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Thoracic Surgery for Lung, Pleural and Esophageal Malignancies: Current Practice...
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Thoracic Surgery for Lung, Pleural and Esophageal Malignancies: Current Practice and Future Directions

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Surgery".

Deadline for manuscript submissions: closed (30 April 2023) | Viewed by 15900

Special Issue Editors

Dr. Emmanouil Kapetanakis

E-Mail Website
Guest Editor
Locum Thoracic and ICU Consultant, General Hospital of Piraeus “Tzaneio”, Athens, Greece
Interests: thoracic oncologic surgery; thoracic malignancies; minimally invasive thoracoscopic surgery (VATS); pleuroscopy—medical thoracoscopy; post-graduate education; COVID-19
Special Issues, Collections and Topics in MDPI journals
Dr. Periklis Tomos

E-Mail Website
Co-Guest Editor
Academic Department of Thoracic Surgery, “Attikon” University Hospital, Medical School, Athens, Greece
Interests: Thoracic Oncologic Surgery; Thoracic Malignancies; Minimally Invasive Thoracoscopic Surgery (VATS); Pleuroscopy - Medical Thoracoscopy; Post-Graduate Education

Special Issue Information

Dear Colleagues,

Thoracic malignancies represent a considerable global health burden not only in developed countries, but also in developing ones, with the incidence and mortality of lung and esophageal cancer increasing year on year. Internationally, lung cancer continues to be the leading cause of cancer-related deaths for both men and women, with varying trends in smoking prevalence generally dictating worldwide patterns in its incidence and mortality. Similarly, esophageal cancer constitutes one of the least studied but deadliest malignancies worldwide, ranking sixth amongst all cancers, because of its extremely aggressive nature and poor survival rate. In contrast, malignant pleural mesothelioma is a rare, but also quite deadly form of cancer, with a very poor prognosis and limited curative interventions available. Following the restrictions in asbestos use and the decline in exposure, its incidence has been steadily decreasing; however, due to the large latency period between exposure and presentation, which can be up to 40 years, incidence rates may decrease very slowly for several years to come.

These three pathological entities represent the bulk of the malignancies the thoracic surgeon is called upon to treat surgically. Recent advances in both surgical and anesthetic technique have allowed for a more minimally invasive surgical approach in the management of thoracic cancers. Therefore, as technology continues to improve and thoracic surgeons gain experience and expertise, video-assisted thoracoscopic surgery (VATS) as well as robot-assisted thoracic surgery (RATS) are becoming more and more prevalent and established. In addition, advances in molecular and immunological-based oncological therapies and improvements in down staging rates have allowed for a larger percentage of surgically eligible patients.

The journal Medicina is launching a Special Issue titled “Thoracic Surgery for Lung, Pleural and Esophageal Malignancies: Current Practice and Future Directions” with the goal of bringing together and presenting current and future developments in thoracic surgery and thoracic oncology.

We are pleased to invite you and your co-workers to submit your articles on this topic. We encourage the submission of original, review, or short report articles dealing with current issues of thoracic surgical practice including outcomes and efficacy of VATS and RATS, as well as traditional operative approaches for lung, esophageal, and pleural cancers, technical challenges, novel video-thoracoscopic techniques, as well as future improvements in equipment, energy devices, instrumentation, and robotic technology. In addition, we encourage the reporting of issues and developments in oncological surgical management. Finally, it would be of interest to receive reports regarding the introduction, integration, and establishment of thoracoscopic surgery within the current clinical practice.

