Preservation Of Pulmonary Function Research Articles

Quantitative computed tomography assessment of pulmonary function and compensation after lobectomy and segmentectomy in lung cancer patients.

The effect of different surgical methods on postoperative lung function in patients with lung cancer is still inconclusive. The main objective of this study was to compare the effects of video-assisted thoracic surgery (VATS) lobectomy and segmentectomy on postoperative pulmonary function and compensatory changes in patients undergoing lung cancer surgery. A total of 120 patients (82 VATS lobectomy, 38 VATS segmentectomy) were assessed for demographic characteristics, baseline pulmonary function, tumor volume, T stage, and histological grade. Postoperative pulmonary function and compensatory changes [percentage of the well-aerated lung (WAL) total (or unilateral) lung volume (LV) (WAL%) and non-operated lung (NOL)] were measured at multiple time points up to 2 years. Logistic regression analysis identified factors associated with WAL% decline after 1 year. Both VATS lobectomy and segmentectomy led to a decrease in pulmonary function, with no significant difference in the extent of decline between the two groups (all P>0.05). Lobectomy triggered a more pronounced compensatory response, characterized by increased ipsilateral NOL volume over time. Segmentectomy induced minimal compensatory changes and had a minimal impact on pulmonary function. Factors associated with decreased pulmonary ventilation after 1 year differed between the lobectomy and segmentectomy groups. In the lobectomy group, a higher preoperative WAL% of ipsilateral NOL [odds ratio (OR) =1.073; 95% confidence interval (CI): 1.017-1.133; P=0.01] was associated with a higher risk of decline in pulmonary function, whereas in the segmentectomy group, the only influencing factor was the preoperative contralateral mean lung density (MLD) (OR =0.932; 95% CI: 0.884-0.984; P=0.01). Both lobectomy and segmentectomy after lung cancer surgery result in a decrease in WAL%, with lobectomy demonstrating a stronger pulmonary compensatory capacity. The application of quantitative computed tomography (CT) has shown significant value in predicting postoperative pulmonary function preservation and compensatory changes, providing strong support for personalized surgical decision-making.

Preservation of Pulmonary Function Following Hematopoietic Cell Transplant for Sickle Cell Disease: A STAR Study

Preservation of Pulmonary Function Following Hematopoietic Cell Transplant for Sickle Cell Disease: A STAR Study

Mycophenolate and azathioprine efficacy in interstitial lung disease: a systematic review and meta-analysis

ObjectivesMycophenolate mofetil (MMF) and azathioprine (AZA) are immunomodulatory treatments in interstitial lung disease (ILD). This systematic review aimed to evaluate the efficacy of MMF or AZA on pulmonary function in...

Ground glass opacity resection extent assessment trial (GREAT): A study protocol of multi-institutional, prospective, open-label, randomized phase III trial of minimally invasive segmentectomy versus lobectomy for ground glass opacity (GGO)-containing early-stage invasive lung adenocarcinoma.

