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Chapkanov A, Todorova M, Chirlova A, Marinov B. Factors affecting prediction accuracy of postoperative FEV1 and D L,CO in patients undergoing lung resection. Folia Med (Plovdiv) 2024; 66:171-178. [PMID: 38690811 DOI: 10.3897/folmed.66.e121799] [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: 02/27/2024] [Accepted: 03/25/2024] [Indexed: 05/03/2024] Open
Abstract
INTRODUCTION Despite significant development in systemic therapy and radiotherapy, surgery is still the cornerstone for curative lung cancer treatment. Although predicted postoperative function (ppo) somewhat exactly correlates with actual postoperative function bigger differences may be a cause of serious clinical outcome.
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Kwon OB, Lee HU, Park HE, Choi JY, Kim JW, Lee SH, Yeo CD. Predicting Postoperative Lung Function in Patients with Lung Cancer Using Imaging Biomarkers. Diseases 2024; 12:65. [PMID: 38667523 PMCID: PMC11049658 DOI: 10.3390/diseases12040065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 03/19/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024] Open
Abstract
There have been previous studies conducted to predict postoperative lung function with pulmonary function tests (PFTs). Computing tomography (CT) can quantitatively measure small airway walls' thickness, lung volume, pulmonary vessel volume, and emphysema area, which reflect the severity of respiratory diseases. These measurements are considered imaging biomarkers. This study aimed to predict postoperative lung function with imaging biomarkers. A retrospective analysis of 79 patients with lung cancer who had undergone lung surgery was completed. Postoperative lung function measured by forced expiratory volume in one second (FEV1) was defined as an outcome. Preoperative clinico-pathological parameters and imaging biomarkers representing airway walls' thickness, severity of emphysema, total lung volume, and pulmonary vessel volume were measured quantitatively in chest CT by an automated segmentation software, AVIEW COPD. Pi1 was defined as the first percentile along the histogram of lung attenuation that represents the degree of emphysema. Wafw was defined as the airway thickness, which was calculated by the full-width at half-maximum method. Logistic and linear regressions were used to assess these variables. If the actual postoperative FEV1 was higher than the postoperative FEV1 projected by a formula, the group was considered to be preserved. Among the 79 patients, 16 of the patients were grouped as a non-preserved group, and 63 of them were grouped as a preserved group. The patients in the preserved FEV1 group had a higher vessel volume than the non-preserved group. Pi1 and Wafw were independent predictors of postoperative lung function. Imaging biomarkers can be considered significant variables in predicting postoperative lung function in patients with lung cancer.
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Affiliation(s)
- Oh-Beom Kwon
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (O.-B.K.); (J.-Y.C.); (J.-W.K.); (S.-H.L.)
- Department of Internal Medicine, Kangwon National University Hospital, Chuncheon 24289, Republic of Korea
| | - Hae-Ung Lee
- Coreline Soft Co., Ltd., Seoul 03991, Republic of Korea; (H.-U.L.); (H.-E.P.)
| | - Ha-Eun Park
- Coreline Soft Co., Ltd., Seoul 03991, Republic of Korea; (H.-U.L.); (H.-E.P.)
| | - Joon-Young Choi
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (O.-B.K.); (J.-Y.C.); (J.-W.K.); (S.-H.L.)
| | - Jin-Woo Kim
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (O.-B.K.); (J.-Y.C.); (J.-W.K.); (S.-H.L.)
| | - Sang-Haak Lee
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (O.-B.K.); (J.-Y.C.); (J.-W.K.); (S.-H.L.)
| | - Chang-Dong Yeo
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (O.-B.K.); (J.-Y.C.); (J.-W.K.); (S.-H.L.)
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Aigner C, Batirel H, Huber RM, Jones DR, Sihoe ADL, Štupnik T, Brunelli A. Resectable non-stage IV nonsmall cell lung cancer: the surgical perspective. Eur Respir Rev 2024; 33:230195. [PMID: 38508666 PMCID: PMC10951859 DOI: 10.1183/16000617.0195-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/11/2024] [Indexed: 03/22/2024] Open
Abstract
Surgery remains an essential element of the multimodality radical treatment of patients with early-stage nonsmall cell lung cancer. In addition, thoracic surgery is one of the key specialties involved in the lung cancer tumour board. The importance of the surgeon in the setting of a multidisciplinary panel is ever-increasing in light of the crucial concept of resectability, which is at the base of patient selection for neoadjuvant/adjuvant treatments within trials and in real-world practice. This review covers some of the topics which are relevant in the daily practice of a thoracic oncological surgeon and should also be known by the nonsurgical members of the tumour board. It covers the following topics: the pre-operative selection of the surgical candidate in terms of fitness in light of the ever-improving nonsurgical treatment alternatives unfit patients may benefit from; the definition of resectability, which is so important to include patients into trials and to select the most appropriate radical treatment; the impact of surgical access and surgical extension with the evolving role of minimally invasive surgery, sublobar resections and parenchymal-sparing sleeve resections to avoid pneumonectomy.
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Affiliation(s)
- Clemens Aigner
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Hasan Batirel
- Department of Thoracic Surgery, Marmara University, Istanbul, Turkey
| | - Rudolf M Huber
- Division of Respiratory Medicine and Thoracic Oncology, and Thoracic Oncology Centre Munich, Ludwig-Maximilians-Universität in Munich, Munich, Germany
| | - David R Jones
- Department of Thoracic Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Alan D L Sihoe
- Department of Cardio-Thoracic Surgery, CUHK Medical Centre, Hong Kong, China
| | - Tomaž Štupnik
- Department of Thoracic Surgery, Ljubljana University Medical Centre, Ljubljana, Slovenia
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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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Software-Based Assessment of Well-Aerated Lung at CT for Quantification of Predicted Pulmonary Function in Resected NSCLC. Life (Basel) 2023; 13:life13010198. [PMID: 36676147 PMCID: PMC9862480 DOI: 10.3390/life13010198] [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: 12/17/2022] [Revised: 12/27/2022] [Accepted: 01/03/2023] [Indexed: 01/11/2023] Open
Abstract
Background: To test the agreement between postoperative pulmonary function tests 12 months after surgery (mpo-PFTs) for non-small cell lung cancer (NSCLC) and predicted lung function based on the quantification of well-aerated lung (WAL) at staging CT (sCT). Methods: We included patients with NSCLC who underwent lobectomy or segmentectomy without a history of thoracic radiotherapy or chemotherapy treatment with the availability of PFTs at 12 months follow-up. Postoperative predictive (ppo) lung function was calculated using the resected lobe WAL (the lung volume between −950 and −750 HU) at sCT. The Spearman correlation coefficient (rho) and intraclass correlation coefficient (ICC) were used to the test the agreement between WAL ppo-PFTs and mpo-PFTs. Results: the study included 40 patients (68 years-old, IQR 62−74 years-old; 26/40, 65% males). The WAL ppo-forced expiratory volume in 1 s (FEV1) and the ppo-diffusing capacity of the lung for carbon monoxide (%DLCO) were significantly correlated with corresponding mpo-PFTs (rho = 0.842 and 0.717 respectively; p < 0.001). The agreement with the corresponding mpo-PFTs of WAL ppo-FEV1 was excellent (ICC 0.904), while it was good (ICC 0.770) for WAL ppo-%DLCO. Conclusions: WAL ppo-FEV1 and WAL ppo-%DLCO at sCT showed, respectively, excellent and good agreement with corresponding mpo-PFTs measured 12 months after surgery for NSCLC. WAL is an easy parameter obtained by staging CT that can be used to estimate post-resection lung function for patients with borderline pulmonary function undergoing lung surgery.
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Tao X, Zhao J, Wei W, Shan Z, Zheng H, Pan T. The feasibility and safety of simultaneous bilateral video-assisted thoracic surgery for the treatment of bilateral pulmonary lesions. Front Oncol 2022; 12:975259. [DOI: 10.3389/fonc.2022.975259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/13/2022] [Indexed: 11/17/2022] Open
Abstract
BackgroundThe aim of this study was to evaluate the feasibility and safety of simultaneous bilateral video-assisted thoracic surgery (VATS) for the treatment of bilateral pulmonary lesions.MethodsThe data of 11 patients who received simultaneous bilateral pulmonary surgery using VATS in the Department of Thoracic Surgery of The Third Affiliated Hospital of Naval Medical University between January 2016 and August 2021 were retrospectively analyzed.ResultsThe cases of four male and seven female patients, with a mean age of 57.54 ± 8.37 years (range, 44-67 years), were reviewed. Nonanatomic wedge resection, pulmonary segmentectomy or lobectomy via VATS were performed depending on each patient’s situation. Mean 1 second forced expiratory volume (FEV1) was 2.55 ± 0.66 L(range, 1.49-3.88 L), mean intraoperative bleeding volume was 91.81 ± 49.56 mL(range, 30-150 mL), mean operating time was 273.72 ± 68.98 min(range, 132-390 min), and mean drainage duration was 5.27 ± 3.60 days(range, 2-14 days), with a mean total drainage volume of 1,515.90 ± 772.75 mL(range, 530-3,225 mL). Only one postoperative complication (air leakage) occurred, with an overall complication rate of 9.09%. The mean postoperative hospital stay was 8.81 ± 3.60 days (range, 5-18 days), and the mean total cost of hospitalization was 67,054.53 ± 20,896.49 RMB (range, 47,578.45-123,530.8 RMB).ConclusionsSimultaneous bilateral pulmonary surgery using VATS for the treatment of bilateral pulmonary lesions is safe and feasible and can therefore be considered after strict preoperative evaluation of the patient.
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Fuzhi Y, Dongfang T, Wentao F, Jing W, Yingting W, Nianping M, Wen G, Xiaoyong S. Rapid Recovery of Postoperative Pulmonary Function in Patients With Lung Cancer and Influencing Factors. Front Oncol 2022; 12:927108. [PMID: 35898890 PMCID: PMC9309725 DOI: 10.3389/fonc.2022.927108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 06/13/2022] [Indexed: 12/24/2022] Open
Abstract
Among malignant tumors, lung cancer has the highest morbidity and mortality worldwide. Surgery is the first-line treatment for early-stage lung cancers, and has gradually advanced from conventional open-chest surgery to video-assisted thoracic surgery (VATS). Additionally, increasingly smaller surgical incisions and less surgical trauma have resulted in reduced pulmonary function damage. Previous studies have found that the level of pulmonary function loss and recovery is significantly correlated with postoperative complications and the quality of life. Thus, an accurate assessment of the preoperative pulmonary function and effective rehabilitation of postoperative pulmonary function are highly important for patients undergoing lung surgery. In addition, pulmonary function assessment after pulmonary rehabilitation serves as an objective indicator of the postoperative pulmonary rehabilitation status and is crucial to facilitating pulmonary function recovery. Furthermore, a complete preoperative assessment and effective rehabilitation are especially critical in elderly patients with pulmonary tumors, poor basic physiological functions, comorbid lung diseases, and other underlying diseases. In this review, we summarize the clinical significance of pulmonary function assessment in patients undergoing lung cancer surgery, postoperative changes in pulmonary function, effective pulmonary function rehabilitation, and the influencing factors of pulmonary function rehabilitation.
