Robotic thymectomy

Thymectomy is the most frequent surgical operation involving the mediastinum, both for the treatment of thymic tumors and for the multidisciplinary management of myasthenia gravis (MG). Different surgical approaches have been described, either traditional open approaches or minimally invasive ones. Robotic thymectomy represents a further step in the evolution of minimally invasive surgery. Available data show that robotic thymectomy may be considered a safe and feasible operation, with encouraging long-term results in myasthenic patients and promising results in patients with early stage thymoma, both in terms of surgical and oncological outcomes. We present the surgical technique of robotic thymectomy that we apply for patients affected by myasthenia gravis and early stage thymoma

Video assisted thoracic surgery (VATS) for recurrent thymoma

Between 10-30% of patients that undergo a radical operation for thymoma develop a recurrence in a variable range of time. The surgical treatment of thymoma relapses is an established and effective therapeutic approach, particularly for a single intrathoracic recurrence; however, no agreement has been reached on the best surgical approach and the extent of surgical resection, particularly in the most common event of pleural relapses. In the era of minimally invasive approach for most thoracic pathologies, the role of the video assisted thoracic surgery (VATS) approach for thymoma recurrence resection is still unclear and controversial: to date, only few authors have reported in their series a thoracoscopic resection of pleuro-pulmonary relapses, mostly when a single lesion was present. Furthermore, a thoracoscopic approach for mediastinal recurrence has been rarely reported after a previous sternotomy to resect the primary tumor. It is likely that in the future, the role of VATS for thymic recurrence resection will be better defined and extensively studied

Pleural recurrences of thymoma: Role and effectiveness of intrathoracic chemohyperthermia

Thymoma is a rare tumor of the anterior mediastinum characterized by a relatively indolent behavior. Surgery is the cornerstone in the treatment of this tumor and completeness of resection is the main prognostic facto

Thoracoscopic wedge resection in single-lung patients

The thoracoscopic approach has become a standard procedure in the field of lung resections. However, its advantage in single-lung patients has not yet been well studied. We describe a series of successful thoracoscopic wedge resections in patients presenting with lung cancer after contralateral pneumonectomy

Successful Treatment of a Recurrent Wide Tracheoesophageal Fistula With a Bioabsorbable Patch

Acquired nonmalignant tracheoesophageal fistula (TEF) is a rare condition that requires proper treatment. We present the case of a 55-year-old woman with a 4.5-cm recurrent TEF, which had developed after an attempted surgical repair. After closure of the esophageal defect in two layers, a tracheoplasty technique was used to repair the tracheal membranous wall with a synthetic bioabsorbable patch (Gore Bio-A tissue reinforcement) covered with an intercostal muscle flap. The use of Gore Bio-A tissue reinforcement is an innovative and effective method to close a wide tracheal defect while achieving a scaffold for epithelial colonization

Successful Treatment of a Recurrent Wide\ua0Tracheoesophageal Fistula With a\ua0Bioabsorbable Patch

Acquired nonmalignant tracheoesophageal fistula (TEF) is a rare condition that requires proper treatment. We present the case of a 55-year-old woman with a 4.5-cm recurrent TEF, which had developed after an attempted surgical repair. After closure of the esophageal defect in two layers, a tracheoplasty technique was used to repair the tracheal membranous wall with a synthetic bioabsorbable patch (Gore Bio-A tissue reinforcement) covered with an intercostal muscle flap. The use of Gore Bio-A tissue reinforcement is an innovative and effective method to close a wide tracheal defect while achieving a scaffold for epithelial colonization

Induction chemotherapy with carboplatin and paclitaxel for thymoma in acute respiratory distress due to myasthenia gravis: a case report

