Luca Luzzi

Università degli Studi di Siena, Siena, Tuscany, Italy

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Publications (54)119.12 Total impact

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    ABSTRACT: Lung transplantation (LTX) is nowadays accepted as a treatment option for selected patients with end-stage pulmonary disease. Idiopathic pulmonary fibrosis (IPF) is characterized by the radiological and histologic appearance of usual interstitial pneumonia. It is associated with a poor prognosis, and LTX is considered an effective treatment to significantly modify the natural history of this disease. The aim of the present study was to analyse mortality during the waiting list in IPF patients at a single institution. A retrospective analysis on IPF patients (n = 90) referred to our Lung Transplant Program in the period 2001-2014 was performed focusing on patients' characteristics and associated risk factors. Diagnosis of IPF was associated with high mortality on the waiting list with respect to other diagnosis (p < 0.05). No differences in demographic, clinical, radiological data and time spent on the waiting list were observed between IPF patients who underwent to LTX or lost on the waiting list. Patients who died showed significant higher levels of pCO2 and needed higher flows of O2-therapy on effort (p < 0.05). Pulmonary function tests failed to predict mortality and no other medical conditions were associated with survival. Patients newly diagnosed with IPF, especially in small to medium lung transplant volume centres and in Countries where a long waiting list is expected, should be immediately referred to transplantation, delay results in increased mortality. Early identification of IPF patients with a rapid progressive phenotype is strongly needed.
    Beiträge zur Klinik der Tuberkulose 07/2015; 193(5). DOI:10.1007/s00408-015-9767-x · 2.27 Impact Factor
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    ABSTRACT: Many reports emphasize the role of sub-lobar resections in the treatment of small peripheral lung cancer. Aim of this study is to investigate a range of prognostic factors, including the extension of resection, which may affect the prognosis in a homogeneous group of patients. We retrospectively reviewed the clinical records of 279 patients affected by N0 small peripheral adenocarcinoma (ADK) <3cm that underwent surgery between 2000 and 2010. Eleven patients were excluded for non-tumour related dead. There were 176 (66%) males and 92 (34%) females with a median age of 74 years (range 47-93). In the series, 229 (85%) patients received a lobar resection and only 39 (15%) a sub-lobar resection. 195 patients (72%) resulted stage IA while 73 (28%) stage IB. No differences in 5-year survival were observed according to: age (p=0.32), sex (p=0.42), T1a vs T1b (p=0.31), Stage IA vs IB (p=0.51) and type of resection (p=0.29). Patients affected by ADK with a predominant lepidic growth showed a better 5-year survival (91.3% vs 81.5%; p=0.044). The multivariate analysis confirmed the growth pattern as an independent risk factor (p=0.048). In patients with visceral pleura infiltration, the sub-lobar resection was associated with a significantly lower 5-year survival compared to lobectomy (63% vs 90%; p=0.033). The visceral pleural infiltration was independent from ADK growth pattern, predominant lepidic vs non lepidic (p=0.51), but it was significantly more frequent in the ADK >2 cm (p=0.012). Small peripheral (<3cm) N0 lung ADK can be easily resected by wedge or anatomical segmentectomy. The lepidic growth pattern is the main prognostic factor independently from the extension of resection however, in case of visceral pleural involvement, lobectomy reduces significantly the risk of recurrence.
