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Lim E, Waller D, Lau K, Steele J, Pope A, Ali C, Bilancia R, Keni M, Popat S, O'Brien M, Tokaca N, Maskell N, Stadon L, Fennell D, Nelson L, Edwards J, Tenconi S, Socci L, Rintoul RC, Wood K, Stone A, Muthukumar D, Ingle C, Taylor P, Cove-Smith L, Califano R, Summers Y, Tasigiannopoulos Z, Bille A, Shah R, Fuller E, Macnair A, Shamash J, Mansy T, Milton R, Koh P, Ionescu AA, Treece S, Roy A, Middleton G, Kirk A, Harris RA, Ashton K, Warnes B, Bridgeman E, Joyce K, Mills N, Elliott D, Farrar N, Stokes E, Hughes V, Nicholson AG, Rogers CA. Extended pleurectomy decortication and chemotherapy versus chemotherapy alone for pleural mesothelioma (MARS 2): a phase 3 randomised controlled trial. Lancet Respir Med 2024:S2213-2600(24)00119-X. [PMID: 38740044 DOI: 10.1016/s2213-2600(24)00119-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 04/02/2024] [Accepted: 04/09/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Extended pleurectomy decortication for complete macroscopic resection for pleural mesothelioma has never been evaluated in a randomised trial. The aim of this study was to compare outcomes after extended pleurectomy decortication plus chemotherapy versus chemotherapy alone. METHODS MARS 2 was a phase 3, national, multicentre, open-label, parallel two-group, pragmatic, superiority randomised controlled trial conducted in the UK. The trial took place across 26 hospitals (21 recruiting only, one surgical only, and four recruiting and surgical). Following two cycles of chemotherapy, eligible participants with pleural mesothelioma were randomly assigned (1:1) to surgery and chemotherapy or chemotherapy alone using a secure web-based system. Individuals aged 16 years or older with resectable pleural mesothelioma and adequate organ and lung function were eligible for inclusion. Participants in the chemotherapy only group received two to four further cycles of chemotherapy, and participants in the surgery and chemotherapy group received pleurectomy decortication or extended pleurectomy decortication, followed by two to four further cycles of chemotherapy. It was not possible to mask allocation because the intervention was a major surgical procedure. The primary outcome was overall survival, defined as time from randomisation to death from any cause. Analyses were done on the intention-to-treat population for all outcomes, unless specified. This study is registered with ClinicalTrials.gov, NCT02040272, and is closed to new participants. FINDINGS Between June 19, 2015, and Jan 21, 2021, of 1030 assessed for eligibility, 335 participants were randomly assigned (169 to surgery and chemotherapy, and 166 to chemotherapy alone). 291 (87%) participants were men and 44 (13%) women, and 288 (86%) were diagnosed with epithelioid mesothelioma. At a median follow-up of 22·4 months (IQR 11·3-30·8), median survival was shorter in the surgery and chemotherapy group (19·3 months [IQR 10·0-33·7]) than in the chemotherapy alone group (24·8 months [IQR 12·6-37·4]), and the difference in restricted mean survival time at 2 years was -1·9 months (95% CI -3·4 to -0·3, p=0·019). There were 318 serious adverse events (grade ≥3) in the surgery group and 169 in the chemotherapy group (incidence rate ratio 3·6 [95% CI 2·3 to 5·5], p<0·0001), with increased incidence of cardiac (30 vs 12; 3·01 [1·13 to 8·02]) and respiratory (84 vs 34; 2·62 [1·58 to 4·33]) disorders, infection (124 vs 53; 2·13 [1·36 to 3·33]), and additional surgical or medical procedures (15 vs eight; 2·41 [1·04 to 5·57]) in the surgery group. INTERPRETATION Extended pleurectomy decortication was associated with worse survival to 2 years, and more serious adverse events for individuals with resectable pleural mesothelioma, compared with chemotherapy alone. FUNDING National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (15/188/31), Cancer Research UK Feasibility Studies Project Grant (A15895).
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Affiliation(s)
- Eric Lim
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK; Imperial College London, London, UK.
| | | | | | | | | | - Clinton Ali
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | | | | | - Sanjay Popat
- The Royal Marsden Hospital and the Institute of Cancer Research, London, UK
| | - Mary O'Brien
- The Royal Marsden Hospital and the Institute of Cancer Research, London, UK
| | - Nadza Tokaca
- The Royal Marsden Hospital and the Institute of Cancer Research, London, UK
| | | | | | | | | | - John Edwards
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Sara Tenconi
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Laura Socci
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Robert C Rintoul
- Papworth Trials Unit Collaboration, Royal Papworth Hospital, Cambridge, UK
| | - Kelly Wood
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Amanda Stone
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | | | - Charlotte Ingle
- East Sussex and North Essex NHS Foundation Trust, Colchester, UK
| | - Paul Taylor
- Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Raffaele Califano
- The Christie NHS Foundation Trust and Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Yvonne Summers
- Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Andrea Bille
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Riyaz Shah
- Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK
| | - Elizabeth Fuller
- South Tyneside and Sunderland NHS Foundation Trust, South Shields, UK
| | - Andrew Macnair
- South Tyneside and Sunderland NHS Foundation Trust, South Shields, UK
| | - Jonathan Shamash
- Queen's Hospital, Barking Havering and Redbridge NHS Trust, Barking, UK
| | - Talal Mansy
- South Tees Hospital NHS Foundation Trust, Middlesbrough, UK
| | | | - Pek Koh
- Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | | | - Sarah Treece
- North West Anglia NHS Foundation Trust, Peterborough, UK
| | - Amy Roy
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | | | - Alan Kirk
- Golden Jubilee National Hospital, Clydebank, UK
| | - Rosie A Harris
- Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Kate Ashton
- Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Barbara Warnes
- Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emma Bridgeman
- Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Katherine Joyce
- Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nicola Mills
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Daisy Elliott
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Nicola Farrar
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Elizabeth Stokes
- University of Oxford Health Economics Research Centre, Oxford, UK
| | - Vikki Hughes
- Papworth Trials Unit Collaboration, Royal Papworth Hospital, Cambridge, UK
| | - Andrew G Nicholson
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK; Imperial College London, London, UK
| | - Chris A Rogers
- Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
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Byers JL, Rao JN, Socci L, Hopkinson DN, Tenconi S, Edwards JG. Costal margin injuries and trans-diaphragmatic intercostal hernia: Presentation, management and outcomes according to the Sheffield classification. J Trauma Acute Care Surg 2023; 95:839-845. [PMID: 37533145 DOI: 10.1097/ta.0000000000004068] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
BACKGROUND Costal margin rupture (CMR) injuries are under-diagnosed and inconsistently managed, while carrying significant symptomatic burden. We hypothesized that the Sheffield Classification system of CMR injuries would relate to injury patterns and management options. METHODS Data were collected prospectively between 2006 and 2023 at a major trauma center in the United Kingdom. Computed tomography scans were interrogated and injuries were categorized according to the Sheffield Classification. Clinical, radiologic, management and outcome variables were assessed. RESULTS Fifty-four patients were included in the study. Intercostal hernia (IH) was present in 30 patients and associated with delayed presentation ( p = 0.004), expulsive mechanism of injury (i.e. such as occurs with coughing, sneezing, or retching), higher body mass index ( p < 0.001), and surgical management ( p = 0.02). There was a bimodal distribution of the level of the costal margin rupture, with IH Present and expulsive mechanism injuries occurring predominantly at the ninth costal cartilage, and IH Absent cases and other mechanisms at the seventh costal cartilage ( p < 0.001). There were correlations between the costal cartilage being thin at the site of the CMR and the presence of IH and expulsive etiology ( p < 0.001). Management was conservative in 23 and surgical in 31 cases. Extrathoracic mesh IH repairs were performed in 3, Double Layer Mesh Repairs in 8, Suture IH repairs in 5, CMR plating in 8, CMR sutures in 2, and associated Surgical Stabilization of Rib Fractures in 11 patients. There was one postoperative death. There were seven repeat surgical procedures in five patients. CONCLUSION The Sheffield Classification is associated statistically with presentation, related chest wall injury patterns, and type of definitive management. Further collaborative data collection is required to determine the optimal management strategies. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.
