Bronchial Stump Research Articles

Experience of the selection and maintainence for donor lung: 62 cases attached

Objective: To summarize the experience of selection and maintainence for the lungs from donation. Methods: From January 2015 to June 2016, 62 cases had been evaluated by Department of Thoracic Surgery, First Affiliated Hospital of Guangzhou Medical University. All the clinic data had been collected to evaluate the donor lungs, including the basic information, physical examination, results of radiology and laboratory, the bronchoscope, etc. All the satisfactory donors had been harvested and transplanted to the receipient and then follow up. Results: Forty cases of donor lung had been harvested from 62 cases. There were 31 male and 9 female cases with average age of 28.7 years. There were 34 cases form donation after brain death and 6 cases from donation after circulatory death. In addition, 8 cases which were considered to be the marginal donors became satisfied after the donor maintanence. The microbe in all 40 cases had been detected and the bacterial infection rate was 82.5% (33/40). The microbe below could be detected in the bronchial stump or lung tissue, including Klebsiella Pneumonia, Baumanii, Staphylococcus Aureus, Enterococcus Faecium, etc. In the end, 22 bilateral lung transplantations, 17 single lung transplantations, 1 heart-lung transplantation had been implemented successfully and the survival rate in the perioperative period was 90.0%. Conclusions: The utilization ratio of donation can be increased and the waste of medical resource in unacceptable donor can be reduced by the sufficient donor selection and maintanence. The participation of multi-department is needed in the process of donor selection and maintanence.

Thoracoscopic Lobectomy in Infants and Children Utilizing a 5 mm Stapling Device.

Purpose: Thoracoscopic lobectomy for congenital cystic lung disease has become an accepted and in many institutions the preferred technique. However, the technical challenges are many. Previous endoscopic staplers (12 mm) used commonly in adults are too large for use in infants This study evaluates the safety and efficacy of using a 5 mm stapling device to seal and divide major pulmonary structures.Methods: From July 2014 to March 2016, 26 patients of age 6 weeks to 13 months underwent thoracoscopic lobectomy for CPAM or sequestration. Weights ranged from 3.2 to 11.4 kg. There were 7 upper lobectomies, 2 middle, and 17 lower lobectomies. In each case, the 5 mm stapler (Justright Surgical; Louisville, Colorado) was the primary device for vessel and bronchial sealing and division. It is 4.8 mm in diameter with an anvil length of 25 mm and lays down four rows of staples and divides between them. A 3 mm sealing device was used for dissection and to take smaller segmental vessels as necessary. Stump lines were evaluated for bleeding or air leak in all cases.Results: All procedures were accomplished successfully thoracoscopically. The stapler was used on the main lobar artery cases and vein in 24 cases, a large systemic sequestration vessel in 5 cases, and the bronchus in all 26. The stapler was also used to complete the minor fissure in 1 case and the major fissure in 1 case. A total of 96 staple loads were fired. Operative times ranged from 35 to 135 minutes. There was no significant bleeding of any vascular stump. In 1 case, the edge of the bronchial stump had to be reinforced, this was thought to be secondary to too much tissue being enclosed in the jaws. There were no postoperative complications.Conclusion: The use of a 5 mm stapling device appears to be safe and effective in thoracoscopic lobectomy in infants. It allows for safe management of major pulmonary vessels and bronchi in the confined chest of an infant through a single 5 mm port.

Post-pneumonectomy bronchopleural fistula: complex surgical repair for a high mortality case

Post-pneumonectomy empyema and bronchopleural fistula are dreaded complications of thoracic surgery. The associated mortality and morbidity is very high. When treatment is delayed secondary complications are more likely and survival is adversely affected. These conditions require early diagnosis and a wellplanned multi-disciplinary team approach for effective management. We present a patient with post-pneumonectomy empyema and bronchopleural fistula following pneumonectomy for post tuberculosis destroyed lung. He underwent debridement of the empyema cavity, double layer closure of the bronchial stump and reinforcement with omental flap and pectoralis major flap was used to obliterate the space. Debridement and pedicle flaps are safe and effective in the definitive management of postpneumonectomy empyema and bronchopleural fistulae.

