Thoracoscopic Tumor Research Articles

Improved Thoracoscopic-Assisted Surgery for the Treatment of Metastatic Thoracic Vertebral Tumors.

The significant progress made in the diagnosis and treatment of malignant tumors has led to improved patient survival rates. However, the metastatic spread of these tumors to the thoracic vertebrae remains a significant challenge, often resulting in bone-related adverse events, such as pathological fractures and severe complications. To address this issue, a refined multidisciplinary approach has been explored, which utilizes thoracoscopic techniques for tumor resection and spinal interventions. Thoracoscopic techniques offer a minimally invasive alternative to traditional open surgical methods, aiming to reduce the overall trauma experienced by patients. By leveraging the advantages of thoracoscopy, clinicians can effectively resect metastatic tumors within the thoracic vertebrae while minimizing the impact on surrounding tissues and structures. This approach, combined with targeted spinal interventions, has the potential to improve patient outcomes and quality of life by mitigating the debilitating effects of pathological fractures and other complications associated with metastatic bone disease. The implementation of this multidisciplinary strategy, incorporating thoracoscopic tumor resection and spinal interventions, represents a promising avenue for the management of metastatic tumors within the thoracic vertebrae. Further research and clinical evaluation are necessary to fully elucidate the long-term benefits and establish the optimal treatment protocols for this patient population, ultimately enhancing the care and outcomes for individuals afflicted by this challenging condition.

Successful thoracoscopic enucleation of a calcifying fibrous tumor of the lower mediastinum in a young woman

BackgroundCalcifying fibrous tumor (CFT) arising from the pleura is a relatively rare benign lesion in young and middle-aged adults. We report a 31-year-old woman with pleural CFT who underwent successful complete thoracoscopic enucleation.Case presentationAn asymptomatic woman presented with a mass in the right lower lung field that was incidentally detected on a chest X-ray during a routine medical checkup. Chest computed tomography showed a well-defined mass in the lower mediastinum, with a maximum diameter of approximately 5.5 cm. Esophagogastroduodenoscopy showed no abnormal findings in the esophagus. An endoscopic ultrasonography (EUS) revealed a well-defined tumor with no internal blood flow. EUS-fine needle aspiration failed to establish a definitive diagnosis. Therefore, thoracoscopic tumor enucleation was performed for diagnostic and therapeutic purposes. Based on the histopathological findings of the resected specimen, the presence of a tumor with a high fibrous component in a young woman, and the identification of granulomatous calcifications, a diagnosis of CFT was established.ConclusionsComplete thoracoscopic tumor enucleation was successfully performed for CFT arising from the pleura in a young adult woman.

Efficacy of rigid-angle bronchial blockers for uniportal video-assisted thoracoscopic tumor resection.

For uniportal video-assisted thoracoscopic surgery (VATS), which is greatly dependent on satisfactory lung collapse without lung compression from another port, few reports have elucidated the intraoperative efficacy of bronchial blockers (BBs). We hypothesized that operation time would be prolonged if BBs required more intraoperative repositioning during surgical manipulation. We compared the operation times of different surgical procedures performed using BBs with double-lumen tubes (DLTs) in uniportal VATS. Patients who underwent intubated uniportal VATS were enrolled retrospectively from March to May 2019. Data on the patient, anesthetic, and surgical factors were collected. Regression analyses were performed to determine the effect of various factors on operation time. 317 patients who underwent uniportal VATS were included. Wedge resection constituted 70.7%, and anatomic resection constituted 29.3% of procedures. BBs were applied for left- and right-side wedge resection (85.6% and 78.7%, respectively) and left- and right-side anatomic resection (74.1% and 56.4%, respectively). The surgical factors significantly affecting operation time were operation procedures (P < .01), number of lymph nodes sampled (P < .001), and size of tumors (P < .01). The efficacy of BBs was comparable to that of DLTs for uniportal VATS wedge resection. With significantly less preference for right-side anatomic resection, the efficacy of DLTs was comparable with that of BBs, which were applied in more than half of right-side uniportal anatomic VATS. We conclude that even in uniportal VATSs, rigid-angled BBs demonstrate comparable efficacy with feasible alternatives.

