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Lung cancer (LC) is the second common and with the highest mortality oncological disease. Specific biomarkers for its diagnostics, treatment, and prognosis are still under the investigations. Aim of our study was to evaluate the relationship between the polymorphisms of TP53 pathway genes TP53 , MDM2 , MDM4 , the polymorphisms of HPV-associated genes MTHFR , CASP8 , CCR5 , and HPV infection with survival of LC patients. SNPs were genotyped using PCR-RFLP. qRT-PCR was used to detect, identify, and quantify HPV. No statistically significant differences were detected between individual SNPs and patient survival with stage I-IV LC. Cluster analysis of SNPs in genes MDM4 A/A, CCR5 wt/Δ32, MTHFR C/T, MDM2 T/T showed possible association with the worse survival. Patients who were diagnosed with C/T polymorphic variant of gene MTHFR tend not to survive stage III-IV LC ( P = .12). There is a tendency between MDM2 gene T/T variant and worse survival of patients diagnosed with late stage LC ( P = .11). HPV infection is very rear among LC patients (3 of 92). Overall, there is a link, although statistically insignificant, between specific SNPs and LC patient survival frequency and time, meanwhile the combination of specific SNPs showed a statistically significant measure. In conclusion, we determined statistically significant ( P = .04) link between the poor survival of LC patients after surgery and the combination of polymorphic variants C/T of the MTHFR and T/T of the MDM2 genes, whereas individually these SNPs do not show significant relationship with the survival of patients after surgery., Competing Interests: CONFLICTS OF INTEREST The authors have no conflicts of interest.

Background: Lithuania remains one of the highest tuberculosis burden countries in Europe. Epidemiological studies have long pointed to infections as important factors of cancer aetiology, but the association between tuberculosis and the risk of non-pulmonary cancers has rarely been tested and results have been inconsistent. The aim of this population-based cohort study was to examine the risk of cancer among patients diagnosed with tuberculosis using data from Lithuanian Tuberculosis, Cancer and Resident's Registries., Methods: The study cohort included 21,986 tuberculosis patients yielding 1583 cancers diagnosed during follow-up (1998-2012). Standardized incidence ratios (SIRs) and 95% confidence intervals (95% CIs) were calculated to compare the incidence of cancer among cohort participants with the general population for overall, non-pulmonary, site-specific cancers, as well as for subgroups of smoking-related, alcohol-related, hormone-related and haematological cancers., Results: The SIRs of all cancers combined were 1.89, 95% CI: 1.79-2.00 in men and 1.34, 95% CI: 1.19-1.50 in women. Risk was increased 3-fold within the first year following diagnosis; it decreased during later years, although remained significantly elevated for ≥5 years. Elevated long-term increased risks persisted for non-pulmonary cancers overall, and for cancers of mouth and pharynx, oesophagus, stomach, larynx, cervix uteri and leukaemias. Tuberculosis was associated with a decreased risk of melanoma. Increased risks were observed for smoking-related cancers in men (SIR 1.95, 95% CI: 1.79-2.13) and women (SIR 1.46, 95% CI: 1.22-1.73), alcohol-related cancers in men (SIR 2.40; 95% CI: 2.14-2.68) and haematological cancers in men (SIR 1.73, 95% CI: 1.33-2.23). The risk of hormone-related cancers was 18% lower (SIR = 0.82, 95% CI: 0.66-0.997) among women, the inverse association was weaker among men (SIR = 0.95, 95% CI: 0.84-1.07)., Conclusions: The risk of total and several non-pulmonary cancers was elevated in a cohort of tuberculosis patients. The recommendation for the awareness of this association among physicians is warranted. Analysis suggests a reduction in risk of hormone-related cancers and melanoma.

Overall, head and neck sqamous cell carcinoma accounts for more than 550,000 cases annually worldwide. It is well known that human papillomavirus (HPV) is the main risk factor for cervical cancer development. As the incidence and the mortality of cervical cancer are closely related to the HPV prevalence, we hypothesized that there is the same association between HPV prevalence and head and neck squamous cell carcinoma. Therefore we performed the study aiming to compare the level of HPV infection and HPV type distribution between two groups of Lithuanian and Belarusian patients with head and neck sqamous cell carcinoma. One hundred ninety head and neck sqamous cell carcinoma patients were included in the study, 75 from Lithuania and 115 from Belarus. PCR was used for HPV detection and typing. The distribution of HPV infection among head and neck sqamous cell carcinoma patients was similar in the Lithuanian (20.0%) and Belarusian (18.3%) patient groups, however differences were found in the distribution of HPV types., (© 2013 Wiley Periodicals, Inc.)