Post-pneumonectomy bronchopleural fistula: complex surgical repair for a high mortality case

Post-pneumonectomy empyema and bronchopleural fistula are dreaded complications of thoracic surgery. The associated mortality and morbidity is very high. When treatment is delayed secondary complications are more likely and survival is adversely affected. These conditions require early diagnosis and a wellplanned multi-disciplinary team approach for effective management. We present a patient with post-pneumonectomy empyema and bronchopleural fistula following pneumonectomy for post tuberculosis destroyed lung. He underwent debridement of the empyema cavity, double layer closure of the bronchial stump and reinforcement with omental flap and pectoralis major flap was used to obliterate the space. Debridement and pedicle flaps are safe and effective in the definitive management of postpneumonectomy empyema and bronchopleural fistulae.

Post-pneumonectomy bronchopleural fistula: complex surgical repair for a high mortality case

Post-pneumonectomy empyema and bronchopleural fistula are dreaded complications of thoracic surgery. The associated mortality and morbidity is very high. When treatment is delayed secondary complications are more likely and survival is adversely affected. These conditions require early diagnosis and a wellplanned multi-disciplinary team approach for effective management. We present a patient with post-pneumonectomy empyema and bronchopleural fistula following pneumonectomy for post tuberculosis destroyed lung. He underwent debridement of the empyema cavity, double layer closure of the bronchial stump and reinforcement with omental flap and pectoralis major flap was used to obliterate the space. Debridement and pedicle flaps are safe and effective in the definitive management of postpneumonectomy empyema and bronchopleural fistulae.

Reinforcing Effect of the New Synthetic Bioabsorbable Sealant (ADVASEAL^ ) for Bronchial Stumps after Pulmonary Resections in Pigs

Reinforcing Effect of the New Synthetic Bioabsorbable Sealant (ADVASEAL^ ) for Bronchial Stumps after Pulmonary Resections in Pigs

P1.31: Pleural Empyema and Broncho Pleural Fistula After Lung Resection: Analyses of 29 Patients Treated in our Clinic

Broncho pleural fistula (BPF) and pleural empyema are seriously complications after anatomical and non anatomical lung resection although is rare. But with high mortality rate particularly after radical pneumonectomy. a BPF may arise either from dehiscience or disruption of a bronchial closure after anatomical lung resection (segmentectomy, lobectomy; bilobectomy, pneumonectomy)or bronchoplastic sleeve resection and nonanatomical lung resection (wedge resection).Postoperative bronchopleural fistula is classified based in time of onset after surgery; as early (within first week); Intermediate (between 7 and 30 days);and late after (30 days). Malnutrition, imunosuppressive steroids therapies, prior thoracic radiation therapy, poorly controlled lung and pleural infection, active smokers, and the use of induction of chemotherapy are a number of predisposing factors that may developing bronchial fistula and subsecuent pleural empyema. Also others factors related with technical side are, long bronchial stump, large diameter bronchial stump, positive resection margin of bronchial stump, devascularisation of bronchial stump from cauter or unappropriate sutures during bronchial closure. Also risk factors for bronchopleural fistula are right Pneumonectomy, Diabetes, Completion Pneumonectomy, Active TB, Extrapleural Pneumonectomy, COPD, positive pressure ventilation, large postoperative fluid requirement, benign diagnosis prolonged chest tube utiliz. Empyema and BPF are extremely uncommon after lobetomy in contemporary series, particularly after thoracoscopic lobectomy. Empyema is seen in less than 2% of cases, and BPF in less than 1%. Post-pneumonectomy BPF and empyema are associated with mortality rates that vary from 5% up to nearly 50%. We are analysing our patients treated with pleural empyema and bronchopleural fistula, treated previously with lung resection,anatomical und non anatomical for malignant und benignen lung disease.Its retrospective study for period of time 2005-2015.The number of patients treated during 2005-2016 with pulmonary rezexion is 560.Mean age of patients 58±5.6 years (ranging from 13-87 years old).Male 420 patients and female 140 patients. Realized of kind Interventi are 47 patients pneumonectomy, 448 patiens anatomical lobectomy, 12 patients segmentectomy, 18 patients bilobectomy, 35 patients non anatomical resection (wedge lung resection). Bronchial fistula as a major complication occurred in 29 patients after lobectomy in 16 patients, after pneumonectomy in 8 patients, in 5 patients after right pneumonectotmise and 3 after left pneumonectomy, in 3 patients after segmentectomy, in 2 patients after wedge lung resection. Fistul bronchial pulmonary without pleural empyema 3 patients. Treated only pleural dranage for a long time 11 patients. In 2 patients are treated by using of fibrin glue bronchoscopicaly in bronchial fistulae under 5 mm and without infection. By open window are treated 18 patients according Elosser and Clagett –Virculla. Mean time hospital stay of patients treated with bronchial fistula et pleural empyema is 25 ± 5 days (average 5-90 days). 90 days mortality was in 5 patients in 2 patents post after lower bilobectomy and in 2 patients after right and left pneumonectomy, 1 patient after wedge lung resection. Cause of deaths, respiratory failure, sepsis, toxic shock. The diagnosis and management of bronchopleural fistula (BPF) remain a major therapeutic challenge for clinicians and surgeons. It is associated with significant morbidity and mortality.

