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Fiorelli A, Forte S, Caronia FP, Ferrigno F, Santini M, Petersen RH, Fang W. Is video-assisted thoracoscopic lobectomy associated with higher overall costs compared with open surgery? Results of best evidence topic analysis. Thorac Cancer 2021; 12:567-579. [PMID: 33544445 PMCID: PMC7919127 DOI: 10.1111/1759-7714.13708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/02/2020] [Accepted: 10/02/2020] [Indexed: 11/28/2022] Open
Abstract
Thoracoscopic lobectomy has become the preferred approach for surgical management of early stage lung cancer, but the potential higher operative costs limit its widespread use. Theoretically, higher direct costs may be significantly counterbalanced by lower indirect costs, resulting in lower overall costs for thoracoscopic than for open lobectomy. To support this hypothesis, we reviewed the literature until May 2020, analyzing all papers comparing the cost of thoracoscopic versus open lobectomy.A total of 20 studies provided the most applicable evidence to evaluate this issue. In all the studies apart from one, thoracoscopic lobectomy was associated with higher operative costs due to the increased use of disposable instruments, and prolonged operative time. By contrast, in 17 studies the increased operative costs were significantly offset by indirect costs which were lower in thoracoscopic than in open lobectomy due to fewer postoperative complications, faster recovery, and lower readmission rates. It translated into lower overall costs for thoracoscopic than for open lobectomy in 10 studies, similar costs in seven, and higher in three, despite the lower hospitalization costs. The low bed fees and high prices of disposable instruments in these three studies may explain the discordance. The careful use of disposable instruments, and the minimizing hospitalization costs can reduce the total costs of thoracoscopic lobectomy to levels similar or to below those of open lobectomy. The worry that video‐assisted thoracoscopic surgery lobectomy (VATSL) might be associated with an increased overal cost is thus not warranted, and should not be used as an excuse against the use of VATS in surgery for early stage lung cancers.
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Affiliation(s)
- Alfonso Fiorelli
- Department of Translation Medicine, Thoracic Surgery Unit, Università della Campania "Luigi Vanvitelli", Naples, Italy
| | - Stefano Forte
- Istituto Oncologico del Mediterraneo (IOM), Catania, Italy
| | | | | | - Mario Santini
- Department of Translation Medicine, Thoracic Surgery Unit, Università della Campania "Luigi Vanvitelli", Naples, Italy
| | - René Horsleben Petersen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Jiao Tong University Medical School, Shanghai, China
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2
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Palumbo VD, Fazzotta S, Fatica F, D'Orazio B, Caronia FP, Cajozzo M, Damiano G, Maffongelli A, Cudia BM, Messina M, Lo Monte AI. Pancoast tumour: current therapeutic options. Clin Ter 2019; 170:e291-e294. [PMID: 31304518 DOI: 10.7417/ct.2019.2150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Pancoast's syndrome is caused by malignant neoplasm of superior sulcus of the lung which produces destructive lesions of thoracic inlet and comes along with the involvement of brachial plexus and stellate ganglion. Computed tomography (CT) or magnetic resonance imaging (MRI) scans can detect early lesions otherwise missed by routine radiographs and can also define the local extent or metastatic progression of the disease. Protocols involving combinations of irradiation, chemotherapy, and surgery are currently being under investigation to determine the best management. AIMS This work reviewed the current diagnostic and therapeutic approaches to Pancoast's tumors. DISCUSSION Patients with lung superior sulcus carcinoma should be considered for surgery only after an appropriate diagnostic assessment. The perfect candidate for surgery should have a confined to the chest disease with T3N0M0 staging. Inoperable patient with severe pain after irradiation therapy may benefit from palliative surgical resection. Medical therapy plays only a secondary role in lung cancers, patients with disseminated lung cancer might require palliative treatment and medical management of paraneoplastic syndrome symptoms. Following surgery, radiation and chemotherapy may improve local and systemic control by addressing individual adverse findings. CONCLUSIONS The cooperation of surgeons, clinicians and radiologists represents the gold standard today and a multidisciplinary approach is essential to achieve the best outcome possible. Further studies are advisable in order to define the best surgical approach and the real advantage of mini-invasive surgery by comparison with open surgery.
