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Lopez-Pastorini A, Stoelben E. [Carinal Resections]. Zentralbl Chir 2024. [PMID: 38359867 DOI: 10.1055/a-2240-9974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Carinal resections are consistently described in the literature as one of the most challenging procedures in thoracic surgery. Depending on the underlying disease and its extent, different resection forms and reconstruction techniques are required. From a surgical point of view, the complex anatomy, and the technique of reconstruction of the central airway are particularly challenging. However, complex airway management and extensive postoperative follow-up demonstrate that these procedures require a multidisciplinary team effort beyond surgical expertise. This article reviews the most important pre-, intra-, and post-operative aspects of these challenging procedures.
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Affiliation(s)
| | - Erich Stoelben
- Thoraxklinik Köln, St. Hildegardis-Krankenhaus, Köln, Deutschland
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Layer JP, Fischer P, Dejonckheere CS, Sarria GR, Mispelbaum R, Hattenhauer T, Wiegreffe S, Glasmacher AR, Layer K, Nour Y, Caglayan L, Grau F, Müdder T, Köksal M, Scafa D, Giordano FA, Lopez-Pastorini A, Stoelben E, Schmeel LC, Leitzen C. Safety and efficacy of helical tomotherapy following lung-sparing surgery in locally advanced malignant pleural mesothelioma. Strahlenther Onkol 2023:10.1007/s00066-023-02174-7. [PMID: 37993554 DOI: 10.1007/s00066-023-02174-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/22/2023] [Indexed: 11/24/2023]
Abstract
PURPOSE To assess the value of radiation therapy (RT) with helical tomotherapy (HT) in the management of locally advanced malignant pleural mesothelioma (MPM) receiving no or lung-sparing surgery. METHODS Consecutive MPM cases not undergoing extrapleural pneumonectomy and receiving intensity-modulated (IM) HT were retrospectively evaluated for local control, distant control, progression-free survival (PFS), and overall survival (OS). Impact of age, systemic treatment, RT dose, and recurrence patterns was analyzed by univariate and multivariate analysis. As a secondary endpoint, reported toxicity was assessed. RESULTS A total of 34 localized MPM cases undergoing IMHT were identified, of which follow-up data were available for 31 patients. Grade 3 side effects were experienced by 26.7% of patients and there were no grade 4 or 5 events observed. Median PFS was 19 months. Median OS was 20 months and the rates for 1‑ and 2‑year OS were 86.2 and 41.4%, respectively. OS was significantly superior for patients receiving adjuvant chemotherapy (p = 0.008). CONCLUSION IMHT of locally advanced MPM after lung-sparing surgery is safe and feasible, resulting in satisfactory local control and survival. Adjuvant chemotherapy significantly improves OS. Randomized clinical trials incorporating modern RT techniques as a component of trimodal treatment are warranted to establish an evidence-based standard of care pattern for locally advanced MPM.
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Affiliation(s)
- Julian P Layer
- Department of Radiation Oncology, University Hospital Bonn/Venusberg-Campus 1, 53127, Bonn, Germany.
- Institute of Experimental Oncology, University Hospital Bonn, Bonn, Germany.
| | - Pascal Fischer
- Department of Thoracic Surgery, St. Hildegardis Hospital, Augustinerinnen Krankenhäuser gGmbH, Cologne, Germany
| | - Cas S Dejonckheere
- Department of Radiation Oncology, University Hospital Bonn/Venusberg-Campus 1, 53127, Bonn, Germany
| | - Gustavo R Sarria
- Department of Radiation Oncology, University Hospital Bonn/Venusberg-Campus 1, 53127, Bonn, Germany
| | - Rebekka Mispelbaum
- Department of Oncology, Hematology, Rheumatology and Immune-Oncology, University Hospital Bonn, Bonn, Germany
| | - Tessa Hattenhauer
- Department of Oncology, Hematology, Rheumatology and Immune-Oncology, University Hospital Bonn, Bonn, Germany
| | - Shari Wiegreffe
- Department of Radiation Oncology, University Hospital Bonn/Venusberg-Campus 1, 53127, Bonn, Germany
| | - Andrea R Glasmacher
- Department of Radiation Oncology, University Hospital Bonn/Venusberg-Campus 1, 53127, Bonn, Germany
| | - Katharina Layer
- Department of Radiation Oncology, University Hospital Bonn/Venusberg-Campus 1, 53127, Bonn, Germany
| | - Youness Nour
- Department of Radiation Oncology, University Hospital Bonn/Venusberg-Campus 1, 53127, Bonn, Germany
| | - Lara Caglayan
- Department of Radiation Oncology, University Hospital Bonn/Venusberg-Campus 1, 53127, Bonn, Germany
| | - Franziska Grau
- Department of Radiation Oncology, University Hospital Bonn/Venusberg-Campus 1, 53127, Bonn, Germany
| | - Thomas Müdder
- Department of Radiation Oncology, University Hospital Bonn/Venusberg-Campus 1, 53127, Bonn, Germany
| | - Mümtaz Köksal
- Department of Radiation Oncology, University Hospital Bonn/Venusberg-Campus 1, 53127, Bonn, Germany
| | - Davide Scafa
- Department of Radiation Oncology, University Hospital Bonn/Venusberg-Campus 1, 53127, Bonn, Germany
| | - Frank A Giordano
- Department of Radiation Oncology, University Medical Center Mannheim, Mannheim, Germany
- DKFZ-Hector Cancer Institute of the University Medical Center Mannheim, Mannheim, Germany
| | - Alberto Lopez-Pastorini
- Department of Thoracic Surgery, St. Hildegardis Hospital, Augustinerinnen Krankenhäuser gGmbH, Cologne, Germany
| | - Erich Stoelben
- Department of Thoracic Surgery, St. Hildegardis Hospital, Augustinerinnen Krankenhäuser gGmbH, Cologne, Germany
| | | | - Christina Leitzen
- Department of Radiation Oncology, University Hospital Bonn/Venusberg-Campus 1, 53127, Bonn, Germany
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Kosse NJ, Galetin T, Schwarz SB, Mathes T, Koryllos A, Lopez-Pastorini A, Beckers F, Stoelben E. Results of the Diaphragmatic Plication Database: 10 Years' Experience. Thorac Cardiovasc Surg 2023; 71:483-489. [PMID: 34655069 DOI: 10.1055/s-0041-1735496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Unilateral diaphragmatic paralysis or paresis (UDP) in adults is an often overlooked disease which relevantly impairs the patient's lung function and quality of life. Particularly in idiopathic UDP, there is no evidence for conservative therapy and only little evidence for surgical therapy. METHODS The method involves retrospective single-center analysis of patients with UDP persistent for at least 1 year who were operated by diaphragmatic resection, plication, and augmentation with a polypropylene mesh. The patients were tested for lung and diaphragmatic function, six-minute walk test (6MWT), and blood gas analysis before, 3 and 12 months after surgery. RESULTS In total, 85 patients received surgery for UDP. The most frequent reasons for UDP were idiopathic (67%), iatrogenic (mainly cardiac and cervical spine surgery; 24%), and trauma (9%). The mean operation time was 84 ± 24 minutes, the length of hospital stay 8.4 ± 3.9 days, chest tubes were removed after 11.7 ± 4.1 days. Overall morbidity was 42%, mortality 0%. Forced expiratory volume in one second (FEV1) in supine position improved by 12.4% absolute, vital capacity by 11.8% absolute, and sniff nasal inspiratory pressure by 1.4 kPa 12 months after surgery (p <0.001 each). Total lung capacity increased by 6.8% absolute at 12 months (p = 0.001) The 6MWT distance improved by 45.9 m at 3 months and 50.9 m at 12 months (p = 0.001, each). CONCLUSION Surgical therapy for UDP is highly effective in the long term. The superiority over conservative treatments needs to be evaluated prospectively with standardized physiotherapeutic protocols. FEV1 in supine position and 6MWT are easy to perform tests and represent statistically and patient-relevant outcomes.
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Affiliation(s)
- Nils Jurriaan Kosse
- Department of Thoracic Surgery, University Witten Herdecke Faculty of Health, Witten, Germany
- Lung Clinic Merheim/Thoracic Surgery, Kliniken der Stadt Köln gGmbH, Koln, Germany
| | - Thomas Galetin
- Department of Thoracic Surgery, University Witten Herdecke Faculty of Health, Witten, Germany
- Lung Clinic Merheim/Thoracic Surgery, Kliniken der Stadt Köln gGmbH, Koln, Germany
| | - Sarah Bettina Schwarz
- Department of Pneumology, University Witten Herdecke Faculty of Health, Witten, Germany
- Lungclinic Merheim/Pneumology, Kliniken der Stadt Köln gGmbH, Koeln, Germany
| | - Tim Mathes
- Institut für Forschung in der operativen Medizin (IFOM), Universität Witten/Herdecke Fakultät für Gesundheit, Witten, Nordrhein-Westfalen, Germany
| | - Aris Koryllos
- Department of Thoracic Surgery, University Witten Herdecke Faculty of Health, Witten, Germany
- Lung Clinic Merheim/Thoracic Surgery, Kliniken der Stadt Köln gGmbH, Koln, Germany
| | - Alberto Lopez-Pastorini
- Department of Thoracic Surgery, University Witten Herdecke Faculty of Health, Witten, Germany
- Lung Clinic Merheim/Thoracic Surgery, Kliniken der Stadt Köln gGmbH, Koln, Germany
| | - Frank Beckers
- Department of Thoracic Surgery, St Vinzenz Hospital, Koeln, Germany
| | - Erich Stoelben
- Department of Thoracic Surgery, University Witten Herdecke Faculty of Health, Witten, Germany
- Lung Clinic Merheim/Thoracic Surgery, Kliniken der Stadt Köln gGmbH, Koln, Germany
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Galetin T, Eckermann C, Defosse JM, Kraja O, Lopez-Pastorini A, Merres J, Koryllos A, Stoelben E. Patients' satisfaction with local and general anaesthesia for video-assisted thoracoscopic surgery-results of the first randomized controlled trial PASSAT. Eur J Cardiothorac Surg 2023; 63:7035944. [PMID: 36782358 DOI: 10.1093/ejcts/ezad046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/24/2022] [Indexed: 02/15/2023] Open
Abstract
OBJECTIVES The objective of this single-centre, open, randomized control trial was to compare the patients' satisfaction with local anaesthesia (LA) or general anaesthesia (GA) for video-assisted thoracoscopy. METHODS Patients with indication for video-assisted thoracoscopy pleural management, mediastinal biopsies or lung wedge resections were randomized for LA or GA. LA was administered along with no or mild sedation and no airway devices maintaining spontaneous breathing, and GA was administered along with double-lumen tube and one-lung ventilation. The primary end point was anaesthesia-related satisfaction according to psychometrically validated questionnaires. Patients not willing to be randomized could attend based on their desired anaesthesia, forming the preference arm. RESULTS Fifty patients were allocated to LA and 57 patients to GA. Age, smoking habits and lung function were similarly distributed in both groups. There was no significant difference between the 2 groups with regard to patient satisfaction with anaesthesiology care (median 2.75 vs 2.75, P = 0.74), general perioperative care (2.50 vs 2.50, P = 0.57), recovery after surgery (2.00 vs 2.00, P = 0.16, 3-point Likert scales). Surgeons and anaesthesiologists alike were less satisfied with feasibility (P < 0.01 each) with patients in the LA group. Operation time, postoperative pain scales, delirium and complication rate were similar in both groups. LA patients had a significantly shorter stay in hospital (mean 3.9 vs 6.0 days, P < 0.01). Of 18 patients in the preference arm, 17 chose LA, resulting in similar satisfaction. CONCLUSIONS Patients were equally satisfied with both types of anaesthesia, regardless of whether the type of anaesthesia was randomized or deliberately chosen. LA is as safe as GA but correlated with shorter length of stay. Almost all patients of the preference arm chose LA. Considering the benefits of LA, it should be offered to patients as an equivalent alternative to GA whenever medically appropriate and feasible.
