Documente Academic
Documente Profesional
Documente Cultură
Comitet de organizare:
Dr. Ciprian Bolca
Dr. Cezar Mota
Dr. Radu Matache
Dr. Radu Brnzea
Dr. Mihai Dumitrescu
Dr. Andrei Bobocea
Dr. Olga Dnil
Dr. Adrian Istrate
Dr. Adrian Iordache
Comitet tiinific
Prof. Dr. Adrian Aldea
Prof. Dr. Alexandru Boianu
Prof. Dr. Ioan Cordo
Prof. Dr. Teodor Horvat
Prof. Dr. Alexandru Nicodin
Prof. Dr. Zeno Popovici
Dr. Cristina Grigorescu
Dr. Dan Nicolau
Dr. Claudiu Nistor
Dr. Cristian Paleru
Nu ne lsm prad...
Nu ne lsm prad unei stri sociale fr precedent i ncercm s dm un bun exemplu,
exemplul unor oameni de bun credin a cror scop declarat sau nu (nu trmbiat!) este acela
de a-i pune viaa n slujba vindecrii sau alinrii suferinei semenilor lor.
Nu ne lsm prad neajunsurilor de tot felul i purcedem la organizarea Celei de-a 9
Conferine Naionale de Chirurgie Toracic cu participare internaional, la jumtatea lunii
octombrie a acestui an ntr-un splendid peisaj montan, n vremea n care lumina molatec a
toamnei va aurii crestele Bucegilor i ale Pietrei Craiului. ntlnirea cu bucurie a
participanilor va avea loc n dup amiaza zilei de joi, 13 octombrie, iar desprirea, cu regret,
la mijlocul zilei de smbt 15 octombrie. Dar ca s nu v supunem la grea ncercare
rbdarea, va anunm locul Conferinei ca fiind noul hotel montan de la Cheile Grditei, la
circa patru sute de metri mai sus de acela n care s-a desfurat Cea de-a 7-a Conferin din
2009.
Fr ndoial alturi de noi vor fi i prieteni apropiai din lumea chirurgiei toracice mondiale
care ne vor mprti din experiena lor. Tema conferinei se va axa mai mult pe tehnici
chirurgicale novatoare sau mai puin uzuale precum i pe promovarea Ghidului de diagnostic
i tratament al cancerului bronho-pulmonar. Sigur spiritul nostru tiinific va fi mult mai bogat
n urma acestor conferine i lucrri i ca de obicei vom aprecia cum se cuvine i programul
social.
Nu ne lsm prad uneltirilor acelora care ncearc s vre dihonia n nu foarte numeroasa
noastr societate i invitm la Conferina noastr pe toi truditorii cu suflet curat, pe toi aceia
care lupt necondiionat pentru bine pacientului: chirurgi toracici, anesteziti, pneumologi,
bronhologi, exploraioniti de toate felurile, anatomo-patologi, toi care ar putea s ne aduc o
ct de mic noutate n activitatea noastr fr preget. Invitm n mod special colegii
pneumologi care, dup spusele profesorului G. Massard, au o mare responsabilitate n
alegerea chirurgului care s le opereze pacientul.
Dorim o ct mai mare participare a membrilor Societii nostre deoarece este an de alegeri, an
n care, n mod cu totul democratic i deschis, vechea conducere va face un bilan al celor doi
ani trecui prednd tafeta noii conduceri pentru a consolida ceea ce s-a realizat, ceas de bilan
i...critici. Firete, n spirit colegial.
Nu ne lsm prad altor preocupri tentante i ne notm n calendar perioada 13-15 octombrie
cnd v ateptm cu nerbdare la Cheile Grditei pentru o ntlnire ntre nvingtori...
Preedintele Societii Romne de Chirurgie Toracic (care-i asum ntreaga rspundere
pentru cele scrise mai sus):
Prof. Dr. Ioan Cordo
16.20 16.30
The importance of histopathological factors in setting the long term prognosis for non-small
cell lung cancer
Suciu B.1, Bud V.1, Copotoiu C.1, Brnzaniuc Klara2, Copotoiu Ruxandra3, Fodor D.1,
Butiurca V.4
Surgical Clinic no. 1, Mure County Emergency Hospital
Anatomy Department, University of Medicine and Pharmacy, Tg.Mure
ICU Clinic, Mure County Emergency Hospital
Student, University of Medicine and Pharmacy, Tg.Mure
16.30 16.40
Cervical video-assisted mediastinoscopic approach of the left main bronchus - a series of six
cases
Cristian Paleru, Olga Danaila, Ciprian Bolca, Radu Matache, Mihai Dumitrescu, Adrian
Istrate, Ruxandra Ulmeanu, Ioan Cordos
Marius Nasta National Institute of Pneumology, Bucharest, Romania
1 - Thoracic Surgery Department
2 - Bronchoscopy Department
16.40 16.50
Extra-musculo-periosteal plombage thoracoplasty with balls still working after 46 years
Boianu Petre Vlah-Horea, Boianu Alexandru-Mihail
Discipline Surgery 4, University of Medicine and Pharmacy from Targu-Mures
16.50 17.00
Thoracic parietal hemangioma
Cezar Mota, Ovidiu Rus, David Achim, Teodor Horvat
