- Email: [email protected]
P3.04-044 Surgical Management of Arteriovenous Malformations: Our Experience
S1410
dissection, with the latissimus dorsi and serratus anterior muscles were protected, no rib cut needed. Case 1: right lower lobe lobectomy was performed first, frozen pathological diagnosis: inflammatory lesion with pneumocyte dysplasia, locally with hemangioma-like lesion. Wedge resection was performed to remove the nodule at right middle lobe. Postoperative pathology: both tumors were sclerosing hemangioma of the lung (Aug 2012). Case 2: enucleation was performed, frozen pathological diagnosis: sclerosing hemangioma of the lung, malignancy should be excluded by later paraffin slides staining. Right upper lobe lobectomy with mediastinal lymph node dissection was performed. Postoperative pathology: sclerosing hemangioma of the lung, no lymph node metastasis (Nov 2012). Both patients recovered much better and more quickly than other patients who underwent TSPT in the same ward at that time. Regular follow-up: both are alive healthily in their 4th year postoperatively, no recurrence and metastasis. No adjuvant treatment was used. Conclusion: Multiple sclerosing pneumocytomas are rare. For sclerosing pneumocytoma, surgical resection is of first choice. Limited resection should be enough and reasonable for this kind of benign tumor, however, lobectomy becomes essential once the tumor size is too big, further, mediastinal lymph node dissection is to be performed when malignancy is suspected. miMRST, is minimally invasive thoracic surgery, with no need to use expensive thoracoscopic devices, is very suitable for lung surgery in developing countries. (This study was partly supported by Science Foundation of Shenyang City, China, No. F16-206-9-05). Keywords: sclerosing hemangioma of the lung, Minimally Invasive Small Incision, Muscle- and Rib-Sparing Thoracotomy, sclerosing pneumocytoma
P3.04-044 Surgical Management of Arteriovenous Malformations: Our Experience Topic: Miscellaneous II Fadil Gradica,1 Lutfi Lisha,2 Dhimitraq Argjiri,3 Flora Gradica,4 Valbona Rexha,5 Alma Cani,6 Fahri Kokici,6 Saudin Maliqi,7 Shqiptar Demaci,7 Agron Poniku,7 Safet Beqiri8 1Thorax Surgery, University Hospital Shefqet Ndroqi, Tirana/Albania, 2 Thorax Surgery, University Hospital’Shefqet Ndroqi”, Al/ Albania, 3Pneumology, University Hospital’Shefqet Ndroqi”, Al/Albania, 4Pharmacy, Public Pharmacy Service, Tirana/Albania, 5Pharmacy Service, Public Pharmacy Service, Tirane/Albania, 6Anestesie Reanimation,
Journal of Thoracic Oncology
Vol. 12 No. 1S
University Hospital’Shefqet Ndroqi”, Al/Albania, 7Thorax Surgery, University Hospital Center “prishtine I”, Ko/ Kosovo, 8Thoracic Surgery, Thoracic Surgery Department Kirckhof Hospital., Gr/Germany Background: Pulmonary arteriovenous malformations are rare lesions with significant clinical complications. These lesions are commonly seen in patients with hereditary hemorrhagic telangiectasia (formerly OslerWeber-Rendu syndrome). Formerly called Osler-WeberRendu, HHT is an inherited disorder of the vasculature associated with AVMs and telangiectasias. Diagnosis of HHT is based upon the presence or absence of four specific clinical criteria often referred to as the Curacao criteria. three criteria are present, the diagnosis is definite. If two criteria are present, the diagnosis of HHT is probable. If less than two criteria are present, the diagnosis is unlikely. Management of arteriovenous malformations (AVMs) remains challenging because of their unpredictable behavior and with high risk mortality. The purpose of this study was to review our surgical experience with surgical to manage arteriovenous malformations (AVMs). Methods: We diagnosed and treated a total of 11 patients with pulmonary arteriovenous malformation (PAVMs).They have been admitted to the clinic with massive