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Affiliation(s)
- Jonathan L Byers
- From the Department of Thoracic Surgery, Sheffield Teaching Hospitals NHS Trust, Sheffield, England
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Scholes H, Gleeson H, Shalom N, George H, Rao J, Socci L, Tenconi S, Hopkinson D, Edwards J. Uncertain resection margins and patterns of recurrence following the surgical resection of non-small cell lung cancer. Lung Cancer 2021. [DOI: 10.1016/s0169-5002(21)00367-6] [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: 11/30/2022]
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Scholes H, Gleeson H, George H, Rao J, Socci L, Tenconi S, Hopkinson D, Edwards J. P08.08 Surgical Resection of Non-Small Cell Lung Cancer: Uncertain Resection Margins and Patterns of Recurrence. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.427] [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: 11/26/2022]
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Bertolaccini L, Batirel H, Brunelli A, Gonzalez-Rivas D, Ismail M, Ucar AM, Ng CSH, Scarci M, Sihoe ADL, Ugalde PA, Akar FA, Bedetti B, Nadal SB, Brandolini J, Crucitti P, Enyedi A, Fernando HC, Furak J, Gallego-Poveda J, Galvez-Munos C, Hanke I, Hernandez-Arenas LA, Janik M, Juhos P, Libretti L, Lucciarini P, Macrì P, Margaritora S, Mahoozi HR, Nachira D, Pardolesi A, Pischik V, Sagan D, Schreurs H, Sekhniaidze D, Socci L, Tosi D, Turna A, Vannucci F, Zielinski M, Rocco G. Corrigendum to 'Uniportal video-assisted thoracic surgery lobectomy: a consensus report from the Uniportal VATS Interest Group (UVIG) of the European Society of Thoracic Surgeons (ESTS)' [Eur J Cardiothorac Surg 2019;56:224-9]. Eur J Cardiothorac Surg 2019; 56:628-629. [PMID: 31436834 DOI: 10.1093/ejcts/ezz229] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Luca Bertolaccini
- Department of Thoracic Surgery, Maggiore Teaching Hospital, Bologna, Italy
| | - Hasan Batirel
- Department of Thoracic Surgery, Marmara University Hospital, Istanbul, Turkey
| | | | - Diego Gonzalez-Rivas
- Minimally Invasive Thoracic Surgery Unit (UCTMI), Department of Thoracic Surgery, Coruna University Hospital, Coruna, Spain
| | - Mahmoud Ismail
- Department of Thoracic Surgery, Klinikum Ernst von Bergmann, Potsdam, Germany
| | | | - Calvin S H Ng
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Marco Scarci
- Department of Thoracic Surgery, San Gerardo Hospital, Monza, Italy
| | - Alan D L Sihoe
- Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,Department of Thoracic Surgery, Tongji University Shanghai Pulmonary Hospital, Shanghai, China
| | - Paula A Ugalde
- Department of Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec (Hôpital Laval), Quebec, Canada
| | - Firas Abu Akar
- Department of Cardiothoracic Surgery, Makassed Charitable Society Hospital, East Jerusalem, Israel.,Department of Cardiothoracic Surgery, Shaare Zedek Medical Center (SZMC), Jerusalem, Israel
| | | | | | - Jury Brandolini
- Department of Thoracic Surgery, Maggiore Teaching Hospital, Bologna, Italy
| | | | - Attila Enyedi
- Division of Thoracic Surgery, University of Debrecen, Debrecen, Hungary
| | - Hiran C Fernando
- Department of Surgery, Fairfax Medical Campus, Falls Church, VA, USA
| | - Jozsef Furak
- Department of Surgery, University of Szeged, Szeged, Hungary
| | | | - Carlos Galvez-Munos
- Department of Thoracic Surgery, General University Hospital, Alicante, Spain
| | - Ivo Hanke
- Department of Thoracic Surgery, University Hospital Hradec Kralove, Hradec, Kralov, Czech Republic
| | - Luis A Hernandez-Arenas
- Department of Thoracic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Miroslav Janik
- Department of Thoracic Surgery, Slovak Medical University, University Hospital Bratislava, Bratislava, Slovakia
| | - Peter Juhos
- Department of Thoracic Surgery, Slovak Medical University, University Hospital Bratislava, Bratislava, Slovakia
| | - Lidia Libretti
- Department of Thoracic Surgery, San Gerardo Hospital, Monza, Italy
| | - Paolo Lucciarini
- Department of Visceral, Transplant and Thoracic Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Paolo Macrì
- Thoracic Surgery Unit, Istituto Clinico Humanitas CCO - Catania, Catania, Italy
| | - Stefano Margaritora
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", Rome, Italy
| | - Hamid Reza Mahoozi
- Department of Thoracic Surgery, Evangelisches Krankenhaus Herne, Herne, Germany
| | - Dania Nachira
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", Rome, Italy
| | | | - Vadim Pischik
- Faculty of Medicine, St-Petersburg State University, Saint-Petersburg, Russia
| | - Dariusz Sagan
- Department of Thoracic Surgery, Medical University of Lublin, Lublin, Poland
| | | | | | - Laura Socci
- Thoracic Surgery Units, Sheffield Teaching Hospital, Sheffield, UK
| | - Davide Tosi
- Division of Thoracic and Transplant Surgery, Fondazione Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Akif Turna
- Department of Thoracic Surgery, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Fernando Vannucci
- Department of Thoracic Surgery, Hospital Federal do Andarai, Rio de Janeiro, Brazil
| | - Marcin Zielinski
- Department of Thoracic Surgery, Pulmonary Hospital, Zakopane, Poland
| | - Gaetano Rocco
- Department of Surgery, Thoracic Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Bertolaccini L, Batirel H, Brunelli A, Gonzalez-Rivas D, Ismail M, Ucar AM, Ng CSH, Scarci M, Sihoe ADL, Ugalde PA, Abu Akar F, Bedetti B, Nadal SB, Brandolini J, Crucitti P, Enyedi A, Fernando HC, Furak J, Gallego-Poveda J, Galvez-Munos C, Hanke I, Hernandez-Arenas LA, Janik M, Juhos P, Libretti L, Lucciarini P, Macrì P, Margaritora S, Mahoozi HR, Nachira D, Pardolesi A, Pischik V, Sagan D, Schreurs H, Sekhniaidze D, Socci L, Tosi D, Turna A, Vannucci F, Zielinski M, Rocco G. Uniportal video-assisted thoracic surgery lobectomy: a consensus report from the Uniportal VATS Interest Group (UVIG) of the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg 2019; 56:224-229. [DOI: 10.1093/ejcts/ezz133] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 03/07/2019] [Accepted: 03/20/2019] [Indexed: 01/05/2023] Open
Abstract
Abstract
OBJECTIVES
Our goal was to report the results of the first consensus paper among international experts in uniportal video-assisted thoracoscopic surgery (UniVATS) lobectomy obtained through a Delphi process, the objective of which was to define and standardize the main procedural steps, optimize its indications and perioperative management and identify elements to assist in future training.
