Category: Thoracic Oncology Introduction: Hyperthermic intrathoracic chemotherapy has been used as an adjuvant treatment after surgical resection of patients diagnosed with disseminated pleural neoplastic disease. The most frequent uses refer to malignant pleural mesothelioma and thymic tumors.(,) Objective: This study aims to describe our initial experience implementing this method of hyperthermic chemotherapy used after cytoreductive surgery. Methods: This is a retrospective study with a series of cases of patients who underwent pleural decortication followed by HITOC. We collected demographic and […]

Category: Thoracic Surgery Introduction: Currently, surgical resection is considered the best treatment available for early-stage lung cancer. In recent decades, minimally invasive procedures have revolutionized thoracic surgery, expanding the benefited patient population by reducing morbidity and mortality rates, incidence of complications, length of hospital stay and postoperative pain.() However, lung resections remain associated with significant morbidity and mortality, with national studies indicating a complication rate of 21.8% and an in-hospital mortality rate of 1.8% for video- assisted surgeries.() Concomitantly, various […]

Category: Thoracic Surgery Introduction: Acute Lung Injury (ALI) and Acute Respiratory Distress Syndrome (ARDS) are critical pulmonary conditions characterized by the sudden onset (<7 days) of severe hypoxemia and bilateral lung infiltrates.(,) The study investigates the occurrence of Acute Lung Injury (ALI) and Acute Respiratory Distress Syndrome (ARDS) following surgical resections, focusing on clinical manifestations, risk factors, and outcomes. Methods: A retrospective analysis of eight cases of ALI post-surgical resection between 2020 and 2023 was conducted. Data on patient demographics, […]

Category: Thoracic Surgery Introduction: The intrathoracic goiter is a mediastinal condition from the thyroid. It can be primary, independent from the cervical thyroid, or secondary, a result of the gland enlargement from the neck to the thorax. The diagnosis is made through physical examinations and imaging tests, such as CT scans and scintigraphy. Total thyroidectomy is the main treatment for substernal goiters, rarely requiring sternotomy. Pre-operative factors such as time of evolution, density and tissue location can predict the need […]

Category: Thoracic Surgery Introduction: With the advance of minimally invasive thoracic surgical techniques, postoperative hospitalization is shorter, and recovery is faster. However, chest drainage may be a limiting factor for hospital discharge, extending the hospital stay. Therefore, it is vital to understand the elements that could affect it so we can develop ways to prevent it. Objective: This study aims to assess the parameters that influence chest drainage for air leaks following anatomical lung resection for lung cancer. Methods: We […]

Category: Thoracic Oncology Introduction: Glomus tumors (GTs) are rare mesenchymal tumors typically developing at the anastomosis of arteries and veins, and generally characterized as benign.() They represent less than 2% of all soft tissue tumors, commonly affect nail beds, extremities, the torso, head and neck. Their occurrence in the trachea is unusual, with around 80 cases reported in literature, commonly occurring in middle-aged individuals, with an average age of 48.8 years, and more prevalent in men than women.(,) Objective: In […]

Category: Thoracic Oncology Introduction: The prognostic evaluation of early-stage non-small cell lung cancer (NSCLC) remains critical for optimizing treatment strategies and improving patient outcomes.(–) Objective: This study aims to delineate the pivotal predictors affecting survival rates among early-stage NSCLC patients, leveraging data from the Brazilian Lung Cancer Registry. Methods: This study retrospectively analyzed data from the Brazilian Lung Cancer Registry, encompassing 2,045 patients who underwent surgical treatment for lung cancer across 14 institutions in five Brazilian states. The registry is […]

Category: Thoracic Oncology Introduction: Bronchogenic tumors, predominantly non-small cell type (NSCLC), are a global health concern, with adenocarcinomas, their most common subtype, being most often diagnosed at advanced stages, making it essential to develop effective therapeutic strategies, especially for patients with NSCLC who do not express the PD-L1 (Programmed Death-Ligand 1) protein. Two pivotal studies, Keynote-189() and Keynote-407,() presented their combined results in 2023, after a 5-year follow-up,() concluding that the combination of Pembrolizumab and chemotherapy demonstrated substantial improvements in […]

