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Alain Bernard - One of the best experts on this subject based on the ideXlab platform.
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Sleeve lobectomy may provide better outcomes than Pneumonectomy for non-small cell lung cancer. A decade in a nationwide study
Journal of Thoracic and Cardiovascular Surgery, 2017Co-Authors: Pierre-benoit Pagès, Pierre Mordant, Stéphane Renaud, Laurent Brouchet, Pascal-alexandre Thomas, Marcel Dahan, Alain BernardAbstract:Introduction: Whenever feasible, sleeve lobectomy is recommended to avoid Pneumonectomy for lung cancer, but these guidelines are based on limited retrospective series. The aim of our study was to compare outcomes following sleeve lobectomy and Pneumonectomy using data from a national database. Methods: From 2005 to 2014, 941 sleeve lobectomy and 5318 Pneumonectomy patients were recorded in the French database Epithor. Propensity score was generated with 15 pretreatment variables and used to create balanced groups with matching (794 matches) and inverse probability of treatment weighting (standardized difference was 0 for matching, and 0.0025 after weighting). Odds ratio (OR) of postoperative complications and mortality and hazard ratio (HR) for overall survival and disease-free survival were calculated using propensity adjustment techniques and a sensitivity analysis. Results: Postoperative mortality after sleeve resection was similar to that after Pneumonectomy (matching OR, 1.24; P = .4; weighting OR, 0.77; P = .4) despite significantly lower odds of pulmonary complications with Pneumonectomy (matching OR, 0.4; P < .0001; weighting OR, 0.12; P < .001). The adjusted HR for death after Pneumonectomy was significantly higher when analyzed using matched analysis but not with weighting (matching HR, 1.63; P = .002; weighting HR, 0.97; P = .92). The same was true for disease-free survival (matching HR, 1.49; P = .01; weighting HR, 1.03; P = .84). Conclusions: Despite early differences in perioperative pulmonary outcomes favoring Pneumonectomy, early overall and disease-free survival was in favor of sleeve lobectomy in the matched analysis but not the weighted analysis. In our opinion, when it is technically feasible, sleeve lobectomy should be the preferred technique.
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empyema and bronchopleural fistula after Pneumonectomy factors affecting incidence
The Annals of Thoracic Surgery, 2001Co-Authors: Claude Deschamps, Alain Bernard, Francis C Nichols, Mark S Allen, Daniel L Miller, Victor F Trastek, Gregory D Jenkins, Peter C PairoleroAbstract:Abstract Background . Factors affecting the incidence of empyema and bronchopleural fistula (BPF) after Pneumonectomy were analyzed. Methods . All patients who underwent Pneumonectomy at the Mayo Clinic in Rochester, Minnesota, from January 1985 to September 1998 were reviewed. There were 713 patients (514 males and 199 females). Ages ranged from 12 to 86 years (median 64 years). Indication for resection was primary malignancy in 607 patients (85.1%), metastatic disease in 32 (4.5%), and benign disease in 74 (10.4%). One hundred fifteen patients (16.1%) underwent completion Pneumonectomy. Factors affecting the incidence of postoperative empyema and BPF were analyzed using univariate and multivariate analysis. Results . Empyema was documented in 53 patients (7.5%; 95% confidence interval [CI], 5.7% to 9.7%) and a BPF in 32 (4.5%; 95% CI, 3.1% to 6.3%). Univariate analysis demonstrated that the development of empyema was adversely affected by benign disease ( p = 0.0001), lower preoperative forced expiratory volume in 1 second (FEV 1 ; p p = 0.0001), lower preoperative serum hemoglobin ( p = 0.05), right Pneumonectomy ( p = 0.0109), bronchial stump reinforcement ( p = 0.007), completion Pneumonectomy ( p p = 0.01), and the amount of blood transfusions ( p p = 0.03), lower preoperative FEV 1 ( p = 0.03) and DLCO ( p = 0.01), right Pneumonectomy ( p p = 0.03), timing of chest tube removal ( p = 0.004), increased intravenous fluid in the first 12 hours ( p = 0.04), and blood transfusions ( p = 0.04). Bronchial stump closure with staples had a protective effect against BPF compared with suture closure ( p = 0.009). No risk factors were identified as being jointly significant in multivariate analysis. Conclusions . Multiple perioperative factors were associated with an increased incidence of empyema and BPF after Pneumonectomy. Prophylactic reinforcement of the bronchial stump with viable tissue may be indicated in those patients suspected at higher risk for either empyema or BPF.
