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Zhao R, Guan X, Zhang P, Liu Y, Xu Y, Sun C, Qiu S, Zhu W, Yang Z, Wang X. Development of postoperative bronchopleural fistula after neoadjuvant immunochemotherapy in non-small cell lung cancer: case reports and review of the literature. J Cancer Res Clin Oncol 2024; 150:175. [PMID: 38573518 PMCID: PMC10995031 DOI: 10.1007/s00432-024-05683-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 03/04/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND The advent of immune checkpoint inhibitors has dramatically changed the treatment paradigm for advanced non-small-cell lung cancer (NSCLC). Due to the complexity and diversity of stage III disease, the inclusion of immune checkpoint inhibitors (ICIs) in neoadjuvant treatment regimens is also required. However, immune-related adverse events (irAEs) limit the application of ICIs to a certain extent. Bronchopleural fistula (BPF) is a serious and fatal complication after pneumonectomy that is rarely reported, especially in patients who accept neoadjuvant immunotherapy or chemoimmunotherapy. CASE PRESENTATION Herein, we reported four patients with postoperative BPF who received a neoadjuvant regimen of sintilimab plus chemotherapy. Postoperative BPF occurred in the late stage in three patients; one patient underwent bronchoscopic fistula repair, and the fistula was closed well after surgery, and the other two patients gradually recovered within 1-2 months after symptomatic treatment with antibiotics. One patient with BPF after left pneumonectomy died of respiratory failure due to pulmonary infection. We also reviewed the literature on the development of postoperative BPF in patients receiving immuno-neoadjuvant therapy to discuss the clinical process further, postoperative pathological changes, as well as risk factors of BPF patients. CONCLUSIONS Central type lung cancer with stage III may be the risk factors of BPF in cases of neoadjuvant immunochemotherapy for lung cancers patients.
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Affiliation(s)
- Renshan Zhao
- Cancer Center, The First Hospital of Jilin University, 1 Xinmin Street, Changchun, 130021, Jilin, China
| | - Xiaomin Guan
- Cancer Center, The First Hospital of Jilin University, 1 Xinmin Street, Changchun, 130021, Jilin, China
| | - Peng Zhang
- Thoracic Surgery Department, The First Hospital of Jilin University, 1 Xinmin Street, Changchun, 130021, Jilin, China
| | - Yunpeng Liu
- Thoracic Surgery Department, The First Hospital of Jilin University, 1 Xinmin Street, Changchun, 130021, Jilin, China
| | - Yinghui Xu
- Cancer Center, The First Hospital of Jilin University, 1 Xinmin Street, Changchun, 130021, Jilin, China
| | - Chao Sun
- Cancer Center, The First Hospital of Jilin University, 1 Xinmin Street, Changchun, 130021, Jilin, China
| | - Shi Qiu
- Cancer Center, The First Hospital of Jilin University, 1 Xinmin Street, Changchun, 130021, Jilin, China
| | - Wenhao Zhu
- Cancer Center, The First Hospital of Jilin University, 1 Xinmin Street, Changchun, 130021, Jilin, China
| | - Zhiguang Yang
- Thoracic Surgery Department, The First Hospital of Jilin University, 1 Xinmin Street, Changchun, 130021, Jilin, China.
| | - Xu Wang
- Cancer Center, The First Hospital of Jilin University, 1 Xinmin Street, Changchun, 130021, Jilin, China.
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Solak N, Çetin M, Can MA, Gürçay N, Gülhan SŞE, Aydoğdu K, Fındık G, Bıçakçıoğlu P. Are precautions actually a risk factor in the development of bronchopleural fistula after pneumonectomy? A retrospective analysis of 299 cases. Updates Surg 2024:10.1007/s13304-024-01772-z. [PMID: 38494568 DOI: 10.1007/s13304-024-01772-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/29/2024] [Indexed: 03/19/2024]
Abstract
PURPOSE Bronchopleural fistula most commonly occurs after pneumonectomies, with high morbidity and mortality. A preventive approach is essential. Risk factors can be classified depending on the patient, anatomy, surgical technique, and other causes. METHODS Patients (n = 370) who underwent pneumonectomy between 2010 and 2020 were evaluated. The digital media and archive files of the patients (n = 299) were reviewed retrospectively. RESULTS While 271 patients (90.6%) were male, 28 (9.4%) were female. The mean age was 56.63 years. The bronchopleural fistula rate was 14.7% (44/299). Serum protein deficiency, right pneumonectomy, completion pneumonectomy, bronchial manual suturing, advanced stage, prolongation of time after neoadjuvant therapy, length of drain and hospital stay, tissue support for the stump, and short bronchial stump were significant for bronchopleural fistula. Smoking in patients operated on for malignancy and low serum albumin value in benign and chronic infectious diseases were significant in terms of fistula. In patients who developed bronchopleural fistula, the 5-year survival rate was 18.4%. CONCLUSION The most important risk factors in bronchopleural fistula depend on the surgical technique and so are completely preventable. Contrary to the literature, short stump and tissue support to the stump were found to be risk factors for fistula. In addition, the effect of the time between neoadjuvant therapy and operation should be examined in further studies.
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Affiliation(s)
- Necati Solak
- Department of Thoracic Surgery, Sincan Training and Research Hospital, Ankara, Turkey.
| | - Mehmet Çetin
- Department of Thoracic Surgery, Etlik City Hospital, Ankara, Turkey
| | - Mehmet Ali Can
- Department of Radiology, Atatürk Sanatoryum Training and Research Hospital, Ankara, Turkey
| | - Nesrin Gürçay
- Department of Pathology, Atatürk Sanatoryum Training and Research Hospital, Ankara, Turkey
| | | | - Koray Aydoğdu
- Department of Thoracic Surgery, Etlik City Hospital, Ankara, Turkey
| | - Göktürk Fındık
- Department of Thoracic Surgery, Atatürk Sanatoryum Training and Research Hospital, Ankara, Turkey
| | - Pınar Bıçakçıoğlu
- Department of Thoracic Surgery, Atatürk Sanatoryum Training and Research Hospital, Ankara, Turkey
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Steimer D, Coughlin JM, Yates E, Xie Y, Mazzola E, Jaklitsch MT, Swanson SJ, Orgill D, Marshall MB. Empiric flap coverage for the pneumonectomy stump: How protective is it? A single-institution cohort study. J Thorac Cardiovasc Surg 2024; 167:849-858. [PMID: 37689236 DOI: 10.1016/j.jtcvs.2023.08.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/31/2023] [Accepted: 08/23/2023] [Indexed: 09/11/2023]
Abstract
OBJECTIVE To evaluate the impact of empiric tissue flaps on bronchopleural fistula (BPF) rates after pneumonectomy. METHODS Patients who underwent pneumonectomy between January 2001 and December 2019 were included. Primary end point was development of BPF. Secondary end points were impact of flap type on BPF rates, time to BPF development, and perioperative mortality. RESULTS During the study period, 383 pneumonectomies were performed; 93 were extrapleural pneumonectomy. Most pneumonectomy cases had empiric flap coverage, with greater use in right-sided operations (right: 97%, 154/159; left: 80%, 179/224, P < .001). Empiric flaps harvested included intercostal, latissimus dorsi, serratus anterior, omentum, pectoralis major, pericardial fat/thymus, pericardium, and pleura. BPF occurred in 10.4% of the entire cohort but decreased to 6.6% when extrapleural pneumonectomy cases were excluded; 90% (36/40) of BPFs occurred on the right side (P < .001). Median time to develop BPF was 63 days, and 90-day mortality was greater in patients with BPF (12.5% BPF vs 7.4% non-BPF, P < .0001). Intercostal muscle had the lowest rate of BPF (4.5%), even in right-sided operations (8.7%). In contrast, larger muscle flaps such as latissimus dorsi (21%) and serratus anterior (33%) had greater rates of BPF, but the sample size was small in these cohorts. CONCLUSIONS Empiric bronchial stump coverage should be performed in all right pneumonectomy cases due to greater risk of BPF. In our series, intercostal muscle flaps had low BPF rates, even in right-sided operations. Coverage of the left pneumonectomy stump is unnecessary due to low incidence of BPF in these cases.
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Affiliation(s)
- Desiree Steimer
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass.
| | - Julia M Coughlin
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Elizabeth Yates
- Department of Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Yue Xie
- Department of Data Sciences, Dana Farber Cancer Institute, Boston, Mass
| | - Emanuele Mazzola
- Department of Data Sciences, Dana Farber Cancer Institute, Boston, Mass
| | | | - Scott J Swanson
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Dennis Orgill
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, Mass
| | - M Blair Marshall
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass
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Nakata JA, Arif A, Chai LF, Su S. First report of a post-pneumonectomy nocardia empyema. J Surg Case Rep 2024; 2024:rjae002. [PMID: 38304314 PMCID: PMC10832585 DOI: 10.1093/jscr/rjae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 01/05/2024] [Indexed: 02/03/2024] Open
Abstract
Post-pneumonectomy empyema (PPE) is an uncommon but serious complication that carries significant therapeutic challenges. We present a late-onset PPE due to Nocardia nova in an immunocompetent individual. Nine years after a right pneumonectomy for non-small cell lung cancer, surveillance scans revealed new right pleural thickening and FDG avidity concerning for recurrence. Thoracoscopic pleural biopsies were negative for malignancy, but tissue cultures grew N. nova. Nocardia empyema is rare with few reported cases. Most occur in immunocompromised hosts, and all were associated with pulmonary or disseminated nocardiosis. Our case describes the first report of a PPE secondary to Nocardia.
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Affiliation(s)
- Jonathan A Nakata
- Division of Thoracic Surgery, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, United States
| | - Azzan Arif
- Division of Thoracic Surgery, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, United States
| | - Louis F Chai
- Department of Thoracic Medicine and Surgery, Temple University Health Systems, Philadelphia, PA 19140, United States
| | - Stacey Su
- Division of Thoracic Surgery, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, United States
- Department of Thoracic Medicine and Surgery, Temple University Health Systems, Philadelphia, PA 19140, United States
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Grapatsas K, Menghesha H, Dörr F, Baldes N, Schuler M, Stuschke M, Darwiche K, Taube C, Bölükbas S. Pneumonectomy for Primary Lung Tumors and Pulmonary Metastases: A Comprehensive Study of Postoperative Morbidity, Early Mortality, and Preoperative Clinical Prognostic Factors. Curr Oncol 2023; 30:9458-9474. [PMID: 37999105 PMCID: PMC10670891 DOI: 10.3390/curroncol30110685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/14/2023] [Accepted: 10/23/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Pneumonectomy is a major surgical resection that still remains a high-risk operation. The current study aims to investigate perioperative risk factors for postoperative morbidity and early mortality after pneumonectomy for thoracic malignancies. METHODS We retrospectively analyzed all patients who underwent pneumonectomy for thoracic malignancies at our institution between 2014 and 2022. Complications were assessed up to 30 days after the operation. Mortality for any reason was recorded after 30 days and 90 days. RESULTS A total of 145 out of 169 patients undergoing pneumonectomy were included in this study. The postoperative 30-day complication rate was 41.4%. The 30-day-mortality was 8.3%, and 90-day-mortality 17.2%. The presence of cardiovascular comorbidities was a risk factor for major cardiopulmonary complications (54.2% vs. 13.2%, p < 0.01). Postoperative bronchus stump insufficiency (OR: 11.883, 95% CI: 1.288-109.591, p = 0.029) and American Society of Anesthesiologists (ASA) score 4 (OR: 3.023, 95% CI: 1.028-8.892, p = 0.044) were independent factors for early mortality. CONCLUSION Pneumonectomy for thoracic malignancies remains a high-risk major lung resection with significant postoperative morbidity and mortality. Attention should be paid to the preoperative selection of patients.
