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Peters NCJ, Hijkoop A, Hermelijn SM, van Schoonhoven MM, Eggink AJ, van Rosmalen J, Otter SCMCD, Tibboel D, IJsselstijn H, Schnater JM, Cohen-Overbeek TE. Prediction of postnatal outcome in fetuses with congenital lung malformation: 2-year follow-up study. Ultrasound Obstet Gynecol 2021; 58:428-438. [PMID: 33206446 DOI: 10.1002/uog.23542] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/09/2020] [Accepted: 10/27/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To identify, in fetuses with a congenital lung malformation (CLM), prenatal predictors of the need for postnatal respiratory support and the need for surgery by calculating the CLM volume ratio (CVR), and to evaluate the concordance between the prenatal appearance and the postnatal type of CLM. METHODS This was an analysis of prenatal, perinatal and postnatal data from fetuses diagnosed with a CLM at the Erasmus University Medical Center - Sophia Children's Hospital in Rotterdam, The Netherlands, between January 2007 and December 2016. For all included fetuses, CVR was measured retrospectively on stored ultrasound images obtained at 18 + 1 to 24 + 6 weeks (US1), 25 + 0 to 29 + 6 weeks (US2) and/or 30 + 0 to 35 + 6 weeks' gestation (US3). Postnatal diagnosis of CLM was based on computed tomography or histology. Primary outcomes were the need for respiratory support within 24 h and surgery within 2 years after birth. RESULTS Of the 80 fetuses with a CLM included in this study, 14 (18%) required respiratory support on the first postnatal day, and 17 (21%) required surgery within 2 years. Only the CVR at US2 was predictive of the need for respiratory support, with a cut-off value of 0.39. Four of 16 (25%) fetuses which showed full regression of the CLM prenatally required respiratory support within 24 h after birth. The CVR at US1, US2 and US3 was predictive of surgery within 2 years. Overall, the prenatal appearance of the CLM showed low concordance with the postnatal type. Prenatally suspected microcystic congenital pulmonary airway malformation (CPAM) was shown on computed tomography after birth to be congenital lobar overinflation in 15/35 (43%) cases. Respiratory support within 24 h after birth and surgical resection within 28 days after birth were needed in all cases of macrocystic CPAM. CONCLUSIONS CVR can predict the need for respiratory support within 24 h after birth and for surgery within 2 years. Regression of a CLM prenatally does not rule out respiratory problems after birth. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. - Legal Statement: This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
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Affiliation(s)
- N C J Peters
- Department of Obstetrics and Gynecology, Division of Obstetrics and Fetal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - A Hijkoop
- Department of Pediatric Surgery and Intensive Care, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - S M Hermelijn
- Department of Pediatric Surgery and Intensive Care, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - M M van Schoonhoven
- Department of Pediatric Surgery and Intensive Care, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - A J Eggink
- Department of Obstetrics and Gynecology, Division of Obstetrics and Fetal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - J van Rosmalen
- Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - S C M Cochius-den Otter
- Department of Pediatric Surgery and Intensive Care, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - D Tibboel
- Department of Pediatric Surgery and Intensive Care, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - H IJsselstijn
- Department of Pediatric Surgery and Intensive Care, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - J M Schnater
- Department of Pediatric Surgery and Intensive Care, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - T E Cohen-Overbeek
- Department of Obstetrics and Gynecology, Division of Obstetrics and Fetal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Azizgolshani NM, Porter ED, Fay KA, Dunbar NM, Hasson RM, Millington TM, Finley DJ, Phillips JD. Preoperative Type and Screen is Unnecessary in Elective Anatomic Lung Resection and Esophagectomy. J Surg Res 2020; 255:411-419. [PMID: 32619855 PMCID: PMC10750229 DOI: 10.1016/j.jss.2020.05.087] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/14/2020] [Accepted: 05/24/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Preoperative type and screen (TS) is routinely performed before elective thoracic surgery. We sought to evaluate the utility of this practice by examining our institutional data related to intraoperative and postoperative transfusions for two common, complex procedures. MATERIALS AND METHODS A single-center, retrospective review of a prospective thoracic surgery database was performed. Patients who underwent consecutive elective anatomic lung resection (ALR) and esophagectomy from January 2015 to April 2018 were included. Perioperative characteristics between patients who received transfusion of packed red blood cells and those who did not were compared. The rates of emergent and nonemergent transfusions were evaluated. Cost data were derived from institutional charges and Centers for Medicare & Medicaid Services fee schedules. RESULTS Of 370 patients, 16 (4.3%) received a transfusion and four (1.1%) were deemed emergent by the surgeons and 0 (0%) by blood bank criteria. For ALR (n = 321), 13 (4.0%) received a transfusion, and four (1.2%) were emergent. For esophagectomies (n = 49), three (6.1%) received a transfusion, and none were emergent. Patients who underwent ALR requiring a transfusion had a lower preoperative hemoglobin (11.7 versus 13.4 gm/dL, P = 0.001), higher estimated blood loss (1325 versus 196 mL, P < 0.001), and longer operative time (291 versus 217 min, P = 0.003) than nontransfused patients. Based on current volumes, eliminating TS in these patients would save at least an estimated $60,100 per year. CONCLUSIONS Emergent transfusion in ALR and esophagectomy is rare. Routine preoperative TS is most likely unnecessary for these cases. These results will be used in a quality improvement initiative to change practice at our institution.
