Obesity in cases undergoing the surgical procedure of lung lobectomy: risk or benefit?

SUMMARY OBJECTIVE: The aim of the study was to evaluate the effect of body mass index on patients' short-term results following lung lobectomy. METHODS: In this retrospective study, we compared the perioperative and short-term postoperative results of obese (BMI≥30 kg/m2) versus non-obese patients (BMI<30 kg/m2) who underwent anatomical lung resection for cancer. The two groups had the same distribution of input risk factors and the same ratio of surgical approaches (thoracoscopy vs. thoracotomy). RESULTS: The study included a total of 144 patients: 48 obese and 96 non-obese patients. Both groups had the same ratio of thoracoscopic vs. thoracotomy approach (50/50%), and were comparable in terms of demographics and clinical data. The g roups did not significantly differ in the frequency of perioperative or postoperative complications. Postoperative morbidity was higher among non-obese patients (34.4 vs. 27.1%), but this difference was not statistically significant (p=0.053). Hospital stay was similar in both study groups (p=0.100). Surgery time was significantly longer among obese patients (p=0.133). Postoperative mortality was comparable between the study groups (p=0.167). CONCLUSIONS: Obesity does not increase the frequency of perioperative and postoperative complications in patients after lung lobectomy. The slightly better results in obese patients suggest that obesity may have some protective role.

Segmentectomy of early stage lung cancer: From technology to clinical research / 中国胸心血管外科临床杂志

@#Segmentectomy is the removal of certain segments of the lung with lesions and retaining the normal lung tissue of the lobe. Lung segmentectomy is considered difficult due to the lack of clear anatomical boundaries between lung segments. Segmentectomy has a variety of indications, such as lung cancer, metastatic lung tumors, and many non-malignant diseases. In the treatment of early stage lung cancer, segmentectomy was initially considered only as a treatment option for patients not suitable for conventional lobectomy. As more evidence emerged, the indications for segmentectomy have continued to change over time, and segmentectomy has been widely performed in patients with early stage lung cancer. Theoretically, segmentectomy leads to better preservation of lung function than lobectomy, but the risk of incomplete tumor resection is higher, so the indication of segmentectomy has become a focus of debate. This article will introduce the surgical techniques of segmentectomy and summarize the published and unpublished clinical studies on segmentectomy for the treatment of early stage lung cancer.

Retrospective Analysis of Single Closed Chest Drainage in Superior Lobectomy of Lung Cancer / 中国肺癌杂志

BACKGROUND@#There is no consensus on one or two chest drains closed chest drainage in superior lobectomy of lung cancer and mediastinal lymph node dissection. This study investigated the postoperative complications about drainage and evaluated the effectiveness.@*METHODS@#We retrospectively reviewed the clinical data of patients with single closed chest drainage in superior lobectomy of lung cancer and mediastinal lymph node dissection of Beijing Friendship Hospital between April 2012 and May 2017, and evaluated the effectiveness.@*RESULTS@#From the available data of 301 patients, the complication rate after superior lobectomy was 9.3%, and the complication rate of drainage after superior lobectomy was 5.64%.@*CONCLUSIONS@#The effectiveness of drainage of single closed chest drainage in superior lobectomy of lung cancer and mediastinal lymph node dissection is no less than double drainage.

Application of three-dimensional simulation technique in the thoracoscopic lobectomy / 中国胸心血管外科临床杂志

@#Objective    To analyze the effect of 3D simulation technique in thoracoscopic lobectomy. Methods    From June 2015 to January 2018, 124 patients with left lower lobe resection underwent thoracoscopy with single-port thoracoscopic surgery, including 64 males and 60 females, aged 42–83 years. They were randomly divided into two groups including an experimental group (preoperatively given 3D simulation surgery in 59 patients) and a control group (preoperatively not given 3D simulation surgery in 65 patients). The clinical effect between the two groups was compared. Results    All patients recovered without any death during hospitalization. In the experimental group, the operation time, intraoperative blood loss and postoperative hospital stay were significantly less than those in the control group (P<0.05). There was no significant difference in postoperative drainage volume, and duration of drainage tube retention and analgesic drug usage between the two groups (P>0.05). Conclusion    3D simulation technique for thoracoscopic lobectomy has advantage in short operation time, minor trauma and quick recovery. It has a guiding role in the preoperative planning of lung cancer surgery and is worthy of popularization and application.

