Surgery Today最新文献

Purpose: To evaluate the efficacy and safety of postoperative pleurodesis using OK-432, focusing on patients with idiopathic interstitial pneumonia (IIP).

Methods: This retrospective cohort study included patients who underwent OK-432 pleurodesis following pulmonary resection. We reviewed clinical characteristics, radiological evidence of IIP, operative findings, postoperative air leak volume, pleurodesis details, morbidity, and mortality; then we compared the outcomes of patients with vs. those without IIP, and analyzed the predictors of ≥Grade II complications.

Results: Pleurodesis was performed in 361 patients, including 67 (19%) with IIP. No significant differences were observed in the incidence of fever or in postpleurodesis parameters. The initial success rate was 58.2% for IIP patients and 70.4% for non-IIP patients. Recurrence developed in 7.5% of patients and surgical intervention was required in 4.1%. Risk factors for ≥Grade II complications included older age, IIP, pleurodesis within 3 postoperative days (PODs), and pre-pleurodesis WBC > 7000/µL. Pneumonia after pleurodesis was more frequent in the IIP patients (11.9% vs. 2.4%, p < 0.01).

Conclusions: There were no treatment-related deaths following OK-432 pleurodesis in IIP patients; however, IIP remained a significant risk factor for pleurodesis-related complications, particularly pneumonia. Early intervention and elevated WBC levels may increase the complication risk. Delaying pleurodesis until the WBC count normalizes is advisable to reduce adverse events.

Purpose: We evaluated the long-term outcomes of children undergoing thoracotomy lung resection for congenital lung malformations in terms of lung function, complications, and health-related quality of life (HRQOL).

Methods: We retrospectively reviewed 27 children who underwent thoracotomy at Osaka University Hospital (1992-2017) with at least five years of follow-up and postoperative lung function testing after six years of age. We compared the percent predicted vital capacity (%VC), percent predicted forced expiratory volume in 1 s (%FEV₁), and FEV₁ to FVC ratio (FEV₁/FVC) as indicators of the lung function. Longitudinal changes in the lung function, pulmonary and musculoskeletal morbidities, and HRQOL were assessed using the Pediatric Quality of Life Inventory.

Results: %VC and FEV₁/FVC remained within the normal range but were significantly lower than the controls; %FEV₁ was below the normal range. No significant longitudinal changes in the lung function were observed. Asthma‑like symptoms appeared in 37.0% of the patients and persisted beyond adolescence. Musculoskeletal morbidities occurred in 33.3% of the patients, with five pectus excavatum cases requiring correction. HRQOL did not differ from that of the healthy controls.

Conclusions: In our study, children undergoing thoracotomy lung resection for congenital lung malformations exhibited a significantly lower lung function than the healthy controls, and these impairments persisted over an extended follow-up period. Long-term complications and a reduced lung function were not reflected in the subjective HRQOL.

Purpose: Perihilar cholangiocarcinoma (PHCC) often presents challenges with intraoperatively detected distal bile duct margin (DM) positivity. We evaluated the safety and oncological impact of performing an additional pancreatoduodenectomy (ad-PD) for converting R1 to R0 resection.

Methods: We retrospectively reviewed 272 patients (1990-2024) who underwent major hepatectomies for PHCC. Patients with positive DM were divided into an ad-PD group (n = 8) and a hepatectomy alone group (DMpos-HA, n = 10).

Results: A manalysis identified lymph node metastasis, non-R0 resection, vascular resection, and CA19-9 > 90 U/mL as independent predictors of a poor overall survival (OS) in the entire cohort (n = 272). Regarding the DM-positive subgroup, the ad-PD group achieved a 100% R0 rate, whereas the DMpos-HA group had a 0% rate (p < 0.001). The 5-year OS rate tended to be higher in the ad-PD group (50.0% vs. 20.0%, p = 0.396), although the difference was not statistically significant. Major complications (Clavien-Dindo ≥IIIa) occurred in 38% of the ad-PD group and 20% of the DMpos-HA group (p = 0.613). Importantly, the in-hospital mortality rate was 0% in both groups.

Conclusion: In carefully selected patients, concomitant ad-PD is a feasible option that achieves a high R0 rate and suggests a trend toward an improved long-term survival without increasing mortality.