Type A thymoma: a rare cause of neoplastic cardiac tamponade with long-term survival

BackgroundThe prognosis of thymoma with cardiac tamponade is generally poor. Most of the reported thymomas with cardiac tamponade were type B or type AB (mixed thymoma), and cardiac tamponade due to type A thymoma, which has a better prognosis compared to type B thymoma, is extremely rare.Case presentationWe encountered a case of cardiac tamponade in a 71-year-old male. He visited our emergency department due to exacerbation of fatigue and dyspnea on exertion that lasted for two weeks. Chest imaging revealed a large amount of pericardial fluid and a contrast-enhanced tumor with calcification in the anterior mediastinum. The patient underwent thoracoscopic tumor biopsy and pathological examinations revealed type A thymoma. In this case, long-term disease-free survival (7.5 years) was achieved by multidisciplinary treatment (preoperative chemotherapy, surgical excision, and postoperative radiation therapy), in accordance with the histological type.ConclusionsThis case indicates that neoplastic cardiac tamponade, even in elderly patients, should not necessarily be regarded as a terminal cancer and requires a systematic investigation for underlying causes.

Ultrasound Image under Artificial Intelligence Algorithm in Thoracoscopic Surgery for Papillary Thyroid Carcinoma

This study aimed to investigate the therapeutic effect of thoracoscopic thyroidectomy guided by an ultrasound image based on an artificial intelligence algorithm on papillary thyroid carcinoma. Patients diagnosed with papillary thyroid carcinoma by imaging examination or needle biopsy in hospital were selected. The subjects were randomly divided into the experimental group and the control group. In the experimental group, 94 patients underwent conventional thoracoscopic thyroid tumor resection. In the control group, 119 patients underwent thoracoscopic thyroidectomy under ultrasonic guidance based on an intelligent algorithm. The adoption effect of ultrasound imaging based on the least variance algorithm in thoracoscopic papillary thyroid carcinoma surgery was evaluated by comparing the differences between the two groups of patients after laparoscopic thyroidectomy. The results showed that the ultrasonic imaging resolution and sound-absorbing spot imaging effect based on an artificial intelligence algorithm were superior to those of conventional ultrasonic imaging. Compared with the control group, the average duration of surgery in the experimental group was reduced and the intraoperative blood loss, postoperative cumulative drainage volume, postoperative drainage tube duration, hospital stay, and pain evaluation were dramatically better ( P &lt; 0.05 ). It was confirmed that ultrasound-guided endoscopic thyroid surgery based on the least variance algorithm had better results than conventional surgery and showed the same safety as traditional surgery, which was of clinical promotion value. However, some evaluations were influenced by subjective judgment, and the accuracy of data conclusions needed to be further studied.

Thoracoscopic Lobectomy Versus Sublobar Resection for pStage I Geriatric Non-Small Cell Lung Cancer.

ObjectivesThe choice of resection method for geriatric patients with early-stage non-small cell lung cancer (NSCLC) remains contentious. This study aimed to evaluate survival and perioperative outcomes after thoracoscopic lobectomy resection (LR) or sublobar resection (SR) in patients aged ≥75 years with pathologic stage (pStage) I NSCLC.Materials and MethodsWe retrospectively examined 258 consecutive patients aged ≥75 years with pStage I NSCLC who underwent thoracoscopic tumor resection at our institute from 2011 to 2018. Propensity score matching (PSM) analysis identified 60 patients in each group for comparison of survival-related parameters, including disease-free survival (DFS), lung cancer-specific overall survival (OS), and non-lung cancer-specific OS, using the Kaplan-Meier analysis.ResultsLR and SR were performed in 84 (32.6%) and 174 (67.4%) patients aged ≥75 years, respectively. The LR group had younger patients, better performance status, larger tumor sizes, and deeper tumor location than the SR group. Multivariate studies showed that the resection method was not a prognostic factor for OS. The two PSM-matched groups were not significantly different with respect to lung cancer-specific OS (p = 0.116), non-lung cancer-specific OS (p = 0.408), and DFS (p = 0.597). SR helped achieve better perioperative outcomes than LR, including fewer postoperative complications (10.0% vs. 28.3%, p = 0.011), shorter operative times (p < 0.001), decreased blood loss (p = 0.026), and shorter chest tube duration (p = 0.010) and hospital stays (p = 0.035).ConclusionsThoracoscopic SR may provide similar oncological outcomes to LR, but may be a safer and more feasible surgical method for geriatric patients with pStage I NSCLC.

