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Carillo C, Pecoraro Y, Anile M, Poggi C, Oliva A, Amore D, Bruschini P, Naldi G, Mantovani S, Francioni F, Pugliese F, De Giacomo T, Venuta F, Diso D. Colistin-based Treatment of Multidrug-resistant Gram-negative Bacterial Pulmonary Infections After Lung Transplantation. Transplant Proc 2018; 51:202-205. [PMID: 30661895 DOI: 10.1016/j.transproceed.2018.04.068] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 04/13/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Lung transplantation (LT) is a viable option for a select group of patients with end-stage lung disease. However, infections are a major complication after LT, accounting for significant morbidity and mortality. Several germs may be responsible; multidrug-resistant Gram-negative (MDR-GN) bacteria are emerging. Colistin is widely used in the treatment of these infections and is administered by inhalation and/or parenterally. At our institution, in patients with tracheostomy, colistin is administered by direct instillation in the airway during bronchoscopy. We reviewed a series of patients who underwent LT complicated by postoperative MDR-GN bacterial pulmonary infection. METHODS From January 2015 to May 2017, 26 lung transplants were performed. In the postoperative course, 14 (54%) developed MDR-GN bacterial infection; respiratory specimen culture, blood tests, and chest X-ray were considered. Colistin was the only antibiotic usable. Thirteen patients received intravenous (IV) colistin; in the subgroup of patients with tracheostomy, colistin was instilled directly in the airway, and 6 patients received inhaled colistin. RESULTS Seven patients needed tracheostomy. Pseudomonas aeruginosa was the predominant infection (86%), with Acinetobacter baumanii seen in 2 cases (14%). An early clinical-laboratory response was observed in 9 patients (64%). White blood cell count and C-reactive protein values improved (P = .02 and P = .001, respectively). A significant reduction in bacterial load was observed on microbiologic bronchoalveolar lavage specimens. CONCLUSION Colistin instilled directly in the airway did not show side effects. The combination of IV and inhaled/instilled colistin could be a useful treatment option for MDR-GN infections after LT.
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Affiliation(s)
- C Carillo
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant "Paride Stefanini", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
| | - Y Pecoraro
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant "Paride Stefanini", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - M Anile
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant "Paride Stefanini", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - C Poggi
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant "Paride Stefanini", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - A Oliva
- Department of Public Health and Infectious Disease, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - D Amore
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant "Paride Stefanini", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - P Bruschini
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant "Paride Stefanini", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - G Naldi
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant "Paride Stefanini", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - S Mantovani
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant "Paride Stefanini", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - F Francioni
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant "Paride Stefanini", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - F Pugliese
- Division of Anesthesia and Transplant Intensive Care Unit, Department of General Surgery and Organ Transplant, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - T De Giacomo
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant "Paride Stefanini", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - F Venuta
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant "Paride Stefanini", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - D Diso
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant "Paride Stefanini", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
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Pecoraro Y, Carillo C, Diso D, Mantovani S, Cimino G, De Giacomo T, Troiani P, Shafii M, Gherzi L, Amore D, Rendina EA, Venuta F, Anile M. Efficacy of Extracorporeal Photopheresis in Patients With Bronchiolitis Obliterans Syndrome After Lung Transplantation. Transplant Proc 2017; 49:695-698. [PMID: 28457374 DOI: 10.1016/j.transproceed.2017.02.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Lung transplantation (LT) is only therapeutic option for patients affected by chronic respiratory failure. Chronic rejection, also known as bronchiolitis obliterans syndrome (BOS), is still the main cause of death and the most important factor that influences post-transplantation quality of life. Currently available therapies have not been proven to result in significant benefit in the prevention or treatment of BOS. Extracorporeal photopheresis (ECP) seems to reduce the rate of lung function decline in transplant recipients with progressive BOS. METHODS From 1991 until now, 239 LTs were performed at our center. Fifty-four patients (22.5%) developed BOS; 15 of these (27.7%) were treated with ECP. At the beginning of the treatment, all patients showed a mean decline of forced expiratory volume in 1 second (FEV1) from baseline values of 45.8% ± 17.2%; 2 patients were in long-term oxygen therapy. RESULTS Mean follow-up from November 2013 to June 2016 was 11.6 ± 7 months. Twelve patients (80%) showed lung function stabilization with an FEV1 range after treatment between -6% to +8% from the pre-treatment values. We did not report any adverse effects or increase of infections incidence. DISCUSSION ECP seems to be an effective and well-tolerated therapeutic option for LT patients with BOS in terms of stabilization of lung function and increased survival.
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Affiliation(s)
- Y Pecoraro
- Department of Thoracic Surgery, Policlinico Umberto I, Sapienza University of Rome, Italy.
| | - C Carillo
- Department of Thoracic Surgery, Policlinico Umberto I, Sapienza University of Rome, Italy
| | - D Diso
- Department of Thoracic Surgery, Policlinico Umberto I, Sapienza University of Rome, Italy
| | - S Mantovani
- Department of Thoracic Surgery, Policlinico Umberto I, Sapienza University of Rome, Italy
| | - G Cimino
- Department of Pediatrics, Policlinico Umberto I, Sapienza University of Rome, Italy
| | - T De Giacomo
- Department of Thoracic Surgery, Policlinico Umberto I, Sapienza University of Rome, Italy
| | - P Troiani
- Department of Pediatrics, Policlinico Umberto I, Sapienza University of Rome, Italy
| | - M Shafii
- Department of Hematology, Policlinico Umberto I, Sapienza University of Rome, Italy
| | - L Gherzi
- Department of Thoracic Surgery, Policlinico Umberto I, Sapienza University of Rome, Italy
| | - D Amore
- Department of Thoracic Surgery, Policlinico Umberto I, Sapienza University of Rome, Italy
| | - E A Rendina
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Italy
| | - F Venuta
- Department of Thoracic Surgery, Policlinico Umberto I, Sapienza University of Rome, Italy
| | - M Anile
- Department of Thoracic Surgery, Policlinico Umberto I, Sapienza University of Rome, Italy
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Carillo C, Pecoraro Y, Anile M, Mantovani S, Oliva A, D'Abramo A, Amore D, Pagini A, De Giacomo T, Pugliese F, Rendina EA, Venuta F, Diso D. Evaluation of Renal Function in Patients Undergoing Lung Transplantation. Transplant Proc 2017; 49:699-701. [PMID: 28457375 DOI: 10.1016/j.transproceed.2017.02.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Acute kidney injury and chronic kidney failure are serious complications after lung transplantation. Glomerular filtration rate (GFR) is the primary indicator of renal function. Several equations have been proposed to evaluate the estimated GFR (eGFR). We compared three different equations to determine which has the better correlation with the development of acute and chronic renal failure in lung recipients. METHODS Twenty-two patients with a mean age of 54.4 ± 8.5 years underwent lung transplantation from 2010 to 2015. Thirteen (59%) had pulmonary fibrosis, 7 (32%) emphysema, 1 (4.5%) bronchiectasis, and 1 (4.5%) lymphangioleiomyomatosis. In all patients, eGFR was measured preoperatively using Cockcroft-Gault (CG), Modification of Diet in Renal Disease (MDRD), and Levey's Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. In 20 patients (90%) eGFR was calculated at 1, 3, and 6 months. RESULTS According to CKD-EPI and MDRD, eight patients (36.3%) had preoperative reduction in eGFR, whereas 6 patients (27.2%) had preoperative reduction according to the CG (P = .04). The mean values were higher for the CG (103.2 vs. 102 vs. 94.4). Five patients (22.7%) developed perioperative acute renal failure requesting a dialysis treatment; four of these showed a preoperative eGFR to the highest CG (P = .05). At 1 and 6 months after lung transplantation, the CG, MDRD and CKD-EPI eGFR values were, respectively, 86.6, 84.1 and 76.6 mL/min/1.73m2 and 75.8, 72.7, and 72.3 mL/min/1.73m2. CKD-EPI eGFR values are more predictable than the other equations of AKI. CONCLUSIONS Preoperative assessment of eGFR using the MDRD and CKD-EPI seems to correlate better than the CG to the prediction of acute renal failure, whereas for the chronic form the three equations seem equivalent.
