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At least 1,045 records · Page 58Linked to original sources
PubMed2006

Outcomes of sublobar resection versus lobectomy for stage I non-small cell lung cancer: a 13-year analysis.

BACKGROUND: The appropriate use of sublobar resection versus lobectomy for stage I non-small cell lung cancer continues to be debated. A long-term analysis of the outcomes of these resections for stage I non-small cell lung cancer in a high-volume tertiary referral university hospital center was performed. METHODS: The outcomes of all stage I non-small cell lung cancer patients (n = 784) undergoing resection were analyzed from our lung cancer registry from 1990 to 2003. Lobectomy was the standard of care for patients with adequate cardiopulmonary reserve. Sublobar resection was reserved for patients with cardiopulmonary impairment prohibiting lobectomy. Predictors of overall survival and disease-free survival were evaluated. Statistical analyses included Kaplan-Meier estimates of survival, log-rank tests of survival differences, and multivariate Cox proportional hazards models. RESULTS: Lobectomy was used for 577 patients and sublobar resection for 207 patients. The median age was 70 years (range, 31 to 107 years). The median follow-up of patients remaining alive was 31 months. Compared with lobectomy, sublobar resection had no significant impact on disease-free survival, with a hazard ratio of 1.20 (95% confidence interval, 0.90 to 1.61; p = 0.24). Sublobar resection had a statistically significant association with overall survival when compared with lobectomy, with an increased hazard ratio of 1.39 (95% confidence interval, 1.11 to 1.75; p = 0.004). Twenty-eight percent of lobectomy patients experienced disease recurrence in that time compared with 29% of the sublobar patients. Seventy-two percent of the recurrences in the lobectomy cohort were distant metastasis versus 52% of the sublobar group recurrences (p = 0.0204). CONCLUSIONS: Although sublobar resection is thought to be associated with increased incidence of local recurrence when compared with lobectomy, we found no difference in disease-free survival between the two types of resection for stage IA patients but slightly worse disease-free survival for stage IB.

Adult↗
PubMed2004

Depressor labii inferioris resection: an effective treatment for marginal mandibular nerve paralysis.

In patients who show their lower teeth during smiling and facial animation, paralysis of the marginal mandibular nerve (MMN) causes a noticeable asymmetry of the lower lip due to the absence of depressor function. This paper presents a balancing technique for this lower lip asymmetry that involves resection of the depressor labii inferioris (DLI) on the nonparalysed side. The anatomy of the muscle, the operative technique, and the effectiveness of the procedure are outlined. A retrospective chart review was performed for 42 adult patients who were treated for MMN palsy with a DLI resection. Seven cases had only the MMN involved, and 35 cases had unilateral facial nerve paralysis. Thirty-six of these patients were available for a follow-up telephone survey. Of the 42 primary DLI resections performed, 36 cases had successful outcomes. Of the six patients who failed to achieve the expected results, five patients had repeat DLI resection and three of these achieved the desired result; the other two patients required a third resection. One patient continued to have DLI action with smiling and subsequently had a Botox injection into the DLI with good results. Of the 36 survey respondents, 21 patients felt their lower lip was asymmetrical at rest prior to DLI resection and 18 of these patients were improved by the procedure (P = 0.0001). Twenty-nine of the 36 patients reported that their lower lip was more symmetrical when they smiled following the DLI resection (P < 0.0001). The bilateral lack of movement in the lower lip when expressing emotions, such as anger and sorrow, was not as important to the patient as the lack of symmetry when expressing these emotions. Patients' speech either improved or showed no change, the amount patients bit their lower lip significantly improved (P = 007) whereas oral continence showed no significant changes (P = 0.147) following the DLI resection. DLI resection is a simple and effective procedure for the treatment of MMN palsy. The results are permanent and predictable. Lower lip symmetry is produced both at rest and with facial animation, without causing a functional deficit. The expected results of surgery can be trialed by local anaesthetic or botulinum toxin to block the activity of the DLI.

