scholarly journals Diaphragm reconstruction by GORE DUALMESH in patients undergoing resection for thoracic malignancies

2020 ◽  
Author(s):  
Atsushi Sano ◽  
Yoko Azuma ◽  
Takashi Sakai ◽  
Satoshi Koezuka ◽  
Hajime Otsuka ◽  
...  

Abstract BackgroundWe used GORE DUALMESH for the reconstruction of diaphragms in patients with thoracic malignancies. Here, we report the results.MethodsBetween July 2015 and August 2017, diaphragm reconstruction using 2-mm GORE DUALMESH was performed in 7 patients undergoing surgical resection for thoracic malignancies. After resection of the diaphragm, the mesh was trimmed to the size of defect and placed with the smooth surface facing the chest cavity and the rough surface facing the abdomen. It was fixed with interrupted sutures consisting of synthetic monofilament nonabsorbable 1-0 to 2 threads.ResultsIndications for resection were malignant mesothelioma and primary lung cancer in 5 and 2 patients, respectively. Patients with malignant mesothelioma underwent pleurectomy with decortication; patients with primary lung cancer underwent lung lobectomy. Right and left diaphragm reconstruction was performed for 4 and 3 patients, respectively. Neither complications related to diaphragm reconstruction nor displacement of mesh occurred during a follow-up period ranging from 11 days to 37 months.ConclusionsGORE DUALMESH is a good synthetic material for diaphragm reconstruction, because its smooth surface prevents adhesions to the lung and its rough surface allows adherence to abdominal tissue.

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Atsushi Sano ◽  
Yoko Azuma ◽  
Takashi Sakai ◽  
Satoshi Koezuka ◽  
Hajime Otsuka ◽  
...  

Abstract Background We used GORE DUALMESH for the reconstruction of diaphragms in patients with thoracic malignancies. Here, we report the results. Methods Between July 2015 and August 2017, diaphragm reconstruction using 2-mm GORE DUALMESH was performed in 7 patients undergoing surgical resection for thoracic malignancies. After resection of the diaphragm, the mesh was trimmed to the size of defect and placed with the smooth surface facing the chest cavity and the rough surface facing the abdomen. It was fixed with interrupted sutures consisting of synthetic monofilament nonabsorbable 1–0 to 2 threads. Results Indications for resection were malignant pleural mesothelioma and primary lung cancer in 5 and 2 patients, respectively. Patients with malignant pleural mesothelioma underwent pleurectomy with decortication; patients with primary lung cancer underwent lung lobectomy. Right and left diaphragm reconstruction was performed for 4 and 3 patients, respectively. Neither complications related to diaphragm reconstruction nor displacement of mesh occurred during a follow-up period ranging from 11 days to 37 months. Conclusions GORE DUALMESH is a good synthetic material for diaphragm reconstruction, because its smooth surface prevents adhesions to the lung and its rough surface allows adherence to abdominal tissue.


1988 ◽  
Vol 3 (2) ◽  
pp. 113-122 ◽  
Author(s):  
P. Santabárbara ◽  
R. Molina ◽  
J. Estapé ◽  
A.M. Ballesta

Phosphohexose isomerase (PHI) and carcinoembryonic antigen (CEA) were measured at the time of diagnosis in 300 patients with lung cancer. Serum levels were high in 75.7% and 53.0% of patients respectively. PHI levels were higher in large cell and small cell carcinomas (p < 0.001). CEA levels were higher in adenocarcinomas (p < 0.001). Metastatic carcinomas showed higher levels on PHI and CEA than localized cases. Survival was significantly longer in patients with normal PHI (p < 0.001) and normal CEA (p < 0.005) than in cases with elevated markers. The prognostic significance of PHI persisted in the different pathological types and stages, whereas CEA only had prognostic impact in non-small cell cases. Serial PHI determinations were useful for follow-up in 82.4% of cases with initial abnormal values and in 55.4% of cases with a normal value. Serial CEA was useful in 41% of cases with initially high value but in less than 15% of those with baseline normal. We conclude that PHI has prognostic significance independently of pathology and stage, whereas CEA was a prognostic indicator only in non-small cell cases; serial PHI determinations were useful more often than CEA for follow-up.


