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Article ; Online: Massive thymoma mimicking a pleural mass.

Palazzo, Stefano / Rahman, Zaid / Femia, Federico / Harrison-Phipps, Karen / Simpson, Thomas

2024 Volume 79, Issue 4, Page(s) 382–383

MeSH term(s)	Humans ; Thymoma/diagnostic imaging ; Thymus Neoplasms/diagnostic imaging ; Pleural Neoplasms/diagnostic imaging ; Pleural Diseases
Language	English
Publishing date	2024-03-15
Publishing country	England
Document type	Journal Article
ZDB-ID	204353-1
ISSN	1468-3296 ; 0040-6376
ISSN (online)	1468-3296
ISSN	0040-6376
DOI	10.1136/thorax-2023-221296
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Article: Long-Term Oncologic Outcomes in Robot-Assisted and Video-Assisted Lobectomies for Non-Small Cell Lung Cancer.

Fabbri, Giulia / Femia, Federico / Lampridis, Savvas / Farinelli, Eleonora / Maraschi, Alessandro / Routledge, Tom / Bille, Andrea

Journal of clinical medicine

2023 Volume 12, Issue 20

Abstract: This study compares long-term outcomes in patients undergoing video-assisted thoracic surgery (VATS) and robotic-assisted thoracic surgery (RATS) lobectomy for non-small cell lung cancer (NSCLC); all consecutive patients who underwent RATS or VATS ... ...

Abstract	This study compares long-term outcomes in patients undergoing video-assisted thoracic surgery (VATS) and robotic-assisted thoracic surgery (RATS) lobectomy for non-small cell lung cancer (NSCLC); all consecutive patients who underwent RATS or VATS lobectomy for NSCLC between July 2015 and December 2021 in our center were enrolled in a single-center prospective study. The primary outcomes were overall survival (OS), disease-free survival (DFS), and recurrence rate. The secondary outcomes were complication rate, length of hospitalization (LOS), duration of chest tubes (LOD), and number of lymph node stations harvested. A total of 619 patients treated with RATS (
Language	English
Publishing date	2023-10-19
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm12206609
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Article ; Online: Intraoperative neuromonitoring in thoracoscopic excision of brachial plexus schwannoma.

Femia, Federico / Junemann, Carola / Ruffini, Enrico / Guerrera, Francesco

Interactive cardiovascular and thoracic surgery

2021 Volume 34, Issue 1, Page(s) 156–158

Abstract: Mediastinal schwannoma arising from brachial plexus are rare, but their surgical treatment could be challenging with a minimally invasive approach, given their position. Furthermore, their proximity to brachial plexus nerve fibres raises the risk for ... ...

Abstract	Mediastinal schwannoma arising from brachial plexus are rare, but their surgical treatment could be challenging with a minimally invasive approach, given their position. Furthermore, their proximity to brachial plexus nerve fibres raises the risk for postoperative upper limb deficits. A 72-year-old man presented mediastinal schwannoma arising from the T1 nerve root. Complete surgical excision was achieved via video-assisted thoracic surgery with the aid of intraoperative neuromonitoring, and no postoperative neurological deficit developed after the intervention. Using intraoperative neuromonitoring, radical minimally invasive surgical treatment can be safely achieved for mediastinal schwannoma arising from brachial plexus.
MeSH term(s)	Aged ; Brachial Plexus/surgery ; Humans ; Male ; Mediastinal Neoplasms/diagnostic imaging ; Mediastinal Neoplasms/surgery ; Neurilemmoma/diagnostic imaging ; Neurilemmoma/surgery ; Thoracic Surgery, Video-Assisted
Language	English
Publishing date	2021-08-18
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	2095298-3
ISSN	1569-9285 ; 1569-9293
ISSN (online)	1569-9285
ISSN	1569-9293
DOI	10.1093/icvts/ivab206
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Article: Intraoperative near-infrared molecular imaging for diagnostic thoracoscopy in difficult clinical scenario.

