Marco Schiavon

Purpose: Ground‐glass opacities (GGOs) are increasingly detected due to widespread low‐dose CT screening for lung cancer. Among them, malignant GGOs (mGGOs) are a clinical challenge. This study aimed to compare the radiological and anatomopathological characteristics of pure and semi‐solid mGGOs and to identify radiological predictive factors for consolidation. Methods: A retrospective study was conducted on patients resected due to mGGOs between 2016 and 2023. Patients were classified based on whether initially pure mGGOs remained pure or developed a solid component before surgery. Radiological, pathological, and molecular characteristics were analyzed. Results: Of 135 patients, 61 (46%) mGGOs became partially solid during surveillance. Semi‐solid mGGOs had a higher acinar component ( p = 0.038) and larger pathological diameter (20 vs. 18 mm, p = 0.047), while pure mGGOs had a higher lepidic percentage (20% vs. 10%, p = 0.026). STAS and LVI were observed in 25% and 15% of cases. Logistic regression showed pleural contact was protective against consolidation ( p = 0.033), while arterial vascularization was predictive of consolidation ( p = 0.028). Five‐year survival was comparable and satisfactory for both groups (81.7% for pures and 85.5% for semi‐solids). Overall, LVI but no STAS was cause of a lower survival expectancy in the entire sample, regardless of consolidation ( p = 0.004). Conclusions: Both pure and semi‐solid mGGOs showed precocious pathological and molecular features. Surgical intervention with curative intent, even in pure GGOs, is accompanied by long expected survivals. Vascular features on imaging may help inform surgical decision‐making, whereas pathological LVI may have prognostic significance in patients with mGGOs.

Background: In patients with non-small cell lung cancer (NSCLC) treated with neoadjuvant chemo-immunotherapy, pulmonary resection can be technically demanding because of hilar/mediastinal inflammation and fibrosis, potentially limiting the use of minimally invasive surgery (MIS). We report our single-center experience with MIS anatomical lung resections after neoadjuvant chemo-immunotherapy. Methods: We retrospectively collected consecutive NSCLC patients who underwent neoadjuvant chemo-immunotherapy followed by anatomical lung resection with an intended MIS approach at our institution between May 2018 and October 2025. Primary endpoints were feasibility and safety (conversion rate, intraoperative and postoperative complications, need for reoperation, and 30-day mortality). Results: Fifty-two patients were included. Mean age was 65.9 ± 8.6 years; 27 (51.9%) were male. Median Charlson Comorbidity Index was 3 (IQR 2–4). Most patients had clinical stage III disease (IIIA 40.4%, IIIB 30.8%). Conversion to open surgery occurred in 7 cases (13.5%). One intraoperative complication was recorded (1.9%). Anatomical resections were predominantly lobectomies (including combined/extended lobectomies) (88.4%); sleeve resections accounted for 11.5%, and bilobectomy for 7.7%. Postoperative complications occurred in 13 patients (25.0%); reoperation for complications was required in 1 case (1.9%). No deaths were recorded in the dataset. Pathological response showed pCR in 22 patients (42.3%) and MPR in 10 (19.2%). Conclusions: In our experience, minimally invasive anatomical lung resection after neoadjuvant chemo-immunotherapy for NSCLC is feasible, with an acceptable conversion rate and manageable morbidity, and is associated with a substantial rate of pathological response. Careful patient selection and surgical expertise remain essential.

Background and Objectives: The use of controlled donation after circulatory death (cDCD) donors has significantly increased during the past decades and successfully expanded the donors’ pool. However, warm ischemia may have detrimental effects on graft function. Italian Law requires a no-touch period of at least 20 min, which is much longer compared to the 5 min accepted in most European countries. Materials and Methods This is an Italian single-centre retrospective review of all cDCD procedures performed from April 2021 to June 2025. Patients with severe brain injury undergoing withdrawal of life-sustaining therapy (WLST) were considered for cDCD. After cardiac arrest and a no-touch period of 20 min, organ reperfusion was performed using abdominal or thoraco-abdominal normothermic regional perfusion (NRP) through femoral vessels cannulation. The primary endpoint was 30-day graft survival; secondary endpoints included: incidence of primary non-function (PNF) and non-anastomotic biliary stricture (NAS) in liver transplantation, PNF and delayed graft function (DGF) in kidney transplantation, primary graft dysfunction (PGD) in heart and lung transplantation, and recipient’s survival. Results: A total of 52 patients, 33 (63%) males, median age 74 (65–79) years, underwent WLST during the study period and were included in the cDCD program. Median functional warm ischemic time (WIT), total WIT, asystolic phase, and NRP duration were 37 (34–40), 40 (37–42), 24 (23–26), and 192 (166–212) min, respectively. A total of 123 organs (46 livers, 61 kidneys, 8 hearts, and 8 lungs) were considered suitable for transplantation, procured, and successfully transplanted in 115 recipients. We report the early and mid-term outcomes of 84 recipients, including 41 liver recipients, 32 kidney recipients, and 8 heart recipients transplanted at the Azienda Ospedaliera Universitaria Integrata of Verona, and 3 lung recipients transplanted at the Azienda Ospedale Università of Padova. The 30-day graft survival was 95% in liver recipients, 97% in kidney recipients, and 100% in heart and lung recipients. PNF was observed in two liver recipients, and PGD in two lung recipients. DGF was recorded in 3 (9%) kidney recipients. Six recipients died during the follow-up, and the mean survival time was 3.9 ± 0.1 years. Conclusions: Solid organ transplantation using cDCD donors is feasible and provides excellent early and mid-term results despite longer donor asystolic times. Larger data and longer follow-up are necessary to confirm these promising results.

