StreszczenieMałoinwazyjne metody anatomicznych resekcji miąższu płuc-nego stają się klinicznym standardem. Wymagają one od chirurga świetnej znajomości anatomii operowanego obszaru. Stworzono kompleksowy opis anatomii prawidłowej oraz znanych z piśmiennictwa zmienności naczyń płucnych na uży-tek torakochirurgii. Przeanalizowano również 642 przypadki zabiegów resekcji miąższu płucnego u pacjentów z rakiem niedrobnokomórkowym płuca operowanych w Klinice Chirurgii Instytutu Gruźlicy i Chorób Płuc w Warszawie, poszukując wzmianek o zmiennościach anatomicznych dostrzeżonych w trakcie zabiegu. Wyniki tej analizy zostały porównane z danymi z piśmiennictwa. Zmienność w obrębie układu tętniczego opisano w 8,72% przypadków, a układu żylnego w 3,12% przypadków. Częstość ta jest niższa, niż zakładana na postawie danych dostępnych w piśmiennictwie. Opisano natomiast kilka bardzo rzadkich, ale potencjalnie niebezpiecznych odmian. Słowa kluczowe: tętnice płucne, żyły płucne, zmienność.Kardiochirurgia i Torakochirurgia Polska 2013; 10 (3) 232 THORACIC SURGERY AbstractThe less invasive methods of lung tissue resection are becoming a clinical standard. This obligates surgeons to be well trained in the field of anatomy. Thus, we decided to create a comprehensive description of normal anatomy as well as anatomical variations of pulmonary vessels for the purpose of thoracic surgery procedures. We also retrospectively analyzed a database of 642 patients with lung cancer who underwent lung tissue resection at the Department of Surgery of the National Tuberculosis and Lung Diseases Research Institute in Warsaw (Poland), searching for descriptions of the anatomic variations observed during the surgical procedures. The results were subsequently compared to existing literature data. Variations of the arterial system were found in 8.72% of cases. Variations of the venous system were described in 3.12%. The frequency of variations in our database is lower than previously suspected based on the literature data. Nevertheless, several rare and potentially dangerous variations were described.

Background: Pulmonary veins (PVs) are important during segmentectomy. Many case reports prove that they may be the source of bleeding during surgery, especially when anatomical variants are present. We decided to describe venous variations and prepare a computed tomography based atlas of our observations. Methods: The study was conducted using 135 chest computed tomography studies with intra venous iodine contrast injection. The study population contained 86 females and 49 males, mean age was 60. Thirteen people had atrial fibrillation. Images were analysed using radiological workstation. Results:The variations were divided into three categories: atypical topography of the PV, atypical venous outflow to the left atrium (LA), atypical venous vascularization of the lung bronchopulmonary segment.Retrobronchial course of the vein of the posterior segment of the right upper lobe was observed in 8.15%.The most common variant of atrial venous outflow was the direct outflow of the middle lobe vein, observed in 25.19% of cases and the long common trunk of left PVs in 11.11%. The split drainage from the middle lobe into the right superior pulmonary vein (RSPV) and the right inferior pulmonary vein (RIPV) was observed in 9.63% as the full drainage into the RIPV in 2.96%.Conclusions: Long common trunk of left PVs and numerous variants of venous vascularisation of the middle lobe are the variations that may pose potential problems during thoracic surgeries. The frequency is high enough to justify the routine assessment of pulmonary vessels with computed tomography before surgery.

Introduction: The problem of treating secondary cancer is very controversial. Huge progress in its treatment began in the 1970s with the introduction of chemotherapy. In the surgical aspect Pastorino's work published in 1997 was a milestone. To this day, most authors cite its research results. Aim: The task is to answer the question what tactics to follow in the surgical treatment of patients with secondary cancer affecting the respiratory system. Material and methods: Retrospective studies were conducted on a group of 577 patients. Men prevailed slightly. The average age was 56 years. Surgical access used in the vast majority of cases was anterolateral thoracotomy. Wedge resection was the most common scope of surgery. Lymph nodes were not removed as standard. Single and multifactorial statistical surveys were conducted (Kaplan-Meier estimator and multifactorial Cox regression analysis). Results: A total of 1,058 operations were performed during which 1889 metastases were removed. Negative tissue margins were obtained in 90.4%. The median survival was 47 months. Complications occurred in 76 patients, which constituted 7.1% of performed procedures. There were 3 perioperative deaths. Conclusions: It was found that the factors negatively affecting survival were lack of radicalism, size of the metastasis > 3 cm, and number of metastases > 1. The factors positively influencing survival were a longer time than primary surgery and a greater number of operations. Histological diagnosis differentiated patient survival.

We conclude that any stable solitary pulmonary lesion in a transplant recipient needs to be resected in order to allow a definitive diagnosis and prevent disease dissemination such as IPA in our patient.

Introduction: Surgical treatment of neoplastic lung metastases is a big therapeutic problem, at the stage of qualifying for the procedure, in the surgical technique itself, and in the tactics of managing subsequent disease relapses. The most doubtful aspect is determining which factors influence the prolongation of survival in patients with such a diagnosis. Aim: To determine which factors influence the effectiveness of surgical treatment of neoplastic metastases to the lungs. Material and methods: A group of 577 patients was subjected to the study. An analysis of all performed operations (1009) was also carried out according to the set goals. Statistical analysis was performed using the estimates of the c 2 test, Kaplan-Meier estimator, and log-rank test. Results: It was established what statistically significant factors may improve the treatment effectiveness. It was found that the lack of radicalism was influenced by: the number of lung metastases, the presence of changes in the lymph nodes, age, histology of the primary tumor and its location, and the number of treatments. Nodal metastases are more common in non-radical procedures, depend on the patient's age, are more often found in unilateral procedures, and depend on the location and histology of the primary tumor. Conclusions: It was found that the radical nature of the procedure did not affect the progression of the disease, but it did have an impact on survival. Relapses are more common in bilateral procedures, reducing survival. Lymph node metastases worsen the prognosis.