Guerrera, Francesco / Femia, Federico / Lyberis, Paraskevas / Filosso, Pier Luigi / Lausi, Paolo Olivo / Ruffini, Enrico

Reports of practical oncology and radiotherapy : journal of Greatpoland Cancer Center in Poznan and Polish Society of Radiation Oncology

2022 Volume 27, Issue 1, Page(s) 176–179

Abstract: Precise diagnosis in intrathoracic malignancies is paramount for adequate treatment planning. Standard approach is histologic analysis from targeted biopsy obtained with different invasive procedures. Rarely, in difficult clinical scenarios, even gold ... ...

Abstract	Precise diagnosis in intrathoracic malignancies is paramount for adequate treatment planning. Standard approach is histologic analysis from targeted biopsy obtained with different invasive procedures. Rarely, in difficult clinical scenarios, even gold standard diagnostic procedures can be ineffective in obtaining a satisfying result. Procedural developments and technological improvements applied to the chosen technique can be helpful to deal with such situation. We present two clinical cases of suspected intrathoracic malignancy in which repeated unsuccessful diagnostic procedures had already been attempted. We adopted a protocol based on intraoperative fluorescence during diagnostic thoracoscopy to increase diagnostic efficacy. In both cases we obtained a precise pathological diagnosis.
Language	English
Publishing date	2022-03-22
Publishing country	Poland
Document type	Journal Article
ZDB-ID	2188087-6
ISSN	1507-1367
ISSN	1507-1367
DOI	10.5603/RPOR.a2022.0008
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Article ; Online: Energy devices versus electrocoagulation in video-assisted thoracoscopic lobectomy: a propensity-match cohort study.

Lyberis, Paraskevas / Guerrera, Francesco / Balsamo, Ludovica / Cristofori, Riccardo C / Della Beffa, Eleonora / Lausi, Paolo O / Rosboch, Giulio L / Filosso, Pier L / Ruffini, Enrico / Femia, Federico

Minerva surgery

2023 Volume 79, Issue 1, Page(s) 21–27

Abstract: Background: The aim of the study was to compare the effect on perioperative outcome of intraoperative use of different devices for tissue dissection (electrocoagulation [EC] or energy devices [ED]) in patients who underwent video-assisted thoracoscopic ... ...

Abstract	Background: The aim of the study was to compare the effect on perioperative outcome of intraoperative use of different devices for tissue dissection (electrocoagulation [EC] or energy devices [ED]) in patients who underwent video-assisted thoracoscopic surgery (VATS) lobectomy for lung cancer. Methods: We retrospectively reviewed 191 consecutive patients who underwent VATS lobectomy, divided into two cohorts: ED (117 patients), and EC (74 patients); after propensity score matching, 148 patients were extracted, 74 for each cohort. The primary endpoints considered were complication rate and 30-day mortality rate. The secondary endpoints considered were length of stay (LOS) and the number of lymph nodes harvested. Results: The complication rate did not differ between the two cohorts (16.22% EC group, 19.66% ED group, P=0.549), before and after propensity matching (16.22% for both EC and ED group, P=1.000). The 30-day mortality rate was 1 in the overall population. Median LOS was 5 days for both groups, before and after propensity match, with the same interquartile range, (IQR: 4-8). ED group had a significantly higher median number of lymph nodes harvested (ED median: 18, IQR: 12-24; EC median: 10, IQR: 5-19; P=0.0002). The difference was confirmed after the propensity score matching (ED median: 17, IQR: 13-23; EC median: 10, IQR: 5-19; P=0.0008). Conclusions: ED dissection during VATS lobectomy did not lead to different complication rates, mortality rates, and LOS compared to EC tissue dissection. ED use led to a significantly higher number of intraoperative lymph nodes harvested compared to EC use.
MeSH term(s)	Humans ; Carcinoma, Non-Small-Cell Lung/pathology ; Carcinoma, Non-Small-Cell Lung/surgery ; Cohort Studies ; Thoracic Surgery, Video-Assisted/adverse effects ; Retrospective Studies ; Pneumonectomy ; Postoperative Complications/epidemiology ; Lung Neoplasms/surgery ; Lung Neoplasms/pathology
Language	English
Publishing date	2023-05-23
Publishing country	Italy
Document type	Journal Article
ZDB-ID	3067899-7
ISSN	2724-5438
ISSN (online)	2724-5438
DOI	10.23736/S2724-5691.23.09944-6
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Article ; Online: Correlation between high-resolution computed tomography appearance and histopathological features in the diagnosis of interstitial lung diseases. A real-life study.

