244 research outputs found
Full Thoracoscopic Right Basilar Segmentectomy for Carcinoid Tumor
No full textCarcinoid tumors are often located at the origin of a lobar or segmental bronchus. Stapling the bronchus, as is usually done during a thoracoscopic lobectomy or segmentectomy, creates the risk of damaging or crushing the tumor.This video demonstrates a right basilar segmentectomy for an obstructive carcinoid tumor located at the origin of the basilar bronchial trunk, which required manual cutting and manual suturing of the bronchus. The procedure is performed using a totally thoracoscopic approach with a fissure-based dissection, a deflectable scope, multiple ports, and microinstruments, according to the authors' standard technique.ReferencesGossot D, Lutz JA, Grigoroiu M, Brian E, Seguin-Givelet A. Unplanned procedures during thoracoscopic segmentectomies. Ann Thorac Surg. 2017;104(5):1710-1717.Gossot D, Zaimi R, Fournel L, Grigoroiu M, Brian E, Neveu C. Totally thoracoscopic pulmonary anatomic segmentectomies: technical considerations. J Thorac Dis. 2013;5 Suppl 3:S200-S206.Dr. Gossot is a consultant for the instrument manufacturer Delacroix-Chevalier.</div
Which patients should be operated on after induction chemotherapy for N2 non–small cell lung cancer? Analysis of a 7-year experience in 175 patients
No full textObjective: The role of surgery in patients with N2 non–small cell lung cancer is debated. The aim of this studywas to evaluate the results of surgical resection after induction chemotherapy.Methods: We retrospectively reviewed the cases of patients with N2 non–small cell lung cancer who underwentneoadjuvant chemotherapy followed by resection between 2001 and 2007. They all had tumors deemed resectable.Results: One hundred seventy-five patients entered the study. Most of them received 2 or 3 cycles of chemotherapy(81%), in all cases platinum-based regimens. Chemotherapy response rate was 62%. Operations included 96lobectomies/bilobectomies and 79 pneumonectomies. Complete resection rate was 94%, and perioperative mortalitywas 4.5%. A pathologic mediastinal downstaging was found in 39% of patients. Overall median survivaltime and 5-year survival were 34.7 months and 30%, respectively. Survival was affected by clinical response(median survival time 51 months and 5-year survival 42% for responders versus 19 months and 10% for nonresponders)and by nodal downstaging (51 months and 45%versus 25%and 22%). In the group of responders,nondownstaged patients showed satisfying survival (median survival time 30 months, 5-year survival 30%). Inthe group of nonresponders, survival was unsatisfactory when a lobectomy was performed (median survival time20 months, 5-year survival 13%) and poor in case of pneumonectomy (15 months and 6%). Multivariate analysisfound 4 factors significantly affecting survival: clinical response, nodal downstaging, number of chemotherapycycles, and histopathologic response.Conclusions: Surgery after chemotherapy could be effective for selected patients with N2 non–small cell lungcancer. Survival for responders is satisfactory, even in case of persistent N2 disease. Prognosis for nonrespondersis disappointing
Surgical treatment of bronchiectasis: early and long-term results.
No full textManagement of bronchiectasis remains controversial and information on long-term results of surgical treatment is poor. Clinical records of 45 patients, who underwent surgery for bronchiectasis in an 8-year period, were retrospectively reviewed. Bronchiectasis focus was isolated in 24 cases, associated with a limited homolateral or controlateral focus in 9 and 11, respectively; two patients had bilateral evident foci. Bronchiectasis was responsible for lobe destruction in 23 cases. All patients had symptoms: haemoptysis (n = 7), recurrent pneumonia (n = 7), persistent bronchorrea with recurrent infection (n = 15), hemoptysis and recurrent infection (n = 16). A total of 23 lobectomies, 11 lobectomies+segmentectomies, 2 bi-lobectomies, 9 segmentectomies and 1 pneumonectomy were carried out. There were no perioperative deaths; complications occurred in 5 patients (postoperative pneumonia in 2, prolonged air-leak, residual air-space and bronchial infection 1 each). Symptoms disappeared in 32 patients, 10 patients experienced a significant improvement. Exercise tolerance remained stable or improved in 33 and 2 cases, respectively, a slight impairment was observed in 9. Out of 32 evaluable patients 11 had an unchanged FEV 1, 15 had a limited FEV lowering (<15%), and 9 had a more important functional loss. Surgical treatment of bronchiectasis obtains satisfactory long-term results, with acceptable morbidity rates
Anatomical Landmarks for Anatomical Segmentectomies
No full textThis video addresses a segmental anatomy operation, which is a key point in segmentectomies performed via video-assisted thoracoscopic surgery (VATS) or robotic-assisted thoracoscopic surgery (RATS).
In this case, the anatomical variations of the segmental bronchovascular pedicles were highly variable. Cases of limited vision are often present in the fields of video-assisted and robotics surgery; this case was no exception. As a result, the operation was conducted with the anticipation of bronchovascular pedicle variations. The preoperative study of the anatomy was conducted via 3D modeling or 3D printing, or even by a mixed-reality system. Advanced anatomical studies are a nearly mandatory step in the practice of segmentectomies.
