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Liang H, Che G, Cui F, Dong J, Gu W, Gu C, Xu S, Ba Y, Cai K, Cao Q, Chen C, Chen C, Chen Q, Cheng L, Feng G, Gou Y, Guo W, He J, He J, Hu J, Huang Y, Wang W, Jiao W, Jiang S, Liu J, Lan L, Li W, Li X, Li Z, Li Y, Liang Z, Liu H, Liu Y, Mei X, Song X, Sun D, Tian H, Tian Z, Wang J, Wang G, Xu X, Xiang X, Xu G, Xue T, Yang C, Yan X, Yang N, Yao F, Yin D, Yin X, Yu B, Zhai W, Zhang Y, Zhang G, Zhang X, Zhang Q, Zhang Y, Zhao J, Zhong H, Brunelli A, Ploenes T, Bertolaccini L, Tam JKC, Kim MP, Refai M, Gonzalez M, Dyas AR, Ardò NP, Fernando HC, Maurizi G, Kocher GJ, Marulli G, Fuentes-Martín Á, Perroni G, Kim KS, Rodriguez M, Taylor M, Zou X, Wang W, He J. Multidisciplinary international expert consensus on perioperative airway management. Transl Lung Cancer Res 2025; 14:1042-1060. [PMID: 40386733 PMCID: PMC12082217 DOI: 10.21037/tlcr-2025-273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2025] [Accepted: 04/11/2025] [Indexed: 05/20/2025]
Abstract
Background Perioperative airway management is critical for patient safety and optimal surgical outcomes. Effective airway management reduces postoperative pulmonary complications and accelerates recovery. This expert consensus aims to update the earlier consensus based on the latest research and emphasize aspects that were previously overlooked. Methods A comprehensive search up to June 2024 was performed. Earlier consensus documents were reviewed to ensure thorough coverage. A modified Delphi method involved 62 domestic experts from various surgical and anesthetic specialties who discussed and voted on preliminary recommendations in face-to-face meetings, requiring ≥70% agreement. Drafts were then reviewed by 18 international experts via email to incorporate diverse insights. Results Through the modified Delphi method, consensus was achieved with ≥70% agreement among the 62 domestic experts, ensuring that the preliminary recommendations were robust and widely supported. Additionally, feedback from the 18 international experts provided diverse insights that further refined and validated the recommendations. Recommendations were established for preoperative airway preparation, anesthesia management, surgical approach, postoperative airway management, and managing coexisting respiratory diseases. These recommendations update the perspectives of earlier consensus documents based on the latest research and emphasize non-intubated surgery, inhalation therapy, and individualized treatment for patients with coexisting pulmonary diseases. Conclusions This expert consensus provides a valuable reference for clinical practice. Further technological optimization and clinical research are needed to improve perioperative airway management.
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Affiliation(s)
- Hengrui Liang
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Fei Cui
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Junguo Dong
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Weiquan Gu
- Department of Thoracic Surgery, The First People’s Hospital of Foshan, Foshan, China
| | - Chundong Gu
- Department of Thoracic Surgery, the First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Shun Xu
- Department of Thoracic Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Yufeng Ba
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Kaican Cai
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qingdong Cao
- Department of Thoracic Surgery and Lung Transplantation, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Qixun Chen
- Department of Thoracic Oncological Surgery, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, China
| | - Liyang Cheng
- Department of General Surgery, the General Hospital of Southern Theater Command, People’s Liberation Army (PLA), Guangzhou, China
| | - Gang Feng
- Department of Thoracic Surgery, School of Medicine, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Yunjiu Gou
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Wenwei Guo
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Jinxi He
- Department of Thoracic Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Junming He
- Department of Hepatobiliary Surgery, Guangdong Province Traditional Chinese Medical Hospital, Guangzhou, China
| | - Jian Hu
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ying Huang
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Wenxi Wang
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Wenjie Jiao
- Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Shunjun Jiang
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Jun Liu
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Lan Lan
- Department of Anesthesia, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wei Li
- Department of Thoracic Surgery, Weifang People’s Hospital, Weifang, China
| | - Xiaofei Li
- Department of Thoracic Surgery, Xi’an International Medical Centre Hospital, Northwestern University, Xi’an, China
| | - Zhongcheng Li
- Department of Thoracic and Cardiovascular Surgery, Affiliated Hospital of Qinghai University, Xining, China
| | - Yin Li
- Section of Esophageal and Mediastinal Oncology, Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhu Liang
- Department of Cardiothoracic Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Hongxu Liu
- Department of Thoracic Surgery, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Yingbin Liu
- State Key Laboratory of Systems Medicine for Cancer, Shanghai Cancer Institute, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Biliary-Pancreatic Surgery, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xinyu Mei
- Department of Thoracic Surgery, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
| | - Xicheng Song
- Department of Otorhinolaryngology, Head and Neck Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Daqiang Sun
- Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin University, Tianjin, China
| | - Hui Tian
- Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Ziqiang Tian
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jianhua Wang