Lyberis, Paraskevas / Verri, Giulia / Solidoro, Paolo / Femia, Federico / Perotti, Costanza / Limerutti, Giorgio / Delsedime, Luisa / Della Beffa, Eleonora / Papotti, Mauro G / Ruffini, Enrico / Albera, Carlo / Guerrera, Francesco

Minerva surgery

2023 Volume 79, Issue 2, Page(s) 133–139

Abstract: Background: According to current guidelines, a surgical biopsy is rarely required when a high-confidence radiologic interstitial lung disease (ILD) diagnosis is made on thin-section high-resolution computed tomography (HRCT). Nevertheless, disowning ... ...

Abstract	Background: According to current guidelines, a surgical biopsy is rarely required when a high-confidence radiologic interstitial lung disease (ILD) diagnosis is made on thin-section high-resolution computed tomography (HRCT). Nevertheless, disowning HRCT scans diagnosed by biopsy are more common than presumed. Our study aimed to describe the concordance rate between HRCT scans and pathological diagnoses of ILDs obtained by surgical biopsy. The current guideline suggests the use of surgical lung biopsy (SLB) in patients with newly detected ILD of unknown cause. Methods: Patients who underwent mini-invasive surgical biopsies for interstitial lung diseases from January 2018 to August 2022 were analyzed. The HRCT scans were reviewed by an observer blinded to the patient's clinical information. The concordance between histological and HRCT-scan were assessed. Results: Data from 104 patients with uncertain low confidence diagnosis of interstitial lung diseases at HRCT were analyzed. Most of the patients are male (65; 62.5%). The more frequent HRCT pattern were: alternative diagnoses (46; 44.23%), UIP probable (42; 40.38%), UIP indeterminate (7; 6.73%), and non-specific interstitial pneumonia (NSIP) (9, 8.65%). The more common histological diagnosis was UIP definite (30; 28.84%), hypersensitivity pneumonia [HP](19; 18.44%), NSIP (15; 14.42%), sarcoidosis (10; 9.60%). In 7 (20%) cases, the final pathological finding denies HRCT-scans diagnoses; indeed, a moderate agreement was observed between HRCT-scan findings and the definitive histological diagnosis (kappa index: 0.428). Conclusions: HRCT-scan has limitations if the objective is to define interstitial lung diseases accurately. Consequently, pathological assessment should be taken into account in order to provide more accurate tailored treatment strategies because the risk is to wait from 12 to 24 months to ascertain if the ILD will be treatable as progressive pulmonary fibrosis (PPF). Undeniably true, video-assisted surgical lung biopsy (VASLB) with endotracheal intubation and mechanical ventilation is associated with a risk of mortality and morbidity that is far from nil. Nevertheless, in recent years a VASLB approach performed in awake subjects under loco-regional anesthesia (awake-VASLB) has been suggested as an effective method to obtain a highly confident diagnosis in patients with diffuse pathologies of the lung parenchyma.
MeSH term(s)	Humans ; Male ; Female ; Lung Diseases, Interstitial/diagnostic imaging ; Lung/diagnostic imaging ; Lung/pathology ; Idiopathic Interstitial Pneumonias/pathology ; Pulmonary Fibrosis/pathology ; Tomography
Language	English
Publishing date	2023-05-23
Publishing country	Italy
Document type	Journal Article
ZDB-ID	3067899-7
ISSN	2724-5438
ISSN (online)	2724-5438
DOI	10.23736/S2724-5691.23.09948-3
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Article ; Online: All-in-one diagnostic and therapeutic precision thoracic surgery using a hybrid operating theatre: the triple-marking technique.

Lyberis, Paraskevas / Della Beffa, Eleonora / Calandri, Marco / Rosboch, Giulio L / Femia, Federico / Garrone, Pamela M / Neitzer, Luca / Gazzera, Carlo / Buttiglieri, Alessandro / Carmelo, Alessandro / Lausi, Paolo O / Carmeci, Antonello / Palmieri, Luciano / Fonio, Paolo / Ruffini, Enrico / Guerrera, Francesco

Minerva surgery

2023 Volume 78, Issue 6, Page(s) 644–650

Abstract: Background: The minimally invasive management of sub-centimetric and often sub-solid lung lesions is quite challenging for thoracic surgeons. As a matter of fact, thoracoscopic wedge resection can often require conversion to thoracotomy when pulmonary ... ...

