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1.
Purpose
Cerebral infarction is a rare complication of lung resection that can result in severe sequelae. Our aim was to investigate the characteristics of patients who suffer from cerebral infarction after surgery for lung cancer.Methods
We retrospectively reviewed all patients who underwent resection of at least a single lobe for lung cancer at our institution between January 2008 and October 2013. We compared the patients who presented with cerebral infarction with those patients who did not within 30 days of surgery.Results
A total of 562 patients underwent surgery, with five males and one female subsequently experiencing cerebral infarction. Five patients underwent left upper lobectomy and one underwent left lower lobectomy. Patient age, sex, body mass index, smoking index, and operative time were not significantly different between the six patients with postoperative cerebral infarction and the other 556 patients; only the type of operative procedure was significantly different (p < 0.001). Contrast-enhanced computed tomography revealed thrombosis in the stump of the left superior pulmonary vein in patients with postoperative cerebral infarction.Conclusions
Cerebral infarction occurs at a high frequency in patients who undergo left upper lobectomy for lung cancer. Thrombosis in the left superior pulmonary-vein stump might cause cerebral infarction.2.
Ryota Sumitomo Takamasa Fukui Satoshi Marumo Yosuke Otake Cheng-long Huang 《General thoracic and cardiovascular surgery》2018,66(8):464-470
Objective
This study aimed to determine if the vessel interruption sequence during thoracoscopic lobectomy affects disease recurrence.Methods
We retrospectively analyzed 187 consecutive patients who underwent video-assisted thoracoscopic surgery lobectomy with curative intent for non-small cell lung cancer between January 2007 and December 2013. Their clinicopathological, operative, and postoperative data were compared. Patients with minimally invasive adenocarcinoma were excluded.Results
A total of 104 patients underwent total venous interruption before interruption of any artery branch (V-first), while 83 patients underwent some artery interruption first (non-V-first). Clinicopathological characteristic distributions were similar between both groups except for the resected lobe. Seven of 104 patients in the V-first group and 15 of 83 patients in the non-V-first group experienced disease recurrences. Among the 187 patients who underwent thoracoscopic lobectomy, overall survival tended to be longer in the V-first group than in the non-V-first group (P?=?0.080). Furthermore, disease-free survival was significantly longer in the V-first group than in the non-V-first group (P?=?0.019), particularly in stage I patients (P?=?0.047). Multivariate analysis showed that vessel interruption sequence was a significant prognostic factor for poor disease-free survival, after adjusting for pathological stage and histology (hazard ratio 2.127; 95% confidence interval 1.009–4.481). There was no significant difference in intraoperative blood loss between both groups.Conclusions
Interrupting the pulmonary vein first may be associated with improved disease-free survival in patients undergoing thoracoscopic lobectomy for non-small cell lung cancer.3.
Purpose
To propose a treatment strategy for simultaneously discovered non-small cell lung cancer (NSCLC) and cardiovascular disease (CVD).Methods
Of 1302 patients who underwent surgery for NSCLC, CVD requiring invasive treatment was simultaneously discovered in 33 (3 %). The details of the treatments as well as the short- and long-term outcomes of pulmonary resection were analyzed.Results
CVD included coronary artery disease in 20 patients, valvular disease in 6, abdominal aortic aneurysm in 5, and congenital heart disease in 2. Twenty-six patients underwent two-stage treatment, while seven received simultaneous surgery. In 23 patients whose treatment for CVD preceded that for lung cancer, the median interval between those treatments was 78 days (range 18–197 days). Postoperative complications occurred in 8 (31 %) of 26 patients who underwent 2-stage treatment and in 3 (43 %) of 7 who underwent simultaneous surgery. Notably, of 3 patients who underwent lobectomy or bilobectomy, 2 (67 %) experienced respiratory dysfunction that required intubation. The 5-year overall survival rate of all 33 patients was 84.5 %.Conclusion
The outcomes of two-stage treatment in the present cohort were favorable. Given our experience, simultaneous surgery for lung cancer and CVD should, therefore, be selected only for patients who may benefit from that strategy.4.
