Saulius Cicėnas

Lung cancer in patients with tuberculosis

BackgroundCoexistent lung cancer and pulmonary tuberculosis is an urgent problem of thoracic surgery presenting a challenging task for diagnosis and surgical treatment.Materials and methodsFrom 1990 to 2005, 2218 patients with lung cancer underwent surgical treatment in Department of Thoracic Surgery and Oncology, Institute of Oncology, Vilnius University. In 46 (2.1%) patients coexistence of lung cancer and tuberculosis was found. Central lung cancer was diagnosed in 37 (80.4%) and peripheral – in 9 (19.6%) patients. Epidermoid cancer was diagnosed in 24 (52.2%) patients, adenocarcinoma – in 10 (21.7%) and adenoepidermoid carcinoma – in 12 (26.1%) patients. Stage I cancer was diagnosed in 12 (26.1%), stage II – in 11 (23.9%), and stage IIIA – in 23 (50%) patients.ResultsPneumonectomy was performed in 18 (39.2%), lobectomy in 10 (21.7%), bilobectomy in 10 (21.7%), segmentectomy in 8 (17.4%) patients. Postoperative surgical complications were observed in 9 (19.5%) patients, non-surgical complications occurred in 19 patients (41.3%). Six patients (13.04%) died. Combined treatment was applied to 23 (50%) patients.ConclusionCoexistence of tuberculosis and lung cancer in thoracic surgery is fairly rare. This combination was diagnosed only in 46 cases (2.1%) out of 2218 operated lung cancer patients. Epidermoid carcinoma and stage IIIA disease was diagnosed in 50% of patients. Postoperative surgical complications occurred in 9 patients (19.5%) with lung cancer and tuberculosis. Six patients (13%) died in postoperative period. Surgery is the method of choice in treatment of combination of tuberculosis and lung cancer. Median survival of these patients was 28 ± 2 months.

Spontaneous pneumothorax as a first sign of pulmonary carcinoma

BackgroundSpontaneous pneumothorax (SP) is a rare manifestation of lung cancer. The mechanisms by which pneumothorax occurs in lung cancer is not clear, resulting in different views being expressed.Case presentationHere we present a case in which pneumothorax occurred as a first manifestation of lung cancer. The chest x-ray of a 68 year old man revealed a right partial pneumothorax. VATS was then performed: the visceral pleura lying over segment S3 was destroyed and air leaks were found in this section. Pathologic examination of the biopsy specimen revealed non-small cell carcinoma. Thoracoscopic talc pleurodesis was performed.ConclusionSpontaneous pneumothorax in association with lung cancer is rarely seen. Pneumothorax can be the first sign of lung cancer. The most common possibility for SP complicating lung cancer is the tumor necrosis mechanism or, in separate cases, rupture of the emphysematous bullae. Lung cancer should always be considered as a possible cause of SP in elderly patients or in heavy smokers.

Cell-free DNA in non-small cell lung cancer

Lung cancer is the leading cause of cancer-associated deaths worldwide. Surgery is the standard treatment for early-stage non-small cell lung cancer (NSCLC). Advances in the knowledge of the biology of non-small cell lung cancer have revealed molecular information used for systemic cancer therapy targeting metastatic disease, with an important impact on patients’ overall survival (OS) and quality of life. However, a biopsy of overt metastases is an invasive procedure limited to certain locations and not easily acceptable in the clinic. The analysis of peripheral blood samples of cancer patients represents a new source of cancer-derived material, known as liquid biopsy, and its components (circulating tumour cells (CTCS), circulating free DNA (cfDNA), exosomes, and tumour-educated platelets (TEP)) can be obtained from almost any body fluids. These components have shown to reflect characteristics of the status of both the primary and metastatic diseases, helping the clinicians to move towards a personalized medicine (1). This review focuses on the liquid biopsy component – circulating free DNA, its benefit for non-invasive screening, early diagnosis, prognosis, response to treatment, and real time monitoring of the disease in non-small cell lung cancer patients.

