Preoperative embolization in surgical management of massive thoracic tumors

Khairy, Mahmoud; Ali, Elsayed Mostafa; Eldin, Eman Nasr

doi:10.1177/0218492312453462

Cited by 10 publications

(5 citation statements)

References 17 publications

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“…However, postoperative complications are closely related to the prognosis of these patients (7,8), and blood loss has been found to be an independent risk factor for postoperative complications (7). Preoperative embolization was first introduced in patients receiving surgery for mediastinal tumors, aiming to reduce intraoperative blood loss, which has been confirmed in some studies (11)(12)(13). Thus, this study was undertaken to investigate the role of preoperative embolization during surgery for the destroyed lung.…”

Section: Discussionmentioning

confidence: 96%

Application of preoperative embolization during surgery for the destroyed lung

et al. 2020

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Background: The destroyed lung has been a challenge in the clinical practice of thoracic surgery, and severe adhesions and massive bleeding during surgery are the main obstacles faced by surgeons. This study aimed to investigate the efficacy of the preoperative embolization of blood vessels in adhesions during surgery for the destroyed lung.Methods: A total of 7 patients underwent preoperative embolization for lung resection of destroyed lungs between June 2016 and February 2019. Preoperative embolization was performed for 45 min to 2 h within 48 h before surgery. The embolized arteries included the intercostal artery, radial artery, subclavian artery and their branches, and the number of embolized arteries ranged from 5 to 13.Results: A posterolateral incision was made in these patients, and endoscope-assisted separation of the adhesions at the top of the chest wall and on the lateral chest wall was performed. The operation time ranged from 3.5 to 8 h, and the blood loss was 1,200-5,000 mL. The postoperative drainage was in the normal range. One patient developed multiple organ failure and bronchopleural fistulas (BPF) one month after surgery, which was resolved after active drainage and argon cauterization; another patient developed BPF 7 months after surgery, which was resolved after placement of a nonreturn valve in the subsegmental bronchi via bronchoscopy.Conclusions: Surgery of the destroyed lung is a great challenge in clinical practice, mainly due to the risk of the blood supply in the adhesions. Preoperative embolization may reduce intraoperative blood loss and surgical difficulty.

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Section: Discussionmentioning

confidence: 96%

Application of preoperative embolization during surgery for the destroyed lung

et al. 2020

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“…El tiempo entre la embolización y el procedimiento quirúrgico no debe superar 24 horas. [19][20][21] Los tratamientos adyuvantes (quimioterapia radioterapia) postoperatorios no han mostrado ningún beneficio en los casos de TFSP malignos. 3 Tabla 2 Factores predictores de malignidad 2,3,7,15,16…”

Section: Discussionunclassified

“…2,7,15 El tratamiento de elección es quirúrgico y algunos pacientes se pueden beneficiar de embolización prequirúrgica. 2,20 El seguimiento de los casos de TFSP gigantes debe ser más riguroso, ya que cursan con peor pronóstico y una mayor probabilidad de transformación maligna, en comparación con pacientes que presentan tumores de menor tamaño.…”

Section: Conclusiónunclassified

Tumor fibroso solitario gigante de pleura. Serie de casos

Fino-Velásquez

Ojeda-León

Granada-Camacho

et al. 2021

Revista Argentina de Radiología / Argentinian Journal of Radiol

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Resumen Introducción El tumor fibroso solitario de pleura (TFSP) es una neoplasia poco frecuente, con aproximadamente 1.000 casos reportados en la literatura mundial. La aproximación diagnóstica inicial se realiza con estudios imagenológicos. Métodos De forma retrospectiva, se recopilaron cuatro casos de pacientes con TFSP gigante operados en nuestra institución. Se describen las características sociodemográficas, clínicas, imagenológicas, macroscópicas y microscópicas de cada caso. Resultados Todos los pacientes de la serie cursaron con manifestaciones clínicas, con un promedio de 23,75 meses de evolución. El 50% de los tumores se localizaron en la cavidad pleural derecha y el 50% en la izquierda. En tomografía computarizada (TC) de tórax, los cuatro casos se presentaron como una masa sólida, de densidad heterogénea, con diámetros mayores entre 17 y 22 cm y contornos variables (lisos en tres casos y lobulados en un paciente). Se observaron calcificaciones intratumorales en dos casos y derrame pleural en tres pacientes. En cirugía, todas las masas presentaron pedículos. El análisis histológico e inmuno-químico confirmó la naturaleza benigna de tres casos y malignidad en una de las neoplasias. Conclusiones Los TFSP generalmente son benignos y de buen pronóstico. Sin embargo, entre 10 y 20% de esos tumores son malignos. Las imágenes diagnósticas pueden sugerir el diagnóstico de TFSP, pero la confirmación de la naturaleza de la lesión debe realizarse con el análisis histopatológico de toda la pieza quirúrgica.

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“…Similarly, Khairy et al . described the use of preoperative embolization of the feeding artery to decrease the size of highly vascular mediastinal giant tumors by 20–30% and to induce perilesional ischemia, which facilitated dissection of the mass . We performed angiography before the second surgery but could not perform preoperative embolization because of the risk of myocardial infarction.…”

Section: Discussionmentioning

confidence: 99%

Development of angiosarcoma in a mediastinal non‐seminomatous germ cell tumor that exhibited growing teratoma syndrome during chemotherapy

et al. 2018

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Herein, we report a case of an angiosarcoma in a mediastinal non‐seminomatous germ cell tumor that exhibited growing teratoma syndrome during chemotherapy. A 26‐year‐old man presented with a giant anterior mediastinal mass, which was diagnosed as a non‐seminomatous germ cell tumor. The patient was administered three cycles of chemotherapy (bleomycin, etoposide, and cisplatin), but the mass grew despite normalization of tumor markers. Massive bleeding during thoracic surgery resulted in incomplete resection, and the mass was clinically and pathologically diagnosed as growing teratoma syndrome (only mature teratoma). The residual mass continued to grow, and complete resection was subsequently achieved after a detailed analysis of its vascular anatomy using angiography. The final pathological findings revealed angiosarcoma, which indicated a rare somatic type of mediastinal non‐seminomatous germ cell tumor.

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Preoperative embolization in surgical management of massive thoracic tumors

Abstract: Preoperative embolization of giant vascular thoracic tumors is useful to decrease perioperative blood loss and facilitate total excision.

Cited by 10 publications

References 17 publications

Application of preoperative embolization during surgery for the destroyed lung

Application of preoperative embolization during surgery for the destroyed lung

Tumor fibroso solitario gigante de pleura. Serie de casos

Development of angiosarcoma in a mediastinal non‐seminomatous germ cell tumor that exhibited growing teratoma syndrome during chemotherapy

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