We report the use of venovenous extracorporeal membrane oxygenation with a single dual lumen cannula in a 42-year-old patient suffering from a post-pneumonectomy fistula and severe respiratory insufficiency, avoiding the classical approach of invasive mechanical ventilation. We discussed the potential advantages of extracorporeal oxygenation as the main support in this particular clinical setting.

We presented a rare case of large tracheal hamartoma in a 14-year-old boy and its management with a novel technique of reparation with pericardium of entire membranous portion of the trachea, after the failure of more conservative approaches like bronchoscopic resection and stenting. We remark the advantages of autologous material instead of prosthetic material.

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Background: The heritage of occupational and environmental asbestos exposure in Piedmont, Italy, is an enduring epidemic of malignant pleural mesothelioma (MPM). Pleural biopsy (PB) performed via thoracoscopy (or video-assisted thoracic surgery (VATS)) remains the diagnostic gold standard for patients with suspected mesothelioma. The aim of our study was to investigate the accuracy of PB via VATS and to analyze the diagnostic path of the patients who experienced an initial MPM misdiagnosis. Method: Patients who underwent PB by VATS for suspected MPM from 2004 to 2013 were analyzed. The Registry of Malignant Mesothelioma (RMM) records were examined to crosscheck incident cases and to recognize misdiagnosed MPM. Sensitivity and specificity of the initial PB assessment versus the final classification of cases by RMM were evaluated. Overall survival (OS) was estimated using the Kaplan-Meier method and compared using log-rank test.Result: Data of 552 patients were analyzed. Of those, MPM was diagnosed in 178 cases (32%) and no false-positive PBs were observed. Sensitivity and specificity were 93% and 100%, respectively. The number of false-negative PBs was 14 (2%). Of those, 10 (71%) had an initial diagnosis of chronic pleuritis, 3 (28.5%) of atypical mesothelial proliferation and 1 had reactive mesothelial proliferation. All of them reported a history of asbestos exposure and the correct diagnosis was reached after a median of 160 days (interquartile range 86-243) as follow: 9 (64%) after a further PB by VATS, 3 (22%) by cytology examination of a pleural effusion, 1 (7%) by fine-needle biopsy and 1 (7%) by open surgery. The median survival time of the patients with eventual MPM diagnosis was 13.8 months (CI 95%: 10.3-16.6).). Oneand 4-year survival were 52% and 10% in MPM PB positive cases and 50% and 19% in false-negative cases (P¼0.66) (Figure 1). Conclusion: When a history of asbestos exposure is reported and a strong clinical suspicion persists after a negative PB, iterative biopsy attempts should be considered. In high-volume centers, MPM misdiagnosis rate remains small and future advancement in diagnostic technologies could further increase the accuracy of diagnosis.

Background: Lung cancer is the leading cause of cancer death worldwide. The long-term survival is one the most important outcome for therapies in oncology. In early stages, it permits to adequately evaluate the quality of the oncological resections of thoracic surgery teams, and in advanced stages it evaluates the quality of the multidisciplinary teams. Screening programs and early diagnosis are the most efficient way to improve survival in lung cancer patients. The results of the surgical treatment in early-stage non-small cell lung cancer of our center is presented. Method: All patients treated by our thoracic surgery team for early-stage non-small cell lung cancer, between june 2010 and december 2017, were entered prospectively and consecutively to a web database. Demographic, clinical and pathological data, as well as every adverse event were recorded. All our patients underwent to an exhaustive staging process. Statistical descriptive analysis of clinical and demographic variables and 5 year overall survival by stage are shown. Result: 174 patients were included with median age of 67.7 years old (range 38-86 years), 51.7% female. Adenocarcinoma was the most frequent histology (60.9%). 81% were treated in Stage I and 29% in Stage II. For Stage I patients, the median follow-up time was 50 months (IQR: 23.6 -70.3), and 5-year overall survival 89.79% (95% CI 82.11-94.29). For Stage II patients, the median follow-up time was 33.6 months (IQR: 16.9 -56.1), and 5-year OS 63.47% (95% CI 33.2-82.91) Stage Ia and Ib patients had similar 5y OS: Ia 89.26% (95% CI 80.09-94,35) and Ib 91.3% (95% CI 68.98-97.82) Conclusion: The epidemiological profile of our patients is similar to that published in most of the series, and adenocarcinoma is the main histology in early stage NSCLC in our center. 5-year overall survival in stage I patients are good compared to other international publications, which we believe is directly related to the exhaustive preoperative and intraoperative study. Correctly assessing the cardiopulmonary capacity of patients allows us to reduce postoperative morbidity and mortality. Accurate staging (imaging, systematic lymph node dissection) allows our group to ensure that stage I patients are actually in stage I, avoiding sub-treating patients who might otherwise require adjuvant therapy.