Publications by authors named "Eugenio Pompeo"

93 Publications

Ergonomical Assessment of Three-Dimensional Versus Two-Dimensional Thoracoscopic Lobectomy.

Semin Thorac Cardiovasc Surg 2020 Winter;32(4):1089-1096. Epub 2020 May 23.

Department of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy. Electronic address:

In this study. we compared ergonomical domains characteristics of three-dimensional (3D) versus two-dimensional (2D) video-systems in thoracoscopic lobectomy using a scoring-scale-based assessment. Seventy patients (mean age, 69 ± 6.9 years, 43 males and 27 females) with early stage lung cancer were randomized to undergo thoracoscopic lobectomy by either 3D (N = 35) or 2D (N = 35) video-systems. All operations were divided into 5 standardized surgical steps (vein, artery, bronchus, fissure, and lymph nodes), which were evaluated by 4 thoracic surgeons using a scoring scale (score range from 1, unsatisfactory to 3,excellent) entailing assessment of 3 ergonomical domains: exposure, instrumentation and maneuvering. Primary outcome was a difference ≥10% in the maneuvering domain steps. At intergroup comparisons, there was no difference in demographics. The 3D system results were better for maneuvering domain total score and particularly for the artery and bronchus steps scores (score ≥10%, P ≤ 0.006). Other significant differences included exposure of the vein, artery and bronchus (P ≤ 0.03). Results favoring the 2D system included maneuvering, exposure and instrumentation of the fissure (P = 0.001). Inter-rater concordance of ergonomics scoring was satisfactory (Cronbach's α range, 0.85-0.88). Operative time was significantly shorter in the 3D group (127 ± 19 min vs 143±18 min, P = 0.001) whereas there was no difference in hospital stay (3.4 ± 1.2 vs 4.1 ± 1.6 days, P = 0.07). In this study comparison of ergonomic domains scoring in 3D versus 2D thoracoscopic lobectomy favored the 3D system for the maneuvering total score, which proved inversely correlated with operative times possibly due to a better perception of depth and more precise surgical maneuvering.
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http://dx.doi.org/10.1053/j.semtcvs.2020.05.018DOI Listing
May 2020

Commentary: Two bullectomies for one pneumothorax-A good deal?

J Thorac Cardiovasc Surg 2020 03 19;159(3):1128-1129. Epub 2019 Sep 19.

Department of Cardiothoracic Surgery, Tanta University, Tanta, Egypt.

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http://dx.doi.org/10.1016/j.jtcvs.2019.08.060DOI Listing
March 2020

Thymomatous myasthenia gravis: novel association with HLA DQB1*05:01 and strengthened evidence of high clinical and serological severity.

J Neurol 2019 Apr 11;266(4):982-989. Epub 2019 Feb 11.

Laboratorio d'Immunogenetica dei Trapianti, Dipartimento di Oncoematologia e Terapia Cellulare e Genica, IRCCS OPBG, Rome, Italy.

Background: The relative prevalence of myasthenia gravis (MG) subtypes is changing, and their differential features and association with HLA class II alleles are not completely understood.

Methods: Age at onset, presence/absence of autoantibodies (Ab) and thymoma were retrospectively considered in 230 adult Italian patients. Clinical severity, assessed by MGFA scale, and the highest Ab titer were recorded. Furthermore, we performed low/high resolution typing of HLA-DRB1 and HLA-DQB1 alleles to detect associations of these loci with MG subtypes.

Results: There were two peaks of incidence: under 41 years of age, with female preponderance, and over 60 years, with higher male prevalence. The former group decreased and the latter increased significantly when comparing onset period 2008-2015 to 2000-2007. Thymomatous (TMG) patients showed a higher prevalence of severe phenotype and significantly higher anti-AChR Ab titer than non-thymomatous (NTMG) patients. Among the latter, those with onset after 60 years of age (LO-NTMG) displayed significantly higher Ab titers but lower MGFA grade compared to early-onset patients (< 41 years; EO-NTMG). Significant associations were found between HLA DQB1*05:01 and TMG patients and between DQB1*05:02 and DRB1*16 alleles and LO-NTMG with anti-AChR Ab.

