Search

Background: Although general thoracic surgery is usually focused on adult patients, there are some settings of pediatric diseases which can benefit from thoracic surgical procedures. In this study, we retrospectively reviewed the contribution of general thoracic surgeons to pediatric patients in a high-volume hospital. Methods: From September 2002 to August 2024, 8897 consecutive patients were operated on; among them, 202 patients (2.2%) were younger than 18. Age, sex, operatory setting, side, indications, procedures, procedure duration, and perioperative mortality were collected for each patient. Results: Among the 202 patients younger than 18, 27 (13.3%) were 0–6 yo; 13 (6.4%) were 6–12 yo; 162 (80.1%) were 12–18 yo. In the first group, metapneumonic pleural effusion was the most frequent indication (44.4%) and chest drain the most frequent procedure (51.8%). No perioperative mortality was reported. In the second group, metapneumonic pleural effusion was the most frequent indication (30.7%) and chest drain the most frequent procedure (46.1%). No perioperative mortality was reported. In the third group, pneumothorax was the most frequent indication (41.3%) and bullectomy the most frequent procedure; (41.3%); one intraoperative death (0.4%) was reported in a case of major trauma. Conclusions: A general thoracic surgeon can effectively contribute to the surgical care of pediatric patients; in younger patients (<12 yo) urgent procedures related to infections are the most commonly performed; on the other hand, in patients aged between 12 and 18, elective procedures are more commonly performed, these being sympathectomy for hyperhidrosis and bullectomy for pneumothorax the most frequent. [ABSTRACT FROM AUTHOR]

Patients with interstitial lung disease (ILD) are about five times more likely to develop lung cancer than those without ILD. The presence of ILD in lung cancer patients complicates diagnosis and management, resulting in lower survival rates. Diagnostic and treatment procedures needed for cancer can increase the risk of acute exacerbation (AE), one of the most severe complications for these patients. Bronchoscopic techniques are generally considered safe, but they can trigger AE-ILD, particularly after cryoprobe biopsies. Surgical procedures for lung cancer, including lung biopsies and resections, carry an elevated risk of AE-ILD. Postoperative complications and mortality rates highlight the importance of meticulous surgical planning and postoperative care. Furthermore, cancer treatments, such as chemotherapy, are all burdened by a risk of AE-ILD occurrence. Radiotherapy is important for managing both early-stage and advanced lung cancer, but it also poses risks. Stereotactic body radiation and particle beam therapies have varying degrees of safety, with the latter potentially offering a lower risk of AE. Percutaneous ablation techniques can help patients who are not eligible for surgery. However, these procedures may complicate ILD, and their associated risks still need to be fully understood, necessitating further research for improved safety. Overall, while advancements in lung cancer treatment have improved outcomes for many patients, the complexity of managing patients with concomitant ILD needs careful consideration and multidisciplinary assessment. This review provides a detailed evaluation of these risks, emphasizing the need for personalized treatment approaches and monitoring to improve patient outcomes in this challenging population. [ABSTRACT FROM AUTHOR]

Simple Summary: Ovarian cancer is often diagnosed at advanced stages, making treatment more challenging. One key factor that affects survival is the amount of cancer left after surgery. There is ongoing debate about whether removing enlarged lymph nodes outside the abdomen during surgery improves outcomes. These lymph nodes can be seen through advanced imaging techniques so that the best surgical methods can be adopted. This approach aims to ensure that as much of the cancer is removed as possible, which is crucial for improving patient prognosis. This review emphasizes the importance of careful knowledge of focused anatomy, imaging, and surgical treatment for advanced ovarian cancer patients with extra-abdominal lymphadenopathies. Ovarian cancer typically presents at advanced stages, with prognosis heavily influenced by the presence of residual disease following cytoreductive surgery. The role of resecting enlarged extra-abdominal lymph nodes during cytoreductive procedures remains contentious. These enlarged lymph nodes are commonly identified through high-resolution imaging techniques such as ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography–computed tomography (PET-CT). A comprehensive understanding of the relevant anatomy, imaging modalities, and surgical techniques for addressing lymphadenopathy in regions such as the supraclavicular fossa, axillae, mediastinum, and pericardiophrenic fat is crucial in determining the feasibility of surgical intervention. An appropriate evaluation of these factors is essential to optimize debulking, which is recognized as the most significant prognostic determinant in patients with ovarian cancer. This review underscores the importance of multidisciplinary approaches in managing advanced ovarian cancer with extra-abdominal lymph node involvement to enhance patient outcomes. [ABSTRACT FROM AUTHOR]

