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ABSTRACT: Several case-series studies of major pulmonary resection (MPR) by video-assisted thoracic surgery (VATS) for non-small-cell lung cancer (NSCLC) have been published, but fully endoscopic MPR is still very rarely performed. Our objective here was to report the outcomes in 71 patients recently managed using fully endoscopic MPR for NSCLC.
From 2007 to 2009, 635 patients with NSCLC underwent MPR (pneumonectomy, lobectomy or segmentectomy). Among them, 71 (11%) had features strongly suggesting clinical stage I NSCLC and were managed by fully endoscopic MPR, with no utility incision. Lobectomy was performed in 63 patients and segmentectomy in eight patients. Conversion to thoracotomy was required in two (2.8%) patients, because of a fused fissure in one and tight pleural adhesions in the other. Radical lymphadenectomy was performed in all patients.
Of the 69 patients managed endoscopically, none died and none experienced intraoperative complications. Mean operating time was 226±38 minutes (range, 137-307 minutes) and mean intraoperative blood loss was 111±93mL (range, 0-450mL). The final histological examination showed stage I NSCLC in 52 patients, NSCLC with node involvement in nine patients (pN1 in 6 and pN2 in 3) and other types of malignancies in eight patients. Mean number of nodes removed was 21±8 after right-sided lymphadenectomy and 23±8 after left-sided lymphadenectomy and the mean number of dissected node sites was 3 (range, 2-5). The postoperative morbidity rate was 23%. Mean postoperative hospital stay length was 6.9±2 days (range, 3-12).
Fully endoscopic MPR is safe and meets the criteria for oncological surgery.
Revue des Maladies Respiratoires 11/2011; 28(9):e123-30. · 0.59 Impact Factor
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ABSTRACT: Mediastinal liposarcomas (LPS) are rare tumours. We report a case of primary myxoid LPS in a 22-year-old woman suffering from cough, dyspnoea on exercise and asthenia for 3 weeks. Thoracic MRI showed a large tumour on the right side. After neoadjuvant chemotherapy, a complete resection was performed, followed by adjuvant thoracic irradiation. Eighteen months after the diagnosis, no sign of recurrence was detected. Mediastinal LPS include a heterogeneous group of bulky tumours, the progression of which depends on the histological type. The prognosis is dominated by the operability of the tumour. Adjuvant therapies are not established.
Revue des Maladies Respiratoires 01/2011; 28(1):84-7. · 0.59 Impact Factor
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Journal de Radiologie 12/2010; 91(12 Pt 1):1302-3. · 0.42 Impact Factor
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ABSTRACT: Rheumatoid arthritis (RA) is a systemic illness where the development of pulmonary nodule has been described in from 4 to 20% of patients. Symptomatic pleural manifestations occur in 3 to 5% of cases. Rarely, pulmonary nodules become necrotic and lead to pleural complications. Bilateral pneumothorax has only rarely been described.
We report the case of a 64-year-old woman, who had been treated for RA for several years and presented with bilateral pneumothorax secondary to necrobiosis of one or several pulmonary rheumatoid nodules. The management of the pneumothorax was very prolonged and difficult, and despite surgical pleurodesis, the lung did not reexpand fully. Pathological examination of the pleura revealed a noncaseating granulomatous pattern. The diagnosis of a sarcoidosis like disease, possibly induced by anti-TNFα, or of pleural tuberculosis were suggested, but we concluded that the final diagnosis was of pleural rheumatoid involvement.
Bilateral pneumothorax secondary to rheumatoid nodule is a rare entity. The management of such a complication is difficult, particularly in patients who receive an immunosuppressant regimen. A granulomatous pattern has been described rarely in the pleural tissue of these patients. Specific RA pleural involvement has to be taken in consideration when other diagnoses are eliminated, especially tuberculosis or sarcoidosis-like disease.
Revue des Maladies Respiratoires 11/2010; 27(9):1119-23. · 0.59 Impact Factor
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ABSTRACT: Several series of video-assisted (VATS) major pulmonary resection (MPR) for non small cell bronchial carcinoma (NSCBC) have been published recently. However, totally endoscopic MPR is still very uncommon. We report the initial results of a recent series of 71 patients.
From 2007 to 2009, 635 patients had a major pulmonary resection (pneumonectomy, lobectomy or segmentectomy) for NSCBC. Seventy-one out of these patients (11%) in whom a clinical stage I NSCBC was strongly suspected were operated on via a totally endoscopic approach, without mini-thoracotomy or utility incision. Sixty-three had a lobectomy and 8 a segmentectomy. There were 2 conversions to thoracotomy (2.8%), for a fused fissure (1 patient) and for tight pleural adhesions (1 patient). The resection was completed by a radical lymphadenectomy in all patients.
For the 69 patients who had a totally endoscopic procedure, there was no mortality. No intraoperative complications occurred. The mean duration of operation was 226 minutes + or - 38 (range: 137-307 minutes). The mean intraoperative blood loss was 111 cc + or - 93 (range: 0-450 cc). Final pathological examination confirmed stage I NSCBC in 52 patients while 9 NSCBC were upstaged pN1 (n = 6) or pN2 (n = 3). In 8 cases, another type of malignant tumour was found. The mean number of lymph nodes collected was 21 + or - 8 after right-side lymphadenectomy and 23 + or - 8 after left-side lymphadenectomy and the mean number of dissected lymph node stations was 3 (range:2-5). Postoperative morbidity was 23%. The mean postoperative stay was 6.9 days + or - 2 (range: 3-12 days).
MPR via a totally endoscopic approach is safe and fulfils the criteria for an oncological resection.