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Affiliation(s)
- Konstantinos Grapatsas
- Department of Thoracic Surgery, West German Cancer Center, Medical Faculty, University Hospital Essen, Ruhrlandklinik, Tueschner Weg 40, 45239 Essen, Germany; (H.M.); (F.D.); (N.B.); (S.B.)
| | - Hruy Menghesha
- Department of Thoracic Surgery, West German Cancer Center, Medical Faculty, University Hospital Essen, Ruhrlandklinik, Tueschner Weg 40, 45239 Essen, Germany; (H.M.); (F.D.); (N.B.); (S.B.)
| | - Fabian Dörr
- Department of Thoracic Surgery, West German Cancer Center, Medical Faculty, University Hospital Essen, Ruhrlandklinik, Tueschner Weg 40, 45239 Essen, Germany; (H.M.); (F.D.); (N.B.); (S.B.)
| | - Natalie Baldes
- Department of Thoracic Surgery, West German Cancer Center, Medical Faculty, University Hospital Essen, Ruhrlandklinik, Tueschner Weg 40, 45239 Essen, Germany; (H.M.); (F.D.); (N.B.); (S.B.)
| | - Martin Schuler
- Department of Medical Oncology, West German Cancer Center, Medical Faculty, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany;
| | - Martin Stuschke
- Department of Radiation Oncology, West German Cancer Center, Medical Faculty, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany;
| | - Kaid Darwiche
- Department of Pneumology, Medical Faculty, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany; (K.D.); (C.T.)
| | - Christian Taube
- Department of Pneumology, Medical Faculty, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany; (K.D.); (C.T.)
| | - Servet Bölükbas
- Department of Thoracic Surgery, West German Cancer Center, Medical Faculty, University Hospital Essen, Ruhrlandklinik, Tueschner Weg 40, 45239 Essen, Germany; (H.M.); (F.D.); (N.B.); (S.B.)
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Matsuo T, Imai K, Takashima S, Kurihara N, Kuriyama S, Iwai H, Tozawa K, Saito H, Nomura K, Minamiya Y. Outcomes and pulmonary function after sleeve lobectomy compared with pneumonectomy in patients with non-small cell lung cancer. Thorac Cancer 2023; 14:827-833. [PMID: 36727556 PMCID: PMC10040283 DOI: 10.1111/1759-7714.14813] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/14/2023] [Accepted: 01/17/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Sleeve lobectomy is recommended to avoid pneumonectomy and preserve pulmonary function in patients with central lung cancer. However, the relationship between postoperative pulmonary functional loss and resected lung parenchyma volume has not been fully characterized. The aim of this study was to evaluate the relationship between pulmonary function and lung volume in patients undergoing sleeve lobectomy or pneumonectomy. METHODS A total of 61 lung cancer patients who had undergone pneumonectomy or sleeve lobectomy were analyzed retrospectively. Among them, 20 patients performed pulmonary function tests, including vital capacity (VC) and forced expiratory volume in 1 s (FEV1) tests, preoperatively and then about 6 months after surgery. VC and FEV1 ratios were calculated (measured postoperative respiratory function/predicted postoperative respiratory function) as the standardized pulmonary functional loss ratio. RESULTS Thirty-day operation-related mortality was significantly lower after sleeve lobectomy (3.2%) than pneumonectomy (9.6%). The 5-year relapse-free survival rate was 46.67% versus 29.03%, and the 5-year overall survival rate was 63.33% versus 38.71% in patients receiving sleeve lobectomy versus pneumonectomy. The VC ratio in the pneumonectomy group was better than in the sleeve lobectomy group (1.003 ± 0.117 vs. 0.779 ± 0.12; p = 0.0008), as was the FEV1 ratio (1.132 ± 0.226 vs. 0.851 ± 0.063; p = 0.0038). CONCLUSIONS Both short-term and long-term outcomes were better with sleeve lobectomy than pneumonectomy. However, actual postoperative pulmonary function after pneumonectomy may be better than clinicians expect, and pneumonectomy should still be considered a treatment option for patients with sufficient pulmonary reserve and in whom sleeve lobectomy is less likely to be curative.
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Affiliation(s)
- Tsubasa Matsuo
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Kazuhiro Imai
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Shinogu Takashima
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Nobuyasu Kurihara
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Shoji Kuriyama
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Hidenobu Iwai
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Kasumi Tozawa
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Hajime Saito
- Department of Thoracic Surgery, Iwate Medical University, Yahaba-cho, Japan
| | - Kyoko Nomura
- Department of Health Environmental Science and Public Health, Akita University Graduate School of Medicine, Akita, Japan
| | - Yoshihiro Minamiya
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
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Porkhanov VA, Zhikharev VA, Bushuev AS, Zima VS, Koryachkin VA, Ivanova MP. [Early predictor of bronchial suture failure after pneumonectomy]. Khirurgiia (Mosk) 2023:71-77. [PMID: 37916560 DOI: 10.17116/hirurgia202310171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
OBJECTIVE To identify the relationship between serum CRP/albumin and bronchial suture failure after pneumonectomy. MATERIAL AND METHODS A retrospective analysis included 100 patients who underwent pneumonectomy with extended lymph node dissection for lung cancer. Patients were divided into 2 groups depending on postoperative complications: group 1 - bronchial stump failure, group 2 - no similar complications. In all patients, we analyzed markers of inflammation (C-reactive protein and albumin) in preoperative period and after 24 postoperative hours. Bronchial stump failure was found in 20 patients (10 patients (14.7%) after left-sided pneumonectomy and 10 (31%) patients after right-sided pneumonectomy). We found a significant relationship between serum CRP/albumin and bronchial stump failure after pneumonectomy (p<0.05). A prognostic formula was based on the ratio of serum C-reactive protein and albumin: PC = CRP/Alb, where PC - prognostic coefficient, CRP - serum C-reactive protein (mg/l) 24 hours after surgery, Alb - serum albumin (g/l) 24 hours after surgery. PC >2.6 determines high risk of bronchial stump failure after pneumonectomy, PC <2.6 - low risk. Sensitivity of this method is 90%, specificity - 97.5%.
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Affiliation(s)
- V A Porkhanov
- Research Institution - Ochapovsky Regional Clinic Hospital No. 1, Krasnodar, Russia
- Kuban State Medical University, Krasnodar, Russia
| | - V A Zhikharev
- Research Institution - Ochapovsky Regional Clinic Hospital No. 1, Krasnodar, Russia
- Kuban State Medical University, Krasnodar, Russia
| | - A S Bushuev
- Research Institution - Ochapovsky Regional Clinic Hospital No. 1, Krasnodar, Russia
| | - V S Zima
- Research Institution - Ochapovsky Regional Clinic Hospital No. 1, Krasnodar, Russia
| | - V A Koryachkin
- St. Petersburg State Pediatric Medical University, St. Petersburg, Russia
| | - M P Ivanova
- Astana Medical University, Astana, Republic of Kazakhstan
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Wang L, He Z, Zhang C. Preliminary experience of autologous free myocutaneous flap combined with free dermal graft in the treatment of refractory empyema with bronchopleural fistula. Heliyon 2022; 8:e11251. [PMID: 36339755 PMCID: PMC9634368 DOI: 10.1016/j.heliyon.2022.e11251] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 08/16/2022] [Accepted: 10/20/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives To explore the effects of autologous free dermal graft combined with free myocutaneous flap on bronchopleural fistula (BPF) with empyema, we summarized and analyzed two cases. Methods Two patients with refractory empyema and BPF were treated with autologous free dermal graft combined with free myocutaneous flap. The treatment included debridement of empyema, rib resection drainage, repair of bronchopleural fistula, and free vastus lateralis myocutaneous flap transplantation to eliminate the empyema. After the free dermal graft was harvested from the healthy skin around the incision, it was inserted into the fistula and sutured with the surrounding pleural tissue. The keys to the operation lies in the anastomosis of the lateral circumflex femoral artery (LCFA), vein and nerve that supply the vastus lateralis muscle flap to the thoracodorsal vessels and nerves. After surgery, the empyema, air leakage, and the survival of the myocutaneous flap were observed. Results There was no disease recurrence after follow-up for seven and six months, respectively. Re-examination of the chest computed tomography (CT) or magnetic resonance imaging (MRI) indicated that the abscess cavity had disappeared. No necrosis of the myocutaneous flap was observed after surgery. Conclusion The application of autologous free dermal graft combined with free vastus lateralis myocutaneous flap transplantation is effective in the treatment of patients with bronchopleural fistula with refractory chronic empyema, and the clinical effect is satisfactory. Surgical treatment of refractory empyema. Autologous free dermal graft combined with free myocutaneous flap in the treatment of refractory bronchopleural fistula with empyema. Application of free myocutaneous flap in patients with empyema.
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Affiliation(s)
- Lei Wang
- Department of Cardiothoracic Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang 310012, China
| | - Zhongliang He
- Department of Cardiothoracic Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang 310012, China
- Corresponding author.
| | - Chun Zhang
- Department of Traumatology and Orthopedic Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang 310012, China
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Xin S, Wu Y, He Z, He X, Wang L, Qi Y. Surgical operation combined with bronchoscopy in the treatment of fungal empyema: 5 cases report. Medicine (Baltimore) 2022; 101:e31080. [PMID: 36281178 PMCID: PMC9592517 DOI: 10.1097/md.0000000000031080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
RATIONALE Fungal empyema is a chronic refractory disease. It is difficult to control thoracic infection, and it is faced with the problem of recurrence. How to control the infection and reduce the probability of recurrence is a difficult problem. Surgical operation combined with endobronchial therapy was used to control infection, seal the fistula and eliminate residual cavity and achieved good results. PATIENT CONCERNS A total of 5 patients with fungal empyema were treated from 2019 to 2021, aged 27 to 72 years, with an average age of 54.8 ± 7.6 years. Two cases were on the left side and 3 cases on the right side. DIAGNOSIS While meeting the diagnostic criteria of empyema, the diagnosis of fungus in pus culture or the discovery of fungus in deep tissue pathology confirmed the diagnosis of fungal empyema in the 5 cases. INTERVENTIONS Through surgical operations combined with bronchoscopy and individualized treatment, the infection was controlled, the fistulas were blocked, and the pus cavity was filled. OUTCOMES After 11 to 30 months of follow-up, the muscle flap in the abscess cavity was mildly atrophied, and there was no recurrence of empyema. Three patients who completed the second-stage operation had their chest tubes removed and returned to normal life. The 2 patients who did not complete the second-stage operation had no recurrence of thoracic infection and no recurrence of cough or fever, and their quality of life was greatly improved. LESSONS Surgical operation combined with bronchoscopy is a reliable method for the treatment of fungal empyema, which can find and plug the fistula more efficiently and eliminate the residual cavity by surgery to avoid recurrence. Therefore, it is a recommended treatment method.