Background: First-line chemotherapy for advanced non-small-cell lung cancer (NSCLC) is usually limited to four to six cycles. Maintenance therapy can delay progression and prolong survival. The oral epidermal growth factor receptor (EGFR) tyrosine-kinase inhibitor erlotinib has proven efficacy and tolerability in second-line NSCLC. We designed the phase 3, placebo-controlled Sequential Tarceva in Unresectable NSCLC (SATURN; BO18192) study to assess use of erlotinib as maintenance therapy in patients with non-progressive disease following first-line platinum-doublet chemotherapy., Methods: Between December, 2005, and May, 2008, 1949 patients were included in the run-in phase (four cycles of platinum-based chemotherapy). At the end of the run-in phase, 889 patients who did not have progressive disease were entered into the main study, and were randomly allocated using a 1:1 adaptive randomisation method through a third-party interactive voice response system to receive erlotinib (150 mg/day; n=438) or placebo (n=451) until progression or unacceptable toxicity. Patients were stratified by EGFR immunohistochemistry status, stage, Eastern Cooperative Oncology Group performance status, chemotherapy regimen, smoking history, and region. Co-primary endpoints were progression-free survival (PFS) in all analysable patients irrespective of EGFR status, and PFS in patients whose tumours had EGFR protein overexpression, as determined by immunohistochemistry. This study is registered with www.ClinicalTrials.gov, number NCT00556712., Findings: 884 patients were analysable for PFS; 437 in the erlotinib group and 447 in the placebo group. After a median follow-up of 11.4 months for the erlotinib group and 11.5 months for the placebo group, median PFS was significantly longer with erlotinib than with placebo: 12.3 weeks for patients in the erlotinib group versus 11.1 weeks for those in the placebo group (HR 0.71, 95% CI 0.62-0.82; p<0.0001). PFS was also significantly longer in patients with EGFR-positive immunohistochemistry who were treated with erlotinib (n=307) compared with EGFR-positive patients given placebo (n=311; median PFS 12.3 weeks in the erlotinib group vs 11.1 weeks in the placebo group; HR 0.69, 0.58-0.82; p<0.0001). The most common grade 3 or higher adverse events were rash (37 [9%] of 443 patients in the erlotinib group vs none of 445 in the placebo group) and diarrhoea (seven [2%] of 443 patients vs none of 445). Serious adverse events were reported in 47 patients (11%) on erlotinib compared with 34 patients (8%) on placebo. The most common serious adverse event was pneumonia (seven cases [2%] with erlotinib and four [<1%] with placebo)., Interpretation: Maintenance therapy with erlotinib for patients with NSCLC is well tolerated and significantly prolongs PFS compared with placebo. First-line maintenance with erlotinib could be considered in patients who do not progress after four cycles of chemotherapy., Funding: F Hoffmann-La Roche Ltd., (Copyright 2010 Elsevier Ltd. All rights reserved.)

Background: Spontaneous pneumothorax (SP) is a rare manifestation of lung cancer. The mechanisms by which pneumothorax occurs in lung cancer is not clear, resulting in different views being expressed., Case Presentation: Here we present a case in which pneumothorax occurred as a first manifestation of lung cancer. The chest x-ray of a 68 year old man revealed a right partial pneumothorax. VATS was then performed: the visceral pleura lying over segment S3 was destroyed and air leaks were found in this section. Pathologic examination of the biopsy specimen revealed non-small cell carcinoma. Thoracoscopic talc pleurodesis was performed., Conclusion: Spontaneous pneumothorax in association with lung cancer is rarely seen. Pneumothorax can be the first sign of lung cancer. The most common possibility for SP complicating lung cancer is the tumor necrosis mechanism or, in separate cases, rupture of the emphysematous bullae. Lung cancer should always be considered as a possible cause of SP in elderly patients or in heavy smokers.

