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The functional benefit of segmentectomy compared with lobectomy remains controversial. This ambispective study characterizes the changes in pulmonary function as correlated to displacement patterns of residual lung after segmentectomies vs lobectomies. Patients with normal preoperative pulmonary function and undergoing segmentectomy or lobectomy between 2017 and 2021 were considered. Pulmonary function testing was scheduled preoperatively and at least 3 months postoperatively. Differences in the proportions of the median forced expiratory volume in 1 second (FEV 1) reduction between segmentectomy and lobectomy were calculated. Covariance analysis was used to estimate the adjusted postoperative FEV 1 (apoFEV 1) and compare the difference value (DV) in apoFEV 1 between segmentectomy and lobectomy. The study enrolled 634 patients (334 lobectomies and 300 segmentectomies). Median difference in the proportions of the FEV 1 reduction between segmentectomy and lobectomy was 4.58%, with maximal difference observed in right S6 (9.08%) and minimal difference in left S1+2+3 (2.80%). For resections involving the upper lobe, apoFEV 1 was significantly higher after segmentectomy than after lobectomy (DV, 0.15-0.22 L), except for left S3 and S1+2+3 segmentectomies (DV, 0.08 L and 0.06 L, respectively). Compared with a lower lobe lobectomy, S6 segmentectomy conferred a higher apoFEV 1 , whereas S7+8 and S9+10 had a similar apoFEV 1 (DV, 0.16-0.18 L, 0.07 L, and 0.00-0.06 L, respectively). Functional recovery after segmentectomy was associated with the number of intersegment planes (P <.01) and the presence of an adjacent nonoperated on lobe (P =.03). Basilar and left S3 segmentectomies did not preserve more pulmonary function compared with their corresponding lobectomies, possibly due to the presence of multiple intersegmental resection planes. [Display omitted] [ABSTRACT FROM AUTHOR]

This study investigated the prognostic impact of epidermal growth factor receptor (EGFR) mutation in clinical stage I lung adenocarcinoma patients. Data for 952 patients who received surgical resection and underwent detection of oncogenic driver mutations were retrospectively collected. Recurrence-free survival (RFS) and overall survival (OS) were estimated by the Kaplan-Meier method and compared using the log-rank test. The adjusted hazard ratio (aHR) with 95% CI of the prognosticator was calculated by Cox proportional hazards model, and cumulative incidence function was measured by competing risk regression model. EGFR mutation was detected in 581 patients (61.0%) and was more frequent in women (63.9%), nonsmokers (85.5%), and those with ground-glass nodules (GGNs; 56.6%). EGFR mutation was not associated with recurrence and death in the entire cohort or GGN cohort. However, for patients with radiologic pure-solid appearance, EGFR mutation was an independent risk factor for RFS (aHR, 1.623; 95% CI, 1.192-2.210) and distant recurrence (aHR, 1.863; 95% CI, 1.311-2.650), but not OS. Subsequently, subgroup analysis based on EGFR mutation subtypes, including exon 19 deletions (19-Del), exon 21 L858R substitution (L858R), and rare mutations in patients with radiologic pure-solid appearance, revealed that all 3 subtypes have poorer RFS (19-Del: aHR, 1.424; 95% CI, 0.991-2.047; L858R: aHR, 1.708; 95% CI, 1.172-2.490; rare mutations: aHR, 2.500; 95% CI, 1.400-4.465) and higher prevalent distant recurrence (19-Del: aHR, 1.595; 95% CI, 1.061-2.400; L858R: aHR, 2.073; 95% CI, 1.371-3.140; rare mutations: aHR, 2.657; 95% CI, 1.397-5.050) compared with wild-type. In clinical stage I lung adenocarcinoma, EGFR mutation was associated with worse RFS and higher prevalent distant recurrence in patients with radiologic pure-solid appearance but not in patients with GGN. [Display omitted] [ABSTRACT FROM AUTHOR]

Pleurectomy and decortication serves as a major component of therapy for malignant pleural mesothelioma (MPM), but the procedure is time consuming. We tentatively applied a carbon dioxide (CO 2) blower into pleurectomy and decortication for a patient with local relapse of MPM. The blower can help increase the potential subpleural place thanks to the positive pressure by CO 2 , while the mist of saline could clean the potential bleeding to increase visibility. Thereby, the procedure was greatly facilitated in a more precise manner, with blood loss of 100 mL and acceptable postoperative air leak and thorax drainage. Therefore, a CO 2 blower may be considered in pleurectomy and decortication for MPM. [ABSTRACT FROM AUTHOR]