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Affiliation(s)
- C Carillo
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant "PARIDE STEFANINI", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
| | - Y Pecoraro
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant "PARIDE STEFANINI", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - M Anile
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant "PARIDE STEFANINI", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - S Mantovani
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant "PARIDE STEFANINI", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - A Oliva
- Department of Public Health and Infectious Disease, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - A D'Abramo
- Department of Public Health and Infectious Disease, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - D Amore
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant "PARIDE STEFANINI", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - A Pagini
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant "PARIDE STEFANINI", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - T De Giacomo
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant "PARIDE STEFANINI", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - F Pugliese
- Division of Anesthesia and Transplant Intensive Care Unit, Department of General Surgery and Organ Transplant, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - E A Rendina
- Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza Univeristy of Rome, Rome, Italy
| | - F Venuta
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant "PARIDE STEFANINI", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - D Diso
- Division of Thoracic Surgery, Department of General Surgery and Organ Transplant "PARIDE STEFANINI", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
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Carillo C, Anile M, Diso D, Onorati I, Mantovani S, Russo E, Pecoraro Y, De Giacomo T, Ciccone A, Longo F, Vitolo D, Rendina E, Venuta F. F-035MULTIMODALITY TREATMENT OF STAGE II THYMIC TUMOURS. Interact Cardiovasc Thorac Surg 2015. [DOI: 10.1093/icvts/ivv204.35] [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
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5
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Anile M, Diso D, Russo E, Patella M, Carillo C, Pecoraro Y, Onorati I, Pugliese F, Ruberto F, De Giacomo T, Angioletti D, Mantovani S, Mazzesi G, Frati G, Rendina E, Venuta F. Extracorporeal Membrane Oxygenation as Bridge to Lung Transplantation. Transplant Proc 2013; 45:2621-3. [DOI: 10.1016/j.transproceed.2013.07.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Venuta F, Tonelli AR, Anile M, Diso D, De Giacomo T, Ruberto F, Russo E, Rolla M, Quattrucci S, Rendina EA, Li Phd N, Coloni GF. Pulmonary hypertension is associated with higher mortality in cystic fibrosis patients awaiting lung transplantation. J Cardiovasc Surg (Torino) 2012:R37126834. [PMID: 22669100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM:Pulmonary hypertension (PH) is frequently found in patients with advanced parenchymal lung diseases. In advanced stages, cystic fibrosis (CF) patients can develop PH and eventually cor pulmonale. Little is known about the prevalence of PH in CF patients and its impact on outcome. METHODS: We retrospectively studied a large cohort of CF patients evaluated for lung transplantation between 1995 and 2010. All the patients underwent right heart catheterization as part of the evaluation. We included 179 unique consecutive adult CF patients. Age was 24±9 years and 45.8% were women. RESULTS:Eighty-seven patients were transplanted (48.6%) and 65 died (36.3%) while waiting for LT. By right heart catheterization, 38.5% of the patients had PH (mean ≥25 mm Hg). PaCO2 (P=0.045) and forced vital capacity (P=0.023) were independent predictors of PH in CF patients. The median survival (free of lung transplantation) was 13.4 months. After adjusting for several covariates, the presence of PH significantly increased mortality (hazard ratio, HR) (P<0.001). Pulmonary vascular resistance was associated with mortality (P=0.03). When both PH and PVR were included in the model, only PH predicted mortality. CONCLUSION: Pulmonary hypertension of mild degree is frequently found in CF patients with advanced lung disease and its presence significantly worsens survival.
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Affiliation(s)
- F Venuta
- Department of Thoracic Surgery, La Sapienza University of Rome, Rome, Italy -
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Francioni F, Tsagkaropoulos S, Telha V, Barile La Raia R, De Giacomo T. Adenosquamous carcinoma of the esophagogastric junction. Case report. G Chir 2012; 33:123-125. [PMID: 22668530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Adenosquamous carcinoma is a rare tumor with coexisting elements of infiltrating squamous cell carcinoma and adenocarcinoma. This tumor is reported to arise in different organs but rarely in the oesophagus. In most cases, it shows highly aggressive biological behaviour with high propensity to regional lymph-node metastasis and poor prognosis. We describe the management of a patient with an aggressive adenosquamous carcinoma of the esophagogastric junction.
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Affiliation(s)
- F Francioni
- "P. Stefanini" Department of Surgery and Transplant, Thoracic Surgery, "Sapienza" University of Rome, Italy
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8
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Anile M, Telha V, Diso D, De Giacomo T, Sciomer S, Rendina EA, Coloni GF, Venuta F. Left atrial size predicts the onset of atrial fibrillation after major pulmonary resections. Eur J Cardiothorac Surg 2011; 41:1094-7; discussion 1097. [DOI: 10.1093/ejcts/ezr174] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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9
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Rolla M, Anile M, Venuta F, Diso D, Quattrucci S, De Giacomo T, Russo E, Ruberto F, Rendina EA, Furio Coloni G. Lung transplantation for cystic fibrosis after thoracic surgical procedures. Transplant Proc 2011; 43:1162-3. [PMID: 21620078 DOI: 10.1016/j.transproceed.2011.01.132] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
During their life, cystic fibrosis (CF) patients may require thoracic surgical procedures for a number of reasons before undergoing lung transplantation. In the past, this has been considered to be a contraindication to lung transplantation. However, a meticulous surgical technique and careful intraoperative management allows one to perform the transplantation safely. Herein we have reported our experience with CF patients undergoing lung transplantation after previous surgical treatment for pneumothorax or bronchiectasis.
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Affiliation(s)
- M Rolla
- Department of Pediatric, University of Rome Sapienza, Rome, Italy
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Carillo C, Anile M, De Giacomo T, Venuta F. Bilateral simultaneous inflammatory myofibroblastic tumor of the lung with distant metastatic spread. Interact Cardiovasc Thorac Surg 2011; 13:246-7. [DOI: 10.1510/icvts.2011.271932] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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11
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Diso D, Venuta F, Anile M, De Giacomo T, Ruberto F, Pugliese F, Francioni F, Ricella C, Liparulo V, Rolla M, Russo E, Rendina EA, Coloni GF. Extracorporeal circulatory support for lung transplantation: institutional experience. Transplant Proc 2010; 42:1281-2. [PMID: 20534281 DOI: 10.1016/j.transproceed.2010.03.114] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Lung transplantation (LT) represents the only available therapy for selected patients affected by end-stage pulmonary disease. Cardiopulmonary bypass (CPBP) is used, when required, during single and sequential double lung transplantation; however, it increases the risk of bleeding, early graft dysfunction, failure, and other potential side effects. We report our experience with 145 patients who underwent lung transplantations, among whom 34 required intraoperative CPBP. The indications for LT among these 34 patients were cystic fibrosis (n = 22), chronic obstructive pulmonary disease (n = 3), bronchiectasis (n = 2), primary pulmonary hypertension (n = 1), fibrosis (n = 2), pulmonary microlithiasis (n = 1), and retransplantation for obliterative bronchilitis (n = 3). CPBP was planned in 12 cases (group I) and unplanned in 22 (group II). The main reason for planning CPBP was primary and secondary pulmonary hypertension (mean pulmonary artery pressure >or=25 mm Hg). Acute right ventricular failure, hemodynamic instability, arterial desaturation, and increased pulmonary artery pressure were mandatory for unplanned CPBP. Among the 34 CPBP patients, the 30-day mortality rate was 35% (12/34) including 9 (70%) in group II (unplanned CPBP). The leading cause of death was multiorgan failure. The 1-year survival rates were 67% and 36%, and the 3-year survival rates were 47% and 18% for groups I and II, respectively. In conclusion, even if it represents a useful tool in the management of critical events, the use of unscheduled CPBP during LT procedures is associated with an increased postoperative morbidity and mortality.
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Affiliation(s)
- D Diso
- Department of Thoracic Surgery, University of Rome, La Sapienza, V le del Policlinico 155, 00161 Rome, Italy.
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12
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Anile M, Venuta F, Diso D, Liparulo V, Ricella C, De Giacomo T, Pugliese F, Rolla M, Quattrucci S, Pecoraro Y, Rendina EA, Coloni GF. Treatment of complex airway lesions after lung transplantation with self-expandable nitinol stents: early experience. Transplant Proc 2010; 42:1279-80. [PMID: 20534280 DOI: 10.1016/j.transproceed.2010.03.092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Airway complications (AC) are considered a serious cause of morbidity after lung transplantation (LT). Mechanical dilatation, laser vaporization, and silicone stent placement usually solve it. However, the use of self-expandable metallic stents (SENS) may be indicated in selected cases. Ten lung transplant recipients with AC were treated with SENS. Six patients underwent LT for cystic fibrosis, 2 for idiopathic pulmonary fibrosis, 1 for bronchiectasis, and 1 for emphysema. All patients received at least 1 treatment attempt with dilatation and silicone stent placement. The indications for SENS placement were the presence of a tortuous airway axis with stenosis and malacia of the right main bronchus in 5 patients; a long stenosis of the main and intermediate right bronchus involving the upper lobe orifice in 3 patients; or malacia that could not be stabilized with silicone stents in 3 cases. In 1 patient the procedure was bilateral. Functional improvement was immediate with a mean forced expiratory volume at 1 second (FEV(1)) gain of 35%. No stent dislocation was observed. Symptoms did not occur again in 5 patients with previous recurrent episodes of pneumonia. One stenosis, which was due to the ingrowth of granulation tissue occurred at 6 months after the procedure, was successfully treated with mechanical dilatation and laser vaporization. The deployment of SENS in a selected group of patients with AC after LT was easy, safe, and effective.
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Affiliation(s)
- M Anile
- Department of Thoracic Surgery, University of Rome Sapienza, Sapienza, Italy.
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13
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De Giacomo T, Di Stasio M, Diso D, Anile M, Venuta F, Furio Coloni G. Sub-lobar lung resection of peripheral T1N0M0 NSCLC does not affect local recurrence rate. Scand J Surg 2010; 98:225-8. [PMID: 20218419 DOI: 10.1177/145749690909800406] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS The use of sub-lobar resection versus lobectomy for stage I non small cell lung cancer is still controversial. This study was undertaken to compare the results of limited resection in terms of survival and local recurrence rate to lobectomy in patients with peripheral stage I non small cell lung cancer. MATERIAL AND METHODS During the 8 year period from 1999 to 2007, 152 consecutive patients with stage I non-small cell lung cancer underwent lung resection at our thoracic surgery unit. In 116 cases we performed a standard lobectomy while in the remaining 36 cases we did sub lobar resection through mini-thoracotomy or video-assisted thoracoscopy. The survival, local recurrence rate and the clinical outcome were analyzed and compared. RESULTS Fifty-one patients were staged as T1 N0 M0, 22 in the sub-lobar resection group (61,1%) and 29 (25%) in the lobectomy group. The remaining were staged as T2 N0 M0. Although the patient population undergone to sub-lobar resection was older, with poorer lung function and more co-morbidities, the Kaplan-Meier survival proportion at 5 year did not differ significantly between the two groups: 64% for lobectomy group vs 66,7% for sub-lobar resection group. Overall local recurrence did approach significance in favour of lobectomy group but analyzing only T1 patients, no differences in terms of survival and local recurrence rate were observed. CONCLUSIONS The results of this study indicate that in patients with peripheral T1N0M0 non small cell lung cancer the outcome of limited resection is comparable with that of pulmonary lobectomy.
