Reconstructive operations on the bronchi and tracheal bifurcation in the surgical and combined treatments of lung cancer

Over the past few years, significant advances in surgical and anesthetic techniques as well as appropriate selection of patients have led to an improvement in the immediate and long-term treatment outcomes in patients with non-small cell lung cancer with involvement of tracheal bifurcation. In accordance with the current selection criteria, patients with contralateral lymph node metastases (lung root, aortic window, paratracheal area) require chemotherapy or chemoradiotherapy with subsequent estimation of follow-up and treatment strategy. Surgeries with resection of tracheobronchial bifurcation are considered technically complicated, and they should be performed in carefully selected lung cancer patients and only in specialized centers with extensive experience. It allows the incidence of intra-and postoperative complications to be significantly reduced.

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18F-FDG accumulation in less-affected lung area predicts postoperative interstitial lung disease acute exacerbation in lung cancer: A case control study

10.21203/rs.3.rs-19006/v1 ◽

2020 ◽

Author(s):

Kentaro Fukunaga ◽

Yukihiro Nagatani ◽

Hiroaki Nakagawa ◽

Ayumi Nitta-Seko ◽

Tamotsu Nagata ◽

...

Keyword(s):

Computed Tomography ◽

Lung Cancer ◽

Interstitial Lung Disease ◽

Pulmonary Surgery ◽

Pet Ct ◽

The Mean ◽

Fdg Pet Ct ◽

Nsclc Patients ◽

Tracheal Bifurcation ◽

Fdg Accumulation

Abstract Background: Pneumonectomy for lung cancer with interstitial lung disease (ILD) has been shown to cause postoperative acute exacerbation (AE) of the ILD. The accumulation of 18F-flurodeoxyglucose (FDG) on normal parenchymal or less-affected lung fields in 18F-FDG-positron emission tomography (PET)/computed tomography (CT) has been reported to be related to ILD disease activity and prognosis. To determine whether 18F-FDG accumulation in normal parenchymal or less-affected lung fields on 18F-FDG-PET/CT can predict postoperative AE of ILD in non-small cell lung cancer (NSCLC) patients with ILD.Methods: This retrospective study included 36 NSCLC patients with ILD, who underwent 18F-FDG-PET/CT at 2 institutions before pulmonary surgery. A single volume-of-interest (VOI) was placed to measure the mean standardized uptake value (SUVmean) in normal or less-affected lung fields at 12 areas on the ventral and dorsal locations of both lungs, in each level of the aortic arch, tracheal bifurcation, and the orifice of the right lower pulmonary vein into the left atrium. The region to which the target VOI was set corresponded to no or minimally increased attenuation on high resolution CT. The SUVmean was defined as the mean SUV of the target VOI, SUVtissue fraction (TF) as the corrected SUVmean by using TF and mean computed tomography density (CTDmean) as the mean attenuation of the corresponding target VOI on HRCT. We performed a phantom study to optimize SUV difference among 2 institutions. The corrected SUVmean (cSUVmean) and corrected SUVTF (cSUVTF) were calculated based on the phantom study result.Results: Among 36 NSCLC patients with ILD who underwent pulmonary surgery, 8 patients developed postoperative AE of ILD. The cSUVmean values in the ventral and dorsal locations at the aortic arch level, and in the ventral location at the tracheal bifurcation level in the group with postoperative AE were higher than in the group without postoperative AE. There was no significant difference in the value of cSUVTF and CTDmean between the groups with and without postoperative AE.Conclusion: 18F-FDG accumulation in the normal or less-affected lung fields can potentially predict postoperative AE of ILD in NSCLC patients with ILD.

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Superior vena cava resection and plastic repair as a part of surgical and combined treatment of lung cancer

Problems in oncology ◽

10.37469/0507-3758-2021-67-1-59-63 ◽

2021 ◽

Vol 67 (1) ◽

pp. 59-63

Author(s):

Evgeny Levchenko ◽

Stepan Ergnyan ◽

Vitalii Shutov ◽

Nikolai Krotov ◽

Nikita Levchenko ◽

...

Keyword(s):

Lung Cancer ◽

Superior Vena Cava ◽

Superior Vena ◽

Combined Treatment ◽

Vena Cava ◽

Long Term Results ◽

Advanced Lung Cancer ◽

Care Providers ◽

Venous Resection ◽

Reconstructive Operations

This article summarizes our own experience of reconstructive operations with resection and plastic repair of the superior vena cava in the field of locally advanced lung cancer surgery. Both technical aspects and methodological approaches of this type of combined interventions are described in detail. Data from 45 patients who underwent wedge (21) and circular (24) superior vena cava resections were analyzed. In most (65%) cases, venous resection and reconstruction were combined with multi-organ resections of other anatomical structures of the chest cavity. 87% of patients received combined treatment in different directions. Postoperative complications were registered in 40% of cases, and the mortality rate was 13%. The unfavorable postoperative prognostic factors were followings: old age, pneumonectomy, combination of vein angioplasty with carinal resection. The 5-year survival rate was 18.5%, with a median survival of 19.4 + 4.6 months. The results allow us to recommend such operations in highly specialized clinics that have extensive experience in tracheobronchial angioplastic surgery and highly-qualified anesthesia care providers. Multimodal treatment allows to achieve satisfactory long-term results.

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Non-small cell lung cancer with the tracheal bifurcation involvement. Carinal pneumonectomy or chemo-radiation therapy?