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Bae SY, Lee H, Na KJ, Na B, Park S, Park IK, Kang CH, Kim YT. Computed tomography volumetric analysis for predicting postoperative lung function for segmentectomy. Interact Cardiovasc Thorac Surg 2022; 35:6649700. [PMID: 35876799 PMCID: PMC9338704 DOI: 10.1093/icvts/ivac195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/22/2022] [Accepted: 07/20/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Seon Yong Bae
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine , Seoul, Korea
| | - Haeju Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine , Seoul, Korea
| | - Kwon Joong Na
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine , Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine , Seoul, Korea
| | - Bubse Na
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine , Seoul, Korea
| | - Samina Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine , Seoul, Korea
| | - In Kyu Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine , Seoul, Korea
| | - Chang Hyun Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine , Seoul, Korea
| | - Young Tae Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine , Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine , Seoul, Korea
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Nonomura R, Tabata T, Sasaki T, Mitomo H, Ishibashi N, Sugawara T, Metoki H. Prediction of Postoperative Respiratory Complications after Lobectomy in Lung Cancer Patients with COPD by Quantitative Image Analysis: A Historical Cohort Study. Ann Thorac Cardiovasc Surg 2022; 28:411-419. [PMID: 36216576 PMCID: PMC9763719 DOI: 10.5761/atcs.oa.22-00133] [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: 12/30/2022] Open
Abstract
PURPOSE We examined whether preoperative assessment of percentage of low attenuation area (LAA%) on the non-resected side can predict postoperative respiratory complications (PRC) after lobectomy. MATERIALS AND METHODS We conducted a historical cohort study of 217 smokers (175 males and 42 females) who underwent lobectomy for primary lung cancer at our hospital between January 2014 and March 2021. First, the relationship between LAA% and respiratory function parameters (RFPs) calculated for both the bilateral and non-resected sides was used to estimate the most effective patient group. Next, multivariate analyses of the relationship between LAA% of the non-resected side and PRC were performed using logistic regression analysis after adjusting for basic patient attributes and respiratory function. RESULTS A correlation was found between LAA% and RFP in smoking males. Multivariate analysis showed a strong relationship between model 3, adjusted for basic patient attributes and lung function factors, and PRC (odds ratio, 2.43; 95% confidence interval, 1.05-5.63). CONCLUSION LAA% of the non-resected side suggested that it may be able to predict the occurrence of PRC after lung cancer lobectomy.
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Affiliation(s)
- Ryo Nonomura
- Department of Thoracic Surgery, Tohoku Medical and Pharmaceutical University, Sendai, Miyagi, Japan
| | - Toshiharu Tabata
- Department of Thoracic Surgery, Tohoku Medical and Pharmaceutical University, Sendai, Miyagi, Japan,Corresponding author: Toshiharu Tabata. Department of Thoracic Surgery, Tohoku Medical and Pharmaceutical University, 1-15-1 Fukumuro, Miyagino-ku, Sendai, Miyagi 983-8536, Japan
| | - Takanobu Sasaki
- Department of Thoracic Surgery, Tohoku Medical and Pharmaceutical University, Sendai, Miyagi, Japan
| | - Hideki Mitomo
- Department of Thoracic Surgery, Tohoku Medical and Pharmaceutical University, Sendai, Miyagi, Japan
| | - Naoya Ishibashi
- Department of Thoracic Surgery, Tohoku Medical and Pharmaceutical University, Sendai, Miyagi, Japan
| | - Takafumi Sugawara
- Department of Thoracic Surgery, Tohoku Medical and Pharmaceutical University, Sendai, Miyagi, Japan
| | - Hirohito Metoki
- Department of Public Health, Tohoku Medical and Pharmaceutical University, Sendai, Miyagi, Japan
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Saito T, Ono R, Tanaka Y, Tatebayashi D, Okumura M, Makiura D, Inoue J, Fujikawa T, Kondo S, Inoue T, Maniwa Y, Sakai Y. The effect of home-based preoperative pulmonary rehabilitation before lung resection: A retrospective cohort study. Lung Cancer 2021; 162:135-139. [PMID: 34798590 DOI: 10.1016/j.lungcan.2021.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/14/2021] [Accepted: 10/24/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study aimed to assess the effect of home-based preoperative pulmonary rehabilitation (HBPPR) on the incidence of postoperative complications, length of stay (LOS), and duration of intercostal catheterization in non-small cell lung cancer (NSCLC) patients who underwent lung resection. MATERIALS AND METHODS In this retrospective cohort study, 144 patients who underwent lung resection were recruited, 51 of whom received HBPPR, comprising respiratory muscle training and was supervised (for patients undergoing it for the first time). Patients continued these programs for 2-4 weeks during the preoperative waiting period, in their homes. Data on postoperative complications graded according to the Clavien-Dindo classification, LOS, and intercostal catheterization duration were collected from medical records. These outcomes were compared between the HBPPR and non-HBPPR groups using Fisher's exact test and Wilcoxon rank sum test, after 1:1 propensity score matching to avoid selection bias. RESULTS Forty-nine matched pairs were extracted using propensity score matching. HBPPR reduced the onset of postoperative complications (p = 0.04), with the relative ratio (RR) for Clavien-Dindo Class I postoperative complications showing a significant difference (RR 0.55, 95% CI 0.30-1.02; p = 0.05), whereas RRs for the other Clavien-Dindo classes were not statistically significant. There was no significant difference in LOS or the duration of intercostal catheterization. CONCLUSION HBPPR reduced the incidence of Clavien-Dindo Class I postoperative complications after lung resection. Implementing HBPPR practices in a clinical setting would benefit patients unable to receive supervised preoperative pulmonary rehabilitation due to access barriers, time, and financial constraints.
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Affiliation(s)
- Takashi Saito
- Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan; Department of Rehabilitation, Tokushima University Hospital, Tokushima, Japan
| | - Rei Ono
- Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Yugo Tanaka
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | | | - Maho Okumura
- Division of Rehabilitation, Kobe University Hospital, Kobe, Japan
| | - Daisuke Makiura
- Division of Rehabilitation, Kobe University Hospital, Kobe, Japan
| | - Junichiro Inoue
- Division of Rehabilitation, Kobe University Hospital, Kobe, Japan
| | - Takashi Fujikawa
- Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan; Department of Rehabilitation, Kobe City Medical Center West Hospital, Kobe, Japan
| | - Shin Kondo
- Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan; Department of Rehabilitation, Tokushima University Hospital, Tokushima, Japan
| | - Tatsuro Inoue
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
| | - Yoshimasa Maniwa
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshitada Sakai
- Division of Rehabilitation, Kobe University Hospital, Kobe, Japan; Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
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Mao X, Ni Y, Niu Y, Jiang L. The Clinical Value of Pulmonary Rehabilitation in Reducing Postoperative Complications and Mortality of Lung Cancer Resection: A Systematic Review and Meta-Analysis. Front Surg 2021; 8:685485. [PMID: 34646857 PMCID: PMC8503917 DOI: 10.3389/fsurg.2021.685485] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/28/2021] [Indexed: 12/25/2022] Open
Abstract
Background: Pulmonary rehabilitation is one meaningful way of improving exercise tolerance and pulmonary function. Thus, it may reduce the postoperative complications and mortality of pulmonary resection. Hence, we refreshed the data and conducted this systemic analysis. Method: We searched Pubmed, Web of Science, and EMBASE using “lung OR pulmonary” AND “operation OR resection OR surgery” AND “rehabilitation or exercise.” The cut-off date was September 30, 2020. The publications were filtrated, and data were extracted from all selected studies by two reviewers. Review Manger 5.1 and the fixed or random regression model were used for calculating the pooled odds ratio (OR). Result: Finally, 13 publications were enrolled in this study. Among them, five publications reported mortality, nine reported postoperative complications, and seven reported postoperative pulmonary complications. The pooled OR of mortality was 1.32 [95% confidence interval (CI): 0.54–3.23] for the pulmonary rehabilitation group, the pooled OR of postoperative complications was 0.62 (95% CI: 0.49–0.79) for the pulmonary rehabilitation group, and the pooled OR of postoperative pulmonary complications was 0.39 (95% CI: 0.27–0.56) for the pulmonary rehabilitation group. Subgroup analysis revealed the perioperative pulmonary rehabilitation was the most important part. Conclusion: Pulmonary rehabilitation may not affect the mortality of pulmonary resection patients, however, it could decrease the number of postoperative complications, especially pulmonary complications. Perioperative pulmonary rehabilitation was the most important part of the program.
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Affiliation(s)
- Xiaowei Mao
- Pulmonary and Critical Care Medicine, Shanghai Jiao Tong University, Shanghai Chest Hospital, Shanghai, China
| | - Yiqian Ni
- Pulmonary and Critical Care Medicine, Shanghai Jiao Tong University, Shanghai Chest Hospital, Shanghai, China
| | - Yanjie Niu
- Pulmonary and Critical Care Medicine, Shanghai Jiao Tong University, Shanghai Chest Hospital, Shanghai, China
| | - Liyan Jiang
- Pulmonary and Critical Care Medicine, Shanghai Jiao Tong University, Shanghai Chest Hospital, Shanghai, China
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Yoshiyasu N, Kojima F, Takahara H, Bando T. Efficacy of the Segment-Counting Method in Predicting Lung Function and Volume Following Stapler-Based Thoracoscopic Segmentectomy. Ann Thorac Cardiovasc Surg 2021; 28:121-128. [PMID: 34556612 PMCID: PMC9081460 DOI: 10.5761/atcs.oa.21-00111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose: To investigate the accuracy of a segment-counting method in predicting lung function and volume after stapler-based thoracoscopic segmentectomy in comparison with lobectomy. Methods: Between 2014 and 2018, patients who underwent these procedures were retrospectively reviewed. Thoracic computed tomography and spirometry data before and 1 year after the surgery were assessed. We evaluated the differences between the predicted values using a segment-counting method and the actual postoperative values for lung function and volume in each group. Sub-analyses were also performed to assess the impact of the number of staples and resected segments in predicting patient outcomes. Results: We included 116 patients (segmentectomy, 69; lobectomy, 47). Actual postoperative lung function and volume values matched the predicted values in the stapler-based segmentectomy group, and significantly exceeded the predictions in the lobectomy group (P <0.01). Sub-analyses revealed lower postoperative lung function values than predicted existed after single segmentectomy, with an odds ratio of 3.29 (95% confidence interval: 1.02–10.70, P = 0.04) in a multivariable analysis. The degree of predicted error regarding lung function was negligible. Conclusions: The segment-counting method was useful in predicting lung function after stapler-based thoracoscopic segmentectomy. Segmentectomy rarely yielded lower- than-predicted lung function and volume values.