Background: Myasthenia gravis (MG) is presented in 30-50% of thymoma cases, particularly in AB, B1 and B2 thymomas, and often associated with antibodies against acetylcholine receptor (AChR). Symptoms include muscle weakness and fatigue, and the severity depends on the muscles involved. Surgery is recommended in resectable thymomas, and after induction chemotherapy in locally advanced cases. The occurrence of acute respiratory insufficiency is a rare but potentially life-threatening event and may preclude the possibility to perform an adequate induction systemic treatment in resectable patients. Case description: We herein describe a case of a patient who underwent induction chemotherapy with carboplatin and paclitaxel for stage IVa thymoma while on ventilator support for respiratory insufficiency due to MG; the remarkable radiological response and the marked improvement in neurological symptoms made it possible to discontinue ventilatory support and carry out surgery with subsequent complete tumor resection. Unfortunately, due to an infection of the surgical wound, it was not possible to complete the therapeutic process with adjuvant radiotherapy. Conclusions: Initiation of chemotherapy induction treatment in a patient on mechanical ventilation because of acute MG is a challenge, but this should not hold back from starting a treatment, if it is considered potentially curative. The recommended induction chemotherapy regimen is the combination of doxorubicin, cisplatin, and cyclophosphamide, but in selected cases non-anthracyline regimens may be chosen. Whenever. Keywords: Thymic epithelial tumors (TETs); case report; induction chemotherapy; myasthenia gravis (MG); respiratory distres

Comparing robotic and trans-sternal thymectomy for early-stage thymoma: a propensity score-matching study

Minimally invasive techniques seem to be promising alternatives to open approaches in the surgical treatment of early-stage thymoma, although there are controversies because of lack of data on long-term results. The aim of the study was to evaluate the surgical and oncological results after robotic thymectomy for early-stage thymoma compared to median sternotomy

Hepatoid Adenocarcinoma of the Lung: A Review of the Most Updated Literature and a Presentation of Three Cases

In a Surgical Thoracic Center, two females and a man were unexpectedly diagnosed with hepatoid adenocarcinoma of the lung (HAL) in a single year. HAL is a rare lung cancer with pathological features of hepatocellular carcinoma with no evidence of liver tumor or other primitive sites of neoplasms. As of today, a comprehensive treatment is still not written. We reviewed the most updated literature on HAL, aiming to highlight the proposed treatments available, and comparing them in terms of survival. General hallmarks of HAL are confirmed: it typically affects middle-aged, heavy-smoker males with a median of 5 cm bulky right upper lobe mass. Overall survival remains poor (13 months), with a longer but non-significant survival in females. Treatments are still unsatisfactory today: surgery guarantees a small benefit compared to non-operated HALs, and only N0 patients demonstrated improved survival (p = 0.04) compared to N1, N2, and N3. Even though the histology is fearsome, these are probably the patients who will benefit from upfront surgery. Chemotherapy seemed to behave as surgery, and there is no statistical difference between chemotherapy only, surgery, or adjuvant treatments, even though adjuvant treatments tend to be more successful. New chemotherapies have been reported with notable results in recent years, such as Tyrosine Kinase Inhibitors and monoclonal antibodies. In this complicated picture, new cases are needed to further build shared evidence in terms of diagnosis, treatments, and survival opportunities

Precision Surgery in NSCLC

Simple Summary The introduction of new therapies for non-small cell lung cancer (NSCLC) has radically changed the point of view of thoracic surgeons, leading them to pay increasingly more attention not only to the clinical stage, but also to the genomic and molecular features of the disease and the potential for multimodality treatments. This is the concept of precision surgery in thoracic oncology. The aim of our paper is to summarize the changes in thoracic surgical practice that occurred after the introduction of immunotherapy and targeted therapy for the treatment of NSCLC. Non-small cell lung cancer (NSCLC) is still one of the leading causes of death worldwide. This is mostly because the majority of lung cancers are discovered in advanced stages. In the era of conventional chemotherapy, the prognosis of advanced NSCLC was grim. Important results have been reported in thoracic oncology since the discovery of new molecular alterations and of the role of the immune system. The advent of new therapies has radically changed the approach to lung cancer for a subset of patients with advanced NSCLC, and the concept of incurable disease is still changing. In this setting, surgery seems to have developed a role of rescue therapy for some patients. In precision surgery, the decision to perform surgical procedures is tailored to the individual patient; taking into consideration not only clinical stage, but also clinical and molecular features. Multimodality treatments incorporating surgery, immune checkpoint inhibitors, or targeted agents are feasible in high volume centers with good results in terms of pathologic response and patient morbidity. Thanks to a better understanding of tumor biology, precision thoracic surgery will facilitate optimal and individualized patient selection and treatment, with the goal of improving the outcomes of patients affected by NSCLC