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1. Predicting a Prolonged Air Leak After Video-Assisted Thoracic Surgery, Is It Really Possible?

Author

Mancuso, M., Pernazza, F., Refai, M., Srella, F., Argnani, D., Marulli, G., De Palma, A., Bortolotti, L., Rizzardi, G., Solli, P.G., Dolci, G.P., Perkmann, R., Zaraca, F., Benvenuti, M., Gavezzoli, D., Cherchi, R., Ferrari, P., Mucilli, F., Camplese, P., Melloni, G., Mazza, F., Cavallesco, G., Maniscalco, P., Voltolini, L., Gonfiotti, A., Sollitto, F., Ardò, N., Pariscenti, G.L., Risso, C., Surrente, C., Lopez, C., Droghetti, A., Giovanardi, M., Breda, C., Giudice, Lo F., Alloisio, M., Bottoni, E., Spaggiari, L., Gasparri, R., Torre, M., Rinaldo, A., Nosotti, M., Tosi, D., Negri, G.P., Bandiera, A., Baisi, A., Raveglia, F., Stefani, A., Natali, P., Scarci, M., Pirondini, E., Curcio, C., Amore, D., Rena, O., Nicotra, S., Dell’ Amore, A., Bertani, A., Tancredi, G., Ampollini, L., Carbognani, P., Puma, F., Vinci, D., Cardillo, G., Carleo, F., Margaritora, S., Meacci, E., Luzzi, L., Ghisalberti, M., Crisci, R., Divisi, D., Lausi, P., Guerrera, F., Fontana, D., Beffa, V. Della, Morelli, A., Londero, F., Imperatori, A., Rotolo, N., Terzi, A., Viti, A., Infante, M., Benato, C., Zaraca, Francesco, Pipitone, Marco, Feil, Birgit, Perkmann, Reinhold, Bertolaccini, Luca, Curcio, Carlo, and Crisci, Roberto

Published
2021
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2. Antithrombotic and Anti-Inflammatory Effects of Fondaparinux and Enoxaparin in Hospitalized COVID-19 Patients: The FONDENOXAVID Study

Author

Cardillo G, Viggiano GV, Russo V, Mangiacapra S, Cavalli A, Castaldo G, Agrusta F, Bellizzi Snr A, Amitrano Snr M, Iannuzzo M, Sacco C, Lodigiani C, Fontanella A, and Di Micco P

Subjects
venous thromboembolism, fibrinogen, d-dimer, covid-19, sars-cov-2, fondaparinux, enoxaparin, Diseases of the blood and blood-forming organs, RC633-647.5
Abstract

Giuseppe Cardillo,1 Giuseppe Vito Viggiano,2 Vincenzo Russo,3 Sara Mangiacapra,4 Antonella Cavalli,5 Giampiero Castaldo,2 Federica Agrusta,2 Annamaria Bellizzi Snr,5 Maria Amitrano Snr,4 Mariateresa Iannuzzo,6 Clara Sacco,7 Corrado Lodigiani,7 Andrea Fontanella,6 Pierpaolo Di Micco6 For The FondenoxavidStudy Group1Medylab, Biochimica Avanzata Laboratory, Naples, Italy; 2UO Pronto Soccorso e Medicina D’urgenza, Semintensiva Covid, Ospedale Ramazzini Di Carpi — AUSL Modena, Modena, Italy; 3Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli Monaldi Hospital, Piazzale Ettore Ruggeri, Naples 80131, Italy; 4UOC Medicina, AO Moscati, Avellino, Italy; 5UOC Medicina-Covid, Presidio Opsedaliero Frangipane Di ArianoIrpino (AV), Naples, Italy; 6UOC Medicina, Ospedale Fatebenefratelli di Napoli, Naples, Italy; 7Humanitas Clinical and Research Center IRCCS, Rozzano, ItalyCorrespondence: Pierpaolo Di Micco Email pdimicco@libero.itBackground: Since the outbreak of novel coronavirus SARS-CoV2 around the world, great attention has been paid to the effects of such antithrombotic drugs as heparinoids, because they have antiviral action in vitro and antithrombotic actions in vivo. We conducted a retrospective analysis in inpatients with confirmed COVID-19 on the anti-inflammatory and antithrombotic effects of enoxaparin and fondaparinux at prophylactic doses.Methods: This retrospective cohort study used patients with confirmed COVID-19 during the first months of the Italian outbreak from February 18 to April 30, 2020. Our aim was to compare clinical characteristics, prophylactic treatment, markers of inflammation, and thrombotic outcomes in inpatients positive for SARS-CoV2 during hospitalization associated with thromboprophylaxis with enoxaparin (40 mg or 60 mg once daily) or fondaparinux (2.5 mg once daily). Statistical analysis was conducted with using MatLab R2016B and ad hoc functions.Results: There were no significatant differences in clinical characteristics between patients that used enoxaparin or fondaparinux as thromboprophylaxis for SARS-CoV2. No differences were found in D-dimer and fibrinogen levels either, which were used as markers of inflammation during the infection at testing on admission and after 3 weeks.Significant differences in CRP, IL6, and LDH were found in patients after 21 days’ treatment.Discussion: Increased levels of fibrinogen and D-dimer in patients with confirmed COVID-19 have been reported in several studies. Our results showed that anti-inflammatory effects of fondaparinux and enoxaparin after 3 weeks of prophylactic treatment were similar when levels of fibrinogen and D-dimer were considered. Furthermore, levels of CRP showed a decrease in patients treated with enoxaparin and fondaparinux, although the decrease in the fondaparinux group seems to be more relevant.Keywords: venous thromboembolism, fibrinogen, D-dimer, COVID-19, SARS-CoV2, fondaparinux, enoxaparin

Published
2021

5. How to Prevent, Reduce, and Treat Severe Post Sympathetic Chain Compensatory Hyperhidrosis: 2021 State of the Art

Author

Raveglia, F, Orlandi, R, Guttadauro, A, Cioffi, U, Cardillo, G, Cioffi, G, Scarci, M, Raveglia F., Orlandi R., Guttadauro A., Cioffi U., Cardillo G., Cioffi G., Scarci M., Raveglia, F, Orlandi, R, Guttadauro, A, Cioffi, U, Cardillo, G, Cioffi, G, Scarci, M, Raveglia F., Orlandi R., Guttadauro A., Cioffi U., Cardillo G., Cioffi G., and Scarci M.

Abstract

The role of thoracic surgery in the management of hyperhidrosis is well-known and thoracoscopic sympathetic interruption is commonly accepted as being the most effective treatment. However, some concerns still remain regarding the potential to develop compensatory hyperidrosis (CH), the most troublesome and frequent side effect after surgery and its management. Compensatory hyperidrosis prevention may be achieved by identifying subjects at higher risk and/or targeting nerve interruption level on the base of single patient characteristics gathered during the preoperative survey. Furthermore, the surgical treatment may consist of different techniques aimed at reversing the effects of previous sympathetic interruption. To predict CH after sympathectomy, the most interesting proposals in recent literature are a temporary thoracoscopic sympathetic block and the introduction of new and targeted preoperative surveys. If the role of nerve clipping technique vs. the definitive cutting is still intensely under debated, new approaches have been recently proposed to reduce the incidence of CH. In particular, extended sympathicotomy has been described as an alternative to overcome severe forms. Last, among the techniques developed to reverse sympathetic interruption effect, diffuse sympathicotomy (DS) and microsurgical sympathetic trunk reconstruction represent advances in this field. An all-round review of these topics is strongly needed. Our aim is to cover all the above issues point by point. Although sympathectomy represents a small part of thoracic surgery, we believe that it is worthy of interest because of the profound effect that complications for a benign condition can have on patients.

Published
2022

6. Sneaky Diagnosis of Pleural Malignant Mesothelioma in Thoracic Surgery: All That Glitters Is Not Gold

Author

Orlandi, R, Bono, F, Cortinovis, D, Cardillo, G, Cioffi, U, Guttadauro, A, Pirondini, E, Canova, S, Cassina, E, Raveglia, F, Orlandi R., Bono F., Cortinovis D. L., Cardillo G., Cioffi U., Guttadauro A., Pirondini E., Canova S., Cassina E. M., Raveglia F., Orlandi, R, Bono, F, Cortinovis, D, Cardillo, G, Cioffi, U, Guttadauro, A, Pirondini, E, Canova, S, Cassina, E, Raveglia, F, Orlandi R., Bono F., Cortinovis D. L., Cardillo G., Cioffi U., Guttadauro A., Pirondini E., Canova S., Cassina E. M., and Raveglia F.

Abstract

Malignant Pleural Mesothelioma (MPM) is a highly aggressive disease whose diagnosis could be challenging and confusing. It could occur with atypical presentations on every examined level. Here, we present three unconventional cases of the complex diagnostic process of MPM that we have experienced during routine practice: a patient with reactive mesothelial hyperplasia mimicking MPM, an unexpected presentation of MPM with persistent unilateral hydropneumothorax, a rare case of MPM in situ. Then, we review the relevant literature on each of these topics. Definitive biomarkers to confidently distinguish MPM from other pleural affections are still demanded. Patients presenting with persistent hydropneumothorax must always be investigated for MPM. MPM in situ is now a reality, and this raises questions about its management.

Published
2022

7. Salvage Surgery After First-Line Alectinib for Locally-Advanced/Metastatic ALK-Rearranged NSCLC: Pathological Response and Perioperative Results

Author

Lococo, Filippo, Cancellieri, Alessandra, Chiappetta, M., Leonetti, A., Cardillo, G., Zanelli, F., Mangiameli, G., Toschi, L., Guggino, G., Romano, F. J., Leuzzi, G., Proto, C., Spaggiari, L., De Marinis, F., Vita, Emanuele, Ampollini, L., Margaritora, Stefano, Tiseo, M., Bria, Emilio, Lococo,F. (ORCID:0000-0002-9383-5554), Cancellieri,A., Vita, E., Margaritora, S. (ORCID:0000-0002-9796-760X), Bria, E. (ORCID:0000-0002-2333-704X), Lococo, Filippo, Cancellieri, Alessandra, Chiappetta, M., Leonetti, A., Cardillo, G., Zanelli, F., Mangiameli, G., Toschi, L., Guggino, G., Romano, F. J., Leuzzi, G., Proto, C., Spaggiari, L., De Marinis, F., Vita, Emanuele, Ampollini, L., Margaritora, Stefano, Tiseo, M., Bria, Emilio, Lococo,F. (ORCID:0000-0002-9383-5554), Cancellieri,A., Vita, E., Margaritora, S. (ORCID:0000-0002-9796-760X), and Bria, E. (ORCID:0000-0002-2333-704X)

Abstract

Background: The role of salvage surgery after tyrosine kinase inhibitors in advanced oncogene-addicted non-small cell lung cancer is largely unexplored. Patients: We aimed to describe the pathological features and surgical early-outcomes of Anaplastic Lymphome Kinase anaplastic lymphome kinase positive non-small cell lung cancer patients undergoing surgery after first-line alectinib treatment. We retrospectively collected and analyzed multicentric data of 10 patients treated with alectinib for advanced-stage anaplastic lymphome kinase positive lung adenocarcinoma who underwent anatomical surgical resection from January 2020 to Decemeber 2021. All patients were treatment naive and received alectinib (600 mg twice daily). Surgery was always proposed after multidisciplinary discussion. The primary endpoints were pathological response and surgical feasibility (technical intraoperative complications, postoperative outcomes). Results: Alectinib was received for a mean of 212 days before surgery (42-415 days) and was generally interrupted about one week before surgery (range: 0-32 days) with no patient experienced grade 4 toxicity. All patients received an R0 resection with surgery consisting of lobectomy in 8 cases with bilobectomy and (left) pneumonectomy in 1 case each. Intra-operative difficulties were described in 7 cases (70%), mostly due to perivascular fibrosis or thickening of mediastinal lymph nodal tissues. Major and minor complications occurred in 0 and 3 cases (30%), respectively. A pathological complete response and major pathological response (defined as 0% and < 10% viable tumor cells, respectively) were observed in 50% and 90% of cases, respectively. Despite short follow-up, only one tumor recurrence was observed (in the only patient who did not resume alectinib after surgery). Interpretation: Despite some technical intraoperative difficulties, salvage surgery was safe and feasible after Alectinib for advanced lung adenocarcinoma.

Published
2023

10. Comparison of operative and postoperative characteristics and outcomes between thoracoscopic segmentectomy and lobectomy for non-small-cell lung cancer: a propensity score matching study from the Italian VATS Group Registry

Author

Dell'Amore, A., Lomangino, I., Cannone, G., Terzi, S., Pangoni, A., Lorenzoni, G., Nicotra, S., Schiavon, M., Zuin, A., Gregori, D., Crisci, R., Curcio, C., Rea, F., Mancuso, M., Pernazza, F., Refai, M., Bortolotti, L., Rizzardi, G., Solli, P., Brandolini, I., Perkmann, R., Zaraca, F., Benvenuti, M., Gavezzoli, D., Cherchi, R., Ferrari, P., Mucilli, F., Camplese, P., Melloni, G., Mazza, F., Cavallesco, G., Maniscalco, P., Voltolini, L., Gonfiotti, A., Stella, F., Argnani, D., Pariscenti, G. L., Iurilli, S., Surrente, C., Lopez, C., Droghett, A., Giovanardi, M., Breda, C., Lo Giudice, F., Alloisio, M., Bottoni, E., Spaggiari, L., Gasparri, R., Torre, M., Rinaldo, A., Nosotti, M., Rosso, L., Negri, G. P., Bandiera, A., Stefani, A., Natali, P., Scarci, M., Pirondini, E., Amore, D., Baietto, G., Casadio, C., Bertani, A., Russo, E., Ampollini, L., Carbognani, P., Puma, F., Vinci, D., Andreetti, C., Poggi, C., Cardillo, G., Margaritora, S., Meacci, E., Luzzi, L., Ghisalberti, M., Zaccagna, G., Lausi, P., Guerrera, F., Fontana, D., Della Beffa, V., Morelli, A., Londero, F., Imperatori, N., Rotolo, A., Terzi, A., Viti, A., Infante, M., and Benato, C.

