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Grossi S, Cattoni M, Filipponi L, Marzorati A, Rotolo N, Carcano G, Imperatori A. Training simulator efficacy in developing thoracic and general surgical skills in a residency programme: a pilot study. Eur J Cardiothorac Surg 2024; 65:ezae044. [PMID: 38331406 DOI: 10.1093/ejcts/ezae044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/08/2024] [Accepted: 02/05/2024] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVES Virtual training simulators have been introduced in several surgical disciplines to improve residents' abilities. Through the use of the LapSim® virtual training simulator (Surgical Science, Göteborg, Sweden), this study aims to plan an effective learning path in minimally invasive thoracic and general surgery. METHODS All thoracic and general surgery trainees in their 1st and 2nd year of residency at the University of Insubria were enrolled and randomized into 2 groups: residents undergoing an intensive twice-a-week virtual training programme (group A: n = 8) and those undergoing a once-weekly non-intensive virtual training programme (group B: n = 9). The virtual training programme was divided into 4 modules, each of 12 weeks. In the 1st module, trainees repeated grasping, cutting, clip application, lifting and grasping, and fine dissection exercises during each training session. Seal-and-cut exercise was performed as the initial and final test. Data on surgical manoeuvres (time and on mistakes) were collected; intra- and inter-group comparisons were planned. RESULTS No significant differences were observed between groups A and B at the 1st session, confirming that the 2 groups had similar skills at the beginning. After 12 weeks, both groups showed improvements, but comparing data between initial and final test, only Group A registered a significant reduction in total time (P-value = 0.0015), left (P-value = 0.0017) and right (P-value = 0.0186) instrument path lengths, and in left (P-value = 0.0010) and right (P-value = 0.0073) instrument angular path lengths, demonstrating that group A acquired greater precision in surgical manoeuvres. CONCLUSIONS Virtual simulator training programme performed at least twice a week was effective for implementing basic surgical skills required for the trainee's professional growth. Additional virtual training modules focused on more complex exercises are planned to confirm these preliminary results.
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Affiliation(s)
- Sarah Grossi
- Center for Thoracic Surgery, Department of Medicine and Surgery (DMC), University of Insubria, Varese, Italy
| | - Maria Cattoni
- Center for Thoracic Surgery, Department of Medicine and Surgery (DMC), University of Insubria, Varese, Italy
| | - Luca Filipponi
- Center for Thoracic Surgery, Department of Medicine and Surgery (DMC), University of Insubria, Varese, Italy
| | - Alessandro Marzorati
- General, Emergency and Transplant Surgery, Department of Medicine and Innovation Technology (DiMIT), University of Insubria, Varese, Italy
| | - Nicola Rotolo
- Center for Thoracic Surgery, Department of Medicine and Surgery (DMC), University of Insubria, Varese, Italy
| | - Giulio Carcano
- General, Emergency and Transplant Surgery, Department of Medicine and Innovation Technology (DiMIT), University of Insubria, Varese, Italy
| | - Andrea Imperatori
- Center for Thoracic Surgery, Department of Medicine and Surgery (DMC), University of Insubria, Varese, Italy
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Imperatori A, Cattoni M, Bertolaccini L, Nosotti M, Rosso L, Cagini L, Vannucci J, Brunelli A, Crisci R, Curcio C, Rotolo N. Assessment of the 90-day mortality risk score after video-assisted thoracoscopic lobectomy in the Italian VATS Group cohort. Monaldi Arch Chest Dis 2023. [PMID: 37522864 DOI: 10.4081/monaldi.2023.2569] [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] [Received: 03/01/2023] [Accepted: 06/20/2023] [Indexed: 08/01/2023] Open
Abstract
A five classes (A-E) aggregate risk score predicting 90-day mortality after video-assisted thoracoscopic lobectomy for lung cancer, including as independent factors male sex (3 points), DLCO <60% (1 point) and operative time >150 minutes (1 point), has been recently published. This study aims to assess the effectiveness and reliability of this risk model in a large, independent cohort of patients, to confirm its generalizability. From the Italian VATS Group Database, we selected 2,209 patients [60% males; median age 69 years (IQR:63-74)] who underwent video-assisted thoracoscopic lobectomy for non-small cell lung cancer. We calculated the aggregate risk score and the corresponding class of 90-day mortality risk for each patient. The correlation between risk classes and mortality rates was tested by Spearman's r-test. Model calibration was evaluated by Hosmer-Lemeshow goodness-of-fit test. Class A-E 90-day mortality rates were 0.33%, 0.51%, 1.39%, 1.31% and 2.56%, respectively. A strong uphill correlation was identified between risk classes and 90-day mortality (r=0.90; p=0.037), showing a positive correlation between increased mortality rate and class A to E. Hosmer-Lemeshow chi-squared value was 67.47 (p<0.001) with overall, Class D and E significantly lower 90-day mortality in our cohort than in the original one [1.04% vs 2.5% (p=0.018), 1.31% vs 5.65% (p=0.005) and 2.56% vs 18.75% (p=0.007), respectively]. Despite our data show a positive correlation between 90-day mortality and risk classes from A to E with modest discriminatory performance, the poor calibration suggests the need for model recalibration using local data to better manage and counsel lung cancer patients eligible for video-assisted thoracoscopic lobectomy.
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Affiliation(s)
- Andrea Imperatori
- Center for Thoracic Surgery and Center for Minimally Invasive Surgery, Department of Medicine and Surgery, University of Insubria, Varese.
| | - Maria Cattoni
- Center for Thoracic Surgery and Center for Minimally Invasive Surgery, Department of Medicine and Surgery, University of Insubria, Varese.
| | - Luca Bertolaccini
- Division of Thoracic Surgery, European Institute of Oncology (IEO) IRCCS, Milan.
| | - Mario Nosotti
- Thoracic Surgery and Lung Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan.
| | - Lorenzo Rosso
- Thoracic Surgery and Lung Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan.
| | - Lucio Cagini
- Department of Thoracic Surgery, University of Perugia Medical School, Perugia.
| | - Jacopo Vannucci
- Department of Thoracic Surgery, University of Perugia Medical School, Perugia.
| | | | - Roberto Crisci
- Thoracic Surgery Unit, University of L'Aquila, "G. Mazzini" Hospital, Teramo.
| | - Carlo Curcio
- Department of Thoracic Surgery, Monaldi Hospital, Naples.
| | - Nicola Rotolo
- Center for Thoracic Surgery and Center for Minimally Invasive Surgery, Department of Medicine and Surgery, University of Insubria, Varese.
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3
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Grossi S, Cattoni M, Rotolo N, Imperatori A. Video-assisted thoracoscopic surgery simulation and training: a comprehensive literature review. BMC Med Educ 2023; 23:535. [PMID: 37501111 PMCID: PMC10375656 DOI: 10.1186/s12909-023-04482-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 06/28/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Video-assisted thoracic surgery (VATS) has become the standard for lung cancer diagnosis and treatment. However, this surgical technique requires specific and dedicated training. In the past 20 years, several simulator systems have been developed to promote VATS training. Advances in virtual reality may facilitate its integration into the VATS training curriculum. The present review aims to first provide a comprehensive overview of the simulators for thoracoscopic surgery, focused especially on simulators for lung lobectomy; second, it explores the role and highlights the possible efficacy of these simulators in the surgical trainee curriculum. METHODS A literature search was conducted in the PubMed, EMBASE, Science Direct, Scopus and Web of Science databases using the following keywords combined with Boolean operators "AND" and "OR": virtual reality, VR, augmented reality, virtual simulation, mixed reality, extended reality, thoracic surgery, thoracoscopy, VATS, video-assisted thoracoscopic surgery, simulation, simulator, simulators, training, and education. Reference lists of the identified articles were hand-searched for additional relevant articles to be included in this review. RESULTS Different types of simulators have been used for VATS training: synthetic lung models (dry simulators); live animals or animal tissues (wet simulators); and simulators based on virtual or augmented reality. Their role in surgical training has been generally defined as useful. However, not enough data are available to ascertain which type is the most appropriate. CONCLUSIONS Simulator application in the field of medical education could revolutionize the regular surgical training curriculum. Further studies are required to better define their impact on surgeons' training programs and, finally, on patients' quality of care.
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Affiliation(s)
- Sarah Grossi
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Via Guicciardini, 9, Varese, 21100, Italy.
| | - Maria Cattoni
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Via Guicciardini, 9, Varese, 21100, Italy
| | - Nicola Rotolo
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Via Guicciardini, 9, Varese, 21100, Italy
- Center for Minimally Invasive Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Andrea Imperatori
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Via Guicciardini, 9, Varese, 21100, Italy
- Center for Minimally Invasive Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
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4
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Fontana F, Piacentino F, Curti M, Ierardi AM, Coppola A, Macchi E, De Marchi G, Faiella E, Santucci D, Moramarco LP, Del Grande F, Piffaretti G, Tozzi M, Imperatori A, Carcano G, Basile A, D'Angelo F, Carrafiello G, Venturini M. Pulmonary Artery Pseudoaneurysms Embolization: Bicentric Experience and Review of the Literature. J Clin Med 2023; 12:jcm12113796. [PMID: 37297991 DOI: 10.3390/jcm12113796] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/10/2023] [Accepted: 05/15/2023] [Indexed: 06/12/2023] Open
Abstract
The purpose of this bicentric case series was to report the safety, efficacy, and clinical outcome of transcatheter embolization in pulmonary artery pseudoaneurysms (PAPAs). Between January 2016 and June 2021, eight patients with PAPA were subjected to transcatheter embolization. The total number of patients was eight, of which five were female, with a mean age of 62 ± 14 years (average ± standard deviation). Etiology was traumatic in 2/8 cases and iatrogenic in 6/8 cases (after positioning a Swan-Ganz catheter in 5/6 cases and a temporary pacemaker in the latter case). In a single case, the PAPA was incidentally discovered during a routine X-ray, in the remaining 7 cases, the procedure was performed in emergency settings. PAPA embolization was performed using detachable coils alone in 3 cases; coils and glue in 1 case; coils, glue, and vascular plug in 1 case; coils and non-adhesive liquid embolic agents (Onyx and Squid respectively) in 2 cases; and non-adhesive liquid embolic agent alone (Onyx) in 1 case. No peri-procedural or post-procedural complications were recorded. Both the technical and clinical success rates were 100.0%. In conclusion, endovascular embolization is a technically feasible and safe therapeutic option for patients with PAPAs.
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Affiliation(s)
- Federico Fontana
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, 21100 Varese, Italy
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy
| | - Filippo Piacentino
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, 21100 Varese, Italy
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy
| | - Marco Curti
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, 21100 Varese, Italy
| | - Anna Maria Ierardi
- Radiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20021 Milan, Italy
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122 Milan, Italy
| | - Andrea Coppola
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, 21100 Varese, Italy
| | - Edoardo Macchi
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, 21100 Varese, Italy
| | - Giuseppe De Marchi
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, 21100 Varese, Italy
| | - Eliodoro Faiella
- Radiology Unit, Sant'Anna Hospital, San Fermo della Battaglia, 22042 Como, Italy
- Department of Radiology, Campus Bio-Medico University, 00128 Rome, Italy
| | - Domiziana Santucci
- Radiology Unit, Sant'Anna Hospital, San Fermo della Battaglia, 22042 Como, Italy
- Department of Radiology, Campus Bio-Medico University, 00128 Rome, Italy
| | | | - Filippo Del Grande
- Istituto di Imaging della Svizzera Italiana (IIMSI), Ente Ospedaliero Cantonale EOC, 6900 Lugano, Switzerland
| | - Gabriele Piffaretti
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy
- Vascular Surgery Unit, ASST Settelaghi, 21100 Varese, Italy
| | - Matteo Tozzi
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy
- Vascular Surgery Unit, ASST Settelaghi, 21100 Varese, Italy
| | - Andrea Imperatori
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy
- Thoracic Surgery Unit, ASST Settelaghi, 21100 Varese, Italy
| | - Giulio Carcano
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy
- General Surgery Unit, ASST Settelaghi, 21100 Varese, Italy
| | - Antonio Basile
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", 95123 Catania, Italy
| | - Fabio D'Angelo
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy
- Orthopedic Surgery Unit, ASST Settelaghi, 21100 Varese, Italy
| | - Gianpaolo Carrafiello
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122 Milan, Italy
- Radiology Unit, Sant'Anna Hospital, San Fermo della Battaglia, 22042 Como, Italy
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, 21100 Varese, Italy
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy
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Rotolo N, Cattoni M, De Maio S, Filipponi L, Mateo-Ramos P, Imperatori A. The surgical approach of late-onset tracheoesophageal fistula in a tracheostomized COVID-19 patient. Monaldi Arch Chest Dis 2023; 93. [PMID: 36786164 DOI: 10.4081/monaldi.2023.2490] [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] [Received: 11/22/2022] [Accepted: 12/16/2022] [Indexed: 02/10/2023] Open
Abstract
In the COVID-19 era the tracheal complications due to prolonged mechanical ventilation have significantly increased. Acquired tracheoesophageal fistula is one of those in ventilated COVID-19 patients. Thus, the knowledge of their management in such fragile patient is crucial. We report a case of tracheoesophageal fistula in a 56-year-old female under prolonged mechanical ventilation for COVID-19 bilateral pneumonia and discuss its management. A surgical approach was proposed. By a collar-shaped transverse cervicotomic access, we transected the trachea at level of fistula en-bloc with the tracheostoma. The esophageal lesion was longitudinally repaired in two-layers. Protective left strap muscle was sandwiched between esophagus and trachea. The tracheal end-to-end anastomosis was completed without a re-tracheostoma. Even if surgical approach of tracheoesophageal fistula in COVID-19 patients has not been tested before, surgery remains the treatment of choice according to the multidisciplinary board.
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Affiliation(s)
- Nicola Rotolo
- Research Center of Minimally Invasive Surgery and Thoracic Surgery, Department of Technological Innovation, Department of Medicine and Surgery, University of Insubria, Varese.
| | - Maria Cattoni
- Research Center of Minimally Invasive Surgery and Thoracic Surgery, Department of Technological Innovation, Department of Medicine and Surgery, University of Insubria, Varese.
| | - Silvia De Maio
- Research Center of Minimally Invasive Surgery and Thoracic Surgery, Department of Technological Innovation, Department of Medicine and Surgery, University of Insubria, Varese.
| | - Luca Filipponi
- Research Center of Minimally Invasive Surgery and Thoracic Surgery, Department of Technological Innovation, Department of Medicine and Surgery, University of Insubria, Varese.
| | - Pau Mateo-Ramos
- Research Center of Minimally Invasive Surgery and Thoracic Surgery, Department of Technological Innovation, Department of Medicine and Surgery, University of Insubria, Varese.
| | - Andrea Imperatori
- Research Center of Minimally Invasive Surgery and Thoracic Surgery, Department of Technological Innovation, Department of Medicine and Surgery, University of Insubria, Varese.
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Piacentino F, Fontana F, Zorzetto G, Saccomanno A, Casagrande S, Franzi F, Imperatori A, Lanza C, Carriero S, Coppola A, Ierardi AM, Carrafiello G, Venturini M. Could Maximum SUV be Used as Imaging Guidance in Large Lung Lesions Biopsies? Double Sampling Under PET-CT/XperGuide Fusion Imaging in Inhomogeneous Lung Uptaking Lesions to Show That it can Make a Difference. Technol Cancer Res Treat 2023; 22:15330338221144508. [PMID: 37116886 PMCID: PMC10155026 DOI: 10.1177/15330338221144508] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 04/30/2023] Open
Abstract
Introduction: The purpose of this study is to evaluate the diagnostic value of positron emission computed tomography-cone beam computed tomography (PET/CT-CBCT) fusion guided percutaneous biopsy, targeted to the maximum standardized uptake value (SUVmax) and minimum standardized uptake value (SUVmin) of large lung lesions. Materials and Methods: Inside a larger cohort of PET/CT-CBCT guided percutaneous lung biopsies, 10 patients with large pulmonary lesions (diameter > 30 mm) were selected retrospectively. These patients have been subjected to double biopsy sampling respectively in the SUVmax area and in the SUVmin area of the lesion. Technical success has been calculated. For each sample, the percentage of neoplastic, inflammatory, and fibrotic cells was reported. Furthermore, the possibility of performing immunohistochemical or molecular biology investigations to specifically define the biomolecular tumor profile was analyzed. Results: Nine lesions were found to be malignant, one benign (inflammation). Technical success was 100% (10/10) in the SUVmax samples and 70% (7/10) in the SUVmin samples (P-value: .21). In the first group, higher percentages of neoplastic cells were found at pathologic evaluation, while in the second group areas of inflammation and fibrosis were more represented. The biomolecular profile was obtained in 100% of cases (9/9) of the first group, while in the second group only in 33.3% of cases (2/6), with a statistically significant difference between the 2 groups (P-value: .011). Conclusion: A correlation between the standardized uptake value value and the technical success of the biopsy sample has been identified. PET/CT-CBCT guidance allows to target the biopsy in the areas of the tumor which are richer in neoplastic cells, thus obtaining more useful information for the planning of patient-tailored cancer treatments.
