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W Klinice Chirurgii Klatki Piersiowej i Transplantacji PUM w latach 1998-2018 wykonano 317 resekcji przełyku. Częstotliwość resekcji sięgała od 3 w 1998 r. do 33 w 2017 r., średnio 16 resekcji na rok. Grupa operowanych chorych składała się z 253 (80%) mężczyzn i 64 (20%) kobiet w wieku 25-82 lat. Najstarsza kobieta miała 79 lat, a najstarszy mężczyzna 82 lata. Najmłodsza kobieta miała 30 lat, a najmłodszy mężczyzna 25 lat. 37 (11,5%) chorych operowano z przyczyn nieonkologicznych, a 280 (89%) - z przyczyn onkologicznych. Grupa młodych chorych 25-47 lat (średnia 39,6) składała się z 20 mężczyzn i 5 kobiet i stanowiła 8% ogółu operowanych. Raka płaskonabłonkowego rozpoznano u 154 (55%) chorych, gruczołowego u 111 (40%) chorych, a raka innego typu u 15 (5%) chorych. W 92 (32,5%) przypadkach zastosowano neoadiuvantową skojarzoną radiochemioterapię, a w 3 przypadkach neoadiuvantową radioterapię. W 25 (8%) przypadkach wykonano operacje jednodostępowe (laparotomia, laparoskopia, torakotomia lewostronna lub prawostronna, torakolaparotomia lewostronna). W 135 przypadkach zastosowano dostęp operacyjny dwupolowy, a w 149 przypadkach dostęp trójpolowy. U 5 (1,5%) chorych wykonano jedynie etap resekcyjny zabiegu, w 3 przypadkach zakres resekcji był niestandardowy. Do etapu rekonstrukcyjnego wykorzystywano żołądek w 289 przypadkach, jelito cienkie w 20 przypadkach, prawą połowę okrężnicy w 2 przypadkach, a poprzecznicę w jed nym przypadku. Technikę małoinwazyjną do tego typu operacji wprowadzono w 2005 roku. Wykonano 50/215 (23%) zabiegów wg protokołu MIE (minimally invasive esophagectomy). W tej grupie było 14 operacji hybrydowych, 3 resekcje jednopolowe (laparoskopia), 19 resekcji dwupolowych (laparoskopia + videotorakoskopia prawostronna) oraz 14 resekcji trójpolowych (laparoskopia, videotorakoskopia prawostronna w ułożeniu pronacyjnym oraz dojście szyjne). Poziom powikłań pooperacyjnych przekraczał 50%. Śmiertelność pooperacyjna była zgodna z krzywą uczenia i sięgała od 37% w 2000 roku do 0% w 2015 roku. W latach 1998-2010 wyniosła 17% (26 zgonów/151 resekcji), w latach 2011-2017 -8,4% (14 zgonów/166 resekcji). Analiza okresu 2015-2017 wykazała dalsze zmniejszenie śmiertelności pooperacyjnej do poziomu 6,6% (5 zgonów/75 resekcji). W 1998 zespół zajmujący się leczeniem przełyku składał się z 2 operatorów i 3 asystentów, a w 2017 roku z 7 operatorów i ogółem 12 osób. [ABSTRACT FROM AUTHOR]

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BACKGROUND: Whether adjuvant chemotherapy improves survival of patients with non-small-cell lung cancer (NSCLC) is not known. We aimed to compare the effect of adjuvant vinorelbine plus cisplatin versus observation on survival in patients with completely resected NSCLC. METHODS: 840 patients with stage IB-IIIA NSCLC from 101 centres in 14 countries were randomly assigned to observation (n=433) or to 30 mg/m(2) vinorelbine plus 100 mg/m(2) cisplatin (n=407). Postoperative radiotherapy was not mandatory and was undertaken according to every centre's policy. The primary endpoint was overall survival. Analysis was by intention to treat. This trial is registered as an International Standard Randomised Controlled Trial, number ISRCTN95053737. FINDINGS: 367 patients in the chemotherapy group and 431 in the control group received their assigned treatment. 301 (36%) patients had stage IB disease, 203 (24%) had stage II disease, and 325 (39%) had stage IIIA disease. Tolerance to chemotherapy mainly included neutropenia in 335 (92%) patients and febrile neutropenia in 34 (9%); seven (2%) toxic deaths were also recorded. Compliance was greater with cisplatin than with vinorelbine (median dose intensity 89% [range 17-108] vs 59% [17-100]). After a median follow-up of 76 months (range 43-116), median survival was 65.7 months (95% CI 47.9-88.5) in the chemotherapy group and 43.7 (35.7-52.3) months in the observation group. Adjusted risk for death was significantly reduced in patients assigned chemotherapy compared with controls (hazard ratio 0.80 [95% CI 0.66-0.96]; p=0.017). Overall survival at 5 years with chemotherapy improved by 8.6%, which was maintained at 7 years (8.4%). INTERPRETATION: Adjuvant vinorelbine plus cisplatin extends survival in patients with completely resected NSCLC, better defining indication of adjuvant chemotherapy. [ABSTRACT FROM AUTHOR]

