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1. Pleural Mesothelioma: Treatable Traits of a Heterogeneous Disease

Author

Bertuccio, Francesco Rocco, primary, Agustoni, Francesco, additional, Galli, Giulia, additional, Bortolotto, Chandra, additional, Saddi, Jessica, additional, Baietto, Guido, additional, Baio, Nicola, additional, Montini, Simone, additional, Putignano, Paola, additional, D’Ambrosio, Gioacchino, additional, Corsico, Angelo G., additional, Pedrazzoli, Paolo, additional, and Stella, Giulia Maria, additional

Published
2023
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2. 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

3. Liquid Biopsy Detecting Circulating Tumor Cells in Patients with Non-Small Cell Lung Cancer: Preliminary Results of a Pilot Study

Author

Mastromarino, Maria Giovanna, primary, Parini, Sara, additional, Azzolina, Danila, additional, Habib, Sara, additional, De Marni, Marzia Luigia, additional, Luise, Chiara, additional, Restelli, Silvia, additional, Baietto, Guido, additional, Trisolini, Elena, additional, Massera, Fabio, additional, Papalia, Esther, additional, Bora, Giulia, additional, Carbone, Roberta, additional, Casadio, Caterina, additional, Boldorini, Renzo, additional, and Rena, Ottavio, additional

Published
2023
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7. Standardized uptake value and radiological density attenuation as predictive and prognostic factors in patients with solitary pulmonary nodules: our experience on 1,592 patients

Author

Divisi, Duilio, Barone, Mirko, Bertolaccini, Luca, Rocco, Gaetano, Solli, Piergiorgio, Crisci, Roberto, Italian Vats Group, Ampollini, Luca, Alloisio, Marco, Andreetti, Claudio, Amore, Dario, Baietto, Guido, Bandiera, Alessandro, Benato, Cristiano, Benetti, Diego, Benvenuti, Mauro, Bertani, Alessandro, Bortolotti, Luigi, Bottoni, Edoardo, Camplese, Pierpaolo, Carbognani, Paolo, Cardillo, Giuseppe, Carleo, Francesco, Casadio, Caterina, Cavallesco, Giorgio, Curcio, Carlo, Denegri, Andrea, Di Rienzo, Gaetano, Dolci, Giampiero, Droghetti, Andrea, Gasparri, Roberto, Ghisalberti, Marco, Gonfiotti, Alessandro, Guerrera, Francesco, Imperatori, Andrea, Infante, Maurizio, Lausi, Paolo, Londero, Francesco, Lopez, Camillo, Luzzi, Luca, Maineri, Paola, Maniscalco, Pio, Marulli, Giuseppe, Monteverde, Marco, Morelli, Angelo, Mucilli, Felice, Natali, Pamela, Negri, Giampiero, Nicotra, Samuele, Nosotti, Mario, Perkmann, Reinhold, Poggi, Camilla, Puma, Francesco, Refai, Mayed, Rinaldo, Alessandro, Rizzardi, Giovanna, Rosso, Lorenzo, Rotolo, Nicola, Russo, Emanuele, Sabatini, Armando, Spaggiari, Lorenzo, Stefani, Alessandro, Stella, Franco, Terzi, Alberto, Torre, Massimo, Vinci, Damiano, Viti, Andrea, Voltolini, Luca, Zaraca, Francesco, Divisi, Duilio, Barone, Mirko, Bertolaccini, Luca, Rocco, Gaetano, Solli, Piergiorgio, Crisci, Roberto, Italian VATS, Group, Negri, G, Ampollini, Luca, Alloisio, Marco, Andreetti, Claudio, Amore, Dario, Baietto, Guido, Bandiera, Alessandro, Benato, Cristiano, Benetti, Diego, Benvenuti, Mauro, Bertani, Alessandro, Bortolotti, Luigi, Bottoni, Edoardo, Camplese, Pierpaolo, Carbognani, Paolo, Cardillo, Giuseppe, Carleo, Francesco, Casadio, Caterina, Cavallesco, Giorgio, Curcio, Carlo, Denegri, Andrea, Di Rienzo, Gaetano, Dolci, Giampiero, Droghetti, Andrea, Gasparri, Roberto, Ghisalberti, Marco, Gonfiotti, Alessandro, Guerrera, Francesco, Imperatori, Andrea, Infante, Maurizio, Lausi, Paolo, Londero, Francesco, Lopez, Camillo, Luzzi, Luca, Maineri, Paola, Maniscalco, Pio, Marulli, Giuseppe, Monteverde, Marco, Morelli, Angelo, Mucilli, Felice, Natali, Pamela, Negri, Giampiero, Nicotra, Samuele, Nosotti, Mario, Perkmann, Reinhold, Poggi, Camilla, Puma, Francesco, Refai, Mayed, Rinaldo, Alessandro, Rizzardi, Giovanna, Rosso, Lorenzo, Rotolo, Nicola, Russo, Emanuele, Sabatini, Armando, Spaggiari, Lorenzo, Stefani, Alessandro, Stella, Franco, Terzi, Alberto, Torre, Massimo, Vinci, Damiano, Viti, Andrea, Voltolini, Luca, and Zaraca, Francesco

