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Introduction. Recently the therapeutic treatment for advanced, stage T2-T4 gastro-oesophageal junction cancer and those adjacent to the regional lymph nodes involves neoadjuvant chemotherapy with subsequent surgical intervention. Method. Neoadjuvant oncological treatment for gastro-oesophageal junction cancer previously consisted of the intravenous administration of epirubicin, cisplatin and fluorouracil (ECF) or epirubicin, cisplatin and capecitabine (ECX) combination (Group I). In the course of the new protocol (FLOT-, F: 5-FU, L: leucovorin, O: oxaliplatin, T: docetaxel), patients were included with resectable gastro-oesophageal junction cancer who had a clinical-stage cT2 or higher nodal positive cN+ disease (Group II). Between 31st of December 2013 and 1st of June 2021 we retrospectively analyzed the effect of these FLOT oncological protocols in terms of surgical outcomes in cases of T2-T4 tumors (n = 9). We compared the results of the randomly assigned nine patients from earlier ECF/ECX protocol (Group I). We analyzed the effect of the different neoadjuvant therapy on tumor regression, and evaluated the types of possible side effects, type of surgery, and the oncological radicality of surgical procedures (number of removed regional lymph nodes, resection margins). Results. Comparing the two groups we found that in cases of FLOT neoadjuvant chemotherapy complete regression was achieved significantly a higher number like in earlier ECX/ECF therapy. Furthermore, the average number of removed lymph nodes, and the safety resection margins (distal, circumferential) no significant difference was found between the two groups. Neutropenia was the most frequently encountered side effect. Leukopenia, neutropenia and nausea occurred more frequently in cases of the old protocol (Group I). Conclusions. As a result of the FLOT neoadjuvant oncological protocol for advanced gastro-oesophageal junction cancer, the number of cases with complete tumor regression has significantly increased. The present results strongly suggest a significant advantage in favor of FLOT neoadjuvant treatment following surgery. The prevalence of side effects was also appreciably lower in cases of the FLOT protocol.

For the centenary of the Department of Surgery, University of Szeged we have investigated and summarized the results and outcomes of 779 anti-reflux surgery cases between 1. January 2000 – 31. May 2021. The indication for surgery was made in close collaboration with the internal medicine workgroup depending on the results of endoscopy and functional tests. The primer indication for surgery was medical therapy-resistant reflux disease. Based on our clinical practice we performed laparoscopic Nissen fundoplication in 98,2% of the cases. Besides the long- and short-term postoperative complications, we investigated the long-term effect of anti-reflux surgery on acid and bile reflux, and the improvement of the patients' quality of life using the Visick score, and modified GERD-HRLQ score. Our investigations have proven the effect of acid and bile reflux in the pathogenesis of Barrett's esophagus and furthermore we have confirmed that laparoscopic anti-reflux surgery restores the function of the lower esophageal sphincter and eliminates acid and bile reflux, so in certain cases Barrett's esophagus regression can be achieved. But due to the heterogeneity of GERD and Barrett's esophagus long-term and regular endoscopic control is necessary.

Case Report: A 71-year-old male with acute exacerbation of chronic bronchitis was treated in summer of 2015. The CT scan has revealed a mass on the right side of 11th thoracic vertebra in the adipose tissue with a sharp edge towards the lung and containing a small amount of contrast agent. The radiologist recommended histological sampling of the mass. The tumor was removed by Video-Assisted Thoracic Surgery (VATS) in August of 2015. The patient was discharged on the fifth postoperative day without complication. Myelolipoma was diagnosed by histological examination. Recurrence was not detected during the one-year-follow-up period., Discussion: Myelolipoma is a benign tumor consisting of mature lobulated adipose tissue and hemopoetic bone marrow. It arises mainly from the adrenal gland. Surgical resection is recommended due to the potential of progressive enlargement. Although the extraadrenal myelolipoma is an uncommon entity, in case of mediastinal, encapsulated, slow-growing tumor, myelolipoma should be considered as a differential diagnosis.