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Affiliation(s)
- T De Giacomo
- University of Rome "Sapienza", Department of Thoracic Surgery, Policlinico Umberto I, Rome, Italy.
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Francioni F, De Giacomo T, Jo Filice M, Anile M, Diso D, Venuta F, Coloni GF. Surgical treatment of redundancy after retrosternal esophagocoloplasty. MINERVA CHIR 2009; 64:317-319. [PMID: 19536059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Redundancy is a well-recognized complication of esophageal replacement with colonic interposition, occurring several years after surgery. In a small number of patients, symptoms are disabling and might require reoperation. This article describes the surgical treatment of a 54-year-old male presenting with severe dysphagia, malnutrition and recurrent aspiration pneumonia, progressively developed 30 years after esophageal replacement with retrosternal ileocolonic interposition for caustic strictures.
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Affiliation(s)
- F Francioni
- Department of Thoracic Surgery, La Sapienza University, Rome, Italy
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Aratari M, Venuta F, De Giacomo T, Rendina E, Anile M, Diso D, Francioni F, Quattrucci S, Rolla M, Pugliese F, Liparulo V, Di Stasio M, Ricella C, Tsagkaropoulos S, Ferretti G, Coloni G. Lung Transplantation for Cystic Fibrosis: Ten Years of Experience. Transplant Proc 2008; 40:2001-2. [DOI: 10.1016/j.transproceed.2008.05.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Anile M, Venuta F, Diso D, Vitolo D, Longo F, De Giacomo T, Francioni F, Liparulo V, Ricella C, Ruberto F, Coloni GF. Preoperative anaemia does not affect the early postoperative outcome in patients with lung cancer. MINERVA CHIR 2007; 62:431-435. [PMID: 18091652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
AIM Several prognostic factors like age, gender, histology, stage, type of operation, associated disorders and administration of induction therapy have been evaluated to assess the risk of postoperative complications and outcome in patients with resectable lung cancer. Anemia is a frequent condition in this subset of patients being estimated up to 50%. The aim of this retrospective study was to evaluate the effect of preoperative anemia on early outcome after lung cancer resection. METHODS One-hundred thirty nine consecutive patients undergoing surgery for non small cell lung cancer were retrospectively considered. The mean age was 64.8+/-11.6 years. No patient received blood transfusions or administration of erythropoetin preoperatively. Overall, we performed 96 lobectomies, 14 pneumonectomies, 2 bilobectomies and 27 atypical resections. A subset of 27 patients (19.4%) (group I) had a preoperative value of Hb less than 12 g/dl (10.4+/-1.9 g/dL). Seven patients of them were stage IA (26%), 9 stage IB (33.3%), 2 stage IIA (7.4%), 6 stage IIB (22.2%), 2 stage IIIA (7.4%) and 1 stage IIIB (3.7%). Age, gender, stage, type of operation, induction chemotherapy, comorbidities were evaluated by univariate analysis comparing patients with and without preoperative anaemia. The two groups were homogenous regarding demographic characteristics. RESULTS Three patients (11.1%) in group I and 2 (1.8%) in group II required blood transfusions after surgery (P=0.01); 4 of them received pneumonectomy (P<0.0001). The overall morbidity was 17.9% (25/139); the most frequent complication was persistent air leakage, followed by retention of secretions. No statistically significant difference was observed between the 2 groups about early mortality (1 patient-3.7% in group I and 2 patients-1.8% in group II) and postoperative complications (5 patients-18.5% in group I and 20 patients-17.9% in group II). CONCLUSION Preoperative anaemia is not a risk factor for an increased rate of postoperative complications and should not be considered a contraindication to surgery.
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Affiliation(s)
- M Anile
- Department of Thoracic Surgery, University of Rome La Sapienza, Rome, Italy.
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De Giacomo T, Venuta F, Anile M, Diso D, Rolla M, Coloni G. Non-Hodgkin’s Lymphoma, Presenting as an Isolated Endobronchial Mass After Bilateral Lung Transplantation: A Case Report. Transplant Proc 2007; 39:3541-4. [DOI: 10.1016/j.transproceed.2007.09.003] [Citation(s) in RCA: 2] [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] [Received: 09/16/2006] [Accepted: 09/11/2007] [Indexed: 10/22/2022]
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Anile M, Venuta F, Diso D, De Giacomo T, Rendina EA, Rolla M, Ruberto F, Liparulo V, Aratari MT, Di Stasio M, Ricella C, Vitolo D, Longo F, Coloni GF. Malignancies following lung transplantation. Transplant Proc 2007; 39:1983-4. [PMID: 17692672 DOI: 10.1016/j.transproceed.2007.05.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
During the last 2 decades, long-term survival after lung transplantation has significantly improved. However, among the complications related to the continuous administration of immunosuppressive drugs, malignancy plays an important role. We retrospectively revisited our series of patients to report our experience. From January 1991 we performed 134 lung transplantations in 128 recipients (mean age, 33.4 +/- 13.5 years). In all patients the first-line immunosuppressive regimen was based on a calcineurin inhibitor (cyclosporine or tacrolimus), an antimetabolic agent (azathioprine), and steroids. Five patients (4.2%) developed malignancy and the mean time of occurrence after the transplantation was 46.4+/-23 months. The mean age was 41 +/- 16 years (P = not significant [ns]). The tumors were as follows: laryngeal cancer (radiotherapy), colon cancer (surgery plus adjuvant chemotherapy), gastric cancer (surgery plus adjuvant chemotherapy), endobronchial non-Hodgkin lymphoma (NHL) (endoscopic resection plus chemoradiotherapy), and cutaneous and visceral Kaposi's sarcoma (KS) (chemotherapy). All patients have reduced the dose of immunosuppressive drugs; in 1 of them, tacrolimus was changed to rapamycin. Two patients died because of neoplastic dissemination, another 1 due to obliterans bronchiolitis. The 2 patients with NHL and KS are alive at 6 and 9 months, respectively, without signs of recurrence. Malignancies after lung transplantation represent an important problem. A multidisciplinary approach is mandatory to obtain satisfactory results in terms of improved quality of life and long-term survival.
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Affiliation(s)
- M Anile
- Department of Thoracic Surgery, University of Rome La Sapienza, Rome, Italy.
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De Giacomo T, Martelli M, Venuta F, Anile M, Diso D, Di Stasio M, Rendina EA, Coloni GF. Lung cancer after treatment for non-Hodgkin lymphoma. MINERVA CHIR 2006; 61:467-71. [PMID: 17211351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
AIM Because of the improvement in treatment and survival of patients with lymphoma, late sequelae, including secondary cancers have been extensively studied. Lung cancer is one of the two most common solid tumors after Hodgkin's disease but fewer studies have been published about lung cancer after non-Hodgkin lymphoma (NHL). METHODS Over the last five years at our Institution we have observed 16 patients, 13 male and 3 female, with a mean age of 61 years, previously treated for NHL and lung cancer. Median latency between NHL and lung cancer was 7 years. In 6 patients (37.5%) the latency period was shorter than 5 years and 3 of them developed lung cancer within 2 years after the end of NHL therapy. RESULTS Ten patients underwent lung complete resection. Two, 3 and 5 year survival rate was respectively 52.7%, 26.3% and 13%. In contrast, the median survival of non surgical patients was 9 months. Comparison of survival between surgical and non-surgical group demonstrated a statistically significant better survival for surgically treated patients (P<0.04). CONCLUSIONS Surgery can improve survival in patients with history of NHL and lung cancer. Early diagnosis and treatment is crucial. NHL survivors should undergo careful follow-up and surveillance for secondary malignancy.
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MESH Headings
- Adenocarcinoma/mortality
- Adenocarcinoma/pathology
- Adenocarcinoma/surgery
- Aged
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/surgery
- Chemotherapy, Adjuvant
- Combined Modality Therapy
- Female
- Follow-Up Studies
- Humans
- Lung/pathology
- Lung Neoplasms/diagnosis
- Lung Neoplasms/diagnostic imaging
- Lung Neoplasms/drug therapy
- Lung Neoplasms/mortality
- Lung Neoplasms/pathology
- Lung Neoplasms/surgery
- Lymphoma, Non-Hodgkin/diagnosis
- Lymphoma, Non-Hodgkin/mortality
- Lymphoma, Non-Hodgkin/pathology
- Lymphoma, Non-Hodgkin/surgery
- Lymphoma, Non-Hodgkin/therapy
- Male
- Mediastinoscopy
- Middle Aged
- Neoplasm Staging
- Neoplasms, Second Primary
- Neuroendocrine Tumors/mortality
- Neuroendocrine Tumors/pathology
- Neuroendocrine Tumors/surgery
- Pneumonectomy
- Prognosis
- Radiography, Thoracic
- Survival Analysis
- Time Factors
- Tomography, X-Ray Computed
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Affiliation(s)
- T De Giacomo
- Department of Thoracic Surgery, University of Rome, La Sapienza, Rome, Italy.
