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1. The Overweight Paradox: Impact of Body Mass Index on Patients Undergoing VATS Lobectomy or Segmentectomy

Author

Parini, Sara, Azzolina, Danila, Massera, Fabio, Mastromarino, Maria Giovanna, Papalia, Esther, Baietto, Guido, Curcio, Carlo, Crisci, Roberto, Rena, Ottavio, Alloisio, Marco, Amore, Dario, Ampollini, Luca, Ardò, Nicoletta, Argnani, Desideria, Baisi, Alessandro, Bandiera, Alessandro, Benato, Cristiano, Benvenuti, Mauro Roberto, Bertani, Alessandro, Bortolotti, Luigi, Bottoni, Edoardo, Breda, Cristiano, Camplese, Pierpaolo, Carbognani, Paolo, Cardillo, Giuseppe, Carleo, Francesco, Cavallesco, Giorgio, Cherchi, Roberto, De Palma, Angela, Dell'Amore, Andrea, Della Beffa, Vittorio, Divisi, Duilio, Dolci, Giampiero, Droghetti, Andrea, Ferrari, Paolo, Fontana, Diego, Gasparri, Roberto, Gavezzoli, Diego, Ghisalberti, Marco, Giovanardi, Michele, Gonfiotti, Alessandro, Guerrera, Francesco, Imperatori, Andrea, Infante, Maurizio, Lausi, Paolo, Lo Giudice, Fabio, Londero, Francesco, Lopez, Camillo, Mancuso, Maurizio, Maniscalco, Pio, Margaritora, Stefano, Marulli, Giuseppe, Mazza, Federico, Meacci, Elisa, Melloni, Giulio, Morelli, Angelo, Mucilli, Felice, Natali, Pamela, Negri, Giampiero, Nicotra, Samuele, Nosotti, Mario, Paladini, Piero, Pariscenti, Gianluca, Perkmann, Reinhold, Pernazza, Fausto, Pirondini, Emanuele, Puma, Francesco, Raveglia, Federico, Refai, Majed, Rinaldo, Alessandro, Risso, Carlo, Rizzardi, Giovanna, Rotolo, Nicola, Scarci, Marco, Solli, Piergiorgio, Sollitto, Francesco, Spaggiari, Lorenzo, Stefani, Alessandro, Stella, Franco, Surrente, Corrado, Tancredi, Giorgia, Terzi, Alberto, Torre, Massimo, Tosi, Davide, Vinci, Damiano, Viti, Andrea, Voltolini, Luca, Zaraca, Francesco, Margaritora, Stefano (ORCID:0000-0002-9796-760X), Meacci, Elisa (ORCID:0000-0001-8424-3816), Parini, Sara, Azzolina, Danila, Massera, Fabio, Mastromarino, Maria Giovanna, Papalia, Esther, Baietto, Guido, Curcio, Carlo, Crisci, Roberto, Rena, Ottavio, Alloisio, Marco, Amore, Dario, Ampollini, Luca, Ardò, Nicoletta, Argnani, Desideria, Baisi, Alessandro, Bandiera, Alessandro, Benato, Cristiano, Benvenuti, Mauro Roberto, Bertani, Alessandro, Bortolotti, Luigi, Bottoni, Edoardo, Breda, Cristiano, Camplese, Pierpaolo, Carbognani, Paolo, Cardillo, Giuseppe, Carleo, Francesco, Cavallesco, Giorgio, Cherchi, Roberto, De Palma, Angela, Dell'Amore, Andrea, Della Beffa, Vittorio, Divisi, Duilio, Dolci, Giampiero, Droghetti, Andrea, Ferrari, Paolo, Fontana, Diego, Gasparri, Roberto, Gavezzoli, Diego, Ghisalberti, Marco, Giovanardi, Michele, Gonfiotti, Alessandro, Guerrera, Francesco, Imperatori, Andrea, Infante, Maurizio, Lausi, Paolo, Lo Giudice, Fabio, Londero, Francesco, Lopez, Camillo, Mancuso, Maurizio, Maniscalco, Pio, Margaritora, Stefano, Marulli, Giuseppe, Mazza, Federico, Meacci, Elisa, Melloni, Giulio, Morelli, Angelo, Mucilli, Felice, Natali, Pamela, Negri, Giampiero, Nicotra, Samuele, Nosotti, Mario, Paladini, Piero, Pariscenti, Gianluca, Perkmann, Reinhold, Pernazza, Fausto, Pirondini, Emanuele, Puma, Francesco, Raveglia, Federico, Refai, Majed, Rinaldo, Alessandro, Risso, Carlo, Rizzardi, Giovanna, Rotolo, Nicola, Scarci, Marco, Solli, Piergiorgio, Sollitto, Francesco, Spaggiari, Lorenzo, Stefani, Alessandro, Stella, Franco, Surrente, Corrado, Tancredi, Giorgia, Terzi, Alberto, Torre, Massimo, Tosi, Davide, Vinci, Damiano, Viti, Andrea, Voltolini, Luca, Zaraca, Francesco, Margaritora, Stefano (ORCID:0000-0002-9796-760X), and Meacci, Elisa (ORCID:0000-0001-8424-3816)

