Faculty of Medicine

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Evaluation of the surgical treatment of lung cancer
(European Respiratory Society, 2024-09)
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R Cholanceski
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N Jakupi
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M Bogdanovska
Lung cancer is the most common malignancy in men and in the entire human population. It is considered that 2,200,000 new patients are detected annually in the world (Globcan 2020), 475,000 in Europe (Globcan 2020), i.e. 1,135 in the Republic of North Macedonia (Globcan 2020). The treatment is multimodality and several factors influence its choice. Surgical treatment is one of the modalities of treatment and its application depends on numerous factors - histological structure of the tumor, stage of the disease, satisfactory respiratory reserves, satisfactory cardiac reserves, general condition of the patient, etc. At the clinic for thoracic and vascular surgery in 2022, only 59 patients were surgically treated, which is 85% of the total surgically treated in the Republic of North Macedonia. Of the 59 patients, 44 (74.6%) are men, the average age of the operated patients is 64.22 years and 37 (62.7%) underwent neoadjuvant chemotherapy preoperatively to reduce the tumor and stage of the disease. Patients who were operated on were mostly in IIIA stage 16 (27.12%). The small percentage of operated patients, 7.7%, and the particularly high percentage of operated patients at an advanced stage indicates that patients are detected at an advanced stage of the disease, which is a contraindication for surgery. Introduction of screening for lung cancer using computed tomography in risk groups will significantly change the therapeutic approach to this group of patients, as well as the outcome of treatment of this group of patients.
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Our experiences in the surgical approach to the treatment of lung cancer
(Peytchinski Publishing Ltd, Pleven, Bulgaria, 2024)
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Risto Cholanceski
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It is considered that 2,200,000 new patients with lung cancer are detected annually in the world (Globcan 2020), i.e. 1,135 in the Republic of North Macedonia (Globcan 2020), of which only 59 patients were surgically treated at the thoracic and vascular surgery clinic in 2022, which is 85% of the total surgically treated in the Republic of North Macedonia. The use of oncological drugs before surgical treatment can contribute to the application of surgery in cases where it was not possible, as well as reduce the tumor so that a less extensive surgical procedure can be applied. At the Thoracic and Vascular Surgery Clinic, of 59 patients surgically treated for lung cancer, 49 (83%) were treated with open anterolateral thoracotomy, and lobectomy with lymphadenectomy was most commonly performed in 41 (49.5%). Early diagnosis of lung cancer, using computed tomography screening, would allow the use of less aggressive approaches, such as videothoracoscopic surgery, robot-assisted surgery, and the use of less extensive lung resections such as segmentectomies with lymphadenectomy.
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Modalities of surgical approach in the treatment of lung cancer
(MIT University Skopje, 2024-03)
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Lung cancer is the most common malignancy in men and in the entire human population. It is considered that 2,200,000 new patients are detected annually in the world (Globcan 2020), i.e. 1,135 in the Republic of North Macedonia (Globcan 2020), of which only 59 patients were surgically treated at the thoracic and vascular surgery clinic in 2022, which is 85% of the total surgically treated in the Republic of North Macedonia.1 Numerous surgical techniques of lung resections are at our disposal in the treatment of lung malignancy, from wedge resection, segmentectomy, lobectomy and pneumectomy, which depends on the stage of the disease, localization of the tumor, involvement of other structures, functional reserves, etc. Lobectomy with lymphadenectomy is still a standard surgical technique in the treatment of early lung cancer (stage I and II non-small cell cancer). The use of oncological drugs before surgical treatment can contribute to the application of surgery in cases where it was not possible, as well as reduce the tumor so that a less extensive surgical procedure can be applied. At the Thoracic and Vascular Surgery Clinic, of 59 patients surgically treated for lung cancer, 49 (83%) were treated with open anterolateral thoracotomy, and lobectomy with lymphadenectomy was most commonly performed in 41 (49.5%).Early diagnosis of lung cancer, using computed tomography screening, would allow the use of less aggressive approaches, such as videothoracoscopic surgery, robot-assisted surgery, and the use of less extensive lung resections such as segmentectomies with lymphadenectomy.
