1,721,014 research outputs found
Thoracic surgery
No full textVengono descritti brevemente gli aspetti di diagnosi e stadiazione delle neoplasie polmonari. Gli autori descrivono poi dettagliatamente gli aspetti dello studio funzionale cardiorespiratorio preoperatorio e la valutazione del rischio perioperatorio. Più brevemente si soffermano sulle principali procedure chirurgiche e infine si descrivono gli aspetti relativi al trattamenti riabilitativo e generale postoperatorio. Il tutto focalizzato ai pazienti anziani,
Conventional Techniques: Transthoracic Approach
No full textThymomas are the most frequent neoplasms of the anterior mediastinal compartment, accounting for approximately 20% of all mediastinal tumors in adults. They are, however, a rare neoplasm, with an incidence of approximately 0.15 cases in 100,000 habitants per year in the USA [1]. Thymomas are neoplasms of epithelial origin which, despite being considered tumors with an often indolent growth pattern, have a well-documented capability to invade adjacent structures and develop metastases in the pleura as well as, though more rarely, distant metastases. Although several histological classifications have been proposed over the last few years, today there is a wide consensus on the use of the classification proposed by the World Health Organization (WHO) in 1999, as reviewed and confirmed in 2003, which breaks down thymic neoplasms into 6 groups based on the presence of cellular atypias and based on the relationship between epithelial and lymphatic cells (Table 16.1) [2]. By now, a unanimous consensus has been reached on the staging system proposed by Masaoka in 1981 and reviewed in 1994 (Table 16.2) [3], which classifies neoplasms based on the presence or absence of a macroscopic or microscopic invasion of the capsule, of adjacent structures, and the presence of metastases. © 2008 Springer Milan
Is laser-assisted resection preferable to lobectomy for pulmonary metastasectomy?
No full textPurposes. The aim of this study was to investigate if laser-assisted resection is appropriate for large and/or central lung metastases, when stapler wedge resection is not feasible, to determine whether this technique can be an alternative to lobectomy.
Methods. All patients who underwent laser-assisted resection for large and/or central metastases were selected for the study. For comparison, patients who underwent lobectomy for metastases between 2005 and 2017 were reviewed. All resections were performed with a 1318-nm Nd:YAG laser. Perioperative features and long-term oncological outcomes were investigated. Some aspects and drawbacks of laser resection were also investigated.
Results. Among 89 patients, 42 (47%) underwent laser resection and 47 underwent lobectomy. Complete resection was achieved in 91% of laser resections and in 98% of lobectomies. The operative time, postoperative drainage time and length of stay were significantly shorter in patients who underwent laser resection than in those who underwent lobectomy. Severe postoperative complications tended to be more frequent after lobectomy. The 5-year survival was 66% and 54% after laser resection and lobectomy respectively, the 5-year disease-free survival was 35% and 32% after laser resection and lobectomy respectively. No differences were found in long-term outcomes between the two techniques.
Conclusions. Our experience showed that laser resection, when performed for large/central metastases, resulted in comparable survival and obtained better perioperative outcomes with respect to lobectomy. We believe that laser resection can be proposed as a reliable and advantageous lung-sparing technique, as an alternative to lobectomy for metastasectomy, when stapler wedge resection is not feasible
Surgery for elastofibroma dorsi: optimizing the management of a benign tumor – an analysis of 70 cases
Full text linkBackground: Elastofibroma dorsi (ED) is a benign soft-tissue tumor of the chest wall located near the
tip of the scapula. Clinical presentation includes swelling, pain and impairment of shoulder movements.
The present literature relies only on few small case series. The aim of this study was to analyze the surgical
management of ED, focusing on the debated topics regarding preoperative evaluation, operative technique,
post-operative outcome and follow-up.
Methods: We conducted a single-center retrospective cohort analysis of patients operated for ED between
2003 and 2018. Diagnostic techniques were ultrasonography (US), computed tomography (CT-scan) and
magnetic resonance imaging (MRI). CT-scan represented our preferred imaging study for preoperative
assessment. Surgery was proposed for symptomatic and/or large lesions. Marginal excision through a musclesparing
approach was performed. An open-door follow-up policy was adopted. All clinical, radiological,
perioperative and pathological variables were matched in a univariate analysis. A multivariate analysis
was performed to investigate risk factors for postoperative complications. Correlations analysis between
radiological and pathological measurements of elastofibroma was conducted.