- Second Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, China
| | - Guangsuo Wang
- Department of Thoracic Surgery, The Second Clinical Medical College of Jinan University, Shenzhen People’s Hospital, Shenzhen, China
| | - Xin Xu
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Xudong Xiang
- No. 2 Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Guobing Xu
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Tao Xue
- Department of Cardiothoracic Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Chao Yang
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Xiaolong Yan
- Department of Thoracic Surgery, Tangdu Hospital, The Air Force Military Medical University, Xi’an, China
| | - Nuo Yang
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Feng Yao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dalong Yin
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Xiaochuan Yin
- Department of Thoracic Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Bentong Yu
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wei Zhai
- Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Zhang
- Department of Otolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, China
| | - Guangjian Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Xiaowen Zhang
- Department of Otolaryngology-Head and Neck Surgery, The Key Laboratory of Advanced Interdisciplinary Studies Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qiang Zhang
- Department of Thoracic Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Yi Zhang
- Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jun Zhao
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Haihui Zhong
- Department of Thoracic Surgery, Meizhou People’s Hospital, Meizhou, China
| | - Alessandro Brunelli
- Department of Thoracic Surgery, St. James’s University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Till Ploenes
- Division of Thoracic Surgery, Department of Visceral, Thoracic and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Department of Thoracic Surgery, Fachkrankenhaus Coswig, Coswig, Germany
| | - Luca Bertolaccini
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - John Kit Chung Tam
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiac, Thoracic, and Vascular Surgery, National University Heart Centre Singapore, Singapore, Singapore
| | - Min P. Kim
- Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Majed Refai
- Department of Thoracic Surgery, Ospedali Riuniti delle Marche, Ancona, Italy
| | - Michel Gonzalez
- Department of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Adam R. Dyas
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Nicoletta Pia Ardò
- Thoracic Surgery Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Hiran C. Fernando
- Department of Cardiothoracic Surgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Giulio Maurizi
- Division of Thoracic Surgery, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Gregor J. Kocher
- Department of Thoracic Surgery, Hirslanden Clinic Beau Site, Bern, Switzerland
| | - Giuseppe Marulli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Thoracic Surgery Unit-IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Álvaro Fuentes-Martín
- Thoracic Surgery Department, University Clinical Hospital of Valladolid, University of Valladolid, Valladolid, Spain
| | - Gianluca Perroni
- Division of Thoracic Surgery, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy
| | - Kyung Soo Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Maria Rodriguez
- Thoracic Surgery Department, Clínica Universidad de Navarra, Madrid, Spain
| | - Marcus Taylor
- Department of Cardiothoracic Surgery, Manchester University Hospital Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Xusen Zou
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Wei Wang
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Jianxing He
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
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Li LL, Wang L, Li HW, Chen H, Shi L, Wan LY, Song YZ. Utility of preoperative 18F-flurodeoxyglucose PET/CT scanning in preoperative evaluation and surgical planning for pulmonary tuberculosis. Nucl Med Commun 2025; 46:180-186. [PMID: 39774102 DOI: 10.1097/mnm.0000000000001930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2025]
Abstract
OBJECTIVE The objective of this study was to investigate the utility of preoperative 18F-FDG PET/CT scanning in preoperative evaluation and surgical planning for pulmonary tuberculosis. METHODS The study involved a retrospective analysis of clinical data and preoperative chest 18F-FDG PET/CT data of 24 patients with pulmonary tuberculosis who underwent pneumonectomy at the Shanghai Public Health Clinical Center between December 2017 and January 2022. RESULTS All 24 patients successfully underwent chest 18F-FDG PET/CT imaging, and complete data pertaining to the maximum standardized uptake value, mean standardized uptake value, minimum standardized uptake value, total lesion glycolysis, and metabolic tumor volume were obtained. Surgical excision plans were finalized using the chest 18F-FDG PET/CT findings along with the conventional chest CT scans. Pneumonectomy was successfully completed in all 24 patients, and these included 13 cases of pulmonary lobectomy, two cases of total pneumonectomy, one case of combined pulmonary lobectomy, one case of segmentectomy, and seven cases of pulmonary wedge resection. The actual surgical procedures had a conformity rate of 100% to the preoperative surgical plans that were made. The intraoperative bronchial stump embedding rate was 69% (11/18 cases), the incidence rate of postoperative air leakage was 3.8% (1/24 cases), and there were no reported cases of postoperative bronchopleural fistula or death. CONCLUSION Preoperative 18F-FDG PET/CT scans had significant utility in surgical planning, the selection of surgical methods, and the formulation of postoperative antituberculosis treatment courses for patients with pulmonary tuberculosis. The use of 18F-FDG PET/CT shows considerable promise in being promoted clinically for the surgical management of patients with pulmonary tuberculosis.
