Adult pulmonary intralobar sequestrations: changes in the surgical management

Abstract

Background: Until now, the traditional procedure to treat intralobar pulmonary sequestration (ILS) in adults has been a lobectomy performed by open chest surgery. We have reviewed our data to determine whether the surgical management of these lesions has evolved over the last years. Methods:We retrospectively reviewed the records of patients who were operated on for an ILS by either posterolateral thoracotomy (PLT group), or by thoracoscopy (TS group) between 2000 and 2016.Results: Eighteen patients were operated on for a ILS during this period. Before 2011, all resections were performed by thoracotomy (n=6) and after 2011 the approach was either a thoracotomy (n=5) or a thoracoscopy (n=7). There was one conversion because of dense pleural adhesions and this patient was integrated in the PLT group for further analysis. ILS presented more frequently on the left side (n=12, 66.7%) than on the right one (n=6, 33.3%) and exclusively in the lower lobes. All the PLT group patients underwent a lobectomy. In the TS group, five patients underwent a sublobar resection (2 segmentectomies S9+10, 1 basilar segmentectomy and 2 atypical resections). There was no mortality. In the PLT group, 5 patients (45%) had complications versus one patient (14%) in the TS group. The mean hospital stay was 7.4 days in the PLT group versus 5.4 days in the TS group.Conclusions: These data confirm that ILS can be safely treated by a sublobar resection that should be performed, whenever possible, without opening the chest. descending thoracic abdominal aorta or even the celiac trunk, with normal venous drainage into the pulmonary veins. They are usually located in the basal segments of the lower lobes. They are covered with a normal visceral pleura shared with the adjacent healthy pulmonary parenchyma. ILS are often detected in adulthood after pulmonary infections and/or haemoptysis, and more rarely, after cardiac insufficiency by venous return overload (2). They are sometimes discovered accidentally or confused with another condition. Until recently, the treatment of ILS was exclusively surgical and was based on the interruption of the systemic artery associated with lobectomy by open chest surgery. Other surgical or non-surgical treatments have recently been proposed, aiming to be less invasive and to spare the pulmonary parenchyma. The aim of this work is to determine if the surgical management of these lesions has evolved over the last years.Methods B e t w e e n J a n u a r y 2 0 0 0 a n d D e c e m b e r 2 0 1 6 , w e retrospectively reviewed the records of patients who underwent surgery for pulmonary sequestration in our department. Clinical and demographic data including patients age, sex, preoperative symptoms, type of surgery, type of resection and postoperative course were analyzed ( Table 1). The approach was a posterolateral thoracotomy (PLT group) or an exclusive thoracoscopy (TS group) according to a standardized technique previously described in details (3). Briefly, the procedure was performed under general anesthesia with spli...

Left basilar VATS segmentectomy for intra lobar pulmonary sequestration using indocyanine green for identification of the intersegmental plane: a case report

“…Left basilar VATS segmentectomy for intra lobar pulmonary sequestration using indocyanine green for identification of the intersegmental plane: a case report entire lobe that is affected and a segmentectomy should be considered (3). I present the following case in accordance with the CARE reporting checklist (available at http:// dx.doi.org/10.21037/jovs-21-21).…”

Anomalous Systemic Arterial Supply to the Left Lung: To Which Category Should This Belong?

“…The ideal treatment of ILS would be the resection of the sequestered lung using segmentectomy and lobectomy [5], as in this case. However, this procedure could lead to prolonged air leakage [5], which may require reoperation for completion lobectomy or necessitated prolonged drainage of pleural cavity.…”

“…The ideal treatment of ILS would be the resection of the sequestered lung using segmentectomy and lobectomy [5], as in this case. However, this procedure could lead to prolonged air leakage [5], which may require reoperation for completion lobectomy or necessitated prolonged drainage of pleural cavity. Simple ligation and arterial coiling embolization of the anomalous artery has also been used to eliminate symptoms in patients with type 1 ILS [6].…”

How to optimize the treatment strategy for patients of pulmonary sequestration with an elevated risk of fatal hemorrhage during operation: case discussion

“…An increasing evidence have indicated that minimally invasive video-assisted thoracic surgery has many advantages in the treatment of PS. Comparing with open surgery, thoracoscopy can clearly reveal the hilar area and aberrant feeding area; other indicators including blood loss, duration of chest tube insertion, postoperative hospital stay and complications also have a slight advantages (10)(11)(12)(13)(14). However, some difficulties still exist.…”