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Harmouchi H, Sani R, Belliraj L, Ammor F, Issoufou I, Lakranbi M, Ouadnouni Y, Smahi M. Pneumonectomy for non-tumoral diseases: etiologies and follow-up in 38 cases. Asian Cardiovasc Thorac Ann 2019; 27:298-301. [PMID: 30808191 DOI: 10.1177/0218492319834823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Pneumonectomy is a surgical procedure associated with high rates of morbidity and mortality. Chronic inflammatory pathologies increase these rates, depending on the degree of pleural symphysis and the underlying pulmonary pathology. The occurrence of a bronchopleural fistula after pneumonectomy remains of great concern to the thoracic surgeon, because it leads to empyema in the pneumonectomy cavity, which requires protracted and difficult management. METHODS A retrospective single-center study was carried out on 38 patients who underwent pneumonectomy for non-tumoral pathologies between 2010 and 2017. Of the 38 patients, 22 (57.8%) men and 16 (42.2%) women, the average age was 40.3 years, and 30 (79%) patients were treated for tuberculosis. RESULTS The symptoms were predominantly hemoptysis with bronchorrhea in 22 (57.9%) cases. Chest computed tomography showed right-sided involvement in 15 (39.5%) patients, with destroyed lung in 31 (81.5%). Early postoperative complications included bleeding in 11 (28.9%) patients, postpneumonectomy empyema in 4 (10.5%), and death in 2 (5.2%). The average duration of follow-up was 2 years, without any recurrence. CONCLUSION The endemicity of tuberculosis in our context, and the absence of screening for lung cancer, explain the frequency of pneumonectomy for chronic inflammatory diseases, and the rate of complications after this surgical procedure.
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Affiliation(s)
- Hicham Harmouchi
- 1 Department of Thoracic Surgery, Hassan II University Hospital, Fez, Morocco
| | - Rabiou Sani
- 1 Department of Thoracic Surgery, Hassan II University Hospital, Fez, Morocco
| | - Layla Belliraj
- 1 Department of Thoracic Surgery, Hassan II University Hospital, Fez, Morocco
| | - Fatimazahra Ammor
- 1 Department of Thoracic Surgery, Hassan II University Hospital, Fez, Morocco
| | - Ibrahim Issoufou
- 1 Department of Thoracic Surgery, Hassan II University Hospital, Fez, Morocco
| | - Marouane Lakranbi
- 1 Department of Thoracic Surgery, Hassan II University Hospital, Fez, Morocco.,2 Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdallah University, Fez, Morocco
| | - Yassine Ouadnouni
- 1 Department of Thoracic Surgery, Hassan II University Hospital, Fez, Morocco.,2 Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdallah University, Fez, Morocco
| | - Mohammed Smahi
- 1 Department of Thoracic Surgery, Hassan II University Hospital, Fez, Morocco.,2 Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdallah University, Fez, Morocco
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Olland A, Falcoz PE, Guinard S, Seitlinger J, Massard G. Surgery as a treatment for pulmonary tuberculosis. Tuberculosis (Edinb) 2018. [DOI: 10.1183/2312508x.10021717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Takahashi R, Fujiwara T, Yamakawa H. Completion pneumonectomy after fenestration for empyema due to nontuberculous mycobacteriosis associated with destroyed lung as a result of cancer surgery. J Thorac Dis 2017; 9:E997-E1001. [PMID: 29268557 DOI: 10.21037/jtd.2017.10.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Long-term follow-up of post-operative lung cancer patients indicates that some patients develop lung complications. Destroyed lung cannot be ignored because it predisposes the patient to recurrent infection. We report a case of thoracic empyema with bronchopleural fistula that developed in lung tissue damaged due to cancer surgery and associated with an infection of Mycobacterium gordonae (M. gordonae); a class of bacterium responsible for nontuberculous mycobacterial infection. The patient's cancer did not recur after surgery and followed a typical course that began with sub-pleural cystitis followed by repeated infection. We performed fenestration because the patient developed fistulous empyema and the infection became difficult to control using antibiotics. The patient then underwent a radical pleuropneumonectomy and his postoperative course was excellent. Thus, in cases of impaired lung function due to cancer surgery and where pharmacologic control of infection is challenging, we suggest that radical surgical intervention should be considered.
