The only way to cure the patient with adenocarcinoma of the pancreas (RT) is surgical excision of the tumor. The standard surgical treatment of resectable pancreatic carcinoma is considered the classic pancreatoduodenectomy (PD) with the Kausch- Whipple procedure, or the pylorus-preserving PD with the Traverso-Longmire method. The most difficult technically and at the same time the most important PD stage from an oncological point of view is the separation of the head of the pancreas from the superior mesenteric artery. Over the last decades several PD modifications have been developed, focusing on this maneuver in the early phase of the operation, i.e. before the pancreas is cut (an irreversible stage of the procedure). These procedures in the English literature are called "artery-first approach" or "SMA-first approach". The term "mesopancreas" was created. Complete removal of the mesopancreas together with the proximal part of the jejunum is considered an R0 resection in the case of a tumor of the head of the pancreas with direct or indirect vascular invasion, or metastases to regional lymph nodes, and in English literature it is referred to as pancreatoduodenectomy with systematic mesopancreas dissection (SMDPD). Distal resection of the pancreas (DRT) due to cancer, is associated with a high percentage of positive margins, insufficient number of removed lymph nodes, low survival rates. A new technique was developed - a radical proximal-distal modular pancreatosplenectomy (RAMPS). In RAMPS, surgical operations proceed from the side of the pancreas head towards the tail, the pancreas is cut early, and the splenectomy is performed at the final stages of the procedure. Currently, following the PD model, attempts are made to further modify the original RAMPS technique, especially in the direction of SMA-first approach. In patients with borderline resectable pancreatic tumors or locally advanced tumors, after neoadjuvant treatment, a technique of radical resection with preservance of arterial vessels - "the TRIANGLE operation" has been elaborated. Despite the tremendous progress of surgical techniques, RT is still detected too late in the phase preventing effective resection.

Open esophagectomy (OE) requires extensive surgery and is associated with significant morbidity and mortality. Furthermore, the long-term results of esophageal cancer surgery are not satisfactory; hence, the best surgical approach is constantly under debate. During the last twenty years, minimally invasive esophagectomy (MIE) employing laparoscopy and/or thoracoscopy has been introduced in a growing number of centers worldwide. To date, several studies have demonstrated that MIE has better outcomes than OE, as it results in shorter hospital stay and decreased overall morbidity. However, the length of operating time in MIE is increased in comparison to OE. The survival benefit has been demonstrated to be similar in OE and MIE. Highly advanced laparo-thoracoscopic skills are required to perform MIE; along with the relatively long learning curve, this makes MIE feasible only in high-volume, experienced university surgical centers. There is a need for further large-scale comparative studies to prove the superiority of MIE over open surgery.

StreszczenieNeuromonitoring (intraoperative neurophysiological monitoring -IONM) jest nową nieinwazyjną techniką, niestanowią-cą dodatkowego obciążenia dla pacjenta. Chirurg za pomocą sondy stymulacyjnej poszukuje w polu operacyjnym nerwu krtaniowego wstecznego. W momencie gdy sonda znajduje się w pobliżu nerwu, system IONM powiadamia o tym sygnałem dźwiękowym i wizualnym. W trakcie stymulacji nerwu pobudzane są mięśnie głosowe, a w rezultacie struny głosowe zaciskają się w rytm podawanych impulsów prądowych na elektrodzie odbiorczej naklejonej na rurkę intubacyjną pacjenta. Neuromonitoring wymaga ścisłej współpracy chirurga z anestezjologiem. System IONM nie zastąpi jednak umiejętności technicznych i gruntownej znajomości warunków anatomicznych szyi. Jego zastosowanie w znaczny sposób poprawia bezpieczeństwo pacjenta i komfort pracy chirurga. Autorzy pracy, na podstawie literatury i własnych doświadczeń, opisali standardy postępowania obowiązujące w neuromonitoringu oraz problemy praktyczne, które mogą wystąpić w trakcie jego stosowania, i sposoby ich rozwiązywania. Słowa kluczowe: neuromonitoring, nerw krtaniowy wsteczny, chirurgia tarczycy. THORACIC SURGERY AbstractNeuromonitoring (intraoperative neurophysiological monitoring -IONM) is a new non-invasive technique, which does not place any additional strain on the patient. The surgeon uses a stimulation probe to search for the recurrent laryngeal nerve within the surgical site. IONM provides auditory and visual cues when the probe is in the vicinity of the nerve. During the stimulation of the nerve, vocal muscles are stimulated as well, which causes the vocal cords to tighten to the rhythm of the electric pulses fed to the recording electrode attached to the endotracheal tube. Neuromonitoring requires close cooperation between the surgeon and the anesthesiologist. IONM cannot serve as a substitute for technical skills and thorough knowledge of neck anatomy. Its use significantly improves patient safety and the comfort of the surgeon. Based on the literature and their own experience, the authors of the article describe the standards of the neuromonitoring procedure, the problems that may occur during its use, as well as solutions for these problems.