Salvage Surgery for Small-Cell Lung Cancer-A Literature Review.

(1) Background: Salvation surgery for small-cell lung cancer (SCLC) is exceptionally performed, and only a few cases are published. (2) Methods: There are 6 publications that present 17 cases of salvation surgery for SCLC-the salvation surgery was performed in the context of modern clearly established protocols for SCLC and after including SCLC in the TNM (tumor, node, metastasis) staging in 2010. (3) Results: After a median follow-up of 29 months, the estimated overall survival (OS) was 86 months. The median estimated 2-year survival was 92%, and the median estimated 5-year survival was 66%. (4) Conclusion: Salvage surgery for SCLC is a relatively new and extremely uncommon concept and represents an alternative to second-line chemotherapy. It is valuable because it may offer a reasonable treatment for selected patients, good local control, and a favorable survival outcome.

Oncologic Outcome after Pulmonary Metastasectomy as Part of Multidisciplinary Treatment in a Tertiary Oncological Center.

(1) Background: Pulmonary metastases are encountered in approximately one-third of patients with malignancies, especially from colorectal, lung, breast, and renal cancers, and sarcomas. Pulmonary metastasectomy is the ablative approach of choice, when possible, as part of the multidisciplinary effort to integrate and personalize the oncological treatment. (2) Methods: The study includes 58 consecutive cases of pulmonary metastasectomies, retrospectively analyzed, performed in 12 consecutive months, in which the pathology reports confirmed lung metastases. (3) Results: Most frequent pathological types of metastases were: 14 of colorectal cancer, 10 breast, 8 lung, and 8 sarcomas. At the time of primary cancer diagnosis, 14 patients (24.14%) were in the metastatic stage. The surgical approach was minimally invasive through uniportal VATS (Video-Assisted Thoracic Surgery) in 3/4 of cases (43 patients, 74%). Almost 20% of resections were typical (lobectomy, segmentectomy). Lymphadenectomy was associated in almost 1/2 of patients and lymph node metastases were found in 11.11% of cases. The mortality rate (intraoperative and 90 days postoperative) is zero. The OS after pulmonary metastasectomy is 87% at 18 months, and the estimated OS for cancer is 90% at 5 years. The worst outcome presents the patients with sarcomas and the best outcome-colorectal and lung cancer. The patients with 1 or 2 resected metastases presented 96% survival at 24 months. (4) Conclusions: After pulmonary metastasectomy, survival is favored by the small number of metastases resected (1 or 2), and by the dimension of metastases under 20.5 mm. The non-anatomic (wedge) type of lung resection may present a lower risk of death compared to lobectomy. No statistical significance on survival has the presence of lymphadenectomy, the laterality right/left lung, the upper/lower lobes. In the future, longer follow-up and prospective randomized trials are needed for drawing definitive conclusions.

Tensioned space after pneumonectomy for cancer with mediastinal shift and cardiac tamponade-causes and treatment (Review).

Regarding the pleural space after pneumonectomy for malignancy, a vast number of studies have assessed early drop in the fluid level, suggesting a broncho-pleural fistula, but only a small number of studies reported on the abnormal increase in the fluid level-a potentially lethal complication. In the present study, the available databases worldwide were screened and 19 cases were retrieved, including 14 chylothorax and 3 hydrothorax cases, 1 pneumothorax and 1 haemothorax case. Tension chylothorax is caused by mediastinal lymph node dissection as an assumed risk in radical cancer surgery. For tensioned haemothorax, the cause has not been elucidated, although lymphatic stasis associated with deep venous thrombosis was suspected. Tensioned pneumothorax was caused by chest wall damage after extrapleural pneumonectomy combined with low aspiration pressure on the chest drain. No cause was determined for none of the tensioned hydrothorax-all 3 cases had the scenario of pericardial resection in addition to pneumonectomy in common. Tensioned space after pneumonectomy for cancer manifests as cardiac tamponade. Initial management is emergent decompression of the heart and mediastinum. Final management depends on the fluid type (chyle, transudate, air, blood) and the medical context of each case. Of the 19 cases, 12 required a major surgical procedure as the definitive management.

Minimally Invasive Thoracic Surgery - Video Assisted Thoracic Surgery: Technique and Indications.

Video-Assisted Thoracic Surgery (VATS) is already practised worldwide, in almost every condition addressed by open thoracic surgery. As part of minimally invasive thoracic surgery (MITS), VATS offers to patients and to healthcare providers excellent results and great satisfactions. Learning and performing VATS use different pathways in trainees and in experienced surgeons. This article presents VATS in its essence: classification, indications, contraindications, instruments and tools, incisions and access, troubleshooting, learning curve and training. We wish that the information helps our colleagues, both trainees and experienced thoracic surgeons, to start and continue performing VATS as standard care in thoracic surgery.