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.

Published
2023

2. Comparison of long occlusive femoropopliteal de novo versus previous endovascularly treated lesions managed with in situ saphenous bypass

Author

Troisi, Nicola, Michelagnoli, Stefano, Adami, Daniele, Berchiolli, Raffaella, Accrocca, Federico, Amico, Alessio, Angelini, Andrea, Arnuzzo, Luca, Marchetti, Andrea Ascoli, Attisani, Luca, Bafile, Gennaro, Baldino, Giuseppe, Barbanti, Enrico, Bartoli, Stefano, Bellosta, Raffaello, Benedetto, Filippo, Borioni, Raoul, Briolini, Franco, Busoni, Cristina, Camparini, Stefano, Cappiello, Pierluigi, Carbonari, Luciano, Casella, Francesco, Celoria, Giovanni, Chiama, Andrea, Chisci, Emiliano, Civilini, Efrem, Codispoti, Francesco Alberto, Conti, Barbara, Coppi, Giovanni, De Blasis, Giovanni, D'Elia, Marcello, Di Domenico, Rossella, Di Girolamo, Carla, Ercolini, Leonardo, Ferrari, Alessandra, Ferrari, Mauro, Forliti, Enzo, Frigatti, Paolo, Frigerio, Dalmazio, Frosini, Pierfrancesco, Garriboli, Luca, Giordano, Antonio Nicola, Guerrieri, Walter, Jannello, Antonio, Massara, Mafalda, Merlo, Maurizio, Mezzetti, Roberto, Miccoli, Tommaso, Milite, Domenico, Mingazzini, Pietro, Muncinelli, Marina, Nano, Giovanni, Natola, Marco, Novali, Claudio, Palasciano, Giancarlo, Perkmann, Reinhold, Persi, Federica, Petruccelli, David, Pinelli, Mauro, Poletto, Giorgio, Porta, Carla, Pratesi, Carlo, Pruner, Gianguido, Ragazzi, Giovanni, Righini, Paolo, Salvini, Mauro, Scovazzi, Paolo, Setacci, Carlo, Settembrini, Alberto Maria, Siani, Andrea, Silingardi, Roberto, Silvestro, Antonino, Talarico, Francesco, Tolva, Valerio, Trani, Antonio, Trimarchi, Santi, Tshomba, Yamume, Vigliotti, Gennaro, Viola, Daniela, Volpe, Pietro, Zani, Federico, Codispoti, Francesco, Tshomba, Yamume (ORCID:0000-0001-7304-7553), Troisi, Nicola, Michelagnoli, Stefano, Adami, Daniele, Berchiolli, Raffaella, Accrocca, Federico, Amico, Alessio, Angelini, Andrea, Arnuzzo, Luca, Marchetti, Andrea Ascoli, Attisani, Luca, Bafile, Gennaro, Baldino, Giuseppe, Barbanti, Enrico, Bartoli, Stefano, Bellosta, Raffaello, Benedetto, Filippo, Borioni, Raoul, Briolini, Franco, Busoni, Cristina, Camparini, Stefano, Cappiello, Pierluigi, Carbonari, Luciano, Casella, Francesco, Celoria, Giovanni, Chiama, Andrea, Chisci, Emiliano, Civilini, Efrem, Codispoti, Francesco Alberto, Conti, Barbara, Coppi, Giovanni, De Blasis, Giovanni, D'Elia, Marcello, Di Domenico, Rossella, Di Girolamo, Carla, Ercolini, Leonardo, Ferrari, Alessandra, Ferrari, Mauro, Forliti, Enzo, Frigatti, Paolo, Frigerio, Dalmazio, Frosini, Pierfrancesco, Garriboli, Luca, Giordano, Antonio Nicola, Guerrieri, Walter, Jannello, Antonio, Massara, Mafalda, Merlo, Maurizio, Mezzetti, Roberto, Miccoli, Tommaso, Milite, Domenico, Mingazzini, Pietro, Muncinelli, Marina, Nano, Giovanni, Natola, Marco, Novali, Claudio, Palasciano, Giancarlo, Perkmann, Reinhold, Persi, Federica, Petruccelli, David, Pinelli, Mauro, Poletto, Giorgio, Porta, Carla, Pratesi, Carlo, Pruner, Gianguido, Ragazzi, Giovanni, Righini, Paolo, Salvini, Mauro, Scovazzi, Paolo, Setacci, Carlo, Settembrini, Alberto Maria, Siani, Andrea, Silingardi, Roberto, Silvestro, Antonino, Talarico, Francesco, Tolva, Valerio, Trani, Antonio, Trimarchi, Santi, Tshomba, Yamume, Vigliotti, Gennaro, Viola, Daniela, Volpe, Pietro, Zani, Federico, Codispoti, Francesco, and Tshomba, Yamume (ORCID:0000-0001-7304-7553)