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Andreetti C, Anile M, Diso D, Francioni F, Venuta F, De Giacomo T, Di Stasio M, Rendina EA, Coloni GF. [Surgical treatment of iatrogenic perforations of the distal third of the esophagus. Personal experience]. MINERVA CHIR 2006; 61:367-71. [PMID: 17159743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
AIM The esophageal perforations are associated with a high mortality and morbidity when they are not diagnosed and treated quickly. The aim of our study is to analyze the treatment and prognosis of the distal iatrogenic esophageal perforations on the basis of time of onset, concomitant disease and size of perforations. METHODS The retrospective review was performed on 10 patients treated for distal iatrogenic esophageal perforations at our Institution from 1994 to 2003. The cause of perforations was: pneumatic dilation (7 patients) and esophageal endoprosthesis placing (3 patients). Seven patients presented within 24 h (Group A), and 3 patients presented after 24 h (Group B). In Group A, 4 patients underwent primary repair, 2 patients required esophagectomy and 1 patient was treated conservatively. In Group B, 2 patients were treated conservatively and 1 patient required an esophagectomy. RESULTS Hospital morbidity was 20% and mortality was 30%. In Group A no patients died. In Group B hospital mortality was 100%. The most common cause of death was multiorgan failure resulting from sepsis. CONCLUSIONS The prognosis for esophageal perforations is influenced by the time elapsed between diagnosis and treatment. Esophagectomy is indicated for patients with extensive perforation and necrosis of the esophagus when primary repair cannot be carried out. It is indicated also as treatment for the concomitant disease.
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Affiliation(s)
- C Andreetti
- Divisione di Chirurgia Toracica, Dipartimento Paride Stefanini, Università degli Studi di Roma La Sapienza, Rome, Italy.
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Francioni F, Anile M, Venuta F, De Giacomo T, Andreetti C, Diso D, Di Stasio M, D'Ecclesia G, Liparulo V, Coloni GF. [Mechanical cervical esophagogastric anastomosis after esophagectomy for cancer]. MINERVA CHIR 2006; 61:79-83. [PMID: 16871138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
AIM Fibrous stenosis of the esophagogastric cervical anastomosis remains a significant complication occurring in up to one third of cases. Trying to reduce the incidence of this complication, we describe our technique of cervical esophago-gastric anastomosis using endoscopic linear stapler which seems to reduce the incidence of fibrous stricture formation after resection of esophageal cancer. METHODS Between March 2000 and December 2004, 34 patients (20 males and 14 females) underwent esophagectomy using tubulized stomach for reconstruction. Mean age was 57 years. Eight patients with advanced stage (5 T3 and 3 T4) underwent induction chemotherapy. The most of patients was affected by squamous cell carcinoma. In all cases we performed cervical esophagogastric anastomosis using linear endoscopic stapler. The occurrence of postoperative anastomotic leak and development of anastomotic stricture were recorded and analyzed. RESULTS All patients survived esophagectomy and 30 of them (88%) were available for postoperative follow-up at 6 months. Anastomotic leak developed in 1 case. No patient developed fibrous stenosis that required dilatation therapy. CONCLUSIONS Complete mechanical esophago-gastric anastomosis, using endoscopic linear stapler is effective and safe, even when a narrow gastric tube is used as esophageal substitute. These technique seems superior to other techniques to reduce the incidence of postoperative anastomotic complications.
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Affiliation(s)
- F Francioni
- Dipartimento di Chirurgia Generale, Specialità Chirurgiche e Trapianti di Organo, Paride Stefanini, Cattedra di Chirurgia Toracica, Università degli Studi di Roma, La Sapienza, Roma, Italy
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Flati G, De Giacomo T, Porowska B, Flati D, Gaj F, Talarico C, Antonellis F, Diana M, Berloco PB. Surgical management of substernal goitres. When is sternotomy inevitable? Clin Ter 2005; 156:191-5. [PMID: 16382967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
PURPOSE Aim of this retrospective study is to report personal experience in the surgical management of substernal goitres emphasizing the guidelines for preoperative planning of sternotomy in selected cases. PATIENTS AND METHODS Medical records of all patients (n=355) submitted to thyroidectomy for struma in our Operative Unit, between 1993-2003, were analysed. A substernal goitre was defined as a goitre having a significant retrosternal extension (>50%) requiring mediastinal dissection. RESULTS A total of 18 out of 355 patients undergoing thyroidectomy for struma in our Operative Unit had substernal goitres. The most common symptoms, at presentation, were the presence of neck mass and respiratory disorders. Standard cervical incision was adequate to achieve total thyroidectomy in 17 cases while, in one patient with computed tomography images showing the presence of a huge goitre extending below the aortic arch, a sternotomic approach was inevitable to ensure safe removal. No major morbidity or perioperative deaths occurred. One patient with scleroderma experienced bilateral paralysis of laryngeal nerves for two months, with full recovery thereafter. CONCLUSIONS While removal of the majority of substernal goitres can be achieved by means of cervical incision, this approach is not always safe. In a selected number of cases with an iceberg shaped substernal goiter and with >70% of the volume lying below the thoracic outlet, a sternotomic approach is inevitable. Preoperative diagnostic work-up should, thus, include chest X-ray and computed tomography. Overall results in the present patient population, have been excellent since morbidity has been minimal and mortality absent, and all patients are symptom free.
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Affiliation(s)
- G Flati
- Department of Surgery P. Stefanini University of Rome La Sapienza Rome, Italy.
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Coloni GF, Venuta F, Ciccone AM, Rendina EA, De Giacomo T, Filice MJ, Diso D, Anile M, Andreetti C, Aratari MT, Mercadante E, Moretti M, Ibrahim M. Lung transplantation for cystic fibrosis. Transplant Proc 2004; 36:648-50. [PMID: 15110621 DOI: 10.1016/j.transproceed.2004.03.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Lung transplantation is a robust therapeutic option to treat patients with cystic fibrosis. PATIENTS AND METHODS Since 1996, 109 patients with cystic fibrosis were accepted onto our waiting list with 58 bilateral sequential lung transplants performed in 56 patients and two patients retransplanted for obliterative bronchiolitis syndrome. RESULTS Preoperative mean FEV(1) was 0.64 L/s, mean PaO(2) with supplemental oxygen was 56 mm Hg, and the mean 6-minute walking test was 320 m. Transplantation was performed through a "clam shell incision" in the first 29 patients and via bilateral anterolateral thoracotomies without sternal division in the remaining patients. Cardiopulmonary bypass was required in 14 patients. In 21 patients the donor lungs had to be trimmed by wedge resections with mechanical staplers and bovine pericardium buttressing to fit the recipient chest size. Eleven patients were extubated in the operating room immediately after the procedure. Hospital mortality of 13.8% was related to infection (n = 5), primary graft failure (n = 2), and myocardial infarction (n = 1). Acute rejection episodes occurred 1.6 times per patient/year; lower respiratory tract infections occurred 1.4 times per patient in the first year after transplantation. The mean FEV(1) increased to 82% at 1 year after operation. The 5-year survival rate was 61%. A cyclosporine-based immunosuppressive regimen was initially employed in all patients; 24 were subsequently switched to tacrolimus because of central nervous system toxicity, cyclosporine-related myopathy, or renal failure, obliterative bronchiolitis syndrome, gingival hyperplasia, or hypertrichosis. Ten patients were subsequently switched to sirolimus. Freedom from bronchiolitis obliterans at 5 years was 60%. CONCLUSIONS Our results confirm that bilateral sequential lung transplantation is a robust therapeutic option for patients with cystic fibrosis.
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Affiliation(s)
- G F Coloni
- UO Chirurgia Toracica, II Clinica Chirurgica, Università La Sapienza, Rome, Italy
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Anile M, De Giacomo T, Venuta F, Angelo Rendina E, Andreetti C, Diso D, Coloni GF. [Mini-invasive treatment of pectus excavatum in adolescence. Initial experience]. MINERVA CHIR 2004; 59:31-5. [PMID: 15111830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
BACKGROUND Personal preliminary experience with Minimally Invasive Repair of Pectus Excavatum (MIRPE), "Nuss" procedure, using VATS is reported. METHODS From January 2001 to February 2002, MIRPE has been performed on 5 patients (age range 13-18 y; mean 14.8 y). Under general anesthesia, a curved steel bar is inserted into the retrosternal tunnel between 2 bilateral midaxillary line incisions. The tunnel passes initially under the pectoral muscles and enters the pleural space at level of the mammilary line. Under thoracoscopic vision, the bar is passed through the tunnel with the concavity facing the front and then is turned over thereby correcting deformity. An epidural catheter relieved perioperative pain successfully. RESULTS In all patients the repair has been good. Mean hospital length of stay has been 6.8 d. Pneumothorax occurred in 1 patient requiring tube thoracostomy. After 45 d 1 patient had a bar displacement requiring a reoperation. All patients have a normal life. CONCLUSIONS The Minimally Invasive Repair of Pectus Excavatum is an effective procedure even in adolescence. Thoracoscopic vision makes safer the creation of the retrosternal tunnel and the passage of the bar. Short-term results have been good. Further follow-up is necessary to determine long-term results.
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Affiliation(s)
- M Anile
- Cattedra di Chirurgia Toracica Università di Roma La Sapienza, Roma.
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Venuta F, Quattrucci S, De Giacomo T, Cimmino G, Anile M, Andreetti C, Diso D, Ruberto F, Rendina E, Coloni G. Pulmonary hemodynamics can predict mortality on the waiting list for lung transplantation in patients with cystic fibrosis. J Heart Lung Transplant 2004. [DOI: 10.1016/j.healun.2003.11.306] [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: 10/26/2022] Open
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Moretti M, De Giacomo T, Francioni F, Rendina EA, Venuta F, Mercadante E, Coloni GF. [Thoracoscopic esophagectomy for esophageal cancer. Personal experience]. MINERVA CHIR 2002; 57:111-5. [PMID: 11941285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
BACKGROUND Esophageal surgery was recently modified by minimally-invasive approach. Personal experience with the thoracoscopic technique for esophagectomy in patients with early stage esophageal cancer is described. METHODS. From 1996 to 2000 at the Department of Thoracic Surgery of the University of Rome "La Sapienza", 10 patients, 7 male and 3 female, underwent video-thoracoscopic esophagectomy for esophageal cancer. Median age was 64 years (range 53-72). With the patient in left lateral decubitus 4 ports were positioned between the 4th and 8th intercostal space. The thoracic esophagus was mobilized in the entire length and circumference with the connective tissue and peri-esophageal nodal stations. A cervicotomy followed by a median laparotomy for tubulization of the stomach was performed. RESULTS Nobody required conversion to thoracotomy. No complication or intraoperative death were observed. The median thoracic time was 110 minutes (range 55-165). No death within 30 days after discharge was recorded. One patient presented left vocal cord paralysis. In one case a recurrence in cervical anastomosis two months after the operation was observed. One patient died after 36 month for metastatic spread. Eight patients are alive with no evidence of disease, with median follow-up of 20 months. CONCLUSIONS In our experience, the video-toracoscopic approach is a viable and safe option for the treatment of early stage esophageal cancer. Low incidence of complications and local recurrence should encourage a most frequent use of this procedure.