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Affiliation(s)
- Lei-Lei Li
- Department of Thoracic Surgery, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
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Liu Z, Ran H, Yu X, Wu Q, Zhang C. Immunocyte count combined with CT features for distinguishing pulmonary tuberculoma from malignancy among non-calcified solitary pulmonary solid nodules. J Thorac Dis 2023; 15:386-398. [PMID: 36910060 PMCID: PMC9992615 DOI: 10.21037/jtd-22-1024] [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: 07/25/2022] [Accepted: 12/02/2022] [Indexed: 02/04/2023]
Abstract
Background Tuberculoma is the most common type of surgically removed benign solid solitary pulmonary nodule (SPN) and can lead to a high risk of misdiagnoses for clinicians. This study aimed to discuss the value of the immunocyte count combined with computed tomography (CT) features in distinguishing pulmonary tuberculoma from malignancy among non-calcified solid SPNs. Methods Forty-eight patients with pulmonary tuberculoma and 52 patients with lung cancer were retrospectively included in our study. Univariate and multivariate analyses were conducted to screen the independent predictors. Receiver operating characteristic (ROC) analysis was performed to investigate the validity of the predictive model. Results The univariate and multivariate analyses revealed that a coarse margin, vacuole, lobulation, pleural indentation, cluster of differentiation (CD)3+ T-lymphocyte count, and CD4+ T-lymphocyte count were independent predictors for distinguishing pulmonary tuberculoma from malignancy. The sensitivity, specificity, accuracy, and the area under the ROC curve of the model comprising the CD3+ T-lymphocyte count were 79.2%, 75%, 74.5%, and 0.845 [95% confidence interval (CI), 0.759-0.910], respectively, and those of the model involving the CD4+ T-lymphocyte count were 77.1%, 78.8%, 77.1%, and 0.857 (95% CI, 0.773-0.919), respectively. Conclusions Immunocyte count combined with CT features is efficient in distinguishing pulmonary tuberculoma from malignancy among non-calcified solid SPNs and has applicable clinical value.
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Affiliation(s)
- Zihao Liu
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Haoyu Ran
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiran Yu
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qingchen Wu
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Cheng Zhang
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Xu G, Du J, Zhang J, Chen H, Zheng B, Yang Z, Chen C. A propensity sore-matched study: Applying a modified chest tube drainage strategy in rapid rehabilitation following uni-portal thoracoscopic pulmonary wedge resection. Thorac Cancer 2022; 13:1657-1663. [PMID: 35481947 PMCID: PMC9161322 DOI: 10.1111/1759-7714.14438] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 12/01/2022] Open
Abstract
PURPOSE This study aimed to compare the value of a modified chest tube drainage strategy to a traditional drainage strategy in single-port thoracoscopic pulmonary wedge resection. METHODS From January 2019 to July 2021, we collected clinical data on 405 patients who underwent single-port thoracoscopic pulmonary wedge resection in the No.1 Department of Thoracic Surgery at Fujian Medical University Union Hospital, with 121 (29.9%) cases in the modified drainage strategy group and 284 (70.1%) cases in the traditional drainage strategy group. The propensity score matching method (Match Ratio = 1:1) was used to reduce differences in clinical characteristics between the two groups. RESULTS Following 1:1 propensity score matching, 120 matched pairs (240 patients) were included in the study. There was no significant difference in general clinical characteristics between the two groups. There was no statistical difference in intraoperative factors except for operative times (71.42 ± 22.98 min vs. 86.80 ± 36.75 min, p < 0.001). In terms of postoperative factors, there were significant differences in postoperative chest tube duration (0.00 ± 0.00 h vs. 32.68 ± 18.51 h, p < 0.001), total drainage volume (143.03 ± 118.33 ml vs. 187.73 ± 140.82 ml, p = 0.008), postoperative hospital stay (2.61 ± 0.70 days vs. 3.27 ± 1.88 days, p < 0.001), number of additional pain relief (0.14 ± 0.40 vs. 0.42 ± 0.74, p < 0.001), facial pain score (2.7 ± 1.8 vs. 3.6 ± 2.7, p = 0.005) and adverse events (p = 0.046). Furthermore, there was a statistical difference between the two groups regarding CTCAE grade-1 complication, but no statistical difference in CTCAE grade-2 complication. CONCLUSIONS A modified drainage strategy in single-port thoracoscopic pulmonary wedge resection is safe and feasible, allowing for less postoperative rehabilitation time, pain relief, reduced postoperative pleural effusion, and reduced clinical workload.
