Safety of video-assisted thoracic surgery lobectomy for non-small-cell lung cancer in a low-volume unit.

Several studies have demonstrated that for complex surgical procedures, surgeons who treat more patients have better outcomes than their lower-volume counterparts. The aim of this paper is to review the experience with video-assisted thoracic surgery (VATS) lobectomies in our small thoracic unit (group A), to understand whether our short-term results were different to the outcomes obtained by the same surgeon previously working in a high-volume unit (group B). 37 patients underwent VATS lobectomy. Hospital stay was on average 4.5 days (group A) versus 4.1 days (group B). Operative time and the number of 'frozen sections' were higher in group A. Hospital mortality was 0. VATS lobectomies are a safe approach in a low-volume unit formed by a single surgeon with a previous high-volume experience.

Lung cancer invading a single left pulmonary vein requiring extended pneumonectomy.

Unilateral single left pulmonary vein is a congenital anomaly of the pulmonary venous system. Surgical treatment is not commonly required for this anatomical variant except in rare circumstances. No previous cases of lung cancer involving the intrapericardial portion of a single left pulmonary vein have been published in the peer-reviewed literature. We describe the case of a 69-year-old man with lung cancer invading single left pulmonary vein, which required intrapericardial pneumonectomy and partial resection of the left atrium.

Awake uniportal video-assisted thoracic surgery for complications after pneumonectomy.

Since 1998, we started a clinical program for awake video-assisted thoracic surgery in our unit using four-step local anesthesia and sedation. Throughout the years, we experienced several difficult cases, three of them had complications postpneumonectomy. The aim of this paper is to report these three cases.

Pleurectomy/decortication and hyperthermic intrapleural chemotherapy for malignant pleural mesothelioma: initial experience.

Cytoreductive surgery and hyperthermic intraoperative intrapleural chemotherapy (HITHOC) are a known option for malignant pleural mesothelioma (MPM). This prospective study was started to prove that pleurectomy/decortication and HITHOC could be successfully performed in a low volume center. Criteria of inclusion were a proven diagnosis of MPM, early-stage disease and good performance status. Six consecutive patients were enrolled. After pleurectomy/decortication, intrapleural cisplatin was administered for 60 min at 42.5 °C. Wedge resections and diaphragmatic reconstruction were added in two and one patient, respectively. Morbidity was 16.6%. Mortality was nil. Hospital stay was 7.8 days. Mean survival was 21.5 months (range: 6-30). This small experience confirms that pleurectomy/decortication and HITHOC are a good therapeutic option in the multimodality treatment of MPM. A randomized controlled trial is necessary.

Preliminary experience with video-assisted thoracic surgery lobectomy for lung malignancies: general considerations moving toward standard practice.

As part of the Second Catania Symposium on Thoracic Oncology, as we started the experience with video-assisted thoracic surgery (VATS) lobectomy for lung malignancies, we reviewed our data and argued some comments in a more general discussion. Operated patients with non-small-cell lung cancer were divided in two groups and compared: VATS (collected in a prospective database) and open (historical group). Out of 74 patients, 31 in group A and 44 in group B. The majority of patients in group A were stage I-II. Mean operative time was shorter in group A. Postoperative hospital stay was shorter in group A. There was no mortality. VATS is effective and safe to perform pulmonary lobectomy in our unit, and it represents our preferred approach for early-stage lung cancer.

Elastofibroma dorsi and the thoracic surgeon: experience with 13 patients.

A total of 13 patients (11 females, average age of 63 years) with elastofibromadorsi were retrospectively analyzed. The disease was confirmed by surgical intervention in five cases. In other patients (n = 8) the diagnosis was achieved on the basis of clinical and radiological features. Typical imaging features allow for the diagnosis of elastofibromadorsi. Symptomatic lesions need to be surgically removed, whereas asymptomatic ones could be clinically and radiologically monitored.

Follicular dendritic cell sarcoma of mediastinum: a key role of radiotherapy in a multidisciplinary approach.

Follicular dendritic cell sarcoma is a rare and aggressive tumor and its management is a major clinical challenge. Surgery is considered the mainstay of treatment and no adjuvant approach has demonstrated the ability to reduce the rate of relapses. We report on a case of a man with a 26-year clinical history of mediastinal follicular dendritic cell sarcoma, with several relapses after multiple surgical interventions. The impact of chemotherapy was very small, unlike the radiation therapy that was performed twice, with an interval time of 8 years, through an intensity-modulated technique and an altered fractionation schedule.

Uniportal video assisted thoracic surgery: summary of experience, mini-review and perspectives.

