Zied Chaari

Background: Pulmonary carcinoid tumors (PCTs) are rare malignant neuroendocrine neoplasms. Surgery is the mainstay of treatment, yet factors affecting postoperative outcomes and long-term survival are not fully defined. This study assessed surgical outcomes, survival, and predictors of morbidity and mortality in PCT patients. Methods: We conducted a 35-year retrospective cohort study including all patients undergoing resection for histologically confirmed PCTs. Demographic, clinical, pathological, and surgical data were analyzed to identify predictors of postoperative complications and mortality. Results: Thirty-one patients were included (SR=0.5, mean age 45±15.9 yrs). Tumors were incidental in 13%, with a mean size of 46 mm. Posterolateral thoracotomy was used in 74.2%. Resections included lobectomy (41.9%), bilobectomy (19.3%), and pneumonectomy (32.2%). Typical PCTs accounted for 74.2%, atypical 25.8%. Most tumors were pT2 (51.6%), reflecting delayed diagnosis prior to routine multidisciplinary tumor boards. Postoperative complications occurred in 54.8%, mainly prolonged air leak (29%), pneumonia (19.3%), and wound infection (13%). Early mortality was 6.4%. Median follow-up was 37 months; 5-yr and 10-yr OS were 68% and 45%, respectively. Age >50 yrs and tumor location in the RUL or LLL were associated with higher morbidity. Tumor type, stage, size, distance from carina, and resection type showed no significant association. Conclusion: Surgical management of PCTs provides favorable long-term survival but substantial postoperative morbidity. Larger prospective/multicenter studies are needed to refine risk stratification and optimize surgical strategies in this rare disease.

Background: The lung is the most common site of hydatid disease in children and is associated with relatively high postoperative morbidity. This study aimed to identify risk factors for postoperative complications after surgery for pediatric pulmonary hydatid cysts (PPHC). Methods: A retrospective analytical study was conducted over 38 years (January 1987–December 2025) in our reference center, including all children younger than 16 years who underwent surgery for pulmonary hydatid cysts. Risk factors for postoperative morbidity were assessed using appropriate statistical tests, with p < 0.05 considered significant. Results: A total of 553 children were included (mean age 10.1±3.8 years; 57.7% boys). Overall postoperative morbidity was 24.4%, with no significant association with sex. Factors significantly associated with increased morbidity included: complicated cysts (p=0.015), preoperative abdominal mass (p=0.024), intraoperative empyema (p<0.0001), need for pleural decortication (p=0.009), and pleural thickening/pachypleuritis (p=0.027). Although only 10 planned anatomical resections were required, they were significantly associated with a higher rate of postoperative complications (p=0.003). Intra-cystic bleeding was associated with increased morbidity (p=0.008). Complicated postoperative courses were more frequent in larger cysts (p=0.041) and in cases with intraoperative blood loss greater than 100mL (p=0.007). Conclusion: Postoperative morbidity after surgery for PPHC is influenced by multiple factors, mainly reflecting complicated cysts, infected or hemorrhagic cystic content, larger cyst size, and the need for anatomical lung resection.

Background: The lung is the most frequent site of hydatid disease in humans, characterized by slow progression and delayed clinical presentation. This study aimed to describe the management of pulmonary hydatid cysts (PHC) in children. Methods: A single-center retrospective study was conducted over 38 years (January 1987–December 2025), including all children under 16 years who underwent surgery for PHC. Epidemiological data, management strategies, and surgical outcomes were analyzed. Results: A total of 553 children were included (mean age 10.1 ± 3.8 years; 57.7% boys). Most patients were from rural areas (95.3%) and had a history of hydatid exposure (79.2%). Previous pulmonary and hepatic hydatid disease was reported in 10.7% and 6.1%, respectively. Clinical symptoms revealed the disease in 91.7% of cases, mainly cough (66.2%), chest pain (57.1%), fever (40.7%), and hemoptysis (39.1%). Hydatid vomica occurred in 19.7%. Cysts were predominantly unilateral (89%), solitary (79.9%), and uncomplicated (64.2%), with a median size of 60mm (10-200mm). Serology was positive in 67%. Posterolateral thoracotomy was performed in 99.5% of cases. Cystectomy was the most common procedure (81%), whereas anatomical resection was required in only 1.8%. Infected cyst contents were found in 26.8%, and bronchial fistulas were identified in 89.3% after evacuation. Morbidity and mortality rates were 24.4% (mainly in complicated cysts) and 0.2% respectively. Conclusion: PHC in children is associated with very low mortality and significant morbidity, particularly in complicated cases. Lung parenchyma preservation remains the standard approach, with limited need for anatomical resection.