Objective: To determine survival of patients with stage IIIA/B non-small cell lung cancer considering disease stage and treatment methods., Material and Methods: A total of 304 patients with non-small cell lung cancer were treated at the Department of Thoracic Surgery and Oncology, Institute of Oncology, Vilnius University, in 2000-2004. Stage IIIA (T3N1-2M0) cancer was diagnosed for 193 (63.5%) patients and stage IIIB (T4N0-1M0) cancer was diagnosed for 111 (36.5%) patients. There were 277 (91.1%) males and 27 (8.9%) females. According to morphology, there were 219 (72%) patients with squamous cell lung cancer, 80 (26.3%) with adenocarcinoma, and 5 (1.7%) patients with large cell carcinoma. Surgery was performed in 145 patients: 84 (57.9%) patients underwent lung resection (T3-4N0-1M0), 51 (35.2%) patients - thoracotomy, and 10 (6.7%) patients - other palliative thoracic procedures (mediastinotomy, pleurectomy, mediastinoscopy). Forty-eight (30.2%) patients were treated with radiation therapy with total doses of >40 Gy and 58 (36.5%) patients were treated with radiation therapy with total doses of <40 Gy. Fifty-four (33.9%) patients were treated with Gemzar and cisplatin and 19 (11.9%) patients were treated with etoposide and cisplatin., Results: Overall median and mean survival was 7.8 months (95% CI, 6.8 to 8.8) and 9.9 months (95% CI, 9.0 to 10.9), respectively. The median and mean survival of patients with stage IIIA cancer was 8.3 months and 10.4 months, respectively, and that of patients with stage IIIB cancer - 6.4 months and 9.0 months, respectively (P < or =0.05). The median survival of the patients with stage IIIA cancer who received a combination of operation, chemotherapy, and radiation therapy with a total dose of >40 Gy was 14.4 months (mean, 14.7 months), and the median survival of those who received operation, chemotherapy, and radiation therapy with a total dose of < or =40 Gy was 9.7 months (mean, 14.1 months); the median survival of the patients who underwent surgery alone was 4.9 months (mean, 6.7 months) (P=0.004 and P=0.007), respectively. There was a significant difference in the median survival comparing the patients with stage IIIB cancer who underwent surgery alone and those who received a combination of radiation therapy and chemotherapy (median survival of 5.0 months [mean, 8.1 months] versus 16.8 months [mean, 17.6 months], respectively; P < or =0.05)., Conclusions: Disease stage had an influence on the survival of patients with non-small cell lung cancer: patients with stage IIIA (T3N0-1M0) cancer without metastases to mediastinal lymph nodes (N factor) survived longer than patients with stage IIIB (T4N1-2M0) cancer, where not only N factor had an impact but T factor as well. Better treatment outcomes, i.e. longer survival, can be achieved when a combination of three treatment types - surgery, chemotherapy, and radiation therapy - is applied to patients with stage IIIA or IIIB non-small cell lung cancer. The patients with stage IIIA disease who received surgery and radiation therapy (total dose, >40 Gy), and combinations of surgery, chemotherapy, and radiation therapy and second-line chemotherapy showed a significantly longer survival than those who received surgery alone.

Objective: To evaluate efficacy of diagnostic procedures, results of surgery, and complications in malignant pleural diseases., Material and Methods: From 1999 to 2006, 169 patients underwent treatment in the Department of Thoracic Surgery and Oncology, Institute of Oncology, Vilnius University. Patients were divided into two groups: group I, patients with primary pleural malignant diseases (93 patients, 55.0%), and group II, secondary pleural tumors (76 patients, 45%). Of the 76 patients, 40 patients (52.6%) were diagnosed with metastatic pleural tumors and 36 patients (47.4%) with tumors invading parietal pleura. We used noninvasive and invasive methods for diagnosis. Noninvasive methods included chest x-ray, chest computed tomography, magnetic resonance imaging, chest ultrasound, positron emission tomography/computed tomography (performed in Germany), and invasive methods included puncture of pleural effusions, transthoracic pleural puncture, drainage, pleural biopsy and video-assisted thoracoscopic pleural biopsy, pleural resection, and ultrasound-guided needle biopsy of the pleura. The following procedures were performed in group I: pleurectomy in 15 patients (16.1%), pleural pneumonectomy in 42 patients (45.2%), pleural decortication in 12 patients (12.9%), extended pleuropneumonectomy with diaphragm and pericardium resections and plastic surgery in 14 patients (15.0%), pleurectomy with costal resections in 10 patients (10.1%). Procedures performed in group II included video-assisted thoracoscopic pleurectomy in 15 patients (19.7%), pleural biopsy in 10 patients (13.2%), pleurectomy in 15 patients (19.7%), pleural drainage and fenestration in 5 patients (6.5%), lung and pleura resection in 12 patients (15.8%), chest wall and pleura resection in 10 patients (13.2%), diaphragm and pleura resections in 9 patients (11.8%)., Results: Early stage primary pleural tumors were found in 24 patients (25.8%). Metastatic pleural disease was found in 32 patients with early primary tumors (80.0%). In all 36 patients (100.0%) with chest wall tumors, disease of advanced stage was determined. Main surgical complications of the group I were observed in 26 patients (27.9%). Six patients (6.5%) died after surgery. In group II, 23 patients (30.2%) had postoperative complications; 3 patients (3.9%) died., Conclusions: In noninvasive methods, the highest sensitivity was achieved for chest computed tomography and magnetic resonance imaging (97%); the specificity of chest magnetic resonance imaging was 100%, and the specificity chest computed tomography and magnetic resonance imaging--98%. The accuracy of chest x-ray plus computed tomography was 98%. In invasive methods, accuracies of pleural biopsy, video-assisted thoracoscopic pleural biopsy, and pleurectomy were 100%, 90%, and 100%, respectively. In case of primary pleural tumors, the main surgery was extended pleuropulmonectomy (45.2%) with or without mediastinal resection. Mortality rate was 6.5%. In case of metastatic pleural disease, the main surgery was video-assisted thoracoscopic pleurectomy (19.7%). Mortality was rate 5%. In cases of pleural invasion by other thoracic malignancies, the main surgeries were chest wall and pleural resection (13.2%) and lung and pleural resection (15.8%). Mortality rate was 2.8%. After 169 operations due to malignant pleural diseases, the rate of postoperative complications ranged from 1.3% to 7.8%.