Chang Chen - One of the best experts on this subject based on the ideXlab platform.
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A clinical model to estimate risk factor of early BPF after Pneumonectomy for NSCLC
Chinese Journal of Thoracic and Cardiovaescular Surgery, 2013Co-Authors: Gening Jiang, Chang Chen, Jia-an Ding, Hao WangAbstract:Objective To evaluate prognostic factors for early bronchopleural fistula after Pneumonectomy with non small cell lung cancer,and establish a validated clinical model to estimate the risk of early-BPF.Methods We reviewed the medical records of 429 patients who underwent Pneumonectomy for NSCLC at our institution.We used univariate and multivariate analysis to identify potential independent risk factors for early-BPF after Pneumonectomy for NSCLC.A model to estimate risk of early-BPF was developed by combining independent risk factors.Results The rate of early-BPF after Pneumonectomy for NSCLC was 6.5％ (28/429).Three factors were independently associated with early-BPF:neoadjuvant therapy (HR:2.406),bleeding (HR:2.171)and diabetes (HR:1.144).A scoring system for early-BPF was developed by assigning 2 points for each major risk factor (neoadjuvant therapy and bleeding) and 1 point for each minor risk factor(diabetes).Scores were grouped as low (0-1),intermediate (2-3),and high (3),yielding the rate of early-BPF was 14％,27％,and 43％,respectively.Conclusion This clinical model is established on the basis of independent risk factors.This model can be used as a predictive tool for early-BPF after Pneumonectomy for NSCLC. Key words: Lung cancer; Pneumonectomy; Early bronchopleural fistula
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a clinical risk model for the evaluation of bronchopleural fistula in non small cell lung cancer after Pneumonectomy
The Annals of Thoracic Surgery, 2013Co-Authors: Liang Duan, Gening Jiang, Hao Wang, Hongcheng Liu, Chang ChenAbstract:Background There are no reliable risk factors to predict bronchopleural fistula (BPF) formation in patients undergoing Pneumonectomy for non-small cell lung cancer (NSCLC). This study aims to create a validated clinical model based on the risk factors for BPF after Pneumonectomy. The model to estimate the risk of BPF may help select patients for intervention therapy to reduce the rate of BPF after Pneumonectomy. Methods This retrospective analysis included 684 patients with NSCLC who underwent Pneumonectomy at our institution from 1995 to 2012. The rates of BPF were estimated by the Kaplan-Meier method. Univariate and multivariate analyses were performed to identify the independent risk factors for the BPF and based on which a clinical model for the prediction of the incidence of BPF was formed. Results The incidence of BPF was 4.4% (30 of 684 patients). Three factors were independently associated with BPF after Pneumonectomy for NSCLC: neoadjuvant therapy (hazard ratio, 2.479), diabetes mellitus (hazard ratio, 1.061), and age 70 years or older (hazard ratio, 1.175). A scoring system for BPF was developed by assigning 2 points for a major risk factor (neoadjuvant therapy) and 1 point for each minor risk factor (diabetes mellitus and age ≥ 70 years). The 684 patients were divided into a low-risk group (score, 0 to 1), moderate-risk group (score, 2), and high-risk group (score, ≥ 3), with respective incidences of early BPF after Pneumonectomy of 2.4%, 18.2%, and 58.3% Conclusions This model, based on readily available clinical characteristics, can estimate the risk of BPF after Pneumonectomy in the NSCLC patients, independent of early BPF and late BPF classifications. This model could be used to select patients for intervention therapy (parenteral alimentation, control of blood glucose level, oxygen therapy, and strengthening the antibiotic treatment) if validated in independent data sets.
Chifu Jeffrey Yang - One of the best experts on this subject based on the ideXlab platform.