Bronchial Stump Recurrence after Complete Resection of Lung Cancer: Effect of the Distance between the Tumor and Bronchial Resection Margin.

The purpose of this study was to evaluate the following parameters after complete resection in established lung cancer patients: the frequency of bronchial stump recurrence (BSR), the effect of the distance between the tumor and bronchial resection margin (DBTM) on BSR, the survival of patients with BSR, and the effect of the DBTM on survival. We retrospectively evaluated 553 consecutive lung cancer patients who underwent complete lung resection. The patients were classified as DBTM: ≤ 10 mm (group 1), 11 to 20 mm (group 2), and > 20 mm (group 3). We found BSR in eight (1.5%) patients. Six patients were in group 1, and two were in group 2. The difference was found to be statistically significant (p = 0004; groups 1 vs. 3). In multivariable analysis, we observed a trend toward significance for the effect of a DBTM on BSR development (p = 0.1). The DBTM did not significantly affect survival (p = 0.61). The survival of patients who developed BSR was significantly poor compared with those who did not develop BSR (p = 0.001). BSR can develop even after complete resection of lung cancer. The DBTM is associated with BSR risk, and the survival of patients who develop BSR is poor.

Patterns of Locoregional Relapses in Patients with Contemporarily Staged Stage III-N2 NSCLC Treated with Induction Chemotherapy and Resection: Implications for Postoperative Radiotherapy Target Volumes