Subjects
Lung adenocarcinoma, Pulmonary and Respiratory Medicine, medicine.medical_specialty, VATS lobectomy, Standardized uptake value, Malignancy, Ground-glass opacity, NO, 030218 nuclear medicine & medical imaging, Maximum standardized uptake value, 03 medical and health sciences, 0302 clinical medicine, ground glass opacities, Solitary pulmonary nodule (SPN), maximum standardized uptake value, lymph node metastases, lung adenocarcinoma, Lymph node metastase, medicine, Ground glass opacities, Lymph node metastases, Lung cancer, Lymph node, business.industry, Ground glass opacitie, Nodule (medicine), medicine.disease, Primary tumor, medicine.anatomical_structure, 030220 oncology & carcinogenesis, Original Article, Radiology, medicine.symptom, business
Abstract

Background: Multislice computed tomography (MSCT) increased detection of solitary pulmonary nodules (SPNs), changing the management based on radiological and clinical factors. When 18-fluorine fluorodeoxyglucose positron emission tomography combined with computed tomography ( 18 F-FDG-PET/CT) was considered for the evaluation of nodules, the maximum standardized uptake value (SUVmax) more than 2.5 is used frequently as a cut off for malignancy. The purpose of this study is to evaluate SUVmax PET/CT and pulmonary attenuation patterns at MSCT in patients with SPN according to morphological and pathological characteristics of the lesion. Methods: A retrospective study on 1,592 SPN patients was carried out following approval by the Italian Registry of VATS Lobectomies. Results: All patients underwent VATS lobectomy. On histologic examination, 98.1% had primary or second metachronous primary lung cancers. In addition, 10.7% presented occult lymph node metastases (pN1 or pN2) on histological examination. Nodule attenuation on CT was associated with the histology of the lesion (p= 0.030); in particular, pure ground glass opacities (pGGOs) and partially solid nodules were related to adenocarcinomatous histotypes. Conversely, a significant relationship between SUVmax and age, nodule size, pathological node status (pN) was found (P=0.007, P=0.000 and P=0.002 respectively). Conclusions: Nodule attenuation can predict the histology of the lesion whereas SUVmax may relate to the propensity to lymph node metastases.

Published
2017
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8. Safety of lymphadenectomy during video-assisted thoracic surgery lobectomy. Analysis from a national database

