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  1. Article ; Online: Bilateral Ultrasound-Guided Erector Spinae Plane Block for Pectus Excavatum Surgery: A Retrospective Propensity-Score Study.

    Fiorelli, Silvia / Menna, Cecilia / Andreetti, Claudio / Peritore, Valentina / Rocco, Monica / De Blasi, Roberto Alberto / Rendina, Erino Angelo / Massullo, Domenico / Ibrahim, Mohsen

    Journal of cardiothoracic and vascular anesthesia

    2022  Volume 36, Issue 12, Page(s) 4327–4332

    Abstract: Objective: Pectus excavatum (PE) repair is burdened by severe postoperative pain. This retrospective study aimed to determine whether the analgesic effect of ultrasound-guided erector spinae plane block (ESPB) plus standard intravenous analgesia (SIVA) ... ...

    Abstract Objective: Pectus excavatum (PE) repair is burdened by severe postoperative pain. This retrospective study aimed to determine whether the analgesic effect of ultrasound-guided erector spinae plane block (ESPB) plus standard intravenous analgesia (SIVA) might be superior to SIVA alone in pain control after PE surgical repair via Ravitch or Nuss technique.
    Design: A retrospective cohort study.
    Setting: At a university hospital.
    Participants: All participants were scheduled for surgical repair of PE.
    Interventions: From January 2017 to December 2019, all patients who received ESPB plus SIVA or SIVA alone were investigated retrospectively. A 2:1 propensity-score matching analysis considering preoperative variables was used to compare analgesia efficacy in 2 groups. All patients received a 24-hour continuous infusion of tramadol, 0.1 mg/kg/h, and ketorolac, 0.05 mg/kg/h, via elastomeric pump, and morphine, 2 mg, intravenously as a rescue drug. The ESPB group received preoperative bilateral ESPB block. Postoperative pain, reported using a numerical rating scale at 1, 12, 24, and 48 hours after surgery; the number of required rescue doses; total postoperative morphine milligram equivalents consumption; and the incidence of postoperative nausea and vomit were analyzed.
    Measurement and main results: A total of 105 patients were identified for analysis. Propensity-score matching resulted in 38 patients in the SIVA group and 19 patients in the ESPB group. Postoperative pain, the number of rescue doses, and postoperative nausea and vomit incidences were lower in the ESPB group (p < 0.005).
    Conclusions: Erector spinae plane block may be an effective option for pain management after surgical repair of PE as part of a multimodal approach. This study showed good perioperative analgesia, opioid sparing, and reduced opioid-related adverse effects.
    MeSH term(s) Humans ; Retrospective Studies ; Funnel Chest/surgery ; Nerve Block/methods ; Analgesics, Opioid ; Postoperative Nausea and Vomiting/surgery ; Pain, Postoperative/diagnosis ; Pain, Postoperative/etiology ; Pain, Postoperative/prevention & control ; Ultrasonography, Interventional ; Morphine Derivatives/therapeutic use
    Chemical Substances Analgesics, Opioid ; Morphine Derivatives
    Language English
    Publishing date 2022-08-27
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1067317-9
    ISSN 1532-8422 ; 1053-0770
    ISSN (online) 1532-8422
    ISSN 1053-0770
    DOI 10.1053/j.jvca.2022.08.018
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    Zs.A 2203: Show issues Location:
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  2. Article ; Online: Early Induction of Bedside Pneumoperitoneum in the Management of Residual Pleural Space and Air Leaks After Pulmonary Resection.

    Pecoraro, Alessandra / Garbarino, Giovanni Maria / Peritore, Valentina / Tiracorrendo, Matteo / Andreetti, Claudio / Ibrahim, Mohsen / Rendina, Erino Angelo / Mercantini, Paolo

    World journal of surgery

    2020  Volume 45, Issue 2, Page(s) 624–630

    Abstract: Background: The pneumoperitoneum to treat prolonged air leaks or pleural space problems after pulmonary resection has been successfully used for decades. The aim of the study is to describe our experience with the early induction of therapeutic ... ...

