Balázs Pécsy

The more the micropapillary pattern in stage I lung adenocarcinoma, the worse the prognosis—a retrospective study on digitalized slides

Although the majority of lung adenocarcinomas show mixed pattern, only the predominant component is taken into account according to the novel classification. We evaluated the proportion of different patterns and their impact on overall survival (OS) and disease-free survival (DFS). Patterns were recorded according to predominance and their proportions were rated and calculated by objective area measuring on digitalized, annotated slides of resected stage I lung adenocarcinomas. Spearman’s rank correlation, Kaplan-Meier models and the log rank test were used for statistical evaluation. Two hundred forty-three stage I adenocarcinoma were included. Lepidic pattern is more frequent in tumours without recurrence (20 vs. 8%), and lepidic predominant tumours have favourable prognosis (OS 90.5%, DFS 89.4%), but proportions above 25% are not associated with improving outcome. Solid and micropapillary patterns are more frequent in patients with recurrence (48 vs. 5% and 13 vs. 4%) and predominance of each one is associated with unfavourable prognosis (OS 64.1%, DFS 56.3% and OS 28.1%, DFS 28.1%, respectively). Above 25%, a growing proportion of solid or micropapillary pattern is not associated with worsening prognosis. In contrast, tumours having micropapillary pattern as secondly predominant form a different intermediate group (OS 51.1%, DFS 57.8%). Our study was based on measured area of each growth pattern on all available slides digitalized. This is the most precise way of determining the size of each component from the material available. We propose using predominant and secondly predominant patterns for prognostic purposes, particularly in tumours having solid or micropapillary patterns.

Tüdőlebeny-eltávolítást követő kemoterápia tolerabilitását befolyásoló perioperatív tényezők

INTRODUCTION Lung cancer is the leading cause of malignancy-related deaths in Hungary, involving complex surgical and oncological treatment. AIM Factors influencing the tolerability of complete/planned and incomplete postoperative chemotherapy after surgery were analyzed. METHOD During a 6-year period (January 1, 2011-December 31, 2016), data of 72 patients operated with lung cancer (adenocarcinoma and squamous cell carcinoma), receiving complete (4 cycles) and incomplete (<4 cycles) postoperative chemotherapy were analyzed. The following factors among the two groups [complete: n = 53; incomplete: n = 19] were analyzed: gender, mean age, body mass index, Malnutrition Universal Screening Tool, Charlson Comorbidity Index, second malignant tumor, atrial fibrillation, Forced Expiratory Volume 1 sec, Performance Status, open/Video-Assisted Thoracic Surgery (VATS) lobectomy, duration of surgery, postoperative fever, need for transfusion, prolonged air leak, redo surgery, histology, tumor stage. RESULTS The rate of complete postoperative cycles obtained from logistic regression analysis, were substantially higher after VATS lobectomies [n = 26 (83.87%)] compared to open procedures [n = 27 (65.85%)]; (p = 0.092; OR = 0.356), without significance. Multivariate analysis (open/VATS lobectomy, upper/middle-lower lobe resection, diabetes, prolonged air leak, postoperative fever) showed significantly increased successful uptake of complete cycles after VATS (p = 0.0495), while upper/middle lobe resections (p = 0.0678) and the lack of diabetes (p = 0.0971) notably increased the number of complete cycles, without significance. CONCLUSION Twenty-six percent of patients were unable to receive complete planned postoperative chemotherapy. VATS lobectomy patients received significantly higher number of complete cycles of postoperative chemotherapy. Diabetes and lower lobe lobectomies had a negative effect on the tolerability of postoperative chemotherapy. Orv Hetil. 2018; 159(19): 748-755.INTRODUCTION Lung cancer is the leading cause of malignancy-related deaths in Hungary, involving complex surgical and oncological treatment. AIM Factors influencing the tolerability of complete/planned and incomplete postoperative chemotherapy after surgery were analyzed. METHOD During a 6-year period (January 1, 2011-December 31, 2016), data of 72 patients operated with lung cancer (adenocarcinoma and squamous cell carcinoma), receiving complete (4 cycles) and incomplete (<4 cycles) postoperative chemotherapy were analyzed. The following factors among the two groups [complete: n = 53; incomplete: n = 19] were analyzed: gender, mean age, body mass index, Malnutrition Universal Screening Tool, Charlson Comorbidity Index, second malignant tumor, atrial fibrillation, Forced Expiratory Volume 1 sec, Performance Status, open/Video-Assisted Thoracic Surgery (VATS) lobectomy, duration of surgery, postoperative fever, need for transfusion, prolonged air leak, redo surgery, histology, tumor stage. RESULTS The rate of complete postoperative cycles obtained from logistic regression analysis, were substantially higher after VATS lobectomies [n = 26 (83.87%)] compared to open procedures [n = 27 (65.85%)]; (p = 0.092; OR = 0.356), without significance. Multivariate analysis (open/VATS lobectomy, upper/middle-lower lobe resection, diabetes, prolonged air leak, postoperative fever) showed significantly increased successful uptake of complete cycles after VATS (p = 0.0495), while upper/middle lobe resections (p = 0.0678) and the lack of diabetes (p = 0.0971) notably increased the number of complete cycles, without significance. CONCLUSION Twenty-six percent of patients were unable to receive complete planned postoperative chemotherapy. VATS lobectomy patients received significantly higher number of complete cycles of postoperative chemotherapy. Diabetes and lower lobe lobectomies had a negative effect on the tolerability of postoperative chemotherapy. Orv Hetil. 2018; 159(19): 748-755.

