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Sicolo E, Zirafa CC, Romano G, Brandolini J, De Palma A, Bongiolatti S, Gallina FT, Ricciardi S, Maestri M, Guida M, Morganti R, Carleo G, Mugnaini G, Tajè R, Calabró F, Lenzini A, Davini F, Cardillo G, Facciolo F, Voltolini L, Marulli G, Solli P, Melfi F. National Multicenter Study on the Comparison of Robotic and Open Thymectomy for Thymic Neoplasms in Myasthenic Patients: Surgical, Neurological and Oncological Outcomes. Cancers (Basel) 2024; 16:406. [PMID: 38254894 PMCID: PMC10814766 DOI: 10.3390/cancers16020406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/16/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
Thymectomy is the gold standard in the treatment of thymic neoplasm and plays a key role in the therapeutic path of myasthenia gravis. For years, sternotomy has been the traditional approach for removing anterior mediastinal lesions, although the robotic thymectomy is now widely performed. The literature is still lacking in papers comparing the two approaches and evaluating long-term oncological and neurological outcomes. This study aims to analyze the postoperative results of open and robotic thymectomy for thymic neoplasms in myasthenic patients. Surgical, oncological and neurological data of myasthenic patients affected by thymic neoplasms and surgically treated with extended thymectomy, both with the open and the robotic approach, in six Italian Thoracic Centers between 2011 and 2021 were evaluated. A total of 213 patients were enrolled in the study: 110 (51.6%) were treated with the open approach, and 103 (48.4%) were treated with robotic surgery. The open surgery, compared with the robotic, presented a shorter operating time (p < 0.001), a higher number of postoperative complications (p = 0.038) and longer postoperative hospitalization (p = 0.006). No other differences were observed in terms of surgical, oncological or neurological outcomes. The robotic approach can be considered safe and feasible, comparable to the open technique, in terms of surgical, oncological and neurological outcomes.
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Affiliation(s)
- Elisa Sicolo
- Minimally Invasive and Robotic Thoracic Surgery—Surgical, Medical, Molecular and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy; (C.C.Z.); (G.R.); (F.C.); (A.L.); (F.D.); (F.M.)
| | - Carmelina Cristina Zirafa
- Minimally Invasive and Robotic Thoracic Surgery—Surgical, Medical, Molecular and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy; (C.C.Z.); (G.R.); (F.C.); (A.L.); (F.D.); (F.M.)
| | - Gaetano Romano
- Minimally Invasive and Robotic Thoracic Surgery—Surgical, Medical, Molecular and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy; (C.C.Z.); (G.R.); (F.C.); (A.L.); (F.D.); (F.M.)
| | - Jury Brandolini
- Department of Thoracic Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (J.B.); (P.S.)
| | - Angela De Palma
- Unit of Thoracic Surgery, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, 70121 Bari, Italy; (A.D.P.); (G.C.); (G.M.)
| | - Stefano Bongiolatti
- Thoracic Surgery Unit, Department of Experimental and Clinical Medicine, Careggi University Hospital, 50134 Florence, Italy; (S.B.); (G.M.); (L.V.)
| | - Filippo Tommaso Gallina
- Thoracic Surgery Unit IRCCS Regina Elena National Cancer Center, 00144 Rome, Italy; (F.T.G.); (R.T.); (F.F.)
| | - Sara Ricciardi
- Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo Forlanini, 00152 Rome, Italy; (S.R.); (G.C.)
| | - Michelangelo Maestri
- Neurology Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, 56124 Pisa, Italy; (M.M.)
| | - Melania Guida
- Neurology Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, 56124 Pisa, Italy; (M.M.)
| | - Riccardo Morganti
- Section of Statistics, University Hospital of Pisa, 56124 Pisa, Italy;
| | - Graziana Carleo
- Unit of Thoracic Surgery, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, 70121 Bari, Italy; (A.D.P.); (G.C.); (G.M.)
| | - Giovanni Mugnaini
- Thoracic Surgery Unit, Department of Experimental and Clinical Medicine, Careggi University Hospital, 50134 Florence, Italy; (S.B.); (G.M.); (L.V.)
| | - Riccardo Tajè
- Thoracic Surgery Unit IRCCS Regina Elena National Cancer Center, 00144 Rome, Italy; (F.T.G.); (R.T.); (F.F.)
| | - Fabrizia Calabró
- Minimally Invasive and Robotic Thoracic Surgery—Surgical, Medical, Molecular and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy; (C.C.Z.); (G.R.); (F.C.); (A.L.); (F.D.); (F.M.)
| | - Alessandra Lenzini
- Minimally Invasive and Robotic Thoracic Surgery—Surgical, Medical, Molecular and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy; (C.C.Z.); (G.R.); (F.C.); (A.L.); (F.D.); (F.M.)
| | - Federico Davini
- Minimally Invasive and Robotic Thoracic Surgery—Surgical, Medical, Molecular and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy; (C.C.Z.); (G.R.); (F.C.); (A.L.); (F.D.); (F.M.)
| | - Giuseppe Cardillo
- Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo Forlanini, 00152 Rome, Italy; (S.R.); (G.C.)
