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Cleveland Clinic Journal of Medicine May 2012Lung resection provides the greatest likelihood of cure for patients with localized lung cancer, but is associated with a risk of mortality, decreased postoperative lung... (Review)
Review
Lung resection provides the greatest likelihood of cure for patients with localized lung cancer, but is associated with a risk of mortality, decreased postoperative lung function, and other complications. Lung function testing using spirometry, diffusing capacity of the lung for carbon monoxide, and peak oxygen consumption helps predict the risk of postoperative complications including mortality. Predicting postoperative lung function using the proportion of lung segments to be resected, radionuclide scanning, or other methods is important for assessing surgical risk. The American College of Chest Physicians, the European Respiratory Society/European Society of Thoracic Surgeons and the British Thoracic Society guidelines provide detailed algorithms for preoperative risk assessment, but their recommended approaches differ somewhat. Smoking cessation and pulmonary rehabilitation are perioperative measures that can improve patients' the short- and long-term outcomes.
Topics: Contraindications; Guidelines as Topic; Humans; Lung Neoplasms; Pneumonectomy; Postoperative Complications; Predictive Value of Tests; Preoperative Care; Respiratory Function Tests; Risk Assessment
PubMed: 22614960
DOI: 10.3949/ccjm.79.s2.04 -
The Journal of Thoracic and... Feb 2001Tracheal sleeve pneumonectomy, although technically demanding, is considered the choice for tracheobronchial angle cancers. Complications in our 49 tracheal sleeve... (Review)
Review
OBJECTIVES
Tracheal sleeve pneumonectomy, although technically demanding, is considered the choice for tracheobronchial angle cancers. Complications in our 49 tracheal sleeve pneumonectomies are reviewed. Results, complications, and technical aspects are critically discussed. Although series in the literature differ in selection of patients and surgical techniques and extend over long periods, we attempt to compare our experience with results from the literature.
METHODS
From 1983 to September 1999, 60 patients eligible for tracheal sleeve pneumonectomy after conventional staging underwent operation. A Sybilla Fome-Cuf ventilation tube (Bivona, Inc, Gary, Ind) was used starting in 1987 to facilitate anastomosis. Since 1993, all patients have undergone video-assisted thoracoscopy immediately before the operation.
RESULTS
There were 11 (18.3%) exploratory thoracotomies, 48 right tracheal sleeve pneumonectomies, and 1 left tracheal sleeve pneumonectomy. Among the tracheal sleeve pneumonectomies, we recorded 4 (8.2%) perioperative deaths (myocardial infarction, n = 1; heart failure, n = 1; pulmonary edema, n = 1; gastric ulcer hemorrhage, n = 1; and anastomotic fistula in a patient who received high-dose radiation before the operation, n = 1). We observed 5 (10.2%) complications (lung edema, n = 1; transitory recurrent nerve palsy, n = 2; empyema without fistula cured conservatively, n = 1; and pneumonia, n = 1). Anastomotic stenosis did not occur. Twenty-six (53%) patients are alive 14 to 87 months postoperatively, 12 (24.5%) of these more than 5 years postoperatively. Five (10.2%) died of mediastinal recurrence at 6 and 54 months. Two others (4.1%) died in road accidents.
CONCLUSIONS
Tracheal sleeve pneumonectomy is a demanding operation with a high risk of complications. Analysis of literature and personal experience shows that complications can be greatly reduced through accurate selection of patients, precise technique, and optimal postoperative care. Long-term survival equals that obtained after standard pneumonectomy.