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Evaluation of the surgical treatment of lung cancer
(Department of Anaesthesia and Reanimation, Faculty of Medicine, "Ss. Cyril and Methodius " University, Skopje, R.N. Macedonia, 2024-03)
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Cholanceski R
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Jakupi N
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Bogdanovska M
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Tolevska N
Lung cancer is the most common malignancy in men and in the entire human population. It is considered that 2,200,000 new patients are detected annually in the world (Globcan 2020), 475,000 in Europe (Globcan 2020), i.e. 1,135 in the Republic of North Macedonia (Globcan 2020). The treatment is multimodal, and several factors influence its choice. Surgical treatment is one of the modalities of treatment and its application depends on numerous factors -histological structure of the tumor, stage of the disease, satisfactory respiratory reserves, satisfactory cardiac reserves, general condition of the patient, etc. At the clinic for thoracic and vascular surgery in 2022, only 59 patients were surgically treated, which is 85% of the total surgically treated in the Republic of North Macedonia. Out of the 59 patients, 44 (74.6%) were men. The average age of the operated patients was 64.22 years, and 37 (62.7%) underwent neoadjuvant chemotherapy preoperatively to reduce the tumor and stage of the disease. Patients who were operated on were mostly in IIIA stage 16 (27.12%). The small percentage of operated patients, 7.7%, and the particularly high percentage of operated patients at an advanced stage indicates that patients are detected at an advanced stage of the disease, which is a contraindication for surgery. Introduction of screening for lung cancer using computed tomography in risk groups will significantly change the therapeutic approach to this group of patients, as well as the outcome of their treatment.
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Genetic Alteration Profiling in North Macedonian Lung Cancer Patients
(MDPI AG, 2025-10-10)
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Background/Objectives: Late diagnosis and inefficient treatment regimens lead to poor prognosis, with a low 5-year survival rate for both non-small-cell lung cancer (NSCLC) and small-cell lung cancer (SCLC). New targeted therapeutic agents can be developed and introduced only by first discovering new driver oncogenes and with a thorough investigation of the known driver genes. The aim of the current study is to investigate the prevalence of alterations in the eight most frequently altered genes in lung cancer-BRAF, EGFR, KRAS, ALK, ROS1, HER2, PD-L1 and PIK3CA. Methods: Real-time polymerase chain reaction (RT-PCR) was used to detect KRAS and EGFR mutations, multiplex PCR and microarray hybridization for KRAS/BRAF/PIK3CA mutations. Immunohistochemical analysis was performed for the detection of ALK, HER2/NEU, ROS-1 and PD-L1 alterations. Results: Overall, 221/603 patients (36.65%) had at least one genetic alteration, of which 22 patients (3.65%) had two genetic alterations and two patients had more than two genetic alterations. Additionally, 50 patients were identified with one or more KRAS mutations (8.29%), 45 patients with EGFR mutations (7.46%), and 1.82% with PIK3CA mutations and 0.66% with BRAF mutations. Furthermore, 50% of the co-occurring alterations were either on KRAS and PIK3CA genes (3/6), on KRAS and BRAF genes (2/6, 33.33%) or on EGFR and PIK3CA genes (1/6, 16.67%), and 10.45% of the patients exhibited PD-L1 overexpression, 5.31% ALK rearrangements, and 2.36% HER2/NEU expression, with no ROS-1 rearrangements detected. Conclusions: Comprehensive testing for somatic alterations in EGFR, BRAF, KRAS, and PIK3CA is significant in guiding therapeutic decisions in lung cancer management. Such testing should be routinely conducted to establish a thorough genetic profile of lung cancers in a manner that is both time-efficient and cost-effective.
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BRAIN METASTASIS FROM LUNG CANCER
(Македонско лекарско друштво = Macedonian medical association, 2025-04)
Nedelkoski, Martin
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Lung cancer is the leading cause of global cancer incidence and mortality, accounting for 2,4 million new cases and 1,8 million deaths in 2022. The most common symptoms of lung cancer include persistent cough, hemoptysis, weight loss, chest pain and dyspnea. One of the most common metastatic sites of lung cancer is the brain, with intracranial involvement in approximately 20% of patients at the time of diagnosis, and although rare the initial presentation of the disease can derive from this site.
