Papers by Paolo Scanagatta
Journal of Thoracic Oncology, Apr 1, 2016
The Journal of Thoracic and Cardiovascular Surgery, Sep 1, 2008
Objective: The main challenge of screening a healthy population with low-dose computed tomography... more Objective: The main challenge of screening a healthy population with low-dose computed tomography is to balance the excessive use of diagnostic procedures with the risk of delayed cancer detection. We evaluated the pitfalls, difficulties, and sources of mistakes in the management of lung nodules detected in volunteers in the Cosmos single-center screening trial. Methods: A total of 5201 asymptomatic high-risk volunteers underwent screening with multidetector low-dose computed tomography. Nodules detected at baseline or new nodules at annual screening received repeat low-dose computed tomography at 1 year if less than 5 mm, repeat low-dose computed tomography 3 to 6 months later if between 5 and 8 mm, and fluorodeoxyglucose positron emission tomography if more than 8 mm. Growing nodules at the annual screening received low-dose computed tomography at 6 months and computed tomography-positron emission tomography or surgical biopsy according to doubling time, type, and size. Results: During the first year of screening, 106 patients underwent lung biopsy and 91 lung cancers were identified (70% were stage I). Diagnosis was delayed (falsenegative) in 6 patients (stage IIB in 1 patient, stage IIIA in 3 patients, and stage IV in 2 patients), including 2 small cell cancers and 1 central lesion. Surgical biopsy revealed benign disease (false-positives) in 15 cases (14%). Positron emission tomography sensitivity was 88% for prevalent cancers and 70% for cancers diagnosed after first annual screening. No needle biopsy procedures were performed in this cohort of patients. Conclusion: Low-dose computed tomography screening is effective for the early detection of lung cancers, but nodule management remains a challenge. Computed tomography-positron emission tomography is useful at baseline, but its sensitivity decreases significantly the subsequent year. Multidisciplinary management and experience are crucial for minimizing misdiagnoses.
Journal of Pain and Symptom Management, Oct 1, 2017
The following story describes a situation which could happen in the professional life of every ph... more The following story describes a situation which could happen in the professional life of every physician, especially in the oncology field. M. was a healthy handsome boy, who loved football, rock music, and watching rally races, and he was just
Journal of Cardiovascular Surgery, Dec 1, 2004
European Journal of Cardio-Thoracic Surgery, 2005
Objective: After an observational study on 50 patients determined the efficacy and safety of a sm... more Objective: After an observational study on 50 patients determined the efficacy and safety of a small calibre (19 F), flexible, fluted spiral drains with round cross-section after non-cardiac thoracic surgery we undertook a prospective study to compare these drains to standard chest drains also in terms of pain using a Visual Analog Score. Methods: One hundred consecutive patients who had to undergo non-cardiac chest surgery either by thoracotomy or by VATS were randomly assigned to receive small calibre drains with round cross-section (group A) or the standard chest drains (group B) to drain the pleural space. Drains were connected to a unitized chest drainage system. Pain was assessed using a Visual Analog Scale (VAS) 0-100. Results: The amount of fluid evacuated daily in patients who received the spiral drains was as much as 1150 ml, that of patients who received standard drains was as much as 950 ml. In no case did spiral drains have to be replaced with standard tubes. In group A first drain was removed after a mean of 3.4 days and the second after a mean of 5.9 days; in group B after a mean of 4.1 and 6.1 days, respectively. Patients were discharged after a mean of 8.5 days in group A (SD 4.04) and 8.1 days in group B (SD 4.76). There were no drainsrelated complications in both groups. The drains-related pain for the patient was significantly less for patients with spiral drains compared to standard drains at rest, during cough induced by respiratory therapists and at the time of removal. Conclusions: Spiral drains proved to be at least as safe and effective as conventional tubes after lung surgery; they allowed for evacuation of large amounts of blood/fluid as well as air, and were associated with minimal discomfort.