With widely use of computed tomography (CT) screening, an increasing number of early-stage lung cancers appearing as ground glass opacity (GGO) have been detected. Therefore, attempts have been made to investigate the feasibility of segmentectomy instead of lobectomy for those patients with GGO. However, the two recently released phase III trials failed to distinguish between GGO-containing lesions from pure solid nodules in the inclusion criteria, and the surgical methods did not distinguish between minimally invasive surgery and open thoracotomy. In addition, total lesion size≤ 2cm was taken as the inclusion criterion, instead of the solid part size recommended in the eighth edition of Union for International Cancer Control/International Association for the Study of Lung Cancer/American Joint Committee on Cancer (UICC/IASLC/AJCC) staging system. Hence, this present trial aims to figure out whether minimally invasive segmentectomy shows superiority in perioperative outcomes and non-inferiority in oncological prognosis over minimally invasive lobectomy among patients with GGO-containing clinical stage T1a-T1b lung invasive adenocarcinoma (IADC). Sample sizes are 1024 patients, who will be randomized into minimally invasive segmentectomy and lobectomy groups . Patients will be collected from 19 hospitals in China. Patients with peripheral mixed ground glass opacity (mGGO) with 0.5cm<total lesion size ≤ 3cm and 0.5cm<solid component size ≤ 2cm in lung window on CT scan are enrolled. The primary endpoint is 5-year recurrence-free survival (RFS). The secondary endpoints are 5-year overall survival (OS), perioperative outcomes and pulmonary function preservation. Kaplan-Meier curves are plotted to compare the survival outcomes between the two arms. Subgroup analyses are also performed to investigate the benefit of segmentectomy among different clinical variables. If the primary endpoint shows at least non-inferiority in 5-year RFS of segmentectomy to lobectomy, minimally invasive segmentectomy can be recommended as an alternative to minimally invasive lobectomy. If second endpoints show non-inferior 5-year OS along with better perioperative outcomes and/or better pulmonary function preservation of segmentectomy compared with lobectomy after the primary endpoint has reached, minimally invasive segmentectomy may become a preferred procedure for patients with GGO-containing clinical stage T1a-T1b IADCs. Chinese Clinical Trial Registry. Trial registration number: ChiCTR2000037065. https://www.chictr.org.cn/, identifier ChiCTR2000037065.

298P Does trisegmentectomy have functional benefit over lobectomy? Comparative analysis of changes in lung function and volumetry among stage IA non-small cell lung cancer patients

It was still controversial regarding the postoperative preservation of pulmonary function after segmentectomy over lobectomy. In particular, resection for three or more segment was associated with more profound decreased in lung function. The purpose of this study was to investigate the effect of left upper division (LUD) segmentectomy on postoperative pulmonary function and lung volume comparison of left upper lobectomy among clinical stage IA non-small cell lung cancer (NSCLC).

Pulmonary-function changes after uniportal video-assisted thoracoscopic anatomical lung resection

ObjectiveThe superiority of segmentectomy over lobectomy with regard to preservation of pulmonary function is controversial. This study aimed to examine changes in pulmonary function after uniportal video-assisted thoracoscopic surgery (VATS) according to the number of resected segments. MethodsWe retrospectively reviewed 135 consecutive patients who underwent anatomical lung resection via uniportal VATS from April 2015 to December 2020. Pulmonary function loss was evaluated using forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1). Patients were grouped according to number of resected segments: one-segment (n = 33), two segments (n = 22), three segments (n = 40), four segments (n = 15), and five segments (n = 25). ResultsClinical characteristics did not significantly differ between groups, except for tumor size. Mean follow-up was 8.96 ± 3.16 months. FVC loss was significantly greater in five-segment resection (10.8%) than one-segment (0.97%, p = 0.008) and two-segment resections (2.44%, p = 0.040). FEV1 loss was significantly greater in five-segment resection (15.02%) than one-segment (3.83%, p < 0.001), two-segment (4.63%, p = 0.001), and three-segment resections (7.63%, p = 0.007). Mean FVC loss and FEV1 loss increased linearly from one-segment resection to five-segment resection. Mean loss in FVC and FEV1 per segment resected was 2.16% and 3.00%, respectively. ConclusionsAnatomical lung resection of fewer segments was associated with better preservation of pulmonary function in patients undergoing uniportal VATS, and function loss was approximately 2%–3% per segment resected with linear relationship.