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Affiliation(s)
- V D Palumbo
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo - Euro-Mediterranean Institute of Science and Technology (IEMEST), Palermo
| | - S Fazzotta
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo
| | - F Fatica
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo
| | - B D'Orazio
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo
| | - F P Caronia
- Mediterranean Oncological Institute (IOM), Viagrande
| | - M Cajozzo
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo
| | - G Damiano
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo
| | - A Maffongelli
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo
| | - B M Cudia
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo
| | - M Messina
- School of Medicine, University of Palermo, Italy
| | - A I Lo Monte
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo
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3
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Affiliation(s)
- Alfonso Fiorelli
- Thoracic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Gaetana Messina
- Thoracic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Giovanni Liguori
- Anaestesia and Intensive care Unit, Cardarelli Hospital, Naples, Italy
| | - Ettore Arrigo
- Thoracic Surgery Unit, Istituto Oncologico del Mediterraneo, Viagrande (CT), Italy
| | | | - Mario Santini
- Thoracic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
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4
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Cajozzo M, Palumbo VD, Mannino V, Geraci G, Lo Monte AI, Caronia FP, Fatica F, Romano G, Puzhlyakov V, D'Anna R, Cocchiara G. Ultrasound-guided port-a-cath positioning with the new one-shoot technique: thoracic complications. Clin Ter 2019; 169:e277-e280. [PMID: 30554248 DOI: 10.7417/ct.2018.2093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Port-a-cath catheterization is often required for those patients who need long-term therapies (malnutrition, neoplasm, renal failure, other severe diseases). The use of ports for a wide range of indications is not exempt from complications. Ultrasound-guided central venous catheterization (CVC) is a safe and fast technique for the introduction of the catheter inside a central vein. This retrospective study reports our experience with US-guided CVC in patient eligible for port-a-cath implantation. MATERIALS AND METHODS From January 2007 to March 2017, 108 CVC (out of 770 procedures), were positioned using an ultrasound guide, with the new "one-shoot technique" (group 1) and the classic Seldinger technique (group 2). RESULTS One-shoot techniques showed a reduced operative time, in comparison to Seldinger technique, with a negligible minor complication rate. No major complication were evidenced. CONCLUSIONS CVC is a safe procedure, although not free from complications. Ultrasonography enhances safety of the procedure by decreasing puncture attempts and complications; it is helpful in patients with vascular anatomical variations, with no visualized or palpable landmarks or for patients with coagulation disorders.
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Affiliation(s)
- M Cajozzo
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo
| | - V D Palumbo
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo - Euro-Mediterranean Institute of Science and Technology (IEMEST), Palermo
| | - V Mannino
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo
| | - G Geraci
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo
| | - A I Lo Monte
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo
| | - F P Caronia
- Mediterranean Oncological Institute (IOM), Viagrande, Italy
| | - F Fatica
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo
| | - G Romano
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo
| | - V Puzhlyakov
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo
| | - R D'Anna
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo
| | - G Cocchiara
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo
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Caronia FP, Fatica F, Librizzi D, Fiorelli A. Uniportal Thoracoscopic Thoracic Duct Clipping in Poirier's Triangle for Postoperative Chylothorax. Ann Thorac Surg 2018; 107:e415-e416. [PMID: 30444992 DOI: 10.1016/j.athoracsur.2018.09.062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 09/18/2018] [Accepted: 09/19/2018] [Indexed: 11/18/2022]
Abstract
Postoperative chylothorax is a rare but potentially life-threatening complication. Conservative treatment is usually unsuccessful in patients with high-output chylothorax, for whom early surgical thoracic duct ligation has been advocated to minimize morbidity and mortality. This report describes left uniportal thoracoscopic closure of persistent high-output chylothorax through Poirier's triangle in a patient undergoing thoracoscopic thymectomy. After resection of pleural adhesions, the mediastinal pleura was resected at the level of the aortic arch, left subclavian artery, and vertebral column, the anatomic limits of Poirier's triangle. The thoracic duct was then isolated from the esophagus and successfully clipped along its path.
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Affiliation(s)
| | - Federica Fatica
- Thoracic Surgery Unit, Ospedale Civico di Palermo, Palermo, Italy
| | - Damiano Librizzi
- Thoracic Surgery Unit, Ospedale Civico di Palermo, Palermo, Italy
| | - Alfonso Fiorelli
- Thoracic Surgery Unit, Università della Campania Luigi Vanvitelli, Naples, Italy.
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Fiorelli A, Izzo AC, Arrigo E, Sgalambro F, Lepore MA, Cajozzo M, Castorina S, Lo Monte AI, Santini M, Caronia FP. Resection of esophageal diverticulum through uniportal video-assisted thoracoscopic surgery. Ann Transl Med 2018; 6:179. [PMID: 29951501 DOI: 10.21037/atm.2018.04.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Open surgery remains the standard strategy for management of esophageal diverticulum in symptomatic patients. However, in the last years an increasing number of minimally invasive approaches have been proposed for this issue in order to reduce the surgical trauma and favor a fast return to daily activity. Herein, we describe a novel technique as uniportal video-assisted thoracoscopic surgery (VATS) for performing resection of esophageal diverticulum. This procedure was successfully carried out in three consecutive patients with giant mid-esophageal diverticulum (mean size: 6.5±0.5 cm). The mean post-operative time was 121±10 minutes. The chest drain was removed 48 hours later in all cases and the mean length of hospital stay was 9±1 days. No intraoperative neither postoperative complications were found in all patients but one. He had a small fistula 15 days later that was successfully treated with stent insertion. No recurrence of diverticulum was seen in all cases. Uniportal VATS is a feasible procedure that in theory could reduce the surgical trauma compared to standard open approach. However, future prospective studies should corroborate our impression before it can be recommended as acceptable therapy.
