Seokkee Lee

Efficacy of polyglycolic acid sheet after thoracoscopic bullectomy for spontaneous pneumothorax.

BACKGROUND Various procedures have been performed to decrease the incidence of recurrent postoperative pneumothorax after thoracoscopic bullectomy. The purpose of this study was to determine the efficacy of a polyglycolic acid (PGA) sheet and pleural abrasion for prevention of recurrent postoperative pneumothorax. METHODS From January 2009 to August 2011, 257 patients underwent thoracoscopic bullectomy for primary spontaneous pneumothorax. In group A, 128 patients underwent pleural abrasion. These patients were compared with 129 patients (group B) who underwent a procedure to cover stable lines with an absorbable PGA sheet in addition to pleural abrasion. RESULTS There was no difference in preoperative demographics, although the age of patients in group A was statistically higher than that of patients in group B (23.67 ± 6.54 versus 21.69 ± 5.65; p = 0.010). In group A, prolonged postoperative air leaks (≥ 3 days) occurred more frequently (7.8% versus 2.3%; p = 0.045). A Kaplan-Meier curve showed that recurrence-free rates were higher in group B (p = 0.047). CONCLUSIONS Coverage with PGA sheet and pleural abrasion after thoracoscopic bullectomy is effective for preventing prolonged postoperative air leaks and reducing postoperative recurrence rates.

Pathologic Correlation of Serum Carcinoembryonic Antigen and Cytokeratin 19 Fragment in Resected Nonsmall Cell Lung Cancer

Background This study focused on the association between preoperative serum carcinoembryonic antigen (CEA) and cytokeratin 19 fragment (Cyfra 21-1) levels and pathologic parameters in patients with resected non-small-cell lung cancer (NSCLC). Materials and Methods The records of 527 patients who underwent pulmonary resection of NSCLC were reviewed. The association between preoperative serum CEA and Cyfra 21-1 levels and variables that had p-values of less than 0.05 in a t-test or one-way analyses of variance was analyzed by multiple linear regression. Results The mean serum CEA and Cyfra 21-1 levels prior to surgery were 6.8±23.1 mg/dL (range, 0.01 to 390.8 mg/dL) and 5.4±12.3 mg/dL (range, 0.65 to 140.2 mg/dL). The serum CEA levels were associated with tumor (T) and lymph node (N) stage and histology. The serum Cyfra 21-1 levels were associated with T stage, tumor size, and histology. Multiple linear regression indicated that serum CEA levels were associated with T (T3/4 vs. T1: β=8.463, p=0.010) and N stage (N2/3 vs. N0: β=9.208, p<0.001) and histology (adenocarcinoma vs. squamous cell: β=6.838, p=0.001), and serum Cyfra 21-1 levels were associated with tumor size (β=2.579, p<0.001) and histology (squamous cell vs. adenocarcinoma: β=4.420, p=0.020). Conclusion Serum CEA level was correlated with T and N stage, and Cyfra 21-1 with tumor size. CEA and Cyfra 21-1 showed histologic correlation. CEA is mainly elevated in adenocarcinoma and Cyfra 21-1 in squamous cell carcinoma. These results might be helpful for predicting pathologic status in preoperative NSCLC.

Sarcopenia of thoracic muscle mass is not a risk factor for survival in lung transplant recipients

BACKGROUND In lung transplantation (LTx), patients with thoracic muscle sarcopenia may have to require longer to recovery. We measured thoracic muscle volume by using the cross sectional area (CSA) and assessed its effect on early outcomes after LTx. METHODS A retrospective analysis was conducted to evaluate the effect of thoracic sarcopenia in patients undergoing LTx between January 2010 and July 2015. The lowest CSA quartile (Q1) was defined as sarcopenia. RESULTS In total, 109 patients were enrolled. The mean CSA was 58.24±15.82 cm(2). Patients in the highest CSA quartile were more likely to be male (92.6% vs. 17.9%, P<0.001), older (55.2±10.1 vs. 43.2±14.9 years, P=0.001), to have a higher body mass index (BMI) (22.3±4.0 vs. 19.4±3.7 kg/m(2), P=0.007), and to have pulmonary fibrosis (85.2% vs. 35.7%, P=0.003) compared with the lowest CSA quartile. Early outcomes including ventilator support duration [32.9±49.2 vs. 24.5±39.9 days, P= not significant (ns)], intensive care unit (ICU) stay duration (28.4±43.7 vs. 24.4±35.9 days, P= ns) and hospital stay duration (61.4±48.2 vs. 50.8±37.2 days, P= ns) tended to be longer in Q1 than Q4, but the difference was not significant. However, the 1-year survival rate was better in Q1 compared with Q4 (66.6% vs. 46.0%, P=0.04). CONCLUSIONS Although patients with thoracic sarcopenia seem to require a longer post-operative recovery time after LTx, this does not compromise their early outcomes. By contrast, patients with larger thoracic muscle volume (Q4) showed poorer survival times.

