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International Journal of Oncology Dec 2022Non‑small cell lung cancer (NSCLC) accounts for ~85% of lung cancer cases and has high morbidity and mortality rates. Over the past decade, treatment strategies for... (Review)
Review
Non‑small cell lung cancer (NSCLC) accounts for ~85% of lung cancer cases and has high morbidity and mortality rates. Over the past decade, treatment strategies for NSCLC have progressed rapidly, particularly with the increasing use of screening programs, leading to improvements in the initial diagnosis and treatment of early‑stage and preinvasive tumors. Surgical intervention remains the primary treatment for early‑stage NSCLC. Thoracoscopic lobectomy has become the main treatment for early‑stage NSCLC, as it results in less postoperative bleeding and pain and fewer complications. However, the complication rate for thoracoscopic lobectomy due to sputum retention and weakened respiratory muscle strength remains as high as 19‑59%. Treating NSCLC remains challenging in terms of postoperative pulmonary rehabilitation. In the present review, recent advances in postoperative pulmonary rehabilitation for patients with NSCLC were presented in order to assist researchers in developing improved treatments to enhance postoperative pulmonary rehabilitation for such patients.
Topics: Humans; Carcinoma, Non-Small-Cell Lung; Lung Neoplasms; Pneumonectomy; Thoracic Surgery, Video-Assisted; Length of Stay; Postoperative Complications; Retrospective Studies
PubMed: 36321778
DOI: 10.3892/ijo.2022.5446 -
Annals of Surgery Apr 2022We sought to quantify and characterize long-term consequences of pneumonectomy, with particular attention to nononcologic mortality.
OBJECTIVE
We sought to quantify and characterize long-term consequences of pneumonectomy, with particular attention to nononcologic mortality.
SUMMARY OF BACKGROUND DATA
Pneumonectomy is associated with profound changes in cardiopulmonary physiology. Studies of long-term outcomes after pneumonectomy typically report generalized measures, such as disease-free and overall survival.
METHODS
Patients undergoing lobectomy or pneumonectomy for lung cancer at our institution from 2000 to 2018 were reviewed. Propensity-score matching was performed for 12 clinicopathologic factors. Ninety-day complications and deaths were compared. Five-year cumulative incidence of oncologic and nononcologic mortality were compared using competing risks approaches.
RESULTS
From 3339 lobectomy and 355 pneumonectomy patients identified, we derived 318 matched pairs. At 90 days, rates of overall complications were similar (46% for pneumonectomy vs 43% for lobectomy; P = 0.40), but rates of major complications (21% vs 13%; P = 0.005) and deaths (6.9% vs 1.9%; P = 0.002) were higher the pneumonectomy cohort. The cumulative incidence of oncologic mortality was not significantly different between cohorts (P = 0.9584). However, the cumulative incidence of nononcologic mortality was substantially higher in the pneumonectomy cohort for both date of surgery and 1-year landmark analyses (P < 0.0001 and P = 0.0002, respectively). Forty-five pneumonectomy patients (18%) died of nononcologic causes 1-5 years after surgery; pneumonia (n = 21) and myocardial infarction (n = 10) were the most common causes. In pneumonectomy patients, preexisting cardiac comorbidity and low diffusion capacity of the lungs for carbon monoxide were predictive of nononcologic mortality.
CONCLUSIONS
Compared to lobectomy, excess mortality after pneumonectomy extends beyond 1 year and is driven primarily by nononcologic causes. Pneumonectomy patients require lifelong monitoring and may benefit from expeditious assessment and intervention at the initial signs of illness.
Topics: Humans; Lung Neoplasms; Pneumonectomy; Propensity Score; Retrospective Studies; Treatment Outcome
PubMed: 32541218
DOI: 10.1097/SLA.0000000000004065 -
European Respiratory Review : An... Sep 2013Surgery remains the best curative option in patients with early stage lung cancer (stage I and II). Developments in minimally invasive techniques now allow surgeons to... (Review)
Review
Surgery remains the best curative option in patients with early stage lung cancer (stage I and II). Developments in minimally invasive techniques now allow surgeons to perform lung resections on elderly patients, patients with poor pulmonary function or significant cardiopulmonary comorbidities. New techniques, such as stereotactic radiotherapy and ablative procedures, are being evaluated in early-stage lung cancer and may represent an alternative to surgery in patients unfit for lung resection. Perioperative mortality rates have dropped significantly at most institutions in the past two decades and complications are managed more efficiently. Progress in imaging and staging techniques have helped cut futile thoracotomy rates and offer patients the most adequate treatment options. Large randomised trials have helped clarify the role of neoadjuvant, induction and adjuvant chemotherapy, as well as radiotherapy. Surgery remains an essential step in the multimodality therapy of selected patients with advanced-stage lung cancer (stage III and IV). Interventional and endoscopic techniques have reduced the role of surgery in the diagnosis and staging of nonsmall cell lung cancer, but surgery remains an important tool in the palliation of advanced-stage lung cancer. Large national/international surgical databases have been developed and predictive risk-models for surgical mortality/morbidity published by learned surgical societies. Nonetheless, lung cancer overall survival rates remain deceptively low and it is hoped that early detection/screening, better understanding of tumour biology and development of biomarkers, and development of efficient targeted therapies will help improve the prognosis of lung cancer patients in the next decade.
