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Simple Summary: This study compared two types of surgery for lung cancer: robot-assisted thoracic surgery (RATS) and video-assisted thoracic surgery (VATS). The researchers looked at the results of 613 patients with similar characteristics who had surgery between 2015 and 2020. They found that RATS took longer than VATS, but there was less bleeding with RATS. The two types of surgery were similar in terms of other outcomes, such as complications after surgery, duration of hospital stay, readmissions, and deaths. More research is needed to see if one surgical approach has significant benefits over the other. Robot-assisted thoracic surgery (RATS) has gained popularity for the treatment of lung cancer, but its quality outcome measures are still being evaluated. The purpose of this study was to compare the perioperative outcomes of lung cancer resection using RATS versus video-assisted thoracic surgery (VATS). To achieve this aim, we conducted a retrospective analysis of consecutive patients who underwent lung cancer surgery between July 2015 and December 2020. A propensity-matched analysis was performed based on patients' performance status, forced expiratory volume in 1 s% of predicted, diffusing capacity of the lungs for carbon monoxide% of predicted, and surgical procedure (lobectomy or segmentectomy). Following propensity matching, a total of 613 patients were included in the analysis, of which 328 underwent RATS, and 285 underwent VATS, with satisfactory performance indicators. The results of the analysis indicated that RATS had a significantly longer operating time than VATS (132.4 ± 37.3 versus 122.4 ± 27.7 min; mean difference of 10 min 95% CI [confidence interval], 4.2 to 15.9 min; p = 0.001). On the other hand, VATS had a significantly higher estimated blood loss compared to RATS (169.7 ± 237.2 versus 82.2 ± 195.4 mL; mean difference of 87.5 mL; 95% CI, 48.1 to 126.8 mL; p < 0.001). However, there were no significant differences between the groups in terms of the duration of chest tubes, length of hospital stay, low- and high-grade complications, as well as readmissions and mortality within 30 days after surgery. Moreover, the number of dissected lymph-node stations was significantly higher with VATS than RATS (5.9 ± 1.5 versus 4.8 ± 2.2; mean difference of 1.2; 95% CI, 0.8 to 1.5; p = 0.001). Nonetheless, the percentage of patients who were upstaged after histopathological analysis of the resected lymph nodes was similar between the two groups. In conclusion, RATS and VATS yielded comparable results for most of the short-term outcomes assessed. Further research is needed to validate the implementation of RATS and identify its potential benefits over VATS. [ABSTRACT FROM AUTHOR]

Background. Complete surgical resection represents one of the most important prognostic factors for thymomas. However, surgery is usually not considered when there is invasion of the pulmonary hilum and mediastinal veins because of technical considerations or potential perioperative morbidity and mortality. Case Presentation. We present the case of a 37-year-old woman with a giant thymoma infiltrating the superior vena cava, left brachiocephalic vein, and most of the right lung. Following 3 cycles of chemotherapy with minimal tumour response, she was hospitalised with COVID-19 and refused further systemic treatment. She subsequently underwent surgery after a thorough preoperative evaluation. Surgical resection of the tumour was performed with concomitant right pneumonectomy and reconstruction of the superior vena cava and left brachiocephalic vein using expanded-polytetrafluoroethylene grafts through a median sternotomy combined with a clamshell incision. Histopathological analysis of the resected specimens demonstrated a type B2, Masaoka-Koga stage IVa thymoma that was completely resected. Following an uneventful course, she was discharged home on the ninth postoperative day with anticoagulation therapy. She has remained free of disease or adverse events after a 12-month follow-up. Conclusions. Complete surgical resection of invasive thymomas with concomitant pneumonectomy and venous graft reconstruction is a feasible and safe procedure. Careful patient selection and adequate postoperative anticoagulation are crucial for successful clinical outcomes. [ABSTRACT FROM AUTHOR]

A recent analysis of the European Society of Thoracic Surgeons database compared video-assisted thoracic surgery (VATS) and open thoracotomy for lobectomy in obese lung cancer patients. The study found that VATS was associated with reduced postoperative complications and shorter hospital stays. However, open surgery may still be necessary in certain cases, such as loco-regionally advanced disease or dense pleural adhesions. The authors suggest that analyzing differences in postoperative complications between surgical approaches could help refine management strategies and improve care. Specifically, they recommend providing details on the specific complications that drove the difference in major cardiopulmonary complications between VATS and open surgery. [Extracted from the article]

