Abstract
Background
Extensive clinical experience has demonstrated the potential usefulness of autologous
fat tissue (AFT) graft in tissue reconstruction, repair or regeneration. In the present
study, we evaluated the feasibility and safety of AFT in the repair of surgically
injured lung surface.
Methods
Eighty consecutive procedures of pulmonary metastasectomy by laser precision resection,
were performed in 66 patients between March 2010 and December 2012. In the first 20
procedures, AFT graft was applied on the wounded pulmonary surface without closure
of parenchymal surface. The following 40 procedures were carried on without AFT (20
leaving the resection margins open and 20 closing the resection margins with a running
suture). In the remaining 20 procedures, AFT was applied and the resection margins
closed. The efficacy of this technique was evaluated by comparing the AFT group with
the non-AFT group, with respect to prolonged alveolar air leakage (PAAL), time to
drain removal, length of hospital stay, and patient survival at four years.
Results
The occurrence of PAAL was lower in the AFT group as compared to non-AFT group (17.5%
versus 42.5%, p = 0.027), and median time to drain removal shorter (4 versus 6 days
respectively, p = 0.016). Overall 4-year survival was 70% for AFT group, and 59% for
non-AFT group (p = 0.34).
Conclusions
This prospective cohort observational study demonstrated the feasibility and safety
of AFT pulmonary grafting after laser metastasectomy. AFT graft improved pulmonary
healing, by reducing the incidence and severity of PAAL. Moreover, there was no evidence
of tumor promotion in the metastatic setting, with a similar overall survival at 4
years.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Surgical OncologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- A Fett transplantation.Verl Dtsch Ges Chir. 1893; : 666
- Long-term survival of fat transplants: controlled demonstrations.Aesthet Plast Surg. 1995; 19: 421-425
- Structural fat grafting.Aesthet Surg J. 1998; 18: 386-388
- Autologous fat transplantation.Plast Reconstr Surg. 1991; 88: 736
- Structural fat grafting.in: Nahai F. The art of aesthetic surgery: principles & techniques. Quality Medical Publishing, St. Louis, Mo2005: 289-363
- Structural fat grafting.Quality Medical Publishing, St. Louis, Mo2004: 30-175
- Clinical treatment of radiotherapy tissue damage by lipoaspirate transplant: a healing process mediated by adipose-derived adult stem cells.Plast Reconstr Surg. 2007; 119 (discussion 1423): 1409-1422
- Human fat grafting alleviates radiation skin damage in a murine model.Plast Reconstr Surg. 2011; 128: 363-372
- Adipose tissue displays trophic properties on normal lung cellular components without promoting cancer cells growth.J Cell Physiol. 2013; 228: 1166-1167
- Long-term results of lung metastasectomy: prognostic analyses based on 5206 cases.J Thorac Cardiovasc Surg. 1997 Jan; 113: 37-49
- Lung metastasectomy: why, when, how.Crit Rev Oncol Hematol. 1997; 26: 137-145
- Muscle-sparing thoracotomy.Ann Thorac Surg. 1989; 47: 330
- Experimental and clinical evaluation of a new synthetic, absorbable sealant to reduce air leaks in thoracic operations.J Thorac Cardiovasc Surg. 1999 Apr; 117: 751-758
- WINPEPI updated: computer programs for epidemiologists, and their teaching potential.Epidemiol Perspect Innov. 2011; 8: 1
- Uniform requirements for manuscripts submitted to biomedical journals.Ann Intern Med. 1997; 126 (International Committee of Medical Journal Editors): 36-47
- Multilineage cells from human adipose tissue: implications for cell-based therapies.Tissue Eng. 2001; 7: 211-228
- Adipogenic potential of adipose stem cell subpopulations.Plast Reconstr Surg. 2011; 128: 663-672
- Secretion of angiogenic and antiapoptotic factors by human adipose stromal cells.Circulation. 2004; 109: 1292-1298
- Plasticity of human adipose lineage cells toward endothelial cells: physiological and therapeutic perspectives.Circulation. 2004; 109: 656-663
- Intrinsics and dynamics of fat grafts: an in vitro study.Plast Reconstr Surg. 2010; 126: 1155-1162
- Discussion the volumetric analysis of fat graft survival in breast reconstruction.Plast Reconstr Surg. 2013; 131: 192-193
- Mega volume autologous fat transfer: part I. Theory and principles.Plast Reconstr Surg. 2014; 133: 550-557
- Mesenchymal stem cells derived from human adipose tissues favor tumor cell growth in vivo.Stem Cells Dev. 2008; 17: 463-473
- Degeneration, regeneration, and cicatrization after fat grafting: dynamic total tissue remodeling during the first 3 months.Plast Reconstr Surg. 2014; 133: 303e-313e
- Fat grafting accelerates revascularisation and decreases fibrosis following thermal injury.J Plast Reconstr Aesthet Surg. 2012; 65: 219-227
- Airtightness of lung parenchyma without a closing suture after atypical resection using the Nd:YAG Laser LIMAX 120.Interact Cardiovasc Thorac Surg. 2014; 18: 92-95
- Air leaks after lobectomy increase the risk of empyema but not of cardiopulmonary complications: a case-matched analysis.Chest. 2006; 130: 1150-1156
- Does external pleural suction reduce prolonged air leak after lung resection? Results from the AirINTrial after 500 randomized cases.Ann Thorac Surg. 2013; 96: 1234-1239
- General features of pulmonary resections.in: Shields T.W. LoCicero J. Reed C.E. Feins R.H. General thoracic surgery. 7th ed. Lippincott Williams & Wilkins, Philadelphia, PA2009: 401-411
- Surgical sealant for the prevention of prolonged air leak after lung resection: meta-analysis.Ann Thorac Surg. 2010; 90: 1779-1785
- Mechanisms of healing in the injured lung treated with the Nd-YAG laser.Lasers Surg Med. 1987; 6: 574-580
- Pulmonary resections: cytostructural effects of different-wavelength lasers versus electrocautery.Tumori. 2012; 98: 90-93
- Investigations of initial airtightness after non anatomic resection of lung parenchyma using a Thulium-doped laser with different optical fibers.Laser Med Sci. 2016; https://doi.org/10.1007/s10103-016-1952-5
- A prospective randomized trial comparing stapler and laser techniques for interlobar fissure completion during pulmonary lobectomy.Lasers Med Sci. 2013; 28: 505-511
- Thulium laser versus staplers for anatomic pulmonary resections with incomplete fissures: negative results of a randomized trial.Tumori. 2014; 100: 259-264
- Peritoneal free autologous fat graft for the control of pulmonary air leaks in emphysematous rat lungs.Ann Thorac Surg. 2014 Jul; 98: 271-276
Article info
Publication history
Published online: October 16, 2017
Accepted:
September 18,
2017
Identification
Copyright
© 2017 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
