25 research outputs found

    Erratum to nodal management and upstaging of disease. Initial results from the Italian VATS Lobectomy Registry

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    [This corrects the article DOI: 10.21037/jtd.2017.06.12.]

    Two-port intrapericardial left VATS pneumonectomy

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    : Pneumonectomy is a surgical treatment for locally advanced lung tumors that deeply infiltrate into the pulmonary hilum, and is a major thoracic procedure. An intrapericardial approach may be necessary in cases where it is  impossible to safely deal with the extrapericardial non-invaded sections of the pulmonary vessels. This article describes our technique for intrapericardial left video-assisted thoracoscopic pneumonectomy in a patient with hilar squamous cell carcinoma. The procedure was performed through a two-incision approach and, because of the involvement of the proximal portion of the pulmonary vessels, an intrapericardial isolation and closure of these structures was performed. Radical lymphadenectomy was performed and a pericardial flap was used for coverage of the bronchial stump. This is a complex and challenging procedure, however the patient had an uneventful postoperative course and was discharged on the 7th postoperative day

    Predictors of unexpected nodal upstaging in patients with cT1-3N0 non-small cell lung cancer (NSCLC) submitted to thoracoscopic lobectomy

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    In the last decades, the use of video-assisted thoracoscopic surgery (VATS) lobectomy for the treatment of early stage non-small cell lung cancer is continuously growing. This is mainly due to the development of more advanced surgical devices, to the rising incidence of peripheral lung tumors and is also favored by the increased reliability of preoperative staging techniques. Despite this progress, postoperative unexpected nodal upstaging is still a relevant issue. Aim of this study is to identify possible predictors of unexpected nodal upstaging in patients affected by cT1-3N0 NSCLC submitted to VATS lobectomy

    Predictors of nodal upstaging in patients with cT1‑3N0 non‑small cell lung cancer (NSCLC): results from the Italian VATS Group Registry

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    PURPOSE: Accurate staging of early non-small cell lung cancer is fundamental for selecting the best treatment. The aim of this study was to identify risk factors for nodal upstaging after video-assisted thoracoscopic lobectomy for clinical T1-3N0 tumors. METHODS: From 2014 to 2017, 3276 thoracoscopic lobectomies were recorded in the prospective database "Italian VATS Group". Linear and multiple logistic regression models were adapted to identify independent predictors of nodal upstaging and factors associated with progression in postoperative N status. RESULTS: Nodal upstaging was found in 417 cases (12.7%), including 206 cases (6.2%) of N1-positive nodes, 81 cases of N2 nodes (2.4%), and 130 cases (4%) of involvement of both N1 + N2 nodes. A total of 241 (7.3%) patients had single-station nodal involvement, whereas 176 (5.3%) had multiple-station involvement. In the final regression model, the tumor grade, histology, pathologic T status, and > 12 resected nodes were independent predictors of nodal upstaging. CONCLUSIONS: The number of resected lymph nodes seems to predict nodal upstaging better than the type of intraoperative lymph node management. Other preoperative risk factors correspond to those for which the current guidelines of the European Society of Thoracic Surgery recommend more extensive preoperative mediastinal staging

    Perioperative outcomes in redo VATS for pulmonary ipsilateral malignancy: A single center experience

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    Background: The role of video-assisted thoracoscopic surgery for oncological major pulmonary resections is now well established; however, the literature within pulmonary re-operations is still limited. The purpose of this study is to evaluate the safety and efficacy of redo thoracoscopic resections for ipsilateral pulmonary malignancy. Methods: Data from patients undergoing video-assisted thoracoscopic surgery at the Unit of Thoracic Surgery of Padua were analyzed, comparing the results between the first and second ipsilateral surgery. The retrospective study included patients who underwent 2 thoracoscopic surgeries for oncological reasons between 2015 and 2022. The variables considered included patients' baseline characteristics, pre, intra, and postoperative data. Results: The study enrolled 51 patients undergoing ipsilateral thoracoscopic re-operation. The statistical analysis showed that surgical time (95min vs 115min; p = 0.009), the presence of intrapleural adhesions at second surgery (30 % vs 76 %; p 0.9) and complications (5.8 % vs 15.6 %; p = 0.11). The conversion rate to open surgery was 11.8 %. Conclusion: Although some differences emerged between the first and second intervention, they had minimal impact on the clinical course of the patients. Therefore, thoracoscopic surgery has been shown to be safe and effective in re-operations with satisfying perioperative outcomes. To achieve such results, these procedures should be reserved for experienced surgeons

    Lobectomy with artery reconstruction and pneumonectomy for NSCLC: a propensity score weighting study

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    The treatment of NSCLC is based, when suitable, on surgical resection. Pneumonectomy has been considered the standard surgical procedure for locally advanced lung cancers but it is associated with high mortality and morbidity rates. Reconstruction of the pulmonary artery, associated with parenchyma sparing techniques, is meant to be an alternative to pneumonectomy
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