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Affiliation(s)
- Alfonso Fiorelli
- Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Anna Cecilia Izzo
- Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Ettore Arrigo
- Thoracic Surgery Unit, Istituto Oncologico del Mediterraneo, Viagrande, Italy
| | - Francesco Sgalambro
- Thoracic Surgery Unit, Istituto Oncologico del Mediterraneo, Viagrande, Italy
| | | | - Massimo Cajozzo
- Thoracic Surgery unit, University of Palermo, Palermo, Italy
| | - Sergio Castorina
- G.B. Morgagni Foundation, Department of Bio-Medical Sciences, University of Catania, Catania, Italy
| | | | - Mario Santini
- Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, Naples, Italy
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7
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Caronia FP, Arrigo E, Failla AV, Sgalambro F, Giannone G, Lo Monte AI, Cajozzo M, Santini M, Fiorelli A. Uniportal thoracoscopy combined with laparoscopy as minimally invasive treatment of esophageal cancer. J Thorac Dis 2018; 10:E265-E269. [PMID: 29850166 DOI: 10.21037/jtd.2018.03.107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A 67-year-old man was referred to our attention for management of esophageal adenocarcinoma, localized at the level of the esophagogastric junction and obstructed the 1/3 of the esophageal lumen. Due to the extension of the disease (T3N1M0-Stage IIIA), the patient underwent neo-adjuvant chemo-radiation therapy and he was then scheduled for a minimally invasive surgical procedure including laparoscopic gastroplasty, uniportal thoracoscopic esophageal dissection and intrathoracic end-to-end esophago-gastric anastomosis. No intraoperative and post-operative complications were seen. The patient was discharged in post-operative day 9. Pathological study confirmed the diagnosis of adenocarcinoma (T2N1M0-Stage IIB) and he underwent adjuvant chemotherapy. At the time of present paper, patient is alive and well without signs of recurrence or metastasis. Our minimally approach compared to standard open procedure would help reduce post-operative pain and favours early return to normal activity. However, future experiences with a control group are required before our strategy can be widely used.
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Affiliation(s)
| | - Ettore Arrigo
- Thoracic Surgery Unit, Istituto Oncologico del Mediterraneo, Viagrande, Catania, Italy
| | | | - Francesco Sgalambro
- Anaesthesiology Unit, Istituto Oncologico del Mediterraneo, Viagrande, Catania, Italy
| | - Giorgio Giannone
- General Surgery Unit, Istituto Oncologico del Mediterraneo, Viagrande, Catania, Italy
| | | | - Massimo Cajozzo
- Thoracic Surgery Unit, Università degli Studi di Palermo, Palermo, Italy
| | - Mario Santini
- Thoracic Surgery Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alfonso Fiorelli
- Thoracic Surgery Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
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8
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Caronia FP, Arrigo E, Trovato S, Lo Monte AI, Cottone S, Sgalambro F, Guglielmo M, Volpicelli A, Fiorelli A. Uniportal bilateral video-assisted sequential thoracoscopic extended thymectomy. J Vis Surg 2017; 3:69. [PMID: 29078632 DOI: 10.21037/jovs.2017.03.29] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 03/21/2017] [Indexed: 11/06/2022]
Abstract
Standard video-assisted thoracoscopic surgery has been reported as a minimally invasive approach alternative to sternotomy for management of myasthenia gravis (MG) associated with thymoma or thymic hyperplasia. Uniportal video-thoracoscopy is an evolution of standard multi-portal video-thoracoscopy for management of several thoracic diseases but its role for resecting mediastinal tumor remains under-evaluated. Herein, we describe our experience with bilateral uniportal thoracoscopic sequential extended thymectomy with case and video illustrations.
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Affiliation(s)
| | - Ettore Arrigo
- Istituto Oncologico del Mediterraneo, Viagrande, Italy
| | | | | | - Salvatore Cottone
- Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | | | | | - Antonio Volpicelli
- Thoracic Surgery Unit, Seconda Università degli Studi di Napoli, Naples, Italy
| | - Alfonso Fiorelli
- Thoracic Surgery Unit, Seconda Università degli Studi di Napoli, Naples, Italy
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9
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Abstract
We propose a technique of uniportal VATS lobectomy using a posterior approach. The main differences of our technique versus standard anterior uniportal VATS are the following: (I) the surgical incision is performed in the auscultatory triangle instead of in the posterior axillary line and (II) the surgeon is placed posteriorly to the patient rather than anteriorly. For thoracic surgeons who are familiar with posterolateral thoracotomy, our technique allows to replicate the same maneuvers performed in the open approach. This strategy was applied with success in 19 consecutive patients for anatomical resection of neoplastic (n=17) and benign (n=2) diseases.