Topics: Carcinoma, Non-Small-Cell Lung; Chemotherapy, Adjuvant; Early Detection of Cancer; Humans; Lung Neoplasms; Neoadjuvant Therapy; Neoplasm Staging; Pneumonectomy; Predictive Value of Tests; Radiotherapy, Adjuvant; Risk Factors; Time Factors; Treatment Outcome
PubMed: 23997065
DOI: 10.1183/09059180.00003913 -
Journal of Cancer Research and... 2011Pneumonectomy is done in patients with operable bronchogenic cancer and intractable end-stage lung diseases such as tuberculosis and bronchiectasis. It is often followed... (Review)
Review
Pneumonectomy is done in patients with operable bronchogenic cancer and intractable end-stage lung diseases such as tuberculosis and bronchiectasis. It is often followed by postoperative complications with an incidence of 20-60%. Factors influencing the incidence and type of complication after lung resection include age, physical status, and procedure. Many of these complications are life threatening and require appropriate immediate management. Therefore, the knowledge of diverse radiologic appearances of these complications and familiarity with the clinical settings in which specific complications are likely to occur are vital for prompt and effective treatment. This pictorial review intends to educate the radiologists and clinicians regarding early detection of these complications.
Topics: Diagnostic Imaging; Humans; Lung Neoplasms; Pneumonectomy; Postoperative Complications
PubMed: 21546734
DOI: 10.4103/0973-1482.80426 -
Annals of the Royal College of Surgeons... Mar 2024There is a paucity of data on the optimal management of oesophagopleural fistula (OPF) following pneumonectomy. The current published literature is limited to case...
INTRODUCTION
There is a paucity of data on the optimal management of oesophagopleural fistula (OPF) following pneumonectomy. The current published literature is limited to case reports and small case series. Although rare, OPF can have a significant impact on both the morbidity and mortality of patients.
METHODS
Two cases of OPF managed at our institution were reported. A systematic review was then conducted in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance concerning OPF following pneumonectomy. Demographic, operative and management data were analysed.
FINDINGS
Systematic review-identified data pertaining to 59 patients from 31 papers was collated. Median patient age was 59.5 years with pneumonectomy performed typically for malignancy (68%) or tuberculosis (19%). Median time from pneumonectomy to a diagnosis of OPF was 12.5 months. Twenty-five per cent of the patients had a synchronous bronchopleural fistula. Management of OPF in this setting is heterogenous. Conservative management was often reserved for asymptomatic or unfit patients. The remainder underwent endoscopic or surgical correction of the fistulae or a combination of the two with varying outcomes. Median follow-up was 18 months. All-cause mortality was 31% (18/59) with a median duration from pneumonectomy to death of 35 days (range 1-1,095).
CONCLUSIONS
Major heterogeneity of management for this rare complication hinders the introduction of standardised guidance of post-pneumonectomy OPF. Surgical and endoscopic intervention is feasible and can be successful in specialist centres. Adopting an multidisciplinary team approach involving both oesophagogastric and thoracic surgery teams and the introduction of a registry database of postoperative complications are likely to yield optimal outcomes.
