[The experience of surgical treatment of lung cancer during fifty years]. / Plauciu vezio chirurginis gydymas (50-ties metu patirtis).

AIM: We have analyzed the results of surgical treatment of lung canced at Lithuanian Institute of Oncology in the course of fifty years. MATERIAL AND METHODS: There were 1885 patients with lung cancer surgically treated at Lithuanian Institute of Oncology in the course of 50 years. There was a change in the tactics of the surgeons for surgical treatment in this long period. We have analyzed the following patients: 1) of 1950-1979 2) of 1980-1999. The last period was divided into two subgroups: a) 1980-1993 and b) 1994-1999. Four hundred ten patients were operated on in the first period, 785 - in 1980-1993 and 690 patients in 1994-1999. In the first period the most common operation was pneumonectomy, performed in 176 cases, bi-lobectomy - to 105 patients. In the second period: in a) subgroup 261 and 418 operations were performed and b) subgroup - 200 and 329 operations. Segmentectomy and wedge resection were rare: 16, 27, 26 cases in all periods. Thoracotomy was performed to 113 patients, in a) subgroup - 78, in b) subgroup -129. RESULTS: The biggest hospital mortality after pneumonectomy was: 12.5%,11.4% and 11% according to the periods. The mortality after lobectomy was low: 2.19%, 1.6% and 2.9%.The most serious surgical complications were bronchial fistula and pneumonia. The follow-up results were satisfactory in all the groups of early stages of the disease and moderate in III stage of the disease. CONCLUSIONS: In the twenty years lobectomy was the most common operation for surgical treatment of lung cancer. Bronchial fistula and pneumonia are the most serious complications after pneumonectomy. Adjuvant therapy (radiotherapy, chemotherapy) improve the results of treatment in stage IIB and stage IIIA of the disease.

[Intercostal nerve blockade with alcohol during operation for postthoracotomy pain]. / Potorakotominio skausmo gydymas tarpsonkauliniu nervu blokadomis.

OBJECTIVE: Purpose of this study was to evaluate the effectiveness of intraoperative intercostal nerve blockade with alcohol in addition to epidural analgesia with morphine for control of postthoracotomy pain syndrome. MATERIAL AND METHODS: 57 oncological patients undergoing antero-axillary thoracotomy were randomized to receive intraoperative intercostal nerve blockade with alcohol plus postoperative epidural analgesia with morphine (n=27) and postoperative epidural analgesia with morphine only (n=30). 31 patients had lobectomy, 10 bilobectomy, 9 pulmonectomy and 7 segmentectomy. There were 42 right sided and 15 left sided procedures. Objective and subjective assessment was carried out at 10 and 30 days postoperatively. Pain was assessed by using a subjective visual pain scale ranging from 1 (no pain) to 10 (worst pain) during coughing. RESULTS: Postsurgical pain was significantly lower in intraoperative intercostal nerve blockade patients group. The mean pain score on the 10 postoperation day was 2.1 and 6.5 accordingly in intraoperative intercostal nerve blockade and epidural analgesia with morphine patients group. The mean pain score on the 30 day was accordingly 1.5 and 4.2. CONCLUSION: Additional intraoperative intercostal nerve blockade with alcohol provides an additional benefit for postthoracotomy pain relief, especially for at least one month following the thoracotomy.

[The treatment of lung cancer relapse after the lung resection]. / Plauciu vezio atkryciu po plauciu rezekciju gydymas.

UNLABELLED: The aim of the study was to analyze the patients with the relapse of tumors after lung resection. MATERIAL AND METHODS: One hundred eight patients with lung cancer were operated at Lithuanian Institute of Oncology during period of 1992-2002. To 28 patients pneumonectomy was performed, 4 - bilobectomy, 51 - lobectomy, 23 - wedge resection, 2 - segmentectomy. According to the stage of tumor operations more often were performed in III stage of the disease - to 62 patients, in II - 20, in I - 12 and in the IV - 14. The most common histologic type of tumor was squamous cell carcinoma - 57 patients, adenocarcinoma - 29, small cell carcinoma - 12, anaplastic carcinoma - 4, other types of tumor were rare. The stage of disease had influence upon the time for the relapse of tumor. The dissemination of tumor was detected in 9 patients with II ir III stage of disease. The treatment of the relapse of lung tumor was the following was: 31 patients received radiotherapy, 4 - photodynamic therapy, 12 - radiotherapy with chemotherapy, 20 - chemotherapy. RESULTS: According to the data of March 31, 2003, 98 patients died from carcinoma, 10 patients lived with the signs of disease. Median survival after relapse of tumor was better in patients with I stage of disease - 26.2 months, II - 20.7 months, III - 13.9 months, IV - 8.2 months. CONCLUSIONS: In the case of locally extended tumor with metastases in regional lymph nodes after lung resection the relapse of tumor was most common. The treatment of the relapse of tumor in early stages of disease was most effective.

[Video-assisted thoracoscopic surgery in diagnosis and treatment of pleuritis]. / Vaizdo torakoskopijos galimybes diagnozuojant ir gydant pleuritus.

