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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/m

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 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.

Video-assisted thoracoscopic surgery (VATS) lobectomy for patients with early-stage non-small cell lung cancer (NSCLC) has spread worldwide and it has become a safe and viable alternative to thoracotomy. The aim of this review was to analyse the evidence presents in the current literature in order to assess the safety and efficacy of VATS versus open lobectomy, in terms of short-term outcomes. To identify relevant articles for inclusion in our analysis, we performed a search of PubMed/Medline database. We looked for randomized controlled trials, case series and comparative studies that reported outcomes following VATS or open lobectomy for NSCLC. Morbidity rates are reduced to 7.7–24.1% and mortality to 0.8–2.5% by the VATS approach. The reported lower morbidity rates included less intraoperative bleeding; shorter duration of air leak; lower incidence of post-operative pneumonia, atelectasis requiring bronchoscopy and atrial fibrillation. Furthermore, VATS lobectomy showed shorter chest tube duration; shorter length of hospital stays; reduced post-operative pain and inflammation; a better pulmonary function in the early post-operative phase, when compared with thoracotomy. Summarizing, thoracoscopic approach represents a valid alternative technique to treat NSCLC compared with standard thoracotomy; it offers patients a faster recovery and a better quality of life and allows high-risk patients to benefit from curative surgical treatment. VATS lobectomy might become the choice surgical approach for early-stage NSCLC.

their anatomic proximity to other vital organs, visceral vessels are rarely injured alone (1), and isolated IMA injury as a result of blunt trauma is extremely rare. To the best of our knowledge, only one case has been reported, in which the injury involved a low-speed motor vehicle accident (2). Two mechanisms have been proposed to explain traumatic visceral artery injury. The first is shearing force causing avulsion of the artery at the junction between the retroperitoneal portion and unfixed portion of the bowel. The second mechanism is compression injury, in which the artery is crushed between the object producing the blunt force and the lumbar spine, as in the present case. In cases involving visceral branch avulsion at the orifice, embolization of the lacerated arterial stump and the arterial orifice is mandatory to achieve hemostasis. Trottier et al (3) reported a similar case with renal artery avulsion. Avulsion of the right renal polar artery originating from the right common iliac artery was treated by placing a stent graft into the right common iliac artery; however, subsequent enlargement of a retroperitoneal hematoma as a result of subclinical back-bleeding from the lacerated arterial stump led to abdominal compartment syndrome. Transcatheter embolization of lacerated IMA origins is another treatment option. Hamid et al (4) reported transcatheter embolization for lumbar artery avulsion using N-butyl cyanoacrylate (Histoacryl; B. Braun Melsungen AG, Melsungen, Germany) glue injected from the artery’s origin. However, glue injection has the potential risk of unintentional distal embolization or reflux to the aorta, and transcatheter embolization using detachable microcoils might be a safer alternative. Our method is a simple and safe method of controlling hemorrhage caused by visceral branch avulsion.

Oligometastasis represents a sub-group of systemic cancer diseases characterized by a limited (1 to 5) number of metastatic or recurrent lesions; when the disease presents in this particular state of progression the possibility to associate a local therapy to systemic treatment can lead to a favourable evolution with long-term survival and even cure. We have reviewed the literature in order to clarify the different trends of treatment in oligometastatic non-small cell lung cancer (NSCLC), particularly referring to single brain or isolated adrenal gland metastasis. The cornerstone of treatment of oligometastatic disease is still represented by systemic therapy (chemotherapy and/or immunotherapy). Local aggressive therapy (surgery and/or radiotherapy) is mandatory to eradicate all known sites of disease (primary tumor and metastases). If technically possible and in fitting patients, surgical resection represents the gold standard in the “local” treatment of isolated metastasis. Radiotherapy is considered as a noninvasive alternative to the reference of surgery in not-fitting patients. Five-year survival ranges between 10% and 30% for brain metastases and between 11% and 34% in isolated adrenal gland metastases. Mediastinal node involvement of primary lung cancer, number of metastases and number of metastatic sites are the prominent predictors of survival in brain oligometastatic disease. Synchronous or metachronous character, side of adrenal metastasis with respect to primary lung cancer and N0/N1 versus N2 lung cancer stage are the principal prognostic factors in adrenal oligometastatic disease. Oligometastatic disease seems to be a less aggressive and slowly-growing cancer, characterized by a different biological and immunological environment, with a more indolent evolution; in this subgroup of patients, if primary tumour is controlled, in the absence of disseminated metastatic disease and in fitting population, an aggressive local approach seems to be not only efficacy, but even mandatory. However it has to be integrated in the setting of a multidisciplinary approach including surgery, chemotherapy, radiotherapy, and targeted therapies.