Association of major postoperative wound and anastomotic complications in thoracic surgery with COVID-19 infection.

Background: One of the most uncommon manifestations of perioperative Covid-19 infection is impaired wound healing. The aim of this study is to present previously unreported observation of thoracotomy and esophageal anastomosis dehiscence in the course of Covid-19 infection after uncomplicated thoracic surgeries. Methods: This is a single-center study describing unusual wound and anastomosis complications in COVID-19 patients after uncomplicated thoracic surgeries. Medical data was prospectively collected and retrospectively reviewed. All patients admitted to the hospital were symptom free and tested negative for COVID-19 infection preoperatively. Clinical courses were compared to a non-infected control group from historical data. Results: The total of 14 patients were included. Study group involved 7 patients with major wound and anastomosis complications concurrent with COVID-19 infection. Control group was composed of 7 patients matched with the type of surgeries and treated before Coronavirus pandemic. Surgeries included lung transplantations, lung cancer surgeries and esophagectomies. The mean age of the study group was 65.7 years. Major wound and anastomosis complications occurred 13.6 days postoperatively while the mean time of Covid-19 detection was 21 days. The course of infection varied from mild to very severe which resulted in 3 deaths due to COVID-19 induced ARDS. The mean time of hospital stay was 40,9 days. There were no differences between both groups in baseline characteristics while hospitalization time was significantly longer in the study group. Conclusions: COVID-19 infection should be included in differential diagnosis in postoperative patients with major wound or anastomosis complications.

Target volume for postoperative radiotherapy in non-small cell lung cancer: results from a prospective trial.

BACKGROUND AND PURPOSE: A previous prospective trial reported that three-dimensional conformal postoperative radiotherapy (PORT) for pN2 NSCLC patients using a limited clinical target volume (CTV) had a late morbidity rate and pulmonary function that did not differ from those observed in pN1 patients treated with surgery without PORT. The aim of this study was to assess locoregional control and localization of failure in patients treated with PORT. MATERIALS AND METHODS: The pattern of locoregional failure was evaluated retrospectively in 151 of 171 patients included in the PORT arm. The CTV included the involved lymph node stations and those with a risk of invasion >10%. Competing risk analysis was used to assess the incidence of locoregional failure and its location outside the CTV. RESULTS: Overall survival at 5years was 27.1% with a median follow-up of 67months for 40 living patients. The 5-year cumulative incidence of locoregional failure was 19.4% (95% CI: 18.2-20.5%) including a failure rate of 2% (95% CI: 0-17%) in locations outside or at the border of the CTV. CONCLUSIONS: The use of limited CTV was associated with acceptable risk of geographic miss. Overall locoregional control was similar to that reported by other studies using PORT for pN2 patients.

[Surgical treatment of malignant lung tumors in solid organ recipients]. / Leczenie operacyjne nowotworów pluc u biorców przeszczepów narzadów litych.

Diagnostic difficulties, serious prognosis and often insufficient response to treatment are all common features of pulmonary complications in solid organ recipients. Some of these complications need invasive diagnostic procedures and surgical treatment or prolonged pharmacological treatment. Tuberculosis, Pneumocystis and fungal infections are examples of infectious complications. Primary lung cancer or metastasis to the lungs developed shortly after solid organ transplantation are oncological complications. Infectious and noninfectious complications are connected with immunosuppression. Treatment of pulmonary complications in solid organ recipients and continuation of immunosuppression therapy can be challenge for therapeutic team. This article presents five cases (2 women and 3 men) of solid organ recipients treated in department of the authors due to lung neoplasms. Four of them were liver recipients and one was recipient of heart. Three patients were treated due to primary lung cancer, additionally in one of them metastasis of lung cancer occurred, two suffered from metastasis of liver cancer (hepatocellular carcinoma) to the lungs. Four patients underwent 6 operation: 2 lobectomies with lymphadenectomy, 1 segmentectomy with lymphadenectomy, 1 bilateral metastasectomy of HCC and 1 metastasectomy of lung cancer. In all cases of primary lung cancer pathological examination revealed squamous cell carcinoma. Immunosuppression schedule, perioperative courses and infectious complications (tuberculosis, disseminated infection, infection of biliary tract, oesophageal candidiasis) in this group were described. All of them were smokers.

Cardiopulmonary morbidity and quality of life in non-small cell lung cancer patients treated with or without postoperative radiotherapy.

AIM: To prospectively assess the cardiopulmonary morbidity and quality of life in patients with non-small cell lung cancer (NSCLC) treated with postoperative radiotherapy (PORT) in comparison to those not receiving PORT. MATERIALS AND METHODS: From 2003 to 2007, 291 patients entered the study; 171 pN2 patients received 3D-planned PORT (PORT group), 120 pN1 patients (non-PORT group) did not. One month after surgery, all patients completed EORTC QLQ C-30 questionnaire and had pulmonary function tests (PFT); cardiopulmonary symptoms were assessed by modified LENT-SOM scale. Two years later, disease-free patients repeated the same examinations. The differences between baseline values and values recorded at two years in QLQ, LENT-SOM and the PFT of the two groups were compared. RESULTS: In the whole cohort, the rate of non-cancer related deaths was 5.3% and 5.0% in PORT and non-PORT group, respectively. Ninety-five patients (47 - PORT group, 48 - non-PORT group) were included into the final analysis. The differences in the QLQ and cardiopulmonary function (LENT/SOM, PFT) between both groups were insignificant. The forced expiratory volume in one second was on average 12.2% and 1.3% better in the PORT and the non-PORT group, respectively, p=0.2. CONCLUSIONS: Our findings support the hypothesis about insignificant morbidity of 3D-planned PORT.