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

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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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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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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Laser-assisted management of a symptomatic anterior pharyngeal diverticulum

The Journal of Laryngology & Otology ◽

10.1017/s0022215117001712 ◽

2017 ◽

Vol 131 (10) ◽

pp. 930-932

Author(s):

K Pujary ◽

A C Agarwal ◽

R Balakrishnan ◽

A Bhandarkar

Keyword(s):

Lung Cancer ◽

Endoscopic Resection ◽

Incidental Finding ◽

The Other ◽

Effective Procedure ◽

Potassium Titanyl Phosphate ◽

Survival Period ◽

Common Symptom ◽

Assisted Management ◽

532 Nm

AbstractBackground:Dysphagia is a relatively common symptom following laryngectomy. An anterior pharyngeal diverticulum is a rare cause of post-laryngectomy dysphagia. However, it is often an incidental finding on rigid telescopic examination.Methods and results:This article describes two patients with a symptomatic anterior pharyngeal diverticulum. They were treated by transoral micro-endoscopic potassium titanyl phosphate 532 nm laser assisted resection. Both patients could take feeds orally after the procedure without any difficulty. One patient died one and a half years after the procedure because of secondary lung cancer. The other patient died after three years as a result of regional recurrence. The patients were able to swallow during their survival period post treatment.Conclusion:Laser-assisted micro-endoscopic resection is a relatively safe, quick and effective procedure for the management of anterior pharyngeal diverticulum.

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Pulmonary Hamartoma Associated With Lung Cancer (PHALC Study): Results of a Multicenter Study

Lung ◽

10.1007/s00408-021-00460-8 ◽

2021 ◽

Author(s):

Alfonso Fiorelli ◽

Antonio D’Andrilli ◽

Annalisa Carlucci ◽

Giovanni Vicidomini ◽

Giacomo Argento ◽

...

Keyword(s):

Risk Factors ◽

Lung Cancer ◽

Surgical Resection ◽

Endoscopic Resection ◽

Multicenter Study ◽

Benign Tumor ◽

Malignant Degeneration ◽

Study Results ◽

Historical Series ◽

Pulmonary Hamartoma

Abstract Purpose Pulmonary hamartoma is the most common benign tumor of the lung. We analyzed a 20-year historical series of patients with pulmonary hamartoma undergoing surgical resection, aiming to evaluate the characteristics, the outcomes, and the association between hamartoma and lung cancer. Methods It was a retrospective multicenter study including the data of all consecutive patients with pulmonary hamartoma undergoing surgical resection. The end-points were to evaluate: (i) the characteristics of hamartoma, (ii) outcomes, and (iii) whether hamartoma was a predictive factor for lung cancer development Results Our study population included 540 patients. Upfront surgical or endoscopic resection was performed in 385 (71%) cases while in the remaining 155 (29%) cases, the lesions were resected 20 ± 3.5 months later due to increase in size. In most cases, lung sparing resection was carried out including enucleation (n = 259; 48%) and wedge resection (n = 230; 43%) while 5 (1%) patients underwent endoscopic resection. Only two patients (0, 2%) had major complications. One patient (0.23%) had recurrence after endoscopic resection, while no cases of malignant degeneration were seen (mean follow-up:103.3 ± 93 months). Seventy-six patients (14%) had associated lung cancer, synchronous in 9 (12%) and metachronous in 67 (88%). Only age > 70-year-old (p = 0.0059) and smokers > 20 cigarettes/day (p < 0.0001) were the significant risk factors for lung cancer. Conclusion PH was a benign tumor, with no evidence of recurrence and/or of malignant degeneration after resection. The association between hamartoma and lung cancer was a spurious phenomenon due to common risk factors.

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Pulmonary Hamartoma Associated With Lung Cancer (PHALC Study): Results of a Multicenter Study

10.21203/rs.3.rs-502596/v1 ◽

2021 ◽

Author(s):

Alfonso Fiorelli ◽

Antonio D’Andrilli ◽

Annalisa Carlucci ◽

Giovanni Vicidomini ◽

Giacomo Argento ◽

...

Keyword(s):

Lung Cancer ◽

Surgical Resection ◽

Endoscopic Resection ◽

Multicenter Study ◽

Cancer Development ◽

Malignant Degeneration ◽

Safe Procedure ◽

Study Results ◽

Historical Series ◽

Pulmonary Hamartoma

Abstract PURPOSEPulmonary hamartoma is the most common benign tumor of the lung. We analyzed a 20-year historical series of patients with pulmonary hamartoma undergoing surgical resection, aiming to evaluate the characteristics, the outcomes, and the association between hamartoma and lung cancer. METHODSIt was a retrospective multicenter study including the data of all consecutive patients with pulmonary hamartoma undergoing surgical resection. The end-points were to evaluate: i) the characteristics of hamartoma, ii) outcomes, iii) whether hamartoma was a predictive factor for lung cancer development RESULTSOur study population included 540 patients. Upfront surgical or endoscopic resection was performed in 385 (71%) cases while in the remaining 155 (29%) cases, the lesions were resected 20±3.5 months after diagnosis due to increase in size. In most cases, lung sparing resection was carried out including enucleation (n=259; 48%) and wedge resection (n=230; 43%) while 5 (1%) patients underwent endoscopic resection. Only two patients (0,2%) had major complications. One patient (0.23%) had recurrence after endoscopic resection, while no cases of malignant degeneration were seen (mean follow-up: 103.3±93 months). Seventy-six patients (14%) had associated lung cancer, synchronous in 9 (12%) and metachronous in 67 (88%). Only age > 70-year-old (p=0.0059) and smokers >20 cigarettes/day (p<0.0001) were the significant risk factors for cancer development on logistic regression analysis. CONCLUSIONSSurgical resection of hamartoma is a safe procedure; recurrence and malignant degeneration are very uncommon and the association between hamartoma and lung cancer seems to be a spurious phenomenon.

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