Visceral pleural infiltration as a negative prognostic factor in lung metastasis

The prognostic value of visceral pleural infiltration in lung metastasis was analysed. Fifty-two patients (32 males and 20 females) were operated on for lung metastases. The locations of the primary tumours were as follows: 19 colon, 10 kidneys, 8 melanomas, 3 breast, 3 bladder, 2 uterus, 2 osteosarcomas, 1 testis, and 1 parotid, 1 haemangiopericytoma, 1 thyroid gland and 1 larynx. Explorative thoracotomies and incomplete resections were excluded from the study. Visceral pleural infiltration was present in 20 of the 52 cases. There was a significant correlation between the occurrence of pleural infiltration and multiple lesions (P=0.019). The overall five-year survival rate was 33.6%. In a subgroup of 38 patients with N0 and single metastases, the five-year survival rate was 73% and 12% in the cases without and with visceral pleural infiltration, respectively (P=0.003). Multivariate analysis of pleural infiltration, lymph node metastasis, multiple lesions and DFI revealed that only pleural infiltration (P=0.003) had a significant impact on survival. In one-third of the pulmonary metastases, visceral pleural infiltration appeared. There was a significant correlation between the occurrence of visceral pleural infiltration and multiple lesions. Visceral pleural infiltration in lung metastasis is a negative prognostic factor, and in these cases, survival was significantly reduced

Anesthetic (r)evolution from the conventional concept to the minimally invasive techniques in thoracic surgery-narrative review

Background and Objective: Thanks to the growing experience with the non-intubated anesthetic and surgical techniques, most pulmonary resections can now be performed by using minimally invasive techniques. The conventional method, i.e., surgery on the intubated, ventilated patient under general anesthesia with one-lung ventilation (OLV) was considered necessary for the major thoracoscopic lung resections for all patients. An adequate analgesic approach (regional or epidural anesthesia) allows video assisted thoracoscopy (VATS) to be performed in anesthetized patients and thus the potential adverse effects related to general anesthesia and mechanical OLV can be minimized.Methods: Multiple medical literature databases (PubMed, Google Scholar, Scopus) were searched, using the terms [(non-intubated) OR (nonintubated) OR (tubeless) OR (awake)] AND [(thoracoscopic surgery)] from 2004 to December 2021. 306 scientific papers were collected. The editorials, commentaries, letters, and papers were excluded, that focus on other than the non-intubated (aka awake or tubeless) VATS technique, as well as the full text scientific papers available in languages other than English.Key Content and Findings: After reviewing the literature, we identified "schools" with different techniques but with very similar results. Most of the differences were in the anesthetic technique, oxygenation and analgesia, however, the immunological results, and the qualitative parameters (inpatient hospital care days, complication rate, mortality) of the perioperative period showed great similarity, in addition, all three schools identified the same risk factors (hypoxia, hypercapnia, airway safety). The combination of spontaneous ventilation with double lumen tube intubation, called VATS-spontaneous ventilation with intubation (SVI) method seems to be suitable for reducing these risk factors, which may serve as an alternative for patients not suitable for the non-intubated technique in the near future.Conclusions: Based on the results, non-intubated thoracic surgery appears to be an increasingly widespread, safe procedure, that will be available to a wider range of patients as experience expands and by the implication of the constantly evolving new processes

Bal oldali teljes tüdőeltávolítás intrapulmonalisan elhelyezkedő Castleman betegség miatt [Left pneumonectomy for intrapulmonary unicentric Castleman disease]

A Castleman-betegség egy ritka lymphoproliferativ betegség, mely a leggyakrabban a gátorüregi nyirokcsomókat érinti. Az intrapulmonalisan elhelyezkedő forma ritkán fordul elő, az angol nyelvű irodalomban 14 eset ismert. A betegség tünetei nem specifikusak, és a diagnózis felállítása gyakran nehézségekbe ütközik. A kezelés fő célja az épben történő sebészi reszekció elérése, mely potenciális esélyt nyújt a recidívamentes túlélésre. 15 éves tünetmentes lánybetegünket ernyőszűrésen bal oldali mellkasi terimével emelték ki. A transthoracalis szövettani mintavétel megerősítette a Castleman-betegség diagnózisát. A centrálisan elhelyezkedő tumormassza érintette a tüdőkapu képleteit, ezért műtét során bal oldali teljes tüdőeltávolítás vált szükségessé a daganatmentes reszekciós szél eléréséhez. A beteg a műtétet követő 7 éves utánkövetési periódus során mindvégig recidívamentes volt. A Castleman-betegség jól kezelhető komplett sebészi reszekcióval, a betegség kiterjedése miatt azonban időnként indokolt lehet a kiterjesztett, radikális tüdőeltávolítás a tumormentes reszekciós szél eléréséhez. Orv Hetil. 2023; 164(37): 1476–1483