Schmitt-Opitz I, Hillinger S. P2.11-03 Smoking Prevention Intervention With School Classes in University Hospital by Thoracic Surgeon und Pulmonologist. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|
9
|
Jungblut LM, Walter JE, Zellweger C, Patella M, Franzen D, Schneiter D, Matter A, Frauenfelder T, Opitz I. Swiss pilot low-dose computed tomography lung cancer screening study. Br J Surg 2022. [DOI: 10.1093/bjs/znac185.002] [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: 11/13/2022]
Abstract
Abstract
Objective
Low-dose computed tomography (LDCT) lung cancer screening is endorsed by US guidelines and has recently been shown effective in a large European randomized controlled trial. Nevertheless, actual realization of a lung cancer screening program is challenging and depends on country-specific factors. This pilot study aimed to evaluate implementation, execution, and performance of LDCT lung cancer screening in Switzerland.
Methods
Since October 2018, asymptomatic participants aged 55–74 years with more than 30 pack-years smoking history were enrolled at a tertiary hospital in Switzerland. Participants with history of lung cancer, major (palliative) health problems or those that had a thorax CT scan 18 months prior to enrollment were excluded. First, we evaluated lung cancer risk according to NLST guidelines. Second, we estimated lung cancer risk using the PLCOm2012 model risk calculator with threshold of 5%. Lung nodules were assessed according to Lung-RADS (Version 1.1. 2019). Participants were recruited through flyers, a newspaper article and pulmonary specialists. Screening consisted of one LDCT-scan, follow-up was recommended for suspicious nodules only. LDCT assessment was performed by two radiologists, one of them a board certified chest radiologist. Enrollment and follow-up are currently ongoing.
Results
To date, 75 participants (25 (33%) females) with a median age of 62 years (interquartile range [IQR] 56–67 years) were included. Median number of pack years smoked was 49 (IQR 41–58 pack years). Median PLCOm2012 6-year lung cancer probability was 2.7% (IQR 2.6–2.9%), 19 (26%) participants had stopped smoking before enrollment. 6 participants required follow up imaging of suspect nodules, resulting in a recall rate of 8%. At baseline, lung cancer was found in 2 (2.7%, one squamous cell (stage IIIA) and one adenocarcinoma (stage IV)) participants.
Conclusion
In this Swiss LDCT lung cancer screening pilot study using modified inclusion criteria, 2.7% were diagnosed with lung cancer to date.
Collapse
Affiliation(s)
- L M Jungblut
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich , Zurich, Switzerland
| | - J E Walter
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich , Zurich, Switzerland
| | - C Zellweger
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich , Zurich, Switzerland
| | - M Patella
- Department of Thoracic Surgery, University Hospital Zurich , Zurich, Switzerland
| | - D Franzen
- Department of Pulmonology, University Hospital Zurich , Zurich, Switzerland
| | - D Schneiter
- Department of Thoracic Surgery, University Hospital Zurich , Zurich, Switzerland
| | - A Matter
- Department of Thoracic Surgery, University Hospital Zurich , Zurich, Switzerland
| | - T Frauenfelder
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich , Zurich, Switzerland
| | - I Opitz
- Department of Thoracic Surgery, University Hospital Zurich , Zurich, Switzerland
| |
Collapse
|
10
|
Hiller A, Schneiter D, Opitz I, Caviezel C. [Lung Cancer Surgery for Severe COPD with Emphysema: Tumor Resection with Improvement of Lung Function]. Praxis (Bern 1994) 2022; 111:457-462. [PMID: 35673842 DOI: 10.1024/1661-8157/a003825] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Lung Cancer Surgery for Severe COPD with Emphysema: Tumor Resection with Improvement of Lung Function Abstract. The golden standard for the therapy of early stage non-small cell lung cancer consists of surgical resection, usually performed as lobectomy or segmentectomy. These procedures demand a certain operability, including certain lung functional reserves. Patients with COPD and emphysema usually have lung function values far below that. Nevertheless, these patients can be offered treatmentif at the same time they qualify for concomitant lung volume reduction surgery (LVRS). LVRS with simultaneous tumor resection can consolidate the diagnosis, provide definite histology, correct staging, and thorough tumor resection might even improve the postoperative lung function. As with all patients with a (possible) diagnosis of cancer, the indication must be discussed in an interdiscplinary tumor board.
Collapse
Affiliation(s)
- Aimée Hiller
- Klinik für Thoraxchirurgie, Universitätsspital Zürich, Zürich, Schweiz
| | - Didier Schneiter
- Klinik für Thoraxchirurgie, Universitätsspital Zürich, Zürich, Schweiz
| | - Isabelle Opitz
- Klinik für Thoraxchirurgie, Universitätsspital Zürich, Zürich, Schweiz
| | - Claudio Caviezel
- Klinik für Thoraxchirurgie, Universitätsspital Zürich, Zürich, Schweiz
| |
Collapse
|
11
|
Blüthgen C, Patella M, Euler A, Baessler B, Martini K, von Spiczak J, Schneiter D, Opitz I, Frauenfelder T. Computed tomography radiomics for the prediction of thymic epithelial tumor histology, TNM stage and myasthenia gravis. PLoS One 2021; 16:e0261401. [PMID: 34928978 PMCID: PMC8687592 DOI: 10.1371/journal.pone.0261401] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 12/01/2021] [Indexed: 12/21/2022] Open
Abstract
Objectives To evaluate CT-derived radiomics for machine learning-based classification of thymic epithelial tumor (TET) stage (TNM classification), histology (WHO classification) and the presence of myasthenia gravis (MG). Methods Patients with histologically confirmed TET in the years 2000–2018 were retrospectively included, excluding patients with incompatible imaging or other tumors. CT scans were reformatted uniformly, gray values were normalized and discretized. Tumors were segmented manually; 15 scans were re-segmented after 2 weeks by two readers. 1316 radiomic features were calculated (pyRadiomics). Features with low intra-/inter-reader agreement (ICC<0.75) were excluded. Repeated nested cross-validation was used for feature selection (Boruta algorithm), model training, and evaluation (out-of-fold predictions). Shapley additive explanation (SHAP) values were calculated to assess feature importance. Results 105 patients undergoing surgery for TET were identified. After applying exclusion criteria, 62 patients (28 female; mean age, 57±14 years; range, 22–82 years) with 34 low-risk TET (LRT; WHO types A/AB/B1), 28 high-risk TET (HRT; WHO B2/B3/C) in early stage (49, TNM stage I-II) or advanced stage (13, TNM III-IV) were included. 14(23%) of the patients had MG. 334(25%) features were excluded after intra-/inter-reader analysis. Discriminatory performance of the random forest classifiers was good for histology(AUC, 87.6%; 95% confidence interval, 76.3–94.3) and TNM stage(AUC, 83.8%; 95%CI, 66.9–93.4) but poor for the prediction of MG (AUC, 63.9%; 95%CI, 44.8–79.5). Conclusions CT-derived radiomic features may be a useful imaging biomarker for TET histology and TNM stage.