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Affiliation(s)
- Shunxin Xin
- Department of Cardiothoracic Surgery, Hangzhou, Zhejiang Province, China
| | - Yongyong Wu
- Department of Cardiothoracic Surgery, Hangzhou, Zhejiang Province, China
| | - Zhongliang He
- Department of Cardiothoracic Surgery, Hangzhou, Zhejiang Province, China
| | - Xueming He
- Department of Cardiothoracic Surgery, Hangzhou, Zhejiang Province, China
| | - Lei Wang
- Department of Cardiothoracic Surgery, Hangzhou, Zhejiang Province, China
| | - Yaoli Qi
- Department of Cardiothoracic Surgical Nursing, Hangzhou, Zhejiang Province, China
- *Correspondence: Yaoli Qi, Department of Cardiothoracic Surgical Nursing, Tongde Hospital of Zhejiang Province, No. 234 Gucui Road, Xihu District, Hangzhou 310004, Zhejiang Province, China (e-mail: )
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Yang YH, Park SY, Kim HE, Park BJ, Lee CY, Lee JG, Kim DJ, Paik HC. Postoperative bronchopleural fistula repair: Surgical outcomes and adverse factors for its success. Thorac Cancer 2022; 13:1401-1405. [PMID: 35393787 PMCID: PMC9058303 DOI: 10.1111/1759-7714.14404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/13/2022] [Accepted: 03/14/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate the results of postoperative bronchopleural fistula repair and to identify adverse factors for its success. METHODS We retrospectively reviewed the surgical results of 39 patients who underwent surgical repair for postoperative bronchopleural fistula between January 2010 and June 2020. Success of bronchopleural fistula repair was defined as the visual closure of the bronchopleural fistula with the absence of an air leak, a recurrence of bronchopleural fistula and infection in the thoracic cavity. RESULTS Twenty-five (64.1%) bronchopleural fistulas occurred after pulmonary resection and 14 (35.9%) after lung transplantation. Bronchopleural fistula was diagnosed 19 days (median) and repaired 28 days (median) after the initial operation by primary closure in 27 (69.2%) patients, and by additional resection in 12 (30.8%) patients. The overall success rate was 59% (23/39) and the overall mortality was 56.4% (22/39). Multivariable analysis revealed that the patients who were supported by mechanical ventilation at the time of repair had significantly lower success rates than those without (15.4%, 2/13 vs. 80.8%, 21/26, respectively, p < 0.001). The omental flap group tended to have a better success rate than the muscle flap group (p = 0.07). CONCLUSIONS There was a high overall mortality rate after bronchopleural fistula repair and a low success rate. Mechanical ventilation at the time of bronchopleural fistula repair was significantly related to the failure of bronchopleural fistula repair.
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Affiliation(s)
- Young Ho Yang
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
| | - Seong Yong Park
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea.,Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ha Eun Kim
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
| | - Byung Jo Park
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
| | - Chang Young Lee
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
| | - Jin Gu Lee
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
| | - Dae Joon Kim
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
| | - Hyo Chae Paik
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
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11
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Hakamifard A, Gharedaghi B, Tabarsi P, Shokouhi S, Negahban H, Sharifynia S, Dorudinia A. Delayed post‐pneumonectomy empyema necessitans caused by
Aspergillus flavus
: An unusual report. Respirol Case Rep 2022; 10:e0930. [PMID: 35309958 PMCID: PMC8907913 DOI: 10.1002/rcr2.930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 02/17/2022] [Accepted: 02/26/2022] [Indexed: 11/30/2022] Open
Abstract
Post‐pneumonectomy empyema (PPE), with or without bronchopleural fistula, is a challenging and serious entity with significant mortality and morbidity. PPE is usually caused by bacteria such as staphylococci, streptococci and also gram‐negative rods. Among fungal pathogens, Aspergillus species is a very rare cause of this entity. Herein, we describe an unusual case of delayed post‐pneumonectomy empyema necessitans caused by Aspergillus flavus in a 65‐year‐old man with favourable clinical outcome by combined surgical and antifungal therapy.
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Affiliation(s)
- Atousa Hakamifard
- Infectious Diseases and Tropical Medicine Research Center Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Babak Gharedaghi
- Lung Transplantation Research Center National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Payam Tabarsi
- Clinical Tuberculosis and Epidemiology Research Center National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Shervin Shokouhi
- Infectious Diseases and Tropical Medicine Research Center Shahid Beheshti University of Medical Sciences Tehran Iran
- Department of Infectious Diseases and Tropical Medicine Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Halimeh Negahban
- Infectious Diseases and Tropical Medicine Research Center Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Somayeh Sharifynia
- Clinical Tuberculosis and Epidemiology Research Center National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Atosa Dorudinia
- Chronic Respiratory Diseases Research Center National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences Tehran Iran
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12
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Torabi J, Jacob JC, Jacob JD. Tracheal Bronchus With Delayed Pleural Fistula After Pneumonectomy Managed With Eloesser Flap. Ann Thorac Surg 2022; 114:e397-e399. [DOI: 10.1016/j.athoracsur.2022.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/03/2022] [Accepted: 02/13/2022] [Indexed: 11/15/2022]
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13
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Li X, Wang S, Yin M, Li X, Qi Y, Ma Y, Li C, Wu G. Treatment of peripheral bronchopleural fistula with interventional negative pressure drainage. Ther Adv Respir Dis 2022; 16:17534666221111877. [PMID: 35848793 PMCID: PMC9297443 DOI: 10.1177/17534666221111877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Bronchopleural fistula is a serious complication of pneumonectomy and lobectomy and results in a reduction in the quality of life of patients. This study aimed to evaluate the efficacy and safety of percutaneous drainage tube placement with continuous negative pressure drainage for the treatment of peripheral bronchopleural fistula. METHODS Data of 16 patients with peripheral bronchopleural fistula were retrospectively analyzed. A percutaneous thoracic drainage tube was placed under fluoroscopy and connected with a negative pressure suction device. The drainage tube was removed when the residual cavity disappeared on computed tomography. RESULTS All 16 patients underwent lobectomy, including 11 patients with lung cancer (68.8%), 4 patients with pulmonary infection (25.0%), and 1 patient with hemoptysis (6.3%). All patients underwent successful drainage tube placement on the first attempt with a technical success rate of 100%. No serious complications occurred during or after the procedure. The drainage tubes were adjusted 3.25 ± 2.24 times (range: 1-8 times). A total of 30 drainage tubes were used (average per patient, 1.88 ± 1.36 tubes). The cure time of 16 patients was 114.94 ± 101.08 days (range, 30-354 days). The median drainage tube indwelling duration was 87 days, and the 75th percentile was 117 days. CONCLUSION Interventional percutaneous thoracic drainage tube placement with continuous negative pressure drainage is an effective, safe, and feasible method for the treatment of peripheral bronchopleural fistula.
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Affiliation(s)
- Xiaobing Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shuai Wang
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Meipan Yin
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiangnan Li
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yu Qi
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yaozhen Ma
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chunxia Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Gang Wu
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe Road, Zhengzhou 450052, China
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14
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Strange CD, Vlahos I, Truong MT, Shroff GS, Ahuja J, Wu CC, Ko JP. Pearls and Pitfalls in Postsurgical Imaging of the Chest. Semin Ultrasound CT MR 2021; 42:563-573. [PMID: 34895612 DOI: 10.1053/j.sult.2021.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A variety of surgical procedures are utilized to treat a spectrum of cardiopulmonary diseases. In the imaging of patients in the post-operative period, it is important to have an understanding of surgical techniques including invasive and minimally invasive procedures and the expected postsurgical findings. Knowledge of certain patient risk factors, various complications associated with specific surgical procedures, and a keen attention to detail are essential to avoid misinterpretation and delay diagnosis. Prompt detection of potential complications allows timely intervention, thereby, optimizing patient outcomes in the post-operative period.
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Affiliation(s)
- Chad D Strange
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Ioannis Vlahos
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mylene T Truong
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Girish S Shroff
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jitesh Ahuja
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Carol C Wu
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jane P Ko
- Department of Radiology, New York University Langone Health, New York, NY
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15
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Abstract
Empyema may occur in the pleural space after pulmonary resection. Subsequent bacterial contamination results in infection and development of frank empyema. Pneumonectomy-surgical removal of the entire lung-is the treatment of choice for centrally located bronchogenic carcinoma, diffuse malignant mesothelioma, and chronic inflammatory lung diseases with destroyed lung from pulmonary tuberculosis, fungal infections, and bronchiectasis. In the uncomplicated case, on the pneumonectomy side, the diaphragm becomes elevated as the air-fluid level decreases with chest wall deformation and gradual disappearance of hydrothorax. The pneumonectomy space is at potential risk for getting infected from bacterial contamination and developing empyema.
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Affiliation(s)
- Farid M Shamji
- University of Ottawa, General Campus, Ottawa Hospital, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada.
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16
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Wang Y, Chen E. Interventional bronchoscopic treatment of lung cancer. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2021. [DOI: 10.1016/j.lers.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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17
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Gelfand G, Barber E. Recognition and Management of Acute and Late Complications of Pneumonectomy: Clinical Cases and Treatment. Thorac Surg Clin 2021; 31:293-302. [PMID: 34304837 DOI: 10.1016/j.thorsurg.2021.04.002] [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: 10/20/2022]
Abstract
Several important complications of pneumonectomy are discussed in a case-based format. Topics include chylothorax, cardiac herniation, postpneumonectomy syndrome, postpneumonectomy pulmonary edema, bronchopleural fistula, and empyema.
