Association of the postoperative white blood cells (WBC) count in peripheral blood after radical surgical treatment of left upper lobe non-small cell lung cancer (NSCLC) with overall survival - single center results.

INTRODUCTION: The individual patient prognosis after radical surgery for Non-small cell lung cancer (NSCLC) of left upper lobe remains still unclear. The purpose of this study is to evaluate the predictive value of elevated white blood cell count in peripheral blood as early indicator of postoperative NSCLC prognosis. METHODS: A retrospective statistical analysis was performed studying patients subject to radical treatment of left upper lobe NSCLC in period of five years with subsequent one to three-year monitoring of morbidity and mortality of the patient population. The statistical ROC (Receiver Operating Characteristic) analysis of the WBC count in peripheral blood third day after the operation was used to evaluate the relationship with overall survival, with respect to patients surviving for at least 24 months. RESULTS: Based on the results of the ROC analysis with a total area under the curve (AUC) of 0.67, it is possible to confirm that the WBC count established third day after the operation allows us to classify patients into groups according to the 24-month overall survival. CONCLUSION: Our findings confirm the potential of using WBC count to improve current protocols to establish postoperative prognosis for NSCLC of the upper left lobe (Tab. 2, Fig. 1, Ref. 11).

[Our experience with chest wall stabilization]. / Nase zkusenosti se stabilizací hrudníku.

INTRODUCTION: An unstable chest wall is defined as a fracture of at least three adjacent ribs broken at least in two planes. As a result of impaired mechanical strength of the chest wall, paradoxical movements occur, resulting in insufficient pulmonary ventilation with the development of respiratory insufficiency with typical consequences - hypoxia, hypercapnia and acidosis. METHODS: In this paper we describe a group of 16 patients who underwent stabilization of the chest wall. The average age of the group was 56 years, the youngest patient was 23 and the oldest one 76 years old. There was an average of 6.1 broken ribs per patient, individually ranging from 4 to 8. In 11 cases, the stabilization was performed for a block fracture, in 5 cases for a serial fracture with a thoracic wall deformity. RESULTS: The average length of hospital stay was 19 days, the time from admission to surgery was 4.46 days, and the average duration of mechanical ventilation was 2.63 days. In our group, we had only one deep wound infection that was healed using vacuum therapy. Concerning other complications, there was one case of bronchopneumonia and one patient developed delirium. No redrainage for fluido- or pneumothorax was necessary. CONCLUSION: The main focus of this paper is on the active surgical approach to treatment of serial and block fractures of ribs with deformation or manifest instability of the chest wall. Not all patients with block fracture required stabilization, whereas 5 patients with serial fracture of the ribs were indicated for surgical revision for chest wall deformity and other complications.Key words: flail chest treatment indications.

[Initial experience with using uniportal VATS (SITS) to treat the implications of thoracic trauma in the 1st Department of Surgery of the Faculty of Medicine at Masaryk University and St. Annes Teaching Hospital in Brno]. / Iniciální zkusenosti s pouzitím "uniportal VATS (SITS)" prístupu pri osetrování dusledku hrudních traumat na I. chirurgické klinice LFMU a FNUSA v Brne.

Thoracic trauma represents a multidisciplinary therapeutic challenge requiring individualized approach to every patient. Continuous development and implementation of mini-invasive techniques in thoracic surgery pave way to so far unique attempts to establish video-assisted thoracic surgery for thoracic trauma as well. The indication is limited by hemodynamic stability of the patient, extent of the trauma, as well as by time required for the treatment. However, proper indication provides an unequivocal benefit in terms of postoperative pain, early mobilization and excellent cosmetic effect. Continuous reduction of the number of incisions down to monoportal approach is currently the peak of mini-invasive approach in thoracic trauma management. The aim of this work is to provide 3 case reports documenting the current spectrum of monoportal video-assisted surgery indication for thoracic trauma.Key words: uniportal VATS thoracic trauma.

[Assessment of thoracic trauma at the 1st Department of Surgery in Brno (1 January 2011 - 31 December 2015)]. / Poranení hrudníku na I. chirurgické klinice LF MU a FN USA v Brne (vyhodnocené období 1. 1. 2011 az 31. 12. 2015).