Minimálisan invazív tüdőlebeny-eltávolítás eredményei osztályunk ötéves anyagában

Absztrakt Bevezetes: Munkankban bemutatjuk az elmult ot evben osztalyunkon, minimalisan invaziv modszerrel (video-assisted thoracic surgery – VATS) elvegzett tudőlobectomiak sebeszi vonatkozasait es korai posztoperativ eredmenyeit. Betegek es modszerek: 2011. januar 1. es 2015. december 31. kozott harom mellkassebesz es egy rezidens 197 VATS-lobectomiat vegzett, 176 esetben malignus es 21 betegnel joindulatu folyamat miatt. A betegek demografiai adatai a kovetkezők: 119 nő es 78 ferfi; atlageletkor 62,4 (41–82) ev. 2011-ben harom VATS-lobectomia tortent, ami az osszlobectomiak 2,2%-a volt, 2012-ben het (7,3%), 2013-ban 13 (12%), 2014-ben 59 (34,5%) es 2015-ben 119 (68,5%). 153 esetben multiportal (78%) es 44 alkalommal uniportal (22%) elulső feltarast alkalmaztunk. Az eltavolitott lebenyek megoszlasa a kovetkező: jobb felső 85, kozepső ot, jobb also 28, bal felső 44, bal also 34, egy felső bilobectomia. Ket alkalommal sleeve lobectomia tortent. Nyolc betegnel (4%) kenyszerultunk thoracotomiara tortenő kon...

Myasthenia gravis miatt végzett három különböző típusú csecsemőmirigy-eltávolítás sebészeti és korai neurológiai eredményei

Absztrakt Celkitűzes: A myasthenia gravis (MG) kezeleseben szamos nyitott, illetve minimalisan invaziv thymectomia ismert. A tanulmany ugyanazon intezeten belul a transsternalis (TS), illetve ketfele minimalisan invaziv thymectomia (video-assisted thoracoscopic extended thymectomy – VATET; unilateral video-assisted thoracoscopic surgery – UL-VATS) eredmenyeit hasonlitja ossze. Anyag es modszerek: Harom kulonboző időintervallumban 71 betegnel tortent thymectomia MG miatt (60 nő, 11 ferfi): 23 transsternalis thymectomia (1995. januar–2004. szeptember), 22 VATET (2004. szeptember – 2009. augusztus) es 26 UL-VATS thymectomia (2009. szeptember – 2011. december). Az eredmenyek ertekelesenel a műteti idő, MG-hez tarsulo neurologiai es a műtet utani sebeszi szovődmenyek, valamint az MG statuszaban az egyeves utankoveteskor eszlelt neurologiai valtozasok szerepeltek. Eredmenyek: Perioperativ mortalitas nem fordult elő. A műteti idő 112, 211, 116 perc (p = 0,001), a korhazi napok szama: 8,9, 5,6 es 4 nap (p = 0,001...