Publications by authors named "Vincenzo Ambrogi"

70 Publications

Subxiphoid completion thymectomy for refractory non-thymomatous myasthenia gravis.

J Thorac Dis 2020 May;12(5):2388-2394

Department of Surgery, Division of Thoracic Surgery, Myasthenia Gravis Unit, Policlinico Tor Vergata University, Rome, Italy.

Background: Completion thymectomy may be performed in patients with non-thymomatous refractory myasthenia gravis (MG) to allow a complete and definitive clearance from residual thymic tissue located in the mediastinum or in lower neck. Hereby we present our short- and long-term results of completion thymectomy using subxiphoid video-assisted thoracoscopy.

Methods: Between July 2010 and December 2017, 15 consecutive patients with refractory non-thymomatous myasthenia, 8 women and 7 men with a median age of 44 [interquartile range (IQR) 38.5-53.5] years, underwent video-thoracoscopic completion thymectomy through a subxiphoid approach.

Results: Positron emission tomography (PET) showed mildly avid areas [standardized uptake value (SUV) more than or equal to 1.8] in 11 instances. Median operative time was 106 (IQR, 77-141) minutes. No operative deaths nor major morbidity occurred. Mean 1-day postoperative Visual Analogue Scale value was 2.53±0.63. Median hospital stay was 2 (IQR, 1-3.5) days. A significant decrease of the anti-acetylcholine receptor antibodies was observed after 1 month [median percentage changes -67% (IQR, -39% to -83%)]. Median follow-up was 45 (IQR, 21-58) months. At the most recent follow-up complete stable remission was achieved in 5 patients. Another 9 patients had significant improvement in bulbar and limb function, requiring lower doses of corticosteroids and anticholinesterase drugs. Only one patient remained clinically stable albeit drug doses were reduced. One-month postoperative drop of anti-acetylcholine receptor antibodies was significantly correlated with complete stable remission (P=0.002).

Conclusions: This initial experience confirms that removal of ectopic and residual thymus through a subxiphoid approach can reduce anti-acetylcholine receptor antibody titer correlating to good outcome of refractory MG.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.21037/jtd.2020.03.81DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7330301PMC
May 2020

Preface.

Authors:
Vincenzo Ambrogi

Thorac Surg Clin 2020 02;30(1):xi-xii

Department of Surgical Sciences, Tor Vergata University, Rome, Italy; Division of Thoracic Surgery, Tor Vergata University Policlinic, Policlinico Tor Vergata University, Viale Oxford 81, Rome 00133, Italy. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.thorsurg.2019.09.004DOI Listing
February 2020

Nonintubated Video-Assisted Wedge Resections in Peripheral Lung Cancer.

Thorac Surg Clin 2020 Feb;30(1):49-59

Department of Surgical Sciences, Tor Vergata University, Via Montpellier 1, Rome 00133, Italy.

Wedge resection in peripheral lung cancer is considered a suboptimal procedure. However, in elderly and/or frail patients it is a reliable and safer alternative. This procedure can be easily performed under nonintubated anesthesia, allowing the recruitment of patients considered otherwise marginal for a surgical treatment. Nonintubated anesthesia can reduce lung trauma, operative time, postoperative morbidity, hospital stay, and global expenses. Furthermore, nonintubated anesthesia produces less immunologic impairment and this may affect postoperative oncological long-term results. Wedge lung resection through nonintubated anesthesia can be performed for diagnosis with higher effectiveness given the similar invasiveness of computed tomography-guided biopsy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.thorsurg.2019.08.006DOI Listing
February 2020

Team Training for Nonintubated Thoracic Surgery.

Thorac Surg Clin 2020 Feb;30(1):111-120

Department of Surgical Sciences, Tor Vergata University, Via Montpellier 1, Rome 00133, Italy; Division of Thoracic Surgery, Tor Vergata University Hospital, Viale Oxford 81, Rome 00133, Italy; Postgraduate Training Course in Thoracic Surgery, Tor Vergata University, Rome 00133, Italy. Electronic address:

Nonintubated thoracic surgery arose as supplemental evolution of minimally invasive surgery and is gaining popularity. A proper nonintubated thoracic surgery unit is mandatory and should involve surgeons, anesthesiologists, intensive care physicians, physiotherapists, psychologists, and scrub and ward nurses. Surgical training should involve experienced and young surgeons. It deserves a step-by-step approach and consolidated experience on video-assisted thoracic surgery. Due to difficulty in reproducing lung and diaphragm movements, training with simulation systems may be of scant value; instead, preceptorships and invited proctorships are useful. Preoperatively, patients must be fully informed. Effective intraoperative communication with patients and among the surgical team is pivotal.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.thorsurg.2019.08.010DOI Listing
February 2020

Impact of Awake Breast Cancer Surgery on Postoperative Lymphocyte Responses.

In Vivo 2019 Nov-Dec;33(6):1879-1884

Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy.