    Minerva chirurgica 07/2015; · 0.68 Impact Factor
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    ABSTRACT: In the present study we evaluated the efficacy and safety of a cisplatin (P), etoposide (E), and bevacizumab (Bev) regimen followed by maintenance oral E and Bev in patients with extensive-stage disease small-cell lung cancer (ED-SCLC). Patients were administered 3-day fractionated P 25 mg/m(2) and E 100 mg/m(2) on days 1 to 3, every 3 weeks. After 3 PE cycles, all patients whose disease did not progress continued treatment with PE combined with Bev 15 mg/kg on day 3 every 3 weeks. After completion of 3 PE/Bev cycles, patients who did not experience tumor progression continued maintenance treatment with oral E 50 mg on days 1 to 14 every 21 days combined with Bev 3 times per week until occurrence of disease progression or unacceptable toxicity. At our institution, 22 patients were enrolled and their median age was 66 years (range, 38-79 years). After completion of induction chemotherapy (3 PE cycles with 3 PE/Bev cycles) the objective response rate was in 17 patients (77.2%) (95% confidence interval [CI], 54.6-92.1). Twenty-one patients received maintenance treatment with oral E and Bev. The 9-month disease control rate was 8 patients (36.3%). Median progression-free survival was 7.8 months (95% CI, 7.0-11.3 months) and median overall survival was 13.2 months (95% CI, 11.8-18.7 months). Grade 3 to 4 neutropenia occurred in 12 patients (54.4%) and 14 patients (63.6%) of patients during cycles 1 to 3 and cycles 4 to 6 of induction chemotherapy, respectively. Severe adverse events during maintenance treatment were rarely observed. A PE and Bev regimen followed by oral E and Bev maintenance treatment appears feasible and effective in terms of 9-month disease control rate in patients with ED-SCLC. Copyright © 2015 Elsevier Inc. All rights reserved.
    Clinical Lung Cancer 05/2015; DOI:10.1016/j.cllc.2015.05.005 · 3.10 Impact Factor
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    ABSTRACT: The present study evaluated the efficacy and safety of cisplatin (Cis), gemcitabine (Gem) and bevacizumab (Bev), followed by maintenance treatment with Bev and oral vinorelbine (Vnb), in patients with advanced non-squamous non-small cell lung cancer (NSCLC). The patients were administered six cycles of induction chemotherapy consisting of intravenously (i.v.) Cis 70 mg/m(2) on day 1 plus i.v. Gem 1000 mg/m(2) on days 1 and 8, plus i.v. Bev 7.5 mg/kg on day 1, every 3 weeks. Patients who did not experience tumor progression remained on maintenance treatment with Bev combined with oral Vnb 60 mg/m(2) weekly until occurrence of disease progression or unacceptable toxicity. Thirty-seven patients were enrolled: The median age was 67 years (range 38-81); 22 patients were male, and 30 patients had stage IV tumors. The response rate was 32.4 % (95 % CI 18-49.7). The 9-month disease-control rate was 45.9 %. The median PFS was 8.4 months (95 % CI 4.4-10.7), and the median OS was 18.1 months (95 % CI 15.3-20.8 months). Grade 3-4 neutropenia occurred in 6 (16.2 %) patients and grade 3-4 thrombocytopenia in four (10.8 %) patients during induction chemotherapy. Bev- or Vnb-associated toxicities were mild. Switch maintenance treatment with Bev and oral Vnb after first-line Cis, Gem and Bev is feasible in patients with non-squamous NSCLC and may achieve encouraging results in terms of PFS and OS.