Abstract

Background: The aim of this study was to compare the 2-year outcomes of de novo versus postendovascular lesion treatment of femoropopliteal occlusions included in a national, multicenter, observational, prospective registry based on the treatment of critical Limb-threatening IschaeMia with infragenicular Bypass adopting in situ SAphenous VEin technique (LIMBSAVE) registry.Methods: From January 2018 to December 2019, 541 patients from43 centers have been enrolled in the LIMBSAVE registry. Of these patients, 460 were included in the present study: 341 (74.1%) with de novo lesions (DN group) and 119 (25.9%) with postendovascular treatment lesions (PE group). Initial outcome measures were assessed at 30 days after treatment. Furthermore, at the 2-year follow-up, the estimated outcomes of primary patency, primary-assisted patency, secondary patency, and limb salvage were analyzed with Kaplan-Meier curves and compared between groups with the log-rank test.Results: Both groups were homogeneous in terms of demographic data, preoperative risk factors, and clinical presentation. However, compared with DN group, more patients in PE group had a great saphenous vein diameter of less than 3 mm (11.1% vs 21%; P = .007). Intraoperatively, both groups showed similar distal anastomosis sites: below-the-knee popliteal artery (63% DN group, 66.4% PE group) and tibial vessel (37% DN group, 33.6% PE group) (P = .3). The overall mean duration of follow-up was 11.6 months (range, 1-24 months). At the 2-year follow-up, there were no differences between the two groups in terms of primary patency (66.3% DN group vs 74.1% PE group; P = .9), primary-assisted patency (78.2% DN group vs 79.5% PE group; P = .2), secondary patency (85.1% DN group vs 91.4% PE group; P = .2), and limb salvage (95.2% DN group vs 95.1% PE group; P = .9).Conclusions: The LIMBSAVE registry did not show a worsening of overall patency and limb salvages rates at the 2-year follow-up in patients undergoing in situ saphenous

Published
2022

3. A Delphi Consensus report from the 'Prolonged Air Leak:A Survey' study group on prevention and management of postoperative air leaks after minimally invasive anatomical resections

Author

Zaraca, Francesco, Brunelli, Alessandro, Pipitone, Marco Damiano, Abdellateef, Amr, Abu Akar, Firas, Augustin, Florian, Batchelor, Tim, Bertani, Alessandro, Crisci, Roberto, D'amico, Thomas, D'journo, Xavier Benoit, Droghetti, Andrea, Fang, Wentao, Gonfiotti, Alessandro, Janík, Miroslav, Jimenez, Marcelo, Kirschbaum, Andreas, Kostic, Marko, Lazzaro, Richard, Lucchi, Marco, Marra, Alessandro, Murthy, Sudish, Ng, Calvin S.H., Nachira, Dania, Pardolesi, Alessandro, Perkmann, Reinhold, Petersen, Rene Horsleben, Pischik, Vadim, Russo, Michele Dario, Opitz, Isabelle, Spaggiari, Lorenzo, Ugalde, Paula A., Vannucci, Fernando, Veronesi, Giulia, Bertolaccini, Luca, Zaraca, Francesco, Brunelli, Alessandro, Pipitone, Marco Damiano, Abdellateef, Amr, Abu Akar, Firas, Augustin, Florian, Batchelor, Tim, Bertani, Alessandro, Crisci, Roberto, D'amico, Thomas, D'journo, Xavier Benoit, Droghetti, Andrea, Fang, Wentao, Gonfiotti, Alessandro, Janík, Miroslav, Jimenez, Marcelo, Kirschbaum, Andreas, Kostic, Marko, Lazzaro, Richard, Lucchi, Marco, Marra, Alessandro, Murthy, Sudish, Ng, Calvin S.H., Nachira, Dania, Pardolesi, Alessandro, Perkmann, Reinhold, Petersen, Rene Horsleben, Pischik, Vadim, Russo, Michele Dario, Opitz, Isabelle, Spaggiari, Lorenzo, Ugalde, Paula A., Vannucci, Fernando, Veronesi, Giulia, and Bertolaccini, Luca