The recurrence rate following thymoma surgery has been reported to be as high as 29%. In cases of localized recurrence, complete resection can result in prolonged patient survival. However, surgery is rarely considered in cases of invasive recurrent thymomas with high disease burden. Here, we present the case of a woman with type B2 thymoma (Masaoka–Koga stage IVa) treated with surgery, chemotherapy, and radiotherapy. The disease recurred 6 years later, with invasion of the left lung and the 12th thoracic vertebra, as well as extension into the retroperitoneum. Due to the development of chemotherapy-associated toxicity, she underwent surgery with complete tumor resection and has remained free of disease at a 12-months follow-up. Radical surgery for recurrent invasive thymoma extending through the diaphragm is a feasible and safe therapeutic option in highly selected patients who are not eligible for systemic treatments. [ABSTRACT FROM AUTHOR]

Multicentric Castleman disease (MCD) causes an extensive range of systematic symptoms and can be life-threatening if not treated promptly and appropriately. The pathophysiology of the disease remains unclear; however, interleukin 6 (IL-6) pathway and human herpesvirus 8 infection appear to play an important role. As a result, the treatment of MCD remains complex and often insufficient, although a plethora of therapeutic approaches have been used. Between these, biological agents in the form of monoclonal antibodies against specific pathogenic processes of the disease have improved survival rates significantly. In the present study, we review the clinical results of rituximab, which targets B lymphocytes, siltuximab and tocilizumab, which target the IL-6 pathway, bortezomib, which is a selective proteasome inhibitor, and anakinra, which is an interleukin 1 receptor antagonist. The introduction of these biological agents in the treatment of MCD appears to be promising in the first studies performed. However, more clinical trials are required to assess the efficacy and safety of each agent and to form therapeutic strategies that will be widely accepted. [ABSTRACT FROM AUTHOR]

This study compares long-term outcomes in patients undergoing video-assisted thoracic surgery (VATS) and robotic-assisted thoracic surgery (RATS) lobectomy for non-small cell lung cancer (NSCLC); all consecutive patients who underwent RATS or VATS lobectomy for NSCLC between July 2015 and December 2021 in our center were enrolled in a single-center prospective study. The primary outcomes were overall survival (OS), disease-free survival (DFS), and recurrence rate. The secondary outcomes were complication rate, length of hospitalization (LOS), duration of chest tubes (LOD), and number of lymph node stations harvested. A total of 619 patients treated with RATS (n = 403) or VATS (n = 216) were included in the study. There was no significant difference in OS between the RATS and VATS groups (3-year OS: 75.9% vs. 82.3%; 5-year OS: 70.5% vs. 68.5%; p = 0.637). There was a statistically significant difference in DFS between the RATS and VATS groups (3-year DFS: 92.4% vs. 81.2%; 5-year DFS: 90.3% vs. 77.6%; p < 0.001). Subgroup analysis according to the pathological stage also demonstrated a significant difference between RATS and VATS groups in DFS in stage I (3-year DFS: 94.4% vs. 88.9%; 5-year DFS: 91.8% vs. 85.2%; p = 0.037) and stage III disease (3-year DFS: 82.4% vs. 51.1%; 5-year DFS: 82.4% vs. 37.7%; p = 0.024). Moreover, in multivariable Cox regression analysis, the surgical approach was significantly associated with DFS, with an HR of 0.46 (95% CI 0.27–0.78, p = 0.004) for RATS compared to VATS. VATS lobectomy was associated with a significantly higher recurrence rate compared to RATS (21.8% vs. 6.2%; p < 0.001). LOS and LOD, as well as complication rate and in-hospital and 30-day mortality, were similar among the groups. RATS lobectomy was associated with a higher number of lymph node stations harvested compared to VATS (7 [IQR:2] vs. 5 [IQR:2]; p < 0.001). In conclusion, in our series, RATS lobectomy for lung cancer led to a significantly higher DFS and significantly lower recurrence rate compared to the VATS approach. RATS may allow more extensive nodal dissection, and this could translate into reduced recurrence. [ABSTRACT FROM AUTHOR]