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Affiliation(s)
- M Moretti
- Dipartimento di Chirurgia Generale, Specialità Chirurgiche e Trapianti d'organo Paride Stefanini, Cattedra di Chirurgia Toracica, Policlinico Umberto I, Università degli Studi di Roma La Sapienza, Rome, Italy
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Venuta F, Rendina E, De Giacomo T, Moretti M, Mercadante E, Francioni F, Pugliese F, Coloni G. Bilateral sequential lung transplantation without sternal division. J Heart Lung Transplant 2002. [DOI: 10.1016/s1053-2498(01)00678-7] [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] Open
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De Giacomo T, Rendina EA, Venuta F, Francioni F, Moretti M, Pugliese F, Coloni GF. Pneumoperitoneum for the management of pleural air space problems associated with major pulmonary resections. Ann Thorac Surg 2001; 72:1716-9. [PMID: 11722070 DOI: 10.1016/s0003-4975(01)03050-8] [Citation(s) in RCA: 31] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The use of pneumoperitoneum to treat prolonged air leaks or space problems, or both, after pulmonary resection has been recently resurrected and used successfully. METHODS During the last 3 years, 14 patients experienced short-term pleural space problems associated with prolonged air leaks after pulmonary resection for lung cancer. All patients, under sedation and local anesthesia, had a mean of 2,100 mL of air injected under the diaphragm, using a Veres needle after a mean time of 7 days (range, 5 to 10 days) from the operation. In 3 patients talc slurry was added to help control the air leak. RESULTS No patients experienced complications during the induction of the pneumoperitoneum. No patients complained of dyspnea, although blood gas analysis showed a slight increment of carbon dioxide partial pressure (p < 0.0004). Obliteration of the pleural space was observed in all cases after a mean time of 4 days (range, 1 to 7 days). Air leaks stopped in all patients after a mean time of 8 days (range, 4 to 12 days). The mean postoperative hospital stay after lung resection was 18 days (range, 14 to 22 days). No patients had significant complications or long-term sequelae. We found that patients who had undergone induction chemotherapy had longer air leak durations than observed in noninduction patients (p = 0.03). CONCLUSIONS Our experience supports the use of postoperative pneumoperitoneum whenever a space problem associated with prolonged air leaks is present. The procedure is effective, safe, and easy to perform.
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Affiliation(s)
- T De Giacomo
- Department of Thoracic Surgery, University of Rome La Sapienza, Policlinico Umberto I, Italy.
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Venuta F, Rendina EA, De Giacomo T, Mercadante E, Ciccone AM, Aratari MT, Moretti M, Coloni GF. Endoscopic treatment of lung cancer invading the airway before induction chemotherapy and surgical resection. Eur J Cardiothorac Surg 2001; 20:464-7. [PMID: 11509264 DOI: 10.1016/s1010-7940(01)00742-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Many patients with advanced lung cancer invading the airway require only palliation; however, induction chemotherapy and surgery may sometimes be considered. Preliminary endoscopic palliation may improve quality of life and functional status, allows better evaluation of tumor extension and contributes to prevent infectious complications. We reviewed our experience with preliminary laser treatment, induction chemotherapy and surgical resection in patients with lung cancer invading the airway. METHODS Twenty-one patients with stage IIIA and IIIB lung cancer presenting with an 80% unilateral airway obstruction were treated with laser resection, induction chemotherapy and surgery. Spirometry, arterial blood gas analysis, quality of life (QLQ-C30 score) and performance status were recorded before and after laser treatment and after chemotherapy. Complications during chemotherapy, surgical morbidity and mortality, and survival were also recorded. RESULTS No complications were observed after endoscopic treatment. FEV(1) significantly improved from 1.4+/-0.4 l/s to 2.2+/-0.7 l/s, as well as FVC (from 2+/-0.5 to 3.1+/-0.8 l), and remained stable after chemotherapy. The QLQ-C30 score significantly improved after laser treatment (from 45+/-4.8 to 31+/-2.5) as well as the Karnofsky status (from 76+/-5 to 90). One patient developed pneumonia during induction chemotherapy. Three patients were not operated on. We performed five pneumonectomies (one right tracheal sleeve pneumonectomy) and 13 lobectomies (five associated to a bronchial sleeve resection). One patient (5.5%) died after the operation. Four patients experienced minor postoperative complications. Three-year survival after the operation was 52%. CONCLUSIONS Preliminary endoscopic palliation of lung cancer invading the airway is feasible, improves evaluation and staging, helps to reduce the incidence of complications during induction chemotherapy without increasing surgical morbidity and mortality.
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Affiliation(s)
- F Venuta
- Department of Thoracic Surgery, University of Rome La Sapienza, Rome, Italy.
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Roberts PF, Venuta F, Rendina E, De Giacomo T, Coloni GF, Follette DM, Richman DP, Benfield JR. Thymectomy in the treatment of ocular myasthenia gravis. J Thorac Cardiovasc Surg 2001; 122:562-8. [PMID: 11547310 DOI: 10.1067/mtc.2001.116191] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Thymectomy is an effective and accepted treatment for myasthenia gravis, but thymectomy for ocular myasthenia gravis (Osserman stage I) is controversial. OBJECTIVE To assess the efficacy and propriety of thymectomy for the treatment of ocular myasthenia gravis. METHODS We conducted a review and follow-up of all patients who had thymectomy for the treatment of ocular myasthenia gravis between 1970 and 1998 at the University of California, Davis, Medical Center, and the University of Rome, "La Sapienza," Rome, Italy. Patient response to thymectomy was categorized as follows: cured, patients who became symptom-free and required no further medication; improved, patients who required less medication and whose symptoms were less severe; unchanged, patients whose symptoms and medications were the same; worse, patients who had more severe symptoms, needed more medication, or died. RESULTS Sixty-one patients (mean age 37 years; range 14-73 years) were followed up for a mean duration of 9 years (range 0.5-29 years). Ocular myasthenia gravis with mixed and cortical thymomas, stages I to IV, occurred in 12 patients, and ocular myasthenia without thymomas occurred in 49 patients. Transsternal thymectomy (n = 55) and transcervical thymectomy (n = 6) resulted in cure in 31 (51%) patients, improvement in 12 (20%) patients, no change in 16 (26%) patients, and worsening of symptoms (including 1 postoperative death) in 2 patients. Patient outcomes were statistically independent of the duration of preoperative symptoms (mean 9.5 months), patient age, or the presence or absence of thymoma. In patients with ocular myasthenia, 70% were cured or improved after thymectomy; in the subgroup of patients with ocular myasthenia and thymoma, 67% were cured or improved. CONCLUSION Thymectomy is an effective and safe treatment for patients with ocular myasthenia gravis.
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Affiliation(s)
- P F Roberts
- Division of Cardiothoracic Surgery, University of California, Davis, Sacramento 95817, Calif, USA.
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31
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Mercadante E, De Giacomo T, Rendina EA, Venuta F, Moretti M, Aratari MT, Furio Coloni G. [Diagnostic delay in post-traumatic diaphragmatic ruptures]. MINERVA CHIR 2001; 56:299-302. [PMID: 11423797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Traumatic ruptures of the diaphragm are associated with closed chest and abdominal traumas, often the outcome of road accidents, with an incidence varying from 1 to 5% depending on the series. Diagnosis is frequently late if the possibility of breakages in two stages is also considered. This delay in diagnosis is encountered in a variable percentage of cases, between 9.5 and 60%. The clinical case of a post-traumatic ruptures of the diaphragm diagnosed 26 years after a car accident is described.
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Affiliation(s)
- E Mercadante
- Policlinico Umberto I, II Clinica Chirurgica, Cattedra di Chirurgia Toracica Università degli studi La Sapienza, Rome, Italy.
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32
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Rocca GD, Coccia C, Pompei L, Ruberto F, Venuta F, De Giacomo T, Pietropaoli P. Hemodynamic and oxygenation changes of combined therapy with inhaled nitric oxide and inhaled aerosolized prostacyclin. J Cardiothorac Vasc Anesth 2001; 15:224-7. [PMID: 11312484 DOI: 10.1053/jcan.2001.21974] [Citation(s) in RCA: 31] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate hemodynamic and oxygenation changes of combined therapy with inhaled nitric oxide (iNO) and inhaled aerosolized prostcyclin (IAP) during lung transplantation. DESIGN Prospective study. SETTING University hospital. PARTICIPANTS Ten patients scheduled for lung transplantation. INTERVENTIONS Ten patients, with a mean age of 38 years (range, 24 to 56 years), were scheduled for lung transplantation (2 single-lung transplantations and 8 double-lung transplantations). During first lung implantation with single-lung perfusion and ventilation, hemodynamic and oxygenation data were analyzed in 3 phases: (1) baseline, 5 minutes after pulmonary artery clamping; (2) inhaled NO phase, 15 minutes after inhaled NO administration (20 ppm) in 100% oxygen; and (3) IAP-inhaled NO phase, 15 minutes after combined administration of inhaled NO (20 ppm) and IAP (10 ng/kg/min) in 100% oxygen. MEASUREMENTS AND MAIN RESULTS During the inhaled NO phase, reductions of mean pulmonary arterial pressure (p < 0.05) and intrapulmonary shunt (p < 0.05) were noted. After the start of prostacyclin inhalation, a further decrease in mean pulmonary arterial pressure (p < 0.05) was observed. PaO2/FIO2 increased during the IAP-inhaled NO phase (p < 0.05), whereas intrapulmonary shunt decreased (p < 0.05). CONCLUSION This study confirms the action of inhaled NO as a selective pulmonary vasodilator during lung transplantation. Combined therapy with IAP and inhaled NO increases the effects on pulmonary arterial pressure and oxygenation compared with inhaled NO administered alone without any systemic changes.
