In this paper we aimed to address the role of pulmonary metastasectomy (PM) in patients affected by Lung Metastases (LM) from Renal Cell Carcinoma (RCC) and to analyse prognostic factors affecting overall survival (OS), disease-free interval (DFI) between primary RCC and first LM, and disease-free survival (DFS) after PM and before lung recurrence. Medical records of 210 patients who underwent PM from RCC in 4 Italian Thoracic Centres, from January 2000 to September 2019, were collected and analysed. All patients underwent RCC resection before lung surgery. The main RCC histology was clear cells (188, 89.5%). The 5- and 10-year OS from the first lung operation were 60% and 34%, respectively. LM synchronous with RCC (p = 0.01) and (Karnofsky Performance Status Scale) KPSS < 80% (p < 0.001) negatively influenced OS. Five- and 10-year DFI were 54% and 28%, respectively. The main factors negatively influencing DFI were: male gender (p = 0.039), KPSS < 80% (p = 0.009) and lactate dehydrogenase > 1.5 times 140 U/L (p = 0.001). Five- and 10-year disease-free survival were 54% and 28%, respectively; multiple LM (p = 0.036), KPSS < 80% (p = 0.001) and histology of RCC other than clear cells negatively influenced disease-free survival. Conclusions: patients with KPSS > 80%, single metachronous LM with a long DFI from RCC diagnosis, and clear cell histology, benefit from pulmonary metastasectomy.

Background: The use of smoking donors (SD) is one strategy to increase the organ pool for lung transplantation (LT), but the benefit-to-risk ratio has not been demonstrated. This study aimed to evaluate the impact of SD history on recipient outcomes and graft alterations. Methods: LTs in 293 patients were retrospectively reviewed and divided into non-SD (n = 225, group I), SD < 20 pack-years (n = 45, group II), and SD ≥ 20 pack-years (n = 23, group III) groups. Moreover, several lung donor biopsies before implantation (equally divided between groups) were evaluated, focusing on smoking-related lesions. Correlations were analyzed between all pathological data and smoking exposure, along with other clinical parameters. Results: Among the three groups, donor and recipient characteristics were comparable, except for higher Oto scores and age in group III. Group III showed a longer intensive care unit (ICU) and hospital stay compared with the other two groups. This finding was confirmed when SD history was considered as a continuous variable. However, survival and other mid- and long-term major outcomes were not affected by smoking history. Finally, morphological lesions did not differ between the three groups. Conclusions: In our study, SDs were associated with a longer post-operative course, without affecting graft aspects or mid- and long-term outcomes. A definition of pack-years cut-off for organ refusal should be balanced with the other extended criteria donor factors.

The understanding of mediastinal anatomy represents a real challenge because of the vital structures inside it and due to its complex relationships with surrounding anatomical regions. Human anatomical specimens are always used both for the teaching of anatomy and the training of young surgeons, thus providing a deep understanding of the most complex anatomical regions and allowing less experienced surgeons to become familiar with surgical instruments and their use on actual human tissues. Despite the spread of these learning practices, there are no principles of dissection to follow for a young physician interested in the anatomy of the mediastinum. Therefore, the main objective of this study is to define a reliable and reproducible protocol for the dissection of the mediastinum. A stratigraphic anatomical dissection on three embalmed human specimens was performed. All steps were documented by high-quality photographs, taken with a professional digital reflex camera, and subsequently edited. A step-by-step anatomical dissection guide was created, detailing every phase, guiding the dissection of the mediastinal anatomy, and leading to the correct identification of its main anatomical structures. We present a step-by-step dissection guide to the mediastinal anatomy with point-by-point explanations and dedicated images, providing an additional tool for the comprehension of this complex anatomical area.