Pulmonary aspergilloma is chronic and invasive, potentially leading to life-threatening massive hemoptysis. The role of surgery for treating pulmonary aspergilloma and its effect on long-term survival needs more study. We reviewed 166 patients with aspergillomas treated at Shanghai Pulmonary Hospital from 2004 to 2017. Surgery indications included destroyed lung parenchyma, recurrent hemoptysis, despite appropriate medical treatment, and isolated pulmonary nodules suspected to be aspergilloma. Pulmonary aspergillomas are classified as simple (in an isolated thin-walled cavity, ≤3 mm) or complex (a thick-walled cyst, >3 mm) based on computed tomographic scan findings. Aspergilloma was complex in 100 patients (60.2%) and simple in 66 (39.8%). The median (interquartile range) size of complex aspergillomas (2.5 [0.3-8.0] cm) was larger than that (2.0 [0.2-6.0] cm) of simple types (P <.001). Hemoptysis occurred in 72 patients (72%) with complex disease and in 35 (53%) with simple disease (P =.014). Video-assisted thoracoscopic surgery was performed in 42 patients (63.6%) with simple aspergillomas, and 75 patients (75%) with of complex aspergillomas underwent thoracotomy. Prolonged air leakage (>7 days) was the most common (17 [10.2%]) postoperative complication. A bronchopleural fistula developed postoperatively in 1 patient (0.6%). One patient (0.6%) died of respiratory failure within 30 days postoperatively. Two patients (1.2%) experienced recurrence during follow-up. The overall 10-year survival rates were 87.7% for complex aspergillomas and 94.97% for simple aspergillomas (P =.478). Diabetes (12 [7.2%]; hazard ratio, 13.15; 95% CI, 1.12-154.46) was associated with a worse prognosis. The perioperative morbidity and mortality of pulmonary aspergillomas are acceptable. Overall survival rates of simple and complex types are comparable. [ABSTRACT FROM AUTHOR]

This study explored the safety and feasibility of uniportal video-assisted thoracoscopic (VATS) decortication in patients presenting with stage III tuberculous empyema with severe rib crowding. From August 2017 to January /2019, 33 patients with stage III tuberculous empyema and severe rib crowding underwent uniportal VATS decortication with partial rib resection and the use of a customized periosteal stripper. Preoperative and postoperative chest computed tomography (CT) imaging and pulmonary function testing were analyzed to evaluate the clinical significance of certain imaging findings and surgical efficacy. There was 1 conversion to open thoracotomy. Median operative time was 3.5 hours (range, 2.1-4.5 hours) and the median blood loss was 500 mL (range, 250-1000 mL). There were no perioperative mortalities. The incidence of prolonged air leaks (>5 days) was 81.8%. Median postoperative hospital stay was 4 days (range, 4-5 days). All patients were discharged with 2 chest tubes, and median duration drainage was 39 days (range, 30-60 days). The presence of a low-density line between the parietal fibrous pleural rind and chest wall was demonstrated on chest CT in 13 patients. Intraoperative blood loss was considerably lower in these patients compared with those without this imaging finding. Follow-up was complete in all patients over a median of 8 months (range, 6-11.5 months). All patients recovered well and achieved notable improvement in pulmonary function. Uniportal VATS decortication is safe and effective. Patients presenting with a low-density line around the thickened fibrous pleural rind on preoperative chest CT scan may be good candidates. [Display omitted] [ABSTRACT FROM AUTHOR]

Currently available techniques and materials for sternal reconstruction are limited in their clinical applicability. We aimed to design a durable prosthetic kit that can be tailored to each patient's sternal anatomy and function intraoperatively. A modularized sternal reconstruction system was designed, containing standardized components of different types and sizes, made of titanium alloy. This technology was applied to patients undergoing sternal resection and reconstruction. The system was employed in 7 patients undergoing sternal resection and reconstruction for local malignancy. Appropriate modules were chosen and integrated at the time of operation. The sternal prostheses were well integrated into the chest wall, without local infection, effusion, or instability. One patient died of recurrence 4 months after surgery. The remaining 6 patients recovered well, without local recurrence or prosthesis failure. The most prominent advantage of this system is that there is no need for individualized design and manufacture before surgery. Therefore, this modularized system is potentially widely applicable as an adaptable and effective prosthesis for sternal reconstruction. [ABSTRACT FROM AUTHOR]

Repairing a large tracheoesophageal fistula with extensive involvement of the membranous wall of the trachea is sometimes troublesome because of the lack of an ideal replacement for the large defect. We report the successful use of a pedicled sternocleidomastoid musculocutaneous flap to repair a large tracheoesophageal fistula in which the cutaneous component was applied to the defect of the membranous trachea after tracheal resection and the muscular component was interposed between the tracheal and esophageal walls. [ABSTRACT FROM AUTHOR]

