The objective of this study is to undertake a narrative review of the oncological adequacy of mediastinal lymphadenectomy performed via robot-assisted thoracic surgery (RATS) in comparison with video-assisted thoracic surgery (VATS) and thoracotomy for non-small cell lung cancer (NSCLC). The focus of the review is on lymph node yield, nodal station dissection, and nodal upstaging rates. A narrative review of literature published in the last decade was conducted using PubMed, Cochrane, and Web of Science databases. Studies examining mediastinal lymphadenectomy outcomes for RATS, VATS, or thoracotomy were included in the discussion. The analysis of 19 studies from diverse geographical regions showed that in six out of nine comparative studies, RATS demonstrated superior lymph node retrieval compared to VATS, with statistically significant differences. RATS achieved comparable or superior nodal station dissection rates and showed particular advantages in upstaging from clinical N0 to pathological N2 status. Additionally, RATS demonstrated favourable perioperative outcomes with reduced morbidity and mortality rates compared to conventional approaches. RATS represents a reliable and oncologically sound approach to mediastinal lymphadenectomy, with potential advantages over conventional techniques. Its enhanced visualization and precision make it an increasingly utilised option for NSCLC treatment in centres with robotic capabilities.

• Klíčová slova
• Lung cancer, Mediastinal lymphadenectomy, Robotic-assisted surgery, Summary, Thoracic surgery,
• MeSH
• hrudní chirurgie video-asistovaná metody   MeSH
• lidé MeSH
• lymfadenektomie * metody   MeSH
• mediastinum chirurgie   MeSH
• nádory plic * chirurgie   patologie   MeSH
• nemalobuněčný karcinom plic * chirurgie   patologie   MeSH
• roboticky asistované výkony * metody   MeSH
• torakotomie metody   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Wilms tumour is a common juvenile cancer of the kidney, and its occurrence in adolescence or adulthood is extremely rare, accounting for around 1% of all adult kidney malignancies. Histopathologically, three tissue patterns can be identified, including blastemal, epithelial, and stromal components, while the overall microscopic appearance of an adult-type tumour does not differ from that of its juvenile counterpart. The blastemal predominant Wilms tumours are the most aggressive and have the worst prognosis. The samples must be histopathologically verified before the definitive diagnosis can be made, and immunohistochemistry examination is critical. Wilms tumours are often positive for keratin, vimentin, desmin, actin, and WT1, which distinguishes this type of tumour from other malignancies. WT1 positivity is indicative of the blastemal component of the tumorous tissue and may be completely absent in the mature epithelial and stromal parts. Only three WT1 negative adult-type Wilms tumours have been reported in the literature to this date. However, none of the patients had a blastemal predominant tumour. That is why we would like to present a highly interesting and diagnostically challenging case of a young man who was diagnosed with a tumorous lesion of the left kidney parenchyma. Genetic analysis did not reveal any known fusion genes associated with round cell sarcomas, ruling out this differential diagnosis. This article also includes a literature review on published articles on WT1 negative Wilms tumour in adults and other concerns related to this topic. The main goal of this publication was to emphasise that, while it is a rare entity in general, similar problematic cases can occur in practise, and thus it is important to be aware of this type of tumour when making a differential diagnosis in cases with similar clinical and histopathological features.

• Klíčová slova
• WT1 negative, Wilms tumour, adult, blastemal predominant, case report, nephroblastoma, renal,
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

INTRODUCTION: This prospective study aimed to evaluate the functional status and risk factors in patients undergoing lung resection. METHODS: Functional status defined by the parameters of spirometry (VC, FVC, FEV1, FEV1/FVC) and whole-body plethysmography (TLC) examination was assessed before lung resection, at hospital discharge, 3 weeks after surgery, and 3 months after surgery. RESULTS: The sample comprised 24 participants who were observed from 5/2021 to 10/2022. The functional status worsened significantly after the surgery, but the lung function values improved over time. CONCLUSIONS: Lung functions dropped sharply after the surgery but improved over time.