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Affiliation(s)
- Nasim M Azizgolshani
- Geisel School of Medicine, Hanover, New Hampshire; Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Eleah D Porter
- Department of Surgery, Section of Thoracic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Kayla A Fay
- Department of Surgery, Section of Thoracic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Rian M Hasson
- Geisel School of Medicine, Hanover, New Hampshire; Department of Surgery, Section of Thoracic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Timothy M Millington
- Geisel School of Medicine, Hanover, New Hampshire; Department of Surgery, Section of Thoracic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - David J Finley
- Geisel School of Medicine, Hanover, New Hampshire; Department of Surgery, Section of Thoracic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Joseph D Phillips
- Geisel School of Medicine, Hanover, New Hampshire; Department of Surgery, Section of Thoracic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
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Belot A, Fowler H, Njagi EN, Luque-Fernandez MA, Maringe C, Magadi W, Exarchakou A, Quaresma M, Turculet A, Peake MD, Navani N, Rachet B. Association between age, deprivation and specific comorbid conditions and the receipt of major surgery in patients with non-small cell lung cancer in England: A population-based study. Thorax 2019; 74:51-59. [PMID: 30100577 DOI: 10.1136/thoraxjnl-2017-211395] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 06/05/2018] [Accepted: 07/16/2018] [Indexed: 11/04/2022]
Abstract
INTRODUCTION We investigated socioeconomic disparities and the role of the main prognostic factors in receiving major surgical treatment in patients with lung cancer in England. METHODS Our study comprised 31 351 patients diagnosed with non-small cell lung cancer in England in 2012. Data from the national population-based cancer registry were linked to Hospital Episode Statistics and National Lung Cancer Audit data to obtain information on stage, performance status and comorbidities, and to identify patients receiving major surgical treatment. To describe the association between prognostic factors and surgery, we performed two different analyses: one using multivariable logistic regression and one estimating cause-specific hazards for death and surgery. In both analyses, we used multiple imputation to deal with missing data. RESULTS We showed strong evidence that the comorbidities 'congestive heart failure', 'cerebrovascular disease' and 'chronic obstructive pulmonary disease' reduced the receipt of surgery in early stage patients. We also observed gender differences and substantial age differences in the receipt of surgery. Despite accounting for sex, age at diagnosis, comorbidities, stage at diagnosis, performance status and indication of having had a PET-CT scan, the socioeconomic differences persisted in both analyses: more deprived people had lower odds and lower rates of receiving surgery in early stage lung cancer. DISCUSSION Comorbidities play an important role in whether patients undergo surgery, but do not completely explain the socioeconomic difference observed in early stage patients. Future work investigating access to and distance from specialist hospitals, as well as patient perceptions and patient choice in receiving surgery, could help disentangle these persistent socioeconomic inequalities.
