Ziad Mansour

University of Strasbourg, Strasburg, Alsace, France

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Publications (10)13.37 Total impact

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    ABSTRACT: Pneumonectomy remains a high-risk procedure. Comprehensive patient selection should be based on analysis of proven risk factors. The records of 323 pneumonectomy patients were retrospectively reviewed. Multiple demographic data were collected. End points were operative mortality at 30 and at 90 days, major procedurally related complications, and cardiovascular events. Univariate and multivariate statistical analyses were performed. Smoking habits, chronic obstructive pulmonary disease (COPD) status, induction chemotherapy status, diabetes, and obesity had no statistical influence on short-term outcomes. After right pneumonectomy, 30-day mortality (p = 0.045) and the incidence of bronchopleural fistulas (p = 0.009) were increased. Multivariate analysis for postoperative bronchopleural fistulas discovered that right pneumonectomies are the sole risk factor (p = 0.015). Univariate analysis for postoperative atrial fibrillation showed that male gender, age 70 and older, hypertension, and dyslipidemia are risk factors. Multivariate analysis found no definite risk factor. Patients with coronary artery disease had more postoperative cardiovascular events (p = 0.003). Among patients free of coronary artery disease, COPD led to an increased 90-day mortality rate (p = 0.028). Patients with right pneumonectomies are at increased risk. Postoperative cardiovascular events are more frequent in coronary artery disease patients. COPD is a risk factor in patients free of coronary disease.
    The Annals of thoracic surgery 12/2009; 88(6):1737-43. · 3.45 Impact Factor
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    ABSTRACT: We report the case of a 35-year-old patient with an incidental finding of an asymptomatic large (9.5 cm in diameter) anterior mediastinal tumour. Radiological findings favoured the diagnosis of a benign mediastinal teratoma. During surgical resection, we found a tumour adhering to the surrounding tissues, and encompassing the innominate vein which was totally occluded. Total tumoural exeresis was performed as well as the double cross-section of the innominate vein. Postoperatively, there was no left upper limb swelling, probably because of a chronic occlusion of the innominate vein. The hospital stay was uneventful. Immunohistochemistry diagnosed a mediastinal 'epithelioid haemangioendothelioma', which is a tumour of vascular origin. We believe that the tumour took origin from the innominate vein and invaded the anterior mediastinum. After a simple radiological follow-up, the patient is in complete remission 30 months after the operation. We present the case of this patient with the iconography, along with a review of the available literature concerning mediastinal epithelioid haemangioendotheliomas.
    Interactive Cardiovascular and Thoracic Surgery 10/2009; 10(1):122-4. · 1.11 Impact Factor
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    ABSTRACT: Operative management of patients with persistent N2 disease after induction therapy is still debated. One hundred fifty-three consecutive patients underwent pneumonectomy from January 1999 until July 2005; 28 patients (18.3%) had persistent N2 disease after induction therapy (group 1), 32 patients (20.9%) had pathologic stage N0 or N1 after induction therapy (group 2), and 93 patients (60.8%) with pathologic N2 disease underwent immediate surgery (group 3). Short-term end points were operative mortality at 30 and 90 days and major complications. Long-term end points were 5-year survival and disease-free survival rates. Demographics of the three groups were similar (age, sex, side of operation, type of chemotherapy, smoking status, and comorbidity such as coronary artery disease, diabetes, and chronic obstructive pulmonary disease). Thirty-day postoperative mortality was 10.7% in group 1, 3.1% in group 2 (p = 0.257), and 4.3% in group 3 (p = 0.201); 90-day postoperative mortality was 10.7% in group 1, 12.5% in group 2 (p = 0.577), and 9.7% in group 3 (p = 0.558). Incidence of major postoperative complications was similar. Five-year survival rate was 32.2% (median, 28 months; 95% confidence interval, 7 to 43) in group 1, 34.8% (median, 27 months; 95% confidence interval, 7 to 47) in group 2 (p = 0.685), and 12.4% (median, 15 months; 95% confidence interval, 11 to 19) in group 3 (p = 0.127). No statistical difference was found in terms of 5-year event-free survival, or regarding the side of pneumonectomy. Our results suggest that pneumonectomy is justified in patients with persistent N2 disease after induction chemotherapy.