Yuji Otsuki Hiroaki Kuwahara Hirofumi Konn 《General thoracic and cardiovascular surgery》2018,66(1):48-53
Objective
The rate of surgical resection of lung cancer in patients on hemodialysis is expected to increase due to the development of hemodialysis, improved diagnosis of lung cancer, and increases in the number and age of patients. However, studies assessing outcomes of lung resection in these patients are limited. In this retrospective case series, we investigated the safety and efficacy of video-assisted thoracic surgery (VATS) for lobectomy or segmentectomy for lung cancer in patients on hemodialysis.Methods
Between January 2010 and January 2017, lobectomy or segmentectomy using VATS was performed for seven lung cancer cases in six patients receiving hemodialysis at our institution. There were two female and five male patients, with a median age of 61 years (range 53–76 years). Six patients underwent lobectomy, and segmentectomy and wedge resection were performed in each one case, respectively; systematic mediastinal lymph node dissection (ND2a-2) was performed in six patients.Results
There were no perioperative deaths in this case series. Median recurrence-free and overall survival rates were 20 months (range 3–82 months) and 31 months (range 3–82 months), respectively.Conclusions
Video-assisted thoracic surgery (VATS) is a safe and effective procedure for resection of lung cancer in hemodialysis patients and should be considered after accurate determination of surgical indications and careful perioperative management.5.
Purpose
Total en bloc spondylectomy (TES) is a surgical procedure performed to achieve complete resection of an aggressive benign spinal tumor or a malignant spinal tumor. When reconstructing the spine after resection, we have been using liquid nitrogen-frozen resected spine bearing tumor as a bone graft, expecting an immunological response to tumor-specific antigen(s). The purpose of this article is to report a successful treatment case of lung adenocarcinoma metastasis with TES and this cryotherapy.Methods
A 59-year-old male presented with rapid progression of neurological deterioration of the lower limbs due to a spinal metastasis from T8 to T10. The primary lung adenocarcinoma had already been excised under thoracoscopy. The patient underwent TES with reconstruction using frozen tumor-bearing vertebra for the bone graft.Results
One month after surgery, a new nodule appeared at the right middle lobe of the lung. However, we carried out no biopsy of the newly emerged nodule and the patient received no adjuvant chemotherapy or radiotherapy. Six months after surgery, the tumor vanished. No local recurrence or metastasis of the tumor has been observed until now.Conclusions
TES with a liquid nitrogen-frozen tumor specimen could be a promising therapeutic option for cancer patients with spine metastasis.6.
Purpose
We aimed to identify the risk factors for thoracic and spinal deformities following lung resection during childhood and to elucidate whether thoracoscopic surgery reduces the risk of complications after lung resection.Methods
We retrospectively examined the medical records of all pediatric patients who underwent lung resection for congenital lung disease at our institution between 1989 and 2014.Results
Seventy-four patients underwent lung resection during the study period and were followed-up. The median age of the patients at the time of surgery was 5 months (range 1 day–13 years), and 22 were neonates. Thoracotomy and thoracoscopy were performed in 25 and 49 patients, respectively. Thoracic or spinal deformities occurred in 28 of the 74 patients (37%). Univariate analyses identified thoracotomy, being a neonate (age: <1 month) at the time of surgery, and being symptomatic at the time of surgery as risk factors for these deformities. However, a multivariate analysis indicated that only thoracotomy and being a neonate were risk factors for deformities.Conclusions
Thoracoscopic surgery reduced the risk of thoracic and spinal deformities following lung resection in children. We suggest that, where possible, lung resection should be avoided until 2 or 3 months of age.7.