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Affiliation(s)
- G D Rocca
- Istituto di Anestesiologia e Rianimazione, Cattedra di Chirurgia Toracica, University of Rome "La Sapienza," Azienda Ospedaliera Policlinico Umberto I, Rome, Italy.
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Venuta F, Rendina EA, De Giacomo T, Della Rocca G, Quattrucci S, Vizza CD, Ciccone AM, Mercadante E, Aratari MT, Rolla M, Cortesini R, Coloni GF. Improved results with lung transplantation for cystic fibrosis. Transplant Proc 2001; 33:1632-3. [PMID: 11267450 DOI: 10.1016/s0041-1345(00)02622-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- F Venuta
- Università di Roma, "La Sapienza,", Rome, Italy.
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34
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Della Rocca G, Passariello M, Costa MG, Coccia C, Pompei L, Pierconti F, Venuta F, De Giacomo T, Pietropaoli P, Cortesini R. Volumetric monitoring in multiorgan donor and related lung transplant recipients. Transplant Proc 2001; 33:1637-9. [PMID: 11267452 DOI: 10.1016/s0041-1345(00)02624-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- G Della Rocca
- Istituto di Anestesiologia e Rianimazione, University of Rome "La Sapienza," Azienda Ospedaliera Policlinico Umberto I, Rome, Italy.
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35
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Rendina EA, Venuta F, De Giacomo T, Furio Coloni G. Stage IIIB non-small-cell lung cancer. Chest Surg Clin N Am 2001; 11:101-19, viii. [PMID: 11253593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Highly selected patients with locally advanced non-small-cell lung cancer achieving cure do not contribute meaningfully to the overall prognosis of stage III. This finding is true particularly if clinicians rely on currently available therapeutic modalities (chemotherapy, radiation therapy, surgery) or refinements thereof. Understanding of the molecular biology continues to improve; it is more likely that in the new millenium, the real breakthroughs in staging and therapy for this high-risk, poor-prognosis group will come from the integration of molecular modalities in the clinical application.
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Affiliation(s)
- E A Rendina
- Department of Thoracic Surgery, Policlinico Umberto Io, University La Sapienza, Rome, Italy.
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36
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Landreneau RJ, De Giacomo T, Mack MJ, Hazelrigg SR, Ferson PF, Keenan RJ, Luketich JD, Yim AP, Coloni GF. Therapeutic video-assisted thoracoscopic surgical resection of colorectal pulmonary metastases. Eur J Cardiothorac Surg 2000; 18:671-6; discussion 676-7. [PMID: 11113674 DOI: 10.1016/s1010-7940(00)00580-7] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Careful patient selection is vital when video-assisted thoracoscopic surgical (VATS) therapeutic pulmonary metastasectomy of colorectal carcinoma is considered. Complete resection of all metastatic disease remains a vital concept. We reviewed our VATS experience for therapeutic metastasectomy of peripheral colorectal pulmonary metastases. METHODS Over 90 months, therapeutic VATS metastasectomy was accomplished upon 80 patients with colorectal metastases. Thin cut computed tomography (CT) was central in identifying lesions. The mean interval from primary carcinoma to VATS resection was 41 months (1-156 months; median, 33). A solitary lesion was resected in 60 patients and multiple (2-7) lesions resected in 20 patients. Statistics were obtained using the Student's t-test. RESULTS No operative mortality or major postoperative complications occurred. The hospital stay was 4.5+/-2. 2 days (range, 1-13). All lesions were resected by VATS, with four conversions to thoracotomy to improve the margins. The mean survival of patients with one lesion was 34.8 months compared with 26.5 months for patients with multiple lesions (P=0.37). The mean survival was 20.5 months when metastases occurred <3 years vs. 28.1 months for >3 years from primary carcinoma resection (P=0.20). Twenty-five (31%) patients are disease free; with a mean interval of 38.7 (3-84; median, 35) months. Sixty-nine percent (55/80) of patients developed a recurrence: 6/80 (8%) local; 19/80 (24%) regional (same hemithorax away from resection); and 30/80 (38%) distant. The overall survival at 1 year was 81.2%, 48.4% at 3 years and 30.8% at 5 years. CONCLUSIONS Therapeutic VATS resection of colorectal metastases appears efficacious. Preoperative CT can identify peripheral colorectal metastases amenable to VATS. Conversion to thoracotomy is indicated when none of the lesions identified by CT are found or when clear surgical margins are jeopardized.
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Affiliation(s)
- R J Landreneau
- Division of Thoracic Surgery, Lung Center, 02 Level, South Tower, Allegheny General Hospital, Pittsburgh, PA 15212-4772, USA.
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Venuta F, Rendina EA, Rocca GD, De Giacomo T, Pugliese F, Ciccone AM, Vizza CD, Coloni GF. Pulmonary hemodynamics contribute to indicate priority for lung transplantation in patients with cystic fibrosis. J Thorac Cardiovasc Surg 2000; 119:682-9. [PMID: 10733756 DOI: 10.1016/s0022-5223(00)70002-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Lung transplantation is a viable option for patients with cystic fibrosis. The current strategy of selection, based on spirometry and deterioration of quality of life, results in a high mortality on the waiting list. We reviewed the case histories of patients with cystic fibrosis accepted for lung transplantation to ascertain whether pulmonary hemodynamics could contribute to predict life expectancy. METHODS Forty-five patients with cystic fibrosis were accepted: 11 died on the waiting list (group I), 24 underwent transplantation (group II), and 10 are still waiting (group III). During evaluation we recorded spirometry, oxygen requirement, ratio of arterial oxygen tension to inspired oxygen fraction (PaO (2)/FIO (2)), arterial carbon dioxide tension (PaCO (2)), 6-minute walk test results, right ventricular ejection fraction, echocardiography, and pulmonary hemodynamics. We compared data from group I, II, and III patients. A comparison was also made within group II between the data collected at the time of evaluation and at the time of transplantation to quantify the deterioration during the waiting time. RESULTS The waiting time, spirometry, 6-minute walk test results, and right ventricular ejection fraction did not differ among the three groups. A statistically significant difference was found for PaO (2)/FIO (2), PaCO (2), mean pulmonary artery pressure, cardiac index, pulmonary arterial wedge pressure, and intrapulmonary shunt between groups I and II. Groups I and III showed statistically significant differences for mean pulmonary artery pressure, PaO (2)/FIO (2), and systemic vascular resistance indexed. No differences were observed between groups II and III. The comparison within group II showed a significant deterioration of pulmonary hemodynamics during the waiting time. CONCLUSIONS Pulmonary hemodynamics are worst in patients dying on the waiting list and deteriorate significantly during the waiting time. They may thus contribute to establish priority for lung transplantation in patients with cystic fibrosis.
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Affiliation(s)
- F Venuta
- University of Rome La Sapienza, Departments of Thoracic Surgery, Rome, Italy.
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Della Rocca G, Coccia C, Pugliese F, Pompei L, Ruberto F, Costa MG, Venuta F, Rendina EA, De Giacomo T, Pietropaoli P, Gasparetto A. [Anesthesia in single and bilateral sequential lung transplantation. Lung Transplantation Group]. Minerva Anestesiol 2000; 66:183-93. [PMID: 10832267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND Anesthesia for lung transplantation: intraoperative complications and long term results. METHODS 52 patients were scheduled for 16 single lung transplantations (SLT) (9 fibrosis and 7 emphysema) and 36 bilateral sequential lung transplantations (DLT) (4 bronchiectasis, 6 emphysema, 3 fibrosis, 22 cystic fibrosis and 1 pulmonary hypertension). Anesthesia was induced with propofol or midazolam, and fentanyl or alfentanil. As muscle relaxant vecuronium bromide was used. Anesthesia was maintained with isoflurane, fentanyl in boluses or sufentanil continuous infusion in O2 100%. Prostaglandin E1 (20-300 ng/kg/min), inhaled nitric oxide (10-40 ppm), dobutamine (5-15 mcg/kg/min), norepinephrine (0.05-3 mcg/kg/min) and ephedrine (5-10 mg per bolus) were used for hemodynamic management. In 2 patients inhaled areosolized prostacyclin were administered. RESULTS Mean pulmonary arterial pressure (mPA) and pulmonary vascular resistance (PVRI) increased after pulmonary artery clamping during first lung (mPA: 3347 nel DLT, 3643 nel SLT; PVRI; 375488 nel DLT, 377420 nel SLT) and second lung implantation (mPA: 3746; PVRI: 263553) and decreased after reperfusion of the first (mPA: 4737 nel DLT, 4329 nel SLT; PVRI: 488263 nel DLT, 420233 nel SLT) and the second lung (mPA: 4629; PVRI: 553260). Only in 9 cases (7 DLT and 2 SLT) C-P bypass was used. CONCLUSIONS With a strong drug support with pulmonary vasodilators, positive inotropic and systemic vasoconstrictor drugs, in most patients we transplanted C-P bypass can be avoided. Intraoperative deaths were not observed. Two years actuarial survival is 65% for DLT and 60% for SLT.