Background: Surgical stress and anesthesia affect the patient's immune system. Analysis of the lymphocyte response after breast-conserving surgery was conducted to investigate the differences between effects after general and local anesthesia.

Materials And Methods: Fifty-six patients with breast cancer were enrolled for BCS through local or general anesthesia. Total leukocytes, total lymphocytes, lymphocyte-subsets including CD3, CD19, CD4, CD8, CD16CD56 and CD4/CD8 ratio was examined at baseline and on postoperative days 1, 2 and 3.

Results: Baseline data showed no statistical difference between the two groups. Within-group ANOVA test showed significant differences for total leukocyte count (p<0.001), total lymphocyte count (p=0.009) and proportion of natural-killer cells (p=0.01) in the control group. Between-group analysis showed lower median values of total lymphocytes in the awake surgery group on postoperative days 1, 2 and 3 (p=0.001, p=0.02 and p=0.01, respectively) when compared to the control group. Patients who underwent surgery under general anesthesia had higher total lymphocyte counts on postoperative day 2 (p=0.04).

Conclusion: In this randomized study, breast-conserving surgery plus local anesthesia had a lower impact on postoperative lymphocyte response when compared to the same procedure performed under general anesthesia.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.21873/invivo.11681DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6899130PMC
March 2020

Surgical Techniques for Myasthenia Gravis: Video-Assisted Thoracic Surgery.

Thorac Surg Clin 2019 May 7;29(2):165-175. Epub 2019 Mar 7.

Myasthenia Gravis Multidisciplinary Program, Tor Vergata University, Viale Oxford 81, Rome 00133, Italy; Department of Surgical Sciences, Tor Vergata University, Via Montpellier 1, Rome 00133, Italy; Division of Thoracic Surgery, Tor Vergata University Policlinic, Viale Oxford 81, Rome 00133, Italy. Electronic address:

We describe the various video-assisted thoracic surgery approaches to the thymus currently adopted in nonthymomatous and thymomatous myasthenic patients. Despite several controversies, video-assisted thoracic surgery thymectomy gained worldwide popularity. Classic 3-port approaches proved safe and effective. Uniportal video-assisted thoracic surgery requires consolidated experience, whereas the bilateral approach is considered more extensive. Subxiphoid represents the ultimate and exciting challenge. As an effect of video-assisted thoracic surgery approach, thymectomy is performed earlier; both patients and neurologists are more prone to accept the procedure given the quicker recovery, lesser pain, and better cosmesis. Outcomes are equivalent to those achieved by sternotomy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.thorsurg.2018.12.005DOI Listing
May 2019

Evidence for association of STAT4 and IL12RB2 variants with Myasthenia gravis susceptibility: What is the effect on gene expression in thymus?

J Neuroimmunol 2018 06 17;319:93-99. Epub 2018 Mar 17.

Laboratory of Molecular Biology and Immunology, Department of Pharmacy, School of Health Sciences, University of Patras, University Campus, Rio, 26504 Patras, Greece. Electronic address:

Myasthenia gravis (MG) is an autoimmune disease mediated by the presence of autoantibodies that bind mainly to the acetylcholine receptor (AChR) in the neuromuscular junction. In our case-control association study, we analyzed common variants located in genes of the IL12/STAT4 and IL10/STAT3 signaling pathways. A total of 175 sporadic MG patients of Greek descent, positively detected with anti-AChR autoantibodies and 84 ethnically-matched, healthy volunteers were enrolled in the study. Thymus samples were obtained from 16 non-MG individuals for relative gene expression analysis. The strongest signals of association were observed in the cases of rs6679356 between the late-onset MG patients and controls and rs7574865 between early-onset MG and controls. Our investigation of the correlation between the MG-associated variants and the expression levels of each gene in thymus did not result in significant differences.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jneuroim.2018.03.008DOI Listing
June 2018

Onset and Evolution of Clinically Apparent Myasthenia Gravis After Resection of Non-myasthenic Thymomas.

Semin Thorac Cardiovasc Surg 2018 6;30(2):222-227. Epub 2018 Mar 6.

Department of Surgery and Experimental Medicine, Multidisciplinary Myasthenia Gravis Unit, Policlinico Tor Vergata University, Rome, Italy.

