Pneumonectomy For Lung Cancer Research Articles

Comparative analysis of sleeve resection and pneumonectomy for lung cancer

Sleeve recestion for lung cancer can get similar tumor and lymph node resection rate as pneumonectomy, with less influence on pulmonary function and much improvement of quality of life. The aim of this study is to compare the 5-year survival and complications of sleeve resection and pneumonectomy for lung cancer. Survival analysis was used to investigate the 5-year survival of 173 patients undergoing sleeve resection and 435 patients undergoing pneumonectomy from January 1990 to December 2000. Their complication and perioperative motality were also analyzed. The overall 5-year survival for sleeve resection and pneumonectomy was 42.3% and 30.9%, respectively (P=0.007). 5-year survival of right lung sleeve resection was better than that of left lung [P=0.004 (N0), 0.025 (N1), 0.042 (N2)]. In left lung cancer patients without nodal involvement, the survival after sleeve resection was better than that after pneumonectomy. There was no survival difference between N1 and N2 lung cancer patients. Survival was not significantly different for bronchoplasty and pulmonary arterioplasty and pneumonectomy. The incidence rate of pneumonia and arrhythmia for sleeve resection was less than those for pneumonectomy (P=0.0019), and no significant difference of mortality was observed between the two groups. In lung cancer patients suitable for sleeve resection or pneumonectomy, sleeve resection should be performed for right lung cancer and left lung cancer of stage I. Bronchoplasty and pulmonary arterioplasty don't prolong the survival of lung cancer patients compared with pneumonectomy.

Bronchopleural Fistula Treated With a Covered Wallstent

Bronchopleural fistula is a well-recognized complication of pneumonectomy, which presents a difficult challenge to the thoracic surgeon. We report the successful treatment of a bronchopleural fistula after right pneumonectomy for lung cancer, using a covered esophageal stent.

P-922 Cardiac and pulmonary function more than 5 years after pneumonectomy for lung cancer

P-922 Cardiac and pulmonary function more than 5 years after pneumonectomy for lung cancer

P-902 Bronchopleural fistula after pneumonectomy for lung cancer:Consideration of 450 consecutive cases

P-902 Bronchopleural fistula after pneumonectomy for lung cancer:Consideration of 450 consecutive cases

O-178 Morbidity and mortality of pneumonectomy for lung cancer:Neoadjuvant chemotherapy does not increase the risk of postoperative complications

O-178 Morbidity and mortality of pneumonectomy for lung cancer:Neoadjuvant chemotherapy does not increase the risk of postoperative complications

69 Long-term survival after sleeve pneumonectomy for lung cancer with resection of the superior vena cava

69 Long-term survival after sleeve pneumonectomy for lung cancer with resection of the superior vena cava

Inability to perform maximal stair climbing test before lung resection: a propensity score analysis on early outcome

The objective of the present study was to assess whether patients unable to perform a preoperative maximal stair climbing test had an increased incidence of morbidity and mortality after major lung resection compared to patients who were able to exercise. Three hundred and ninety one patients submitted to pulmonary lobectomy or pneumonectomy for lung cancer were analyzed. Forty-five of these patients were unable to perform a preoperative maximal stair climbing test for underlying comorbidities. Unadjusted and propensity score case matched comparisons were performed between patients who could and who could not perform a preoperative stair climbing test. Multi-variable analyses were then performed to identify predictors of morbidity and mortality, and were validated by bootstrap bagging. Patients who could not perform the stair climbing test had similar morbidity rates (31.1 vs. 35.6%, respectively, P=0.7), but higher mortality rates (15.6 vs. 4.4%, respectively, P=0.08) and deaths among complicated patients (50 vs. 12.5%, respectively, P=0.025), compared to propensity score matched patients who could perform the stair climbing test. Logistic regression analyses showed that the inability to perform the stair climbing test was an independent and reliable predictor of mortality (P=0.005) but not of morbidity (P=0.2). Patients unable to perform a preoperative maximal exercise test had an increased risk of mortality after major lung resection. Half of these patients did not survive postoperative complications, due to their decreased aerobic reserve caused by physical inactivity which made them unable to cope with the increased oxygen demand.

