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Alessandro STEFANI

Professore Associato
Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell'Adulto

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Pubblicazioni

2023 - Oligorecurrent Non-Small-Cell Lung Cancer Treated by Chemo-Radiation Followed by Immunotherapy and Intracranial Radiosurgery: A Case Report and Mini Review of Literature [Articolo su rivista]
Bruni, Alessio; Bertolini, Federica; D'Angelo, Elisa; Guaitoli, Giorgia; Imbrescia, Jessica; Cappelli, Anna; Guidi, Gabriele; Stefani, Alessandro; Dominici, Massimo; Lohr, Frank
abstract

Locally advanced non-small-cell lung cancer still represents a "grey zone" in terms of the best treatment choice and optimal clinical outcomes. Indeed, most patients may be suitable to receive different treatments with similar outcomes such as chemo-radiotherapy (CHT-RT) followed by immunotherapy (IO) or surgery followed by adjuvant local/systemic therapies. We report a clinical case of a patient submitted to primary thoracic surgery who developed a mediastinal nodal recurrence successfully treated by CHT-RT-IO. Subsequently, a single brain lesion was found to have been successfully treated by single fraction stereotactic ablative radiotherapy. The patient is still on follow-up and she is free from disease having a good quality of life. In this report, we also perform a mini review about the role of CHT-RT followed by IO in treating loco-regional relapse after surgery. The role of SABR after IO is also evaluated, finding that it is safe and well tolerated. More robust and larger clinical data are needed in this particular setting to better define the role of the combination of systemic and local treatments in the management of intrathoracic and intracranial relapse for patients already submitted to CHT-RT followed by immunotherapy.

2022 - Cancer Stem Cells and Cell Cycle Genes as Independent Predictors of Relapse in Non-small Cell Lung Cancer: Secondary Analysis of a Prospective Study [Articolo su rivista]
Masciale, V.; Banchelli, F.; Grisendi, G.; D'Amico, R.; Maiorana, A.; Stefani, A.; Morandi, U.; Stella, F.; Dominici, M.; Aramini, B.
abstract

PURPOSE: Cancer stem cells (CSCs) are described as resistant to chemotherapy and radiotherapy. It has been shown that CSCs influence disease-free survival in patients undergoing surgery for lung cancer (NCT04634630). We recently described an overexpression of CSCs recurrence-related genes (RG) in lung cancer. This study aims to investigate CSC frequency and RG expression as predictors of disease-free survival in lung cancer. EXPERIMENTAL DESIGN: This secondary analysis of a prospective cohort study involved 22 surgical tumor specimens from 22 patients harboring early (I-II) and locally advanced (IIIA) stages ACL and SCCL. Cell population frequency analysis of ALDHhigh (CSCs) and ALDHlow (cancer cells) was performed on each tumor specimen. In addition, RG expression was assessed for 31 target genes separately in ALDHhigh and ALDHlow populations. CSCs frequency and RG expression were assessed as predictors of disease-free survival by Cox analysis. RESULTS: CSCs frequency and RG expression were independent predictors of disease-free survival. CSC frequency was not related to disease-free survival in early-stage patients (HR = 0.84, 95%CI = 0.53-1.33, P = .454), whereas it was a risk factor for locally advanced-stage patients (HR = 1.22, 95%CI = 1.09-1.35, P = .000). RG expression-if measured in CSCs-was related to a higher risk of recurrence (HR = 1.19, 95%CI = 1.03-1.39, P = .021). The effect of RG expression measured in cancer cells on disease-free survival was lower and was not statistically significant (HR = 1.12, 95%CI = 0.94-1.33, P = .196). CONCLUSIONS: CSCs frequency and RG expression are independent predictors of relapse in lung cancer. Considering these results, CSCs and RG may be considered for both target therapy and prognosis.

2022 - Endoscopic Bronchopleural Fistula Repair Using Autologous Fat Graft [Articolo su rivista]
Marchioni, Alessandro; Mattioli, Francesco; Tonelli, Roberto; Andreani, Alessandro; Cappiello, Gaia Francesca; Serafini, Edoardo; Stefani, Alessandro; Marchioni, Daniele; Clini, Enrico
abstract

Bronchopleural fistula (BPF) represents a not rare catastrophic complication of pulmonary resection with high mortality rates. While surgical treatments of BPF are often technically difficult and can only be tolerated by a limited number of patients, less invasive endoscopic approaches showed variable success rates, mainly related to the size of the fistula. With this report, we describe for the first time the successful treatment of large BPF by means of endoscopic autologous fat implantation and we discuss the surgical technical details of the procedure.

2022 - Molecular Mechanisms and Physiological Changes behind Benign Tracheal and Subglottic Stenosis in Adults [Articolo su rivista]
Marchioni, Alessandro; Tonelli, Roberto; Andreani, Alessandro; Cappiello, Gaia Francesca; Fermi, Matteo; Trentacosti, Fabiana; Castaniere, Ivana; Fantini, Riccardo; Tabbì, Luca; Andrisani, Dario; Gozzi, Filippo; Bruzzi, Giulia; Manicardi, Linda; Moretti, Antonio; Baroncini, Serena; Samarelli, ANNA VALERIA; Marchioni, Daniele; Pinelli, Massimo; DE SANTIS, Giorgio; Stefani, Alessandro; Mattioli, Francesco; Clini, Enrico
abstract

Laryngotracheal stenosis (LTS) is a complex and heterogeneous disease whose pathogenesis remains unclear. LTS is considered to be the result of aberrant wound-healing process that leads to fibrotic scarring, originating from different etiology. Although iatrogenic etiology is the main cause of subglottic or tracheal stenosis, also autoimmune and infectious diseases may be involved in causing LTS. Furthermore, fibrotic obstruction in the anatomic region under the glottis can also be diagnosed without apparent etiology after a comprehensive workup; in this case, the pathological process is called idiopathic subglottic stenosis (iSGS). So far, the laryngotracheal scar resulting from airway injury due to different diseases was considered as inert tissue requiring surgical removal to restore airway patency. However, this assumption has recently been revised by regarding the tracheal scarring process as a fibroinflammatory event due to immunological alteration, similar to other fibrotic diseases. Recent acquisitions suggest that different factors, such as growth factors, cytokines, altered fibroblast function and genetic susceptibility, can all interact in a complex way leading to aberrant and fibrotic wound healing after an insult that acts as a trigger. However, also physiological derangement due to LTS could play a role in promoting dysregulated response to laryngo-tracheal mucosal injury, through biomechanical stress and mechanotransduction activation. The aim of this narrative review is to present the state-of-the-art knowledge regarding molecular mechanisms, as well as mechanical and physio-pathological features behind LTS.

2021 - A case of cervico-mediastinal paraganglioma mimicking an ectopic goiter [Articolo su rivista]
Bianchi, D.; Scamporlino, A.; Costantini, M.; Cavallesco, G.; Morandi, U.; Stefani, A.
abstract

Introduction and importance: Mediastinal paragangliomas are rare neuroendocrine tumors that originate from extra-adrenal paraganglia, occasionally secreting catecholamines. Nonfunctional mediastinal paragangliomas present nonspecific clinical and radiological features and represent a diagnostic challenge. Case presentation: A 53-year old woman presented with cough and dyspnea increasing over time. CT-scan and ultrasonography showed a large vascularized cervico-mediastinal mass, consistent with an intrathoracic ectopic goiter. Preoperative angiography showed a blood supply from neck vessels. The lesion was completely removed through a cervical approach. The diagnosis of paraganglioma was a histological surprise. The patient is alive without recurrence 30 months after surgery. Clinical discussion: When preoperatively diagnosed, the treatment of choice of a mediastinal paraganglioma is surgical excision. However, a preoperative diagnosis of mediastinal paraganglioma is difficult to obtain, especially in cases of nonfunctional lesions. Distinction between an intrathoracic goiter and a nonfunctional paraganglioma can be extremely difficult and, given the rarity of the latter, an ectopic goiter is suspected in first instance. CT-scan and ultrasonography are of little use in the differential diagnosis. However, scintigraphy with 123I-metaiodobenzylguanidine can be an useful diagnostic tool when a paraganglioma is suspected. In case of vascularized cervico-mediastinal mass, such as paragangliomas or intrathoracic goiter, preoperative angiography should be performed to study the blood supply and orient the surgical approach. Conclusion: Although uncommon, paragangliomas should be considered in the differential diagnosis of mediastinal masses, especially when an ectopic goiter is suspected.

2021 - Erratum: The role of postoperative radiotherapy for thymomas: A multicentric retrospective evaluation from three Italian centers and review of the literature (Journal of Thoracic Disease (2020) 12 (7518-7530) DOI: 10.21037/jtd-2019-thym-09) [Articolo su rivista]
Bruni, A.; Stefani, A.; Perna, M.; Borghetti, P.; Levra, N. G.; D'Angelo, E.; D'Onofrio, A.; Rubino, L.; Frassinelli, L.; Salvestrini, V.; Mariotti, M.; Alongi, F.; Gonfiotti, A.; Livi, L.; Scotti, V.
abstract

This article that appeared on Page: 7518-7530, Vol 12, No 12 (December 2020) Issue of the Journal of Thoracic Disease (JTD) (1), the authors’ affiliations were published incorrectly. The affiliations should be corrected as follows: Alessio Bruni1, Alessandro Stefani2, Marco Perna3, Paolo Borghetti4, Niccolò Giaj Levra5, Elisa D’Angelo1, Alessandra D’Onofrio4, Laura Rubino1, Luca Frassinelli1, Viola Salvestrini3, Matteo Mariotti3, Filippo Alongi4,5, Alessandro Gonfiotti6, Lorenzo Livi3, Vieri Scotti3 1Radiotherapy Unit, Hematology and Oncology Department, University Hospital of Modena, Modena, Italy; 2Division of Thoracic Surgery, Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, Modena, Italy; 3Department of Radiation Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy; 4Department of Radiation Oncology, Spedali Civili of Brescia, Brescia, Italy; 5Department of Radiation Oncology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy; 6Thoracic Surgery Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy.

2021 - Le malattie della pleura e del mediastino [Capitolo/Saggio]
Stefani, A; Aramini, B; Morandi, U
abstract

2021 - New Perspectives in Different Gene Expression Profiles for Early and Locally Advanced Non-Small Cell Lung Cancer Stem Cells. [Articolo su rivista]
Masciale, Valentina; Banchelli, Federico; Grisendi, Giulia; D'Amico, Roberto; Maiorana, Antonino; Stefani, Alessandro; Morandi, Uliano; Dominici, Massimo; Aramini, Beatrice
abstract

Introduction: Lung cancer is one of the most common cancers in the world, causing over 1.7 million deaths in 2018. Thus far, no effective treatments against lung cancer for advanced stages have been found. For early stages, although surgery is considered the gold standard treatment, 30–55% of patients develop recurrence within the first 5 years of surgery. Our aim is to assess whether cancer stem cells (CSC) display overexpression of a pool of genes that were previously identified for adenocarcinoma recurrence in patients with early and locally advanced stages of non-small cell lung cancer (NSCLC). Methods: This cross-sectional study was carried out by harvesting surgical tumor specimens obtained from patients harboring early (I-II) and locally advanced (IIIA) stages of NSCLC. For each patient, cell sorting was performed to identify and isolate the ALDHhigh (CSC) and ALDHlow (cancer cells) populations. The mRNA expressions of 31 recurrence-related genes (target genes) in both ALDHhigh and ALDHlow populations were then assessed and compared. Results: Surgical specimens were obtained from 22 patients harboring NSCLC. Sixteen (51.6%) out of 31 recurrence-related genes were significantly overexpressed in ALDHhigh cells in the early stages and 9 (29.0%) were overexpressed in the locally advanced stages of NSCLC. Overall, the relative mRNA expressions for these recurrence-related genes were higher in early-stage patients. The average fold change, considering all 31 recurrence-related genes together, was 4.5 (95% CI = 3.1-6.3) in early-stage patients and 1.6 (95% CI = 1.2-2.2) in locally advanced-stage patients. Conclusions: Our study represents the first attempt toward identifying genes associated with recurrence that are overexpressed in cancer stem cells in patients with early and ocally advanced stages of NSCLC. This finding may contribute to the identification of new target therapies tailored for NSCLC stages.

2021 - Post-operative outcomes and quality of life assessment after thoracoscopic lobectomy for Non-small-cell lung cancer in octogenarians: Analysis from a national database [Articolo su rivista]
Bongiolatti, S; Gonfiotti, A; Borgianni, S; Crisci, R; Curcio, C; Voltolini, L; Stefani, A
abstract

Background: Thoracoscopic lobectomy (VATS-L) for non-small-cell lung cancer (NSCLC) is a well-established option for early stage NSCLC, but the evidences are limited for octogenarians. Objective: The objectives of this multi-institutional study were to evaluate the post-operative outcomes of VATS-L in octogenarians and to estimate the post-operative quality of life (QoL) using a validated questionnaire (EuroQoL5D). Methods: Data from patients underwent VATS-L between 2014 and 2019 were analysed and divided into two groups: Group A (younger patients) and Group B (octogenarians). To define predictors for complications, univariate and multivariable logistic regression analysis were performed. Results: 7023 patients underwent VATS-L and 329 (4.6%) were octogenarians. 30-day and 90-day post-operative mortality were similar (0.95% vs 0.91%, p = 0.84 and 1.3% vs 1.2%, p = 0.58), whereas the percentage of patients who suffered from any complication (25.5% vs 31.9%, p = 0.012) and the complication rate (31.6% vs 45.2%, p=<0.01) were higher for octogenarians. At discharge, the values of EuroQoL5D were worse in group B, but after one month these levels became similar. Age >80 years had a significant influence on morbidity on both univariate and multivariable analyses (p = 0.025). Conclusions: VATS-L for NSCLC can be performed in selected octogenarians without increased risk of postoperative death, acceptable not-life-threatening complications and a moderate impact on QoL.

2021 - Surgical stabilization of severe flail chest with Judet and Sanchez-Lloret plates. A case report [Articolo su rivista]
Stefani, A; Tormen, F; Scamporlino, A; Natali, P; Cavallesco, G; Morandi, U
abstract

INTRODUCTION: Flail chest is now usually treated by conservative methods and surgical fixation remainsindicated in selected cases. Different techniques can be used for fixation. The aim of this paper is topresent a case in which Judet and Sanchez-Loret plates were employed and to discuss the usefulness ofthis traditional technique.PRESENTATION OF CASE: A 79-year-old woman was admitted for left thoracic trauma with severe antero-lateral flail chest. She was affected by COPD with chronic respiratory failure, ischemic heart disease,autoimmune thrombocytopenia treated on chronic steroid therapy and severe osteoporosis. CT-scandetected multiple rib fractures, left hemothorax and lung contusions. An initial conservative treatmentof flail chest involved compressive bandage and then internal pneumatic stabilization in ICU, but it failed.The patient underwent successful surgical treatment of the flail chest by fixation of the anterior fracturesfrom the second to the eight rib. Judet and Sanchez-Lloret plates were used. A bilateral pneumoniadeveloped during the rehabilitation period and the patient died two months after operation.DISCUSSION: Judet and Sanchez-Lloret plates represent a traditional technique for fixation of flail chest.This technique is less and less used and progressively replaced by newer materials, especially titaniumplates with screws or intramedullary struts. Our patient had multiple comorbidities and a very fragilebones that advised against use of screws or intramedullary struts.CONCLUSION: Judet and Sanchez-Lloret plates can be still considered a useful tool for the fixation of flailchest in cases of thin and fragile bones.

2021 - Use of Octreotide in association with talc poudrage for the management of a severe chylothorax: A case report [Articolo su rivista]
Lovati, Eleonora; Ruggiero, Ciro; Masciale, Valentina; Stefani, Alessandro; Morandi, Uliano; Aramini, Beatrice
abstract

Chylothorax is an uncommon form of pleural effusion characterized by the presence of chylomicrons, triglycerides and cholesterol in the physical and chemical examination of the pleural fluid. It may have poor prognosis if not properly treated. Currently, conservative measures are the first line of treatment for managing chylothorax. The aim of our study is to show and suggest the use of octreotide in association with talc poudrage as good option to manage post-operative a severe chylothorax.

2020 - Cancer Stem-Like Cells in a Case of an Inflammatory Myofibroblastic Tumor of the Lung. [Articolo su rivista]
Masciale, Valentina; Grisendi, Giulia; Banchelli, Federico; D'Amico, Roberto; Maiorana, Antonino; Sighinolfi, Pamela; Brugioni, Lucio; Stefani, Alessandro; Morandi, Uliano; Dominici, Massimo; Aramini, Beatrice
abstract

Background: Inflammatory myofibroblast tumor (IMT) is a rare tumor with obscure etiopathogenesis in which different inflammatory cells and myofibroblastic spindle cells are seen histologically. Although the majority of these neoplasms have a benign clinical course, the malignant form has also been reported. The gold standard is surgical treatment for complete removal. Our report describes a 50-year-old woman who underwent surgery for IMT of the lung. The aim is to determine whether cancer stem cells may be present in IMT of the lung. Methods: In April 2018, the patient underwent surgery for tumor mass asportation through lateral thoracotomy. The histology of the tumor was consistent with IMT of the lung. The ALDEFLUOR assay, after tissue digestion, was used to identify and sort human lung cancer cells expressing high and low aldehyde dehydrogenase (ALDH) activity. SOX2, NANOG, OCT-4, and c-MYC positivity were additionally determined by immunohistochemistry. Results: The specimen contained 1.10% ALDHhigh cells among all viable lung cancer cells, which indicates the population of cancer stem cells is not negligible. Immunohistochemically assessed cell positivity for ALDH1A1, SOX2, NANOG, OCT-4, and c-MYC, which are considered as lung cancer stem-like cells markers. Conclusion: For the first time, we demonstrated the presence of cancer stem cells in a case of IMT of the lung. This finding may provide a base for considering new pathological and molecular aspects of this tumor. This perspective suggests further studies to understand the possibility of developing recurrence depending on the presence of cancer stem cells.

2020 - CD44+/EPCAM+ cells detect a subpopulation of ALDHhigh cells in human non-small cell lung cancer: A chance for targeting cancer stem cells? [Articolo su rivista]
Masciale, Valentina; Grisendi, Giulia; Banchelli, Federico; D'Amico, Roberto; Maiorana, Antonino; Sighinolfi, Pamela; Stefani, Alessandro; Morandi, Uliano; Dominici, Massimo; Aramini, Beatrice
abstract

Objectives: Several studies demonstrated that aldehyde dehydrogenase (ALDH) and CD44 are the most considered cancer stem cells (CSC) markers. However, a comparison between ALDH high cells and CD44+ cells have been previously described with no significant correlation. Indeed, the aim of the present research is to identify a superficial marker able to match with ALDH high cells population in freshly isolated human lung cancer cells. Materials and Methods: This cross-sectional study analyzed the expression of ALDHhigh/low cells and the positivity for CD44 and epithelium cell adhesion molecule (EPCAM) antigens in surgical lung cancer tissues. The main approach was a cytofluorimetric analysis of ALDH expression and positivity for CD44/EPCAM on primary cell population obtained from 23 patients harboring NSCLC. Results: There was a highly positive correlation between the expressions of ALDHhigh and CD44+/EPCAM+ cells, with a Pearson’s correlation coefficient equal to 0.69 (95% CI 0.39–0.86; P = 0.0002), and Spearman’s correlation coefficient equal to 0.52 (P = 0.0124). The average paired difference between the expression of ALDHhigh and CD44+/EPCAM+ cells was very close to 0, being 0.1% (SD 2.5%); there was no difference between these subpopulations in terms of means (95% CI = –1.0; 1.2%, P = 0.8464). These results highlight a strong similarity between ALDHhigh and CD44+/EPCAM+ cells. Conclusions: Our study is the first attempt which identifies a high correlation between the ALDHhigh and the CD44+/EPCAM+ cells, thus suggesting the possibility to use this superficial marker for future target treatments against lung cancer stem cells.

2020 - Correction to: Predictors of nodal upstaging in patients with cT1-3N0 non-small cell lung cancer (NSCLC): results from the Italian VATS Group Registry (Surgery Today, (2020), 50, 7, (711-718), 10.1007/s00595-019-01939-x) [Articolo su rivista]
Marulli, G.; Faccioli, E.; Mammana, M.; Nicotra, S.; Comacchio, G.; Verderi, E.; De Palma, A.; Curcio, C.; Rea, F.; Bertani, A.; Russo, E.; Voltolini, L.; Gonfiotti, A.; Nosotti, M.; Rosso, L.; Muriana, G.; Droghetti, A.; Crisci, R.; Zaccagna, G.; Amore, D.; di Rienzo, G.; Lopez, C.; Morelli, A.; Londero, F.; Spaggiari, L.; Gasparri, R.; Baietto, G.; Casadio, C.; Infante, M.; Benato, C.; Alloisio, M.; Bottoni, E.; Cardillo, G.; Carleo, F.; Stella, F.; Dolci, G.; Puma, F.; Vinci, D.; Cavallesco, G.; Maniscalco, P.; Ampollini, L.; Carbognani, P.; Terzi, A.; Viti, A.; Negri, G.; Bandiera, A.; Perkmann, R.; Zaraca, F.; Andreetti, C.; Poggi, C.; Mucilli, F.; Camplese, P.; Luzzi, L.; Ghisalberti, M.; Imperatori, A.; Rotolo, N.; Bortolotti, L.; Rizzardi, G.; Torre, M.; Rinaldo, A.; Sabbatini, A.; Refai, M.; Benvenuti, M. R.; Benetti, D.; Stefani, A.; Natali, P.; Lausi, P.; Guerrera, F.; Melloni, G.; Mazza, F.; Argnani, D.; Sanna, S.; Fontana, D.; Beffa, V. D.; Meda, S.; Pernazza, F.
abstract

In the original publication, Carlo Curcio was not included in the author list. The correct author list is included in this Correction. Also an Appendix listing VATS author group is included in this correction.

