Results Of Pulmonary Resection Research Articles

Systematic Review of Neoadjuvant Immunotherapy for Patients With Non–Small Cell Lung Cancer

There is a paucity of robust clinical evidence for the role of neoadjuvant immunotherapy in patients with resectable non-small cell lung cancer. The primary aim of the study was to identify the available data on the feasibility, safety and efficacy of neoadjuvant immunotherapy. A systematic review was conducted using electronic databases. Relevant studies were identified according to predefined selection criteria. Five relevant publications on 4 completed trials were identified. In most studies, >90% of patients were able to undergo surgery within the planned timeframe after neoadjuvant immunotherapy. There was a high incidence of open thoracotomy procedures, either planned or converted from a planned minimally invasive approach. Mortality ranged from 0 to 5%, but none of the reported deaths were considered directly treatment-related. Morbidities were reported according to adverse events related to neoadjuvant systemic therapy, and postoperative surgical complications. Survival outcomes were limited due to short follow-up periods. Major pathologic response ranged from 40.5 to 56.7%, whilst complete pathologic response of the primary tumor ranged from 15 to 33%. Radiological responses were reported according to RECIST criteria and fluorodeoxyglucose-avidity. This systematic review reported safe perioperative outcomes of patients who underwent resection following neoadjuvant immunotherapy. However, there was a relatively high incidence of open thoracotomy procedures, partly due to the technical challenges associated with increased fibrosis and inflammation of tissue, as well as the more advanced stages of disease in patients enrolled in the studies. Future studies should focus on identifying predictors of pathological response.

Indications et résultats des exérèses pulmonaires dans un pays en développement

Indications for pulmonary excision are dominated by infectious pulmonary pathologies in developing countries. We conducted this study to describe the indications and results of pulmonary resections in the thoracic surgery department of the Mali hospital. This is a retrospective and descriptive study from January 2012 to December 2019, carried out in the thoracic surgery department of the Mali hospital. It involved 76 patients who had a pulmonary resection. The variables studied were the epidemiological data, the operating indications, the therapeutic data and the prognosis. The mean age of the patients was 35.5 years. The sex ratio was 1.7. The average consultation time in thoracic surgery was 11.6 months with extremes of 7 days and 96 months. A history of pulmonary tuberculosis was noted in 46.1% of patients. The main indications for pulmonary resection were infectious parenchymal destruction in 64.5%, bullous dystrophy in 14.5%, bronchopulmonary cancer in 11.8% and thoracic trauma in 4% of the cases. The procedures performed were: a lobectomy (39.5%), atypical resection (36.8%), culminectomy (7.9%) and pneumonectomy (15.8%). Morbidity was dominated by thoracic empyema (9.2%) postoperative hemorrhage (5.2%), parietal suppuration (7.8%) and bronchopleural fistula (1.3%). The average length of hospital stay was 14.3 days. Mortality was 10.5%. There was a statistically significant correlation between pneumonectomy and deaths (P=0.01). Infectious lung destruction is the main indication for pulmonary resection in Mali. The consultation period is quite long. Morbidity and mortality remains high.

Le rôle des résections pulmonaires dans le traitement de la tuberculose multirésistante. Une série monocentrique de 29 patients

Multidrug-resistant tuberculosis (MDR-TB) is a worldwide health problem. Surgery is often used as an adjuvent therapy with anti-tuberculosis agents. The aim of this study is to present our results of pulmonary resections in the treatment of MDR-TB. [corrected] This is a retrospective monocentric study of 29 patients operated on between 1995 and 2010 for MDR-TB. Tuberculosis was evolving from 9 to 108 months with a median of 34.77±19.88 months. The average number of tuberculosis relapses was 2.73 per patient. All patients had a destroyed and/or cavitary parenchyma and 17 had bacilli in sputum at the time of surgery. Lobectomy (51.17%) and pneumonectomy (41.37%) were the main interventions carried out. The operative mortality was 3.44%. Complications such prolonged air leaking and empyema had occurred in 9 patients. The rate of postoperative microbiological conversion was 88.23%. One patient had a relapse 5 months after surgery. Surgery associated with medical treatment provides a high cure rate to the detriment of an acceptable morbidity and mortality.

Clinical profile and postoperative outcome in patients with simple and complex aspergilloma of lung.