Patients with thymoma and without clinical or electromyographical myasthenic signs may occasionally develop myasthenia several years after thymectomy. Hereby, we investigated the predictors and the evolution of this peculiar disease. We performed a retrospective analysis in 104 consecutive patients who underwent thymectomy between 1987 and 2013 for thymoma without clinical or electromyographic signs of myasthenia gravis. Predictors of post-thymectomy onset of myasthenia gravis were investigated with univariate time-to-disease analysis. Evolution of myasthenia was analyzed with time-to-regression analysis. Eight patients developed late myasthenia gravis after a median period of 33 months from thymectomy. No significant correlation was found for age, gender, Masaoka's stage, and World Health Organization histology. Only high preoperative serum acetylcholine-receptor antibodies titer (>0.3 nmol/L) was significantly associated with post-thymectomy myasthenia gravis at univariate time-to-disease (P = 0.003) analysis. Positron emission tomography was always performed in high-titer patients, and increased metabolic activity was detected in 4 of these patients. Surgical treatment through redo-sternotomy or video-assisted thoracoscopy was performed in these last cases with a remission in all patients after 12, 24, 32 and 48 months, respectively. No patient under medical treatment has yet developed a complete remission. In our study the presence of preoperative high-level serum acetylcholine receptor antibodies was the only factor significantly associated with the development of post-thymectomy myasthenia gravis. The persistence of residual islet of ectopic thymic tissue was one of the causes of the onset of myasthenia and its surgical removal was successful.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1053/j.semtcvs.2018.02.027DOI Listing
November 2018

A glance at the history of uniportal video-assisted thoracic surgery.

J Vis Surg 2017 7;3:157. Epub 2017 Nov 7.

Department of Surgery and Experimental Medicine, Official Group of Awake Thoracic Surgery Research, Policlinico Tor Vergata University, Rome, Italy.

In the history of thoracic surgery, the advent of video-assisted thoracic surgery (VATS) had on effect equivalent to that provoked by a true revolution. VATS successfully allowed minor, major and complex procedures for various lung and mediastinal pathologies with small incision instead of the traditional accesses. These small incisions abolished ugly scars, generated less acute and chronic pain, reduced hospital stay and costs, allowed faster return to normal day life activities. Conventional VATS was initially performed through 3-4 ports and rapidly evolved to uniportal or single portal access [uniportal video-assisted thoracic surgery (uniVATS)]. First uniportal procedures were published in 2000. In 2010, uniportal technique for lobectomy was described. Focused experimental courses, live surgery events, the internet media favored the rapid diffusion of this technique over the world. Major and complex uniVATS lung resections involving segmentectomy, pneumonectomy, bronchoplasty and vascular reconstruction, redo VATS, chest wall resections have been accomplished with satisfactory outcomes. Interestingly, different uniportal approaches and techniques are emerging from a number of VATS centers particularly experienced in the mini-invasive thoracic surgery. As confidence grew, in 2014, the first uniVATS left upper lobectomy via the subxiphoid approach was reported. This novel technique is quite challenging but appropriate patient selection as well as availability of dedicated instruments allowed to perform procedures safely. The diffusion of uniVATS paralleled with the development of nonintubated awake anesthesia technique. In 2007 the first nonintubated lobectomy was described. In 2014 the first single port VATS lobectomy in a nonintubated patient with lung cancer of the right middle lobe was accomplished. The nonintubated uniVATS represents an intriguing technique, so that very experienced thoracoscopic surgeons may enroll to surgery elderly and high risk patients. Decreased postoperative pain and hospitalization, faster access to the radio-chemotherapy and diminished inflammatory response are important benefits of the modern approach to the thoracic pathologies. The history of uniVATS documented a constant and irresistible progress. This technique may further provide unthinkable surprises in next future.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.21037/jovs.2017.10.11DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5676155PMC
November 2017

Uniportal non-intubated lung metastasectomy.

J Vis Surg 2017 14;3:118. Epub 2017 Sep 14.

Department of Surgery and Experimental Medicine, Tor Vergata University of Rome, Rome, Italy.

Background: More than 15 years ago, we started a program of uniportal video-assisted thoracoscopies (VATS) lung metastasectomy in non-intubated local anesthesia. Hereby we present the short and long-term results of this combined surgical-anesthesiological technique.

Methods: Between 2005 and 2015, 71 patients (37 men and 34 women) with pulmonary oligometastases, at the first episode, underwent uniportal VATS metastasectomy under non-intubated anesthesia.

Results: Four patients (5.6%) required intubation for intolerance. Mean number of lesions resected per patient was 1.51. There was no mortality. The study group demonstrated a significant reduction of operative time from the beginning of the experience (P=0.001), good level of consciousness at Richmond scale and quality of recovery after both 24 and 48 hours. Median hospital stay was 3 days and major morbidity rate was 5.5%. Both disease-free survival and overall survival were similar to those achieved with intubated surgery.

Conclusions: VATS lung metastasectomy in non-intubated local anesthesia was safely performed in selected patients with oligometastases with significant advantages in overall operative time, hospital stay and economical costs. Long-term results were similar.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.21037/jovs.2017.07.12DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5639041PMC
September 2017

In situ preservation of the partathyroid glands in total thyroidectomy: a propensity score matched analysis.

Ann Ital Chir 2017 ;88:288-294

Aim: Severe hypocalcemia due to parathyroid gland damage may be a serious complication after thyroidectomy. In order to save parathyroid integrity we developed a no-touch parathyroid (NTP) thyroidectomy technique.