Thoracic Surgery Clinic, Alexandru.Trestioreanu National Institute of Oncology, Bucharest
17.00 17.10
Unusual case of leyomiofibromatosis with multiple locations the truth beyond the
appearances case report
Adrian Istrate, Cristian Paleru, Mihai Dumitrescu, Ioan Cordos
1st Clinical Department of Thoracic Surgery, Marius Nasta National Institute of
Pneumology, Bucharest
17.10 17.20
Videothoracoscopic thimectomy in nonthymomatous patients with myasthenia gravis
Cristina Grigorescu*, Trufa Denis*, Iosep Gabriel**
*Clinic of Thoracic Surgery. University of Medicine Gr.T.Popa Iasi
** ICU , Hospital of Pneumology Iasi
17.20 17.30
Hydatid cyst of anterior mediastinum
Cezar Mota, Natalia Mota, Mihnea Davidescu, Elena Moise, Ovidiu Rus, Daniel Banciu,
David Achim, Teodor Horvat
Thoracic Surgery Clinic, Alexandru.Trestioreanu National Institute of Oncology, Bucharest
12.00 12.10
Classical technique versus nuss in the treatment of failed surgery for pectus excavatum
G.V.Cozma, I.A.Petrache, O.N.Burlacu, A.C.Nicodin
Thoracic Surgery Department, Municipal Hospital, Timisoara
12.10 12.20
Our experience in the anterior surgical approach of c7-t1 spine
*Adrian Ciuche, *Claudiu Nistor, *Marian Mitrica, **Teodor Horvat
*Emergency University Military Central Hospital Dr. Carol Davila, Bucharest
** Institute of Oncology "Prof. Dr. Alexandru Trestioreanu, Bucharest
12.20 12.30
Postesophagectomy benign gastric tube to tracheobronchial tree fistulas. Presentation of two
cases, literature review, classification and treatment protocol
Bolca Ciprian*, Eric Frechette**
*1st Clinical Department of Thoracic Surgery, Marius Nasta National Institute of
Pneumology, Bucharest
** Thoracic Surgery Department, Institut Universitaire de Cardiologie et de Pneumologie de
Quebec (IUCPQ), Quebec City, Canada
12.30 12.40
Serial resection for double tracheal stenosis post oro-tracheal intubation
Codin Saon, Liliana Caracuda, Felix Dobritoiu, Ioan Cordos, Genoveva Cadar, Emilia Crisan
1st Clinical Department of Thoracic Surgery, Marius Nasta National Institute of
Pneumology, Bucharest
12.40 12.50
Our experience in the surgery of the chest wall tumors
A.C.Nicodin, I.Miron, O.Sirbu, G.V.Cozma, O.N.Burlacu, I.A.Petrache, A.C.Nicola,
C.Mogoi.
Thoracic Surgery Department, Municipal Hospital, Timisoara
12.50 13.00
Ectopic thymomas with lateral paracardiac development
Boianu Alexandru-Mihail, Boianu Petre Vlah-Horea, Urcan Marius, Chiujdea Drago,
Lucaciu Oana, Hogea Timur, Batog Olivia, Pvloiu Valerian
Discipline Surgery 4, University of Medicine and Pharmacy from Targu-Mures
Poster session
1. Rare mediastinal masses: bronchogenic cyst and castleman's disease
Andrei Cristian Bobocea, Radu Matache, Ion Jentimir, Ioan Cordos
1st Clinical Department of Thoracic Surgery, Marius Nasta National Institute of
Pneumology, Bucharest
2. Pericardial drainage in malignant effusions - early results
Cezar Mota, Natalia Mota, Mihnea Davidescu, Ovidiu Rus, Elena Moise, Andreea tefan,
David Achim, Teodor Horvat
Thoracic Surgery Clinic, Alexandru.Trestioreanu National Institute of Oncology, Bucharest
3. Triple tracheo-bronchial lesion post-mediastinoscopy and ebus
Natalia Mota, Cezar Mota, Ovidiu Rus, Teodor Horvat
Thoracic Surgery Clinic, Alexandru.Trestioreanu National Institute of Oncology, Bucharest
4. Malignant pleural pseudomesothelioma
Mihnea Davidescu, Elena Moise, Ovidiu Rus, Teodor Horvat
Thoracic Surgery Clinic, Alexandru.Trestioreanu National Institute of Oncology, Bucharest
5. Bullous dystrophy of the middle lobe
Corina Bluoss, David Achim, Elena Moise, Teodor Horvat
Thoracic Surgery Clinic, Alexandru.Trestioreanu National Institute of Oncology, Bucharest
6. Ianusian aspect of tyroid pathology
Elena Moise, Cezar Motas, Ovidiu Rus, Teodor Horvat
Thoracic Surgery Clinic, Alexandru.Trestioreanu National Institute of Oncology, Bucharest
7. Giant pleural tumor case report
Radu Matache, Andrei Cristian Bobocea, Ioan Cordos
1st Clinical Department of Thoracic Surgery, Marius Nasta National Institute of
Pneumology, Bucharest
8. The role of the geroulanos procedure in the treatment of lung hydatic cyst today
G.V.Cozma, O.N.Burlacu, V.T.Voiculescu, C.P.Tunea, I.Miron, I.A.Petrache, M.Butas, A.C.