Modern Oncology ◽

10.26442/18151434.2018.4.180161 ◽

2018 ◽

Vol 20 (4) ◽

pp. 32-35

Author(s):

I A Dadyev ◽

M M Davydov ◽

M S Shogenov ◽

A G Abdullaev ◽

M A Ibraev ◽

...

Keyword(s):

Lung Cancer ◽

Radiation Therapy ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Small Cell ◽

Long Term Results ◽

Control Analysis ◽

Small Cell Lung ◽

Tracheal Bifurcation

The aim of the study: the aim of this study was to compare the immediate and long-term results of treatment of patients with non-small cell lung cancer with involvement of tracheal bifurcation, which were underwent pneumonectomy with resection of the tracheal bifurcation or radical chemo-radiation therapy (CRT). Materials and methods. We conducted a retrospective non-randomized clinical study with following groups of patients: 1) 65 patients who underwent pneumonectomy with resection of the tracheal bifurcation; 2) 30 patients to whom CRT was performed. Evaluation of the effectiveness of immediate and long-term results was carried out by statistical processing using the Statistic 6.0 program. A case-control analysis was performed to compare two groups. The time of the operation, intra- and postoperative complications was estimated depending on the type of resection of the tracheal bifurcation. Results. The complication rate was 46.1% in the surgical group. In the CRT group complications developed in 13 (43.3%) patients. The overall 1-, 3-, 5-year survival rate in the group of patients with surgical treatment was 56.92, 31.7 and 26.1%, respectively. The median overall survival was 14.5 months. Indicators of 1-, 3-, and 5-year survival in the group of patients who underwent radical CRT were 31.6, 24.4, 16.2%.

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Sedoanalgesia with dexmedetomidine and ketamine during endoscopic resection of an obstructing tumor of tracheal bifurcation in the patient with lung cancer and its atelectasis

Messenger of Anesthesiology and Resuscitation ◽

10.21292/2078-5658-2019-16-5-61-64 ◽

2019 ◽

Vol 16 (5) ◽

pp. 61-64

Author(s):

E. S. Gorobets ◽

A. R. Shin ◽

L. V. Cherkes

Keyword(s):

Lung Cancer ◽

Endoscopic Resection ◽

Tracheal Bifurcation

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ENDOSCOPIC PHOTODYNAMIC THERAPY OF A PATIENT WITH LUNG CANCER METASTASIS IN BIFURCATION LYMPH NODES (CLINICAL OBSERVATION)

Biomedical Photonics ◽

10.24931/2413-9432-2018-7-2-50-54 ◽

2018 ◽

Vol 7 (2) ◽

pp. 50-54

Author(s):

V. M. Legostaev ◽

O. Yu. Babenkov ◽

G. V. Balitskiy

Keyword(s):

Lung Cancer ◽

Photodynamic Therapy ◽

Lymph Nodes ◽

Cancer Metastasis ◽

Histological Analysis ◽

Lower Lobe ◽

Metastatic Lesion ◽

Lung Cancer Metastasis ◽

The Right ◽

Tracheal Bifurcation

AbstractThis clinical case demonstrates the feasibility of photodynamic therapy (PDT) as a method of choosing the treatment of recurrent lung cancer in inoperable patients with ineffective chemoradiotherapy. An operation was performed on the patient with a diagnosis of pT4N0M0 central cancer of the lower lobe of the right lung after 2 courses of neoadjuvant chemotherapy in October 2015: an expanded combined lower bilobectomy of the right lung, with resection of the pericardium and left atrium. Then 4 courses of adjuvant chemotherapy (cisplatin + vinorelbine) and a course of radiotherapy on the mediastinum area up to a total dose of 45 Gy were carried out. After 2 months, a metastatic lesion of bifurcation lymph nodes with invasion of the mucosa of the tracheal bifurcation, involving the distal trachea, proximal right and left main bronchi was detected. The result of histological analysis: G2 squamous cell carcinoma without keratinization. From Dec 2016 to Jun 2017, the patient underwent 5 courses of PDT, as a result of which a significant cytoreductive effect and stabilization of the process were achieved. The continuation of the PDT treatment is planned.

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Immunosuppressive Role of Myeloid-Derived Suppressor Cells and Therapeutic Targeting in Lung Cancer

Journal of Immunology Research ◽

10.1155/2018/6319649 ◽

2018 ◽

Vol 2018 ◽

pp. 1-9 ◽

Cited By ~ 11

Author(s):

Jie Ma ◽

Huaxi Xu ◽

Shengjun Wang

Keyword(s):

Lung Cancer ◽

Cancer Therapy ◽

Suppressor Cells ◽

Myeloid Derived Suppressor Cells ◽

Cancer Death ◽

Combined Treatments ◽

Therapeutic Targeting ◽

Multiple Factors ◽

Lung Cancer Therapy

Lung cancer is the leading cause of cancer death worldwide due to its late diagnosis and poor outcome. Immunotherapy is becoming more and more encouraging and promising in lung cancer therapy. Myeloid-derived suppressor cells (MDSCs) are the main tumor suppressor factors, and the treatment strategy of targeting MDSCs is gradually emerging. In this review, we summarize what is currently known about the role of MDSCs in lung cancer. In view of the emerging importance of MDSCs in lung cancer, the treatment of targeting MDSCs will be useful to the control of the development and progression of lung cancer. However, the occurrence, metastasis, and survival of cancer is the result of multiple factors and multiple mechanisms, so combined treatments using different strategies will become the major therapy method for lung cancer in the future.

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