Complications and outcomes of thoracoscopic-assisted lung lobectomy in dogs

Leakage pressures of partial and total lung lobectomies performed with thoracoabdominal staplers in cadaveric dogs

OBJECTIVE

To compare leakage pressures of stapled partial and total lung lobectomies using thoracoabdominal (TA) staplers in canine cadaveric specimens.

STUDY DESIGN

Ex vivo experimental study.

SAMPLE POPULATION

A total of 29 lung lobes from six canine cadavers.

METHODS

Lower respiratory tracts were harvested from canine cadavers >15 kg. Lung lobes were randomized to groups: total lobectomy with a TA30-V3 (TL-30), partial lobectomy with two TA30-V3 cartridges in a wedge configuration (PL-30), and partial lobectomy with a TA60-3.5 mm (PL-60). The leakage pressure (pressure at which air bubbles were first seen from submerged tissue) was assessed, and groups were compared.

RESULTS

All nine PL-30 and all nine PL-60 sites leaked at median pressures of 10 cm H2O (range 10-15) and 18 cm H2O (range 10-20), respectively. Only 1/11 TL-30 site leaked during testing at a pressure of 22 cm H2O. PL-30 and PL-60 sites were more likely to leak at 20 (OR: 437; 95% CI: 7.9-24 171; p = .003) and 30 (OR: 133; 95% CI: 4.8-3674.2; p = .003) cm H2O compared to TL-30 sites, and the leakage pressure was greater for TL-30 as compared to PL-30 (marginal effect: -46.14; 95% CI: -55.9 to -36.38; p < .001) and PL-60 (marginal effect: -41.2; 95% CI: -51.73 to -30.67; p < .001) sites. PL-60 leakage pressures were greater than those of PL-30 (marginal effect: 4.94; 95% CI: 1.43-8.44; p = .006).

CONCLUSION

In canine cadaveric lung, total lobectomies with a TA30-V3 were less likely to leak at physiological pressures than partial lobectomies with either TA30-V3 or TA60-3.5 mm staplers.

CLINICAL SIGNIFICANCE

These results suggest a greater potential risk for air leakage at physiologically relevant pressures following partial as compared to total lobectomies with the TA stapling devices and techniques used commonly in veterinary surgery.

Evaluation of lung lobectomy and adjuvant treatment for primary pulmonary carcinoma in dogs: 89 cases (2005-2022)

OBJECTIVES

Primary lung cancer is relatively common in dogs. Despite the existing literature on long-term follow-up and outcome, further clinical studies focusing on a single histotype are needed, specifically about epithelial tumours since they are the ones most frequently detected.

MATERIALS AND METHODS

The medical records of four European institutions were reviewed to identify dogs undergoing lung lobectomy for a primary lung carcinoma between 2005 and 2022.

RESULTS

A total of 89 dogs were included. Median age was 11 years (range 5 to 17 years) and median body weight was 23 kg (range 2.5 to 47 kg). Overall median survival time was 252 days (range 6 to 1558 days) and overall progression-free interval was 140 days (range 7 to 684 days). The 1-, 2- and 3-year survival rates were 61%, 47% and 30%, respectively. Presence of clinical signs at presentation, pleural effusion, completeness of surgical margins, histopathological features and use of adjuvant chemotherapy did not influence survival. Patients with maximum tumour diameter ≥ 5 cm had a reduced survival compared to patients with smaller tumours (median survival time 284 days vs. 717 days, 95% CI 8 to 719), and dogs with histologically confirmed lymph node metastasis had a reduced survival compared to patients with no evidence of local metastasis (median survival time 162 days vs. 614 days, 95% CI 39 to 760). None of the other assessed variables influenced progression-free interval.

CLINICAL SIGNIFICANCE

Dogs with primary pulmonary carcinoma with no lymph node involvement and with a maximum tumour diameter of < 5 cm may have a better prognosis and prolonged survival. Further studies are needed to elucidate the role of adjuvant chemotherapy in case of clinically aggressive lung cancer.

Canine lung carcinoma-A descriptive review

Primary lung cancer is a relatively uncommon tumor in dogs, accounting for about 1% of all canine malignancies. Clinical signs in affected dogs can range from being asymptomatic to exhibiting chronic cough, and in rare cases, dyspnoea. Surgical excision of the primary tumor, along with resection of the affected locoregional lymph nodes is the preferred treatment option for most cases. Although chemotherapy, targeted therapy and radiation therapy have been employed, their effectiveness remain controversial. Dogs with stage T1 tumors can experience extended survival times of up to 2 years. However, the prognosis for dogs with advanced metastatic tumors is generally very poor. This review article discusses the etiology, clinical signs, diagnosis, staging, treatment options, and prognosis of primary lung carcinoma in dogs.

Short-term outcomes of dogs and cats undergoing lung lobectomy using either a self-ligating loop or a thoracoabdominal stapler

OBJECTIVE

To assess clinical outcomes of lung lobectomies in dogs and cats using either self-ligating loops (SLLs) or thoracoabdominal (TA) staplers, aiming to inform sample size calculations for future superiority trials.

STUDY DESIGN

Retrospective study.