Nicodin
Thoracic Surgery Department, Municipal Hospital, Timisoara
9. Role of muscle flaps in the treatment of unresectable abscesses
Boianu Petre Vlah-Horea, Boianu Alexandru-Mihail, Gliga Mirela, Ionic Sebastian,
Chiujdea Drago, Lucaciu Oana, Hogea Timur, Batog Olivia
Discipline Surgery 4, University of Medicine and Pharmacy from Targu-Mures
10. Reversal of the flow in the thoracic drainage system rare postoperative accident
Boianu Alexandru-Mihail, Boianu Petre Vlah-Horea, Lucaciu Oana, Chiujdea Drago
Discipline Surgery 4, University of Medicine and Pharmacy from Targu-Mures
13.00 13.30
Traian Oancea award, for the best presentation during the conference
Closing remarks
16.20 16.30
Importana factorilor histopatologici n stabilirea prognosticului pacienilor operai pentru
cancer pulmonar fr celule mici
Suciu B.1, Bud V.1, Copotoiu C.1, Brnzaniuc Klara2, Copotoiu Ruxandra3, Fodor D.1,
Butiurca V.4
Clinica Chirurgie I, Spitalul Clinic Judeean de Urgen Mure
Disciplina de Anatomie, Universitatea de Medicin i Farmacie Tg. Mure
Clinica ATI, Spitalul Clinic Judeean de Urgen Mure
Student, Universitatea de Medicin i Farmacie Tg. Mure
16.30 16.40
Abordul cervical videomediastinoscopic al broniei primitive stngi - o serie de 6 cazuri
Cristian Paleru, Olga Danaila, Ciprian Bolca, Radu Matache, Mihai Dumitrescu, Adrian
Istrate, Ruxandra Ulmeanu, Ioan Cordos
Institutul National de Pneumologie Marius Nasta, Bucuresti
1 Clinica I Chirurgie Toracica
2 Departamentul Bronhologie
16.40 16.50
Plombaj extra-musculo-periostal cu bile funcional dup 46 de ani
Boianu Petre Vlah-Horea, Boianu Alexandru-Mihail
Disciplina Chirurgie 4, Universitatea de Medicin i Farmacie din Trgu-Mure, Romnia
16.50 17.00
Hemangiom parietal toracic
Cezar Mota, Ovidiu Rus, David Achim, Teodor Horvat
Clinica de Chirurgie Toracic, Institutul Oncologic Prof. Dr. Alexandru Trestioreanu
Bucureti
17.00 17.10
Leiomiofibromatoza cu multiple localizari adevarul dincolo de aparente prezentare de caz
Adrian Istrate, Cristian Paleru, Mihai Dumitrescu, Ioan Cordos
Clinica 1 Chirurgie Toracic, Institutul Naional de Pneumologie Marius Nasta, Bucureti
17.10 17.20
Timectomia videotoracoscopica in hiperplazia timica cu miastenie gravis
Cristina Grigorescu*, Trufa Denis*, Iosep Gabriel**
*Clinica de Chirurgie Toracica Iasi, UMF Gr.T.Popa Iasi
** Sectia de ATI, Spital clinic de Pneumoftiziologie Iasi
17.20 17.30
Chistul hidatic al mediastinului anterior
Cezar Mota, Natalia Mota, Mihnea Davidescu, Elena Moise, Ovidiu Rus, Daniel Banciu,
David Achim, Teodor Horvat
Clinica de Chirurgie Toracic, Institutul Oncologic Prof. Dr. Alexandru Trestioreanu
Bucureti
Sesiunea postere
1. Tumori mediastinale rare: chist bronhogenetic si boala castleman mediastinala
Andrei Cristian Bobocea, Radu Matache, Ion Jentimir, Ioan Cordos
Clinica 1 Chirurgie Toracic, Institutul Naional de Pneumologie Marius Nasta, Bucureti
2. Drenajul pericardic n revrsatele maligne rezultate precoce
Cezar Mota, Natalia Mota, Mihnea Davidescu, Ovidiu Rus, Elena Moise, Andreea tefan,
David Achim, Teodor Horvat
13.00 13.30
Decernarea premiului Traian Oancea pentru cea mai bun prezentare n cadrul
sesiunilor de lucrri
nchiderea conferinei
ABSTRACTS
CONFERENCES
Miotomia extramucoas a sfincterului esofagian superior
Teodor Horvat
Clinica de Chirurgie Toracic, Institutul Oncologic Bucureti
Se prezint un subiect mai puin cunoscut n literatura medical din Romnia
miotomia extramucoas a sfincterului esofagian superior.
Sunt trecute n revist date de anatomie chirurgical i aspecte de fiziologie i fiziopatologie
ale sfincterului esofagian superior. Sunt aduse n discuie maladiile care pot afecta
funcionarea normal a complexului faringe-sfincter-esofag cervical, care n principal pot fi
boli neurologice centrale i/sau periferice, afeciuni musculare congenitale sau ctigate,
maladii intrinseci ale muchiului cricofaringian etc.
Se prezint indicaiile i contraindicaiile chirurgicale ale miotomiei extramucoase faringocrico-esofagiene, date de tehnic chirurgical, operaii asociate, complicaii postoperatorii.
Rezultate postoperatorii i re-miotomii extramucoase sunt trecute n revist.
Extramucosal myotomy of upper esophageal sphincter
Teodor Horvat
Thoracic Surgery Clinic, Institute of Oncology, Bucharest
A less known subject in romanian medical literature is presented extramucosal myotomy of
the upper esophageal sphincter.
This paper presents surgical anatomy data, physiologic and physiopathologic aspects of the
upper esophageal sphincter. The maladies which affect the normal function of the pharinxsphincter-esophagus are also presented, meaning neurological diseases (central and/or
peripheral), muscular diseases (congenital or aquired), intrinsec conditions of cricopharyngeal
muscle etc.
Surgical indications and contraindications of the pharingo-crico-esophageal extramucosal
myotomy are presented and also surgical techniques, associated procedures and postoperatory
complications. Postoperatory results and extramucosal re-myotomy are reviewed.
donation team a broncoscopy is performed in the OR and the lungs are visually inspected and
palpated by the donor surgeon. When the lung(s) are accepted for donation, the implant team
is called to proceed with the acceptor operation. The main pulmonary artery is canulated to
deliver antegrade pulmoplegia and the left atrial appendage is opened to allow for drainage.
After pulmoplegia, the lungs are harvested n bloc and on a side table retrograde pulmoplegia
is given into the pulmonary veins to wash out any clots.
The lungs are then packed in 3 sterile plastic bags and stored in a cooler box on melting ice.
In the near future we expect that continuous perfusion and ventilation of donor lungs will
become standard practice in order to minimize ischemia time.