Topics: Adenocarcinoma; Carcinoma, Adenoid Cystic; Carcinoma, Large Cell; Carcinoma, Squamous Cell; Humans; Lung Neoplasms; Pneumonectomy
PubMed: 11174728
DOI: 10.1067/mtc.2001.111970 -
The Journal of Thoracic and... Apr 2016
Topics: Female; Humans; Male; Pneumonectomy; Tachycardia, Supraventricular
PubMed: 26778382
DOI: 10.1016/j.jtcvs.2015.11.061 -
The Annals of Thoracic Surgery May 2010
Topics: Antifungal Agents; Female; Humans; Male; Pneumonectomy; Pulmonary Aspergillosis; Severity of Illness Index; Survival Analysis; Treatment Outcome
PubMed: 20417787
DOI: 10.1016/j.athoracsur.2010.03.005 -
Interactive Cardiovascular and Thoracic... Aug 2013A best evidence topic was written according to a structured protocol. The question addressed was whether dissection of the pulmonary ligament during an upper lobectomy... (Review)
Review
A best evidence topic was written according to a structured protocol. The question addressed was whether dissection of the pulmonary ligament during an upper lobectomy would result in improved outcomes. A total of 85 articles were found using the reported search, of which eight represented the best evidence to answer the clinical question. The authors, date, journal, study type, population, main outcome measures and results are tabulated. Reported measures were complications associated with dissection (atelectasis, bronchial stenosis, bronchial obstruction and bronchial deformation) and preservation (insufficient lung expansion, pooling of effusion and atelectasis) of the pulmonary ligament, ratio (%) of dead space in longitudinal axis (movement of nonoperated lobes), change in the angle (degrees) of main bronchus on the operated side, overall morbidity and mortality, overall survival and conversion rates. In a randomized control trial, the dissection of the pulmonary ligament revealed no significant difference in the dead space ratio or change in the angle of the main bronchus when compared with preservation. Dissection of the ligament, in theory, reduces the free space in the upper thorax by increasing the mobility of the residual lobes. Dissection of the ligament may lead to bronchial deformation, stenosis, obstruction or lobar torsion. Preservation of the ligament may prevent this complication by suppressing the upward movement of residual lobes. However, this may result in pleural effusion in the free thoracic space that may potentially become infected resulting in an empyema or bronchial fistula. Five large case series were analysed; three routinely dissected the pulmonary ligament and two did not. There was no observed difference in clinical outcomes between the two groups. There is no convincing evidence that dissection of the pulmonary ligament in an upper lobectomy significantly improves outcomes and reduces complications.
Topics: Benchmarking; Dissection; Evidence-Based Medicine; Female; Humans; Ligaments; Male; Middle Aged; Pneumonectomy; Postoperative Complications; Risk Factors; Treatment Outcome
PubMed: 23628653
DOI: 10.1093/icvts/ivt144 -
The Annals of Thoracic Surgery May 2009
Topics: Chest Tubes; Drainage; Equipment Design; Humans; Pneumonectomy; Thoracic Wall
PubMed: 19379901
DOI: 10.1016/j.athoracsur.2009.03.002 -
Future Oncology (London, England) Jun 2020
Topics: Evidence-Based Medicine; History, 20th Century; History, 21st Century; Humans; Lung Neoplasms; Patient Selection; Pneumonectomy; Practice Guidelines as Topic; Surgical Oncology; Thoracic Surgery, Video-Assisted
PubMed: 31849247
DOI: 10.2217/fon-2018-0755 -
Thoracic Cancer Feb 2021Uniportal video-assisted thoracoscopic surgery (VATS) is being more widely used in lung cancer, yet reports on its application in pneumonectomies are limited. This study...
BACKGROUND
Uniportal video-assisted thoracoscopic surgery (VATS) is being more widely used in lung cancer, yet reports on its application in pneumonectomies are limited. This study aimed to evaluate the safety and feasibility of uniportal video-assisted thoracoscopic left pneumonectomy for lung cancer.
METHODS
A series of 18 lung cancer patients who had received uniportal video-assisted thoracoscopic left pneumonectomies were included in the study. Their clinical, pathological, and surgical features, as well as postoperative recovery, were analyzed.
RESULTS
The majority of the patients were male and smokers and their average age was 62.0 ± 8.9 years. All had primary lung cancer, while three (16.7%) had received neoadjuvant therapy. A total of 16 (88.9%) patients had stage II-III disease, with an average tumor size of 3.6 ± 1.5 cm. The average surgery time was 137.4 ± 47.0 minutes, with a 16.7% (3/18) conversion rate. The mean blood loss was 37.5 ± 59.4 mL and no patients needed blood transfusion during, or after, surgery. There was no perioperative death and the overall complication rate was 22.2% (4/18). Two (11.1%) patients needed to stay in the intensive care unit after surgery, and the average length of hospital stay after surgery was 6.3 ± 1.1 days (range 4-7 days).
