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@#Objective Through the perioperative outcome analysis of da Vinci robot-assisted sleeve lobectomy, to clarify its efficacy and safety. Methods A retrospective analysis was performed on 10 patients with centrally located lung cancer undergoing robot-assisted sleeve lobectomy from March to December 2019 in our center, including 9 males and 1 female, aged 45-67 (55.0±8.9) years. Preoperative imaging and bronchoscopy showed central non-small cell lung cancer, involving the right upper lung in 3 patients, right lower lung in 2 patients, the left upper lung in 4 patients, and left lower lung in 1 patient. The operation time, Docking time, intraoperative blood loss volume, bronchial anastomosis time, number of dissected lymph nodes, drainage volume and postoperative hospital stay were analyzed. Results The da Vinci robot-assisted bronchial sleeve lobectomy was completed smoothly on 10 patients. The operation time was 135-183 (157.8±14.3) min, Docking time 6-15 (10.0±2.9) min, intraoperative blood loss volume 55-250 (124.5±61.8) mL, bronchial anastomosis time 17-40 (27.7±7.3) min, the number of dissected lymph nodes 16-23 (19.7±2.8), the drainage volume 200-600 (348.0±148.4) mL and postoperative hospital stay 7-11 (8.7±1.6) d. All patients had no bronchopleural fistula, pulmonary infection or atelectasis, and there was no perioperative death. Postoperative pathological findings were all squamous cell carcinoma. Conclusion Da Vinci robot-assisted sleeve lobectomy is safe and effective.
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BACKGROUND@#Pneumonectomy and sleeve resection are routine operations for the treatment of central non-small cell lung cancer (NSCLC), but some patients suffered of central NSCLC, whose pulmonary function is too poor to tolerate pneumonectomy, or the tumor involves the bronchus and pulmonary artery extensively,it is hard to perform bronchovascular sleeve lobectomy. The aim of this study is to assess the feasibility of lung autotransplantation in the treatment of central NSCLC.@*METHODS@#The clinical data of 3 cases with central NSCLC treated by lung autotransplantation was reviewed from December 2016 to December 2018. One patient underwent double sleeve resection of left upper lobe with end-to-end anastomosis of the bronchus. Because the resection of the pulmonary artery was too long to perfrom a tension-free anastomosis, the inferior pulmonary vein was cut off, then the left lower lobe was moved up for an anastomosis of the inferior pulmonary vein and the stump of the superior pulmonary vein. In the other 2 cases, left pneumonectomy was performed directly, and the upper left lobe was excised in vitro. The lower left lobe was reset to the chest after trimming and flushing and then the bronchus, pulmonary artery and pulmonary vein were anastomosed in turn.@*RESULTS@#The average operation time was 333 min, the average time of vascular occlusion was 86 min, the average blood loss was 450 mL, and the average hospital stay was 18.7 d; Perioperative complications included a case of bronchial obstruction, which improved after sputum aspiration through bronchofibroscope. The average follow-up period was 20 mon; One case died of cancer, one case had recurrence of anastomotic stoma and brain metastasis, one case had 4R lymph node metastasis (stable condition after chemotherapy), and one case survived without recurrence.@*CONCLUSIONS@#For patients with central NSCLC with extensive tumor invasion, thus inability to tolerate sleeve resection or pneumonectomy, autologous lung transplantation can preserve lung function to the greatest extent with a complete tumor resection and improve postoperative quality of life.