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Affiliation(s)
- Filippo Piacentino
- Department of Diagnostic and Interventional Radiology, Circolo Hospital and Macchi Foundation, Insubria University, Varese, Italy
| | - Federico Fontana
- Department of Diagnostic and Interventional Radiology, Circolo Hospital and Macchi Foundation, Insubria University, Varese, Italy
| | - Giada Zorzetto
- Postgraduate School of Radiodiagnostics, Insubria University, Varese, Italy
| | - Angiola Saccomanno
- Postgraduate School of Radiodiagnostics, Insubria University, Varese, Italy
| | - Sabrina Casagrande
- Nuclear Medicine Unit, Circolo Hospital and Macchi Foundation, Varese, Italy
| | - Francesca Franzi
- Division of Pathological Anatomy, Circolo Hospital and Macchi Foundation, Insubria University, Varese, Italy
| | - Andrea Imperatori
- Division of Thoracic Surgery, Circolo Hospital and Macchi Foundation, Insubria University, Varese, Italy
| | - Carolina Lanza
- Postgraduate School of Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Serena Carriero
- Postgraduate School of Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Andrea Coppola
- Department of Diagnostic and Interventional Radiology, Circolo Hospital and Macchi Foundation, Insubria University, Varese, Italy
| | - Anna Maria Ierardi
- Interventional Radiology Unit, Department of Radiology, Foundation IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Gianpaolo Carrafiello
- Interventional Radiology Unit, Department of Radiology, Foundation IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Massimo Venturini
- Department of Diagnostic and Interventional Radiology, Circolo Hospital and Macchi Foundation, Insubria University, Varese, Italy
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Parini S, Azzolina D, Massera F, Mastromarino MG, Papalia E, Baietto G, Curcio C, Crisci R, Rena O, Alloisio M, Amore D, Ampollini L, Ardò N, Argnani D, Baisi A, Bandiera A, Benato C, Benvenuti MR, Bertani A, Bortolotti L, Bottoni E, Breda C, Camplese P, Carbognani P, Cardillo G, Carleo F, Cavallesco G, Cherchi R, De Palma A, Dell'Amore A, Della Beffa V, Divisi D, Dolci G, Droghetti A, Ferrari P, Fontana D, Gasparri R, Gavezzoli D, Ghisalberti M, Giovanardi M, Gonfiotti A, Guerrera F, Imperatori A, Infante M, Lausi P, Lo Giudice F, Londero F, Lopez C, Mancuso M, Maniscalco P, Margaritora S, Marulli G, Mazza F, Meacci E, Melloni G, Morelli A, Mucilli F, Natali P, Negri G, Nicotra S, Nosotti M, Paladini P, Pariscenti G, Perkmann R, Pernazza F, Pirondini E, Puma F, Raveglia F, Refai M, Rinaldo A, Risso C, Rizzardi G, Rotolo N, Scarci M, Solli P, Sollitto F, Spaggiari L, Stefani A, Stella F, Surrente C, Tancredi G, Terzi A, Torre M, Tosi D, Vinci D, Viti A, Voltolini L, Zaraca F. The Overweight Paradox: Impact of Body Mass Index on Patients Undergoing VATS Lobectomy or Segmentectomy. Semin Thorac Cardiovasc Surg 2023; 35:164-176. [PMID: 35182733 DOI: 10.1053/j.semtcvs.2022.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 02/02/2022] [Indexed: 11/12/2022]
Abstract
The aim of this study was to assess the impact of BMI on perioperative outcomes in patients undergoing VATS lobectomy or segmentectomy. Data from 5088 patients undergoing VATS lobectomy or segmentectomy, included in the VATS Group Italian Registry, were collected. BMI (kg/m2) was categorized according to the WHO classes: underweight, normal, overweight, obese. The effects of BMI on outcomes (complications, 30-days mortality, DFS and OS) were evaluated with a linear regression model, and with a logistic regression model for binary endpoints. In overweight and obese patients, operative time increased with BMI value. Operating room time increased by 5.54 minutes (S.E. = 1.57) in overweight patients, and 33.12 minutes (S.E. = 10.26) in obese patients (P < 0.001). Compared to the other BMI classes, overweight patients were at the lowest risk of pulmonary, acute cardiac, surgical, major, and overall postoperative complications. In the overweight range, a BMI increase from 25 to 29.9 did not significantly affect the length of stay, nor the risk of any complications, except for renal complications (OR: 1.55; 95% CI: 1.07-2.24; P = 0.03), and it reduced the risk of prolonged air leak (OR: 0.8; 95% CI: 0.71-0.90; P < 0.001). 30-days mortality is higher in the underweight group compared to the others. We did not find any significant difference in DFS and OS. According to our results, obesity increases operating room time for VATS major lung resection. Overweight patients are at the lowest risk of pulmonary, acute cardiac, surgical, major, and overall postoperative complications following VATS resections. The risk of most postoperative complications progressively increases as the BMI deviates from the point at the lowest risk, towards both extremes of BMI values. Thirty days mortality is higher in the underweight group, with no differences in DFS and OS.
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Affiliation(s)
- Sara Parini
- Division of Thoracic Surgery, Ospedale Maggiore della Carità, Novara, Italy; Università degli Studi di Torino, Turin, Italy
| | - Danila Azzolina
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Fabio Massera
- Division of Thoracic Surgery, Ospedale Maggiore della Carità, Novara, Italy
| | | | - Esther Papalia
- Division of Thoracic Surgery, Ospedale Maggiore della Carità, Novara, Italy
| | - Guido Baietto
- Division of Thoracic Surgery, Ospedale Maggiore della Carità, Novara, Italy
| | - Carlo Curcio
- Division of Thoracic Surgery, Ospedale Monaldi, Naples, Italy
| | - Roberto Crisci
- Division of Thoracic Surgery, Ospedale G. Mazzini, Teramo, Italy
| | - Ottavio Rena
- Division of Thoracic Surgery, Ospedale Maggiore della Carità, Novara, Italy; Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy.
| | | | | | - Dario Amore
- Division of Thoracic Surgery, Ospedale Monaldi, Naples, Italy
| | - Luca Ampollini
- Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Nicoletta Ardò
- Azienda Ospedaliero-Universitaria "Ospedali Riuniti", Foggia, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Duilio Divisi
- Division of Thoracic Surgery, Ospedale G. Mazzini, Teramo, Italy
| | | | | | | | | | | | | | | | | | | | - Francesco Guerrera
- AOU Città della Salute e della Scienza di Torino, Ospedale Molinette, Torino, Italy
| | | | | | - Paolo Lausi
- AOU Città della Salute e della Scienza di Torino, Ospedale Molinette, Torino, Italy
| | | | | | | | - Maurizio Mancuso
- Azienda Ospedaliera Santi Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Pio Maniscalco
- Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | | | | | | | - Elisa Meacci
- Policlinico Universitario Agostino Gemelli, Roma, Italy
| | | | | | | | - Pamela Natali
- Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | | | | | - Mario Nosotti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | | | | | - Fausto Pernazza
- Azienda Ospedaliera Santi Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | | | - Francesco Puma
- Azienda Ospedaliera Santa Maria della Misericordia, Perugia, Italy
| | | | - Majed Refai
- Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | | | - Carlo Risso
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Nicola Rotolo
- Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | | | | | | | | | | | | | | | | | - Alberto Terzi
- IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Massimo Torre
- ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Davide Tosi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Damiano Vinci
- Azienda Ospedaliera Santa Maria della Misericordia, Perugia, Italy
| | - Andrea Viti
- IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Luca Voltolini
- AOUC Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
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8
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Cardillo G, Nosotti M, Scarci M, Torre M, Alloisio M, Benvenuti MR, Bertani A, Cagini L, Casablanca G, Cavallesco G, Cherchi R, Crucitti P, Curcio C, Denegri A, Droghetti A, Guggino G, Imperatori A, Infante MV, Lucchi M, Macrì P, Marulli G, Melloni G, Paci M, Paladini P, Pariscenti GL, Potenza E, Rea F, Refai M, Rena O, Ricciardi S, Rusca M, Sollitto F, Taurchini M, Terzi A, Voltolini L, Crisci R. Air leak and intraoperative bleeding in thoracic surgery: a Delphi consensus among the members of Italian society of thoracic surgery. J Thorac Dis 2022; 14:3842-3853. [PMID: 36389328 PMCID: PMC9641338 DOI: 10.21037/jtd-22-619] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 05/18/2022] [Accepted: 09/09/2022] [Indexed: 01/25/2023]
Abstract
Background Persistent air leak and the management of intraoperative blood loss are common threats in thoracic surgical practice. The availability of new procedures, technology and materials is constantly evolving topical hemostats and surgical sealants must be added to this toolkit. Topical hemostats and surgical sealants differ according to their chemical nature and physical characteristics, to their origin and mechanism of action, regulatory/registration and vigilance paths. A Delphi consensus was set to highlight the different points of view on the use of topical haemostatic products and sealants among the members of Italian Society of thoracic surgery. Methods The board was formed by a group of five Italian experts; in the first phase after a careful review of the scientific literature and two rounds, the board finally generated 16 consensus statements for testing across a wider audience. During the second phase, the statements were collated into a questionnaire, which was electronically sent to a panel of 46 Italian surgeons, experts in the field. Results Out of 46 Italian surgeons, 33 (72%) panel members responded to the Delphi questionnaire. All the items reached a positive consensus, with elevated levels of agreement, as demonstrated by the presence of a 100% consensus for nine items. For the remaining 7 statements the minimum level of consent was 88% (29 participants approved the statement and 4 disagreed) and the maximum was 97% (32 participants approved the statement and 1 was in disagreement). Conclusions The present Delphi analysis shows that air leak and intraoperative bleeding are clinical problems well known among thoracic surgeons. Nevertheless, the aim of the scientific societies and of the group of experts is to execute the education activities in the surgery community. This Delphi survey suggest the need of wider and updated scientific information about technical and registration characteristics of most recent technologic solutions, such as the of topical hemostats and surgical sealants to provide healthcare and administrative staff with the opportunity to work and interact through a common and shared language and eventually to guarantee minimal requirements of assistance.
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Affiliation(s)
- Giuseppe Cardillo
- Department of Thoracic Surgery, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
- Unicamillus - Saint Camillus International University of Health Sciences, Rome, Italy
| | - Mario Nosotti
- University of Milan, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Scarci
- Imperial College Healthcare NHS Trust, London, UK
| | - Massimo Torre
- Department of Thoracic Surgery, ASST GOM Niguarda, Milan, Italy
| | - Marco Alloisio
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | | | - Alessandro Bertani
- Thoracic Surgery and Lung Transplant Division, IRCCS ISMETT – UPMC, Palermo, Italy
| | - Lucio Cagini
- Department of Thoracic Surgery, University of Perugia, Perugia, Italy
- Thoracic Surgery Department, Ospedale del Mare, Naples, Italy
| | | | - Giorgio Cavallesco
- Department of Surgery 1 Thoracic, Hospital Unit University of Ferrara, Ferrara, Italy
| | - Roberto Cherchi
- Department of Thoracic Surgery, U.O.C A.R.N.A.S. -Brotzu, Cagliari, Italy
| | - Pierfilippo Crucitti
- Department of Thoracic Surgery, Fondazione Policlinico Campus Bio-Medico of Rome, Rome, Italy
| | - Carlo Curcio
- UOC Thoracic Surgery, AORN dei Colli. Monaldi Hospital, Naples, Italy
| | - Andrea Denegri
- Department of Thoracic Surgery, UOC Azienda Ospedaliera SS Annunziata Cosenza, Cosenza, Italy
| | | | - Gianluca Guggino
- Department of Thoracic Surgery, UOC Azienda Ospedaliera Rilievo Nazionale “A. Cardarelli”, Naples, Italy
| | - Andrea Imperatori
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | | | - Marco Lucchi
- Division of Thoracic Surgery, University of Pisa, Pisa, Italy
| | - Paolo Macrì
- Department of Thoracic Surgery, Humanitas Istituto Clinico Catanese, Misterbianco, Italy
| | - Giuseppe Marulli
- Thoracic Surgery Unit, Department of Emergency and Organ Transplantation, University Hospital of Bari, Bari, Italy
| | - Giulio Melloni
- Department of Thoracic Surgery, S.Croce e Carle General Hospital, Cuneo, Italy
| | - Massimiliano Paci
- Department of Thoracic Surgery, Azienda Unità Sanitaria Locale–IRCCS, Reggio Emilia, Italy
| | - Piero Paladini
- Department of Thoracic Surgery, University of Siena, Siena, Italy
| | - Gian Luca Pariscenti
- Department of Thoracic Surgery, IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Enrico Potenza
- Department of Thoracic Surgery, U.O.C. A.O.R.N.A.S. Garibaldi Nesima, Catania, Italy
| | - Federico Rea
- Unit of Thoracic Surgery and Lung Transplantation, Department of Cardio-Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Majed Refai
- Department of Thoracic Surgery, AOU Ospedali Riuniti, Ancona, Italy
| | - Ottavio Rena
- Thoracic Surgery Unit, University Hospital “Maggiore della Carità”, Novara, Italy
| | - Sara Ricciardi
- Unit of Thoracic Surgery, San Camillo Forlanini Hospital, Rome, Italy
- PhD Program, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | | | | | - Marco Taurchini
- Department of Thoracic Surgery, UOC Policlinico SS Annunziata Asl Taranto, Taranto, Italy
| | - Alberto Terzi
- IRCCS Sacro Cuore-Don Calabria, Hospital Negrar di Valpolicella, Valpolicella, Italy
| | - Luca Voltolini
- Thoracic Surgery Unit, University Hospital Careggi, Florence, Italy
| | - Roberto Crisci
- Department of Thoracic Surgery, MeSVA Department University of L’Aquila, L’Aquila, Italy
- Division of Thoracic Surgery, “Mazzini” Hospital, Teramo, Italy
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9
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Qin W, Ge J, Gong Z, Zhang Y, DiBardino DM, Imperatori A, Tandon YK, Yanagiya M, Yao F, Qiu Y. The incidence and risk factors of acute pain after preoperative needle localization of pulmonary nodules: a cross-sectional study. Transl Lung Cancer Res 2022; 11:1667-1677. [PMID: 36090632 PMCID: PMC9459605 DOI: 10.21037/tlcr-22-557] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/11/2022] [Indexed: 11/23/2022]
Abstract
Background The incidence, severity and associated risk factors of acute pain after preoperative needle localization of pulmonary nodules are poorly characterized. We therefore conducted a cross-sectional study to quantify the acute pain induced by preoperative needle localization of small pulmonary nodules before video-assisted thoracoscopic surgery (VATS). Methods We conducted this study at Shanghai Chest Hospital from September 2021 through December 2021. Eligible patients were between 18 and 75 years old and had small pulmonary nodules requiring preoperative CT-guided needle localization. The intensity of acute pain was assessed using the visual analogue scale (VAS) after preoperative needle localization. A VAS score ≥4 cm indicated moderate to severe pain. Patient demographics and CT-guided localization factors were collected to identify significant predictors associated with moderate to severe pain. Results A total of 300 patients were included in the final analysis, with a mean (SD) age of 51 (SD =12) years old; 63% were female. Moderate to severe pain occurred in 50.8% of patients during deep breathing and 45.7% of patients during movement. Multivariate logistic regression analysis showed that multiple localization needles [multiple needle localizations vs. single needle localization, odds ratio (OR): 2.363, 95% confidence interval (CI): 1.157–4.825, P=0.018] and the specific location of needle puncture on the chest wall were significant predictors of moderate to severe pain after CT-guided needle localization (lateral chest wall vs. anterior chest wall OR: 2.235, 95% CI: 1.106–4.518, P=0.025; posterior chest wall vs. anterior chest wall OR: 1.198, 95% CI: 0.611–2.349, P=0.599). Conclusions In adult patients receiving hookwire CT-guided localization, moderate to severe pain was common. Avoiding the localization route through lateral chest wall may be helpful and pharmacological medications or regional blockade is necessitated in high-risk population.
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Affiliation(s)
- Wen Qin
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jun Ge
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zhihao Gong
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yunyun Zhang
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - David M. DiBardino
- Section of Interventional Pulmonology, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Masahiro Yanagiya
- Department of Thoracic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Feng Yao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yuwei Qiu
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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10
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Baci D, Cekani E, Imperatori A, Ribatti D, Mortara L. Host-Related Factors as Targetable Drivers of Immunotherapy Response in Non-Small Cell Lung Cancer Patients. Front Immunol 2022; 13:914890. [PMID: 35874749 PMCID: PMC9298844 DOI: 10.3389/fimmu.2022.914890] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 04/07/2022] [Accepted: 05/13/2022] [Indexed: 11/13/2022] Open
Abstract
Despite some significant therapeutic breakthroughs leading to immunotherapy, a high percentage of patients with non-small cell lung cancer (NSCLC) do not respond to treatment on relapse, thus experiencing poor prognosis and survival. The unsatisfying results could be related to the features of the tumor immune microenvironment and the dynamic interactions between a tumor and immune infiltrate. Host-tumor interactions strongly influence the course of disease and response to therapies. Thus, targeting host-associated factors by restoring their physiologic functions altered by the presence of a tumor represents a new therapeutic approach to control tumor development and progression. In NSCLC, the immunogenic tumor balance is shifted negatively toward immunosuppression due to the release of inhibitory factors as well as the presence of immunosuppressive cells. Among these cells, there are myeloid-derived suppressor cells, regulatory T cells that can generate a tumor-permissive milieu by reprogramming the cells of the hosts such as tumor-associated macrophages, tumor-associated neutrophils, natural killer cells, dendritic cells, and mast cells that acquire tumor-supporting phenotypes and functions. This review highlights the current knowledge of the involvement of host-related factors, including innate and adaptive immunity in orchestrating the tumor cell fate and the primary resistance mechanisms to immunotherapy in NSCLC. Finally, we discuss combinational therapeutic strategies targeting different aspects of the tumor immune microenvironment (TIME) to prime the host response. Further research dissecting the characteristics and dynamic interactions within the interface host-tumor is necessary to improve a patient fitness immune response and provide answers regarding the immunotherapy efficacy, with the aim to develop more successful treatments for NSCLC.