Pulmonary sarcomatoid carcinoma (PSC) is a rare type of lung cancer. This study aimed to explore the appropriate treatment for PSC. Two cohorts were used: patients from the Surveillance, Epidemiology, and End Results (SEER) database (1988 to 2014) and Shanghai resident patients at Shanghai Pulmonary Hospital (2009 to 2019) in China. Cox regression analysis was applied to identify prognostic factors for progression-free survival and overall survival (OS). Interaction assessments were performed using likelihood ratio tests to examine relationships between adjuvant chemotherapy and other baseline characteristics. In the SEER cohort, 1640 patients with PSC were identified, with a median survival and a 5-year OS rate of 7 months (95% confidence interval (CI), 6 to 8 months) and 19.5%, respectively. Multivariable Cox analysis of surgically treated patients revealed that adjuvant chemotherapy was significantly associated with better survival (hazard ratio, 0.78; 95% CI, 0.62 to 0.98), and the benefit was more pronounced in T3 to T4 stage (P =.04) and N-positive patients (P <.01). In the Shanghai Pulmonary Hospital cohort (n = 175), the median progression-free survival and OS were 8 months (95% CI, 7 to 12 months) and 12 months (95% CI, 10 to 18 months), respectively, with a 5-year OS rate of 25.1%. Similarly, the survival benefit of adjuvant chemotherapy was confirmed in patients with surgical resection (hazard ratio, 0.50; 95% CI, 0.31 to 0.81), but this benefit was restricted to patients who were younger (age <63 years; P =.02) and had a higher body mass index (>25 kg/m2; P <.01) by interaction assessments. The disease control rate after chemotherapy was 58.62%, and the disease control rate after targeted therapy was 57.14%. Adjuvant chemotherapy should be recommended for patients with surgically treated PSC, especially for patients with advanced-stage cancer, younger age, or higher body mass index. [ABSTRACT FROM AUTHOR]

• Carinal resection with lung parenchyma sparing is a challenging issue in thoracic surgery. • It is usually not used for the difficulty of the technique. • It is replaced by pneumonectomy when the patient conditions allow this approach. • Complications after carina resection are quite frequent. • A high expertise and good coordination are mandatory to prevent severe complications. Carinal resection (CR) with or without lung parenchyma sparing is one of the challenging issues in thoracic surgery and performed rarely. It is usually not used for the difficulty of the technique, or, in the majority of the situations, it is replaced by pneumonectomy when the patient conditions and the tumor characteristics allow the radical surgical approach. The difficulty includes the dissection of the trachea and main bronchi, the resection of the carina and the reconstruction of the trachea and bronchus. In spite of the knowledge of the technique, one of the most important problem is the incidence of postoperative complications which is higher compared to standard resections. We show two cases of carina resection for a bronchogenic tumor with lung parenchyma sparing and good postoperative outcomes. Our results demonstrate that this type of surgery is possible in selected centers with good quality of life for the patient after surgery. [ABSTRACT FROM AUTHOR]

When multiple target lung nodules exist, the computed tomography (CT)–guided percutaneous localization procedure becomes complicated. In this study, a three-dimensional (3D)–printed template was designed that could guide hook wire localization of multiple lung nodules. The pilot study aimed for preliminary validation of the feasibility of template-guided localization for multiple lesions. Patients with multiple lung nodules (<2 cm) and who were scheduled for surgical resection were recruited for participation in this study. After securing their preadmission CT images, the study investigators reconstructed a 3D thorax model from which they designed a digital model as a navigational template. A physical template was then printed for guiding the percutaneous localization of lung nodules. The localization accuracy was evaluated on the basis of the deviation between the localizer and the nodule. From April 2018 to November 2018, the study enrolled 16 patients with 34 lung nodules. All nodules were successfully localized under template guidance, with a median procedural time of 10.0minutes (interquartile range [IQR], 8.5-12.6 minutes) and a median radiation exposure of 235 mGy • cm (IQR, 195-254 mGy • cm). The median deviation from the hook wires and nodule centers was 9.0 mm (IQR, 6.2-11.8 mm). Except for 2 cases of pneumothorax without need for further intervention, no complications occurred. Navigational templates built using 3D printing may serve as an effective approach for facilitating localization of multiple lung nodules. [ABSTRACT FROM AUTHOR]