To compare the clinical presentation and results of pulmonary resection in simple and complex aspergilloma of the lung. Observational study. The Department of Thoracic Surgery, Jinnah Postgraduate Medical Centre, Karachi, from January 2003 to December 2008. Fifty-one adult patients with unilateral aspergilloma lung were included in this study. Patients were divided into two groups: A (simple aspergilloma-SA, n=14) and B (complex aspergilloma-CA, n=37), based on the radiological and operative characteristics of the cavitatory lesion and the presence or absence of extensive adhesions with the chest wall. Suitability for resection was assessed with arterial gases, pulmonary function tests and echocardiogram. Results were compared using Fishers exact test. Recurrent hemoptysis was the predominant symptom in both the groups. Exertional dyspnea (A=21.4%; B=56.8%; p=0.03), chest pain (A=21.4%; B=59.5%; p=0.027), cough (A=35.7%; B=70.3%; p < 0.05) and postoperative complications like residual pleural space A=14.2%; B=54%; p=0.013) and pleural collection (A=7.1%; B=37.8%; p=0.041) were predominant in group B. Lobectomy was the most common procedure performed in group B (A=28.6%; B=59.5%), while wedge excision was performed in the majority of patients in group A (A=42.9%; B=29.7%). Recurrence of aspergilloma was seen in 3 patients (8.1%) in group B only. Total number of early and late complications in SA and CA were 7, and 60, respectively. Early mortality was 8.1% and 0.0% in group B and group A, [corrected] respectively (p=0.552). The overall mortality was 5.4%. Symptoms were more frequently associated with CA as compared to SA. Surgery for CA was associated with low mortality but significant morbidity, whereas SA had low postoperative morbidity and no mortality.

Results of pulmonary resection following neoadjuvant therapy for locally advanced (IIIA–IIIB) lung cancer

We performed this study to determine the role and prognostic factors of neoadjuvant therapy followed by surgery for locally advanced non-small cell cancer. One hundred patients with clinical stage III non-small cell lung cancer (79 IIIA, 21 IIIB; 78 males, 22 females; average age 60.5 years) received neoadjuvant therapy, of whom 84 received two cycles of platinum chemotherapy combined with an average radiation dose of 41.5Gy, and 16 patients underwent chemotherapy alone. The mean follow-up duration was 80.9 months. Survival rate was estimated by the Kaplan-Meier method, and a Cox proportional hazards model was applied to determine the prognostic factors. The operative procedures included 74 lobectomies, 7 bi-lobectomies, and 19 pneumonectomies. Two patients died within 30 days due to adult respiratory distress syndrome and acute pulmonary embolism, respectively. The overall 5-year survival rate was 39.7% with a median survival time (MST) of 39.6 months. The 5-year survival rate for downstaged (pN1,2) patients was 53.5% while it was 16.3% for patients with residual N2. There was no difference in survival between lobectomy and pneumonectomy (MST 38 months vs 42 months). Univariate and multivariate analyses revealed that nodal status and tumor size after neoadjuvant therapy were independent prognostic factors. Neoadjuvant therapy was shown to deliver the optimal effect for surgery for cIIIA/IIIB NSCLC with acceptable mortality. Re-staging to exclude the residual multiple nodal metastasis can lead to the proper patient selection. A pneumonectomy, as a last option, following neoadjuvant therapy did not affect the mortality.

Resection of the Right Middle Lobe and Lingula in Children for Middle Lobe/Lingula Syndrome

To review our experience with specific characteristics, indications, and results of pulmonary resection in children with middle lobe/lingula syndrome. Retrospective cohort study. Thoracic Surgery Department, Chest Diseases Hospital, Kuwait. Thirteen children with middle lobe, lingula, or both syndromes were treated with pulmonary resection from January 1995 to December 1999. The mean age was 7.5 years (range, 5 to 10 years). Eight patients were girls, and five were boys. All patients underwent high-resolution CT and bronchoscopy. Bronchiectasis and atelectasis of right middle lobe, lingula, or both was noted in nine patients. Bronchial stenosis and inflammation of the bronchus was found endoscopically in four patients. The indications for surgery were recurrent respiratory tract infection with persistent atelectasis and bronchiectasis in nine patients, and recurrent respiratory tract infection with bronchiectasis in four patients. A right middle lobectomy was done on seven patients and a lingulectomy on four patients. Two patients underwent staged thoracotomies (right middle lobectomy and lingulectomy). There were no operative deaths. Only two patients had postoperative complications: atelectasis (n = 1), and pneumothorax (n = 1). Mean follow-up was 3.5 years (range, 3 to 5 years) for all patients. Nine patients were asymptomatic, and four patients had improved. Right middle lobe or lingula syndrome with the presence of bronchiectasis, bronchial stenosis, or failure of lung to re-expand are indications for early pulmonary resection.

