29 research outputs found
Enhanced recovery pathways in thoracic surgery from Italian VATS group: preoperative optimisation
Abstract: Preoperative patient optimisation is a key point of enhanced recovery after thoracic surgery
pathways. This could be particularly advantageous when considering video-assisted thoracic surgery (VATS)
lobectomy, because reduced trauma related to minimally invasive techniques is one of the main factors
favouring improved postoperative outcome. Main specific interventions for clinical optimisation before major
lung resection include assessment and treatment of comorbidities, minimizing preoperative hospitalization,
optimisation of pharmacological prophylaxis (antibiotic and thromboembolic) and minimizing preoperative
fasting. Literature data and clinical evidences in this setting are reported and discussed
Parenchymal sparing surgery for lung cancer: focus on pulmonary artery reconstruction
Simple Summary Reconstruction of the pulmonary artery associated with lobectomy for the radical resection of lung cancer is a safe and effective therapeutic option that may allow radical resection when lobectomy is not technically feasible, avoiding pneumonectomy. This review addresses some controversial aspects concerning the intraoperative and perioperative management of a sleeve resection with pulmonary artery reconstruction that may influence the outcome. Pulmonary artery reconstruction associated with lobectomy is a safe and viable parenchymal sparing intervention to radically treat lung cancer, allowing better long-term survival, lower perioperative morbidity and mortality rates and functional benefits if compared with PN. Reconstruction of the pulmonary artery (PA) associated with lobectomy for the radical resection of lung cancer has been progressively gaining diffusion in lung cancer surgery as a safe and effective therapeutic option that may allow radical resection when lobectomy is not technically feasible, avoiding pneumonectomy. There are some controversial aspects concerning the intraoperative and perioperative management of a sleeve resection with PA reconstruction that may influence the outcome. In the present article, the authors have analyzed some of the main technical and oncological aspects to take stock of what they have learned from their lung-sparing operations experience over time. PA reconstruction may require prosthetic materials including different options with variable cost. A main concern in vascular reconstructive procedures is avoiding tension on the anastomosis. When PA reconstruction is required, appropriate anticoagulation management is crucial. Results from the main literature data confirm the reliability of lobectomy associated with PA reconstruction in terms of perioperative morbidity and long-term survival. Sleeve lobectomy and PA reconstruction can be performed safely and effectively even after induction therapy
Salvage resection of advanced mediastinal tumors
The surgical treatment of locally advanced mediastinal tumors invading the great vessels and
other nearby structures still represent a tricky question, principally due to the technical complexity of the
resective phase, the contingent need to carry out viable vascular reconstructions and, therefore, the proper
management of pathophysiologic issues. Published large-number series providing oncologic outcomes
of patients who have undergone extended radical surgery for invasive mediastinal masses are just a few.
Furthermore, the wide variety of different histologies included in some of these studies, as well as the
heterogeneity of chemo and radiation therapies employed, did not allow for the development of clear
oncologic guidelines. Usually in the past, surgical resections of large masses along with the neighbouring
structures were not offered to patients because of related morbidity and mortality and limited information
available on the prognostic advantage for long term. However, in the last decades, advances in surgical
technique and perioperative management, as well as increased oncologic experience in this field, have allowed
radical exeresis in selected patients with invasive tumors requiring resections extended to the surrounding
structures and complex vascular reconstructions. Such aggressive surgical treatment has been proposed in
association or not with adjuvant chemo- or radiotherapy regimens, achieving encouraging oncologic results
with limited morbidity and mortality in experienced institutions. Congestive heart failure or impending
cardiovascular collapse due to the compression by the large mass are the most frequent immediately lifethreatening
problems that some of these patients can experience. In this setting, medical palliation is usually
ineffective and an aggressive salvage surgical treatment may remain the only therapeutic option
Prognostic factors of lung cancer in lymphoma survivors (the LuCiLyS study)
Background
Second cancer is the leading cause of death in lymphoma survivors, with lung cancer representing the most common solid tumor. Limited information exists about the treatment and prognosis of second lung cancer following lymphoma. Herein, we evaluated the outcome and prognostic factors of Lung Cancer in Lymphoma Survivors (the LuCiLyS study) to improve the patient selection for lung cancer treatment.
Methods
This is a retrospective multicentre study including consecutive patients treated for lymphoma disease that subsequently developed non-small cell lung cancer (NSCLC). Data regarding lymphoma including age, symptoms, histology, disease stage, treatment received and lymphoma status at the time of lung cancer diagnosis, and data on lung carcinoma as age, smoking history, latency from lymphoma, symptoms, histology, disease stage, treatment received, and survival were evaluated to identify the significant prognostic factors for overall survival.
Results
Our study population included 164 patients, 145 of which underwent lung cancer resection. The median overall survival was 63 (range, 58–85) months, and the 5-year survival rate 54%. At univariable analysis no-active lymphoma (HR: 2.19; P=0.0152); early lymphoma stage (HR: 1.95; P=0.01); adenocarcinoma histology (HR: 0.59; P=0.0421); early lung cancer stage (HR: 3.18; P<0.0001); incidental diagnosis of lung cancer (HR: 1.71; P<0.0001); and lung cancer resection (HR: 2.79; P<0.0001) were favorable prognostic factors. At multivariable analysis, no-active lymphoma (HR: 2.68; P=0.004); early lung cancer stage (HR: 2.37; P<0.0001); incidental diagnosis of lung cancer (HR: 2.00; P<0.0001); and lung cancer resection (HR: 2.07; P<0.0001) remained favorable prognostic factors. Patients with non-active lymphoma (n=146) versus those with active lymphoma (n=18) at lung cancer diagnosis presented better median survival (64 vs. 37 months; HR: 2.4; P=0.02), but median lung cancer specific survival showed no significant difference (27 vs. 19 months; HR: 0.3; P=0.17).
Conclusions
The presence and/or a history of lymphoma should not be a contraindication to resection of lung cancer. Inclusion of lymphoma survivors in a lung cancer-screening program may lead to early detection of lung cancer, and improve the survival