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Background: 60% of patients diagnosed with lung cancer are older than 65 years and are at risk for substandard treatment due to a reluctance to recommend surgery. Pneumonectomy remains a high risk procedure especially in elderly patients. Nevertheless, the impact of age and neoadjuvant treatment on outcomes after pneumonectomy is still not well described. Methods: We performed a multicentric retrospective study, analyzing outcomes of patients older than 70 years who underwent pneumonectomy for central primary lung malignancy between January 2009 and June 2019 in 7 thoracic surgery departments: Lucerne and Bern (Switzerland), Hamilton (Canada), Alicante (Spain), Monza (Italy), London (UK), Leuven (Belgium). Survival was estimated with Kaplan-Meier, and differences in survival were determined by log-rank analysis. We investigated pre-and post-operative prognostic factors using Cox proportional hazards regression model; multivariable analysis was performed only with variables, which were statistically significant at the invariable analysis. Results: A total of 136 patients were included in the study. Mean age was 73.8 years (SD 3.6). 24 patients (17.6%) had an induction treatment (chemotherapy alone in 15 patients and chemo-radiation in 9). Mean length of stay (LOS) was 12.6 days (SD 10.39) and 74 patients (54.4%) had experienced a post-operative complication: 29 (21.3%) had a pulmonary complication, 33 (24.3%) had a cardiac complication and in 12 cases (8.8%) patients experienced both cardiac and pulmonary complications. 16 patients were readmitted [median LOS 13.7 days (range, 2-39 days)] and of those 14 (10.3%) required redo surgery. Median overall survival (OS) of the entire cohort was 38 months (95% CI: 29.9-46.1 months); in-hospital mortality was 1.5%, 30-day mortality rate was 3.7%, while 90-day mortality was 8.8% accounting for 5 and 12 patients respectively. Patients receiving neo-adjuvant therapy did not experience a higher incidence of postoperative complications (P=0.633), did not have a longer postoperative course (P=0.588), nor did they have an increased mortality rate (P=0.863). Conclusions: Age should not be considered an absolute contraindication for pneumonectomy in elderly patients even after neoadjuvant treatment. It has become apparent that especially in these patients, a patient tailored approach with a careful selection should be used to define the risk-benefit balance.

Introduction: Lobar lung transplantation is an option which provides the possibility to transplant an urgent listed recipient of small size with a size mismatched donor lung. We report our short and long term results with bilateral lobar lung transplantation with long term outcomes. Material and [for full text, please go to the a.m. URL], 130. Kongress der Deutschen Gesellschaft für Chirurgie

Ziel: Unsere 11-jährige Erfahrung am Universitätsspital Zürich mit Induktions-Chemotherapie und extrapleuraler Pneumonektomie (EPP) für das Maligne Pleuramesotheliom (MPM) zusammenzufassen. Methodik: Patienten mit histologisch bewiesenem MPM (alle Subtypen), eines Stadiums cT1-3[for full text, please go to the a.m. URL], Gemeinsame Jahrestagung der Deutschen, Österreichischen und Schweizer Gesellschaft für Thoraxchirurgie

Hintergrund: Die thorakoskopische Resektion von mediastinalen Tumoren ist machbar, die Indikationen sind aber aufgrund der limitierten Beweglichkeit der Instrumente und der zwei-dimensionale Sicht beschränkt. Wir haben den Einsatz des Da Vinci® Telemanipulators für Resektionen von unterschiedlichen[for full text, please go to the a.m. URL], 16. Jahrestagung der Deutschen Gesellschaft für Thoraxchirurgie

Background: In patients with a centrally located broncho-pulmonary lesion, sleeve resection is the operation of choice in order to avoid a pneumonectomy. Most centers wrap the bronchial anastomoses with viable tissue to protect them from insufficiencies. In this study we report our single center experience[for full text, please go to the a.m. URL], Gemeinsame Jahrestagung der Deutschen, Österreichischen und Schweizer Gesellschaft für Thoraxchirurgie

Chronic obstructive pulmonary disease (COPD) is a very heterogeneous disease characterised by an obstructive lung pattern that constitutes worldwide a major cause of high morbidity and mortality. In the last decades, lung volume reduction surgery (LVRS) has demonstrated to be a potential good alternative to transplantation in patients affected by COPD. The trend toward minimally invasive techniques resulted not only in surgical procedures better tolerated by the patients but also in several endoscopic treatments modality that are rapidly gaining ground.

Background: Postpneumonectomy syndrome (PPS) is a rare complication after pneumonectomy. It consists of an excessive mediastinal shift resulting in compression and stretching of the tracheobronchial tree and the esophagus. The aim of this study was to give a comprehensive overview of diagnosis, variety of symptoms and evaluation of surgical treatment of PPS. Methods: We retrospectively reviewed the charts of all our patients with PPS since 1994 with respect to symptomatology, treatment and outcome. Our results were compared with case reports and case seriesintheliterature.Results:Sixwomenwithamedianageof56.5years(range49—65)developedPPSafterpneumonectomyforthetreatment of lung cancer. Four presented with a right PPS and two with a left PPS, respectively. Symptomsconsisted of shortness of breath in all patients and dysphagia as well as heartburn in two patients. Correction of PPS required re-exploration of the pneumonectomy space, reposition of the mediastinum followed by the insertion of single silicone prosthesis in five patients or fixation of the mediastinum with a xenopericardial graft in one patient. We could observe an improvement of the FEV1/FVC ratio in all our patients and the clinical improvement of shortness of breath was better than we expectedby changes of lung function.Four patients returnedto theirregular activities with a follow-up of four years. We found 73 cases of PPS in the literature, on the right side in 50 patients (68%) and on the left side in 23 patients (32%). Fifty-nine patients (81%) were treated surgically. Symptoms can be suspicious for cardiogenic origin and vary from heartburn to recurrent syncopes. Conclusion: PPS is rare and not predictable.Itcanoccurafterrightorleftpneumonectomy. Symptomsaremanifoldandresult fromashift,leadingto compressionandstretching of the two conduits located within the mediastinum, the tracheobronchial tree and the esophagus and consists of shortness of breath, stridor and heartburn. Diagnosis must be made by exclusion. Implantation of prosthesis is the most commonly used and effective treatment. # 2008 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.