Collapse
Affiliation(s)
- Christian Blüthgen
- Institute of Diagnostic and Interventional Radiology, University Hospital of Zurich, Zurich, Switzerland
- * E-mail:
| | - Miriam Patella
- Department of Thoracic Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - André Euler
- Institute of Diagnostic and Interventional Radiology, University Hospital of Zurich, Zurich, Switzerland
| | - Bettina Baessler
- Institute of Diagnostic and Interventional Radiology, University Hospital of Zurich, Zurich, Switzerland
| | - Katharina Martini
- Institute of Diagnostic and Interventional Radiology, University Hospital of Zurich, Zurich, Switzerland
| | - Jochen von Spiczak
- Institute of Diagnostic and Interventional Radiology, University Hospital of Zurich, Zurich, Switzerland
| | - Didier Schneiter
- Department of Thoracic Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - Thomas Frauenfelder
- Institute of Diagnostic and Interventional Radiology, University Hospital of Zurich, Zurich, Switzerland
| |
Collapse
|
12
|
Furrer K, Werner R, Curioni-Fontecedro A, Hillinger S, Schneiter D, Inci I, Opitz I. P30.02 Salvage Surgery in Patients With Locally Advanced Non-Small Cell Lung Cancer – Outcomes and Longtime Results. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
13
|
Jungblut L, Walter J, Zellweger C, Patella M, Franzen D, Schneiter D, Matter A, Frauenfelder T, Opitz I. P61.10 Swiss Pilot Low-Dose Computed Tomography Lung Cancer Screening Study. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
14
|
Furrer K, Iliev E, Weder W, Hillinger S, Schneiter D, Inci I, Opitz I. Surgery of remnant lung after contralateral pneumonectomy is safe. Lung Cancer 2021. [DOI: 10.1183/13993003.congress-2021.pa2298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
15
|
Furrer K, Werner* RS, Hillinger S, Schneiter D, Inci I, Opitz I. Salvage surgery in patients with locally advanced non-small cell lung cancer – outcomes and longtime results. Lung Cancer 2021. [DOI: 10.1183/13993003.congress-2021.pa2295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
16
|
Caviezel C, Guglielmetti LC, Ladan M, Hansen HJ, Perch M, Schneiter D, Weder W, Opitz I, Franzen D. Lung volume reduction surgery as salvage procedure after previous use of endobronchial valves. Interact Cardiovasc Thorac Surg 2021; 32:263-269. [PMID: 33280038 DOI: 10.1093/icvts/ivaa261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 09/03/2020] [Revised: 09/25/2020] [Accepted: 10/04/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Lung volume reduction (LVR) is an efficient and approved treatment for selected emphysema patients. There is some evidence that repeated LVR surgery (LVRS) might be beneficial, but there are no current data on LVRS after unsuccessful bronchoscopic LVR (BLVR) with endobronchial valves (EBVs). We hypothesize good outcome of LVRS after BLVR with valves. METHODS In this study, we retrospectively investigated all patients who underwent LVRS between 2015 and 2019 at 2 centres after previous unsuccessful EBV treatment. They were further divided into subgroups with patients who never achieved the intended improvement after BLVR (primary failure) and patients whose benefit was fading over time due to the natural development of emphysema (secondary failure). Patients with severe air leak after BLVR and immediate concomitant LVRS and fistula closure thereafter were analysed separately. RESULTS A total of 38 patients were included. Of these, 19 patients had primary failure, 15 secondary failure and 4 were treated as an emergency due to severe air leak. At 3 months after LVRS, forced expiratory volume in 1 s had improved significantly by 12.5% (P = 0.011) and there was no 90-day mortality. Considering subgroups, patients with primary failure after BLVR seem to profit more than those with secondary failure. Patients with severe air leak after BLVR did not profit from fistula closure with concomitant LVRS. CONCLUSIONS LVRS after previous BLVR with EBVs can provide significant clinical improvement with low morbidity, although results might not be as good as after primary LVRS.
Collapse
Affiliation(s)
- Claudio Caviezel
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | | | - Mateja Ladan
- Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen, Denmark
| | | | - Michael Perch
- Department of Cardiology, Section for Lung Transplantation, Rigshospitalet, Copenhagen, Denmark
| | - Didier Schneiter
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Walter Weder
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Daniel Franzen
- Department of Pulmonary Medicine, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
17
|
Abstract
Randomized controlled trials have demonstrated that lung volume reduction surgery (LVRS) improves exercise capacity, lung function, and quality of life in patients with heterogenous emphysema on computed tomographic and perfusion scan. However, most patients have a nonheterogenous type of destruction. These patients, summarized under "homogeneous emphysema," may also benefit from LVRS as long they are severely hyperinflated, and adequate function is remaining with a diffusing capacity of the lungs for carbon monoxide greater than 20% and no pulmonary hypertension. Surgical mortality is low when patients are well selected.
Collapse
Affiliation(s)
- Walter Weder
- Thoracic Surgery, Thoraxchirurgie Bethanien, Toblerstrasse 61, 8044 Zürich, Switzerland.
