Mario Santini
Verified @unicampania.it
Scopus Publications
Scopus Publications
Beatrice Leonardi, Giovanni Natale, Gaetana Messina, Giorgia Opromolla, Rosa Mirra, Francesca Capasso, Vincenzo Di Filippo, Francesco Leone, Davide Gerardo Pica, Giuseppe Vicario,et al.
AME Publishing Company
Gaetana Messina, Mary Bove, Giovanni Natale, Alfonso Fiorelli, Giovanni Vicidomini, Mario Santini, Andrea Ronchi, Mario Pirozzi, Sergio Facchini, Fortunato Ciardiello,et al.
AME Publishing Company
Background Solitary fibrous tumor (SFT) is a rare mesenchymal neoplasm, generally arising in the visceral pleura. It rarely originates from other sites such as trachea, orbital cavities, nasal cavities, peritoneum, paranasal sinuses, meninges, salivary glands, thyroid gland, diaphragm, liver, pancreas, lung kidney, adrenal gland, mediastinum, spermatid cord, pericardium, urinary bladder, prostate, uterine cervix, testis, spinal cord, periosteum, skin, soft tissue and bone. Case Description We present a surgical case of a rare primary tracheal tumor. High resolution computed tomography (HRCT) scan of the chest showed a 5 mm hypodense lesion, located on the right lateral wall of the proximal third of trachea; however the tracheal lumen was normal. We performed a rigid bronchoscopy in order to remove the endotracheal tumor with palliative purposes only. For this reason, we did not perform a prior histologic examination. The lesion was easily removed with common biopsy forceps and with standard aspirator. The debulking of the tumor was achieved with the use of laser Nd-YAP, electrocautery was used also for hemostasis to prevent bleeding during the operation. Without complications during the endoscopic treatment, the procedure was well tolerated by the patient. The pathological diagnosis was SFT. Conclusions SFT located in the trachea can be endoscopically resceted. Endoscolical treatment is indicated for patients with poor clinical conditions (heart disease, respiratory failure) that are not elegible for surgical resection.
Luigi Di Tommaso, Ettorino Di Tommaso, Raffaele Giordano, Emilio Mileo, Mario Santini, Emanuele Pilato, and Gabriele Iannelli
SAGE Publications
Purpose: Surgical treatment of primary lung T4 tumors is controversial especially when the cancer invades the mediastinal structures or the descending thoracic aorta. Conventional surgical treatment is associated with a high perioperative mortality and morbidity rate. Thoracic EndoVascular Aortic Repair has emerged as a valid off-label alternative to conventional surgery. We aimed to assess perioperative and midterm aortic-related outcome of patients who have undergone aortic stent-graft implantation, followed by en bloc surgical treatment of the involved aorta and lung cancer resection. Materials and Methods: From July 2017 to May 2020, we treated 5 patients diagnosed with a T4 lung cancer by the involvement of the descending thoracic aorta. When only the descending thoracic aorta is involved, a 2-stage procedure was considered, with aortic stent-graft implantation performed before tumor resection. One-stage strategy, with stent-graft implantation carried out before thoracotomy, was preferred for patients with the involvement of cardiac and/or other vascular mediastinal structures. Results: The mean age was 58.4 ± 6.2 years. All patients were affected by non–small cell lung cancer. All 5 patients required a single stent-graft to completely cover the involved segment of aorta. Four patients underwent a 2-stage procedure. One patient, with the involvement of the left inferior pulmonary vein, required a 1-stage en bloc resection of the left lower lobe, aortic wall adventitia, left inferior pulmonary vein, and reconstruction of the left atrial wall. Primary procedural success was achieved in all. At follow-up, no patient developed aortic-related complications. One patient died 2 years after surgery, due to local recurrence of the tumor. Conclusion: T4 lung resection combined with aortic stent-graft implantation can be safely performed. Endovascular surgery, by avoiding the use of cardiopulmonary bypass, aortic cross-clamping, and graft replacement, can reduce significant morbidity and mortality rate. Postoperative and long-term outcome of these patients treated with endovascular surgery is mainly related to pulmonary disease, not to aortic treatment.
