Annual General Meeting of the Irish Thoracic Society - IJMS | Irish ...

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SESSION THREE ONE
ANNUAL MEETING OF THE IRISH THORACIC SOCIETY • 11 - 12 November 2005 • WESTWOOD HOUSE HOTEL, GALWAY
ANNUAL MEETING OF THE IRISH THORACIC SOCIETY • 11 - 12 November 2005 • WESTWOOD HOUSE HOTEL, GALWAY
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SESSION
SESSION THREE ONE
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Managing mesothelioma: a study of local experience
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Single surgeons audit of carinal resections
Introduction
According to predictions the incidence of malignant
mesothelioma cases is expected to peak by 2020 and
to decline thereafter. As we approach this expected
peak it is useful to consider the number of cases now
being seen at District General Hospital level and the
utilisation of healthcare services in the management
of this condition.
Method
All cases of malignant mesothelioma made either
by the pathology department, or from the clinical
coding department at the hospital, from 2000 to
2005, were included in the study. The notes were
reviewed retrospectively in August 2005. The BTS
statement on Malignant Mesothelioma 1 in the UK
was used as a reference.
Results
A total of 14 cases diagnosed as malignant
mesothlioma were included in this study. Of the 14
cases a positive occupational link with asbestos was
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identified in eight cases. One case was peritoneal
mesothelioma, one case was female. The age range
was 51-95, (mean 68.6). Half of the cases had a
diagnosis confirming pleural biopsy. No patients
were considered suitable for referral re radical meso
surgery. Chemotherapy was used in two cases and
Radiotherapy in five.
Conclusions
Malignant mesothelioma remains an uncommon
malignancy but incidence is increasing as observed
in one District General practice. It usually affects
middle aged men. Ultrasound and CT guided biopsy
are underutilised as an investigation tool. Palliative
care involvement from the time of diagnosis is
valuable given the limited treatment options and the
very poor prognosis.
Reference
1. BTS Statement on Malignant Mesothlioma in the
United Kingdom. Thorax 2001; 56:250-265 (April)
Five-year audit of Abrams pleural biopsy
Introduction
Thoracentesis or pleural fluid aspiration is a common
and relatively straightforward procedure in the
investigation of unexplained pleural effusion. The role
of Abrams pleural biopsy is less certain, particularly
with increasing availability of thoracoscopy.
Aim
To assess the results and complications of Abrams
pleural biopsy at St James’s from 2000-2004.
Method
Interrogation of the St James’s histopathology
database and retrospective chart review.
Results
Seventy-five patients (mean age 63, 48 male, 27
female) had Abrams biopsy as part of their work-up
for unexplained pleural effusion. In 66 patients pleura
was present in the biopsy material. Of these, 13 were
reported malignant or suspicious for malignancy, all of
whom had a final diagnosis of malignancy. Thirty-six
showed inflammatory changes, nine of whom had a
final diagnosis of malignancy and three of whom had
lymphocytic inflammation and a final diagnosis of TB.
Ten were reported normal, two of whom had a final
diagnosis of malignancy. Therefore, of 24 patients with
a final diagnosis of malignancy, 13 were confirmed or
suspicious on Abrams Bx (including four of six with
a final diagnosis of mesothelioma). Seven patients
had granulomatous inflammation on Abrams Bx, all
of whom had a final diagnosis of TB, but only two of
whom were ZN positive on pleural fluid. One patient
suffered a vasovagal episode and three suffered
a small pneumothorax, none of whom required
intercostal tube drainage.
Conclusions
Abrams pleural Bx has a high false negative rate in
malignancy, but where positive may avoid the need
for more invasive procedures such as thoracoscopy.
The false negative rate for TB is low and the finding
of granulomatous inflammation provides early
confirmation of the diagnosis when the pleural
fluid is ZN negative. The false positive rate for both
malignancy and TB in this series was zero and the
complication rate was low.