Simple Summary: The therapeutic strategies of NSCLC focus on systemic strategies, mainly chemotherapy and immunotherapy. Unfortunately, cancer has some aces up it's sleeve, in particular the tumoral microenvironment. An intratumoral strategy can be useful to overcome cancer's shelters. Some intratumoral strategies have been analyzed and proved during the last decades, including a treatment based on "classical" antiblastic agents, immunotherapy, and immunomodulating agents, which can be administered by direct injection, inhalation, and intrapleuraly. Other treatments take advantage of ablation techniques, including photodynamic and thermal. Moreover, it is possible to evaluate the use of electric fields, a promising technique, and brachytherapy, a consolidated one. Finally, nanoparticles are interesting and useful both for their direct activity and for their carrier role. Each intratumoral strategy should be chosen based on setting, metastasis status, cancer type, and patient features, etc. Furthermore, the evaluation of a combined approach is fundamental, because intratumoral and systemic strategies together can overcome the other's limitations and mutually enhance one another in order to become more efficient tools in the anticancer war. According to a modern view, cancer no longer follows a purely mechanistic model. Rather, a tumor is conceived as a more complex structure, composed of cancer cells, the activities of which may interact and reshape the so-called tumor microenvironment (TME), leading to preservation of specific tumoral niches and promoting the survival of tumoral stem cells. Background/Objective: Therapeutic strategies must deal with this unique cancer architecture in the near future by widening their range of activities outside the cancer cells and rewiring a TME to ensure it is hostile to cancer growth. Therefore, an intratumoral therapeutic strategy may open the door to a new type of anticancer activity, one that directly injures the tumoral structure while also eliciting an influence on the TME through local and systemic immunomodulation. This review would like to assess the current situation of intratumoral strategies and their clinical implications. Methods We analyzed data from phase I, II, and III trials, comprehensive reviews and relevant clinical and preclinical research, from robust databases, like PUBMED, EMBASE, Cochrane Library, and clinicaltrials.gov. Results: Intratumoral strategies can be quite variable. It is possible the injection and inhalation of traditional antiblastic agents or immunomodulant agents, or intrapleural administration. Ablation strategy is available, both thermal and photodynamic method. Moreover, TTfields and NPs are analyzed and also brachytherapy is mentioned. Intratumoral therapy can find space in "adjuvant"/perioperative or metastatic settings. Finally, intratumoral strategies allow to synergize their activities with systemic therapies, guaranteeing better local and systemic disease control. Conclusions: Intratumoral strategies are overall promising. Antiblastic/immunomodulant injection and NPs use are especially interesting and intriguing. But, there is generally a lack of phase II and III trials, in particular NPs use need additional experimentation and clinical studies. [ABSTRACT FROM AUTHOR]

Background Lung cancer is the leading cause of cancer-related deaths, and surgery is still the first treatment of choice in early and locally advanced cases. One of the iatrogenic complications is the serratus anterior palsy, which could lead to a winged scapula (WS). Unfortunately, the incidence of this deficit in thoracic surgery is unclear. Our primary aim was to determine the incidence of WS in lung cancer patients in a single-center experience. Methods We conducted a retrospective analysis of prospectively collected data with patients eligible for oncological thoracic surgery from March 2013 until January 2014. A physical evaluation of the WS was performed pre- and postoperatively, at the discharge and after 1 year of follow-up. Results A total of 485 patients were evaluated; 135 (27.8%) showed WS. Longer operative time (p < 0.0001), type of surgery (p < 0.0001), lymphadenectomy (p < 0.0001), and neoadjuvant treatment prior surgery (p = 0.0005) were significantly related to the WS injury. Multivariable analysis showed that type of surgery was significantly associated with WS (p < 0.0001). After 1 year, 41.6% still had WS. Conclusion The incidence of WS was similar to the literature. As WS incidence is underdiagnosed, assessment and correct education about possible deficits or impairments should be improved. Moreover, when a minimally invasive approach is not planned, it is a good clinical practice to discuss surgical strategies with surgeons to reduce this deficit. [ABSTRACT FROM AUTHOR]