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Affiliation(s)
- Denisa Baci
- Molecular Cardiology Laboratory, IRCCS-Policlinico San Donato, San Donato Milanese, Milan, Italy.,Immunology and General Pathology Laboratory, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Elona Cekani
- Medical Oncology Clinic, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Andrea Imperatori
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Domenico Ribatti
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari Aldo Moro Medical School, Bari, Italy
| | - Lorenzo Mortara
- Immunology and General Pathology Laboratory, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
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11
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Piacentino F, Fontana F, Curti M, Imperatori A, Venturini M. Trancatheter embolization of pulmonary artery pseudoaneurysm with detachable coils in association with non-adhesive liquid embolizing agent (Squid). Acta Biomed 2021; 92:e2021274. [PMID: 34747386 PMCID: PMC10523060 DOI: 10.23750/abm.v92is1.11542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/21/2021] [Indexed: 11/23/2022]
Abstract
A nodular lesion at the lower left pulmonary lobe was detected in a 46 years old male during a preoperative chest X-Ray for appendicitis. To further characterise the nodule, a contrast enhanced computed tomography (CE-CT) was performed showing a 20 mm vascular lesion, which was suspected to be a pseudoaneurysm. The diagnostic angiography detected a flattening of the vascular wall with a voluminous pseudoaneurysm (PSA) in the distal portion of the tributary branch of the inferior left lobe. To treat the lesion, a 2.9F microcatheter was advanced into the sac and 4 detachable coils were placed (16-18mm Penumbra Inc) to pack the PSA. To block vascular supply to the lesion, the feeding artery was embolized with an ethylene vinyl alcohol copolymer agent (Squid Peri 18, Emboflu). The final angiographic control showed the exclusion of the pseudoaneurysmal sac which was confirmed by SEMAR™ reconstructed CE-CT scan after 40 days. Furthermore, no signs of pulmonary infarction were reported. (www.actabiomedica.it).
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Affiliation(s)
- Filippo Piacentino
- Department of Diagnostic and Interventional Radiology, Circolo Hospital: Macchi Foundation; Ph.D. student of the "Life Sciences and Biotechnology" Ph.D. Program at Insubria University, Circolo Hospital: Macchi Foundation, Varese, Italy..
| | - Federico Fontana
- Department of Diagnostic and Interventional Radiology, Circolo Hospital: Macchi Foundation; Insubria University, Varese, Italy..
| | - Marco Curti
- Department of Diagnostic and Interventional Radiology, Circolo Hospital: Macchi Foundation; Insubria University, Varese, Italy..
| | - Andrea Imperatori
- Department Thoracic Surgery, Circolo Hospital: Macchi Foundation; Insubria University, Varese, Italy..
| | - Massimo Venturini
- Department of Diagnostic and Interventional Radiology, Circolo Hospital: Macchi Foundation; Insubria University, Varese, Italy..
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12
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Tosi D, Pieropan S, Cattoni M, Bonitta G, Franzi S, Mendogni P, Imperatori A, Rotolo N, Castellani M, Cuzzocrea M, Schiorlin I, Casagrande S, De Palma D, Nosotti M, Dominioni L. Prognostic Value of 18F-FDG PET/CT Metabolic Parameters in Surgically Treated Stage I Lung Adenocarcinoma Patients. Clin Nucl Med 2021; 46:621-626. [PMID: 34034316 PMCID: PMC8257474 DOI: 10.1097/rlu.0000000000003714] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/29/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE OF THE REPORT This article aims to explore the prognostic role of 18F-FDG PET/CT metabolic parameters in stage I lung adenocarcinoma patients. PATIENTS AND METHODS One hundred eighty pathological stage I lung adenocarcinoma patients were retrospectively reviewed. Semiquantitative analysis of FDG tumor uptake was performed with TrueD software on the Siemens Leonardo workstation. SUVmean and MTV were calculated using SUV threshold of 41% of SUVmax; the total lesion glycolysis (TLG) was calculated as the product of SUVmean and MTV. Correlation was evaluated using Spearman correlation coefficient. Maximally selected rank statistics was performed to detect the optimal cutoff used for dichotomizing each PET parameter (6.5 for SUVmean, 9.6 for SUVmax, and 19.1 for TLG). RESULTS Our main finding was the significant correlation between 18F-FDG PET/CT parameters (SUVmean, SUVmax, and TLG) and disease-free survival in pathologic stage I non-small cell lung cancer. SUVmean has the greatest accuracy in recurrence prediction (integrated area under the curve, 0.803; 95% confidence interval, 0.689-0.918). We run the maximally selected rank statistics to provide the classification of observations in 2 groups by a continuous predictor parameter; the free from recurrence rate was significantly greater in patients with SUVmean ≤6.5, SUVmax ≤9.6, and TLG ≤19.1. CONCLUSIONS Our research supports the hypothesis that SUVmean, SUVmax, and TLG are well correlated with free from recurrence rate in stage I adenocarcinoma patients, subjected to pulmonary lobectomy. Our findings also indicate these markers as promising prognostic indicators.
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Affiliation(s)
- Davide Tosi
- From the Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan
| | - Sara Pieropan
- From the Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan
| | - Maria Cattoni
- Department of Medicine and Surgery, Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese
| | - Gianluca Bonitta
- From the Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan
| | - Sara Franzi
- From the Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan
| | - Paolo Mendogni
- From the Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan
| | - Andrea Imperatori
- Department of Medicine and Surgery, Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese
| | - Nicola Rotolo
- Department of Medicine and Surgery, Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese
| | - Massimo Castellani
- Nuclear Medicine Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan
| | - Marco Cuzzocrea
- Nuclear Medicine Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan
| | | | | | | | - Mario Nosotti
- From the Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan
| | - Lorenzo Dominioni
- Department of Medicine and Surgery, Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese
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13
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Bertolaccini L, Viti A, Bertoglio P, Imperatori A, Morelli A, Zaraca F, Spaggiari L, Crisci R. Work in progress report of a multicentre retrospective observational study to evaluate the association between the airflows and the intrapleural pressures digitally recorded after video-assisted lobectomy. Interact Cardiovasc Thorac Surg 2021; 33:372-376. [PMID: 33969408 DOI: 10.1093/icvts/ivab096] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 09/07/2020] [Revised: 02/15/2020] [Accepted: 03/07/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Digital chest drainage systems allow real-time and continuous monitoring and recording of air leak flow rate and intrapleural pressure (IPP) from the immediate postoperative period to the chest drainage removal. A multicentre retrospective observational analysis of consecutive patients undergoing pulmonary lobectomy for lung cancer was performed to evaluate the association between the airflow and IPP digitally recorded during the immediate postoperative period after video-assisted thoracic surgery (VATS) lobectomy for lung cancer. Here, we present a work in progress report. METHODS All patients treated with VATS lobectomies for lung cancer were included. Multiple airflow measurements and minimum and maximum IPP through the chest tubes were digitally monitored and recorded using microelectronic mechanical sensor technology. The PALs were defined as an air leak lasting >5 days from the conclusion of the surgical procedure. The cessation of air leaks was defined as an airflow <10 ml/min during 6 consecutive hours. RESULTS This analysis comprised 76 patients who underwent VATS lobectomy for lung cancer. Nineteen patients (25%) showed prolonged air leaks (PAL) (≥5 days). The operative time was higher in the PAL group (mean difference = 44 min) without a statistically significant difference. Before the 7th postoperative hours, there were no statistically significant differences in IPPs. CONCLUSIONS Patients with PAL showed less negative IPP in the first 24 postoperative hours. Therefore, the 7th-24th postoperative hours were critical in PAL prediction since the mechanism for PAL seems to develop after the 7th postoperative hour.
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Affiliation(s)
- Luca Bertolaccini
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Andrea Viti
- Division of Thoracic Surgery, IRCCS Sacro Cuore-Don Calabria Hospital, Negrar, Italy
| | - Pietro Bertoglio
- Division of Thoracic Surgery, IRCCS Sacro Cuore-Don Calabria Hospital, Negrar, Italy
| | - Andrea Imperatori
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Angelo Morelli
- Department of Cardiothoracic Surgery, S. Maria della Misericordia University Hospital, Udine, Italy
| | - Francesco Zaraca
- Department of Vascular and Thoracic Surgery, Regional Hospital, Bolzano, Italy
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Roberto Crisci
- Department of Thoracic Surgery, University of L'Aquila, Teramo, Italy
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14
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Imperatori A, Nardecchia E, Cattoni M, Mohamed S, Di Natale D, Righi I, Mendogni P, Diotti C, Rotolo N, Dominioni L, Rosso L. Perioperative identifications of non-palpable pulmonary nodules: a narrative review. J Thorac Dis 2021; 13:2524-2531. [PMID: 34012598 PMCID: PMC8107557 DOI: 10.21037/jtd-20-1712] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Early detection of lung cancer is the key to improving treatment and prognosis of this disease, and the advent of advances in computed tomography (CT) imaging and national screening programs have improved the detection rate of very small pulmonary lesions. As such, the management of this sub-centimetric and often sub-solid lesions has become quite challenging for clinicians, especially for choosing the most suitable diagnostic method. In clinical practice, to fulfill this diagnostic yield, transthoracic needle biopsy (TTNB) is often the first choice especially for peripheral nodules. For lesions for which TTNB could present technical difficulties or failed, other diagnostic strategies are needed. In this case, video-assisted thoracic surgery (VATS) is the gold standard to reach the diagnosis of lung nodules suspect of being malignant. Nonetheless it’s often not easy the identification of such lesions during VATS because of their little dimensions, non-firm consistency, deep localization. In literature various marking techniques have been described, in order to improve intraoperative nodules detection and to reduce conversion rate to thoracotomy: CT-guided hookwire positioning, methylene blue staining, intra-operative ultrasound and electromagnetic navigation bronchoscopy are the most used. The scientific evidence on this matter is weak because there are no randomized clinical trials but only case series on single techniques with no comparison on efficacy, so there are no guidelines to refer. From this standing, in this article we conducted a narrative review of the existing literature on the subject, with the aim of outlining a framework as complete as possible. We analyzed strengths and weaknesses of the main techniques reported, so as to allow the clinician to orient himself with greater ease.
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Affiliation(s)
- Andrea Imperatori
- Center for Thoracic Surgery and Center for Minimally Invasive Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Elisa Nardecchia
- Center for Thoracic Surgery and Center for Minimally Invasive Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Maria Cattoni
- Center for Thoracic Surgery and Center for Minimally Invasive Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Shehab Mohamed
- Thoracic Surgery and Lung Transplant Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Davide Di Natale
- Center for Thoracic Surgery and Center for Minimally Invasive Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Ilaria Righi
- Thoracic Surgery and Lung Transplant Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Mendogni
- Thoracic Surgery and Lung Transplant Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Cristina Diotti
- Thoracic Surgery and Lung Transplant Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Rotolo
- Center for Thoracic Surgery and Center for Minimally Invasive Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Lorenzo Dominioni
- Center for Thoracic Surgery and Center for Minimally Invasive Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Lorenzo Rosso
- Thoracic Surgery and Lung Transplant Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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15
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Cattoni M, Rotolo N, Nardecchia E, De Maio S, Dominioni L, Imperatori A. Energy devices safety and impact on video-assisted thoracoscopic lung lobectomy postoperative course: monopolar electrocautery versus ultrasonic dissector. J Cardiothorac Surg 2021; 16:40. [PMID: 33743749 PMCID: PMC7981968 DOI: 10.1186/s13019-021-01421-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 03/11/2021] [Indexed: 11/25/2022] Open
Abstract
Background This study aims to compare safety and impact of monopolar electrocautery and ultrasonic dissector (Harmonic ACE Plus®) on postoperative short-term outcomes after video-assisted thoracoscopic (VATS) lobectomy and lymphadenectomy for lung cancer. Methods We analyzed the prospectively collected data of 140 consecutive patients [59% male; median age: 71(IQR:62–76) years] undergoing VATS lobectomy and lymphadenectomy in our institution between October 2016 and November 2019. Patients were divided in two groups based on device used: monopolar electric hook in 79 cases (Group A); ultrasonic dissector in 61(Group B). Energy instrument-related intraoperative accidents, hemothorax/chylothorax incidence, total pleural effusion volume at 48 postoperative hours and chest tube duration were compared between groups. Multivariable analysis was performed to test energy device as possible independent risk factor either for increased pleural effusion volume or for prolonged chest tube duration. Results No intraoperative accidents due to energy device occurred. No hemothorax was recorded. Postoperative chylothorax incidence was slightly higher in Group A (2.5% vs 0%; p-value = 0.21). Total pleural effusion volume at 48 h was significantly higher in Group B: 400 (285–500) vs 255 (150–459) ml (p-value = 0.005). Chest tube duration was similar in the two groups: 5 (3–9) vs 5 (3–8) days (p-value = 0.77). At multivariable analysis the energy device used was not associated with increased pleural effusion volume (p-value = 0.43) nor with prolonged chest tube duration (p-value = 0.28). Conclusions Monopolar electrocautery and Harmonic ACE Plus® were safe and had a similar impact on short-term outcomes after VATS lobectomy and lymphadenectomy, suggesting that energy devices choice could be left to surgeon’s preference.
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Affiliation(s)
- Maria Cattoni
- Center for Thoracic Surgery and Center for Minimally Invasive Surgery, Department of Medicine and Surgery, University of Insubria, Via Guicciardini 9, 21100, Varese, Italy
| | - Nicola Rotolo
- Center for Thoracic Surgery and Center for Minimally Invasive Surgery, Department of Medicine and Surgery, University of Insubria, Via Guicciardini 9, 21100, Varese, Italy
| | - Elisa Nardecchia
- Center for Thoracic Surgery and Center for Minimally Invasive Surgery, Department of Medicine and Surgery, University of Insubria, Via Guicciardini 9, 21100, Varese, Italy
| | - Silvia De Maio
- Center for Thoracic Surgery and Center for Minimally Invasive Surgery, Department of Medicine and Surgery, University of Insubria, Via Guicciardini 9, 21100, Varese, Italy
| | - Lorenzo Dominioni
- Center for Thoracic Surgery and Center for Minimally Invasive Surgery, Department of Medicine and Surgery, University of Insubria, Via Guicciardini 9, 21100, Varese, Italy
| | - Andrea Imperatori
- Center for Thoracic Surgery and Center for Minimally Invasive Surgery, Department of Medicine and Surgery, University of Insubria, Via Guicciardini 9, 21100, Varese, Italy.
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Bertoglio P, Ventura L, Aprile V, Cattoni M, Nachira D, Lococo F, Rodriguez M, Guerrera F, Minervini F, Gnetti L, Bacchin D, Franzi F, Querzoli G, Rindi G, Bellafiore S, Femia F, Viti A, Kestenholz P, Ruffini E, Paci M, Margaritora S, Imperatori A, Lucchi M, Ampollini L, Terzi A. P08.01 Prognostic Impact of Second Predominant Pattern in Lung Adenocarcinoma: Analysis From a Large Multicentric European Database. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.420] [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: 11/29/2022]
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17
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Cattoni M, Rotolo N, Mastromarino MG, Cardillo G, Nosotti M, Mendogni P, Rizzi A, Raveglia F, Siciliani A, Rendina EA, Cagini L, Matricardi A, Filosso PL, Passone E, Margaritora S, Vita ML, Bertoglio P, Viti A, Imperatori A. Analysis of pneumothorax recurrence risk factors in 843 patients who underwent videothoracoscopy for primary spontaneous pneumothorax: results of a multicentric study. Interact Cardiovasc Thorac Surg 2021; 31:78-84. [PMID: 32353121 DOI: 10.1093/icvts/ivaa064] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 12/16/2019] [Revised: 02/20/2020] [Accepted: 03/03/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Risk factors for pneumothorax recurrence after videothoracoscopy for primary spontaneous pneumothorax are still being debated. The goal of this study was to assess whether the pleurodesis technique and other variables are possibly associated with the postoperative ipsilateral recurrence of pneumothorax. METHODS We retrospectively collected data of 1178 consecutive ≤40-year-old patients who underwent videothoracoscopy for primary spontaneous pneumothorax in 9 centres between 2007 and 2017. We excluded patients with hybrid pleurodesis and/or incomplete follow-up, leaving for analysis 843 cases [80% men; median age (interquartile range) 22 (18-28) years]. Univariable and multivariable analyses were performed by logistic regression and tested by Cox regression model to assess factors related to ipsilateral pneumothorax recurrence including age, gender, body mass index, smoking habit, cannabis smoking, respiratory comorbidity, dystrophic severity score, surgical indication, videothoracoscopy port number and side, lung resection, pleurodesis technique and postoperative prolonged air leak (>5 days). RESULTS Blebs/bullae resection was performed in 664 (79%) patients. Pleurodesis was achieved by partial pleurectomy in 228 (27%) cases; by pleural electrocauterization in 176 (21%); by pleural abrasion in 121 (14%); and by talc poudrage in 318 (38%). During a median follow-up period of 70.0 months (95% confidence interval 66.6-73.4), pneumothorax recurred in 79 patients (9.4%); among these, 29 underwent redo surgery; 34, chest drain/talc slurry; and 16, clinicoradiological observation. The only independent risk factor for recurrence was postoperative prolonged air leak (P < 0.001) that was significantly related to blebs/bullae resection (P = 0.03). CONCLUSIONS In this multicentric series, postoperative ipsilateral pneumothorax recurrence was remarkable and independently related to prolonged postoperative air leak; besides the retrospective study setting, the pleurodesis method did not have an impact on recurrence. To prevent prolonged air leak, blebs/bullae treatment should be accurate and performed only if indicated.