• Klíčová slova
• functional status, lung resection, spirometry, whole-body plethysmography,
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Advancements in immunotherapeutic approaches only had a modest impact on the therapy of lung neuroendocrine neoplasms (LNENs). Our multicenter study aimed to investigate the expression patterns of novel immunotherapy targets in intermediate- and high-grade LNENs. METHODS: The expressions of V-domain Ig suppressor of T cell activation (VISTA), OX40L, Glucocorticoid-induced TNF receptor (GITR), and T cell immunoglobulin and mucin domain 3 (TIM3) proteins were measured by immunohistochemistry in surgically resected tumor samples of 26 atypical carcinoid (AC), 49 large cell neuroendocrine lung cancer (LCNEC), and 66 small cell lung cancer (SCLC) patients. Tumor and immune cells were separately scored. RESULTS: Tumor cell TIM3 expression was the highest in ACs (p < 0.001), whereas elevated tumor cell GITR levels were characteristic for both ACs and SCLCs (p < 0.001 and p = 0.011, respectively). OX40L expression of tumor cells was considerably lower in ACs (vs. SCLCs; p < 0.001). Tumor cell VISTA expression was consistently low in LNENs, with no significant differences across histological subtypes. ACs were the least immunogenic tumors concerning immune cell abundance (p < 0.001). Immune cell VISTA and GITR expressions were also significantly lower in these intermediate-grade malignancies than in SCLCs or in LCNECs. Immune cell TIM3 and GITR expressions were associated with borderline prognostic significance in our multivariate model (p = 0.057 and p = 0.071, respectively). CONCLUSIONS: LNEN subtypes have characteristic and widely divergent VISTA, OX40L, GITR, and TIM3 protein expressions. By shedding light on the different expression patterns of these immunotherapy targets, the current multicenter study provides support for the future implementation of novel immunotherapeutic approaches.

• Klíčová slova
• Immune phenotype, Immunohistochemistry, Immunotherapy target, Lung neuroendocrine neoplasm,
• MeSH
• antigeny B7 metabolismus   MeSH
• buněčný receptor 2 viru hepatitidy A * metabolismus   MeSH
• dospělí MeSH
• glukokortikoidy indukovaný protein související s TNRF * metabolismus   MeSH
• imunoterapie * metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• ligand OX40 metabolismus   MeSH
• nádorové biomarkery * metabolismus   MeSH
• nádory plic * imunologie   patologie   terapie   metabolismus   MeSH
• neuroendokrinní nádory * imunologie   metabolismus   terapie   patologie   MeSH
• prognóza MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• stupeň nádoru MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• Názvy látek
• antigeny B7 MeSH
• buněčný receptor 2 viru hepatitidy A * MeSH
• glukokortikoidy indukovaný protein související s TNRF * MeSH
• HAVCR2 protein, human MeSH Prohlížeč
• ligand OX40 MeSH
• nádorové biomarkery * MeSH
• TNFRSF18 protein, human MeSH Prohlížeč
• VSIR protein, human MeSH Prohlížeč

Lung malignancies have a substantial impact on cancer incidence and mortality worldwide. Even though many factors involved in the development of the disease are known, many questions remain unanswered. Previous studies suggest that the intestinal microbiota may have a role in developing malignant diseases. According to some findings, the microbiota has proven to be a key modulator of carcinogenic processes and the immune response against cancer cells, potentially influencing the effectiveness of immunotherapy. In our study, we characterized culturable microorganisms associated with non-small cell lung cancer (NSCLC) that can be recovered from rectal swabs and mouthwash. In addition, we also explored differences in the culturable microbiota with two main types of NSCLC - adenocarcinoma (ADC) and squamous cell carcinoma (SCC). With 141 patients included in the study (86 ADC and 55 SCC cases), a significant difference was observed between the two types in seven bacterial species (Collinsella, Corynebacterium, Klebsiella, Lactobacillus, Neisseria, Rothia, and Streptococcus), including the site of origin. The relationship between microbial dysbiosis and lung cancer is poorly understood; future research could shed light on the links between gut microbiota and lung cancer development.

