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INTRODUCTION: Nowadays ever smaller, sub-centimetre lung nodules are screened and diagnosed. For these, minimally invasive resection is strongly recommended both with diagnostic and therapeutic purpose. AIM: Despite many advantages of minimally invasive thoracic surgery, thorough palpation of the lung lobes and thus the localization of lung nodules are still limited. There are several options to solve this problem. From the possibilities we have chosen and tried wire- and isotope-guided lung nodule localization. MATERIALS AND METHODS: In 2017, at the Thoracic Surgery Department of the National Institute of Oncology we performed wire- and isotope-guided minimally invasive pulmonary nodule resection in five patients. The diameter of the lung nodules was between 0.5 and 1.2 cm. The age of the patients was between 44 and 65 years and none of them had severe comorbidities, which meant low risk for complications. RESULTS: We successfully performed the minimally invasive atypical resection in all cases. After the wire and isotope placement we found a 2-3 mm pneumothorax in one patient that did not need urgent drainage. In another patient we found that high amount of intraparenchymal bleeding surrounded the channel of the wire. During the operation, two wires were displaced when the lung collapsed, and in another case the mentioned bleeding got into the thoracic cavity and made it difficult to detect the nodule. In one case we resected the wire-guided lung tissue, but the isotope-guided lung nodule was below the resection line. CONCLUSION: Both techniques could help to localize the non-palpable lung nodules. Based on our initial experiences, the isotope-guided method provides more details to estimate the exact depth of the nodule from the visceral surface of the pleura and we can avoid the unpleasantness of wire displacement. On the other hand, the production of the isotope requires a more developed infrastructure and the exact timing of the operation after the isotope injection is more strict. Orv Hetil. 2018; 159(34): 1399-1404.
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Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Nódulo Pulmonar Solitario/cirugía , Cirugía Torácica Asistida por Video/métodos , Tomografía Computarizada por Rayos X/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nódulo Pulmonar Solitario/diagnóstico por imagenRESUMEN
The first lung transplantation in Hungary was performed on 12th of December, 2015. It was a joint effort of the National Institute of Oncology and the Semmelweis University. Hereby we summarise the results and experiences from the first three years. Until August, 2018, 55 lung transplantations were performed in Hungary. This was a retrospective analysis. All patients were listed according to the recommendation of the Lung Transplantation Committee. All implanted lungs have been procured from brain dead donors. Postoperative treatment and rehabilitation of the patients were continued at the Semmelweis University. Between 12. 12. 2015 and 31. 07. 2018, our team performed 76 organ retrievals: out of 45 Hungarian offers, 23 came from Eurotransplant countries and 8 outside of the Eurotransplant region. From these donations, 54 double and 1 single side transplantations were successfully performed. The surgical approach was single side thoracotomy (n = 1), bilateral thoracotomy (n = 1) and in the majority of the cases clamshell incision (n = 53). For the intraoperative veno-arterial extracorporeal membrane oxygenation support was used. The extracorporeal membrane oxygenation support had to be prolonged in 3 patients into the early postoperative period, two other recipients were bridged to transplant with extracorporeal membrane oxygenation. In the same time period, one combined lung-kidney transplantation was also performed. The distribution of recipients according to the underlying disease was: chronic obstructive pulmonary disease (n = 28); idiopathic pulmonary fibrosis (n = 8); cystic fibrosis (n = 12); primary pulmonary hypertension (n = 2); hystiocytosis-X (n = 1); bronchiectasis (n = 2); lymphangioleiomyomatosis (n = 1); and re-transplantation following bronchiolitis obliterans syndrome (n = 1), respectively. The mean age of recipients was 47.5 ± 15.18 years. The youngest recipient was 13 years old. We unfortunately lost 12 patients on our waiting list. The mean intensive care unit stay was 24.6 ± 18.18 days. Two patients were lost in the early postoperative phase. Tracheostomy was necessary in 13 cases due to the need of prolonged ventilation. 1-year survival of the recipients was 82.96% (until 31. 07. 2018). When looking at the first three years of the program, the case numbers elevated quickly throughout the years which is rather unique when compared to other centres in their starting period. Perioperative mortality and morbidity is comparable with high-volume lung transplantation centres. In the future we would like to increase the number of patients on the waiting list, thus increasing the total number of transplantations performed, and we are also planning to implement the use of the ex vivo lung perfusion system (EVLP) in our program. Orv Hetil. 2018; 159(46): 1859-1868.