Video-assisted thoracoscopic tracheal tumor resection with acupuncture drug compound non-intubated anesthesia

Video-assisted thoracoscopic tracheal tumor resection with acupuncture drug compound non-intubated anesthesia

Pneumothorax as a Rare Presentation of Bronchial Schwannoma

Tracheobronchial schwannomas are rare diseases. Common signs and symptoms of this tumor include cough, wheezing, and dyspnea. In contrast, pneumothorax is an exceptional presentation. This study reports the first case of bronchial schwannoma presenting with pneumothorax. A 79-year-old woman was diagnosed with pneumothorax by chest radiography. Chest computed tomography unexpectedly revealed a tumor occluding the right main bronchus. Following the pathological diagnosis of bronchial schwannoma, the patient underwent thoracoscopic tumor enucleation. The airway lumens are consequently secured postoperatively. Pneumothorax should be aware of a rare presentation of non-malignant tracheobronchial tumors.

A case of IgG4-related anterior mediastinal sclerosing disease coexisting with autoimmune pancreatitis

BackgroundIgG4-related disease (IgG4-RD) is a systemic fibro-inflammatory condition that predominantly involves exocrine organs. Concerning its thoracic presentation, it often manifests as interstitial lung disease or fibrosing mediastinitis. It is very rare for IgG4-RD to form a well-defined mass in the anterior mediastinum, mimicking an encapsulated thymoma.Case presentationAn 82-year-old man with autoimmune pancreatitis under treatment with oral corticosteroids was found to have peripancreatic lymphadenopathy on computed tomography. Subsequent positron emission tomography revealed abnormal uptake (maximal value 3.6) by a thymic mass as well as the peripancreatic lymph nodes. Exacerbation of IgG4-RD was suspected, and we increased the oral steroid dosage. As a result, the peripancreatic lymph nodes, and the anterior mediastinal mass, decreased in size. The thymic mass was suspected to be an encapsulated thymoma because of its lobulated shape, degree of fluorodeoxyglucose accumulation, and response to steroids, and the patient was referred to our department. The serum anti-acetylcholine receptor antibody test was negative. A thoracoscopic tumor resection was performed as diagnostic therapy. Histopathological analysis revealed dense lymphoplasmacytic infiltration with sclerotic stroma within the tumor. Immunohistochemical analysis revealed abundant IgG4-positive plasma cell infiltrates and over 50% IgG4/IgG-positive plasma cells. We did not see either keratin-positive thymocytes or terminal deoxynucleotidyl transferase-positive lymphocytes. Furthermore, deviation in the kappa chain and lambda chain-positive plasma cells was not noted. Accordingly, IgG4-related sclerosing disease was diagnosed.ConclusionsIgG4-related sclerosing masses in the anterior mediastinum are very rare, and the effect of tumor resection on prognosis remains unclear. IgG4-RD had potentially been categorized as Castleman’s disease.

A case of an unexpected posterior mediastinal functional paraganglioma: case report and literature review

BackgroundParaganglioma can be found in a wide range of locations. However, paraganglioma in the posterior mediastinum is rare. An unexpected paraganglioma located in the posterior mediastinum was found during surgery. The anesthesia management of this patient was challenging.Case presentationA 65-year-old male with a posterior mediastinal tumor was scheduled for thoracoscopic mediastinal tumor resection. Severe hemodynamic changes during the operation and postoperative pathological diagnosis showed that the patient had a rare case of posterior mediastinal functional paraganglioma, which was not found before the operation. Although the patient did not experience side effects after surgery, he did experience a dangerous surgical process.ConclusionsThe correct diagnosis of paraganglioma, intensive preoperative screening, adequate preoperative preparation, and accurate intraoperative anesthesia management could provide better anesthesia for paraganglioma patients.

