Alessandro Brunelli

Alessandro Brunelli
Leeds Teaching Hospitals NHS Trust · Thoracic Surgery

MD

About

458
Publications
47,747
Reads
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11,866
Citations
Citations since 2016
200 Research Items
7933 Citations
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201620172018201920202021202205001,0001,500
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
Additional affiliations
January 2015 - present
University of Leeds
Position
  • Honorary Clinical Associate Professor
February 2014 - present
Leeds Teaching Hospitals NHS Trust
Position
  • Consultant Thoracic Surgeon and Honorary Clinical Associate Professor
November 2009 - May 2010
Mayo Clinic - Rochester
Position
  • Clinical Research

Publications

Publications (458)
Article
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...
Article
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...
Article
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...
Article
Full-text available
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...
Article
Full-text available
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...
Article
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...
Article
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...
Article
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...
Article
Full-text available
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...
Article
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...
Article
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...
Article
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...
Article
Full-text available
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...
Article
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...
Article
Full-text available
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...
Article
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...
Article
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...
Article
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...
Article
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)...
Article
Full-text available
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...
Article
Full-text available
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...
Article
Full-text available
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....
Article
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...
Article
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...
Article
Full-text available
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...
Preprint
Full-text available
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...
Article
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...
Article
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,...
Article
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...
Article
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...
Article
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...
Article
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...
Article
Full-text available
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...
Article
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....
Article
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...
Chapter
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...
Article
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...
Article
Full-text available
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...
Article
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...
Article
Full-text available
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...
Article
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...
Article
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...
Article
Full-text available
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...
Article
Objectives: We sought to identify the risk factors associated with mortality post-video-assisted thoracoscopic surgery (VATS) lobectomy over a 2-year period. Methods: Analysis was performed using a sample from an institutionally maintained database. All lobectomies for non-small-cell lung cancer from April 2014 to March 2018 started with VATS ap...
Article
Although isolated local (LRs) and regional recurrences (RRs) constitute a minority of post-stereotactic ablative radiotherapy (SABR) relapses, their management is becoming increasingly important as the use of SABR continues to expand. However, few evidence-based strategies are available to guide treatment of these potentially curable recurrences. O...
Article
Objectives: To develop a simplified version of the Eurolung risk model to predict cardiopulmonary morbidity and 30-day mortality after lung resection from the ESTS database. Methods: A total of 82 383 lung resections (63 681 lobectomies, 3617 bilobectomies, 7667 pneumonectomies and 7418 segmentectomies) recorded in the ESTS database (January 200...
Article
Full-text available
In the originally published version of this article two co-authors names were missing: Luis Hernandez Arenas and Laura Socci. Their names have been added to the list of this corrigendum and also in the HTML version of this full article. The institution of Mahmoud Ismail has also changed since publication and is updated here.
Article
Background: Lung cancer has changed significantly during the past two decades in its epidemiology and treatment. We conducted a retrospective analysis using data from seven major areas of China over ten years to evaluate clinicopathologic and surgical treatment trends of lung cancer in China during the past decade METHODS: Data from 7184 primary l...
Article
Objectives: Our goal was to report the results of the first consensus paper among international experts in uniportal video-assisted thoracoscopic surgery (UniVATS) lobectomy obtained through a Delphi process, the objective of which was to define and standardize the main procedural steps, optimize its indications and perioperative management and id...
Article
Objectives: A 1995 survey of Society of Thoracic Surgeons (STS) members revealed wide variation in postresection lung cancer surveillance practices and pessimism regarding any survival benefit. We sought to compare contemporary practice patterns and attitudes among members of STS, European Society of Thoracic Surgeons (ESTS) and the Japanese Assoc...
Article
Full-text available
Background: The emphysema interventional treatment involves mainly lung volume reduction surgery (LVRS) and endobronchial valve (EBV) implantation. Few institutes discuss these cases at a dedicated emphysema multidisciplinary team (MDT) meeting. Objectives: To investigate the impact of a newly established dedicated emphysema MDT meeting on the i...
Article
Objectives: To evaluate the postoperative complications and 30-day mortality rates associated with neoadjuvant chemotherapy before major anatomic lung resections registered in the European Society of Thoracic Surgeons (ESTS) database. Methods: Retrospective analysis on 52 982 anatomic lung resections registered in the ESTS database (July 2007-31...
Article
Objectives: The purpose of this study was to develop a score to predict the complexity of video-assisted thoracoscopic surgery (VATS) lobectomies preoperatively. Methods: One hundred and thirty-nine consecutive patients undergoing VATS lobectomy operated on by a single surgeon as the first operator were included. Complex operations were defined...
Chapter
Video-assisted thoracoscopic surgery is the surgical treatment of choice for spontaneous pneumothorax. Most recently, this technique has been made even less invasive by the use of the single-port technique. Uniportal VATS treatment of spontaneous pneumothorax has been shown to be superior to traditional VATS in terms of pain and long-term paraesthe...
Article
Objectives: We queried the European Society of Thoracic Surgeons (ESTS) prospective thymic database for descriptive analysis and for comparison with the ESTS retrospective thymic database (1990-2010). Methods: Data were retrieved (January 2007-November 2017) for 1122 patients from 75 ESTS institutions. Results: There were 484 (65%) thymomas, 2...