METHODS
The 40 members of the working group were convened and organized on a voluntary basis by the Uniportal VATS Interest Group (UVIG) of the European Society of Thoracic Surgeons (ESTS). An e-consensus finding exercise using the Delphi method was applied to require 75% agreement for reaching consensus on each question. Repeated iterations of anonymous voting continued for 3 rounds.
RESULTS
Overall, 31 international experts from 18 countries completed all 3 rounds of questionnaires. Although a technical quorum was not achieved, most of the responders agreed that the maximum size of a UniVATS incision should be ≤4 cm. Agreement was reached on many points outlining the currently accepted definition of a UniVATS lobectomy, its indications and contraindications, perioperative clinical management and recommendations for training and future research directions.
CONCLUSIONS
The UVIG Consensus Report stated that UniVATS offers a valid alternative to standard VATS techniques. Only longer follow-up and randomized controlled studies will predict whether UniVATS represents a valid alternative approach to multiport VATS for major lung resections or whether it should be performed only in selected cases and by selected centres. The next step for the ESTS UVIG is the establishment of a UniVATS section inside the ESTS databases.
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Affiliation(s)
- Luca Bertolaccini
- Department of Thoracic Surgery, Maggiore Teaching Hospital, Bologna, Italy
| | - Hasan Batirel
- Department of Thoracic Surgery, Marmara University Hospital, Istanbul, Turkey
| | | | - Diego Gonzalez-Rivas
- Minimally Invasive Thoracic Surgery Unit (UCTMI), Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain
| | - Mahmoud Ismail
- Department of Thoracic Surgery, Klinikum Ernst von Bergmann, Potsdam, Germany
| | | | - Calvin S H Ng
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Marco Scarci
- Department of Thoracic Surgery, San Gerardo Hospital, Monza, Italy
| | - Alan D L Sihoe
- Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Department of Thoracic Surgery, Tongji University Shanghai Pulmonary Hospital, Shanghai, China
| | - Paula A Ugalde
- Department of Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec (Hôpital Laval), Quebec, Canada
| | - Firas Abu Akar
- Department of Cardiothoracic Surgery, Makassed Charitable Society Hospital, East Jerusalem, Israel
- Department of Cardiothoracic Surgery, Shaare Zedek Medical Center (SZMC), Jerusalem, Israel
| | | | | | - Jury Brandolini
- Department of Thoracic Surgery, Maggiore Teaching Hospital, Bologna, Italy
| | | | - Attila Enyedi
- Division of Thoracic Surgery, University of Debrecen, Debrecen, Hungary
| | - Hiran C Fernando
- Department of Surgery, Fairfax Medical Campus, Falls Church, VA, USA
| | - Jozsef Furak
- Department of Surgery, University of Szeged, Szeged, Hungary
| | | | - Carlos Galvez-Munos
- Department of Thoracic Surgery, General University Hospital, Alicante, Spain
| | - Ivo Hanke
- Department of Thoracic Surgery, University Hospital Hradec Kralove, Hradec, Kralov, Czech Republic
| | - Luis A Hernandez-Arenas
- Department of Thoracic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Miroslav Janik
- Department of Thoracic Surgery, Slovak Medical University, University Hospital Bratislava, Bratislava, Slovakia
| | - Peter Juhos
- Department of Thoracic Surgery, Slovak Medical University, University Hospital Bratislava, Bratislava, Slovakia
| | - Lidia Libretti
- Department of Thoracic Surgery, San Gerardo Hospital, Monza, Italy
| | - Paolo Lucciarini
- Department of Visceral, Transplant and Thoracic Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Paolo Macrì
- Thoracic Surgery Unit, Istituto Clinico Humanitas CCO – Catania, Catania, Italy
| | - Stefano Margaritora
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario “A. Gemelli”, Rome, Italy
| | - Hamid Reza Mahoozi
- Department of Thoracic Surgery, Evangelisches Krankenhaus Herne, Herne, Germany
| | - Dania Nachira
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario “A. Gemelli”, Rome, Italy
| | | | - Vadim Pischik
- Faculty of Medicine, St-Petersburg State University, Saint-Petersburg, Russia
| | - Dariusz Sagan
- Department of Thoracic Surgery, Medical University of Lublin, Lublin, Poland
| | | | | | - Laura Socci
- Thoracic Surgery Units, Sheffield Teaching Hospital, Sheffield, UK
| | - Davide Tosi
- Department of Thoracic Surgery, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Akif Turna
- Division of Thoracic and Transplant Surgery, Fondazione Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fernando Vannucci
- Department of Thoracic Surgery, Hospital Federal do Andaraí, Rio de Janeiro, Brazil
| | - Marcin Zielinski
- Department of Thoracic Surgery, Pulmonary Hospital, Zakopane, Poland
| | - Gaetano Rocco
- Department of Surgery, Thoracic Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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George H, Gleeson H, Hocknell E, Rao J, Socci L, Tenconi S, Hopkinson D, Edwards J. Quality outcome measures for single-port VATS resection of non-small cell lung cancer. Lung Cancer 2019. [DOI: 10.1016/s0169-5002(19)30258-2] [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: 11/16/2022]
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Gleeson H, George H, Hocknell E, Rao J, Socci L, Tenconi S, Hopkinson D, Edwards J. Clinical outcomes related to smoking status in the era of single-port VATS resection for non-small cell lung cancer. Lung Cancer 2019. [DOI: 10.1016/s0169-5002(19)30260-0] [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: 10/27/2022]
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Viti A, Socci L, Congregado M, Ismail M, Nachira D, Muñoz CG, Bolufer S, Rückert JC, Margaritora S, Terzi A. The everlasting issue of prolonged air leaks after lobectomy for non-small cell lung cancer: A data-driven prevention planning model in the era of minimally invasive approaches. J Surg Oncol 2018; 118:1285-1291. [PMID: 30399200 DOI: 10.1002/jso.25289] [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] [Received: 07/05/2018] [Accepted: 10/17/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND OBJECTIVES Prolonged air leaks (PAL) are the most frequent complication after lobectomy for non-small cell lung cancer, even in case of minimally invasive approaches. We developed a novel score to identify high-risk patients for PAL during minimally invasive lobectomy. METHODS A dedicated database was created. We investigated preoperative candidate features and specific intraoperative variables. Univariate and subsequent logistic regression analysis with bootstrap resampling have been used. Model performance has been assessed by reckoning the area under the receiver operating characteristics curve and the Hosmer-Lemeshow goodness of fit. RESULTS PAL (>5 days) occurred in 72 (15.69%) patients. Five variables emerged from the model. Each one was assigned a score to provide a cumulative scoring system: forced expiratory volume in 1 second below 86% (P = 0.004, 1.5 points), body mass index <24 ( P = 0.002, 1 point), active smoking ( P = 0.001, 1.5 points), incomplete fissures ( P = 0.004, 1.5 points), and adhesions ( P = 0.0001, 1 point). The new score provided a stratification into four risk classes. CONCLUSIONS The risk score incorporates either general or more specific variables, providing a risk stratification that could be readily applied intra- and postoperatively. Henceforth, specific technical and management measures could be properly allocated to curb PAL.