    The Annals of thoracic surgery 08/2008; 86(1):228-33. · 3.45 Impact Factor
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    ABSTRACT: There is an ongoing debate whether induction therapy increases post-operative mortality and morbidity, especially when performing pneumonectomy. We therefore reviewed a consecutive series of patients having undergone pneumonectomy in a single center. The charts of 298 patients operated on between January 1999 and July 2005 were reviewed. Patients were divided into two groups: group 1 included those who received induction chemotherapy (60 patients, 20.1%), and group 2 included those who underwent surgery alone (238 patients, 79.9%). Endpoints were operative mortality at 30 and at 90 days, and major complications such as empyema, bronchial fistula and acute respiratory distress syndrome. Statistical analyses were performed using SPSS 11.0 software. Demographic data were similar for both groups when considering side of operation, comorbidity and weaning from tobacco; patients were older in group 2 (61.83+/-9.58 years vs 57.75+/-8.94 years; p=0.003) and there were more female patients in group 2 (17.2% vs 5.0%; p=0.010). Post-operative mortality at 30 days was 6.7% in group 1 and 5.5% in group 2 (p=0.458), and 11.7% for group 1 and 10.9% in group 2 at 90 days (p=0.512). Incidence of empyema was 1.7% in group 1 and 2.1% in group 2 (p=0.652); incidence of bronchopleural fistulas was 1.7% in group 1 and 5.5% in group 2 (p=0.188); incidence of acute respiratory distress syndrome was 3.3% in group 1 and 3.4% in group 2 (p=0.675). In opposition to previous reports, induction chemotherapy did not significantly jeopardize post-operative outcome following pneumonectomy in our experience.
    European Journal of Cardio-Thoracic Surgery 03/2007; 31(2):181-5. · 2.67 Impact Factor
  • Journal of Thoracic Oncology - J THORAC ONCOL. 01/2007; 2(1):99-100.
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    ABSTRACT: This study evaluates the impact of the underlying disease upon the surgical outcome of bronchoplastic lobectomy, comparing typical carcinoid tumours with primary lung carcinoma. This retrospective study includes 98 consecutive patients (78 males, 20 females). Eighteen patients had a typical carcinoid tumour (group 1), and 80 had a primary bronchial carcinoma (group2). Fifty-six patients underwent bronchoplasty with full sleeve resection (10 patients from group 1, 46 from group 2) and 42 patients had a bronchoplasty with bronchial wedge resection (8 from group 1 and 34 from group 2). Right upper lobectomy was the most common procedure. We compared demographic data, surgical indications, the type of bronchoplasty and postoperative complications. The average age in group 1 (38.5+/-16.3 years; range 15-77) was significantly lower than in group 2 (61.4+/-9.5 years; range 14-75) (p<0.001). There were no postoperative deaths. Procedure-specific complications (anastomotic dehiscence and atelectasis) were found in 7 patients (8.75%) in group 2 (of which, three had a combination of two of the above-mentioned complications) but none (0%) in group 1 (p=0.23). Seven patients from group 2 (8.75%) required treatment for a residual pneumothorax for none (0%) in group 1 (p=0.23). The mean duration for air leak was comparable in both groups (p=0.366). Three patients (16.67%) from group 1 had non-surgical complications compared to 17 (21.25%) in group 2 (of which, one had a combination of two non-surgical complications) (p=0.35). Bronchoplastic resection is a safe operation in patients with carcinoid tumours and should be the reference for treatment.
    European Journal of Cardio-Thoracic Surgery 07/2006; 30(1):168-71. · 2.67 Impact Factor
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    ABSTRACT: Background: This study evaluates the impact of the underlying disease upon the surgical outcome of bronchoplastic lobectomy, comparing typical carcinoid tumours with primary lung carcinoma. Patients and methods: This retrospective study includes 98 consecutive patients (78 males, 20 females). Eighteen patients had a typical carcinoid tumour (group 1), and 80 had a primary bronchial carcinoma (group2). Fifty-six patients underwent bronchoplasty with full sleeve resection (10 patients from group 1, 46 from group 2) and 42 patients had a bronchoplasty with bronchial wedge resection (8 from group 1 and 34 from group 2). Right upper lobectomy was the most common procedure. We compared demographic data, surgical indications, the type of bronchoplasty and postoperative complications. Results: The average age in group 1 (38.5±16.3 years; range 15–77) was significantly lower than in group 2 (61.4±9.5 years; range 14–75) (p
    European Journal of Cardio-thoracic Surgery - EUR J CARDIO-THORAC SURG. 01/2006; 30(1):168-171.
