Mariusz Bella

Pneumonectomy due to lung cancer results in a more pronounced activation of coagulation system than lobectomy.

UNLABELLED Surgical treatment of lung cancer is associated with an elevated risk of thrombo-embolic complications. The question is whether the extent of pulmonary resection influences the concentration of serum coagulation system proteins. OBJECTIVE This study aims to compare the blood coagulation activation parameters among patients undergoing pneumonectomy and lobectomy due to primary lung cancer. METHODS A prospective study was carried out in 40 patients. Of whom, 30 underwent lobectomy and 10 treated with pneumonectomy. Serum concentrations of tissue factor (TF), tissue factor pathway inhibitor (TFPI), tissue factor pathway inhibitor-activated factor X complex (TFPI/Xa), thrombin-antithrombin complex (TAT), L-selectin, E-selectin and P-selectin were measured on the first and seventh postoperative days. RESULTS On the first postoperative day, the results of selected proteins concentrations were similar in both groups. However, on the seventh postoperative day, significantly higher concentrations of TF, TAT complex and E-selectin were found in patients who underwent pneumonectomy (median values: TF: 182.4 pg ml(-1) vs 116.6 pg ml(-1), P=0.031; TAT: 6.2 mg ml(-1) vs 3.9 mg ml(-1), P=0.048; E-selectin 40.24 ng ml(-1) vs 26.54 ng ml(-1), P=0.049). CONCLUSIONS Pneumonectomy was associated with significantly higher activation of coagulation system on the seventh postoperative day than lobectomy. TAT complex, TF and E-selectin are promising markers of extensive postoperative activation of coagulation and efficacy of antithrombotic prophylaxis.

Carcinome mucoépidermoïde chez une femme de 20 ans

INTRODUCTION Muco-epidermoid carcinoma is a rare primary malignancy of the tracheo-bronchial tree. It presents mainly in young patients and is located in the proximal large airways. The tumour is composed of epithelial cells, mucus-secreting cells and cells of an intermediate type identical to those occurring in the salivary glands. There is no standard treatment for these tumours. The prognosis depends on the histological grade and may be poor, particularly in older subjects. CASE REPORT We report the case of a 20-year-old woman with a tumour in the intermediate bronchus. Mechanical resection of the tumour was performed with the tip of the rigid bronchoscope. Histological examination revealed muco-epidermoid carcinoma. We performed a right middle and lower sleeve lobectomy with mediastinal lymphadenectomy. The patient remains in remission after 12 months follow-up. CONCLUSIONS Muco-epidermoid carcinoma is a rare primary malignancy of the tracheobronchial tree which is difficult to diagnose by limited biopsy. The prognosis is variable and depends upon the histological type. Owing to its rare occurrence the possibility of a primary muco-epidermoid carcinoma of the salivary glands with pulmonary metastases should be considered.

Results of surgical treatment of primary lung cancer with synchronous brain metastases.

Introduction The surgical treatment of non-small cell lung cancer (NSCLC) with synchronous brain matastases is more effective than other therapeutic options, but this management is still controversial. The aim of the study The aim of the study was to evaluate the survival of patients after pulmonary resection NSCLC preceded by resection of brain metastases. Material and methods From 2007 to 2012, 645 patients underwent pulmonary resection for NSCLC at our department. In 25 of them (3.87%) thoracic surgery was preceded by resection of a single brain metastasis of NSCLC and a PET CT scan. No signs of nodal involvement or distant metastases were detected. Results The group consisted of 18 men (72%) and 7 women (28%). Average age was 57.62 years (46-70). In all cases, whole brain radiotherapy (5 × 4 Gy) was performed. The average interval between excision of brain metastasis and lung resection was 31.4 days (27-41). Pneumonectomy was performed in 1, lobectomy/bilobectomy in 17 and wedge resection in 7 cases. Pathological stage N0 was diagnosed in 17, N1 in 5 and N2 in 3 patients. Average survival was 18.68 months (4-74). Survival at 1, 2 and 5 years was 64%, 28% and 28% respectively. Average disease-free survival was 17.52 months. Histological type (p = 0.57) and G (p = 0.82) have no influence on survival. All the patients with hilar lymph node involvement died within 26 months and with mediastinal one within 12 months. Conclusions Surgical treatment of patients with NSCLC with synchronous brain metastases may prove beneficial in selected patients after excluding other distant metastases and lymph node involvement.