Topics: Humans; Conservative Treatment; Databases, Factual; Fistula; Pneumonectomy; Postoperative Complications
PubMed: 37642088
DOI: 10.1308/rcsann.2023.0053 -
Annals of Thoracic and Cardiovascular... Jun 2019Pulmonary metastases are a sign of advanced malignancy and an omen of poor prognosis. Once primary tumors metastasize, they become notoriously difficult to treat and... (Review)
Review
Pulmonary metastases are a sign of advanced malignancy and an omen of poor prognosis. Once primary tumors metastasize, they become notoriously difficult to treat and interdisciplinary management often involves a combination of chemotherapy, radiotherapy, and surgery. Over the last 25 years, the emerging body of evidence has recognized the curative potential of pulmonary metastasectomy. Surgical resection of pulmonary metastases is now commonly considered for patients with controlled primary disease, absence of widely disseminated extrapulmonary disease, completely resectable lung metastases, sufficient cardiopulmonary reserve, and lack of a better alternative systemic therapy. Since the development of these selection criteria, other prognostic factors have been proposed to better predict survival and optimize the selection of surgical candidates. Disease-free interval (DFI), completeness of resection, surgical approach, number and laterality of lung metastases, and lymph node metastases all play a dynamic role in determining patient outcomes. There is a definite need to continue reviewing these prognosticators to identify patients who will benefit most from pulmonary metastasectomy and those who should avoid unnecessary loss of lung parenchyma. This literature review aims to explore and synthesize the last 25 years of evidence on the long-term survival, prognostic factors, and patient selection process for pulmonary metastasectomy.
Topics: Disease Progression; Disease-Free Survival; Forecasting; History, 20th Century; History, 21st Century; Humans; Lung Neoplasms; Metastasectomy; Pneumonectomy; Risk Factors
PubMed: 30971647
DOI: 10.5761/atcs.ra.18-00229 -
Thoracic Cancer Mar 2023Sleeve lobectomy is recommended to avoid pneumonectomy and preserve pulmonary function in patients with central lung cancer. However, the relationship between...
BACKGROUND
Sleeve lobectomy is recommended to avoid pneumonectomy and preserve pulmonary function in patients with central lung cancer. However, the relationship between postoperative pulmonary functional loss and resected lung parenchyma volume has not been fully characterized. The aim of this study was to evaluate the relationship between pulmonary function and lung volume in patients undergoing sleeve lobectomy or pneumonectomy.
METHODS
A total of 61 lung cancer patients who had undergone pneumonectomy or sleeve lobectomy were analyzed retrospectively. Among them, 20 patients performed pulmonary function tests, including vital capacity (VC) and forced expiratory volume in 1 s (FEV1) tests, preoperatively and then about 6 months after surgery. VC and FEV1 ratios were calculated (measured postoperative respiratory function/predicted postoperative respiratory function) as the standardized pulmonary functional loss ratio.
RESULTS
Thirty-day operation-related mortality was significantly lower after sleeve lobectomy (3.2%) than pneumonectomy (9.6%). The 5-year relapse-free survival rate was 46.67% versus 29.03%, and the 5-year overall survival rate was 63.33% versus 38.71% in patients receiving sleeve lobectomy versus pneumonectomy. The VC ratio in the pneumonectomy group was better than in the sleeve lobectomy group (1.003 ± 0.117 vs. 0.779 ± 0.12; p = 0.0008), as was the FEV1 ratio (1.132 ± 0.226 vs. 0.851 ± 0.063; p = 0.0038).
CONCLUSIONS
Both short-term and long-term outcomes were better with sleeve lobectomy than pneumonectomy. However, actual postoperative pulmonary function after pneumonectomy may be better than clinicians expect, and pneumonectomy should still be considered a treatment option for patients with sufficient pulmonary reserve and in whom sleeve lobectomy is less likely to be curative.
Topics: Humans; Carcinoma, Non-Small-Cell Lung; Pneumonectomy; Lung Neoplasms; Retrospective Studies; Neoplasm Recurrence, Local; Lung
PubMed: 36727556
DOI: 10.1111/1759-7714.14813 -
The Journal of Thoracic and... Jul 2020Mortality rates of 5% to 10% after pneumonectomy have remained constant during the last decade. To understand the patterns of outcomes after pneumonectomy, we...
OBJECTIVES
Mortality rates of 5% to 10% after pneumonectomy have remained constant during the last decade. To understand the patterns of outcomes after pneumonectomy, we investigated the time-varying risks of readmission and death during the first postoperative year and examined the contributions of specific causes to these patterns over time.
METHODS
We retrospectively reviewed all pneumonectomies for lung cancer at our institution from 2000 to 2018. The time-varying instantaneous risk of all-cause readmission and mortality up to 1 year after pneumonectomy was estimated using parametric analyses and was repeated for each primary cause of readmission (oncologic, infectious, pulmonary, cardiac, or other) and death (oncologic or nononcologic).
