Background: Chronic empyema thoracis is a debilitating illness with high morbidity and mortality, and is seen among all age groups in Nigeria. Objective: To review all cases of chronic empyema thoracis treated by pleu...Background: Chronic empyema thoracis is a debilitating illness with high morbidity and mortality, and is seen among all age groups in Nigeria. Objective: To review all cases of chronic empyema thoracis treated by pleurectomy and lung decortication and highlight the indications, challenges and the outcome. Materials and Method: In a 10-year period spanning 2007-2016, 90 patients with chronic empyema thoracis were admitted and managed in our institution. A retrospective study of 36 patients who underwent surgery was performed. Results: Ten patients (27.80%) out of 36 patients had unsuccessful one month closed chest tube drainage (CTTD). Six patients (16.67%) were referred from peripheral hospitals as chronic empyema thoracis that had failed CTTD. The remainder, 20 (55.60%) were diagnosed as chronic empyema thoracis de novo. Conclusion: Chronic empyema thoracis is a very difficult disease to manage especially in developing countries like ours, where patients present very late and the requisite facilities are inadequate.展开更多
Spontaneous pneumothorax, primary or secondary, is a common medical emergency for which specific indications for surgical intervention are well defined in selected patients. The traditional surgical approach has been ...Spontaneous pneumothorax, primary or secondary, is a common medical emergency for which specific indications for surgical intervention are well defined in selected patients. The traditional surgical approach has been by limited thoracotomy using axillary or posterolateral incision. With the advent of video-assisted minimally invasive technique in the last 20 years the traditional approach is infrequently used. The definitive operation to prevent recurrent pneumothorax by surgical approach requires bullectomy and parietal pleurectomy. The recurrence rate after the traditional open surgical approach has been low at <2%. On the other hand, video-assisted thoracoscopic surgery, although better tolerated has a higher recurrence rate at 5% [1]. Information on post-operative morbidity and mortality are lacking. For this reason, we have reviewed our experience at one institution on the outcome of the VATS approach. We found that prolonged post- operative air leak is the most common complication and cigarette smoking remains an important associated factor.展开更多
Malignant pleural mesothelioma(MPM)is a primary solid malignancy related to inhalational asbestos exposure.Despite advances in therapy,MPM remains challenging to treat with a post-treatment survival of only 15%at 5-ye...Malignant pleural mesothelioma(MPM)is a primary solid malignancy related to inhalational asbestos exposure.Despite advances in therapy,MPM remains challenging to treat with a post-treatment survival of only 15%at 5-year.In recent years,extra-pleural pneumonectomy has decreased in popularity due to a high morbidity rate and mortality compared to pleurectomy/decortication and other therapeutic alternatives.In this review,we will discuss both procedures,outcomes,ongoing studies,and the roles of surgery in the future treatment of this disease.展开更多
Background and Objective:Pleural mesothelioma is an aggressive disease with poor prognosis due to the tendency to relapse.Despite the lack of uniform protocols of therapy,surgery remains the cornerstone of multimodal ...Background and Objective:Pleural mesothelioma is an aggressive disease with poor prognosis due to the tendency to relapse.Despite the lack of uniform protocols of therapy,surgery remains the cornerstone of multimodal treatment.Nevertheless,the debate on which is the optimal choice for surgical-based approach lasts over time and is based over the oncological benefits of obtaining a theoretical greater radicality rather than preserving the anatomical integrity in view of further treatments.This review is intended to summarize the topics of this dispute still ongoing.Methods:A review on the PubMed/Medline literature database of the different surgical approach was carried out,screening all the publications in English from 2000 to 2021.The search strategy has been focused on comparative studies of surgical techniques to understand if and how the choice of the type of surgery to be offered in the forefront has changed over the years.Key Content and Findings:Within the multimodal strategy the goal of surgery,performed with radical intent,is to achieve the macroscopic complete removal.Two procedures are aimed to this purpose:the lung-sacrificing surgery as the extrapleural pneumonectomy and the lung-sparing surgery as the pleurectomy/decortication extended or not to resection/reconstruction of diaphragm and pericardium.Many centers today have abandoned the most radical procedure in favor of the most conservative,but the superiority of one technique over the other remains controversial.Conclusions:In the absence of comparative randomized trials,the choice of surgical technique is determined by the experience of individual centers and by the attitude of surgeons.Further research is needed to standardize treatment protocols and to define the role of surgery in the context of multimodal therapy.展开更多
