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.
Since 2000, many studies have been published, including randomized ones, which have demonstrated that anatomical segmentectomy for early-stage non-small-cell lung cancer (NSCLC) yields oncological equivalent results with respect to those of lobectomy, with a potential lung-sparing effect 1–4.
An unusual case of a calcified carcinoid tumour Meda, Stefano; Pernazza, Fausto; Di Stasio, Mario
European journal of cardio-thoracic surgery,
12/2013, Letnik:
44, Številka:
6
Journal Article
Los animales domésticos se hallan expuestos a diferentes sustancias que pueden provocar intoxicaciones leves a graves. Las producidas por la ingestión de plantas son comunes en grandes animales pero ...también pueden constituir un problema para mascotas. Los veterinarios en general no están familiarizados con las plantas nativas de su zona geográfica y el daño potencial que pueden causar. El género Brunfelsia (“jazmín paraguayo”, Solanaceae) incluye arbustos atractivos por sus flores que cambian de color púrpura a blanco, circunstancia que les otorga el nombre común de “ayer, hoy y mañana”. La intoxicación provocada por esta planta se debe a su elevada concentración de alcaloides tropánicos. En este trabajo se presentan dos casos de intoxicación por Brunfelsia australis en caninos, uno de ellos fatal. El canino que murió presentó signos neurológicos y vómitos que contenían material vegetal con pequeños fragmentos similares a frutos y semillas de color marrón oscuro. El otro canino también presentó signos neurológicos y diarrea de color verde que contenía material vegetal con fragmentos de hojas y tallos. Ambas muestras fueron examinadas por observación macroscópica/microscópica y comparación con patrones de referencia, comprobándose que correspondían a B. australis. Además de los hallazgos clínicos, el análisis de muestras biológicas constituye un método complementario para el diagnóstico de intoxicaciones provocadas por plantas. Para el caso particular de B. australis se comprueba que la ingestión de frutos puede resultar fatal y que la ingestión de hojas y ramas produciría una intoxicación menos grave. Se destaca la necesidad de que los profesionales se familiaricen con la morfología y composición química de las plantas ornamentales tóxicas propias de su región, para poder instaurar el tratamiento adecuado.
Validation of predictive risk models for prolonged air leak (PAL) is essential to understand if they can help to reduce its incidence and complications. This study aimed to evaluate both the clinical ...and statistical performances of 4 existing models. We selected 4 predictive PAL risk models based on their scientific relevance. We referred to these models as Chicago, Bordeaux, Leeds and Pittsburgh model, respectively, according to the affiliation place of the first author. These predicting risk models were retrospectively applied to patients recorded on the second edition of the Italian Video-Assisted Thoracoscopic Surgery Group registry. Predictions for each patient were calculated based on the logistic regression coefficient values provided in the original manuscripts. All models were tested for their overall performance, discrimination, and calibration. We recalibrated the original models with the re-estimation of the model intercept and slope. We used curve decision analysis to describe and compare the clinical effects of the studied risk models. Better statistical metrics characterize the models developed on larger populations (Chicago and Bordeaux models). However, no model has a valid benefit for threshold probability greater than 0.30. The Net benefit of the most performing model (Bordeaux model) at the threshold probability of 0.11 is 23 of 1000 patients, burdened by 333 false positive cases. One of 1000 is the Net benefit at the threshold probability of 0.3. The use of PAL scores based on preoperative predictive factors cannot be currently used in a clinical setting because of a high false positive rate and low positive predictive value.
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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 < 0.001). There was a statistical difference on the second and third postoperative days; odds ratio (OR) 2.28 95% confidence interval (CI) 1.62–3.21; P < 0.001 and OR 2.58 (95% CI 1.74–3.83; P < 0.001), respectively. The uniportal-VATS group had higher operative time (P < 0.001), shorter chest drain permanence (P < 0.001) and shorter length of stay (P < 0.001).
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.
Mesenchymal cystic hamartoma (MCH) of the lung is a rare disease, with an indolent course in the majority of cases. It can be single or multifocal and it is composed of primitive mesenchymal cells ...admixed with cystic spaces. Only few cases have been reported in the literature, with variable clinical presentation. We describe the case of a huge MCH, presenting with spontaneous pneumothorax in a 65-year-old man. Further, we provide a brief overview of the literature and discuss the differential diagnosis with other entities, and the possible diagnostic pitfalls.
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