2020 - Is laser-assisted resection preferable to lobectomy for pulmonary metastasectomy? [Articolo su rivista]
Stefani, A; Oricchio, Francesco; Cinquepalmi, A; Aramini, B; Morandi, U
abstract

Purposes. The aim of this study was to investigate if laser-assisted resection is appropriate for large and/or central lung metastases, when stapler wedge resection is not feasible, to determine whether this technique can be an alternative to lobectomy. Methods. All patients who underwent laser-assisted resection for large and/or central metastases were selected for the study. For comparison, patients who underwent lobectomy for metastases between 2005 and 2017 were reviewed. All resections were performed with a 1318-nm Nd:YAG laser. Perioperative features and long-term oncological outcomes were investigated. Some aspects and drawbacks of laser resection were also investigated. Results. Among 89 patients, 42 (47%) underwent laser resection and 47 underwent lobectomy. Complete resection was achieved in 91% of laser resections and in 98% of lobectomies. The operative time, postoperative drainage time and length of stay were significantly shorter in patients who underwent laser resection than in those who underwent lobectomy. Severe postoperative complications tended to be more frequent after lobectomy. The 5-year survival was 66% and 54% after laser resection and lobectomy respectively, the 5-year disease-free survival was 35% and 32% after laser resection and lobectomy respectively. No differences were found in long-term outcomes between the two techniques. Conclusions. Our experience showed that laser resection, when performed for large/central metastases, resulted in comparable survival and obtained better perioperative outcomes with respect to lobectomy. We believe that laser resection can be proposed as a reliable and advantageous lung-sparing technique, as an alternative to lobectomy for metastasectomy, when stapler wedge resection is not feasible.

2020 - Overall survival in patients with lung adenocarcinoma harboring "niche" mutations: an observational study [Articolo su rivista]
Aramini, Beatrice; Banchelli, Federico; Bettelli, Stefania Raffaella; Manfredini, Samantha; D'Amico, Roberto; Masciale, Valentina; Pinelli, Massimo; MORETTI FANTERA, Margherita; Stefani, Alessandro; Bertolini, Federica; Dominici, Massimo; Morandi, Uliano; Maiorana, Antonino
abstract

Objective: In addition to the most common somatic lung cancer mutations (i. e., KRAS and EGFR mutations), other genes may harbor mutations that could be relevant for lung cancer. We defined BRAF, c-MET, DDR2, HER2, MAP2K1, NRAS, PIK3CA, and RET mutations as “niche” mutations and analyzed. The aim of this retrospective cohort study was to assess the differences in the overall survival (OS) of patients with lung adenocarcinoma harboring niche somatic mutations. Results: Data were gathered for 252 patients. Mutations were observed in all genes studied, except c-MET, DDR2, MAP2K1, and RET. The multivariable analysis showed that 1) niche mutations had a higher mortality than EGFR mutations (HR = 2.3; 95% CI = 1.2–4.4; p = 0.009); 2) KRAS mutations had a higher mortality than EGFR mutations (HR = 2.5; 95% CI = 1.4–4.5; p = 0.003); 3) niche mutations presented a similar mortality to KRAS mutations (HR = 0.9; 95% CI = 0.6–1.5; p = 0.797). Methods: Three cohorts of mutations were selected from patients with lung adenocarcinoma and their OS was compared. Mutations that were searched for, were 1) BRAF, c-MET, DDR2, HER2, MAP2K1, NRAS, PIK3CA, and RET; 2) K-RAS; and 3) EGFR. Differences in OS between these three cohorts were assessed by means of a multivariable Cox model that adjusted for age, sex, smoking habits, clinical stages, and treatments. Conclusions: Niche mutations exhibited an increased risk of death when compared with EGFR mutations and a similar risk of death when compared with KRAS mutations.

2020 - Predicting a prolonged air leak after video assisted thoracic surgery, is it really possible? [Articolo su rivista]
Zaraca, F; Pipitone, M; Feil, B; Perkmann, R; Bertolaccini, L; Curcio, C; Crisci, R; Stefani, A
abstract

Validation of predictive risk models for prolonged air leak (PAL) is essential to understand if they can help to reduce its incidence and complications. This study aimed to evaluate both the clinical and statistical performances of 4 existing models. We selected 4 predictive PAL risk models based on their scientific relevance. We referred to these models as Chicago, Bordeaux, Leeds and Pittsburgh model, respectively, according to the affiliation place of the first author. These predicting risk models were retrospectively applied to patients recorded on the second edition of the Italian Video-Assisted Thoracoscopic Surgery Group registry. Predictions for each patient were calculated based on the logistic regression coefficient values provided in the original manuscripts. All models were tested for their overall performance, discrimination, and calibration. We recalibrated the original models with the re-estimation of the model intercept and slope. We used curve decision analysis to describe and compare the clinical effects of the studied risk mod els. Better statistical metrics characterize the models developed on larger populations (Chicago and Bordeaux models). However, no model has a valid benefit for threshold probability greater than 0.30. The Net benefit of the most performing model (Bordeaux model) at the threshold probability of 0.11 is 23 of 1000 patients, burdened by 333 false positive cases. One of 1000 is the Net benefit at the threshold probability of 0.3. The use of PAL scores based on preoperative predictive factors cannot be currently used in a clinical setting because of a high false positive rate and low positive pre dictive value

2020 - Predictors of nodal upstaging in patients with cT1‑3N0 non‑small cell lung cancer (NSCLC): results from the Italian VATS Group Registry [Articolo su rivista]
Giuseppe, Marulli; Eleonora, Faccioli; ·marco, Mammana; Samuele, Nicotra; Giovanni, Comacchio; Enrico, Verderi; Angela De, Palma; Federico, Rea; Stefani, Alessandro
abstract

PURPOSE: Accurate staging of early non-small cell lung cancer is fundamental for selecting the best treatment. The aim of this study was to identify risk factors for nodal upstaging after video-assisted thoracoscopic lobectomy for clinical T1-3N0 tumors. METHODS: From 2014 to 2017, 3276 thoracoscopic lobectomies were recorded in the prospective database "Italian VATS Group". Linear and multiple logistic regression models were adapted to identify independent predictors of nodal upstaging and factors associated with progression in postoperative N status. RESULTS: Nodal upstaging was found in 417 cases (12.7%), including 206 cases (6.2%) of N1-positive nodes, 81 cases of N2 nodes (2.4%), and 130 cases (4%) of involvement of both N1 + N2 nodes. A total of 241 (7.3%) patients had single-station nodal involvement, whereas 176 (5.3%) had multiple-station involvement. In the final regression model, the tumor grade, histology, pathologic T status, and > 12 resected nodes were independent predictors of nodal upstaging. CONCLUSIONS: The number of resected lymph nodes seems to predict nodal upstaging better than the type of intraoperative lymph node management. Other preoperative risk factors correspond to those for which the current guidelines of the European Society of Thoracic Surgery recommend more extensive preoperative mediastinal staging.

2020 - Secondary spontaneous pneumothorax and bullous lung disease in cannabis and tobacco smokers. A case-control study. [Articolo su rivista]
Stefani, A; Aramini, B; Baraldi, C; Pellesi, L; Della Casa, G; Morandi, U; Guerzoni, S.
abstract

Background The notion that smoking cannabis may damage the respiratory tract has been introduced in recent years but there is still a paucity of studies on this subject. The aim of this study was to investigate the relationship between cannabis smoking, pneumothorax and bullous lung disease in a population of operated patients. Methods and findings We performed a retrospective study on patients operated on for spontaneous pneumothorax. Patients were divided into three groups according to their smoking habit: cannabis smokers, only-tobacco smokers and nonsmokers. Cannabis lifetime exposure was expressed in dose-years (1d/y = 1 gram of cannabis/week for one year). Clinical, radiological and perioperative variables were collected. The variables were analyzed to find associations with smoking habit. The impact of the amount of cannabis consumption was also investigated by ROC curves analysis. Of 112 patients, 39 smoked cannabis, 23 smoked only tobacco and 50 were nonsmokers. Median cannabis consumption was 28 dose/years, median tobacco consumption was 6 pack/years. Cannabis smokers presented with more severe chronic respiratory symptoms and bullous lung disease and with a higher incidence of tension pneumothorax than both tobacco smokers and nonsmokers. Cannabis smokers also developed a larger pneumothorax, experienced prolonged postoperative stay and demonstrated a higher incidence of pneumothorax recurrence after the operation than nonsmokers did. The risk of occurrence of chronic respiratory symptoms and bullous lung disease in cannabis smokers was dose-related. Conclusions Cannabis smoking seems to increase the risk of suffering from respiratory complaints and can have detrimental effects on lung parenchyma, in a dose-dependent manner. Cannabis smoking also negatively affected the outcome of patients operated for spontaneous pneumothorax. A history of cannabis abuse should always be taken in patients with pneumothorax. There may be need for a specific treatment for pneumothorax in cannabis smokers.

2020 - Surgery for elastofibroma dorsi: optimizing the management of a benign tumor – an analysis of 70 cases [Articolo su rivista]
Scamporlino, A; Ruggiero, C; Aramini, B; Morandi, U; Stefani, A
abstract

Background: Elastofibroma dorsi (ED) is a benign soft-tissue tumor of the chest wall located near the tip of the scapula. Clinical presentation includes swelling, pain and impairment of shoulder movements. The present literature relies only on few small case series. The aim of this study was to analyze the surgical management of ED, focusing on the debated topics regarding preoperative evaluation, operative technique, post-operative outcome and follow-up. Methods: We conducted a single-center retrospective cohort analysis of patients operated for ED between 2003 and 2018. Diagnostic techniques were ultrasonography (US), computed tomography (CT-scan) and magnetic resonance imaging (MRI). CT-scan represented our preferred imaging study for preoperative assessment. Surgery was proposed for symptomatic and/or large lesions. Marginal excision through a musclesparing approach was performed. An open-door follow-up policy was adopted. All clinical, radiological, perioperative and pathological variables were matched in a univariate analysis. A multivariate analysis was performed to investigate risk factors for postoperative complications. Correlations analysis between radiological and pathological measurements of elastofibroma was conducted. Results: Seventy elastofibromas were excised in 59 patients. Mean age was 59 years and female prevalence was 59%. All elastofibromas were completely resected with no recurrence. Postoperative complications rate was 17%. Complications were mild in most cases. At the univariate analysis, patients with body mass index (BMI) >25 had a longer operative time (P=0.048), patients on antiplatelet medications experienced a prolonged drainage time (P=0.006) and a higher rate of complications (P=0.038); the occurrence of complications resulted in prolonged drainage time (P=0.047) and length of stay (P=0.023). A BMI ≤25 was the only independent risk factor for postoperative morbidity (OR 8.71, P=0.024). CT-scan showed the highest correlation with pathological size (r=0.819), US the lowest (r=0.421). Conclusions: Marginal resection through a muscle-sparing approach is safe and effective for the treatment of ED. CT-scan can be adequate for preoperative assessment. Giving the benign nature of the lesion and the absence of recurrence after complete resection, an open-door follow-up may be appropriate.

2020 - The role of postoperative radiotherapy for thymomas: a multicentric retrosepective evaluation from three Italian centers and review of the literature. [Articolo su rivista]
Bruni, A; Stefani, A; Perna, M; Borghetti, P; Giaj Levra, N; D’Angelo, E; D’Onofrio, A; Rubino, L; Frassinelli, L; Salvestrini, V; Mariotti, M; Alongi, F; Gonfiotti, A; Livi, L; Scotti, V
abstract

2020 - Wound complication after modified Ravitch for pectus excavatum: A case of conservative treatment enhanced by pectoralis muscle transposition [Articolo su rivista]
Aramini, B; Morandi, U; De Santis, G; Brugioni, L; Stefani, A; Ruggiero, C; Baccarani, A
abstract

Ravitcha b s t r a c tINTRODUCTION: Multiple surgical debridement sessions are mandatory before wound closure in cases ofinfection after a modified Ravitch procedure for pectus excavatum. Vacuum-assisted closure (VAC) is awell-established technical resource for treating complicated wounds; however, in cases of suspicion ofbone infection, this approach is not enough to prevent bar removal.PRESENTATION OF THE CASE: We present a case of surgical wound dehiscence with hardware exposure in apatient who had undergone chondrosternoplasty for pectus excavatum. Several sessions of debridement(three) and VAC were applied every time. The final result was achieved without the necessity to removethe hardware; however, to avoid the risk of infection, a bilateral pectoralis muscle flap mobilization wasperformed as the final step after the surgical wound revisions, although this approach is suggested tobe used during the modified Ravitch procedure. This approach allows for a significant reduction in latecomplications and improves morphological outcomes.DISCUSSION: In summary, the pectoralis muscle flap transposition is very useful not only for aestheticalresults but also in combination with multiple surgical revisions for conservative management in caseof wound infection during a modified Ravitch procedure. In our case, this technique was adopted afteraccurate care of the wound and before the final closure, which helps to maintain good vascularizationand a very satisfying result.CONCLUSION: It is important to consider this approach during the modified Ravitch procedure, not onlyfor better aesthetical results but also to prevent infections or wound dehiscence at the level of the bar

2019 - A case of mixed-pattern calcifications in multinodular goiter associated with a benign diagnosis [Articolo su rivista]
Bianchi, D; Morandi, Uliano; Stefani, A; Aramini, B.
abstract

BACKGROUND: Calcified nodules are often found in a goiter when performing an ultrasound of the neck. An analysis of different calcification patterns could contribute to discriminating between nodules with a lower malignancy risk and those with a higher malignancy risk. In certain cases, the results of a simple cytological analysis of a nodule are not specific enough to be completely trusted. CASE PRESENTATION: We present the case of a goiter with a mixed calcification pattern, including a type of calcification that is strongly associated with a malignant diagnosis, for which a completely benign diagnosis was determined. CONCLUSION: We believe that further studies examining a combination of ultrasound (US) and computed tomography (CT) scan presentations of thyroid nodules need to be performed.

2019 - Can surgery relieve pain and act as first-line treatment for a large metastasis of the sternum? [Articolo su rivista]
Manfredini, Beatrice; Morandi, U.; De Santis, G.; Catani, F.; Stefani, A.; Pinelli, M.; Baccarani, A.; Starnoni, M.; BELLINI ARTIOLI, Francesco; Aramini, B.
abstract

BACKGROUND: There are few papers published on sternal metastasis from renal cell carcinoma. The unifying element is the operability of the sternal metastasis if it is the only site of metastasis, on the operability of the primary site of the tumor and on the patient's health conditions. PRESENTATION OF THE CASE: We present a case of a 66-years-old man undergone sternal resection for a large painful metastasis. He was previously undergone left nephrectomy for clear cells carcinoma. En bloc resection of the sternal manubrium and right clavicle was performed, a Gore-Tex mesh was placed. Histology confirmed metastasis of kidney clear cells carcinoma. Patient was discharged with no complications and no pain. Chest CT at six months follow up was negative for recurrence. DISCUSSION AND CONCLUSION: We highlighted the importance of surgery as possible first-line treatment in symptomatic large sternum metastasis. Therefore, prospective studies should be considered to confirm our strategy.

2019 - Cannonball-like lung nodules in a patients with a colorectal tumor. [Articolo su rivista]
Scamporlino, A; Mengoli, Mc; Calabrese, Olga; Della Casa, G; Aramini, B; Spallanzani, A; Morandi, U; Stefani, A
abstract

N.D.

2019 - Conversion due to vascular injury during video-assisted thoracic surgery lobectomy: a multicentre retrospective analysis form the Italian video-assisted thoracic surgery group registry [Articolo su rivista]
Bertolaccini, L; Davoli, F; Pardolesi, A; Brandolini, J; Argnani, D; Betani, A; Droghetti, A; Gonfiotti, A; Divisi, D; Crisci, R; Solli, Pg; Stefani, A; and the Italian VATS, Group
abstract

Vascular injuries in VATS lobectomies represented a rare complication which could directly affect the postoperative outcomes. The predictive factors for conversion were multifactorial and depended on characteristichs of centres and surgeon's seniority. Minimally invasive VATS lobectomy approaches did not influence the risk of vaclular damages.

2019 - Correction to: Risk factors and impact of conversion from VATS to open lobectomy: analysis from a national database (Surgical Endoscopy, (2019), 33, 12, (3953-3962), 10.1007/s00464-019-06682-5) [Articolo su rivista]
Bongiolatti, S.; Gonfiotti, A.; Viggiano, D.; Borgianni, S.; Politi, L.; Crisci, R.; Curcio, C.; Voltolini, L.; Amore, D.; Marulli, G.; Nicotra, S.; De Negri, A.; Maineri, P.; Dirienzo, G.; Lopez, C.; Divisi, D.; Morelli, A.; Bertani, A.; Russo, E.; Londero, F.; Rosso, L.; Spaggiari, L.; Gasparri, R.; Baietto, G.; Casadio, C.; Infante, M.; Benato, C.; Alloisio, M.; Bottoni, E.; Droghetti, A.; Giovanardi, A.; Cardillo, G.; Carleo, F.; Bertolaccini, L.; Solli, P.; Stella, F.; Dolci, G.; Puma, F.; Vinci, D.; Cavallesco, G.; Maniscalco, P.; Argnani, D.; Ampollini, L.; Carbognani, P.; Terzi, A.; Viti, A.; Negri, G.; Bandiera, A.; Perkmann, R.; Zaraca, F.; Ibrahim, M.; Poggi, C.; Mucilli, F.; Camplese, P.; Luzzi, L.; Ghisalberti, M.; Imperatori, A.; Rotolo, N.; Bortolotti, L.; Rizzardi, G.; Torre, M.; Rinaldo, A.; Sabbatini, A.; Refai, M.; Benvenuti, M. R.; Benetti, D.; Stefani, A.; Natali, P.; Lausi, P.; Guerrera, F.
abstract

In the “Results” section of the Abstract, the sentence: “The mortality rate was similar, but the percentage of patients who suffered from any complication (41.7% vs 24.4%, p < 0.01), the complication rate (65% vs 32.2%, p < 0.01), chest tube duration (p < 0.01) and the hospitalisation rate (p < 0.01) were higher for patients converted.”.

2019 - Correlating tumor-infiltrating lymphocytes and lung cancer stem cells: a cross-sectional study. [Articolo su rivista]
Masciale, Valentina; Grisendi, Giulia; Banchelli, Federico; D'Amico, Roberto; Maiorana, Antonino; Sighinolfi, Pamela; Pinelli, Massimo; Lovati, Eleonora; Stefani, Alessandro; Morandi, Uliano; Dominici, Massimo; Aramini, Beatrice
abstract

Background: Lung cancer stem cells (LCSCs) are endowed with high aldehyde dehydrogenase (ALDH) expression and play roles in tumor proliferation, metastasis, and drug resistance. Their elusive nature may allow them to escape the immune response by tumor-infiltrating lymphocytes (TILs), which can positively affect the outcome in non-small cell lung cancer (NSCLC) patients. Despite independent investigations on both LCSCs and TILs, the relationship between the two has been very marginally considered. We analyzed whether these two cell types may be related as a prerequisite for novel diagnostic and therapeutic approaches. Methods: In this cross-sectional study, NSCLC human surgical specimens from 12 patients were tested by ALDEFLUOR assay to identify ALDHhigh cells. Fluorescence-activated cell sorting (FACS) analyses for CD3+, CD4+, and CD8+ TILs were performed in combination with immunohistochemistry evaluation. Results: Statistically positive correlations were found between ALDH+ and CD8+, and between ALDH+ and CD3+ cells populations; no correlation was found between ALDH+ and CD4+ cells. The expression of CD3+ and CD8+ by cells accounted for 40.1% and 58.7%, respectively, of the variability of ALDH+ cell expression by an R-squared index, which highlights the strong correlation between TILs and LCSCs. Immunohistochemistry revealed 6–25% positive cells. Conclusions: We report a correlation between cytotoxic TILs and LCSCs, which may contribute to the future development of targeted therapies focusing on the different roles of lymphocytes against lung cancer.

2019 - Correlazione tra fumo di cannabis e pneumotorace spontaneo. [Poster]
Aramini, B; Stefani, A; Guerzoni, S; Dellacasa, G; Pellesi, L; Baraldi, C; Morandi, U
abstract

Scopo del lavoro. Lo scopo dello studio è di investigare le associazioni esistenti tra il fumo di cannabis e il pneumotorace spontaneo, analizzando una popolazione di pazienti giovani operati, prendendo in considerazione anche le interazioni con il fumo di tabacco. Materiali e metodi. Studio retrospettivo sui pazienti operati in videotoracoscopia per pneumotorace spontaneo recidivante o cronico tra il 2009 e il 2018, di età inferiore ai 40 anni e che abbiano eseguito una TC-torace prima dell’intervento. Sono state considerate variabili cliniche (età, sesso, sintomi respiratori cronici), tossicologiche (consumo di cannabis in dose/years, 1d/y=5mg di cannabis/settimana; consumo di tabacco in pack/years), radiologiche (gravità del pneumotorace sul radiogramma, grado di enfisema alla TC), perioperatorie (aspetto del polmone secondo Vanderschueren, durata intervento, numero cariche di suturatrice utilizzate per la bullectomia, complicanze postoperatorie, durata drenaggio e durata degenza, recidiva postoperatoria). Il consumo di cannabis è stato correlato con ciascuna delle variabili. Un confronto è stato inoltre eseguito tra 3 gruppi: fumatori di cannabis (più eventualmente tabacco), fumatori soltanto di tabacco, non fumatori. Risultati. 112 pazienti: 39 fumatori di cannabis (media 9.8d/y, 37 fumavano anche tabacco), 23 fumatori di solo tabacco (media 7.5p/y), 50 non fumatori. Il consumo di cannabis è risultato significativamente correlato con sesso maschile, presenza di sintomi respiratori cronici, severità dell’enfisema, gravità del pneumotorace, classe di Vanderschueren, numero di cariche utilizzate e recidiva del pneumotorace. I fumatori di cannabis hanno presentato sintomi respiratori e un grado di enfisema più severi, un pneumotorace di entità più grave e un maggior rischio di recidiva postoperatoria rispetto ai non fumatori e ai fumatori di solo tabacco. Conclusioni. Lo studio evidenzia l’associazione tra fumo di cannabis e pneumotorace, argomento poco studiato in letteratura. L’aggiunta di tabacco funge probabilmente da moltiplicatore degli effetti della cannabis. E’ auspicabile una maggiore consapevolezza da parte della popolazione dei danni polmonari indotti dal fumo di cannabis, ormai chiaramente dimostrati.