Adult↗
PubMed2006

Does adjuvant radiation therapy improve disease-free survival in completely resected Masaoka stage II thymoma?

OBJECTIVE: To determine whether or not patients with completely resected Masaoka stage II thymoma benefit from postoperative radiotherapy (RT). METHODS: We retrospectively review the case records and compared the long-term outcomes of patients affected by Masaoka stage II thymoma treated by resection alone with same stage thymoma patients submitted to resection and RT. Surgical specimens were reviewed to confirm pathological stage, negative resection margins and histological subtype. RESULTS: Between 1988 and 2000, we performed 197 resections for thymoma; 58 patients resulted to be affected by completely resected tumours with microscopic transcapsular invasion (stage IIA, n=25) or macroscopic invasion into the surrounding fatty tissue with or without adhesion to the mediastinal pleura (stage IIB, n=33). Thirty-two patients underwent only complete surgical resection (14 stage IIA and 18 stage IIB); 26 patients underwent complete resection and subsequent mediastinal RT (11 stage IIA and 15 stage IIB). RT dosages were 45-54grays (Gy), in 25-30 fractions. Histological subtypes were similarly represented in both groups. Median follow-up was 91 months (range 9-170). Five intrathoracic recurrences occurred: three radiated patients (2 stage IIB - 1 AB and 1 B2 thymoma; 1 stage IIA B1 thymoma) and two not-radiated patients (1 stage IIA AB thymoma and 1 stage IIB B1 thymoma). Disease-free survival rate at 5- and 10-year were 94% and 87%, respectively. Log-rank test showed no difference in Kaplan-Meier survival curves (p=0.432) between radiated and not-radiated patients. CONCLUSIONS: These data support the concept that radical surgical resection alone should be considered a sufficient treatment for stage II thymoma.

Adult↗
PubMed2004

Pancreaticoduodenectomy with vascular resection: margin status and survival duration.

Major vascular resection performed at the time of pancreaticoduodenectomy (PD) for adenocarcinoma remains controversial. We analyzed all patients who underwent vascular resection (VR) at the time of PD for any histology at a single institution between 1990 and 2002. Preoperative imaging criteria for PD included the absence of tumor extension to the celiac axis or superior mesenteric artery (SMA). Tangential or segmental resection of the superior mesenteric or portal veins was performed when the tumor could not be separated from the vein. As a separate analysis, all patients who underwent PD with VR for pancreatic adenocarcinoma were compared to all patients who underwent standard PD for pancreatic adenocarcinoma. A total of 141 patients underwent VR with PD. Superior mesenteric-portal vein resections included tangential resection with vein patch (n=36), segmental resection with primary anastomosis (n=35), and segmental resection with autologous interposition graft (n=55). Hepatic arterial resections were performed in 10 patients, and resections of the anterior surface of the inferior vena cava were performed in 5 patients. PD was performed for pancreatic adenocarcinoma in 291 patients; standard PD was performed in 181 and VR in 110. Median survival was 23.4 months in the group that required VR and 26.5 months in the group that underwent standard PD (P=0.177). A Cox proportional hazards model was constructed to analyze the effects of potential prognostic factors (VR, tumor size, T stage, N status, margin status) on survival. The need for VR had no impact on survival duration. In conclusion, properly selected patients with adenocarcinoma of the pancreatic head who require VR have a median survival of approximately 2 years, which does not differ from those who undergo standard PD and is superior to historical patients believed to have locally advanced disease treated nonoperatively.

Adenocarcinoma↗
PubMed2005

Current practice patterns in pancreatic surgery: results of a multi-institutional analysis of seven large surgical departments in Germany with 1454 pancreatic head resections, 1999 to 2004 (German Advanced Surgical Treatment study group).

