Vena cava anomalies in thoracic surgery

Background: Vena cava anomalies are a rare group of anatomical variations due to an incorrect development of the superior or inferior vena cava during fetal life. They generally show no clinical relevance and the diagnosis is done due to the association with congenital heart diseases in most of cases. However, preoperative identification of these anomalies is mandatory for surgeons to proper surgical planning. If not recognized, lethal complications may occur, as already reported in literature. Case presentation: We report a case series of three different unidentified vena cava anomalies in patients undergoing lung resection. These unrecognized anomalies led to minor complications in two cases and required an accurate intraoperative evaluation in another. A careful retrospective evaluation of preoperative radiological images showed the anomalies. Conclusions: A careful evaluation of the vena cava anatomy at pre-operative imaging is mandatory for thoracic surgeons to properly plan the surgery and avoid complications

Surgical treatment of lung cancer with adjacent lobe invasion in relation to fissure integrity

Background Tumor with adjacent lobe invasion (T‐ALI) is an uncommon condition. Controversy still exists regarding the optimal resection of adjacent lobe invasion, and the prognostic value in relation to fissure integrity at the tumor invasion point. The aims of this paper were to evaluate the prognosis of T‐ALI with regard to fissure integrity, and type of resection. Methods This was a retrospective multicenter study which included all consecutive patients with T‐ALI undergoing surgical treatment. Based on radiological, intraoperative and histological findings, T‐ALI patients were differentiated into two groups based on whether the fissure was complete (T‐ALI‐A group) or incomplete (T‐ALI‐D Group) at the level of tumor invasion point. Clinico‐pathological features and survival of two study groups were analyzed and compared. Results Study population included 135 patients, of these 98 (72%) were included into T‐ALI‐A group, and 37 (38%) into T‐ALI‐D Group. T‐ALI‐D patients had better overall survival than T‐ALI‐A patients (63.9 ± 7.0 vs. 48.9 ± 3.9; respectively, P = 0.01) who presented with a higher incidence of lymph node involvement (35% vs. 4%; P = 0.004), and recurrence rate (43% vs. 16%; P = 0.01). At multivariable analysis, T‐ALI‐D (P = 0.01), pN0 stage (P = 0.0002), and pT≤5 cm (P = 0.0001) were favorable survival prognostic factors. Conclusions T‐ALI‐D presented a better prognosis than T‐ALI‐A while extent of resection had no effect on survival. Thus, in patients with small T‐ALI‐D and without lymph node involvement, sublobar resection of adjacent lobe rather than lobectomy could be indicated. Key points The extent of resection of adjacent lobe had no effect on survival while T‐ALI‐D, pN0 stage, and pT≤5 cm were significant prognostic factors. In patients with small T‐ALI‐D and without lymph node involvement, sublobar resection of adjacent lobe could be indicated as an alternative to lobectomy

Simultaneous MALT lymphoma of the thymus and parotid gland: independent lymphomas or metastatic spread?

Background: Mucosa associated lymphoid tissue (MALT) lymphoma of the thymus is rare and generally associated with autoimmune disorders. It is generally suspected in middle-aged asian women with Sjogren’s syndrome or other autoimmune diseases presenting a multicystic mediastinal mass. Contrary to other MALT lymphomas, the etiology of these tumors is still uncertain especially those affecting patients with no autoimmune diseases. Thymic MALT lymphoma with simultaneous salivary gland involvement is extremely rare, with only few cases described in literature. Case presentation: We present a case of a 33 years-old male, with a recent history of MALT lymphoma of right parotid gland, affected by thymic mass. The patient underwent a right video-assisted thoracoscopy with radical thymectomy. The histological examination revealed a MALT lymphoma of the thymus. The molecular analysis on both thymic and parotid MALT lymphoma for clonal rearrangement of the immunoglobulin heavy chain gene suggests the origin from the same lymphomatous clone. Conclusions: It is still unclear if multiple localizations of MALT lymphomas are attributable to the development of different primary lymphomas or can be caused by lymphatic metastatic spread. Our analysis reveal that the hypothesis of metastatic spread cannot be excluded in patients with simultaneous MALT lymphoma of the thymus and parotid gland, especially in non-autoimmune related MALT lymphomas

Pulmonary artery resections for lung cancer. When and how?

Resection and reconstruction of the pulmonary artery (PA), whether associated or not to a sleeve resection of the bronchus, allows complete resection of centrally located lung cancer, thus avoiding pneumonectomy. Despite initial concern related to technical difficulties, perioperative management and long term survival, recent studies showed continuous enhancement of the surgical technique and reconstruction materials, reduction of the complication rate and improvement in the survival. This allowed this procedure to gain widespread acceptance in the treatment of lung cancer