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right sided versus left sided Pneumonectomy after induction therapy for non small cell lung cancer
The Annals of Thoracic Surgery, 2019Co-Authors: Chifu Jeffrey Yang, Shivani A Shah, Belle K Lin, Keith W Vandusen, Derek Y Chan, Wendy D Tan, David N Ranney, Morgan L CoxAbstract:Background A right-sided Pneumonectomy after induction therapy for non-small cell lung cancer (NSCLC) has been shown to be associated with significant perioperative risk. We examined the effect of laterality on long-term survival after induction therapy and Pneumonectomy using the National Cancer Data Base. Methods Perioperative and long-term outcomes of patients who underwent Pneumonectomy after induction chemotherapy, with or without radiotherapy, from 2004 to 2014 in the National Cancer Data Base were evaluated using multivariable Cox proportional hazards modeling and propensity score-matched analysis. Results During the study period, 1,465 patients (right, 693 [47.3%]; left, 772 [52.7%]) met inclusion criteria. Right-sided Pneumonectomy was associated with significantly higher 30-day (8.2% [57 of 693] vs 4.2% [32 of 772], p Conclusions In this national analysis, right-sided Pneumonectomy after induction therapy was associated with a significantly higher perioperative but not worse long-term mortality compared to a left-sided procedure.
Valerie W Rusch - One of the best experts on this subject based on the ideXlab platform.
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extrapleural Pneumonectomy versus pleurectomy decortication in the surgical management of malignant pleural mesothelioma results in 663 patients
The Journal of Thoracic and Cardiovascular Surgery, 2008Co-Authors: Raja M Flores, Joseph Dycoco, Venkatraman E. Seshan, Maureen F. Zakowski, Manjit S Bains, Michele Carbone, Harvey I. Pass, Valerie W RuschAbstract:OBJECTIVE: The optimal procedure for resection of malignant pleural mesothelioma is controversial, partly because previous analyses include small numbers of patients. We performed a multi-institutional study to increase statistical power to detect significant differences in outcome between extrapleural Pneumonectomy and pleurectomy/decortication. METHODS: Patients with malignant pleural mesothelioma who underwent extrapleural Pneumonectomy or pleurectomy/decortication at 3 institutions were identified. Survival and prognostic factors were analyzed by the Kaplan-Meier method, log-rank test, and Cox proportional hazards analysis. RESULTS: From 1990 to 2006, 663 consecutive patients (538 men and 125 women) underwent resection. The median age was 63 years (range, 26-93 years). The operative mortality was 7% for extrapleural Pneumonectomy (n = 27/385) and 4% for pleurectomy/decortication (n = 13/278). Significant survival differences were seen for American Joint Committee on Cancer stages 1 to 4 (P < .001), epithelioid versus non-epithelioid histology (P < .001), extrapleural Pneumonectomy versus pleurectomy/decortication (P < .001), multimodality therapy versus surgery alone (P < .001), and gender (P < .001). Multivariate analysis demonstrated a hazard rate of 1.4 for extrapleural Pneumonectomy (P < .001) controlling for stage, histology, gender, and multimodality therapy. CONCLUSION: Patients who underwent pleurectomy/decortication had a better survival than those who underwent extrapleural Pneumonectomy; however, the reasons are multifactorial and subject to selection bias. At present, the choice of resection should be tailored to the extent of disease, patient comorbidities, and type of multimodality therapy planned.
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Indications for Pneumonectomy. Extrapleural Pneumonectomy.
Chest surgery clinics of North America, 1999Co-Authors: Valerie W RuschAbstract:Surgical resection is considered a mainstay for the treatment of malignant pleural mesothelioma (MPM), but the indications for extrapleural Pneumonectomy in this disease remain controversial. In general terms, an operation contributes to cancer management if it can be performed with low morbidity and mortality and improves local control, overall survival, or quality of life. The potential role of extrapleural Pneumonectomy in MPM is best considered in this context.
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the role of extrapleural Pneumonectomy in malignant pleural mesothelioma a lung cancer study group trial
The Journal of Thoracic and Cardiovascular Surgery, 1991Co-Authors: Valerie W Rusch, Steven Piantadosi, E C HolmesAbstract:Malignant pleural mesothelioma is usually a fatal cancer for which operation has been the mainstay of treatment because chemotherapy and radiation are relatively ineffective. The choice of operation for malignant pleural mesothelioma remains controversial. Extrapleural Pneumonectomy has been advocated because it allows complete removal of gross tumor and can be associated with long-term survival. To evaluate extrapleural Pneumonectomy, we conducted a prospective multiinsritutional trial in patients with biopsy-proved previously untreated malignant pleural mesothelioma. Criteria for extrapleural Pneumonectomy were (1) potentially completely resectable unilateral disease by computed tomography scan, (2) predicted postresection forced expiratory volume in 1 second >1 L/sec, and (3) no other major medical problems. Patients who were not candidates for extrapleural Pneumonectomy had a more limited operation with or without adjuvant therapy or had nonsurgical treatment From September 1985 to June 1988 83 eligible patients (64 male, 19 female) were entered. The mean age for all patients was 59.7 years. Only 20 of the 83 patients (24%) underwent extrapleural Pneumonectomy. Three of these 20 patients (15%) died postoperatively. The recurrence-free survival was significantly longer for the patients undergoing extrapleural Pneumonectomy than for the other two groups (p = 0.03), but there was no difference in overall survival among the three groups. In univariate analyses, epithelial versus sarcomatoid and mixed histologic findings and platelet count
Gening Jiang - One of the best experts on this subject based on the ideXlab platform.
