Pneumonectomy For Lung Cancer Research Articles

Open left pneumonectomy: ancillary considerations

Pneumonectomy becomes an infrequently surgical procedure, representing now less than 10% of all types of major pulmonary resections performed to cure lung cancer (1). The performance of a pneumonectomy for lung cancer remains a high-risk surgical procedure despite optimization of surgical technique and postoperative care. Therefore, general thoracic surgeons try to avoid pneumonectomy whenever possible because of the reported poor quality of life, increased morbidity and mortality, and the thought that a pneumonectomy is, in itself, a disease (2). However, sometimes a pneumonectomy is the only way to achieve a R0 resection, typically for centrally located tumors. Actually, left pneumonectomy is a more easily accepted and performed procedure because its associated perioperative mortality is half lower than that of a right pneumonectomy (1,3). Theoretic rationales supporting these clues are a smaller parenchymal volume removed and a bronchial stump less exposed to the pleural space, thereby lessening the incidence of post-pneumonectomy respiratory failure and bronchial leaks, respectively. As a result, complex bronchoplastic and angioplastic lung sparing resections are less likely to be used on the left side (4). Indeed, current mortality and morbidity figures of left pneumonectomy are very similar to those of complex extended lobectomies (1,4). Therefore, left pneumonectomy should remain a valuable tool in every thoracic surgeon’s armamentarium.

175 Pneumonectomy for lung cancer: long-term outcome of 15-year experience of a single center

175 Pneumonectomy for lung cancer: long-term outcome of 15-year experience of a single center

Endobronchial closure of bronchopleural fistula using Amplatzer device.

Bronchopleural fistulas (BPF) are a dreaded complication after lobectomy and pneumonectomy and are associated with high morbidity and mortality. BPF are treated by a range of surgical and endoscopic techniques. Amplatzer devices (ADs), normally used for the closure of cardiac defects, may enable the minimally invasive occlusion of these defects. Three patients with BPF were treated with the bronchoscopic closure of BPF using AD. Under general anaesthesia, the fistula was located using bronchography and the self-expanding AD was placed under direct bronchoscopic and fluoroscopic guidance into the fistula. Bronchography was used to control the complete occlusion of the BPF. Three male patients with a mean age of 63 years (range, 53-73 years) were successfully treated by AD. Two BPF occurred after lobectomy of the right lower lobe for lung cancer and one after right pneumonectomy for lung cancer. In all patients the bronchoscopic procedure was successful and symptoms of empyema and BPF showed no recurrence over a median follow-up of 22 months. Endobronchial closure of BPF using AD represents a safe, effective and promising method for postoperative BPF.

Open thoracotomy for pneumothorax.

A thoracotomy is an incision into the pleural space of the chest. It is performed by surgeons (or emergency physicians under certain circumstances) to gain access to the thoracic organs, most commonly the heart, the lungs, or the esophagus, or for access to the thoracic aorta or the anterior spine. This surgical procedure is a major surgical maneuver it is the first step in many thoracic surgeries including lobectomy or pneumonectomy for lung cancer and as such requires general anesthesia with endotracheal tube insertion and mechanical ventilation, rigid bronchoscope can be also used if necessary. Thoracotomies are thought to be one of the most difficult surgical incisions to deal with post-operatively, because they are extremely painful and the pain can prevent the patient from breathing effectively, leading to atelectasis or pneumonia. In the current review we will present the steps of this procedure.

Iron and Iron-Related Proteins in Asbestosis.

We tested the postulate that iron homeostasis is altered among patients diagnosed to have asbestosis. Lung tissue from six individuals diagnosed to have had asbestosis at autopsy was stained for iron, ferritin, divalent metal transporter 1 (DMT1), and ferroportin 1 (FPN1). Slides from six individuals having pneumonectomy for lung cancer were employed as controls. Lung tissue from those patients with asbestosis demonstrated stainable iron, whereas control lung tissue did not. Staining for this metal was observed predominantly in airway and alveolar macrophages. Expression of the iron-related proteins ferritin, DMT1, and FPN1 was elevated in lung tissue from the six asbestosis patients relative to controls. This increased expression of iron-transport and iron-storage proteins was evident in both airway and alveolar epithelial cells. Asbestos bodies were abundant in lung tissue from patients diagnosed to have had asbestosis. While staining for iron, ferruginous bodies did not demonstrate uptake of antibodies for ferritin, DMT1, and FPN1. We conclude that iron homeostasis is altered in lung disease among those diagnosed to have asbestosis with an accumulation of the metal and a modified expression of iron-related proteins being evident.