Background: Despite intensive use of asbestos, no cancer case has ever been diagnosed as asbestos related in Lithuania. This paper attempts to estimate the proportion of those occupationally exposed to asbestos among respiratory cancer patients., Material and Methods: Occupational exposure to asbestos was assessed retrospectively for 298 lung cancer and four mesothelioma patients, admitted to the Institute of Oncology, Vilnius. The evaluation was based on personal interview data using an internationally established questionnaire covering most likely activities of asbestos exposure at the workplace. Cumulative exposure to asbestos at work was estimated in fiber years. Lung tissue asbestos fiber burden analysis was conducted by scanning transmission electron microscopy on 23 samples., Results: A cumulative asbestos exposure of > or =25 fiber years was found for 10 lung cancer patients (3.4%). They worked in foundries, construction, installation, shipyard, power plant, railway, asbestos cement, glass and chemical industry. In a further 56 lung cancer patients (18.8%) and for one (25%) mesothelioma patient, a cumulative exposure from 5 to 24.9 fiber years was assessed. Asbestos fibers were detected in 18 cases, the burden ranged from 0.1 to 4.1 million fibers/g dry lung tissue; concentrations exceeding 1 million f/g dry lung tissue were found in four cases. All fibers were chrysotile., Conclusions: Findings indicate that a fraction (3.4%) of the lung cancer cases could be attributed to heavy occupational exposure to asbestos using the Helsinki criterion of > or =25 fiber years. Therefore, approximately 50 lung cancer cases per year in Lithuania could be asbestos-related compensable occupational diseases.

Background: Coexistent lung cancer and pulmonary tuberculosis is an urgent problem of thoracic surgery presenting a challenging task for diagnosis and surgical treatment., Materials and Methods: From 1990 to 2005, 2218 patients with lung cancer underwent surgical treatment in Department of Thoracic Surgery and Oncology, Institute of Oncology, Vilnius University. In 46 (2.1%) patients coexistence of lung cancer and tuberculosis was found. Central lung cancer was diagnosed in 37 (80.4%) and peripheral--in 9 (19.6%) patients. Epidermoid cancer was diagnosed in 24 (52.2%) patients, adenocarcinoma--in 10 (21.7%) and adenoepidermoid carcinoma--in 12 (26.1%) patients. Stage I cancer was diagnosed in 12 (26.1%), stage II--in 11 (23.9%), and stage IIIA--in 23 (50%) patients., Results: Pneumonectomy was performed in 18 (39.2%), lobectomy in 10 (21.7%), bilobectomy in 10 (21.7%), segmentectomy in 8 (17.4%) patients. Postoperative surgical complications were observed in 9 (19.5%) patients, non-surgical complications occurred in 19 patients (41.3%). Six patients (13.04%) died. Combined treatment was applied to 23 (50%) patients., Conclusion: Coexistence of tuberculosis and lung cancer in thoracic surgery is fairly rare. This combination was diagnosed only in 46 cases (2.1%) out of 2218 operated lung cancer patients. Epidermoid carcinoma and stage IIIA disease was diagnosed in 50% of patients. Postoperative surgical complications occurred in 9 patients (19.5%) with lung cancer and tuberculosis. Six patients (13%) died in postoperative period. Surgery is the method of choice in treatment of combination of tuberculosis and lung cancer. Median survival of these patients was 28 +/- 2 months.

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.

Unlabelled: The aim of the study was to analyze the patients with the relapse of tumors after lung resection., Material and Methods: One hundred eight patients with lung cancer were operated at Lithuanian Institute of Oncology during period of 1992-2002. To 28 patients pneumonectomy was performed, 4 - bilobectomy, 51 - lobectomy, 23 - wedge resection, 2 - segmentectomy. According to the stage of tumor operations more often were performed in III stage of the disease - to 62 patients, in II - 20, in I - 12 and in the IV - 14. The most common histologic type of tumor was squamous cell carcinoma - 57 patients, adenocarcinoma - 29, small cell carcinoma - 12, anaplastic carcinoma - 4, other types of tumor were rare. The stage of disease had influence upon the time for the relapse of tumor. The dissemination of tumor was detected in 9 patients with II ir III stage of disease. The treatment of the relapse of lung tumor was the following was: 31 patients received radiotherapy, 4 - photodynamic therapy, 12 - radiotherapy with chemotherapy, 20 - chemotherapy., Results: According to the data of March 31, 2003, 98 patients died from carcinoma, 10 patients lived with the signs of disease. Median survival after relapse of tumor was better in patients with I stage of disease - 26.2 months, II - 20.7 months, III - 13.9 months, IV - 8.2 months., Conclusions: In the case of locally extended tumor with metastases in regional lymph nodes after lung resection the relapse of tumor was most common. The treatment of the relapse of tumor in early stages of disease was most effective.