Despite decreasing mortality rates, morbidity is still high after pancreatic head resection. Comparative data in the United States and Europe show a relationship between hospital volume and mortality. Treatment strategies vary frequently, partially because of the lack of evidence-based data. We performed a multi-institutional analysis in Germany evaluating current numbers, indications, techniques, and complication rates of pancreatic head resection. Questionnaires were completed by seven high-volume surgical departments regarding quantitative and qualitative aspects of pancreatic head resections in the period from 1999 to 2004 (five prospective and two retrospective institutional databases). A total of 1454 pancreatic head resections (944 for malignancy) were reported. Mean annual hospital volume ranged from 14 to 52 (10 to 43 in malignancy). Mortality was between 1.1% and 4.8%, morbidity was between 24% and 46%, and pancreatic leakage was between 9% and 20%. In malignant disease, all centers perform standard lymphadenectomy and regard arterial infiltration as a contraindication for resection. However, the rate of portal vein resection varied from 0% to 28%. No consensus is seen on the type of surgery for malignancy and chronic pancreatitis. After resection for pancreatic cancer less than one fourth of the patients receive adjuvant therapy. The results of our analysis in Germany confirm that pancreatic head resection can be performed with low mortality in specialized units. Variations in indications, operative technique, and perioperative care may demonstrate the lack of evidence-based data and/or personal and institutional experience. The low number of patients receiving adjuvant therapy after resection of pancreatic cancer suggests that more efforts must be made to establish novel adjuvant therapies under randomized study conditions.

Digestive System Surgical Procedures↗
PubMed2006

Loading of the index metacarpal after trapezial and partial versus complete trapezoid resection.

PURPOSE: To examine the effects of partial or complete trapezoidectomy in conjunction with trapezium resection on proximal migration of the index metacarpal during axial loading. METHODS: Five specimens from below the elbow were obtained from fresh-frozen cadavers. A customized vise was used to position the wrist in 20 degrees extension and 5 degrees ulnar deviation, simulating a power grip. The index metacarpal was instrumented to allow axial loading at 125 N and 250 N. Specimens were tested under 4 experimental conditions: (1) in the intact state, (2) after trapezial resection, (3) after partial trapezoid resection, and (4) after complete trapezoid resection. Specimens were tested 5 times under each experimental condition, displacement was measured with a linear variable differential transformer, and stiffness was calculated. RESULTS: There was no difference in stiffness between the different treatments at either 125 N or 250 N. Displacement was not significantly different between treatments for loads of 125 N. For loads of 250 N the displacement was approximately 1 mm greater with complete trapezoid resection than with any of the other treatment conditions. Displacement did not differ significantly between the other 3 treatments. CONCLUSIONS: The addition of a partial trapezoid resection performed at the time of trapezial resection does not affect proximal migration of the second metacarpal. When a complete trapezoidectomy is performed at the time of trapezial excision, however, the loading characteristics of the index metacarpal do change statistically significantly, although the magnitude of that change is only approximately 1 mm. Further testing will be necessary to elucidate the biomechanical effects of a partial trapezoid resection in conjunction with a trapezial resection on the second metacarpal in other planes.

Cadaver↗
PubMed2004

Perinatally diagnosed asymptomatic congenital cystic adenomatoid malformation: to resect or not?

BACKGROUND: Management of asymptomatic congenital cystic adenomatoid malformation (CCAM) is controversial. The natural history of untreated asymptomatic CCAM is unknown, although most surgeons recommend resection of these lesions to prevent future infection. The aim of this study was to determine the relative surgical risk of resection compared with the risk of observation for these patients. METHODS: A retrospective review of hospital records between 1996 and 2002 in a tertiary care pediatric referral center was conducted. All perinatally (prenatal or neonatal) diagnosed CCAMs were included. In addition, patients presenting with late diagnosis of CCAM were also reviewed. RESULTS: Forty-eight children had CCAM diagnosed perinatally. Thirteen of these were symptomatic and required surgery within 6 months; these were excluded from the analysis. Of the 35 asymptomatic infants, 6 were operated on electively before 6 months of age (median age, 4.5 months). The other 29 asymptomatic infants were followed up for more than 6 months. Of these, 9 remained asymptomatic and were eventually operated on electively (median age, 13 months). Three (10%) had CCAM infections at 7, 8, and 11 months of age and required resection. The remaining 17 children have not undergone resection and are still asymptomatic (median follow-up, 3 years). An additional 12 patients presented with a late diagnosis of CCAM. All of these presented with complications (infection or pneumothorax) and underwent resection (median age, 6 years). Overall, the complication rate after resection of an asymptomatic CCAM was not significantly different from those of resected CCAM that had already developed infection or pneumothorax (P =.64). CONCLUSIONS: Ten percent of perinatally diagnosed asymptomatic patients had 5 complications requiring surgery during follow-up. The true incidence is probably higher given the relatively short follow-up in our series. Morbidity after resection of a complicated CCAM was not statistically significantly higher than after elective resection for an asymptomatic CCAM. Although conservative management of asymptomatic CCAM may be warranted, a more extended period of follow-up is necessary before this approach can be recommended.