Induction immunotherapy followed by surgery for hilar unicentric Castleman disease

Castleman disease is a rare disease borne of a B cell lymphoproliferative disorder of uncertain cause. Standard therapy for the unicentric type of Castleman disease localized as a single mass or single lymph‐node station is surgical extirpation. Nevertheless, in the thoracic cavity, unresectable cases or cases of incomplete extirpation of the tumor without lung scarring owing to tumor size/location have been noted. In such cases, lung resection (e.g., lobectomy, pneumonectomy) or additional therapy (immunotherapy, chemotherapy, radiotherapy) after resection is required. However, few instances of patients receiving induction immunotherapy or chemotherapy followed by surgery have been reported. Here, we describe a 21‐year‐old woman with unicentric Castleman disease originating from the left hilum. The tumor seemed to involve/be in contact with the pulmonary vein and bronchus. Tumor location indicated that initial resection was necessary to sacrifice upper and lower pulmonary lobes. To avoid these pulmonary resections, induction therapy followed by surgery was selected. Induction therapy using rituximab was very efficacious. Resection after induction therapy was completed only by tumor extirpation, and resulted in preservation of pulmonary function. Thoracic surgeons might consider induction therapy followed by resection if the tumor is resectable UCAD, but initial resection is needed and sacrifices a large amount of pulmonary function.

A prospective trial of CT-guided percutaneous microwave ablation for lung tumors.

BackgroundPercutaneous ablation is an alternative treatment for lung cancer in non-operable patients. This is a prospective clinical trial for percutaneous microwave ablation (pMWA) of biopsy-proven lung cancer to demonstrate safety and efficacy.MethodsA prospective trial from 6-1-2016 to 1-1-2019 enrolled patients with biopsy-proven primary or metastatic lung cancer <3 cm in size and 1 cm away from the pleura for pMWA with the Emprint Ablation System with Thermosphere Technology for Phase I analysis, (Clinicaltrials.gov; #NCT0267302). Patients were followed for 1 year with PET/CT and PET/MR to determine patterns of recurrence and efficacy of ablation.ResultsAfter 12 patients consented for biopsy, 6 patients underwent treatment of 7 lesions, 3/6 women, median age of 67 (IQR, 65–70) years, body mass index (BMI): 27.8 (IQR, 21.4–32.1) kg/m2, lesion distance to pleura 24.4 (IQR, 13–38) mm, lesion size of 10.7 (IQR, 6–14) mm, and ablation duration time 5.9 (IQR, 3–10) minutes. pMWA were completed at 75 W. Twelve adverse events were reported (1 Grade 3, 3 Grade 2, and 8 Grade 1 events) with Grade 4 or 5 events. Mean % change after ablation in forced expiratory volume in one second (FEV1) was −2% and diffusion capacity for carbon monoxide (DLCO) was −1%. After 2–3 months, the lesions would decrease in size, rim thickness, fluorodeoxyglucose (FDG) activity, and T2 signal. FDG activity after 6 months was below blood pool in all cases. The ablation zones stabilized by 6–12 months. One patient expired during the study from pneumonia unrelated to ablation without local recurrence. Of the seven ablations during the 1 year follow-up, there was local tumor recurrence at 271 days following ablation at the apex of the ablation zone, subsequently successfully treated with percutaneous cryoablation (Cryo).ConclusionspMWA appears to be a safe and effective mechanism for treatment of primary and secondary tumors of the lung, with possible preservation of pulmonary function.

The effect of ultrasound-guided transversus abdominis plane block on pulmonary function in patients undergoing laparoscopic cholecystectomy: a prospective randomized study.

