Comparative Study of Early Postoperative Complications: Thoracic Anastomosis vs Cervical Anastomosis - in Esophageal Replacement with Gastric Graft.

Gastric pull-up is the most commonly used procedure for esophageal replacement in both malignant and benign conditions. In our article we compare the differences in mortality and morbidity between thoracic anastomosis and cervical anastomosis during gastric pull-up. The study group comprised of 126 patients - 58 patients (56%) with cervical anastomosis and 68 patients (64%) with thoracic anastomosis. The overall mortality in the study group was 5.55% (7 patients), while the overall morbidity was higher at 28%. There were no significant differences between the two subgroups regarding mortality and morbidity, although the rate of anastomotic leakage was higher in the cervical subgroup (13.8% vs 1.5%). We recommend performing thoracic anastomosis during gastric pull-up whenever the location of the lesion allows it, since the procedure is safe, relatively easy to master and it shortens operating time by excluding the cervical approach.

Postintubation Tracheoesophageal Fistula - Diagnosis, Treatment and Prognosis.

Introduction: Postintubation tracheoesophageal fistula is a severe complication occurring under certain conditions in patients that require prolonged mechanical ventilation. MATERIAL AND METHODS: This article focuses on a sample of 11 patients with postintubation tracheoesophageal fistula, operated in our department between 2005 and 2015. The anterior approach with tracheal resection was performed in 10 of these patients, while an atypical surgical technique was preferred in a case involving a large-sized fistula. Three of these patients were subject to surgery while still on the ventilator, in order to help weaning them from mechanical ventilation. Two patients were operated following a relapse of the fistula, after attempts of closing it in other surgical units. Results: Two patients (of those who were still on mechanical ventilation) died from intubation-related complications that persisted after tracheal resection (anastomotic dehiscence with mediastinitis and tracheoarterial fistula in the brachiocephalic arterial trunk). The nine remaining patients improved, with their airways restored and having regained normal deglutition. Conclusions: The surgical approach of this pathology is successful in surgical units that are specialised in tracheal and oesophageal surgery. Adequately timing the surgery is crucial for a good outcome.

Pulmonary metastasectomy--general issues.

Pulmonary metastasectomy has been widely accepted by thoracic surgeons and is applied to the treatment of a variety of histologies, but the evidence that the patient may benefit from lung metastasectomy is not yet elucidated and the best way of integrating oncologic therapies (induction or adjuvant chemotherapy or radiotherapy) with surgical resection are still unknown. When there is no good clinical alternative, the resection of pulmonary metastases can give some patients long-lasting disease free intervals. Patients should be carefully selected on the basis of clinical staging with defined prognostic indicators. In order to obtain suitable results the management of these patients should be based on a multidisciplinary team decision.

Synchronous primary lung cancer and controlateral pulmonary renal cell carcinoma metastases.

Synchronous malignant lesions will always entail treatment related difficulties which would ideally require discussions within a multidisciplinary committee in such a way as to reach the optimal solution for the patient. Presented herewith are two patients suffering from lung cancer and clear cell renal carcinoma contralateral metastases and the treatment alternatives that I have opted for.