Sublobar resection versus lobectomy for stage IA non-small-cell lung cancer ≤ 2 cm: a systematic review and patient-level meta-analysis.

Despite lobectomy being the standard of care for early-stage non-small-cell lung cancer (NSCLC), sublobar resection (segmentectomy or wedge resection) has recently been suggested to achieve similar outcomes. An electronic literature search was conducted to retrieve randomized controlled trials (RCTs) or propensity score-matched studies (PSMs) comparing lobectomy to sublobar resection in stage IA NSCLC ≤ 2 cm in size, with provision of Kaplan-Meier curves for overall survival (OS) and disease-free survival (DFS). A graphical reconstructive algorithm was used to obtain OS and DFS of individual patients, which was then pooled under random-effects individual patient data meta-analysis using Cox models to determine hazard ratios (HRs).

VATS hand sewn intrathoracic esophagogastric anastomosis.

Totally endoscopic two stage (laparoscopic and VATS) esophagectomy for carcinoma of the esophagus is a well-established procedure. There are currently many methods to perform the intrathoracic esophagogastric anastomosis by VATS. This article describes a totally hand sewn VATS intrathoracic esophagogastric anastomosis technique in a 64-year-old female with a T2N0M0 adenocarcinoma of the lower third of the esophagus.

Left video-assisted thoracoscopic enucleation of a giant horseshoe oesophageal leiomyoma.

Oesophageal leiomyomas are rare neoplasms of the oesophagus, accounting for approximately 4% of all oesophageal tumours. Most oesophageal leiomyomas are small and well encapsulated. We report a rare case of a giant horseshoe oesophageal leiomyoma which was removed via video-assisted thoracoscopic enucleation and describe the management of an intra-operative complication of a mucosal breach.

Beyond the limits, extreme minimally invasive surgery in invasive thymic tumours.

Generally accepted indications for minimally invasive surgery (MIS) approach to thymic tumours include small, well encapsulated non-invasive tumours. MIS for more advanced complicated thymic tumours remain controversial. This is due to concerns on whether an oncologically complete resection can be done.

Video-assisted thoracoscopic bronchoplasty.

Video-assisted thoracoscopic surgery (VATS) bronchoplasty is an advanced VATS technique requiring experience in endoscopic sewing, tying and suturing techniques reserved for cancers arising from central airways. There are three main types of bronchoplasty depending on the extent of cancer involvement of the bronchus. In this paper the author describes his experience with different types of bronchoplasty with case and video illustrations.

Initial experience with video-assisted thoracoscopic bronchoplasty.

Objectives: Bronchial-origin involvement by endobronchial tumours or direct invasion by tumour or metastatic lymph nodes is a relative contraindication for video-assisted thoracoscopic (VATS) lobectomy. However, selected cases can be resected by VATS bronchoplasty.

Methods: Between 2006 and 2009, 21 of 231 (9.

Results of surgery for bronchiectasis and pulmonary abscesses.

Bronchiectasis and lung abscess are generally treated medically, reserving surgery for when medical treatment has failed. Current goals of surgical therapy for bronchiectasis are to offer possible cure and better quality of life after medical treatment has failed and to resolve and prevent complications, such as empyema, severe hemoptysis, and lung abscess. Whenever possible, complete resections of localized disease should be done, reserving palliative resections to selected diffuse bronchiectasis with localized severe disease.

Can invasive thymomas be resected by video-assisted thoracoscopic surgery?

Although video-assisted thoracic surgery can be used for well-encapsulated thymomas, its role in invasive thymomas remains controversial. Between 1998 and 2009, 77 patients aged 22-76 years underwent thymomectomy by video-assisted thoracic surgery. Tumors <5 cm without major invasion on preoperative computed tomography were selected.

Genomic profiles specific to patient ethnicity in lung adenocarcinoma.

Purpose: East-Asian (EA) patients with non-small-cell lung cancer (NSCLC) are associated with a high proportion of nonsmoking women, epidermal growth factor receptor (EGFR)-activating somatic mutations, and clinical responses to tyrosine kinase inhibitors. We sought to identify novel molecular differences between NSCLCs from EA and Western European (WE) patients.

Experimental Design: A total of 226 lung adenocarcinoma samples from EA (n = 90) and WE (n = 136) patients were analyzed for copy number aberrations (CNA) by using a common high-resolution SNP (single nucleotide polymorphism) microarray platform.

Continuous absorbable suture technique for tracheobronchial sleeve resections.

From January 2000, we changed from the traditional interrupted suture technique for tracheobronchial sleeve resections to a continuous suture technique with absorbable suture. This retrospective study reviewed our experience in the first 50 consecutive patients operated on between January 2000 and August 2006. The median age was 61 years (range, 30 to 80 years).

Novel use of the internal thoracic artery retractor in transcervical thymectomy.