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Clinical Characteristics and Outcomes of Patients with Lung Cancer and Venous Thromboembolism
(2018)
Ruiz-Artacho P,
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Trujillo-Santos J,
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López-Jiménez L,
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Font C,
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Díaz-Pedroche MDC,
Background The natural history of patients with lung cancer and venous thromboembolism (VTE) has not been consistently evaluated. Methods We used the RIETE (Registro Informatizado Enfermedad TromboEmbólica) database to assess the clinical characteristics, time course, and outcomes during anticoagulation of lung cancer patients with acute, symptomatic VTE. Results As of May 2017, a total of 1,725 patients were recruited: 1,208 (70%) presented with pulmonary embolism (PE) and 517 with deep vein thrombosis (DVT). Overall, 865 patients (50%) were diagnosed with cancer <3 months before, 1,270 (74%) had metastases, and 1,250 (72%) had no additional risk factors for VTE. During anticoagulation (median, 93 days), 166 patients had symptomatic VTE recurrences (recurrent DVT: 86, PE: 80), 63 had major bleeding (intracranial 11), and 870 died. The recurrence rate was twofold higher than the major bleeding rate during the first month, and over threefold higher beyond the first month. Fifty-seven patients died of PE and 15 died of bleeding. Most fatal PEs (84%) and most fatal bleeds (67%) occurred within the first month of therapy. Nine patients with fatal PE (16%) died within the first 24 hours. Of 72 patients dying of PE or bleeding, 15 (21%) had no metastases and 29 (40%) had the VTE shortly after surgery or immobility. Conclusion Active surveillance on early signs and/or symptoms of VTE in patients with recently diagnosed lung cancer and prescription of prophylaxis in those undergoing surgery or during periods of immobilization might likely help prevent VTE better, detect it earlier, and treat it more efficiently.
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Video-assisted thoracic surgery (VATS) right lower lobectomy after neoadjuvant treatment – case report
(2022-01-10)
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Nexhati Jakupi
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Dzikovksi Igor
Lung cancer is the most common cause of cancer-related death in men and second-most common in women. While surgical resection offers the best chance of curing those with early-stage lung cancer, the traditional open-chest approach (called a thoracotomy) typically requires five to seven days of recovery in the hospital, with an extended recovery at home. Over the past two decades, video-assisted thoracic surgery (VATS) has revolutionized how thoracic surgeons diagnose and treat lung diseases. This video-assisted thoracic surgery (VATS) technique reduces a patient's hospital stay to about three to four days, and the patient experiences a more rapid recovery with less pain after VATS lobectomy surgery as compared with the traditional thoracotomy approach. We report a VATS right lower lobectomy case in a 65-year-old patient with post neoadjuvant therapy for adenocarcinoma. With pre-surgical tests, which include: a complete physical exam, CT scan, PET scan, bronchoscopy, blood test, electrocardiogram and spirometry. The patient was proposed for two-portal thoracoscopic surgery. The patient was placed in a left lateral decubitus position, and a double incision was performed at the anterior level of the 5th intercostal space (4 cm incision) and the second one at the level of the 8th intercostal space (2 cm incision). A right lower lobectomy with a two-portal technique was successfully performed. The postoperative course was without complications, and the patient was discharged home on the 4th postoperative day. The two-portal video-assisted thoracoscopic surgery (VATS) approach is an excellent option for lung cancer management, offering a quick recovery and low morbidity.
