Early Postoperative Results after Thymectomy for Thymic Cancer: A Single-Institution Experience.

BACKGROUND: Surgery for thymic cancers is considered the key of curative treatment. Preoperative patients' characteristics and intraoperative features might influence postoperative outcome. We aim to verify short-term outcomes and possible risk factors for complications after thymectomy. METHODS: We retrospectively investigated patients undergoing surgery for thymoma or thymic carcinoma in the period between January 1, 2008, and December 31, 2021, in our department. Preoperative features, surgical technique (open, bilateral VATS, RATS), intraoperative characteristics and incidence of postoperative complications (PC) were analyzed. RESULTS: We included in the study 138 patients. Open surgery was performed in 76 patients (55.1%), in 36 VATS (26.1%) and in 26 RATS (36.1%). Resection of one or more adjacent organs due to neoplastic infiltration was required in 25 patients. PC appeared in 25 patients (52% Clavien-Dindo grade I, 12% grade IVa). Open surgery had a higher incidence of PC (p < 0.001), longer postoperative in-hospital stay (p = 0.045) and larger neoplasm (p = 0.006). PC were significant related to pulmonary resection (p = 0.006), phrenic nerve resection (p = 0.029), resection of more than one organ (p = 0.009) and open surgery (p = 0.001), but only extended surgery of more organs was confirmed as independent prognostic factor for PC (p = 0.0013). Patients with preoperative myasthenia symptoms have a trend toward stage IVa complications (p = 0.065). No differences were observed between outcomes of VATS and RATS. CONCLUSIONS: Extended resections are related to a higher incidence of PC, while VATS and RATS guarantee a lower incidence of PC and shorter postoperative stay even in patients that require extended resections. Symptomatic myasthenia patients might have a higher risk toward more severe complications.

Thoracic myopericytoma in an older adult, rare but possible: A case report.

Myopericytoma is a rare tumor generally arising from skin and soft tissues of extremities, trunk, head, and neck regions, rarely from visceral sites. An intrathoracic visceral localization may carry a broad differential diagnosis including primary lung, pleura and chest wall lesions, or metastatic lesions. To date, any radiological features have been recognized and diagnosis of myopericytoma with intrathoracic localization remains still challenging. Here, we describe the case of a subpleural lesion incidentally diagnosed in an older adult affected by gastric cancer. Radiological features did not allow a differential diagnosis between a benign lesion, a primary tumor, or a metastasis. After resection, the histological examination showed histopathological features congruent with the diagnosis of myopericytoma. This unusual presentation reflects the need to share clinical, radiological, and histopathological data about this uncommon but frequently misdiagnosed disease.

Robotic resection of mediastinal left vagus neurofibroma.

A Correction has been published | View Neurogenic tumors represent 10 to 34% of all mediastinal tumors and among them, neurofibroma originating from the vagus nerve are rare entities. We present a case of a neurofibroma with cystic degeneration originating from the left branch of the vagus nerve in a 27-year-old man without von Recklinghausen disease. A complete robotic resection of the mediastinal mass has been performed, with amputation of the vagus nerve enclosed in the mass. The postoperative course was uneventful and the patient was discharged in two days.

Surgical Management and Reconstruction of Diaphragm, Pericardium and Chest Wall in Mesothelioma Surgery: A Review.

Mesothelioma is an aggressive disease arising from parietal pleura. Surgery is a valuable option in the frame of a multimodality treatment. Several surgical approaches have been standardized with the aim of a macroscopic complete resection; these often require homolateral diaphragm and pericardial resection and reconstruction. Extrapleural pneumonectomy (EPP) and extended pleurectomy decortication (EPD) have been recognized as radical surgical procedures. Nevertheless, both operations are technically challenging and associated with a significant rate of peri-operative morbidity and non-negligible mortality. The diaphragmatic and pericardial reconstruction technique is mandatory to avoid respiratory impairment and to reduce post-operative complications like gastric and cardiac herniation. Moreover, in the case of localized chest wall recurrence, surgery might be considered a valuable therapeutical option for highly selected and fit patients. All the technical aspects of the resection and reconstruction of the diaphragm, pericardium, and chest wall are described as well as the possible use of new minimally invasive techniques. In addition, the choice of different prosthetic materials, considering the most recent innovations in the field, are discussed.

Abscopal effect in lung cancer: three case reports and a concise review.

The abscopal effect describes the ability of locally administered radiotherapy to induce systemic antitumor effects. Over the past 40 years, reports on the abscopal effect following conventional radiation have been relatively rare, especially in less immunogenic tumors such as lung cancer. However, with the continued development and use of immunotherapy, reports on the abscopal effect have become increasingly frequent during the last decade. Here, we present three illustrative case reports from our own institution and previous published cases of the abscopal effect in patients with non-small cell lung cancer, treated with immune checkpoint inhibitors and radiotherapy. We also present a concise review of the clinical and experimental literature on the abscopal effect in non-small cell lung cancer.

A bicenter study on adjuvant surgery following treatment with tyrosine kinase inhibitors in patients with advanced lung adenocarcinoma.

