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The Annals of Thoracic Surgery Feb 2017
Topics: Health Care Surveys; Hospitals; Humans; Lung Neoplasms; Outcome Assessment, Health Care; Patient Safety; Pneumonectomy; Registries; Thoracic Surgery, Video-Assisted; United States
PubMed: 28109349
DOI: 10.1016/j.athoracsur.2016.08.095 -
Multimedia Manual of Cardiothoracic... Oct 2022Individual basal segmentectomies can be particularly challenging. The author has previously used an anterior approach when performing S10 segmentectomies. However, he...
Individual basal segmentectomies can be particularly challenging. The author has previously used an anterior approach when performing S10 segmentectomies. However, he finds that a posterior approach allows direct access to the vein and bronchus, which is further aided by dividing the posterior portion of the S6-S10 intersegmental plane. The trunk of the inferior pulmonary vein now becomes a convenient landmark because it hugs and delineates the segmental bronchus while it courses posteriorly. The author currently favors this approach for all S10 segmentectomies. Cross-sectional imaging and/or 3-dimensional reconstructions are essential in delineating anatomic relationships, in particular the relationship of the vein and its branches (which may vary) and the bronchus. They are also useful for locating the segmental artery, which typically lies just deep to the bronchus. Imaging is used both as a tool for preoperative planning and as a guide during operative dissection. Regardless of the approach, the S10 remains a difficult segmentectomy. Great care is required while dissecting and dividing delicate bronchovascular structures located deep within the operative field.
Topics: Humans; Lung Neoplasms; Male; Mastectomy, Segmental; Pneumonectomy; Thoracoscopy
PubMed: 36239739
DOI: 10.1510/mmcts.2022.077 -
Journal of the Royal Society of Medicine Oct 1993
Topics: Empyema; Humans; Pneumonectomy
PubMed: 8230052
DOI: 10.1177/014107689308601001 -
The Annals of Thoracic Surgery Mar 2016
Topics: Education, Medical; Humans; Lung Diseases; Pneumonectomy; Societies, Medical; Teaching; Thoracic Surgery; Thoracic Surgery, Video-Assisted; United States
PubMed: 26897185
DOI: 10.1016/j.athoracsur.2015.12.033 -
The Journal of Thoracic and... Aug 2022
Topics: Humans; Lung Neoplasms; Pandemics; Pneumonectomy
PubMed: 34872758
DOI: 10.1016/j.jtcvs.2021.11.038 -
The Journal of Thoracic and... Jan 2012Pneumonectomy after neoadjuvant therapy remains controversial. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Pneumonectomy after neoadjuvant therapy remains controversial.
METHODS
A systematic PubMed search was performed for original articles from 1990 through 2010 describing pneumonectomy after neoadjuvant therapy. Specific data on 30-day and 90-day perioperative mortalities were abstracted from these articles. Meta-analysis compared 30-day mortality between right and left pneumonectomy with a fixed-effects model. Comparison between 30-day and 90-day mortalities was also performed.
RESULTS
The search strategy yielded 27 studies. Overall, 30-day and 90-day perioperative mortalities were 7% and 12%, respectively. Among 15 studies providing side-specific 30-day mortality, cumulative mortalities were 11% and 5% for right and left pneumonectomies, respectively. In the meta-analysis that included 10 studies, 30-day mortality for right pneumonectomy remained greater than for left pneumonectomy (odds ratio, 1.97; 95% confidence interval, 1.11-3.49; P = .02). Among 6 studies providing side-specific 90-day mortality, cumulative mortalities were 20% and 9% for right and left pneumonectomies, respectively. In the meta-analysis that included 4 studies, 90-day mortality for right pneumonectomy was greater than for left pneumonectomy (odds ratio, 2.01; 95% confidence interval, 1.09-3.72; P = .03). Among 11 studies providing both 30-day and 90-day mortalities, mortality difference was 5% (95% confidence interval, 4%-7%, P < .0001). Pulmonary complications were the most common cause of 30-day and 90-day deaths.
CONCLUSIONS
Right pneumonectomy is associated with significantly higher 30-day and 90-day mortalities after neoadjuvant therapy than left pneumonectomy. Also, 90-day mortality for all pneumonectomies appears to be greater than expected, suggesting that the 30-day mortality figure may inadequately assess the perioperative mortality.
Topics: Carcinoma, Non-Small-Cell Lung; Humans; Lung Neoplasms; Neoadjuvant Therapy; Pneumonectomy; Time Factors
PubMed: 22056364
DOI: 10.1016/j.jtcvs.2011.09.002 -
Journal of the Royal Society of Medicine Feb 2011There is a resurgence of interest in lung-sparing extirpative surgery for malignant pleural mesothelioma with recent reports of better survival and fewer adverse... (Review)
Review
OBJECTIVES
There is a resurgence of interest in lung-sparing extirpative surgery for malignant pleural mesothelioma with recent reports of better survival and fewer adverse consequences than with extrapleural pneumonectomy. However, these operations are not well-characterized and to offer evidence-based clinical recommendations and to plan future trials a summary of what is already known is required.