Results: Seventy elastofibromas were excised in 59 patients. Mean age was 59 years and female prevalence
was 59%. All elastofibromas were completely resected with no recurrence. Postoperative complications
rate was 17%. Complications were mild in most cases. At the univariate analysis, patients with body mass
index (BMI) >25 had a longer operative time (P=0.048), patients on antiplatelet medications experienced
a prolonged drainage time (P=0.006) and a higher rate of complications (P=0.038); the occurrence of
complications resulted in prolonged drainage time (P=0.047) and length of stay (P=0.023). A BMI ≤25 was
the only independent risk factor for postoperative morbidity (OR 8.71, P=0.024). CT-scan showed the
highest correlation with pathological size (r=0.819), US the lowest (r=0.421).
Conclusions: Marginal resection through a muscle-sparing approach is safe and effective for the treatment
of ED. CT-scan can be adequate for preoperative assessment. Giving the benign nature of the lesion and the
absence of recurrence after complete resection, an open-door follow-up may be appropriate
Prognostic role of clusterin in resected adenocarcinomas of the lung
No full textPrognostic role of clusterin in resected adenocarcinomas of the lung.
Panico F, Casali C, Rossi G, Rizzi F, Morandi U, Bettuzzi S, Davalli P, Corbetta L, Storelli ES, Corti A, Fabbri LM, Astancolle S, Luppi F.
Source
Section of Respiratory Diseases, Department of Oncology, Haematology & Pulmonology, University of Modena and Reggio Emilia, Modena, Italy.
Abstract
RATIONALE:
Clusterin expression may change in various human malignancies, including lung cancer. Patients with resectable non-small cell lung cancer (NSCLC), including adenocarcinoma, have a poor prognosis, with a relapse rate of 30-50% within 5 years. Nuclear factor kB (Nf-kB) is an intracellular protein involved in the initiation and progression of several human cancers, including the lung.
OBJECTIVES:
We investigate the role of clusterin and Nf-kB expression in predicting the prognosis of patients with early-stage surgically resected adenocarcinoma of the lung.
FINDINGS:
The level of clusterin gradually decreased from well-differentiated to poorly differentiated adenocarcinomas. Clusterin expression was significantly higher in patients with low-grade adenocarcinoma, in early-stage disease and in women. Clusterin expression was inversely related to relapse and survival in both univariate and multivariate analyses. Finally, we observed an inverse correlation between Nf-kB and clusterin.
CONCLUSIONS:
Clusterin expression represents an independent prognostic factor in surgically resected lung adenocarcinoma and was proven to be a useful biomarker for fewer relapses and longer survival in patients in the early stage of disease. The inverse correlation between Nf-kB and clusterin expression confirm the previously reported role of clusterin as potent down regulator of Nf-kB
Congenital cystic adenomatoid malformation in adults presenting as a single cyst
No full textCongenital cystic adenomatoid malformations are lung anomalies usually detected prenatally or in newborns and infants.
Type 1 congenital cystic adenomatoid malformations appears as a multicystic lesion, with cysts up to 2 cm in diameter,
or as a single large cyst. In the latter case, when detected in adults, the preoperative diagnosis is challenging because
congenital cystic adenomatoid malformations can be confused with other more common lesions.We describe two cases
of uniloculated type 1 congenital cystic adenomatoid malformation in adults. In both cases, the preoperative clinical
diagnosis was missed and the patients were surgically treated with lung-sparing cyst resections
Stem cells and lung cancer : between advanced diagnostics and new therapeutics.
No full textLung cancers (LCs) remain a significant and devastating cause of morbidity and mortality worldwide. Despite the very recent success of immunotherapy, the diagnosis and treatment of LC remain one of the greatest challenges in chest surgery, clinical oncology, and molecular medicine. A growing number of investigations on normal/cancer stem cells and cellular therapies are offering exciting new avenues to advance knowledge on LC. Here, we will be focusing on the multiple relationships between LC and stem cells accounting for cancer stem cell (CSC) diagnostics and progenitor-based therapeutics for LC. Cancer cell repopulation after chemotherapy and/or radiotherapy still represents a major factor limiting the efficacy of treatment since CSCs play critical roles during this process by reciprocal connections between CSCs and tumor microenvironment. This calls for new opportunities to integrate advanced CSC diagnostics and targeted approaches also based on immunotherapy. In addition, recent discoveries on malignant pleural and other LC highlight that mesenchymal stromal/stem cells may be a novel platform for drug delivery within still unexplored gene therapy strategies. This chapter will dissect these two apparently distant technologies within a unified stem-cell-based vision aimed at providing better diagnostics and therapeutics for LC at the forefront of modern clinical oncology
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