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Management of the irradiated bronchus after lobectomy for lung cancer.

BACKGROUND: Radiation effects make operative dissection difficult, impair subsequent healing, and increase morbidity. This study evaluates tissue reinforcement of the irradiated bronchus as a modality to reduce morbidity after lobectomy for lung cancer. METHODS: We retrospectively reviewed all patients who had preoperative radiotherapy before lobectomy for lung cancer between May 1977 and June 2000. RESULTS: There were 56 patients (33 men and 23 women) who ranged in age from 42 to 80 years (median, 59 years). Bronchial stump reinforcement included no coverage in 24 patients (42.8%), mediasti

Exploring the Impact of the Obesity Paradox on Lung Cancer and Other Malignancies.

There is a paradoxical relationship between obesity, as measured by BMI, and many types of cancer, including non-small-cell lung cancer. Obese non-small-cell lung cancer patients have been shown to fare better than their non-obese counterparts. To analyze the multifaceted effects of obesity on oncologic outcomes, we reviewed the literature on the obesity paradox, methods to measure adiposity, the obesity-related derangements in immunology and metabolism, and the oncologic impact of confounding variables such as gender, smoking, and concomitant medications such as statins and metformin. We anal

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… The impact of preoperative body mass index on respiratory complications after pneumonectomy for non-small-cell lung cancer. Results from a series of 154 consecutive standard pneumonectomies. Eur. J. Cardio-Thorac. Surg. 2011;39:738–744. doi: 10.1016/j.ejcts.2010.09.007. 116. …

[Long-term survival of personalized surgical treatment of locally advanced non-small cell lung cancer based on molecular staging].

BACKGROUND AND OBJECTIVE: Approximately 35%-40% of patients with newly diagnosed non-small cell Lung cancer have locally advanced disease. T … tery reconstruction combined with reconstruction of aorta sheath was carried out in 10 cases; Right pneumonectomy combined with resection and reconstruction partial left atrium, total right diaphragm with Dacron, and post cava and right liver vein was performed in one case; Lobectomy combined with resection and reconstruction of carina was carried out in 10 cas …

Malignant mesothelioma tumours: molecular pathogenesis, diagnosis, and therapies accompanying clinical studies.

The pathetic malignant mesothelioma (MM) is a extremely uncommon and confrontational tumor that evolves in the mesothelium layer of the pleural cavities (inner lining- visceral pleura and outer lining- parietal pleura), peritoneum, pericardium, and tunica vaginalis and is highly resistant to standard treatments. In mesothelioma, the predominant pattern of lesions is a loss of genes that limit tumour growth. Despite the worldwide ban on the manufacture and supply of asbestos, the prevalence of mesothelioma continues to increase. Mesothelioma presents and behaves in a variety of ways, making dia

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… Extra pleural pneumonectomy (EPP), which removes the diseased pleura and lung as well as the pericardium and half of the diaphragm, or radical pleurectomy/decortication (P/D) are the two surgical options for patients eligible for macroscopic surgery ( 9 ). … Pneumonectomy decortication (P/D) or extrapleural pneumonectomy (EPP) were other names for the procedure. In the 1970s, this procedure was performed to treat mesothelioma, cancer caused by asbestos exposure. …

Loss of Muscle Mass is a Novel Predictor of Postoperative Early Recurrence in N2-Positive Non-Small-Cell Lung Cancer.

BACKGROUND: We often experienced early recurrence in patients with completely resected N2-positive non-small-cell lung cancer (NSCLC). Loss of muscle mass is a poor prognostic factor in patients with several stages of NSCLC. This study aimed to investigate the relationship between preoperative loss of muscle mass and postoperative early recurrence in patients with N2-positive NSCLC. METHODS: We retrospectively analyzed 47 male patients with completely resected pathological N2-positive NSCLC. Early recurrence was defined as that diagnosed within 1 year after the operation. We used the L3 muscl

The long-term survival of robotic lobectomy for non-small cell lung cancer: A multi-institutional study.

OBJECTIVE: Our objective is to report the world's largest series with the longest follow-up of robotic lobectomy for non-small cell lung cancer (NSCLC). METHODS: This was a multi-institutional retrospective review of a consecutive series of patients from 4 institutions' prospective robotic databases. RESULTS: There were 1339 patients (men 55%, median age 68 years). The median operative time was 136 minutes, median number of lymph nodes was 13 (5 N2 stations and 1 N1), median blood loss was 50 cc, and 4 (0.005%) patients received intraoperative transfusions. Conversions occurred in 116 patien

Outcome of infants operated on for congenital pulmonary malformations.

