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Article: Resection of Contralateral Scapular Oligometastasis in Non-small Cell Lung Cancer Post Right Salvage Pneumonectomy.

Djouani, Adam / Maddipati, Teja / Smith, Alexander / Okiror, Lawrence

2023 Volume 15, Issue 5, Page(s) e39790

Abstract: A 74-year-old male was diagnosed with right hilar T4N1M0 squamous cell carcinoma of the lung. Radical oncological treatment was initiated with curative intent. Despite this, a post-operative computed tomography scan showed residual disease. Therefore, ... ...

Abstract	A 74-year-old male was diagnosed with right hilar T4N1M0 squamous cell carcinoma of the lung. Radical oncological treatment was initiated with curative intent. Despite this, a post-operative computed tomography scan showed residual disease. Therefore, right thoracotomy and salvage pneumonectomy were performed. The patient recovered well post-operatively. Unfortunately, seven months later, he re-presented with a left scapula subcutaneous mass, with a biopsy confirming metastatic lung squamous cell carcinoma. Radiotherapy was not possible as it would have irradiated the remaining lung, and therefore, surgical resection and chest wall reconstruction were undertaken. The patient remains free of disease at 6 months follow-up. We present an interesting case of surgical management of oligometastatic lung cancer.
Language	English
Publishing date	2023-05-31
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.39790
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Article ; Online: Lung Cancer Surgery in the Early Phase After Acute COVID-19 Pneumonitis.

Robinson, Dean P / Smith, Alexander E / Okiror, Lawrence

The Annals of thoracic surgery

2021 Volume 113, Issue 4, Page(s) e243–e245

Abstract: A 65-year-old woman was diagnosed with early-stage lung cancer in 2020 and scheduled for robotic assisted-left upper lobectomy. Unfortunately, the patient contracted symptomatic COVID-19, resulting in postponement of lung resection. She was admitted for ... ...

Abstract	A 65-year-old woman was diagnosed with early-stage lung cancer in 2020 and scheduled for robotic assisted-left upper lobectomy. Unfortunately, the patient contracted symptomatic COVID-19, resulting in postponement of lung resection. She was admitted for surgery 6 weeks after the acute infection. A preoperative computed tomographic scan showed widespread interstitial pneumonitis. However, the operation went ahead given concerns over tumor progression, albeit with a lesser resection to preserve lung tissue because the patient was slightly hypoxic. Her postoperative recovery was uneventful, and she was discharged 5 days later. Final histology confirmed a fully resected stage T1c N0 M0 adenocarcinoma of the lung.
MeSH term(s)	Adenocarcinoma/complications ; Adenocarcinoma/diagnosis ; Adenocarcinoma/surgery ; Aged ; COVID-19 ; Female ; Humans ; Lung Neoplasms/pathology ; Pneumonectomy/methods ; Pneumonia/surgery
Language	English
Publishing date	2021-07-01
Publishing country	Netherlands
Document type	Case Reports
ZDB-ID	211007-6
ISSN	1552-6259 ; 0003-4975
ISSN (online)	1552-6259
ISSN	0003-4975
DOI	10.1016/j.athoracsur.2021.06.016
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Article: Bronchoscopic Endobronchial Valve Therapy for Persistent Air Leaks in COVID-19 Patients Requiring Veno-Venous Extracorporeal Membrane Oxygenation.

Ficial, Barbara / Whebell, Stephen / Taylor, Daniel / Fernández-Garda, Rita / Okiror, Lawrence / Meadows, Christopher I S

Journal of clinical medicine

2023 Volume 12, Issue 4

Abstract: COVID-19 acute respiratory distress syndrome (ARDS) can be associated with extensive lung damage, pneumothorax, pneumomediastinum and, in severe cases, persistent air leaks (PALs) via bronchopleural fistulae (BPF). PALs can impede weaning from invasive ... ...

