Twenty four-month follow-up after bullectomy, unilateral and bilateral lung volume reduction surgery: a single-center retrospective analysis of consecutive cases.

PURPOSE: While pharmacologic therapy remains the cornerstone of lung emphysema treatment, surgery is an additional therapeutic option in selected patient groups with advanced emphysema. The aim of lung volume reduction surgery (LVRS) is to improve lung function, exercise capacity, quality of life and survival. We sought to determine the therapeutic value of surgical resection in specific patients with lung emphysema. PATIENTS AND METHODS: A retrospective study was performed consisting of 58 patients with lung emphysema who underwent surgical intervention over a 10-year period and were followed for 2 years postoperatively. The clinical characteristics recorded were FEV1 (forced expiratory volume in 1 s), the 6-min walk test (6-MWT), the Modified Medical Research Council (mMRC), body mass index (BMI) and quality of life prior to and 6, 12 and 24 months after surgical intervention. Moreover, all peri- and post-operative complications were noted. RESULTS: Out of 58 emphysema patients (72% male, FEV1 (L) 2.21 ± 0.17, RV (L) 3.39 ± 0.55), 19 underwent surgical bullectomy, 31 unilateral LVRS and 8 sequential bilateral LVRS. Six months after surgery, there was a statistically significant improvement in FEV1, RV, TLC, 6-MWT and mMRC. Over a period of 12 to 24 months postoperatively, clinical benefit gradually declines most likely due to COPD progression but patients still experienced a significant improvement in FEV1. The most common postoperative complications were persistent air leakage (> 7 days), arrhythmia and subcutaneous emphysema in 60%, 51.6% and 22.4%, respectively. No deaths were observed after surgical intervention. CONCLUSION: In a selected patient population, surgery led to significant improvement of lung function parameters, exercise capacity and quality of life. Over a period of 12 to 24 months postoperatively, clinical benefit gradually decreased most likely due to COPD progression.

The role of the diaphragm in prediction of respiratory function in the immediate postoperative period in lung cancer patients using a machine learning model.

BACKGROUND: The prediction of postoperative respiratory function is necessary in identifying patients that are at greater risk of complications. There are not enough studies on the effect of the diaphragm on postoperative respiratory function prediction in lung cancer surgical patients. The objective of this study is to estimate the precision of machine learning methods in the prediction of respiratory function in the immediate postoperative period and how diaphragm function contributes to that prediction. MATERIALS AND METHODS: Our prospective study included 79 patients who underwent lung cancer surgery. Diaphragm function was estimated by its mobility measured both ultrasonographically and radiographically and by noninvasive muscle strength tests. We present a new machine learning multilayer regression metamodel, which predicts FEV1 for each patient based on preoperative measurements. RESULTS: The proposed regression models are specifically trained to predict FEV1 in the immediate postoperative period and were proved to be highly accurate (mean absolute error in the range from 8 to 11%). Predictive models based on resected segments give two to three times less precise results. Measured FEV1 was 44.68% ± 14.07%, 50.95% ± 15.80%, and 58.0%1 ± 14.78%, and predicted postoperative (ppo) FEV1 was 43.85% ± 8.80%, 50.62% ± 9.28%, and 57.85% ± 10.58% on the first, fourth, and seventh day, respectively. By interpreting the obtained model, the diaphragm contributes to ppoFEV1 13.62% on the first day, 10.52% on the fourth, and 9.06% on the seventh day. CONCLUSION: The machine learning metamodel gives more accurate predictions of postoperative lung function than traditional calculations. The diaphragm plays a notable role in the postoperative FEV1 prediction.

Hemoptysis. Is it caused by Pasteurella multocida infection or congenital pulmonary artery anomalies?