| | - Laurens J Ceulemans
- Department of Thoracic Surgery, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Didier Schneiter
- Department of Thoracic Surgery, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Claudio Caviezel
- Department of Thoracic Surgery, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland
| |
Collapse
|
18
|
Inci I, Benker M, Çitak N, Schneiter D, Caviezel C, Hillinger S, Opitz I, Weder W. Complex sleeve lobectomy has the same surgical outcome when compared with conventional lobectomy in patients with lung cancer. Eur J Cardiothorac Surg 2021; 57:860-866. [PMID: 31919516 DOI: 10.1093/ejcts/ezz357] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 11/11/2019] [Accepted: 11/29/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES No significant data are available to assess whether complex sleeve lobectomy (complex-SL) can be considered comparable to conventional lobectomy (CL) in terms of surgical outcome. The purpose of this study was to compare surgical and oncological outcomes of complex-SL with CL in patients with lung cancer. METHODS Between 2000 and 2015, a total of 568 patients who underwent open CL (defined as resection of only 1 lobe) and 187 patients who underwent SL were analysed. The SL group was divided into 2 subgroups: standard-SL (bronchial SL, n = 106) and complex-SL (n = 81) (defined as bronchial sleeve resection together with another surgical intervention: bronchovascular SL, n = 40; vascular SL, n = 26; atypical bronchoplasty with resection of more than 1 lobe, n = 12; bronchial SL + chest wall resection, n = 3). RESULTS The complex-SL group had more patients with chronic obstructive pulmonary disease (COPD) (25.9% vs 12.5%, P = 0.001), neoadjuvant treatment (39.5% vs 12.0%, P < 0.001), advanced-stage non-small-cell lung cancer (53.2% vs 33.1%, P = 0.001) and low preoperative forced expiratory volume in 1 s (77.2% vs 84.3%, P = 0.004) than the CL group. The overall surgical mortality (in-hospital or 30-day) was 2.6% (n = 20); it was 2.8% for CL and 2.8% for complex-SL. Postoperative complications occurred in 34.9% of the CL group and 39.5% of the complex-SL group (P = 0.413). The pulmonary complication rate was similar between the groups (24.1% for CL, 27.2% for complex-SL, P = 0.552). The 5-year survival in the CL group was 57.1%, and in the complex-SL group it was 56.2% (P = 0.888). Multivariate analysis showed that TNM stage (P < 0.001) and N status (P < 0.001) were significant and independent negative prognostic factors for survival. CONCLUSIONS Complex-SL had a comparable outcome to CL, although the complex-SL group had more patients with advanced-stage NSCLC, low preoperative forced expiratory volume in 1 s and COPD.
Collapse
Affiliation(s)
- Ilhan Inci
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Martina Benker
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Necati Çitak
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland.,Department of Thoracic Surgery, Bakırköy Dr. Sadi Konuk Research and Education Hospital, Istanbul, Turkey
| | - Didier Schneiter
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Claudio Caviezel
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Sven Hillinger
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Walter Weder
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
19
|
Ingelfinger F, Krishnarajah S, Kramer M, Utz SG, Galli E, Lutz M, Zwicky P, Akarca AU, Jurado NP, Ulutekin C, Bamert D, Widmer CC, Piccoli L, Sallusto F, Núñez NG, Marafioti T, Schneiter D, Opitz I, Lanzavecchia A, Jung HH, De Feo D, Mundt S, Schreiner B, Becher B. Single-cell profiling of myasthenia gravis identifies a pathogenic T cell signature. Acta Neuropathol 2021; 141:901-915. [PMID: 33774709 PMCID: PMC8113175 DOI: 10.1007/s00401-021-02299-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/08/2021] [Accepted: 03/17/2021] [Indexed: 01/01/2023]
Abstract
Myasthenia gravis (MG) is an autoimmune disease characterized by impaired neuromuscular signaling due to autoantibodies targeting the acetylcholine receptor. Although its auto-antigens and effector mechanisms are well defined, the cellular and molecular drivers underpinning MG remain elusive. Here, we employed high-dimensional single-cell mass and spectral cytometry of blood and thymus samples from MG patients in combination with supervised and unsupervised machine-learning tools to gain insight into the immune dysregulation underlying MG. By creating a comprehensive immune map, we identified two dysregulated subsets of inflammatory circulating memory T helper (Th) cells. These signature ThCD103 and ThGM cells populated the diseased thymus, were reduced in the blood of MG patients, and were inversely correlated with disease severity. Both signature Th subsets rebounded in the blood of MG patients after surgical thymus removal, indicative of their role as cellular markers of disease activity. Together, this in-depth analysis of the immune landscape of MG provides valuable insight into disease pathogenesis, suggests novel biomarkers and identifies new potential therapeutic targets for treatment.
Collapse
Affiliation(s)
- Florian Ingelfinger
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerland
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | | | - Michael Kramer
- Institute for Research in Biomedicine, Università Della Svizzera Italiana, Bellinzona, Switzerland
| | - Sebastian G Utz
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerland
| | - Edoardo Galli
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerland
| | - Mirjam Lutz
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerland
| | - Pascale Zwicky
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerland
| | - Ayse U Akarca
- Department of Cellular Pathology, University College London Hospital, London, UK
| | | | - Can Ulutekin
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerland
| | - David Bamert
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerland
| | - Corinne C Widmer
- Department of Medical Oncology and Hematology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Luca Piccoli
- Institute for Research in Biomedicine, Università Della Svizzera Italiana, Bellinzona, Switzerland
| | - Federica Sallusto
- Institute for Research in Biomedicine, Università Della Svizzera Italiana, Bellinzona, Switzerland
- Institute of Microbiology, ETH Zurich, Zurich, Switzerland
| | - Nicolás G Núñez
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerland
| | - Teresa Marafioti
- Department of Cellular Pathology, University College London Hospital, London, UK
| | - Didier Schneiter
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Antonio Lanzavecchia
- Institute for Research in Biomedicine, Università Della Svizzera Italiana, Bellinzona, Switzerland
| | - Hans H Jung
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Donatella De Feo
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerland
| | - Sarah Mundt
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerland
| | - Bettina Schreiner
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerland.
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland.
| | - Burkhard Becher
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerland.
