Large-cell neuroendocrine carcinoma of the lung: A clinicopathologic study of eighteen cases and the efficacy of adjuvant treatment with octreotide

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Digital versus traditional air leak evaluation after elective pulmonary resection: A prospective and comparative mono-institutional study

BACKGROUND: The increased demand to reduce costs and hospitalization in general pushed several institution worldwide to develop fast-tracking protocols after pulmonary resections. One of the commonest causes of protracted hospital stay remains prolonged air leaks (ALs). We reviewed our clinical practice with the aim to compare traditional vs. digital chest drainages in order to evaluate which is the more effective to correctly manage the chest tube after pulmonary resection. METHODS: All patients submitted to elective pulmonary resection for lung malignancies, between April to December, 2014 in our General Thoracic Surgery Department were included in the study. The primary outcome was the chest tube duration, the secondary the postoperative overall hospitalization. Significant differences between traditional and digital groups were investigated with logistic regression models. Numerical variables between the groups were compared by means of the unpaired Wilcoxon-Mann-Whitney test. RESULTS: Both series of patients were comparable for clinical, surgical and pathological characteristics. Chest tube duration showed to be significantly shorter in the digital group (3 vs. 5 days, P=0.0009), while the hospitalization was longer in traditional one [8 vs. 7 days in digital drainage (DD); P=0.0385]. No chest drainage replacement was required at 30-day, in both groups. CONCLUSIONS: We were able to demonstrate that patients managed with a digital system experienced a shorter chest tube duration as well as a lower overall hospital length of stay, compared to those who received the traditional drainage (TD)

Does morbid obesity influence perioperative outcomes after video-assisted thoracic surgery (VATS) lobectomy for non-small cell lung cancer? Analysis of the Italian VATS group registry

Objectives: Obesity in Europe, and worldwide, has been an increasing epidemic during the past decades. Moreover, obesity has important implications regarding technical issues and the risks associated with surgical interventions. Nevertheless, there is a lack of evidence assessing the influence of obesity on video-assisted thoracic surgery (VATS) lobectomy results. Our study aimed to assess the impact of morbid obesity on perioperative clinical and oncological outcomes after VATS lobectomy using a prospectively maintained nationwide registry. Methods: The Italian VATS lobectomy Registry was used to collect all consecutive cases from 55 Institutions. Explored outcome parameters were conversion to thoracotomy rates, complication rates, intra-operative blood loss, surgical time, hospital postoperative length of stay, chest tube duration, number of harvested lymph-node, and surgical margin positivity. Results: From 2016 to 2019, a total of 4412 patients were collected. 74 patients present morbid obesity (1.7%). Multivariable-adjusted analysis showed that morbid obesity was associated with a higher rate of complications (32.8% vs 20.3%), but it was not associated with a higher rate of conversion, and surgical margin positivity rates. Moreover, morbid obesity patients benefit from an equivalent surgical time, lymph-node retrieval, intraoperative blood loss, hospital postoperative length of stay, and chest tube duration than non-morbid obese patients. The most frequent postoperative complications in morbidly obese patients were pulmonary-related (35%). Conclusion: Our results showed that VATS lobectomy could be safely and satisfactorily conducted even in morbidly obese patients, without an increase in conversion rate, blood loss, surgical time, hospital postoperative length of stay, and chest tube duration. Moreover, short-term oncological outcomes were preserved

Digital versus traditional air leak evaluation after elective pulmonary resection: A prospective and comparative mono-institutional study

BACKGROUND: The increased demand to reduce costs and hospitalization in general pushed several institution worldwide to develop fast-tracking protocols after pulmonary resections. One of the commonest causes of protracted hospital stay remains prolonged air leaks (ALs). We reviewed our clinical practice with the aim to compare traditional vs. digital chest drainages in order to evaluate which is the more effective to correctly manage the chest tube after pulmonary resection. METHODS: All patients submitted to elective pulmonary resection for lung malignancies, between April to December, 2014 in our General Thoracic Surgery Department were included in the study. The primary outcome was the chest tube duration, the secondary the postoperative overall hospitalization. Significant differences between traditional and digital groups were investigated with logistic regression models. Numerical variables between the groups were compared by means of the unpaired Wilcoxon-Mann-Whitney test. RESULTS: Both series of patients were comparable for clinical, surgical and pathological characteristics. Chest tube duration showed to be significantly shorter in the digital group (3 vs. 5 days, P=0.0009), while the hospitalization was longer in traditional one [8 vs. 7 days in digital drainage (DD); P=0.0385]. No chest drainage replacement was required at 30-day, in both groups. CONCLUSIONS: We were able to demonstrate that patients managed with a digital system experienced a shorter chest tube duration as well as a lower overall hospital length of stay, compared to those who received the traditional drainage (TD)

NMR and MRCP After Secretin Infusion in a Long-Term Comparison Study of Pancreogastro- vs. Pancreojejuno-Duodenopancreatectomy

Context After pylorus-preserving pancreaticoduodenectomy the anastomosis of pancreatic remnant may be done with the stomach (pancreogastric, PGA) or the jejunum (pancreojejunum, PJA). Recently, we have found that, in the long-term, PGA is associated with a more severe impairment of the residual pancreatic function. No data are available on the RNM ability to demonstrate an impairment of the residual pancreatic secretion or morphological changes after surgery. Methods Patients who 6 years ago entered a controlled short term comparison of PGA and PJA were studied by RNM and MRCP after secretin infusion (quantification of residual pancreatic volume, pancreatic duct diameter immediately proximal to the anastomosis, qualitative impairment of secretion), and tests of exocrine (fecal elastase-1, fecal fat balance) function. Two radiologists, blinded to the results of functional parameters, independently scored the residual pancreatic volume, duct diameter and secretin-stimulated secretion. Mean±SEM are shown. The Student’s t test was used. Results We studied 34 patients (16 PGA, 18 PJA; age 56.6±2.7 vs. 57.5±2.5 years; time from surgery 81±5 vs. 80±3 months). PGA was associated with a more severe impairment of steatorrhea than PJA (26.6±4.1 vs. 18.2±3.6 g/day; reference range: 0-7; P<0.01) and of fecal elastase-1 (70.2±25.5 vs. 121.4±6.7 µg/g; P<0.001). RNM showed in PGA a more marked dilatation of the pancreatic duct (diameter 4.63±0.91 vs. 2.50±0.18 mm, P<0.05) and non significant tendency to a smaller residual pancreas (26.3±3.0 vs. 35.9±4.1 mL; P=0.069). There is a power correlation between residual pancreas and steatorrhea. After secretin infusion, the secretion was consistently considered by two different radiologists to be more frequently impaired in PGA (42%) than in PJA (18%; P=0.05, Fisher test). Conclusion The pancreo-gastric anastomosis is associated, in the long run, with more severe morphological and functional impairment of exocrine function than the pancreo-jejunal one