Efficacy of intra-operative unilateral diaphragm plication for patients undergoing unilateral phrenicotomy during extended surgery

Our plain-English summary of Efficacy of intra-operative unilateral diaphragm plication for patients undergoing unilateral phrenicotomy during extended surgery, by T. Tokunaga, N. Sawabata, Y. Kadota, et al (European Journal of Cardio-thoracic Surgery, 2010).

The study

• Authors: T. Tokunaga, N. Sawabata, Y. Kadota, T. Utsumi, M. Minami, M. Inoue, M. Ohta, M. Okumura
• Journal: European Journal of Cardio-thoracic Surgery
• Published: 2010;38(5):600-3
• Cited by: 14 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objective: Diaphragm plication is used to improve lung function and respiratory insufficiency in patients suffering from diaphragm paralysis. We assessed the efficacy of intra-operative unilateral diaphragm plication for prevention of postoperative pulmonary complications in patients, who underwent a phrenicotomy due to extended surgical intervention.

Methods: Intra-operative unilateral diaphragm plication was performed in 13 patients, who underwent a unilateral phrenicotomy during an extended thoracic operation. Six patients had lung cancer, six had a mediastinal tumour and one had a mesothelioma. We retrospectively observed the postoperative clinical courses in the perioperative period and lung function results at 1 year after operation. The postoperative lung function was compared with the predicted postoperative lung function. In addition, we observed clinical symptoms and radiological findings of the follow-up period.

Results: Ten (77%) of the cases revealed no postoperative complications, while three (23%) had pulmonary complications and two (15%) required prolonged mechanical ventilation. Diaphragm paralysis was not shown clinically and radiologically during the follow-up period. Postoperative lung function was similar to predicted postoperative lung function.

Conclusion: Unilateral diaphragm plication in a patient undergoing a unilateral phrenicotomy during an extended thoracic operation is effective to prevent postoperative pulmonary complications and to preserve postoperative lung function.

Copyright © 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

In plain English

This retrospective observational study covered 13 patients (11 males, two females, median age 55 years) at Osaka University Hospital, Japan, between June 2000 and September 2002. During extended chest operations for tumours, each had a phrenic nerve cut on one side (unilateral phrenicotomy). The phrenic nerve controls the diaphragm. During the same operation, surgeons stitched that side of the diaphragm tighter (diaphragm plication). Six patients had lung cancer, six had a mediastinal tumour and one had a mesothelioma. The article does not discuss asbestos. Three of the 13 patients had what the authors called pulmonary complications (re-expansion pulmonary oedema, vocal cord oedema and pneumonia). Two of them needed a breathing machine for more than 7 days. Eight patients were tested at 1 year. In them, vital capacity averaged 88.2% and FEV1.0 (air forcibly breathed out in one second) averaged 98.5% of the values predicted after allowing for the lung removed. No symptoms or X-ray findings of diaphragm paralysis were seen during follow-up. The authors concluded that the procedure was effective. They noted the study had no randomisation and no control group.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective observational study (case series) with no control group
• Who was studied: 13 patients (11 males, 2 females, median age 55 years, range 12 to 69) who had a unilateral phrenicotomy during extended thoracic surgery at Osaka University Hospital, Japan, between June 2000 and September 2002. Six had lung cancer, six had a mediastinal tumour and one had a mesothelioma.
• Exposure: No asbestos exposure was studied. The intervention was intra-operative unilateral diaphragm plication using a mattress suture. It was performed during extended resections that included cutting the phrenic nerve on one side.
• Main results:
  • Pulmonary complications, as the authors classed them, occurred in 3 of the 13 patients: re-expansion pulmonary oedema, vocal cord oedema and pneumonia.
  • Two of the 13 patients (cases 3 and 8) needed mechanical ventilation for more than 7 days.
  • Eight patients had lung function tests at 1 year. In them, measured vital capacity averaged 88.2% of predicted postoperative vital capacity (range 66.4% to 106%). The predicted value was calculated from preoperative values, allowing for the resected lung subsegments.
  • In the same 8 patients, measured FEV1.0 (forced expiratory volume in 1 second) averaged 98.5% of predicted postoperative FEV1.0 (range 72.5% to 122%).
  • During follow-up, no clinical symptoms or radiological findings related to diaphragm paralysis were seen.
• The authors' conclusion: The authors concluded that unilateral diaphragm plication is effective to prevent postoperative pulmonary complications in patients who undergo a unilateral phrenicotomy during extended surgery.
• Limitations the authors state:
  • There was no randomisation.
  • There was no control group.

Topics

Medical terms in this study, explained in our Lexicon: Diaphragm, Lung Cancer, Mesothelioma.

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