| |
Collapse
|
20
|
Ehrsam J, Caviezel C, Schneiter D, Hillinger S, Schuurmans M, Opitz I, Inci I. Cause of Death after Lung Transplantation - A Single Center Analysis. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
21
|
Caviezel C, Schneiter D, Lauk O, Opitz I. Firefly robotic lung volume reduction surgery: case report. J Vis Surg 2021. [DOI: 10.21037/jovs-20-73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
22
|
Ehrsam J, Lauk O, Hillinger S, Schneiter D, Opitz I, Schuurmans M, Inci I. Surgical Management of Bronchial Stump Complication in Cadaveric Lobar Lung Transplantation. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.2046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
|
23
|
Guglielmetti LC, Schneiter D, Hillinger S, Opitz I, Caviezel C, Weder W, Inci I. Lymphovascular invasion is an independent prognostic factor for survival in pathologically proven N2 non-small cell lung cancer. Swiss Med Wkly 2021; 151:w20385. [PMID: 33577703 DOI: 10.4414/smw.2021.20385] [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: 11/18/2022] Open
Abstract
BACKGROUND We aimed to analyse the nodal spread of our non-small cell lung cancer pN2 cohort according to tumour location, the possible implications of an unusual spreading pattern, and other factors influencing postoperative survival after anatomical lung resection. METHODS In this retrospective observational study, clinical data was collected for 124 consecutive non-small cell lung cancer (NSCLC) patients with a pathological N2 (stage IIIA or B) undergoing anatomical lung resection at our institution between 2001 and 2010. Cox regression was used to analyse independent predictors of 5-year overall survival and recurrence-free survival. RESULTS A total of 105 patients were included in the final analysis. Tumour location in the right upper lobe and middle lobe was significantly more often associated with involvement of lymph node stations 2 and 4 than NSCLC in the right lower lobe (station 2: right upper vs right lower lobe, p = 0.001 and middle vs right lower lobe, p = 0.038; station 4: right upper vs right lower lobe, p<0.001 and middle vs right lower lobe, p = 0.056), while tumours in the right upper lobe showed significantly less involvement of stations 7 and 8 compared with right lower lobe tumours (station 7 p <0.001, station 8 p = 0.004). Left sided tumours in the upper lobe had significantly more involvement of station 5 compared to lower lobe tumours (p = 0.009). However, atypical lymphatic nodal zone involvement did not emerge as a significant predictor of survival. Lymphovascular invasion was the only independent prognostic factor for 5-year overall survival (hazard ratio [HR] 2.10, p = 0.015) and recurrence-free survival (HR 1.68, p = 0.049) when controlled for adjuvant therapy. CONCLUSION Lymphovascular invasion was identified as the only independent prognostic factor for 5-year overall survival and recurrence-free survival in our pathologically proven N2 NSCLC cohort when controlled for adjuvant therapy. This study extends the current evidence of an adverse prognostic effect of lymphovascular invasion on a stage III population, confirms the adverse prognostic effect of lymphovascular invasion detected by immunohistochemistry, and thereby reveals another subgroup within the pN2 population with worse prognosis regarding 5-year overall survival and recurrence-free survival.  .
Collapse
Affiliation(s)
| | | | - Sven Hillinger
- Department of Thoracic Surgery, University Hospital of Zurich, Switzerland
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital of Zurich, Switzerland
| | - Claudio Caviezel
- Department of Thoracic Surgery, University Hospital of Zurich, Switzerland
| | - Walter Weder
- Department of Thoracic Surgery, University Hospital of Zurich, Switzerland
| | - Ilhan Inci
- Department of Thoracic Surgery, University Hospital of Zurich, Switzerland
| |
Collapse
|
24
|
Inci I, Schuurmans MM, Caviezel C, Hillinger S, Opitz I, Schneiter D, Weder W. Long-Term Outcomes of Cadaveric Lobar Lung Transplantation: An Important Surgical Option. Ann Thorac Cardiovasc Surg 2021; 27:244-250. [PMID: 33473053 PMCID: PMC8374092 DOI: 10.5761/atcs.oa.20-00237] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cadaveric lobar lung transplantation (L-LTx) is developed to overcome donor-recipient size mismatch. Controversial short- and long-term outcomes following L-LTx have been reported compared to full-sized lung transplantation (F-LTx). This study reports long-term outcomes after L-LTx. METHODS We reviewed patients undergoing lung transplantation (LTx) between 2000 and 2016. The decision to perform L-LTx was made based mainly on donor-recipient height discrepancy and visual assessment of donor lungs. Predicted donor-recipient total lung capacity (TLC) ratio was calculated more recently. Primary outcome was overall survival. RESULTS In all, 370 bilateral LTx were performed during the study period, among those 250 (67%) underwent F-LTx and 120 (32%) underwent L-LTx, respectively. One- and 5-year survival rates were 85% vs. 90% and 53% vs. 63% for L-LTx and F-LTx, respectively (p = 0.16). Chronic lung allograft dysfunction (CLAD)-free survival at 5 years was 48% in L-LTx vs. 51% in F-LTx recipients (p = 0.89), respectively. Age, intraoperative extracorporeal membrane oxygenation (ECMO) use, intensive care unit (ICU) stay, and postoperative renal replacement therapy (RRT) were significant prognostic factors for survival using multivariate analysis. CONCLUSIONS Overall survival and CLAD-free survival following L-LTx were comparable to F-LTx. Given the ongoing donor organ shortage, cadaveric L-LTx remains as an important resource in LTx.
Collapse
Affiliation(s)
- Ilhan Inci
- Department of Thoracic Surgery, Zurich University Hospital, University of Zurich, Zurich, Switzerland
| | - Mace M Schuurmans
- Division of Pulmonology, Zurich University Hospital, University of Zurich, Zurich, Switzerland
| | - Claudio Caviezel
- Department of Thoracic Surgery, Zurich University Hospital, University of Zurich, Zurich, Switzerland
| | - Sven Hillinger
- Department of Thoracic Surgery, Zurich University Hospital, University of Zurich, Zurich, Switzerland
| | - Isabelle Opitz
- Department of Thoracic Surgery, Zurich University Hospital, University of Zurich, Zurich, Switzerland
| | - Didier Schneiter
- Department of Thoracic Surgery, Zurich University Hospital, University of Zurich, Zurich, Switzerland
| | - Walter Weder
- Department of Thoracic Surgery, Zurich University Hospital, University of Zurich, Zurich, Switzerland
| |
Collapse
|
25
|
Benoit TM, Schwotzer R, Schneiter D, Rüschoff JH, Franzen DP. Rare cause of emphysema. Thorax 2020; 76:421-422. [PMID: 33298579 DOI: 10.1136/thoraxjnl-2020-215561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 10/13/2020] [Accepted: 10/26/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Tobias Matthieu Benoit
- Department of Medical Oncology and Haematology, University Hospital Zurich, Zurich, Switzerland
| | - Rahel Schwotzer
- Department of Medical Oncology and Haematology, University Hospital Zurich, Zurich, Switzerland
| | - Didier Schneiter
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Jan Hendrik Rüschoff
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | | |
Collapse
