초록접수 현황
| 16F-014 | 구연 발표 |
Experience of Trans-sternal Transpericardial Lung Resection in Advanced Lung Pathology
Joonsuk Park, Heesuk Jung, Dooyun lee
Department of Thoracic and Cardiovascular Surgery, CHA Bundang Medical Center, CHA University College of Medicine, Gyeonggi-do, Korea
Background : In advanced lung disease such as locally advanced lung cancer and Tb-destroyed lung, lung resection can be technically difficult and even hazardous because of difficulties in dealing with the hilar structures. By trans-sternal Transpericardial (TSTP) approach used in postpneumonectomy BPF, both pneumonectomies and left upper lobectomy could be successfully performed.
Methods : From 2013 to 2016, 6 patients had surgery via TSTP approach. The first one was for BPF closure after left VATS pneumonectomy. In 2 right pneumonectomies for Tbc destroyed lung, surgery was performed to control ongoing bleeding into previous Eloesser space in one and to control purulent sputum / to prevent contralateral lung contamination in the other. Two left pneumonectomies and 1 LULobectomy was performed in patients with locally advanced lung cancer, in which tumor was encasing the left main pulonary artery or apical trunk.
Surgery was perfomed via classic median sternotomy, pericardial tenting. Both main pulmonary artery was suficiently released before lung resection. All bronchovascular stuructures were divided intrapericardially under gentle heart traction and inotropic support. Pericardial defect was securelly reconstructed to prevent pericardial space contamination from pleural material.
Results : No operative mortality. No procedure-related significant morbidity.
In 1 patient with left pneumonectomy, brief episode of cardiac arrest occurred due to LVOTO by aortic traction to expose main bronchus. Other 2 patients with pneumonectomy had episodes of atrial fibrillation postoperatively.
One had postpneumonectomy empyema and xyphoid necrosis 45 days after right pneumonectomy for Tb destroyed lung, but no BPF, no intrapericardial infection. Despite short f/u period, no locoregional recurrence in cancer patient until now.
Conclusion : TSTP approach can be useful in advanced lung disease in which hilar approach is difficult or hazardous. Significant complication could be prevented By meticulous intraoperative management. In this short series, operative outcomes were comparable to those after conventional lung resection by open thoracotomy.
Methods : From 2013 to 2016, 6 patients had surgery via TSTP approach. The first one was for BPF closure after left VATS pneumonectomy. In 2 right pneumonectomies for Tbc destroyed lung, surgery was performed to control ongoing bleeding into previous Eloesser space in one and to control purulent sputum / to prevent contralateral lung contamination in the other. Two left pneumonectomies and 1 LULobectomy was performed in patients with locally advanced lung cancer, in which tumor was encasing the left main pulonary artery or apical trunk.
Surgery was perfomed via classic median sternotomy, pericardial tenting. Both main pulmonary artery was suficiently released before lung resection. All bronchovascular stuructures were divided intrapericardially under gentle heart traction and inotropic support. Pericardial defect was securelly reconstructed to prevent pericardial space contamination from pleural material.
Results : No operative mortality. No procedure-related significant morbidity.
In 1 patient with left pneumonectomy, brief episode of cardiac arrest occurred due to LVOTO by aortic traction to expose main bronchus. Other 2 patients with pneumonectomy had episodes of atrial fibrillation postoperatively.
One had postpneumonectomy empyema and xyphoid necrosis 45 days after right pneumonectomy for Tb destroyed lung, but no BPF, no intrapericardial infection. Despite short f/u period, no locoregional recurrence in cancer patient until now.
Conclusion : TSTP approach can be useful in advanced lung disease in which hilar approach is difficult or hazardous. Significant complication could be prevented By meticulous intraoperative management. In this short series, operative outcomes were comparable to those after conventional lung resection by open thoracotomy.
책임저자: Joonsuk Park
Department of Thoracic and Cardiovascular Surgery, CHA Bundang Medical Center, CHA University College of Medicine, Gyeonggi-do, Korea
발표자: Joonsuk Park, E-mail : parkjs@cha.ac.kr