Smoking Lung Cancer Patients and Tobacco Cessation - Is the Current Treatment in Germany Sufficient?

Lung cancer is the most preventable neoplastic disease for men and women. The incidence rate per year is 14.000 in Germany. Smoking is the main risk factor for the onset of lung cancer and for a share of 90% of cases, lung cancer is associated with smoking. Recent studies have shown that the time slot of diagnosing lung cancer is a teachable moment for tobacco cessation interventions. The therapy that was rated most effective was a combination of cognitive behavioral therapy and pharmacotherapy (e. g. NRT, Bupropion, Varenicline). We examined the smoking status of all patients undergoing lung cancer surgery in 2011, 2012 and 2013 in this study. A retrospective semi structured interview via telephone was conducted regarding smoking habits and current quality of life. 131 patients (36.6% female, average age of 68.7 years) of an urban German hospital were included.Results showed a relapse rate of 22.3%, while 86.2% used to be highly addicted smokers; A multivariate analysis of covariance (MANCOVA) indicated a significant overall impact of smoking status on quality of life with a medium effect size, controlled for age, gender, living conditions, tumor stage, duration of smoking abstinence, type of cancer therapy, type of resection method, and the time period between the date of surgery and of the survey. Two thirds of all smokers did not see an association between their habit and their disease.So far motivation to quit and long term abstinence rates are not sufficiently established even among seriously sick patients in Germany; further initiatives should focus on new and more intense interventions and educational strategies.

[Early chest tube removal after video-assisted thoracoscopic surgery. Results of a prospective randomized study]. / Frühe Drainagenentfernung nach videoassistierten thorakoskopischen Operationen. Ergebnisse einer prospektiv randomisierten Studie.

BACKGROUND: Chest tubes frequently cause postoperative patient discomfort after video-assisted thoracoscopic surgery (VATS). Therefore, a prospective randomized study was conducted to analyze whether early chest tube removal within 2 h postoperatively is justified in VATS. METHODS: Ninety-three patients fulfilled the inclusion criteria (VATS including wedge resection, complete lung extension on postoperative chest roentgenogram) and showed no exclusion criteria (lung volume reduction surgery, extensive pulmonary fibrosis, pneumothorax, pleural effusion, air fistula). Randomization resulted in early chest tube removal in 48 patients and in conventional chest tube management in 45 patients. RESULTS: Pain intensity was significantly reduced after early chest tube removal (P=0.03, t-test). In consequence, the mean analgesic requirement was significantly reduced (P=0.0001, t-test). The number of postoperative chest roentgenograms was significantly reduced after early chest tube removal (P=0.0001, t-test). The mean postoperative length of hospital stay was 5.4 vs 6.7 days (P=0.11, t-test). No postoperative complication occurred after early chest tube removal, while postoperative complications were observed in six patients with conventional chest tube management (P=0.01, Fisher's test). CONCLUSION: Early chest tube removal after video-assisted thoracoscopic wedge resection is recommended. The inclusion and exclusion criteria of this study should be considered for future early chest tube removal. Long-term follow-up will clarify if early chest tube removal also leads to a reduction in chronic pain.

[Complications in the therapy of spontaneous pneumothorax]. / Komplikationen in der Therapie des Spontanpneumothorax.

The therapy of spontaneous pneumothorax is a common necessity in hospitals of all care hierarchies In addition to sufficient primary treatment by placement of a thorax drainage, knowledge of complicationg constellations, recognition of complications and irregular courses during the therapy of spontaneous pneumothorax are of fundamental importance for achieving a satisfactory treatment outcome. Furthermore, the enlightenment of patients regarding the pathogenesis of the disease, possible measures for influencing the recurrence rate and information about future behavioral and lifestyle modifications are important. The principal complications during hospital treatment can be subdivided into complications of the surgical placement of the thorax drain and relief of the pleural cavity, problems in the management of treatment of the pleural negative pressure, the possibly demanding management of a persisting air leak and the individualized decision-making with respect to an interventional or operative procedure. The most common complicating constellations and possible complications during the inpatient hospital stay are described, the.

Invasive staging of non-small cell lung cancer--a prospective study.