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Trasplante de Pulmón/estadística & datos numéricos , Donantes de Tejidos/estadística & datos numéricos , Obtención de Tejidos y Órganos/estadística & datos numéricos , Femenino , Humanos , Hipertensión Pulmonar/cirugía , Masculino , Enfermedad Pulmonar Obstructiva Crónica/cirugía , Tasa de SupervivenciaRESUMEN
INTRODUCTION: The presence of a substernal goiter which compresses the adjacent structures is per se an indication for resection, mostly total thyreoidectomy should be performed either by a head and neck or general surgeon. In about 1-10% of the cases the goiter is located behind the sternum, and the removal requires different surgical technique. MATERIALS AND METHODS: Authors operated 182 patients between 2000-2014 with substernal goiter which all reached the level of the jugulum. The 182 cases were examined retrospectively. RESULTS: All the patients were symptomatic with choking and dyspnea. In 31 cases neck ultrasound were performed, in 7 cases neck MRI and in 138 cases neck-upper mediastinal CT scan were indicated to discover the real situation of the lobes. 15 patients had previous partial thyreoidectomy. Acervical approach was used in 175 cases, 7 patients required median sternotomy to complete the operation. Transient recurrent laryngeal nerve palsy occurred in 1 patient, permanent RLNP in 3. Nine lesions were malignant, 173 were benign. CONCLUSION: Choking and dyspnea are the most common symptoms of substernal goiter. CT scan is an important preoperative evaluation, while it helps not only to define the position of the thyroid lobes, but also put the right operating team together. Although most of the retrosternal goiters can be removed by a cervical approach, some of them need additional incisions. Hence, it is important to have a thoracic surgeon available. Reviewing the Hungarian literature the authors have not found any other study examining so many patients.
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Right-sided spontaneous oesophageal rupture developed two days after left pneumonectomy and vomiting. In this extremely rare emergency, we used a transhiatal approach for primary repair of the rupture, combined with right-sided pleural and mediastinal drainage, gastrostomy and feeding jejunostomy. The seven-day barium meal showed healing of the rupture. It was mandatory that contamination of the pneumonectomized left thoracic cavity during rupture closure as well as a contralateral thoracotomy with its respiratory consequences had to be avoided by all means. Reconstruction and reinforcement (with omentum) of the oesophageal wall was achieved without difficulties, but we did not mobilize the oesophagus to avoid rupture of the left-sided mediastinal pleura. After massive haematamesis, a 68-year-old man was admitted for a huge (8×5 cm) mass in the lower-posterior mediastinum at the right side of the vertebra, seen on CT scan. On the barium meal incarcerated hiatal hernia, secondary short oesophagus and intramediastinally penetrating high lesser curvature ulcer was discovered. To reduce the magnitude of intervention one-stage transhiatal approach was decided. Through enlarged hiatus, dissection of incarcerated and firmly adherent hiatal hernia and of the short oesophagus was done. The following step was the removal of an encapsulated, huge lipomatosus mass from the posterior mediastinum, extending high from behind the vertebra, arising from the lesser curvature of the stomach. The lesser curvature ulcer was excised - sutured and a Toupet type (270 posterior) fundoplication was finally carried out. The follow-up was free from recurrence. This experience suggests that for some particular lower posterior mediastinal or esophageal problems, transhiatal access seems to be a useful alternative of traditional mediastinal approaches.
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CASE REPORT: Invasive aspergillosis is a life threatening complication in immune-compromised patients causing lung tissue destruction. Aspergillus empyema requires aggressive multimodality treatment. MATERIAL AND METHOD: We present a case of Aspergillus empyema treated by thoracic and plastic surgery preserving the lung function in an 18 year-old male patient suffering dermatomyositis and treated with steroids for a long time. After open window thoracostomy (OWT) we used pedicled musculus latissimus dorsi (MLD) flap and mobilised the anterior serratus muscle to close the pleural cavity. CONCLUSION: The intrathoracic use of muscle flaps after OWT in case of chronic Aspergillus empyema can preserve the underlying lung tissue. Cooperation of thoracic and plastic surgeons - as in the cases presented - provides an excellent opportunity to treat successfully of otherwise hopeless patients.
