Bronchial stump reinforcement with an azygous vein flap

Completion pneumonectomy: a valuable option for lung cancer recurrence or new primaries

Background

The preoperative selection of patients with lung cancer recurrence remains a major clinical challenge. Several aspects of this kind of surgery are still insufficiently evidence-based, with only a few series with more than 50 patients.

Methods

A retrospective study on 29 patients who underwent a completion pneumonectomy for postoperative lung cancer recurrence or new primary was done in the period between October 2004 and December 2015. Inclusion criteria include complete (R0) first and second resections, histologically proven recurrent or new malignancy, complete pathohistological report after both operations, and exact data about the treatment outcome at the time of the last contact with patients or their families.

Results

There were 25 (86.2%) males and 4 (13.8%) females (M:F 6.2:1). In 13/29 patients, the interval between the first and second operations was less than 2 years, while in the remaining 16 patients, it was longer than 2 years. Concerning the operative stage distribution, stage I was more frequent after the first operation (44.8 vs. 22%), while stage III was dominant after the second operation (40.7 vs. 10.3%). The same tumor histology after the first and second operations existed in 24 (82.8%) patients. Adjuvant treatment was given to 53.6% of patients after the first and to 45.5% of patients after the second operation. The overall 5-year survival was 30%, median survival being 35 ± 16.9 months (1.896, 68.104 95% CI). A median survival of patients in post-surgery stage I after re-do surgery was better in comparison with that in higher stages (35 ± 22.6 vs.17.2 ± 15.1 vs. 21 ± 6.7 months, p > 0.05). Patients with the same tumor type at both operations lived significantly longer (median survival 48 ± 21.5 vs. 7.7 ± 1.9 months) than patients with different tumor histology after the second operation. Patients under 60 years (42.9%) lived longer than patients older than 60 years (median survival 69 ± 4.5 vs. 17.2 ± 14.3 months). The Cox regression analysis revealed only the disease stage at first operation and the same/different tumor histology as significant prognostic factors. One patient died from cardiac insufficiency caused by bronchopleural fistula (3.4% operative mortality). Operative morbidity was 34.4%.

Conclusion

Completion pneumonectomy may be a reasonable option for postoperative lung cancer recurrence or new primaries only in carefully selected patients, in whom the potential oncological benefits overweigh the surgical risk.

Single-port video-assisted thoracoscopic surgery (VATS) right pneumonectomy: a case report

When it comes to surgical treatment of non-small cell lung cancer (NSCLC), modern principles dictate that every possible effort should be made to avoid pneumonectomy, its debilitating consequences and a higher rate of complications. In marginal cases where video-assisted thoracoscopic surgery (VATS) sleeve or double sleeve lobectomy cannot be performed a conversion to open sleeve lobectomy is always preferred over a VATS pneumonectomy. We present a case of a 64-year-old male patient with two synchronous tumors of the right lung, both centrally located in the right upper and the right lower lobe. A single-port VATS right pneumonectomy was performed. The patient was discharged on the post-operative day 5 in good general condition.

Thymic flap for bronchial stump reinforcement after lobectomy

Buttressing of the bronchial stump after pulmonary resection has been reported to decrease the prevalence of bronchopleural fistula. This adjuvant maneuver is most commonly performed in patients undergoing resection for infection or in those who have received preoperative radiation. The anatomic location of the upper lobe bronchus often makes it difficult to create a tension-free flap using muscle or pericardial fat. Parietal pleura is often mobilized for such cases. We present a case in which the parietal pleura was not available, and the right inferior pole of the thymus was used for bronchial coverage following upper lobectomy.

Wedge tracheobronchoplasty technique for primary pulmonary carcinoma of the right upper bronchus

We describe a novel tracheobronchoplasty procedure for advanced squamous cell carcinoma of the right upper lung. A 78-year-old male was referred for further investigation of an abnormal shadow on a chest x-ray. A conventional right upper sleeve lobectomy was not applicable because of the invasion of lateral wall of the lower trachea. So, we performed a modified tracheobronchoplasty. This report shows that our cutting design for the trachea and bronchus was reasonable and appropriate for a caliber mismatch, with adaptation and suturing of each edge of the wedge-shaped defect of the trachea.