OBJECTIVES: A small number of patients with advanced pulmonary adenocarcinomas treated with tyrosine kinase inhibitors (TKIs) was subsequently considered eligible for surgery. Our goal was to report the clinical characteristics, pathological features and prognosis of these patients with the aim of exploring the feasibility of this strategy of care. METHODS: We retrospectively reviewed the medical files of 19 patients in whom systemic treatment, including TKIs, resulted in a possible stabilization of the disease such that they were considered eligible for surgery (adjuvant surgery). RESULTS: Lobectomy, pneumonectomy or segmentectomy was performed in 68.4%, 26.3% and 5.3% of cases, respectively. Limited fibrotic tissues were detected intraoperatively in 8 patients who received TKIs as the sole systemic treatment. The postoperative course in the hospital was uneventful in 13 (68.4%) cases; 3 (15.8%) patients suffered major complications. The post-pneumonectomy early morbidity rate was 60%. A pathological analysis of the tumours showed that the median rate of fibrosis was 32.5% (0-100); of viable neoplastic tissue, 25.0% (0-90); and of necrosis, 12.5% (0-80%). Four tumours (21.1%) exhibited no viable tumour cells. The fibrosis ratio was higher in patients older than 60 years (P = 0.01) and in those treated with erlotinib (P = 0.03). The 3- and 5-year overall survival and disease-free survival rates were 79.5%/39.8% and 44.4%/29.6%, respectively. Pneumonectomy and <50% fibrosis or >30% viable tumour cells in the pathological specimens were factors significantly associated with lower disease-free survival. CONCLUSIONS: In a subset of highly selected patients, adjuvant lung surgery following treatment with TKI showed a large spectrum of histological changes in the pathological specimens and encouraging preliminary survival results. Pending further research, it may prove a relatively reliable and safe therapeutic choice, except when an extensive resection like a pneumonectomy is planned.

Video-assisted thoracoscopic surgery is a safe option for benign lung diseases requiring lobectomy.

BACKGROUND: Lobectomy for benign lung disease is renowned to be technically complex and to be subjected to an increased complication rate. The objective of this study was to evaluate whether the results obtained with video-assisted surgery (VATS) in benign disease are comparable to those obtained in oncologic surgery, where VATS has been validated. METHODS: We have reviewed the files of 246 consecutive patients who underwent VATS lobectomy from January 2012 to August 2015. The cohort was divided into two groups according to pathology (benign or malignant). Outcome parameters on scrutiny were demographics, pathology, duration of air leak, drainage and hospital stay, conversion, and perioperative complication rate. Comparisons were made with the χ 2 test and Student's t test; any p value ≤0.05 was considered as significant. RESULTS: Group 1 (36 patients) included patients who underwent lobectomy for benign disease and group 2 (210 patients) patients affected by lung cancer or pulmonary metastases. The two groups differed with reference to age (p < 0.001), history of cancer (p < 0.001), history of stroke (p = 0.05), and the presence of pleural adhesions (p = 0.03). There was no difference for duration of air leaks, chest tube drainage and hospital stay, conversion rate, and perioperative complication rate. CONCLUSIONS: We conclude that pathology did not impact on outcomes after VATS lobectomy. This study suggests that VATS is as a safe option in selected patients with benign disease requiring lobectomy, despite a more complex technical context.

Microscopic N2 disease exhibits a better prognosis in resected non-small-cell lung cancer.

OBJECTIVES: The management of pIIIA-N2 non-small-cell lung cancer (NSCLC) is still controversial. In particular, there are wide variations in overall survival (OS), suggesting the existence of subgroups among N2 patients. We aimed to evaluate the prognostic value of microscopic pN2 in NSCLC. METHODS: Between 1996 and 2015, the data from all 982 pathologically stage IIIA-N2 patients who underwent surgery with curative intent for NSCLC were retrospectively reviewed. Microscopic pN2 disease was defined as a nodal metastasis ranging from 0.2 to 2 mm in size. RESULTS: With a median follow-up of 17 months (2-101), the 5-year OS for the whole cohort was 31%. Microscopic N2 was observed in 309 (31.5%) patients. Microscopic N2 was associated with better median OS compared with macroscopic N2 [42 months (95% CI 36.85-47.15) vs 23 months (95% CI 19.7-26.29), P < 0.0001, with a corresponding 5-year OS rate of 39 and 21%, respectively]. In multivariate analysis, microscopic N2 remained a favourable independent prognostic factor [HR 0.681 (95% CI 0.481-0.967), P = 0.03]. The median OS of microscopic N2 patients who benefitted from simple follow-up was significantly better than those who underwent chemotherapy, radiation therapy or both [43 months (95% CI 24.22-61.78) vs 22 months (95% CI 17.43-26.47) vs 31 months (95% CI 27.66-34.34) vs 16 months (95% CI 14.6-17.4), P = 0.008]. CONCLUSION: Microscopic N2 seems to be associated with better prognosis in patients with pIIIA-N2 NSCLC and these could benefit from a simple follow-up. Prospective cohort studies are necessary to confirm these preliminary results.

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 center's 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.

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.