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Affiliation(s)
- Aurélien Belot
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Helen Fowler
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Edmund Njeru Njagi
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Miguel-Angel Luque-Fernandez
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Camille Maringe
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Winnie Magadi
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Aimilia Exarchakou
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Manuela Quaresma
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Adrian Turculet
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Michael D Peake
- Department of Respiratory Medicine, University Hospitals of Leicester, Leicester, UK
- National Cancer Registration and Analysis Service, Public Health England, London, UK
- Centre for Cancer Outcomes, University College London Hospitals, London, UK
| | - Neal Navani
- UCL Respiratory, University College London, London, UK
- Department of Thoracic Medicine, University College London Hospital, London, UK
| | - Bernard Rachet
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Li S, Wang Z, Huang J, Fan J, Du H, Liu L, Che G. Systematic review of prognostic roles of body mass index for patients undergoing lung cancer surgery: does the 'obesity paradox' really exist? Eur J Cardiothorac Surg 2018; 51:817-828. [PMID: 28040677 DOI: 10.1093/ejcts/ezw386] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 10/26/2016] [Indexed: 01/11/2023] Open
Abstract
Summary The paradoxical benefit of obesity, the 'obesity paradox', has been recently identified in surgical populations. Our goal was to evaluate by a systematic review with meta-analysis the prognostic role of body mass index (BMI) and to identify whether the 'obesity paradox' exists in lung cancer surgery. Comprehensive literature retrieval was conducted in PubMed to identify the eligible articles. The odds ratios (OR) and hazard ratios (HR) with the corresponding 95% confidence intervals (CI) were used to synthesize in-hospital and long-term survival outcomes, respectively. The heterogeneity level and publication bias between studies were also estimated. Finally, 25 observational studies with 78 143 patients were included in this review. The pooled analyses showed a significantly better long-term survival rate in patients with higher BMI, but no significant benefit of increased BMI was found for in-hospital morbidity. The pooled analyses also showed that overall morbidity (OR: 0.84; 95% CI: 0.73-0.98; P = 0.025) and in-hospital mortality (OR: 0.78; 95% CI: 0.63-0.98; P = 0.031) were significantly decreased in obese patients. Obesity could be a strong predictor of the favourable long-term prognosis of lung cancer patients (HR: 0.69; 95% CI: 0.56-0.86; P = 0.001). The robustness of these pooled estimates was strong. No publication bias was detected. In summary, obesity has favourable effects on in-hospital outcomes and long-term survival of surgical patients with lung cancer. The 'obesity paradox' does have the potential to exist in lung cancer surgery.
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Pashkova IA, Porkhanov VA, Polyakov IS, Sitnik SD, Mozheiko MP, Zueva ZY, Sholin IY. BLOOD TRANSFUSION IN LUNG OPERATIONS. Vestn Khir Im I I Grek 2016; 175:47-53. [PMID: 30444094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The authors admit the risks of blood transfusion, as well as the fact that the blood is a limited resource. These conclusions became the basis of the research in order to make an analysis and develop transfusion strategies in the hospital. An assessment of blood components application was performed in specific cases. There was changed the management of blood transfusion and further monitoring was continued. It was shown that the efficacy of an introduction of a new transfusion strategy confirmed the decrease of the rate of inappropriate blood transfusions, the quantity of patients who obtained transfusion of allogenic blood components and as a result, the new methods reduced the number of blood transfusions.
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Rivera C, Chevalier B, Fabre E, Pricopi C, Badia A, Arame A, Foucault C, Dujon A, Le Pimpec Barthes F, Riquet M. [Lung cancer surgery and cirrhosis]. Rev Pneumol Clin 2015; 71:12-19. [PMID: 25687820 DOI: 10.1016/j.pneumo.2014.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 08/28/2014] [Accepted: 09/05/2014] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Lung cancer is the leading cause of death by cancer and cirrhosis is the fourteenth, all causes included. Surgery increases postoperative risks in cirrhotic patients. Our purpose was to analyze this point in lung cancer surgery. METHODS We collected, among 7162 patients, the data concerning those operated for lung cancer (n=6105) and compared patients with hepatic disease (n=448) to those presenting other medical disorder (n=2587). We analyzed cirrhotic patients' characteristics (n=49). RESULTS Five-year survival of patients with hepatic disease was lower (n=5657/6105): 35.3% versus 43.8% for patients with no hepatic disease, P=0.0021. Survival of cirrhotic patients was not statistically different from the one of patients with other hepatic disorder, but none survived beyond 10 years (0% versus 26.4%). Surgery in cirrhotic patients consisted in one explorative thoracotomy, three wedges resections, two segmentectomies, 33 lobectomies and 10 pneumonectomies. Postoperative mortality (8.2%; 4/49) was not different for patients without hepatic disease (4.2%; 239/5657) (P=0.32), as well as the rate of complications (40.8%; 20/49 and 24.8%; 1404/5657, P=0.11). Only one postoperative death was associated to a hepatic failure. Multivariate analysis pointed age, histological subtype of the tumour and stage of disease as independent prognosis factors. CONCLUSION When cirrhosis is well compensated, surgical resection of lung cancer can be performed with acceptable postoperative morbidity and satisfactory rates of survival. Progressive potential of this disease is worse after five years.