Post-operative quality of life (QOL) has become crucial in choosing operative approaches in thoracic surgery. However, compared to VATS and thoracotomy, QOL results post-RATS are limited. We compared QOL before and after RATS and between RATS, VATS, and thoracotomy. We conducted a retrospective review of lung cancer surgical patients from 2015 to 2020. Patients completed validated EORTC QOL questionnaires (QLQ-C30 and QLQ-LC13). Results were analysed using the EORTC Scoring Guide, with statistical analysis. A total of 47 (94%) pre- and post-RATS questionnaires were returned. Forty-two patients underwent anatomical lung resections. In addition, 80% of patients experienced uncomplicated recovery. All global and functional QOL domains improved post-operatively, as did most symptoms (13/19). Only four symptoms worsened, including dyspnoea (p = 0.017), with two symptoms unchanged. Of the 148 returned questionnaires for all approaches (open-22/VATS-79/RATS-47), over 70% showed a high pre-operative performance status. Most patients underwent anatomical lung resection, with only VATS patients requiring conversion (n = 6). Complications were slightly higher in RATS, with one patient requiring re-intubation. RATS patients demonstrated the highest global and functional QOL. Physical QOL was lowest after thoracotomy (p = 0.002). RATS patients reported the fewest symptoms, including dyspnoea (p = 0.046), fatigue (p < 0.001), and pain (p = 0.264). Overall, RATS results in a significantly better post-operative QOL and should be considered the preferred surgical approach for lung cancer patients. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide OBJECTIVES We seek to identify preoperative prognostic factors and measure their effect on 5-year survival following pulmonary metastasectomy (PM) for Colorectal Cancer (CRC). METHODS We systematically reviewed the databases of Cochrane Library, MEDLINE, Embase and Google Scholar from January 2000 to April 2021 to identify preoperative factors that have been investigated for their prognostic effect on survival following PM. Quality assessment was performed using the QUIPS tool. The prognostic effect of each identified factor on 5-year survival post-PM was estimated using random-effects meta-analyses. RESULTS We identified 115 eligible articles which included 13 294 patients who underwent PM from CRC. The overall 5-year survival after resection of the lung metastasis was 54.1%. The risk of bias of the included studies was at least moderate in 93% (107/115). Seventy-seven preoperative factors had been investigated for their prognostic effect. Our analysis showed that 11 factors had favourable and statistically significant prognostic effect on 5-year survival post-PM. These included solitary metastasis, size <2 cm, unilateral location, N0 thoracic disease, no history of extra-thoracic or liver metastasis, normal carcinoembryonic antigen levels both before PM and CRC excision, no neo-adjuvant chemotherapy before PM, CRC T-stage < T4 and no p53 mutations on CRC. Disease-free interval at 24 months did not appear to affect 5-year survival. CONCLUSIONS Despite the considerable risk of bias in the literature, our study consolidates the available evidence on preoperative prognostic factors for PM from CRC. These findings can complement both clinical practice and the design of future research on the field of PM. [ABSTRACT FROM AUTHOR]

Massive hemoptysis is a life-threatening medical condition which usually occurs in the course of parenchymal destructive diseases. We herein report the case of a 61-year-old male patient who presented with massive hemoptysis six months after commencement of dual antiplatelet therapy with acetylsalicylic acid and ticagrelor, for drug-eluting coronary stents. Control of bleeding with discontinuation of both antiplatelet agents, as well as negative imaging and laboratory studies for other pulmonary hemorrhage causes, indicate that either of the antiplatelet drugs or combination thereof was the cause of the pulmonary hemorrhage. In contrast to the previous limited case reports with pulmonary hemorrhage early during antiplatelet therapy with ticagrelor, this case highlights that it can even occur later in the course of antiplatelet therapy. [ABSTRACT FROM AUTHOR]

It is well established that patients with non-small-cell lung cancer (NSCLC) and an isolated brain or adrenal metastasis are amenable to resection of both the primary tumour and the metastasis [2]. With regard to the status of LN metastasis in the N1 lesion, among patients on observation alone, 135 (76.3%) had LN metastasis in the N1 lesion. Non-metastatic LNs and SND areas where LNs were not dissected [i.e. the lower mediastinal area in patients with an upper-lobe tumour and lobespecific nodal dissection (LND)]. [Extracted from the article]