During the donation procedure, the implantation team has already started with the acceptor
operation. For bilateral lungtransplantation we position the patient on a special v-shaped
pillow with both arms in a low position to make a clam shell incision. For unilateral
lungtransplantation we use a standard postero-lateral thoracotomy. Extirpation of the
diseased lungs can be extremely difficult due to severe adhesions and hilar lymphadenopathy.
When a patient can not tolerate single lung ventilation, extra corporeal circulation is needed.
The technique of implantation is described with special attention for the bronchial
anastomosis and several tips and tricks are discussed for the anastomosis of the pulmonary
veins.
Lungtransplantation: organization and logistic problems
APWM (Lex) Maat
Thoraxcenter, Erasmus MC, Rotterdam, Netherlands
Organ donation procedures can be performed in the setting of a heart beating procedure or a
non heartbeating procedure. In heartbeating procedures the donor is braindead and the
procedure can be planned and performed in an semi-elective setting. In a heartbeating donor,
often the heart is also donated. Cardiac surgeon and lung surgeon have to work carefull
together in order to harvest both organs in an optimal way for implantation. In non
heartbeating donation the donor has severe braindamage and can not survive but the donor is
non brain dead. With the explant teams ready in the OR, ventilation is stopped; after
ventilation stop the EKG has to be flat within 1 hour. After cardiac arrest, there is a 5 minute
no touch time and then the donor is rushed to the OR. A midline sternotomy/laparotomy is
performed, clamping of descending aorta, perfusion of abdominal organs and lungs and after
perfusion organ harvest. In these procedures, the heart is not donated but is extirpated in order
to allow for easy access to both lungs. When in non-heartbeating donation the heart does not
stop in the hour after ventilation stop, the procedure is cancelled and the patient will not
donate any organs.
Lung donation is in most cases part a multi organ donation. It means different teams from
different hospitals have to be taken to the donor hospital and meet together in the OR. To
organize this is often very challenging. Most of these teams have never met before, never
worked together and often speak different languages and this can lead to problems.
From an experience of more then 25 years with heart- and lungtransplantion, we present
several unexpected and difficult situations we and other teams came accross.
Most cases of tracheobronchial stenosis can be solved by simply following the guidelines
mentioned in the medical literature: establishing a precise diagnosis, performing a carefully
planned procedure, applying tracheal relaxation inducing methods, avoiding the disruption of
blood supply to the ends chosen for anastomosis, and making sure the patient respects the
recovery program following surgery.
The most difficult cases can benefit from (1) sophisticated plastic and reconstructive surgery
procedures in which richly vascularized musculocutaneous flaps are used, (2) transplants with
tracheal tissue grown from the patients own stem cells, (3) tracheal graft from the aortic
segment, and with less extent (4) tracheal stents.
In between these categories, we find the challenging cases, less mentioned in the medical
literature and studies, cases in which ad hoc solutions must be found. The challenges lie in (1)
establishing a correct diagnosis, (2) determining the topography of the region, (3) anticipating
and managing postoperative events and in (4) the surgical act itself.
Tracheobronchial stenoses are of benign or malignant origin, the latter being either primary or
secondary.
Among the cases listed in the benign section, we consider the following to be the most
challenging: resection for recurrent stenosis or even rupture, following a late anastomosis in
which the proximal end healed by complete obstruction (four cases) or post-traumatic
stenosis of the primitive left bronchia occured (two cases). Another case of benign stenosis
was encountered in a patient with permanent terminal tracheostomy following a total
laryngectomy.
From the primary malignant section, we wish to mention a case of adenoid cystic carcinoma
(ACC) at the junction of the second and third segments of the trachea, which had extended to
the tissue surrounding the trachea.
From the secondary malignant section, the cases worth mentioning are those involving the
thyroid (three cases) and a metastasis with Mycosis fungoides (granuloma fungoides).
In two unusual cases, diagnostic confusion led to a tracheobronchial pulmonary resection
(upper pulmonary lobe resection) followed by tracheobronchial reconstructive surgery.
Despite the post-operative risks, the recovery period was uneventful.
In this presentation we wished to draw attention to some particular cases which could serve as
a stepping stone to other challenging cases and at the same time offer solutions which we
consider to be relevant and viable, given the good long term results we obtained in most of the
patients we operated on.
play a major role and much research is carried out to unravel these mysteries. So far without
much result
The new edition of the TNM system has greatly expanded our knowledge. It is based on a
large data set, over 80.000 cases, from all over the world, and also includes cases with best
palliative care.
However, because the system has to be applicable to every country in the world it is still
based on anatomical criteria. Tumour behavior has still to come.
Two things have to be kept in mind when using the 7th edition. First of all there is an
increasing number of subsets, which automatically occurs when one has a large number of
data. But in surgical practice this can be confusing. Second, the groups were not defined by
resectability but by prognosis. Which means that tumor types are grouped together, which
may be very different. For example, stage IIIA contains patients with T4N0, but also patients
with N2 disease. The 7th TNM edition did not look into treatment, these data were considered
not reliable enough.
But surgeons need criteria for treatment. Prognosis and treatment approaches are not the
same and both are not static. Better imaging may lead to stage migration and better treatments
lead to a better prognosis.
Therefore we need biological criteria. Recently it was proposed to classify tumors according
to their clinical presentation (1). The growth pattern may very well reflect the biological
behavior
Four types of growth pattern have been postulated: 1) Direct local invasion, 2) Spread to
lymphnodes, 3) additional foci in the lung, and 4) (early)distant metastases. This emphasis on
clinical presentation can be used beside the new TNM system and may help the surgeon in
making treatment decisions. And help him in the discussion with non-surgical to prevent
undertreatment in some patients.