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Empiema Pleural/cirugía , Pulmón/fisiopatología , Músculo Esquelético/cirugía , Procedimientos de Cirugía Plástica/métodos , Aspergilosis Pulmonar/cirugía , Toracostomía , Dermatomiositis/tratamiento farmacológico , Empiema Pleural/fisiopatología , Humanos , Masculino , Aspergilosis Pulmonar/etiología , Aspergilosis Pulmonar/fisiopatología , Pruebas de Función Respiratoria , Esteroides/administración & dosificación , Esteroides/efectos adversos , Colgajos Quirúrgicos , Toracotomía , Resultado del Tratamiento , Adulto JovenRESUMEN
Background: Our knowledge is still limited about the characteristics and treatment of rare lung tumors. The aim of our study was to determine programmed cell death ligand-1 (PD-L1) and programmed cell death-1 (PD-1) expression in rare pulmonary tumors to assess the potential role of immunotherapy. Methods: 66 pathologically confirmed rare lung tumors including 26 mucoepidermoid carcinomas (MECs), 27 adenoid cystic carcinomas (ACCs), and 13 tracheobronchial papillomas (TBPs) were collected retrospectively. Immunohistochemical (IHC) staining was performed on formalin fixed paraffin embedded (FFPE) tumor tissues, and PD-L1 expression on tumor cells (TCs) and immune cells (ICs), and PD-1 expression on ICs were determined. The cut off value for positive immunostaining was set at 1% for all markers. Results: PD-L1 expression on TCs was observed in two cases of MEC (7.7%), one case of ACC (3.7%), and was absent in TBP samples. PD-L1 expression on ICs could be demonstrated in nine cases of MEC (34.6%), four cases of ACC (14.8%), and was absent in TBPs. All PD-L1 TC positive tumors were also PD-L1 IC positive. Higher expression level than 5% of PD-L1 TC and/or IC was observed only in one ACC and in two MEC patients. Among them, strong PD-L1 immunopositivity of >50% on TCs and of >10% on ICs could be demonstrated in one MEC sample. PD-L1 expression of ≥1% on ICs was significantly more common in MEC, than in TBP (p < 0.001). In MEC ≥1% PD-L1 TC or IC expressions were significantly more common in patients aged 55 or older, than in younger patients (p = 0.046, and p = 0.01, respectively). PD-1 expression on ICs was found in five cases of MEC (19.2%), four cases of ACC (14.8%), and in two cases of TBP (15.4%). Only one MEC case showed a higher than 5% expression level of PD-1 on ICs. Conclusion: This retrospective study comprehensively demonstrated the rare expression of PD-L1 and PD-1 in pulmonary MEC, ACC, and TBP. However, we found very strong PD-L1 immunopositivity on both TCs and ICs in one MEC sample, which warrants further investigations in a larger cohort.
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Antígeno B7-H1 , Neoplasias Pulmonares , Humanos , Estudios Retrospectivos , Antígeno B7-H1/metabolismo , Receptor de Muerte Celular Programada 1 , Neoplasias Pulmonares/patología , Pulmón/patología , Biomarcadores de Tumor/metabolismoRESUMEN
Background: Although the expression of tight junction protein claudins (CLDNs) is well known in common histological subtypes of lung cancer, it has not been investigated in rare lung cancers. The aim of our study was to examine the expression of different CLDNs in pulmonary salivary gland tumors. Methods: 35 rare lung cancers including pathologically confirmed 12 adenoid cystic carcinomas (ACCs) and 23 mucoepidermoid carcinomas (MECs) were collected retrospectively. Immunohistochemical (IHC) staining was performed on formalin fixed paraffin embedded (FFPE) tumor tissues, and CLDN1, -2, -3, -4, -5, -7, and -18 protein expressions were analyzed. The levels of immunopositivity were determined with H-score. Certain pathological characteristics of ACC and MEC samples (tumor grade, presence of necrosis, presence of blood vessel infiltration, and degree of lymphoid infiltration) were also analyzed. Results: CLDN overexpression was observed in both tumor types, especially in CLDN2, -7, and -18 IHC. Markedly different patterns of CLDN expression were found for ACC and MEC tumors, especially for CLDN1, -2, -4, and -7, although none of these trends remained significant after correction for multiple testing. Positive correlations between expressions of CLDN2 and -5, CLDN3 and -4, and CLDN5 and -18 were also demonstrated. Tumors of never-smokers presented lower levels of CLDN18 than tumors of current smokers (p-value: 0.003). Conclusion: This is the first study to comprehensively describe the expression of different CLDNs in lung ACC and MEC. Overexpression of certain CLDNs may pave the way for targeted anti-claudin therapy in these rare histological subtypes of lung cancer.
