Alessandro BrunelliLeeds Teaching Hospitals NHS Trust · Thoracic Surgery
Alessandro Brunelli
MD
About
489
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Introduction
Consultant Thoracic Surgeon, St. James's University Hospital NHS Trust, Leeds, UK
Honorary Clinical Associate Professor University of Leeds.
President of the European Society of Thoracic Surgeons
Publications
Publications (489)
Objective
To evaluate the surgical outcomes following neoadjuvant chemo-immunotherapy and surgery for locally advanced non-small cell lung cancer.
Methods
Prospective analysis on all consecutive patients who underwent neoadjuvant chemotherapy and nivolumab followed by surgery (March 2023-April 2024), in a single centre. Indication for neoadjuvant...
OBJECTIVES
Our objective was to assess the incidence and reason of last-minute cancellations before surgery for lung cancer and their association with outcomes.
METHODS
Retrospective analysis on all consecutive patients booked for elective lung cancer surgery from January 2017 through December 2022 in a single centre.
Last minute cancellation: a c...
OBJECTIVES
CALGB140503/JCOG0802 RCTs comparing lobectomy with sublobar resection in stage IA NSCLC have confirmed the non-inferiority of segmentectomy. Additional insight is needed to improve preoperative work-up and intraoperative strategies to increase safety and promote the dissemination of minimally invasive segmentectomy (MIS). A Delphi panel...
OBJECTIVES
The aim of this study was to assess the self-reported current dyspnoea and perioperative changes of dyspnoea in long-term survivors after minimally invasive segmentectomy or lobectomy for early-stage lung cancer.
METHODS
Cross-sectional telephonic survey of patients alive and disease-free as of March 2023, with pathologic stage IA1–2, n...
Objective
To evaluate the oncologic outcome of patients with hypermetabolic tumors resected by segmentectomy or lobectomy.
Methods
This was a retrospective analysis of all consecutive patients with peripheral clinical stage IA1-2 non–small cell lung cancer (January 2017-June 2023) who underwent resection by segmentectomy or lobectomy in a single c...
Surgery remains an essential element of the multimodality radical treatment of patients with early-stage nonsmall cell lung cancer. In addition, thoracic surgery is one of the key specialties involved in the lung cancer tumour board. The importance of the surgeon in the setting of a multidisciplinary panel is ever-increasing in light of the crucial...
OBJECTIVES
Robotic-assisted thoracic surgery is increasingly used in our specialty. We surveyed European Society of Thoracic Surgeons membership with the objective to determine current status of robotic thoracic surgery practice including training perspectives.
METHODS
A survey of 17 questions was rolled out with 1 surgeon per unit responses consi...
Background
Dyspnoea is common following surgical resection for non-small cell lung cancer (NSCLC). The effects range from reduced quality of life to impact on adjuvant therapy outcomes. Currently, dyspnoea beyond the immediate postoperative phase and risk factors are not well characterised. We hope to assess the evolution of patient-reported dyspno...
Objective
The objective of this study is to compare in a real-world series the short- and long-term results of segmentectomy and lobectomy for peripheral clinical stage IA non-small cell lung cancer.
Methods
Single center cohort study including a series of consecutive patients undergoing minimally invasive segmentectomy or lobectomy for peripheral...
OBJECTIVE
To assess variations in surgical stage distribution in two centres within the same UK region. One centre was covered by an active screening program started in November 2018 and the other not covered by screening.
METHOD
Retrospective analysis of 1895 patients undergoing lung resections (2018–2022) in 2 centres. Temporal distribution was...
We appreciate the insightful perspective presented by Condello regarding the proactive approach in cardiac surgery and the importance of multidisciplinary considerations for organ protection [1]. Thoracic and cardiac surgeries often involve complex procedures that require meticulous planning and execution. The involvement of multiple disciplines an...
Introduction
Lung cancer screening is currently being rolled-out across England following recommendation by the UK National Screening Committee in September 2022 and Ministerial approval in June 2023. The US Preventive Services Task Force recommendations for lung cancer screening specify that this should only be offered to people able and willing t...
OBJECTIVES
There is a lack of evidence on whether perioperative outcomes differ in obese patients after video-assisted thoracic surgery (VATS) or open lobectomy. We queried the European Society of Thoracic Surgeons database to assess morbidity and postoperative length of hospital stay in obese patients submitted to VATS and open pulmonary lobectomy...