Transcervical thymectomy is a standard approach to the thymus and anterior mediastinum, but it is limited by poor exposure of the lower recesses of the anterior mediastinum. A novel technique using the widely available internal thoracic artery sternal retractor and a 30°-video camera allows enhanced exposure of the anterior mediastinum.

Revisiting the prone position in video-assisted thoracoscopic surgery.

The fully prone position, once used in surgery for chronic inflammatory lung diseases, has become obsolete. In the last 2 years, a modified semiprone position was used for video-assisted thoracoscopic surgery in 358 patients undergoing lobectomy with mediastinal complete lymphadenectomy The ports were placed with the patient in the lateral decubitus position. The patient was rotated 45-60 degrees towards the surgeon, giving enhanced exposure of the posterior mediastinum, esophagus, subcarinal and paratracheal spaces, due to displacement of the lung under gravity away from the operative field.

Clinical outcome of video-assisted thymectomy for myasthenia gravis and thymoma.

We reviewed our experience of video-assisted thoracoscopic thymectomy for myasthenia gravis and thymomas in 119 patients, aged 12-83 years, who were treated between 1998 and 2007. Disease severity was graded using the Osserman classification. To prevent rupture of the tumor capsule and tumor seeding, thymomas were resected using a modified no-touch technique.

A unique case of spontaneous regression of metastatic papillary renal cell carcinoma: a case report.

Spontaneous regression of cancer is a rare, but well documented, phenomenon. We present a unique case of an 82 year old Chinese male who experienced spontaneous regression of histologically-verified metastatic type II papillary renal cell carcinoma in the absence of intervening systemic therapy or surgery. This is the first reported case of spontaneous regression of papillary renal cell carcinoma.

Using whole genome amplification (WGA) of low-volume biopsies to assess the prognostic role of EGFR, KRAS, p53, and CMET mutations in advanced-stage non-small cell lung cancer (NSCLC).

Background: Progression of non-small cell lung cancer (NSCLC) from early- to late-stage may signify the accumulation of gene mutations. An advanced-stage tumor's mutation profile may also have prognostic value, guiding treatment decisions. Mutation detection of multiple genes is limited by the low amount of deoxyribonucleic acid extracted from low-volume diagnostic lung biopsies.

Harmonic scalpel in video-assisted thoracoscopic thymic resections.

Video-assisted thoracoscopic thymectomy is safe, but the efficacy of this technique in thymomectomy is unproved. Data of 103 consecutive patients who had thoracoscopic thymectomy and thymomectomy between 1998 and 2006 were retrospectively reviewed. Conventional monopolar diathermy and endoscopic Liga clips were used in the first 50 patients, and the Harmonic Scalpel was employed in the next 53.

Induction concurrent chemoradiotherapy using Paclitaxel and Carboplatin combination followed by surgery in locoregionally advanced non-small cell lung cancer--Asian experience.

Introduction: It has been established that combined chemoradiotherapy treatment benefits selected patients with stage III Non Small Cell Lung Cancer (NSCLC). However, locoregional recurrence still poses a problem. The addition of surgery as the third modality may provide a possible solution.

Thoracic complications of radiofrequency ablation of recurrent hepatoma.

Introduction: Radiofrequency ablation (RFA) for unresectable primary or secondary hepatic malignancies have gained widespread availability and acceptance over the past 5 years. Complication rates have been reported to range from 0% to 27%.

Clinical Picture: We report a patient with symptomatic right pleural effusion due to a diaphragmatic fistula and another with biliptysis post-RFA, for recurrent hepatoma.

Total tracheal resection for long-segment benign tracheal stenosis.

Tracheal resection for long benign tracheal stenosis is challenging because of the lack of a suitable replacement to facilitate tension-free anastomosis. We describe a patient with a 6-cm post-tuberculous tracheal stricture, severely debilitated post-recurrent bronchoscopic intervention. Staged resection facilitated near-total tracheal resection with primary anastomosis and complete symptom resolution.

Evaluation of partial carbon dioxide rebreathing cardiac output measurement during thoracic surgery.

Objective: Noninvasive partial CO2 rebreathing (NICO; Novametrix Medical Systems, Inc, Wallingford, CT) is a relatively new alternative to thermodilution (TDCO) for measurement of cardiac output. This study compares the 2 methods during thoracic surgery and one-lung ventilation.

Design: A prospective, observational study.

An alternative approach to determining therapeutic choices in advanced non-small cell lung carcinoma (NSCLC): maximizing the diagnostic procedure and the use of low-volume lung biopsies.

Background: Accurate mutational analysis, especially epidermal growth factor receptor (EGFR) mutations, of diagnostic biopsies from all Asian NSCLC patients is crucial to their clinical management, but faces problems. Here, we explore, within usual hospital constraints, the practicalities of incorporating mutational analysis in every newly diagnosed case of NSCLC, namely, maximizing tissue acquisition during the diagnostic procedure and determining the maximum quantity and quality of DNA sequence data available from these biopsies.

Methods: Sixty-eight Chinese patients were enrolled.