Search

Background In lung transplantation (LT), the length of ischemia time is controversial as it was arbitrarily stablished. We ought to explore the impact of extended cold-ischemia time (CIT) on ischemia-reperfusion injury in an experimental model. Methods Experimental, randomized pilot trial of parallel groups and final blind analysis using a swine model of LT. Donor animals (n = 8) were submitted to organ procurement. Lungs were subjected to 6 h (n = 4) or 12 h (n = 4) aerobic hypothermic preservation. The left lung was transplanted and re-perfused for 4 h. Lung biopsies were obtained at (i) the beginning of CIT, (ii) the end of CIT, (iii) 30 min after reperfusion, and (iv) 4 h after reperfusion. Lung-grafts were histologically assessed by microscopic lung injury score and wet-to-dry ratio. Inflammatory response was measured by determination of inflammatory cytokines. Caspase-3 activity was determined as apoptosis marker. Results We observed no differences on lung injury score or wet-to-dry ratio any given time between lungs subjected to 6 h-CIT or 12h-CIT. IL-1β and IL6 showed an upward trend during reperfusion in both groups. TNF-α was peaked within 30 min of reperfusion. IFN-γ was hardly detected. Caspase-3 immunoexpression was graded semiquantitatively by the percentage of stained cells. Twenty percent of apoptotic cells were observed 30 min after reperfusion. Conclusions We observed that 6 and 12 h of CIT were equivalent in terms of microscopic lung injury, inflammatory profile and apoptosis in a LT swine model. The extent of lung injury measured by microscopic lung injury score, proinflammatory cytokines and caspase-3 determination was mild.

Despite carcinological results awaiting validation, sublobar resections (SLRs) are of increasing interest due to the progressive change in tumour profile and to their lower morbidity when compared to lobectomies. However, this morbidity remains too high in comparison to non-surgical alternatives. Decreasing the complication rate requires greater precision. We present here the different ways to improve the accuracy of the different steps of these interventions: (I) performing these procedures via a closed chest approach; (II) knowing as much as possible about segmental anatomy and studying mapping; (III) performing an intraoperative examination on the intersegmental lymph nodes and on resection margins; (IV) using a preoperative or intraoperative marking method to determine the intersegmental plane (ISP); (V) stapling ISP, an imperfect method but that currently represents the least bad compromise between accuracy and safety.

The lung is the second site of metastasis after the liver, affecting 30 to 40 % of all patients with a malignant tumor. Chemotherapy seems to be ineffective for some types of tumor. Although there are no prospective randomized studies that confirm the benefit of surgical pulmonary metastasectomy, many studies have shown the existence of a group of patients with pulmonary metastases who benefit from a complete resection for curative purposes in case of complete resection of lung metastases. Different approaches are known to achieve a complete resection with maximum lung parenchyma sparing. Minimal invasive approaches appear to offer a better quality of life and have equivalent oncologic outcomes compared to the open approach.Au cours d’un cancer, 40 % des patients vont développer des métastases pulmonaires et dans cette situation un traitement seul de chimiothérapie est généralement peu efficace. Même s’il n’existe pas d’études randomisées prospectives qui confirment le bénéfice de la métastasectomie pulmonaire chirurgicale, diverses études ont montré l’existence d’un groupe de patients atteints de métastases pulmonaires qui bénéficient d’une résection à visée curative en cas de résection complète des métastases pulmonaires. Différentes approches chirurgicales peuvent être utilisées ayant pour but principal une résection complète et une épargne maximale du parenchyme pulmonaire. Les approches minimales invasives semblent offrir une meilleure qualité de vie et un résultat oncologique équivalent à l’approche par voie ouverte.

Resumen Introduccion El numero de resecciones pulmonares mayores endoscopicas ha presentado un incremento exponencial durante la ultima decada. La realizacion de la videotoracoscopia (VTC) puede ocasionar dificultades para la correcta interpretacion de la anatomia toracica debido a la ausencia de exploracion manual y de la vision en profundidad en el caso de trabajar con monitores bidimensionales. En consecuencia, el hecho de conocer con exactitud la anatomia de cada paciente contribuiria enormemente a la realizacion de una cirugia segura y precisa. El objetivo del estudio es analizar la eficacia de las reconstrucciones volumetricas realizadas mediante angiotomografia computarizada multidetector para identificar el patron de ramificacion de la arteria pulmonar en el preoperatorio de lobectomias y segmentectomias endoscopicas. Metodos Estudio descriptivo prospectivo de 25 pacientes seleccionados de noviembre de 2015 a julio de 2016 para realizacion de lobectomia/segmentectomia VTC en un hospital de tercer nivel. En todos los casos se realizo una reconstruccion volumetrica de la arteria pulmonar mediante angiotomografia computarizada multidetector de 16 coronas. Se analizaron comparativamente el numero de ramas arteriales identificadas mediante reconstruccion volumetrica y las observadas durante la reseccion pulmonar. Resultados En total 67 de las 68 (98%) ramas de la arteria pulmonar fueron correctamente identificadas mediante la reconstruccion volumetrica preoperatoria. La unica rama no objetivada mediante la reconstruccion volumetrica presentaba un diametro menor a 2 mm. No fue precisa ninguna conversion a toracotomia abierta debido a accidente vascular. Conclusiones La reconstruccion volumetrica es util como herramienta diagnostica preoperatoria para la correcta identificacion del patron de ramificacion de la arteria pulmonar.

Background: Stapling is becoming the method of choice for dividing the intersegmental plane during thoracoscopic segmentectomies. The technique however is controversial as it can impair re-expansion of preserved segments. We have analyzed the morbidity and lung re-expansion on a series of 175 thoracoscopic segmentectomies. Methods: A total of 175 patients underwent a thoracoscopic anatomic segmentectomy. Ten patients were excluded due to conversion into thoracotomy. There were 89 females (54%) and 76 males (46%). Mean age was 63 years (range, 18–83 years). Indications for segmentectomy were as follows: primary lung cancer (n=100, 61%), metastases (n=27, 16%), benign non-infectious lesions (n=20, 12%) and benign infectious lesions (n=18, 11%). The intersegmental plane was divided with an endostapler in all patients. Lung re-expansion assessment included chest roentgenograms at discharge and at one-month consultation. Results: The overall complication rate was 17%. There were 0.6% major complications and 16% minor complications. The average duration of drainage was 3 days (range, 1–13 days) and average length of stay was 5.7 days (range, 2–22 days). At discharge and at 1-month follow-up chest radiography, incomplete lung re-expansion was observed in 12 (7.4%) and 4 patients (2.8%) respectively. Patients who underwent upper lobe segmentectomy had significantly more incomplete re-expansion at discharge and at 1-month follow-up. On univariate analysis, mean drainage duration was significantly longer in patients who underwent upper segmentectomy (mean 3.7 days; range, 1–13) than those who underwent lower segmentectomy (mean 2.7 days; range, 1–5). Conclusions: Although stapling of the intersegmental plane most likely slightly impairs lung re-expansion, clinical and radiological consequences are minimal.

Lung cancer is the leading cause of cancer-related deaths among men and women in the world, accounting for the 25% of cancer mortality. Early diagnosis is an unmet clinical issue. In this work, we focused to develop a novel approach to identify highly sensitive and specifc biomarkers by investigating the use of extracellular vesicles (EVs) isolated from the pleural lavage, a proximal fuid in lung cancer patients, as a source of potential biomarkers. We isolated EVs by ultracentrifuge method from 25 control pleural fuids and 21 pleural lavages from lung cancer patients. Analysis of the expression of EVassociated miRNAs was performed using Taqman OpenArray technology through which we could detect 288 out of the 754 miRNAs that were contained in the OpenArray. The diferential expression analysis yielded a list of 14 miRNAs that were signifcantly dysregulated (adj. p-value

Indications and surgical approach for pulmonary metastasectomy remain controversial as randomized clinical trials are lacking to validate its effectiveness. To this end, non-anatomical lung wedge resection, widely performed by staplers, persists as preferred surgical procedure. With the advent of new technologies, laser assisted surgery evolved and has been advocated mainly for multiple pulmonary metastases in open surgery fashion. However, video-assisted thoracic surgery (VATS) laser pulmonary metastasectomy has been rarely reported. This review is based on a selective search of the PubMed database for articles that were published from 1990 to 2018 and contained the keywords ‘laser assisted surgery’, ‘pulmonary metastasectomy’, ‘thoracoscopic laser metastasectomy’, and ‘VATS’. No prospective clinical trial has been performed to provide evidence whether to treat pulmonary metastasis with laser or conventional techniques. According to retrospective cohort studies and descriptive series, open approach laser assisted surgery facilitates the resection of a higher number of metastases, sparing healthy lung parenchyma, while obtaining similar recurrence rates compared to conventional staplers. In central lesions, optimal surgical margins can be achieved around the lesion avoiding injury to deep located structures such as major vessels or bronchus. However, evidence about thoracoscopic laser pulmonary metastasectomy is remarkably poor consisting in only a few small series of patients with one or two resected metastases. Laser assisted pulmonary metastasectomy is safe and effective. Video-assisted laser resection of lung metastases is a marginal technique to date. Postulated benefits of open laser assisted pulmonary metastasectomy could not be assumed by thoracoscopic approach with available data. Further studies are needed to demonstrate whether multiple and centrally lesions could be effectively resected by thoracoscopic laser metastasectomy.

Lobectomy by video-assisted thoracic surgery (VATS) is now considered as a standard in the treatment of early-stage lung cancer with equivalent oncologic outcome as open lobectomy (1). Consequently, the widespread practice of thoracoscopic procedures pushed surgeons to perform more extended and complex resections. The feasibility of pulmonary segmentectomy, pneumonectomy, sleeve or carinal resections by VATS has been demonstrated in expert centers (2-4). However, the clinical and oncologic safety of such procedures has yet to be established.

Background The interest for endoscopic pulmonary anatomic resections has grown exponentially during the last decade. During thoracoscopic procedures surgeons cannot rely on digital handling and operative field is viewed on a two-dimensional video monitor, thus frequently encountering anatomical difficulties. The hypothesis is that foreknowledge of the anatomy of each patient would greatly contribute to the safety and accuracy of the operation. The aim of the study was to evaluate the effectiveness of three-dimensional multidetector computed tomography (3D-MDCT) software to identify the pulmonary artery branching pattern during the preoperative study of endoscopic lobectomies and segmentectomies. Methods Descriptive prospective study of 25 consecutive patients scheduled from November 2015 to July 2016 in a tertiary referral academic hospital for VATS lobectomy or segmentectomy and evaluated about branching pattern of the pulmonary artery with preoperative 16-row 3D-MDCT angiography. Intraoperative findings of the pulmonary branching pattern were compared with the preoperative 3D-MDCT angiography images. Results According to the intraoperative findings, 67 out of 68 (98%) of pulmonary artery branches were well defined in the 3D-MDCT angiography images. There was a unique 2 mm undetected branch. No conversion to open thoracotomy was needed because of intraoperative bleeding. Conclusion 3D-MDCT angiography imaging is useful for preoperative identification of the pulmonary artery branching pattern.

One third of non-small cell lung cancer (NSCLC) affects elderly patients in a locally advanced (LA) stage. Induction therapy followed by a curative approach is becoming the standard-of-care for LA-NSCLC.We compared the efficacy and tolerance to induction chemotherapy or chemo-radiation followed by surgery or definitive radiotherapy in patients younger (N=64) and older (N=44) than 70 years with LA-NSCLC.Elderly patients trended towards having a worse baseline performance status, and presented a higher percentage of IIIB, and squamous tumors. Nevertheless, no significant differences in response rate, operability, or disease-free and overall survival were found between age groups in the whole series, nor in the sub-group of resected patients. Grade 3-4 toxicity tended to be lower in elderly patients.Age by itself did not significantly worsen either the efficacy or tolerance to combined induction and definitive treatment in patients with LA-NSCLC and Eastern Cooperative Oncology Group performance status 0-2.