Purpose: This study was performed in order to evaluate effectiveness of controlled hypotension decreasing blood lose in transthoracic esophageal resection., Patients and Methods: Thirty-six patients were enrolled in this randomized study. The patients were divided in to two groups. We used controlled hypotension induced by thoracic epidural anaesthesia for the group T (n=18/50%). For the group K (n=18/50%) we used only endotracheal anesthesia. The median arterial pressure was about 50 mmHg in group T and 80-110 mmHg in group K. We investigated intra-operative and post-operative blood loss, the average operating time, opioid and inhaled anesthetic use and stay in intensive care unite., Results: The intra-operative blood loss was less for 45.7% in group T than in group K but post-operative blood loss was the same in groups. The mean operation time was 14.2% shorter in group T. We used 80% less fentanyl and 43% less inhaled anesthetics in group T. The stay in intensive care unit was 2.6 days in group T and 3.9 in group K. There were no significant complications caused by controlled hypotension., Conclusion: We conclude that controlled hypotension is an effective method to decrease blood loos and blood transfusions. It creates better conditions for surgery and reduces operation time. There were no serious cardiac, neurological and renal intra-operative and post-operative complications resulting from the use of controlled hypotension.

Aim: We have analyzed the results of surgical treatment of lung canced at Lithuanian Institute of Oncology in the course of fifty years., Material and Methods: There were 1885 patients with lung cancer surgically treated at Lithuanian Institute of Oncology in the course of 50 years. There was a change in the tactics of the surgeons for surgical treatment in this long period. We have analyzed the following patients: 1) of 1950-1979 2) of 1980-1999. The last period was divided into two subgroups: a) 1980-1993 and b) 1994-1999. Four hundred ten patients were operated on in the first period, 785 - in 1980-1993 and 690 patients in 1994-1999. In the first period the most common operation was pneumonectomy, performed in 176 cases, bi-lobectomy - to 105 patients. In the second period: in a) subgroup 261 and 418 operations were performed and b) subgroup - 200 and 329 operations. Segmentectomy and wedge resection were rare: 16, 27, 26 cases in all periods. Thoracotomy was performed to 113 patients, in a) subgroup - 78, in b) subgroup -129., Results: The biggest hospital mortality after pneumonectomy was: 12.5%,11.4% and 11% according to the periods. The mortality after lobectomy was low: 2.19%, 1.6% and 2.9%.The most serious surgical complications were bronchial fistula and pneumonia. The follow-up results were satisfactory in all the groups of early stages of the disease and moderate in III stage of the disease., Conclusions: In the twenty years lobectomy was the most common operation for surgical treatment of lung cancer. Bronchial fistula and pneumonia are the most serious complications after pneumonectomy. Adjuvant therapy (radiotherapy, chemotherapy) improve the results of treatment in stage IIB and stage IIIA of the disease.

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.

Objective: This study evaluated effectiveness of hypotensive epidural anesthesia in decreasing blood loss, operation and extubation time, opiates use and stay in intensive care unit., Material and Methods: Fifty-eight patients were enrolled in the study. Right (n=16) or left (n=42) pneumectomy was performed for the study patients. We used the hypotensive anesthesia induced by thoracic epidural anesthesia for the group T (n=29/50%) and normotensive anesthesia for the group K (n=29/50%). The epidural catheter was introduced into the epidural space at the level Th4-5. Arterial pressure was reduced using bupivacaine into epidural space. In the group T median arterial pressure was about 50-60 mmHg. For the group K we used only general anesthesia and median arterial pressure was 80-120 mmHg., Results: The average intra-operative blood loss was 534+/-198 ml in the group T and 1287+/-380 ml in the group K (p<0.001). Post-operative blood loss was the same in both groups. The average operation time was 10% shorter in the group T (p=0.078). Fentanyl use in the T group was 203+/-91 microg and 1266+/-601 microg in the K group (p<0.001). Patients in the T group were safely extubated after 66+/-17 min (p<0.001) and discharged from intensive care unit after 2+/-1.1 days (p<0.05). The patients in the group K were extubated after 138+/-37 min and discharged from intensive care unit after 3.27+/-1.3 days., Conclusion: Hypotensive epidural anesthesia is an effective method to decrease blood loss and blood transfusions in thoracic surgery. It creates better conditions for surgery and reduces stay in intensive care unit. Also there were no serious cardiac, neurological and renal intra-operative and post-operative complications that could be conditioned by the use of hypotension.

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.