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Affiliation(s)
- Guobing Xu
- Department of Thoracic SurgeryFujian Medical University Union HospitalFuzhouChina
- Key Laboratory of Cardio‐Thoracic Surgery (Fujian Medical University)Fujian Province UniversityFuzhouChina
| | - Jianting Du
- Department of Thoracic SurgeryFujian Medical University Union HospitalFuzhouChina
- Key Laboratory of Cardio‐Thoracic Surgery (Fujian Medical University)Fujian Province UniversityFuzhouChina
| | - Jiarong Zhang
- Department of Thoracic SurgeryFujian Medical University Union HospitalFuzhouChina
- Key Laboratory of Cardio‐Thoracic Surgery (Fujian Medical University)Fujian Province UniversityFuzhouChina
| | - Hao Chen
- Department of Thoracic SurgeryFujian Medical University Union HospitalFuzhouChina
- Key Laboratory of Cardio‐Thoracic Surgery (Fujian Medical University)Fujian Province UniversityFuzhouChina
| | - Bin Zheng
- Department of Thoracic SurgeryFujian Medical University Union HospitalFuzhouChina
- Key Laboratory of Cardio‐Thoracic Surgery (Fujian Medical University)Fujian Province UniversityFuzhouChina
| | - Zhang Yang
- Department of Thoracic SurgeryFujian Medical University Union HospitalFuzhouChina
- Key Laboratory of Cardio‐Thoracic Surgery (Fujian Medical University)Fujian Province UniversityFuzhouChina
| | - Chun Chen
- Department of Thoracic SurgeryFujian Medical University Union HospitalFuzhouChina
- Key Laboratory of Cardio‐Thoracic Surgery (Fujian Medical University)Fujian Province UniversityFuzhouChina
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Xu Q, Mo X, Xiong J, Zhang Y. Case Report: Discontinuous Spontaneous Ventilating Anesthesia for McKeown Esophagectomy by Laryngeal Mask: A Case Series-A Novel Approach of Discontinuous Spontaneous Ventilating Anesthesia for Esophagectomy. Front Surg 2021; 8:783859. [PMID: 34957206 PMCID: PMC8696255 DOI: 10.3389/fsurg.2021.783859] [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] [Received: 09/27/2021] [Accepted: 11/17/2021] [Indexed: 11/13/2022] Open
Abstract
Double lumen endobronchial ventilation in McKeown esophagectomy is common for esophageal cancer. In spite of most patients could be extubated immediately after surgery under adequate multimodal analgesia, still some patients require extended mechanical ventilation or airway support post-surgery because of pain or difficult respiration. The present study reported a novel challenge for McKeown esophagectomy with discontinuous spontaneous ventilating anesthesia by the laryngeal mask. Three esophageal cancer patients underwent McKeown esophagectomy under discontinuous spontaneous ventilating anesthesia with local and regional analgesia and appropriate sedation. Two of them were accomplished under non-intubated video-assisted thoracoscopic surgery (NIVATS), and then, the abdominal and neck surgery was managed under laryngeal mask airway with appropriate muscle relaxation. One patient was endured high PetCO2 level, and converted to regular double lumen endobronchial intubation for safety. However, from the two successful cases, we still proved that the discontinuous spontaneous ventilating anesthesia achieved the same anesthetic effect as bronchial intubation under general anesthesia for McKeown esophagectomy, which reduced the postoperative pharyngeal discomfort, might be beneficial to the patients for enhanced recovery after surgery (ERAS).
