It is not clear as to which is the best treatment among surgery and stereotactic radiotherapy (SBRT) for lung oligometastases. A systematic review of literature with a priori selection criteria was... Lay abstract Patients with metastatic cancer with a limited number of deposits may benefit from surgical removal or irradiation of tumor nodules in addiction to chemotherapy. Surgical resection has...

Pulmonary sequestrations are rare congenital malformations. They are often located in the lower lobes, and they are supplied by an aberrant systemic vessel arising from the thoracic aorta or abdominal arteries. These pulmonary malformations are divided into intra- and extralobar sequestrations, depending on the respective lack or presence of an independent pleural covering. Pulmonary sequestration can be asymptomatic or lead to recurrent pulmonary infections. The goal of this study was to analyse the feasibility and safety of a hybrid sequential approach. We report a small series of intralobar pulmonary sequestrations, from November 2017 to December 2018, successfully treated with a hybrid minimally invasive approach consisting of endovascular embolization of the aberrant arterial branch followed by video-assisted thoracoscopic lobectomy the day after. Thoracic pain following endovascular embolization was noted in all cases. Patients were discharged early in the absence of major postoperative complications. Prolonged air leak was observed in only 1 case. Despite the presence of sequestration-related pulmonary inflammation, in our experience, hybrid treatment for intralobar pulmonary sequestration is a safe and reproducible approach in terms of postoperative complications and hospital stay.

The aim of this study was to assess the prognostic value of preoperative neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) levels in patients undergoing resection of pulmonary oligometastases. A retrospective analysis on 141 patients undergoing a first pulmonary metastasectomy in a single center was carried out. Two distinct analysis were performed subdividing patients according to their NLR ratio and CRP level. The main outcomes were survival and time to recurrence. At completion of follow-up 74 patients were still alive (52.5%). Subdividing patients according to their NLR yielded a significant difference in five-year progression-free survival (PFS, NLR < 4:32% vs. NLR ≥ 4:18%, p = 0.01). When subdivided by their CRP levels, patients with preoperative CRP < 5 mg/L demonstrated higher values of five-year overall survival (OS, 57% vs. 34%, p = 0.006) and five-year PFS (35% vs. 22%, p = 0.04). At multivariate analysis, level of neutrophils (p = 0.009) and lung comorbidities (p = 0.021) were independent predictors of death, whereas preoperative CRP (p = 0.002), multiple metastases (p = 0.003) and presence of lung comorbidities (p = 0.001) were independent predictors of recurrence. NLR and CRP are important predictors of prognostic outcome in patients undergoing pulmonary metastasectomy.

Obesity correlates with better outcomes in many neoplastic conditions. The aim of this study was to assess its role in the prognosis and morbidity of patients submitted to resection of lung oligometastases from colorectal cancer. Seventy-six patients undergoing a first pulmonary metastasectomy were retrospectively included in the study. Seventeen (22.3%) were obese (body mass index (BMI) >30 kg/m²). Assessed outcomes were overall survival, time to recurrence, and incidence of post-operative complications. Median follow-up was 33 months (IQR 16–53). At follow-up, 37 patients (48.6%) died, whereas 39 (51.4%) were alive. A significant difference was found in the 3-year overall survival (obese 80% vs. non-obese 56.8%, p = 0.035). Competing risk analysis shows that the cumulative incidence of recurrence was not different between the two groups. Multivariate analysis reveals that the number of metastases (p = 0.028), post-operative pneumonia (p = 0.042), and DFS (p = 0.007) were significant predictors of death. Competing risk regression shows that no independent risk factor for recurrence has been identified. The complication rate was not different between the two groups (17.6% vs. 13.6%, p = 0.70). Obesity is a positive prognostic factor for survival after pulmonary metastasectomy for colorectal cancer. Overweight patients do not experience more post-operative complications. Our results need to be confirmed by large multicenter studies.

Background: The proportion of octogenarian patients who undergo surgery for lung cancer is growing over recent years. Elderly patients are characterized by age-related changes, such as inflammatory modifications of the lower respiratory tract, responsible for structural and functional alterations and tumor progression. Inflammatory markers (IMs) are a well-known prognostic factor in several tumor types, but they have not been analyzed extensively in octogenarian patients submitted to thoracoscopic lobectomy for early-stage lung cancer. The aim of our study is to assess the impact of the pre-operative IMs on the overall survival (OS), disease-free survival (DFS), and post-operative complications of this subset of patients. Methods: We conducted a retrospective and multi-institutional study. All octogenarian patients submitted to thoracoscopic lobectomy for early-stage lung cancer from January 2013 to April 2019 were enrolled. Pre-operative cellular IMs were measured in peripheral blood samples and their cut-off values were set according to previous findings in literature. Cox regression model was used to analyze the relationship between IMs, and OS and DFS. Kaplan-Meier method was used to calculate the OS and DFS rates. The follow-up period was 36 months. All P values lower than 0.05 were considered statistically significant. Results: A total of 118 patients were included. At multivariate analysis adjusted by sex, age, and chronic obstructive pulmonary disease (COPD), neutrophils-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) were strongly associated with higher risk of mortality [hazard ratio (HR) 2.89, 95% confidence interval (CI): 1.05–8.02, P=0.04, HR 2.74, 95% CI: 1.15–6.52, P=0.02, respectively]. NLR >2.5 and CRP >3 were associated with worse survival (respectively P=0.02 and P=0.02). Higher levels of monocyte-to-lymphocyte ratio (MLR) were still associated with a higher mortality rate, although more weakly (P=0.056). Conclusions: Elevated pre-operative NLR and CRP can be considered as a prognostic indicator in patients with non-small cell lung cancer (NSCLC) undergoing surgery with minimally invasive approach. Post-operative course and DFS is not influenced by pre-operative IMs levels.

Background/Objectives: Several studies previously investigated the risk factors for post-operative recurrence of primary spontaneous pneumothorax (PSP), with conflicting results. Identification of patients at greater risk of recurrence may help optimize therapeutic strategies. The aim of this study is to identify potential predictors of post-operative recurrence of PSP and compare our results with the available literature. Methods: We retrospectively evaluated all patients who underwent surgery for PSP at our institution between January 2005 and December 2022. We analyzed data on patient characteristics, surgical details, method of pleurodesis and perioperative outcomes and used Cox regression analysis to identify predictors post-operative ipsilateral recurrence. Results: 226 patients were included in our study, of which 29 (12.8%) developed an ipsilateral recurrence of pneumothorax. A positive history of previous contralateral episodes (37.9% vs. 19.3%, p = 0.03) and the positioning of larger chest drains after the procedure (65.5% vs. 44.8%, p = 0.032) were more frequent in the recurrence group. At multivariable regression analysis, a history of previous contralateral pneumothorax was found to be the only independent predictive factor of pneumothorax recurrence (HR 2.16, 95% C.I. 1.001–4.662, p = 0.049). Conclusions: Previous contralateral pneumothorax is a risk factor for the development of post-operative recurrences.