Subjects
Segmentectomy, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Lung Neoplasms, medicine.medical_treatment, VATS lobectomy, Video-assisted thoracic surgery, Context (language use), Mastectomy, Segmental, Postoperative outcome, Postoperative Complications, Lobectomy, Non-small-cell lung cancer, Carcinoma, Non-Small-Cell Lung, Humans, Medicine, Registries, Thoracotomy, Pneumonectomy, Propensity Score, Lung cancer, Retrospective Studies, Thoracic Surgery, Video-Assisted, business.industry, Confounding, Postoperative complication, General Medicine, medicine.disease, Surgery, Propensity score matching, Non small cell, Cardiology and Cardiovascular Medicine, business
Abstract

OBJECTIVES Only few studies compared the surgical morbidity and mortality of thoracoscopic segmentectomy versus lobectomy for non-small-cell lung cancer, in particular, by relating the segmental resections with the corresponding anatomical lobes. METHODS We enrolled a total of 7487 patients who underwent VATS lobectomy (7269) or segmentectomy (218) from January 2014 to July 2019. A propensity score matching approach was used to account for potential confounding factors between the 2 groups. After matching, 349 lobectomies and 208 segmentectomies were included in the analysis. We analysed the operative and postoperative outcomes of video-assisted anatomical segmentectomy compared with video-assisted lobectomy and, in details, the results of segmentectomy with its corresponding lobectomy in a large cohort of patients from the Italian VATS Group Registry. RESULTS The overall conversion rate to thoracotomy was not statistically different between the groups (27 patients 8% vs 7 patients 3%, P = 0.1). The lobectomy group had a greater number of resected lymph nodes (median 11 vs 8, P = 0.006). No significant differences were detected in 30-day mortality (1.4%, 5 patients vs 0.9%, 2 patients), overall complications (18%, 62 patients vs 14%, 29 patients) and prolonged air leakage (31 patients, 9% vs 12 patients, 6%) between lobectomy and segmentectomy, respectively. No statistical differences were found regarding the median duration of drainage (3.2 days, P = 1) and the overall median length of hospital stay (6.4 days, P = 0.1) between the 2 groups. In the context of segmentectomy versus corresponding lobectomy, the right upper lobectomy compared with right upper segmentectomy showed a higher number of resected lymph nodes (P = 0.027). No statistical differences were reported in terms of conversion rate and postoperative complication and mortality. CONCLUSIONS Segmentectomy could be considered a safe procedure without significant differences compared to thoracoscopic lobectomy in terms of postoperative morbidity and mortality.

Published
2021

11. Do we really need a chest-CT in Primary Spontaneous Pneumothorax?

Author

Ricciardi, S, primary, Giovanniello, D, additional, Carleo, F, additional, Di Martino, M, additional, Jaus, M O, additional, Mantovani, S, additional, Carbone, L, additional, Aratari, M T, additional, De Massimi, A, additional, Salvadori, L, additional, Treggiari, S, additional, and Cardillo, G, additional

Published
2022
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13. EP07.01-017 Malignant Fibrous Solitary Tumour of the Pleura Is Not All the Same: Evaluation of Risk Stratification Models in a Large Single Centre Series

Author

Ricciardi, S., primary, Giovanniello, D., additional, Di Martino, M., additional, Carleo, F., additional, Jaus, M.O., additional, Mantovani, S., additional, Salvadori, L., additional, Aratari, M.T., additional, Carbone, L., additional, De Massimi, A.R., additional, Treggiari, S., additional, and Cardillo, G., additional

Published
2022
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14. EP05.03-008 Surgery after First-Line Alectinib for (Locally) Advanced ALK-rearranged NSCLC: Pathological Response and Peri-Operative Results

Author

Lococo, F., primary, Chiappetta, M., additional, Cancellieri, A., additional, Cardillo, G., additional, Zanelli, F., additional, Mangiameli, G., additional, Toschi, L., additional, Guggino, G., additional, Romano, F., additional, Leuzzi, G., additional, Proto, C., additional, Spaggiari, L., additional, De Marinis, F., additional, Vita, E., additional, Menna, E., additional, Margaritora, S., additional, and Bria, E., additional

Published
2022
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17. The Role of Surgery in Patients with COVID-19-Related Thoracic Complications

Author

Raveglia, F, Scarci, M, Rimessi, A, Orlandi, R, Rebora, P, Cioffi, U, Guttadauro, A, Ruffini, E, Benvenuti, M, Cardillo, G, Patrini, D, Vannucci, F, Yusuf, N, Jindal, P, Cerfolio, R, Raveglia, Federico, Scarci, Marco, Rimessi, Arianna, Orlandi, Riccardo, Rebora, Paola, Cioffi, Ugo, Guttadauro, Angelo, Ruffini, Enrico, Benvenuti, Mauro, Cardillo, Giuseppe, Patrini, Davide, Vannucci, Fernando, Yusuf, Nasser, Jindal, Pramoj, Cerfolio, Robert, Raveglia, F, Scarci, M, Rimessi, A, Orlandi, R, Rebora, P, Cioffi, U, Guttadauro, A, Ruffini, E, Benvenuti, M, Cardillo, G, Patrini, D, Vannucci, F, Yusuf, N, Jindal, P, Cerfolio, R, Raveglia, Federico, Scarci, Marco, Rimessi, Arianna, Orlandi, Riccardo, Rebora, Paola, Cioffi, Ugo, Guttadauro, Angelo, Ruffini, Enrico, Benvenuti, Mauro, Cardillo, Giuseppe, Patrini, Davide, Vannucci, Fernando, Yusuf, Nasser, Jindal, Pramoj, and Cerfolio, Robert

Abstract

Objective: Patients with several thoracic complications induced by SARS-CoV-2 infection may benefit from surgery, but its role in this condition is largely unknown, and many surgeons’ advice against any surgical referrals. Our aim is to investigate the efficacy and safety of surgery in COVID-19 patients with thoracic complications requiring surgery. Methods: We designed a multicenter observational study, involving nine thoracic surgery departments, evaluating patients who developed thoracic complications in hospital, surgically managed from March 1, 2020, to May 31, 2021. An overall 30-day mortality was obtained by using the Kaplan–Meier method. Multivariable Cox regression model and logistic models were applied to identify the variables associated with mortality and postoperative complications. Results: Among 83 patients, 33 (40%) underwent surgery for complicated pneumothorax, 17 (20.5%) for pleural empyema, 13 (15.5%) for hemothorax, 8 (9.5%) for hemoptysis, 5 patients (6%) for lung abscess, 4 (5%) for infected pneumatoceles, and 3 (3.5%) for other causes. Within 30 days of surgery, 60 patients (72%) survived. At multivariable analysis, age (HR 1.05 [95% CI, 1.01, 1.09], p = 0.022), pulmonary hypertension (HR 3.98 [95% CI, 1.09, 14.5], p = 0.036), renal failure (HR 2.91 [95% CI, 1.19, 7.10], p-value 0.019), thoracotomy (HR 4.90 [95% CI, 1.84, 13.1], p-value 0.001) and infective affections (HR 0.17 [95% CI, 0.05, 0.58], p-value 0.004) were found to be independent prognostic risk factors for 30-day mortality. Age (OR 1.05 [95% CI, 1.01, 1.10], p = 0.023) and thoracotomy (OR 3.85 [95% CI, 1.35, 12.0] p = 0.014) became significant predictors for 30-day morbidity. Conclusion: Surgical management of COVID-19-related thoracic complications is affected by high mortality and morbidity rates, but a 72% survival rate still seems to be satisfactory with a rescue intent. Younger patients without pulmonary hypertension, without renal insufficiency and undergoing surgery for in

Published
2022

18. The prognostic value of 18f-fdg pet imaging at staging in patients with malignant pleural mesothelioma: A literature review

Author

Taralli, Silvia, Giancipoli, R. G., Caldarella, Carmelo, Scolozzi, V., Ricciardi, S., Cardillo, G., Calcagni, Maria Lucia, Taralli S., Caldarella C. (ORCID:0000-0002-1047-3333), Calcagni M. L. (ORCID:0000-0002-0805-8245), Taralli, Silvia, Giancipoli, R. G., Caldarella, Carmelo, Scolozzi, V., Ricciardi, S., Cardillo, G., Calcagni, Maria Lucia, Taralli S., Caldarella C. (ORCID:0000-0002-1047-3333), and Calcagni M. L. (ORCID:0000-0002-0805-8245)

Abstract

Malignant pleural mesothelioma (MPM) is an aggressive malignancy, frequently diagnosed at locally-advanced/metastatic stages. Due to a very poor prognosis and limited treatment options, the need to identify new prognostic markers represents a great clinical challenge. The prognostic role of metabolic information derived from Positron Emission Tomography (PET) with 18F-Fluoro-deoxy-glucose (18F-FDG) has been investigated in different MPM settings, however with no definitive consensus. In this comprehensive review, the prognostic value of FDG-PET imaging exclusively performed at staging in MPM patients was evaluated, conducting a literature search on PubMed/MEDLINE from 2010 to 2020. From the 19 selected studies, despite heterogeneity in several aspects, staging FDG-PET imaging emerges as a valuable prognostic biomarker, with higher tumor uptake predictive of worse prognosis, and with volumetric metabolic parameters like Metabolic Tumor Volume, (MTV) and Total Lesion Glycolisis (TLG) performing better than SUVmax. However, PET uptake parameters were not always confirmed as independent prognostic factors, especially in patients previously treated with pleurodesis and with a non-epithelioid histotype. Future prospective studies in larger and clinically homogeneous populations, and using more standardized methods of PET images analysis, are needed to further validate the value of staging FDG-PET in the prognostic MPM stratification, with a potential impact on better patient-tailored treatment planning, in the perspective of personalized medicine.

Published
2022

19. Uniportal and three-portal video-assisted thoracic surgery lobectomy: analysis of the Italian video-assisted thoracic surgery group database

Author

Tosi, D, Nosotti, M, Bonitta, G, Mazzucco, A, Righi, I, Mendogni, P, Rosso, L, Palleschi, A, Rocco, G, Crisci, R, Mancuso, M, Pernazza, F, Refai, M, Bortolotti, L, Rizzardi, G, Gargiulo, G, Dolci, Gp, Perkmann, R, Zaraca, F, Benvenuti, M, Gavezzoli, D, Cherchi, R, Ferrari, P, Mucilli, F, Camplese, P, Melloni, G, Mazza, F, Cavallesco, G, Maniscalco, P, Voltolini, L, Gonfiotti, A, Stella, F, Argnani, D, Pariscenti, Gl, Lurilli, Surrente, C, Lopez, C, Droghetti, A, Giovanardi, M, Breda, C, Lo Giudice, F, Alloisio, M, Bottoni, E, Spaggiari, L, Gasparri, R, Torre, M, Rinaldo, A, Negri, Gp, Bandiera, A, Stefani, A, Natali, P, Scarci, M, Pirondini, E, Curcio, C, Amore, D, Baietto, G, Casadio, C, Nicotra, S, Dell'Amore, A, Bertani, A, Russo, E, Ampollini, L, Carbognani, P, Puma, F, Vinci, D, Andreetti, C, Poggi, C, Cardillo, G, Margaritora, S, Meacci, Elisa, Luzzi, L, Ghisalberti, M, Zaccagna, G, Lausi, P, Guerrera, F, Fontana, D, Della Beffa, V, Morelli, A, Londero, F, Imperatori, A, Rotolo, N, Terzi, A, Viti, A, Infante, M, Benato, C, Tosi, D., Nosotti, M., Bonitta, G., Mazzucco, A., Righi, I., Mendogni, P., Rosso, L., Palleschi, A., Rocco, G., Crisci, R., Mancuso, M., Pernazza, F., Refai, M., Bortolotti, L., Rizzardi, G., Gargiulo, G., Dolci, G. P., Perkmann, R., Zaraca, F., Benvenuti, M., Gavezzoli, D., Cherchi, R., Ferrari, P., Mucilli, F., Camplese, P., Melloni, G., Mazza, F., Cavallesco, G., Maniscalco, P., Voltolini, L., Gonfiotti, A., Stella, F., Argnani, D., Pariscenti, G. L., Surrente, C., Lopez, C., Droghetti, A., Giovanardi, M., Breda, C., Lo Giudice, F., Alloisio, M., Bottoni, E., Spaggiari, L., Gasparri, R., Torre, M., Rinaldo, A., Negri, G, Bandiera, A., Stefani, A., Natali, P., Scarci, M., Pirondini, E., Curcio, C., Amore, D., Baietto, G., Casadio, C., Nicotra, S., Dell'Amore, A., Bertani, A., Russo, E., Ampollini, L., Carbognani, P., Puma, F., Vinci, D., Andreetti, C., Poggi, C., Cardillo, G., Margaritora, S., Meacci, E., Luzzi, L., Ghisalberti, M., Zaccagna, G., Lausi, P., Guerrera, F., Fontana, D., Della Beffa, V., Morelli, A., Londero, F., Imperatori, A., Rotolo, N., Terzi, A., Viti, A., Infante, M., Benato, C., Tosi D., Nosotti M., Bonitta G., Mazzucco A., Righi I., Mendogni P., Rosso L., Palleschi A., Rocco G., Crisci R., Mancuso M., Pernazza F., Refai M., Bortolotti L., Rizzardi G., Gargiulo G., Dolci G.P., Perkmann R., Zaraca F., Benvenuti M., Gavezzoli D., Cherchi R., Ferrari P., Mucilli F., Camplese P., Melloni G., Mazza F., Cavallesco G., Maniscalco P., Voltolini L., Gonfiotti A., Stella F., Argnani D., Pariscenti G.L., Surrente C., Lopez C., Droghetti A., Giovanardi M., Breda C., Lo Giudice F., Alloisio M., Bottoni E., Spaggiari L., Gasparri R., Torre M., Rinaldo A., Negri G.P., Bandiera A., Stefani A., Natali P., Scarci M., Pirondini E., Curcio C., Amore D., Baietto G., Casadio C., Nicotra S., Dell'amore A., Bertani A., Russo E., Ampollini L., Carbognani P., Puma F., Vinci D., Andreetti C., Poggi C., Cardillo G., Margaritora S., Meacci E., Luzzi L., Ghisalberti M., Zaccagna G., Lausi P., Guerrera F., Fontana D., Della Beffa V., Morelli A., Londero F., Imperatori A., Rotolo N., Terzi A., Viti A., Infante M., and Benato C.