Methods: We performed a total extracapsular thyroidectomy with NTP technique in consecutive 50 cases of benign goiter between July 2014 and June 2015. Parathyroid glands were firstly indentified, then they were separated from the thyroid avoiding manipulation or trauma and preserving their vascularization. Traditional scissors were preferentially used for dissection around the glands. Patients operated with NTP technique were matched by a propensity score to a control group.

Results: NTP was feasible in all foreseen patients except one. Propensity score selected a group of 23 patients/group for matching. No mortality has been observed in either group. Operative time were comparable between groups. Blood loss were significantly less abundant in the NTP group. No laryngeal permanent paralysis was experienced. Hospital stay was shorter yet not significantly in NTP group. Neither hypocalcemic crisis nor permanent hypoparathyroidism were described in either group. Serum calcium levels (NTP Vs control) were significantly higher in NTP group at day 1 (p=0.03) and day 2 (p=0.002), respectively. Similarly, intact parathormone dosages were significantly higher at day 1 (p=0.004) and day 7 (p=0.001), respectively.

Conclusions: We conclude that NTP thyroidectomy is a feasible in the majority of the patientsand, allows a significant reduction of blood loss without prolonging the operative time. After the procedureboth values of calcemia and intact parathormonewere stable and no hypocalcemic crisis was experienced.

Key Words: Parathyroid, Hypoparathyroidism, Hypocalcemia, Total thyroidectomy.
View Article and Find Full Text PDF

Download full-text PDF

Source
July 2018

Immunological and Inflammatory Impact of Non-Intubated Lung Metastasectomy.

Int J Mol Sci 2017 Jul 7;18(7). Epub 2017 Jul 7.

Department of Surgery and Experimental Medicine, Tor Vergata University of Rome, Rome 00173, Italy.

Background: We hypothesized that video-assisted thoracic surgery (VATS) lung metastasectomy under non-intubated anesthesia may have a lesser immunological and inflammatory impact than the same procedure under general anesthesia.

Methods: Between December 2005 and October 2015, 55 patients with pulmonary oligometastases (at the first episode) successfully underwent VATS metastasectomy under non-intubated anesthesia. Lymphocytes subpopulation and interleukins 6 and 10 were measured at different intervals and matched with a control group composed of 13 patients with similar clinical features who refused non-intubated surgery.

Results: The non-intubated group demonstrated a lesser reduction of natural killer lymphocytes at 7 days from the procedure ( = 0.04) compared to control. Furthermore, the group revealed a lesser spillage of interleukin 6 after 1 ( = 0.03), 7 ( = 0.04), and 14 ( = 0.05) days. There was no mortality in any groups. Major morbidity rate was significantly higher in the general anesthesia group 3 (5%) vs. 3 (23%) ( = 0.04). The median hospital stay was 3.0 vs. 3.7 ( = 0.033) days, the estimated costs with the non-intubated procedure was significantly lower, even excluding the hospital stay.

Conclusions: VATS lung metastasectomy in non-intubated anesthesia had significantly lesser impact on both immunological and inflammatory response compared to traditional procedure in intubated general anesthesia.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/ijms18071466DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5535957PMC
July 2017

Uniportal video-assisted thoracic surgery colorectal lung metastasectomy in non-intubated anesthesia.

J Thorac Dis 2017 Feb;9(2):254-261

Department of Surgery and Experimental Medicine, Tor Vergata University, Rome, Italy.

Background: More than ten years ago we started a program of video-assisted thoracic surgery (VATS) lung metastasectomy in non-intubated local anesthesia. In this study we investigated the effectiveness and long term results of this combined surgical-anesthesiological technique.

Methods: Between 2005 and 2014, 48 patients (25 men and 23 women) with pulmonary oligometastases from colorectal cancer, at the first episode, underwent VATS metastasectomy under non-intubated local anesthesia. Three patients required intubation for intolerance. In the same period 13 patients scheduled for non-intubated metastasectomy refused awake surgery and were used as a control group.

Results: The two groups were homogeneous for both demographic and pathological features. Mean number of lesions resected per patient were 1.51 (non-intubated) 1.77 (control), respectively (P=0.1). The oxygenation was significantly lower in the non-intubated group especially at the end of the procedure, but the values inverted from the first postoperative hour. There was no mortality in any groups. The non-intubated group demonstrated a significant shorter overall operating time (P=0.04), better quality of recovery after both 24 (P=0.04) and 48 hours (P=0.04), shorter median hospital stay (P=0.03) and lower estimated costs (P=0.03), even excluding the hospital stay. Major morbidity rate was lower (6% 23%) yet not significant (P=0.1). Both disease free survival and overall survival were similar between groups.

