Kohn's pores are not responsible for collateral ventilation between inflated and deflated segments: a microscopic study of pulmonary intersegmental septa in the human lung

Zuo, Yizhi; Li, Lin; Liu, Shuwei

doi:10.1111/joa.12288

Cited by 5 publications

(5 citation statements)

References 13 publications

(31 reference statements)

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“…Lymph node metastases can appear in the NTB segments, lobes, and even skip metastasis, with regard to lymph drainage on the abnormal anatomy of pulmonary segments. Zuo et al [31] found that pulmonary segmental anatomy was relatively independent, owing to continuous interval segments, with no alveolar hole sections. We hypothesized that tumors invading adjacent parenchyma across the interval would be hindered and that the interval might shut down the spread pathway of spread for tumor cells along the alveolar hole.…”

Section: Discussionmentioning

confidence: 99%

Lymph node metastasis outside of a tumor-bearing lobe in primary lung cancer and the status of interlobar fissures

Wang

Zhang³

et al. 2019

Medicine

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The new Tumor Node Metastasis staging system does not recognize fissure status with respect to adjacent lobe invasion (ALI) in lung cancer. Furthermore, no specific surgical strategies have been recommended for lymph node dissections around adjacent nontumor-bearing lobes (NTBLs) according to fissure status. Therefore, this study was undertaken to investigate the necessity of removing additional adjacent lobe lymph nodes in patients with nonsmall cell lung cancer (NSCLC) for lesions limited to in the vicinity of the interlobar fissure. From August 2013 to March 2015, the records of 332 patients, who underwent systematic mediastinal lymph node dissection, were reviewed in this retrospective study. The bronchial lymph nodes had been subjected to pathological examination, and the status of the fissures was also recorded. A statistical analysis was performed to identify the significant predictors of lymph node metastasis. The patients were divided into a nonadjacent lobe invasion (NALI) group (n = 295) and an ALI group (n = 37). There was a significant difference in tumors with pN2 disease between the ALI and NALI groups (37.8% vs 8.8%, P = .001). ALI tumors had significantly more frequent pleural involvement than NALI tumors (62.2% vs 43.1%, P = .035). The frequency of N2 involvement among tumors invading across the complete fissure was higher than that of the tumors invading across the incomplete fissure (44.4% vs 14.3%, P = .015). However, the frequency of N1 involvement among tumors invading across the incomplete fissure was not statistically different than that of tumors not invading across incomplete fissure (32.1% vs 24.2%, P = .357). Regarding lymph node metastasis in NTBL, 15 (12.7%) patients had lymph node metastases in NTBLs. Pleural involvement was an independent predictor of lymph node metastasis in an NTBL. A greater frequency of N2 lymph nodes existed in NSCLC with invading adjacent lobe across complete fissure, extensive lymphatic resection within the hilum, and NTBL in tumors with pleural involvement are justifiable and necessary.

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Section: Discussionmentioning

confidence: 99%

Lymph node metastasis outside of a tumor-bearing lobe in primary lung cancer and the status of interlobar fissures

Wang

Zhang³

et al. 2019

Medicine

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“…Although the exact contribution of each of the possible anatomic pathways of collateral ventilation (pores of Kohn, Martin's and Lambert's channels) to gas exchange in both normal and disease states is unknown, the physiologic studies in which collateral ventilation was affected by a hypoxic and hypercarbic stimulus, as well as pharmacologic agents, suggest that Martin's and Lambert's channels and the intersegmental bronchioles are the effective collateral channels in normal lungs (30). These observations are supported by evidence on microscopy that no pores of Kohn exist in intersegmental septa (31).…”

Section: Physiology Of Collateral Ventilationmentioning

confidence: 95%

The Clinical Significance of Collateral Ventilation

Terry

Traystman

2016

Annals ATS

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Oxygen delivery and carbon dioxide removal being critical to cell survival, mammals have developed collateral vascular and ventilation systems to ensure tissue viability. Collateral ventilation, defined as ventilation of alveoli via pathways that bypass normal airways, is present in humans and many other species. The presence of collateral ventilation can be beneficial in certain disease states, whereas its relative absence can predispose to other diseases. These well defined anatomical pathways contribute little to ventilation in normal humans, but modulate ventilation perfusion imbalance in a variety of diseases, including obstructive diseases, such as asthma and emphysema. These pathways can be affected by pharmaceuticals and inhaled gas compositions. The middle lobe and lingula, constrained by their isolated, segmental anatomy, have reduced collateral ventilation, which predisposes them to disease. Recently, attempts to improve the quality of life of patients with emphysema, by performing nonsurgical lung volume reduction via use of endobronchial valves, have led to mixed results, because the role of collateral ventilation in the success or failure of the procedure was not initially appreciated. This review describes the anatomical pathways of collateral ventilation, their physiology and relationship to disease states, their modulatory effects on gas exchange, treatment considerations, and their effect on diagnostic procedures.

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“…There have been many terminologies which have described the boundary between lung segments, 18 , 19 such as the intersegmental line, intersegmental septum, intersegmental fissure, and intersegmental plane. Each of these terms is a different understanding of the boundary in different perspective or dimension.…”

Section: Discussionmentioning

confidence: 99%

Division of the intersegmental demarcation using the “modified hand‐tearing method” is safe and feasible in thoracoscopic anatomical segmentectomy

Feng

et al. 2022

Thoracic Cancer

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Background: The accurate and safe division of the intersegmental demarcation (ISD) is critical and challenging during thoracoscopic anatomical segmentectomy. Here, we provide an improved technique which emphasizes the application of an electric hook and blunt division of ISD. The technique is termed as the "modified hand-tearing method" (MHT method) with combined application of an electric hook and staplers. The study aimed to review the outcomes of patients who underwent thoracoscopic anatomical segmentectomy, with or without the MHT method in our institute and assess its feasibility and safety. In addition, we compared the feasibility between video-assisted thoracoscopic surgery (VATS) and robot-assisted thoracoscopic surgery (RATS) using the MHT method. Methods: From 2018 July to 2021 June, we retrospectively analyzed 701 patients who underwent segmentectomy. Using propensity score matching, data of two well-matched pairs of 276 cases in the MHT method and non-MHT method groups, and two wellmatched pairs of 40 cases in the VATS and RATS subgroups were obtained. The clinical and perioperative characteristics of patients were compared between groups. Results: Compared with the non-MHT method group, the MHT method group had shorter operation time and shorter postoperative hospital stay. Period of chest tube drainage and postoperative total drainage and postoperative complications had no between-group difference. Compared with VATS, the RATS subgroup had less intraoperative bleeding and shorter postoperative hospital stay. Conclusion: Division of ISD using the MHT method has advantages in precision and ease of operation, so it has the potential to become a feasible and effective method for thoracoscopic anatomical segmentectomy.

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Kohn's pores are not responsible for collateral ventilation between inflated and deflated segments: a microscopic study of pulmonary intersegmental septa in the human lung

Cited by 5 publications

References 13 publications

Lymph node metastasis outside of a tumor-bearing lobe in primary lung cancer and the status of interlobar fissures

Lymph node metastasis outside of a tumor-bearing lobe in primary lung cancer and the status of interlobar fissures

The Clinical Significance of Collateral Ventilation

Division of the intersegmental demarcation using the “modified hand‐tearing method” is safe and feasible in thoracoscopic anatomical segmentectomy

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