• Klíčová slova
• lung cancer, microbiota, non-small cell lung carcinoma, oncogenic mutations,
• MeSH
• adenokarcinom * MeSH
• lidé MeSH
• mikrobiota * MeSH
• nádory plic * mikrobiologie   patologie   MeSH
• nemalobuněčný karcinom plic * mikrobiologie   patologie   MeSH
• spinocelulární karcinom * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

There have been studies on antibiotic use concerning lung cancer and its potential impact on carcinogenesis and microbiome. However, subsequent research has failed to support these associations consistently. In terms of the potential carcinogenic of antibiotics on lung cancer, the available evidence has not been sufficient to draw any definitive conclusions. Maintaining immune homeostasis and preventing pathogen invasion is critically dependent on the microbiome. The subtle balance of the body microbiota, including the lungs, is susceptible to disruption by antibiotic use. There is an association between disruptions of the lung microbiome and respiratory diseases, including lung cancer, and decreased efficacy of treatments. Patients with lung cancer are often indicated for antibiotic treatment due to respiratory infections or other comorbidities. Pulmonary infections in the area of undetected lung tumors are not uncommon. They can be an early sign of malignancy, which may explain the association between antibiotic use and lung cancer diagnosis. Antibiotic use can also affect the effectiveness of immune checkpoint inhibitor therapy. Studies suggest that antibiotic use can impair the efficacy of immune checkpoint inhibitor therapy in lung cancer patients, particularly around the time when treatment is initiated. These findings require further study, understanding underlying mechanisms, and identifying microbiota signatures associated with treatment response.

• Klíčová slova
• antibiotics, immunotherapy, lung, microbiome, non-small-cell lung cancer,
• MeSH
• antibakteriální látky škodlivé účinky   MeSH
• inhibitory kontrolních bodů terapeutické užití   MeSH
• lidé MeSH
• nádory plic * farmakoterapie   patologie   MeSH
• nemalobuněčný karcinom plic * farmakoterapie   patologie   MeSH
• plíce patologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• antibakteriální látky MeSH
• inhibitory kontrolních bodů MeSH

BACKGROUND: Lung cancer poses a significant challenge with high mortality rates. Minimally invasive surgical approaches, including the uniportal thoracoscopic technique, offer potential benefits in terms of recovery and patient compliance. This study focuses on evaluating the radicality of mediastinal lymphadenectomy during uniportal thoracoscopic lung resection, specifically assessing the reachability of established lymphatic stations. METHODS: A comparative study was conducted at the University Hospital Ostrava from January 2015 to July 2022, focusing on the evaluation of radicality in mediastinal lymphadenectomy across three patient subgroups: uniportal thoracoscopic approach, multiportal thoracoscopic approach, and thoracotomy approach. The study implemented the routine identification and excision of 8 lymph node stations from the respective hemithorax to assess the radicality of lymph node harvesting. RESULTS: A total of 428 patients were enrolled and evaluated. No significant differences were observed in the number of lymph nodes removed between the subgroups. The mean number of lymph nodes removed was 6.50 in the left hemithorax and 6.49 in the right hemithorax. The 30-day postoperative morbidity rate for the entire patient population was 27.3%, with 17.5% experiencing minor complications and 6.5% experiencing major complications. Statistically significant differences were observed in major complications between the uniportal approach and the thoracotomy approach (3.5% vs 12.0%, p = 0.002). The overall mortality rate in the study population was 3%, with a statistically significant difference in mortality between the uniportal and multiportal approaches (1.0% vs 6.4%, p = 0.020). CONCLUSIONS: The uniportal approach demonstrated comparable accessibility and lymph node yield to multiportal and thoracotomy techniques. It is equivalent to established methods in terms of postoperative complications, with fewer major complications compared to thoracotomy. While our study indicates a potential for lower mortality following uniportal lung resection in comparison to multiportal lung resection, and demonstrates comparable outcomes to thoracotomy, it is important to approach these findings cautiously and refrain from drawing definitive conclusions.

