Department Of Thoracic Surgery Research Articles

Surgical tactics for the treatment of subpleural and intra-pulmonary hematomas as a result of pneumonia caused by COVID-19

BACKGROUND. In December 2019, cases of pneumonia of unknown etiology were detected in Wuhan (China), and later a new type of coronavirus was identified – SARS-CoV-2. In March 2020, spread of the SARS-CoV-2 was officially recognized as a pandemic.
 OBJECTIVE. To demonstrate to the doctors of the thoracic surgery and pulmonology departments our experience in the tactics of treating subpleural and intrapulmonary hematomas, which is a consequence of a coronavirus infection, and determining the need for surgical intervention.
 MATERIALS AND METHODS. From the beginning of the COVID-19 pandemic on the basis of the clinical department of the surgical treatment of tuberculosis and non-specific diseases complicated by purulent-septic infections of the SI “National Institute of Phthisiology and Pulmonology named after F.G. Yanovsky of the NAMS of Ukraine” treated 11 patients with spontaneous hematomas of post-COVID genesis, of which subpleural hematomas accounted for 9 cases (81.8 %), and intrapulmonary – 2 (18.2 %). The distribution by gender was as follows: 7 (63.6 %) women were treated, and 4 (36.4 %) men. The age of the patients ranged from 28 to 70 years, the average age was 45 years. This group of patients had the following associated pathologies: chronic obstructive pulmonary disease – 3 (27.3 %), hypertension – 3 (27.3 %), diabetes – 2 (18.2 %), chronic renal failure – 1 (9.0 %), ischemic heart disease – 2 (18.2 %).
 CONCLUSIONS. Lack of timely diagnosis and surgical treatment of subpleural and intrapulmonary hematomas often leads to the addition of secondary infection, which complicates the treatment process.

Comparative efficacy of different combinations of acapella, active cycle of breathing technique, and external diaphragmatic pacing in perioperative patients with lung cancer: a randomised controlled trial

BackgroundAcapella plus active cycle of breathing technique (ACBT), external diaphragm pacemaker (EDP) plus ACBT have been shown to facilitate the recovery of functional capacity and lung function in patients suffering from airway obstruction but the efficacy in perioperative patients with lung cancer has not been proven.MethodsWe conducted a three-arm, prospective, randomized, assessor-blinded, controlled trial in patients with lung cancer who underwent thoracoscopic lobectomy or segmentectomy in the department of thoracic surgery, China. Patients were randomly assigned (1:1:1) to receive Acapella plus ACBT, EDP plus ACBT, or ACBT group (control group) using SAS software. The primary outcome was functional capacity, measured by the 6-minute walk test (6MWT).ResultsWe recruited 363 participants over 17 months: 123 assigned to the Acapella plus ACBT group, 119 to the EDP plus ACBT group, and 121 to the ACBT group. Statistically significant differences were noted for functional capacity between the EDP plus ACBT and control groups at each follow-up time (1-week follow-up: difference = 47.25 m, 95% CI, 31.56–62.93; P < 0.001; and 1-month follow-up: difference = 49.72 m, 95% CI, 34.04–65.41; P < 0.001), between the Acapella plus ACBT and control groups at postoperative week 1 (difference = 35.23 m, 95% CI, 19.30–51.16; P < 0.001) and postoperative month 1 (difference = 34.96 m, 95% CI, 19.03–50.89; P < 0.001), and between the EDP plus ACBT and Acapella plus ACBT groups at 1-month follow-up (difference = 14.76 m, 95% CI, 1.34–28.19; P = 0.0316).ConclusionEDP plus ACBT and Acapella plus ACBT significantly improved functional capacity and lung function in perioperative patients with lung cancer, compared with single-model ACBT, and the effects of EDP plus ACBT were clearly superior to those of other programs.Trial registrationThe study was registered in the clinical trial database (clinicaltrials.gov) on June 4, 2021 (No. NCT04914624).

Living-donor lobar lung transplantation for pulmonary hypertension: living on the edge?