Immediate Postoperative Results in the Surgical Treatment of Neoplastic Pericarditis - 76 Consecutive Cases.

Introduction: Pericardial effusion, accumulation of fluid in the pericardial sac, may develop in any type of cancer. It was revealed in up to 20% of oncological patients. Method: We made a retrospective study of patients with pericardial efusion presented in our clinic between 2010 and 2015. We included 76 consecutive patients with indication for peri cardial drainage - we performed on them 80 surgical procedures: pericardocentesis, subxiphoid pericardial window, left paraxifoidian pericardial window, intercostal video-assisted thoracic surgery (VATS) pericardial fenestration, and classical thoracic surgery (fenestration or partial pericardiectomy). We had patients with ages between 28 and 83 years. 23 patients were admitted with cardiac tamponade. The immediate postoperatory survival is 97.3 % and the 30-days-postoperatory survival is 81.5 %. Results: The immediate postoperatory mortality is 2.7% and the 30-days-postoperatory mortality is 8.5%. Conclusions: The immediate prognosis of the patient with malignant pericardial effusion is influenced by the risk of postoperative Low-Cardiac-Output-Syndrome (LCOS), or pericardial decompression syndrome (PDS), which remains the main cause of mortality. The long-term prognosis is related to the type of malignant tumor. The most effective tehnique with the lowest rate of recurrence is pericardo-pleural window done thoracoscopically/ by VATS; pericardocentesis has the highest rate of recurrence - 90% and is associated with high rates of cardiac complications and mortality.

Ordinary symptom for a serious pathology - giant solitary fibrous tumor of the pleura.

The solitary fibrous tumor of the pleura (SFTP) is a rare primary tumor arising from mesenchymal cells in the areolar tissue subjacent to the mesothelial-lined pleura. From an epidemiological standpoint, solitary fibrous tumors of the pleura account for less than 5% of primary pleural tumors, and commonly affect patients in the sixth and seventh decades. We presented the case of a 38-year-old woman, without any significant pathological history, who presented at the emergency room for unspecific respiratory symptoms. Imagistic investigations showed a giant opacity in the upper half part of the left hemithorax. The patient underwent surgery and en bloc resection of the tumor (30/25 cm) in oncological limits was performed. Definite diagnosis - solitary fibrous tumor of the pleura - was obtained through histological examination and immunohistochemistry. Even if SFTP are benign tumors, a long follow-up period is mandatory as even patients with complete resection are at risk of recurrence several years after surgery.

A rare case of unicentric plasma cell type Castleman's disease in the mediastinum.

Castleman's disease is a very rare (and thus little-known) lymphoproliferative disorder characterized by lymph node follicular hyperplasia with abnormal interfollicular vascular growth. It can be classified into unicentric and multicentric variants according to its localization, and into three histological types: hyaline-vascular, plasma cell and mixed. We describe the case of a 51 year-old woman who presented with precordial chest pain. Chest X-Ray and computed tomography (CT) raised the suspicion of an aortic aneurysm, and the patient was sent to the Interventional Cardiology Clinic at the Military Emergency Clinical Center for Cardiovascular Diseases (CCUBCVA), where the diagnosis of mediastinal tumor was made by ultrasonography, coronarography and CT. The patient was transferred to our clinic, where a diagnostic mediastinoscopy proved histolopathologically inconclusive. A lateral thoracotomy with ideal tumorectomy was decided upon and carried out, and the diagnosis of plasma cell type Castleman's disease was established. This paper discusses the pathogenic mechanisms, symptoms, diagnosis and treatment of Castleman's disease.

[Cervico-mediastinal lymphangioma]. / Limfangiomul cervico-mediastinal.

The authors are describing three cases of lymphangioma, one at a seven years old child with cervico-mediastinal localization; another at a 39 years old person, situated only in mediastinum, the third is a cervical lymphangioma at a 55 years old subject. The respiratory symptoms are present in the two cases with mediastinal involvement. The patient with cervical localization had no symptoms. The radiological exams: thoracic radiography, CT or the ultrasound test are revealing a cystic tumor in mediastinum or in cervical region. We performed a complete surgical tumor resection through median sternotomy, left thoracotomy and cervicotomy. The evolution was very good in all cases. The diagnosis had histopathological confirmation.