Publications (15)42.94 Total impact
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Article: The impact of decreasing cutoff values for maximal oxygen consumption (VO(2)max) in the decision-making process for candidates to lung cancer surgery.
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ABSTRACT: BACKGROUND: Maximal oxygen consumption (VO(2)max) is considered a decisive test for risk prediction in patients with borderline cardiopulmonary reserve. Guidelines have adopted decreasing VO(2)max cut-off values to define operability within acceptable mortality and morbidity limits. We wanted to investigate how the adoption of decreasing VO(2)max cut-off-values assessment contributed to better select lung surgery candidates. METHODS: One hundred and nineteen consecutive surgical candidates have been prospectively analyzed as a sample population. Preoperative work-up included spirometry and transfer factor (DLco); irrespective of the spirometric values, these patients were subjected to VO(2)max assessment. Surgical eligibility was decided by the same surgeon throughout the series. In the postoperative period, overall mortality and the occurrence of any, major or minor complications was recorded and graded according to the Common Terminology Criteria for Adverse Events v.4.3. RESULTS: Three arbitrary cut-offs were introduced at 15, 14 and 12 mL(.)kg(-1) (.)min(-1). Notably, 15 and 12 mL(.)kg(-1) (.)min(-1) correlated with percentage VO(2)max values of 50% and 35% of predicted (P<0.0001 and 0.0079), respectively. Accordingly, the patients were subdivided into groups in which the prevalence of postoperative morbidity was recorded. The groups were homogeneous as to age, BMI, preoperative absolute and percentage FEV1 and DLco. In the Cox proportionate-hazards multivariate analysis, VO(2)max less than 35% (P=0.0017) and CTCAE >2 (P=0.0457) emerged as significant predictors of survival after surgery. Conversely on logistic regression analysis, age over 70 years (P=0.03) and pneumonectomy (P=0.001), but not VO(2)max cut-off values, were significant predictors of major (CTCAE >2) morbidity. CONCLUSIONS: Since VO(2)max is increasingly used to contribute to risk prediction for the individual patient, surgeons need to be advised that the concept of a definitive, generalized cut-off value for VO(2)max is probably a contradiction in terms. Patient-specific VO(2)max values are more likely to contribute to risk assessment since they may reflect the primarily affected component among the determinants of maximal oxygen consumption. Whether patient-specific VO(2)max should be routinely used by surgeons to define operability for borderline patients needs further evaluation.Journal of thoracic disease. 02/2013; 5(1):12-18. -
Article: Corrigendum to 'Is flexible bronchoscopy necessary to confirm the position of double-lumen tubes before thoracic surgery?'[Eur J Cardiothorac Surg 2011;40:912-18].
European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 06/2012; 41(6):1411. · 2.40 Impact Factor -
Article: Ultrasonographic identification of peripheral pulmonary nodules through uniportal video-assisted thoracic surgery.
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ABSTRACT: An intrinsic limitation of video-assisted thoracic surgery (VATS) resides in the impossibility to palpate the lung to identify embedded nodules. We wanted to investigate the use of intraoperative ultrasonography to detect pulmonary nodules during uniportal VATS. We describe our initial experience with the identification of peripheral pulmonary nodules with an articulating ultrasound probe introduced through a single VATS incision. The instrument was used in 2 patients with solitary pulmonary nodules and previous history of extrathoracic cancer. The lung nodules were identified by the articulating probe and resected on wide tumor-free margins through uniportal VATS. Subsequent lung palpation through minithoracotomy confirmed the absence of additional lesions. Intraoperative ultrasound scanning of the lung with an articulating probe can be successfully used through uniportal VATS to identify peripheral nodules.The Annals of thoracic surgery 09/2011; 92(3):1099-101. · 3.74 Impact Factor -
Article: Video-assisted thoracic surgery rib resection and reconstruction with titanium plate.
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ABSTRACT: A 38-year-old man was diagnosed with fibrous dysplasia of the anterolateral segment of the fifth rib by core biopsy. A decision was made to resect the rib by video-assisted thoracic surgery (VATS) taking care to preserve the muscle and overlying myodermal layers. Subsequent reconstruction was done using a straight titanium plate locked in place under thoracoscopic guidance to avoid friction of the plate on the skin and to verify that the transfixed screws would not injure the lung or the pericardium. The patient made an uneventful recovery and was dismissed on day 2 after surgery. Final diagnosis confirmed fibrous dysplasia.The Annals of thoracic surgery 08/2011; 92(2):744-5. · 3.74 Impact Factor -
Article: Is flexible bronchoscopy necessary to confirm the position of double-lumen tubes before thoracic surgery?