    Medical Oncology 04/2015; 32(4):587. DOI:10.1007/s12032-015-0587-x · 2.63 Impact Factor

  • Interactive Cardiovascular and Thoracic Surgery 07/2014; 17(suppl 1):S22-S22. DOI:10.1093/icvts/ivt288.83 · 1.16 Impact Factor
  • S. Tenconi · L. Luzzi · C. Rapicetta · M. Gallazzi · G. Gotti ·

    Interactive Cardiovascular and Thoracic Surgery 07/2014; 17(suppl 1):S19-S19. DOI:10.1093/icvts/ivt288.73 · 1.16 Impact Factor

  • Interactive Cardiovascular and Thoracic Surgery 06/2014; 18(suppl 1):S59-S59. DOI:10.1093/icvts/ivu167.226 · 1.16 Impact Factor
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    ABSTRACT: The aim of this study is to assess the prognostic significance of Mib1 expression, Mitosis (Mi) and Apoptosis (Ai) in residual tumour cells after induction chemotherapy in surgically resected IIIA-N2 patients. Between January 2002 and November 2008, we reviewed 50 consecutive patients (39 males) with histologically proven stage IIIA-N2 NSCLC, who underwent radical resection following induction chemotherapy. Five-year survival in the series was evaluated in relation to lymph node downstaging, histology, extent of resection, number of chemotherapy cycles, pT status, sex and age. It was then also evaluated in relation to the proliferative indexes (Mi, Ap and Mib 1 expression), dividing the patients into two groups according to whether they were above or below the 50th percentile for each parameter. The associations between mortality and the abovementioned prognostic factors were explored using the Kaplan-Meier method, the logrank test, and Cox regression analysis. The monovariate analysis confirmed the positive prognostic role of lymph node downstaging in terms of 5yr survival: 31% vs. 12% (p=0.018). However Mi and Mib1 expression under the 50th percentile were also associated with better 5yr survival: respectively 46% vs. 5% (p=0.007) and 40% vs. 6% (p=0.017). Neither apoptosis nor the other prognostic factors showed any statistical impact on longterm survival. The multivariate analysis showed Mi to be an independent prognostic factor (p=0.005). Although lymph node downstaging has been considered the principal prognostic factor after induction chemotherapy and surgical resection, Mi and Mib1 expression in residual tumour can predict long-term survival more accurately.
    The Journal of cardiovascular surgery 04/2014; · 1.46 Impact Factor
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    ABSTRACT: Wide surgical excision with tumour-free margins is the mainstay of therapy for primary chest wall chondrosarcoma (PCWC). Few studies on treatment outcome and prognostic factors of PCWC requiring chest wall resection are available. We analysed our experience on surgical treatment of PCWC with emphasis on survival and recurrence prognostic factors. From 1986 to 2012, 89 patients (65.2% males, median age 55 years) with PCWC were operated on. The median tumour maximum diameter was 7 cm (range 2-30 cm). We performed 23 sternectomies and 66 lateral chest wall resections (median ribs resected: 2; range 1-7). Resections were extended to lung (n = 19), diaphragm (n = 13), vertebral body (n = 6) or clavicle (n = 1). Negative margins were obtained in 85.4% of cases. Chest wall reconstruction was obtained mainly by prosthetic non-rigid or rigid materials and muscle flap coverage. In the last years, 3 patients received a sternal replacement with cadaveric allograft, and 2 had a chest wall reconstruction with titanium bars and 17 with a rib-like prosthesis. Perioperative mortality and morbidity rates were 0 and 12.4%, and 5- and 10-year overall and disease-free (on R0 resections) survival rates were 67.1 and 57.8%, and 70 and 52%, respectively. A favourable outcome (univariate analysis) was seen for G1 tumours (P < 0.0001), negative surgical margins (P < 0.0001), age ≤55 years (P = 0.005), no adjuvant treatment (P < 0.001) and diameter ≤6 cm (P = 0.005). Independent predictors of better survival (multivariate analysis) were negative surgical margins (P = 0.0001), G1 tumours (P = 0.02), age ≤55 years (P = 0.006) and diameter ≤6 cm (P = 0.006). A predictive risk factor for recurrence was histological grade. Surgical resection of PCWC leads to good oncological outcome. Wide surgical margins and G1 tumours predicted a better prognosis and a lower recurrence rate. The evolution of surgical technique and the introduction in clinical practice of new prosthetic materials allowed larger resections, and safe and anatomical reconstruction.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 03/2014; 45(6). DOI:10.1093/ejcts/ezu095 · 3.30 Impact Factor