Author

Gonfiotti, Alessandro, Bertani, Alessandro, Nosotti, Mario, Viggiano, Domenico, Bongiolatti, Stefano, Bertolaccini, Luca, Droghetti, Andrea, Solli, Piergiorgio, Crisci, Roberto, Voltolini, Luca, Curcio, Carlo, Amore, Dario, Marulli, Giuseppe, Nicotra, Samuele, De Negri, Andrea, Maineri, Paola, Di Rienzo, Gaetano, Lopez, Camillo, Divisi, Duilio, Morelli, Angelo, Russo, Emanuele, Londero, Francesco, Rosso, Lorenzo, Spaggiari, Lorenzo, Gasparri, Roberto, Baietto, Guido, Casadio, Caterina, Infante, Maurizio, Benato, Cristiano, Alloisio, Marco, Bottoni, Edoardo, Giovanardi, Andrea, Cardillo, Giuseppe, Carleo, Francesco, Stella, Franco, Dolci, Giampiero, Puma, Francesco, Vinci, Damiano, Cavallesco, Giorgio, Maniscalco, Pio, Argnani, Desideria, Ampollini, Luca, Carbognani, Paolo, Terzi, Alberto, Viti, Andrea, Negri, Giampiero, Bandiera, Alessandro, Perkmann, Reinhold, Zaraca, Francesco, Ibrahim, Mohsen, Poggi, Camilla, Mucilli, Felice, Camplese, Pierpaolo, Luzzi, Luca, Ghisalberti, Marco, Imperatori, Andrea, Rotolo, Nicola, Bortolotti, Luigi, Rizzardi, Giovanna, Torre, Massimo, Rinaldo, Alessandro, Sabbatini, Armando, Refai, Majed, Benvenuti, Mauro Roberto, Benetti, Diego, Stefani, Alessandro, Natali, Pamela, Lausi, Paolo, Guerrera, Francesco, Gonfiotti, Alessandro, Bertani, Alessandro, Nosotti, Mario, Viggiano, Domenico, Bongiolatti, Stefano, Bertolaccini, Luca, Droghetti, Andrea, Solli, Piergiorgio, Crisci, Roberto, Voltolini, Luca, Curcio, Carlo, Amore, Dario, Marulli, Giuseppe, Nicotra, Samuele, De Negri, Andrea, Maineri, Paola, Di Rienzo, Gaetano, Lopez, Camillo, Divisi, Duilio, Morelli, Angelo, Russo, Emanuele, Londero, Francesco, Rosso, Lorenzo, Spaggiari, Lorenzo, Gasparri, Roberto, Baietto, Guido, Casadio, Caterina, Infante, Maurizio, Benato, Cristiano, Alloisio, Marco, Bottoni, Edoardo, Giovanardi, Andrea, Cardillo, Giuseppe, Carleo, Francesco, Stella, Franco, Dolci, Giampiero, Puma, Francesco, Vinci, Damiano, Cavallesco, Giorgio, Maniscalco, Pio, Argnani, Desideria, Ampollini, Luca, Carbognani, Paolo, Terzi, Alberto, Viti, Andrea, Negri, Giampiero, Bandiera, Alessandro, Perkmann, Reinhold, Zaraca, Francesco, Ibrahim, Mohsen, Poggi, Camilla, Mucilli, Felice, Camplese, Pierpaolo, Luzzi, Luca, Ghisalberti, Marco, Imperatori, Andrea, Rotolo, Nicola, Bortolotti, Luigi, Rizzardi, Giovanna, Torre, Massimo, Rinaldo, Alessandro, Sabbatini, Armando, Refai, Majed, Benvenuti, Mauro Roberto, Benetti, Diego, Stefani, Alessandro, Natali, Pamela, Lausi, Paolo, and Guerrera, Francesco

Subjects
Male, Lung Neoplasms, Time Factors, medicine.medical_treatment, 030204 cardiovascular system & hematology, Logistic regression, 0302 clinical medicine, Carcinoma, Non-Small-Cell Lung, 80 and over, Prospective Studies, Lobectomy, Lung cancer, Video-assisted thoracic surgery, Adult, Aged, Aged, 80 and over, Female, Follow-Up Studies, Humans, Lymph Node Excision, Lymphatic Metastasis, Mediastinum, Middle Aged, Neoplasm Staging, Pneumonectomy, Thoracic Surgery, Video-Assisted, Treatment Outcome, Prospective cohort study, Non-Small-Cell Lung, Thoracic Surgery, General Medicine, medicine.anatomical_structure, Cardiothoracic surgery, Cardiology and Cardiovascular Medicine, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Video-Assisted, NO, 03 medical and health sciences, medicine, Rank correlation, business.industry, Carcinoma, medicine.disease, Surgery, 030228 respiratory system, Lymphadenectomy, business, Lobectomy, Lung cancer, Video-assisted thoracic surgery
Abstract