INTRODUCTION: Patients operated on for congenital pulmonary malformations (CPM) have excellent survival rates, but little is known about long-term morbidity. Our aim is to report the sequelae in patients operated on for CPM in infancy and to define factors that may influence their outcome. METHODS: All patients operated on for major congenital anomalies are followed in a dedicated outpatient program and evaluated at 6, 24, and 48 months of life (corrected for gestational age) and at school age at 4, 6, 8, and 12 years of life. The data are prospectively collected. Patients operated on for CPM

Outcomes and prognostic factors of non-small-cell lung cancer with lymph node involvement treated with induction treatment and surgical resection.

OBJECTIVES: Induction therapy (IT) has gained popularity in recent years, becoming a standard of treatment in resectable lymph node-positive NSCLC. IT aims to downstage the disease (shrinkage of tumour and clearance of lymph node-metastases), clear distant micrometastases and prolong survival. Potential disadvantages are increased morbidity and/or mortality after surgery and risk of progression of disease that could have been initially resected. The purpose of this study was to evaluate the outcomes and prognostic factors in a series of patients with lymph node-positive NSCLC receiving IT foll

Prior thoracoscopic surgery may improve reoperative pulmonary resection.

OBJECTIVES: although video-assisted thoracoscopic surgery for pulmonary resection appears to be associated with more favorable postoperative outcomes than thoracotomy, no reports have discussed its benefit at subsequent reoperative pulmonary resection. METHODS: between January 2000 and December 2009, 144 patients underwent reoperative pulmonary resections for benign and malignant nodules at the Mayo Clinic, Rochester. Their data were evaluated retrospectively. Twenty-three (16%) patients had prior video-assisted thoracoscopic surgery, and 121 (84%) had undergone a prior open thoracotomy. Intr

Ten cases of resected solitary pulmonary metastases arising from gastric cancer.

BACKGROUND: Because carcinomatous lymphangitis and carcinomatous pleuritis are the usual forms of metastasis associated with gastric cancer, resection of solitary pulmonary metastases arising from gastric cancer is rarely performed. To clarify the characteristics of pulmonary metastases from gastric cancer, we investigated patients who underwent resection of metastatic solitary lung tumors arising from gastric cancer. METHODS: Between October 2003 and October 2012, 10 patients underwent pulmonary metastasectomy for metastatic gastric cancer at our institution. We retrospectively evaluated fea

Benefits of rib head resection via costotransverse ligament release method for T3 lung cancer in the paravertebral space.

OBJECTIVE: Lung cancer located in the paravertebral region occasionally invades the rib head (T3) and not the spine (T4). In such cases, a costotransverse ligament release (CTLR) method may be useful for complete resection without performing a vertebrectomy. METHODS: Eighteen patients with lung cancer underwent chest wall resection between 2001 and 2009 at our institutions. Of those, 7 who underwent chest wall removal with rib head resection via a CTLR method (group A) and 11 without rib head resection(conventional distal rib resection, group B) were retrospectively analyzed. RESULTS: Three

Pericardial fat pad tissue produces angiogenic factors for healing the bronchial stump.

Maintaining blood flow in and supplying various anti-inflammatory or angiogenic cytokines to the bronchial stump are very important factors involved in its healing. Pericardial fat pad tissue samples surgically obtained from 20 patients were assessed, and their angiogenic ability was investigated. The messenger RNA level of all angiogenic cytokines, including vascular endothelial growth factor, fibroblast growth factor-2 (FGF-2), platelet-derived growth factor-A (PDGF-A), angiopoietin-1 (Ang-1), Ang-2 and hepatocyte growth factor (HGF) were detected in the pericardial fat pad tissue. The prote

The maximum standardized 18F-fluorodeoxyglucose uptake on positron emission tomography predicts lymph node metastasis and invasiveness in clinical stage IA non-small cell lung cancer.

