Papers by Pierre-Emmanuel Falcoz
surgical stabilization improve outcomes in patients with isolated
Objective: Bronchial ischemia is a frequent problem encountered after lung transplantation. The r... more Objective: Bronchial ischemia is a frequent problem encountered after lung transplantation. The resulting stenosis will delay functional recovery of the graft, reduce effective secretions drainage and lead to repetitive invasive endoscopy sessions before complete healing. The aim of our study was to identify risk factors for bronchial ischemia in a multi-centric study of single-lung transplantations. Method: With the agreement of 10 French centers, we recorded all single-lung transplantations performed between 1998 and 2008 especially 180 twinned recipients. According to that model, we compared characteristics of paired recipients presenting a discordant evolution of bronchial anastomosis. We recorded recipient age at the time of transplantation, respiratory disease and transplantation indication, nutritional state by body mass index (BMI), duration of cold ischemia, side of transplantation and immunosuppressive treatment. In our model, harvesting and graft preservation are identica...
Current Challenges in Thoracic Surgery
In general thoracic surgery, extracorporeal mechanical cardio-respiratory support (EMCS) techniqu... more In general thoracic surgery, extracorporeal mechanical cardio-respiratory support (EMCS) techniques are performed intraoperatively mainly for respiratory but also for cardiocirculatory support. The increasing panel of EMCS technologies available in thoracic surgery is the result of a century of clinical practices, engineering progress, and improvements of physiological knowledge. Complex procedures of tumor resection, traqueal and main airway surgery or lung transplantation are the scenarios where these techniques should be considered if needed. The aim of this review is to describe different modalities of EMCS used in general thoracic surgery with a particular attention to the cannulation techniques. Venovenous extracorporeal membrane oxygenation (VV-ECMO) is the most common EMCS modality and represents the most efficient in supporting lung function. Venoarterial ECMO (VA-ECMO) may be achieved in both central and peripheral cannulation. Central VA-ECMO is the main modality for intraoperative emergent support, which brought a decrease in popularity of classic cardiopulmonary bypass (CPB) due to lower risk of complications. Peripheral VA-ECMO is traditionally performed in a femorofemoral configuration. Extracorporeal CO 2 removal (ECCO 2 R) and Novalung are marginal alternatives for intraoperative support during general thoracic surgery. Although rarely used, ECMS techniques should be part of every general thoracic surgeon armamentarium and should be brought to mind in complex cases or in emergency settings.
European Journal of Cardio-Thoracic Surgery
European Journal of Cardio-Thoracic Surgery
OBJECTIVES We report an overview of surgical practices and outcomes in patients undergoing pulm... more OBJECTIVES We report an overview of surgical practices and outcomes in patients undergoing pulmonary metastasectomy based on data from the European Society of Thoracic Surgeons database. METHODS We retrieved data on resections performed for pulmonary metastases between July 2007 and July 2019. We evaluated baseline characteristics, surgical management and postoperative outcomes. Open and video-assisted thoracic surgery (VATS) procedures were compared in terms of surgical management, morbidity and mortality. RESULTS We selected 8868 patients [male/female 5031/3837; median age: 64 years (interquartile range 55–71)] who underwent pulmonary metastasectomy. Surgical approach consisted of open thoracotomy in 63.5% of cases (n = 5627) and VATS in 36.5% (n = 3241), with a conversion rate of 2.1% (n = 69). Surgical resection was managed by wedge or local excision in 61% (n = 5425) of cases and anatomical resection in 39% (n = 3443); lobectomy: 26% (n = 2307); segmentectomy: 11% (n = 949); ...
