Advancements in the Management of Postoperative Air Leak following Thoracic Surgery: From Traditional Practices to Innovative Therapies.

Postoperative air leak (PAL) is a frequent and potentially serious complication following thoracic surgery, characterized by the persistent escape of air from the lung into the pleural space. It is associated with extended hospitalizations, increased morbidity, and elevated healthcare costs. Understanding the mechanisms, risk factors, and effective management strategies for PAL is crucial in improving surgical outcomes.

Poor preoperative quality of life predicts prolonged hospital stay after VATS lobectomy for lung cancer.

Objectives: The aim of this study was to assess whether quality of life (QoL) scales are associated with postoperative length of stay (LoS) following video-assisted thoracoscopic surgery (VATS) lobectomy for lung cancer.

Methods: This is a single-centre retrospective analysis on 250 consecutive patients submitted to VATS lobectomies (233) or segmentectomies (17) over a period of 3 years. QoL was assessed in all patients by the self-administration of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 questionnaire.

Ninety-day hospital costs associated with prolonged air leak following lung resection.

Objectives: Our goal was to assess the postoperative 90-day hospital costs of patients with prolonged air leak (PAL) including costs incurred after discharge from the initial index hospitalization.

Methods: We performed a retrospective analysis of 982 patients undergoing lobectomy (898) or segmentectomy (78) (April 2014-August 2018). A total of 167 operations were open, 780 were video-assisted thoracoscopic surgery and 28 were robotic.

Ninety-day hospital costs for anatomic lung resections†.

Objectives: The study aimed to assess the total cost (TC) and relative cost (RC) of 90-day postoperative care at the hospital after anatomic lung resection.

Methods: Six hundred and forty lung resections (April 2014-September 2016) were performed at a single centre (547 lobectomies, 55 pneumonectomies and 38 segmentectomies). TC was calculated up to 90 days from the date of surgery and included the postoperative cost of the index hospitalization and the costs of hospital or emergency department readmissions, clinic appointments, medications and radiology post-discharge up to 90 days from the operation.

Ipsilateral pulmonary infarction after major lung resection.

Background Lung infarction is a rare complication of lung resection, developing mainly because of technical errors. In some cases, a specific reason cannot be identified. This study aimed to investigate the occurrence, characteristics, and outcome of this pathology in a series of patients.

Do pleural adhesions influence the outcome of patients undergoing major lung resection?

Objectives: Our goal was to investigate whether pleural adhesions identified during an operation can induce adverse events. We investigated the outcome of major lung resection in patients with pleural adhesions encountered on entry into the pleural cavity.

Methods: We conducted a retrospective analysis of 144 patients undergoing major lung resection over a period of 9 months.

Operating room scheduling is not associated with early outcome following elective anatomic lung resections: a propensity score case-matched analysis.

Objectives: To investigate the effect of operating room scheduling on the outcome of patients undergoing elective lung resection.

Methods: In total, 420 patients submitted to anatomical pulmonary resections (363 lobectomies, 35 pneumonectomies, 22 segmentectomies) (April 2014-November 2015) were analysed. Ninety-two patients (22%) were operated on during weekends (Friday or Saturday) and 161 patients (38%) in the afternoon.

Totally Endoscopic (VATS) First Rib Resection for Thoracic Outlet Syndrome.

Background: Thoracic outlet syndrome (TOS) causes neurologic symptoms in 95% of cases and vascular symptoms in 5% of cases. Surgical resection is curative. Endoscopic-assisted transaxillary first rib resection has been previously reported.

Performance of wider parenchymal lung resection than preoperatively planned in patients with low preoperative lung function performance undergoing video-assisted thoracic surgery major lung resection.

Objectives: Pulmonary assessment before major lung resections is used to determine patient's operability. In marginal cases, extensive pulmonary assessment is additionally important under the fear of a more radical parenchymal removal. This study investigates the outcome of wider lung parenchymal resections in patients with low lung functional status undergoing video-assisted thoracic surgery (VATS) major lung resection.

A risk-adjusted financial model to estimate the cost of a video-assisted thoracoscopic surgery lobectomy programme.

Objective: To develop a clinically risk-adjusted financial model to estimate the cost associated with a video-assisted thoracoscopic surgery (VATS) lobectomy programme.