Background: Non‐small cell lung cancer (NSCLC) patients undergoing neoadjuvant chemotherapy (NACT) followed by surgery represent an ideal clinical setting to identify prognostic factors. To date, major pathological response (MPR) and complete pathological response (pCR) have been used as surrogates of NACT response and clinical outcome. The aim of the study was to investigate the role of additional clinico‐pathological features, taking advantage of morphometry and artificial intelligence (AI). Methods: Seventy stage III NSCLC patients undergoing surgery after NACT were studied. A granular evaluation of histological parameters with morphometrical quantification of the stromal components (fibrosis/inflammation) in addition to the tumour bed analysis (2020 IASLC statement) was carried out in all cases. An AI algorithm of the different immunophenotypes was also applied on immunohistochemistry‐stained whole‐slide images. A ClinPATH combined score including MPR, baseline blood lymphocytes, perineural invasion, vascular invasion, proliferative index, fibrosis extension percentage and AI‐quantified CD4+ cell % was tested. Results: MPR and pCR were related to disease‐free survival (DFS) and overall survival (OS) but also vascular/perineural/pleural invasion and Ki‐67 were useful in stratifying the study population. Concerning the tumour bed stromal components, only morphometrical quantification highlighted the prognostic role of fibrosis and inflammation, particularly when distinguishing CD4+ and FOXP3+ cells, mainly in adenocarcinomas. Interestingly, the combination of the most impactful clinico‐pathological parameters in a ClinPATH combined score correlated better with DFS and OS than any individual parameter, including MPR or pCR. Conclusion: AI‐based method can be used to accurately decipher the complexity of tumour bed stromal components, providing extra information for outcome prediction. The combination of different clinico‐pathological features could be highly valuable in guiding therapeutic decisions and ultimately improve patient outcomes.

Background: Ex vivo lung perfusion (EVLP) is a technique for graft preservation, evaluation and treatment, that could expand donor pool for transplantation. Nevertheless, the wide spectrum of available platforms has generated disparities in use, outcome, and costs. This study is an attempt to create a national consensus on EVLP use by a group of experts from the Italian Society of Organ Transplantation.Methods: The 9-member promoting committee was divided into 3 groups to propose statements. Using the DELPHI method 27 experts (three from each of the 9 lung transplant centres) voted agreement to each statement in 3 rounds. The cutoff for acceptance was set at 80% agreement.Results: In the first vote, 52 statements were proposed, and an agreement was reached for 20 of them (38%). After revision, the second round resulted in a quorum for 36 out of 40 statements proposed (90%). At the third vote, agreement was confirmed for 36 statements (8 indications for use, 19 modalities for use, 13 evaluation parameters).Conclusion: The statements outlined in this document do not represent absolute guidelines, but rather recommendations. The statements selected and presented are therefore aimed to assist Italian clinicians in the use of an ex vivo normothermic perfusion platform in the right context.

Malignant Triton Tumors (MTTs) are rare, high-grade malignant peripheral nerve sheath tumors (MPNSTs) frequently associated with Type 1 Neurofibromatosis (NF1). NF1, an autosomal dominant disorder, predisposes approximately 10% of affected individuals to developing MPNSTs, with 50% of these tumors occurring in NF1 patients, while others arise sporadically or in association with radiation exposure. MTTs predominantly affect anatomical regions rich in large nerves, such as the limbs, spinal root, and cranial nerves. Mediastinal presentations are exceedingly rare, posing significant diagnostic and therapeutic challenges. Current treatment strategies include surgical resection, chemotherapy, radiotherapy, and lung-sparing procedures for metastatic disease. Molecular studies of MPNSTs have revealed that NF1 mutations lead to dysregulation of the RAS signalling pathway, while epigenetic alterations (e.g., SUZ12/EED mutations) further contribute to tumor progression. Dysregulated phylogenetically conserved pathways, including Wnt/beta-catenin and non-canonical SHH signalling, play a role in sarcoma progression and Schwann cell transformation. Recent advances in miRNA research highlight their involvement in tumor invasion and progression, with dysregulated miRNA expression and chromatin remodeling contributing to the pathogenesis of these neoplasms. However, the distinct molecular profiles for MTTs remain incompletely understood. Further investigation of the genetic and epigenetic landscape is essential for improving our understanding and identifying potential therapies. Herein, we present a single-center retrospective case series of three patients with an intrathoracic triton tumor treated at our University Hospital between 2000 and 2024, serving as a starting point for future insights into MPNST pathobiology.