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Affiliation(s)
- C Rivera
- Service de chirurgie thoracique, université Paris-Descartes, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - B Chevalier
- Service de chirurgie thoracique, université Paris-Descartes, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - E Fabre
- Service d'oncologie médicale, université Paris Descartes, hôpital européen Georges-Pompidou, Paris, France
| | - C Pricopi
- Service de chirurgie thoracique, université Paris-Descartes, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - A Badia
- Service de chirurgie thoracique, université Paris-Descartes, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - A Arame
- Service de chirurgie thoracique, université Paris-Descartes, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - C Foucault
- Service de chirurgie thoracique, université Paris-Descartes, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - A Dujon
- Service de chirurgie thoracique, centre médico-chirurgical du Cèdre, Bois-Guillaume, France
| | - F Le Pimpec Barthes
- Service de chirurgie thoracique, université Paris-Descartes, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - M Riquet
- Service de chirurgie thoracique, université Paris-Descartes, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
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Abdennadher M, Rivera C, Gibault L, Fabre E, Pricopi C, Arame A, Foucault C, Dujon A, Le Pimpec Barthes F, Riquet M. [Mucoepidermoid tracheo-bronchial tumors in adulthood. A series of 22 cases]. Rev Pneumol Clin 2015; 71:27-36. [PMID: 25687822 DOI: 10.1016/j.pneumo.2014.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 09/18/2014] [Accepted: 09/21/2014] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Mucoepidermoid tumours (TME) are rare tumours arising from the submucosal glands of the tracheobronchial tree. The majority of these tumours develop in a benign fashion but some of them are malignant. The latter can be easily mistaken for adenosquamous carcinomas. PATIENTS AND METHOD We have reviewed 22 patients suffering from TME observed over a period of 25 years. Two arose from the trachea and 20 from the cartilaginous bronchi; 12 of these tumours had macroscopic and histological criteria of low-grade malignancy, 4 had macroscopic and 6 macroscopic and microscopic criteria of high grade malignancy. RESULTS Prognosis of the latter was very poor and no survival observed after 6 years follow-up, a behavior similar to that observed in non-small cell lung carcinomas and adenosquamous carcinomas. CONCLUSION The best treatment of these orphan tumours remains surgery.
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Affiliation(s)
- M Abdennadher
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris-Descartes, 75015 Paris, France
| | - C Rivera
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris-Descartes, 75015 Paris, France
| | - L Gibault
- Service d'anatomie pathologique, hôpital européen Georges-Pompidou, université Paris-Descartes, 75015 Paris, France
| | - E Fabre
- Service d'oncologie, hôpital européen Georges-Pompidou, université Paris-Descartes, 75015 Paris, France
| | - C Pricopi
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris-Descartes, 75015 Paris, France
| | - A Arame
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris-Descartes, 75015 Paris, France
| | - C Foucault
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris-Descartes, 75015 Paris, France
| | - A Dujon
- Service de chirurgie thoracique, centre médico-chirurgical du Cèdre, 76230 Bois Guillaume, France
| | - F Le Pimpec Barthes
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris-Descartes, 75015 Paris, France
| | - M Riquet
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris-Descartes, 75015 Paris, France.
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Vafin AZ, Diad'kov AV, Aĭdemirov AN, Malanka MI, Abdokov AD. [Diagnostics and surgery of combined lung echinococcosis]. Vestn Khir Im I I Grek 2013; 172:21-25. [PMID: 24640743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
An analysis of surgical treatment of 162 patients with lung echinococcosis was made. The main group consisted of 74 patients with combined forms of echinococcosis of the lung and other organs. They were treated in clinic in the period of time since 1982 till 2011 years. The control group included of 88 patients with echinococcosis of lung and the patients were followed-up in the period of time since 1991 till 2000. Plasma technology was applied in all patients of control group. The patients from main group (25) were operated by using the conventional methods and 49 patients - with the application of plasma technology. An analysis shows a reliable reduction of the rate of postoperative complications after application of plasma technology in 4 times. The lethality significantly decreased in this group of patients.