Objectives: Herein we present the results of lobectomies performed with minimally invasive approach (video-assisted thoracic surgery - VATS) at our department during a period of five years., Methods: Between 1 January 2011 and 31 December 2015, 197 lobectomies (malignant lesions: 176 cases, benign lesions: 21 cases) were performed by three thoracic surgeons and one resident. Demographical data are as follows: 119 female/78 male, mean age: 62.4 years (range: 41-82 years). In 2011 three VATS lobectomies were performed, equaling 2.2 % of all lobectomies in that year. During the upcomig years the number of VATS lobectomies were as follows: 2012: 7 (7.3%), 2013: 13 (12%), 2014: 59 (34.5%) and 2015: 119 (68.5%). In 153 cases multiportal (78%) and in 44 cases uniportal (22%) anterior approach was performed. The resected lobes showed the following distribution: right upper: 85, mid lobe: 5, right lower: 28, left upper: 44, left lower: 34, upper bilobectomy: 1. In two cases sleeve lobectomy was performed. In 8 cases (4%) conversion to thoracotomy was needed and among the 46 uniportal procedures, 5 cases needed to be expanded into biportal approach (11%)., Results: During the study period, no intraoperative, or perioperative mortality occured. Mean operative time was 123 minutes (range: 60-135 minutes) and mean time of chest drainage was 4.3 days (range: 1-27 days). Air leakage lasting more than 7 days was present in 11.7%. Reoperation was needed in 4 cases (2%), in two cases due to bleeding, and in two cases because of expansive difficulties due to extended subcutaneous emphysema. Among the 176 VATS lobectomies performed due to malignant lesions, 169 lung cancers and 7 metastases were removed. The distribution according to the stage and histology of lung cancers was as follows: IA: 100 cases, IB: 28 cases, IIA: 17 cases, IIB: 3 cases, IIIA: 16 cases, IIIB: 1 case, and IV: 4 cases; adenocarcinoma: 128 cases, squamous cell carcinoma: 26 cases, large cell carcinoma: 3 cases, small cell lung cancer: 1 case, typical carcinoid: 10 cases, and atypical carcinoid: 1 case., Conclusions: Over the years VATS lobectomy became a rutin procedure at our institution. Nowadays more than two-thirds of lobectomies are performed with minimally invasive technique. Taking the learning curve of the four thoracic surgeons into consideration, our results correlate with international data.

Objectives: Different methods of open or minimally invasive thymectomies have been recommended for the treatment of myasthenia gravis (MG). We compared the results of standard transsternal thymectomy (TS) and two different types of minimally invasive thymectomies [video-assisted thoracoscopic extended thymectomy (VATET) and classic Video-Assisted Thoracoscopic Surgery (cVATS)] performed at the same department., Methods: During three different time periods 71 patients (60 female and 11 male; mean age 31 [range, 14-84] years) underwent thymectomy for MG. Twenty-three underwent standard transsternal thymectomy (January 1995 - September 2004), 22 VATET (September 2004 - August 2009), and 26 cVATS (September 2009 - December 2011) thymectomy for the right side. Operative data, MG- and surgery-related postoperative morbidity and early improvement of MG during the initial 1-year follow-up period were compared among the three methods., Results: There were no perioperative deaths during the study period. Operative time was 112, 211, and 116 minutes (p = 0.001) in the TS, VATET and cVATS, respectively, and the length of hospital stay was 8.9, 5.6, and 4.0 (p = 0.001) days. Postoperative MG-related neurological morbidity affected 21.7%, 18.2%, and 7.7% (p = 0.365) of the patients and the surgery-related morbidity rate was 4.3%, 13.7%, and 0% (p = 0.118) in the TS, VATET and cVATS groups, respectively. Symptom improvement rates were 91.3%, 94.7%, and 87.5% (p = 0.712), and complete remission rates were 13%, 10.5%, and 11.5% (p = 0.917) after TS, VATET and cVATS thymectomies, respectively., Conclusions: In terms of operative time and hospital stay the best results were found after cVATS. The use of a less invasive surgical intervention resulted in less surgical-, and MG related neurological complications. The improvement of MG symptoms was excellent and results were similar after different types of thymectomies.

Introduction: Barrett's esophagus (BE) is the only known precursor of adenocarcinoma occuring in the lower third of the esophagus. According to statistics, severity and elapsed time of gastroesophageal reflux disease (GERD) are major pathogenetic factors in the development of Barrett's esophagus., Patients and Methods: In a retrospective study between 2001 and 2008, we compared the preoperative results (signs and sympthoms, 24 hour pH manometry, esophageal manometry, Bilitec) and treatment efficacy of 176 GERD patients and 78 BE patients, who have undergone laparoscopic Nissen procedure for reflux disease., Results: The two groups of patients had similar demographic features, and elapsed time of reflux sympthoms were also equal. Both groups were admitted for surgery after a median time of 1.5 years (19.87 vs. 19.20 months) of ineffective medical (proton pump inhibitors) treatment. Preoperative functional tests showed a more severe presence of acid reflux in the BE group (DeMeester score 18.9 versus 41.9, p < 0.001). On the other hand, mano-metry - despite confirming lower esophageal sphincter (LES) damage - did not show difference between the two groups (12.10 vs. 12.57 mmHg, p = 0.892). We did not experience any mortality cases with laparoscopic antireflux procedures, although in two cases we had to convert during the operation (1 due to extensive adhesions, and 1 due to injury to the spleen). 3 months after the procedure - according to Visick score - both groups experienced a significant decrease, or lapse in reflux complaints (group I: 73%, group II: 81% of patients), LES functions improved (17.58 vs.18.70 mmHg), and the frequency and exposition of acid reflux decreased (DeMeester score 7.73 vs. 12.72)., Conclusion: The severity of abnormal acid reflux occuring parallel with the incompetent function of the damaged LES triggers not only inflammation in the gastroesophageal junction (GEJ), but also metaplastic process, and the development of Barrett's esophagus. Laparoscopic Nissen procedure for reflux disease can further improve outcome among patients with GERD not responding to conservative therapy.