Cystic Adenomatoid Malformation of Lung, Congenita↗
PubMed2004

The impact of gross total resection on local control and survival in high-risk neuroblastoma.

BACKGROUND/PURPOSE: Gross total resection of the primary tumor in treatment of high-risk neuroblastoma remains controversial. Furthermore, there are few reports of the effect of primary tumor resection on local control as opposed to overall survival. The authors reviewed their institutional experience to assess the effect of primary tumor resection on local control and overall survival. METHODS: A total of 141 patients were treated on protocol between November 1, 1979 and June 25, 2002 and are the subject of this report. Gross total resection was assessed by review of operative notes, postoperative computerized axial tomograms, and postoperative meta-iodobenzyl guanidine (MIBG)1 scans when available. RESULTS: The median age was 3.3 years, and all patients were International Neuroblastoma Staging System (INSS) stage 4 with 79% having metastases to cortical bone. The primary site was the adrenal gland in 74%, the central abdominal compartment in 13%, the posterior mediastinum in 7%, and other sites in 6%. Gross total resection was accomplished in 103 (73%) but was more than 90% for the last 3 protocols. Five kidneys were lost overall. The probability of local progression was 50% in unresected patients compared with 10% in patients undergoing gross total resection (P <.01). Overall survival rate in resected patients was 50% compared with 11% in unresected patients (P <.01). CONCLUSIONS: Our data indicate that local control and overall survival rate are correlated with gross total resection of the primary tumor in high-risk neuroblastoma. Gross total resection should be part of the management of stage 4 neuroblastoma in patients greater than 1 year of age.

Abdominal Neoplasms↗
PubMed2005

Long-term results after carinal resection for carcinoma: does the benefit warrant the risk?

OBJECTIVE: We sought to determine whether the benefit warrants the risk in patients undergoing carinal resection for carcinoma. METHODS: This was a retrospective single-center study. RESULTS: Between June 1981 and August 2004, 119 patients underwent carinal resection for carcinoma in our institution. Carinal pneumonectomy was performed in 103 cases (96 right and 7 left pneumonectomies), carinal resection plus right upper lobectomy in 3, carinal resection after left pneumonectomy in 2, and carinal resection without pulmonary resection in 11. Superior vena caval resection was combined with carinal pneumonectomy in 25 patients with bronchogenic carcinoma (13 patients had complete superior vena caval resection with graft interposition). Nine (7.6%) patients died in the hospital or within 30 days of the operation. Follow-up was complete for 117 (98%) patients up to August 2004 or to the date of death. The 5- and 10-year survivals were 44% and 25%, respectively, for patients with bronchogenic carcinoma (n = 100). However, survival was significantly better in patients with N0 or N1 disease (n = 73) than in those with N2 or N3 disease (n = 27; 53% vs 15% at 5 years, respectively). The 5- and 10-year survivals in the remaining 19 patients reached 66% and 48%, respectively, and were best in patients with neuroendocrine carcinoma (100% survival at 10 years) and adenoid cystic carcinoma (69% survival at 10 years). CONCLUSIONS: Surgical intervention for carcinoma involving the carina is feasible, with acceptable mortality and good long-term survival in selected patients. The presence of positive N2 disease should, however, be considered a potential contraindication to carinal resection in patients with bronchogenic carcinoma because of the poor long-term survival.