Anterior Mediasten Feokromasitoma Vakasında Anestezi Yönetimi

Paraganglioma can be found in different parts of the body. In this case report, a rare case of anterior mediastinal paraganlioma was examined. Pheochromocytoma can pose problems in intraoperative anesthesia management. A 17-year-old male patient with an anterior mediastinal mass was first scheduled for thoracoscopic tumor resection, and then proceeded with open thoracotomy. The patient, who was diagnosed with preoperative pheochromocytoma, had a history of dual antihypertensive drug use. The patient, who showed an intraoperative labile course, had episodes of hypertension (270/140 mmHg) and tachycardia (200 bpm). Esmolol and nitroglycerin infusion was applied and intervened. Diagnosis of paraganglioma-related pheochromocytoma can be challenging. Risks can be minimized by making appropriate decisions and interventions before and during the operation.

Risk factors and intervention measures of pulmonary infection after thoracoscopic mediastinal tumor resection

Objective To investigate the risk factors and intervention measures of pulmonary infection after thoracoscopic mediastinal tumor resection. Methods The clinical data of 128 patients who underwent thoracoscopic mediastinal tumor resection in this hospital from June 2016 to June 2017 were retrospectively analyzed, and the incidence of postoperative respiratory tract infection and related risk factors were analyzed, and intervention measures were formulated. Results The incidence of postoperative pulmonary infection was 20.31% in 128 patients with mediastinal tumor resection under thoracoscopy (26/128). Logistic multivariate analysis showed that age over 60, lymph node dissection, preoperative diabetes mellitus, thoracic drainage indwelling time over 3 days, and postoperative wound contamination were all independent risk factors for postoperative pulmonary infection in patients undergoing thoracoscopic mediastinal tumor resection(P<0.05). Preoperative antibiotic prophylaxis and expectoration training were protective factors(P<0.05). Conclusions There are many risk factors for postoperative pulmonary infection in patients undergoing thoracoscopic mediastinal tumor resection, and the preoperative preventive application of antibiotics and the preoperative sputum expectoration and discharge training will help to prevent and reduce the incidence of postoperative pulmonary infection. Key words: Thoracoscopy; Mediastinal tumor resection; Postoperative pulmonary infection; Risk factors

Giant cell arteritis and polymyalgia rheumatica as first manifestation of typical pulmonary carcinoid tumor

Giant cell arteritis (GCA), a systemic vasculitis of unknown origin, may appear rarely as a paraneoplastic syndrome. Cases secondary to pulmonary neuroendocrine tumors have not been reported. A 75-year-old female developed prednisone-responsive GCA/polymyalgia rheumatica (PMR) shortly followed by syndrome of inappropriate antidiuretic hormone secretion. An 8 mm carcinoid lung tumor with positron emission tomography normal uptake was found. After a thoracoscopic tumor resection the patient experienced complete clinical and laboratory remission. This is the first report of GCA with PMR in the context of carcinoid lung tumor. It emphasizes the role of paraneoplastic vasculitis as a possible cause of GCA.

PO-20 - Crosstalk between the lectin pathway and haemostasis in patients with pulmonary cancer