ANIMALS

A total of 72 dogs and 15 cats.

METHODS

Records from January 2003 to October 2023 at a single institution were reviewed. Cases with lung lobectomy performed via TA stapler or SLL with a minimum 14-day postoperative follow-up were included. Pre-, intra-, and postoperative data were collected, with outcomes of interest including the frequency of intra- and postoperative complications. Outcome comparisons between techniques were performed to inform sample size calculations.

RESULTS

A total of 101 lung lobectomies were performed. The TA stapler was used in 83 (82.2%) and the SLL in 18 (17.8%) lung lobectomies. Intraoperative complications were identified in 14/101 lung lobectomies (13.9%), including intraoperative hemorrhage in 12/101 lobectomies (11.8%) and air leakage in 2/101 lobectomies (1.9%). Postoperative complications were identified in 12/87 cases (13.8%), including 4 (4.6%) catastrophic complications and 5 (5.8%) major complications. All intra- and postoperative complications occurred in cases having undergone stapled lung lobectomy; however, no differences were identified between surgical technique and either intraoperative (p = .069) or postoperative complications (p = .112). A sample size of 103 lobectomies per technique group would be required for appropriate evaluation.

CONCLUSION

Lung lobectomy using either surgical technique provided a good short-term outcome in this population.

CLINICAL SIGNIFICANCE

Self-ligating loop lung lobectomy provided a comparable alternative to stapled lung lobectomy. Further studies are needed to assess technique superiority.

Anaesthetic mortality in dogs: A worldwide analysis and risk assessment

BACKGROUND

Ensuring patient safety during small animal anaesthesia is crucial. This study aimed to assess anaesthetic-related deaths in dogs globally, identify risks and protective factors and inform clinical practice.

METHODS

This prospective cohort multicentric study involved 55,022 dogs from 405 veterinary centres across various countries. Data on anaesthesia-related deaths from premedication to 48 hours post-extubation were collected. Logistic regression was used to analyse patient demographics, American Society of Anesthesiologists (ASA) classification, procedure type and anaesthetic drugs used.

RESULTS

Anaesthetic-related mortality was 0.69%. Most deaths occurred postoperatively (81%). Age, obesity and a higher ASA classification score were associated with increased mortality. Urgent procedures, non-urgent but unscheduled anaesthesias and short procedures also had higher mortality. Some sedatives, systemic analgesics, hypnotics and the use of locoregional anaesthesia were linked to a decrease in mortality.

LIMITATIONS

The limitations of the study include the non-randomised sample, potential selection bias, lack of response rate quantification, variable data quality control, subjectivity in classifying causes of death and limited analysis of variables.

CONCLUSION

Careful patient evaluation, drug selection and monitoring can be associated with reduced mortality. These findings can be used to develop guidelines and strategies to improve patient safety and outcomes. Further research is needed to refine protocols, enhance data quality systems and explore additional risk mitigation measures.

Advances in Minimally Invasive Procedures of the Thoracic Cavity

Significant advances in veterinary minimally invasive surgeries and procedures have occurred in the past 10 years. These advances have been allowed due to continual research into optimizing working space through one-lung ventilation techniques and carbon dioxide insufflation. Additionally, minimally invasive surgery enthusiasts have joined forces with interventionalists and, in many cases, physicians to push the boundaries, minimize pain, suffering, and time away from owners with advances in a variety of procedures. Several larger multi-institutional retrospective studies on various disease processes allow veterinarians and owners to understand that minimally invasive approaches allow for outcomes comparable to traditional open surgery and, in some cases, may now be considered the standard of care in canine and feline patients.

Retrospective study evaluating the efficacy of stereotactic body radiation therapy for the treatment of confirmed or suspected primary pulmonary carcinomas in dogs

Canine primary pulmonary carcinomas (PCCs) are commonly treated with surgery with overall median survival times (MST) around a year; however, due to extent of disease, prognosis, or client preference, alternative treatments have been considered. Stereotactic body radiation therapy (SBRT) has been utilized in human cancer patients for local control of lung tumours as a surgical alternative. Twenty-one PCCs in 19 dogs that received SBRT for local control were retrospectively evaluated. Dogs were staged according to the canine lung carcinoma stage classification (CLCSC) system with three as Stage 1, five as Stage 2, three as Stage 3, and eight as Stage 4. Overall MST was 343 days with 38% of patients alive at 1 year. Stage did not significantly impact survival time (p = .72). Five (26%) dogs had lymphadenopathy and MST was not significantly different from dogs without lymphadenopathy (343 vs. 353 days; p = .54). Five out of 18 evaluable dogs (28%) experienced acute lung VRTOG effects and 2 of 12 dogs (17%) experienced late lung VRTOG effects. Median lung dose, V5, V20, and D30 to the lung did not correlate significantly with the development of adverse radiation events. Twelve dogs had follow-up imaging and the best response included a complete response (17%), partial response (42%), and stable disease (42%). Progressive disease was noted in seven dogs a median of 229 days after SBRT. SBRT was documented to be a safe and effective alternative to surgery and may have survival advantages for Stage 3 or 4 dogs according to the CLCSC.