Abstract

OBJECTIVES: This study reports the results of an international expert consensus process evaluating the assessment of intraoperative air leaks (IAL) and treatment of postoperative prolonged air leaks (PAL) utilizing a Delphi process, with the aim of helping standardization and improving practice. METHODS: A panel of 45 questions was developed and submitted to an international working group of experts in minimally invasive lung cancer surgery. Modified Delphi methodology was used to review responses, including 3 rounds of voting. The consensus was defined a priori as >50% agreement among the experts. Clinical practice standards were graded as recommended or highly recommended if 50-74% or >75% of the experts reached an agreement, respectively. RESULTS: A total of 32 experts from 18 countries completed the questionnaires in all 3 rounds. Respondents agreed that PAL are defined as >5 days and that current risk models are rarely used. The consensus was reached in 33/45 issues (73.3%). IAL were classified as mild (<100 ml/min; 81%), moderate (100-400 ml/min; 71%) and severe (>400 ml/min; 74%). If mild IAL are detected, 68% do not treat; if moderate, consensus was not; if severe, 90% favoured treatment. CONCLUSIONS: This expert consensus working group reached an agreement on the majority of issues regarding the detection and management of IAL and PAL. In the absence of prospective, randomized evidence supporting most of these clinical decisions, this document may serve as a guideline to reduce practice variation.

Published
2022

4. Preliminary six-month outcomes of LIMBSAVE (treatment of critical Limb IscheMia with infragenicular Bypass adopting in situ SAphenous VEin technique) registry

