Wedge Resection For Lung Cancer Research Articles

Margin quality analysis for wedge resection of lung cancer and construction of a predictive model.

Insufficient pulmonary wedge resection margin is associated with malignant positive margins and high local recurrence risk for lung cancer. This study aimed to identify the risk factors of insufficient or guideline discordant resection margin distance and establish a predictive model to preoperatively estimate the risk of discordant margin for individual patient. Guideline discordant resection margin was defined as ratio of resection margin distance to tumor size less than one. Patients who had pulmonary malignancies and underwent wedge resection between April 2014 and February 2023 were enrolled and stratified by quality of resection margin. Multivariable logistic regression analysis was employed to identify risk factors of guideline discordant margin and a predictive model was developed. Data from March 2023 to January 2024 were collected for internal validation. A total of 530 patients were included. The incidence of guideline discordant wedge resection margin was 37.2%. Longer tumor's max distance to pleura and larger tumor size were variables associated with increased risk and included in the final model. Preoperative localization and right-side surgery were protective variables in the predictive model. A nomogram was built based on the predictive model. The model showed satisfying predictive performance with a concordance index of 0.720 for the predictive model, and 0.761 for internal validation. The goodness-if-fit tests were non-significant for both model development and internal validation data set. The preoperative predictive model and nomogram show good predictive performance to estimate the risk of guideline discordant wedge resection margin. Individualized surgical plans or preoperative nodule localization can be made for high-risk patients.

Pulmonary wedge resection for lung cancer developing in a single transplanted lung: a case report

BackgroundPrimary lung cancer arising in a transplanted lung is much rarer than cancer arising in a native lung. We herein describe a case of lung cancer developing in a transplanted lung after single-lung transplantation. Wedge resection was safely and successfully completed using venovenous extracorporeal membrane oxygenation (VV-ECMO).Case presentationA 63-year-old man underwent right single-lung transplantation for idiopathic interstitial pneumonia from a donor in his 60s with a 44-pack-year history of smoking. One year 6 months later, computed tomography revealed a 10-mm nodule in the right lower lobe of the transplanted lung. Fluorodeoxyglucose-positron emission tomography showed abnormal accumulation of fluorodeoxyglucose (maximum standardized uptake value, 2.8) in the same area, suggesting lung cancer. However, percutaneous or transbronchial biopsy was technically impossible. Surgical diagnosis and treatment were planned, and VV-ECMO was introduced before wedge resection. Although pleural adhesion and the location of the nodule close to the hilum resulted in a challenging procedure, the operation was completed in 190 min. The final pathological diagnosis was papillary adenocarcinoma.ConclusionsLung cancer arising in a lung transplanted from a brain-dead donor is rare. Limited lung resection using VV-ECMO is considered a useful option, particularly in cases of single-lung transplantation.

Basal segment deep wedge resection for lung cancer with pulmonary fibrosis

Acute exacerbation (AE) of idiopathic pulmonary fibrosis (IPF) is among the most fatal postoperative complications of lung resection in patients with IPF. Non-small-cell lung cancer (NSCLC) with IPF exhibits basal segment dominance. Treatment options for these lesions include lobectomy or basal segment segmentectomies. However, these procedures potentially increase risks of AE due to surgical stress including prolonged operative time and loss of pulmonary function. Therefore, as an alternative to these procedures, we developed a simple and practical deep wedge resection technique for basal segments. Our technique is minimally invasive and quick and simple approach in patients with NSCLC and IPF.

A Case of Chylothorax Following Thoracoscopic Wedge Resection for Lung Cancer

A Case of Chylothorax Following Thoracoscopic Wedge Resection for Lung Cancer

Prognostic impact of underlying lung disease in pulmonary wedge resection for lung cancer.

Pulmonary wedge resection is an option for lung cancer patients with limited cardiopulmonary preservation. As the impact of underlying lung status on the prognosis of such patients remains unclear, we assessed this issue. A total of 149 borderline surgical candidates with localized lung cancer who had undergone wedge resection were retrospectively investigated. Clinical variables related to perioperative morbidity, local control rate, and oncological outcomes based on underlying lung disease were analyzed. According to the risk analysis of postoperative complications, underlying lung disease did not influence the surgical morbidity. Postoperative recurrence occurred in 65 patients (locoregional recurrence in 36, distant metastasis in 12, and both simultaneously in 17). Multivariate analysis revealed that emphysema on computed tomography (CT) [hazard ratio (HR) 0.45; 95% confidence interval (CI) 0.21-0.99] was an independent indicator of locoregional recurrence. Forty-four patients died of lung cancer and 29 of other causes. Multivariate analysis demonstrated that interstitial lung disease on CT (HR 1.98; 95% CI 1.01-3.89) was a predictor of poor prognosis. Pulmonary wedge resection can be safely undergone by lung cancer patients regardless of pulmonary comorbidity, although underlying lung disease may influence the prognosis after wedge resection.