A model to predict the decline of the forced expiratory volume in one second and the carbon monoxide lung diffusion capacity early after major lung resection

The objective of the study was to develop regression models for the prediction of the decline of the forced expiratory volume in one second (FEV1) and the carbon monoxide lung diffusion capacity (DLCO) early after major lung resection. One hundred and ninety patients submitted to pulmonary lobectomy or pneumonectomy for lung cancer performed preoperative and early postoperative (mean 10.9 after operation) pulmonary function tests. One hundred and fifty of these patients also underwent DLCO measurements by the single breath method. The decline of FEV1 and DLCO were expressed as percentage losses from preoperative values. Stepwise multiple regression analyses were performed to develop two models estimating the percent reduction of FEV1 and DLCO from preoperative values. The multivariate procedures were then validated by bootstrap analyses. The following regression equations were derived: estimated percent reduction in FEV1 = 21.34 - (0.47 x age) + (0.49 x percentage of functioning parenchyma removed during operation) + (17.91 x COPD-index); estimated percent reduction in DLCO = 35.99 - (0.31 x age) - (36.47 x FEV1/FVC ratio) + (0.33 x DLCO) + (0.54 x percentage of functioning parenchyma removed during operation). The comparison between observed and estimated losses of FEV1 and DLCO (by using these regression equations) was not significantly different. We think the regression models generated in this study may be reliably used for risk stratification purposes.

P-399 Determinants of perioperative morbidity and mortality after pneumonectomy for lung cancer

P-399 Determinants of perioperative morbidity and mortality after pneumonectomy for lung cancer

Modified Dumon stent for the treatment of a bronchopleural fistula after pneumonectomy

We describe the case of a 72-year-old man in whom a bronchopleural fistula developed after induction chemotherapy followed by right pneumonectomy for lung cancer. Resuturing of the right main bronchial stump, endoscopic treatment, and repair using a latissimus dorsi muscle flap were not effective. Consequently we placed a modified Dumon stent in the carina, which effectively closed the stump.

Subsequent pulmonary resection for bronchogenic carcinoma after pneumonectomy

Background. Patients who have undergone a pneumonectomy for bronchogenic carcinoma are at risk of cancer in the contralateral lung. Little information exists regarding the outcome of subsequent lung operation for lung cancer after pneumonectomy. Methods. The records of all patients who underwent lung resection after pneumonectomy for lung cancer from January 1980 through July 2001 were reviewed. Results. There were 24 patients (18 men and 6 women). Median age was 64 years (range, 43 to 84 years). Median preoperative forced expiratory volume in 1 second was 1.47 L (range, 0.66 to 2.55 L). Subsequent pulmonary resection was performed 2 to 213 months after pneumonectomy (median, 23 months). Wedge excision was performed in 20 patients, segmentectomy in 3, and lobectomy in 1. Diagnosis was a metachronous lung cancer in 14 patients and metastatic lung cancer in 10. Complications occurred in 11 patients (44.0%), and 2 died (operative mortality, 8.3%). Median hospitalization was 7 days (range, 2 to 72 days). Follow-up was complete in all patients and ranged between 6 and 140 months (median, 37 months). Overall 1-, 3-, and 5-year survivals were 87%, 61%, and 40%, respectively. Five-year survival of patients undergoing resection for a metachronous lung cancer (50%) was better than the survival of patients who underwent resection for metastatic cancer (14%; p = 0.14). Five-year survival after a solitary wedge excision was 46% compared with 25% after a more extensive resection ( p = 0.54). Conclusions. Limited pulmonary resection of the contralateral lung after pneumonectomy is associated with acceptable morbidity and mortality. Long-term survival is possible, especially in patients with a metachronous cancer. Solitary wedge excision is the treatment of choice.

Risk Factors for Early Mortality and Major Complications Following Pneumonectomy for Non-small Cell Carcinoma of the Lung

To assess the mortality rate and the incidence of cardiopulmonary complications after pneumonectomy for non-small cell lung carcinoma (NSCLC) and to identify possible associated risk factors. Observational study of patients who underwent pneumonectomy. Potential risk factors were analyzed from a local database including all thoracic surgical cases. A university hospital and a chest medical center. From January 1, 1990, to April 30, 2000, 193 consecutive pneumonectomies were performed for NSCLC in two affiliated institutions. The following information was recorded: demographic, clinical, functional, and surgical variables; as well as intraoperative and postoperative events. The risk of mortality and cardiopulmonary complications was evaluated using multiple logistic regression analysis to estimate odds ratios (ORs) and 95% confidence intervals (CIs). After undergoing pneumonectomy, all patients were successfully extubated in the operating room and then transferred to a postanesthesia care unit (126 patients) or ICU (67 patients). The 30-day mortality rate was 9.3%, and cardiovascular and/or pulmonary complications occurred in 47% of cases. Coronary artery disease (CAD) was a predictor of 30-day mortality (OR, 2.9; 95% CI, 1.1 to 8.9). Cardiac morbidity (mainly arrhythmias) was significantly related to advanced age (OR, 3.7; 95% CI, 1.6 to 8.6) and pathologic stages III/IV (OR, 1.4; 95% CI, 1.1 to 4.7), whereas continuous epidural analgesia was associated with a reduced incidence of respiratory complications (OR, 0.2; 95% CI, 0.1 to 0.6). Pneumonectomy for lung cancer is a high-risk procedure, the risk for which is significantly related to the presence of CAD and advanced pathologic stages. Importantly, the provision of epidural analgesia contributes to lower the risk of respiratory complications.

Extrapleural pneumonectomy for lung cancer with carcinomatous pleuritis.

Extrapleural pneumonectomy for lung cancer with carcinomatous pleuritis.

Superphysiologic FDG Uptake in the Non-Paralyzed Vocal Cord: Resolution of a False-Positive PET Result with Combined PET-CT Imaging

The application of positron emission tomography imaging with 18F-fluorodeoxyglucose (FDG) to the extracranial head and neck has been proven to be effective in the detection and staging of malignancy. The FDG uptake of normal laryngeal tissue is symmetric and low, while benign lesions typically have only slight increases in FDG uptake. We report a case of asymmetric, superphysiologic FDG uptake in the contralateral vocal cord of a patient with a unilateral vocal cord paralysis secondary to sacrifice of the recurrent laryngeal nerve during pneumonectomy for lung cancer. The FDG uptake of the non-paralyzed vocal cord was increased multiple-fold, placing it well within the range of malignancy. Use of unique, combined PET-CT imaging localized the high FDG uptake to the non-paralyzed vocal cord, and laryngoscopy confirmed no evidence of malignancy in the vocal cord. This case demonstrates that a benign cause of false-positive FDG-PET imaging may be encountered during evaluation of the extracranial head and neck for malignancy. We aim to alert the reader to this potential pitfall in the interpretation of FDG-PET imaging, which can be resolved with the use of combined PET-CT imaging and clinical correlation.

Completion pneumonectomy for lung cancer

Completion pneumonectomy for lung cancer

Bronchial stump aspergillosis

Two cases of bronchial stump aspergillosis were diagnosed 5 and 6 years after pneumonectomy for lung cancer. In each case, the fungal mass was endoscopically removed using standard forceps. A recurrence of the fungal mass persisted until all visible protruding nylon threads in the airway lumen were destroyed with a Nd:YAG laser. Removal of the visible suture is necessary for eliminating the infection. No additional local or systemic antifungal therapy is needed.

Video-Assisted Contralateral Treatment for Bronchial Stump Diastasis After Left Pneumonectomy

Postoperative bronchial stump failure is a life-threatening complication, and several surgical approaches and procedures have been developed to close the stump. In this report, we describe a case of left mainstem bronchial stump diastasis after pneumonectomy for lung cancer, in which the bronchial stump was re-closed using a contralateral approach with video-assisted thoracic surgery, with good success. The left main bronchus was closed with an automatic stapler device, but the stump reopened and left pyothorax developed postoperatively. Emergent intratracheal intubation and ventilation was required due to rapid progression of right pyothorax. Under strict nutritional management by IV hyperalimentation, administration of antibiotics to which the organisms were sensitive, and drainage, the patient recovered from pneumonia. However, thoracic air leak increased daily, and reoperation for bronchial diastasis was performed. Using this approach, the left main bronchus near the carina was easily exposed extrapleurally, with only the azygos vein being incised. Video-assisted contralateral treatment was effective in avoiding sternal osteomyelitis due to a transpericardial approach via median sternotomy in the case of mainstem bronchial stump failure, only after left pneumonectomy.

