[Descending Necrotising Mediastinitis: the Choice of Drainage]. / Deszendierende nekrotisierende Mediastinitis: Wahl der Drainage.

INTRODUCTION: Descending necrotising mediastinitis (DNM) is a rare, but very severe, septic condition, caused by the spread of infection from the neck to the mediastinum. Delay in diagnosis and inadequate surgical procedures may lead to a life-threatening situation. MATERIAL: We retrospectively evaluated a group of patients who suffered from DNM and were treated in our department by mediastinal drainage in the last 10 years (2010 - 2019). All patients required one of the following methods of drainage: cervicomediastinal, mediastinothoracic or cervicomediastinothoracic "Rendevouz" drainage (MTC-D). In the group, we evaluated the source of infection, microbiologic findings, method of mediastinal drainage, length of hospitalisation, ventilation duration and inflammatory laboratory parameters. RESULTS: In total, we treated 22 patients with DNM, including 14 men and 8 women, aged 23 - 85 years, with a mean age of 54.1 years. After the spread of infection, in 8 cases the initial cervicomediastinal type of drainage had to be followed by one of the types of thoracic drainage. As the final method, in 8 patients we chose irrigation drainage from the cervical approach, from thoracotomy in 6 cases and in 8 cases irrigation CMT-D. The method of mediastinal drainage was chosen according to the initial CT findings, and further intervention was chosen according to CT signs during the treatment. Four patients died of DNM (mortality 18.2%). Pharyngeal focus was responsible for 15 cases of DNM; odontogenic infection caused 6 DNM cases; in 1 case the origin was unclear. Although we always chose the method individually and CMT-D for the most difficult cases, there were no statistically significant (p < 0.05) differences between the evaluated parameters. For CMT-D, there was even a shorter hospital stay (not significant) and ventilation duration. CONCLUSION: In cases of DNM with severe inflammation of caudal and distal compartments of the mediastinum we consider CMT-D as an ideal method of treatment. This appraoch is radical enough and in our group of patients, despite the severity of this illness, both the length of treatment and mortality were sufficient.

Predictive Significance of Thymidylate Synthase Expression in Non-small Cell Lung Cancer.

BACKGROUND/AIM: To date, many studies have suggested that thymidylate synthase (TS) could be used as a prognostic and predictive marker in non-small cell lung cancer (NSCLC) patients. However, results have been contradictory. The aim of this study was to evaluate TS mRNA levels in tumor tissue of NSCLC patients who underwent complete surgical resection and to analyze its prognostic and predictive potential. MATERIALS AND METHODS: The study group consisted of 64 patients who underwent curative lung resection. Paired lung tissue samples were taken directly from the tumor tissue and from adjacent, histologically cancer-free lung tissue. The quantitative estimation of TS expression was performed by reverse transcription real-time polymerase chain reaction (RT-qPCR). The relationship between TS expression level and disease-free interval (DFI) and overall survival (OS) was analyzed. RESULTS: There was significantly higher TS expression in NSCLC tumor tissue comparing to normal lung tissue. In the group of patients who received adjuvant chemotherapy based on platinum derivatives in combination with paclitaxel or gemcitabine, we found shorter DFI (p=0.0473) and OS (p=0.0053) in those with high expression of TS. CONCLUSION: Our results demonstrated the relationship of high tumor tissue TS levels to adverse prognosis in patients undergoing adjuvant chemotherapy. TS is a non-specific tumor marker with respect to NSCLC, therefore we think that its best use would be as a member of the panel of predictors of adjuvant treatment efficacy.

Esophageal stents for less invasive treatment of mediastinitis.