2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e18562-e18562
Author(s):  
Cynthia van Arkel ◽  
Daphne Dumoulin ◽  
Bart van Straten ◽  
Joost ter Woorst ◽  
Saskia Houterman ◽  
...  

e18562 Background: To determine factors predicting early and long term mortality in patients who underwent a thoracotomy because of primary lung cancer. Methods: Data of patients who underwent a thoracotomy in the Catharina Hospital Eindhoven between 1 January 1995 and 1 January 2011 have been collected retrospectively from the medical files. Early mortality was defined as mortality <30 days after surgery. Last date of follow up was 1 January 2013. Patients were divided in three periods according to date of surgery (1: 1995-1999, 2: 2000-2004 and 3: 2005-2010). Predicting factors for early mortality were assessed with uni- and multivariate logistic regression analysis. For long term mortality and survival predicting factors were assessed using the Cox proportional hazards model and Kaplan-Meier survival curves. Results: In total 501 patients underwent a thoracotomy due to primary lung cancer. Overall 30 day mortality was 5.8% (n=29). Early mortality was 3.0% for lobectomy (n=289), 0.2% for bilobectomy (n=29) and 11% for pneumonectomy (n=109). Multivariate analysis showed that age over 70 (p=0.002), pneumonectomy (p=0.008) and a pre-operative VO2max of <15 ml/kg/min (p=0.02) were significant predictors of early mortality. With respect to long term survival, 308 (62%) patients had died at the end of the follow-up period. Median survival time was 44 months, with an overall 5- and 10- year survival of 45% and 27% respectively. The 5- and 10-year survival for stage I, II and III-IV was 61% and 37%; 46% and 30%;16% and 6.6%, respectively (p<0.0001, log rank test). Finally Cox regression analysis showed that stage (stage I (HR 0.30; 95% CI 0.22-0.42), stage II (HR 0.38; 95% CI 0.26-0.57) compared to stage III-IV, FEV1% ≤70% (HR 1.57; 95% CI 1.61-2.11), a history of cerebrovascular disease (CVD) (HR 1.97; 95% CI 1.20-3.23) and surgery in an earlier time period (1 (HR 1.50; 95% CI 1.04-2.17); 2 (HR 1.46; 95% CI 1.05-2.02) compared to 3) were significant predictors of long term mortality. Conclusions: In this cohort age, pneumonectomy and pre-operative VO2max are significant predictors of early mortality. Significant predictors of long term mortality are disease stage, FEV1%, a history of CVD and surgery in an earlier time period.


2021 ◽  
pp. e20210025 ◽  
Author(s):  
Juliana B F Morellato1 ◽  
Marcos D Guimarães2 ◽  
Maria L L Medeiros1 ◽  
Hélio A Carneiro1 ◽  
Alex D Oliveira2 ◽  
...  

Objective: To report the experience of a routine follow-up program based on medical visits and chest CT. Methods: This was a retrospective study involving patients followed after complete surgical resection of non-small cell lung cancer between April of 2007 and December of 2015. The follow-up program consisted of clinical examination and chest CT. Each follow-up visit was classified as a routine or non-routine consultation, and patients were considered symptomatic or asymptomatic. The outcomes of the follow-up program were no evidence of cancer, recurrence, or second primary lung cancer. Results: The sample comprised 148 patients. The median time of follow-up was 40.1 months, and 74.3% of the patients underwent fewer chest CTs than those recommended in our follow-up program. Recurrence and second primary lung cancer were found in 17.6% and 11.5% of the patients, respectively. Recurrence was diagnosed in a routine medical consultation in 69.2% of the cases, 57.7% of the patients being asymptomatic. Second primary lung cancer was diagnosed in a routine medical appointment in 94.1% of the cases, 88.2% of the patients being asymptomatic. Of the 53 patients who presented with abnormalities on chest CT, 41 (77.3%) were diagnosed with cancer. Conclusion: Most of the cases of recurrence, especially those of second primary lung cancer, were confirmed by chest CT in asymptomatic patients, indicating the importance of a strict follow-up program that includes chest CTs after surgical resection of lung cancer.