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transthoracic esophagectomy using endobronchial blocker after previous Pneumonectomy
The Annals of Thoracic Surgery, 2014Co-Authors: Haifeng Wang, Gening JiangAbstract: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.
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A clinical model to estimate risk factor of early BPF after Pneumonectomy for NSCLC
Chinese Journal of Thoracic and Cardiovaescular Surgery, 2013Co-Authors: Gening Jiang, Chang Chen, Jia-an Ding, Hao WangAbstract:Objective To evaluate prognostic factors for early bronchopleural fistula after Pneumonectomy with non small cell lung cancer,and establish a validated clinical model to estimate the risk of early-BPF.Methods We reviewed the medical records of 429 patients who underwent Pneumonectomy for NSCLC at our institution.We used univariate and multivariate analysis to identify potential independent risk factors for early-BPF after Pneumonectomy for NSCLC.A model to estimate risk of early-BPF was developed by combining independent risk factors.Results The rate of early-BPF after Pneumonectomy for NSCLC was 6.5％ (28/429).Three factors were independently associated with early-BPF:neoadjuvant therapy (HR:2.406),bleeding (HR:2.171)and diabetes (HR:1.144).A scoring system for early-BPF was developed by assigning 2 points for each major risk factor (neoadjuvant therapy and bleeding) and 1 point for each minor risk factor(diabetes).Scores were grouped as low (0-1),intermediate (2-3),and high (3),yielding the rate of early-BPF was 14％,27％,and 43％,respectively.Conclusion This clinical model is established on the basis of independent risk factors.This model can be used as a predictive tool for early-BPF after Pneumonectomy for NSCLC. Key words: Lung cancer; Pneumonectomy; Early bronchopleural fistula
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a clinical risk model for the evaluation of bronchopleural fistula in non small cell lung cancer after Pneumonectomy
The Annals of Thoracic Surgery, 2013Co-Authors: Liang Duan, Gening Jiang, Hao Wang, Hongcheng Liu, Chang ChenAbstract:Background There are no reliable risk factors to predict bronchopleural fistula (BPF) formation in patients undergoing Pneumonectomy for non-small cell lung cancer (NSCLC). This study aims to create a validated clinical model based on the risk factors for BPF after Pneumonectomy. The model to estimate the risk of BPF may help select patients for intervention therapy to reduce the rate of BPF after Pneumonectomy. Methods This retrospective analysis included 684 patients with NSCLC who underwent Pneumonectomy at our institution from 1995 to 2012. The rates of BPF were estimated by the Kaplan-Meier method. Univariate and multivariate analyses were performed to identify the independent risk factors for the BPF and based on which a clinical model for the prediction of the incidence of BPF was formed. Results The incidence of BPF was 4.4% (30 of 684 patients). Three factors were independently associated with BPF after Pneumonectomy for NSCLC: neoadjuvant therapy (hazard ratio, 2.479), diabetes mellitus (hazard ratio, 1.061), and age 70 years or older (hazard ratio, 1.175). A scoring system for BPF was developed by assigning 2 points for a major risk factor (neoadjuvant therapy) and 1 point for each minor risk factor (diabetes mellitus and age ≥ 70 years). The 684 patients were divided into a low-risk group (score, 0 to 1), moderate-risk group (score, 2), and high-risk group (score, ≥ 3), with respective incidences of early BPF after Pneumonectomy of 2.4%, 18.2%, and 58.3% Conclusions This model, based on readily available clinical characteristics, can estimate the risk of BPF after Pneumonectomy in the NSCLC patients, independent of early BPF and late BPF classifications. This model could be used to select patients for intervention therapy (parenteral alimentation, control of blood glucose level, oxygen therapy, and strengthening the antibiotic treatment) if validated in independent data sets.