Thoracic Surgery: Current and Future Strategies

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Pulmonology".

Deadline for manuscript submissions: closed (31 March 2024) | Viewed by 3625

Special Issue Editors


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Guest Editor
1. Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
2. Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca’ Granda - Ospedale Maggiore Policlinico of Milan, Via F. Sforza, 35 20122 Milan, Italy
Interests: lung transplantation; donation after circulatory death (DCD); video-assisted thoracic surgery (VATS); robotic-assisted thoracic surgery (RATS); diaphragm dysfunction
Special Issues, Collections and Topics in MDPI journals

E-Mail Website
Guest Editor
1. Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
2. Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca’ Granda - Ospedale Maggiore Policlinico of Milan, Via F. Sforza, 35 20122 Milan, Italy
Interests: lung transplantation; non-small-cell lung cancer; mediastinum; thymic malignancies; video-assisted thoracic surgery (VATS); robotic-assisted thoracic surgery (RATS)
Special Issues, Collections and Topics in MDPI journals

E-Mail Website
Guest Editor
Thoracic Surgery Unit, University of Milan—Aziende Socio Sanitarie Territoriali (ASST) Santi Paolo e Carlo, Via Antonio di Rudinì, 8, 20142 Milan, Italy
Interests: non-small-cell lung cancer; thymic malignancies; video-assisted thoracic surgery (VATS); robotic-assisted thoracic surgery (RATS)

Special Issue Information

Dear Colleagues,

Thoracic surgery has acquired considerable innovations in recent years. New technologies and surgical approaches have radically changed the management of several thoracic diseases, from diagnosis to radical therapy. Sublobar lung resections have become increasingly popular in recent years, along with the development of new technologies such as virtual-assisted lung mapping and 3D reconstructions. Video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracic surgery (RATS) have proved to be oncologically appropriate, ensuring excellent patient outcomes. In addition, medical therapies have also made significant progress (new drugs, immunotherapy, target therapy), becoming more and more targeted to the patient. This has led to the development of new surgical scenarios as part of a multidisciplinary pathway.

In conclusion, advances in techniques, patient care and multidisciplinary treatment have led to real advances for thoracic surgery.

This Special Issue of the Journal of Clinical Medicine aims to publish contributions from distinguished authors with active experience of innovation in the field of thoracic surgery who wish to provide more solid scientific evidence. All researchers are invited to contribute original works and reviews.

Dr. Alessandro Palleschi
Dr. Davide Tosi
Dr. Alessandra Mazzucco
Guest Editors

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Keywords

  • thoracic surgery
  • lung cancer
  • minimally invasive surgery
  • video-assisted thoracoscopic surgery
  • robotic-assisted thoracic surgery
  • new technologies
  • diagnostics
  • oncological treatment

Published Papers (3 papers)