INTRODUCTION: The number of cases of thorax injury increased steadily between 2011 and 2015. This is probably related to a more active lifestyle of the younger generations and also to the increasing average age of citizens. The aim of the study was to show problems connected with thorax injury. METHOD: Our retrospective study evaluated a group of patients with thoracic injury (diagnosis codes S20-S29) in the period from 1 January 2011 to 31 December 2015 who were treated in our Department. RESULTS: We evaluated a group of 1,697 patients with thoracic injury were divided into five subgroups: 1) simple contusion of the thorax, 2) simple rib fractures, 3) contusion of the thorax with vertebral fractures, 4) serial, multiple rib fractures, 5) stab and gunshot injuries of the thorax. Each subgroup was analyzed independently and in detail. The number of thoracic injuries increased steadily, year on year. More than 40% of the patients were older than 60 years. In the group with simple rib fractures, the authors found 14 cases of pneumothorax (5.1%), which was drained in only 8 cases. The most common complications in the serial rib fractures group included pneumothorax (33 cases, 20%), hemothorax (28 cases, 16.9%) and lung contusion (15 cases, 9%). Stabilization of the thoracic wall was performed 16 times, out of the total of 26 multiple rib fracture cases (61.5%). CONCLUSIONS: Thorax injury is routinely encountered by surgeons. The authors recommend to pay particular attention not only to serious, but also to simple thorax injuries in very old patients, for instance those on anticoagulation therapy. Adequate caution also needs to be taken with serial rib fractures and flail chest and their treatment.Key words: thorax injury - rib fractures - hemothorax - pneumothorax.

[Multiple Primary Lung Cancer - a  Case Report and Literature Review]. / Vícenásobné nádorové onemocnení plic -  kazuistika a prehled literatury.

BACKGROUND: Multiple primary lung cancer is a relatively rare nosological entity. This case report is a reminder and points out the pitfalls of its diagnosis and therapy. CASE REPORT: A 62-year-old patient was indicated for surgical therapy for non-small cell lung cancer of the middle lobe and right lung, which were diagnosed during a screening investigation after the patient had undergone previous mastectomy of the right breast with axillary dissection for invasive ductal adenocarcinoma. Another infiltration in the lower lobe of the same lung was removed at the same time and was classified as a primary lung carcinoma; it was a synchronous lung cancer. CONCLUSION: Lung cancer presenting with more than one primary lesion in the lung is a rare nosological entity that can be classified into two types; synchronous and metachronous. Whereas synchronous cancers arise in the lung at the same time, metachronous cancers develop after treatment of the initial lesion. The incidence of multiple lung cancer is increasing due to earlier diagnosis and because successful treatment of the initial cancer at an early stage has led to an increase in patient survival, resulting in an increase in the interval between detection of the initial cancer and detection of the second. Smoking is one of the main risk factors. Diagnosis is made difficult because metastatic disease must be excluded. Basic information is obtained from a biopsy of the tumor. The staging of more than one primary lung cancer is complex and needs to be meticulous if curative resection is being contemplated. Magnetic resonance imaging of the brain and fluorodeoxyglucose positron emission tomography should be performed to evaluate for extra-thoracic metastases. KEY WORDS: lung carcinoma - multiple cancer disease - synchronous - metachronous - diagnosis - therapyThe authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.Submitted: 22. 2. 2016Accepted: 20. 4. 2016.

[Parametric monitoring of the quality of total mesorectal excision and surgical treatment of rectal carcinoma results of a multicenter study]. / Parametrické sledování kvality totální mezorektální excize a chirurgické lécby karcinomu rekta výsledky multicentrické studie.

INTRODUCTION: Tumour size and the quality of its complete surgical removal are the main prognostic factors in rectal cancer treatment. The number of postoperative local recurrences depends on whether the mesorectum has been completely removed - total mesorectal excision (TME) - and whether tumour-free resection margins have been achieved. The surgery itself and its quality depend on the accuracy of preoperative diagnosis and detection of risk areas in the rectum and mesorectum, on the surgeons skills, and finally on pathological assessment evaluating whether complete tumour excision has been accomplished including circumferential margins of the tumour, and whether mesorectal excision is complete. The aim of our study was to implement and standardize a new method of evaluation of the quality of the surgical procedure - TME - in rectal cancer treatment using an assessment of its circumferential margins (CRO) and completeness of the excision. METHODS: The study consisted of two parts. The first, multi-centre retrospective phase with 288 patients analysed individual partial parameters of the diagnosis, operations and histological examinations of the rectal cancer. Critical points were identified and a unified follow-up protocol was prepared. In the second, prospective part of this study 600 patients were monitored parametrically focusing on the quality of the TME and its effect on the oncological treatment results. RESULTS: The proportion of patients with restaging following neoadjuvant therapy increased from 60.0% to 81.7% based on preoperative diagnosis. The number of specimens missing an assessment of the mesorectal excision quality decreased from 52.9% in the retrospective part of to the study to 22.8% in the prospective part. The proportion of actually complete TMEs rose from 22.6% to 26.0%, and that of nearly complete TMEs from 10.1% to 24.0%. CONCLUSION: The introduction of parametric monitoring into routine clinical practice improved the quality of pre-treatment and preoperative diagnosis, examination of the tissue specimen, and consequently improved quality of the surgical procedure was achieved. KEY WORDS: rectal cancer TME - parametric monitoring - quality control.