INTRODUCTION: In spite of the progress in diagnosis and therapeutic options, esophageal perforation resulting in mediastinitis is a very serious condition with a high morbidity. AIM: To evaluate the use of esophageal stents for the treatment of patients suffering from mediastinitis. MATERIAL AND METHODS: Retrospective (2008-2012) analysis of a group of patients requiring surgical treatment. The evaluation was focused on the cause of perforation, stent type and its parameters, the surgical method used, duration of stenting and total length of treatment. RESULTS: In total, 16 patients were treated by stenting. All patients were treated with the stent being placed across the defect in the esophagus. Mediastinitis was accessed and drained with the aid of a thoracotomy or thoracolaparotomy (8 cases), or using a combination of a laparotomy/laparostomy and pleural drainage (5 cases). The most basic interventions were either pleural or external cervical drainage (3 and 1 cases, respectively). One patient, in whom a stricture had developed at the healed perforation, was subjected to esophageal resection. Four patients died. The average period that the stent was left in situ was 53.7 days. The average period of hospitalization of those patients who survived was 53.4 days. CONCLUSIONS: Using stents in therapy neither increased survival (mortality of 25%), nor decreased the length of therapy of patients once mediastinitis had developed. The main advantage of stenting is the preservation of the native esophagus and the reduced extent of surgical mediastinal drainage.

A complex oncosurgical approach to increasing the resectability of colorectal cancer metastases - a case report.

AIM: In this case report, the authors aim to demonstrate the success of recent methods in the radical treatment of a patient with primary inoperable liver and subsequent colorectal cancer pulmonary metastases. METHODS: A 75 year old patient with inoperable bulky metastasis in the right hepatic lobe and insufficient future remnant liver volume was indicated for a stage procedure in the liver parenchyma. Embolization of the right branch of the portal vein was first performed with subsequent administration of stem cells into the contralateral liver lobe. Following compensatory growth of the left liver lobe, right-sided hepatectomy was performed with subsequent adjuvant oncological treatment. Six months after the surgery, a metastasis developed in the right pulmonary lobe which was solved by metastasectomy. RESULTS: The patient, one year after the diagnosis of inoperable liver metastasis, is completely healthy and free of signs of disease recurrence. CONCLUSION: A comprehensive oncosurgical approach using up-to-date diagnostic and treatment options may offer patients with metastatic colorectal cancer, radical treatment with the hope of long-term quality survival.

Surgical treatment of colorectal cancer pulmonary metastases: 12-year results.

UNLABELLED: The objective of the present study was to retrospectively analyze a cohort of patients who underwent surgery for colorectal cancer pulmonary metastases during a 12-year period. PATIENTS AND METHODS: The sample included 75 patients who were monitored in terms of overall survival (OS) and disease-free interval (DFI) in relation to patient's age, preoperative values of biomarkers, type of surgery, number and size of metastases, occurrence of complications and length of hospitalisation. RESULTS: A total of 95 surgical interventions were performed and 133 metastases were removed. Out of these, 28% of patients were free of any signs of relapse or disease progression for 5 years after metastasectomy. Those with two or more metastases are 2.3-times more at risk of disease progression. Tissue polypeptide specific antigen (TPS) values above the 140 IU/l cut-off point increase the risk of progression 3.9-times. The five-year survival rate among the group was 45%. Patients with 2 or more metastases are 2.7-times more at risk of death. TPS values above the 140 IU/l cut-off increase the risk of death 5.5 times, and carbohydrate antigen CA19-9 values above the 28 IU/ml cut-off point increase the risk of death by 3.2 times. CONCLUSION: The number of metastases and the preoperative TPS values are decisive prognostic factors influencing both OS and DFI.

Prognostic significance of ERCC1, RRM1 and BRCA1 in surgically-treated patients with non-small cell lung cancer.