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Affiliation(s)
- Nobuyuki Yoshiyasu
- Department of Thoracic Surgery, St. Luke's International Hospital, Tokyo, Japan.,Department of Thoracic Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Fumitsugu Kojima
- Department of Thoracic Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Hirotomo Takahara
- Department of Thoracic Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Toru Bando
- Department of Thoracic Surgery, St. Luke's International Hospital, Tokyo, Japan
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Zheng H, Peng Q, Xie D, Duan L, Zhao D, Jiang G, Zhu Y, Chen C. Simultaneous bilateral thoracoscopic lobectomy for synchronous bilateral multiple primary lung cancer-single center experience. J Thorac Dis 2021; 13:1717-1727. [PMID: 33841962 PMCID: PMC8024796 DOI: 10.21037/jtd-20-3325] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The aim of this study was to investigate the feasibility and safety of simultaneous bilateral thoracoscopic lobectomy and compare perioperative and late outcomes between simultaneous and staged bilateral thoracoscopic lobectomy. Methods Between January 2013 and December 2017, the medical records of patients who underwent bilateral thoracoscopic lobectomy for synchronous bilateral multiple primary lung cancer (SPLC) were reviewed retrospectively. Univariate analysis was used to examine the factors associated with morbidity. Survival was estimated with the Kaplan-Meier method. Results In the simultaneous resection group (n=41) and the staged groups (n=66), 11 and 16 patients underwent postoperative complication, respectively, whereas no significant differences existed between two groups (P=0.850). Univariate analysis showed that preoperative comorbidities (P=0.009), FEV1 <2 L (P=0.001), FEV1% <80% (P=0.036), and the number of pulmonary segments resected ≥9 (P=0.014) were the risk factors to increased simultaneous resection postoperative complication. In addition, simultaneous resection could significantly reduce total cost compared to staged resection (10,854.6±1,998.8 vs. 16,241.4±2,972.8 USD, P<0.001). In long-time outcomes, the patients with simultaneous resection showed better disease-free survival (DFS) than patients with staged resection at 5 years (67.7% vs. 45.9%, P=0.039). In subgroup analysis, simultaneous resection also had a significantly better survival than staged resection in patients with bilateral pure solid lesions or the biggest tumor size >3 cm. Conclusions Bilateral thoracoscopic lobectomy could be a feasible option for SPLC based on appropriate patient selection and careful perioperative management. Meanwhile, simultaneous resection has significantly advantaged in reducing the cost, preventing tumor progression compare to staged resection.
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Affiliation(s)
- Hui Zheng
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qiao Peng
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Dong Xie
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Liang Duan
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Deping Zhao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yuming Zhu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
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14
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Hanaoka J, Yoden M, Hayashi K, Shiratori T, Okamoto K, Kaku R, Kawaguchi Y, Ohshio Y, Sonoda A. Dynamic perfusion digital radiography for predicting pulmonary function after lung cancer resection. World J Surg Oncol 2021; 19:43. [PMID: 33563295 PMCID: PMC7874664 DOI: 10.1186/s12957-021-02158-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/31/2021] [Indexed: 12/25/2022] Open
Abstract
Background Accurate prediction of postoperative pulmonary function is important for ensuring the safety of patients undergoing radical resection for lung cancer. Dynamic perfusion digital radiography is an excellent and easy imaging method for detecting blood flow in the lung compared with the less-convenient conventional lung perfusion scintigraphy. As such, the present study aimed to confirm whether dynamic perfusion digital radiography can be evaluated in comparison with pulmonary perfusion scintigraphy in predicting early postoperative pulmonary function and complications. Methods Dynamic perfusion digital radiography and spirometry were performed before and 1 and 3 months after radical resection for lung cancer. Correlation coefficients between blood flow ratios calculated using dynamic perfusion digital radiography and pulmonary perfusion scintigraphy were then confirmed in the same cases. In all patients who underwent dynamic perfusion digital radiography, the correlation predicted values calculated from the blood flow ratio, and measured values were examined. Furthermore, ppo%FEV1 or ppo%DLco values, which indicated the risk for perioperative complications, were examined. Results A total of 52 participants who satisfied the inclusion criteria were analyzed. Blood flow ratios measured using pulmonary perfusion scintigraphy and dynamic perfusion digital radiography showed excellent correlation and acceptable predictive accuracy. Correlation coefficients between predicted FEV1 values obtained from dynamic perfusion digital radiography or pulmonary perfusion scintigraphy and actual measured values were similar. All patients who underwent dynamic perfusion digital radiography showed excellent correlation between predicted values and those measured using spirometry. A significant difference in ppo%DLco was observed for respiratory complications but not cardiovascular complications. Conclusions Our study demonstrated that dynamic perfusion digital radiography can be a suitable alternative to pulmonary perfusion scintigraphy given its ability for predicting postoperative values and the risk for postoperative respiratory complications. Furthermore, it seemed to be an excellent modality because of its advantages, such as simplicity, low cost, and ease in obtaining in-depth respiratory functional information. Trial registration Registered at UMIN on October 25, 2017. https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_his_list.cgi?recptno=R000033957 Registration number: UMIN000029716 Supplementary Information The online version contains supplementary material available at 10.1186/s12957-021-02158-w.
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Affiliation(s)
- Jun Hanaoka
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Shiga, Japan.
| | - Makoto Yoden
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Kazuki Hayashi
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Takuya Shiratori
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Keigo Okamoto
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Ryosuke Kaku
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Yo Kawaguchi
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Yasuhiko Ohshio
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Akinaga Sonoda
- Department of Radiology, Shiga University of Medical Science, Shiga, Japan
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15
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Kanno H, Deguchi H, Tomoyasu M, Kudo S, Shigeeda W, Kaneko Y, Yoshimura R, Saito H. Prediction formula for predicted diffusion capacity of lung for carbon monoxide in pulmonary surgery. Gen Thorac Cardiovasc Surg 2020; 68:1432-1438. [PMID: 32623560 DOI: 10.1007/s11748-020-01424-0] [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: 04/13/2020] [Accepted: 06/20/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Diffusion capacity of the lung for carbon monoxide (DLCO) is a useful value for perioperative risk assessment of non-small cell lung cancer (NSCLC). The percentage of the predicted DLCO (%DLCO: DLCO/predicted DLCO × 100) is often evaluated by setting cutoff values as in the clinical field, but several formulae are available for calculating the predicted DLCO, and the %DLCO thus varies depending on the formula used to predict DLCO. We examined differences in %DLCO calculated using several commonly used prediction formulae. METHODS A total of 490 eligible patients who underwent completed video-assisted thoracoscopic surgery (c-VATS), especially radical pulmonary lobectomy, for NSCLC were analyzed retrospectively. Predicted DLCO was calculated using the prediction formulae described by Burrows, Nishida, Cotes, and Kanagami, then the relationships with postoperative complications were evaluated. RESULTS The %DLCO from Nishida's formula was two-thirds the value of that from Burrows' (p < 0.05). On logistic regression analysis, predicted postoperative %DLCO (ppo-DLCO) based on the formulae of Burrows, Cotes and Kanagami were independent factors related to postoperative pulmonary complications after c-VATS lobectomy for NSCLC (odds ratios 2.46, 1.79 and 2.33, p = 0.005, 0.043 and 0.009, respectively). CONCLUSIONS The %DLCO is a useful index for surgical risk assessment of c-VATS lobectomy for NSCLC, while the results differ markedly between individual prediction formulae. Specification of the formula used is necessary in cases considering risk evaluations.
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Affiliation(s)
- Hironaga Kanno
- Department of Thoracic Surgery, Iwate Medical University, 2-1-1 Idai-dori, Yahaba, Shiwa, Iwate, 028-3695, Japan.
| | - Hiroyuki Deguchi
- Department of Thoracic Surgery, Iwate Medical University, 2-1-1 Idai-dori, Yahaba, Shiwa, Iwate, 028-3695, Japan
| | - Makoto Tomoyasu
- Department of Thoracic Surgery, Iwate Medical University, 2-1-1 Idai-dori, Yahaba, Shiwa, Iwate, 028-3695, Japan
| | - Satoshi Kudo
- Department of Thoracic Surgery, Iwate Medical University, 2-1-1 Idai-dori, Yahaba, Shiwa, Iwate, 028-3695, Japan
| | - Wataru Shigeeda
- Department of Thoracic Surgery, Iwate Medical University, 2-1-1 Idai-dori, Yahaba, Shiwa, Iwate, 028-3695, Japan
| | - Yuka Kaneko
- Department of Thoracic Surgery, Iwate Medical University, 2-1-1 Idai-dori, Yahaba, Shiwa, Iwate, 028-3695, Japan
| | - Ryuichi Yoshimura
- Department of Thoracic Surgery, Iwate Medical University, 2-1-1 Idai-dori, Yahaba, Shiwa, Iwate, 028-3695, Japan
| | - Hajime Saito
- Department of Thoracic Surgery, Iwate Medical University, 2-1-1 Idai-dori, Yahaba, Shiwa, Iwate, 028-3695, Japan
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16
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Rea F, Ieva F, Pastorino U, Apolone G, Barni S, Merlino L, Franchi M, Corrao G. Number of lung resections performed and long-term mortality rates of patients after lung cancer surgery: evidence from an Italian investigation. Eur J Cardiothorac Surg 2020; 58:70-77. [PMID: 32034907 DOI: 10.1093/ejcts/ezaa031] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/18/2019] [Accepted: 12/25/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Although it has been postulated that patients might benefit from the centralization of high-volume specialized centres, conflicting results have been reported on the relationship between the number of lung resections performed and the long-term, all-cause mortality rates among patients who underwent surgery for lung cancer. A population-based observational study was performed to contribute to the ongoing debate. METHODS The 2613 patients, all residents of the Lombardy region (Italy), who underwent lung resection for lung cancer from 2012 to 2014 were entered into the cohort and were followed until 2018. The hospitals were classified according to the annual number of pulmonary resections performed. Three categories of lung resection cases were identified: low (≤30), intermediate (31-95) and high (>95). The outcome of interest was all-cause death. A frailty model was used to estimate the death risk associated with the categories of numbers of lung resections performed, taking into account the multilevel structure of the data. A set of sensitivity analyses was performed to account for sources of systematic uncertainty. RESULTS The 1-year and 5-year survival rates of cohort members were 90% and 63%. Patients operated on in high-volume centres were on average younger and more often women. Compared to patients operated on in a low-volume centre, the mortality risk exhibited a significant, progressive reduction as the numbers of lung resections performed increased to intermediate (-13%; 95% confidence interval +10% to -31%) and high (-26%; 0% to -45%). Sensitivity analyses revealed that the association was consistent. CONCLUSIONS Further evidence that the volume of lung resection cases performed strongly affects the long-term survival of lung cancer patients has been supplied.