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Affiliation(s)
- Andrea Viti
- Division of Thoracic Surgery, Department of Surgery, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Italy
| | - Laura Socci
- Department of Cardiothoracic Surgery, Sheffield Teaching Hospitals NHS Trust, Northern General Hospital, Sheffield, UK
| | - Miguel Congregado
- Department of General Thoracic Surgery, Virgen Macarena University Hospital, Seville, Spain
| | - Mahmoud Ismail
- Department of Surgery, Competence Center of Thoracic Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Dania Nachira
- Department of General Thoracic Surgery, Fondazione Policlinico "A.Gemelli" - Catholic University of Sacred Heart, Rome, Italy
| | - Carlos Galvez Muñoz
- Department of Thoracic Surgery, University General Hospital Alicante, Alicante, Spain
| | - Sergio Bolufer
- Department of Thoracic Surgery, University General Hospital Alicante, Alicante, Spain
| | - Jens C Rückert
- Department of Surgery, Competence Center of Thoracic Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Stefano Margaritora
- Department of General Thoracic Surgery, Fondazione Policlinico "A.Gemelli" - Catholic University of Sacred Heart, Rome, Italy
| | - Alberto Terzi
- Division of Thoracic Surgery, Department of Surgery, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Italy
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Surendrakumar V, Martin-Ucar AE, Edwards JG, Rao J, Socci L. Evaluation of surgical approaches to anatomical segmentectomies: the transition to minimal invasive surgery improves hospital outcomes. J Thorac Dis 2017; 9:3896-3902. [PMID: 29268399 DOI: 10.21037/jtd.2017.09.91] [Citation(s) in RCA: 7] [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] [Indexed: 11/06/2022]
Abstract
Background We aim to evaluate the transition process from open to video-assisted thoracoscopic surgery (VATS) anatomical segmentectomies in a regional thoracic surgical unit. Methods In a retrospective study from January 2013 to December 2015, we identified all anatomical segmentectomies performed in our unit. Pre, peri and postoperative data were compared between the three years (2013, 2014 and 2015) and according to operative approach. Thoracotomy after VATS intraoperative biopsy was considered a conversion for the purposes of the study. Results A total of 86 consecutive cases [56 females and 30 males, median age 70 years (range, 43 to 83 years); median FEV1 of 78% predicted (range, 41% to 126%)] were included. There was a significant change in the surgical approach with time. Fifty-two cases underwent VATS (73% via single-port) and 34 open surgeries, including nine conversions. There were no postoperative deaths in the VATS group and one in the open group. Operative outcomes were similar over time with no haemorrhagic events, equivalent R1 resection and nodal stations explored in all lymph node positive patients. In node negative cases however, open surgery was associated with more extensive mediastinal exploration. Patients in 2015 had a shorter hospital stay in comparison to those in previous years [median 4 days (range, 1-15 days) vs. median 6 days (range, 3-27 days), P=0.01]. There were no differences in the incidence of complications or readmissions to hospital over time. Conclusions The transition over a short period of time from open to single-port VATS segmentectomy has allowed us to significantly reduce postoperative hospital stay without compromising operative or postoperative outcomes.
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Affiliation(s)
- Veena Surendrakumar
- Department of Cardiothoracic Surgery, Sheffield Teaching Hospitals NHS Trust, Northern General Hospital, Sheffield, UK
| | - Antonio E Martin-Ucar
- Department of Cardiothoracic Surgery, Sheffield Teaching Hospitals NHS Trust, Northern General Hospital, Sheffield, UK
| | - John G Edwards
- Department of Cardiothoracic Surgery, Sheffield Teaching Hospitals NHS Trust, Northern General Hospital, Sheffield, UK
| | - Jagan Rao
- Department of Cardiothoracic Surgery, Sheffield Teaching Hospitals NHS Trust, Northern General Hospital, Sheffield, UK
| | - Laura Socci
- Department of Cardiothoracic Surgery, Sheffield Teaching Hospitals NHS Trust, Northern General Hospital, Sheffield, UK
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Rawashdeh M, Ganti S, Socci L, Edwards J, Rao J. Trainees Experience in Uniportal VATS Lobectomy for Primary Lung Cancer. A Single UK Centre Study. Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.060] [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: 11/30/2022]
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Socci L, Martin-Ucar A, Rawashdeh M, Rao J, Edwards J. P-131SERIES OF AUDITS HELP TO ENSURE THE SUSTAINABILITY OF THE BENEFITS OBTAINED AFTER THE IMPLEMENTATION OF ENHANCED RECOVERY AFTER MAJOR THORACIC SURGERY. Interact Cardiovasc Thorac Surg 2017. [DOI: 10.1093/icvts/ivx280.131] [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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Martin-Ucar AE, Socci L. Uniportal VATS lymphadenectomy. Video-assist Thorac Surg 2017. [DOI: 10.21037/vats.2017.08.16] [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: 11/06/2022]
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Martin-Ucar AE, Aragon J, Bolufer Nadal S, Galvez Munoz C, Luo Q, Perez Mendez I, Sihoe ADL, Socci L. The influence of prior multiport experience on the learning curve for single-port thoracoscopic lobectomy: a multicentre comparative study†. Eur J Cardiothorac Surg 2017; 51:1183-1187. [DOI: 10.1093/ejcts/ezx003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 11/23/2016] [Indexed: 11/15/2022] Open
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Ajab S, Begum S, Stanley H, Matthews S, Fisher P, Socci L, Deeley Y, Edwards J. 166: Searching for MARS-2: The North Trent Cancer Research Network Specialist Mesothelioma MDT screening experience. Lung Cancer 2017. [DOI: 10.1016/s0169-5002(17)30216-7] [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: 11/25/2022]
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Surendraumar V, Martin-Ucar A, Edwards J, Rao J, Socci L. F-041EVALUATING THE SURGICAL APPROACHES TO ANATOMICAL SEGMENTECTOMIES: THE TRANSITION TO VIDEO-ASSISTED THORACOSCOPIC SURGERY IMPROVES HOSPITAL OUTCOMES. Interact Cardiovasc Thorac Surg 2016. [DOI: 10.1093/icvts/ivw260.41] [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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Martin-Ucar A, Aragon J, Bolufer S, Munoz CG, Luo Q, Mendez IP, Sihoe A, Socci L. P-235THE INFLUENCE OF PRIOR VIDEO-ASSISTED THORACOSCOPIC SURGERY EXPERIENCE IN THE LEARNING CURVE FOR SINGLE-PORT VIDEO-ASSISTED THORACOSCOPIC LOBECTOMY: A MULTICENTRE COMPARATIVE STUDY. Interact Cardiovasc Thorac Surg 2016. [DOI: 10.1093/icvts/ivw260.232] [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: 11/12/2022] Open
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Martin-Ucar AE, Socci L. Why perform uniportal video-assisted thoracic surgery?-multiple considerations. J Vis Surg 2016; 2:108. [PMID: 29399495 DOI: 10.21037/jovs.2016.06.01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 05/31/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Antonio E Martin-Ucar
- Department of Thoracic Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Laura Socci
- Department of CardioThoracic Surgery, Sheffield Teaching Hospitals, Sheffield, UK
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Martin-Ucar AE, Socci L. Location techniques of pulmonary lesions during video-assisted thoracic surgery: a perspective. J Vis Surg 2016; 2:36. [PMID: 29078464 DOI: 10.21037/jovs.2016.03.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 02/23/2016] [Indexed: 11/06/2022]
Affiliation(s)
| | - Laura Socci
- Department of Cardio Thoracic Surgery, Sheffield Teaching Hospitals, Sheffield, UK
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Mesa-Guzman M, Periklis P, Niwaz Z, Socci L, Raubenheimer H, Adams B, Gurung L, Uzzaman M, Lim E. Determining optimal fluid and air leak cut off values for chest drain management in general thoracic surgery. J Thorac Dis 2015; 7:2053-7. [PMID: 26716045 DOI: 10.3978/j.issn.2072-1439.2015.11.42] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Chest drain duration is one of the most important influencing aspects of hospital stay but the management is perhaps one of the most variable aspects of thoracic surgical care. The aim of our study is to report outcomes associated with increasing fluid and air leak criteria of protocol based management. METHODS A 6-year retrospective analysis of protocolised chest drain management starting in 2007 with a fluid criteria of 3 mL/kg increasing to 7 mL/kg in 2011 to no fluid criteria in 2012, and an air leak criteria of 24 hours without leak till 2012 when digital air leak monitoring was introduced with a criteria of <20 mL/min of air leak for more than 6 hours. Patient data were obtained from electronic hospital records and digital chest films were reviewed to determine the duration of chest tube drainage and post-drain removal complications. RESULTS From 2009 to 2012, 626 consecutive patients underwent thoracic surgery procedures under a single consultant. A total of 160 did not require a chest drain and data was missing in 22, leaving 444 for analysis. The mean age [standard deviation (SD)] was 57±19 years and 272 (61%) were men. There were no differences in the incidence of pneumothoraces (P=0.191), effusion (P=0.344) or re-interventions (P=0.431) for drain re-insertions as progressively permissive criteria were applied. The median drain duration dropped from 1-3 days (P<0.001) and accordingly hospital stay reduced from 4-6 days (P<0.001). CONCLUSIONS Our results show that chest drains can be safely removed without fluid criteria and air leak of less than 20 mL/min with median drain duration of 1 day, associated with a reduced length of hospital stay.