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@#Objective To explore the feasibility of robotic sleeve lobectomy and bronchoplasty and to summarize the experience of quality control and technical process management. Methods From January to December 2018, our hospital completed robotic sleeve lobectomy and bronchoplasty for 5 patients, including the upper right lung lobe in 2 patients, the middle right lung lobe in 1 patient and the lower left lung lobe in 2 patients. There were 3 males and 2 females with an age of 56.6 (39-75) years. The surgical approach was the same as the surgical incision of the robotic lobectomy. During the operation, the lobes were separated, all enlarged mediastinal lymph nodes were cleaned, pulmonary hilum was dissected, pulmonary arteriovenous vessels and bronchi were exposed, and pulmonary vessels were treated. After exposing the main bronchi, the bronchi were cut off at the distal end of the lesion, and the lobes where the lesion was located (including lesions) were excised by sleeve type and the bronchi were continuously sutured with 3-0 Prolene from the back wall for anastomosis. After the anastomosis, no air leakage was found in the expanded lung, and the anastomosis was no longer wrapped. Results The operation time was 147.4 (100-192) min, including bronchial anastomosis time 17.6 (14-25) min. Intraoperative blood loss was 60.0 (20-100) mL, and 20 (9-37) lymph nodes were dissected. Three patients had squamous cell carcinoma, 1 adenocarcinoma, and 1 neuroendocrine tumor. All patients showed negative results in the freezing pathology of bronchial stump during operation. All patients recovered well after surgery, without perioperative complications, and the anastomosis was smooth. Postoperative hospital stay was 10.8 (7-14) days. The patients were followed up for 6 to 12 months without anastomotic stenosis or other complications. Conclusion Since the robot system is a special instrument with 3D vision and 7 degrees of freedom for movable joints, the robotic bronchial suture is more flexible and accurate. The robotic sleeve lobectomy and bronchoplasty are safe and feasible.
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Objective@#To explore the efficacy of thoracoscopic bronchial sleeve lobectomy for central non-small cell lung cancer (NSCLC), and to evaluate the safety of this operation.@*Methods@#The clinical data of 29 patients who underwent thoracoscopic bronchial sleeve lobectomy at Shanxi Provincial Cancer Hospital from May 2015 to September 2018 were retrospectively analyzed, and the surgical effect and safety were analyzed.@*Results@#Twenty-nine cases underwent thoracoscopic bronchial sleeve lobectomy. The types of resection included 13 cases of right upper, 10 cases of left upper, and 6 cases of left lower sleeve lobectomy. The operation time was 180-400 min, and the median time was 240 min. The bronchial anastomosis time was 35-60 min, and the median time was 48 min. The intraoperative blood loss was 150-460 ml, and the median blood loss was 220 ml. The number of lymph node dissection was 12-39 lymph nodes per patient, with a median of 19.6 lymph nodes per patient. The thoracic drainage tube was placed for 4-16 days after operation, with a median of 6 days; the postoperative hospital stay was 6-16 days, with a median of 9 days. The postoperative complication rate was 24.1% (7/29), including 1 case with pulmonary air leakage (> 7 days), 2 cases with pulmonary infections, 3 cases with arrhythmia, and 1 patient discharged from the hospital on the 7th day after surgery, but died of anastomotic fistula bleeding on the 40th day. The rest of the patients recovered smoothly after surgery. The median follow-up time was 6 months (3-12 months). No tumor recurrence or anastomotic stenosis was observed.@*Conclusion@#Thoracoscopic bronchial sleeve lobectomy is a safe and feasible surgical treatment for central NSCLC.
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Objective To evaluate the learning curve of video-assisted thoracoscopic sleeve lobectomy in patients with central lung cancer.Methods A total of 86 consecutive patients with resected central lung cancer in the second department of thoracic surgery of Hunan Cancer Hospital between Apirl 2016 and July 2018 were retrospectively enrolled.Video-assisted tho-racoscopic tracheoplasty with sleeve resection and lobectomy were performed in 56 patients, video-assisted thoracoscopic tra-cheoplasty with wedge resection and lobectomy were performed in 20 patients, and 10 patients transit to thoracotomy.Surgical parameter of patients who underwent video-assisted thoracoscopic sleeve lobectomy were investigated to assess the learning curve, including operation duration, bleeding volume, amount of lymph nodes examined(medianstinal and intrapulmonary). Lowess smoothing method was performed to fit curve to evaluate the variation tendency of surgical parameters .Cut-off point, as well as the confidence interval, were identified using piecewise regression analysis.Results Surgical duration tend to be stable (almost 200 min) when the cumulative case amount of video-assisted thoracoscopic sleeve lobectomy reach 40.Surgical bleed-ing tend to be stable( almost 200 ml) when the cumulative case amount of video-assisted thoracoscopic sleeve lobectomy reach 20.There is no significant correlation between the amount of lymph node harvest and surgical volume .Conclusion The cut-off point for video-assisted thoracoscopic sleeve lobectomy is approximately 40 cases.
