Carinal resection and reconstruction: now and in the future.
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ABSTRACT:
SUBMITTER: Matsuura N
PROVIDER: S-EPMC8577976 | biostudies-literature | 2021 Oct
REPOSITORIES: biostudies-literature
Publications
Carinal resection and reconstruction: now and in the future.
Matsuura Natsumi N Igai Hitoshi H Kamiyoshihara Mitsuhiro M
Translational lung cancer research 20211001 10
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Project description: Not available
| S-EPMC8512463 | biostudies-literature
Project description:ObjectivesA rare and complex procedure, total lung sparing left secondary carinal resection and reconstruction is only performed in a few specialized centers in a restricted group of patients. We reviewed our experience to evaluate its safety.MethodsPatients who underwent left secondary carinal resection and reconstruction with complete lung parenchymal preservation for low-grade bronchial malignancies at the Shanghai Chest Hospital and the Padua University Hospital were retrospectively reviewed. Clinicopathologic factors and perioperative outcomes were analyzed.ResultsThirty patients underwent the procedure between July 2012 and July 2019 (mean age, 42.9 years). No operative mortality occurred and postoperative complications developed in 4 patients (13.3%), including pneumonia (n = 3 [10.0%]), subcutaneous emphysema (n = 2 [6.7%]), and prolonged air leak (n = 2 [6.7%]). Pathologies included adenoid cystic carcinoma (n = 11), mucoepidermoid carcinoma (n = 6), carcinoid tumors (n = 9 [8 typical and 1 atypical subtypes]), inflammatory myofibroblastic tumor (n = 3), and myoepithelioma (n = 1). The margins were positive in 8 patients (26.7%), whereas 2 patients (6.7%) had positive lymph nodes. Adjuvant therapies were performed postoperatively, including chemoradiotherapy for positive lymph nodes and radiotherapy for positive margins.ConclusionsTotal lung sparing left secondary carinal resection and reconstruction can be performed safely in well-selected and oncologically appropriate patients with low-grade bronchial malignancies.
| S-EPMC8350885 | biostudies-literature
Project description:BackgroundCarinal resection, performed in only a few high-volume centers, remains one of the most complicated and technically demanding surgeries. Few studies have examined the outcomes of carinal resection and reconstruction with complete pulmonary parenchyma preservation.MethodsPatients who underwent isolated carinal resection and reconstruction at the Shanghai Chest Hospital between 2006 and 2020 were retrospectively reviewed. Clinicopathological, perioperative, and follow-up outcomes were analyzed.ResultsA total of 36 patients were included, including 19 men and 17 women. The average age was 50.7±14.8 years. Right posterolateral thoracotomy (n=33, 91.7%) and cross-field intubation during anastomosis (n=31, 86.1%) were selected for the majority of the carinal surgeries. The average intraoperative blood loss was 225.0 mL, and the mean operation duration was 196.1 minutes. Postoperative complications were observed in 14 patients (38.9%), including cicatricial stenosis (n=8, 22.2%), anastomotic fistula (n=3, 8.3%), air leak (n=1, 2.8%), cardiac arrhythmia (n=4, 11.1%), pneumonia (n=2, 5.6%), respiratory failure (n=1, 2.8%), and pulmonary embolism (n=1, 2.8%). There were 2 perioperative deaths (5.6%). Multivariate analysis revealed that being overweight was an independent favorable factor for postoperative complications [P=0.042, odds ratio (OR) =0.092, 95%, confidence interval (CI): 0.009-0.922]. Pathological diagnoses included squamous cell carcinoma (SCC) (n=12, 33.3%), adenoid cystic carcinoma (ACC) (n=15, 41.7%), mucoepidermoid carcinoma (MEC) (n=2, 5.6%), stricture (n=1, 2.8%), and other rare histological types. An R0 resection was achieved in 14 patients, while 21 patients (60.0%) had microscopically positive margins. Lymph node metastasis was confirmed in 6 patients (17.1%). Overall survival (OS) was 94.4% at 1 year and 79.4% at 5 years, with 107 months as the median survival time (95% CI: 64.0-150.0 months). All patients with negative margins remained alive during the follow-up period, while those who received R1 resections had much poorer survival rates due to tumor recurrence [P=0.042, hazard ratio (HR) =4.938, 95% CI: 1.062-22.950].ConclusionsIn selected patients, carinal resection and reconstruction with complete pulmonary parenchyma preservation was a feasible option to achieve an appreciable long-term survival at the risk of acceptable operative mortality and morbidity, particularly when complete resection with negative margins could be realized.
| S-EPMC8743516 | biostudies-literature
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| S-EPMC8674613 | biostudies-literature
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| S-EPMC8674610 | biostudies-literature
Project description:Surgical resection is currently the mainstay of treatment for tracheobronchial mucoepidermoid carcinoma (TMEC). The parenchymal sparing secondary carinal resection and reconstruction for TMEC under the uniportal thoracoscopic approach has seldomly been reported in the literature. Here, we report a case of a 42-year-old male patient complaining of the incidental finding of a 1.5 × 1.2 cm neoplasm at the opening of the right bronchus intermedius and a 5.1 × 3.1 cm patchy lesion located at the left upper lobe by chest CT scans in February 2021. This patient successively underwent fiberoptic bronchoscopic biopsy of the bronchial neoplasm and CT-guided biopsy of the left upper lobe lesion. Pathological examination confirmed the diagnosis of the endobronchial mass in the right bronchus intermedius as low-grade mucoepidermoid carcinoma and left upper lobe lesion as tuberculosis. This patient successfully underwent uniportal thoracoscopic parenchymal sparing tumor resection, reconstruction of the secondary carina and lymphadenectomy at our center. Intraoperative frozen section showed no residual cancer at any bronchial stumps. Postoperative pathology indicated that no metastases were seen in any of the resected lymph nodes. The patient recovered well after surgery. He received a 9-month course of anti-tuberculosis treatment postoperatively. He did not complain of any special discomfort and there was no local recurrence at the 9-month postoperative follow-up. Although technical demanding, this case highlights that uniportal video-assisted thoracoscopic parenchymal sparing secondary carinal resection and reconstruction for TMEC is safe and feasible with the preservation of lung function and excellent outcomes.
| S-EPMC8803630 | biostudies-literature
Project description: Not available
| S-EPMC9938368 | biostudies-literature
Project description:BackgroundCross-field ventilation is used as a conventional choice during carinal resection and anastomosis, but may interfere with surgical procedures. High-frequency jet ventilation (HFJV) allows for control of oxygenation in the open airways; nevertheless, there is a paucity of data to support its benefits versus cross-field ventilation. Herein, we aimed to investigate the efficacy of HFJV on intraoperative oxygen saturation compared with cross-field ventilation in patients undergoing carinal surgeries.MethodsWe conducted a retrospective analysis of 82 adults who underwent carinal resection and reconstruction (CRR) for benign or malignant diseases and received cross-field ventilation or HFJV at Shanghai Chest Hospital between January 2018 and September 2021. Patients were excluded when they had emergency surgeries or critical airway stenosis requiring extracorporeal life support, or limited resection without the need for cross-field ventilation or HFJV. Patients were classified into two groups based on the airway approach: cross-field ventilation group and HFJV group. The primary outcome was the area under the curve (AUC) of intraoperative hypoxemia defined as peripheral oxygen saturation (SpO2) below 90% lasting at least 1 minute. The secondary outcomes included cumulative time of SpO2 below 90%, AUC and cumulative time of severe intraoperative hypoxemia (defined as SpO2 below 80% lasting at least 1 minute), and AUC and cumulative time of suboptimal SpO2 (defined as SpO2 below 95% lasting at least 1 minute).ResultsThirty-two patients were included in the final analysis, with 22 patients in cross-field ventilation group and 10 patients in HFJV group. The two groups did not differ in the severity and duration of intraoperative hypoxemia (P=0.366). The median (IQR) AUC of SpO2 below 90% was 21.92 (4.28, 54.48) min in cross-field ventilation group and 28.93 (10.78, 199.89) min in HFJV group. The cumulative time of SpO2 <90% was 16.67 (4.46, 37.11) min in cross-field ventilation group and 19.32 (7.50, 121.24) min in HFJV group, without statistical difference between groups (P>0.05). Severe intraoperative hypoxemia did not occur in either group.ConclusionsThis retrospective case series demonstrates that HFJV can be adopted to maintain oxygenation in CRR, without the interruption of surgical procedure.
| S-EPMC9562552 | biostudies-literature
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| S-EPMC8577970 | biostudies-literature
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| S-EPMC9840025 | biostudies-literature