Introduction: The consequence of inflammatory bowel diseases (IBD) is cytokine-mediated severe local tissue damage. Our aim was to determine the extent of inflammatory response and to influence the morphologic changes during the subacute phase of trinitro-benzene sulfonic acid (TNBS)-induced experimental colitis by oral phosphatidylcholine (PC) and N-methyl-D-aspartate (NMDA) receptor antagonist kynurenic acid therapy., Methods: Sprague-Dawley rats were randomized to control, untreated colitis (ic TNBS), colitis fed with 2% PC-containing diet (3 days pre-treatment +3 days treatment after TNBS induction), colitis with kynurenic acid treatment (on day 6, n = 7) groups. The colitis was characterized by tissue myeloperoxidase and plasma TNF-alpha levels, the extent of tissue damage, structural changes in microvasculature (FITC-dextran staining) and mucosal injury (acridine orange staining) were determined by in vivo confocal laser scanning endomicroscopy (Optiscan Five1, Australia) and conventional histology (hematoxyilin-eosin staining)., Results: Significant elevation in myeloperoxidase and TNF-alpha levels with remarkable damage in epithelial structure was detected in the colitis group. Both treatment regimens significantly decreased the level of inflammatory activation but only PC pretreatment could preserve the number of goblet cells and the epithelial structure. Treatment with kynurenic acid did not alter the morphology changes., Conclusion: Oral PC pretreatment is a promising possibility in the therapy of IBDs through decreasing inflammatory reaction and increasing the number of goblet cells.

Unlabelled: The authors discuss the management of an enormous fibrolipoma which rarely occurs in the mediastinum. A 54-year-old patient underwent an extended posterolateral thoracotomy and resection of a mass which was preoperatively diagnosed as liposarcoma. The size of the removed specimen was 42×35×23 cm and weight was 5200 g. Final histology revealed a primary mediastinal fibrolipoma. Following a long-standing lung compression, the lung has fully expanded after a temporary postoperative failure of expansion. Postoperative serial chest x-rays confirmed that the marked mediastinal midline shift gradually resolved, and the patient's complaints improved considerably, too., Discussion: the vast majority of tumors located in the mediastinum needs to be operated on. Surgical techniques available involve open or videothoracoscopic methods. The latter is limited though by the patient's general condition and the size of the mass needs to be resected. In cases when the tumour is deemed to be irresectable, surgical debulking and oncological adjuvant treatment can be justified to improve quality of life.

Aim: The authors analyzed the results and outcome of surgical treatment of primary pleural tumors in patients treated in the last 11 years., Methods: 31 operations were performed for primary pleural tumors in 25 patients (17 males, 8 females). The tumors were classified into the following groups: benign local fibrous tumors (benign LFTP; n = 15), recurrent malignant fibrous tumors (recurrent malignant LFTP; n = 2) and malignant mesotheliomas (MPM; n = 12). 40% of patients with MPM were exposed to asbestos. Complete resections of benign LFTPs were performed, with additional resection of the chest wall and lobectomy in two cases. Completion pneumonectomy and lobectomy were done in recurrent malignant LFTP cases. Five biopsies and pleurodesis, and one open decortication were performed. In four cases, after the biopsy, two pleurectomies and decortications (P/D) and two pleuropneumonectomies (PPN)/extra-pleural pneumonectomies (EPP) were carried out., Results: There was no operative mortality. Pathological examination revealed seven epithelial, two sarcomatous and one biphasic malignant mesotheliomas. Survival was one (currently alive) and 49 months after malignant recurrent LFTP. Survival in MPM cases was 9,7 months (3-17) without resection and 17,3 months (5 (currently alive) - 29) in P/D or PPN (EPP) cases., Conclusions: The PPN (EPP) and P/D are safe procedures providing relatively good survival when it is done as part of complete oncological treatment. In cases of recurrent LFTP, anatomical resections recommended with completion pneumonectomy or lobectomy.