2019 - Giant bulla or pneumothorax: How to distinguish. [Articolo su rivista]
Aramini, Beatrice; Ruggiero, Ciro; Stefani, Alessandro; Morandi, Uliano
abstract

BACKGROUND: The differential diagnosis between pneumothorax and giant bullae is thought to be straightforward but sometimes poses a challenge. CASE PRESENTATION: We present a case of a 54-year-old Caucasian man with a giant emphysematous bulla who underwent surgical resection. He had no smoking history and had previous pneumonia episodes. The surgery was free of complications, without air leaks, and he showed good ventilation of the lung. DISCUSSION: The main complications of bullae are pneumothorax, infection and hemorrhage. Pneumothorax is a serious complication in patients with compromised lung function. Therefore, it is very important to carefully distinguish bullae from pneumothorax to avoid iatrogenic pneumothorax in patients with bullous disease. CONCLUSION: We emphasize how to differentiate between giant bullae and pneumothorax utilizing history, physical examination, and radiological studies, including computed tomography (CT) scan.

2019 - Isolation and Identification of Cancer Stem-Like Cells in Adenocarcinoma and Squamous Cell Carcinoma of the Lung: A Pilot Study [Articolo su rivista]
Masciale, Valentina; Grisendi, Giulia; Banchelli, Federico; D'Amico, Roberto; Maiorana, Antonino; Sighinolfi, Pamela; Stefani, Alessandro; Morandi, Uliano; Dominici, Massimo; Aramini, Beatrice
abstract

Background: Lung cancer stem cells (CSCs) share many characteristics with normal stem cells, such as self-renewal and multipotentiality. High expression of aldehyde dehydrogenase (ALDH) has been detected in many tumors, particularly in the CSC compartment, and it plays an important role in tumor proliferation, metastasis, and drug resistance. CD44 is commonly used as a cell surface marker of cancer stem-like cells in epithelial tumors. The aim of this study was to isolate and analyze cancer stem-like cells from surgically removed specimens to compare lung adenocarcinoma (ADENO) and squamous (SQUAMO) cell carcinoma. Methods: The ALDEFLUOR assay was used to identify and sort ALDHhigh and ALDHlow human lung cancer cells following tissue digestion. Fluorescence-activated cell sorting analysis for CD44 was performed with tumor cells. Quantitative real-time PCR was performed to assess the expression of SOX2 and NANOG as stemness markers. ALDH1A1 expression was additionally determined by immunohistochemistry. Anchorage-independent ALDHhigh cell growth was also evaluated. ALDHhigh ADENO and SQUAMO cells were cultured to analyze spheroid formation. Results: All specimens contained 0.5–12.5% ALDHhigh cells with 3.8–18.9% CD44-positive cells. SOX2 and NANOG relative expression in ALDHhigh compared to ALDHlow cells in ADENO and SQUAMO was analyzed and compared between the histotypes. Immunohistochemistry confirmed the presence of ALDH1A1 in the sections. SOX2 and NANOG were expressed at higher levels in the ALDHhigh subpopulation than in the ALDHlow subpopulation only in ADENO cells, and the opposite result was seen in SQUAMO cells. In vitro functional assays demonstrated that ALDHhigh cells exhibited migration capacity with distinct behaviors between ALDHhigh spheres in ADENO vs. SQUAMO samples. Conclusions: Our results highlight the importance of a better characterization of cancer stem-like cells in ADENO and SQUAMO histotypes. This may suggest new differential approaches for prognostic and therapeutic purposes in patients with non-small-cell lung cancer.

2019 - Pectoralis Muscle Transposition in Association with the Ravitch Procedure in the Management of Severe Pectus Excavatum. [Articolo su rivista]
BACCARANI, ALESSIO; Aramini, Beatrice; DELLA CASA, GIOVANNI; BANCHELLI, FEDERICO; D'AMICO, Roberto; RUGGIERO, Ciro; Starnoni, Marta; Pedone, Antonio; STEFANI, Alessandro; MORANDI, Uliano; DE SANTIS, Giorgio
abstract

Background: Pectus excavatum (PE) is the most common congenital chest wall deformity. PE is sometimes associated with cardiorespiratory impairment, but is often associated with psychological distress, especially for patients in their teenage years. Surgical repair of pectus deformities has been shown to improve both physical limitations and psychosocial well-being in children. The most common surgical approaches for PE treatment are the modified Ravitch technique and the minimally invasive Nuss technique. A technical modification of the Ravitch procedure, which includes bilateral mobilization and midline transposition of the pectoralis muscle flap, is presented here. Methods: From 2010 to 2016, 12 patients were treated by a modified Ravitch procedure with bilateral mobilization and midline transposition of the pectoralis muscle flap for severe PE. Outcomes, morphological results, and complications were analyzed with respect to this new combined surgical approach. Results: There was a statistically significant difference between pre- and postoperative values (P = 0.0025) of the Haller index at the 18-month follow-up, showing a significant morphological improvement for all treated patients. After surgery, no morbidity and mortality were noted. The mean hospital stay was 7 days, and all patients were discharged without major complications. Conclusion: This technique significantly improved patients’ postoperative morphological outcomes and significantly reduced long-term complications, such as wound dehiscence, skin thinning, and hardware exposure.

2019 - Risk factors and impact of conversion from VATS to open lobectomy: analysis from a national database. [Articolo su rivista]
Bongiolatti, Stefano; Gonfiotti, Alessandro; Viggiano, Domenico; Borgianni, Sara; Politi, Leonardo; Crisci, Roberto; Stefani, Alessandro
abstract

The objective of the study is to analyse the causes and impact of conversion from VATS to thoracotomy identifying any possbile pre-operative risk factors and related consequences

2019 - Total thyroidectomy in HIV positive patient with buffalo hump and taurine neck [Articolo su rivista]
Carrese, Elena; Morandi, Uliano; Stefani, Alessandro; Aramini, Beatrice.
abstract

BACKGROUND: The authors present a case of multinodular goiter in an HIV-positive patient affected by lipodystrophy with particular accumulation of adipose tissue in the region of the neck and trunk. CASE PRESENTATION: The patient, a 53-year-old man, presented with multinodular struma with partial retrosternal engagement, as well as multiple thyroid nodules increasing in size; some of the nodules had suspicious characteristics on ultrasound. Needle aspiration biopsy was difficult to use to determine the presence of lipodystrophy; however, even in the absence of cytology, surgical treatment was necessary due to the presence of dyspnea during exercise, the dimension of the goiter with retrosternal engagement, and the ovalization of the tracheal lumen. The patient underwent total thyroidectomy by anterior cervicotomy with particular attention to patient positioning because of the buffalo hump and taurine neck. Histological examination was positive for adenomatous hyperplasia with outbreaks of papillary microcarcinoma. CONCLUSIONS: The aim of this case report was to highlight the importance of the perioperative teamwork, with particular attention to patient positioning before surgery, as well as professional collaboration and experience among the operators.

2019 - Uniportal and three-portal video-assisted thoracic surgery lobectomy: analysis of the Italian video-assisted thoracic surgery group database. [Articolo su rivista]
Tosi, D; Nosotti, M; Bonitta, G; Mazzucco, A; Righi, I; Mendogni, P; Rosso, L; Palleschi, A; Rocco, G; Crisci, R; Stefani, Alessandro
abstract

OBJECTIVES: This study compares the uniportal with the 3-portal video-assisted thoracic surgery (VATS) by examining the data collected in the Italian VATS Group Database. The primary end point was early postoperative pain; secondary end points were intraoperative and postoperative complications, surgical time, number of dissected lymph nodes and length of stay. METHODS: This was an observational, retrospective, cohort, multicentre study on data collected by 49 Italian thoracic units. Inclusion criteria were clinical stage I-II non-small-cell lung cancer, uniportal or 3-portal VATS lobectomy and R0 resection. Exclusion criteria were cT3 disease, previous thoracic malignancy, induction therapy, significant comorbidities and conversion to other techniques. The pain parameter was dichotomized: the numeric rating scale ≤3 described mild pain, whereas the numeric rating scale score >3 described moderate/severe pain. The propensity score-adjusted generalized estimating equation was used to compare the uniportal with 3-portal lobectomy. RESULTS: Among 4338 patients enrolled from January 2014 to July 2017, 1980 met the inclusion criteria; 1808 patients underwent 3-portal lobectomy and 172 uniportal surgery. The adjusted generalized estimating equation regression model using the propensity score showed that over time pain decreased in both groups (P < 0.001). There was a statistical difference on the second and third postoperative days; odds ratio (OR) 2.28 [95% confidence interval (CI) 1.62-3.21; P < 0.001] and OR 2.58 (95% CI 1.74-3.83; P < 0.001), respectively. The uniportal-VATS group had higher operative time (P < 0.001), shorter chest drain permanence (P < 0.001) and shorter length of stay (P < 0.001). CONCLUSIONS: Data from the Italian VATS Group Database showed that in clinical practice uniportal lobectomy seems to entail a higher risk of moderate/severe pain on second and third postoperative days.

2019 - What counts more: the patient, the surgical technique, or the hospital? A multivariable analysis of factors affecting perioperative complications of pulmonary lobectomy by video-assisted thoracoscopic surgery from a large nationwide registry. [Articolo su rivista]
Infante, Mv; Benato, C; Silva, R; Stefani, A
abstract

nd

2018 - An unusual drain in the pleural cavity: iatrogenic pneumothorax due to pulmonary misplacement of a nasogastric tube [Articolo su rivista]
Stefani, A; Ruggiero, C; Aramini, B; Scamporlino, A
abstract

Gli autori descrivono un raro caso di pneumotorace conseguente a un errato posizionamento intrabronchiale di un sondino nasogastrico in una paziente in stato soporoso

2018 - Best practices for the management of thymic epithelial tumors: A position paper by the Italian collaborative group for ThYmic MalignanciEs (TYME). [Articolo su rivista]
Imbimbo, M; Ottaviani, M; Vitali, M; Stefani, A
abstract

Thymic epithelial tumors (TETs) are a heterogenous group of rare tumors, with a complex histopatological classification. Furthermore, the recent introduction of the first TNM staging system, that is scheduled to replace the Masaoka-Koga system, may create further difficulties in TET management, that remains challenging. Several guidelines for treatment of TETs are available and provide recommendations based mainly on non randomized trials and retrospective or limited series. Often the lack of evidence leads to formulation of indications based on expert opinions. As for other rare cancers it is crucial to create networks to coordinate the work among centres involved in treatment of these diseases in order to offer the best diagnostic and therapeutic tools. For this purpose, in 2014 a network named TYME (ThYmic MalignanciEs), was founded in Italy with the aim of improving care and research in TETs. In September 2017 a panel of multidisciplinary experts from TYME network and from other Italian centres strongly involved in TET diagnosis and treatment convened a first Italian Expert meeting together with representatives of association for patients affected by rare thoracic cancers Tu.To.R, to explore how these tumors are managed in the different centres of Italy compared to ESMO guidelines. In this paper we summarize the issues discussed during that meeting and we propose recommandations based on Masaoka Koga and the new TNM staging system.

2018 - Congenital cystic adenomatoid malformation in adults presenting as a single cyst [Articolo su rivista]
Scamporlino, Adriana; Ambrosini, A; Turrini, E; Morandi, U; Stefani, A
abstract

Congenital cystic adenomatoid malformations are lung anomalies usually detected prenatally or in newborns and infants. Type 1 congenital cystic adenomatoid malformations appears as a multicystic lesion, with cysts up to 2 cm in diameter, or as a single large cyst. In the latter case, when detected in adults, the preoperative diagnosis is challenging because congenital cystic adenomatoid malformations can be confused with other more common lesions.We describe two cases of uniloculated type 1 congenital cystic adenomatoid malformation in adults. In both cases, the preoperative clinical diagnosis was missed and the patients were surgically treated with lung-sparing cyst resections.

2018 - La malformazione congenita adenomatoido-cistica del polmone nell’adulto: difficoltà diagnostiche e approccio chirurgico [Abstract in Atti di Convegno]
Scamporlino, A; Ambrosini Spaltro, A; Turrini, E; Morandi, U; Stefani, A.
abstract

ND

2018 - National adoption of video-assisted thoracoscopic surgery (VATS) lobectomy: the Italian VATS register evaluation [Articolo su rivista]
Divisi, Duilio; Bertolaccini, Luca; Barone, Mirko; Amore, Dario; Argnani, Desideria; Zaccagna, Gino; SOLLI, Piergiorgio; Di Rienzo, Gaetano; Curcio, Carlo; Crisci, Roberto; STEFANI, Alessandro
abstract

Background: The expertise curve of video-assisted thoracoscopic surgery (VATS) lobectomies still stirs debate and controversy both because of the number of procedures to carry out and of the evaluation of the learning threshold. The purpose of our study was the examination of the variables related to the learning curve of the video-assisted approach, to establish what may be an expression of the technical maturity of the surgeon. Methods: The National Register for VATS lobectomy built in 2013 was used to collect data from 65 Thoracic Surgery Units. Out of more than 3,700 patients enrolled, only information from Units with ≥100 VATS lobectomies were retrospectively analysed. Unpaired Student’s t-tests, Fisher’s exact tests, Pearson’s χ2 were applied as needed. Cumulative summative analysis and one-way ANOVA were used to identify the expertise curve of VATS lobectomy. Results: Ten institutions contributed a total of 1,679 patients, who were divided into three uniform groups according to the chronological sequence of surgery. The length of utility incision, the number of dissected lymph nodes and the operative time were not statistically significant (P=0.999, P=0.972 and P=0.307, respectively) among groups. Conversion to thoracotomy and postoperative air leaks occurred in 125 (7.44%) and 109 (6.49%) patients, gradually declined in Group 3 with statistical significance (P=0.048 and P=0.00086). Conclusions: The conversion rate and the percentage of air leaks seem to define the expertise of VATS lobectomy, being linked to the ability to manage more complicated surgical cases or intraoperative adverse events.

2018 - Safety of lymphadenectomy during video-assisted thoracic surgery lobectomy: analysis from a national database [Articolo su rivista]
Gonfiotti, A; Bertani, A; Nosotti, M; Viggiano, D; Bongiolatti, S; Bertolaccini, L; Droghetti, A; Solli, P; Crisci, R; Voltolini, L; Stefani, A
abstract

N.N.

2018 - Un raro caso di PECOMA maligno all’interno di un sequestro polmonare extralobare. [Abstract in Atti di Convegno]
Cinquepalmi, Alessandro; Stefani, A; Aramini, B; Morandi, U
abstract

N.D.

2017 - Analysis of a panel of druggable gene mutations and of ALK and PD-L1 expression in a series of thymic epithelial tumors (TETs). [Articolo su rivista]
Tiseo, M; Damato, Angela; Longo, Luigia; Barbieri, F; Bertolini, F; Stefani, Alessandro; Migaldi, M; Gnetti, L; Camisa, R; Bordi, P; Buti, S; Rossi, G
abstract

Introduction: Thymic epithelial tumors (TETs) are rare neoplasms with different prognosis lacking consis-tent molecular alterations possibly leading to targeted therapy. We collected a consecutive series of TETsaimed at investigating the mutational status of druggable genes (EGFR, c-KIT, KRAS, BRAF, PDGFR-alphaand −beta, HER2 and c-MET) and the expression of ALK and PD-L1.Patients and methods: One hundred twelve consecutive cases of TETs and relative clinico-pathologic fea-tures were collected. Immunohistochemical expression of ALK (clone D5F3) and PD-L1 (clone E1L3N),molecular analysis of EGFR (exons 18–21), c-KIT (exons 9,11,13,14,17), KRAS (exon 2), BRAF (exon 15),PDGFR-alpha (exon 12) and -beta (exons 12, 14, 18), HER-2 (exons 19 and 20) and c-MET (exons 14,17, 18, 19) mutations were performed. Immuno-molecular results were then statistically matched withclinico-pathologic characteristics.Results: Patients were male in 54% of cases, with a median age of 61 years (range 19–83) and affectedmainly by thymoma (78%) in stage II (45%). At molecular analysis, there were 4 c-KIT mutations (occurringin exon 11 V559A, L576P, Y553N and exon 17 D820E) in thymic carcinomas (type C), but not in other tumortypes (p = 0.003). No mutations were detected in other genes and none case was ALK positive. Twenty-nine (26%) cases were PD-L1 positive (65% of thymic carcinomas and 18% of thymomas). High PD-L1expression was statistically associated with WHO classification stage type C (p < 0.001) and Masaoka stageIII–IV disease (p = 0.007). In univariate analysis, WHO classification type C, advanced Masaoka stage andabsence of myasthenia, but not PD-L1 expressions were correlated with worse survival; at multivariateanalysis, only WHO type C confirmed its negative prognostic role.Conclusion: A subset of TETs as thymic carcinomas can harbor c-KIT mutations and elevated PD-L1 expres-sion that could represent targets of potential therapeutic use.

2017 - Erratum: Nodal management and upstaging of disease: Initial results from the Italian VATS Lobectomy Registry [J Thorac Dis, 9, (2017), (2061-2070)] DOI: 10.21037/jtd.2017.06.12 [Articolo su rivista]
Bertani, A.; Gonfiotti, A.; Nosotti, M.; Ferrari, P. A.; De Monte, L.; Russo, E.; Di Paola, G.; Solli, P.; Droghetti, A.; Bertolaccini, L.; Crisci, R.; Curcio, C.; Amore, D.; Marulli, G.; Nicotra, S.; De Negri, A.; Maineri, P.; di Rienzo, G.; Lopez, C.; Morelli, A.; Londero, F.; Spaggiari, L.; Gasparri, R.; Baietto, G.; Casadio, C.; Infante, M.; Benato, C.; Alloisio, M.; Bottoni, E.; Cardillo, G.; Carleo, F.; Stella, F.; Dolci, G.; Puma, F.; Vinci, D.; Cavallesco, G.; Maniscalco, P.; Ampollini, L.; Carbognani, P.; Terzi, A.; Viti, A.; Negri, G.; Bandiera, A.; Perkmann, R.; Zaraca, F.; Andretti, C.; Poggi, C.; Mucilli, F.; Camplese, P.; Luzzi, L.; Ghisalberti, M.; Imperatori, A.; Rotolo, N.; Bortolotti, L.; Rizzardi, G.; Torre, M.; Rinaldo, A.; Sabbatini, A.; Refai, M.; Benvenuti, M. R.; Benetti, D.; Stefani, A.; Natali, P.; Lausi, P.; Guerrera, F.
abstract

In the article that appeared on page 2061-2070, Vol 9, No 7 (July 2017) Issue of the Journal of Thoracic Disease (1), there are some mistakes in the presented authors information. In the list of collaborators of the Italian VATS Group are not included the following author names: Alessandro Bertani, Alessandro Gonfiotti, Mario Nosotti, Paolo Albino Ferrari, Lavinia De Monte, Emanuele Russo, Gioacchino Di Paola, Piergiorgio Solli, Andrea Droghetti, Luca Bertolaccini, Roberto Crisci. The correct list of collaborators of the Italian VATS Group should have been shown as below. Alessandro Bertani, MD (IRCCS ISMETT, Palermo); Alessandro Gonfiotti, MD (Careggi Hospital, Firenze); Mario Nosotti, MD (Policlinico Ca'Granda, Milano); Paolo Albino Ferrari, MD (IRCCS ISMETT, Palermo); Lavinia De Monte, MD (IRCCS ISMETT, Palermo); Emanuele Russo, MD (IRCCS ISMETT, Palermo); Gioacchino Di Paola, MD (IRCCS ISMETT, Palermo); Piergiorgio Solli, MD PhD (AUSL Romagna Teaching Hospital, Forlì); Andrea Droghetti, MD (ASST Mantova-Cremona, Mantova); Luca Bertolaccini, MD PhD (AUSL Romagna Teaching Hospital, Forlì); Roberto Crisci, MD PhD (Università dell'Aquila, L'Aquila); Carlo Curcio, MD (Monaldi Hospital, Napoli); Dario Amore, MD (Monaldi Hospital, Napoli); Giuseppe Marulli, MD (University of Padova); Samuele Nicotra, MD (University of Padova); Andrea De Negri, MD (San Martino Hospital, Genova); Paola Maineri, MD (San Martino Hospital, Genova); Gaetano di Rienzo (Vito Fazzi Hospital, Lecce); Camillo Lopez, MD (Vito Fazzi Hospital, Lecce); Angelo Morelli, MD (S. Maria delle Misericordia Hospital, Udine); Francesco Londero, MD (S. Maria delle Misericordia Hospital, Udine); Lorenzo Spaggiari, MD (IEO Hospital, Milano); Roberto Gasparri, MD (IEO Hospital, Milano); Guido Baietto, MD (Maggiore della Carità Hospital, Novara); Caterina Casadio, MD (Maggiore della Carità Hospital, Novara); Maurizio Infante, MD (Borgo Trento Hospital, Verona); Cristiano Benato, MD (Borgo Trento Hospital, Verona); Marco Alloisio, MD (IRCCS Humanitas, Milano); Edoardo Bottoni, MD (IRCCS Humanitas, Milano); Giuseppe Cardillo, MD (Forlanini Hospital, Roma); Francesco Carleo, MD (Forlanini Hospital, Roma); Franco Stella, MD (S. Orsola Hospital, Bologna); Giampiero Dolci, MD (S. Orsola Hospital, Bologna); Francesco Puma, MD (University of Perugia); Damiano Vinci, MD (University of Perugia); Giorgio Cavallesco, MD (University of Ferrara); Pio Maniscalco, MD (University of Ferrara); Luca Ampollini, MD (University of Parma); Paolo Carbognani, MD (University of Parma); Alberto Terzi, MD (Negrar Hospital, Verona); Andrea Viti, MD (Negrar Hospital, Verona); Giampiero Negri, MD (S. Raffaele Hospital, Milano); Alessandro Bandiera, MD (S. Raffaele Hospital, Milano); Reinhold Perkmann, MD (Bolzano Hospital, Bolzano); Francesco Zaraca, MD (Bolzano Hospital, Bolzano); Claudio Andretti, MD (S. Andrea Hospital, Roma); Camilla Poggi, MD (S. Andrea Hospital, Roma); Felice Mucilli, MD (S. Maria Annunziata Hospital, Chieti); Pierpaolo Camplese, MD (S. Maria Annunziata Hospital, Chieti); Luca Luzzi, MD (University of Siena); Marco Ghisalberti, MD (University of Siena); Andrea Imperatori, MD (University of Varese); Nicola Rotolo, MD (University of Varese); Luigi Bortolotti, MD (Humanitas Gavazzeni Hospital, Bergamo); Giovanna Rizzardi, MD (Humanitas Gavazzeni Hospital, Bergamo); Massimo Torre, MD (Niguarda Hospital, Milano); Alessandro Rinaldo, MD (Niguarda Hospital, Milano); Armando Sabbatini, MD (Ospedali Riuniti, Ancona); Majed Refai, MD (Ospedali Riuniti, Ancona); Mauro Roberto Benvenuti, MD (Spedali Civili, Brescia); Diego Benetti, MD (Spedali Civili, Brescia); Alessandro Stefani, MD (Ospedale Policlinico, Modena); Pamela Natali, MD (Ospedale Policlinico, Modena); Paolo Lausi, MD (Ospedale Molinette, Torino); Francesco Guerrera, MD (Ospedale Molinette, Torino).