hemoptysis. Unknown initially diagnose .All patients are presented to hospital urgently with such clinical signs, epistaxis, cough, hemostasis, weakness, sweat, fever, dyspnea, thoracic malaise and, massive right hemothorax. But 3 patients with clinical signs of hemorrhagic shock with massive hemoptisi, tachycardia, weak pulse, hypotension, severe anemia. In one patient was presented with massive hemothorax dexter et hypovolemiv shock. She was treated with right pleural drainage (average 2000ml)and intensive therapy et hemotransfusion (8 flacons). All patients are treated initially with intensive therapy and hemotransfuzion and after that with hemodynamic parameters stable were treated with surgery. Pacients were completed with all the necessary of emergency examinations as thoracic radiography, biochemical examinations, CT scaner toracal, MRI, Bronchoscopy, EKG, cardiac echo and cateterisation, gaseous exchange. Pulmonary angiography was performed in 8 patients. All patients were treated by surgical approach. Embolo/sclerotherapy was not definitive choice. Results: Arteriovenous malformation size ranged from 3.5 cm, on average (1-5 cm) and right lung location in seven patients, right lower lobe in 4 patients, middle lobe 1 patient, right upper lobe 2 patients. Location on left lung in 4 patients. In left upper lobe in one patient and left lower lobe in 3 patients. They were treated by
January 2017
lobectomy in 5 patients, anatomical segmentectomy in 3 patients, wedge resection in 3 patients. Morbidity 2 % and mortality in one patient Conclusion: Diagnosis and management of AVMs by surgical therapy resection was with very good results and with limited morbidity and low mortality and no recurrence during early follow-up. Keywords: Pulmonary arteriovenous malformation (PAVMs), hemorrhage hereditare telangiectasia, lung resection
Abstracts
S1411
survival is poor, suggesting that lung cancers present as pneumothorax at an advanced stage of disease. Keywords: chest X-ray, lung cancer, Pneumothorax
P3.04-046 Cases of Surgical Resection of PostOperative Lymph Node Recurrences from Primary Lung Cancer Topic: Miscellaneous II
P3.04-045 Primary Lung Cancer Presenting as Pneumothorax Topic: Miscellaneous II Fadil Gradica,1 Lutfi Lisha,2 Flora Gradica,3 Dhimitraq Argjiri,4 Valbona Rexha,3 Sali Gradica,3 Alma Cani,5 Fahri Kokici,5 Perlat Kapisyzi,4 Elton Bollano6 1Thorax Surgery, University Hospital Shefqet Ndroqi, Tirana/Albania, 2Thorax Surgery, University Hospital’Shefqet Ndroqi”, Al/Albania, 3 Pharmacy Service, Public Pharmacy Service, Tirane/ Albania, 4Pneumology, University Hospital’Shefqet Ndroqi”, Al/Albania, 5Anestesie Reanimation, University Hospital’Shefqet Ndroqi”, Al/Albania, 6Visceral Surgery, University Hospital Center “mother Theresa”, Tirane/ Albania Background: Analysis of our patients with primary lung cancer presenting as pneumothorax. Methods: Between 2010 -2015 we treated in our clinic among 338 adults (258 men and 80 women) presenting with spontaneous pneumothorax, there were nine men and two woman with lung cancer: Seven squamous cell carcinoma, three adenocarcinoma and one oat cell carcinoma. Pneumothorax led to the diagnosis in 11 cases and the remaining occurred as a complication of known neoplastic disease. The average age was 60 years from (32-72 years old). Results: We analyze these 11 cases treated in our hospital. In patients with normal chest x-ray film findings after lung expansion, further investigation for neoplastic disease is not justified. But we need to perform and chest CT and other investigation in patients with, heavy smoking, chronic bronchitis, bullous emphysema and incomplete lung expansion after chest drainage also patients with age over 50 years old. Conclusion: The occurrence of a pneumothorax in patients with lung cancer, worsening prognosis. Five-year
