Bajoriūnas, Vytis

Lung cancer is among the most prevalent and severe forms of cancer. According to WHO, in 2022 estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer show as lung cancer remains the leading cause of cancer death, with an estimated 1.6 million deaths. Radical lobectomy remains the cornerstone surgical intervention for patients with lung cancer, offering a potential cure. However, the procedure carries a risk of significant post-operative complications, which may be influenced by patients' pre-existing comorbidities. This literature review aims to investigate and evaluate the incidence and types of complications following radical lobectomy in lung cancer patients, with a particular focus on the relationship between these complications and existing comorbid conditions. By analysing and synthesizing current research, the thesis explores how factors such as cardiovascular disease, chronic obstructive pulmonary disease, and diabetes may affect post- operative outcomes. Understanding these associations is critical for developing risk stratification strategies, informing preoperative planning, and optimizing post-operative care to enhance patient outcomes.

SUMMARY

Autor: Manohar Reddy Venna. Research title: Impact of Residual Tumor on Non-Small Cell Lung Cancer Patient Survival after Radical Lobectomy: A Retrospective Analysis. Aim: To investigate the impact of residual tumour on Non-Small Cell Lung Cancer patient survival after radical lobectomy. Objectives:

1. To identify the proportion of patients with R1 and R2 residual tumours in all patients who underwent radical surgery for Non-Small Cell Lung Cancer at Lithuanian University of Health Sciences Hospital Kauno Klinikos.
2. To compare the Disease-free survival and Overall survival of patients with R0, R1 and R2 residual tumours.
3. To determine the impact of the pathological cancer stage on patient survival with R0, R1 and R2 residual tumours.
4. To evaluate the correlation between preoperative blood tests and patient survival with R0, R1 and R2 residual tumours. Methodology: This retrospective cohort study investigated clinical characteristics, survival outcomes, and the association between preoperative blood markers and survival in patients with NSCLC who underwent radical surgery at a single centre between 2018 and 2022. Patients who received curative-intent lobectomy with lymph node dissection were included, with propensity score matching employed to balance potential confounders between R0 and R1-2 resection margin groups. Data on demographics, pathological stage, surgical margin status, survival data, and preoperative blood test results were collected from electronic medical records. Descriptive statistics summarized these variables, with survival analysis utilizing Kaplan-Meier curves and a Log-rank test for significance. Additionally, Kendall's τ-b coefficient assessed the correlation between preoperative blood test results and survival outcomes. Results: The study analyzed 60 patients undergoing radical lobectomy for non-small cell lung cancer, with most being male and around 63 years old. Squamous cell carcinoma was more common than non-squamous, and the majority had stage 3 disease. Patients with residual tumours (R1-2) experienced higher rates of disease recurrence (55%) compared to those without residual tumours (R0). Median disease-free survival was shorter in R1-2 (19.9 months) than in R0 (28 months), and more R1-2 patients died during follow-up (43.3% vs. 37.2%). Lower disease stage led to longer survival in the R0 group, but not in R1-2 group. Additionally, preoperative inflammation markers like C-reactive protein and white blood cell count were associated with survival outcomes, with higher levels predicting poorer prognosis in R0 patients. Meanwhile, lymphocyte counts were found to be positively correlated with survival in R1-2 group. These findings highlight the importance of disease staging and inflammation levels in predicting outcomes for non-small cell lung cancer patients undergoing surgery. Conclusions: The comprehensive analysis of radical surgery for Non-small cell lung Cancer (NSCLC) at Lithuanian University of Health Sciences Hospital Kauno Klinikos from 2018 to 2022 offers valuable insights into various facets of NSCLC management. The study underscores the significance of early diagnosis and complete tumor resection in enhancing patient outcomes. Furthermore, correlations between preoperative blood tests and survival outcomes highlight the role of systemic inflammation and immune response in NSCLC progression. These findings advocate for personalized treatment approaches tailored to individual patient profiles to optimize therapeutic outcomes. Overall, this study contributes to the evolving understanding of NSCLC management and sets the stage for further research aimed at refining treatment strategies and improving patient care.

Darbo tikslas: Palyginti krūtines sienos vientisumo atstatymo ir pleuros liekamosios ertmės užpildymo didžiąja taukine galimybes, mobilizavus ją pilvaplevės ertmėje laparoskopijos būdu ir mobilizavus taukinę atlikus laparotomiją.

Darbo uždaviniai: 1. Palyginti operacijos būdus, taikytus pacientams, kuriems dėl suformuotos pleurostomos buvo atlikta pleuros ertmės plastika taukine: plastika atliekant didžiosios taukinės mobilizaciją laparoskopijos būdu ir mobilizuojant didžiąją taukinę laparotomijos būdu (operacijos trukmė, kraujo netekimas operacijos metu). 2. Palyginti pooperacinę eigą (komplikacijos, pleuros ertmės drenavimo laikas, antibiotikoterapijos poreikis). 3. Palyginti pooperacinių dienų skaičių.

Darbo metodika: Retrospektyviai analizuotos pacientų ligos istorijos, kuriems LSMUL KK krūtinės chirurgijos skyriuje liekamoji pleuros ertmė buvo plastikuota didžiąja taukine. Vertinti 2008-2016 m. LSMUL KK Krūtinės chirurgijos skyriuje operuotų pacientų ligos istorijų duomenys. Atskyrus grupes pagal atliktos operacijos tipą, buvo palyginti duomenys ir įvertinti naudojant SPSS (Statistical Package for the Social Science) 20.0 versiją.

Darbo rezultatai: 2008-2016 buvo atlikta 21 operacija. 14 - laparaskopijos būdu (pirmoji grupė) ir 7 - laparotomijos būdu (antroji grupė). Operuojant laparoskopijos būdu netekto kraujo kiekis buvo 43±16,8 ml, o laparatomijos grupėje – 121,6±20,2. Operacijos laikas mobilizuojant taukinę laparoskopiniu būdu buvo vidutiniškai 240,9±40,0 minučių, tuo tarpu laparatomijos metu 316,1±58,9 minučių. Pirmoje, laparoskopijos, grupėje vidutinis lovadienių skaičius po operacijos buvo 11,57±2,0 dienų, o antroje grupėje vidurkis siekė 20,86±4,4 dienų.

Išvados: Pleuros ertmės plastikos būdas, kai didžioji taukinė mobilizuojama laparoskopijos būdu yra saugus pacientui, nes yra trumpesnė pooperacinė lovadienių trukmė. Minimaliai invaziniai gydymo būdai gali praplėsti indikacijas naudoti didžiają taukinę plastikai.