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Carcinoma Adenoide Quístico , Claudinas , Neoplasias Pulmonares , Tumor Mucoepidermoide , Estudios Retrospectivos , Humanos , Masculino , Femenino , Persona de Mediana Edad , Claudinas/análisis , Claudinas/genética , Carcinoma Adenoide Quístico/química , Carcinoma Adenoide Quístico/patología , Tumor Mucoepidermoide/química , Tumor Mucoepidermoide/patología , Inmunohistoquímica , Neoplasias Pulmonares/química , Neoplasias Pulmonares/patología , TranscriptomaRESUMEN
Authors present a case of a 52-year-old female patient, who underwent an emergency tracheostomy due to life threatening dyspnoea caused by an external compression of a large goiter. Total thyreoidectomy needed to be carried out later, too. Since the atypical tracheostomy did not close spontaneously a reconstruction was planned. A part of the anterior wall of the trachea needed to be replaced, which was done by an osteocutaneous flap on raised on the supraclavicular artery. An island on the artery was harvested with a thin bone chip taken from the coracoid process of the clavicle, which was rotated into the defect then. The bone chip was sutured to the trachea wall and the donor site was closed primarily. Having reviewed the literature the authors propose the application of this flap in a wide range of cases. The advantages of this flap are the satisfactory functional and cosmetic results, as well as the fact that the donor site does not need skin grafting.
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Fístula Cutánea/cirugía , Fístula/cirugía , Colgajos Quirúrgicos , Enfermedades de la Tráquea/cirugía , Traqueostomía/efectos adversos , Clavícula , Femenino , Humanos , Persona de Mediana Edad , Procedimientos de Cirugía Plástica/métodos , Trasplante de Piel , Colgajos Quirúrgicos/irrigación sanguínea , Resultado del TratamientoRESUMEN
INTRODUCTION: The procedure of the ETS is carried out by two ports, a videothoracoscop and a diathermy instrument are introduced into the pleural cavity. After the identification of the sympathetic chain, the relevant ganglia are divided or excised. MATERIALS AND METHODS: 22 patient underwent bilateral video assisted thoracoscopic T2-T4 sympathectomy in a half-way sitting position for palmar and axillary hyperhydrosis between December 2008 and January 2011. RESULTS: 5 male and 17 female patients with a mean age of 39.9 years, (19-63) underwent the above procedure. The mean operation time was 36 minutes, (30-61 minutes). CONCLUSION: No postoperative complications were detected. The authors believe that two port VATS sympathectomy is a safe and effective method for the treatment of hyperhydrosis even as one day surgical procedure.
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Procedimientos Quirúrgicos Ambulatorios , Hiperhidrosis/cirugía , Simpatectomía/métodos , Cirugía Torácica Asistida por Video , Adulto , Axila , Femenino , Mano , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
INTRODUCTION: Pseudomyxoma Peritonei (PMP) is a rare condition, which arises from the abdominal cavity and it may also involve the pleural cavity occasionally. Concomitant involvement of both cavities is rare. The disease is characterized by production of mucinous ascites, and a low-grade carcinoma deriving mostly from the appendix. Pleural seeding may be due to diaphragmatic perforation during surgical intervention, tumour progression, or persistent congenital malformation between the abdominal and pleural cavities. CASE REPORT: A 44 year-old female patient was treated with pleuropulmonary involvement of pseudomyxoma. Since both the lungs and pleura were involved, radical resection could not have been carried out, and cytoreduction with intraoperative chemotherapy was applied only. DISCUSSION: Pleural progression of pseudomyxoma is uncommon and carries a poor prognosis. Management is similar to abdominal PMP, which involves aggressive cytoreduction and local and/or systemic chemotherapy, if possible. CONCLUSION: PMP is a very uncommon disease with poor prognosis. Extra-abdominal manifestation is rare, too. However, early recognition of the condition may enhance treatment options.