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ABSTRACT: Flexible bronchoscopy is recommended to confirm correct placement of double-lumen tubes used for thoracic anesthesia. However, there is still controversy over routine bronchoscopic confirmation of their position. This study aimed to verify the usefulness of flexible bronchoscopy for confirming the position of double-lumen tubes after blind intubation. During a 9-month period, consecutive patients undergoing elective oncologic thoracic surgery were prospectively enrolled in the study. All patients were intubated with a left disposable polyvinyl chloride double-lumen tube. Immediately after intubation, clinical verification was made by the anesthesiologist. Then, the endoscopist performed flexible bronchoscopy with a 2.8-mm diameter Olympus(®) video bronchoscope, and verified the position of the double-lumen tube, before positioning the patient. The double-lumen tube was in optimal position, if the bronchial cuff was immediately below the tracheal carina, and there was a clear view of the left subcarina, with unobstructed left upper and lower bronchi. Misplacement of the double-lumen tube was diagnosed when the tube had to be moved (in or out) for more than 0.5 cm to correct its position. Critical malposition meant a double-lumen tube dislocated in the trachea or in the right bronchi, requiring immediate re-intubation under bronchoscopic guidance. A total of 144 patients (44 women (42%) and 60 men (58%), with a mean age of 51 years (range 25-77 years)) were enrolled in the study. Surgical procedures included 37 right-sided and 31 left-sided thoracotomies, 22 video-assisted thoracoscopic surgeries (VATSs) (16 right-sided and six left-sided), one median sternotomy, six mediastinotomies, and seven miscellaneous procedures. In 66 (63%, 95% confidence interval 53.2-71.8%) cases, there was complete agreement between the anesthesiologist and the endoscopist. The latter diagnosed misplacement of the double-lumen tube in 33 (32%, 95% confidence interval 22.8-40.7%) patients and critical malposition in five (5%, 95% confidence interval 0.7-8.9%) cases. After blind intubation, 37% of double-lumen tubes required repositioning by means of flexible bronchoscopy, despite positive evaluation made by the anesthesiologist. Our data suggests that initial bronchoscopic assessment should be made with the patient still in the supine position, and confirms that flexible bronchoscopy is useful in verifying the correct position of double-lumen tubes or adjusting possible misplacements, before starting thoracic surgery.European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 07/2011; 40(4):912-6. · 2.40 Impact Factor -
Article: Management of localized pneumothoraces after pulmonary resection with intrapulmonary percussive ventilation.
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ABSTRACT: Intrapulmonary percussive ventilation (IPV) aims at clearing retained secretions through oscillary vibrations generated by high frequency bursts of gas delivered into the airways at rates between 200 and 300 breaths per minute and at a delivery pressure of 10 to 20 cm water. In addition, IPV can improve recruitment of alveolar units and deliver aerosolized medications. The use of IPV to resolve challenging postlobectomy localized pneumothoraces is hereafter described. Between January 2005 and March 2009, four patients with long-term complicated postresectional residual air spaces persisting 6 months (mean, 187 days) after primary surgery were treated by IPV. The type of operation was upper lobectomy and lower lobectomy-wedge resection in 1 and 3 patients, respectively. Mean preoperative and immediate postsurgical forced expiratory volume in the first second of expiration were 2.31 L and 1.49 L, respectively. Mean preoperative and immediate postsurgical forced vital capacity were 3.13 L and 2.1 L, respectively. Patients were subjected to 12-minute-long IPV sessions up to a total of 8 to 12 sessions administered every other day in an outpatient setting. Complete resolution of the spaces within a mean of 22 days of beginning of treatment was noted. The post-IPV forced expiratory volume in the first second of expiration and forced vital capacity were 1.72 and 2.4 liters, respectively. No treatment-related morbidity was observed. Intrapulmonary percussive ventilation can be expected to decisively contribute to resolving long-term localized pneumothoraces after subtotal pulmonary resections in an outpatient setting.The Annals of thoracic surgery 11/2010; 90(5):1658-61. · 3.74 Impact Factor -
Article: Omental flap and titanium plates provide structural stability and protection of the mediastinum after extensive sternocostal resection.
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ABSTRACT: Major tenets in the reconstruction of the anterolateral chest wall include preservation of structural stability and function and coverage of the mediastinal contents. To reach these goals, a rigid support has been advocated by several authors. We describe a patient with extensive anterolateral defect after sternocostal resection of chondrosarcoma. Successful reconstruction was performed by using three metallic transverse plates and an omental flap wrapped onto the plates. This method simplifies reconstruction in comparison with previously described techniques concerning complete solid coverage and leaves several options intact in the event of future recurrences.The Annals of thoracic surgery 07/2010; 90(1):e14-6. · 3.74 Impact Factor -
Article: Awake single-access (uniportal) video-assisted thoracoscopic surgery for peripheral pulmonary nodules in a complete ambulatory setting.