Journal Article Accepted manuscript Living-donor lobar lung transplantation for pulmonary hypertension: living on the edge? Get access Dirk Van Raemdonck, MD, PhD, Dirk Van Raemdonck, MD, PhD Departments of Thoracic Surgery, University Hospitals LeuvenDepartment of Chronic Diseases and Metabolism, Katholieke Universiteit Leuven, Leuven, Belgium Corresponding Author Contact Information: Dirk Van Raemdonck, MD, PHD, Department of Thoracic Surgery, University Hospital Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium. E-mail: dirk.vanraemdonck@uzleuven.be Phone:+32 16 34 68 23, Facsimile:+32 16 34 68 24 https://orcid.org/0000-0003-1261-0992 Search for other works by this author on: Oxford Academic PubMed Google Scholar Robin Vos, MD, PhD, Robin Vos, MD, PhD Departments of Respiratory Diseases, University Hospitals LeuvenDepartment of Chronic Diseases and Metabolism, Katholieke Universiteit Leuven, Leuven, Belgium https://orcid.org/0000-0002-3468-9251 Search for other works by this author on: Oxford Academic PubMed Google Scholar Geert M Verleden, MD, PhD, Geert M Verleden, MD, PhD Departments of Respiratory Diseases, University Hospitals LeuvenDepartment of Chronic Diseases and Metabolism, Katholieke Universiteit Leuven, Leuven, Belgium https://orcid.org/0000-0003-3048-2429 Search for other works by this author on: Oxford Academic PubMed Google Scholar Laurens J Ceulemans, MD, PhD Laurens J Ceulemans, MD, PhD Departments of Thoracic Surgery, University Hospitals LeuvenDepartment of Chronic Diseases and Metabolism, Katholieke Universiteit Leuven, Leuven, Belgium https://orcid.org/0000-0002-4261-7100 Search for other works by this author on: Oxford Academic PubMed Google Scholar European Journal of Cardio-Thoracic Surgery, ezad097, https://doi.org/10.1093/ejcts/ezad097 Published: 23 March 2023 Article history Received: 03 March 2023 Accepted: 13 March 2023 Published: 23 March 2023

Evaluation of the Thoracic Surgery Integrated Care Program at the University Health Network

Introduction: In 2019, the University Health Network (UHN) implemented the Integrated Care (IC) program in the Thoracic Surgery Department. This program aims to facilitate the transition from hospital to community care for patients by providing support including accessible communication with an IC lead. Based on surgical procedure, patients were placed into low, medium, or high care paths. The IC program evaluation investigated risk of readmission and emergency department (ED) visits up to 90 days post-discharge in thoracic surgery patients. Methods and Analysis: This retrospective cohort study used IC cohorts: 1) Original IC patients discharged from June 2019 - Feb 2020, 2) New IC patients discharged from March 2020 – March 2022 3) Combined IC patients discharged from June 2019 – March 2022. These cohorts were compared to historical patients discharged from June 2018 - Feb 2019. Stratified by care path, readmission and ED visit risk were modelled using log-binomial models, adjusting for age, sex, and residence status. Outcomes: The new IC cohort had higher proportions of ED visits and readmissions compared to all other IC cohorts. In the low care path, there was a 15% reduction in readmission risk (RR: 0.85; 95% CI: 0.56, 1.28) in the new IC cohort compared to historical while there was a 20% reduction in readmission risk (RR: 0.81; 95% CI: 0.55, 1.19) in the combined IC cohort compared to historical. Similar trends followed for ED visits. Confidence intervals indicated insufficient evidence to conclude statistically significantly differences between cohorts. Conclusion: When comparing the results with the original IC cohort, there were higher proportions of readmission and ED visits in the new IC cohort. The attenuation of the risk ratio in the new IC cohort compared to the combined IC cohort (RR: 0.85 vs 0.81) suggests the IC program is less effective with new patients.

Clinical profile, surgical management and outcome of bronchial carcinoids - a single centre experience

Background and objectives: Bronchial carcinoid tumors are neuroendocrine neoplasms that range from low-grade typical carcinoids to more aggressive atypical carcinoids and, therefore demonstrate a wide spectrum of clinical behaviors, histologic features and outcome. The aim of the present study was to investigate the clinical profile, surgical management and outcome of bronchial carcinoids at a single centre over two years period. Materials and methods: Patients with a final histologic diagnosis of bronchial carcinoid tumor were included in the study. Evaluation comprised of clinical history and physical examination, postero-anterior and lateral chest radiographs, and computed tomographic (CT) scans of the chest and upper abdomen (including liver and adrenal glands). Performance status was assessed by the Karnofsky scale. Pulmonary function tests were performed routinely. Results: A total of 18 patients were included in the study. Out of 18 cases, 10 (55.6%) were female and 8 (44.4%) were males. Sixteen (88.9%) patients had typical carcinoid tumor and 2 (11.1%) had atypical carcinoid tumor. The tumor was located in the right lung in 11 (61.1%) and in the left lung in 7 patients (38.9%). Surgeries included 15 standard lobectomies and 3 bronchial sleeve resection. At one month post surgery, there was 13-22% increase in post operative FEV1 in patients who underwent bronchial sleeve resection while in patients who underwent lobectomy, the post operative FEV1 was 84% of pre-operative FEV1. Post surgery, all patients were in group A as per Karnofsky performance status. Conclusion: Standard care of bronchial carcinoid tumors is surgical resection, and the surgical approach should depend on tumor’s size, location and histology. IMC J Med Sci. 2023; 17(2):003. DOI: https://doi.org/10.55010/imcjms.17.013 *Correspondence: Farooq Ahmad Ganie, Department of Cardiovascular and Thoracic Surgery, SKIMS, Soura, Srinagar, Kashmir, India. Email: farooq.ganie@ymail.com

Pulmonary Surgical Apgar Score in clinical practice: how far we can go and how we can go further?