The authors report a case of a 57-year old asymptomatic patient, whose routine chest X-ray demonstrated a left-sided lung tumour. Bronchoscopy, chest CT and PET-CT revealed double granular cell tumours on the posterior wall of the distal part of the left mainstem bronchus as well as in the bronchus of the segment 6, in addition to the suspected malignant tumour in the 2nd segment. His surgical management involved the atypical resection of segment 2 lesion first, which was tuberculotic origin based on frozen section. Next, the double granular cell tumours were removed by segmentectomy of segment 6 and bifurcation resection of the mainstem bronchus. In case of granular cell tumours, resection of the mainstem bronchus is a safe procedure with good results. Further, surgical exploration is indicated in symptomatic patients with a suspicion of malignant coin lesions.

Objective: The aim of our study was to analyse the results of surgical treatment in lung cancer cases., Patients and Methods: Between 1990 and 1999, 860 patients were operated on for primary lung cancer. In 775 patients (90.1%), resection was performed, 85 patients underwent explorative thoracotomy., Results: The 5-year survival rate was 45.3%, the mean survival time was 47 months. In the univariate analysis, the radicality of the resection (p < 0.0001), the pT stage (p < 0.0001), the pN stage (p < 0.0001) and the histological type (p = 0.0039) had a significant correlation with the survival. The survival was not influenced whether N2 lymph node metastases were observed at one or more level. In the multivariate survival calculations sex (p = 0.024), histological type (p = 0.006), pT classification (p = 0.002) and the pN classification (p < 0.0001) proved to be independent prognostic factor. The pM status did not affect the survival. Postoperative complications were observed in 242 of patients (28.2%). The most frequent complication were expansions problems (9.7%), bronchial stump insufficiency (3.3%), retention of bronchial secretion (2.1%) and cardiac complications (7.1%). 26 patients died, the 30-day mortality rate was 2.8%. 32 reoperations were necessary (3.7%)., Conclusions: Our results indicate that non-small-cell lung cancer can be operated on with good survival possibilities and limited risk, in selected cases even with more advanced tumour stages.

This case report describes the successful resection of a solitary pancreatic metastasis that developed 21 months following lobectomy of an early pulmonary adenocarcinoma (pT1N0M0). The metastasis caused no complaints. The resected pancreas contained a glucagonoma in addition to the metastasis. In the literature we have found no similar case of simultaneous operable metastatic and a secondary pancreatic tumor.

Background: The effects of glucocorticoids on acute pancreatitis (AP) have remained contradictory. To investigate the time courses of the effects of the exogenous glucocorticoid agonists dexamethasone (DEX) and hydrocortisone (HYD) and a glucocorticoid antagonist (RU-38486), and to characterize the local and systemic responses in experimental AP., Methods: The glucocorticoid agonists and antagonist were administered just before AP induction. Serum amylase activity determinations, IL-6 bioassays, pancreatic weight/body weight ratio measurements and survival analysis were performed. Liver and lung injuries were assessed via neutrophil leukocyte infiltration in myeloperoxidase (MPO) assays, tissue adenosine triphosphate (ATP) level determinations and histology., Results: In the glucocorticoid agonist groups, the survival rate increased, while the serum amylase level, the IL-6 activity and the pancreatic weight/body weight ratio decreased significantly as compared with the control and RU-treated groups. AP resulted in significant decreases in tissue ATP levels in both the liver and the lung. In the DEX- or HYD-treated groups, the liver ATP levels were significantly elevated, while both the liver and the lung MPO levels were attenuated as compared with the AP and RU-treated groups., Conclusions: These results suggest that glucocorticoids may play important roles in mitigating the progression of the inflammatory reaction during the early phases of AP.

Unlabelled: Our aims were to examine microcirculation during experimental reflux esophagitis in dogs. We compared the effects of microcirculation of the mucosa to 3-hr exposure with acid, mixed acid and bile, we measured the changes in constitutive and inducible nitric oxide synthase activity (cNOS and iNOS)., Methods: The microcirculation of the upper esophagus was investigated by intravital videomicroscopy. The functional capillary density (FCD), relative vessel area (RVA) and red blood cell velocity (RBCV) were measured. Mucosal barrier integrity was examined by vascular and epithelial permeability indices. Myeloperoxidase (MPO) enzyme activity, cNOS, iNOS activities and microscopic damage were examined in biopsies., Results: The vascular permeability index, the RBCV and the RVA increased significantly in the treated groups, the FCD significantly decreased after acid exposure. The MPO and iNOS activities were significantly elevated in all treated groups. The cNOS activity did not change after exposure to acid + bile or acid, but significantly decreased after sole bile treatment. Severe mucosal damage was observed after bile exposure., Conclusion: Bile induced characteristic microcirculatory changes during experimental reflux esophagitis. Tissue damage and leukocyte infiltration could be exacerbated by bile-induced cNOS inhibition.