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Affiliation(s)
- G Della Rocca
- Istituto di Anestesia e Rianimazione, Università degli Studi di Roma La Sapienza.
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Abstract
Bronchial and vascular reconstructive procedures are a technically feasible alternative to pneumonectomy and have the advantage of sparing functioning lung parenchyma. Between 1989 and 1999, we performed bronchovascular sleeve resection and reconstruction in 145 patients (109 men, 36 women; age range, 26 to 76 years, mean, 56 years) with non-small-cell lung cancer (NSCLCL). Forty-one patients had induction chemotherapy and 3 had pre-operative radiotherapy. Immediate and long-term postoperative evaluation included bronchoscopy, spirometry, electrocardiogram, Doppler echocardiography, and perfusion lung scans, computed tomography and, only recently, angio-magnetic resonance (MR) imaging. Follow-up ranged between 3 months and 10 years (mean, 3.7 years) and is complete for all patients. We report the results of this series and conclude that morbidity, mortality, and functional data indicate that bronchovascular reconstructions are equal to standard lobectomy in terms of pulmonary function. Long-term survival is comparable with that reported for standard resection (lobectomy-pneumonectomy). These findings suggest that even complex lung-sparing operations can be proposed as adequate procedures in the treatment of lung cancer as long as a complete anatomical resection is obtained.
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Affiliation(s)
- E A Rendina
- Department of Thoracic Surgery, University La Sapienza, Rome, Italy.
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Abstract
The authors report a case of esophageal perforation after sequential double-lung transplantation for bronchiectasis. This complication was probably related to the devascularization of the esophageal wall during pneumonectomy.
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Affiliation(s)
- F Venuta
- Department of Thoracic Surgery, University of Rome "La Sapienza," Rome, Italy.
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Venuta F, Rendina EA, De Giacomo T, Coloni GF. Lung transplantation for emphysema. Monaldi Arch Chest Dis 1999; 54:506-9. [PMID: 10695321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Affiliation(s)
- F Venuta
- Dept of Thoracic Surgery, University of Rome La Sapienza, Italy
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Rocco G, Rendina EA, Meroni A, Venuta F, Della Pona C, De Giacomo T, Robustellini M, Rossi G, Massera F, Vertemati G, Rizzi A, Coloni GF. Prognostic factors after surgical treatment of lung cancer invading the diaphragm. Ann Thorac Surg 1999; 68:2065-8. [PMID: 10616978 DOI: 10.1016/s0003-4975(99)01121-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Diaphragmatic invasion from lung cancer (T3-diaphragm) is a rare occurrence reported to portend a poor prognosis. METHODS Fifteen patients with T3-diaphragm (14 males, 1 female; median age, 64 years) were surgically treated over a twenty-year period by en bloc resection (14 patients). One patient was only explored. Pathologic stage IIB (T3N0) was found in 11 patients. A partial infiltration of the diaphragm was observed in 3 patients, whereas full-depth invasion was found in 12. Diaphragmatic reconstruction was done primarily in 9 patients, and, by prosthetic material in 5. RESULTS Two patients are still alive without evidence of disease at 88, and, 114 months from surgery. Overall median survival was 23 months (range, 3 to 168). The actuarial 5-year survival was 20%, when all patients were considered, and, 27%, for T3N0 patients. Univariate analysis showed that prosthetic replacement of the muscle (p = 0.018) was significantly related to survival. CONCLUSIONS T3-diaphragm is best treated with en bloc resections with wide tumor-free margins and prosthetic replacement of the diaphragm.
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Affiliation(s)
- G Rocco
- Division of General Thoracic Surgery, Azienda Ospedaliera E. Morelli, Sondalo, (Sondrio), Italy.
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Rendina EA, Venuta F, De Giacomo T, Ciccone AM, Moretti M, Ruvolo G, Coloni GF. Sleeve resection and prosthetic reconstruction of the pulmonary artery for lung cancer. Ann Thorac Surg 1999; 68:995-1001; discussion 1001-2. [PMID: 10509997 DOI: 10.1016/s0003-4975(99)00738-9] [Citation(s) in RCA: 93] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Lobectomy associated with reconstruction of the pulmonary artery (PA) is a technically feasible alternative to pneumonectomy in patients with lung cancer. However, concern about postoperative complications and long-term survival limited its acceptance so far. METHODS Between 1989 and 1996, we performed a PA reconstruction in 52 patients (41 men, 11 women; age range 35 to 75 years, mean 60 years) with lung cancer. Eleven patients had induction chemotherapy. We performed 15 PA sleeve resections, 34 PA reconstructions by a pericardial patch, and three PA reconstructions by a pericardial conduit, associated with a bronchial sleeve lobectomy or bilobectomy (33), or with standard lobectomy (19). Immediate and long-term postoperative evaluation included spirometry, echocardiography, perfusion lung scans, computed tomography, and PA angiography. The follow-up ranged between 27 and 96 months and is complete for all patients. RESULTS We had one specific postoperative complication (PA thrombosis) and no mortality. Perfusion scans and PA angiography were normal in all but the 1 patient having thrombosis. Mean forced expiratory volume (FEV) in 1 s and forced vital capacity (FVC) were, respectively, 72% and 80% preoperatively, 65% and 76% 1 month after surgery, and then they plateaued at 70% and 78% after 6 months. Echocardiography showed patterns in the normal range and normal estimates of PA pressures in all but 2 patients. Five-year survival was 38.3% for the entire group, 18.6% for stages IIIA and B, and 64.4% for stages I and II. CONCLUSIONS Morbidity, mortality, and functional data do not differ from what is currently reported for standard lobectomy. Long-term survival is in line with that reported for standard resection. These data support PA reconstruction as a viable option in the treatment of lung cancer.
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Affiliation(s)
- E A Rendina
- Department of Thoracic Surgery La Sapienza University of Rome, Italy
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Venuta F, Rendina EA, Bufi M, Della Rocca G, De Giacomo T, Costa MG, Pugliese F, Coccia C, Ciccone AM, Coloni GF. Preimplantation retrograde pneumoplegia in clinical lung transplantation. J Thorac Cardiovasc Surg 1999; 118:107-14. [PMID: 10384193 DOI: 10.1016/s0022-5223(99)70149-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Retrograde pneumoplegia seems to improve early graft function in experimental and clinical lung transplantation. We evaluated the role of retrograde flushing in addition to antegrade pneumoplegia in clinical lung transplantation. METHODS Fourteen patients undergoing lung transplantation were randomized into 2 groups: in group I we performed antegrade pulmonary artery flushing with alprostadil (prostaglandin E1) and modified Euro-Collins solution at the time of retrieval. In group II additional retrograde flushing through the pulmonary veins was performed at the back table, before reimplantation. Hemodynamic variables, mean airway pressure, and blood gas analysis were monitored at different time points. Postoperative volumetric monitoring was performed to assess extravascular lung water. The reimplantation response was assessed by a radiographic score; extubation time and intensive care unit stay were recorded. RESULTS During retrograde flushing, blood and clots coming out from the pulmonary artery were observed; 2 lungs harvested from a donor with multiple bone fractures had fat emboli in the retrograde perfusate. Hemodynamic monitoring did not demonstrate any difference between the 2 groups. The ratio of arterial oxygen tension to inspired oxygen fraction, extravascular lung water, duration of intubation, and length of stay in the intensive care unit were improved in group II, but the differences did not reach statistical significance. Intrapulmonary shunt fraction was significantly improved in group II at each time point ( P =.02), as well as indexed alveolar-arterial oxygen tension gradient (P =.04), mean airway pressure (P =.04), and chest x-ray score ( P =.03). CONCLUSIONS Preimplantation retrograde flushing is not detrimental and helps to improve early graft function.
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Affiliation(s)
- F Venuta
- University of Rome "La Sapienza," Departments of Thoracic Surgery and Anesthesia, Rome, Italy.
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Abstract
OBJECTIVES Single lung transplantation is a viable option for patients with end-stage pulmonary disease; despite encouraging results, we observed serious complications arising in the native lung. We retrospectively reviewed 36 single lung transplants to evaluate the incidence of complications arising in the native lung, their treatment and outcome. METHODS Between 1991 and 1997, 35 patients received 36 single lung transplants for emphysema (16), pulmonary fibrosis (14), lymphangioleiomyomatosis (4), primary pulmonary hypertension (1) and bronchiolitis obliterans (1). The clinical records were reviewed and the complications related to the native lung were divided into early (up to 6 weeks after the transplant) and late complications. RESULTS Nineteen complications occurred in 18 patients (50%), leading to death in nine (25%). Early complications (within 6 weeks from the transplant) were bacterial pneumonia (1), overinflation (3), retention of secretions with bronchial obstruction and atelectasis (1), hemothorax (1), pneumothorax (1) and invasive aspergillosis (3); one patient showed active tuberculosis at the time of transplantation. Two patients developed bacterial pneumonia and invasive aspergillosis leading to sepsis and death. The other complications were treated with separate lung ventilation (1), bronchoscopic clearance (1), chest tube drainage (1) and wedge resection and pleurodesis (mechanical) by VATS (1). One patient with hyperinflation of the native lung eventually required pneumonectomy and died of sepsis. The patient with active tuberculosis is alive and well after 9 months of medical treatment. Late complications were recurrent pneumothorax (4), progressive overinflation with functional deterioration (2), aspergillosis (1) and pulmonary nocardiosis (1). Recurrent pneumothorax was treated with chest tube drainage alone (1), thoracoscopic wedge resection and/or pleurodesis (2) and pneumonectomy (1); hyperinflation was treated with thoracoscopic lung volume reduction in both cases; both patients with late infectious complications died. CONCLUSIONS After single lung transplantation, the native lung can be the source of serious problems. Early and late infectious complications generally result in a fatal outcome; the other complications can be successfully treated in most cases, even if surgery is required.