Abstract	COVID-19 acute respiratory distress syndrome (ARDS) can be associated with extensive lung damage, pneumothorax, pneumomediastinum and, in severe cases, persistent air leaks (PALs) via bronchopleural fistulae (BPF). PALs can impede weaning from invasive ventilation or extracorporeal membrane oxygenation (ECMO). We present a series of patients requiring veno-venous ECMO for COVID-19 ARDS who underwent endobronchial valve (EBV) management of PAL. This is a single-centre retrospective observational study. Data were collated from electronic health records. Patients treated with EBV met the following criteria: ECMO for COVID-19 ARDS; the presence of BPF causing PAL; air leak refractory to conventional management preventing ECMO and ventilator weaning. Between March 2020 and March 2022, 10 out of 152 patients requiring ECMO for COVID-19 developed refractory PALs, which were successfully treated with bronchoscopic EBV placement. The mean age was 38.3 years, 60% were male, and half had no prior co-morbidities. The average duration of air leaks prior to EBV deployment was 18 days. EBV placement resulted in the immediate cessation of air leaks in all patients with no peri-procedural complications. Weaning of ECMO, successful ventilator recruitment and removal of pleural drains were subsequently possible. A total of 80% of patients survived to hospital discharge and follow-up. Two patients died from multi-organ failure unrelated to EBV use. This case series presents the feasibility of EBV placement in severe parenchymal lung disease with PAL in patients requiring ECMO for COVID-19 ARDS and its potential to expedite weaning from both ECMO and mechanical ventilation, recovery from respiratory failure and ICU/hospital discharge.
Language	English
Publishing date	2023-02-08
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm12041348
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Article ; Online: Impact of waiting times on tumour growth and pathologic upstaging in patients with non-small cell lung cancer having lung resection.

Bhat, Insha / Okiror, Lawrence / Nair, Arjun / Billè, Andrea

Tumori

2020 Volume 107, Issue 4, Page(s) 329–334

Abstract: Objective: There are limited data on tumour growth or pathologic upstaging in patients with early-stage lung cancer awaiting lung resection. We aimed to evaluate whether waiting times on the current lung cancer treatment pathway were associated with ... ...

Abstract	Objective: There are limited data on tumour growth or pathologic upstaging in patients with early-stage lung cancer awaiting lung resection. We aimed to evaluate whether waiting times on the current lung cancer treatment pathway were associated with significant tumour growth or pathologic upstaging. Methods: This is a retrospective observational study of a consecutive series of patients with early-stage, non-small cell lung cancer who underwent resection for lung cancer. The difference between tumour size at diagnostic and preoperative computed tomography (CT) scans was calculated. Significant tumour growth was defined as a diameter increase of ⩾5 mm or ⩾20%. The time intervals between baseline and repeat CT (CT-int) and between baseline CT and date of surgery (Surg-int), as well as other potential clinical and pathologic prognostic factors, were compared between upstaged and nonupstaged patients. Results: There were 121 patients identified. Fifty-four patients (44.6%) had tumour growth ⩾5 mm and 27 patients (22%) had tumour growth ⩾20%. Median CT-int and Surg-int were 2.4 and 2.6 months, respectively. Forty-four patients (36%) were upstaged at surgery due to new lymph node involvement (n = 19), pleural invasion (n = 12), satellite nodules (n = 4), or increase in tumour diameter (n = 9). There was a marginal, but statistically insignificant, difference in median CT intervals in patients who had tumour growth <20% vs ⩾20% at 2.4 vs 2.6 months ( Conclusion: Current cancer pathway waiting times are not associated with significant tumour growth or pathologic upstaging in this cohort.
MeSH term(s)	Adenocarcinoma of Lung/pathology ; Adenocarcinoma of Lung/surgery ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Large Cell/pathology ; Carcinoma, Large Cell/surgery ; Carcinoma, Non-Small-Cell Lung/pathology ; Carcinoma, Non-Small-Cell Lung/surgery ; Carcinoma, Squamous Cell/pathology ; Carcinoma, Squamous Cell/surgery ; Female ; Follow-Up Studies ; Humans ; Lung Neoplasms/pathology ; Lung Neoplasms/surgery ; Male ; Middle Aged ; Neoplasm Staging ; Pneumonectomy/methods ; Retrospective Studies ; Time-to-Treatment/statistics & numerical data
Language	English
Publishing date	2020-10-06
Publishing country	United States
Document type	Journal Article ; Observational Study
ZDB-ID	280962-x
ISSN	2038-2529 ; 0300-8916
ISSN (online)	2038-2529
ISSN	0300-8916
DOI	10.1177/0300891620960217
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Ud II Zs.43: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular ab Jg. 2022: Lesesaal (EG)
Zs.MO 287: Show issues