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Affiliation(s)
- Miguel Mesa-Guzman
- 1 Department of Thoracic Surgery, 2 Department Quality and Safety, Royal Brompton Hospital, London, UK
| | - Perikleous Periklis
- 1 Department of Thoracic Surgery, 2 Department Quality and Safety, Royal Brompton Hospital, London, UK
| | - Zakiyah Niwaz
- 1 Department of Thoracic Surgery, 2 Department Quality and Safety, Royal Brompton Hospital, London, UK
| | - Laura Socci
- 1 Department of Thoracic Surgery, 2 Department Quality and Safety, Royal Brompton Hospital, London, UK
| | - Hilgardt Raubenheimer
- 1 Department of Thoracic Surgery, 2 Department Quality and Safety, Royal Brompton Hospital, London, UK
| | - Ben Adams
- 1 Department of Thoracic Surgery, 2 Department Quality and Safety, Royal Brompton Hospital, London, UK
| | - Lokesh Gurung
- 1 Department of Thoracic Surgery, 2 Department Quality and Safety, Royal Brompton Hospital, London, UK
| | - Mohsin Uzzaman
- 1 Department of Thoracic Surgery, 2 Department Quality and Safety, Royal Brompton Hospital, London, UK
| | - Eric Lim
- 1 Department of Thoracic Surgery, 2 Department Quality and Safety, Royal Brompton Hospital, London, UK
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Surendrakumar V, Vaughan PR, Rao J, Edwards JG, Socci L. Comparing the quality of uniportal and multiportal video-assisted anatomical resection for primary lung cancer: the preliminary results of a single centre audit. J Cardiothorac Surg 2015. [PMCID: PMC4695700 DOI: 10.1186/1749-8090-10-s1-a235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Zakeri R, Patel H, Rao J, Edwards J, Socci L. Enhanced recovery after thoracic surgery: Outcomes following implementation of a tailored eras pathway in a tertiary centre. Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Zakeri R, Rao J, Edwards J, Socci L. F-105ENHANCED RECOVERY AFTER THORACIC SURGERY: OUTCOMES FOLLOWING IMPLEMENTATION OF A TAILORED ERAS PATHWAY IN A TERTIARY CENTRE. Interact Cardiovasc Thorac Surg 2015. [DOI: 10.1093/icvts/ivv204.105] [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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Abstract
Lobar torsion is a rare but potentially life-threatening complication following pulmonary resection. Surgical management usually entails an exploratory thoracotomy and resection of the involved lobe if nonviable. We present the case of a 67-year-old woman diagnosed with right middle lobe torsion 5 days after thoracotomy and right upper lobectomy for squamous carcinoma of the lung. A thoracoscopic right middle lobectomy was successfully performed utilizing a single 4-cm port placed along the midaxillary line in the 5th intercostal space.
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Affiliation(s)
| | - Yama Shoaib Haqzad
- Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield, UK
| | - Jagan Nath Rao
- Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield, UK
| | - Laura Socci
- Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield, UK
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Anderson M, Greco R, Folukoya D, Edwards J, Rao J, Socci L. 173: Uniportal VATS anatomical resection for NSCLC; is it worth the pain? Lung Cancer 2015. [DOI: 10.1016/s0169-5002(15)50167-0] [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: 10/24/2022]
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Zakeri R, Martin K, Socci L. 15: Treatment of bilateral synchronous lung cancer in high risk patients: the role of single-port VATS approach and perioperative rehabilitation. Lung Cancer 2015. [DOI: 10.1016/s0169-5002(15)50015-9] [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: 10/24/2022]
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Mesa-Guzman M, Socci L, Niwaz Z, Pericleous P, Raubenheimer H, Di Chiara F, Adams B, Gurung L, Uzzaman M, Lim E. P-208 * DETERMINING OPTIMAL FLUID AND AIR LEAK CUT-OFF VALUES FOR CHEST DRAIN MANAGEMENT. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu167.208] [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: 11/12/2022] Open
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Socci L, Atkins E, Barua A, Internullo E, Malik M, Catton J, Raurell A, Martin-Ucar A. P-217THE USE OF BIOLOGICAL IMPLANTS FOR SOFT TISSUE AND CHEST WALL RECONSTRUCTION IN THORACIC SURGERY IS SAFE EVEN IN CONTAMINATED ENVIRONMENTS. Interact Cardiovasc Thorac Surg 2013. [DOI: 10.1093/icvts/ivt288.217] [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: 11/12/2022] Open
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30
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Socci L, Sharma A, Malik M, Internullo E, Martin-Ucar A. F-021AN AUDIT OF POSTOPERATIVE ANALGESIA AFTER SINGLE-PORT VIDEO-ASSISTED THORACOSCOPIC LOBECTOMY. CAN WE AVOID EPIDURAL CATHETERS? Interact Cardiovasc Thorac Surg 2013. [DOI: 10.1093/icvts/ivt288.21] [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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Socci L, Jones V, Malik M, Internullo E, Martin-Ucar A. P-157SINGLE-PORT VIDEO-ASSISTED THORACIC LUNG VOLUME REDUCTION SURGERY FOR EMPHYSEMA: REDUCING SURGICAL TRAUMA DOES NOT COMPROMISE THE PROCEDURE. Interact Cardiovasc Thorac Surg 2013. [DOI: 10.1093/icvts/ivt288.157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Socci L, Kumaran M, Malik M, Martin-Ucar AE. The left thoracotomy approach for excision of distal tracheal carcinoma in the presence of right-sided aorta. Interact Cardiovasc Thorac Surg 2013; 16:560-2. [PMID: 23315182 DOI: 10.1093/icvts/ivs498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Tracheal primary carcinoma is a rare malignancy, and we believe that its presence in a patient with a right-sided aorta has not been described before. We report a case of a primary tracheal squamous carcinoma in a patient with a four-branched right-sided aortic arch. The patient underwent a tracheal resection approached by a left thoracotomy. The surgical exposure was excellent once the ligamentum arteriosum had been divided. All the aortic arch branches and the phrenic, vagus and recurrent laryngeal nerves were identified and preserved.
