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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 -
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 -
Proceedings (Baylor University. Medical... Oct 2019A 74-year-old man presented to an orthopedic spine surgeon with signs and symptoms consistent with cervical radiculopathy. Investigation revealed metastasis of a...
A 74-year-old man presented to an orthopedic spine surgeon with signs and symptoms consistent with cervical radiculopathy. Investigation revealed metastasis of a Pancoast tumor to the patient's brachial plexus. A year after initial diagnosis, the patient achieved full neurological function of his left arm. Pancoast tumors are rare in the orthopedic population. Thorough physical examination, imaging, and nerve conduction studies ultimately led to the patient's diagnosis.
PubMed: 31656428
DOI: 10.1080/08998280.2019.1647737 -
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 -
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 -
Agri : Agri (Algoloji) Dernegi'nin... Apr 2020A Pancoast or superior sulcus tumor is a rare, bronchogenic carcinoma. In the early period, shoulder pain is the most common symptom. In this case, the patient had...
A Pancoast or superior sulcus tumor is a rare, bronchogenic carcinoma. In the early period, shoulder pain is the most common symptom. In this case, the patient had presented with complaints of shoulder and arm pain at other outpatient clinics and was examined primarily for musculoskeletal causes and radiculopathy. The patient had no complaints of facial symptoms and Horner's syndrome signs, such as anhidrosis of the face and neck region, were not noticed. Advanced imaging of a patient with preganglionic Horner's syndrome is important. Fewer than 50% of patients with a Pancoast tumor have a resectable lesion at the first diagnosis. Diagnosis is often delayed or there may be a misdiagnosis because musculoskeletal disorders are the focus and there are few lung-related complaints. A detailed examination and anamnesis is very important in patients with arm and shoulder pain.
Topics: Adult; Diagnosis, Differential; Horner Syndrome; Humans; Male; Pancoast Syndrome; Shoulder Pain
PubMed: 32297960
DOI: 10.5505/agri.2018.14892 -
American Journal of Hematology Nov 2020
Topics: Diagnosis, Differential; Humans; Leukemia, Plasma Cell; Magnetic Resonance Imaging; Male; Middle Aged; Pancoast Syndrome; Tomography, X-Ray Computed
PubMed: 32833248
DOI: 10.1002/ajh.25977 -
Cureus Apr 2023A 46-year-old female patient was diagnosed with a rare and benign intrapulmonary schwannoma, a neurogenic tumor that represents approximately 20% of adult mediastinal...
A 46-year-old female patient was diagnosed with a rare and benign intrapulmonary schwannoma, a neurogenic tumor that represents approximately 20% of adult mediastinal tumors, with schwannomas being the most common subtype. The patient was initially asymptomatic; however, after a period of four years, the patient presented with bilateral extremity edema, chronic venous stasis, elevated right ventricular systolic pressure, and a slightly enlarged inferior vena cava. These symptoms were caused by the lung tumor compressing intrathoracic structures. This case highlights the need for early evaluation and proper management of neurogenic tumors to avoid serious symptoms and complications. It also emphasizes the importance of vigilant monitoring and prompt surgery to achieve the best outcome for patients with neurogenic tumors.
PubMed: 37081901
DOI: 10.7759/cureus.37788 -
Cureus Nov 2019Pancoast tumors are non-small cell lung tumors, which can invade the ribs, vertebrae, sympathetic ganglia and brachial plexus. In this study, a patient with right-sided...
Pancoast tumors are non-small cell lung tumors, which can invade the ribs, vertebrae, sympathetic ganglia and brachial plexus. In this study, a patient with right-sided Pancoast tumor presented with intractable chronic pain on the right neck, upper extremity and chest wall. The chronic pain associated with Pancoast tumor, which was difficult to treat with opioids and other medications, was effectively treated with a high-thoracic erector spinae plane block (ESPB). Prolonged analgesia was provided with an ESP catheter to wean the patient from opioids. This case report provides an example where the novel interfacial ESP block can provide pain relief in challenging situations such as lung malignancies involving deeper structures and extensive areas of pain.
PubMed: 31857924
DOI: 10.7759/cureus.6092