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Affiliation(s)
- Qiaoqiao Xu
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong Science and Technology University, Wuhan, China
| | - Xuan Mo
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong Science and Technology University, Wuhan, China
| | - Juan Xiong
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong Science and Technology University, Wuhan, China
| | - Yi Zhang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong Science and Technology University, Wuhan, China
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Jargin S. Surgical and endoscopic treatment of pulmonary tuberculosis: A report from russia. HAMDAN MEDICAL JOURNAL 2021. [DOI: 10.4103/hmj.hmj_29_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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沈 诚, 常 帅, 周 坤, 车 国. [The Present Situation and Prospect of Day Surgery and Enhanced Recovery
after Surgery in Thoracic Surgery]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2020; 23:800-805. [PMID: 32752581 PMCID: PMC7519962 DOI: 10.3779/j.issn.1009-3419.2020.102.08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/02/2020] [Accepted: 03/05/2020] [Indexed: 02/05/2023]
Abstract
The good results of enhanced recovery after surgery (ERAS) combined with minimally invasive surgery are reflected in reducing the incidence of perioperative complications and shortening the length of hospitalization (LOS). It has been widely used in surgical fields of different specialties. The implementation of the day surgery mode can shorten the waiting time for patients and reduce the financial burden. Especially in thoracic surgery, the shorter the waiting time in the hospital, the more beneficial for the patient's physical and psychological recovery. With the widespread implementation of minimally invasive technology and accelerated rehabilitation procedures, the application of ERAS in thoracic surgery has made it possible for some thoracic surgery to be completed in the day surgery. This article summarizes the current application of ERAS in the field of thoracic surgery and the development prospects of day surgery models in China.
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Affiliation(s)
- 诚 沈
- />610041 成都,四川大学华西医院胸外科Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 帅 常
- />610041 成都,四川大学华西医院胸外科Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 坤 周
- />610041 成都,四川大学华西医院胸外科Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 国卫 车
- />610041 成都,四川大学华西医院胸外科Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
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Pohnán R, Hytych V, Holmquist I, Boštíková V, Doležel R, Ryska M. Increasing incidence of tuberculosis diagnosed by surgery: a single centre analysis in low-incidence country. Cent Eur J Public Health 2020; 28:48-52. [PMID: 32228817 DOI: 10.21101/cejph.a5789] [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: 04/15/2019] [Accepted: 03/27/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this study was to assess the incidence of thoracic tuberculosis (TB) in patients who underwent surgery for indeterminate lung nodules, mass and pleural effusions. METHODS A monocentric retrospective study was carried out from 2012 to 2018 in a high-volume thoracic surgery centre. All patients with finding of thoracic TB within surgery and/or confirmed post-surgery were studied. Demography, origin, TB related symptoms, immunosuppression, type of surgery, and complication of surgery were analyzed. RESULTS During the seven-year period TB was diagnosed in 71 cases, 58% were men. The mean age was 50 years. 21% of the cases had family history of TB or were successfully treated for TB in the past. 14% of patients had prior history of treatment for malignancy. Five patients (7%) received immunosuppressive therapy. The indication for surgery was indeterminate lung nodules and mass in 55 patients (77.5%) and indeterminate recurrent or persistent pleural effusions in 21 patients (22.5%). In five patients (7%) a lung carcinoma and a concomitant TB infection was detected. 63 of the cases (88.7%) had positive real-time PCR TBC test. Direct microscopic detection of Mycobacterium tuberculosis detected TB in five cases (7%). The microbiological diagnosis by culture was achieved in 19 patients (26.8%). Two patients (2.8%) were diagnosed with multidrug-resistant TB. Surgical procedure complications occurred in nine cases (12.7%). CONCLUSIONS Although the overall incidence of TB in the Czech Republic is low and constantly continues to decrease, the number of TB detected by surgical procedures is increasing. Surgery still remains an important tool in diagnostics of nonobvious cases of TB, especially in patients with a potential risk of malignancy.
