Prevention, early detection, and management of complications after 328 consecutive extrapleural pneumonectomies

Sugarbaker, David J.; Jaklitsch, Michael T.; Bueno, Raphael; Richards, William G.; Lukanich, Jeanne M.; Mentzer, Steven J.; Colson, Yolonda L.; Linden, Phillip; Chang, Michael Y.; Capalbo, Leah; Oldread, Elizabeth; Neragi-Miandoab, Siyamek; Swanson, Scott J.; Zellos, Lambros

doi:10.1016/j.jtcvs.2004.02.021

Cited by 357 publications

(228 citation statements)

References 8 publications

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“…2,3,17,18 The results from this study of a 6% 30-day mortality rate are comparable to our own published data showing a 30-day mortality rate of 4% after pneumonectomy without induction therapy. 19 In addition, only 4 patients in the current series developed fatal pulmonary complications compared with the 11 patients who died as a result of ARDS (21%) in the Intergroup study. This is significant because one would expect that if RT increased toxicity from surgical resection it would be because of decreased pulmonary reserve.…”

Section: Discussionmentioning

confidence: 54%

Pneumonectomy after chemoradiation

Allen

Mentzer

Yeap

et al. 2008

Cancer

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Acute lymphoblastic leukemia (ALL) is the most common cancer in children. The current treatment protocol for ALL involves an intense chemotherapy regimen yielding cure rates of nearly 80%. However, new therapies need to be designed not only to increase the survival rate but also to combat the risk of severe therapy associated toxicities including secondary malignancies, growth problems, organ damage, and infertility. The c‐Myb proto‐oncogene is highly expressed in immature hematopoietic cells. In this study, we demonstrate that loss of c‐Myb itself decreased the viability of these leukemic cells. Additionally, the inhibition of c‐Myb caused a decrease in cell proliferation, significantly increased the number of cells in G0/G1 phase of the cell cycle, increased the sensitivity of pre‐B‐ALL cells to cytotoxic agents in vitro, and significantly delayed disease onset in a mouse model of leukemia. Furthermore, we demonstrate that Bcl‐2 is a target of c‐Myb in pre‐B‐ALL cells. Our results identify c‐Myb as a potential therapeutic target in pre‐B‐ALL and suggest that suppression of c‐Myb levels or activity, in combination with currently used therapies and/or dose reduction, may lead to a decrease in toxicity and an increase in patient survival rates. Because c‐Myb is aberrantly expressed in several other malignancies, targeting c‐Myb will have broad clinical applications. Am. J. Hematol., 2012. © 2012 Wiley Periodicals, Inc.

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Section: Discussionmentioning

confidence: 54%

Pneumonectomy after chemoradiation

Allen

Mentzer

Yeap

et al. 2008

Cancer

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“…Mortality can be even higher when associated with preoperative chemotherapy (3). The combination with other procedures such as extrapleural pneumonectomy is associated with a mortality rate of 4 to 7% (4,5). Traumatic injuries requiring emergency pneumonectomy can achieve mortality rates higher than 70% (6).…”

Section: Introductionmentioning

confidence: 99%

Effects of pneumonectomy on nitric oxide synthase expression and perivascular edema in the remaining lung of rats

Samano

Pazetti

Prado

et al. 2009

Braz J Med Biol Res

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Pneumonectomy is associated with high mortality and high rates of complications. Postpneumonectomy pulmonary edema is one of the leading causes of mortality. Little is known about its etiologic factors and its association with the inflammatory process. The purpose of the present study was to evaluate the role of pneumonectomy as a cause of pulmonary edema and its association with gas exchange, inflammation, nitric oxide synthase (NOS) expression and vasoconstriction. Forty-two non-specific pathogen-free Wistar rats were included in the study. Eleven animals died during or after the procedure, 21 were submitted to left pneumonectomy and 10 to sham operation. These animals were sacrificed after 48 or 72 h. Perivascular pulmonary edema was more intense in pneumonectomized rats at 72 h (P = 0.0131). Neutrophil density was lower after pneumonectomy in both groups (P = 0.0168). There was higher immunohistochemical expression of eNOS in the pneumonectomy group (P = 0.0208), but no statistically significant difference in the expression of iNOS. The lumen-wall ratio and pO2/FiO2 ratio did not differ between the operated and sham groups after pneumonectomy. Left pneumonectomy caused perivascular pulmonary edema with no elevation of immunohistochemical expression of iNOS or neutrophil density, suggesting the absence of correlation with the inflammatory process or oxidative stress. The increased expression of eNOS may suggest an intrinsic production of NO without signs of vascular reactivity

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“…Gore and Associates, Flagstaff, AZ) (16). After resection of the entire specimen, some patients received intraoperative intracavitary lavage with a solution of 225 mg/m 2 cisplatin in dialysate (Baxter, Deerfield, IL) maintained at 42°C, as previously described (10). This was given because pharmacokinetic studies showed that patients could benefit from the high local concentration of cisplatin while minimizing systemic toxicity (only 3% of intracavitary cisplatin is absorbed systemically) (17).…”

Section: Materials and Methods Data Sources Data Collection And Patmentioning

confidence: 99%

Use of Postoperative Creatinine to Predict Sustained Kidney Injury in Patients Undergoing Mesothelioma Surgery

Mizuguchi

Mitani

Waikar

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives AKI leads to increased morbidity and mortality and progression to chronic kidney injury is a frequent consequence of AKI. Surgical treatment of mesothelioma is associated with increased risk for kidney injury. However, sustained kidney injury may limit therapeutic options for treating residual cancer. This study hypothesized that patients with significant serum creatinine (sCr) elevation within 48 hours of surgery would be at risk for sustained kidney injury. The goal was to determine the best acute sCr measure predictive of sustained kidney injury defined as a 50% increase in sCr from baseline measured 2-4 weeks after surgery.Design, setting, participants, & measurements In a prospective, observational cohort of surgical patients with mesothelioma, receiver operator characteristic curves were generated for the 24-and 48-hour absolute difference and relative sCr change over baseline in the derivation cohort (n=279). The prediction was tested in a validation cohort (n=207). The ability of various other AKI definitions to predict sustained kidney injury was evaluated.Results Sustained kidney injury occurred in 9.8% of patients in the derivation cohort. A $59% increase in sCr 48 hours after surgery was most predictive of sustained kidney injury (c statistic=0.78). Among other AKI definitions, a sCr increase of 0.3 mg/dl in 24 hours or 0.5 mg/dl increase in 48 hours (Waikar and Bonventre criteria) also reliably predicted sustained kidney injury.Conclusions Development of clinically significant sustained kidney injury can be predicted by acute postoperative sCr elevation in patients treated for mesothelioma.

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Prevention, early detection, and management of complications after 328 consecutive extrapleural pneumonectomies

Abstract: Complications after extrapleural pneumonectomy require a unique approach to management, and mortality can be minimized by early detection and aggressive treatment.

Cited by 357 publications

References 8 publications

Pneumonectomy after chemoradiation

Pneumonectomy after chemoradiation

Effects of pneumonectomy on nitric oxide synthase expression and perivascular edema in the remaining lung of rats

Use of Postoperative Creatinine to Predict Sustained Kidney Injury in Patients Undergoing Mesothelioma Surgery

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