Current challenges in thoracic surgery最新文献_第8页

Surgery in large anterior mediastinal mass: case series of Hospital Kuala Lumpur 大型前纵隔肿块的外科治疗：吉隆坡医院病例系列

Current challenges in thoracic surgery Pub Date : 2021-05-25 DOI: 10.21037/CCTS-20-119

Ammar Ahmad, N. Sathiamurthy, B. Dharmaraj, N. Balasubbiah, Diong Nguk Chai, A. N. M. Kamil, M. Thiagarajan

{"title":"Surgery in large anterior mediastinal mass: case series of Hospital Kuala Lumpur","authors":"Ammar Ahmad, N. Sathiamurthy, B. Dharmaraj, N. Balasubbiah, Diong Nguk Chai, A. N. M. Kamil, M. Thiagarajan","doi":"10.21037/CCTS-20-119","DOIUrl":"https://doi.org/10.21037/CCTS-20-119","url":null,"abstract":"Background: Mediastinal masses comprise of a wide variety of tumors and accounts for about 3% of tumors within the chest. Very few studies have been produced so far on large anterior mediastinal masses, as this pathology is infrequently encountered in clinical practice and tend to be asymptomatic until compression symptoms occur, which leads to mediastinal mass syndrome (MMS). The aim of this writing is to assess the surgical feasibility, approach, safety of resection and outcome in large anterior mediastinal masses. Methods: A retrospective review was conducted on patients referred for mediastinal mass to the Thoracic Surgery Unit, Hospital Kuala Lumpur from October 2017 until March 2020 (30 months). Patients with evidence of primary anterior mediastinal mass measuring >6 cm on contrast-enhanced computed tomography (CECT) of thorax and had undergone treatment in our centre were included. Data were analysed by proportions, means and standard deviations. Categorical data were expressed as percentage, whereas interquartile range was used to describe continuous variables. Results: Out of 63 patients with anterior mediastinal mass, 16 (25.4%) patients had anterior mediastinal mass larger than 6 cm and was included in the analysis. The average tumor size was 11.9 cm. Five patients (31.3%) had MMS. Twelve out of 16 patients were operated with 75% rate of clear tumor margin. There was no postoperative mortality recorded within 30 days of surgery. Conclusions: Positive outcome of definitive surgery in this series suggests clinical feasibility with acceptable short-term safety. Multidisciplinary approach with adequate preoperative assessment, intraoperative preparation and short- and long-term postoperative care were key features to successful treatment of this disease.","PeriodicalId":72729,"journal":{"name":"Current challenges in thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49414973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 2

A narrative review of the impact of donor factors and selection criteria on outcomes after lung transplantation 供者因素和选择标准对肺移植术后预后影响的叙述性综述

Current challenges in thoracic surgery Pub Date : 2021-01-01 DOI: 10.21037/ccts-21-2

M. Peltz

引用次数: 0

Malignant tracheoesophageal fistula: diagnosis and management 恶性气管食管瘘的诊断与治疗

Current challenges in thoracic surgery Pub Date : 2021-01-01 DOI: 10.21037/ccts-21-8

J. Kakuturu, Ankit Dhamija, A. Toker

{"title":"Malignant tracheoesophageal fistula: diagnosis and management","authors":"J. Kakuturu, Ankit Dhamija, A. Toker","doi":"10.21037/ccts-21-8","DOIUrl":"https://doi.org/10.21037/ccts-21-8","url":null,"abstract":": Tracheoesophageal fistula (TEF) refers to a pathological connection between the tracheobronchial tree and esophagus, and may be found in 5–15% of esophageal and 1% of tracheo-bronchial malignancies. Individuals with such advanced malignancy resulting in TEF, are usually at terminal stages of disease. They are often burdened with intolerance to feeding and are subject to frequent pulmonary infections secondary to respiratory contamination. Presentation varies from mild coughing to florid sepsis due to aspiration pneumonia. Diagnosis can usually be made by bronchoscopy and esophagoscopy. In cases where the TEF is small and cannot be visualized by these methods, fluoroscopic swallow evaluation may be useful. The primary aims of treatment are to initiate broad spectrum antibiotics when sepsis is present, to separate the esophagus from the respiratory tree preventing soilage, and to ensure enteral nutrition. In order to determine the approach to management, patients may be categorized into those who present with TEF without a diagnosis of a malignancy, those who present with TEF during oncological treatment with chemotherapy and/or radiation, and those in remission after treatment with definitive chemotherapy and/or radiation, and have developed TEF as a complication. The mainstay of therapy is endoscopic stenting of the esophagus and/or airway. Definitive surgical intervention is usually reserved for patients who are tumor free and involves take-down of the fistula with interposition of a muscle flap. Although therapy is mainly palliative in most circumstances, a systematic approach to this disease may provide patients with a better quality of life. fistula (TEF); airway stent tracheal repair, and esophageal repair (4-0 PDS). Post-operative esophagogram showed no evidence of TEF and no strictures of the esophagus.","PeriodicalId":72729,"journal":{"name":"Current challenges in thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45928064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 3