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Affiliation(s)
- Thomas Galetin
- Department of Thoracic Surgery, University Witten/Herdecke, Witten, Germany.,Department of Thoracic Surgery, Kliniken der Stadt Köln Merheim (City Hospital Cologne-Merheim), Cologne, Germany.,Department of Thoracic Surgery, Florence-Nightingale-Hospital Düsseldorf, Düsseldorf, Germany
| | - Christoph Eckermann
- Department of Thoracic Surgery, Bundeswehrzentralkrankenhaus (German Armed Forces Hospital) Koblenz, Koblenz, Germany
| | - Jerome M Defosse
- Department of Thoracic Surgery, Kliniken der Stadt Köln Merheim (City Hospital Cologne-Merheim), Cologne, Germany.,Department of Anaesthesiology II, [University Witten/Herdecke, Witten, Germany
| | - Olger Kraja
- Department of Thoracic Surgery, Helios Klinikum Hildesheim, Hildesheim, Germany
| | - Alberto Lopez-Pastorini
- Department of Thoracic Surgery, University Witten/Herdecke, Witten, Germany.,Department of Thoracic Surgery, Kliniken der Stadt Köln Merheim (City Hospital Cologne-Merheim), Cologne, Germany.,Department of Thoracic Surgery, St. Hildegardis Hospital Cologne, Cologne, Germany
| | - Julika Merres
- Department of Thoracic Surgery, University Witten/Herdecke, Witten, Germany.,Department of Thoracic Surgery, Kliniken der Stadt Köln Merheim (City Hospital Cologne-Merheim), Cologne, Germany.,Department of Thoracic Surgery, St. Hildegardis Hospital Cologne, Cologne, Germany
| | - Aris Koryllos
- Department of Thoracic Surgery, University Witten/Herdecke, Witten, Germany.,Department of Thoracic Surgery, Kliniken der Stadt Köln Merheim (City Hospital Cologne-Merheim), Cologne, Germany.,Department of Thoracic Surgery, Florence-Nightingale-Hospital Düsseldorf, Düsseldorf, Germany
| | - Erich Stoelben
- Department of Thoracic Surgery, University Witten/Herdecke, Witten, Germany.,Department of Thoracic Surgery, Kliniken der Stadt Köln Merheim (City Hospital Cologne-Merheim), Cologne, Germany.,Department of Thoracic Surgery, St. Hildegardis Hospital Cologne, Cologne, Germany
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Lopez-Pastorini A, Eckermann C, Koryllos A, Galetin T, Ludwig C, Hammer-Hellmig M, Stoelben E. Clinical and bronchoscopic aspects of bronchial healing after sleeve resection for lung cancer: a multivariate analysis on 541 cases. J Thorac Dis 2022; 14:927-938. [PMID: 35572887 PMCID: PMC9096294 DOI: 10.21037/jtd-21-1627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/07/2022] [Indexed: 11/26/2022]
Abstract
Background Anastomotic insufficiency is a feared complication after sleeve lobectomy. Bronchoscopy can help to identify anastomoses at risk. We evaluated negative predictors of anastomotic healing using a bronchoscopic grading system in a large collective of lung cancer patients. Methods From 2006 to 2019, 541 sleeve lobectomies for lung cancer were performed. Anastomotic healing was documented by bronchoscopy on the seventh postoperative day using a standardized classification system for anastomotic grading (grade 1, perfect healing to 5, insufficiency). Grade 1 and 2 were considered satisfactory and the patients were discharged. Grade 3 or higher was considered critical. These patients received systemic antibiotic treatment and re-bronchoscopy was performed 4 days later. Results In 18.5% of the patients, the anastomosis was assessed as critical. 19% of patients with critical anastomosis on the 7th postoperative day developed anastomotic insufficiency during the postoperative course, compared to 0.2% in patients with satisfactory anastomotic healing. Bilobectomies, low preoperative forced expiratory volume in 1 second (FEV1) values, high preoperative levels of C-reactive protein and neoadjuvant radiation were identified as independent risk factors for critical anastomotic healing. Conclusions Bronchoscopic assessment of anastomotic healing is an effective tool to identify critical anastomoses. Neoadjuvant radiation, bilobectomies and acute or chronic inflammation were independent risk factors for bronchial healing disorders and should be considered at the planning stage of surgery.
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Affiliation(s)
- Alberto Lopez-Pastorini
- Department of Thoracic Surgery, Lung Clinic Merheim, Hospital of Cologne, University of Witten-Herdecke, Cologne, Germany
| | - Christoph Eckermann
- Department of Thoracic Surgery, Lung Clinic Merheim, Hospital of Cologne, University of Witten-Herdecke, Cologne, Germany
| | - Aris Koryllos
- Department of Thoracic Surgery, Lung Clinic Merheim, Hospital of Cologne, University of Witten-Herdecke, Cologne, Germany
| | - Thomas Galetin
- Department of Thoracic Surgery, Lung Clinic Merheim, Hospital of Cologne, University of Witten-Herdecke, Cologne, Germany
| | - Corinna Ludwig
- Department of Thoracic Surgery, Florence Nightingale Hospital, Düsseldorf, Germany
| | - Michaela Hammer-Hellmig
- Department of Radio-oncology, Hospital of Cologne, University of Witten-Herdecke, Cologne, Germany
| | - Erich Stoelben
- Department of Thoracic Surgery, Lung Clinic Merheim, Hospital of Cologne, University of Witten-Herdecke, Cologne, Germany
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Kosse NJ, Windisch W, Koryllos A, Lopez-Pastorini A, Piras D, Schroiff HW, Straßmann SE, Stoelben E, Schwarz SB. Development of the Diaphragmatic Paralysis Questionnaire: a simple tool for patient relevant outcome. Interact Cardiovasc Thorac Surg 2021; 32:244-249. [PMID: 33221909 DOI: 10.1093/icvts/ivaa258] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/02/2020] [Accepted: 10/04/2020] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES Measurement tools of health-related quality of life (HRQL) that are specific for the underlying disorder are inevitably needed to assess HRQL changes following specific treatment strategies. The aim of the current study was to develop a questionnaire assessing HRQL in patients with unilateral diaphragmatic paresis. METHODS Firstly, topics of health impairments covering physical, psychological, social and functional aspects were predefined by a physician expert panel to ensure face validity. Secondly, all predefined topics were rated by a patient group with unilateral diaphragmatic paresis (untreated: n = 11; postoperative: n = 9) using a 5-point Likert scale ranging from 'not relevant at all' (-2) to 'absolutely relevant' (+2) to guarantee content validity. Thirdly, only relevant topics (0 to +2) were used for item development, while non-relevant items (<0) were not subject for item development. RESULTS In total, 20 patients rated a total of 43 topics covering a broad spectrum of health impairment. 21 were considered as relevant for item development. Items are answered on a 5-point Likert scale ranging from 'completely untrue' (-2) to 'always true' (+2). The Diaphragmatic Paralysis Questionnaire (DPQ) Summary Score ranges from 0 (worst HRQL) to 100 (best HRQL). Finally, the German DPQ was professionally translated and transculturally adapted into English, Italian, Dutch, French, Greek and Spanish, using translation/back-translation procedures. CONCLUSIONS The DPQ is the first diseases-specific HRQL measure developed for patients with diaphragmatic paresis. In addition, the DPQ is available in 7 languages free of charge for non-profit purposes. CLINICAL TRIAL REGISTRATION German clinical trials register: DRKS00017056.
