The pandemic spread of the COVID-19 virus significantly affected daily life, but the highest pressure was piled on the health care system. Our aim was to evaluate an impact of COVID-19 pandemic management measures on cancer services at the National Cancer Institute (NCI) of Lithuania. We assessed the time period from 1 February 2020 to 31 December 2020 and compared it to the same period of 2019. Data for our analysis were extracted from the NCI Hospital Information System (HIS) and the National Health Insurance Fund (NHIF). Contingency table analysis and ANOVA were performed. The COVID-19 pandemic negatively affected the cancer services provided by NCI. Reductions in diagnostic radiology (−16%) and endoscopy (−29%) procedures were accompanied by a decreased number of patients with ongoing medical (−30%), radiation (−6%) or surgical (−10%) treatment. The changes in the number of newly diagnosed cancer patients were dependent on tumor type and disease stage, showing a rise in advanced disease at diagnosis already during the early period of the first lockdown. The extent of out-patient consultations (−14%) and disease follow-up visits (−16%) was also affected by the pandemic, and only referrals to psychological/psychiatric counselling were increased. Additionally, the COVID-19 pandemic had an impact on the structure of cancer services by fostering the application of modified systemic anticancer therapy or hypofractionated radiotherapy. The most dramatic drop occurred in the number of patients participating in cancer prevention programs; the loss was 25% for colon cancer and 62% for breast cancer screening. Marked restriction in access to preventive cancer screening and overall reduction of the whole spectrum of cancer services may negatively affect cancer survival measures in the nearest future.

Background. Bronchopleural fistulas (BPFs) development after pneumo nectomy remains a serious complication and is associated with high mortality rate. We evaluated incidence and risk factors, that influenced BPF rate after pneumonectomies for lung cancer patients treated at the Department of Thoracic Surgery and Oncology of the Institute of Oncology, Vilnius University, and compared different bronchial stump suturing techniques. Methods. It is a retrospective study. We reviewed 580 lung cancer patients who underwent pneumonectomies from January 1990 to January 2009. The average patient's age was 60.1 ± 7.9 years (range from 34 to 76). Patients according to postoperative staging: stage IIA-30 patients, IIB-80, IIIA-320, IIIB-96, IV-54. The most common tumor histology was planocellular carcinoma-301, adenocarcinoma-108, small-cell carcinoma-76. Results. There were 327 (56.4%) right and 253 (43.6%) left pneumonectomies. Mediastinal lymph node dissection (LND) was performed to 387 (66.7%) and lymph node sampling (LNS) to 193 (33.3%) patients. The bronchial stump was covered in 285 (49.1%) patients. Bronchopleural fistula after pneumonectomy developed in 48 (8.3%) patients (bronchial dehiscence was confirmed by bronchoscopy), and 7 patients with BPF died (14.5%). BPF after right pneumonectomy occurred in 30 cases (9.5%) and after left pneumonectomy in 18 cases (7.1%), the difference was not statistically significant (p > 0.05). BPF after LND occurred in 38 cases (9.82%) and after LNS in 10 cases (5.18%), the diff erence was statistically significant (p < 0.05). BPF rate using suturing devices with changeable staples (UKL-40, UKL-60, UO-40, UO-60) was 12.6%, using me chanical staplers and handmade suture it was 4.1% and 8.8%, respectively. The difference between the groups was statistically significant (p = 0.0071). Conclusions. 1. BPF rate after pneumonectomies for lung cancer patients was lowest using mechanical staplers (4.1%). 2. BPF occurrence rate after right and left pneumonectomy had no statistically significant difference. 3. BPF rate after pneumonectomy was higher in the LND group (9.82%) than in the LNS group (5.18%), the difference was statistically significant (p < 0.05).