Adult↗
PubMed1998

[Is pancreatectomy with resection of the retro-pancreatic vessels for cancer justified?].

AIM OF THE STUDY: Tumoural invasion of the retropancreatic vessels and particularly of the superior mesentericoportal vein confluence (SMPV) is often considered as a contraindication to resection of malignant tumours of the pancreas. The aim of this retrospective study is to report a series of 20 patients and to demonstrate that resection of the vessels supposed to be involved is justified when it is the only barrier to a complete tumoural resection. PATIENTS AND METHOD: Twenty patients, 11 men and nine women (mean age: 61.7 years) underwent a right (n = 14), left (n = 2) or total (n = 4) pancreatic resection for pancreatic adenocarcinoma (n = 19) or cystadenocarcinoma (n = 1) associated with partial resection of SMPV (n = 17), inferior vena cava (n = 1), right hepatic artery (n = 1) and common hepatic artery (n = 1). The veins were reconstructed in all cases by end to end anastomosis and the arteries by direct suture in one patient and venous or artery graft in two patients. RESULTS: Tumoural invasion was histologically present in the vascular wall in nine patients, in the perivascular area in six and negative in five. The in-hospital mortality was nil. One patient had an early venous thrombosis of the repaired SMPV which was reoperated and treated with success by desobstruction and venous graft. The 3-year actuarial survival rate was 16%. CONCLUSION: Segmental venous resection of the SMPV confluence can be performed safely. Localised invasion of the vascular wall, considered as the only obstacle for a complete tumoural resection, is not associated with a poor prognosis. In case of tight adhesions between tumour and SMPV (inflammatory or tumoural) the venous resection may be included in a deliberate surgical strategy. On the other hand, total obstruction of SMPV, extrapancreatic tumoural extension, tumoural invasion of superior mesenteric artery or coeliac trunk are contraindications to pancreatic resection.

Actuarial Analysis↗
PubMed2001

Liver resections with or without pedicle clamping.

BACKGROUND: Decreasing operative bleeding during liver resection, and thus extent of transfusions, has become a main criterion to evaluate operative results of hepatectomies. Hepatic pedicle clamping (HPC) is widely used for this purpose. The aim of the study was to evaluate safety, efficacy, technique, and contraindications of HPC during liver resections, comparing results of resections performed with or without HPC. METHODS: Data from 245 liver resections were analyzed. In all, 125 resections were performed with HPC (group A), continuous in 100 cases and intermittent in 25 cases. The average duration of ischemia in group A was 39 +/- 20 minutes (range 7 to 107). In 20 cases (16%) ischemia was prolonged for 60 minutes or more. A total of 120 resections were performed without HPC (group B). Major resections were 53.6% in group A (67 cases) and 38.3% in group B (46 cases). Cirrhosis was present in 36 cases, 19 in group A and 17 in group B. RESULTS: Operative mortality was nil. Postoperative mortality was 2.9%, morbidity 22.4%. Percentage of transfused cases (34.4% versus 60.0%; P <0.001) and number of blood units per transfused case (2 +/- 1 versus 4 +/- 3; P <0.001) were lower in group A versus group B. Similar figures were found by considering only major resections. Postoperative blood chemistries did not show important differences between the two groups, and postoperative alterations were related more to extent and complexity of the operation than to length of HPC. CONCLUSIONS: HPC during liver resection is a safe and effective technique. This is demonstrated in a context where HPC is used continuously in most cases, intermittently in cases with impaired liver function and for more prolonged ischemia, and avoided in cases with limited bleeding, jaundice, and simultaneous bowel anastomoses.

Adolescent↗
PubMed1994

Does intraoperative hepatic ultrasonography change surgical decision making during liver resection?