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Affiliation(s)
- Radek Pohnán
- Department of Surgery, Second Faculty of Medicine, Charles University and Central Military Hospital, Prague, Czech Republic.,Thomayer Hospital, Prague, Czech Republic
| | | | - Ivana Holmquist
- Emory University Hospital Midtown, Atlanta, Georgia, USA.,Department of Epidemiology, Faculty of Health Sciences, University of Defence, Hradec Kralove, Czech Republic
| | - Vanda Boštíková
- Department of Epidemiology, Faculty of Health Sciences, University of Defence, Hradec Kralove, Czech Republic
| | - Radek Doležel
- Department of Surgery, Second Faculty of Medicine, Charles University and Central Military Hospital, Prague, Czech Republic
| | - Miroslav Ryska
- Department of Surgery, Second Faculty of Medicine, Charles University and Central Military Hospital, Prague, Czech Republic
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9
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Shen C, Che G. Tubeless minimally invasive treatment: taking a new step in enhanced recovery after surgery (ERAS). Thorac Cancer 2019; 10:2067-2070. [PMID: 31588634 PMCID: PMC6825901 DOI: 10.1111/1759-7714.13206] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 09/10/2019] [Accepted: 09/11/2019] [Indexed: 02/05/2023] Open
Affiliation(s)
- Cheng Shen
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, China
| | - Guowei Che
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, China
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10
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He J, Liu J, Zhu C, Dai T, Cai K, Zhang Z, Cheng C, Qiao K, Liu X, Wang G, Xu S, Yang R, Fan J, Li H, Jin J, Dong Q, Liang L, Ding J, He K, Liu Y, Ye J, Feng S, Jiang Y, Huang H, Zhang H, Liu Z, Feng X, Xia Z, Ma M, Duan Z, Huang T, Li Y, Shen Q, Tan W, Ma H, Sun Y, Chen C, Cui F, Wang W, Li J, Hao Z, Liu H, Liang W, Zou X, Liang H, Yang H, Li Y, Jiang S, Ng CSH, González-Rivas D, Pompeo E, Flores RM, Shargall Y, Ismail M, Ambrogi V, Elkhouly AG, Sung SW, Ang K. Expert consensus on tubeless video-assisted thoracoscopic surgery (Guangzhou). J Thorac Dis 2019; 11:4101-4108. [PMID: 31737292 DOI: 10.21037/jtd.2019.10.04] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jianxing He
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Jun Liu
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Chengchu Zhu
- Department of Thoracic Surgery, Taizhou Hospital, Taizhou 318000, China
| | - Tianyang Dai
- Department of Thoracic Surgery, Southwest Medical University Affiliated Hospital, Luzhou 646000, China
| | - Kaican Cai
- Department of Thoracic Surgery, Nanfang Hospital of Southern Medical University, Guangzhou 510120, China
| | - Zhifeng Zhang
- Department of Thoracic Surgery, Jieyang People's Hospital, Jieyang 522000, China
| | - Chao Cheng
- Department of Thoracic Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510120, China
| | - Kun Qiao
- Department of Thoracic Surgery, Third People's Hospital of Shenzhen, Shenzhen 518000, China
| | - Xiang Liu
- Department of Thoracic Surgery, Second Affiliated Hospital of the University of South China, Hengyang 420100, China
| | - Guangsuo Wang
- Department of Thoracic Surgery, People's Hospital of Shenzhen, Shenzhen 518000, China
| | - Shun Xu
- Department of Thoracic Surgery, First Affiliated Hospital of China Medical University, Shenyang 110000, China
| | - Rusong Yang
- Department of Thoracic Surgery, Nanjing Chest Hospital, Nanjing 210000, China
| | - Junqiang Fan
- Department of Thoracic Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
| | - Hecheng Li
- Department of Thoracic Surgery, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200000, China
| | - Jiang Jin
- Department of Thoracic Surgery, Taizhou Hospital, Taizhou 318000, China
| | - Qinglong Dong
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Lixia Liang
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Jinfeng Ding
- Department of Anesthesia, Taizhou Hospital, Taizhou 318000, China
| | - Kaiming He
- Department of Thoracic Surgery, Southwest Medical University Affiliated Hospital, Luzhou 646000, China
| | - Yulin Liu
- Department of Anesthesia, Southwest Medical University Affiliated Hospital, Luzhou 646000, China
| | - Jing Ye
- Department of Anesthesia, Nanfang Hospital of Southern Medical University, Guangzhou 510120, China
| | - Siyang Feng
- Department of Thoracic Surgery, Nanfang Hospital of Southern Medical University, Guangzhou 510120, China
| | - Yu Jiang
- Department of Anesthesia, Nanfang Hospital of Southern Medical University, Guangzhou 510120, China
| | - Haoda Huang
- Department of Thoracic Surgery, Jieyang People's Hospital, Jieyang 522000, China
| | - Huankai Zhang
- Department of Anesthesia, Jieyang People's Hospital, Jieyang 522000, China
| | - Zhenguo Liu
- Department of Thoracic Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510120, China
| | - Xia Feng