Conclusions: VATS lung metastasectomy in non-intubated local anesthesia was safely performed in selected patients with oligometastases with significant advantages in overall operative time, hospital stay and economical costs. Morbidity rate was lower yet not significant. Long term results were similar.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.21037/jtd.2017.02.40DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5334099PMC
February 2017

Benefits of Comprehensive Rehabilitation Therapy in Thymectomy for Myasthenia Gravis: A Propensity Score Matching Analysis.

Am J Phys Med Rehabil 2017 Feb;96(2):77-83

From the Department of Thoracic Surgery, Multidisciplinary Myasthenia Gravis Unit, Tor Vergata University, Rome, Italy.

Objective: To demonstrate the effectiveness of a comprehensive program of rehabilitation therapy in patients undergoing thymectomy for myasthenia gravis (MG).

Design: From 2005 to 2010, 46 consecutive patients affected by MG underwent a rehabilitation program both before and after thymectomy. We matched each patient with a "control patient" who underwent thymectomy within the period 1999 to 2004 with no preoperative rehabilitation, who had the closest propensity score matching.

Results: All patients but 2 were able to complete the intended program. Eighteen patients (41%) experienced mild fatigue (>25 at MG quantitative score). Propensity score selected a group of 17 patients for the matching process. The group of patients who underwent the rehabilitation program showed significant preoperative improvement associated with a reduced operative risk, a decreased early postoperative morbidity, a lower rate of postoperative intensive care unit needed (12% vs 35%; P = 0.01) and a shorter hospital stay (3 vs 5 days; P = 0.04). After the expected perioperative decline, all major myasthenic outcomes demonstrated a significant faster recovery at 3 months. Complete stable remission did not reveal significant differences.

Conclusions: Exercise is not necessarily a contraindication in MG, and rehabilitation can be safely performed before and after thymectomy, reducing operative risks and decreasing recovery time.

To Claim Cme Credits: Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCMECME OBJECTIVES: Upon completion of this article, the reader should be able to do the following: (1) appreciate the benefits of physical therapy in individuals with myasthenia gravis; (2) describe the benefits of physical therapy on postoperative morbidity in myasthenia gravis patients who undergo thymectomy; and (3) incorporate appropriate rehabilitation into the treatment plan of patient with myasthenia gravis.

Level: AdvancedACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/PHM.0000000000000538DOI Listing
February 2017

1000 cases of tubeless video-assisted thoracic surgery at the Rome Tor Vergata University.

Future Oncol 2016 Dec 30;12(23s):13-18. Epub 2016 Sep 30.

Official Awake Thoracic Surgery Research Group, Department of Thoracic Surgery Tor Vergata University, Policlinic Tor Vergata University, Viale Oxford 81, 00161, Rome, Italy.

In the early 2000s, the 'Awake Thoracic Surgery Research Group' at Tor Vergata University began a program of thoracic operations in awake nonintubated patients. To our knowledge this was the first program created with this specific purpose. Since then over 1000 tubeless operations have been carried out successfully, making this series one of the widest in the world. Both nononcologic and oncologic conditions were successively approached and major operations for lung cancer are now being performed. Uniportal access was progressively adopted with significant positive outcomes in postoperative recovery, patient acceptance and economical costs. Failure rates due to patient's intolerance and open surgery conversion are progressively reducing. Tubeless thoracic surgery can be accomplished in a safe manner with effective results.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2217/fon-2016-0348DOI Listing
December 2016

Moving around the thymus: More technology, more safety, more efficiency.

J Thorac Cardiovasc Surg 2016 Jul 29;152(1):280-1. Epub 2016 Mar 29.

Department of Thoracic Surgery, Tor Vergata Multidisciplinary Myasthenia Gravis Unit, Tor Vergata University, Rome, Italy.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jtcvs.2016.03.045DOI Listing
July 2016

Lung metastasectomy: an experience-based therapeutic option.

Ann Transl Med 2015 Aug;3(14):194

Thoracic Surgery Department, Tor Vergata University, Tor Vergata Policlinico, viale Oxford 81, 00133 Rome, Italy.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3978/j.issn.2305-5839.2015.08.15DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4560696PMC
August 2015

Survival is higher after repeat lung metastasectomy than after a first metastasectomy: Too good to be true?

J Thorac Cardiovasc Surg 2015 May 11;149(5):1249-52. Epub 2015 Feb 11.

Francesca Fiorentino Cardiothoracic Surgery, National Heart and Lung Institute Imperial College London, London, United Kingdom.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jtcvs.2015.01.067DOI Listing
May 2015

Video-assisted thoracoscopic thymectomy surgery: Tor Vergata experience.

Thorac Cardiovasc Surg 2015 Apr 17;63(3):187-93. Epub 2015 Feb 17.

Thoracic Surgery Division, Multidisciplinary Myasthenia Gravis Unit, Policlinico Tor Vergata University, Rome, Italy.

