The Prognostic Value of Preoperative C-Reactive Protein Levels in Resected Early-Stage Lung Cancer.

Introduction: C-reactive protein (CRP) is the most widely used marker of the systemic inflammatory response. An association between preoperative elevated levels and prognosis has been demonstrated for numerous tumors. The aim of this study was to investigate the association between preoperative CRP levels and survival in early-stage nonsmall cell lung cancer.

Staging of Early-Stage Lung Cancer without Routine PET in Candidates for Segmentectomy.

Introduction:  We aimed to investigate the accuracy of clinical staging without the routine use of positron emission tomography/computed tomography (PET/CT) in patients with cIA1 and cIA2 non-small-cell lung cancer (NSCLC) scheduled for segmentectomy.

Methods:  A total of 305 consecutive segmentectomies were retrospectively analyzed. Overall survival was calculated using the Kaplan-Meier method.

[Delphi Expert Consensus of the German Society for Thoracic Surgery on Segmentectomy for Non-small Cell Lung Cancer].

Background: Findings from two recently published randomised controlled trials have shown favourable oncological results of segmentectomy for early-stage NSCLC < 2 cm. This has generated a growing interest in this procedure, which is however considered technically more challenging than lobectomy. The aim of the working group of the German Society for Thoracic Surgery (DGT) was to address, via an expert consensus project, topics concerning implementation of segmentectomy in lung cancer surgery.

Patients' satisfaction with local and general anaesthesia for video-assisted thoracoscopic surgery-results of the first randomized controlled trial PASSAT.

Objectives: The objective of this single-centre, open, randomized control trial was to compare the patients' satisfaction with local anaesthesia (LA) or general anaesthesia (GA) for video-assisted thoracoscopy.

Methods: Patients with indication for video-assisted thoracoscopy pleural management, mediastinal biopsies or lung wedge resections were randomized for LA or GA. LA was administered along with no or mild sedation and no airway devices maintaining spontaneous breathing, and GA was administered along with double-lumen tube and one-lung ventilation.

A New Approach in Airway Management for Tracheal Resection and Anastomosis: A Single-Center Prospective Study.

Objectives: The evaluation of the use of laryngeal mask airways (LMA) as an alternative form of airway management for surgical tracheal reconstruction.

Design: A prospective case series.

Setting: At a single German university hospital.

Clinical and bronchoscopic aspects of bronchial healing after sleeve resection for lung cancer: a multivariate analysis on 541 cases.

Background: Anastomotic insufficiency is a feared complication after sleeve lobectomy. Bronchoscopy can help to identify anastomoses at risk. We evaluated negative predictors of anastomotic healing using a bronchoscopic grading system in a large collective of lung cancer patients.

[Resection of Lung Cancer in Old Patients - Does Demographic Change Cause a Rethink?].

Due to the demographic change prevailing in Germany, the age pyramid is shifting more and more upwards. According to the WHO, a patient over the age of 75 is considered to be old. Whether or not and to what extent an old patient can tolerate thoracic surgery purely based on his age and comorbidities remains unclear.

Results of the Diaphragmatic Plication Database: 10 Years' Experience.

Background: Unilateral diaphragmatic paralysis or paresis (UDP) in adults is an often overlooked disease which relevantly impairs the patient's lung function and quality of life. Particularly in idiopathic UDP, there is no evidence for conservative therapy and only little evidence for surgical therapy.

Methods: The method involves retrospective single-center analysis of patients with UDP persistent for at least 1 year who were operated by diaphragmatic resection, plication, and augmentation with a polypropylene mesh.

Most patient conditions do not a priori debilitate the sensitivity of thoracic ultrasound in thoracic surgery-a prospective comparative study.

Background: The few existing studies on the accuracy of lung ultrasound in the detection of a postoperative pneumothorax after thoracic surgery differ in the sonographic technique and the inclusion criteria. Several conditions are considered unfavourable in the sonographic examination of the lung. We aim to test these conditions for their impact on the diagnostic accuracy of lung ultrasound.

Hypercapnia in COPD Patients Undergoing Endobronchial Ultrasound under Local Anaesthesia and Analgosedation: A Prospective Controlled Study Using Continuous Transcutaneous Capnometry.

Background: Flexible bronchoscopy (FB) in analgosedation causes alveolar hypoventilation and hypercapnia, the more so if patients suffer from COPD. Nonetheless, neither is capnometry part of standard monitoring nor is there evidence on how long patients should be monitored after sedation.

Objectives: We investigated the impact of COPD on hypercapnia during FB with endobronchial ultrasound (EBUS) in sedation and how the periprocedural monitoring should be adapted.

Development of the Diaphragmatic Paralysis Questionnaire: a simple tool for patient relevant outcome.

Objectives: Measurement tools of health-related quality of life (HRQL) that are specific for the underlying disorder are inevitably needed to assess HRQL changes following specific treatment strategies. The aim of the current study was to develop a questionnaire assessing HRQL in patients with unilateral diaphragmatic paresis.

Methods: Firstly, topics of health impairments covering physical, psychological, social and functional aspects were predefined by a physician expert panel to ensure face validity.

Sleeve lobectomy versus lobectomy for primary treatment of non-small-cell lung cancer: A single-center retrospective analysis.

Background And Objectives: It is unclear how much additional perioperative risk a sleeve lobectomy could pose in comparison to lobectomy. The objective of this analysis was to compare the complication rate, 30-day mortality, and overall survival between lobectomy and sleeve lobectomy without prior neoadjuvant treatment in non-small-cell lung cancer (NSCLC).

