Background: We hypothesized that video-assisted thoracic surgery (VATS) lung metastasectomy under non-intubated anesthesia may have a lesser immunological and inflammatory impact than the same procedure under general anesthesia. Methods: Between December 2005 and October 2015, 55 patients with pulmonary oligometastases (at the first episode) successfully underwent VATS metastasectomy under non-intubated anesthesia. Lymphocytes subpopulation and interleukins 6 and 10 were measured at different intervals and matched with a control group composed of 13 patients with similar clinical features who refused non-intubated surgery. Results: The non-intubated group demonstrated a lesser reduction of natural killer lymphocytes at 7 days from the procedure (p = 0.04) compared to control. Furthermore, the group revealed a lesser spillage of interleukin 6 after 1 (p = 0.03), 7 (p = 0.04), and 14 (p = 0.05) days. There was no mortality in any groups. Major morbidity rate was significantly higher in the general anesthesia group 3 (5%) vs. 3 (23%) (p = 0.04). The median hospital stay was 3.0 vs. 3.7 (p = 0.033) days, the estimated costs with the non-intubated procedure was significantly lower, even excluding the hospital stay. Conclusions: VATS lung metastasectomy in non-intubated anesthesia had significantly lesser impact on both immunological and inflammatory response compared to traditional procedure in intubated general anesthesia.

Intraoperative nerve monitoring (IONM) aimed at reducing the injuries of recurrent laryngeal nerve during thyroidectomy is controversial. We conducted a meta-analysis to assess the incidence of nerve injuries with or without IONM. Studies published from January 1994 to February 2012 in English language on humans were identified. Heterogeneity of studies was checked by the Higgins test. Summary estimates of predictive values of injury were made using the Mantel-Haenszel test based on the fixed-effects model. Publication bias was assessed by a funnel plot and Egger's method. Eight articles were selected accounting a total of 5257 nerves at risk. IONM revealed a significant impact in preventing transient injuries (positive predictive value = 5% [95% CI: 2-8], negative = 96% [95% CI: 91-100], relative risk = 0.73 [95% CI: 0.54-0.98], p = 0.035), whereas they failed to demonstrate effect on permanent injuries (positive predictive value = 2% [95% CI: 0.6-3.8], negative 99% [95% CI: 97-100], relative risk = 0.73 [95% CI: 0.44-1.23], p = 0.235). This meta-analysis demonstrated the merit of IONM in preventing transient injury during thyroidectomy. No advantage was found in permanent injuries.

We reviewed our 10-year experience in skin metastases from lung cancer. We identified a total of 26 patients with 49 resected skin metastases. Skin metastases were synchronous in 6 patients, 3 of whom underwent primary simultaneous resection, and solitary in 6 (6/26=23.07%). Negative prognostic factors were primary non-resectability (p=0.001), small cell lung cancer (p=0.032), simultaneous discovery of other cutaneous (p=0.048) or extracutaneous (p=0.0005, Wald test p<0.002, Odds ratio =14.37) metastases. Skin metastasis represented the unique distant localization in almost one quarter of our cases that represent the best-survivor category: in these patients skin metastasectomy is justified.

BACKGROUND: Despite radical surgical resection, thymomas often recur. The objective of the current retrospective study was to investigate the prognostic relevance of the expression of cell‐cycle proteins in these neoplasms to formulate a possible therapeutic surveillance strategy for the prevention of recurrence.METHODS: The authors retrospectively reviewed the main clinicopathologic factors, including the World Health Organization (WHO) classification, of patients with thymoma who had undergone radical surgical resection. Specimens were studied using immunohistochemistry and the expression of cell‐cycle proteins (i.e., p21, p27, and p53) was assessed. Univariate and multivariate analysis of predicting survival prognostic factors were performed.RESULTS: The authors analyzed 88 patients with thymoma who underwent radical surgical resection at the study institution. According to the Masaoka staging system, 41 patients had Stage I disease, 31 patients had Stage II disease, and 16 patients had Stage III disease. There were 24 tumor recurrences (27.3%), 4 of which were local, 16 of which were distant intrathoracic, and 4 of which were extrathoracic. The second radical resection provided a disease‐free survival rate that was similar to the first. Only Masaoka stage (P = 0.001), WHO classification (P=0.001), high expression of p53 (P=0.03), and low expression of p21 (P=0.02) and p27 (P=0.001) were found to be correlated with a reduced disease‐free survival. Low p27 expression was found to be the most significant predictive factor of a short disease‐free survival (P=0.001), especially when associated with low p21 expression and high p53 expression (P=0.0001).CONCLUSIONS: Long‐term disease‐free survival in thymoma patients treated with radical surgical resection was found to be correlated with Masaoka stage, WHO classification, and expression of cell‐cycle proteins, with the latter found to be the most significant predictive factor. Functional cooperation between cell‐cycle proteins might constitute another level of regulation in tumor growth. More careful surveillance should be adopted whenever there is negative cell‐cycle protein expression. Cancer 2005. © 2005 American Cancer Society.