Removal of tumors that invade the trachea or carina often results in a massive defect that exceeds the limits of end-to-end anastomosis. The purpose of this study is to discuss the clinical value of bronchial flap for the closure of central airway defects after noncircumferential tracheal or carinal resection. From 1990 to 2016, 73 patients underwent noncircumferential tracheal or carinal resection. From size, location, and pulmonary function, there were six different types of bronchial flap reconstruction. We performed bronchial flap upturned reconstruction with right pneumonectomy (n = 45), right upper lobectomy (n = 9), left pneumonectomy (n = 7), left upper lobectomy (n = 3), and bronchial flap downturned reconstruction with right pneumonectomy (n = 5), left pneumonectomy (n = 4). The size of airway defects that were replaced by bronchial flap ranged from 0.5 × 2 to 2.5 × 7 cm and was at most 50% of the airway circumference. Postoperative major complications occurred in 17.8% (13 of 73) of patients: four bronchopleural fistulas (5.5%), five serious postoperative infections (6.8%), two pulmonary atelectasis (2.7%), and two airway stenosis (2.7%). However, no significant differences were found in postoperative complications between resection lengths shorter than 4 cm and longer than 4 cm (p = 0.295). The overall 30-day mortality rate was 2.7%. The overall survival rate was 63.5% and 23.6% at 2 and 5 years, respectively. The six different types of bronchial flap reconstruction present an efficient therapeutic strategy to close massive central airway defects after noncircumferential tracheal or carinal resection when the patient has poor pulmonary function or when an end-to-end anastomosis is unfeasible and risky. [ABSTRACT FROM AUTHOR]

We investigated the association between survival and the number of examined lymph nodes after sublobar resection for node-negative non-small cell lung cancer with size of 2 cm or less. The Surveillance, Epidemiology, and End Results database was used to identify patients diagnosed with non-small cell lung cancer 2 cm or less from 2004 to 2014 and underwent wedge resection or segmentectomy. Patients were stratified by the procedure (wedge resection, segmentectomy), the size of tumors (≤1 cm, 1 to 2 cm), and the number of lymph nodes examined (0, 1 to 3, 4 to 9, ≥10). The relationship between the number of resected lymph nodes and overall survival (OS)/lung cancer-specific survival (LCSS) was analyzed. A total of 2,298 patients with wedge resection and 566 patients with segmentectomy were identified. Segmentectomy was performed for bigger tumors (1.43 cm versus 1.38 cm) and was associated with more lymph nodes resected (median number: 3 versus 1). Multivariable analysis after propensity score matching revealed that lymph node resection improved survival for patients undergoing wedge resection while not for patients undergoing segmentectomy. In the wedge resection group, 1 to 3 nodes resected improved OS and 4 to 9 nodes improved OS and LCSS compared with patients without nodes evaluated for lesions 1 cm or less. No survival benefit was observed when 10 or more nodes were resected. For lesions 1 to 2 cm, incremental improvement in survival appeared with the increase of examined lymph node number. More than 16 nodes resected conferred no additional survival benefit compared with patients with 10 to 16 nodes resected. In wedge resection, 4 to 9 and 10 to 16 lymph nodes should be examined for lesions 1 cm or less and 1 to 2 cm, respectively. In segmentectomy, lymph node resection did not confer survival benefits for lesions 2 cm or less. [ABSTRACT FROM AUTHOR]

Abstract Rapid development of tissue engineering technology provides new methods for tracheal cartilage regeneration. However, the current lack of an ideal scaffold makes engineering of trachea cartilage tissue into a three-dimensional (3-D) tubular structure a great challenge. Although a decellularized trachea matrix (DTM) has become a recognized scaffold for trachea cartilage regeneration, it is difficult for cells to detach from or penetrate the matrix because of its non-porous structure. To tackle these problems, a laser micropore technique (LMT) was applied in the current study to enhance trachea sample porosity, and facilitate decellularizing treatment and cell ingrowth. Furthermore, after optimizing LMT and decellularizing treatment parameters, LMT-treated DTM (LDTM) retained its natural tubular structure with only minor extracellular matrix damage. Moreover, compared with DTM, the current study showed that LDTM significantly improved the adherence rate of cells with perfect cell biocompatibility. Moreover, the optimal implantation cell density for chondrogenesis with LDTM was determined to be 1 × 108 cells/ml. Collectively, the results suggest that the novel LDTM is an ideal scaffold for trachea tissue engineering. Graphical abstract fx1 [ABSTRACT FROM AUTHOR]

Synovial sarcoma (SS) is an uncommon malignant tumor associated with poor prognosis, and SS arising from the trachea is even rarer, with only 3 cases reported previously. We present the case of a 19-year-old man for whom imaging studies revealed a mass of soft tissue density in the lower trachea. An en bloc trachea segmental resection and postoperative proton beam therapy were performed. Diagnosis was confirmed by the SS18-SSX gene rearrangement. The patient was alive without tumor recurrence for 18 months. This case report presents tracheal SS successfully treated with surgery and postoperative proton therapy. [ABSTRACT FROM AUTHOR]