Pediatric medicine, Mar 1, 2019
Why did we decide to present a focused issue on pediatric thoracic surgery? The answer is not so ... more Why did we decide to present a focused issue on pediatric thoracic surgery? The answer is not so easy, because the topic is rare, seldom debated and heterogeneously described in the Literature, moreover it could be somewhat altered by personal opinions of every single reader's experience. We would rather start from what pediatric thoracic surgery eventually is: a subspeciality whose aim is to treat a majority of rare conditions and disease dealing with a selected population of patients with peculiar physical and psychological needs. In the twenty-first century we do believe that these patients should not be treated by general pediatric surgeons alone, thus seriously affecting the possibility of cure. Children and adolescents are not merely little adults, they surely need to be cured and follow-up in a proper way, however they also have unexpected and sometimes incredible possibilities of recovering and healing, and so they could be considered to be scheduled for ambitious and aggressive multidisciplinary treatments, to be administered in specialized and dedicated institutions. This is not a book, but a collection of contributions and topics of eminent specialists in the thoracic-surgery field, with the aim to help readers to get introduced and informed about difficulties and variety of conditions treated and to foresee future perspectives.
Medical Oncology, Jul 25, 2015
The role of complete surgery for lung metastases in patients with high-grade osteosarcoma is well... more The role of complete surgery for lung metastases in patients with high-grade osteosarcoma is well established, while it is unclear whether surgery is always indicated, regardless of the number of lesions or when an early relapse occurs [1–3]. Hence, our present study reports on two cases of children with osteosarcoma. The first was a 13-year-old female with localized femur osteosarcoma treated with high-dose methotrexate, adriamycin and cisplatin (MAP), plus surgery with wide margins. Necrosis after chemotherapy was very poor (\15 %). Immediately after completing the treatment, chest CT scan showed bilateral lung metastases. The patient received three cycles of high-dose ifosfamide with her lung disease remaining stable, and then, she underwent right lateral thoracotomy and the removal of 38 lesions (all revealing vital tumor). The patient was discharged on the seventh day after surgery. She was then given another course of high-dose ifosfamide followed by left thoracotomy and the removal of 33 tumor lesions and was again discharged 7 days later. To date (42 months after diagnosis), she continues to be disease free. The second patient was a 17-year-old male with tibia osteosarcoma, synchronous bilateral lung metastases and hilar adenopathy. He was treated with MAP chemotherapy and surgery with wide margins, showing a post-chemotherapy necrosis of 70 %. After two more chemotherapy cycles, he underwent right thoracotomy with the precision resections of 57 nodules and excision of the hilar adenopathy. The male continued on chemotherapy, completing five cycles of high-dose ifosfamide, with substantially stable disease in the left lung. He consequently underwent left thoracotomy, involving 142 precision resections, and he was discharged on the sixth day afterwards. Histology showed a necrosis [90 %. He remains disease free 36 months after diagnosis. These cases prompted lively debate among clinicians and surgeons. The chances of achieving a prolonged and complete pathological and clinical response were considered minimal for both patients. In fact, in the first case, the disease very soon relapsed (9 months after its diagnosis), with bilateral lung involvement ([10 nodules on each side) and the necrosis achieved after preoperative chemotherapy was poor too. In the second, the patient had countless lung lesions and hilar adenopathy already at diagnosis and, here again, the necrosis achieved after chemotherapy was poor. Anyway, we decided to refer both patients to our thoracic surgeon in view of their very good general clinical condition, the potential resectability of all their lesions, and the low morbidity and stability of the disease on the side of the male’s unoperated lung. In conclusion, we would recommend considering the resection of all lung metastases of osteosarcoma, whatever their number, in all cases of stable lung disease—but up to what point we are allowed to push with surgery, in high surgery volume centers, remains debatable.
Expert Review of Anticancer Therapy, May 3, 2020
Introduction: Osteosarcoma is the most common malignant bone tumor. It is currently treated with ... more Introduction: Osteosarcoma is the most common malignant bone tumor. It is currently treated with pre-and postoperative chemotherapy, associated with surgical resection of the tumor. Area covered: Relapses occur in about one in three patients presenting with localized disease, and three in four of those with metastases at diagnosis. Relapsing disease carries a very poor prognosis, with 5-year survival rates ranging between 13% and 40%. Expert opinion: Patients with unilateral lung involvement or solitary lung metastases and a recurrencefree interval (RFI) longer than 24 months have a better prognosis, and could be managed with surgical resection and close observation. Complete surgical resection of all sites of disease remains essential to survival: patients unable to achieve complete remission have a catastrophic overall survival rate. The role of second-line chemotherapy is not at all clear, and no controlled studies are available on this topic. It is worth considering for patients unable to achieve complete surgical remission, and those with multiple metastases and/or a RFI <24 months. Given their dismal prognosis, patients with multiple sites of disease not amenable to complete surgical resection should also be considered for innovative therapeutic approaches.