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Affiliation(s)
- Laura Socci
- Department of Thoracic Surgery, Nottingham University Hospitals, NHS Trust, Nottingham, UK
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Socci L, Quereshi A, Wake P, Malik M, Internullo E, Rivas DG, Martin-Ucar AE. P201 Single-Port VATS Lobectomy. Minimising Minimally Invasive Surgery. Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.262] [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: 11/04/2022]
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Barua A, Catton JA, Socci L, Raurell A, Malik M, Internullo E, Martin-Ucar AE. Initial Experience With the Use of Biological Implants for Soft Tissue and Chest Wall Reconstruction in Thoracic Surgery. Ann Thorac Surg 2012; 94:1701-5. [DOI: 10.1016/j.athoracsur.2012.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 06/27/2012] [Accepted: 07/03/2012] [Indexed: 10/27/2022]
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Barua A, Handagala SD, Socci L, Barua B, Malik M, Johnstone N, Martin-Ucar AE. Accuracy of two scoring systems for risk stratification in thoracic surgery. Interact Cardiovasc Thorac Surg 2012; 14:556-9. [PMID: 22361128 DOI: 10.1093/icvts/ivs021] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We investigate the suitability of the two existing risk stratification systems available for predicting mortality in a cohort of patients undergoing lung resection under a single surgeon. Data from the 290 consecutive patients who underwent pulmonary resection between January 2008 and January 2011 were extracted from a prospective clinical data base. In-hospital mortality risk scores are calculated for every patient by using Thoracoscore and ESOS.01 and were compared with actual in-hospital mortality. The receiver operating characteristic (ROC) curve was used to establish how well the systems rank for predicting patient mortality. Actual in-hospital mortality was 3.1% (n = 9). Thoracoscore and ESOS values (mean ± SEM) were 4.93 ± 0.32 and 4.08 ± 0.41, respectively. The area under the ROC curve values for ESOS and Thoracoscore were 0.8 and 0.6, respectively. ESOS was reasonably accurate at predicting the overall mortality (sensitivity 88% and specificity 67%), whereas Thoracoscore was a weaker predictor of mortality (sensitivity 67% and specificity 53%). The ESOS score had better predictive values in our patient population and might be easier to calculate. Because of their low specificity, the use of these scores should be limited to the assessment of outcomes of surgical cohorts, but they are not designed to predict risks for individual patients.
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Affiliation(s)
- Anupama Barua
- Department of Thoracic Surgery, Nottingham University Hospital NHS Trust, Nottingham, UK
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Socci L, Marta HSJS, López MFJ. [Treatment of post-pneumonectomy empyema: goodbye to Clagett's thoracostomy]. Cir Esp 2011; 89:329-32. [PMID: 21342682 DOI: 10.1016/j.ciresp.2010.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Revised: 04/02/2010] [Accepted: 04/19/2010] [Indexed: 11/30/2022]
Affiliation(s)
- Laura Socci
- Unidad de Cirugía Torácica Umberto I, Hospital Regional, Ancona, Italia
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Refai M, Brunelli A, Xiumé F, Salati M, Sciarra V, Socci L, Di Nunzio L, Sabbatini A. Short-term perioperative treatment with ambroxol reduces pulmonary complications and hospital costs after pulmonary lobectomy: a randomized trial. Eur J Cardiothorac Surg 2009; 35:469-73. [PMID: 19144532 DOI: 10.1016/j.ejcts.2008.11.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Revised: 10/28/2008] [Accepted: 11/10/2008] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To assess in a randomized clinical trial the influence of perioperative short-term ambroxol administration on postoperative complications, hospital stay and costs after pulmonary lobectomy for lung cancer. METHODS One hundred and forty consecutive patients undergoing lobectomy for lung cancer (April 2006-November 2007) were randomized in two groups. Group A (70 patients): ambroxol was administered by intravenous infusion in the context of the usual therapy on the day of operation and on the first 3 postoperative days (1000 mg/day). Group B (70 patients): fluid therapy only without ambroxol. Groups were compared in terms of occurrence of postoperative complications, length of stay and costs. RESULTS There were no dropouts from either group and no complications related to treatment. The two groups were well matched for perioperative and operative variables. Compared to group B, group A (ambroxol) had a reduction of postoperative pulmonary complications (4 vs 13, 6% vs 19%, p=0.02), and unplanned ICU admission/readmission (1 vs 6, 1.4% vs 8.6%, p=0.1) rates. Moreover, the postoperative stay and costs were reduced by 2.5 days (5.6 vs 8.1, p=0.02) and 2765 Euro (2499 Euro vs 5264 Euro, p=0.04), respectively. CONCLUSIONS Short-term perioperative treatment with ambroxol improved early outcome after lobectomy and may be used to implement fast-tracking policies and cut postoperative costs. Nevertheless, other independent trials are needed to verify the effect of this treatment in different settings.
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Affiliation(s)
- Majed Refai
- Department of Thoracic Surgery, Umberto I Regional Hospital Ancona, Italy.
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Pennati G, Socci L, Rigano S, Boito S, Ferrazzi E. Computational patient-specific models based on 3-D ultrasound data to quantify uterine arterial flow during pregnancy. IEEE Trans Med Imaging 2008; 27:1715-1722. [PMID: 19033087 DOI: 10.1109/tmi.2008.924642] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Information on uterine blood flow rate during pregnancy would widely improve our knowledge on feto-placental patho-physiology. Ultrasonographic flow rate evaluation requires the knowledge of the spatial velocity profiles throughout the investigated vessel; these data may be obtained from hemodynamic simulations with accurate computational models. Recently, computational models of superficial vessels have been created using 3-D ultrasound data; unfortunately, common reconstruction methods are unsuitable for the uterine arteries due to the low quality achievable of imaged deep vessels. In this paper a simplified spline-based technique was applied to create computational models for patient-specific simulations of uterine arterial heamodynamics. Moreover, a novel method to quantify the uterine flow rates was developed based on echo-Doppler measurements and computational data. Preliminary results obtained for four patients indicated a quite narrow range for the blood flow rate through the main uterine artery with large variability in the flow split between corporal and cervical branches. Furthermore, parabolic-like velocity profiles were obtained in the branching region of the different patients, suggesting a clinical use of averaged, not patient-specific, spatial velocity distribution coefficients for the blood flow rate calculation. The developed reconstruction method based on 3-D ultrasound imaging is efficient for creating realistic custom models of the uterine arteries. The results of the fluid dynamic simulations allowed us to quantify the uterine arterial flow and its repartition in normal pregnancies.
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Affiliation(s)
- Giancarlo Pennati
- Laboratory of Biological Structures, Department of Structural Engineering, Politecnico di Milano, 20133 Milan, Italy.
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Brunelli A, Belardinelli R, Refai M, Salati M, Socci L, Pompili C, Sabbatini A. Peak oxygen consumption during cardiopulmonary exercise test improves risk stratification in candidates to major lung resection. Chest 2008; 135:1260-1267. [PMID: 19029436 DOI: 10.1378/chest.08-2059] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The objective of this investigation was to assess the association of peak oxygen consumption (Vo(2)) with postoperative outcome in a prospective cohort of patients undergoing major lung resection for the treatment of lung cancer. METHODS Preoperative symptom-limited cardiopulmonary exercise testing (CPET) performed using cycle ergometry was conducted in 204 consecutive patients who had undergone pulmonary lobectomy or pneumonectomy. Peak Vo(2) was tested for possible association with postoperative cardiopulmonary complications and mortality. Logistic regression analysis, validated by a bootstrap analysis, was used to adjust for the effect of other perioperative factors. The role of peak Vo(2) in stratifying the surgical risk was further assessed in different groups of patients subdivided according to their cardiorespiratory status. RESULTS Logistic regression showed that peak Vo(2) was an independent and reliable predictor of pulmonary complications (p = 0.04). All six deaths occurred in patients with a peak Vo(2) of < 20 mL/kg/min (four deaths in patients with a peak Vo(2) of < 12 mL/kg/min). The mortality rate in this high-risk group was 10-fold higher (4 of 30 patients; 13%) compared to those with higher peak Vo(2) (p = 0.006). Compared to patients with a peak Vo(2) of > 20 mL/kg/min, those with a peak Vo(2) of < 12 mL/kg/min had 5-fold, 8-fold, 5-fold, and 13-fold higher rates, respectively, of total cardiopulmonary complications pulmonary complications, cardiac complications, and mortality. CONCLUSIONS The present study supports a more liberal use of CPET before lung resection compared to the current guidelines since this test can help in stratifying the surgical risk and optimizing perioperative care.
