1,721,015 research outputs found
Invited commentary - Left atrial resection for T4 lung cancer without cardiopulmonary bypass : technical aspects and outcomes
No full textInvited commentary - Usefulness of fluorine-18 fluorodeoxyglucose-positron emission tomography in management strategy for thymic epithelial tumors.
No full textThe role of endobronchial treatment for bronchial carcinoid : consideration from the thoracic surgeons’s point of view
No full textSURVIVAL AFTER INDUCTION CHEMOTHERAPY ANDS SURGERY IN N2 (MEDIASTINOSCOPY) NSCLC PATIENTS
No full textRedo Tracheal Resection and Laryngotracheal Reconstruction for Recurrent Subglottic Cicatricial Stenosis
No full textA 19-year-old male was referred to the authors’ department from another hospital because of a tight recurrent subglottic stenosis following tracheal resection and reconstruction for subglottic post-intubation stenosis. Several rigid bronchoscopies had already been performed without any effective result. The patient presented with left vocal cord palsy, probably due to previous treatments.
On admission, a rigid bronchoscopy was attempted to dilate the stenosis by laser-assisted mechanical resection. Due to the extent and hardness of the lesion no effective dilation was obtained, preventing placement of a Dumon stent or Montgomery tube.
Following orotracheal intubation with a 5.0 mm tube, the patient underwent redo cervicotomy, as normal subplatysmal anatomy had been modified by previous surgical approaches, a tracheal stoma, and a severe inflammatory reaction. Dissection was carried out along the surface and border of the sternocleidomastoid muscles on either side. Initial dissection was carried up to the level of the cricoid cartilage; inferiorly, cutaneous and platysmal flaps were raised to the sternal notch. The medial margins of the sternohyoid muscles were identified and elevated laterally for a short distance, followed by the sternothyroid muscles. The anterior surface of the trachea was then dissected.
The thyroid was dissected away from the tracheal wall on either side; the substernal plane was bluntly dissected to maximize tracheal mobilization, but without the need for sternal or manubrium division. In the area of stenosis, dissection was kept very close to the scarred portion of the trachea to avoid damaging the recurrent laryngeal nerves. Circumferential dissection of the trachea was performed only at the level of the stenosis, and for no more than 1 to 2 cm above and below that level, to avoid injury to the blood supply that could result in subsequent tracheal necrosis and severe restenosis.
Once the tracheal stenosis was completely isolated, the anesthetist was asked to deflate the cuff on the endotracheal tube. A flexible endotracheal tube with its connectors and sterile anesthesia tubing were clipped into place at the level of the incision, and the proximal anesthesia tubes were passed through the drapes to the anesthetist. The trachea was then divided transversely. The distal trachea was intubated across the operative field, inflating the cuff just enough to obtain a seal. Dissection was completed in areas of difficult scarring until the proximal end of the area of stenosis was reached. Great care was taken proximally when approaching the cricoid cartilage with its severe inflammatory reaction.
Following complete excision of the stenotic tracheal tract, the patient’s neck was put in flexion with the chin approaching the upper sternum. An anastomosis with interrupted 4-0 PDS stitches was commenced with an initial suture posteriorly in the midline of the membranous wall, which passed from outside into the lumen, in either the upper or the lower segment of the trachea, and then from inside to outside in the opposite segment. Sutures were placed approximately 4 mm apart and 3 to 4 mm away from the cut edge of the trachea. When all posterior anastomotic sutures were placed, the endotracheal tube across the field was removed. The orotracheal tube was drawn into the field and positioned beyond the anastomosis, and a guiding catheter was then removed. The anterior defect was sutured. A leak test was performed.
A suction drain was placed in the pretracheal space, and strap muscles were sutured in the midline. The platysma was closed and the skin sutured with subcuticular stitches. Two heavy “guardian” sutures were placed to prevent excessive extension of the neck in the immediate postoperative period. This suture passed transversely through a generous bit of skin in the submental crease and then through the presternal skin. Postoperative flexible bronchscopy confirmed the full patency of the anastomosis.