Abstract	Background: The minimally invasive management of sub-centimetric and often sub-solid lung lesions is quite challenging for thoracic surgeons. As a matter of fact, thoracoscopic wedge resection can often require conversion to thoracotomy when pulmonary lesions cannot be visually identified. Hybrid operating rooms (ORs) can serve as a helpful tool in a multidisciplinary setting, providing real-time lesion imaging and targeting, allowing preoperative or intraoperative percutaneous placement of different lesions targeting techniques to help locate non-palpable lung nodules during video-assisted thoracic surgery. The aim of the study is to assess whether the lung nodule marking using methylene blue, indocyanine green, and gold seeds - the "triple-marking technique" - in the hybrid OR is effective in helping locate non-visible or palpable nodules. Methods: We conducted a retrospective study on 19 patients with non-palpable lung lesions requiring VATS wedge resection and underwent lesional targeting in the hybrid operating room with different marking systems, including gold seeds placement, methylene blue, or indocyanine green. Lesions were considered non-palpable due to sizing, radiological subsolid aspect, or location and then identified using intraoperative CT scans, also allowing to elaborate needle trajectory. The intraoperative diagnosis was obtained in all of the patients guiding the type of surgery performed. Results: The radio-opaque gold seed marker was used in all of the patients except for two cases that developed intraprocedural pneumothoraces with no major consequences. In these patients, the nodule marking using dyes was still performed and successful in allowing to locate the lesion. Methylene blue and indocyanine green were always used in combination during the dye-targeting phase. Methylene blue appeared to be non-visible in two patients. The indocyanine green was correctly visualized in every patient. We observed the gold seed dislocation in two patients. We were able to identify the lung lesion in all the patients correctly. No conversion was needed. No allergic reactions were observed due to dye administration, and no prophylaxis was performed prior to lesional marking. The lung lesions were visually identified in 100% of the patients thanks to at least one marking technique. Conclusions: Our experience confirms that the hybrid operating room can represent a suitable tool in helping locate hard-to-find lung lesions in planned VATS resections. Using different techniques, a multiple marking approach seems advisable to maximize the lung lesions detecting rate by direct vision, therefore reducing the VATS conversion rate.
MeSH term(s)	Humans ; Indocyanine Green ; Operating Rooms ; Lung Neoplasms/diagnostic imaging ; Lung Neoplasms/surgery ; Retrospective Studies ; Thoracic Surgery ; Methylene Blue ; Solitary Pulmonary Nodule/diagnosis ; Solitary Pulmonary Nodule/pathology ; Solitary Pulmonary Nodule/surgery ; Coloring Agents
Chemical Substances	Indocyanine Green (IX6J1063HV) ; Methylene Blue (T42P99266K) ; Coloring Agents
Language	English
Publishing date	2023-05-18
Publishing country	Italy
Document type	Journal Article
ZDB-ID	3067899-7
ISSN	2724-5438
ISSN (online)	2724-5438
DOI	10.23736/S2724-5691.23.09945-8
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Article ; Online: Proctor-guided virtual reality-enhanced three-dimensional video-assisted thoracic surgery: an excellent tutoring model for lung segmentectomy.

Guerrera, Francesco / Nicosia, Samanta / Costardi, Lorena / Lyberis, Paraskevas / Femia, Federico / Filosso, Pier Luigi / Arezzo, Alberto / Ruffini, Enrico

Tumori

2020 Volume 107, Issue 6, Page(s) NP1–NP4

Abstract: Objective: Lung segmentectomy using video-assisted thoracoscopic surgery (VATS) is an effective strategy to treat early-stage lung cancer. The objective of this case report is to show the efficacy of Hyper Accuracy 3D™ (HA3D) reconstruction as a tool ... ...