N Chapman,
MA McCann, J Frazer,
RP Convery
Air Lab, Craigavon Area
Hospital
B Kent, D Breen,
D O’Calaghan,
F O’Connell
CResT Directorate,
St James’s Hospital,
Dublin
Carinal resection is one of the most complicated
procedures in tracheo-bronchial surgeries. We
present our experience of carinal resections
with histological analysis, operative techniques,
complications and long-term survival.
Since 2001 we have performed six carinal resections
in St. James’s Hospital. Indications for surgery
included Non Small Cell Carcinoma (NSCCa). The
length extended from one to five tracheal rings.
The operative approach was right postero-lateral
thoracotomy in all the cases.
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One out of the six patients died post-operatively due
to infection. As quoted in the literature mortality and
the incidence of complications were significantly
correlated to length of resection and preoperative
patients functional status.
The feasibility of carinal resection is limited by
the patient’s pulmonary function status and the
anatomical extension of the tumour growth.
Thorough selection of patients may improve
immediate and long-term results.
Malignant chest wall tumours and tumours invading
the chest wall: surgical techniques and results
Primary chest wall tumours and lung cancer
invading chest wall are the most common diseases
indicating chest wall resection and reconstruction.
We evaluated patients who underwent chest wall
resection and reconstruction for primary chest wall
tumours and lung cancer invading chest wall.
Fourteen patients underwent chest wall resection
and reconstruction for primary chest wall tumours
and local invasion of lung cancer year between
February 2001 to December 2004. Wide chest wall
resection was performed and reconstruction was
done by sandwich method with Composite Marlex
mesh and Methyl-Metacryalate. In the majority of
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cases it was possible to approximate the soft tissues
over the reconstruction. However in a small number
of cases Plastic surgical colleagues helped in closing
the defect.
There was no operative or postoperative mortality.
We looked at the mean length of in-hospital stay,
histological types, Morbidity and Long-term survival.
Wide excision reduces the chances of local
recurrence. Simultaneous skeletal reconstruction of
the chest wall prevents postoperative complications
and restores the respiratory dynamics by avoiding
paradoxical or harmful movements.
Role of vascular reconstruction in the resection of
thoracic malignancy
Since the revised staging of lung cancer in 1997 1 , local
invasion of chest wall or vascular structures does not
preclude curative lung resection.
Vascular reconstruction is an important adjunct to
resection of intra thoracic malignancy This includes
primary lung tumours invading major vessels in
the chest such as Superior Venacava and head and
neck vessels as well as invasive thymomas which
normally involves the superior venacava and the
brachiocephalic vessels, in addition a small group of
lung cancers are respectable with the exception of
involvement of the left atrium and again a portion of
left atrium may be excised to give a clear margin.
We present a group of patients who had resection
and reconstruction of a variety of vascular structures,
including Superior Venacava, Brachiocephalic vein,
Subclavian artery, Left Atrium and Pulmonary artery.
Despite the technically complex nature of these
operations we believe that they are justified if the
thoracic malignancy is totally resectable otherwise.
Reference
1. Adapted from Mountain, CF, Chest 1997; 111:1710
K Doddakula, T Akbar,
M El Siddig, A Raza,
V Young
Dept of Cardiothoracic
Surgery, St James’s
Hospital, Dublin
K Doddakula,
W Ahmed, T Akbar,
I Chong, V Young
Dept of Cardiothoracic
Surgery, St James’s
Hospital, Dublin
K Doddakula,
W Ahmed, T Akbar,
I Chong, V Young
Dept of Cardiothoracic
Surgery, St James’s
Hospital, Dublin
44 IRISH JOURNAL OF MEDICAL SCIENCE • VOLUME 174 • NUMBER 4 • SUPPLEMENT 3
IRISH JOURNAL OF MEDICAL SCIENCE • VOLUME 174 • NUMBER 4 • SUPPLEMENT 3 45