Literature:
1. Anatomy, biology and Concepts, pertaining to Lung Cancer Stage Classification.
Detterbeck FC, Tanoue LT, Boffa DJ.
JTO 2009; 4: 437 -443.
Surgical procedures performed in both typical versus atypical carcinoids were: standard
resections 598 (75%) /106 (83,4%) (lobectomy 427/71, bilobectomy 88/13 and
pneumonectomy 83/22), 114 sublobar procedures (14,3%)/15 (11,8%) and 84 bronchoplastic
procedures (11%)/6 (4,7%), respectively.
In patients with TC, 22 of 796 (2.8%) presented metastases. Additionally, 10 (1.3%)
presented local recurrence -3 of them associated with distant metastases- and another 7 only
local recurrence. The characteristics of the different factors for patients with and without
metastases were as follows: Demographics: male, 63.6% and 44.4% (p=0.074), mean age
43.317.3 and 49.0316.1 years (p=0.651), size of primary tumour 33.419.15 and 24.913.5
mms (p=0.031), respectively.
When considering patients with AC, 27 of 127 patients (21.3%) presented metastases 5 of
which were associated to local recurrence. Additionally, 4 patients presented isolated local
recurrence. The behaviour of the factors analyzed as concerns TC with and without
metastases in these tumours was the following: Demographics: male, 63.9% and 52%
(p=0.310), mean age 60.18.6 and 52.917.8 years (p=0.000), size of primary tumour
35.617.3 and 31.415.7 mms (p=0.627), respectively.
According to 2009 TNM stage classification the results in percentage of T, N, and M factors
and tumour stage in both the TC and AC patients group are described in Table Ia.
Comparisons for the described parameters between patients with or without metastases are
defined in Table I.
Table I. A)TNM 2009 Classification. B) Comparisons for the described parameters between
patients with or without metastases.
T1a
T1b
T2a
T2b
T3
T4
All
patients
248
105
375
31
28
9
Typical
Carcinoid
With
metastases
7
2
7
2
3
1
N0
N1
N2
N3
734
40
22
0
Atypical carcinoid
With
metastases
2
3
17
1
1
3
2.8
1.9
1.8
6.4
10.7
11.1
All
patients
20
16
66
11
9
5
16
5
1
0
2.1
12.5
4.5
0
84
18
24
1
14
5
8
0
16.7
27.8
33.4
0
M0 791
M1a 1
M1b 4
21
0
1
2.6
0
25
121
0
6
22
0
5
18.2
0
83.4
Ia
Ib
IIa
IIb
IIIa
IIIb
6
5
6
2
2
0
1.9
1.4
9.7
6.9
6.7
0
29
40
19
6
24
3
3
5
5
1
7
1
10.3
12.5
26.3
16.7
21.2
33.3
326
344
62
29
30
0
10.0
18.8
25.8
9.1
11.1
12
IV
B
T factor
N Factor
M factor
Stage
20
Typical Carcinoids
0.036
0.000
0.018
0.000
83.3
Atypical Carcinoids
0.136
0.275
0.000
0.004
The influence of surgical procedure and nodal involvement in the presence of metastases and
overall survival was analyzed considering central vs. peripheral location in these tumours.
(Table II)
Table II
Central
Location
Typical
carcinoid
Atypical
carcinoid
P
Standard Bronchoplastic Others Metastases Overall Local
resection resection
survival recurrence
N0 400
77
24
0.691
0.129
0.004
N+ 37
0.386
0.709
0.202
N0 39
0.585
0.723
N+ 27
0.481
0.145
0.893
Standard Sublobar
resection resection
142
89
0.975
0.447
0.375
19
0.773
0.900
0.950
N0 30
13
0.45
0.599
0.018
N+ 11
0.763
0.727
0.345
Peripheral
location
Typical
N0
carcinoid
N+
Atypical
carcinoid
Conclusion
Our results allow us to conclude the conditions in which the conservative resection of
parenchyma in carcinoid tumours is advisable. In central typical carcinoid the use of lungsparing bronchoplastic techniques demands the intraoperative pathologic verification of the
existence of an adequate surgical margin 5mm by frozen section avoiding local recurrence.
In peripheral atypical carcinoids the increase in the local recurrence probability after a limited
resection makes it not advisable.
References
1. Travis WD, Rush W, Flieder DB, Falk R, Fleming M, Gal A, et al. Survival analysis
of 200 pulmonary neuroendocrine tumors with clarification of criteria for atypical
carcinoid and its separation from typical carcinoid. Am J Surg Pathol 1998; 22:93444.
2. Stamatis G, Freitag L, Greschuchna D. Limited and radical resection for tracheal and
bronchopulmonary carcinoid tumour. Report on 227 cases. Eur J Cardiothorac Surg
1990; 4: 527-532.
3. Thomas CH F, Tazelaar HD, Jett JR. Typical and atypical pulmonary carcinoids.
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decades and currently four categories are distinguished: typical carcinoid tumor, atypical
carcinoid tumor, large cell neuroendocrine carcinoma and small cell carcinoma. Because of
differences in clinical behavior, therapy, and prognosis, a reliable histological diagnosis, as
well as clinical and pathological staging system are essential for an appropriate medical
proceedings. The most effective treatment of bronchial carcinoids and large cell
neuroendocrine carcinoma in an early stage is complete surgical resection, whereas
chemotherapy remains the primary treatment for small cell carcinoma.Increased knowledge
about pulmonary neuroendocrine tumors biology and the genetic characteristics, imply that
carcinoid tumors appear to have a different etiology and pathogenesis than large cell
neuroendocrine and small cell carcinoma. In practice, it could be easiest to conceptualize this
group of pulmonary tumors as a spectrum of malignancy ranging from the low grade typical
carcinoid to the highly malignant large cell neuroendocrine and small cell carcinoma. Typical
carcinoid tumors associated with a fairly benign behavior should be classified as low-grade
neuroendocrine tumor/carcinoma (G1) and atypical carcinoid tumors as intermediate-grade
tumor/carcinoma (G2). Whereas, large cell neuroendocrine and small cell carcinoma should
be grouped together under the designation of high-grade neuroendocrine tumor/carcinoma
(G3).No medical therapy exists for the primary treatment of neuroendocrine tumor of the
lung. Chemotherapeutic agents and radiation therapy have been used in the treatment of
metastatic disease but have met with virtually no success. A response rate of 30-35% has been
reported using a combination of 5-fluorouracil and streptozotocin. Symptomatic relief of
carcinoid syndrome from metastatic disease has been achieved by administration of
octreotide.
