Autologous Tracheal Replacement: Surgical Technique and Outcomes.

Finding a good and durable substitute to trachea and proximal airways has remained the holy grail for thoracic surgeons for many decades. Autologous tracheal reconstruction using armed forearm free flap with rib cartilage achieved satisfactory results in managing extended tracheal lesions without the need for synthetic materials or immunosuppression. This well-vascularized and rigid neo trachea limits postoperative airway collapse, mediastinal infection, and ischemic airway issues, and achieves long-term functional benefit and prolonged survival.

Operability assessment in CTEPH: Lessons from the CHEST-1 study.

Pulmonary endarterectomy is the gold standard treatment for chronic thromboembolic pulmonary hypertension and is potentially curative, although some patients are unsuitable for pulmonary endarterectomy and require alternative management. Lack of standardized assessment of pulmonary endarterectomy eligibility risks suboptimal treatment in some patients. We discuss the implications for future clinical trials and practice of a unique operability assessment in patients who have chronic thromboembolic pulmonary hypertension and were initially screened for inclusion in the CHEST-1 (Chronic Thromboembolic Pulmonary Hypertension Soluble Guanylate Cyclase Stimulator Trial-1) study.

Autologous tracheal replacement for cancer.

Surgical research has failed during fifty years to find an ideal substitute for the trachea after extended resection. All the prostheses could erode the adjacent structures or lead to infection or obstructive issues. Innovation in surgery development has been improved using novel techniques of plastic surgery.

Subclavian artery resection and reconstruction for thoracic inlet neoplasms.

Background: To update the long-term outcomes after subclavian artery (SA) resection and reconstruction during surgery for thoracic inlet (TI) cancer through the anterior transclavicular approach.

Methods: Between 1985 and 2014, 85 patients (60 men and 25 women; mean age, 52 years) underwent en bloc resection of thoracic-inlet non-small cell lung cancer (NSCLC) (n=69), sarcoma (n=11), breast carcinoma (n=3) or thyroid carcinoma (n=2) involving the SA. L-shaped transclavicular cervicothoracotomy was performed, with posterolateral thoracotomy in 18 patients or a posterior midline approach in 15 patients.

Surgical management of malignant tumours invading the inferior vena cava.

Objectives: The management of malignant tumours invading the inferior vena cava (IVC) generally requires a high-risk surgery with low long-term benefits. Surgical treatment with resection and/or embolectomy of the IVC may, however, be beneficial in selected patients. We describe our experience with regard to patient selection, operative technique and outcomes through a standardized and simplified approach.

A paradigm shift for sternal reconstruction using a novel titanium rib bridge system following oncological resections.

Objectives: The postoperative course following sternectomy for cancer carries significant morbidity due to paradoxical breathing, pulmonary infections and infectious complications. The purpose of this report is to evaluate the outcomes in patients undergoing sternal reconstruction using an innovative titanium rib bridge system (STRATOS).

Methods: From 2008 to 2011, 24 patients underwent sternectomy with a titanium rib bridge system reconstruction.

Long-term outcome of pleuropneumonectomy for Masaoka stage IVa thymoma.

Objective: Because pleuropneumonectomy is associated with a high mortality rate, its indication for the treatment of Masaoka stage IVa thymoma is debated. We reviewed retrospectively our single-center experience in order to determine if the benefits warrant the risk of such procedure.

Methods: Between 1970 and 2009, 17 patients (12 men and 5 women) with a mean age of 44 years (range, 25-62 years) underwent a pleuropneumonectomy for a Masaoka stage IVa thymoma in our institution.

Interventional and surgical modalities of treatment in pulmonary hypertension.

Most patients with chronic thromboembolic pulmonary hypertension are operable, and pulmonary endarterectomy is the treatment of choice. Pulmonary endarterectomy should not be delayed for medical therapy, and risk stratification helps to define patients likely to achieve the best outcome. Inoperable patients should be referred for trials of medical agents.

Composite cervical skin and cartilage flap provides a novel large airway substitute after long-segment tracheal resection.

Objective: Airway replacement after long-segment tracheal resection for benign and malignant disease remains a challenging problem because of the lack of a substitute conduit. Ideally, an airway substitute should be well vascularized, rigid, and autologous to avoid infections, airway stenosis, and the need for immunosuppression. We report the development of an autologous tracheal substitute for long-segment tracheal resection that satisfies these criteria and demonstrates excellent short-term functional results in a large-animal study.

