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Thoracic Surgery Between Tradition and Innovations

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

Deadline for manuscript submissions: 30 November 2025 | Viewed by 298

Special Issue Editor


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Guest Editor
Thoracic Surgery Unit, Department of Medicine and Surgery, University of Perugia Medical School, Perugia, Italy
Interests: lung cancer; pleural disease; chest wall resection and reconstruction; VATS; robotic surgery

Special Issue Information

Dear Colleagues,

The recent progress in thoracic oncology and medical applied technology has given many opportunities to develop new strategies in surgical oncology for lung cancer, pleural tumors and chest wall neoplasms. Besides, the new achievements in immunotherapy and targeted therapy have led to important changes in the multimodal treatments. Regarding the early diagnosis, screening programs for lung cancer proved to have a role. All these tangible and epocal changes have pushed the evolution of thoracic surgery into the modern era. Minimally invasive sugery is now the leading approach and sublobar resections for lung primaries have an increased indication since the screening programs usually give the surgeons early-stage tumors. However some traditional solid principles still remain pivotal for the final clinical success. In this issue, the importance of innovations and the solidity of basic values concerning the surgical planning and attention to technical details pretend to be stressed in order to address a balanced perpective for the future advancement of thoracic surgery.

Dr. Jacopo Vannucci
Guest Editor

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Keywords

  • thoracic surgery
  • lung cancer
  • pulmonary resections
  • pleural disease
  • perioperative medicine
  • mesothelioma
  • lung transplantation
  • chest wall resection and reconstruction
  • esophageal cancer
  • thoracic trauma
  • emergency
  • pulmonary metastasectomy

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Published Papers (1 paper)

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Research

17 pages, 7286 KiB  
Article
Oesophageal Perforation Surgical Treatment: What Affects the Outcome? A Multicenter Experience
by Antonio Giulio Napolitano, Dania Nachira, Leonardo Petracca Ciavarella, Eleonora Coviello, Domenico Pourmolkara, Rita Vaz Sousa, Elisa Meacci, Tiziano De Giacomo, Federico Venuta, Venanzio Porziella, Stefano Margaritora, Francesco Puma and Jacopo Vannucci
J. Clin. Med. 2025, 14(12), 4019; https://doi.org/10.3390/jcm14124019 - 6 Jun 2025
Viewed by 202
Abstract
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 [...] Read more.
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. Full article
(This article belongs to the Special Issue Thoracic Surgery Between Tradition and Innovations)
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