Objective: Purpose of this study was to evaluate the effectiveness of intraoperative intercostal nerve blockade with alcohol in addition to epidural analgesia with morphine for control of postthoracotomy pain syndrome., Material and Methods: 57 oncological patients undergoing antero-axillary thoracotomy were randomized to receive intraoperative intercostal nerve blockade with alcohol plus postoperative epidural analgesia with morphine (n=27) and postoperative epidural analgesia with morphine only (n=30). 31 patients had lobectomy, 10 bilobectomy, 9 pulmonectomy and 7 segmentectomy. There were 42 right sided and 15 left sided procedures. Objective and subjective assessment was carried out at 10 and 30 days postoperatively. Pain was assessed by using a subjective visual pain scale ranging from 1 (no pain) to 10 (worst pain) during coughing., Results: Postsurgical pain was significantly lower in intraoperative intercostal nerve blockade patients group. The mean pain score on the 10 postoperation day was 2.1 and 6.5 accordingly in intraoperative intercostal nerve blockade and epidural analgesia with morphine patients group. The mean pain score on the 30 day was accordingly 1.5 and 4.2., Conclusion: Additional intraoperative intercostal nerve blockade with alcohol provides an additional benefit for postthoracotomy pain relief, especially for at least one month following the thoracotomy.

Unlabelled: Objective was to evaluate prognostic factors influencing the postoperative mortality after esophagectomy., Material and Methods: The results of surgical treatment of 106 patients suffering from esophageal cancer were analyzed retrospectively. The presurgical risk factors in the surviving patients (group I, n=94) and in those patients, who died within the postoperative period (group II, n=12), were compared. The following indicators were analyzed: patients' age, body mass index, preoperative loss of body mass, tumor location, type and duration of operation, amount of blood transfused, ECG changes, changes in the lungs visible on chest X-ray, and spirometry indices. We examined the volume of forced expiration within the first second (FEV1), forced expiratory vital capacity (FVC), peak expiratory flow (PEF), Gaensler index (FEV1/FVC), Tiffeneu index (FEV1/VC) and amount of PaCO(2)in arterial blood., Results: Postoperative mortality was 11.3%. The following statistically reliable differences in the indices of group I and group II patients were established: FEV1 (82.3% and 65.4%), Gaensler index (75.2% and 68.5%), PaCO(2)(37.4 mmHg ir 42 mmHg), radiographic changes in the lings (13.6%l and 61.2%), loss of body mass within the preoperative period (11.2% and 18.3%), lower albumin values (39.9 g/l and 30.5 g/l) and tumor localization within the upper third of the esophagus (22% and 68.8%). The leak of anastomosis - 11.8% and 82.8%., Conclusion: The postoperative mortality after esophagectomy mostly depends on the status of pulmonary function during the postoperative period, inadequate nutrition during the preoperative period and tumor localization in the upper third of the esophagus. Main complications after esophagectomy are pulmonary insufficiency and leak of anastomosis.

Objectives: The aim of the present study was to assess the incidence of larynx cancer in Lithuania in the years 1978-2001 and to outline possible future trends., Materials and Methods: The number of new laryngeal cancer cases in 1978-2001 was obtained from the Lithuanian Cancer Registry. The Lithuanian Department of Statistics provided data on the population being at the same age in the same years. The data were adjusted for age, using the direct method in accordance with the European standard; a linear regression analysis of trends in the larynx cancer incidence was performed., Results: After standardization of data for the period of 1978-2001, an upward trend was registered for both men and women: in 1978 the incidence was 10.73 for men and 0.26 for women per 100000 population, in 2001 the corresponding data were 11.6 and 0.7. Throughout the study period the incidence was higher in men than in women and the mean age of male and female larynx cancer patients was increasing: mean age for men was annually increasing by 0.1566 years and for women by 0.0602 years. The forecast for men in 2006 is 13.88 and for women 0.54 cases per 100000 population., Conclusions: The increase in larynx cancer incidence is growing more rapidly among women than among men, and the mean age of the patients is also increasing. The forecast is that in 2006 the incidence rate will be increasing, and both men and women will get ill at an older age.

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.

Unlabelled: Objective of our study was to analyze the cases of coexistent pulmonary tuberculosis and lung cancer., Material and Methods: During 1990-2002, 2218 patients with lung cancer were operated in Republic Santariskiu Tuberculosis and Lung Diseases Hospital and the Department of Thoracic Surgery and Oncology at the Institute of Oncology of Vilnius University., Results: Forty-six (2.1%) patients were diagnosed lung cancer and tuberculosis-associated pathology. By stages patients were divided into: I(st)stage - 12 patients (26.1%), II(nd)stage - 11 patients (23%), IIIA stage - 23 patients (50%). In 37 cases (80.4%) central tumor type was found, and in 9 cases (19.6%) - peripheric type. According to morphology, in 24 (52.2%) patients squamous cell was found, in 10 (21.2%) patients - adenocarcinoma and in 12 (26.1%) patients - mixed adenosquamous tumors. All these 46 patients were operated on: pneumectomy was performed for 18 (39.2%) patients, lobectomy - for 10 (21.7%) patients, bilobectomy - for 10 (21.7%) patients, and segmentectomy - for 8 (17.4%) patients. Six (21.4%) patients deceased. The development of cancer on site of previous active tuberculosis and residence metatuberculosis changes was evident. This shows the importance of the control strategy of patients with tuberculosis., Conclusions: Coexistence of lung cancer and tuberculosis is very rare. Out of 2218 patients, operated on due to lung cancer, this pathology was diagnosed to 46 (2.1%). Squamous cell cancer was found in 52% and stage IIIA was observed in 50% of cases. Postoperative complications occurred in 28 (80%) patients, and 6 (28%) patients died. Crucial treatment method of lung cancer in tuberculosis patients is surgery. Average survival of these patients was 28+/-2 months.