OBJECTIVES The Italian VATS Group database was accessed to evaluate whether preoperative and intraoperative factors may affect the safety of lymphadenectomy (LA) during video-assisted thoracic surgery lobectomy. METHODS All video-assisted thoracic surgery lobectomy procedures performed between 1 January 2014 and 30 March 2017 for non-small-cell lung cancer with cN0 or cN1 disease were identified in the database. LA safety was evaluated based on intraoperative (operative time, bleeding and conversion rate) and postoperative (30-day morbidity and mortality, chest drain duration and length of stay) outcomes and was correlated with the number of resected lymph nodes and the rates of nodal upstaging. Continuous variables were presented as mean ± standard deviation and compared using the unpaired t-test; the X2 test was used for categorical variables. Univariable analysis was performed on selected variables. Significant variables (P < 0.30) were entered into a Cox multivariable logistic regression model, using the overall and specific occurrence of complications as dependent variables. The Spearman's rank correlation coefficient was applied as needed. RESULTS A total of 3181 cases (2077 men, 65.3%; mean age of 69 years) met the enrolment criteria. Final pathology was consistent with adenocarcinoma (n = 2262, 67.5%), squamous cell (n = 520, 15.5%), typical (n = 184, 5.5%) and atypical carcinoid (n = 48, 1.4%) and other (n = 335, 10%). The mean number of resected lymph nodes was 13.42 ± 8.24; nodal upstaging occurred in 308 of 3181 (9.68%) cases. Six hundred and fifty-five complications were recorded in 404 (12.7%) patients; in this series, no mortality was observed. Univariable and multivariable analyses did not show any association between the extension of LA and intraoperative or postoperative outcomes. The number of resected lymph nodes and nodal upstagings showed a minimal correlation with intraoperative outcomes and a moderate correlation with postoperative air leak (p = 0.35 and p = 0.48, respectively), arrhythmia (p = 0.29 and p = 0.35, respectively), chest drain duration (p = 0.35 and p = 0.51, respectively) and length of stay (p = 0.35). CONCLUSIONS Based on the VATS Group data, video-assisted thoracic surgery LA proved to be safe and displayed good outcomes even when performed with an extended approach.

Published
2018

9. Nodal management and upstaging of disease: Initial results from the Italian VATS Lobectomy Registry

Author

Bertani, Alessandro, Gonfiotti, Alessandro, Nosotti, Mario, Ferrari, Paolo Albino, De Monte, Lavinia, Russo, Emanuele, Di Paola, Gioacchino, Solli, Piero, Droghetti, Andrea, Bertolaccini, Luca, Crisci, Roberto, Curcio, Carlo, Amore, Dario, Marulli, Giuseppe, Nicotra, Samuele, De Negri, Andrea, Maineri, Paola, di Rienzo, Gaetano, Lopez, Camillo, Morelli, Angelo, Londero, Francesco, Spaggiari, Lorenzo, Gasparri, Roberto, Baietto, Guido, Casadio, Caterina, Infante, Maurizio, Benato, Cristiano, Alloisio, Marco, Bottoni, Edoardo, Cardillo, Giuseppe, Carleo, Francesco, Stella, Franco, Dolci, Giampiero, Puma, Francesco, Vinci, Damiano, Cavallesco, Giorgio, Maniscalco, Pio, Ampollini, Luca, Carbognani, Paolo, Terzi, Alberto, Viti, Andrea, Negri, Giampiero, Bandiera, Alessandro, Perkmann, Reinhold, Zaraca, Francesco, Andretti, Claudio, Poggi, Camilla, Mucilli, Felice, Camplese, Pierpaolo, Luzzi, Luca, Ghisalberti, Marco, Imperatori, Andrea, Rotolo, Nicola, Bortolotti, Luigi, Rizzardi, Giovanna, Torre, Massimo, Rinaldo, Alessandro, Sabbatini, Armando, Refai, Majed, Benvenuti, Mauro Roberto, Benetti, Diego, Stefani, Alessandro, Natali, Pamela, Lausi, Paolo, Guerrera, Francesco, Bertani, A, Gonfiotti, A, Nosotti, M, Ferrari, Pa, De Monte, L, Russo, E, Di Paola, G, Solli, P, Droghetti, A, Bertolaccini, L, Crisci, R, Italian VATS, Group, Negri, G, Bertani, Alessandro, Gonfiotti, Alessandro, Nosotti, Mario, Ferrari, Paolo Albino, De Monte, Lavinia, Russo, Emanuele, Di Paola, Gioacchino, Solli, Piero, Droghetti, Andrea, Bertolaccini, Luca, Crisci, Roberto, Curcio, Carlo, Amore, Dario, Marulli, Giuseppe, Nicotra, Samuele, De Negri, Andrea, Maineri, Paola, di Rienzo, Gaetano, Lopez, Camillo, Morelli, Angelo, Londero, Francesco, Spaggiari, Lorenzo, Gasparri, Roberto, Baietto, Guido, Casadio, Caterina, Infante, Maurizio, Benato, Cristiano, Alloisio, Marco, Bottoni, Edoardo, Cardillo, Giuseppe, Carleo, Francesco, Stella, Franco, Dolci, Giampiero, Puma, Francesco, Vinci, Damiano, Cavallesco, Giorgio, Maniscalco, Pio, Ampollini, Luca, Carbognani, Paolo, Terzi, Alberto, Viti, Andrea, Negri, Giampiero, Bandiera, Alessandro, Perkmann, Reinhold, Zaraca, Francesco, Andretti, Claudio, Poggi, Camilla, Mucilli, Felice, Camplese, Pierpaolo, Luzzi, Luca, Ghisalberti, Marco, Imperatori, Andrea, Rotolo, Nicola, Bortolotti, Luigi, Rizzardi, Giovanna, Torre, Massimo, Rinaldo, Alessandro, Sabbatini, Armando, Refai, Majed, Benvenuti, Mauro Roberto, Benetti, Diego, Stefani, Alessandro, Natali, Pamela, Lausi, Paolo, and Guerrera, Francesco