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Neoplasias Peritoneales , Neoplasias Pleurales , Seudomixoma Peritoneal , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Diagnóstico Precoz , Femenino , Humanos , Periodo Intraoperatorio , Neoplasias Peritoneales/diagnóstico por imagen , Neoplasias Peritoneales/tratamiento farmacológico , Neoplasias Peritoneales/cirugía , Neoplasias Pleurales/diagnóstico por imagen , Neoplasias Pleurales/tratamiento farmacológico , Neoplasias Pleurales/cirugía , Pronóstico , Seudomixoma Peritoneal/diagnóstico por imagen , Seudomixoma Peritoneal/tratamiento farmacológico , Seudomixoma Peritoneal/cirugía , Radiografía , Enfermedades RarasRESUMEN
OBJECTIVE: Approximately 30% of malignant, primary bone tumors are chondrosarcomas, which occur on the anterior chest wall most frequently. Patients who are treated with adequate surgical intervention recover well, 10 years survival rate is 97%. Besides the aesthetic outcome, preservation of breathing and loading are crucial. METHODS: Authors present a case of a 44-year-old male patient who worked as a sport masseur operated on Grade II chondrosarcoma of the manubrium. Concerning the age of the patient, an immediate reconstruction was carried out. The involved part of the sternum was resected with wide margins. The reconstruction was performed with Dual Mesh covered by a pedicled left sided pectoral major muscle. As a unique technique, authors used the tendons of the semitendinous and gracilis muscles to fix both claviculas together to give the proper stability and function for the shoulder girdle. RESULT: After an uneventful postoperative period the patient had a fast recovery. CONCLUSION: There are no data in the literature for such a method of fixation of the anterior chest wall. The method is suggested by the authors.
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Neoplasias Óseas/cirugía , Condrosarcoma/cirugía , Manubrio/cirugía , Procedimientos de Cirugía Plástica/métodos , Colgajos Quirúrgicos , Mallas Quirúrgicas , Adulto , Neoplasias Óseas/patología , Condrosarcoma/patología , Humanos , Masculino , Manubrio/patología , Clasificación del Tumor , Resultado del TratamientoRESUMEN
Introduction. Thymoma is the most common tumour of the anterior mediastinum. Video-Assisted Thoracic Surgery technique of thymoma resection is spreading world-wide, but the thoracoscopic method is still contentious in many ways. Authors evaluate the early and mid-term results of a 17 years period of VATS unilateral approach at 2 Hungarian thoracic surgical centers. Method. Depending on the anatomical situation of the thymoma, we performed thymectomy, or partial thymectomy (thymomectomy) for the MasaokaKoga IIIIII stage thymoma from the right or left side through 2 or 3 intercostal ports. We managed the operations with ultrasonic dissector and electrocauter. By using international standards we evaluated perioperative morbidity, mid-term oncological results and clinical symptoms of myasthenia. Results. 23 of the 54 patients were man, 31 were woman, the average age was 58 (2679) years, 23 of them had myasthenia. The conversion rate was 11,5% (7/61). The average operation time was 84 (39150) minutes. The average hospitalisation time was 5.5 (319) days. The average size of the thymomas was 46 (1890) mm. The histology resulted thymoma type A in 2 cases, AB in 19 cases, B1/2/3 in 11/11/1 cases, mixed B in 10 cases. The examination of the resection line was R0/1/2 in 42/11/1 cases. The MasaokaKoga stages were: I (17), IIA (28), IIB (2), III (7). There was 25 thymomectomies, and 29 thymectomies. In seven cases there were extension of the operation to the pericardium (2), to the lung (2), to the phrenic nerve (6), and to innominate vein (1). The in-hospital mortality over 30 day was in 1 case (1.85%). The morbidity was 11/54 (20.4%). The average follow-up time was 62.56 (5198) months. In the group with myasthenia the effectivity of the operation was 18/21 (85.7%), including complete remission of 5/21 (23.8%). Post-thymectomy myasthenia gravis developed in 2/31 cases (6.5%). The average 5 years survival was 100%, tumour-free 5 years survival was 96%. Conclusions. The higher proportion of the thymomectomy in the early results, higher conversion rate and lower R0 proportion might be in connection with the attitude of the surgeons, with the learning curve and with the limitations of the unilateral method. After a longer follow-up time late results may become more real and comparable. Instead of unilateral VATS technique we have changed to the subxyphoideal approach of VATS because of its better visualisation.
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Timoma , Neoplasias del Timo , Humanos , Timectomía , Timoma/cirugía , Neoplasias del Timo/cirugíaRESUMEN
Secondary chest wall infections after previous surgical procedures are well known but the primary form of this is a relatively rare entity. We present a case of a 34-year-old man who suffered from primary suppurative costochondritis diagnosed by ultrasound and chest CT scan. The patient underwent a wide necrosectomy with a muscle flap reconstruction.