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Affiliation(s)
| | | | - Majed Refai
- Division of Thoracic Surgery, Umberto I Regional Hospital, Ancona, Italy
| | - Michele Salati
- Division of Thoracic Surgery, Umberto I Regional Hospital, Ancona, Italy
| | - Laura Socci
- Division of Thoracic Surgery, Umberto I Regional Hospital, Ancona, Italy
| | - Cecilia Pompili
- Division of Thoracic Surgery, Umberto I Regional Hospital, Ancona, Italy
| | - Armando Sabbatini
- Division of Thoracic Surgery, Umberto I Regional Hospital, Ancona, Italy
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Gijsen FJH, Migliavacca F, Schievano S, Socci L, Petrini L, Thury A, Wentzel JJ, van der Steen AFW, Serruys PWS, Dubini G. Simulation of stent deployment in a realistic human coronary artery. Biomed Eng Online 2008; 7:23. [PMID: 18684321 PMCID: PMC2525649 DOI: 10.1186/1475-925x-7-23] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2007] [Accepted: 08/06/2008] [Indexed: 12/26/2022] Open
Abstract
Background The process of restenosis after a stenting procedure is related to local biomechanical environment. Arterial wall stresses caused by the interaction of the stent with the vascular wall and possibly stress induced stent strut fracture are two important parameters. The knowledge of these parameters after stent deployment in a patient derived 3D reconstruction of a diseased coronary artery might give insights in the understanding of the process of restenosis. Methods 3D reconstruction of a mildly stenosed coronary artery was carried out based on a combination of biplane angiography and intravascular ultrasound. Finite element method computations were performed to simulate the deployment of a stent inside the reconstructed coronary artery model at inflation pressure of 1.0 MPa. Strut thickness of the stent was varied to investigate stresses in the stent and the vessel wall. Results Deformed configurations, pressure-lumen area relationship and stress distribution in the arterial wall and stent struts were studied. The simulations show how the stent pushes the arterial wall towards the outside allowing the expansion of the occluded artery. Higher stresses in the arterial wall are present behind the stent struts and in regions where the arterial wall was thin. Values of 200 MPa for the peak stresses in the stent strut were detected near the connecting parts between the stent struts, and they were only just below the fatigue stress. Decreasing strut thickness might reduce arterial damage without increasing stresses in the struts significantly. Conclusion The method presented in this paper can be used to predict stresses in the stent struts and the vessel wall, and thus evaluate whether a specific stent design is optimal for a specific patient.
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Affiliation(s)
- Frank J H Gijsen
- Department of Biomedical Engineering, Thoraxcentre Ee2322, Erasmus Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
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Brunelli A, Refai M, Xiumé F, Salati M, Sciarra V, Socci L, Sabbatini A. Performance at symptom-limited stair-climbing test is associated with increased cardiopulmonary complications, mortality, and costs after major lung resection. Ann Thorac Surg 2008; 86:240-7; discussion 247-8. [PMID: 18573431 DOI: 10.1016/j.athoracsur.2008.03.025] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2008] [Revised: 03/09/2008] [Accepted: 03/14/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Exercise tests are increasingly used during preoperative evaluation before lung resection. This study assessed the association between performance at the symptom-limited stair-climbing test and postoperative cardiopulmonary morbidity, mortality, and costs after major lung resections. METHODS As part of their routine preoperative evaluation, 640 patients who had lobectomy (n = 533) or pneumonectomy (n = 107) for lung cancer from January 2000 through April 2007 performed a preoperative symptom-limited stair-climbing test. Sensitivity/specificity analysis was used to identify the best cutoff values of altitude climbed (number of steps x height of the step in m) associated with outcome. Univariate and multivariate regression analyses (validated by bootstrap) were used to test associations between preoperative and operative factors and postoperative cardiopulmonary complications, mortality, and postoperative costs. RESULTS The altitude reached at the stair-climbing test was reliably associated with increased cardiopulmonary complications (p = 0.04), mortality (p = 0.02), and costs (p < 0.0001). In patients who climbed less than 12 m, cardiopulmonary complications, mortality, and costs were 2-fold (p < 0.0001), 13-fold (p < 0.0001), and 2.5-fold higher, respectively, than in patients who climbed more than 22 m. CONCLUSIONS Performance at a maximal stair-climbing test was reliably associated with postoperative morbidity and mortality. We recommend the use of this simple and economic test in all lung resection candidates. Patients who perform poorly at the stair-climbing test should undergo a formal cardiopulmonary exercise test with measurement of oxygen consumption to optimize their perioperative management.
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Radaelli AG, Augsburger L, Cebral JR, Ohta M, Rüfenacht DA, Balossino R, Benndorf G, Hose DR, Marzo A, Metcalfe R, Mortier P, Mut F, Reymond P, Socci L, Verhegghe B, Frangi AF. Reproducibility of haemodynamical simulations in a subject-specific stented aneurysm model--a report on the Virtual Intracranial Stenting Challenge 2007. J Biomech 2008; 41:2069-81. [PMID: 18582891 DOI: 10.1016/j.jbiomech.2008.04.035] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2007] [Revised: 04/24/2008] [Accepted: 04/24/2008] [Indexed: 10/21/2022]
Abstract
This paper presents the results of the Virtual Intracranial Stenting Challenge (VISC) 2007, an international initiative whose aim was to establish the reproducibility of state-of-the-art haemodynamical simulation techniques in subject-specific stented models of intracranial aneurysms (IAs). IAs are pathological dilatations of the cerebral artery walls, which are associated with high mortality and morbidity rates due to subarachnoid haemorrhage following rupture. The deployment of a stent as flow diverter has recently been indicated as a promising treatment option, which has the potential to protect the aneurysm by reducing the action of haemodynamical forces and facilitating aneurysm thrombosis. The direct assessment of changes in aneurysm haemodynamics after stent deployment is hampered by limitations in existing imaging techniques and currently requires resorting to numerical simulations. Numerical simulations also have the potential to assist in the personalized selection of an optimal stent design prior to intervention. However, from the current literature it is difficult to assess the level of technological advancement and the reproducibility of haemodynamical predictions in stented patient-specific models. The VISC 2007 initiative engaged in the development of a multicentre-controlled benchmark to analyse differences induced by diverse grid generation and computational fluid dynamics (CFD) technologies. The challenge also represented an opportunity to provide a survey of available technologies currently adopted by international teams from both academic and industrial institutions for constructing computational models of stented aneurysms. The results demonstrate the ability of current strategies in consistently quantifying the performance of three commercial intracranial stents, and contribute to reinforce the confidence in haemodynamical simulation, thus taking a step forward towards the introduction of simulation tools to support diagnostics and interventional planning.
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Affiliation(s)
- A G Radaelli
- Computational Imaging Laboratory, Information and Communication Technologies Department, Universitat Pompeu Fabra, Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain.