2017 - Nodal management and upstaging of disease: Initial results from the Italian VATS Lobectomy Registry [Articolo su rivista]
Bertani, Alessandro; Gonfiotti, Alessandro; Nosotti, Mario; Albino Ferrari, Paolo; De Monte, Lavinia; Russo, Emanuele; Di Paola, Gioacchino; Solli, Piero; Droghetti, Andrea; Bertolaccini, Luca; Crisci, Roberto; Stefani, Alessandro
abstract

Background: VATS lobectomy is an established option for the treatment of early-stage NSCLC. Complete lymph node dissection (CD), systematic sampling (SS) or resecting a specific number of lymph nodes (LNs) and stations are possible intra-operative LN management strategies. Methods: All VATS lobectomies from the “Italian VATS Group” prospective database were retrospectively reviewed. The type of surgical approach (CD or SS), number of LN resected (RN), the positive/resected LN ratio (LNR) and the number and types of positive LN stations were recorded. The rates of nodal upstaging were assessed based on different LN management strategies. Results: CD was the most frequent approach (72.3%). Nodal upstaging rates were 6.03% (N0-to-N1), 5.45% (N0-to-N2), and 0.58% (N1-to-N2). There was no difference in N1 or N2 upstaging rates between CD and SS. The number of resected nodes was correlated with both N1 (OR =1.02; CI, 1.01–1.04; P=0.03) and N2 (OR =1.02; CI, 1.01–1.05; P=0.001) upstaging. Resecting 12 nodes had the best ability to predict upstaging (6 N1 LN or 7 N2 LN). The finding of two positive LN stations best predicted N2 upstaging [area under the curve (AUC) of receiver operating characteristic (ROC) =0.98]. Conclusions: Nodal upstaging (and, indirectly, the effectiveness of intra-operative nodal management) cannot be predicted based on the surgical technique (CD or SS). A quantitative assessment of intra-operative LN management may be a more appropriate and measurable approach to justify the extension of LN resection during VATS lobectomy

2017 - Pathologic findings and long-term results after surgical treatment for pulmonary sarcomatoid tumors: a multicenter analysis [Articolo su rivista]
56) Lococo, F; Rapicetta, C; Cardillo, G; Stefani, A; Margaritora, S; Leuzzi, G; Rossi, G; Ciavarella, L; Morandi, U; Facciolo, F; Ricchetti, T; Cesario, A; Paci, M.
abstract

Background Pulmonary sarcomatoid carcinoma (PSC) is a very rare subtype of non-small cell lung cancer (NSCLC). The aim of this study was to clarify the pathologic characteristics and long-term survival after surgical treatment in patients with PSC. Methods From January 2003 to December 2013, we retrospectively reviewed the clinical findings, surgical notes, and pathologic and follow-up data from 148 consecutive patients who underwent curative resection for PSC in 5 institutions. The Kaplan-Meier method, log-rank test, and Cox regression analysis were used. Results Mean age and male to female ratio were 66.6 ± 9.9 years and 120:28, respectively. Surgical resection (pneumonectomy in 8 patients, bilobectomy in 132 patients, and sublobar resection in 8 patients) was complete in 142 cases (96%). At pathologic evaluation, 36 patients (24%) had stage I, 69 patients (47%) had stage II, 33 patients (22%) had stage III, and 10 patients (7%) had stage IV disease. A “biphasic tumor” (PSC with an NSCLC component) was observed in 77 patients (52%). We detected a high rate of vascular emboli in the surgical specimens (overall, 68%; 57% in pathologic stage I tumors), whereas lymphatic emboli were found in 30% of cases (5% of pathologic stage I tumors). Overall median and 5-year long-term survival (LTS) was 19 months and 12.6% (LTS, 16.3% in pathologic stage I), respectively. Distant recurrences frequently occurred after surgical treatment (81%), even in pathologic stage I tumors that underwent R0 resection (62%). Multivariable survival analysis identified R+ resection (hazard ratio [HR],12.3; 95% confidence interval [CI], 3.67–41.28; p < 0.0001), advanced pathologic stage (HR, 5.75; 95% CI, 2.55–12.98; p < 0.0001), and the presence of vascular emboli (HR, 1.67; 95% CI, 1.05–2.67; p = 0.0327) as independent negative prognostic factors. Conclusions PSCs have very aggressive behavior and high metastatic potential even in early stages. R+ resection, pathologic TNM status, and the presence of vascular emboli are independent prognostic factors

2017 - Re: Anthracosis mimicking mediastinal lymph node metastases with 18F-FCholine in high-risk prostate cancer [Articolo su rivista]
Mengoli, MARIA CECILIA; Stefani, Alessandro; Rossi, Giulio
abstract

Gli Autori descrivono un caso di adenopatie mediastiniche fortemente PET positive (18-FDG PET), inizialmente considerate come neoplastiche. Sono stati eseguiti prelievi in mediastinoscopia e il risultato dell'esame anatomopatologico ha evidenziato trattarsi di una proliferazione attiva di cellule fusate legate alla antracosilicosi.

2017 - Standardized uptake value and radiological density attenuation as predictive and prognostic factors in patients with solitary pulmonary nodules. Our experience on 1592 patients [Articolo su rivista]
60) Divisi, D; Barone, M; Bertolaccini, L; Rocco, G; Solli, P; Crisci, R; Stefani, A
abstract

Background: Multislice computed tomography (MSCT) increased detection of solitary pulmonary nodules (SPNs), changing the management based on radiological and clinical factors. When 18-fluorine fluorodeoxyglucose positron emission tomography combined with computed tomography (18F-FDG-PET/CT) was considered for the evaluation of nodules, the maximum standardized uptake value (SUVmax) more than 2.5 is used frequently as a cut off for malignancy. The purpose of this study is to evaluate SUVmax PET/CT and pulmonary attenuation patterns at MSCT in patients with SPN according to morphological and pathological characteristics of the lesion. Methods: A retrospective study on 1,592 SPN patients was carried out following approval by the Italian Registry of VATS Lobectomies. Results: All patients underwent VATS lobectomy. On histologic examination, 98.1% had primary or second metachronous primary lung cancers. In addition, 10.7% presented occult lymph node metastases (pN1 or pN2) on histological examination. Nodule attenuation on CT was associated with the histology of the lesion (p= 0.030); in particular, pure ground glass opacities (pGGOs) and partially solid nodules were related to adenocarcinomatous histotypes. Conversely, a significant relationship between SUVmax and age, nodule size, pathological node status (pN) was found (P=0.007, P=0.000 and P=0.002 respectively). Conclusions: Nodule attenuation can predict the histology of the lesion whereas SUVmax may relate to the propensity to lymph node metastases.

2017 - Thoracic surgery [Capitolo/Saggio]
Morandi, U; Stefani, A; Aramini, B
abstract

Vengono descritti brevemente gli aspetti di diagnosi e stadiazione delle neoplasie polmonari. Gli autori descrivono poi dettagliatamente gli aspetti dello studio funzionale cardiorespiratorio preoperatorio e la valutazione del rischio perioperatorio. Più brevemente si soffermano sulle principali procedure chirurgiche e infine si descrivono gli aspetti relativi al trattamenti riabilitativo e generale postoperatorio. Il tutto focalizzato ai pazienti anziani,.

2016 - Bronchopulmonary Carcinoids causing Cushing Syndrome: Results from a Multicentric Study Suggesting a More Aggressive Behavior [Articolo su rivista]
Lococo, MARCO FRANCESCO; Margaritora, S; Cardillo, G; Filosso, Pier Luigi; Novellis, P; Rapicetta, C; Carleo, F; Bora, Giulia; Cesario, A; Stefani, A; Rossi, G; Paci, M.
abstract

Objective Cushing syndrome (CS) caused by bronchopulmonary carcinoids (BCs) is a very rare entity. The aim of this study was to revisit the features of a multicenter clinical series to identify significant prognostic factors. Methods From January 2002 to December 2013, the clinical and pathological data of 23 patients (treated in five different institutions) were retrospectively reviewed. Survival analysis was performed to explore the relative weight of potential prognostic factors. Results Median age and male/female ratio were 48 years and 14/9, respectively. Most (> 80%) of the patients presented with CS-related symptoms at diagnosis. Tumor location was peripheral in 13 patients (57%) and central in 10 (43%). All patients but two (treated with chemotherapy) underwent surgical resection with curative intent. Definitive cyto/histology was indicative of typical carcinoid (TC) in 16 cases (70%) and atypical carcinoid (AC) in 7 cases (30%). A complete remission of CS was obtained in 16 cases (70%). Lymph nodal involvement was detected in 11 cases (48%), with N2 disease occurring in 7 (∼ 30% of all cases). Four patients (22%) experienced a relapse of the disease after radical surgery. Overall 5-year survival (long-term survival, LTS) was 60%, better in TCs when compared with AC (LTS: 66 v s. 48%, p = 0.28). Log-rank analysis identified ECOG performance status, cTNM and cN staging, pTNM and pN staging, persistence of CS and relapses (local p = 0.006; distant p = 0.001) as significant prognostic factors in this cohort of patients. Conclusion BCs causing CS are characterized by a high rate of lymph-nodal involvement, a suboptimal prognosis (5-year survival = 60%, 66% in TCs) and a remarkable risk of relapse even after radical resection. Advanced stage, lymph-nodal involvement and the persisting of the CS after treatment correlate with a poor prognosis.

2016 - Immune contexture and histological response after neoadjuvant chemotherapy predict clinical outcome of lung cancer patients [Articolo su rivista]
Remark, Romain; Lupo, Audray; Alifano, Marco; Biton, J; Ouakrim, H; Stefani, Alessandro; Cremer, I; Goc, J; Regnard, Jean-Francois; Dieu-Nosjean, Mc; Damotte, Diane
abstract

There is now growing evidence that the immune contexture influences cancer progression and clinical outcome of patients with non-small cell lung cancer (NSCLC). If chemotherapy is widely used to treat patients with advanced-stage NSCLC, it remains unclear how it could modify the immune contexture and impact its prognostic value. Here, we analyzed two retrospective cohorts, respectively composed of 122 stage III-N2 NSCLC patients treated with chemotherapy before surgery and 39 stage-matched patients treated by surgery only. In patients treated with neoadjuvant chemotherapy, the histological characteristics, the expression of PD-L1 protein, and the tumor immune microenvironment (CD8+ T cells, DC-LAMP+ mature dendritic cells, and CD68+ macrophages) were evaluated and their prognostic value assessed together with standard clinical parameters. By analyzing pre- and post-treatment specimens, we did not find any changes in the PD-L1 expression. We also found that the tumor immune contexture in patients treated with neoadjuvant chemotherapy exhibited a similar pattern that the one found in chemotherapy-naive patients, with comparable densities of tumor-infiltrating CD8+ and DC-LAMP+ cells and a similar spatial organization. The percentage of residual viable tumor cells and the immune pattern (CD8+ and DC-LAMP+ cell densities) were significantly associated with the clinical outcome and allowed the identification of short- and long-term survivors, respectively. In multivariate analysis, the immune pattern was found to be the strongest independent prognostic factor. In conclusion, this study decrypts the complex interplay between cancer and immune cells in patients undergoing chemotherapy and supports potential beneficial synergistic effect of immunotherapy and chemotherapy

2016 - Mucorales-specific T cells in patients with hematologic malignancies [Articolo su rivista]
Potenza, Leonardo; Vallerini, Daniela; Barozzi, Patrizia; Riva, Giovanni; Gilioli, Andrea; Forghieri, Fabio; Candoni, Anna; Cesaro, Simone; Quadrelli, Chiara; Maertens, Johan; Rossi, Giulio; Morselli, Monica; Codeluppi, Mauro; Mussini, Cristina; Colaci, Elisabetta; Messerotti, Andrea; Paolini, Ambra; Maccaferri, Monica; Fantuzzi, Valeria; DEL GIOVANE, Cinzia; Stefani, Alessandro; Morandi, Uliano; Maffei, Rossana; Marasca, Roberto; Narni, Franco; Fanin, Renato; Comoli, Patrizia; Romani, Luigina; Beauvais, Anne; Viale, Pier Luigi; Latgè, Jean Paul; Lewis, Russell E.; Luppi, Mario
abstract

Background: Invasive mucormycosis (IM) is an emerging life-threatening fungal infection. It is difficult to obtain a definite diagnosis and to initiate timely intervention. Mucorales-specific T cells occur during the course of IM and are involved in the clearance of the infection. We have evaluated the feasibility of detecting Mucorales-specific T cells in hematological patients at risk for IM, and have correlated the detection of such cells with the clinical conditions of the patients. Methods and Findings: By using an enzyme linked immunospot assay, the presence of Mucorales-specific T cells in peripheral blood (PB) samples has been investigated at three time points during highdose chemotherapy for hematologic malignancies. Mucorales-specific T cells producing interferon-γ, interleukin-10 and interleukin-4 were analysed in order to detect a correlation between the immune response and the clinical picture. Twenty-one (10.3%) of 204 patients, accounting for 32 (5.3%) of 598 PB samples, tested positive for Mucorales-specific T cells. Two groups could be identified. Group 1, including 15 patients without signs or symptoms of invasive fungal diseases (IFD), showed a predominance of Mucorales-specific T cells producing interferon-gamma. Group 2 included 6 patients with a clinical picture consistent with invasive fungal disease (IFD):2 cases of proven IM and 4 cases of possible IFD. The proven patients had significantly higher number of Mucorales-specific T cells producing interleukin-10 and interleukin-4 and higher rates of positive samples by using derived diagnostic cut-offs when compared with the 15 patients without IFD. Conclusions: Mucorales-specific T cells can be detected and monitored in patients with hematologic malignancies at risk for IM. Mucorales-specific T cells polarized to the production of T helper type 2 cytokines are associated with proven IM and may be evaluated as a surrogate diagnostic marker for IM.

2016 - Prediction of distant recurrence in resected stage I and II lung adenocarcinoma [Articolo su rivista]
Aramini, Beatrice; Casali, Christian; Stefani, Alessandro; Bettelli, Stefania; Wagner, Susanne; Sangale, Zaina; Hughes, Elisha; Lanchbury, Jerry S.; Maiorana, Antonino; Morandi, Uliano
abstract

Objectives Optimal procedures for adjuvant treatment and post-surgical surveillance of resected non-small-cell lung cancer remain under discussion. Pathological features are the main determinant of follow-up therapy but have limited ability to identify patients at risk of recurrence. Increasingly, molecular markers are incorporated into clinical decision-making, including measures of tumor growth. The CCP score is a quantitative, molecular measure of proliferation derived from the RNA expression of 31 cell cycle genes and a component of the molecular prognostic score (mPS). The mPS score is a linear combination of CCP score and pathological stage. CCP score and mPS are independent predictors of survival in resected lung adenocarcinoma. Materials and methods CCP scores were determined by RT-qPCR for 318 patients diagnosed with stage I–II lung adenocarcinoma. Association of mPS and CCP score with distant recurrence and lung-cancer specific survival was assessed in Cox proportional hazards regression models adjusted for age, gender, tumor size, pathological stage and pleural invasion. Distant recurrence-free survival and lung-cancer specific survival by mPS risk group were calculated by Kaplan-Meier survival analysis. Results CCP scores were obtained for 205 stage I and 84 stage II patients. CCP score and mPS were independent markers of distant recurrence (CCP: HR 1.62, 95%CI 1.15-2.29, p = 0.0055; mPS: HR 2.22, 95%CI 1.11-4.44, p = 0.023). Patients with low mPS tumors were at significantly reduced risk of distant recurrence (log-rank p = 4.2 × 10−5). Among stage I patients, stratification by mPS identified a patient group with increased risk of distant recurrence (36%, 95%CI 28–46%, log-rank p = 0.0011) Conclusions The molecular prognostic score stratifies early-stage, resected lung cancer patients for risk of distant recurrence and could be useful to inform treatment and surveillance decisions.

2016 - Prediction of Distant Recurrence-Free Survival in Resectable Lung Adenocarcinoma. [Abstract in Atti di Convegno]
Aramini, B; Casali, C; Stefani, A; Bettelli, S; Wagner, ; Sangale, Z; Hughes, E; S., Lanchbury J; Maiorana, A; Morandi, U.
abstract

OBJECTIVES: Optimal procedures for adjuvant treatment and post-surgical surveillance of resected non-small-cell lung cancer remain under discussion. Pathological features are the main determinant of follow-up therapy but have limited ability to identify patients at risk of recurrence. Increasingly, molecular markers are incorporated into clinical decision-making, including measures of tumor growth. The CCP score is a quantitative, molecular measure of proliferation derived from the RNA expression of 31 cell cycle genes and a component of the molecular prognostic score (mPS). The mPS score is a linear combination of CCP score and pathological stage. CCP score and mPS are independent predictors of survival in resected lung adenocarcinoma. MATERIALS AND METHODS: CCP scores were determined by RT-qPCR for 318 patients diagnosed with stage I-II lung adenocarcinoma. Association of mPS and CCP score with distant recurrence and lung-cancer specific survival was assessed in Cox proportional hazards regression models adjusted for age, gender, tumor size, pathological stage and pleural invasion. Distant recurrence-free survival and lung-cancer specific survival by mPS risk group were calculated by Kaplan-Meier survival analysis. RESULTS: CCP scores were obtained for 205 stage I and 84 stage II patients. CCP score and mPS were independent markers of distant recurrence (CCP: HR 1.62, 95%CI 1.15-2.29, p=0.0055; mPS: HR 2.22, 95%CI 1.11-4.44, p=0.023). Patients with low mPS tumors were at significantly reduced risk of distant recurrence (log-rank p=4.2×10-5). Among stage I patients, stratification by mPS identified a patient group with increased risk of distant recurrence (36%, 95%CI 28-46%, log-rank p=0.0011) CONCLUSIONS: The molecular prognostic score stratifies early-stage, resected lung cancer patients for risk of distant recurrence and could be useful to inform treatment and surveillance decisions.

2016 - Primary sarcomatoid carcinoma of the lung: radiometabolic (18F-FDG PET/CT) findings and correlations with clinico-pathological and survival results [Articolo su rivista]
Rapicetta, Christian; Lococo, Filippo; Stefani, Alessandro; Rossi, Giulio; Richetti, Tommaso; Filice, A; Franceschetto, Antonella; Treglia, G; Paci, Massimiliano
abstract

Introduction: Pulmonary sarcomatoid carcinoma (PSC) is a very rare and uninvestigated subtype of non-small cell lung cancer (NSCLC). Methods: The aims of this study were to define the radiometabolic features (by 18F-FDG PET/CT) in a bi-centric cohort of 49 PSC patients and to explore their relation with clinico-pathological characteristics and long-term survival results after surgical treatment. Results: There were 40 males and 9 females aged 65.2 ± 10.47 years. Overall long-term survival was 26.7 % at 5 years. Mean and median values of SUVmax were 15.21 and 15, respectively (SD ±5.5). Performing an age-, gender- and staging-matched analysis comparing PSC Stage-I only with a cohort of Stage-I NSCLC (n = 93), we observed significantly higher SUVmax values in PSC group (15.11 vs 7.66, p = 0.001). Conclusions: No differences in terms of SUVmax were found with regard to tumour dimensions, histology (pure vs mixed, pleomorphic vs others), pathological stage and pattern of recurrence. P-stage, surgical radicality, vascular/lymphatic invasion but not SUVmax affected long-term survival in PSC

2016 - Pulmonary Carcinosarcoma Arising in the Framework of an Idiopathic Pulmonary Fibrosis [Articolo su rivista]
Lococo, Filippo; Luppi, Fabrizio; Cerri, Stefania; Montanari, Gloria; Stefani, Alessandro; Rossi, Giulio
abstract

Si descrive un raro caso di paziente con fibrosi polmonare idiopatica nell'ambito della quale è insorto in carcinosarcoma polmonare. Il paziente è stato operato con intento radicale ma ha presentato una riacutizzazione della fibrosi polmonare nel postoperatorio. Trattato farmacologicamente e con supporto ventilatorio è progressivamente migliorato fino a venire dimesso in buone condizioni.