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Affiliation(s)
- Maria Cattoni
- Center for Thoracic Surgery and Center for Minimally Invasive Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Nicola Rotolo
- Center for Thoracic Surgery and Center for Minimally Invasive Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | | | - Giuseppe Cardillo
- Unit of Thoracic Surgery, Regional Hospital San Camillo-Forlanini, Rome, Italy
| | - Mario Nosotti
- Thoracic Surgery and Lung Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Mendogni
- Thoracic Surgery and Lung Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandro Rizzi
- Thoracic Surgery, ASST Santi Paolo e Carlo, Ospedale San Paolo, Milan, Italy
| | - Federico Raveglia
- Thoracic Surgery, ASST Santi Paolo e Carlo, Ospedale San Paolo, Milan, Italy
| | | | - Erino A Rendina
- Department of Thoracic Surgery, Sapienza University of Rome, Rome, Italy
| | - Lucio Cagini
- Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy
| | - Alberto Matricardi
- Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy
| | - Pier Luigi Filosso
- Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Erika Passone
- Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Stefano Margaritora
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Letizia Vita
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Pietro Bertoglio
- Division of Thoracic Surgery, IRCCS, Sacro Cuore-Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Andrea Viti
- Division of Thoracic Surgery, IRCCS, Sacro Cuore-Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Andrea Imperatori
- Center for Thoracic Surgery and Center for Minimally Invasive Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
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Cattoni M, Rotolo N, Mastromarino MG, Cardillo G, Nosotti M, Mendogni P, Rizzi A, Raveglia F, Siciliani A, Rendina EA, Cagini L, Matricardi A, Filosso PL, Passone E, Margaritora S, Vita ML, Bertoglio P, Viti A, Dominioni L, Imperatori A. Chronic chest pain and paresthesia after video-assisted thoracoscopy for primary pneumothorax. J Thorac Dis 2021; 13:613-620. [PMID: 33717534 PMCID: PMC7947510 DOI: 10.21037/jtd-20-2860] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Indexed: 12/01/2022]
Abstract
Background This study aims to identify clinical and surgical risk factors for chronic chest pain and paresthesia after video thoracoscopic surgery for primary spontaneous pneumothorax. Methods We retrospectively collected the data of 1,178 consecutive patients <40-years-old undergoing video thoracoscopic surgery for primary spontaneous pneumothorax in 9 Italian centers in 2007–2017. Cases with <2-month follow-up were excluded, leaving 920 patients [80% male; median age: 21 (IQR, 18–27) years] for statistical analysis. The following risk factors for chronic chest pain and chronic paresthesia were assessed by univariable and multivariable Cox regression model: age, gender, cannabis smoking, video thoracoscopy ports number, pleurodesis technique (partial pleurectomy/pleural electrocauterization/pleural abrasion/talc poudrage), chest tube size (24/28 F), postoperative chest tube stay. Results Blebs/bullae resection with pleurodesis was performed in 732 (80%) cases; pleurodesis alone in 188 (20%). During a median follow-up of 68 (IQR: 42–95) months, chronic chest pain developed in 8% of patients, chronic chest paresthesia in 22%; 0.5% of patients regularly assumed painkillers. Chronic chest pain was independently associated with partial pleurectomy/pleura abrasion (P<0.001) and postoperative chest tube stay (P=0.019). Chronic chest paresthesia was independently associated with pleurodesis by partial pleurectomy (P<0.001), chest tube stay (P=0.035) and 28 F chest tube (P<0.001). Conclusions After video thoracoscopic surgery for primary spontaneous pneumothorax, the incidence of chronic chest pain and paresthesia was significantly lower when pleurodesis was performed by pleural electrocauterization or talc poudrage, and chest tube was removed early. A 24 F chest tube was associated with lower risk of chronic chest paresthesia.
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Affiliation(s)
- Maria Cattoni
- Center for Thoracic Surgery and Center for Minimally Invasive Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Nicola Rotolo
- Center for Thoracic Surgery and Center for Minimally Invasive Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | | | - Giuseppe Cardillo
- Unit of Thoracic Surgery, Regional Hospital San Camillo-Forlanini, Rome, Italy
| | - Mario Nosotti
- Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Mendogni
- Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandro Rizzi
- Thoracic Surgery, ASST Santi Paolo e Carlo, Ospedale San Paolo, Milan, Italy
| | - Federico Raveglia
- Thoracic Surgery, ASST Santi Paolo e Carlo, Ospedale San Paolo, Milan, Italy
| | | | | | - Lucio Cagini
- Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy
| | - Alberto Matricardi
- Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy
| | - Pier Luigi Filosso
- Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Erika Passone
- Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Stefano Margaritora
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Letizia Vita
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Pietro Bertoglio
- Division of Thoracic Surgery, IRCCS, Sacro Cuore-Don Calabria Hospital, Negrar di Valpolicella,Verona, Italy
| | - Andrea Viti
- Division of Thoracic Surgery, IRCCS, Sacro Cuore-Don Calabria Hospital, Negrar di Valpolicella,Verona, Italy
| | - Lorenzo Dominioni
- Center for Thoracic Surgery and Center for Minimally Invasive Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Andrea Imperatori
- Center for Thoracic Surgery and Center for Minimally Invasive Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
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Giraldi L, Vecchioni A, Carioli G, Bilotta M, La Rosa S, Imperatori A, Volante M, Brizzi MP, Inzani F, Petrone G, Schinzari G, Bianchi A, Margaritora S, Alfieri S, La Vecchia C, Boccia S, Rindi G. Risk factors for pancreas and lung neuroendocrine neoplasms: a case-control study. Endocrine 2021; 71:233-241. [PMID: 32869113 PMCID: PMC7835148 DOI: 10.1007/s12020-020-02464-5] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/19/2020] [Indexed: 01/13/2023]
Abstract
PURPOSE Neuroendocrine neoplasia (NEN) has been displaying an incremental trend along the last two decades. This phenomenon is poorly understood, and little information is available on risk factor for neuroendocrine neoplasia development. Aim of this work is to elucidate the role of potentially modifiable risk factors for pancreatic and pulmonary NEN. METHODS We conducted a case-control study on 184 patients with NEN (100 pancreas and 84 lung) and 248 controls. The structured questionnaire included 84 queries on socio-demographic, behavioral, dietary and clinical information. RESULTS Increased risk was associated with history of cancer ("other tumor", lung OR = 7.18; 95% CI: 2.55-20.20 and pancreas OR = 5.88; 95% CI: 2.43-14.22; "family history of tumor", lung OR = 2.66; 95% CI: 1.53-4.64 and pancreas OR = 1.94; 95% CI: 1.19-3.17; "family history of lung tumor", lung OR = 2.56; 95% CI: 1.05-6.24 and pancreas OR = 2.60; 95% CI: 1.13-5.95). Type 2 diabetes mellitus associated with an increased risk of pancreatic NEN (OR = 3.01; 95% CI: 1.15-7.89). CONCLUSIONS Besides site-specific risk factors, there is a significant link between neuroendocrine neoplasia and cancer in general, pointing to a shared cancer predisposition.
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Affiliation(s)
- Luca Giraldi
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Alessia Vecchioni
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Greta Carioli
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Mirna Bilotta
- Section of Anatomic Pathology, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Stefano La Rosa
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
- Institute of Pathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Andrea Imperatori
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Marco Volante
- Department of Oncology, University of Turin at San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Maria Pia Brizzi
- Department of Oncology, University of Turin at San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Frediano Inzani
- Section of Anatomic Pathology, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Gianluigi Petrone
- Section of Anatomic Pathology, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Giovanni Schinzari
- Department of Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Antonio Bianchi
- Department of Endocrinology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Stefano Margaritora
- Department of Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Sergio Alfieri
- Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Stefania Boccia
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Roma, Italia
- Section of Hygiene, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Guido Rindi
- Section of Anatomic Pathology, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Roma, Italia.
- Section of Anatomic Pathology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia.
- Roma European NeuroEndocrine Tumor Society (ENETS) Center of Excellence, Roma, Italia.
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Rotolo N, Cattoni M, Nardecchia E, De Maio S, Franzi F, Pettenon F, Imperatori A. Surgical management of tracheal chondrosarcoma. Acta Chir Belg 2020; 122:361-365. [PMID: 33306456 DOI: 10.1080/00015458.2020.1863039] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 10/22/2022]
Abstract
Background: Tracheal chondrosarcoma is an extremely rare, slow-growing, malignant tumour. This study aims to analyze the cases of tracheal chondrosarcoma published in the literature and our case report, in order to better define tracheal chondrosarcoma management.Methods: A systematic review of the English literature was carried out for fully described tracheal chondrosarcoma cases. Additionally, we reported a new case of a 58-year-old man undergoing tracheal resection and reconstruction for tracheal chondrosarcoma.Results: To date, 30 cases were published. This tumour predominantly involved male patients (93%; median age: 65 years), generally conditioning dyspnoea and cough. Most of the patients underwent tracheal resection with end-to-end anastomosis, without recurrence (median follow-up: 2 years). Tumours endoscopically treated recurred in half cases.Conclusion: Tracheal resection is the treatment of choice for chondrosarcoma, with an excellent prognosis. Endoscopic treatment and/or radiotherapy should be indicated for patients unfit for surgery.
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Affiliation(s)
- Nicola Rotolo
- Research Center for Minimally Invasive Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Maria Cattoni
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Elisa Nardecchia
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Silvia De Maio
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Francesca Franzi
- Unit of Pathology, Department of Medicine and Surgery, University of Insubria, ASST Sette Laghi, Varese, Italy
| | - Fabiana Pettenon
- Unit of Pathology, Department of Medicine and Surgery, University of Insubria, ASST Sette Laghi, Varese, Italy
| | - Andrea Imperatori
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
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21
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Imperatori A, Fontana F, Dominioni L, Piacentino F, Macchi E, Castiglioni M, Desio M, Cattoni M, Nardecchia E, Rotolo N. Video-assisted thoracoscopic resection of lung nodules localized with a hydrogel plug. Interact Cardiovasc Thorac Surg 2019; 29:137-143. [PMID: 30793736 DOI: 10.1093/icvts/ivz030] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 09/03/2018] [Revised: 12/03/2018] [Accepted: 01/08/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Computed tomography (CT)-guided hydrogel plug deployment was recently proposed for lung nodule preoperative localization and simultaneous prevention of pneumothorax. We analysed our initial experience with CT-guided hydrogel plug localization of lung nodules in patients undergoing video-assisted thoracoscopic (VATS) resection. METHODS We retrospectively evaluated the medical notes from 27 consecutive patients (mean age 68 ± 11 SD years; men 74%) undergoing VATS lung wedge resection for biopsy or definitive treatment of 28 small pulmonary nodules (malignant 82%) at a single institution between October 2017 and July 2018. Difficult intraoperative nodule localization was anticipated with a lesion <10 mm, a depth from pleura:size ratio >1, ground-glass opacity or the judgement of the operating surgeon. All lesions were preoperatively marked by deployment of a CT-guided hydrogel plug. Study end points were frequency of postlocalization pneumothorax; feasibility of delayed surgery; rate of localization of intraoperative nodule and rate of successful VATS resection. RESULTS The mean sizes of the solid nodules (n = 24) and of the ground-glass opacities (n = 4) were, respectively, 10.4 ± 3.4 mm and 16.0 ± 6.2 mm. One (4%) hydrogel plug marking procedure caused a clinically relevant pneumothorax. Nodule resection was scheduled flexibly as required by patient management/operating room scheduling: same day (11 nodules) or delayed [median 6 days (range 1-60 days)]; (17 nodules). All nodules were localized intraoperatively: 25 (89%) by hydrogel plug; 3 (11%) by palpation and pleural puncture hole visible after plug displacement. All nodules were completely excised by VATS, without complications. CONCLUSIONS CT-guided hydrogel plug marking was valuable for VATS localization and resection of challenging lung nodules. The plug minimized clinically relevant pneumothoraxes and allowed flexible surgical schedules.
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Affiliation(s)
- Andrea Imperatori
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Federico Fontana
- Interventional Radiology, Department of Radiology, University of Insubria, Varese, Italy
| | - Lorenzo Dominioni
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Filippo Piacentino
- Interventional Radiology, Department of Radiology, University of Insubria, Varese, Italy
| | - Edoardo Macchi
- Interventional Radiology, Department of Radiology, University of Insubria, Varese, Italy
| | - Massimo Castiglioni
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Matteo Desio
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Maria Cattoni
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Elisa Nardecchia
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Nicola Rotolo
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
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22
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Cattoni M, Vallières E, Brown LM, Sarkeshik AA, Margaritora S, Siciliani A, Filosso PL, Guerrera F, Imperatori A, Rotolo N, Farjah F, Wandell G, Costas K, Mann C, Hubka M, Kaplan S, Farivar AS, Aye RW, Louie BE. Large Cell Neuroendocrine Tumor Size >3 cm Negatively Impacts Long-Term Outcomes After R0 Resection. World J Surg 2019; 43:1712-1720. [PMID: 30783763 DOI: 10.1007/s00268-019-04951-x] [Citation(s) in RCA: 5] [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: 01/17/2023]
Abstract
BACKGROUND Minimal knowledge exists regarding the outcome, prognosis and optimal treatment strategy for patients with pulmonary large cell neuroendocrine carcinomas (LCNEC) due to their rarity. We aimed to identify factors affecting survival and recurrence after resection to inform current treatment strategies. METHODS We retrospectively reviewed 72 patients who had undergone a curative resection for LCNEC in 8 centers between 2000 and 2015. Univariable and multivariable analyses were performed to identify the factors influencing recurrence, disease-specific survival and overall survival. These included age, gender, previous malignancy, ECOG performance status, symptoms at diagnosis, extent of resection, extent of lymphadenectomy, additional chemo- and/or radiotherapy, tumor location, tumor size, pT, pleural invasion, pN and pStage. RESULTS Median follow-up was 47 (95%CI 41-79) months; 5-year disease-specific and overall survival rates were 57.6% (95%CI 41.3-70.9) and 47.4% (95%CI 32.3-61.1). There were 22 systemic recurrences and 12 loco-regional recurrences. Tumor size was an independent prognostic factor for systemic recurrence [HR: 1.20 (95%CI 1.01-1.41); p = 0.03] with a threshold value of 3 cm (AUC = 0.71). For tumors ≤3 cm and >3 cm, 5-year freedom from systemic recurrence was 79.2% (95%CI 43.6-93.6) and 38.2% (95%CI 20.6-55.6) (p < 0.001) and 5-year disease-specific survival was 60.7% (95%CI 35.1-78.8) and 54.2% (95%CI 32.6-71.6) (p = 0.31), respectively. CONCLUSIONS A large proportion of patients with surgically resected LCNEC will develop systemic recurrence after resection. Patients with tumors >3 cm have a significantly higher rate of systemic recurrence suggesting that adjuvant chemotherapy should be considered after complete resection of LCNEC >3 cm, even in the absence of nodal involvement.
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Affiliation(s)
- Maria Cattoni
- Division of Thoracic Surgery, Swedish Cancer Institute, 1101 Madison Street, Suite 900, Seattle, WA, 98105, USA.,Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Ospedale di Circolo, 9 Via Guicciardini, 21100, Varese, Italy
| | - Eric Vallières
- Division of Thoracic Surgery, Swedish Cancer Institute, 1101 Madison Street, Suite 900, Seattle, WA, 98105, USA
| | - Lisa M Brown
- Section of General Thoracic Surgery, Department of Surgery, UC Davis Health, 2221 Stockton Boulevard, Room 2115, Sacramento, CA, 95817, USA
| | - Amir A Sarkeshik
- Section of General Thoracic Surgery, Department of Surgery, UC Davis Health, 2221 Stockton Boulevard, Room 2115, Sacramento, CA, 95817, USA
| | - Stefano Margaritora
- Unit of Thoracic Surgery, Catholic University 'Sacred Heart', 1 Largo Francesco Vito, 00168, Rome, Italy
| | - Alessandra Siciliani
- Unit of Thoracic Surgery, Catholic University 'Sacred Heart', 1 Largo Francesco Vito, 00168, Rome, Italy
| | - Pier Luigi Filosso
- Department of Thoracic Surgery, San Giovanni Battista Hospital, 3 Via Genova, 10126, Turin, Italy
| | - Francesco Guerrera
- Department of Thoracic Surgery, San Giovanni Battista Hospital, 3 Via Genova, 10126, Turin, Italy
| | - Andrea Imperatori
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Ospedale di Circolo, 9 Via Guicciardini, 21100, Varese, Italy
| | - Nicola Rotolo
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Ospedale di Circolo, 9 Via Guicciardini, 21100, Varese, Italy
| | - Farhood Farjah
- Division of Cardiothoracic Surgery, University of Washington Medical Center, 1959 NE Pacific Street, 3rd Floor, Seattle, WA, 98195, USA
| | - Grace Wandell
- Division of Cardiothoracic Surgery, University of Washington Medical Center, 1959 NE Pacific Street, 3rd Floor, Seattle, WA, 98195, USA
| | - Kimberly Costas
- Division of Thoracic Surgery, Providence Regional Medical Center, 1330 Rockefeller Avenue, Suite 400, Everett, WA, 98201, USA
| | - Catherine Mann
- Division of Thoracic Surgery, Swedish Cancer Institute, 1101 Madison Street, Suite 900, Seattle, WA, 98105, USA
| | - Michal Hubka
- Division of Thoracic Surgery, Virginia Mason Hospital & Seattle Medical Center, 1100 9th Avenue, Seattle, WA, 98101, USA
| | - Stephen Kaplan
- Division of Thoracic Surgery, Virginia Mason Hospital & Seattle Medical Center, 1100 9th Avenue, Seattle, WA, 98101, USA
| | - Alexander S Farivar
- Division of Thoracic Surgery, Swedish Cancer Institute, 1101 Madison Street, Suite 900, Seattle, WA, 98105, USA
| | - Ralph W Aye
- Division of Thoracic Surgery, Swedish Cancer Institute, 1101 Madison Street, Suite 900, Seattle, WA, 98105, USA
| | - Brian E Louie
- Division of Thoracic Surgery, Swedish Cancer Institute, 1101 Madison Street, Suite 900, Seattle, WA, 98105, USA.