Recent research has focused on the complement system in cancer, including the lectin pathway of complement activation. Mannose-binding lectin (MBL), a key activator of the lectin pathway, can bind to tumor cell surfaces in vitro, and lectin pathway activation is increased in several types of cancer. The exact role of the complement system in cancer is currently discussed. However, one possible consequence of the increased complement activation could be contribution to the increased thrombosis risk which cancer patients experience. Proteins of the lectin pathway can activate coagulation and impair fibrinolysis in vitro, but the significance of this in a clinical setting is not well understood. We aim to investigate associations between lectin pathway and haemostatic activation in patients with lung cancer undergoing thoracoscopic surgery. Patients with lung cancer (n=60) eligible for thoracoscopic tumor resection were included as part of a randomized controlled trial, the COPPVATS project (EudraCT no: 2012-002409-23), conducted at the Department of Thoracic Surgery, Aarhus University Hospital. Exclusion criteria were arterial or venous thrombosis within the last three months, other systemic disease than cancer, and anticoagulant treatment prior to inclusion. Blood samples were obtained the day before surgery, perioperatively, and on the 1st and 2nd postoperative days. Laboratory analyses on the complement system include MBL, MBL-associated protease (MASP)-1 and -2, MBL-MASP complex, ficolin-1, -2, and -3 and complement factor C3b. Haemostasis was evaluated with routine coagulation parameters (INR, APTT, fibrinogen, fibrin d-dimer), platelet function, and tissue factor-induced thrombin generation. Recruitment of the study subjects is concluded, and laboratory work is in progress. The complement analyses and data processing will be performed during early spring 2016, so that results will be ready for presentation on the conference. The present project will provide new knowledge on lectin pathway activation and the pathogenesis of thrombosis in cancer patients. In the long term, this will help improve the individual risk assessment and lead to new studies on thromboprophylaxis and treatment in conditions with increased complement activation.

Pulmonary Hilar Tumor: An Unusual Presentation of Sclerosing Hemangioma.

Pulmonary sclerosing hemangioma is an uncommon benign tumor of the lung; however, on rare occasions it can arise from the pulmonary hilar region. Herein, we report a 53-year-old female patient who presented with a round opacity in the right upper lung field on a radiograph. Chest computed tomography scanning revealed a 3.1 cm mass in the right pulmonary hilum. Thoracoscopic tumor excision was subsequently performed. On pathohistologic study, the tumor was well defined and composed of round stromal cells and surface cells arranged in a papillary, sclerotic, solid, and hemorrhagic pattern. In immunochemical study, the round cells were positive for thyroid transcription factor-1 (TTF-1) and epithelial membrane antigen (EMA) and negative for cytokeratin. The surface cells were positive for TTF-1, EMA, and cytokeratin. Therefore, a final diagnosis of sclerosing hemangioma was confirmed. In conclusion, pulmonary sclerosing hemangioma is uncommon and rare in the pulmonary hilar region. CT scanning is useful to determine its benignity, although imaging features are not specific for a definite differential diagnosis from other pulmonary tumors. Therefore, tissue diagnosis is usually necessary, and pulmonary sclerosing hemangioma should be listed in the differential diagnoses of pulmonary hilar tumors.

P6.01 - Dramatic response to ASP-3026 in patient with highly aggressive pulmonary inflammatory myofibroblastic tumor harboring ALK rearrangement

ABSTRACT ALK rearrangement (ALKr) is known to occur in various carcinomas such as anaplastic large cell lymphoma, NSCLC, inflammatory myofibroblastic tumors (IMT), and renal medullary carcinoma. It reportedly has been proposed that tumors carrying abnormal ALK as an essential growth driver be collectively termed “ALKoma”. ALKr has been documented in approximately 50% of IMTs. IMTs can occur in the retroperitoneum, mediastinum, spleen, brain, pancreas, liver, or GI tract. Surgical resection is the only effective treatment for IMTs. However, there is no standard treatment for advanced IMT.ASP-3026 is a potent and selective multi-kinase inhibitor of ALK, ROS, and ACK. Here we present, a case report of a dramatic response to ASP-3026 in a patient with highly aggressive pulmonary IMT harboring ALKr. A 57-year-old male current smoker had presented with massive right pleural effusion, and a huge mass arising in the right pleural cavity with dyspnea and chest pain. He underwent a thoracoscopic tumor biopsy. On the basis of histology and IHC findings, the pathological diagnosis was IMT. The histological and molecular profiles of the biopsy samples were reviewed and FISH analysis showed a RANBP2-ALKr which is a known aggressive variant. Curative resection was not indicated due to an insufficient pulmonary reserve. He was enrolled in a phase I study of ASP-3026 in patients with advanced solid tumors. ASP-3026 treatment (125mg q.d.) was initiated on Feb 14, 2012 as first-line treatment. After administration of ASP-3026, dramatic tumor shrinkage was revealed by computed tomography, and symptoms decreased rapidly. Furthermore, it is noteworthy that this case represents the first report of use of serum hyaluronan levels to assist in monitoring of treatment and disease progression in an IMT.