Ema Mitsui,1 Masafumi Kataoka,1 Daisuke Okutani,1 Haruyuki Kawai,2 Kazuhiko Watanabe,2 Toshinori Ohara1 1Surgery, Okayama Saiseikai General Hospital, Okayama/Japan, 2Internal Medicine, Okayama Saiseikai General Hospital, Okayama/Japan Background: The prognosis of patients with recurrent nodal metastasis after resection of primary lung cancer is poor, and surgical resection is not indicated for patients with lymph node (LN) disease beyond N3. Recently, some reports showed the efficacy of surgical resection of the small number of distant metastases (oligometastasis). In our hospital, we had 7 cases of nodal metastasis resection after primary lung cancer resection. The purpose of this study was to discuss the possibility of improving prognosis by resection of nodal recurrence. Methods: From 2007 to 2013, we examined 7 patients for whom lymphadenectomy was performed to treat lymph nodal recurrence following curative resection of the primary cancer at our hospital. The mean age was 58 years (45-73 years); there were 2 female and 5 male patients. At the initial operation, there was 1 case of stageIIA, 1 case of stageIIB, 4 cases of stageIIIA, 1 case of stageIIIB cancer. Pathologically, there were 3 adenocarcinoma cases, 3 squamous cell carcinoma cases, and 1 adenosquamous carcinoma case. All patients underwent postoperative adjuvant chemotherapy, and 4 patients underwent postoperative radiotherapy for residual or recurrent tumors. Results: All 7 patients underwent lymphadenectomy;3 had supraclavicular recurrent LN and 4 had mediastinal recurrent LN. In 2 of the supraclavicular cases and 1 of the mediastinal cases, the patients are alive without any recurrence. In the other four cases, the patients showed re-recurrence, received chemotherapy, and are alive. The median survival time from the day of recurrent lymphadenectomy was 32 months (27-62 months) and that from the day of the initial operation was 76 months (36101 months). The median disease-free survival time
dissection, with the latissimus dorsi and serratus anterior muscles were protected, no rib cut needed. Case 1: right lower lobe lobectomy was performed first, frozen pathological diagnosis: inflammatory lesion with pneumocyte dysplasia, locally with hemangioma-like lesion. Wedge resection was performed to remove the nodule at right middle lobe. Postoperative pathology: both tumors were sclerosing hemangioma of the lung (Aug 2012). Case 2: enucleation was performed, frozen pathological diagnosis: sclerosing hemangioma of the lung, malignancy should be excluded by later paraffin slides staining. Right upper lobe lobectomy with mediastinal lymph node dissection was performed. Postoperative pathology: sclerosing hemangioma of the lung, no lymph node metastasis (Nov 2012). Both patients recovered much better and more quickly than other patients who underwent TSPT in the same ward at that time. Regular follow-up: both are alive healthily in their 4th year postoperatively, no recurrence and metastasis. No adjuvant treatment was used. Conclusion: Multiple sclerosing pneumocytomas are rare. For sclerosing pneumocytoma, surgical resection is of first choice. Limited resection should be enough and reasonable for this kind of benign tumor, however, lobectomy becomes essential once the tumor size is too big, further, mediastinal lymph node dissection is to be performed when malignancy is suspected. miMRST, is minimally invasive thoracic surgery, with no need to use expensive thoracoscopic devices, is very suitable for lung surgery in developing countries. (This study was partly supported by Science Foundation of Shenyang City, China, No. F16-206-9-05). Keywords: sclerosing hemangioma of the lung, Minimally Invasive Small Incision, Muscle- and Rib-Sparing Thoracotomy, sclerosing pneumocytoma
