Objective: Primary major airway tumors are rare. A retrospective analysis of referral centers experience could be helpful for their management.

Methods: Fifty-one patients, including 44 (86%) malignant and seven (14%) benign with primary tumors of subglottis, trachea, carina, and main stem bronchi, were managed in a 14-year period. Based on computed tomography (CT) scan and rigid bronchoscopy findings, those who evaluated as resectable underwent airway resection and reconstruction. The others were managed by one or a combination of these methods: core out, laser, chemotherapy, radiotherapy, and tracheostomy. Follow-up was completed in 88.2%, mean (35.2 ± 33.2 months).

Results: Extraluminal extension of the tumor found in CT scan was significantly associated with unresectability (p = 0.006). Thirty-two patients underwent resection with three complications (9%) and one mortality (3%). Nineteen were managed by non-resectional methods; of these, 15 were found unresectable, because of tumor length, extensive local invasion or diffuse distant metastases, and four due to risk–benefit ratio or patient preference. Among 18 patients with adenoid cystic carcinoma 13 (72%) were resected (seven with negative margins). Overall 1-, 2-, 5-, and 8-year survival was 90.9%, 90.9%, 77.9%, and 19.5%, respectively. In unresectable tumors with adenoid cystic carcinoma, overall 1- and 2-year survival was 60% and 40%, respectively. Data analysis found significant association of long-term survival with resection (p = 0.005) but not with negative margins in adenoid cystic carcinoma. Among 15 patients with carcinoid tumors, all were alive at the end of follow-up, except one who died after surgery.

Conclusions: Airway resection, if feasible, may extend survival and may even be curative, with low morbidity and mortality, in most patients with major airway tumors.

Objective: Although it may seem intuitive that obesity is an additional risk factor for surgical patients, few studies have correlated this condition with lung cancer resection. The only data currently available suggest that obesity does not increase the rate of complications after anatomic resection for non-small-cell lung cancer (NSCLC).

Methods: We enrolled 154 consecutive patients undergoing standard pneumonectomy for NSCLC at the Department of Thoracic Surgery of the European Institute of Oncology from January 2004 to April 2008. To determine the influence of preoperative body mass index (BMI) on postoperative complications, patients were classified into two groups: (1) BMI ≥ 25 kg m^–2; n = 93 (60.4%); and (2) BMI < 25 kg m^–2; n = 61 (39.6%). Data on sex, age, cigarette smoking, preoperative albumin, total proteins and creatinine values, forced expiratory volume in 1 s percentage (FEV1%), diffusion lung capacity for carbon monoxide/alveolar volume percentage (DLCO/AV%) and histology and pathological stage were collected. Information on total postoperative complications, 30-day mortality rate, specific pulmonary and cardiac complications, intensive care unit (ICU) admission and hospital stay was collected and analysed for the BMI group.

Results: Among the 154 operated patients, 30 (19.5%) were women with a mean age of 63.4 years (range: 36–82). As many as 136 (88.3%) patients were smokers or former smokers; 80 patients (51.9%) received presurgical treatment. A total of 64 (41.6%) right pneumonectomy procedures were performed. Mean ± SD for preoperative variables were FEV1%: 83.5 ± 19.2, DLCO/AV: 85.4% ± 20.3, albumin: 4.07 ± 0.44 g dl^–1, total proteins: 7.23 ± 0.59 g dl^–1, creatinine: 0.81 ± 0.23 mg dl^–1. Ten patients died within the first 30 days (30-day mortality: 6.5%). The male sex was significantly more prevalent in the high BMI group (p = 0.039). The preoperative mean creatinine value was significantly higher in the high BMI group (0.86 mg dl^–1 vs 0.75 mg dl^–1, p = 0.002) and preoperative DLCO/AV values were better in the high BMI group than in the BMI group < 25 kg m^–2 (79.9 vs 88.8, p = 0.009). The high BMI group had a higher incidence of respiratory complications (21.5% vs 4.9% p = 0.005, odds ratio (OR) = 5.3, 95% confidence interval (CI): 1.5, 18.7). No significant differences were observed between the two groups regarding ICU admission, hospital stay, 30-day mortality and total and specific cardiac complications.

Conclusions: The risk of respiratory complications in patients with BMI higher than 25 kg m^–2 undergoing pneumonectomy for lung cancer is 5.3 times higher than that of patients with BMI < 25 kg m^–2. Thoracic surgeons and anaesthesiologists should be aware of this information before planning elective pneumonectomy in overweight and especially in obese patients.

Objective: Because pleuropneumonectomy is associated with a high mortality rate, its indication for the treatment of Masaoka stage IVa thymoma is debated. We reviewed retrospectively our single-center experience in order to determine if the benefits warrant the risk of such procedure.

Methods: Between 1970 and 2009, 17 patients (12 men and 5 women) with a mean age of 44 years (range, 25–62 years) underwent a pleuropneumonectomy for a Masaoka stage IVa thymoma in our institution. Eight patients had recurrent thymoma after a mean postoperative period of 47 ± 28 months, and nine patients presented de novo with stage IVa disease. A multimodality treatment including chemotherapy, radiotherapy, or both was performed in 14 (82%) patients.

Results: Eight patients (47%) experienced a major postoperative complication, including four broncho-pleural fistulae (23%). There were no operative deaths and the 30-day mortality was 17.6% (3/17). But two patients died at 2 and 3 months, increasing the postoperative mortality to 29.4% (5/17). Complete resection was achieved in 11 (65%) patients. By univariate analysis, myasthenia gravis was the only risk factor for broncho-pleural fistulae. With a median survival of 76 months and median follow-up of 59 months (range, 1–262 months), 5-year and 10-year survivals were 60% and 30%, respectively. During follow-up, a recurrence occurred in two patients at 26 and 87 months, respectively, which was treated medically without success.

Conclusions: Pleuropneumonectomy for Masaoka stage IVa thymoma is associated with a high morbid-mortality rate. However, included in a multimodality strategy and in highly selected patients this procedure may provide good long-term survival.