Treatment of pulmonary nodule: from VATS to RATS

The incidental detection of solitary pulmonary nodule (SPN) is currently increasing due to the widespread use of computed tomography (CT) during the follow up in oncological patients or in screening trials. A quick and definitive histological diagnosis of these nodes is mandatory as, in case of primitive lung cancer, an early detection could improve both surgical results and prognosis. The minimally invasive pulmonary resection (MIPR) is the gold standard procedure for diagnosis and treatment of small lung nodules, but it can be difficult to localize deep nonpalpable nodes that lie in the lung parenchyma. Hence, throughout the years several techniques have been developed to better localize deep or sub solid nodes. We describe our experience with radio-guided technique

Correlation between olfactory function, age, sex, and cognitive reserve index in the Italian population

Purpose: Loss of smell decreases the quality of life and contributes to the failure in recognizing hazardous substances. Given the relevance of olfaction in daily life, it is important to recognize an undiagnosed olfactory dysfunction to prevent these possible complications. Up to now, the prevalence of smell disorders in Italy is unknown due to a lack of epidemiological studies. Hence, the primary aim of this study was to evaluate the prevalence of olfactory dysfunction in a sample of Italian adults. Methods: Six hundred and thirty-three participants (347 woman and 286 men; mean age 44.9 years, SD 17.3, age range 18-86) were recruited from 10 distinct Italian regions. Participants were recruited using a convenience sapling and were divided into six different age groups: 18-29 years (N = 157), 30-39 years (N = 129), 40-49 years (N = 99), 50-59 years (N = 106), > 60 years (N = 142). Olfactory function, cognitive abilities, cognitive reserve, and depression were assessed, respectively, with: Sniffin' Sticks 16-item Odor Identification Test, Montreal Cognitive Assessment, Cognitive Reserve Index, and the Beck Depression Inventory. Additionally, socio-demographic data, medical history, and health-related lifestyle information were collected. Results: About 27% of participants showed an odor identification score < 12 indicating hyposmia. Multiple regression analysis revealed that OI was significantly correlated with age, sex, and cognitive reserve index, and young women with high cognitive reserve index showing the highest olfactory scores. Conclusion: This study provides data on the prevalence of olfactory dysfunction in different Italian regions

Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy

IMPORTANCE Delays in screening programs and the reluctance of patients to seek medical attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced colorectal cancers at diagnosis. OBJECTIVE To evaluate whether the SARS-CoV-2 pandemic was associated with more advanced oncologic stage and change in clinical presentation for patients with colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study included all 17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December 31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period), in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was 30 days from surgery. EXPOSURES Any type of surgical procedure for colorectal cancer, including explorative surgery, palliative procedures, and atypical or segmental resections. MAIN OUTCOMES AND MEASURES The primary outcome was advanced stage of colorectal cancer at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding, lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable. RESULTS A total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years) underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142 (56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR], 1.07; 95%CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95%CI, 1.15-1.53; P < .001), and stenotic lesions (OR, 1.15; 95%CI, 1.01-1.31; P = .03). CONCLUSIONS AND RELEVANCE This cohort study suggests a significant association between the SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for these patients

Resezioni polmonari maggiori con tecnica robotica in pazienti affetti da NSCLC: risultati oncologici a lungo termine