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23
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Coelho M, Imperatori A, Chiaravalli AM, Franzi F, Castiglioni M, Rasini E, Luini A, Legnaro M, Marino F, Ribeiro L, Cosentino M. Beta1- and Beta2-Adrenoceptors Expression Patterns in Human Non-small Cell Lung Cancer: Relationship with Cancer Histology. J Neuroimmune Pharmacol 2019; 14:697-708. [PMID: 31620969 DOI: 10.1007/s11481-019-09879-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 08/27/2019] [Indexed: 02/04/2023]
Abstract
Assessment of Beta-AR protein expression on tumour tissues might be a plausible strategy to select cancer patients who can benefit from Beta-blockers therapy. The aim of this study is to evaluate the differences between resected tissue specimens from primary lung cancer (adenocarcinoma (ADC) and squamous cell carcinoma (SCC)) in terms of expression pattern of Beta1- and Beta2-AR in both tumour and adjacent surrounding non-tumour tissue. This retrospective study was based on the analysis of 80 patients with histologically confirmed diagnosis of primary Non-Small Cell Lung Cancer (NSCLC) who received surgical treatment. The cases were carefully selected in order to obtain the most homogeneous sample in terms of histologic subtype (40 ADCs and 40 SCCs) and clinical stage (10 each). Beta1- and Beta2-AR expression was determined by immunohistochemistry and the staining evaluated by semi-quantitative scoring using the H-score method. In our NSCLC series, Beta1- and Beta2-AR are differentially expressed. Beta1-AR expression is present at low levels in both SCC and ADC. Likewise, when compared with the matched surrounding non-tumour tissues, Beta1-AR expression level was significantly lower in both histologic subtypes. Conversely, Beta2-AR is highly expressed in both histologic subtypes, but clearly highly expressed in ADC when compared with SCC and with their matched surrounding non-tumour tissue. Overall, this clinicopathological study highlights the differential expression of Beta1- and Beta2-AR in ADC and SCC. Repurposing non-selective Beta-blockers in oncologic setting might be a suitable therapeutic strategy for lung ADC. Graphical abstract.
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MESH Headings
- A549 Cells
- Adrenergic beta-1 Receptor Agonists/pharmacology
- Adrenergic beta-2 Receptor Agonists/pharmacology
- Aged
- Biomarkers, Tumor/biosynthesis
- Biomarkers, Tumor/genetics
- Carcinoma, Non-Small-Cell Lung/genetics
- Carcinoma, Non-Small-Cell Lung/metabolism
- Carcinoma, Non-Small-Cell Lung/pathology
- Dose-Response Relationship, Drug
- Female
- Gene Expression Regulation, Enzymologic/drug effects
- Humans
- Lung Neoplasms/genetics
- Lung Neoplasms/metabolism
- Lung Neoplasms/pathology
- Male
- Middle Aged
- Receptors, Adrenergic, beta-1/biosynthesis
- Receptors, Adrenergic, beta-1/genetics
- Receptors, Adrenergic, beta-2/biosynthesis
- Receptors, Adrenergic, beta-2/genetics
- Retrospective Studies
- S Phase/drug effects
- S Phase/physiology
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Affiliation(s)
- Marisa Coelho
- Department of Biomedicine, Unit of Biochemistry, Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, s/n, 4200-450, Porto, Portugal.
- I3S - Instituto de Investigação e Inovação em Saúde, University of Porto, Rua Alfredo Allen, 4200-135, Porto, Portugal.
- Center of Research in Medical Pharmacology, University of Insubria, Via Monte Generoso 71, 21100, Varese, Italy.
| | - Andrea Imperatori
- Center for Thoracic Surgery, Department of Medicine and Surgery, ASST Sette Laghi, University of Insubria, via Guicciardini 9, 21100, Varese, Italy
| | - Anna Maria Chiaravalli
- Unit of Pathology, Department of Medicine and Surgery, ASST Sette Laghi, University of Insubria, via Rossi 9, 21100, Varese, Italy
| | - Francesca Franzi
- Unit of Pathology, Department of Medicine and Surgery, ASST Sette Laghi, University of Insubria, via Rossi 9, 21100, Varese, Italy
| | - Massimo Castiglioni
- Center for Thoracic Surgery, Department of Medicine and Surgery, ASST Sette Laghi, University of Insubria, via Guicciardini 9, 21100, Varese, Italy
| | - Emanuela Rasini
- Center of Research in Medical Pharmacology, University of Insubria, Via Monte Generoso 71, 21100, Varese, Italy
| | - Alessandra Luini
- Center of Research in Medical Pharmacology, University of Insubria, Via Monte Generoso 71, 21100, Varese, Italy
| | - Massimiliano Legnaro
- Center of Research in Medical Pharmacology, University of Insubria, Via Monte Generoso 71, 21100, Varese, Italy
| | - Franca Marino
- Center of Research in Medical Pharmacology, University of Insubria, Via Monte Generoso 71, 21100, Varese, Italy
| | - Laura Ribeiro
- Department of Biomedicine, Unit of Biochemistry, Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, s/n, 4200-450, Porto, Portugal
- I3S - Instituto de Investigação e Inovação em Saúde, University of Porto, Rua Alfredo Allen, 4200-135, Porto, Portugal
| | - Marco Cosentino
- Center of Research in Medical Pharmacology, University of Insubria, Via Monte Generoso 71, 21100, Varese, Italy
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24
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Bertoglio P, Cattoni M, Nachira D, Lococo F, Aprile V, Rodriguez M, Guerrera F, Franzi F, Viti A, Bellafiore S, Rindi G, Bacchin D, Lozano Escario M, Femia F, Querzoli G, Tobar LG, Ruffini E, Paci M, Margaritora S, Lucchi M, Imperatori A, Terzi A. P2.17-29 Impact of Second Predominant Pattern on Recurrence in Early Stage Resected Lung Adenocarcinoma: A Multicentric Study. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1940] [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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25
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D'Antona P, Cattoni M, Dominioni L, Poli A, Moretti F, Cinquetti R, Gini E, Daffrè E, Noonan DM, Imperatori A, Rotolo N, Campomenosi P. Serum miR-223: A Validated Biomarker for Detection of Early-Stage Non-Small Cell Lung Cancer. Cancer Epidemiol Biomarkers Prev 2019; 28:1926-1933. [PMID: 31488416 DOI: 10.1158/1055-9965.epi-19-0626] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/15/2019] [Accepted: 08/23/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The published circulating miRNA signatures proposed for early-stage non-small cell lung cancer (NSCLC) detection are inconsistent and difficult to replicate. Reproducibility and validation of an miRNA simple signature of NSCLC are prerequisites for translation to clinical application. METHODS The serum level of miR-223 and miR-29c, emerging from published studies, respectively, as a highly sensitive and a highly specific biomarker of early-stage NSCLC, was measured with droplet digital PCR (ddPCR) technique in an Italian cohort of 75 patients with stage I-II NSCLC and 111 tumor-free controls. By ROC curve analysis we evaluated the miR-223 and miR-29c performance in discerning NSCLC cases from healthy controls. RESULTS Reproducibility and robust measurability of the two miRNAs using ddPCR were documented. In a training set (40 stage I-II NSCLCs and 56 controls), miR-223 and miR-29c, respectively, showed an AUC of 0.753 [95% confidence interval (CI), 0.655-0.836] and 0.632 (95% CI, 0.527-0.729) in identifying NSCLC. Combination of miR-223 with miR-29c yielded an AUC of 0.750, not improved over that of miR-223 alone. Furthermore, in an independent blind set (35 stage I-II NSCLCs and 55 controls), we validated serum miR-223 as an effective biomarker of stage I-II NSCLC (AUC = 0.808; 95% CI, 0.712-0.884), confirming the miR-223 diagnostic performance reported by others in Chinese cohorts. CONCLUSIONS Using ddPCR technology, miR-223 was externally validated as a reproducible, effective serum biomarker of early-stage NSCLC in ethnically different subjects. Combination with miR-29c did not improve the miR-223 diagnostic performance. IMPACT Serum miR-223 determination may be proposed as a tool for refining NSCLC risk stratification, independent of smoking habit and age.
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Affiliation(s)
- Paola D'Antona
- Department of Biotechnology and Life Sciences, DBSV, University of Insubria, Varese, Italy
| | - Maria Cattoni
- Department of Biotechnology and Life Sciences, DBSV, University of Insubria, Varese, Italy.,Department of Medicine and Surgery, DMS, Center for Thoracic Surgery, University of Insubria, Varese, Italy
| | - Lorenzo Dominioni
- Department of Medicine and Surgery, DMS, Center for Thoracic Surgery, University of Insubria, Varese, Italy
| | - Albino Poli
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Francesca Moretti
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Raffaella Cinquetti
- Department of Biotechnology and Life Sciences, DBSV, University of Insubria, Varese, Italy
| | - Elisabetta Gini
- Department of Biotechnology and Life Sciences, DBSV, University of Insubria, Varese, Italy
| | - Elisa Daffrè
- Department of Medicine and Surgery, DMS, Center for Thoracic Surgery, University of Insubria, Varese, Italy
| | - Douglas M Noonan
- Department of Biotechnology and Life Sciences, DBSV, University of Insubria, Varese, Italy.,Scientific and Technological Pole, IRCCS MultiMedica, Milan, Italy
| | - Andrea Imperatori
- Department of Medicine and Surgery, DMS, Center for Thoracic Surgery, University of Insubria, Varese, Italy
| | - Nicola Rotolo
- Department of Medicine and Surgery, DMS, Center for Thoracic Surgery, University of Insubria, Varese, Italy
| | - Paola Campomenosi
- Department of Biotechnology and Life Sciences, DBSV, University of Insubria, Varese, Italy.
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26
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Cattoni M, Vallières E, Brown LM, Sarkeshik AA, Margaritora S, Siciliani A, Filosso PL, Guerrera F, Imperatori A, Rotolo N, Farjah F, Wandell G, Costas K, Mann C, Hubka M, Kaplan S, Farivar AS, Aye RW, Louie BE. Sublobar Resection in the Treatment of Peripheral Typical Carcinoid Tumors of the Lung. Ann Thorac Surg 2019; 108:859-865. [DOI: 10.1016/j.athoracsur.2019.04.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 02/17/2019] [Accepted: 04/01/2019] [Indexed: 10/26/2022]
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27
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Russo P, Andria G, Baldinelli A, Boffi ML, Cerini E, Della Casa R, Imperatori A, Luciani GB, Morra E, Parini R, Pieroni M, Prioli MA, Ragni L, Rapezzi C, Rinelli G, Rubino M, Sarais C, Sciacca P, Seddio F, Limongelli G. [Cardiologists and mucopolysaccharidoses. Recommendations of GICEM (Cardiology Experts on Metabolic Disease Italian Group) for diagnosis, follow-up and cardiological management]. G Ital Cardiol (Rome) 2019; 18:638-649. [PMID: 28845875 DOI: 10.1714/2741.27947] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Mucopolysaccharidoses (MPS) represent a group of rare lysosomal storage disorders, with a heterogeneous clinical presentation in terms of inheritance (autosomal and X-linked recessive), age of onset (infants, children, and adults), systemic and cardiac manifestations (mild to severe disease forms). Evidence-based recommendations on the diagnosis and management of cardiovascular disease in MPS are scarce. GICEM (Gruppo Italiano Cardiologi Esperti Malattie Metaboliche) is a group of cardiologists, cardiac surgeons and pediatricians with a specific expertise in metabolic diseases including MPS. In this paper, we report our experience and recommendations on the diagnosis and management of cardiovascular aspects in MPS, with a tailored approach based on current evidence, and taking into account MPS phenotype (particularly, I, II, IVa, VI), age at presentation, and severity of systemic and cardiac manifestations.
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Affiliation(s)
- Pierluigi Russo
- U.O. Assistenza Specialistica, Distretto Socio-Sanitario Trani-Bisceglie, Ambulatorio di Cardiologia Pediatrica e delle Cardiopatie Congenite e Genetiche nell'Adulto, Trani (BT) - GICEM Core Writers Cardiologi
| | - Generoso Andria
- Sezione di Pediatria, Dipartimento di Scienze Mediche Traslazionali, Università degli Studi "Federico II", Napoli - GICEM Core Writers Metabolisti
| | - Alessandra Baldinelli
- S.O.D. Cardiochirurgia e Cardiologia Pediatrica e dei Congeniti, Azienda Ospedaliera Universitaria, Ospedali Riuniti di Ancona, Ancona - GICEM Core Writers Cardiologi
| | - Maria Lucia Boffi
- U.O. Cardiologia, A.O. San Gerardo, Monza (MB) - GICEM Core Writers Cardiologi
| | - Emma Cerini
- Servizio di Ecocardiografia Neonatale e Pediatrica, A.O. Carlo Poma, Mantova
| | - Roberto Della Casa
- Sezione di Pediatria, Dipartimento di Scienze Mediche Traslazionali, Università degli Studi "Federico II", Napoli
| | | | - Giovanni Battista Luciani
- U.O. Cardiochirurgia, Dipartimento di Scienze Chirurgiche Odontostomatologiche e Materno-Infantili, Università degli Studi, Verona
| | - Elisa Morra
- Divisione di Cardiologia, Azienda Sanitaria dell'Alto Adige, Merano, Provincia Autonoma Bolzano-Alto Adige
| | - Rossella Parini
- U.O.S. Malattie Metaboliche Rare, Clinica Pediatrica, A.O. San Gerardo, Monza (MB) - GICEM Core Writers Metabolisti
| | | | | | - Luca Ragni
- U.O. Cardiologia Pediatrica e dell'Età Evolutiva, Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università degli Studi, Bologna
| | - Claudio Rapezzi
- U.O. Cardiologia, Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università degli Studi, Bologna
| | | | - Marta Rubino
- U.O. Cardiologia SUN, Dipartimento di Scienze Cardiotoraciche e Respiratorie, AO. dei Colli, Napoli
| | - Cristiano Sarais
- U.O. Cardiologia, Azienda Ospedaliera Universitaria di Padova, Padova
| | - Pietro Sciacca
- Ambulatorio Cardiovascolare Pediatrico, U.O. Broncopneumologia Pediatrica, Università degli Studi, Catania - GICEM Core Writers Cardiologi
| | | | - Giuseppe Limongelli
- U.O. Cardiologia Pediatrica e U.O. di Riabilitazione e Scompenso Cardiaco, Ospedale Monaldi, A.O. dei Colli, Dipartimento di Scienze Cardio-Toraciche e Respiratorie, Seconda Università degli Studi, Napoli - GICEM Core Writers Cardiologi
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28
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La Rosa S, Volante M, Uccella S, Maragliano R, Rapa I, Rotolo N, Inzani F, Siciliani A, Granone P, Rindi G, Dominioni L, Capella C, Papotti M, Sessa F, Imperatori A. ACTH-producing tumorlets and carcinoids of the lung: clinico-pathologic study of 63 cases and review of the literature. Virchows Arch 2019; 475:587-597. [PMID: 31264037 DOI: 10.1007/s00428-019-02612-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 05/31/2019] [Accepted: 06/20/2019] [Indexed: 12/17/2022]
Abstract
Adrenocorticotropic hormone (ACTH)-secreting lung carcinoids represent the principal cause of ectopic Cushing syndrome, but the prevalence of ACTH expression and the association between ACTH production and Cushing syndrome in lung carcinoids have scarcely been investigated. In addition, available information on the prognostic meaning of ACTH production is controversial. The aims of this multicentric retrospective study, also including a review of the literature, were to describe the clinico-pathologic features of ACTH-producing lung carcinoids, to assess recurrence and specific survival rates, and to evaluate potential prognostic factors. To identify ACTH production in 254 unselected and radically resected lung carcinoids, we used a double approach including RT-PCR (mRNA encoding for pro-opiomelanocortin) and immunohistochemistry (antibodies against ACTH and β-endorphin). Sixty-three (24.8%) tumors produced ACTH and 11 of them (17.4%), representing 4.3% of the whole series, were associated with Cushing syndrome. The median follow-up time was 71 months. The 10-year overall and specific survival rates were 88.5% and 98.2%, respectively, with difference neither between functioning and nonfunctioning tumors nor between ACTH-positive and ACTH-negative carcinoids. At univariate analysis, histological type (typical or atypical) and Ki67 index significantly correlated with tumor recurrence. The literature review identified 172 previously reported patients with functioning ACTH-secreting lung carcinoids, and the meta-analysis of survival showed that 92% of them were alive after a mean follow-up time of 50 months. Our results demonstrate that ACTH-producing lung carcinoids are not rare, are not always associated with Cushing syndrome, and do not represent an aggressive variant of lung carcinoid.