Ankstyvų stadijų nesmulkialąstelio plaučio vėžio chirurginio gydymo rezultatai

The increasing incidence of lung cancer in Lithuania and in the world remains relevant to improving the effectiveness of treatment. Lung cancer is often diagnosed at an older age. Non-small cell lung cancer accounts for about 85%, and small cell lung cancer 15% of all diagnosed lung cancers. About 25% of newly diagnosed non-small cell lung cancer cases are stage I and II, in other cases, however, local or distant spread of lung cancer is detected, when surgical treatment is not indicated. Early-stage non-small cell lung cancer treatment start is radical resection, if the patient’s condition allows. After the operation, an adjuvant platinum–based chemotherapy is combined with etoposide. We analyzed 82 IB–IIIA non-small cell stage lung cancer sufferers who underwent radical resection in combination with a subsequent adjuvant chemotherapy. 1–2 of years after surgery disease progression was noted in 22 patients (27%), while in the 60 (73%) we observed disease remission. These findings stress necessity of additional DNA testing to individualize the treatment itself and improve treatment outcome.

Endoskopinis gerybinio trachėjos naviko pašalinimas

Background Benign fibroepithelial polyps of respiratory tract are very rare. Case report A 42-year-old man was admitted to our hospital suffering from cough and dyspnea. The CT scan of the thorax revealed a round, smooth tumor in the middle part of the trachea. The tumor was successfully removed endoscopically using an electrocautery snare. The postoperative period was uneventful; patient‘s condition was perfect. Histology showed a fibroepithelial polyp – a rare benign lesion of the trachea. Conclusions Endobronchial electrosurgery is a safe and effective treatment method. Clinicians should always consider the possibility of tracheobronchial tumors.

Klajoklio nervo krūtininės dalies neurilemoma: klinikinis atvejis

Neurilemoma – periferinių nervų dangalų auglys. Jis auga lėtai ir pradžia dažniausiai būna besimptomė. Pasiekes kritinį dydį auglys, priklausomai nuo atsiradimo vietos, pasireiskia spaudimo į aplinkinius organus klinika. Neurilemomos dažniausiai atsiranda galūnėse 30–50 gyvenimo metais nepriklausomai nuo lyties. Klajoklio nervo neurilemoma yra nedažna patologija, o krūtininės klajoklio nervo dalies neurilemoma pasitaiko itin retai. Diagnozuojant svarbiausi yra radiologiniai tyrimo metodai. Gydymas – chirurginis auglio pasalinimas. Pateikiame krūtininės klajoklio nervo dalies neurilemomos, nustatytos 39 metų moteriai, klinikinį atvejį. Auglys aptiktas radiologiniais tyrimais (krūtinės rentgeno, kompiuterinės tomografijos ir tarpuplaucio magnetinio branduolių rezonanso), pasalintas naudojant vaizdo torakoskopine (VATS) metodiką. Diagnozė galutinai patvirtinta histologiniu tyrimu. Astuntą parą po operacijos ligonė israsyta į namus. Reiksminiai žodžiai: neurilemoma, klajoklis nervas, operacija Neurilemoma of intrathoracal vagal nerve: clinical case Renatas Askinis, Arnoldas Krasauskas, Sigitas Zaremba, Saulius Cicėnas Neurilemoma is a tumour of peripleurical nervous tissues. It grows slowly and has an asymptomatic manifestation. During tumour enlargement, depending on localisation, clinical symptoms appear because of the tumour pressure to the surrounding tissues. Mostly neurilemomas appear in extremities of patients aged 30–50 years. N. vagus neurilemoma is a very rare disease. The diagnosis is made using radiology. The treatment is surgical removal. We present a clinical case of intrathoracal n. vagus neurilemoma in a 39-year-old woman. The diagnosis was made using radiological findings (chest X-ray, chest CT, and the MRI of the mediastinum). The removal of the tumour was made by VATS. The diagnosis was proved morphologically. After 8 days, the patient was discharged from the hospital. Key words: neurilemoma, vagal nerve, operation

