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Povzetek: Background: Chest drains are routinely used after video-assisted thoracoscopic surgery (VATS) lung resections to evacuate fluid and air from the pleural space. We compared the impact of coaxial silicone (SIL) drains vs. standard polyvinyl chloride (PVC) drains on postoperative pain, drainage efficacy, and short-term treatment outcome following VATS lobectomy. Methods: The prospective randomized study included 80 patients who underwent VATS lobectomy for lung cancer between September 2020 and June 2023. Patients were randomized into two groups based on the type of chest drain used postoperatively: 40 in the experimental group (coaxial SIL drain Fr 24) and 40 in the control group (standard PVC drain Fr 24). The researchers collecting the data and the caregivers were not blinded to the group allocation. The primary objective was to evaluate pain over the initial 2 postoperative days by assessing analgesic consumption, respiratory muscle strength [measured as maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP)], and pain intensity using the visual analog scale (VAS). MIP, MEP, and VAS were measured both at rest and during physical activity. Results: Sixty-nine patients were included in the final analysis: 35 in the experimental group and 34 in the control group. The groups were comparable in terms of drainage efficacy and short-term treatment outcome, but pain was significantly lower in the experimental group (coaxial SIL drain). Diclofenac consumption was significantly lower in the experimental group (P=0.004), with a trend toward lower consumption of other analgesics. All respiratory muscle strength measurements were higher in the experimental group, with significant differences in static MIP on the second postoperative day (P=0.046), both static (P=0.02) and dynamic (P=0.050) MEP on the first postoperative day, and static MEP on the second postoperative day (P=0.02). Static VAS (S-VAS) on the first postoperative day was statistically significantly lower in the experimental group (P=0.003). Dynamic VAS (D-VAS) was comparable between the groups. Conclusions: This study confirmed the hypothesis that coaxial SIL drains, owing to their softer material, cause less pain while maintaining efficacy comparable to standard PVC drains.
Ključne besede: video-assisted thoracoscopic surgery, VATS, lobectomy, postoperative pain, chest tube, analgesia
Objavljeno v DiRROS: 12.12.2025; Ogledov: 133; Prenosov: 70
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Ključne besede: zborniki
Objavljeno v DiRROS: 09.09.2025; Ogledov: 289; Prenosov: 87
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Povzetek: Background Two prospective randomized studies analysing cutaneous melanoma (CM) patients with sentinel lymph node (SLN) metastases and rapid development of systemic adjuvant therapy have changed our approach to stage III CM treatment. The aim of this study was to compare results of retrospective survival analysis of stage III CM patients% treatment from Slovenian national CM register to leading international clinical guidelines. Patients and methods Since 2000, all Slovenian CM patients with primary tumour % TIb are treated at the Institute of Oncology Ljubljana and data are prospectively collected into a national CM registry. A retrospective analysis of 2426 sentinel lymph node (SLN) biopsies and 789 lymphadenectomies performed until 2015 was conducted using Kaplan-Meier survival curves and log-rank tests. Results Positive SLN was found in 519/2426 (21.4%) of patients and completion dissection (CLND) was performed in 455 patients. The 5-year overall survival (OS) of CLND group was 58% vs. 47% of metachronous metastases group (MLNM) (p = 0.003). The 5-year OS of patients with lymph node (LN) metastases and unknown primary site (UPM) was 45% vs. 21% of patients with synchronous LN metastasis. Patients with SLN tumour burden < 0.3 mm had 5-year OS similar to SLN negative patients (86% vs. 85%; p = 0.926). The 5-year OS of patients with burden > 1.0 mm was similar to the MLNM group (49% vs. 47%; p = 0.280). Conclusions Stage III melanoma patients is a heterogeneous group with significant OS differences. CLND after positive SLNB might still remain a method of treatment for selected patients with stage III.
Ključne besede: cutaneous melanoma, surgery treatment, sentinel node biopsy
Objavljeno v DiRROS: 17.07.2024; Ogledov: 944; Prenosov: 563
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Povzetek: The aim of our study was to evaluate the quality of surgery of Slovenian breast cancer screening program (DORA) using the requested EU standards. Furthermore, we investigated whether regular quality control over the 3-year period improved the quality of surgical management. Patients and methods. Patients who required surgical management within DORA between January 1st, 2016 and December 31st, 2018 were included in the retrospective study. Quality indicators (QIs) were adjusted mainly according to European Society of Breast Cancer Specialists (EUSOMA) and European Breast Cancer Network (EBCN) recommendations. Five QIs for therapeutic and two for diagnostic surgeries were selected. Additionally, variability in achieving the requested QIs among surgeons was analysed. Results. Between 2016 and 2018, 14 surgeons performed 1421 breast procedures in 1398 women. There were 1197 therapeutical (for proven breast cancer) and 224 diagnostic surgical interventions respectively. Overall, the minimal standard was met in two QIs for therapeutic and none for diagnostic procedures. A statistically significant improvement in three QIs for therapeutic and in one QI for diagnostic procedures was observed however, indicating that regular quality control improves the quality of surgery. A high variability in achieving the requested QIs was observed among surgeons, which remained high throughout the study period. Conclusions. Adherence to all selected surgical QIs in patients from screening program is difficult to achieve, especially to those specifically defined for screen-detected lesions. Regular quality control may improve results over time. Reducing the number of surgeons dedicated to breast pathology may reduce variability of management inside the institution.
Ključne besede: breast surgery, mammography, screening program, quality control
Objavljeno v DiRROS: 12.07.2024; Ogledov: 904; Prenosov: 342
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Ključne besede: rak, onkologija, nacionalni programi, državni program obvladovanja raka (DPOR), umetna inteligenca, imunoterapija, zborniki
Objavljeno v DiRROS: 16.05.2024; Ogledov: 1248; Prenosov: 896
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