Thoraxchirurgie

When to operate: procalcitonin as a predictive factor in parapneumonic empyema

Abstract: 
Objective: The objective of this retrospective study is to evaluate the clinical value of procalcitonin (PCT) plasma concentration in its preoperative course before decortication of parapneumonic pleural empyema. We hypothesize that the PCT is a valuable factor in determining the time to operate regarding its attribute to evaluate the course of infection. It might predict the regression of pneumonia and the decrease of systemic inflammation and thus a fitter patient for surgery. 

Conclusion: Our patients show a favorable postoperative course with almost no complications after pleurektomie and decortication. They might benefit from a longer preoperative period while recovering from pneumonia and therefore be fitter for surgery with a shorter postoperative length of stay with less complications. Altough this approach might extend the time prior to operation the overall lenght of stay is retrospectively not prolonged and complications are less comparing to the current literature. Preoperative PCT might be a usefull co-factor in determining this timing for operation. 

Komplettes Abstract

PET-CT or contrast-CT for active surveillance after curative lung cancer treatment: preliminary results of a prospective randomized trial.

Abstract:
Introduction: The first two years after curative treatment of non small cell lung cancer (NSCLC) represent the high risk period in terms of cancer recurrence. Although scientific data are scares most thoracic societies recommend active surveillance. Both, PET-CT and contrast-CT are suitable modalities for post treatment surveillance of NSCLC patients. The purpose of this study was to investigate the specificity and positive predictive value of PET-CT and contrast-CT in the post treatment surveillance of NSCLC patients in a randomized prospective manner. 
Results: So far 89 patients have been included (49 PET-CT and 40 contrast-CT, respectively), a complete dataset is available for 56 patients (33 and 22, respectively). Asymptomatic recurrence was diagnosed in 17 (51%) and 14 (63%) patients, respectively. The specificity and positive predictive values of the two imaging modalities were 64% / 60% and 70% / 69%, respectively. Conclusion: So far PET-CT and contrast-CT seem to have comparable specificities and positive predictive values in the post-treatment surveillance setting of NSCLC patients. Further analyses of the current data are planned.  A comparison of the costs of the two modalities will be of particular concern. 

Komplettes Abstract