RESULTS
In our cohort of 355 patients who underwent pneumonectomy, risk of readmission was highest immediately after discharge and was halved by 14 days. This risk reached a nadir and remained constant from 4 to 8 months, after which it gradually increased. Pulmonary causes accounted for most readmissions within 90 days, after which oncologic causes predominated. Likewise, the overall risk of death was highest immediately after surgery, was halved by 7 days, reached a nadir at 90 days, and then increased throughout the remainder of the first year. All deaths during the first 90 days after surgery were due to nononcologic causes.
CONCLUSIONS
Nononcologic causes of readmission and death predominate in the first 90 days after pneumonectomy, after which oncologic causes prevail. We also identify specific causes that pose the highest risk of readmission immediately after discharge. Efforts are warranted to define the effects of specific causes of readmission on overall mortality after pneumonectomy.
Topics: Aged; Female; Humans; Lung Neoplasms; Male; Middle Aged; Patient Readmission; Pneumonectomy; Postoperative Complications; Retrospective Studies; Treatment Outcome
PubMed: 32249082
DOI: 10.1016/j.jtcvs.2020.02.086 -
Advances in Respiratory Medicine 2020Nonsurgical approaches involving bronchoscopic lung volume reduction (BLVR) have been developed in the last decade. One of these, the BLVR coil procedure, is a treatment... (Review)
Review
Nonsurgical approaches involving bronchoscopic lung volume reduction (BLVR) have been developed in the last decade. One of these, the BLVR coil procedure, is a treatment option for patients with homogeneous and heterogeneous end-stage emphysema and a forced expiratory volume in 1 second (FEV1) of 15-45%. This treatment decreases hyperinflation and improves lung function, the quality of life, and exercise capacity. It is very important to prepare patients for treatment, premedications, anesthesia applications, intubation, post-procedure follow-up and treatments. Further, it has been observed that various complications can develop during and after the procedure. Generally, the observed and reported complications are chronic obstructive pulmonary disease (COPD) exacerbation, chest pain, mild bleeding, pneumonia, pneumothorax, and respiratory failure. Rarely, aspergillus cavitation (coil-related aspergilloma), bronchopleural fistula and penetration into the pleural space, bronchiectasis, coil-associated inflammatory response and opacities, and hiccups are observed. Common complications are usually mild or moderate, while the rare ones can be life-threatening (except hiccup), so early diagnosis and treatment are necessary. However, patients treated with BLVR have lower mortality rates than untreated patients with similar morbidity. Based on the findings of this review, we can estimate that premedication one day before and just before the procedure may reduce potential complications. Some medical centers apply and recommend 30-day macrolide treatment after the procedure. New generation supraglottic devices may be preferred to avoid complications due to endotracheal intubation. Moreover, further research is needed to identify risk factors, prevent potential complications, and a common consensus is required for routine preventive treatment.
Topics: Humans; Pneumonectomy; Pneumonia; Pulmonary Emphysema; Quality of Life; Respiratory Function Tests
PubMed: 33169816
DOI: 10.5603/ARM.a2020.0152 -
Revista Da Associacao Medica Brasileira... 2010This study intends to review the literature on the efficacy, safety and feasibility of lung volume reduction surgery (LVRS) in patients with advanced emphysema. Studies... (Review)
Review
This study intends to review the literature on the efficacy, safety and feasibility of lung volume reduction surgery (LVRS) in patients with advanced emphysema. Studies on LVRS from January 1995 to December 2009 were included by using Pubmed (MEDLINE) and Cochrane Library literature in English. Search words such as lung volume reduction surgery or lung reduction surgery, pneumoplasty or reduction pneumoplasty, COPD or chronic obstructive pulmonary disease and surgery, were used. We also compared medical therapy and surgical technique. Studies consisting of randomized controlled trials, controlled clinical trials (randomized and nonrandomized), reviews and case series were analyzed. Questions regarding validity of the early clinical reports, incomplete follow-up bias, selection criteria and survival, confounded the interpretation of clinical data on LVRS. Patients with upper, lower and diffuse distribution of emphysema were included; we also analyzed as key points perioperative morbidity and mortality and lung function measurement as FEV1. Bullous emphysema was excluded from this review. Surgical approach included median sternotomy, unilateral or bilateral thoracotomy, and videothoracoscopy with stapled or laser ablation. Results of prospective randomized trials between medical management and LVRS are essential before final assessment can be established.
Topics: Humans; Pneumonectomy; Preoperative Care; Pulmonary Disease, Chronic Obstructive; Pulmonary Emphysema
PubMed: 21271143
DOI: 10.1590/s0104-42302010000600025