|
26
|
Caviezel C, Froehlich T, Schneiter D, Muehlematter U, Frauenfelder T, Guglielmetti LC, Opitz I, Weder W. Identification of target zones for lung volume reduction surgery using three-dimensional computed tomography rendering. ERJ Open Res 2020; 6:00305-2020. [PMID: 32963992 PMCID: PMC7487346 DOI: 10.1183/23120541.00305-2020] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 06/04/2020] [Indexed: 11/05/2022] Open
Abstract
Background The key issues for performing lung volume reduction surgery (LVRS) is the identification of the target zones. Recently introduced three-dimensional computed tomography rendering methods are used to identify the morphological distribution and its severity of lung emphysema by densitometry. We demonstrate a new software for emphysema imaging and show the pre- and post-operative results in patients undergoing LVRS planned based on this new technology. Methods A real-time three-dimensional image analysis software system was used pre- and 3 months post-operatively in five patients with heterogeneous emphysema and a single patient with homogeneous morphology scheduled for LVRS. Focus was on low attenuation areas with <950 HU, distribution on both lungs and the value of the three-dimensional images for planning surgery. Functional outcome was assessed by pulmonary function tests after 3 months. Results Five patients underwent bilateral LVRS and one patient had unilateral LVRS. All patients showed a median increase in forced expiratory volume in 1 s of 70% (range 30–120%), compared with baseline values. Hyperinflation (expressed as residual volume/total lung capacity ratio) was reduced by 30% (range 5–32%). In the patients with heterogeneous emphysema, the pre- and post-operative computed tomography scans and the densitometries showed a decrease in low attenuation areas by 23% (right side) and by 17% (left side), respectively. Conclusion We demonstrate three-dimensional computed tomography-rendered images for planning personalised remodelling of hyperinflated lungs using LVRS. This user-friendly software has the potential to assist surgeons and interventional pulmonologists to select patients and to visualise target areas in LVRS procedures. New, user-friendly software with 3D CT-rendered images can be used for planning personalised remodelling of hyperinflated lungs using LVRShttps://bit.ly/3fbICn2
Collapse
Affiliation(s)
- Claudio Caviezel
- Dept of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Tamara Froehlich
- Dept of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Didier Schneiter
- Dept of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Urs Muehlematter
- Institute for Interventional and Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Frauenfelder
- Institute for Interventional and Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Isabelle Opitz
- Dept of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Walter Weder
- Dept of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
27
|
Ingelfinger F, Kramer M, Utz S, Mundt S, Krishnarajah S, Galli E, Lutz M, Jurado NP, Widmer C, Reichen IC, Piccoli L, Sallusto F, Schneiter D, Opitz I, Jung HH, Lanzavecchia A, Schreiner B, Becher B. Myasthenia gravis: From single cell signatures to cancer diagnosis. The Journal of Immunology 2020. [DOI: 10.4049/jimmunol.204.supp.224.50] [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] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Abstract
Myasthenia gravis is a rare but archetypic autoimmune disease that is characterized by the autoantibody-mediated disruption of the neuromuscular junction leading to a skeletal muscle weakness. Immunomodulatory treatment options for Myasthenia gravis patients are largely unspecific, include suppression of the entire immune compartment and are often accompanied by severe side effects.
In order to identify novel biomarkers for more targeted and effective therapeutic approaches, we combined high-dimensional mass and flow cytometry with supervised and unsupervised machine-learning algorithms. Analysis of the peripheral immune compartment of Myasthenia gravis patients and healthy controls revealed a cellular immune signature consisting of inflammatory memory T helper cells with a defined cytokine profile. The abundance of the identified leukocytes in the blood strongly correlated with the patients clinical disease activity, far better than auto-Ab titers. Moreover, we were able to locate T cells with the defined signature enriched in the inflamed thymus of Myasthenia gravis patients – the key organ for the induction and maintenance of the autoimmune disease. Lastly, using an unbiased pattern recognition approach, we identified lymphomas in a subset of Myasthenia gravis patients, further highlighting the potential of the applied analysis tools.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Luca Piccoli
- 3Institute for Research in Biomedicine, Switzerland
| | | | | | | | | | | | - Bettina Schreiner
- 1University of Zurich, Switzerland
- 2University Hospital Zurich, Switzerland
| | | |
Collapse
|
28
|
Ehrsam J, Hillinger S, Opitz I, Schneiter D, Inci I. Risk of Malignancy after Lung Transplantation: A Single Center Experience. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
29
|
Ehrsam J, Hillinger S, Opitz I, Schneiter D, Inci I. Charlson-Deyo-Comorbidity-Index Predicts Long-Term Survival in Lung Transplantation. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
30
|
Yamada Y, Kaplan T, Soltermann A, Schmitt-Opitz I, Schneiter D, Weder W, Inci I. Surgical Outcomes and Risk Analysis of Primary Pulmonary Sarcoma. Thorac Cardiovasc Surg 2019; 69:101-108. [PMID: 31499540 DOI: 10.1055/s-0039-1695784] [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: 10/26/2022]
Abstract
BACKGROUND Primary pulmonary sarcoma (PPS) is a rare malignant lung neoplasm, and there is very little medical evidence about treatment of PPS. The aim of this study is to clarify the clinical characteristics and therapeutic outcome of patients who underwent surgical resection for PPS. METHODS We retrospectively reviewed the records of patients who underwent surgical resection for PPS in our institution between 1995 and 2014. Cases who only underwent biopsy were excluded. RESULTS A total of 24 patients (18 males, 6 females), with a median age of 60 (interquartile range: 44-67) years, were analyzed. The surgical procedures performed in these patients were pneumonectomy (n = 10), lobectomy (n = 11), and wedge resection (n = 3). Complete resection was achieved in 16 patients. The pathological stages (tumor, node, metastases lung cancer classification, 8th edition) of the patients were I (n = 4), II (n = 12), III (n = 2), and IV (n = 5), and there were four cases of lymph node metastasis. The 5-year overall survival rate of the patients was 50% (95% confidence interval [CI]: 29-72). Adverse prognostic factors for overall survival were incomplete resection (hazard ratio [HR]: 4.4, 95% CI: 2.1-42), advanced pathological stage (HR 14, 95% CI: 2.8-66), higher pathological grade (HR 4.5, 95% CI: 1.2-17), and tumor size ≥ 7 cm (HR 4.7, 95% CI: 1.1-21). CONCLUSIONS Our series of PPS revealed that incomplete resection, advanced pathological stage, higher pathological grade, and tumor size were unfavorable factors for long-term survival.