P3.04-044 Surgical Management of Arteriovenous Malformations: Our Experience Topic: Miscellaneous II Fadil Gradica,1 Lutfi Lisha,2 Dhimitraq Argjiri,3 Flora Gradica,4 Valbona Rexha,5 Alma Cani,6 Fahri Kokici,6 Saudin Maliqi,7 Shqiptar Demaci,7 Agron Poniku,7 Safet Beqiri8 1Thorax Surgery, University Hospital Shefqet Ndroqi, Tirana/Albania, 2 Thorax Surgery, University Hospital’Shefqet Ndroqi”, Al/ Albania, 3Pneumology, University Hospital’Shefqet Ndroqi”, Al/Albania, 4Pharmacy, Public Pharmacy Service, Tirana/Albania, 5Pharmacy Service, Public Pharmacy Service, Tirane/Albania, 6Anestesie Reanimation,
Journal of Thoracic Oncology
Vol. 12 No. 1S
University Hospital’Shefqet Ndroqi”, Al/Albania, 7Thorax Surgery, University Hospital Center “prishtine I”, Ko/ Kosovo, 8Thoracic Surgery, Thoracic Surgery Department Kirckhof Hospital., Gr/Germany Background: Pulmonary arteriovenous malformations are rare lesions with significant clinical complications. These lesions are commonly seen in patients with hereditary hemorrhagic telangiectasia (formerly OslerWeber-Rendu syndrome). Formerly called Osler-WeberRendu, HHT is an inherited disorder of the vasculature associated with AVMs and telangiectasias. Diagnosis of HHT is based upon the presence or absence of four specific clinical criteria often referred to as the Curacao criteria. three criteria are present, the diagnosis is definite. If two criteria are present, the diagnosis of HHT is probable. If less than two criteria are present, the diagnosis is unlikely. Management of arteriovenous malformations (AVMs) remains challenging because of their unpredictable behavior and with high risk mortality. The purpose of this study was to review our surgical experience with surgical to manage arteriovenous malformations (AVMs). Methods: We diagnosed and treated a total of 11 patients with pulmonary arteriovenous malformation (PAVMs).They have been admitted to the clinic with massive hemoptysis. Unknown initially diagnose .All patients are presented to hospital urgently with such clinical signs, epistaxis, cough, hemostasis, weakness, sweat, fever, dyspnea, thoracic malaise and, massive right hemothorax. But 3 patients with clinical signs of hemorrhagic shock with massive hemoptisi, tachycardia, weak pulse, hypotension, severe anemia. In one patient was presented with massive hemothorax dexter et hypovolemiv shock. She was treated with right pleural drainage (average 2000ml)and intensive therapy et hemotransfusion (8 flacons). All patients are treated initially with intensive therapy and hemotransfuzion and after that with hemodynamic parameters stable were treated with surgery. Pacients were completed with all the necessary of emergency examinations as thoracic radiography, biochemical examinations, CT scaner toracal, MRI, Bronchoscopy, EKG, cardiac echo and cateterisation, gaseous exchange. Pulmonary angiography was performed in 8 patients. All patients were treated by surgical approach. Embolo/sclerotherapy was not definitive choice. Results: Arteriovenous malformation size ranged from 3.5 cm, on average (1-5 cm) and right lung location in seven patients, right lower lobe in 4 patients, middle lobe 1 patient, right upper lobe 2 patients. Location on left lung in 4 patients. In left upper lobe in one patient and left lower lobe in 3 patients. They were treated by
January 2017
lobectomy in 5 patients, anatomical segmentectomy in 3 patients, wedge resection in 3 patients. Morbidity 2 % and mortality in one patient Conclusion: Diagnosis and management of AVMs by surgical therapy resection was with very good results and with limited morbidity and low mortality and no recurrence during early follow-up. Keywords: Pulmonary arteriovenous malformation (PAVMs), hemorrhage hereditare telangiectasia, lung resection
Abstracts
S1411
survival is poor, suggesting that lung cancers present as pneumothorax at an advanced stage of disease. Keywords: chest X-ray, lung cancer, Pneumothorax
