Search

Objectives: The potential benefit of surgery for malignant pleural mesothelioma (MPM), especially concerning pleurectomy/decortication (P/D), is unclear from the literature. The aim of this study was to evaluate the outcome after multimodality treatment of MPM involving different types of P/D and to analyse the prognostic factors., Methods: We reviewed 314 patients affected by MPM who were operated on in 11 Italian centres from 1 January 2007 to 11 October 2014., Results: The characteristics of the population were male/female ratio: 3.7/1, and median age at operation was 67.8 years. The epithelioid histotype was observed in 79.9% of patients; neoadjuvant chemotherapy was given to 57% of patients and Stage III disease was found following a pathological analysis in 62.3% of cases. A total of 162 (51.6%) patients underwent extended P/D (EP/D); 115 (36.6%) patients had P/D and 37 (11.8%) received only a partial pleurectomy. Adjuvant radiotherapy was delivered in 39.2% of patients. Median overall survival time after surgery was 23.0 [95% confidence interval (CI): 19.6-29.1] months. On multivariable (Cox) analysis, pathological Stage III-IV [ P  = 0.004, hazard ratio (HR):1.34; 95% CI: 1.09-1.64], EP/D and P/D ( P  = 0.006, HR for EP/D: 0.46; 95% CI: 0.29-0.74; HR for P/D: 0.52; 95% CI: 0.31-0.87), left-sided disease ( P  = 0.01, HR: 1.52; 95% CI: 1.09-2.12) and pathological status T4 ( P  = 0.0003, HR: 1.38; 95% CI: 1.14-1.66) were found to be independent significant predictors of overall survival., Conclusions: Whether the P/D is extended or not, it shows similarly good outcomes in terms of early results and survival rate. In contrast, a partial pleurectomy, which leaves gross tumour behind, has no impact on survival., (© The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Objective: Aim of this study is to evaluate whether Myasthenia Gravis (MG) might influence Overall Survival (OS) and Cumulative Incidence of Recurrence (CIR) in thymoma patients., Methods: this is a multicenter retrospective study of patients operated in 6 high-volume Italian Institutions between 1990 and 2012. OS was estimated by the Kaplan-Meier method and CIR by considering death from any cause as a competing event. Crude and adjusted comparisons by MG for OS and CIR were performed using Cox and Fine&Gray models. Adjusted models included MG, age, gender, stage, histology, induction therapy, completeness of resection, adjuvant therapy., Results: Seven hundred ninety-seven patients were included: 375 (47%) had MG. MG patients were younger and more frequently female, with a B2-B3 thymoma. At the end of the study, 129 patients (54 with MG) developed a recurrence and 165 (66 with MG) died. At univariate analysis, MG showed a slight protective effect on OS, not confirmed by the multivariate model. Age, incomplete resection, advanced stages and thymic carcinoma were negative prognostic variables. Univariate analyses showed no evidence of MG protective effect on CIR. Advanced stages and induction therapy were significant negative predictors., Conclusion: our study showed that MG was significantly associated with female, lower age and B2-B3 thymoma; it demonstrated a slight protective effect on OS at the univariate analysis which was not confirmed in multivariate as well as no impact on CIR. Advanced tumor stages and thymic carcinoma histology for OS and induction therapy and advanced stages for CIR were negative prognostic variables., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Objectives: Despite impressive results in diagnosis and treatment of non-small-cell lung cancer (NSCLC), more than 30% of patients with Stage I NSCLC die within 5 years after surgical treatment. Identification of prognostic factors to select patients with a poor prognosis and development of tailored treatment strategies are then advisable. The aim of our study was to design a model able to define prognosis in patients with Stage I NSCLC, submitted to surgery with curative intent., Methods: A retrospective analysis of two surgical registries was performed. Predictors of survival were investigated using the Cox model with shared frailty (accounting for the within-centre correlation). Candidate predictors were: age, gender, smoking habit, morbidity, previous malignancy, Eastern Cooperative Oncology Group performance status, clinical N stage, maximum standardized uptake value (SUV(max)), forced expiratory volume in 1 s, carbon monoxide lung diffusion capacity (DLCO), extent of surgical resection, systematic lymphadenectomy, vascular invasion, pathological T stage, histology and histological grading. The final model included predictors with P < 0.20, after a backward selection. Missing data in evaluated predictors were multiple-imputed and combined estimates were obtained from 10 imputed data sets., Results: Analysis was performed on 848 consecutive patients. The median follow-up was 48 months. Two hundred and nine patients died (25%), with a 5-year overall survival (OS) rate of 74%. The final Cox model demonstrated that mortality was significantly associated with age, male sex, presence of cardiac comorbidities, DLCO (%), SUV(max), systematic nodal dissection, presence of microscopic vascular invasion, pTNM stage and histological grading. The final model showed a fair discrimination ability (C-statistic = 0.69): the calibration of the model indicated a good agreement between