ObjectivesOur aim was to evaluate locoregional relapse (LR) patterns after induction chemotherapy and surgery for stage III-N2 NSCLC staged with current standard methods and their impact on radiation target volumes for postoperative radiotherapy (PORT). MethodsA total of 150 patients with stage III-N2 NSCLC from a prospective database of patients who underwent surgical resection at the University Hospitals of Leuven or the Oncologic Centre Limburg between 1998 and 2012 were included. Patients were staged with fluorodeoxyglucose F 18 positron emission tomography/computed tomography and brain imaging and treated with induction chemotherapy and surgery. PORT was performed for incomplete resection (R1/R2) and/or persistent nodal disease (ypN2). For the non-PORT group, we created a virtual planning target volume (PTV). In general, the clinical target volume encompassed the bronchial stump, the ipsilateral hilum, the subcarinal region (station 7), and the initially involved mediastinal lymph nodes. ResultsAfter a mean follow-up time of 49 months, the 5-year overall survival was 35.1% in all patients; disease-free survival was 31.8%. PORT was delivered to 70 patients. LR was seen in 26 patients in the PORT group (37%) and 32 in the non-PORT group (40%). Fifty-eight nodal relapse sites were seen in the PORT group (2.2 sites per patient) versus 113 in the non-PORT group (3.5 sites per patient) (p < 0.01). In the PORT group, the most frequent sites of LR were the ipsilateral hilum (21%), lymph node station 7 (15%), ipsilateral station 4 (9%), ipsilateral station 5 (9%) and ipsilateral station 6 (9%). For the non-PORT group these were station 7 (19%), ipsilateral 4 (16%), and ipsilateral hilum (14%). The dominant pattern of failure was inside (inside or both inside and outside) the PTV. Regarding the out-of-PTV relapses, 47% and 69% of LRs occurred in the contralateral mediastinum for the PORT and non-PORT groups, respectively. Out-of-PTV relapses occurred mostly in initially left-sided tumors. ConclusionsDespite the limitations of this retrospective study, our data support the role of PORT in decreasing local relapses. Because of the large number of out-of-PTV relapses in the contralateral mediastinum, inclusion of elective contralateral lymph node stations in the PTV could be considered in left-sided tumors. However, prospective randomized trials are needed to verify this.

Clinical results of bronchial stump coverage using free pericardial fat pad.

Bronchial fistula is a severe complication after thoracic surgery. Although many methods of coverage using various autologous tissues including pedicled pericardial fat pad have been reported to be useful for the prevention of bronchial fistula, the ideal roles of these approaches and the coverage techniques yielding the best results still remain unclear. The clinical use of an autologous free fat graft has been reported in the various surgical fields including otolaryngology, orthopaedics and plastic surgery. Therefore, we have used a free pericardial fat pad (FPFP) as the material for covering the bronchial stump instead of a pedicled pericardial fat pad. Between January 2009 and December 2013, 1134 patients with lung cancer underwent pneumonectomy or lobectomy without bronchoplasty at our institution. Among them, 46 patients underwent bronchial stump coverage using a FPFP and we investigated the clinical results obtained retrospectively. Bronchial fistula occurred in 5 patients during the study period. Although we performed bronchial stump coverage mainly in patients with several risk factors for bronchial fistula, no bronchial fistula developed in this group. To investigate the viability of the FPFP, we examined the fat tissue around the bronchial stump demonstrated by chest computed tomography retrospectively. Although fat tissue at the bronchial stump gradually decreased in size, it remained evident for 5 months and was identified in almost half of the patients even at 1 year after surgery. No bronchial fistula developed in the FPFP group. Although the FPFP is a free flap, it remains viable for many months after surgery and may contribute to good wound healing of the bronchial stump by offering a wet environment. A pericardial fat pad is easy to make, can be used anywhere in the thoracic cavity and may be useful for bronchial stump reinforcement.

A tale of surviving three consecutive cardiorespiratory arrests on table during a right sided pneumonectomy.