Journal of Thoracic Disease
PE. VATS lobectomy vs. open lobectomy for early-stage lung cancer: an endless question-are we clo... more PE. VATS lobectomy vs. open lobectomy for early-stage lung cancer: an endless question-are we close to a definite answer? J
Journal of Thoracic Disease
Journal of Thoracic Disease, Dec 1, 2019
PE. VATS lobectomy vs. open lobectomy for early-stage lung cancer: an endless question-are we clo... more PE. VATS lobectomy vs. open lobectomy for early-stage lung cancer: an endless question-are we close to a definite answer? J
Journal of Thoracic Disease, Oct 1, 2018
European Journal of Cardio-Thoracic Surgery
OBJECTIVES The performance of prediction models tends to deteriorate over time. The purpose of th... more OBJECTIVES The performance of prediction models tends to deteriorate over time. The purpose of this study was to update the Thoracoscore risk prediction model with recent data from the Epithor nationwide thoracic surgery database. METHODS From January 2016 to December 2017, a total of 56 279 patients were operated on for mediastinal, pleural, chest wall or lung disease. We used 3 recommended methods to update the Thoracoscore prediction model and then proceeded to develop a new risk model. Thirty-day hospital mortality included patients who died within the first 30 days of the operation and those who died later during the same hospital stay. RESULTS We compared the baseline patient characteristics in the original data used to develop the Thoracoscore prediction model and the validation data. The age distribution was different, with specifically more patients older than 65 years in the validation group. Video-assisted thoracoscopy accounted for 47% of surgeries in the validation grou...
Lung cancer
Objective: Our study aims at assessing the outcomes and survival after completion pneumonectomy (... more Objective: Our study aims at assessing the outcomes and survival after completion pneumonectomy (CP) for non-small cell lung cancer (NSCLC). Methods: We restrospectively recorded all CP performed in our centre for NSCLC from January 1st,1999 to December 31st, 2015. Immediate post-operative outcome and overall survival were studied. Results: A total of 48 patients underwent CP. All patients had a previous pulmonary resection for NSCLC except for one with previous benign disease. Most of patients were male (81,3%), and weaned smoker (70.8%). Ten (20,8%) patients received neo-adjuvant chemotherapy. A post-operative complication occurred in 62,5% patients: haemorrhage requiring blood transfusion (33,3%), lung infection (16,7%), recurrent nerve paralysis (10,4%), and atrial fibrillation (8,3%). Only 6,3% of patients required a re-operation for bleeding. None of the patients presented with bronchopleural fistula as a post-operative complication of CP. Inhospital mortality occurred in four (8,3%) patients. Despite the need for CP, 35,4% of patients had a stage I disease, and 43.8% had a stage II disease. Recurrence occurred in 47,9% of patients with a mean disease-free survival of 11 months. Mean overall survival following CP reached 45 months (>3 years). Conclusions: In experienced hands, CP is a safe curative treatment for NSCLC. Despite its complications, the mortality rate was low. A further prolonged overall survival was offered by CP to patients who already had a previous NSCLC treated with surgery.
Journal of Thoracic Disease
Transplantation Proceedings
OBJECTIVE To study patient survival and glycemic control before and after lung transplantation (L... more OBJECTIVE To study patient survival and glycemic control before and after lung transplantation (LTx) according to the diabetes status in patients submitted to an organized management of diabetes mellitus (DM) at the Strasbourg University Hospital, France. MATERIAL AND METHODS Two hundred and sixty-seven LTx recipients were included retrospectively and analyzed according to diabetes status: pretransplant diabetes, new-onset diabetes mellitus after transplant (NODAT) or no diabetes. Organized DM management was coordinated by a diabetologist trained in DM management before and after transplantation and included pretransplant screening, a close monitoring of glycemia after transplant and optimized treatment before and after LTx. RESULTS DM was well-controlled after transplantation: mean glycosylated hemoglobin and fasting blood glucose levels after LTx were 5.8 ± 0.2% and 5.4 ± 0.1 mmol/L respectively, in pretransplant DM patients and 5.7 ± 0.1% and 5.6 ± 0.2 mmol/L respectively, in NODAT patients. The overall median survival time was 8.3 ± 1.9 years. Pretransplant DM increased the risk of mortality (1.82-fold increase; 95% confidence interval, 1.08-3.06; P = .02) in LTx recipients. CONCLUSIONS Organized management of diabetes achieved very satisfactory glycemic control in both pretransplant DM and NODAT patients. However, no specific protocols have been created for managing DM following LTx. As DM continues to become an increasing comorbidity in LTx, there exist a significant need of studies in this area.