The importance of thoracic surgery clinics for emergency medicine: a retrospective analysis of consultations 胸外科门诊对急诊医学的重要性:会诊的回顾性分析

Current challenges in thoracic surgery Pub Date : 2021-01-01 DOI: 10.26663/cts.2021.0021

İsmail Ertuğrul Gedik, Okan Bardakçı, T. Alar

{"title":"The importance of thoracic surgery clinics for emergency medicine: a retrospective analysis of consultations","authors":"İsmail Ertuğrul Gedik, Okan Bardakçı, T. Alar","doi":"10.26663/cts.2021.0021","DOIUrl":"https://doi.org/10.26663/cts.2021.0021","url":null,"abstract":"Background: Thoracic Surgery serves as a consultant for many specialties of medicine. In this study, we aimed to analyze the basic characteristics of the consultations requested by the Department of Emergency Medicine to the Department of Thoracic Surgery in a university hospital. Materials and Methods: This study includes the retrospective analysis of emergency medicine consultations of patients over the age of 18 to the Thoracic Surgery Clinics of Çanakkale Onsekiz Mart University (COMU) Faculty of Medicine between 01/03/2014 and 01/03/2020. The cases were analyzed in two groups: the consultations requested with the initiative of the emergency medicine physician (Group A) and consultations requested as per recommendations of other physicians (Group B). Results: Of 486 consultations that met the inclusion criteria, 434 (89.3%) consultations were requested as per the recommendations of the emergency medicine physicians (Group A) and 52 (11.7%) were requested as per the recommendations of other physicians (Group B). No thoracic surgical diagnosis was established in 107 (22%) consultations. When compared between the two groups, no thoracic surgical pathology was found in 55 (12.6%) consultations from Group A and 52 (100%) consultations from Group B (p < 0.001). Conclusion: In our study, no thoracic surgical diagnosis was established in more than 20% of consultations requested by the emergency service. We believe that adding formal rotation training to thoracic surgery during the residency training of emergency medicine, which is the first specialty that meets emergency applications, will lead the diagnosis and treatment of thoracic surgical emergencies faster and more accurately.","PeriodicalId":72729,"journal":{"name":"Current challenges in thoracic surgery","volume":"79 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75431987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Comparing the outcomes of video-assisted thoracoscopic surgery and rethoracotomy in the management of postoperative hemorrhage 电视胸腔镜手术与开胸手术治疗术后出血的效果比较

Current challenges in thoracic surgery Pub Date : 2021-01-01 DOI: 10.26663/cts.2021.0010

V. Erdoğu, M. Onay, A. Çiftçi, Ece Yasemin Emetli, Semih Erduhan, A. Pekçolaklar, M. Doğru, Y. Aksoy, A. Kutluk, M. Metin

{"title":"Comparing the outcomes of video-assisted thoracoscopic surgery and rethoracotomy in the management of postoperative hemorrhage","authors":"V. Erdoğu, M. Onay, A. Çiftçi, Ece Yasemin Emetli, Semih Erduhan, A. Pekçolaklar, M. Doğru, Y. Aksoy, A. Kutluk, M. Metin","doi":"10.26663/cts.2021.0010","DOIUrl":"https://doi.org/10.26663/cts.2021.0010","url":null,"abstract":"Background: Although postoperative hemorrhage after thoracic surgery is uncommon, it is the most common indication for revision surgery after these procedures. Most postoperative hemorrhages are due to surgical technique, although some comorbidities can predispose the patient to bleeding. We investigated whether video-assisted thoracoscopic surgery (VATS) and re-thoracotomy had the same outcomes in the management of postoperative hemorrhage in patients who underwent open thoracotomy or VATS. Materials and Methods: We retrospectively analyzed patients with postoperative hemorrhage after thoracotomy (n = 659) or VATS (n = 883) between 2018 and 2020. Revision surgery was performed after thoracotomy in 22 patients (3.3%) and after VATS in 4 patients (0.4%). Of these, 11 patients (42.3%) were re-operated by re-thoracotomy (Re-thoracotomy Group) and 15 patients (57.7%) by revision VATS (VATS Group). Results: Revision due to postoperative hemorrhage was required significantly more frequently after thoracotomy than VATS (3.3% vs. 0.4%, p < 0.001). In patients with hemorrhage after pneumonectomy (n = 14), revision by VATS was preferred to re-thoracotomy (n = 10, 71.4% vs. n = 4, 28.6%). The mean time to discharge after revision surgery was 5.1 ± 2.2 days (range, 2-12 days) overall and was significantly shorter in the revision VATS Group than in the Re-thoracotomy Group (4.4 ± 1.5 days vs. 6.2 ± 2.5 days, p = 0.004). Conclusions: VATS has similar results to re-thoracotomy and is advantageous in terms of earlier recovery and shorter hospital stay. Therefore, VATS should be the preferred method for postoperative hemorrhage management.","PeriodicalId":72729,"journal":{"name":"Current challenges in thoracic surgery","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72543359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Pulmonary large cell neuroendocrine carcinoma: a diagnostic challenge 肺大细胞神经内分泌癌:一个诊断挑战

Current challenges in thoracic surgery Pub Date : 2021-01-01 DOI: 10.26663/cts.2021.0015

Demet Yaldız, M. Yaldız, A. Tan

引用次数: 0

The evidence behind lung cancer screening: a narrative review of randomized clinical trials 肺癌筛查背后的证据:随机临床试验的叙述性回顾

Current challenges in thoracic surgery Pub Date : 2021-01-01 DOI: 10.21037/ccts-21-30

V. Mase, Ulaş Kumbasar, F. Detterbeck

引用次数: 0

Anesthetic management of tracheo-esophageal fistula 气管食管瘘的麻醉处理

Current challenges in thoracic surgery Pub Date : 2021-01-01 DOI: 10.21037/CCTS-20-183

F. Uzumcugil

{"title":"Anesthetic management of tracheo-esophageal fistula","authors":"F. Uzumcugil","doi":"10.21037/CCTS-20-183","DOIUrl":"https://doi.org/10.21037/CCTS-20-183","url":null,"abstract":": The anesthetic management of a neonate diagnosed to have tracheoesophageal fistula with or without esophageal atresia (EA) is challenging, especially due to abnormally connected airway and esophagus interfering with patency of the airway and compromising ventilation. The anatomical variations regarding this congenital anomaly and the associated anomalies in various systems, determines both the surgical intervention and the anesthetic management. An urgent surgical intervention may be required within the first 48 hours after birth in case of severe respiratory compromise. On the other hand, a staged approach may be preferred including a gastrostomy in case of either the presence of low-birth-weight, isolated EA or more critical co-morbidities. A laryngotracheobronchoscopy is often performed prior to definitive surgery in order to identify the location and size of fistula, as well as, secondary upper airway anomalies. In the preoperative period, airway must be secured, and optimizing the status of the neonate in terms of other system functions should have a high priority. Intraoperatively, regardless of the agents used, the anesthetic management should focus on adequate depth of anesthesia, and adequate ventilation and oxygenation. The coordination between the anesthetist and the surgeon is crucial during the surgery in order to secure adequate ventilation and oxygenation. The associated anomalies should be considered as the main determinants of perioperative mortality and morbidity, hence, anesthetic management should also focus on intraoperative maintenance of preoperatively optimized functions. The analgesic management in the postoperative period is often provided by multimodal analgesic use. 6","PeriodicalId":72729,"journal":{"name":"Current challenges in thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41960784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Perioperative pain management for thoracic surgery: a narrative review of the literature 胸外科围手术期疼痛管理：文献综述

Current challenges in thoracic surgery Pub Date : 2021-01-01 DOI: 10.21037/ccts-20-184

A. Clairoux, R. Issa, Marie‐Ève Bélanger, R. Urbanowicz, P. Richebé, Véronique Brulotte

引用次数: 0

Extracorporeal membrane oxygenation for COVID-19: lessons learned 体外膜氧合治疗COVID-19:经验教训

Current challenges in thoracic surgery Pub Date : 2021-01-01 DOI: 10.21037/ccts-21-22

G. Schwartz, B. Blough, Kara Monday, R. Weddle, C. Hebert, C. Spak, U. Sandkovsky, R. Gottlieb, O. Hernandez, Kaitlyn Lingle, Dan Meyer

引用次数: 1