Journal Article Accepted manuscript Pulmonary Surgical Apgar Score in clinical practice: how far we can go and how we can go further? Get access Tian Jiang, Tian Jiang Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, ChinaCancer Center, Zhongshan Hospital, Fudan University, Shanghai, ChinaKey Laboratory of Lung Inflammation and Injury, Shanghai, China Search for other works by this author on: Oxford Academic PubMed Google Scholar Lijie Tan Lijie Tan Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, ChinaCancer Center, Zhongshan Hospital, Fudan University, Shanghai, ChinaKey Laboratory of Lung Inflammation and Injury, Shanghai, China Correspondence author: #Prof. Lijie Tan, Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, No.180 Fenglin Road, Shanghai 200032, China. Tel: +86-13681972151; Fax: +86-21-64041990; email: tan.lijie@zs-hospital.sh.cn Search for other works by this author on: Oxford Academic PubMed Google Scholar European Journal of Cardio-Thoracic Surgery, ezad092, https://doi.org/10.1093/ejcts/ezad092 Published: 13 March 2023 Article history Received: 01 March 2023 Accepted: 07 March 2023 Published: 13 March 2023

Clinical efficacy of robot-assisted subxiphoid versus lateral thoracic approach in the treatment of anterior mediastinal tumors

BackgroundThe purpose of this study was to compare the perioperative efficacy and safety of da Vinci robot-assisted thoracoscopic surgery (RATS) for treating anterior mediastinal tumors through the subxiphoid and lateral thoracic approaches under the anesthesia of nontracheal intubation (i.e., laryngeal mask airway).MethodsWe retrospectively analyzed the clinical data of 116 patients with anterior mediastinal tumors treated by RATS under laryngeal mask anesthesia completed by the same operator in the Department of Thoracic Surgery, Gansu Provincial People’s Hospital, from October 2016 to October 2022. There were a total of 52 patients including 24 males and 28 females, with an average age of 45.40±4.94 years, in the subxiphoid approach (subxiphoid group). On the other hand, there were a total of 64 patients including 34 males and 30 females, with a mean age of 46.86±5.46 years in the lateral thoracic approach (lateral thoracic group). Furthermore, we have detailedly compared and analyzed the operating time, intraoperative bleeding, and total postoperative drainage in the two groups.ResultsAll patients in both groups successfully completed resection of the anterior mediastinal tumor without occurring perioperative death. Compared with the lateral thoracic group, the subxiphoid group has more advantages in terms of total postoperative drainage (P=0.035), postoperative drainage time (P=0.015), postoperative hospital stay (P=0.030), and visual analog scale (VAS) pain on postoperative days 2 (P=0.006) and 3 (P=0.002). However, the lateral thoracic group has more advantages in the aspect of docking time (P=0.020). There was no statistically significant difference between the two groups in terms of operative time (P=0.517), total operative time (P=0.187), postoperative day 1 VAS pain score (P=0.084), and postoperative complications (P=0.715).ConclusionThe subxiphoid approach of RATS under laryngeal mask anesthesia is safe and feasible for resecting anterior mediastinal tumors. Compared with the lateral thoracic approach, the subxiphoid approach has advantages in terms of rapid postoperative recovery and postoperative patient pain, and patient acceptance is also higher and thus is worth promoting in hospitals where it is available.

Physiotherapy and Exercise Management of People Undergoing Surgery for Lung Cancer: A Survey of Current Practice across Australia and New Zealand

Moderate- to high-certainty evidence supports the benefits of pre- and post-operative exercise for people undergoing surgical resection for lung cancer. Despite this, exercise programs are not commonly provided. Previous data regarding exercise practices are a decade old. Therefore, this study aimed to understand current exercise practices in surgical lung cancer care in Australia and New Zealand. An online cross-sectional survey of Australian and New Zealand allied health professionals specialising in exercise-based interventions was carried out. Survey development and reporting adhered to CHERRIES and CROSS checklists. Institutions with thoracic surgery departments were invited to participate via email, and additional responses were sought via snowballing. The response rate was 81%, with a total of 70 health services responding. A total of 18 (26%) pre-operative services, 59 (84%) inpatient post-operative services, and 39 (55%) community/outpatient post-operative services were identified. Only eight (11%) services provided a pre-operative exercise program. Half of the respondents referred less than 25% of patients to community/outpatient exercise programs on hospital discharge. Respondents reported that their clinical management was predominantly influenced by established workplace practices and personal experience rather than evidence. The availability and uptake of pre- and post-operative exercise remain low, and work should continue to make pre/post-operative exercise training usual practice.

Perioperative and oncological outcomes of uniportal versus three-port thoracoscopic segmentectomy for lung cancer: a propensity score matching analysis.