Objectives: To evaluate outcomes of patients undergoing lung segmentectomy using open thoracotomy, Video-Assisted Thoracoscopic Surgery (VATS), or Robotic-Assisted Thoracoscopic Surgery (RATS) approaches. Methods: A total of 157 patients (mean age: 68.7 years; 58% male) who underwent lung segmentectomy from 2015 to 2024 at the Thoracic Surgery of Siena were retrospectively enrolled and divided into groups based on the surgical approach: thoracotomy (n = 60), VATS (n = 58), and RATS (n = 39). No significant differences were observed between groups in terms of age, gender, or tumor stage. Peri-operative outcomes, and, in patients with non-small cell lung cancer (NSCLC, n = 104), long-term outcomes, were analyzed. Group comparisons were conducted using Kruskal–Wallis, Dunn’s test, Chi-squared, or Fisher’s exact test and Kaplan–Meier analysis with log-rank test. Results: Conversion rate was 13% and 0% for VATS and RATS, respectively (p = 0.005). Pleural effusion on first post-operative day was lower in RATS than VATS (p = 0.0006) and open (p < 0.0001). The maximum Visual Analogue Scale (VAS) value recorded was lower in RATS than open (p = 0.016) and VATS (p = 0.013). Surgery time was longer for RATS than open (p = 0.001) and VATS (p = 0.013). No differences were found in hospital stay and post-operative complications. In patients with NSCLC, the median follow-up was 25 months. The 90-day mortality rate was 9.5% in thoracotomy, 0% in VATS and RATS (p = 0.05). The 1- and 2-year overall survival was higher in VATS and RATS groups than thoracotomy (p = 0.001 and p = 0.040, respectively). The number of harvested lymph nodes was larger in the open group (p = 0.010), while a higher number of stations were harvested in RATS and open than VATS (p = 0.001). No differences were found in local recurrence (p= 0.08). Conclusions: RATS segmentectomy ensures a lower conversion rate, less post-operative pain, reduced daily pleural effusion, and a greater number of harvested lymph node stations compared to VATS, providing comparable peri-operative outcomes. RATS and VATS segmentectomy offer an advantage over the open approach in short- and long-term survival.

BackgroundPure ground-glass opacities (pGGOs) represent a growing diagnostic challenge in the era of lung cancer screening. Although often perceived as indolent, a subset of these lesions may harbor biologically aggressive features such as PD-L1 expression or EGFR mutations. Identifying non-invasive predictors of these molecular markers could enhance risk stratification and guide clinical management.MethodsThis multicenter retrospective study analyzed invasive pGGOs from the Italian GORDON database. Only nodules with preoperative high-resolution CT, histologically confirmed invasive adenocarcinoma, and available molecular profiling for EGFR mutations and/or PD-L1 expression were included. Qualitative and quantitative CT features, including attenuation values, Difference CT value, and Relative Attenuation, were assessed.ResultsPD-L1 expression was found in 29.5% of 132 analyzed nodules and was significantly associated with lower unenhanced attenuation (–451 HU vs. –328 HU, p = 0.01), lower Difference CT value (p = 0.02), and lower Relative Attenuation (p = 0.01). Arterial vascular supply was less common in PD-L1+ nodules (p = 0.02). ROC analysis of attenuation parameters showed moderate predictive performance. EGFR mutations were identified in 38.8% of 129 nodules, significantly more frequent in women and younger patients. No radiologic predictors were significantly associated with EGFR status, except for a lower prevalence of bubble-like lucency in EGFR-mutant nodules (p = 0.01).ConclusionQuantitative CT features, particularly attenuation metrics, may aid in identifying PD-L1–expressing pGGOs, even in the absence of morphological aggressiveness. In contrast, conventional imaging lacks predictive value for EGFR mutations, highlighting the need for further molecular integration.

Background/Objectives: This study aims to analyze the short- and medium-term outcomes of lung transplantation (LT) in recipients aged 65 years and older, comparing them with those of younger individuals. The primary endpoints were 90-day and 1-year survival, while secondary measures included perioperative complications and chronic lung allograft dysfunction (CLAD) rates. Methods: A retrospective cohort analysis was conducted on 135 patients who underwent LT at the Siena Lung Transplant Center between January 2013 and December 2023. The participants were stratified into three age groups: under 60 years (Group Y), 60–65 years (Group M), and over 65 years (Group O). Outcomes assessed included ischemia times, transplant type (single or bilateral), ICU and hospital stay, postoperative complications, and CLAD incidence. The data were analyzed using non-parametric statistics, Kaplan–Meier survival curves, and correlation tests between clinical variables and survival outcomes. Results: Among the patients, 88 belonged to Group Y, 36 to Group M, and 11 to Group O. Idiopathic pulmonary fibrosis (IPF) was prevalent in older recipients (82%). Patients over 65 showed a lower prevalence of diabetes (p = 0.025) and pulmonary hypertension (p < 0.01). Bilateral LT was most common in Group Y (91%) and least in Group O (36%, p < 0.0001). Group Y had the longest maximum ischemia time (425 ± 161 min vs. 315 ± 140 min in Group O, p = 0.048). ICU stay (p = 0.289) and hospital stay (p = 0.900) did not differ significantly across groups. No group differences were observed in rates of primary graft dysfunction (p = 0.869), need for renal replacement therapy (p = 0.358), or prolonged ventilation (p = 0.609). CLAD incidence was comparable (p = 0.400), as were 90-day (p = 0.997) and 1-year survival rates (p = 0.174). Conclusions: Carefully selected patients over 65 years old can achieve similar short- and medium-term outcomes to younger LT recipients. These findings support the inclusion of older candidates in transplant programs, while highlighting the need for further research to optimize perioperative strategies and long-term management in this age group.