Comparison of the effects of isoflurane versus propofol-remifentanil anesthesia on oxygen delivery during thoracoscopic lung lobectomy with one-lung ventilation in dogs

This study compared effects of isoflurane inhalation (ISO) and propofol-remifentanil combined total intravenous anesthesia (TIVA) on oxygenation during thoracoscopic lung lobectomy with 30-min one-lung ventilation (1LV). Thoracoscopic right middle lung lobectomy was performed in ten dogs divided into ISO and TIVA groups, and cardiopulmonary parameters were measured with blood gas analysis. Throughout the study, isoflurane was inhaled up to 1.5%, and the infusion rates of propofol and remifentanil were 0.2 to 0.4 mg/kg/min and 6 to 11 µg/kg/h, respectively. Cardiac index was not affected in the ISO group, but it increased during 1LV in the TIVA group. There were significant alterations in arterial oxygen pressure, arterial oxygen saturation, oxygen content, and shunt fraction associated with 1LV in each group. However, oxygen delivery did not decrease significantly due to open chest condition, 1LV, or surgical maneuver in either group, rather it increased during 1LV in the TIVA group. All parameters showed no significant difference between groups. Pulmonary vascular resistant index was unaffected in both groups, and there was no difference between groups except in re-ventilation phase. Accordingly, the effect of both anesthetic regimens on oxygenation was not different between groups and can be used with short-term 1LV for thoracoscopic lung lobectomy in dogs.

Dieulafoy's disease of the bronchial tree: a case report / Doença de Dieulafoy da árvore brônquica: relato de caso

ABSTRACT CONTEXT: Dieulafoy's disease of the bronchial tree is a very rare condition. Few cases have been reported in the literature. It can be asymptomatic or manifest with massive hemoptysis. This disease should be considered among heavy smokers when recurrent massive hemoptysis is present amid otherwise normal findings. The treatment can be arterial embolization or surgical intervention. CASE REPORT: A 16-year-old girl was admitted to the emergency department due to hemoptysis with an unknown lesion in the bronchi. She had suffered massive hemoptysis and respiratory failure one week before admission. Fiberoptic bronchoscopy revealed a lesion in the bronchus of the right lower lobe, which was suspected to be a Dieulafoy lesion. Segmentectomy of the right lower lobe and excision of the lesion was carried out. The outcome for this patient was excellent. CONCLUSION: Dieulafoy's disease is a rare vascular anomaly and it is extremely rare in the bronchial tree. In bronchial Dieulafoy's disease, selective embolization has been suggested as a method for cessation of bleeding. Nevertheless, standard anatomical lung resection is a safe and curative alternative.

RESUMO CONTEXTO: A doença de Dieulafoy da árvore brônquica é uma condição muito rara, poucos casos foram descritos na literatura. Pode ser assintomática ou manifestar-se com hemoptise maciça. Esta doença deve ser considerada em fumadores pesados quando eles têm recorrentes hemoptises maciças sem outros achados anormais. O tratamento pode ser tanto embolização arterial como intervenção cirúrgica. RELATO DE CASO: Uma menina de 16 anos foi admitida no Serviço de Urgências devido a hemoptise com uma lesão nos brônquios de origem desconhecida. Havia sofrido hemoptise maciça e insuficiência respiratória uma semana antes da admissão. A broncoscopia de fibra óptica relevou lesão no brônquio do lobo inferior direito, com suspeita de ser lesão de Dieulafoy. Foi realizada uma segmentectomia do lobo inferior direito com excisão da lesão. O resultado da paciente foi excelente. CONCLUSÃO: A doença de Dieulafoy é uma anomalia vascular rara, sendo extremamente rara na árvore brônquica. Na doença de Dieulafoy bronquial, embolização seletiva tem sido sugerida como método para cessação do sangramento; no entanto, a habitual resseção anatômica do pulmão é uma alternativa segura e curativa.