Dr. Emmanouil Kapetanakis
Dr. Periklis Tomos
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • thoracic oncology
  • lung cancer
  • esophageal cancer
  • malignant pleural mesothelioma
  • thoracic surgery
  • video assisted thoracic surgery (VATS)
  • robotic assisted thoracic surgery (RATS)
  • pleuroscopy
  • thoracoscopy

Published Papers (9 papers)

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Research

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11 pages, 456 KiB  
Article
Clinical and Oncological Outcomes after Uniportal Anatomical Segmentectomy for Stage IA Non-Small Cell Lung Cancer
by Konstantinos Gioutsos, Yves J. Hayoz and Patrick Dorn
Medicina 2023, 59(6), 1064; https://doi.org/10.3390/medicina59061064 - 01 Jun 2023
Cited by 1 | Viewed by 1165
Abstract
Background and Objectives: The existing literature comparing sublobar and lobar resection in the treatment of stage IA lung cancer highlights the trend and overall need for further evaluation of minimally invasive, parenchymal-sparing techniques. The role of uniportal minimally invasive segmentectomy in the [...] Read more.
Background and Objectives: The existing literature comparing sublobar and lobar resection in the treatment of stage IA lung cancer highlights the trend and overall need for further evaluation of minimally invasive, parenchymal-sparing techniques. The role of uniportal minimally invasive segmentectomy in the oncological therapy of early-stage non-small cell lung cancer (NSCLC) remains controversial. The aim of this study was to evaluate the clinical and midterm oncological outcomes of patients who underwent uniportal video-assisted anatomical segmentectomy for pathological stage IA lung cancer. Materials and Methods: We retrospectively analyzed all patients with pathological stage IA lung cancer (8th edition UICC) who underwent uniportal minimally invasive anatomical segmentectomy at our institution from January 2015 to December 2018. Results: 85 patients, 54 of whom were men, were included. The median length of hospital stay was 3 days (1.-3. IQR 3–5), whereas 30-day morbidity was 15.3% (13 patients), and the in-hospital mortality rate was 1.2% (1 patient). The 3-year overall survival rate was 87.9% for the total population. It was 90.5% in the IA1 group, 93.3% in the IA2 group, and 70.1% in the IA3 group, respectively. Conclusions: There were satisfactory short-term clinical outcomes with low 30-day morbidity and mortality and promising midterm oncological survival results following uniportal minimally invasive anatomical segmentectomy for pathological stage IA non-small cell lung cancer. Full article
(This article belongs to the Special Issue Thoracic Surgery for Lung, Pleural and Esophageal Malignancies: Current Practice and Future Directions)
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6 pages, 260 KiB  
Communication
Establishing a Multidisciplinary Team-Based Pleural Service in the Era of Financial Austerity: The Role of the Thoracic Surgeon
by Emmanouil I. Kapetanakis, Tatiana Sidiropoulou, Ioannis P. Tomos, Christos F. Kampolis, Thomas Raptakis and Periklis I. Tomos
Medicina 2023, 59(3), 432; https://doi.org/10.3390/medicina59030432 - 22 Feb 2023
Viewed by 859
Abstract
Medical thoracoscopy/pleuroscopy has become, after bronchoscopy, the second most commonly utilized endoscopic procedure in interventional pulmonology. Due to their common origin, medical thoracoscopy/pleuroscopy and video-assisted thoracic surgery (VATS) are quite similar procedures technically. In contrast to the prevailing attitude that it should predominantly [...] Read more.
Medical thoracoscopy/pleuroscopy has become, after bronchoscopy, the second most commonly utilized endoscopic procedure in interventional pulmonology. Due to their common origin, medical thoracoscopy/pleuroscopy and video-assisted thoracic surgery (VATS) are quite similar procedures technically. In contrast to the prevailing attitude that it should predominantly be performed by interventional pulmonologists, we believe that, like all hybrid-in-nature techniques, it should be implemented as part of a combined specialist care service/team. Herewith, we describe our attempt to establish a multidisciplinary pleural disease program during a difficult economic period for our country, comprising thoracic surgeons, pulmonologists and anesthesiologists, all of whom brought in their experience, expertise and resources to establish and develop the service resulting in a hybridization of the technique, with, as reported, quite favorable results. Full article
(This article belongs to the Special Issue Thoracic Surgery for Lung, Pleural and Esophageal Malignancies: Current Practice and Future Directions)
18 pages, 8309 KiB  
Article
Platelet-Rich Plasma for Pleurodesis: An Experimental Study in Rabbits
by Styliani Maria Kolokotroni, Dimitrios Lamprinos, Nikolaos Goutas, Emmanouil I. Kapetanakis, Konstantinos Kontzoglou, Despoina Perrea and Periklis Tomos
Medicina 2022, 58(12), 1842; https://doi.org/10.3390/medicina58121842 - 15 Dec 2022
Viewed by 1459
Abstract
Background and Objectives: This study was designed to evaluate platelet-rich plasma (PRP) as a method of pleurodesis in a rabbit model. Pleurodesis with PRP was compared against the gold-standard use of talc. The secondary evaluation assessed the ideal time for achieving pleurodesis. [...] Read more.
