ABSTRACT
BACKGROUND: Numerous reports have been published on the application of fibrin glues, biological adhesives used as sealants for air leaks after pulmonary resection; however, the use of blood products has been questioned from both safety and economic perspectives. Therefore we were prompted to attempt the use of Integran (method C), a sheet-type absorbable topical collagen hemostat that is neither expensive nor derived from blood. OBJECTIVE: To compare the efficacy of method C with that of method G, a combined approach in which TachoComb or a polyglycolic acid (PGA) sheet was fixed with a fibrin glue in a randomized controlled trial to prevent pulmonary fistula formation after lung surgery. MATERIALS AND METHODS: Of the patients who were scheduled to undergo pulmonary resection in 2006 at the Department of General Thoracic Surgery, Juntendo University, and who provided informed consent for the study before surgery, those who developed visible air leaks during lobectomy, segmentectomy, partial resection for lung tumor or pulmonary cyst, or intractable pneumothorax were included as the subjects of this study. The subjects were randomized for treatment with either of 2 procedures, namely, method C or method G. Pulmonary fistula was defined as an obvious air leak persisting until day 3 after surgery. RESULTS: A total of 38 patients were assigned to method C and 34 to method G. Three patients (7.9%) assigned to method C (including 1 who underwent lobectomy and 2 who underwent partial resection), and 6 (17.6%) patients assigned to method G, including 3 who each underwent a lobectomy and partial resection, developed postoperative pulmonary fistula. The incidence of pulmonary fistula was significantly lower in the group assigned to method C, with a statistically significant difference of p = 0.044. CONCLUSIONS: In a randomized controlled trial of sealing with a sheet-type collagen vs. a combined approach of fixing a collagen sponge, using fibrin glue for closure of air leaks, the use of Integran, a sheet-type absorbable topical collagen hemostat, is feasible to prevent pulmonary fistula after lung surgery. It is also affordable and safe because it is not a blood product.
Subject(s)
Aprotinin/administration & dosage , Collagen/administration & dosage , Fibrin Tissue Adhesive/administration & dosage , Fibrinogen/administration & dosage , Hemostatic Techniques , Hemostatics/administration & dosage , Polyglycolic Acid/administration & dosage , Pulmonary Surgical Procedures/adverse effects , Respiratory Tract Fistula/prevention & control , Thrombin/administration & dosage , Administration, Topical , Dosage Forms , Drug Combinations , Feasibility Studies , Female , Humans , Male , Middle Aged , Respiratory Tract Fistula/etiology , Time Factors , Treatment OutcomeABSTRACT
OBJECTIVE: Chronic dry cough is reported to occur in about 25% of patients following lung cancer surgery. Experimental data suggest that it may be caused mainly by stimulation of C-fibers, which are widely distributed to the lower trachea and bronchi. We assessed the clinical usefulness of suplatast tosilate (IPD) for chronic dry cough after lung cancer surgery. METHODS: The subjects were patients with stage I lung cancer who had undergone lobectomy combined with mediastinal lymph node dissection. IPD was administered orally at 400 mg daily, and its efficacy was evaluated by patient interview 1, 2, and 3 months after the start of treatment. The subjects were 19 patients, and the duration of cough before entering the study was 393.2 days. RESULTS: The response rate was 84.2% (16/19) 1 month after the start of treatment. It seems that IPD inhibits cough resulting from stimulation of the bifurcated trachea with a high content of C-fibers. CONCLUSION: The present study suggested the efficacy of IPD for controlling chronic dry cough after lung cancer surgery.
Subject(s)
Antitussive Agents/therapeutic use , Arylsulfonates/therapeutic use , Cough/drug therapy , Lung Neoplasms/surgery , Pneumonectomy/adverse effects , Sulfonium Compounds/therapeutic use , Administration, Oral , Aged , Aged, 80 and over , Antitussive Agents/administration & dosage , Arylsulfonates/administration & dosage , Chronic Disease , Cough/etiology , Female , Humans , Lung Neoplasms/pathology , Lymph Node Excision , Male , Middle Aged , Neoplasm Staging , Sulfonium Compounds/administration & dosage , Time Factors , Treatment OutcomeABSTRACT
OBJECTIVE: In this retrospective study, we clarified the impact of smoking on prognosis and the association of clinicopathological factors, particularly histologic subtype, in patients with small adenocarcinoma of the lung. METHODS: Between 1996 and December 2006, 121 patients presenting with adenocarcinomas that had a diameter =2 cm were analyzed. The clinicopathological records of the patients were examined for age, gender, nodal status (c-N and p-N), tumor size, serum carcinoembryonic antigen level, histologic subtype, and smoking history. A histologic subtype was defined using a modified World Health Organization classification. These subtypes are bronchioloalveolar carcinoma (BAC), adenocarcinoma with little or no BAC component (Non or min BAC), and mixed bronchioloalveolar carcinoma with other adenocarcinoma components. RESULTS: The overall 5-year survival rates were 94.4% for never-smokers (N = 55) and 79.2% for smokers (N = 66) (p = 0.05). Cancer-specific 5-year survival rates were 98.0% for never-smokers and 80.4% for smokers (p = 0.03). Gender, serum carcinoembryonic antigen level, and histologic subtype were significantly associated with smoking status. Histologic subtype (Non or min BAC) was the only significant prognostic factor in multivariate analyses. The prevalence of smoking by histologic subtype was 27.3% for BAC, 43.2% for mixed bronchioloalveolar carcinoma, and 74.6% for Non or min BAC. The prevalence was significantly higher in Non or min BAC than in the others. Furthermore, the smoking index (daily cigarette consumption times years of smoking) was significantly higher in Non or min BAC than in the other two subtypes. In addition, patients with a high smoking index showed a greater percentage of Non or min BAC subtypes. Finally, male gender was associated with Non or min BAC independent of smoking status (p = 0.03). CONCLUSIONS: When adenocarcinomas were small (diameter =2 cm) cigarette smoking and male gender were associated with Non or min BAC histologic subtypes, which are thought to have more aggressive biologic features resulting in poorer outcome compared with other subtypes.