Lobectomy versus Sublobar Resection in Non-Lepidic Small-Sized Non-Small Cell Lung Cancer

BACKGROUND: Recently, many surgeons have chosen sublobar resection for the curative treatment of lung tumors with ground-glass opacity, which is a hallmark of lepidic lung cancer. The purpose of this study was to evaluate the oncological results of sublobar resection for non-lepidic lung cancer in comparison with lobectomy. METHODS: We conducted a retrospective chart review of 328 patients with clinical N0 non-small cell lung cancer sized ≤2 cm who underwent curative surgical resection from January 2009 to December 2014. The patients were classified on the basis of their lesions into non-lepidic and lepidic groups. The survival rates following lobectomy and sublobar resection were compared within each of these 2 groups. RESULTS: The non-lepidic group contained a total of 191 patients. The 5-year recurrence-free survival rate was not significantly different between patients who received sublobar resection or lobectomy in the non-lepidic group (80.1% vs. 79.2%, p=0.822) or in the lepidic group (100% vs. 97.4%, p=0.283). Multivariate analysis indicated that only lymphatic invasion was a significant risk factor for recurrence in the non-lepidic group. Sublobar resection was not a risk factor for recurrence in the non-lepidic group. CONCLUSION: The oncological outcomes of sublobar resection and lobectomy in small-sized non-small cell lung cancer did not significantly differ according to histological type.

Effect of high-altitude exposure on safety of complete video-assisted thoracoscopic surgery lobectomy in elderly patients with non-small cell lung cancer and analysis of prognosis / 肿瘤

Objective: To investigate the effect of high-altitude exposure (above altitude of 2 000 meters) on safety of c-VATS (complete video-assisted thoracoscopic surgery) lobectomy in elderly patients (> 60 years) with NSCLC (non-small cell lung cancer) and analysis of prognosis. Methods: Matched case-control study was performed to recruit 49 elderly NSCLC patients receiving c-VATS lobectomy and 49 matched (according to clinical staging and histology) elderly NSCLC patients receiving COT (conventional open thoracotomy) lobectomy in high-altitude area between January 1, 2010 and December 31, 2010. The perioperative variables including operative time, intraoperative blood loss, duration of postoperative chest tube placement, postoperative pleural effusion, time to suture removal, length of hospitalization, postoperative incisional pain rating and complication rate were compared between c-VATS lobectomy group and COT lobectomy group. The variables of pulmonary function and arterial blood gas tests before and six months after operation were also compared between the two groups. The follow-up was conducted. The one- and two-year survival rates were calculated and compared between the two groups. Results: The operative time was longer in c-VATS lobectomy group than in COT lobectomy group (P 0.05). Conclusion: Compared with COT lobectomy, elderly NSCLC patients who undergo c-VATS lobectomy may have less trauma, bleeding and damage of pulmonary function, fewer complications, and more rapid recovery. These results reveal a clinical significance of application of c-VATS lobectomy in high-altitude area. Copyright © 2013 by TUMOR.

Conducta anestésica en un lactante con enfisema lobar congénito / Behavior of anesthesia in an infant with congenital lobar emphysema

Se presenta el caso clínico de un lactante con enfisema lobar congénito, tratado en el Hospital Infantil Sur de Santiago de Cuba con antecedentes de cuadros respiratorios recurrentes y varias hospitalizaciones previas. Inicialmente ingresó con bronconeumonía y disnea, por lo que se sospechó la presencia de un neumotórax, pero mediante estudios radiológicos se obtuvo el diagnóstico definitivo y se decidió aplicarle tratamiento quirúrgico. En el período intraoperatorio tuvo una complicación cardiovascular (bradicardia extrema), que fue tratada con las medidas adecuadas (oxígeno a 100 %, masaje cardíaco directo y sulfato de atropina), las cuales permitieron una evolución posoperatoria satisfactoria en la Unidad de Cuidados Intensivos Pediátricos.

The case of an infant with congenital lobar emphysema is reported, who was treated in the Southern Children Hospital of Santiago de Cuba with history of recurrent respiratory symptoms and several previous hospitalizations. Initially he was admitted with bronchopneumonia and dyspnea, and the presence of pneumothorax was suspected, but a definitive diagnosis was obtained by radiological studies and surgical treatment was decided. In the intraoperative period he had a cardiovascular complication (extreme bradycardia), which was treated with appropriate measures (100 % oxygen, direct heart massage and atropine sulfate), which allowed a satisfactory postoperative course in the Pediatric Intensive Care Unit.

