Determining the specific type of a thorax deformity could be considered a type-related physiotherapy as conservative treatment or vacuum treatment and if surgery is indicated a type-related surgical correction can be performed. A type-related and adapted surgical correction can prevent subsequent mitral valve prolapse, recurrent infections, vertebral disturbances caused by kypho-scoliosis and increasing psychological irritation. Typing chest-deformities are an additional and essential help for the surgeon to perform specific surgical procedures: detorsion of the sternum, correction of the sterno-costal region, the costal arch bow and the kind of chest wall immobilization by metal struts. It can also compare the postoperative results more accurately in similar types of chest-deformities.
Lymphatic spread of bronchial carcinoma can reach any part of the mediastinum, irrespective of the localisation of the primary tumor. Metastatic spread may not affect all topographical lymph node positions, but this is unpredictable. The number of lymph nodes in each position varies. Therefore, systematic mediastinal lymph node dissection includes all ipsilateral compartments of the mediastinum. It is also possible to reach contralateral sites. In right-sided thoracotomies the lymph node dissection is standardized. Mobilizing the aortic arch and the large vessels also allows complete mediastinal dissection by a left-sided approach. The surgical technique is described. Perioperative morbidity does not increase. Systematic mediastinal lymph node dissection is the gold standard for evaluation of an exact pN stage. The stage-related survival rate is significantly improved. Therefore, it should be required that systematic mediastinal lymph node dissection be standard in the surgical treatment of bronchial carcinoma.
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