Pleuro-pulmonary surgery

 

includes conventional pleuro-pulmonary surgery but increasingly focuses on complex operations using new techniques developed at the CCML.

 

Ablation of lung tumours encroaching on the tracheobronchial bifurcation, the superior vena cava, the chest wall and the pleuro-pulmonary apex (syndromes of Pancoast and Tobias).

 

Only the CCML is capable of performing many of these complex operations, the long-term outcomes of which are excellent.

 

Surgery to repair the sequelae of tuberculosis or to treat pulmonary aspergillosis is still a complicated undertaking, meaning that patients are referred to the CCML from all over France because so few teams have experience in this type of surgery.

 

Mediastinal tumour surgery

 

A special technique to remove malignant mediastinal tumours necessitating the replacement of vascular structures has been used since 1980.

 

These tumours invade the superior vena cava which has to be replaced with a prosthesis. Such extended resection surgery is relevant to thymoma, undifferentiated mediastinal tumours, sarcoma and malignant carcinoid tumours.

 

Surgery on the chest wall

 

Primary tumours of the chest wall (sternum, ribs, even vertebral expansion), and post-radiotherapy (notably for breast cancer) parietitis can be resected using procedures developed-including some developed at the CCML-over the last fifteen years.

 

Tracheolaryngeal surgery

 

Stenosis of the Tracheolaryngeal junction require a combination of chest and ENT surgical techniques.

 

Oeso-tracheal fistulae, common after artificial respiration.

 

Resection-reconstruction of the tracheobronchial bifurcation.

 

Tumours of the cervico-mediastinal junction: this type of surgery is performed in our department in collaboration with cervico-facial surgeons from the Institut Gustave Roussy.

 

Oesophageal surgery:

 

Oesophageal disease covers bulky diaphragmatic hernia repair (with or without associated gastro-oesophageal reflux), the removal of benign or malignant oesophageal tumours, and damage to or rupture of the oesophagus.

 

Vascular surgery:

 

The CCML can perform operations on all vessels from the right aortic arch as far as the distal arteries of the lower limbs (apart from varicose vein ablation). Endovascular procedures (dilatation, stenting, aortic stenting) are performed in collaboration with vascular radiologists. Combined procedures are performed in a special room.

 

Emergency surgery for chest injury & vessel repair:

 

The technical resources available at the CCML attracts many patients for emergency surgery for chest injury & vessel repair, be it rupture of the aorta or major vessels of the chest, rupture of the trachea or bronchi, heart damage, rupture of an aneurysm in the thoraco-abdominal aorta, or rupture of the diaphragm.

 

Lung & heart-lung transplantation:

 

Our transplantation team is one of the few (together with Pittsburgh and Bordeaux) with genuine experience in all three types of lung tranplantation:

 

At the CCML, 70 % of all transplantation procedures are for pulmonary arterial hypertension and is the Centre that performs the greatest number of this type of operation.

 

Surgery to manage acute and chronic pulmonary thromboembolism

 

A pulmonary endarteriectomy programme with circulatory arrest in deep hypothermia to correct post-embolism pulmonary hypertension was undertaken in direct collaboration the Department of Lung Diseases of the Hôpital Antoine Béclère.

 

The CCML has become the leading European centre for the treatment of chronic pulmonary thromboembolic disease. It is the only Centre in France capable of this spectacular operation.

 

Surgery to manage respiratory failure

 

Our lung transplantation programme has attracted a large number of patients with emphysema. Instead of undergoing transplantation, some of these prove eligible for surgical ablation of the emphysematous bullae or a reduction in lung volume (for non-bullous emphysema).

 

Intercurrent diseases:

 

Thanks to close collaboration between the Adult Heart and Congenital Heart Defect Surgery Departments, heart problems coupled with pulmonary conditions can be treated in a single operation performed by teams working in parallel.