Subjects
Male, Lung Neoplasms, Thoracic, Italian VATS Group, computer.software_genre, Postoperative pain, Settore MED/21 - CHIRURGIA TORACICA, Carcinoma, Non-Small-Cell Lung, Lobectomy, Three-portal, Uniportal, Video-assisted thoracic surgery, Aged, Equipment Design, Female, Humans, Neoplasm Staging, Operative Time, Pneumonectomy, Retrospective Studies, Thoracic Surgery, Video-Assisted, Tomography, X-Ray Computed, Stage (cooking), Non-Small-Cell Lung, Tomography, Database, Thoracic Surgery, X-Ray Computed, Cardiothoracic surgery, Cohort, Cardiology and Cardiovascular Medicine, Pulmonary and Respiratory Medicine, Italian VATS Group, Lobectomy, Postoperative pain, Three-portal, Uniportal, Video-assisted thoracic surgery, medicine.medical_specialty, VATS lobectomy, Video-Assisted, NO, medicine, Lung cancer, business.industry, Carcinoma, Odds ratio, medicine.disease, Confidence interval, Propensity score matching, Surgery, business, computer
Abstract

OBJECTIVES This study compares the uniportal with the 3-portal video-assisted thoracic surgery (VATS) by examining the data collected in the Italian VATS Group Database. The primary end point was early postoperative pain; secondary end points were intraoperative and postoperative complications, surgical time, number of dissected lymph nodes and length of stay. METHODS This was an observational, retrospective, cohort, multicentre study on data collected by 49 Italian thoracic units. Inclusion criteria were clinical stage I–II non-small-cell lung cancer, uniportal or 3-portal VATS lobectomy and R0 resection. Exclusion criteria were cT3 disease, previous thoracic malignancy, induction therapy, significant comorbidities and conversion to other techniques. The pain parameter was dichotomized: the numeric rating scale ≤3 described mild pain, whereas the numeric rating scale score >3 described moderate/severe pain. The propensity score-adjusted generalized estimating equation was used to compare the uniportal with 3-portal lobectomy. RESULTS Among 4338 patients enrolled from January 2014 to July 2017, 1980 met the inclusion criteria; 1808 patients underwent 3-portal lobectomy and 172 uniportal surgery. The adjusted generalized estimating equation regression model using the propensity score showed that over time pain decreased in both groups (P CONCLUSIONS Data from the Italian VATS Group Database showed that in clinical practice uniportal lobectomy seems to entail a higher risk of moderate/severe pain on second and third postoperative days.

Published
2019

20. MA01.03 PREC Multicentre Restrospective Study: A Preoperative Risk Classification for Synchronous Oligometastatic Non-Small Cell Lung Cancer

Author

Bertolaccini, L., primary, Spaggiari, L., additional, Facciolo, F., additional, Gallina, F., additional, Rea, F., additional, Schiavon, M., additional, Margaritora, S., additional, Congedo, M.T., additional, Lucchi, M., additional, Ceccarelli, I., additional, Alloisio, M., additional, Bottoni, E., additional, Negri, G., additional, Carretta, A., additional, Cardillo, G., additional, Ricciardi, S., additional, Ruffini, E., additional, Costardi, L., additional, Muriana, G., additional, Viggiano, D., additional, Rusca, M., additional, Ventura, L., additional, Marulli, G., additional, De Palma, A., additional, Rosso, L., additional, Mendogni, P., additional, Crisci, R., additional, De Vico, A., additional, Maniscalco, P., additional, Tamburini, N., additional, Puma, F., additional, Ceccarelli, S., additional, Voltolini, L., additional, Bongiolatti, S., additional, Morelli, A., additional, and Londero, F., additional

Published
2021
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21. Short 2-[18F]Fluoro-2-Deoxy-D-Glucose PET Dynamic Acquisition Protocol to Evaluate the Influx Rate Constant by Regional Patlak Graphical Analysis in Patients With Non-Small-Cell Lung Cancer

Author

Indovina, Luca, Scolozzi, V., Capotosti, A., Sestini, S., Taralli, Silvia, Cusumano, Davide, Giancipoli, R. G., Ciasca, Gabriele, Cardillo, G., Calcagni, Maria Lucia, Indovina L., Taralli S., Cusumano D., Ciasca G. (ORCID:0000-0002-3694-8229), Calcagni M. L. (ORCID:0000-0002-0805-8245), Indovina, Luca, Scolozzi, V., Capotosti, A., Sestini, S., Taralli, Silvia, Cusumano, Davide, Giancipoli, R. G., Ciasca, Gabriele, Cardillo, G., Calcagni, Maria Lucia, Indovina L., Taralli S., Cusumano D., Ciasca G. (ORCID:0000-0002-3694-8229), and Calcagni M. L. (ORCID:0000-0002-0805-8245)

Abstract

Purpose: To test a short 2-[18F]Fluoro-2-deoxy-D-glucose (2-[18F]FDG) PET dynamic acquisition protocol to calculate Ki using regional Patlak graphical analysis in patients with non-small-cell lung cancer (NSCLC). Methods: 24 patients with NSCLC who underwent standard dynamic 2-[18F]FDG acquisitions (60 min) were randomly divided into two groups. In group 1 (n = 10), a population-based image-derived input function (pIDIF) was built using a monoexponential trend (10–60 min), and a leave-one-out cross-validation (LOOCV) method was performed to validate the pIDIF model. In group 2 (n = 14), Ki was obtained by standard regional Patlak plot analysis using IDIF (0–60 min) and tissue response (10–60 min) curves from the volume of interests (VOIs) placed on descending thoracic aorta and tumor tissue, respectively. Moreover, with our method, the Patlak analysis was performed to obtain Ki,s using IDIFFitted curve obtained from PET counts (0–10 min) followed by monoexponential coefficients of pIDIF (10–60 min) and tissue response curve obtained from PET counts at 10 min and between 40 and 60 min, simulating two short dynamic acquisitions. Both IDIF and IDIFFitted curves were modeled to assume the value of 2-[18F]FDG plasma activity measured in the venous blood sampling performed at 45 min in each patient. Spearman's rank correlation, coefficient of determination, and Passing–Bablok regression were used for the comparison between Ki and Ki,s. Finally, Ki,s was obtained with our method in a separate group of patients (group 3, n = 8) that perform two short dynamic acquisitions. Results: Population-based image-derived input function (10–60 min) was modeled with a monoexponential curve with the following fitted parameters obtained in group 1: a = 9.684, b = 16.410, and c = 0.068 min−1. The LOOCV error was 0.4%. In patients of group 2, the mean values of Ki and Ki,s were 0.0442 ± 0.0302 and 0.33 ± 0.0298, respectively (R2 = 0.9970). The Passing–Bablok regression for comparison betwe

Published
2021

22. A risk stratification scheme for synchronous oligometastatic non-small cell lung cancer developed by a multicentre analysis

Author

Spaggiari, L., Bertolaccini, L., Facciolo, F., Gallina, F. T., Rea, F., Schiavon, M., Margaritora, S., Congedo, M. T., Lucchi, M., Ceccarelli, I., Alloisio, M., Bottoni, E., Negri, G., Carretta, A., Cardillo, G., Ricciardi, S., Ruffini, E., Costardi, L., Muriana, G., Viggiano, D., Rusca, M., Ventura, L., Marulli, G., De Palma, A., Rosso, L., Mendogni, P., Crisci, R., De Vico, A., Maniscalco, P., Tamburini, N., Puma, F., Ceccarelli, S., Voltolini, L., Bongiolatti, S., Morelli, A., Londero, F., Margaritora S. (ORCID:0000-0002-9796-760X), Congedo M. T., Bottoni E., Ventura L., Ceccarelli S., Spaggiari, L., Bertolaccini, L., Facciolo, F., Gallina, F. T., Rea, F., Schiavon, M., Margaritora, S., Congedo, M. T., Lucchi, M., Ceccarelli, I., Alloisio, M., Bottoni, E., Negri, G., Carretta, A., Cardillo, G., Ricciardi, S., Ruffini, E., Costardi, L., Muriana, G., Viggiano, D., Rusca, M., Ventura, L., Marulli, G., De Palma, A., Rosso, L., Mendogni, P., Crisci, R., De Vico, A., Maniscalco, P., Tamburini, N., Puma, F., Ceccarelli, S., Voltolini, L., Bongiolatti, S., Morelli, A., Londero, F., Margaritora S. (ORCID:0000-0002-9796-760X), Congedo M. T., Bottoni E., Ventura L., and Ceccarelli S.

Abstract

Backgrounds: Oligometastatic Non-Small Cell Lung Cancer (NSCLC) patients represent a category without a standard therapeutic approach. However, in selected oligometastatic NSCLC, radical surgery seems to offer a good prognosis. This retrospective study aimed to analyse the long-term outcomes of synchronous oligometastatic patients treated with curative intent and identify the factors associated with better results and the proposal of a risk stratification system for classifying the synchronous oligometastatic NSCLC. Methods: The medical records of patients from 18 centres with pathologically diagnosed synchronous oligometastatic NSCLC were retrospectively reviewed. The inclusion criteria were synchronous oligometastatic NSCLC, radical surgical treatment of the primary tumour with or without neoadjuvant/adjuvant therapy and radical treatment of all metastatic sites. The Kaplan – Meier method estimated survivals. A stratified backward stepwise Cox regression model was assessed for multivariable survival analyses. Results: 281 patients were included. The most common site of metastasis was the brain, in 50.89 % patients. Median overall survival was 40 months (95 % CI: 29–53). Age ≤65 years (HR = 1.02, 95 % CI: 1.00–1.05; p = 0.019), single metastasis (HR = 0.71, 95 % CI: 0.45–1.13; p = 0.15) and presence of contralateral lung metastases (HR = 0.30, 95 % CI: 0.15 – 0.62; p = 0.001) were associated with a good prognosis. The presence of pathological N2 metastases negatively affected survival (HR = 2.00, 95 % CI: 1.21–3.32; p = 0.0065). These prognostic factors were used to build a simple risk classification scheme. Conclusions: Treatment of selected synchronous oligometastatic NSCLC with curative purpose could be conducted safely and at acceptable 5-year survival levels, especially in younger patients with pN0 disease.

Published
2021

24. What counts more: The patient, the surgical technique, or the hospital? A multivariable analysis of factors affecting perioperative complications of pulmonary lobectomy by video-assisted thoracoscopic surgery from a large nationwide registry

Author

Infante, Maurizio V, Benato, Cristiano, Silva, Ronaldo, Rocco, Gaetano, Bertani, Alessandro, Bertolaccini, Luca, Gonfiotti, Alessandro, Giovannetti, Riccardo, Bonadiman, Cinzia, Lonardoni, Alessandro, Canneto, Barbara, Falezza, Giovanni, Gandini, Paola, Curcio, Carlo, Crisci, Roberto, Alloisio, M, Amore, D, Ampollini, L, Andreetti, C, Argnani, D, Baietto, G, Bandiera, A, Benato, C, Benvenuti, M, Bertani, A, Bertolaccini, L, Bortolotti, L, Bottoni, E, Breda, C, Camplese, P, Carbognani, P, Cardillo, G, Casadio, C, Cavallesco, G, Cherchi, R, Crisci, R, Curcio, C, Dell'Amore, A, Beffa, V, Dolci, G, Droghetti, A, Ferrari, Pa, Fontana, D, Gargiulo, G, Gasparri, R, Gavezzoli, D, Ghisalberti, M, Giovanardi, M, Gonfiotti, A, Guerrera, F, Imperatori, A, Infante, M, Iurilli, L, Lausi, P, Logiudice, F, Londero, F, Lopez, C, Luzzi, L, Mancuso, M, Maniscalco, P, Margaritora, S, Meacci, E, Melloni, G, Morelli, A, Mucilli, F, Natali, P, Negri, G, Nicotra, S, Nosotti, M, Pariscenti, G, Perkmann, R, Pernazza, F, Pirondini, E, Poggi, C, Puma, F, Refai, M, Rinaldo, A, Rizzardi, G, Rosso, L, Rotolo, N, Russo, E, Sabbatini, A, Scarci, M, Spaggiari, L, Stefani, A, Solli, P, Surrente, C, Terzi, A, Torre, M, Vinci, D, Viti, A, Voltolini, L, Zaccagna, G, Zaraca, F., Infante M.V., Benato C., Silva R., Rocco G., Bertani A., Bertolaccini L., Gonfiotti A., Giovannetti R., Bonadiman C., Lonardoni A., Canneto B., Falezza G., Gandini P., Curcio C., Crisci R., Zaraca F., Alloisio M., Amore D., Ampollini L., Andreetti C., Argnani D., Baietto G., Bandiera A., Benvenuti M., Bortolotti L., Bottoni E., Breda C., Camplese P., Carbognani P., Cardillo G., Casadio C., Cavallesco G., Cherchi R., Dell'Amore A., Beffa V., Dolci G., Droghetti A., Ferrari P.A., Fontana D., Gargiulo G., Gasparri R., Gavezzoli D., Ghisalberti M., Giovanardi M., Guerrera F., Imperatori A., Iurilli L., Lausi P., Lo Giudice F., Londero F., Lopez C., Luzzi L., Mancuso M., Maniscalco P., Margaritora S., Meacci E., Melloni G., Morelli A., Mucilli F., Natali P., Negri G., Nicotra S., Nosotti M., Pariscenti G., Perkmann R., Pernazza F., Pirondini E., Poggi C., Puma F., Refai M., Rinaldo A., Rizzardi G., Rosso L., Rotolo N., Russo E., Sabbatini A., Scarci M., Spaggiari L., Stefani A., Solli P., Surrente C., Terzi A., Torre M., Vinci D., Viti A., Voltolini L., Zaccagna G., Infante, M. V., Benato, C., Silva, R., Rocco, G., Bertani, A., Bertolaccini, L., Gonfiotti, A., Giovannetti, R., Bonadiman, C., Lonardoni, A., Canneto, B., Falezza, G., Gandini, P., Curcio, C., Crisci, R., the Italian VATS group, Member, and Negri, G.

