Results 1-14 of 14.
((uid:50035775))

Bookmark and Share    
Full Text
Peer Reviewed
See detailConversion from video-assisted thoracic surgery (VATS) to thoracotomy during major lung resection: how does it affect perioperative outcomes?
Seitlinger, Joseph; Olland, Anne; Guinard, Sophie et al

in Interactive Cardiovascular and Thoracic Surgery (2020)

Objectives: Since video-assisted thoracic surgery (VATS) was first performed in the early 1990s, there have been many developments, and the conversion rate has decreased over the years. This article ... [more ▼]

Objectives: Since video-assisted thoracic surgery (VATS) was first performed in the early 1990s, there have been many developments, and the conversion rate has decreased over the years. This article highlights the specific outcomes of patients undergoing conversion to thoracotomy despite initially scheduled VATS lung resection. Methods: We retrospectively reviewed 501 patients who underwent thoracoscopic anatomic lung resection (i.e. lobectomy, segmentectomy or bilobectomy) between 1 January 2012 and 1 August 2017 at our institution. We explored the risk factors for surgical conversion and adverse events occurring in patients who underwent conversion to thoracotomy. Results: A total of 44/501 patients underwent conversion during the procedure (global rate: 8.8%). The main reasons for conversion were (i) anatomical variation, adhesions or unexpected tumour extension (37%), followed by (ii) vascular causes (30%) and (iii) unexpected lymph node invasion (20%). The least common reason for conversion was technical failure (13%). We could not identify any specific risk factors for conversion. The global complication rate was significantly higher in converted patients (40.9%) than in complete VATS patients (16.8%) (P = 0.001). Postoperative atrial fibrillation was a major complication in converted patients (18.2%) [odds ratio (OR) 5.09, 95% confidence interval (CI) 1.80-13.27; P = 0.001]. Perioperative mortality was higher in the conversion group (6.8%) than in the VATS group (0.2%) (OR 33.3, 95% CI 3.4-328; P = 0.003). Conclusions: Through the years, the global conversion rate has dramatically decreased to <10%. Nevertheless, patients who undergo conversion represent a high-risk population in terms of complications (40.9% vs 16.8%) and perioperative mortality (6.8% vs 0.2%). [less ▲]

Detailed reference viewed: 29 (1 UL)
Full Text
Peer Reviewed
See detailEuropean Respiratory Society Statement on Thoracic Ultrasound
Laursen, Christian B.; Clive, Amelia; Hallifax, Rob et al

in European Respiratory Journal (2020)

Thoracic ultrasound is increasingly considered to be an essential tool for the pulmonologist. It is used in diverse clinical scenarios, including as an adjunct to clinical decision making for diagnosis, a ... [more ▼]

Thoracic ultrasound is increasingly considered to be an essential tool for the pulmonologist. It is used in diverse clinical scenarios, including as an adjunct to clinical decision making for diagnosis, a real-time guide to procedures, and a predictor or measurement of treatment response. The aim of this European Respiratory Society task force was to produce a statement on thoracic ultrasound for pulmonologists using thoracic ultrasound within the field of respiratory medicine. The multidisciplinary panel performed a review of the literature, addressing major areas of thoracic ultrasound practice and application. The selected major areas include equipment and technique, assessment of the chest wall, parietal pleura, pleural effusion, pneumothorax, interstitial syndrome, lung consolidation, diaphragm assessment, intervention guidance, training, and the patient perspective. Despite the growing evidence supporting the use of thoracic ultrasound, the published literature still contains a paucity of data in some important fields. Key research questions for each of the major areas were identified, which serve to facilitate future multi-centre collaborations and research to further consolidate an evidence-based use of thoracic ultrasound, for the benefit of the many patients being exposed to clinicians using thoracic ultrasound. [less ▲]

Detailed reference viewed: 31 (1 UL)
Full Text
Peer Reviewed
See detailAdverse events reporting in stage III NSCLC trials investigating surgery and radiotherapy
Iseli, Thomas; Berghmans, Thierry; Glatzer, Markus et al

in ERJ Open Research (2020)