Background and Objectives: This study was designed to evaluate platelet-rich plasma (PRP) as a method of pleurodesis in a rabbit model. Pleurodesis with PRP was compared against the gold-standard use of talc. The secondary evaluation assessed the ideal time for achieving pleurodesis. Materials and Methods: 25 healthy New Zealand white rabbits were assigned to three groups, as follows: 12 animals in the first and second groups, as well as one animal with no intervention in the final group, which was used as a control. The talc pleurodesis group (baseline) underwent pleurodesis with sterile talc, which is the gold-standard sclerosing agent used for pleurodesis. The PRP group underwent pleurodesis using autologous PRP. The last group had one rabbit with no intervention. A total of 12 rabbits (n = 6 for the talc pleurodesis group and n = 6 for the PRP group) were sacrificed 3 days (72 h) after the intervention, and 12 rabbits (n = 6 for the talc pleurodesis group and n = 6 for the PRP group) were sacrificed 6 days (144 h) after the intervention. In both the talc and PRP group, FBC and CRP were measured before the intervention and in 3 or 6 days afterwards, respectively. The pleura and the lungs were evaluated histopathologically. Results: Macroscopically, there were no statistically significant differences between the two groups. In terms of microscopic findings, there were no statistically significant differences in inflammatory reactions provoked in the visceral and parietal pleura between the PRP and talc. In addition, with talc pleurodesis, a foreign-body reaction was observed in about 50% of the cases, which was not observed with PRP. In terms of inflammation between 3 and 6 days, there were no statistically significant differences with PRP, there was only a statistically significant difference between 3 and 6 days regarding the parietal pleura in the talc group. Conclusions: The instillation of autologous PRP in the pleural cavity shows promise in achieving pleurodesis. The efficacy of PRP as a pleurodesis agent should be examined further. Full article
(This article belongs to the Special Issue Thoracic Surgery for Lung, Pleural and Esophageal Malignancies: Current Practice and Future Directions)
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9 pages, 2332 KiB  
Article
Localization Technique Using Mixture of Indigo Carmine and Lipiodol of Pulmonary Nodule via Bronchoscopic Navigation
by Na-Hyeon Lee, Hyun-Sung Chung, Jeong-Su Cho, Yeong-Dae Kim, Jung-Seop Eom and Hyo-Yeong Ahn
Medicina 2022, 58(9), 1235; https://doi.org/10.3390/medicina58091235 - 06 Sep 2022
Cited by 2 | Viewed by 1907
Abstract
Background and Objectives: As the number of minimally invasive surgeries, including video-assisted thoracoscopic surgery, increases, small, deeply located lung nodules are difficult to visualize or palpate; therefore, localization is important. We studied the use of a mixture of indigo—carmine and lipiodol, coupled [...] Read more.
Background and Objectives: As the number of minimally invasive surgeries, including video-assisted thoracoscopic surgery, increases, small, deeply located lung nodules are difficult to visualize or palpate; therefore, localization is important. We studied the use of a mixture of indigo—carmine and lipiodol, coupled with a transbronchial approach—to achieve accurate localization and minimize patient discomfort and complications. Materials and Methods: A total of 60 patients were enrolled from May 2019 to April 2022, and surgery was performed after the bronchoscopy procedure. Wedge resection or segmentectomy was performed, depending on the location and size of the lesion. Results: In 58/60 (96.7%) patients, the localization of the nodules was successful after localization, and 2/60 required c-arm assistance. None of the patients complained of discomfort during the procedure; in all cases, margins were found to be free from carcinoma, as determined by the final pathology results. Conclusions: We recommend this localization technique using mixture of indigo carmine and lipiodol, in concert with the transbronchial approach, because the procedure time is short, patient’s discomfort is low, and success rate is high. Full article
(This article belongs to the Special Issue Thoracic Surgery for Lung, Pleural and Esophageal Malignancies: Current Practice and Future Directions)
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7 pages, 824 KiB  
Article
Factors Affecting Postoperative Lung Functions in Patients Undergoing Lobectomy for Non-Small Cell Lung Cancer
by Soo-Jin Lee, Hyo-Yeong Ahn, Jong-Hwan Park and Jeong-Su Cho
Medicina 2022, 58(8), 1021; https://doi.org/10.3390/medicina58081021 - 29 Jul 2022
Cited by 1 | Viewed by 1976
Abstract
Background and Objectives: The estimation of lung function impairment after pulmonary lobectomy for primary non-small cell lung cancer (NSCLC) has been of great interest since the reduction of respiratory function might severely affect a patient’s quality of life. The perioperative factors that [...] Read more.
Background and Objectives: The estimation of lung function impairment after pulmonary lobectomy for primary non-small cell lung cancer (NSCLC) has been of great interest since the reduction of respiratory function might severely affect a patient’s quality of life. The perioperative factors that may have an influence on widening the gap between the postoperative measured lung function and predicted postoperative lung function were our greatest concern. We aimed to analyze the perioperative patient factors that may influence postoperative lung function in patients undergoing pulmonary lobectomy. Materials and Methods: A retrospective study was conducted using the medical records of 199 patients who underwent lobectomy for lung cancer between July 2017 and May 2020. After comparing the achieved postoperative forced expiratory volume in 1 s (FEV1) and predicted postoperative (ppo) FEV1, patients were divided into two groups: group A (n = 127), who had preserved pulmonary lung function; and group B (n = 72), who had decreased pulmonary lung function. Primary endpoints included location of pulmonary resection, preoperative performance status, body mass index (BMI) on admission, total muscle area, and muscle index. Results In group A, the proportion of normal weighted patients was significantly higher than that in group B (67.7% vs. 47.2%, p = 0.003). Conversely, the proportion of overweight patients was significantly higher in group B than in group A (47.2% vs. 28.3%, p = 0.003). Group B had a significantly high incidence of upper lobe resection (p = 0.012). The mean total muscle area in group A was higher than that in group B, but the difference was not statistically significant. Conclusions: A greater decrease in postoperative lung function than in ppo FEV1 was associated with BMI and the location of pulmonary resection in patients who underwent lobectomy. Postoperative physiologic changes due to high BMI and the resection of upper lobes need to be discussed to prevent postoperative morbidities. Full article