With an increasing amount of small nodules being detected, segmentectomy has recently received a great deal of attention. We have previously reported the feasibility and safety of uniportal segmentectomy. This study aims to further compare the perioperative and oncological outcomes of uniportal and three-port thoracoscopic segmentectomy in lung cancer patients. Patients undergoing thoracoscopic segmentectomy for lung cancer from January 2014 to March 2021 were enrolled. Clinical data were collected from the Western China Lung Cancer Database, a prospectively maintained database at the Department of Thoracic Surgery, West China Hospital. Propensity score matching (PSM) was used to reduce the heterogeneity in baseline characteristics. Perioperative outcomes, 1-, 3-, and 5-year overall survival (OS), and progression-free survival (PFS) were compared. Of the 10,063 lung cancer patients who underwent thoracoscopic lung resection, 2,630 patients receiving segmentectomy were selected (uniportal: 400; three-port: 2,230). After matching, similar results were found between the 2 groups (uniportal: 400; three-port: 1,200) regarding the number of lymph nodes harvested, the length of postoperative hospital stays, chest tube drainage volume, and postoperative complication rate. The mean follow-up duration was 27 months. Uniportal regimen showed similar 1- (100% vs. 99.9%, P=0.36), 3- (100% vs. 90.4%, P=0.20), 5-year OS (97.7% vs. 99.4%, P=0.78), as well as PFS, with the three-port regimen. Uniportal video-assisted thoracoscopic segmentectomy is proven to be safe and feasible, and the perioperative outcomes and oncological results were similar between the uniportal and three-port regimens.

The predictive accuracy of CT radiomics combined with machine learning in predicting the invasiveness of small nodular lung adenocarcinoma.

Conventionally, the judgment of whether small pulmonary nodules are invasive is mainly made by thoracic surgeons according to the chest computed tomography (CT) features of patients. However, there are limits to how much useful information can be obtained from this approach. A large number of feature information was extracted from CT images by CT radiomics. The machine learning algorithm was used to construct models based on radiomic characteristics to predict the invasiveness of lung adenocarcinoma (LUAD) with a good prediction accuracy. A total of 416 patients with pathologically confirmed preinvasive lesions and LUAD after video-assisted thoracoscopic surgery (VATS) in the Department of Thoracic Surgery of the First People's Hospital of Yunnan Province from February 2020 to February 2022 were retrospectively analyzed. According to random classification, patients were divided into 2 groups. The RadCloud platform was used to extract radiomics features, and the most relevant radiomics features were selected by continuous dimension reduction method. Then, 6 machine learning algorithms were used to establish and verify the prediction model of small lung nodular adenocarcinoma invasiveness. Receiver operating characteristic (ROC) curve and area under curve (AUC) were used to evaluate the predictive performance. There were 78 cases of pre-invasive lesions and 226 cases of invasive lesions in the training group, and 34 cases of pre-invasive lesions and 78 cases of invasive lesions in the validation group. In the training group, the AUC values of the 6 models were all more than 0.914, the 95% confidence interval (CI) was 0.857-1.00, the sensitivity was equal or more than 0.87, and the specificity was equal or more than 0.85. In the validation group, the AUC values of the 6 models were all equal or more than 0.732, the 95% CI was 0.651-1.00, the sensitivity was equal or more than 0.7, and the specificity was more than 0.77. Machine learning algorithms were used to construct models to predict the invasiveness of small nodular LUAD based on radiomics features, which it could provide more evidence for doctors to make diagnoses and more personalized treatment plans for patients.

Uniportal-VATS vs. open McKeown esophagectomy: Surgical and long-term oncological outcomes.

Till now there are very few reports about surgical results of Uniportal-VATS esophagectomy and no one about long-term outcomes. This study is the first comparing surgical and oncological outcomes of Uniportal-VATS with open McKeown esophagectomy, with the largest reported series and longest oncological follow-up. The prospectively collected clinical, surgical and oncological data of 75 patients, undergone McKeown esophagectomy at our Thoracic Surgery Department, from January 2012 to August 2022, were retrospectively analyzed. Nineteen patients underwent esophagectomy by thoracotomy and reconstruction according to McKeown technique while 56 by Uniportal-VATS approach. Gastric tubulization was performed totally laparoscopic or through a mini-laparatomic access and cervical anastomosis was made according to Orringer's technique. The mean operative thoracic time was similar in both accesses (102.34 ± 15.21 min in Uniportal-VATS vs. 115.56 ± 23.12 min in open, p: 0.646), with a comparable number of mediastinal nodes retrieved (Uniportal-VATS:13.40 ± 8.12 vs. open:15.00 ± 6.86, p: 0.275). No case needed conversion from VATS to open. The learning curve in Uniportal-VATS was completed after 34 cases, while the Mastery was reached after 40. Both approaches were comparable in terms of minor post-operative complications (like pneumonia, lung atelectasis, anemization, atrial fibrillation, anastomotic-leak, left vocal cord palsy, chylothorax), while the number of re-operation for major complications (bleeding or mediastinitis) was higher in open group (21.0% vs. 3.6%, p: 0.04). Both techniques were also effective in terms of surgical radicality and local recurrence but VATS approach allowed a significantly lower chest tube length (11.89 ± 9.55 vs. 25.82 ± 24.37 days, p: 0.003) and post-operative stay (15.63 ± 11.69 vs. 25.53 ± 23.33, p: 0.018). The 30-day mortality for complications related to surgery was higher in open group (p: 0.002). The 2-, 5- and 8-year survival of the whole series was 72%, 50% and 33%, respectively. Combined 2- and 5-year OS in Uniportal-VATS group was 76% and 47% vs. 62% and 62% in open group, respectively (Log-rank, p: 0.286; Breslow-Wilcoxon: p: 0.036). No difference in DFS was recorded between the two approaches (5 year-DFS in Uniportal-VATS: 86% vs. 72%, p: 0.298). At multivariate analysis, only pathological stage independently affected OS (p: 0.02), not the surgical approach (p: 0.276). Uniportal-VATS seems to be a safe, feasible and effective technique for performing McKeown esophagectomy, with equivalent surgical and long-term oncological results to standard thoracotomy, but with a faster and unharmed recovery, and a quite short learning curve.

