Faculty of Medicine

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    Item type:Publication,
    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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    Item type:Publication,
    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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    Item type:Publication,
    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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    Item type:Publication,
    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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    Item type:Publication,
    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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    Item type:Publication,
    SMOKING HABIT AS A RISK FACTOR ASSOCIATED WITH OCCURRENCE OF LUNG CANCER
    (Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, 2024-07)
    Dimitrievska, Ljubica
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    Grivcevska, Milena
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    Nehteparova, Meliha
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    Lung cancer is one of the most common causes of mortality in the world, right after cardiovascular diseases. The motivation for conducting this study was the fact that the number of newly diagnosed and death cases from lung cancer has been constantly growing, especially in the last few years. The aim of the study was to present lung cancer (LC) as a public health problem today at the global level as well as in the Republic of North Macedonia. This is an analytical case-control study. It included all patients with a confirmed diagnosis of lung cancer (LC) with histopathological analysis (examined group) and patients who have not had any history of malignancy (control group), in a period of six months. Survey data were collected using a specially designed questionnaire. The study included a total of 82 respondents in both, the examined and the control group. Regarding the habit of cigarette smoking, the largest percentage of examined respondents (56%) were current smokers, compared to the control group where the largest percentage (56%) were non-smokers. The results obtained showed that the two groups differed significantly with regards to the habit of cigarette smoking. This study confirmed the association of cigarette smoking habit and lung cancer, where several variables related to smoking were examined (age at which cigarette smoking started, number of cigarettes smoked per day, duration of smoking status, type of cigarettes).
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    SOCIO-DEMOGRAPHIC AND CLINICAL CHARACTERISTICS OF LUNG CANCER PATIENTS IN NORTH MACEDONIA
    (Macedonian Association of Anatomists, 2024-04)
    Dimitrievska, Ljubica
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    Stefanoska, Julijana
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    Nehteparova, Meliha
    Lung cancer disease is one of the most common causes of mortality in the world, coming right after cardiovascular diseases. It is a big and is a special problem in the highly developed countries, especially in the USA, but also in developing countries. The reason for the research is the fact that the number of newly diagnosed and death cases from lung cancer is constantly growing, especially in the last few years. The aim of the study is to determine the influence of socio-demographic factors in the occurrence of lung cancer(gender, age, national and ethnic origin, place of residence) and smoking as the main risk factor associated with this neoplasm. The research is a descriptive study in which 82 patients with pathohistological confirmed lung cancer participated. It was implemented at the Institute for Oncology and Radiotherapy at the clinical center in Skopje for a period of 3 months. A total of 82 patients were registered from Institute for Oncology and Radiotherapy in Skopje, North Macedonia who were diagnosed with primary lung cancer. Of all, 64.7% of them were males and 35.3% were females. Histologically, 51.2% had adenocarcinoma, 25.6 had squamous cell carcinoma, 20.7% had small cell carcinoma and 7.4% had no small cell carcinoma. It was observed that the proportion of females diagnosed with primary lung cancer is increasing. Patients get diagnosed at a later stage of the disease, which calls for screening and early detection of lung cancer.
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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.