Author

Troisi, Nicola, Blasis, Giovanni De, Salvini, Mauro, Michelagnoli, Stefano, Setacci, Carlo, LIMBSAVE registry Collaborative, Group, Accrocca, Federico, Adami, Daniele, Angelini, Andrea, Arnuzzo, Luca, Ascoli Marchetti, Andrea, Attisani, Luca, Bafile, Gennaro, Baldino, Giuseppe, Barbanti, Enrico, Bartoli, Stefano, Bellosta, Raffaello, Benedetto, Filippo, Borioni, Raoul, Briolini, Franco, Busoni, Cristina, Camparini, Stefano, Cappiello, Pierluigi, Carbonari, Luciano, Casella, Francesco, Celoria, Giovanni, Chisci, Emiliano, Civilini, Efrem, Codispoti, Francesco Alberto, Conti, Barbara, Coppi, Giovanni, D’Amico, Alessio, De Blasis, Giovanni, D’Elia, Marcello, Di Domenico, Rossella, Di Girolamo, Carla, Ercolini, Leonardo, Ferrari, Alessandra, Ferrari, Mauro, Forliti, Enzo, Frigatti, Paolo, Frigerio, Dalmazio, Frosini, Pierfrancesco, Garriboli, Luca, Nicola Giordano, Antonio, Guerrieri, Walter, Jannello, Antonio, Massara, Mafalda, Merlo, Maurizio, Mezzetti, Roberto, Miccoli, Tommaso, Milite, Domenico, Mingazzini, Pietro, Muncinelli, Marina, Nano, Giovanni, Natola, Marco, Novali, Claudio, Palasciano, Giancarlo, Perkmann, Reinhold, Persi, Federica, Petruccelli, David, Pinelli, Mauro, Poletto, Giorgio, Porta, Carla, Pratesi, Carlo, Pruner, Gianguido, Ragazzi, Giovanni, Righini, Paolo, Scovazzi, Paolo, Maria Settembrini, Alberto, Siani, Andrea, Silingardi, Roberto, Silvestro, Antonino, Talarico, Francesco, Tolva, Valerio, Trani, Antonio, Trimarchi, Santi, Tshomba, Yamume, Vigliotti, Gennaro, Viola, Daniela, Volpe, Pietro, Zani, Federico, Codispoti, Francesco, Tshomba, Yamume (ORCID:0000-0001-7304-7553), Troisi, Nicola, Blasis, Giovanni De, Salvini, Mauro, Michelagnoli, Stefano, Setacci, Carlo, LIMBSAVE registry Collaborative, Group, Accrocca, Federico, Adami, Daniele, Angelini, Andrea, Arnuzzo, Luca, Ascoli Marchetti, Andrea, Attisani, Luca, Bafile, Gennaro, Baldino, Giuseppe, Barbanti, Enrico, Bartoli, Stefano, Bellosta, Raffaello, Benedetto, Filippo, Borioni, Raoul, Briolini, Franco, Busoni, Cristina, Camparini, Stefano, Cappiello, Pierluigi, Carbonari, Luciano, Casella, Francesco, Celoria, Giovanni, Chisci, Emiliano, Civilini, Efrem, Codispoti, Francesco Alberto, Conti, Barbara, Coppi, Giovanni, D’Amico, Alessio, De Blasis, Giovanni, D’Elia, Marcello, Di Domenico, Rossella, Di Girolamo, Carla, Ercolini, Leonardo, Ferrari, Alessandra, Ferrari, Mauro, Forliti, Enzo, Frigatti, Paolo, Frigerio, Dalmazio, Frosini, Pierfrancesco, Garriboli, Luca, Nicola Giordano, Antonio, Guerrieri, Walter, Jannello, Antonio, Massara, Mafalda, Merlo, Maurizio, Mezzetti, Roberto, Miccoli, Tommaso, Milite, Domenico, Mingazzini, Pietro, Muncinelli, Marina, Nano, Giovanni, Natola, Marco, Novali, Claudio, Palasciano, Giancarlo, Perkmann, Reinhold, Persi, Federica, Petruccelli, David, Pinelli, Mauro, Poletto, Giorgio, Porta, Carla, Pratesi, Carlo, Pruner, Gianguido, Ragazzi, Giovanni, Righini, Paolo, Scovazzi, Paolo, Maria Settembrini, Alberto, Siani, Andrea, Silingardi, Roberto, Silvestro, Antonino, Talarico, Francesco, Tolva, Valerio, Trani, Antonio, Trimarchi, Santi, Tshomba, Yamume, Vigliotti, Gennaro, Viola, Daniela, Volpe, Pietro, Zani, Federico, Codispoti, Francesco, and Tshomba, Yamume (ORCID:0000-0001-7304-7553)

Abstract

ObjectivesGuidelines recommend open bypass surgery for long occlusions of infrainguinal arteries. In situ saphenous vein bypass is a standardized technique. The aim of this study was to report preliminary six-month outcomes of a national, multicenter, observational, prospective registry based on the examination of treatment of critical Limb IscheMia with infragenicular Bypass adopting the in situ SAphenous VEin technique (LIMBSAVE).MethodsFrom January 2018 until October 2019, 428 patients from 41 centers were enrolled in the LIMBSAVE registry. Data were prospectively collected in a dedicated database, including demographics, preoperative risk factors, clinical and diagnostic preoperative assessments, intraoperative measures (including safety and effectiveness of the valvulotome during the surgical procedures), and 30-day follow-up data. Furthermore, estimated six-month outcomes according to Kaplan-Meier curves in terms of primary patency, primary assisted patency, secondary patency, and limb salvage were evaluated.ResultsPatients were predominantly male (n = 332, 77.6%) with a mean age of 73.3 years (range 39-95). Technical success, defined as bypass pulse after use of the valvulotome, was obtained in all cases. The proximal anastomosis could be reached by the valvulotome in all cases. The mean number of valvulotome uses was 2.5 (range 1-5). No vein perforation was reported. In nine cases (2.1%), a vein lesion with intramural hemorrhage occurred. The mean length of hospital stay was 11.1 days (range 1-60). At 30-day follow-up, the overall bypass patency rate was 97.4%, and the rate of open or endo reinterventions for failing bypass was 5.4%. At six-month follow-up, the estimated primary patency, primary assisted patency, secondary patency, and limb salvage were 78.1%, 86.2%, 92.1%, and 94.7%, respectively.ConclusionsPreliminary intraprocedural outcomes of the LIMBSAVE registry show that the in situ technique with the valvulotome is safe and effective in disrupting v

Published
2021

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