ORAL PRESENTATIONS
BLEEDING FROM AN ADRENAL METASTASIS AS AN ATYPICAL CLINICAL
ONSET OF A STAGE IV LUNG CANCER
Boianu Petre Vlah-Horea1, Boianu Alexandru-Mihail1, Porav Daniel2, Boianu Ana-Maria
Voichia3
1
-Clinica Chirurgie IV UMF Trgu-Mure
2
-Clinica Urologie UMF Trgu-Mure
3
-Clinica Medical IV UMF Trgu-Mure
Introduction. We present a particular clinical onset of a lung cancer.
Material and method. We report a 46 years old male, with a history of 2 episodes of acute
pancreatitis and a laparoscopic cholecystectomy, whose actual disease started sudden with
intense pain in the left lumbar area. The patient presented to the Urology Clinic where the
diagnostic of renal colic was excluded (no pielo-caliceal dilatations) and the patient was
referred to the general surgery emergency department with the suspicion of acute abdomen.
Ultrasound showed a left adrenal mass and emergeny CT scan showed a 6 cm diameter
suppurated right pulmonary tumor and a left adrenal mass with a 7 cm diameter and
periglandular hemorrhagic infiltration, with no other secondary lesions. For pain control we
used opioides, followed by placement of an epidural catheter. We started with the thoracic
lesion, performing a non-anatomic resection of segment 6 Fowler, and after 10 days we
performed a left adrenalectomy through a left subcostal incision.
Results. The Immediate postoperative course was favourable, with complete resolution of the
lumbar pain after the left adrenalectomy. Pathologic examination showed in both specimens
adenoscuamous pulmonary carcinoma, the adrenal mass being a metastasis with diffuse
intraglandular bleeding. At 21 months after surgery, the patient has no abdominal or thoracic
complaints and has no signs of tumoral recurrence.
Conclusions. The case is interesting due to the sudden and atypical clinical onset of the lung
cancer due to the bleeding from the adrenal metastasis, due to the pain management problems
and the presence of secondary pulmonary suppuration which required to start the surgical
approach with the thoracic lesion.
spontaneous ventilation with local and intravenous analgesia was appropriate in 2 selected
cases.
Results:
Pleural biopsies were performed in all cases; when possible, intraoperatory talc
poudrage was added. A malignant diagnosis was made in 46 cases and chronical
inflammation in 10 cases. In 6 cases of unknown previous malignancy a pleural neoplasy was
diagnosed.
Conclusion: Uniportal thoracoscopy is a safe and effective diagnostic and therapeutical
procedure in pleural effusions. Double-lumen intubation anesthesia is reccomended but for
pleural biopsy and chemical pleurodhesis a single-lumen intubation can be safely used.
Introduction: The paper presents 2 cases admitted in the thoracic surgery department with
malignant sternal tumors: a 49 years old female with manubrial secondary tumor (tubulopapilary adenocarcinoma) after a right breast cancer (right Halsted mastectomy with pre and
postoperative chemo and radiotherapy) and a 45 years old male with a primary
chondrosarcoma of the sternal body.
The authors reveal the modality of sternal resection and reconstruction in approaching of
these cases through very illustrative preoperative, intraoperative and postoperative images.
Material and method: In both cases, after radical resection of the tumors, the rigid
reinforcement of the sternum was achieved with thoratex mesh reinforced with STRATOS
system and Kryptonite bone cement. The soft reconstruction was made with widely mobilized
pectoralis major muscle flaps (humeralis, sterno-costal and clavicular insertions transected)
shifted to the midline for loose closure.
Results: The complete removal of the tumors and very good chest wall stability was achieved
in both cases. In the second case, the kryptonite bone cement mixed with healthy
osteochondral fragments is useful both for the rigid sternal reconstruction and for creation of a
neosternum (porous structure was favorable for osseointegration and bone regeneration).
Conclusions: Large sternal defects after resection for malignant sternal tumors are safely
reconstructed with this complex surgical system combined with pectoral major muscular
flaps.
statistical importance. We also took into consideration the value of N from the TNM staging
as a prediction factor for long term survival in the patients that underwent surgical
intervention for pulmonary cancer. The p parameter was 0.0152 so we can say that we
obtained a direct connection between the stages of adenopathy and long term survival rate
Conclusions
Long time survival rate of the patients depends on the histological type of the tumor. Long
term survival prediction rate is better if the patients are over 60 years, compared with the
patients that are under 60 years. The N descriptor can be considered an important prediction
factor, while the T descriptors value is useless. The existence of Ns descriptor in more
stages of the TNM complex shows the limits of it and encourages for further improvements.
Key words : lung, cancer, prognosis, descriptor
Introduction
The parafluide density tumors are often a problem of therapeutic management. Late
presentation of a patient to the doctor may generate complications, such as rupture of the
tumor content into the pleural space.
Method
The case of 52 years old patient, admited for chest pain and minimum haemoptysis for
approximately
2
months,
is
presented.