Transversus abdominis plane block (TAPB) is commonly used for postoperative pain control after laparoscopic cholecystectomy. However, few studies have analyzed its effect on pulmonary function. The goal of this study was to elucidate the effect of ultrasound-guided bilateral TAPB on pulmonary function preservation and analgesia after laparoscopic cholecystectomy. We enrolled 58 patients who underwent laparoscopic cholecystectomy. Among them, 53 were randomized to group T (n = 27) and group C (n = 26). Group T and group C received ultrasound-guided bilateral TAPB with 40ml of 0.375% ropivacaine and 40ml of 0.9% normal saline, respectively. Visual analog scale (VAS) scores, patient-controlled analgesia (PCA) consumption, forced vital capacity (FVC), forced expiratory volume in 1s (FEV1), FEV1/FVC, peak expiratory flow rate (PEF), and modified Borg scale scores were measured until 24h post-surgery. The VAS scores were significantly lower in group T than in group C at 1 and 8h after the surgery. PCA consumption was significantly lower in group T than in group C at all postoperative time points. FEV1, PEF, and FEV1/FVC were more preserved in group T than in group C at 1h. Group T had significantly lower modified Borg scale scores than did group C at 1 and 8h. Ultrasound-guided TAPB is effective in pulmonary function preservation and pain control after laparoscopic cholecystectomy. Therefore, it could be a great option for multimodal analgesia, preservation of pulmonary function, prevention of pulmonary complications including atelectasis, and promotion of postoperative recovery after laparoscopic cholecystectomy. This study was enrolled in the Clinical Research Information Service (Clinical Research Information Service, KCT0004435, Hwa Yong Shin, 2019-08-19).

Lobectomy versus segmentectomy: a propensity score-matched comparison of postoperative complications, pulmonary function and prognosis.

OBJECTIVESTo demonstrate the differences in clinical outcomes between lobectomy and segmentectomy for non-small cell lung cancer using propensity score matching.METHODSA single-centre, retrospective, matched cohort study was conducted in clinical T1N0M0 non-small cell lung cancer patients treated by surgery between 2012 and 2019. Differences in freedom from recurrence, overall survival, postoperative complications, chest drainage and preservation of pulmonary function between lobectomy and segmentectomy were evaluated using the propensity score model. Matched variables of patients were age, sex, comorbidity index and pulmonary function. Matched variables of tumours were tumour size, T-stage, fluorodeoxyglucose uptake on positron emission tomography, histopathology, lobe site and tumour distance ratio from the hilum.RESULTSOf the 112 patients treated by lobectomy and 233 patients treated by segmentectomy, 93 patients each from both groups were selected after the matching. The median tumour distance ratio from hilum was 0.7 in lobectomy and 0.8 in segmentectomy group (P = 0.59), i.e. almost outer third tumour location. There were no significant differences in freedom from recurrence (P = 0.38), overall survival (P = 0.51), postoperative complications (P = 0.94), drainage period (P = 0.53) and prolonged air leakage (P = 0.82) between the two. Median preservation of pulmonary function was 93.2% after segmentectomy, which was significantly higher than 85.9% after lobectomy (P < 0.001).CONCLUSIONSFreedom from recurrence, overall survival, postoperative complications and chest drainage were similar between segmentectomy and lobectomy. Segmentectomy could be one of the options for clinical T1N0M0 non-small cell lung cancer located outer third as well as being able to preserve pulmonary function better than lobectomy.Clinical trial registrationName: Retrospective analysis of segmentectomy and lobectomy for cT1N0M0 non-small cell lung cancerDate of approval: February 2014Number of IRB approval: 14-003.

Pulmonary function after segmentectomy versus lobectomy in patients with early-stage non-small-cell lung cancer: a meta-analysis.

ObjectiveSegmentectomy is widely performed for early-stage lung cancer. However, the effects of segmentectomy versus lobectomy on pulmonary function remain unclear. We performed a meta-analysis with the aim of comparing segmentectomy and lobectomy in terms of preservation of pulmonary function in patients with early-stage non-small-cell lung cancer (NSCLC).MethodsWe conducted a literature search of PubMed using the terms ‘pulmonary function’ AND ‘segmentectomy’ AND ‘lobectomy’. The primary outcomes of interest were the forced expiratory volume in 1 second (FEV1), FEV1 as percent of predicted (%FEV1), change in FEV1 (Δ%FEV1), and the ratio of postoperative to preoperative FEV1.ResultsThirteen studies comprising 2027 patients met the inclusion and exclusion criteria and were included for analysis, including 787 patients in the segmentectomy group and 1240 patients in the lobectomy group. Patients in the segmentectomy group showed significantly better preservation of FEV1 and %FEV1 compared with the lobectomy group. The reduction in FEV1 after surgery was significantly less in the segmentectomy group compared with the lobectomy group, and Δ%FEV1 was significantly higher in the segmentectomy group than in the lobectomy group.ConclusionSegmentectomy results in better preservation of pulmonary function compared with lobectomy in patients with early-stage NSCLC.

Negative impact of chemical pleurodesis on postoperative pulmonary function for managing prolonged air leakage after segmentectomy.

Prolonged air leakage (PAL) is the most common postoperative complication after segmentectomy and chemical pleurodesis (CP) is one of the common procedures for managing PAL. However, the impact of CP on postoperative pulmonary function remains unclear. We performed a propensity score matching analysis for postoperative pulmonary function in lung cancer patients who underwent segmentectomy. The percentage of postoperative functional change of forced vital capacity (δFVC) and forced expiratory volume in 1s (δFEV1.0) at postoperative 6 and 12months were compared between patients who were managed for PAL by CP (CP group, n = 21) and those who did not receive CP (non-CP, n = 21). The predicted δFVC and δFEV1.0 after segmentectomy and lobectomy were also assessed to evaluate the loss of preserved lung function. δFVC and δFEV1.0 in the CP group were confirmed by a significantly larger decline in postoperative pulmonary function than that seen in the non-CP group at postoperative 6 and 12months (δFVC at 6months, - 21.1% versus - 5.1%, - 20.8% versus - 6.8% at 12months, δFEV1.0 at 6months, - 19.1% versus - 7.2%, - 19.6% versus - 9.7%, at 12months, p < 0.05 respectively). Both δFVC and δFEV1.0 in the CP group were significantly lower than those predicted after segmentectomy (p < 0.01). They were not statistically different from the values predicted if lobectomy was performed. CP after segmentectomy caused the same amount of loss in pulmonary function that was predicted if lobectomy was performed. The benefit of segmentectomy compared to lobectomy for preservation of pulmonary function is impaired by CP.

Association of Monocyte Migration Marker CD11b With Pulmonary Function in People Living With HIV.

Maladaptive immune responses contribute to the pathogenesis of many chronic lung diseases. Here, we tested hypotheses that CD4 and CD8 T-cell and monocyte phenotypes are associated with lung function in people living with HIV and those without HIV. Markers of T cell differentiation, activation, exhaustion and senescence, and markers of monocyte recruitment and migration were quantified in 142 HIV-positive and 73 HIV-negative participants of the Pittsburgh HIV Lung Cohort. All participants underwent lung function testing. CD4 or CD8 T-cell phenotypes were not associated with measures of lung function in HIV-positive or HIV-negative participants after adjustment for multiple comparisons. In HIV-positive participants, however, the percentage of classical monocytes that were CD11b+ had positive associations at the Bonferroni-adjusted significance threshold of P = 0.05/63 with prebronchodilator and postbronchodilator forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) ratio (β = 0.36; P = 0.00003 and β = 0.31; P = 0.0003, respectively). In stratified analyses of n = 87 participants with CD4 ≥ 500 cells/µL, associations of percentage of classical monocytes that were CD11b+ with prebronchodilator and postbronchodilator FEV1/FVC ratio were stronger (β = 0.48 and β = 0.41, for pre- and post-, respectively) than in the entire HIV-positive study population. Significant associations of monocyte phenotypes were not observed in HIV-negative participants after adjustment for multiple comparisons. CD11b+ expression on classical monocytes is positively associated with FEV1/FVC ratio in people living with HIV including in those with CD4 T-cell recovery. Given the normal surveillance activity of monocytes, such association suggests this monocyte subset may play a role in preservation of pulmonary function in PLWH.

