Background and Objectives: Postoperative pneumonia and complications significantly impact outcomes in thoracic surgery, particularly for patients undergoing lobectomy for non-small cell lung cancer (NSCLC). This study evaluates whether preoperative premedication influences the risk of postoperative pneumonia and overall complications. Materials and Methods: This retrospective study included 346 patients who underwent lobectomy for NSCLC at the University Hospital Ostrava between 2015 and 2021. Data on demographic variables, tumour staging, surgical approach, and premedication (anticholinergics, benzodiazepines, antihistamines, and analgesics) were analysed. Postoperative outcomes included pneumonia and complications classified by the modified Clavien-Dindo system. Results: Premedication was not significantly associated with postoperative pneumonia (10.7%) or overall complications (26.0%). Tumour size was the only factor significantly associated with complications, with larger tumours increasing the odds (OR: 1.16, p = 0.032). Other factors, including age, ASA classification, BMI, and surgical approach, did not demonstrate significant associations with postoperative outcomes. Conclusions: Premedication does not appear to significantly influence the risk of postoperative pneumonia or overall complications in patients undergoing lobectomy for NSCLC. Similarly, other clinical variables, such as age, ASA classification, BMI, and surgical approach, also did not show significant associations with these outcomes. These findings suggest that premedication can be individualised without increasing postoperative risks. However, tumour size emerged as a significant factor associated with complications, highlighting the need for careful preoperative assessment and planning, particularly in patients with larger tumours.

• Klíčová slova
• lobectomy, lung cancer, postoperative complication, postoperative pneumonia, premedication, risk factors, thoracic surgery,
• MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory plic * chirurgie   MeSH
• nemalobuněčný karcinom plic * chirurgie   MeSH
• pneumektomie * škodlivé účinky   metody   MeSH
• pneumonie etiologie   epidemiologie   prevence a kontrola   MeSH
• pooperační komplikace * prevence a kontrola   etiologie   epidemiologie   MeSH
• premedikace * metody   MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• senioři nad 80 let MeSH
• senioři 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

Postoperative pneumonia is the most common complication in patients after lung resection for non-small cell lung cancer (NSCLC). The tolerable incidence of this complication ranges from 5 to 8 %. The aim of this study was to evaluate the influence of initial risk factors on the incidence of postoperative pneumonia in patients undergoing lung resection for NSCLC. A retrospective cohort study was conducted at the University Hospital Ostrava between January 1, 2016, and December 31, 2022. All adult patients who underwent pulmonary lobectomy for primary NSCLC during the study period were included in the study. A total of 350 patients were included in the study. The incidence of postoperative pneumonia was 10.9%. Analysis of baseline risk factors did not show a statistically significant association with the incidence of this complication. The only statistically significant finding was a longer hospital stay in patients with postoperative pneumonia. The risk of postoperative pneumonia in patients undergoing lung resection for non-small cell lung cancer cannot be clearly explained by the initial risk factors examined alone. The complex nature of this risk also requires a comprehensive approach to prevention, including both patient-centred measures and improved postoperative care.

• Klíčová slova
• non-small cell lung carcinoma, postoperative pneumonia, lung resection, risk factors, incidence,
• MeSH
• délka pobytu MeSH
• incidence MeSH
• kohortové studie MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory plic * chirurgie   MeSH
• nemalobuněčný karcinom plic * chirurgie   MeSH
• pneumektomie * škodlivé účinky   MeSH
• pneumonie * etiologie   epidemiologie   MeSH
• pooperační komplikace * etiologie   MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Bronchoscopic lung volume reduction (BLVR) with one-way endobronchial valves (EBV) has better outcomes when the target lobe has poor collateral ventilation, resulting in complete lobe atelectasis. High-inspired oxygen fraction (FIO2) promotes atelectasis through faster gas absorption after airway occlusion, but its application during BLVR with EBV has been poorly understood. We aimed to investigate the real-time effects of FIO2 on regional lung volumes and regional ventilation/perfusion by electrical impedance tomography (EIT) during BLVR with EBV. METHODS: Six piglets were submitted to left lower lobe occlusion by a balloon-catheter and EBV valves with FIO2 0.5 and 1.0. Regional end-expiratory lung impedances (EELI) and regional ventilation/perfusion were monitored. Local pocket pressure measurements were obtained (balloon occlusion method). One animal underwent simultaneous acquisitions of computed tomography (CT) and EIT. Regions-of-interest (ROIs) were right and left hemithoraces. RESULTS: Following balloon occlusion, a steep decrease in left ROI-EELI with FIO2 1.0 occurred, 3-fold greater than with 0.5 (p < 0.001). Higher FIO2 also enhanced the final volume reduction (ROI-EELI) achieved by each valve (p < 0.01). CT analysis confirmed the denser atelectasis and greater volume reduction achieved by higher FIO2 (1.0) during balloon occlusion or during valve placement. CT and pocket pressure data agreed well with EIT findings, indicating greater strain redistribution with higher FIO2. CONCLUSIONS: EIT demonstrated in real-time a faster and more complete volume reduction in the occluded lung regions under high FIO2 (1.0), as compared to 0.5. Immediate changes in the ventilation and perfusion of ipsilateral non-target lung regions were also detected, providing better estimates of the full impact of each valve in place. TRIAL REGISTRATION: Not applicable.