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Affiliation(s)
| | - Ettore Arrigo
- Thoracic Surgery Unit, Istituto Oncologico del Mediterraneo, Catania, Italy
| | - Alfonso Fiorelli
- Thoracic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
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10
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Caronia FP, Loizzi D, Nicolosi T, Castorina S, Fiorelli A. Tubeless tracheal resection and reconstruction for management of benign stenosis. Head Neck 2017; 39:E114-E117. [DOI: 10.1002/hed.24942] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 07/15/2017] [Accepted: 07/28/2017] [Indexed: 11/11/2022] Open
Affiliation(s)
| | - Domenico Loizzi
- Thoracic Surgery Unit; Università degli Studi di Foggia; Foggia Italy
| | - Tommaso Nicolosi
- Dipartimento di Chirurgia Toracica; Centro Clinico e Diagnostico Morgagni; Catania Italy
| | - Sergio Castorina
- Dipartimento di Chirurgia Toracica; Centro Clinico e Diagnostico Morgagni; Catania Italy
| | - Alfonso Fiorelli
- Thoracic Surgery Unit; Università della Campania “Luigi Vanvitelli”; Naples Italy
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11
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Caronia FP, Fiorelli A, Santini M, Lo Monte AI. Uniportal Video-Assisted Thoracoscopic Surgery Resection of a Giant Midesophageal Diverticulum. Ann Thorac Surg 2017; 103:e365-e367. [PMID: 28359500 DOI: 10.1016/j.athoracsur.2016.09.054] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 08/30/2016] [Accepted: 09/08/2016] [Indexed: 11/18/2022]
Abstract
We describe a new video-assisted technique for the management of a giant midesophageal diverticulum using a single 5-cm port. It maintained the same principles of the traditional open technique as diverticulectomy, myotomy, and fundoplication. The better visualization of the main esophageal body, diverticulum, and esophagogastric junction and the better alignment of the stapler cartridge to the longitudinal axis of the esophagus are all technical factors supporting our procedure. Heavily calcified mediastinal lymph nodes and diffuse pleural adhesions are the main contraindications. However, future experiences are needed before this technique can be recommended as acceptable treatment.
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Affiliation(s)
| | - Alfonso Fiorelli
- Thoracic Surgery Unit, Seconda Università degli Studi di Napoli, Naples, Italy.
| | - Mario Santini
- Thoracic Surgery Unit, Seconda Università degli Studi di Napoli, Naples, Italy
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Cajozzo M, Palumbo VD, Buscemi S, Damiano G, Florena AM, Cabibi D, Raffaele F, Anzalone AA, Fatica F, Cocchiara G, Dioguardi S, Bruno A, Caronia FP, Lo Monte AI. Mediastinal syndrome from plasmablastic lymphoma in human immunodeficiency virus and human herpes virus 8 negative patient with polycythemia vera: a case report. J Med Case Rep 2017; 11:75. [PMID: 28320457 PMCID: PMC5360031 DOI: 10.1186/s13256-016-1183-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 12/20/2016] [Indexed: 12/03/2022] Open
Abstract
Background Plasmoblastic lymphoma is a rare and aggressive subtype of diffuse large B cell lymphoma, which occurs usually in the jaw of immunocompromised subjects. Case presentation We describe the occurrence of plasmoblastic lymphoma in the mediastinum and chest wall skin of an human immunodeficiency virus-negative 63-year-old Caucasian man who had had polycytemia vera 7 years before. At admission, the patient showed a superior vena cava syndrome, with persistent dyspnoea, cough, and distension of the jugular veins. Imaging findings showed a 9.7 × 8 × 5.7 cm mediastinal mass. A chest wall neoformation biopsy and ultrasound-guided fine-needle aspiration biopsy of the mediastinal mass allowed diagnosis of plasmoblastic lymphoma and establishment of an immediate chemotherapeutic regimen, with rapid remission of compression symptoms. Conclusions Plasmoblastic lymphoma is a very uncommon, difficult to diagnose, and aggressive disease. The presented case represents the first rare mediastinal plasmoblastic lymphoma in a human immunodeficiency virus-/human herpesvirus-8-negative patient. Pathologists should be aware that this tumor does appear in sites other than the oral cavity. Fine-needle aspiration biopsy is a low-cost, repeatable, easy-to-perform technique, with a high diagnostic accuracy and with very low complication and mortality rates. Fine-needle aspiration biopsy could represent the right alternative to surgery in those patients affected by plasmoblastic lymphoma, being rapid and minimally invasive. It allowed establishment of prompt medical treatment with subsequent considerable reduction of the neoplastic tissue and resolution of the mediastinal syndrome.
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Affiliation(s)
- Massimo Cajozzo
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Via Del Vespro 129, 90127, Palermo, Italy
| | - Vincenzo Davide Palumbo
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Via Del Vespro 129, 90127, Palermo, Italy. .,Euro-Mediterranean Institute of Science and Technology (IEMEST), Palermo, Italy.
| | - Salvatore Buscemi
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Via Del Vespro 129, 90127, Palermo, Italy
| | - Giuseppe Damiano
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Via Del Vespro 129, 90127, Palermo, Italy
| | - Ada Maria Florena
- Department of Science for Health Promotion and for Mother and Child "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Daniela Cabibi
- Department of Science for Health Promotion and for Mother and Child "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Francesco Raffaele
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Via Del Vespro 129, 90127, Palermo, Italy
| | - Antonino Alessio Anzalone
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Via Del Vespro 129, 90127, Palermo, Italy
| | - Federica Fatica
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Via Del Vespro 129, 90127, Palermo, Italy
| | - Gerlando Cocchiara
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Via Del Vespro 129, 90127, Palermo, Italy
| | - Salvatore Dioguardi
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Via Del Vespro 129, 90127, Palermo, Italy
| | - Antonio Bruno
- Department of Diagnostic Medicine and Prevention, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | | | - Attilio Ignazio Lo Monte
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Via Del Vespro 129, 90127, Palermo, Italy
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13
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Caronia FP, Reginelli A, Santini M, Alfano R, Trovato S, Arrigo E, Fiorelli A. Trans-tracheostomy repair of tracheo-esophageal fistula under endoscopic view in a 75-year-old woman. J Thorac Dis 2017; 9:E176-E179. [PMID: 28449498 DOI: 10.21037/jtd.2017.02.81] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Tracheo-esophageal fistula is a life-threatening condition for fatal pulmonary complications. Surgery is the treatment of choice. Unfortunately, the most of patients are unfit for surgery and in these cases there is no a standardized management. Herein, we reported a clinical case of a 75-year-old-woman with a tracheoesophageal fistula related to tracheostomy. The fistula was localized 3.5 cm below the vocal folds and extended 3 cm distally. The patient's poor clinical condition contraindicated surgery while the characteristics of fistula prevented any successfully endoscopic repair with standard methods as application of fibrin glue, clipping, or stenting. Thus, we performed a minimally invasive procedure as trans-tracheotomy closure of the fistula under endoscopic view. Under general anesthesia, the patient was intubated with a rigid bronchoscopy. The cannula was removed and a standard needle-holder was inserted through the tracheotomy. The tear was closed from the distal to the proximal ends with interrupted stitch. Following, a Montgomery T tube was inserted to protect the suture and maintain the air-way patency. At the last follow-up (7 months after the procedure), the patient was alive and tolerated a full diet.