Intraoperative cardiorespiratory arrest secondary to lower airway obstruction is often difficult to manage. We describe the management of one such technically challenging case of three consecutive cardiorespiratory arrests during a right pneumonectomy in a young boy. A 10 years boy with a large fleshy vascular endobronchial tumor (biopsy proven squamous papilloma), completely occluding the right main-stem bronchus with collapse-consolidation of underlying right lung, was posted for a right pneumonectomy. There were dense adhesions of lung to the parieties and the lung was completely damaged. Twenty-five minutes into the surgery, patient started desaturating and the anesthetist was having difficulty in ventilating him. Check bronchoscopy showed endobronchial bleeding and the double lumen tube abutting the tumor. He was turned supine and CPR performed along with suctioning of blood and repositioning of tube. Patient revived and surgery continued. One and a half hour into the surgery the boy had a second cardiorespiratory arrest due to similar airway obstruction and managed in similar fashion. Lower lobectomy was speedily done to gain access to the hilum followed by quick completion pneumonectomy. Immediately following specimen removal, the patient had the third cardiorespiratory arrest and anesthetist was unable to ventilate the patient even after suctioning and repositioning of tube. With patient in lateral position, through the thoracotomy, right bronchial stump was opened and a quick bronchial intubation performed by the surgeon in chief. On opening the bronchus a tumor ball was seen occluding the left main bronchus, which probably got detached from the main tumor during pneumonectomy. Residual tumor was delivered out and the bronchial stump closed. Patient was transferred to ICU on ventilatory support. Postoperatively he was extubated after 48 hours and was found to have no neurological deficit. Chest drain came out on POD2 and he was discharged on POD5. Promptly and methodically addressing this technical challenge helped us to prevent mortality. We also managed to avoid neurological sequelae of cardiorespiratory arrest. Learning point in this case is that when faced with a similar situation, it's important to stay calm and focused and to handle the challenge in a scientific and logical manner.

(1019) - Cadaveric Lobar Lung Transplantation Based on the Experiences of Living-Donor Lobar Lung Transplantation

Donor shortages in lung transplantation (LT) continue to be problematic for pediatric and small adult patients due to graft size incompatibility issues. As a solution to this problem, the usefulness of cadaveric lobar LT (CLLT) has been recently reported, and CLLT has been shown to provide favorable outcomes. However, because several technical points required elaboration in CLLT, the techniques of CLLT have not been widely adopted. Based on our experiences of living-donor lobar LT (LDLLT), we applied the techniques of LDLLT to CLLT. The purpose of this study was to examine the outcomes of CLLT and provide a description of the techniques of CLLT at our institution. We retrospectively investigated 8 recipients who underwent CLLT, of 145 LT recipients at our institution between October 1998 and October 2015. The median age at the time of cadaveric LT was 34 years (14-54 years). The male-to-female ratio was 1:1. Four of 8 patients had pulmonary fibrosis characterized by the reduced chest cavity. All 8 patients underwent bilateral LT after the anatomic lobectomy of 1 or 3 lobes. The cause of lobectomy was pneumonia in 5 patients and oversized graft in 3 patients. All 8 patients required cardiopulmonary bypass during CLLT. Although 3 patients required tracheostomy for primary graft dysfunction, no patients required extracorporeal membrane oxygenation after LT. Three of 8 patients had bronchial stump after lobectomy, and no patient encountered bronchopleural fistula. One patient who underwent the right lower lobectomy, developed vanishing bronchus intermedius syndrome, requiring stent insertion. After we changed the method to transect the bronchus at the level of the lobar bronchus as in LDLLT, we did not encounter bronchial complications. Survival analysis showed no significant difference between CLLT group and the other LT patients from our institution. CLLT could be a safe and effective option for pediatric and small adult recipients. In CLLT, the bronchus should be transected not to form the bronchial stump.

Single-incision thoracoscopic right pneumonectomy with primary division of the pulmonary artery.

In recent years video-assisted thoracoscopic surgery (VATS) techniques have gained popularity also for major lung resections. Furthermore, especially in experienced VATS centers, single-incision thoracoscopic surgery is more and more adapted due to its even lesser invasiveness. Most thoracic surgeons still prefer an open approach to perform pneumonectomy, although reports of VATS and even single-incision VATS pneumonectomy are increasing. Unlike other authors we prefer to divide the pulmonary artery (PA) as one of the first steps of the procedure in order to obtain a clear field of vision on one hand and to obtain optimal control of bleeding and total blood loss on the other hand. Herein we describe our technique for single incision thoracoscopic right pneumonectomy and mediastinal lymphadenectomy without rib-spreading and with division of the PA as a first step. Furthermore we prefer to routinely cover the bronchial stump (BS) with an in situ azygos vein (AV) flap during right pneumonectomy.