The therapeutic effect of thymectomy on myasthenia gravis is not completely understood. Several types of thymectomy varying in approach and extent have been performed. None of these disclosed a neat superiority over others. Patients desire thymectomy through small, painless, and cosmetically favorable operations. Video-assisted thoracoscopic surgery (VATS) thymectomy fits all these requests as well as that of the surgeon. Indeed, this approach allows for ample operative space, easy maneuverability, and extended thymectomy. No mortality, low morbidity, faster recovery, short hospital stay, and small economical costs are undoubtedly advantages of VATS over transsternal and transcervical thymectomy. In the near future, the introduction of robotic devices will lead to a new era in the surgery of the thymus. Herein we analyzed our comprehensive experience.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0034-1395984DOI Listing
April 2015

Multi-reoperations for lung metastases.

Future Oncol 2015 ;11(2 Suppl):37-41

Thoracic Surgery Division, Tor Vergata University, Viale Oxford 81, 00133 Roma, Italy.

In this study, we investigated role and results of multi-reoperations for lung metastases. From 1986 to 2010, 113 consecutive patients (61 men and 52 women; mean age: 53.2 ± 12.8 years) underwent repeated lung metastasectomy with curative intent in our institution. Two procedures were performed in 113 patients, three in 54, four in 31, five in eight and six in three. There was no perioperative mortality. Cumulative 5-year survival was 65% and this was significantly higher than the value recorded for patients undergoing only one metastasectomy (42%; p = 0.021). Size, number of resections and probability of recurrence increased by number of operation whereas disease free interval reduced. At any metastasectomy both short disease-free interval and multiple metastases resulted in the most significant negative prognosticators. In conclusion, redo metastasectomy is worthwhile for the initial procedures, afterwards both disease-free and overall survivals decrease and surgery lose its efficacy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2217/fon.14.282DOI Listing
October 2015

May positron emission tomography reveal ectopic or active thymus in preoperative evaluation of non-thymomatous myasthenia gravis?

J Cardiothorac Surg 2014 Sep 5;9:146. Epub 2014 Sep 5.

Background: In myasthenia gravis (MG) both native and ectopic thymic tissue containing germinal centers should show greater metabolism compared to adjacent tissues. We evaluated whether preoperative standardized uptake value (SUV) of 18fluoro-deoxy-glucose on Positron Emission Tomography (PET) might be increased and correlated with the presence of native or ectopic germinal centers.

Methods: From 2005 to 2012 we performed extended thymectomy in 68 patients with non-thymomatous MG. All patients underwent PET-scan preoperatively and one-year postoperatively. SUVs were assessed in thymic and perithymic regions. Then it was matched with same-age, non-MG and non-neoplastic control group and finally correlated with presence of germinal centers in native thymus or in the ectopic tissue found in the surgical specimens.

Results: Mean SUV was significantly increased in MG patients compared to control group. Thymic SUV was significantly higher in presence of thymic germinal centers [3.5 (2.4-5.0) Vs 2.1 (1.4-2.5), p = 0.021] while perithymic SUV was significantly higher in presence of ectopic germinal centers [3.1 (2.7-3.5) Vs 1.3 (0.9-1.7), p = 0.001]. SUV was significantly correlated with MG score (rho = 0.289, p = 0.017) and marginally with antibodies anti-acetylcholine receptors (rho = 0.129, p = 0.05). At Kaplan Meier analysis, ectopic thymic tissue (p = 0.045) and ectopic germinal centers (p = 0.036) were significant predictors of complete stable remission, but preoperative dichotomized thymic (3.5 or more Vs less) (p = 0.083) and perithymic (2.1 or more Vs less) (p = 0.052) SUVs did not.

Conclusions: Thymic and perithymic SUVs were significantly higher in patients with MG than non-MG and non-neoplastic patients. Thymic SUV was significantly correlated with the presence of germinal centers. Perithymic SUV resulted significantly correlated with the discovery of ectopic active thymic tissue. Neither thymic nor perithymic high SUVs predicted remission.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13019-014-0146-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4174284PMC
September 2014

VATS biopsy for undetermined interstitial lung disease under non-general anesthesia: comparison between uniportal approach under intercostal block vs. three-ports in epidural anesthesia.

J Thorac Dis 2014 Jul;6(7):888-95

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

Objective: Video-assisted thoracoscopic (VATS) biopsy is the gold standard to achieve diagnosis in undetermined interstitial lung disease (ILD). VATS lung biopsy can be performed under thoracic epidural anesthesia (TEA), or more recently under simple intercostal block. Comparative merits of the two procedures were analyzed.

Methods: From January 2002 onwards, a total of 40 consecutive patients with undetermined ILD underwent VATS biopsy under non-general anesthesia. In the first 20 patients, the procedures were performed under TEA and in the last 20 with intercostal block through a unique access. Intraoperative and postoperative variables were retrospectively matched.