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Affiliation(s)
| | | | - Mario Santini
- Thoracic Surgery Unit, Luigi Vanvitelli University, Naples, Italy
| | - Roberto Alfano
- General Surgery Unit, Luigi Vanvitelli University, Naples, Italy
| | - Sebastiano Trovato
- Thoracic Surgery Unit, Oncology Institute of Mediterranean, Viagrande (CT), Italy
| | - Ettore Arrigo
- Thoracic Surgery Unit, Oncology Institute of Mediterranean, Viagrande (CT), Italy
| | - Alfonso Fiorelli
- Thoracic Surgery Unit, Luigi Vanvitelli University, Naples, Italy
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14
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Caronia FP, Fiorelli A, Arrigo E, Trovato S, Santini M, Monte AIL. Bilateral single-port thoracoscopic extended thymectomy for management of thymoma and myasthenia gravis: case report. J Cardiothorac Surg 2016; 11:153. [PMID: 27876071 PMCID: PMC5120463 DOI: 10.1186/s13019-016-0547-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 11/09/2016] [Indexed: 11/10/2022] Open
Abstract
Background Video-assisted thoracoscopy is become a widely accepted approach for the resection of anterior mediastinal masses, including thymoma. The current trend is to reduce the number of ports and minimize the length of incisions to further decrease postoperative pain, chest wall paresthesia, and length of hospitalization. Herein, we reported an extended resection of thymoma in a patient with myasthenia gravis through an uniportal bilateral thoracoscopic approach. Case presentation A 74 years old woman with myasthenia gravis was referred to our attention for management of a 3.5 cm, well capsulate, thymoma. All laboratory and cardio-pulmonary tests were within normal; thus, she was scheduled for thymoma resection through an uniportal bilateral thoracoscopic approach. Under general anaesthesia and selective intubation, the patient was placed in a 60° right lateral decubitus. A 3 cm skin incision was performed in the fourth right intercostal space and, through that a 30° video-camera and working instruments were inserted without rib spreading. After complete dissection of the thymus and mediastinal fat, the contralateral pleura was opened, and, through that the specimen was pushed into the left pleural cavity. Then, the patient was placed in the left lateral decubitus. Similarly to the right side procedure, a 3-cm incision was performed in the fourth left intercostal space to complete thymic dissection and retrieve the specimen. No intraoperative and post-operative complications were found. The patient was discharged four days later. Pathological examination revealed a type A thymoma (Masaoka stage I). No recurrence was found at 18 months of follow-up Conclusions Bilateral single-port thoracoscopy is an available procedure for management of thymoma associated with myasthenia gravis. The less post-operative pain, the reduction of hospital stay and the better esthetic results are all potential advantages of this approach over traditional technique. Obviously, our impression should be validated by larger studies in terms of long-term oncological outcomes. Electronic supplementary material The online version of this article (doi:10.1186/s13019-016-0547-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Alfonso Fiorelli
- Thoracic Surgery Unit, Second University of Naples, Piazza Miraglia, 2, I-80138, Naples, Italy.
| | - Ettore Arrigo
- Thoracic Surgery Unit, Istituto Oncologico del Mediterraneo, Catania, Italy
| | - Sebastiano Trovato
- Thoracic Surgery Unit, Istituto Oncologico del Mediterraneo, Catania, Italy
| | - Mario Santini
- Thoracic Surgery Unit, Second University of Naples, Piazza Miraglia, 2, I-80138, Naples, Italy
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Caronia FP, Fioretti A, Santini M, Arrigo E. Extrapleural Pneumonectomy for Malignant Pleural Mesothelioma: A Novel Mini-Invasive Technique. Innovations 2016. [DOI: 10.1177/155698451601100614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Alfonso Fioretti
- Thoracic Surgery Unit, Second University of Naples, Naples, Italy
| | - Mario Santini
- Thoracic Surgery Unit, Second University of Naples, Naples, Italy
| | - Ettore Arrigo
- Thoracic Surgery Unit, Istituto Oncologico del Mediterraneo, Catania, Italy
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Caronia FP, Fiorelli A, Santini M, Alfano R, Castorina S. A new technique to repair huge tracheo-gastric fistula following esophagectomy. Ann Transl Med 2016; 4:403. [PMID: 27867955 DOI: 10.21037/atm.2016.10.32] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We reported the management of a life-threatening condition as a large tracheo-gastric fistula involved the carina, the left and the right bronchus that complicated Ivor Lewis esophagogastrectomy for esophageal cancer. An urgent right thoracotomy was performed and the tracheal defect was covered with a reversed pedicled pericardial patch reinforced with an intercostal muscle flap. Cervical esophagostomy and a feeding jejunostomy completed the operation. Five months later, the continuity of gastrointestinal tract was restored using a transverse colon.