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Research

12 pages, 1111 KiB  
Article
Pulmonary Lobectomy for Early-Stage Lung Cancer with Uniportal versus Three-Portal Video-Assisted Thoracic Surgery: Results from a Single-Centre Randomized Clinical Trial
by Davide Tosi, Alessandra Mazzucco, Valeria Musso, Gianluca Bonitta, Lorenzo Rosso, Paolo Mendogni, Ilaria Righi, Rosaria Carrinola, Francesco Damarco and Alessandro Palleschi
J. Clin. Med. 2023, 12(22), 7167; https://doi.org/10.3390/jcm12227167 - 18 Nov 2023
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Abstract
Video-assisted thoracic surgery (VATS) is a consolidated approach; however, there is no consensus on the number of ports leading to less postoperative pain. We compared early postoperative pain after uniportal and three-portal VATS lobectomy for early-stage NSCLC. In this randomized clinical trial, patients [...] Read more.
Video-assisted thoracic surgery (VATS) is a consolidated approach; however, there is no consensus on the number of ports leading to less postoperative pain. We compared early postoperative pain after uniportal and three-portal VATS lobectomy for early-stage NSCLC. In this randomized clinical trial, patients undergoing VATS lobectomy were randomly assigned to receive uniportal (U-VATS Group) or three-portal (T-VATS Group) VATS. The inclusion criteria were age ≤ 80 years and ASA < 4. The exclusion criteria were clinical T3, previous thoracic surgery, induction therapy, chest radiotherapy, connective tissue or vascular diseases, major organ failure, and analgesics or corticosteroids use. The postoperative analgesia protocol was based on NRS. Pain was measured as analgesic consumption; the secondary endpoints were intra- and postoperative complications, conversion rate, surgical time, dissected lymph nodes, hospital stay, and respiratory function. Out of 302 eligible patients, 120 were included; demographics were distributed homogeneously. The mean cumulative morphine consumption (CMC) in the U-VATS Group after 7 days was lower than in the T-VATS Group (77.4 mg vs. 90.1 mg, p = 0.003). Intraoperative variables and postoperative complications were comparable. The 30-day intercostal neuralgia rate was lower in the U-VATS Group, without reaching statistical significance. Patients undergoing U-VATS showed a lower analgesic consumption compared with the T-VATS Group; analgesic consumption was moderate in both groups. Full article
(This article belongs to the Special Issue Thoracic Surgery: Current and Future Strategies)
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12 pages, 1565 KiB  
Article
Adjuvant Transthoracic Negative-Pressure Ventilation in Nonintubated Thoracoscopic Surgery
by Riccardo Taje, Eleonora Fabbi, Roberto Sorge, Stefano Elia, Mario Dauri and Eugenio Pompeo
J. Clin. Med. 2023, 12(13), 4234; https://doi.org/10.3390/jcm12134234 - 23 Jun 2023
Viewed by 966
Abstract
Background: To minimize the risks of barotrauma during nonintubated thoracoscopic-surgery under spontaneous ventilation, we investigated an adjuvant transthoracic negative-pressure ventilation (NPV) method in patients operated on due to severe emphysema or interstitial lung disease. Methods: In this retrospective study, NPV was employed for [...] Read more.
Background: To minimize the risks of barotrauma during nonintubated thoracoscopic-surgery under spontaneous ventilation, we investigated an adjuvant transthoracic negative-pressure ventilation (NPV) method in patients operated on due to severe emphysema or interstitial lung disease. Methods: In this retrospective study, NPV was employed for temporary low oxygen saturation and to achieve end-operative lung re-expansion during nonintubated lung volume reduction surgery (LVRS) for severe emphysema (30 patients, LVRS group) and in the nonintubated wedge resection of undetermined interstitial lung disease (30 patients, wedge-group). The results were compared following 1:1 propensity score matching with equivalent control groups undergoing the same procedures under spontaneous ventilation, with adjuvant positive-pressure ventilation (PPV) performed on-demand through the laryngeal mask. The primary outcomes were changes (preoperative–postoperative value) in the arterial oxygen tension/fraction of the inspired oxygen ratio (ΔPO2/FiO2;) and ΔPaCO2, and lung expansion completeness on a 24 h postoperative chest radiograph (CXR-score, 2: full or 1: incomplete). Results: Intergroup comparisons (NPV vs. PPV) showed no differences in demographic and pulmonary function. NPV could be accomplished in all instances with no conversion to general anesthesia with intubation. In the LVRS group, NPV improved ΔPO2/FiO2 (9.3 ± 16 vs. 25.3 ± 30.5, p = 0.027) and ΔPaCO2 (−2.2 ± 3.15 mmHg vs. 0.03 ± 0.18 mmHg, p = 0.008) with no difference in the CXR score, whereas in the wedge group, both ΔPO2/FiO2 (3.1 ± 8.2 vs. 9.9 ± 13.8, p = 0.035) and the CXR score (1.9 ± 0.3 vs. 1.6 ± 0.5, p = 0.04) were better in the NPV subgroup. There was no mortality and no intergroup difference in morbidity. Conclusions: In this retrospective study, NITS with adjuvant transthoracic NPV resulted in better 24 h oxygenation measures than PPV in both the LVRS and wedge groups, and in better lung expansion according to the CXR score in the wedge group. Full article
(This article belongs to the Special Issue Thoracic Surgery: Current and Future Strategies)
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11 pages, 1179 KiB  
Article
Smoking Habit and Respiratory Function Predict Patients’ Outcome after Surgery for Lung Cancer, Irrespective of Histotype and Disease Stage
by Davide Piloni, Francesco R. Bertuccio, Cristiano Primiceri, Pietro Rinaldi, Vittorio Chino, David Michael Abbott, Federico Sottotetti, Chandra Bortolotto, Francesco Agustoni, Jessica Saddi and Giulia M. Stella
J. Clin. Med. 2023, 12(4), 1561; https://doi.org/10.3390/jcm12041561 - 16 Feb 2023
Cited by 3 | Viewed by 1231
Abstract
Background. Growing evidence suggests that sublobar resections offer more favorable outcomes than lobectomy in early-stage lung cancer surgery. However, a percentage of cases that cannot be ignored develops disease recurrence irrespective of the surgery performed with curative intent. The goal of this work [...] Read more.
Background. Growing evidence suggests that sublobar resections offer more favorable outcomes than lobectomy in early-stage lung cancer surgery. However, a percentage of cases that cannot be ignored develops disease recurrence irrespective of the surgery performed with curative intent. The goal of this work is thus to compare different surgical approaches, namely, lobectomy and segmentectomy (typical and atypical) to derive prognostic and predictive markers. Patients and Methods. Here we analyzed a cohort of 153 NSCLC patients in clinical stage TNM I who underwent pulmonary resection surgery with a mediastinal hilar lymphadenectomy from January 2017 to December 2021, with an average follow-up of 25.5 months. Partition analysis was also applied to the dataset to detect outcome predictors. Results. The results of this work showed similar OS between lobectomy and typical and atypical segmentectomy for patients with stage I NSCLC. In contrast, lobectomy was associated with a significant improvement in DFS compared with typical segmentectomy in stage IA, while in stage IB and overall, the two treatments were similar. Atypical segmentectomy showed the worst performance, especially in 3-year DFS. Quite unexpectedly, outcome predictor ranking analysis suggests a prominent role of smoking habits and respiratory function, irrespective of the tumor histotype and the patient’s gender. Conclusions. Although the limited follow-up interval cannot allow conclusive remarks about prognosis, the results of this study suggest that both lung volumes and the degree of emphysema-related parenchymal damage are the strongest predictors of poor survival in lung cancer patients. Overall, these data point out that greater attention should be addressed to the therapeutic intervention for co-existing respiratory diseases to obtain optimal control of early lung cancer. Full article
(This article belongs to the Special Issue Thoracic Surgery: Current and Future Strategies)
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