Background: Current treatment options for stage III non-small cell lung cancer (NSCLC) consist of different combinations of chemotherapy, surgery, radiotherapy and immunotherapy. Treatment choices are ... [more ▼]

Background: Current treatment options for stage III non-small cell lung cancer (NSCLC) consist of different combinations of chemotherapy, surgery, radiotherapy and immunotherapy. Treatment choices are highly individual decisions, in which adverse events (AEs) are relevant for decision-making. This study aims to analyse reporting of AEs in prospective stage III NSCLC trials, focussing on trials including radiotherapy and/or surgery. Methods: PubMed was searched for prospective studies dealing with stage III NSCLC from January 1987 to April 2019. Meta-analyses were screened as a positive control. Pearson’s Chi-squared test and smooth kernel distribution were used to estimate distributions. Data was resampled using bootstrapping. Results: Out of 1193 initially identified studies, 119 met the inclusion criteria. Of these, 31 had a surgical procedure in any study arm. Grade 3 and 4 AEs were reported in 94.12% and 92.44% of the included studies, respectively. Reporting of grade 5 AEs was provided in 87.39% of cases. Grade 1 and 2 AEs were less commonly reported at 53.78% and 63.03%, respectively. One study did not mention any AEs. Of the 31 treatment arms including any form of surgery, AEs were not reported in 10. Overall, 231 different AE items were reported, only 18 of them were included in at least 20% of the analysed studies. Conclusion: Overall, AE reporting in stage III NSCLC was inconsistent and inhomogeneous. Studies including surgical study arms often reported only treatment-related deaths in regards of surgical AEs. Underreporting of AEs prohibits the extraction of patient-relevant information for decision-making and represents a suboptimal use of invested resources. [less ▲]

Detailed reference viewed: 67 (1 UL)
Full Text
Peer Reviewed
See detailDoes lobar or size-reduced lung transplantation offer satisfactory early and late outcomes?
Silva, João Santos; Olland, Anne; Massard, Gilbert UL et al

in Interactive Cardiovascular and Thoracic Surgery (2020)

A best evidence topic was constructed according to a structured protocol. The question addressed was whether size-reduced or lobar lung transplantation (LLTx) offers the same benefit as classic lung ... [more ▼]

A best evidence topic was constructed according to a structured protocol. The question addressed was whether size-reduced or lobar lung transplantation (LLTx) offers the same benefit as classic lung transplantation (LTx). Of the 147 papers found using the reported search, 9 were selected to provide the best evidence. Details of the studies regarding authors, date, journal, country of publication, study type, group studied, relevant outcomes and results are given. All studies reported survival rates of LLTx and most compared it with classical LTx. No statistical differences were reported in medium term and long term. Two of the studies reported a higher incidence of postoperative complications, such as the need for cardiopulmonary bypass, reperfusion oedema or primary graft dysfunction, and longer intubation or intensive care unit stay times. Although the largest study showed a significantly worse 1-year survival in LLTx, a sub-analysis considering patients successfully discharged showed similar outcomes at 1, 3 and 5 years when compared with classic LTx patients. We conclude that LLTx is a valid therapeutic option for recipients with significant donor size mismatch, offering similar outcomes as classical LTx in the medium term and long term. [less ▲]

Detailed reference viewed: 57 (1 UL)
Full Text
Peer Reviewed
See detailTraining Curriculum for European Thoracic Surgeons: A Joint Initiative of the European Society of Thoracic Surgeons and the European Respiratory Society
Massard, Gilbert UL; Tabin, Nathalie; Konge, Lars et al

in European Journal of Cardio-Thoracic Surgery (2020)

Because of the differing definitions of the margins of thoracic surgery as a specialty and the variability in the training curricula among European countries, the European Society of Thoracic Surgeons ... [more ▼]