Conclusions: Two distinct cutoffs (< 41 and > 60 years) conveniently define EO-NTMG and LO-NTMG, with different characteristics. LO-NTMG is the most frequent disease subtype, with an increasing incidence. TMG patients reach higher clinical severity and higher antibody titers than NTMG patients. Moreover, TMG and LO-NTMG with anti-AChR Ab differ in their HLA-DQ association, providing further evidence that these two forms may have different etiologic mechanisms.
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http://dx.doi.org/10.1007/s00415-019-09225-zDOI Listing
April 2019

Spontaneous ventilation thoracoscopic thymectomy: attractive or exceptionable?

J Thorac Dis 2018 Nov;10(Suppl 33):S3981-S3983

Department of Cardiothoracic Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt.

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http://dx.doi.org/10.21037/jtd.2018.09.75DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6297479PMC
November 2018

Nonintubated surgical biopsy of undetermined interstitial lung disease: a multicentre outcome analysis.

Interact Cardiovasc Thorac Surg 2019 05;28(5):744-750

Section of Biostatistics, Tor Vergata University, Rome, Italy.

Objectives: Nonintubated surgical biopsy (NISB) of interstitial lung disease (ILD) has shown promise in unicentre reports as a reliable method to achieve pathological diagnosis with low morbidity. The aim of this study was to investigate for the first time early outcomes of NISB of ILD using a multicentre retrospective analysis.

Methods: Seven European and extra-European institutions participated in the study. Overall, 112 procedures were included. The mean age was 60 ± 12 years (65 men and 47 women). Preoperative total lung capacity and diffusion capacity of carbon monoxide were 74 ± 16% predicted and 57 ± 18% predicted, respectively. Forty-five patients had 1 or more associated comorbidities. NISB of ILD were performed under spontaneous ventilation by intercostal block (n = 84) or epidural anaesthesia (n = 28) with (n = 58) or without (n = 54) sedation and by thoracoscopic surgery (n = 88) or minithoracotomy (n = 24).

Results: Mean anaesthesia time, operative time and global time spent in the operating room were 31 ± 31 min, 29 ± 15 min and 89 ± 156 min, respectively. Feasibility was scored as excellent, good, satisfactory or unsatisfactory requiring conversion to general anaesthesia with intubation in 92, 12, 2 and 6 instances, respectively. There were no deaths. Morbidity was 7.1% and included prolonged air leaks in 4 patients and pneumonia, atelectasis, anaemia and gastric bleeding in 1 patient each. A precise pathological diagnosis was achieved in 108 patients (96%). The mean hospital stay was 2.5 ± 2.7 days. Comparisons of results achieved in the largest single-centre series (group A, 60 patients operated on) versus those resulting from the sum of the patients operated on in the other centres (group B, 52 patients operated on) showed no differences in feasibility (P = 0.10) and morbidity (P = 0.10) whereas hospital stay was shorter in group A (1.3 ± 0.5 days vs 3.9 ± 3.4 days, P < 0.001).

Conclusions: Results of this multicentre study confirm the satisfactory feasibility of NISB of ILD in 82% of patients with no deaths and a low morbidity rate. Intergroup comparisons indicated that the hospital stay was shorter in group A whereas there were no differences in feasibility and morbidity rates.
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http://dx.doi.org/10.1093/icvts/ivy320DOI Listing
May 2019

Thoracic Aneurysm Sac Endoleak. Not Only a Risk of Rupture.

Ann Vasc Surg 2019 04 23;56:360-361. Epub 2018 Nov 23.

Vascular Surgery Unit, Biomedicine and Prevention Department, University of Rome Tor Vergata, Rome, Italy.

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http://dx.doi.org/10.1016/j.avsg.2018.11.003DOI Listing
April 2019

Hump-like giant desmoid tumor of the chest: a postresectional reconstruction challenge.

AME Case Rep 2017 17;1. Epub 2017 Nov 17.

Department of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy.