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Affiliation(s)
- Gary Gelfand
- Department of Surgery, Section of Thoracic Surgery, University of Calgary, Foothills Medical Centre, Room G33H, 1403 29th Street Northwest, Calgary, Alberta T2N 2T9, Canada.
| | - Evan Barber
- Department of Surgery, Section of Thoracic Surgery, University of Calgary, Foothills Medical Centre, Room G33H, 1403 29th Street Northwest, Calgary, Alberta T2N 2T9, Canada
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18
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Brunelli A, Rocco G, Szanto Z, Thomas P, Falcoz PE. Morbidity and mortality of lobectomy or pneumonectomy after neoadjuvant treatment: an analysis from the ESTS database. Eur J Cardiothorac Surg 2021; 57:740-746. [PMID: 31638692 DOI: 10.1093/ejcts/ezz287] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 09/18/2019] [Accepted: 09/20/2019] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES To evaluate the postoperative complications and 30-day mortality rates associated with neoadjuvant chemotherapy before major anatomic lung resections registered in the European Society of Thoracic Surgeons (ESTS) database. METHODS Retrospective analysis on 52 982 anatomic lung resections registered in the ESTS database (July 2007-31 December 2017) (6587 pneumonectomies and 46 395 lobectomies); 5143 patients received neoadjuvant treatment (9.7%) (3993 chemotherapy alone and 1150 chemoradiotherapy). To adjust for possible confounders, a propensity case-matched analysis was performed. The postoperative outcomes (morbidity and 30-day mortality) of matched patients with and without induction treatment were compared. RESULTS 8.2% of all patients undergoing lobectomies and 20% of all patients undergoing pneumonectomies received induction treatment. Lobectomy analysis: propensity score analysis yielded 3824 pairs of patients with and without induction treatment. The incidence of cardiopulmonary complications was higher in the neoadjuvant group (626 patients, 16% vs 446 patients, 12%, P < 0.001), but 30-day mortality rates were similar (71 patients, 1.9% vs 75 patients, 2.0%, P = 0.73). The incidence of bronchopleural fistula and prolonged air leak >5 days were similar between the 2 groups (neoadjuvant: 0.5% vs 0.4%, P = 0.87; 9.2% vs 9.9%, P = 0.27). Pneumonectomy analysis: propensity score analysis yielded 1312 pairs of patients with and without induction treatment. The incidence of cardiopulmonary complications was higher in the treated patients compared to those without neoadjuvant treatment (neoadjuvant 275 cases, 21% vs 18%, P = 0.030). However, the 30-day mortality was similar between the matched groups (neoadjuvant 68 cases, 5.2% vs 5.3%, P = 0.86). Finally, the incidence of bronchopleural fistula was also similar between the 2 groups (neoadjuvant 1.8% vs 1.4%, P = 0.44). CONCLUSIONS Neoadjuvant chemotherapy is not associated with an increased perioperative risk after either lobectomy or pneumonectomy, warranting a more liberal use of this approach for patients with locally advanced operable lung cancer.
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Affiliation(s)
| | - Gaetano Rocco
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Pascal Thomas
- Aix-Marseille University & Hospitals System of Marseille, Marseille, France
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19
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Asaad M, Van Handel A, Akhavan AA, Huang TCT, Rajesh A, Shen KR, Allen MA, Sharaf B, Moran SL. Prophylactic Bronchial Stump Support With Intrathoracic Muscle Flap Transposition. Ann Plast Surg 2021; 86:317-322. [PMID: 33555686 DOI: 10.1097/sap.0000000000002451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Bronchopleural fistula (BPF) is a dreaded complication of pulmonary resection. For high-risk patients, bronchial stump coverage with vascularized tissue has been recommended. The goal of this study was to report our experience with intrathoracic muscle transposition for bronchial stump coverage. METHODS A retrospective review of all patients who underwent intrathoracic muscle flap transposition as a prophylactic measure at our institution between 1990 and 2010 was conducted. Demographics, surgical characteristics, and complication rates were abstracted and analyzed. RESULTS A total of 160 patients were identified. The most common lung resections performed were pneumonectomy (n = 69, 43%) and lobectomy (n = 60, 38%). A total of 168 flaps were used where serratus anterior was the most common flap (n = 136, 81%), followed by intercostal (n = 14, 8%), and latissimus dorsi (n = 12, 7%). Ten patients (6%) developed BPF, and empyema occurred in 13 patients (8%). Median survival was 20 months, and operative mortality occurred in 7 patients (4%). CONCLUSIONS Reinforcement of the bronchial closure with vascularized muscle is a viable option for potentially decreasing the incidence of BPF in high-risk patients. Further randomized studies are needed to determine the efficacy of this technique for BPF prevention.
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Affiliation(s)
- Malke Asaad
- From the Division of Plastic Surgery, Department of Surgery, Mayo Clinic
| | | | | | - Tony C T Huang
- From the Division of Plastic Surgery, Department of Surgery, Mayo Clinic
| | | | - K Robert Shen
- Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Mark A Allen
- Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Basel Sharaf
- From the Division of Plastic Surgery, Department of Surgery, Mayo Clinic
| | - Steven L Moran
- From the Division of Plastic Surgery, Department of Surgery, Mayo Clinic
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20
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Han JY, Lee KN, Yoon YS, Lee J, Lee H, Choi SJ, Choo HJ, Baek JW, Heo YJ, Shin GW, Park J, Kim D. CT Follow-Up of Postoperative Bronchopleural Fistula: Risk Factors for Progression to Chronic Complicated Infection. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2021; 82:128-138. [PMID: 36237453 PMCID: PMC9432413 DOI: 10.3348/jksr.2020.0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/21/2020] [Accepted: 06/11/2020] [Indexed: 11/15/2022]
Abstract
Purpose Materials and Methods Results Conclusion
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Affiliation(s)
- Ji-Yeon Han
- Department of Radiology, Respiratory Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Ki-Nam Lee
- Department of Radiology, Dong-A University College of Medicine, Busan, Korea
| | - Yoo Sang Yoon
- Department of Thoracic Surgery, Respiratory Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Jihyun Lee
- Department of Radiology, Dongnam Institute of Radiological & Medical Sciences Cancer Center, Busan, Korea
| | - Hongyeul Lee
- Department of Internal Medicine, Respiratory Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Seok Jin Choi
- Department of Radiology, Respiratory Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Hye Jung Choo
- Department of Radiology, Respiratory Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Jin Wook Baek
- Department of Radiology, Respiratory Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Young Jin Heo
- Department of Radiology, Respiratory Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Gi Won Shin
- Department of Radiology, Respiratory Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Jinyoung Park
- Department of Radiology, Respiratory Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Dasom Kim
- Department of Radiology, Respiratory Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
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21
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Caushi F, Qirjako G, Skenduli I, Xhemalaj D, Hafizi H, Bala S, Hatibi A, Mezini A. Is the flap reinforcement of the bronchial stump really necessary to prevent bronchial fistula? J Cardiothorac Surg 2020; 15:248. [PMID: 32917252 PMCID: PMC7488725 DOI: 10.1186/s13019-020-01290-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/03/2020] [Indexed: 11/27/2022] Open
Abstract
Background/aim The development of bronchopleural fistula (BPF) remains the most severe complication of lung resection, especially after pneumonectomy. Studies provide controversial reports regarding the benefits of flap reinforcement of the bronchial stump (FRBS) in preventing BPF’s occurrence. Methods This is a retrospective cohort study of 558 patients that underwent lung resection in a 12-year period (from 2007 to 2018). Ninety patients (16.1%) underwent pneumonectomy. Patient follow-up period varied from 1 to 12 years. Results Out of 558 patients in this study, 468 (83.9%) underwent lobectomy, and the remnant underwent pneumonectomy. In 114 cases with lobectomy, only 24.4% had FRBS, meanwhile in 56 cases with pneumonectomy only 62.2% had FRBS. BPF occurred in 8 patients with lobectomy (1.7%) and in 10 patients with pneumonectomy (11.1%). Among cases with post-pneumonectomy BPF, 6 (10.7%) had FRBS performed, while no FRBS was performed among patients with post-lobectomy BPF, although these data weren’t statistically (p > 0.05). In 24 patients (20 lobectomies and 4 pneumonectomies) with lung cancer (10.4%) neoadjuvant treatment was performed, in which 20 patients underwent chemotherapy and 4 underwent radiotherapy. FRBS was applied in each of the above 24 operative cases, but only in 4 of them the BPF was verified. Conclusion The idea of enhancing the blood supply through the FRBS for BPF prevention has gain traction. Although FRBS has been identified as valuable and effective method in BPF prevention following lung resection, our study results did not support this evidence.
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Affiliation(s)
- Fatmir Caushi
- Department of Thoracic Surgery, University Hospital "Shefqet Ndroqi", Tirana, Albania. .,Department of Surgery, Our Lady of Good Counsel University, Tirana, Albania.
| | - Gentiana Qirjako
- Department of Public Health, University of Medicine, Tirana, Albania
| | - Ilir Skenduli
- Department of Thoracic Surgery, University Hospital "Shefqet Ndroqi", Tirana, Albania
| | - Daniela Xhemalaj
- Department of Thoracic Surgery, University Hospital "Shefqet Ndroqi", Tirana, Albania
| | - Hasan Hafizi
- Department of Thoracic Surgery, University Hospital "Shefqet Ndroqi", Tirana, Albania
| | - Silva Bala
- Department of Thoracic Surgery, University Hospital "Shefqet Ndroqi", Tirana, Albania
| | - Alban Hatibi
- Department of Thoracic Surgery, University Hospital "Shefqet Ndroqi", Tirana, Albania
| | - Arian Mezini
- Department of Thoracic Surgery, University Hospital "Shefqet Ndroqi", Tirana, Albania
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22
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Guo X, Wang H, Wei Y. [Pneumonectomy for Non-small Cell Lung Cancer: Predictors of Operative Mortality and Survival]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2020; 23:573-581. [PMID: 32702791 PMCID: PMC7406439 DOI: 10.3779/j.issn.1009-3419.2020.101.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
外科手术是目前根治非小细胞肺癌(non-small cell lung cancer, NSCLC)的最有效方式。全肺切除作为一种术式被应用于临床中。对于中央型肺癌,袖式肺叶切除术因其术后肺功能丧失少、术后并发症及死亡率低逐渐取代全肺切除术成为主流。然而为保证肿瘤学效果,当其他术式无法完全切除时,全肺切除术式仍是必要的。全肺切除术后主要发生心肺并发症,充分了解全肺切除术后相关并发症能帮助临床医师及时做出诊断,并进一步采取相关措施降低术后并发症对患者的不良影响。充分了解预后相关危险因素可帮助临床医师提前采取措施尽可能规避风险,从而改善患者预后。
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Affiliation(s)
- Xiaokang Guo
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - Huafeng Wang
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - Yucheng Wei
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, China
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23
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Matthews CR, Goswami D, Ramchandani NK, Huffard AL, Rieger KM, Young JV, Martinez RV, Kesler KA. The Influence of Airway Closure Technique for Right Pneumonectomy on Wall Tension During Positive Pressure Ventilation: An Experimental Study. Semin Thorac Cardiovasc Surg 2020; 32:1076-1084. [PMID: 32442665 DOI: 10.1053/j.semtcvs.2020.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/01/2020] [Indexed: 11/11/2022]
Abstract
Bronchopleural fistula (BPF) remains a significant source of morbidity and mortality after right pneumonectomy (RPN). Postoperative mechanical ventilation represents a primary risk factor for BPF. We undertook an experiment to determine the influence of airway diameter on suture line tension during mechanical ventilation after RPN. RPN was performed in 6 fresh human adult cadavers. After initial standard bronchial stump closure (BSC), the airway suture lines were subjected to 5 cm H2O incremental increases in airway pressures beginning at 5-40 cm H2O. To minimize airway diameter, a carinal resection was then performed with trachea to left main bronchial anastomosis and the airway suture lines subjected to similar incremental airway pressures. Wall tension (N/m) at the suture lines was measured using piezoresistive sensors at each pressure point. As delivered airway pressure increased, there was a concomitant increase in wall tension after BSC and carinal resection. At every point of incremental positive pressure, wall tension was however significantly lower after carinal resection when compared to BSC (P < 0.05). Additionally the differences in airway tension became even more significant with higher delivered airway pressure (P < 0.001). Airway diverticulum after BSC leads to significantly increased tension on the bronchial closure with positive airway pressure as compared to a closure which minimize airway diameter after RPN. This supports the role of Laplacian Law where small increases in airway diameter result in significant increases on closure site tension. Techniques which reduce airway diameter at the airway closure will more reliably reduce the incidence of BPF following RPN.
