Thoracic Surgery Outcomes Research Network (ThORN) Consensus Document on Defining a High Quality Wedge Resection for Early Stage Lung Cancer.

With the publication of CALGB 140503, an increase in wedge resections for small, peripheral non-small cell lung cancer is expected; however, a relative paucity of data exists as to what defines a high quality oncologic wedge resection. The Thoracic Surgery Outcomes Research Network (ThORN), through expert discussion, guided by review of what limited data does exist, and through use of a modified Delphi process, provides these consensus statements defining an oncologically sound, high quality wedge resection. The statements are classified into five categories: 1) Preoperative Considerations 2) Technical Aspects 3) Lymph Node Assessment 4) Margin Assessment and 5) Tissue Handling by Pathology.

Quality of Anatomic Staging of Breast Carcinoma in Hospitals in the United States, With Focus on Measurement of Tumor Dimension.

Objectives: We investigated the accuracy of clinical breast carcinoma anatomic staging and the greatest tumor dimension measurements.

Methods: We compared clinical stage and greatest dimension values with the pathologic reference standard values using 57,747 cases from the 2016 US National Cancer Institute Surveillance, Epidemiology, and End Results program who were treated by surgical resection without prior neoadjuvant therapy.

Results: Agreement for clinical vs pathologic anatomic TNM group stage, overall, is 74.

Simplified, standardized methods to assess the accuracy of clinical cancer staging.

Background: Hospitals lack intuitive methods to monitor their accuracy of clinical cancer staging, which is critical to treatment planning, prognosis, refinements, and registering quality data.

Methods: We introduce a tabulation framework to compare clinical staging with the reference-standard pathological staging, and quantify systematic errors. As an example, we analyzed 9,644 2016 U.

Risk Factors for Nonhome Discharge After Esophagectomy for Neoplastic Disease.

Background: Esophagectomies are known to be technically challenging operations that create significant physiologic changes. These patients often require assisted care postoperatively that necessitates a nonhome discharge. The purpose of this study was to assess factors associated with nonhome discharge after esophagectomy for neoplastic disease.

Clinical Non-Small Cell Lung Cancer Staging and Tumor Length Measurement Results From U.S. Cancer Hospitals.

Rationale And Objectives: Examine the accuracy of clinical non-small cell lung cancer staging and tumor length measurements, which are critical to prognosis and treatment planning.

Materials And Methods: Compare clinical and pathological staging and lengths using 10,320 2016 National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) and 559 2010-2018 non-SEER single-institute surgically-treated cases, and analyze modifiable causes of disagreement.

Results: The SEER clinical and pathological group-stages agree only 62.

Minimally invasive esophagectomy: results of a prospective phase II multicenter trial-the eastern cooperative oncology group (E2202) study.

Objective: The primary aim of this trial was to assess the feasibility of minimally invasive esophagectomy (MIE) in a multi-institutional setting.

Background: Esophagectomy is an important, potentially curative treatment for localized esophageal cancer, but is a complex operation. MIE may decrease the morbidity and mortality of resection, and single-institution studies have demonstrated successful outcomes with MIE.

Surgery for small cell lung cancer.

Small-cell lung cancer (SCLC) comprises approximately 14% of all lung cancer cases. Most patients present with locally advanced or metastatic disease and are therefore treated nonoperatively with chemotherapy, radiotherapy, or both. A small subset of patients with SCLC present with early-stage disease and will benefit from surgical resection plus chemotherapy.

American College of Chest Physicians and Society of Thoracic Surgeons consensus statement for evaluation and management for high-risk patients with stage I non-small cell lung cancer.

Background: The standard treatment of stage I non-small cell lung cancer (NSCLC) is lobectomy with systematic mediastinal lymph node evaluation. Unfortunately, up to 25% of patients with stage I NSCLC are not candidates for lobectomy because of severe medical comorbidity.

Methods: A panel of experts was convened through the Thoracic Oncology Network of the American College of Chest Physicians and the Workforce on Evidence-Based Surgery of the Society of Thoracic Surgeons.

Chest computed tomography for penetrating thoracic trauma after normal screening chest roentgenogram.

Background: Chest computed tomography (CCT) is a method of screening for intrathoracic injuries in hemodynamically stable patients with penetrating thoracic trauma. The objective of this study was to examine the changes in utilization of CCT over time and evaluate its contribution to guiding therapeutic intervention.

Methods: A level 1 trauma center registry was queried between 2006 and 2011.

Chest wall resection and reconstruction: a true thoracoscopic approach.