Subjects
Male, Registrie, Conversion, Morbidity, Postoperative complications, Video-assisted thoracoscopic surgery lobectomy, Lung Neoplasms, Intraoperative Complication, Aged, Female, Hospitals, Humans, Intraoperative Complications, Lung, Middle Aged, Pneumonectomy, Postoperative Complications, Registries, Retrospective Studies, Risk Factors, Thoracic Surgery, Video-Assisted, medicine.medical_treatment, Interquartile range, Retrospective Studie, Settore MED/21 - CHIRURGIA TORACICA, Conversion, Morbidity, Postoperative complications, Video-assisted thoracoscopic surgery lobectomy, Thoracic Surgery, General Medicine, Video-assisted thoracoscopic surgery, Cardiology and Cardiovascular Medicine, Human, Pulmonary and Respiratory Medicine, medicine.medical_specialty, VATS lobectomy, Video-Assisted, NO, Hospital, medicine, business.industry, Risk Factor, Retrospective cohort study, Perioperative, medicine.disease, Comorbidity, Surgery, Postoperative complication, Lung Neoplasm, Complication, business
Abstract

OBJECTIVESInherent technical aspects of pulmonary lobectomy by video-assisted thoracoscopic surgery (VATS) may limit surgeons’ ability to deal with factors predisposing to complications. We analysed complication rates after VATS lobectomy in a prospectively maintained nationwide registry.METHODSThe registry was queried for all consecutive VATS lobectomy procedures from 49 Italian Thoracic Units. Baseline condition, tumour features, surgical techniques, devices, postoperative care, complications, conversions and the reasons thereof were detailed. Univariable and multivariable regressions were used to assess factors potentially linked to complications.RESULTSFour thousand one hundred and ninety-one VATS lobectomies in 4156 patients (2480 men, 1676 women) were analysed. The median age-adjusted Charlson index of the patients was 4 (interquartile range 3–6). Grade 1 and 2 and Grade 3–5 complications were observed in 20.1% and in 5.8%, respectively. Ninety-day mortality was 0.55%. The overall conversion rate was 9.2% and significantly higher in low-volume centres (CONCLUSIONSVATS lobectomy is a safe procedure even in medically compromised patients. An improved classification system for conversions is proposed and prevention strategies are suggested to reduce conversion rates and possibly complications in less-experienced centres.

Published
2019

26. Predictors of nodal upstaging in patients with cT1-3N0 non-small cell lung cancer (NSCLC): results from the Italian VATS Group Registry

Author

Marulli, G., Faccioli, E., Mammana, M., Nicotra, S., Comacchio, G., Verderi, E., De Palma, A., Curcio, C., Rea, F., Bertani, A., Russo, E., Voltolini, L., Gonfiotti, A., Nosotti, M., Rosso, L., Muriana, G., Droghetti, A., Crisci, R., Zaccagna, G., Amore, D., 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., Andreetti, 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., Guerrera, F., Melloni, G., Mazza, F., Argnani, D., Sanna, S., Fontana, D., Beffa, V. D., Meda, S., Pernazza, F. a, and Italian VATS Group

Subjects
Oncology, Male, Lung Neoplasms, medicine.medical_treatment, non-small cell lung cancer (NSCLC), Nodal upstaging, VATS lobectomy, 0302 clinical medicine, Risk Factors, Carcinoma, Non-Small-Cell Lung, 80 and over, Registries, Non-Small-Cell Lung, Child, Pneumonectomy, GeneralLiterature_REFERENCE(e.g.,dictionaries,encyclopedias,glossaries), Aged, 80 and over, Thoracic Surgery, Video-Assisted, Thoracic Surgery, General Medicine, Middle Aged, Lymph node dissection, Mediastinal staging, Predictive risk factors, Adolescent, Adult, Aged, Disease Progression, Female, Humans, Italy, Lymph Node Excision, Neoplasm Staging, Predictive Value of Tests, Young Adult, 030220 oncology & carcinogenesis, Predictive value of tests, 030211 gastroenterology & hepatology, Lymph node dissection, Mediastinal staging, Nodal upstaging, Predictive risk factors, VATS lobectomy, medicine.medical_specialty, Video-Assisted, NO, 03 medical and health sciences, Internal medicine, medicine, In patient, business.industry, Disease progression, Carcinoma, medicine.disease, Surgery, Neoplasm staging, business
Abstract

Accurate staging of early non-small cell lung cancer is fundamental for selecting the best treatment. The aim of this study was to identify risk factors for nodal upstaging after video-assisted thoracoscopic lobectomy for clinical T1-3N0 tumors.From 2014 to 2017, 3276 thoracoscopic lobectomies were recorded in the prospective database "Italian VATS Group". Linear and multiple logistic regression models were adapted to identify independent predictors of nodal upstaging and factors associated with progression in postoperative N status.Nodal upstaging was found in 417 cases (12.7%), including 206 cases (6.2%) of N1-positive nodes, 81 cases of N2 nodes (2.4%), and 130 cases (4%) of involvement of both N1 + N2 nodes. A total of 241 (7.3%) patients had single-station nodal involvement, whereas 176 (5.3%) had multiple-station involvement. In the final regression model, the tumor grade, histology, pathologic T status, and 12 resected nodes were independent predictors of nodal upstaging.The number of resected lymph nodes seems to predict nodal upstaging better than the type of intraoperative lymph node management. Other preoperative risk factors correspond to those for which the current guidelines of the European Society of Thoracic Surgery recommend more extensive preoperative mediastinal staging.

Published
2020

27. Correction to: Predictors of nodal upstaging in patients with cT1-3N0 non-small cell lung cancer (NSCLC): results from the Italian VATS Group Registry (Surgery Today, (2020), 50, 7, (711-718), 10.1007/s00595-019-01939-x)

Author

Marulli, G., Faccioli, E., Mammana, M., Nicotra, S., Comacchio, G., Verderi, E., De Palma, A., Curcio, C., Rea, F., Bertani, A., Russo, E., Voltolini, L., Gonfiotti, A., Nosotti, M., Rosso, L., Muriana, G., Droghetti, A., Crisci, R., Zaccagna, G., Amore, D., 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., Andreetti, 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., Guerrera, F., Melloni, G., Mazza, F., Argnani, D., Sanna, S., Fontana, D., Beffa, V. D., Meda, S., and Pernazza, F.

Subjects
NO
Published
2020

29. Management of pulmonary ground-glass opacities: A position paper from a panel of experts of the Italian Society of Thoracic Surgery (SICT)

Author

Lococo, Filippo, Luzzi, L., Cusumano, G., De Filippis, A. F., Pariscenti, G., Guggino, G., Rena, O., Davini, F., Grossi, W., Marulli, G., Lococo, A., Cardillo, G., Lococo F. (ORCID:0000-0002-9383-5554), Lococo, Filippo, Luzzi, L., Cusumano, G., De Filippis, A. F., Pariscenti, G., Guggino, G., Rena, O., Davini, F., Grossi, W., Marulli, G., Lococo, A., Cardillo, G., and Lococo F. (ORCID:0000-0002-9383-5554)

Abstract

OBJECTIVES: A significant gap in our knowledge of how to manage pulmonary ground-glass opacities (GGOs) still exists. Accordingly, there is a lack of consensus among clinicians on this topic. The Italian Society of Thoracic Surgery (Societa` Italiana di Chirurgia Toracica, SICT) promoted a national expert meeting to provide insightful guidance for clinical practice. Our goal was to publish herein the final consensus document from this conference. METHODS: The working panel of the PNR group (Pulmonary Nodules Recommendation Group, a branch of the SICT) together with 5 scientific supervisors (nominated by the SICT) identified a jury of expert thoracic surgeons who organized a multidisciplinary meeting to propose specific statements (n = 29); 73 participants discussed and voted on statements using a modified Delphi process (repeated iterations of anonymous voting over 2 rounds with electronic support) requiring 70% agreement to reach consensus on a statement. RESULTS: Consensus was reached on several critical points in GGO management, in particular on the definition of GGO, radiological and radiometabolic evaluation, indications for a non-surgical biopsy, GGO management based on radiological characteristics, surgical strategies (extension of pulmonary resection and lymphadenectomy) and radiological surveillance. A list of 29 statements was finally approved. CONCLUSIONS: The participants at this national expert meeting analysed this challenging topic and provided a list of suggestions for health institutions and physicians with practical indications for GGO management.

Published
2020

30. Predicting a Prolonged Air Leak After Video-Assisted Thoracic Surgery, Is It Really Possible?

Author

Zaraca, Francesco, primary, Pipitone, Marco, additional, Feil, Birgit, additional, Perkmann, Reinhold, additional, Bertolaccini, Luca, additional, Curcio, Carlo, additional, Crisci, Roberto, additional, Mancuso, M., additional, Pernazza, F., additional, Refai, M., additional, Srella, F., additional, Argnani, D., additional, Marulli, G., additional, De Palma, A., additional, Bortolotti, L., additional, Rizzardi, G., additional, Solli, P.G., additional, Dolci, G.P., additional, Perkmann, R., additional, Zaraca, F., additional, Benvenuti, M., additional, Gavezzoli, D., additional, Cherchi, R., additional, Ferrari, P., additional, Mucilli, F., additional, Camplese, P., additional, Melloni, G., additional, Mazza, F., additional, Cavallesco, G., additional, Maniscalco, P., additional, Voltolini, L., additional, Gonfiotti, A., additional, Sollitto, F., additional, Ardò, N., additional, Pariscenti, G.L., additional, Risso, C., additional, Surrente, C., additional, Lopez, C., additional, Droghetti, A., additional, Giovanardi, M., additional, Breda, C., additional, Giudice, Lo F., additional, Alloisio, M., additional, Bottoni, E., additional, Spaggiari, L., additional, Gasparri, R., additional, Torre, M., additional, Rinaldo, A., additional, Nosotti, M., additional, Tosi, D., additional, Negri, G.P., additional, Bandiera, A., additional, Baisi, A., additional, Raveglia, F., additional, Stefani, A., additional, Natali, P., additional, Scarci, M., additional, Pirondini, E., additional, Curcio, C., additional, Amore, D., additional, Rena, O., additional, Nicotra, S., additional, Dell’ Amore, A., additional, Bertani, A., additional, Tancredi, G., additional, Ampollini, L., additional, Carbognani, P., additional, Puma, F., additional, Vinci, D., additional, Cardillo, G., additional, Carleo, F., additional, Margaritora, S., additional, Meacci, E., additional, Luzzi, L., additional, Ghisalberti, M., additional, Crisci, R., additional, Divisi, D., additional, Lausi, P., additional, Guerrera, F., additional, Fontana, D., additional, Beffa, V. Della, additional, Morelli, A., additional, Londero, F., additional, Imperatori, A., additional, Rotolo, N., additional, Terzi, A., additional, Viti, A., additional, Infante, M., additional, and Benato, C., additional

Published
2021
Full Text
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32. National adoption of video-assisted thoracoscopic surgery (VATS) lobectomy: The Italian VATS register evaluation

Author

Divisi D., Bertolaccini L., Barone M., Amore D., Argnani D., Zaccagna G., Solli P., Di Rienzo G., Curcio C., Crisci R., Ampollini L., Alloisio M., Andreetti C., Baietto G., Bandiera A., Benato C., Benetti D., Benvenuti M., Bertani A., Bortolotti L., Bottoni E., Camplese P., Carbognani P., Cardillo G., Carleo F., Casadio C., Cavallesco G., Negri A. D., Dolci G., Droghetti A., Gasparri R., Ghisalberti M., Gonfiotti A., Guerrera F., Imperatori A., Infante M., Lausi P., Londero F., Lopez C., Luzzi L., Maineri P., Maniscalco P., Marulli G., Monteverde M., Morelli A., Mucilli F., Natali P., Negri G., Nicotra S., Nosotti M., Perkmann R., Poggi C., Puma F., Refai M., Rinaldo A., Rizzardi G., Rosso L., Rotolo N., Russo E., Sabatini A., Spaggiari L., Stefani A., Stella F., Terzi A., Torre M., Vinci D., Viti A., Voltolini L., Zaraca F., Divisi D., Bertolaccini L., Barone M., Amore D., Argnani D., Zaccagna G., Solli P., Di Rienzo G., Curcio C., Crisci R., Ampollini L., Alloisio M., Andreetti C., Baietto G., Bandiera A., Benato C., Benetti D., Benvenuti M., Bertani A., Bortolotti L., Bottoni E., Camplese P., Carbognani P., Cardillo G., Carleo F., Casadio C., Cavallesco G., Negri A.D., Dolci G., Droghetti A., Gasparri R., Ghisalberti M., Gonfiotti A., Guerrera F., Imperatori A., Infante M., Lausi P., Londero F., Lopez C., Luzzi L., Maineri P., Maniscalco P., Marulli G., Monteverde M., Morelli A., Mucilli F., Natali P., Negri G., Nicotra S., Nosotti M., Perkmann R., Poggi C., Puma F., Refai M., Rinaldo A., Rizzardi G., Rosso L., Rotolo N., Russo E., Sabatini A., Spaggiari L., Stefani A., Stella F., Terzi A., Torre M., Vinci D., Viti A., Voltolini L., Zaraca F., Divisi, Duilio, Bertolaccini, Luca, Barone, Mirko, Amore, Dario, Argnani, Desideria, Zaccagna, Gino, Solli, Piergiorgio, Di Rienzo, Gaetano, Curcio, Carlo, Crisci, Roberto, Italian VATS, Group, and Negri, G