Pneumonectomy for lung cancer: Contemporary national early morbidity and mortality outcomes

The study objective was to determine contemporary early outcomes associated with pneumonectomy for lung cancer and to identify their predictors using a nationally representative general thoracic surgery database (EPITHOR). After discarding inconsistent files, a group of 4498 patients who underwent elective pneumonectomy for primary lung cancer between 2003 and 2013 was selected. Logistic regression analysis was performed on variables for mortality and major adverse events. Then, a propensity score analysis was adjusted for imbalances in baseline characteristics between patients with or without neoadjuvant treatment. Operative mortality was 7.8%. Surgical, cardiovascular, pulmonary, and infectious complications rates were 14.9%, 14.1%, 11.5%, and 2.7%, respectively. None of these complications were predicted by the performance of a neoadjuvant therapy. Operative mortality analysis, adjusted for the propensity scores, identified age greater than 65 years (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.5-2.9; P<.001), underweight body mass index category (OR, 2.2; 95% CI, 1.2-4.0; P=.009), American Society of Anesthesiologists score of 3 or greater (OR, 2.310; 95% CI, 1.615-3.304; P<.001), right laterality of the procedure (OR, 1.8; 95% CI, 1.1-2.4; P=.011), performance of an extended pneumonectomy (OR, 1.5; 95% CI, 1.1-2.1; P=.018), and absence of systematic lymphadenectomy (OR, 2.9; 95% CI, 1.1-7.8; P=.027) as risk predictors. Induction therapy (OR, 0.63; 95% CI, 0.5-0.9; P=.005) and overweight body mass index category (OR, 0.60; 95% CI, 0.4-0.9; P=.033) were protective factors. Several risk factors for major adverse early outcomes after pneumonectomy for cancer were identified. Overweight patients and those who received induction therapy had paradoxically lower adjusted risks of mortality.

Pulmonary hypertension after pneumonectomy for lung cancer

We aimed to consolidate our clinical observations regarding the development of pulmonary hypertension following pneumonectomy for lung cancer. Sixty-nine of 82 initially selected patients without pulmonary or cardiac comorbidities, who underwent pneumonectomy for lung cancer between October 2009 and October 2011, accomplished our protocol. Mean patient age was 60.6 years (range 44-78 years) and 10.1% were women. Postoperative complications occurred in 16 (23.2%) patients. Mortality at 1, 12, and 18 months postoperatively was 4.3%, 15.9%, and 29%, respectively. One year postoperatively, 37.9% of patients developed mild to moderate pulmonary hypertension and 3.4% had severe pulmonary hypertension. The calculated mean pulmonary artery systolic pressure at 1, 6, and 12 months postoperatively was 21.9 ± 6.6, 27.3 ± 9.3, and 34.1 ± 14 mm Hg, respectively (p < 0.001). Receiver operating characteristic curve analysis showed a cutoff point at 35.5 mm Hg for late postoperative (at 12 months) pulmonary artery systolic pressure (sensitivity 80%, specificity 82%; p < 0.001) related to suboptimal clinical outcomes (decreased performance status or death), with a detected 18-fold risk for these patients (p < 0.001). Pulmonary hypertension may occur after pneumonectomy with its known adverse effects. Patients with late postoperative pulmonary artery systolic pressure > 35.5 mm Hg are at higher risk of a suboptimal clinical outcome.