Desmoid tumors (DT) are rare neoplasms with unknown etiology arising from musculoaponeurotic structures. Chest wall localization is uncommon and has been associated with high recurrence rate unless radical resection with negative margins is carried out. Postresectional reconstruction can be challenging in presence of giant lesions and might require adoption of complex reconstruction methods including use of well vascularized muscle flaps. We present a case of giant hump-like recurrent chest wall DT, which was radically resected following placement of multiple subcutaneous silicon tissue expanders, to gain redundant skin, which eventually allowed in conjunction with two transposition, cutaneous-adipose flaps, harvested from the upper gluteal region, an optimal reconstruction of the large postresectional defect.
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http://dx.doi.org/10.21037/acr.2017.11.01DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6155693PMC
November 2017

Staged unilateral lung volume reduction surgery: from mini-invasive to minimalist treatment strategies.

J Thorac Dis 2018 Aug;10(Suppl 23):S2754-S2762

Department of Radiology, Policlinico Tor Vergata University, Rome, Italy.

Lung volume reduction surgery (LVRS) entailing unilateral or bilateral non-anatomical resection of severely damaged emphysematous tissue carried out by thoracoscopic or open surgical approaches, under general anesthesia with single-lung ventilation, has resulted in significant and long-lasting clinical and functional benefit. Unfortunately, the morbidity rates reported by simultaneous bilateral resectional LVRS has led to raise criticism regarding its cost-effectiveness and has stimulated in recent years the development of less invasive bronchoscopic and surgical non-resectional methods of treatment that are preferentially performed in a staged unilateral fashion. We had previously proposed an innovative LVRS modality, which did not entail any resection of lung tissue and was electively carried out according to a staged unilateral strategy by a multiport thoracoscopic access, through thoracic epidural anesthesia in conscious, spontaneously ventilating patients (awake LVRS). The awake LVRS resulted in significant clinical benefit paralleling that achieved by the resectional method with lower morbidity rates and shorter hospital stay. Moreover, the awake LVRS proved also suitable to be employed in stringently selected patients to perform redo procedures following previous successful bilateral LVRS. More recently, in order to minimize the global surgery- and anesthesia-related traumas, we have modified our original non-resectional method by adopting a single thoracoscopic access as well as an anesthesia protocol entailing use of a simple intercostal block with target control sedation, to realize an ultra-minimally invasive or LVRS. Hence, a deeper investigation of the pros and cons of staged unilateral LVRS strategies as well as of the novel surgical non-resectional and redo LVRS is warranted in order to verify, the optimal strategies of treatment, which will prove to reduce the typical LVRS-related morbidity while assuring the most durable benefit in patients with advanced emphysema.
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http://dx.doi.org/10.21037/jtd.2018.05.171DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6129814PMC
August 2018

Nonintubated Subxiphoid Bilateral Redo Lung Volume Reduction Surgery.

Ann Thorac Surg 2018 11 24;106(5):e277-e279. Epub 2018 May 24.

Department of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy. Electronic address:

This report describes a nonintubated, bilateral thoracoscopic redo lung volume reduction surgery procedure through a single subxiphoid access in a patient who previously underwent one-stage bilateral volume reduction for upper lobe-predominant heterogeneous emphysema 19 years earlier. The patient was uneventfully discharged on postoperative day 2, and meaningful improvement in respiratory function and exercise tolerance occurred at 3 months postoperatively. This novel surgical approach may merge the potential benefits of a subxiphoid incision for bilateral treatment, nonintercostal passage of chest drains, and adoption of a nonintubated anesthesia protocol.
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http://dx.doi.org/10.1016/j.athoracsur.2018.04.061DOI Listing
November 2018

Sliding esophagoplasty in esophageal obstruction after endovascular stent grafting of thoracic aortic aneurysm.

J Thorac Cardiovasc Surg 2018 07 17;156(1):e23-e26. Epub 2018 Feb 17.

Department of Vascular Surgery, Policlinico Tor Vergata University, Rome, Italy.

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http://dx.doi.org/10.1016/j.jtcvs.2018.02.037DOI Listing
July 2018

Laser speckle flow graph-assisted sympathetic gangliectomy for treatment of facial blushing: Can technology aid psychology?

Authors:
Eugenio Pompeo

J Thorac Cardiovasc Surg 2018 09 13;156(3):1332-1333. Epub 2018 Feb 13.

Department of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy. Electronic address:

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http://dx.doi.org/10.1016/j.jtcvs.2018.01.077DOI Listing
September 2018

A new method of infrared-fluorescence-enhanced thoracoscopic segmentectomy.