Collapse
Affiliation(s)
- Yoshito Yamada
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland.,Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Tevfik Kaplan
- Department of Thoracic Surgery, Ufuk University School of Medicine, Ankara, Çankaya, Turkey
| | - Alex Soltermann
- Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | | | - Didier Schneiter
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Walter Weder
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Ilhan Inci
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
31
|
Caviezel C, Aruldas C, Franzen D, Ulrich S, Inci I, Schneiter D, Weder W, Opitz I. Lung volume reduction surgery in selected patients with emphysema and pulmonary hypertension. Eur J Cardiothorac Surg 2019. [PMID: 29538689 DOI: 10.1093/ejcts/ezy092] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Pulmonary hypertension (PH) is considered a contraindication for lung volume reduction surgery (LVRS). Because, it has been reported that endobronchial lung volume reduction may have a beneficial effect without increased mortality in patients with emphysema and PH, we evaluated its effect on PH in patients undergoing LVRS. METHODS From January 2014 until June 2016, 119 LVRSs were performed at Zurich University Hospital. PH was a contraindication for patients with homogeneous emphysema but was acceptable for those with heterogeneous emphysema. Thirty patients underwent echocardiography before and after LVRS, 10 of whom had preoperative systolic pulmonary artery pressures >35 mmHg and 20 of whom had normal systolic pulmonary artery pressure. The effect of LVRS on pulmonary artery pressure, lung function and survival was analysed. RESULTS Ninety-day mortality for all 30 patients was 0, and the postoperative course did not differ significantly between the 2 groups. In patients with PH, the median systolic pulmonary artery pressure decreased from 41 mmHg [interquartile range (IQR) 39-47] to 37 mmHg (IQR 36-38, P = 0.04). These patients had an improvement of forced expiratory volume in 1 s from the median 27% predicted (IQR 23-34) to 33% (IQR 28-40, P = 0.007) 3 months postoperatively. CONCLUSIONS If further confirmed in other cohorts, mild to moderate PH may no longer be considered a contraindication for LVRS in patients with heterogeneous emphysema.
Collapse
Affiliation(s)
- Claudio Caviezel
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Carlson Aruldas
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Daniel Franzen
- Department of Respiratory Diseases, University Hospital Zurich, Zurich, Switzerland
| | - Silvia Ulrich
- Department of Respiratory Diseases, University Hospital Zurich, Zurich, Switzerland
| | - Ilhan Inci
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Didier Schneiter
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Walter Weder
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
32
|
Opitz I, Lauk O, Schneiter D, Ulrich S, Maisano F, Weder W, Bode-Lesniewska B. Intraluminal EWSR1-CREB1 gene rearranged, low-grade myxoid sarcoma of the pulmonary artery resembling extraskeletal myxoid chondrosarcoma (EMC). Histopathology 2018; 74:526-530. [PMID: 30326150 DOI: 10.1111/his.13773] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/10/2018] [Accepted: 10/12/2018] [Indexed: 01/23/2023]
Affiliation(s)
- Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Olivia Lauk
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Didier Schneiter
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Silvia Ulrich
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Francesco Maisano
- Department of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Walter Weder
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Beata Bode-Lesniewska
- Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
33
|
Caviezel C, von Rotz J, Schneiter D, Inci I, Hillinger S, Opitz I, Weder W. Improved postoperative lung function after sublobar resection of non-small-cell lung cancer combined with lung volume reduction surgery in patients with advanced emphysema. J Thorac Dis 2018; 10:S2704-S2710. [PMID: 30210822 DOI: 10.21037/jtd.2018.06.79] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Radiotherapy is recommended as primary local therapy for inoperable patients with non-small cell lung cancer (NSCLC). We hypothesized that selected patients with advanced emphysema could be candidates for surgery and improved functional outcome might result in addition to low mortality and morbidity and successful cancer control when sublobar resection in a lung volume reduction surgery (LVRS) concept is applied. Methods All patients with NSCLC and severe emphysema who underwent cancer resection in a LVRS concept between 2003 and 2015 were included for analysis. Postoperative 90-day mortality, complications, survival and lung function with forced expiratory volume in one second pre-operatively and three months postoperatively served as endpoints. Results Fourteen patients were included. Three procedures were bilateral and eleven unilateral, eight have been performed with thoracoscopy and six with conversion to an open procedure due to adhesions. In ten patients, tumor resection was atypical and in four patients an anatomic segmentectomy was performed. All patients had lung volume reduction. Prolonged air leak occurred in three patients. Perioperative 90-mortality was zero. Median pre-operative forced expiratory volume in one second was 32.5% and increased to 37% (P=0.002) 3 months following surgery. Three and 5-year survival rates were 50% and 35%, respectively. Conclusions Sublobar resection of NSCLC combined with LVRS in patients with severely impaired lung function due to emphysema can be performed with low mortality and morbidity making it an alternative treatment modality to radiotherapy. This approach allows cancer resection in marginal patients and improves emphysema symptoms simultaneously.
Collapse
Affiliation(s)
- Claudio Caviezel
- Department of Thoracic Surgery, University Hospital Zurich, Switzerland
| | - Julia von Rotz
- Department of Thoracic Surgery, University Hospital Zurich, Switzerland
| | - Didier Schneiter
- Department of Thoracic Surgery, University Hospital Zurich, Switzerland
| | - Ilhan Inci
- Department of Thoracic Surgery, University Hospital Zurich, Switzerland
| | - Sven Hillinger
- Department of Thoracic Surgery, University Hospital Zurich, Switzerland
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Switzerland
| | - Walter Weder
- Department of Thoracic Surgery, University Hospital Zurich, Switzerland
| |
Collapse
|
34
|
Abstract
The aim of lung volume reduction surgery (LVRS) for patients suffering from severe emphysema is to improve lung function and palliate dyspnea. Careful patient selection in a multidisciplinary approach in a high-volume center is mandatory for a successful outcome. Pulmonary complications including air leak and pneumonia as well as cardiac complications are the most common complications after LVRS. The following article will focus on most common complications observed after LVRS and review the management strategies to improve surgical outcome.
Collapse
Affiliation(s)
- Max Lacour
- Department of Thoracic Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Claudio Caviezel
- Department of Thoracic Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Walter Weder
- Department of Thoracic Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Didier Schneiter
- Department of Thoracic Surgery, University Hospital Zürich, Zürich, Switzerland
| |
Collapse
|
35
|
Martini K, Caviezel C, Schneiter D, Milanese G, Opitz I, Weder W, Frauenfelder T. Dynamic magnetic resonance imaging as an outcome predictor for lung-volume reduction surgery in patients with severe emphysema†. Eur J Cardiothorac Surg 2018; 55:446-454. [DOI: 10.1093/ejcts/ezy277] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/29/2018] [Accepted: 07/08/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Katharina Martini
- Institute for Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Claudio Caviezel
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Didier Schneiter
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Gianluca Milanese
- Institute for Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Walter Weder
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Frauenfelder
- Institute for Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| |
Collapse
|
36
|
Abstract
Lung volume reduction surgery (LVRS) for symptomatic patients with advanced emphysema was proven to be successful in a large randomized multi-center trial (NETT) and in several smaller randomized single center trials. This evidence primarily concerns patients with heterogeneous, upper-lobe predominant emphysema and low exercise tolerance within certain selection criteria regarding lung function values. As the most important effect of LVRS is generated by reducing the hyperinflation, even patients with homogeneous emphysema morphology profit from the procedure. Simultaneously, by removing distended and functionless areas in heterogeneous emphysema, also patients with seriously impaired diffusion capacity, moderate pulmonary arterial hypertension, a history of previous LVRS and alpha-1-antitrypsin-deficiency (AATD) can be considered as candidates for (re-)-LVRS. This article summarizes indications for LVRS in these various subtypes of emphysema patients.