[Rare discovery of metastasis of renal cell carcinoma in location of struma polynodosa]. / Raritní nález metastázy svetlobunecného karcinomu z renálních bunek v terénu polynodózní strumy.

Renal carcinoma metastasis to the thyroid gland is not particularly rare; the interval since the initial diagnosis in the case presented, that is, nephrectomy, is more of a rarity. We present the case of a 58-year-old man admitted to our hospital with the diagnosis of polynodular retrosternal goitre. Complete thyroidectomy by cervical approach was performed. Histological examination showed multiple metastases of conventional renal carcinoma located within colloid struma polynodosa. Postoperative progress was uneventful, the surgical wound healed per primam. Renal carcinoma metastasing to the thyroid gland is rather unusual and is often found only postoperatively.Key words: renal carcinoma - metastasis - thyroid gland.

[Intraoperative sentinel lymph node detection in colon cancer resection - preliminary results]. / Peroperacní detekce sentinelové uzliny pri resekci pro karcinom kolon - predbezné výsledky.

INTRODUCTION: The aim of this paper is to evaluate the results of intraoperative sentinel node detection in colon cancer patients and to compare the number of nodes retrieved per specimen in comparison with standard resection. METHODS: Patients undergoing elective colon cancer resection were included in the study. The specimen and the sentinel lymph node were sent for histopathological examination. A group of patients from 2011 who underwent elective resection served as the study control. RESULTS: The control group comprised 56 patients. The average node count was 12.73 (4-27). The study group included 102 patients; 29 patients had to be excluded because of protocol deviation. Out of the remaining 73 (46 male and 27 female) patients, 24 were N-positive and 2 of them were pN1c. In the remaining 22 patients, the sentinel node was positive in 8 cases, corresponding to a sensitivity of 36.36%. The average lymph node count was 15.97(3-30) after patent blue dye injection. CONCLUSION: Intraoperative sentinel lymph node detection is an easy and feasible method. Despite the low sensitivity, the main positive effect of the method is the increased lymph node count per resection specimen.

[Pathologic fluid collection of mesentery, differential diagnosis of mesenteric cysts - case report]. / Patologická tekutinová kolekce mezenteria, diferenciální diagnostika mezenteriální cysty - kazuistika.

Mesenteric cyst is a pathologic fluid collection that very rarely occurs anywhere in the mesentery of the gastrointestinal tract from the duodenum to the rectum. The etiology of mesenteric cysts has not yet been completely understood. It ranges from tumorous, infectious, lymphatic and embryological to post-traumatic or post-operative origin. Symptoms of the illness are usually non-specific, caused mainly by intestinal obstruction. Diagnosis is often accidental. Therapy is exclusively surgical. In the following text, the authors present a case report of a 50-year-old patient operated on due to a mesenteric cyst. The patient had undergone bilateral nephrectomy for polycystic kidney disease and was followed up for polycystic liver disease. CT accidentally revealed a mesenteric cyst around 14 cm in size in the right meso-hypogastrium. It was necessary to perform its histological verification before the planned renal transplantation.

[Metachronous lung metastases of mammary carcinoma, or dual malignancy? a surgeons and oncologists point of view case report]. / Metachronní plicní metastázy mamárního karcinomu nebo duplexní malignita? Pohled chirurga a onkologa kazuistika.

Synchronous and metachronous metastases significantly diminish the possibility of remission from cancer. Therefore, therapy needs to be highly effective and strictly individualised. The authors present a case report of a female patient after radical mastectomy due to breast cancer with incidental detection of peripheral lung carcinoid. The aim of the case report is to inform about current trends in primary lung carcinoid therapy through a surgeons and oncologists point of view.

[Clostridium colitis at a surgical department]. / Problematika klostridiové kolitidy na chirurgickém pracovisti.