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Affiliation(s)
- Nils Jurriaan Kosse
- Cologne Merheim Hospital, Department of Thoracic Surgery, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Cologne, Germany
| | - Wolfram Windisch
- Cologne Merheim Hospital, Department of Pneumology, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Cologne, Germany
| | - Aris Koryllos
- Cologne Merheim Hospital, Department of Thoracic Surgery, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Cologne, Germany
| | - Alberto Lopez-Pastorini
- Cologne Merheim Hospital, Department of Thoracic Surgery, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Cologne, Germany
| | - Denis Piras
- Sankt Marienhospital Birkesdorf, Department of Surgery, Düren, Germany
| | - Hans-Willi Schroiff
- RWTH Business School, Marketing Department, Rheinische-Westfälische Technische Hochschule, Aachen, Germany
| | - Stephan Eric Straßmann
- Cologne Merheim Hospital, Department of Pneumology, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Cologne, Germany
| | - Erich Stoelben
- Cologne Merheim Hospital, Department of Thoracic Surgery, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Cologne, Germany
| | - Sarah Bettina Schwarz
- Cologne Merheim Hospital, Department of Pneumology, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Cologne, Germany
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Galetin T, Defosse J, Schieren M, Marks B, Lopez-Pastorini A, Koryllos A, Kosse N, Wappler F, Stoelben E. Sensitivity of chest ultrasound for postoperative pneumothorax in comparison to chest X-ray after lung resecting surgery. Eur J Cardiothorac Surg 2021; 57:846-853. [PMID: 31800020 DOI: 10.1093/ejcts/ezz332] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 10/21/2019] [Accepted: 11/04/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Thoracic ultrasound is superior to chest X-ray for the detection of a pneumothorax in trauma and intensive care medicine. Data regarding its use in non-cardiac thoracic surgery are scarce and contradictory. Previous studies are heterogeneous regarding sonographic methodology and patient selection. This study aimed to evaluate the accuracy of thoracic ultrasound for pneumothorax assessment after lung resecting surgery in unselected patients. METHODS SONOR (SONOgraphy vs x-Ray) is a prospective observational trial (registry-ID DRKS00014557). A total of 123 consecutive patients with lung resecting surgery received a standardized thoracic ultrasound the same day and in addition to routine chest X-rays in erect position after removal of the chest tube. The sonographer was blinded to radiological findings and vice versa. RESULTS Sensitivity, specificity, positive and negative predictive values of ultrasound after removing the chest tube were 0.32, 0.85, 0.54, 0.69 for any pneumothorax and 1.0, 0.82, 0.19, 1.0 for pneumothorax ≥3 cm. No clinically relevant pneumothorax was missed. The agreement between sonography- and routine-based therapeutic decisions was 97%. Lung pulse was the most frequently detected sign to sonographically rule out a pneumothorax. CONCLUSIONS Postoperative thoracic ultrasound in unselected patients has a low overall sensitivity to detect a residual pneumothorax; however, its sensitivity and negative predictive values regarding clinically relevant pneumothorax are high. Test quality depends on the distinct sonographic methodology and patient selection. Anatomic differences in postsurgical and medical patients may be responsible for the contradictory results of previous trials. Studies with a larger population size are required to validate the accuracy of relevant pneumothoraces and identify appropriate selection criteria. CLINICAL TRIAL REGISTRATION NUMBER DRKS-German Clinical Trials Register, www.drks.de, registry-ID DRKS00014557.
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Affiliation(s)
- Thomas Galetin
- Department of Thoracic Surgery, Lung Clinic, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
| | - Jérôme Defosse
- Department of Anaesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
| | - Mark Schieren
- Department of Anaesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
| | - Ben Marks
- Department of Radiology, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
| | - Alberto Lopez-Pastorini
- Department of Thoracic Surgery, Lung Clinic, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
| | - Aris Koryllos
- Department of Thoracic Surgery, Lung Clinic, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
| | - Nils Kosse
- Department of Thoracic Surgery, Lung Clinic, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
| | - Frank Wappler
- Department of Anaesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
| | - Erich Stoelben
- Department of Thoracic Surgery, Lung Clinic, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
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Strohleit D, Galetin T, Kosse N, Lopez-Pastorini A, Stoelben E. Guidelines on analgosedation, monitoring, and recovery time for flexible bronchoscopy: a systematic review. BMC Pulm Med 2021; 21:198. [PMID: 34112130 PMCID: PMC8193886 DOI: 10.1186/s12890-021-01532-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 05/10/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Patients undergoing bronchoscopy in spontaneous breathing are prone to hypoxaemia and hypercapnia. Sedation, airway obstruction, and lung diseases impair respiration and gas exchange. The restitution of normal respiration takes place in the recovery room. Nonetheless, there is no evidence on the necessary observation time. We systematically reviewed current guidelines on bronchoscopy regarding sedation, monitoring and recovery. METHODS This review was registered at the PROSPERO database (CRD42020197476). MEDLINE and awmf.org were double-searched for official guidelines, recommendation or consensus statements on bronchoscopy from 2010 to 2020. The PICO-process focussed on adults (Patients), bronchoscopy with maintained spontaneous breathing (Interventions), and recommendations regarding the intra- and postprocedural monitoring and sedation (O). The guideline quality was graded. A catalogue of 54 questions was answered. Strength of recommendation and evidence levels were recorded for each recommendation. RESULTS Six guidelines on general bronchoscopy and three expert statements on special bronchoscopic procedures were identified. Four guidelines were evidence-based. Most guidelines recommend sedation to improve the patient's tolerance. Midazolam combined with an opioid is preferred. The standard monitoring consists of non-invasive blood pressure, and pulse oximetry, furthermore electrocardiogram in cardiac patients. Only one guideline discusses hypercapnia and capnometry, but without consensus. Two guidelines discuss a recovery time of two hours, but a recommendation was not given because of lack of evidence. CONCLUSION Evidence for most issues is low to moderate. Lung-diseased patients are not represented by current guidelines. Capnometry and recovery time lack evidence. More primary research in these fields is needed so that future guidelines may address these issues, too.
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Affiliation(s)
- Daniel Strohleit
- Lung Clinic Cologne-Merheim, Thoracic Surgery, Hospital of Cologne, University of Witten/Herdecke, Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - Thomas Galetin
- Lung Clinic Cologne-Merheim, Thoracic Surgery, Hospital of Cologne, University of Witten/Herdecke, Ostmerheimer Str. 200, 51109, Cologne, Germany.
| | - Nils Kosse
- Lung Clinic Cologne-Merheim, Thoracic Surgery, Hospital of Cologne, University of Witten/Herdecke, Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - Alberto Lopez-Pastorini
- Lung Clinic Cologne-Merheim, Thoracic Surgery, Hospital of Cologne, University of Witten/Herdecke, Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - Erich Stoelben
- Lung Clinic Cologne-Merheim, Thoracic Surgery, Hospital of Cologne, University of Witten/Herdecke, Ostmerheimer Str. 200, 51109, Cologne, Germany
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Hao Z, Liang H, Zhang Y, Wei W, Lan Y, Qiu S, Lin G, Wang R, Liu Y, Chen Y, Huang J, Wang W, Cui F, Goto T, Jeong JY, Veronesi G, Lopez-Pastorini A, Igai H, Liang W, He J, Liu J. Surgery for advanced-stage non-small cell lung cancer: lobectomy or sub-lobar resection? Transl Lung Cancer Res 2021; 10:1408-1423. [PMID: 33889519 PMCID: PMC8044485 DOI: 10.21037/tlcr-21-39] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Metastatic non-small cell lung cancer (NSCLC) has many comorbidities, such as chronic obstructive pulmonary disease, coronary heart disease, and older age-related comorbidities. A survival benefit was observed in such patients who underwent surgery for selected oligometastatic disease. However, to the best of our knowledge, there is no evidence to support whether lobectomy (compared with sub-lobar resection) would further prolong these patients' lives. Methods Patients with metastatic NSCLC who underwent primary tumor resection were identified from the Surveillance, Epidemiology, and End Results (SEER) database and then divided into lobectomy and sub-lobar resection groups. Propensity score matching (PSM, 1:1) was performed to match the baseline characteristics of the two groups. Cancer-specific survival (CSS) was estimated. Results In total, 24,268 patients with metastatic NSCLC were identified; 4,114 (16.95%) underwent primary tumor surgery, and of these, 2,045 (49.71%) underwent lobectomy and 1,766 (42.93%) underwent sub-lobar resection. After PSM, 644 patients in each group were included. Lobectomy was independently correlated with longer median CSS time [hazards ratio (HR): 0.70, 95% confidence interval (CI): 0.61-0.80, P<0.001]. The 1, 2, and 3-year survival rates after PSM also favored the lobectomy group. However, no significant survival difference was found for wedge resection and segmentectomy (HR: 0.96, 95% CI: 0.70-1.31, P=0.490). The 1-, 2-, and 3-year survival rates after PSM also exhibited no difference within the sub-lobar group. We explored whether lymph node dissection would provide additional survival benefits for stage IV NSCLC patients. According to the multivariate Cox analysis of the matched population, lymph node dissection was independently associated with better CSS (HR: 0.76, 95% CI: 0.66-0.88, P<0.001) and overall survival (OS) (HR: 0.74, 95% CI: 0.65-0.86, P<0.001). We confirmed this result in the different types of surgery and found that the lymph node dissection group consistently had better survival outcomes both in the lobectomy group and sub-lobar resection population. According to the subgroup analysis, with the exception of stage T4 and brain metastatic patients, all of the patient subtypes exhibited greater benefit from lobectomy than sub-lobar resection. Conclusions Lobectomy has a greater survival benefit in metastatic NSCLC patients compared with sub-lobar resection when radical treatment of primary site was indicated.