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@#Surgery has remained the cornerstone of lung cancer therapy. Sleeve lobectomy, which is featured by not only the maximal resection of tumors but also the maximal preservation of functional lung parenchyma, has been proved to be a valid therapeutic option for the treatment of some centrally located lung cancer . Evidence points toward equivalent oncologic outcomes with improved survival and quality of life after sleeve resections compared with pneumonectomy. However, the postoperative morbidities and the long-term results after sleeve lobectomy remain controversial, especially in relation to nodal involvement and after induction therapy. With the development of technology, minimally invasive procedures have been performed more and more widely.
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Objective Summarize 8 cases of non-small cell lung cancer (NSCLC) that has accepted completely video-as-sisted thoracoscopic sleeve lobectomy in People's Hospital of Peking University in china,to explore the safety,effectiveness indications and experience of this procedure.Methods Between September 2011 and December 2011,Medical records of 8 cases of non-small cell lung cancer that has accepted complete thoracoscopic sleeve lobectomy were reviewed (7 male,1 female).Median patient age was 62.4 years.And median maximal diameter of solid tumors was 2.3 cm.This group consisted of 5 cases of right upper lobe sleeve lobectomy,2 case of left lower lobe sleeve lobectomy and 1 case of left upper lobe sleeve lobectomy.The operation procedure was completely VATS anatomic sleeve lobectomy combined with systematic lymph node resection (at least 3 groups of lymph nodes in the mediastinum area).All procedure were underwent under general anesthesia with double-lumen endotracheal intubation.The patient was placed lateral decubitus position.Three incision were made at the seventh intercostal space on the median axillary line,the fourth intercostal space anterior axillary line and the seventh intercostal space subscapularis line.Bronchial were anastomosed combine with simple continuous suture anastomosis of membranous part of bronchus and simple interrupted suture anastomosis of cartilaginous part of bronchus,and then covered by? Surrounding tissue with blood supply? Results All procedures were carried out smoothly without serious complication.The median operative time was 240min median,the median bronchial anastomosis time was 45 min,the median blood loss was 200 ml,and median number of resected lymph nodes was 19.8.There were no conversion to open thoracotomy.Post operative show pathology squamous cell carcinoma in 7 cases and adenocarcinoma in 1 case.pTNM staging show 1 case of T1a N0 M0,4 cases of T1b N0 M0,2 case of T1b N1 M0 and 1 case of T1b N2 M0.There was 1 case of slight post operative complication.The median postoperative chest tube drainage duration was 7 days,and median postoperative hospital stay was 9 days.All patients were well during the followed up for 3-8 months.Conclusion Completely thoracoscopic sleeve lobectomy was a safe and effective surgical procedure for patients with non-small cell lung cancer; the operative incision placed at the fourth intercostal space anterior on the axillary line was convenient for anastomosis; anastomosis combine with simple continuous suture anastomosis of membranous part of bronchus and simple interrupted suture anastomosis of cartilaginous part of bronchus was a fast and secure mode; keeping azygos vein does not affect the anastomosis.
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La lobectomía pulmonar con broncoplastia (lobectomía en manguito) se introdujo para las resecciones de cáncer pulmonar en pacientes que no toleraban una neumonectomía. Sin embargo, con el paso del tiempo se ha ido consolidando como un procedimiento oncológico, aunque persisten algunas preguntas sin resolver en la literatura.Se presenta el caso de un paciente con cáncer pulmonar al que se le practicó una lobectomía en manguito y se revisa la literatura al respecto, tratando de responder las preguntas sobre la validez de este procedimiento como una cirugía oncológica, los riesgos quirúrgicos y los efectos fisiológicos en la función pulmonar.A pesar de requerir una anastomosis bronquial, la lobectomía en manguito es un procedimiento oncológicamente válido y comparable a una neumonectomía pero con un menor impacto funcional en el pulmón, por lo que se recomienda en los pacientes que anatómicamente la necesitan.