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ABSTRACT: Traditional 3-port video-assisted thoracoscopic surgery (VATS) in a patient who is awake has been proposed as a breakthrough in the direction of fast tracking patients through routine thoracic surgical procedures. We wanted to explore the possibility of further reducing surgical invasiveness by resecting a peripheral pulmonary nodule with single-access (uniportal) VATS in an awake, nonintubated, nonventilated patient, with selective occlusion of the tributary lobar bronchus. A 47-year-old woman with bilateral peripheral nodules underwent uniportal VATS wedge resection of an undetermined nodule in the right middle lobe. The patient was awake and under mild sedation for the entire procedure. Single-shot epidural regional anesthesia was administered. Under guidance provided by a reusable, portable flexible bronchoscope, a Fogarty balloon was positioned to occlude the right middle lobe bronchus to facilitate collapse of the targeted parenchyma. At the end of the procedure, the chest drain was connected to a portable vacuum system delivering autonomous suction. Awake uniportal VATS resection of peripheral nodules in selected patients is feasible and appears to be safe. Available technology may enable further reduction of costs related to length of hospitalization. The concept of ambulatory thoracic surgery may further evolve by utilizing uniportal VATS in an awake patient to solve the often-challenging diagnostic dilemmas represented by undetermined lung lesions.The Annals of thoracic surgery 05/2010; 89(5):1625-7. · 3.74 Impact Factor -
Article: V-Y latissimus dorsi flap for coverage of anterior chest wall defects after resection of recurrent chest wall chondrosarcoma.
The Journal of thoracic and cardiovascular surgery 02/2009; 138(5):1242-3. · 3.41 Impact Factor -
Article: Partial least squares path modelling for the evaluation of patients' satisfaction after thoracic surgical procedures.
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ABSTRACT: Patient satisfaction can be measured by criteria inspired by currently available marketing research methods. Among the latter, qualitative methods can be performed on limited population samples and be based on latent variables, i.e., variables that are not directly observed but deducted from mathematical analysis (i.e., quality of life). Qualitative research methods include the partial least squares (PLS) path modelling aimed at defining optimal linear relations among latent variables in order to assemble the best set of predictions. In the February-May 2007 period, 73 patients (41 males and 32 females) consecutively discharged from the Division of Thoracic Surgery of the National Cancer Institute at Naples underwent an adaptation of the PLS path modelling by accepting to file an itemized questionnaire on 29 different aspects of hospitalization. The sampled population represented about 32% of all patients operated by a single surgeon and about 21% of all patients admitted to a 12-bed thoracic surgical ward in 2007. Five categories of performance were identified, i.e., quality of the facilities, quality and clarity of provided Information, quality of relationship with surgeons and nurses, quality of the received care, overall patient satisfaction. During the analyzed period, the overall patient satisfaction reached 91% (+/-15). The mean scores were 62% (+/-33), 80% (+/-28), 84% (+/-21), 81% (+/-19), 88% (+/-15) for ward facilities, information provided, relationship with personnel, clinical services, and, perceived quality, respectively. In addition, overall perceived quality, relationship with personnel and the provision of information were the variables with greatest positive impact on patient satisfaction. Conversely, waiting times for radiological procedures, quality of meals and duration of visiting hours adversely affected the level of satisfaction. In the setting of a thorough audit of current clinical practice, PLS path modelling may represent another valuable tool to measure quality in the setting of managed health care since it allows for the identification of areas where the service can be improved.European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 12/2008; 35(2):353-7; discussion 357-8. · 2.40 Impact Factor -
Article: Visualization of bronchoalveolar fistula as the presenting sign of lung cancer.
The Journal of thoracic and cardiovascular surgery 04/2008; 135(3):704-5. · 3.41 Impact Factor -
Article: Minimally invasive combined approach for an hourglass-shaped mass at the thoracic inlet.
The Journal of thoracic and cardiovascular surgery 09/2007; 134(2):528-9. · 3.41 Impact Factor -
Article: The combination of multiple materials in the creation of an artificial anterior chest cage after extensive demolition for recurrent chondrosarcoma.
The Journal of thoracic and cardiovascular surgery 05/2007; 133(4):1112-4. · 3.41 Impact Factor -
Article: Uniportal VATS for mediastinal nodal diagnosis and staging.
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ABSTRACT: The objective of the present study was to assess feasibility of single port (uniportal) VATS in the diagnosis and staging of mediastinal nodal enlargements. To this purpose, between January 2002 and October 2005, 13 patients (8 males and 5 females; mean age 54 years) have undergone uniportal VATS sampling of mediastinal nodes either as part of a diagnostic pathway or as a staging procedure for primary lung cancer when either nodal stations were inaccessible to standard mediastinoscopy or in the event of redo nodal biopsy. Sampled stations were the aortopulmonary window (6), subcarinal (1), right paratracheal (5), and, paraesophageal (1) ones. In all cases, sufficient samples were made available for pathological diagnosis. Postoperatively, neither morbidity nor mortality was observed. The median length of stay in the hospital was 1 day. In conclusion we showed that uniportal VATS can be effectively used to achieve diagnosis and staging of mediastinal nodal stations.Interactive cardiovascular and thoracic surgery 09/2006; 5(4):430-2. -
Article: Uniportal video-assisted thoracoscopic surgery pericardial window.
The Journal of thoracic and cardiovascular surgery 05/2006; 131(4):921-2. · 3.41 Impact Factor
Top co-authors
Top Journals
Institutions
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2008–2012
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Istituto Nazionale Tumori "Fondazione Pascale"
Marano di Napoli, Campania, Italy
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2011
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Second University of Naples
Caserta, Campania, Italy
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