Ryoichi Nakanishi Yoshihisa Fujino Masato Kato Takashi Miura Manabu Yasuda Risa Oda Keisuke Yokota Katsuhiro Okuda Hiroshi Haneda 《General thoracic and cardiovascular surgery》2018,66(12):723-730
Objectives
There is no evidence concerning the appropriate drainage volume for indicating chest tube removal after pulmonary lobectomy. A prospective multi-institutional cohort study was designed to elucidate the safety of early chest tube removal after thoracoscopic lobectomy.Methods
Between April 2009 and November 2011, 310 patients with suspected or histologically documented lung cancer were screened. Patients without air leakage or bloody, chylous, or purulent pleural effusion underwent chest tube removal on the day after thoracoscopic lobectomy, independent of the drainage volume. The subjects were classified into three groups as tertiles according to the drainage volume that was observed for approximately 24 h after surgery. The associations between the drainage volume and the development of complications were investigated, with several clinical factors taken into account.Results
The 162 patients who were enrolled underwent early chest tube removal via this protocol and were classified into three groups according to their drainage volume (0–219 mL, n?=?52; 220–349 mL, n?=?56; and ≥?350 mL, n?=?54). A 7F backup tube placed within the dead space to prevent troubles was removed by postoperative day 4 in all patients because nothing happened. Univariate and multivariate analyses showed that the drainage volume was not associated with the risk of complications.Conclusions
Early removal of the chest tube on the day after thoracoscopic lobectomy appears to be a safe treatment protocol in patients without air leakage or bloody, chylous, or purulent pleural effusion; however, careful surveillance is needed for patients who have a drainage volume of ≥?350 mL/day.Clinical registration number
University Hospital Medical Information Network Clinical Trials Registry, 000028971 (Japan).8.
Purpose
To investigate the surgical outcomes of surgery for non-small cell lung cancer (NSCLC) in patients with atrial fibrillation (AF) as a preoperative comorbidity.Methods
Among 805 patients who underwent surgery for NSCLC, 27 (3.4%) had a history of AF. We analyzed the perioperative and long-term outcomes of these 27 patients.Results
Fourteen patients (52%) had chronic AF and 13 (48%) had paroxysmal AF; being high rates of a comorbid illness. Nineteen patients (70%) underwent lobectomy, and 8 (30%) underwent sublobar resection. Ten patients (37%) received perioperative heparinization. There was no mortality. Other non-AF postoperative complications developed in 8 patients (30%), this incidence being higher than among the patients without AF (16%, 127 out of 778, p = 0.09). A thromboembolic event occurred in one patient (4%). With respect to the long-term outcomes, the 5-year overall survival and disease-free survival rates among the patients with AF were 70.3 and 60.8%, respectively, which were similar to those in the patients without AF (79.8 and 72.6%, p = 0.30 and 0.31).Conclusions
Lung cancer surgery in patients with AF is safe and provides favorable long-term outcomes; however, thoracic surgeons should monitor these patients carefully for postoperative thromboembolic events.9.
Teus J. Weijs Jelle P. Ruurda Misha D. P. Luyer Grard A. P. Nieuwenhuijzen Sylvia van der Horst Ronald L. A. W. Bleys Richard van Hillegersberg 《Surgical endoscopy》2016,30(9):3816-3822
Background
Pulmonary vagus branches are transected as part of a transthoracic esophagectomy and lymphadenectomy for cancer. This may contribute to the development of postoperative pulmonary complications. Studies in which sparing of the pulmonary vagus nerve branches during thoracoscopic esophagectomy is investigated are lacking. Therefore, this study aimed to determine the feasibility and pitfalls of sparing pulmonary vagus nerve branches during thoracoscopic esophagectomy.Methods
In 10 human cadavers, a thoracoscopic esophagectomy was performed while sparing the pulmonary vagus nerve branches. The number of intact nerve branches, their distribution over the lung lobes and the number and location of the remaining lymph nodes in the relevant esophageal lymph node stations (7, 10R and 10L) were recorded during microscopic dissection.Results
A median of 9 (range 5–16) right pulmonary vagus nerve branches were spared, of which 4 (0–12) coursed to the right middle/inferior lung lobe. On the left side, 10 (3–12) vagus nerve branches were spared, of which 4 (2–10) coursed to the inferior lobe. In 8 cases, lymph nodes were left behind, at stations 10R and 10L while sparing the vagus nerve branches. Lymph nodes at station 7 were always removed.Conclusions
Sparing of pulmonary vagus nerve branches during thoracoscopic esophagectomy is feasible. Extra care should be given to the dissection of peribronchial lymph nodes, station 10R and 10L.10.