- Department of Anesthesia, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510120, China
| | - Zhaohua Xia
- Department of Thoracic Surgery, Third People's Hospital of Shenzhen, Shenzhen 518000, China
| | - Mingfei Ma
- Department of Anesthesia, Third People's Hospital of Shenzhen, Shenzhen 518000, China
| | - Zhongxin Duan
- Department of Anesthesia, Second Affiliated Hospital of the University of South China, Guangzhou 510120, China
| | - Tonghai Huang
- Department of Thoracic Surgery, People's Hospital of Shenzhen, Shenzhen 518000, China
| | - Yali Li
- Department of Anesthesia, People's Hospital of Shenzhen, Shenzhen 518000, China
| | - Qiming Shen
- Department of Thoracic Surgery, First Affiliated Hospital of China Medical University, Shenyang 110000, China
| | - Wenfei Tan
- Department of Thoracic Surgery, First Affiliated Hospital of China Medical University, Shenyang 110000, China
| | - Hong Ma
- Department of Anesthesia, First Affiliated Hospital of China Medical University, Shenyang 110000, China
| | - Yang Sun
- Department of Anesthesia, Nanjing Chest Hospital, Nanjing 210000, China
| | - Congcong Chen
- Department of Anesthesia, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
| | - Fei Cui
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Wei Wang
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Jingpei Li
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Zhexue Hao
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Hui Liu
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Wenhua Liang
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Xusen Zou
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Hengrui Liang
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Hanyu Yang
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Yingfen Li
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Shunjun Jiang
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Calvin S H Ng
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | | | - Eugenio Pompeo
- Department of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy
| | - Raja M Flores
- Department of Thoracic Surgery, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yaron Shargall
- Division of Thoracic Surgery, McMaster University, St. Joseph's Healthcare, Hamilton, Canada
| | - Mahmoud Ismail
- Department of Thoracic Surgery, Klinikum Ernst von Bergmann, Academic Hospital of the Charité - Universitätsmedizin Humboldt University Berlin, Potsdam Germany
| | - Vincenzo Ambrogi
- Department of Surgery and Experimental Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Ahmed G Elkhouly
- Department of Cardiothoracic Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Sook Whan Sung
- Department of Thoracic & Cardiovascular Surgery, Ewha Womens University Seoul Hospital, Gangseo, Seoul, Republic of Korea
| | - Keng Ang
- Department of Thoracic Surgery, Nottingham City Hospital and Glenfield Hospital, Leicester, UK
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11
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Huang HL, Liu CJ, Lee MR, Cheng MH, Lu PL, Wang JY, Chong IW. Surgical resection is sufficient for incidentally discovered solitary pulmonary nodule caused by nontuberculous mycobacteria in asymptomatic patients. PLoS One 2019; 14:e0222425. [PMID: 31513659 PMCID: PMC6742351 DOI: 10.1371/journal.pone.0222425] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 08/28/2019] [Indexed: 12/20/2022] Open
Abstract
Incidentally discovered solitary pulmonary nodules (SPN) caused by nontuberculous mycobacteria (NTM) is uncommon, and its optimal treatment strategy remains uncertain. This cohort study determined the clinical characteristics and outcome of asymptomatic patients with NTM-SPN after surgical resection. Resected SPNs with culture-positive for NTM in six hospitals in Taiwan during January, 2010 to January, 2017 were identified. Asymptomatic patients without a history of NTM-pulmonary disease (PD) or same NTM species isolated from the respiratory samples were selected. All were followed until May 1, 2019. A total of 43 patients with NTM-SPN were enrolled. Mycobacterium avium complex (60%) and M. kansasii (19%) were the most common species. The mean age was 61.7 ± 13.4. Of them, 60% were female and 4% had history of pulmonary tuberculosis. The NTM-SPN was removed by wedge resection in 38 (88%), lobectomy in 3 (7%) and segmentectomy in 2 (5%). Caseating granuloma was the most common histologic feature (58%), while chronic inflammation accounts for 23%. Mean duration of the follow-up was 5.2 ± 2.8 years (median: 4.2 years [2.5–7.0]), there were no mycobacteriology recurrence or NTM-PD development. In conclusion, surgical resection is likely to curative for incidentally discovered NTM-SPN in asymptomatic patients without culture evidence of the same NTM species from respiratory specimens, and routine mycobacterium culture for resected SPN might be necessary for differentiating pulmonary tuberculosis and NTM because further treatment differs.