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    ABSTRACT: To analyse clinical and biomolecular prognostic factors associated with the surgical approach and the outcome of 247 patients affected by primary atypical carcinoids (ACs) of the lung in a multi-institutional experience. We retrospectively evaluated clinical data and pathological tissue samples collected from 247 patients of 10 Thoracic Surgery Units from different geographical areas of our country. All patients were divided into four groups according to surgical procedure: sub-lobar resections (SURG1), lobar resections (SURG2), tracheobronchoplastic procedures (SURG3) and pneumonectomies (SURG4). Overall survival analysis was performed using the Kaplan-Meier method and log-rank test. Survival was calculated from the date of surgery to the last date of follow-up or death. The parameters evaluated included age, gender, smoking habits, laterality, type of surgery, 7th edition of TNM staging, mitosis Ki-67 (MIB1), multifocal forms, tumourlets, type of lymphadenectomy and neo/adjuvant therapy. For multivariate analysis, a Cox regression model was used with a forward stepwise selection of covariates. Two hundred and forty-seven patients (124 females and 123 males; range 10-84, median 60 years) underwent surgical resection for AC in the last 30 years as follows: n = 38 patients in SURG1, 181 in SURG2, 15 in SURG3 and 14 in SURG4. A smoking history was present in 136 of 247 (55%) patients. The median follow-up period was 98.7 (range 11.2-369.9) months. The overall survival probability analysis of the AC was 86.7% at 5 years, 72.4% at 10 years, 64.4% at 15 years and 58.1% at 20 years. Neuroendocrine multicentric forms were detected in 12 of 247 patients (4.8%; 1 of 12 pts) during the follow-up (range 11.2-200.4, median 98.7 months) and 33.4% had recurrence of disease. There were no significant differences between gender, tumour location and type of surgery at the multivariate analysis. Age [P < 0.001, hazard ratio (HR) 0.60; confidence interval (CI) 0.32-1.12], smoking habits (P = 0.002; HR 0.43, 95% CI 0.23-0.80) and lymph nodal metastatic involvement (P = 0.008; HR 0.46, 95% CI 0.26-0.82) were all significant at multivariate analysis. ACs of the lung are malignant neuroendocrine tumours with a worst outcome in patients over 70 years and in smokers. With the exception of pneumonectomy, the extent of resection does not seem to affect survival and should be accompanied preferably by lymphadenectomy. Pathological staging, along with a mitotic index more than Ki-67 (MIB1), appears to be the most significant prognostic factor at the univariate analysis.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 10/2013; DOI:10.1093/ejcts/ezt470 · 3.30 Impact Factor

  • Interactive Cardiovascular and Thoracic Surgery 09/2013; 17(suppl 2):S151-S151. DOI:10.1093/icvts/ivt372.338 · 1.16 Impact Factor

  • Interactive Cardiovascular and Thoracic Surgery 09/2013; 17(suppl 2):S89-S89. DOI:10.1093/icvts/ivt372.83 · 1.16 Impact Factor
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    ABSTRACT: Objectives: The study aimed to determine the impact of interstitial lung disease (ILD) on postoperative morbidity, mortality and long-term survival of patients with non-small-cell lung cancer (NSCLC) undergoing pulmonary resection. Methods: We performed a retrospective chart review of 775 consecutive patients who had undergone lung resection for NSCLC between 2000 and 2009. ILD, defined by medical history, physical examination and abnormalities compatible with bilateral lung fibrosis on high-resolution computed tomography, was diagnosed in 37 (4.8%) patients (ILD group). The remaining 738 patients were classified as non-ILD (control group). We also attempted to identify the predictive factors for early and late survival in patients with ILD following pulmonary resection. Results: There was no significant difference between the two groups in terms of age (69 vs 66 years), sex (79 vs 72% male), smoking history (93 vs 90% smokers), forced expiratory volume in 1 s % of predicted (89 vs 84%), predicted values of forced vital capacity (FVC)% (92 vs 94%), types of surgical resection and histology. Patients with ILD had a higher incidence of postoperative acute respiratory distress syndrome (ARDS; 13 vs 1.8%, P < 0.01) and higher postoperative mortality (8 vs 1.4%, P < 0.01). The overall 5-year survival rate was 52% in the ILD and 65% in the non-ILD patients, respectively (P = 0.019). In the ILD group, at the median follow-up of 26 months (range 4-119), 19 (51%) patients were still alive and 18 (49%) had died in the ILD group. The major cause of late death was respiratory failure due to the progression of fibrosis (n = 7, 39%). In the ILD group, lower preoperative FVC% (mean 77 vs 93%, P < 0.01) and lower diffusing capacity of the lung for carbon monoxide (DLCO%; 47 vs 62%; P < 0.01) were significantly associated with postoperative ARDS. Conclusions: In conclusion, major lung resection in patients with NSCLC and ILD is associated with an increased postoperative morbidity and mortality. Patients with a low preoperative FVC% should be carefully assessed prior to undergoing surgery, particularly in the presence of a lower DLCO%. Long-term survival is significantly lower when compared with patients without ILD, but still achievable in a substantial subgroup. Thus, surgery can be offered to properly selected patients with lung cancer and ILD, keeping in mind the risk of respiratory failure during the evaluation of such patients.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 11/2012; 43(1). DOI:10.1093/ejcts/ezs560 · 3.30 Impact Factor
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    ABSTRACT: Objectives: The present study aimed to assess the additional value of a pocket-sized imaging device (PSID) as an adjunct to plain chest X-rays in the diagnosis of pleural effusion (PE), mainly for those requiring pleural thoracentesis. Methods: We performed a thoracic ultrasound examination using a PSID in 73 patients with an abnormal chest X-ray diagnostic for unilateral PE. Abundant PE was defined as an interpleural distance between the diaphragm and visceral pleura (VP) of ≥ 30 mm at the apex of the 50 mm bisector line of the costodiaphragmatic recess at end expiration. Results: According to PSID ultrasound evaluation, abundant PE was present in 46 patients (63%), while 27 (37%) patients showed the presence of mild PE or absence of PE. Thoracentesis was performed successfully and without procedure-induced complications in all 46 patients with abundant PE. Using the above-mentioned method, we obtained a high diagnostic accuracy (area under the curve = 0.99) and excellent sensitivity and specificity of 91.7 and 99.9%, respectively, to predict a PE >1000 ml, when VP was >6.3 cm. Conclusions: PSID is a useful tool that may integrate and complete the physical examination, also providing additional information to chest X-ray in the clinical management of patients with suspected PE. PSID evaluation can also increase the effectiveness and safety of thoracentesis.
    Interactive Cardiovascular and Thoracic Surgery 07/2012; 15(4):596-601. DOI:10.1093/icvts/ivs223 · 1.16 Impact Factor
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    ABSTRACT: To assess the risk, for patients with thymoma, of developing an additional malignancy (AM). We studied 68 patients with thymomas. Based on the World Health Organization classification, the tumours were categorised as A, AB or B (B1, B2, B3) thymomas. Control populations comprised 114 patients with colorectal cancer, 108 patients with lymphoma and 123 patients with thyroid carcinoma. Patients with thymomas showed a higher risk of developing an AM (22 of 68 patients versus 11 of 114, eight of 108, and eight of 123 patients, respectively; P = 0.0002). The association between thymomas and AMs was related to the thymoma histotype, with B1, B2, B3 and AB tumours showing a higher risk of developing an AM than A thymomas (P = 0.0474). Patients affected by thymomas showed a significantly higher risk of developing additional malignancies than those in the control groups, and cases that exhibited a predominantly cortical component were more likely to develop other neoplasms. This may be related to the functions of cortical thymic epithelial cells in providing for T lymphocyte maturation through interaction with major histocompatibility complexes.