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Affiliation(s)
- Federico Rea
- National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy.,Laboratory of Healthcare Research & Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Francesca Ieva
- National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy.,MOX, Department of Mathematics, Politecnico di Milano, Milan, Italy.,CADS-Center for Analysis Decisions and Society, Human Technopole, Milan, Italy
| | - Ugo Pastorino
- Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | | | - Sandro Barni
- Department of Oncology, ASST Bergamo Ovest, Bergamo, Italy
| | - Luca Merlino
- Epidemiologic Observatory, Lombardy Regional Health Service, Milan, Italy
| | - Matteo Franchi
- National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy.,Laboratory of Healthcare Research & Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Giovanni Corrao
- National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy.,Laboratory of Healthcare Research & Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
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17
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Arnon-Sheleg E, Haberfeld O, Kremer R, Keidar Z, Weiler-Sagie M. Head-to-Head Prospective Comparison of Quantitative Lung Scintigraphy and Segment Counting in Predicting Pulmonary Function in Lung Cancer Patients Undergoing Video-Assisted Thoracoscopic Lobectomy. J Nucl Med 2019; 61:981-989. [PMID: 31862797 DOI: 10.2967/jnumed.119.234526] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 11/06/2019] [Indexed: 12/25/2022] Open
Abstract
Prediction of postoperative pulmonary function in lung cancer patients before tumor resection is essential for patient selection for surgery and is conventionally done with a nonimaging segment counting method (SC) or 2-dimensional planar lung perfusion scintigraphy (PS). The purpose of this study was to compare quantitative analysis of PS to SPECT/CT and to estimate the accuracy of SC, PS, and SPECT/CT in predicting postoperative pulmonary function in patients undergoing lobectomy. Methods: Seventy-five non-small cell lung cancer patients planned for lobectomy were prospectively enrolled (68% male; average age, 68.1 ± 8 y). All patients completed tests of preoperative forced expiratory volume capacity in 1 s (FEV1) and diffusing capacity of the lungs for carbon monoxide (DLCO), as well as 99mTc-macroaggregated albumin PS and SPECT/CT quantification. A subgroup of 60 patients underwent video-assisted thoracoscopic lobectomy and measurement of postoperative FEV1 and DLCO. Relative uptake of the lung lobes estimated by PS and SPECT/CT was compared. Predicted postoperative FEV1 and DLCO were derived from SC, PS, and SPECT/CT. Prediction results were compared between the different methods and the true postoperative measurements in patients who underwent lobectomy. Results: Relative uptake measurements differed significantly between PS and SPECT/CT in right lung lobes, with a mean difference of -8.2 ± 3.8, 18.0 ± 5.0, and -11.5 ± 6.1 for right upper, middle, and lower lobes, respectively (P < 0.001). The differences between the methods in the left lung lobes were minor, with a mean difference of -0.4 ± 4.4 (P > 0.05) and -2.0 ± 4.0 (P < 0.001) for left upper and lower lobes, respectively. No significant difference and a strong correlation (R = 0.6-0.76, P < 0.001) were found between predicted postoperative lung function values according to SC, PS, SPECT/CT, and the actual postoperative FEV1 and DLCO. Conclusion: Although lobar quantification parameters differed significantly between PS and SPECT/CT, no significant differences were found between the predicted postoperative lung function results derived from these methods and the actual postoperative results. The additional time and effort of SPECT/CT quantification may not have an added value in patient selection for surgery. SPECT/CT may be advantageous in patients planned for right lobectomy, but further research is warranted.
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Affiliation(s)
| | - Ori Haberfeld
- Rambam Medical Center, Haifa, Israel; and.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ran Kremer
- Rambam Medical Center, Haifa, Israel; and.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Zohar Keidar
- Rambam Medical Center, Haifa, Israel; and.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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18
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Zheng B, Xu G, Fu X, Wu W, Liang M, Zeng T, Zhang S, Zhu Y, Zheng W, Chen C, Bédat B, Swanson SJ, Koike T, Iwata H, Bedetti B, Sato M. Management of the inter-segmental plane using the "Combined Dimensional Reduction Method" is safe and viable in uniport video-assisted thoracoscopic pulmonary segmentectomy. Transl Lung Cancer Res 2019; 8:658-666. [PMID: 31737501 DOI: 10.21037/tlcr.2019.09.12] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The management of the intersegmental plane (ISP) is challenging during uniport video-assisted thoracoscopic (VATS) pulmonary segmentectomy. Staplers and electrocautery have been used extensively in ISP management. However, both of them have their respective drawbacks. Currently, we have provided a revised technique termed as "Combined Dimensional Reduction Method" (CDR method), for managing the ISP with combined application of ultrasonic scalpel and staplers. The study aimed to review the outcomes of patients who underwent uniport VATS segmentectomy with or without the CDR method in our institute and assess the feasibility and safety of the CDR method. Methods From March 2017 to February 2018, 220 patients who underwent uniport VATS segmentectomy were retrospectively reviewed. By using IQQA software, pulmonary structures were reconstructed as three-dimensional (3D) images, making the targeted structures could be identified preoperatively. For the management of the ISP, in the CDR group, we firstly used the ultrasonic scalpel to trim the 3D pulmonary structure along the intersegmental demarcation, making the remaining targeted parenchyma both sufficiently thin enough and located on a 2D plane; thus, enabling easy use of staplers in managing ISP. Whereas, in the non-CDR group, we only use the staplers to manage the ISPs. The clinical characteristics, complications, and postoperative pulmonary functions were compared between the two groups. Results Propensity score analysis generated 2 well-matched pairs of 71 patients in CDR and non-CDR groups. There was no 30-day postoperative death or readmission in either group. The CDR group was significantly associated with the shorter operative time (178.3±35.8 vs. 209.2±28.7 min) (P=0.031) and postoperative stay (4.5±2.3 vs. 5.7±4.2 days) (P=0.041), compared to the non-CDR group. Moreover, no significant difference was observed in blood loss, a period of chest tube drainage, a period of ultrafine tube drainage, and postoperative pulmonary complications between the two groups. Moreover, the recovery rate of postoperative forced expiratory volume in 1 second (FEV1) or vital capacity (VC) at 1 and 3 months after segmentectomy was comparable between them. Conclusions The CDR method could make segmentectomy easier and more accurate, and therefore has the potential to be a viable and effective technique for uniport VATS pulmonary segmentectomy.
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Affiliation(s)
- Bin Zheng
- Thoracic Department, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Guobing Xu
- Thoracic Department, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Xiayu Fu
- Thoracic Department, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Weidong Wu
- Thoracic Department, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Mingqiang Liang
- Thoracic Department, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Taidui Zeng
- Thoracic Department, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Shuliang Zhang
- Thoracic Department, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Yong Zhu
- Thoracic Department, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Wei Zheng
- Thoracic Department, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Chun Chen
- Thoracic Department, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Benoît Bédat
- Thoracic and Endocrine Unit, University Hospitals of Geneva, Geneva, Switzerland
| | - Scott J Swanson
- Division of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Terumoto Koike
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hisashi Iwata
- Department of General Thoracic Surgery, Center of Respiratory Disease, Gifu University Hospital, Gifu, Japan
| | | | - Masaaki Sato
- Department of Thoracic Surgery, The University of Tokyo Hospital, Bunkyo, Tokyo, Japan
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The impact of surgical chest wall damage caused by classic thoracotomy on pulmonary function and morphology. Gen Thorac Cardiovasc Surg 2019; 68:508-515. [PMID: 31728835 DOI: 10.1007/s11748-019-01250-z] [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] [Received: 09/11/2019] [Accepted: 11/06/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Postoperative changes in pulmonary function (PF) and morphology due to surgical chest wall damage by thoracotomy with rib resection are unclear. Therefore, we evaluated the effects of surgical damage on PF and morphology at > 6 months postoperatively by comparing different lung lobectomy approaches. METHODS A total of 140 patients who underwent lobectomy for lung diseases between January 2006 and March 2016 were analyzed. Patients who underwent PF tests and computed tomography (CT) scans preoperatively and postoperatively were divided into posterolateral thoracotomy with one rib resection (PT) group and video-assisted thoracoscopic surgery (VATS) group. A 1:1 propensity score-matched (PSM) analysis was used to balance clinically important confounders between the groups. Regarding morphology, lung volume was measured semi-automatically using image analysis software and reconstructed three-dimensional (3D) images. RESULTS After PSM, 31 patients in each group were compared. Perioperative reduction ratios in forced vital capacity (FVC) (- 23% vs. - 13%; P = 0.006) and forced expiratory volume in 1 s (FEV1) (- 19% vs. - 12%; P = 0.02) were significantly larger for the PT group. No significant differences in lung volume values based on 3D CT volumetry (PT vs. VATS; total lung volume: - 7.9% vs. - 7.2%, P = 0.82; non-resected ipsilateral lung volume: + 36% vs. + 40%, P = 0.69; contralateral lung volume: + 9.3% vs. + 9.4%, P = 0.98) were found in either group. CONCLUSIONS Among the patients underwent lobectomy, classic thoracotomy decreased PF by an additional FVC loss of 10% and FEV1 loss of 7% compared with VATS, without affecting residual lung volume.
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Oswald NK, Halle-Smith J, Mehdi R, Nightingale P, Naidu B, Turner AM. Predicting Postoperative Lung Function Following Lung Cancer Resection: A Systematic Review and Meta-analysis. EClinicalMedicine 2019; 15:7-13. [PMID: 31709409 PMCID: PMC6833443 DOI: 10.1016/j.eclinm.2019.08.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/19/2019] [Accepted: 08/21/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Lung resection remains the gold standard treatment for early stage lung cancer; prediction of postoperative lung function is a key selection criterion for surgery with the aim of determining risk of postoperative dyspnoea. We aimed to identify the different prediction techniques used, and compare their accuracy. METHODS A systematic review and meta-analysis sought to synthesise studies conducted that assess prediction of postoperative lung function up to 18/02/2018 (n = 135). PROBAST was used to assess risk of bias in studies, 17 studies were judged to be at low risk of bias. FINDINGS Meta-analysis revealed CT volume and density measurement to be the most accurate (mean difference 71 ml) and precise (standard deviation 207 ml) of the reported techniques used for predicting FEV1; evidence for predicting gas transfer was lacking. INTERPRETATION The evidence suggests using CT volume and density is the preferred technique in the prediction of postoperative FEV1. Further studies are required to ensure that the methods and thresholds we propose are linked to patient reported outcomes. FUNDING Salary support for NKO, RM, PN, BN, and AMT was provided by University Hospitals Birmingham NHS Foundation Trust.
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Affiliation(s)
- Nicola K. Oswald
- Institute of Inflammation and Ageing, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom of Great Britain and Northern Ireland
| | - James Halle-Smith
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom of Great Britain and Northern Ireland
| | - Rana Mehdi
- Department of Thoracic Surgery, Heartlands Hospital, Bordesley Green East, Birmingham B9 5SS, United Kingdom of Great Britain and Northern Ireland
| | - Peter Nightingale
- Institute of Translational Medicine, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham B15 2TH, United Kingdom of Great Britain and Northern Ireland
| | - Babu Naidu
- Institute of Inflammation and Ageing, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom of Great Britain and Northern Ireland
- Corresponding author at: Institute of Inflammation and Ageing, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom of Great Britain and Northern Ireland.
| | - Alice M. Turner
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom of Great Britain and Northern Ireland
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21
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Denlinger CE. Commentary: Two chests are better than one. J Thorac Cardiovasc Surg 2019; 158:1718-1719. [PMID: 31519415 DOI: 10.1016/j.jtcvs.2019.07.063] [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: 07/21/2019] [Accepted: 07/22/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Chadrick E Denlinger
- Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC.