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Affiliation(s)
- Zhexue Hao
- Department of Thoracic Surgery and Oncology, 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
| | - Hengrui Liang
- Department of Thoracic Surgery and Oncology, 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
| | - Yichi Zhang
- Department of Clinical Medicine, Guangzhou Medical University, Guangzhou, China
| | - Wei Wei
- Department of Thoracic Surgery, Huizhou Municipal Central Hospital, Huizhou, China
| | - Yuting Lan
- Department of Clinical Medicine, Guangzhou Medical University, Guangzhou, China
| | - Shuxian Qiu
- Department of Clinical Medicine, Guangzhou Medical University, Guangzhou, China
| | - Guo Lin
- Department of Clinical Medicine, Guangzhou Medical University, Guangzhou, China
| | - Runchen Wang
- Department of Clinical Medicine, Guangzhou Medical University, Guangzhou, China
| | - Yulin Liu
- Department of Clinical Medicine, Guangzhou Medical University, Guangzhou, China
| | - Yingying Chen
- Department of Clinical Medicine, Guangzhou Medical University, Guangzhou, China
| | - Jun Huang
- Department of Thoracic Surgery and Oncology, 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 and Oncology, 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
| | - Fei Cui
- Department of Thoracic Surgery and Oncology, 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
| | - Taichiro Goto
- Lung Cancer and Respiratory Disease Center, Yamanashi Central Hospital, Yamanashi, Japan
| | - Jin Yong Jeong
- Department of Thoracic and Cardiovascular Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Giulia Veronesi
- Division of Thoracic Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Lopez-Pastorini
- Department of Thoracic Surgery, Lung Clinic, Hospital of the City of Cologne, University of Witten-Herdecke, Cologne, Germany
| | - Hitoshi Igai
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Wenhua Liang
- Department of Thoracic Surgery and Oncology, 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 and Oncology, 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 and Oncology, 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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10
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Schroeder-Finckh A, Lopez-Pastorini A, Galetin T, Stoelben E, Koryllos A. [Chest Wall Reconstruction Using Polypropylene Mesh: a Single-Center 8-Year Analysis]. Zentralbl Chir 2020; 146:329-334. [PMID: 32629509 DOI: 10.1055/a-1180-9621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Chest wall resection for malignant tumours is usually combined with reconstruction of the bony defect. We analysed our single centre, 8-year, experience using polypropylene mesh for chest wall reconstruction. The goal of our retrospective study was to identify material-related complications and to compare them with the existing literature. METHODS The inclusion criterion in our retrospective cohort was a full-thickness chest wall excision and reconstruction using a polypropylene mesh with a mainly oncological indication spectrum (e.g. sarcomas, metastases, lung carcinomas with infiltration of the chest wall) in the period from January 2008 to January 2017. Primary endpoints were material-related complications: local infection, seroma, material migration, mesh explantation and chest wall instability. Secondary endpoints were the following postoperative complications: pneumonia, acute respiratory distress syndrome (ARDS), postoperative bleeding and prolonged postoperative ventilation (> 24 h postoperatively). RESULTS A total of 202 chest wall resections were performed in our clinic over a period of 8 years. Of these, 138 defects were reconstructed using a polypropylene mesh. Pneumonia was the most common postoperative complication at a rate of 12.3%. In 5.7% of the cases, a wound seroma developed that made it necessary to insert a Redon suction drain. Local wound infection was confirmed microbiologically in three cases (2.1%). In one of these cases, the reconstruction material had to be removed. The 30-day mortality rate was 1.4% with two postoperative deaths. Material migration or chest wall instability with a paradoxical pattern of breathing movement were not documented. CONCLUSION Chest wall reconstruction using polypropylene mesh is a technique with low material-related complication rate. The low rate of local infections, material explantation, and chest instability documented in our cohort can be a helpful decision factor for the operating thoracic surgeon looking for the appropriate reconstruction material.
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Affiliation(s)
- Alexander Schroeder-Finckh
- Lungenklinik, Lehrstuhl für Thoraxchirurgie, Universität Witten/Herdecke, Kliniken der Stadt Köln gGmbH, Deutschland
| | - Alberto Lopez-Pastorini
- Lungenklinik, Lehrstuhl für Thoraxchirurgie, Universität Witten/Herdecke, Kliniken der Stadt Köln gGmbH, Deutschland
| | - Thomas Galetin
- Lungenklinik, Lehrstuhl für Thoraxchirurgie, Universität Witten/Herdecke, Kliniken der Stadt Köln gGmbH, Deutschland
| | - Erich Stoelben
- Lungenklinik, Lehrstuhl für Thoraxchirurgie, Universität Witten/Herdecke, Kliniken der Stadt Köln gGmbH, Deutschland
| | - Aris Koryllos
- Lungenklinik, Lehrstuhl für Thoraxchirurgie, Universität Witten/Herdecke, Kliniken der Stadt Köln gGmbH, Deutschland
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Koryllos A, Lopez-Pastorini A, Zalepugas D, Galetin T, Ludwig C, Hammer-Hellmig M, Stoelben E. Optimal timing of surgery for bronchial sleeve resection after neoadjuvant chemoradiotherapy. J Surg Oncol 2020; 122:328-335. [PMID: 32436267 DOI: 10.1002/jso.25945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 04/12/2020] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Sleeve resection is an established oncological operative treatment for centrally located tumors with reduced complications compared to pneumonectomy. In cases of neoadjuvant chemoradiotherapy, the optimal timing of surgery for bronchial anastomotic healing has not been adequately explored. MATERIALS AND METHODS Between 2006 and 2017, 584 tracheobronchial sleeve resections were retrospectively analyzed. We selected all patients (n = 88) after sleeve lobectomy or sleeve bilobectomy for lung cancer with fully completed neoadjuvant chemoradiotherapy. Bronchial healing was assessed by bronchoscopy on the 7th postoperative day using our earlier published classification from grades 1 to 5. RESULTS The median interval to surgery was 50 days (interquartile range 46-53, mean 50.03 ± 3.72). Mean anastomotic grade was 2.05 ± 1.03 and in 29.5% of the patients a critical anastomosis (grade ≥3) was documented. Anastomotic healing showed optimal results (bronchoscopic grade mean value: 1.5 ± 0.70) between the 6th and 8th postchemoradiotherapy week (P = .001). All patients operated before (bronchoscopic grade mean value: 2.3 ± 1.02) or after the above period (bronchoscopic grade mean value: 2.5 ± 1.15) had an increased ratio of anastomotic healing complications. CONCLUSION It is safer to perform sleeve-resections for non-small cell lung cancer after neoadjuvant trimodal treatment between the 6th and 8th week of completion of chemoradiotherapy.
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Affiliation(s)
- Aris Koryllos
- Lung Clinic, Hospital of Cologne, Chair of Thoracic Surgery, University of Witten Herdecke, Cologne, Germany
| | - Alberto Lopez-Pastorini
- Lung Clinic, Hospital of Cologne, Chair of Thoracic Surgery, University of Witten Herdecke, Cologne, Germany
| | - Donatas Zalepugas
- Lung Clinic, Hospital of Cologne, Chair of Thoracic Surgery, University of Witten Herdecke, Cologne, Germany
| | - Thomas Galetin
- Lung Clinic, Hospital of Cologne, Chair of Thoracic Surgery, University of Witten Herdecke, Cologne, Germany
| | - Corinna Ludwig
- Department of Thoracic Surgery, Florence Nightingale Hospital, Duesseldorf, Germany
| | | | - Erich Stoelben
- Lung Clinic, Hospital of Cologne, Chair of Thoracic Surgery, University of Witten Herdecke, Cologne, Germany
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Koryllos A, Lopez-Pastorini A, Galetin T, Defosse J, Strassmann S, Karagiannidis C, Stoelben E. Use of Extracorporeal Membrane Oxygenation for Major Cardiopulmonary Resections. Thorac Cardiovasc Surg 2020; 69:231-239. [PMID: 32268398 DOI: 10.1055/s-0040-1708486] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND In thoracic surgery, utilization of extracorporeal membrane oxygenation (ECMO) is mainly established for patients undergoing lung transplantation. The aim of our study was to summarize our single-center experience with intraoperative use of veno-venous- or veno-arterial-ECMO in patients undergoing complex lung surgery involving the main carina, or the left atrium or the descending aorta. METHODS A total of 24 patients underwent combined complex lung, carinal, aortal, or left atrial resections. In cases of carinal resection, percutaneous veno-venous, jugular-femoral cannulation was considered suitable. For combined resection of lung and descending aorta, a percutaneous femoral veno-arterial cannulation was used. In cases of extended left atrial resection, a percutaneous jugular-femoral veno-venous-arterial cannulation was favored. RESULTS Procedures were divided into three groups: carinal resections and reconstruction (n = 8), resections of the descending aorta and left lung (n = 7), resections of lung and left atrium (n = 9). No intraoperative complications occurred. Overall 30-day mortality was 25%. A complete resection was achieved in 18 patients. Median survival was 12 months. One- and 5-year survival were 48.1 and 22.7%, respectively. CONCLUSION The present study shows that intraoperative use of ECMO for extended carinal, aortic, or atrial resections is feasible with minimal intraoperative complications allowing surgeons increased operating-field safety. Perioperative mortality is high, but this is rather an attribute of local extended disease and patient comorbidities.
