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General Thoracic and Cardiovascular... Aug 2022A major challenge in treating superior sulcus tumors is achieving complete surgical resection because of technical difficulties associated with the anatomical structures...
A major challenge in treating superior sulcus tumors is achieving complete surgical resection because of technical difficulties associated with the anatomical structures and approaches to the thorax. Our technique combines posterior minimally invasive thoracotomy with robot-assisted right upper lobectomy, thereby reducing the invasiveness of the surgical approach and postoperative complications, including wound pain. In the presented case, the tumor was located on the apical right upper lobe, directly invading the apical thoracic wall structures. Hybrid robotic and minimally invasive thoracotomy with thoracic wall resection was performed. The postoperative course was uneventful. The patient discharged from our hospital with minimal wound pain.
Topics: Humans; Lung Neoplasms; Pain; Pancoast Syndrome; Pneumonectomy; Robotic Surgical Procedures; Robotics; Thoracic Surgery, Video-Assisted; Thoracic Wall
PubMed: 35666358
DOI: 10.1007/s11748-022-01839-x -
The American Journal of Case Reports Sep 2020BACKGROUND Shoulder pain is a common complaint in general practice and typically has an orthopedic or rheumatological etiology. However, it may be the presenting symptom...
BACKGROUND Shoulder pain is a common complaint in general practice and typically has an orthopedic or rheumatological etiology. However, it may be the presenting symptom of a serious underlying condition, such as lung cancer. CASE REPORT A 60-year-old man with a 30 pack-year history of smoking presented with worsening right shoulder pain over the last 6 months. He had no respiratory symptoms or weight change. He was seen at several general practice clinics and treated for a rotator cuff injury. However, his pain became severe, to the point that it affected his activities of daily living. A shoulder X-ray revealed opacity in the right apical zone. After a thorough investigation, the patient was found to have lung cancer with local invasion and intracranial metastases. However, in light of the advanced stage of the disease, a palliative approach was taken. The patient remained on multiple oral analgesics for the control of his pain. CONCLUSIONS The present case shows that common symptoms such as shoulder pain can be indicative of serious underlying pathology. Physicians should remain alert and maintain a high index of suspicion for Pancoast tumor in patients who are heavy smokers. Furthermore, a chest X-ray needs to be performed in elderly patients and smokers with shoulder pain.
Topics: Activities of Daily Living; Aged; Humans; Male; Middle Aged; Pancoast Syndrome; Rotator Cuff Injuries; Shoulder Pain; Smokers
PubMed: 32913177
DOI: 10.12659/AJCR.926643 -
The Annals of Thoracic Surgery Aug 2022Lung autotransplantation with ex vivo bench surgery is a useful surgical technique for centrally located and locally advanced lung cancer to spare lung parenchyma by...
Lung autotransplantation with ex vivo bench surgery is a useful surgical technique for centrally located and locally advanced lung cancer to spare lung parenchyma by avoiding pneumonectomy. Here, we present a patient with a bulky superior sulcus tumor with hilar involvement for which lung-sparing complete resection was achieved with autotransplantation. After concurrent chemoradiotherapy, en bloc resection, consisting left pneumonectomy combined with apical chest wall resection (1-4 ribs), back-table extended double-sleeve resection after lung preservation, and reimplantation of basal segment was performed. The postoperative course was uneventful, and the patient is alive without tumor recurrence at 18 months after surgery.
Topics: Humans; Lung; Lung Neoplasms; Neoplasm Recurrence, Local; Pancoast Syndrome; Pneumonectomy; Transplantation, Autologous
PubMed: 34902305
DOI: 10.1016/j.athoracsur.2021.10.062 -
Cureus Jan 2024[This retracts the article DOI: 10.7759/cureus.19418.].
[This retracts the article DOI: 10.7759/cureus.19418.].
PubMed: 38274616
DOI: 10.7759/cureus.r94 -
Interactive Cardiovascular and Thoracic... Jan 2022This article aims to evaluate the feasibility and safety of a hybrid video-assisted thoracic surgery (VATS) approach to achieve en bloc lobectomy and spinal resection...
OBJECTIVES
This article aims to evaluate the feasibility and safety of a hybrid video-assisted thoracic surgery (VATS) approach to achieve en bloc lobectomy and spinal resection for non-small-cell lung cancer (NSCLC).
METHODS
Between October 2015 and November 2020, 10 patients underwent VATS anatomical lobectomy and en bloc chest wall and spinal resection through a limited posterior midline incision as a single operation for T4 (vertebral involvement) lung cancer. Nine patients had Pancoast syndrome without vascular involvement and 1 patient had NSCLC of the right lower lobe with invasion of T9 and T10.
RESULTS
There were 5 men and 5 women. The mean age was 61 years (range: 47-74 years). Induction treatment was administered to 9 patients (90%). The average operative time was 315.5 min (range: 250-375 min). The average blood loss was 665 ml (range: 100-2500 ml). Spinal resection was hemivertebrectomy in 6 patients and wedge corpectomy in 4 patients. Complete resection (R0) was achieved in all patients. The average hospitalization stay was 14 days (range: 6-50 days). There was no in-hospital mortality. The mean follow-up was 32.3 months (range: 6-66 months). Six patients (60%) are alive without recurrence.
CONCLUSIONS
VATS is feasible and safe to achieve en bloc resection of NSCLC inviding the spine without compromising oncological efficacy. Further experience and longer follow-up are needed to determine if this approach provides any advantages over thoracotomy.
Topics: Carcinoma, Non-Small-Cell Lung; Female; Humans; Lung Neoplasms; Male; Middle Aged; Pancoast Syndrome; Pneumonectomy; Thoracic Surgery, Video-Assisted; Thoracic Vertebrae
PubMed: 34999810
DOI: 10.1093/icvts/ivab215 -
Multimedia Manual of Cardiothoracic... Nov 2023The current gold standard for the treatment of Pancoast tumours is considered to be neoadjuvant chemoradiation followed by radical resection of the affected upper lobe...