Because of the differing definitions of the margins of thoracic surgery as a specialty and the variability in the training curricula among European countries, the European Society of Thoracic Surgeons formed a task force to elaborate a consensual proposal. The first step comprised creating a harmonized syllabus that was completed and published in 2018. This publication presents a proposal for a curriculum upon which the task force and the external expert reviewers have agreed. The curriculum was developed by the task force: each module and item describe the expected level of knowledge, skills and attitudes to be attained by the participants; learning opportunities, assessment tools and minimal clinical exposures have been defined as well. Competence in terms of non-technical skills has been defined for each module according to the CanMEDS (http://www.royalcollege.ca/rcsite/canmeds/canmeds-framework-e) glossary. The different modules were subsequently submitted to an internal and an external review process and re-edited accordingly before final validation. The authors hope that this document will serve as a roadmap for both thoracic surgical trainees and mentors. It should further guide continuous professional development. However, evolving scientific and technological advances are expected to modify the diagnosis and treatment of diseases and disorders in the future and hence will mandate periodical revisions of the document. [less ▲]

Detailed reference viewed: 49 (1 UL)
Full Text
Peer Reviewed
See detailA Pathway to Keep All Lifelong Learners Up to Date: The ERS Continuing Professional Development Programme
Farr, Amy; Aliberti, Stefano; Loukides, Stelios et al

in European Respiratory Journal (2020)

Detailed reference viewed: 54 (2 UL)
Full Text
Peer Reviewed
See detailOrganized Management of Diabetes Mellitus in Lung Transplantation: Study of Glycemic Control and Patient Survival in a Single Center
Riou, Marianne; Renaud-Picard, Benjamin; Munch, Marion et al

in Transplantation Proceedings (2019)

Objective: To study patient survival and glycemic control before and after lung transplantation (LTx) according to the diabetes status in patients submitted to an organized management of diabetes mellitus ... [more ▼]

Objective: To study patient survival and glycemic control before and after lung transplantation (LTx) according to the diabetes status in patients submitted to an organized management of diabetes mellitus (DM) at the Strasbourg University Hospital, France. Material and methods: Two hundred and sixty-seven LTx recipients were included retrospectively and analyzed according to diabetes status: pretransplant diabetes, new-onset diabetes mellitus after transplant (NODAT) or no diabetes. Organized DM management was coordinated by a diabetologist trained in DM management before and after transplantation and included pretransplant screening, a close monitoring of glycemia after transplant and optimized treatment before and after LTx. Results: DM was well-controlled after transplantation: mean glycosylated hemoglobin and fasting blood glucose levels after LTx were 5.8 ± 0.2% and 5.4 ± 0.1 mmol/L respectively, in pretransplant DM patients and 5.7 ± 0.1% and 5.6 ± 0.2 mmol/L respectively, in NODAT patients. The overall median survival time was 8.3 ± 1.9 years. Pretransplant DM increased the risk of mortality (1.82-fold increase; 95% confidence interval, 1.08-3.06; P = .02) in LTx recipients. Conclusions: Organized management of diabetes achieved very satisfactory glycemic control in both pretransplant DM and NODAT patients. However, no specific protocols have been created for managing DM following LTx. As DM continues to become an increasing comorbidity in LTx, there exist a significant need of studies in this area. [less ▲]

Detailed reference viewed: 127 (0 UL)
Full Text
Peer Reviewed
See detailImpact of Donor, Recipient and Matching on Survival After High Emergency Lung Transplantation in France
Roussel, Arnaud; Sage, Edouard; Massard, Gilbert UL et al

in European Respiratory Journal (2019)

Introduction: Since July 2007, the French high emergency lung transplantation (HELT) allocation procedure prioritises available lung grafts to waiting patients with imminent risk of death. The relative ... [more ▼]