P3.04-046 Cases of Surgical Resection of PostOperative Lymph Node Recurrences from Primary Lung Cancer Topic: Miscellaneous II
P3.04-045 Primary Lung Cancer Presenting as Pneumothorax Topic: Miscellaneous II Fadil Gradica,1 Lutfi Lisha,2 Flora Gradica,3 Dhimitraq Argjiri,4 Valbona Rexha,3 Sali Gradica,3 Alma Cani,5 Fahri Kokici,5 Perlat Kapisyzi,4 Elton Bollano6 1Thorax Surgery, University Hospital Shefqet Ndroqi, Tirana/Albania, 2Thorax Surgery, University Hospital’Shefqet Ndroqi”, Al/Albania, 3 Pharmacy Service, Public Pharmacy Service, Tirane/ Albania, 4Pneumology, University Hospital’Shefqet Ndroqi”, Al/Albania, 5Anestesie Reanimation, University Hospital’Shefqet Ndroqi”, Al/Albania, 6Visceral Surgery, University Hospital Center “mother Theresa”, Tirane/ Albania Background: Analysis of our patients with primary lung cancer presenting as pneumothorax. Methods: Between 2010 -2015 we treated in our clinic among 338 adults (258 men and 80 women) presenting with spontaneous pneumothorax, there were nine men and two woman with lung cancer: Seven squamous cell carcinoma, three adenocarcinoma and one oat cell carcinoma. Pneumothorax led to the diagnosis in 11 cases and the remaining occurred as a complication of known neoplastic disease. The average age was 60 years from (32-72 years old). Results: We analyze these 11 cases treated in our hospital. In patients with normal chest x-ray film findings after lung expansion, further investigation for neoplastic disease is not justified. But we need to perform and chest CT and other investigation in patients with, heavy smoking, chronic bronchitis, bullous emphysema and incomplete lung expansion after chest drainage also patients with age over 50 years old. Conclusion: The occurrence of a pneumothorax in patients with lung cancer, worsening prognosis. Five-year
Ema Mitsui,1 Masafumi Kataoka,1 Daisuke Okutani,1 Haruyuki Kawai,2 Kazuhiko Watanabe,2 Toshinori Ohara1 1Surgery, Okayama Saiseikai General Hospital, Okayama/Japan, 2Internal Medicine, Okayama Saiseikai General Hospital, Okayama/Japan Background: The prognosis of patients with recurrent nodal metastasis after resection of primary lung cancer is poor, and surgical resection is not indicated for patients with lymph node (LN) disease beyond N3. Recently, some reports showed the efficacy of surgical resection of the small number of distant metastases (oligometastasis). In our hospital, we had 7 cases of nodal metastasis resection after primary lung cancer resection. The purpose of this study was to discuss the possibility of improving prognosis by resection of nodal recurrence. Methods: From 2007 to 2013, we examined 7 patients for whom lymphadenectomy was performed to treat lymph nodal recurrence following curative resection of the primary cancer at our hospital. The mean age was 58 years (45-73 years); there were 2 female and 5 male patients. At the initial operation, there was 1 case of stageIIA, 1 case of stageIIB, 4 cases of stageIIIA, 1 case of stageIIIB cancer. Pathologically, there were 3 adenocarcinoma cases, 3 squamous cell carcinoma cases, and 1 adenosquamous carcinoma case. All patients underwent postoperative adjuvant chemotherapy, and 4 patients underwent postoperative radiotherapy for residual or recurrent tumors. Results: All 7 patients underwent lymphadenectomy;3 had supraclavicular recurrent LN and 4 had mediastinal recurrent LN. In 2 of the supraclavicular cases and 1 of the mediastinal cases, the patients are alive without any recurrence. In the other four cases, the patients showed re-recurrence, received chemotherapy, and are alive. The median survival time from the day of recurrent lymphadenectomy was 32 months (27-62 months) and that from the day of the initial operation was 76 months (36101 months). The median disease-free survival time