• Klíčová slova
• Absorption atelectasis, Electrical impedance tomography, Emphysema, Endobronchial valves, Lung volume reduction,
• MeSH
• atelektáza diagnostické zobrazování   patofyziologie   MeSH
• bronchoskopie * metody   MeSH
• časové faktory MeSH
• elektrická impedance * MeSH
• měření objemu plic metody   MeSH
• plíce diagnostické zobrazování   patofyziologie   chirurgie   fyziologie   MeSH
• pneumektomie metody   MeSH
• prasata MeSH
• tomografie metody   MeSH
• zvířata MeSH
• Check Tag
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Standard treatment with neoadjuvant nivolumab plus chemotherapy significantly improves outcomes in patients with resectable non-small-cell lung cancer (NSCLC). Perioperative treatment (i.e., neoadjuvant therapy followed by surgery and adjuvant therapy) with nivolumab may further improve clinical outcomes. METHODS: In this phase 3, randomized, double-blind trial, we assigned adults with resectable stage IIA to IIIB NSCLC to receive neoadjuvant nivolumab plus chemotherapy or neoadjuvant chemotherapy plus placebo every 3 weeks for 4 cycles, followed by surgery and adjuvant nivolumab or placebo every 4 weeks for 1 year. The primary outcome was event-free survival according to blinded independent review. Secondary outcomes were pathological complete response and major pathological response according to blinded independent review, overall survival, and safety. RESULTS: At this prespecified interim analysis (median follow-up, 25.4 months), the percentage of patients with 18-month event-free survival was 70.2% in the nivolumab group and 50.0% in the chemotherapy group (hazard ratio for disease progression or recurrence, abandoned surgery, or death, 0.58; 97.36% confidence interval [CI], 0.42 to 0.81; P<0.001). A pathological complete response occurred in 25.3% of the patients in the nivolumab group and in 4.7% of those in the chemotherapy group (odds ratio, 6.64; 95% CI, 3.40 to 12.97); a major pathological response occurred in 35.4% and 12.1%, respectively (odds ratio, 4.01; 95% CI, 2.48 to 6.49). Grade 3 or 4 treatment-related adverse events occurred in 32.5% of the patients in the nivolumab group and in 25.2% of those in the chemotherapy group. CONCLUSIONS: Perioperative treatment with nivolumab resulted in significantly longer event-free survival than chemotherapy in patients with resectable NSCLC. No new safety signals were observed. (Funded by Bristol Myers Squibb; CheckMate 77T ClinicalTrials.gov number, NCT04025879.).

• MeSH
• adjuvantní chemoterapie MeSH
• doba přežití bez progrese choroby MeSH
• dospělí MeSH
• dvojitá slepá metoda MeSH
• inhibitory kontrolních bodů terapeutické užití   škodlivé účinky   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory plic * farmakoterapie   mortalita   chirurgie   patologie   MeSH
• nemalobuněčný karcinom plic * farmakoterapie   mortalita   chirurgie   patologie   MeSH
• neoadjuvantní terapie * MeSH
• nivolumab * terapeutické užití   škodlivé účinky   aplikace a dávkování   MeSH
• pneumektomie MeSH
• protinádorové látky imunologicky aktivní terapeutické užití   škodlivé účinky   aplikace a dávkování   MeSH
• protokoly protinádorové kombinované chemoterapie terapeutické užití   škodlivé účinky   MeSH
• senioři MeSH
• staging nádorů MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky, fáze III MeSH
• multicentrická studie MeSH
• randomizované kontrolované studie MeSH