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, Lymph node (LN), VATS lobectomy, Nodal upstaging, 030204 cardiovascular system & hematology, Resection, NO, 03 medical and health sciences, 0302 clinical medicine, medicine, Quantitative assessment, Lymph node, Surgical approach, Receiver operating characteristic, business.industry, lymph node (LN), nodal upstaging, Surgery, Dissection, medicine.anatomical_structure, 030220 oncology & carcinogenesis, Original Article, Radiology, business
Abstract

Background: VATS lobectomy is an established option for the treatment of early-stage NSCLC. Complete lymph node dissection (CD), systematic sampling (SS) or resecting a specific number of lymph nodes (LNs) and stations are possible intra-operative LN management strategies. Methods: All VATS lobectomies from the “Italian VATS Group” prospective database were retrospectively reviewed. The type of surgical approach (CD or SS), number of LN resected (RN), the positive/resected LN ratio (LNR) and the number and types of positive LN stations were recorded. The rates of nodal upstaging were assessed based on different LN management strategies. Results: CD was the most frequent approach (72.3%). Nodal upstaging rates were 6.03% (N0-to-N1), 5.45% (N0-to-N2), and 0.58% (N1-to-N2). There was no difference in N1 or N2 upstaging rates between CD and SS. The number of resected nodes was correlated with both N1 (OR =1.02; CI, 1.01–1.04; P=0.03) and N2 (OR =1.02; CI, 1.01–1.05; P=0.001) upstaging. Resecting 12 nodes had the best ability to predict upstaging (6 N1 LN or 7 N2 LN). The finding of two positive LN stations best predicted N2 upstaging [area under the curve (AUC) of receiver operating characteristic (ROC) =0.98]. Conclusions: Nodal upstaging (and, indirectly, the effectiveness of intra-operative nodal management) cannot be predicted based on the surgical technique (CD or SS). A quantitative assessment of intra-operative LN management may be a more appropriate and measurable approach to justify the extension of LN resection during VATS lobectomy.