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Affiliation(s)
| | - Alfonso Fiorelli
- Thoracic Surgery Unit, Second University of Naples, Naples, Italy
| | - Mario Santini
- Thoracic Surgery Unit, Second University of Naples, Naples, Italy
| | - Roberto Alfano
- General Surgery Unit, Second University of Naples, Naples, Italy
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Fiorelli A, Mazzella A, Cascone R, Caronia FP, Arrigo E, Santini M. Bilateral thoracoscopic extended thymectomy versus sternotomy. Asian Cardiovasc Thorac Ann 2016; 24:555-561. [DOI: 10.1177/0218492316647215] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Background Complete open surgical resection is the standard treatment for thymoma and myasthenia gravis. We evaluated the feasibility of bilateral video-assisted thoracoscopic extended thymectomy, and compared it to surgery via sternotomy. Methods From 2011 to 2014, 43 patients undergoing thymectomy were divided into 2 groups: 23 underwent video-assisted thoracoscopic extended thymectomy, and 20 had thymectomy via sternotomy. The primary outcomes were postoperative pain score (visual analog scale) at 6, 12, 24, 48, and 72 h, and 1-month postoperatively, and morphine consumption in the first 48 h. Secondary outcomes were surgical and clinical results. Results There were no significant differences between the 2 groups in terms of demographics and preoperative clinical data. Compared to the sternotomy group, the video-assisted thoracoscopic thymectomy group had lower pain scores and morphine consumption at all time points, significantly less operative blood loss and chest drainage volume, and shorter hospital stay. The rates of improvement in myasthenia gravis were 85% and 86% in the video-assisted thoracoscopic thymectomy and sternotomy groups, respectively. No recurrence of thymoma was found in either group (median follow-up 27 months). Conclusions Our results seem to confirm that in selected cases, video-assisted thoracoscopic thymectomy allows complete resection of thymus and perithymic tissue, similar to sternotomy but with the known advantages of minimally invasive surgery including less pain and a good cosmetic result.
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Affiliation(s)
- Alfonso Fiorelli
- Thoracic Surgery Unit, Istituto Oncologico del Mediterraneo, Catania, Italy
| | - Antonio Mazzella
- Thoracic Surgery Unit, Istituto Oncologico del Mediterraneo, Catania, Italy
| | - Roberto Cascone
- Thoracic Surgery Unit, Istituto Oncologico del Mediterraneo, Catania, Italy
| | | | - Ettore Arrigo
- Thoracic Surgery Unit, Second University of Naples, Naples, Italy
| | - Mario Santini
- Thoracic Surgery Unit, Istituto Oncologico del Mediterraneo, Catania, Italy
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Caronia FP, Fiorelli A, Arrigo E, Santini M, Castorina S. Management of subtotal tracheal section with esophageal perforation: a catastrophic complication of tracheostomy. J Thorac Dis 2016; 8:E337-9. [PMID: 27162695 DOI: 10.21037/jtd.2016.03.77] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Herein, we reported a catastrophic condition as the almost complete rupture of trachea associated with esophageal lesion following an urgent surgical tracheostomy performed for unexpected difficult intubation. The extent of lesions required a surgical management. We decided against a resection and an end to end anastomosis but preferred to perform a direct suture of the lesion due to the presence of local and systemic infection. Then, the diagnosis of a tracheal fistula led us to perform a direct suture of the defect that was covered with muscle flaps. Actually the patient is alive without problems. Emergency situations as unexpected airway difficult intubation increase morbidity and mortality rate of tracheostomy also in expert hands. Sometimes these events are unpredictable. Mastery with a number of advanced airway technique should be sought when faced dealing with unexpected difficult intubations and written consent of such a concern should be given to the patient.