INTRODUCTION: Lung cancer is a serious health problem with a high mortality rate. In the context of surgical management, minimally invasive approaches, including uniportal thoracoscopic techniques, offer potential benefits such as faster recovery and increased patient cooperation. The aim of this study was to compare the accessibility of the mediastinal lymph nodes between uniportal and multiportal thoracoscopic approaches and to verify whether the use of the uniportal approach affects the radicality of the lymphadenectomy. METHODS: A comparative study conducted from January 2015 to July 2022 at the University Hospital Ostrava focused on evaluating the radicality of mediastinal lymphadenectomy between subgroups of patients undergoing surgery using the uniportal thoracoscopic approach and the multiportal thoracoscopic approach. RESULTS: A total of 278 patients were included in the study. There were no significant differences in the number of available lymphatic stations between the subgroups. The mean number of lymph node stations removed was 6.46 in the left hemithorax and 6.50 in the right hemithorax. Thirty-day postoperative morbidity for the entire patient population was 24.5%, with 18.3% having minor complications and 3.6% having major complications. The overall mortality rate in the study population was 2.5%, with a statistically significant difference in mortality between uniportal and multiportal approaches (1.0% vs 6.4%, p=0.020). CONCLUSIONS: The uniportal approach demonstrated comparable accessibility and lymph node yield to the multiportal approach. There was also no difference in postoperative morbidity between the two approaches. The study suggests the possibility of lower mortality after uniportal lung resection compared with multiportal lung resection, but this conclusion should be interpreted with caution.

• Klíčová slova
• Lobectomy, lung recection, lymphadenectomy, resection, uniportal approaches,
• MeSH
• hrudní chirurgie video-asistovaná MeSH
• lidé středního věku MeSH
• lidé MeSH
• lymfadenektomie * metody   MeSH
• mediastinum * chirurgie   MeSH
• nádory plic * chirurgie   patologie   MeSH
• pneumektomie * metody   MeSH
• pooperační komplikace MeSH
• senioři MeSH
• torakoskopie metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie 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

INTRODUCTION: The initiation of lung cancer screening in Czechia and diagnosis in earlier stages has been reflected by an increasing demand for anatomical lung segmentectomy. The purpose of this study was to describe early results of the first robotic-assisted thoracoscopic segmentectomies performed in the country. METHODS: Our institution has performed 151 robotic anatomical lung resections since the initiation of the screening program in August 2020, which enabled us to attain the status of a proctoring and case observation centre. The robotic segmentectomy program was initiated after completing 70 robotic lobectomies. We performed a retrospective analysis of the results of our first 20 patients indicated for robotic segmentectomy. RESULTS: Median age of the patients was 60, with 11 females and 7 males. The most common indications included primary lung malignancy (n=13), pulmonary metastasis (n=2) and benign lesions (n=3). We performed 11 simple segmentectomies, 6 complex (S2, S3, S1a+2, S10 on the right) and one right S6 segmentectomy with bronchoplasty. The mean number of harvested lymph nodes for NSCLC was 20, the mean blood loss was 25 mL (from 10 mL to 100 mL), and the mean operative time was 200 minutes. All resection margins were tumour-free. There was no conversion to thoracotomy. Two patients were excluded as they required conversion to robotic lobectomy given that their lesions were localized close to the intersegmental plane. One complication (recurrent laryngeal nerve paralysis) occurred in 1 patient. Mean chest tube duration was 1.9 days and length of stay 3.9 days. CONCLUSION: Our experience suggests that implementation of the robotic segmentectomy program after completion of the robotic learning curve provides promising outcomes. Robotic technology and preoperative planning facilitate this technically demanding procedure especially when bronchoplasty is required.