Background. The study objective is to evaluate the efficacy of pump operations in locally advanced IIIB (T4N0-1M0) lung cancer and other thoracic malignancies and the results of treatment. Materials and methods. In the period 2003–2011, 6 patients (pts) with locally advanced thoracic malignancies underwent surgery in the Center of Cardiac Surgery of Vilnius University Hospital Santariskiu Clinics (VUH SC). Patients’ characteristics and stage: lung cancer – 3 pts (50.0%), stage IIIB (T4N0-1M0), sarcoma of mediastinum – 2 pts (33.3%), fibrous tumour of mediastinum – 1 pt (16.7%). Patients according to morphology: squamous cell carcinoma – 3 pts (50.0%), neuroangiosarcoma – 1 pt (16.7%), neurosarcoma – 1 pt (16.7%), solitary fibrous tumour – 1 pt (16.7%). After surgery patients received adjuvant treatment: 3 pts with lung cancer received 4 cycles of chemotherapy Gemcitabine with cisplatinum, 2  pts with angiosarcoma received radiation therapy 66 Gy and 6 cycles of chemotherapy Ifosfamide. Results. We performed pneumonectomy with left atrium resection  –  2  pts (33.3%), left pneumonectomy with aorta resection  –  1  pt (16.7%), left atrium resection with left upper lobectomy  –  1  pt (16.7%), mediastinum resection with chest wall reconstruction – 1 pt (16.7%), left pneumonectomy – 1 pt (16.7%). We had no complications after pump operations. Median survival of patients with lung cancer was 2.5 ± 0.5 years, with angiosarcoma 3.5 ± 1.0 years. Five-year survival was 25%. Conclusions. 1. Pump operations are safe and possible in locally advanced thoracic malignancies. 2.  Pump operations and adjuvant treatment may prolong median survival in IIIB (T4N0-1M0) lung cancer patients by 2.5 ± 0.5 years and in angiosarcoma patients by 3.5 ± 1.0 years.

AbstractThe development of non-small-cell lung cancer (NSCLC) is a multistep process, which is triggered and maintained by various factors. Many steps of non-small-cell lung carcinogenesis, risk factors and biomarkers have been identified; however no consistent model has been established of personalized medicine for these patients. Distinct various gene expression, products of mutated genes and other markers such as circulating nucleic acids or tumor cells has been proven to be potential biomarkers of non-small cell lung cancer as well as potential targets for new treatment strategies. This article will highlight promising biomarkers in non-small cell lung cancer prognosis.

Saulius Cicėnas, Pranas Naujokaitis, Dainius Piščikas, Arnoldas Krasauskas, Renatas AškinisVilniaus universiteto Onkologijos instituto Krūtinės chirurgijos ir onkologijos skyrius,Santariškių g. 1, LT-08660 VilniusEl paštas: cicenas@loc.lt Tikslas Įvertinti mediastinoskopijos svarbą diagnozuojant plaučių vėžio plitimą į tarpuplaučio limfmazgius, šios procedūros komplikacijas ir patikimumą. Ligoniai ir metodai Vilniaus universiteto Onkologijos instituto Krūtinės chirurgijos ir onkologijos skyriuje 2001–2006 m. buvo atliktos 184 kaklinės mediastinoskopijos, kurių tikslas – įvertinti plaučių vėžio plitimą į tarpuplaučio limfmazgius. Mediastinoskopijos metu 85 (46,2%) ligoniams buvo pašalinti limfmazgiai iš kairės ir dešinės tarpuplaučio zonų, 15 (8,2%) ligonių – iš trachėjos keteros viršutinių ir apatinių zonų ir 84 (45,6%) ligoniams limfmazgiai buvo šalinami iš visų mediastinoskopijos metu prieinamų limfmazgių zonų (tarp jų 6 (7,1%) ligoniams iš kairės pusės aortos pulmoninių