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Procedimientos de Cirugía Plástica/métodos , Colgajos Quirúrgicos , Pared Torácica/cirugía , Síndrome de Tietze/diagnóstico , Síndrome de Tietze/cirugía , Adulto , Humanos , Masculino , Supuración , Mallas Quirúrgicas , Pared Torácica/patología , Síndrome de Tietze/patología , Resultado del TratamientoRESUMEN
Tumors that are confined to specific areas of the airway (e.g. left main stem bronchus or the bronchus intermedius) can be removed with resections of the bronchus only and preservation of the parenchyma. During the period of January 2004 to February 2009 five patients underwent isolated bronchial resection for lung tumor with curative intent. In this study we analyzed the data of five men with a median age of 47.6 years (range 2968 years). In four cases resection of the intermediate bronchus was performed, and in one case left main bronchus was removed. Intraoperative frozen section revealed negative bronchial resection margins in all cases. Four patients had carcinoid tumors, while one was diagnosed with chemodectoma. Minor postoperative complications were observed in two patients only. Isolated bronchial resection for lung tumor is associated with low morbidity and mortality. Lung sparing procedures are preferable in the above cases but sufficient experience and conditions are mandatory to achieve adequate results.
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Bronquios/patología , Bronquios/cirugía , Neoplasias de los Bronquios/diagnóstico , Neoplasias de los Bronquios/cirugía , Adulto , Anciano , Neoplasias de los Bronquios/patología , Tumor Carcinoide/diagnóstico , Tumor Carcinoide/cirugía , Secciones por Congelación , Humanos , Masculino , Persona de Mediana Edad , Paraganglioma Extraadrenal/diagnóstico , Paraganglioma Extraadrenal/cirugía , Estudios Retrospectivos , Procedimientos Quirúrgicos Operativos/métodos , Resultado del TratamientoRESUMEN
Results of 86 minimally invasive anterior chest wall reconstructions for pectus excavatum by the method of Nuss are evaluated retrospectively. Complications, possible ways of avoiding those and technical details of the operation are discussed. Nuss method is also evaluated in terms of suitability patients' age. Minimally invasive anterior chest wall reconstructions were performed in 86 patients in the last seven years. The average age was 21.4 years. There were no severe intra-operative complications. Four dislocations of the metal bar (12 and 53 days after chest reconstruction) were observed and treated by Nuss-technique. One metal bar had to be removed on the 13th postoperative day for local septic complication, and another one for significant sterile dislocation 14 months after the operation. One patient asked for removal of the metal bar because of pain. In one case bleeding from a small side-branch of the internal mammary artery was stopped by VATS technique, a small superficial lung injury was treated by thoracic drainage. Over 90 percent of patients were satisfied with the cosmetic results. Operating time and length of hospital stay gradually decreased throughout the years. Nuss technique can be performed safely in young adults for pectus excavatum with excellent long-term results. Less pain and shorter operating time of minimally invasive repair are the advantages of the procedure. Age above 30 years and previous open chest correction increases the risk for operation.
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Tórax en Embudo/cirugía , Procedimientos de Cirugía Plástica/métodos , Pared Torácica/cirugía , Adolescente , Femenino , Tórax en Embudo/psicología , Humanos , Tiempo de Internación , Masculino , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Procedimientos de Cirugía Plástica/efectos adversos , Resultado del Tratamiento , Adulto JovenRESUMEN
The incidence of lung cancer in Hungary remains among the highest in Europe. Despite its high mortality rate, surgical treatment of early stage disease may lead to full recovery. In the past two decades, the field of thoracic surgery has seen significant technological advances, as well as a major paradigm shift. Our article aims to summarize these recent improvements. Prediction of survival rates improved significantly due to the 8th revision of the TNM system, but there are other new predictive models too. The growing number of minimally invasive surgical procedures shortened and eased the pre- and postoperative periods. Perioperative risks can be reduced and quality of life will improve with sub-lobar resections. A range of newly developed equipment enables gas exchange leaving free access to airways thus ensuring patient safety during extended procedures. Finally, the development of novel biological drugs brought on the need to reconsider the operability of oligometastatic patients and those requiring so-called salvage procedures.
