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Chest Wall Resection and Reconstruction – A 13-Year Experience
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Abstracts
Purpose: Our study is designed to examine the functional performance and cellular protection of porcine donor hearts preserved using 3 different cardioplegic solutions - St. Thomas’, Custodiol and Adenocaine. Methodology: Donor hearts will be procured using one of the three solutions under investigation. They will be kept in cold static storage for 10 hours and then reanimated. Cardiac performance will be assessed functionally on a purpose-built rig and cellular outcomes measured by examining activation of a common death pathway via the mitochondrial permeability transition pore. The ability of solutions to activate Survivor Activating Factor Enhancement (SAFE) and Reperfusion Injury Salvage Kinase (RISK) prosurvival pathways is also assessed. Results: This study is still ongoing. To date we have designed and tested our rig, developed a reliable setup with automated data capture on pump flow and haemodynamics. We have developed a cell isolation technique to deliver a high yield of live, disaggregated and calcium tolerant myocytes which can then be subjected to flow cytometry to determine mitochondrial permeability status as well as SAFE and RISK pathway activation. We are currently engaged in the live experimental phase of the project. Conclusion: We hope to have the project completed in the next 12 months. http://dx.doi.org/10.1016/j.hlc.2015.12.020 SCIENTIFIC SESSION 9: SURGERY OF THE MEDIASTINUM AND CHEST WALL 18th Nov (WED) 11:40 - 11:50 Chest Wall Resection and Reconstruction – A 13-Year Experience Niamh Keenan *, Sofia Kassou, Phillip Antippa Royal Melbourne Hospital, Melbourne, VIC, Australia Introduction: Despite major advances in surgical techniques and peri-operative care, chest wall resection and reconstruction remains a significant challenge, both for the patient and the surgeon. Even in large volume centres in the US, the number of cases annually is relatively few. The aim of this study was to provide a contemporary review of surgical experience with chest wall resection and reconstruction in a tertiary referral centre in Australia. Methods: We conducted a database review of all patients undergoing chest wall resection and reconstruction from January 2002 to June 2015. All patients undergoing at least one rib resection were included. Data on patient demographics and surgical procedure was reviewed. Results: During this time, 33 patients underwent 34 procedures. The mean age at time of surgery was 56(range 1982); and the majority of patients were male(64%). Indications for surgery were as follows: lung tumour 18(55%); primary chest wall tumour 4(12%); metastasis 3(9%); thoracic outlet syndrome 2(6%); breast cancer 1(3%); miscellaneous 6(18%). The number of ribs resected ranged from 1 to 4; with defects up to 20cms. Concomitant lung resection was performed in
19 patients. 12 of the defects were closed primarily; 18 were closed with prosthetic material and 3 had autologous cover. Conclusion: Chest wall resection and reconstruction remains a significant undertaking. However, the evolution of surgical techniques and novel prostheses have led to increased feasibility and improved outcomes in these complex cases. Further study is ongoing looking at morbidity and long-term functional outcomes in our patient group. http://dx.doi.org/10.1016/j.hlc.2015.12.021 SCIENTIFIC SESSION 9: SURGERY OF THE MEDIASTINUM AND CHEST WALL 18th Nov (WED) 11:50 - 12:00 Perioperative Analgesia Usage in Major Thoracic Resection Chin Leng Poh *, Ashleigh Xie, Clare Brown, Andy Wang, Tristan D. Yan Royal Prince Alfred Hospital, Sydney, NSW, Australia Purpose: To evaluate efficacy of perioperative pain management in patients undergoing lobectomies via thoracotomy or thoracoscopic approach. Methodology: Between February 2014 to June 2015, 100 consecutive patients undergoing major lung resections (lobectomy or pneumonectomy) utilised our recently devised perioperative analgesia protocol in one centre. Perioperative analgesia consisted of 0.2% Ropivacaine via regional catheter infusion (RCI) at 0.2 ml/kg/hr, Fentanyl via patient controlled analgesia (PCA) and breakthrough oral opioids. The same analgesia protocol was utilised for both VATS and thoracotomy patients. Their numerical pain score (010) were documented on postoperative day 0 and day 7. Results: Of the 100 patients, there were 64 patients who underwent video-assisted thoracoscopic surgery (VATS) lobectomies. Thirty-six patients had open thoracotomy. Pain score at day 0 was significantly lower for VATS patients at 2 vs 7 (p<0.001) but similar by day 7 (5 vs 6). Patients who received VATS surgery required shorter duration (36.5 vs 46 hours) and lower total dose of PCA (1160 vs 1843 mg fentanyl) throughout admission. Duration of RCI required appeared to be shorter in VATS patients (31 versus 40 hours). Breakthrough Endone requirements were lower in VATS patients (105 versus 182 mg). Patients who underwent VATS had shorter chest drain duration (2 vs 4.5 days; p=0.004) and hospitalisation (4 vs 7 days; p<0.001). Conclusion: Our perioperative analgesia protocol is feasible for patients undergoing major lung resections via either VATS or open thoracotomy approach. Patients who underwent VATS required lower dosage and shorter duration of perioperative analgesia and had improved perioperative outcomes. http://dx.doi.org/10.1016/j.hlc.2015.12.022
