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The aim of the study is to evaluate clinical applications, safety, and effectiveness of a porcine-derived acellular cross-linked dermal matrix biological mesh in chest wall reconstruction.We retrospectively analyzed a prospective multicenter database of chest wall reconstructions using a biological mesh in adult patients undergoing operation between October 2013 and December 2020. We evaluated preoperative data, type of resection and reconstruction, hospitalization, 30-day morbidity and mortality, and overall survival.A total of 105 patients (36 women [34.2%]; mean age, 57.0 ± 16.1 years; range, 18-90 years) were included, they have admitted for: primary chest wall tumor (n = 52; 49.5%), secondary chest wall tumor (n = 29; 27.6%), lung hernia (n = 12; 11.4%), trauma (n = 10; 9.6%), and infections (n = 2; 1.9%). The surgical sites were preoperatively defined as at high risk of infection in 28 patients (26.7%) or as infected in 16 (15.2%) patients. Thirty-days morbidity was 30.5% (n = 32 patients); 14 patients (13.3%) had postoperative complications directly related to chest wall surgical resection and/or reconstruction. We experienced no 30-day mortality; 1-year and 2-year mortality was 8.4% and 16.8%, respectively.Biological mesh represents a valuable option in chest wall reconstruction even when surgical sites are infected or at high-risk of infections. This mesh shows low early and late postoperative complication rates and excellent long-term stability.

Backgrounds Oligometastatic Non-Small Cell Lung Cancer (NSCLC) patients represent a category without a standard therapeutic approach. However, in selected oligometastatic NSCLC, radical surgery seems to offer a good prognosis. This retrospective study aimed to analyse the long-term outcomes of synchronous oligometastatic patients treated with curative intent and identify the factors associated with better results and the proposal of a risk stratification system for classifying the synchronous oligometastatic NSCLC. Methods The medical records of patients from 18 centres with pathologically diagnosed synchronous oligometastatic NSCLC were retrospectively reviewed. The inclusion criteria were synchronous oligometastatic NSCLC, radical surgical treatment of the primary tumour with or without neoadjuvant/adjuvant therapy and radical treatment of all metastatic sites. The Kaplan – Meier method estimated survivals. A stratified backward stepwise Cox regression model was assessed for multivariable survival analyses. Results 281 patients were included. The most common site of metastasis was the brain, in 50.89 % patients. Median overall survival was 40 months (95 % CI: 29–53). Age ≤65 years (HR = 1.02, 95 % CI: 1.00–1.05; p = 0.019), single metastasis (HR = 0.71, 95 % CI: 0.45–1.13; p = 0.15) and presence of contralateral lung metastases (HR = 0.30, 95 % CI: 0.15 – 0.62; p = 0.001) were associated with a good prognosis. The presence of pathological N2 metastases negatively affected survival (HR = 2.00, 95 % CI: 1.21–3.32; p = 0.0065). These prognostic factors were used to build a simple risk classification scheme. Conclusions Treatment of selected synchronous oligometastatic NSCLC with curative purpose could be conducted safely and at acceptable 5-year survival levels, especially in younger patients with pN0 disease.

Background: In previous multicentre studies, the longest survival was observed in synchronous lung oligometastatic patients without pN2 disease. This paper aimed to identify preoperative favourable prognostic factors and propose a preoperative classification for categorising the synchronous oligometastatic non-small cell lung cancer (NSCLC). Methods: A retrospective review of prospectively collected patients was performed. The inclusion criteria were: synchronous oligometastatic NSCLC (≤5 extrapulmonary metastases), radical surgical treatment of the primary tumour and all metastatic sites (2005–2018). Exclusion criteria were: palliative surgery, recurrent lung cancer, low-performance status, follow-up information unavailable. The reverse Kaplan – Meier method estimated median overall survival (OS) and progression-free survival. A stratified backward stepwise Cox regression model was employed for multivariable survival analyses. A prognostic grouping considering all the relevant prognostic factors simultaneously was constructed, and a Receiver Operating Characteristic (ROC) curve was generated. Hosmer-Lemeshow χ statistics was used for measuring OS calibration within groups. Findings: 281 patients were included. Data from the Cox regression model were used to construct a prognostic risk classification. Four parameters (age ≤65 years, site of metastasis, clinical nodal status, and induction treatment) were used to build a risk classification. Group A: no risk factors (age ≤65 years, lung/brain metastasis, cN0, induction treatment); Group B: one risk factor (age >65 years or no lung/brain metastasis or cN1–2 or no induction treatment); Group C: two risk factors; Group D: ≥3 risk factors. The Area Under the Curve (AUC) was 0.56 (95% CI: 0.49–0.62), Hosmer-Lemeshow χ statistics was 21.3 (3 degrees of freedom, p=0.0042). Interpretations: Patient selection is critical in identifying the proper subsets of oligometastatic NSCLC. After clinical validation, this preoperative risk classification might support decision-making during the multidisciplinary team assessment and patient selection for enrolment in future randomised trials. Funding: This work was partially supported by the Italian Ministry of Health with Ricerca Corrente and 5 x 1000 funds. Declaration of Interest: All authors have no conflict of interest to declare. Ethical Approval: This research was carried out following the Helsinki Declaration 10. The Ethical Committee authorised the study (785/19).