Prognostic effect of matrix metalloproteinase-9 in patients with resected Non small cell lung cancer

BackgroundThe role of tumor matrix metalloproteinase-9 (MMP-9) expression in non-small cell lung cancer (NSCLC) remains controversial. In this study, we investigated the prognostic value of tumor MMP-9 expression and other clinicopathologic factors in patients with completely resected NSCLC.MethodsThis retrospective study included patients who underwent complete resection of pathological stage I–IIIA NSCLC at Severance Hospital, Seoul, Korea, between 1998 and 2009. Tumor samples of 417 patients were stained by immunohistochemistry, and the expression of MMP-9 in tumor cells was evaluated, using the median immunohistochemical score of 10 (range, 0-300) as the cut-off.ResultsTumor MMP-9 expression was observed in 161 (38.6%) of 417 patients. Log-rank analysis showed a significant association of tumor MMP-9 expression with shortened disease-free survival (p = 0.01) but not with overall survival (p = 0.109). Multivariate analysis demonstrated that tumor MMP-9 expression was not an independent prognostic factor of recurrence (p = 0.142) or survival (p = 0.807). However, among patients with adenocarcinoma, tumor MMP-9 expression was associated with relapse (p = 0.003) and poor survival (p = 0.033). Furthermore, tumor MMP-9 expression was an independent prognostic indicator of relapse in patients with adenocarcinoma (p = 0.035).ConclusionsAmong patients with NSCLC, tumor MMP-9 expression was associated with poor outcomes in those with adenocarcinoma, but not in those with squamous cell carcinoma. In addition, MMP-9 expression was identified as an independent predictor of relapse of completely resected lung adenocarcinoma.

Trainees Can Safely Learn Video-Assisted Thoracic Surgery Lobectomy despite Limited Experience in Open Lobectomy

Background The aim of this study was to establish whether pulmonary lobectomy using video-assisted thoracic surgery (VATS) can be safely performed by trainees with limited experience with open lobectomy. Methods Data were retrospectively collected from 251 patients who underwent VATS lobectomy at a single institution between October 2007 and April 2011. The surgical outcomes of the procedures that were performed by three trainee surgeons were compared to the outcomes of procedures performed by a surgeon who had performed more than 150 VATS lobectomies. The cumulative failure graph of each trainee was used for quality assessment and learning curve analysis. Results The surgery time, estimated blood loss, final pathologic stage, thoracotomy conversion rate, chest tube duration, duration of hospital stay, complication rate, and mortality rate were comparable between the expert surgeon and each trainee. Cumulative failure graphs showed that the performance of each trainee was acceptable and that all trainees reached proficiency in performing VATS lobectomy after 40 cases. Conclusion This study shows that trainees with limited experience with open lobectomy can safely learn to perform VATS lobectomy for the treatment of lung cancer under expert supervision without compromising outcomes.

Pulmonary fissure development is a prognostic factor for patients with resected stage I lung adenocarcinoma

Pulmonary fissure differs among patients, but the relationship between pulmonary fissure development and survival in patients with resected lung adenocarcinoma has not been evaluated. In this study, we analyzed the effect of fissure development on prognosis in patients with stage I lung adenocarcinoma.

The effects of the climatic elements on occurrence of the spontaneous pneumothorax

Results 342 of the patients were male and 42 were female. Mean age was 21.9±0.5 years old. Month (p=0.563), season (p=0.264) and weather (p=0.327) were not associated with the occurrence rate of SPM. Mean temperatures, mean humidity, mean wind velocities of SPM occurrence day and non-occurrence day were 12.4±10.5°C : 12.8±10.5° C (p=0.504), 61.8±15.5% : 60.9±15.0% (p=0.372), 2.6±1.0m/s : 2.6±2.1m/s (p=0.893) respectively. As to the atmospheric pressure, mean, maximum, minimal value of occurrence day and non-occurrence day were 1012.6±9.7 hPa : 1012.7±9.0 hPa (p=0.850), 1018.7±8.2 hPa : 1018.5 ±7.8 hPa (p=0.645), 1013.4±8.1 hPa : 1013.6±7.9 hPa (p=0.755) respectively. But, differences between maximum and minimum value were 5.3±2.9 hPa on occurrence day and 4.9±2.6 hPa on non-occurrence day (p=0.037). Conclusion There was no relationship between the occurrence of SPM and weather, season, temperature, humidity and wind velocity. But, the difference of the atmospheric pressure throughout the day was associated with occurrence of SPM. We concluded that the change of atmospheric pressure influenced the rupture of bullas that caused SPM.