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22
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Deguchi H, Tomoyasu M, Shigeeda W, Kaneko Y, Kanno H, Saito H. Influence of prophylactic antibiotic duration on postoperative pneumonia following pulmonary lobectomy for non-small cell lung cancer. J Thorac Dis 2019; 11:1155-1164. [PMID: 31179057 DOI: 10.21037/jtd.2019.04.43] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Although postoperative pneumonia after radical surgery for non-small cell lung cancer (NSCLC) carries a mortality risk, the duration of postoperative prophylactic antibiotics against pneumonia has not been elucidated. This study aimed to evaluate the influence of the duration of prophylactic antibiotics on postoperative pneumonia following radical surgery for NSCLC in patients who received antibiotics intraoperatively (short period) and in those who received antibiotics both intraoperatively and postoperatively (long period). Methods A total of 477 patients who underwent radical lobectomy for NSCLC were analyzed retrospectively. Propensity score analysis generated two matched pairs of 152 patients in both the short and long period groups. Results After propensity score matching, the incidence of postoperative pneumonia following pulmonary lobectomy was significantly less in the long period group than in the short period group (3.9% vs. 16.4%, P<0.001). On logistic regression analysis, short period of prophylactic antibiotic administration was the independent risk factor for postoperative pneumonia (odds ratio: 6.82, P<0.001). Conclusions Prophylactic antibiotic administration in both the intraoperative and postoperative periods reduced the incidence of pneumonia after pulmonary lobectomy for NSCLC.
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Affiliation(s)
- Hiroyuki Deguchi
- Department of Thoracic Surgery, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Makoto Tomoyasu
- Department of Thoracic Surgery, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Wataru Shigeeda
- Department of Thoracic Surgery, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Yuka Kaneko
- Department of Thoracic Surgery, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Hironaga Kanno
- Department of Thoracic Surgery, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Hajime Saito
- Department of Thoracic Surgery, School of Medicine, Iwate Medical University, Iwate, Japan
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Impact of induction chemoradiotherapy on pulmonary function after lobectomy for lung cancer. J Thorac Cardiovasc Surg 2018; 155:2129-2137.e1. [DOI: 10.1016/j.jtcvs.2017.12.081] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 12/11/2017] [Accepted: 12/16/2017] [Indexed: 11/21/2022]
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Nomori H, Shiraishi A, Cong Y, Sugimura H, Mishima S. Differences in postoperative changes in pulmonary functions following segmentectomy compared with lobectomy. Eur J Cardiothorac Surg 2017; 53:640-647. [DOI: 10.1093/ejcts/ezx357] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 09/02/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Hiroaki Nomori
- Department of General Thoracic Surgery, Kameda Medical Center, Chiba, Japan
| | - Atsushi Shiraishi
- Department of Emergency and Trauma Center, Kameda Medical Center, Chiba, Japan
| | - Yue Cong
- Department of General Thoracic Surgery, Kameda Medical Center, Chiba, Japan
| | - Hiroshi Sugimura
- Department of General Thoracic Surgery, Kameda Medical Center, Chiba, Japan
| | - Shuji Mishima
- Department of General Thoracic Surgery, Kameda Medical Center, Chiba, Japan
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Saito H, Hatakeyama K, Konno H, Matsunaga T, Shimada Y, Minamiya Y. Impact of pulmonary rehabilitation on postoperative complications in patients with lung cancer and chronic obstructive pulmonary disease. Thorac Cancer 2017; 8:451-460. [PMID: 28696575 PMCID: PMC5582456 DOI: 10.1111/1759-7714.12466] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 05/25/2017] [Accepted: 06/01/2017] [Indexed: 12/24/2022] Open
Abstract
Background Given the extent of the surgical indications for pulmonary lobectomy in breathless patients, preoperative care and evaluation of pulmonary function are increasingly necessary. The aim of this study was to assess the contribution of preoperative pulmonary rehabilitation (PR) for reducing the incidence of postoperative pulmonary complications in non‐small cell lung cancer (NSCLC) patients with chronic obstructive pulmonary disease (COPD). Methods The records of 116 patients with COPD, including 51 patients who received PR, were retrospectively analyzed. Pulmonary function testing, including slow vital capacity (VC) and forced expiratory volume in one second (FEV1), was obtained preoperatively, after PR, and at one and six months postoperatively. The recovery rate of postoperative pulmonary function was standardized for functional loss associated with the different resected lung volumes. Propensity score analysis generated matched pairs of 31 patients divided into PR and non‐PR groups. Results The PR period was 18.7 ± 12.7 days in COPD patients. Preoperative pulmonary function was significantly improved after PR (VC 5.3%, FEV1 5.5%; P < 0.05). The FEV1 recovery rate one month after surgery was significantly better in the PR (101.6%; P < 0.001) than in the non‐PR group (93.9%). In logistic regression analysis, predicted postoperative FEV1, predicted postoperative %FEV1, and PR were independent factors related to postoperative pulmonary complications after pulmonary lobectomy (odds ratio 18.9, 16.1, and 13.9, respectively; P < 0.05). Conclusions PR improved the recovery rate of pulmonary function after lobectomy in the early period, and may decrease postoperative pulmonary complications.
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Affiliation(s)
- Hajime Saito
- Department of Thoracic Surgery, Akita University School of Medicine, Akita, Japan
| | | | - Hayato Konno
- Department of Thoracic Surgery, Akita University School of Medicine, Akita, Japan
| | | | - Yoichi Shimada
- Department of Orthopedic Surgery, Akita University School of Medicine, Akita, Japan
| | - Yoshihiro Minamiya
- Department of Thoracic Surgery, Akita University School of Medicine, Akita, Japan
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Karenovics W, Licker M, Ellenberger C, Christodoulou M, Diaper J, Bhatia C, Robert J, Bridevaux PO, Triponez F. Short-term preoperative exercise therapy does not improve long-term outcome after lung cancer surgery: a randomized controlled study†. Eur J Cardiothorac Surg 2017; 52:47-54. [DOI: 10.1093/ejcts/ezx030] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 12/18/2016] [Indexed: 11/13/2022] Open
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Management of Intersegmental Plane on Pulmonary Segmentectomy Concerning Postoperative Complications. Ann Thorac Surg 2017; 103:1773-1780. [PMID: 28366465 DOI: 10.1016/j.athoracsur.2017.01.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 12/21/2016] [Accepted: 01/03/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND For primary lung cancer, anatomic pulmonary segmentectomy may have a functional advantage over lobectomy; however, persistent air leak or delayed pneumothorax after segmentectomy is prevalent and increases surgical morbidity. To prevent pulmonary complications after pulmonary segmentectomy, we used 2 methods for the involved intersegmental plane: coverage using polyglycolic acid mesh and fibrin glue (mesh cover) or closing it by suturing the pleural edge (pleural suture). We aimed to compare postoperative pulmonary function and complications between the 2 groups. METHODS A total of 133 patients who underwent pulmonary segmentectomy for stage IA non-small cell lung cancer were analyzed retrospectively. A pulmonary function test, including vital capacity and forced expiratory volume in 1 second, was performed preoperatively and at 1 and 6 months postoperatively. Propensity score analysis generated 2 matched pairs of 46 patients in the pleural suture and mesh cover groups. RESULTS In each group, there was no significant difference in the recovery rate of vital capacity and forced expiratory volume in 1 second at 1 and 6 months postoperatively. Compared with the pleural suture group, the mesh cover group had higher incidence of prolonged air leak (8.7% versus 0%; p = 0.042), delayed pneumothorax (10.9% versus 2.2%; p = 0.051). On logistic regression analysis, management of intersegmental plane by either mesh cover or pleural suture was the only independent factor related to pulmonary complications (prolonged air leak or delayed pneumothorax) after pulmonary segmentectomy (odds ratio: 5.26, p = 0.047; odds ratio: 13.39, p = 0.018, respectively). CONCLUSIONS Pleural suturing of the involved intersegmental plane during pulmonary segmentectomy appeared to be an acceptable method to reduce postoperative pulmonary complications.
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Barskiy DA, Coffey AM, Nikolaou P, Mikhaylov DM, Goodson BM, Branca RT, Lu GJ, Shapiro MG, Telkki VV, Zhivonitko VV, Koptyug IV, Salnikov OG, Kovtunov KV, Bukhtiyarov VI, Rosen MS, Barlow MJ, Safavi S, Hall IP, Schröder L, Chekmenev EY. NMR Hyperpolarization Techniques of Gases. Chemistry 2017; 23:725-751. [PMID: 27711999 PMCID: PMC5462469 DOI: 10.1002/chem.201603884] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Indexed: 01/09/2023]
Abstract
Nuclear spin polarization can be significantly increased through the process of hyperpolarization, leading to an increase in the sensitivity of nuclear magnetic resonance (NMR) experiments by 4-8 orders of magnitude. Hyperpolarized gases, unlike liquids and solids, can often be readily separated and purified from the compounds used to mediate the hyperpolarization processes. These pure hyperpolarized gases enabled many novel MRI applications including the visualization of void spaces, imaging of lung function, and remote detection. Additionally, hyperpolarized gases can be dissolved in liquids and can be used as sensitive molecular probes and reporters. This Minireview covers the fundamentals of the preparation of hyperpolarized gases and focuses on selected applications of interest to biomedicine and materials science.