    Histopathology 02/2012; 60(3):437-42. DOI:10.1111/j.1365-2559.2011.04111.x · 3.45 Impact Factor
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    ABSTRACT: Recent studies have reported a high incidence of perioperative in-stent trombosis with myocardial infarction (MI), in patients undergoing non-cardiac surgery, early after coronary angioplasty and stenting. The short and long-term results of surgery for non-small cell lung cancer (NSCLC) after prophylatic coronary angioplasty and stenting were analyzed. Prospective collected data were examined for postoperative complications and long-term survival in 16 consecutive patients who underwent mayor lung resection for NSCLC after prophylactic coronary angioplasty and stenting for significant coronary artery disease , from 2001 to 2008. One and two non-drug-eluting stents were placed in 75% or (25% of the patient, respectively. All patients had four weeks of dual antiplatelet therapy, that was discontinued 5 days prior to surgery and replaced by low molecular weight heparin. Patients were keep sedated and intubated overnight, according to our protocol. There were no postoperative deaths nor MI. A patient experienced pulmonary embolism with moderate troponin release and underwent coronary angiography that showed patency of the stent. Two patients developed postoperative bleeding complications haemothorax requiring a re-thoracotomy in 1, gastric bleeding requiring blood transfusion in 1. At the mean follow-up of 30 months (range 3-95), none of the patients showed evidence of myocardial ischemia, while 5 (31%) patients died, mostly (N.=4) due to distant metastasis. The five-year survival rate was 53%. In contrast to previous reports, lung resection after prophylactic coronary angioplasty and stenting is a safe and effective treatment for NSCLC and myocardial ischemia. The application of a refined protocol could be the key factor for improved results.
    Minerva chirurgica 02/2012; 67(1):77-85. · 0.68 Impact Factor
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    ABSTRACT: Bevacizumab, is a humanized monoclonal antibody to vasculo-endothelial-growth-factor, with anticancer activity in non-small-cell-lung cancer (NSCLC) patients. Our previous results from a dose/finding phase I trial in NSCLC patients, demonstrated the anti-angiogenic effects and toxicity of a newest bevacizumab-based combination with fractioned cisplatin and daily oral etoposide. We designed a phase II trial to evaluate in advanced NSCLC patients the antitumor activity and the safety of this novel regimen. In particular, 45 patients (36 males and 9 females), with a mean age of 54 years, an ECOG ≤ 2, stage IIIB/IV and NSCLC (28 adenocarcinomas, 11 squamous-cell carcinomas, 2 large-cell carcinomas, 4 undifferentiated carcinomas), were enrolled. They received cisplatin (30 mg/sqm, days 1-3), oral etoposide (50 mg, days 1-15) and bevacizumab (5 mg/kg, day 3) every three weeks (mPEBev regimen). Patients who achieved an objective response or stable disease received maintenance treatment with bevacizumab in combination with erlotinib until progression. Grade I-II hematological, mucosal toxicity and alopecia were the most common adverse events. The occurrence of infections (17%), thromboembolic events (4.4%) and severe mood depression (6.7%) was also recorded. A partial response was achieved in 31 (68.8%) patients, disease remained stable in 8 (17.8%), and disease progressed in 6 (13.3%) with a progression-free-survival of 9.53 months (95%CI, 7.7-11.46). Our bio-chemotherapy regimen resulted very active in advanced NSCLC, however, the toxicity associated with the treatment requires strict selection of the patients to enroll in future studies.
    Cancer biology & therapy 07/2011; 12(2):112-8. DOI:10.4161/cbt.12.2.15722 · 3.07 Impact Factor
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    ABSTRACT: To assess the long-term impact of standard lobectomy on respiratory function in octogenarian patients with mild/moderate chronic obstructive pulmonary disease (COPD). We reviewed all octogenarians (n=38), who underwent lobectomy for stage I-II non-small-cell lung cancer (NSCLC) from 2000 to 2006. Inclusion criteria were: Tiffenau index<0.7, no adjuvant therapies, smoking cessation after surgery, spirometric data available after 12±3 months from surgery in the absence of relapsing disease. After excluding 14 patients (three died perioperatively), 24 fulfilled the inclusion criteria. The median preoperative forced expiratory volume in 1s (FEV1) was 80% (range 56.7-100%). The mean change in FEV1 after lobectomy resulted in