Early thoracic surgery consultation and location of therapy impact time to esophagectomy.

Background: Neoadjuvant chemoradiation therapy (nCRT) followed by esophagectomy is the standard treatment for resectable, locally advanced esophageal cancer. The ideal timing between neoadjuvant therapy and esophagectomy is unclear. Delayed esophagectomy is associated with worse outcomes.

Long-term Outcomes Following Esophagectomy in Older and Younger Adults with Esophageal Cancer.

Background: Patterns of overall and disease-free survival after esophagectomy for esophageal cancer in older adults have not been carefully studied.

Methods: Retrospective analysis of all patients with esophageal cancer undergoing esophagectomy from 2005 to 2020 at our institution was performed. Differences in outcomes were stratified by age groups, < 75 and ≥ 75 years old, and two time periods, 2005-2012 and 2013-2020.

Thoracic surgery with geriatric assessment and collaboration can prepare frail older adults for lung cancer surgery.

Background And Objectives: We assessed frailty, measured by a comprehensive geriatric assessment-based frailty index (FI-CGA), and its association with postoperative outcomes among older thoracic surgical patients.

Methods: Patients aged ≥65 years evaluated in the geriatric-thoracic clinic between June 2016 through May 2020 who underwent lung surgery were included. Frailty was defined as FI-CGA > 0.

Perioperative Esophagectomy Outcomes in Older Esophageal Cancer Patients in Two Different Time Eras.

To investigate perioperative outcomes of esophagectomies by age groups. Retrospective analysis of esophageal cancer patients undergoing esophagectomy from 2005 to 2020 at a single academic institution. Baseline characteristics and outcomes were analyzed by 3 age groups: <70, 70-79, and ≥80 years-old.

Manubrium Reconstruction.

To date, there is no standard approach for manubrial reconstruction. We had previously utilized mesh; however, this resulted in breakage, infection, and poor cosmesis. In this case series, we describe our transition to iliac wing autograft reconstruction.

Pre-COVID-19 National Mortality Trends in Open and Video-Assisted Lobectomy for Non-Small Cell Lung Cancer.

Introduction: In the current era of episode-based hospital reimbursements, it is important to determine the impact of hospital size on contemporary national trends in surgical technique and outcomes of lobectomy.

Methods: Patients aged >18 y undergoing open and video-assisted thoracoscopic surgery (VATS) lobectomy from 2008 to 2014 were identified using insurance claims data from the National Inpatient Sample. The impact of hospital size on surgical approach and outcomes for both open and VATS lobectomy were analyzed.

Validation of the Pictorial Fit-Frail Scale in a Thoracic Surgery Clinic.

Objective: Examine feasibility and construct validity of Pictorial Fit-Frail scale (PFFS) for the first time in older surgical patients.

Background: The PFFS uses visual images to measure health state in 14 domains and has been previously validated in outpatient geriatric clinics.

Methods: Patients ≥65 year-old who were evaluated in a multidisciplinary thoracic surgery clinic from November 2020 to May 2021 were prospectively included.

Geographic differences in therapy for stage I non-small-cell lung cancer in older adults.

Background: Geographic and socioeconomic factors impact patient treatment choices for certain cancers. Whether they impact treatment in older adults with lung cancer is unknown. We investigated geographic differences in treatment for stage I non-small-cell lung cancer (NSCLC) in older adults in the United States.

Correlation between Restless Leg Syndrome and Superficial Venous Reflux.

Restless leg syndrome (RLS) is a common cause of lower extremity discomfort. We hypothesized that patients with RLS symptoms have higher rates of deep and superficial venous reflux (SVR). Retrospective review of patients ≥18 years of age evaluated in a venous center from December 2018 to February 2019.

Routine Chest Roentgenogram After Chest Tube Removal Is Not Indicated for Minimally Invasive Lung Resection.

Background: Chest roentgenograms after chest tube removal are common practice in postoperative thoracic surgery patients. Whether these roentgenograms change clinical management is debatable. We investigated prevalence and management of post-pull pneumothoraces after lung resection.

Risk factors for prolonged air leak and need for intervention following lung resection.

Objectives: Prolonged air leak (PAL; >5 days) following lung resection is associated with postoperative morbidity. We investigated factors associated with PAL and PAL requiring intervention.

Methods: Retrospective review of all patients undergoing lobectomy, segmentectomy or wedge resection from 2016 to 2019 at our institution.

Internal Staging Discordance in National Cancer Databases for Non-Small Cell Lung Cancer.

Background: The Surveillance, Epidemiology and End Results (SEER) and the National Cancer Database (NCDB) are databases for cancer analysis that may be subject to error in data reporting. This study examined the rates and impact of discordant data for non-small cell lung cancer.

Methods: NCDB and SEER were queried for non-small cell lung cancer pathologic tumor, node, metastasis data (NCDB) or "derived" data (SEER).