Methods: Prospectively collected data of 236 VATS lobectomy patients (August 2012-December 2013) were analysed retrospectively. Fixed and variable intraoperative and postoperative costs were retrieved from the Hospital Accounting Department.

Major morbidity after video-assisted thoracic surgery lung resections: a comparison between the European Society of Thoracic Surgeons definition and the Thoracic Morbidity and Mortality system.

Background: The thoracic morbidity and mortality (TM&M) classification system univocally encodes the postoperative adverse events by their management complexity. This study aims to compare the distribution of the severity of complications according to the TM&M system versus the distribution according to the classification proposed by European Society of Thoracic Surgeons (ESTS) Database in a population of patients submitted to video assisted thoracoscopic surgery (VATS) lung resection.

Methods: A total of 227 consecutive patients submitted to VATS lobectomy for lung cancer were analyzed.

High-risk patients and postoperative complications following video-assisted thoracic surgery lobectomy: a case-matched comparison with lower-risk counterparts†.

Objectives: To assess the postoperative incidence of major complications in high-risk patients following video-assisted thoracoscopic surgery (VATS) lobectomy for lung cancer compared with their lower risk counterparts.

Methods: A retrospective analysis on prospectively collected data of 348 consecutive patients subjected to VATS lobectomy (August 2012-September 2014) was performed. Patients were defined as high risk if one or more of the following characteristics were present: age >75 years, forced expiratory volume in 1 s (FEV1) <50%, carbon monoxide lung diffusion capacity (DLCO) <50%, history of coronary artery disease (CAD).

Real-time monitoring of a video-assisted thoracoscopic surgery lobectomy programme using a specific cardiopulmonary complications risk-adjusted control chart†.

Objectives: To implement internal monitoring using a risk-adjusted model specific for video-assisted thoracoscopic surgery (VATS) lobectomy.

Methods: Retrospective analysis on prospectively collected data of 348 patients submitted to VATS lobectomy (August 2012-August 2014). Baseline and surgical variables were tested for a possible association with postoperative cardiopulmonary complications.

Novel technique in managing bronchobiliary fistula in adults: Endobronchial embolization using silicone spigots in 2 cases.

Bronchobiliary fistula (BBF) can complicate most hepatic pathologies. This is a challenging group of patients, especially when surgery is precluded. The bronchoscopic application of silicon spigots is a recognized technique for the treatment of massive hemoptysis and the management of patients with bronchopleural fistula following lung resection.

Adrenocortical oncocytic carcinoma with recurrent metastases: a case report and review of the literature.

Background: Adrenal cortex oncocytic carcinoma (AOC) represents an exceptional pathological entity, since only 22 cases have been documented in the literature so far.

Case Presentation: Our case concerns a 54-year-old man with past medical history of right adrenal excision with partial hepatectomy, due to an adrenocortical carcinoma. The patient was admitted in our hospital to undergo surgical resection of a left lung mass newly detected on chest Computed Tomography scan.

Massive bronchogenic cyst mimicking ischaemic chest pain.

The presentation of the bronchogenic cyst is variable making preoperative diagnosis difficult. The majority are either asymptomatic or discovered incidentally. The most common presenting symptoms are cough, fever and dyspnoea.

Simultaneous bilateral carotid endarterectomy under local anesthesia.

A 75-year-old man with bilateral carotid stenosis and severe coronary artery disease underwent successful simultaneous bilateral carotid endarterectomy under local anesthesia. A few days later, coronary artery bypass grafting was performed with no complications.

A structural basis for the aortic stress-strain relation in uniaxial tension.

A constitutive law that includes three analytical expressions was recently proposed to approximate the low, physiologic, and high-stress parts of the aortic stress-strain relation in uniaxial tension, consistent with the biphasic nature of the aortic wall under passive conditions. This consistency, and the fact that previous phenomenological uniaxial laws have only indirectly been related to vessel wall structure, motivates the investigation of the structural basis underlying the newly proposed three-part constitutive law. For this purpose, longitudinally oriented aortic strips were fixed in Karnovsky's solution, while subjected to various pre-selected levels of uniaxial tensile stress.