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Potenza R, Andolfi M, Dell’Amore A, Lugaresi M, Roca G, Valentini L, Catelli C, Buia F, Dolci G, Floridi C, Moretti R, Colafigli C, Refai M, Rea F, Puma F, Daddi N. Unlocking the Potential of Computed Tomography-Guided Tracers in Pinpointing Lung Lesions during Surgery: A Collaborative Multi-Institutional Journey. J Clin Med 2024; 13:6041. [PMID: 39457991 PMCID: PMC11508513 DOI: 10.3390/jcm13206041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2024] [Revised: 10/04/2024] [Accepted: 10/08/2024] [Indexed: 10/28/2024] Open
Abstract
Background: Multiple techniques exist for the preoperative localization of small, deeply located solid or subsolid pulmonary nodules to guide limited thoracoscopic resection. This study aims to conduct a multi-institutional comparison of three different tomography-guided tracers' methods. Methods: A retrospective multicenter cross-sectional study was conducted. All patients suitable for CT-guided tracers with microcoil (GROUP1, n = 58), hook wire (GROUP2, n = 86), or bioabsorbable hydrogel plug (GROUP3, n = 33) were scheduled for video-assisted thoracoscopic wedge resection. Outcome variables: successful nodule localization, safety, and the feasibility of the tracers' placement. A χ2 test or Fisher's test for expected numbers less than five and a Kruskal-Wallis test were used to analyze the categorical and continuous variables, respectively. For the power calculations, we used G*Power version 3.1.9.6. Results: One hundred seventy-seven patients underwent the localization and resection of 177 nodules detected with three different CT-guided tracers. A significant difference was recorded for cancer history (p = 0.030), respiratory function, Charlson comorbidity index (p = 0.018), lesion type (p < 0.0001), distance from pleura surface (p < 0.0001), and time between preoperative CT-guided tracers and surgical procedures (p < 0.0001). Four post-procedural complications were recorded and in GROUP2, four cases of tracer dislocations occurred. Finally, hook wire group was associated with the shortest surgical time (93 min, p = 0.001). Conclusions: All methods were feasible and efficient, resulting in a 100% success rate for the microcoils and the bioabsorbable hydrogel plugs and a 94.2% success rate for the hook wires. Our results highlight the need to choose a technique that is less stressful for the patient and helps the surgeon by extending the approach to deep nodules and resecting over the course of several days from deployment.
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Affiliation(s)
- Rossella Potenza
- Thoracic Surgery Unit, University of Perugia Medical School, 06129 Perugia, Italy; (R.P.); (F.P.)
| | - Marco Andolfi
- Thoracic Surgery Unit, AOU delle Marche, 60121 Ancona, Italy;
| | - Andrea Dell’Amore
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences, University of Padua, 06129 Padua, Italy; (A.D.); (G.R.); (C.C.); (F.R.)
| | - Marialuisa Lugaresi
- Department of Medicine and Surgery (DIMEC), University of Bologna, 40126 Bologna, Italy;
| | - Gabriella Roca
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences, University of Padua, 06129 Padua, Italy; (A.D.); (G.R.); (C.C.); (F.R.)
| | - Leonardo Valentini
- Thoracic Surgery Unit, Alma Mater Studiorum—IRCSS Ospedaliero-Universitaria S. Orsola di Bologna, 40138 Bologna, Italy; (L.V.); (G.D.)
| | - Chiara Catelli
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences, University of Padua, 06129 Padua, Italy; (A.D.); (G.R.); (C.C.); (F.R.)
| | - Francesco Buia
- Cardio-Thoracic-Radiology Unit, Department of Cardio-Thoracic-Vascular, IRCSS Ospedaliero-Universitaria S. Orsola di Bologna, 40138 Bologna, Italy;
| | - Giampiero Dolci
- Thoracic Surgery Unit, Alma Mater Studiorum—IRCSS Ospedaliero-Universitaria S. Orsola di Bologna, 40138 Bologna, Italy; (L.V.); (G.D.)
| | - Chiara Floridi
- Department of Radiological Sciences, Università Politecnica Marche, AOU delle Marche, 60121 Ancona, Italy;
| | - Riccardo Moretti
- Department of Radiology, Santa Maria della Misericordia Hospital, 06129 Perugia, Italy; (R.M.); (C.C.)
| | - Claudia Colafigli
- Department of Radiology, Santa Maria della Misericordia Hospital, 06129 Perugia, Italy; (R.M.); (C.C.)
| | - Majed Refai
- Thoracic Surgery Unit, AOU delle Marche, 60121 Ancona, Italy;
| | - Federico Rea
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences, University of Padua, 06129 Padua, Italy; (A.D.); (G.R.); (C.C.); (F.R.)
| | - Francesco Puma
- Thoracic Surgery Unit, University of Perugia Medical School, 06129 Perugia, Italy; (R.P.); (F.P.)
| | - Niccolò Daddi
- Thoracic Surgery Unit, Alma Mater Studiorum—IRCSS Ospedaliero-Universitaria S. Orsola di Bologna, 40138 Bologna, Italy; (L.V.); (G.D.)