Background Some clinical N0 lung adenocarcinomas have been pathologically diagnosed as N1 or N2. To improve the preoperative diagnostic accuracy of lymph node disease, we developed a prediction model for lymph node metastasis in cT1 N0 M0 lung adenocarcinoma based on computed tomography texture analysis and clinical characteristics to estimate the probability of lymph node metastasis. Methods The records of 501 consecutive patients with cT1 N0 M0 lung adenocarcinoma who underwent computed tomography scan and pulmonary resection with systematic lymph nodes dissection or lymph nodes sampling were reviewed. Each nodule was manually segmented, and its computerized texture features were extracted. Multivariate logistic regression with fivefold validation was used to estimate independent predictors and build the prediction model. The prediction model was then externally validated. A nomogram was developed based on logistic regression results. Results Among 501 patients, 41 were diagnosed with positive lymph nodes (8.18%). Four independent predictors were identified: the skewness and 90th percentile of computed tomography number, nodule compactness, and carcinoembryonic antigen level. This model showed good calibration (Hosmer-Lemeshow test, p = 0.337), with an area under the curve of 0.883 (95% confidence interval, 0.842 to 0.924; p < 0.001). The area under the curve was 0.808 (95% confidence interval, 0.735 to 0.880) when validated with independent data. Conclusions A model based on computerized textures and carcinoembryonic antigen level can assess the lymph node status of patients with cT1 N0 M0 lung adenocarcinoma preoperatively, which could assist surgeons in making subsequent clinical decisions. [ABSTRACT FROM AUTHOR]

Background Safety and short-term efficacy of video-assisted thoracoscopic surgery (VATS) for early-stage non-small lung cancer (NSCLC) has been demonstrated by observational studies previously. However, these outcomes have never been verified by a large randomized controlled trial (RCT). The aim of our RCT was to confirm that VATS is not inferior or even superior to open operation for early-stage NSCLC in terms of short-term and oncologic efficacy. Methods The trial was undertaken at five tertiary hospitals. Patients aged between 18 and 75 years with clinically early-stage NSCLC were randomly assigned to the VATS and axillary thoracotomy groups. Lobectomy plus mediastinal lymph node dissection was standard surgical intervention. Because patients continue to be followed up for oncologic outcome, the short-term perioperative outcomes would be reported here. Results Between 2008 and 2014, 508 patients were recruited and 425 were eligible for analyses (215 VATS and 210 axillary thoracotomy). Eight VATS procedures were converted to open operation intraoperatively (3.72%). Median operation time with VATS was significantly less than axillary thoracotomy (150 versus 166 minutes, p = 0.009). In addition, VATS was associated with less intraoperative blood loss ( p = 0.001). There was no difference for postoperative pleural drainage, length of hospitalization, and rates of morbidity and mortality. Cancer residual margins were found in 1 patient with VATS and 5 with axillary thoracotomy ( p = 0.128). The yield of lymph nodes from either surgical approach was similar ( p = 0.389). Conclusions Our study demonstrates that VATS lobectomy is safe and reliable to treat NSCLCs, and it may be superior to axillary thoracotomy for operation time and intraoperative blood loss. ClinicalTrials.gov identifier: NCT01102517 . [ABSTRACT FROM AUTHOR]

Tissue-engineered trachea provides a promising approach for reconstruction of long segmental tracheal defects. However, a lack of ideal biodegradable scaffolds greatly restricts its clinical translation. Decellularized trachea matrix (DTM) is considered a proper scaffold for trachea cartilage regeneration owing to natural tubular structure, cartilage matrix components, and biodegradability. However, cell residual and low porosity of DTM easily result in immunogenicity and incomplete cartilage regeneration. To address these problems, a laser micropore technique (LMT) was applied in the current study to modify trachea sample porosity to facilitate decellular treatment and cell ingrowth. Decellularization processing demonstrated that cells in LMT treated samples were more easily removed compared with untreated native trachea. Furthermore, after optimizing the protocols of LMT and decellular treatments, the LMT-treated DTM (LDTM) could retain their original tubular shape with only mild extracellular matrix damage. After seeding with chondrocytes and culture in vitro for 8 weeks, the cell-LDTM constructs formed tubular cartilage with relatively homogenous cell distribution in both micropores and bilateral surfaces. In vivo results further confirmed that the constructs could form mature tubular cartilage with increased DNA and cartilage matrix contents, as well as enhanced mechanical strength, compared with native trachea. Collectively, these results indicate that LDTM is an ideal scaffold for tubular cartilage regeneration and, thus, provides a promising strategy for functional reconstruction of trachea cartilage. Statement of Significance Lacking ideal biodegradable scaffolds greatly restricts development of tissue-engineered trachea. Decellularized trachea matrix (DTM) is considered a proper scaffold for trachea cartilage regeneration. However, cell residual and low porosity of DTM easily result in immunogenicity and incomplete cartilage regeneration. By laser micropore technique (LMT), the current study efficiently enhanced the porosity and decellularized efficacy of DTM. The LMT-treated DTM basically retained the original tubular shape with mild matrix damage. After chondrocyte seeding followed by in vitro culture and in vivo implantation, the constructs formed mature tubular cartilage with matrix content and mechanical strength similar to native trachea. The current study provides an ideal scaffold and a promising strategy for cartilage regeneration and functional reconstruction of trachea. [ABSTRACT FROM AUTHOR]