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Mordant P, De Dominicis F, Berna P, Riquet M. [Tracheobronchial and pulmonary parenchymatous congenital abnormalities requiring surgical treatment in adults]. Rev Pneumol Clin 2012; 68:110-116. [PMID: 22361066 DOI: 10.1016/j.pneumo.2012.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/19/2011] [Indexed: 05/31/2023]
Abstract
Most tracheobronchial and parenchymatous congenital abnormalities of the respiratory system are diagnosed in early life. However, some lesions may be initially silent and diagnosed only in adulthood. These cases included congenital abnormalies of the tracheobronchial tract (tracheal and/or bronchial stenosis, bronchogenic cysts, bronchial atresia, oesotracheal fistula, oesobronchial fistula, and tracheal diverticulum), and lung parenchyma itself (pulmonary sequestration, congenital cystic adenomatoïd malformation, lobar emphysema, lobar or lung hypoplasia). To avoid dreadful complications, these rare cases deserve surgical management, and must be known by chest physicians and surgeons.
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Affiliation(s)
- P Mordant
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 20 rue Leblanc, Paris, France
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Abstract
Both technical and anatomical features and the need for a long follow-up, usually over several years, explain the specificity of lung surgery in children. Apart from the oncological resections, the main indications for this surgery are congenital lung anomalies (cystic adenomatoid malformation, bronchopulmonary sequestration, lobar emphysema), symptomatic postinfectious lesions (bronchiectasis, atelectasis, abscess) and pneumothorax. Advances in miniaturization of the surgical equipment are used to carry the majority of these interventions by thoracoscopy, except when performed at the neonatal period. In the newborn, for which the indications for lung surgical resections are exceptional, ventilatory conditions and the tightness of the chest lead to still prefer open surgery. Pulmonary malformations can also be managed prenatally when they affect lung development or cause heart failure because of compressive complications. These interventions, performed after the 30th week of gestation, are not intended to remove the lesions, but to release the compression. But these procedures are still under evaluation and, in light of possible fetal and maternal complications, they should only be performed in tertiary centers and in the context of specific protocols.
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Affiliation(s)
- N Khen-Dunlop
- Service de chirurgie pédiatrique viscérale, hôpital Necker-Enfants malades, 149 rue de Sèvres, Paris, France.
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Avaro JP, Thefenne H, Brioude G, Orsini B, Garnotel E, Thomas P. [Role of surgery in the management of pulmonary parasitosis]. Rev Pneumol Clin 2012; 68:117-122. [PMID: 22364834 DOI: 10.1016/j.pneumo.2012.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/19/2011] [Indexed: 05/31/2023]
Abstract
Pulmonary parasitosis is scarcely encountered in France, and its diagnosis is quite difficult. If numerous parasites can be responsible for respiratory symptoms, only few of them can develop in the lung parenchyma and lead to complications necessitating a surgical treatment. The most common example is the hydatic disease of the lung. The authors review the biological cycles, clinical forms, diagnostic and treatment principles of those main lung parasites, which deserve surgical consideration.
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Affiliation(s)
- J-P Avaro
- Service de chirurgie thoracique, hôpital d'instruction des armées Alphonse-Laveran, boulevard Laveran, Marseille cedex 13, France.
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Riquet M, Mordant P. [Lung surgery for non-tumoral disease]. Rev Pneumol Clin 2012; 68:65-66. [PMID: 22425503 DOI: 10.1016/j.pneumo.2012.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/19/2011] [Indexed: 05/31/2023]
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Abstract
Lung abscesses and necrotizing pneumonia are rare complications of community-acquired pneumonia since the advent of antibiotics. Their management leans first of all on the antibiotic treatment adapted on the informed germs. However, in 11 to 20% of the cases of lung abscesses, this treatment is insufficient, and drainage, either endoscopic or percutaneous, must be envisaged. In first intention, we shall go to less invasive techniques: endoscopic or percutaneous radio-controlled. In case of failure of these techniques, a percutaneous surgical drainage by minithoracotomy will be performed. In the necrotizing pneumonia, because of the joint obstruction of the bronchus and blood vessels corresponding to a lung segment, the systemic antibiotic treatment will be poor effective. In case of failure of this one we shall propose, a percutaneous surgical drainage, especially if the necrosis limits itself to a single lobe. The surgical treatment will be reserved: in the failures of the strategy of surgical drainage, in the necroses extending in several lobes.
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Affiliation(s)
- P-B Pagès
- Service de chirurgie thoracique, hôpital du Bocage Central, CHU de Dijon, 14 rue Gaffarel, Dijon cedex, France.