Thoracoscopic therapy of pleural empyema after pneumonectomy

In a 4-year period two right-sided empyemas occurred following a total of 39 pneumonectomies for lung cancer. In another case pneumonectomy was performed for left-sided lung cancer with concomitant empyema as an emergency procedure in a patient referred from an outside hospital. Empyema was treated with repeated thoracoscopic debridements and intermittent lavage with polyvinylpyrrolidine-iodine solution and streptocinase/streptodornase. Three to seven thoracoscopies were required to sterilize the pleural cavity. After a median follow-up of 14 months all three patients are well and without any evidence of infection. VATS is suitable for definitive treatment of postpneumonectomy empyema and is associated with excellent functional and cosmetic results.

Results of tracheobronchoplasty for bronchogenic carcinoma.

Tracheobronchial reconstruction is a safe and effective procedure for patients with the neoplasms of low grade malignancy and bronchogenic carcinoma. We present herein a series of 18 cases that had tracheobronchial reconstruction, and discuss a postoperative complication and prognosis. From 1981 to 1997, 18 patients (2.8%) of 647 cases had tracheobronchial reconstruction with mediastinal lymph node dissection. The average age of the 13 males and 5 females, was 61 (range 51-72) years. We analyzed clinical features, postoperative complication and prognosis. Seventeen patients underwent sleeve lobectomy and one lobectomy with carinal reconstruction (Barkley's montage type). There were 13 squamous cell carcinomas, and one each of adenocarcinoma, typical carcinoid, adenoid cystic carcinoma, mucoepidermoid carcinoma and undifferentiated carcinoma. Stage was IA in 3, stage IB in 6, stage IIB in 3, stage IIIA in 5, and stage IIIB in 1 patient. Curative resection was achieved in 11 patients and non-curative resection in 7 patient who had radiotherapy. Six patients (33.3%) had postoperative complications. Five-year survival and mean survival time were 92.3% and 126 months, respectively. Tracheoplasty group had significantly better prognosis than pneumonectomy group or lobectomy group (p<0.01). This study suggests that tracheobronchoplasty is a more useful procedure than pneumonectomy for lung cancer.

ANESTHESIA FOR THORACIC SURGERY IN THE ONCOLOGY PATIENT

Thoracic surgery is a surgical discipline that has essentially had its birth and rapid development in the twentieth century. This incredible growth could not have been possible without advances in anesthesia, specifically the use of positive pressure ventilation. Early surgical and anesthetic difficulties were encountered related to the management of pulmonary collapse, pneumothorax, and mediastinal shift whenever the thoracic cavity was opened. Sauerbruch and others intitially designed elaborate negative pressure chambers for the patient and operative team to maintain the negative chest pressure and allow net flow of air into the lungs. Endotracheal intubation was used in the nineteenth century for experimental work in animals but was not applied and widely accepted into clinical practice until the 1920s. Early thoracic procedures were generally used to treat suppurative processes or tuberculosis. Ewarts Graham directed the scalpel to treat cancers involving the thoracic cavity and performed the first one-stage pneumonectomy for lung cancer in 1933; this was the standard resection for lung cancer for many years. Nearly 70 years later, thoracic oncologic resections still represent some of the most physiologically challenging procedures for patients who are usually elderly with many comorbidities. Minimizing surgical morbidity and mortality depends on the appropriate preoperative selection of the patient by the surgeon, meticulous intraoperative surgical techniques, and close monitoring and early intervention in the postoperative period should complications occur. Favorable outcomes, however, are equally dependent on precise preoperative and intraoperative anesthetic evaluation and techniques, which require an in-depth understanding by the anesthesiologist of the planned procedure and the potential complications associated with each. Most procedures require frequent communication between the surgical team and the anesthesia team, with adjustments of ventilation parameters and fluids, as significant hemodynamic changes can occur with manipulation of the lung and cardiovascular structures during the surgical dissection. The postoperative management of pain by a dedicated acute pain service is central to early extubation and ambulation and improved pulmonary toilet for these patients. Well-placed and well-managed thoracic epidurals can save lives and save money through shortened hospital stays. A poorly placed or poorly managed catheter can result in the death of a patient. Clearly, the welfare of the patients undergoing these complex procedures is dependent on the combined skills of the surgeon and the anesthesiologist. This article reviews the surgical aspects and potential complications of various thoracic oncology procedures. It is hoped that presenting these procedures from a surgical perspective will allow better planning and conduction of anesthetics in these challenging patients.