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.

Background: Descending necrotizing mediastinitis (DNM) is a life-threatening condition, generally caused by downward dissemination of oropharyngeal infections through cervical fascial planes. Mediastinal drainage is conventionally achieved by thoracotomy, but a Video-Assisted Thoracoscopic Surgery (VATS) approach is gaining interest due to the reduced invasiveness of procedure. We aimed to evaluate the effectiveness of VATS treatment in patients with DNM. Methods: We conducted a retrospective multicenter study including patients with descending mediastinitis that underwent mediastinal drainage through VATS (VATS group) or thoracotomy (thoracotomy group), both in association with cervical drainage. Patients with mediastinitis secondary to cardiac, pulmonary, or esophageal surgery were excluded. The intergroup differences regarding surgical outcome and postoperative morbidity and mortality were compared. Results: A total of 21 patients were treated for descending mediastinitis during the study period. Cervicotomy and thoracotomy were performed in 15 patients (71%), while cervicotomy and VATS were performed in 6 patients (29%). There were no significant differences in surgical outcome, postoperative morbidity, and mortality between groups. VATS treatment was not associated with a higher complication rate. Patients in the VATS group had a shorter operative time (p = 0.016) and shorter ICU stay (p = 0.026). Conclusions: VATS treatment of DNM is safe and effective. The comparison with thoracotomy showed no significant differences in postoperative morbidity and mortality. The VATS approach is associated with a shorter operative time and ICU stay than thoracotomy.

Introduction: In chest wall reconstruction, the main objectives are the restoration of the chest wall integrity, function, and aesthetic, which is often achieved with the placement of implants. We aimed to evaluate whether 3D printed models can be useful for preoperative planning and surgical treatment in chest wall reconstruction to improve the outcome of the surgery and to reduce the rate of complications. Methods: We conducted a systematic review of literature using PubMed, Scopus, Embase, and Google Scholar databases until 8 November 2021 with the following keywords: (“3D printing” or “rapid prototyping” or “three-dimensional printing” or “bioprinting”) and (“chest wall” or “rib” or “sternum” or “ribcage” or “pectus excavatum”). Results were then manually screened by two independent authors to select studies relevant to 3D printing application in chest wall reconstruction. The primary outcome was morphological correction, and secondary outcomes were changes in operating time and procedure-related complication rate. Results: Eight articles were included in our review. Four studies were related to pectus excavatum correction, two studies were related to rib fracture stabilization, and two studies were related to chest wall tumor resection and reconstruction. Seven studies reported 3D printing of a thorax model or template implants for preoperative planning and implant modeling, and one study reported 3D printing of a PEEK prosthesis for direct implantation. Four studies reported comparison with a conventionally treated control group, and three of them detected a shorter operative time in the 3D printing model-assisted group. Satisfactory morphological correction was reported in all studies, and six studies reported a good implant fitting with minimal need for intraoperative adjustments. There were no major intraoperative or postoperative complications in any of the studies. Conclusions: The use of 3D printing models in chest wall reconstruction seems to be helpful for the production of personalized implants, reducing intraoperative adjustments. Results of morphological correction and postoperative recovery after the 3D printing-assisted surgery were satisfactory in all studies with a low rate of complication. Our literature review suggests good results regarding prosthesis fitting, accuracy of surgical planning, and reduction in operative time in 3D printing-assisted procedures, although more evidence is needed to prove this observation.