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    ABSTRACT: Background : There is an ongoing debate whether induction therapy increases post-operative mortality and morbidity, especially when performing pneumonectomy. We therefore reviewed a consecutive series of patients having undergone pneumonectomy in a single center. Methods: The charts of 298 patients operated on from January 1999 till July 2005 were reviewed. Patients were divided into 2 groups: group 1 included those who received induction chemotherapy (60 patients, 20.1%), and group 2 included those who underwent surgery alone (238 patients, 79.9%). Endpoints were operative mortality at 30 and at 90 days, and major complications such as empyema, bronchial fi stula and ARDS. Statistical analyses were performed using SPSS 11.0 software. Results: Demographic data were similar for both groups when considering side of operation, comorbidity and weaning from tobacco; group 2 included older patients (61.83±9.58 years versus 57.75±8.94 years; p=0.003), more female patients in group 2 (17.2% versus 5.0%; p= 0.010), and more diabetic patients (13.4% versus 5.0 % ; p = 0.048). Post-operative mortality at 30 days was 6.7% in group 1 and 5.5% in group 2 (p=0.458), and 11.7% for group 1 and 10.9% in group 2 at 90 days (p=0.512). Incidence of empyema was 1.7% in group 1 and 2.1% in group 2 (p=0.652); incidence of bronchopleural fi stulas was 1.7% in group 1 and 5.5% in group 2 (p=0.188); incidence of acute respiratory distress syndrome was 3.3% in group 1 and 3.4% in group 2 (p=0.675). Conclusion: In opposition to previous reports, induction chemotherapy did not signifi cantly jeopardize post-operative outcome following pneumonectomy in our experience. Key-words: Ilung cancer, induction chemotherapy, pneumonectomy
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    ABSTRACT: Objectives : Treatment of persistent N2 disease following induction therapy remains controversial. The aim of this study was to evaluate the operative risk and long term survival in patients who underwent pneumonectomy. Methods : We included 153 patients who underwent pneumonectomy from January 1999 to July 2005 ; 28 patients (18.3 %) had persistent N2 disease following induction therapy (group 1), 32 patients (20.9 %) were pN0 or pN1 following induction chemotherapy (group 2), and 93 patients (60.8 %) with stage pN2 underwent primary surgery (group 3). Endpoints were 30 day and 90 day mortality, major complications, rough survival and survival free of disease. Statistical analysis was made with SPSS 11.5 software. Results : Thez 3 groups were similar for demographics (age, gender, side of operation, type of chemotherapy, smoking, comorbidities such as coronary artery disease, diabetes, COPD). 30-day mortality was 10.7% in group 1, 3.1% in group 2 (p=0.257), and 4.3% in group 3 (p=0.201) ; 90-day mortality was 10.7% in group 1, 12.5% in group 2 (p=0.577), and 9.7% in group 3 (p=0.558). Major complication rate was similar. 5-year survival was 32.2% (median = 28 months ; 95% CI : 7-43) in group 1, 34.8% (median = 27 months ; 95% CI : 7-47) in group 2 (p=0.685), and 12.4% (median = 15 months ; 95% CI : 11-19) in group 3 (p=0.127). 5-year survival without recurrence was 43.3% (median = 18 months ; 95% CI : 0-41) in group 1, 48.3% (median = 47 months) in group 2 (p=0.480), and 23.3% (median = 12 months ; 95% CI : 9-15) in group 3 (p=0.336). Conclusion : Our results suggest that pneumonectomy is a valuable option in patients with persistant N2 disease after induction chemotherapy. We did not observe any increased operative risk, and 5-year survival was satisfactory.