Thymic carcinoma is an epithelial tumor derived from thymic epithelial cells. Thymic tumors may be associated with other simultaneous and/or metachronous extra-thymic tumors (e.g., lung cancer). Here, we report a case of simultaneous surgical management of lung and mediastinal neoplasm together with a review of the literature. During radiological follow-up for prostate and colorectal cancer, an 82-year-old man was diagnosed with lung cancer with simultaneous mediastinal suspected neoplasm. Both were surgically removed with a single intervention performed via a uniportal videoassisted thoracic surgery (uni-VATS) approach. The literature emphasizes how extrathymic cancer can be diagnosed before, concurrently and consecutively with thymic neoplasia. The surgical treatment of such simultaneous cancer is challenging. We succeeded in the excision of both neoplasia with a mini-invasive surgical technique. This report highlights the feasibility of uniportal VATS in a patient with very unusual clinical and oncological history.
HighlightsTeratomas are tumours composed by different tissues derived from one or more of the three primitive germ cell layers. The frequency of mediastinal teratomas ranged from 1 to 5 %, in most cases with localization in the anterior/superior mediastinum.VATS technique is minimally invasive, and it is characterized by a shorter recovery period, a minor blood loss and a shorter hospital stay. VATS has been advocated since 2010 for pulmonary resections, but today it is also performed for mediastinal intervention and a series of reports have demonstrated that it is feasible and safe.We demonstrate that uniportal VATS could be used also to remove mediastinal giant mass, without complications for patients, with a reduction hospital stay, less post-operative pain and better cosmetic results.
Background: Thoracic surgery is a constantly evolving field that require innovative solutions. Invisible near-infrared fluorescence imaging with indocyanine green is an intraoperative technology that could be help for surgeons. Indocyanine green is a nontoxic dye with low rate of adverse reaction. Indocyanine green binds with plasma proteins and lipoprotein that allow a deep tissue penetration, and also the amphiphilic proprieties allow indocyanine green to migrate within lymphatics. Methods: We selected forty-nine previous studies from the literature searching terms “lung cancer”, “indocyanine green”, “thoracic surgery”, “fluorescent images”. The topics of the paper were: sentinel lymph node mapping, pulmonary nodes identification, intersegmental plane identification, and other application (pulmonary bullous lesions, bronchopleural fistula, bronchoplasty, pulmonary sequestration, chyle leak, hyperidrosis). Results: In the different applications indocyanine green showed a high identification rate, overall accuracy, sensibility, and specificity. Conclusions: This review describes the advantages and current applications in thoracic surgery of intraoperative near-infrared fluorescence imaging using indocyanine green.
BackgroundThe International Association for the Study of Lung Cancer defined types of surgical resection and considered the positivity of the highest mediastinal lymph node resected a parameter of “uncertain resection” (R-u). We investigated the metastases in the highest mediastinal lymph node, defined as the lowest numerically numbered station among those resected. We aimed to evaluate the prognostic value of R-u compared with R0.Materials and methodsWe selected 550 patients with non-small cell lung cancer at clinical Stage I, IIA, IIB (T3N0M0), or IIIA (T4N0M0) undergoing lobectomy and systematic lymphadenectomy between 2015 and 2020. The R-u group included patients with positive highest mediastinal resected lymph node.ResultsIn the groups of patients with mediastinal lymph node metastasis, we defined 31 as R-u (45.6%, 31/68). The incidence of metastases in the highest lymph node was related to the pN2 subgroups (p < 0.001) and the type of lymphadenectomy performed (p < 0.001). The survival analysis compared R0 and R-u: 3-year disease-free survival was 69.0% and 20.0%, respectively, and 3-year overall survival was 78.0% and 40.0%, respectively. The recurrence rate was 29.7% in R0 and 71.0% in R-u (p-value < 0.001), and the mortality rate was 18.9% and 51.6%, respectively (p-value < 0.001). R-u variable showed a tendency to be a significant prognostic factor for disease-free survival and overall survival (hazard ratio: 4.6 and 4.5, respectively, p-value < 0.001).ConclusionsThe presence of metastasis in the highest mediastinal lymph node removed seems to be an independent prognostic factor for mortality and recurrence. The finding of these metastases represents the margin of cancer dissemination at the time of surgery, so it could imply metastasis into the N3 node or distant metastasis.
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