The Effect of a Breathing Exercise Intervention on Pulmonary Function after Lung Lobectomy / 종양간호학회지

PURPOSE: The aim of this study was to evaluate the effect of a breathing exercise intervention by measuring pulmonary function test (PFT) three times; preoperative, 3rd and 5th day after operation. METHODS: This study was designed as a non-equivalent control group pretest-posttest design. A total of 55 patients with lung cancer were recruited from a Chonnam university hospital in Hawsun-gun, Korea from January to December 2008. RESULTS: 'Forced Vital Capacity (FVC)' and 'Forced Expiratory Volume in 1 second (FEV1)' were significantly improved in the experimental group than those in the control group (p<.05). CONCLUSION: Breathing exercise intervention was found to be effective in improving pulmonary function among lung cancer patients underwent lung lobectomy. Thus, the breathing exercise can be applied in hospitals and communities for patients with lung cancer as one of the nursing intervention modalities for their better postoperative rehabilitation.

Aspergillosis in Liver Transplant Recipients: A Single Center Experience

PURPOSE: The aim of this study was to review the epidemiology, clinical features, diagnosis, and effect of treatments of aspergillosis infections in adult liver transplantation patients. METHODS: We retrospectively studied the cases of aspergillosis among 625 (164 deceased donor liver transplantation (DDLT), 461 living donor liver transplantation (LDLT)) adult liver transplantation recipients (> or =18 yrs old) operated between May 1996 to May 2008. RESULTS: Fourteen cases of aspergillosis infection were detected, which consisted of 9 cases of invasive aspergillosis, 5 cases of aspergilloma in maxillary sinuses which occurred before the transplantation. One patient with invasive aspergillosis, who had received liver transplantation overseas and had post-operation care in our center, was also included. Among the 8 cases (1.28%) of invasive aspergillosis (excluding one case operated overseas), 6 cases (3.7%) were DDLT and 2 cases (0.4%) LDLT (P-value<0.05). Among the 6 patients with early onset of invasive aspergillosis, 5 patients (1.8%) had fluconazole and only 1 patient (0.3%) had itraconazole as prophylactic antifungal agent (P-value<0.05). The three cases with localized lesions in the lung survived after lobectomy, but the disseminated and inoperable cases died. CONCLUSION: The incidence of invasive aspergillosis was lower in LDLT cases and prophylactic itraconazole might be more effective than fluconazole. Paranasal aspergilloma, detected before transplantation had no relation with posttransplant invasive aspergillosis infection. Patients who had localized lesion in the lung, and underwent surgery had better survival than who could not.

The effect of two modes of one-lung ventilation on lung lobectomy in pediatric patients / 重庆医科大学学报

Objective: To investigate the effect of two modes of one-lung ventilation(OLV) on lung lobectomy in pediatric patients.Metheds: Twenty ASA Ⅰ-Ⅱ patients(8 male,12 female) aged 2~14 year,weighing 10~30 kg,and undergoing lung lobectomy were enrolled in this study.The patients were premedicated with intramuscular Sod Luminal 3~5 mg/kg and Atropine 0.01 mg/kg im,30 minutes before induction.Induction was performed with Dorcum 0.1 mg/kg,Fentanyl 5 ?g/kg and Vecuronium 0.1 mg/kg,maintained with Vecuronium 70 ?g/(kg?h) and Propofol 5mg/(kg?h) iv boluses.Ordinary tracheal tube was inserted into bronchus(14right,6 left) during OLV.First,OLV with volume-control mode maintained 25 min,and then,OLV with pressure-control mode was performed.In first step Vt was set at 8~10 ml/kg and respiratory rate was adjusted to maintain PetCO2 between 30~40 mmHg.In second step the inspiratory pressure was set according to the plateau pressure during step 1,hemodynamics and PaO2 were measured and recorded.Results : During OLV with pressure-control mode PaO2 was significantly increased,as compared with that during volume-control mode(P