Methods of main bronchus stump closure and incidence of bronchopleural fistula after pneumonectomies for lung cancer (a retrospective single center review)

Background. Bronchopleural fistulas (BPFs) development after pneumo­nectomy remains a serious complication and is associated with high mortality rate. We evaluated incidence and risk factors, that influenced BPF rate after pneumonectomies for lung cancer patients treated at the Department of Thoracic Surgery and Oncology of the Institute of Oncology, Vilnius University, and compared different bronchial stump suturing techniques. Methods. It is a retrospective study. We reviewed 580 lung cancer patients who underwent pneumonectomies from January 1990 to January 2009. The average patient’s age was 60.1 ± 7.9 years (range from 34 to 76). Patients according to postoperative staging: stage IIA – 30 patients, IIB – 80, IIIA – 320, IIIB – 96, IV – 54. The most common tumor histology was planocellular carcinoma – 301, adenocarcinoma – 108, small-cell carcinoma – 76. Results. There were 327 (56.4%) right and 253 (43.6%) left pneumonectomies. Mediastinal lymph node dissection (LND) was performed to 387 (66.7%) and lymph node sampling (LNS) to 193 (33.3%) patients. The bronchial stump was covered in 285 (49.1%) patients. Bronchopleural fistula after pneumonectomy developed in 48 (8.3%) patients (bronchial dehiscence was confirmed by bronchoscopy), and 7 patients with BPF died (14.5%). BPF after right pneumonectomy occurred in 30 cases (9.5%) and after left pneumonectomy in 18 cases (7.1%), the difference was not statistically significant (p &gt; 0.05). BPF after LND occurred in 38 cases (9.82%) and after LNS in 10 cases (5.18%), the dif­f erence was statistically significant (p

Single-port video-assisted thoracoscopic surgery for lung cancer.

In 2004, novel results using pulmonary wedge resection executed through single-port video-assisted thoracoscopic surgery (VATS) was first described. Since that time, single-port VATS has been advocated for the treatment of a spectrum of thoracic diseases, especially lung cancer. Lung cancer remains one of the top three cancer-related deaths in Taiwan, and surgical resection remains the "gold standard" for early-stage lung cancer. Anatomical resections (including pneumonectomy, lobectomy, and segmentectomy) remain the primary types of lung cancer surgery, regardless of whether conventional open thoracotomy, or 4/3/2-ports VATS are used. In the past three years, several pioneers have reported their early experiences with single-port VATS lobectomy, segmentectomy, and pneumonectomy for lung cancer. Our goal was to appraise their findings and review the role of single-port VATS in the treatment of lung cancer. In addition, the current concept of mini-invasive surgery involves not only smaller resections (requiring only a few incisions), but also sub-lobar resection as segmentectomy. Therefore, our review will also address these issues.

The Society of Thoracic Surgeons and the Thoracic Surgery Foundation for Research and Education

he Thoracic Surgery Foundation for Research and TEducation (TSFRE) was created to help perpetuate the pioneering cardiothoracic surgical tradition, highlighted by Dr Evarts A. Graham’s first successful pneumonectomy for lung cancer on April 4, 1932, Dr Robert A. Gross’ division of a patent ductus arteriosus in 1938, the first Blalock-Taussig shunt operation on November 29, 1944, and Dr Clarence Crafoord’s successful correction of coarctation of the aorta [1–4]. When Dr John H. Gibbons, Jr, successfully used cardiopulmonary bypass on May 6, 1953, it was the result of research started 23 years before to address an insoluble problem he had seen at the bedside [5]. Now, heart valve repairs and replacements and heart-lung transplants are regularly successful, and cardiothoracic surgeons are studying such things as genomics, molecular biology, and tissue engineering. How can we perpetuate this tradition? In the 1980s, Martin F. McKneally, MD, and others noted that “following a period of leadership and innovation . . . cardiothoracic surgeons had become more practice centered [and] . . . the emphasis had shifted away from science” [6]. He pointed out the need and proposed a research and education foundation to The Society of Thoracic Surgeons (STS) Council on June 4, 1984. However, little happeneduntil 1988,whenhe andDrRobert L. Replogle approached David S. Sheridan [7], a good friend of Ralph D. Alley, MD. Dave, as Sheridan preferred to be called, responded with a grant of $50,000 and a commitment for $1 million to honor Dr Alley, who had suffered a series of strokes. This crucial donation paved the way for incorporation of the STS Education and Research Foundation in Illinois on December 23, 1988. Loving consideration of the name “Ralph Alley Foundation” was outweighed by vision. On October 25, 1989, Dr Replogle, the fledging group’s first president and one of Dr Alley’s strongest admirers, wrote to Dr Robert G. Ellison, saying that the foundation’s name needed to express “a wider and more long-range objective.” On March 2, 1992, the organization, previously known as “The Foundation,” became self-sustaining, and the name was changed to the Thoracic Surgery Foundation for Research and Education. Administrative management services were provided by Smith, Bucklin and Associates until October 1, 2002. Thereafter,

