The findings lead to the conclusion that tissue lateral thermal damage after Harmonic Scalpel application at standard output power is greater when a longer sustained period of application is used. Lateral thermal damage also is greater if the Harmonic Scalpel application time is continuous rather than of the same total duration with a brief midpoint interruption.

From 23rd World Congress of the World Society of Cardio-Thoracic Surgeons Split, Croatia. 12-15 September 2013 ObjectivesThe extend of lymph node involvement in patients NSCLC is the cornerstone of staging and influences both multimodality treatment and final outcome. We studied safety, accuracy and characteristics of intraoperative ultrasound guided systematic mediastinal nodal dissection in patients with resected NSCLC. MethodsProspective randomized trial of intraoperative surgical staging after radical surgery for NSCLC was carried out. Intraoperative hand held ultrasound probe was used in systematic mediastinal nodal dissection in 124 patients after radical surgery for NSCLC and compared with 120 patients who underwent radical surgery followed by standard systematic mediastinal nodal dissection. Mapping of the lymph nodes by their number and sation followed by histopathologic evaluation was performed. Patients data were statistically analyzed. ResultsThe surgical procedure used was comparable in both groups of patients. Operating time was prolonged for 10 (6-20) minutes in patients with US guided mediastinal nodal dissection, but number and stations of evaluated lymph nodes were significantly higher (p < 0.001) at the same group of patients. Skip nodal metasteses were found in 24 % of patients without N1 nodal involvement. We upstaged 12 (10 %) patients using US guided mediastinal lyphadenectomy. Median follow-up was 38 (range 10-52) months. Standard staging system seemed to be improved in US guided mediastinal lyphadenecetomy patients.Complication rate showed no difference between analyzed groups of patients. ConclusionHigher number and location of analyzed mediastinal nodal stations in patients with resected NSCLC using hand held ultrasound probe siggested to be of great oncological significance. Procedure showed absolute safety and high accuracy. Our results indicate that intraoperative US may have important staging implication. Further clinical studies should be performed in order to improve intraoperative staging in NSCLC patients.

Conclusions: This meta-analysis shows a modest but significant improvement in overall survival and local failures at the expense of a clearly increased severe esophagitis. Difficulties of increased treatment frequency and the continuous therapy over weekends make these strategies hard to adopt. On the other hand, due to the heterogeneity of altered fractionation modalities among the trials included, our results should be considered with caution and must be interpreted as an hypothesis generator. TRIAL n HFRT type Chemotherapy Median OS p Ball 204 60 Gy in 3 wks Weekly CBDCA 14.7 vs 15.4 ns Saunders (CHART)

The aim of this study was to analyse the expression of PD-L1 in non-small cell lung cancer (NSCLC) and its correlation with immune microenvironment response (IMR), clinic-pathological parameters, and outcome. The sample included 76 male and 32 female patients who underwent surgical resection. The mean age of the males was 66 years, and that of the females was 64 years. Adenocarcinoma (ADC) was diagnosed in 68 (63%) cases, squamous cell carcinoma in 35 (32%) cases, and NSCLC (not otherwise specified) in 5 (5%) cases. Metastatic lymph nodes were found in 38 (36%) patients, 18 with N1 nodes and 20 with N2 nodes. PD-L1 expression was valuated as the percentage of positive cancer cells among all cancer cells. Gender, age, and histologic type were not associated with PD-L1 expression (all p > 0.05). The subtypes of ADC were associated with PD-L1 expression (p = 0.050). The papillary subtype was 4.3 times more common among PD-L1 negative than PD-L1 positive ADC; the solid subtype was 1.9 times more common among PD-L1 positive than PD-L1 negative ADC. IMR was predominantly strong in 19 cases, weak in 36, and absent in 53 cases. The median value of PD-L1 expression in cancer cells was positively correlated with IMR (p = 0.039). PD-L1 expression was not correlated with overall survival (p = 0.643). The patients with strong, inflammatory-like IMR had an average survival time that was 12 months longer than patients with absent/low IMR (LR = 2.8; p = 0.132). In conclusion, the papillary subtype was more commonly PD-L1 negative in comparison with other subtypes of ADC. Positive PD-L1 expression in tumour cells was connected with strong, inflammatory-like IMR. Patients with strong IMR tended to experience better outcomes. Further investigations are needed on larger-scale cohorts to elucidate the insights of this descriptive study.

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