Early operative mortality after surgical treatment of bronchogenic carcinoma

Background : A retrospective analysis of the results of pulmonary resection over a 7 years period for bronchogenic carcinoma was performed. Methods: Three hundred and eleven patients with primary bronchogenic carcinoma were operated upon at Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, between January 1996 to June 2002. There were 62 pneumonectomies (19.93%), 174 lobectomies (55.94%) and 75 lesser resections (24.11%). Results: The overall operative mortality was 4.82%. The mortality rate for pneumonectomy, lobectomy and lesser resections were 9.6%, 4.5% and 1.3% respectively. There was no significant difference in operative mortality between pneumonectomy and lobectomy, and between lobectomy and lesser resections. Post operative mortality rate increased as the age of patient increased. Mortality was 2.3;2.9;5.0;7.41; and 14.2 in the age groups of <50 years, 50-59 years, 60-69 years, 70-79 years and 80 years and above respectively. Pneumonia and respiratory failure caused most deaths (46.66%). Conclusions: Pulmonary resections can be performed with satisfactory mortality and morbidity in bronchogenic carcinoma. (Ind J Thorac Cardiovasc Surg, 2003; 19: 174–177)

Pulmonary Resection in Infants for Congenital Pulmonary Malformation

To review our experience with indications, timing, and results of pulmonary resection in infants. Retrospective cohort study. Thoracic Surgery Department, Chest Diseases Hospital, Kuwait. Forty-seven infants with congenital lung diseases were treated with pulmonary resection from January 1993 to December 2000. The mean age at the time of diagnosis was 90 days (range, 7 days to 11 months). Thirty-four patients were male (72%). Congenital lobar emphysema, congenital cystic adenomatoid malformation, pulmonary sequestration, and atelectasis were seen in 26, 10, 6, and 5 patients, respectively. The indications for surgery were respiratory distress in 32 patients (68%), respiratory tract infections in 12 patients (26%), and the presence of asymptomatic chest radiographic findings in 3 patients (6%). A lobectomy was performed in 42 patients (89%), bilobectomy in 2 patients (4%), left pneumonectomy in 1 patient (2%), and excision of a mass in 2 patients with extralobar sequestration (4%). An emergency lobectomy was performed in seven patients (15%). Only one postoperative death occurred following a left pneumonectomy for extensive congenital adenomatoid malformation due to pulmonary hypertension. Four patients (9%) had postoperative complications: atelectasis (n = 2), prolonged air leak (n = 1), and pneumothorax (n = 1). Mean follow-up was 4 years (range, 1 to 5 years) for all patients. None of the patients had any physical limitations. Pulmonary resection is indicated for the majority of patients with congenital lung malformations. In case of severe respiratory distress, an emergency lobectomy can be performed safely.

Factors influencing survival following pulmonary resection for metastatic colorectal carcinoma.

The results of pulmonary resection and clinical factors relating to long-term survival were evaluated in 29 patients with histologically proven pulmonary metastasis from colorectal carcinoma. The patients were followed up from 4 months to 120 months, with an average of 43.7 months. Overall 5- and 10-year survival rates were 41% and 34% respectively. The 5- and 10-year survival rates in patients with metastatic nodules 30 cm or less in diameter were 77% and 58%, respectively, a significantly better result than in those with metastatic nodules over 30 mm in diameter. Survival in patients without nodal involvement was significantly better than that in patients with lymph node metastases. Multivariate analysis according to Cox proportional hazards model demonstrated that the size of the metastasis was an independent prognostic factor.

Pulmonary Resection for Metastatic Soft Tissue Sarcomas

The therapeutic results of pulmonary resection for metastatic soft tissue sarcomas were analyzed. From 1970 to 1992, 23 patients (15 male and 8 female) underwent 40 pulmonary resections for metastatic soft tissue sarcomas. Nine (39%) patients had multiple thoracotomies for recurrences (range, 2-6). The 5-year actuarial overall survival was 32% (median, 28 months). Statistical analysis showed that age, gender, location of primary tumor, histology, site of pulmonary metastasis, tumor doubling time, or chemotherapy did not impact on survival. Significant prognostic factors associated with improved survival (p < 0.05) included a disease-free interval, and completeness and extent of the initial pulmonary resection. Patients with disease-free intervals > or = 12 months survived longer (5-year survival, 48.5%) than patients with disease-free intervals < 12 months (12%). Patients who could be rendered free of disease at their initial thoracotomy, without extended chest-wall resection, achieved a better outcome (5-year survival, 44%) than the others (5-year survival, 0%).