Chest CT scan, performed before admission, shows a bulky tumor, round-oval (10 / 5,5 / 4
cm), with parafluid structure, relatively homogeneous, well defined, in lower lob of right
lung
without
other
associated
pathological
lesions.
The patient condition is deteriorating after admission with main symptoms such as increased
chest pain and dyspneea. CT exam confirms fluids accumulated in the pleural space.
Results
The right thing in this case was decided to be an emergency surgery. We have discovered
during the intervention liquid in the pleural cavity, about 1000ml, and also a relatively welldemarcated tumor with a 5 cm diameter, with a hard consistency, presenting on mediastinal
face of the right lung a fistula that had a tumoral content with purulent aspect. It was
performed a right lower lobectomy with lymphadenectomy and pleuro-pulmonary Williams
decortication.
Cystic formation proved to be a mesenchymal tumor with large areas of necrosis, and after the
IHC tests, the diagnosis of synovial sarcoma was put.
Conclusions
This case draws attention to a rare, possible evolution, in lung tumors.
months, and one year after the last intervention, showed that the tracheal lumen caliber
remains unchanged.
tumorala a fost excizata in intregime. Drenajul pleural a fost asigurat de prezenta a 2 tuburi de
dren pleurale.
Rezultate:
La nivelul capsulei timice a fost identificat un nodul format in principal din celule
paratiroidiene, fara forme microcelulare de malignitate;. Diagnosticul histopatologic final a
fost de adenom paratiroidian ectopic. Postoperator evolutia pacientei a fost favorabila cu
prabusirea valorilor PTH de la 1392.4 pg/ml preoperator la 4 pg/ml a doua zi dupa operatie.
Pacienta a fost urmarita in clinica de endocrinologie pentru reechilibrare electrolitica si
hormonala.
Concluzii:
Dupa suprimarea chirurgicala a formatiunii tumorale mediastinale, suspicionata imagistic si
confirmata histopatologic ca fiind paratiroida ectopica, sindromul hiperparatiroidian primar a
fost remis.
ridicata. Acest caz necesit investigaii suplimentare, care ar putea elucida etiologia si posibila
asociere cu alta entitate patologic.
S-a efectuat rezectia in bloc a glandei tiroide impreuna cu 3-5 inele traheale, iar intr-un caz s-a
practicat si rezectia portiunii anterioare a cartilajului cricoid. Limfadenectomia locala a fost
facuta in toate cazurile.
Rezultate
Anatomopatologic s-au identificat 3 carcinoame tirodiene nediferentiate si 4 carcinoame
tirodiene bine diferentiate. Mortalitatea postoperatorie a fost nula. Intr-un singur caz de
carcinom tirodian nediferentiat a existat o fistula de anastomoza ce a necesitat traheostomie
definitiva. Supravietuirea la distanta a fost de 6, 9 si 14 luni in cazul pacientilor cu carcinom
tirodian nediferentiat, respectiv 13 luni la un pacient din lotul cu carcinom tirodian bine
diferentiat. Ceilalti trei pacienti supravietuiesc la 9, 16 si respectiv 25 de luni postoperator
fara semne de recurenta a bolii sau metastaze la distanta.
Concluzii
Exista controverse privind metoda chirurgicala optima: rezectia tangentiala cu tesut tumoral
microscopic restant sau rezectia completa tireo-traheala.
Rezectia traheala cu anastomoza in cazurile de carcinoame tiroidiene cu invazia cailor aeriene
aduce paliatie de lunga durata si poate fi curativa pentru un numar semnificativ de pacienti ce
sufera de aceasta boala.
prin intervenie chirurgical imediat i altul prin masuri conservatoare. Tratatele i articolele
de specialitate ofer informaii limitate privitor la aceast problem. O cutare n Medline a
permis indentificarea a 42 de cazuri prezentate n literatur. Dup studierea acestora, am
ncercat s stabilim o clasificare i un protocol de tratament general valabil pentru aceast
complicaie.
Rezultate
nchiderea traiectului fistulos a fost obinut n amndou cazurile prezentate. Prin studierea
literaturii s-a putut identifica un model n ceea ce privete etiologia i factorii favorizani,
timpul de la operaia iniial pn la apariia fistulei i modalitile de tratment, aspecte care
ne-au permis s propunem o clasificare i un protocol terapeutic.
Concluzii
Formarea unei fistule ntre neoesofag i calea aerian este o complicaie neobinuit i dificil
de tratat. Simptomatologia, dimensiunile i localizarea traiectului fistulos i durata de timp de
la intervenia iniial vor dicta modalitatea de tratament n vederea restabilirii continuitaii
digestive i a cii aeriene i deci, de a rezolva aceast complicaie sever
POSTERS
RARE MEDIASTINAL MASSES: BRONCHOGENIC CYST AND CASTLEMAN'S
DISEASE
Andrei Cristian Bobocea, Radu Matache, Ion Jentimir, Ioan Cordos
1st Clinical Department of Thoracic Surgery, Marius Nasta National Institute of
Pneumology, Bucharest
Introduction
The differential diagnosis of mediastinal masses includes over 30 different diseases, most
frecquent lymphomas, substernal goiter, thymomas, or, rarely, Castlemans disease and
bronchogenetic cyst.
Castleman's disease is a rare lymphoproliferative disorder also called angiofollicular lymph
node hyperplasia.
Bronchogenic cysts, although relatively rare, represent the most common cystic lesion of the
mediastinum.
Cases report
A 45 year old male complaining of dyspnoea was presented with a mediastinal mass
mimicking a thymoma. By posterolateral thoracotomy the mass was completely excised.
Pathology examination of specimen showed Castleman's disease.