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Abstract
The incidence of bronchiectasis has declined significantly in industrialized countries and its management has also changed because of the progress of antibiotic therapy. However, for some patients, medical treatment is not sufficient to control the disease and the quality of life is affected. Surgical treatment is then a very good alternative, when a gesture of complete resection of the affected areas is feasible in terms of lung function and it allows, with a low morbidity and mortality, for very satisfactory long-term results and slows down the progression of the disease. In cases of diffuse and inhomogeneous bronchiectasis, a gesture of incomplete resection of cystic, non-perfused and suppurative areas improves symptoms and reduces recurrent infections. When the bronchiectasis is diffuse, but homogeneous, associated with severe respiratory failure, lung transplantation should be considered. Therefore, surgery remains important in the management of bronchiectasis. Its indications and the lung resection gesture to achieve should be discussed based on the symptoms, imaging examinations and the lung function of the patient.
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Affiliation(s)
- F De Dominicis
- Service de chirurgie thoracique, hôpital Sud, CHU d'Amiens, université de Picardie, avenue René-Laennec, Amiens cedex 1, France
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Radu DM, Macey J, Bouvry D, Seguin A, Valeyre D, Martinod E. [Surgical lung biopsy: Indications and therapeutic implications]. Rev Pneumol Clin 2012; 68:161-169. [PMID: 22425502 DOI: 10.1016/j.pneumo.2012.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/19/2011] [Indexed: 05/31/2023]
Abstract
Surgical biopsy of lung parenchyma can be used to establish a diagnosis in interstitial lung disease both of acute and chronic presentation. The present article summarizes the current indications, the therapeutic implications, the different surgical techniques and postoperative complications of the procedure. Common controversies and problems related to surgical lung biopsy are also presented.
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Affiliation(s)
- D M Radu
- Service de chirurgie thoracique et vasculaire, pôle activités cancérologiques spécialisées, hôpital Avicenne, CHU de Paris-Seine-Saint-Denis, AP-HP, 125 rue de Stalingrad, Bobigny cedex, France
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16
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Pagès PB, Abou Hanna H, Caillot D, Bernard A. [Place of surgery in pulmonary aspergillosis and other pulmonary mycotic infections]. Rev Pneumol Clin 2012; 68:67-76. [PMID: 22425505 DOI: 10.1016/j.pneumo.2012.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/19/2011] [Indexed: 05/31/2023]
Abstract
Surgery is part of the therapeutic strategy of aspergillosis and mucormycosis. The aspergilloma is defined as a rounded mass, developing in a cavity by the proliferation of spores of Aspergillus. The most common complication was haemoptysis reported in 50-95% of cases. The pleuropulmonary lesions predisposing are: tuberculosis, residual pleural space, emphysema and lung destroyed by fibrosis or radiotherapy or bronchiectasis. The indications for surgery depend on symptoms, respiratory function, the parenchyma and the type of aspergilloma (simple or complex). In a patient with an intrapulmonary aspergilloma, lung resection preceded by embolization is recommended based on respiratory function. For intrapleural aspergilloma, thoracoplasty is recommended according to the patient's general condition. The invasive pulmonary aspergillosis (IPA) is characterized by an invasion of lung tissue and blood vessels by hyphae in immunocompromised patients. The death rate of patients who have an API after treatment for leukemia or lymphoma was 30 to 40%, after bone marrow transplantation 60%, after solid organ transplantation from 50 to 60% and after any other cause of immunocompromising from 70 to 85%. The main cause of these deaths is massive hemoptysis. Surgery (lobectomy) is indicated for the prevention of hemoptysis when the mass is in contact with the pulmonary artery or one of its branches, and if it increases in size with the disappearance of border security between the mass and the vessel wall. The patient will be operated in an emergency before the white blood cells do not exceed the threshold of 1000 cells/μl. A persistent residual mass after antifungal treatment may justify a lung resection (lobectomy or wedge) before a new aggressive therapy. Mucormycosis affects patients following immunocompromising states--haematologic malignancy, diabetes mellitus, transplantation, burns and malnutrition. The treatment of pulmonary mucormycosis combines surgical and medical approach.