Use of Erector Spinae Plane Block in Thoracic Surgery Leads to Rapid Recovery From Anesthesia

Ultrasound guidance has resulted in a continuous evolution in techniques for pain control for video-assisted thoracoscopic surgery (VATS). The objective of this study was to compare erector spinae plane block with intercostal block as multimodal analgesia to elucidate quality of postoperative pain control and preservation of pulmonary function after VATS. A consecutive cohort of patients undergoing elective VATS was enrolled in the study and divided into erector spinae plane block and intercostal block groups. Spirometry and visual analog scale pain score exams were performed to measure forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC ratio, and forced expiratory flow in intervals of 25% to 75%. Chronic pain was assessed by reviewing surgical follow-up notes. Seventy-eight patients were included. Comparing the erector spinae plane block group with the intercostal block group found significant improvement in visual analog scale pain score (3.2 vs 6.4, P < .001), postanesthesia care unit length of stay (127.3 vs 189.5 minutes, P= .045), preservation in lung volume parameters at 2 hours (FVC: 40.5% vs 51.4%, P < .001; FEV1: 40.9% vs 53.8%, P < .001; and forced expiratory flow in intervals of 25%-75%: 39.7% vs 53.7%, P= .019) and at 24 hours (FVC: 37.8% vs 50.5%, P < .001; FEV1: 34.3% vs 51.9%, P < .001; forced expiratory flow in intervals of 25%-75%: 27.1% vs 56.3%, P < .001), respectively. Erector spinae plane block improves acute and chronic pain control and preserves lung function. Thus, it has the potential for enhanced recovery from VATS as part of a multimodal analgesia regimen.

Are We Neglecting Long Term Effects of Vertebral Shortening on Pulmonary Function in Spinal Tuberculosis?

Background: In developing part of world, it is common to see near complete destruction of vertebral bodies in TB due to contiguous involvement of multiple vertebrae. This leads to frequent occurrence of spinal deformities including kyphosis. Resultant loss of vertebral column height & its effects on pulmonary function haven't been studied previously. Our study aims to assess effect of spinal TB with vertebral shortening on pulmonary function. Methods: 50 cases consisted of both operative & non operatively managed cases of spinal TB who presented to tertiary care institute between the years 2011 to 2016 were assessed. Vertebral height loss was assessed by SDI. All patients underwent pulmonary function testing and various spirometry variables were considered. Arm span was used as a surrogate marker for height. Findings: Study group consisted of 14 males & 36 females with mean age of 27.9 years. 11 patients with mean SDI of 2.72 ± 1.1 showed normal lung function. 36 patients showed a restrictive pattern of which 12 showed mild, 14 moderate and 10 showed severe pattern. Only 3 cases showed an Obstructive pattern. 36 patients had Thoracic affection, 13 patients had a thoracolumbar affection while 1 patient had a purely Lumbar affection. As the apex of the curve shifted proximally, the FVC% reduced and the decrement was statistically significant. Increase in the SDI value was associated with a fall in the vital capacity and FEV1. Increase in the kyphotic angle was associated with a deleterious effect on PFT results. SDI showed significant difference between Normal & restrictive pattern groups. Interpretations: Careful preservation of pulmonary function along with restoration of neurological function should be the aim of management of TB spine. Usually shortening procedures are better tolerated by spinal cord as compared to distraction. However, pulmonary dysfunction resulting from vertebral body height loss due to kyphosis is neglected. This risk stratification will further emphasize the need for early detection of this disease before the deformity sets in & need for long term observation for possible deterioration in lung function. Funding Statement: The authors hereby declare that they have not received any funding for this manuscript. Declaration of Interests: Each author certifies that he or she has no commercial associations (e.g. consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. Ethics Approval Statement: Approval from the IRB was taken prior to commencement.

