1,721,055 research outputs found
Expert consensus on perioperative immunotherapy in non-small cell lung cancer: an editorial
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A Podcast on Pre- or Perioperative Chemoimmunotherapy for Stage III Non-Small Cell Lung Cancer: Shared Agreement from the Thoracic Surgeon and Oncologist Perspectives
Full text linkManagement of stage II-III non-small cell lung cancer (NSCLC) has been dramatically revolutionized by studies testing the addition of immunotherapy (IO) to chemotherapy in the pre- or perioperative setting. That is because the integration of chemoimmunotherapy (chemo-IO) with surgery has consistently shown a significant improvement in pathological complete response (path CR) rate, event-free survival, and, more recently, overall survival, versus preoperative chemotherapy alone. Particularly, resectable stage III NSCLCs represent a disease entity with a high risk of distant recurrence after radical surgery, for whom pre- or perioperative chemo-IO should be considered as the preferential treatment option. However, owing to the heterogeneity of stage III NSCLC, a standard definition of resectability is not established yet, being often subjective according to the expertise and clinical background of the thoracic surgeon. In addition, careful patient selection on the basis of tumor biomarkers, meticulous staging of the disease, and accurate monitoring of treatment-related adverse events are critical factors that could prevent the ineligibility for surgery of patients treated with pre- or perioperative chemo-IO. Finally, the impact of downstaging for initially borderline resectable tumors, as well as the exact number of preoperative chemo-IO cycles needed and the indications for adjuvant IO, still need to be fully elucidated. In this podcast, we will touch upon the above-mentioned topics from the perspectives of the thoracic surgeon and the oncologist, and suggest a shared agreement between two of the main actors involved in the treatment of resectable stage III NSCLCs.Podcast audio available for this publication
Robot-assisted lobectomy for lung cancer in the presence of intraoperatively discovered broncho-vascular anomalies affecting right upper and middle lobes
No full texthttp://hdl.handle.net/20.500.11768/9662
Treatment 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
Immunotherapy in the neoadjuvant settings: a new challenge for the thoracic surgeon?
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Treatment of late tracheomediastinal fistula following diagnostic mediastinoscopy treated by multiple pedicled muscle flaps
No full textDuring mediastinoscopy in a 38-year-old woman, there was uncontrolled bleeding that required a sternal split. One month later, chest and neck CT scan demonstrated tracheomediastinal fistula. The patient underwent urgent operation. Repair of the tracheal defect was accomplished using a pedicled right sternohyoid muscle; the right sternocleidomastoid muscle was used to separate the trachea from the innominate artery and the left pectoralis major muscle was used to fill the anterior mediastinal space. The postoperative course was uneventful. One month later, another CT scan demonstrated complete resolution. Careful use of coagulation during mediastinoscopy is of paramount importance to avoid thermal injury to the trachea. This case also underlines the importance of a good knowledge of the anatomy of the skeletal muscles of the chest wall and adjacent regions. © Georg Thieme Verlag KG Stuttgart • New York
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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