Collapse
Affiliation(s)
- Claudio Caviezel
- Department of Thoracic Surgery, University Hospital Zurich, Switzerland
| | - Didier Schneiter
- Department of Thoracic Surgery, University Hospital Zurich, Switzerland
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Switzerland
| | - Walter Weder
- Department of Thoracic Surgery, University Hospital Zurich, Switzerland
| |
Collapse
|
37
|
Inci I, Hillinger S, Schneiter D, Opitz I, Schuurmans M, Benden C, Weder W. Lung Transplantation with Controlled Donation after Circulatory Death Donors. Ann Thorac Cardiovasc Surg 2018; 24:296-302. [PMID: 29962390 PMCID: PMC6300426 DOI: 10.5761/atcs.oa.18-00098] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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] [Indexed: 11/18/2022] Open
Abstract
Purpose: Utilization of donation after circulatory death (DCD) donors has the potential to decrease donor shortage in lung transplantation (LTx). This study reviews the long-term outcome of LTx from DCD donors. Methods: We included all consecutive DCD (Maastricht Category III) and all donations after brain death (DBD) donor lung transplants at our Center performed between January 2012 and February 2017. Data were analyzed comparing the two groups in regard of survival after LTx as primary outcome. Results: Median withdrawal to cardiac arrest time was 17 min (interquartile range [IQR]: 11.5–20.5). Median cardiac arrest to cold perfusion was 32 min (IQR: 24.5–36.5). Primary graft dysfunction (PGD) grade 3 at T72 occurred in three recipients. Chronic lung allograft dysfunction (CLAD) led to death in two cases. In DCD group, there was no 90-day mortality. In DCD, group 1- and 3-year survival rates were 100% and 80%. In DBD group, 1- and 3-year survival rates were 85% and 69% (p = 0.4). Conclusions: Our report confirmed the comparable outcome from DCD donors compared with DBD donors. Utility of DCD donors is a safe option to overcome donor shortage.
Collapse
Affiliation(s)
- Ilhan Inci
- Department of Thoracic Surgery, Zurich University Hospital, Switzerland
| | - Sven Hillinger
- Department of Thoracic Surgery, Zurich University Hospital, Switzerland
| | - Didier Schneiter
- Department of Thoracic Surgery, Zurich University Hospital, Switzerland
| | - Isabelle Opitz
- Department of Thoracic Surgery, Zurich University Hospital, Switzerland
| | - Macé Schuurmans
- Division of Pulmonary Medicine, Zurich University Hospital, Switzerland
| | - Christian Benden
- Division of Pulmonary Medicine, Zurich University Hospital, Switzerland
| | - Walter Weder
- Department of Thoracic Surgery, Zurich University Hospital, Switzerland
| |
Collapse
|
38
|
Inci I, Schuurmans M, Iskender I, Hillinger S, Opitz I, Schneiter D, Caviezel C, Benden C, Weder W. The Incidence of Chronic Lung Allograft Dysfunction After Cadaveric Lobar Lung Transplantation is Comparable to Conventional Lung Transplantation. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.1155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
39
|
Caviezel C, Schaffter N, Schneiter D, Franzen D, Inci I, Opitz I, Weder W. Outcome After Lung Volume Reduction Surgery in Patients With Severely Impaired Diffusion Capacity. Ann Thorac Surg 2018; 105:379-385. [DOI: 10.1016/j.athoracsur.2017.09.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 08/09/2017] [Accepted: 09/11/2017] [Indexed: 10/18/2022]
|
40
|
Opitz I, Schneiter D. [Modern Aspects of Lung Cancer Surgery]. Praxis (Bern 1994) 2018; 107:1383-1391. [PMID: 31166876 DOI: 10.1024/1661-8157/a003141] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Modern Aspects of Lung Cancer Surgery Abstract. Surgery is still an inherent part of the treatment of non-small cell lung cancer. This article summarizes various aspects of the surgical treatment of early and locally advanced stages of lung cancer. Minimally invasive techniques for lung cancer resection - video- or robotic-assisted - are today standard for early stages. Perioperative mortality is below 1 % and the oncological outcome is equal to open surgery. The learning curve is at 50 VATS lobectomies in a program with a minimum of 25 VATS lobectomies/year to obtain satisfying results. In specialized centers, Locally advanced tumors can be resected technically and oncologically safe, with acceptable morbidity and mortality rates. With careful patient selection and planning, 5-year survival rates can be as high as 48 %.
Collapse
|
41
|
Yamada Y, Leisibach P, Schneiter D, Soltermann A, Weder W, Jungraithmayr W. P1.17-016 Immunohistochemical Markers as Prognostic Factors in Malignant Thymic Epithelial Tumors. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
42
|
Aruldas C, Caviezel C, Schneiter D, Inci I, Weder W, Opitz I. B-001PULMONARY HYPERTENSION MAY IMPROVE IN SELECTED PATIENTS AFTER LUNG VOLUME REDUCTION SURGERY. Interact Cardiovasc Thorac Surg 2017. [DOI: 10.1093/icvts/ivx280.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
43
|
Inci I, Iskender I, Ehrsam J, Caviezel C, Hillinger S, Opitz I, Schneiter D, Weder W. Previous lung volume reduction surgery does not negatively affect survival after lung transplantation†. Eur J Cardiothorac Surg 2017; 53:596-602. [DOI: 10.1093/ejcts/ezx318] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 08/07/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ilhan Inci
- Department of Thoracic Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ilker Iskender
- Department of Thoracic Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jonas Ehrsam
- Department of Thoracic Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Claudio Caviezel
- Department of Thoracic Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sven Hillinger
- Department of Thoracic Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Didier Schneiter
- Department of Thoracic Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Walter Weder
- Department of Thoracic Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| |
Collapse
|
44
|
Gautschi F, Opitz I, Schneiter D, Franzen D. Mediastinitis After Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration of a Follicular Dendritic Cell Sarcoma. Arch Bronconeumol 2017; 54:220-221. [PMID: 28843365 DOI: 10.1016/j.arbres.2017.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 06/20/2017] [Accepted: 06/22/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Fiorenza Gautschi
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland.