Subjects
Database, Learning curve, Learning tools, Non-small cell lung cancer, Training, Video-assisted thoracoscopic surgery lobectomy (VATS lobectomy), Pulmonary and Respiratory Medicine, medicine.medical_specialty, medicine.medical_treatment, VATS lobectomy, Air leak, NO, 03 medical and health sciences, 0302 clinical medicine, Learning tool, database, learning curve, learning tools, non-small cell lung cancer, training, medicine, Thoracotomy, business.industry, General surgery, Database, Learning curve, Learning tools, Non-small cell lung cancer, Training, Video-assisted thoracoscopic surgery lobectomy (VATS lobectomy), 030228 respiratory system, Cardiothoracic surgery, 030220 oncology & carcinogenesis, Video-assisted thoracoscopic surgery, Operative time, Original Article, business
Abstract

Background: The expertise curve of video-assisted thoracoscopic surgery (VATS) lobectomies still stirs debate and controversy both because of the number of procedures to carry out and of the evaluation of the learning threshold. The purpose of our study was the examination of the variables related to the learning curve of the video-assisted approach, to establish what may be an expression of the technical maturity of the surgeon. Methods: The National Register for VATS lobectomy built in 2013 was used to collect data from 65 Thoracic Surgery Units. Out of more than 3,700 patients enrolled, only information from Units with ≥100 VATS lobectomies were retrospectively analysed. Unpaired Student’s t-tests, Fisher’s exact tests, Pearson’s χ 2 were applied as needed. Cumulative summative analysis and one-way ANOVA were used to identify the expertise curve of VATS lobectomy. Results: Ten institutions contributed a total of 1,679 patients, who were divided into three uniform groups according to the chronological sequence of surgery. The length of utility incision, the number of dissected lymph nodes and the operative time were not statistically significant (P=0.999, P=0.972 and P=0.307, respectively) among groups. Conversion to thoracotomy and postoperative air leaks occurred in 125 (7.44%) and 109 (6.49%) patients, gradually declined in Group 3 with statistical signi cance (P=0.048 and P=0.00086). Conclusions: The conversion rate and the percentage of air leaks seem to de ne the expertise of VATS lobectomy, being linked to the ability to manage more complicated surgical cases or intraoperative adverse events.

Published
2018

33. Corrigendum to: What counts more: The patient, the surgical technique, or the hospital? A multivariable analysis of factors affecting perioperative complications of pulmonary lobectomy by video-assisted thoracoscopic surgery from a large nationwide registry (European Journal of Cardio-thoracic Surgery (2019) DOI: 10.1093/ejcts/ezz187)

Author

Infante, M. V., Benato, C., Silva, R., Rocco, G., Bertani, A., Bertolaccini, L., Gonfiotti, A., Giovannetti, R., Bonadiman, C., Lonardoni, A., Canneto, B., Falezza, G., Gandini, P., Curcio, C., Crisci, R., Zaraca, F., Alloisio, M., Amore, D., Ampollini, L., Andreetti, C., Argnani, D., Baietto, G., Bandiera, A., Benvenuti, M., Bortolotti, L., Bottoni, E., Breda, C., Camplese, P., Carbognani, P., Cardillo, G., Casadio, C., Cavallesco, G., Cherchi, R., Dell'Amore, A., Beffa, V., Dolci, G, Droghetti, A, Ferrari, P. A., Fontana, D., Gargiulo, G., Gasparri, R., Gavezzoli, D., Ghisalberti, M., Giovanardi, M., Guerrera, F., Imperatori, A., Iurilli, L., Lausi, P., Lo Giudice, F., Londero, F., Lopez, C., Luzzi, L., Mancuso, M., Maniscalco, P., Margaritora, S., Meacci, E., Melloni, G., Morelli, A., Mucilli, F., Natali, P., Negri, G., Nicotra, S., Nosotti, M., Pariscenti, G., Perkmann, R., Pernazza, F., Pirondini, E., Poggi, C., Puma, F., Refai, M., Rinaldo, A., Rizzardi, G, Rosso, L., Rotolo, N., Russo, E., Sabbatini, A., Scarci, M., Spaggiari, L., Stefani, A., Solli, P., Surrente, C., Terzi, A., Torre, M., Vinci, D., Viti, A., Voltolini, L., Zaccagna, G., and the Italian VATS group members

Subjects
Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Lung Neoplasms, Thoracic, medicine.medical_treatment, MEDLINE, NO, Postoperative Complications, Risk Factors, Pulmonary lobectomy, Humans, Medicine, Registries, Intraoperative Complications, Pneumonectomy, Lung, Aged, Retrospective Studies, Thoracic Surgery, Video-Assisted, business.industry, General surgery, General Medicine, Perioperative, Middle Aged, Corrigenda, Hospitals, Video-assisted thoracoscopic surgery, Female, Surgery, Cardiology and Cardiovascular Medicine, business
Abstract

OBJECTIVES: Inherent technical aspects of pulmonary lobectomy by video-assisted thoracoscopic surgery (VATS) may limit surgeons’ ability to deal with factors predisposing to complications. We analysed complication rates after VATS lobectomy in a prospectively maintained nationwide registry. METHODS: The registry was queried for all consecutive VATS lobectomy procedures from 49 Italian Thoracic Units. Baseline condition, tumour features, surgical techniques, devices, postoperative care, complications, conversions and the reasons thereof were detailed. Univariable and multivariable regressions were used to assess factors potentially linked to complications. RESULTS: Four thousand one hundred and ninety-one VATS lobectomies in 4156 patients (2480 men, 1676 women) were analysed. The median age-adjusted Charlson index of the patients was 4 (interquartile range 3–6). Grade 1 and 2 and Grade 3–5 complications were observed in 20.1% and in 5.8%, respectively. Ninety-day mortality was 0.55%. The overall conversion rate was 9.2% and significantly higher in low-volume centres (

Published
2019

36. What counts more: the patient, the surgical technique, or the hospital? A multivariable analysis of factors affecting perioperative complications of pulmonary lobectomy by video-assisted thoracoscopic surgery from a large nationwide registry

Author

Infante, Mv, Benato, C, Silva, R, Rocco, G, Bertani, A, Bertolaccini, L, Gonfiotti, A, Giovannetti, R, Bonadiman, C, Lonardoni, A, Canneto, B, Falezza, G, Gandini, P, Curcio, C, Crisci, R, Alloisio, M, Amore, D, Ampollini, L, Andreetti, C, Argnani, D, Baietto, G, Bandiera, A, Benvenuti, Mr, Bortolotti, L, Bottoni, E, Breda, C, Camplese, P, Carbognani, P, Cardillo, G, Casadio, C, Cavallesco, G, Cherchi, R, Dell'Amore, A, Della Beffa, V, Dolci, G, Droghetti, A, Ferrari, Pa, Fontana, D, Gargiulo, G, Gasparri, R, Gavezzoli, D, Ghisalberti, M, Giovanardi, M, Guerrera, F, Imperatori, A, Infante, M, Iurilli, L, Lausi, P, Lo Giudice, F, Londero, F, Lopez, C, Luzzi, L, Mancuso, M, Maniscalco, P, Margaritora, Stefano, Meacci, Elisa, Melloni, G, Morelli, A, Mucilli, F, Natali, P, Negri, G, Nicotra, S, Nosotti, M, Pariscenti, G, Perkmann, R, Pernazza, F, Pirondini, E, Poggi, C, Puma, F, Refai, M, Rinaldo, A, Rizzardi, G, Rosso, L, Rotolo, N, Russo, E, Sabbatini, A, Scarci, M, Spaggiari, L, Stefani, A, Solli, P, Surrente, C, Terzi, A, Torre, M, Vinci, D, Viti, A, Voltolini, L, Zaccagna, G, Zaraca, F, Margaritora, S (ORCID:0000-0002-9796-760X), Meacci, E (ORCID:0000-0001-8424-3816), Infante, Mv, Benato, C, Silva, R, Rocco, G, Bertani, A, Bertolaccini, L, Gonfiotti, A, Giovannetti, R, Bonadiman, C, Lonardoni, A, Canneto, B, Falezza, G, Gandini, P, Curcio, C, Crisci, R, Alloisio, M, Amore, D, Ampollini, L, Andreetti, C, Argnani, D, Baietto, G, Bandiera, A, Benvenuti, Mr, Bortolotti, L, Bottoni, E, Breda, C, Camplese, P, Carbognani, P, Cardillo, G, Casadio, C, Cavallesco, G, Cherchi, R, Dell'Amore, A, Della Beffa, V, Dolci, G, Droghetti, A, Ferrari, Pa, Fontana, D, Gargiulo, G, Gasparri, R, Gavezzoli, D, Ghisalberti, M, Giovanardi, M, Guerrera, F, Imperatori, A, Infante, M, Iurilli, L, Lausi, P, Lo Giudice, F, Londero, F, Lopez, C, Luzzi, L, Mancuso, M, Maniscalco, P, Margaritora, Stefano, Meacci, Elisa, Melloni, G, Morelli, A, Mucilli, F, Natali, P, Negri, G, Nicotra, S, Nosotti, M, Pariscenti, G, Perkmann, R, Pernazza, F, Pirondini, E, Poggi, C, Puma, F, Refai, M, Rinaldo, A, Rizzardi, G, Rosso, L, Rotolo, N, Russo, E, Sabbatini, A, Scarci, M, Spaggiari, L, Stefani, A, Solli, P, Surrente, C, Terzi, A, Torre, M, Vinci, D, Viti, A, Voltolini, L, Zaccagna, G, Zaraca, F, Margaritora, S (ORCID:0000-0002-9796-760X), and Meacci, E (ORCID:0000-0001-8424-3816)

Abstract

OBJECTIVES: Inherent technical aspects of pulmonary lobectomy by video-assisted thoracoscopic surgery (VATS) may limit surgeons' ability to deal with factors predisposing to complications. We analysed complication rates after VATS lobectomy in a prospectively maintained nationwide registry.METHODS: The registry was queried for all consecutive VATS lobectomy procedures from 49 Italian Thoracic Units. Baseline condition, tumour features, surgical techniques, devices, postoperative care, complications, conversions and the reasons thereof were detailed. Univariable and multivariable regressions were used to assess factors potentially linked to complications.RESULTS: Four thousand one hundred and ninety-one VATS lobectomies in 4156 patients (2480 men, 1676 women) were analysed. The median age-adjusted Charlson index of the patients was 4 (interquartile range 3-6). Grade 1 and 2 and Grade 3-5 complications were observed in 20.1% and in 5.8%, respectively. Ninety-day mortality was 0.55%. The overall conversion rate was 9.2% and significantly higher in low-volume centres (<100 cases, P < 0.001), but there was no significant difference between intermediate- and high-volume centres under this aspect. Low-volume centres were significantly more likely to convert due to issues with difficult local anatomy, but not significantly so for bleeding. Conversion, lower case-volume, comorbidity burden, male gender, adhesions, blood loss, operative time, sealants and epidural analgesia were significantly associated with increased postoperative morbidity.CONCLUSIONS: VATS lobectomy is a safe procedure even in medically compromised patients. An improved classification system for conversions is proposed and prevention strategies are suggested to reduce conversion rates and possibly complications in less-experienced centres.

Published
2019

37. Is adjuvant chemotherapy worthwhile after radical resection for single lung metastasis from colorectal cancer? A multicentric analysis evaluating the risk of recurrence

Author

Rapicetta, C., Lococo, Filippo, Davini, F., Carleo, F., Kauppi, J., Di Stefano, T. S., Ricciardi, S., Di Martino, M., Rasanen, J., Paci, M., Melfi, F., Cardillo, G., Lococo F. (ORCID:0000-0002-9383-5554), Rapicetta, C., Lococo, Filippo, Davini, F., Carleo, F., Kauppi, J., Di Stefano, T. S., Ricciardi, S., Di Martino, M., Rasanen, J., Paci, M., Melfi, F., Cardillo, G., and Lococo F. (ORCID:0000-0002-9383-5554)

Abstract

Background: Adjuvant chemotherapy after resection of colorectal cancer (CRC) lung metastases may reduce recurrences and improve survival. The choice of best candidates for adjuvant chemotherapy in this setting is controversial, especially when a single lung metastases (SLM) is resected. The aim of this study is to evaluate the risk of recurrence after radical resection for single lung metastasis from CRC. Patients and methods: Demographic, clinical, and pathological data were retrospectively collected for patients radically operated on for single pulmonary metastasis from CRC in 4 centers. Survival was computed by Kaplan-Meyer methods. Chi-square, log-rank test, and for multivariate analysis, Cox-regression and binary logistic regression were used when indicated. Results: The sample consisted of 344 patients, mean age 65 yrs. Overall 5 yrs survival was 61.9%. Recurrence occurred in 113 pts (32.8%). At univariate analysis, age > 70 (p = 0.046) and tumor size > 2 cm (p = 0.038) were predictive of the worst survival chance, while synchronous lung metastasis (p = 0.039), previous resection of extrathoracic metastasis (p = 0.017), uptake at FDG-PET scan (p = 0.006) and short (<12 months) disease-free interval (DFI) prior to lung metastasectomy (p = 0.048) were risk factors for recurrence. At multivariate analysis, only high CEA (>4 ng/mL) was associated with worst survival (HR: 4.3, p = 0.014), while prior abdominal surgery (HR: 3, p = 0.033), PET positivity (HR: 2.7, p = 0.041), and DFI > 12 months (HR: 0.14, p < 0.001) confirmed to predict recurrence of disease. Conclusions: Surgical resection of solitary lung metastases from CRC is associated with prolonged survival. High value of CEA, PET positivity, previous extrathoracic resected metastasis, and short (<12 months) DFI were found to be predictive of death or disease recurrence and might identify in this scenario patients at higher risk which could potential benefit of chemotherapy.