Surgical treatment to multiple primary lung cancer patients: a systematic review and meta-analysis

BackgroundAs there is no consensus on the optimal surgery strategy for multiple primary lung cancer (MPLC), we conducted this study to address this issue by comparing the prognosis of MPLC patients underwent different surgical strategies including sublobar resection and the standard resection through a systemic review and meta-analysis.MethodsRelevant literature was obtained from three databases including PubMed, Embase and Web of Science. Inclusion and exclusion criteria were set for the screening of articles to be selected for further conduction of systemic review and meta-analysis. The HRs of OS of the sublobar group compared with standard resection group were extracted directly or calculated indirectly from included researches.ResultsTen researches published from 2000 to 2017 were included in this study, with 468 and 445 MPLC cases for the standard resection group and sublobar resection group respectively. The result suggested that OS of MPLC patients underwent sublobar resection (segmentectomy or wedge resection for at least one lesion) was comparable with those underwent standard resection approach (lobectomy or pneumonectomy for all lesions), with HR 1.07, 95% CI 0.67–1.71, p = 0.784. Further analysis found no difference in subgroups of synchronous and metachronous (from second metachronous lesion), different population region and dominant sex type.ConclusionsThis study may reveal that sublobar resection is acceptable for patients with MPLC at an early stage, because of the equivalent prognosis to the standard resection and better pulmonary function preservation. Further research is needed to validate these findings.

Pre-operative Bronchodilator Treated Patients Preserve Better Pulmonary Function in CABG Cases

Background: Bronchodilator {P2selective adrenergic drug-salbutamol) causes bronchodilation and increases the vital capacity, tidal volume and total lung capacity and reduces gas trapping. Use of bronchodilator in patients undergoing Off-pump coronary artery bypass graft (OPCABG) may lead to better preservation of pulmonary function.&#x0D; Objective: To evaluate the role of bronchodilator on preservation of post-operative pulmonary function in patients who underwent OPCABG.&#x0D; Methods: This study was conducted on 50 patients randomized into two groups to assess the pulmonary function after off-pump CABG. Among them, 25 patients (group-I) were treated by preoperatively bronchodilator and compared them with other 25 patients (group-II) who were not treated by preoperative bronchodilator. We compared arterial blood gas analysis, duration of total mechanical ventilation, days spent in the surgical ICU and spirometric indices.&#x0D; Results: Mean±SE value of mechanical ventilation time after operation in group-I was 14.25±0.85 hours and in group-II was 16.88±0.85 hours. Mean±SE value of ICU stay after surgery was 98.64±2.07 hours in group I and 110.56±2.36 hours in group-II. Both results were statistically significant (P=0.042 and P=0.001 respectively). The FVC and FEV1 after admission were not statistically significant (P&gt;0.05). On the day before surgery the values of FVC and FEV1 were increased (more in group-1 who were treated with bronchodilator) and 7th postoperative day the value were decreased (more in group -11 who were not treated with bronchodilator). The results were found statistically significant in between two groups (P&lt;0.05). Significant difference were found in PaO2 and PaCO2 on arterial blood gas analysis at half an hour after extubation and on 1st POD (P&lt;0.05). Mean±SE value of postoperative hospital day in group-1 was 8.88±0.24 days and in group II was 10.14±0.43 days which was found statistically significant (p=0.014). Among post-operative pulmonary complications, in group 1, one (4%) patient was found with pleural effusion and one (4%) patient with atelectasis. but in group-II, one (4%) patient was found with pleural effusion and five (20%) patients were found with atelectasis.&#x0D; Conclusion: Use of bronchodilator preoperatively in patients who underwent OPCABG with impaired pulmonary function leads to reduced mechanical ventilation time, less ICU stay after surgery, better preservation of pulmonary function, reduced post-operative pulmonary complications and reduced hospital stay.&#x0D; Journal of Surgical Sciences (2014) Vol. 18 (2) : 51-56

Single-port video-assisted thoracoscopic surgery subsegmentectomy: The learning curve and initial outcome

