BACKGROUND: Surgical treatment of early-stage non-small cell lung cancer (NSCLC) yields highest expectations for recovery. However, the frequency of further disease progression remains high since micro-metastatic disease may be undetected by conventional diagnostic methods. We test the presence and prognostic impact of circulating tumor cells (CTCs) in peripheral blood (PB), tumor-draining pulmonary blood (TDB) and bone marrow (BM) samples from NSCLC patients. METHODS: The presence of circulating/disseminated tumor cells (CTCs/DTCs) was detected by quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) analysis in PB, TDB and BM samples before surgery in 119 stage IA-IIIA NSCLC patients (Clinical Trial NS10285). RESULTS: NSCLC patients with the presence of carcinoembryonic antigen (CEA) mRNA-positive CTCs/DTCs in TDB and BM had significantly shorter cancer-specific survival (CSS) (P<0.013, resp. P<0.038). Patients with the presence of epithelial cellular adhesion molecule (EpCAM) mRNA-positive CTCs in TDB samples had significantly shorter CSS and disease-free survival (DFS) (P<0.031, resp. P<0.045). A multivariate analysis identified the presence of CEA mRNA-positive CTCs in the PB as an independent negative prognostic factor for DFS (P<0.005). No significant correlation of CTCs/DTCs presence and other prognostic factors was found. CONCLUSIONS: In NSCLC patients undergoing radical surgery, the presence of CEA and EpCAM mRNA-positive CTCs/DTCs is associated with poorer survival.
- Publikační typ
- časopisecké články MeSH
- Publikační typ
- abstrakt z konference MeSH
A single-center retrospective study the complication and mortality of surgical treatment of esophageal cancer 2006 to 2015 is presented. A total of 212 patients with esophageal cancer were operated at the First Department of Surgery University Hospital Olomouc, Czech Republic in the period between 2006 and 2015. Adenocarcinoma was histologically described in 127 patients (59.9%), squamous cell carcinoma in 82 patients (38.7%), and other types of carcinoma were described in 3 cases. According to the preoperative staging of esophageal cancer, the patients with early stage disease (T1-2N0M0) had primary surgery, while the patients with advanced stage (T3-4N0-2M0) were indicated for neoadjuvant chemoradiation with the surgery being performed subsequently. Transhiatal laparoscopic esophagectomy was performed in 183 patients, and Orringer esophagectomy in 4 patients. Thoracoscopic esophagectomy was performed in 17 patients and thoracotomy in 30 patients. Respiratory failure with the development of ARDS syndrome accompanied by multiple-organ failure occurred in 21 patients. Statistically significant association between mortality and ASA (p = 0.009) and between respiratory complications and ASA (p = 0.006) was demonstrated. The majority of patients who died were under 60 years of age (p = 0.039). Further, significant association between 30-day mortality and tumor stage (p = 0.021), gender (p = 0.022) and age (p = 0.018) was evident. A significant association between tumor stage and fistula in anastomosis, (p = 0.043) was observed. Esophagectomy is a procedure, which should be performed in specialized high-volume centers experienced in treatment of this serious malignancy and by certified oncology surgeons with long time experience in esophageal surgery.
- MeSH
- adenokarcinom chirurgie mortalita MeSH
- ezofagektomie metody škodlivé účinky MeSH
- gastroplastika MeSH
- lidé středního věku MeSH
- lidé MeSH
- miniinvazivní chirurgické výkony MeSH
- nádory jícnu * diagnóza chirurgie mortalita radioterapie MeSH
- neoadjuvantní terapie MeSH
- peroperační komplikace MeSH
- retrospektivní studie MeSH
- spinocelulární karcinom chirurgie mortalita MeSH
- staging nádorů MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
Úvod: Kombinované srdeční operace s resekčními výkony na plicích jsou stále kontroverzním tématem. Tento přístup umožňuje léčbu dvou různých onemocnění v rámci jedné intervence, celkově kratší dobu hospitalizace, menší zátěž pro nemocného a nižší náklady spolu s uspokojivými výsledky. Diskutovanou otázkou zůstává nejasný vliv mimotělního oběhu na rozsev malignity, dostatečnost rozsahu plicní resekce z nestandardního chirurgického přístupu a větší riziko pooperačního krvácení. Metody: Od listopadu 2010 do dubna 2014 podstoupilo na naší klinice celkem deset nemocných (devět mužů, jedna žena) kombinovaný kardiochirurgický výkon spolu s resekcí plic (průměrný věk 69 ± 7 let). Patologický nález na plicích byl následující (čtyři primární karcinomy, čtyři benigní léze, jedna metastáza, jeden karcinoid). Pravá plíce byla operována v pěti případech, levá plíce také v pěti případech (pětkrát lobektomie, jednou extraanatomická resekce, třikrát enukleace). V jednom případě, v souvislosti s rozsahem malignity, byla provedena pouze explorace, pneumonektomie poté v druhé době z thorakotomie. Kardiochirurgické výkony byly následující: pětkrát aortokoronární bypass, třikrát náhrada aortální chlopně, jednou náhrada mitrální chlopně, jednou náhrada vzestupné aorty, třikrát ablace MAZE. Sternotomie byla metodou přístupu v osmi případech, ve dvou byla použita levostranná thorakotomie a revaskularizace myokardu byla provedena metodou MIDCAB (minimally invasive direct coronary artery bypass). Revaskularizace bez mimotělního oběhu byla použita čtyřikrát. Výsledky: V souboru byla zaznamenána nulová hospitalizační mortalita. Žádný z nemocných nebyl revidován pro pooperační krvácení, všechny kardiochirurgické výkony byly bez komplikací. V jednom případě byl léčen protrahovaný „air-leak“. Všichni nemocní s benigním nálezem (čtyři) jsou naživu. Nemocný s rozsáhlou malignitou, operovaný dvoufázově, zemřel v terminální fázi onemocnění. Další nemocný s malignitou zemřel z důvodů nevztahujících se k operaci rok po výkonu. Ostatní jsou pravidelně sledováni v pneumo-onkologické ambulanci. Závěr: Kombinované srdeční operace s resekčními výkony na plicích mohou být prováděny bez zvýšené mortality a morbidity. Tento přístup eliminuje nutnost druhé intervence a má uspokojivé výsledky.