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Affiliation(s)
- Stefano La Rosa
- Institute of Pathology, University Hospital and University of Lausanne, Lausanne, Switzerland.
- Institut Universitaire de Pathologie, CHUV, 25 rue du Bugnon, 1011, Lausanne, Switzerland.
| | - Marco Volante
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Italy
| | - Silvia Uccella
- Pathology Unit, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Roberta Maragliano
- Pathology Unit, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Ida Rapa
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Italy
| | - Nicola Rotolo
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Frediano Inzani
- UOC Ginecopatologia e Patologia Mammaria, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandra Siciliani
- UOC Chirurgia Toracica, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
- Division of Thoracic Surgery, Sant'Andrea Hospital, Faculty of Medicine and Psychology, University of Rome 'Sapienza', Rome, Italy
| | - Pierluigi Granone
- UOC Chirurgia Toracica, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Guido Rindi
- UOC Anatomia Patologica, Fondazione Policlinico Universitario A. Gemelli IRCCS- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lorenzo Dominioni
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Carlo Capella
- Pathology Unit, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Mauro Papotti
- Department of Oncology, City of Health and Science, University of Turin, Torino, Italy
| | - Fausto Sessa
- Pathology Unit, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Andrea Imperatori
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
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29
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Miyazaki T, Imperatori A, Jimenez M, Drosos P, Gomez-Hernandez MT, Varela G, Novoa N, Nagayasu T, Brunelli A. An aggregate score to stratify the technical complexity of video-assisted thoracoscopic lobectomy. Interact Cardiovasc Thorac Surg 2019; 28:728-734. [PMID: 30500910 DOI: 10.1093/icvts/ivy319] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 10/03/2018] [Accepted: 10/14/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The purpose of this study was to develop a score to predict the complexity of video-assisted thoracoscopic surgery (VATS) lobectomies preoperatively. METHODS One hundred and thirty-nine consecutive patients undergoing VATS lobectomy operated on by a single surgeon as the first operator were included. Complex operations were defined as: operation time >180 min (corresponding to the 75th percentile) or a conversion to thoracotomy. Several patient-related baseline and radiological variables were tested for a possible association with surgical complexity by logistic regression analysis. An aggregate score was created by weighing the regression estimates of the significant predictors. Patients were then grouped in classes of risk according to their scores. Finally, the score was validated in an external population of 154 VATS lobectomy patients. RESULTS Twenty-nine VATS lobectomies (21%) were classified as complex. The following variables were found to be significantly associated with a complex operation and were used to calculate the risk score in each patient (1 point each): male (P = 0.006), presence of thick pleura (P = 0.003), presence of emphysema (P = 0.001), enlarged hilar nodes (P = 0.003). Patients were grouped in 4 classes showing an incremental incidence of complex operations (P < 0.0001): score 0, 7.4%; score 1, 18%; score 2, 27%; score >2, 67%. In the external validation set, the score confirmed its association with the incidence of complex operations (P < 0.001): score 0, 7.3%; score 1, 10%; score 2, 16%; score >2 50%. CONCLUSIONS The complexity score appeared to be reproducible in an external setting and can be used to preoperatively identify appropriate candidates for VATS lobectomies to improve the efficiency and safety of the training phase.
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Affiliation(s)
- Takuro Miyazaki
- Department of Thoracic Surgery, The Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Andrea Imperatori
- Department of Thoracic Surgery, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Marcelo Jimenez
- Department of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
| | - Polivios Drosos
- Department of Thoracic Surgery, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Gonzalo Varela
- Department of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
| | - Nuria Novoa
- Department of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
| | - Takeshi Nagayasu
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Alessandro Brunelli
- Department of Thoracic Surgery, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
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30
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Rotolo N, Cattoni M, D'Andria M, Cavanna L, Patrizio G, Imperatori A, Nicolini A. Comparison of an expiratory flow accelerator device versus positive expiratory pressure for tracheobronchial airway clearance after lung cancer lobectomy: a preliminary study. Physiotherapy 2019; 110:34-41. [PMID: 33563372 DOI: 10.1016/j.physio.2019.01.011] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 01/06/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE A new type of device has recently been introduced in chest physiotherapy as an aid to tracheo-bronchial airway clearance: expiratory flow accelerator (EFA). It promotes mucus clearance without generating any pressure gradient, allowing patients to breathe at tidal volume against no resistance. DESIGN Pilot randomized controlled study. SETTING Tertiary hospital. PARTICIPANTS Fifty adult patients who underwent lung cancer lobectomy were randomized to undergo chest physiotherapy with EFA (n=26) or PEP (n=24). INTERVENTIONS EFA; PEP bottle. MAIN OUTCOMES Incidence of postoperative pulmonary complications (PPC) and length of stay. SECONDARY OUTCOMES trends in inspiratory capacity, respiratory rate, oxygen saturation, and dyspnoea. Patients rated user-friendliness of the two devices on a 5-point Likert scale. RESULTS A slightly different incidence of PPCs was observed between the EFA and PEP group. Nevertheless, the length of stay was similar in the two groups. No substantial differences were seen in trends of inspiratory capacity, respiratory rate, oxygen saturation, dyspnoea between the two groups. Patient-reported user-friendliness of the two devices did not differ significantly, although the use of the EFA device appeared less strenuous. CONCLUSIONS Results of this pilot study point to the use of EFA as an alternative treatment option rather than as a replacement for the PEP bottle in chest physiotherapy following lung cancer lobectomy. EFA may be preferable for weaker patients and/or with airway leakages in whom PEP has limited indications. Further investigation in a larger sample is required to statistically confirm the findings. Clinical Trial Registration Number ChiCTR-ONC-17013255.
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Affiliation(s)
- Nicola Rotolo
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Maria Cattoni
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Michele D'Andria
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Laura Cavanna
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Giorgia Patrizio
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Andrea Imperatori
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
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Li S, Han Z, He J, Gao S, Liu D, Liu L, He J, Huang Y, Xu S, Mao W, Tan Q, Chen C, Li X, Zhang Z, Jiang G, Xu L, Zhang L, Fu J, Li H, Wang Q, Tan L, Li D, Zhou Q, Fu X, Jiang Z, Chen H, Fang W, Zhang X, Li Y, Tong T, Yu Z, Liu Y, Zhi X, Yan T, Zhang X, Imperatori A, Ibrahim M, Novoa NM, Ng CSH, Petersen RH, Chen JS, Fukuchi Y, Brunelli A, Ismail M, Valverde JA, Rodriguez-Lucas C. Society for Translational Medicine expert consensus on the use of antibacterial drugs in thoracic surgery. J Thorac Dis 2019; 10:6356-6374. [PMID: 30622808 DOI: 10.21037/jtd.2018.10.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Shanqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Zhijun Han
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Jie He
- Department of Thoracic Surgical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; National Cancer Center, Beijing 100021, China
| | - Shugeng Gao
- Department of Thoracic Surgical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; National Cancer Center, Beijing 100021, China
| | - Deruo Liu
- Department of Thoracic Surgery, China and Japan Friendship Hospital, Beijing 100096, China
| | - Lunxu Liu
- Department of Cardiovascular and Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jianxing He
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510230, China.,Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Yunchao Huang
- Department of Thoracic and Cardiovascular Surgery, The Third Affiliated Hospital of Kunming Medical University (Yunnan Tumor Hospital), Kunming 650118, China
| | - Shidong Xu
- Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, Harbin 150086, China
| | - Weimin Mao
- Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Qunyou Tan
- Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing 400042, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Xiaofei Li
- Department of Thoracic Surgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an 710038, China
| | - Zhu Zhang
- Department of Thoracic Surgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital of Tongji University, Shanghai 200433, China
| | - Lin Xu
- Department of Thoracic Surgery, Nanjing Medical University Affiliated Cancer Hospital, Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Cancer Institute of Jiangsu Province, Nanjing 210009, China
| | - Lanjun Zhang
- Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China
| | - Jianhua Fu
- Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China
| | - Hui Li
- Department of Thoracic Surgery, Beijing Chao-Yang Hospital, Beijing 100020, China
| | - Qun Wang
- Department of Thoracic Surgery, Shanghai Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Lijie Tan
- Department of Thoracic Surgery, Shanghai Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Danqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Qinghua Zhou
- Department of Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xiangning Fu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zhongmin Jiang
- Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan 250014, China
| | - Haiquan Chen
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Xun Zhang
- Tianjin Chest Hospital, Tianjin 300051, China
| | - Yin Li
- Department of Thoracic Surgery, Henan Cancer Hospital, Zhengzhou 450008, China
| | - Ti Tong
- Department of Thoracic Surgery, Second Hospital of Jilin University, Changchun 130041, China
| | - Zhentao Yu
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - Yongyu Liu
- Department of Thoracic Surgery, Liaoning Cancer Hospital and Institute, Shenyang 110042, China
| | - Xiuyi Zhi
- Department of Thoracic Surgery, Xuanwu Hospital of Capital Medical University, Beijing 100053, China
| | - Tiansheng Yan
- Department of Thoracic Surgery, Peking University Third Hospital, Beijing 100083, China
| | - Xingyi Zhang
- Department of Thoracic Surgery, The Second Hospital of Jilin University, Changchun 130041, China
| | - Andrea Imperatori
- Center for Thoracic Surgery, Department of Medicine and Surgery, School of Medicine, University of Insubria, Varese, Italy
| | - Mohsen Ibrahim
- Division of Thoracic Surgery, Faculty of Medicine and Psychology, Sant'Andrea Hospital, University of Rome 'Sapienza', Rome, Italy
| | - Nuria M Novoa
- Thoracic Surgery Service, University Hospital of Salamanca, 37007 Salamanca, Spain
| | - Calvin Sze Hang Ng
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China
| | - René Horsleben Petersen
- Department of Cardiothoracic Surgery, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Jin-Shing Chen
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, 10002, Taipei
| | | | | | - Mahmoud Ismail
- Department of Thoracic Surgery, Klinikum Ernst von Bergmann, Potsdam, Germany.,Academic Hospital of the Charité-Universitätsmedizin, Humboldt University Berlin, Berlin, Germany
| | - Javier Aragón Valverde
- Departament of Thoracic Surgery, Asturias University Central Hospital, Oviedo, Asturias, Spain
| | - Carlos Rodriguez-Lucas
- Department of Microbiology, Asturias University Central Hospital, Oviedo, Asturias, Spain
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Brunelli A, Pompili C, Dinesh P, Bassi V, Imperatori A. Financial validation of the European Society of Thoracic Surgeons risk score predicting prolonged air leak after video-assisted thoracic surgery lobectomy. J Thorac Cardiovasc Surg 2018; 156:1224-1230. [DOI: 10.1016/j.jtcvs.2018.04.085] [Citation(s) in RCA: 10] [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: 11/30/2017] [Revised: 04/17/2018] [Accepted: 04/18/2018] [Indexed: 11/16/2022]
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Pompili C, Koller M, Velikova G, Franks K, Absolom K, Callister M, Robson J, Imperatori A, Brunelli A. EORTC QLQ-C30 summary score reliably detects changes in QoL three months after anatomic lung resection for Non-Small Cell Lung Cancer (NSCLC). Lung Cancer 2018; 123:149-154. [PMID: 30089587 DOI: 10.1016/j.lungcan.2018.07.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [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: 01/04/2018] [Revised: 05/14/2018] [Accepted: 07/16/2018] [Indexed: 11/15/2022]
Abstract
INTRODUCTION We tested the European Organization for Research and Treatment of Cancer Quality of Life (EORTC QLQ-C30) summary score (SumSC) to detect changes in the HRQOL after Non-small-cell lung cancer (NSCLC) surgery and compared its performance to the traditional scales. METHOD EORTC QLQ-C30 data was obtained from 326 consecutive pre-operative patients submitted for anatomical lung resections for NSCLC.66 patients completed post-operative assessments 3 months after surgery. The data was analysed to evaluate the ability of the SumSC compared to the traditional scales to [1] preoperatively differentiate between clinical groups [2]; detect post-op changes and to [3] compare pre and post-op changes in clinically different groups.The importance of perioperative changes was measured by calculating the effect size (ES). RESULTS Of the 326 patients, those older than 70 years, with higher DLCO value and Performance Status (PS) ≤1 had a significantly better preoperative SumScore. Physical function (PF) showed a large and significant decline (ES 0.91). Role and social function also showed a significant and medium decline (ES 0.62 and 0.41). Postoperatively some symptoms scales showed significant increases in the values, implying worse symptoms with the largest increase in dyspnoea (ES -0.88). The change in General Health score (GH) was not significant after surgery (ES 0.26, p = 0.062). The SumSc, decreased significantly postoperatively. In particular, medium or large postoperative declines of SumSc were observed in both males and females, in patients with lower FEV1, lower performance score, and in those older than 70 years. Interestingly the decline of SumSc was observed irrespective of the preoperative DLCO level. DISCUSSION The Summary Score was more sensitive to changes in subjects' HRQOL, than the GH score. The SumSc can be used as a parsimonious and easy to interpreted patient-reported-outcome measure in multi-institutional database and future clinical trials.
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Affiliation(s)
- Cecilia Pompili
- Section of Patient Centered Outcomes Research, Leeds Institute of Cancer and Pathology, University of Leeds, UK.
| | - Michael Koller
- Centre for Clinical Studies, University Hospital Regensburg, Germany
| | - Galina Velikova
- Section of Patient Centered Outcomes Research, Leeds Institute of Cancer and Pathology, University of Leeds, UK
| | - Kevin Franks
- Department of Clinical Oncology, St. James's University Hospital, Leeds, UK
| | - Kate Absolom
- Section of Patient Centered Outcomes Research, Leeds Institute of Cancer and Pathology, University of Leeds, UK
| | - Matthew Callister
- Department of Respiratory Medicine, St. James's University Hospital, Leeds, UK
| | - Jonathan Robson
- Department of Respiratory Medicine, St. James's University Hospital, Leeds, UK
| | - Andrea Imperatori
- Department of Thoracic Surgery St. James's University Hospital, Leeds, UK
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Rotolo N, Cattoni M, La Rosa S, Imperatori A. A Rare Case of Incidental Tracheal Lipoma. Arch Bronconeumol 2018; 54:630-632. [PMID: 29803520 DOI: 10.1016/j.arbres.2018.02.023] [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] [Received: 11/17/2017] [Revised: 02/27/2018] [Accepted: 02/28/2018] [Indexed: 10/16/2022]
Affiliation(s)
- Nicola Rotolo
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy.
| | - Maria Cattoni
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Stefano La Rosa
- Service of Clinical Pathology, Institute of Pathology, Lausanne University Hospital, Lausanne, Switzerland
| | - Andrea Imperatori
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
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35
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Affiliation(s)
| | - Andrea Imperatori
- Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK
| | - Andrea Droghetti
- Department of Thoracic Surgery, Carlo Poma Hospital, Mantova, Italy
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36
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Brunelli A, Imperatori A, Droghetti A. Enhanced recovery pathways version 2.0 in thoracic surgery. J Thorac Dis 2018. [DOI: 10.21037/jtd.2017.12.8] [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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37
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Imperatori A, Cattoni M, Nardecchia E, Rotolo N. A 90-day mortality risk model as a support in managing patients undergoing video-assisted thoracic surgery for lung cancer. Video-assist Thorac Surg 2018. [DOI: 10.21037/vats.2018.03.02] [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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38
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La Rosa S, Simbolo M, Franzi F, Uccella S, Imperatori A, Nardecchia E, Rotolo N, Dominioni L, Scarpa A, Sessa F. Combined adenocarcinoma–atypical carcinoid of the lung. Targeted Next-Generation Sequencing (NGS) suggests a monoclonal origin of the two components. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.mpdhp.2018.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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39
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Guerrera F, Filosso PL, Pompili C, Olivetti S, Roffinella M, Imperatori A, Brunelli A. Application of the coaxial smart drain in patients with a large air leak following anatomic lung resection: a prospective multicenter phase II analysis of efficacy and safety. J Vis Surg 2018; 4:26. [PMID: 29445612 DOI: 10.21037/jovs.2018.01.07] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 11/22/2017] [Indexed: 11/06/2022]
Abstract
Background The presence of air leak following lung resection remains a frequent problem, which may prolong hospital stay and increase hospital costs. In the past, some studies documented the efficacy of soft and flexible chest tube in patients who underwent thoracic surgery. Nevertheless, safety in case of post-operative large air or liquid leak remains questionable. The objective of this study was to verify through a multicentre study the safety and the effectiveness of the coaxial chest tube in a consecutive series of selected patients who underwent anatomical pulmonary resection and with an active and large air leak. Methods Between October 2016 and September 2017, data from patients submitted to anatomical lung resection with curative intent and operated in two Department of Thoracic Surgery of two different were prospectively collected. The inclusion criteria consisted in the presence of an air leak greater than 50 mL/min measured with a digital drainage system during the 3 postoperative hours. A descriptive statistic was used to report the incidence of complications assumed to be associated with the use of the coaxial drain. Results Forty-eight consecutive patients (27 males) submitted to lobectomy (37 patients: 77%) or anatomic segmentectomies (11 patients) were included in the analyses. Thirty-four operations (71%) were performed by video-assisted thoracic surgery (VATS). The median duration of chest tubes was 13 days [interquartile range (IQR), 4-19] and the median duration of air leak was 9 days (IQR, 2-17.5). No patient had undrained postoperative pleural effusion judged to require an additional chest tube placement. There were 12 (25%) cases of clinically or radiologically significant surgical emphysema; in none of these patients any additional procedure or re-operation was required, and they were treated conservatively by increasing the level of suction. Conclusions Our experience with this novel Coaxial Drain was satisfactory with no clinically relevant complication caused using this drain, no need to insert additional drain or replace the existing one with another drain a duration of air leak and chest tubes as well as the incidence of subcutaneous emphysema that was in line with what observed in the daily practice in similar highly selected patients with large air leak.