    Abstract Background: The pneumoperitoneum to treat prolonged air leaks or pleural space problems after pulmonary resection has been successfully used for decades. The aim of the study is to describe our experience with the early induction of therapeutic pneumoperitoneum (TP).
    Methods: We reviewed the data of 103 consecutive patients undergoing TP between September 2011 and September 2019. Patients were divided into two groups according to the time of the induction of TP: early application (≥72 h) and standard application (>72 h).
    Results: In total, 52 early TP and 51 standard TP were analyzed. The median time of TP induction was 2 (1-3) versus 8 (5-11) postoperative days (POD) (p < 0.001). The time for obliteration of the residual pleural space (7 vs.9 days, p = 0.805) and the time of resolution of the air leaks (14 vs. 16 days, p = 0.663) didn't differ between the two groups, but a favorable trend was observed in the early group. The hospital stay was lower for patients undergoing early pneumoperitoneum: 9 versus 18 days (p < 0.001). The multivariate analysis showed that POD of induction of TP (p < 0.001), time of resolution of the air leak (p < 0.001) and Heimlich valve (p = 0.002) were independent variables associated with the hospital stay.
    Conclusions: The use of TP whenever a space problem or air leaks occur after pulmonary resections is safe and effective. Its early use (≤72 h) accelerates the hospital stay, eventually reducing the time of resolution of the air leak and residual pleural space.
    MeSH term(s) Aged ; Anastomotic Leak/diagnosis ; Anastomotic Leak/etiology ; Anastomotic Leak/therapy ; Female ; Humans ; Injections, Intraperitoneal ; Length of Stay ; Male ; Middle Aged ; Pleural Diseases/diagnostic imaging ; Pleural Diseases/etiology ; Pleural Diseases/therapy ; Pneumonectomy/adverse effects ; Pneumoperitoneum, Artificial/adverse effects ; Pneumoperitoneum, Artificial/methods ; Pneumothorax/diagnostic imaging ; Pneumothorax/etiology ; Pneumothorax/therapy ; Retrospective Studies
    Language English
    Publishing date 2020-10-15
    Publishing country United States
    Document type Journal Article ; Observational Study
    ZDB-ID 224043-9
    ISSN 1432-2323 ; 0364-2313
    ISSN (online) 1432-2323
    ISSN 0364-2313
    DOI 10.1007/s00268-020-05813-7
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    Zs.A 1336: Show issues Location:
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  3. Article: Advances in Endoscopic Management of Endobronchial Carcinoid.

    Messina, Gaetana / Pica, Davide Gerardo / Vicario, Giuseppe / Bove, Mary / Natale, Giovanni / Di Filippo, Vincenzo / Capasso, Francesca / Mirra, Rosa / Panini D'Alba, Francesco / Conzo, Giovanni / Posta, Tecla Della / Giorgiano, Noemi Maria / Vicidomini, Giovanni / Capaccio, Damiano / Peritore, Valentina / Teodonio, Leonardo / Andreetti, Claudio / Rendina, Erino Angelo / Fiorelli, Alfonso

    Journal of clinical medicine

    2023  Volume 12, Issue 16

    Abstract: Introduction: Bronchial carcinoid (BC) tumors represent between 1% and 5% of all lung cancers and about 20-30% of carcinoid tumors; they are classified into two groups: typical and atypical bronchial carcinoids. The aim of the present study was to ... ...

