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

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

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

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

INTRODUCTION: The number of patients with necrotizing pneumonia has increased in recent years. The aim of this study is to review the incidence, management, and outcome of pediatric necrotizing pneumonia requiring surgical therapy and to prove that lung resection results in favorable development of patients. We hypothesize that overall lung function in children after lung resection does not differ from that of the healthy population. MATERIALS AND METHODS: A retrospective tertiary referral center study with a prospective follow-up spirometric study of patients with necrotizing pneumonia managed between January 2010 and December 2019 was performed. RESULTS: The study cohort consisted of 1,295 patients admitted to the pediatric department for community-acquired pneumonia; 47 patients developed necrotizing pneumonia, 36 of whom underwent parenchymal lung resection. A 5-year rise in the occurrence of necrotizing pneumonia requiring resection was 77%, with a significant increase in the last 3 years (p < 0.05). The median age at the time of surgery was 32.5 (interquartile range [IQR]: 32.25) months. Streptococcus pneumoniae was the most prevalent pathogen (83%), although 53.3% of these patients were vaccinated against the agent. In 67% of patients, preresection procedures were performed: drainage of pneumothorax (17%), drainage of empyema (46%), drainage of empyema with use of alteplase (25%), and thoracoscopic decortication (12%). Surgical procedures included lobectomy (72.2%), wedge resection (13.9%), bilobectomy (8.3%), and pneumonectomy (5.6%). The postoperative complication was bronchopleural fistula in three patients. There were two (5.5%) postoperative deaths due to multiple organ failure. The follow-up spirometry was performed 43.3 (median, IQR 23.8-66.7) months after surgical intervention. Normal lung function was detected in 35 (64.8%) patients, restrictive pattern in 6 (11.1%) patients, obstructive pattern in 11 (20.4%) patients, and combined in 2 (3.7%) patients. CONCLUSION: The number of patients with necrotizing pneumonia requiring resection has increased significantly in the last 3 years (p < 0.05). Aggressive surgical treatment results in significant clinical improvement in most cases and favorable lung function outcome. Long-term follow-up showed normal spirometry in 64.8% of cases.

• MeSH
• dítě MeSH
• empyém * chirurgie   MeSH
• lidé MeSH
• následné studie MeSH
• nekrotizující pneumonie * chirurgie   MeSH
• plíce chirurgie   MeSH
• pneumektomie škodlivé účinky   metody   MeSH
• počítačová rentgenová tomografie MeSH
• předškolní dítě MeSH
• prospektivní studie MeSH
• retrospektivní studie MeSH
• výsledek terapie MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• předškolní dítě MeSH
• Publikační typ
• časopisecké články MeSH

Surgical resection is a principal treatment modality in the early stages of non-small cell lung cancer. The risks of surgical procedures are decreasing due to advancements in surgical techniques. However, optimal treatment strategy in locally advanced stages is unclear. Neoadjuvant immunotherapy could be a future treatment alternative.

• Klíčová slova
• NSCLC stages, VATS, immunotherapy, immunother­apy, lung cancer,
• MeSH
• lidé MeSH
• nádory plic patologie   chirurgie   MeSH
• pneumektomie metody   normy   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Lung metastasis and metachronous double primary lung cancer are both common and often present diagnostic challenges. We present a case of metachronous isolated contralateral lung metastasis from pulmonary adenosquamous carcinoma with EGFR mutation. A 75-yearold woman presented with left lung nodule on a routine follow-up chest radiograph. She had had surgery for pulmonary adenocarcinoma with EGFR Ex21 L858R mutation 6 years ago. She underwent surgical resection, and histologic findings revealed adenosquamous carcinoma with the same EGFR mutation. Re-assessment of the resected specimen of the primary tumor resected 6 years ago revealed the morphologically similarity to the left lung tumor. Based on morphological and genetic identity, final diagnosis was adenosquamous cell carcinoma and metachronous isolated contralateral lung metastasis. The diagnosis of metachronous isolated metastasis is difficult but important for appropriate management and prediction of prognosis. A careful pathological examination and evaluation of genetic abnormality are needed to make the correct diagnosis.

• Klíčová slova
• EGFR mutation, lung adenosquamous carcinoma, recurrence,
• MeSH
• adenoskvamózní karcinom * genetika   patologie   chirurgie   MeSH
• diferenciální diagnóza MeSH
• erbB receptory genetika   MeSH
• lidé MeSH
• management péče o pacienta metody   MeSH
• metastázy nádorů * genetika   patologie   MeSH
• mutace MeSH
• nádory plic * genetika   patologie   chirurgie   MeSH
• pneumektomie metody   MeSH
• sekundární malignity * genetika   patologie   MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• Názvy látek
• EGFR protein, human MeSH Prohlížeč
• erbB receptory MeSH

OBJECTIVES: Our goal was to report the results of the first consensus paper among international experts in uniportal video-assisted thoracoscopic surgery (UniVATS) lobectomy obtained through a Delphi process, the objective of which was to define and standardize the main procedural steps, optimize its indications and perioperative management and identify elements to assist in future training. METHODS: The 40 members of the working group were convened and organized on a voluntary basis by the Uniportal VATS Interest Group (UVIG) of the European Society of Thoracic Surgeons (ESTS). An e-consensus finding exercise using the Delphi method was applied to require 75% agreement for reaching consensus on each question. Repeated iterations of anonymous voting continued for 3 rounds. RESULTS: Overall, 31 international experts from 18 countries completed all 3 rounds of questionnaires. Although a technical quorum was not achieved, most of the responders agreed that the maximum size of a UniVATS incision should be ≤4 cm. Agreement was reached on many points outlining the currently accepted definition of a UniVATS lobectomy, its indications and contraindications, perioperative clinical management and recommendations for training and future research directions. CONCLUSIONS: The UVIG Consensus Report stated that UniVATS offers a valid alternative to standard VATS techniques. Only longer follow-up and randomized controlled studies will predict whether UniVATS represents a valid alternative approach to multiport VATS for major lung resections or whether it should be performed only in selected cases and by selected centres. The next step for the ESTS UVIG is the establishment of a UniVATS section inside the ESTS databases.

• Klíčová slova
• Consensus, Delphi approach, Lung cancer, Single site incision, Uniportal video-assisted thoracoscopic surgery,
• MeSH
• delfská metoda MeSH
• hrudní chirurgie video-asistovaná metody   MeSH
• lidé MeSH
• pneumektomie metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• konsensus - konference MeSH
• Geografické názvy
• Evropa MeSH