Asian Cardiovasc Thorac Ann 2018 Mar 11;26(3):247-249. Epub 2018 Jan 11.

2 Department of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy.

Optimal identification of the intersegmental plane can be challenging during thoracoscopic anatomical segmentectomy for lung cancer. We describe a simple new method of infrared-fluorescence-enhanced thoracoscopy with selected injection of indocyanine green into the bronchi not targeted for resection, which allows us to clearly identify the intersegmental plane in thoracoscopic segmentectomy.
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http://dx.doi.org/10.1177/0218492317751827DOI Listing
March 2018

Minimalist thoracoscopic resection of thymoma associated with myasthenia gravis.

J Thorac Cardiovasc Surg 2017 10 22;154(4):1463-1465. Epub 2017 Jun 22.

Department of Thoracic Surgery, Assaf Harofeh Medical Center, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.

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http://dx.doi.org/10.1016/j.jtcvs.2017.05.084DOI Listing
October 2017

Minimalist video-assisted thoracic surgery biopsy of mediastinal tumors.

J Thorac Dis 2016 Dec;8(12):3704-3710

Department of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy.

Background: Mediastinal tumors often require surgical biopsy to achieve a precise and rapid diagnosis. However, subjects with mediastinal tumors may be unfit for general anesthesia, particularly when compression of major vessels or airways does occur. We tested the applicability in this setting of a minimalist (M) uniportal, video-assisted thoracic surgery (VATS) strategy carried out under locoregional anesthesia in awake patients (MVATS).

Methods: We analyzed in a comparative fashion including propensity score matching, data from a prospectively collected database of patients who were offered surgical biopsy for mediastinal tumors through either MVATS or standard VATS. Tested outcome measures included feasibility, diagnostic yield, and morbidity.

Results: A total of 24 procedures were performed through MVATS. Diagnostic yield was 100%. Median hospital stay and time interval to oncologic treatment were 2 days (IQR, 2-3 days) and 7 days (IQR, 5.5-11.5 days), respectively. At overall comparison (MVATS, N=24 VATS, N=23), there was a significant difference in both frequency and severity of postoperative complication as measured by Clavien-Dindo classification (P<0.006). In a propensity score matched comparison (8 patients per group), grade 3 or 4 complications requiring aggressive management were found only in the general anesthesia group. Global time spent in the operating room was shorter in the MVATS group (P=0.05). Time interval to oncological treatment was the same between groups. Other differences were also found in SIRS score (P=0.05) and PaO/FiO (P=0.04) thus suggesting better adaption to perioperative stress.

Conclusions: MVATS biopsy appears to be a reliable tool to optimize diagnostic assessment in patients with mediastinal tumors. It can offer high diagnostic accuracy due to large tissue samples, while reducing morbidity rate compared to the same operation under general anesthesia. More robust evaluation is needed to define the appropriateness of MVATS in this specific clinical setting.
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http://dx.doi.org/10.21037/jtd.2016.06.33DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5227266PMC
December 2016

Pectoralis Muscle Flap Repair Reduces Paradoxical Motion of the Chest Wall in Complex Sternal Wound Dehiscence.

Korean J Thorac Cardiovasc Surg 2016 Oct 5;49(5):366-373. Epub 2016 Oct 5.

Cardiac Surgery Unit, Clinica Mediterranea, Policlinic of Tor Vergata University.

Background: The aim of the study was to test the hypothesis that in patients with chronic complex sternum dehiscence, the use of muscle flap repair minimizes the occurrence of paradoxical motion of the chest wall (CWPM) when compared to sternal rewiring, eventually leading to better respiratory function and clinical outcomes during follow-up.

Methods: In a propensity score matching analysis, out of 94 patients who underwent sternal reconstruction, 20 patients were selected: 10 patients underwent sternal reconstruction with bilateral pectoralis muscle flaps (group 1) and 10 underwent sternal rewiring (group 2). Eligibility criteria included the presence of hemisternum diastases associated with multiple (≥3) bone fractures and radiologic evidence of synchronous chest wall motion (CWSM). We compared radiologically assessed (volumetric computed tomography) ventilatory mechanic indices such as single lung and global vital capacity (VC), diaphragm excursion, synchronous and paradoxical chest wall motion.