Mitral valve and coronary artery bypass surgeries 13 years after pneumonectomy for lung cancer : case report

We successfully performed coronary artery bypass grafting and mitral valve replacement in a 72-year-old man who had undergone a left pneumonectomy 13 years previously due to a malignant mass. The patient was admitted to our clinic with symptoms of dyspnoea, palpitations, chest pain and fatigue. He was diagnosed with mitral valve disease and two-vessel coronary artery disease, as seen from echocardiography and catheterisation studies. Conventional cardiopulmonary bypass grafting was performed following sternotomy. The patient's heart was completely displaced to the left hemithorax. Saphenous vein grafts were harvested. Distal anastomoses were performed with the use of the on-pump beatingheart technique without cross clamping. Afterwards a cross clamping was placed and a left atriotomy was performed. The mitral valve was severely calcific. A mitral valve replacement was performed using number 27 mechanical valve after the valve had been excised. The patient's postoperative course was uneventful. Cardiac contractility was seen to be normal and the mitral valve was functioning on echocardiography done in the second postoperative month.

Salvage esophagectomy through a transhiatal approach for cancer of the thoracic esophagus after left pneumonectomy for lung cancer

Here we report on a 54-year-old man who had undergone left pneumonectomy for a primary lung cancer 25 years earlier and who underwent salvage blunt esophagectomy for a recurrent esophageal cancer after definitive chemoradiotherapy. The patient received chemoradiotherapy for a cancer in the upper thoracic esophagus at the clinical stage IA (T1bN0M0) because of a past history of left pneumonectomy for lung cancer, and the esophageal cancer showed complete response. At 1 year after chemoradiotherapy, local recurrence was found in the upper thoracic esophagus. Although chemotherapy using docetaxel was administered, this was not effective. Transhiatal esophagectomy as salvage surgery was successfully done by a combination of laparo-mediastinoscopy assisted blunt dissection with the eversion stripping method. The postoperative course was uneventful. The patient died of lung and brain metastasis at 23 months after the salvage surgery. Transhiatal esophagectomy may be an option as a salvage esophagectomy in cases with a history of major lung surgery.

Pulmonary Resection for Metachronous Lung Cancer Following Contralateral Pneumonectomy

Patients who undergo pneumonectomy for lung cancer are at risk of recurrent disease and metachronous tumours in the remaining lung. Establishing a diagnosis can be difficult as biopsy may induce a pneumothorax, whilst resection is limited by remaining lung function. However, pneumonectomy should not be a contraindication to further lung resection. We report two cases of lung cancer resection in the residual lung 6 and 11 years following pneumonectomy respectively. A limited resection can be safely performed for a new pulmonary parenchymal lesion on a background of a previous pneumonectomy.

Oclusão arterial aguda de membros inferiores por êmbolo tumoral em paciente com neoplasia de pulmão

A embolia arterial periférica originada de tumores malignos é considerada uma manifestação rara da doença neoplásica, podendo se originar de vários sítios, incluindo coração, aorta e veias pulmonares, sendo estas últimas, fontes massivas de embolia por trombo ou tumores com erosão para seu lúmen. Apesar de infrequente, a neoplasia pulmonar deve ser considerada como uma fonte de êmbolos para as extremidades, principalmente quando há invasão neoplásica para as veias pulmonares. Apresentamos o caso de um paciente do sexo masculino submetido à pneumectomia por neoplasia pulmonar, que evoluiu com oclusão arterial aguda de membros inferiores por êmbolo tumoral " a cavaleiro".