2015 - Everolimus effectively blocks pulmonary metastases from meningioma [Articolo su rivista]
Bertolini, Federica; Pecchi, Annarita; Stefani, Alessandro; Fontana, Annalisa; Rossi, Giulio
abstract

L'utilizzo di everolimus a lungo termine ha permesso in una paziente affetta da metastasi multiple polmonari bilaterali da meningioma di bloccare l'evoluzione della malattia.

2015 - Is fludeoxyglucose-fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT) really useless in staging pulmonary carcinoid tumors and in discriminating histological subtypes? Controversial points and future perspectives [Articolo su rivista]
Lococo, Filippo; Stefani, Alessandro; Treglia, Giorgio
abstract

La FDG-PET è molto limitata nella stadiazione linfonodale dei carcinoidi polmonari

2015 - Malattie della pleura e del mediastino [Capitolo/Saggio]
Stefani, Alessandro; Morandi, Uliano
abstract

Gli autori descrivono le principali malattie della pleura e del mediastino di interesse chirurgico

2015 - Morbidity and Mortality in Patients with Idiopathic Pulmonary Fibrosis Undergoing Diagnostic Surgical Lung Biopsy [Abstract in Atti di Convegno]
Zelent, Gabriele; Cerri, Stefania; Sghedoni, Enrico; Montanari, Gloria; Taddei, Sofia; Aramini, Beatrice; Rossi, Giulio; Stefani, Alessandro; Torricelli, Pietro; Morandi, Uliano; Luppi, Fabrizio
abstract

Morbidity and Mortality In Patients With Idiopathic Pulmonary Fibrosis Undergoing Diagnostic Surgical Lung Biopsy.

2014 - A standardized technique for lung biopsy in idiopathic interstitial pneumonias [Articolo su rivista]
Stefani, Alessandro; Aramini, Beatrice; Morandi, Uliano
abstract

Objective. In cases of suspected idiopathic interstitial pneumonia, a surgical lung biopsy can be necessary to obtain a definitive diagnosis. The optimal site, size and specimen number to ensure adequate sampling remain controversial. We developed a standardized technique to perform surgical lung biopsy. Methods. Patients with preoperative suspicion of IIP were evaluated for this kind of operation. When diffuse, bilateral and uniformly distributed abnormalities were seen at high-resolution computed-tomography the patient underwent this operation. Three pulmonary segments of the left lung (lingula, lateral/posterior basal and apical segment of the lower lobe) were biopsied using a three-ports videothoracoscopic approach. The operation was conducted under general anaesthesia and double-lumen endotracheal intubation for single-lung ventilation. No frozen examination nor microbiological examination were routinely requested. Results. Fifty-nine patients were operated using this technique. No conversions from VATS to thoracotomy were necessary. The mean operative time was 38 minutes. Mortality was 3.3%. A firm clinicopathological diagnosis was achieved in all patients. Conclusions. The proposed technique has been proved to have a high diagnostic yield and to be safe, simple and fast in the various form of idiopathic interstitial pneumonias. Conversely, the technique is not indicated in diffuse parenchymal lung diseases in which the distribution of the lesions at HRCT is non-uniform and inhomogeneous. In these cases the various distribution of pathological changes requires a case-by-case evaluation of the optimal site, size and number of biopsies.

2014 - An unusual case of giant benign metastasizing leiomyoma mimicking solitary fibrous tumor of the pleura [Articolo su rivista]
Stefani, Alessandro; Rossi, Giulio; Longo, Lucia; Morandi, Uliano
abstract

Benign metastasizing leiomyoma is a rare entity usually manifesting with asymptomatic multiple pulmonary nodules in women with history of uterine leiomyoma. Surgical resection is the treatment of choice when feasible, alternatively hormonal therapy can be proposed. We describe a case of a 72-year-old woman with a giant and symptomatic benign metastasizing leiomyoma of the left lung, developed 22 years after hysterectomy. Complete surgical excision of the mass was performed. The patient is alive without recurrence 20 months after the operation.

2014 - Identification of malignant pleural effusion by tumor markers: a National multicenter trial. [Abstract in Atti di Convegno]
Griffo, Salvatore; Elia, Stefano; Vetrani, A; Morandi, Uliano; Pacelli, F; Stefani, Alessandro
abstract

All examined concetnrations of tumor markers examined in pleural effusions were significantly higher in malignant effusions than in benign

2014 - Large cell carcinoma of the lung: clinically oriented classification integrating immunohistochemistry and molecular biology. [Articolo su rivista]
Rossi, G; Mengoli, Mc; Cavazza, Alessia; Nicoli, D; Barbareschi, M; Cantaloni, C; Papotti, M; Tironi, A; Graziano, P; Paci, Massimiliano; Stefani, Alessandro; Migaldi, Mario; Sartori, Giuliana; Pelosi, G.
abstract

This study aimed at challenging pulmonary large cell carcinoma (LLC) as tumor entity and defining different subgroups according to immunohistochemical and molecular features. Expression of markers specific for glandular (TTF-1, napsin A, cytokeratin 7), squamous cell (p40, p63, cytokeratins 5/6, desmocollin-3), and neuroendocrine (chromogranin, synaptophysin, CD56) differentiation was studied in 121 LCC across their entire histological spectrum also using direct sequencing for epidermal growth factor receptor (EGFR) and v-Ki-ras2 Kirsten rat sarcoma viral oncogene homolog (KRAS) mutations and FISH analysis for ALK gene translocation. Survival was not investigated. All 47 large cell neuroendocrine carcinomas demonstrated a true neuroendocrine cell lineage, whereas all 24 basaloid and both 2 lymphoepithelioma-like carcinomas showed squamous cell markers. Eighteen out of 22 clear cell carcinomas had glandular differentiation, with KRAS mutations being present in 39 % of cases, whereas squamous cell differentiation was present in four cases. Eighteen out of 20 large cell carcinomas, not otherwise specified, had glandular differentiation upon immunohistochemistry, with an exon 21 L858R EGFR mutation in one (5 %) tumor, an exon 2 KRAS mutation in eight (40 %) tumors, and an ALK translocation in one (5 %) tumor, whereas two tumors positive for CK7 and CK5/6 and negative for all other markers were considered adenocarcinoma. All six LCC of rhabdoid type expressed TTF-1 and/or CK7, three of which also harbored KRAS mutations. When positive and negative immunohistochemical staining for these markers was combined, three subsets of LCC emerged exhibiting glandular, squamous, and neuroendocrine differentiation. Molecular alterations were restricted to tumors classified as adenocarcinoma. Stratifying LCC into specific categories using immunohistochemistry and molecular analysis may significantly impact on the choice of therapy.

2014 - Osteomielite ed osteonecrosi della parete toracica anteriore con radiodermite consensuale: risultati di due casi trattati con parietectomia toracica anteriore e ricostruzione della parete con lembo peduncolato di grande omento. [Abstract in Atti di Convegno]
Nesci, Jessica; Pignatti, Marco; Stefani, Alessandro; Loschi, Pietro; Deruvo, Nicola; DE SANTIS, Giorgio; Morandi, Uliano
abstract

Una complicanza relativamente rara, ma debilitante descritta nelle pazienti che hanno subito una mastectomia con successiva radioterapia per neoplasia della mammella può essere la formazione di ulcere radionecrotiche infette della parete toracica. In questi casi, in assenza di recidiva neoplastica l’indicazione terapeutica di scelta è l’asportazione chirurgica di tutti i tessuti infetti con successiva ricostruzione del difetto creato con tessuti altamente vascolarizzati. Presenteremo due casi di pazienti donne, entrambe sottoposte da più di 20 anni a mastectomia radicale destra, successivamente radiotrattate e che hanno entrambe sviluppato un’ ulcera radionecrotica infetta della parete toracica anteriore destra. Le pazienti sono state trattate chirurgicamente dopo il fallimento di medicazioni ripetute e della terapia antibiotica mirata. In entrambi i casi abbiamo eseguito un ampio debridement parietale con rimozione di tutti i tessuti macroscopicamente infetti o necrotici, mantenendo adeguati margini di resezione. In entrambi i casi è stato necessario asportare dalla terza alla sesta cartilagine costale insieme ai relativi spazi inetrcostali e l’emisterno destro nella porzione di corpo compresa tra il secondo e il quinto spazio intercostale. Nel primo caso l’area totale del difetto era di 108 cm2, mentre nel secondo caso era più ampia e misurava 160 cm2. La ricostruzione della parete toracica è stata fatta in tutti e due i casi con un lembo peduncolato di grande omento e il lembo è stato successivamente coperto con un innesto cutaneo prelevato dalla coscia sinistra. Nella prima paziente abbiamo osservato una necrosi post operatoria parziale del lembo che è stata trattata con successo grazie a VAAC (vacuum-assisted closure) therapy e con un successivo nuovo innesto cutaneo. Il decorso post operatorio della seconda paziente è stato privo di complicanze. Le possibilità ricostruttive dei difetti di parete della prete toracica anteriore prevedono l’utilizzo del muscolo grande dorsale, del muscolo retto dell’addome o del grande omento. In questi casi il muscolo grande pettorale e il retto dell’addome non erano utilizzabili a causa del pregresso irradiamento, mentre il gran dorsale non era sufficientemente trofico. Lembi liberi non peduncolati non rappresentano una buona alternativa a causa della insufficiente vascolarizzazione. In letteratura sono presenti pochi casi di ulcere radionecrotiche infette trattate con questa tecnica. La nostra esperienza conferma che l’ampia resezione dell’area di parete toracica patologica, la successiva ricostruzione con un lembo peduncolato di grande omento e la copertura del lembo con un innesto cutaneo rappresenta un trattamento valido delle ulcere radionecrotiche infette della parte toracica anteriore in pazienti precedentemente radiotrattati.

2014 - Un caso inusuale di interstiziopatia polmonare cistica [Abstract in Atti di Convegno]
Aramini, Beatrice; Stefani, Alessandro; Rossi, Giulio; Pecchi, Annarita; Bertolini, Federica; Falasca, Angelo; Morandi, Uliano
abstract

Nel marzo 2011, una donna di 27 anni è stata ricoverata per cefalea persistente. La RMN dell’encefalo mostrava una neoformazione parasagittale destra, eterogenea, con aree emorragiche e compressione del tessuto circostante, compatibile con meningioma. Il radiogramma del torace mostrava una interstiziopatia diffusa reticolonodulare e pneumotorace sinistro. La HRCT evidenziava la presenza di lesioni cistiche bilaterali, diffuse prevalentemente ai lobi inferiori e sottopleuriche, micronoduli peribronchiali e centrolobulari e confermava il pneumotorace, completo a sinistra, soltanto apicale a destra. Le cisti, da pochi millimetri a un centimetro, presentavano pareti sottili e tendenza a confluire. La paziente non riferiva sintomatologia respiratoria. La diagnosi radiologica è stata di interstiziopatia polmonare a componente cistica. Gli esami di laboratorio (compresi test-HIV, ANAtest, immunoelettroforesi) e una TC addome-pelvi sono risultati negativi. La paziente è stata sottoposta ad intervento neurochirurgico di rimozione completa della neoplasia cerebrale in craniotomia. La diagnosi istologica è stata di meningioma benigno (grado I). Dopo tre settimane sono state eseguite biopsie polmonari multiple in videotoracoscopia. L'esame istologico ha mostrato una proliferazione di tipo nodulare e cistico di cellule fusate, con rare mitosi, senza necrosi. All’immunoistochimica queste cellule si presentavano diffusamente positive per vimentina, EMA, CD56 e recettori per estrogeni/progesterone, focalmente positive per S100. In considerazione dell’analogo quadro morfologico e immunoistochimico con la neoplasia cerebrale, è stata posta diagnosi di metastasi polmonari da meningioma. Questa diagnosi è stata ulteriormente avvalorata dai test molecolari. La paziente ha iniziato chemioterapia con idrossiurea, interrotta dopo 12 mesi a causa di progressione della malattia polmonare. Da Giugno 29012 è in terapia con everolimus e da allora la malattia rimane stabile. Le metastasi da meningioma sono rare (0,1 % dei meningiomi) e il polmone è l’organo più colpito. Metastatizzano principalmente i meningiomi maligni (grado II-III), eccezionalmente le forme benigne (circa 20 casi riportati in letteratura). Le metastasi polmonari sono descritte in genere come masse o noduli, più spesso isolate, raramente come lesioni multiple o bilaterali. Questo è il primo caso riportato di presentazione con aspetto microcistico. L’aspetto radiologico poneva la diagnosi differenziale con altre forme di interstiziopatia cistica (linfoangioleiomiomatosi, istiocitosi a cellule di Langherans, neurofibromatosi-1, LIP, collagenopatie), per cui è stata obbligatoria la biopsia polmonare. All’esame istologico l’aspetto morfologico non poteva escludere altre proliferazioni a cellule fusate riscontrabili a livello polmonare, (linfoangioleiomiomatosi, meningoteliomatosi) ma le caratteristiche immunoistochimiche nel contesto clinico di un meningioma cerebrale hanno supportato la diagnosi di metastasi. E’ stata decisiva l’analisi molecolare per la diagnosi di certezza.

2014 - Utilità della FDG-PET/TC nella diagnosi dei carcinoidi polmonari [Abstract in Atti di Convegno]
Stefani, Alessandro; Franceschetto, Antonella; Nesci, Jessica; Aramini, Beatrice; Proli, Chiara; Kaleci, Shaniko; Casolo, Lucia; Massi, Lucia; Casali, Christian; Morandi, Uliano
abstract

Scopo del lavoro I carcinoidi polmonari entrano nella diagnosi differenziale dei noduli polmonari solitari (NPS). I carcinoidi sono tradizionalmente considerati come tumori PET negativi, anche se studi più recenti hanno evidenziato una certa sensibilità della FDG-PET/TC per la diagnosi di queste neoplasie. Lo scopo di questo studio è di determinare l’utilità della PET/TC nella valutazione dei NPS sospetti per carcinoide. Materiali e metodi Si tratta di uno studio retrospettivo eseguito su tutti i pazienti sottoposti ad exeresi chirurgica di carcinoide e precedente FDG-PET/TC dal 2006 al 2012. L’esame PET/TC è stato eseguito con la stessa macchina e la stessa tecnica in tutti i casi. Sono state analizzate le seguenti variabili: età, sesso, aspetti TC (lato, sede, dimensioni, forma, margini), SUVmax, tipo di intervento, aspetti patologici (dimensioni, numero di mitosi). Riguardo alla valutazione PET, è stato considerato soltanto il SUVmax e non la valutazione qualitativa. I carcinoidi sono stati classificati come tipici o atipici e periferici o centrali. E’ stato registrato anche il follow-up a distanza. Il SUVmax è stato confrontato con tutte le altre variabili cliniche, radiologiche e patologiche, al fine di evidenziare eventuali associazioni o differenze. Risultati Sono stati recuperati 25 pazienti. Si è trattato di 24 forme tipiche e un carcinoide atipico, 21 periferici e 4 centrali. Il diametro medio alla TC è stato di 25.3mm e il dato correlava con le dimensioni patologiche. 60% dei tumori avevano forma ovalare e il 68% margini lisci. Il SUVmax medio è stato 3.6 (range 1.4-12.9). Tutte le lesioni sono state asportate in modo radicale. L’analisi di regressione lineare ha evidenziato una associazione diretta tra il SUVmax e le dimensioni (p=0.004), mentre nessun’altra correlazione è stata ritrovata tra il SUVmax e le altre variabili. Nessun paziente ha presentato recidiva o è morto durante il follow-up. Conclusioni Questo studio dimostra che la FDG-PET/TC è utile nella valutazione del NPS sospetto per carcinoide. E’ necessario utilizzare il SUVmax e non la valutazione qualitativa e il confronto deve essere eseguito con il resto del polmone e non con la captazione mediastinica, come usualmente nell’interpretazione della captazione FDG. Quando un NPS si presenta con forma ovoidale/rotonda e margini lisci alla TC e mostra una captazione alla FDG-PET superiore a quella del polmone circostante, con un SUVmax>1-1.5, in questo caso è elevato il sospetto di carcinoide. Pertanto, se si può ragionevolmente escludere una lesione benigna, si raccomanda la resezione chirurgica o almeno una biopsia della lesione.

2013 - A standardized technique for lung biopsy in idiopathic interstitial pneumonia. [Abstract in Atti di Convegno]
Aramini, B; Stefani, A; Morandi, U.
abstract

A standardized technique for lung biopsy in idiopathic interstitial pneumonia.

2013 - An unusual case of cystic interstitial lung disease [Articolo su rivista]
Stefani, A.; Rossi, G.; Pecchi, A.; Bertolini, F.; Falasca, A.; Aramini, B.; Morandi, U.
abstract

NON DISPONIBILE

2013 - Characterization of Specific Immune Responses to Different Aspergillus Antigens during the Course of Invasive Aspergillosis in Hematologic Patients [Articolo su rivista]
Potenza, Leonardo; Vallerini, Daniela; Barozzi, Patrizia; Riva, Giovanni; Forghieri, Fabio; Beauvais, Anne; Beau, Remi; Candoni, Anna; Maertens, Johan; Rossi, Giulio; Morselli, Monica; Zanetti, Eleonora; Quadrelli, Chiara; Codeluppi, Mauro; Guaraldi, Giovanni; Pagano, Livio; Caira, Morena; DEL GIOVANE, Cinzia; Maccaferri, Monica; Stefani, Alessandro; Morandi, Uliano; Tazzioli, Giovanni; Girardis, Massimo; Delia, Mario; Specchia, Giorgina; Longo, Giuseppe; Marasca, Roberto; Narni, Franco; Merli, Francesco; Imovilli, Annalisa; Apolone, Giovanni; Carvalho, Agostinho; Comoli, Patrizia; Romani, Luigina; Latgè, Jean Paul; Luppi, Mario
abstract

Several studies in mouse model of invasive aspergillosis (IA) and in healthy donors have shown that different Aspergillus antigens may stimulate different adaptive immune responses. However, the occurrence of Aspergillus-specific T cells have not yet been reported in patients with the disease. In patients with IA, we have investigated during the infection: a) whether and how specific T-cell responses to different Aspergillus antigens occur and develop; b) which antigens elicit the highest frequencies of protective immune responses and, c) whether such protective T cells could be expanded ex-vivo. Forty hematologic patients have been studied, including 22 patients with IA and 18 controls. Specific T cells producing IL-10, IFN-γ, IL-4 and IL-17A have been characterized through enzyme linked immunospot and cytokine secretion assays on 88 peripheral blood (PB) samples, by using the following recombinant antigens: GEL1p, CRF1p, PEP1p, SOD1p, α1-3glucan, β1-3glucan, galactomannan. Specific T cells were expanded through short term culture. Aspergillus-specific T cells producing non-protective interleukin-10 (IL-10) and protective interferon-gamma (IFN-γ) have been detected to all the antigens only in IA patients. Lower numbers of specific T cells producing IL-4 and IL-17A have also been shown. Protective T cells targeted predominantly Aspergillus cell wall antigens, tended to increase during the IA course and to be associated with a better clinical outcome. Aspergillus-specific T cells could be successfully generated from the PB of 8 out of 8 patients with IA and included cytotoxic subsets able to lyse Aspergillus hyphae. Aspergillus specific T-cell responses contribute to the clearance of the pathogen in immunosuppressed patients with IA and Aspergillus cell wall antigens are those mainly targeted by protective immune responses. Cytotoxic specific T cells can be expanded from immunosuppressed patients even during the infection by using the above mentioned antigens. These findings may be exploited for immunotherapeutic purposes in patients with IA. © 2013 Potenza et al.

2013 - Identification of malignant pleural effusions (mpes) by tumor markers: a national multi-center trial. [Abstract in Rivista]
S., Elia; Morandi, Uliano; A., Vetrani; S., Griffo; R., Massoud; S., Iona; Stefani, Alessandro; A., Pierantozzi; F., Pacelli; A., Destefano; G., Petrella
abstract

l'abstract descrive i risultati definitivi del progetto PRIN 20083YAR35, in cui gli autori hanno studiato la presenza di markers all'interno del liquido pleurico predittivi di versamento pleurico neoplastico.