Introduction: Since July 2007, the French high emergency lung transplantation (HELT) allocation procedure prioritises available lung grafts to waiting patients with imminent risk of death. The relative impacts of donor, recipient and matching on the outcome following HELT remain unknown. We aimed at deciphering the relative impacts of donor, recipient and matching on the outcome following HELT in an exhaustive administrative database. Methods: All lung transplantations performed in France were prospectively registered in an administrative database. We retrospectively reviewed the procedures performed between July 2007 and December 2015, and analysed the impact of donor, recipient and matching on overall survival after the HELT procedure by fitting marginal Cox models. Results: During the study period, 2335 patients underwent lung transplantation in 11 French centres. After exclusion of patients with chronic obstructive pulmonary disease/emphysema, 1544 patients were included: 503 HELT and 1041 standard lung transplantation allocations. HELT was associated with a hazard ratio for death of 1.41 (95% CI 1.22-1.64; p<0.0001) in univariate analysis, decreasing to 1.32 (95% CI 1.10-1.60) after inclusion of recipient characteristics in a multivariate model. A donor score computed to predict long-term survival was significantly different between the HELT and standard lung transplantation groups (p=0.014). However, the addition of donor characteristics to recipient characteristics in the multivariate model did not change the hazard ratio associated with HELT. Conclusions: This exhaustive French national study suggests that HELT is associated with an adverse outcome compared with regular allocation. This adverse outcome is mainly related to the severity status of the recipients rather than donor or matching characteristics. [less ▲]

Detailed reference viewed: 40 (0 UL)
Full Text
Peer Reviewed
See detailMultiple Lung Transplant in a Patient Within 25 Years: A Case Report
Zhang, Min; SecoAntunes, Ana Rita; Kessler, Romain et al

in Experimental and Clinical Transplantation (2019)

With survival after retransplant improving over the years, issues regarding multiple retransplant have emerged. Here, we report the 25-year follow-up of a 16-year-old male patient who received 4 ... [more ▼]

With survival after retransplant improving over the years, issues regarding multiple retransplant have emerged. Here, we report the 25-year follow-up of a 16-year-old male patient who received 4 successful lung transplant procedures in 1990, 1991, 1995, and 2005. [less ▲]

Detailed reference viewed: 51 (1 UL)
Full Text
Peer Reviewed
See detailPatients Treated for Central Airway Stenosis After Lung Transplantation Have Persistent Airflow Limitation
Mazzetta, Andrea; Porzio, Michele; Riou, Marianne et al

in Annals of Transplantation: Quarterly of the Polish Transplantation Society (2019)

BACKGROUND: Although central airway stenosis (CAS) is a common complication after lung transplantation, its consequences have been poorly evaluated. The objective of our study was to evaluate the impact ... [more ▼]

BACKGROUND: Although central airway stenosis (CAS) is a common complication after lung transplantation, its consequences have been poorly evaluated. The objective of our study was to evaluate the impact of CAS on lung function after lung transplantation. MATERIAL AND METHODS: All lung transplant recipients from June 2009 to August 2014 in a single center (Strasbourg, France) were retrospectively reviewed. RESULTS: A total of 191 lung transplantations were performed: 175 bilateral, 15 single, and 1 heart-lung transplantation. Of the 161 bilateral lung-transplanted patients who survived >3 months, 22 (13.6%) developed CAS requiring endobronchial treatment. All these patients were treated by endoscopic balloon dilatation, and 9 additionally needed endobronchial stents. Respiratory function tests demonstrated persistent obstructive ventilatory pattern despite endoscopic treatment in recipients with CAS compared to those without CAS at 6, 12, and 18 months post-transplant. At 18 months, CAS patients had significantly lower post-transplant FEV1 (1.96±0.60 L versus 2.57±0.76 L, p=0.001) and FEV1/FVC (61±14% versus 81±13%, p<0.001). The percentage of patients hospitalized for respiratory infections and number of hospital days were significantly increased in recipients with CAS (20 [91%] versus 92 [66%] p=0.036, and 144±110 days versus 103±83 days p=0.042, respectively). Survival in transplant recipients did not significantly differ between those with CAS and those without. CONCLUSIONS: CAS after lung transplantation was not associated with worse survival, but it did have a significant and persistent effect on lung function, and was associated with increased rate of respiratory infection. [less ▲]