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Affiliation(s)
- Aris Koryllos
- Department of Thoracic Surgery, Kliniken der Stadt Köln gGmbH, Lung Clinic, University of Witten Herdecke, Cologne, Nordrhein-Westfalen, Germany
| | - Alberto Lopez-Pastorini
- Department of Thoracic Surgery, Kliniken der Stadt Köln gGmbH, Lung Clinic, University of Witten Herdecke, Cologne, Nordrhein-Westfalen, Germany
| | - Thomas Galetin
- Department of Thoracic Surgery, Kliniken der Stadt Köln gGmbH, Lung Clinic, University of Witten Herdecke, Cologne, Nordrhein-Westfalen, Germany
| | - Jerome Defosse
- Department of Anaesthesiology and Intensive Care Medicine, Kliniken der Stadt Köln gGmbH, University of Witten Herdecke, Cologne, Nordrhein-Westfalen, Germany
| | - Stephan Strassmann
- ARDS and ECMO Centre, Kliniken der Stadt Köln gGmbH, Lung Clinic, University of Witten Herdecke, Cologne, Nordrhein-Westfalen, Germany
| | - Christian Karagiannidis
- ARDS and ECMO Centre, Kliniken der Stadt Köln gGmbH, Lung Clinic, University of Witten Herdecke, Cologne, Nordrhein-Westfalen, Germany
| | - Erich Stoelben
- Department of Thoracic Surgery, Kliniken der Stadt Köln gGmbH, Lung Clinic, University of Witten Herdecke, Cologne, Nordrhein-Westfalen, Germany
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13
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Koryllos A, Lopez-Pastorini A, Zalepugas D, Ludwig C, Hammer-Helmig M, Stoelben E. Bronchus Anastomosis Healing Depending on Type of Neoadjuvant Therapy. Ann Thorac Surg 2019; 109:879-886. [PMID: 31843636 DOI: 10.1016/j.athoracsur.2019.10.049] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 09/15/2019] [Accepted: 10/18/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Preoperative radiotherapy and/or chemotherapy of lung cancer in patients with locally advanced disease is an option in multimodal treatment. Sleeve lobectomy has an important part in decreasing complications and sparing lung function. We present our experience in a large cohort of patients after sleeve lobectomy with or without neoadjuvant treatment and standardized assessment of bronchial anastomotic healing. METHODS The data used for this study were collected in a prospective database in our hospital. Anastomotic healing was documented by bronchoscopy on the seventh postoperative day and thereafter only when necessary, using a standardized scoring system. From 2006 to 2017, we performed 501 sleeve lobectomies representing 19% of all lung cancer resections. A total of 365 of patients had no preoperative treatment (73%), 41 had neoadjuvant chemotherapy (8%), and 95 had radiochemotherapy (19%). RESULTS Using our scoring system of the bronchial anastomosis from 1 (excellent) to 5 (insufficient), we found the anastomosis was worse than grade 2 after no treatment, chemotherapy, or radiochemotherapy in 17%, 10%, and 30%, respectively (P = .002). The rate of anastomotic insufficiency was equally low after no pretreatment and chemotherapy (2.7% and 2.4%) and rose to 10.4% after radiotherapy (P = .002). Similarly, the risk for pulmonary complications was higher after radiochemotherapy (39%) compared with no pretreatment (29%) or chemotherapy (27%), respectively (P = .382). CONCLUSIONS Neoadjuvant radiotherapy is associated with worse wound healing of the anastomosis after sleeve lobectomy in lung cancer. There seems to be a higher risk for anastomotic insufficiency and complications.
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Affiliation(s)
- Aris Koryllos
- Lung Clinic, Hospital of Cologne, Thoracic Surgery, University of Witten Herdecke, Cologne.
| | | | - Donatas Zalepugas
- Lung Clinic, Hospital of Cologne, Thoracic Surgery, University of Witten Herdecke, Cologne
| | - Corinna Ludwig
- Department of Thoracic Surgery, Florence Nightingale Hospital, Duesseldorf
| | | | - Erich Stoelben
- Lung Clinic, Hospital of Cologne, Thoracic Surgery, University of Witten Herdecke, Cologne
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Galetin T, Lopez-Pastorini A, Kosse N, Koryllos A, Stoelben E. [Video-assisted Thoracoscopic Surgery in Local Anaesthesia and Analgosedation - a Survey of the Members of the German Society of Thoracic Surgeons]. Zentralbl Chir 2019; 145:278-283. [PMID: 31639853 DOI: 10.1055/a-0988-0085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION There is increasing international interest in the use of video-assisted thoracoscopic procedures (VATS) with spontaneous respiration in the treatment of elderly and multimorbid patients. Data on the application and acceptance in Germany are not yet available. METHOD Germany-wide, online-based survey among the departments of thoracic surgery registered at the German Society of Thoracic Surgeons (DGT) on the application of VATS in local anaesthesia (LA). RESULTS 101 of 157 hospitals responded (64%). 42% of the respondents perform non-intubated VATS (NIVATS), 31% VATS in LA. Reasons not to perform VATS in LA are lack of experience (51%), doubts about feasibility (29%) and missing indications (24%). Among the performing clinics, the most frequent procedures are pleural catheterisation (94%), pleural biopsy (87%) and pleurodesis (87%). 42% of the clinics perform wedge resections and 10% also anatomical resections in LA. Main target groups are multimorbid patients (77%), elderly patients (65%), patients with anxiety about general anaesthesia (55%) and patients with pre-existing lung diseases (52%). In 97% of the departments, sedation is performed by anaesthesiologists. The main technical difficulties mentioned are impaired view of the surgical field (39%), hypercapnia (29%) and panic attacks (23%). Pain is of minor importance (3%). DISCUSSION About one third of the participating departments already perform VATS in LA; others have plans to introduce the method. The majority of respondents regard multimorbid, elderly and lung patients as the main target groups, as fewer inflammatory, respiratory and neurological complications are expected.
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Affiliation(s)
- Thomas Galetin
- Thoraxchirurgie, Kliniken der Stadt Köln gGmbH, Köln, Deutschland.,Thoraxchirurgie, Universität Witten/Herdecke, Fakultät für Gesundheit, Witten, Deutschland
| | - Alberto Lopez-Pastorini
- Thoraxchirurgie, Kliniken der Stadt Köln gGmbH, Köln, Deutschland.,Thoraxchirurgie, Universität Witten/Herdecke, Fakultät für Gesundheit, Witten, Deutschland
| | - Nils Kosse
- Thoraxchirurgie, Kliniken der Stadt Köln gGmbH, Köln, Deutschland
| | - Aris Koryllos
- Thoraxchirurgie, Kliniken der Stadt Köln gGmbH, Köln, Deutschland.,Thoraxchirurgie, Universität Witten/Herdecke, Fakultät für Gesundheit, Witten, Deutschland
| | - Erich Stoelben
- Thoraxchirurgie, Kliniken der Stadt Köln gGmbH, Köln, Deutschland.,Thoraxchirurgie, Universität Witten/Herdecke, Fakultät für Gesundheit, Witten, Deutschland
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15
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Schroeder-Finckh A, Lopez-Pastorini A, Galetin T, Defosse J, Stoelben E, Koryllos A. Anterior Chest Wall Reconstruction Using Polypropylene Mesh: A Retrospective Study. Thorac Cardiovasc Surg 2019; 68:341-351. [DOI: 10.1055/s-0039-1694033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background Anterior chest wall resection for oncological purposes is usually combined with a form of reconstruction. Most surgeons are convinced that ventrally located defects more than 4 to 5 cm require adequate reconstruction to minimize the risk of lung herniation and respiratory distress through paradox motion. We describe our in-house results of ventral chest wall reconstruction using polypropylene mesh without the use of metallic or biological implants regardless of the extent of chest wall resection.
Methods Patient selection involved ventral chest wall resection and reconstruction by polypropylene mesh for all indications such as primary tumors, metastasis, or infiltration by lung cancer from January 2008 to December 2016. Primary end point was the difference between both sides. Secondary end points were postoperative complications such as infection, surgical revision, and pulmonary complications.
Results Forty-five cases of isolated anterior reconstruction could be identified. In 34 cases, postoperative computed tomography scan of the thorax was available. Fifteen males and 19 females with a median age of 70.5 years were operated. The evaluation of maximum hemithorax diameter between operated and nonoperated sides was documented in centimeters, and the difference was documented in percentage. The mean percentage difference was 11.1% (minimum: 0.3, maximum: 44.4). In one case, wound infection with positive culture could not be treated conservatively and required operative revision and removal of the polypropylene mesh.
Conclusion Polypropylene mesh, though not rigid, can safely be used for anterior chest wall reconstruction.
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Affiliation(s)
| | - Alberto Lopez-Pastorini
- Lung Clinic, Hospital Cologne-Merheim, Witten/Herdecke University, Köln, Nordrhein-Westfalen, Germany
| | - Thomas Galetin
- Lung Clinic, Hospital Cologne-Merheim, Witten/Herdecke University, Köln, Nordrhein-Westfalen, Germany
| | - Jerome Defosse
- Clinic for Anaesthesiology and Operative Intensive Medicine, Hospital Cologne-Merheim, Witten/Herdecke University, Köln, Nordrhein-Westfalen, Germany
| | - Erich Stoelben
- Lung Clinic, Hospital Cologne-Merheim, Witten/Herdecke University, Köln, Nordrhein-Westfalen, Germany
| | - Aris Koryllos
- Lung Clinic, Hospital Cologne-Merheim, Witten/Herdecke University, Köln, Nordrhein-Westfalen, Germany
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Ried M, Eichhorn M, Winter H, Grützner U, Lindner M, Hatz RA, Haager B, Passlick B, Galetin T, Lopez-Pastorini A, Stoelben E, Hofmann HS. [Expert Recommendation for the Implementation of Hyperthermic Intrathoracic Chemotherapy (HITOC) in Germany]. Zentralbl Chir 2019; 145:89-98. [PMID: 31291667 DOI: 10.1055/a-0934-7806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION During the last few years, hyperthermic intrathoracic chemotherapy (HITOC) has been performed in several departments for thoracic surgery in Germany. The objective of this expert recommendation is to provide elementary recommendations for a standardised HITOC treatment, which are based on clinical experiences and research data. METHODS Between October and December 2018, a group of experts for thoracic surgery in five departments of thoracic surgery developed recommendations for the HITOC procedure in Germany. These experts were selected by the latest national survey for HITOC and had the most clinical experience with HITOC. All recommendations are based on clinical experience, the experts' research data and recent literature. RESULTS All recommendations were evaluated by all participating departments in one consensus survey. Finally, a total of six main conclusions including a total of 17 recommendations were developed. For each recommendation, the strength of the consensus is presented in percentages. 100% agreement was established for nomenclature, technique, the chemotherapeutic agent, the perioperative management, the safety measures and the indications for HITOC. All experts recommended cisplatin as the first choice chemotherapeutic agent for HITOC. The dosage of cisplatin is specified in mg/m2 body surface area (BSA) and should be between 150 and 175 mg/m2 BSA. The volume of the perfusion fluid (approximately 4 - 5 l) seems to play a role for the concentration gradient of cisplatin and should therefore also be taken into account. CONCLUSIONS These expert recommendations provide a standardised and consistent implementation of the HITOC procedure. On this basis, postoperative complications associated to HITOC should be reduced and comparison of the results should be improved.