BACKGROUND: Intraoperative hepatic ultrasonography (IOUS) has been used to accurately identify and localize hepatic tumors as an adjunct to hepatic resection and for the detection of occult liver metastases during primary resection of other gastrointestinal carcinomas. The face validity of IOUS to identify more lesions than conventional diagnostic modalities and the content validity of IOUS to change the planned surgical management has been assessed in a blinded, prospective manner. METHODS: Sixty-two patients were studied at two institutions by one surgeon. IOUS was compared with computed tomography (CT) angioportography in 30 patients undergoing planned hepatic resection (19 metastatic, 11 primary) and with conventional hepatic ultrasonography (+/- venous enhanced CT scan) in 32 patients undergoing primary excision of gastrointestinal carcinomas. RESULTS: Twenty of the 30 hepatic resections (67%) were changed or guided by IOUS as determined by the operating surgeon at the completion of the laparotomy. IOUS detected 26 more metastases (44%) in 10 of 19 patients (1 to 5 per patient). Two patients had preoperatively suspected metastases refuted by IOUS-guided biopsy. Eight of the 11 patients (73%) undergoing resection of primary carcinoma of the liver had the planned procedure changed or guided by IOUS. This included four hepatocellular carcinomas with more extensive involvement at the confluence of the hepatic veins and the inferior vena cava, necessitating resection with the aid of total vascular isolation. In 32 patients undergoing primary resection of gastrointestinal carcinomas, 5 patients (16%) had the stage of disease altered by IOUS when compared with conventional ultrasound (+/- venous enhanced CT scan). CONCLUSIONS: The validity of IOUS is good. IOUS guided the intraoperative surgical management of two thirds of the patients undergoing hepatic resection when compared with CT angioportography. Intraoperative hepatic ultrasonography using a reproducible systematic approach can change the clinical management of patients undergoing hepatic resection for malignancy.

Algorithms↗
PubMed1992

Results of surgical resection of pulmonary metastases of squamous cell carcinoma of the head and neck.

In this retrospective review of 58 patients (12 females and 46 males) with pulmonary metastases of squamous cell carcinoma of the head and neck treated between January 1, 1970, and December 31, 1989, we evaluated their clinical courses and analyzed the outcomes of those who underwent pulmonary resection. For the entire group of patients, factors predictive of survival in those patients with a diagnosis of pulmonary metastases included pulmonary resection of metastases (p = 0.0001), locoregional control of the head and neck primary tumor at the time of diagnosis of pulmonary metastases (p = 0.007), TNM stage of the head and neck primary tumor (p = 0.02), a single nodule seen on the chest radiograph (p = 0.02), and disease-free interval (DFI) from the primary tumor of the head and neck of 2 years or more (p = 0.05). Twenty-four of 58 patients underwent thoracotomy for resection of metastases. Four (17%) were found to have a second primary tumor of the lung. Of the 20 remaining patients who underwent explorative surgery for possible pulmonary resection, 18 (90%) underwent complete resection of all malignant disease with an estimated 5-year survival of 29%. In these patients, a DFI of less than 1 year was associated with a 5-year survival rate of 0%, whereas a DFI of 1 to 2 years was associated with a 5-year survival rate of 43% and a DFI of 2 years or longer had a 5-year survival rate of 33%. The number of malignant pulmonary nodules that were resected ranged from one to five and was not significant in predicting survival (p = 0.19). Of eight patients who underwent the resection of more than one malignant pulmonary nodule, 50% survived 2 years, but none survived 5 years. Resection of a solitary pulmonary metastasis from squamous cell carcinoma of the head and neck resulted in long-term survival in selected patients. Important prognostic factors included locoregional control of the head and neck primary tumor, the number of nodules seen on chest radiograph, the TNM stage of the primary tumor, and the DFI from the head and neck primary tumor. The value of resection in patients with more than one malignant pulmonary nodule remains to be defined for this group of patients.

Carcinoma, Squamous Cell↗
PubMed1996

Evaluation of surgical resection for small hepatocellular carcinomas.