Malignant pleural effusion is the presence of malignant cells within the pleural fluid, representing the second most common cause of pleural exudate. Although diagnostic methods and management techniques for malignant pleural effusion have dramatically improved over the decades, the current treatment is still palliative, aiming to remove pleural fluid, possibly prevent its recurrence, and alleviate symptoms through a wide range of available procedures. Treatment should be tailored to the individual patient, considering comorbidities, size of the effusion, rate of fluid accumulation, underlying cardiac or respiratory conditions, rate of recurrence, presence of loculations or trapped lung, tumor characteristics, cancer type, and patient preferences. This manuscript aims to review the available literature and to present the latest evidence on malignant pleural effusion management in order to provide an updated perspective on its diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Lung cancer represents the second most frequent neoplasm and the leading cause of neoplastic death among both women and men, causing almost 25% of all cancer deaths. Patients undergoing lung resection—both for primary and secondary tumors—require careful preoperative cardiopulmonary functional evaluation to confirm the safety of the planned resection, to assess the maximum tolerable volume of resection or to exclude surgery, thus shifting the therapeutic approach toward less invasive options. Cardiopulmonary reserve, pulmonary lung function and mechanical respiratory function represent the cornerstones of preoperative assessment of patients undergoing major lung resection. Spirometry with carbon monoxide diffusing capacity, split function tests, exercise tests and cardiologic evaluation are the gold standard instruments to safely assess the entire cardiorespiratory function before pulmonary resection. Although pulmonary mechanical and parenchymal function, together with cardiorespiratory compliance represent the mainstay of preoperative evaluation in thoracic surgery, the variables that are responsible for fitness in patients who have undergone lung resection have expanded and are being continually investigated. Nevertheless, because of the shift to older patients who undergo lung resection, a global approach is required, taking into consideration variables like frailty status and likelihood of postoperative functional deterioration. Finally, the decision to go ahead with surgery in fragile patients being consideredfor lung resection should be evaluated in a multispecialty preoperative discussion to provide a personalized risk stratification. The aim of this review is to focus on preoperative evaluation of cardiopulmonary reserve and surgical risk stratification of patients candidate for lung cancer resection. It does so by a literature search of clinical guidelines, expert consensus statements, meta-analyses, clinical recommendations, book chapters and randomized trials (1980–2022). [ABSTRACT FROM AUTHOR]

The results of a prospective, multi-institutional randomized trial developed to assess the equality of sublobar resection versus standard lobectomy were first published in 1995. They concluded that, compared with lobectomy, sublobar resections did not show any significant improvement either in terms of postoperative morbidity and mortality nor in terms of late post-resectional cardiorespiratory function. Moreover, due to the higher mortality and local recurrence rate related to sublobar resection, lobectomy had to be judged as the best surgical option for patients diagnosed with peripheral early-stage non-small-cell lung cancer. Since then, lobectomy has been considered the best surgical option for fit patients suffering from early-stage non-small cell lung cancer. In 2022 and 2023, three non-inferiority randomized trials were published, comparing lobectomy with the sublobar resection in T1a N0 patients whose tumors were up to 2 cm in size. Although presenting some important differences, all three trials met their primary endpoints, disclosing the non-inferiority of sublobar resections in terms of overall and disease-free survival. This narrative review aims to compare the newly published results of these trials as well as to report results from recent non-randomized studies on this topic. [ABSTRACT FROM AUTHOR]

Thoracic outlet syndrome (TOS) is a group of symptoms caused by the compression of neurovascular structures of the superior thoracic outlet. The knowledge of its clinical presentation with specific symptoms, as well as proper imaging examinations, ranging from plain radiographs to ultrasound, computed tomography and magnetic resonance imaging, may help achieve a precise diagnosis. Once TOS is recognized, proper treatment may comprise a conservative or a surgical approach. [ABSTRACT FROM AUTHOR]

Simple Summary: Hyperthermic intrathoracic chemotherapy (HITHOC) is an intraoperative and topical administration of chemotherapeutic drugs with simultaneous warming of the thoracic cavity. This procedure was first described by Spratt in 1980 as a thermal transfusion infiltration system, performed on canine models to treat malignant effusions of metastatic abdominal cancers. The main tumors causing malignant pleural effusion, which have been seen to benefit from hyperthermic intrathoracic chemotherapy, are mesothelioma, thymic malignancies and lung cancer: despite the high prevalence of MPE in patients with metastatic breast and ovarian cancers, there are still inadequate data on the use of HITHOC as a treatment option for these malignancies. Pleural mesothelioma (PM) is a rare but aggressive thoracic tumor with a poor prognosis. Multimodal treatment—including induction chemotherapy, aggressive surgical resection, radiotherapy and immunotherapy in selected cases—currently represents the best therapeutic option. Single-center studies advocate hyperthermic intrathoracic chemotherapy (HITHOC) during surgical resection as an additional therapeutic option, although its impact on post-operative morbidity and survival has not yet been evaluated on a larger scale. HITHOC can be applied not only in the case of mesothelioma, but also in the case of thymoma with pleural involvement or—in very selected cases—in patients with secondary pleural metastases. Despite favorable outcomes and reduced clinical risks, there is no uniform approach to HITHOC, and a wide variety of indications and technical applications are still reported. Based on available data, HITHOC seems to offer a clear benefit in regard to overall survival of all mesothelioma patients; however, multicenter randomized controlled trials are required to validate and standardize this approach. The aim of this review is to focus on the present role of HITHOC in thoracic tumors with pleural involvement as well as on future challenges, particularly in the light of possible combined therapy of thoracic tumors still presenting poor prognoses. [ABSTRACT FROM AUTHOR]