Published
2019

38. 18 F-FDG PET/CT diagnostic performance in solitary and multiple pulmonary nodules detected in patients with previous cancer history: reports of 182 nodules

Author

Taralli, S., Scolozzi, V., Foti, M., Ricciardi, S., Forcione, A. R., Cardillo, G., Calcagni, Maria Lucia, Calcagni M. L. (ORCID:0000-0002-0805-8245), Taralli, S., Scolozzi, V., Foti, M., Ricciardi, S., Forcione, A. R., Cardillo, G., Calcagni, Maria Lucia, and Calcagni M. L. (ORCID:0000-0002-0805-8245)

Abstract

Purpose: In oncological patients, 18 F-FDG PET/CT performance for pulmonary nodules’ characterization is not well-established. Thus, the purpose of this study was to evaluate the 18 F-FDG PET/CT diagnostic performance in pulmonary nodules detected during follow-up in oncological patients and the relationship between malignancy and nodules’ characteristics. Methods: We retrospectively evaluated 182 pulmonary nodules (121 solitary, 61 multiple; mean size = 16.5 ± 8.1 mm, mean SUVmax = 5.2 ± 5.1) in 148 oncological patients (89 males; mean age = 69.5 ± 8.4 years). Final diagnosis was established by histology or radiological follow-up. Diagnostic performance of 18 F-FDG visual analysis (malignancy-criterion: uptake ≥ mediastinal activity), ROC curve analysis for SUVmax and nodules’ characteristics were assessed. Results: In 182 nodules, the prevalence of malignancy was 75.8%; PET/CT provided sensitivity = 79%, specificity = 81.8%, accuracy = 79.7%, PPV = 93.1%, NPV = 55.4%; ROC analysis (SUVmax cut-off = 1.7) provided sensitivity = 85.5%, specificity = 72.7%. In 121 solitary nodules, the prevalence of malignancy was 87.6%; PET/CT provided sensitivity = 82.1%, specificity = 73.3%, accuracy = 81%, PPV = 95.6%, NPV = 36.7%; ROC analysis (SUVmax cut-off = 2) provided sensitivity = 84%, specificity = 80%. In 61 multiple nodules, the prevalence of malignancy was 52.5%; PET/CT (nodule and patient-based analysis, respectively) provided sensitivity = 68.7% and 88.9%, specificity = 86.2% and 55.6%, accuracy = 77% and 77.8%, PPV = 84.4% and 80%, NPV = 71.8% and 71.5%; ROC analysis (nodule-based, SUVmax cut-off = 1.8) provided sensitivity = 71.9%, specificity = 82.8%. Malignant nodules were prevalent in males, in solitary pattern and in upper lobes, and had significantly greater size and metabolic activity (SUVmax and TLG) than benign ones, with no differences in interval-time between previous cancer diagnosis and nodule detection, patients’ age or other nodules’ features

Published
2019

39. Systemic air embolism as a complication of percutaneous computed tomography guided transthoracic lung biopsy

Author

Ialongo P, Tinti, Cardillo G, Suadoni Mn, and Ciarpaglini L

Subjects
Image-Guided Biopsy, Male, medicine.medical_specialty, Percutaneous, medicine.medical_treatment, Lung biopsy, 030204 cardiovascular system & hematology, Air embolism, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, Fatal Outcome, 0302 clinical medicine, medicine.artery, Biopsy, medicine, Embolism, Air, Humans, Cardiopulmonary resuscitation, Lung, medicine.diagnostic_test, business.industry, Biopsy, Needle, General Medicine, Middle Aged, medicine.disease, Heart Arrest, Prone position, Online Case Report, Embolism, Descending aorta, Surgery, Radiology, Tomography, X-Ray Computed, business
Abstract

A 57-year-old man underwent prone position computed tomography (CT) guided percutaneous transthoracic lung biopsy. After removal of the 18-gauge biopsy needle, the patient lost consciousness and developed shock. CT showed signs of air embolism in descending aorta and left atrium. Cardiopulmonary resuscitation was unsuccessful. A postmortem CT scan confirmed a massive air embolism in the descending aorta, left ventricle and brain. Systemic air embolism occurs in around 0.001–0.003% of lung biopsy procedures. Recommendations to reduce the risk include requesting the patient to stop breathing during the procedure and preventing the exposure of the outer cannula of a coaxial biopsy needle to the atmosphere.

Published
2017

40. Outcomes from the Delphi process of the Thoracic Robotic Curriculum Development Committee

Author

Veronesi, G., Dorn, P., Dunning, J., Cardillo, G., Schmid, R. A., Collins, J., Baste, J. -M., Limmer, S., Shahin, G. M. M., Egberts, J. -H., Pardolesi, A., Meacci, Elisa, Stamenkovic, S., Casali, G., Rueckert, J. C., Taurchini, M., Santelmo, N., Melfi, F., Toker, A., Meacci E. (ORCID:0000-0001-8424-3816), Veronesi, G., Dorn, P., Dunning, J., Cardillo, G., Schmid, R. A., Collins, J., Baste, J. -M., Limmer, S., Shahin, G. M. M., Egberts, J. -H., Pardolesi, A., Meacci, Elisa, Stamenkovic, S., Casali, G., Rueckert, J. C., Taurchini, M., Santelmo, N., Melfi, F., Toker, A., and Meacci E. (ORCID:0000-0001-8424-3816)

Abstract

OBJECTIVES: As the adoption of robotic procedures becomes more widespread, additional risk related to the learning curve can be expected. This article reports the results of a Delphi process to define procedures to optimize robotic training of thoracic surgeons and to promote safe performance of established robotic interventions as, for example, lung cancer and thymoma surgery. METHODS: In June 2016, a working panel was spontaneously created by members of the European Society of Thoracic Surgeons (ESTS) and European Association for Cardio-Thoracic Surgery (EACTS) with a specialist interest in robotic thoracic surgery and/or surgical training. An e-consensus-finding exercise using the Delphi methodology was applied requiring 80% agreement to reach consensus on each question. Repeated iterations of anonymous voting continued over 3 rounds. RESULTS: Agreement was reached on many points: a standardized robotic training curriculum for robotic thoracic surgery should be divided into clearly defined sections as a staged learning pathway; the basic robotic curriculum should include a baseline evaluation, an e-learning module, a simulation-based training (including virtual reality simulation, Dry lab and Wet lab) and a robotic theatre (bedside) observation. Advanced robotic training should include e-learning on index procedures (right upper lobe) with video demonstration, access to video library of robotic procedures, simulation training, modular console training to index procedure, transition to full-procedure training with a proctor and final evaluation of the submitted video to certified independent examiners. CONCLUSIONS: Agreement was reached on a large number of questions to optimize and standardize training and education of thoracic surgeons in robotic activity. The production of the content of the learning material is ongoing.

Published
2018

41. Current Practices in the Management of Pulmonary Ground-Glass Opacities: A Survey of SICT Members

Author

Lococo, Filippo, Cusumano, G., De Filippis, A. F., Curcuru, G., Quercia, R., Marulli, G., Monaco, G., Granone, Pierluigi, Muriana, G., Rea, F., Crisci, Serena, Di Rienzo, G., Cardillo, G., Lococo, A., Amore, D., Divisi, D., Dolci, G., Guggino, G., Larocca, V., Loizzi, D., Luzzi, L., Monaco, F., Porziella, Venanzio, Rena, O., Lococo F. (ORCID:0000-0002-9383-5554), Granone P. (ORCID:0000-0002-8826-3045), Crisci R., Porziella V. (ORCID:0000-0001-6000-3172), Lococo, Filippo, Cusumano, G., De Filippis, A. F., Curcuru, G., Quercia, R., Marulli, G., Monaco, G., Granone, Pierluigi, Muriana, G., Rea, F., Crisci, Serena, Di Rienzo, G., Cardillo, G., Lococo, A., Amore, D., Divisi, D., Dolci, G., Guggino, G., Larocca, V., Loizzi, D., Luzzi, L., Monaco, F., Porziella, Venanzio, Rena, O., Lococo F. (ORCID:0000-0002-9383-5554), Granone P. (ORCID:0000-0002-8826-3045), Crisci R., and Porziella V. (ORCID:0000-0001-6000-3172)

Abstract

Background: Several gray areas and controversies exist concerning the management of pulmonary ground-glass opacities (GGOs), and there is a lack of consensus among clinicians on this topic. One of the main aims of the Italian Society of Thoracic Surgery is to promote education and research, so we decided to perform a survey on this topic to estimate current trends in practice in a large sample of thoracic surgeons. Methods: A total of 160 thoracic surgeons responded, namely, completed our questionnaire (response rate, 53%; 160 of 302). The survey was composed of 36 questions divided into six subsections: (1) demographic characteristics of the respondents; (2) terminology and taxonomy; (3) radiologic and radiometabolic evaluation; (4) diagnostic approach and indications for surgery; (5) surgical management; and (6) radiologic surveillance. Results: We observed some divergence of opinion regarding the definition of mixed GGOs, the role of 18F fluorodeoxyglucose positron emission tomography and computed tomography scans, indications for nonsurgical biopsy, intraoperative techniques for localizing GGOs, indications for surgery, extension of lung resection and lymph node dissection according to the radiologic scenario, use of intraoperative frozen section analysis, and radiologic surveillance of pure GGOs. Conclusions: This topic warrants more investigation in the future. An upcoming consensus conference of Italian Society of Thoracic Surgery experts (also open to experts in other specialties) could provide updated indications for GGO management based on the literature, expert opinions, and the results of the present survey.

Published
2018

43. The kinetics of 18F-FDG in lung cancer: compartmental models and voxel analysis

Author

Silvestri, E., Scolozzi, V., Rizzo, G., Indovina, Luca, Castellaro, M., Mattoli, M. V., Graziano, P., Cardillo, G., Bertoldo, A., Calcagni, Maria Lucia, Indovina L., Calcagni M. L. (ORCID:0000-0002-0805-8245), Silvestri, E., Scolozzi, V., Rizzo, G., Indovina, Luca, Castellaro, M., Mattoli, M. V., Graziano, P., Cardillo, G., Bertoldo, A., Calcagni, Maria Lucia, Indovina L., and Calcagni M. L. (ORCID:0000-0002-0805-8245)

Abstract

Background: The validation of the most appropriate compartmental model that describes the kinetics of a specific tracer within a specific tissue is mandatory before estimating quantitative parameters, since the behaviour of a tracer can be different among organs and diseases, as well as between primary tumours and metastases. The aims of our study were to assess which compartmental model better describes the kinetics of 18F-Fluorodeoxygluxose(18F-FDG) in primary lung cancers and in metastatic lymph nodes; to evaluate whether quantitative parameters, estimated using different innovative technologies, are different between lung cancers and lymph nodes; and to evaluate the intra-tumour inhomogeneity. Results: Twenty-one patients (7 females; 71 ± 9.4 years) with histologically proved lung cancer, prospectively evaluated, underwent 18F-FDG PET-CT for staging. Spectral analysis iterative filter (SAIF) method was used to design the most appropriate compartmental model. Among the compartmental models arranged using the number of compartments suggested by SAIF results, the best one was selected according to Akaike information criterion (AIC). Quantitative analysis was performed at the voxel level. K1, Vb and Ki were estimated with three advanced methods: SAIF approach, Patlak analysis and the selected compartmental model. Pearson’s correlation and non-parametric tests were used for statistics. SAIF showed three possible irreversible compartmental models: Tr-1R, Tr-2R and Tr-3R. According to well-known 18F-FDG physiology, the structure of the compartmental models was supposed to be catenary. AIC indicated the Sokoloff’s compartmental model (3K) as the best one. Excellent correlation was found between Ki estimated by Patlak and by SAIF (R2 = 0.97, R2 = 0.94, at the global and the voxel level respectively), and between Ki estimated by 3K and by SAIF (R2 = 0.98, R2 = 0.95, at the global and the voxel level respectively). Using the 3K model, the lymph nodes showed higher mea