The recently published recommendations on technical standards of segmentectomy from Brunelli et al. are welcomed [1]. The surgical landscape has changed over the last couple of years with the manner and type of resection for early-stage lung cancer subject to significant debate. There is of course now the general acknowledgement that with the earli...
OBJECTIVES
Ventilatory efficiency (VE/VCO2 slope) can be measured at sub-maximal workload during cardiopulmonary exercise test. The aim of this study is to assess the association between VE/VCO2 slope and outcome after lung cancer resections.
METHODS
Retrospective, single centre analysis on all patients undergoing lung resection for cancer (April...
Background
Screening for lung cancer with low radiation dose computed tomography has a strong evidence base, is being introduced in several European countries and is recommended as a new targeted cancer screening programme. The imperative now is to ensure that implementation follows an evidence-based process that will ensure clinical and cost effec...
Background:
Screening for lung cancer with low radiation dose computed tomography has a strong evidence base, is being introduced in several European countries and is recommended as a new targeted cancer screening programme. The imperative now is to ensure that implementation follows an evidence-based process that will ensure clinical and cost eff...
We thank Waller et al. [1] for their insightful comments on statements 13 and 14 of our expert consensus recommendations [2]. Indeed, their position supports the opinion of 25% of the panellists who disagreed on a systematic lymph node frozen section.
Interestingly, statement 13 barely reached consensus, while 96% agreed to proceed to a lobectomy i...
The General Data Protection Regulation (GDPR), enacted in the European Union in 2018, has significantly transformed the landscape of personal data management and protection. This article provides an overview of GDPR's impact, focusing on its applicability, fundamental principles and influence on data management practices, particularly within the Eu...
A five classes (A-E) aggregate risk score predicting 90-day mortality after video-assisted thoracoscopic lobectomy for lung cancer, including as independent factors male sex (3 points), DLCO <60% (1 point) and operative time >150 minutes (1 point), has been recently published. This study aims to assess the effectiveness and reliability of this risk...
INTRODUCTION
The recent findings from the JCOG0802 and CALGB randomized control trials [1, 2] have corroborated previous observational reports series [3–8] showing favourable short-term and long-term results of segmentectomy in patients operated for peripheral (outer third of the lung), early-stage non-small-cell lung cancer (NSCLC) (2 cm or less)....
Objective
Surgical management of pulmonary metastases in colorectal cancer patients is a debated topic. There is currently no consensus on this matter, which sparks considerable risk for international practice variation. The European Society of Thoracic Surgeons (ESTS) ran a survey to assess current clinical practices and to determine criteria for...
Background:
Venous thromboembolism (VTE), which includes deep vein thrombosis and pulmonary embolism, is a potentially fatal but preventable postoperative complication. Thoracic oncology patients undergoing surgical resection, often after multimodality induction therapy, represent among the highest risk groups for postoperative VTE. Currently ther...
Background:
The type of initial intervention i.e., endobronchial valve (EBV) implantation or lung volume reduction surgery (LVRS) to be offered as initial intervention remains vague in the treatment of emphysema-chronic obstructive pulmonary disease (COPD) patients. Aim of the present study was to compare the outcomes of EBV with that of LVRS in e...
Background:
Venous thromboembolism (VTE), which includes deep vein thrombosis and pulmonary embolism, is a potentially fatal but preventable postoperative complication. Thoracic oncology patients undergoing surgical resection, often after multimodality induction therapy, represent among the highest risk groups for postoperative VTE. Currently ther...
Prolonged air leak (PAL) after lung anatomical resection
remains a long-unsolved problem. After the advent
of minimally invasive thoracic surgery (MITS) and
the enhanced recovery after surgery (ERAS) era, PAL
significantly burdens the postoperative course (1). Often the
average hospital stay is less than 5 days, so the appearance of
PAL can prolong...
Objectives:
For centrally located lung tumours, sleeve lobectomy is preferred over pneumectomy. We report on surgical practices and peri-operative outcomes of sleeve resections based on the European Society of Thoracic Surgeons database.
Methods:
We retrieved data of patients undergoing sleeve lobectomy or bilobectomy from 2007 to 2021. We evalu...