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Affiliation(s)
- P-B Pagès
- Service de chirurgie thoracique, hôpital du Bocage-Central, CHU de Dijon, 14 rue Gaffarel, Dijon cedex, France
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17
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Sioris T, Sihvo E, Sankila R, Salo J. Effect of surgical volume and hospital type on outcome in non-small cell lung cancer surgery: a Finnish population-based study. Lung Cancer 2007; 59:119-25. [PMID: 17825951 DOI: 10.1016/j.lungcan.2007.07.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2007] [Revised: 07/17/2007] [Accepted: 07/24/2007] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Hospital mortality and long-term survival in major cancer surgery seems to be affected by hospital related factors. We evaluated the effect of university versus non-university hospital type, and surgical volume (0-4, 5-10, 11-20, and >20 average of cases/year) on the immediate and long-term survival of surgical non-small cell lung cancer (NSCLC) patients. PATIENTS AND METHODS Between 1988 and 2002, the number of NSCLC resections with curative intent in Finland was 5339. Follow-up until the end of 2003 from national registries was available on 91% (4878 of 5339) of patients. RESULTS Multivariate analysis showed that hospital mortality was unaffected by hospital type or volume, but delay of >4 months from diagnosis to surgery did have an adverse effect. Surgery at university hospitals was associated with significantly better cancer-related and overall survival, as also was surgery at very low-volume but mainly private hospitals (0-4 cases/year). CONCLUSIONS Undergoing surgery for non-small cell lung cancer at a university hospital may offer an advantage for long-term survival, but large hospital volume in itself did not. SUMMARY Multivariate analysis on the effect of hospital type and surgical volume on immediate and long-term survival of 4878 lung cancer surgery patients, 1988-2002, showed that surgery at university hospitals was associated with significantly better cancer-related and overall survival, but hospital mortality did not differ. Large hospital volume did not independently predict a better outcome.
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Affiliation(s)
- Thanos Sioris
- Tampere University Hospital, Heart Center, P.O. Box 2000, FIN-33521 Tampere, Finland.
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18
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Abstract
BACKGROUND Reports on the temporal evolution in lung resection are limited. To elucidate temporal changes in the demographics of lung resections, we analyzed nationally representative data that were collected for the National Hospital Discharge Survey from 1988 to 2002. METHODS Data collected between 1988 and 2002 were analyzed. Patients with International Classification of Diseases, ninth revision, clinical modification, procedure codes for lung resection were included in the sample. Three 5-year time periods were created (1988 to 1992, 1993 to 1997, and 1998 to 2002) to simplify the temporal analysis. Changes in the prevalence of procedures, age, gender, race, length of care, mortality, disposition status, and distribution by hospital size were evaluated. Trends in procedure-related complications were analyzed. RESULTS Between 1988 and 2002, a total of 512,758 lung resections were performed. Comparing the earliest to the most recent time period, we found increases in the average age (61.1 years [range, 1 to 89 years] vs 63.2 years [range, 1 to 91 years], respectively), in the proportion of patients who were female (40.1% vs 49.6%, respectively), and in the proportion of Medicare/Medicaid patients (43.8% vs 49%/4.7% vs 6.7%, respectively). Decreases in the average length of stay (12.9 days [range, 1 to 358 days] vs 9.1 days [range, 1 to 175 days], respectively) and in the proportion of patients discharged to their primary residence (86% vs 79.5%, respectively) were seen. The proportion of patients who had undergone lobectomies compared to other types of lung resection increased. Mortality rates were 5% vs 5.4%, respectively, while the frequency of complications decreased. CONCLUSION We identified temporal changes in lung resection surgery that may help in the construction of health-care policies to address the changing needs of and financial burdens on the health-care system.
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Affiliation(s)
- Stavros G Memtsoudis
- Department of Anesthesiology, Perioperative, and Pain Medicine, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical Center, Boston, MA, USA.
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Japanese Association for Thoracic Surgery, Committee of Science. Thoracic and cardiovascular surgery in Japan during 2000. Annual report by the Japanese Association for Thoracic Surgery. Jpn J Thorac Cardiovasc Surg 2002; 50:398-412. [PMID: 12387248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
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20
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Japanese Association for Thoracic Surgery. Thoracic and cardiovascular surgery in Japan during 1999. Annual report by the Japanese Association for Thoracic Surgery. Jpn J Thorac Cardiovasc Surg 2001; 49:528-41. [PMID: 11552283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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21
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Sawamura K. [Current status of pulmonary tuberculosis through surgical procedure]. Rinsho Kyobu Geka 1997; 7:215-9. [PMID: 9301778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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