Recurrence in complete responders after trimodality therapy in esophageal cancer

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Commentary: Transoral endoscopic repair of Zenker's diverticulum by a thoracic surgical service

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Left main bronchial sleeve resection with total lung parenchymal preservation: a tailored surgical approach

Bronchial sleeve resection is an uncommon thoracic surgical procedure. Under specific conditions, patients can be selected to undergo a sleeve resection of the main bronchus with complete parenchymal preservation. The left main bronchus is longer than the contralateral bronchus, therefore left endobronchial tumours can be localized at the proximal end of the bronchus or distally, near the secondary carina. Bronchial anastomosis in these 2 situations requires different approaches. We present the surgical technique of left main bronchus resection with complete preservation of lung parenchyma through a hemi-clamshell incision (proximal tumour) or posterolateral thoracotomy (distal tumour)

Two-stage free anterolateral thigh flap in the management of full-thickness chest wall resection

International audienceFree tissue transfers are sometimes required in the reconstruction of large full-thickness chest wall defects. To minimize the risk of viscera exposure in case of free flap complications, we describe a two-stage procedure using an anterolateral thigh flap

Contraceptive Implant Embolism Into the Pulmonary Artery: Thoracoscopic Retrieval

International audienceAn 18-year old woman had migration of a subdermal contraceptive implant in a subsegmental branch of her left lower lobe pulmonary artery. She was managed successfully through a conservative surgical approach, as the implant was removed from the pulmonary artery thoracoscopically, thereby avoiding the need of thoracotomy or lung resection. (C) 2017 by The Society of Thoracic Surgeon

European perspective in Thoracic surgery-eso-coloplasty: when and how?

23rd Annual Meeting of the European-Society-of-Thoracic-Surgeons (ESTS), Lisbon, PORTUGAL, MAY 31-JUN 03, 2015International audienceColon interposition has been used since the beginning of the 20th century as a substitute for esophageal replacement. Colon interposition is mainly chosen as a second line treatment when the stomach cannot be used, when the stomach has to be resected for oncological or technical reasons, or when the stomach is deliberately kept intact for benign diseases in young patients with long-life expectancy. During the surgery the vascularization of the colon must be carefully assessed, as well as the type of the graft (right or left colon), the length of the graft, the surgical approach and the route of the reconstruction. Early complications such as graft necrosis or anastomotic leaks, and late complications such as redundancy depend on the quality of the initial surgery. Despite a complex and time-consuming procedure requiring at least three or four digestive anastomoses, reported long term functional outcomes of colon interposition are good, with an acceptable operative risk. Thus, in very selected indications, colon interposition could be seen as a valuable alternative for esophageal replacement when stomach cannot be considered. This review aims at briefly defining ``when'' and ``how'' to perform a coloplasty through demonstrative videos

Peripheral location of lung cancer is associated with higher local disease recurrence

International audienceOBJECTIVES To evaluate the association between the distance of the tumour to the visceral pleura, and the rate of local recurrence in patient surgically treated for stage pI lung cancer. METHODS A single centre retrospective review of 578 subsequent patients with a clinical stage IA lung cancer who underwent lobectomy or segmentectomy from January 2010 to December 2019. Were excluded those 107 patients with either positive margins, previous lung cancer, neoadjuvant treatment, pathological stage II or higher status, or patients in whom preoperative CT-scan was not available at the time of the study. Distance between the tumour and the closest visceral pleura area (fissure/mediastinum/lateral) was assessed by two independent investigators, using the preoperative CT-scan and multiplanar 3D reconstructions. An AUC curve was performed to determine the best threshold for tumour/pleura distance, and then multivariable survival analyses to assess the relationship between local recurrence and this threshold adjusting on other variables. RESULTS Local recurrence occurred in 27/471 patients (5.8%). A cut-off value of 5 mm between the tumour and the pleura was statistically determined. In multivariable analysis, local recurrence rate was significantly higher in patients with tumour-to-pleura ≤5mm, compared to patients with tumour-to-pleura >5mm (8.5% vs 2.7%, HR 3.36, 95% CI: 1.31–8.59, p = 0.012). Sub-group analyses regarding patients with pIA and tumour size ≤2cm found local recurrence in 4/78 patients treated with segmentectomy (5.1%), with a significant higher occurrence in tumour-to-pleura ≤5mm (11.4% vs 0%, p = 0.037), and in 16/292 patients treated with lobectomy (5.5%) without significant higher occurrence in tumour-to-pleura ≤5mm (7.7% vs 3.4%, p = 0.13). CONCLUSIONS Peripheral location of lung tumour is associated with a higher rate of local recurrence and should be taken into account during preoperative planning when considering segmental versus lobar resection

Postoperative morphine consumption and anaesthetic management of patients undergoing video-assisted or robotic-assisted lung resection: a prospective, propensity score-matched study

International audienceBackground: Robotic assistance is increasingly being used for treatment of early stage of non-small cell lung cancer. Our objectives were to compare the morphine consumption during the postoperative 48 hours after robotic-assisted thoracic surgery and that after video-assisted thoracic surgery as well as compare the patient's haemodynamic and respiratory function during the procedures. Methods: This observational, prospective study was conducted in a single referral centre for thoracic surgery from January 2016 to March 2017. Patients who were scheduled to undergo surgical lung resection were included. A propensity score based on age, sex, American society of Anesthesiology score was used between groups. Linear regression analyses were used to determine the mean difference in the postoperative morphine consumption. We also compared the haemodynamic and respiratory function during the two procedures. Results: Among the 194 patients included, 105 (54%) and 89 (46%) underwent video and robotic surgery, respectively. Total 75 of each group were matched using the propensity score. The consumption of morphine was 23.0 (16.5-39.0) mg and 33.0 (19.3-46.5) mg (P=0.05) in the video and robotic groups, respectively. Linear regression revealed an average difference (95% Cl) of 6.76 mg (0.32-13.26) (P=0.04) in the morphine consumption after adjusting for the body mass index and local anaesthetic use. Robotic surgery was associated with worse haemodynamic and respiratory function than video surgery. Conclusions: As compared with video, robotic surgery was associated with increased use of morphine and greater alteration in the haemmlynarnic and respiratory functions