[Clinical efficacy of ct-guided transthoracic needle biopsy of peripheral lung lesions]. / Klinicheskaya effektivnost' transtorakal'noi biopsii perifericheskikh novoobrazovanii legkikh pod kontrolem MSKT.

OBJECTIVE: To evaluate the effectiveness of a step-by-step protocol for GT-guided transthoracic biopsy in verification of peripheral lung tumors. MATERIAL AND METHODS: A retrospective analysis of the results of GT-guided transthoracic biopsies of focal lung neoplasms was performed between October 2019 and December 2020. The analysis included the results of 176 biopsies in 158 patients. RESULTS: Primary biopsy was informative in 139 (87.97%) out of 158 patients. There were 155 (88.07%) informative and 21 (11.93%) non-informative biopsies. Lung adenocarcinoma was diagnosed in 41 (25.95%) patients, squamous cell carcinoma in 35 (22.15%) patients, and small cell carcinoma in 9 (5.7%) patients. There were 17 (10.76%) patients with uninformative biopsy results. Sensitivity, specificity and accuracy were 86%, 95.5%, and 87.8%, respectively. PPV was 98.9%, NPV - 58.3%. Various complications occurred after 65 (36.93%) out of 176 biopsies (95% CI 30.15-44.27). Pneumothorax followed by pleural drainage was detected after 8 (4.55%) biopsies. CONCLUSION: Accuracy of a step-by-step protocol for transthoracic biopsy was 88% that is not inferior to similar results in large-scale studies devoted to specialized navigation systems.

[Enhanced recovery in thoracic surgery]. / Uskorennaya reabilitatsiya v torakal'noi khirurgii.

OBJECTIVE: To present an experience of adapting the accelerated rehabilitation protocol at the thoracic surgery department of the Moscow City Clinical Oncology Hospital No. 1. MATERIAL AND METHODS: An effectiveness of the accelerated rehabilitation program in the city oncology hospital was retrospectively analyzed for the period from February to December 2019. Lung resections were performed in 252 patients with median age 66 (59; 71) years and an equal ratio of men and women (124/128). Primary non-small cell lung cancer was noted in 194 (77%) patients, secondary malignant neoplasms of lungs - in 58 (23%) cases. ASA grading system of anesthetic risk was applied (American Society of Anesthesiologists): grade II - 56 (22.2%) patients, grade III - 203 (75.2%) patients, grade IV - 7 (2.8%) patients. RESULTS: Lobectomy was performed in 147 patients, segmentectomy - in 32, bilobectomy, pneumonectomy and marginal resection - in 1, 3 and 69 cases, respectively. Endoscopic operations made up 13.6% (n=20), 12.5% (n=4) and 78% (n=54). Postoperative 30-day complications occurred in 19 (7.5%) out of 252 patients (95% CI 4.9-11.5). Postoperative 30-day mortality was 1.98% (5 out of 252 patients, 95% CI 0.9-4.6). Median postoperative hospital-stay was 7 (6; 8) days. CONCLUSION: Implementation of fast track protocol requires time and the first results can be assessed after 6-12 months. Continuous monitoring of implementation of the protocol elements by all members of multidisciplinary team, analysis of complications and long-term results are required to realize all potential benefits of this program.

[Analysis of postoperative complications after pneumo-n-ectomy using thoracic morbidity and mortality (tmm) system in nsclc patients for a 5-year period]. / Analiz posleoperatsionnykh oslozhnenii po sisteme TMM u bol'nykh nemelkokletochnym rakom legkogo posle pnevmonektomii za 5-letnii period.

AIM: Postoperative complications after pneumonectomy for NSCLC depend on the extension of surgery, comorbidities and accurate registration of any adverse event. The aim of the study was to evaluate the short-term results after standard and extended pneumonectomy in NSCLC patients according to the TMM grading system. MATERIAL AND METHODS: We included 216 NSCLC patients consecutively submitted to pneumonectomy at our institution from January 2009 to December 2013 in the retrospective study performed on data prospectively collected in an electronic clinical database. All patients were divided into two different groups: standard (n=142) and extended (n=74) pneumonectomy, where resection of adjacent organs was indicated. The patients undergone extended pneumonectomy were subdivided into single (n=49) and multi-organ resection (n=25) groups. Morbidity and mortality rate was analyzed according to the standard criteria and TMM classification system. RESULTS: Postoperative morbidity and mortality rate after standard pneumonectomy (23,9% and 3,5%) was significantly lower than extended procedure (43,2% and 10,8%) (p=0.02). Multi-organ resection was an independent prognostic factor of unfavourable outcome: morbidity and mortality was significantly higher in the multi-organ group (48,0% and 16,0%), while in the single-organ group it was 40,8% and 8,2% respectively (p=0.01). Major complications rate (grade IIIA and higher according to the TMM) was significantly higher in the multi-organ group (40,0%) than in the single-organ (28,6%) and standard (14,8%) group (p=0.01). CONCLUSION: TMM classification system is more accurate in grading and further analysis of postoperative complications after pneumonectomy in NSCLC patients in compare with standard criteria. Multi-organ resection should be carried out with caution due to unacceptable high morbidity and mortality rate.