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Neoplasias Pulmonares , Calidad de Vida , Europa (Continente) , Humanos , Hungría , Neoplasias Pulmonares/cirugía , Procedimientos Quirúrgicos Mínimamente InvasivosRESUMEN
Introduction: Surgical technique of thymectomy performed for treatment of myasthenia gravis has considerably changed in the last almost 30 years. In addition to standard interventions transsternal and transcervical thymectomy , video-assisted thoracoscopic interventions (VATS), later on robotic surgery came into general use. In our two institutions, we apply VATS thymectomy since 2011. Methods: There are several different surgical techniques for this purpose; we approached the mediastinum through the right thoracic cavity. We prepared initially 3, later on 2 perimammal ports for the access of the thymus; the patients were in supine position during surgery. We used an ultrasonic cutting device in all cases. In order to perform extended thymectomy, we removed the fatty tissue around the thymus and opened widely the left thoracic cavity, too. During patient enrollment, we preferred patients with normal or lower body weight. Results: During 8 years and 4 months, we operated on 92 patients using this method for myasthenia gravis without thymoma; there were 20 male and 72 female patients at the age of 33 years on average (1975 years). Duration of surgery was 35160 minutes, 82.3 minutes on average. The bulky fatty tissue around the thymus made the orientation and the complete removal more difficult in a few patients. We experienced vascular injury in 4 cases and injury of the contralateral lung in 3 cases. Conversion was necessary in 2 cases (1 sternotomy and 1 thoracotomy), there were no nerve injuries. Assisted ventilation was necessary in case of ten patients in the postoperative period for a few hours; all other patients were extubated on the operating table. There was no need for repeated intubation and tracheostomy; there was no respiratory insufficiency and perioperative mortality. Duration of ICU care was 1.1 days on the average (011 days), that of the total hospital care 4.8 days on average (315 days). Duration of thoracic drainage was 1.16 days on average (14 days). Two patients (2.41%) died within one and five years after surgery. During 12108 months (48 months on average) follow-up of 81 patients, 21 patients (25.3%) suffering from myasthenia total recovery was observed, pharmacologic remission was achieved in 4 patients (5.3%), minimal manifestation remained in 23 patients (24.1%), while in 28 patients (33.73%) other improvement was observed. The status of 4 patients (4.82%) remained unchanged and that of 4 patients (5.3%) worsened. Conclusion: VATS thymectomy represents a completely new surgical method for surgeons having experience in transsternal surgical technique. Bulky mediastinal fatty tissue makes surgery very difficult. The perioperative period is advantageous for the patients and also the long term follow-up results are acceptable. It is questionable that the thymus can be completely removed with this method in all cases.
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Miastenia Gravis/cirugía , Cirugía Torácica Asistida por Video/métodos , Timectomía/métodos , Timoma/cirugía , Neoplasias del Timo/cirugía , Adulto , Anciano , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Introduction: Most modern thoracic operations are performed with single-lung ventilation balancing between convenient surgical approach and adequate gas exchange. The technical limitations include difficult airways or insufficient parenchyma for the intraoperative single-lung ventilation. Earlier, cardiopulmonary bypass was the only solution, however, today the extracorporeal membrane oxygenation is in the forefront. Aim: We retrospectively analysed our elective operations by use of venovenous ECMO to assess the indication, safety, perioperative morbidity and mortality. Patients and method: 12 patients were operated using venovenous (VV-) ECMO between 28 April 2014 and 30 April 2018 in the National Institute of Oncology. The main clinicopathological characteristics, data regarding the operation, the use of ECMO and survival were collected. Results: The mean age was 45 years, 2 patients had benign and 10 had malignant diseases. Extreme tracheal stricture was the indication for ECMO in 3 cases, while 4 patients had previous lung resection and lacked enough parenchyma for single-lung ventilation. 5 patients had both airway and parenchymal insufficiency. The average time of apnoea was 142 minutes without interruption in any of the cases. We did not experience any ECMO-related complication. We had no intraoperative death and 30-day mortality was 8.33%. Conclusion: In case of technical inoperability, when there is no airway or insufficient parenchyma for gas exchange, but pulmonary vascular bed is enough and there is no need for great-vessel resection, VV-ECMO can safely replace the complete gas exchange without further risk of bleeding. The use of VV-ECMO did not increase the perioperative morbidity and mortality. Previously inoperable patients can be operated with VV-ECMO. Orv Hetil. 2019; 160(42): 1655-1662.
