A Single-Center Experience on the Treatment Outcomes of Patients with COVID-19-Pleural Disorders: Lessons for the Future.

Background: Pleural disorders in novel coronavirus disease 2019 (COVID-19), responsible for the deaths of more than 6.7 million people worldwide, are relatively uncommon and underappreciated findings. The severity of the pleural disease in these patients correlates with the treatment outcome and overall prognosis. Objective: We aim to review our experience with treatment modalities and prognosis in 45 patients with COVID-19, who were treated at our Clinic between April 2020 and October 2021. Methods: We conducted a retrospective, single-center, cross-sectional study. Demographic data, the type of thoracosurgical intervention(s), and treatment outcome for 45 patients included in this study were recorded for every patient. We analyzed the type and number of treatment modalities according to the pleural disorder, and the outcome of the treatment. Results: Pneumothorax was the most common COVID-19-related pleural disorder, followed by the pleural effusion. Tube thoracostomy was the mainstay of treatment, performed in 84.4% of patients with unilateral pleural complications. In total, 20% of our patients were on mechanical ventilation, and all of them had a fatal outcome. We found statistical significance in comparison to the percentage of fatal outcomes between patients treated with and without mechanical ventilation (p=0.000). Conclusion: COVID-19-related pleural disorders are prognostic markers of disease progression. Mechanically ventilated patients who require tube thoracostomy have an unfavorable prognosis.

Effects of Neoadjuvant Therapy After the Initial Assessment of Operability in Patients with Borderline Operable and Inoperable Stage IIIA Non-small Lung Cancer.

INTRODUCTION: Lung cancer is a neoplasm with the highest mortality rate in the world. The role of neoadjuvant therapy in patients with initially assessed borderline operable or inoperable lung cancer is to improve survival by downstaging the tumor and allowing surgical resection, as well as the potential treatment of micrometastatic disease. AIM: Establishing the justification and efficacy of neoadjuvant therapy after the initial assessment of operability in patients with borderline operable and inoperable histopathologically verified stage IIIA non-small cell lung cancer. METHODS: The retrospective study included 65 patients with initially assessed stage IIIA lung cancer, who underwent neoadjuvant therapy. After the cycles of neoadjuvant therapy, 19 patients who achieved the regression of the tumor underwent surgery. We analyzed the histological type of the tumor, extent, and prevalence of surgical resection, the status of regional lymph nodes, and the achieved R status. RESULTS: Of the total number of patients who underwent neoadjuvant therapy, after reevaluation of the disease, 19 patients (19/65, 29.23% of cases) achieved a clinical response, i.e. tumor downstaging. Of 19 patients who underwent surgery, 16 patients underwent surgical resection, while three patients underwent surgical exploration. The largest number of patients had N0 and N1 status (six patients each). R0 status was achieved in 14 patients (14/16, 87.5% of cases), while R1 in the remaining two. One patient had a fatal outcome. CONCLUSION: Neoadjuvant therapy plays an important role in the treatment of initially assessed borderline operable or inoperable lung cancers. By downstaging the tumor, it allows surgical resection and potential treatment of micrometastatic disease.

Comparison of Efficiency of Pleurodesis Between Video Assisted Thoracoscopic Surgery (VATS) and Standard Thoracostomy.

BACKGROUND: Chemical pleurodesis is generally accepted palliative dyspnea therapy and preventive of re-accumulation of pleural fluid in patients with malignant pleural effusions. AIM: Comparative analyses of efficiency of chemical pleurodesis between Video Assisted Thoracoscopic Surgery (VATS) and standard thoracostomy. METHODS: From 01.01.2016-01.01.2017 at the Clinic for Thoracic Surgery of University Clinical Center (UCC) Sarajevo retrospective analysis was performed. Studied patients underwent VATS pleurodesis (G1) and standard thoracostomy pleurodesis (G2), with 60 in each group, respecting defined inclusion and exclusion criteria. Pleurodesis success was examined radiologically over the next three months. RESULTS: Average age of all patients was 63.97±8.75 years. Gender related, 45% were men and 55% were women (F/M=1.47:1). Average hospitalization was 7.22±1.37 (G1: 6.68±1.16; G2: 7.44±1.40; Mann-Whitney U-test: p=0.0016) days. Average thoracic drainage duration was 5.45±1.69, (G1: 4.28±1.15,G2: 6.05±1.58; Mann-Whitney U-test p<0.0001) days. Pleurodesis success after first month was 98.30% in G1, 91.60% in G2 (G1 vs. G2; p=0.2089); after second month was 98.30% in G1, 78.30% in G2 (G1 vs. G2; p=0.0011) and after three months was 91.60% in G1, 63.30% in G2(G1 vs. G2; p=0.0006). Average dyspnea degree (0-5) after the pleurodesis was 0.050±0.22 in G1 and 0.62±0.76 in G2 (Mann-Whitney U-test; p=0.0001). Complication were noticed in 9.2% patients, in G1 3.3%, 15.0% in G2. CONCLUSION: Difference in pleurodesis efficiency between the G1 and G2 was established after second month and was even more evident after third month in favor of G1. Results show the significant statistical improvement of the degree of dyspnea in G1 as opposite to the G2.

