Janusz Warmus

Optimal mediastinal staging in non-small cell lung cancer: What is the role of TEMLA and VAMLA?

OBJECTIVES The aim of this review is to present the current role of two techniques of extensive mediastinal dissection, in the staging of lung cancer. MATERIALS AND METHODS The authors performed a search for original papers published in English language, peer-reviewed journals. RESULTS According to the published evidence, definitions of VAMLA and TEMLA are given and the main elements of the operative technique are briefly presented. Extensiveness and completeness of mediastinal lymph node dissection using these techniques, their diagnostic yield as well as complications and use of hospital resources are discussed. The role of VAMLA and TEMLA in the contemporary staging of lung cancer is presented in context of other staging techniques and the current clinical practice guidelines. CONCLUSION On the basis of the evidence currently available, it may be concluded that VAMLA and TEMLA have no contemporarily use in the routine mediastinal staging of lung cancer. This is because of their invasiveness and - at least for TEMLA - high risk of complications and mortality, which renders it unacceptable as a diagnostic procedure, and also due to the development of equally accurate, but far less invasive techniques, i.e. EBUS-NA and EUS-NA.

Iatrogenic injuries to the trachea and main bronchi

Introduction Iatrogenic tracheobronchial injuries are rare. Aim To analyse the mechanism of injury, symptoms and treatment of these patients. Material and methods Retrospective analysis of hospital records of all patients treated for main airway injuries between 1990 and 2012 was performed. Results There were 24 patients, including 21 women and 3 men. Mean time between injury and initiation of treatment was 12 hours (range: 2-48). In 16 patients the injury occurred during tracheal intubation, in 1 during rigid bronchoscopy, in 1 during rigid oesophagoscopy, in 1 during mediastinoscopy and in 5 during open surgery. Mean length of airway tear was 3.8 cm (range: 1.5-8). In 1 patient there was an injury to the cervical trachea and in the remaining 23 in the thoracic part of the airway. The treatment included repair of the membranous part of the trachea performed via right thoracotomy in 10 patients (in 1 patient additionally coverage with a pedicled intercostal muscle flap was used), a self-expanding metallic stent in 1 patient, suture of the right main bronchus and the oesophagus in 1, left upper sleeve lobectomy in 1, right upper lobectomy in 1, implantation of a silicone Y stent in 3, mini-tracheostomy in 1, and conservative treatment in 5 patients. Conclusions Intubation is the most frequent cause of iatrogenic main airway injuries. Patients with these life-threatening complications require an individualised approach and treatment in a reference centre.

Giant oesophageal polyp prolapse

Janusz Wlodarczyk, Janusz Warmus, Wojciech Gocyk and Jaroslaw Kuzdzal* Department of Thoracic Surgery, Jagiellonian University Collegium Medicum, John Paul II Hospital, Krakow, Poland * Corresponding author. Department of Thoracic Surgery, Jagiellonian University Collegium Medicum, John Paul II Hospital, Ul. Prdnicka 80, 31-202 Krakow, Poland. Tel: +48-663430242; fax: +48-126143431; e-mail: j.kuzdzal@mp.pl ( J. Kuzdzal). Received 24 December 2012; received in revised form 10 January 2013; accepted 21 January 2013