Annals of thoracic surgery short reports最新文献

A pheochromocytoma is a malignant tumor with metastatic potential. Moreover, the cardiovascular effects of abnormal amounts of catecholamines resulting from pheochromocytoma impact prognosis. Resection of the primary tumor is useful for reducing catecholamine production; however, the significance of resection of metastases remains unclear. Herein, we report a case in which multiple lung resections for metastases from pheochromocytoma were performed 5 years after primary tumor resection. Complete resection of 6 pulmonary lesions was achieved, maintaining reduced catecholamine levels and blood pressure without any sign of recurrence for a year.

Hybrid repair of complex aortic arch disease typically requires aortic debranching to create a proximal landing zone for completion arch endografting. Despite advances in endograft technology, physician-modified endografting may be required to customize a prosthesis for challenging anatomy. We present a case of a complex distal arch aneurysm after a prior coarctation repair with a pediatric interposition graft several decades earlier, treated with hybrid repair by double transposition for arch debranching and physician-modified arch endografting for complete aneurysm exclusion.

Stiff person syndrome (SPS) is a neurologic disorder, some cases of which are associated with malignant disease. Here, we report a case of thymoma-associated SPS that was successfully treated with surgical resection. A 57-year-old man with progressive muscle stiffness and weakness was diagnosed with thymoma-related SPS. After administration of medication and intravenous immunoglobulin, the patient underwent extended thymectomy, partial pericardial resection, and pericardial reconstruction. After tumor resection, the symptoms gradually diminished, and performance status and respiratory function improved significantly. This report indicates that tumor resection may improve respiratory function, eliminate dyspnea, and improve performance status in tumor-related SPS.

Moderate or severe aortic insufficiency is a contraindication to transvalvular Impella left ventricular assist device (Abiomed) use out of concern for worsening valvular insufficiency and recirculation. This report describes the case of a 75-year-old man with severe eccentric aortic insufficiency and systemic hypoperfusion who was supported with a transvalvular Impella 5.5 device for 6 days as preoperative rehabilitation before aortic valve replacement. The Impella device provided adequate systemic tissue perfusion, and left ventricular function remained without signs of volume overload and recirculation. Moderate or severe aortic insufficiency may not be an absolute contraindication to transvalvular Impella use, although this is case dependent.

Rosai-Dorfman disease (RDD) is a nonmalignant disease of histiocyte proliferation. RDD usually presents with painless cervical lymphadenopathy, although extranodal involvement can occur. Cardiac involvement was reported in <0.1% of cases. We present a case of cardiac RDD with obstruction at the inferior vena cava-right atrial junction.

Background

The technical complexity of segmentectomy and preservation of lung parenchyma compared with lobectomy vary by lobe. This study evaluated the impact of non-small cell lung cancer tumor location on segmentectomy use and outcomes.

Methods

Outcomes after lobectomy or segmentectomy for cT1N0M0 (≤2 cm) non-small cell lung cancer patients stratified by tumor location in smaller (right upper/middle) vs larger (bilateral lower/left upper) lobes were evaluated with logistic regression, Kaplan-Meier curves, and Cox proportional hazards methods.

Results

A minority of patients in the cohort (N = 31,243) underwent segmentectomy (n = 2783, 9%). Segmentectomy was more common for tumors in larger compared with smaller lobes (11.8% vs 5.1%, P < .001). Major morbidity after segmentectomy was significantly lower than lobectomy for both smaller (2.6% vs 5.7%, odds ratio, 0.41, P < .001) and larger (2.5% vs 5.2%, odds ratio, 0.46, P < .001) lobes. Segmentectomy was associated with smaller lymph node harvest for both types of lobes (small lobes 7.0 vs 10.5, P < .001; large lobes 7.5 vs 10.4, P < .001) but did not compromise survival in multivariate analysis for both small (hazard ratio, 0.99, P = .9) and large (hazard ratio, 1.05, P = .34) lobes.

Conclusions

Segmentectomy that does not compromise oncologic principles should be considered if complete resection is feasible regardless of tumor location.