Interactive Cardiovascular and Thoracic Surgery, Nov 15, 2013
Annals of Surgical Oncology, Nov 20, 2010
Ejso, Dec 1, 2017
Background: Extensive clinical experience has demonstrated the potential usefulness of autologous... more Background: Extensive clinical experience has demonstrated the potential usefulness of autologous fat tissue (AFT) graft in tissue reconstruction, repair or regeneration. In the present study, we evaluated the feasibility and safety of AFT in the repair of surgically injured lung surface. Methods: Eighty consecutive procedures of pulmonary metastasectomy by laser precision resection, were performed in 66 patients between March 2010 and December 2012. In the first 20 procedures, AFT graft was applied on the wounded pulmonary surface without closure of parenchymal surface. The following 40 procedures were carried on without AFT (20 leaving the resection margins open and 20 closing the resection margins with a running suture). In the remaining 20 procedures, AFT was applied and the resection margins closed. The efficacy of this technique was evaluated by comparing the AFT group with the non-AFT group, with respect to prolonged alveolar air leakage (PAAL), time to drain removal, length of hospital stay, and patient survival at four years. Results: The occurrence of PAAL was lower in the AFT group as compared to non-AFT group (17.5% versus 42.5%, p=0.027), and median time to drain removal shorter (4 versus 6 days respectively, p=0.016). Overall 4-year survival was 70% for AFT group, and 59% for non-AFT group (p= 0.34). Conclusions: This prospective cohort observational study demonstrated the feasibility and safety of AFT pulmonary grafting after laser metastasectomy. AFT graft improved pulmonary healing, by reducing the incidence and severity of PAAL. Moreover, there was no evidence of tumor promotion in the metastatic setting, with a similar overall survival at 4 years.
Expert Review of Anticancer Therapy, Apr 6, 2016
Osteosarcoma is the most common malignant bone tumor, currently treated with pre-and postoperativ... more Osteosarcoma is the most common malignant bone tumor, currently treated with pre-and postoperative chemotherapy in association with the surgical removal of the tumor. About 15-20% of patients have evidence of metastases at diagnosis, mostly in the lungs. Patients with metastatic disease still have a very poor prognosis, with approximately 20-30% of long-term survivors, as compared with 65-70% of patients with localized disease. The optimum management of these patients has not been standardized yet due to several patterns of metastatic disease harboring different prognosis. Complete surgical resection of all sites of disease is mandatory and predictive of survival. Patients with multiple sites of disease not amenable to complete surgery removal should be considered for innovative therapeutic approaches because of poor prognosis.
Diagnostic and interventional radiology, Jul 25, 2013
We aimed to evaluate the validity of lung lobe weight assessment via computed tomography (CT) by ... more We aimed to evaluate the validity of lung lobe weight assessment via computed tomography (CT) by comparing CT-derived and ex vivo measurements. MATERIALS AND METHODS Unenhanced CT scanning was performed in 30 consecutive patients before lobectomy for lung cancer. The CT images were analyzed using research software after allowing for lobar weight quantitation. The lobar weight estimated by CT was then compared with that measured after surgery using a precision scale (ex vivo measurement). Comparisons as well as assessment of intra-and interoperator variability were conducted using the Bland-Altman method and the coefficient of repeatability (CR). Correlations were examined using Pearson's correlation analysis. RESULTS Comparison analyses were feasible for 28 cases. The ex vivo lobe weight was 186.2±57.3 g, whereas the weights measured by the two operators by CT were 190.0±55 and 182.4±58.2 g, respectively. As compared with ex vivo weights, the CR was 36.4 for operator 1 and 50.4 for operator 2; the mean differences were 3.8 and-3.8 for operators 1 and 2, respectively. The intraoperator and interoperator CR were 20.9 and 36.6, respectively. The mean differences for the intra-and interoperator analysis were-1.5 and-7.5, respectively. The correlation was very high between CT-based and ex vivo measurements (r=0.95 and r=0.90 for operators 1 and 2, respectively; P < 0.001). CONCLUSION Estimation of lung lobe weight by semi-automated CT analysis is sufficiently reproducible and in agreement with ex vivo measurements.