INTRODUCTION: The aim of our study was to identify risk factors associated with the development of Clostridium difficile colitis and determining the severity of clostridial colitis in a group of surgical patients. Identification of its predispositions is necessary for preventive interventions and effective treatment. MATERIAL AND METHODS: 51 patients diagnosed with clostridial colitis were included in our study. The inclusion criterion was based on laboratory detection of clostridial toxin in each patient. We analysed age, concomitant malignancy, recent surgical intervention, antibiotic and proton pump inhibitors treatment. The severity of clostridial colitis and its correlation to possible risk factors mentioned above was described and statistically evaluated. Non-parametric Fischer test was used for the statistical evaluation. RESULTS: We confirmed the importance of potential risk factors in the evaluated group of surgical patients with Cl. difficile colitis. The course of the disease was described as serious in 39.2% of patients in the study group. Recurrent attack of colitis was diagnosed in 4 patients, in 2 of them the second recurrence, in 1 patient the third relapse occurred. 2 patients with clostridial colitis evaluated in our group died, but the relation of their death to the clostridial GIT infection was not causal and the primary cause of death in both of them was multiple organ failure caused by serious comorbidities. We did not indicate any surgical intervention and no toxic megacolon developed in our study group. We did not detect any statistical correlation between the described risk factors and the severity of colitis. CONCLUSION: Clostridium difficile colitis needs to be recognised as a serious complication, especially in hospitalised patients. Its increased frequency and severity should not be underestimated. Although we can identify potential risk factors, we cannot exclude some of them completely (e.g. antibiotic and PPI treatment). On the other hand, a rational approach to antibiotic treatment in particular can be helpful in reducing the frequency and severity of clostridium difficile colitis.

[Systematic mediastinal lymphadenectomy in surgery for sarcomatous pulmonary metastases]. / Význam systematické mediastinální lymfadenektomie v chirurgii plicních metastáz sarkomového puvodu.

PURPOSE OF THE STUDY: Systematic lymph node dissection is performed as standard curative resection for non-small cell lung cancer. Its role in lung metastasectomy is unknown. The aim of our study was to find out the frequency of lymph node metastases, the survival of patients with and without lymph node involvement, and to consider if routine lymph node dissection should be recommended. MATERIAL AND METHODS: The study was undertaken at three departments of surgery and included 14 patients undergoing lung metastasectomy between July 2008 and December 2011. In all patients systematic lymph node dissection was also performed. When wedge resection was done, N1 nodes were removed only as part of a local procedure at that anatomical site. Patients with mediastinal lymph node involvement detected by pre-operative CT or PET scans were not included in the study. RESULTS: Lung metastasectomy for metastatic sarcoma was performed in 14 patients. Nine patients had bilateral lung metastases. Solitary lung metastasis was found in only one case. The mean number of removed mediastinal lymph nodes was 14.8 (7-32). Mediastinal lymph node metastases were found in two patients (14.3%). The average disease free interval (DFI) was 79.6 months (median, 25.5 months). Using the Kaplan-Meier method, the 3-year survival rate was 46% (0.46±0.15). The Cox-Mantel test for comparing the survival curves showed, at a 0.05 level of significance, better survival rates for the patients with no metastatic lymph node involvement (p=0.01). DISCUSSION: The frequency of mediastinal lymph node involvement in our study was 14.3% and this was in agreement with the data reported in the literature. The 3-year survival rate was 46% in our patients; the published 5-year survival is 15-50%. A systematic mediastinal lymphadenectomy during lung metastasectomy for metastatic sarcoma has been recommended, but also argued against because of a low incidence of mediastinal lymph node involvement in sarcomatous metastases reported by some authors. We showed that mediastinal lymph node involvement was a negative prognostic factor. Systematic mediastinal lymphadenectomy as a routine procedure provides for a better staging. This is important in association with the development of adjuvant modalities, such as monoclonal antibodies, at present or a gene therapy in the future. CONCLUSIONS: Even in a carefully selected group of patients, incidence of mediastinal lymph node metastases is high. Since no relevant data based on large patient groups are available, we recommend routine nodal dissection for all patients indicated for lung metastasectomy. Drawing a definite conclusion will require analyses of large numbers of data from multi-institutional studies and cooperation with the international database, if possible.

[Repeated resection for recurrent pulmonary metastases]. / Opakované plicní resekce v chirurgii plicních metastáz.