BACKGROUND: The surgical results for small hepatocellular carcinomas (HCCs) are not necessarily satisfactory. The resectional therapy for small HCC was evaluated to elucidate its benefits and limitations. PATIENTS AND METHODS: Data were analyzed concerning 52 patients having small HCC of <3 cm in diameter and <3 nodules, who underwent hepatic resections from 1978 to 1989. RESULTS: Cumulative and disease-free survival at 5 years after resection were 57% and 37%, respectively. Histologic features, such as differentiation of HCCs, pseudocapsular invasion, and ploidy pattern of nuclear DNA, appeared to be good prognostic indicators. The survival rate of the large-resection group (number of resected segments greater than number of tumor-occupying segments) was significantly better than that in the small-resection group (84% versus 48% at 5 years, P<0.05). CONCLUSIONS: Surgical resection of small HCCs is a safe and effective therapy. A large resection appears to provide better patient survival and tumor-free survival compared to a small resection.

Adult↗
PubMed2001

Pulmonary resection for Mycobacterium xenopi pulmonary infection.

BACKGROUND: Results of medical therapy for Mycobacterium xenopi pulmonary infection remain unreliable. Pulmonary resection may be beneficial to patients whose disease is localized and who can tolerate a resectional operation. METHODS: Eighteen patients underwent pulmonary resection between 1991 and 2000: 14 men and 4 women, with a mean age of 50 +/- 12 years (range 27 to 68 years). Indications for operation were either therapeutic (n = 9) or diagnostic (n = 9). Four patients received antimycobacterial chemotherapy before their operation and 2 patients were HIV positive. RESULTS: Therapeutic procedures included completion pneumonectomy (n = 1), lobectomy (n = 6), segmentectomy (n = 1), and bilateral wedge resection (n = 1). Diagnostic procedures included lobectomy (n = 1) and wedge resection (n = 8). Complete resection could be achieved in 15 patients (83%). There was no in-hospital mortality. Postoperative complications included prolonged air leak (5 of 18 patients, 27.7%) and pleural effusion requiring insertion of a new chest tube (3 of 18 patients, 16.6%). Mean hospital stay was 14 +/- 8 days. Follow-up was 100% complete. Eleven patients received antimycobacterial chemotherapy for 4 to 24 months, postoperatively. Late mortality was 11% and was unrelated to progression of mycobacterial disease. After the operation, the sputum remained positive in only 2 patients (11%) with incomplete resections. Fourteen patients were asymptomatic with no relapse at a mean follow-up of 38 +/- 22 months (range 85 to 13 months). CONCLUSIONS: Resection represents an important adjunct to chemotherapy for the treatment of M. xenopi pulmonary disease. In the setting of localized nodular or cavitary disease, failure to respond to medical therapy, relapse after treatment discontinuation, coexistent aspergilloma or polymicrobial contamination, or patient intolerance of medical therapy, pulmonary resection can be undertaken with acceptable morbidity and mortality.

AIDS-Related Opportunistic Infections↗
PubMed1998

Incidence and predictors of supraventricular dysrhythmias after pulmonary resection.

BACKGROUND: Patients undergoing pulmonary resection were evaluated prospectively in an effort to determine the incidence of and predictors for the development of postoperative supraventricular dysrhythmias. Specifically, we wished to test the hypothesis that the incidence of postoperative supraventricular dysrhythmias is dependent on the magnitude of pulmonary resection. METHODS: One hundred sixteen patients undergoing pulmonary resection had continuous Holter monitoring preoperatively, the day of operation, and the second postoperative day, as well as continuous cardiac monitoring throughout hospitalization. Holter interpretation was blinded to extent of resection. RESULTS: Twenty-six patients underwent pneumonectomy, 7 bilobectomy, 47 lobectomy, and 36 wedge resection. Twenty-six patients (22.4%) had supraventricular dysrhythmias, all atrial fibrillation +/- flutter. The incidence of atrial fibrillation with pneumonectomy, bilobectomy, single lobectomy, and wedge resection was 46.1%, 14.3%, 17.0%, and 13.8%, respectively (p < 0.005 pneumonectomy versus others). Overall, 31% of patients having pneumonectomy required pharmacologic therapy for dysrhythmia compared with 16% of patients having lesser resections, (p = 0.03). The peak incidence of onset of atrial fibrillation occurred on postoperative days 2 and 3 and lasted for less than 1 to 7 days, average 2.5 days. The average age of patients with dysrhythmias (64 years) was greater than those without (58 years) (p = 0.039). Thirty pre- and postoperative variables tested were not found to be significant predictors for development of postoperative atrial fibrillation. CONCLUSIONS: Atrial fibrillation occurs commonly after pulmonary resections but is not predictable. Development of atrial fibrillation is not dependent on the magnitude of pulmonary resection but is associated with the procedure pneumonectomy for reasons not elucidated.