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Article ; Online: Analysis of survival of patients with metastatic malignant pleural mesothelioma.

Billè, Andrea / Okiror, Lawrence / Harling, Leanne / Pernazza, Fausto / Muzio, Alberto / Roveta, Annalisa / Grosso, Federica

Tumori

2020 Volume 107, Issue 2, Page(s) 110–118

Abstract: Aim: To report the outcomes and prognosis of patients with malignant pleural mesothelioma (MPM) who present with or develop metastases during treatment.: Methods: This is a retrospective observational study of patients diagnosed with MPM over 7 years. ...

Abstract	Aim: To report the outcomes and prognosis of patients with malignant pleural mesothelioma (MPM) who present with or develop metastases during treatment. Methods: This is a retrospective observational study of patients diagnosed with MPM over 7 years. Metastases at presentation or during follow-up were recorded. Multivariate Cox regression was used to evaluate the relationship of clinicopathologic variables and overall survival (OS). Logistic regression was used for propensity score matching of patients to assess chemotherapy treatment effect. Results: There were 367 patients included with a median age of 71 years (range, 29-91). A total of 69 patients (18%) had metastases: 14 at presentation and 55 during follow-up. Patients presenting with metastases had significantly worse median and 2-year OS compared to those developing metastases during follow-up: 13.3 months (95% confidence interval [CI], 2-24.6 months) and 0% versus 20.2 months (95% CI, 16.7-23.3 months) and 33%, respectively ( Conclusions: T4 disease carries a similar OS as metastatic MPM. Female sex, advanced age, nonepithelioid histology, and not receiving chemotherapy were independent poor prognostic factors.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Carboplatin/administration & dosage ; Cisplatin/administration & dosage ; Female ; Humans ; Male ; Mesothelioma, Malignant/drug therapy ; Mesothelioma, Malignant/pathology ; Middle Aged ; Multivariate Analysis ; Neoplasm Metastasis ; Neoplasm Staging ; Pemetrexed/administration & dosage ; Pleural Neoplasms/drug therapy ; Pleural Neoplasms/pathology ; Prognosis ; Retrospective Studies ; Survival Analysis
Chemical Substances	Pemetrexed (04Q9AIZ7NO) ; Carboplatin (BG3F62OND5) ; Cisplatin (Q20Q21Q62J)
Language	English
Publishing date	2020-05-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	280962-x
ISSN	2038-2529 ; 0300-8916
ISSN (online)	2038-2529
ISSN	0300-8916
DOI	10.1177/0300891620926239
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Ud II Zs.43: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular ab Jg. 2022: Lesesaal (EG)
Zs.MO 287: Show issues

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Article ; Online: Clinicopathological predictors of survival in resected primary lung adenocarcinoma.

Jhala, Hiral / Harling, Leanne / Rodrigo, Alberto / Nonaka, Daisuke / Mclean, Emma / Ng, Wen / Okiror, Lawrence / Bille, Andrea

Journal of clinical pathology

2021 Volume 75, Issue 5, Page(s) 310–315

Abstract: Aims: Primary lung adenocarcinoma consists of a spectrum of clinical and pathological subtypes that may impact on overall survival (OS). Our study aims to evaluate the impact of adenocarcinoma subtype and intra-alveolar spread on survival after ... ...

Abstract	Aims: Primary lung adenocarcinoma consists of a spectrum of clinical and pathological subtypes that may impact on overall survival (OS). Our study aims to evaluate the impact of adenocarcinoma subtype and intra-alveolar spread on survival after anatomical lung resection and identify different prognostic factors based on stage and histological subtype. Methods: Newly diagnosed patients undergoing anatomical lung resections without induction therapy, for pT1-3, N0-2 lung adenocarcinoma from April 2011 to March 2013, were included. The effect of clinical-pathological factors on survival was retrospectively assessed. Results: Two hundred and sixty-two patients were enrolled. The 1-year, 3-year and 5-year OS were 88.8%, 64.3% and 51.1%, respectively. Univariate analysis showed lymphovascular, parietal pleural and chest wall invasion to confer a worse 1-year and 5-year prognosis (all p<0.0001). Solid predominant adenocarcinomas exhibited a significantly worse OS (p=0.014). Multivariate analysis did not identify solid subtype as an independent prognostic factor; however, identified stage >IIa, lymphovascular invasion (p=0.002) and intra-alveolar spread (p=0.009) as significant independent predictors of worse OS. Co-presence of intra-alveolar spread and solid predominance significantly reduced OS. Disease-free survival (DFS) was reduced with parietal pleural (p=0.0007) and chest wall invasion (p<0.0001), however, adenocarcinoma subtype had no significant impact on DFS. Conclusions: Our study demonstrates that solid predominant adenocarcinoma, intra-alveolar spread and lymphovascular invasion confer a worse prognosis and should be used as a prognostic tool to determine appropriate adjuvant treatment.
MeSH term(s)	Adenocarcinoma/pathology ; Adenocarcinoma of Lung/pathology ; Adenocarcinoma of Lung/surgery ; Disease-Free Survival ; Humans ; Lung/pathology ; Lung Neoplasms/diagnosis ; Neoplasm Staging ; Prognosis ; Retrospective Studies
Language	English
Publishing date	2021-04-07
Publishing country	England
Document type	Journal Article
ZDB-ID	80261-x
ISSN	1472-4146 ; 0021-9746
ISSN (online)	1472-4146
ISSN	0021-9746
DOI	10.1136/jclinpath-2021-207388
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Article ; Online: Complete resection of a large phosphaturic mesenchymal tumour by chest wall resection and reconstruction.

Okiror, Lawrence / Khalil, Haitham / Vaiyapuri, Sumathi / Kalkat, Maninder

General thoracic and cardiovascular surgery

2016 Volume 64, Issue 6, Page(s) 355–358

Abstract: Phosphaturic mesenchymal tumour is an extremely rare mesenchymal neoplasm of bone or soft tissue. It is associated with paraneoplastic oncogenic osteomalacia through secretion of fibroblast growth factor-23 (FGF-23) which inhibits renal proximal tubule ... ...

Abstract	Phosphaturic mesenchymal tumour is an extremely rare mesenchymal neoplasm of bone or soft tissue. It is associated with paraneoplastic oncogenic osteomalacia through secretion of fibroblast growth factor-23 (FGF-23) which inhibits renal proximal tubule phosphate re-uptake. We report a case of a 36-year-old woman with a large chest wall tumour completely excised by extensive chest wall resection and reconstruction with polypropylene mesh-methylmethacrylate composite and pedicled muscle flaps.
MeSH term(s)	Adult ; Bone Substitutes/therapeutic use ; Female ; Humans ; Neoplasms, Connective Tissue/surgery ; Phosphates/metabolism ; Polypropylenes/therapeutic use ; Ribs/surgery ; Surgical Flaps ; Thoracic Neoplasms/surgery ; Thoracic Wall/surgery ; Thoracoplasty/methods
Chemical Substances	Bone Substitutes ; Phosphates ; Polypropylenes
Language	English
Publishing date	2016-06
Publishing country	Japan
Document type	Case Reports ; Journal Article
ZDB-ID	2376888-5
ISSN	1863-6713 ; 1863-6705
ISSN (online)	1863-6713
ISSN	1863-6705
DOI	10.1007/s11748-014-0505-8
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Zs.A 1173: Show issues

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Article ; Online: New N1/N2 classification and lobe specific lymphatic drainage: Impact on survival in patients with non-small cell lung cancer treated with surgery.

