Background: Video-Assisted and Robotic-Assisted techniques become constantly more prominent practice in thoracic surgery for lung cancer. Furthermore, the increased frequency in detection of small lung cancers makes the intra-operative identification of these cancers even more challenging. Indocyanine Green (ICG) is one of the most commonly used dyes that assists surgeons identify small lung cancers intra-operatively. Our study aimed to evaluate the effectiveness and safety of ICG in lung cancer detection.Methods: We performed a systematic review of the literature by screening the databases of MEDLINE, EMBASE, CENTRAL and Scopus until 30th April 2022 and the first 300 articles of Google Scholar for any suitable grey literature. We included any study that investigated the effectiveness of ICG in lung cancer detection. We excluded studies that explored the use of ICG only in identification of intersegmental planes, lymph node mapping, case reports and non-English articles. We aimed to perform a meta-analysis on test accuracy studies using hierarchical summary receiver operating characteristic (HSROC) and the bivariate random-effects models. In cases where the data for a localization technique was not sufficient for that analysis, it was presented with tables with narrative purposes. Each study was assessed for Risk of Bias (RoB) and Applicability using the QUADAS-2 tool.Results: We found 30 eligible studies that included a total of 1,776 patients who underwent ICG localization of pulmonary nodules. We identified three ICG localization techniques: CT-guided, endobronchial and intravenous. From the 30 studies, 13 investigated CT-guided localization, 12 explored an endobronchial method while 8 studies administered ICG intravenously the median reported success rate was 94.3% (IQR: 91.4%–100%) and 98.3% (IQR: 94%–100%) for the first two techniques respectively. Intravenous ICG lung cancer localization showed Sensitivity of 88% (95% CI: 59%–0.97%) and Specificity of 25% (95% CI: 0.04%–0.74%). There were 15.2% (150/989) patients who experienced complications from CT guided ICG localization. No ICG-related complications were reported in endobronchial or intravenous techniques.Conclusion: Our study provides a comprehensive review of the literature on ICG localization techniques for lung cancer. Current evidence suggests that ICG is boh effective and safe. Further prospective research with standardized protocols across multiple thoracic units is required in order to accurately validate these findings.

Solitary fibrous tumors of the pleura (pSFT) are a relatively rare neoplasms that can arise from either visceral or parietal pleura and may have different aggressive biological behaviors. Surgery is well known to be the cornerstone of the treatment for pSFT. We reviewed the existing literature, focusing on the role of surgery in the management and treatment of pSFT. All English-written literature has been reviewed, focusing on those reporting on the perioperative management and postoperative outcomes. Surgery for pSFT is feasible and safe in all experiences reported in the literature, but surgical approaches and techniques may vary according to the tumor dimensions, localization, and surgeons’ skills. Long-term outcomes are good, with a 10-year overall survival rate of more than 70% in most of the reported experiences; on the other hand, recurrence may happen in up to 17% of cases, which occurs mainly in the first two years after surgery, but case reports suggest the need for a longer follow-up to assess the risk of late recurrence. Malignant histology and dimensions are the most recognized risk factors for recurrence. Recurrence might be operated on in select patients. Surgery is the treatment of choice in pSFT, but a radical resection and a careful postoperative follow-up should be carried out.

The thymus plays a crucial role in the development of immune system, regulating the maturation, selection and migration of T lymphocytes. Alterations in lymphatic content and structure of the thymus are observed in many autoimmune diseases. Moreover, changes of the epithelial component may cause the development of thymic tumours. Thymoma is a rare epithelial tumor of the anterior mediastinal compartment with a wide spectrum of clinical presentations. The causes of thymoma are still unknown and several hypotheses have been formulated. Thymomas show a variable course causing, frequently, a prolonged clinical history. The presence of metastasis at the time of diagnosis is very uncommon. Even if about 30% of the patients with thymoma are asymptomatic, they may have local symptoms (such as cough, pain, hoarseness, and dyspnea) or paraneoplastic disorders. The role of immune system in the pathogenesis of these tumors and related paraneoplastic syndromes is not completely clear. A clinical diagnosis, especially if the first manifestation is a thymoma-associated paraneoplastic disease, is not always easy and should be supported by an appropriate imaging in order to guide the proper management for each patient. In this article, we would like to give an overview of the local and systemic clinical manifestations, which can be found in patients affected by thymoma.

Although smoking prevalence has shown a decreasing trend, the total number of smokers remains high due to population growth. Smoking causes several diseases, including lung cancer, COPD, coronary heart disease, stroke and peripheral vascular disease. Most of the adverse effects of smoking are reversible and smoking cessation treatments are a cost-effective and high-impact intervention for reducing the risk of mortality and morbidity from smoking-related illness. Smoking cessation may have a significant impact in patients diagnosed with lung cancer, as continued tobacco use can critically compromise treatment efficacy, increase the risk of recurrence and reduce overall survival. Moreover, the benefits of smoking cessation in lung cancer patients can also improve quality of life. The tremendous health and economic consequences of the smoking epidemic should make tobacco control a top priority for governments worldwide. This review aims to highlight the necessity of incorporating smoking cessation as a standard component of lung cancer treatment protocols to enhance patients' clinical outcomes and quality of life. At the same time, we identified a lack of current evidence regarding the optimal timing of smoking cessation among lung cancer patients, which provides the basis for further investigation.

Introduction: Thymomas are the most common tumors of the mediastinum. Traditionally, thymectomies have been performed through a transsternal (TS) approach. With the development of robot-assisted thoracic surgery (RATS), a promising, minimally invasive, alternative surgical technique for performing a thymectomy has been developed. In the current paper, the oncological and surgical outcomes of the TS vs. RATS thymectomies are discussed. Methods: For the RATS thymectomy, two 8 mm working ports and one 12 mm camera port were used. In the transsternal approach, we performed a median sternotomy and resected the thymic tissue completely, in some cases en bloc with part of the lung and/or, more frequently, a partial pericardiectomy with consequent reconstruction using a bovine pericardial patch. The decisions for using the TS vs. RATS methods were mainly based on the suspected tumor invasion of the surrounding structures on the preoperative CT scan and tumor size. Results: Between January 2010 and November 2020, 149 patients were submitted for an anterior mediastinal tumor resection at our institution. A total of 104 patients met the inclusion criteria. One procedure was performed through a hemi-clamshell incision. A total of 81 (78%) patients underwent RATS procedures, and 22 (21.1%) patients were treated using a transsternal (TS) tumor resection. Thymoma was diagnosed in 53 (51%) cases. In the RATS group, the median LOS was 3.2 ± 2.8 days and the median tumor size was 4.4 ± 2.37 cm compared to the TS group, which had a median LOS of 9 ± 7.3 days and a median tumor size of 10.4 ± 5.3 cm. Both differences were statistically significant (p < 0.001). Complete resection was achieved in all patients. Conclusion: While larger and infiltrating tumors (i.e., thymic carcinomas) were usually resected via a sternotomy, the RATS procedure is a good alternative for the resection of thymomas of up to 9.5 cm, and the thymectomy is a strong approach for myasthenia gravis. The oncological outcomes and survival rates were not influenced by the chosen approach.