DESIGN
A formal literature search was performed and all recovered titles were sequentially sifted by title, abstract and full-text reading according to prespecified criteria. Papers were selected if they contained data relevant to the area of enquiry. Quantitative synthesis and textual analysis, appropriate to the material, were performed.
SETTING
Follow-up studies of patients undergoing surgery for malignant pleural mesothelioma in specialist thoracic or cardiothoracic units.
PARTICIPANTS
Among the operated patients described in these papers, a total of 1270 patients had undergone lung-sparing surgery for mesothelioma.
RESULTS
There were no randomized trials or other forms of controlled studies. From 464 titles, 26 papers contained sufficient data on 1270 patients to be included in the systematic review. Operative descriptions for all series were extracted and tabulated and variation was found in the nature of surgery within and between series, and the degree of detail with which it was described. There was more operative detail in recent papers. All available numerical data were extracted, tabulated and summarized using quantitative methods. The average survival at 1, 2, 3, 4 and 5 years was 51%, 26%, 16%, 11% and 9%, respectively. There were no data on patients' performance status, symptomatic change, or other patient reported outcomes.
CONCLUSIONS
In the absence of any form of control data, no conclusions can be drawn concerning survival differences or symptomatic benefits attributable to surgery. As mesothelioma surgery is restricted to a selected minority of patients who often have multiple therapies, future research will require controlled studies with explicit definitions of the clinical and surgical intent.
Topics: Humans; Lung; Mesothelioma; Pleura; Pleural Neoplasms; Pneumonectomy; Treatment Outcome
PubMed: 21282797
DOI: 10.1258/jrsm.2010.100345 -
Zhongguo Fei Ai Za Zhi = Chinese... Sep 2019Lung is the most common metastatic site for tumors other than the liver. Pulmonary metastasectomy is also one of the common operations in thoracic surgery. However, the... (Review)
Review
Lung is the most common metastatic site for tumors other than the liver. Pulmonary metastasectomy is also one of the common operations in thoracic surgery. However, the effect of pulmonary metastasectomy is controversial. As far as the current experience is concerned, patients with pulmonary metastases with long disease free interval, low-grade malignant tumor and complete excision have the greatest benefit from metastasectomy. This review is about the progress of surgical treatment of pulmonary metastases. .
Topics: Humans; Lung Neoplasms; Pneumonectomy
PubMed: 31526461
DOI: 10.3779/j.issn.1009-3419.2019.09.04 -
The Journal of Surgical Research May 2017Although commonly performed in adult swine, unilateral pneumonectomy in piglets requires significant modifications in the surgical approach and perioperative care...
BACKGROUND
Although commonly performed in adult swine, unilateral pneumonectomy in piglets requires significant modifications in the surgical approach and perioperative care because of their smaller size and limited physiological reserve.
METHODS
Nineteen neonatal piglets underwent a left pneumonectomy. They were allowed 5-7 d of preoperative acclimation and nutritional optimization. Preoperative weight gain and laboratory values were obtained before the time of surgery. A "ventro-cranial" approach is adopted where components of the pulmonary hilum were sequentially identified and ligated, starting from the most ventral and cranial structure, the superior pulmonary vein. The principle of gentle ventilation was followed throughout the entire operation.
RESULTS
The median age of the piglets at the time of surgery was 12 (10-12) d. The median preoperative weight gain and albumin level were 20% (16-26%) and 2.3 (2.1-2.4) g/dL, respectively. The median operative time was 59 (50-70) min. Five of the first nine piglets died from complications, two from poor preoperative nutritional optimization (both with <10% weight gain and 2 g/dL for albumin), one from an intubation complication, one from intra-operative bleeding, and one in the postoperative period from a ruptured bulla. No mortality occurred for the next 10 cases.
CONCLUSIONS
Successful outcomes for unilateral pneumonectomy in piglets require special attention to preoperative nutritional optimization, gentle ventilation, and meticulous surgical dissection. Preoperative weight gain and albumin levels should be used to identify appropriate surgical candidates. The "ventro-cranial" approach allows for a technically straightforward completion of the procedure.
Topics: Animals; Female; Models, Animal; Perioperative Care; Pneumonectomy; Swine
PubMed: 28550900
DOI: 10.1016/j.jss.2017.01.010 -
The Journal of Thoracic and... Sep 2020
Topics: Carcinoma, Non-Small-Cell Lung; Humans; Lung Neoplasms; Pneumonectomy; Propensity Score; Robotic Surgical Procedures; Sutures
PubMed: 31926733
DOI: 10.1016/j.jtcvs.2019.11.129