Results: Two patients, one from each group, required shift to general anesthesia. There was no 30-day postoperative mortality and two cases of major morbidity, one for each group. Global operative time was shorter for operations performed under intercostal block (P=0.041). End-operation parameters significantly diverged between groups with better values in intercostal block group: one-second forced expiratory flow (P=0.026), forced vital capacity (P=0.017), oxygenation (P=0.038), PaCO2 (P=0.041) and central venous pressure (P=0.045). Intraoperative pain coverage was similar. Significant differences with better values in intercostal block group were also experienced in 24-hour postoperative quality of recovery-40 questionnaire (P=0.038), hospital stay (P=0.033) and economic expenses (P=0.038). Histology was concordant with radiologic diagnosis in 82.5% (33/40) of patients. Therapy was adjusted or modified in 21 patients (52.5%).

Conclusions: Uniportal VATS biopsies under intercostal block can provide better intraoperative and postoperative outcomes compared to TEA. They allow the indications for VATS biopsy in patients with undetermined ILD to be extended.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3978/j.issn.2072-1439.2014.07.06DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4120175PMC
July 2014

Nonintubated VATS segmentectomy: when and for whom?

Ann Thorac Surg 2014 Jul;98(1):388

Division of Thoracic Surgery, Tor Vergata University, Viale Oxford 81, 00133, Rome, Italy.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.athoracsur.2014.01.037DOI Listing
July 2014

Quality of life and outcomes after nonintubated versus intubated video-thoracoscopic pleurodesis for malignant pleural effusion: comparison by a case-matched study.

J Palliat Med 2014 Jul 28;17(7):761-8. Epub 2014 Apr 28.

Department of Experimental Medicine and Surgery, Division of Thoracic Surgery, Policlinico Tor Vergata University , Rome, Italy .

Background: Malignant pleural effusion can be treated successfully by video-assisted thoracic surgery (VATS) talc pleurodesis. This procedure can also be performed using local anesthesia on nonintubated patients.

Objectives: To evaluate quality of life and major outcomes after VATS talc pleurodesis performed under local anesthesia in nonintubated patients with malignant pleural effusion.

Design: Retrospective, nonrandomized case-matched comparison (nonintubated versus intubated) pairing the patients by computer according to their clinical features.

Setting/subjects: Since 2002, 231 consecutive patients underwent uniport VATS talc pleurodesis under local anesthesia (nonintubated group). These patients were case matched with 231 homogeneous subjects, selected from a larger group that preferred general anesthesia (intubated group) in the same period.

Measurements: Quality of life (European Organization for Research and Treatment of Cancer QLQ-C30 core questionnaire) and other major outcomes were considered.

Results: Pleurodesis was successful in 198 (85.7%) nonintubated and 193 (83.5%) intubated patients, but the former group showed shorter total operating room time (65.8±7.5 versus 84.9±13.3 minutes, p<0.0001), duration of postoperative pleural fluid leakage (2.5±1.0 versus 4.0±1.5 days, p=0.014), postoperative hospital stay (3.1±2.5 versus 4.9±2.8 days, p=0.011), as well as lower perioperative mortality (0% versus 2.3%, p=0.017), morbidity (5.2% versus 9.0%, p=0.042), and costs (6,090±517 versus 9,660±713€, p=0.015). Quality of life presented a similar evolution between groups, however, the early postoperative improvement in physical function (p<0.05), global health (p<0.05), and dyspnea (p<0.01) was significantly greater in nonintubated patients. Significant improvements in respiratory exchanges, postoperative acute stress markers, and mental confusion were also documented. Effusion-free (p=0.35) and overall (p=0.52) survival was similar between groups.

Conclusion: Nonintubated VATS talc pleurodesis can achieve similar results in pleural effusion to the same operation performed under general anesthesia but with earlier improvement of some quality-of-life domains as well as better mortality, morbidity, hospital stay, and costs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/jpm.2013.0617DOI Listing
July 2014

Piero della Francesca's coral pendants: the hidden bronchial anatomy.

Authors:
Vincenzo Ambrogi

Thorax 2014 Dec 1;69(12):1161. Epub 2014 Apr 1.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/thoraxjnl-2014-205344DOI Listing
December 2014

Erythrocyte osmotic resistance recovery after lung volume reduction surgery.

Eur J Cardiothorac Surg 2014 May 25;45(5):870-5. Epub 2013 Sep 25.

Thoracic Surgery Division and Department, Emphysema Center, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata University Rome, Rome, Italy.

Objectives: Alteration of erythrocyte osmotic resistance, with increment of reticulocytes, is common in emphysema. This fragility is probably due to an altered fatty acid membrane composition from lipid peroxidation, a reaction triggered by the disease-related increment of reactive oxidative species. We analysed the effects of lung volume reduction surgery (LVRS) on this anomaly compared with respiratory rehabilitation (RR) therapy.

