Pathologies treated in the Thoracic Surgery Unit:

 

SURGERY FOR PRIMARY LUNG CANCER

Lung cancer is the first cancer-related cause of death in male population. Nevertheless, Its incidence has been growing in women in the last decade as well.

This kind of cancer usually affects people in their 50s; being the main risk factor a long lasting smoking habit. Surgical resection of the involved part of the lung remains the mainstay of treatment. After the diagnostic work-up has been carried out, the patient undergoes a multidisciplinary team evaluation (including Thoracic Surgeon, Pulmonologist, Thoracic Oncologist, Radiation Therapy Oncologist) in order to plan the appropriate treatment schedule, according to the most recent international guidelines. This multidisciplinary evaluation pursues a “tailored” approach to the single patient and a proper follow up after all required therapeutic procedures have been accomplished.

Surgical procedures are performed by means of a minimally invasive approach (Video Assisted Thoracic Surgery) in the majority of cases. Also in more advanced cases, especially after induction chemotherapy, surgery aims for a conservative approach, within the respect of oncologic radicality (i.e. avoidance of pneumonectomy whenever possible by means of bronchial and arterial resections and reconstructions). Surgery for locally advanced disease: en block resection and reconstruction of the thoracic wall, pericardium, diaphragm, Superior Vena Cava, are performed when the tumor involves these structures.

All resections are associated with hilo-mediastinal lymphadenectomy according to the European Society of Thoracic Surgery/ European Association for Cardiothoracic surgery (EACTS – ESTS) guidelines.

 

INVASIVE DIAGNOSTIC PROCEDURES FOR PULMONARY NEOPLASMS:

Mediastinoscopy, Anterior Mediastinotomy, Video-thoracoscopy are routinely performed, should some of the less invasive techniques (EBUS-EUS) not have been successful.

 

SURGERY OF PULMONARY METASTASIS

 

SURGERY OF THE PRIMARY AND SECONDARY PNEUMOTHORAX WITH VIDEO-THORACOSCOPY TECHNIQUE:

Spontaneous pneumothorax is characterized by a high percentage of relapse, usually around 30%, with a range that varies from 16% to 52% in those patients treated simply through observation or chest drainage. In a period ranging from 6 months to two year after the first occurrence, a second episode may easily ensue. Secondary (not spontaneous) Pneumothorax ( a common complication of advanced stage COPD) the percentage of relapse is higher. In order to avoid relapse, surgical treatment through a minimally invasive approach allows proper treatment, almost eliminating the risk of further relapse. The procedure consists in the resection of a small portion of lung harboring sub pleural anomalous blebs and induction of pleural sticking by means of mechanical pleurodesis.

 

SURGERY OF BENIGN PULMONARY PATHOLOGIES

Exeresis of bronchogenic cysts, treatment of Bullous Emphysema. Surgical treatment of infectious diseases of the lung and their sequelae ( surgery for tuberculosis destroyed lung, mycetomas, thora-coplasty with intrathoracic transposition of muscular grafts). Minimally invasive pulmonary biopsy for interstitial lung disease.

 

SURGERY OF PRIMARY AND SECONDARY TUMOURS OF THE PLEURA

In case of metastatic tumours to the pleura (effusion due to pleural localizations in advanced-stage cancer ) thoracoscopy ( pleural exploration via a 5 mm camera) has both a diagnostic and a symptomatic treatment, which aims to avoid or reduce dyspnoea due to rapidly relapsing pleural effusion. Talc pleurodesis provides a reliable tool in the treatment of pleural effusions. In selected cases we provide a permanent drainage system, which can be easily managed at home.

The primary tumour of the pleura is MALIGNANT MESOTHELIOMA.

It is often caused by exposure to asbestos.

Malignant pleural mesothelioma (MPM) always requires a multidisciplinary treatment, encompassing both preoperative chemotherapy followed by surgical resection. We provide two surgical procedures for Mesothelioma treatment:

1: pleurectomy and decortication, low morbidity (25%) and low mortality (2%)

2: extrapleural pneumonectomy which displays an higher rate of morbidity and 3.8% mortality; (only highly selected patients who are able to afford a pneumonectomy).

 

SURGERY OF PALM AND AXILLARY HYPERHIDROSIS

Excessive sweating of the hands is generally considered the most unpleasant of all forms of hyperhidrosis and affects around 2% of the population. The hands are much more exposed than any other part of the body and play a very important role in professional envi-ronment, all practical daily activities as well as in our social lives.

Many people afflicted by this condition may suffer severe limitations in their social life, considering the difficulties in handling some materials, such as paper, or due to the embarrassment felt when dealing with social situation ( need to shake hands, etc). Axillary hyperhidrosis can also provoke embarrassment due to the formation of wet stains on clothes, sometimes surrounded by white lines due to the high salt content.

A minimally invasive technique has been developed in order to interrupt the sympathetic nerve and the ganglions that transmit signals to the sweat glands. The procedure is carried out through a mini-invasive technique using two small accesses of ap-proximately 7mm in the axillary area.This endoscopic technique proved to be safe and, in experienced hands, it may definitively remove the aforementioned symptoms in almost 100% of treated patients, leaving just one or two tiny scars in the axillary area.With a mini-invasive technique using two small cuts of approximately 7mm around the armpit area, we can interrupt the sympathetic nerve and the ganglions that transmit signals to the sweat glands.

Those suffering combined palmar-plantar hyperhidrosis have a good chance of improvement of perspiration of the feet following an operation aimed at alleviating perspiration in the palms. Average hospital stay day is one day, no drainage is necessary.

 

SURGICAL TREATMENT OF PLEURAL EMPYEMA (MINIMALLY INVASIVE APPROACH IS PROVIDED FOR STAGE I/II EMPHYEMA ACCORDINGLY WITH EACTS RACOMMENDATIONS)

 

SURGERY OF THE DIAPHRAGM (MINIMALLY INVASIVE DIAPHRAGM PLICATION, DIAPHRAGM RECONSTRUCTION FOR ENDOMETRIOSIS LOCALIZATIONS)

 

SURGERY OF THE TRACHEA (BENIGN STENOSIS, TRACHEAL TUMORS).

 

SURGERY OF MALFORMATIONS OF THE THORACIC WALL

Pectus excavatum, pectus carenatum.

 

SURGERY OF MEDIASTINAL NEOFORMATIONS AND MYASTHENIA GRAVIS

Minimally invasive resection of mediastinal tumors and extended thymectomy (thymomas, germinal tumors, neurogeneous tumors, mediastinal cysts, etc.).

Open (through a sternotomy or thoracotomy) extended thymectomy (associated with pericardium and/or vascular resection/ recon-struction whenever required) for locally advanced Thymomas and other tumors (usually after induction chemotherapy).