The aim of this study was to analyse the results of robotic lobectomy for lung cancer. Clinical records of 212 patients who underwent robotic major surgery from January 2010 to December 2015 for NSCLC were retrospectively analyzed; 127 male and 85 female. Mean age was 66,3 months (range 30 – 82). Surgical procedures consisted in 57 right upper lobectomy, 17 medium lobectomy, 74 right lower lobectomy, 34 left upper lobectomy, 29 left lower lobectomy and 1 superior bilobectomy. Mean operative time was 215 minutes (range 65 – 460), mean chest drainage duration was 3,6 days (range 2 – 13) and mean postoperative stay was 6,6 days (range 4 – 29). Mean disease free survival was 66,3 months (range 1 – 83). Disease free survival carcer-correlated was for adenocarcinoma 66,4 months (range 1 – 83), for squamous cell carcinoma 64,4 months (range 6 – 82) and for other histology was 47,6 months (range 6 – 58). Disease free survival stage-correlated for stage I was 75,6 months (range ); for stage II was 42,3 months (range 1 – 67); for stage III 51,2 months (range 19 – 74) for stage IV 10,3 months (range 0 – 12). Mean overall survival was 78,6 months (range 4 – 83). Overall survival carcer-correlated was for adenocarcinoma 79,2 months (range 4 – 83), for squamous cell carcinoma 79 months (range 12 – 82) and for other histology was 48,8 months (range 17 – 58). Overall survival stage-correlated for stage I was 82 months (range 9 – 83), for stage II was 73,5 months (range 10 – 82) for stage III was 61,4 months (range 22 – 68) and for stage IV 68 months. Robotic lung surgery is one of the most innovative and increasingly widespread techniques, due to to high-definition 3D vision and great maneuverability permit to perform pulmonary resection. The extended intuitive dexterity offered by the endo-wristed robotic instruments complemented by excellent magnified stereoscopic view, allows to perform a radical dissection, and the mini-invasive approach guarantees minimal injury to patients. This study suggests a positive oncological outcomes for patients NSCLC affected who underwent robotic major surgery

Long-term oncologic results for robotic major lung resection in non-small cell lung cancer (NSCLC) patients

Objective(s): Robotic lobectomy is becoming a widespread surgical procedure in NSCLC treatment, but data on oncologic outcomes is still lacking. The aim of this study was to analyze long term oncologic results of robotic lobectomy for non small lung cancer. Methods: Clinical records of consecutive NSCLC patients underwent robotic major surgery, between January 2010 and December 2015, were collected and analyzed. Results: We analyzed data of 212 patients (127 male and 85 female), with a median age of 66.3 years. The median follow-up time was 40.3 months (range 4–83). The median disease free survival was 66.3 months. Free disease survival stage-correlated was 75.6 months for stage I, 42.3 months for stage II, 51.2 months for stage III and 10.3 months for stage IV. The median overall survival was 78.6 months. Overall survival stage-correlated was 82 months for stage I, 73.5 months for stage II, 61.4 months for stage III and 41.3 months for stage IV. Conclusions: This study suggests high safety level, positive post-operative and oncologic outcomes for patients NSCLC underwent robotic major surgery, also in advanced stages

Nodal upstaging evaluation in NSCLC patients treated by robotic lobectomy

Open pulmonary resection is considered the gold standard treatment of early-stage non-small cell lung cancer (NSCLC). However, in the last decades, the use of minimal-invasive techniques has given promising results. Survival in lung cancer, after surgery, depends on the number of pathological nodes (pN), thus lymph nodal upstaging can be considered a surrogate for surgical quality of the procedure. Several studies have demonstrated a lower rate of upstaging in video-assisted thoracic surgery than in open surgery, suggesting an approach-related difference in lymphadenectomy. Features of robotic technique could consent a lymph nodal dissection similar to open surgery. The aim of the study is to compare nodal upstaging between thoracotomy and robotic approaches to evaluate the oncologic radicality