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Affiliation(s)
- Ryo Takahashi
- Department of General Thoracic Surgery, National Hospital Organization Chiba-East Hospital, Chiba, Japan.,Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.,Department of Surgery, Jinken Clinic, Kanagawa, Japan
| | - Taiki Fujiwara
- Department of General Thoracic Surgery, National Hospital Organization Chiba-East Hospital, Chiba, Japan.,Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hisami Yamakawa
- Department of General Thoracic Surgery, National Hospital Organization Chiba-East Hospital, Chiba, Japan.,Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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Massard G, Olland A, Santelmo N, Falcoz PE. Surgery for the Sequelae of Postprimary Tuberculosis. Thorac Surg Clin 2012; 22:287-300. [DOI: 10.1016/j.thorsurg.2012.05.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lejay A, Falcoz PE, Santelmo N, Helms O, Kochetkova E, Jeung M, Kessler R, Massard G. Surgery for aspergilloma: time trend towards improved results? Interact Cardiovasc Thorac Surg 2011; 13:392-5. [DOI: 10.1510/icvts.2011.265553] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Bollmann T, Hegenscheid K, Busemann A, Kölble K, Hosten N, Heidecke CD, Kähler CM, Ewert R. Spontaneous haemoptysis as a late complication of plombage in a tuberculosis patient. Wien Med Wochenschr 2011; 161:217-21. [PMID: 21533928 DOI: 10.1007/s10354-011-0886-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2010] [Accepted: 01/18/2011] [Indexed: 11/30/2022]
Abstract
The endemic spread of tuberculosis after World War II and the deficiency of appropriate antituberculous drugs had led to a renaissance of the surgical tuberculosis therapy until the early 1950s. Late complications of plombage performed decades before are rare and are mainly related to infection and/or migration of the inserted foreign material and are scarcely recognized today. We report on a 73-year-old male patient, who was admitted to the emergency room of our hospital with acute massive haemoptysis for four days. On physical examination the patient presented with decreased breath sounds over the left lung and an old left-sided thoracotomy scar. Radiological findings and bronchoscopy revealed an empyema and a fistula as late complications 53 years after collapse therapy with insertion of a plombage for the treatment of pulmonary tuberculosis. The endobronchial nylon threads in the left bronchial tree and the fistula ending in the left lower bronchus confirmed our diagnosis. The patient was successfully treated by resection of the affected lower lobe. The present casuistic demonstrates a rare cause of spontaneous haemoptysis: late complications after extrapleural pneumolysis and plombage for cavitary tuberculosis over 50 years after the initial operation.
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Affiliation(s)
- Tom Bollmann
- Department of Internal Medicine B - Cardiology, Pulmonary Medicine, Infectious Diseases, Intensive Care Medicine, University Hospital Greifswald, Ernst-Moritz-Arndt-University, Greifswald, Germany.
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Arsalane A, Zidane A, Atoini F, Traibi A, Ameziane N, Kabiri EH. [Pulmonary decortication: value of lung function recovery]. REVUE DE PNEUMOLOGIE CLINIQUE 2009; 65:279-286. [PMID: 19878801 DOI: 10.1016/j.pneumo.2009.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2008] [Revised: 11/21/2008] [Accepted: 03/05/2009] [Indexed: 05/28/2023]
Abstract
PURPOSE Based on the experience in the thoracic surgery unit at Hôpital Militaire d'Instruction Mohammed-V in Rabat, this study analyses the indications as well as the results of pulmonary decortication. MATERIALS AND METHODS Twenty-five cases of pulmonary decortication were examined over a period of 5 years ranging from January 2002 to December 2006. The aetiology of chronic pyothorax was dominated by non tubercular causes. The clinical symptomatology mainly involved fever and dyspnoea (48% and 44% respectively). Pachypleuritis, collapse of the lung and pleural effusion account for most of the lesions found on the thoracic imaging. Surgery was indicated after failure in the medical treatment after four months on the average. RESULTS The respiratory function was assessed in 20 patients three months after the intervention. The improvement in the spirometry was good in 85% of the cases (n=17), was not highly satisfactory in 10% of the cases (n=2) and a deterioration was noted in 5% of the cases (n=1). This unfavourable evolution was correlated with the tubercular aetiology and the poor state of the pulmonary parenchyma. CONCLUSION Non tubercular causes, early diagnosis and absence of parenchymatous lesion seem to be predictive factors of good results after decortication.
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Affiliation(s)
- A Arsalane
- Service de Chirurgie Thoracique, Hôpital Militaire d'Instruction Mohamed-V, Avenue des Forces-Armées-Royales, Hay Riad, Rabat, Morocco.