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Obstrucción de las Vías Aéreas/terapia , Oxigenación por Membrana Extracorpórea/métodos , Cirugía Torácica/métodos , Procedimientos Quirúrgicos Torácicos/métodos , Adulto , Anciano , Obstrucción de las Vías Aéreas/etiología , Oxigenación por Membrana Extracorpórea/efectos adversos , Femenino , Humanos , Hungría , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Procedimientos Quirúrgicos Torácicos/efectos adversos , Resultado del TratamientoRESUMEN
Introduction: Completion pneumonectomy (CP) means the removal of the entire residual lung tissue after previously performed lung resection. Mortality and morbidity of CP are higher when compared to those of standard pneumonectomy. In this article, we give an overview on indications and perioperative results of CP. Method: We analysed the perioperative results of CP performed during a period of 15 years in a retrospective manner, based on the patients' medical records, descriptions of surgeries and histological findings. We divided the indications into three groups: rescue surgery for complications in the early postoperative period (rescue: rCP), incomplete resection verified by histological results (pathological: pCP) and conventional surgeries performed in the late postoperative period (conventional: cCP). We classified the complications according to an international scale. Results: The overall surgery-related morbidity of 102 patients was 70.5% (minor: 36.27%, major: 34.23%), the mortality was 16.6%. There were no lethal complications during the surgical procedures. rCP: 24 patients (18 men, 6 women, 46-77 years, average 61.7 years). Intervals between operations: 10.87 days (0-32 days). Indications: necrosis or abscess formation (8 cases), bronchial fistula (5 cases), insufficient or blocked anastomosis (3 cases), massive haemoptysis (3 cases), intrathoracic bleeding (2 cases), non-expanding lung (3 cases). Overall morbidity: 79.19%. Nine patients died (37.5%). pCP: 7 patients (5 men, 2 women), 45-66 years (average: 56.3 years). Primary surgery: 6 lobectomies, 1 bilobectomy. Intervals between operations: 1-5 months (average: 2.84 months). Three patients did not develop complications, four had anaemia requiring blood transfusion, one empyema requiring fenestration, one died (14.28%) due to intrathoracic bleeding. There were no tumours in the removed lung tissues in cases of four patients. cCP: 71 patients (22 women, 44 men, 29-79 years (average: 60.3 years). Intervals between operations: 34 days - 40 years (average: 6.7 years). Histological findings of the previous surgeries: primary lung tumour (64 patients), metastases of tumours in other organs (1 patient), bronchiectasia (1 patient) and tuberculosis (5 patients). Indications of cCP: late bronchial fistula (2 patients), verified or suspected tumour (65 patients), other (4 patients). Histological findings with primary lung tumour in the patient's history: 32 new tumours, 15 local recurrences, 9 metastases, 2 metastases or recurrences, 7 non-malignant. Histological findings without malignancy in the patient's history: 3 new tumours, 1 tuberculosis and 2 chronic inflammations. Overall morbidity was 76.2%, mortality within 30 days or in the hospital 9.8%. Conclusions: Morbidity and mortality are the highest after rCP, but these patients usually do not have any other chance for healing. We have not performed repeat surgery for incomplete tumour resection in the last 10 years. Comparing our results to the international data, the morbidity after cCP is high, the mortality is similar.
Asunto(s)
Enfermedades Pulmonares , Neoplasias Pulmonares , Neumonectomía , Femenino , Humanos , Enfermedades Pulmonares/cirugía , Neoplasias Pulmonares/cirugía , Masculino , Recurrencia Local de Neoplasia , Complicaciones Posoperatorias , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Use of 3D planning and 3D printing is expanding in healthcare. One of the common applications is the creation of anatomical models for the surgical procedure from DICOM files. These patient-specific models are used for multiple purposes, including visualization of complex anatomical situations, simulation of surgical procedures, patient education and facilitating communication between the different disciplines during clinical case discussions. Cardiac and thoracic surgical applications of this technology development include the use of patient-specific 3D models for exploration of ventricle and aorta function and surgical procedural planning in oncology. The 3D virtual and printed models provide a new visualization perspective for the surgeons and more efficient communication between the different clinical disciplines. The 3D project was started at the Semmelweis University with the cooperation of the Thoracic Surgery Department of the National Institute of Oncology in 2018. The authors want to share their experiences in 3D designed medical tools. Orv Hetil. 2019; 160(50): 1967-1975.