UNLABELLED: Chemotherapy is an important modality of treatment for non-small cell lung cancer (NSCLC). Recent studies have shown that assessment of predictive molecular markers could be helpful for estimation of the response rate to chemotherapy. The aim of our study was to assess the relation of mRNA levels of DNA repair genes excision repair cross-complementary group 1 (ERCC1), ribonucleotide reductase subunit M1 (RRM1) and breast cancer 1 (BRCA1), in surgically-resected tumor tissues from patients who underwent adjuvant chemotherapy, to the disease-free interval (DFI) and overall survival (OS). We investigated if potential residual tumor cells after resection reflect properties of the primary tumor and response to chemotherapy according to the level of predictive markers with respect to current knowledge. PATIENTS AND METHODS: We studied a group of 90 patients with NSCLC who had undergone curative lung resection; 59 of them were subsequently treated with adjuvant chemotherapy, DFI and OS were evaluated only in this subgroup. Quantitative estimation of mRNA of selected genes in paired (tumor and control)-lung tissue samples was performed by real-time reverse transcription-polymerase chain reaction (RT-PCR). RESULTS: We found a significantly lower mRNA expression of ERCC1 (p<0.001) and RRM1 (p=0.023) in NSCLC tumor tissues compared to normal lung tissues. Comparing expression in histological subtypes, we recorded higher mRNA expression of ERCC1 (p=0.021), RRM1 (p=0.011) and BRCA1 (p=0.011) in adenocarcinoma than in squamous cell carcinoma (SCC). Differences in DFI and OS were found only in specific subgroups according to tumor type and stage. We found longer OS for patients with adenocarcinoma with higher expression of the RRM1 mRNA (p=0.002), and for patients with SCC with higher expression of the BRCA1 mRNA (p=0.041). In patients with NSCLC of stage III, we found longer DFI in those with higher expression of RRM1 (p=0.004) and ERCC1 (p=0.038). CONCLUSION: Patients who had been treated with adjuvant chemotherapy and had shown lower expression of repair genes had adverse prognosis. We observed that the assessment of DNA repair gene level in primary tumors treated by surgical resection had prognostic significance and did not predict response to adjuvant chemotherapy.

The role of MonoTotal in the primary diagnosis, prognosis and follow-up of patients with non-small cell lung cancer (NSCLC).

BACKGROUND: A new cytokeratin tumor marker, MonoTotal was studied in lung cancer, the most common cause of cancer mortality worldwide. In non-small cell lung cancer (NSCLC) patients MonoTotal serum levels and their relationship to the tumor stage, histological subtype, early relapse and cancer-related death were evaluated. PATIENTS AND METHODS: MonoTotal serum levels were studied, using immunoradiometric assay in a group of 93 patients with newly diagnosed NSCLC undergoing radical surgery, and were compared to those with benign lung diseases. RESULTS: A diagnostic power of MonoTotal in distinguishing patients with NSCLC from benign lung diseases was demonstrated. Higher levels of MonoTotal were associated with advanced stages of squamous cell carcinoma and there was a positive correlation of marker with tumor size. Marker levels showed significant relation to disease-free survival and overall survival. CONCLUSION: MonoTotal seems to be a potentially very interesting serum marker that, in conjunction with other clinical data, might be used for monitoring of patients with NSCLC.

Prognostic significance of TIMP-1 in non-small cell lung cancer.

UNLABELLED: Tissue inhibitor of metalloproteinases 1 (TIMP1) regulates not only extracellular matrix catabolism but the major effect in tumor tissue is promotion of cell growth and anti-apoptotic activity. The aim of our study was to evaluate plasma TIMP1 levels and tissue TIMP1 mRNA expression as prognostic markers in NSCLC patients. PATIENTS AND METHODS: We studied a group of 108 patients with NSCLC who had undergone lung surgery. Estimation of TIMP1 mRNA was performed by quantitative polymerase chain reaction (qPCR) and estimation of plasma TIMP1 protein using enzyme-linked immunosorbent assay (ELISA). RESULTS: There was shorter disease-free interval (DFI) for NSCLC patients at stage II, with a higher expression of TIMP1 mRNA in tumor tissue (p=0.0246). We recorded a relationship between tumor tissue TIMP1 mRNA expression and DFI in squamous cell carcinoma (SCC) (p=0.0117). Shorter overall survival was found in patients at stages IIIa+IIIb+IV, with a higher expression of TIMP1 mRNA (p=0.0389). We found differences in plasma TIMP1 levels between patients with SCC and those with adenocarcinoma (p=0.0491). CONCLUSION: A higher tissue level of TIMP1 mRNA is related to an adverse prognosis of patients. However, our results did not show any relation of TIMP1 protein in blood plasma to prognosis.