Background: Primary graft dysfunction (PGD) is a form of acute lung injury (ALI) that occurs within 72 h after lung transplantation (LuTx) and is the most common early complication of the procedure. PGD is diagnosed and graded based on the ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen and chest X-ray results. PGD grade 3 increases recipient mortality and the chance of chronic lung allograft dysfunction (CLAD)., Method: The aim of this retrospective study was to identify new PGD risk factors. The inclusion criteria were met by 59 patients, who all received transplants at the same center between 2010 and 2018. Donor data were taken from records provided by the Polish National Registry of Transplantation and analyzed in three variants: PGD 1-3 vs. PGD 0, PGD 3 vs. PGD 0 and PGD 3 vs. PGD 0-2., Results: A multiple-factor logistic regression model was used to identify decreasing recipient age; higher donor BMI and higher donor central venous pressure (CVP) for the PGD (of the 1-3 grade) risk factor., Conclusions: Longer cold ischemia time (CIT) and higher donor CVP proved to be independent risk factors of PGD 3.

Introduction: Postpneumonectomy empyema (PPE) is a severe and often fatal complication of pneumonectomy, but some benefits of PPE were reported in patients who underwent either lobe or an entire lung resection due to lung cancer., Aim: To compare the survival outcomes of patients with non-small-cell lung carcinoma (NSCLC), who developed PPE after pneumonectomy with uneventful recoveries available in our center's database., Material and Methods: Outcomes of 928 pneumonectomies performed due to NSCLC between 1995 and 2009 were evaluated. The selection of the control group took into account the requirements for propensity score matching in terms of follow-up period, age, sex, tumor histopathology, TNM classification and the side of surgery., Results: Thirty-two patients with a PPE syndrome and 96 patients without complications after pneumonectomy were included. The estimated 5- and 10-year survival rates were 71% and 59%, respectively. The average and median survival was almost two- and three-fold longer compared to the group with uneventful recoveries. A 2-fold lower cancer-related mortality rate and a 1.5-fold higher cancer-unrelated mortality rate were noted in the PPE group as opposed to the group without complications. Having recovered from PPE, the patients had their risk of death reduced by 2.5-fold and 3.5-fold due to all causes and cancer, respectively., Conclusions: Pleural empyema in NSCLC patients who underwent pneumonectomy seems to improve the survival outcomes compared to patients with uneventful recoveries., Competing Interests: The authors report no conflict of interest., (Copyright: © 2024 Polish Society of Cardiothoracic Surgeons (Polskie Towarzystwo KardioTorakochirurgów) and the editors of the Polish Journal of Cardio-Thoracic Surgery (Kardiochirurgia i Torakochirurgia Polska).)

Objective: The aim of this study was to compare pressure resistance of the most common methods of vessel occlusion during thoracic surgical procedures: ligations, clips, and vascular endostaplers., Methods: Pulmonary vessels were obtained during routine thoracic surgeries. A ball-tipped cannula was inserted through an opening in the side wall and secured with a linen ligature from slipping out. Subsequently, saline was infused into the vessel. We recorded the pressure on which a leakage occurred., Results: A total of 65 vessels, divided between 3 groups, were enrolled in the study. In the endostaplers group, median bursting pressures were 262.5 mmHg and 300 mmHg for arteries and veins, respectively. In the case of clips, it was over 750 mmHg in both types of the vessels. The same results were observed in the ligation group. Minimal bursting pressures in endostapler occlusion were 187.5 mmHg and 225 mmHg in arteries and veins, respectively. In the case of clips, it was 600 mmHg for arteries and 675 mmHg for veins. A total of 525 mmHg (arteries) and 750 mmHg (veins) were the minimal leaking values observed in vessels occluded with ligations. Comparative analysis showed statistically significant differences in endostapler-clips and endostapler-ligations pairs ( p  < 0.001). There were no differences between clips and ligations., Conclusions: The examined methods are capable of occluding pulmonary vessels under physiological conditions. Furthermore, ligations and clips are resistant to pressures highly exceeding physiological values., Competing Interests: Conflict of interestThe authors declare no competing interests., (© The Author(s) 2023.)

