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Our goal was to examine the postoperative indicators after the first 300 thoracic robotic cases in the National Institute of Oncology. We retrospectively analyzed the clinicopathological and postoperative indicators of the first 300 patients. We also compared the first 30 cases performed by one surgeon to his 30 VATS (video-assisted thoracic surgery) and open cases. The average hospital stay was 5.2 days, the chest tube was removed on the second day. Conversion, need for reoperation and morbidity was low (1.8%, 2% and 10.6%, respectively). The change in operating time slows down after 20 cases. The hospital stay and complications were slightly favorable with RATS (robotic-assisted thoracic surgery) than with VATS. The intensive care stay, however, was significantly shorter while the amount of removed lymph nodes was significantly higher in RATS procedures. As a conclusion, RATS is a safe technique in thoracic surgery. Moreover, more lymph nodes are removed with RATS which can lead to better staging.

COVID-19 pandemic affected the diagnosis and management of many diseases, including the most vulnerable group of patients with cancer. In this retrospective survey we evaluated the course of disease of patients treated for melanoma, who got infected with COVID-19 virus between March 2020 and April 2021. 382 patients had been treated for advanced melanoma in our center in this time period. 24 of them had been infected with coronavirus. Six of them suffered in stage III melanoma, the remaining 18 patients had stage IV disease. 14, 5 and 4 of the infected patients had been administered with checkpoint inhibitor, targeted therapy and chemotherapy, respectively. Seven (29%) patients died in COVID-19 infection, in a median of 12 days. None of our patients who had been vaccinated at least one time, had severe symptoms. As a conclusion, the mortality of COVID-19 infection was significantly higher among our melanoma patients compared to the age-standardized mortality rate in Hungary.

The COVID-19 pandemic has created significant barriers to the treatment of cancer patients requiring regular hospitalisation, as coronavirus infection significantly increases the risk of serious and even fatal complications. In our case report, a middle-aged patient with advanced melanoma has developed immune-mediated pancreatitis after more than a year of pembrolizumab treatment. After changing the therapy, the patient was diagnosed with coronavirus infection, which led to nearly a month of hospitalisation and rehabilitation, thus suspending active oncotherapeutical treatment. Thanks to professional medical care, our patient successfully recovered from the severe COVID-19 pneumonia caused by the infection, even in the absence of a coronavirus vaccine. After recovery, he received two Pfizer- BioNTech vaccines in August and September 2021, and a follow-up CT scan showed almost complete remission. Given the patient's lack of complaints and the absence of tumours other than two residual pulmonary nodules, he was observed afterwards. Our patient was in a serious condition before the vaccines were introduced, but has recovered thanks to professional medical care.

Introduction: Most modern thoracic operations are performed with single-lung ventilation balancing between convenient surgical approach and adequate gas exchange. The technical limitations include difficult airways or insufficient parenchyma for the intraoperative single-lung ventilation. Earlier, cardiopulmonary bypass was the only solution, however, today the extracorporeal membrane oxygenation is in the forefront. Aim: We retrospectively analysed our elective operations by use of venovenous ECMO to assess the indication, safety, perioperative morbidity and mortality. Patients and method: 12 patients were operated using venovenous (VV-) ECMO between 28 April 2014 and 30 April 2018 in the National Institute of Oncology. The main clinicopathological characteristics, data regarding the operation, the use of ECMO and survival were collected. Results: The mean age was 45 years, 2 patients had benign and 10 had malignant diseases. Extreme tracheal stricture was the indication for ECMO in 3 cases, while 4 patients had previous lung resection and lacked enough parenchyma for single-lung ventilation. 5 patients had both airway and parenchymal insufficiency. The average time of apnoea was 142 minutes without interruption in any of the cases. We did not experience any ECMO-related complication. We had no intraoperative death and 30-day mortality was 8.33%. Conclusion: In case of technical inoperability, when there is no airway or insufficient parenchyma for gas exchange, but pulmonary vascular bed is enough and there is no need for great-vessel resection, VV-ECMO can safely replace the complete gas exchange without further risk of bleeding. The use of VV-ECMO did not increase the perioperative morbidity and mortality. Previously inoperable patients can be operated with VV-ECMO. Orv Hetil. 2019; 160(42): 1655-1662.