Background: The goal of this prospective study was to determine risk factors for prolonged air leak (PAL) for patients who underwent video-assisted thoracoscopic surgery (VATS) for spontaneous pneumothorax. Methods: Between January 2002 and June 2012, a total of 2,292 patients were eligible for enrollment in the study: 1,800 patients had primary spontaneous pneumothorax and 492 patients had secondary spontaneous pneumothorax. There were 312 female and 1,980 male patients with a mean age of 41 years (range, 13 to 85 years). Twenty-three variables were recorded for each patient. The primary endpoint was rate of postoperative PAL (chest tube drainage for >7 days). Statistical evaluation used univariate and multivariate logistic regression analyses. Results: A total of 223 (9.73%) cases of postoperative PAL occurred in 2,292 patients. Comparing clinical characteristics between the patients with and without PAL, mean age in the air leak group (59 ± 18 y) was significantly older than that in non-air-leak group (39 ± 18 y) (p < 0.05). Multivariate analyses found 4 variables related to PAL (p < 0.05): age, American Society of Anesthesiologists scores, bilateral procedures, and bullae diameter. No significant relationships were found between pleural abrasions and/or talc pleurodesis and PAL. Conclusions: Prolonged air leak is one of the most common complications after spontaneous pneumothorax operations. Age, American Society of Anesthesiologists scores, bilateral procedures, and bullae diameter were risk factors for PAL. Use of talc pleurodesis with pleural abrasion may not decrease the incidence of PAL in VATS spontaneous pneumothorax operation. Talc pleurodesis with pleural abrasion should be used cautiously in patients with significant comorbid conditions or advanced age. [Copyright &y& Elsevier]

Background: It has been technically challenging to perform simultaneous triple plasty on the superior vena cava (SVC), pulmonary artery (PA), and main bronchus for central-type lung cancers. In the present study, the authors describe a corresponding technique and clinical outcomes of this surgical manipulation. Methods: Clinical data from 4 patients with non–small cell lung cancer (NSCLC) who underwent triple plastic resections and reconstructions were retrospectively reviewed. Three patients received neoadjuvant chemotherapy for pathologically proven locally advanced disease. For pulmonary arteries, sleeve resection with end-to-end anastomosis was performed in 2 patients; tangential resection was used in the other 2 patients. SVC resection with ringed polytetrafluoroethylene (PTFE) graft interposition was performed in 1 patient; the other 3 patients underwent tangential SVC resection. Sleeve resection of the bronchus was performed in all 4 patients. Systemic lymphadenectomy was accomplished in all patients. Results: There was histologic confirmation of large cell carcinoma, adenocarcinoma, squamous cancer, and adenosquamous cancer, respectively, in these 4 patients. Stage pT4N2M0-IIIB was confirmed in 2 patients, and stage T4N1M0-IIIA and stage T2aN2M0-IIIA were confirmed in the other 2 patients. There were no perioperative deaths. Postoperative atrial fibrillation and prolonged air leakage occurred in 2 patients, respectively. Four patients underwent postoperative chemotherapy and 2 patients were administered radiotherapy. Patients were followed for 21 to 38 months: Two patients had disease-free survival at their 32-month and 38-month follow-ups, and the other 2 patients died 21 and 22 months, respectively, after operation because of remote metastasis. Conclusions: Triple plasty of bronchus, PA, and SVC is both practical and safe for patients with locally advanced NSCLC. For patients with strict indications, the long-term survival is favorable. [ABSTRACT FROM AUTHOR]

Background: Bronchiectasis is one of the common diseases diagnosed in the world. No major improvement for the treatment approaches and limited efficacy promote a big challenge for management of this disease. Video-assisted thoracoscopic surgery (VATS) offers a new choice for the treatment of bronchiectasis. The purpose of this study was to present our experience of VATS for bronchiectasis and to compare this with thoracotomy in our institution. Methods: We reviewed the medical records of patients who underwent VATS lobectomy and general lobectomy for bronchiectasis between January 2005 and December 2009. Results: A total of 279 patients underwent thoracotomy, 52 patients underwent attempted VATS lobectomy. Fifty-two patients from 279 patients for thoracotomy were selected and compared with the VATS group. Pleural adhesion was observed in 15 patients (28.8%) in VATS. The VATS lobectomy was converted to open thoracotomy in 7 patients. There was no difference in the blood loss and median operative time between the two groups, but the patients with VATS had shorter length of stay in hospital (p = 0.045), fewer complications (p = 0.039) than those with thoracotomy. Forty-nine (94%) and 46 (88%) patients fully recovered after operation by VATS and thoracotomy, respectively. Conclusions: Video-assisted thoracoscopic lobectomy in localized bronchiectasis is a safe and more efficient procedure in selected patients with better recovery. [Copyright &y& Elsevier]