Abstract	Objective: Lung segmentectomy using video-assisted thoracoscopic surgery (VATS) is an effective strategy to treat early-stage lung cancer. The objective of this case report is to show the efficacy of Hyper Accuracy 3D™ (HA3D) reconstruction as a tool for trainee surgeons and expert surgeons to perform complex procedures. Methods: An 84-year-old man was treated for colon-rectal cancer. During follow-up, a pulmonary nodule on the right anterior upper lobe suspected for intestinal metastasis was revealed by a computed tomography scan. According to functional tests and radiology, a right anterior upper lobe segmentectomy was planned. HA3D lung reconstruction was used during surgery. Results: Using the HA3D virtual model, the procedure was performed with healthy tissue sparing, ensuring safe resection margins. No postoperative morbidities were noted. The patient referred good pain control. The hospital stay was 6 days. Conclusions: VATS segmentectomy is a technically demanding procedure. HA3D lung reconstruction can help surgeons effectively perform the resection, aiding at individuating intersegmental planes, bronchi, and vessels, guaranteeing oncologic radicality and safe surgical margins, and preserving respiratory function.
MeSH term(s)	Aged, 80 and over ; Humans ; Imaging, Three-Dimensional/methods ; Lung Neoplasms/pathology ; Lung Neoplasms/surgery ; Male ; Margins of Excision ; Pneumonectomy/methods ; Teaching ; Thoracic Surgery, Video-Assisted/methods ; Tomography, X-Ray Computed/methods ; Virtual Reality
Language	English
Publishing date	2020-11-11
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	280962-x
ISSN	2038-2529 ; 0300-8916
ISSN (online)	2038-2529
ISSN	0300-8916
DOI	10.1177/0300891620972173
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Article ; Online: Pathological and clinical features of multiple cancers and lung adenocarcinoma: a multicentre study.

Bertoglio, Pietro / Ventura, Luigi / Aprile, Vittorio / Cattoni, Maria Angela / Nachira, Dania / Lococo, Filippo / Rodriguez Perez, Maria / Guerrera, Francesco / Minervini, Fabrizio / Gnetti, Letizia / Lenzini, Alessandra / Franzi, Francesca / Querzoli, Giulia / Rindi, Guido / Bellafiore, Salvatore / Femia, Federico / Bogina, Giuseppe Salvatore / Bacchin, Diana / Kestenholz, Peter /

Ruffini, Enrico / Paci, Massimiliano / Margaritora, Stefano / Imperatori, Andrea Selenito / Lucchi, Marco / Ampollini, Luca / Terzi, Alberto Claudio

Interactive cardiovascular and thoracic surgery

2022 Volume 35, Issue 1

Abstract: Objectives: Lung cancer is increasingly diagnosed as a second cancer. Our goal was to analyse the characteristics and outcomes of early-stage resected lung adenocarcinomas in patients with previous cancers (PC) and correlations with adenocarcinoma ... ...

Abstract	Objectives: Lung cancer is increasingly diagnosed as a second cancer. Our goal was to analyse the characteristics and outcomes of early-stage resected lung adenocarcinomas in patients with previous cancers (PC) and correlations with adenocarcinoma subtypes. Methods: We retrospectively reviewed data of patients radically operated on for stage I-II lung adenocarcinoma in 9 thoracic surgery departments between 2014 and 2017. Overall survival (OS) and time to disease relapse were evaluated between subgroups. Results: We included 700 consecutive patients. PC were present in 260 (37.1%). Breast adenocarcinoma, lung cancer and prostate cancer were the most frequent (21.5%, 11.5% and 11.2%, respectively). No significant differences in OS were observed between the PC and non-PC groups (P = 0.378), with 31 and 75 deaths, respectively. Patients with PC had smaller tumours and were more likely to receive sublobar resection and to be operated on with a minimally invasive approach. Previous gastric cancer (P = 0.042) and synchronous PC (when diagnosed up to 6 months before lung adenocarcinoma; P = 0.044) were related, with a worse OS. Colon and breast adenocarcinomas and melanomas were significantly related to a lower incidence of high grade (solid or micropapillary, P = 0.0039, P = 0.005 and P = 0.028 respectively), whereas patients affected by a previous lymphoma had a higher incidence of a micropapillary pattern (P = 0.008). Conclusions: In patients with PC, we found smaller tumours more frequently treated with minimally invasive techniques and sublobar resection, probably due to a more careful follow-up. The impact on survival is not uniform and predictable; however, breast and colon cancers and melanoma showed a lower incidence of solid or micropapillary patterns whereas patients with lymphomas had a higher incidence of a micropapillary pattern.
MeSH term(s)	Adenocarcinoma/pathology ; Adenocarcinoma of Lung/pathology ; Humans ; Lung Neoplasms/diagnosis ; Lung Neoplasms/epidemiology ; Lung Neoplasms/surgery ; Male ; Neoplasm Staging ; Prognosis ; Retrospective Studies
Language	English
Publishing date	2022-02-19
Publishing country	England
Document type	Journal Article ; Multicenter Study
ZDB-ID	2095298-3
ISSN	1569-9285 ; 1569-9293
ISSN (online)	1569-9285
ISSN	1569-9293
DOI	10.1093/icvts/ivac047
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Article ; Online: Impact of High-Grade Patterns in Early-Stage Lung Adenocarcinoma: A Multicentric Analysis.