    Abstract Introduction: Bronchial carcinoid (BC) tumors represent between 1% and 5% of all lung cancers and about 20-30% of carcinoid tumors; they are classified into two groups: typical and atypical bronchial carcinoids. The aim of the present study was to review the results of endoscopic treatments as an alternative to surgical treatment in selected patients.
    Materials and methods: The present study was a retrospective and multicentric study, in which all data were reviewed for patients with BC in the central airways, referred to the Thoracic Surgery Units of Luigi Vanvitelli University of Naples and Sant'Andrea Hospital in Rome between October 2012 and December 2022 Overall, 35 patients, 13 of whom were female, were included in the study (median age, 53 years; range, 29-75 years). All patients underwent rigid bronchoscopy combined with flexible bronchoscopy. Tumor clearance was mostly performed by use of Argon Plasma Coagulation or Thulep Laser, mechanical debridement and excision with the use of forceps and aspirator through the working channel of the 8.5 mm-sized rigid bronchoscope. There were no complications during the treatment.
    Results: Endobronchial treatment provided complete tumor eradication in all patients; two patients had controlled bleeding complications; however, bleeding was well controlled without patient desaturation, and only one patient died of renal failure during the follow-up period. We found two recurrences in the left and right main bronchus, in patients with atypical carcinoma during fiberoptic bronchoscopy follow-up. Only one patient died of renal failure. At the first analysis, there were no significant differences between the patients receiving endobronchial treatment and patients receiving surgical treatment in the present study (
    Conclusions: Endobronchial treatment is a valid and effective alternative for patients with BC unsuitable for surgery.
    Language English
    Publishing date 2023-08-16
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2662592-1
    ISSN 2077-0383
    ISSN 2077-0383
    DOI 10.3390/jcm12165337
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  4. Article ; Online: Subxifoid versus transthoracic thoracoscopic lobectomy: Results of a retrospective analysis before and after matching analysis.

    Andreetti, Claudio / Peritore, Valentina / Ibrahim, Mohsen / Gagliardi, Antonio / Argento, Giacomo / Maurizi, Giulio / Teodonio, Leonardo / Serra, Nicola / Rendina, Erino Angelo / Santini, Mario / Fiorelli, Alfonso

    Thoracic cancer

    2021  Volume 12, Issue 9, Page(s) 1279–1290

    Abstract: Background: Here, we report our initial experience with subxifoid video-assisted thoracoscopic surgery (SVATS) lobectomy for the management of primary lung cancer, and compared the outcomes of SVATS with those of conventional transthoracic VATS (CVATS) ... ...

    Abstract Background: Here, we report our initial experience with subxifoid video-assisted thoracoscopic surgery (SVATS) lobectomy for the management of primary lung cancer, and compared the outcomes of SVATS with those of conventional transthoracic VATS (CVATS) lobectomies to validate its feasibility and usefulness.
    Methods: The clinical data of consecutive patients undergoing VATS lobectomy via SVATS or CVATS for lung cancer were retrospectively compared. The endpoints were to evaluate the statistical differences in surgical results, postoperative pain (measured with visual analog scale [VAS] scores at 8 hours, Day 1, Day 2, Day 3, at discharge, one month and three months after surgery) and paresthesia (measured at one- month, and three months after surgery). The two groups were compared before and after matching analysis.
    Results: Our study population included 223 patients: 84 in the SVATS and 139 in the CVATS group. The two groups were not comparable for sex (P = 0.001), preoperative comorbidity as cardiopathy (P = 0.007), BMI value (P = 0.003), left-sided procedure (P = 0.04), tumor stage (P = 0.04), and tumor size (P = 0.002). These differences were overcome by propensity score matching (PSM) analysis that yielded two well-matched groups which included 61 patients in each group. Surgical outcomes including blood loss, hospital stay and complications were similar before and after matching analysis, but SVATS compared to CVATS was associated with longer operative time before (159 ± 13 vs. 126 ± 6.3, P < 0.0001), and after matching analysis (161 ± 23 vs. 119 ± 8.3; P < 0.0001) and significant reduction of postoperative pain during the different time-points (P < 0.001), and paresthesia at one (P = 0.001), and three months (P < 0.0001).
    Conclusions: SVATS lobectomy is a feasible and safe strategy with surgical outcomes similar to CVATS lobectomy but with less postoperative pain and paresthesia.
    Key points: SIGNIFICANT FINDINGS OF THE STUDY: Subxifoid thoracoscopic lobectomy is a feasible and safe procedure, with potential benefits in terms of postoperative pain and paresthesia compared to conventional thoracoscopic lobectomy Our results showed that surgical outcomes including blood loss, hospital stay, morbidity and mortality are similar but subxifoid thoracoscopy was associated with significant reduction of postoperative pain and paresthesia.
    What this study adds: Subxifoid thoracoscopy is a safe procedure; compared to conventional transthoracic thoracoscopy, it avoids intercostal incisions, and spares nerve trauma, resulting in a reduction of postoperative pain and paresthesia.
    MeSH term(s) Carcinoma, Non-Small-Cell Lung/surgery ; Female ; Humans ; Lung Neoplasms/surgery ; Male ; Matched-Pair Analysis ; Middle Aged ; Pneumonectomy/methods ; Retrospective Studies ; Thoracic Surgery, Video-Assisted/methods
    Language English
    Publishing date 2021-03-10
    Publishing country Singapore
    Document type Journal Article
    ZDB-ID 2625856-0
    ISSN 1759-7714 ; 1759-7706
    ISSN (online) 1759-7714
    ISSN 1759-7706
    DOI 10.1111/1759-7714.13778
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    Zs.A 6921: Show issues Location:
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  5. Article ; Online: Intraoperative cardiac function assessment by transesophageal echocardiography versus FloTrac/Vigileo™ system during pectus excavatum surgical repair.

