Mediastinal reinforcement after induction therapy and pneumonectomy: comparison of intercostal muscle versus diaphragm flaps.

Details

Ressource 1Download: serval:BIB_C3DA0BF4B8D4.P001 (223.42 [Ko])
State: Public
Version: author
License: Not specified
It was possible to publish this article open access thanks to a Swiss National Licence with the publisher.
Serval ID
serval:BIB_C3DA0BF4B8D4
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Mediastinal reinforcement after induction therapy and pneumonectomy: comparison of intercostal muscle versus diaphragm flaps.
Journal
European Journal of Cardio-thoracic Surgery
Author(s)
Lardinois D., Horsch A., Krueger T., Dusmet M., Ris H.B.
ISSN
1010-7940
Publication state
Published
Issued date
2002
Peer-reviewed
Oui
Volume
21
Number
1
Pages
74-78
Language
english
Abstract
OBJECTIVE: Prospective non-randomised comparison of full-thickness pedicled diaphragm flap with intercostal muscle flap in terms of morbidity and efficiency for bronchial stump coverage after induction therapy followed by pneumonectomy for non-small cell lung cancer (NSCLC). METHODS: Between 1996 and 1998, a consecutive series of 26 patients underwent pneumonectomy following induction therapy. Half of the patients underwent mediastinal reinforcement by use of a pedicled intercostal muscle flap (IF) and half of the patients by use of a pedicled full-thickness diaphragm muscle flap (DF). Patients in both groups were matched according to age, gender, side of pneumonectomy and stage of NSCLC. Postoperative morbidity and mortality were recorded. Six months follow-up including physical examination and pulmonary function testing was performed to examine the incidence of bronchial stump fistulae, gastro-esophageal disorders or chest wall complaints. RESULTS: There was no 30-day mortality in both groups. Complications were observed in one of 13 patients after IF and five of 13 after DF including pneumonia in two (one IF and one DF), visceral herniations in three (DF) and bronchopleural fistula in one patient (DF). There were no symptoms of gastro-esophageal reflux disease (GERD). Postoperative pulmonary function testing revealed no significant differences between the two groups. CONCLUSIONS: Pedicled intercostal and diaphragmatic muscle flaps are both valuable and effective tools for prophylactic mediastinal reinforcement following induction therapy and pneumonectomy. In our series of patients, IF seemed to be associated with a smaller operation-related morbidity than DF, although the difference was not significant. Pedicled full-thickness diaphragmatic flaps may be indicated after induction therapy and extended pneumonectomy with pericardial resection in order to cover the stump and close the pericardial defect since they do not adversely influence pulmonary function.
Keywords
Aged, Carcinoma, Non-Small-Cell Lung, Diaphragm, Female, Humans, Intercostal Muscles, Lung Neoplasms, Male, Mediastinum, Middle Aged, Neoplasm Staging, Pneumonectomy, Prospective Studies, Surgical Flaps, Suture Techniques
Pubmed
Web of science
Open Access
Yes
Create date
29/01/2008 12:59
Last modification date
25/09/2019 6:10
Usage data