Published
2017

10. Erratum: Nodal management and upstaging of disease: Initial results from the Italian VATS Lobectomy Registry [J Thorac Dis, 9, (2017), (2061-2070)] DOI: 10.21037/jtd.2017.06.12

Author

Bertani, Alessandro, Gonfiotti, Alessandro, Nosotti, Mario, Ferrari, Paolo Albino, De Monte, Lavinia, Russo, Emanuele, Di Paola, Gioacchino, Solli, Piero, Droghetti, Andrea, Bertolaccini, Luca, Crisci, Roberto, Curcio, Carlo, Amore, Dario, Marulli, Giuseppe, Nicotra, Samuele, De Negri, Andrea, Maineri, Paola, di Rienzo, Gaetano, Lopez, Camillo, Morelli, Angelo, Londero, Francesco, Spaggiari, Lorenzo, Gasparri, Roberto, Baietto, Guido, Casadio, Caterina, Infante, Maurizio, Benato, Cristiano, Alloisio, Marco, Bottoni, Edoardo, Cardillo, Giuseppe, Carleo, Francesco, Stella, Franco, Dolci, Giampiero, Puma, Francesco, Vinci, Damiano, Cavallesco, Giorgio, Maniscalco, Pio, Ampollini, Luca, Carbognani, Paolo, Terzi, Alberto, Viti, Andrea, Negri, Giampiero, Bandiera, Alessandro, Perkmann, Reinhold, Zaraca, Francesco, Andretti, Claudio, Poggi, Camilla, Mucilli, Felice, Camplese, Pierpaolo, Luzzi, Luca, Ghisalberti, Marco, Imperatori, Andrea, Rotolo, Nicola, Bortolotti, Luigi, Rizzardi, Giovanna, Torre, Massimo, Rinaldo, Alessandro, Sabbatini, Armando, Refai, Majed, Benvenuti, Mauro Roberto, Benetti, Diego, Stefani, Alessandro, Natali, Pamela, Lausi, Paolo, and Guerrera, Francesco

Subjects
Pulmonary and Respiratory Medicine, NO
Published
2017

13. Conversion due to vascular injury during video-assisted thoracic surgery lobectomy: A multicentre retrospective analysis from the Italian video-assisted thoracic surgery group registry

Author

Luca Bertolaccini, Fabio Davoli, Alessandro Pardolesi, Jury Brandolini, Desideria Argnani, Alessandro Bertani, Andrea Droghetti, Alessandro Gonfiotti, Duilio Divisi, Roberto Crisci, Piergiorgio Solli, Mario Nosotti, Carlo Curcio, Dario Amore, Giuseppe Marulli, Samuele Nicotra, Andrea De Negri, Paola Maineri, Gaetano di Rienzo, Camillo Lopez, Angelo Morelli, Francesco Londero, Lorenzo Spaggiari, Roberto Gasparri, Guido Baietto, Caterina Casadio, Maurizio Infante, Cristiano Benato, Marco Alloisio, Edoardo Bottoni, Giuseppe Cardillo, Francesco Carleo, Franco Stella, Giampiero Dolci, Francesco Puma, Damiano Vinci, Giorgio Cavallesco, Pio Maniscalco, Luca Ampollini, Paolo Carbognani, Alberto Terzi, Andrea Viti, Giampiero Negri, Alessandro Bandiera, Reinhold Perkmann, Francesco Zaraca, Claudio Andretti, Camilla Poggi, Felice Mucilli, Pierpaolo Camplese, Luca Luzzi, Marco Ghisalberti, Andrea Imperatori, Nicola Rotolo, Luigi Bortolotti, Giovanna Rizzardi, Massimo Torre, Alessandro Rinaldo, Armando Sabbatini, Majed Refai, Mauro Roberto Benvenuti, Diego Benetti, Alessandro Stefani, Pamela Natali, Paolo Lausi, Francesco Guerrera, Bertolaccini, Luca, Davoli, Fabio, Pardolesi, Alessandro, Brandolini, Jury, Argnani, Desideria, Bertani, Alessandro, Droghetti, Andrea, Gonfiotti, Alessandro, Divisi, Duilio, Crisci, Roberto, Solli, Piergiorgio, Nosotti, Mario, Curcio, Carlo, Amore, Dario, Marulli, Giuseppe, Nicotra, Samuele, De Negri, Andrea, Maineri, Paola, di Rienzo, Gaetano, Lopez, Camillo, Morelli, Angelo, Londero, Francesco, Spaggiari, Lorenzo, Gasparri, Roberto, Baietto, Guido, Casadio, Caterina, Infante, Maurizio, Benato, Cristiano, Alloisio, Marco, Bottoni, Edoardo, Cardillo, Giuseppe, Carleo, Francesco, Stella, Franco, Dolci, Giampiero, Puma, Francesco, Vinci, Damiano, Cavallesco, Giorgio, Maniscalco, Pio, Ampollini, Luca, Carbognani, Paolo, Terzi, Alberto, Viti, Andrea, Negri, Giampiero, Bandiera, Alessandro, Perkmann, Reinhold, Zaraca, Francesco, Andretti, Claudio, Poggi, Camilla, Mucilli, Felice, Camplese, Pierpaolo, Luzzi, Luca, Ghisalberti, Marco, Imperatori, Andrea, Rotolo, Nicola, Bortolotti, Luigi, Rizzardi, Giovanna, Torre, Massimo, Rinaldo, Alessandro, Sabbatini, Armando, Refai, Majed, Benvenuti, Mauro Roberto, Benetti, Diego, Stefani, Alessandro, Natali, Pamela, Lausi, Paolo, Guerrera, Francesco, Bertolaccini L., Davoli F., Pardolesi A., Brandolini J., Argnani D., Bertani A., Droghetti A., Gonfiotti A., Divisi D., Crisci R., Solli P., Nosotti M., Curcio C., Amore D., Marulli G., Nicotra S., De Negri A., Maineri P., di Rienzo G., Lopez C., Morelli A., Londero F., Spaggiari L., Gasparri R., Baietto G., Casadio C., Infante M., Benato C., Alloisio M., Bottoni E., Cardillo G., Carleo F., Stella F., Dolci G., Puma F., Vinci D., Cavallesco G., Maniscalco P., Ampollini L., Carbognani P., Terzi A., Viti A., Negri G., Bandiera A., Perkmann R., Zaraca F., Andretti C., Poggi C., Mucilli F., Camplese P., Luzzi L., Ghisalberti M., Imperatori A., Rotolo N., Bortolotti L., Rizzardi G., Torre M., Rinaldo A., Sabbatini A., Refai M., Benvenuti M.R., Benetti D., Stefani A., Natali P., Lausi P., and Guerrera F.