The mortality of severe ARDS is almost 60%. Ventilation-associated lung-injury can be avoided by low-pressure, low-volume ventilation. Potential use of ECMO in case of refractory hypoxemia beside modern ventilatory therapy can be considered. Increasing numbers of respiratory ECMO runs are seen worldwide, though the efficacy remains controversial. The authors present the first successful venovenous-ECMO treatment in severe ARDS in our Institute. We report the case of a 67-year-old male who was admitted with community-acquired pneumonia caused by Legionella. Despite empirical and later targeted antibiotic therapy, severe ARDS with sepsis evolved. Neither ventilation nor prone position resulted in permanent improvement in oxygenation. The patient was referred to our Institute for extracorporeal life support (ECLS) therapy. On admission, blood gas showed severe hypoxemia with mild hypercapnia (PaO 2 /FiO 2 : 60, pCO 2 : 53 mmHg at PEEP: 14 mmHg, PIP: 45 mmHg). X-ray showed bilateral patchy infiltrates while cardiac impairment (EF: 45%) and dilated right ventricle were seen on echocardiography. Elevated pulmonary artery pressure (mPAP: 41 mmHg) was measured. After implantation of femoral-jugular VV ECMO, oxygen saturation was appropriate with lung protective ventilation (FiO 2 : 0.5, TV: 3-4 ml/kg). Improving lung function enabled us to stop ECMO after 8 days and further 5 days later the patient was weaned off ventilation. After 21 days of intensive care we discharged him to the referral hospital. By reporting this case we emphasise the potential role of respiratory ECMO. Consideration should be given to increase the contingent of this modality in the Hungarian intensive care in accordance with international practice. Orv Hetil. 2019; 160(6): 235-240.

The first lung transplantation in Hungary was performed on 12th of December, 2015. It was a joint effort of the National Institute of Oncology and the Semmelweis University. Hereby we summarise the results and experiences from the first three years. Until August, 2018, 55 lung transplantations were performed in Hungary. This was a retrospective analysis. All patients were listed according to the recommendation of the Lung Transplantation Committee. All implanted lungs have been procured from brain dead donors. Postoperative treatment and rehabilitation of the patients were continued at the Semmelweis University. Between 12. 12. 2015 and 31. 07. 2018, our team performed 76 organ retrievals: out of 45 Hungarian offers, 23 came from Eurotransplant countries and 8 outside of the Eurotransplant region. From these donations, 54 double and 1 single side transplantations were successfully performed. The surgical approach was single side thoracotomy (n = 1), bilateral thoracotomy (n = 1) and in the majority of the cases clamshell incision (n = 53). For the intraoperative veno-arterial extracorporeal membrane oxygenation support was used. The extracorporeal membrane oxygenation support had to be prolonged in 3 patients into the early postoperative period, two other recipients were bridged to transplant with extracorporeal membrane oxygenation. In the same time period, one combined lung-kidney transplantation was also performed. The distribution of recipients according to the underlying disease was: chronic obstructive pulmonary disease (n = 28); idiopathic pulmonary fibrosis (n = 8); cystic fibrosis (n = 12); primary pulmonary hypertension (n = 2); hystiocytosis-X (n = 1); bronchiectasis (n = 2); lymphangioleiomyomatosis (n = 1); and re-transplantation following bronchiolitis obliterans syndrome (n = 1), respectively. The mean age of recipients was 47.5 ± 15.18 years. The youngest recipient was 13 years old. We unfortunately lost 12 patients on our waiting list. The mean intensive care unit stay was 24.6 ± 18.18 days. Two patients were lost in the early postoperative phase. Tracheostomy was necessary in 13 cases due to the need of prolonged ventilation. 1-year survival of the recipients was 82.96% (until 31. 07. 2018). When looking at the first three years of the program, the case numbers elevated quickly throughout the years which is rather unique when compared to other centres in their starting period. Perioperative mortality and morbidity is comparable with high-volume lung transplantation centres. In the future we would like to increase the number of patients on the waiting list, thus increasing the total number of transplantations performed, and we are also planning to implement the use of the ex vivo lung perfusion system (EVLP) in our program. Orv Hetil. 2018; 159(46): 1859-1868.

Interleukin-6 is a multifunctional cytokine participating in the regulation of several immunologic and other cell-physiological phenomena. It acts via a receptor consisting of two components, that besides the ligand-specific chain also contains a second component of 130 kD (gp 130). The soluble form of the ligand-specific component of this receptor was shown to occur physiologically in body fluids and -following the binding of interleukin-6-to be capable of associating with the membrane-bound receptor component and inducing signal-transduction. We studied the possible differences between the effects of interleukin-6 exerted via membrane-bound or soluble receptors on HepG2 human hepatoma and primary rat hepatocyte cultures. We used two methods to study the action of interleukin-6: the mRNA expression of the protooncogene junB as an early marker, and the protein production of fibrinogen as a late one. The effect of interleukin-6 on both cell types examined with both methods used was lower via the soluble than the membrane-bound receptor. In addition, the soluble receptors alone (without interleukin-6) could induce the expression of the junB gene. Considering the wide-spread biological and pathological activities of interleukin-6 these phenomena could have some role in the pathogenesis of some diseases.