• Klíčová slova
• Lung cancer, Lung resection, Mediastinal lymphadenectomy, Morbidity, Mortality, Uniportal thoracoscopy,
• MeSH
• hrudní chirurgie video-asistovaná metody   MeSH
• lidé MeSH
• lymfadenektomie metody   MeSH
• nádory plic * chirurgie   patologie   MeSH
• plíce patologie   MeSH
• pneumektomie škodlivé účinky   metody   MeSH
• retrospektivní studie MeSH
• torakotomie * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Although pneumonia presents a relatively common diagnosis, it does not always present with classic clinical symptoms, nor does it follow a regular course without complications. The presented case describes a rare case of aspiration necrotizing pneumonia, which despite intensive therapy, progressed to lung gangrene and required a lung lobectomy. Another peculiarity is that the correct diagnosis was established only after the onset of abdominal pain, surprisingly by a trauma surgeon. This case emphasizes the necessity of a thorough general examination and draws attention to a rare, but conservatively intractable necrotizing pneumonia complicated by lung gangrene.

• Klíčová slova
• Abdominal pain, Lobectomy, Pediatrics, abdominal pain, acute abdomen, necrotizing pneumonia, paediatrics,
• MeSH
• aspirační pneumonie * MeSH
• bolesti břicha MeSH
• gangréna MeSH
• lidé MeSH
• nekrotizující pneumonie * MeSH
• plíce MeSH
• předškolní dítě MeSH
• Check Tag
• lidé MeSH
• předškolní dítě MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

OBJECTIVE: Peptic ulcer perforation presents the most serious complication of ulcer disease with mortality that varies significantly depending on the age and conditions. The coronavirus disease 2019 pandemic was effective worldwide in 2020 and continues to date. The aim of this study was to investigate the initial clinical parameters and short-term outcomes of patients with acute peptic ulcer perforation before and during the coronavirus disease 2019 pandemic. METHODS: A retrospective cohort study was conducted in the Department of Surgery, University Hospital Ostrava, Czech Republic. The patients undergoing surgical modality of a simple suture of peptic ulcer perforation with/without omentoplasty in the post-coronavirus disease 2019 (January 1, 2020 to December 31, 2021) and the pre-coronavirus disease 2019 (January 1, 2018 to December 31, 2019) had been incorporated in this study. RESULTS: This study included a total of 46 cases (26 in the pre-coronavirus disease 2019, 20 in the post-coronavirus disease 2019). The age, body mass index, Boey score, duration of symptoms, surgery time, and length of hospital stay were comparable in both study subgroups. During the coronavirus disease 2019 pandemic, patients were admitted with a statistically significantly lower degree of perioperative risk according to the American Society of Anesthesiologists classification (p=0.013). Notably, 30-day postoperative morbidity was significantly higher in pre-coronavirus disease 2019 (73.1 vs. 55.0%, p=0.038). The mortality rate in the laparoscopic group was 13.6%, in the laparotomy group 41.4%, and the mortality rate was higher in pre-coronavirus disease 2019 than in post-coronavirus disease 2019 (34.6 vs. 20.0%, p=0.166). CONCLUSION: In fact, the coronavirus disease 2019 pandemic had not significantly influenced therapeutic management and short-term outcomes of patients undergoing acute surgical repair of peptic ulcer perforation.

• MeSH
• akutní nemoc MeSH
• COVID-19 * komplikace   MeSH
• laparoskopie * škodlivé účinky   MeSH
• lidé MeSH
• pandemie MeSH
• perforace peptického vředu * diagnóza   etiologie   chirurgie   MeSH
• pooperační komplikace epidemiologie   MeSH
• retrospektivní studie MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Thoracic duct injuries are very rare due to its protected location. Duct is most often injured in polytraumas and during operations in his vicinity. Treatment is primarily conservative, based on a low-fat diet or parenteral nutrition and adequate chest drainage. If the conservative management fails, a surgical duct ligation via thoracotomy, or more conveniently thoracoscopic approach, is necessary. The presented case reports describe the surgical treatment of isolated injury of the thoracic duct via thoracoscopic approach.

• Klíčová slova
• chylothorax, thoracic duct, thoracoscopy,
• MeSH
• chylotorax * chirurgie   MeSH
• ductus thoracicus * zranění   chirurgie   MeSH
• lidé MeSH
• ligace MeSH
• torakoskopie * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• přehledy MeSH