OBJECTIVES: Clinical prognosis and treatment schedules of non-small cell lung cancer (NSCLC) are dependent on tumor stage. This explains the importance of an exact pretreatment staging of the primary tumor and lymph nodes especially in locally advanced NSCLC, to differentiate between resectable and non-resectable disease. To assess the lymph node status of the upper mediastinum, the diagnostic value of mediastinoscopy is accepted to be superior to radiological methods. In contrast, thoracoscopy is not yet established as a standard staging tool. PATIENTS AND METHODS: Seventy-three consecutive patients with CT-based suspicion of advanced NSCLC have been investigated as part of a phase II study on neoadjuvant treatment of NSCLC. All patients underwent mediastinoscopy and mediastinal lymph node sampling. In the case of a negative result we performed additional thoracoscopy. RESULTS: In 52.1% (n = 38) of the patients the invasive diagnostic methods led to results that were effectively different from those of the radiological findings. In 11 patients (15.1%) CT-assessed lymph node metastases could invasively not be confirmed, whereas nine patients (12.3%) had positive mediastinal lymph nodes but no corresponding CT signs (diameter <1 cm). The results were achieved by mediastinoscopy in 15 (20.5%) and by thoracoscopy in five (6.8.%) patients. A radiologically unexpected T4 stage has been found in four (5.5%) and a M1 stage in four (5.5%) patients by thoracoscopy. On the contrary, in seven patients a suspected infiltration of mediastinum or parietal pleura could be thoracoscopically excluded. Four patients have been in an unexpected high stage of tumor progression at the moment of diagnostic procedures and therefore have been included in palliative therapy schedules. Ten patients have been 'overstaged' by radiological methods and benefited from a primarily curative resection after invasive staging. CONCLUSIONS: Of the 73 prospectively studied patients with locally advanced NSCLC, 12 (16.4%) have been staged too low and 13 (17.8%) too high. If exclusively staged by radiological methods, about 34% of lung cancers have been classified incorrectly. Therefore, these tools are not a sufficient basis for diagnosis of stage III NSCLC disease. Mediastinoscopy with consecutive thoracoscopy is an essential part of the therapeutic planning in locally advanced NSCLC, and results are significantly superior to clinical staging.

[Complications of malignant tumors--malignant pleural effusions]. / Jetzt kann es nur noch um die Lebensqualität gehen. Entlastende Massnahmen beim malignen Pleuraerguss.

Malignant pleural effusion is a complication of malignant diseases that has an appreciable negative impact on the patient's quality of life. In view of the greatly reduced life expectancy of between 3 and 12 months (median), diagnostic and therapeutic management must be orientated to the principles of palliation. Diagnostic measures comprise cytological/histological confirmation of the malignant effusion and, where necessary, of the underlying malignant disease and the extent of the intrathoracic tumor growth. In view of the tendency of malignant pleural effusion to relapse, pleurodesis is indicated, which is most effectively accomplished by video-assisted thoracoscopic talcum poudrage.

[Surgical therapy of chest wall infiltrating local recurrence of breast carcinoma]. / Zur chirurgischen Therapie des brustwandinfiltrierenden Mammakarzinom-Lokalrezidivs.

Chest wall resection and--reconstruction for malignant tumors have to fulfill oncological, functional and cosmetic demands. We report on 19 operated patients with chest wall recurrence or metastasis from breast cancer. Resection included excision of the thoracic shield (n = 14), additional partial resection of breast bone (n = 5) and of clavicle (n = 1). Chest wall stability was achieved by PTFE-patches and lyophilized bone, soft tissue reconstruction was performed by myocutaneous flaps. Resection rate was 95%, morbidity rate was 23%, we saw no in-hospital deaths. 1-year-survival was 95%.

[Minimally invasive concepts in esophageal surgery--thoracoscopic anastomosis. An animal experiment study]. / Minimal-invasive Konzepte in der Osophaguschirurgie--thorakoskopische Anastomosierung. Eine tierexperimentelle Studie.

Based on animal trials the presented study describes two versions of thoracoscopic oesophageal anastomosis within the scope of abdomino-thoracoscopic oesophagectomy. This experimental approach is considered to provide a solution for the oncological problem to salvage the tumor bearing oesophagus. We describe the procedure of intrathoracic stapler anastomosis under thoracoscopic vision. By using a laparoscopic purse string suture clamp we were enabled to prepare the proximal oesophageal stump for anastomosis. A circular stapling instrument turned out to be very suitable for the thoracoscopic use. The final evaluation of the importance of minimally invasive surgery for the resection of oesophageal carcinomas should not be given until multicenter studies are performed.