observed and predicted survival., Conclusions: We designed an effective prognostic model based on clinical, pathological and surgical covariates. Our preliminary results need to be refined and validated in a larger patient population, in order to provide an easy-to-use prognostic tool for Stage I NSCLC patients., (© The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Objectives: In thymomas, the roles of Masaoka-Koga stage, histology and the presence of myasthenia gravis (MG) have been considered fundamental for patient management and outcomes. In this study, we retrospectively evaluated several clinical variables, with the aim of outlining their relationships and clinical/prognostic significance in resected thymoma patients., Methods: A retrospective search of our surgical database for patients operated on for thymoma in six Italian high-volume thoracic surgery centres between 2000 and 2011 was conducted. The following clinical variables were evaluated: Masaoka-Koga Stage, tumour histology, the presence of MG, other autoimmune syndromes or second tumours, the completeness of tumour resection and the development of recurrences., Results: Five hundred and thirty-seven (273 males-51%) were retrospectively included in this study. Our results indicate that: (i) MG correlates with early Masaoka-Koga stage and B-type thymoma; (ii) Stage III-IVa tumours correlate with B-type tumour; (iii) autoimmune paraneoplastic syndromes correlate with Stage I-II thymoma; (iv) second malignancies correlate with the absence of paraneoplastic disorders and weakly with B-type tumour and (v) overall survival was influenced by Masaoka-Koga stage and completeness of surgical resection., Conclusions: In thymomas, Masaoka-Koga stage, histology, MG, other autoimmune syndromes and second malignancies are inter-related, but only Masaoka-Koga tumour stage, amid these clinical variables, has been demonstrated to be a strong prognostic indicator of survival., (© The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Objective: Thymic carcinoma (TC) is a rare and invasive mediastinal tumor, with poor prognosis. Most of the previous published papers are single-institution based, reporting small series of patient, sometimes including palliative resection. This study collected patients with TC treated in 5 high-volume Italian Thoracic Surgery Institutions., Methods: A multicenter retrospective study of patients operated for TC between 2000 and 2011 was conducted. Exclusion criteria were: Neuroendocrine thymic neoplasms, debulking/palliative resection and tumor biopsy. Cause specific survival (CSS) was the primary endpoint., Results: Four hundred and seventy-eight patients underwent surgery for thymic malignancies: 40 of them (8.4%) had TC. Eleven (27.5%) received induction chemotherapy because of their radiological invasiveness. A complete resection (R0) was achieved in 36 (90%; 9/11 submitted to induction chemotherapy). Adjuvant radio/chemotherapy was offered to 37 patients, according to the type of surgical resection and tumor invasiveness. Three, 5 and 10-year survival rates were 79%, 75% and 58%. Recurrences developed in 10 patients. R0 resection (p<0.0003) and absence of tumor recurrences (p=0.03) resulted significant prognostic factors at univariate analysis. Independent CSS predictor was the achievement of a complete resection (p<0.05)., Conclusions: TC is a rare and invasive mediastinal tumor. A multimodal approach is indicated especially in TC invasive forms. The achievement of a complete surgical resection is fundamental to improve survival., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Objectives: Previous studies of the human fibrinogen-thrombin patch TachoSil® for air leak management in thoracic surgery have excluded patients undergoing redo surgery, a group at high risk of persistent air leaks. This is the first study to assess TachoSil® in patients undergoing redo surgery., Methods: Patients who had undergone pulmonary resection for primary lung cancer or lung metastasis and were scheduled for completion lobectomy plus lymphadenectomy due to tumour recurrence were eligible. After complete lobectomy, patients with intraoperative Macchiarini grade 3 air leaks (or >30% of the tidal volume at plethysmographic assessment) were randomized to receive either TachoSil® or further lung parenchymal stapling/suturing procedures according to standard surgical practice., Results: A total of 24 patients were randomized to TachoSil® (n = 13) or standard treatment (n = 11). Mean duration of surgery was significantly shorter in the TachoSil® group than in the standard group (3.6 vs 4.0 h; P = 0.023). The mean duration of air leaks was also significantly reduced in the TachoSil® group (4.7 vs 10.0 days; P < 0.001), and the removal of both the first and the second chest tubes occurred earlier (mean 3.8 vs 5.5 days; P = 0.005; and 6.1 vs 10.8 days; P < 0.001, respectively). TachoSil® was also effective in reducing persistent (≥ 9 days) air leaks (1 vs 7 patients; P = 0.008). There were no significant differences between groups in other postoperative complications. Mean length of hospital stay was significantly shorter in TachoSil®-treated patients (6.9 vs 9.5 days; P < 0.001)., Conclusions: TachoSil® was superior to standard stapling and suturing aerostatic techniques in reducing postoperative air leaks in patients undergoing redo thoracic surgery.