CONCLUSIONS
Uniportal video-assisted thoracoscopic left pneumonectomy is a safe and feasible procedure for selected lung cancer patients. The use of uniportal VATS in right pneumonectomies and the effect of uniportal video-assisted thoracoscopic pneumonectomy on the survival of patients merits further study. Patients receiving uniportal VATS pneumonectomies had standard surgical results and recovery. Uniportal VATS pneumonectomy is safe for properly selected lung cancer patients.
KEY POINTS
Significant findings of the study: • Patients receiving uniportal VATS left pneumonectomies had standard surgical results and recovery.
WHAT THIS STUDY ADDS
• Uniportal VATS left pneumonectomy is safe for properly selected lung cancer patients.
Topics: Adult; Aged; Female; Humans; Male; Middle Aged; Pneumonectomy; Retrospective Studies; Thoracic Surgery, Video-Assisted
PubMed: 33410290
DOI: 10.1111/1759-7714.13728 -
The Journal of Thoracic and... Nov 2014Although much is known regarding the importance of postoperative care, the surveillance of patients after 30 days from the surgical procedure can be improved. It must be...
Although much is known regarding the importance of postoperative care, the surveillance of patients after 30 days from the surgical procedure can be improved. It must be recognized that mortality between 30 and 90 days exceeds what is commonly considered "operative mortality"—death within 30 days of surgery. Significant effort should be dedicated to the design of predictive models to prevent readmission. More importantly, surgeons must develop better models to manage the complications that arise after readmission to prevent mortality in readmitted patients. Finally, current guidelines for oncologic surveillance are an area of controversy, and future studies are needed for better direction of resources.
Topics: Carcinoma, Non-Small-Cell Lung; Female; Humans; Lung Neoplasms; Male; Patient Readmission; Pneumonectomy; Postoperative Complications
PubMed: 25444180
DOI: 10.1016/j.jtcvs.2014.09.095 -
Zhongguo Fei Ai Za Zhi = Chinese... Jun 2016Thoracoscopic segmentectomy is technically much more meticulous than lobectomy, due to the complicated anotomical variations of segmental bronchi and vessels.... (Review)
Review
Thoracoscopic segmentectomy is technically much more meticulous than lobectomy, due to the complicated anotomical variations of segmental bronchi and vessels. Preoperative three-dimensional computed tomography bronchography and angiography, 3D-CTBA) could reveal the anatomical structures and variations of the segmental bronchi/vessels and locate the pulmonary nodules, which is helpful for surgery planning. Preoperative nodule localization is of vital importance for thoracoscopic segmentectomy. Techniques involved in this procedure include dissection of the targeted arteries, bronchus and intra-segmental veins, retention of the inter-segmental veins, identification of the inter-segmental boarder with the inflation-deflation method and seperation of intra-segmental pulmonary tissues by electrotome and/or endoscopic staplers. The incision margin for malignant nodules should be at least 2 cm or the diameter of the tumor. Meanwhile, sampling of N1 and N2 station lymph nodes and intraoperative frozen section is also necessary. The complication rate of thoracoscopic segmentectomy is comparatively low. The anatomic relationship between pulmonary segments and lobes is that a lobe consists of several irregular cone-shaped segments with the inter-segmental veins lies between the segments. Our center has explored a method to separate pulmonary segments from the lobe on the basis of cone-shaped principle, and we named it "Cone-shaped Segmentectomy". This technique could precisely decide and dissect the targeted bronchi and vessels, and anatomically separate the inter-segmental boarder, which ultimately achieve a completely anatomical segmentectomy.
Topics: Humans; Lung; Pneumonectomy; Thoracoscopy
PubMed: 27335301
DOI: 10.3779/j.issn.1009-3419.2016.06.16