Third-Degree Atrioventricular Block And Asystole After Lung Resection: A Rare Complication.

Surgical resection remains the optimal therapeutic option for early-stage operable NSCLC. Despite significant advances in recent years related to anesthetic and surgical techniques, cardiopulmonary complications remain major causes for postoperative morbimortality. In this paper we present a case of a patient who developed complete AV block followed by asystole after lung resection surgery. The patient underwent surgery via right VATS and the procedure was uneventful.  On the first post-operative day patient developed a third-degree atrioventricular block followed by 6 seconds asystole. Pharmacological treatment was instituted and implementation of a permanent pacemaker occurred on the third post-operative day, without complications. The remaining postoperative course was uneventful and the patient was discharged home on the sixth post-operative day. It is the objective of the authors to report and highlight this rare and potencial fatal complication of lung resection.

Spreading Through Air Spaces And Thinking About Lung Metastases.

INTRODUCTION: Spread through air spaces (STAS) is a novel pattern of invasion in primary lung cancers, which was introduced in the 2015 World Health Organization classification. Several studies have validated STAS to be a predictor of clinical outcome in lung adenocarcinoma. However, little is known about STAS as a mode of intraparenchymal diffusion of pulmonary metastases (PMs). OBJECTIVES: The aim of this study was to investigate the incidence of STAS among PMs and the association between STAS and clinicopathological characteristics of PMs. METHODS: From August 1, 2017 to July 31, 2022, 50 patients underwent pulmonary metastectomy in our center. Clinicopathological characteristics of patients were retrospectively evaluated. Continuous variables were compared by using unpaired Students t-test or MannWhitney test, as appropriate. Categorical variables were compared by using Qui-squared test or Fishers exact test as appropriate. RESULTS: A total of 50 patients with PMs who underwent surgical resection were analyzed, 68% being male. The median age of the study population was 60 years (range 24-80). Most patients had primary cancer originating from epithelial tissue (n=45) and the remaing from mesenchymal tissue (n=5). Colorectal cancer was the most frequent primary site of PMs (n= 32), followed by kidney (n=4) and osteosarcoma (n=3). 60% of patients (n=30) underwent sublobar resection (wedge resection or anatomic segmentectomy). STAS was observed in 10 patients (20%): 7 patients with PMs from CRC, 1 with PM from palatine tonsil, 1 from kidney and 1 from uterus. STAS was more frequent in elder patients (62 years, SD=7.099 vs 60 years, SD= 13.889; p = 0.034). Notably, STAS was significantly more frequent in PMs with larger dimension (2.8 cm, SD=2.049 vs 2.03 SD=1.104; p = 0.010), patients with lymph node metastases (p = 0.004) and in patients who underwent lobectomy rather than sublobar resection (70% vs 32.5%; p = 0.03). Although without statistically significant difference, locorregional recurrence and mortality was higher in patients with STAS+ (40% vs 22.5% and 40% vs 20%, respectively). CONCLUSION: VSTAS is nowadays considered to be a lung-specific tumour invasion pattern and is commonly observed in PMs of different origins.

VIDEO-ASSISTED THORACOSCOPIC SURGERY WITHOUT CHEST DRAIN PLACEMENT.

BACKGROUND: Placement of chest drain following thoracoscopic procedures has been the gold standard. Nevertheless, a drainless approach may be safe and feasible in selected patients and procedures. In this study we aim to report our clinical experience after drainless video-assisted thoracoscopic surgery. METHODS: We retrospectively analyzed data of all subjects submitted to drainless video-assisted thoracoscopic surgery at our centre between January 1, 2010 and December 31, 2019. The preoperative clinical and surgical data and the immediate postoperative data were retrospectively evaluated through the consultation of the clinical processes and the computer registry system. We used descriptive statistics: mean or median, according to data distribution, and absolute or relative frequencies. RESULTS: We included 161 patients, mean age of 31 years (min:15; max:78). We analyzed data from patients submitted to: thoracic sympathectomy(67.1%), wedge resection, for lung biopsy, metastasis or small nodules resection (21.7%), mediastinal cysts removal (6.2%), pleural lesions resection (3.7%) and emphysematous bullae resection (1.2%). The average length of stay was 1 day. Residual pneumothorax was noted in 15 patients (9.3%). Postoperative pleural drain placement due to pneumothorax occur in 4 patients (2.5%). There was no intra-hospitalar mortality. CONCLUSIONS: Video-assisted thoracoscopic surgery without postoperative chest drain seems to be valid and safe according to our results.

