Istvan Benko

Complications after ultrasonic lung parenchyma biopsy: a strong note for caution

BackgroundThis study aimed to determine the possible cause for an unacceptable frequency of postresectional pneumothorax in cases of ultrasonic scalpel use without a further reinforcing maneuver in lung biopsy during video-assisted thoracic surgery (VATS).MethodsData for a series of 16 consecutive VATS lung biopsy patients (group A) in which a disturbingly high number of minor and medium complications occurred were compared with data for a group of 20 patients previously subject to the same ultrasonic lung biopsy method (group B) without complication.ResultsThe two groups were identical in terms of all significant factors considered in relation to ultrasonic scalpel biopsy. Six notable air leakage complications occurred among the 16 patients of group A. One patient needed redrainage while still in the hospital. Two other patients required readmission and redrainage. In 4 of the 16 cases, late pneumothorax was detected after a “silent” 48-h postoperative period prolonging their hospital stay. Altogether, three medium complications occurred in group A, as compared with none in group B. The drainage duration in group B was not significantly shorter than in group A . Multivariate analysis showed a significant difference in complications favoring group B (odds ratio, 1.88).ConclusionsA high postoperative air leakage rate was observed in a simple case series using an unsecured harmonic scalpel after a randomized trial of the same method in the same institute with a diametrically opposite outcome. The medium complication rate of 3 in 16 cases is unacceptable for a minor procedure such as lung biopsy. The two groups differed only in their thromboembolic prophylaxis protocol. Therefore, it is hypothesized that the recent introduction of low-molecular-weight heparin from day 1 may influence the complication rate. The authors’ observation calls for caution in use of the harmonic scalpel on lung tissue without reinforcing maneuvers (i.e., stitches or clips). To avoid unnecessary complications, operative technique adjustment is recommended.

The use of a smartphone application for fast lung cancer risk assessment

OBJECTIVES The overall prognosis of lung cancer is poor: Only every 8 patient survives 5 years after diagnosis. This outcome is partly attributable to late diagnosis. To implement a screening program for early diagnosis, selection of high-risk individuals is essential. Our aim was to construct a personalized lung cancer risk assessment tool using geographic localization to lead the high-risk individuals to the local health care provider. METHODS A smartphone application was created for Android and iOS mobile platforms using a risk assessment questionnaire. The software provides immediate classification into low, moderate and high-risk groups. The high-risk group is directed to the nearest screening centre based on GPS location. The complete test data set is recorded on a collection server database for further analysis. RESULTS The application was downloaded 13 890 times and completed by 89 500 persons over a period of 20 months. The mean age of the tested users was 36.91 years (9-93 years); the majority were men living in an urban area (62.3%). The test was completed by 38 850 active smokers and 26 710 persons who reported having already quit smoking, resulting in 30 072 moderate and 10 740 high-risk users. CONCLUSIONS This free application is an active communication tool for most smartphone owners. It helps those who might need further medical attention. The affected users can be easily connected and localized via the smartphone, which helps recruit individuals into screening programs.

Role of surgery for lung cancer in elderly patients

Lung cancer is a leading cause of death in the civilised world. Surgical resection, which play a crucial role in the complex oncological treatment, has to be offered in older ages than it was done before, due to an ageing population. Results of surgical treatment of patients older than 75 years are investigated retrospectively in the present paper. A retrospectively analysis was carried out of 54 from a total of 884 lung resections for primary lung cancer performed for patients older than 75 years between 1995-2005. Twelve of these patients were above 80 years. Kaplan-Meier analysis was performed to calculate survival and multifactor analysis for the risk factors. Average age was 77.5 years (75-85). Two pneumonectomies, two bilobectomies, 41 lobectomies, seven sublobar resections and two lobectomies with chest wall resections were performed. The average hospital stay was 11.4 days (8-36). Mortality: 7.4% (n = 4), morbidity: 52% (n = 28) including: sputum retention: 43%, arrhythmia 33%, atelectasia: 15%. There were two bronchial stump insufficiencies (4%) and three reoperations were performed (5%). The average follow up was: 32 months and the five year survival 33.7% (median 43 months). Multifactorial analysis show that extended resection, male gender, age above 80 years are risk factors for adverse outcome. Female gender, stage Ia and lobectomy are considered as predictive factors for long survival. We conclude, that with proper patient selection (below ASA3, early stage) and with carefully conducted postoperative care (physiotherapy, monitoring) surgical resection should be offered to elderly lung cancer patients as well.