We set out to perform resection of a chest wall mass with subsequent reconstruction using a pure thoracoscopic approach. Using video-assisted thoracic surgery via a three-incision approach, we successfully removed an 8.5 × 3.

Perioperative smoking cessation.

Smoking is the leading cause of preventable death worldwide. Smoking cessation programs that include counseling and pharmacotherapy have been proved to be effective in achieving long-standing abstinence. Smoking cessation is associated with significant improvements in quality of life, mortality, life expectancy, and postsurgical complication rates.

Successful thoracoscopic resection of a large mediastinal liposarcoma.

We report a case of a rare, large mediastinal liposarcoma diagnosed in a 74-year-old woman after a syncopal episode. Chest roentgenogram and computed tomographic scan showed a large mass occupying most of the right chest and abutting the great vessels and pericardium. A thoracoscopic approach was used for exploration and surgical excision of this large mediastinal mass.

Toward a simulation and assessment method for the practice of camera-guided rigid bronchoscopy.

We have developed a way to measure performance during a camera-guided rigid bronchoscopy using manikin-based simulation. In an effort to measure contact pressures within the airway during a rigid bronchoscopy, we instrumented pressure sensors in a commercially available bronchoscopy task trainer. Participants were divided into two groups based on self-reported levels of expertise: novice (none to minimal experience in rigid bronchoscopy) and experts (moderate to extensive experience).

Bronchial carcinoid secreting insulin-like growth factor-1 with acromegalic features.

Acromegaly caused by a bronchial carcinoid tumor is rare. We report a patient with acromegaly caused by a bronchial carcinoid tumor secreting insulin-like growth factor-1. The patient was treated successfully with bilobectomy.

Mucosal tube technique for creation of esophageal anastomosis after esophagectomy.

Background: The definitive treatment of esophageal cancer remains surgical resection. Morbidity and mortality are highly influenced by the success of the anastomosis created in the reconstruction of the resected esophagus. The results of an anastomotic technique that creates an esophageal mucosal tube are analyzed.

Acute superior vena cava occlusion after stenting of tracheoesophageal fistula.

Acute development of superior vena cava syndrome is unusual. This report describes a patient who suddenly presented with a superior vena cava obstruction after esophageal and tracheal stenting for a malignant tracheoesophageal fistula. Stenting of the superior vena cava rapidly alleviated the obstruction and resulted in resolution of symptoms.

Surgical considerations for the management and resection of esophageal gastrointestinal stromal tumors.

Background: Gastrointestinal stromal tumors (GISTs) are the most common sarcoma of the gastrointestinal tract, but occur rarely in the esophagus. Use of tyrosine kinase inhibitors has revolutionized therapy for GISTs but complete resection remains the treatment of choice. Esophageal GISTs require special consideration regarding perioperative treatment, evaluation, and conduct of operation.

Minimally invasive esophagectomy.

Minimally invasive esophagectomy can be safely performed in selected cases in centers specializing in minimally invasive esophageal surgery.Potential benefits include lessened physiologic insult, with decreased hospital stay and a more rapid recovery to full activity. Drawbacks include the cost of the disposable instrumentation and the steep learning curve.

Endoscopic therapies for gastroesophageal reflux disease.

Gastroesophageal reflux disease (GERD) is a chronic condition affect-ing over 7% of the US population. The primary objective of therapy is symptom relief, with secondary goals to heal esophagitis, prevent reflux-related complications, and maintain remission. There are several new endoscopic therapies (ETs) for treatment of GERD, generating considerable interest.

Quality of life measurement in the management of gastroesophageal reflux disease.

QOL measurement is being reported with increasing frequency in the surgical literature. The authors have found, as have others, that the use ofa generic instrument such as the SF36 in combination with a disease-specific instrument will provide the most comprehensive information. GERD isa significant health problem that primarily affects the QOL of a large segment of the population.

Radiofrequency ablation for the treatment of non-small cell lung cancer in marginal surgical candidates.

Objective: Treatment options for patients with non-small cell lung cancer who are not surgical candidates or who refuse operation are limited. Radiofrequency ablation represents a potential less invasive option for these patients. Our initial experience with radiofrequency ablation for peripheral, primary non-small cell lung cancer is reported.

Radiofrequency ablation: identification of the ideal patient.

Radiofrequency (RF) ablation (RFA) is a relatively new modality that is being used for lung tumors with increasing frequency. Radiofrequency energy consists of an alternating current that moves from an active electrode that is placed within the tumor to dispersive electrodes that are placed on the patient. As the RF energy is applied, frictional heating of tissues results, with cell death occurring at temperatures > 60 degrees C.