Giant aneurysmal dilation of an intralobar pulmonary sequestration artery.

Bronchopulmonar intralobar sequestrations receive their arterial blood supply through anomalous arteries from the systemic circulation. Usually the lumen of the aberrant artery can be oversized, but it is unusual to find a true arterial aneurysm. Here, we report a case of a 40-year-old woman with this unusual evolution.

Complete resection of pulmonary inflammatory pseudotumors has excellent long-term prognosis.

Objective: Pulmonary inflammatory pseudotumor is an uncommon disease, often with a benign presentation. However, invasion of adjacent thoracic organs, local recurrence, and distant metastases have been described, and the best management strategy remains unclear. We present a single large institutional experience in patients with pulmonary inflammatory pseudotumor and propose guidelines for treatment of this patient population.

Results of primary surgery with T4 non-small cell lung cancer during a 25-year period in a single center: the benefit is worth the risk.

Background: The purpose of this study was to assess operative mortality, morbidity, and long-term results of patients with surgically resected T4 non-small cell lung carcinoma.

Methods: A retrospective review of 271 patients with T4 non-small cell lung carcinoma between 1981 and 2006 was undertaken. They were divided into four subgroups: 126 patients with superior sulcus tumors, 92 with carinal involvement, 39 with superior vena cava replacement, and 14 with the tumor invading other mediastinal structures.

Factors affecting early and long-term outcomes after completion pneumonectomy.

Objective: To identify factors that affect operative mortality and morbidity and long-term survival after completion pneumonectomy.

Methods: We retrospectively reviewed the charts of consecutive patients who underwent completion pneumonectomy at our cardiothoracic surgery department from January 1996 to December 2005.

Results: We identified 69 patients, who accounted for 17.

Two cases of intra-pericardial tumors arising from the ascending aorta in adults.

Two female patients aged 64 and 50 years, who had intra-pericardial tumors arising from the ascending aorta, are reported. Both patients were admitted with mediastinal mass. Surgery was performed by median sternotomy with complete excision.

Morbidity, mortality, and long-term survival after sleeve lobectomy for non-small cell lung cancer.

Objective: Sleeve lobectomy is a widely accepted procedure for central tumors for which the alternative is pneumonectomy. The purpose of this study is to assess operative mortality, morbidity, and long-term results of sleeve lobectomies performed for non-small cell lung carcinoma (NSCLC).

Methods: A retrospective review of 218 patients who underwent sleeve lobectomy for NSCLC between 1981 and 2005 was undertaken.

Tracheal compression caused by straight back syndrome, chest wall deformity, and anterior spinal displacement: techniques for relief.

Background: Straight back syndrome and other causes of extreme narrowing of the space between sternal notch and vertebrae can cause critical tracheal obstruction. Additional points of compression may result from the brachiocephalic artery and from anterior vertebral displacement.

Methods: Individualized surgical maneuvers are necessary to correct all points of obstruction.

Heterotopic en bloc tracheobronchial transplantation with direct revascularization in pigs.

Objective: This article describes the application of a novel aortic tube technique for directly revascularized tracheobronchial transplantation with dual blood supply in pigs.

Methods: Eleven adult Large White pigs underwent heterotopic tracheal transplantation with a dual revascularization technique (inferior thyroid artery and bronchial artery). Seven tracheobronchial grafts were perfused ex vivo, and hemodynamic data were collected.

Sternal resection and reconstruction for primary malignant tumors.

Background: Primary malignant sternal tumors (PMST) are locally aggressive and their optimal surgical management still continues to evolve.

Methods: From 1986 to 2002, 38 patients (25 females/13 males) underwent radical resection of PMST. This series included 33 sarcomas, 17 of which had been radiation-induced, 3 hematologic tumors, and 2 carcinomas.

Sleeve lobectomy for bronchogenic cancers: factors affecting survival.

Background: Sleeve lobectomy is a parenchyma-sparing procedure that is particularly valuable in patients with cardiac or pulmonary contraindications to pneumonectomy. The purpose of this study is to report our experience with sleeve lobectomy for bronchogenic cancer and to investigate factors associated with long-term survival.

Methods: Between January 1981 and June 2001, 169 patients underwent sleeve lobectomy for non-small-cell lung cancer (n = 139) or carcinoid tumor (n = 30), including 61 with a preoperative contraindication to pneumonectomy.