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Affiliation(s)
- Francesco Paolo Caronia
- 1 Thoracic Surgery Unit, Istituto Oncologico del Mediterraneo, Catania, Italy ; 2 Thoracic Surgery Unit, Second University of Naples, Naples, Italy ; 3 GB Morgagni Foundation, Department of Bio-Medical Sciences, University of Catania, Catania, Italy
| | - Alfonso Fiorelli
- 1 Thoracic Surgery Unit, Istituto Oncologico del Mediterraneo, Catania, Italy ; 2 Thoracic Surgery Unit, Second University of Naples, Naples, Italy ; 3 GB Morgagni Foundation, Department of Bio-Medical Sciences, University of Catania, Catania, Italy
| | - Ettore Arrigo
- 1 Thoracic Surgery Unit, Istituto Oncologico del Mediterraneo, Catania, Italy ; 2 Thoracic Surgery Unit, Second University of Naples, Naples, Italy ; 3 GB Morgagni Foundation, Department of Bio-Medical Sciences, University of Catania, Catania, Italy
| | - Mario Santini
- 1 Thoracic Surgery Unit, Istituto Oncologico del Mediterraneo, Catania, Italy ; 2 Thoracic Surgery Unit, Second University of Naples, Naples, Italy ; 3 GB Morgagni Foundation, Department of Bio-Medical Sciences, University of Catania, Catania, Italy
| | - Sergio Castorina
- 1 Thoracic Surgery Unit, Istituto Oncologico del Mediterraneo, Catania, Italy ; 2 Thoracic Surgery Unit, Second University of Naples, Naples, Italy ; 3 GB Morgagni Foundation, Department of Bio-Medical Sciences, University of Catania, Catania, Italy
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Caronia FP, Fiorelli A, Ruffini E, Nicolosi M, Santini M, Lo Monte AI. Corrigendum to "A comparative analysis of Pancoast tumour resection performed via video-assisted thoracic surgery versus standard open approaches" [Interact CardioVasc Thorac Surg 2014;19(3):426-435]. Interact Cardiovasc Thorac Surg 2015; 22:121. [PMID: 26708569 DOI: 10.1093/icvts/ivv341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Alfonso Fiorelli
- Unità Operativa di Chirurgia Toracica, Seconda Università di Napoli, Napoli, Italy
| | - Enrico Ruffini
- Unità Operativa di Chirurgia Toracica, Università di Torino, Torino, Italy
| | | | - Mario Santini
- Unità Operativa di Chirurgia Toracica, Seconda Università di Napoli, Napoli, Italy
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Caronia FP, Loizzi D, Fiorelli A. P-193TRACHEAL RESECTION WITH PATIENT UNDER LOCAL ANAESTHESIA AND SEDATION. Interact Cardiovasc Thorac Surg 2015. [DOI: 10.1093/icvts/ivv204.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Caronia FP, Fiorelli A. V-107MANAGEMENT OF CATASTROPHIC TRACHEOSTOMY WITH OESOPHAGEAL PERFORATION AND SUBTOTAL TRACHEAL SECTION. Interact Cardiovasc Thorac Surg 2015. [DOI: 10.1093/icvts/ivv204.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Musso N, Caronia FP, Castorina S, Lo Monte AI, Barresi V, Condorelli DF. Somatic loss of an EXT2 gene mutation during malignant progression in a patient with hereditary multiple osteochondromas. Cancer Genet 2015; 208:62-7. [PMID: 25744876 DOI: 10.1016/j.cancergen.2015.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 12/19/2014] [Accepted: 01/11/2015] [Indexed: 10/24/2022]
Abstract
Multiple osteochondromas (MO) is an autosomal-dominant skeletal disorder caused by mutations in the exostosin-1 (EXT1) or exostosin-2 (EXT2) genes. In this study, we report the analysis of the mutational status of the EXT2 gene in tumor samples derived from a patient affected by hereditary MO, documenting the somatic loss of the germline mutation in a giant chondrosarcoma and in a rapidly growing osteochondroma. The sequencing of all exons and exon-intron junctions of the EXT1 and EXT2 genes from blood DNA of the proband did not reveal any mutation in the EXT1 gene but did demonstrate the presence of the transition point mutation c.67C > T in the EXT2 gene, determining the introduction of a stop codon in the coding sequence (p.Arg23*). A mutational analysis of other members of the family and the presence of osteochondromas in the metaphysis of long bones confirmed the diagnosis of hereditary multiple osteochondromas. Direct sequencing from DNA extracted from different sites of two tumor samples (a small rapidly growing osteochondroma and a giant peripheral secondary chondrosarcoma, each located at different chondrocostal junctions) revealed the loss of the germline EXT2 mutation. Analysis of microsatellite polymorphic markers in the 11p region harboring the EXT2 gene did not reveal any loss of heterozygosity. This observation supports a recent model of sarcomagenesis in which osteochondroma cells bear EXT homozygous inactivation, whereas chondrosarcoma-initiating cells are EXT-expressing cells.
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Affiliation(s)
- Nicolò Musso
- Scuola Superiore di Catania, University of Catania, Catania, Italy; Department of Biomedical and Biotechnological Sciences, Section of Medical Biochemistry, University of Catania, Catania, Italy
| | - Francesco Paolo Caronia
- Dipartimento di Chirurgia Toracica, Centro Clinico e Diagnostico "G.B Morgagni", Catania, Italy
| | - Sergio Castorina
- Dipartimento di Chirurgia Toracica, Centro Clinico e Diagnostico "G.B Morgagni", Catania, Italy; Department of Biomedical and Biotechnological Sciences, Section of Human Anatomy and Histology, University of Catania, Catania, Italy
| | | | - Vincenza Barresi
- Scuola Superiore di Catania, University of Catania, Catania, Italy; Department of Biomedical and Biotechnological Sciences, Section of Medical Biochemistry, University of Catania, Catania, Italy
| | - Daniele Filippo Condorelli
- Scuola Superiore di Catania, University of Catania, Catania, Italy; Department of Biomedical and Biotechnological Sciences, Section of Medical Biochemistry, University of Catania, Catania, Italy.