We report initial surgical results and learning process of single-port video-assisted thoracoscopic surgery (VATS) subsegmentectomy in comparison with segmentectomy in our institution as the presentative of minimal invasiveness and precise resection for early stage lung cancer. All patients undergoing single-port VATS sublobar anatomic resection between January 2014 and December 2018 for clinical diagnosis of lung cancer were included. The learning curve was analyzed using the cumulative summation (CUSUM) method. Comparisons were done between those who underwent single-port VATS subsegmentectomy and segmentectomy. A total of 364 patients underwent single-port VATS segmentectomy and 91 patients underwent single-port VATS subsegmentectomy were included. Lung adenocarcinoma was the most common (61.1%) diagnosis. The operative time and blood loss in the subsegmentectomy group were less than the segmentectomy group. The incidence of intraoperative complication was also lower in the subsegmentectomy group. The surgical proficiency was reached at 28 cases in single-port VATS subsegmentectomy. For primary lung cancer, the tumor size in subsegmentectomy group was smaller than segmentectomy group (1.1cm versus 1.4cm, p=0.026). The resection margin was smaller in subsegmentectomy group, and both groups reached adequate margin without significant difference (94.7% versus 95.5%, p=0.737). During the follow-up period, 2 (3.5%) patients in subsegmentectomy group and 9 (4.1%) patients in segmentectomy group developed distant metastasis. Single-port VATS subsegmentectomy is safe and feasible for small-sized lung lesion, providing the benefit of minimal invasiveness, preservation of pulmonary function, and clearance of lymphatic drainage at the intersegmental plane. The surgical proficiency could be achieved based on the experiences in single-port VATS segmentectomy.

Tolerogenic signaling of alveolar macrophages induces lung adaptation to oxidative injury

Inhaled oxidative toxicants present in ambient air cause airway epithelial injury, inflammation, and airway hyperresponsiveness. Effective adaptation to such environmental insults is essential for the preservation of pulmonary function, whereas failure or incomplete adaptation to oxidative injury can render the host susceptible to the development of airway disease. We sought to explore the mechanisms of airway adaptation to oxidative injury. For a model to study pulmonary adaptation to oxidative stress-induced lung injury, we exposed mice to repeated nose-only chlorine gas exposures.Outcome measures were evaluated 24hours after the last chlorine exposure. Lung mechanics and airway responsiveness to methacholine were assessed by using the flexiVent. Inflammation and antioxidant responses were assessed in both bronchoalveolar lavage fluid and lung tissue. Using both loss or gain of function and genomic approaches, we further dissected the cellular and molecular mechanisms involved in pulmonary adaptation. Repeated exposures to oxidative stress resulted in pulmonary adaptation evidenced by abrogation of neutrophilic inflammation and airway hyperresponsiveness. This adaptation was independent of antioxidant mechanisms and regulatory Tcells but dependent on residential alveolar macrophages (AMs). Interestingly, 5% of AMs expressed forkhead box P3, and depletion of these cells abolished adaptation. Results from transcriptomic profiling and loss and gain of function suggest that adaptation might be dependent on TGF-β and prostaglandin E2. Pulmonary adaptation during oxidative stress-induced lung injury is mediated by a novel subset of forkhead box P3-positive AMs that limits inflammation, favoring airway adaptation and host fitness through TGF-β and prostaglandin E2.

Robotic surgery for pulmonary segmentectomy

Although pulmonary segmentectomy for early stage of non-small cell lung cancer (NSCLC) has been debated regarding its effect on local recurrence and survival, it has several advantages including preservation of pulmonary function and decreased perioperative risk (1). Among anatomical pulmonary segmentectomies, segmentectomy for medial and anterior basal segments of lower lobe is one of the most challenging operations. Hiebinger et al . have performed bisegmentectomy for these segments via video-assisted thoracoscopic surgery (VATS) and Li et al . have performed it via robotic surgery (2,3).