| | - Francesco Facciolo
- Thoracic Surgery Unit IRCCS Regina Elena National Cancer Center, 00144 Rome, Italy; (F.T.G.); (R.T.); (F.F.)
| | - Luca Voltolini
- Thoracic Surgery Unit, Department of Experimental and Clinical Medicine, Careggi University Hospital, 50134 Florence, Italy; (S.B.); (G.M.); (L.V.)
| | - Giuseppe Marulli
- Unit of Thoracic Surgery, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, 70121 Bari, Italy; (A.D.P.); (G.C.); (G.M.)
| | - Piergiorgio Solli
- Department of Thoracic Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (J.B.); (P.S.)
| | - Franca Melfi
- Minimally Invasive and Robotic Thoracic Surgery—Surgical, Medical, Molecular and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy; (C.C.Z.); (G.R.); (F.C.); (A.L.); (F.D.); (F.M.)
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Abstract
From 1977 to 1990, 37 patients with Stage III or IV invasive thymoma (20 men and 17 women; median age, 40 years of age) were referred for chemotherapy to the Padova Medical Oncology Department. All patients initially received the same regimen (50 mg/m2 of cisplatin and 40 mg/m2 of doxorubicin intravenously (IV) on day 1, 0.6 mg/m2 of vincristine IV on day 3, and 700 mg/m2 of cyclophosphamide IV on day 4 [ADOC]), recycling at monthly intervals. No life-threatening side effects were noted. The overall clinical response rate (complete response plus partial response) was 91.8%, with 43% complete remissions. Median duration of response and survival were 12 months (range, 2 to 96+ months) and 15 months (range, 5 to 96+ months), respectively. Seven of the 16 complete remissions were pathologically confirmed at subsequent thoracotomy. Other chemotherapy combinations and radiation therapy have been applied as second-line treatment, achieving only minimal responses. In the opinion of the authors, such chemotherapy deserves evaluation for adjuvant and neo-adjuvant treatment of invasive (and/or inoperable) thymoma due to the high complete response rate and overall response rate.
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De Marinis L, Mancini A, D'Amico C, Zuppi P, Tofani A, Della Casa S, Saporosi A, Sambo P, Fiumara C, Calabró F. Influence of naloxone infusion on prolactin and growth hormone response to growth hormone-releasing hormone in anorexia nervosa. Psychoneuroendocrinology 1991; 16:499-504. [PMID: 1811245 DOI: 10.1016/0306-4530(91)90033-p] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Anorexia nervosa (AN) is frequently associated with anomalies of growth hormone (GH) and prolactin (PRL) secretion. We studied the GH and PRL responses to GHRH1-44 (50 micrograms IV) and the effect of a naloxone infusion (1.6 mg/hr), started 1 hr before GHRH administration, on this response in 12 female patients with AN, aged 15-30 yr, and in seven normal women, aged 19-27 yr, during the follicular phase as controls. In AN, GHRH induced an increase in GH levels similar to that observed in normal subjects. A significant inhibition of the GH response to GHRH was observed during naloxone infusion, similar to the inhibition in normal female subjects during the follicular phase. PRL levels showed a significant increment after GHRH alone and a slight, nonsignificant, PRL increment after GHRH during naloxone infusion in AN patients. In contrast a slight PRL decrease was observed after GHRH, both before and during naloxone infusion, in the normal subjects. Our study demonstrates that endogenous opioids play a role in influencing PRL secretion in patients with AN different from their role in normal subjects.
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Affiliation(s)
- L De Marinis
- Institute of Endocrinology, Catholic University School of Medicine, Rome, Italy
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De Marinis L, Mancini A, D'Amico C, Calabró F, Zuppi P, Fiumara C, Barini A. Periovulatory plasma prolactin response to gonadotropin-releasing hormone: role of endogenous opiates. Neuroendocrinology 1990; 51:717-20. [PMID: 2114008 DOI: 10.1159/000125416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
It has been previously shown that in normal women during the periovulatory period, prolactin (PRL) levels increase after the administration of nonspecific stimuli, such as growth hormone-releasing hormone or gonadotropin-releasing hormone (GnRH). In order to gain insight into the mechanism of this response, we have tested the effect of a naloxone infusion (1.6 mg/h) on the PRL response to GnRH in 5 normal females, aged 20-27 years, tested during the periovulatory period. Naloxone was administered starting 60 min before GnRH administration (100 micrograms as an i.v. bolus). Naloxone clearly blunted the PRL response (basal 10.7 +/- 1.7 ng/ml, peak 11.8 +/- 0.2 ng/ml at 30 min, versus: basal 9.0 +/- 0.5 ng/ml, peak 20.6 +/- 3.9 ng/ml at 45 min after GnRH alone; significance of difference between peaks: p less than 0.05). A secondary late increase of PRL levels was observed, reaching about 60% of basal levels at 120 min (16.8 +/- 2.6 ng/ml). These data indicate that periovulatory PRL dynamics are altered by naloxone administration and suggest a possible involvement of opioid peptides in the 'paradoxical' PRL response to GnRH in normal subjects.
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Affiliation(s)
- L De Marinis
- Institut of Endocrinology, Catholic University School of Medicine, Rome, Italy
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