INTRODUCTION: Repeated pulmonary resections are predominantly used in sarcomas, colorectal cancer, Grawitz tumours, and at a young age in general. Patients with the recurrence of pulmonary metastases within a period of six months have a poor prognosis. MATERIAL AND METHODS: During the period from I/1997 to XII/2011, a total of 165 operations were performed in 149 patients. 11patients had multiple pulmonary resections. According to histological origin, sarcomas were found in 6 cases, Grawitz tumours in 2 cases, Schwannoma malignum in 1 case and laryngeal carcinoma in 1 case. There was synovialosarcoma, osteosarcoma, rhabdomyosarcoma, alveolar sarcoma and uterine sarcoma in the group of sarcomas. RESULTS: In our retrospective study, the most commonly used approach was muscle-sparing vertical thoracotomy in 14 patients, posterolateral thoracotomy in 8 patients, VATS in 3 patients and clamshell thoracotomy in 3 patients. We performed 22 extraanatomic resections - of which 3 times VATS, 6 times lobectomy (of which 1 completion pneumonectomy). We observed complications in 6 cases (small air leak in 3 patients, wound infection in 3 patients) in the postoperative period. No rethoracotomy for complications was needed, lethality was 0. The overall 5-year survival that we observed was 45.4%. CONCLUSION: Surgery is an integral part of complex oncological care. What is extremely important is strict selection of patients eligible for surgery for repeated resections and, of course, an experienced team of thoracic surgeons, but also other physicians. When performed by experienced specialists, surgical treatment of lung metastases is a safe and very useful procedure.

[Wound microbial sampling methods in surgical practice, imprint techniques]. / Metody odberu vzorku na kultivacní vysetrení v chirurgické praxi, otiskové metody.

The wound is a damage of tissue. The process of healing is influenced by many systemic and local factors. The most crucial and the most discussed local factor of wound healing is infection. Surgical site infection in the wound is caused by micro-organisms. This information is known for many years, however the conditions leading to an infection occurrence have not been sufficiently described yet. Correct sampling technique, correct storage, transportation, evaluation, and valid interpretation of these data are very important in clinical practice. There are many methods for microbiological sampling, but the best one has not been yet identified and validated. We aim to discuss the problem with the focus on the imprint technique.

[Resection and reconstruction of the chest wall for primary or metastatic tumours]. / Resekce a rekonstrukce hrudní steny pro primární ci metastatické nádorové onemocnení.

PURPOSE OF THE STUDY: The aim of the study was to assess mortality and the complication rate after the extensive resection of chest wall tumour and subsequent soft tissue reconstruction. We wanted to evaluate the justification for major surgery in the group of patients with primary or secondary tumours, including those with an advanced stage of disease. MATERIALS AND METHODS: A total of 35 patients after major chest wall resection within an eight-year period (2000-2008) were analysed retrospectively. A major resection was defined as resection of 75 cm2 or more of full thickness of the chest wall. There were 19 cases of primary malignant tumour of the chest wall, 10 cases of secondary tumour, and 6 cases of benign or semi-malignant lesions. The chest was stabilised with the help of either polypropylene or a double layer mesh of polyester covered with polyurethane. For soft tissue reconstruction, a musculocutaneous flap was used in 18 cases. The number of resected ribs ranged from two to seven. The vertebral body was partially resected in four cases, and total sternectomy was performed in two cases. This surgery was carried out with potentially curative intent in 30 (85.7%) and with palliative intent in five patients (14.3%). RESULTS: No post-operative mortality occurred. The complication rate was 17.1 %. The one-year survival rate was 88.6 %. There were seven long-term survivors at 5 or more years after resection of the chest wall for soft tissue sarcoma. Local recurrence occurred in six patients (17.1%). Neither the type of prosthesis nor the type of surgical procedure influenced the complication rate. DISCUSSION: Chest wall resection is an established surgical procedure in the treatment of primary chest wall tumours and, occasionally, solitary metastatic disease. The groups of patients reported in the literature have been heterogeneous and usually small, and thus an estimation of the true risk of the major procedure is difficult. Three studies involving large patient groups published in the last 11 years have shown morbidity in 24.4%, 33.2% and 46.0% of patients and mortality in 7.0%, 3.8% and 4.1% of patients, respectively. The results in our group of unselected patients are comparable with these studies; however, we did not perform extensive procedures like pneumonectomy and chest wall resection, or extended fore quarter amputation. CONCLUSIONS Complete resection of the chest wall is feasible even in advanced tumours without significant peri-operative morbidity and mortality. Major chest wall resection as a palliative procedure remains selective for motivated patients in a good physical condition but with low quality of life caused by a chest wall tumour.

