Video-assisted thoracic surgery for pulmonary aspergilloma: a safe and effective procedure.

BACKGROUND: A variety of complications occur in patients with pulmonary aspergilloma. The safety and feasibility of a thoracoscopic approach to therapeutic lung resection for pulmonary aspergilloma have not been well evaluated. METHODS: The medical records of patients who underwent video-assisted thoracic surgery (VATS) or a thoracotomy for therapeutic resection of pulmonary aspergilloma between January 2005 and December 2012 were retrospectively reviewed for age, sex, indications for surgery, approach and procedures, postoperative pain, operative time, blood loss, hospital stay, cost, and complications. RESULTS: A total of 310 patients underwent thoracotomy, 76 patients underwent attempted VATS lobectomy. Seventy-six patients from 310 patients for thoracotomy were selected and compared with the VATS group. Nine cases (11.8%) in the VATS group were converted to a thoracotomy for the following reasons: bleeding (n =2); dense fibrous adhesions (n =3); fused interlobar fissure (n =2); and hilar lymphadenopathy (n = 2). Lesions treated with pneumonectomy failed to be done using VATS. There was no difference in the blood loss and median operative time between the 2 groups, but the patients with VATS had shorter length of stay in the hospital (p = 0.035) and fewer complications (p = 0.032) than those with thoracotomy. CONCLUSIONS: Video-assisted thoracic surgery is an alternative to open procedures in the management of pulmonary aspergilloma. Simple aspergilloma and complex aspergilloma without infiltration of the hilum are good candidates for VATS resection. Aspergilloma lesions that require a pneumonectomy are still a major challenge for VATS.

Surgical treatment for pulmonary aspergilloma: a 35-year experience in the Chinese population.

The surgical treatment of pulmonary aspergilloma is challenging and controversial. This study was designed to evaluate the clinical profile, indications and surgical outcomes of pulmonary aspergilloma operated on in our institute. A total of 256 patients with pulmonary aspergilloma underwent surgical treatment from 1975 to 2010. The patients were divided into two groups: Group A (simple aspergilloma, n = 96) and Group B (complex aspergilloma, n = 160). The principal underlying lung disease was tuberculosis (71.1%). The surgical procedures consisted of 212 lobectomies in both groups; eight cavernoplasties, 10 bilobectomies, 16 pneumonectomies and six thoracoplasties in Group B; four segmentectomies and six wedge resections in Group A. Postoperative complications occurred in 40 patients (15.6%). The major complications were residual pleural space (3.9%), prolonged air leak (3.1%), bronchopleural fistula (1.6%), excessive bleeding (1.6%), respiratory insufficiency (1.9%) and empyema (1.2%). No intraoperative deaths occurred. The overall mortality within 30 days post-operation was 1.2%, occurring only in Group B. There was no statistically significant difference in the postoperative morbidity between Groups A and B (P = 0.27). With the good selection of patients, meticulous surgical techniques and good postoperative management, aggressive surgical treatment with anti-fungal therapy for pulmonary aspergilloma is safe and effective, and can achieve favourable outcomes.

Reconstruction of the lower trachea using a pedicled autologous bronchial flap.

We describe a technique used in a patient for resection of adenoid cystic carcinoma arising from the left main bronchus and extending along the lateral wall of the lower trachea without carinal invasion. A flap was mobilized from the noninvolved lateral wall of the left main bronchus, which was left attached to the carina. This was used to close the defect in the lower trachea with the implantation of the left main bronchus, avoiding a tracheal sleeve pneumonectomy. Clinical course of this case was good. The pedicled autologous bronchial flap provides reliable material to repair and reconstruct a massive central airway defect.

[Skip metastasis to mediastinal lymph nodes: clinical significance and prognosis in stage III non-small cell lung cancer].

OBJECTIVE: To analyze the significance and prognosis of skip metastasis to mediastinal lymph nodes in stage III non-small cell lung cancer (NSCLC). METHODS: The data of 65 patients who underwent resection for NSCLC with a pN(2)-stage were analyzed retrospectively. Twenty-one of these patients (32.3%), showing no metastatic involvement of hilar (N(1)) lymph nodes, were compared to the remaining 44 patients with infiltration of hilar nodes (N(1)) as well as N(2) nodes. Software SPSS 10.0 was used for statistical analysis. RESULTS: Multivariate analysis showed no statistically significant difference between the skip metastasis and the continuous N(2) group regarding sex, age, histology, location, and T-or M-status. In the skip metastasis group, mediastinal node metastasis was found in >or=2 region in 16 patients (36.4%) and in continuous N(2) group in 2 patients (9.5%, chi(2) = 8.571, P = 0.036). The 5-year survival rate of pN(2) patients with skip metastasis was 41% compared to 21% in patients with involvement of N(1) and N(2) nodes (P = 0.022 6), and the mean survival time was 44 months and 26 months respectively. CONCLUSIONS: pN(2) patients with mediastinal lymph node skip metastasis have a more favorable prognosis compared to pN(2) patients with continuous infiltration of the regional lymph nodes. Skip metastasis is an independent prognostic factor for survival. Skip metastasis may represent a subgroup of pN(2) classification.