3D liver model-based surgical education improves preoperative decision-making and patient satisfaction—a randomized pilot trial

ObjectiveHepatobiliary surgery bares obstacles to informed consent for the patients due to its complexity and related risk of postoperative complications. 3D visualization of the liver has been proven to facilitate comprehension of the spatial relationship between anatomical structures and to assist in clinical decision-making. Our objective is to utilize individual 3D-printed liver models to enhance patient satisfaction with surgical education in hepatobiliary surgery.Design, settingWe conducted a prospective, randomized pilot study comparing 3D liver model-enhanced (3D-LiMo) surgical education against regular patient education during preoperative consultation at the department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Dresden, Germany.ParticipantsOf 97 screened patients, undergoing hepatobiliary surgery, 40 patients were enrolled from July 2020 to January 2022.ResultsThe study population (n = 40) was predominantly of male gender (62.5%) with a median age of 65.2 years and a high prevalence of preexisting diseases. Underlying disease, warranting hepatobiliary surgery, was malignancy in the majority of cases (97.5%). Patients in the 3D-LiMo group were more likely to feel very thoroughly educated and exhibited a higher level of satisfaction following surgical education than the control group (80 vs. 55%, n.s.; 90 vs. 65%, n.s.; respectively). Applying 3D models was also associated with enhanced understanding of the underlying disease with regard to amount (100% vs. 70%, p = 0.020) and location of liver masses (95 vs. 65%, p = 0.044). 3D-LiMo patients also demonstrated enhanced understanding of the surgical procedure (80 vs. 55%, n.s.), leading to better awareness for the occurrence of postoperative complications (88.9, vs. 68.4%, p = 0.052). Adverse event profiles were similar.ConclusionIn conclusion, individual 3D-printed liver models increase patient satisfaction with surgical education and facilitate patients’ understanding of the surgical procedure as well as awareness of postoperative complications. Therefore, the study protocol is feasible to apply to an adequately powered, multicenter, randomized clinical trial with minor modifications.

Adjusting the RAPID score with 2 additional variables significantly increases its predictive value in patients with empyema

Pleural empyema is a serious condition leading to a significant burden on health care systems due to protracted hospitalisations. Treatment ranges from non-surgical interventions such as antibiotic therapy and chest tube placement to thoracoscopic or open surgery. Various risk factors which impact outcomes have been investigated. The RAPID (renal, age, purulence, infection source, and dietary factors) score is a clinical risk score which identifies patients at risk of death and may be used to formulate individual treatment strategies accordingly. All patients undergoing surgical interventions for empyema at a major tertiary medical centre in Germany from 2017 to 2020 were analysed. The aim was to identify perioperative risk factors which significantly impact treatment outcomes but are currently not included in the RAPID score. 245 patients with pleural empyema surgically treated at the Department of General, Visceral and Thoracic Surgery at the University Medical Centre, Hamburg, Germany (admitted from January 2017 to April 2020) were retrospectively analysed. All patients which received either minimally invasive or open thoracic surgery were included. Epidemiological as well as perioperative data was analysed to identify risk factors which impact long-term overall outcomes. 90-day mortality rate was the primary endpoint. The mean age was 59.4 years with a bimodal distribution. There was a male predominance across the cohort (71.4% compared to 28.6%), with no significant differences across ages below or above 60 years. 53 (21.6%) patients died within the first 90 days. Diabetes type 1 and 2, renal replacement therapy, immunosuppression, postoperative bleeding, intraoperative transfusion as well as microbiologically confirmed bacterial invasion of the pleura all led to higher mortality rates. Higher RAPID scores accurately predicted higher 90-day mortality rates. Modifying the RAPID score by adding the comorbidities diabetes and renal replacement therapy significantly increased the predictive value of the score. We demonstrated various perioperative and patient related risk-factors not included in the RAPID score which negatively impact postoperative outcome in patients receiving surgical treatment for pleural empyema. These should be taken into consideration when deciding on the best course of treatment. If confirmed in a prospective study including non-surgical patients with a significantly larger cohort, it may be worth considering expanding the RAPID score to include these.