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Affiliation(s)
- Michael Ried
- Abteilung für Thoraxchirurgie, Universitätsklinikum Regensburg, Deutschland
| | - Martin Eichhorn
- Chirurgische Abteilung, Thoraxklinik am Universitätsklinikum Heidelberg, Deutschland
| | - Hauke Winter
- Chirurgische Abteilung, Thoraxklinik am Universitätsklinikum Heidelberg, Deutschland
| | - Uwe Grützner
- Thoraxchirurgisches Zentrum München, Klinikum der Universität München, Deutschland
| | - Michael Lindner
- Asklepios Fachkliniken München-Gauting, Klinikum der Universität München, Thoraxchirurgisches Zentrum München, Deutschland
| | - Rudolf A Hatz
- Thoraxchirurgisches Zentrum München, Klinikum der Universität München, Deutschland
| | - Benedikt Haager
- Klinik für Thoraxchirurgie, Universitätsklinikum Freiburg, Deutschland
| | - Bernward Passlick
- Klinik für Thoraxchirurgie, Universitätsklinikum Freiburg, Deutschland
| | - Thomas Galetin
- Lungenklinik, Lehrstuhl für Thoraxchirurgie, Private Universität Witten Herdecke, Kliniken der Stadt Köln gGmbH, Deutschland
| | - Alberto Lopez-Pastorini
- Lungenklinik, Lehrstuhl für Thoraxchirurgie, Private Universität Witten Herdecke, Kliniken der Stadt Köln gGmbH, Deutschland
| | - Erich Stoelben
- Lungenklinik, Lehrstuhl für Thoraxchirurgie, Private Universität Witten Herdecke, Kliniken der Stadt Köln gGmbH, Deutschland
| | - Hans-Stefan Hofmann
- Abteilung für Thoraxchirurgie, Universitätsklinikum Regensburg, Deutschland.,KH Barmherzige Brüder Regensburg, Klinik für Thoraxchirurgie, Deutschland
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Lopez-Pastorini A, Stoelben E, Koryllos A. Editorial on "Trans-inferior-pulmonary-ligament VATS basal segmentectomy: application of single-direction strategy in segmentectomy of left S9+10". J Thorac Dis 2019; 11:S283-S285. [PMID: 30997198 DOI: 10.21037/jtd.2019.01.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Alberto Lopez-Pastorini
- Department of Thoracic Surgery, Lung Clinic, Hospital of the City of Cologne, University of Witten-Herdecke, Cologne, Germany
| | - Erich Stoelben
- Department of Thoracic Surgery, Lung Clinic, Hospital of the City of Cologne, University of Witten-Herdecke, Cologne, Germany
| | - Aris Koryllos
- Department of Thoracic Surgery, Lung Clinic, Hospital of the City of Cologne, University of Witten-Herdecke, Cologne, Germany
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Galetin T, Bretzke P, Lopez-Pastorini A, Schieren M, Koryllos A, Kosse N, Schnell J, Defosse JM, Wappler F, Stoelben E. Rationale and design of PASSAT - patients' satisfaction with local or general anaesthesia in video-assisted thoracoscopic surgery: study protocol for a randomised controlled trial with a non-randomised side arm. Trials 2019; 20:149. [PMID: 30813955 PMCID: PMC6391793 DOI: 10.1186/s13063-019-3190-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 01/10/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although general anaesthesia (GA) with one-lung ventilation is the current standard of care, minor thoracoscopic surgery, i.e. treatment of pleural effusions, biopsies and small peripheral pulmonary wedge resections, can also be performed using local anaesthesia (LA), analgosedation and spontaneous breathing. Whilst the feasibility and safety of LA have been demonstrated, its impact on patient satisfaction remains unclear. Most studies evaluating patient satisfaction lack control groups or do not meet psychometric criteria. We report the design of the PASSAT trial (PAtientS' SATisfaction in thoracic surgery - general vs. local anaesthesia), a randomised controlled trial with a non-randomised side arm. METHODS Patients presenting for minor thoracoscopic surgery and physical eligibility for GA and LA are randomised to surgery under GA (control group) or LA (intervention group). Those who refuse to be randomised are asked to attend the study on the basis of their own choice of anaesthesia (preference arm) and will be analysed separately. The primary endpoint is patient satisfaction according to a psychometrically validated questionnaire; secondary endpoints are complication rates, capnometry, actual costs and cost effectiveness. The study ends after inclusion of 54 patients in each of the two randomised study groups. DISCUSSION The PASSAT study is the first randomised controlled trial to systematically assess patients' satisfaction depending on LA or GA. The study follows an interdisciplinary approach, and its results may also be applicable to other surgical disciplines. It is also the first cost study based on randomised samples. Comparison of the randomised and the non-randomised groups may contribute to satisfaction research. TRIAL REGISTRATION German Clinical Trials Register, DRKS00013661 . Registered on 23 March 2018.
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Affiliation(s)
- Thomas Galetin
- University Witten/Herdecke, Department of Thoracic Surgery, Alfred-Herrhausen-Str. 50, Witten, D-58448, Germany. .,University Witten/Herdecke, Medical Centre Cologne-Merheim, Department of Thoracic Surgery, Ostmerheimer Str. 200, Cologne, D-51109, Germany.
| | - Pascal Bretzke
- Sana IT Services GmbH, Burger Straße 211, Remscheid, 42859, Germany
| | - Alberto Lopez-Pastorini
- University Witten/Herdecke, Department of Thoracic Surgery, Alfred-Herrhausen-Str. 50, Witten, D-58448, Germany.,University Witten/Herdecke, Medical Centre Cologne-Merheim, Department of Thoracic Surgery, Ostmerheimer Str. 200, Cologne, D-51109, Germany
| | - Mark Schieren
- University Witten/Herdecke, Department of Anaesthesiology and Intensive Care Medicine, Alfred-Herrhausen-Str. 50, Witten, D-58448, Germany.,University Witten/Herdecke, Medical Centre Cologne-Merheim, Department of Anaesthesiology and Intensive Care Medicine, Ostmerheimer Str. 200, Cologne, D-51109, Germany
| | - Aris Koryllos
- University Witten/Herdecke, Department of Thoracic Surgery, Alfred-Herrhausen-Str. 50, Witten, D-58448, Germany.,University Witten/Herdecke, Medical Centre Cologne-Merheim, Department of Thoracic Surgery, Ostmerheimer Str. 200, Cologne, D-51109, Germany
| | - Nils Kosse
- University Witten/Herdecke, Medical Centre Cologne-Merheim, Department of Thoracic Surgery, Ostmerheimer Str. 200, Cologne, D-51109, Germany
| | - Jost Schnell
- University Witten/Herdecke, Medical Centre Cologne-Merheim, Department of Thoracic Surgery, Ostmerheimer Str. 200, Cologne, D-51109, Germany
| | - Jerome M Defosse
- University Witten/Herdecke, Department of Anaesthesiology and Intensive Care Medicine, Alfred-Herrhausen-Str. 50, Witten, D-58448, Germany.,University Witten/Herdecke, Medical Centre Cologne-Merheim, Department of Anaesthesiology and Intensive Care Medicine, Ostmerheimer Str. 200, Cologne, D-51109, Germany
| | - Frank Wappler
- University Witten/Herdecke, Department of Anaesthesiology and Intensive Care Medicine, Alfred-Herrhausen-Str. 50, Witten, D-58448, Germany.,University Witten/Herdecke, Medical Centre Cologne-Merheim, Department of Anaesthesiology and Intensive Care Medicine, Ostmerheimer Str. 200, Cologne, D-51109, Germany
| | - Erich Stoelben
- University Witten/Herdecke, Department of Thoracic Surgery, Alfred-Herrhausen-Str. 50, Witten, D-58448, Germany.,University Witten/Herdecke, Medical Centre Cologne-Merheim, Department of Thoracic Surgery, Ostmerheimer Str. 200, Cologne, D-51109, Germany
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Schnell J, Koryllos A, Lopez-Pastorini A, Lefering R, Stoelben E. Spontaneous Pneumothorax. Dtsch Arztebl Int 2018; 114:739-744. [PMID: 29169430 DOI: 10.3238/arztebl.2017.0739] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 03/13/2017] [Accepted: 07/31/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND Few reliable data are available on the epidemiology and treatment of spontaneous pneumothorax. We studied the sex and age distribution, frequency of hospitalization, mortality, and conservative versus surgical care of this condition in Germany in order to draw well-founded conclusions about its in-hospital diagnosis and treatment. METHODS Data from all patients aged 10 or older who were hospitalized in the period 2011-2015 with a main discharge diagnosis of pneumothorax of neither traumatic nor iatrogenic origin were retrieved from the German Federal Statistical Office. Because of their source, all data were based on case numbers rather than patient numbers. RESULTS During the period of the study, there were 52 738 admissions with the main diagnosis of spontaneous pneumothorax, corresponding to an annual frequency of hospitalization of 14.3 per 100 000 persons per year (95% confidence interval, 14.0 to 14.5). Men were more frequently affected than women. The lethality and in-hospital mortality of this condition (≤ 0.08% and ≤ 0.3%, respectively) were low among persons aged 15 to 45, but markedly higher in persons over age 90 (9.4% and 15.9%, respectively). The frequency of accompanying pulmonary diagnoses also rose with age. Computerized tomography (CT) was performed in 38.9-54.6% of hospitalizations, depending on age. Monitoring on an intensive care unit was carried out in 36% of cases. More than one-quarter of cases involved surgical treatment. CONCLUSION The danger to life and the likelihood of an accompanying pulmonary diagnosis are both low up to age 45. Treatment on an intensive care unit and computerized tomography of the chest should be performed only for strict indications in patients under age 45. The pathophysiological basis of the differing patterns of illness depending on age and sex requires further investigation.