The uniportal-video assisted thoracic surgery (VATS) technique comprises operations which can be performed with skin incisions ranging from 2 to 8 cm and the manifest result of the introduction of the uniportal lobectomy had made possible to increase rapidly the number of published papers on this subject. Many of the large ensuing literature report incomplete historical information on uniportal VATS, and doubts exist about the indication of uniportal VATS for some thoracic oncologic pathologies. Known limitations have been overcome. On the other hand, the modern thoracic surgical team includes one surgeon, one assistant and a scrub nurse, and it is clear that the new generation of thoracic surgeons need to use the "less" used hand. The new technology which permitted the introduction of the uniportal VATS could influence the future need of thoracic surgeons worldwide.

Wider implications of video-assisted thoracic surgery versus open approach for lung metastasectomy.

Lung metastasectomy is considered a safe and potentially curative procedure despite there is not a strong evidence that metastasectomy prolongs long-term survival in patients with lung metastases. Moreover, the debate is open regarding the best approach for lung metastasectomy, video-assisted thoracic surgery versus open approach. A systematic review of literature to clarify what is the best approach to prolong survival in patients with lung metastases was performed. Our study confirms that overall survival is equivalent for video-assisted thoracic surgery and thoracotomy, therefore the 'gold standard' surgical treatment for lung metastases remains a point of debate. The choice of the surgical approach still depends more on the single center or surgeon practice than on strong scientific evidence. A prospective randomized trial could clarify the question.

Cytoreductive surgery and hyperthermic intrapleural chemotherapy for malignant pleural diseases: preliminary experience.

Cytoreductive surgery and hyperthermic-intraoperative-intrapleural-chemotherapy (HITHOC) is a known approach for malignant pleural diseases (MPD). This study was started to clarify the role of cytoreductive surgery and HITHOC in MPD. Criteria of inclusion were early-stage disease in malignant pleural mesothelioma (MPM), young age, good condition and selected stage-M1a lung cancer. Six patients with MPM and two patients with lung cancer were enrolled. After surgical debulking, intrapleural cisplatin was administered for 60 min at 42.5°C. Wedge, rib resection and repaired diaphragm were added in three, one and one patient, respectively. Morbidity, toxicity and mortality was nil. Hospital stay was 8 days. Mean survival is 13.6 months. This experience confirms that cytoreductive surgery and HITHOC is a good option in the treatment of MPD. A randomized controlled trial is necessary.

An unsual symptomatic case of mediastinal myelolipoma treated by VATS approach.

Symptomatic mediastinal location of an extra-adrenal myelolipoma is extremely rare. We describe a 56-year-old female with unusual pain in the right lower posterior chest radiated to the neck and to the upper abdomen. Chest CT showed a lesion of 3.5 x 2.2 cm in the posterior mediastinum. Video-assisted resection was performed and the final pathologic examination revealed the presence of a myelolipoma. Herein we discuss the clinical presentation, the differential diagnosis and treatment of mediastinal myelolipoma.

Two cases of giant solitary fibrous tumor of the pleura: a not-so-rare tumor?

Solitary fibrous tumors of the pleura are rare intrathoracic neoplasms, especially in the giant form. The treatment of choice remains complete surgical resection which provides a benign clinical outcome. All patients need long-term follow-up due to the possibility of late recurrences. We describe 2 new cases of giant pleural fibrous tumor, which underwent resection via thoracotomy, and discuss the diagnostic and therapeutic modalities.

Lung-sparing approach for an intrapulmonary bronchogenic cyst involving the right upper and middle lobes.

Intrapulmonary bronchogenic cysts (IBC) represent 20% of abnormal budding of the respiratory tract. Lobectomy is the recommended treatment for IBC in symptomatic adults. We presented a case of a patient with an IBC involving the right upper and middle lobes (RUL-RML). A 27-year-old woman presented with a 2-month history of thoracic pain, cough and haemoptysis. An opacity was found on the chest X-ray. High-resolution CT/MRI showed a 7×4.5 cm marginated mass with an air bubble inside. A video-assisted thoracoscopic surgery was performed. The cyst was neither palpable nor visible. An intraoperative ultrasonography localised the cyst involving the RUL-RML. The lung above the cyst was incised, and a greenish-mucoid content was aspirated. A branch of the superior pulmonary vein was visible. The remaining cystic wall was cauterised. The patient was discharged on day 4. Histology confirmed the IBC. The patient is asymptomatic at a 16-month follow-up. The lung-sparing operation in a young woman with IBC involving the RUL-RML has been beneficial. A long-term follow-up is mandatory.

Minimal access anterior mediastinotomy.

Anterior mediastinotomy and VATS are today the most common surgical approaches to obtain tissue diagnosis or to remove mediastinal lesions. However, both methods lead to inconveniences. This report demonstrates the advantages of a minimal access mediastinotomy to remove or diagnose mediastinal lesions.