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Affiliation(s)
- F Venuta
- Department of Thoracic Surgery, University of Rome La Sapienza, Cattedra di Chirurgia Toracica, Policlinico Umberto I, Rome, Italy.
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De Giacomo T, Venuta F, Rendina EA, Della Rocca G, Ciccone AM, Ricci C, Coloni GF. Video-assisted thoracoscopic treatment of giant bullae associated with emphysema. Eur J Cardiothorac Surg 1999; 15:753-6; discussion 756-7. [PMID: 10431854 DOI: 10.1016/s1010-7940(99)00092-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Surgical treatment of bullous emphysema has received renewed attention because of recent advances in minimally invasive techniques. We describe our experience in the thoracoscopic management of patients with bullous emphysema over the last 5 years. METHODS Twenty-five patients (24 male, one female) with a mean age of 57 years with giant bullae associated with various degree of underlying emphysema, were operated on thoracoscopically at our Institution. The severity of the emphysema was classified according to the criteria of the American Thoracic Society: five patients were in stage I (FEV 1 > 50%), eight patients were in stage II (FEV1 35 to 49%) and 12 patients were in stage III (FEV1 < 35%). Nine patients underwent operation to treat complications related to bullae, 12 presented dyspnoea and four were asymptomatic. We performed 23 unilateral and two bilateral staged thoracoscopic procedures. RESULTS No intraoperative complications developed. Mean operative time was 107+/-25 min. No patient dead. Mean post-operative chest tube duration was 8+/-4.13 days and mean post-operative hospital stay was 11+/-5.76 days. The most frequent post-operative complication was air-leakage that in 12 patients lasted more than 7 days. Pulmonary function tests were obtained 3-6 months after the operation and statistical comparison between pre-operative and post-operative data was performed using Student's paired t-test. We observed best results in I and II stage patients, but also stage III patients experienced clinical improvement and better quality of life. CONCLUSIONS Our experience supports the safety and effectiveness of video-assisted thoracoscopy for the treatment of giant bullae. Minimally invasive approach is fully justified especially in the group of patients with severe impairment of lung function.
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Affiliation(s)
- T De Giacomo
- Department of Thoracic Surgery, University of Rome, Italy.
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De Giacomo T, Rendina EA, Venuta F, Ciccone AM, Coloni GF. Thoracoscopic resection of solitary lung metastases from colorectal cancer is a viable therapeutic option. Chest 1999; 115:1441-3. [PMID: 10334166 DOI: 10.1378/chest.115.5.1441] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES The reported 5-year survival rate after pulmonary metastasectomy from colorectal carcinoma, usually accomplished through thoracotomy or median sternotomy, ranges from 9 to 47%. Video-assisted thoracoscopy (VAT) is employed routinely for many thoracic surgical procedures, but the main concern about this approach for resection of lung metastases is that VAT does not allow complete lung palpation to identify and remove metastases not detected by preoperative radiologic examinations. DESIGN In this study, we reviewed our experience with thoracoscopic resection of single peripheral lung metastases from colorectal carcinoma with potentially curative intent. PATIENTS AND INTERVENTIONS From July 1992 to September 1998, 24 patients (15 male, 9 female) with a mean age of 56 years, who previously had undergone resection for colorectal carcinoma and had a single limited and peripheral lung lesion identified by high-resolution CT, underwent thoracoscopic wedge resection of the lesions. RESULTS No intraoperative complications developed. Three patients had minor postoperative complications successfully treated. In one case, we found a benign lesion, and this patient was excluded from the analysis. In the remaining cases, metastases from colorectal cancer were confirmed. The median follow-up was 29 months, ranging from 3 to 67 months. Thirteen patients (56.5%) developed recurrence of the disease, and 5 of them (21.7%) had local recurrence. Cumulative 5-year survival estimated by Kaplan-Meier method was 49.5%, not really different from the data reported in the literature. CONCLUSIONS Thoracoscopic resection of single peripheral lung metastases from colorectal cancer with potentially curative intent seems effective and justified since the ultimate outcome of this highly selected group of patients seems to be not different from that obtained after a more invasive approach.
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Affiliation(s)
- T De Giacomo
- University of Rome La Sapienza, Department of Thoracic Surgery, Italy.
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Venuta F, Rendina EA, De Giacomo T, Della Rocca G, Antonini G, Ciccone AM, Ricci C, Coloni GF. Thymectomy for myasthenia gravis: a 27-year experience. Eur J Cardiothorac Surg 1999; 15:621-4; discussion 624-5. [PMID: 10386407 DOI: 10.1016/s1010-7940(99)00052-4] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Thymectomy is considered an effective therapeutic option for patients with myasthenia gravis (MG). We reviewed our 27-year experience with surgical treatment of MG with respect to long-term results and factors affecting outcome. METHODS Between 1970 and 1997, we performed 232 thymectomies for MG. Fifteen patients were lost to follow-up; the remaining 217 form the object of our study. Sixty-two patients (28.4%) had thymoma. Myasthenia was graded according to a modified Osserman classification: 51 patients (23.5%) were in class I, 81(37.3%) in class IIA, 52 (24%) in class IIB, 26 (12%) in class III and seven (3.2%) in class IV. Mean duration of symptoms before the operation was 12+/-10 months. Fifty-eight thymectomies for thymoma were performed through a median sternotomy and four through a clamshell incision. Forty-six thymectomies for non-thymomatous MG were performed through a standard cervicotomy, 101 procedures through a partial upper sternal-splitting incision and eight through a complete median sternotomy. RESULTS Operative mortality was 0.92% (two patients). After a mean follow-up of 119 months, 71% of all patients improved their clinical status (25% without medications and asymptomatic; 46% with a reduction of medications and/or clinically improved); 39 (18%) have a stable disease with no clinical modifications; 12 (5%) presented a deterioration of their clinical status with worse symptoms, required more medications, or both. Thirteen patients (6%) died because of MG (mean survival 34.3+/-3.6 months). The presence of a thymoma negatively influenced the prognosis. Younger patients showed a more favorable outcome as well as patients with a shorter duration of symptoms before the operation; patients with lower classes of myasthenia showed a higher rate of remission. CONCLUSIONS Thymectomy is effective in the management of patients with MG at all stages with low morbidity. Patients with thymoma present a less favorable outcome.
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Affiliation(s)
- F Venuta
- Department of Thoracic Surgery, University of Rome La Sapienza, Italy.
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Abstract
OBJECTIVE We used induction chemotherapy in a prospective, single-institution clinical trial intended to achieve resectability in patients with centrally located, unresectable T4 non-small cell lung cancer. Other types of IIIB disease were excluded. METHODS Between January 1990 and April 1996, we enrolled 57 patients with histologically confirmed non-small cell lung cancer. Eligibility criteria for T4 were clinical (superior vena cava syndrome, 9 patients), vocal cord paralysis (6 patients), dysphagia from esophageal involvement (1 patient), radiologic (computed tomography and magnetic resonance evidence of infiltration, 10 patients), bronchoscopic (tracheal infiltration, 11 patients), and thoracoscopic (histologically proven mediastinal infiltration, 20 patients). After 3 cycles of cisplatin (120 mg/m2), vinblastine (4 mg/m2), and mitomycin (2 mg/m2), patients were reevaluated. RESULTS Forty-two patients (73%; 36 men, 6 women; age range, 42-75 years; mean, 58 years) responded to therapy and underwent thoracotomy; 11 patients did not respond, and 4 patients had major toxicity. Thirty-six patients (63% of the entire group) had complete resection. We performed 4 exploratory thoracotomies, 6 pneumonectomies, 32 lobectomies (20 procedures were associated with reconstruction of hilar-mediastinal structures). Overall, 4 patients had no histologic evidence of disease. We had 2 bronchopleural fistulas with 1 death and 5 other major complications. Overall survival at 1 and 4 years is 61.4% and 19.5%, respectively. Forty-two patients (73%) underwent exploratory operation, with a 4-year survival of 25.9%; 36 patients (63%) had complete resection, with a 4-year survival of 30.5%. CONCLUSIONS Induction chemotherapy is effective for downstaging and surgical reconversion of centrally located T4 non-small cell lung cancer. Survival is promising, especially in patients whose disease becomes resectable.
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MESH Headings
- Adenocarcinoma/diagnosis
- Adenocarcinoma/drug therapy
- Adenocarcinoma/mortality
- Adenocarcinoma/pathology
- Adenocarcinoma/surgery
- Adult
- Aged
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Carcinoma, Non-Small-Cell Lung/diagnosis
- Carcinoma, Non-Small-Cell Lung/drug therapy
- Carcinoma, Non-Small-Cell Lung/mortality
- Carcinoma, Non-Small-Cell Lung/pathology
- Carcinoma, Non-Small-Cell Lung/surgery
- Carcinoma, Squamous Cell/diagnosis
- Carcinoma, Squamous Cell/drug therapy
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/surgery
- Chemotherapy, Adjuvant
- Cisplatin/administration & dosage
- Cisplatin/adverse effects
- Female
- Humans
- Lung Neoplasms/diagnosis
- Lung Neoplasms/drug therapy
- Lung Neoplasms/mortality
- Lung Neoplasms/pathology
- Lung Neoplasms/surgery
- Lymph Node Excision
- Male
- Middle Aged
- Mitomycin/administration & dosage
- Mitomycin/adverse effects
- Neoplasm Staging
- Pneumonectomy
- Preoperative Care/methods
- Prospective Studies
- Vindesine/administration & dosage
- Vindesine/adverse effects
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Affiliation(s)
- E A Rendina
- Department of Thoracic Surgery, University La Sapienza, Rome, Italy
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