Massive hemoptysis is a life-threatening medical condition which usually occurs in the course of parenchymal destructive diseases. We herein report the case of a 61-year-old male patient who presented with massive hemoptysis six months after commencement of dual antiplatelet therapy with acetylsalicylic acid and ticagrelor, for drug-eluting coronary stents. Control of bleeding with discontinuation of both antiplatelet agents, as well as negative imaging and laboratory studies for other pulmonary hemorrhage causes, indicate that either of the antiplatelet drugs or combination thereof was the cause of the pulmonary hemorrhage. In contrast to the previous limited case reports with pulmonary hemorrhage early during antiplatelet therapy with ticagrelor, this case highlights that it can even occur later in the course of antiplatelet therapy. [ABSTRACT FROM AUTHOR]

Pectus Excavatum (PE) or "funnel chest," the most common deformity of the anterior chest wall characterized by sternal depression, can be repaired via either operative or non-invasive techniques. Vacuum Bell (VB) device is the most widespread of the latter one which can be applied either intraoperatively or as monotherapy. The present narrative review examines the efficacy of that innovative method. A thorough search of the literature resulted in 13 English-written articles concerning VB therapy from its first description to February 2019. The studies included patients with mild to moderate PE, mainly evaluated via Haller-Index and/or sternum depth prior to and following treatment. Concerning depth-improvement, 37-90% showed amelioration while 10-40% of them an excellent correction to normal. In 42%, Haller-Index also improved with a median decrease of 0.3 after VB application. A correlation was attempted to be found between the efficacy of VB and factors such as the frequency and duration of VB application, patient age, gender, PE severity and type, and differential pressure of the suction cup. Complications may be frequent yet mild and temporary. Intraoperatively, VB widows Minimally Invasive Repair of Pectus Excavatum (MIRPE) operation a safer procedure with greater results. VB as conservative treatment is an effective and well-tolerated alternative therapeutic option for selected patients with PE who meet specific criteria. It also constitutes a device of significant efficacy, appropriate for intraoperative use during MIRPE procedure. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 (COVID-19), caused by the SARS-CoV-2, has resulted in widespread global morbidity and mortality. Herein, we report a case of spontaneous pneumomediastinum and subcutaneous emphysema of the neck and chest wall in a patient hospitalized with respiratory failure due to COVID-19. Since our patient was not treated with mechanical ventilation, this case demonstrates that spontaneous pneumomediastinum can appear in patients with COVID-19 regardless of barotrauma and highlights the pathophysiology of this complication. [ABSTRACT FROM AUTHOR]

Keywords: Pulmonary metastasectomy; Prognostic factors; Lung metastases; 5-Year survival EN Pulmonary metastasectomy Prognostic factors Lung metastases 5-Year survival 1 1 1 07/04/23 20230601 NES 230601 We would like to thank Prof. Treassure I et al. i for their insightful comments on our article as we consider them leaders in the field of pulmonary metastasectomy (PM) research [[1]]. We agree with the proposal from Prof. Treassure I et al. i [[1]] to incorporate our findings in preoperative prognostic factors in future trials. However, the 5-year survival rate of 54.1% from our systematic review of nearly 10 000 patients who underwent the procedure reflects arguably the best available estimate for these patients. [Extracted from the article]

Primary hyperparathyroidism due to parathyroid adenomas may be associated with ectopic parathyroid gland localization in 20-25% of the patients. We report herein the excision of an ectopic parathyroid adenoma which was detected in the thymus gland by gamma probe intraoperatively. A 38-year-old patient presented to our clinic with a history of bilateral nephrolithiasis, chronic hypercalcaemia, and PTH elevation. A combination of Technetium-99 m sestamibi scintigraphy and Computed Tomography scan of the chest and neck revealed an ectopic parathyroid adenoma of 8.5 mm in its greatest dimension. The patient underwent sternotomy and the adenoma was found within the right lobe of the thymus gland with the intraoperative use of gamma probe. PTH detection and frozen biopsy were performed during surgery and confirmed the successful excision of the adenoma, while mild hypocalcaemia was noticed postoperatively. We conclude that accurate preoperative and intraoperative localization of an ectopic parathyroid adenoma is crucial to successful surgery. The use of at least two diagnostic modalities before surgical excision minimizes the risk of re-operation for recurrent hyperparathyroidism, while the intraoperative use of gamma probe offers a significant advantage over conventional techniques by reducing surgical time, morbidity and/or complications associated with surgical exploration. [ABSTRACT FROM AUTHOR]

