Résection pulmonaire élargie à l'oreillette gauche pour cancer broncho-pulmonaire non à petites cellules, à propos d'une série chirurgicale

Le cancer broncho-pulmonaire est actuellement une des causes les plus fréquentes de mortalité dans le monde. La prise en charge curative des stades précoces de CBNPC est essentiellement chirurgical. En revanche, la chirurgie des stades III est plus controversée. Nous rapportons les résultats d'une série de patients ayant bénéficié d'une résection pulmonaire élargie àl'oreillette gauche sans CEC grâce à une technique de dissection du septum inter-atrial. Il s'agit d'une étude rétrospective monocentrique des patients opérés entre novembre 2004 et juin 2011. En cas de résection élargie sur l'OG du côté droit, 3 niveaux de dissection du SIA étaient définis. Analyses de la morbi-mortalité, du taux de survie et du taux de survie sans récidive. 17 patients ont bénéficié d'une résection pulmonaire élargie à l'OG sans avoir recours à une CEC. 11 malades ont reçu un traitement néo-adjuvant. 10 résections concernaient le côté droit, la dissection du SIA était de niveau 1 dans 10% des cas, de niveau 2 dans 60% des cas, de niveau 3 dans 30% des cas. Il existait une atteinte T4 dans 94,2% des patients. Le statut ganglionnaire définitif comportait respectivement 5,8%, 58,8% et 35,4% de pNO, pN1 et pN2. Une résection R0 était obtenue dans 88,2% des cas. La morbidité globale était de 70,58%, la mortalité à 30 jours de 5,88% et à 90 jours de 11,76%. Le suivi moyen était de 26,15 mois. Le taux de survie global était de 66,9% à 5 ans, le taux de récidive à 5 ans était de 23,52%. En analyse uni-variée, le côté gauche, la résection incomplète R1 et le statut pN2 apparaissaient comme des facteurs de risque de récidive. La résection pulmonaire élargie à l'OG dans le cadre de la prise en charge des stades avancés de CBNPC peut être réalisée au prix d'une sélection attentive des malades. La morbidité post-opératoire est acceptable et la mortalité à 90 jours est faible. L'objectif doit être de réaliser une résection complète. La technique de dissection du SIA proposée permet d'augmenter les marges de résection dans ce but.CLERMONT FD-BCIU-Santé (631132104) / SudocSudocFranceF

Lung cancer: what are the links with oxidative stress, physical activity and nutrition.

International audienceOxidative stress appears to play an essential role as a secondary messenger in the normal regulation of a variety of physiological processes, such as apoptosis, survival, and proliferative signaling pathways. Oxidative stress also plays important roles in the pathogenesis of many diseases, including aging, degenerative disease, and cancer. Among cancers, lung cancer is the leading cause of cancer in the Western world. Lung cancer is the commonest fatal cancer whose risk is dependent on the number of cigarettes smoked per day as well as the number of years smoking, some components of cigarette smoke inducing oxidative stress by transmitting or generating oxidative stress. It can be subdivided into two broad categories, small cell lung cancer and non-small-cell lung cancer, the latter is the most common type. Distinct measures of primary and secondary prevention have been investigated to reduce the risk of morbidity and mortality caused by lung cancer. Among them, it seems that physical activity and nutrition have some beneficial effects. However, physical activity can have different influences on carcinogenesis, depending on energy supply, strength and frequency of exercise loads as well as the degree of exercise-mediated oxidative stress. Micronutrient supplementation seems to have a positive impact in lung surgery, particularly as an antioxidant, even if the role of micronutrients in lung cancer remains controversial. The purpose of this review is to examine lung cancer in relation to oxidative stress, physical activity, and nutrition

Microbial composition of tumour and its environment reflects the presence or absence of local lymph node metastases

International audienc

Superior vena cava graft infection in thoracic surgery: a retrospective study of the French EPITHOR database

International audienceAbstract OBJECTIVES To report our experience on the management of superior vena cava graft infection. METHODS Between 2001 and 2018, patients with superior vena cava synthetic graft or patch reconstruction after resection of intrathoracic tumours or benign disease were selected retrospectively from the French EPITHOR database and participating thoracic centres. Our study population includes patients with superior vena cava graft infection, defined according to the MAGIC consensus. Superior vena cava synthetic grafts in an empyema or mediastinitis were considered as infected. RESULTS Of 111 eligible patients, superior vena cava graft infection occurred in 12 (11.9%) patients with a polytetrafluoroethylene graft secondary to contiguous contamination. Management consisted of either conservative treatment with chest tube drainage and antibiotics (n = 3) or a surgical graft-sparing strategy (n = 9). Recurrence of infection appears in 6 patients. Graft removal was performed in 2 patients among the 5 reoperated patients. The operative mortality rate was 25%. CONCLUSIONS Superior vena cava graft infection may develop as a surgical site infection secondary to early mediastinitis or empyema. Graft removal is not always mandatory but should be considered in late or recurrent graft infection or in infections caused by aggressive microorganisms (virulent or multidrug resistant bacteria or fungi)

A Multicenter Study to Assess a Systematic Screening of Occupational Exposures in Lung Cancer Patients

Occupational lung cancer cases remain largely under-reported and under-compensated worldwide. In order to improve the detection and compensation of work-related lung cancers, we implemented a systematic screening of occupational exposures, combining a validated self-administered questionnaire to assess occupational exposures and a specialized occupational cancer consultation. After a pilot study, the present prospective, open-label, scale-up study aimed to assess this systematic screening of occupational exposures in lung cancer patients in five sites in France by associating university hospitals with cancer centers. Patients with lung cancer were sent a self-administered questionnaire to collect their job history and potential exposure to lung carcinogens. The questionnaire was assessed by a physician to determine if a specialized occupational cancer consultation was required. During the consultation, a physician assessed if the lung cancer was occupation-related and, if it was, delivered a medical certificate to claim for compensation. Patients were offered help from a social worker for the administrative procedure. Over 15 months, 1251 patients received the questionnaire and 462 returned it (37%). Among them, 176 patients (38.1%) were convened to the occupational cancer consultation and 150 patients attended the consultation. An exposure to occupational lung carcinogen was identified in 133 patients and a claim for compensation was judged possible for 90 patients. A medical certificate was delivered to 88 patients and 38 patients received compensation. Our national study demonstrated that a systematic screening of occupational exposures is feasible and will bring a significant contribution to improve the detection of occupational exposures in lung cancer patients