Published
2018

44. First italian consensus conference on VATS lobectomy for NSCLC

Author

Nosotti, Mario, Droghetti, Andrea, Luzzi, Luca, Solli, Piergiorgio, Crisci, Roberto, VATS Group Italia, Alloisio, M, Amore, D, Ampollini, D, Andreetti, C, Aresu, Argnani, D, Baletto, G, Bandiera, A, Benato, C, Bertani, A, Bertolaccini, L, Bortolotti, L, Camplese, P, Carbognani, P, Cardillo, G, Carleo, F, Cavallesco, G, Curcio, C, Dell’Amore, D, De Monte, L, Denegri, A, De Vico, A, Di Rienzo, G, Divisi, D, Dolci, Gp, Ghisalberti, M, Giovanardi, M, Gonfiotti, A, Gotti, G, Imperatori, A, Infante, M, Lo faso, F, Lopez, C, Magnanelli, G, Maineri, P, Mancuso, M, Maniscalco, P, Marulli, G, Morelli, A, Mucilli, F, Muriana, G, Negri, Gp, Nicotra, S, Palleschi, A, Perkmann, R, Pernazza, F, Poggi, C, Puma, F, Rinaldo, A, Rizzardi, G, Roncon, A, Rosso, L, Rotolo, N, Solaini, L, Stella, F, Terzi, A, Torre, M, Vinci, D, Voltolini, L, and Zaraca, F

Subjects
medicine.medical_specialty, Surgical strategy, medicine, consensus conference, medicine.medical_treatment, VATS lobectomy, practical recommendations, thoracotomy, 030204 cardiovascular system & hematology, carcinoma, lung neoplasms, 03 medical and health sciences, 0302 clinical medicine, Carcinoma, Non-Small-Cell Lung, Medicine, Thoracotomy, lung cancer, non-small-cell lung, humans, Italy, thoracic surgery, video-assisted, oncology, cancer research, video-assisted, Perioperative management, business.industry, Thoracic Surgery, Video-Assisted, General surgery, Consensus conference, General Medicine, thoracic surgery, 030228 respiratory system, Cardiothoracic surgery, business
Abstract

Purpose Video-assisted thoracoscopic surgery (VATS) lobectomy has become an accepted procedure for the treatment of selected cases of lung cancer. The aim of this project was to establish national practical recommendations for the management of patients suitable for VATS lobectomy. Methods The Scientific Committee of the VATS Lobectomy Group (a branch of the Italian Society of Thoracic Surgery) identified the consensus conference as an appropriate tool for a national debate. The consensus conference was organized following indications of the Italian Department of Health: a panel of experts reviewed the literature, the jury board revised the experts’ reports, and the national conference discussed and voted on statements. The strength of recommendation for a statement was classified as weak, fair, or high when the total score ranged between 51% and 67%, 68% and 84%, or 85% and 100%, respectively. Results Eighty-six Italian thoracic surgeons attended the 1st Italian Consensus Conference on VATS lobectomy in Giulianova, Italy, on October 29-30, 2015. Thirty-three topics were discussed: indications, surgical strategy, perioperative management, and training were the main topics. Consensus was reached on 24 statements that were consequently recommended. Conclusions The Italian Consensus Conference is the first attempt to discuss VATS lobectomy-related issues in a national scientific community. Such experience determined an improvement in epistemic knowledge among the Italian thoracic surgeons and could be a suggestion for other national communities.

Published
2017

47. Epigenetic effects of butyrate in children with congenital chloride diarrhea: an in-vivo and in-vitro study

Author

Terrin G, Elce A, Castaldo G, Pedrolli A, Centenari C, Cardillo G, Tomaiuolo R, Amato F, Passariello A, Di Costanzo M, Troncone R, and Berni Canani R, Terrin, G., Elce, A., Castaldo, G., Tomaiuolo, R., Cardillo, G., Amato, Felice, Pedrolli, A., Centenari, C., Passariello, A., Di Costanzo, M., Troncone, Riccardo, BERNI CANANI, Roberto, Terrin, G, Elce, A, Castaldo, G, Pedrolli, A, Centenari, C, Cardillo, G, Tomaiuolo, R, Amato, F, Passariello, A, Di Costanzo, M, Troncone, R, and and Berni Canani, R

Published
2011

48. BUTYRATE MODULATES EPITHELIAL DRA EXPRESSION IN CHILDREN WITH CONGENITAL CHLORIDE DIARRHEA

Author

Terrin, Gianluca, Elce, A., Castaldo, G., Pedrolli, A., Centenari, C., Cardillo, G., Amato, F., Tomaiuolo, R., Passariello, A., Di Costanzo, M., Cosenza, L., Salvatore, F., Troncone, R., Berni Canani, R., Terrin, G., Elce, A., Castaldo, G., Pedrolli, A., Centenari, C., Cardillo, G., Amato, Felice, Tomaiuolo, R., Passariello, A., Di Costanzo, M., Cosenza, L., Salvatore, F., Troncone, R., BERNI CANANI, Roberto, Terrin, G, Elce, A, Castaldo, G, Pedrolli, A, Centenari, C, Cardillo, G, Amato, F, Tomaiuolo, R, Passariello, A, Di Costanzo, M, Cosenza, L, Salvatore, F, Troncone, R, and Berni Canani, R

Published
2011

50. Prognostic Impact of Diabetes and Prediabetes on Survival Outcomes in Patients With Chronic Heart Failure: A Post‐Hoc Analysis of the GISSI‐HF (Gruppo Italiano per lo Studio della Sopravvivenza nella Insufficienza Cardiaca‐Heart Failure) Trial