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Affiliation(s)
- Caleb R Matthews
- Indiana University Melvin and Bren Simon Cancer Center, Department of Surgery, Division of Cardiothoracic Surgery, Indianapolis, Indiana
| | - Debkalpa Goswami
- Purdue University, School of Industrial Engineering, West Lafayette, Indiana
| | - Neal K Ramchandani
- Indiana University Melvin and Bren Simon Cancer Center, Department of Surgery, Division of Cardiothoracic Surgery, Indianapolis, Indiana
| | - Adrian L Huffard
- Indiana University Melvin and Bren Simon Cancer Center, Department of Surgery, Division of Cardiothoracic Surgery, Indianapolis, Indiana
| | - Karen M Rieger
- Indiana University Melvin and Bren Simon Cancer Center, Department of Surgery, Division of Cardiothoracic Surgery, Indianapolis, Indiana
| | - Jerry V Young
- Indiana University Melvin and Bren Simon Cancer Center, Department of Anesthesiology, Indianapolis, Indiana
| | - Ramses V Martinez
- Purdue University, School of Industrial Engineering, West Lafayette, Indiana; Purdue University, Weldon School of Biomedical Engineering, West Lafayette, Indiana
| | - Kenneth A Kesler
- Indiana University Melvin and Bren Simon Cancer Center, Department of Surgery, Division of Cardiothoracic Surgery, Indianapolis, Indiana.
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Asaad M, Van Handel A, Akhavan AA, Huang TCT, Rajesh A, Allen MA, Shen KR, Sharaf B, Moran SL. Muscle Flap Transposition for the Management of Intrathoracic Fistulas. Plast Reconstr Surg 2020; 145:829e-838e. [PMID: 32221235 DOI: 10.1097/prs.0000000000006670] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Intrathoracic fistulas pose unique challenges for thoracic and reconstructive surgeons. To decrease the incidence of fistula recurrence, pedicled flaps have been suggested to buttress the repair site. The authors aimed to report their experience with muscle flap transposition for the management of intrathoracic fistulas. METHODS A retrospective review of all patients who underwent intrathoracic muscle flap transposition for the management of intrathoracic fistulas from 1990 to 2010 was conducted. Patient demographics, surgical characteristics, and complication rates were abstracted and analyzed. RESULTS A total of 198 patients were identified. Bronchopleural fistula was present in 156 of the patients (79 percent), and 48 had esophageal fistula (24 percent). A total of 238 flaps were used, constituting an average of 1.2 flaps per patient. After the initial fistula repair, bronchopleural fistula complicated the course of 34 patients (17 percent), and esophageal fistula occurred in 13 patients (7 percent). Partial flap loss was identified in 11 flaps (6 percent), and total flap loss occurred in four flaps (2 percent). Median follow-up was 27 months. At the last follow-up, 182 of the patients (92 percent) had no evidence of fistula, 175 (89 percent) achieved successful chest closure, and 164 (83 percent) had successful treatment. Preoperative radiation therapy and American Society of Anesthesiologists score of 4 or greater were identified as risk factors for unsuccessful treatment. CONCLUSIONS Intrathoracic fistulas remain a source of major morbidity and mortality. Reinforcement of the fistula closure with vascularized muscle flaps is a viable option for preventing dehiscence of the repair site and can be potentially life-saving. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Malke Asaad
- From the Divisions of Plastic Surgery and General Thoracic Surgery, Department of Surgery, Mayo Clinic; and the Mayo Clinic Alix School of Medicine
| | - Amelia Van Handel
- From the Divisions of Plastic Surgery and General Thoracic Surgery, Department of Surgery, Mayo Clinic; and the Mayo Clinic Alix School of Medicine
| | - Arya A Akhavan
- From the Divisions of Plastic Surgery and General Thoracic Surgery, Department of Surgery, Mayo Clinic; and the Mayo Clinic Alix School of Medicine
| | - Tony C T Huang
- From the Divisions of Plastic Surgery and General Thoracic Surgery, Department of Surgery, Mayo Clinic; and the Mayo Clinic Alix School of Medicine
| | - Aashish Rajesh
- From the Divisions of Plastic Surgery and General Thoracic Surgery, Department of Surgery, Mayo Clinic; and the Mayo Clinic Alix School of Medicine
| | - Mark A Allen
- From the Divisions of Plastic Surgery and General Thoracic Surgery, Department of Surgery, Mayo Clinic; and the Mayo Clinic Alix School of Medicine
| | - K Robert Shen
- From the Divisions of Plastic Surgery and General Thoracic Surgery, Department of Surgery, Mayo Clinic; and the Mayo Clinic Alix School of Medicine
| | - Basel Sharaf
- From the Divisions of Plastic Surgery and General Thoracic Surgery, Department of Surgery, Mayo Clinic; and the Mayo Clinic Alix School of Medicine
| | - Steven L Moran
- From the Divisions of Plastic Surgery and General Thoracic Surgery, Department of Surgery, Mayo Clinic; and the Mayo Clinic Alix School of Medicine
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25
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Cossu A, Martin Rother MD, Kusmirek JE, Meyer CA, Kanne JP. Imaging Early Postoperative Complications of Cardiothoracic Surgery. Radiol Clin North Am 2020; 58:133-150. [DOI: 10.1016/j.rcl.2019.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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26
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Hicham H, Ibrahim I, Rabiou S, Marouane L, Yassine O, Mohamed S. Postpneumonectomy empyema: risk factors, prevention, diagnosis, and management. Asian Cardiovasc Thorac Ann 2019; 28:89-96. [PMID: 31865750 DOI: 10.1177/0218492319888048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Postpneumonectomy empyema is a collection of pus in the pleural space after removal of the underlying lung. Postpneumonectomy empyema is a serious complication responsible for high rates of morbidity and mortality. Several risk factors for the development of postpneumonectomy empyema have been highlighted in the literature. The association of postpneumonectomy empyema with a bronchopleural fistula increases the rate of mortality by flooding the remaining lung. The management of postpneumonectomy empyema depends on the timing of presentation and the presence or absence of a bronchopleural fistula. The goals of care in the acute period are mainly preservation of the contralateral lung and sterilization of the pleural space, which may take a considerable time. The aims in the late period are closure of the bronchopleural fistula, obliteration of the pleural space, and closure of the chest wall.
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Affiliation(s)
| | | | - Sani Rabiou
- Department of Thoracic Surgery, CHU Hassan II, Fez, Morocco
| | - Lakranbi Marouane
- Department of Thoracic Surgery, CHU Hassan II, Fez, Morocco.,Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdallah University, Fez, Morocco
| | - Ouadnouni Yassine
- Department of Thoracic Surgery, CHU Hassan II, Fez, Morocco.,Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdallah University, Fez, Morocco
| | - Smahi Mohamed
- Department of Thoracic Surgery, CHU Hassan II, Fez, Morocco.,Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdallah University, Fez, Morocco
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27
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Mammana M, Marulli G, Zuin A, Perissinotto E, Comacchio GM, De Franceschi E, Rea F. Postpneumonectomy bronchopleural fistula: analysis of risk factors and the role of bronchial stump coverage. Surg Today 2019; 50:114-122. [PMID: 31493198 DOI: 10.1007/s00595-019-01871-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 07/11/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Bronchopleural fistula (BPF) is a potentially fatal complication of pneumonectomy. We analyze its occurrence rate, risk factors, and the methods used for its prevention. METHODS We reviewed the medical records of patients who underwent pneumonectomy at our Institution between January, 1990 and March, 2016. The risk factors for postoperative BPF were analyzed by univariate analysis and multiple logistic regression. RESULTS Over the study period, 511 patients underwent pneumonectomy for non-small cell lung cancer (NSCLC) and had the bronchus closed by manual suturing. BPF developed in 23 patients (4.5%). Multiple logistic regression identified no coverage of the bronchial stump, right-sided pneumonectomy, residual tumor in the bronchial stump, postoperative ventilatory support, and completion pneumonectomy, as independent risk factors for BPF. The cumulative rate of BPF decreased significantly over time from 18% between 1990 and 1995 to 1% between 2011 and 2016 (p < 0.001). Concurrently, the data of several patients showed a significant positive trend over time, including bronchial stump coverage (BSC). DISCUSSION Several known risk factors for BPF were confirmed. The more frequent usage of tissue flaps for coverage of the bronchial stump may have contributed to the reduction in the rate of postoperative BPF over time.
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Affiliation(s)
- Marco Mammana
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani, 2, 35128, Padua, Italy
| | - Giuseppe Marulli
- Thoracic Surgery Unit, Department of Emergency and Organ Transplantation, University Hospital of Bari, Piazza Giulio Cesare, 11, 70120, Bari, Italy.
| | - Andrea Zuin
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani, 2, 35128, Padua, Italy
| | - Egle Perissinotto
- Biostatistic Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani, 2, 35128, Padua, Italy
| | - Giovanni Maria Comacchio
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani, 2, 35128, Padua, Italy
| | - Elisa De Franceschi
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani, 2, 35128, Padua, Italy
| | - Federico Rea
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani, 2, 35128, Padua, Italy
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28
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Harmouchi H, Lakranbi M, Issoufou I, Ouadnouni Y, Smahi M. Pulmonary aspergilloma: surgical outcome of 79 patients in a Moroccan center. Asian Cardiovasc Thorac Ann 2019; 27:476-480. [DOI: 10.1177/0218492319855492] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Pulmonary aspergilloma presents in two clinical and radiological forms: simple and complex aspergilloma. Surgery is the best therapeutic option, most often by anatomic lung resection. Our aim was to report the surgical outcomes according to our experience. Methods A retrospective study was conducted on data of 79 patients operated on for pulmonary aspergilloma over a period of 10 years. There were 57 (72.15%) men and 22 women (27.84%), with a mean age of 40.45 years. Results Tuberculosis, all-form combined, was the predominant pathological antecedent in 57 (72.15%) patients, and hemoptysis was the most frequent functional sign in 43 (54.43%). The right side was involved in 39 (49.36%) patients. All patients were operated on via a posterolateral thoracotomy, and an extrapleural plane was necessary in 40 (50.63%). The surgical procedure was a lobectomy in 38 (48.10%) patients and a pneumonectomy in 14 (17.72%). Transfusion of red blood cells was carried out in 10 (12.65%) patients, with one (1.26%) requiring a rethoracotomy for postoperative clotted hemothorax. Two (2.53%) patients presented with empyema after pneumonectomy. The mortality rate was 2.53% (2 patients), and the mean follow-up was 2.5 years. Conclusion Surgery for pulmonary aspergilloma is associated with a high rate of morbidity and mortality. This surgery has been performed in our department with a very acceptable rate of mortality, especially considering that all patients were operated on by open surgery.