Introduction: Combined heart surgery and lung resection remain a controversial issue. This method facilitates the treatment of two major problems with one intervention, reducing hospitalization cost with acceptable outcomes. On the other hand, skepticism exists related to the effects of cardiopulmonary bypass on malignancy, proper extent of lung resection from non-standard approach and to a possible greater risk of perioperative bleeding. Methods: Between November 2010 and April 2014 ten patients (male 9, female 1) underwent simultaneous cardiac surgery and pulmonary resection (mean age 69 ± 7 years). Pathological findings were as follows: primary carcinoma 4, benign lesion 4, metastasis 1, and carcinoid 1. Surgery at right lung was done in five cases and on left lung in five cases (lobectomy 5, extraanatomical resection 1, enucleation 3). In one case, because of the extent of malignant process, exploration only was done via sternotomy and pneumonectomy was performed later through thoracotomy. Cardiac procedures were as follows: coronary artery bypass grafting 5, aortic valve replacement 3, mitral valve replacement 1, ascending aorta replacement 1, and MAZE procedure 3. Sternotomy was performed in eight patients; in two of them left lateral thoracotomy was used and coronary artery revascularization was performed with MIDCAB principle. Off-pump surgery was used four times. Results: There was no hospital mortality. There was no reexploration because of bleeding. Cardiac part of procedures was in all cases without complications. Prolonged air-leak was found in one case. All patients with benign pathology are alive. In the malignant group, one patient with staged approach died in terminal phase of disease and the second patient deceased because of disease-non-related reasons one year after surgery. The rest of them are followed up regularly by pneumo-oncology outpatient department. Conclusion: Combined heart surgery and lung resection can be performed without increased mortality and/or morbidity. The synchronous treatment avoids the necessity of a second intervention with good results and economic benefits.
- MeSH
- chirurgie plic metody MeSH
- hrudní chirurgické výkony * metody MeSH
- kardiovaskulární chirurgické výkony metody MeSH
- komorbidita MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory plic chirurgie MeSH
- nemoci srdce chirurgie MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
INTRODUCTION: The indication for minimally invasive esophagectomy (MIE) in esophageal cancer has an increasing tendency. AIM: To present our cohort of patients operated on between 2006 and 2012. MATERIAL AND METHODS: A single centre study of 106 consecutive esophagectomies performed for esophageal cancer by a minimally invasive approach in 79 patients was performed. Transhiatal laparoscopic esophagectomy (THLE) was performed in 66 patients, transthoracic esophagectomy (TTE) in 13 patients, with histological findings of squamous cell carcinoma in 28 and adenocarcinoma in 51 patients. RESULTS: The MIE was completed in 76 (96.2%) patients. In cases of TTE, the operation was converted to an open procedure in 3 cases. Operation time ranged from 225 to 370 min (average 256 min). The number of lymph nodes removed was 7-16 (11 on average). The postoperative course was without any complications in 54 (68.3%) patients. Respiratory complications were observed in 14 (17.7%) patients (9 following THLE, 5 following TTE). Other serious complications included acute myocardial infarction (1 patient) and necrosis of the gastroplasty (1 patient). Anastomotic dehiscence was observed in 8 patients, left recurrent laryngeal nerve paralysis in 8 patients, intra-abdominal abscesses in 2 patients, and pleural empyema in 1 case. The overall morbidity of patients operated on by MIE was 31.6%. Thirty-day mortality was 10.1%. CONCLUSIONS: The MIE belongs to the therapeutic portfolio of surgical procedures performed for esophageal cancer. Successful performance requires erudition of the surgical team in both minimally invasive procedures as well as in classical surgical treatment of esophageal cancer; therefore centralization of patients is imperative.
- Publikační typ
- časopisecké články MeSH
