RESUMEN
BACKGROUND: Results of pneumonectomy after chemotherapy are controversial, and the procedure is often considered as potentially dangerous. METHODS: Records of patients who underwent pneumonectomy after chemotherapy for non-small cell lung cancer in a single institution in a 6-year period were reviewed retrospectively. RESULTS: One hundred eighteen patients had pneumonectomy after chemotherapy. Indications for preoperative chemotherapy were N2 disease, 74; potentially resectable T4 disease, 17; doubtful resectability, 18; stage IV disease (nodule on another ipsilateral lobe), 4; and participation in a randomized trial on induction chemotherapy in initial stages, 5. Chemotherapy protocols were platinum-based. Imaging reevaluation showed complete, partial, minor response, and disease stability in 0, 24, 39, and 55 patients, respectively. Operative mortality was 5.9% (7 of 118), consisting of 4 of 54 after pneumonectomy, and 3 of 64 after left pneumonectomy. Bronchopleural fistula caused one death. No factor among those evaluated (sex, age, comorbidities, forced expiratory volume in 1 second, symptoms, side and location of tumor; indication for operation, number of cycles, and response to chemotherapy; extent of resection, TNM status, pathologic stage) predicted postoperative death. Median and overall 5-year survival was 22 months and 23.7%, respectively. At univariate analysis, pathologic stage, T status, and the occurrence of postoperative complications influenced 5-year survival. At multivariate analysis, T status (p = 0.0054), the occurrence of postoperative complications (p = 0.0015), and clinical response to induction chemotherapy (p = 0.028) were identified as independent predictors of 5-year survival. CONCLUSIONS: Pneumonectomy after chemotherapy has acceptable mortality. Long-term results are encouraging.
Asunto(s)
Antineoplásicos/uso terapéutico , Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/cirugía , Terapia Neoadyuvante , Neumonectomía/mortalidad , Complicaciones Posoperatorias/mortalidad , Anciano , Carboplatino/administración & dosificación , Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Carcinoma de Pulmón de Células no Pequeñas/patología , Cisplatino/administración & dosificación , Femenino , Estudios de Seguimiento , Francia , Mortalidad Hospitalaria , Humanos , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Ensayos Clínicos Controlados Aleatorios como Asunto , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
Management of bronchiectasis remains controversial and information on long-term results of surgical treatment is poor. Clinical records of 45 patients, who underwent surgery for bronchiectasis in an 8-year period, were retrospectively reviewed. Bronchiectasis focus was isolated in 24 cases, associated with a limited homolateral or controlateral focus in 9 and 11, respectively; two patients had bilateral evident foci. Bronchiectasis was responsible for lobe destruction in 23 cases. All patients had symptoms: haemoptysis (n=7), recurrent pneumonia (n=7), persistent bronchorrea with recurrent infection (n=15), hemoptysis and recurrent infection (n=16). A total of 23 lobectomies, 11 lobectomies+segmentectomies, 2 bi-lobectomies, 9 segmentectomies and 1 pneumonectomy were carried out. There were no perioperative deaths; complications occurred in 5 patients (postoperative pneumonia in 2, prolonged air-leak, residual air-space and bronchial infection 1 each). Symptoms disappeared in 32 patients, 10 patients experienced a significant improvement. Exercise tolerance remained stable or improved in 33 and 2 cases, respectively, a slight impairment was observed in 9. Out of 32 evaluable patients 11 had an unchanged FEV(1), 15 had a limited FEV(1) lowering (<15%), and 9 had a more important functional loss. Surgical treatment of bronchiectasis obtains satisfactory long-term results, with acceptable morbidity rates.
Asunto(s)
Bronquiectasia/cirugía , Neumonectomía , Toracotomía , Adolescente , Adulto , Anciano , Bronquiectasia/complicaciones , Bronquiectasia/diagnóstico por imagen , Bronquiectasia/fisiopatología , Niño , Tolerancia al Ejercicio , Femenino , Volumen Espiratorio Forzado , Hemoptisis/etiología , Hemoptisis/cirugía , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Neumonectomía/efectos adversos , Neumonía/etiología , Neumonía/cirugía , Recuperación de la Función , Recurrencia , Estudios Retrospectivos , Toracotomía/efectos adversos , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
A simple and quick technique to fashion a mitral ring was developed using a stainless steel wire covered by a Gore-Tex strip. This technique allows a 15-fold reduction in the cost of a mitral ring compared with commercially available rings. As such, cardiac surgery becomes more readily available to patients in developing countries such as Africa and Asia. These homemade rings were implanted in 6 patients with similar results to commercially available rings.