2013 - Integrated FDG-PET/CT imaging is useful in the apporach to carcinoid tumors of the lung [Articolo su rivista]
Stefani, Alessandro; Franceschetto, Antonella; Nesci, Jessica; Aramini, Beatrice; Proli, Chiara; Kaleci, Shaniko; Casolo, Alessandra; Massi, Lucia; Casali, Christian; Morandi, Uliano
abstract

Background. Carcinoids enter the differential diagnosis of the solitary pulmonary nodule. Bronchial carcinoids have been traditionally considered as FDG-PET negative but recent studies have found an higher sensitivity of integrated FDG-PET/CT for the detection of these neoplasms. The purpose of this study was to investigate the value of integrated FDG-PET/CT for the evaluation of SPN suspected to be carcinoids. Methods. All patients with pathologically proven bronchial carcinoids who had FDG-PET/CT scans between 2006 and 2012 have been retrospectively reviewed. PET/CT was performed with the same scanner and the same technique for all patients. The following data were retrieved: age, sex CT findings (side, location, size, shape, margins), SUVmax, type of operation, pathological findings (size and number of mitoses). Regarding PET findings, only SUVmax was considered, whereas the visual assessment was not undertaken. Carcinoids were defined as typical and atypical and as central and peripheral. The long-term follow-up was also recorded. The SUVmax was compared with the other clinical, radiological and pathological variables to find any significant difference or correlation. Results. Twenty-five patients were retrieved, 24 typical and one atypical carcinoid, 21 peripheral and 4 central lesions. The mean diameter on CT-scan was 25.3mm and the clinical size correlated well with the pathological size. Fifty-six percent of the tumors were ovoid and 68% had smooth margins. The mean SUVmax was 3.6 (range 1.4-12.9). All the lesions were completely resected. The regression analysis showed a direct correlation between the SUVmax and the tumor size (p=0.004). No further correlations were found between the SUVmax and the other variables. None of the patients had recurrent disease or died during the follow-up. Conclusions. Our study showed that FDG-PET/CT might be a useful tool in the evaluation of SPNs suspected to be bronchial carcinoids. When a solitary pulmonary nodule shows an ovoid/round shape and smooth margins on the CT scan and demonstrates an FDG uptake higher than that of the normal lung and with a SUVmax value >1-1.5, a carcinoid should be suspected. If benign lesions can be presumably excluded, surgical resection or at least a biopsy of the lesion is recommended.

2013 - La metodica STRATOS nella correzione del pectus excavatum: esperienza in due casi trattati. [Abstract in Atti di Convegno]
Nesci, J.; Stefani, Alessandro; B., Aramini; Morandi, Uliano
abstract

Gli autori riportano la loro esperienza su due casi di pectus excavatum trattati con la nuova metodica con barre metalliche fissate alle coste e allo sterno proposta dalla STRATOS.

2013 - Preoperative predictors of a successful surgical treatment in the management of parapneumonic empyema [Articolo su rivista]
Stefani, Alessandro; Aramini, B.; Dellacasa, G.; Ligabue, Guido; Kaleci, Shaniko; Casali, C.; Morandi, Uliano
abstract

Background: Video-assisted thoracoscopic surgery (VATS) and thoracotomy are the main surgical options for treating parapneumonic empyema. The choice of either operation depends on many preoperative features, including the patient's condition, clinical and radiologic findings, and pleural fluid characteristics. The identification of the combination of those preoperative findings that will allow surgeons to select the appropriate approach for a successful operation (VATS or thoracotomy) could be of great interest in clinical settings. Methods: We retrospectively reviewed a series of 97 patients who had undergone successful VATS or thoracotomy for parapneumonic empyema; in all cases, the operation had begun through VATS and was changed to a thoracotomy if a complete decortication was needed. Preoperative clinical, radiologic, and laboratory features were compared between the two groups to search for differences that might serve as predictive factors for either operation. Perioperative findings were also analyzed. Results: The operation was accomplished by VATS in 40 patients (41%), and conversion to thoracotomy was necessary in 57 (59%). Significant predictive factors for conversion were a prolonged delay from diagnosis to operation, the presence of fever and of pleural thickness on computed tomography (CT) images. The 25 patients who presented with these three features were cured by thoracotomy. The operative time and postoperative complication rate were significantly higher for the thoracotomy patients. Conclusions: Some preoperative features can help the surgeon to better select patients for the appropriate operation. Delayed operation, fever, and pleural thickness can be used to predict the likelihood of conversion to thoracotomy. © 2013 The Society of Thoracic Surgeons.

2013 - Role of blebs and bullae detected by high-resolution computed tomography and recurrent spontaneous pneumothorax. [Articolo su rivista]
Casali, C.; Stefani, Alessandro; Ligabue, Guido; P., Natali; B., Aramini; Torricelli, Pietro; Morandi, Uliano
abstract

Background: The prevention of recurrence after a first episode of primary spontaneous pneumothorax (PSP) remains a debated issue. The likelihood of recurrence based on the presence of blebs and bullae detected on high-resolution computed tomography (HRCT) imaging is controversial. Methods: We evaluated patients conservatively treated for PSP who underwent chest HRCT scan in a single-institution retrospective longitudinal study. Absolute risk values and positive and negative predictive values of recurrence based on HRCT findings were the primary end points. Results: We analyzed 176 patients. Ipsilateral and contralateral recurrence developed in 44.8% and 12% of patients, respectively. The risk of recurrence was significantly related to the presence of blebs or bullae, or both, at HRCT. The risk of ipsilateral recurrence for patients with or without blebs and bullae was 68.1% and 6,1%, respectively (positive predictive value, 68.1%; negative predictive value, 93,9%). The risk of contralateral pneumothorax for patients with or without blebs and bullae was 19% and 0%, respectively (positive predictive value, 19%; negative predictive value, 100%). The risk of ipsilateral recurrence was directly related to the dystrophic severity score: recurrence risk increased by up to 75% in patients with bilateral multiple lesions. Multivariate analysis showed that a positive HRCT was significantly related to ipsilateral recurrence. Conclusions: The presence of blebs and bullae at HRCT after a first episode of PSP is significantly related to the development of an ipsilateral recurrence or a contralateral episode of pneumothorax. Further studies are needed to validate the dystrophic severity score in the selection of patients for early surgical referral. © 2013 The Society of Thoracic Surgeons.

2013 - STRATOS system for the repair of pectus excavatum [Articolo su rivista]
Stefani, Alessandro; J., Nesci; Morandi, Uliano
abstract

Open techniques represent a valid repair option for severe asymmetric pectus excavatum in adults. The use of metal supports is recommended to reduce the risk of recurrence. A wide variety of metal supports have been proposed, with pre-, trans- or retrosternal fixation. A novel open technique using titanium bars fixed to the ribs with clips has been recently introduced (STRATOS™ system) for chest wall reconstruction, rib fracture fixation and chest wall malformation repair. We employed this technique in two adult patients with severe asymmetric pectus excavatum: after sternal mobilization, one bar is passed below the body of the sternum and secured with clips bilaterally to two ribs. In the first case, the results remained excellent 5 years after surgery. In the second case, the initial results were satisfying but the bar ruptured after 30 months: removal of the bars and clips was performed and a subsequent recurrence of the deformity occurred. The experiences reported in literature are still too limited to draw firm conclusions about the use of the STRATOS™ system in pectus excavatum repair, but it seems that the use of two bars may reduce the risk of rupture. At present, we are the only ones who reported long-term results.

2013 - Una metodica standardizzata di biopsia polmonare per la diagnosi di polmonite interstiziale idiopatica. [Abstract in Atti di Convegno]
Aramini, B; Stefani, A; Nesci, J; Morandi, U.
abstract

Una metodica standardizzata di biopsia polmonare per la diagnosi di polmonite interstiziale idiopatica.

2013 - Una metodica standardizzata di biopsia polmonare (SLB) per la diagnosi di polmonite interstiziale idiopatica. [Abstract in Atti di Convegno]
Aramini, B.; Stefani, Alessandro; Nesci, J.; Pedrazzi, M.; Morandi, Uliano
abstract

Gli Autori descrivono una tecnica standardizzata, rapida, semplice ed efficace per eseguire la biopsia polmonare chirurgica in videotoracoscopia nei pazienti affetti da polmonite interstiziale idiopatica.

2012 - Idiopathic pulmonary fibrosis: diagnostic pitfalls and therapeutic challenges. [Articolo su rivista]
Spagnolo, Paolo; Tonelli, Roberto; Cocconcelli, E; Stefani, Alessandro; Richeldi, Luca
abstract

Idiopathic pulmonary fibrosis (IPF), the most common of the idiopathic interstitial pneumonias, is a devastating condition that carries a prognosis worse than that of many cancers. As such, it represents one of the most challenging disease for chest physicians. The diagnostic process is complex and relies on the clinician integrating clinical, laboratory, radiologic, and/or pathologic data. Therefore, a close collaboration between chest physicians, radiologists, and pathologists experienced in the diagnosis of interstitial lung diseases (ILDs) is necessary in order to minimize diagnostic uncertainty. Similarly, the management of IPF continues to pose major difficulties. However, while there are no proven effective therapies for IPF beyond lung transplantation, recent trials of novel agents suggest that pharmacological treatment may retard the progression of the disease. In this regard, enrolment of patients into clinical trials is considered the "best current practice"by the most recent guidelines as it offers IPF patients the chance to receive new agents that may be more effective than current therapies. A more recent trend focusing on improving quality of life in IPF patients has also been gaining ground.The diagnosis and management of IPF remains a constant challenge for even the most experienced of clinicians. However, a multidisciplinary approach to this complex disease is steadily improving diagnostic accuracy, while recent advances in the pharmacological therapy offer the genuine promise of future treatments for this devastating disease.

2012 - Resezione atipica versus lobectomia nel trattamento chirurgico del NSCLC T1AN0. [Abstract in Atti di Convegno]
Stefani, Alessandro; Nesci, J; Casali, C; Morandi, Uliano
abstract

nd

2012 - Thoracoscopic pleural abrasion [Capitolo/Saggio]
Morandi, Uliano; Stefani, Alessandro; Casali, C.
abstract

Pleural abrasion represents a surgical technique to achieve pleural symphysis in order to prevent recurrence in spontaneous pneumothorax. It can be performed either by thoracotomy or VATS. Pleural abrasion is obtained by scrubbing the parietal pleura until a uniform aspect of bloody pleura is achieved. Various tools can be used for this purpose, such as meshes, gauzes, sponges, the electro-surgical tip cleaner or pleural abraders especially fit for VATS. The recurrence rate of pneumothorax after pleural abrasion vary from 0% to 10%, according the type of surgical approach, with thoracotomy having the lowest rate of recurrences but the drawbacks of a more invasive approach. Considering the balance between effectiveness and risks, pleural abrasion performed by VATS is considered today as the procedure of choice for the treatment of spontaneous pneumothorax.

2012 - Wedge resection versus lobectomy for T1aN0 non-small-cell lung cancer. [Articolo su rivista]
Stefani, Alessandro; Casali, C; Nesci, J; Morandi, Uliano
abstract

ABSTRACT Objective Advances in imaging techniques and screening protocols can detect more small lung cancers. Controversy exists regarding surgical management of these small tumors. Methods. Records and long-term outcome of all patients with T1N0 (≤ 2cm) non-small cell lung cancer undergoing wedge resection with curative intent from 1996 through 2010 were retrospectively reviewed. Those patients were compared with a group of patients treated with lobectomy during the same period and for a disease at the same stage. Sublobar resections were performed in compromised patients in all cases. Results. The study included 206 patients: 82 received wedge resection, 124 lobectomy. Morbidity and mortality were similar between the two groups. Locoregional recurrence rate was significantly higher for wedge resection compared with lobectomy (22% versus 8% respectively), cancer-specific survival and disease-free survival were significantly poorer for wedge resection with respect to lobectomy: 5-year survival of 74% versus 85% respectively, 5-year disease-free survival of 62% versus 77%. The type of operation resulted as an independent prognostic factor of cancer-specific survival. Conclusions. We found poorer outcome for wedge resection compared to lobectomy. We believe that caution should be used when suggesting the use of wedge resection as intentional limited resection for patients with small non-small cell lung cancer who may otherwise tolerate lobectomy. Two randomized trials comparing limited resection and lobectomy are ongoing in Japan and in United States: they will better clarify the role of limited resection, especially segmentectomy, in the treatment of T1aN0 tumors. Wedge resection may remain a valid option for compromised patients.

2011 - N1 non-small-cell lung cancer. A 20-year surgical experience. [Articolo su rivista]
C., Casali; Stefani, Alessandro; Morandi, Uliano
abstract

N1 non-small-cell lung cancer has heterogeneous prognosis in relation to node descriptors. There is no agreement on the ideal type of resection. A new classification of N1 descriptors was proposed in the 7(th) edition of the TNM staging system. A retrospective study was conducted on 384 patients with T1-T3N1 non-small-cell lung cancer who underwent complete pulmonary resection. The prognostic role of N1 descriptors according to the current and new staging systems and type of resection was investigated. The 5-year survival rate was 46\%. Involvement of hilar node stations, multiple stations, and multiple nodes were poor prognostic factors (5-year survival, 33\%, 21\%, and 30\%, respectively), as well as involvement of the hilar zone and multiple zones (5-year survival, 27\% and 23\%, respectively). Pneumonectomy showed significantly better survival rates compared to lobectomy or bilobectomy (5-year survival, 60\% vs. 29\%). Multivariate analysis showed that the number of N1 zones and type of resection were independent prognostic factors. Patients with hilar nodal, multiple-level, or multiple-zone involvement had poor prognosis. Standard lobectomy remains the procedure of choice, but in cases of fixed nodes in the hilar zone, sleeve resection or even pneumonectomy should be considered.

2011 - Role of blebs and/or bullae detected by High Resolution Computed Tomography (HRCT) in predicting recurrence after a first episode of primary spontaneous pneumothorax. [Abstract in Atti di Convegno]
Aramini, B; Casali, C; Stefani, A; Natali, P; Ligabue, G.; Torricelli, P. and Morandi U.
abstract

Role of blebs and/or bullae detected by High Resolution Computed Tomography (HRCT) in predicting recurrence after a first episode of primary spontaneous pneumothorax.

2011 - Thoracoplasty in the Current Practice of Thoracic Surgery: A Single-Institution 10-Year Experience [Articolo su rivista]
Stefani, Alessandro; R., Jouni; M., Alifano; A., Bobbio; S., Strano; P., Magdeleinat; Regnard, J. F.
abstract

Background We retrospectively reviewed our recent experience with thoracoplasty to define its role in the context of current surgical practice. Methods Twenty-six patients underwent thoracoplasty in the last 10 years with the aim of obliterating a residual pleural space or pulmonary cavity. Twenty-one patients had a postresectional empyema, 3 had a primary empyema and 2 had a cavernostomy performed for a pulmonary aspergilloma. A bronchopleural fistula was present in 10 cases. Infection had been previously controlled in all cases by intercostal drainage, open-window thoracostomy, or cavernostomy (in 4, 20, and 2 patients, respectively). Twenty-two extramuscoloperiosteal thoracoplasties, 3 thoracomyoplasties, and 1 Andrews thoracoplasty were performed. Intrathoracic flap transposition followed thoracoplasty in 9 cases; a second step of the Clagett procedure followed thoracoplasty in 2 cases. Results One patient died postoperatively (3.8%). Thoracoplasty alone (n = 6) or combined with a procedure to fill the residual space (n = 14) was successful in achieving complete obliteration of the residual space in 77% of patients (n = 20). In 4 patients thoracoplasty alone reduced the residual cavity but filling procedures were not feasible. In 1 patient thoracoplasty failed to obliterate the cavity and infection recurred. Three patients experienced chronic thoracic sequelae. Conclusions Thoracoplasty remains an option for the treatment of residual pleural or pulmonary spaces (with or without bronchopleural fistula) once infection has been controlled, when other more conservative procedures are not effective or feasible. In our experience it was effective both when used alone in favorable conditions and when combined with other procedures to fill the residual cavity. © 2011 The Society of Thoracic Surgeons

2010 - Analysis of prognostic factors in surgically resected N1 non small cell lung cancer [Abstract in Rivista]
Di Prima, E; Iacuzio, L; Casali, C; Stefani, Alessandro; Morandi, Uliano
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2010 - Le role de la thoracoplastie dans la chirurgie thoracique moderne, 10 ans d’experience. [Abstract in Atti di Convegno]
Alifano, M; Stefani, Alessandro; Jouni, R; Bobbio, A; Magdeleinat, P; Regnard, Jf
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2010 - Which patients should be operated on after induction chemotherapy for N2 non–small cell lung cancer? Analysis of a 7-year experience in 175 patients [Articolo su rivista]
Stefani, Alessandro; M., Alifano; A., Bobbio; M., Grigoroiu; R., Jouni; P., Magdeleinat; Regnard, J. F.
abstract

Objective: The role of surgery in patients with N2 non–small cell lung cancer is debated. The aim of this studywas to evaluate the results of surgical resection after induction chemotherapy.Methods: We retrospectively reviewed the cases of patients with N2 non–small cell lung cancer who underwentneoadjuvant chemotherapy followed by resection between 2001 and 2007. They all had tumors deemed resectable.Results: One hundred seventy-five patients entered the study. Most of them received 2 or 3 cycles of chemotherapy(81%), in all cases platinum-based regimens. Chemotherapy response rate was 62%. Operations included 96lobectomies/bilobectomies and 79 pneumonectomies. Complete resection rate was 94%, and perioperative mortalitywas 4.5%. A pathologic mediastinal downstaging was found in 39% of patients. Overall median survivaltime and 5-year survival were 34.7 months and 30%, respectively. Survival was affected by clinical response(median survival time 51 months and 5-year survival 42% for responders versus 19 months and 10% for nonresponders)and by nodal downstaging (51 months and 45%versus 25%and 22%). In the group of responders,nondownstaged patients showed satisfying survival (median survival time 30 months, 5-year survival 30%). Inthe group of nonresponders, survival was unsatisfactory when a lobectomy was performed (median survival time20 months, 5-year survival 13%) and poor in case of pneumonectomy (15 months and 6%). Multivariate analysisfound 4 factors significantly affecting survival: clinical response, nodal downstaging, number of chemotherapycycles, and histopathologic response.Conclusions: Surgery after chemotherapy could be effective for selected patients with N2 non–small cell lungcancer. Survival for responders is satisfactory, even in case of persistent N2 disease. Prognosis for nonrespondersis disappointing.

2009 - Quels patients opérer après traitement d’induction pour cancer du poumon N2? [Abstract in Atti di Convegno]
Stefani, Alessandro; Alifano, M; Grigoroiu, M; Bobbio, A; Magdeleinat, P; Regnard, J. F.
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2008 - Surgical treatment of bronchiectasis: early and long-term results. [Articolo su rivista]
R., Giovannetti; M., Alifano; Stefani, Alessandro; A., Legras; M., Grigoroiu; Collet, J. Y.; P., Magdeleinat; Regnard, J. F.
abstract

Management of bronchiectasis remains controversial and information on long-term results of surgical treatment is poor. Clinical records of 45 patients, who underwent surgery for bronchiectasis in an 8-year period, were retrospectively reviewed. Bronchiectasis focus was isolated in 24 cases, associated with a limited homolateral or controlateral focus in 9 and 11, respectively; two patients had bilateral evident foci. Bronchiectasis was responsible for lobe destruction in 23 cases. All patients had symptoms: haemoptysis (n = 7), recurrent pneumonia (n = 7), persistent bronchorrea with recurrent infection (n = 15), hemoptysis and recurrent infection (n = 16). A total of 23 lobectomies, 11 lobectomies+segmentectomies, 2 bi-lobectomies, 9 segmentectomies and 1 pneumonectomy were carried out. There were no perioperative deaths; complications occurred in 5 patients (postoperative pneumonia in 2, prolonged air-leak, residual air-space and bronchial infection 1 each). Symptoms disappeared in 32 patients, 10 patients experienced a significant improvement. Exercise tolerance remained stable or improved in 33 and 2 cases, respectively, a slight impairment was observed in 9. Out of 32 evaluable patients 11 had an unchanged FEV 1, 15 had a limited FEV lowering (<15%), and 9 had a more important functional loss. Surgical treatment of bronchiectasis obtains satisfactory long-term results, with acceptable morbidity rates.

2007 - La chirurgia toracica a Modena. 30 anni di esperienze vissute e di risultati conseguiti [Articolo su rivista]
Morandi, U; Fontana, G; Lavini, C; Ruggiero, Ciro; Stefani, A; Casali, C; Natali, P; Brandi, L; Chiapponi, A; Lodi, R.
abstract

L'articolo riporta i risultati conseguiti in 30 anni di attività della clinica di chirurgia toracica di modena

2007 - LE INDICAZIONI AL TRATTAMENTO CHIRURGICO DELLE METASTASI POLMONARI. [Capitolo/Saggio]
Stefani, Alessandro
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2007 - Le metastasi polmonari: diagnosi e terapia [Monografia/Trattato scientifico]
Morandi, Uliano; Stefani, Alessandro
abstract

Non disponibile

2007 - Primary intrapulmonary thymoma associated with congenital hyperhomocysteinemia. [Articolo su rivista]
Stefani, Alessandro; E., Boulenger; S., Mehaut; A., Ciupea; M., Alifano
abstract

Primary intrapulmonary thymomas (PITs) are very uncommon,with 28 cases reported to date.1-3 Because ofthe paucity of studies, the biologic behavior and pathologicfeatures of these neoplasms are not well known.The C677T methylenetetrahydrofolate reductase (MTHFR) genotypeis a congenital disorder leading to low folate levels; theresultant mild hyperhomocysteinemia is associated with increasedrisk of venous thromboembolism and malignancies.4,5We present a case of PIT associated with hyperhomocysteinemiacaused by the C677T variant of MTHFR.