Adult↗
PubMed1999

Treatment of gastric tumors by endoscopic mucosal resection with a ligating device.

BACKGROUND: This study attempted to determine the indication for endoscopic mucosal resection with a ligating device (EMRL) and to assess the efficacy of radical (complete) resection of early gastric carcinoma and adenoma. METHODS: Sixteen patients with early gastric carcinoma (17 lesions) and 21 patients with gastric adenoma (23 lesions) underwent EMRL with an endoscope with a ligating device. After epinephrine solution was injected into the submucosa, the lesions were aspirated, ligated, and resected. RESULTS: Twelve of 17 early carcinomas (70.6%) and 18 of 23 adenomas (78.3%) were radically resected by EMRL. The average size of the resected specimens was 12.8 x 11.0 mm. The rate of successful radical resection by EMRL, including piecemeal resection, was 100% (15/15) for lesions located in the antrum, 80% (4/5) in the angle, 61.1% (11/18) in the body, and 0% (0/2) for lesions at the cardia. Repeat EMRL was performed successfully in cases of partial resection (n = 3). No serious complication was encountered. No recurrence of the tumors was identified in cases of radical resection during a median follow-up period of 22.8 months. CONCLUSION: EMRL is suitable for the treatment of gastric tumorous lesions. For the treatment of early carcinoma, well-differentiated mucosal carcinomas smaller than 10 mm located in the distal stomach represent the best indication for EMRL.

Adenocarcinoma↗
PubMed1999

Endoscopic mucosal resection with a cap-fitted endoscope versus freehand gastric mucosectomy in an animal model.

BACKGROUND: Endoscopic mucosal resection with a cap-fitted endoscope appears to be as effective but easier to perform than freehand mucosectomy. However, experience with this technique has been limited to small case series and there is a lack of data from direct comparison trials. METHODS: Nine pigs were randomized to mucosectomy using a cap-fitted endoscope or the freehand technique. Five mucosal resections were performed at five different sites in the gastric body in each pig. Eight to ten milliliters of a saline, epinephrine, and methylene blue solution were injected to raise a bleb to simulate a mucosal lesion. Endoscopic mucosal resection with a cap-fitted endoscope was performed by suctioning the bleb into the cap device pre-looped with an oval snare; mucosectomy was performed electrosurgically. Freehand mucosectomy was performed by encircling and then resecting the bleb using an oval snare. The ease of procedure (1 = "very easy" to 5 = "unable to complete") was assessed after each resection. The animals were recovered, maintained, and then humanely sacrificed after 2 weeks. RESULTS: Five pigs underwent endoscopic mucosal resection with a cap-fitted endoscope and 4 underwent freehand mucosectomy. Eight animals survived for 2 weeks without complications and one animal from the freehand group died of massive hemorrhage within 48 hours of endoscopy. Both methods produced rounded resection specimens measuring 9 to 12 mm in diameter of the full thickness of the mucosa and the submucosa. Overall ease of resection was 1.84 +/- 0.52 for the cap-fitted group and 2.98 +/- 0.86 for the freehand group (p < 0.0001). All of the sites identified at autopsy were completely re-epithelialized, except for the five sites found in the pig that died prematurely. CONCLUSIONS: Endoscopic mucosal resection with a cap-fitted endoscope is as effective, safe, but easier to perform compared with freehand mucosectomy.

Animals↗