Background/aim The development of bronchopleural fistula (BPF) remains the most severe complication of lung resection, especially after pneumonectomy. Studies provide controversial reports regarding the benefits of flap reinforcement of the bronchial stump (FRBS) in preventing BPF’s occurrence. Methods This is a retrospective cohort study of 558 patients that underwent lung resection in a 12-year period (from 2007 to 2018). Ninety patients (16.1%) underwent pneumonectomy. Patient follow-up period varied from 1 to 12 years. Results Out of 558 patients in this study, 468 (83.9%) underwent lobectomy, and the remnant underwent pneumonectomy. In 114 cases with lobectomy, only 24.4% had FRBS, meanwhile in 56 cases with pneumonectomy only 62.2% had FRBS. BPF occurred in 8 patients with lobectomy (1.7%) and in 10 patients with pneumonectomy (11.1%). Among cases with post-pneumonectomy BPF, 6 (10.7%) had FRBS performed, while no FRBS was performed among patients with post-lobectomy BPF, although these data weren’t statistically (p > 0.05). In 24 patients (20 lobectomies and 4 pneumonectomies) with lung cancer (10.4%) neoadjuvant treatment was performed, in which 20 patients underwent chemotherapy and 4 underwent radiotherapy. FRBS was applied in each of the above 24 operative cases, but only in 4 of them the BPF was verified. Conclusion The idea of enhancing the blood supply through the FRBS for BPF prevention has gain traction. Although FRBS has been identified as valuable and effective method in BPF prevention following lung resection, our study results did not support this evidence.

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Background Patients with thoracic trauma caused by gunshots face a high risk of death, and medical staff often encounter technical difficulties in resolving these cases. Most gunshot wounds result in an entrance and exit wound. In cases with no exit wound, missiles are seen in other areas with screening radiographs. The bullet may migrate depending on gravity, coughing, swallowing, blood flow, or local erosion. Case presentation We present the case of a teenager who was hospitalized in critical condition owing to a left hemithorax injury caused by an improvised explosive device. The patient underwent two surgeries: an anterior left thoracotomy during which a hole in the myocardium was sutured, and after radiography, anterolateral right thoracotomy was performed, in which a deformed projectile was found at the level of the intermediate right pulmonary artery. Conclusions This case highlights the crucial importance of repeated imaging to assess the possibility of projectile migration within the cardiovascular system in similar cases of penetrating injury. Immediate surgery was necessary and very important for the survival of our patient, despite the difficulties presented by this complicated case.

Background: Lung is often affected by metastases from other organs that are subject of surgery. The efficacy of surgical treatment in pulmonary metastases depends on type of primary tumors and several clinical factors such as: risk of metastasis in other organs, sensitivity to chemotherapy and hormonotherapy and the possibility of a new primary tumor. The aim of our study was to find the most common metastasis in lung, to evaluate the benefits of metastasectomy and the possible prognostic factors associated with overall survival after surgical treatment. Methods: This is a retrospective, descriptive study from January 2004 to December 2014. Data were examined for age, gender, primary tumor histology, operative approaches and resection margins. The surgical approach used was wedge resection in free margins confirmed also by histopathology. Kaplan-Meier analysis was used to estimate the survival data one year after metastasectomy. Results: 112 pulmonary metastasectomies were performed (males 64, females 48). Median age was 38.2 years. Definitive pathology revealed sarcoma in 54%, epithelial tumor in 36%, and melanoma in 10%. Complete resection (R0) was achieved in all patients. Average postoperative hospital length of stay was 7.4 days. The 1-year survival rates were 64% for epithelial tumors, 43% for sarcomas. Conclusions: Most common lung metastasis was sarcoma but epithelial tumor profits much more from metastasectomy. Pulmonary metastasectomy is an effective choice of treatment. Univariate analyses verified that histopathology of the tumor, disease-free interval, number of metastatic lesions, and lymph node involvement were significant prognostic factors in patients undergoing pulmonary metastasectomy. Legal entity responsible for the study: