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Sandri A, Donati G, Blanc CD, Nigra VA, Gagliasso M, Barmasse R. Anterior chest wall resection and sternal body wedge for primary chest wall tumour: reconstruction technique with biological meshes and titanium plates. J Thorac Dis 2020; 12:17-21. [PMID: 32055419 DOI: 10.21037/jtd.2019.06.45] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Chest wall tumours are heterogeneous neoplasms, either primary or metastatic, with a malignancy rate of 50%. Surgical resection is one of the mainstays of the treatment, however, chest wall resections can be particularly challenging depending onto the resection size, site and patient habitus. The surgical strategy should be carefully analysed preoperatively, keeping in mind the need of an oncological radical resection (R0) in accordance to the reconstruction principles elicited by le Roux and Sherma since 1983, which include restoring the chest wall rigidity, preserving pulmonary mechanics, protect the intrathoracic organs, avoiding paradox movements of the chest cavity and, possibly, to reduce the thoracic deformity. In this context, we herewith report our surgical reconstruction technique following an anterior chest wall resection and sternal body wedge for a primary chest wall tumour (chondrosarcoma).
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Affiliation(s)
- Alberto Sandri
- Unit of Thoracic Surgery, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | | | | | - Victor Auguste Nigra
- Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, University of Turin, Torino, Italy
| | - Matteo Gagliasso
- Unit of Thoracic Surgery, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
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Filosso PL, Nigra VA, Lanza G, Costardi L, Bora G, Solidoro P, Cristofori RC, Molinatti M, Lausi PO, Ruffini E, Oliaro A, Guerrera F. Digital versus traditional air leak evaluation after elective pulmonary resection: a prospective and comparative mono-institutional study. J Thorac Dis 2015; 7:1719-24. [PMID: 26623093 DOI: 10.3978/j.issn.2072-1439.2015.09.12] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The increased demand to reduce costs and hospitalization in general pushed several institution worldwide to develop fast-tracking protocols after pulmonary resections. One of the commonest causes of protracted hospital stay remains prolonged air leaks (ALs). We reviewed our clinical practice with the aim to compare traditional vs. digital chest drainages in order to evaluate which is the more effective to correctly manage the chest tube after pulmonary resection. METHODS All patients submitted to elective pulmonary resection for lung malignancies, between April to December, 2014 in our General Thoracic Surgery Department were included in the study. The primary outcome was the chest tube duration, the secondary the postoperative overall hospitalization. Significant differences between traditional and digital groups were investigated with logistic regression models. Numerical variables between the groups were compared by means of the unpaired Wilcoxon-Mann-Whitney test. RESULTS Both series of patients were comparable for clinical, surgical and pathological characteristics. Chest tube duration showed to be significantly shorter in the digital group (3 vs. 5 days, P=0.0009), while the hospitalization was longer in traditional one [8 vs. 7 days in digital drainage (DD); P=0.0385]. No chest drainage replacement was required at 30-day, in both groups. CONCLUSIONS We were able to demonstrate that patients managed with a digital system experienced a shorter chest tube duration as well as a lower overall hospital length of stay, compared to those who received the traditional drainage (TD).
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Affiliation(s)
- Pier Luigi Filosso
- 1 Department of Thoracic Surgery, University of Torino, Torino, Italy ; 2 Service of Pulmonology, San Giovanni Battista Hospital, Torino, Italy
| | - Victor Auguste Nigra
- 1 Department of Thoracic Surgery, University of Torino, Torino, Italy ; 2 Service of Pulmonology, San Giovanni Battista Hospital, Torino, Italy
| | - Giovanni Lanza
- 1 Department of Thoracic Surgery, University of Torino, Torino, Italy ; 2 Service of Pulmonology, San Giovanni Battista Hospital, Torino, Italy
| | - Lorena Costardi
- 1 Department of Thoracic Surgery, University of Torino, Torino, Italy ; 2 Service of Pulmonology, San Giovanni Battista Hospital, Torino, Italy
| | - Giulia Bora
- 1 Department of Thoracic Surgery, University of Torino, Torino, Italy ; 2 Service of Pulmonology, San Giovanni Battista Hospital, Torino, Italy
| | - Paolo Solidoro
- 1 Department of Thoracic Surgery, University of Torino, Torino, Italy ; 2 Service of Pulmonology, San Giovanni Battista Hospital, Torino, Italy
| | - Riccardo Carlo Cristofori
- 1 Department of Thoracic Surgery, University of Torino, Torino, Italy ; 2 Service of Pulmonology, San Giovanni Battista Hospital, Torino, Italy
| | - Massimo Molinatti
- 1 Department of Thoracic Surgery, University of Torino, Torino, Italy ; 2 Service of Pulmonology, San Giovanni Battista Hospital, Torino, Italy
| | - Paolo Olivo Lausi
- 1 Department of Thoracic Surgery, University of Torino, Torino, Italy ; 2 Service of Pulmonology, San Giovanni Battista Hospital, Torino, Italy
| | - Enrico Ruffini
- 1 Department of Thoracic Surgery, University of Torino, Torino, Italy ; 2 Service of Pulmonology, San Giovanni Battista Hospital, Torino, Italy
| | - Alberto Oliaro
- 1 Department of Thoracic Surgery, University of Torino, Torino, Italy ; 2 Service of Pulmonology, San Giovanni Battista Hospital, Torino, Italy
| | - Francesco Guerrera
- 1 Department of Thoracic Surgery, University of Torino, Torino, Italy ; 2 Service of Pulmonology, San Giovanni Battista Hospital, Torino, Italy
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