Pulmonary carcinoid tumors represent bronchopulmonary neuroendocrine neoplasms which might synthetize serotonin, histamine, bombesin or other types of hormones responsible for the development of a broad spectrum of signs and symptoms, known as carcinoid syndrome. Data of 98 patients submitted to surgery for bronchial carcinoid tumors in the Thoracic Surgery Clinic of the 'Marius Nasta' Institute of Pneumophtisiology between 2014 and 2018 were retrospectively reviewed. All patients were submitted to paraclinical tests, imagistic studies (computed tomography or magnetic resonance imaging), bronchoscopy and biopsy in order to have a positive diagnostic of pulmonary carcinoid. The most common clinical symptoms at the time of presentation were: Persistent cough followed by dyspnea and recurrent pulmonary infections. The main neuroendocrine syndromes found were Cushing and Carcinoid Syndrome. All patients were submitted to surgery with curative intent consisting of wedge resection (in 4 cases, 4.08%), lobectomy (in 79 cases, 80.61%), bilobectomy (in 5 cases, 5.1%) and pneumonectomy respectively (in 10 cases, 10.2%). In all cases neuroendocrine specific symptoms disappeared once the carcinoid tumor was removed. In conclusion, bronchial carcinoid tumors have a positive outcome in most cases. Specific neuroendocrine markers as well as neuroendocrine syndrome disappears once the tumor is removed.

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OBJECTIVES Segmentectomy may be indicated for T1a-cN0 non-small cell lung cancer. However, several patients are upstaged pT2a at final pathological examination due to visceral pleural invasion. As resection is usually not completed to lobectomy, this may raise issue of potential worse prognosis. The aim of this study is to compare prognosis of visceral pleural invasion upstaged cT1N0 patients operated on by segmentectomy or lobectomy. METHODS Data of patients from 3 centers were analyzed. This was a retrospective study, of patients operated on from April 2007 to December 2019. Survival and recurrence were assessed by Kaplan Meier method and cox regression analysis. RESULTS Lobectomy and segmentectomy were performed in 191 (75.4%) and in 62 (24.5%) patients, respectively. No difference in 5-year disease-free survival rate between lobectomy (70%) and segmentectomy (64.7%) was observed. There was no difference in locoregional recurrence, nor in ipsilateral pleural recurrence. The distant recurrence rate was higher (p = 0.027) in the segmentectomy group. Five-year overall survival rate was similar for both lobectomy (73%) and segmentectomy (75.8%) groups. After propensity score matching, there was no difference in 5-year disease-free survival rate (p = 0.27) between lobectomy (85%) and segmentectomy (66.9%), and in 5-year overall survival rate (p = 0.42) between the 2 groups (lobectomy 76.3% versus segmentectomy 80.1%). Segmentectomy was not impacting neither recurrence, nor survival. CONCLUSIONS Detection of visceral pleural invasion (pT2a upstage) on patient who underwent segmentectomy for cT1a-c non-small cell lung cancer does not seem to be an indication to extend resection to lobectomy.

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Pulmonary hernia is a rare medical condition with an old history that dates back to the XV century. About a half of cases have been reported after trauma. The pulmonary hernia is also known as a complication of open thoracic surgery. Although it has been reported after closed chest surgery, it seems to be underreported. We report four cases of pulmonary hernia after minor or major thoracoscopic procedures.We present clinical data of patients and discuss clinical features and prevention of this adverse effect of thoracoscopic surgery. Three patients were symptomatic, a painful bulge increasing with chest strain at the specimen extraction incision scar, and they were operated on. The diagnostic of pulmonary hernia is not always straightforward at clinical examination which is the milestone of the diagnostic. CT scan can mislead, especially when it is not performed under the Valsalva maneuver. The pulmonary hernia following thoracoscopy is treated like other hernias. The peculiarity of the pulmonary hernia following the VATS would be, the hernia orifice is often a tiny opening, that is a theoretical risk of pulmonary strangulation; its anterior inferior location is a risk of possible enlargement of the hernia to the abdomen. For these 2 reasons some would directly operate almost each pulmonary hernia after thoracoscopy. We think that, only symptomatic patients with either persistent or worsening symptoms should have a surgical repair. The postoperative outcome is uneventful. More care is expected in the diagnostic phase. The pulmonary hernia should be discussed as differential diagnostic for a patient who has been operated on after a thoracoscopy with lingering parietal symptoms, especially pain.