A clinical audit of thoracotomy done in a tertiary care center

Authors

  • Zeeshanuddin Ahmad Department of Surgical Oncology, Sri Aurobindo Medical College and Post Graduate Institute, Indore Ujjain Highway, Bhawrasla, Indore, Madhya Pradesh, India-452001
  • Deepak Agrawal Department of Surgical Oncology, Sri Aurobindo Medical College and Post Graduate Institute, Indore Ujjain Highway, Bhawrasla, Indore, Madhya Pradesh, India-452001
  • Sanjay M. Desai Department of Surgical Oncology, Sri Aurobindo Medical College and Post Graduate Institute, Indore Ujjain Highway, Bhawrasla, Indore, Madhya Pradesh, India-452001
  • Amar Jain Department of Surgical Oncology, Sri Aurobindo Medical College and Post Graduate Institute, Indore Ujjain Highway, Bhawrasla, Indore, Madhya Pradesh, India-452001

DOI:

https://doi.org/10.18203/2320-6012.ijrms20182279

Keywords:

Decortication, Lobectomy, Pneumonectomy, Thoracotomy

Abstract

Background: Sri Aurobindo Medical College and Post Graduate Institute is a tertiary care center in Indore. The surgical oncology department is performing various oncological surgeries. One subspeciality is thoracic surgery, where surgeries for benign as well as malignant cases are being done. Thoracotomy is done for various lung, pleural and mediastinal pathology. Open and VATS are two main modalities with each having their pros and cons.

Methods: All thoracotomies done from 2016 to January 2018 were included in the study. Decortications, wide local excision, lobectomies, pneumonectomies, hilar lymph node dissections were done.

Results: Total 30 cases were done in a span of 2 years. Of these 9 cases were done for a malignant origin, 4 for benign tumor, 3 for benign non-infective disease and rest 14 for infective origin. Posterolateral thoracotomies were done most often. Average duration of the procedure was 157 minutes. Average blood loss was approximately 340 ml. Mean duration of stay was 10.9 days.

Conclusions: Thoracic oncologic procedures are less often done due to paucity of the cases. However, surgical oncologist being well versed with the anatomy, relations and oncologic concepts can perform both neoplastic as well as infected cases. With increasing number of cases, the standard of care is increasing, operating time is lessened, complications are brought down, and the results are better.

References

Sengupta S. Post-operative pulmonary complications after thoracotomy. Indian J Anaesthesia. 2015;59(9):618-26.

Jensik RJ. Miniresection of small peripheral carcinoma of the lung. Surg Clin North Am. 1987;67:951-8.

Lung Cancer Study Group (Ginsberg RJ, Rubinstein LV). Randomized trial of lobectomy versus limited resection for T1N0 non-small cell lung cancer. Ann Thorac Surg. 1995;60:615-23.

Ginsberg RJ. Alternative (muscle sparing) incision in thoracic surgery. Ann Thorac Surg. 1993;56:752-4.

Giudicelli R, Thomas P, Lonjon T, Ragni J, Morati N, Ottomani R, et al. Video-assisted mini thoracotomy versus muscle-sparing thoracotomy for performing lobectomy. Annals Tho Surg. 1994 Sep 1;58(3):712-8.

Light RW. A new classification of parapneumonic effusions and empyema. Chest 1995;108;299-301.

Carey JA, Hamilton JR, Spencer DA, Gould K, Hasan A. Empyema thoracis: a role for open thoracotomy and decortication. Archives of disease in childhood. 1998 Dec 1;79(6):510-3.

Pastorino U, Valente M, Bedini V, Infante M, Tavecchio L, Gherardini G, Ravasi G. Limited resection for stage I lung cancer. Lung Cancer. 1991 Jan 1;7:85.

Miller JI, Hatcher CR Jr. Limited resection of bronchogenic carcinoma in the patient with marked impairment of pulmonary function. Ann Thorac Surg. 1987;44:340-43.

Jaklitsch MT, Mery CM, Bueno R, Vasconcelles MJ, Richards WG, Mentzer S, et al. Lesser pulmonary resections are more common in elderly non-small cell lung cancer (NSCLC) patients but do not adversely affect survival. InProc Am Soc Clin Oncol 1999 (Vol. 18, p. 471a).

Rock C, Doyle C, Demark-Wahnefried W, Meyerhardt J, Courneya K, Schwartz A, et al. Nutrition and physical activity guidelines for cancer survivors. CA: A Cancer J Clin. 2013;62:242-74.

Biswas A, Oh P, Faulkner G, Bajaj R, Silver M, Mitchell M, et al. Sedentary time and its association with risk for disease incidence, mortality and hospitalization in adults: a systematic review and meta-analysis. Annals Int Med. 2015;162:123-32.

McTiernan A. Mechanisms linking physical activity with cancer. Nat Rev Cancer. 2008;8:205-11.

Agostini P, Cieslik H, Rathinam S, Bishay E, Kalkat M, Rajesh P, et al. Postoperative pulmonary complications following thoracic surgery: are there any modifiable risk factors? Thorax. 2010;65:815-818.

Light RW. Parapneumonic effusions and empyema. Proc Am Thorac Soc. 2006;3:75-80.

Thourani VH, Brady KM, Mansour KA, Miller JI Jr, Lee RB. Evaluation of treatment modalities for thoracic empyema: a cost-effectiveness analysis. Ann Thorac Surg. 1998;66:1121-7.

Colice GL, Curtis A, Deslauriers J, Heffner J, Light R, Littenberg B, et al. Medical and surgical treatment of parapneumonic effusions: an evidence-based guideline. Chest. 2000;118:1158-71.

Peto J, Decarli A, La Vecchia C, Levi F, Negri E. The European mesothelioma epidemic. Br J Cancer. 1999;79:666-72.

Maziak DE, Gagliardi A, Haynes AE, Mackay JA, Evans WK. Surgical management of malignant pleural mesothelioma: a systematic review and evidence summary. Lung Cancer. 2005;48:157-69.

Downloads

Published

2018-05-25

How to Cite

Ahmad, Z., Agrawal, D., Desai, S. M., & Jain, A. (2018). A clinical audit of thoracotomy done in a tertiary care center. International Journal of Research in Medical Sciences, 6(6), 2012–2017. https://doi.org/10.18203/2320-6012.ijrms20182279

Issue

Section

Original Research Articles