OBJECTIVES Exercise testing is an additional tool to standard pulmonary assessment before radical pulmonary resection in lung cancer patients. Evidence is lacking, supporting the significance of routine implementation of these simple physiological tests in preoperative evaluation. METHODS Between April 2009 and October 2011, 253 lung cancer patients, who underwent lobectomy in a single institution, were entered into this study. All of the patients were accepted for resection based on a standard evaluation protocol. Additionally on the day before the surgery, patients performed a 6-min walk test (6MWT). Patients were categorized, depending on the result of 6MWT, in order to stratify their risk of postoperative complications. Threshold values of 6MWT were assessed on the basis of maximum area under ROC curves. RESULTS There were 148 men and 105 women with a mean age of 63 years. All patients underwent lobectomies due to primary lung cancer. A distance of 500 m and 100% of the predicted 6MWT were taken as threshold values differentiating risk of postoperative complications. The cut-off value of 500 m separates individuals with an increased risk of postoperative complications [60.6 vs 36.9%, odds ratio (OR): 2631; 95% confidence interval (CI): 1.423–4.880] and prolonged hospitalization (7 vs 6 days). By applying a cut-off value of 500 m, the higher incidence of atrial fibrillation (21.2 vs 11.7%; OR: 2019; 95% CI: 0.904–4.484) and higher requirement for blood transfusion (18.1 vs 9.0%; OR: 2222; 95% CI: 0.928–5.289) fairly reached the level of significance. There were no early postoperative deaths in the analysed groups. CONCLUSIONS Patients who walk <500 m during the 6MWT before lobectomy have an increased risk of postoperative complications and prolonged hospital stay.

Catamenial pneumothorax should be defined as recurrent accumulation of air in the pleural cavity in reproductive-age women without concomitant respiratory diseases. The sine qua non criterion is the occurrence of the pneumothorax in the period of 72 hours before or after the menses. Additional...

In recent years, much research has been focused on the field of adoptive cell therapies (ACT) that use native or genetically modified T cells as therapeutic tools. Immunotherapy with T cells expressing chimeric antigen receptors (CARs) demonstrated great success in the treatment of haematologic malignancies, whereas adoptive transfer of autologous tumour infiltrating lymphocytes (TILs) proved to be highly effective in metastatic melanoma. These encouraging results initiated many studies where ACT was tested as a treatment for various solid tumours. In this review, we provide an overview of the challenges of T cell-based immunotherapies of solid tumours. We describe alternative approaches for choosing the most efficient T cells for cancer treatment in terms of their tumour-specificity and phenotype. Finally, we present strategies for improvement of anti-tumour potential of T cells, including combination therapies.

Due to its debilitating character pneumonectomy this is last-resort procedure. Preoperative results of the 6-min walking test (6MWT) help to identify high risk of postoperative complications and increased mortality in patients undergoing lobectomy for lung cancer. The aim of the study was to validate the value of 500 m in 6MWT as an indicator, which differentiates risk of complications in patients undergoing pneumonectomy. 125 patients who underwent pneumonectomy at Thoracic Surgery Department between 2009 and 2018. On the day preceding the surgery, patients underwent 6MWT. The patients were in median age of 63 years. The cut-off value of 500 m identified patients with increased 90-day mortality [17.9% vs. 3.5%, odds ratio (OR) 6.271, 95% confidence interval (CI) 1.528–25.739], first-year mortality (30.7% vs. 11.6%, OR 3.378, 95% CI 1.310–8.709), and overall survival (p = 0.02). Patients who covered a distance ≤ 500 m had an increased risk of atrial fibrillation (35.9% vs. 16.3%, OR 2.880, 95% CI 1.207–6.870) and cardiac complications (38.4% vs. 19.8%, OR 2.537, 95% CI 1.100–5.849). Patients unable to reach 500 m in 6MWT are in a high risk of postoperative death after pneumonectomy, what may be a result of increased frequency of postoperative cardiac complications. Poor result of 6MWT is a predictor of worse overall survival.

New drugs, including immune checkpoint inhibitors and targeted therapy, have changed the prognosis in a subset of patients with advanced lung cancer, and are now actively investigated in a number of trials with neoadjuvant and adjuvant regimens. However, no phase III randomized studies were published yet. The current narrative review proves that targeted therapies are safe in neoadjuvant approach. Unsurprisingly, administration of therapy is related to an acceptable toxicity profile. Severe adverse events’ rate that rarely compromises outcomes of patients with advanced lung cancer is not that commonly accepted in early lung cancer as it may lead to missing the chance of curative surgery. Among those complications, the most important factors that may limit the use of targeted therapies are severe respiratory adverse events precluding the resection occurring after treatment with some anaplastic lymphoma kinase and rarely after epidermal growth factor receptor tyrosine kinase inhibitors. At this point, in the presented literature assessing the feasibility of neoadjuvant therapies with anaplastic lymphoma kinase and epidermal growth factor receptor tyrosine kinase inhibitors, we did not find any unexpected intraoperative events that would be of special interest to a thoracic surgeon. Moreover, the postoperative course was associated with typical rate of complications.