Purpose
In 2009, the Centers for Disease Control and Prevention published Guidelines for the Prevention of Catheter-Associated Urinary Tract Infections, which limited the indications for perioperative urinary catheter use. We conducted this study to evaluate the safety of elective laparoscopic cholecystectomy (LC) without urinary catheter placement and to investigate whether it reduces the incidence of urinary complications.Methods
Of 244 patients who underwent elective LC between March, 2010 and April 2011, 192 patients fulfilled the eligibility criteria and underwent surgery without urinary catheterization (non-catheterized group). We compared the clinical features and surgical outcomes of the non-catheterized group with those of an historical control of 90 patients who underwent LC with routine urinary catheterization.Results
The operating times were similar in the two groups and there was no case of conversion to open surgery. The postoperative hospital stay was slightly shorter and the incidence of urinary complications was significantly lower in the non-catheterized group. Three patients in the non-catheterized group suffered urinary retention, which resolved after temporary catheterization.Conclusion
Our study demonstrated that elective LC without urinary catheter placement is feasible for most patients and might reduce the incidence of perioperative urinary complications.11.
Purpose
Laparoscopic colorectal surgery is increasingly being performed in patients treated with previous abdominal surgery. This is a retrospective study designed to evaluate the feasibility of laparoscopic right colectomy in patients with a previous history of gastrectomy.Methods
Of 838 consecutive patients who underwent elective laparoscopic right colectomy, 23 had previously undergone gastrectomy (PG group) and 516 had no history of previous abdominal surgery (NS group). The short-term surgical outcomes were retrospectively investigated in the PG and NS groups.Results
The median patient age was 75 years in the PG group and 67 years in the NS group (p = 0.0026), and the median body mass index in both groups was 19.2 and 22.6 kg/m2, respectively (p = 0.0006). The mean operative time, amount of blood loss and postoperative hospital stay were similar. One patient in the PG group and five patients in the NS group required conversion to laparotomy (p = 0.1307). Three patients in the PG group experienced postoperative complications, one each with an intraperitoneal abscess, wound infection and enterocolitis; however, none of these complications were directly attributable to adhesiolysis. The rates of intraoperative and postoperative complications were similar.Conclusions
Laparoscopic right colectomy is feasible in patients treated with previous gastrectomy.12.
Yusuke?Muranishi Makoto?Sonobe Toshi?Menju Akihiro?Aoyama Toyohumi?F.?Chen-Yoshikawa Toshihiko?Sato Hiroshi?Date
Purpose
Atrial fibrillation (Af) is a common post-operative cardiac complication after lung cancer surgery; however, the type of lung cancer surgery being performed has evolved, remarkably, into minimally invasive surgical procedures. The purpose of this study was to quantify the incidence and severity of post-operative Af and to identify the risk factors for Af, using a recent cohort of lung cancer surgery patients.Methods
We reviewed, retrospectively, the medical records of 593 patients, who underwent lung cancer surgery between 2011 and 2013, for the development of post-operative Af.Results
The overall incidence of post-operative Af in our study was 6.4 % (38/593). Three (8 %) of these 38 patients, subsequently, suffered brain infarction. Multivariate analysis revealed that mediastinal lymph node dissection (OR ND-2/ND-0–1 = 3.06; 95 % CI 1.06–10.9) was associated with the development of post-operative Af.Conclusion
Omission of mediastinal lymph dissection for patients with early stage lung cancer and a high risk of Af should be considered to prevent post-operative Af.13.
Purpose
Lung transplantation is accepted as an effective modality for patients with end-stage pulmonary lymphangioleiomyomatosis (LAM). Generally, bilateral lung transplantation is preferred to single lung transplantation (SLT) for LAM because of native lung-related complications, such as pneumothorax and chylothorax. It remains controversial whether SLT is a suitable surgical option for LAM. The objective of this study was to evaluate the morbidity, mortality and outcome after SLT for LAM in a lung transplant center in Japan.Methods
We reviewed the records of 29 patients who underwent SLT for LAM in our hospital between March, 2000 and November, 2017. The data collected included the pre-transplant demographics of recipients, surgical characteristics, complications, morbidity, mortality and survival after SLT for LAM.Results
The most common complication after SLT for LAM was contralateral pneumothorax (n?=?7; 24.1%). Six of these recipients were treated successfully with chest-tube placement and none required surgery for the pneumothorax. The second-most common complication was chylous pleural effusion (n?=?6; 20.7%) and these recipients were all successfully treated by pleurodesis. The 5-year survival rate after SLT for LAM was 79.5%.Conclusion
LAM-related complications after SLT for this disease can be managed. SLT is a treatment option and may improve access to lung transplantation for patients with end-stage LAM.14.
Objectives
The aim of this study is to evaluate the feasibility and safety of video-assisted thoracic surgery (VATS) for the treatment of middle lobe syndrome (MLS) through comparison with thoracotomy during the same period.Methods
We retrospectively reviewed all consecutive patients with MLS who underwent lobectomy or lingular segmentectomy between December 2005 and November 2015 in a single institute. Thirty patients were enrolled and divided into two groups: VATS group (n = 19) and thoracotomy group (n = 11). Data regarding the patients’ demographics, medical history were collected and statistically compared.Results
All patients received successful middle lobe resection or lingular segmentectomy. In terms of operation time, blood transfusion, chest drainage amount, duration of chest drainage and postoperative complications, no significant differences were found between the two groups (p > 0.05). The mean intraoperative blood loss of VATS group was less than thoracotomy group (79.0 ± 63.9 vs. 165 ± 94.9 ml, p = 0.04). In VATS group, the mean length of postoperative hospital stay was 6.0 ± 2.4 days, shorter than that in group thoracotomy (9.0 ± 3.5 days, p = 0.01).Conclusions
VATS was a feasible and safe method for the surgical treatment of MLS in selected patients when no severe calcified lymph nodes surrounding hilus pulmonis was observed by preoperative chest CT scan.15.
Takuya Ueda Kenji Suzuki Takeshi Matsunaga Kazuya Takamochi Shiaki Oh 《General thoracic and cardiovascular surgery》2018,66(2):95-100
Objective
The aim of this study was to elucidate the characteristics and predictors of postoperative atrial fibrillation (POAF) from the standpoint of surgical mode.Methods
Retrospective analysis was carried out on 607 patients who underwent lobectomy or segmentectomy for clinical stage IA lung cancer. We investigated the clinical factors to determine the predictors of the development of POAF.Results
Of the 607 patients, 443 underwent lobectomy, and 164 underwent segmentectomy. POAF developed in 37 patients. Of these, 34 (7.7%) were in the lobectomy group, and 3 (1.8%) in the segmentectomy group. In the univariate analysis for predictors of POAF, age (p?<?0.01), history of ischemic heart disease (p?=?0.03), FEV1.0% (p?<?0.01) and surgical mode (p?=?0.01) showed significant differences between the groups. The multivariate analysis revealed that increasing age (p?<?0.01, HR 1.059, CI 1.015–1.106), surgical mode (p?=?0.02, HR 5.734, CI 1.350–24.361) and FEV1.0%?<?70% (p?=?0.03, HR 2.182, CI 1.067–4.461) were independent predictors of POAF.Conclusion
POAF was significantly less following segmentectomy compared with lobectomy.16.
Nadav Nevo Subhi Abu-Abeid Guy Lahat Joseph Klausner Shai M. Eldar 《Obesity surgery》2018,28(2):364-368
Background
Sleeve gastrectomy (SG) is gaining popularity and has become the procedure of choice for many bariatric surgeons. Long-term weight loss failure is not uncommon. The preferred revisional procedure for these patients is still under debate.Objective
The objective of this study was to assess the safety and efficacy of laparoscopic gastric bypass as a revisional surgery for sleeve gastrectomy patients with weight loss failure.Setting
The study was done at a bariatric surgery center in a university hospital.Methods
We reviewed our prospectively collected database and identified all patients who underwent conversion of a sleeve gastrectomy to a gastric bypass for weight loss failure. Data on patient demographics, baseline characteristics, and outcomes of bariatric surgery were retrieved.Results
Twenty-three patients with a mean body mass index (BMI) of 41.6 kg/m2 (range 34.1–50.1 kg/m2) underwent conversion to a gastric bypass. Four patients underwent a gastric band prior to the sleeve gastrectomy, and two patients underwent a re-sleeve gastrectomy prior to conversion to a gastric bypass.At a mean follow-up of 24 months (range 9–46 months), the average body mass index (BMI) decreased to 33.8 kg/m2 and the excess body mass index loss (EBMIL) was 42.6%. Diabetes, hypertension, dyslipidemia, and obstructive sleep apnea resolved or improved in 44.4, 45.5, 50, and 50% of the patients, respectively. Three patients developed early postop complications (13%), while late complications occurred in four patients (17%).Conclusion
Converting a sleeve gastrectomy to a gastric bypass for weight loss failure is safe, yet weight loss benefit is limited.17.