Purpose: To make assessments of the rates of cases of larynx cancer in Lithuania in the years 1978-2001 as well as possible trends of changes in the future., Material and Methods: The data contained in the Lithuanian Cancer Register for the period 1978-2001 about new cases as well as the data compiled by the Lithuanian Department of Statistics on the average number of population of Lithuania within the same period in the same age groups have been used in the course of the study. The data have been standardized by age using direct method, in accordance with the European standard; a regression analysis of larynx cancer case rates was made., Results: After standardization of data for the period 1978-2001, tendencies of increase have been registered both among men and women: in 1978 the case rate per 100,000 population was 10.73 among men and 0.26 among women, in 2001 the corresponding data were 11.6 among men and 0.7 among women. Throughout the period the investigated case rate for men was higher than for women. An increasing average age of men and women suffering from this disease has been noticed: average age for men is annually increasing by 0.1566 years and for women--0.0602 years. The forecast for men in the year 2006 is 13.88 cases per 100,000 population and 0.54 for women., Conclusions: The increase of larynx cancer case rates is growing more rapidly among women than among men, and also average age of the patients is increasing. The forecast is that in 2006 the case rate will be growing up, and both men and women will get ill at older age.

An unresectable neuroendocrine tumor (NET) of the pancreas was diagnosed in a male patient in 1997. The tumor was bleeding and the patient underwent tumor embolisation with complete control of the bleeding. In December 2001 the patient presented again with gastric bleeding at the Emergency Hospital of Vilnius University, where the case was considered inoperable. In January 2002 the patient was transfered to the Lithuanian Oncology Center and was radically and succesfully operated.

Unlabelled: The objective of our paper was to show the data of our treated patients with malignant pleural mesothelioma. In the Department of Thoracic Surgery of Oncology Institute at Vilnius University from 1980 till 01.06.2002, 33 patients (pts), to whom diagnosis of pleural mesothelioma was confirmed by pathologist, were treated in the Clinic. A malignant pleural mesothelioma was diagnosed in 31 pts, two pts had a non-malignant form of mesothelioma. Among patients were 19 men and 14 women. The distribution of pts according to the stage of the disease was: I stage - 3, II - 1, III - 17, IV - 10. Videothoracoscopy is the best method for diagnosing pleural mesothelioma. Radical operations were performed only in 17 cases: 6 - pulmonectomy with pleuroectomy, 1 - lobectomy, 3 - atypical segmentectomy, 4 - pleuroectomy, 4 - tumorectomy. Thoracotomy was performed in 9 cases. Insufflation of talc was performed in 6 pts. Adjuvant therapy (chemotherapy or radiotherapy) was given to 10 pts., Results: Nineteen pts died of the progression of disease. Median survival of pts was 15.7 months., Conclusions: 1. Diagnosis of malignant pleural mesothelioma is difficult and confirmation of the disease is possible only after histological examination of tumor. 2. The best results of treatment were achieved after combined treatment: surgery, after chemotherapy and radiotherapy. 3. In cases of pleural effusion of diffuse pleural mesothelioma insufflation of talc or other chemical substances into pleural cavity is recommended.

Unlabelled: Objective of our work was to evaluate efficacy of bronchoplastic operations for lung cancer and time to progression in combined treatment. From 1997 till 2001, 57pts were operated for early I-IIB stages of lung cancer. Operations were: tracheal resections in 3pts (5.2%), window right pneumonectomies in 5pts (8.7%), window left pneumonectomies in 2pts (3.5%), window right upper lobe in 22pts (38.5%), bifurcation resections 2pts (3.5%), sleeve right upper lobe resections 7pts (12.2%), sleeve left upper lobe resections in 11pts (19.2%). We had complications: in 7pts (12.2%) suture failure, 26pts (45.6%) obstructive pneumonia, 3pts (5.2%) kinking of anastomosis, 2pts (3.7%) bronchial bleeding, 6pts (10.5%) covered bronchial fistulas, 5pts (8.7%) died after operations., Results: 32pts (56%) underwent radiation after surgery, 13pts (22.8%) radiation and chemotherapy. Three-year survival was in 82.4% (47pts), in 10pts (17.4%) disease progressed., Conclusions: 1. Bronchoplastic operations are sufficient for early lung cancer treatment. 2. Three-year was in survival 82.7% of pts. Seventeen percent of patients failed after combined treatment.