2007 - Reply to Margaritora et al [Articolo su rivista]
Stefani, Alessandro; Natali, P; Casali, C; Morandi, Uliano
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2007 - Reply to molnar and rami-porta [Articolo su rivista]
Stefani, Alessandro; P., Natali; C., Casali; Morandi, Uliano
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2007 - Toracotomia: quando e perché. [Capitolo/Saggio]
Stefani, Alessandro; Morandi, Uliano
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2006 - A therapeutical protocol for postoperative pain relief in thoracic surgery. [Abstract in Rivista]
Stefani, Alessandro; Casali, C; Morandi, Uliano
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2006 - Attivazione di un percorso diagnostico-stadiativo accelerato per neoplasia polmonare al Policlinico di Modena. [Articolo su rivista]
Callegaro, A; Campagna, A; Pieroni, G; Morandi, Uliano; Casali, C; Stefani, Alessandro; Bortolotti, M.
abstract

Dal Novembre 2001 la DS dell'AO Policlinico di Modena, in collaborazione con la struttura complessa di Chirurgia Toracica e il DH della SC di Malattie dell'apparato Respiratorio, ha iniziato la sperimentazione di un percorso diagnostico finalizzato a accelerare i tempi di stadiazione delle neoplasie polmonari, al fine di trattare chirurgicamente i pazienti operabili entro 30 giorni dalla diagnosi, riducendo il periodo di degenza pre-operatoria. L'attivazione di tale percorso parte dal presupposto che un adeguato studio diagnostico-stadiativo della neoplasia e una scrupolosa valutazione funzionale del paziente sono le condizioni indispensabili per una corretta indicazione chirurgica e per una buona riuscita dell'intervento chirurgico, sia in termini di risultati a breve che a lungo termine. Il paziente che giungeva all'attenzione degli specialisti del Policlinico inviato dai medici del territorio in modo differenziato e con una certa disomogeneità anche nell'invio da parte dei medici interni, ora viene preso in carico dalla SC di Pneumologia mediante un percorso diagnostico pre-operatorio per neoplasia polmonare. L'introduzione del nuovo percorso diagnostico preoperatorio per pazienti candidabili ad exeresi chirurgica per cancro polmonare , anche attraverso l'importante contributo fornito dall'approccio multidisciplinare, ha portato ad un miglioramento sia in termini gestionali (degenze medie e tempi di attesa) che qulitativi dell'attività chirurgica (diminuzione toracotomie esplorative). Attraverso tale iter al paziente viene garantito un trattamento chirurgico in linea con gli standard internazionali nel quadro di un'ottimizzazione della gestione aziendale.

2006 - Prognostic factors and survival after resection of lung metastases from epithelial tumours. [Articolo su rivista]
C., Casali; Stefani, Alessandro; E., Storelli; Morandi, Uliano
abstract

Lung metastasectomy is an accepted treatment for selected patients with pulmonary metastases. Resectability, disease-free interval and number of metastases are well characterised prognostic indicators after lung metastasectomy. Patients treated with lung metastasectomy for epithelial tumours were retrospectively reviewed. One hundred and forty-two patients were reviewed. The rate of mediastinal node metastases was 12\%. Overall 5-year survival rate was 36\% with a median survival time of 47 months. Recurrence rate after lung metastasectomy was 50\%. Five-year disease-free survival was 26\% with a median of 29 months. Mediastinal nodal status negatively affected survival at univariate analysis (5-years 32\% for N+ and 40\% for N-, P=0.013). Disease-free survival was significantly different according to nodal status: 5-year disease-free survival 17 and 28\% for N+ and N-, respectively (P=0.053). Systemic recurrences were more frequent in patients with nodal involvement (P=0.058). Mediastinal nodal involvement resulted in a significant prognostic factor at multivariate analysis (N+: RRD=3.0; 95\% CI 1.3-6.7). Patients with pulmonary metastases and nodal involvement had a poor prognosis and relapsed early after pulmonary metastasectomy. Nodal status should be considered in the selection of patients for lung metastasectomy.

2006 - Résultats du talcage pleural au cours des pleurésies néoplasiques. [Poster]
Stefani, Alessandro; Natali, P; Casali, C; Morandi, Uliano
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2006 - Simpaticectomia toracoscopica [Capitolo/Saggio]
Stefani, Alessandro; Morandi, Uliano
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2006 - Talc poudrage versus talc slurry in the treatment of malignant pleural effusion. A prospective comparative study [Articolo su rivista]
Stefani, Alessandro; Natali, P; Casali, C; Morandi, Uliano
abstract

Objective: The aim of this study was to investigate the effectiveness, safety and appropriate mode of administration of intrapleural talc for pleurodesis, in the treatment of malignant pleural. effusion (MPE). Methods: Prospective not randomized trial was conducted to compare thoracoscopic talc poudrage (TP) with tube thoracostomy and talc slurry (TS) for the local control of malignant pleural. effusion. Both procedures were previously standardized; 6 g of talc was administered for each procedure. Only the patients with lung re-expansion after drainage entered the study. Patients at high risk for general anaesthesia, poor general conditions and short life-expectancy received talc slurry through a chest tube, at the bedside. All. the other patients underwent videothoracoscopic talc poudrage, with a pneumatic atomizer, under general anaesthesia. Morbidity, 30-day freedom from recurrence and long-term results were assessed and the two groups were compared. Results: One hundred and nine patients entered the study (72 TP, 37 TS). Sixty-three patients in the TP group (87.5%) and 27 in the TS group (73%) had an immediate successful pleurodesis (p = 0.049); 53 patients (88.3%) and 16 patients (69.6%) had a successful pleurodesis 90 days after the procedure; 59 patients (81.9%) and 23 patients (62.2%), respectively, had a life-long pleural symphysis (p = 0.023). Adverse effects were generally mild: chest pain (36.1% in TP patients, 48.6% in TS patients) and fever (38.8% and 35.1%, respectively) were the more common but the difference was not significant between the two groups. We observed neither acute respiratory failure nor mortality due to the procedure. Conclusions: Our study confirms that intrapleural talc carries good results in the treatment of malignant pleural effusion. TP was significantly more effective than TS; both methods were safe but TS had a higher incidence of thoracic pain during the procedure. Talc pleurodesis should be offered to every patient with MPE, apart from terminally ill. ones, provided that a satisfying lung re-expansion has been achieved. TP should be performed whenever possible; otherwise, a slurry bedside procedure will be worthwhile, even in patients with low performance status (PS), though poorer results have to be expected. A careful selection is essential to define the proper technique. (c) 2006 Elsevier B.V. All. rights reserved.

2006 - Talc poudrage versus talc slurry in the treatment of malignant pleural effusion: a prospective trial [Abstract in Rivista]
Natali, P; Stefani, Alessandro; Casali, C; Morandi, Uliano
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2006 - VERSAMENTI PLEURICI [Capitolo/Saggio]
Stefani, Alessandro
abstract

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2005 - Il pneumotorace spontaneo dalla genetica al trattamento chirurgico [Monografia/Trattato scientifico]
Morandi, Uliano; Stefani, Alessandro
abstract

Non disponibile

2005 - Il trattamento chirurgico del cancro del polmone non a piccole cellule infiltrante la parete toracica [Abstract in Atti di Convegno]
Stefani, Alessandro; Casali, C; Morandi, Uliano
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2005 - Il trattamento dell'empiema pleurico metapneumonico in videotoracoscopia [Abstract in Rivista]
Stefani, Alessandro; Casali, C; Natali, P; Ruggiero, C; Lavini, C; Morandi, Uliano
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2005 - LA CHIRURGIA A CIELO APERTO NEL TRATTAMENTO DEL PNEUMOTORACE SPONTANEO PRIMITIVO E SECONDARIO. [Capitolo/Saggio]
Fontana, G; Stefani, Alessandro; Natali, P.
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2005 - Le indicazioni al trattamento chirurgico del pneumotorace spontaneo. [Capitolo/Saggio]
Stefani, Alessandro; Morandi, Uliano
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2005 - L'importanza della diagnosi precoce nel trattamento chirurgico delle neoplasie polmonari primitive metacrone [Abstract in Rivista]
Pirondini, E; Casali, C; Stefani, Alessandro; Morandi, Uliano
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2005 - Prognostic factors in surgically resected N2 non-small cell lung cancer: the importance of patterns of mediastinal lymph nodes metastases. [Articolo su rivista]
C., Casali; Stefani, Alessandro; P., Natali; G., Rossi; Morandi, Uliano
abstract

Patients with non-small cell lung cancer (NSCLC) with metastases to ipsilateral mediastinal lymph nodes (N2) are an heterogeneous group of patients as regard to prognosis and treatment. Indication and timing of surgery remain controversial. The present study investigates the prognostic factors, in order to identify homogenous subgroups of patients.Histologically proven N2-NSCLC patients, who underwent a complete surgical resection were retrospectively reviewed. Clinical and pathological features were reported and analyzed, and survival study was performed.One hundred eighty-three patients were analyzed. Overall 1.3 and 5 years survival rates were, respectively, 70, 35 and 20\%, with a median survival time of 24 months. Univariate analysis showed a significant better prognosis for: incidental N2 respect to clinical N2 (5-years 35.4 vs 17.4\%); single level lymph node involvement respect to multiple levels (5-years 23.8 vs 14.7\%); metastases to superior mediastinal or aortic nodes respect to lower mediastinal nodes (5-years 32 and 24.3 vs 16.3\%); right upper lobe tumors with superior mediastinal nodes and left upper lobe tumors with aortic nodes respect to lower lobes tumors with lower mediastinal nodes (5-years 31.8 and 26.9 vs 15.7\%). Skip metastases had not a significant survival advantage respect to continuous lymphatic spread. N2 clinical status, the number of levels involved and the two specific patterns of lymphatic spread resulted significant prognostic factors at multivariate analysis.Clinical N2 status, number of lymph nodes levels involved and specific patterns of lymphatic spread identify homogenous subgroups of patients that can be proposed for different therapeutic strategies.

2004 - Il ruolo prognostico dell'espressione recettoriale estrogenica nella metastasectomia polmonare da carcinoma mammario [Abstract in Rivista]
Casali, C; Stefani, Alessandro; Natali, P; Pirondini, E; Parise, A; Morandi, Uliano
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2004 - La simpaticectomia toracica in videotoracoscopia: una tecnica efficace e mini-invasiva per il trattamento dell'iperidrosi palmare [Abstract in Rivista]
Natali, P; Stefani, Alessandro; Casali, C; Parise, A; Pirondini, E; Morandi, Uliano
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2004 - Mediastinoscopy: past, present and future [Relazione in Atti di Convegno]
Morandi, Uliano; Stefani, Alessandro; Casali, C.
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2004 - Metodiche mini-invasive nella stadiazione linfonodale del cancro del polmone. Il punto di vista del chirurgo [Capitolo/Saggio]
Morandi, Uliano; Stefani, Alessandro; Lavini, C; Casali, C.
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2004 - Risultati nel trattamento delle metastasi polmonari da neoplasia della mammella. [Capitolo/Saggio]
Stefani, Alessandro; Casali, C; Pirondini, E; Morandi, Uliano
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2004 - The prognostic role of c-kit protein expression in resected large cell neuroendocrine carcinoma of the lung. [Articolo su rivista]
C., Casali; Stefani, Alessandro; G., Rossi; Migaldi, Mario; S., Bettelli; A., Parise; Morandi, Uliano
abstract

Large cell neuroendocrine carcinoma (LCNEC) is a high-grade neuroendocrine tumor of the lung that shares some clinicopathologic and molecular features with small cell lung carcinoma (SCLC). Optimal treatment has not yet been standardized and significant prognostic factors are lacking. Because c-kit protein overexpression has been recently reported as a negative prognostic factor in SCLC we investigated its expression and prognostic value in a series of LCNEC.Resected LCNEC fulfilling the morphologic criteria of the 1999 World Health Organization classification of lung tumors and showing neuroendocrine differentiation by appropriate immunohistochemical markers were retrospectively reviewed. Immunostaining for c-kit protein expression was performed using the polyclonal antibody CD117. Clinical and pathologic characteristic were reported and analyzed and a survival study was performed.Thirty-three patients underwent radical resection. Thirty-one were male (94\%) and 32 were smokers (97\%). Ten (30.3\%), 11 (33.3\%), 5 (15.2\%), and 7 (21.2\%) were at stage IA, IB, IIB, and IIIA respectively. Overall 1-, 3-, and 5-year survival rates were respectively 79\%, 58\%, and 51\%. Survival analysis showed no differences for any of the clinicopathological features except for CD117 immunostaining: 1-year and 3-year survival rates were respectively 91\% and 82\% for CD117-negative LCNEC, and 72\% and 44\% for CD117-positive ones (p = 0.046). Positivity of CD117 was significantly related to recurrence rate: 60\% versus 23\% for CD117 positive and negative LCNEC respectively (p = 0.037).Radical resection of large cell neuroendocrine carcinoma achieves poor outcomes. The c-kit protein is frequently expressed in this neoplasia and its expression represents a negative prognostic factor. This immunohistochemical marker may represent the basic rationale to select LCNEC for novel targeted therapy.

2003 - Die prognostiche rolle der protein c-kit expression bei operierten grosszelligen neuroendokrin karzinomen [Relazione in Atti di Convegno]
Stefani, Alessandro; Casali, C; Parise, A; Lavini, C; Morandi, Uliano
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2003 - Il cancro del polmone con versamento pleurico consensuale. L’importanza della videotoracoscopia come indagine preliminare del tempo exeretico [Capitolo/Saggio]
Lavini, C; Ruggiero, C; Natali, P; Stefani, Alessandro; Morandi, Uliano
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2003 - Il nodulo polmonare solitario. Minitoracotomia o VATS? Contributo casistico. [Abstract in Atti di Convegno]
Lavini, C; Ruggiero, C; Stefani, Alessandro; Pirondini, E; Morandi, Uliano
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2003 - La biopsia polmonare in videotoracoscopia nelle polmoniti interstiziali idiopatiche: una tecnica semplice, sicura ed efficace [Abstract in Atti di Convegno]
Stefani, Alessandro; Fontana, G; Lavini, C; Ruggiero, C; Morandi, Uliano
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2003 - La biopsia polmonare in videotoracoscopia per "diffuse parenchimal lung disease": una tecnica standardizzata, semplice e sicura [Abstract in Rivista]
Stefani, Alessandro; Casali, C; Giovannetti, R; Natali, P; Parise, A; Morandi, Uliano
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2003 - Tubercolosi linfonodale periferica in due pazienti in trattamento emodialitico cronico [Abstract in Rivista]
Olmeda, F; Stipo, L; Lucchi, L; Furci, L; Rovatti, E; Stefani, Alessandro; Albertazzi, Alberto
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2002 - Il pectus excavatum. Indicazioni chirurgiche e risultati. Analisi di una casistica. [Articolo su rivista]
C., Lavini; Stefani, Alessandro; C., Ruggiero; R., LODI R; Morandi, Uliano
abstract

Gli autori fanno il punto sullo stato dell'arte della chirurgia del pectus excavatum riportando la loro esperienza personale

2002 - Risultati della chemioterapia neoadiuvante seguita da resezione chirurgica nel trattamento del NSCLC in stadio IIIA (N2). [Abstract in Atti di Convegno]
Stefani, Alessandro; Casali, C; Natali, P; Morandi, Uliano
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2002 - Risultati della chemioterapia neoadiuvante seguita da resezione chirurgica nel trattamento del NSCLC in stadio IIIA (N2) [Relazione in Atti di Convegno]
Stefani, Alessandro; Casali, C; Natali, P; Morandi, Uliano
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2002 - Significance of incidental N2 and other prognostic factors in N2 non small-cell lung cancer [Articolo su rivista]
Morandi, Uliano; Stefani, Alessandro; C., Casali; P., Natali; A., Parise
abstract

Background: patients with IIIA-N2 non-small cell lung cancer represent a large and heterogeneous group. Some N2-related factors affecting prognosis have been identified. The present study investigated the prognostic factors of a group of N2 patients and gave an overview of available literature on this issue, especially considering N clinical status. Methods: the study comprised 187 patients. All the patients had a postoperative histologic diagnosis of mediastinal lymph node involvement and underwent complete resection.The following N2-related factors were investigated: N clinical status, number of metastatic lymph node levels, topography of lymph node involvement. Results: univariate analysis showed a significantly better prognosis for incidental N2, single station involvement and right-sided metastatic nodes (5-year survival respectively 35.4%, 28.3% and 33.7%). Survival analysis for number of metastatic levels stratified for N clinical status demonstrated the best prognosis for the cN0-1/single level subgroup (5-ys 38%). In the multivariate analysis only N clinical status was found as significant prognostic factor. Conclusions: our study has confirmed the relevance of N clinical status as a prognostic factor. The overview of the literature has shown that number of metastatic levels and subcarinal involvement may also be relevant prognostic factors. For cN0-1 patients surgery is mandatory. For cN2 patients correlation with other variables should be considered: when good prognostic factors are associated, surgery may be indicated but in a mulimodality setting; when negative factors are associated, results of surgery are poor and exclusive administration of radiation therapy should be evaluated. The development of an optimal procedure for preoperative staging is needed, to better detect N2-related prognostic factors.

2001 - Emergency tracheostomy. [Capitolo/Saggio]
Stefani, Alessandro; D., Gossot
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2001 - Il carcinoma bronchioloalveolare: caratteristiche cliniche e fattori di prognosi nella indicazione al trattamento chirurgico. [Abstract in Rivista]
Natali, P; Stefani, Alessandro; Morandi, Uliano
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2001 - Pectus excavatum: le alterazioni cardiorespiratorie come indicatori per l’intervento correttivo e come elementi di valutazione dei risultati. [Abstract in Rivista]
Stefani, Alessandro; Brandi, L; Lodi, R.
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2001 - Percutaneous tracheostomy [Capitolo/Saggio]
Stefani, Alessandro; D., Gossot
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2001 - Sistema portatile di drenaggio del torace per la gestione delle perdite idro-aeree prolungate [Articolo su rivista]
Lodi, R; Stefani, Alessandro; Chiapponi, A; Passacqua, Gc
abstract

Gli autori in questa nota descrivono un originale sistema di drenaggio delle perdite prolungate di aria e di liquidi dopo exeresi polmonari o dopo pleurotomia e drenaggio del pneumotorace. Il nuovo sistema è portatile e consente un vantaggioso controllo ambulatoriale delle perdite idroaeree del torace. Esso è composto da un reservoir dotato di due valvole unidirezionali e viene collegato al tubo di drenaggio del torace. Vengono esaminati i motivi di vantaggio dell'impiego di questo sistema rispetto all'utilizzo della valvola di Heimlich. Nella pratica clinica, già estesa e consistente, il nuovo sistema ha consentito di migliorare la qualità della vita dei pazienti operati al torace e con perdite idroaeree prolungate, riducendone i tempi di ospedalizzazione a vantaggio dei benefici rispetto ai costi.

2001 - Surgical management of solitary pulmonary nodules. An unexpected lucky case. [Articolo su rivista]
C., Casali; Stefani, Alessandro; M., Paci; Morandi, Uliano; R., Lodi
abstract

The case of a 63-year-old woman with a solitary pulmonary nodule (SPN) is reported. Surgical wedge resection revealed an hamartoma. Digital examination of the lung parenchyma showed an unexpected (not previously visualized by thoracic imaging) second nodule that intraoperative frozen examination revealed an adenocarcinoma. The operation was completed with a right upper lobectomy and complete lymphoadenectomy. The authors recommend an early open surgical procedure for any SPNs with risk factors for developing lung cancer.

2001 - Tracheostomy [Capitolo/Saggio]
Stefani, Alessandro; D., Gossot
abstract

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2000 - A lucky case of penetrating injury of the low chest [Articolo su rivista]
Paci, M; Stefani, Alessandro; Ruggiero, C; Urgese, A; Casali, C; Lodi, R.
abstract

Gli Autori descrivono un caso di grave trauma toracico penetrante da incidente sul lavoro trattato efficacemente con doppio drenaggio pleurico e laparotomia esplorativa.

2000 - A new portable chest drainage device [Abstract in Rivista]
Stefani, Alessandro; Paci, M; Ruggiero, C; Urgese, Al; Casali, C; Lodi, R.
abstract

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2000 - A new portable chest drainage device [Articolo su rivista]
Lodi, Renzo; Stefani, Alessandro
abstract

Background. persistent air leak is a frequent complication in lung operation. The Heimlich valve is the standard system for venting the pleural cavity. The device achieves good results and is well tolerated, but the main problem is when air leak is associated with fluid leakage. Methods. In order to improve the outpatient management of persistent air and fluid drainage after resectional procedures, we developed an original device. It is a portable system provided with a one-way valve connected to the chest tube for drainage of air and fluid, a reservoir for collecting fluid, and a one-way exhaust valve to evacuate air from the bag. Results. We analyze the advantages of our device versus the Heimlich valve in the first series of 18 selected patients. Our system is drier and cleaner, easier to manage, and ambulatory visits are seldom needed. There is also a cost savings. Conclusions. Our device enhances ambulation, independence, and the quality of life of the patients, and decreases the need for hospital and outpatient care.

2000 - Cardiac tamponade and pericardial window treatment. [Abstract in Rivista]
Ruggiero, C; Brandi, L; Urgese, Al; Paci, M; Casali, C; Stefani, Alessandro; Morandi, Uliano; Lodi, R.
abstract

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2000 - Il pectus excavatum: presente e futuro. [Articolo su rivista]
Lodi, R; Paci, M; Stefani, Alessandro; Brandi, L.
abstract

Gli autori descrivono una tecnica originale di correzione del pectus excavatum.

2000 - Preoperative embolization in surgical treatment of mediastinal hemangiopericytoma [Abstract in Rivista]
Stefani, Alessandro; Morandi, Uliano; Desantis, M; Paci, M; Ruggiero, C; Urgese, Al; Casali, C; Lodi, R.
abstract

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2000 - Preoperative embolization in surgical treatment of mediastinal hemangiopericytoma. [Articolo su rivista]
Morandi, Uliano; Stefani, Alessandro; M., Desantis; M., Paci; R., Lodi
abstract

The case of a 47-year-old man with a tumor of the posterosuperior mediastinum is reported. Surgical biopsy sample revealed a hemangiopericytoma, but radical excision was impossible because of massive bleeding. Percutaneous embolization of mediastinal tumor was performed to reduce peroperative blood loss. It allowed uneventful complete removal of the lesion. We recommend preoperative embolization in cases of hypervascular mediastinal tumors.

