European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
-
Eur J Cardiothorac Surg · Apr 2012
Pneumonectomy: calculable or non-tolerable risk factor in trimodal therapy for Stage III non-small-cell lung cancer?
Lung cancer is the leading cause of death in cancer statistics throughout developed countries. While single surgical approach provides best results in early stages, multimodality approaches have been employed in advanced disease and demonstrated superior results in selected patients. With either full-dose chemotherapy and/or radiotherapy, patients usually have a poor general condition when entering surgical therapy and therefore neoadjuvant therapy can lead to a higher morbidity and mortality. Especially in the case of pneumonectomy as the completing procedure, mortality rate can exceed over 40%. Therefore, chest physicians often shy away from recommending pneumonectomy as final step in trimodal protocols. We analysed our experience with pneumonectomy after neoadjuvant chemoradiotherapy in advanced non-small-cell lung cancer (NSCLC) with a focus on feasibility, outcome and survival. ⋯ Pneumonectomy in neoadjuvant trimodal approach for Stage III NSCLC can be done safe with acceptable mortality rate. Patients should not withhold from operation because of necessitating pneumonectomy. Not the procedure but the selection, response rate and R0-resection are crucial for survival after trimodal therapy in experienced centres.
-
The importance of surgical simulation has grown in the quickly changing climate of modern surgical training. Prior to operating on human hearts, practice in appropriate experimental models is necessary to attain adequate experience. Nowadays, training of surgery residents has shifted to simulation workshops and residency programmes outside the operating theatre. ⋯ Previously, the heart would be fixed on the tablecloth with simple stitches, which proved to be a complex and difficult technique while performing surgery. Moving forwards, we have built a successful 'surgical table' to achieve better stabilization and to simplify the surgery. This paper describes our model, which could be a helpful tool for any cardiac surgeon performing surgical techniques successfully at home.