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Affiliation(s)
- Danila A Barskiy
- Department of Radiology, Department of Biomedical Engineering, Department of Physics, Vanderbilt-Ingram Cancer Center (VICC), Vanderbilt University Institute of Imaging Science (VUIIS), Vanderbilt University, Nashville, TN, 37232, USA
| | - Aaron M Coffey
- Department of Radiology, Department of Biomedical Engineering, Department of Physics, Vanderbilt-Ingram Cancer Center (VICC), Vanderbilt University Institute of Imaging Science (VUIIS), Vanderbilt University, Nashville, TN, 37232, USA
| | - Panayiotis Nikolaou
- Department of Radiology, Department of Biomedical Engineering, Department of Physics, Vanderbilt-Ingram Cancer Center (VICC), Vanderbilt University Institute of Imaging Science (VUIIS), Vanderbilt University, Nashville, TN, 37232, USA
| | | | - Boyd M Goodson
- Southern Illinois University, Department of Chemistry and Biochemistry, Materials Technology Center, Carbondale, IL, 62901, USA
| | - Rosa T Branca
- Department of Physics and Astronomy, Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - George J Lu
- Division of Chemistry and Chemical Engineering, California Institute of Technology, Pasadena, CA, 91125, USA
| | - Mikhail G Shapiro
- Division of Chemistry and Chemical Engineering, California Institute of Technology, Pasadena, CA, 91125, USA
| | | | - Vladimir V Zhivonitko
- International Tomography Center SB RAS, 630090, Novosibirsk, Russia
- Novosibirsk State University, Pirogova St. 2, 630090, Novosibirsk, Russia
| | - Igor V Koptyug
- International Tomography Center SB RAS, 630090, Novosibirsk, Russia
- Novosibirsk State University, Pirogova St. 2, 630090, Novosibirsk, Russia
| | - Oleg G Salnikov
- International Tomography Center SB RAS, 630090, Novosibirsk, Russia
- Novosibirsk State University, Pirogova St. 2, 630090, Novosibirsk, Russia
| | - Kirill V Kovtunov
- International Tomography Center SB RAS, 630090, Novosibirsk, Russia
- Novosibirsk State University, Pirogova St. 2, 630090, Novosibirsk, Russia
| | - Valerii I Bukhtiyarov
- Boreskov Institute of Catalysis SB RAS, 5 Acad. Lavrentiev Pr., 630090, Novosibirsk, Russia
| | - Matthew S Rosen
- MGH/A.A. Martinos Center for Biomedical Imaging, Boston, MA, 02129, USA
| | - Michael J Barlow
- Respiratory Medicine Department, Queen's Medical Centre, University of Nottingham Medical School, Nottingham, NG7 2UH, UK
| | - Shahideh Safavi
- Respiratory Medicine Department, Queen's Medical Centre, University of Nottingham Medical School, Nottingham, NG7 2UH, UK
| | - Ian P Hall
- Respiratory Medicine Department, Queen's Medical Centre, University of Nottingham Medical School, Nottingham, NG7 2UH, UK
| | - Leif Schröder
- Molecular Imaging, Department of Structural Biology, Leibniz-Institut für Molekulare Pharmakologie (FMP), 13125, Berlin, Germany
| | - Eduard Y Chekmenev
- Department of Radiology, Department of Biomedical Engineering, Department of Physics, Vanderbilt-Ingram Cancer Center (VICC), Vanderbilt University Institute of Imaging Science (VUIIS), Vanderbilt University, Nashville, TN, 37232, USA
- Russian Academy of Sciences, 119991, Moscow, Russia
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Systemic and regional pulmonary function after segmentectomy. J Thorac Cardiovasc Surg 2016; 152:747-53. [DOI: 10.1016/j.jtcvs.2016.05.059] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 05/17/2016] [Accepted: 05/31/2016] [Indexed: 11/18/2022]
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Predicting exercise capacity after lobectomy by single photon emission computed tomography and computed tomography. Gen Thorac Cardiovasc Surg 2016; 64:537-42. [PMID: 27256350 DOI: 10.1007/s11748-016-0670-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 05/26/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES This study compared the prediction of postoperative exercise capacity by employing lung perfusion scintigraphy images obtained with single photon emission computed tomography together with computed tomography (SPECT/CT) versus the common method of counting subsegments (SC method). METHODS In 18 patients scheduled for lobectomy, predicted postoperative maximum oxygen uptake per kilogram body weight ([Formula: see text]) was calculated by the SPECT/CT and SC methods. Correlations were examined between the [Formula: see text] predicted by SPECT/CT or the SC method, and the actual [Formula: see text] measured at 2 weeks (mean 15.4 ± 1.5 days) and 1 month (mean 29.1 ± 0.75 days) after surgery to determine whether SPECT/CT was more accurate than SC for predicting postoperative exercise capacity. RESULTS There was a significant positive correlation between the [Formula: see text] predicted by SPECT/CT and the actual value at 2 weeks (r = 0.802, p < 0.0001) or 1 month (r = 0.770, p < 0.0001). There was also a significant positive correlation between the [Formula: see text] predicted by SC and the actual value at 2 weeks (r = 0.785, p < 0.0001) or 1 month (r = 0.784, p < 0.0001). CONCLUSIONS This study showed that both SPECT/CT and the SC method were useful for predicting postoperative [Formula: see text] in the clinical setting.
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Kent MS, Mandrekar SJ, Landreneau R, Nichols F, DiPetrillo TA, Meyers B, Heron DE, Jones DR, Tan AD, Starnes S, Putnam JB, Fernando HC. Impact of Sublobar Resection on Pulmonary Function: Long-Term Results from American College of Surgeons Oncology Group Z4032 (Alliance). Ann Thorac Surg 2016; 102:230-8. [PMID: 27101728 DOI: 10.1016/j.athoracsur.2016.01.069] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 01/04/2016] [Accepted: 01/06/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND Sublobar resection (SR) in high-risk operable patients may result in a long-term decrease in pulmonary function. We previously reported 3-month pulmonary function outcomes from a randomized phase III study of SR alone compared with SR with brachytherapy in patients with non-small cell lung cancer. We now report long-term pulmonary function after SR. METHODS Pulmonary function was measured at baseline and at 3, 12, and 24 months. A decline of 10% or more from baseline in the percentage predicted forced expiratory volume of 1 percentage or in the diffusion capacity of the lung for carbon monoxide was considered clinically meaningful. The effect of study arm, tumor location, size, approach (video-assisted thoracoscopic surgery vs thoracotomy), and SR type (wedge vs segmentectomy) on pulmonary function was assessed using a Wilcoxon rank sum test. A generalized estimating equation model was used to assess the effect of each factor on longitudinal data, including all four time points. RESULTS Complete pulmonary function data at all time points was available in 69 patients. No significant differences were observed in pulmonary function between SR and SR with brachytherapy, thus the study arms were combined for all analyses. A decline of 10% or more (p = 0.02) in the percentage predicted forced expiratory volume in 1 second was demonstrated for lower-lobe resections at 3 months but was not at 12 or 24 months. A decline of 10% or more (p = 0.05) in the percentage predicted diffusion capacity of the lung for carbon monoxide was seen for thoracotomy at 3 months but was not at 12 or 24 months. CONCLUSIONS Clinically meaningful declines in pulmonary function occurred after lower lobe resection and after thoracotomy at 3 months but subsequently recovered. This study suggests that SR does not result in sustained decreased pulmonary function in high-risk operable patients.
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Affiliation(s)
- Michael S Kent
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
| | - Sumithra J Mandrekar
- Department of Health Sciences Research, Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota
| | - Rodney Landreneau
- Department of Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | | | - Thomas A DiPetrillo
- Department of Radiation Oncology, Rhode Island Hospital, Providence, Rhode Island
| | - Bryan Meyers
- Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Dwight E Heron
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - David R Jones
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Angelina D Tan
- Department of Health Sciences Research, Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota
| | - Sandra Starnes
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Joe B Putnam
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Hiran C Fernando
- Department of Surgery, Boston Medical Center, Boston, Massachusetts
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Mizobuchi T, Yamamoto N, Nakajima M, Baba M, Miyoshi K, Nakayama H, Watanabe SI, Katoh R, Kohno T, Kamiyoshihara M, Nishio W, Kamada T, Fujisawa T, Yoshino I. Salvage surgery for local recurrence after carbon ion radiotherapy for patients with lung cancer. Eur J Cardiothorac Surg 2015; 49:1503-9. [PMID: 26468271 DOI: 10.1093/ejcts/ezv348] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 09/03/2015] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Carbon ion radiotherapy (CIRT) has been expected to be an alternative for surgery for early-stage non-small-cell lung cancer (NSCLC) and adopted as the second-best choice even in operable patients although local recurrence after CIRT is sometimes experienced. The purpose of this study was to investigate the demographic data, perioperative courses and therapeutic outcomes of patients who underwent salvage resection for local recurrence after CIRT. METHODS From November 1994 to February 2012, CIRT was applied for 602 c-T1/T2/T3N0M0 NSCLC lesions of 599 patients at the National Institute of Radiological Science. A total of 95 (16%) patients were diagnosed as having local recurrence, of whom 12 underwent salvage surgeries. The medical records were retrospectively reviewed. RESULTS There were 7 men and 5 women (mean age, 63 ± 7.4 years). The clinical stages upon initial presentation with NSCLC were as follows: 4 IA, 7 IB and 1 IIB. All the patients were operable, but refused surgery and underwent CIRT. The median progression-free survival time after CIRT was 20 months (range, 7.1-77 months), and salvage surgery was performed at a median of 24 months (range, 9-78 months) after CIRT. All surgeries were successfully performed without any significant CIRT-related adhesions during the surgery, resulting in no mortality or Clavien-Dindo grade 3-4 postoperative complications. However, the distribution of pathological stages was as follows: 4 IA, 3 IB, 2 IIB, 2 IIIA and 1 IV, which included 6 upstages from the clinical stages before CIRT. The Kaplan-Meier estimate of overall survival after the salvage surgery showed that the 3-year survival rate was 82%. CONCLUSIONS The dose intensity of CIRT spared the hilum of the lungs and parietal pleura, none of the patients developed adhesions outside of the radiation field, such that the salvage surgeries for local recurrence after CIRT were safe and feasible.
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Affiliation(s)
- Teruaki Mizobuchi
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan Pneumothorax Research Center and Thoracic Surgery Division, Nissan Tamagawa Hospital, Tokyo, Japan
| | - Naoyoshi Yamamoto
- Research Center for Charged Particle Therapy, National Institute of Radiological Science, Chiba, Japan
| | - Mio Nakajima
- Research Center for Charged Particle Therapy, National Institute of Radiological Science, Chiba, Japan
| | - Masayuki Baba
- Research Center for Charged Particle Therapy, National Institute of Radiological Science, Chiba, Japan
| | - Kentaro Miyoshi
- Department of Thoracic Surgery, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Haruhiko Nakayama
- Department of Thoracic Surgery, Kanagawa Cancer Center Hospital, Yokohama, Japan
| | - Syun-Ichi Watanabe
- Division of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Ryoichi Katoh
- Department of Pulmonology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
| | - Tadasu Kohno
- Department of Thoracic Surgery, Respiratory Center, Toranomon Hospital, Tokyo, Japan
| | | | - Wataru Nishio
- Department of Thoracic Surgery, Hyogo Cancer Center, Akashi, Japan
| | - Tadashi Kamada
- Research Center for Charged Particle Therapy, National Institute of Radiological Science, Chiba, Japan
| | - Takehiko Fujisawa
- Research Chiba Foundations for Health Promotion and Disease Prevention Center, Chiba, Japan
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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Eslick EM, Bailey DL, Harris B, Kipritidis J, Stevens M, Li BT, Bailey E, Gradinscak D, Pollock S, Htun C, Turner R, Eade T, Aslani A, Snowdon G, Keall PJ. Measurement of preoperative lobar lung function with computed tomography ventilation imaging: progress towards rapid stratification of lung cancer lobectomy patients with abnormal lung function. Eur J Cardiothorac Surg 2015; 49:1075-82. [PMID: 26248634 DOI: 10.1093/ejcts/ezv276] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 07/06/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES In lung cancer preoperative evaluation, functional lung imaging is commonly used to assess lobar function. Computed tomography ventilation (CT-V) imaging is an emerging lung function imaging modality. We compared CT-V imaging assessment of lobar function and its prediction of postoperative lung function to that achieved by (i) positron emission tomography ventilation (PET-V) imaging and (ii) the standard anatomical segment counting (ASC) method. We hypothesized (i) that CT-V and PET-V have similar relative lobar function and (ii) that functional imaging and anatomic assessment (ASC) yield different predicted postoperative (ppo) lung function and therefore could change clinical management. METHODS In this proof-of-concept study, 11 patients were subjected to pulmonary function tests, CT-V and PET-V imaging. The Bland-Altman plot, Pearson's correlation and linear regression analysis were used to assess the agreement between the CT-V-, PET-V- and ASC-based quantification of lobar function and in the ppo lung function. RESULTS CT-V and PET-V imaging demonstrated strong correlations in quantifying relative lobar function (r = 0.96; P < 0.001). A Wilcoxon-signed rank test showed no significant difference in the lobar function estimates between the two imaging modalities (P = 0.83). The Bland-Altman plot also showed no significant differences. The correlation between ASC-based lobar function estimates with ventilation imaging was low, r < 0.45; however, the predictions of postoperative lung function correlated strongly between all three methods. CONCLUSIONS The assessment of lobar function from CT-V imaging correlated strongly with PET-V imaging, but had low correlations with ASC. CT-V imaging may be a useful alternative method in preoperative evaluation for lung cancer patients.
