Custom-made life-saving asymmetrical Y-stent for restenosis after carinal resection and reconstruction for tracheal cancer.

We report the case of a 50-year-old male treated with carinal resection and neocarina reconstruction for tracheal mucoepidermoid carcinoma. One month postoperatively, the patient developed severe respiratory failure due to restenosis and excessive dynamic airway collapse (EDAC) at the trachea-right main bronchus anastomosis. Initial management with balloon dilatation and a standard Dumon silicone stent failed due to stent migration.

Endoscopic management of subglottic stenosis with innovative transcordal stent.

Single-stage tracheal resection and anastomosis represents the gold standard for benign subglottic stenosis' management. Nevertheless, also considering the complexity of the surgical procedure, some patients are considered unfit for tracheal surgery (stenosis involving vocal cords, comorbidities, and relapse after surgery). Until now, the only alternative was tracheostomy which represents the only real alternative to secure the patency of the airway.

Phrenic nerve infiltration: A good practice to combine pulmonary expansion and pain control in patients with high risk of prolonged air leak.

Objective: Prolonged air leak due to residual air space after lung resection is a main challenge. To date, few surgical options have been described to prevent this complication. The aim of this study is to investigate the safety and the efficacy of intraoperative phrenic nerve infiltration with long-acting anesthetics in producing transient hemidiaphragm paralysis in patients at high risk for prolonged air leak, thus improving pulmonary expansion after surgery and reducing air leaks, while controlling postoperative pain.

Posterior cricoid plate drill enlargement in idiopathic subglottic stenosis.

Objectives: Idiopathic subglottic stenosis (ISS) is an airway stricture between larynx and trachea, within 1 cm from the vocal cords. Resection-reconstruction present technical issues because of the need to resect the anterior portion of the cricoid cartilage, but not the posterior plate beyond which the recurrent laryngeal nerves access the vocal cords. The main surgical challenge consists of the minute airway calibre short below the cords, ensuing after the resection.

Mini-Invasive Thoracic Surgery for Early-Stage Lung Cancer: Which Is the Surgeon's Best Approach for Video-Assisted Thoracic Surgery?

The choice of the best Video-Assisted Thoracic Surgery (VATS) surgical approach is still debated. Surgeons are often faced with the choice between innovation and self-confidence. The present study reports the experience of a high-volume single institute, comparing data of uni-portal, bi-portal and tri-portal VATS, to find out the safest and most effective mini-invasive approach, leading surgeon's choice.

Carinal Reconstruction for Lung Cancer and Airway Tumors: Long-term Results.

Background: Resection and reconstruction of the carina infiltrated by non-small cell lung cancer (NSCLC) or an airway tumor is a technically demanding operation allowing oncologic radical treatment. Hereby we report the results of a 20-year experience from a high-volume center.

Methods: Carinal resection was performed in 41 patients for NSCLC (n = 32) or primary airway tumor (n = 9).

Multidisciplinary Management of Descending Necrotizing Mediastinitis: Is Thoracoscopic Treatment Feasible?

Descending necrotizing mediastinitis (DNM) is a life-threatening condition, generally caused by downward dissemination of oropharyngeal infections through cervical fascial planes. Mediastinal drainage is conventionally achieved by thoracotomy, but a Video-Assisted Thoracoscopic Surgery (VATS) approach is gaining interest due to the reduced invasiveness of procedure. We aimed to evaluate the effectiveness of VATS treatment in patients with DNM.

New perspectives on tracheal resection for COVID-19-related stenosis: A propensity score matching analysis.

Objective: The large number of patients with COVID-19 subjected to prolonged invasive mechanical ventilation has been expected to result in a significant increase in tracheal stenosis in the next years. The aim of this study was to evaluate and compare postoperative outcomes of patients who survived COVID-19 critical illness and underwent tracheal resection for postintubation/posttracheostomy tracheal stenosis with those of non-COVID-19 patients.

Methods: It was single-center, retrospective study.

Prognostic Factors of Non-Predominant-Lepidic Lung Adenocarcinoma Presenting as Ground Glass Opacity: Results of a Multicenter Study.

This study aims to define the clinicopathological characteristics and prognosis of non-predominant lepidic invasive adenocarcinoma presenting as Ground Glass Opacity (GGO) nodules. The goal is to assess statistical relationships between histology, tumor size, location, and the incidence of relapse and lymph node dissemination. A retrospective multicenter study was conducted, including patients with GGO observed on CT scans between 2003 and 2021.

Advances in Endoscopic Management of Endobronchial Carcinoid.

Introduction: Bronchial carcinoid (BC) tumors represent between 1% and 5% of all lung cancers and about 20-30% of carcinoid tumors; they are classified into two groups: typical and atypical bronchial carcinoids. The aim of the present study was to review the results of endoscopic treatments as an alternative to surgical treatment in selected patients.

Materials And Methods: The present study was a retrospective and multicentric study, in which all data were reviewed for patients with BC in the central airways, referred to the Thoracic Surgery Units of Luigi Vanvitelli University of Naples and Sant'Andrea Hospital in Rome between October 2012 and December 2022 Overall, 35 patients, 13 of whom were female, were included in the study (median age, 53 years; range, 29-75 years).

Reconstruction of the heart and the aorta for radical resection of lung cancer.

Introduction: We report a single-center experience of resection and reconstruction of the heart and aorta infiltrated by lung cancer in order to prove that involvement of these structures is no longer a condition precluding surgery.

Methods: Twenty-seven patients underwent surgery for lung cancer presenting full-thickness infiltration of the heart (n = 6) or the aorta (n = 18) and/or the supra-aortic branches (subclavian n = 3). Cardiac reconstruction was performed in 6 patients (5 atrium, 1 ventricle), with (n = 4) or without (n = 2) cardiopulmonary bypass, using a patch prosthesis (n = 4) or with deep clamping and direct suture (n = 2).

Endoscopic Management of Benign Airway Stenosis in Coronavirus Disease 2019 Patients.

Background: The aims of this study were to evaluate the results of endoscopic dilation for simple benign airway stenosis in coronavirus disease 2019 (COVID-19) patients and whether COVID-19 infection was associated with higher rate of recurrence compared with a control group.

Methods: It was an observational multicenter study including consecutive patients with simple benign airway stenosis undergoing endoscopic dilatation with at least 6 months of follow-up. The outcome of patients with COVID-19 infection was compared with that of a control group in relation to patient and stenosis characteristics, and procedure type.

Bilateral Ultrasound-Guided Erector Spinae Plane Block for Pectus Excavatum Surgery: A Retrospective Propensity-Score Study.

Objective: Pectus excavatum (PE) repair is burdened by severe postoperative pain. This retrospective study aimed to determine whether the analgesic effect of ultrasound-guided erector spinae plane block (ESPB) plus standard intravenous analgesia (SIVA) might be superior to SIVA alone in pain control after PE surgical repair via Ravitch or Nuss technique.

Design: A retrospective cohort study.

Complete Lymphadenectomy for Clinical Stage I Lepidic Adenocarcinoma of the Lung: Is it justified?

The role of a systematic lymphadenectomy in patients undergoing surgery for clinical stage I lung lepidic adenocarcinoma is still unclear. In the last years, some authors have advocated the possibility to avoid a complete lymph-node dissection in this setting. Results of patients who received systematic hilar-mediastinal nodal dissection for this oncologic condition are here reported.

Adjuvant chemotherapy, extent of resection, and immunoistochemical neuroendocrine markers as prognostic factors of early-stage large-cell neuroendocrine carcinoma.

Background: We investigated whether adjuvant chemotherapy, extent of resection, and immunoistochemical neuroendocrine markers affected survival of patients with the early stage of large-cell neuroendocrine cancer.

Methods: This was a retrospective multicenter study including consecutive patients undergoing resection of node negative large-cell neuroendocrine carcinoma. Five-year survival and disease-free survival rate were evaluated by the Kaplan-Meier method and the log-rank test in relation to adjuvant chemotherapy, extent of resection, and immunoistochemical neuroendocrine markers (synaptophysin, chromogranin A, and neuron-specific enolase).

Intraoperative cardiac function assessment by transesophageal echocardiography versus FloTrac/Vigileo™ system during pectus excavatum surgical repair.

Background: Pectus excavatum (PE), a congenital deformity of the chest wall, can lead to cardiac compression and related symptoms. PE surgical repair can improve cardiac function. Intraoperative transesophageal echocardiography (TEE) has been successfully employed to assess intraoperative hemodynamic variations in patients undergoing PE repair.