A 65 year old female was presented with a mediastinal mass compressing the trachea
diagnosed as bronchogenic cyst. Transcervical complete resection was performed with
remission of dyspnoea.
Discussions
The initial presentation of mediastinal masses may be respiratory distress and symptoms can
be life threatening when they produce airway compromise.
Castleman's disease is a lymphoid tumour with majority of lesions occurring within the chest.
The unicentric pattern is usually localized to the mediastinum or pulmonary hilum. Less
commonly sites include neck, pelvis, retroperitoneum and axilla.
The bronchogenetic cysts are usually found using prenatal ultrasonography and in early
childhood or adulthood by routine chest radiography. It is rarely diagnosed in elderly.
Extrathoracic cysts are found in the neck, abdomen, and retroperitoneal space. The
mediastinal cysts are mostly carinal and paratracheal; intrapulmonary cases were reported.
Mostly, the complete resection of the bronchogenic cyst was performed by thoracotomy.
Conclusions
Castleman's disease of the mediastinum is a rare clinical finding often diagnosed after onset of
non-specific thoracic symptoms such as dyspnoea, cough or chest-wall pain.
Bronchogenetic cysts are rare findings in elderly patients and produce symptoms when
altering airway dynamics.
Complete surgical removal of this type of mediastinal masses is usually curative alone. In
cases where subtotal excision has been performed, short-term recurrences were seldom
reported.
silicone tube, small amounts of lavage and repeated tracheo-bronho-aspirations, along with
intensive care support. In spite of all efforts, after 18 days the patient died due to cardiorespiratory arrest. The hystologic result from previous mediastinoscopy was Hodgkin
lymphoma.
Conclusion: Unrecognised tracheo-bronchial iatrogenic injury can lead to catastrofic
consequences in matter of hospital expenses and cost of life.
complete obliteration of the diseases space and closure-reinforcement of the bronchial fistula;
the choice of the flap was made according to the local anatomy. Preoperative preparation was
made by daily lavages with antibiotics and disinfectants, including transparietal punction
using ultrasound guidance.
Results. We have encountered no mortality and no major complications. Hospitalisation
ranged between 25 and 46 days. At late follow-up (6 month 9 years) we encountered no
recurrence and no major sequelae.
Conclusions. The use of muscle flaps is a valuable solution for unresectable pulmonary
abscesses if the preoperative preparation is an adequate one. Compared to the classic
techniques, the extensive mobilization of the flaps offers a good-quality biological material
with considerable volume.
Material i metod: ntre martie 2010 i august 2011 am efectuat 27 drenaje pericardice la 25
pacieni (14 brbai i 11 femei) cu pericardite lichidiene i neoplasme cunoscute: 18
pulmonare, 5 mamare, 1 de col uterin i 1 de buz.
Drenajul pericardic a fost efectuat n urgen imediat n 11 cazuri de tamponad cardiac (2
tamponade localizate) i n urgen amnat la 16 pacieni.
Procedee de drenaj: 17 aborduri paraxifoidiene (62,96%), 5 fenestrri pericardo-pleurale
toracoscopice (18,51%), 2 drenaje prin cateter percutan (7,4%), 2 aborduri subxifoidiene cu
rezecia xifoidului (7,4%) i 1 fenestrare pericardic prin toracotomie stng (3,7%).
Cele 17 drenaje paraxifoidiene au fost efectuate sub anestezie local, la care n 10 cazuri a fost
adugat analgezia i.v. pentru confortul pacientului. Am efectuat 3 pericardoscopii
paraxifoidiene (17,64%).
Rezultate: Cantitatea medie de lichid pericardic evacuat intraoperator a fost de 845ml. Am
efectuat biopsie pericardic n 25 cazuri n doar 6 cazuri histologia a fost malign (24%).
Citologia a fost malign n 16 din 19 cazuri (84,21%).
Mortalitatea intraoperatorie a fost zero; mortalitatea postoperatorie imediat a fost 3,7% (1
deces la 9h dup masaj cardiac intern pentru stop cardiac n tamponad).
n 14 cazuri, pericardita a fost asociat cu pleurezie: n 5 cazuri s-a efectuat fenestrare
pericardo-pleural prin toracoscopie (anestezie general) iar la 9 pacieni starea general a
impus doar anestezie local, pleurezia fiind drenat prin pleurotomie minim asociat.
Am avut 1 caz cu dubl recidiv a pericarditei neoplazice (dup drenaj paraxifoidian i
pericardocentez eco-ghidat) cu tamponad localizat la emergena marilor vase ce a impus
pericardectomie parial stng prin toracotomie.
Concluzii: Deoarece permite biopsierea facil a pericardului, abordul paraxifoidian este extrem
de util n drenajul pericarditelor maligne. Endoscopul cu vedere la 0 grade nu este potrivit
pentru pericardoscopie paraxifoidian.
Radiografia toracic evideniaz mai multe caviti cu nivele hidroaerice situate n treimea
inferioar a cmpului pulmonar drept.
CT torace cu substan de contrast relev caviti cu nivel hidroaeric la nivelul lobului
mediu(dimensiuni maxime 9.2/11.7cm), cu coninut fluid i parafluid.
Bronhoscopic se evideniaz secreii mucopurulente n lobara medie i bazalele drepte (examen
microbiologic: Str. Pyogenes i Candida albicans).
Intraoperator se constat bule de emfizem de diferite dimensiuni, localizate la nivelul lobului
mediu, una dintre ele depaind puin scizura la nivelul lobului superior. Se practic lobectomie
medie i rezecie atipic lob superior drept.
Evoluia postoperatorie este favorabil.
Concluzii: Particularitatea cazului este reprezentat de descoperirea la vrsta adult a unei
malformaii congenitale (distrofia buloas) care a debutat prin hemoptizie.