Gaetana Messina, Mary Bove, Giovanni Natale, Vincenzo Di Filippo, Giorgia Opromolla, Eva Massimilla, Mauro Forte, Anna Rainone, Giuseppe Vicario, Beatrice Leonardi,et al.
Wiley
INTRODUCTION
Central airway tumors involving the trachea and main-stem bronchi are a common cause of airway obstruction and a significant cause of mortality among the patients of thoracic diseases with respiratory failure. Debulking in rigid bronchoscopy is quick, safe, and effective. It can be complex and hard in patients with severe bronchial or tracheal obstruction and/or with intraluminal bleeding tumors because of inadequate distal airway control. We have used laser tube as a new technique of ventilation for severe central airway obstruction.
MATERIALS AND METHODS
Forty-six patients with severe airway obstruction undergoing rigid bronchoscopy from September 2020 to June 2022 at the Thoracic Surgery Department of the University L. Vanvitelli of Naples underwent placement of laser tube.
RESULTS
In all patients who underwent rigid bronchoscopy with the use of the laser tube, a reduction of obstruction of more than 50% was obtained and in all patients no hypoxia (saturation < 88%), nor hypercapnia, nor significant bleeding were reported.
DISCUSSION
The results of this study suggest that rigid bronchoscopic debulking with the use of laser tube is a safe and effective technique in the management of central airway obstruction.
CONCLUSIONS
The use of the laser tube allows the monitoring of gas exchange, which controls hypoxemia. Thanks to the double cuff put distally to the tracheal obstruction or in the contralateral bronchus to the obstructed one, the laser tube prevents the flooding of blood from debulking below the stenosis. Rigid bronchoscopy with laser tube will expand its use in the future.
Gaetana Messina, Mary Bove, Giovanni Natale, Vincenzo Di Filippo, Giorgia Opromolla, Anna Rainone, Beatrice Leonardi, Mario Martone, Alfonso Fiorelli, Giovanni Vicidomini,et al.
Wiley
BACKGROUND
Malignant pleural mesothelioma (MPM) is an invasive, aggressive pleural tumor with a predominantly local spread. The objective of this study was to assess thoracic ultrasound (TUS) as an imaging modality with high sensitivity for the identification of malignant pleural involvement and in order to guide pleural biopsies.
METHODS
In this retrospective single-center study between January 2018 and June 2022, 51 consecutive patients with impassable circumferential pleural thickening underwent TUS at the Thoracic Surgery Unit of the Vanvitelli University of Naples. Pleural biopsies were performed, and then large and multiple samples were sent to the pathological anatomy for histological examination.
RESULTS
In all patients who underwent ultrasound examination, we chose the optimal point of entry to perform pleural biopsies and selected the areas of greater thickening without pleural effusion. No patient had any complications. No drainage tubes were placed after the pleural biopsies and no pneumothorax was present during the following days of hospitalization. The patients were discharged on the second postoperative day.
CONCLUSION
With TUS the precise pleural thickening localization, local infiltration, mass extent, its nature (solid, cystic or complex) and ultrasound features can be easily defined. Furthermore, ultrasound is more economical than computed tomography and avoids the risks associated with radiation. Thoracic ultrasound is an important component of the diagnostic procedure in detecting a safe entry site for biopsies of MPMs.
Federica Zito Marino, Carminia Maria Della Corte, Vincenza Ciaramella, Stefania Erra, Andrea Ronchi, Alfonso Fiorelli, Giovanni Vicidomini, Mario Santini, Giosuè Scognamiglio, Floriana Morgillo,et al.
MDPI AG
Malignant pleural mesothelioma (MPM) is a highly lethal malignancy that unfortunately cannot benefit from molecularly targeted therapies. Although previous results showed the pivotal role of various receptor tyrosine kinases (RTKs) in MPM tumorigenesis, the treatment with a single inhibitor targeting one specific RTK has been shown to be ineffective in MPM patients. The main aim of the present study was to investigate the potential role of AXL and MET receptors in MPM and the possible efficacy of treatment with AXL and MET multitarget inhibitors. Immunohistochemical and FISH analyses were performed in a wide series of formalin-fixed paraffin-embedded MPM samples to detect the expression of two receptors and the potential gene amplification. In vitro studies were performed to evaluate putative correlations between the target’s expression and the cell sensitivity to AXL-MET multitarget inhibitors. In our series, 10.4% of cases showed a co-expression of AXL and MET, regardless of their ligand expression, and the gene amplification. Furthermore, our in vitro results suggest that the concomitant pharmacological inhibition of AXL and MET may affect the proliferative and aggressiveness of MPM cells. In conclusion, the subset of MPM patients with AXL-MET co-activation could benefit from treatment with specific multitarget inhibitors.
Gaetana Messina, Mary Bove, Giovanni Natale, Antonio Noro, Mario Martone, Giorgia Opromolla, Vincenzo Di Filippo, Beatrice Leonardi, Morena Fasano, Rita Polito,et al.
Oxford University Press (OUP)
Abstract OBJECTIVES Application of video-assisted thoracoscopy brought lung surgery into the minimally invasive era; the lack of tactile feedback using VATS, remains a disadvantage because surgeons are unable to locate lesions with a finger or device. This study aimed to investigate the effectiveness, the applicability and the utility of intraoperative ultrasound (IU), for the localization of small ground-glass opacity (GGO) lesions in the parenchyma, as a guide in finding their margins in a deflated lung. MATERIALS AND METHODS We included 15 consecutive patients undergoing diagnostic resection of GGOs via VATS in the Thoracic Surgery Unit of the University of ‘Luigi Vanvitelli’ of Naples from November 2019 to December 2021. They were under general anaesthesia, when the lung had been collapsed, the probe was placed in the region where the target lesion was thought to reside on the basis of low-dose computed tomography scanning. GGO could be identified their sizes, echo levels and posterior echo was recorded by IU when the lung was completely deflated. RESULTS We conducted a retrospective single-centre study. All GGOs were identified by IU. The mean size and depth were 14.1 ± 0.5 and 4.8 ± 0.3 mm, respectively. Six (40%) lesions had hyperechoic patterns, 9 (60%) had mixed echogenicity where the hyperechoic patterns were irregularly mixed with hypoechoic patterns. The final diagnoses included 2 (15%) atypical adenomatous hyperplasia; 2 (15%) adenocarcinomas in situ; 3 (23%) minimally invasive adenocarcinomas and 6 (46%) invasive adenocarcinomas. CONCLUSIONS The results of our study showed that IU could safely and effectively detect GGOs.
Alfonso Fiorelli, Stefano Forte, Salvatore Tolone, Giovanni Natale, Mario Santini, and Ludovico Docimo
Elsevier BV
Gaetana Messina, Mary Bove, Antonio Noro, Giorgia Opromolla, Giovanni Natale, Rosa Mirra, Francesca Capasso, Davide Gerardo Pica, Vincenzo Di Filippo, Mario Pirozzi,et al.
Wiley
INTRODUCTION
Staging of the mediastinum lymph nodes involvement in patients with non-small cell lung cancer (NSCLC) is an important prognostic factor determining the most appropriate multimodality treatment plan. The objective of this study is to assess ultrasound characteristics of mediastinal lymph nodes metastasis and effectiveness of intraoperative ultrasound-guided mediastinal nodal dissection in patients with resected NSCLC.
MATERIALS AND METHODS
All patients undergoing video-assisted thoracoscopic surgery lobectomy and pulmonary lymphadenectomy from November 2020 to March 2022 at the thoracic surgery department of the Vanvitelli University of Naples underwent intraoperative ultrasound-guided mediastinal lymph nodal dissection.
RESULTS
This study evaluates whether individual B-mode features and a compounding thereof can be used to accurately and reproducibly predict lymph node malignancy.
DISCUSSION
Intraoperative ultrasound, during systematic mediastinal lymph node dissection, is helpful in preventing lesion to mediastinal structures. Pathological nodal sonographic characteristics are round shape, short-axis diameter, echogenicity, margin, the absence or presence of coagulation necrosis sign, and the absence or presence of central hilar structure, increased color Doppler flow, the absence or presence of calcification, and nodal conglomeration. Operating time was not substantially prolonged. The procedure is simple, safe and highly accurate.
CONCLUSIONS
Ultrasonic techniques allow surgeons to detect the relationship between lymph nodes and surrounding large blood vessels during biopsy, improving the safety and simplicity of the operation, increasing the number of harvested lymph nodes, and reducing the risk of intraoperative injury; it is a fast, easily reproducible, and inexpensive method.
Gaetana Messina, Mary Bove, Antonio Noro, Giorgia Opromolla, Giovanni Natale, Francesco Leone, Vincenzo Di Filippo, Beatrice Leonardi, Mario Martone, Mario Pirozzi,et al.
Springer Science and Business Media LLC
Abstract Introduction Video-assisted thoracic surgery (VATS) for ipsilateral reoperations is controversial, because after the first surgical intervention, pleural adhesions occur frequently in the thoracic cavity and/or chest wall. This study assessed the usefulness of preoperative ultrasonography to reduce the incidence of lung injury at the time of the initial port insertion during secondary ipsilateral VATS. Materials and methods This was a retrospective, single-center study. Nine patients who underwent thoracic surgery at Vanvitelli Hospitalfrom September 2019 to February 2022, were scheduled for a second VATS surgeryon ipsilateral lung, because of inconclusive intraoperative histologic examination. All nine patients underwent preoperative ultrasonography to assess the possible presence of pleural adhesions. We evaluated the lung sliding, since the presence of pleural adhesions does not permit to appreciate it. Statistical analysis Hard severe adhesions were observed in all nine patients without sliding lung sign (specificity 100%). In this series, the sensitivity, PPV, and NPV of the sliding lung sign were 93%, 100% and 94% respectively. Results The presence of the lung respiratory changes can be evaluated as the “sliding lung sign” by chest ultrasonography; we believe that the sliding lung sign might also predict intrathoracic adhesion. Conclusions Preoperative detection of pleural adhesions using transthoracic ultrasonography was useful for ipsilateral secondary pulmonary resection patients undergoing VATS. Using preoperative ultrasonography can improve the safety and feasibility of placing the initial port in VATS.
Alfonso Fiorelli, Gaetana Messina, and Mario Santini
Elsevier BV
Alfonso Fiorelli, Giovanni Natale, Vincenzo Di Filippo, Giorgia Opromolla, Giovanni Vicidomini, and Mario Santini
SAGE Publications
Congenital pericardial defect is an uncommon anomaly due to the congenital absence of the pericardium. In this case, it was associated with diaphragmatic hernia and incidentally discovered during thoracoscopic left upper lobectomy for lung cancer. The thoracoscopic dissection of the hilar structures was complicated with arrhythmia and hypotension. Thus, we converted thoracoscopy to thoracotomy, and the lobectomy was successfully performed. The pericardial defect and diaphragmatic hernia were not repaired, but the vessels and bronchial stump were covered to avoid heart injury. Postoperative course was unremarkable and at six-month follow-up patient did not have any problems.
Alfonso Fiorelli, Stefano Forte, Mario Santini, René Horsleben Petersen, and Wentao Fang
Wiley
The potential complications related to unplanned conversion to thoracotomy remains a major concern in thoracoscopic lobectomy and may limit the wide adoption of this strategy. We reviewed the literature from 1990 until February 2022, analyzing all papers comparing successful thoracoscopic lobectomy versus converted thoracoscopic lobectomy and/or upfront thoracotomy lobectomy to establish whether unplanned conversion negatively affected outcomes. Thirteen studies provided the most applicable evidence to evaluate this issue. Conversion to thoracotomy was reported to occur in up to 23% of cases (range, 5%-16%). Vascular injury, calcified lymph nodes, and dense adhesions were the most common reasons for conversion. Converted thoracoscopic lobectomy compared to successful thoracoscopic lobectomy was associated with longer operative time and hospital stay in all studies, with higher postoperative complication rates in seven studies, and with higher perioperative mortality rates in four studies. No significant differences were found between converted thoracoscopic lobectomy and upfront thoracotomy lobectomy. Five studies evaluated long-term survival, and in all papers conversion did not prejudice survival. Surgeons should not fear unplanned conversion during thoracoscopic lobectomy, but to avoid unexpected conversion that may negatively impact surgical outcome, a careful selection of patients is recommended-especially for frail patients.
Gaetana Messina, Antonio Noro, Giovanni Natale, Mary Bove, Morena Fasano, Giovanni Vicidomini, Mario Santini, and Alfonso Fiorelli
Oxford University Press (OUP)
Abstract Prolonged chest tube drainage is one of the most common postoperative complications of pulmonary resections; it is related to complications such as residual pleural spaces or continuous alveolar air leaks. We retrospectively evaluated the efficacy of artificial intraoperative pneumoperitoneum in the treatment of such complications after lung resections. The presence of a residual space associated with prolonged air leaks can be difficult to treat, exposes the patient to a high risk of infection, prolongs hospitalization, and in some cases mandates reoperation. Between October 2016 and March 2020, four patients underwent pneumoperitoneum. The obliteration of the pleural cavity and the absence of air leaks were observed in 3 patients; only 1 patient was discharged with a Heimlich valve. Artificial intraoperative pneumoperitoneum is a safe and simple procedure. It decreases the duration of chest drainage and of the hospital stay; however, further studies are needed to corroborate our data. The learning curve for this technique may be relatively short.
Gaetana Messina, Nicola Tartaglia, Antonio Ambrosi, Chiara Porro, Angelo Campanozzi, Anna Valenzano, Gaetano Corso, Alfonso Fiorelli, Rita Polito, Mario Santini,et al.
MDPI AG
Lung cancer is the most lethal cancer: it has a significant incidence and low survival rates. Lifestyle has an important influence on cancer onset and its progression, indeed environmental factors and smoke are involved in cancer establishment, and in lung cancer. Physical activity is a determinant in inhibiting or slowing lung cancer. Certainly, the inflammation is a major factor responsible for lung cancer establishment. In this scenario, regular physical activity can induce anti-inflammatory effects, reducing ROS production and stimulating immune cell system activity. On lung function, physical activity improves lung muscle strength, FEV1 and forced vital capacity. In lung cancer patients, it reduces dyspnea, fatigue and pain. Data in the literature has shown the effects of physical activity both in in vivo and in vitro studies, reporting that its anti-inflammatory action is determinant in the onset of human diseases such as lung cancer. It has a beneficial effect not only in the prevention of lung cancer, but also on treatment and prognosis. For these reasons, it is retained as an adjuvant in lung cancer treatment both for the administration and prognosis of this type of cancer. The purpose of this review is to analyze the role of physical activity in lung cancer and to recommend regular physical activity and lifestyle changes to prevent or treat this pathology.
Alfonso Fiorelli, Gaetana Messina, Mary Bove, Giovanni Natale, Antonio Noro, Roberto Cascone, Giorgia Opromolla, Domenico Testa, Gaetano Motta, and Mario Santini
Elsevier BV
BACKGROUND
Ultrasound is a reliable tool for airway assessment and management. We evaluated the accuracy of Ultrasound in the pre-procedure planning and follow-up evaluation of patients undergoing airway stenting for benign upper airway stenosis.
METHODS
This was a retrospective single center study on patients with benign upper airway stenosis treated with airway stenting. Ultrasound evaluated the characteristics of the stenosis (distance from vocal folds, diameter and length) before treatment and any complications after treatment; these results were then statistically compared with those obtained by computed tomography, taking the endoscopy as the reference method.
RESULTS
Twenty-seven patients were evaluated. Ultrasound was significantly correlated with endoscopy and computed tomography scan measurements as distance of stenosis from vocal folds (r=0.88; p<0.001 and r=0.87; p<0.001, respectively); diameter of the stenosis (r=0.97; p<0.001 and r=0.97; p<0.001, respectively); and length of the stenosis (r=0.97; p<0.001 and r=0.97; p<0.001, respectively). Four out of 27 (15%) patients presented complications after treatment as stent migration (n=2; 7%); stent obstruction (n=1; 4%), and granulation of vocal fold (n=1; 4%). All complications but granulation of vocal fold were correctly depicted by Ultrasound and Computed Tomography without significant difference in comparison to endoscopy (p=0.87) CONCLUSIONS: Ultrasound is a promising tool in assessment of airway stenosis and follow-up of patients after stenting; it may be routinely used in adjunction to computed tomography and/or endoscopy in this setting, if our results are corroborated by future larger study.
Alfonso Fiorelli, Giovanni Natale, Fausto Ferraro, Roberta Fiorito, and Mario Santini
AME Publishing Company
Background: Staplers play a crucial role for thoracoscopic lobectomy, but their malfunction may be associated with post-operative morbidity and/or mortality. Case Description: Herein, we reported a case of stapler trouble during thoracoscopic left lower lobectomy. At the end of the operation, interlobar fissure was divided by stapler with 60 mm purple (3.5 mm) cartridge. After firing, the jaws did not open, and remained stuck to the lung tissue. A fissureless approach was performed and the interlobar fissure was divided at last using a stapler with 60 mm purple (3.5 mm) cartridge. After firing, the jaws did not open, and remained stuck to the lung tissue. All secondary maneuvers recommended from the manufacturer for opening the jaws were performed, but without success. An additional stapler with 60 mm purple (3.5 mm) cartridge was inserted through the anterior incision, and divided the tissue between the stuck stapler and the pulmonary artery. The tissue with the locked stapler was divided from the specimen using energy device, and taken out of the patient through the anterior incision. The specimen was then inserted within the endo-bag and retrieved through the anterior incision in a standard manner. Extended lymphadenectomy completed the procedure, and intraoperative sealing test revealed no air leakage. The postoperative course was unremarkable, and patient was discharged five days later. The actual follow-up showed no sign of recurrence. Conclusions: Our strategy may be useful for surgeons to deal an unpredicted similar situation that may occur either for stapler malfunction or for improper use
Alfonso Fiorelli, Gaetana Messina, Roberta Fiorito, Mario Martone, Fausto Ferraro, and Mario Santini
AME Publishing Company
Background: Malignant central airway stenosis (CAO) is a life-threatening condition that may lead to emergency intubation and mechanical ventilation to manage severe respiratory failure. Airway stenting may facilitate extubation, and preserve stable airway for further cancer specific treatments. Herein, we reported an unconventional life-saving strategy using endotracheal tube (ETT) to relocate a displaced airway stent in a patient with critical CAO. Case Description: A 69-year-old man with severe malignant tracheal stenosis underwent emergent intubation. Airway stenting was placed and patient moved to Intensive Care Unit (ICU) with ETT in situ . Soon after extubation, the patient developed severe breathing difficulty due to stent dislocation. Under endoscopic view, a 7.5 mm ETT was placed within the stent; the balloon was inflated, and the tube with the stent was gently moved toward the carina, till the stent forced and covered the stenosis and its distal end was located above the carina. The balloon was then deflated, and the ETT was removed. Conclusions: Our method was not the first choice for relocating dislocating airway stent, but it should be considered as a life-saving treatment to perform in emergent situation when rigid bronchoscope and operating room were not readily available. The main lesson to be learned from this case was to not extubate a patient with a high-risk airway unless physicians are prepared to deal with the potential complications.
Beatrice Leonardi, Caterina Sagnelli, Alfonso Fiorelli, Francesco Leone, Rosa Mirra, Davide Gerardo Pica, Vincenzo Di Filippo, Francesca Capasso, Gaetana Messina, Giovanni Vicidomini,et al.
MDPI AG
Enhanced recovery after surgery protocols have shown improved clinical outcomes after lung resection surgery, but their application after empyema surgery is still limited. We retrospectively evaluated the outcomes of an adapted enhanced recovery after surgery (ERAS) protocol for immunocompromised patients who underwent video-assisted thoracoscopic surgery (VATS) surgery for chronic empyema between December 2013 and December 2021. The patients were divided into an ERAS group and a conventional treatment group. Peri-operative data were collected and compared between the two groups. The primary outcome was post-operative length of stay. Secondary outcomes were post-operative pain and post-operative complications (air leaks, atelectasis). A total of 86 patients, 45 in the ERAS group and 41 in the non-ERAS group, were considered. Chest tube duration (6.4 ± 2.3 vs. 13.6 ± 6.8 days) and post-operative length of stay (7.6 ± 1.6 vs. 16.9 ± 6.9 days) were significantly shorter in the ERAS group. The volume of chest drainage (103 ± 78 vs. 157 ± 89 mL/day) was significantly smaller in the ERAS group. There were no significant differences in operative time, blood loss, need for transfusion, tube reinsertion and median VAS score. The incidence of air leaks and atelectasis was significantly reduced in the ERAS group, as was the need for bronchoscopic aspiration. The application of an ERAS protocol after empyema VATS surgery for immunocompromised patients improved the surgical outcome, reducing the post-operative length of stay and rate of complications.
Claudio Andreetti, Mohsen Ibrahim, Antonio Gagliardi, Camilla Poggi, Giulio Maurizi, Domenico Armillotta, Valentina Peritone, Leonardo Teodonio, Erino Angelo Rendina, Federico Venuta,et al.
Wiley
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).
RESULTS
Our study population included 117 patients; 47 (40%) of these received adjuvant chemotherapy. Patients treated with adjuvant chemotherapy had better survival (74% vs. 45%, p = 0.002) and disease-free survival (79% vs. 40%, p = 0.001) in all cases except patients with tumor <20 mm (79.5% vs. 57.4%, p = 0.43). Lobectomy compared to sublobar resection was associated with better survival (67% vs. 0.1%, p < 0.0001) and disease-free survival (65% vs. 0.1%, p < 0.0001) also in patients with tumor <20 mm (79% vs. 28%, p = 0.001). Patients with triple-positive neuroendocrine markers had better survival (79% vs. 35%, p = 0.0001) and disease-free survival (69% vs. 42%, p = 0.0008). Regression analysis showed that tumor size <20 mm, lobectomy, adjuvant chemotherapy, and triple-positive immunistochemical neuroendocrine markers were significant favorable prognostic factors for survival outcomes.
CONCLUSIONS
Lobectomy seems to be the management of choice in patients with large-cell neuroendocrine cancer <20 mm while adjuvant chemotherapy should be administered only in patients with tumor >20 mm.
Chiara Porro, Maria Ester La Torre, Nicola Tartaglia, Tarek Benameur, Mario Santini, Antonio Ambrosi, Giovanni Messina, Giuseppe Cibelli, Alfonso Fiorelli, Rita Polito,et al.
MDPI AG
Lung cancer is a devastating disease with a high incidence and low survival rates, so recent studies have focused on analyzing the risk factors that might prevent this disease from developing or have protective/therapeutic effects. Nutrition is an important key factor in the prevention and treatment of lung cancer. Various factors appear to be involved in the development of the latter, such as cigarette smoking or certain external environmental factors. The increase in oxidative stress is therefore an integral part of the carcinogenesis process. The biological role of bioactive factors derived from adipose tissue, mainly adipokines, is implicated in various cancers, and an increasing body of evidence has shown that certain adipocytokines contribute to the development, progression and prognosis of lung cancer. Not all adipokines stimulate tumor growth; in fact, adiponectin inhibits carcinogenesis by regulating both cell growth and the levels of inflammatory cytokines. Adiponectin expression is deregulated in several cancer types. Many nutritional factors have been shown to increase adiponectin levels and therefore could be used as a new therapeutic strategy for combating lung cancer. In addition, foods with antioxidant and anti-inflammatory properties play a key role in the prevention of many human diseases, including lung cancer. The purpose of this review is to analyze the role of diet in lung cancer in order to recommend dietary habit and lifestyle changes to prevent or treat this pathology.
Alfonso Fiorelli, Gaetana Messina, Alfonso Pecoraro, and Mario Santini
Springer Science and Business Media LLC
We read with great interest the paper of Iyoda et al. [1]. They retrospectively compared the data of 106 patients undergoing airway stenting with silicone stent (SS) (n = 45) and metallic stent (MS) (n = 61) for malignant airway stenosis within a period of 20 years. SS compared to MS group had higher survival rate (p = 0.0173), more additional treatments for thoracic malignancy (p = 0.0007), including chemoradiotherapy (p = 0.0268) and radiotherapy (p = 0.0300), and similar complication rates. On multivariate analysis, additional treatments and complication rates were favorable prognostic factors. SS compared to MS facilitated a greater degree of additional treatments, resulting in prolonged survival. The incompatibility of MS with radiotherapy was addicted as possible explanation. We congratulate with the authors [1] for their work and fully agree that airway stenting has a key role in the management of malignant stenosis. Despite all, some points should be discussed before drawing definitive conclusions. First, recent experimental and clinical studies [2, 3] showed that MS did not significantly affect radiation dose in the airway and surrounding tissues. Second, despite the ideal stent does not exist, MS is usually selected in patients with advanced cancers, end stage or poor PS, because of (i) its easy procedure, (ii) no rigid bronchoscope and general anesthesia are required for the insertion, and (iii) it conforms to the twisting airway. Thus, MS over SS group could include higher rates of patients with poor PS, of non-naïve patients and/or of end stage patients. All these factors likely limited additional treatments [4] and demonstrated short survival, independently from the characteristic of the stent. Third, the immunotherapy may be an additional treatment in these patients who cannot tolerate standard CT and RT [5]. Obviously, the present paper cannot evaluate this issue being a retrospective analysis of 20 years of experience, and thus future studies should clarify the role of immunotherapy in these patients.
Antonio Noro, Beatrice Leonardi, Giovanni Natale, Mary Bove, Mario Martone, Davide Gerardo Pica, Francesco Leone, Rosa Mirra, Mario Santini, and Alfonso Fiorelli
Elsevier
Antonio Noro, Giovanni Natale, Gaetana Messina, Beatrice Leonardi, Anna Rainone, Mario Santini, and Alfonso Fiorelli
Georg Thieme Verlag KG
Abstract Background Incomplete interlobar fissure may increase the difficulty of thoracoscopic lobectomy. Herein, we compared the accuracy of visual versus quantitative analysis to predict fissure integrity in lung cancer patients undergoing thoracoscopic lobectomy and evaluated the effects of fissure integrity on surgical outcome. Methods This was a single-center retrospective study including consecutive patients undergoing VATS (video-assisted thoracoscopic surgery) lobectomy for lung cancer. The target interlobar fissures were classified as complete or incomplete by visual and quantitative analysis. Using the intraoperative finding as the reference method, the diagnostic accuracy of the two methods to define fissure completeness (dependent variable) was calculated and statistically compared. Yet, we evaluated differences in postoperative outcomes between patients with complete and incomplete fissure integrity. Results A total of 93 patients were included in the study; 33/93 (36%) presented complete fissure. Visual and quantitative analyses correctly identified complete fissure in 19/33 (57%) and 29/33 (88%) patients, respectively, and incomplete fissure in 56/60 (93%) and 58/60 (96%) patients, respectively. Quantitative analysis had better diagnostic accuracy than visual analysis (81 vs. 93%; p = 0.01). Patients with incomplete fissure compared with those with complete fissure had a higher conversion rate (6 vs. 13%; p = 0.43), higher persistent air leak rate (0/33 vs. 14/60; p = 0.03), and longer hospitalization (12.6 ± 3.8 vs. 7.1 ± 2.4 days; p = 0.01). Conclusions Quantitative analysis accurately predicted the fissures' integrity; it may be useful for selecting suitable cases for thoracoscopic lobectomy especially for surgeons with limited minimally invasive experience.