Bertoglio, Pietro / Aprile, Vittorio / Ventura, Luigi / Cattoni, Maria / Nachira, Dania / Lococo, Filippo / Perez, Maria Rodriguez / Guerrera, Francesco / Minervini, Fabrizio / Querzoli, Giulia / Bocchialini, Giovanni / Bacchin, Diana / Franzi, Francesca / Rindi, Guido / Bellafiore, Salvatore / Femia, Federico / Bogina, Giuseppe Salvatore / Solli, Piergiorgio / Kestenholz, Peter /

Ruffini, Enrico / Paci, Massimiliano / Margaritora, Stefano / Imperatori, Andrea Selenito / Lucchi, Marco / Gnetti, Letizia / Terzi, Alberto Claudio

Lung

2022 Volume 200, Issue 5, Page(s) 649–660

Abstract: Objective: The presence of micropapillary and solid adenocarcinoma patterns leads to a worse survival and a significantly higher tendency to recur. This study aims to assess the impact of pT descriptor combined with the presence of high-grade components ...

Abstract	Objective: The presence of micropapillary and solid adenocarcinoma patterns leads to a worse survival and a significantly higher tendency to recur. This study aims to assess the impact of pT descriptor combined with the presence of high-grade components on long-term outcomes in early-stage lung adenocarcinomas. Methods: We retrospectively collected data of consecutive resected pT1-T3N0 lung adenocarcinoma from nine European Thoracic Centers. All patients who underwent a radical resection with lymph-node dissection between 2014 and 2017 were included. Differences in Overall Survival (OS) and Disease-Free Survival (DFS) and possible prognostic factors associated with outcomes were evaluated also after performing a propensity score matching to compare tumors containing non-high-grade and high-grade patterns. Results: Among 607 patients, the majority were male and received a lobectomy. At least one high-grade histological pattern was seen in 230 cases (37.9%), of which 169 solid and 75 micropapillary. T1a-b-c without high-grade pattern had a significant better prognosis compared to T1a-b-c with high-grade pattern (p = 0.020), but the latter had similar OS compared to T2a (p = 0.277). Concurrently, T1a-b-c without micropapillary or solid patterns had a significantly better DFS compared to those with high-grade patterns (p = 0.034), and it was similar to T2a (p = 0.839). Multivariable analysis confirms the role of T descriptor according to high-grade pattern both for OS (p = 0.024; HR 1.285 95% CI 1.033-1.599) and DFS (p = 0.003; HR 1.196, 95% CI 1.054-1.344, respectively). These results were confirmed after the propensity score matching analysis. Conclusions: pT1 lung adenocarcinomas with a high-grade component have similar prognosis of pT2a tumors.
MeSH term(s)	Adenocarcinoma/pathology ; Adenocarcinoma/surgery ; Adenocarcinoma of Lung/pathology ; Adenocarcinoma of Lung/surgery ; Female ; Humans ; Lung Neoplasms/pathology ; Male ; Neoplasm Recurrence, Local/pathology ; Neoplasm Staging ; Prognosis ; Retrospective Studies
Language	English
Publishing date	2022-08-21
Publishing country	United States
Document type	Journal Article ; Multicenter Study
ZDB-ID	6165-7
ISSN	1432-1750 ; 0341-2040
ISSN (online)	1432-1750
ISSN	0341-2040
DOI	10.1007/s00408-022-00561-y
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