Robotic Right Upper Lobe Sleeve Lobectomy

<p><strong>Clinical Summary</strong></p><p>A 52-year-old male light smoker was under regular annual checks following a previous ocular melanoma, which was treated in 2013 with brachytherapy. During one of the follow-up visits, a lesion was found in the upper right lobe (RUL), close to the right main bronchus without hilar or mediastinal adenopathy. Flexible bronchoscopy showed, in the right-side airways, a tumor occluding almost the entire right upper bronchus and involving the proximal main bronchus. A biopsy confirmed a typical carcinoid tumor, and the patient was scheduled to undergo a robotic upper lobe sleeve-lobectomy (daVinci Surgical System, Intuitive Surgical, Mountain View, CA, USA). </p><p><strong>Surgical Technique</strong></p><p>Under general anesthesia, the patient was positioned into a left lateral decubitus position. The port-mapping implied 4 ports: an 8 mm camera port in the sixth intercostal space below the scapula tip; two ports at the sixth intercostal space posteriorly, following the same space with a distance between them of about 5 cm; and a final port placed anteriorly at the 6th intercostal space, just above the diaphragm. The camera was maintained in the same position for the entire procedure. The first step was to open the mediastinal pleura below the azygos vein to identify the tumor arising from the right upper bronchus. This was followed by the exposure of the Boyden branch and the upper vein. All lobar vessels were individually dissected and encircled with a vessel loop. To complete the posterior fissure and all the vessel transections, a 45 mm robotic stapler (Intuitive Surgical, Mountain View, CA, USA) was used. At this point, a 45 mm endostapler (Covidien Endo GIA™) was used to complete the fissures.</p><p>The right main bronchus and the upper lobe bronchus were dissected and cleared using the robotic scissors. The bronchial resection started from the anterior wall of the right main bronchus. Once the tumor was visualized, the resection was extended to the intermediate bronchus under bronchoscopic control. The specimen was removed and the inferior pulmonary ligament was released to allow a decrease in tension on the anastomosis. The anastomosis was performed through two running V-lock™ (Covidien) sutures using a 3-0 nonabsorbable autolocking suture. The suture was started from the caudal corner of the pars cartilaginea to the pars membranacea, toward the anterior bronchial wall. The tension of the suture was assessed at each step. The continuity of the suture was guaranteed by tying the two sutures through a double knot. The pars membranacea was left as a final step. Once concluded, the integrity of the anastomosis was checked endoscopically and through irrigation. A single 24 Fr chest tube was placed through the camera port. The patient had an uneventful clinical course and was discharged on the fifth postoperative day. Pathological analysis confirmed typical carcinoid with bronchial involvement, with no bronchial margins and no lymph node malignancy. The follow-up through bronchoscopy showed a good caliber anastomosis [1-2].</p> <p><strong>References</strong></p><p>1) Schmid T, Augustin F, Kainz G, Pratschke J, Bodner J. Hybrid video-assisted thoracic surgery-robotic minimally invasive right upper lobe sleeve lobectomy. <em><a href="https://doi.org/10.1016/j.athoracsur.2010.08.079">Ann Thorac Surg. 2011;91(6): 1961-1965</a></em>.<br>2) Cerfolio RJ. Robotic sleeve lobectomy: technical details and early results. <em><a href="https://doi.org/10.3978/j.issn.2072-1439.2016.01.70">J Thorac Dis. 2016;8(suppl 2): S223-S226</a></em>.</p

A comparison between amniotic fluid index and the single deepest vertical pocket technique in predicting adverse outcome in prolonged pregnancy

OBJECTIVE: to compare perinatal outcome in induced postterm pregnancies with normal amniotic volume and in patients with prolonged pregnancy undergone induction for oligohydramnios, evaluated by two different ultrasonographic methods. METHODS: amniotic fluid volume was measured, using Single Deepest Vertical Pocket (SDVP) and Amniotic Fluid Index (AFI), in 961 singleton uncomplicated prolonged pregnancies. In 109 of these patients, hospitalization was planned for induction of labor, during or after 42 weeks of gestation, for oligohydramnios, postterm pregnancy and other indications in 47, 51 and 11 cases, respectively. Perinatal outcome included: rate of caesarean section, fetal distress, non reassuring fetal heart tracing, presence of meconium, umbilical artery pH < 7.1, Apgar score at 5 minutes < 7, admission to neonatal intensive care unit (NICU). RESULTS: oligohydramnios was diagnosed in 4.89% of cases, when at least one of the two methods was used. A reduced AFI and SDVP value identified 4.47% and 3.75% of cases, respectively, even if without statistical difference. No statistical differences were reported in perinatal outcomes in postterm versus prolonged pregnancies with oligohydramnios, also in relation to the two different ultrasonographic methods. CONCLUSIONS: oligohydramnios is more frequently diagnosed using AFI than SDVP, consequently determining a higher rate of induction of labor. Moreover, perinatal outcome in prolonged induced pregnancies is not affected by oligohydramnios

Mepolizumab effectiveness and allergic status in real life

It is not clear whether mepolizumab is differently effective in allergic and nonallergic severe eosinophilic asthmatics (SEA) in real life