Prevencinis epidurinis skausmo malšinimas atliekant krūtinės operacijas

Renatas Tikuisis, Povilas Miliauskas, Saulius Cicėnas, Narimantas Evaldas Samalavicius Vilniaus universiteto Onkologijos institutas, Santariskių g. 1, LT-08660 Vilnius El pastas: renatas.tikuisis@vuoi.lt Įvadas / tikslas: Soninė torakotomija yra viena is skausmingiausių operacijų, o epidurinis skausmo malsinimas yra vienas is efektyviausių atliekant krūtinės operacijas. Sio darbo tikslas ir buvo nustatyti, ar prevencinis epidurinis skausmo malsinimas yra pranasesnis už epidurinį skausmo malsinimą operacijos pabaigoje. Ligoniai ir metodai: Į tyrimą buvo įtraukti 28 pacientai. Astuoniems pacientams buvo pasalintas desinysis plautis ir 20 pacientų – kairysis plautis. Atsitiktinės atrankos būdu pacientai suskirstyti į tiriamąją grupe (T grupe) ir kontroline grupe (K grupė). Abiejų grupių pacientams taikyta tiek bendroji nejautra, tiek epidurinis skausmo malsinimas. T grupės pacientams į epidurinį tarpą buvo leidžiami bupivakainas (0,25 %) ir morfinas dar neprasidėjus operacijai. Bupivakaino infuzija buvo tesiama operacijos metu. K grupės pacientams taikytas intraveninis skausmo malsinimas fentaniliu operacijos metu. Operacijos pabaigoje abiejų grupių pacientams į epidurinį tarpą buvo susvirksta 6 ml bupivakaino 0,125 %, o K grupės pacientams į epidurinį tarpą buvo susvirksta ir morfino. Rezultatai: T grupės pacientams prireikė mažiau sevoflurano operacijos metu, o skausmo intensyvumas buvo mažesnis pirmas 4 valandas po operacijos, palyginti su K grupės pacientais. Taip pat tiriamosios grupės pacientams reikėjo mažiau analgetikų po operacijos. Isvada: Prevencinis bupivakaino ir morfino svirkstimas į epidurinį tarpą yra pranasesnis už sių vaistų svirkstimą operacijos pabaigoje. Reiksminiai žodžiai: prevencinis skausmo malsinimas, epidurinis skausmo malsinimas, krūtinės chirurgija. Preemptive epidural analgesia for thoracic surgery Renatas Tikuisis, Povilas Miliauskas, Saulius Cicėnas, Narimantas Evaldas Samalavicius Vilnius University, Institute of Oncology, Santariskių str. 1, LT-08660 Vilnius, Lithuania E-mail: renatas.tikuisis@vuoi.lt Background / objective: Post-thoracotomy pain is one of the most severe types of pain. Epidural analgesia has emerged as the analgesic technique of choise for thoracotomy pain management. The purpose of this study was to determine whether preemptive epidural analgesia performed before thoracotomy and at the end of operation reduces postoperative pain. Patients and methods: 28 patients were included in this study. Right (n=8) and left (n=20) pneumectomy was performed for these patients. The patients were randomized to study (“T” gr.) and control (“K” gr.) groups. Both groups received combined general – epidural anaesthesia. Patients in the study group (T gr.) received 0.25 % bupivacaine and morphine via the epidural route prior to skin incision and continued, 0.25% bupivacaine infusion. The control group received intravenous fentanyl infusion during the operation. At the time of chest closure, all patients in both groups were dosed 6 ml – 0.125% bupivacaine via epidural route. The control group received also morphine via epidural catheter. Results: The patients in the main group required less sevoflurane intraoperatively and had lower pain scores in the first 4 hours postoperatively. They needed less analgesic infusion after operation. Conclusion: These results show that preemptive bupivacaine and morphine epidural injection is superior to the injection of these drugs at the end of operation. Key words: preemptive analgesia, epidural analgesia, thoracic surgery.