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Affiliation(s)
- Jost Schnell
- Department of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln, Cologne, Germany
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Lopez-Pastorini A, Koryllos A, Schnell J, Galetin T, Defosse J, Schieren M, Ludwig C, Stoelben E. Perioperative outcome after open and thoracoscopic segmentectomy for the treatment of malignant and benign pulmonary lesions: a propensity-matched analysis. J Thorac Dis 2018; 10:3651-3660. [PMID: 30069363 DOI: 10.21037/jtd.2018.05.80] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background The aim of this study was to compare the perioperative outcome of patients receiving anatomic segmentectomy either by open surgery or video-assisted thoracoscopic surgery (VATS). To assess the short-term morbidity of the procedure itself, lung cancer patients in all stages as well as patients with pulmonary metastases and benign lesions scheduled for segmental resection were enrolled in this study. Methods A retrospective analysis of prospectively collected data on 445 consecutive patients that underwent segmentectomy either by VATS (n=233) or thoracotomy (n=212) was performed. A propensity-matched analysis was conducted based on age, gender, smoking history, histology, tumor size, forced expiratory volume in 1 second (FEV1) and history of previous pulmonary resections. The matched sample included two groups of 140 patients each. Results Both study groups were comparable with respect to age, gender, smoking history, diagnosis, tumor size, pulmonary function and history of previous pulmonary resections. VATS segmentectomy was associated with decreased length of stay (7.4 vs. 9.5 days, P<0.001), drainage treatment time (4.7 vs. 5.9 days, P=0.012) and severe postoperative complications (1.4% vs. 7.1%, P=0.018). Conclusions VATS segmentectomy is safe and effective for the treatment of benign and malignant pulmonary lesions. Compared with open thoracotomy, it is associated with shorter hospitalization time and decreased number of severe complications. The preservation of functional lung tissue, combined with a minimally invasive approach, make VATS segmentectomy highly suitable for patients with reduced pulmonary function or severe comorbidities.
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Affiliation(s)
- Alberto Lopez-Pastorini
- Department of Thoracic Surgery, Lung Clinic Merheime, Hospital of the City of Cologne, University of Witten-Herdecke, Cologne, Germany
| | - Aris Koryllos
- Department of Thoracic Surgery, Lung Clinic Merheime, Hospital of the City of Cologne, University of Witten-Herdecke, Cologne, Germany
| | - Jost Schnell
- Department of Thoracic Surgery, Lung Clinic Merheime, Hospital of the City of Cologne, University of Witten-Herdecke, Cologne, Germany
| | - Thomas Galetin
- Department of Thoracic Surgery, Lung Clinic Merheime, Hospital of the City of Cologne, University of Witten-Herdecke, Cologne, Germany
| | - Jérôme Defosse
- Department of Anaesthesiology and Intensive Care Medicine, Hospital of the City of Cologne, University of Witten-Herdecke, Cologne, Germany
| | - Mark Schieren
- Department of Anaesthesiology and Intensive Care Medicine, Hospital of the City of Cologne, University of Witten-Herdecke, Cologne, Germany
| | - Corinna Ludwig
- Department of Thoracic Surgery, Florence Nightingale Hospital, Düsseldorf, Germany
| | - Erich Stoelben
- Department of Thoracic Surgery, Lung Clinic Merheime, Hospital of the City of Cologne, University of Witten-Herdecke, Cologne, Germany
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Defosse J, Schieren M, Loop T, Arndt C, Röhrig R, Stoelben E, Ludwig C, Schleppers A, Wappler F, Gerbershagen M, Lopez-Pastorini A. [The German Thorax Registry: Implementation of an Established Tool of Perioperative Health Care Research]. Zentralbl Chir 2017. [PMID: 28641357 DOI: 10.1055/s-0043-104770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The collection of clinical treatment data in registry databases is an important aspect of health services research. It allows for a critical evaluation of the safety, efficacy and cost-effectiveness of clinical treatment concepts in large patient populations. The findings of registry research represent real-world patients and treatment structures as they are not limited by strict inclusion criteria or unrealistic conditions as applied in prospective clinical trials. The implementation of the German Thorax Registry has enabled the collection and analysis of data on the interdisciplinary care (thoracic surgery, anaesthesiology, intensive care, pain management) of patients undergoing thoracic surgery. Under the auspices of the German Society of Anaesthesiology and Intensive Care Medicine and the German Society of Thoracic Surgery, a registry of the Hospital of the University Witten/Herdecke-Cologne, purely surgical at first, was expanded in close cooperation with the University Hospital of Freiburg. After a comprehensive data protection concept was drafted and a test phase completed, the German Thorax Registry was officially launched in January 2016. Most notably, participating hospitals profit from the registry's "benchmarking" services. "Benchmarking", i.e. the comparison of treatment quality between different hospitals, enables participants to identify individual profiles, strengths and weaknesses on a nation-wide level and follow their own progress over the course of several years. An online database for data entry and benchmarking is always accessible (www.thoraxregister.de). In October 2016, the spectrum of participants was expanded to include all hospitals performing at least 50 thoracic operations a year.
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Affiliation(s)
- Jérôme Defosse
- Klinik für Anästhesiologie und operative Intensivmedizin, Klinikum der Universität Witten/Herdecke, Köln, Deutschland
| | - Mark Schieren
- Klinik für Anästhesiologie und operative Intensivmedizin, Klinikum der Universität Witten/Herdecke, Köln, Deutschland
| | - Torsten Loop
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Freiburg, Deutschland
| | - Cerstin Arndt
- Klinik für Anästhesiologie-, Intensiv- und Schmerzmedizin, Unfallkrankenhaus Berlin, Deutschland
| | - Rainer Röhrig
- Abteilung Medizinische Informatik, Carl-von-Ossietzky-Universität Oldenburg, Deutschland
| | - Erich Stoelben
- Lungenklinik, Klinikum der Universität Witten/Herdecke, Köln, Deutschland
| | - Corinna Ludwig
- Klinik für Thoraxchirurgie, Kaiserswerther Diakonie, Düsseldorf, Deutschland
| | - Alexander Schleppers
- DGAI, Deutsche Gesellschaft für Anästhesiologie und operative Intensivmedizin, Nürnberg, Deutschland
| | - Frank Wappler
- Klinik für Anästhesiologie und operative Intensivmedizin, Klinikum der Universität Witten/Herdecke, Köln, Deutschland
| | - Mark Gerbershagen
- Klinik für Anästhesiologie und operative Intensivmedizin, Klinikum der Universität Witten/Herdecke, Köln, Deutschland
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Ploenes T, Lopez-Pastorini A, Stoelben E. Erratum to: Surgical approach is superior to palliative treatment in oligometastatic lung cancer. Eur Surg 2016. [DOI: 10.1007/s10353-016-0445-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Lopez-Pastorini A, Koryllos A, Brockmann M, Windisch W, Stoelben E. Pseudoaneurysm of the pulmonary artery with massive haemoptysis due to an invasive pulmonary mucormycosis. Thorax 2015; 71:199-200. [DOI: 10.1136/thoraxjnl-2015-207713] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 09/03/2015] [Indexed: 11/04/2022]
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Lopez-Pastorini A, Plönes T, Brockmann M, Ludwig C, Beckers F, Stoelben E. Spontaneous regression of non-small cell lung cancer after biopsy of a mediastinal lymph node metastasis: a case report. J Med Case Rep 2015; 9:217. [PMID: 26377170 PMCID: PMC4573999 DOI: 10.1186/s13256-015-0702-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 08/31/2015] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Spontaneous regression of cancer is defined as a complete or partial, temporary or permanent disappearance of tumor in the absence of specific therapy. With only a few cases reported, spontaneous regression is extremely rare in primary lung cancer. Regarding spontaneous regression in lung cancer, recent investigations revealed the role of immunological mechanisms, thus indicating potential treatment options by specific immunotherapy in the future. CASE PRESENTATION A 76-year-old Caucasian man with progressive dyspnea presented to our hospital. A computed tomography scan revealed a tumor mass in the upper lobe of his right lung and enlarged mediastinal lymph nodes. A biopsy of a paratracheal lymph node by mediastinoscopy disclosed metastatic lung cancer. By immunohistochemical findings the tumor was classified as large cell carcinoma. Diagnosed with clinical stage IIIA non-small cell lung cancer, a neoadjuvant therapy concept was indicated. However, before starting chemoradiation, a computed tomography scan showed a regression of both the tumor mass in the upper lobe of his right lung and the mediastinal lymphadenopathy. As a repeated computed tomography scan showed further regression, we agreed with our patient to perform routine follow-up instead of starting therapy. To date, no relapse has been reported. CONCLUSIONS Given the circumstances that regression started after the biopsy and involved both the tumor in the upper lobe of his right lung and the mediastinal lymph node metastases, an immune response is a reasonable explanation for the observed spontaneous regression in this case.
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Affiliation(s)
- Alberto Lopez-Pastorini
- Department of Thoracic Surgery, University Medical Center Witten/Herdecke, Lung Clinic Merheim, Campus Cologne, Ostmerheimerstr. 200, 51109, Cologne, Germany.
| | - Till Plönes
- Department of Thoracic Surgery, University Medical Center Witten/Herdecke, Lung Clinic Merheim, Campus Cologne, Ostmerheimerstr. 200, 51109, Cologne, Germany.
| | - Michael Brockmann
- Department of Pathology, University Medical Center Witten/Herdecke, Clinic Merheim, Campus Cologne, Ostmerheimerstr. 200, 51109, Cologne, Germany.
| | - Corinna Ludwig
- Department of Thoracic Surgery, University Medical Center Witten/Herdecke, Lung Clinic Merheim, Campus Cologne, Ostmerheimerstr. 200, 51109, Cologne, Germany.
| | - Frank Beckers
- Department of Thoracic Surgery, University Medical Center Witten/Herdecke, Lung Clinic Merheim, Campus Cologne, Ostmerheimerstr. 200, 51109, Cologne, Germany.
| | - Erich Stoelben
- Department of Thoracic Surgery, University Medical Center Witten/Herdecke, Lung Clinic Merheim, Campus Cologne, Ostmerheimerstr. 200, 51109, Cologne, Germany.
