Napolitano AG, et al. Ann Surg Treat Res. 2023 Aug;105(2):76-81. https://doi.org/10.4174/astr.2023.105.2.76

Background: Oesophageal perforation (OP) is a life-threatening condition requiring prompt diagnosis and treatment. Mortality is influenced by several factors, such as aetiology, defect location, comorbidities, age, and delays in treatment. This study reviews patients with OP undergoing surgery, analysing mortality risks and the impact of timing on surgical outcomes. Methods: Medical records of 45 patients surgically treated for OP across three tertiary centers were analysed. Results: Of the 45 patients, 31 were male (68.88%) and 14 were female (31.11%), with a mean age of 66.00 ± 17.75 years. Pre-operative CT was performed in all patients, and 18 (40%) underwent oesophagogastroduodenoscopy. As many as 25 patients (55.55%) presented within 24 h, 10 (22.22%) within 24–72 h, and 10 (22.22%) after 72 h. Symptoms included pain, vomiting, fever, dysphagia, and subcutaneous emphysema. Foreign body ingestion and Boerhaave’s syndrome were the leading causes (33.33% each), followed by caustic ingestion (17.77%) and iatrogenic and traumatic cases. Treatments included primary repair, debridement, oesophagectomy, and oesophagogastrectomy. Primary repair was performed in 22 cases (48.88%), and muscle flaps reinforced 11 of these. Direct repair showed the highest success rate when performed within 24 h. Thirty patients (66.66%) experienced complications, including respiratory failure, oesophagopleural fistula, and sub-stenosis. The hospital stay average was 36.34 ± 35.03 days. Nine patients underwent same-session/two-stage gastroplasty or retrosternal coloplasty for reconstruction, with complications including stenosis and leaks. Six patients (13.33%) died within the first 24 h after surgery, primarily due to severe comorbidities (three (50%) were octogenarians). Conclusions: OP is a life-threatening condition with high mortality. Primary repair is the preferred treatment. Oesophagectomy and gastrectomy are reserved for extensive lesions. Muscle flaps can reinforce sutures in cervical and thoracic perforations. Mortality is mainly influenced by the severity of the patient’s clinical picture and comorbidities, rather than by time and type of treatment.

Schwannoma is a benign tumour originating from the Schwann cells. Patients can remain asymptomatic, as the onset of symptoms usually depends on the compressive effect on adjacent organs; dimensional and morphological variability increase the time for the diagnosis. We report the case of a successful surgical resection, performed by video-assisted thoracoscopic surgery, on a patient with radiological evidence of a massive cystic intrathoracic neoformation, histologically revealed to be a peculiar Schwannoma.

Pulmonary sequestration is a rare congenital pulmonary anomaly where a portion of the lung parenchyma is supplied by an anomalous systemic artery, usually originating from the thoracic or abdominal aorta. Traditionally surgical resection and ligation of the aberrant feeding vessel are the gold standard treatments of this disease. Hybrid operations consisting in endovascular arterial embolization and surgical resection is a promising treatment option. We report a case of a 69-years-old man with symptomatic intralobular sequestration successfully treated by hybrid approach.

Background: Spread through air spaces (STAS) consists of micropapillary clusters, solid nests, and/or single neoplastic cells into the air spaces of the lung parenchyma beyond the edge of the primary tumor. To date, its prognostic role in patients with lung adenocarcinoma is crucial, resulting in an independent negative factor for both overall survival (OS) and disease-free survival (DFS). The study aims to assess the prognostic impact of STAS in patients with lung adenocarcinoma undergoing curative resection. Methods: A retrospective, observational single-center study enrolling consecutive patients who underwent lung resections for adenocarcinoma from January 2018 to December 2023 was performed. OS and DFS were analyzed. Univariable and multivariable Cox proportional hazard models, along with the inverse probability of treatment weight–adjusted Kaplan–Meier curves, were used to evaluate the prognostic impact of STAS. A logistic regression model was used to estimate the odds ratios and 95%-confidence intervals for clinical variables associated with the STAS status. Results: In total, 329 patients were enrolled, and two different groups were defined (STAS-present: 30; STAS-absent: 299). No statistically significant differences were observed in OS and DFS when comparing patients according to their STAS status. Conversely, STAS-present patients were more frequently associated with pN2-nodal involvement (22.7% vs. 77.3%, p = 0.022), stage IIIA disease (p = 0.003), and the presence of an adenocarcinoma-predominant micropapillary-pattern (p < 0.001). Female patients were associated with better outcomes than male patients in survival analysis, while stage IIIA disease and micropapillary-pattern emerged as statistically significant after the logistic regression. Conclusions: Our study provides relevant information on the relationship between STAS and clinicopathological characteristics, demonstrating its potential aggressive histological feature, due to the significant correlation with stage IIIA disease, and the adenocarcinoma micropapillary pattern. Therefore, STAS may identify a subgroup of patients in whom the prognostic implications should be further investigated.

Background: Primary and secondary tumors of the abdominal lower third of the bony thorax are relatively rare. Therefore, indications and techniques for chest wall reconstructions in this area are not well defined. Methods: The techniques for reconstructing basal chest wall defects using the diaphragm are described. Indications for phrenoplasty are limited to reconstruction after full-thickness resection of at least two of the last four ribs in the midaxillary line. The diaphragm can be used for reconstructive purposes both if it is intact and if it is partially involved in the resection of the chest wall. Results: At our institution, the abovementioned reconstructive technique was successfully performed in five patients with an uneventful post-operative course. Conclusions: The main advantages of these methods are the use of promptly available, high-quality autologous tissue and the exclusion of the pleural space from the defect area, thus transforming a thoracic defect into an abdominal one. The disadvantage is a variable reduction in the volume of the hemithorax. These techniques could be compared with other reconstruction techniques using pre-/post-operative respiratory functional tests.