BackgroundE-learning has become an important tool in surgical education in the last decade. The European Society of Thoracic Surgeons launched its e-learning platform in 2013 and started its educational webinars series in 2018. The aim of this paper is to discuss the introduction, evolution and impact of the educational webinars within this e-learn...
Background:
We designed this study to investigate the rate and risk factors of prolonged air leak (PAL) in patients undergoing pulmonary segmentectomy in our unit.
Methods:
We performed a retrospective cohort study on 191 patients undergoing pulmonary segmentectomy (January 2017-August 2021). A PAL was defined as an air leak >5 days.
Results:...
Background:
We investigated the association between preoperative quality of life (QoL) and long-term survival in patients undergoing surgical resection for non-small cell lung cancer (NSCLC).
Methods:
Retrospective analysis was conducted on 388 consecutive patients who completed the Quality of Life assessment through the European Organisation fo...
Non-small cell lung cancer (NSCLC) accounts for 85% of all newly diagnosed lung cancer cases. Among patients with NSCLC, about 20% are diagnosed with stage I and II, and 30% with stage III diseases (1). In recent years, the popularity of low-dose computed tomography (CT) screening for thoracic disease has resulted in a higher proportion of early-st...
Background
The purpose of this randomized controlled trial was to determine if enhanced recovery after surgery (ERAS) would improve outcomes for three-stage minimally invasive esophagectomy (MIE).
Methods
Patients with esophageal cancer undergoing MIE between March 2016 and August 2018 were consecutively enrolled, and were randomly divided into 2...
OBJECTIVES
This study reports the results of an international expert consensus process evaluating the assessment of intraoperative air leaks (IAL) and treatment of postoperative prolonged air leaks (PAL) utilizing a Delphi process, with the aim of helping standardization and improving practice.
METHODS
A panel of 45 questions was developed and sub...
Eurolung models have been published by the European Society of Thoracic Surgeons Database Committee to adjust morbidity and mortality outcomes with the purpose to be used among other quality indicators as part of the Composite Performance Score [1, 2]. This score incorporates outcome and processes end-points in a single score to assess the eligibil...
To investigate factors associated with the ability to receive adjuvant chemotherapy in patients with pathological N1 and N2 stage after anatomic lung resections for non-small cell lung cancer (NSCLC). Multicenter retrospective analysis on 707 consecutive patients found pathologic N1 (pN1) or N2 (pN2) disease following anatomic lung resections for N...
Background:
Prolonged air leaks are increasingly treated in the outpatient setting, with patients discharged with chest tubes in place. We evaluated the incidence and risk factors associated with readmission, empyema development and further interventions in this patient population.
Methods:
We undertook a retrospective cohort analysis of all pat...
OBJECTIVES
The aim of this study was to analyse the outcomes of an international cohort of patients affected by Masaoka stage III thymic epithelial tumours with vascular involvement and treated by surgery.
METHODS
Study design was the observational multicentre retrospective cohort study. Data were extracted from the European Society of Thoracic Su...
Objectives:
The goal of this study was to develop a risk-adjusting model to stratify the risk of an unplanned admission to the intensive care unit (following lung resection).
Methods:
We performed a retrospective analysis of 3123 patients undergoing anatomical lung resections (2014-2019) in 2 centres. A risk score was developed by testing severa...
Pleural tent is a procedure performed after upper lobectomies or lung volume reduction surgery to minimize the residual apical pleural space and favour pleura-pleura apposition. The final aim is to reduce the occurrence of air leak. This article describes the step by step technique to create a pleural tent after a videothoracoscopic upper lobectomy...
Introduction
Video-assisted thoracoscopic (VATS) lung resection is the recommended curative treatment for early-stage non-small cell lung cancer (NSCLC). Patients considered at high surgical risk, are treated with stereotactic ablative body radiotherapy (SABR) as a lower morbidity alternative. This study aims to investigate the impact of SABR and V...
Background:
Few studies have exclusively investigated the value of pathological complete response (pCR), in esophageal squamous cell carcinoma (ESCC) patients, although it is a clinically significant parameter to evaluate the impact of neoadjuvant chemoradiotherapy (nCRT) on treatment outcome after surgery. The aim of our study was to explore the...
The study from Hoeijmakers et al. [1] is an interesting snapshot of the current incidence of prolonged air leak (PAL) following lung resection in the Netherlands as collected in the Dutch Lung Cancer Audit for Surgery registry. The overall incidence of PAL in the registry is similar to what reported in previous series from other Countries and in or...
