Marcin Zieliński

Background: The Codubix^® ŻEBRA and Codubix^® S ŻEBRA prostheses (by Tricomed SA), made of a biocompatible polypropylene–polyester braid, were developed as tools for the treatment of bone defects resulting from cancer surgery or mechanical injuries. Methods: The retrospective analysis investigation presents the efficacy and safety of rib bone prostheses made of knitted polyester–polypropylene fabric used to fill defects in the ribs and sternum. Data were collected from 113 patients (68 males, 45 females) undergoing surgery at three clinical centres. Prosthesis implantation was performed to bridge bone defects in the ribs and/or sternum. The analysis included preoperative and intraoperative data, two follow-up visits and a final interview with the patients. All prostheses were implanted using two techniques for filling defects in the chest wall: the ‘hammock’ (suspension) fixation method in 87 patients, and the ‘rigid’ fixation method in 26 patients. Results: The main cause of defects was cancer surgery (95.6%) performed in cases of sarcomas, squamous cell carcinomas, and desmoid tumours. Other causes (e.g., congenital defects and mechanical trauma) were less common. The ‘rigid’ fixation method extended the surgery time by approximately 16 min compared to the suspension method. Differences were also noted in the recovery period—an average of 56 days for the ‘hammock’ method and 30 days for the ‘rigid’ method. During the second follow-up visit, the treatment outcome using these prostheses was rated as good in 90.3% of cases. The average duration of hospitalisation was 21 days, regardless of the implantation method. No prosthesis-related adverse events were reported. Complications were observed in 21 cases in the first days after surgery. The most common ones were sensory disturbances (5.3%), infections (3.5%), haematomas and blood effusions (2.7%). Conclusions: A retrospective study demonstrates that knitted prostheses are safe and effective solution for repairing extensive defects resulting from tumours, trauma or congenital malformations. The implants ensure high patient comfort and maintain normal physical functioning without interference.

Restaging of mediastinal lymph nodes plays a crucial role in the multimodal treatment of stage IIIA Non-Small-Cell Lung Cancer (NSCLC). This study aimed to assess the impact of restaging using endobronchial ultrasound (EBUS), endoesophageal ultrasound (EUS), and transcervical extended mediastinal lymphadenectomy (TEMLA) after neoadjuvant chemotherapy (CHT) or chemoradiotherapy (CRT) on the 5-year overall survival (OS) of patients with NSCLC diagnosed with clinical stage IIIA-IIIB and metastatic ipsilateral mediastinal nodes (N2) who underwent radical pulmonary resections. Patients diagnosed with stage IIIA-IIIB NSCLC and N2 mediastinal nodes were included in this study. Restaging of mediastinal lymph nodes was performed using EBUS, EUS, and TEMLA. The patients were divided into two groups based on the restaging method: the TEMLA restaging group and the chest CT scan-only group. The primary outcome measure was the 5-year OS rate, and the secondary outcome measures included median OS and survival percentages. Statistical analysis, including the log-rank test, was conducted to assess the differences between the two groups. The TEMLA restaging group demonstrated significantly better overall survival compared to the chest CT scan-only group (log-rank test, p = 0.02). This was evident through a four-fold increase in median OS (59 vs. 14 months) and a higher 5-year OS rate of 55.9% (95% CI: 40.6–71.1) compared to 25.0% (95% CI: 13.7–36.3) in the chest CT scan-only group (p = 0.003). Invasive restaging of mediastinal lymph nodes improves the selection of patients with stage IIIA-IIIB (N2) NSCLC after neoadjuvant therapy. The use of EBUS, EUS, and TEMLA provides valuable information for identifying patients who may benefit from surgery by identifying N2 to N0-1 downstaging. These findings emphasize the importance of incorporating restaging procedures into the treatment decision-making process for NSCLC patients with mediastinal lymph node involvement.