(This article belongs to the Special Issue Thoracic Surgery for Lung, Pleural and Esophageal Malignancies: Current Practice and Future Directions)
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11 pages, 474 KiB  
Article
The Association of Minimally Invasive Surgical Approaches and Mortality in Patients with Malignant Pleuropericarditis—A 10 Year Retrospective Observational Study
by Claudiu-Eduard Nistor, Camelia Stanciu Găvan, Alexandra-Andreea Ciritel, Alexandra Floriana Nemes and Adrian Ciuche
Medicina 2022, 58(6), 718; https://doi.org/10.3390/medicina58060718 - 27 May 2022
Cited by 2 | Viewed by 1692
Abstract
Background and Objectives: Malignant neoplasms are common causes of acute pleuropericardial effusion. Pleuropericarditis denotes poor patient prognosis, is associated with shortened average survival time, and represents a surgical emergency. Materials and Methods: We analyzed the impact of two minimally invasive surgical approaches, the [...] Read more.
Background and Objectives: Malignant neoplasms are common causes of acute pleuropericardial effusion. Pleuropericarditis denotes poor patient prognosis, is associated with shortened average survival time, and represents a surgical emergency. Materials and Methods: We analyzed the impact of two minimally invasive surgical approaches, the type of cancer, and other clinical variables on the mortality of 338 patients with pleuropericarditis admitted to an emergency hospital in Romania between 2009 and 2020. All patients underwent minimally invasive surgeries to prevent the recurrence of the disease and to increase their life expectancy. Log-rank tests were used to check for survival probability differences by surgical approach. We also applied univariate and multivariate Cox proportional hazard models to assess the effect of each covariate. Results: No significant differences were found in the 2-year overall survival rate between patients who underwent the two types of surgery. The multivariate Cox proportional regression model adjusted for relevant covariates showed that age, having lung cancer, and a diagnosis of pericarditis and right pleural effusion increased the mortality risk. The surgical approach was not associated with mortality in these patients. Conclusion: These findings open up avenues for future research to advance the understanding of survival among patients with pleuropericarditis. Full article
(This article belongs to the Special Issue Thoracic Surgery for Lung, Pleural and Esophageal Malignancies: Current Practice and Future Directions)
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11 pages, 5054 KiB  
Article
Simultaneous Patent Blue Dye Injections Aid in the Preoperative CT-Guided Localization of Multiple Pulmonary Nodules
by Ya-Che Chen, Tsai-Wang Huang, Hsian-He Hsu, Wei-Chou Chang and Kai-Hsiung Ko
Medicina 2022, 58(3), 405; https://doi.org/10.3390/medicina58030405 - 09 Mar 2022
Cited by 1 | Viewed by 2465
Abstract
Background and Objectives: Clinically, a major challenge of multiple nodule localization is puncture-related pneumothorax, which may hamper the successful localization. This study aims to investigate and compare the efficacy and safety of the simultaneous and sequential patent blue dye (PBD) injections for [...] Read more.
Background and Objectives: Clinically, a major challenge of multiple nodule localization is puncture-related pneumothorax, which may hamper the successful localization. This study aims to investigate and compare the efficacy and safety of the simultaneous and sequential patent blue dye (PBD) injections for identifying multiple pulmonary nodules during preoperative CT-guided localization. Materials and Methods: Sixty-one consecutive patients with multiple pulmonary nodules who underwent preoperative CT-guided localization with PBD injections between January 2020 and December 2020 were retrospectively enrolled. Of these patients, 31 patients with 64 nodules who underwent simultaneous injections were designated as the simultaneous group; the remaining 30 patients with 63 nodules who underwent sequential punctures were designated as the sequential group. The clinical and radiological features, technical information, pathological results, and procedure-related variables and complications of the two groups were reviewed and analyzed. Results: The localization success rate of the simultaneous group was higher than that of the sequential group (100% [64/64] vs. 93.7% [59/63], p = 0.041). The incidences of pneumothorax (32.3 vs. 33.3%, p = 0.929) and pulmonary hemorrhage (6.3 vs. 3.0%, p = 1) were not significantly different between the two groups, and all cases were minor, which did not require further intervention. Additionally, a significantly lower radiation dose (2.7 vs. 3.5 mSv, p = 0.001) and a shorter procedure time (20.95 vs. 25.28 min, p = 0.001) were observed in the simultaneous group than in the sequential group. Conclusions: Compared with the sequential method, simultaneous PBD injections may improve the localization success rate with a shorter procedure time and less radiation exposure if the patient with multiple pulmonary nodules can be approached in a single position. Further prospective studies are needed to validate these results. Full article
(This article belongs to the Special Issue Thoracic Surgery for Lung, Pleural and Esophageal Malignancies: Current Practice and Future Directions)
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Review