Pneumonectomy in Lung Cancer: Analysis of Predictive Factors of Postoperative Morbidity and Mortality

Pneumonectomy in Lung Cancer: Analysis of Predictive Factors of Postoperative Morbidity and Mortality

Nutritional Status and Postoperative Outcome After Pneumonectomy for Lung Cancer

The influence of nutritional status on outcome after major lung resection remains controversial. Nutritional assessment is not included as a major recommendation in lung cancer guidelines. The purpose of this study was to assess the nutritional status of patients referred for pneumonectomy and to assess the predictive value of malnutrition in determining the surgical outcome. This study was a multicenter observational trial. The eligibility criterion for participants was pneumonectomy for lung cancer. Criteria for group classification according to nutritional status were albumin and transthyretin levels. Predicted outcomes were major infectious and noninfectious complications and 90-day mortality. Univariate analysis identified independent variables for the predictive model of age, sex, induction chemotherapy, extended resections, treatment side, smoking, and malnutrition. Predictive variables were then included in a logistic regression model. Between January 2010 and December 2011, 86 (mean age, 61.5 years) consecutive patients referred for pneumonectomy (left side, n = 58; right side, n = 28) at 4 thoracic surgery centers were included. The malnutrition group included 33 patients (39%) and the normal nutritional status group included 53 patients. Univariate analysis elected malnutrition, recent active smoking, and extended resection to be included in a multivariate analysis. Multivariate analysis identified malnutrition, recent smoking, and extended resection as predictive variables for major complications and mortality. The frequency of malnutrition detected by biological markers was dramatically high. Malnutrition, as well as recent active smoking and extended resection, is a predictive factor for infectious complications and mortality after pneumonectomy. Nutritional assessment with appropriate markers should be considered before pneumonectomy.

Thoracic 131I Uptake After Previous Pneumonectomy in Patients Treated for Differentiated Thyroid Cancer

In patients treated for differentiated thyroid cancer with radioiodine (131I), abnormal uptake on post-therapeutic whole-body scan may lead to repeated administration of 131I. Uptake not linked to thyroid cancer but to other conditions should be recognized so that patients are not overtreated. We describe 3 cases of unilateral thoracic 131I uptake in patients previously treated by pneumonectomy for lung cancer, without evidence of persistent lung cancer.

The Early Days of Pneumonectomy for Lung Cancer

There is no doubt that the widespread habit of cigarette smoking, which commenced among the troops in the First World War and which became almost universal in the second, was responsible for the rise in incidence of cancer of the lung throughout the Western World to its position today as the commonest cause of deaths from malignant disease.

Endobronchial closure of bronchopleural fistulas with Amplatzer vascular plug

Bronchopulmonary fistula (BPF) is a severe complication following lobectomy or pneumonectomy and is associated with a high rate of morbidity and mortality. We have developed a novel minimally invasive method of central BPF closure using Amplatzer vascular plug (AVP) device that was originally designed for the transcatheter closure of vascular structures in patients with small BPF. Patients with BPFs were treated under conscious sedation by bronchoscopic closure of BPFs using AVP. After locating the fistula using bronchography, the self-expanding nitinol made AVP occluder to be delivered under direct bronchoscopic guidance over a loader wire into the fistula followed by bronchography to assure correct device positioning and sealing of the BPF. Six AVPs were placed in five patients, four males and one female, with a mean age of 62.3 years (range: 51-82 years). The underlying disorders and etiologies for BPF development were lobectomy (two patients), pneumonectomy for lung cancer (one patient), lobectomy due to necrotizing pneumonia (one patient), and post-tracheostomy tracheo-pleural fistula (one patient). In all the patients, the bronchoscopic procedure was successful and symptoms related to BPF disappeared following closure by the AVP. The results were maintained over a median follow-up of 9 months (range: 5-34 months). Endobronchial closure using the AVP is a safe and effective method for treatment of small postoperative BPF. The ease of their implantation by bronchoscopy under conscious sedation adds this novel technique to the armatorium of minimally invasive modalities for the treatment of small BPF.

Pneumonectomy for Lung Cancer: A Further Step in Minimally Invasive Surgery

Robotic lobectomies have been proven to be technically and oncologically feasible. To date, however, pneumonectomy is still considered as a too extensive resection to be performed by the da Vinci robotic system (Intuitive Surgical, Mountain View, CA). We describe 2 patients with centrally located non-small cell lung cancer requiring pneumonectomy and radical lymph node dissection. The operations, consisting of a left and a right pneumonectomy, were successfully performed by a totally video-assisted robotic approach. Tips and pitfalls in this latest innovation in the minimally invasive surgery for lung cancer are discussed.