Talc pleurodesis by flexi-rigid thoracoscope under local anaesthesia: visual talc slurry?

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Primary palmar hyperhidrosis: double-stage three levels clipping

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Early outcome of anatomical lung resection for non-small cell lung cancer in the elderly

OBJECTIVE Surgery is the mainstay of early-stage lung cancer treatment. However, since life expectancy is constantly increasing, we wanted to investigate whether this principle also applies to elderly (≥70-year-old) patients. PATIENTS AND METHODS We analyzed a prospectively maintained database on anatomical lung resections at our institute. Patients were divided in two groups: <70 years and ≥70 years (elderly). Outcome indicators were postoperative cardiopulmonary complications rate and 30-day readmission rate. Baseline and surgical characteristics were compared by mean of t-test, Mann-Whitney U test, chi2 and Fisher exact tests. Propensity score matching was performed to account for differences between groups in the outcome's analysis. RESULTS We selected 241 patients with lung cancer (2017-2021) who underwent anatomical lung resections. Median age was 70.5 (IQR: 64-76). 133 patients (54%) aged 70 and above. Patients and surgical characteristics (comorbidities, lung function, performance status, type and extension of lung resection and surgical approach) were similar among groups, except for atrial fibrillation (p=0.01) and previous cancer history (p<0.0001) which were more frequent in the elderly group. Non-elderly patients were more frequently active smokers (p<0.0001). Cardiopulmonary complications rate was 23%, 30-day readmission rate was 12.6%. We did not observe any significant difference in all the short-term outcome indicators between the elderly and the younger counterpart. Particularly, complications rate (p=0.91) and 30-day readmission (p=0.84) did not differ between groups. CONCLUSIONS In our series, short-term outcomes are not compromised in elderly patients. The evolution in surgical strategy and expertise contribute to offer surgical resection with curative intent for lung cancer to a large spectrum of patients

Surgical treatment in patient with non-small-cell lung cancer with fissure involvement: Anatomical versus nonanatomical resection

OBJECTIVE: Despite the intense debate concerning the prognostic impact of fissure involvement (FI) in patients with non-small-cell lung cancer, no specific surgical strategies have been yet recommended when this condition occurs. In this setting, we report our monocentric 10-years experience to investigate this issue. METHODS: From January 2000 to January 2010, the clinical data of 40 non-small-cell lung cancer patients with FI undergoing curative resection were retrospectively reviewed. The sample was stratified according to the type of resection: group A (28 patients): anatomical resection (bilobectomy [21 patients], pneumonectomy [7 patients]); group B (12 patients): nonanatomical resection (lobectomy plus wedge resection [LWR]). The end-points were (1) impact of different surgical approach on the pulmonary function (measured before surgery and 1 month after discharge); (2) disease-specific survival; and (3) tumor recurrence.The t test, χ, and log-rank tests, Kaplan-Meier method, and Cox and logistic regression analyses were used for the statistical analysis. RESULTS: No differences between the two groups were found when comparing the clinical characteristics, histology, pN or pT status, p-stage, residual (R1) disease, tumor grading, or tumor size. Similarly, the baseline preoperative function (tested as forced expiratory volume in 1 second-%-predicted, FEV1%) was likewise comparable (92.5% ± 21.0% in group A versus 85.2% ± 20.0% in group B; p = not significant). The decline of FEV1% after surgery was slightly higher in group A (-24.9% ± 13.5%) when compared with that in group B (-19.5% ± 13.3%), but this difference was not statistically significant (p = ns). Nevertheless, the 5-year disease-specific survival was 56% for group A and 47% for group B (p = ns). The recurrence rate did not differ between the patients undergoing a LWR (3 of 12 patients) and those undergoing a bilobectomy or pneumonectomy (9 of 28 patients) (p = ns). The presence of FI extended for more than 3 cm was found to be the most significant prognostic factor when analyzing survival (p = 0.002) and recurrence rate (p&lt; 0.001). CONCLUSIONS: Our results suggest that nonanatomical resection (LWR) could be considered as a feasible surgical option (especially in "frail" patients with an extent of FI less than 3 cm) in the light of the similar oncological and functional outcome compared with anatomical resection. Further studies based on larger series are needed to confirm these preliminary data and also to investigate the impact on the postoperative quality of life

post operative rehabilitation for surgically resected non small cell lung cancer patients serial pulmonary functional analysis

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Uniportal VATS for pectus excavatum: the Southern Switzerland experience

OBJECTIVE: The Nuss procedure is a minimally invasive approach used to treat the pectus excavatum. One to three curved metal bars are inserted behind the sternum in order to push it into a normal position. A bilateral thoracoscopy, with 3 or 4 incisions on each side, has been reported as a safe method to repair the chest. The aim of this observational cohort study is to evaluate the safety and efficacy of the modified uniportal thoracoscopic Nuss procedure. PATIENTS AND METHODS: A retrospective review on 248 consecutive patients treated in Southern Switzerland in the last 5 years for chest deformity was performed. Conservative treatment with vacuum bel or dinamic compression was performed in 235 cases. Thirteen patients with pectus excavatum were surgically treated with a modified single-incision thoracoscopic approach and introduction of a single retrosternal Nuss Bar. Demographics, clinical characteristics, surgical data and results were analyzed and discussed. RESULTS: The male/female ratio was 11/2, with mean age of 20.75 (±5.05) years. The Haller index was 3.65±0.5. The operative duration was 68. 2±13.3 min and hospitalization stay ranged from 2 to 10 days. There was no instance of intraoperative cardiac perforation or macrovascular injury. No pleural effusion or infection was reported. The overall complication rate after a postoperative follow-up of 24.6±3 months was 7.6%, without mortality, major bleeding, infectious complications, displacement or recurrence. Patients satisfaction and postoperative pain were also analyzed. CONCLUSIONS: The modified single-incision thoracoscopic Nuss procedure is both safe and effective for pectus excavatum correction with non-recurrence after two years

Is 18F-FDG-PET/CT really able to differentiate between malignant and benign solitary fibrous tumor of the pleura?

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