Management of Bronchial Stumps in Anatomic Lung Segmentectomy

Stapling or suturing techniques are commonly used to close bronchial stumps in lung lobectomy, although with the segmentectomy procedure, various types of closure are likely to be performed. Weinvestigated the safety of various types of bronchial closure methods used in anatomic lung segmentectomy. Between 2005 and 2013, we performed anatomic lung segmentectomies including segmentectomies through open thoracotomy for 41 patients and thoracoscopy for 167 patients. Bronchial closures were performed through open and thoracoscopy methods for 66 and 231 stumps, respectively. Data were collected regarding segmental bronchus type, stump closure methods, and closure-related complications. Since 2006, bronchial caliber was measured from preoperative 1 mm(3) computed tomography. In the open group, 17 stumps (26%) were closed by stapling, 48 (73%) by thread ligation, and 1(1%)by suturing. In the thoracoscopy group, 116 stumps (50%) were closed by stapling, 76 (33%) by thread ligation, and39 (17%) by polymer clip ligation (p < 0.001). Staplers were used for all bronchial trunks that supplied more than a single segment; the mean diameter was 8.1mm. For single segmental bronchi, ligation was usedfor 80% in the open group and stapling for 75% inthe thoracoscopy group; the mean diameter was 6.6mm. For subsegmental bronchi, ligation or clipping were applied for 95% in both groups; the mean diameter was 4.6 mm. One bronchopleural fistula was observed at 6 months postoperatively in upper division segmentectomy of the left upper lobe using a stapler in the open group. Ligation can be used safely for small-diameter segmental bronchial stump closures in anatomic lung segmentectomies or subsegmentectomies. The use of a polymer clip can be an alternative method toclose the bronchial stump of subsegmentectomies.

Surgery of the airway: historic notes.

Prior to the 20(th) century, the need for surgical procedures on the airway was infrequent and consisted mainly of tracheostomy to relieve airway obstruction or repair of tracheal injuries such as lacerations. Even the ability of tracheal suture lines to heal primarily was viewed with concern due to the rigidity of the tracheal wall, its precarious blood supply and uncertainty as to whether the cartilage components could heal without complications. In the 20(th) century the evolution of tracheal procedures on major airways evolved to meet the challenges provided by the expanding fields of thoracic surgery and advent of mechanical respiratory support with its associated complications. In the first half of the century lobar and lung resections done for tuberculosis and lung cancer required methods for safe closure of the resulting bronchial stumps and end-to-end bronchial anastomosis in the case of sleeve resections of the lung. Beginning in mid-century the advent of respiratory care units for the treatment of polio and for the expanding fields of thoracic and cardiac surgery resulted in a significant number of post-intubation tracheal stenosis requiring resection and primary repair. In the last 20 years of the century the development of lung transplantation with its requirement for successful bronchial anastomoses between the donor and recipient bronchi, created unique challenges including ischemia of the donor bronchus the adverse effects of immunosuppression, donor lung preservation and diagnosis and management of post-transplant infection and rejection.

Surgical treatment of lung cancer in patients under 45 years of age

The aim of the study was to evaluate the characteristics and prognosis of radical surgical treatment in young patients under the age of 45 with lung cancer. We retrospectively analysed the data of 85 young patients and 211 older patients who underwent anatomical lung resections in Wroclaw Thoracic Surgery Centre. Less lobectomies were performed (p = 0.048), the incidence of carcinoid was significantly higher (p < 0.0001), stage I of lung cancer was observed less frequently (p = 0.023), the frequency of metastasis to subcarinal lymph nodes was higher (p = 0.007), a bronchial stump was microscopically infiltrated more frequently, the complete resection was noted rarer (p = 0.016) and 3-year survival rate of squamous cell carcinoma patients was worse in younger group (p = 0.017). The statistical significance was not observed between the frequency of recurrences and overall survival. Lung cancer in younger patients seems to be more advanced at the time of surgery. It is probable that the group of younger patients with squamous cell carcinoma will require additional treatment after surgery.