OBJECTIVE: To evaluate possibilites of video-assisted thoracoscopic surgery in diagnosis and treatment of pleuritis. 1997-2002 in Department of Thoracic Surgery and Oncology of Vilnius University Institute of Oncology 206 patients underwent videothoracoscopic procedures (146 (70.8%) of them for pleuritis). All procedures were performed in general anesthesia using double lumen tube. Mean patient age was 61+/-10 years. One hundred three women (71%) and 43 men (29%) were operated. Seventy four (51%) chemopleurodesis was performed with pleural biopsies: for 2 patients (1.36%) bleocine was used, and for 74 patients (50.6%) sterile talk. RESULTS: Significance of pleural videobiopsies reaches 93%. Eleven patients (7%) failed in diagnosis: in 5 cases (3.4 %) due to adhesions, in 6 cases (3.4%) we made false positive diagnosis. COMPLICATIONS: postoperative pneumonia - 12 patients (8.8%), pneumothorax - 2 patients (1.5%), pleural empiema - 1 patient (0.75%), bleeding - 1 patient (0.75%). CONCLUSIONS: Specificity of video-assisted thoracoscopic surgery in pleural diseases reaches 93.0%. Video-assisted thoracoscopic surgery is necessary even in cases of failed "blind" biopsies and possible in elderly patients. Video-assisted thoracoscopic surgery provides not only easy morphologic verification of pleural diseases but also performance of chemopleurodesis.

[Postoperative adjuvant therapy in combined lung cancer treatment]. / Pooperacines papildomos terapijos galimybes gydant plauciu vezi.

UNLABELLED: The aim of the study was: to evaluate efficacy of postoperative chemotherapy and chemoradiotherapy in patients with NSCLC (N2) disease and to point out time to tumor progression and reccurence, as well as to patients survival. Study was performed as a part of International Adjuvant Lung Cancer Treatment (IALT) protocol. In 1999-2000, 110 patients patients with NSCLC with metastases to N1 and N2 regions entered the trial. Patients were randomized for investigonal group: postoperative chemotherapy 31 patients (48.4%), and chemoradiotherapy 34 patients (53.1%). These patients were compared to 45 patients who underwent only surgery (control group). Patients in the first group according to stages were: II A st. 30 patients (46.1%), IIB - 6 patients. (9.2%), IIIA st. 29 patients (44.6%). Morphology: squamos cell 44 patients (67.6%) and adeno 16 patients (24.6%). OPERATIONS: lobectomy - 20 patients (30.7%), bilobectomy - 6 patients (9.2%), pleuropneumonectomy 13 patients (20%), combined pneumonectomy 13 patients (20%), pneumonectomy 12 patients (18.4%). Chemotherapy started within 60 days after operation. Radiation started in 10 days after last cycle of chemotherapy. RESULTS: Postoperatively 42.8% patients had reccurences after pneumonectomy. In surgery group 26.6% patients had reccurences in 3-year period. Medial survival in adjuvant group was 21.3 months. In surgery group three-year survival was in 19.7% of patients, chemoradiation group - 42.4%, and chemotherapy group - 37.2%. CONCLUSIONS: Postoperative adjuvant therapy remains unsolved and controversal problem. Neither chemotherapy, nor chemoradiotherapy has real impact on survival: 3-year survival in surgery group was observed in 19.7%, in chemoradiation - 42.2%, and in chemotherapy group in 37.2% of patients. Efficacy of postoperative treatment depends on radical removal of lymphodes, tumor morphology and postoperative complications.

[Surgery for esophageal cancer: 10 years experience]. / Stemples vezio chirurginio gydymo galimybes (10-ties metu patirtis).

UNLABELLED: Objective of work was to evaluate efficacy of surgery for esophageal cancer with one-step gastric pipe reconstruction, to analyze postoperative complications, causes of deaths and patient's life expectancy. In 1992-2002 in Clinic of Surgery Vilnius University Institute of Oncology 213 patients underwent surgery for esophageal cancer; 177 patients (83.0%) were applied transthoracic approach, 34 patients (15.9%) transhiatal and 2 patients (0.9%) Lewis type operations. TNM of patients were T3N1M0 - 99 (46.4%), T2N1M0 - 17 (7.9%), T2N0M0 - 16 (7.5%), T4N2M0 - 54 (25.3%), T2-3N2M1 - 27 (12.6%). Patient performance status according to WHO scale was 0-2. The following postoperative complications were observed: vagus pneumonia - 52 (24.2%) patients, heart insufficiency- 13 patients (6.1%), aortal bleeding 3 (1.4%) patients, suture leakadge - 33 (15.4%) patients, injury of n. reccurentis 17 (7.9%) patients, pleurites 29 (13.6%). Postoperative mortality after transthoracic approach - 29.3%, transhiatal - 15%, Lewis resections - 0%. Median survival after transthoracic approach - 29 months, transhiatal - 34 months, Lewis resections - 39 months. CONCLUSIONS: Surgery for esophageal cancer is the most sufficient way of esophageal cancer treatment. Three-level lymphadenectomies postpone early relapses. Postoperative mortality varies from 15 to 29.3%, median survival from 29 to 39 months.