Aim: Prolonged air leaks remain one of the most important complication after pulmonary resection. The aim of this study was to test a new fast-track chest tube removal protocol using a new drainage system, which digitally records postoperative air leaks, compared to the traditional one, with subjective visual air leak assessment., Methods: Patients with moderate COPD undergoing lobectomy for primary lung cancer at the Department of Thoracic Surgery of the University of Torino were randomised in two groups with different chest drainage systems and different removal protocols: in Group A the drainage was removed after digitally recordered measurement of air leaks; in Group B the tube was removed according to the air leaks visualization by bubbling in the water column. The following variables were evaluated: first and second drainage removal day; overall hospital length of stay; overall hospitalization costs., Results: First and second drainages were removed sooner in those patients with the digital drainage system. An earlier drainage removal is associated with significative reduction in hospital length of stay and overall hospitalization costs., Conclusion: The digital and continuous air leak measurement reduces the hospital length of stay by a more accurate and reproductive air leaks measurement. Further studies are mandatory to corroborate our preliminary results.

Background: After the liver, the lungs represent the most frequent site of metastasis from primary tumours. Surgical treatment of lung secondary neoplasms leads to a significant improvement in survival., Methods: Between 1960-1997, 178 patients with lung metastases underwent surgery at the Thoracic Surgery Department of Turin University in a total of 193 operations. A retrospective study was made in order to identify the prognostic factors which influenced final survival in this population., Results: Overall survival was 47% after 2 years and 20% after five years. Prognosis was not influenced by the size of metastases, the type of surgery, adjuvant therapy and the number of operations on the same patient. On the other hand, useful prognostic factors were found to be the histological type of the primary tumour, the original site of the neoplasm, the number of metastases and, above all, the disease-free interval (DFI)., Conclusions: Lung metastasectomy is an important therapeutic aid in selected patients, whereas the preoperative evaluation of the above prognostic factors enables a reasonably precise prognosis to be made in most patients.

From 1980 to 1990, 1505 patients underwent thoracotomy as definitive treatment for non small cell lung cancer. Computed tomography (CT) of the chest has been used routinely since 1984 for assessment of mediastinal lymph node involvement. A total of 235 cervical mediastinoscopies and 71 anterior parasternal mediastinotomies were performed on the same patient population as preoperative staging when CT scan demonstrated mediastinal lymph nodes larger than 1 cm. Radical resections showed a constant increase in number from 70.1% in the period 1980-84 to 82.7% in the period 1985-90. Exploratory thoracotomies and thoracotomies with residual tumor showed a parallel reduction: 14.5% in 1980-84 to 7.4% in 1985-90 for the former, 15.4% in 1980-84 to 9.8% in 1985-90 for the latter. The percentage of N2 disease to the total number of thoracotomies decreased from 23.6% in 1980-81 to 11.2% in 1989-90. We conclude that a selective use of cervical mediastinoscopy and anterior parasternal mediastinotomy, based upon the results of CT scan, may have contributed to reduce the number of exploratory thoracotomies and thoracotomies with residual tumor.

The paper reports the epidemiology and causal factors of esophageal carcinoma, and compares the authors' personal experience with already published data. The clinical importance of epidemiology is stressed as a means of identifying risk factors for esophageal carcinoma, thus aiding an early diagnosis. The authors underline the central role of surgery in the treatment of esophageal carcinoma.

The study was conducted on patients with initially diagnosed tuberculosis encountered in 1986-87. A series of 269 bacterial antibiograms performed on sputum [correction of excreate] and other materials was examined in order to ascertain the resistance of Koch's bacillus to R/AMP, INH, SM and EMB. Primary drug resistance was found in 64 cases (23.79% of the total) and was isolated in 32 (11.89%), multiple in the rest. The response to the individual antibiotics was a follows resistance to INH was isolated in 11 cases (4.08%), combined with resistance to other drugs in 27 (10.03%); resistance to SM was isolated in 13 cases (4.81%) multiple in 24 (8.92%); resistance to R/AMP was isolated in 4 cases (1.48%), multiple in 14 (5.2%); resistance to EMB was isolated in 4 (1.48%) multiple in 19 (7.06%). Comparison with earlier studies in the Turin area highlights that the incidence of TB, in decline up to 1979, significantly increased in the period considered.