INTRODUCTION: Pasteurella multocida colonizes the oropharynx of various domestic and wild animals. In humans, respiratory tract P. multocida infection is the second most frequent localization and usually manifests as pneumonia. Unilateral absence of pulmonary artery (UAPA) is a very rare congenital anomaly. Adult patients with UAPA are usually asymptomatic or their symptoms are nonspecific. CASE REPORT: We report a female patient with hemoptysis admitted to our clinic where we isolated P. multocida in sputum. The organism was also isolated from nasopharyngeal swab of her dog. During hospitalization, she was also diagnosed with UAPA and chronic obstructive pulmonary disease (COPD). DISCUSSION: Respiratory P. multocida infection develops more commonly through contact with animal secretions. It occurs most often in immunocompromised patients and in individuals with comorbidities. Hemoptysis very rarely follows P. multocida infection while it is common in cases of UAPA due to existing developed collateral circulation especially in older patients. CONCLUSIONS: Ceased hemoptysis after adequate treatment and no recurrence of it over six years of following up the patient led us to conclude that the cause of hemoptysis was P. multocida infection and not UAPA which was more likely to be the case.

Comparison of mediastinal lymph node status and relapse pattern in clinical stage IIIA non-small cell lung cancer patients treated with neoadjuvant chemotherapy versus upfront surgery: A single center experience.

BACKGROUND: In spite of the progress made in neoadjuvant therapy for operable non small-cell lung cancer (NSCLC), many issues remain unsolved, especially in locally advanced stage IIIA. METHODS: Retrospective data of 163 patients diagnosed with stage IIIA NSCLC after surgery was analyzed. The patients were divided into two groups: a preoperative chemotherapy group including 59 patients who received platinum-etoposide doublet treatment before surgery, and an upfront surgery group including 104 patients for whom surgical resection was the first treatment step. Adjuvant chemotherapy or/and radiotherapy was administered to 139 patients (85.3%), while 24 patients (14.7%) were followed-up only. RESULTS: The rate of N2 disease was significantly higher in the upfront surgery group ( P < 0.001). The one-year relapse rate was 49.5% in the preoperative chemotherapy group compared to 65.4% in the upfront surgery group. There was a significant difference in relapse rate in relation to adjuvant chemotheraphy treatment ( P = 0.007). The probability of relapse was equal whether radiotherapy was applied or not ( P = 0.142). There was no statistically significant difference in two-year mortality ( P = 0.577). The median survival duration after two years of follow-up was 19.6 months in the preoperative chemotherapy group versus 18.8 months in the upfront surgery group ( P = 0.608 > 0.05). CONCLUSION: There was significant difference in preoperative chemotherapy group regarding relapse rate and treatment outcomes related to the lymph node status comparing to the upfront surgery group. Neoadjuvant/adjuvant chemo-therapy is a part of treatment for patients with stage IIIA NSCLC, but further investigation is required to determine optimal treatment.

Diaphragm motion and lung function prediction in patients operated for lung cancer--a pilot study on 27 patients.

BACKGROUND: The influence of the diaphragm motion to the accuracy of postoperative lung function prediction after the lung resction is still debatable. METHODS: Prospective study that included 27 patients who underwent a lung resection for cancer. Diaphragm movements were assessed radiographically and by ultrasonography before the operation and postoperatively, with the lung fully expanded. The relationship between the diaphragm movements and differences between ppo FEV1 and measured postoperative FEV1, was analysed by expressing diaphragm movements as preoperative diaphragm amplitudes, preoperative-postoperative amplitude differences or in relation to fixed intrathoracic distances. RESULTS: The mean difference between preoperative and postoperative diaphragm amplitudes of the diseased side was 2.42 ± 1.25 cm and 2.11 ± 2.04 cm when measured radiographically and by ultra sound respectively (p > 0.05). A significant positive correlation was found for the entire group only between the patients' height and the differences ppo FEV1 - actual FEV1: the prediction was more unprecise in taller patients. With the cut-off value of 550 ml for differences between ppo FEV1 and actual FEV1, a significant inverse correlation was found only if the preoperative ipsilateral diaphragm amplitude was presented as a percentage of the preoperative apex-base distance in inspiration. For right-sided tumours, the greater the difference between preoperative and postoperative ipsilateral diaphragm amplitudes, the greater discrepancy between predicted and actual postoperative FEV1. For left-sided tumours, inverse correlation existed if the preoperative diaphragm amplitude was presented as a percentage of the preoperative distance apex-base. CONCLUSION: Diaphragm movements influence the accuracy of the postoperative lung function prediction.