Batıhan Güntuğ, Ceylan Kenan Can
Department of Thoracic Surgery, Kafkas University, No 30, Asik Sabri Simsekoglu st., Sehitler District, Kars, Turkey.
Izmir Faculty of Medicine, Department of Thoracic Surgery, University of Health Sciences Turkey, Izmir, Turkey.
J Cardiothorac Surg. 2024 Dec 31;19(1):696. doi: 10.1186/s13019-024-03270-0.
Intrapericardial pneumonectomy is a complex procedure indicated for large lung tumors where safe dissection of major vascular structures outside the pericardium is unfeasible or when the pericardium itself is invaded. Traditionally managed via open thoracotomy, recent advancements in VATS techniques now allow for intrapericardial pneumonectomy even in cases with extensive tumors or locally advanced disease. In this article, we detail the clinical outcomes and surgical considerations of six patients with non-small cell lung cancer who underwent VATS intrapericardial pneumonectomy. In this article, we detail the clinical outcomes and surgical considerations of six patients with non-small cell lung cancer who underwent VATS intrapericardial pneumonectomy.
This study analyzed data from 24 patients who underwent VATS pneumonectomy for non-small cell lung cancer at two thoracic surgery centers in Turkey between January 2015 and March 2024. Among them, 6 patients underwent intrapericardial pneumonectomy; 5 had left pneumonectomy, and 1 had right pneumonectomy. All patients were male, with a mean age of 72.8 years, and a mean tumor size of 6.2 cm. Pericardial invasion was observed in 5 patients. Postoperative complications included respiratory failure and septic shock in one patient, leading to death. Long-term follow-up showed one additional death due to cancer progression; four patients are alive and under routine follow-up.
VATS intrapericardial pneumonectomy offers a viable alternative to traditional open surgery for patients with large or locally advanced non-small cell lung cancer, providing enhanced visualization, reduced postoperative pain, and faster recovery. Our multi-center experience with six patients demonstrates the procedure's feasibility and safety, even in challenging cases with pericardial invasion. Despite the complexity of the surgery, the use of advanced VATS techniques and careful intraoperative assessments can lead to successful outcomes. However, given the associated risks, especially with postoperative complications, further studies with larger cohorts are needed to validate these findings and refine surgical techniques.
心包内肺切除术是一种复杂的手术，适用于无法在心包外安全解剖主要血管结构的大型肺部肿瘤，或心包本身受到侵犯的情况。传统上通过开胸手术进行治疗，如今电视辅助胸腔镜手术（VATS）技术的最新进展使得即使在肿瘤广泛或局部晚期疾病的情况下也能进行心包内肺切除术。在本文中，我们详细介绍了6例行VATS心包内肺切除术的非小细胞肺癌患者的临床结果和手术注意事项。在本文中，我们详细介绍了6例行VATS心包内肺切除术的非小细胞肺癌患者的临床结果和手术注意事项。
本研究分析了2015年1月至2024年3月期间在土耳其两个胸外科中心接受VATS非小细胞肺癌肺切除术的24例患者的数据。其中，6例患者接受了心包内肺切除术；5例行左肺切除术，1例行右肺切除术。所有患者均为男性，平均年龄72.8岁，平均肿瘤大小为6.2厘米。5例患者观察到心包侵犯。术后并发症包括1例患者出现呼吸衰竭和感染性休克，导致死亡。长期随访显示，另有1例患者因癌症进展死亡；4例患者存活并接受常规随访。
对于大型或局部晚期非小细胞肺癌患者，VATS心包内肺切除术为传统开放手术提供了一种可行的替代方案，具有更好的视野、减轻术后疼痛和更快的恢复速度。我们对6例患者的多中心经验证明了该手术的可行性和安全性，即使在有心包侵犯的具有挑战性的病例中也是如此。尽管手术复杂，但使用先进的VATS技术和仔细的术中评估可带来成功的结果。然而，鉴于相关风险，尤其是术后并发症，需要更大样本量的进一步研究来验证这些发现并完善手术技术。