Results: Follow-up was 100% complete (mean 85±24 months). CWPM was inversely correlated with single lung VC (Spearman R=-0.72, p=0.0003), global VC (R=-0.51, p=0.02) and diaphragm excursion (R=-0.80, p=0.0003), whereas it proved directly correlated with dyspnea grade (Spearman R=0.51, p=0.02) and pain (R=0.59, p=0.005). Mean CWPM and single lung VC were both better in group 1, whereas there was no difference in CWSM, diaphragm excursion and global VC.

Conclusion: Our study suggests that in patients with complex chronic sternal dehiscence, pectoralis muscle flap reconstruction guarantees lower CWPM and greater single-lung VC when compared with sternal rewiring and it is associated with better clinical outcomes with less pain and dyspnea.
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http://dx.doi.org/10.5090/kjtcs.2016.49.5.366DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5059123PMC
October 2016

Non-intubated video-assisted thoracic surgery: where does evidence stand?

J Thorac Dis 2016 Apr;8(Suppl 4):S364-75

Department of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy.

In recent years, non-intubated video-assisted thoracic surgery (NIVATS) strategies are gaining popularity worldwide. The main goal of this surgical practice is to achieve an overall improvement of patients' management and outcome thanks to the avoidance of side-effects related to general anesthesia (GA) and one-lung ventilation. The spectrum of expected benefits is multifaceted and includes reduced postoperative morbidity, faster discharge, decreased hospital costs and a globally reduced perturbation of patients' well-being status. We have conducted a literature search to evaluate the available evidence on this topic. Meta-analysis of collected results was also done where appropriate. Despite some fragmentation of data and potential biases, the available data suggest that NIVATS operations can reduce operative morbidity and hospital stay when compared to equipollent procedures performed under GA. Larger, well designed prospective studies are thus warranted to assess the effectiveness of NIVATS as far as to investigate comprehensively the various outcomes. Multi-institutional and multidisciplinary cooperation will be welcome to establish uniform study protocols and to help address the questions that are to be answered yet.
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http://dx.doi.org/10.21037/jtd.2016.04.39DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4856847PMC
April 2016

The impact of non-intubated versus intubated anaesthesia on early outcomes of video-assisted thoracoscopic anatomical resection in non-small-cell lung cancer: a propensity score matching analysis.

Eur J Cardiothorac Surg 2016 Nov 10;50(5):920-925. Epub 2016 May 10.

Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China

Objectives: To comparatively assess the impact of non-intubated intravenous anaesthesia with spontaneous ventilation (NIIASV) versus intubated anaesthesia with single-lung mechanical ventilation (IASLV) on early outcomes of video-assisted thoracoscopic (VATS) anatomical resection of non-small-cell lung cancer (NSCLC).

Methods: A total of 339 patients with NSCLC undergoing VATS anatomical resection (282 lobectomies and 57 segmentectomies) between December 2011 and December 2014 were included for analysis and divided into two groups according to anaesthesia type: NIIASV (151 patients) and IASLV (188 patients). Comprehensive early outcome data including intraoperative and postoperative variables were compared between subgroups. Propensity score matching was used to control for selection bias due to non-random group assignment in a 1:1 manner, resulting in 136 pairs (20 for segmentectomy and 116 for lobectomy) with balanced baseline characteristics.

Results: The NIIASV procedure was completed uneventfully in all 32 patients undergoing segmentectomy and in 119 lobectomy patients undergoing lobectomy, whereas 9 lobectomy patients required conversion to IASLV. These 9 cases were excluded from the comparative analysis. Comparisons between NIIASV and IASLV results showed no intergroup differences in demographics, baseline data, operative time, intraoperative blood loss, number of resected lymph nodes and duration of chest tube dwell time. Conversely, significantly better results occurred in the NIIASV group in postoperative fasting time (P < 0.001), overall postoperative chest drainage volume (P < 0.04) and hospital stay (P < 0.02).