Mandatory Nodal Evaluation During Resection of Clinical T1a Non-Small Cell Lung Cancers.

Background: Recommendations for intraoperative lymph node evaluation are uniform regardless of whether a primary tumor is clinical T1a or T2a according to TNM 8th edition for stage I non-small cell lung cancer (NSCLC). We quantified nodal disease risk in patients with T1a disease (≤1 cm).

Methods: The National Cancer Database was queried for clinical T1a N0 M0 primary NSCLCs ≤1 cm undergoing lobectomy with mediastinal nodal evaluation from 2004-2014.

Outcomes of trimodality CROSS regimen in older adults with locally advanced esophageal cancer.

Background: Chemoradiotherapy for Esophageal cancer followed by Surgery (CROSS regimen) is standard of care for locally-advanced esophageal cancer. We evaluated CROSS completion rates, toxicity, and postoperative outcomes between older and younger adults receiving trimodality therapy.

Methods: Retrospective analysis of patients with locally-advanced esophageal cancer who underwent CROSS regimen from May 2016 to January 2020 at a single academic center.

Preserving NLST mortality benefits and acceptable morbidity for lung cancer surgery in a community hospital.

Background And Objectives: The aim of this study was to demonstrate whether academic thoracic surgeons could achieve morbidity and mortality rates in community hospitals equivalent to those seen in National Lung Screening Trial (NLST).

Methods: This was a retrospective review of community hospital lung cancer procedures for clinical Stage I-III non-small-cell lung cancers from 2007 through 2014. Variables include age, comorbidities, computed tomography (CT) characterization, and operative techniques.

Impact of radial margins after esophagectomy for esophageal cancer.

Introduction: The prognostic significance of radial margin (RM) involvement in esophagectomy cancer specimens is unclear. Our study investigated survival and recurrence rates between different depths of RM involvement.

Materials And Methods: We retrospectively analyzed 1103 esophagectomies at our institution from 2005 to 2019.

Risk of chyle leak after robotic versus video-assisted thoracoscopic esophagectomy.

Background: We investigate the incidence and risk factors for post-operative outcomes including chyle leak following minimally invasive esophagectomy (MIE).

Methods: Patients undergoing MIE from May 2016 until August 2020 were prospectively followed. Outcomes of robotic and video-assisted thoracoscopic surgery (VATS) esophagectomy were analyzed.

Analysis of Lymph Node Sampling Minimums in Early Stage Non-Small-Cell Lung Cancer.

Analyze "number of nodes" as an integer-valued variable to identify possible minimum lymph node (LN) number to sample during lung cancer resection. The National Cancer Database (NCDB) queried 2004-14 for surgically treated clinical stage I/II non-small-cell lung cancer (NSCLC). Overall survival (OS) by number of LN sampled was examined for the complete dataset, by adenocarcinoma, and by degree of resection using number of sampled LN both as integer-valued (0-30 nodes) variable and collapsed into classes.

Impact of Neoadjuvant Chemoradiation on Adverse Events After Bronchial Sleeve Resection.

Background: We analyzed the association between neoadjuvant chemoradiation in patients undergoing bronchial sleeve resection with the incidence of postoperative pulmonary and airway complications.

Methods: After instructional review board approval we performed a retrospective review of a prospectively maintained database of 136 patients who underwent sleeve resection in our institution between January 1998 and December 2016. Administration of neoadjuvant chemoradiation treatment was the studied exposure.

Prehabilitation of the Thoracic Surgery Patient.

Outcomes after thoracic surgery are better predicted by preoperative evaluation of patients' physiologic reserve (also known as personal biologic age rather than chronologic age), using validated assessment tools in multidisciplinary collaboration with geriatricians. Targetable risk factors should be identified, and methods should be utilized to minimize these risks. Prehabilitation has been validated as a tool to increase functional and nutritional status of patients undergoing surgery in other specialties and improve outcomes.

New evidence supporting lung cancer screening with low dose CT & surgical implications.

Introduction: Lung cancer is the leading cause of cancer-death worldwide. The U.S.

Minimizing residual occult nodal metastasis in NSCLC: recent advances, current status and controversies.

: Nodal involvement in lung cancer is a significant determinant of prognosis and treatment management. New evidence exists regarding the management of occult lymph node metastasis and residual disease in the fields of imaging, mediastinal staging, and operative management.: This review summarizes the latest body of knowledge on the identification and management of occult lymph node metastasis in NSCLC.

Risk factors for delirium after esophagectomy.

Introduction: Postoperative delirium is a common complication after major surgical procedures and affects outcomes and long-term survival. We identified factors associated with postoperative delirium in patients undergoing esophagectomy.

Methods: Retrospective cohort analysis of 378 patients undergoing esophagectomy.