The patient’s postoperative course was uneventful and he was discharged on postoperative day 14
Salvage tracheal resection for primary tracheal tumor after combined radiotherapy and brachytherapy
No full textA 58-year-old man was admitted to the authors' department for neoplastic cervical trachea obstruction, causing stridor and dyspnoea. The patient had previously undergone a tongue resection and chemo-radiotherapy for squamous cell carcinoma, and lingulectomy for pT2pN0 squamous cell carcinoma. He also underwent an emergency laser-assisted mechanical resection of the occluding lesion by negative-pressure ventilation rigid bronchoscopy for successful normal airway lumen restoration. The patient underwent intensity-modulated radiation therapy and endotracheal brachytherapy. Due to the patient’s refusal, a tracheal resection was not preformed. Restaging PET and CT scans confirmed focal persistent pathological uptake only in the involved tracheal tract. The patient accepted the proposed operation and was scheduled for a tracheal resection after bronchoscopic biopsies confirmed a squamous cell carcinoma. A cervicotomy was performed. The pretracheal planes were sharply and bluntly dissected from adhesions caused by previous radiotherapy. Laryngotracheal release was performed to maximize tracheal mobilization. On the basis of tracheal measurements acquired during pre-operative rigid bronchoscopy, the trachea was proximally transected and separated from the esophagus. The orotracheal tube was then retracted, the tracheal lumen opened, and the involved tract resected. Cross field ventilation was started, followed by proximal ring resection. Laryngeal release was optimized. Airway reconstruction was accomplished by 2/0 PDS running suture of the pars membranacea and 2/0 PDS single stitches on the cartilaginous rings. The endotracheal tube across the field was removed and the orotracheal tube was drawn into the field and positioned beyond the anastomosis. Two more crico-tracheal stitches were placed to reduce tension on the anastomosis. A suction drain was placed in the pretracheal space, and strap muscles were sutured in the midline. The platysma was closed and the skin sutured with subcuticular stitches. Two heavy "guardian" sutures were placed to prevent excessive extension of the neck in the immediate postoperative period. These sutures passed transversely through a generous bite of skin in the submental crease and then through the presternal skin. Postoperative flexible bronchoscopy confirmed the full patency of the anastomosis
Multidisciplinary treatment of malignant thymoma
No full textPURPOSE OF REVIEW:
Thymomas are the most common tumors of the anterior mediastinum. Although surgery remains the only curative treatment, the use of multimodality therapy for primary unresectable thymomas has led to change the clinical management of these tumors.
RECENT FINDINGS:
Nowadays Masaoka stage, WHO, and radical surgical resection are considered by many authors as independent prognostic factors for long-term survival. Radiotherapy may be useful as adjuvant therapy in cases of incomplete surgical resection with microscopic or macroscopic residual disease, or for those patients with locally advanced or metastatic unresectable disease. Chemotherapy is considered a valid option in selected patients with residual disease after local treatments or as a neoadjuvant approach to improve resectability in Masaoka stages III or IV-a thymomas. Currently, no standardized regimen for chemotherapy or agreed timing exists.
SUMMARY:
So far, multimodality treatment has been related to low morbidity and long survival rate, but there are still many concerns regarding a different regimen of therapy and the correct timing
OCCULT N2 DISEASE AFTER SURGICAL RESECTION FOR CLINICAL STAGE I NSCLC:FACTORS AFFETTING SURVIVAL
No full textExtended pulmonary metastasectomy : is it worthwhile?
No full textOBJECTIVE: the role of extended pulmonary resection for lung metastases is still unclear, and very poor information is available in literature. This study was performed to analyze the outcomes and prognostic factors of extended resections for pulmonary metastases.
METHODS: from 1998 to 2013, 1027 patients underwent lung metastasectomy procedures. Twenty nine patients had extended pulmonary resections: 3 resection of the chest wall, 1 azygos, 1 diaphragm, 4 vascular resections/reconstructions, 6 sleeve resections, and 14 pneumonectomies.
RESULTS: extended resection was performed for metastatic disease mainly from epithelial (62.1%) and sarcomatous (20.7%) tumors. Complete resection was obtained in all patients. 30-day operative morbidity and mortality rate was respectively 38% (11/29) and 0%. Only one patient had a major complication due to bronco pleural fistula. The mean duration of hospital stay was 6 days. After a mean follow-up of 51 months, 16 patients (55%) had died. Survival was determined by histology of the primary tumor (p=0.01), and not by number of metastases, nodal status, DFI and extension of surgery (pneumonectomy vs. lobar resection). The actuarial survival after complete extended metastasectomy was 66% at 2 years, 42% at 5 years, and 36% at 10 years.
CONCLUSIONS: Extended resections, which can be performed during pulmonary metastasectomies, were associated with low rates of mortality and morbidity, and an acceptable long-term survival when performed in selected patients amenable to complete resection.2
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