Abstracts
Purpose: Our study is designed to examine the functional performance and cellular protection of porcine donor hearts preserved using 3 different cardioplegic solutions - St. Thomas’, Custodiol and Adenocaine. Methodology: Donor hearts will be procured using one of the three solutions under investigation. They will be kept in cold static storage for 10 hours and then reanimated. Cardiac performance will be assessed functionally on a purpose-built rig and cellular outcomes measured by examining activation of a common death pathway via the mitochondrial permeability transition pore. The ability of solutions to activate Survivor Activating Factor Enhancement (SAFE) and Reperfusion Injury Salvage Kinase (RISK) prosurvival pathways is also assessed. Results: This study is still ongoing. To date we have designed and tested our rig, developed a reliable setup with automated data capture on pump flow and haemodynamics. We have developed a cell isolation technique to deliver a high yield of live, disaggregated and calcium tolerant myocytes which can then be subjected to flow cytometry to determine mitochondrial permeability status as well as SAFE and RISK pathway activation. We are currently engaged in the live experimental phase of the project. Conclusion: We hope to have the project completed in the next 12 months. http://dx.doi.org/10.1016/j.hlc.2015.12.020 SCIENTIFIC SESSION 9: SURGERY OF THE MEDIASTINUM AND CHEST WALL 18th Nov (WED) 11:40 - 11:50 Chest Wall Resection and Reconstruction – A 13-Year Experience Niamh Keenan *, Sofia Kassou, Phillip Antippa Royal Melbourne Hospital, Melbourne, VIC, Australia Introduction: Despite major advances in surgical techniques and peri-operative care, chest wall resection and reconstruction remains a significant challenge, both for the patient and the surgeon. Even in large volume centres in the US, the number of cases annually is relatively few. The aim of this study was to provide a contemporary review of surgical experience with chest wall resection and reconstruction in a tertiary referral centre in Australia. Methods: We conducted a database review of all patients undergoing chest wall resection and reconstruction from January 2002 to June 2015. All patients undergoing at least one rib resection were included. Data on patient demographics and surgical procedure was reviewed. Results: During this time, 33 patients underwent 34 procedures. The mean age at time of surgery was 56(range 1982); and the majority of patients were male(64%). Indications for surgery were as follows: lung tumour 18(55%); primary chest wall tumour 4(12%); metastasis 3(9%); thoracic outlet syndrome 2(6%); breast cancer 1(3%); miscellaneous 6(18%). The number of ribs resected ranged from 1 to 4; with defects up to 20cms. Concomitant lung resection was performed in
19 patients. 12 of the defects were closed primarily; 18 were closed with prosthetic material and 3 had autologous cover. Conclusion: Chest wall resection and reconstruction remains a significant undertaking. However, the evolution of surgical techniques and novel prostheses have led to increased feasibility and improved outcomes in these complex cases. Further study is ongoing looking at morbidity and long-term functional outcomes in our patient group. http://dx.doi.org/10.1016/j.hlc.2015.12.021 SCIENTIFIC SESSION 9: SURGERY OF THE MEDIASTINUM AND CHEST WALL 18th Nov (WED) 11:50 - 12:00 Perioperative Analgesia Usage in Major Thoracic Resection Chin Leng Poh *, Ashleigh Xie, Clare Brown, Andy Wang, Tristan D. Yan Royal Prince Alfred Hospital, Sydney, NSW, Australia Purpose: To evaluate efficacy of perioperative pain management in patients undergoing lobectomies via thoracotomy or thoracoscopic approach. Methodology: Between February 2014 to June 2015, 100 consecutive patients undergoing major lung resections (lobectomy or pneumonectomy) utilised our recently devised perioperative analgesia protocol in one centre. Perioperative analgesia consisted of 0.2% Ropivacaine via regional catheter infusion (RCI) at 0.2 ml/kg/hr, Fentanyl via patient controlled analgesia (PCA) and breakthrough oral opioids. The same analgesia protocol was utilised for both VATS and thoracotomy patients. Their numerical pain score (010) were documented on postoperative day 0 and day 7. Results: Of the 100 patients, there were 64 patients who underwent video-assisted thoracoscopic surgery (VATS) lobectomies. Thirty-six patients had open thoracotomy. Pain score at day 0 was significantly lower for VATS patients at 2 vs 7 (p<0.001) but similar by day 7 (5 vs 6). Patients who received VATS surgery required shorter duration (36.5 vs 46 hours) and lower total dose of PCA (1160 vs 1843 mg fentanyl) throughout admission. Duration of RCI required appeared to be shorter in VATS patients (31 versus 40 hours). Breakthrough Endone requirements were lower in VATS patients (105 versus 182 mg). Patients who underwent VATS had shorter chest drain duration (2 vs 4.5 days; p=0.004) and hospitalisation (4 vs 7 days; p<0.001). Conclusion: Our perioperative analgesia protocol is feasible for patients undergoing major lung resections via either VATS or open thoracotomy approach. Patients who underwent VATS required lower dosage and shorter duration of perioperative analgesia and had improved perioperative outcomes. http://dx.doi.org/10.1016/j.hlc.2015.12.022