Preceding bronchial cutting for exposure of the pulmonary artery buried in scar tissue after chemoradiotherapy.

It is often difficult to expose the pulmonary artery buried in a scar tissue, especially in lung cancer patients that responded well to neoadjuvant chemoradiotherapy. Difficulty to access pulmonary artery branches may lead to potentially unnecessary pneumonectomy. To complete lobectomy in such cases, a technique with preceding bronchial cutting for exposure of the pulmonary artery is presented. After dissecting the pulmonary vein, the lobar bronchus is cut from the opposite side of the pulmonary artery with scissors. The back wall of the lobar bronchus is cut using a surgical knife from the luminal face, which can expose the pulmonary artery behind the bronchial stump and then complete lobectomy. Fourteen patients have been treated using the present technique, enabling complete resection by lobectomy (including sleeve lobectomy in 3 patients) without major bleeding. The present procedure can expose pulmonary artery buried in scar tissue, resulting in making the lobectomy safer.

Simultaneous stapling of the lobar bronchus and pulmonary artery: is it actually dangerous?

We performed a left caudal lobectomy on a 3-month old male swine. During the lobectomy, the lobar bronchus and pulmonary artery were stapled simultaneously using an endostapler. According to a postmortem examination 42 days after the operation, the stumps were surrounded by granulation tissue with prominent accumulation of inflammatory cells. With respect to the bronchus, the stapled tissue remained as it was just after stapling, without degradation of the cartilage, smooth muscle or epithelial layers. In contrast, with respect to the pulmonary artery, the stapled tissue disappeared, which resulted in the formation of a new vascular stump with recruitment of a new adventitial layer and fibrotic tissue. Therefore, despite the simultaneous stapling, the vascular stump was separated from the bronchial stump. Our results suggest that the process of stump healing after stapling of the bronchus is different from that after stapling of the pulmonary artery: bronchial stump healing consists of extraluminal covering of the fibrotic tissues, while pulmonary arterial stump healing consists of intraluminal reformation of the intima and media. On the basis of the results, we believe that a bronchovascular fistula will not develop after simultaneous bronchovascular stapling unless the anterior wall of the bronchus has fallen away due to major stump necrosis.

ENDOSCOPIC DIAGNOSIS OF EARLY RECURRENCE IN PATIENTAS UNDERGOING SURGERY FOR LUNG CANCER

The purpose of the study: to evaluate the effectiveness of postoperative management of the bronchial stump in lung cancer patients. material and methods. Forty-four patients with stage III lung cancer underwent endoscopic examination of the bronchial tree 3, 6, 9 and 12 months after surgery. The EVIS EXERAII and LUCERA videoendoscopic complexes with consistent use of white light mode, autofluorescence and narrow- spectrum mode were used. Endoscopic results were compared with morphological findings. Results. X-ray of the chest was negative for tumor recurrence in 3 (6.8 %) cases and early metachronous tumor of the trachea was revealed in 1 (2.3 %) case. The main endoscopic symptoms of early local recurrence in the bronchial stump were the marked lilac glow identified in the AFI mode and the mucosal vascular pattern deformation Timely diagnosis of recurrence allows a special treatment to be performed.

Re-operations in thoracic surgery

To optimize the outcomes of reoperations for postoperative complications in patients with thoracic diseases and injuries. The study enrolled 1258 patients with different thoracic diseases and injuries. Postoperatively 58 (4.6%) patients underwent re-thoracotomy and 15 (1.1%) patients - video-assisted interventions for any complications. Indications for re-operations were intrapleural bleeding, bronchial stump failure, esophagogastrostomy insufficiency, prolonged air leak through the drains due to unsealed lung parenchyma, clotted hemothorax. Postoperative complications were observed in 16 patients after re-thoracotomy (including 14 deaths), while only 1 patient died after VATS surgery. Early diagnosis and rational surgical approach are key for successful surgical treatment of early postoperative complications in thoracic surgery.