Procedure
The case shown in the video above successively treated the nomenclature of segments and the anatomy of the right upper, middle, left upper, and two lower lobes. In this procedure, the two lower lobes were studied together. The procedure was based on 3D models and intraoperative views derived from 850 thoracoscopic anatomical segmentectomies. The case’s base data was borrowed from the Illustrated Anatomical Segmentectomy for Lung Cancer atlas by Hiroaki Nomori and Morihito Okada.
References
1. Nomori, H. and M. Okada. Illustrated anatomical Segmentectomy for Lung Cancer. Tokyo, Springer-Verlag 2012.
2. Gossot, D. Atlas of endoscopic major pulmonary resections – 3rd edition, Springer-Verlag 2021.
3. Seguin-Givelet A, Grigoroiu M, Brian E, Gossot D. Planning and marking for thoracoscopic anatomical segmentectomies. J Thorac Dis. 2018;10(Suppl 10):S1187-S1194
4. Gossot D, Mariolo AV, Grigoroiu M, Bardet J, Boddaert G, Brian E, Seguin-Givelet A. Thoracoscopic complex basilar segmentectomies: an analysis of 63 procedures. J Thorac Dis. 2021;13:4378-4387
5. Sekine Y, Itoh T, Toyoda T, Kaiho T, Koh E, Kamata T, Hoshino H, Hata A. Precise Anatomical Sublobar Resection Using a 3D Medical Image Analyzer and Fluorescence-Guided Surgery With Transbronchial Instillation of Indocyanine Green. Semin Thorac Cardiovasc Surg. 2019;31:595-60
6. Gossot D, Lutz JA, Grigoroiu M, Brian E, Seguin-Givelet A. Unplanned Procedures During Thoracoscopic Segmentectomies. Ann Thorac Surg. 2017;104:1710-1717</p
PW01-12 - Two or Three Age-of-Onset Groups in Bipolar I Disorder? Findings of Commingling Analysis in Romanian and German Bipolar I Patients
No full textBackgroundAge-of-onset (AO) seems to be a phenotypic variable with a strong genetic component and therefore useful in molecular analysis of bipolar disorder (BP). A debate about the cut-off point for defining early AO has developed over the last few years. Using an Expectation-Maximization algorithm Bellivier et al. (2001) found the best fit for a model with three onset-groups, proposing the age 20-21 as cut-off for early onset, while using the same algorithm Kennedy et al. (2005) found the best fit for a two onset-group model with age 40 as cut-off with an incidence peak for mania in the age-band 21-25. Based on segregation analysis, we proposed a two AO-group model with cut-off age 25 for early onset (Grigoroiu-Serbanescu et al. 2001). The present study aimed at investigating the best AO-model in 500 Romanian BPI and 1458 German BPI patients using commingling analysis (SAGEv6.01-software) (Elston et al, 2009). The best model was selected according to Akaike's Information Criterion (AIC).ResultsThe two AO-group and three AO-group models provided similar AIC-values both in the Romanian and the German sample. The Romanian early-onset group (40% cases) had means around 18 years, SDs=6-7, while in the German early-onset group the mean AO was around 20 years (SDs=9-11) (50% cases). Thus the cut-off for early-onset (X +1SD) was different.ConclusionOur results overlapped with the findings of Kennedy et al (2005) showing that two-curve and three-curve AO mixtures similarly fit the AO-distribution in BPI disorder and the cut-offs for early-onset differ by sample.</jats:sec
[Surgical treatment of early stage non-small cell lung cancer by thoracoscopic segmental resection].
No full textThe rate of segmental resection for early stage non-small cell lung carcinoma (NSCLC) is increasing. However, the indications remain controversial. The aim of this study is to analyze the preliminary results of thoracoscopic segmental resection in early stage NSCLC in terms of morbidity, oncological validity and survival. We report the preliminary results of a consecutive series of 226 thoracoscopic segmentectomies for suspicion of early stage NSCLC.
PATIENTS AND METHODS
Between 2007 and 2016, we performed 322 thoracoscopic anatomical sublobar resections (ASLR). Two hundred and twenty six of these were for suspicion of early stage NSCLC in 222 patients. Data were recorded prospectively and analysed retrospectively on an intent-to-treat basis. Overall and disease-free survivals were estimated on a Kaplan-Meier curve and differences were calculated by a log-rank test.
RESULTS
Twenty-two patients were upstaged (10.4%), in 10 cases to T3 or T4, in 6 cases to N1 and in 6 others to N2 for metastasis. Out of the 6 N1 cases, 3 were discovered at frozen section and resulted in a switch from segmentectomy to lobectomy. There were 10 conversions to thoracotomy (3.9%). Seventeen patients had a more extensive resection than initially planned (7.5%), most often for oncological reasons: invasion of intersegmental lymph nodes (n=3) or insufficient resection margin at frozen section (n=7). Morbidity and mortality were 25.7% and 1.3 % respectively. For pT1aN0 carcinomas, overall and disease-free survivals were 87.1% and 80.6%, respectively. For pT1bN0 carcinomas, overall and disease-free survivals were 88.8 %, and 75.3% respectively.