Background: Video-assisted thoracic surgery (VATS) is associated with reduced morbidity and mortality compared to open thoracotomy. However, access to structured VATS training remains limited, particularly in low-resource countries. We developed SMART-VATS (Simulation Model of an Affordable and Realistic Trainer for Video-Assisted Thoracic Surgery), a low-cost hybrid simulation model to facilitate the early acquisition of fundamental lung resection VATS skills. Materials and methods: This prospective analytical feasibility simulation study evaluates the SMART-VATS model using ovine heart–lung blocks. Participants performed simulated uniportal or multiportal lobectomies in a hemi-thorax-shaped box-trainer. Primary outcomes focused on anatomical realism and feasibility via a 5-point Likert scale. Secondary metrics included expert-led performance assessments. Statistical analysis compared junior and senior cohorts to validate the model’s educational utility and haptic fidelity. Results: Seventy-four participants (51 residents and 23 seniors) completed 7 simulation sessions. The overall success rate was 77%, with no significant statistical disparity between seniority levels ( P = 0.558). Vascular injuries occurred in 16.2% of cases, primarily among juniors ( P = 0.32). Participants highly rated the model’s haptic feedback (94%), color-coded vascular identification (92%), and realism (90.3%), noting its close resemblance to actual surgical conditions. Although the absence of lymph nodes was noted, the SMART-VATS model was validated as an affordable (100%), reproducible (96%), and easy-to-prepare training tool (82%). Conclusions: Our study suggests that SMART-VATS is a feasible, affordable, and reproducible early-phase VATS training model. It provides a valuable foundational platform for lung-resection-skill acquisition, particularly in resource-limited environments. Further studies are required to validate objective skill transfer to clinical performance.

Beyond the Usual Course: A Rare Case of Persistent Traumatic Pulmonary Pneumatoceles With 8-Year Favorable Evolution - Article abstract #952276

Introduction and importance: Chest wall tumors are common and predominantly benign. Exceptionally, long-standing evolution over decades can lead to the development of giant tumors, posing substantial technical and strategic challenges in determining the optimal surgical approach. Presentation of case: We report a rare case of a giant pedunculated chest wall lipoma that had been growing for over 40 years in a 73-year-old man. CT scan revealed a mass with a 5 cm-suprascapular-implantation base, hanging posteriorly and mimicking a pseudo-limb, measuring 17 × 7 cm in diameter and 34 cm in length. Complete surgical resection was performed, and histopathology confirmed a benign lipoma with no signs of malignancy. Clinical discussion: To our knowledge, this is the first reported case of a huge lipoma with more than 40 years of evolution and an unusual pedunculated presentation resembling a third upper limb. Conclusion: This case is exceptional due to its pedunculated appearance resembling an additional limb, and a slow evolution over more than 40 years. Complete surgical resection ensures a favorable prognosis. Highlights:

Pulmonary carcinoid tumors (PCTs), rare malignant neuroendocrine epithelial tumors constituting less than 1% of lung cancers, pose unique challenges in management. Surgical resection is the primary treatment modality, but consensus on the optimal approach remains elusive. This study aims to present the outcomes of surgical interventions for PCTs at the Thoracic and Cardiovascular Surgery Department of Habib Bourguiba University Hospital in Sfax, to assess postoperative survival, and to identify potential risk factors contributing to morbidity. The 33-year retrospective cohort study included all patients surgically treated for PCTs from 1989 to December 2022. Statistical analyses were conducted to uncover potential risk factors associated with morbidity and mortality. Over the study period, 21 patients underwent surgery for histologically confirmed PCTs. The sex ratio was 0.5, and the mean age was 45. Incidental discovery occurred in 14% of cases. Surgical procedures were performed via posterolateral thoracotomy, and the mean resections were: lobectomy (43%), bilobectomy (19%), and pneumonectomy (33%). Atypical carcinoids were present in 24% of cases. A higher percentage of T2-stage tumors (52%) suggested delayed medical attention before multidisciplinary discussion. Postoperative complications were noted for 57% of patients, with one death. Advanced age was significantly correlated with complications (p=0.006), and tumor location influenced their occurrence. This analysis underscores surgery's effectiveness in managing PCTs while highlighting significant morbidity factors. Prospective or multicenter studies are essential for a more comprehensive understanding of this rare pathology.

Introduction: Chest trauma (CT) is a common entity nowadays and a frequent hospitalization indication in trauma centers. The management of CT is different according to the underlying lesions, associated complications, and patients’ profiles. This study aims to establish the profile of CT lesions in a non-intensive-care-unit (ICU) and to determine the results of its management. Methods: This was a retrospective and analytical cohort carried out in our department from January 2015 to December 2023 including all patients presenting CT whatever its type (blunt or penetrating) and its mechanism. Results: We collected 944 patients with a mean age of 43.8 years (2-99 years) and a sex ratio of 6.86. Road traffic accidents, domestic accidents and physical assaults were the most common reported mechanisms in 52.5%, 19.7% and 19.3% of cases respectively. Penetrating trauma was recorded for 18.4% of patients especially after stab wounds (95.4%). ICU hospitalization was necessary for 38.8% of patients before their transfer to our department. Surgery was necessary for 8.2% of patients. Mortality and morbidity rates were 1.7% and 6.8% respectively. After analytical study, the independent morbidity risk factors were: ICU hospitalization (p<0.0001), over 5 fractured ribs (p=0.021), flail chest (p=0.002), lung contusion (p<0.0001), recourse to surgery (p<0.0001). the independent mortality factors were: suicide attitude (p=0.008), ICU hospitalization (p<0.0001), hemothorax (0.003), abdominal trauma (0.02), and transfusion (p<0.001). Conclusion: Several factors are associated to high mortality and morbidity rates for CT victims even if they were not hospitalized in ICU and should be taken under consideration for better outcomes