文摘Background: Chronic empyema thoracis is a debilitating illness with high morbidity and mortality, and is seen among all age groups in Nigeria. Objective: To review all cases of chronic empyema thoracis treated by pleurectomy and lung decortication and highlight the indications, challenges and the outcome. Materials and Method: In a 10-year period spanning 2007-2016, 90 patients with chronic empyema thoracis were admitted and managed in our institution. A retrospective study of 36 patients who underwent surgery was performed. Results: Ten patients (27.80%) out of 36 patients had unsuccessful one month closed chest tube drainage (CTTD). Six patients (16.67%) were referred from peripheral hospitals as chronic empyema thoracis that had failed CTTD. The remainder, 20 (55.60%) were diagnosed as chronic empyema thoracis de novo. Conclusion: Chronic empyema thoracis is a very difficult disease to manage especially in developing countries like ours, where patients present very late and the requisite facilities are inadequate.
文摘Spontaneous pneumothorax, primary or secondary, is a common medical emergency for which specific indications for surgical intervention are well defined in selected patients. The traditional surgical approach has been by limited thoracotomy using axillary or posterolateral incision. With the advent of video-assisted minimally invasive technique in the last 20 years the traditional approach is infrequently used. The definitive operation to prevent recurrent pneumothorax by surgical approach requires bullectomy and parietal pleurectomy. The recurrence rate after the traditional open surgical approach has been low at <2%. On the other hand, video-assisted thoracoscopic surgery, although better tolerated has a higher recurrence rate at 5% [1]. Information on post-operative morbidity and mortality are lacking. For this reason, we have reviewed our experience at one institution on the outcome of the VATS approach. We found that prolonged post- operative air leak is the most common complication and cigarette smoking remains an important associated factor.
文摘Malignant pleural mesothelioma(MPM)is a primary solid malignancy related to inhalational asbestos exposure.Despite advances in therapy,MPM remains challenging to treat with a post-treatment survival of only 15%at 5-year.In recent years,extra-pleural pneumonectomy has decreased in popularity due to a high morbidity rate and mortality compared to pleurectomy/decortication and other therapeutic alternatives.In this review,we will discuss both procedures,outcomes,ongoing studies,and the roles of surgery in the future treatment of this disease.
文摘Background and Objective:Pleural mesothelioma is an aggressive disease with poor prognosis due to the tendency to relapse.Despite the lack of uniform protocols of therapy,surgery remains the cornerstone of multimodal treatment.Nevertheless,the debate on which is the optimal choice for surgical-based approach lasts over time and is based over the oncological benefits of obtaining a theoretical greater radicality rather than preserving the anatomical integrity in view of further treatments.This review is intended to summarize the topics of this dispute still ongoing.Methods:A review on the PubMed/Medline literature database of the different surgical approach was carried out,screening all the publications in English from 2000 to 2021.The search strategy has been focused on comparative studies of surgical techniques to understand if and how the choice of the type of surgery to be offered in the forefront has changed over the years.Key Content and Findings:Within the multimodal strategy the goal of surgery,performed with radical intent,is to achieve the macroscopic complete removal.Two procedures are aimed to this purpose:the lung-sacrificing surgery as the extrapleural pneumonectomy and the lung-sparing surgery as the pleurectomy/decortication extended or not to resection/reconstruction of diaphragm and pericardium.Many centers today have abandoned the most radical procedure in favor of the most conservative,but the superiority of one technique over the other remains controversial.Conclusions:In the absence of comparative randomized trials,the choice of surgical technique is determined by the experience of individual centers and by the attitude of surgeons.Further research is needed to standardize treatment protocols and to define the role of surgery in the context of multimodal therapy.
