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Background: We report short and long-term results with the dedicated Synthes ® titanium plates system, introduced 5 years ago, for chest wall stabilization and reconstruction. Methods: We retrospectively analyzed (January 2010 to December 2014) 27 consecutive patients (22 males, 5 females; range 16–83 years, median age 60 years), treated with this system: primary [3] and secondary [8] chest wall tumor; flail chest [5]; multiple ribs fractures [5]; sternal dehiscence-diastasis [3]; sternal fracture [1]; sternoclavicular joint dislocation [1]; Poland syndrome [1]. Short-term results were evaluated as: operating time, post-operative morbidity, mortality, hospital stay; long-term results as: survival, plates-related morbidity, spirometric values, chest pain [measured with Verbal Rating Scale (VRS) and SF12 standard V1 questionnaire]. Results: Each patient received from 1 to 10 (median 2) titanium plates/splints; median operating time was 150 min (range: 115–430 min). Post-operative course: 15 patients (55.6%) uneventful, 10 (37%) minor complications, 2 (7.4%) major complications; no post-operative mortality. Median post-operative hospital stay was 13 days (range: 5–129 days). At a median follow-up of 20 months (range: 1–59 months), 21 patients (78%) were alive, 6 (22%) died. Three patients presented long-term plates-related morbidity: plates rupture [2], pin plate dislodgment [1]; two required a second surgical look. One-year from surgery median spirometric values were: FVC 3.31 L (90%), FEV1 2.46 L (78%), DLCO 20.9 mL/mmHg/min (76%). On 21 alive patients, 7 (33.3%) reported no pain (VRS score 0), 10 (47.6%) mild (score 2), 4 (19.1%) moderate (score 4), no-one severe (score >4); 15 (71.5%) reported none or mild, 6 (28.5%) moderate pain influencing quality of life. Conclusions: An optimal chest wall stabilization and reconstruction was achieved with the Synthes ® titanium plates system, with minimal morbidity, no post-operative mortality, acceptable operating time and post-operative hospital stay. Long-term restoration of a normal respiratory function was achieved, with minimal plates-related morbidity and chest pain.

Vascular injury is the most dreadful complication during a video-assisted thoracoscopic surgery (VATS) lobectomy and often lead to conversion to thoracotomy. While the rate of this event considerably drops with the progression on surgical team’s learning curve, however, it is always useful to have an emergency plan to deal with it. The repairing approaches described in literature are mostly based on suction-compression angiorrhaphy technique (SCAT), involving a suture on the damaged vessels. In our case-report we display a good alternative to SCAT when we are dealing with small size lesions, without resorting to conversion. A 63-year-old with lung adenocarcinoma underwent a right upper VATS lobectomy: during the procedure, an iatrogenic lesion to intrascissural upper lobe artery occurred. We made use of suction and compression but, instead of performing a suture on the vessel, we applied hemostatic matrix sealant agent. The bleeding was effectively stopped and the wound sealed, allowing us to safely carry out the lobectomy without conversion to thoracotomy. No post-operative complications were highlighted and the patient was still alive after 6 months since the procedure. Our approach could be a useful addition to techniques already described and could be easily executed by surgeons still in learning curve. This is the first case of vascular injury managed specifically with only hemostatic matrix sealant agent described in literature and it has proven effective as well as the angiorrhaphy technique when it comes to small size artery lesions. Thanks to the easiness of sealant application, execution time of our method is shorter than a more complex repair in VATS, allowing inexperienced surgeons to fix the injury with little effort.

Lung cancer is considered one of the major causes of cancer-related mortality. Our case report wishes to highlight the confusion one may have when faced with a lesion that could be a synchronous lesion or metastasis from an index lesion, and its management including whether re-do VATS is a good option. We report our case of a 68 years old male who came to our attention in March 2018 with history of weight loss and repeated chest infections. He was smoking until he was reviewed in our clinic, with a 40- pack year history. PET scan revealed an intense uptake of left lower nodule of size 3.5 cm (cT2aN0M0). He underwent uniportal VATS left basal segmentectomy and lymphadenectomy with the histopathology confirming a squamous cell carcinoma (SCC) (pT2aN0M0R0). During his follow-up, a new left upper lobe lesion was noticed in February 2019. PET scan showed increased uptake in the lesion and CT guided biopsy showed poorly differentiated SCC (cT1cN0M0). The patient underwent uniportal VATS left upper trisegmentectomy and lymphadenectomy with histopathology revealing the presence of two different lesions this time around: the larger one being a SCC with a staging of pT1cN0M0R0 and the smaller being a basaloid type of SCC with a staging of pT1aN0M0. In our opinion, the three cancerous nodules the patient developed represented multiple primary tumours arising on a background of field change rather than intrapulmonary metastasis from an index lesion (differentiating this was important from management point of view). Moreover, we managed to safely perform a redo surgery via uniportal VATS for the same sided lung lesion. This is feasible as long as the patient has an adequate cardiorespiratory function. We wish to take this opportunity to add to the literature our experience with this case of multiple primary lung cancer (MPLC).

Background: To evaluate morbidity, mortality, and survival of interventional bronchoscopy for management of critical neoplastic central airway obstruction. Methods: This is a retrospective single-center study included all consecutive patients with neoplastic central airway obstruction undergoing interventional bronchoscopy. Characteristics of obstruction, endoscopic strategy, adjuvant treatments, morbidity, mortality, and survival were recorded and then statistically analysed. Results: Our study population counted 37 patients (mean age 67±15 years old). The trachea was involved in 6 (16%), the carina in 5 (14%), and the main bronchus in 26 (70%) patients. Restore of airway patency was obtained in 33 (89%) patients. A stent was inserted in 21 (57%) patients. Adjuvant therapy was carried out in 13/37 (35%) patients. The median overall survival was 17 months. The re-opening of airway (P Conclusions: Interventional bronchoscopy is a life-saving procedure in non-surgical patients with central airway obstruction. Recanalization of airway and the administration of adjuvant therapy remain the only significant survival prognostic factors.

Insertion of silicone stent is a palliative treatment of airway stenosis in patients unfit for surgery. Follow up is mandatory for a prompt diagnosis and treatment of complications related to stent insertion. Herein, we reported a case of dislocated stent that remained undiagnosed 15 years after the insertion and caused a life-threatening obstruction of central air-way. Patient underwent emergent extraction of the stent through rigid bronchoscope. The lack of the elasticity of silicone stent and the presence of tenacious adhesions made particularly challenging this procedure. After extraction of the stent, the granulomas related to dislocated stent were resected with laser to reassure air-way patency. At last follow-up, the patient was in good clinical condition with normal air-way patency.