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Affiliation(s)
- Hicham Harmouchi
- Department of Thoracic Surgery, Centre Hospitalier Universitaire Hassan II, Fez, Morocco
| | - Marouane Lakranbi
- Department of Thoracic Surgery, Centre Hospitalier Universitaire Hassan II, Fez, Morocco
- Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdallah University, Fez, Morocco
| | - Ibrahim Issoufou
- Department of Thoracic Surgery, Centre Hospitalier Universitaire Hassan II, Fez, Morocco
| | - Yassine Ouadnouni
- Department of Thoracic Surgery, Centre Hospitalier Universitaire Hassan II, Fez, Morocco
- Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdallah University, Fez, Morocco
| | - Mohammed Smahi
- Department of Thoracic Surgery, Centre Hospitalier Universitaire Hassan II, Fez, Morocco
- Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdallah University, Fez, Morocco
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29
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[Interventional treatment of tracheopleural and bronchopleural fistulas]. Chirurg 2019; 90:697-703. [PMID: 31161248 DOI: 10.1007/s00104-019-0977-2] [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: 10/26/2022]
Abstract
BACKGROUND Interventional bronchoscopy is an indispensable option to manage bronchopleural and tracheopleural fistulas in patients in a poor general condition and at high risk for developing postoperative complications. METHODS This article is based on a search in the PubMed database for relevant publications and own experiences as surgeons and pneumologists. RESULTS Various interventional techniques can be used for the treatment of bronchopleural and tracheopleural fistulas. Currently, the insertion of stents or endobronchial valves is the most frequently used treatment. Ideally, the attending anesthesiologist will have experience with high frequency jet ventilation and the attending surgeon will have experience with rigid bronchoscopy, flexible bronchoscopy, and interventional bronchoscopy. DISCUSSION Due to a lack of standardized treatment recommendations, individual treatment plans must be decided according to the location of the bronchopleural or tracheopleural fistula and taking existing comorbidities into account.
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30
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Casiraghi M, Guarize J, Sandri A, Maisonneuve P, Brambilla D, Romano R, Galetta D, Petrella F, Gasparri R, Gridelli C, De Marinis F, Spaggiari L. Pneumonectomy in Stage IIIA-N2 NSCLC: Should It Be Considered After Neoadjuvant Chemotherapy? Clin Lung Cancer 2019; 20:97-106.e1. [DOI: 10.1016/j.cllc.2018.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 10/14/2018] [Indexed: 11/26/2022]
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31
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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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Bribriesco A, Patterson GA. Management of Postpneumonectomy Bronchopleural Fistula: From Thoracoplasty to Transsternal Closure. Thorac Surg Clin 2018; 28:323-335. [PMID: 30054070 DOI: 10.1016/j.thorsurg.2018.05.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Development of postpneumonectomy empyema with bronchopleural fistula is a life-threatening condition that requires prompt action. Although measures should be taken to prevent bronchopleural fistula at time of pneumonectomy, many patients experience this complication. Management focuses on drainage of the pleural space, control of the pleural infection including repair of the bronchopleural fistula, and obliteration of the residual pleural cavity. Multiple techniques and procedures have been developed over time to achieve these goals. Knowledge of the diverse therapeutic options is important to select the optimal treatment for these complex patients.
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Affiliation(s)
- Alejandro Bribriesco
- Department of Thoracic & Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J4-1, Cleveland, OH 44195, USA.
| | - G Alexander Patterson
- Division of Cardiothoracic Surgery, Washington University in St. Louis, 660 South Euclid, Campus Box 8234, St Louis, MO 63110, USA
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Zeng Y, Gao HZ, Zhang XB, Lin HH. Closure of Bronchopleural Fistula with Mesenchymal Stem Cells: Case Report and Brief Literature Review. Respiration 2018; 97:273-276. [PMID: 30368513 DOI: 10.1159/000493757] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 09/11/2018] [Indexed: 11/19/2022] Open
Abstract
Closure of bronchopleural fistula remains a difficult challenge for clinicians. Although several therapeutic approaches have been proposed, the clinical results are commonly unsatisfactory. Previous reports have indicated that autologous mesenchymal stem cells (MSCs) are useful for aiding treatment of bronchopleural fistula. We report here the use of umbilical cord MSCs to effect the successful closure of a bronchopleural fistula (5 mm) in a 33-year-old woman 6 months after a lobectomy. A review of the relevant literature is included. The use of MSCs may be a promising therapeutic method for the closure of bronchopleural fistula. Randomized controlled trials with larger samples are required.
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Affiliation(s)
- Yiming Zeng
- Department of Pulmonary and Critical Care Medicine, the Second Affiliated Hospital of Fujian Medical University, the Second Clinical Medical College of Fujian Medical University, Center of Respiratory Medicine of Fujian Province, Quanzhou,
| | - Hong-Zhi Gao
- Department of Central Laboratory, the Second Affiliated Hospital of Fujian Medical University, the Second Clinical Medical College of Fujian Medical University, Quanzhou, China
| | - Xiao-Bin Zhang
- Department of Pulmonary and Critical Care Medicine, the Second Affiliated Hospital of Fujian Medical University, the Second Clinical Medical College of Fujian Medical University, Center of Respiratory Medicine of Fujian Province, Quanzhou, China.,Department of Respiratory Medicine, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Hui-Huang Lin
- Department of Pulmonary and Critical Care Medicine, the Second Affiliated Hospital of Fujian Medical University, the Second Clinical Medical College of Fujian Medical University, Center of Respiratory Medicine of Fujian Province, Quanzhou, China
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34
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Ono CR, Tedde ML, Scordamaglio PR, Buchpiguel CA. Pulmonary inhalation-perfusion scintigraphy in the evaluation of bronchoscopic treatment of bronchopleural fistula. Radiol Bras 2018; 51:385-390. [PMID: 30559556 PMCID: PMC6290752 DOI: 10.1590/0100-3984.2017.0133] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Abstract
Objective To evaluate the use of pulmonary inhalation-perfusion scintigraphy as an alternative method of investigation and follow-up in patients with bronchopleural fistula (BPF). Materials and Methods Nine patients with BPFs were treated through the off-label use of a transcatheter atrial septal defect occluder, placed endoscopically, and were followed with pulmonary inhalation-perfusion scintigraphy, involving inhalation, via a nebulizer, of 900-1300 MBq (25-35 mCi) of technetium-99m-labeled diethylenetriaminepentaacetic acid and single-photon emission computed tomography with a dual-head gamma camera. Results In two cases, there was a residual air leak that was not identified by bronchoscopy or the methylene blue test but was detected only by pulmonary inhalation-perfusion scintigraphy. Those results correlated with the evolution of the patients, both of whom showed late signs of air leak, which confirmed the scintigraphy findings. In the patients with complete resolution of symptoms and fistula closure seen on bronchoscopy, the scintigraphy was completely negative. In cases of failure to close the BPF, the scintigraphy confirmed the persistence of the air leak. In two patients, scintigraphy was the only method to show residual BPF, the fistula no longer being seen on bronchoscopy. Conclusion We found pulmonary inhalation-perfusion scintigraphy to be a useful tool for identifying a residual BPF, as well as being an alternative method of investigating BPFs and of monitoring the affected patients.
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Affiliation(s)
- Carla Rachel Ono
- Nuclear Medicine Division, Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil
| | - Miguel Lia Tedde
- Department of Thoracic Surgery, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor/HC-FMUSP), São Paulo, SP, Brazil
| | - Paulo Rogerio Scordamaglio
- Respiratory Endoscopy Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor/HC-FMUSP), São Paulo, SP, Brazil
| | - Carlos Alberto Buchpiguel
- Nuclear Medicine Division, Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil
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35
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Petrella F, Sandri A, Rizzo S, Borri A, Galetta D, Gasparri R, Spaggiari L. Emergency drain for post pneumonectomy bronchopleural fistula: a drain placement technique based on the siphon principle. J Thorac Dis 2018; 10:468-471. [PMID: 29600080 DOI: 10.21037/jtd.2017.11.145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Post pneumonectomy bronchopleural fistula (BPF) is a life-threatening complication requiring pleural cavity drainage to avoid acute mediastinal shift and contralateral aspiration pneumonia. Chest drain insertion in this situation may be technically difficult because of drastic anatomical changes such as mediastinal dislocation, diaphragm elevation and, sometimes, massive subcutaneous emphysema. In addition, the most important part of the pleural cavity to be drained is the costophrenic recess that is scarcely drained by a standard chest tube with its tip aiming high and upwards. We propose a safe, simple and effective technique based on the siphon principle to drain the lowest part of the pleural cavity.
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Affiliation(s)
- Francesco Petrella
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
| | - Alberto Sandri
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Stefania Rizzo
- Division of Radiology, European Institute of Oncology, Milan, Italy
| | - Alessandro Borri
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Domenico Galetta
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Roberto Gasparri
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Lorenzo Spaggiari
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
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36
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Customized airway stenting for bronchopleural fistula after pulmonary resection by interventional technique: single-center study of 148 consecutive patients. Surg Endosc 2018; 32:4116-4124. [DOI: 10.1007/s00464-018-6152-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 03/21/2018] [Indexed: 10/17/2022]
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37
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Postpneumonectomy bronchopleural fistula in non-small cell lung cancer patients: incidence, survival, mortality, and treatment analysis. Surg Today 2018. [PMID: 29516277 DOI: 10.1007/s00595-018-1648-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE Bronchopleural fistula (BPF) is a catastrophic complication after pneumonectomy, still associated with high mortality. We reviewed our recent experience of managing BPF, particularly after right pneumonectomy for non-small cell lung cancer (NSCLC), and analyzed our findings. METHODS A total of 436 patients underwent pneumonectomy for NSCLC in our department between January 2000 and June 2017. BPF developed during follow-up in 47 of these patients, who are the subjects of this retrospective analysis. RESULTS The overall incidence of BPF was 10.8% (47/436), being 22.8% (33/145) after right pneumonectomy and 4.8% (14/291) after left pneumonectomy (P = 0.0001). The incidence of BPF in patients with a history of tuberculosis was 33.3% (6/18; P = 0.008). The fistula healed in 48.9% (23/47) of the patients and the rate of mortality caused by the fistula was 19.1% (9/47). CONCLUSIONS The side of the pneumonectomy and previous tuberculosis were the two most important risk factors independent of the bronchial closure methods. The incidence of BPF was much higher after right pneumonectomy than after left pneumonectomy. The high mortality and morbidity rates show that the treatment of BPF is still not satisfactory.