1996 ◽  
Vol 114 (6) ◽  
pp. 1298-1302 ◽  
Author(s):  
Flávio Xavier ◽  
Lucélia de Azevedo Henn ◽  
Oliveira Marja ◽  
Luciane Orlandine

The frequency of smoking among patients with primary lung cancer diagnoses admitted to the Hospital de Clinicas de Porto Alegre (HCPA) during the 1980's was investigated. The objective of this study was to analyze cigarette consumption patterns through the number of cigarettes smoked per day and the age at which smoking began, correlating this data to the overall survival rate and histological type of the lung cancer. Methods: This retrospective study analyzed patients with primary lung cancer diagnosed at the HCPA between January 1980 and December 1989. All patients considered underwent follow-up for at least three years. Patient information was obtained either from the hospital's records or by contacting patients via letter or phone. Results: More than 90 percent of the patients were smokers or had smoked previously; most had started smoking before the age of 20.The overall 24-month survival rate after diagnosis varied depending on whether the patient had smoked less than 40 cigarettes per day or not. The percentage of smokers and non-smokers was established for each histological type, with the bronchoalveolar adenocarcinoma type showing the highest percentage of non-smokers (40 percent). Conclusion:The overall survival rates of patients with lung cancer was related to the number of cigarettes smoked, and not to the fact of the patient having smoked or not.The number of smokers among patients with lung cancer was not so high only for the bronchoalveolar adenocarcinoma histological type.


2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e21088-e21088
Author(s):  
Ying Liu

e21088 Background: Simultaneous multiple primary lung cancer (sMPLC) is detected increasingly nowadays with the development of image technology. But it has not been well characterized. Methods: All consecutive patients diagnosed as sMPLC according to Martini-Melamed and American College of Chest Physicians criteria from June 2010 to June 2019 were enrolled in our center. The clinical characteristics and outcomes were compared between patients with same histology and different histology. Results: A total of 336 patients were enrolled, consist of 297 (88.4%) patients with same histology and 39(11.6%) patients with different histology. Compared to patients with same histology, patients with different histology were more common male (87.2% vs. 34%, p < 0.001) and diagnosed at an older age (54 [62-69] vs. 59 [52-65], p < 0.001). Also, more than half of them (56.4%) had respiratory symptom or pain before diagnosis and most of them had smoking history (79.5% vs. 19.2%, p < 0.001). During follow-up, 5 patients were lost and 16 patients were died, contributing the 1-, 2-, and 3-year survival of overall patients was 97.7%, 96.1%, and 92.2%, respectively. Importantly, the survival rate was lower in patients with different histology (1-, 2-, and 3-year 88.5%, 75.4, and 64.3%) than same histology (1-, 2-, and 3-year 99.2%, 99.2, and 96.8%) (p < 0.001). Conclusions: Although relative less common in sMPLC, patients with different histology showed different clinical features and worse prognosis. [Table: see text]


Thorax ◽  
1989 ◽  
Vol 44 (10) ◽  
pp. 788-793 ◽  
Author(s):  
P C van Bodegom ◽  
S S Wagenaar ◽  
B Corrin ◽  
J P Baak ◽  
J Berkel ◽  
...  

Author(s):  
Jenny Mitchell ◽  
Rachel Benamore ◽  
Fergus Gleeson ◽  
Elizabeth Belcher

Abstract OBJECTIVES The optimal imaging programme for the follow-up of patients who have undergone resection of primary lung cancer is yet to be determined. We investigated the incidence and patterns of new and recurrent malignancy after resection for early-stage lung cancer in patients enrolled into a computed tomography (CT) follow-up programme. METHODS We reviewed the outcomes of consecutive patients who underwent CT follow-up after resection of early-stage primary lung cancer at the Oxford University Hospitals NHS Foundation Trust, between 2013 and 2017. RESULTS Four hundred and sixty-six consecutive patients underwent resection of primary lung cancer between 1 January 2013 and 31 March 2017. Three hundred and thirty-one patients (71.0%) were enrolled in CT follow-up. The median follow-up was 98 weeks (range 26–262). Sixty patients (18.2%) were diagnosed with programme-detected malignancy. Recurrence was diagnosed in 36 patients (10.9%), new primary lung cancer in 16 patients (4.8%) and non-lung primary tumours in 8 patients (2.4%). A routine CT scan identified the majority of new primary lung cancers (84.2%) and those with disease recurrence (85.7%). The majority of programme-detected malignancies were radically treatable (55%). The median survival of programme-detected cancers was 92.4 versus 23.0 weeks for patients with clinically detected tumours (P < 0.0001). Utilizing the CT scout image as a surrogate for chest X-ray, the sensitivity of this modality was 16.95% (8.44–28.97%) and specificity was 89.83% (79.17–96.18%). Negative likelihood ratio was 0.92 (0.8–1.07). CONCLUSIONS CT follow-up of surgically treated primary lung cancer patients identifies malignancy at a stage where radical treatment is possible in the majority of patients. Chest X-ray follow-up may not be of benefit following lung cancer resection.


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