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Socci L, Pennati G, Gastaldi D, Vena P. Modeling and mechanobiology of cerebral aneurysms. J Appl Biomater Biomech 2008; 6:63-71. [PMID: 20740448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The purpose of this work is to review the computational models of the adaptive behavior of the cerebral vascular wall aimed at simulating aneurysm formation and enlargement. Cerebral aneurysms are localized abnormal enlargements of the intracranial arterial vessels. The origin of this pathology is still unclear: however, aneurysm formation is thought to be the result of interplay between biomechanical properties of the vessel wall and their possible changes, such as adaptive response to mechanical stimuli. Recently, different computational approaches were suggested in the literature aiming to describe the mechanobiology of the cerebral vascular wall. Most of the computational adaptive models showed a common approach for the geometrically non-linear kinematic description of the phenomenon, whilst the constitutive laws defining the rates of growth variables may differ considerably according to the specific phenomenon considered. These studies allowed the reproduction of some peculiar aspects of aneurysm mechanobiology; however, continued interdisciplinary research is mandatory for a better understanding of the mechanisms involved in the evolution of cerebral aneurysms.
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Affiliation(s)
- L Socci
- Department of Structural Engineering, Laboratory of Biological Structure Mechanics (LaBS), Politecnico di Milano, Milano - Italy
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Brunelli A, Varela G, Rocco G, Socci L, Novoa N, Gatani T, Salati M, La Rocca A. A model to predict the immediate postoperative FEV1 following major lung resections. Eur J Cardiothorac Surg 2007; 32:783-6. [PMID: 17766133 DOI: 10.1016/j.ejcts.2007.07.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [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: 04/26/2007] [Revised: 07/02/2007] [Accepted: 07/13/2007] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE FEV1 measured on the first postoperative day has shown to be a better predictor of complications than traditional ppoFEV1. Therefore, its estimation before operation may enhance risk stratification. The objective of this study was to develop and validate a model to predict FEV1 on the first postoperative day after major lung resection. METHODS FEV1 was prospectively measured on the first postoperative day in 272 patients submitted for lobectomy or pneumonectomy at two centers. A random sample of 136 patients was used to develop a model estimating the first day FEV1 by using multiple regression analysis including several preoperative and operative factors. The model was then validated by bootstrap analysis and tested on the other sample of 136 patients. RESULTS Factors reliably associated with postoperative first day FEV1 were age (p=0.002), preoperative FEV1 (p<0.0001), the presence of epidural analgesia (p<0.0001), and the percentage of non-obstructed segments removed during operation (p=0.001). The following model estimating the first day postoperative FEV1 was derived: -2.648+0.295 x age+0.371 x FEV1+8.216 x epidural analgesia - 0.338 x percentage of non-obstructed segments removed during operation. In the validation set, the mean predicted first day postoperative FEV1 value did not differ from the observed one (42.6 vs 42.0, respectively; p=0.3) and the plot of the observed versus the predicted first day FEV1 showed a satisfactory calibration. CONCLUSIONS We developed a model predicting the first day postoperative FEV1. If future analyses will prove its role in stratifying the early postoperative risk, it may be integrated in preoperative evaluation algorithms to refine risk stratification.
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Brunelli A, Socci L, Refai M, Salati M, Xiumé F, Sabbatini A. Quality of life before and after major lung resection for lung cancer: a prospective follow-up analysis. Ann Thorac Surg 2007; 84:410-6. [PMID: 17643607 DOI: 10.1016/j.athoracsur.2007.04.019] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.1] [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: 02/02/2007] [Revised: 03/31/2007] [Accepted: 04/02/2007] [Indexed: 11/20/2022]
Abstract
BACKGROUND The objective of this study was to assess the preoperative and postoperative quality of life of candidates for major lung resection with lung cancer. METHODS In all, 156 consecutive patients (144 lobectomies, 12 pneumonectomies) were prospectively assessed by means of the Short Form-36 Health Survey, version 2, preoperatively and 1 month and 3 months after operation. Serial quality of life scales were compared by repeated measures analysis of variance. RESULTS In our series, most quality of life values were reduced compared with the general population. Compared with preoperative values, the physical composite scale was significantly reduced at 1 month (51 versus 45.1, p < 0.0001), and completely recovered at 3 months (51 versus 52.4, p = 0.2), whereas the mental composite scale remained unchanged. All correlation coefficients between these values and forced expiratory volume in 1 second, carbon monoxide lung diffusion capacity, and height reached at stair-climbing test at each evaluation period were below 0.2. With the exception of pneumonectomy patients (who had a significantly lower physical composite scale [p = 0.04]), no significant differences in both physical and mental values were noted in other high-risk subgroups of patients (elderly, coronary artery disease, poor pulmonary function) compared with lower-risk counterparts. CONCLUSIONS Candidates for lung resection with lung cancer had a worse preoperative quality of life compared with the general population. Quality-of-life measures had poor correlation with forced expiratory volume in 1 second, carbon monoxide lung diffusion capacity, and exercise test performance. Therefore, these functional variables cannot substitute for specific evaluation instruments. Finally, patients traditionally considered at higher risk for lung resection had postoperative physical and emotional quality of life scores similar to those observed in younger and fitter patients.
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Socci L, Pennati G, Gervaso F, Vena P. An axisymmetric computational model of skin expansion and growth. Biomech Model Mechanobiol 2006; 6:177-88. [PMID: 16767451 DOI: 10.1007/s10237-006-0047-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2005] [Accepted: 03/25/2006] [Indexed: 10/24/2022]
Abstract
Skin expansion is the principal technique used in plastic surgery to repair large cutaneous defects, typically after tumour removal, burn care, craniofacial surgery and post-mastectomy breast reconstruction. It allows a gain of new tissue by means of gradual expansion of a prosthesis, surgically implanted beneath the patient's skin. Nevertheless, wide clinical use is not supported by a deep quantitative knowledge of the phenomena occurring during the expansion. A finite element model of the skin expansion was developed to evaluate the stresses and the strains of the skin due to the expander inflation and validated by proper in vitro experiments; furthermore, a growth model based on the mechanical stimulus was implemented to estimate the skin area gain. The developed computational approach, composed of the skin expansion model interaction and the growth law, proved its validity to investigate skin expansion phenomena: its use suggests a new predictive tool to optimize clinical procedures and the expander devices' design.
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Affiliation(s)
- L Socci
- Laboratory of Biological Structure Mechanics, Department of Structural Engineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, Milan, Italy.
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Socci L, Pennati G, Migliavacca F, Dubini G. Computational haemodynamics in cerebral aneurysm custom models based on different reconstructive methodologies. J Biomech 2006. [DOI: 10.1016/s0021-9290(06)85505-3] [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: 10/24/2022]
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Boschetti F, Camera M, Socci L, Spirito R, Di Martino E. Mechanical properties of intraluminal thrombus from abdominal aortic aneurysm under compressive loads. J Biomech 2006. [DOI: 10.1016/s0021-9290(06)85506-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Pennati G, Socci L, Gervaso F, Dubini G, Festa P, Luisi V, Migliavacca F. Fluid dynamics in patient-specific models of cavopulmonary connections. J Biomech 2006. [DOI: 10.1016/s0021-9290(06)84114-x] [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: 11/25/2022]
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Socci L, Gervaso F, Migliavacca F, Pennati G, Dubini G, Ait-Ali L, Festa P, Amoretti F, Scebba L, Luisi VS. Computational fluid dynamics in a model of the total cavopulmonary connection reconstructed using magnetic resonance images. Cardiol Young 2005; 15 Suppl 3:61-7. [PMID: 16248928 DOI: 10.1017/s1047951105001666] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [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] [Indexed: 11/06/2022]
Abstract
The recent developments in imaging techniques have created new opportunities to give an accurate description of the three-dimensional morphology of vessels. Such three-dimensional reconstruction of anatomical structures from medical images has achieved importance in several applications, such as the reconstruction of human bones, spine portions, and vascular districts.
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Affiliation(s)
- Laura Socci
- Structural Engineering Department and Laboratory of Biological Structure Mechanics, Politecnico di Milano, Milan, Italy.
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