Interactive CardioVascular and Thoracic Surgery
OBJECTIVES: A small number of patients with advanced pulmonary adenocarcinomas treated with tyros... more OBJECTIVES: A small number of patients with advanced pulmonary adenocarcinomas treated with tyrosine kinase inhibitors (TKIs) was subsequently considered eligible for surgery. Our goal was to report the clinical characteristics, pathological features and prognosis of these patients with the aim of exploring the feasibility of this strategy of care. METHODS: We retrospectively reviewed the medical files of 19 patients in whom systemic treatment, including TKIs, resulted in a possible stabilization of the disease such that they were considered eligible for surgery (adjuvant surgery). RESULTS: Lobectomy, pneumonectomy or segmentectomy was performed in 68.4%, 26.3% and 5.3% of cases, respectively. Limited fibrotic tissues were detected intraoperatively in 8 patients who received TKIs as the sole systemic treatment. The postoperative course in the hospital was uneventful in 13 (68.4%) cases; 3 (15.8%) patients suffered major complications. The post-pneumonectomy early morbidity rate was 60%. A pathological analysis of the tumours showed that the median rate of fibrosis was 32.5% (0-100); of viable neoplastic tissue, 25.0% (0-90); and of necrosis, 12.5% (0-80%). Four tumours (21.1%) exhibited no viable tumour cells. The fibrosis ratio was higher in patients older than 60 years (P = 0.01) and in those treated with erlotinib (P = 0.03). The 3-and 5-year overall survival and disease-free survival rates were 79.5%/39.8% and 44.4%/29.6%, respectively. Pneumonectomy and <50% fibrosis or >30% viable tumour cells in the pathological specimens were factors significantly associated with lower disease-free survival. CONCLUSIONS: In a subset of highly selected patients, adjuvant lung surgery following treatment with TKI showed a large spectrum of histological changes in the pathological specimens and encouraging preliminary survival results. Pending further research, it may prove a relatively reliable and safe therapeutic choice, except when an extensive resection like a pneumonectomy is planned.
Journal of Visualized Surgery
Metastasectomy is steadily gaining place in the arsenal of treatments of patients suffering from ... more Metastasectomy is steadily gaining place in the arsenal of treatments of patients suffering from lung metastasis of colorectal carcinoma (CRC). Meanwhile thoracotomy has been the gold standard approach during years for lung metastasectomy of CRC, the use of video-assisted thoracic surgery (VATS) in this field is currently thriving. Indeed, in addition of known advantages of minimally-invasive surgery, VATS has shown equivalent oncologic outcomes in comparison to open techniques. Otherwise, several questions in the management of these particular patients remained unsolved. In particular, only few studies have explored the role of anatomical resections (i.e., segmentectomy/lobectomy/pneumonectomy) compared to wedge resections. Despite their low level of evidence, these studies highlight interesting preliminary results, in particular a survival advantage of anatomical resections over non-anatomical. Most recent works have even suggested a potential role of molecular markers to select candidates who would benefit from an anatomical resection.
