Relapse in resected lung cancer revisited: does intensified follow up really matter? A prospective study.

BACKGROUND: beside the well known predominance of distant vs. loco-regional relapse, several aspects of the relapse pattern still have not been fully elucidated. METHODS: prospective, controlled study on 88 patients operated for non-small cell lung cancer (NSCLC) in a 15 months period. Stage IIIA existed in 35(39.8%) patients, whilst stages IB, IIA and IIB existed in 10.2%, 4.5% and 45.5% patients respectively. INCLUSION CRITERIA: stage I-IIIA, complete resection, systematic lymphadenectomy with at least 6 lymph node groups examined, no neoadjuvant therapy, exact data of all aspects of relapse, exact data about the outcome of the treatment. RESULTS: postoperative lung cancer relapse occurred in 50(56.8%) patients. Locoregional, distant and both types of relapse occurred in 26%, 70% and 4% patients respectively. Postoperative cancer relapse occurred in 27/35(77.1%) pts. in the stage IIIA and in 21/40(52.55) pts in the stage IIB. In none of four pts. in the stage IIA cancer relapse occurred, unlike 22.22% pts. with relapse in the stage IB. The mean disease free interval in the analysed group was 34.38 +/- 3.26 months.The mean local relapse free and distant relapse free intervals were 55 +/- 3.32 and 41.62 +/- 3.47 months respectively Among 30 pts. with the relapse onset inside the first 12 month after the lung resection, in 20(66.6%) pts. either T3 tumours or N2 lesions existed. In patients with N0, N1 and N2 lesions, cancer relapse occurred in 30%, 55.6% and 70.8% patients respectively. Radiographic aspect T stage, N stage and extent of resection were found as significant in terms of survival. Related to the relapse occurrence, although radiographic aspect and extent of resection followed the same trend as in the survival analysis, only T stage and N stage were found as significant in the same sense as for survival. On multivariate, only T and N stage were found as significant in terms of survival.Specific oncological treatment of relapse was possible in 27/50(54%) patients. CONCLUSION: the intensified follow up did not increase either the proportion of patients detected with asymptomatic relapse or the number of patients with specific oncological treatment of relapse.

[Pulmonary sequestration--report of three cases].

INTRODUCTION: Pulmonary sequestration is a non-functioning pulmonary parenchyma that is separated from tracheobronchial tree and receives its blood supply via systemic arteries. The diagnosis of sequestration pulmonis is based on clinical symptoms and characteristic radiologic findings. CASE REPORTS: In this report, radiological findings of pulmonary sequester in three patients with non-resolving pneumonia were retrospectively reviewed. All patients underwent chest x-ray, computerized tomography of thorax and angiography. X-ray revealed in all cases tumorlike, unsharply bordered shadows in the posterior basal parts of the lung, two on the right and one on the left side. Computerized tomography (CT) finding showed solid-cystic tumor masses and angiography revealed anomalous blood supply from systemic arteries arising from aorta and running to the shadow in the lung. This finding is typical of bronchopulmonary sequestration. All patients were operated on and histological analysis of operative material confirmed diagnosis of intralobar pulmonary sequestration. DISCUSSION: Sequestration pulmonis can cause a diagnostic problem due to unspecific symptoms and atypical radiographic and CT findings. Therefore, it is important to demonstrate the arterial supply and venous drainage of the sequestered segment preoperatively. Today, with the help of non-invasive imaging techniques such as CT and magnetic resonance imaging (MRI), preoperative diagnosis of pulmonary sequester can be made easily, so, invasive techniques such as angiography are not required frequently.

Lung function changes and complications after lobectomy for lung cancer in septuagenarians.

BACKGROUND: In septuagenarians, lobectomy is the preferable operation, with lower morbidity than for pneumonectomy. However, the 1-year impact of lobectomy on lung function has not been well studied in elderly patients. MATERIALS AND METHODS: Retrospective study including 30 patients 70 years or older (study group), 25 patients with chronic obstructive pulmonary disease (COPD) under 70 years (control group 1), and 22 patients under 70 years with normal lung function (control group 2) operated for lung cancer in a 2-year period. The study and control groups were compared related to lung function changes after lobectomy, operative morbidity, and mortality. RESULTS: Postoperative lung function changes in the elderly followed the similar trend as in patients with COPD. There were no significant differences between these two groups related to changes in forced expiratory volume in the first second (FEV1) and vital capacity (VC). Unlike that, the pattern of the lung function changes in the elderly was significantly different compared with patients with normal lung function. The mean postoperative decrease in FEV1 was 14.16% in the elderly, compared with a 29.23% decrease in patients with normal lung function (P < 0.05). In the study and control groups, no patients died within the first 30 postoperative days. The operative morbidity in the elderly group was significantly lower than in patients with COPD (23.3% vs. 60%). CONCLUSIONS: The lung function changes after lobectomy in the elderly are similar to those in patients with COPD. The explanation for such a finding needs further investigation. Despite a high proportion of concomitant diseases, the age itself does not carry a prohibitively high risk of operative mortality and morbidity.

Influence of chronic obstructive pulmonary disease on postoperative lung function and complications in patients undergoing operations for primary non-small cell lung cancer.