The off-pump literature is divided into three eras: the "early phase" with results favouring off-pump surgery supported with randomized control trials (RCTs) mainly from Bristol, UK; an "intermediate phase" dominated by the results of the ROOBY trial and finally a more "contemporary phase" whereby the off/on-pump argument is unsettled. Although the literature has failed to project an overall superiority of off-pump versus on-pump surgery, nevertheless, small randomized control trials and large meta-analysis studies are concluding that the incidence of a stroke is less than 1 % when an aortic off-pump techniques (especially the non-touch technique) are advocated in patients with diseased ascending aorta. Furthermore, off-pump combined with hybrid procedures may lead to a reduction of adverse outcome in the aged high-risk population with concomitant poor left ventricular function and co-morbidities.The current review attempts to bring an insight onto the last ten years knowledge on the on/off-pump debate, with an aim to draw some clear conclusions in order to allow practitioners to reflect on the subject. [ABSTRACT FROM AUTHOR]

Most surgeons perform coronary bypass surgery with the aid of cardiopulmonary bypass, which inflicts a massive systemic inflammatory response to the body leading to adverse clinical outcome. In an attempt to make CABG less invasive, interest have been diverted to the off pump technique.The current review attempts to bring an insight onto the last ten years knowledge on the off-pump impact in end organ function, with an aim to draw some clear conclusions in order to allow practitioners to reflect on the subject. [ABSTRACT FROM AUTHOR]

Primary hyperparathyroidism due to parathyroid adenomas may be associated with ectopic parathyroid gland localization in 20-25% of the patients. We report herein the excision of an ectopic parathyroid adenoma which was detected in the thymus gland by gamma probe intraoperatively. A 38-year-old patient presented to our clinic with a history of bilateral nephrolithiasis, chronic hypercalcaemia, and PTH elevation. A combination of Technetium-99 m sestamibi scintigraphy and Computed Tomography scan of the chest and neck revealed an ectopic parathyroid adenoma of 8.5 mm in its greatest dimension. The patient underwent sternotomy and the adenoma was found within the right lobe of the thymus gland with the intraoperative use of gamma probe. PTH detection and frozen biopsy were performed during surgery and confirmed the successful excision of the adenoma, while mild hypocalcaemia was noticed postoperatively. We conclude that accurate preoperative and intraoperative localization of an ectopic parathyroid adenoma is crucial to successful surgery. The use of at least two diagnostic modalities before surgical excision minimizes the risk of re-operation for recurrent hyperparathyroidism, while the intraoperative use of gamma probe offers a significant advantage over conventional techniques by reducing surgical time, morbidity and/or complications associated with surgical exploration. [ABSTRACT FROM AUTHOR]

PURPOSE: Primary hyperparathyroidism due to parathyroid adenomas may be associated with an ectopic parathyroid localization in 20-25% of the patients. Between 11% and 22% of patients with primary hyperparathyroidism are estimated to have mediastinal adenomas. Most of them are found in close proximity to the thymus, with the inferior parathyroid glands originating from the third bronchial pouch with the thymus. MATERIAL‟s-METHOD‟s: A 38-year-old patient presented to our clinic with a history of bilateral nephrolithiasis, chronic hypercalcemia and PTH elevation. The use for the concordance of at least two diagnostic modalities before surgical excision minimizes the risk of re-operation for recurrent hyperparathyroidism. The combination of 99mTc sestamibi scintigraphy and CT scan of the chest and neck gave important preoperative information in our case, proceeding to a successful surgical exploration. We also used intraoperative gamma probe which offers a significant advantage over conventional techniques by reducing surgical time, morbidity and/or complications associated with surgical exploration. RESULTS: An ectopic parathyroid adenoma 8.5 mm in its greatest dimension was detected preoperatively. Intraoperatively, the patient underwent sternotomy and after the use of γ-probe adenoma the adenoma was identified inside the right lobe of the thymus gland. Intraoperative PTH detection and frozen biopsy confirmed the successful excision of the adenoma, while mild postoperative hypocalcemia was noticed. CONCLUSION: Accurate preoperative and intraoperative localization of ectopic parathyroid adenoma is crucial to successful surgery. [ABSTRACT FROM AUTHOR]