Current Opinion in Oncology, Mar 1, 2007
Purpose of review The aim of this review is to analyze recent evidence for optimal treatment of e... more Purpose of review The aim of this review is to analyze recent evidence for optimal treatment of elderly patients with non-small cell lung cancer, focusing on surgery, and possibly to foresee the future strategies to apply in these patients. Recent findings Surgery in elderly patients affected by non-small cell lung cancer is safe and feasible when careful preoperative respiratory and cardiac studies have been carried out and the disease has been properly staged. The surgical treatment is not to be denied in elderly patients due to age per se, but when a major contraindication to surgery has been recognized. Long term survival for elderly patients with early stage lung cancer treated by anatomical pulmonary resection is comparable to the survival rate of younger patients. Pneumonectomy, extended surgical procedure or preoperative induction chemotherapy are major risk factors for an increased postoperative morbidity and mortality rate. When co-morbidities are present or a patient is 80 years or older, there is evidence that a non-anatomical resection can be performed without affecting long-term results. Summary Due to the aging of the general population, elderly patients will become a large percentage of the cases of non-small cell lung cancer to be treated. Implementing preoperative cardiologic studies and redefining selective respiratory criteria specifically could dramatically improve results.
Objective: Pneumonectomy is not always sufficient for the radical resection of cancer. In the pre... more Objective: Pneumonectomy is not always sufficient for the radical resection of cancer. In the present study, pneumonectomy may be associated with an extended resection of mediastinal or parietal structures. The postoperative risk and the oncologic benefits of such an extended procedure have not been sufficiently demonstrated. Methods: We have defined "extended" pneumonectomy (EP) as the removal of the entire lung, associated with one or more of the following structures: superior vena cava, tracheal carina, left atrium, aorta, chest wall, or diaphragm. Our clinical database was retrospectively reviewed to identify patients who underwent EP to assess their postoperative morbidity, mortality, and long-term survival. Results: Between 1998 and 2005, 47 EPs were performed. The "extended" procedure included left atrium resection in 15 patients, combined SVC and carinal resection in 9 patients, aortic resection in 8 patients (in 3 patients with prosthetic replacement), chest wall or diaphragmatic resection in 6 patients, SVC resection in 4 patients, and carinal resection in 4 patients. A partial esophageal muscular resection was performed in 1 patient. Overall 60-day mortality was 8.5%. Major postoperative complications occurred in 8 patients (17%). The 2-and 5-year survival rates for the overall population were 42% and 22.8%, respectively. Interestingly, long-term survivors were recorded only in the group of patients who received induction treatment. Conclusions: Extended pneumonectomy is a feasible procedure with an acceptable risk factor. To improve the selection of patients, all candidates should undergo preoperative mediastinoscopy and induction chemotherapy. In patients with positive response to chemotherapy or stable disease, extended pneumonectomy may afford a radical resection in more than 80% of cases and may result in a permanent cure in some instances. C omplete tumor removal is the objective of any surgical resection when treating lung cancer. 1 A tumor may infiltrate contiguous structures such as the superior vena cava (SVC), tracheal carina, left atrium, diaphragm, or chest wall. It has been demonstrated that in all of these situations, a radical resection can be achieved by combining an "extended" procedure such as SVC
The Annals of Thoracic Surgery, Aug 1, 2009
ABSTRACT
Tumori Journal, Oct 21, 2021
Introduction Half a century ago, Edward Beattie and Ralph Marcove, thoracic and orthopedic surgeo... more Introduction Half a century ago, Edward Beattie and Ralph Marcove, thoracic and orthopedic surgeons at Memorial Sloan Kettering Cancer Center (MSKCC), published a report on 22 patients with osteogenic sarcoma, showing few longterm survivors after repeated lung metastasectomies. 1 At that time, 80% of children with osteosarcoma presented with or developed pulmonary metastases shortly after diagnosis, and all of them died of distant progression, often after limb amputation. 2 To circumvent such unfavorable conditions, Marcove and Gerry Rosen, a medical oncologist at MSKCC, designed a preoperative chemotherapy clinical trial aimed at reducing the risk of
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Journal of pediatric surgery case reports, Mar 1, 2022
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Papers by Paolo Scanagatta