[Bronchoplastic operations for lung cancer]. / Bronchoplastiniu operaciju galimybes kompleksiskai gydant plauciu vezi.

UNLABELLED: Objective of our work was to evaluate efficacy of bronchoplastic operations for lung cancer and time to progression in combined treatment. From 1997 till 2001, 57pts were operated for early I-IIB stages of lung cancer. Operations were: tracheal resections in 3pts (5.2%), window right pneumonectomies in 5pts (8.7%), window left pneumonectomies in 2pts (3.5%), window right upper lobe in 22pts (38.5%), bifurcation resections 2pts (3.5%), sleeve right upper lobe resections 7pts (12.2%), sleeve left upper lobe resections in 11pts (19.2%). We had complications: in 7pts (12.2%) suture failure, 26pts (45.6%) obstructive pneumonia, 3pts (5.2%) kinking of anastomosis, 2pts (3.7%) bronchial bleeding, 6pts (10.5%) covered bronchial fistulas, 5pts (8.7%) died after operations. RESULTS: 32pts (56%) underwent radiation after surgery, 13pts (22.8%) radiation and chemotherapy. Three-year survival was in 82.4% (47pts), in 10pts (17.4%) disease progressed. CONCLUSIONS: 1. Bronchoplastic operations are sufficient for early lung cancer treatment. 2. Three-year was in survival 82.7% of pts. Seventeen percent of patients failed after combined treatment.

[Role of thoracoscopy in the diagnosis and treatment of lung cancer and pleural diseases]. / Vaizdo torakoskopijos reiksme diagnozuojant ir gydant plauciu ir pleuros ligas.

OBJECTIVE: Evaluate efficacy of videothoracoscopic operations in diagnosis and treatment of lung and pleural diseases. In 1997-2001 186 operations were performed using videothoracoscopic devices in the Department of Thoracic Surgery, Institute of Oncology, Vilnius University. Fourty eight resections were performed: 4 (8%) lobectomies, 1 (2%) pericardial cystectomy, 3 (6%) simpatectomies, 3 (6%) intrathoracal lipomectomies, 1 (2%) removing calcificate, 3 (6%) resections of pericardium, 15 (30%) removing metastases, 12 (25%) hamartomas, 6 (13%) wedge resections of lungs tissue due to I(st) stage NSCLC performed for the elderly. One hundred thirty eight diagnostic procedures were performed in pts with various lung and pleura diseases: 66 (48%) biopsies of lungs tissue and 72 (52%) biopsies with chemopleurodesis. From oncological point of view videothoracoscopic operations are confirmed. These operations shortens hospitalization and combined treatment starts quicker. Middle period of hospitalization - 5 days. We had complications: 22 pts (12%) postoperative pneumonia, 4 pts (2%) - short duration pneumothorax, 1 pts (0.5%) - pleural empiema 1 pts (0.5%) - drop of the lung 1 pts (0.5%) - bleeding. After resections margins were free of tumor invasion. CONCLUSIONS: 1. Video-assisted thoracic surgery (VATS) surgery is effective safe method of treatment for lung and pleural diseases. 2. In some cases VATS surgery is the only way to remove tumours, and it shortens hospital stay till 5 days. 3. VATS surgery is very effective in elderly patients with concomitant diseases. 4. Chemopleurodesis is very useful in treatment of pleural fluid.

[Diagnosis and treatment of pleural mesothelioma]. / Pleuros mezoteliomos diagnozavimas ir gydymas.

UNLABELLED: The objective of our paper was to show the data of our treated patients with malignant pleural mesothelioma. In the Department of Thoracic Surgery of Oncology Institute at Vilnius University from 1980 till 01.06.2002, 33 patients (pts), to whom diagnosis of pleural mesothelioma was confirmed by pathologist, were treated in the Clinic. A malignant pleural mesothelioma was diagnosed in 31 pts, two pts had a non-malignant form of mesothelioma. Among patients were 19 men and 14 women. The distribution of pts according to the stage of the disease was: I stage - 3, II - 1, III - 17, IV - 10. Videothoracoscopy is the best method for diagnosing pleural mesothelioma. Radical operations were performed only in 17 cases: 6 - pulmonectomy with pleuroectomy, 1 - lobectomy, 3 - atypical segmentectomy, 4 - pleuroectomy, 4 - tumorectomy. Thoracotomy was performed in 9 cases. Insufflation of talc was performed in 6 pts. Adjuvant therapy (chemotherapy or radiotherapy) was given to 10 pts. RESULTS: Nineteen pts died of the progression of disease. Median survival of pts was 15.7 months. CONCLUSIONS: 1. Diagnosis of malignant pleural mesothelioma is difficult and confirmation of the disease is possible only after histological examination of tumor. 2. The best results of treatment were achieved after combined treatment: surgery, after chemotherapy and radiotherapy. 3. In cases of pleural effusion of diffuse pleural mesothelioma insufflation of talc or other chemical substances into pleural cavity is recommended.