Journal of Thoracic Disease
Background: Surgical repair has demonstrated a beneficial effect on outcome for patients presenti... more Background: Surgical repair has demonstrated a beneficial effect on outcome for patients presenting with flail chest or with multiple rib fractures. We hypothesized that benefit on outcome parameters concerns predominantly patients being extubated within 24 hours post-operatively. Methods: We prospectively recorded all patients presenting with chest traumatism eligible for surgical repair with anticipated early extubation according to our institutional consensus (flail chest, major deformity, poor pain control, associated lesions requiring thoracotomy). We compared outcomes of patients extubated within 24 hours post-operatively to those who required prolonged ventilator support. We tested predictive factors for prolonged intubation with univariate and multivariate analysis. Results: From 2010 to 2014, 132 patients required surgical repair. Two thirds were extubated within 24 hours following surgical repair. Pneumonia was the main complication and occurred in 30.3% of all patients. Patients extubated within 24 hours following surgical repair had significantly shorter ICU stay and shorter in-hospital stay (P<0.0001 both). Pneumonia occurred significantly more often in patients with longer mechanical ventilation (over 24 hours) (P<0.0001) and the overall post-operative complications rate was higher (P=0.0001). Main independent risk factors for delayed extubation were bilateral chest rib fractures and initially associated pneumothorax. Conclusions: We conclude that patients extubated within 24 hours after repair have an improved outcome with reduced complication rate and shorter hospital stay. The initial extent of the trauma is an important risk factor for delayed extubation and high complication rate despite surgical stabilization.
Lietuvos chirurgija
Sternal pseudoarthrosis after resternotomy treated with the Strasbourg Thoracic Osteosyntheses Sy... more Sternal pseudoarthrosis after resternotomy treated with the Strasbourg Thoracic Osteosyntheses System: a case report Sternal dehiscence is a serious complication after general thoracic and cardiac surgery. Sternal resuturing, performed by simple rewiring or technical modification of rewiring, can fail overall when the bone quality is poor or the sternum is completely destroyed. A number of different sternal closure systems consisting of plates, screws, clips, and titanium bars have been recently introduced to treat the complicated sternal dehiscence. We describe the use of the Strasbourg Thoracic Osteosyntheses System (STRATOS) to treat complicated sternal dehiscence causing chest and back pain, sternum and chest instability, which was applied for the first time in Lithuania.Key words: sternotomy, sternal pseudoarthrosis, sternal osteosynthesis, chest instability, STRATOS.
Journal of thoracic disease, 2018
The European Society of Thoracic Surgeons (ESTS) thymic database is a satellite database of the E... more The European Society of Thoracic Surgeons (ESTS) thymic database is a satellite database of the ESTS registry collecting patients with thymic tumors (thymomas, thymic carcinomas and neuroendocrine thymic tumors) among the ESTS Institutions. The database is free of charge for any ESTS member, easily accessible to any ESTS institution, web-based, prospective, periodically maintained and updated. It may serve as an institutional database for the storage of data about patients with thymic tumors at no cost for each participating institution. It may be used by any ESTS member to propose studies using one of the largest thymic databases worldwide. The present review focuses on the history and the development of the ESTS thymic database (retrospective and prospective) and its structure with a particular reference to the concept of the minimum dataset and the Clinical Care Analysis (CCA) box. A brief overview about the role of the ESTS thymic database in the global effort for the new TNM st...
Journal of thoracic disease, 2018
Registering details of thoracic surgical activity has a long tradition in Hungary. Implemented fi... more Registering details of thoracic surgical activity has a long tradition in Hungary. Implemented first as a procedure based register, characteristics of the treatment, complications and outcomes has been noted for the last three decades. Although the limitations of the used database hindered the scientific analysis in the dataset and restricted the possibility of benchmarking. The European Society of Thoracic Surgeons (ESTS) database is offering a specialty-specific, procedure-specific, web-based electronic database for data contribution enabling international comparisons. Our aim was to accommodate and implement the ESTS database as the new Hungarian national thoracic surgical registry. In 2014, cooperation of the ESTS Database Committee and the Hungarian Society of Thoracic Surgery evolved a new structure for contributing national thoracic surgical data, called the ESTS database "Hungarian model". The European dataset was translated into Hungarian, extended questionnaire a...
Uploads
Papers by Pierre-Emmanuel Falcoz