Occupational characteristics of respiratory cancer patients exposed to asbestos in Lithuania

Objective: To assess characteristics of asbestos exposure in respiratory cancer patients in Lithuania. Methods. Information on occupational exposure to asbestos was collected by personal interviews and occupational characteristics were evaluated among 183 lung cancer and mesothelioma patients with cumulative asbestos exposure ≥0.01 fibre years hospitalized at the Institute of Oncology, Vilnius. Additionally, some results of workplace air measurements were reviewed. Results. Cases with estimated cumulative exposure ≥5 fibre years had worked mainly in the construction industry (49%), installation and maintenance (13%), foundry and metal products manufacturing (6%), heating trades and boilerhouses (6%) as fitters/maintenance technicians, construction workers, welders, electricians or foremen. Typical asbestos materials used by the patients were asbestos powder, asbestos cement sheets and pipes, asbestos cord, brake and clutch linings. Patients were exposed to asbestos when insulating boilers, furnaces, pipes in power stations, industrial facilities, ships, locomotives, buildings, while covering and repairing roofs, at the asbestos cement plant or unloading asbestos products. Most patients with estimated cumulative exposure of ≥0.01-4.9 fibre years worked as lorry, bus or tractor drivers and motor vehicle mechanics. In 2002-2007 workplace air asbestos concentrations exceeded the limit value of 0.1 f/cm3 in 11 samples out of 208 measurements. Conclusion. The results of this study indicate that since the 1960s occupational exposure to chrysotile asbestos was extensive in Lithuania.