ODONTOGENIC PHLEGMON OF THE MAXILLOFACIAL AREA, COMPLICATIONS AND PROGNOSIS

The purpose of the study was analyzed the case of a patient M. admitted to the department of thoracic surgery in connection with a diagnosis confi rmed by MRI: gangrenous mediastinitis, in which the pathway of the purulent contents from the mandibular apparatus was completely and accurately described (1 molar left) with a lesion of the periosteum, further into the posterior- pharyngeal space and through the anatomical intercellular spaces of the neck to the mediastinum for 4 days. According to CT scanner of organs of the chest cavity we can see that CT scan is a sign of acute gangrenous mediastinitis with a primary process in the submandibular region. In the left parts of the lower jaw there is a small defect in the outer compact plate for up to 4.0 mm. In the soft tissues of the neck, along the whole length from the level of the larynx, multiple gas accumulations are determined both in the prevertebral space and on both sides, symmetrically under the nival muscles, where there is especially a lot of gas, and along the vascular bundles. There is a gas in the region of the fl oor of the mouth, the chin-tongue muscle. All tissues are swollen because of what anatomical structures do not diff erentiate. The process goes through the interfascial spaces, as well as along the pharynx, larynx, thyroid gland in the mediastinum, where gas is determined along all main arteries and trachea. Then it spreads along the anterior and posterior mediastinum to the diaphragm along the heart and esophagus. In its course, there is infi ltration of the tissue of the posterior mediastinum, and in the anterior one there is more pronounced accumulation of fl uid, more to the right, especially near the right atrium, where its thickness reaches 25.0 mm and there is a reaction of the adjacent parts of the right lung. Osteo-destructive changes are not detected. Thus we observed the pathway of the spread of the purulent infl ammatory process from teeth of the lower jaw to the mediastinum cavity as a consequence of infraction of asepsis (ules therefore a patient M. who had been operated twice and had clinical death was discharged from the department of the hospital with positive dynamics.

Multivariate analysis of prognostic factors in patients with lung cancer.

Lung cancer is the leading cause of cancer-related mortality in China. The purpose of this study was to determine the effect of non-therapeutic and therapeutic factors of patients with lung cancer on survival rate. In this retrospective study, a total of 458 patients diagnosed as lung cancer at the Department of Thoracic Surgery, the Fourth Affiliated Hospital of Hebei Medical University from September 2008 to October 2013 were enrolled. The COX proportional hazards model was used to analyze the possible factors affecting the survival of patients. Model variables included age, sex, family history, smoking, tumor location, pathological type, stage, chemotherapy, radiotherapy, operation, and targeted therapy. The median survival time (MST) was 32.0 months (95% CI: 29.0-34.0 months), while the 1-, 3-, and 5-year survival rates were 70.74%, 36.90%, and 30.13%, respectively. The univariate analysis showed that stage, chemotherapy, radiotherapy, and operation significantly affected the median survival time of patients. Multivariate cox regression analysis suggested that sex (female vs male, 2.096, 95% CI: 1.606-2.736), stage (stage I vs IV, 0.111, 95% CI: 0.039-0.314; stage II vs IV, 0.218, 95%CI: 0.089-0.535), chemotherapy (no vs yes, 0.469, 95% CI: 0.297-0.742), and operation (no vs yes, 2.667, 95% CI: 1.174-6.055) were independently associated with the survival of patients with lung cancer. Our study showed that male, early stage, operation were protective factors for the survival of patients, while female, advanced stage, chemotherapy were risk factors for the survival of patients. Larger studies are required to address the usefulness of these prognostic factors in defining the management of patients with lung cancer.

Patients’ Perceptions of Experiences of Postoperative Chest Drain Tube Insertion: A Pilot Survey

Pleural drainage is a routine procedure conducted after thoracotomy and thoracoscopy. It is used to remove air or excess fluid from a pleural cavity and enables proper lung expansion. Essential elements of care provided during hospitalization and treatment include meeting patients' growing expectations and continually improving quality while optimizing safety. This study aimed to explore patients' experiences with pleural drainage after thoracic surgery and their correlation with socio-demographic data. A pilot survey with an exploratory design was conducted at a large teaching hospital in Poland, in the Department of Thoracic Surgery at the University Clinical Centre in Gdansk. The study involved the analysis of 100 randomly selected subjects with a chest tube drain. A self-designed questionnaire was used to collect social, demographic, and clinical data. Twenty-three questions related to experiences with pleural drainage, ailments, limitations in daily functioning, and security with a chest tube were evaluated using a 5-point Likert scale. Patients completed the questionnaire on the third postoperative day. Individuals fitted with a traditional water-seal drainage system felt safer than those from the digital drainage group (p = 0.017). Statistically significant differences were found in the assessment of nursing assistance (p = 0.025); the number of satisfied patients was greater in a group of unemployed people. No correlation was found between demographic and social factors and the patients' sense of security (gender: p = 0.348, age: p = 0.172, education level: p = 0.154, professional activity: p = 0.665). Demographic and social characteristics did not significantly affect patients' sense of safety with chest drainage types. Patients with traditional drainage felt significantly safer than patients with digital drainage. Patient knowledge of pleural drainage management was not satisfactory, with a number of patients indicating a lack of knowledge in this area. This is important information that should be considered when planning measures to improve the quality of care.