Category: Thoracic Oncology Introduction: Primary tracheal tumors have a prevalence around 0.2% of the entire respiratory system.() Two-thirds of tracheal tumors are malignant, of which 75% are squamous cell carcinoma and 15% are adenoid cystic carcinoma. Due to the low incidence, we chose to report the case of a patient with adenoid cystic carcinoma approached via videothoracoscopy and sternotomy with incomplete resection of the lesion (R1) with clinical and radiological control of the disease following adjuvant therapy.() Case video Summary: […]

Category: Thoracic Oncology Introduction: Despite the proven survival benefits of adjuvant systemic therapy (AT) in resected non-small-cell lung cancer (NSCLC), its underutilization remains a concern.(–) Objecitve: This study aims to explore the extent to which socioeconomic disparities influence AT underutilization. Methods: Data from the Brazilian Registry of Lung Cancer (2009-2023), was queried for patients with complete surgical resected stage IB-III and stratified based on AT delivery. Demographic, clinical, and pathological variables were evaluated. Logistic regression model was performed. The model’s […]

Category: Thoracic Oncology Introduction: Genomic mutational profiling, obtained through next-generation sequencing (NGS) plays a pivotal role in assisting clinicians in therapeutic decision- making in patients with non-small cell cancer (NSCLC).(,) However, these techniques require high quality and sufficient quantity of material to produce reliable results.(,) Our study proposes the use of tissue scraping from histological and cytological slides as an alternative method for obtaining genomic DNA (gDNA) of better quality and quantity, and also an optimized extraction protocol from paraffin […]

Category: Robotic Technology in Thoracic Diseases Introduction: Recent two randomized studies have demonstrated that for lung cancers peripherally and smaller <2cm, segmentectomy accompanied by intraoperative lymph node assessment is as effective as lobectomy in terms of overall survival.() The video presents a comprehensive guide to performing a right robotic segmentectomy, specifically of segments 9 of the lung.() This includes a thorough hilar and mediastinal nodal dissection. Additionally, the video showcases the application of Indocyanine Green (ICG) to accurately identify the […]

Category: Robotic Technology in Thoracic Diseases Introduction: Colorectal cancer (CRC) is the leading cause of cancer death worldwide.() It is estimated that about 50% of patients with CRC develop metastasis during follow-up, most commonly in the liver followed by the lung. Lung metastasis is seen in approximately 10 – 15% of patients diagnosed with CRC.(,) Pulmonary metastasectomy is the treatment with the best survival rate.() Due to the high incidence of lung recurrence, in approximately 50% of cases, parenchyma-sparing lung […]

Category: Robotic Technology in Thoracic Diseases Introduction: Although usually of an indolent nature, thymoma recurrence rates vary between 15% and 50%.() While surgery remains the cornerstone of treatment, advanced or recurrent thymomas present significant challenges due to their invasive nature and propensity for local recurrence. Hyperthermic intrathoracic chemotherapy (HITHOC) has emerged as a promising adjunctive therapy to address these challenges.(,) This case report presents the utility and outcomes of HITHOC associated with robotic-assisted thoracic surgery (RATS) in the management of […]

Category: Robotic Technology in Thoracic Diseases Introduction: Robotic-assisted thoracic surgery (RATS) is well-established for the treatment of mediastinal tumors. Oncological results are comparable to invasive techniques, albeit providing fewer complications and less postoperative pain.(,) We present our initial experience with the subxiphoid technique. Methods: This retrospective case series includes patients submitted to RATS subxiphoid thymectomy. Demographic, perioperative, and postoperative data were gathered, analyzed, and reported with descriptive statistics. Results: Case 1: A 48-year-old woman, ex-smoker, with a history of colon […]

Category: Respiratory Endoscopy Introduction: Histopathological analyses and classification by the Tumor, Node, Metastasis System (TNM) are key-elements in therapeutic decision-making for non-small cell lung cancer (NSCLC).() Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is effective in obtaining biopsies of hilar and mediastinal lymph nodes (MLN), for tissue collection to mediastinal staging in NSCLC.(,) The assessment of clinically significant genomic alterations in surgically resected primary tumors (PT) and MLN aspirates obtained by EBUS-TBNA can provide valuable insights into the risk of recurrence, […]

Robotic surgery allows for better visualization and better handling of tissues during procedures because of the 3D view and articulated instruments which have more degrees of freedom than our own human wrist. Consequently, it is apparently easier to learn than other modalities of minimally invasive surgery (videoassisted thoracic surgery – VATS) and allows more surgeons to perform more complex procedures, particularly those that require bronchovascular sutures or reconstruction. Contributing for this assumption, recent studies have demonstrated that when compared to […]