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Affiliation(s)
- Francesco Guerrera
- Department of Surgical Science, University of Torino, Torino, Italy.,Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Pier Luigi Filosso
- Department of Surgical Science, University of Torino, Torino, Italy.,Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Cecilia Pompili
- Section of Patient Centered Outcomes Research, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Stefania Olivetti
- Department of Surgical Science, University of Torino, Torino, Italy.,Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Matteo Roffinella
- Department of Surgical Science, University of Torino, Torino, Italy.,Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Andrea Imperatori
- Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK
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Paleari L, Rotolo N, Imperatori A, Puzone R, Sessa F, Franzi F, Meacci E, Camplese P, Cesario A, Paganuzzi M. Osteopontin is not a Specific Marker in Malignant Pleural Mesothelioma. Int J Biol Markers 2018; 24:112-7. [DOI: 10.1177/172460080902400208] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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]
Abstract
Background and aims: Osteopontin (OPN) is an integrin-binding protein recently shown to be related to tumorigenesis, progression and metastasis in different experimental models of malignancy. Malignant pleural mesothelioma (MPM) is a fatal disease in which the prognosis remains very poor and the knowledge of predictive factors for outcome is insufficient. The identification of new molecules involved in cancer initiation and development is a fundamental step for improving the curability of this kind of tumor. The purpose of this study is to define the role of OPN in the diagnosis of MPM by determining its prognostic and diagnostic value. Methods: a group of 24 surgically staged MPM subjects was compared with a group of 31 subjects with non-malignant pulmonary diseases, and with 37 healthy controls. Tumor tissue was analyzed for OPN by immunohistochemical tests, and plasma OPN levels were measured by an enzyme-linked immunosorbent assay. Results: Plasma OPN levels were not significantly higher in either of the patient groups compared with the control group. Immunohistochemical analysis revealed OPN staining of tumor cells in 21 of 24 MPMs. Receiver operating characteristic curve/area under the curve (ROC/AUC) analysis comparing the plasma OPN levels in the healthy group with those of MPM patients showed 40% sensitivity and 100% specificity at a cutoff value of 60.8 ng of OPN per milliliter (AUC 0.6). Conclusion: Plasma OPN levels do not discriminate between chronic inflammatory and malignant lung diseases and staining intensity in MPM specimens does not correlate with OPN plasma levels.
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Affiliation(s)
- Laura Paleari
- Lung Cancer Unit, National Cancer
Research Institute, Genoa
| | - Nicola Rotolo
- Thoracic Surgery Unit, University of
Insubria, Varese
| | | | - Roberto Puzone
- Clinical Epidemiology, National Cancer
Research Institute, Genoa
| | - Fausto Sessa
- IRCCS Multimedica, Milan
- Pathology Unit, University of
Insubria, Varese
| | | | - Elisa Meacci
- Thoracic Surgery Unit, Catholic
University, Rome
| | | | - Alfredo Cesario
- Thoracic Surgery Unit, Catholic
University, Rome
- IRCCS San Raffaele Pisana, Rome
| | - Michela Paganuzzi
- Clinical Pathology Laboratory,
National Cancer Research Institute, Genoa - Italy
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Ariani A, Imperatori A, Castiglioni M, Daffrè E, Aiello M, Bertorelli G, Chetta A, Dominioni L, Rotolo N. Quantitative computed tomography detects interstitial lung diseases proven by biopsy. Sarcoidosis Vasc Diffuse Lung Dis 2018; 35:16-20. [PMID: 32476875 DOI: 10.36141/svdld.v35i1.6537] [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] [Received: 06/06/2017] [Accepted: 08/24/2017] [Indexed: 11/02/2022]
Abstract
Background: The Quantitative chest CT (QCT) is emerging as a promising tool in the assessment of interstitial lung disease (ILD). However, the precise relationship between QCT parameters and the fibrosis detectable in lung tissue, remains to be established. Objectives: The aim of this study was to compare QCT and histopathological features in patients with ILD. Moreover we verified if the QCT assessment is similar in patients with or without a ILD diagnosis proven by a biopsy. Methods: Twenty patients affected by ILD who underwent a chest CT and, later, a lung biopsy, were enrolled. Patients were divided according to the histopathological findings (IPF vs sarcoidosis) in two groups (respectively bIPF and bSarc). Other 20 patients with a radiological diagnosis of IPF were included in a control group (rIPF). All CTs were post-processed with a free software (Horos) in order to obtain an ILD quantitative assessment. Results: There were no differences in terms of gender, smoking habit and spirometric values between patients' groups. rIPF subjects were older than the other: 70 vs 59 and 47 years (p<0.001). A different distribution of QCT parameters was observed between bIPF and bSarc (p<0.01) while it was comparable within bIPF and rIPF. Conclusions: QCT parameters were similar in subjects affected by the same type of ILD detected with biopsy and with CT alone. These findings make stronger the assumption that QCT can identify the presence of pulmonary fibrosis and, ultimately, that it can represent an useful and effective tool to assess ILD. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 16-20).
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Affiliation(s)
- Alarico Ariani
- Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Andrea Imperatori
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Massimo Castiglioni
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Elisa Daffrè
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Marina Aiello
- Department of Medicine & Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy
| | - Giuseppina Bertorelli
- Department of Medicine & Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy
| | - Alfredo Chetta
- Department of Medicine & Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy
| | - Lorenzo Dominioni
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Nicola Rotolo
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
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Moretti F, D’Antona P, Finardi E, Barbetta M, Dominioni L, Poli A, Gini E, Noonan DM, Imperatori A, Rotolo N, Cattoni M, Campomenosi P. Systematic review and critique of circulating miRNAs as biomarkers of stage I-II non-small cell lung cancer. Oncotarget 2017; 8:94980-94996. [PMID: 29212284 PMCID: PMC5706930 DOI: 10.18632/oncotarget.21739] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [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: 08/09/2017] [Accepted: 09/22/2017] [Indexed: 12/25/2022] Open
Abstract
Selected circulating microRNAs (miRNAs) have been suggested for non-invasive screening of non-small cell lung cancer (NSCLC), however the numerous proposed miRNA signatures are inconsistent. Aiming to identify miRNAs suitable specifically for stage I-II NSCLC screening in serum/plasma samples, we searched the databases "Pubmed", "Medline", "Scopus", "Embase" and "WOS" and systematically reviewed the publications reporting quantitative data on the efficacy [sensitivity, specificity and/or area under the curve (AUC)] of circulating miRNAs as biomarkers of NSCLC stage I and/or II. The 20 studies fulfilling the search criteria included 1110 NSCLC patients and 1009 controls, and were of medium quality according to Quality Assessment of Diagnostic Accuracy Studies checklist. In these studies, the patient cohorts as well as the control groups were heterogeneous for demographics and clinicopathological characteristics; moreover, numerous pre-analytical and analytical variables likely influenced miRNA determinations, and potential bias of hemolysis was often underestimated. We identified four circulating miRNAs scarcely influenced by hemolysis, each featuring high sensitivity (> 80%) and AUC (> 0.80) as biomarkers of stage I-II NSCLC: miR-223, miR-20a, miR-448 and miR-145; four other miRNAs showed high specificity (> 90%): miR-628-3p, miR-29c, miR-210 and miR-1244. In a model of two-step screening for stage I-II NSCLC using first the above panel of serum miRNAs with high sensitivity and high AUC, and subsequently the panel with high specificity, the estimated overall sensitivity is 91.6% and overall specificity is 93.4%. These and other circulating miRNAs suggested for stage I-II NSCLC screening require validation in multiple independent studies before they can be proposed for clinical application.
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Affiliation(s)
- Francesca Moretti
- Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - Paola D’Antona
- Department of Biotechnology and Life Sciences, DBSV, University of Insubria, Varese, Italy
| | - Emanuele Finardi
- Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - Marco Barbetta
- Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - Lorenzo Dominioni
- Department of Medicine and Surgery, DMS, Center for Thoracic Surgery, University of Insubria, Varese, Italy
| | - Albino Poli
- Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - Elisabetta Gini
- Department of Biotechnology and Life Sciences, DBSV, University of Insubria, Varese, Italy
| | - Douglas M. Noonan
- Department of Biotechnology and Life Sciences, DBSV, University of Insubria, Varese, Italy
- Scientific and Technological Pole, IRCCS MultiMedica, Milan, Italy
| | - Andrea Imperatori
- Department of Medicine and Surgery, DMS, Center for Thoracic Surgery, University of Insubria, Varese, Italy
| | - Nicola Rotolo
- Department of Medicine and Surgery, DMS, Center for Thoracic Surgery, University of Insubria, Varese, Italy
| | - Maria Cattoni
- Department of Medicine and Surgery, DMS, Center for Thoracic Surgery, University of Insubria, Varese, Italy
| | - Paola Campomenosi
- Department of Biotechnology and Life Sciences, DBSV, University of Insubria, Varese, Italy
- The Protein Factory, Centro Interuniversitario di Ricerca in Biotecnologie Proteiche, Politecnico di Milano, ICRM-CNR Milano and University of Insubria, Varese, Italy
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Imperatori A, Castiglioni M, Gasperini L, Borrelli J, Grande A, Nardecchia E, Desio M, Dominioni L, Rotolo N. F-034KINESIOLOGY TAPING IMPROVES RECOVERY OF VENTILATORY FUNCTION AFTER THORACOTOMY LOBECTOMY FOR LUNG CANCER. Interact Cardiovasc Thorac Surg 2017. [DOI: 10.1093/icvts/ivx280.034] [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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Abstract
Thyroidectomy associated to en bloc tracheal resection with end-to-end anastomosis is the treatment of choice of thyroid tumor invading the tracheal wall and is associated with a good prognosis. However, the postoperative morbidity is not irrelevant. The present review aims to discuss the complications occurring after this aggressive surgical procedure. The search was performed using PubMed through an overarching for the following terms: "complication of tracheal resection [AND] invasive thyroid cancer". Postoperative complications rate after tracheal sleeve resection with end-to-end anastomosis for thyroid cancer invading tracheal wall range from 15% to 39%. Postoperative mortality is about 1.2%. The most common postoperative complications are: anastomotic dehiscence, airway stenosis, infections and bleeding. Tumor local recurrence can be considered a late on set complication. To conclude, in locally invasive thyroid cancer, en bloc resection of the thyroid with the tracheal segment interested by the tumor provides a good prognosis despite the non-negligible postoperative morbidity rate. Patients' selection and accurate surgical technique performing a tracheal tension-free anastomosis are mandatory to reduce postoperative morbidity and mortality.
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Affiliation(s)
- Nicola Rotolo
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Maria Cattoni
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Andrea Imperatori
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
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Rotolo N, Nosotti M, Santambrogio L, Imperatori A, Dominioni L, Crosta G, Foccoli P, Pariscenti G, Passera E, Bortolotti L, Falezza G, Infante M, Rosso L. F-029FALSE-NEGATIVE RATE AND VOLUME OF ENDOBRONCHIAL ULTRASOUND GUIDED TRANSBRONCHIAL NEEDLE ASPIRATION PROCEDURES FOR NON-SMALL CELL LUNG CANCER STAGING: A MULTICENTRE STUDY IN ITALY. Interact Cardiovasc Thorac Surg 2017. [DOI: 10.1093/icvts/ivx280.029] [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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Imperatori A, Nardecchia E, Dominioni L, Sambucci D, Spampatti S, Feliciotti G, Rotolo N. Surgical site infections after lung resection: a prospective study of risk factors in 1,091 consecutive patients. J Thorac Dis 2017; 9:3222-3231. [PMID: 29221299 DOI: 10.21037/jtd.2017.08.122] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 12/21/2022]
Abstract
Background To assess incidence and risk factors of surgical site infections (SSI) (wound infection, pneumonia, empyema) in a monocentric series of patients undergoing lung resection over a decade. Methods All patients undergoing lung resection at our institution in 2006-2015 [wedge resection, n=579; lobectomy, n=472 (12% after chemo/radiotherapy); pneumonectomy, n=40 (47% after chemo/radiotherapy)], were prospectively enrolled. Perioperative SSI risk factors were recorded: age, gender, blood haemoglobin, lymphocyte count, serum albumin, forced expiratory volume in 1 second percentage (FEV1%) of predicted, antibiotic prophylaxis, length of stay, diabetes, malignancy, steroid therapy, induction chemo/radiotherapy, resection in 2006-2010/2011-2015, urgent/elective procedure, videothoracoscopic/open approach, resection type, operative time. SSIs diagnosed within 30 days from surgery were prospectively recorded and association with risk factors was evaluated. Results Of the 1,091 resected patients [median age, 65 (range, 13-91) years; male, 74%; malignancy, 65%], 124 (11.4%) developed one or more SSI. Wound infection, pneumonia and empyema rates were respectively 3.2%, 8.3% and 1.9%, stable through the decade. Overall infection rates after wedge resection, lobectomy and pneumonectomy were 4.8%, 17.4% and 35.0%, respectively. Thirty-day postoperative mortality was 0.6%; of the 7 deaths, 4 were causally related with SSI. Multivariable analysis showed that male gender, diabetes, preoperative steroids, induction chemo/radiotherapy, missed antibiotic prophylaxis and resection type were independent risk factors for overall SSI. Conclusions SSI rates after lung resection were stable over the decade. The observed 11.4% frequency of SSI indicates that postoperative infections remain a relevant issue and a predominant cause of mortality after lung surgery. Focusing on SSI risk factors that are perioperatively modifiable may improve surgical results.
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Affiliation(s)
- Andrea Imperatori
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Elisa Nardecchia
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Lorenzo Dominioni
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Daniele Sambucci
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Sebastiano Spampatti
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Giancarlo Feliciotti
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Nicola Rotolo
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
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Gao S, Zhang Z, Aragón J, Brunelli A, Cassivi S, Chai Y, Chen C, Chen C, Chen G, Chen H, Chen JS, Cooke DT, Downs JB, Falcoz PE, Fang W, Filosso PL, Fu X, Force SD, Garutti MI, Gonzalez-Rivas D, Gossot D, Hansen HJ, He J, He J, Holbek BL, Hu J, Huang Y, Ibrahim M, Imperatori A, Ismail M, Jiang G, Jiang H, Jiang Z, Kim HK, Li D, Li G, Li H, Li Q, Li X, Li Y, Li Z, Lim E, Liu CC, Liu D, Liu L, Liu Y, Lobdell KW, Ma H, Mao W, Mao Y, Mou J, Ng CSH, Novoa NM, Petersen RH, Oizumi H, Papagiannopoulos K, Pompili C, Qiao G, Refai M, Rocco G, Ruffini E, Salati M, Seguin-Givelet A, Sihoe ADL, Tan L, Tan Q, Tong T, Tsakiridis K, Venuta F, Veronesi G, Villamizar N, Wang H, Wang Q, Wang R, Wang S, Wright GM, Xie D, Xue Q, Xue T, Xu L, Xu S, Xu S, Yan T, Yu F, Yu Z, Zhang C, Zhang L, Zhang T, Zhang X, Zhao X, Zhao X, Zhi X, Zhou Q. The Society for Translational Medicine: clinical practice guidelines for the postoperative management of chest tube for patients undergoing lobectomy. J Thorac Dis 2017; 9:3255-3264. [PMID: 29221303 PMCID: PMC5708414 DOI: 10.21037/jtd.2017.08.165] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [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: 02/05/2023]
Abstract
The Society for Translational Medicine and The Chinese Society for Thoracic and Cardiovascular Surgery conducted a systematic review of the literature in an attempt to improve our understanding in the postoperative management of chest tubes of patients undergoing pulmonary lobectomy. Recommendations were produced and classified based on an internationally accepted GRADE system. The following recommendations were extracted in the present review: (I) chest tubes can be removed safely with daily pleural fluid of up to 450 mL (non-chylous and non-sanguinous), which may reduce chest tube duration and hospital length of stay (2B); (II) in rare instances, e.g., persistent abundant fluid production, the use of PrRP/B <0.5 when evaluating fluid output to determine chest tube removal might be beneficial (2B); (III) it is recommended that one chest tube is adequate following pulmonary lobectomy, except for hemorrhage and space problems (2A); (IV) chest tube clearance by milking and stripping is not recommended after lung resection (2B); (V) chest tube suction is not necessary for patients undergoing lobectomy after first postoperative day (2A); (VI) regulated chest tube suction [-11 (-1.08 kPa) to -20 (1.96 kPa) cmH2O depending upon the type of lobectomy] is not superior to regulated seal [-2 (0.196 kPa) cmH2O] when electronic drainage systems are used after lobectomy by thoracotomy (2B); (VII) chest tube removal recommended at the end of expiration and may be slightly superior to removal at the end of inspiration (2A); (VIII) electronic drainage systems are recommended in the management of chest tube in patients undergoing lobectomy (2B).