Subjects
Registrie, Male, Complications, Lung Neoplasms, medicine.medical_treatment, Iatrogenic Disease, 030204 cardiovascular system & hematology, 0302 clinical medicine, Retrospective Studie, Risk Factors, Thoracotomy, Registries, Pneumonectomy, Video-assisted thoracic surgery lobectomy, Univariate analysis, Thoracic Surgery, Video-Assisted, Thoracic Surgery, General Medicine, Treatment Outcome, Oncology, Italy, Cardiothoracic surgery, Female, Lung cancer, Human, medicine.medical_specialty, Complications, Conversion, Lung cancer, Lymph nodes dissection, Vascular injury, Video-assisted thoracic surgery lobectomy, VATS lobectomy, Video-Assisted, Vascular injury, NO, 03 medical and health sciences, medicine, Conversion, Lymph nodes dissection, Aged, Humans, Retrospective Studies, Vascular System Injuries, business.industry, Risk Factor, nutritional and metabolic diseases, Retrospective cohort study, medicine.disease, Surgery, Lung Neoplasm, 030228 respiratory system, business, Complication
Abstract

Objectives Vascular injuries are among the most severe causes of unplanned conversion during VATS lobectomies. The study aimed to analyse the incidence of vascular injuries and their risk factors during VATS lobectomy. Methods The Italian VATS lobectomy Registry was used to collect data from 66 Thoracic Surgery Units. From 2013 to October 2016 (out of more than 3,700 patients enrolled) only information from Units with an enrollment >100 VATS lobectomies were retrospectively analysed. Logistic regression analysis was performed on selected variables of the univariate analysis. Results Ten institutions contributed a total of 1,679 patients. Vascular injuries leading to conversion occurred in 44 (2.6%) patients. Years of experiences were inversely related to the risk of vascular injuries. Univariate analysis showed age, gender, surgical activity, Charlson Index Score and number of resected lymph nodes like significantly associated variables. Multivariate analysis revealed that number of resected lymph nodes, VATS experience ratio (number of VATS lobectomies/total lobectomies performed in the same year at same centre), and surgical activity of the centre were significantly associated with the risk of conversion. Unplanned thoracotomy was correlated with postoperative morbidity. Conclusion Vascular injuries in VATS lobectomies represented a rare complication which could directly affect the postoperative outcomes. The predictive factors for conversion were multifactorial and depended on characteristics of centres and surgeons’ seniority. Minimally invasive VATS lobectomy approaches did not influence the risk of vascular damages.