Background: The global incidence of bronchiectasis is increasing, and this disease is prevalent in rural China. This study examined operative mortality, morbidity, and outcomes of surgery for bronchiectasis at a single institution in China. Methods: We retrospectively reviewed the medical records of 790 consecutive patients who underwent surgery for bronchiectasis in our department between January 1989 and December 2008. Localized bronchiectasis was diagnosed by high-resolution computed tomography. The persistence of symptoms after failure of nonsurgical treatment was an indication for surgery. Cystic fibrosis patients were excluded from this study. Results: The study sample included 790 patients (466 male, 324 female) who underwent 810 operations for bronchiectasis. Mean age at time of surgery was 41.6 years (range, 6 to 79 years). Several surgical procedures were used: lobectomy (497; 62.9%), segment resection (37; 4.7%), pneumonectomy (90; 11.3%), bilobectomy (56; 7.1%), and lobectomy and segmentectomy (110; 14.0%). There were no intraoperative deaths. Nine (1.1%) patients died in the postoperative period. Univariate analysis showed that advanced age (p = 0.04) and renal failure (p = 0.001) were associated with postoperative mortality, and multivariate analysis revealed that preoperative renal failure was associated with mortality (p = 0.025). The mean follow-up time was 4.2 years (range, 10 months to 10 years). After surgery, 478 (60.5%) patients were asymptomatic, 111 (14.1%) had improved, and 117 (14.8%) showed no improvement or worsened condition. Conclusions: Localized bronchiectasis is usually the indication for surgical resection, which is a safe procedure with acceptable operative morbidity, mortality, and outcomes. [Copyright &y& Elsevier]

Background: We retrospectively analyzed risk factors for late bronchopleural fistula after non-small cell lung cancer (NSCLC) surgery and compared with those for early bronchopleural fistula. Methods: In all, 6,239 patients with NSCLC who underwent surgery were studied, and clinical risk factors were examined by univariate and multivariate analysis. This study included 23 patients (0.38%) with late bronchopleural fistula and 43 patients (0.65%) with early bronchopleural fistula among all 6,239 patients. Follow-up data were recorded until December 2005 or until death. Statistical significance was calculated using the log rank test. Results: By univariate analysis, patients with radiotherapy after operation, pneumonia after operation, pneumonectomy, and advanced age were related to higher risk of bronchopleural fistula. In the multiple logistic regression models, both pneumonia and operative procedure were among the independent risk factors of early and late bronchopleural fistula. Early bronchopleural fistula was observed primarily in the aged. Late bronchopleural fistula was associated with postoperative radiotherapy. The average intervals of bronchopleural fistula between pneumonectomy and lobectomy were significantly different. Compared with the mortality rate of late bronchopleural fistula (0%), the mortality rate of early bronchopleural fistula (11.6%) was significantly higher. Conclusions: There are both similarities and differences between the risk factors for early and late bronchopleural fistula. We should analyze the different reasons for the occurrence of bronchopleural fistula, and adopt different preventive measures. Different follow-up should be provided for the different operations. [Copyright &y& Elsevier]