Abstract
OBJECTIVES: Resection of thymic tumours including the removal of both the tumour and the thymus gland (thymothymectomy; TT) is the
procedure of choice and is recommended in most relevant articles in the literature. Nevertheless, in recent years, some authors have sug�gested that resection of the tumour (simple thymomectomy; ST) may suffice...
Background
With a 5% improvement in 5-year overall survival achieved with current neoadjuvant or adjuvant chemotherapy, new treatments for resectable non-small cell lung cancer (NSCLC) are urgently needed. The use of immune checkpoint inhibitors (ICI) is established in metastatic NSCLC and is being evaluated in resectable NSCLC.
Methods
Publicatio...
Objective
Lobectomy is a standard treatment for stage I non-small cell lung cancer (NSCLC), but a significant proportion of patients are considered at high risk for complications after lobectomy and may not be candidates. Identifying who is at risk is important and in evolution. The objective of the AATS Clinical Practice Standards Committee (CPSC)...
Background
Management of clinical stage IIIA-N2 (cIIIA-N2) non-small cell lung cancer (NSCLC) remains controversial. We evaluated treatment strategies and outcomes in cIIIA-N2 NSCLC patients who underwent pulmonary resection in The Society of Thoracic Surgeons General Thoracic Surgery Database (STS GTSD) and the European Society of Thoracic Surgeon...
OBJECTIVES
Resection of thymic tumours including the removal of both the tumour and the thymus gland (thymothymectomy; TT) is the procedure of choice and is recommended in most relevant articles in the literature. Nevertheless, in recent years, some authors have suggested that resection of the tumour (simple thymomectomy; ST) may suffice from an on...
Objectives:
Technology has the potential to assist healthcare professionals in improving patient-doctor communication during the surgical journey. Our aims were to assess the acceptability of a quality of life (QoL) application (App) in a cohort of cancer patients undergoing lung resections and to depict the early perioperative trajectory of QoL....
OBJECTIVES
The American College of Chest Physicians functional guidelines classify patients with predicted postoperative forced expiratory volume in 1 s or predicted postoperative carbon monoxide lung diffusion capacity <60% and with maximal oxygen consumption (VO2max) between 10 and 20 ml/kg/min in a heterogeneous category broadly defined as ‘mode...
Background
The United Kingdom National Institute for Health and Care Excellence guidelines recommend that patients and professionals make shared decisions between surgery and stereotactic ablative radiotherapy (SABR) when treating early stage non-small cell lung cancer (NSCLC). Variation by centre suggests treatment decisions may be disproportionat...
Background:
The feasibility of segmental resection for early-stage non-small cell lung cancer (NSCLC) is still controversial. This study aimed to compare survival outcomes following lobectomy and segmental resection in patients with pathological T1cN0M0 (tumor size 21-30 mm) NSCLC.
Methods:
Patients diagnosed between 1998 and 2016 with pathologi...
Background
Management of clinical stage IIIA-N2 (cIIIA-N2) non-small cell lung cancer (NSCLC) remains controversial. We evaluated treatment strategies and outcomes in cIIIA-N2 NSCLC patients who underwent pulmonary resection in The Society of Thoracic Surgeons General Thoracic Surgery Database (STS GTSD) and the European Society of Thoracic Surgeon...
The symposium Patient-centered care in thoracic care: a holistic approach was held on June 22, 2021, as a virtual event in the context of the European conference on general thoracic surgery. Its aim was to explore how to improve patient outcomes in thoracic surgery by using enhanced recovery after surgery (ERAS®) frameworks and collaboration within...
OBJECTIVES
The use of sealants is one of the methods available to reduce the occurrence of intraoperative air leaks. The objective of this modified Delphi survey among ESTS members is to understand the attitudes of clinicians to the optimal use of sealants in air leak management.
METHODS
To understand the attitudes of a wider sample of clinicians,...
OBJECTIVES
We report an overview of surgical practices and outcomes in patients undergoing pulmonary metastasectomy based on data from the European Society of Thoracic Surgeons database.
METHODS
We retrieved data on resections performed for pulmonary metastases between July 2007 and July 2019. We evaluated baseline characteristics, surgical manage...