Metastasectomy for isolated pulmonary metastasis can improve disease-free and overall-survival in well-selected patients. When feasible, a minimally invasive wedge resection is the preferred approach. However, a hostile ipsilateral chest can hinder surgical resection. In this report, we describe the resection of an isolated metastasis in the lingula through the right chest and anterior mediastinum using a robotic-assisted thoracoscopic approach in a patient with a prior left thoracotomy and pleurodesis.

Background

In 2022, the American Association for Thoracic Surgery (AATS) and the European Society of Thoracic Surgeons (ESTS) published joint guidelines regarding the timing, duration, and choice of agent for perioperative venous thromboembolism prophylaxis for thoracic cancer patients. Now, 1 year after their release, we looked to assess practices and general adherence to these recommendations.

Methods

We conducted a survey among board-certified/board-eligible thoracic surgeons in the United States, between July and October 2023.

Results

A total of 103 board-certified thoracic surgeons responded to the survey. Over half of the surgeons reported using preoperative chemical thromboprophylaxis routinely for lobectomy/sublobar resections (56.3%), pneumonectomy/extended lung resections (64.1%), and esophagectomy (67%). Over two thirds of thoracic surgeons limited the duration of postoperative chemical thromboprophylaxis to the patient’s length of hospital stay and never administered chemoprophylaxis post-discharge. Among surgeons who always continued chemical thromboprophylaxis post-discharge, low-molecular-weight heparin (LMWH) was the most commonly used agent (>70%), followed by direct oral anticoagulants (13.8%-16.7%). Only 33.3% of surgeons prescribing post-discharge chemical thromboprophylaxis after lobectomy/sublobar resections continued prophylaxis up to 4 weeks postoperatively.

Conclusions

Contrary to the 2022 joint AATS/ESTS guidelines, the majority of surveyed thoracic surgeons in the United States do not routinely prescribe postoperative thromboprophylaxis after lung and esophageal cancer resections. The dogma of routine extended thromboprophylaxis must be reevaluated as modern minimally invasive thoracic surgery allows for very earlier ambulation and enhanced recovery. There is a need for randomized controlled trials exploring the utility of extended thromboprophylaxis and newer agents such as direct oral anticoagulants.

We report 3 cases of extremely rare familial idiopathic diffuse pulmonary ossification, 2 of 3 received lung transplantation and the other is listed for lung transplantation. The clinical courses of family members varied greatly, and rapid deterioration could occur; therefore, early and close examination is recommended for transplant registration. During transplantation, the lungs appeared and felt exactly like a “pumice stone” and could not collapse, and good visual field was not easily obtained. Both patients had no recurrence of pulmonary ossification for more than 2 years.

Background

As value-based care models continue to gain emphasis, along with the need for improved profiling across the continuum of lung cancer care, a better understanding of geographic variation in utilization of services surrounding episodes of care is needed.

Methods

In this retrospective cohort study of patients undergoing lung cancer resection from 2017 to 2019, we examined geographic variation in utilization of services surrounding episodes of lung cancer resection. We utilized hierarchical logistic regression models to determine risk-adjusted utilization of services. This study utilized inpatient and ambulatory databases across 4 states: New Jersey, Pennsylvania, Florida, and Maryland. All patients undergoing lung cancer resection were included. The primary outcome was risk-adjusted utilization of services.

Results

Mean risk-adjusted utilization of ambulatory procedures across all hospital referral regions (HRRs) was 34.1% (95% CI 30.7%-37.6%), while the individual HRR utilization varied from 10.9% to 54.9% (P < .01). Mean risk-adjusted utilization of inpatient admissions in the 6 months prior to surgery was 15.3% (95% CI 13.9%-16.7%), ranging from 7.4% to 24.7% (P = .07) across HRRs. Finally, mean risk-adjusted utilization of inpatient hospitalizations in the 6 months following surgery was 19.4% (95% CI 17.7-21.0%), ranging from 10.0% to 33.6% (P = .19) across HRRs.

Conclusions

Overall, we observed that utilization of ambulatory services varied significantly across HRRs, while inpatient utilization did not demonstrate significant variation. Given these findings, there may be geographic drivers of variation in the utilization of services surrounding lung cancer resection.