To compare short- and long-term outcomes between sleeve lobectomy and pneumonectomy for lung cancer in a single center during a 15-year period. One thousand nine hundred eighty-one patients who underwent either a sleeve lobectomy (n = 964; 48.7%) or a pneumonectomy (n = 1017; 51.3%) from January 2003 to December 2017 at the Shanghai Pulmonary Hospital, were matched according to a propensity score to produce 2 groups of 665 patients each. The study period was divided into 3 5-year subperiods. Sleeve lobectomy was associated with a lower 30- and 90-day mortality (0.60% and 0.90% vs 1.5% and 3.91%; P =.177 and P =.001, respectively, after matching), lower morbidity (4.36% vs 8.16%; P =.005 before matching, 3.61% vs 8.72%; P <.001 after matching), improved 5-year survival (62.7% vs 43.1%; P <.001 before matching and 61% vs 44.7%; P <.001 after matching), and 5-year disease-free survival after matching (56.6% vs 46.2%; P <.001). The sleeve lobectomy to pneumonectomy ratio increased by 78%, whereas 90-day mortality decreased by 66.81% between the first and the last subperiods. Sleeve lobectomy is associated with improved short- and long-term outcomes and should be the resection of choice for centrally located lung cancers, when feasible. Of the 2754 initial pool of patients, 1981 patients were eligible to be included in our study. After 1:1 matching based on propensity scores, 2 cohorts of 665 patients each were produced. The outcomes measured were 30- and 90-day mortality rate, complications, overall survival (OS) and disease-free survival (DFS). There was a significant advantage of the sleeve lobectomy (SL) group compared with the pneumonectomy (PN) group regarding the 90-day mortality, 5-year OS, and 5-year DFS. NSCLC , Non–small cell lung cancer; HR , hazard ratio. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: Multidrug-resistant tuberculosis (MDR-TB) has become a challenge to TB control, and surgical resection is regaining its status as an integral component of multimodal treatment. We evaluated the efficacy and risks of pulmonary resection in the treatment of MDR-TB. Methods: A retrospective review was performed of 56 patients who had undergone pulmonary resection for MDR-TB from January 1995 to July 2006. Preoperative diagnoses included cavitation in 25 patients, lung destruction in 17, endobronchial TBs in 10, and tuberculoma in 4. Results: Mycobacterium tuberculosis resistant to both isoniazid and rifampin was isolated from the sputum of all patients preoperatively but in only 5 patients postoperatively. Pneumonectomy was performed on 25 patients and lobectomy on 31. No patients died perioperatively, but major complications occurred in 14 patients, with a morbidity of 25%. Complications included reoperation due to uncontrollable postoperative bleeding in 1 patient, chylothorax in 1, wound infection in 1, bronchopleural fistula in 9, and chronic tuberculous empyema in 2. Analysis of variance showed that lung function was significantly correlated with the type of preoperative diagnosis. Univariate and multivariate logistic regression analyses revealed that endobronchial TB significantly contributed to the development of bronchopleural fistula, and bronchial stump reinforcement could prevent its occurrence. Conclusions: Pulmonary resection plays an important role in the treatment of MDR-TB. Endobronchial TB is a significant risk factor for developing bronchopleural fistula, but bronchial stump reinforcement can effectively prevent its occurrence. [Copyright &y& Elsevier]

Resection of the trachea is usually limited by the length of involvement. We present a case of long segment tracheal resection performed by adding an autologous pedicled pectoralis major myocutaneous flap transposition. By applying of this technique, a segment of trachea as long as 7.5 cm was safely resected without complications. [ABSTRACT FROM AUTHOR]

Esophagectomy after pneumonectomy is very rare. We present a case of esophagectomy for esophageal cancer after left pneumonectomy. By application of an endobronchial blocker, satisfactory results were achieved and the disadvantages of extracorporeal membrane oxygenation, cardiopulmonary bypass, and other ventilation methods were avoided. [Copyright &y& Elsevier]

The aim of this study was to investigate the adequacy of bronchial sleeve lobectomy by video-assisted thoracoscopic surgery in perioperative outcomes and its oncological efficacy by comparing with thoracotomy in a balanced population. A total of 363 patients who received bronchial sleeve lobectomy for non–small cell lung cancer from January 2013 to December 2017 were included and placed in the thoracotomy (n = 251) and video-assisted thoracoscopic surgery (n = 112) groups. Statistical analyses were performed to compare patients' demographics, perioperative outcomes, and survival between the 2 groups. A total of 116 thoracotomy cases were matched with 72 video-assisted thoracoscopic surgery cases by propensity score. Compared with thoracotomy, patients in the video-assisted thoracoscopic surgery group after matching had less intraoperative blood loss (P <.01) and length of postoperative hospital stay (P <.01), duration of chest tube drainage (P <.01), and intensive care unit stay (P =.03) despite comparable operative time, complication rate, and 30- to 90-day mortality rate. The overall survival and recurrence-free survival were similar in patients who received sleeve lobectomy by thoracotomy and video-assisted thoracoscopic surgery (log-rank, P =.24 and.20, respectively) at 3 years. Although advanced TNM stage was independently associated with worse overall survival and recurrence-free survival in multivariable analysis, older age was only predictive for worse overall survival (hazard ratio, 1.04; 95% confidence interval, 1.01-1.07; P =.02). Body mass index was also found be a predictive factor (overall survival: hazard ratio, 0.93; 95% confidence interval, 0.86-0.99, P =.03; recurrence-free survival: hazard ratio, 0.93; 95% confidence interval, 0.87-0.99, P =.02). With appropriate patient selection and continued experience, video-assisted thoracoscopic surgery appears to be safe in the short-term perioperative period and does not appear to comprise oncologic outcomes in performing sleeve lobectomy. Compared with thoracotomy, VATS is a safe and reliable surgical procedure for sleeve lobectomy in selected patients with centrally located NSCLC without compromising perioperative and oncologic outcomes. [ABSTRACT FROM AUTHOR]

Bronchogenic cyst (BC) is a rare congenital developmental abnormality. BCs are usually encountered in the mediastinum, but ectopic BCs are rare. We present a case of BC located within the diaphragm in an adult female patient. The lesion was successfully resected via thoracotomy. Diagnosis was confirmed by pathology. [Copyright &y& Elsevier]