Journal of Chest Surgery最新文献

Background: Sarcopenia is a progressive skeletal muscle disorder characterized by the loss of muscle mass and function. Computed tomography (CT) scans are a reliable method for diagnosing sarcopenia, as they allow for the measurement of muscle density using Hounsfield units (HU). In this study, we conducted a retrospective investigation into the prevalence of sarcopenia and its impact on postoperative complications in patients who underwent decortication for empyema.

Methods: Between September 2020 and August 2023, we measured the average HU values of the bilateral paravertebral muscles at the T12 thoracic vertebra level using CT. This study included 145 patients who underwent thoracotomy and decortication for empyema at the Thoracic Surgery Clinic of Konya City Hospital. Based on their HU values, patients were categorized into 2 groups: the sarcopenia group (group S) and the control group (group C). Our objectives were to determine the prevalence of sarcopenia in these patients, evaluate its influence on early postoperative complications, and explore its potential role as a risk factor for postoperative complications.

Results: Sarcopenia was identified in 49 (33.7%) of the patients who underwent thoracotomy and decortication for empyema. In group S, the rates of postoperative surgical site infection and pneumonia were significantly higher. Regression analysis revealed that sarcopenia was an independent risk factor for both postoperative pneumonia and surgical site infection. Additionally, the length of stay in the intensive care unit and the hospital was significantly longer in group S than in group C.

Conclusion: In patients who underwent thoracotomy for empyema, sarcopenia independently increases the risk of postoperative pneumonia and surgical site infections.

Background: Pectus excavatum (PE), the most common congenital chest wall deformity, is increasingly treated with minimally invasive repair (MIRPE). However, postoperative complications such as bar displacement remain a significant challenge, occurring in approximately 9.5% of cases. While surgical modifications and stabilization techniques aim to reduce risks, bar displacement persists as a critical concern.

Methods: This PROSPERO-registered systematic review followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A search of PubMed, Scopus, and CINAHL through October 2024 identified studies evaluating bar displacement in PE patients undergoing MIRPE or alternative surgical approaches. The inclusion criteria focused on risk factors, stabilization techniques, and reoperation strategies. Data extraction and risk-of-bias assessments were independently conducted by multiple reviewers to ensure accuracy and quality.

Results: Thirteen studies spanning 23 years were included. Bar displacement rates varied widely (0.9%-33.3%), with key risk factors including patient age, chest wall rigidity, bar length, and placement technique. Advanced stabilization methods-such as bridge fixation, shorter bars, multipoint fixation, and adjunct stabilizers-significantly reduced displacement rates. Common postoperative complications included wound infections, seromas, pleural effusions, and bar re-dislocation. Imaging modalities like chest X-rays and 3-dimensional computed tomography scans proved critical for early detection. Heterogeneity in stabilization approaches underscores a shift toward patient-specific strategies to optimize outcomes.

Conclusion: Tailored stabilization techniques are essential for successful PE correction. Although advancements in fixation methods have reduced displacement risks, standardized postoperative protocols and multicenter studies are needed to validate these innovations and improve long-term outcomes (PROSPERO: CRD42024595337).

Background: Currently, clinical T staging in non-small cell lung cancer (NSCLC) is based on the largest radiological diameter observed on computed tomography (CT). Under this system, tumors with varying shapes-such as spherical, amorphous, or spiculated tumors- can be assigned the same T stage even with different volumes. We aimed to propose a 3-dimensional (3D) volumetric staging system for NSCLC as an alternative to diameter- based T staging and to conduct comparative survival analyses between these methods.

Methods: We retrospectively analyzed data from patients who underwent surgery for pT1-4N0M0 primary NSCLC between January 2018 and May 2022. Digital Imaging and Communications in Medicine data from patient CT scans were uploaded to 3D Slicer software for volumetric tumor measurement. Using the paired samples t-test or the Wilcoxon test, we compared the expected tumor volumes, calculated by tumor diameter, with the actual volumes measured by 3D Slicer. Receiver operating characteristic analysis was employed to determine the cut-off value for tumor volume. Kaplan-Meier analysis was utilized to assess overall survival, while the log-rank method was applied to compare survival differences between groups. The significance of changes in T stage was evaluated using the marginal homogeneity test.

Results: The study included 136 patients. Significant differences were observed between expected and actual tumor volumes (p=0.01), and associated changes in T stage were also significant (p=0.04). The survival analysis performed using tumor volume (p=0.009) yielded superior results compared to that based on diameter (p=0.04) in paients with early tumor stage.

Conclusion: T-factor staging based on tumor volume could represent an alternative staging method for NSCLC.

Sternal wound dehiscence after cardiac surgery is usually accompanied by a high morbidity and mortality rate. When sternal rewiring fails, rigid fixation systems may be used for sternal reconstruction. We report a case involving a female patient with multiple risk factors for sternal dehiscence who underwent a coronary artery bypass graft procedure. Postoperatively, she experienced sternal dehiscence that necessitated primary rewiring. Despite the surgical intervention and clinical optimization, the sternal wound dehiscence recurred. The patient experienced severe chest pain and thoracic instability, presenting with complete non-union of the sternal segments and right ventricular protrusion. Given the symptoms and the risk of both direct and indirect trauma to the heart, the multidisciplinary team opted to reinforce the anterior chest wall with a pre-planned titanium prosthesis to provide protection and stability. This report highlights the advantages of a comprehensive strategy for managing repeated sternal dehiscence.

In emergency surgery for acute type A aortic dissection, the creation of needle holes can cause various issues and complications. One persistent challenge is the prevention of distal anastomotic new entry tears, which frequently necessitate additional intervention. Modification of the distal reinforcement technique offers a straightforward solution by combining existing hemostatic agents with tools such as occlusion balloons. We describe a modified distal reinforcement procedure employing a balloon-and-glue technique to help prevent new entry tears at the distal anastomosis and avoid total arch replacement. Ten patients with acute type A aortic dissection were treated using this technique. Postoperative computed tomography indicated no evidence of distal anastomotic entry tears. In conclusion, this modified distal reinforcement technique represents not only a method to prevent distal anastomotic new entry tears but also a palliative approach that may obviate the need for total arch replacement in patients in poor condition or of advanced age.

Lung transplantation remains the only curative option for patients with end-stage, medically refractory respiratory failure. Traditionally, the clamshell incision has been the primary surgical approach, as it provides extensive access to the mediastinum and bilateral pleural cavities. However, it is also associated with notable drawbacks, such as an increased risk of sternal nonunion and wound complications, which can impede postoperative recovery. This article introduces an alternative approach-double lung transplantation using video-assisted bilateral anterior thoracotomy. We present a detailed step-by-step surgical guide, offer practical tips, and highlight the advantages of this method over the conventional clamshell incision.