    Fiorelli, Silvia / Capua, Gelsomina / Menna, Cecilia / Andreetti, Claudio / Giorni, Elisabetta / Riva, Ettore / Agostini, Elisabetta / D'Andrea, Fabrizio / Massullo, Elisa / Peritore, Valentina / Rocco, Monica / Massullo, Domenico

    Journal of Anesthesia, Analgesia and Critical Care (Online)

    2021  Volume 1, Issue 1, Page(s) 21

    Abstract: Background: Pectus excavatum (PE), a congenital deformity of the chest wall, can lead to cardiac compression and related symptoms. PE surgical repair can improve cardiac function. Intraoperative transesophageal echocardiography (TEE) has been ... ...

    Abstract Background: Pectus excavatum (PE), a congenital deformity of the chest wall, can lead to cardiac compression and related symptoms. PE surgical repair can improve cardiac function. Intraoperative transesophageal echocardiography (TEE) has been successfully employed to assess intraoperative hemodynamic variations in patients undergoing PE repair. FloTrac/Vigileo™ system (Edwards Life-sciences Irvine, CA) (FT/V) is a minimally invasive cardiac output monitoring system. This retrospective study aimed to assess hemodynamic changes in surgical repair of PE using FT/V and concordance with parameters measured by TEE.
    Results: N=19 patients submitted to PE repair via Ravitch or Nuss technique were enrolled. Intraoperative cardiac assessments simultaneously obtained via TEE and FT/V system were investigated. The agreement between TEE-derived cardiac output (CO-TEE) and FT/V system parameter (COAP) was evaluated. The relationship between COTEE and COAP was analyzed for all data using linear regression analysis. A significant correlation between COAP and COTEE values (R = 0.65, p < 0.001) was found. Bland-Altman analysis of COAP and COTEE showed a bias of 0.13 L/min and a limit of agreement of - 2.33 to 2.58 L/min, with a percentage error of 48%. Intraoperative measurements by TEE and FT/V both showed a significant increase in CO after surgical correction of PE (p < 0.005).
    Conclusions: FT/V system compared to TEE in hemodynamic monitoring during PE surgery yielded clinically unacceptable results due to a high percentage error. After surgical correction of PE, CO, measured by TEE and FT/V, significantly improved.
    Language English
    Publishing date 2021-12-09
    Publishing country England
    Document type Journal Article
    ISSN 2731-3786
    ISSN (online) 2731-3786
    DOI 10.1186/s44158-021-00025-4
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  6. Article ; Online: Bilateral ultrasound-guided erector spinae plane block for postoperative pain management in surgical repair of pectus excavatum via Ravitch technique.

    Fiorelli, Silvia / Leopizzi, Giulio / Saltelli, Giorgia / Andreetti, Claudio / Fiorelli, Alfonso / Peritore, Valentina / Rocco, Monica / Massullo, Domenico

    Journal of clinical anesthesia

    2019  Volume 56, Page(s) 28–29

    MeSH term(s) Adolescent ; Adult ; Anesthesia, Intravenous/methods ; Funnel Chest/surgery ; Humans ; Male ; Nerve Block/methods ; Orthopedic Procedures/adverse effects ; Orthopedic Procedures/methods ; Pain Measurement ; Pain, Postoperative/diagnosis ; Pain, Postoperative/etiology ; Pain, Postoperative/prevention & control ; Paraspinal Muscles/diagnostic imaging ; Paraspinal Muscles/innervation ; Treatment Outcome ; Ultrasonography, Interventional
    Language English
    Publishing date 2019-01-23
    Publishing country United States
    Document type Case Reports ; Letter
    ZDB-ID 1011618-7
    ISSN 1873-4529 ; 0952-8180
    ISSN (online) 1873-4529
    ISSN 0952-8180
    DOI 10.1016/j.jclinane.2019.01.026
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    Zs.A 2622: Show issues Location:
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  7. Article ; Online: Anorectal melanoma: a rare aggressive type of melanoma.

    Virgilio, Edoardo / Mercantini, Paolo / Santangelo, Giusi / Canali, Giulia / Peritore, Valentina / Balducci, Genoveffa

    ANZ journal of surgery

    2017  Volume 87, Issue 5, Page(s) 421–422

    MeSH term(s) Aged ; Anal Canal/pathology ; Anal Canal/surgery ; Anus Neoplasms/diagnostic imaging ; Anus Neoplasms/pathology ; Colonoscopy/methods ; Female ; Humans ; Immunotherapy/methods ; Melanoma/drug therapy ; Melanoma/pathology ; Melanoma/surgery ; Rectal Neoplasms/diagnostic imaging ; Rectal Neoplasms/pathology ; Rectal Neoplasms/surgery ; Treatment Outcome
    Language English
    Publishing date 2017-05-03
    Publishing country Australia
    Document type Case Reports ; Letter
    ZDB-ID 2050749-5
    ISSN 1445-2197 ; 1445-1433 ; 0004-8682
    ISSN (online) 1445-2197
    ISSN 1445-1433 ; 0004-8682
    DOI 10.1111/ans.13942
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  8. Article ; Online: Histological growth patterns and molecular analysis of resected colorectal lung metastases.

    Pilozzi, Emanuela / Fedele, Damiano / Montori, Andrea / Lorenzon, Laura / Peritore, Valentina / Mannocchi, Giorgia / Bagheri, Nikta / Leone, Chiara / Palumbo, Antonio / Roberto, Michela / Ranazzi, Giulio / Rendina, Erino / Balducci, Genoveffa / Ibrahim, Mohsen

    Pathology, research and practice

    2021  Volume 222, Page(s) 153414

    Abstract: Lung is the site of metastasis in about 15-25 % of colorectal cancer (CRC) patients. Lung metastasectomy of CRC represents a standard therapy in patients with resectable metastases. In this study we investigated both histological patterns of metastases ... ...

    Abstract Lung is the site of metastasis in about 15-25 % of colorectal cancer (CRC) patients. Lung metastasectomy of CRC represents a standard therapy in patients with resectable metastases. In this study we investigated both histological patterns of metastases and mutations in MAPkinase pathway genes and their relationship to prognosis. The study included 74 patients that underwent metastasectomy of colorectal lung metastasis (CLM). In patients that underwent surgical resection of more than one metastasis in the same operation the largest was chosen. In patients that had undergone multiple lung metastasectomy only the sample from the first metastasectomy was included. Histologically metastases were scored according to amount and distribution of necrosis and fibrosis and three patterns were identified: "pattern A", metastasis with extensive, confluent central necrosis surrounded by a rim of neoplastic glands; "pattern B", metastasis characterized by a proliferation of neoplastic glands in a dense stroma with focal necrosis mainly intraglandular; "pattern C", metastasis with a mixed A and B morphology. In all samples direct sequencing of exon 2 of KRAS and NRAS genes and exon 15 of BRAF genes was carried out.Histological patterns weren't related to metastasis size or other clinical features however pattern C metastases showed a significant worst disease free survival (DFS). KRAS mutations were observed in 39 % of patients. Mutations in KRAS codon 13 resulted significantly associated with synchronous metastasis and poor prognosis. No mutations were identified in exon 2 NRAS gene whilst 1.4 % harboured a mutation in BRAF. To our knowledge this is the first study that investigates in a large series of CLM histological growth patterns, molecular alterations and their relationship to prognosis. Our data suggest a prognostic role in CLM of KRAS specific mutations and histopathological patterns.
    MeSH term(s) Aged ; Biomarkers, Tumor/genetics ; Colorectal Neoplasms/genetics ; Colorectal Neoplasms/mortality ; Colorectal Neoplasms/pathology ; Disease-Free Survival ; Exons ; Humans ; Lung Neoplasms/genetics ; Lung Neoplasms/mortality ; Lung Neoplasms/pathology ; Male ; Middle Aged ; Prognosis ; Progression-Free Survival ; ras Proteins/genetics
    Chemical Substances Biomarkers, Tumor ; ras Proteins (EC 3.6.5.2)
    Language English
    Publishing date 2021-03-24
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 391889-0
    ISSN 1618-0631 ; 0344-0338
    ISSN (online) 1618-0631
    ISSN 0344-0338
    DOI 10.1016/j.prp.2021.153414
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  9. Article ; Online: Cardio-Pulmonary Changes After Bronchoscopic Lung Volume Reduction with Endobronchial One-Way Valves.