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Affiliation(s)
- Hung-Ling Huang
- Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chia-Jung Liu
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Meng-Rui Lee
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- National Taiwan University, College of Medicine, Taipei, Taiwan
| | - Meng-Hsuan Cheng
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Po-Liang Lu
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Jann-Yuan Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- National Taiwan University, College of Medicine, Taipei, Taiwan
- * E-mail: (IWC); (JYW)
| | - Inn-Wen Chong
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Departments of Respiratory Therapy, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- * E-mail: (IWC); (JYW)
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12
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Byun HG, Yoo JY, Kim SJ, Lee OJ, Yoo MY. Coexistence of lung adenocarcinoma and pulmonary tuberculosis within a single lesion: A rare case report. Medicine (Baltimore) 2019; 98:e17378. [PMID: 31574888 PMCID: PMC6775354 DOI: 10.1097/md.0000000000017378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
RATIONALE Pulmonary tuberculosis and lung adenocarcinoma are highly prevalent pulmonary diseases associated with high mortality. However, the coexistence of lung cancer and pulmonary tuberculosis is rare. Further, the morphological features of lung cancer with coexisting pulmonary tuberculosis are similar to that of lung cancer without pulmonary tuberculosis, even though the lesion is predominantly cavity. For these reasons, the diagnosis in patients with coexisting lung cancer and pulmonary tuberculosis could be delayed until the advanced stage, and therefore, prognosis in these patients is worse compared with that of lung cancer patients without coexisting pulmonary tuberculosis. Therefore, early diagnosis of the condition is essential for initiating timely and suitable treatment. PATIENT CONCERNS A 67-year-old man was detected abnormal finding on chest CT performed outside the hospital during health screening without significant symptom. DIAGNOSES Chest CT revealed a 3.2, irregular, enhancing cavitary mass in right lower lobe of lung and PET-CT revealed significant uptake of 18 FDG by the cavitary mass, which was suggestive of lung cancer. Pathology results confirmed a diagnosis of coexisting lung adenocarcinoma and tuberculosis. INTERVENTIONS AND OUTCOME The patient underwent a right lower lobectomy. No significant complications occurred in a 24 month post-surgery follow-up period LESSONS:: Although rare, the coexistence of lung adenocarcinoma and tuberculosis within a single lesion can occur. Therefore, early diagnosis of such a lesion is essential to improve the prognosis in affected patients.
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Affiliation(s)
- Hong Gwon Byun
- Department of Radiology, Chungbuk National University Hospital
| | - Jin Young Yoo
- Department of Radiology, Chungbuk National University Hospital
| | | | - Ok Jun Lee
- Department of Pathology, Chungbuk National University College of Medicine
| | - Min Young Yoo
- Department of Nuclear Medicine, Chungbuk National University Hospital, Cheongju, Korea
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13
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Molnar TF. Tuberculosis: mother of thoracic surgery then and now, past and prospectives: a review. J Thorac Dis 2018; 10:S2628-S2642. [PMID: 30345099 PMCID: PMC6178290 DOI: 10.21037/jtd.2018.04.131] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 04/19/2018] [Indexed: 11/06/2022]
Abstract
Knowledge on ontogenesis of thoracic surgery is essential not only for understanding present concepts and debates on surgery for tuberculosis, but it also contributes to the further developments in operative treatment of lung cancer. Both diseases have been the leading cause of death in their respective ages. History of tuberculosis follows the classic algorithm: diagnostic, casuistic and therapeutical stages. Villemin followed by Virchow, and, finally, Koch revealed the pathoanatomy and the cause of tuberculosis. The therapeutic phase of lung cancer has been reached without identified cause of the disease. Chest surgery, eradication of the macroscopic focus by physical interference with the involved tissue mass, in both diseases preceded medical treatment. Identification of phenotypes of lung cancer-if it is a single disease at all-does not contravene the concept: the tumor mass should been eliminated. However, causation is not an absolute sine qua non of an effective treatment, as the tuberculosis-lung cancer analogy also proves. Surgical approach of both diseases suffered from the same paraoxon: eradication without direct interference with the causative factor. While lung cancer seems to be controlled by an emerging array of new drugs, tuberculosis poses a new challenge, as multidrug resistant and extensively drug resistant Koch bacteria are emerging and fragile societies' immunity is weakening. Thoracic surgery has a significant share in the fight against tuberculosis, when drugs and/or society fail. Palliative and radical adjuvant surgery multiplies the chance of cure in those cases, where not much hope is left. The jury is still out in a series of questions, but it is obvious, that surgery is only an option and not a panacea where medicines and their providers fail. Deeper understanding of our past and present failures with tuberculosis and its surgery might contribute to new concepts in coping with lung cancer as well.
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Affiliation(s)
- Tamas F. Molnar
- Department of Operational Medicine, Medical Humanities Unit, University of Pécs, Pécs, Hungary
- Department Surgery, St Sebastian Thoracic Surgery Unit, Petz A University Teaching Hospital, Győr, Hungary
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