Nicola Tamburini

Long-Term Outcome for Early Stage Thymoma: Comparison between Thoracoscopic and Open Approaches

BACKGROUND Complete surgical excision is the most important long-term prognostic factor of thymomas. Although video-assisted thoracoscopic surgery (VATS) has been reported as an effective treatment to excise mediastinal thymic lesions, it has not replaced median sternotomy as the standard approach because of the lack of long-term follow-up studies. The objective of this study was to analyze and to compare the outcome of VATS extended thymectomy with the traditional open approach. METHODS This is a single centers retrospective study of 27 patients submitted to surgery for early stage thymomas between 1995 and 2007. Histologic subtype and clinicopathologic staging were classified, respectively, according to World Health Organization and Masaoka criteria. Patients with preoperative computed tomography scan evidence of clinical Masaoka stage 1 thymomas were selected for VATS thymectomy with unilateral technique. RESULTS All patients successfully underwent surgery: 3 with VATS and 4 with an open approach. There were no differences in time of surgery and postoperative complication between the two groups. Patients who had VATS had shorter postoperative hospital stay than patients who had open technique. After a median follow-up of 123 months, there were no postoperative recurrences. CONCLUSION VATS is a safe operation and has comparable effectiveness to the open technique in terms of oncological radicality for small, early stage thymoma.

Multidisciplinary management improves survival at 1 year after surgical treatment for non-small-cell lung cancer: a propensity score-matched study†

OBJECTIVES The management of patients affected by lung cancer requires the expertise of specialists from different disciplines. Although the advantages of multidisciplinary team discussions seem obvious, there are limited studies evaluating the influence of this approach on postoperative outcomes in non-small-cell lung cancer (NSCLC). The aim of this study is to examine the impact of a multidisciplinary approach on survival of patients undergoing surgery for NSCLC. METHODS A retrospective analysis was performed on consecutive patients who underwent surgery for NSCLC between January 2008 and December 2015. Data were compared between patients treated before the implementation of a multidisciplinary tumour board (MTB), between 2008 and 2012, and those who received treatment after the implementation of the MTB, between 2012 and 2015. Patients were matched one to one according to the discussion of the MTB and on the basis of a propensity score built using several patient characteristics. A propensity score-matched analysis was performed to compare patient outcomes. RESULTS A total of 246 patients were treated prior to the initiation of the MTB and 231 patients after the initiation of the MTB. Based on the propensity score, 2 well-matched groups of 170 patients were identified. Patients who were discussed at the MTB were noted to have better outcomes when compared with those who were not discussed at the MTB on different terms including complete staging evaluation, early tumour, node and metastasis (TNM) stages and 1-year survival rate. CONCLUSIONS Implementation of a multidisciplinary thoracic malignancy conference increased the 1-year survival rate of patients who underwent a surgical resection for NSCLC.

Capsaicin patch for persistent postoperative pain after thoracoscopic surgery, report of two cases

Effective postoperative pain control after thoracic surgery is a significant clinical issue because it reduces pulmonary complications and accelerates the pace of recovery. Persistent postoperative pain syndrome is a recognized and frequent complication after thoracoscopic surgery. The capsaicin 8% patch contains a high concentration of synthetic capsaicin approved for treatment of peripheral neuropathic pain in adults. Little clinical data exist on the use of capsaicin patch in thoracic persistent postoperative pain syndrome. This report included two patients who were evaluated after receiving capsaicin for thoracic surgery. Satisfactory pain relief was achieved in both cases without side effects.

Diffuse pulmonary meningothelial like nodules simulating metastatic thymoma

Diffuse pulmonary meningotheliomatosis (DPM) is a parenchymal lung disease characterized by disseminated bilateral minute pulmonary meningothelial-like nodules (MPMNs). These meningothelial-like nodules are classically encountered as benign solitary or multiple pulmonary nodules containing small epithelioid cell collections nestled within normal pulmonary parenchyma.