    Fiorelli, Alfonso / Cascone, Roberto / Natale, Giovanni / Peritore, Valentina / Vanni, Camilla / Poggi, Camilla / Venuta, Federico / Rendina, Erino Angelo / Santini, Mario / Andreetti, Claudio

    Lung

    2020  Volume 198, Issue 3, Page(s) 565–573

    Abstract: Introduction: To evaluate the cardio-pulmonary hemodynamics changes before and after valve treatment, and their correlation with lobe volume reduction.: Methods: This retrospective multicentre study included consecutive patients undergoing ... ...

    Abstract Introduction: To evaluate the cardio-pulmonary hemodynamics changes before and after valve treatment, and their correlation with lobe volume reduction.
    Methods: This retrospective multicentre study included consecutive patients undergoing bronchoscopic valve treatment for heterogeneous emphysema. In addition to standard functional evaluation, patients underwent cardiac evaluation by Doppler trans-thoracic echocardiography. The difference in respiratory and cardio-pulmonary hemodynamics indexes before and 3-month after the procedure, and their relationship with changes in lobar volume were evaluated.
    Results: Seventy-seven patients were included in the study; of these 13 (17%) presented pulmonary hypertension. Only patients with target lobar volume reduction ≥ 563 mL (n = 50) presented a significant improvement of forced expiratory volume in one second, residual volume, 6 min-walk test, and St. George's Respiratory Questionnaire score; a significant reduction of pulmonary artery pressure, and an improvement of left and right ventricle end-systolic volume; of left and right ventricle end-diastolic volume, and of left and right ventricle stroke volume. The change in residual volume was significantly correlated with changes in forced expiratory volume in one second (r = 0.68; p < 0.001); in 6 min-walk test (r = 0.71; p < 0.001); in St. George's Respiratory Questionnaire (r = 0.54; p < 0.001); in pulmonary artery pressure (r = 0.39; p = 0.001), in left (r = 0.28; p = 0.01) and right (r = 0.33; p = 0.002) ventricle end-systolic volume, in left (r =  - 0.29; p = 0.008) and right (r =  - 0.34; p = 0.007) end-diastolic volume, and in left (r =  - 0.76; p = 0.009) and right (r =  - 0.718; p = 0.001) ventricle stroke volume.
    Conclusion: Bronchoscopic valve treatment seemed to have positive effects on cardio-pulmonary hemodynamics, and these changes were correlated with reductions of lobar volume.
    MeSH term(s) Aged ; Bronchoscopy/methods ; Female ; Forced Expiratory Volume/physiology ; Hemodynamics/physiology ; Humans ; Lung Volume Measurements ; Male ; Pneumonectomy/methods ; Pulmonary Emphysema/diagnosis ; Pulmonary Emphysema/physiopathology ; Pulmonary Emphysema/surgery ; Residual Volume/physiology ; Retrospective Studies ; Surveys and Questionnaires ; Tomography, X-Ray Computed ; Treatment Outcome
    Language English
    Publishing date 2020-04-07
    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/s00408-020-00351-4
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  10. Article: Surgical Resection of Pulmonary Metastases from Melanoma in Oligometastatic Patients: Results from a Multicentric Study in the Era of Immunoncology and Targeted Therapy.