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Ploenes T, Lopez-Pastorini A, Ludwig C, Stoelben E. F-088SURGICAL APPROACH IS SUPERIOR TO PALLIATIVE TREATMENT IN OLIGOMETASTATIC LUNG CANCER. Interact Cardiovasc Thorac Surg 2015. [DOI: 10.1093/icvts/ivv204.88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lopez-Pastorini A, Kraja O, Ludwig C, Plönes T, Storre JH, Rommel T, Riecker A, Stoelben E. [Reduction of Tracheotomy Associated Tracheal Stenosis by Surgical Closure of the Tracheostomy]. Pneumologie 2015; 69:335-40. [PMID: 25962568 DOI: 10.1055/s-0034-1391840] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The most common long-term complication of tracheotomy is the benign stenosis of the trachea, which is described for up to 20% of the cases. Typically, the stenosis occurs after decannulation in the context of secondary wound healing. This study examined whether the closure of the tracheostomy by surgical procedure reduces stenosis. METHOD With the help of our clinical database a retrospective analysis of 401 surgical tracheotomies was performed. Variables that were recorded were the indication for tracheotomy, the clinical course and complications occurred. RESULTS 155 patients were successfully decannulated. In 92 of these patients the tracheostomy was closed by a surgical procedure, in 63 cases the closure occurred spontaneously by wound healing. After decannulation 3% (n=3) of the surgically closed and 22% (n=14) of the spontaneously closed tracheostomies developed a symptomatic tracheal stenosis (p<0.001). CONCLUSION Secondary wound healing of the tracheostomy often leads to symptomatic tracheal stenosis. The incidence of symptomatic tracheal stenosis was significantly reduced applying closure of the tracheostomy by surgical procedure.
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Affiliation(s)
- A Lopez-Pastorini
- Lungenklinik Köln-Merheim, Kliniken der Stadt Köln gGmbH, Private Universität Witten/Herdecke
| | - O Kraja
- Lungenklinik Köln-Merheim, Kliniken der Stadt Köln gGmbH, Private Universität Witten/Herdecke
| | - C Ludwig
- Lungenklinik Köln-Merheim, Kliniken der Stadt Köln gGmbH, Private Universität Witten/Herdecke
| | - T Plönes
- Lungenklinik Köln-Merheim, Kliniken der Stadt Köln gGmbH, Private Universität Witten/Herdecke
| | - J H Storre
- Lungenklinik Köln-Merheim, Kliniken der Stadt Köln gGmbH, Private Universität Witten/Herdecke
| | - T Rommel
- RehaNova Neurologische/Neurochirurgische Rehabilitationsklinik Köln GmbH
| | - A Riecker
- RehaNova Neurologische/Neurochirurgische Rehabilitationsklinik Köln GmbH
| | - E Stoelben
- Lungenklinik Köln-Merheim, Kliniken der Stadt Köln gGmbH, Private Universität Witten/Herdecke
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Slottosch I, Liakopoulos O, Kuhn E, Deppe A, Lopez-Pastorini A, Schwarz D, Neef K, Choi YH, Jung K, Mühlfeld C, Wahlers T. Erratum to "Controlled lung reperfusion to reduce pulmonary ischaemia/reperfusion injury after cardiopulmonary bypass in a porcine model [Interact CardioVasc Thorac Surg 2014;19(6):962-970] ". Interact Cardiovasc Thorac Surg 2015; 20:567. [PMID: 25791967 DOI: 10.1093/icvts/ivv045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ingo Slottosch
- Department of Cardiothoracic Surgery, Heartcenter, University Hospital Cologne, Cologne, Germany
| | - Oliver Liakopoulos
- Department of Cardiothoracic Surgery, Heartcenter, University Hospital Cologne, Cologne, Germany Department Thoracic and Cardiovascular Surgery, West German Heart Center Essen, University Hospital Essen, Essen, Germany
| | - Elmar Kuhn
- Department of Cardiothoracic Surgery, Heartcenter, University Hospital Cologne, Cologne, Germany
| | - Antje Deppe
- Department of Cardiothoracic Surgery, Heartcenter, University Hospital Cologne, Cologne, Germany
| | - Alberto Lopez-Pastorini
- Department of Cardiothoracic Surgery, Heartcenter, University Hospital Cologne, Cologne, Germany
| | - David Schwarz
- Department of Cardiothoracic Surgery, Heartcenter, University Hospital Cologne, Cologne, Germany
| | - Klaus Neef
- Department of Cardiothoracic Surgery, Heartcenter, University Hospital Cologne, Cologne, Germany
| | - Yeong-Hoon Choi
- Department of Cardiothoracic Surgery, Heartcenter, University Hospital Cologne, Cologne, Germany
| | - Kristina Jung
- Institute of Anatomy and Cell Biology, University of Giessen, Giessen, Germany
| | - Christian Mühlfeld
- Institute of Anatomy and Cell Biology, University of Giessen, Giessen, Germany Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Heartcenter, University Hospital Cologne, Cologne, Germany
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Lopez-Pastorini A, Kraja O, Kosse N, Stoelben E. Reduktion Tracheostoma-assoziierter Trachealstenosen durch chirurgischen Stomaverschluss. Eine retrospektive Analyse von 401 Tracheotomien. Zentralbl Chir 2014. [DOI: 10.1055/s-0034-1389307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Slottosch I, Liakopoulos O, Kuhn E, Deppe A, Lopez-Pastorini A, Schwarz D, Neef K, Choi YH, Sterner-Kock A, Jung K, Mühlfeld C, Wahlers T. Controlled lung reperfusion to reduce pulmonary ischaemia/reperfusion injury after cardiopulmonary bypass in a porcine model. Interact Cardiovasc Thorac Surg 2014; 19:962-70. [PMID: 25142069 DOI: 10.1093/icvts/ivu270] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Ischaemia/reperfusion (I/R) injury of the lungs contributes to pulmonary dysfunction after cardiac surgery with cardiopulmonary bypass (CPB), leading to increased morbidity and mortality of patients. This study investigated the value of controlled lung reperfusion strategies on lung ischaemia-reperfusion injury in a porcine CPB model. METHODS Pigs were subjected to routine CPB for 120 min with 60 min of blood cardioplegic cardiac arrest (CCA). Following CCA, the uncontrolled reperfusion (UR, n = 6) group was conventionally weaned from CPB. Two groups underwent controlled lung reperfusion strategies (CR group: controlled reperfusion conditions, n = 6; MR group: controlled reperfusion conditions and modified reperfusate, n = 6) via the pulmonary artery before CPB weaning. Sham-operated pigs (n = 7) served as controls. Animals were followed up until 4 h after CPB. Pulmonary function, haemodynamics, markers of inflammation, endothelial injury and oxidative stress as well as morphological lung alterations were analysed. RESULTS CPB (UR group) induced deterioration of pulmonary function (lung mechanics, oxygenation index and lung oedema). Also, controlled lung reperfusion groups (CR and MR) presented with pulmonary dysfunction after CPB. However, compared with UR, controlled lung reperfusion strategies (CR and MR) improved lung mechanics and reduced markers of oxidative stress, but without alteration of haemodynamics, oxygenation, inflammation, endothelial injury and lung morphology. Both controlled reperfusion groups were similar without relevant differences. CONCLUSION Controlled lung reperfusion strategies attenuated a decrease in lung mechanics and an increase in oxidative stress, indicating an influence on CPB-related pulmonary injury. However, they failed to avoid completely CPB-related lung injury, implying the need for additional strategies given the multifactorial pathophysiology of postoperative pulmonary dysfunction.
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Affiliation(s)
- Ingo Slottosch
- Department of Cardiothoracic Surgery, Heartcenter, University Hospital Cologne, Cologne, Germany
| | - Oliver Liakopoulos
- Department of Cardiothoracic Surgery, Heartcenter, University Hospital Cologne, Cologne, Germany Department Thoracic and Cardiovascular Surgery, West German Heart Center Essen, University Hospital Essen, Essen, Germany
| | - Elmar Kuhn
- Department of Cardiothoracic Surgery, Heartcenter, University Hospital Cologne, Cologne, Germany
| | - Antje Deppe
- Department of Cardiothoracic Surgery, Heartcenter, University Hospital Cologne, Cologne, Germany
| | - Alberto Lopez-Pastorini
- Department of Cardiothoracic Surgery, Heartcenter, University Hospital Cologne, Cologne, Germany
| | - David Schwarz
- Department of Cardiothoracic Surgery, Heartcenter, University Hospital Cologne, Cologne, Germany
| | - Klaus Neef
- Department of Cardiothoracic Surgery, Heartcenter, University Hospital Cologne, Cologne, Germany
| | - Yeong-Hoon Choi
- Department of Cardiothoracic Surgery, Heartcenter, University Hospital Cologne, Cologne, Germany
| | | | - Kristina Jung
- Institute of Anatomy and Cell Biology, University of Giessen, Giessen, Germany
| | - Christian Mühlfeld
- Institute of Anatomy and Cell Biology, University of Giessen, Giessen, Germany Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Heartcenter, University Hospital Cologne, Cologne, Germany
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Lopez-Pastorini A, Plönes T, Ludwig C, Stoelben E. Intrapulmonary aspergilloma in an old tuberculous cavity with access to the bronchial system. Eur J Cardiothorac Surg 2013; 46:144. [PMID: 24321992 DOI: 10.1093/ejcts/ezt533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Alberto Lopez-Pastorini
- Department of Thoracic Surgery, University Medical Center Witten/Herdecke, Lung Clinic Merheim, Campus Cologne, Germany
| | - Till Plönes
- Department of Thoracic Surgery, University Medical Center Witten/Herdecke, Lung Clinic Merheim, Campus Cologne, Germany
| | - Corinna Ludwig
- Department of Thoracic Surgery, University Medical Center Witten/Herdecke, Lung Clinic Merheim, Campus Cologne, Germany
| | - Erich Stoelben
- Department of Thoracic Surgery, University Medical Center Witten/Herdecke, Lung Clinic Merheim, Campus Cologne, Germany
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