Unlabelled: Objective of our work was to show how the mediastinoscopy helps to diagnose various diseases of mediastinum. In the period from 1967 till 1971 in Kaunas University of Medicine Hospital and during 2000-2001 in the Department of Thoracic surgery of Lithuanian Oncology Center were performed 40 and 24 mediastinoscopy in 64 patients, who had various diseases of mediastinum. Fourty one patients were with lung cancer. After mediastinoscopy the patients were operated. In 17 cases of 26 patients, metastases of lung cancer were found in lymph nodes of mediastinum. Most patients (60%) were operated in III(rd) stage of disease. Seventeen patients had other diseases: 10 - sarcoidosis Beck, 5 - lymphagranulomatosis, 2 - bronchitis tuberculosis. Diagnosis of disease was confirmed by histology in 15 patients., Conclusions: 1. Metastases of lymph nodes of mediastinum were confirmed in 65.38% of patients. 2. The mediastinoscopy reduced the number of exploratory thoracotomy. 3. Diagnosis of diseases was confirmed in 88.23% cases in sistematic pathology of lymph nodes. 4. Mediastinoscopy must make only experienced thoracic surgeon, who can perform thoracotomy and sternotomy.

Objective: Evaluate efficacy of videothoracoscopic operations in diagnosis and treatment of lung and pleural diseases. In 1997-2001 186 operations were performed using videothoracoscopic devices in the Department of Thoracic Surgery, Institute of Oncology, Vilnius University. Fourty eight resections were performed: 4 (8%) lobectomies, 1 (2%) pericardial cystectomy, 3 (6%) simpatectomies, 3 (6%) intrathoracal lipomectomies, 1 (2%) removing calcificate, 3 (6%) resections of pericardium, 15 (30%) removing metastases, 12 (25%) hamartomas, 6 (13%) wedge resections of lungs tissue due to I(st) stage NSCLC performed for the elderly. One hundred thirty eight diagnostic procedures were performed in pts with various lung and pleura diseases: 66 (48%) biopsies of lungs tissue and 72 (52%) biopsies with chemopleurodesis. From oncological point of view videothoracoscopic operations are confirmed. These operations shortens hospitalization and combined treatment starts quicker. Middle period of hospitalization - 5 days. We had complications: 22 pts (12%) postoperative pneumonia, 4 pts (2%) - short duration pneumothorax, 1 pts (0.5%) - pleural empiema 1 pts (0.5%) - drop of the lung 1 pts (0.5%) - bleeding. After resections margins were free of tumor invasion., Conclusions: 1. Video-assisted thoracic surgery (VATS) surgery is effective safe method of treatment for lung and pleural diseases. 2. In some cases VATS surgery is the only way to remove tumours, and it shortens hospital stay till 5 days. 3. VATS surgery is very effective in elderly patients with concomitant diseases. 4. Chemopleurodesis is very useful in treatment of pleural fluid.

Objective: To view combined anesthesia benefits versus general anesthesia and to compare postoperative epidural analgesia and patient-controlled analgesia with intravenous morphine., Material and Methods: Twenty four patients scheduled for elective thoracoabdominal esophagectomy were randomized to T (n=12) and K (n=12) groups. Group T patients received epidural analgesia with 0.125 percent bupivocaine and morphine after combined general-epidural anesthesia and group K patients received intravenous patient-controlled analgesia with morphine after general anesthesia. The patients were monitored for operation and extubation time, for postoperative pain and length of intensive care unite (ICU) stay., Results: T group patients received 79 percents less narcotics than K group. At rest there were no differences in pain relief between the groups. Pain scores at mobilization showed a significantly lower value in the T group. Patients in T group were tracheally extubated earlier (mean 210 minutes vs 380 min.) after admission to the ICU and discharged from the ICU earlier (mean 2.3 vs 4.3 days)., Conclusions: Combined anesthesia and epidural analgesia improve overall outcome, provide better postoperative pain relief, shorten the intubation time and intensive care stay in patients undergoing esophageal resection operations.

Aim: Follow-up results after a limited resection (segmentectomy, wedge resection of lung) are represented in this paper according to the TNM classification and histological type of tumour., Methods: Since 1980 until 1997, 1173 patients (pts) with lung cancer were treated surgically. 42 (36 males and 6 females) of them underwent a limited resection of lung. Distribution of pts according to the TNM classification was: T1N0 was found in 12 pts and T2N0 in 11 pts, T2N0 in 11pts, T2N1 in 7 pts, other 12 pts had N2. Sqamous cell carcinoma was in 19 pts, Adenocarcinoma in 13 pts, Small cell carcinoma in 9 pts, one pt--Carcinosarcoma. After the operation 9 pts received radiation therapy, 9 pts--chemotherapy., Results: The best follow-up results were in pts with T1-2N0 who received adjuvant therapy: median survival was 45.7 months. The pts, treated only surgically, lived 36.7 months. The pts with N2 lived only 9 months., Conclusion: 1. A limited resection of lung with lymph nodes dissection can be performed only in cases T1-2N0. 2. In cases with N0 of undifferentiated carcinoma (anaplastic, small cell) adjuvant therapy ought to be given after operation. 3. In cases of N1, N2 we recommend adjuvant therapy regardless of histological type of tumour.