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Thoracic Surgery for Tuberculosis. Tuberculosis (Edinb) 2004. [DOI: 10.1007/978-3-642-18937-1_25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Shiraishi Y, Nakajima Y, Koyama A, Takasuna K, Katsuragi N, Yoshida S. Morbidity and mortality after 94 extrapleural pneumonectomies for empyema. Ann Thorac Surg 2000; 70:1202-6; discussion 1206-7. [PMID: 11081871 DOI: 10.1016/s0003-4975(00)01612-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Extrapleural pneumonectomy is still indicated in some patients with empyema. We examined morbidity and mortality after this high-risk operation. METHODS Between 1979 and 1998, 94 (92 chronic, 2 postsurgical) patients with empyema underwent extrapleural pneumonectomy. There were 79 men and 15 women (mean age, 59 years). Eighty-eight patients had a history of tuberculosis, and 53 had undergone a therapeutic pneumothorax. The right side was operated on in 50 patients and left in 44. RESULTS Operative mortality was 8.5%. Fifteen major complications (1 esophageal perforation, 9 empyemas, and 5 bronchopleural fistulas) occurred in 13 patients. Eight patients required reexploration for hemorrhage. Reexploration was a risk factor for empyema. Bronchopleural fistulas occurred only on the right side. Eighty-nine percent of the 86 operative survivors were free of empyemas at 5 years. Overall 5-year survival was 83%, and survival was better in patients without than in those with empyema. CONCLUSIONS Extrapleural pneumonectomy for empyema has acceptable morbidity and mortality. Postoperative empyema affects prognosis. Covering a bronchial stump with muscle is recommended, especially when the operation is performed on the right side.
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Affiliation(s)
- Y Shiraishi
- Section of Chest Surgery, Fukujuji Hospital, Kiyose, Tokyo, Japan.
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Abstract
OBJECTIVE In an attempt to establish a treatment protocol for tuberculous empyema, we retrospectively reviewed our experience over a 3-year period. METHODS Between January 1996 and December 1998, 26 patients (23 male and three female) with an average age of 33.8 years (range 18-61 years) presented with tuberculous empyema. The empyema was right-sided in 13, left-sided in 12 and bilateral in one patient. Patients presented with respiratory symptoms for a mean duration of 4.43 months (range 1-48 months). All patients had a computerized scan of the chest and managed according to the stage of empyema. RESULTS In patients with exudative empyema (n=4) the fluid was aspirated, but one patient required intercostal tube (ICT) drainage for 6 days. There were four patients with fibrinopurulent empyema treated with thoracoscopic drainage with a mean post-operative stay of 8 days (range 4-12 days). In the organizing stage (n=18), initial drainage with large ICT was performed. The pleura was less than 2 cm in thickness in eight patients, for which repeated installation of streptokinase was performed (three to seven times). Satisfactory results were achieved in six patients (75%) and the remaining two required decortication. Of the ten patients with thick cortex, one required a window and nine had decortication, two of which had additional lobectomy and two had pneumonectomy. All patients fully recovered with no mortality and with a mean duration of drainage of 18 days (range 3-61 days). CONCLUSION Its stage and the state of the underlying lung should guide surgical treatment for tuberculous empyema. This protocol aims to achieve cure utilizing the least invasive approach and acceptable hospital stay.
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Affiliation(s)
- K M Al-Kattan
- Division of Thoracic Surgery, King Khalid University Hospital, P.O. Box 7805, Riyadh, Saudi Arabia.
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Nakahashi H, Hamatake M, Kaneko S. [Decortication in chronic thoracic empyemas--a report of three cases]. THE JAPANESE JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY : OFFICIAL PUBLICATION OF THE JAPANESE ASSOCIATION FOR THORACIC SURGERY = NIHON KYOBU GEKA GAKKAI ZASSHI 1998; 46:499-504. [PMID: 9654936 DOI: 10.1007/bf03217780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Three cases of chronic thoracic empyema treated by decortication are reported with special reference to the indications for surgery. The first patient was a 68-year-old man who had right chronic thoracic empyema with a bronchopleural fistula. He underwent open thoracostomy, and decortication was performed after 8 months. The second patient was a 74-year-old man who had right chronic empyema without bronchopleural fistula. Open thoracostomy was also performed and decortication was done after 2 months. Postoperative pulmonary function was significantly improved in both patients. The third patient was a 66-year-old man who had left chronic empyema with a bronchopleural fistula. He underwent open thoracostomy and left lower lobectomy, and then decortication and the omental pedicle flap method were performed after 4 months. All three patients are still doing well currently. It is concluded that decortication significantly improves pulmonary function in properly selected patients, and that computed tomography is helpful for assessing the re-expansion ability of the collapsed lung.