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38
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Stern J, Fournel L, Wyplosz B, Girard P, Al Nakib M, Gossot D, Seguin‐Givelet A. Early and delayed post‐pneumonectomy empyemas: Microbiology, management and prognosis. CLINICAL RESPIRATORY JOURNAL 2017; 12:1753-1761. [DOI: 10.1111/crj.12740] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 10/05/2017] [Accepted: 11/05/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Jean‐Baptiste Stern
- Pulmonary Unit, Institut du ThoraxInstitut Mutualiste MontsourisParis France
| | - Ludovic Fournel
- Thoracic Surgery Unit, Institut du ThoraxInstitut Mutualiste MontsourisParis France
| | - Benjamin Wyplosz
- Infectious Disease DepartmentAssistance Publique‐Hôpitaux de Paris, CHU BicêtreLe Kremlin‐Bicêtre France
| | - Philippe Girard
- Pulmonary Unit, Institut du ThoraxInstitut Mutualiste MontsourisParis France
| | - Malik Al Nakib
- Biology Laboratory DepartmentInstitut Mutualiste MontsourisParis France
| | - Dominique Gossot
- Thoracic Surgery Unit, Institut du ThoraxInstitut Mutualiste MontsourisParis France
| | - Agathe Seguin‐Givelet
- Thoracic Surgery Unit, Institut du ThoraxInstitut Mutualiste MontsourisParis France
- Faculty of Medicine SMBHParis 13 University, Sorbonne Paris CitéBobigny France
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39
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Abstract
Bronchopleural fistula (BPF) with prolonged air leak (PAL) is most often, though not always, a sequela of lung resection. When this complication occurs post-operatively, it is associated with substantial morbidity and mortality. Surgical closure of the defect is considered the definitive approach to controlling the source of the leak, but many patients with this condition are suboptimal operative candidates. Therefore there has been active interest for decades in the development of effective endoscopic management options. Successful use of numerous bronchoscopic techniques has been reported in the literature largely in the form of retrospective series and, at best, small prospective trials. In general, these modalities fall into one of two broad categories: implantation of a device or administration of a chemical agent. Closure rates are high in published reports, but the studies are limited by their small size and multiple sources of bias. The endoscopic procedure currently undergoing the most systematic investigation is the placement of endobronchial valves. The aim of this review is to present a concise discussion on the subject of PAL and summarize the described bronchoscopic approaches to its management.
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Affiliation(s)
- Sevak Keshishyan
- Division of Pulmonary, Critical Care, and Sleep Medicine, Westchester Medical Center, Valhalla, NY, USA
| | - Alberto E Revelo
- Division of Pulmonary, Critical Care, and Sleep Medicine, Westchester Medical Center, Valhalla, NY, USA
| | - Oleg Epelbaum
- Division of Pulmonary, Critical Care, and Sleep Medicine, Westchester Medical Center, Valhalla, NY, USA
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40
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The American Association for Thoracic Surgery consensus guidelines for the management of empyema. J Thorac Cardiovasc Surg 2017; 153:e129-e146. [PMID: 28274565 DOI: 10.1016/j.jtcvs.2017.01.030] [Citation(s) in RCA: 167] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 12/24/2016] [Accepted: 01/08/2017] [Indexed: 11/24/2022]
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41
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Nachira D, Chiappetta M, Fuso L, Varone F, Leli I, Congedo MT, Margaritora S, Granone P. Analysis of risk factors in the development of bronchopleural fistula after major anatomic lung resection: experience of a single centre. ANZ J Surg 2017; 88:322-326. [DOI: 10.1111/ans.13886] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 07/08/2016] [Accepted: 11/20/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Dania Nachira
- Department of General Thoracic Surgery; Catholic University; Rome Italy
| | - Marco Chiappetta
- Department of General Thoracic Surgery; Catholic University; Rome Italy
| | - Leonello Fuso
- Pulmonary Medicine Unit; Catholic University; Rome Italy
| | | | - Ilaria Leli
- Pulmonary Medicine Unit; Catholic University; Rome Italy
| | - Maria T. Congedo
- Department of General Thoracic Surgery; Catholic University; Rome Italy
| | | | - Pierluigi Granone
- Department of General Thoracic Surgery; Catholic University; Rome Italy
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42
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Lakranbi M, Rabiou S, Belliraj L, Issoufou I, Ammor FZ, Ghalimi J, Ouadnouni Y, Smahi M. [What place for the thoracostomy-thoracmyoplasty in the management of the chronic pleural empyema?]. REVUE DE PNEUMOLOGIE CLINIQUE 2016; 72:333-339. [PMID: 27776948 DOI: 10.1016/j.pneumo.2016.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 08/18/2016] [Accepted: 08/27/2016] [Indexed: 06/06/2023]
Abstract
INTRODUCTION The occurrence of empyema after pneumonectomy or in suites with chronic pleural pocket is a dreaded complication. The management is long and difficult. The authors report their experience before this complication including infection control by an emptying of the pleural pocket percutaneous drainage or thoracostomy which will be complemented by a thoracomyoplasty the aim to erase the pleural pocket. MATERIALS AND METHODS This is a retrospective study conducted between 2009 and 2015 concerning the records of 9 patients treated for empyema or in the aftermath of a lung resection or as part of a chronic pleural pocket and calcific. RESULTS We had identified all 9 male patients aged 30 to 67 years. This was pyothorax complicating pneumonectomy in 4 patients and 1 pyothorax after a left upper lobectomy in 1 case. For the other 4 patients, there was a post-tuberculous pleural pocket, calcified chronic and whose attempts to decortication seemed impossible. We observed 3 cases of bronchopleural fistula. All patients had received evacuation of the contents of the pleural drainage bag is either thoracostomy laying the bed of a possible filling thoracomyoplasty. The evolution of pleural cavities after thoracostomy was favorable on septic map leading to a retraction of the pleural cavity and its spontaneous closure in 1 patient. In 6 patients, filling the cavity with thoracomyoplasty was necessary. The evolution immediate postoperative was favorable in all patients and no deaths were noted in connection with this technique. CONCLUSION Pyothorax on pneumonectomy cavity and chronic pleural calcified pockets are serious complications whose management is long and delicate. The thoracomyoplastie is a real alternative to the filling of the cavity in fragile patients with significant operational risk. The results are satisfactory in the hands of a broken team this technique.
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Affiliation(s)
- M Lakranbi
- Service de chirurgie thoracique C1, CHU Hassan II, Fès, Maroc
| | - S Rabiou
- Service de chirurgie thoracique C1, CHU Hassan II, Fès, Maroc.
| | - L Belliraj
- Service de chirurgie thoracique C1, CHU Hassan II, Fès, Maroc
| | - I Issoufou
- Service de chirurgie thoracique C1, CHU Hassan II, Fès, Maroc
| | - F Z Ammor
- Service de chirurgie thoracique C1, CHU Hassan II, Fès, Maroc
| | - J Ghalimi
- Service de chirurgie thoracique C1, CHU Hassan II, Fès, Maroc
| | - Y Ouadnouni
- Service de chirurgie thoracique C1, CHU Hassan II, Fès, Maroc; Faculté de médecine et de pharmacie, université Sidi-Mohamed-Ben-Abdellah, Fès, Maroc
| | - M Smahi
- Service de chirurgie thoracique C1, CHU Hassan II, Fès, Maroc; Faculté de médecine et de pharmacie, université Sidi-Mohamed-Ben-Abdellah, Fès, Maroc
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Liu Y, Gao Y, Zhang H, Cheng Y, Chang R, Zhang W, Zhang C. Video-assisted versus conventional thoracotomy pneumonectomy: a comparison of perioperative outcomes and short-term measures of convalescence. J Thorac Dis 2016; 8:3537-3542. [PMID: 28149547 DOI: 10.21037/jtd.2016.12.24] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Pneumonectomy is a proven treatment for lung diseases. We sought to present a comparison between video-assisted thoracic surgery pneumonectomy (VATS-P) and conventional thoracotomy pneumonectomy (CP) on perioperative outcomes and short-term measures of convalescence. METHODS A retrospective cohort study was performed to assess perioperative outcomes among patients underwent VATS-P and CP. A total of 32 patients undergoing VATS-P were matched 2:1 about comorbidity, surgical indication, tumour size and lesion location to a previous cohort of 64 patients who underwent CP. Demographic and perioperative data were obtained. Statistical analysis was performed. RESULTS Mean patient age was 55.4 years for both groups, with equal sex distribution. Pneumonectomy for malignant and benign lesion patients was evaluated individually. For malignant tumour patients, median tumour size was 3.9 cm for both groups. There was no difference between VATS-P and CP cases in transfusion rates (2% vs. 10%, P=0.50), dissected lymph node numbers (11.9 vs. 14.2, P=0.26), dissected lymph node stations (5.0 vs. 4.9, P=0.75), estimated blood loss (226.0 vs. 261.3 mL, P=0.40), complication rate (20.0% vs. 22.5%, P=0.82), postoperative drainage time (5.9 vs. 6.2, P=0.50) or length of hospital stay (7.5 vs. 8.1, P=0.50). Operation time in VATS-P was higher than conventional groups (187.5 vs. 146.3 min, P=0.00) but the mean pain score was significantly less. For benign patients, over 1,000 mL blood losing (1,033.3 vs. 1,233.3 mL, P=0.78) and 180 minutes (186.6 vs. 105.8, P=0.73) OR time was found in both groups. The Length of stay (7.6 vs. 6.3 d, P=0.57), transfusion rates (66.7% vs. 33.3%), complications rates (zero in both group) and length of drainage (6.7 vs. 6.7 d, P=1.0) between two groups are identical. CONCLUSIONS Complete video-assisted thoracic surgery (VATS) pneumonectomy is feasible and safe technique and can be recommended as a surgical treatment for lung cancer patients. However, long-term benefits need to be evaluated by further studies and large sample tests.
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Affiliation(s)
- Yuanqi Liu
- Department of Thoracic Surgery, Xiangya Hospital Central South University, Changsha 410000, China
| | - Yang Gao
- Department of Thoracic Surgery, Xiangya Hospital Central South University, Changsha 410000, China
| | - Huajun Zhang
- Department of Thoracic Surgery, Xiangya Hospital Central South University, Changsha 410000, China
| | - Yuanda Cheng
- Department of Thoracic Surgery, Xiangya Hospital Central South University, Changsha 410000, China
| | - Ruimin Chang
- Department of Thoracic Surgery, Xiangya Hospital Central South University, Changsha 410000, China
| | - Weixing Zhang
- Department of Thoracic Surgery, Xiangya Hospital Central South University, Changsha 410000, China
| | - Chunfang Zhang
- Department of Thoracic Surgery, Xiangya Hospital Central South University, Changsha 410000, China
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Issoufou I, Sani R, Belliraj L, Ammor FZ, Moussa Ounteini A, Ghalimi J, Lakranbi M, Ouadnouni Y, Smahi M. [Pneumonectomy for tuberculosis destroyed lung: A series of 26 operated cases]. REVUE DE PNEUMOLOGIE CLINIQUE 2016; 72:288-292. [PMID: 27576025 DOI: 10.1016/j.pneumo.2016.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 06/25/2016] [Accepted: 07/02/2016] [Indexed: 06/06/2023]
Abstract
UNLABELLED Pneumonectomy keeps a greatest place in the treatment of tuberculosis lung destroyed despite high morbidity and mortality. The aim of our study was to analyze the results of pneumonectomy in the treatment of tuberculosis lung destroyed in our institution. METHOD A retrospective study over a period of 5 years (2009 to 2014) was realized. Are involved in the study all patients admitted to the thoracic surgery department of CHU Hassan II with tuberculosis lung destroyed and operated during the study period. RESULTS This is a series of 26 patients, including 17 men and 9 women treated and cured for pulmonary tuberculosis of which 2 for multiresistant tuberculosis. The average age was 38.8 years. Hemoptysis (77 %) and recurrent respiratory infections (65.4 %) were the major clinical signs. Aspergilloma have been reported on cavitary lesion in 23 % of cases and in 11.5 % pyothorax was associated. Extra-pericardial pneumonectomy was performed in 65.4 %, intra-pericardial pneumonectomy in 19.3 % and pleural-pneumonectomy in 15.3 %. The outcome was favorable in 23 patients. We noted a pyothorax on pneumonectomy cavity in 3 patients. Postoperative mortality was 7.7 %. The regularly clinical and radiological control of all patients is satisfactory with a mean of 41 months. CONCLUSION Pneumonectomy for tuberculosis lung destroyed remains effective in young patients with an acceptable complication rate.