Lung bronchoplastic techniques (sleeve lobectomy) were introduced for patients suffering lung cancer who did not tolerate a pneumonectomy, however with time they are now considered an oncologic procedure but there are still some unanswered questions in the literature.The case of a patient with lung cancer who underwent a sleeve lobectomy and a review of the literature are reported in order to answer the questions about the validity of this procedure as an oncologic procedure, the operative risks and the physiologic effects on lung function.Although a bronchial anastomosis is needed, the sleeve lobectomy is a valid oncologic procedure comparable to a pneumonectomy but without the lung functional impact of this operation, and is recommended for patients which anatomically require it.
Subject(s)
Humans , Bronchial Neoplasms , Carcinoma, Non-Small-Cell Lung , Lung Neoplasms , Pneumonectomy , ThoracotomyABSTRACT
We report a surgical case of primary polymorphous low-grade adenocarcinoma (PLGA) of the minor salivary gland-type of the lung. A PLGA originating from the right upper lobar bronchial inlet was successfully treated by sleeve right upper lobectomy. PLGAs are thought to be indolent tumors that are preferentially localized to the palate, and they affect the minor salivary glands almost exclusively. Until now, two cases of distant metastases to the lung have been reported in the English literature. To the best of our knowledge, only one case of PLGA of minor salivary glandtype of the lung without evidence of a previous oropharyngeal primary tumor has been reported in the English literature. But the case was not a single lesion; it was bilateral tumors accompanied by tumors of the cervical lymph nodes. We report here the first case of a single primary PLGA of the minor salivary gland-type of the lung, which was successfully treated by sleeve bronchial resection of right upper lobe.
Subject(s)
Humans , Female , Aged , Treatment Outcome , Salivary Gland Neoplasms/pathology , Lung Neoplasms/pathology , Bronchi/surgery , Adenocarcinoma/pathologyABSTRACT
Of the 49 patients(male 43, female 6) collected from October 1983 to April 2000, 46 were malignancy with 29 in TNM stage I, 15 in stage II, and 2 in stage Ⅲa. Age ranged from 10～68. Upper lobectomy with sleeve resection was performed in 43 cases(14 in left lung, 29 in right lung) and right upper lobectomy with wedge bronchoplasty in 2 cases, left upper lobectomy with bronchoplasty and angioplasty in 2 cases , left lower lobectomy with sleeve resection in 2 cases. There was no mortality in our group and all patients recovered well. No such major complications as bronchial anastomotic fistula or stenosis occurred. The 1,5 and 10 year survival rates of malignant cases were 93.0%, 48.1% and 8.3% respectively. The results suggested that the operation plan for malignant lung diseases should be made individually. However, instead of a total pneumonectomy, a sleeve lobectomy is sometimes preferabe for the sake of the safety in those with poor cardiopulmonary function to save the lung capacity as much as possible.
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BACKGROUND: Sleeve lobectomy of the main bronchus has been proposed to spare lung tissue in patients who cannot tolerate pneumonectomy because of impaired lung function. The purpose of this study was to evaluate whether sleeve lobectomy can preserve lung function as expected from preoperative evaluation of lung function in patients with non-small cell lung cancer. METHOD: Between January 1995 and March 1998, 15 patients with non-small cell lung cancer who underwent sleeve resection were evaluated. Preoperative evaluations included spirometry and quantitative lung perfusion scan, from which predicted postoperative FEV1 was calculated. At least 3 months after operation follow up spirometry and bronchoscopy were performed. Predicted FEV1 was compared with measured postoperative FEV1. RESULT: Fourteen men and one woman, with median age of 58 years, were reviewed. The diagnosis was squamous cell carcinoma in 13 patients and adenocarcinoma of lung in 2 patients. Our results showed a excellent preservation of pulmonary function after sleeve lobectomy. Correlation between the predicted (mean, 2180 +/- 570mL) and measured FEV1 (mean, 2293 +/- 499mL) was good ( r = 0.67, P< 0.05 ). Furthermore, patient with low FEV1 (<2L) showed improved lung function after sleeve lobectomy. CONCLUSION: These findings indicated a complete recovery of the reimplanted lung lobes after sleeve lobectomy. Therefore, this technique could be safely used in lung cancer patients with impaired lung function.