Methods: We retrospectively compared 58 male patients with moderate-to-severe emphysema who underwent LVRS with 56 similar patients who underwent standardized RR. Respiratory function parameters, erythrocyte osmotic resistance and antioxidant enzymes levels were evaluated before and 6 months after treatments.

Results: Significant improvements in respiratory function, exercise capacity, unsaturated fatty acid content (+10.0%, P = 0.035), erythrocyte osmotic resistance (hyperosmolar resistance -21.0%, P = 0.001; hyposmolar resistance -18.0%, P = 0.007) and erythrocyte antioxidant enzymes [superoxide dismutase (SOD) +60.0%, P < 0.001; glutathione peroxidase +39.0%, P = 0.004 and glutathione reductase +24.5%, P = 0.008] were observed after surgery. In the RR group, we did not find any significant improvements in osmotic resistance, although respiratory and functional parameters were significantly improved. Correlation analysis in the surgical group showed that the reduction in residual volume (RV) significantly correlated the normalization of hyperosmotic (P = 0.019) and hyposmotic resistances (P = 0.006), the decrease in the absolute number of reticulocytes (P = 0.037) and increase in SOD (P < 0.001).

Conclusions: LVRS improved unsaturated fatty acid content, erythrocyte osmotic resistance and levels of erythrocyte antioxidant enzymes compared with RR. Correlations between erythrocyte osmotic resistance and antioxidant intracellular enzymes with RV suggest that reduction in lung hyperinflation with the elimination of inflammatory emphysematous tissue may explain such improvements after surgery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ejcts/ezt474DOI Listing
May 2014

Malignant pleural mesothelioma: factors influencing the prognosis.

Oncology (Williston Park) 2012 Dec;26(12):1164-75

Department of Experimental Medicine and Surgery, Policlinico Tor Vergata University, Rome, Italy.

Malignant pleural mesothelioma (MPM) is a highly severe primary tumor of the pleura mainly related to exposure to asbestos fibers. The median survival after symptom onset is less than 12 months. Conventional medical and surgical therapies--either as single lines or combined--are not wholly effective. No universally accepted guidelines have yet been established for patient selection and the use of therapeutic strategies. In addition, retrospective staging systems have proved inadequate at improving therapeutic outcomes. Therapy is currently guided by gross tumor characteristics and patient features; however, these seem less accurate than the biological fingerprint of the tumor. A number of clinical prognostic factors have been considered in large multicenter series and independently validated. A series of novel biomarkers can predict the evolution of the disease. Here we summarize the principal and novel factors that influence prognosis and are thus potentially useful for selecting patients for targeted therapy.
View Article and Find Full Text PDF

Download full-text PDF

Source
December 2012

Outcomes after thymectomy in class I myasthenia gravis.

J Thorac Cardiovasc Surg 2013 May 11;145(5):1319-24. Epub 2013 Jan 11.

Department of Thoracic Surgery, Multidisciplinary Myasthenia Gravis Unit, Policlinico Tor Vergata University, Rome, Italy.

Objective: The role of extended thymectomy in the treatment of class I myasthenia gravis is still controversial. This study compared the long-term outcomes of operated and nonoperated patients allocated according to their will.

Methods: We retrospectively reviewed 47 patients with class I nonthymomatous myasthenia gravis undergoing extended thymectomy between 1980 and 2007. These patients were matched with 62 class I patients who refused surgery and received only pharmacologic therapy. Outcomes were stable remission and clinical or pharmacologic improvement. Predictors of remission were analyzed by Kaplan-Meier and Cox regression.

Results: We observed low postoperative major morbidity (n = 2; 4.2%) and no perioperative mortality. Heterotopic thymus was found in 22 patients (46%). Twenty-one patients showed active germinal centers, in the heterotopic thymus in 12 patients (57.1%). Thirty operated patients (64%) versus 34 nonoperated patients (55%) achieved stable remission, and 8 patients (17%) versus 5 patients (9%) showed pharmacologic improvement. Nine patients who had no postoperative improvement showed active ectopic thymus. Surgery was a marginal prognosticator (P = .053). Early treatment (≤6 months from symptoms onset) was the unique significant prognosticator (P = .045), but this was due to the contribution of the operated patients (P = .002). Other predictors of remission in the operated group were the absence of ectopic thymus (P = .007) with no germinal centers (P = .009). No significant predictor of remission was found in the nonoperated group.

Conclusions: Extended thymectomy achieved a more rapid remission than after nonsurgical treatment of class I myasthenia gravis. Significantly better outcomes resulted when thymectomy was performed within 6 months from the onset of symptoms.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jtcvs.2012.12.053DOI Listing
May 2013

Lung nodule and facial erythematous plaques: a quiz.

Acta Derm Venereol 2013 May;93(3):380-1

Department of Dermatology, University of Rome Tor Vergata, Viale Oxford 81, IT-00144 Rome, Italy.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2340/00015555-1489DOI Listing
May 2013