[Is pneumonectomy justified in the management of lung metastases?]. / Je oprávnené provedení pneumonektomie v lécbe plicních metastáz?

The authors discuss about questions of possibility pneumonectomy in concept of lung metastasis therapy. They analysed in detail indications, surgery, complications, survival and factors of survival. The authors also introduce case report of one patient with pneumonectomy in your group of patients.

[Spontaneous pneumomediastinum--a case review]. / Spontánní pneumomediastinum--kazuistika.

The authors present in the following case review a patient with spontaneous pneumomediastinum which can be on of the causes of acute chest pain and it is necessary to think about it in the differential diagnosis of this condition.

[Rates of metastatic affections of mediastinal nodes during pulmonary metastasectomy]. / Cetnost metatastického postizení mediastinálních uzlin behem plicní metastasektomie.

OBJECT: The aim is the evaluation of lymph node metastasis rate during pulmonary metastasectomy harvested by technique of systematic mediastinal lymphadenectomy in year 2009-2010. METHODS: We performed systematic mediastinal lymphadenectomy (the same technique as in non-small cell lung cancer) during pulmonary metastasectomy. RESULTS: There was found lymph node metastasis in four cases from 70 patients. The rate of metastatic involved mediastinal lymph node 5.7% harvested during lung metastasectomy is on lower limit of published interval. We expected higher lymph node involvement in lung metastasis of colorectal origin.

[Evaluation of neoadjuvant chemo-radiotherapy with locally advanced rectal cancer by comparing tumour volume before and after treatment]. / Hodnocení neoadjuvantní chemoradioterapie u lokálne pokrocilého karcinomu rekta srovnáním objemu tumoru pred lécbou a po lécbe.

BACKGROUND: Neoadjuvant chemotherapy is a standard preoperative therapeutical procedure with locally advanced rectal adenocarcinoma. The aim of the study was to compare the tumour volume reduction before and after the oncological therapy in relation to the change in the CEA value and to the outcome of the histopathological evaluation of response to the treatment. PATIENTS AND METHODS: In the years 2004-2008, 274 rectal cancer patients were evaluated, of which 64 underwent neoadjuvant CRT with subsequent surgery and had also completed other inclusion criteria. The tumour volume before and after the CRT, percentage reduction in the tumour volume and the relation to the change in the CAE value and the histopathological evaluation were evaluated. RESULTS: The distance between the anus and the tumour was from 3 to 15 centimetres, the average value being 8.1 centimetres. In 5 cases the tumour was not histologically found in the resected specimen. Average value of the CEA value before the CRT was 18.12 ng/ml, range 0.7-98.1 ng/ml, after the CRT the average value was 7.00 ng/ml, range 0.5-18.7 ng/ml. The average tumour volume before CRT was 32.48, range 10.3-88.5, after the CRT the average volume was 20.13, range 4.7-55.1. CONCLUSION: A relation between the change in the T value and the volume reduction before and after the CRT of statistical significance has been proven in this group of patients. This relation however has not been proved in the N value change. Only in one-third of the evaluated patients was there a positive change in both T and N classification. No relation between the CEA value and the tumour volume change has been proven.

[Mediastinal lymphadenectomy in surgery of pulmonary metastasis]. / Mediastinální lymfadenektomie v chirurgii plicních metastáz.

The effect of lymphadenectomy in pulmonary metastasectomy is unceratain. Good indication and right radicality of resection are to-days surgery possibilities to manage the best patient survival. Next possibility is performance of systematic mediastinal lymphdenecomy for currative effect and increasing of staging quality for indication of adjuvant therapy by metatatic lymphnode involvement. The answer about performance of mediastinal lyphadenectomy and its kind was seeked by authors in retrospective study in years 1999-2008. Hundred and six patient underwent pulmonary metastasectomy, 34% patients were of sarcomatous origin. Mediastinal lymhadenectomy was made in 31% patients. There were found the lyphnode involvement in five cases. The group of own patiens is non homogenous for exact conclusion of impact mediastinal lymphadenectomy on survival after pulmonary metastasectomy. The comparison of patient survival with diferent kind of lymphadenectomy isn't acceptable because sampling of lymphonodes may be false negative. For exact comparison of mediastinal lymphadenectomy importance is necessary to do systematic mediastinal lymphadenectomy in prospective multicentric study.