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Affiliation(s)
- Shugeng Gao
- Department of Thoracic Surgical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; National Cancer Center, Beijing 100021, China
| | - Zhongheng Zhang
- Department of Emergency Medicine, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | | | | | | | - Ying Chai
- Department of Thoracic Surgery, Second Affiliated Hospital, Medical College of Zhejiang University, Hangzhou 310009, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Shanghai 200433, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fujian 350001, China
| | - Gang Chen
- Department of Thoracic Surgery, Guangdong General Hospital, Guangzhou 510080, China
| | - Haiquan Chen
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai 200030, China
| | - Jin-Shing Chen
- Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 10002, Taiwan
| | - David Tom Cooke
- Section of General Thoracic Surgery, University of California, Davis Health System, Sacramento, CA, USA
| | - John B. Downs
- Department of Anesthesiology and Critical Care Medicine, University of Florida, Gainesville, FL, USA
| | | | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai 200030, China
| | | | - Xiangning Fu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Seth D. Force
- Cardiothoracic Surgery, Emory University, The Emory Clinic, Atlanta, GA, USA
| | - Martínez I. Garutti
- Department of Anaesthesia and Postoperative Care, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | | | - Dominique Gossot
- Department of Thoracic Surgery, Institut Mutualiste Montsouris, Paris, France
| | - Henrik Jessen Hansen
- Department of Cardiothoracic Surgery, Rigshospitalet (National University Hospital), Copenhagen, Denmark
| | - Jianxing He
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510000, China
- Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou 510000, China
| | - Jie He
- Department of Thoracic Surgical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; National Cancer Center, Beijing 100021, China
| | - Bo Laksáfoss Holbek
- Department of Cardiothoracic Surgery and Section for Surgical Pathophysiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jian Hu
- Department of Thoracic Surgery, First Affiliated Hospital, Medical College of Zhejiang University, Hangzhou 310003, China
| | - Yunchao Huang
- Department of Thoracic Surgery, Yunnan Cancer Hospital, Kunming 650100, China
| | - Mohsen Ibrahim
- Division of Thoracic Surgery, Faculty of Medicine and Psychology, Sant’Andrea Hospital, University of Rome ‘Sapienza’, Rome, Italy
| | - Andrea Imperatori
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Mahmoud Ismail
- Charité Kompetenzzentrum für Thoraxchirurgie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Shanghai 200433, China
| | - Hongjing Jiang
- Department of Esophageal Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China
| | - Zhongmin Jiang
- Department of Thoracic Surgery, Shandong Qianfoshan Hospital, Jinan 250014, China
| | - Hyun Koo Kim
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Danqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Beijing 100032, China
| | - Gaofeng Li
- Department of Thoracic Surgery, Yunnan Cancer Hospital, Kunming 650100, China
| | - Hui Li
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Beijing 100049, China
| | - Qiang Li
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Chengdu 610041, China
| | - Xiaofei Li
- Department of Thoracic Surgery, Tangdu Hospital Fourth Military Medical University, Xi’an 710038, China
| | - Yin Li
- Henan Cancer Hospital, Zhengzhou 450008, China
| | - Zhijun Li
- Department of Thoracic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Eric Lim
- Imperial College and The Academic Division of Thoracic Surgery, Royal Brompton Hospital, Sydney Street, London, UK
| | - Chia-Chuan Liu
- Division of Thoracic Surgery, Department of Surgery, Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Deruo Liu
- Department of Thoracic Surgery, China and Japan Friendship Hospital, Beijing 100029, China
| | - Lunxu Liu
- Department of Cardiovascular and Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yongyi Liu
- Department of Thoracic Surgery, Liaoning Cancer Hospital and Institute, Shengyang 110042, China
| | - Kevin W. Lobdell
- Department of Thoracic and Cardiovascular Surgery, Sanger Heart and Vascular Institute, Carolinas Medical Center, Charlotte, NC, USA
| | - Haitao Ma
- Department of Thoracic Surgery, The First Hospital Affiliated to Soochow University, Suzhou 215000, China
| | - Weimin Mao
- Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310000, China
| | - Yousheng Mao
- Department of Thoracic Surgical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; National Cancer Center, Beijing 100021, China
| | - Juwei Mou
- Department of Thoracic Surgical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; National Cancer Center, Beijing 100021, China
| | - Calvin Sze Hang Ng
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., Hong Kong, China
| | - Nuria M. Novoa
- Thoracic Surgery Service, University Hospital of Salamanca, Paseo de San Vicente 58-182, 37007 Salamanca, Spain
| | - René H. Petersen
- Department of Cardiothoracic Surgery, Rigshospitalet (National University Hospital), Copenhagen, Denmark
| | - Hiroyuki Oizumi
- Second Department of Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | | | - Cecilia Pompili
- Department of Thoracic Surgery, St. James’s University Hospital, Leeds, UK
- Leeds Institute of Cancer and Pathology, Leeds, UK
| | - Guibin Qiao
- Department of Thoracic Surgery, Guangzhou General Hospital of Guangzhou Military Area Command, Guangzhou 510000, China
| | - Majed Refai
- Thoracic Surgery Department, United Hospitals of Ancona, Via San Vincenzo 5/f Polverigi, Ancona, Italy
| | - Gaetano Rocco
- Department of Thoracic Surgery and Oncology, National Cancer Institute, Pascale Foundation, Naples, Italy
| | - Erico Ruffini
- Department of Thoracic Surgery, University of Torino, Torino, Italy
| | - Michele Salati
- Unit of Thoracic Surgery, Ospedali Riuniti Ancona, Ancona, Italy
| | | | - Alan Dart Loon Sihoe
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Lijie Tan
- Department of Thoracic Surgery, Shanghai Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Qunyou Tan
- Department of Thoracic Surgery, Daping Hospital, Research Institute of Surgery Third Military Medical University, Chongqing 400042, China
| | - Tang Tong
- Department of Thoracic Surgery, Second Affiliated Hospital of Jilin University, Changchun 130041, China
| | - Kosmas Tsakiridis
- Cardiac and Thoracic Department, Private Hospital “St.Lukes”, Thessaloniki, Greece
| | - Federico Venuta
- Department of Surgery “Paride Stefanini” - Thoracic Surgery Unit, Policlinico Umberto I, University of Rome SAPIENZA, Rome, Italy
| | - Giulia Veronesi
- Robotic Surgery, Division of Thoracic Surgery, Humanitas Research Hospital, Via Manzoni 56, Rozzano, Italy
| | | | - Haidong Wang
- Department of Thoracic Surgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Qun Wang
- Department of Thoracic Surgery, Shanghai Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Ruwen Wang
- Department of Thoracic Surgery, Daping Hospital, Research Institute of Surgery Third Military Medical University, Chongqing 400042, China
| | - Shumin Wang
- Department of Thoracic Surgery, General Hospital of Shenyang Military Area, Shenyang 110015, China
| | - Gavin M. Wright
- Department of Surgical Oncology, St Vincent’s Hospital, Melbourne, Australia
- Department of Surgery, St Vincent’s Hospital, University of Melbourne, Melbourne, Australia
- Division of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Deyao Xie
- Department of Cardiovascular and Thoracic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Qi Xue
- Department of Thoracic Surgical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; National Cancer Center, Beijing 100021, China
| | - Tao Xue
- Department of Thoracic Surgery, Zhongda Hospital Affiliated to Southeast University, Nanjing 210009, China
| | - Lin Xu
- Department of Thoracic Surgery, Jiangsu Cancer Hospital, Nanjing 210008, China
| | - Shidong Xu
- Department of Thoracic Surgery, Heilongjiang Cancer Hospital, Harbin 150049, China
| | - Songtao Xu
- Department of Thoracic Surgery, Shanghai Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Tiansheng Yan
- Department of Thoracic Surgery, Peking University Third Hospital, Beijing 100083, China
| | - Fenglei Yu
- Department of Cardiovascular Surgery, Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Zhentao Yu
- Department of Esophageal Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China
| | - Chunfang Zhang
- Department of Thoracic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Lanjun Zhang
- Cancer Center, San Yat-sen University, Guangzhou 510060, China
| | - Tao Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Xinjiang Medical Hospital, Urumqi 830011, China
| | - Xun Zhang
- Department of Thoracic Surgery, Tanjin Chest Hospital, Tianjin 300300, China
| | - Xiaojing Zhao
- Department of Thoracic Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200003, China
| | - Xuewei Zhao
- Department of Thoracic Surgery, Shanghai Changzheng Hospital, Shanghai 200000, China
| | - Xiuyi Zhi
- Department of Thoracic Surgery, Xuanwu Hospital of Capital University of Medical Sciences, Beijing 100053, China
| | - Qinghua Zhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
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Cattoni M, Vallières E, Brown LM, Sarkeshik AA, Margaritora S, Siciliani A, Imperatori A, Rotolo N, Farjah F, Wandell G, Costas K, Mann C, Hubka M, Kaplan S, Farivar AS, Aye RW, Louie BE. External Validation of a Prognostic Model of Survival for Resected Typical Bronchial Carcinoids. Ann Thorac Surg 2017; 104:1215-1220. [PMID: 28821334 DOI: 10.1016/j.athoracsur.2017.05.019] [Citation(s) in RCA: 6] [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: 12/29/2016] [Revised: 05/04/2017] [Accepted: 05/05/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND This study aimed to assess the reliability and the validity of a prognostic model of survival recently developed by the European Society of Thoracic Surgery Neuroendocrine Tumor Working Group to predict 5-year overall survival after surgical resection of pulmonary typical carcinoid. METHODS We retrospectively collected data on 240 consecutive patients (164 men, 76 women; median age, 58 years [interquartile range, 47 to 68]) who underwent curative lung resection for pulmonary typical carcinoid in seven centers between 2000 and 2015. For each patient, we calculated the corresponding risk class (A, B, C, D) using the following variables: male, age, previous malignancy, Eastern Cooperative Oncology Group performance status, peripheral tumor, TNM stage. Kaplan-Meier method, and Cox proportional hazards model were used for the statistical analysis. RESULTS During a median follow-up of 42 months (interquartile range, 11 to 84), the 5-year overall survival was 94.2% (95% confidence interval [CI]: 90.2% to 98.2%); 15 of 240 patients died. A significantly decreasing rate of survival was observed from class A to class D (p = 0.004) with rates of 100% (95% CI: 100% to 100%), 96.3% (95% CI: 88.6% to 98.8%), 86.7% (95% CI: 63.0% to 95.7%), and 33.3% (95% CI: 0.9% to 77.4%), respectively, for class A, B, C, and D. This difference persisted also using clinical stage as a variable in the risk class calculation (p = 0.006). No differences were observed in term of overall survival among TNM stage I, II, and III patients (p = 0.94). CONCLUSIONS This prognostic model of survival is easily applicable, it is validated by our independent cohort, and it appears to stratify better than the traditional TNM staging. Therefore, it may be useful in counseling patients about their outcomes from surgical treatment and in tailoring treatment for high-risk patients.
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Affiliation(s)
- Maria Cattoni
- Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, Washington
| | - Eric Vallières
- Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, Washington
| | - Lisa M Brown
- Section of General Thoracic Surgery, Department of Surgery, UC Davis Medical Center, Sacramento, California
| | - Amir A Sarkeshik
- Section of General Thoracic Surgery, Department of Surgery, UC Davis Medical Center, Sacramento, California
| | | | | | - Andrea Imperatori
- Center of Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Nicola Rotolo
- Center of Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Farhood Farjah
- Division of Cardiothoracic Surgery, University of Washington Medical Center, Seattle, Washington
| | - Grace Wandell
- Division of Cardiothoracic Surgery, University of Washington Medical Center, Seattle, Washington
| | - Kimberly Costas
- Division of Thoracic Surgery, Providence Regional Medical Center, Everett, Washington
| | - Catherine Mann
- Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, Washington
| | - Michal Hubka
- Division of Thoracic Surgery, Virginia Mason Hospital and Seattle Medical Center, Seattle, Washington
| | - Stephen Kaplan
- Division of Thoracic Surgery, Virginia Mason Hospital and Seattle Medical Center, Seattle, Washington
| | | | - Ralph W Aye
- Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, Washington
| | - Brian E Louie
- Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, Washington.
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Rotolo N, Cattoni M, Crosta G, Nardecchia E, Poli A, Moretti F, Conti V, La Rosa S, Dominioni L, Imperatori A. Comparison of multiple techniques for endobronchial ultrasound-transbronchial needle aspiration specimen preparation in a single institution experience. J Thorac Dis 2017; 9:S381-S385. [PMID: 28603649 DOI: 10.21037/jtd.2017.04.25] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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 The optimal method for specimen preparation of endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) is still controversial. This study aims to compare several techniques available for EBUS-TBNA specimen acquisition and processing, in order to identify the best performing technique. METHODS We retrospectively reviewed the data of 199 consecutive patients [male, 73%; median age, 64 years (IQR: 52-74 years)] undergoing EBUS-TBNA at our institution from 2012 through 2014 for diagnosis of hilar-mediastinal lymph node enlargement suspect of neoplastic (n=139) or granulomatous (n=60) disease. All procedures were performed by two experienced bronchoscopists, under conscious sedation and local anaesthesia, using 21/22-Gauge (G) needle, without rapid on-site evaluation (ROSE). Five specimen-processing techniques were used: cytology slides in 42 cases (21%); cell-block in 25 (13%); core-tissue in 60 (30%); combination of cytology slides and core-tissue in 51 (26%); combination of cytology slides and cell-block in 21 (10%). To assess the diagnostic accuracy of each tissue-processing technique we compared the EBUS-TBNA results to those obtained with surgical lymphadenectomy, or 1-year follow-up in non-operated patients. RESULTS Diagnostic yield, accuracy and area under the curve (AUC) were as follows. Cytology slides: 81%, 80%, 0.90; cell-block: 48%, 33%, 0.67; core-tissue: 87%, 99%, 0.96; cytology slides + core-tissue: 80%, 100%, 1.00; cytology slides + cell-block: 86%, 100%, 1.00. Cytology slides and core-tissue method showed non-significantly different diagnostic yield (P=0.435) and AUC (P=0.152). CONCLUSIONS In our single-institution experience, cytology slides and core-tissue preparations demonstrated high and similar diagnostic performance. Cytology slides combination with core-tissue or cell-block showed the highest performance, however these combination methods were more resource-consuming.
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Affiliation(s)
- Nicola Rotolo
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Maria Cattoni
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Giorgio Crosta
- Department of Specialistic Medicine, Unit of Pneumology, ASST Sette Laghi, Hospital of Varese, Italy
| | - Elisa Nardecchia
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Albino Poli
- Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - Francesca Moretti
- Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - Valentina Conti
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Stefano La Rosa
- Institute of Pathology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Lorenzo Dominioni
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Andrea Imperatori
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
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50
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Rotolo N, Imperatori A, Nosotti M, Santambrogio L, Palleschi A, Dominioni L, Crosta G, Foccoli P, Pariscenti G, Passera E, Bortolotti L, Falezza G, Infante M, Daffrè E, Cattoni M, Rosso L. Multicentric study of endobronchial ultrasound-transbronchial needle aspiration for lung cancer staging in Italy. J Thorac Dis 2017; 9:S370-S375. [PMID: 28603647 DOI: 10.21037/jtd.2017.04.26] [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: 12/25/2022]
Abstract
BACKGROUND Multi-institutional studies of endobronchial-ultrasound transbronchial needle aspiration (EBUS-TBNA) for mediastinal staging in lung cancer are scarce. It is unclear if the high diagnostic performance of EBUS-TBNA reported by experts' guidelines can be generally achieved. METHODS This is a retrospective study performed in five tertiary referral centers of thoracic surgery in Italy, to assess the EBUS-TBNA diagnostic performance in patients with non-small cell lung cancer (NSCLC). Patient inclusion criteria were: both genders; >18 years old; with suspect/confirmed NSCLC; undergoing EBUS-TBNA for mediastinal node enlargement at computed tomography (size >1 cm, ≤3 cm) and/or pathological uptake at positron emission tomography. Altogether we included 485 patients [male, 366; female, 119; median age, 68 years (IQR, 61-74 years)] undergoing mediastinal staging between January 2011 and July 2016. All EBUS-TBNAs were performed by experienced bronchoscopists, without pre-defined quality standards. Depending on usual practice in each center, EBUS-TBNA was done under conscious sedation, with 21- or 22-Gauge (G) needle, and specimen preparation was cell-block, or cytology slides, or core-tissue. Sampling was classified inadequate in absence of lymphocytes, or when sample was insufficient. We analyzed the EBUS-TBNA procedural steps likely to influence the rate of adequate samplings (diagnostic yield). RESULTS EBUS-TBNA sensitivity, negative predictive value (NPV) and accuracy respectively were 90%, 78% and 93% in the whole cohort. At multivariate analysis, use of 21-G needle was associated with better diagnostic yield (P<0.001). Center and specimen processing technique were not independent factors affecting EBUS-TBNA diagnostic yield. CONCLUSIONS In this multicentric study, EBUS-TBNA was a highly sensitive and accurate method for NSCLC mediastinal node staging. Results indicate better performance of EBUS-TBNA with 21-G needle, and suggest that specimen processing technique could be chosen according to the local practice preference.
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Affiliation(s)
- Nicola Rotolo
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Andrea Imperatori
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Mario Nosotti
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luigi Santambrogio
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandro Palleschi
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lorenzo Dominioni
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Giorgio Crosta
- Department of Specialistic Medicine, Unit of Pneumology, ASST Sette Laghi, Hospital of Varese, Varese, Italy
| | | | | | - Eliseo Passera
- Thoracic Surgery Department, Humanitas Gavazzeni Hospital, Bergamo, Italy
| | - Luigi Bortolotti
- Thoracic Surgery Department, Humanitas Gavazzeni Hospital, Bergamo, Italy
| | | | | | - Elisa Daffrè
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Maria Cattoni
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Lorenzo Rosso
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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