The Lung and the Pleura
E. George Elias in CRC Handbook of Surgical Oncology, 2020
Surgical resections offer the best chance for a cure. However, this approach has two main limitations, namely, that the majority of the patients are diagnosed when the disease has progressed beyond the limits of surgical approach, and the presence of occult metastasis in almost half of the patients who are selected for curative surgery. Surgery is the treatment of choice for early stages of lung cancers if the patient’s status allows it.9 Appropriate resection may include segmentectomy, lobectomy, or pneumonectomy. Sleeve resection with a pneumonectomy is also being performed. The mortality rate after segmentectomy and lobectomy is in the range of 4%, and after pneumonectomy, it is about 8%. Even selected patients with locally and/or regionally advanced stage of carcinomas of the lung can be considered for surgery. These include patients with localized chest wall invasion and some of those with Pancoast tumors. Patients with Pancoast tumors usually do receive preoperative irradiation. Patients with well-differentiated carcinomas with ipsilateral mediastinal lymph node involvement are also considered for surgical resection followed by postoperative irradiation.10-14
Station 1: Respiratory
Saira Ghafur, Parminder K Judge, Richard Kitchen, Samuel Blows, Fiona Moss in The MRCP PACES Handbook, 2017
How would you differentiate between a lobectomy and a pneumonectomy? Pneumonectomy The trachea is deviated away towards the side of surgery.Decreased breaths sounds (or no sounds) over the whole lung field.Reduced chest expansion.Lobectomy Trachea may be shifted away from the side of surgery.Audible breath sounds from the lobes that have not been operated on.Chest expansion may be reduced.
Drug-Resistant Tuberculosis
Lloyd N. Friedman, Martin Dedicoat, Peter D. O. Davies in Clinical Tuberculosis, 2020
The decision for a thoracosurgical intervention should be made by a multidisciplinary team of experts and the procedure should be performed in a center with experience in MDR-TB thoracic surgery.185 Surgery should be considered in patients with localized pulmonary disease that cannot be cured by medical treatment alone (e.g., non-culture conversion after 6 months of adequate medical treatment, especially when there are large cavities) or when there are life-threatening complications, e.g., pulmonary hemorrhage, non-resolving pleural empyema, or extensive necrosis. The best treatment outcomes are achieved with partial unilateral lung resections though this likely reflects a selection bias.186 Patients considered for pneumonectomy must be carefully selected. A recent meta-analysis on the role of surgery for patients with MDR-TB found no overall benefit of extensive surgical procedures though there were many confounders.186
XIST/miR-34a-5p/PDL1 axis regulated the development of lung cancer cells and the immune function of CD8+ T cells
Published in Journal of Receptors and Signal Transduction, 2022
Jing Li, Liyan Che, Chang Xu, Dongdong Lu, Yan Xu, Mengru Liu, Wenshu Chai
Lung cancer is the most common malignant tumor worldwide, with an annual incidence of 18 million and an annual death toll of 16 million [1]. Risk factors for lung cancer include smoking and passive smoking, indoor fuel, and oil fume pollution, radon pollution, and family history of lung cancer [2]. Anatomical pneumonectomy is the main treatment for early and mid-stage lung cancer, but it is easy to induce respiratory and cardiovascular complications after surgery [3]. Radiotherapy and chemotherapy are also common methods to treat lung cancer, but cancer cells are easily resistant to radiotherapy and chemotherapy [4]. In recent years, immunotherapy represented by immune checkpoint inhibitors has made gratifying progress [5]. Immune checkpoints broadly include costimulatory molecules represented by CD28, ICOS, and HVEN, and inhibitory molecules represented by programmed cell death 1 (PD-1), T-cell immunoglobulin and mucin domain 3 (TIM3), and lymphocyte-activation gene 3 (LAG3). They are like accelerators or brakes of the immune system and act a crucial part in the stimulation and suppression of the immune system [6,7]. Therefore, the development of preparations or drugs that target immune checkpoints has become the key to the treatment of lung cancer [8].
Efficacy and safety of percutaneous tube drainage in lung abscess: a systematic review and meta-analysis
Published in Expert Review of Respiratory Medicine, 2020
Qibin Lin, Minli Jin, Yacan Luo, Meixi Zhou, Chang Cai
In the pre-antibiotic era, 30–40% of patients with lung abscess would die, and the other third of patients would survive with sequelae, such as chronic lung abscess [4,5]. However, with the introduction of antibiotics, 80–90% of lung abscesses were successfully treated [2]. In recent years, however, the bacterial resistance rate has increased markedly due to antibiotic abuse, coupled with the aging of the population, host secondary immunodeficiency, such as acquired immunodeficiency syndrome (AIDS) and other factors; consequently, the treatment of lung abscess constantly faces new challenges [6]. When medical treatment fails, pneumonectomy is usually recommended. However, even with surgery, the mortality rate for lung abscesses ranges from 15% to 20% [7]. Another treatment option is abscess drainage.
What is the best clinical approach to recurrent/refractory osteosarcoma?
Published in Expert Review of Anticancer Therapy, 2020
Cristina Meazza, Stefano Bastoni, Paolo Scanagatta
The use of staplers to perform wedge resections can be considered when there are only a few, localized nodules. Precision resections with the electrocautery or laser are preferable when there are more than three lesions in order to ensure radical surgery with adequate margins and limited volumetric distortion and restriction [50]. The number of metastases is a prognostic factor, but the real issue is the feasibility of complete macroscopic resection. There are reports in the literature of as many as 124 [51], or even 142 resections being performed on the same lung [52]. When there are many resected areas to close, it would be impossible to suture them without restricting postoperative lung function and expansion. We therefore usually close only the deeper defects, and cover the more superficial ones with autologous fat tissue grafts [53], or with commercial aerostatic fibrin glues or patches to reduce air leaks [54]. Anatomical resections (segmentectomy, lobectomy or pneumonectomy) severely impair lung function, and should be reserved for selected cases when such a sacrifice might be oncologically justified. An example would be a recurrent pulmonary oligometastatic disease when salvage surgery is the only chance.
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