Initial treatment of isolated thoracic injuries.

INTRODUCTION: Isolated thoracic injuries are relatively common and they are on the second place as a cause of death overall trauma. Most patients with isolated thoracic injuries are treated on an outpatient basis while only serious cases are hospitalized. The basis of the treatment of thoracic trauma is efficient cardiopulmonary reanimation followed by an early detection and treatment of life threatening injuries. Less than 15% of patients with thoracic trauma require thoracotomy. PATIENTS: Only the patients with exclusively isolated thoracic trauma were analyzed. RESULTS: Based on initial diagnostic procedures initial conservative treatment was indicated and sufficient for 63.75% (204/320) cases while initial surgery treatment was necessary in 36.25% (116/320) of the injured. In relation to the type of surgery the thoracic drainage was performed in 81.03% (94/116) while thoracotomy and VATS procedure was necessary for 7.75% (9/116) of the injured. After the secondary examination or shorter monitoring of the status of the injured, the additional diagnostic procedure was suggested and performed in only 5% (16/320) of the injured. The average period of the hospitalization for all injured with isolated thoracic trauma was 5.9 +/- 4.0 days (from 6 hours to 16 days). In cases of patients with blunt injuries the average period of hospitalization was 6.07 +/- 4.26 days, while for the patients with penetrating trauma it was 5.4 +/- 3.36 days. The calculated value oft-student test (0.2766 > 0.05) indicates that there is no statistically significant difference in the period of the hospitalization in relation to the type of trauma (blunt vs. penetrating). The average period of thoracic drainage was 5.58 +/- 3.3 days (from 3 to 17 days). The average duration of thoracic drainage in the patients with blunt trauma was 5.81 +/- 2.67 days, while in the patients with penetrating trauma it was 5.08 +/- 1.99 days. The calculated value of the probability of t-test (0.1478 > 0.05) shows that there is no significant difference in the period of drainage in cases of blunt and penetrating trauma. Out of total number of patients, 98.0% (315/320) of the injured were successfully treated. The complications were found in 1.25% (4/320) cases. Death was the outcome in 1.5% (5/320) of injured. CONCLUSION: Based on the results of the initial diagnostic treatment, in majority of injured with isolated thoracic trauma, it was possible to conduct the relevant and appropriate therapeutic procedures. On the basis of relatively short period of thoracic drainage, hospitalization and low rates of morbidity and mortality, it may be confirmed that the application of initial diagnostic and therapeutic protocols of the Clinic for thoracic surgery resulted in the achievement of the successful treatments in majority of the injured for this type of the

Evaluation of the preoperative stage and operative findings in patients with non-small cell lung cancer.

Lung cancer is responsible for 40% mortalities from malignant diseases in man and exhibits an extremely infiltrating way of growing. It does not respect the lobes' or the organs' borders and spreads by blood system, lymph system and per continuitatem. According to its biological characteristics and response to treatments it may be divided in to small cell lung cancer (SCLC) and non small cell lung cancer (NSCLC), which also includes other histological types. Lung cancer treatment includes surgical treatment, chemotherapy, radiotherapy, the combination of the former three as well as symptomatic treatment. In this study, we analyzed 125 patients with lung cancer, that were hospitalized at the Clinic for Thoracic Surgery in KCU Sarajevo. The difference according to gender is statistically significant because we had 111 (88,8%) male patients in comparison with 14 (11,2%) female patients. The average age of male patients was 60,3 years while female patients were 61,9 years old on average. Thus, the difference in average age is not statistically significant. In diagnostic procedures: chest radiography was the most significant in peripheral lesions (60, 8%). CT of the thoracic organs has a statistical significance because the tumor changes were confirmed in 123 patients (98,4%). In bronchoscopy, we had 120 patients (96,0%). The number of patients with preformed lobectomy (63) is statistically significantly greater in the observed group (125) then the number of patients with other operative procedures preformed. From the postoperative complications we had exitus letalis 2 (1,6%), wound infection 19 (15,2%), and 104 without complications (83,2%). The results of testing the significance of differences according to the cancer types in non small cell lung cancer were planocellular, adenocarcinoma, and macrocellular. Comparing the preoperative staging and operative findings through stages we obtained to the following results: in stage ST0 the deviation was 16,7%, STIA the deviation was 40,1%, STIB the deviation was 16,1%, STIIA the deviation was 11,1%, STIIB the deviation was 12,5%, STIIIA the deviation was 33,33%, STIIIB the deviation was 33, 3%. From the overall number of patients, who were in preoperatively graded stage STIA, operative findings confirmed STIA, which makes the most important statistically significant difference. In 36 patients or 28,8% the status was changed in operative finding. In 89 patients preoperative status or 72,2% remained unchanged following the operation.