[Pulmonary intralobar sequestration in adults: Evolution of surgical treatment]. / Séquestrations pulmonaires intralobaires de l'adulte : évolution du traitement chirurgical.

BACKGROUND: Until now, the traditional procedure to treat intralobar pulmonary sequestration (ILS) in adults has been a lobectomy performed by open thoracotomy. We have reviewed our data to observe if the surgical management of these lesions has evolved over the last years. METHODS: We retrospectively reviewed the records of the patients who were operated for an ILS either by posterolateral thoracotomy (PLT group), or by thoracoscopy (TS group) between 2000 and 2016. RESULTS: Eighteen patients were operated for a SIL during this period. Prior to 2011, all resections were performed by thoracotomy (n=6) and after 2011 the surgical approach was either a thoracotomy (n=5) or a thoracoscopy (n=7). There was one conversion because of dense pleural adhesions and this patient was integrated in the PLT group for further analysis. ILS were more frequently encountered on the left side (n=12, 66.6 %) than on the right one (n=6, 33.3 %) and exclusively in the lower lobes. All patients of the PLT group underwent a lobectomy. In the TS group, 5 patients underwent a sublobar resection (2 segmentectomiesS9+10, 1 basilar segmentectomy and 2 atypical resections). There was no mortality. In the PLT group, 5 patients (45 %) had complications versus one patient (14 %) in the TS group. The mean hospital stay was 7.4 days in the PLT group versus 5.4 days in the TS group. CONCLUSIONS: These data confirm that ILS can be safely treated by a sublobar resection that should be performed, whenever possible, thoracoscopically.

[Surgical treatment of early stage non-small cell lung cancer by thoracoscopic segmental resection]. / Traitement chirurgical des cancers bronchiques non à petites cellules (CBNPC) de stade précoce par segmentectomie à thorax fermé : résultats préliminaires.

The rate of segmental resection for early stage non-small cell lung carcinoma (NSCLC) is increasing. However, the indications remain controversial. The aim of this study is to analyze the preliminary results of thoracoscopic segmental resection in early stage NSCLC in terms of morbidity, oncological validity and survival. We report the preliminary results of a consecutive series of 226 thoracoscopic segmentectomies for suspicion of early stage NSCLC. PATIENTS AND METHODS: Between 2007 and 2016, we performed 322 thoracoscopic anatomical sublobar resections (ASLR). Two hundred and twenty six of these were for suspicion of early stage NSCLC in 222 patients. Data were recorded prospectively and analysed retrospectively on an intent-to-treat basis. Overall and disease-free survivals were estimated on a Kaplan-Meier curve and differences were calculated by a log-rank test. RESULTS: Twenty-two patients were upstaged (10.4%), in 10 cases to T3 or T4, in 6 cases to N1 and in 6 others to N2 for metastasis. Out of the 6 N1 cases, 3 were discovered at frozen section and resulted in a switch from segmentectomy to lobectomy. There were 10 conversions to thoracotomy (3.9%). Seventeen patients had a more extensive resection than initially planned (7.5%), most often for oncological reasons: invasion of intersegmental lymph nodes (n=3) or insufficient resection margin at frozen section (n=7). Morbidity and mortality were 25.7% and 1.3 % respectively. For pT1aN0 carcinomas, overall and disease-free survivals were 87.1% and 80.6%, respectively. For pT1bN0 carcinomas, overall and disease-free survivals were 88.8 %, and 75.3% respectively. CONCLUSION: For early stage NSCLC, thoracoscopic ASLR allows reduced perioperative morbidity while offering satisfactory survival. However, a rigorous technique must be applied to reduce the rates of conversion to thoracotomy and extension to lobectomy when required for oncological reasons.

[Intrapulmonary bronchogenic cysts]. / Kystes bronchogéniques intrapulmonaires.

INTRODUCTION: Bronchogenic cysts are congenital malformations that are usually located in the mediastinum. Intrapulmonary location is rare. OBSERVATION: Four cases of intrapulmonary bronchogenic cysts are reported in order to discuss their clinical and radiological presentation and their treatment. CONCLUSION: Intrapulmonary bronchogenic cysts diagnostic is often missed. This condition must however be known so as to foresee a resection in order to prevent a potential complication.