[Video-assisted thoracoscopic surgery in diagnosis and treatment of pleuritis]. / Vaizdo torakoskopijos galimybes diagnozuojant ir gydant pleuritus.

OBJECTIVE: To evaluate possibilites of video-assisted thoracoscopic surgery in diagnosis and treatment of pleuritis. 1997-2002 in Department of Thoracic Surgery and Oncology of Vilnius University Institute of Oncology 206 patients underwent videothoracoscopic procedures (146 (70.8%) of them for pleuritis). All procedures were performed in general anesthesia using double lumen tube. Mean patient age was 61+/-10 years. One hundred three women (71%) and 43 men (29%) were operated. Seventy four (51%) chemopleurodesis was performed with pleural biopsies: for 2 patients (1.36%) bleocine was used, and for 74 patients (50.6%) sterile talk. RESULTS: Significance of pleural videobiopsies reaches 93%. Eleven patients (7%) failed in diagnosis: in 5 cases (3.4 %) due to adhesions, in 6 cases (3.4%) we made false positive diagnosis. COMPLICATIONS: postoperative pneumonia - 12 patients (8.8%), pneumothorax - 2 patients (1.5%), pleural empiema - 1 patient (0.75%), bleeding - 1 patient (0.75%). CONCLUSIONS: Specificity of video-assisted thoracoscopic surgery in pleural diseases reaches 93.0%. Video-assisted thoracoscopic surgery is necessary even in cases of failed "blind" biopsies and possible in elderly patients. Video-assisted thoracoscopic surgery provides not only easy morphologic verification of pleural diseases but also performance of chemopleurodesis.

[Possibilities of diagnosis and treatment of malignant pleural mesothelioma]. / Piktybines pleuros mezoteliomos diagnostikos bei gydymo galimybes.

UNLABELLED: Objective of our work was to evaluate: incidence, ethiology, diagnostic and treatment methods of malignant pleural mesothelioma. MATERIAL AND METHODS: During period 1992-2001 125 cases of pleural mesothelioma were diagnosed in Lithuania. Conventional X-rays and ultrasound were used in 125 cases (100%), chest CT scans in 57 (45.6%), and chest X-rays and CT scans in 38 (30.4%) cases. In 5 cases (4.0%) we performed chest CT scans and MRI. Various surgical diagnostic methods were used: videothoracoscopy in 35 (28.0%) cases, pleural biopsies 72 (57.6%) cases, diagnostic "mini" thoracotomies - 18 (14.4%) cases. Malignant pleural mesothelioma in all cases was proved morphologically. These operations were performed: pleuropulmonectomies - 62 (60.1%), extended pleuropulmonectomies with resections of pericardium and subtotal diaphragm - 10 (9.7%), parietal pleurectomies without resection of lung and pericardium - 17 (16.5%), partial pleurectomies with resection of pericardium - 4 (3.8%), debulking of tumor (partial resections) - 10 (9.7%). Totally 103 patients were operated (82.4%). Twenty two patients were treated conservatively when diagnosis was confirmed. There were such main postoperative complications: fistulas of bronchial stump - 6 cases (5.8%), chylothorax - 5 cases (4.8%), injury of sympatic ganglion - 2 cases (1.9%), and hemothorax - 10 cases (9.7%); 3 patients (2.91%) died after operation. RESULTS: Mean survival time after combined treatment was 12+/-2 months. After conservative treatment alone - 6.0+/-2 months. In combined treatment group 22 patients (17.6%) had recurrence of disease during 3 years. In conservative treatment group no one survived 3 years. CONCLUSIONS: Combined surgical treatment of malignant pleural mesothelioma is still the most effective. Most of diagnosed cases were found in delayed stage. Mean survival time after combined treatment is 12.0+/-2 months, after conservative - 6.0+/-2 months, and recurrence of the disease during 3 years - 17.6% and 100% respectively.

[Postoperative adjuvant therapy in combined lung cancer treatment]. / Pooperacines papildomos terapijos galimybes gydant plauciu vezi.

UNLABELLED: The aim of the study was: to evaluate efficacy of postoperative chemotherapy and chemoradiotherapy in patients with NSCLC (N2) disease and to point out time to tumor progression and reccurence, as well as to patients survival. Study was performed as a part of International Adjuvant Lung Cancer Treatment (IALT) protocol. In 1999-2000, 110 patients patients with NSCLC with metastases to N1 and N2 regions entered the trial. Patients were randomized for investigonal group: postoperative chemotherapy 31 patients (48.4%), and chemoradiotherapy 34 patients (53.1%). These patients were compared to 45 patients who underwent only surgery (control group). Patients in the first group according to stages were: II A st. 30 patients (46.1%), IIB - 6 patients. (9.2%), IIIA st. 29 patients (44.6%). Morphology: squamos cell 44 patients (67.6%) and adeno 16 patients (24.6%). OPERATIONS: lobectomy - 20 patients (30.7%), bilobectomy - 6 patients (9.2%), pleuropneumonectomy 13 patients (20%), combined pneumonectomy 13 patients (20%), pneumonectomy 12 patients (18.4%). Chemotherapy started within 60 days after operation. Radiation started in 10 days after last cycle of chemotherapy. RESULTS: Postoperatively 42.8% patients had reccurences after pneumonectomy. In surgery group 26.6% patients had reccurences in 3-year period. Medial survival in adjuvant group was 21.3 months. In surgery group three-year survival was in 19.7% of patients, chemoradiation group - 42.4%, and chemotherapy group - 37.2%. CONCLUSIONS: Postoperative adjuvant therapy remains unsolved and controversal problem. Neither chemotherapy, nor chemoradiotherapy has real impact on survival: 3-year survival in surgery group was observed in 19.7%, in chemoradiation - 42.2%, and in chemotherapy group in 37.2% of patients. Efficacy of postoperative treatment depends on radical removal of lymphodes, tumor morphology and postoperative complications.

[Surgery for esophageal cancer: 10 years experience]. / Stemples vezio chirurginio gydymo galimybes (10-ties metu patirtis).

UNLABELLED: Objective of work was to evaluate efficacy of surgery for esophageal cancer with one-step gastric pipe reconstruction, to analyze postoperative complications, causes of deaths and patient's life expectancy. In 1992-2002 in Clinic of Surgery Vilnius University Institute of Oncology 213 patients underwent surgery for esophageal cancer; 177 patients (83.0%) were applied transthoracic approach, 34 patients (15.9%) transhiatal and 2 patients (0.9%) Lewis type operations. TNM of patients were T3N1M0 - 99 (46.4%), T2N1M0 - 17 (7.9%), T2N0M0 - 16 (7.5%), T4N2M0 - 54 (25.3%), T2-3N2M1 - 27 (12.6%). Patient performance status according to WHO scale was 0-2. The following postoperative complications were observed: vagus pneumonia - 52 (24.2%) patients, heart insufficiency- 13 patients (6.1%), aortal bleeding 3 (1.4%) patients, suture leakadge - 33 (15.4%) patients, injury of n. reccurentis 17 (7.9%) patients, pleurites 29 (13.6%). Postoperative mortality after transthoracic approach - 29.3%, transhiatal - 15%, Lewis resections - 0%. Median survival after transthoracic approach - 29 months, transhiatal - 34 months, Lewis resections - 39 months. CONCLUSIONS: Surgery for esophageal cancer is the most sufficient way of esophageal cancer treatment. Three-level lymphadenectomies postpone early relapses. Postoperative mortality varies from 15 to 29.3%, median survival from 29 to 39 months.