Introduction: Bronchial carcinoid (BC) tumors represent between 1% and 5% of all lung cancers and about 20–30% of carcinoid tumors; they are classified into two groups: typical and atypical bronchial carcinoids. The aim of the present study was to review the results of endoscopic treatments as an alternative to surgical treatment in selected patients. Materials and methods: The present study was a retrospective and multicentric study, in which all data were reviewed for patients with BC in the central airways, referred to the Thoracic Surgery Units of Luigi Vanvitelli University of Naples and Sant’Andrea Hospital in Rome between October 2012 and December 2022 Overall, 35 patients, 13 of whom were female, were included in the study (median age, 53 years; range, 29–75 years). All patients underwent rigid bronchoscopy combined with flexible bronchoscopy. Tumor clearance was mostly performed by use of Argon Plasma Coagulation or Thulep Laser, mechanical debridement and excision with the use of forceps and aspirator through the working channel of the 8.5 mm-sized rigid bronchoscope. There were no complications during the treatment. Results: Endobronchial treatment provided complete tumor eradication in all patients; two patients had controlled bleeding complications; however, bleeding was well controlled without patient desaturation, and only one patient died of renal failure during the follow-up period. We found two recurrences in the left and right main bronchus, in patients with atypical carcinoma during fiberoptic bronchoscopy follow-up. Only one patient died of renal failure. At the first analysis, there were no significant differences between the patients receiving endobronchial treatment and patients receiving surgical treatment in the present study (p-value > 0.05—it means statistically insignificant). Conclusions: Endobronchial treatment is a valid and effective alternative for patients with BC unsuitable for surgery.

Patients with advanced lung cancer are candidates for systemic therapies. In the context of improved tumor responses and prolonged survival periods, the treatment of tumor/therapy‐related complications must be taken into account. Rescue surgery consists of a surgical resection without oncologic purpose but with the aim of controlling an acute and life‐threatening complication. We evaluated the postoperative outcomes of patients with advanced stage lung cancer who underwent rescue surgery for tumor or therapy‐related life‐threatening complications. We conducted a systematic review of literature using PubMed, Scopus, Embase, and Google Scholar using following keywords: (“rescue surgery” or “salvage surgery” or “salvage lung resection”) and (“lung cancer” or “non‐small cell lung cancer” or “NSCLC” or “SCLC”). The primary outcome was overall survival. Secondary outcomes were the morbidity and mortality. Nine articles were included in our review for a total of 64 patients. The most common indications for rescue surgery were lung abscess, post‐obstructive pneumonia, hemoptysis, and empyema. The lung resection consisted of lobectomy (n = 31, 48%), bilobectomy (n = 5, 8%), pneumonectomy (n = 11, 17%), sleeve pneumonectomy (n = 15, 23%), sleeve lobectomy (n = 1, 2%), and segmentectomy (n = 1, 2%). The mean overall survival was 12 months; the postoperative complication rate was 51%. No intraoperative deaths were observed. Rescue surgery is feasible for patients with advanced lung cancer and tumor/therapy‐related life‐threatening complications. Rescue surgery may allow access to ulterior systemic therapies; but the risk–benefit imbalance should always be taken into account, considering this as a last resort treatment.

Introduction: The mediastinum is a complex anatomical region that contains vital structures such as the great vessels, heart, esophagus, and trachea. Mediastinal masses include a wide range of lesions, both malignant and benign. Our study aimed to evaluate whether the combination of intraoperative ultrasound (IUS) and VATS can allow obtaining an adequate, correct, and safer diagnosis in patients with a mediastinal mass, especially in severely ill patients affected by heart failure, renal failure, advanced oncological stage, and respiratory failure.Material and Method: This single‐center, retrospective, observational study included 298 consecutive patients with mediastinal mass, evaluated between March 2018 and December 2024 at the Thoracic Surgery Department of Vanvitelli University of Naples. All patients underwent biopsies of mediastinal masses via VATS with IUS. Mediastinal masses were classified based on their ultrasound characteristics, allowing precise identification of the site and solid part of the lesions for biopsy. No significant complications were reported.Results: A total of 298 patients underwent VATS for mediastinal mass biopsy. About 185 of these patients underwent biopsies via VATS with IUS. All were under general anesthesia with single‐lung ventilation. A specific diagnosis was obtained in all patients who underwent biopsies via VATS with IUS (185/185), with lymphoma being the most common entity (58.6%), followed by germ cell tumors (24.3%) and thymic carcinoma (12.4%). A significant difference in diagnostic accuracy, specificity, and sensibility was found between the group that used IUS versus the group in which no IUS was used (100%vs. 93%, 99.8% vs. 94%, 98.5% vs. 90.5% respect).Conclusion: IUS‐guided biopsy allows for correct, safe, and precise identification of mediastinal lesions, establishing IUS as the “Gold Standard” for procedure guidance when the target lesion is adequately visualized.