1,721,152 research outputs found
Thymectomy and transpericardial nodal dissection
No full textNeuroendocrine thymic tumors (NETTs) are rare neoplasms. Surgical resection of the tumor and the involved lymph node remains the treatment of choice. We describe the surgical technique adopted in a patient with preoperative diagnosis of thymic malignant tumor and subcarinal nodal involvement. Through a median sternotomy, an extended thymectomy was performed as a first step. Then, through the transpericardial approach (opening of the anterior and posterior pericardium and isolation of ascending aorta, superior vena cava, and main right pulmonary artery), mediastinal nodal dissection (#2R, #4R, #4L, #5 and #7) was performed. Definitive pathology showed a NETT without nodal involvement. The patient received adjuvant chemotherapy, and is alive without disease 19 months after the surgery. Complete surgical excision and adjuvant therapy appears to offer the best hope for prolonged survival for NETTs. The surgical technique should be individualized according to tumor location. Thoracic surgeons should be familiar with this technique, which provides a good technical and oncological result
Carinal resection
Full text linkCarinal resection is defined as the resection of tracheo-bronchial bifurcation, with or without lung parenchyma resection. It represents one of the most challenging areas of airway resection and reconstruction, basically due to the variability in the location and extent of the lesions. Main indications for this procedure are primary tumours of the carina or the distal trachea or, more frequently, bronchogenic carcinoma with carinal involvement. Very different approaches and reconstruction techniques have been experimentally and clinically described in the last 50 years, with some corner stone procedures in the history of modern thoracic surgery. Despite many technical and oncological difficulties encountered in this field, encouraging results have been reported in recent series, in particular an excellent 5-year survival rate of 50% in pN0 patients suffering form carinal infiltration form lung cancer. Several aspects of the multimodality approach to neoplastic carinal involvement still remain debatable like radio-chemotherapeutic approach instead of the extremely rare left carinal pneumonectomy as well as the role of induction treatments before embarking in such demanding procedures, according to the pathological nodal status
The pleural and human fibrin glue sandwich : a quick and effective post-pneumonectomy bronchial stump coverage technique
No full textBackground: Protection of the bronchial stump after pneumonectomy reduces the incidence of bronchopleural fistula. However, which technique provides the most satisfactory results remains open for debate. Materials and Methods: We describe a study in which a bronchial stump coverage technique was performed using 2 layers of human fibrin glue (Tissucol; Baxter, Deerfield, IL USA) with an interposed patch of parietal pleura. From July 2005 to June 2007, this technique was used in 31 consecutive patients after standard pneumonectomy by a single surgeon. Results: None of the patients developed early or late bronchopleural fistula, and no clinical adverse reaction was recorded. During the same period, alternative stump coverage techniques were used by different surgeons in 71 pneumonectomies. In this group, the rate of fistula was 6% (4 patients). Conclusion: These preliminary data demonstrate the feasibility of the technique and suggest that it is at least equivalent to the other type of flaps used. The main advantages of this technique are the restoration of the natural separation between the mediastinum and pleural cavities, as well as the reduced operating time (duration 5 minutes)
Lymph-node dissection for the treatment of lung cancer: sampling or complete nodal dissection?
No full textTracheal and carinal resection for primary adenoid cystic carcinoma
No full textpurpose: Adenoid cystic carcinoma (ACC) is the second most common malignant tumor of
the airway. Complete surgical resection of tracheal or carinal ACC remains the treatment of
choice and is associated with long survival. This video illustrates the imaging studies and the
surgical techniques adopted in 5 different tumor location.
methods: The first two patients presented with an upper and lower tracheal ACC,
respectively. They underwent an en bloc tracheal resection followed by an end-to-end
tracheal anastomosis through a cervico-sternal and a posterolateral thoracotomy, respectively.
In the third case, ACC was located in the left tracheo-bronchial angle: a reverse Barclay
carinal resection through a trans-sternal, trans-pericardial approach was accomplished. In the
fourth patient the ACC involved the right tracheo-bronchial angle and the carina. A large
portion of the lateral wall of the trachea and the carina were removed through a lateral
thoracotomy (LT). The main right bronchus was shaped as a "flute-beak" and anastomosed
to the trachea and the main left bronchus. Finally, an ACC involving the lower left tracheal
wall and the main right bronchus with the carina was removed by a right tracheal sleeve
pneumonectomy by LT.
Results: On 40 carinal resections performed for airway neoplasms, 5 (12.5%) were for ACC.
Neither operative nor major postoperative complications occurred and all patients obtained
an excellent surgical result, survival, and disease free survival ranging from 1 to 72 months.
Only one patient had regional nodal involvement by tumor. Postoperative radiotherapy (PR)
was administered in 3 patients who presented microscopic tumor infiltration of resected
margins.
Conclusions: ACC of the trachea and carina has a good long-term prognosis if treated by
surgical resection. Surgical technique must be individualized according to tumor location.
Patients with tumor infiltration of the surgical margins should receive PR
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