Giovanni Natale

Background: The localization of lung nodules is challenging during thoracoscopy. In this study, we evaluated the use of three‐dimensional (3D) lung reconstruction for use in the operating room to guide the identification of lung nodules during thoracoscopy.Methods: This was a single‐center retrospective study. All consecutive patients undergoing thoracoscopic resection of lung nodules were included in the study. Patients were retrospectively divided into two groups based upon whether the thoracoscopic resection was performed with the assistance (3D group) or not (standard group) of 3D lung reconstruction. The operative time (minutes) to detect lung nodules was statistically compared between the two study groups in relation to the characteristics of lung nodules as size, localization, and distance from the visceral pleura.Results: Our study population consisted of 170 patients: 85 in the 3D group and 85 in the standard group. No intergroup difference differences were found regarding the characteristics and histological diagnosis of lesions. The standard group compared to the 3D group was associated with a significantly longer operative time for the detection of lesions p < 0.001), lesions between 10 and 20 mm (5.05 ± 0.84 vs. 3.89 ± 0.92; p = 0.03), lesions localized in complex segments (7.49 ± 4.25 vs. 5.11 ± 0.97; p < 0.001), and deep lesions (9.58 ± 4.82 vs. 5.4 ± 1.01, p < 0.001).Conclusions: Our 3D lung reconstruction model for use in the operating room may be an additional tool for thoracic surgeons to guide the detection of small and deep nodules during thoracoscopy. It is a noninvasive and cost saving procedure and may be widely used.

Background: Intrathoracic neurogenic tumors (INTs) are derived from nerve tissue and grow within the chest. Preoperative diagnosis can be challenging and only complete surgical exeresis enables confirmation of the suspected diagnosis. Here, we analyzed our experience on management of paravertebral lesions with solid and cystic patterns. Methods: A monocentric retrospective study was conducted, which included 25 consecutive cases of ITNs in the period from 2010 to 2022. These cases had been surgically treated by thoracoscopic resection alone, or in combination with neurosurgery in the case of dumbbell tumors. The demographic and operative data along with complications were recorded and analyzed. Results: Twenty‐five patients were diagnosed with a paravertebral lesion of which 19 (76%) had solid features and six (24%) had cystic features. The most common diagnosis was schwannoma (72%), followed by neurofibroma (20%) and malignant schwannoma (8%). In four cases (12%) the tumor showed an intraspinal extension. None of the patients had recurrence until 6 months of follow‐up. Comparison between the VATS and thoracotomy procedures showed that outcome of discharge on the postoperative day, on average, was 2.61 ± 0.5 versus 3.51 ± 0.53, respectively ( p ‐value <0.001). Conclusion: The treatment of choice for INTs is complete resection which is tailored to tumor size, location, and extension. In our study, paravertebral tumors with cystic characteristics were not associated with an intraspinal extension and did not show a different behavior from solid tumors.

Background: In selected patients with pulmonary metastases, surgical resection is the treatment of choice. Despite thoracoscopy is the preferred approach for management early lung cancer, its role in management pulmonary metastases is still debate due to the risk of leaving undetected malignant nodules during surgery. We aimed to evaluate the outcome of patients undergoing resection of lung metastasis performed using thoracoscopy to establish whether this approach did not compromise oncological results. Methods: We performed a systematic review of literature using Medline, PubMed, Scopus, Google Scholar, and Cochrane databases until the end of March 2020. English papers reporting the survival and/or recurrence after thoracoscopic metastasectomy were included in the analysis. Results: Ten papers were selected. Nine out of ten studies compared survival and/or recurrence rates between thoracoscopy and thoracotomy approach; no significant differences were found in 7 studies, while in two thoracoscopy was associated with a better overall survival. The remaining one study evaluated only thoracoscopy outcome, finding an overall 5-year survival rate of 54%, that was comparable to that expected for metastasectomy by thoracotomy. Multivariable analysis were performed in four studies; in one thoracoscopy was correlated to better survival, while in the other three the surgical approach did not influence outcomes. Two studies evaluated perioperative outcomes, and in both studies thoracoscopy was associated with shorter hospital stay, and lesser postoperative morbidity than thoracotomy. Conclusions: Despite our results seems to support the use of thoracoscopy, however several limitations should be taken in account before drawing definitive conclusions. All evaluated studies are retrospective; the different patient characteristics (i.e. number of lesions, laterality, size, primary metastatic cancer type), and the extend of resection make thoracoscopy and thoracotomy groups not comparable. Thus, only future randomized controlled trials could definitively define the oncological validity of video-assisted thoracoscopic surgery (VATS) for treatment of lung metastases.