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Nomogram Predicting the Risk of Postoperative Major Wound Complication in Soft Tissue Sarcoma of the Trunk and Extremities after Preoperative Radiotherapy. Cancers (Basel) 2022; 14:cancers14174096. [PMID: 36077636 PMCID: PMC9454623 DOI: 10.3390/cancers14174096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/21/2022] [Accepted: 08/22/2022] [Indexed: 11/16/2022] Open
Abstract
Preoperative radiotherapy increases the risk of postoperative wound complication in the treatment of soft tissue sarcoma (STS). This study aims to develop a nomogram for predicting major wound complication (MaWC) after surgery. Using the Oxford University Hospital (OUH) database, a total of 126 STS patients treated with preoperative radiotherapy and surgical resection between 2007 and 2021 were retrospectively reviewed. MaWC was defined as a wound complication that required secondary surgical intervention. Univariate and multivariate regression analyses on the association between MaWC and risk factors were performed. A nomogram was formulated and the areas under the Receiver Operating Characteristic Curves (AUC) were adopted to measure the predictive value of MaWC. A decision curve analysis (DCA) determined the model with the best discriminative ability. The incidence of MaWC was 19%. Age, tumour size, diabetes mellitus and metastasis at presentation were associated with MaWC in the univariate analysis. Age, tumour size, and metastasis at presentation were independent risk factors in the multivariate analysis. The sensitivity and specificity of the predictive model is 0.90 and 0.76, respectively. The AUC value was 0.86. The nomogram constructed in the study effectively predicts the risk of MaWC after preoperative radiotherapy and surgery for STS patients.
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Ala M, Liu J, Kou J, Wang X, Sun M, Hao C, Wu J. The risk factors for the failure of hook wire localization of ground glass nodules prior to thoracoscopic surgery. J Cardiothorac Surg 2022; 17:114. [PMID: 35546677 PMCID: PMC9092699 DOI: 10.1186/s13019-022-01866-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 03/20/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives To retrospectively analyse the potential influencing factors of CT-guided hook wire localization failure prior to thoracoscopic resection surgery of ground glass nodules (GGNs), and determine the main risk elements for localization failure. Methods In all, 372 patients were included in this study, with 21 patients showing localization failure. The related parameters of patients, GGNs, and localization were analysed through univariate and multiple logistic regression analysis to determine the risk factors of localization failure. Results Univariate logistic regression analysis indicated that trans-fissure (odds ratio [OR] 4.896, 95% confidence interval [CI] 1.489–13.939); trans-emphysema (OR 3.538, 95% CI 1.343–8.827); localization time (OR 0.956, 95% CI 0.898–1.019); multi-nodule localization (OR 2.597, 95% CI 1.050–6.361); and pneumothorax (OR 10.326, 95% CI 3.414–44.684) were risk factors for localization failure, and the p-values of these factors were < 0.05. However, according to the results of multivariate analysis, pneumothorax (OR 5.998, 95% CI 1.680–28.342) was an exclusive risk factor for the failure of preoperative localization of GGNs. Conclusion CT-guided hook wire localization of GGNs prior to thoracoscopic surgery is often known to fail; however, the incidence is low. Pneumothorax is an independent risk factor for failure in the localization process.
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Affiliation(s)
- Musu Ala
- Graduate School, Tianjin Medical University, Tianjin, 300070, People's Republic of China.,Department of Ultrasound, The Affiliated Hospital of Inner Mongolia Medial University, Hohhot, Inner Mongolia, 010050, People's Republic of China
| | - Junzhong Liu
- Department of Radiology, Weifang People's Hospital, The First Affiliated Hospital of Weifang Medical University, Weifang, 261041, Shandong, People's Republic of China
| | - Jieli Kou
- Department of Medical Imaging, Cangzhou People's Hospital, Cangzhou, 061001, Hebei, People's Republic of China
| | - Xinhua Wang
- Department of Radiology, Weifang No. 2 People's Hospital, The Second Affiliated Hospital of Weifang Medical University, Weifang, 261041, Shandong, People's Republic of China
| | - Minfeng Sun
- Department of Radiology, Weifang No. 2 People's Hospital, The Second Affiliated Hospital of Weifang Medical University, Weifang, 261041, Shandong, People's Republic of China
| | - Changcheng Hao
- Thoracic Surgery Department, Weifang No. 2 People's Hospital, The Second Affiliated Hospital of Weifang Medical University, Weifang, 261041, Shandong, People's Republic of China
| | - Jianlin Wu
- Graduate School, Tianjin Medical University, Tianjin, 300070, People's Republic of China. .,Department of Medical Imaging, Affiliated Zhongshan Hospital of Dalian University, 6 Jiefang Street, Dalian, 116001, Liaoning, People's Republic of China.
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Chao YK, Chi CL, Gao X, Tai CC. Preoperative percutaneous localization of multiple ipsilateral pulmonary nodules: A systematic review. FORMOSAN JOURNAL OF SURGERY 2022. [DOI: 10.4103/fjs.fjs_108_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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