Thoracoscopic Enucleation of Esophageal Submucosal Tumor by Prone Position Under Artificial Pneumothorax by CO2 Insufflation

Recently, the usefulness of the prone position for thoracoscopic esophagectomy has been demonstrated. Thoracoscopic resection of an esophageal submucosal tumor using a prone position also offers advantages over a lateral decubitus position. We describe 2 cases operated on using the prone position for the resection of esophageal submucosal tumor. Case 1 was a 35-year-old man, who was diagnosed with a 50×20 mm leiomyoma in the middle thoracic esophagus, and underwent right thoracoscopic tumor enucleation. Case 2 was a 61-year-old female, who had 45×30 mm esophageal schwannoma in the lower thoracic esophagus with symptoms of dysphagia, and underwent left thoracoscopic tumor enucleation. No complication was observed in both cases. Thoracoscopic esophageal submucosal resection with prone position may add the merits to conventional decubitus position, such as superior visualization, and less bleeding. The side of incision should be determined according to the location of the tumor and anatomic rationality.

Epithelioid inflammatory myofibroblastic sarcoma arising in the pleural cavity

A 57-year-old Japanese man presented with massive right pleural effusion, and a huge tumor arising in the pleural cavity was detected by chest computed tomography. A thoracoscopic tumor biopsy revealed that the tumor protruded extensively into the pleural cavity, and its gross appearance was cystic and glossy. Microscopically, the tumor cells were rounded and epithelioid in shape. Prominent and abundant myxoid stroma was also present together with an inflammatory infiltrate, and the tumor was anaplastic lymphoma kinase (ALK)-immunopositive. Fluorescence in situ hybridization revealed that the Ran-binding protein 2-ALK fusion gene was present. Taken together, these findings supported the diagnosis of epithelioid inflammatory myofibroblastic sarcoma (EIMS), which is a variant of an inflammatory myofibrobrastic tumor. This is the first reported case of an EIMS arising in the pleural cavity.

Desmoplastic Small Round Cell Tumor of the Lung

We report a rare case of desmoplastic small round cell tumor, which arose from the left lung. A 25-year-old man was found to have an abnormal shadow during a routine physical examination and was admitted to our hospital. A thoracoscopic tumor biopsy was performed under general anesthesia. According to the histopathologic findings of permanent sections, the tumor was composed of sharply outlined nests, clusters, and trabeculae of small round to oval cells separated by a spindle-shaped desmoplastic stroma. A gene analysis revealed chimera genes of Ewing's sarcoma and Wilms' tumor by reverse transcription polymerase chain reaction.

Intrathoracic Psammomatous Melanotic Schwannoma Associated With the Carney Complex

The Carney complex is a multiple neoplasia syndrome characterized by myxomas, schwannomas, mucocutaneous spotty pigmentations, and endocrine overactivity with or without endocrine tumors. Herein, we report the rare case of a 49-year-old man with a paravertebral intrathoracic tumor, a history of bilateral adrenalectomy, and resection of an atrial myxoma. A thoracoscopic en-bloc tumor extirpation with minimal safety margins was performed. Histopathologic examination revealed the diagnosis of a malignant psammomatous melanotic schwannoma that is associated with the Carney complex in 50% of these patients. Prognosis of all melanotic schwannomas is usually poor due to local recurrences or metastases. Although treatment guidelines for this rare tumor do not exist, radiotherapy was performed in our patient to prevent possible recurrence or regrowth of this malignant tumor. Twenty-four months after operation the patient showed no signs of tumor recurrence or metastases.