Tsitsias, Thomas / Okiror, Lawrence / Veres, Lukacs / King, Juliet / Harrison-Phipps, Karen / Routledge, Tom / Pilling, John / Bille, Andrea

Lung cancer (Amsterdam, Netherlands)

2020 Volume 151, Page(s) 84–90

Abstract: Objective: to validate the proposed N descriptor revision on a large cohort of patients and assess the impact of tumour location on the distribution pattern of lymph node metastases for patients with NSCLC.: Methods: This is a retrospective review of ...

Abstract	Objective: to validate the proposed N descriptor revision on a large cohort of patients and assess the impact of tumour location on the distribution pattern of lymph node metastases for patients with NSCLC. Methods: This is a retrospective review of a consecutive series of patients who had anatomical lung resections. Systematic lymph node dissection was done for all patients. Results: Between January 2009 and December 2019 2566 patients had surgical resection for NSCLC. 448 patients (17.5%) had histologically confirmed lymph node metastases: 257 (57.4 %) had pN1 and 191 pN2. Median age of the study population was 69.1 years. Overall survival (OS) for study population was 37.3 months with 5-year survival rate of 35.7 %. The survival analysis of the N subgroups showed the pN2 patients had a median OS of 27.9 months vs. 41.7 months for pN1 patients (p = 0.013). Analysis as per the new proposal of the N subgroups N1a vs N1b vs N2a1 vs N2a2 vs N2b showed that median survival OS was 41.7 vs. 39.2 mo vs. 33.3 mo vs. 28.9 mo vs. 24.6 mo (p = 0.099). There was statistically significant difference in survival between N2 patients with skip metastasis and N2 patients without skip metastases: OS 32.2 (95 % CI: 16.8-47.6) months vs. 24.2 months (p = 0.024). On multivariate analysis only pathological N (p = 0.011) and the new proposed N classification (p = 0.006) were independent prognostic factors for survival. Conclusions: N1 and N2 disease are heterogeneous groups and require further stratification. The number of N2 lymph node stations involved and the presence or not of N1 disease translated to significant differences in survival and therefore have to be included in N staging.
MeSH term(s)	Aged ; Carcinoma, Non-Small-Cell Lung/pathology ; Carcinoma, Non-Small-Cell Lung/surgery ; Humans ; Lung Neoplasms/pathology ; Lung Neoplasms/surgery ; Lymph Nodes/pathology ; Neoplasm Staging ; Prognosis ; Retrospective Studies
Language	English
Publishing date	2020-11-16
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	632771-0
ISSN	1872-8332 ; 0169-5002
ISSN (online)	1872-8332
ISSN	0169-5002
DOI	10.1016/j.lungcan.2020.11.005
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Zs.A 2135: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Does Previous Surgical Training Impact the Learning Curve in Video-Assisted Thoracic Surgery Lobectomy for Trainees?

Billè, Andrea / Okiror, Lawrence / Harrison-Phipps, Karen / Routledge, Tom

The Thoracic and cardiovascular surgeon

2016 Volume 64, Issue 4, Page(s) 343–347

Abstract: Background To analyze if the number of open lung resections performed by trainees before starting video-assisted thoracic surgery (VATS) lobectomy training program has any impact on intraoperative and postoperative outcomes. Materials and Methods ... ...