Methods: This is a retrospective study using our prospective database for quality assurance in our hospital.

[Chest Wall Reconstruction Using Polypropylene Mesh: a Single-Center 8-Year Analysis].

Background: Chest wall resection for malignant tumours is usually combined with reconstruction of the bony defect. We analysed our single centre, 8-year, experience using polypropylene mesh for chest wall reconstruction. The goal of our retrospective study was to identify material-related complications and to compare them with the existing literature.

Post-thoracotomy pain syndrome: seldom severe, often neuropathic, treated unspecific, and insufficient.

Background: Post-thoracotomy pain syndrome (PTPS) is reported with a prevalence ranging between 33% and 91% in literature. However, the difference between open (TT) and video-assisted thoracic surgery (VATS) concerning the prevalence and neuropathic character of PTPS has not yet been systematically investigated. Furthermore, knowledge on analgesic treatment and its efficacy is limited.

Optimal timing of surgery for bronchial sleeve resection after neoadjuvant chemoradiotherapy.

Introduction: Sleeve resection is an established oncological operative treatment for centrally located tumors with reduced complications compared to pneumonectomy. In cases of neoadjuvant chemoradiotherapy, the optimal timing of surgery for bronchial anastomotic healing has not been adequately explored.

Materials And Methods: Between 2006 and 2017, 584 tracheobronchial sleeve resections were retrospectively analyzed.

Use of Extracorporeal Membrane Oxygenation for Major Cardiopulmonary Resections.

Background: In thoracic surgery, utilization of extracorporeal membrane oxygenation (ECMO) is mainly established for patients undergoing lung transplantation. The aim of our study was to summarize our single-center experience with intraoperative use of veno-venous- or veno-arterial-ECMO in patients undergoing complex lung surgery involving the main carina, or the left atrium or the descending aorta.

Methods: A total of 24 patients underwent combined complex lung, carinal, aortal, or left atrial resections.

[Delphi Expert Consensus of the German Thoracic Surgery Society on Perioperative Management of Oncological Anatomical Lung Resections].

Background: Anatomical lung resection for curative treatment of a tumour disease is the most common selective procedure in oncological thoracic surgery. The goal of the working group of the German Thoracic Surgery Society (DGT) was to achieve a consensus on the perioperative management of selective oncological lung resection procedures.

Methods: The assigned group of the DGT designed and conducted two electronic rounds of questions in all major thoracic and lung centres.

Bronchus Anastomosis Healing Depending on Type of Neoadjuvant Therapy.

Background: Preoperative radiotherapy and/or chemotherapy of lung cancer in patients with locally advanced disease is an option in multimodal treatment. Sleeve lobectomy has an important part in decreasing complications and sparing lung function. We present our experience in a large cohort of patients after sleeve lobectomy with or without neoadjuvant treatment and standardized assessment of bronchial anastomotic healing.

Sensitivity of chest ultrasound for postoperative pneumothorax in comparison to chest X-ray after lung resecting surgery.

Objectives: Thoracic ultrasound is superior to chest X-ray for the detection of a pneumothorax in trauma and intensive care medicine. Data regarding its use in non-cardiac thoracic surgery are scarce and contradictory. Previous studies are heterogeneous regarding sonographic methodology and patient selection.

[Video-assisted Thoracoscopic Surgery in Local Anaesthesia and Analgosedation - a Survey of the Members of the German Society of Thoracic Surgeons].

Introduction: There is increasing international interest in the use of video-assisted thoracoscopic procedures (VATS) with spontaneous respiration in the treatment of elderly and multimorbid patients. Data on the application and acceptance in Germany are not yet available.

Method: Germany-wide, online-based survey among the departments of thoracic surgery registered at the German Society of Thoracic Surgeons (DGT) on the application of VATS in local anaesthesia (LA).

[Delphi Expert Consensus of the German Thoracic Surgery Society on the Management of Chest Tube Drainage].

Background: Chest tubes are a valuable instrument and are used on a daily basis - not only by thoracic surgeons but also by a variety of medical specialists who treat pneumothorax or pleural effusions. The goal of the working group of the German Thoracic Society (DGT) was to achieve a consensus on the management of chest tube/drainage using the Delphi process.

Methods: The assigned group of the DGT designed and conducted two electronic rounds of questions in all major thoracic and lung cancer centres.

Anterior Chest Wall Reconstruction Using Polypropylene Mesh: A Retrospective Study.

Background: Anterior chest wall resection for oncological purposes is usually combined with a form of reconstruction. Most surgeons are convinced that ventrally located defects more than 4 to 5 cm require adequate reconstruction to minimize the risk of lung herniation and respiratory distress through paradox motion. We describe our in-house results of ventral chest wall reconstruction using polypropylene mesh without the use of metallic or biological implants regardless of the extent of chest wall resection.

Rationale and design of PASSAT - patients' satisfaction with local or general anaesthesia in video-assisted thoracoscopic surgery: study protocol for a randomised controlled trial with a non-randomised side arm.

Background: Although general anaesthesia (GA) with one-lung ventilation is the current standard of care, minor thoracoscopic surgery, i.e. treatment of pleural effusions, biopsies and small peripheral pulmonary wedge resections, can also be performed using local anaesthesia (LA), analgosedation and spontaneous breathing.