The current gold standard for the treatment of Pancoast tumours is considered to be neoadjuvant chemoradiation followed by radical resection of the affected upper lobe en bloc with resection of the chest wall. Shaw and Paulson first described the most commonly used approach in 1961 via an extended posterolateral thoracotomy. However, because this approach comes with significant soft tissue damage and occasionally provides only suboptimal exposure, especially for anterior superior sulcus tumours, other approaches have been published in recent years, including open anterior approaches (Dartevelle and Gruenenwald) in addition to rare case reports of minimally invasive assisted hybrid procedures. Because we routinely perform robotic anatomical lung resections as well as three-port robotic first rib resections for thoracic inlet/outlet syndrome in our department, combining both techniques with our accumulated experience seemed to be the next logical step. We describe step-by-step what is (to our knowledge) one of the first reported cases of a fully portal robotic-assisted Pancoast tumour resection consisting of a left upper lobe resection en bloc with the first rib after neoadjuvant chemoradiation therapy. This approach proved to be safe and allowed for excellent exposure, especially of the thoracic outlet.
Topics: Humans; Pancoast Syndrome; Thoracic Wall; Robotic Surgical Procedures; Lung Neoplasms; Lung
PubMed: 37970683
DOI: 10.1510/mmcts.2023.072 -
Cureus Apr 2022
PubMed: 35463566
DOI: 10.7759/cureus.x16 -
Cureus Nov 2020The superior vena cava syndrome (SVCS) is caused by a mechanical obstruction; 90% are of neoplasic etiology (lung cancer (LC) and non-Hodgkin lymphoma (NHL) mostly),...
The superior vena cava syndrome (SVCS) is caused by a mechanical obstruction; 90% are of neoplasic etiology (lung cancer (LC) and non-Hodgkin lymphoma (NHL) mostly), epithelial neoplasms of the thymus (NET) is a rare cause, thymic carcinoma (TC) causing less than 1% of cases. A 56-year-old male presented with a four-month history of dyspnea, dysphonia, facial and cervical edema and bilateral cervical lymphadenopathy. The tomography showed bilateral, mediastinal, retroperitoneal lymphadenopathies, and obstruction of the internal jugular vein, right apical pulmonary nodules. A superficial adenopathy biopsy was taken, which is not conclusive, so it was decided to take an image-guided biopsy. During its evolution, it presents asymptomatic cardiovascular changes; in extension studies, systemic disease is evidenced. The definitive histopathological study reported thymic carcinoma. Systemic treatment with chemotherapy and radiation therapy was planned.
PubMed: 33391908
DOI: 10.7759/cureus.11670 -
Thoracic Cancer Jan 2021Non-small cell lung cancer (NSCLC) is the first cause of cancer-related death among men and the second among women worldwide. It also poses an economic threat to the...
BACKGROUND
Non-small cell lung cancer (NSCLC) is the first cause of cancer-related death among men and the second among women worldwide. It also poses an economic threat to the sustainability of healthcare services. This study estimated the direct costs of care for patients with NSCLC by stage at diagnosis, and management phase of pathway recommended in local and international guidelines.
METHODS
Based on the most up-to-date guidelines, we developed a very detailed "whole-disease" model listing the probabilities of all potentially necessary diagnostic and therapeutic actions involved in the management of each stage of NSCLC. We assigned a cost to each procedure, and obtained an estimate of the total and average per-patient costs of each stage of the disease and phase of its management.
RESULTS
The mean expected cost of a patient with NSCLC is 21,328 € (95% C.I. -20 897-22 322). This cost is 16 291 € in stage I, 19530 € in stage II, 21938 € in stage III, 22175 € in stage IV, and 28 711 € for a Pancoast tumor. In the early stages of the disease, the main cost is incurred by surgery, whereas in the more advanced stages radiotherapy, medical therapy, treatment for progressions, and supportive care become variously more important.
CONCLUSIONS
An estimation of the direct costs of care for NSCLC is fundamental in order to predict the burden of new oncological therapies and treatments on healthcare services, and thus orient the decisions of policy-makers regarding the allocation of resources.
KEY POINTS
SIGNIFICANT FINDINGS OF THE STUDY: The high costs of surgery make the early stages of the disease no less expensive than the advanced stages.
WHAT THIS STUDY ADDS
An estimation of the direct costs of care is fundamental in order to orient the decisions of policy-makers regarding the allocation of resources.
Topics: Carcinoma, Non-Small-Cell Lung; Disease Management; Female; Humans; Lung Neoplasms; Male; Neoplasm Staging
PubMed: 33219738
DOI: 10.1111/1759-7714.13616 -
Journal of Surgical Case Reports Dec 2020Here we describe the successful outcome of a complex and challenging resection of a left-sided pancoast tumour involving the left subclavian artery and vertebral bodies....
Here we describe the successful outcome of a complex and challenging resection of a left-sided pancoast tumour involving the left subclavian artery and vertebral bodies. The resection was performed following neoadjuvant chemoradiotherapy in a multi-staged fashion involving multiple teams including thoracic surgery, plastic surgery, neurosurgery and vascular surgery. Each operation was less than 6 h, without complication, and the patient was discharged within 1 week of each procedure. This case report highlights the importance of multidisciplinary team collaboration and planning in order to achieve a successful oncologic outcome and a good quality of life following treatment of these challenging tumours. The patient had a good functional outcome and no evidence of recurrence 1.5 years later.
PubMed: 33343859
DOI: 10.1093/jscr/rjaa384