Abstract	Background To analyze if the number of open lung resections performed by trainees before starting video-assisted thoracic surgery (VATS) lobectomy training program has any impact on intraoperative and postoperative outcomes. Materials and Methods Retrospective analysis of 46 consecutive patients who underwent VATS lobectomies between December 2011 and September 2012 by two trainees (A.B. and L.O.). The previous surgical experience of the two trainees was evaluated to assess for any difference in terms of learning curve. Group A comprised 25 VATS lobectomies performed by one trainee (A.B.) and group B comprised 21 VATS lobectomies performed by the other trainee (L.O.). Results There was no statistical difference in terms of operating time and intraoperative bleeding between the two groups (p = 0.16 and p = 0.6). The conversion rate was 8% (2 out of 25 cases) in group A and 23.8% (5 out of 21 cases) in group B (p = 0.002). Evaluation of vascular injury showed no difference in the conversion rate (p = 0.56). The median length of the drainage and of hospital stay were 4 days and 7 days in group A and 4 days and 8 days in group B, respectively (p = 0.36 and p = 0.24). The complication rate was 44% in group A and 47.6% in group B (p = 0.52). A.B. had performed 139 and L.O. 70 operations as first operator before starting their VATS lobectomy training; the surgical experience had an impact only on the conversion rate. Conclusion Our study showed that a training program in VATS lobectomy is feasible, and previous surgical training has a minimal impact on intraoperative and postoperative outcomes.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Blood Loss, Surgical ; Clinical Competence ; Curriculum ; Drainage ; Education, Medical, Graduate/methods ; Feasibility Studies ; Female ; Humans ; Internship and Residency ; Learning Curve ; Length of Stay ; Male ; Middle Aged ; Operative Time ; Pneumonectomy/adverse effects ; Pneumonectomy/education ; Pneumonectomy/methods ; Postoperative Complications/etiology ; Retrospective Studies ; Thoracic Surgery, Video-Assisted/adverse effects ; Thoracic Surgery, Video-Assisted/education ; Thoracic Surgery, Video-Assisted/methods ; Time Factors ; Treatment Outcome
Keywords	covid19
Language	English
Publishing date	2016-06
Publishing country	Germany
Document type	Comparative Study ; Journal Article
ZDB-ID	800050-5
ISSN	1439-1902 ; 0171-6425 ; 0946-4778 ; 0172-6137
ISSN (online)	1439-1902
ISSN	0171-6425 ; 0946-4778 ; 0172-6137
DOI	10.1055/s-0034-1396094
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Article ; Online: Solitary lung meningioma with synchronous brain nodules: clinical and pathological features.

Okiror, Lawrence / von der Thusen, Jan / Ladas, George

General thoracic and cardiovascular surgery

2012 Volume 61, Issue 11, Page(s) 648–650

Abstract: Meningiomas are tumours arising from the meninges that ensheath the central nervous system. They are benign tumours, but can very rarely metastasize. We report a case of pulmonary meningioma diagnosed incidentally with concurrent brain masses in an ex- ... ...

Abstract	Meningiomas are tumours arising from the meninges that ensheath the central nervous system. They are benign tumours, but can very rarely metastasize. We report a case of pulmonary meningioma diagnosed incidentally with concurrent brain masses in an ex-smoker and discuss the difficulties in surgical decision making in a mass that may have represented lung cancer with brain metastases. We also review the literature reporting pulmonary meningiomas.
MeSH term(s)	Brain Neoplasms/diagnosis ; Female ; Humans ; Lung Neoplasms/diagnosis ; Lung Neoplasms/secondary ; Lung Neoplasms/surgery ; Meningeal Neoplasms/diagnosis ; Meningeal Neoplasms/pathology ; Meningeal Neoplasms/surgery ; Meningioma/diagnosis ; Meningioma/pathology ; Meningioma/surgery ; Middle Aged ; Neoplasms, Multiple Primary/diagnosis
Language	English
Publishing date	2012-10-10
Publishing country	Japan
Document type	Case Reports ; Journal Article ; Review
ZDB-ID	2376888-5
ISSN	1863-6713 ; 1863-6705
ISSN (online)	1863-6713
ISSN	1863-6705
DOI	10.1007/s11748-012-0163-7
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