    Meacci, Elisa / Nachira, Dania / Congedo, Maria Teresa / Ibrahim, Mohsen / Pariscenti, Gianluca / Petrella, Francesco / Casiraghi, Monica / De Stefani, Alessandro / Del Regno, Laura / Peris, Ketty / Triumbari, Elizabeth Katherine Anna / Schinzari, Giovanni / Rossi, Ernesto / Petracca-Ciavarella, Leonardo / Vita, Maria Letizia / Chiappetta, Marco / Siciliani, Alessandra / Peritore, Valentina / Manitto, Mattia /
    Morelli, Lucia / Zanfrini, Edoardo / Tabacco, Diomira / Calabrese, Giuseppe / Bardoni, Claudia / Evangelista, Jessica / Spaggiari, Lorenzo / Margaritora, Stefano

    Cancers

    2023  Volume 15, Issue 9

    Abstract: In the last decade, the emergence of effective systemic therapies (ESTs) in the form of both targeted and immuno-based therapies has revolutionized the treatment of patients with advanced stage III and stage IV melanoma. Even though lungs represent the ... ...

    Abstract In the last decade, the emergence of effective systemic therapies (ESTs) in the form of both targeted and immuno-based therapies has revolutionized the treatment of patients with advanced stage III and stage IV melanoma. Even though lungs represent the most frequent site of melanoma metastases, only limited data are available on the role of surgery in isolated pulmonary metastases from malignant melanoma (PmMM) in the era of ESTs. The aim of this study is to describe the outcomes of patients who underwent metastasectomy of PmMM in the era of ESTs, in order to identify prognostic factors affecting survival and to provide a framework for more informed patient selection of treatmeant with lung surgery in the future. Clinical data of 183 patients who underwent metastasectomy of PmMM between June 2008 and June 2021 were collected among four Italian Thoracic Centers. The main clinical, surgical and oncological variables reviewed were: sex, comorbidities, previous oncological history, melanoma histotypes and primary site, date of primary cancer surgical treatment, melanoma growth phase, Breslow thickness, mutation pattern disease, stage at diagnosis, metastatic sites, DFI (Disease Free Interval), characteristics of lung metastases (number, side, dimension, type of resection), adjuvant therapy after lung metastasectomy, site of recurrence, disease-free survival (DFS) and cancer-specific survival (CSS; defined as the time interval between the first melanoma resection or lung metastasectomy and death from cancer). All patients underwent surgical resection of the primary melanoma before lung metastasectomy. Twenty-six (14.2%) patients already had a synchronous lung metastasis at the time of primary melanoma diagnosis. A wedge resection was performed in 95.6% of cases to radically remove the pulmonary localizations, while an anatomical resection was necessary in the remaining cases. The incidence of major post-operative complications was null, while only 21 patients (11.5%) developed minor complications (mainly air leakage followed by atrial fibrillation). The mean in-hospital stay was 4.46 ± 2.8 days. Thirty- and sixty-day mortality were null. After lung surgery, 89.6% of the population underwent adjuvant treatments (47.0% immunotherapy, 42.6% targeted therapy). During a mean FUP of 107.2 ± 82.3 months, 69 (37.7%) patients died from melanoma disease, 11 (6.0%) from other causes. Seventy-three patients (39.9%) developed a recurrence of disease. Twenty-four (13.1%) patients developed extrapulmonary metastases after pulmonary metastasectomy. The CSS from melanoma resection was: 85% at 5 years, 71% at 10 years, 54% at 15 years, 42% at 20 years and 2% at 25 years. The 5- and 10-year CSS from lung metastasectomy were 71% and 26%, respectively. Prognostic factors negatively affecting CSS from lung metastasectomy at multivariable analysis were: melanoma vertical growth (
    Language English
    Publishing date 2023-04-25
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2527080-1
    ISSN 2072-6694
    ISSN 2072-6694
    DOI 10.3390/cancers15092462
    Database MEDical Literature Analysis and Retrieval System OnLINE

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