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Case Report: Uniportal Video-Assisted Thoracoscopic Parenchymal Sparing Secondary Carinal Resection and Reconstruction for the Treatment of Tracheobronchial Mucoepidermoid Carcinoma

ABSTRACT: Surgical resection is currently the mainstay of treatment for tracheobronchial mucoepidermoid carcinoma (TMEC). The parenchymal sparing secondary carinal resection and reconstruction for TMEC under the uniportal thoracoscopic approach has seldomly been reported in the literature. Here, we report a case of a 42-year-old male patient complaining of the incidental finding of a 1.5 × 1.2 cm neoplasm at the opening of the right bronchus intermedius and a 5.1 × 3.1 cm patchy lesion located at the left upper lobe by chest CT scans in February 2021. This patient successively underwent fiberoptic bronchoscopic biopsy of the bronchial neoplasm and CT-guided biopsy of the left upper lobe lesion. Pathological examination confirmed the diagnosis of the endobronchial mass in the right bronchus intermedius as low-grade mucoepidermoid carcinoma and left upper lobe lesion as tuberculosis. This patient successfully underwent uniportal thoracoscopic parenchymal sparing tumor resection, reconstruction of the secondary carina and lymphadenectomy at our center. Intraoperative frozen section showed no residual cancer at any bronchial stumps. Postoperative pathology indicated that no metastases were seen in any of the resected lymph nodes. The patient recovered well after surgery. He received a 9-month course of anti-tuberculosis treatment postoperatively. He did not complain of any special discomfort and there was no local recurrence at the 9-month postoperative follow-up. Although technical demanding, this case highlights that uniportal video-assisted thoracoscopic parenchymal sparing secondary carinal resection and reconstruction for TMEC is safe and feasible with the preservation of lung function and excellent outcomes.

SUBMITTER: Hu Y

PROVIDER: S-EPMC8803630 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Background:Cough is one of the shared complications after lung surgery. In this study, a prospective analysis was conducted for exploring the risk factors of persistent cough after uniportal video-assisted thoracoscopic pulmonary resection. Methods:One hundred thirty-five patients with pulmonary nodules who underwent surgical treatment in the same surgical group from November 2019 to January 2020 were enrolled in this prospective study. The severity of cough and its impact on patients' quality of life before and after surgery were assessed by the Mandarin Chinese version of the Leicester cough questionnaire (LCQ-MC), and postoperative cough was tested by the cough visual analog scale (VAS) and cough symptom score (CSS). Risk factors of cough after pulmonary resection (CAP) were determined by univariate and multivariate logistic regression analysis. Results:The incidence of postoperative cough was 24.4% (33 of 135 patients). Univariate analysis showed that gender (female), the surgical site (upper right), the resection (lobectomy), subcarinal lymph node dissection, postoperative acid reflux, length of hospitalization contributed to the development of CAP resection. Multivariate logistic regression analysis showed that the resection (lobectomy) (OR 3.590, 95% CI: 0.637-20.300, P=0.017), subcarinal lymph node dissection (OR 4.420, 95% CI: 1.342-14.554, P=0.001), postoperative acid reflux (OR 13.55, 95% CI: 3.186-57.633, P<0.001) and duration of anesthesia (over 153 minutes, OR 0.987, 95% CI: 0.978-0.997, P=0.011) were independent risk factors for postoperative cough. Conclusions:The application of uniportal video-assisted thoracoscopic techniques to several types of lung surgery are conducive to enhanced recovery after surgery (ERAS). Postoperative cough is related to an ocean of factors, the resection (lobectomy), subcarinal lymph node dissection, postoperative acid reflux, and duration of anesthesia (over 153 minutes) are independent high-risk factors for CAP resection. Trial registration:This study was registered on ClinicalTrials.gov (NCT04204148).