Results of pulmonary resection in cases of unilateral bronchiectasis.

Follow-up studies of 22 patients treated surgically for unilateral bronchiectasis showed that all patients were improved postoperatively following an average observation time of 9 years, 50% being completely free of respiratory symptoms. In all patients the number of days of recurrent illness had declined significantly after surgery. As mortality and morbidity rates in this kind of surgery are not negligible, a most careful pre-operative selection of patients suffering from bronchiectasis is indicated.

Pulmonary resection in cystic fibrosis. Results in 23 cases, 1957-1970.

The results of pulmonary resection in 23 patients with cystic fibrosis are described. Before surgery, patients were classified into three groups on clinical and radiological grounds, those in whom (A) a good prognosis was expected after surgery, (B) surgery was considered palliative but it was hoped to improve general health and to reduce symptoms, (C) surgery might be immediately life saving. Preoperative and postoperative management is described, and the results are reviewed one year after operation and at the present time. It is concluded that pulmonary resection has a place in the management of cystic fibrosis: it may result in clearing of staphylococci from sputum and pharynx, with lessening of the generalized bronchial changes seen on chest x-ray. Careful selection is essential and surveillance must be continued after operation. Immediate postoperative complications may lead to an increase of localized disease. The ability of the parents or child to accept long-term supervision and medical management is a big factor in success.

RESECTION IN PATIENTS WITH ATYPICAL PUMONARY TUBERCULOSIS

The results of pulmonary resection in 27 cases of atypical tuberculosis have been analysed. In only two cases has relapse occurred after resection, and the relapses occurred six years and three years respectively after resection. The other 25 patients have been followed up carefully for from six months to more than nine years after resection. On the whole, there was a 93% favourable result, and one of the two patients who relapsed responded satisfactorily to retreatment with ethambutol plus other drugs. It is suggested that until more effective chemotherapy is available for atypical mycobacterial disease, resection should be considered the treatment of choice. This may be possible in only a small number of patients because of age, extent of disease, and other associated diseases. No doubt it is wise to “cover” the operation with some antituberculosis chemotherapy and it is likely that at present a combination of ethambutol, capreomycin and isoxyl is of greatest value (Evans and Thong, 1969). However, most of the patients reported in this series had received only standard antituberculosis chemotherapy with streptomycin, isoniazid and para-aminosalicylic acid before and after operation. Some “atypical” features in the histology of the lung lesions due to atypical mycobacterial infection have been suggested in this study, and further work is in progress.

SURGICAL TREATMENT OF PULMONARY METASTASES FROM PRIMARY TUMOURS OF BONE

1 . A series of twelve patients with solitary lung metastases from primary tumours of bone is reviewed. There were seven osteosarcomas, two chondrosarcomas, two fibrosarcomas and one malignant chondroblastoma. In each patient the lung desposit was resected. 2. Four patients have so far died from the disease. The average survival of the others since pulmonary resection is six years and seven months. 3. It is suggested that the results of pulmonary resection in carefully selected patients with solitary pulmonary metastases fully justify the procedure. 4. Careful investigation to ensure as far as possible that the metastasis is solitary, and a "waiting period" in case others should develop, are essential if unnecessary surgery is to be avoided. A waiting period of three months is recommended.

Results of Pulmonary Resection in the Treatment of Tuberculosis

SUMMARY This study represents a review of 360 patients subjected to 364 pulmonary resections between May, 1955 and September, 1959. The minimal follow-up for patients alive in January, 1960 is four months, the maximum being four years and six months. The majority of the patients have been followed in our chest clinics after discharge from the hospital. Approximately 91 per cent of the survivals are well and leading normal lives, 4.7 per cent still have active disease with or without positive sputum.

U.S. Veterans Administration Armed Forces cooperative studies of tuberculosis. IV. Results of pulmonary resection, 1952-1955.

U.S. Veterans Administration Armed Forces cooperative studies of tuberculosis. IV. Results of pulmonary resection, 1952-1955.

Spontaneous pneumothorax, a review with the results of pulmonary resection in nineteen patients.

Spontaneous pneumothorax, a review with the results of pulmonary resection in nineteen patients.