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Affiliation(s)
- H Nakahashi
- Department of Surgery, Matsuyama Red Cross Hospital, Japan
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Chatzimichalis A, Massard G, Kessler R, Barsotti P, Claudon B, Ojard-Chillet J, Wihlm JM. Bronchopulmonary aspergilloma: a reappraisal. Ann Thorac Surg 1998; 65:927-9. [PMID: 9564903 DOI: 10.1016/s0003-4975(98)00060-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Classically, most complications observed after operations for aspergilloma occurred in patients with sequelae of tuberculosis. Because the incidence of tuberculosis has declined over the past two decades, aspergilloma is expected to develop with increasing frequency in patients without previous tuberculosis. Therefore, our hypothesis was that operative outcome should have improved during the most recent years in comparison with our previous experience. METHODS Operative outcome of 12 recently accrued patients was evaluated and compared with a historic control group of 55 patients, previously reported by the same center. RESULTS As expected, only 17% of patients of the present series had a history of tuberculosis, compared with 57% in the former series. Postoperatively, there was no mortality. Major morbidity has decreased, although this difference is not statistically significant: bleeding decreased from 44% to 9% of patients; space problems decreased from 47% to 18%; and prolonged hospital stay (>30 days) decreased from 32% to 9%. CONCLUSIONS Our results support a trend toward improved postoperative outcome of operations for aspergilloma owing to a decreased incidence of aspergilloma growing in tuberculous cavitations.
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Affiliation(s)
- A Chatzimichalis
- Department of Thoracic Surgery, Hôpitaux Universitaires de Strasbourg, France
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Massard G, Thomas P, Barsotti P, Riera P, Giudicelli R, Reboud E, Morand G, Fuentes PA, Wihlm JM. Long-term complications of extraperiosteal plombage. Ann Thorac Surg 1997; 64:220-4; discussion 224-5. [PMID: 9236365 DOI: 10.1016/s0003-4975(97)00344-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND As soon as complications due to migration of extraperiosteal plombage material had been documented, early removal became the rule. Some patients who have escaped this rule may still present with long-term complications. METHODS Since 1980, 14 patients aged 54 +/- 10 years were admitted 28 +/- 11 years after collapse therapy. Eight presented with signs of infection, 4 with hemoptysis, and 2 with periscapular pain. Vascular erosion, suspected in 3 patients, was demonstrated with angiograms in 1. RESULTS Ablation of the material was combined with excision of the devitalized ribs in 13 patients. Femorofemoral bypass was used in 2 patients for repair of an aortic erosion. Single ablation of subcutaneously migrated material was performed in a poor-risk patient. Operative bleeding was moderate except in 2 patients; 1 of them died intraoperatively during repair of an aortic erosion. A second patient died postoperatively with a massive pulmonary embolus on day 11. Infection was diagnosed in 8 patients (Mycobacterium tuberculosis, 4; and pyogens, 4). Operative outcome was satisfactory in all 12 operative survivors. A single patient presented with an infected apical space at 1 year and underwent complementary resection of the first rib. CONCLUSIONS We recommend routine ablation of any residual plombage material whenever operative risk is acceptable because of the high incidence of spontaneous complications.
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Affiliation(s)
- G Massard
- Department of Thoracic Surgery, University Hospital of Strasbourg, France
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Massard G, Dabbagh A, Wihlm JM, Kessler R, Barsotti P, Roeslin N, Morand G. Pneumonectomy for chronic infection is a high-risk procedure. Ann Thorac Surg 1996; 62:1033-7; discussion 1037-8. [PMID: 8823086 DOI: 10.1016/0003-4975(96)00596-6] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purpose of this study was to estimate operative risk, and to identify indicators of adverse prognosis, in patients undergoing pneumonectomy for chronic infection. METHODS Twenty-five patients aged 41 +/- 15 years underwent pneumonectomy (three completions) for chronic infection: sequelae of tuberculosis, 15; cystic bronchiectasis, 9; and radiation pneumonitis, 1. Eight patients had aspergilloma (7 after tuberculosis, 1 with radiation pneumonitis). RESULTS Operative mortality was 4%. Operative blood loss was estimated at 1,983 +/- 1,424 mL, ranging from 150 to 5,600 mL. A single patient required reexploration. Eight patients (32%) had empyema, and a further 3 (12%) had bronchopleural fistula; thoracoplasty was required for 10 (40%). Sequelae of tuberculosis heralded increased operative bleeding (t = 2.884; p < 0.005). Incidence of empyema or bronchopleural fistula was increased in patients with sequelae of tuberculosis (chi 2 = 3.896; p < 0.05), patients with aspergilloma (chi 2 = 4.588; p < 0.05), patients in whom the parenchymal cavities were entered (chi 2 = 11.5; p < 0.001), and those in whom blood loss was in excess of 1,000 mL (chi 2 = 4.911; p < 0.05). CONCLUSIONS We conclude that pneumonectomy is a high-risk procedure, especially in patients with sequelae of tuberculosis.
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Affiliation(s)
- G Massard
- Department of Thoracic Surgery, University Hospital of Strasbourg, France
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