Project description:BackgroundUniportal video-assisted thoracoscopic surgery (U-VATS) has recently emerged as an alternative procedure for non-small cell lung cancer (NSCLC); however, whether U-VATS has advantages over multiportal VATS (M-VATS) remains unknown.MethodsWe performed a systematic review of two databases (Pubmed and Web of Science) to search comparative studies of U-VATS and M-VATS anatomical pulmonary resection for NSCLC. Operative time, blood loss, number of resected lymph nodes, drainage duration, length of postoperative stay, pain in postoperative day 1(POD1) and conversion rates were retrieved to estimate the comparison of outcomes. A subgroup analysis stratified by study type (propensity-matched analysis and randomized-controlled trial versus non-propensity matched analysis) was performed.ResultA total of 20 studies with 4142 patients were included in this meta-analysis. U-VATS was performed on 1869 patients, whereas the other 2173 patients underwent M-VATS. This meta-analysis showed that there was no significant difference in operative time (U-VATS: 146.48 ± 55.07 min versus M-VATS: 171.70 ± 79.40 min, P = 0.81), blood loss (74.49 ± 109.03 mL versus 95.48 ± 133.67 mL, P = 0.18), resected lymph nodes (17.28 ± 9.46 versus 18.31 ± 10.17, P = 0.62), conversion rate (6.18% versus 4.34%, P = 0.14), drainage duration (3.90 ± 2.94 days versus 4.44 ± 3.12 days, p = 0.09), length of postoperative stay (6.16 ± 4.40 days versus 6.45 ± 4.80 days, P = 0.22), and pain in POD1 (3.94 ± 1.68 versus 3.59 ± 2.76, p = 0.07). Subgroup analysis showed the value of PSM and RCT group consistency with overall value.ConclusionThis up-to-date meta-analysis shows that the perioperative outcomes of U-VATS and M-VATS anatomical pulmonary resection are equivalent. In addition, the differences in long-term outcomes of these two approaches are still unclear. Thoracic surgeons should pay more emphasize on providing high-quality and personalized surgical care for patients, to improve the survival ultimately.

Project description:Background Cross-field endotracheal intubation is typically performed during tracheal anastomosis to maintain single-lung ventilation. To minimize obstruction of the surgical field by the cross-field tube, special equipment such as high-frequency jet ventilation (HFJV) and extracorporeal membrane oxygenation (ECMO) or advanced techniques such as non-intubated ventilation have been proposed. Here, we describe a simple and practical airway management strategy that requires only conventional ventilators and techniques. Our operation is completed under uniportal video-assisted thoracoscopic surgery (VATS). Case Description We report a case of tracheal adenoid cystic carcinoma (ACC) presenting with cough with bloody sputum in a 53-year-old man. Computed tomography (CT) and flexible bronchoscopy revealed an irregular polypoid neoplasm attached to the right wall of the distal trachea, which almost completely blocked the tracheal lumen. To relieve the symptoms, transbronchoscopic resection of the tumor, followed by curative resection via uniportal VATS under general anesthesia was performed. To maintain single-lung ventilation during tracheal reconstruction, we took advantage of a thin suction tube [internal diameter (ID) 3 mm; external diameter (ED) 4 mm], which was connected to a conventional ventilator. Specifically, by introducing the suction tube into the distal left main bronchus through the endotracheal tube and blowing 100% oxygen, we achieved satisfactory oxygenation throughout the anastomotic process; and the blood CO2 partial pressure was also acceptable. The view of the anastomotic site was far less obstructed owing to the small diameter of the suction tube, and the anastomotic process was smooth and accurate. Postoperative recovery was good, and no stenosis of the reconstructed trachea was observed at the 3-month follow-up. Conclusions Our technique proves to be safe and feasible for selected patients with tracheal tumors, and can be a practical choice for medical centers that are not equipped with HFJV or ECMO.

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Case Report: Uniportal Video-Assisted Thoracoscopic Parenchymal Sparing Secondary Carinal Resection and Reconstruction for the Treatment of Tracheobronchial Mucoepidermoid Carcinoma

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