The effects of neoadjuvant chemotherapy on pulmonary structures: a quantitative analysis.

BACKGROUND: The effects of neoadjuvant therapy on perioperative and postoperative outcomes of patients with stage IIIA non-small cell lung cancer remain controversial. We investigated histopathological changes possibly caused by neoadjuvant chemotherapy and their effect on the tensile forces of pulmonary structures. METHODS: A prospective study of 30 patients who had undergone lung resection was performed. The patients were divided into two groups. Group 1 included those who received neoadjuvant chemotherapy, and Group 2 included those who underwent surgery alone. Tensile stress tests were performed on freshly excised vascular and bronchial strips after lung resection. The pulmonary artery, veins, and bronchi that had not been invaded by the tumor were histopathologically examined in both groups. Intraoperative and postoperative complications were recorded. RESULTS: This study showed that the tensile strength of pulmonary vessels and bronchi was less in the neoadjuvant group than in the control group. There were statistically significant differences in the tissue strips obtained from arteries, veins, and bronchi between the two groups. In the chemotherapy group, most cases exhibited extensive fibrosis. There was no statistically significant difference in complications between the groups. CONCLUSIONS: Neoadjuvant chemotherapy did not increase postoperative morbidity or mortality. The decreased tensile strength of pulmonary vessels and bronchi after neoadjuvant therapy should alert thoracic surgeons to possible surgical complications.

The effect of blood vessel invasion on prognosis of operated stage I non-small cell lung cancer patients.

OBJECTIVE: A retrospective study was conducted to identify the effect of blood vessel invasion on prognosis in surgically treated stage I non-small cell lung cancer patients. METHODS: A total of 71 consecutive patients who had undergone complete resection for stage I primary non-small cell lung cancer (NSCLC) between 1998 and 2007 were evaluated. All pathological specimens were examined for evidence of blood vessel invasion. The follow-up period was 5-118 months. Survival data were analyzed for all patients using the Kaplan-Meier test. RESULTS: There were 63 men and 8 women (mean age 59.2, age range 35-86). The most common tumor types were adenocarcinoma (35 patients, 49 %) and squamous cell carcinoma (26 patients, 37 %). Twenty-five patients (35 %) had stage IA disease, and 46 had (65 %) stage IB disease. In 13 cases (18 %) blood vessel invasion was demonstrated, whereas in the remaining 58 cases there was no evidence of vascular invasion. Minimum and maximum follow-up periods were 5 and 118 months respectively, with a mean of 41.76 +/- 27 months (median 33.5 months). Overall disease-free survival was 79.6 +/- 6.4 months: 38.3 +/- 12.0 months for the group with blood vessel invasion and 87.5 +/- 6.7 months for the remaining group. The difference between the two groups was statistically significant ( P < 0.003). Overall survival rate was 86.7 +/- 6.7 months: 44.5 +/- 11.3 months for blood vessel invasion group and 98.2 +/- 6.2 months for the remaining group. The difference between the two groups was statistically significant ( P < 0.001). CONCLUSION: Vascular invasion can be an important factor for predicting unfavorable prognosis in stage I NSCLC patients.

Ligasure vessel sealing system versus harmonic scalpel for sutureless nonanatomical pulmonary resections in a rabbit model. Which one is safer?

BACKGROUND: The safety and efficacy of the ligasure vessel sealing system (LVSS) and harmonic scalpel (HS) in sutureless nonanatomical lung resections were evaluated. METHODS: On twenty adult rabbit lungs, 1 x 1 cm wedge resections were performed under one-lung ventilation with both LVSS and HS. The air tightness and tissue damage caused by these different techniques were measured and compared. RESULTS: No statistically significant differences were found when the air tightness for both devices was compared after resection (p = 0.37). Tissue damage was obtained for LVSS, and the difference was statistically significant (p < 0.001). discussion: LVSS and HS can both be used for peripheral lung resections without any need of further intervention for securing the air tightness. LVSS was found safer by means of tissue damage when compared with HS in this experimental study.

Comparison of the harmonic scalpel and the ultrasonic surgical aspirator in subsegmental lung resections: an experimental study.

BACKGROUND: In this study, we evaluated the effectiveness of two devices using ultrasonic energy for dissection of lung parenchyma in an experimental animal model by comparing the two methods with each other. METHODS: Twenty New Zealand rabbits were used. One-lung ventilation was obtained under direct vision and the left lung was collapsed. The rabbits were ventilated with pressure-controlled ventilation during the experiment, beginning with a pressure level of 10 cmH(2)O. After a 1 x 1-cm pulmonary wedge resection of part of the collapsed left lung using a harmonic scalpel (group A) or an ultrasonic surgical aspirator (group B), the left lung was inflated and the pressure level was increased by 5 cmH(2)O every five minutes. The pressure level which caused an air leak from the resection surface was recorded. The morphological damage to the lung parenchyma was evaluated under light microscopy. RESULTS: The mean value of airway pressure levels that resulted in an air leak from the resection surface was 32.5 +/- 9.2 cmH(2)O for group A and 24.5 +/- 2.9 cmH(2)O for group B, and the difference between the two groups was statistically significant. The mean level of coagulation necrosis was 558.6 +/- 380.8 microns (133 - 1064 microns) for group A. No tissue damage to pulmonary parenchyma was observed in group B. CONCLUSION: The harmonic scalpel can be safely used in peripheral lung resections without needing any other method to ensure hemostasis and air tightness. The ultrasonic surgical aspirator can be used for the dissection and resection of deeper lesions and preserves more lung tissue but requires additional interventions for control of the air leak from the resection surface.

The efficacy of intrathecal morphine in post-thoracotomy pain management.

This study compared the analgesic efficacy of intrathecal (IT) morphine plus IV patient-controlled analgesia (PCA) morphine with IV PCA morphine alone in 33 patients undergoing thoracotomy randomized to two groups: the IT morphine group (n=17) received 10 microg/kg morphine 1 h before the end of surgery, while the control group (n=16) did not. All patients had access to an IV PCA pump post-operatively that delivered 2 mg morphine boluses. Post-operative pain and sedation scores, respiratory and haemodynamic parameters, and morphine demand and delivery were assessed up to 48 h. Post-operative pain scores and morphine consumption were significantly reduced, while peak expiratory flow rates were significantly increased in the IT morphine group compared with controls. We concluded that IT morphine in addition to IV PCA established superior analgesia and maintained better respiratory function compared with IV PCA alone in post-thoracotomy patients.

Experimental use of N-butyl cyanoacrylate tissue adhesive on lung parenchyma after pulmonary resection.

BACKGROUND: The aim of this study was to investigate the effectiveness of N-butyl cyanoacrylate tissue adhesive for the prevention of air leak together with the morphological changes to lung parenchyma. METHODS: Twelve New Zealand rabbits were used. The rabbits were ventilated with pressure-controlled ventilation during the experiment, beginning with a pressure level of 10 cm H (2)O. After a 2 x 2-cm pulmonary wedge resection, the resection surface was sealed with N-butyl cyanoacrylate and the pressure level was increased every five minutes in 5-cm H (2)O increments. The pressure level which caused an air leak from the resection surface was recorded. The morphological damage to the lung parenchyma was evaluated under light microscopy. RESULTS: The mean value of the pressure levels that caused air leak was 43.3 +/- 8.8 cm H (2)O. No tissue damage to lung parenchyma was recorded after histopathological examination. CONCLUSION: N-butyl cyanoacrylate was effective in preventing air leak from the pulmonary resection surface even with high airway pressure levels. It could be used as an aid for pulmonary resection lines or to control the air leak from pulmonary parenchyma.