51,020 research outputs found
Immunotherapy in the neoadjuvant settings: a new challenge for the thoracic surgeon?
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Expert consensus on perioperative immunotherapy in non-small cell lung cancer: an editorial
No full textTreatment of Chylothorax after Lung Resection: Indications, Timing, and Outcomes
No full textBackground Chylothorax following pulmonary resection and lymphadenectomy for cancer is a potential severe complication in thoracic surgery. In the present study, we investigated the efficacy of the nonsurgical approach as well as the need for reoperation after conservative approach failure. Methods Chylothorax was diagnosed when chylous leakage from the chest drainage was observed and confirmed by the presence of triglycerides in the pleural fluid. We initially treated all the patients conservatively with complete oral intake cessation and total parenteral nutrition; if drainage output remained more than 800 mL/d after the first 5 days or major pleural effusion was observed at chest X-ray after chest tube removal, surgical treatment of chylothorax was indicated. Results Between January 1998 and December 2018, 5,072 patients underwent standard anatomical resection and mediastinal lymph node dissection for cancer at our institution. Among them, 30 patients (0.6%) developed chylothorax: 20 patients were effectively treated only by nil per os and low-fat diet, while 10 patients (33.3%) required surgical treatment. Mean age was 63 years; there were 24 male patients (80%); right-sided chylothorax was more frequent than left-sided chylothorax (22 vs. 8, respectively) although not statistically significant (p = 0.38); the only factor that seems to influence the need for reoperation is chylothorax flow rate during conservative treatment (p = 0.06). Conclusion Conservative treatment is effective in the case of low flow-rate chylothorax (< 800 mL/d); in the case of a higher flow rate, surgical exploration is needed and thoracic duct ligation-with or without lymphatic sites clipping-provides definitive lymphostasis
Next-generation lung cancer surgery: a brief trip into the future of the research
Full text linkLung cancer is the third most frequent cancer and the leading cause of cancer-related mortality worldwide
On the razor's edge: navigating mature experience and the challenges of aging in modern surgery
Full text linkOncological outcomes of upfront surgery in patients with “occult” pathological N2 non-small cell lung cancer: an international multicntre study
Full text linkThe role of surgery in the multimodality treatment stage IIIa/N2 NSCLC remains controversial. To assess the oncological outcomes of upfront lung resection and potential prognostic factors, we examined a subset of patients diagnosed with "occult" pN2 NSCL
Surgical Approaches to Pancoast Tumors
Full text linkPancoast tumors, also defined as superior sulcus tumors, still represent a complex clinical condition requiring high technical surgical skills within more articulated multimodality treatment. The morbidity and mortality rates after Pancoast tumor treatments range from 10 to 55% and 0 to 7%, respectively, and the 5-year survival rate has significantly improved in recent years thanks to the advancement of treatments. Although a multimodality approach combining chemotherapy, radiotherapy, and surgery allows for radical resection and effective local control in the vast majority of patients, many patients cannot receive surgical resection or complete the whole programmed therapeutic regimen. Systemic relapse, particularly cerebral recurrence, still poses a significant issue in this cohort of patients. Surgical resection still plays a pivotal role within the multimodality approach. Here, we focus on surgical approaches to both anterior and posterior Pancoast tumors: the anterior transclavicular approach (Dartevelle); the anterior transmanubrial approach (Grunenwald–Spaggiari); the anterior trap-door approach (Masaoka, Nomori); the posterior approach (Shaw–Paulson); the hemiclamshell approach; and hybrid approaches. Global clinical condition, tumor histology, and long-term perspectives should always be taken into consideration when embarking on such a demanding oncologic scenario
Predicting a prolonged air leak after video assisted thoracic surgery, is it really possible?
No full textValidation of predictive risk models for prolonged air leak (PAL) is essential to
understand if they can help to reduce its incidence and complications. This
study aimed to evaluate both the clinical and statistical performances of 4
existing models. We selected 4 predictive PAL risk models based on their
scientific relevance. We referred to these models as Chicago, Bordeaux,
Leeds and Pittsburgh model, respectively, according to the affiliation place
of the first author. These predicting risk models were retrospectively applied
to patients recorded on the second edition of the Italian Video-Assisted
Thoracoscopic Surgery Group registry. Predictions for each patient were
calculated based on the logistic regression coefficient values provided in the
original manuscripts. All models were tested for their overall performance,
discrimination, and calibration. We recalibrated the original models with the
re-estimation of the model intercept and slope. We used curve decision
analysis to describe and compare the clinical effects of the studied risk mod
els.
Better statistical metrics characterize the models developed on larger
populations (Chicago and Bordeaux models). However, no model has a valid
benefit for threshold probability greater than 0.30. The Net benefit of the
most performing model (Bordeaux model) at the threshold probability of
0.11 is 23 of 1000 patients, burdened by 333 false positive cases. One of
1000 is the Net benefit at the threshold probability of 0.3. The use of PAL
scores based on preoperative predictive factors cannot be currently used in
a clinical setting because of a high false positive rate and low positive pre
dictive valu
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