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Affiliation(s)
- Enid M Eslick
- Radiation Physics Laboratory, Sydney Medical School - Central, University of Sydney, Sydney, NSW, Australia
| | - Dale L Bailey
- Sydney Medical School - Northern, University of Sydney, St Leonards, NSW, Australia Department of Nuclear Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Benjamin Harris
- Sydney Medical School - Northern, University of Sydney, St Leonards, NSW, Australia Department of Sleep and Respiratory Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - John Kipritidis
- Radiation Physics Laboratory, Sydney Medical School - Central, University of Sydney, Sydney, NSW, Australia
| | - Mark Stevens
- Sydney Medical School - Northern, University of Sydney, St Leonards, NSW, Australia Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Bob T Li
- Sydney Medical School - Northern, University of Sydney, St Leonards, NSW, Australia Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Elizabeth Bailey
- Department of Nuclear Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Denis Gradinscak
- Department of Nuclear Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Sean Pollock
- Radiation Physics Laboratory, Sydney Medical School - Central, University of Sydney, Sydney, NSW, Australia
| | - Chris Htun
- Department of Sleep and Respiratory Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Robin Turner
- School of Public Health and Community Medicine, University of New South Wales, Kensington, NSW, Australia
| | - Thomas Eade
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Ali Aslani
- Department of Nuclear Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Graeme Snowdon
- Department of Nuclear Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Paul J Keall
- Radiation Physics Laboratory, Sydney Medical School - Central, University of Sydney, Sydney, NSW, Australia
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Drakou E, Kanakis MA, Papadimitriou L, Iacovidou N, Vrachnis N, Nicolouzos S, Loukas C, Lioulias A. Changes in Simple Spirometric Parameters After Lobectomy for Bronchial Carcinoma. J Cardiovasc Thorac Res 2015; 7:68-71. [PMID: 26191395 PMCID: PMC4492181 DOI: 10.15171/jcvtr.2015.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Accepted: 05/25/2015] [Indexed: 11/19/2022] Open
Abstract
Introduction: The purpose of this study was to describe the postoperative changes in lung function after pure open lobectomy for lung carcinoma.
Methods: 30 patients (mean age 64 ± 7 years old, 16 men and 14 women) underwent a left or right lobectomy. They underwent spirometric pulmonary tests preoperatively, and at 1 and 6 months after the operation.
Results: The average preoperative forced expiratory volume in 1 second (FEV1) was 2.55±0.62lt and the mean postoperative FEV1 at 1 and 6 months was 1.97 ± 0.59 L and 2.15±0.66 L respectively. The percentage losses for FEV1 were 22.7% and 15.4% after 1 and 6 months respectively. An average percentage increase of 9.4% for FEV1 was estimated at the time of 6 months in comparison with this of 1 month after the operation. The average preoperative forced vital capacity (FVC) was 3.17 ± 0.81 L and the mean postoperative FVC at 1 and 6 months after the operation was 2.50 ± 0.63 L and 2.72 ± 0.67 L respectively. The percentage losses for FVC were 21.1% and 14.2% after 1 and 6 months respectively. An average percentage increase of 8.7% was observed at the time period of 6 months in comparison with this of 1 month after the operation.
Conclusion: Although, we observed a significant decrease in FEV1 and FVC after the operation, all patients were in excellent clinical status. FEV1 and FVC of 6 months were increased in comparison with the respective values of 1 month after the operation, but did not reach the preoperative values in any patient.
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Affiliation(s)
- Eleni Drakou
- Department of Thoracic Surgery, Sismanoglio General Hospital of Athens, Athens, Greece
| | - Meletios A Kanakis
- Department of Thoracic Surgery, Sismanoglio General Hospital of Athens, Athens, Greece
| | | | - Nicoletta Iacovidou
- Department of Neonatology, Aretaieio Hospital, School of Medicine, University of Athens, Athens, Greece
| | - Nikolaos Vrachnis
- 2nd Department of Obstetrics and Gynecology, Aretaieio Hospital, School of Medicine, University of Athens, Athens, Greece
| | - Stefanos Nicolouzos
- Department of Thoracic Surgery, Sismanoglio General Hospital of Athens, Athens, Greece
| | - Constantinos Loukas
- Medical Physics Laboratory, School of Medicine, University of Athens, Athens, Greece
| | - Achilleas Lioulias
- Department of Thoracic Surgery, Sismanoglio General Hospital of Athens, Athens, Greece
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Overstreet S, Parekh KR, Gross TJ. Cardiopulmonary exercise testing after laryngectomy: A connection conundrum. Respir Med Case Rep 2015; 16:11-4. [PMID: 26744642 PMCID: PMC4681887 DOI: 10.1016/j.rmcr.2015.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 06/08/2015] [Accepted: 06/10/2015] [Indexed: 11/15/2022] Open
Abstract
A patient presents with a new bronchogenic carcinoma 5 years after laryngectomy for recurrent laryngeal tumor and 13 years after chemoradiation for concurrent lung cancer with synchronous base-of-tongue tumor. Due to his complex history and perceived limited respiratory reserve, he was felt high risk for the completion pneumonectomy needed for resection of this new tumor. The attending surgeon requested a full cardiopulmonary exercise test for risk assessment prior to surgery. We found that there was no commercially available connector that would allow our CPET equipment to reliably collect respiratory gases from a patient with tracheostomy stoma or tube. We report here a simple coupling devised "in house" that allowed for the performance of an interpretable test leading to a significant change in medical care.
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Affiliation(s)
- Shana Overstreet
- Departments of Respiratory Care, Carver College of Medicine, University of Iowa Health Care, USA
| | - Kalpaj R Parekh
- Departments of Cardiothoracic Surgery, Carver College of Medicine, University of Iowa Health Care, USA
| | - Thomas J Gross
- Department of Internal Medicine, Division of Pulmonary & Critical Care, Carver College of Medicine, University of Iowa Health Care, USA
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Nagamatsu Y, Sueyoshi S, Tsubuku T, Kawasaki M, Akagi Y. Predicting postoperative exercise capacity after major lung resection. Surg Today 2015; 45:1501-8. [PMID: 25663072 DOI: 10.1007/s00595-015-1121-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 11/25/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE This study investigates whether postoperative exercise capacity can be predicted from preoperative lung perfusion scintigraphy and the number of subsegments resected. METHODS We studied 315 patients, with 158 being assigned odd numbers and 157 being assigned even numbers. In the 158 patients assigned odd numbers, the predicted postoperative VO2 max/m2 (ppo VO2 max/m2) was obtained from the results of lung perfusion scintigraphy and the number of subsegments scheduled for resection. We then examined correlations with the actual values, 2 weeks and 1 month postoperatively, to obtain a regression equation (Series 1). In the 157 patients assigned even numbers, the ppo VO2 max/m2 corrected by the regression equation derived from Series 1 (corrected-ppo VO2 max/m2) was compared with the actual values, 2 weeks and 1 month postoperatively, to establish whether the postoperative VO2 max/m2 could be predicted. RESULTS The regression equation between the ppo VO2 max/m2 and its actual value was y = 0.83x + 103, 2 weeks postoperatively, and y = 0.923x + 82, 1 month postoperatively. The difference between the corrected-ppo VO2 max/m2 and the actual postoperative value was small. CONCLUSIONS Calculating the residual [Formula: see text]o2 max/m2 preoperatively from the results of lung perfusion scintigraphy and the number of segments scheduled for resection is useful for predicting postoperative exercise capacity.
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Affiliation(s)
- Yoshinori Nagamatsu
- Department of Thoracic Surgery, Omuta City Hospital, 2-19-1 Takarazaka-machi, Omuta, Fukuoka, 836-8567, Japan.
| | - Susumu Sueyoshi
- Department of Surgery, Omuta City Hospital, Ohmuta, Fukuoka, Japan
| | - Tatsuji Tsubuku
- Department of Surgery, Omuta City Hospital, Ohmuta, Fukuoka, Japan
| | - Masayuki Kawasaki
- Department of Respiratory Medicine, National Hospital Organization Omuta National Hospital, Ohmuta, Fukuoka, Japan
| | - Yoshito Akagi
- Department of Surgery, School of Medicine, Kurume University, Kurume, Fukuoka, Japan
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Kitano M, Iwano S, Hashimoto N, Matsuo K, Hasegawa Y, Naganawa S. Lobar analysis of collapsibility indices to assess functional lung volumes in COPD patients. Int J Chron Obstruct Pulmon Dis 2014; 9:1347-56. [PMID: 25525352 PMCID: PMC4266257 DOI: 10.2147/copd.s72616] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background We investigated correlations between lung volume collapsibility indices and pulmonary function test (PFT) results and assessed lobar differences in chronic obstructive pulmonary disease (COPD) patients, using paired inspiratory and expiratory three dimensional (3D) computed tomography (CT) images. Methods We retrospectively assessed 28 COPD patients who underwent paired inspiratory and expiratory CT and PFT exams on the same day. A computer-aided diagnostic system calculated total lobar volume and emphysematous lobar volume (ELV). Normal lobar volume (NLV) was determined by subtracting ELV from total lobar volume, both for inspiratory phase (NLVI) and for expiratory phase (NLVE). We also determined lobar collapsibility indices: NLV collapsibility ratio (NLVCR) (%) = (1 − NLVE/NLVI) × 100%. Associations between lobar volumes and PFT results, and collapsibility indices and PFT results were determined by Pearson correlation analysis. Results NLVCR values were significantly correlated with PFT results. Forced expiratory volume in 1 second, measured as percent of predicted results (FEV1%P) was significantly correlated with NLVCR values for the lower lobes (P<0.01), whereas this correlation was not significant for the upper lobes (P=0.05). FEV1%P results were also moderately correlated with inspiratory, expiratory ELV (ELVI,E) for the lower lobes (P<0.05). In contrast, the ratio of the diffusion capacity for carbon monoxide to alveolar gas volume, measured as percent of predicted (DLCO/VA%P) results were strongly correlated with ELVI for the upper lobes (P<0.001), whereas this correlation with NLVCR values was weaker for upper lobes (P<0.01) and was not significant for the lower lobes (P=0.26). Conclusion FEV1%P results were correlated with NLV collapsibility indices for lower lobes, whereas DLCO/VA%P results were correlated with NLV collapsibility indices and ELV for upper lobes. Thus, evaluating lobar NLV collapsibility might be useful for estimating pulmonary function in COPD patients.