Vaizdo torakoskopijos reikšmė diagnozuojant ir gydant plaučių ir krūtinės ligas

Renatas Askinis, Vladislavas Vencevicius, Saulius Cicėnas Vilniaus universiteto Onkologijos instituto Krūtinės chirurgijos ir onkologijos skyrius, Santariskių g. 1, LT-08660 Vilnius El pastas: vaida.strolyte@loc.lt Tikslas Įvertinti vaizdo torakoskopinių (VATS) operacijų galimybes diagnozuojant ir gydant plaucių ir krūtinės ligas. Ligoniai ir metodai Vilniaus universiteto Onkologijos instituto Krūtinės chirurgijos ir onkologijos skyriuje 1997–2006 m. buvo atlikta 415 vaizdo torakoskopinių operacijų. Taciau mes siame straipsnyje nagrinėjame gydymo rezultatus 106 (25,5%) ligonių, kuriems buvo atlikta rezekcinė plaucių ir pleuros operacija. Pries operaciją ligoniams daryta krūtinės ląstos rentgenograma, istirta kvėpavimo sistemos funkcija, atlikti echoskopiniai tyrimai. Kai reikėdavo patikslinti klinikine patologiją, buvo atliekama fibrobronchoskopija ir kompiuterinė tomografija. Rezultatai Vilniaus universiteto Onkologijos instituto Krūtinės chirurgijos ir onkologijos skyriuje 1997–2006 m. buvo atliktos 106 vaizdo torakoskopinės rezekcinės operacijos. Is jų: lobektomija – 6 (5,6%), krastinė rezekcija dėl periferinio I stadijos nesmulkialąstelinio plaucių vėžio (NSLPV) – 13 (12,2%), plaucių metastazių salinimas – 33 (31,1%), hamartomos rezekcija – 22 (20,7%), perikardo cistos pasalinimas – 3 (2,8%), perikardo rezekcija – 7 (6,6%), intratorakalinės lipomos pasalinimas – 9 (8,4%), kalcifikatų pasalinimas – 4 (3,7%), simpatektomija dėl Reino ligos – 9 (8,4%) ligoniams. Atlikdami plaucių skilties ar krastines rezekcijas, naudojome endoskopinius staplerius ir siuvamuosius linijinius aparatus. Endoskopinės operacijos sutrumpino hospitalizacijos laiką iki 5 dienų. Pooperacinės komplikacijos pasireiskė 20 (18,8%) ligonių: pooperacinė pneumonija – 8 (40%) ligoniams, trumpalaikis pneumotoraksas – 2 (10%), pleuros empiema – 2 (10%), kraujavimas dėl plaucio atskyrimo nuo krūtinės ląstos sienos – 4 (20%), poodinė emfizema – 4 (20%). Visi ligoniai pasveiko gydomi konservatyviai. Isvados Vaizdo torakoskopinė chirurgija yra veiksmingas, saugus ir patikimas plaucių ir pleuros ligų gydymo metodas. Endoskopinė chirurgija kartais yra vienintelis galimas būdas pasalinti periferinius navikus, mažinti ligonių lovadienių skaicių bei greiciau pradėti sudėtinį gydymą. Vaizdo torakoskopinė chirurgija galima ligoniams, vyresniems kaip 70 metų bei sergantiems kvėpavimo ir sirdies nepakankamumo ligomis, kai tipinė torakotomija negalima. Pagrindiniai žodžiai: vaizdo torakoskopinė chirurgija, periferiniai plaucių navikai, krastinė ir kylinė plaucių audinio rezekcija Videothoracoscopy (VATS) in the diagnosis and treatment of lung and chest diseases Renatas Askinis, Vladislavas Vencevicius, Saulius Cicėnas Vilnius University Institute of Oncology, Department of Thoracic Surgery and Oncology, Santariskių str. 1, LT-08660 Vilnius, Lithuania E-mail: vaida.strolyte@loc.lt Objective To evaluate the efficacy of videothoracoscopic (VATS) operations in diagnosis and treatment of lung and chest diseases. Patients and methods In 1997–2006, 415 videothoracoscopies were performed at Department of Thoracic Surgery and Oncology, Institute of Oncology, Vilnius University. In this article, we analyse the possibilities of video-assisted thoracoscopic surgery used in 106 (25.5%) pts to whom lung and pleural resections were performed. Preoperative evaluation included chest radiography, respiratory function test and sonoscopical investigation. Flexible bronchoscopy and chest CT were performed when clinically indicated. Results In 1997–2006, at Institute of Oncology of Vilnius University, using video-assisted thoracoscopic surgery 106 resection of operations were performed: lobectomies – 6 (5.6%) pts, wedge resections lung tissue to I0NSCLC – 13 (12.2%) pts, removed lung metastases – 33 (31.1%) pts, removed hamartomas – 22 (20.7%) pts, pericardial cystectomies with electrocoagulation – 3 (2.8%) pts, resections of pericardium – 7 (6.6%) pts, resections of intrathoracal lipomectomies – 9 (8.4%) pts, calcificate – 4 (3.7%) pts, sympatectomies for patients with Raynaud‘s disease – 9 (8.4%) pts. Wedge and marginal endoscopic resections of the lung and lobectomy were performed using endoscopic staplers and endoscopic sewing equipment. Endoscopic operations shorten hospitalization and a quicker start of complex treatment. The mean period of our patients’ hospitalization was 5 days. After video-assisted thoracoscopic resection we had complications in 20 (18.8%) pts. All patients recovered. Conclusions Video-assisted thoracoscopic surgery (VATS) is aneffective and safe method of treatment for lung and pleural diseases. In some cases, VATS is the only way to remove tumors, and it shortens hospital stay to 5 days. VATS surgery is very effective in elderly patients with concomitant diseases. Keywords: video-assisted thoracoscopic surgery, peripherical lung tumors, wedge and marginal resection, lobectomy