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8 pages, 304 KiB  
Review
Radiation-Induced Esophageal Cancer: Investigating the Pathogenesis, Management, and Prognosis
by Athanasios Syllaios, Michail Vailas, Maria Tolia, Nikolaos Charalampakis, Konstantinos Vlachos, Emmanouil I. Kapetanakis, Periklis I. Tomos and Dimitrios Schizas
Medicina 2022, 58(7), 949; https://doi.org/10.3390/medicina58070949 - 18 Jul 2022
Cited by 1 | Viewed by 2064
Abstract
One of the most serious late side effects of irradiation is the promotion of tumorigenesis. Radiation-induced esophageal cancer (RIEC) can arise in a previously irradiated field, mostly in patients previously irradiated for thoracic malignancies such as breast cancer, Hodgkin and non-Hodgkin lymphomas, head [...] Read more.
One of the most serious late side effects of irradiation is the promotion of tumorigenesis. Radiation-induced esophageal cancer (RIEC) can arise in a previously irradiated field, mostly in patients previously irradiated for thoracic malignancies such as breast cancer, Hodgkin and non-Hodgkin lymphomas, head and neck cancers, lung cancer, or previous esophageal cancer. RIEC is rare and accounts for less than 1% of all carcinomas of the esophagus. There are little data available in the current literature regarding pathogenesis, diagnosis, treatment, and outcome of esophageal cancer developed in a previously irradiated field. RIEC seems to represent a biologically aggressive disease with a poor prognosis. Although it is difficult to perform radical surgery on a previously irradiated field, R0 resection remains the mainstay of treatment. The use of neoadjuvant and adjuvant chemoradiotherapy remains very helpful in RIEC, similarly to conventional esophageal cancer protocols. The aim of this article is to elucidate this rare but challenging entity. Full article
(This article belongs to the Special Issue Thoracic Surgery for Lung, Pleural and Esophageal Malignancies: Current Practice and Future Directions)