OBJECTIVES: Recent data have suggested that there is a flexibility of borderline values of lung function tests in allowing safe lung resection. The aim of this study was to assess the pattern of postoperative lung function change in patients with chronic obstructive pulmonary disease compared with that of patients with normal lung function, and to compare the operative morbidity and mortality between these groups. METHODS: The study included 35 patients with chronic obstructive pulmonary disease and a control group of 47 patients with normal lung function who underwent lung resection for non-small cell lung cancer. The percent changes of lung function parameters after lung resection and operative morbidity and mortality were compared between groups. RESULTS: The mean postoperative loss in forced expiratory volume in the 1st second was significantly less in patients with chronic obstructive pulmonary disease who underwent lobectomy compared with that of patients with normal lung function (11.88% vs 24.6%, P < .05); forced expiratory flows at low lung volumes (50% and 25%) improved in patients who underwent lobectomy. The lung function change after pneumonectomy followed the same trend as that after lobectomy. In patients with chronic obstructive pulmonary disease, forced expiratory volume in the 1st second and small airways function significantly improved after preoperative bronchodilator therapy. In the group with chronic obstructive pulmonary disease, operative mortality was 0 and operative morbidity was 51.43%. CONCLUSIONS: Because the pattern of lung function change is different in patients with chronic obstructive pulmonary disease compared with that of patients with normal lung function, surgery can be offered to carefully selected patients with lung cancer, even in the presence of severely limited lung function.

Mucous gland adenoma simulating bronchial asthma: case report and literature review.

We report a case of mucous gland adenoma arising in the left main bronchus which was initially misdiagnosed as asthma and review the previous reported cases of this rare tumor published in the available literature.

[Surgical treatment of patients with lung cancer and limited lung function--preoperative assessment, operative mortality and morbidity].

INTRODUCTION: Lung resection in patients with limited lung function is one of the greatest challenges in general thoracic surgery. OBJECTIVE: The aim of the study was to analyse the pattern of lung function changes after operation, operative morbidity and mortality and to compare them with control group of patients. METHOD: The study included 34 patients with limited lung function, operated for primary lung cancer in one-year period. All patients underwent preoperative desobstructive treatment. The type of ventilatory disorder was analysed depending on preoperative radiographic and bronchoscopic aspect. STATISTICS: chi-square test, t-test. RESULTS: In patients with lobectomy, the mean difference in forced expiratory volume in the first second (FEV1) between preoperative and postoperative values was 16.81%, whilst in the pneumonectomy group this difference was 39.51%. The mean change in forced vital capacity (FVC) in the lobectomy and pneumonectomy group was 15.83% and 42.73% respectively. In the control group of 28 patients with lobectomy, the decrease in FVC and FEV1 was 19.9% and 24.18% respectively. In the control group of 28 patients with pneumonectomy, the decrease in FVC and FEV1 was 43.52% and 41.36% respectively. In patients with limited lung function and lobectomy, changes in FEV1 and VC after resection were significantly lower compared to the control group of patients with lobectomy and normal lung function. None of 34 operated patients with borderline lung function died inside 30 postoperative days. In the same period, of a total number of 344 patients without respiratory function impairement, operative mortality was 3.1%. In the analysed group, operative morbidity was 32.35%. Cardiovascular and respiratory complications in the analysed and control groups occurred in 14.7% and 6.1% of patients respectively (p > 0.05). CONCLUSION: Surgery should not be excluded in patients with borderline lung function prior to preoperative treatment and additional lung function assessment.

[The impact of resistant strains of Mycobacterium tuberculosis on relapse of tuberculosis].

INTRODUCTION: Relapses of tuberculosis are fairly rare nowdays and they represent the onset of tuberculosis two, or more than two years after completion of previous treatment. MATERIAL AND METHODS: In the previous period, relapses of tuberculosis occurred in 141 patients (87 male and 54 female). Their mean age was 46.2 years. RESULTS: Relapses of tuberculosis occurred after 11.3 years, on average. All patients presented with pulmonary tuberculosis, and two patients also had pulmonary and extrapulmonary tuberculosis (bones). Resistance was one of the statistically significant factors for relapse of tuberculosis. Resistance to one antituberculotic agent was most common--8 patients, resistance to two drugs--4 patients, resistance to three drugs--4 patients, resistance to four drugs in 5 patients. Due to these findings on resistant strains of mycobacterium tuberculosis, a huge number of patients with relapses of tuberculosis had full recovery and completed the treatment. CONCLUSION: The importance of resistant strains of mycobacterium tuberculosis is really huge in our conditions. The findings of these resistant strains of mycobacterium tuberculosis and adequate medical treatment are obligatory nowadays.

[Pneumonectomy in bronchial carcinoma after prior pleural empyema]. / Pneumonektomija zbog karcinoma bronha posle empijema pleure.

Pneumonectomy is a lung resection that is associated with significantly higher operative mortality and morbidity than lobectomy. Beside classical causes of operative morbidity, such as respiratory and cardiovascular, the most important cause of postoperative complications is bronchopleural fistula. This complication occurs in 5 to 10 percents of patients with pneumonectomy, in some series up to 15 percents before introducing mechanical bronchial suture. The risk of the occurrence of this complication is increased in patients undergoing pneumonectomy after previous infection in the pleural space. Not so frequently, surgeons are faced with the necessity of performing pneumonectomy after pleural empyema as the first manifestation of the bronchus carcinoma. Over the last 5 years, in the the Institute of Lung Diseases, 4 patients underwent pneumonectomy after pleural empyema. The preoperative assessment, operative procedure and postoperative problems are the subject of this paper. Unlike the last three patients, in the first patient, pleural empyema was not recognized preoperatively. Based on the outcome of the treatment of the presented patients, we can conclude that pleural empyema, as the first manifestation of the bronchus carcinoma, does not necessarily exclude surgical treatment. Such a statement is based on the fact that, even in these patients, it is possible to achieve postoperative course without significant morbidity and with a possibility to perform various forms of adjuvant therapy.