CONCLUSION
For early stage NSCLC, thoracoscopic ASLR allows reduced perioperative morbidity while offering satisfactory survival. However, a rigorous technique must be applied to reduce the rates of conversion to thoracotomy and extension to lobectomy when required for oncological reasons
Use of Indocyanine Green as a Mark for Intersegmental Plane During Thoracoscopic Segmentectomies: An Apparent Failure
No full textThe use of near-infrared imaging after systemic injection of indocyanine green (ICG) is becoming the method of choice for marking the intersegmental plane during video-assisted segmentectomies. The authors present a short video showing a suspected failure of ICG during a thoracoscopic basilar segmentectomy. A thorough examination of the three-dimensional modelization demonstrated that this was not a failure of the ICG but rather an anatomic variation that had not been previously appreciated.Suggested ReadingGuigard S, Triponez F, Bédat B, Vidal-Fortuny J, Licker M, Karenovics W. Usefulness of near-infrared angiography for identifying the intersegmental plane and vascular supply during video-assisted thoracoscopic segmentectomy. Interact Cardiovasc Thorac Surg. 2017;25(5):703-709.Gossot D, Lutz JA, Grigoroiu M, Brian E, Seguin-Givelet A. Unplanned procedures during thoracoscopic segmentectomies. Ann Thorac Surg. 2017;104(5):1710-1717.</div
Incongruent psychosis in bipolar i disorder: heritability and importance for genetic association studies
No full textIntroductionPhenotype homogeneity and heritability are important conditions for identifying the genetic basis of bipolar I disorder (BPI) in association studies. Our objective was to study the heritability of mood-incongruent psychosis (MIP) in BPI in a sample of 504 families ascertained through BPI probands (294 females; 210 males) recruited from consecutive hospital admissions.MethodThere were 402 families with a psychotic proband and 275 families with a proband with MIP. All probands were directly interviewed as well as 79.55% first-degree and 22.59% second-degree relatives. The narrow and the broad sense heritability (h2) of MIP and the effect of sex and age were estimated using S.A.G.E.v.6.01-software (2009).ResultsThere was no sex difference for the psychosis prevalence in probands but MIP was two times more frequent in females than in males. In families with MIP probands the narrow-sense h2 for MIP was 0.14 (SE = 0.02, P = 0.002) and the broad-sense h2 was 0.20 (SE = 0.014, P = 0.0000). Significant but lower heritabilities were found in families with a psychotic proband (narrow-sense h2 = 0.12; broad-sense h2 = 0.13). In the total sample the narrow-sense h2 was 0.06 (P < 0.005) and the broad-sense h2 was 0.10 (P < 0.00001). The female sex was more prone to incongruency (χ2 = 33.32, P = 0.0000).ConclusionThe heritability of MIP was significant but not high in families ascertained through BPI probands regardless of familial psychopathology. These finding is in line with GWAS-studies showing that the polygenic score fails to differentiate psychotic BPI from non-psychotic BPI. Is therefore incongruent psychosis a useful dimension for association studies?</jats:sec
Selective effect of paternal age on age-of-onset in bipolar i disorder
No full textObjectiveThe study investigated the effect of the parental age on the age-of-onset (AO) in bipolar I disorder (BPI) in connection with proband gender and family history for major psychoses in a directly interviewed sample of 530 BPI probands.MethodAll 530 probands, 73.0% of their first-degree and 22.62% of their second-degree relatives were administered the DIGS and FIGS interviews. The family history (FH) method was used for unavailable relatives. The impact of parental age on proband early/late AO was evaluted through logistic regressions. The commingling analysis (SAGEv6.1-software) was used to determine the cut-off age separating the early/late AO.ResultsWe evidenced a significant influence of the paternal age ≥ 35 years on AO in BPI disorder in the total sample (p = 0.023) and in some subgroups defined by positive/negative FH for major psychoses: the sporadic group (p = 0.035) and the group with FH of recurrent unipolar major depression (Mdd-RUP) (p = 0.041). No effect of the paternal/maternal age on disease AO was found in patients with FH of bipolar/schizoaffective disorders/schizoprenia (BP/SA/SCZ). The global significant effect of the advancing paternal age on the decreasing proband AO was generated by female patients (p = 0.022). No effect of the paternal/maternal age on disease AO was found in male patients. Paternal age was older in fathers of sporadic cases and of cases with FH of Mdd-RUP than in cases with FH of BP/SA/SCZ (p = 0.011).ConclusionWe evidenced a selective effect of the advancing paternal age on bipolar onset depending on offspring gender and type of FH for major psychoses.</jats:sec
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