| | - Isabelle Opitz
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Didier Schneiter
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Daniel Franzen
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
45
|
Guglielmetti L, Lauk O, Schneiter D, Inci I, Plock J, Giovanoli P, Weder W, Opitz I. P184 Rare localization of distant metastasized Evans tumor in the chest cavity. Chest 2017. [DOI: 10.1016/j.chest.2017.04.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
46
|
Inci I, Lenherr R, Hillinger S, Schneiter D, Beschir M, Schmitt-Opitz I, Schuepbach R, Schuurmans M, Benden C, Weder W. Lung Transplantation with Controlled Donation After Circulatory Death Donors: Initial Experience in Switzerland. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.1528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
47
|
Tutic-Horn M, Gambazzi F, Rocco G, Mosimann M, Schneiter D, Opitz I, Martucci N, Hillinger S, Weder W, Jungraithmayr W. Curative resection for lung cancer in octogenarians is justified. J Thorac Dis 2017; 9:296-302. [PMID: 28275477 DOI: 10.21037/jtd.2017.02.22] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Due to an increased life expectancy in a healthy aging population and a progressive incidence of lung cancer, curative pulmonary resections can be performed even in octogenarians. The present study aims to investigate whether surgery is justified in patients reaching the age of 80 years and older who undergo resection for non-small cell lung cancer (NSCLC). METHODS In this retrospective multi-centre analysis, the morbidity, mortality and long-term survival of 88 patients (24 females) aged ≥80 who underwent complete resection for lung cancer between 2000 and 2013 were analysed. Only fit patients with few comorbidities, low cardiopulmonary risk, good quality of life and a life expectancy of at least 5 years were included. RESULTS Curative resections from three thoracic surgery centres included 61 lobectomies, 9 bilobectomies, 6 pneumonectomies and 12 segmentectomies or wide wedge resections with additional systematic mediastinal lymphadenectomy in all cases. Final histology revealed squamous cell carcinoma [33], adenocarcinoma [41], large cell carcinoma [5] or other histological types [9]. Lung cancer stage distribution was 0 [1], I [53], II [17] and IIIA [14]. The overall 90-day mortality was 1.1%. The median hospitalisation and chest drainage times were 10 days (range, 5-27 days) and 5 days (range, 0-17 days), respectively. Thirty-six patients were complication-free (41%). In particular, pulmonary complications occurred in 25 patients (28%). In addition, 23 patients (26%) developed cardiovascular complications requiring medical intervention, while 24 patients (27%) had cerebrovascular complications, urinary tract infection and others. The median survival time was 51 months (range, 1-110 months), and the 5-year overall survival reached 45% without significance between tumour stages. CONCLUSIONS Curative lung resections in selected octogenarians can be safely performed up to pneumonectomy for all tumour stages with a perioperative mortality, morbidity, and 5-year survival rate comparable to younger cohorts.
Collapse
Affiliation(s)
- Michaela Tutic-Horn
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Franco Gambazzi
- Division of Thoracic Surgery, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Gaetano Rocco
- Division of Thoracic Surgery, University Hospital Naples, Naples, Italy
| | - Monique Mosimann
- Division of Thoracic Surgery, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Didier Schneiter
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Nono Martucci
- Division of Thoracic Surgery, University Hospital Naples, Naples, Italy
| | - Sven Hillinger
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Walter Weder
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Wolfgang Jungraithmayr
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland;; Department of Thoracic Surgery, Medical University Brandenburg, Germany
| |
Collapse
|
48
|
Kostron A, Friess M, Inci I, Hillinger S, Schneiter D, Gelpke H, Stahel R, Seifert B, Weder W, Opitz I. Propensity matched comparison of extrapleural pneumonectomy and pleurectomy/decortication for mesothelioma patients†. Interact Cardiovasc Thorac Surg 2017; 24:740-746. [DOI: 10.1093/icvts/ivw422] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 11/17/2016] [Indexed: 11/13/2022] Open
|
49
|
Yamada Y, Kaplan T, Inci I, Soltermann A, Schneiter D, Schmitt-Opitz I, Weder W. P2.04-029 Primary Pulmonary Sarcoma: Risks and Optimal Surgical Treatment Options. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.1409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
50
|
Franzen D, Schneiter D, Weder W, Kohler M. Impact of sedation technique on the diagnostic accuracy of endobronchial ultrasound-guided transbronchial needle aspiration. Endosc Ultrasound 2017; 6:257-263. [PMID: 28663531 PMCID: PMC5579912 DOI: 10.4103/2303-9027.190925] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background and Objectives: There is a paucity of data concerning the impact of the sedation technique used for endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) on diagnostic accuracy. The aim of this retrospective study was to compare the diagnostic accuracy of EBUS-TBNA in deep and moderate sedations, and to investigate other possible determinants of diagnostic accuracy in three lymph node locations (mediastinal, subcarinal, and hilar). Materials and Methods: The first consecutive patients at our institution undergoing EBUS-TBNA for selective sampling in deep sedation were compared with the first consecutive patients in moderate sedation between 2006 and 2014. Diagnoses based on EBUS-TBNA were compared with those on surgical or radiological follow-up. Results: In a total of 232 patients, the overall diagnostic accuracy for correct diagnosis at the mediastinal, subcarinal, and hilar locations irrespective of the sedation technique was 91%, 93%, and 92%, respectively. At the three mentioned lymph node locations, overall diagnostic accuracy of EBUS-TBNA in deep sedation compared to moderate sedation was 88.5% and 95.5% (P = 0.3), 93.2 and 93.6% (P = 0.9), and 88.6 and 94.0% (P = 0.4), respectively. Conclusions: The sedation technique does not seem to influence the diagnostic accuracy of EBUS-TBNA.
Collapse
Affiliation(s)
- Daniel Franzen
- Division of Pulmonology, University Hospital Zurich, Raemistrasse, Zurich, Switzerland
| | - Didier Schneiter
- Division of Thoracic Surgery, University Hospital Zurich, Raemistrasse, Zurich, Switzerland
| | - Walter Weder
- Division of Thoracic Surgery, University Hospital Zurich, Raemistrasse, Zurich, Switzerland
| | - Malcolm Kohler
- Division of Pulmonology, University Hospital Zurich, Raemistrasse, Zurich, Switzerland
| |
Collapse
|