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Affiliation(s)
- Mariko Kitano
- Department of Radiology, Nagoya University, Nagoya, Aichi, Japan
| | - Shingo Iwano
- Department of Radiology, Nagoya University, Nagoya, Aichi, Japan
| | - Naozumi Hashimoto
- Department of Respiratory Medicine, Graduate School of Medicine, Nagoya University, Nagoya, Aichi, Japan
| | - Keiji Matsuo
- Department of Radiology, Ichinomiya Municipal Hospital, Ichinomiya, Aichi, Japan
| | - Yoshinori Hasegawa
- Department of Respiratory Medicine, Graduate School of Medicine, Nagoya University, Nagoya, Aichi, Japan
| | - Shinji Naganawa
- Department of Radiology, Nagoya University, Nagoya, Aichi, Japan
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Risk assessment of lung resection for lung cancer according to pulmonary function: republication of systematic review and proposals by guideline committee of the Japanese Association for Chest Surgery 2014. Gen Thorac Cardiovasc Surg 2014; 63:14-21. [DOI: 10.1007/s11748-014-0475-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Indexed: 12/25/2022]
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Cukic V. Reduction of pulmonary function after surgical lung resections of different volume. Med Arch 2014; 68:231-5. [PMID: 25568542 PMCID: PMC4240564 DOI: 10.5455/medarh.2014.68.231-235] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 06/25/2014] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION In recent years an increasing number of lung resections are being done because of the rising prevalence of lung cancer that occurs mainly in patients with limited lung function, what is caused with common etiologic factor - smoking cigarettes. OBJECTIVE To determine how big the loss of lung function is after surgical resection of lung of different range. METHODS The study was done on 58 patients operated at the Clinic for thoracic surgery KCU Sarajevo, previously treated at the Clinic for pulmonary diseases "Podhrastovi" in the period from 01.06.2012. to 01.06.2014. The following resections were done: pulmectomy (left, right), lobectomy (upper, lower: left and right). The values of postoperative pulmonary function were compared with preoperative ones. As a parameter of lung function we used FEV1 (forced expiratory volume in one second), and changes in FEV1 are expressed in liters and in percentage of the recorded preoperative and normal values of FEV1. Measurements of lung function were performed seven days before and 2 months after surgery. RESULTS Postoperative FEV1 was decreased compared to preoperative values. After pulmectomy the maximum reduction of FEV1 was 44%, and after lobectomy it was 22% of the preoperative values. CONCLUSION Patients with airway obstruction are limited in their daily life before the surgery, and an additional loss of lung tissue after resection contributes to their inability. Potential benefits of lung resection surgery should be balanced in relation to postoperative morbidity and mortality.
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Affiliation(s)
- Vesna Cukic
- Clinic for Pulmonary Diseases and TB "Podhrastovi", Clinical Centre of Sarajevo University, Bosnia and Herzegovina
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Burt BM, Kosinski AS, Shrager JB, Onaitis MW, Weigel T. Thoracoscopic lobectomy is associated with acceptable morbidity and mortality in patients with predicted postoperative forced expiratory volume in 1 second or diffusing capacity for carbon monoxide less than 40% of normal. J Thorac Cardiovasc Surg 2014; 148:19-28, dicussion 28-29.e1. [DOI: 10.1016/j.jtcvs.2014.03.007] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 03/04/2014] [Accepted: 03/10/2014] [Indexed: 12/25/2022]
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Improved prediction of lobar perfusion contribution using technetium-99m-labeled macroaggregate of albumin single photon emission computed tomography/computed tomography with attenuation correction. J Thorac Cardiovasc Surg 2014; 148:2345-52. [PMID: 24882061 DOI: 10.1016/j.jtcvs.2014.04.036] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 03/03/2014] [Accepted: 04/16/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Lung cancer resection can require removal of an entire lobe and, at times, bilobectomy or pneumonectomy. Many patients will also have significantly compromised lung function that requires limiting the extent of surgery or could preclude surgery altogether. The preoperative assessment should include predicted postoperative forced expiratory volume in 1 second (ppoFEV1), because a ppoFEV1 of <40% predicts significantly increased perioperative morbidity. The ppoFEV1 can be estimated by multiplying the preoperative FEV1 by the residual perfused territory percentage, as predicted on planar perfusion scintigraphy (PPS). However, ppoFEV1 using PPS has shown variable correlation with spirometry-measured postoperative FEV1. METHODS We propose an improved method for assessing regional lung perfusion in preoperative lung surgery patients. Patients undergo single photon emission computed tomography/computed tomography (SPECT/CT) imaging with attenuation correction using the conventional perfusion agent, technetium-99m-labeled macroaggregate of albumin. The CT image provides information for manual segmentation of each lobe. These segmentations are applied to the SPECT images to determine lobar perfusion. This proposed method was compared with PPS. RESULTS This technique was evaluated in 17 patients. As expected, the perfusion contributions of the right and left lungs, calculated from SPECT/CT, correlated closely with those obtained from PPS (Pearson r=0.995). However, the lobar perfusion contributions obtained by PPS and SPECT/CT were significantly different, by 2 methods of comparison (Hotelling's P=1.7×10(-6) and P=1.7×10(-4)). CONCLUSIONS This new SPECT/CT technique provides an anatomically more accurate assessment of lobar perfusion. This technique can refine which patients should be operative candidates and allow better prediction of postoperative function in contrast to the anatomically inaccurate planar scintigraphic predictions, which often underestimate the postoperative FEV1. This new technique is expected to have a significant effect on the resectability of patients with lung cancer.
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Pulmonary Function After Lobectomy Versus Segmentectomy in Patients with Stage I Non-Small Cell Lung Cancer. World J Surg 2014; 38:2025-31. [DOI: 10.1007/s00268-014-2521-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Mazzone PJ. Preoperative evaluation of the lung cancer resection candidate. Expert Rev Respir Med 2014; 4:97-113. [DOI: 10.1586/ers.09.68] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ayabe T, Tomita M, Chosa E, Kawagoe K, Nakamura K. Effect of Inhaled Tiotropium as the Perioperative Management of Patients Undergoing Pulmonary Resection for Primary Lung Cancer. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/jct.2014.59093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Berthet JP, Paradela M, Jimenez MJ, Molins L, Gómez-Caro A. Extended Sleeve Lobectomy: One More Step Toward Avoiding Pneumonectomy in Centrally Located Lung Cancer. Ann Thorac Surg 2013; 96:1988-97. [DOI: 10.1016/j.athoracsur.2013.07.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 06/12/2013] [Accepted: 07/01/2013] [Indexed: 11/30/2022]
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Outcomes of Lobectomy in Patients with Severely Compromised Lung Function (Predicted Postoperative Diffusing Capacity of the Lung for Carbon Monoxide % ≤ 40%). Ann Am Thorac Soc 2013; 10:616-21. [DOI: 10.1513/annalsats.201305-117oc] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Long-term pulmonary function after major lung resection. Gen Thorac Cardiovasc Surg 2013; 62:24-30. [DOI: 10.1007/s11748-013-0346-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Indexed: 11/26/2022]
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Mizobuchi T, Chen F, Yoshino I, Iwata T, Yoshida S, Bando T, Date H. Radiologic evaluation for volume and weight of remnant lung in living lung donors. J Thorac Cardiovasc Surg 2013; 146:1253-8. [DOI: 10.1016/j.jtcvs.2013.05.038] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 04/20/2013] [Accepted: 05/10/2013] [Indexed: 10/26/2022]
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Mizobuchi T, Wada H, Sakairi Y, Suzuki H, Nakajima T, Tagawa T, Iwata T, Motoori K, Yoshida S, Yoshino I. Spirometric and radiological evaluation of the remnant lung long after major pulmonary resection: can compensatory phenomena be recognized in clinical cases? Surg Today 2013; 44:1735-43. [DOI: 10.1007/s00595-013-0702-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 07/19/2013] [Indexed: 11/29/2022]
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Cukic V, Lovre V. Changes of arterial blood gases after different ranges of surgical lung resection. Mater Sociomed 2013; 24:165-70. [PMID: 23922525 PMCID: PMC3732354 DOI: 10.5455/msm.2012.24.165-170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 08/15/2012] [Indexed: 11/23/2022] Open
Abstract
Introduction: In recent years there has been increase in the number of patients who need thoracic surgery – first of all different types of pulmonary resection because of primary bronchial cancer, and very often among patients whose lung function is impaired due to different degree of bronchial obstruction so it is necessary to assess functional status before and after lung surgery to avoid the development of respiratory insufficiency. Objective: To show the changes in the level of arterial blood gases after various ranges of lung resection. Material and methods: The study was done on 71 patients surgically treated at the Clinic for Thoracic Surgery KCU Sarajevo, who were previously treated at the Clinic for Pulmonary Diseases “Podhrastovi” in the period from 01. 06. 2009. to 01. 09. 2011. Different types of lung resection were made. Patients whose percentage of ppoFEV1 was (prognosed postoperative FEV1) was less than 30% of normal values of FEV1 for that patients were not given a permission for lung resection. We monitored the changes in levels-partial pressures of blood gases (PaO2, PaCO2 and SaO2) one and two months after resection and compared them to preoperative values. As there were no significant differences between the values obtained one and two months after surgery, in the results we showed arterial blood gas analysis obtained two months after surgical resection. Results were statistically analyzed by SPSS and Microsoft Office Excel. Statistical significance was determined at an interval of 95%. Results: In 59 patients (83%) there was an increase, and in 12 patients (17%) there was a decrease of PaO2, compared to preoperative values. In 58 patients (82%) there was a decrease, and in 13 patients (18%) there was an increase in PaCO2, compared to preoperative values. For all subjects (group as whole): The value of the PaO2 was significantly increased after lung surgery compared to preoperative values (p <0.05) so is the value of the SaO2%. The value of the PaCO2 was significantly decreased after lung surgery compared to preoperative values (p <0.05). Respiratory insufficiency was developed in none of patients. Conclusion: If the % ppoFEV1 (% prognosed postoperative FEV1) is bigger than 30% of normal values of FEV1 (according to sex, weight, height, age) in patient planned for lung resection surgery there is no development of respiratory insufficiency after resection.
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Affiliation(s)
- Vesna Cukic
- Clinic for Pulmonary Diseases and TB "Podhrastovi", Clinical center of University of Sarajevo, Bosnia and Herzegovina
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