A rare case of intralobar pulmonary sequestration: combined endovascular and video-assisted thoracoscopic approach

Pulmonary sequestration is a congenital malformation characterized by cystic, non-functioning embryonic lung tissue supplied by an abnormal systemic artery. Its a rare disease widely variable in clinical presentation and severity, depending mostly on the degree of lung involvement and location in the thoracic cavity. Most patients have recurrent infections and inflammatory conditions in the affected lobe. Surgical resection continues to be the gold standard of therapy and in this context anatomical resection is the procedure of choice and yields excellent long-term results. There are few studies reporting the use of combined endovascular and thoracoscopic approaches for pulmonary sequestration. We describe a case of intralobar pulmonary sequestration located in the lower lobe of the right lung, which was treated with video-assisted thoracoscopic surgery (VATS) after endovascular embolization of systemic artery arising from celiac trunk.

A Rare Case of Solitary Rib MetastasisThirty-Two Years after Resection ofParotid Gland Adenocarcinoma

Context: Parotid adenocarcinoma is a rare salivary gland neoplasm, showing distant metastases in 12%-26% of cases, according to histologic grade. The most frequent locations are the cervical lymph nodes, liver, lungs and bones and metastatic disease is usually associated with poor prognosis. Single late-onset rib metastasis from adenocarcinoma of parotid gland has never been reported in the literature. Case report: We describe the case of a sixty-three-years-old male presenting with an osteolytic rib lesion 32 yrs after surgery for parotid gland adenocarcinoma. The patient was successfully treated with en bloc resection of the 11th rib for parotid gland adenocarcinoma metastasis. The patient has no evidence of local recurrence or metastatic disease 40 months after resection. Conclusion: This case may be useful for making clinical decisions because underlines the challenges of giving patients the optimal treatment considering the limited ability to predict prognosis and highlights the need for careful follow-up even in absence of recurrence for 10 yrs after curative resection.

Conservative Therapy in Iatrogenic Tracheal Rupture: A Retrospective Analysis and a Call for Research

Introduction: Iatrogenic tracheal rupture is a rare potentially life-threatening lesion. The best treatment has still not been determined in the case of mechanically ventilated patients for whom surgery has a high mortality rate. The aim of this study is to assess the role of conservative management in patients with iatrogenic posterior tracheal wall perforation and to verify its role in critically ill mechanically ventilated patients. Methods: We reviewed the cases occurred at our hospital: a retrospective study was performed and 7 patients over a four-year period were identified. Conservative treatment consisted in endoscopic evaluation of tracheal tear healing and O2 therapy when dealing with spontaneous breathing patients with none or few symptoms without progression. When symptoms progressed and spontaneous ventilation wasn’t possible, patients underwent tracheal intubation or tracheostomy tube replacement and inflation of the cuff distal to the tear. This conduct has been chosen in membranous trachea injuries, independent of the injury size, diagnostic delay, or cause. Results: Conservative therapy was attempted in 5 over 7 cases, it was successful in all 5 cases without complications. No clinically evident mediastinitis or postoperative tracheobronchial stenosis was observed on endoscopic follow up. Conclusion: Our retrospective analysis showed that nonsurgical treatment could be a safe and suitable solution to achieve tracheal healing secondary to membranous injury. In cases where mechanical ventilation is needed, bridging the tear with the tracheal tube seems to give good results. Surgical treatment is advisable in cases of mediastinitis, progression of emphysema and difficulty in bridging the defect with an artificial airway. In the lack of randomized clinical trials comparing surgical and conservative treatments we reviewed our cases and created the ConservAtive vs surgery registry of tracheal ruPTUREs (CAPTURE registry) to collect data from different centers to provide clinicians with further evidences.

Gastrointestinal bleeding in lung leiomyosarcoma history: report of a case

The paper presents an unusual case of single small bowel metastasis from primary lung leiomyosarcoma (PLL) presenting with abdominal pain and gastrointestinal (GI) bleeding successfully treated by surgery with radical aim.