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Affiliation(s)
- I Issoufou
- Service de chirurgie thoracique, CHU Hassan II, BP 1893, Km 2.200, route de Sidi Harazem, 3000 Fès, Maroc.
| | - R Sani
- Service de chirurgie thoracique, CHU Hassan II, BP 1893, Km 2.200, route de Sidi Harazem, 3000 Fès, Maroc
| | - L Belliraj
- Service de chirurgie thoracique, CHU Hassan II, BP 1893, Km 2.200, route de Sidi Harazem, 3000 Fès, Maroc
| | - F Z Ammor
- Service de chirurgie thoracique, CHU Hassan II, BP 1893, Km 2.200, route de Sidi Harazem, 3000 Fès, Maroc
| | - A Moussa Ounteini
- Service de pneumologie, CHU Hassan II, BP 1893, Km 2.200, route de Sidi Harazem, 3000 Fès, Maroc
| | - J Ghalimi
- Service de chirurgie thoracique, CHU Hassan II, BP 1893, Km 2.200, route de Sidi Harazem, 3000 Fès, Maroc
| | - M Lakranbi
- Service de chirurgie thoracique, CHU Hassan II, BP 1893, Km 2.200, route de Sidi Harazem, 3000 Fès, Maroc
| | - Y Ouadnouni
- Service de chirurgie thoracique, CHU Hassan II, BP 1893, Km 2.200, route de Sidi Harazem, 3000 Fès, Maroc
| | - M Smahi
- Service de chirurgie thoracique, CHU Hassan II, BP 1893, Km 2.200, route de Sidi Harazem, 3000 Fès, Maroc
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Chichevatov D, Gorshenev A, Sinev E. Preventive Diaphragm Plasty after Pneumonectomy on Account of Lung Cancer. Asian Cardiovasc Thorac Ann 2016; 14:265-72. [PMID: 16868097 DOI: 10.1177/021849230601400401] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Experience is presented of 53 cases of diaphragm plasty of the bronchial stump, tracheobronchial anastomosis, pericardium, and esophagus wall after extended pneumonectomy on account of lung cancer. A pedicled diaphragm flap was used to prevent bronchopleural fistula in 53 patients, as well as heart dislocation after wide resection of the pericardium in 26, and esophagopleural fistula after resection of the muscle coat of the esophagus in 2. In all cases, there was a high risk of these complications. Dehiscence of the bronchial stump or tracheobronchial anastomosis occurred in 9 patients, but due to diaphragm plasty, a bronchopleural fistula formed in only 3. Restoration of the pericardium and the esophageal muscle coat was successful in all cases. Overall morbidity was 22.6%, 30-day mortality was 7.5%, hospital mortality was 11.3%. Causes of death were fulminant pneumonia of the single lung, cerebral hemorrhage, pulmonary embolism, heart failure, early tumor progression, and sepsis, in one case each. The results were compared with those in 49 patients who underwent other methods of bronchial stump or tracheobronchial anastomosis reinforcement. The analysis revealed that the diaphragm flap was highly efficacious as a multipurpose plastic material.
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Affiliation(s)
- Dmitry Chichevatov
- Department of Thoracic Surgery, Penza Regional Oncology Health Center, 37a Prospect Stroitelei, 440071 Penza, Russia.
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Abstract
The emergence of multidrug-resistant tuberculosis poses a serious challenge to traditional drug therapy. In view of the relapse rate of up to 50% following medical management, there has been renewed interest in the role of surgery for this problem. We report our experience with lung resection for this condition. Over a 5-year period, resection was performed in 23 patients who were diagnosed with multidrug resistance after completing a course of standard chemotherapy and at least 3 months of second-line therapy. Pneumonectomy was performed in 17 patients and lobectomy in 6. There was no operative or postoperative mortality. Major complications developed in 4 patients (17.4%): 2 had post-pneumonectomy empyema and 2 underwent rethoracotomy for bleeding. Ten patients were sputum positive preoperatively, and only 1 remained positive after surgery. The patients were put on appropriate chemotherapy and followed up for 18 months. The cure rate was 95.6%. Pulmonary resection can be considered as an important adjunct to medical therapy in carefully selected patients: those who have localized disease with adequate pulmonary reserve, or who have multiple previous relapses, or whose sputum remains positive after 4 to 6 months of appropriate medical treatment. Surgery offers high cure rates with acceptable morbidity and mortality.
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Affiliation(s)
- Rishen Naidoo
- Cardiothoracic Surgery, Inkosi Albert Luthuli Central Hospital, Mayville, South Africa.
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Abstract
The surgical management of pulmonary tuberculosis has evolved since collapse therapy was the mainstay of treatment. Despite this, resection for active tuberculosis is viewed with circumspection. Details of 106 patients with pathologically proven active pulmonary tuberculosis, who were operated on from January 1997 to January 2005, were reviewed retrospectively. Demographic data, radiographic profiles, indications for surgery, sputum status, and preoperative drug therapy were analyzed in relation to outcomes. The indications for surgery included multidrug-resistant tuberculosis in 27 patients, hemoptysis in 44, bronchiectasis in 27, and diagnostic dilemmas where a tumor could not be excluded in 8. All patients were operated on while receiving antituberculous therapy, and 17 were sputum positive at the time of surgery. Two (1.9%) patients died postoperatively. Morbidity was 16.9%, including 6 cases of postpneumonectomy empyema and one of bronchopleural fistula. Surgery for active tuberculosis may be undertaken with acceptable morbidity and mortality.
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Affiliation(s)
- Rishendran Naidoo
- Department of Cardiothoracic Surgery, Inkosi Albert Luthuli Central Hospital, Mayville, South Africa.
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Stephen T, Thankachen R, Madhu AP, Neelakantan N, Shukla V, Korula RJ. Surgical Results in Bronchiectasis: Analysis of 149 Patients. Asian Cardiovasc Thorac Ann 2016; 15:290-6. [PMID: 17664200 DOI: 10.1177/021849230701500405] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Bronchiectasis remains a serious problem in developing countries. We reviewed the morbidity, mortality, and functional outcome of surgical treatment for bronchiectasis in our institution. Between 1992 and 2003, 149 patients (105 males, 44 females) underwent pulmonary resection for bronchiectasis. Their mean age was 33.7 years (range, 5–66 years). The indications for surgery were failure of conservative treatment in 59 (40%) patients, recurrent hemoptysis in 53 (36%), bronchial obstruction by a tumor in 9 (6%), and destroyed lung in 28 (19%). Bilateral disease was seen in 24 (16%) patients. Surgical treatment included pneumonectomy in 55 (37%) patients, lobectomy in 55 (37%), bilobectomy in 37 (25%), and lobectomy and/or segmentectomy in 2 (1%). There was one operative death (mortality, 0.67%) and morbidity occurred in 22 (14.8%) patients. Follow-up was complete in 94 patients, for a mean of 4.8 years (range, 3 months to 12 years). After surgery, 51 (34%) patients were asymptomatic. Surgical treatment for bronchiectasis can achieve good results with acceptable morbidity and mortality, not only in localized disease but also in extensive disease, if complete resection can be achieved.
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Affiliation(s)
- Thomas Stephen
- Cardiothoracic Surgery Unit II, Christan Medical College, Vellore 632 004, India
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Closure of a Recurrent Bronchopleural Fistula Using a Matrix Seeded With Patient-Derived Mesenchymal Stem Cells. Stem Cells Transl Med 2016; 5:1375-1379. [PMID: 27343169 PMCID: PMC5031186 DOI: 10.5966/sctm.2016-0078] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 04/25/2016] [Indexed: 12/03/2022] Open
Abstract
This is the first-in-human application of an autologous mesenchymal stem cell (MSC)-seeded matrix graft to repair a multiply recurrent postpneumonectomy bronchopleural fistula (BPF). Adipose-derived MSCs were isolated from patient abdominal adipose tissue, expanded, and seeded onto bio-absorbable mesh, which was surgically implanted at the BPF site. After clinical follow-up of 1.5 years, the patient is clinically asymptomatic without evidence of recurrence or malignant degeneration of MSC populations in situ. Management of recurrent bronchopleural fistula (BPF) after pneumonectomy remains a challenge. Although a variety of devices and techniques have been described, definitive management usually involves closure of the fistula tract through surgical intervention. Standard surgical approaches for BPF incur significant morbidity and mortality and are not reliably or uniformly successful. We describe the first-in-human application of an autologous mesenchymal stem cell (MSC)-seeded matrix graft to repair a multiply recurrent postpneumonectomy BPF. Adipose-derived MSCs were isolated from patient abdominal adipose tissue, expanded, and seeded onto bio-absorbable mesh, which was surgically implanted at the site of BPF. Clinical follow-up and postprocedural radiological and bronchoscopic imaging were performed to ensure BPF closure, and in vitro stemness characterization of patient-specific MSCs was performed. The patient remained clinically asymptomatic without evidence of recurrence on bronchoscopy at 3 months, computed tomographic imaging at 16 months, and clinical follow-up of 1.5 years. There is no evidence of malignant degeneration of MSC populations in situ, and the patient-derived MSCs were capable of differentiating into adipocytes, chondrocytes, and osteocytes using established protocols. Isolation and expansion of autologous MSCs derived from patients in a malnourished, deconditioned state is possible. Successful closure and safety data for this approach suggest the potential for an expanded study of the role of autologous MSCs in regenerative surgical applications for BPF. Significance Bronchopleural fistula is a severe complication of pulmonary resection. Current management is not reliably successful. This work describes the first-in-human application of an autologous mesenchymal stem cell (MSC)-seeded matrix graft to the repair of a large, multiply recurrent postpneumonectomy BPF. Clinical follow-up of 1.5 years without recurrence suggests initial safety and feasibility of this approach. Further assessment of MSC grafts in these difficult clinical scenarios requires expanded study.
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Matsuoka K, Imanishi N, Yamada T, Matsuoka T, Nagai S, Ueda M, Miyamoto Y. Clinical results of bronchial stump coverage using free pericardial fat pad. Interact Cardiovasc Thorac Surg 2016; 23:553-9. [DOI: 10.1093/icvts/ivw193] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 05/10/2016] [Indexed: 11/13/2022] Open
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