Hiroyoshi Tsubochi Tomoki Shibano Shunsuke Endo 《General thoracic and cardiovascular surgery》2018,66(2):71-80
Objectives
To improve surgical outcomes, clinicians must provide optimal perioperative care for comorbidities identified as significant factors in risk models for patients undergoing lung cancer surgery.Methods
We reviewed trends in perioperative care for idiopathic pulmonary fibrosis, cardiovascular diseases, and end-stage renal diseases in patients undergoing lung cancer surgery, as large clinical databases indicate that these comorbidities are significant risk factors for lung cancer surgery. Articles identified by keyword searches were included in the analysis.Results
Significant predictive factors for acute exacerbation of idiopathic pulmonary fibrosis were identified. However, no effective perioperative care was identified for prevention of acute exacerbation of interstitial pneumonia. The timing of coronary revascularization and antithrombotic management for cardiovascular diseases are subjects of ongoing research, and acid–base balance is essential in the management of hemodialysis patients with end-stage renal diseases.Conclusions
To improve surgical outcomes for lung cancer patients, future studies should continue to study optimal perioperative management of comorbidities.18.
Purpose
Lung cancer surgery can be dangerous in patients with interstitial pneumonia (IP) as acute exacerbation of the IP may prove fatal. It remains unclear if patients with collagen diseases (CD), who often suffer from IP, are also at increased risk during lung cancer surgery.Methods
We retrospectively examined 17 (3.1%) patients with CD among 545 patients who underwent surgery for lung cancer at our institution.Results
Nine patients with rheumatoid arthritis, five with systemic sclerosis, two with Sjögren's disease, and one with systemic lupus erythematosus were enrolled in this study. Eleven patients (65%) were taking corticosteroids at the time of surgery. Fourteen patients underwent lobectomy and lymph node dissection, and three patients with pStage IA lung cancer underwent pulmonary wedge resection. Pathologically, 11 (65%) patients had IP with various inflammatory cellular infiltrations, and three (18%) had honeycombing of the lung. Postoperatively, none of the patients suffered acute exacerbation of their IP.Conclusions
Despite the high incidence of IP in patients with lung cancer and CD, our results suggest that CD is not a contraindication to the surgical resection of lung cancer.19.
Yo Kawaguchi Jun Hanaoka Yasuhiko Ohshio Tomoyuki Igarashi Yoko Kataoka Keigo Okamoto Ryosuke Kaku Kazuki Hayashi 《General thoracic and cardiovascular surgery》2018,66(9):537-542
Objective
In elderly patients with lung cancer, the presumed fear of postoperative complications has resulted in the delivery of limited resection. Surgical decision-making for such patients would become easier if clinicians could predict who is at high risk of postoperative complications. The purpose of this study is to propose a scoring system to predict the risk of postoperative complications for elderly patients with lung cancer.Methods
We reviewed patients aged 75 years or older who underwent lobectomy for lung cancer at a single hospital (n?=?199). A multivariable logistic regression model was utilized to determine risk factors for postoperative complications.Results
Six risk factors for postoperative complications were identified, and we derived a risk score by assigning weights to these factors based on their odds ratios, as follows: Risk score?=?7 × (performance status of 2)?+?6 × (coronary artery disease)?+?3 × (a history of cerebrovascular accident)?+?2 × (restrictive ventilatory impairment)?+?1 × (male sex)?+?1 × (interstitial pneumonia). The postoperative complication rates in patients with risk scores of 0, 1–2, 3–5, 6–8, and 9–14 were 19, 29, 56, 68, and 90%, respectively.Conclusions
The proposed risk score was able to predict the incidence of postoperative complications. The risk score can be used to identify high-risk patients and to select proper treatment strategies.20.