Mini-sternotomy versus full sternotomy aortic valve replacement: a single-centre experience.

BACKGROUND: full sternotomy (FS) is the gold standard approach to perform surgical aortic valve replacement (AVR). However, potential advantages of a less traumatic approach fomented the development of so-called minimally invasive procedures, which include upper mini-sternotomy (MS). OBJECTIVE: to compare immediate postoperative clinical results and mid-term mortality after AVR through MS and FS. METHODS: single-centre retrospective study including all patients who underwent isolated AVR through MS between January 1, 2011 and July 31, 2017. These were then matched with patients who underwent the same procedure through FS and by the same surgeons who performed MS, using coarsened exact matching for the variables age, gender, body mass index and diabetes mellitus. Groups were later characterized and compared regarding postoperative results using Qui- -squared and Mann-Whitney tests and regarding mid-term mortality through Kaplan-Meier curves. RESULTS: we included 82 patients (n=41 in each group). Aortic cross clamp [78 vs. 63 minutes, p=0.001] and cardiopulmonary bypass times [107 vs. 90 minutes, p=0.002] were significantly longer in the MS group vs. FS group, respectively. Although without reaching statistical significant difference, a smaller percentage of patients from the MS group required red blood cells transfusions during surgery (39.0% vs. 53.7%, p=0.184). Similar results were found regarding mechanical ventilation, inotropic support, morphine infusion, intensive care unit length of stay and incidence of de novo atrial fibrillation. Cumulative survival at 6 years was 86.7% after MS and 88.5% after FS (p=0.650). CONCLUSIONS: Aortic valve replacement through MS seems to be a safe alternative to the gold standard FS.

Introdução: a esternotomia completa (EC) é a abordagem gold standard da cirurgia de substituição valvular aórtica (SVA). Contudo, as potenciais vantagens de uma abordagem menos traumática promoveram o desenvolvimento de procedimentos minimamente invasivos, incluindo a mini-esternotomia (ME). Objetivo: comparar resultados clínicos no pós-operatório imediato e mortalidade, após SVA por ME e EC. Métodos: estudo retrospetivo unicêntrico incluindo todos os doentes submetidos a SVA isolada por ME, de 1 de janeiro de 2011 a 31 de julho de 2017, emparelhados com doentes submetidos ao mesmo procedimento, pelos mesmos cirurgiões por EC. Utilizou-se o método de emparelhamento coarsened exact matching para as variáveis idade, género, índice massa-corporal e diabetes mellitus. Os grupos foram caracterizados e comparados quanto aos resultados no pós-operatório imediato através de testes Qui-quadrado e Mann-Whitney e quanto à sobrevida através de curvas de Kaplan-Meier. Resultados: foram incluídos 82 doentes (n=41 em cada grupo). Os tempos de clampagem aórtica [78 vs. 63 minutos, p=0,001] e de circulação extracorporal [107 vs. 90 minutos, p=0.002] foram significativamente superiores no grupo ME vs. EC, respetivamente. Embora a frequência de transfusões sanguíneas durante a cirurgia fosse menor no grupo ME, essa diferença não foi estatisticamente significativa (39,0% vs. 53,7%, p=0,184). Os resultados foram semelhantes relativamente ao tempo de ventilação mecânica, suporte inotrópico, infusão de morfina, tempo de permanência em unidade de cuidados intensivos e incidência de fibrilação auricular de novo. A sobrevida cumulativa aos 6 anos foi de 86,7% após ME e 88,5% após EC (p=0,650). Conclusões: a SVA por ME parece ser uma alternativa segura comparativamente ao gold standard EC.