Revue des Maladies Respiratoires 11/2009; 26(9):961-70. · 0.59 Impact Factor
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ABSTRACT: In patients with a previous history of malignancy, the occurrence of a mediastinal mass with significant uptake of 18 Fluorodeoxyglucose on a PET-scan may lead to biopsy or resection.
We report the case of a posterior mediastinal mass, with significant uptake of 18 Fluorodeoxyglucose on PET- scan, in a patient with a previous history of testicular seminoma. The lesion was actually a benign schwannoma.
In the case of a mediastinal mass with conventional imaging being in favour of a neurogenic tumour a PET scan cannot confirm benignity or malignancy.
Revue des Maladies Respiratoires 02/2009; 26(1):63-5. · 0.59 Impact Factor
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ABSTRACT: Several techniques for video-assisted pulmonary lobectomy have been reported. However full thoracoscopic lobectomy, i.e., without the help of a utility incision has seldom been performed. We report our results based on a series of resections for benign or metastatic conditions where mediastinal lymphadenectomy is not indicated.
Fifty-six patients (29 males and 27 females) with a mean age of 46 years (range: 8-82 years) had an attempted major pulmonary resection (54 lobectomies and 2 segmentectomies) via thoracoscopy alone for either a benign lesion (30 cases) or a metastasis (26 cases).
There was no operative mortality. Six patients required conversion to thoracotomy (11%). In the 50 remaining patients who underwent an exclusively thoracoscopic operation, there was 1 intra-operative complication that was managed thoracoscopically. The duration of the procedure ranged from 65 to 230 minutes (mean: 157 minutes). Intra-operative blood loss was 55 cc (range: 0 to 200 cc) in the "metastasis group" and 109 cc (range: 0 to 280 cc) in the "benign lesion group". There were 5 postoperative complications (10%). Postoperative duration of stay ranged from 3 to 15 days (Mean: 6.7 days). All patients were seen at the first postoperative month and no clinical or radiological complication was noticed.
Full thoracoscopic lobectomies are feasible and safe provided appropriate equipment is used and the surgical team is experienced in endoscopic surgery.
Revue des Maladies Respiratoires 02/2008; 25(1):50-8. · 0.59 Impact Factor
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ABSTRACT: Treatment of post surgical thoracic empyema consists of chest tube drainage, antibiotic administration, and in some cases surgical lavage of infected spaces. Data in human on the diffusion of antibiotics in pleural cavity after post surgical empyema are lacking.
We studied on 9 patients with post surgical thoracic empyema (including 6 pneumonectomy) the diffusion of 2 antibiotics commonly used in this situation: amoxicillin (for 7 patients) and vancomycin (for 2 patients). Antibiotics concentrations were measured after at least 3 days of treatment (3-12 days), in order to reach a plateau concentration in the pleural space.
The ratio pleural/plasma antibiotic concentration was 1.96 (range: 0.6-4.9). The pleural infection was cured for 8 on 9 patients. The last patients required thoracostomy, and the outcome was favorable after this procedure.
That the penetration of amoxicillin and vancomycin in pleural space after post surgical empyema is good. Pleural antibiotics concentrations are in the majority of cases higher than plasmatic concentrations.
Revue des Maladies Respiratoires 10/2007; 24(7):853-8. · 0.59 Impact Factor
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ABSTRACT: IntroductionRheumatoid arthritis (RA) is a systemic illness where the development of pulmonary nodule has been described in from 4 to 20% of patients. Symptomatic pleural manifestations occur in 3 to 5% of cases. Rarely, pulmonary nodules become necrotic and lead to pleural complications. Bilateral pneumothorax has only rarely been described.Case reportWe report the case of a 64-year-old woman, who had been treated for RA for several years and presented with bilateral pneumothorax secondary to necrobiosis of one or several pulmonary rheumatoid nodules. The management of the pneumothorax was very prolonged and difficult, and despite surgical pleurodesis, the lung did not reexpand fully. Pathological examination of the pleura revealed a noncaseating granulomatous pattern. The diagnosis of a sarcoidosis like disease, possibly induced by anti-TNFα, or of pleural tuberculosis were suggested, but we concluded that the final diagnosis was of pleural rheumatoid involvement.ConclusionBilateral pneumothorax secondary to rheumatoid nodule is a rare entity. The management of such a complication is difficult, particularly in patients who receive an immunosuppressant regimen. A granulomatous pattern has been described rarely in the pleural tissue of these patients. Specific RA pleural involvement has to be taken in consideration when other diagnoses are eliminated, especially tuberculosis or sarcoidosis-like disease.
Revue des Maladies Respiratoires.
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ABSTRACT: IntroductionTreatment of post surgical thoracic empyema consists of chest tube drainage, antibiotic administration, and in some cases surgical lavage of infected spaces. Data in human on the diffusion of antibiotics in pleural cavity after post surgical empyema are lacking.Methods
We studied on 9 patients with post surgical thoracic empyema (including 6 pneumonectomy) the diffusion of 2 antibiotics commonly used in this situation: amoxicillin (for 7 patients) and vancomycin (for 2 patients). Antibiotics concentrations were measured after at least 3 days of treatment (3-12 days), in order to reach a plateau concentration in the pleural space.ResultsThe ratio pleural/plasma antibiotic concentration was 1.96 (range: 0.6-4.9). The pleural infection was cured for 8 on 9 patients. The last patients required thoracostomy, and the outcome was favorable after this procedure.Conclusion
That the penetration of amoxicillin and vancomycin in pleural space after post surgical empyema is good. Pleural antibiotics concentrations are in the majority of cases higher than plasmatic concentrations.
Revue des Maladies Respiratoires. 24(7):853-858.