Conclusions: In this study, VATS anatomical resection for NSCLC patients is feasible under NIIASV. Perioperative data comparisons with IASLV have shown that postoperative fasting time, overall drainage volume and hospital stay were significantly better with NIIASV, suggesting a more rapid recovery. Further investigation is warranted to assess the long-term effects and survival of this promising globally less invasive surgical strategy.
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http://dx.doi.org/10.1093/ejcts/ezw160DOI Listing
November 2016

High expression of cellular retinol binding protein-1 in lung adenocarcinoma is associated with poor prognosis.

Genes Cancer 2015 Nov;6(11-12):490-502

Anatomic Pathology, Department of Biomedicine and Prevention, Tor Vergata University of Rome, Italy; Department of Anatomic Pathology, Tor Vergata Policlinic of Rome, Italy.

Purpose: Adenocarcinoma, the most common non-small cell lung cancer is a leading cause of death worldwide, with a low overall survival (OS) despite increasing attempts to achieve an early diagnosis and accomplish surgical and multimodality treatment strategies. Cellular retinol binding protein-1 (CRBP-1) regulates retinol bioavailability and cell differentiation, but its role in lung cancerogenesis remains uncertain.

Experimental Design: CRBP-1 expression, clinical outcome and other prognostic factors were investigated in 167 lung adenocarcinoma patients. CRBP-1 expression was evaluated by immunohistochemistry of tissue microarray sections, gene copy number analysis and tumor methylation specific PCR. Effects of CRBP-1 expression on proliferation/apoptosis gene array, protein and transcripts were investigated in transfected A549 lung adenocarcinoma cells.

Results: CRBP-1(High) expression was observed in 62.3% of adenocarcinomas and correlated with increased tumor grade and reduced OS as an independent prognostic factor. CRBP-1 gene copy gain also associated with tumor CRBP-1(High) status and dedifferentiation. CRBP-1-transfected (CRBP-1(+)) A549 grew more than CRBP-1(-) A549 cells. At >1μM concentrations, all trans-retinoic acid and retinol reduced viability more in CRBP-1(+) than in CRBP-1(-) A549 cells. CRBP-1(+) A549 cells showed up-regulated RARα/ RXRα and proliferative and transcriptional genes including pAkt, pEGFR, pErk1/2, creb1 and c-jun, whereas RARβ and p53 were strongly down-regulated; pAkt/pErk/ pEGFR inhibitors counteracted proliferative advantage and increased RARα/RXRα, c-jun and CD44 expression in CRBP-1(+) A549 cells.

Conclusion: CRBP-1(High) expression in lung adenocarcinoma correlated with increased tumor grade and reduced OS, likely through increased Akt/Erk/EGFR-mediated cell proliferation and differentiation. CRBP-1(High) expression can be considered an additional marker of poor prognosis in lung adenocarcinoma patients.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4701228PMC
http://dx.doi.org/10.18632/genesandcancer.89DOI Listing
November 2015

Minimally invasive thoracic surgery: new trends in Italy.

Authors:
Eugenio Pompeo

Ann Transl Med 2015 Oct;3(18):269

Department of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy.

In Italy there exists quite a long and rich history in minimally invasive thoracic surgery. Pioneer Italian surgeons have been amongst those who first adopted video-assisted thoracic surgery (VATS) to perform procedures such as lobectomy and esophagectomy, respectively and quite many others have provided important contributions related to minimally invasive thoracic surgery and have proposed innovative ideas and creative technical refinements. According to a web search on recent studies published in Italy on minimally invasive thoracic surgery along the last 3 years, uniportal, nonintubated, and robotic VATS as well as VATS lobectomy have been found to represent the most frequently investigated issues. An ongoing active investigation in each of these sub-topics is contributing to a better definition of indications advantages and disadvantages of the various surgical strategies. In addition it is likely that combination strategies including adoption of uniportal and nonintubated approaches will lead to define novel ultra-minimally invasive treatment options.
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http://dx.doi.org/10.3978/j.issn.2305-5839.2015.10.26DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4630544PMC
October 2015

Urgent awake thoracoscopic treatment of retained haemothorax associated with respiratory failure.

Ann Transl Med 2015 May;3(8):112

Departments of 1 Thoracic Surgery, 2 Pulmonology, 3 Anesthesia and Intensive Care, Policlinico Tor Vergata University, Rome, Italy.

