Long-term outcomes after lung-sparing surgery for epithelial mesothelioma.

Background: This observational study evaluates retrospectively the long-term outcomes after pleurectomy/decortication for pleural mesothelioma, with and without the resection/reconstruction of diaphragm and pericardium.

Methods: Data from 155 consecutive patients undergoing lung-sparing surgery for epithelial pleural mesothelioma were reviewed. Selection criteria for surgery were cT1-3, cN0-1, good performance status, age <80 years.

Real surgical morbidity and mortality after extrapleural pneumonectomy.

As for other major thoracic operations the conventional 30-day morbidity and mortality marker may underestimate the actual surgical risk of extrapleural pneumonectomy. We retrospectively analysed the prolonged follow-up of 78 patients submitted to extrapleural pneumonectomy for pleural mesothelioma (55), lung cancer with associated carcinomatous (7) or purulent (8) pleuritis, empyema/destroyed lung (4), and mediastinal (2) and chest wall (2) tumours with pleuro-pulmonary involvement. Significant rates of surgery-related major complications (19%) and fatalities (6.

Intraoperative identification and effective "blood patch" prevention of persistent air leak in lung resections.

Persistent air leak (PAL) is the most common complication after lung resection, requiring additional treatments and hospital stay. Intraoperative prevention of PAL is usually left to the surgeon's subjective judgement, with inconsistent results. The aim of the study was to establish systematic, reproducible quantification of air leaks at thoracotomy in order to identify those which are potentially persistent, to be preventively treated by intraoperative "blood patch" pneumo-stasis.

Adenocarcinoma of the pancreas: the rationale for neoadjuvant therapy.

The survival of patients with pancreatic cancer is dismal: tumor's resection is possible in only 10-20% of patients. This has prompted clinical studies with chemotherapy and/or radiotherapy designed to increase the number of patients eligible for surgery, to maximize local tumor control and to improve the length of survival. Since postoperative chemoradiation is often delayed in these patients due to morbidity and prolonged recovery time associated with surgery, investigators are assessing the efficacy of chemoradiation before pancreatic resection in patients with potentially resectable pancreatic carcinoma or the potential to downstage locally advanced pancreatic cancer to resectable tumor.

18-Fluorodeoxyglucose positron emission tomography in predicting survival of patients with pancreatic carcinoma.

The prediction of survival of patients with pancreatic cancer is usually based on tumor staging and grading and on the level of tumor markers. However, accurate tumor staging can be obtained only after resection, and still there is a great difference in survival rates among patients with the same clinicopathologic parameters. Recently the uptake of 18-fluorodeoxyglucose (FDG) by positron emission tomography (PET) has been found to be correlated with survival in patients with pancreatic cancer.