Resumen Antecedentes Los micronodulos pulmonares solitarios (MNPS) se caracterizan por un diametro de 0,1-0,5 cm. Objetivo El objetivo de este estudio prospectivo es evaluar el abordaje quirurgico del MNPS con objeto de establecer el tratamiento mas apropiado. Metodos Entre enero del 2007 y junio del 2011, se evaluo prospectivamente a un total de 146 pacientes con MNPS, 94 varones y 52 mujeres. Se dividio a los pacientes en 2 grupos en funcion de los antecedentes de enfermedad maligna (grupo A, 59 pacientes) y los factores de riesgo genericos para el cancer de pulmon (grupo B, 87 pacientes). Tras obtener informacion sobre los pacientes, propusimos la cirugia o un seguimiento mediante tomografia computarizada de cortes finos (TCCF) a ambos grupos. Resultados La preferencia por la cirugia frente al seguimiento con TCCF fue del 90% frente al 10% en el grupo A y del 78% frente al 22% en el grupo B, respectivamente. En el grupo A detectamos 46 metastasis de un cancer previo (78%), 8 canceres primarios de pulmon (14%) y 5 lesiones benignas (8%). En el grupo B encontramos 5 metastasis (6%), 13 canceres de pulmon no microciticos (15%) y 69 lesiones benignas (79%). El analisis estadistico puso de relieve un valor predictivo positivo elevado (VPP = 0,9) para el total de pacientes quirurgicos frente a los pacientes con seguimiento mediante TCCF. Conclusiones La indicacion para la cirugia en el micronodulo pulmonar solitario tiene como finalidad establecer un diagnostico precoz y la curacion de la enfermedad maligna. Nuestro estudio indica que, en los pacientes con un cancer previo, la cirugia es imprescindible. En los pacientes con un riesgo generico de cancer de pulmon, las indicaciones quirurgicas deben ser mas cuidadosas, aun cuando un 21% de enfermedades malignas en el grupo B parece indicar en cualquier caso la conveniencia de la cirugia.

Resume Objectifs : La morbidite de la tracheotomie chirurgicale a pousse les auteurs a elaborer de nouvelles techniques d’execution. Le but de cette etude retrospective est d’evaluer la tracheotomie translaryngee (TLT) ainsi que ses complications et son cout. Patients et methodes : De janvier 1998 a janvier 2001, nous avons effectue une tracheotomie translaryngee chez 104 patients, 69 hommes (66,3 %) et 35 femmes (33,7 %), d’âge moyen 52,6 ± 9,5 ans. La pathologie d’origine etait de nature traumatique (36 cas), neurologique (37 cas), chirurgicale (9 cas), cardiaque (4 cas) ou respiratoire (18 cas). Le delai entre l’intubation et l’execution de la TLT a ete de 4,2 ± 1,3 jours. Resultats : Cinquante quatre patients sont decedes (52 %) et 50 patients sont vivants (48 %). Deux complications (1,9 %) sont a deplorer parmi les survivants : 1) la dechirure du guide metallique pendant la traction (1 cas), qui a necessite l’emploi d’un clamp pour completer l’extraction de la canule armee du cou, 2) une hemorragie au 2eme jour (1 cas), due a la rupture d’un vaisseau thyroidien, qui a necessite une tracheotomie classique pour l’hemostase. Le delai moyen de decanulation a ete de 25 ± 1 jours. Conclusion : La tracheotomie translaryngee minimise le traumatisme exerce sur la trachee et les structures adjacentes. La simplicite et la fiabilite du geste font de la TLT modifiee la methode de choix, en dehors de l’urgence, chez les enfants et les adultes, meme chez les brachytypes ou les obeses.