Successful Total Tracheal Replacement by Cryopreserved Aortic Allograft in a Patient Post-COVID-19 Infection.

This is the first report to our knowledge of a successful total tracheal replacement in a post-COVID-19 patient by cryopreserved aortic allograft. The graft was anastomosed to the cricoid and carina; a silicon stent was inserted to ensure patency. The patient was extubated on the operative table and was immediately able to breathe, speak, and swallow.

Subxifoid versus transthoracic thoracoscopic lobectomy: Results of a retrospective analysis before and after matching analysis.

Background: Here, we report our initial experience with subxifoid video-assisted thoracoscopic surgery (SVATS) lobectomy for the management of primary lung cancer, and compared the outcomes of SVATS with those of conventional transthoracic VATS (CVATS) lobectomies to validate its feasibility and usefulness.

Methods: The clinical data of consecutive patients undergoing VATS lobectomy via SVATS or CVATS for lung cancer were retrospectively compared. The endpoints were to evaluate the statistical differences in surgical results, postoperative pain (measured with visual analog scale [VAS] scores at 8 hours, Day 1, Day 2, Day 3, at discharge, one month and three months after surgery) and paresthesia (measured at one- month, and three months after surgery).

Surgery for laryngotracheal stenosis: Improved results.

Objective: Laryngotracheal resection is still considered a challenging operation and few high-volume institutions have reported large series of patients in this setting. During the 5 years, novel surgical techniques as well as new trends in the intra- and postoperative management have been proposed. We present results of our increased experience with laryngotracheal resection for benign stenosis.

Direct Cross-Clamping for Resection of Lung Cancer Invading the Aortic Arch or the Subclavian Artery.

Background: Resection of lung cancer infiltrating the aortic arch or the subclavian artery can be accomplished in selected patients with the use of cardiopulmonary bypass (CPB). Direct cross-clamping of the aortic arch and the left subclavian artery without CPB for radical resection of the tumor can be an alternative. This study presents one group's experience with this technique.

Early Induction of Bedside Pneumoperitoneum in the Management of Residual Pleural Space and Air Leaks After Pulmonary Resection.

Background: The pneumoperitoneum to treat prolonged air leaks or pleural space problems after pulmonary resection has been successfully used for decades. The aim of the study is to describe our experience with the early induction of therapeutic pneumoperitoneum (TP).

Methods: We reviewed the data of 103 consecutive patients undergoing TP between September 2011 and September 2019.

Perspectives in surgical and anaesthetic management of lung cancer in the era of coronavirus disease 2019 (COVID-19).

Early in 2020, coronavirus disease 2019 (COVID-19) quickly spread globally, giving rise to a pandemic. In this critical scenario, patients with lung cancer need to continue to receive optimal care and at the same be shielded from infection with the potentially severe acute respiratory syndrome coronavirus 2. Upgrades to the prevention and control of infection have become paramount in order to lower the risk of hospital contagion.

Novel Duck Bill-Shaped Laryngotracheal Stent for Management of Subglottic Stenosis.

Subglottic stenosis developed in a 23-year-old man 6 months after tracheal resection for postintubation stenosis. A standard Dumon stent (Novatech SA, La Ciotat, France) was placed; however, 2 months later, the stenosis extended superiorly, near the vocal folds. A modified Dumon stent with a longitudinal cut was then placed through the vocal folds and over the proximal end of the previous stent to cover all of the stenosis.

The use of Transcollation Technology for Video-Assisted Thoracic Surgery lobectomy.

Background: Video-Assisted Thoracic Surgery (VATS) lobectomy is now considered the preferred approach at many centers for early stage lung cancer. However, it needs an adequate learning curve, and it may be challenging in non-expert hands. The aim of this study was to evaluate the effectiveness of Transcollation Technology over Traditional Electrocautery to perform hilar and mediastinal dissection during VATS lobectomy.

Does the length of uniportal video-assisted thoracoscopic lobectomy affect postoperative pain? Results of a randomized controlled trial.

Background: Uniportal video-assisted thoracoscopic surgery (VATS) lobectomy has become a common approach for the treatment of early stage lung cancer. Here, we aimed to establish whether the length of uniportal incision could affect postoperative pain and surgical outcomes in consecutive patients undergoing uniportal VATS lobectomy for early stage lung cancer.

Methods: This was a unicenter Randomized Control Trial (NCT03218098).