• Klíčová slova
• bronchoplasty, learning curve, lung cancer, lymphadenectomy, mediastinal, robotic lung segmentectomy,
• MeSH
• časná detekce nádoru MeSH
• hrudní chirurgie video-asistovaná metody   MeSH
• lidé MeSH
• nádory plic * chirurgie   MeSH
• plíce patologie   MeSH
• pneumektomie MeSH
• retrospektivní studie MeSH
• roboticky asistované výkony * MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

INTRODUCTION: Thanks to perfect visualization and high maneuverability of instruments, the robotic technique is a preferable type of lung resection, even though the number of required incisions is usually higher compared to the video-assisted approach. This case report presents our initial experience with the reduced-port approach in performing robotic biportal lobectomy. CASE REPORT: The 72-years-old female, examined for hemoptysis, was diagnosed with a carcinoid tumor of the left lower lobe bronchus based on bronchoscopy. The patient underwent a biportal fully robotic left lower lobectomy. The time of operation was 235 minutes, longer compared to the average time of multiportal procedures, i.e. 190±52 minutes, and the blood loss of 100 mL was higher compared to 43±54 mL. The patient was discharged without complications on the third postoperative day. Histological analysis confirmed the diagnosis of a typical carcinoid with tumor free margins and seven tumor free lymph nodes. The patient continues to be followed at the Department of Pneumology, showing no signs of disease recurrence for eight months. CONCLUSION: The robotic biportal approach offers a reduction in chest wall traumatization while maintaining oncological radicality. Although this approach is safe and feasible, limitations in instrument movements necessitate specific training.

• Klíčová slova
• biportal robotic lung resection, case report, minimally invasive thoracic surgery, robotic pulmonary lobectomy, robotic-assisted thoracoscopic surgery,
• MeSH
• hrudní chirurgie video-asistovaná metody   MeSH
• lidé MeSH
• lokální recidiva nádoru chirurgie   MeSH
• nádory plic * chirurgie   MeSH
• plíce patologie   MeSH
• pneumektomie MeSH
• roboticky asistované výkony * metody   MeSH
• robotika * metody   MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Chronic obstructive pulmonary disease (COPD) is one of the three leading causes of death worldwide. If the feature of the disease is dominated by emphysema, we speak of an emphysematic phenotype. Interventional treatment is a standard part of the management of patients with the emphysematic phenotype of COPD. Interventional methods are surgical and endoscopic. An important point in the indication of these methods is the correct selection of profitable patients. In addition to the correct execution of the individual procedure, periprocedural management, anticipation, and optimal handling of complications in the field of severe functional disability have an important effect on the care results.

• Klíčová slova
• COPD, Emphysema, Lung transplantation, endoscopic volume reduction, lung volume reduction surgery, volume reduction,
• MeSH
• chronická obstrukční plicní nemoc * komplikace   chirurgie   MeSH
• emfyzém * komplikace   chirurgie   MeSH
• kvalita života MeSH
• lidé MeSH
• plicní emfyzém * chirurgie   etiologie   MeSH
• pneumektomie škodlivé účinky   metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVE: The aim of the study was to evaluate the effect of body mass index on patients' short-term results following lung lobectomy. METHODS: In this retrospective study, we compared the perioperative and short-term postoperative results of obese (BMI≥30 kg/m2) versus non-obese patients (BMI<30 kg/m2) who underwent anatomical lung resection for cancer. The two groups had the same distribution of input risk factors and the same ratio of surgical approaches (thoracoscopy vs. thoracotomy). RESULTS: The study included a total of 144 patients: 48 obese and 96 non-obese patients. Both groups had the same ratio of thoracoscopic vs. thoracotomy approach (50/50%), and were comparable in terms of demographics and clinical data. The g roups did not significantly differ in the frequency of perioperative or postoperative complications. Postoperative morbidity was higher among non-obese patients (34.4 vs. 27.1%), but this difference was not statistically significant (p=0.053). Hospital stay was similar in both study groups (p=0.100). Surgery time was significantly longer among obese patients (p=0.133). Postoperative mortality was comparable between the study groups (p=0.167). CONCLUSIONS: Obesity does not increase the frequency of perioperative and postoperative complications in patients after lung lobectomy. The slightly better results in obese patients suggest that obesity may have some protective role.

• MeSH
• délka pobytu MeSH
• lidé MeSH
• nádory plic * chirurgie   MeSH
• obezita etiologie   MeSH
• plíce MeSH
• pneumektomie * škodlivé účinky   metody   MeSH
• pooperační komplikace etiologie   MeSH
• retrospektivní studie MeSH
• torakotomie škodlivé účinky   metody   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH