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Future Opportunities in Thoracic Surgery: The Cutting Edge
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Future Opportunities in Thoracic Surgery: The Cutting Edge

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "General Surgery".

Deadline for manuscript submissions: closed (25 August 2024) | Viewed by 3350

Special Issue Editor

Dr. Giulio Maurizi

E-Mail Website
Guest Editor
Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
Interests: thoracic surgery; thoracic oncology; lung cancer; sleeve resections; savage surgery
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Nowadays, lung cancer is still the leading cause of cancer-related deaths worldwide, and non-small cell lung cancer (NSCLC) accounts for nearly 85%. Surgery is considered the treatment of choice for early-stage lung cancer, whereas locally advanced cancers are considered for multi-modal treatments, including neoadjuvant and adjuvant therapy, beside surgery.

Mortality reduction for NSCLC over the past decade is partly attributed to enhanced treatments and

many ongoing clinical trials have reported encouraging outcomes based on new surgical and oncological aspects. In fact, limited resections as segmentectomies are considered the new standard for surgical treatment for early stage lung cancer up to 2 centimeters of diameters and immunotherapy has been introduced in the neoadjuvant multimodal treatment for advanced stage lung cancer.

In this fascinating era of important innovations, it would be interesting to debate about the novel surgical and oncological strategies. Dealing with surgery, it would be interesting to understand the indications for parenchymal sparing techniques compared to standard surgery, to achieve the same oncological results. Considering the wide spread of target- and immunotherapies, even the indication for surgery not also for curative intentions but even for diagnostic necessities in advanced stage lung cancer is under debate, in order to collect a wide portion of tissue for molecular profile.

Immunotherapy has improved curative effects, prognosis, and tolerability compared with traditional chemotherapy. It would be interesting analyzing the effect of novel pre- and post-surgical therapies and the impact of novel therapies on tissue during surgery.

Dr. Giulio Maurizi
Guest Editor

Manuscript Submission Information

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • surgical resection
  • immunotherapy
  • target therapy
  • thoracic surgery
  • thoracic oncology
  • lung cancer

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Related Special Issue

Published Papers (2 papers)

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13 pages, 1140 KiB  
Article
Early Hospital Discharge on Day Two Post-Robotic Lobectomy with Telehealth Home Monitoring
by Giuseppe Mangiameli, Edoardo Bottoni, Alberto Tagliabue, Veronica Maria Giudici, Alessandro Crepaldi, Alberto Testori, Emanuele Voulaz, Umberto Cariboni, Emanuela Re Cecconi, Matilde Luppichini, Marco Alloisio, Debora Brascia, Emanuela Morenghi and Giuseppe Marulli
J. Clin. Med. 2024, 13(20), 6268; https://doi.org/10.3390/jcm13206268 - 21 Oct 2024
Cited by 1 | Viewed by 1581
Abstract
Background: Despite the implementation of enhanced recovery programs, the reported average postoperative length of stay after robotic lobectomy remains as 4 days. In this prospective study, we present the outcomes of early discharge (on day 2) with telehealth home monitoring device after robotic [...] Read more.
Background: Despite the implementation of enhanced recovery programs, the reported average postoperative length of stay after robotic lobectomy remains as 4 days. In this prospective study, we present the outcomes of early discharge (on day 2) with telehealth home monitoring device after robotic lobectomy for lung cancer in selected patients. Methods: All patients with a caregiver were discharged on postoperative day 2 (POD 2) with a telemonitoring device provided they met the specific discharge criteria. Inclusion criteria: <75 years old, stage I-II NSCLC, with caregiver, ECOG 0–2, scheduled for lobectomy, logistic proximity to hospital (<60 km); intra-postoperative exclusion criteria: conversion to open surgery, early complications needing hospital monitoring or redo-operation, difficult pain management, <92 HbO2% saturation on room air or need for O2 supplementation, altered vital or laboratory parameters. Teleconsultations were scheduled as follows: the first one in afternoon of POD2, two on POD3, then once a day until chest tube removal. After discharge, patients recorded their vital signs at least four times a day using the device, which allowed two surgeons to monitor them via a mobile application. In the event of sudden changes in vital signs or the occurrence of adverse events, patients had access to a direct phone line and a dedicated re-hospitalization pathway. The primary outcome was safety, assessed by the occurrence of post-discharge complications or readmissions, as well as feasibility. Secondary outcomes: comparison of safety profile with a matched control group in which the standard of care and the evaluation of resource optimization were maintained and economic evaluation. Results: Between July 2022 and February 2024, 48 patients were enrolled in the present study. Six patients (12.5%) dropped out due to unsatisfied discharge criteria on POD2. Exclusion causes were: significant air leaks (n:2) requiring monitoring and the use of suction device, uncontrolled pain (n:2), atrial fibrillation, and occurrence of cerebral ischemia (n:1 each). The adherence rate to vital signs monitoring by patients was 100%. A mean number of four measurements per day was performed by each patient. During telehealth home monitoring, a total of 71/2163 (1.4%) vital sign measurements violated the established acceptable threshold in 22 (52%) patients. All critical violations were managed at home. During the surveillance period (defined as the time from POD 2 to the day of chest tube removal), a persistent air leak was recorded in one patient requiring readmission to the hospital (on POD 13) and re-intervention with placement of a second thoracic drainage due to unsatisfactory lung expansion. No other postoperative complication occurred nor was there any readmission needed. Compared to the control group, the discharge gain was 2.5 days, with an economic benefit of 528 €/day (55.440 € on the total enrolled population). Conclusions: Our results confirm that the adoption of telehealth home monitoring is feasible and allows a safe discharge on postoperative day two after robotic surgery for stage I-II NSCLC in selected patients. A potential economic benefit (141 days of hospitalizations avoided) for the healthcare system could result from the adoption of this protocol. Full article
(This article belongs to the Special Issue Future Opportunities in Thoracic Surgery: The Cutting Edge)
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13 pages, 568 KiB  
Systematic Review
Uniportal Laser-Assisted Video-Assisted Thoracoscopy (U-LA-VATS) for Lung Metastasectomy: Technical Description, Peri-Operative Results and Pertinent Literature Review
by Carolina Sassorossi, Marco Chiappetta, Dania Nachira, Annalisa Campanella, Gloria Santoro, Giuseppe Calabrese, Chiara Scognamiglio, Antonio Giulio Napolitano, Alessia Senatore, Leonardo Petracca Ciavarella, Maria Letizia Vita, Stefano Margaritora and Filippo Lococo
J. Clin. Med. 2024, 13(18), 5346; https://doi.org/10.3390/jcm13185346 - 10 Sep 2024
Cited by 1 | Viewed by 1261
Abstract
Pulmonary metastasectomy (PM) is a well-established treatment that is able to contribute to the cure of oligometastatic cancer. Surgery should adopt the most lung-sparing approach possible to preserve pulmonary function (and, consequently, the quality of life) and to spare the lung for potential [...] Read more.
Pulmonary metastasectomy (PM) is a well-established treatment that is able to contribute to the cure of oligometastatic cancer. Surgery should adopt the most lung-sparing approach possible to preserve pulmonary function (and, consequently, the quality of life) and to spare the lung for potential additional lung resections. In this framework, laser technology has been introduced in recent decades, but only few experiences combining laser technology with VATS approaches have been reported till now. The main focus of this manuscript is to report our institutional experience in performing lung-sparing laser-assisted PM by uniportal VATS (uniportal laser-assisted VATS: U-LA-VATS). The surgical technique and peri-operative results from our series of patients were herein presented and compared with the pertinent literature. Methods: Between March 2021 and November 2023, among 98 patients who underwent PM, a total of 24 patients (18 men (75%); 6 women (25%); mean age 61.4 years; age range 13–83 years) were treated with laser-assisted PM at our institution. Patients who underwent anatomical resection were excluded for the purpose of the analysis. The U-LA-VATS procedure adopted a modified laser-assisted lung resection technique for performing PM via VATS. Dedicated instruments are used, characterized by a long shape and a curved shape, with distal and proximal articulations. A surgical laser system (Thulium + Diodo OUTPUT 30–10 W, Quanta System S.p.a., Solbiate Olona, Italy) was used, and a 550-μm sterile optical fibre conducted through a specific thoracoscopic handpiece was introduced in the lowest part of the incision. Peri-operative results were analysed in all cohort and compared according to the surgical technique. Moreover, these results were compared with those reported in the literature. Comprehensive research of the literature was conducted on PubMed from 2000 to 2024. A review was performed and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results: In 12 cases (50%), thulium laser-assisted resection was performed using uniportal video-assisted thoracic surgery (VATS), and in the other cases (12, 50%), a (mini)thoracotomy access was adopted. In the thoracotomy group, the mean duration of surgery was 95 ± 57.7 min; meanwhile, it was 73.5 ± 35.5 in the uniportal VATS group. At the univariate analysis, this difference resulted to be statistically significant (p value 0.025). We did not observe intra-operative complications or remarkable malfunction of the laser system. We also did not report major complications after surgery; also the air-leak rate was 8.3% and 0% after thoracotomic and VATS procedures, respectively. Surgical margins were free from disease in all cases. Major and minor post-op complication rates were similar in both groups. The mean hospitalization after surgery was 2.9 ± 0.3 days for the uniportal VATS group and 3.7 ± 0.9 days for the thoracotomy group, this difference being statistically significant at the univariate analysis (p value = 0.015). Conclusions: U-LA-VATS is a safe and effective procedure, able to combine a parenchymal sparing exeresis with a mini-invasive approach. This procedure is associated with a shorter hospital stay compared with PM performed by a thoracotomic approach. Compared with the selected works for the review, our series is the only one describing the use of laser resection combined with a uniportal VATS approach. Full article
(This article belongs to the Special Issue Future Opportunities in Thoracic Surgery: The Cutting Edge)
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