OBJECTIVES
The aim of this study was to assess whether quality of life (QoL) scales are associated with postoperative length of stay (LoS) following video-assisted thoracoscopic surgery (VATS) lobectomy for lung cancer.
METHODS
This is a single-centre retrospective analysis on 250 consecutive patients submitted to VATS lobectomies (233) or segment...
Objectives:
We queried the European Society of Thoracic Surgeons (ESTS) database with the aim to assess cardiopulmonary morbidity and 30-day mortality of segmentectomies and lobectomies in patients with a Eurolung-predicted mortality above the upper interquartile and classified as high risk.
Methods:
A total of 61 492 patients registered in the...
Objectives:
Our goal was to assess the postoperative 90-day hospital costs of patients with prolonged air leak (PAL) including costs incurred after discharge from the initial index hospitalization.
Methods:
We performed a retrospective analysis of 982 patients undergoing lobectomy (898) or segmentectomy (78) (April 2014-August 2018). A total of...
Objectives:
There is widespread acknowledgement that coronavirus disease 2019 (COVID-19) has disrupted surgical services. The European Society of Thoracic Surgeons (ESTS) sent out a survey to assess what impact the COVID-19 pandemic has had on the practice of thoracic oncology surgery.
Methods:
All ESTS members were invited (13-20 April 2020) to...
Objective
To verify whether the Eurolung score was associated with long term prognosis after lung cancer resection.
Methods
1359 consecutive patients undergoing anatomic lung resection (1136 lobectomies, 103 pneumonectomies, 120 segmentectomies) (2014-2018) were analysed. The parsimonious aggregate Eurolung2 score was calculated for each patient....
Background
The aim of the study was to investigate Programmed cell Death protein 1 (PD-1) and Programmed Death-Ligand 1 (PD-L1) and their mRNA expression in thymic epithelial tumors (TETs).
Research design and Methods
We analyzed 68 samples of formalin-fixed paraffin embedded tissue (63 thymomas and 5 thymic carcinomas). PD-1 and PD-L1 protein exp...
Exercise tests have established themselves as an important part of the preoperative functional evaluation of patients being considered for lung cancer surgery. When assessing the apparently healthy patient, the aim is to identify those with underlying and undetected cardiorespiratory deficit that can increase their surgical risk. This then allows f...
Modern surgical practice places increased emphasis on treatment outcomes. There has been a paradigm shift from paternalistic ways of practicing medicine to patients having a major involvement in decision making and treatment planning. The combination of these two factors undoubtedly leaves the surgeon open to greater scrutiny in respect of results...
Background:
Esophagectomy is a pivotal curative modality for localized esophageal or esophagogastric junction cancer (EC or EJC). Postoperative anastomotic leakage (AL) remains problematic. The use of fibrin sealant (FS) may improve the strength of esophageal anastomosis and reduce the incidence of AL.
Aim:
To assess the efficacy and safety of a...
OBJECTIVES
Venous thromboembolic events can be successfully prevented with chemical and/or mechanical prophylaxis measures, but evidence-based guidelines in thoracic surgery are limited, particularly regarding extended post-discharge prophylaxis. This study attempts to gather an international consensus on best practices to inform the development of...
Background:
Patient's satisfaction has been regarded as a subjective reflection of the quality of care received by patients during their hospital stay. However, which factors may influence patient satisfaction in different healthcare settings needs to be determined.
Methods:
Cross-sectional investigation of satisfaction at the time of discharge...
Because of the differing definitions of the margins of thoracic surgery as a specialty and the variability in the training curricula among European countries, the European Society of Thoracic Surgeons formed a task force to elaborate a consensual proposal. The first step comprised creating a harmonized syllabus that was completed and published in 2...
Objectives:
Venous thromboembolic events (VTE) after thoracic surgery (TS) can be prevented with mechanical and chemical prophylaxis. Unlike other surgical specialties, TS lacks evidence-based guidelines. In the process of developing these guidelines, an understanding of the current prophylaxis methods practiced internationally is necessary and is...
Intraoperative bleeding is the most crucial safety concern of video-assisted thoracic surgery (VATS) for a major pulmonary resection. Despite the advances in surgical techniques and devices, intraoperative bleeding is still not rare and remains the most common and potentially fatal cause of conversion from VATS to open thoracotomy. Therefore, to gu...