Jan Simonek

Pneumonectomy for non-small cell lung cancer: predictors of early mortality and morbidity.

Abstract Background: The aim of this study was to determine independent risk factors affecting postoperative morbidity and mortality after pneumonectomy for non-small cell lung cancer (NSCLC). Methods: A review of 329 patients having pneumonectomy for NSCLC between January 1, 1998 and July 31, 2012 was undertaken. Factors affecting morbidity and mortality were analyzed by univariate and multivariate analyses. Results: The overall 30-day mortality rate was 5.1%. Smoking habits, chronic obstructive pulmonary disease (COPD) status, neoadjuvant therapy and obesity had no statistical influence on the short-term outcome. Coronary artery disease and respiratory failure were identified as risk factors for increased 30-day mortality (p < 0.01). Right pneumonectomy and presence of respiratory failure with mechanical ventilation increased the incidence of bronchopleural fistula (p < 0.01). Conclusions: Pneumonectomy for NSCLC carries an acceptable operative morbidity and mortality. Coronary artery disease, right pneumonectomy and respiratory failure adversely affect morbidity and mortality after this procedure.

Predictors of atelectasis after pulmonary lobectomy

PurposeTo define the incidence of and factors predisposing to postlobectomy atelectasis (PLA).MethodsThe subjects were 412 patients who underwent pulmonary lobectomy at our hospital between January 2004 and April 2007. This study was performed as a retrospective analysis of our prospective database. Postlobectomy atelectasis was defined as ipsilateral opacification of the involved lobe or segment with an ipsilateral shift of the mediastinum on chest radiograph, requiring bronchoscopy.ResultsPostlobectomy atelectasis developed in 27 patients (6.6%), accounting for 29% of all postoperative pulmonary complications. There were no significant differences between the PLA and no-PLA groups in age, sex, American Society of Anesthesiology performance status, cardiovascular comorbidity, or operation time. Chronic obstructive pulmonary disease (COPD) was the only preoperative variable predictive of PLA (P < 0.05). Right upper lobectomy (RUL), either alone or in combination with right middle lobectomy, was associated with a significantly higher incidence of PLA than any other type of resection (P < 0.05).ConclusionsPostlobectomy atelectasis is an important postoperative complication. Patients with COPD and those undergoing RUL are at higher risk of this complication. Although often isolated, PLA is associated with longer hospital stay.

Long-term outcomes and prognostic factors of patients with pulmonary carcinoid tumors.

The aim of the study was to evaluate type of surgery, long-term survival and factors influencing outcome of pulmonary carcinoid tumors. We reviewed our database of 137 patients surgically treated for typical or atypical carcinoid tumors at our department between 1998 and 2013. There were 95 (69%) patients with typical carcinoid (87 N0, 6 N1, 2 N2) and 42 (31%) with atypical carcinoid (26 N0, 8 N1, 8 N2). Patients with atypical carcinoid were older than those with typical carcinoid (median age of 57±8.1 and 50.5±15.8 years, respectively, p<0.00001). The resection performed consisted of 6 (4.4%) pneumonectomies, 110 (80.1%) lobectomies and bilobectomies, 15 (11%) sleeve lobectomies, 2 (1.5%) resections of main bronchus and 4 (3%) wedge resections. Overall 5- and 10-year survival rates for different tumors were as follows: typical carcinoid: 97.2% and 89.9%, respectively; atypical carcinoid 71.1% and 62.2%, respectively. Statistical analyses indicated that histology (typical carcinoid, p<0.00001), age (less than 45 years, p=0.004) and nodal status (N0, p=0.0002) were significant prognostic factors for better prognosis. Histological sub-type and nodal involvement appear as the most important factors influencing the prognosis. Systemic lymphadenectomy is recommended and should always be performed.

Case-Control Study: Smoking History Affects the Production of Tumor Antigen–Specific Antibodies NY-ESO-1 in Patients with Lung Cancer in Comparison with Cancer Disease–Free Group

Introduction: Lung cancer is the leading cause of cancer mortality worldwide; therefore, understanding the biological or clinical role of tumor‐associated antigens and autoantibodies is of eminent interest for designing antitumor immunotherapeutic strategies. Methods: Here we prospectively analyzed the serum frequencies of New York esophageal squamous cell carcinoma 1 (NY‐ESO‐1), human epidermal growth factor 2/neu, and melanoma‐associated antigen A4 (MAGE‐A4) antibodies and expression of the corresponding antigens in tumors of 121 patients with NSCLC undergoing an operation without prior neoadjuvant chemotherapy and compared them with those in 57 control age‐matched patients with no history of a malignant disease. Results: We found that only antibodies specific for NY‐ESO‐1 (19.8% [n = 24 of 121]) were significantly increased in the group of patients with NSCLC compared with in the controls. NY‐ESO‐1 seropositivity was significantly positively associated with an active smoking history in patients with NSCLC but not in smokers from the control group. In tumors, the frequency of NY‐ESO‐1 mRNA expression was 6.3% (in four of 64 patients), the frequency of human epidermal growth factor 2/neu (HER 2/neu) expression was 11.9% (five of 42), and the frequency of MAGE‐A4 expression was 35.1% (20 of 57). MAGE‐A4 expression in tumors correlated with smoking status and male sex in patients with NSCLC. Patients with squamous cell carcinoma displayed higher expression of NY‐ESO‐1 and MAGE‐A4 in tumors than did patients with adenocarcinoma. On the other hand, 94.7% of nonsmoking patients in our study had adenocarcinoma (of whom 73.7% were women). Conclusion: These results confirm the reported high immunogenicity of NY‐ESO‐1 and suggest that a smoking‐induced chronic inflammatory state might potentiate the development of NY‐ESO‐1–specific immune responses. Moreover, smoking might contribute to the expression of other cancer/testis antigens such as MAGE‐A4 at early stages of NSCLC development.

Comparison of postoperative complications of 60- and 70-year-old patients after lung surgery

This study investigated the association of age and postoperative complications in two different age groups undergoing thoracotomy and pulmonary resection. We retrospectively reviewed the medical records of all patients (n=150) older than 60 years who underwent pulmonary operations between January 2000 and December 2001. Group A consisted of 91 patients at the age of 60-69 years. In group B, there were 59 patients older than 70 years. We recorded preoperative assessment, clinical parameters, pre- and postoperative complications. The incidence of postoperative complications were compared between the two age groups using univariate and multivariate analysis. The incidence of postoperative complications in group A was 30% compared to 35.6% in group B. The most frequent complications were: cardiac arrhythmias 9.9% in group A vs. 15.2% in group B, and prolonged air leak 8.8% in group A vs. 8.5% in group B. Thirty days mortality was 0 vs. 1.2%. We concluded that there was no significantly higher incidence of postoperative complications in these two age groups.