A number of video-assisted thoracoscopic surgery (VATS) procedures are being increasingly performed by awake anesthesia in an attempt of minimizing the surgical- and anesthesia-related traumas. However, so far the usefulness of awake VATS for urgent management of retained haemothorax has been scarcely investigated. Herein we present two patients with retained haemothorax following previous thoracentesis and blunt chest trauma, respectively, who developed acute respiratory failure and underwent successful urgent awake VATS management under local anesthesia through a single trocar access.
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http://dx.doi.org/10.3978/j.issn.2305-5839.2015.04.13DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4436418PMC
May 2015

The complex care of severe emphysema: role of awake lung volume reduction surgery.

Ann Transl Med 2015 May;3(8):108

Departments of 1 Thoracic Surgery, 2 Pulmonology, 3 Epidemiology and Public Health, 4 Anatomic Pathology, 5 Anesthesia and Intensive Care, Policlinico Tor Vergata University, Rome, Italy.

The resectional lung volume reduction surgery (LVRS) procedure entailing nonanatomic resection of destroyed lung regions through general anesthesia with single-lung ventilation has shown to offer significant and long-lasting improvements in respiratory function, exercise capacity, quality of life and survival, particularly in patients with upper-lobe predominant emphysema and low exercise capacity. However mortality and morbidity rates as high as 5% and 59%, respectively, have led to a progressive underuse and have stimulated investigation towards less invasive surgical and bronchoscopic nonresectional methods that could assure equivalent clinical results with less morbidity. We have developed an original nonresectional LVRS method, which entails plication of the most severely emphysematous target areas performed in awake patients through thoracic epidural anesthesia (TEA). Clinical results of this ultra-minimally invasive procedure have been highly encouraging and in a uni-center randomized study, intermediate-term outcomes paralleled those of resectional LVRS with shorter hospital stay and fewer side-effects. In this review article we analyze indications, technical details and results of awake LVRS taking into consideration the available data from the literature.
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http://dx.doi.org/10.3978/j.issn.2305-5839.2015.04.17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4436426PMC
May 2015

Surgical pneumothorax under spontaneous ventilation-effect on oxygenation and ventilation.

Ann Transl Med 2015 May;3(8):106

1 Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata-Chair of Anesthesia and Intensive care, Rome, Italy ; 2 Department of Biomedicine and Prevention, University of Rome Tor Vergata-Chair of Thoracic Surgery, Rome, Italy ; 3 Department of Anesthesia and Intensive Care Medicine, Policlinico Tor Vergata University, Rome, Italy.

Surgical pneumothorax allows obtaining comfortable surgical space for minimally invasive thoracic surgery, under spontaneous ventilation and thoracic epidural anesthesia, without need to provide general anesthesia and neuromuscular blockade. One lung ventilation (OLV) by iatrogenic lung collapse, associated with spontaneous breathing and lateral position required for the surgery, involves pathophysiological consequences for the patient, giving rise to hypoxia, hypercapnia, and hypoxic pulmonary vasoconstriction (HPV). Knowledge of these changes is critical to safely conduct this type of surgery. Surgical pneumothorax can be now considered a safe technique that allows the realization of minimally invasive thoracic surgery in awake patients with spontaneous breathing, avoiding the risks of general anesthesia and ensuring a more physiological surgical course.
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http://dx.doi.org/10.3978/j.issn.2305-5839.2015.03.53DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4436421PMC
May 2015

Non-intubated thoracic surgery: nostalgic or reasonable?

Authors:
Eugenio Pompeo

Ann Transl Med 2015 May;3(8):99

Department of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy.

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http://dx.doi.org/10.3978/j.issn.2305-5839.2015.03.59DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4436423PMC
May 2015

About lemons and lemonade.

J Thorac Cardiovasc Surg 2015 Apr;149(4):1224-6

Department of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy.

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http://dx.doi.org/10.1016/j.jtcvs.2015.01.004DOI Listing
April 2015

Non-intubated thoracic surgery-A survey from the European Society of Thoracic Surgeons.

