[Curative Treatment of Esophageal Carcinoma - Disease, Diagnostics, Therapy in 2022]. / Kurative Therapie des Ösophaguskarzinomes.

Curative Treatment of Esophageal Carcinoma - Disease, Diagnostics, Therapy in 2022 Abstract. Surgical resection remains the gold standard for non-metastatic carcinoma of the lower and middle third of the esophagus. Locally advanced tumors (T3) are pretreated neoadjuvantly (radiochemotherapy) or perioperatively (chemotherapy). A differentiated primary staging and an interdisciplinary case presentation are of essential importance today. The individual risk assessment, the pre-habilitation and the individualized treatment play a major role. Clinically, the further advancement of access minimization - through laparoscopic/thoracoscopic and robot-assisted procedures and the associated reduction of access trauma - as well as the treatment of this entity in high volume centers are clearly in the foreground. For cervical carcinomas definitive radiotherapy is often the better alternative, both for tumor biological reasons and for reasons of the increase in complications during surgery.

Misinterpretation of a pulmonary GI anastomosis stapler line as a retained foreign body.

Intraoperatively retained foreign bodies are both medical and medico-legal problems. We report a patient who underwent a lower left lobectomy initially for nonresolving chronic organizing pneumonia. Rethoracotomy was performed due to a suspicious CT finding of a retained surgical sponge that turned out to be a GI anastomosis (GIA) staple line. Postoperatively, the situation was simulated using a surgical sponge adherent to the skin, to demonstrate the difference between the radioopaque marker of the surgical gauze and the GIA staple line. The facts of this case suggest the need for careful interpretation of such radiographic studies in the context of radioopaque materials intentionally employed during the first operation. If in doubt, digital magnification for more detailed and accurate inspection should be performed to avoid unnecessary rethoracotomy.

Surgery in the tri-modality treatment of small cell lung cancer. Stage-dependent survival.

OBJECTIVE: Patients with small cell lung cancer (SCLC) are frequently denied surgical treatment despite growing body of evidence for a longer duration of remission and overall survival, if surgical intervention is integrated in a tri-modality therapy concept including chemotherapy, surgery, and radiotherapy. METHODS: A retrospective analysis was performed using data derived from 95 patients with SCLC operated upon over a period of 9 years. A subset of these patients was primarily operated upon and being diagnosed as SCLC only after thoracotomy, received radio-/chemotherapy postoperatively (n=64, group I). The second cohort had surgery after neoadjuvant chemotherapy which was continued postoperatively in addition to thoracic and cranial radiotherapy (n=31, group II). The patients in the second group were further divided into two subgroups: complete histological regression of tumor tissue in the mediastinal lymph nodes (group IIA), and those with persistent mediastinal lymph nodal involvement detected after thoracotomy (group IIB). RESULTS: Group I patients had stage I or II disease, whereas group II patients had clinical stage IIIA or IIIB. The overall 30-day mortality rate was as low as 5%. The median survival was 31.3 months for patients in group I, 31.7 months for adjuvant surgery with complete regression of mediastinal nodes (group IIA), and 12.4 months for adjuvant surgery without regression of mediastinal nodes (group IIB). CONCLUSIONS: Surgical intervention is promising and warrants prospective trials to be evaluated as an important adjunct to multi-modality therapy regimen in SCLC as regards to its impact on relapse free and overall survival.

Manubriotomy versus median sternotomy in thymectomy for myasthenia gravis. Evaluation of the pulmonary status.

OBJECTIVE: In a prospective study, the effect of thymectomy on the pulmonary status of 50 consecutive patients with myasthenia gravis was evaluated over a time range of 4 years in the Chest and Chest surgery departments in the Cairo University Clinics and Thoracic Surgery Department of the Evangelisches Krankenhaus Duisburg-Nord. METHODS: The patients were divided into two groups: Group I included 26 patients who underwent thymectomy through median sternotomy. The mean age of the patients in this group was 24.8+/-10.5 (5-41) years. They were 19 females and seven males. Thirteen of the patients were in Myasthenia Gravis Foundation of America (MGFA) class IIa, and 12 were in class IIb, and one was in class IIIa. Group II included 24 patients who underwent thymectomy through manubriotomy. The mean age of the patients in this group was 25.2+/-9.2 (12-41) years. They were 13 females and 11 males. Eight of the patients were in MGFA class 2a, 14 were in class IIb, and two were in class IIIa. RESULTS: When compared to group I in which postoperative ventilation was required in 15.4% of patients, postoperative ventilation was not necessary in patients of group II with a statistically significant difference (P=0.04). The mean duration of stay in the intensive care unit was 111.4h in group II, and 169.7h in group I (P=0.03). The peak inspiratory flow rate and the forced vital capacity were also statistically significantly better in group II. There was no mortality in both groups, and the morbidity was higher in the median sternotomy group. CONCLUSION: Thymectomy through a manubriotomy, which allows extensive removal of ectopic thymic tissue in addition to the thymus through a less invasive approach than a full median sternotomy, is associated with a significantly smoother postoperative course and less pulmonary complications, when compared with thymectomy through a full median sternotomy.

Surgical versus conservative treatment of flail chest. Evaluation of the pulmonary status.

Through a prospective randomized comparative study, treatment of flail chest by a non-surgical method of packing, strapping, and mechanical ventilation vs. surgical fixation were compared. After management, stability of the chest wall occurred in 85% of the patients in the surgical group. Forty-five percent of patients in this group required ventilatory support after fixation for an average of 2 days. Whereas in the conservative group, stability occurred in 50% of their patients, and 35% of patients required ventilatory support for an average of 12 days. Chest wall deformity in the form of stove-in chest and crowding of ribs was still obvious in 9 patients among the conservatively treated group, compared to only one patient who developed chest wall deformity in the surgically treated group. The pulmonary functions tested two months after management indicated that in the surgical group the patients had a significantly less restrictive pattern. Thus, surgical fixation of a flail segment is a method of great value in the treatment of flail chest, in which stability is achieved without deformity of the chest wall and patients have less restrictive impairment of pulmonary functions.