In patients with clinical stage IA non-small cell lung cancer (NSCLC), we investigated whether the maximum standardized uptake value (SUVmax) of 18F-fluorodeoxyglucose (FDG) by the tumor correlated with lymph node metastasis, intratumoral lymphatic and vascular invasion of tumor cells, and pleural invasion. From April 2005 to November 2008, 58 patients underwent a lobectomy with systematic hilar and mediastinal lymph node dissection for clinical stage IA NSCLC. All patients had integrated FDG-positron emission tomography (PET)/computed tomography (CT) performed in our center as part of the pre

Mediastinoscopy might not be necessary in patients with non-small cell lung cancer with mediastinal lymph nodes having a maximum standardized uptake value of less than 5.3.

OBJECTIVE: Accurate pretreatment staging in non-small cell lung cancer remains tantamount in formulating an appropriate treatment plan. The maximum standardized uptake value obtained with integrated fluorodeoxyglucose-positron emission tomography/computed tomography has been proposed to be a predictor of malignancy in mediastinal lymph nodes. A recent study has also suggested that accuracy of integrated fluorodeoxyglucose-positron emission tomography/computed tomography might be improved by increasing the maximum standardized uptake value used for calling a lymph node positive from 2.5 to 5.3.

Autologous fibrin sealant reduces the incidence of prolonged air leak and duration of chest tube drainage after lung volume reduction surgery: a prospective randomized blinded study.

OBJECTIVE: Prolonged air leak is reported in up to 50% of patients after lung volume reduction surgery. The effect of an autologous fibrin sealant on the intensity and duration of air leak and on the time to chest drain removal after lung volume reduction surgery was investigated in a randomized prospective clinical trial. METHODS: Twenty-five patients underwent bilateral thoracoscopic lung volume reduction surgery. In each patient, an autologous fibrin sealant was applied along the staple lines on one side, whereas no additional measure was taken on the other side. Randomization of treatment

Prediction of prognosis and surgical indications for pulmonary metastasectomy from colorectal cancer.

BACKGROUND: Treatment of pulmonary metastases from colorectal cancer by excision has increased rapidly, but reports on indications and prognostic factors are inconsistent. We sought to identify poor prognostic factors preoperatively and to retrospectively evaluate preoperative clinical indications for surgery. METHODS: A total of 75 patients with colorectal cancer had pulmonary metastases excised from 1986 to 2003. Tumor size, number, laterality, hilar or mediastinal lymphadenopathy, and carcinoembryonic antigen level were possible risk factors for metastatic tumors, with primary site of colo

[Surgical treatment of non-small cell lung cancer with mediastinal node invasion. A retrospective study].

OBJECTIVE: To analyze the survival of patients classified as N2M0 (N2 by cytohistology) with non-small cell lung cancer treated by surgical resection of the primary tumor and lymphadenectomy. PATIENTS AND METHODS: Among 1043 consecutive patients with lung cancer who were considered for surgery between 1990 and 2000, 155 were classified N2M0 by histology. Surgical exeresis of the primarily pulmonary tumor and lymphadenectomy were performed in 116 patients of the 130 patients who underwent thoracotomy. Among the 116 N2M0 patients undergoing surgical resection, 23 were diagnosed N2c(C3) by media

Chest and Mediastinum

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… pulmonary embolism, tumour-related narrowing of the pulmonary artery Disorders of ventilation: Congenital lobar emphysema Bronchial occlusion by mucus Foreign body Central mass Swyer-James syndrome Bronchiolitis obliterans Defects of the lung parenchyma: Bullae Compensatory hyperinflation such as after pneumonectomy … Fig. 19.36 ) , after pneumonectomy with compensatory hyperinflation of the remaining lung and fibrous tissue in the affected side. Rarely, a unilateral lymphangitis carcinomatosa is seen with reduced volume. Fig. 19.36 Atelectasis. …

Video-assisted thoracoscopic surgery for lung cancer after induction therapy.

Background Although thoracoscopic surgery is widely performed for early-stage lung cancer, only a few small studies have evaluated the role of video-assisted thoracoscopic surgery in patients with locally advanced lung cancer who had received preoperative chemotherapy. Methods Among 1655 patients who underwent anatomical lung resection for lung cancer between January 2009 and December 2014 in our institution, we retrospectively examined the short- and long-term outcomes of 110 (6.6%) who had undergone induction therapy. Thoracoscopic surgery was performed in 79 of these patients and thoracotom