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Current concepts in CT Diagnosis and TNM-8 staging of Lung Cancer
(2023-11)
Regardless of the colossal efforts in lung cancer treatment, the majority of patients will present at an advanced stage when any curative treatment will no longer be an option. The overall 5-year survival for all tumor stages is disturbingly low at 15%, and lung cancer is the leading cause of cancer-related deaths for both genders worldwide. Early diagnosis as well as appropriate radiological staging is of utter importance for patients with early-stage lung cancer that can greatly benefit from timely treatment. The current 8th revision of tumor, node, metastasis (TNM) staging system accepted by The International Association for the Study of Lung Cancer (IASLC) and the American Joint Committee on Cancer (AJCC) was published in January, 2017, and the edition has committed some major alternations, including modification of the T classification based on 1 cm increment, down staging of the T descriptor disregarding its distance from carina (T2), integrating total and partial atelectasis/pneumonitis into the same T category (T2), upstaging diaphragmatic invasion to T4, new classification concepts of adenocarcinoma in situ and minimally invasive adenocarcinoma for pure and part-solid ground-glass nodules, and further division of extra thoracic metastasis into M1b and M1c based on their number and location. There is an agreement for some ambiguous conditions, such as the classification of Pancoast tumor based on its invasion depth, as well as categorization of various sites of pulmonary involvement. The IASLC Staging Project has provided evidence based recommendations for the TNM Classification for Thoracic Cancers in the last 20 years. The upgraded 9th edition of the TNM will be published on January 1, 2024 and will consider new data elements, including genetic biomarkers, protein alterations, and copy number alterations. In order for a radiologist to present an accurate clinical stage of lung cancer using consistent standards introduced in the 8th edition of the TNM Lung Cancer Staging System, it is important to acknowledge the prospective difficulties and limitations of imaging interpretation.
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LUNG CANCER AS A COMORBIDITY OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)
(2023-01)
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Buklioska Adriana
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Mickovski Ivana
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Trajkova Vesna
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COPD is a risk factor for lung cancer development independent of smoking status, with three to six times more likely to develop lung cancer at a rate of 0.8–1.7%/year. This may be associated with genetic susceptibility to cigarettes, chronic inflammation caused by toxic gases. Inflammatory mediators may promote the growth of bronchioalveolar stem cells, and activation of nuclear factor-κB and signal transducer and activator of transcription 3 play crucial roles in the development of lung cancer from COPD. The aim of the study is to evaluate the prevalence of lung cancer in patients with COPD. We performed a retrospective study, from 2012 to 2022, among patients with pathologically confirmed diagnosis of lung cancer, aged 40-75 years. Patients with lung cancer that had COPD diagnosed >= 10 years before lung cancer diagnosis, were investigated group. Histological subtypes of lung cancer were determined based on histopathology reports and were categorized as squamous carcinoma, adenocarcinoma, small cell lung cancer (SCLC), large cell lung cancer (LCLC; including large cell neuroendocrine carcinoma), and other histological types according to 2015 WHO classification of lung tumors. At the time of registration, sex, age, BMI, smoking status, treatment history, and symptoms, including the CAT score, were recorded. In addition, at the time of registration, spirometry was performed both before and after inhalation of a bronchodilator, and a blood test and chest CT were also performed. The GOLD criteria was used to diagnose and assign severity of COPD: patients with a postbronchodilator FEV1/FVC <0.70 were classified as having COPD; FEV1 ≥0.8 was defined as mild, 0.5≤ FEV1 <0.8 as moderate, 0.3≤ FEV1 <0.5 as severe, and FEV1 ≤0.3 as extremely severe. Patients were excluded if they presented with simultaneous or sequential second primary cancers or had a history of asthma, bronchiectasis, tuberculosis, pulmonary fibrosis, or other confounding diseases. The middle age of lung cancer diagnosis was 61.1±8.5 years. Of the total number of patients with COPD and lung cancer (260), 195 (75.0%) were male and 65 (25.0%) female. 190 (73.07%) were current smokers or ex-smokers. The histological subtypes identified were as follows: squamous carcinoma (96 [36.9%]), adenocarcinoma (115 [44.2%]), SCLC ( 26 [10.0%]), LCLC (13 [5.0%]), and other histologic types (including adenosquamous, carcinoma carcinoid tumors, sarcomatoid carcinoma; 16 [6.15%]). The proportion of squamous carcinoma was higher in smokers/ex smokers with COPD, while adenocarcinoma was more frequently observed in COPD non-smokers. Emphysema predominant phenotype was an independent prognostic risk factor for squamous carcinoma. The prevalence of COPD in lung cancer patients was 35.5%. Compared with lung cancer patients with non-COPD, those with COPD were older (P<0.001), had a lower BMI (P<0.001), and majority were male (P<0.001) and smokers (P<0.001). Annual low-dose computed tomography (LDCT) is an effective procedure for the early detection of lung cancer in high-risk patients like patients with COPD.

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