ABSTRACT
AIM: Endoscopic Ultrasound (EUS) is well-established mode of intervention for tissue acquisition in solid organs with rapid on-site evaluation (ROSE). In the Covid-19 era implementation of infection control mechanisms has led modified hybrid technique to get high diagnostic yield for tissue sampling. Combination of Covid-19 SOPs and tissue acquisition method outline this hybrid technique to get high diagnostic Yield.We share our initial experience of EUS cases performed with this approach without ROSE. METHODS: All 84 cases who underwent EUS guided biopsy from June 2020 till December 2021 were included. The Procedure was done in a negative pressure room with all SOPs as per institutional guidelines for patient and staff safety with a minimum number of persons during procedure. RESULTS: Among these cases, 55 were male, mean age 56 years (range 22-90), Mean duration of procedure 25 min mean (10-90 min). 63 came for organ targeted for malignant pathology include pancreas 35, liver 02, lymph nodes 17, subepithelial lesions 06, mediastinal lesions 08, common-bile duct/gall bladder 04. 17 cases had a multi-targeted biopsy for the additional staging of disease. The number of 'passes' with the needle was average 02 with single pass 17, two pass 39, three passes 11, multitarget single pass in 17. Needle size (Franseen design) used for procedures was 22G in 78 cases and 25G in 6. Common tissue diagnoses include pancreatic adenocarcinoma 26, neuroendocrine tumours 04, tuberculosis 05, gastrointestinal stromal tumours 02, leiomyoma 03, lymphoma 03, metastatic renal cell carcinoma 04, squamous cell carcinoma 04, cholangiocarcinoma/ gall bladder adenocarcinoma 07, Sarcoma 02 and solid pseudopapillary epithelial neoplasm of pancreas (SPEN) 01. There were no immediate or early complications in all cases. CONCLUSIONS: Hybrid EUS in Covid 19 Era has emerged as a useful/cost-effective and safe approach to get tissue yield without the need for ROSE.
ABSTRACT
TYPE: TOPIC: Disorders of the Mediastinum PURPOSE: Infiltration of superior vena cava (SVC) is not uncommon in stage III–IVa thymic epithelial tumours (TETs). SVC extent of resection is proportional to width of neoplastic invasion region. Aim: to assess the safety and long-term results of prolonged thymectomy for TETs with and without SVC resection. METHODS: Retrospective review of patients who underwent extended thymectomy for TETs during the preceding two decades, using STROBE method. Kaplan–Meier technique was used to calculate progression-free survival (PFS) and overall survival (OS). To evaluate the factors related to long-term outcomes, a backward stepwise Cox regression multivariate analysis was done. RESULTS: Between January 1998 and April 2019, 78 individuals received surgery for advanced-stage TETs (Masaoka-Koga stages III–IVa). 14 (17.9%) received thymectomy with SVC resection. At multivariate analysis, presence of thymic cancer (HR=2.26;95%CI=1.82–6.18;p=0.038) and SVC resection (HR=1.89;95%CI=1.11–3.96;p=0.041) were found to be unfavourable prognostic variables. All SVC resected patients had median OS=50 months (range: 5–207) and median PFS=31 months (range: 5–151). There was no statistically significant difference in OS (p=0.28) or PFS (p=0.32) between patients with and without SVC resection. CONCLUSIONS: SVC resection is a safe and successful surgery for re-establishing the continuity of the venous system that appears not to influence survival or disease recurrence. CLINICAL IMPLICATIONS: Surgical approaches vary considerably according to extent of SVC infiltration, and issues associated with SVC resection for TETs remain unresolved. SVC resection is a safe and effective operation that appears not to affect survival or recurrence. This surgical technique enables complete resection of locally progressed TETs, even following neoadjuvant treatment. DISCLOSURE: No conflict of interest to declare. This was submitted (ad accepted) in Chest 2020 Bologna withdrawn due to the COVID pandemic. KEYWORD: thymic epithelial neoplasm