limfmazgių). Rezultatai Komplikacijų buvo 18 (9,8%) ligonių: kraujavimas iš dešinės pusės arterijos (A1) – 2 (1,1%) ligoniams, pneumotoraksas – 9 (4,9%), mediastinitas – 1 (0,5%), tarpuplaučio hematoma – 3 (1,6%), žaizdos supūliavimas – 3 (1,6%). Naviko diagnozė morfologiškai buvo patvirtinta 65,3% atvejais. Atliekant mediastinoskopiją, iš pradžių buvo palpaciniu būdu patikrinamas priekinis tarpuplautis bei šalinami padidėję, kieti tarpuplaučio limfmazgiai. Kraujavimas stabdytas prideginant ar naudojant metalinius spaustukus. Dažniausiai tarpuplautis nebuvo drenuojamas, tačiau baigus procedūrą tarpuplautyje buvo paliekama hemostatinė kempinė. Tyrimo jautrumas pasiektas 81% atvejų, specifiškumas – 100%, tikslumas – 97%, teigiama dianostinė vertė – 1,0%, neigiama – 0,91%. Išvados Kaklinė mediastinoskopija yra tikslus (97% atvejų), jautrus (81%) ir specifiškas (100%) plaučių vėžio plitimo į tarpuplaučio limfmazgius mikroinvazinis diagnostikos metodas. Įvaldžius šio metodo technines galimybes, galima saugiai pašalinti (atlikti biopsijas) iš įvairių zonų visus įtartinus tarpuplaučio limfmazgius. Morfologiškai diagnozė buvo patvirtinta 65,3% atvejų. Pooperacinių komplikacijų skaičius siekė 9,8%. Mirčių nebuvo. Pagrindiniai žodžiai: mediastinoskopija, plaučių vėžys, plitimas į tarpuplaučio limfmazgius Cervical mediastinoscopy in evaluating lung cancer metastases Saulius Cicėnas, Pranas Naujokaitis, Dainius Piščikas, Arnoldas Krasauskas, Renatas AškinisVilnius University, Institute of Oncology, Department of Thoracic Surgery and Oncology,Santariškių str. 1, LT-08660 Vilnius, LithuaniaE-mail: cicenas@loc.lt Objective To evaluate role of cervical mediastinoscopy in the diagnosis of lung cancer metastases to mediastinal lymph nodes, complication rate and prevalence. Patients and methods In 2001–2006, 184 cervical mediastinoscopies were performed at Department of Thoracic Surgery and Oncology, Institute of Oncology, Vilnius University. In 85 (46.2%) pts lymph nodes were removed from the left and right mediastinal zones, in 15 (8.2%) pts from supra and infra carinal regions, and in 84 (45.6%) pts lymph nodes were removed from all accessible zones in the mediastinum (including 6 (7.1%) pts from the left aorto-pulmonar region). Results Complications after the procedures were observed in 18 (9.8%) pts: bleeding from the right superior artery (A1) 2 (1.1%) pts, pneumothorax – 9 (4.9%) pts, mediastinitis – 1 (0.5%) pt, hematoma of mediastinum – 3 (1.6%) pts and vulnar infection – 3 (1.6%) pts. Morphology was achieved in 65.3% of cases. During mediastinoscopy, the front mediastinum was examined by finger and enlarged lymph nodes were removed. Bleeding was stopped by cautery and using clips. Routinely we leave the hemostatic sponge in the mediastinum. No drainage was used. Sensitivity was achieved in 81% cases, specificity in 100% cases, accuracy in 97% cases, positive predictive value – 1%, negative – 0.91% cases. Conclusions Cervical mediastinoscopy is an accurate (97%), sensitive (81%), specific (100%) diagnostic method of lung cancer speard to the mediastinum. For an experienced physician, this method is safe and allows removing lymph nodes from various regions of the mediastinum. The diagnosis was morphologically proved in 65.3% of cases. Postoperative complication rate was 9.8% cases. We had no deaths after the procedures. Keywords: mediastinoscopy, lung cancer, spread to mediastinum lymph nodes