Other

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7 pages, 2739 KiB  
Case Report
Refractory Chylothorax Secondary to Sizeable Azygos Vein Hemangioma: Tailored Multimodal Treatment of a Challenging Case Report
by Paolo Albino Ferrari, Federico Fusaro, Antonio Ferrari, Alessandro Tamburrini, Giulia Grimaldi, Massimiliano Santoru, Sara Zappadu, Elisabetta Tanda, Sonia Nemolato, Simone Comelli and Roberto Cherchi
Medicina 2023, 59(1), 91; https://doi.org/10.3390/medicina59010091 - 31 Dec 2022
Cited by 1 | Viewed by 1176
Abstract
Background: Mediastinal hemangiomas are rare, and their etiology remains unclear. Most patients affected have no pathognomonic clinical symptoms, and the diagnosis is often incidental. Due to the paucity of the available literature regarding the management of this disease, the choice and timing of [...] Read more.
Background: Mediastinal hemangiomas are rare, and their etiology remains unclear. Most patients affected have no pathognomonic clinical symptoms, and the diagnosis is often incidental. Due to the paucity of the available literature regarding the management of this disease, the choice and timing of treatment remains controversial. Case presentation: Herein, we report the case of a hemangioma of the azygos vein arch in a 66-year-old woman who presented with dyspnea, chest discomfort, dysphagia, and weight loss. A simultaneous right chylothorax refractory to conservative management was found. A CT-guided biopsy of the mass was performed, and it confirmed the vascular nature of the lesion. Therefore, the patient underwent an angiography followed by endo-vascular embolization. Three days later, thoracoscopic surgical resection of the mass and the repair of the chyle leakage were performed safely. The patient was discharged uneventfully on postoperative day seven, with complete resolution of all the presenting symptoms. Conclusions: Treatment of symptomatic mediastinal hemangiomas could be mandatory, but a thorough multidisciplinary approach to these rare malformations is essential. Despite the risk of intraoperative bleeding, selective endovascular embolization followed by thoracoscopic surgery allowed for a complete and safe resection with a good outcome. Full article
(This article belongs to the Special Issue Thoracic Surgery for Lung, Pleural and Esophageal Malignancies: Current Practice and Future Directions)
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