2000 - Preoperative embolization in the treatment of mediastinal hemangiopericytoma. [Abstract in Atti di Convegno]
Stefani, Alessandro; Desantis, M; Morandi, Uliano
abstract

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2000 - Sindrome di Poland. Descrizione di un caso. [Articolo su rivista]
Ariosi, P; Torricelli, Pietro; Stefani, Alessandro; Morandi, Uliano
abstract

Gli Autori descrivono un raro caso di Sindrome di Poland in maschio di 16 anni. Non è stata necessaria correzione chirurgica.

2000 - Surgical management of pulmonary solitary nodules: an unexpected lucky case. [Abstract in Rivista]
Casali, C; Stefani, Alessandro; Paci, M; Ruggiero, C; Urgese, Al; Morandi, Uliano; Lodi, R.
abstract

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2000 - The surgical treatment of flail chest. [Abstract in Rivista]
Ruggiero, C; Paci, M; Stefani, Alessandro; Casali, C; Urgese, Al; Morandi, Uliano; Lodi, R.
abstract

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1999 - Carcinoid tumors of the lung: an analysis of 65 operated cases [Articolo su rivista]
Stefani, Alessandro; Morandi, Uliano; Urgese, Al; Rivasi, Francesco; Lodi, Renzo
abstract

Background The aim of this study was to analyse two groups of patients operated for bronchopulmonary neuroendocrine neoplasms (bronchial carcinoid and well-differentiated neuroendocrine carcinoma) and to investigate their clinico-pathological data and long-term survival. Methods. From January 1978 to June 1996, 65 patients with bronchial carcinoids underwent operation at our Institution. There were 33 males and 32 females, whose mean age was 49.8 years. Forty-four neoplasms (67.7%) were considered to be central. Histology revealed 54 typical bronchial carcinoids (83%) and 11 well-differentiated neuroendocrine carcinomas (17%), Surgical resection of tumor and complete lymph node dissection was performed in all cases, Results, All patients entered follow-up: 5-year survival was 91% for patients with bronchial carcinoid and 49% for those with well-differentiated neuroendocrine carcinoma (p<0.05). Univariate analysis found that there was a significant decrease in survival also for peripheral location of the tumor, advanced pathologic stage and histologically positive lymph nodes. Conclusions. These results point out that carcinoid tumors are malignant neoplasms, so they require a complete and radical surgical resection, Most tumors are only locally invasive and show a low aggressive behaviour; therefore, when possible, it is recommended to attempt a limited resection, Frozen sections of bronchial margins and complete lymphadenectomy should be routinely performed. The same criteria should apply to well differentiated neuroendoctine carcinomas, though their behaviour is more aggressive.

1999 - Carcinoma bronchioloalveolare: aspetti clinici e diagnostici e risultati della terapia chirurgica. [Articolo su rivista]
P., Natali; Stefani, Alessandro; Morandi, Uliano
abstract

Gli autori descrivono la loro casistica di 72 pazienti affetti da BAC operati tra il 1979 e il 1999.

1999 - Su due casi di sarcomi primitivi del cuore [Articolo su rivista]
Santi, C; Stefani, Alessandro; Debellis, A; Brandi, L; Lodi, R.
abstract

I sarcomi primitivi del cuore sono tumori maligni molto rari, che di solito si sviluppano all'interno delle camere cardiache e interessano il pericardio. Ne riportiamo due casi, un fibrosarcoma e un rabdomiosarcoma, che si sono presentati con caratteristiche cliniche diverse: il rpimo con versamento pericardico e temponamento cardiaco, il secondo con scompenso cardiaco congestizio. E' stato seguito un diverso approccio terapeutico, in fuzione delle dimensioni e della sede delle due neoplasie. La paziente con fibrosarcoma è stata sottoposta a chirurgia palliativa per il temponamento cardiaco, mediante pericardiostomia sottoxifoidea ed è deceduta 6 mesi dopo. Nel caso del rabdomiosarcoma è stato possibile eseguire l'asportazione radicale del tumore e la paziente è viva senza recidiva a distanza di 12 mesi. Gli aspetti clinici e il trattamento dei due casi vengono conformtati con le esperienze in letteratura. Il tentativo di asportazione chirurgica è giustificato dalla possibilità di lunga sopravvivenza e di miglioramento della qualità di vita.

1999 - Technical advances and results in surgical correction of pectus excavatum [Abstract in Rivista]
Stefani, Alessandro; Ruggiero, C; Paci, M; Casali, C; Urgese, Al; Morandi, Uliano; Lodi, R.
abstract

nd

1999 - The seat belt syndrome [Articolo su rivista]
M., Paci; Stefani, Alessandro; C., Casali; R., Lodi
abstract

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1998 - A case of traumatic pericardiophrenic rupture [Articolo su rivista]
Stefani, Alessandro; Brandi, L; Ruggiero, C; Lodi, R.
abstract

An unusual case of traumatic pericardiophrenic rupture is presented. The defect was Limited to the central tendon of the diaphragm, with herniation of the stomach into the pericardial sac. A correct preoperative diagnosis was not made because laparotomy was quickly performed for splenic rupture. Successful operative repair of the tear was performed, with interrupted reabsorbable sutures. The case is discussed and the management of patients with these rare lesions is reviewed.

1998 - Correzione di steno-insufficienza mitralica severa mediante tecnica convenzionale associata a rotazione del muscolo papillare anteriore: tre casi sequenziali. [Abstract in Atti di Convegno]
Santi, C; Affatato, A; Debellis, A; Avossa, N; Stefani, Alessandro; Tommaselli, A; Lodi, R.
abstract

nd

1998 - Il trattamento chirurgico delle metastasi polmonari. [Abstract in Atti di Convegno]
Stefani, Alessandro; Morandi, Uliano; Urgese, Al; Paci, M; Brandi, L; Lodi, R.
abstract

nd

1998 - Indagine sui livelli ematici e tissutali di Se, Zn e Cu in pazienti con patologia neoplastica. [Poster]
Piccinini, L; Borella, Paola; Bargellini, Annalisa; Arigliano, V; Zanelli, F; Franchini, M; Zoboli, A; Fontana, I; Morandi, Uliano; Stefani, Alessandro
abstract

nd

1998 - Limiti della chirurgia exeretica del cancro del polmone [Relazione in Atti di Convegno]
Morandi, Uliano; Stefani, Alessandro
abstract

nd

1998 - Migration of pectus excavatum correction metal support into the abdomen. [Articolo su rivista]
Stefani, Alessandro; Morandi, Uliano; R., Lodi
abstract

The authors describe a case of migration of a metal support, used to fix a corrected pectus excavatum deformity, into the peritoneal cavity. The migrated wire caused abdominal pain. A video laparoscopic removal of the wire was undertaken and the patient made a full recovery. A review of the literature shows that this has not been reported before and that serious complications related to metal struts are very uncommon. We do not believe that a revision of this surgical technique is needed; anyway, foreign body migration should always be considered as a cause for unusual symptoms in patients undergoing this operation.

1998 - Migrazione di un supporto metallico nella cavità addominale dopo correzione chirurgica di un pectus excavatum [Abstract in Atti di Convegno]
Stefani, Alessandro; Morandi, Uliano; Urgese, Al; Santi, C; Lodi, R.
abstract

nd

1998 - Plasma, hair and tissue levels of trace elements in lung cancer [Relazione in Atti di Convegno]
Piccinini, Lino; Borella, Paola; Bargellini, Annalisa; Morandi, Uliano; Stefani, Alessandro; V., Arigliano; Davalli, Pierpaola
abstract

The purpose of this study was to investigate the relationship between plasma, hair and tissue levels of Se, Zn and Cu, and cancer.

1998 - Progressi tecnici e risultati a distanza della correzione chirurgica del pectus excavatum. [Articolo su rivista]
Lodi, R; Morandi, Uliano; Stefani, Alessandro; Brandi, L.
abstract

ND

1998 - Results of surgical resection for lung metastases [Articolo su rivista]
Morandi, Uliano; Stefani, Alessandro; A. L., Urgese; C., Ruggiero; M., Paci; R., Lodi
abstract

Fifty-nine consecutive patients underwent thoracotomy with curative intent for lung metastases, with no operative deaths, between 1978 and 1996. Six patients could not be rendered free of disease; their long term survival was significantly lower respect to the 53 patients undergoing curative resection: 31% at one year versus 38% at five years respectively. By considering patients rendered free of disease, wedge excision was performed in 29 cases (55%) and it was the procedure of choice. Apart from resectability, the only significant factors influencing survival were morphology, with the best prognosis for carcinomas, intermediate for sarcomas and the worst one for melanoma and lymph node involvement, with a significant better survival for patients without nodal involvement. Survival was not influenced by primary site, disease-free interval, diameter and location of the pulmonary metastases, number of metastases resected and number of thoracotomies. We conclude that resection of lung metastases is safe and effective, that multiple lesions do not preclude resection but a known nodal involvement contraindicates it and that repeated thoracotomy is justified.

1998 - Selenium, Zinc and Copper il lung cancer: modifications in fluids and tissues [Abstract in Atti di Convegno]
Piccinini, L; Borella, Paola; Bargellini, Annalisa; Morandi, Uliano; Stefani, Alessandro; Arigliano, V; Davalli, P.
abstract

nd

1998 - Su due casi di tumori primitivi del cuore [Abstract in Atti di Convegno]
Santi, C; Affatato, A; Debellis, A; Avossa, N; Stefani, Alessandro; Tommaselli, A; Lodi, R.
abstract

nd

1998 - Su un caso di rottura traumatica pericardio-frenica [Abstract in Atti di Convegno]
Stefani, Alessandro; Brandi, L; Santi, C; Lodi, R.
abstract

nd

1998 - The role of surgical resection in the management of limited small-cell lung cancer [Relazione in Atti di Convegno]
Morandi, Uliano; Stefani, Alessandro
abstract

nd

1997 - CEREBRAL PERFUSION THROUGH BALLOON CATHETER IN THE SURGICAL TREATMENT OF THORACIC AORTA [Relazione in Atti di Convegno]
Scorsin, M; Menasché, P; Lodi, R; Stefani, Alessandro
abstract

nd

1997 - Conoscere meglio il tabagismo e la metodologia del suo trattamento [Articolo su rivista]
Renzo, Lodi; Stefani, Alessandro
abstract

nd

1997 - CORRECTION OF PECTUS EXCAVATUM: MODALITIES, TECHNIQUES AND RESULTS AT DISTANCE [Relazione in Atti di Convegno]
Morandi, Uliano; Stefani, Alessandro; Ruggiero, C; Paci, M; Cavozza, C; Lodi, R.
abstract

nd

1997 - I trapianti di cuore nell’uomo: 30 anni dopo ( 1967-1997) [Articolo su rivista]
R., Lodi; C., Santi; Stefani, Alessandro
abstract

Gli autori passano in rassegna la storia e l'evoluzione dei trapianti di cuore nel trentennale dall'esecuzione del primo trapianto di cuore.

1997 - Iatrogenic rupture of the trachea and main bronchus after intubation. [Relazione in Atti di Convegno]
Ruggiero, C; Cavozza, C; Paci, M; Urgese, Al; Stefani, Alessandro; Guida, M; Pennetta, A.
abstract

nd

1997 - Morphological researches on lung preservation with a modified University of Wisconsin solution containing gelatine polypeptides (Haemaccel) [Articolo su rivista]
G., Spagna; P., Bruzzone; I., Pecorella; R., Lorenzini; Stefani, Alessandro; Morandi, Uliano; R., Lodi
abstract

University of Wisconsin solution (U.W.S.) has prolonged hypotermic preservation of liver and kidney. This solution has been afterwards tested for heart and lung preservation. The high-potassium content and viscosity of the solution suggested to us to bring some modifications: addition of plasma expanders, aprotinin and an increased concentration of gluthatione. We studied the effect of this original solution using an animal model: 10 males adult Yuchatan micro-pig, undergoing excision of the heart-lung block. A morphological study of preserved lung was performed, then we compared the effect of standard UW solution and our modified solution. The cyto-histological findings, at different preservation times, showed that superior results have been obtained with the modified UW solution, such as better hematic wash-out from the pulmonary vessels and milder vasoconstriction in the pulmonary artery bed. Using our solution we observed a satisfactory preservation of pulmonary endothelium and bronchial epithelium respectively after 8 and 12 hours of hypotermic ischemia. This was the first step of our research; in a further study we shall perform the single-lung transplantation in a micro-pig model, to report a functional in vivo evaluation of the clinical applicability and quality of our solution for lung preservation

1997 - Results of surgical resection in patients over the age of 70 years with non small-cell lung cancer. [Articolo su rivista]
Morandi, Uliano; Stefani, Alessandro; M., Golinelli; C., Ruggiero; L., Brandi; A., Chiapponi; C., Santi; R., Lodi
abstract

From January 1989 to October 1993, at the Department of Cardio-Thoracic Surgery of the University of Modena, 806 patients underwent thoracotomy and curative pulmonary resection for non small-cell lung cancer. Eighty five patients were 70 years old or older (mean 73.4 years, range 70-88). There were 78 males (91.7\%) and 7 females (8.3\%). This population was compared to 130 younger patients (under 70 years old), treated during the same period and with similar features with respect to the type of resection, sex, histology, grading and staging. Lobectomy was the procedure of preference in both groups.As regards postoperative mortality and overall complications, no significant differences were noted between the two groups of patients (two younger patients died and 43.8\% had postoperative complications; one patient of the older group died and 55.2\% had postoperative complications), but in the older ones a higher incidence of cardiovascular complications was found (P < 0.01). With respect to the long-term survival (follow-up 12-70 months), no significant difference was found between the two groups.Such findings show that pulmonary resection for bronchogenic cancer is feasible and justified in patients more than 70 years old, even if a higher incidence of cardiovascular complications may occur: a careful preoperative selection ought to be performed and lobectomy should be preferred.

1997 - Selenium, Zinc and Copper levels in blood, hair and tissue of patients affected by lung and breast cancer [Abstract in Atti di Convegno]
Bargellini, Annalisa; Borella, Paola; Morandi, Uliano; Arigliano, V; Stefani, Alessandro; Fontana, I; Caselgrandi, E; Piccinini, L.
abstract

nd

1997 - Studio caso-controllo dei tassi di Selenio (Se) nel sangue e nei tessuti di soggetti sani o affetti da tumore [Poster]
Piccinini, L; Borella, Paola; Bargellini, Annalisa; Arigliano, V; Malavolta, L; Longo, L; Zoboli, A; Fontana, I; Morandi, Uliano; Stefani, Alessandro
abstract

nd

1997 - Trace element content of normal and cancerous lung and breast tissue [Abstract in Atti di Convegno]
Piccinini, L; Borella, Paola; Bargellini, Annalisa; Morandi, Uliano; Arigliano, V; Stefani, Alessandro; Fontana, I.
abstract

nd

1997 - VIDEO-ASSISTED THORACIC SURGERY. THE EXPERIENCE FROM THE CENTRE OF MODENA [Relazione in Atti di Convegno]
Urgese, Al; Paci, M; Cavozza, C; Guida, M; Ruggiero, C; Stefani, Alessandro; Pennetta, A; Morandi, Uliano
abstract

nd

1996 - Fattori di rischio, mortalità e morbidità della chirurgia di rivascolarizzazione miocardica nell’ottavo decennio di vita. [Abstract in Rivista]
Santi, C; Ruggiero, C; Golinelli, M; Stefani, Alessandro; Paci, M; Brandi, L; Morandi, Uliano; Lodi, R.
abstract

nd

1996 - Il trattamento chirurgico dei carcinoidi bronco-polmonari [Abstract in Rivista]
Morandi, Uliano; Stefani, Alessandro; Ruggiero, C; Lodi, R.
abstract

nd

1996 - Primary right atrial fibrosarcoma diagnosed by endocardial biopsy [Articolo su rivista]
Basso, C; Stefani, Alessandro; Calabrese, F; Fasoli, G; Valente, M.
abstract

nd

1996 - Procedura originale di anuloplastica della tricuspide. [Abstract in Rivista]
Santi, C; Coulon, P; Ruggiero, C; Stefani, Alessandro; Chiapponi, A; Paci, M; Lodi, R.
abstract

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1995 - Esperienza sull’impiego della angioplastica coronarica diretta nell’infarto miocardico acuto dell’anziano. [Abstract in Atti di Convegno]
Brandi, L; Santi, C; Rossi, P; Ruggiero, C; Cavozza, C; Stefani, Alessandro; Paci, M; Chiapponi, A; Lodi, R.
abstract

nd

1995 - Il trattamento chirurgico dei carcinoidi bronco-polmonari. [Abstract in Atti di Convegno]
Morandi, Uliano; Rivasi, F; Campanini, A; Ruggiero, C; Stefani, Alessandro; Cavozza, C; Paci, M; Lodi, R.
abstract

nd

1995 - La correzione chirurgica del pectus excavatum. Modalità tecniche e risultati morfo-funzionali [Abstract in Atti di Convegno]
Morandi, Uliano; Stefani, Alessandro; Golinelli, M; Ruggiero, C; Cavozza, C; Brandi, L; Santi, C; Lodi, R.
abstract

nd

1995 - La correzione chirurgica del pectus excavatum. Modalità tecniche e risultati morfo-funzionali. [Abstract in Atti di Convegno]
Morandi, Uliano; Stefani, Alessandro; Golinelli, M; Ruggiero, C; Cavozza, C; Brandi, L; Santi, C; Lodi, R.
abstract

nd

1995 - Le exeresi polmonari per cancro negli ultrasettantenni [Abstract in Atti di Convegno]
Morandi, Uliano; Stefani, Alessandro; Golinelli, M; Ruggiero, C; Cavozza, C; Chiapponi, A; Brandi, L; Santi, C; Lodi, R.
abstract

nd

1995 - Original technique for tricuspid valve anuloplasty [Relazione in Atti di Convegno]
Santi, C; Coulon, P; Ruggiero, C; Stefani, Alessandro; Chiapponi, A; Vaglio, F; Lodi, R.
abstract

nd

1995 - Pericardial window e pericardioscopia nel trattamento del tamponamento cardiaco [Abstract in Rivista]
Morandi, Uliano; Santi, C; Golinelli, M; Brandi, L; Ruggiero, C; Stefani, Alessandro; Cavozza, C; Lodi, R.
abstract

nd

1995 - Studio cardiologico preoperatorio polistrumentale per la valutazione del rischio toracochirurgico. [Abstract in Atti di Convegno]
Brandi, L; Morandi, Uliano; Ruggiero, C; Golinelli, M; Stefani, Alessandro; Cavozza, C; Tartoni, Pl; Stella, F; Santi, C; Lodi, R.
abstract

nd

1995 - Trattamento chirurgico del cancro bronco-polmonare (NSCLC): popolazioni a confronto (serie di ultrasettantenni-serie di età inferiore). [Abstract in Atti di Convegno]
Morandi, Uliano; Stefani, Alessandro; Golinelli, M; Ruggiero, C; Brandi, L; Chiapponi, A; Lodi, R.
abstract

nd

1995 - Valutazione cardiorespiratoria predittiva del rischio operatorio in chirurgia exeretica del cancro bronco-polmonare. [Abstract in Atti di Convegno]
Brandi, L; Morandi, Uliano; Pennetta, Ra; Ruggiero, C; Golinelli, M; Stefani, Alessandro; Cavozza, C; Chiapponi, A; Tartoni, Pl; Stella, F; Santi, C; Lodi, R.
abstract

nd

1995 - "Yellow nail syndrome" associated with chronic recurrent pericardial and pleural effusions. [Articolo su rivista]
Morandi, Uliano; M., Golinelli; L., Brandi; C., Ruggiero; Stefani, Alessandro; R., Lodi
abstract

The authors describe a case of yellow nail syndrome in a 44-year-old male patient, with a clinical picture characterized by hand and foot onychodystrophy, lymphedema in the legs and recurrent pleural and pericardial effusions. They indicate subxiphoid pericardiostomy and pleural drainage as the rational surgical procedure for the treatment of this particular associated pathology.

1994 - Pericardial window e pericardioscopia nel trattamento del tamponamento cardiaco [Relazione in Atti di Convegno]
Morandi, Uliano; Santi, C; Golinelli, M; Brandi, L; Ruggiero, C; Stefani, Alessandro; Cavozza, C; Lodi, R.
abstract

nd

1994 - Significato prognostico del contenuto di DNA e dell'attività proliferativa cellulare nel carcinoma polmonare non a piccole cellule operato [Articolo su rivista]
Morandi, Uliano; Sabbatini, R; Stefani, Alessandro; Piccinini, L; Golinelli, M; Bandieri, E; Frassoldati, A; Lodi, R.
abstract

Scopo dello studio è stato quello di ricercare una correlazione tra l'evoluzione clinica dei pazienti affetti da NSCLC, la ploidia e l'attività proliferativa del tumore. Campioni tumorali di 127 pazienti operati dal 1989 al 1991 sono stati studiati mediante citofluorimetria a flusso. Novanta casi sono risultati aneuploidi. il valore medio della SPF era 19.6%. DNA-index e SPF sono stati correlati con istotipo, grading e stadio ma non sono state trivate differenze significative. . A 2 anni dall'intervento è stato studiato l'intervello libero da malattia dei pazienti allo stadio I e II sottoposti a intervento radicale: 83/127, di cui soltanto 55 valutabili per la fase S. I pazienti con tumore aneuploide e con elevata SPF hanno presentato un maggior numero di recidive a 24 mesi, 50% contro 26%. Questa differenza, ancorchè non significativa (0.08)suggerische una possibile tendenza delle neoplasie aneuploidi ed altamente proliferanti ad avere una prognosi peggiore.

1994 - Valutazione ecocardiografica preoperatoria in pazienti toracochirurgici ad alto rischio cardiovascolare [Abstract in Atti di Convegno]
Brandi, L; Santi, C; Ruggiero, C; Golinelli, M; Stefani, Alessandro; Tartoni, Pl; Stella, F; Morandi, Uliano; Lodi, R.
abstract

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