Detailed reference viewed: 29 (0 UL)
Full Text
Peer Reviewed
See detailIn Lung Transplantation, Are Pulmonary Grafts From Donors Deceased From Hanging as Suitable as Grafts From Donors Deceased From Other Causes?
Santos Silva, João; Olland, Anne; Massard, Gilbert UL et al

in Interactive Cardiovascular and Thoracic Surgery (2019)

A best evidence topic was constructed according to a structured protocol. The question addressed was whether pulmonary grafts from donors deceased from hanging offer the same benefit as grafts from donors ... [more ▼]

A best evidence topic was constructed according to a structured protocol. The question addressed was whether pulmonary grafts from donors deceased from hanging offer the same benefit as grafts from donors deceased from other causes in lung transplantation. Of the 17papers found, 4 provided the best evidence to answer the question. The authors, date, journal, country of publication, study type, group studied, relevant outcomes and results of these papers are tabulated. One study reported a large cohort of donors and analysed the out-comes by cause of death, reporting no differences in survival. The remaining 3 papers analysed observational studies on the outcomes of lung transplantation using pulmonary grafts from donors deceased from hanging, compared with donors deceased from other causes. No differences in the rates of post-transplantation pulmonary graft dysfunction and long-term overall survival were reported. Although the cohort of donors deceased from hanging is small, we conclude that these donors are an important contribution to the donor pool. Ex vivo lung perfusion may have a role in assessing graft viability in this scenario [less ▲]

Detailed reference viewed: 70 (0 UL)
Full Text
Peer Reviewed
See detailSurgical Stabilization for Multiple Rib Fractures: Whom the Benefit? -A Prospective Observational Study
Olland, Anne; Puyraveau, Marc; Guinard, Sophie et al

in Journal of Thoracic Disease (2019)

Background: Surgical repair has demonstrated a beneficial effect on outcome for patients presenting with flail chest or with multiple rib fractures. We hypothesized that benefit on outcome parameters ... [more ▼]

Background: Surgical repair has demonstrated a beneficial effect on outcome for patients presenting with flail chest or with multiple rib fractures. We hypothesized that benefit on outcome parameters concerns predominantly patients being extubated within 24 hours post-operatively. Methods: We prospectively recorded all patients presenting with chest traumatism eligible for surgical repair with anticipated early extubation according to our institutional consensus (flail chest, major deformity, poor pain control, associated lesions requiring thoracotomy). We compared outcomes of patients extubated within 24 hours post-operatively to those who required prolonged ventilator support. We tested predictive factors for prolonged intubation with univariate and multivariate analysis. Results: From 2010 to 2014, 132 patients required surgical repair. Two thirds were extubated within 24 hours following surgical repair. Pneumonia was the main complication and occurred in 30.3% of all patients. Patients extubated within 24 hours following surgical repair had significantly shorter ICU stay and shorter in-hospital stay (P<0.0001 both). Pneumonia occurred significantly more often in patients with longer mechanical ventilation (over 24 hours) (P<0.0001) and the overall post-operative complications rate was higher (P=0.0001). Main independent risk factors for delayed extubation were bilateral chest rib fractures and initially associated pneumothorax. Conclusions: We conclude that patients extubated within 24 hours after repair have an improved outcome with reduced complication rate and shorter hospital stay. The initial extent of the trauma is an important risk factor for delayed extubation and high complication rate despite surgical stabilization. [less ▲]

Detailed reference viewed: 83 (1 UL)
Full Text
Peer Reviewed
See detailContinuous Professional Development: Elevating Thoracic Oncology Education in Europe
van Geffen, Wouter H; Blum, Torsten G; Aliberti, Stefano et al

in Breathe (2019), 15(4),

Detailed reference viewed: 67 (0 UL)