Published
2019

14. Comparison of frailty indexes as predictors of clinical outcomes after major thoracic surgery.

Author

Parini S, Azzolina D, Massera F, Garlisi C, Papalia E, Baietto G, Bora G, Mastromarino MG, Barini M, Ruffini E, Carriero A, and Rena O

Abstract

Background: Despite greater appreciation for the importance of frailty in surgical patients, due to improved understanding that frailty is often linked to poor outcomes, the optimal method of assessment remains unknown. In this study, we sought to evaluate the prevalence of frailty in patients considered for elective thoracic surgery and to test the ability of several frailty measurements to predict postoperative outcomes., Methods: Patients included were candidates for major elective thoracic surgery. Preoperative assessment of frailty included the Fried frailty phenotype, the Edmonton Frail Scale (EFS), the modified frailty index (mFI), the Clinical Frailty Scale (CFS), and additional components of frailty. Outcome data include days with chest drain, length of hospital stay, and postoperative adverse events., Results: According to the Fried frailty phenotype, 53% of 94 patients included were prefrail or frail. A significant association between frailty and postoperative complications was found (odds ratio 7.65; P=0.001). No association between CFS, mFI, EFS, and complications was observed. The Frailty Phenotype seemed the most accurate in predicting postoperative complications, with an area under the curve (AUC) of 0.77. Twenty-seven percent of patients meet the criteria for depression according to the Geriatric Depression Scale and they showed a higher risk of postoperative complications (OR 2.47; P=0.03). A lower psoas muscle index was associated with a higher risk of complications (OR 3.40; P=0.04)., Conclusions: According to our results, the Fried frailty phenotype seems the most accurate tool to test frailty in patients undergoing thoracic resections. Surgeons should be aware that, although these aspects are not routinely tested, they are potential targets to improve clinical outcomes. Studies on additional interventions specifically targeting frail people in the setting of elective thoracic surgery are required., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-23-963/coif). The authors have no conflicts of interest to declare., (2024 Journal of Thoracic Disease. All rights reserved.)

Published
2024
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15. The Redax ® Coaxial Drain in pulmonary lobectomy: a study of efficacy.

Author

Rena O, Parini S, Papalia E, Massera F, Turello D, Baietto G, and Casadio C

Abstract

Background: Pleural drainage is required after pulmonary lobectomy to evacuate air-leak and fluid. We compared the performance of the new Redax ® Coaxial Drain (CD) (Redax, Mirandola, Italy) with a standard chest tube (CT) in terms of fluid and air-leak evacuation., Methods: Fifty-two patients receiving a 24-F CD under water-seal after pulmonary lobectomy through open surgery or video-assisted thoracic surgery (VATS) were matched according to demographic, clinical and pathological variables with 104 patients receiving a 24-F CT. Fluid evacuation and post-operative day 0 (POD0) fluid evacuation rate, air-leak rate, tension pneumothorax or increasing subcutaneous emphysema, tube occlusion at removal, visual analog scale (VAS) score at rest and during cough, chest drain duration, pleural fluid accumulation or residual pleural cavity after tube removal, post-operative morbidity and mortality rate were recorded and compared between the two groups., Results: No differences were recorded in post-operative morbidity and mortality rates. Fluid drainage rates on POD0 were significantly higher in CD group (73% vs . 48%; P=0.004); air-leak occurrence was similar in both groups and no differences were recorded in terms of tension pneumothorax or increasing subcutaneous emphysema rates; VAS score was lower for CD when compared with CT and it reached significant difference in the subgroups of patients operated on by VATS; no cases of occlusion at removal were recorded in CD patient., Conclusions: Redax ® CD is safe and efficient in air-leak and fluid evacuation; due to its design and constituting material it is superior to standard CTs in terms of fluid evacuation rate and patient post-operative comfort., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.

Published
2017
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