Surgically treated lung cancer patients: do they all smoke and would they all have been detected with lung cancer screening?

Since publication of the National Lung Cancer Screening Trial (NLST) results early lung cancer detection has been widely studied, targeting individuals based on smoking history and age. However, over recent decades several changes in lung cancer epidemiology, including risk factors, have taken place. The aim of the current study was to explore smoking prevalence among lung cancer patients who had been treated surgically or undergone a diagnostic operation and whether these patients would have met the NLST inclusion criteria. All patients operated on for lung cancer in a university hospital in Estonia between 2009 and 2015 were included. Data were collected from hospital records. 426 patients were operated on for lung cancer, with smoking history properly documented in 327 patients (87 females; median age 67 years). 170 (52%) patients were smokers, 97 (30%) patients were ex-smokers and 60 (18%) patients were nonsmokers. The proportion of females among smokers was 15%, among ex-smokers was 9% and among nonsmokers was 87%. 107 of our patients would not have met the NLST age criteria and 128 of our patients would not have met the NLST smoking criteria. In total, 183 patients (56% (79% of females and 48% of males)) would not have met the NLST inclusion criteria. Only half of surgically treated lung cancer patients were current smokers and more than half did not meet the NLST inclusion criteria.

Resection of unicentric interlobar Castleman disease with following adjuvant radiotherapy.

A 22-year-old female patient with rare interlobar unicentric Castleman disease is presented. The tumour was discovered incidentally and thoracoscopic biopsy was planned to rule out malignancy. Due to dense adhesions to the adjacent anatomical structures and diffuse bleeding when mobilizing the tumour, a thoracoscopic approach was converted to thoracotomy. The tumour was removed without lung resection. Adjuvant radiotherapy was used to avoid possible recurrence of the disease. During the follow-up of 6 years, the patient remains free of any symptoms and evidence of recurrence.

Prospective study of percutaneous tracheostomy: Role of bronchoscopy and surgical technique.

OBJECTIVE: Percutaneous tracheostomy is a common procedure but varies considerably in approach. The aim of our study was to evaluate the need for intraoperative bronchoscopy and to compare various surgical techniques. METHODS: During 1 year all percutaneous tracheostomies in three intensive care units were prospectively documented according to a unified protocol. In one unit, bronchoscopy was used routinely and in others only during the study. RESULTS: A total of 111 subjects (77 males) with median age 64 (range, 18-86) years and body mass index 25.4 (range, 15.9-50.7) were included. In unit A, tracheal wall was directly exposed; in unit B, limited dissection to enable tracheal palpation was made. In both units, bronchoscopy was used to check the location of an already inserted guiding needle; needle position required correction in 8% and 12% of cases, respectively. In unit C, in tracheostomies without pretracheal tissue dissection, bronchoscopy was used to guide needle insertion; needle position required correction in 66% of cases. Median duration of operations performed by thoracic surgeons and residents was 10 (range, 3-37) min and by intensive care doctors and residents was 16.5 (range, 3-63) min (p < 0.001). Time from the beginning of preparations for tracheostomy until the end of the whole procedure was median 32 min for bedside tracheostomies and 64 min for operations in the operating theatre (p < 0.001). CONCLUSION: Limited pretracheal tissue dissection enabled proper guiding needle insertion and bronchoscopy was rarely needed. Percutaneous tracheostomies performed by thoracic surgeons took less time, and duration of the whole procedure was remarkably shorter when performed at bedside.