In this study we have considered the importance of house dust mites (Dermatophagoides farinae and pteronyssinus) in the pathogenesis of respiratory allergic diseases in Piedmont. We have identified, from 1980 to 1986, 1530 subjects with sensitization to at least one of the tested allergens; 479 of these (31.3%) were allergic to both or to one of the tested mites. Particularly 97 subjects (6.3%) were sensitized to Dermatophagoides farinae, 73 (4.8%) to Dermatophagoides pteronyssinus and 309 (20.2%) to both of them. This group included 258 males (53.9%) and 221 females (46.1%). Most of the examined subjects had shown the clinical symptoms before the 35th year of age (366 subjects, 76.4%). The mean age of beginning of clinical picture has come out to be of 27.377 +/- 11.527 SD year old. This result shows no significant differences with the mean age come out in allergic subjects to other allergens (26.939 +/- 10.755 SD); 196 subjects (40.9%) presented rhinitis-conjunctivitis, while 102 subjects presented bronchial asthma-rhinitis-conjunctivitis. We have found that bronchial asthma (alone or with other symptoms) was present in 186 subjects (38.8%), while in the allergic subjects sensitized to other allergens was present only in 299 out of 1051 (28.4%); 277 subjects had continuous symptoms (57.8%) while 202 subjects (42.2%) had symptoms only in some periods of the year.

Forty-one cases of laryngeal tuberculosis accounting for 0.79% of the TB cases observed in 1975-85 are examined. The M/F ratio was 9.2:1; the mean age 52 years 9 months. In all cases current or earlier tubercular lesions on the pulmonary parenchyma were also noted. The laryngeal sites affected were as follows, in order of frequency: true vocal cords, epiglottis, false cords and laryngeal ventricles, arytenoid and interarytenoid area, subglottic area. The patients were treated with R/AMP, INH, EMB or SM, EMB with satisfactory results. Two cases required exeresis of laryngeal lesions and 3 tracheotomy.

Retrospective research has been carried out on the clinical reports of 618 cases of patients suffering from silicosis admitted to the S. Luigi Gonzaga Hospital in 1973-1987 (1.4% of all pneumopathy admittances). A comparative evaluation of the five-year periods 1973-77, 1978-82, 1983-87 showed a steady reduction in the percentage of silicosis to total cases (from 1.62% to 1.55% and 1.16%). Among the 618 cases assessed, the following pneumopathies were associated with silicosis either alone or in combination: chronic obstructive bronchopneumopathy (89.4%), pulmonary tuberculosis (22.2%), bronchogenic carcinoma (8.4%), acute aspecific infections (26.1%), mycosis (0.6%), sarcoidosis (0.3%), other pneumopathies (1.1%). Comparison between the three five-year periods shows an increase in the frequency of the silicosis-carcinoma association and a fall in the silicosis-tuberculosis and silicosis-COLD associations.

In this study conducted from 1979 to 1984 we have examined 2315 subjects with rhinitis. All the subjects lived in Piedmont. The skin tests identified 1100 subjects (47.5%) allergic to at least one of the tested allergens. This group included 575 (52.3%) males and 525 (47.7%) females (males/females = 1.1). In the 6-15 age range we have found a clear predominance of males over females (112 against 57 or males/females = 2). At the time of testing, 854 patients (77.7%) were in the 6-35 age range. Only 75 subjects (6.8%) had rhinitis alone; the most common combination of symptoms encountered was rhinitis-conjunctivitis, found in 580 patients (52.7%). Symptoms were seasonal in 909 subjects (82.6%), while 191 (17.4%) were symptomatic throughout the year. Among the subjects with pollen allergy, the grass pollen accounted for the highest percentage (883 subjects or 80.3%). Among the subjects allergic to permanent inhalants Dermatophagoides Farinae (252 subjects or 22.9%) and Dermatophagoides Pteronyssinus (240 subjects or 21.8%) accounted for the largest number. Mycophyte sensitivity was negligible (36 subjects or 3.3%). In the end we have seen that grass pollen and Dermatophagoides sensitivity prefer males, while Parietaria sensitivity prefers females.