Validating margin status in lung wedge resection for clinical stage I non-small cell lung cancer.

Stage I non-small cell lung cancer (NSCLC) is a localized disease without metastasis; therefore, it can be treated effectively with local therapies. Pulmonary resection is the most frequent treatment, performed as pulmonary wedge resection, segmentectomy, lobectomy, or pneumonectomy. Some retrospective clinical studies of pulmonary wedge resection suggest that its outcome may be inferior to that of anatomical pulmonary resection, whereas other recent studies, which assess surgical margin status, leveled acceptable outcomes. Since the outcome of pulmonary wedge resection for lung cancer may depend on tumor size, distance from the surgical margin to the tumor, tumor size/margin distance ratio, and margin cytology results, a prospective study assessing these parameters is ongoing. This will allow us to identify the clinical implications of these factors and predict which patients are likely to have a good outcome.

A no-touch technique for pulmonary wedge resection of lung cancer.

Many of the surgical patients with lung cancer die by metastasis originated from circulating tumor cells (CTCs) which are seeds of metastases. A ring-shaped catching forceps, which generates the great pressure by compression, may reduce the risk of tumor cell spreading. Here, we investigated the efficacy of such forceps based on CTC occurrence. Twenty-three patients with clinical stage IA lung cancer who underwent a pulmonary wedge resection were investigated in a clinical-pathological manner. They were divided into those treated using ring forceps catching without tumor release (R group) (n = 16) and non-complete use of ring forceps (N group) (n = 7), then were determined circulating tumor cells (CTCs). Radiographic findings, tumor location, pathological diagnosis, and stapling method were not significantly different between the groups. The risk of detection of CTCs after surgery was significantly lower in group R (12.5 vs. 85.7%, p = 0.02), whereas there were no significant differences found in risk of negative-stapled margin cytology, pre-OP CTC detection, V (+), Ly (+), and Pl (+). Patients who underwent pulmonary wedge resection of lung cancer had low chance of CTC detection after surgery when they were treated with ring forceps without tumor release, which might become a no-touch isolation technique.

Dose pulmonary wedge resection for lung cancer always provide worse survival result than segmentectomy?

Dose pulmonary wedge resection for lung cancer always provide worse survival result than segmentectomy?

Value of Wedge Resection for Lung Cancer in Poor Cardiopulmonary Status Patients

The strategic management of primary lung cancer in patients with poor cardiopulmonary status is still controversial. The aim of this study was to ascertain the early and late results of wide-margin wedge resection with curative intent in this group of patients. Between January 1995 and January 2002, 24 patients (13 males; mean age, 69.96 years) with baseline poor cardiopulmonary status underwent wide-margin wedge resection of preoperatively diagnosed primary lung cancer. All patients suffered from chronic obstructive pulmonary disease and 9 (37.5%) also had symptomatic ischemic heart disease. Eight patients were in New York Heart Association class III and 12 were in class IV. There were no post-operative deaths. Complications included chest infection in 3, surgical emphysema with prolonged air leak in 1, and atrial fibrillation in 6. Overall 7-year survival was 23.3%. Three patients with ischemic heart disease suffered late non-cancer-related death due to myocardial infarction at 48, 60, and 60 months postoperatively. Cancer-free 5-year survival was 54.3%, with 7/24 (29%) late recurrences. Our study suggests that wide-margin wedge resection is a valuable surgical option for primary lung cancer in patients with poor cardiopulmonary status.

PD-125 Efficacy of wedge resection of lung cancer: Ten year survival

PD-125 Efficacy of wedge resection of lung cancer: Ten year survival

P-165 Robatic (da Vinci robot) placement of I 125 seeds after wedge resection for lung cancer

P-165 Robatic (da Vinci robot) placement of I 125 seeds after wedge resection for lung cancer

Fatal Venous Air Embolism during Lung Surgery

Venous air embolism (VAE) can be a lethal complication of surgical procedures during which (1) venous pressure at the site of surgery is subatmospheric or (2} air (or gas) is forced under pressure into a body cavity. We experienced a case of fatal massive venous ir embolism during lung surgery in a 52 years old patient undergoing a right upper lobectomy and ight lower lobe superior segment wedge resection for lung cancer. Anesthetic induction and the initial intraoperative course were completely uneventful until sudden severe hypotension and abrupt bradycardia occurred after artificial air insufflation into the intraabdominal cavity through the diaphragm to reduce the dead space of the thoracic cavity. We considered a venous air embolism as the etiology of these events and treated the patient with manual cardiac massage, various cardiotonic drugs and removal of air through the right atrium. The patient was extubated at 3 days after surgery and discharged from the hospital without the complication of the venous air embolism.