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Caronia FP, Fiorelli A, Zanchini F, Santini M, Lo Monte AI, Castorina S. Reconstruction with a pectoralis major myocutaneous flap after left first rib and clavicular chest wall resection for a metastasis from laryngeal cancer. Gen Thorac Cardiovasc Surg 2014; 64:294-7. [PMID: 25319560 DOI: 10.1007/s11748-014-0485-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 10/03/2014] [Indexed: 11/28/2022]
Abstract
We presented a case of recurrent metastasis from epidermoid cancer that occurred in the left clavicle of a patient with a history of laryngeal cancer treated on April 2005 with extended hemilaryngectomy, neck dissection and chemoradiation therapy. On September 2008, he developed a left clavicular metastasis. The disease was initially well controlled by chemoradiotherapy but it recurred 17 months later. The optimal treatment plan was established by several multidisciplinary meetings and the patient subsequently underwent an en bloc resection of the left clavicle, first rib and all the other involved structures. Coverage of the thoracic defect was achieved using pectoralis major myocutaneous flap. The patient had a successful surgical outcome. At 1-year follow-up, he had no evidence of disease, a good cosmetic result and returned to normal daily activity. He died for bone metastasis with an overall 21 months post-surgical survival.
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Affiliation(s)
| | - Alfonso Fiorelli
- Thoracic Surgery Unit, Second University of Naples, Piazza Miraglia 3, 80138, Naples, Italy.
| | - Fabio Zanchini
- Orthopedic Unit, Second University of Naples, 80138, Naples, Italy
| | - Mario Santini
- Thoracic Surgery Unit, Second University of Naples, Piazza Miraglia 3, 80138, Naples, Italy
| | | | - Sergio Castorina
- G.B. Morgagni Foundation, Department of Bio-Medical Sciences, University of Catania, Catania, Italy
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Caronia FP, Fiorelli A, Ruffini E, Nicolosi M, Santini M, Lo Monte AI. A comparative analysis of Pancoast tumour resection performed via video-assisted thoracic surgery versus standard open approaches. Interact Cardiovasc Thorac Surg 2014; 19:426-35. [DOI: 10.1093/icvts/ivu115] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Alfonso Fiorelli
- Unità Operativa di Chirurgia Toracica, Seconda Università di Napoli, Napoli, Italy
| | - Enrico Ruffini
- Unità Operativa di Chirurgia Toracica, Università di Torino, Torino, Italy
| | | | - Mario Santini
- Unità Operativa di Chirurgia Toracica, Seconda Università di Napoli, Napoli, Italy
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Caronia FP, Monte AL. O-087REPAIR OF A COMPLEX POST-TRAUMATIC TRACHEAL DEFECT. Interact Cardiovasc Thorac Surg 2013. [DOI: 10.1093/icvts/ivt288.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Caronia FP, Santini M, Fiorelli A, Monte AL, Ruffini E. F-046A COMPARATIVE ANALYSIS OF PANCOAST TUMOURS RESECTION PERFORMED VIA VIDEO-ASSISTED THORACIC SURGERY VERSUS STANDARD OPEN APPROACHES. Interact Cardiovasc Thorac Surg 2013. [DOI: 10.1093/icvts/ivt288.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Caronia FP, Fiorelli A, Santini M, Monte AL. P-199SEQUENTIAL THORACOSCOPY AND ANTERIOR CONTRALATERAL THORACOTOMY VERSUS STERNOTOMY: A COMPARATIVE ANALYSIS. Interact Cardiovasc Thorac Surg 2013. [DOI: 10.1093/icvts/ivt288.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Caronia FP, Ruffini E, Lo Monte AI. The use of video-assisted thoracic surgery in the management of Pancoast tumors☆. Interact Cardiovasc Thorac Surg 2010; 11:721-6. [DOI: 10.1510/icvts.2010.244657] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Caronia FP, Cortese E, Mosnier H. [Laparoscopic rectopexy: our experience in the treatment of complete rectal prolapse]. G Chir 1999; 20:311-3. [PMID: 10390928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Surgical treatments of rectal prolapse still await a final arrangement. The aim of this work is to present Authors' experience with 12 female patients who underwent laparoscopic rectopexy. The patients, aged between 67 and 84 years, were suffering of a different degree of incontinence classified according to the Browing and Parks scale. Pneumoperitoneum was induced through the Veres needle end 5 trocars were placed. The technique used was the modified Orr-Loygue. One no death was observed and only two not serious intraoperative complications were registered, in both conversion to laparotomy was not necessary. Functional result as for incontinence has been really good (disappeared in 11 cases and improved in one). Whereas regarding the constipation, no improvement was observed in those in who in it was preexisting the operation, not appearing nevertheless, as on the contrary reported by other Authors, in those in whom it wasn't present before surgical treatment. The patients, all in follow-up (range between 10 and 36 months, average 25.08), still now experienced no relapse. In conclusion, on the base of Authors' experience, laparoscopic rectopexy is considered free of particular risks and excellent in the results even if, due to the slight number of series, any definitive judgement can be expressed.
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Affiliation(s)
- F P Caronia
- Servizio di Chirurgia Laparoscopica, Hôpital des Diaconnes Parigi, Francia
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