Postoperative clinical outcomes of patients with thymic epithelial tumors after over-3-year follow-up at a single-center

BackgroundTo evaluate postoperative clinical outcomes and analyze influencing factors for patients with thymic epithelial tumors over 3 years after operation.MethodsPatients with thymic epithelial tumors (TETs) who underwent surgical treatment in the Department of Thoracic Surgery at Beijing Hospital from January 2011 to May 2019 were retrospectively enrolled in the study. Basic patient information, clinical, pathological, and perioperative data were collected. Patients were followed up by telephone interviews and outpatient records. Statistical analyses were performed using SPSS version 26.0.ResultsA total of 242 patients (129 men, 113 women) with TETs were included in this study, of which 150 patients (62.0%) were combined with myasthenia gravis (MG) and 92 patients (38.0%) were not. 216 patients were successfully followed up and their complete information was available. The median follow-up period was 70.5 months (range, 2–137 months). The 3-year overall survival (OS) rate of the whole group was 93.9%, and the 5-year OS rate was 91.1%. The 3-year relapse-free survival (RFS) rate of the whole group was 92.2%, and the 5-year relapse-free survival rate was 89.8%. Multivariable COX regression analysis indicated that recurrence of thymoma was an independent risk factor for OS. Younger age, Masaoka-Koga stage III + IV, and TNM stage III + IV were independent risk factors for RFS. Multivariable COX regression analysis indicated that Masaoka-Koga staging III + IV, WHO type B + C were independent risk factors for postoperative improvement of MG. For patients with MG, the postoperative complete stable remission (CSR) rate was 30.5%. And the result of multivariable COX regression analysis showed that thymoma patients with MG with Osserman staging IIA + IIB + III + IV were not prone to achieving CSR. Compared with patients without MG, MG was more likely to develop in patients with WHO classification type B, and patients with myasthenia gravis were younger, with longer operative duration, and more likely to develop perioperative complications.ConclusionsThe 5-year overall survival rate of patients with TETs was 91.1% in this study. Younger age and advanced stage were independent risk factors for RFS of patients with TETs, and recurrence of thymoma were independent risk factors for OS. In patients with MG, WHO classification type B and advanced stage were independent predictors of poor outcomes of MG treatment after thymectomy.

Effectiveness of precise and quantitative rapid pulmonary rehabilitation nursing program for elderly patients with lung cancer during the perioperative period: A randomized controlled trial.

Preoperative rehabilitation should improve the functional condition of patients. Improvements in metabolism, lung mechanics, cardiovascular function, and muscle-function can be achieved by pulmonary rehabilitation. Hence, we focused on elderly patients with lung cancer undergoing surgery, and assessed the effectiveness of a rapid and precise pulmonary rehabilitation nursing program during the perioperative period. This randomized controlled trial at the department of thoracic surgery; Shanghai pulmonary hospital, China during 2021 was conducted amongst 218 elderly patients with lung cancer treated by surgical operation into either a precision quantitative nursing model nursing group (experimental group) or a perioperative routine nursing group (control group). After individual planning of the pulmonary rehabilitation nursing outpatient clinic, nurses distributed breathing trainers, instructed the patients in breathing training, and supervised the patients after the operation. For our evaluation we considered pulmonary function tests, postoperative thoracic drainage tube indwelling times, postoperative hospital stays, postoperative complication rates, and postoperative quality of life results. The experimental group showed better pulmonary function, length of hospital stay, and quality of life outcomes than the control group, but the differences were not statistically significant. However, we found a significantly higher postoperative complications rate in the control group (11.9%) than in the experimental group (3.7%; p=0.02). Strengthening pulmonary rehabilitation nursing interventions for elderly patients with lung cancer during the perioperative period can reduce their postoperative complications and promote their rapid recovery. Clinical Trial: Registration Number - ChiCTR2100042916.].