Introduction: Near-infrared spectroscopy (NIRS) is a non-invasive method of regional tissue oxygenation measurement. Intraoperative use of NIRS to monitor brain oxygenation (BO) during surgery might be beneficial to identify cerebral desaturations., Aim: To compare peripheral blood saturation (SpO 2 ) with BO measurements and evaluate the utility of BO in thoracic surgery., Material and Methods: We took BO and SpO 2 measurements in a group of 100 patients undergoing standard thoracic surgery. Measurements were made every 15 minutes. The Mann-Whitney U test was used to compare study groups. Spearman's rank correlation coefficient was used to determine correlation between studied parameters., Results: We found a negative correlation between patients' age and BO at the beginning of surgery. Operations lasted between 30 and 200 minutes. We found a positive correlation between BO and SpO 2 between 15 and 90 minutes of surgery. Subsequently, BO remained at a low level while SpO 2 returned to baseline values. Higher minimum SpO 2 values were noted in patients undergoing left-sided procedures., Conclusions: Cerebral oxygenation does not return to baseline values until the end of the surgery as opposed to the SpO 2 . Furthermore, both SpO 2 and BO correlate negatively with the overall duration of thoracic surgery. In addition, after 90 minutes of surgery, SpO 2 stopped reflecting brain oxygenation., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2023 Polish Society of Cardiothoracic Surgeons (Polskie Towarzystwo KardioTorakochirurgów) and the editors of the Polish Journal of Cardio-Thoracic Surgery (Kardiochirurgia i Torakochirurgia Polska).)

Human echinococcosis is a zoonotic infection caused by the larvae of the tapeworm species Echinococcus. The liver is the most common location for a primary echinococcosis. However, the parasite may bypass or spread from the liver to the lungs, causing primary or secondary pulmonary echinococcosis, respectively. Pulmonary echinococcosis is a clinically challenging condition in which anthelminthic regiments are important, but surgery has the central role in removing the cysts and preventing recurrences. Surgical treatment may involve cystotomy, enucleation, capitonnage, or atypical resections, which occasionally are in combination with hepatic procedures. The utilization of modern devices is greatly underdescribed in surgery for thoracic infections, even though these facilitate much of the work. Therefore, this article aims to describe pulmonary echinococcosis and the role of modern surgical devices in the treatment process. Furthermore, we report surgical treatment of three different cases of pulmonary echinococcosis. Surgeries of uncomplicated and ruptured hepatic or pulmonary cysts are described. Simple small pulmonary echinococcal lesions can be excised by endostaplers both for diagnostic and curative reasons. Larger cysts can be removed by energy devices unless large bronchial air leaks occur. Complicated cysts require treatment by more extensive techniques. Inexperienced surgeons should not abstain but should carefully decide preoperatively how to proceed.

Background: Infections are one of the leading causes of death in the early postoperative period after lung transplantation (LuTx)., Methods: We analyzed 59 transplantations and culture results of the donor bronchial aspirates (DBA), graft endobronchial swabs (GES), and recipient cultures (RC) before and after the procedure (RBA). We correlated the results with a cold ischemic time (CIT), recipient intubation time, and length of stay in the hospital and intensive care unit (ICU), among others., Results: CIT of the first and second lungs were 403 and 541 min, respectively. Forty-two and eighty-three percent of cultures were positive in DBA and GES, respectively. Furthermore, positive results were obtained in 79.7% of RC and in 33.9% of RBA. Longer donor hospitalization was correlated with Gram-negative bacteria isolation in DBA. Longer CIT was associated with Gram-positive bacteria other than Staphylococcus aureus in GES and it resulted in longer recipient stay in the ICU. Furthermore, longer CIT resulted in the development of the new pathogens in RBA., Conclusion: Results of GES brought more clinically relevant information than DBA. Donor hospitalization was associated with the occurrence of Gram-negative bacteria. Positive cultures of DBA, GES, and RBA were not associated with recipient death.