Ann Transl Med 2015 Mar;3(3):37

1 Department of Thoracic Surgery, 2 Biostatisticts, Tor Vergata University, Rome, Italy ; 3 Department of Thoracic Surgery, Institute of Surgery, Pavlov First State Medical University, Saint-Petersburg, Russia ; 4 Department of General Thoracic Surgery, Virgen Macarena University Hospital, Seville, Spain ; 5 Department of Thoracic Surgery and Transplantation, Pomeranian Medical University, Szczecin, Poland.

Background: A survey amongst the European Society of Thoracic Surgeons (ESTS) members has been performed to investigate the currents trends, rates of adoption as well as potential for future expansion of non-intubated thoracic surgery (NITS) performed under spontaneous ventilation.

Methods: A 14-question-based questionnaire has been e-mailed to ESTS members. To facilitate the completion of the questionnaire, questions entailed either quantitative or multiple-choice answers. Investigated issues included previous experience with NITS and number of procedures performed, preferred types of anesthesia protocols (i.e., thoracic epidural anesthesia, intercostal or paravertebral blocks, laryngeal mask, use of additional sedation), type of procedures, ideal candidates for NITS, main advantages and technical disadvantages. Non-univocal answer to multiple-choice questions was permitted.

Results: Out of 105 responders, 62 reported an experience with NITS. The preferred types of anesthesia were intercostal blocks with (59%) or without (50%) sedation, followed by laryngeal mask with sedation (43%) and thoracic epidural anesthesia with sedation (20%). The most frequently performed procedures included thoracoscopic management of recurrent pleural effusion (98%), pleural decortication for empyema thoracis and lung biopsy for interstitial lung disease (26% each); pericardial window and mediastinal biopsy (20% each). More complex procedures such as lobectomy, lung volume reduction surgery and thymectomy have been performed by a minority of responders (2% each). Poor-risk patients due to co-morbidities (70%) and patients with poor pulmonary function (43%) were considered the ideal candidates. Main advantages included faster, recovery (67%), reduced morbidity (59%) and shorter hospital stay with decreased costs (43% each). Reported technical disadvantages included coughing (59%) and poor maneuverability due to diaphragmatic and lung movements (56%). Overall, 69% of responders indicated that NITS procedures will be likely to increase in the near future.

Conclusions: Results of this survey, suggest that NITS is already quite widely adopted by ESTS members to perform simple thoracoscopic procedures. A future expanded adoption of this strategy is also hypothesized.
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http://dx.doi.org/10.3978/j.issn.2305-5839.2015.01.34DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4356863PMC
March 2015

State of the art and perspectives in non-intubated thoracic surgery.

Authors:
Eugenio Pompeo

Ann Transl Med 2014 Nov;2(11):106

Department of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy.

Non-intubated thoracic surgery (NITS) entails procedures performed through regional anesthesia methods in awake or mildly sedated, spontaneously ventilating patients. The rationale is the avoidance of side-effects of intubated general anesthesia and maintenance of more physiologic muscular, neurologic, and cardiopulmonary status in order to reduce the procedure-related traumas, fasten recovery and optimize outcomes. Preliminary reports including some randomized studies have suggested optimal feasibility of several surgical procedures including management of pleural effusion, of spontaneous pneumothorax, wedge resection of undetermined pulmonary nodules, lung volume reduction surgery (LVRS) for severe emphysema and anatomical lung resection for lung cancer treatment. So far more widely accepted indications for NITS include easy-to-perform procedures as well as surgical management of patients with significant risks for intubated general anesthesia. On the other hand, the adoption of NITS for major procedures such as anatomic lung resections and LVRS is still controversial. Further detailed investigation including further randomized trials is expected to help define indications, advantages and limitations of NITS, which might represent excellent ultra-minimally invasive strategies of treatment to be reliably offered in the near future to an increasing number of patients.
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http://dx.doi.org/10.3978/j.issn.2305-5839.2014.10.01DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4245516PMC
November 2014

Invited commentary.

Authors:
Eugenio Pompeo

Ann Thorac Surg 2014 Dec 1;98(6):2004. Epub 2014 Dec 1.

Section of Medical and Surgical Lung Diseases, Department of Biomedicine and Prevention, Tor Vergata University, Via Montpellier 1, 00133 Rome, Italy. Electronic address:

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http://dx.doi.org/10.1016/j.athoracsur.2014.08.012DOI Listing
December 2014