Comparison of the LigaSure™ bipolar vessel sealer to monopolar electrocoagulation for thoracoscopic lobectomy and lymphadenectomy: a prospective randomized controlled trial

BackgroundHigh-energy devices allow better vessel sealing compared with monopolar electrocautery and could improve the outcomes of surgical operations. The objective of the study was to compare tissue dissection by the LigaSure™ device with that by monopolar electrocoagulation for thoracoscopic lobectomy and lymphadenectomy.MethodsThis pragmatic, parallel group, prospective randomized controlled trial was funded by the Medtronic External Research Program (ISR-2016–10,756) and registered at www.clinicaltrials.gov (NCT03125798). The study included patients aged 18 years or older, who had undergone thoracoscopic lobectomy with lymphadenectomy at the Department of Thoracic Surgery of Poznan University of Medical Sciences between May 3, 2018, and November 4, 2021. Using simple randomization, the patients were assigned to undergo tissue dissection with either the LigaSure device (study group) or monopolar electrocautery (control group). Participants and care givers, except operating surgeons, were blinded to group assignment. The primary outcome was postoperative chest drainage volume. Secondary outcomes were change of the esophageal temperature during subcarinal lymphadenectomy and C-reactive protein level 72 h after surgery.ResultsStudy outcomes were analyzed in 107 patients in each group. We found no differences between the study and control groups in terms of chest drainage volume (550 vs. 600 mL, respectively; p = 0.315), changes in esophageal temperature (− 0.1 °C vs. − 0.1 °C, respectively; p = 0.784), and C-reactive protein levels (72.8 vs. 70.8 mg/L, respectively; p = 0.503). The mean numbers of lymph nodes removed were 12.9 (SD: 3.1; 95% CI, 12.4 to 13.5) in the study group and 11.6 (SD: 3.2; 95% CI, 11.0 to 12.2) in the control group (p < 0.001).ConclusionsThe use of the LigaSure device did not allow to decrease the chest drainage volume, local thermal spread, and systemic inflammatory response. The number of lymph nodes removed was higher in patients operated with the LigaSure device, which indicated better quality of lymphadenectomy.

Sniffer Dogs Diagnose Lung Cancer by Recognition of Exhaled Gases: Using Breathing Target Samples to Train Dogs Has a Higher Diagnostic Rate Than Using Lung Cancer Tissue Samples or Urine Samples.

Sniffer dogs can diagnose lung cancer. However, the diagnostic yields of different samples and training methods for lung cancer remain undetermined. Six dogs were trained in three stages with the aim of improving the diagnostic yield of lung cancer by comparing training methods and specimens. The pathological tissues of 53 lung cancer patients and 6 non-lung cancer patients in the Department of Thoracic Surgery of Kaohsiung Chang Gung Hospital were collected, and the exhaled breath samples and urine samples were collected. Urine and exhaled breath samples were also collected from 20 healthy individuals. The specimens were sent to the Veterinary Department of Pingtung University of Science and Technology. The dogs had a very low response rate to urine target samples in the first and second stages of training. The experimental results at the second stage of training found that after lung cancer tissue training, dogs were less likely to recognize lung cancer and healthy controls than through breath target training: the response rate to exhaled breathing target samples was about 8-55%; for urine target samples, it was only about 5-30%. When using exhaled air samples for training, the diagnosis rate of these dogs in lung cancer patients was 71.3% to 97.6% (mean 83.9%), while the false positive rate of lung cancer in the healthy group was 0.5% to 27.6% (mean 7.6%). Compared with using breathing target samples for training, the diagnosis rate of dogs trained with lung cancer tissue lung cancer was significantly lower (p < 0.05). The sensitivity and specificity of lung cancer tissue training (50.4% and 50.1%) were lower than the exhaled breath target training (91.7% and 85.1%). There is no difference in lung cancer diagnostic rate by sniff dogs among lung cancer histological types, location, and staging. Training dogs using breathing target samples to train dogs then to recognize exhaled samples had a higher diagnostic rate than training using lung cancer tissue samples or urine samples. Dogs had a very low response rate to urine samples in our study. Six canines were trained on lung cancer tissues and breathing target samples of lung cancer patients, then the diagnostic rate of the recognition of exhaled breath of lung cancer and non-lung cancer patients were compared. When using exhaled air samples for training, the diagnosis rate of these dogs in lung cancer patients was 71.3% to 97.6% (mean 83.9%), while the false positive rate of lung cancer in the healthy group was 0.5% to 27.6% (mean 7.6%). There was a significant difference in the average diagnosis rate of individual dog and overall dogs between the lung cancer group and the healthy group (p < 0.05). When using lung cancer tissue samples for training, lung cancer diagnosis rate of these dogs among lung cancer patients was only 15.5% to 40.9% (mean 27.7%). Compared with using breathing target samples for training, the diagnosis rate of dogs trained with lung cancer tissue lung cancer was significantly lower (p < 0.05). The sensitivity and specificity of lung cancer tissue training (50.4% and 50.1%) were lower than the exhaled breath target training (91.7% and 85.1%). The diagnostic rate of lung cancer by sniffer dogs has nothing to do with the current stage of lung cancer, pathologic type, and the location of tumor mass. Even in stage IA lung cancer, well-trained dogs can have a diagnostic rate of 100%. Using sniffer dogs to screen early lung cancer may have good clinical and economic benefits.