Background: Pancoast tumors are a rare subset of lung cancers that require a multimodal approach (induction chemoradiotherapy and surgery), best performed in highly specialized centers. This study analyzes the outcomes and prognostic factors in patients treated at a high-volume center over an extended period. Methods: We retrospectively reviewed 43 patients who underwent surgery for Pancoast tumors, following induction treatment between 2005 and 2023. Survival was estimated using the Kaplan–Meier method, and a Cox proportional hazards model was applied to identify prognostic factors (significance level p = 0.05). Results: The median patient age was 63 years, with over 90% having a disease at stage III or higher. Induction chemoradiotherapy was administered to 79% of the patients, achieving a pathological complete response (PCR) in 23% of the patients. The median overall survival (OS) was 37 months, with 1–3 and 5-year OS rates of 71%, 52%, and 41%, respectively. The median disease-free survival (DFS) was 38 months, with 1-, 3-, and 5-year DFS rates of 72%, 62%, and 35%, respectively. A pathological complete response (PCR) and vertebral and/or vascular infiltration significantly influenced recurrence and mortality risk. Conclusions: Trimodal therapy still offers the best short- and long-term outcomes in patients with Pancoast tumors. Future strategies incorporating tyrosine kinase inhibitors and anti-PD1/PD-L1 may improve outcomes for patients by increasing PCR rates and improving disease control.

Background: Evidence supporting robotic thymectomy for myasthenia gravis is generally based on small sample‐size studies, heterogeneous in patient selection and in reporting outcomes. Therefore, this study was conducted to assess the surgical and neurological outcomes of robotic thymectomy in myasthenic patients and to identify prognostic factors associated with symptoms' remission through a large cohort of patients operated in a 20 years' period.Methods: A retrospective analysis of a prospectively maintained database was conducted for all patients undergoing robotic thymectomy for myasthenia gravis between 2002 and 2022. Myasthenia Gravis Foundation of America (MGFA) recommendations were used to report the neurological outcomes. Complete remission and overall improvement were evaluated using Cumulative Incidence Functions, while the effect of preoperative variables on the probability of remission was estimated with Cox models.Results: In total, 267 patients underwent robotic thymectomy. Median operative time was 135 min and there were 7 (2.6%) open conversions. Clinical follow‐up (median 83 months) showed a 5‐year probability of complete remission of 18% and of overall improvement of 84%. Complete remission was negatively associated with age (HR 0.97, 95% CI 0.95–0.99, p = 0.001) and preoperative use of pyridostigmine (HR 0.34, 95% CI 0.15–0.81, p = 0.014), while severe MGFA class did not reach significance (HR 0.55, 95% CI 0.3–1.01, p = 0.052). Instead, there was a benefit in patients operated on in later years (HR 1.11, 95% CI 1.04–1.18, p = 0.01).Comment: Robotic thymectomy is a safe procedure. Long‐term neurological follow‐up demonstrated an improvement in most patients, also in subgroups that historically showed worse outcomes.

Background: The tumour inflammatory microenvironment (TIME) reflects a selective activation of the central immune system (IS), particularly T-cells expansion, which leads to immune cells migrating to the target, such as lung cancer, via the bloodstream and lymphatic vessels. In this study, the aim is to investigate whether the distribution of peripheral blood cells varies based on the immune status of patients with lung adenocarcinoma. Methods: This is a single-center retrospective study conducted in the Thoracic Surgery Unit of the University of Padua (Italy) between 1 January 2016 and 1 April 2024. It included patients (>18 years old) with lung adenocarcinoma deemed resectable (cT2bN0M0 or lower) who experienced pathological upstaging (IIB or higher). Patients were classified as TIME-active (with tumour-infiltrating lymphocytes—TILs and/or PD-L1 expression) or TIME-silent (without TILs or PD-L1). According to the TIME status, peripheral blood cell counts with clinical and pathological data were compared between groups using the Fisher’s, Pearson’s or Wilcoxon’s test when appropriate. A Kaplan–Meier estimator investigated overall survival (OS) and recurrence-free survival (RFS) adopting the log-rank test. Results: Preoperatively, the TIME-a group demonstrated a significantly higher lymphocyte count (p = 0.02) and a lower absolute neutrophil rate (p = 0.01) than TIME-s. These differences persisted after resection (p = 0.06 and p = 0.02) while they became similar one month after surgery (p = 1 and p = 0.32). The neutrophil-to-lymphocyte ratio—NLR showed similar trends (p = 0.01 and p = 1). Better OS and RFS were shown in the TIME-a group (p = 0.02 and 0.03, respectively). Conclusions: Resected upstaged lung adenocarcinomas show distinct peripheral blood cell profiles based on immune status. TIME-active patients had a significantly lower NLR, which normalized post-surgery. Surgical resection may help restore native immune surveillance.