Author

Dauriz, Marco, primary, Targher, Giovanni, additional, Temporelli, Pier Luigi, additional, Lucci, Donata, additional, Gonzini, Lucio, additional, Nicolosi, Gian Luigi, additional, Marchioli, Roberto, additional, Tognoni, Gianni, additional, Latini, Roberto, additional, Cosmi, Franco, additional, Tavazzi, Luigi, additional, Maggioni, Aldo Pietro, additional, Barlera, Simona, additional, Franzosi, Maria Grazia, additional, Maggioni, Aldo P., additional, Porcu, Maurizio, additional, Yusuf, Salim, additional, Camerini, Fulvio, additional, Cohn, Jay N., additional, Decarli, Adriano, additional, Pitt, Bertram, additional, Sleight, Peter, additional, Poole‐Wilson, Philip A., additional, Geraci, Enrico, additional, Scherillo, Marino, additional, Fabbri, Gianna, additional, Bartolomei, Barbara, additional, Bertoli, Daniele, additional, Cobelli, Franco, additional, Fresco, Claudio, additional, Ledda, Antonietta, additional, Levantesi, Giacomo, additional, Opasich, Cristina, additional, Rusconi, Franco, additional, Sinagra, Gianfranco, additional, Turazza, Fabio, additional, Volpi, Alberto, additional, Ceseri, Martina, additional, Alongi, Gianluca, additional, Atzori, Antonio, additional, Bambi, Filippo, additional, Bastarolo, Desiree, additional, Bianchini, Francesca, additional, Cangioli, Iacopo, additional, Canu, Vittoriana, additional, Caporusso, Concetta, additional, Cenni, Gabriele, additional, Cintelli, Laura, additional, Cocchio, Michele, additional, Confente, Alessia, additional, Fenicia, Eva, additional, Friso, Giorgio, additional, Gianfriddo, Marco, additional, Grilli, Gianluca, additional, Lazzaro, Beatrice, additional, Lonardo, Giuseppe, additional, Luise, Alessia, additional, Nota, Rachele, additional, Orlando, Mariaelena, additional, Petrolo, Rosaria, additional, Pierattini, Chiara, additional, Pierota, Valeria, additional, Provenzani, Alessandro, additional, Quartuccio, Velia, additional, Ragno, Anna, additional, Serio, Chiara, additional, Spolaor, Alvise, additional, Tafi, Arianna, additional, Tellaroli, Elisa, additional, Ghio, Stefano, additional, Ghizzardi, Elisa, additional, Masson, Serge, additional, Crociati, Lella, additional, La Rovere, Maria Teresa, additional, Corrà, Ugo, additional, Finzi, Andrea, additional, Gorini, Marco, additional, Milani, Valentina, additional, Orsini, Giampietro, additional, Bianchini, Elisa, additional, Cabiddu, Silvia, additional, Cangioli, Ilaria, additional, Cipressa, Laura, additional, Cipressa, Maria Lucia, additional, Di Bitetto, Giuseppina, additional, Ferri, Barbara, additional, Galbiati, Luisa, additional, Lorimer, Andrea, additional, Pera, Carla, additional, Priami, Paola, additional, Vasamì, Antonella, additional, Moccetti, T., additional, Rossi, M.G., additional, Pasotti, E., additional, Vaghi, F., additional, Roncarolo, P., additional, Zunino, M.T., additional, Matta, F., additional, Perinetto, E. Actis, additional, Gaita, F., additional, Azzaro, G., additional, Zanetta, M., additional, Paino, A.M., additional, Parravicini, U., additional, Vegis, D., additional, Conte, R., additional, Ferraro, P., additional, De Bernardi, A., additional, Morelloni, S., additional, Fagnani, M., additional, Lucchina, P. Greco, additional, Montagna, L., additional, Bellone, E., additional, Sappè, D., additional, Ferraro, F., additional, Delucchi, M., additional, Reynaud, S.G., additional, Dore, M., additional, La Brocca, A., additional, Massobrio, N., additional, Bo, L., additional, Trinchero, R., additional, Imazio, M., additional, Brocchi, G., additional, Nejrotti, A., additional, Rissone, L., additional, Gabasio, S., additional, Zocchi, C., additional, Randazzo, S., additional, Crenna, A., additional, Giannuzzi, P., additional, Bonanomi, E., additional, Mezzani, A., additional, De Marchi, M., additional, Begliuomini, G., additional, Gianonatti, C.A., additional, Gavazzi, A., additional, Grosu, A., additional, Dei Cas, L., additional, Nodari, S., additional, Garyfallidis, P., additional, Bertoletti, A., additional, Bonifazi, C., additional, Arisi, S., additional, Mascaro, F., additional, Fraccarollo, M., additional, Dell'Orto, S., additional, Sfolcini, M., additional, Bortolini, F., additional, Raccagni, D., additional, Turelli, A., additional, Santarone, M., additional, Miglierina, E., additional, Sormani, L., additional, Jemoli, R., additional, Tettamanti, F., additional, Pirelli, S., additional, Bianchi, C., additional, Verde, S., additional, Mariani, M., additional, Ziacchi, V., additional, Ferrazza, A., additional, Russo, A., additional, Bortolotti, M., additional, Pasini, G.F., additional, Volpi, A., additional, Jones, K.N., additional, Cuzzucrea, D., additional, Gullace, G., additional, Carbone, C., additional, Granata, A., additional, De Servi, S., additional, Del Rosso, G., additional, Inserra, C., additional, Renaldini, E., additional, Zappa, C., additional, Moretti, M., additional, Zanini, R., additional, Ferrari, M., additional, Moroni, E., additional, Cei, A., additional, Lissi, C., additional, Dovico, E., additional, Fiorentini, C., additional, Palermo, P., additional, Brusoni, B., additional, Negrini, M., additional, Heyman, J., additional, Danzi, G.B., additional, Finzi, A., additional, Frigerio, M., additional, Turazza, F., additional, Beretta, L., additional, Sachero, A., additional, Casazza, F., additional, Squadroni, L., additional, Lombardi, F., additional, Marano, L., additional, Margonato, A., additional, Fragasso, G., additional, Febo, O.C., additional, Aiolfi, E., additional, Olmetti, F., additional, Grieco, A., additional, Antonazzo, V., additional, Specchia, G., additional, Mortara, A., additional, Robustelli, F., additional, Songini, M.G., additional, Schweiger, C., additional, Frisinghelli, A., additional, Palvarini, M., additional, Campana, C., additional, Scelsi, L., additional, Ajmone Marsan, N., additional, Cobelli, F., additional, Gualco, A., additional, Opasich, C., additional, De Feo, S., additional, Mazzucco, R., additional, Iannone, M.A., additional, Diaco, T., additional, Zaniboni, D., additional, Milanesi, G., additional, Nassiacos, D., additional, Meloni, S., additional, Giani, P., additional, Nicoli, T., additional, Malinverni, C., additional, Gusmini, A., additional, Pozzoni, L., additional, Bisiani, G., additional, Margaroli, P., additional, Schizzarotto, A., additional, Daverio, A., additional, Occhi, G., additional, Partesana, N., additional, Bandini, P., additional, Rosella, M.G., additional, Giustiniani, S., additional, Cucchi, G., additional, Pedretti, R., additional, Raimondo, R., additional, Vaninetti, R., additional, Fedele, A., additional, Ghezzi, I., additional, Rezzonico, E., additional, Salerno Uriarte, J.A., additional, Morandi, F., additional, Salvucci, F., additional, Valenti, C., additional, Graziano, G., additional, Romanò, M., additional, Cimminiello, C., additional, Mangone, I., additional, Lombardo, M., additional, Quorso, P., additional, Marinoni, G., additional, Breghi, M., additional, Erckert, M., additional, Dienstl, A., additional, Mirante Marini, G., additional, Stefenelli, C., additional, Cioffi, G., additional, Buczkowska, E., additional, Bonanome, A., additional, Bazzanini, F., additional, Parissenti, L., additional, Serafini, C., additional, Catania, G., additional, Tarantini, L., additional, Rigatelli, G., additional, Boni, S., additional, Pasini, A., additional, Masini, E., additional, Zampiero, A.A., additional, Zanchetta, M., additional, Franceschetto, L., additional, Delise, P., additional, Marcon, C., additional, Sacchetta, A., additional, Borgese, L., additional, Artusi, L., additional, Casolino, P., additional, Corbara, F., additional, Banzato, A., additional, Barbiero, M., additional, Aldegheri, M.P., additional, Bazzucco, R., additional, Crivellenti, G., additional, Raviele, A., additional, Zanella, C., additional, Pascotto, P., additional, Sarto, P., additional, Milan, S., additional, Barbieri, E., additional, Girardi, P., additional, Dalla Villa, W., additional, Dalle Mule, J., additional, Di Sipio, M.L., additional, Cazzin, R., additional, Milan, D., additional, Zonzin, P., additional, Carraro, M., additional, Rossi, R., additional, Carbonieri, E., additional, Rossi, I., additional, Stritoni, P., additional, Meneghetti, P., additional, Risica, G., additional, Tenderini, P.L., additional, Vassanelli, C., additional, Zanolla, L., additional, Perini, G., additional, Brighetti, G., additional, Chiozza, R., additional, Giuliano, G., additional, Gortan, R., additional, Cesanelli, R., additional, Nicolosi, G.L., additional, Piazza, R., additional, Mos, L., additional, Vriz, O., additional, Pavan, D., additional, Pascottini, G., additional, Alberti, E., additional, Werren, M., additional, Solinas, L., additional, Sinagra, G., additional, Longaro, F., additional, Fioretti, P., additional, Albanese, M.C., additional, Miani, D., additional, Gianrossi, R., additional, Pende, A., additional, Rubartelli, P., additional, Magaia, O., additional, Domenicucci, S., additional, Caruso, D., additional, Faraguti, A.S., additional, Magliani, L., additional, Miccoli, F., additional, Guglielmino, G., additional, Bertoli, D., additional, Cantarelli, A., additional, Orlandi, S., additional, Vallebona, A., additional, Pozzati, A., additional, Brega, G., additional, Pancaldi, L.G., additional, Vandelli, R., additional, Urbinati, S., additional, Poci, M.G., additional, Zoli, M., additional, Costa, G.M., additional, Guiducci, U., additional, Zobbi, G., additional, Tartagni, F., additional, Tisselli, A., additional, Gentili, A., additional, Pieri, P., additional, Cagnetta, E., additional, Bendinelli, S., additional, Barbieri, A., additional, Conti, R., additional, Ferrari, R., additional, Merlini, F., additional, Fucili, A., additional, Moruzzi, P., additional, Buia, E., additional, Galvani, M., additional, Ferrini, D., additional, Baggioni, G., additional, Yiannacopulu, P., additional, Canè, G., additional, Bonfiglioli, A., additional, Zandomeneghi, R., additional, Brugioni, L., additional, Giannini, A., additional, Di Ruvo, R., additional, Giuliani, M., additional, Rusconi, L., additional, Del Corso, P., additional, Piovaccari, G., additional, Bologna, F., additional, Venturi, P., additional, Melandri, F., additional, Bagni, E., additional, Bolognese, L., additional, Perticucci, R., additional, Zuppiroli, A., additional, Nannini, M., additional, Consoli, N., additional, Petrone, P., additional, Pipitò, C., additional, Colombi, L., additional, Bernardi, D., additional, Mariani, P.R., additional, Testa, R., additional, Mazzinghi, F., additional, Cosmi, F., additional, Cosmi, D., additional, Zipoli, A., additional, Cecchi, A., additional, Castelli, G., additional, Ciaccheri, M., additional, Mori, F., additional, Pieri, F., additional, Valoti, P., additional, Chiarantini, D., additional, Santoro, G.M., additional, Minneci, C., additional, Marchi, F., additional, Milli, M., additional, Zambaldi, G., additional, Brandinelli Geri, A.A., additional, Cipriani, M., additional, Alessandri, M., additional, Severi, S., additional, Stefanelli, S., additional, Comella, A., additional, Poddighe, R., additional, Digiorgio, A., additional, Carluccio, M., additional, Berti, S., additional, Rizza, A., additional, Bonatti, V., additional, Molendi, V., additional, Brancato, A., additional, D'Aprile, N., additional, Giappichini, G., additional, Del Vecchio, S., additional, Mantini, G., additional, De Tommasi, F., additional, Meucci, G., additional, Cordoni, M., additional, Bechi, S., additional, Barsotti, L., additional, Baldini, P., additional, Romei, M., additional, Scopelliti, G., additional, Lauri, G., additional, Pestelli, F., additional, Furiozzi, F., additional, Cocchieri, M., additional, Severini, D., additional, Patriarchi, F., additional, Chiocchi, P., additional, Buccolieri, M., additional, Martinelli, S., additional, Wee, A., additional, Angelici, F., additional, Bernardinangeli, M., additional, Proietti, G., additional, Biscottini, B., additional, Panciarola, R., additional, Marinacci, L., additional, Perna, G.P., additional, Gabrielli, D., additional, Moraca, A., additional, Moretti, L., additional, Partemi, L., additional, Gregori, G., additional, Amici, R., additional, Patteri, G., additional, Capone, P., additional, Savini, E., additional, Morgagni, G.L., additional, Paccaloni, L., additional, Pezzuoli, F., additional, Carincola, S., additional, Papi, S., additional, De Crescentini, S., additional, Gerardi, P., additional, Midi, P., additional, Gallenzi, E., additional, Pajes, G., additional, Mancone, C., additional, Di Spirito, V., additional, Di Gennaro, M., additional, Calcagno, S., additional, Toscano, S., additional, Antonicoli, S., additional, Carta, F., additional, Giorgi, G., additional, Comito, F., additional, Daniele, E., additional, Ciarla, O., additional, Gelfo, P.G., additional, Acquaviva, A., additional, Testa, D., additional, Testa, G., additional, Pagliaro, F.A., additional, Russo, F., additional, Vetta, F., additional, Marchese, I., additional, Di Sciascio, G., additional, D'Ambrosio, A., additional, Leggio, F., additional, Del Sindaco, D., additional, Lacchè, A., additional, Avallone, A., additional, Risa, M.P., additional, Azzolini, P., additional, Baldo, E., additional, Giovannini, E., additional, Pulignano, G., additional, Tondo, C., additional, Picchio, E., additional, ani, E., additional, Tanzi, P., additional, Pozzar, F., additional, Farnetti, F., additional, Azzarito, M., additional, Santini, M., additional, Varveri, A., additional, Ferraiuolo, G., additional, Valtorta, C., additional, Gaspardone, A., additional, Barbato, G., additional, Ceci, V., additional, Aspromonte, N., additional, Bellocci, F., additional, Colizzi, C., additional, Fedele, F., additional, Perez, F.I., additional, Galati, A., additional, Rossetti, A., additional, Mainella, A., additional, etta, D., additional, Matteucci, C., additional, Busi, G., additional, De Angelis, A., additional, Farina, G., additional, Granatelli, A., additional, Leone, F., additional, Frasca, F., additional, Di Giovambattista, R., additional, Castellani, G., additional, Massaro, G., additional, Mastrogiuseppe, G., additional, Vacri, A., additional, De Sanctis, F., additional, Cioli, M., additional, Di Luzio, S., additional, Napoletano, C., additional, Piccioni, L.L., additional, De Simone, G., additional, Ottaviano, A., additional, Mazza, V., additional, Spedaliere, C., additional, Staniscia, D., additional, Calgione, E., additional, De Marco, G., additional, Chiacchio, T., additional, Di Napoli, T., additional, Romanzi, S., additional, Salvatore, G., additional, Golino, P., additional, Palermo, A., additional, Mascia, F., additional, Vetrano, A., additional, Vinciguerra, A., additional, Caliendo, L., additional, Longobardi, R., additional, De Caro, G., additional, Di Nola, R., additional, Piemonte, F., additional, Prinzi, D., additional, De Rosa, P., additional, De Rosa, V., additional, Riello, F., additional, Capuano, V., additional, Vecchio, G., additional, Landi, M., additional, Amato, S., additional, Garofalo, M., additional, D'Avino, M., additional, Sensale, P., additional, Maiolica, O., additional, Santoro, R., additional, Caso, P., additional, Miceli, D., additional, Maurea, N., additional, Bianchi, U., additional, Crispo, C., additional, Chiariello, M., additional, Perrone Filardi, P., additional, Russo, L., additional, Capuano, N., additional, Ungaro, G., additional, Vergara, G., additional, Scafuro, F., additional, D'Angelo, G., additional, Campaniello, C., additional, Bottiglieri, P., additional, Volpe, A., additional, Battista, R., additional, De Risi, L., additional, Cardillo, G., additional, Sibilio, G., additional, Marino, A.P., additional, Silvestri, F., additional, Predotti, P., additional, Iervoglini, A., additional, De Matteis, C., additional, Sarnicola, P., additional, Matarazzo, M.M., additional, Baldi, S., additional, Iuliano, V., additional, Astarita, C., additional, Cuccaro, P., additional, Liguori, A., additional, Liguori, G., additional, Gregorio, G., additional, Petraglia, L., additional, Antonelli, G., additional, Amodio, G., additional, De Luca, I., additional, Traversa, D., additional, Franchini, G., additional, Lenti, M.L., additional, Cavallari, D., additional, D'Agostino, C., additional, Scalera, G., additional, Altamura, C.M., additional, Russo, M., additional, Mascolo, A.R., additional, Pettinati, G., additional, Ciricugno, S.A., additional, Scrutinio, D., additional, Passantino, A., additional, Mastrangelo, D., additional, Di Masi, A., additional, De Carne, R., additional, Cannone, M., additional, Dibiase, F., additional, Pensato, M., additional, Loliva, F., additional, Trapani, F., additional, Panettieri, I., additional, Leone, L., additional, Di Biase, M., additional, Carrone, M., additional, Gallone, V., additional, Cocco, F., additional, Costantini, M., additional, Tritto, C., additional, Cavalieri, F., additional, Stella, L., additional, Magliari, F., additional, Callerame, M., additional, De Giorgi, A., additional, Pellegrino, L., additional, Correra, M., additional, Portulano, V., additional, Nisi, G.L., additional, Grassi, G., additional, Cristallo, E., additional, De Laura, D., additional, Salerno, C., additional, Fanelli, R., additional, Villella, M., additional, Pede, S., additional, Renna, A., additional, De Lorenzi, E., additional, Urso, L., additional, Lenti, V., additional, Peluso, A., additional, Baldi, N., additional, Polimeni, G., additional, Palma, P., additional, Lauletta, R., additional, Tagliamonte, E., additional, Cirillo, T., additional, Silvestri, B., additional, Centonze, G., additional, D'Alessandro, B., additional, Truncellito, L., additional, Mecca, D., additional, Petruzzi, M.A., additional, Coviello, R.O.M., additional, Lopizzo, A., additional, telli, M., additional, Barbuzzi, S., additional, Gubelli, S., additional, Germinario, G., additional, Cosentino, N., additional, Mingrone, A., additional, Vico, R., additional, Borrello, G., additional, Mazza, M.L., additional, Cimino, R., additional, Galasso, D., additional, Cassadonte, F., additional, Talarico, U., additional, Perticone, F., additional, Cassano, S., additional, Catapano, F., additional, Calemme, S., additional, Feraco, E., additional, Cloro, C., additional, Misuraca, G., additional, Caporale, R., additional, Vigna, L., additional, Spagnuolo, V., additional, De Rosa, F., additional, Spadafora, G., additional, Zampaglione, G., additional, Russo, R., additional, Schipani, F.A., additional, Ferragina, A.F., additional, Stranieri, D., additional, Musca, G., additional, Carpino, C., additional, Bencardino, P., additional, Raimondo, F., additional, Musacchio, D., additional, Pulitanò, G., additional, Ruggeri, A., additional, Provenzano, A., additional, Salituri, S., additional, Musolino, M., additional, Calandruccio, S., additional, Marrari, A., additional, Tripodi, E., additional, Scali, R., additional, Anastasio, L., additional, Arone, A., additional, Aragona, P., additional, Donnangelo, L., additional, Comito, M.G.A., additional, Bilotta, F., additional, Vaccaro, I., additional, Rametta, R., additional, Ventura, V., additional, Bonvegna, A., additional, Alì, A., additional, Cinnirella, C., additional, Raineri, M., additional, Pompeo, F., additional, Cascio Ingurgio, N., additional, Carini, V., additional, Coco, R., additional, Giunta, G., additional, Leonardi, G., additional, Randazzo, V., additional, Di Blasi, V., additional, Tamburino, C., additional, Russo, G., additional, Mangiameli, S., additional, Cardillo, R., additional, Castelli, D., additional, Inserra, V., additional, Arena, A., additional, Gulizia, M.M., additional, Raciti, S., additional, Rapisarda, G., additional, Romano, R., additional, Prestifilippo, P., additional, Braschi, G.B., additional, Ledda, G., additional, Terrazzino, R., additional, De Caro, M., additional, Scilabra, G., additional, agnino, B., additional, Grassi, R., additional, Di Tano, G., additional, Scimone, G.F., additional, Vasquez, L., additional, Coppolino, C., additional, Casale, A., additional, Castelli, M., additional, D'Urso, G., additional, D'Antonio, E., additional, Lo Presti, L., additional, Badalamenti, E., additional, Conti, P., additional, Sanfilippo, N., additional, Cirrincione, V., additional, Cinà, M.T., additional, Cusimano, G., additional, Taormina, A., additional, Giuliano, P., additional, Bajardi, A., additional, Mandalà, V., additional, Canonico, A., additional, Geraci, G., additional, Sabella, F.P., additional, Enia, F., additional, Floresta, A.M., additional, Lo Cascio, I., additional, Gumina, D., additional, Cavallaro, A., additional, Piccione, G., additional, Ferrante, R., additional, Blandino, M., additional, Iudicello, M.S., additional, Mossuti, E., additional, Romano, G., additional, Lombardo, L., additional, Monastra, P., additional, Di Vincenzo, D., additional, Porcu, M., additional, Orrù, P., additional, Muscas, F., additional, Giardina, G., additional, Corda, M., additional, Locci, G., additional, Podda, A., additional, Ledda, M., additional, Siddi, P., additional, Lai, C., additional, Pili, G., additional, Mercuro, G., additional, Mureddu, G., additional, Ganau, A., additional, Meloni, G., additional, Poddighe, G., additional, and Sanna, G., additional

Published
2017
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