a loss of 11% (range -32% to +7%, p=0.004). Considering two groups on the basis of median FEV1 (group 1: FEV1≤80%, group 2: FEV1>80%), mean FEV1 loss after surgery was 7.9% in group 1 and 14.9% in group 2, respectively (p=0.17). No statistical differences were found between the two groups in changes after surgery of forced vital capacity (FVC), arterial oxygen and carbon-dioxide tension. Diffusion capacity of the lung for carbon monoxide (DLCO)% loss was significantly higher in group 2 compared with group 1 (-22.5% vs +1.5%, p=0.001). Six patients showed an improvement of postoperative FEV1: all had a preoperative FEV1 less than 60%, an upper or homogeneous pattern of emphysema, and received an upper lobectomy. In group 2, the FEV1 loss was not affected by the type of lobectomy whereas in group 1, the resection of lower lobe was associated to a major FEV1 loss (-14.5% vs +5.3%, p=0.05). Octogenarians with lower preoperative FEV1% have a better late preservation of pulmonary function after lobectomy. Upper lobectomy seems to produce a lung-volume reduction effect, leading to an improvement in the expiratory volume in patients with higher airflow obstruction.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 04/2011; 39(4):555-9. DOI:10.1016/j.ejcts.2010.07.043 · 3.30 Impact Factor
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    ABSTRACT: To assess the usefulness of (18)fluorine-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) for differentiating the grade of malignancy of thymic epithelial neoplasm, and to determine whether (18)F-FDG PET/CT can have a role in pretreatment evaluation and possibly modify treatment strategy. The data of 26 consecutive patients (14 males and 12 females) diagnosed with a thymic epithelial neoplasm were prospectively collected and analyzed retrospectively. All patients underwent standard clinical assessment and (18)F-FDG PET/CT. The patients were divided into two subgroups according to a simplified histologic classification: low-risk thymoma (types A, AB and B1) and high-risk thymoma (types B2, B3 and C). The maximum standardized uptake value (SUV(max)) of the tumor, the mean SUV of mediastinum, and the tumor/mediastinum (T/M) ratio (ratio of peak SUV of the tumor to mean SUV of mediastinum) were compared to determine whether the two subgroups (low-risk versus high-risk tumors) could be distinguished by (18)F-FDG PET/CT, and to test for possible correlations between (18)F-FDG uptake and disease stage. There was a strong statistical correlation between SUV(max) and patient subgroup and between SUV(max) and disease stage, and an even stronger correlation between SUV(max) and patient subgroup and the T/M ratio; a T/M ratio of 2.75 emerged as the cut-off value for differentiating between low-risk and high-risk thymomas. (18)F-FDG PET/CT can be used a "metabolic biopsy" to divide thymic epithelial neoplasm into two subgroups of high and low risk and is useful in pretreatment staging.
    Lung cancer (Amsterdam, Netherlands) 03/2011; 74(2):239-43. DOI:10.1016/j.lungcan.2011.02.018 · 3.96 Impact Factor
  • L Bertolaccini · G Rizzardi · L Luzzi · A Terzi ·
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    ABSTRACT: During mediastinoscopy in a 38-year-old woman, there was uncontrolled bleeding that required a sternal split. One month later, chest and neck CT scan demonstrated tracheomediastinal fistula. The patient underwent urgent operation. Repair of the tracheal defect was accomplished using a pedicled right sternohyoid muscle; the right sternocleidomastoid muscle was used to separate the trachea from the innominate artery and the left pectoralis major muscle was used to fill the anterior mediastinal space. The postoperative course was uneventful. One month later, another CT scan demonstrated complete resolution. Careful use of coagulation during mediastinoscopy is of paramount importance to avoid thermal injury to the trachea. This case also underlines the importance of a good knowledge of the anatomy of the skeletal muscles of the chest wall and adjacent regions.
    The Thoracic and Cardiovascular Surgeon 03/2011; 59(6):364-6. DOI:10.1055/s-0030-1250481 · 0.98 Impact Factor

Publication Stats

474 Citations
119.12 Total Impact Points


  • 2000-2014
    • Università degli Studi di Siena
      • • Department of Medical Biotechnologies
      • • Department of Medicine, Surgery and Neuroscience
      Siena, Tuscany, Italy
  • 2009
    • Santa Croce e Carle General Hospital
      Coni, Piedmont, Italy
  • 2008-2009
    • Azienda Sanitaria Ospedaliera S.Croce e Carle Cuneo
      Coni, Piedmont, Italy