An Evaluation of Lymph Node Harvest in Sublobar Resections in a Statewide Quality Collaborative.

Objective: Evaluate the effectiveness of nodal harvest in sublobar resections (SLR) for peripheral non-small cell lung cancer (NSCLC).

Methods: Retrospective review of prospectively collected data for patients who underwent wedge resection (WR) and segmentectomy (SG) for NSCLC from January 2015 to March 2023 at 21 centers within a statewide quality collaborative. The primary end point was the extent of lymph node (LN) harvest defined as ≥ 10 LNs, ≥5 lymph node stations (LNS), or 3 mediastinal LNS and 1 hilar LNS (3/1 LNS).

Influence of air quality on lung cancer in people who have never smoked.

Objective: Lung cancer is the leading cause of cancer-related death. The percentage of people who have never smoked with lung cancer has risen recently, but alternative risk factors require further study. Our goal was to determine the influence of air quality on incidence of lung cancer in people who have smoked or never smoked.

Lung Cancer and Air Quality in a Large Urban County in the United States.

Lung cancer is the leading cancer-related killer in the United States. The incidence varies geographically and may be affected by environmental pollutants. Our goal was to determine associations within time series for specific air pollutants and lung cancer cases over a 33-year period in Wayne County, Michigan, controlling for population change.

Regional trends in diagnosis of advanced lung cancer in Michigan over 33 years.

Background: Lung cancer is the most common cancer killer worldwide. Nearly 80 percent of lung cancers are diagnosed at advanced stages. Lack of access to medical care and undwerutilized lung cancer screening are key reasons for advanced diagnoses.

Spatial and spatio-temporal clusters of lung cancer incidence by stage of disease in Michigan, United States 1985-2018.

Lung cancer is the most common cause of cancer-related death in Michigan. Most patients are diagnosed at advanced stages of the disease. There is a need to detect clusters of lung cancer incidence over time, to generate new hypotheses about causation and identify high-risk areas for screening and treatment.

Safety and usability of an endo staple line reinforcement device for pulmonary resections.

Background: Pulmonary resection can present technical challenges for surgeons due to the dissection and closure of tissues, which vary in thickness and elastic properties, occasionally leading to prolonged air leaks. Staple line reinforcements (SLRs) are widely utilized tools for fortifying the stability and integrity of closures in thoracic surgery, however, materials available and ease of use for both surgeon and scrub nurse have been suboptimal. A novel "click-and-go" device pre-loaded with bioabsorbable buttress material was recently developed, the Echelon Endopath SLR (ESLR, Ethicon, Inc.

Quality improvement mechanisms to improve lymph node staging for lung cancer: Trends from a statewide database.

Objective: Our statewide thoracic quality collaborative has implemented multiple quality improvement initiatives to improve lung cancer nodal staging. We subsequently implemented a value-based reimbursement initiative to further incentivize quality improvement. We compare the impact of these programs to steer future quality improvement initiatives.

Evidence-based opioid prescribing guidelines after lung resection: a prospective, multicenter analysis.

Background: Opioid prescribing guidelines have significantly decreased overprescribing and post-discharge use after cardiac surgery; however, limited recommendations exist for general thoracic surgery patients, a similarly high-risk population. We examined opioid prescribing and patient-reported use to develop evidence-based, opioid prescribing guidelines after lung cancer resection.

Methods: This prospective, statewide, quality improvement study was conducted between January 2020 to March 2021 and included patients undergoing surgical resection of a primary lung cancer across 11 institutions.

Clinical Outcome in Patients With Early-Stage Small Cell Lung Cancer Treated With Surgery or Radiation in the Absence of Prophylactic Cranial Irradiation: A Single-Center Retrospective Study.

Purpose: As screening chest computed tomography for patients at high risk for cancer has become more widely accepted, increasing numbers of patients with early-stage small cell lung cancer (SCLC) are being diagnosed. Although surgery is an accepted option for patients with early-stage SCLC, for patients who decline or cannot undergo surgery, stereotactic body radiation treatment (SBRT) is an alternative. Although prophylactic cranial irradiation (PCI) improves survival in patients with limited-stage SCLC, PCI for early-stage SCLC (stage T1-T2) has not been explored.

Understanding Racial Differences in Lung Cancer Surgery Through a Statewide Quality Collaborative.

Background: Persistent racial disparities in lung cancer incidence, treatment, and survival are well documented. Given the importance of surgical resection for lung cancer treatment, racial disparities in surgical quality were investigated using a statewide quality collaborative.

Methods: This retrospective study used data from the Michigan Society of Cardiothoracic Surgeons General Thoracic database, which includes data gathered for the Society of Thoracic Surgeons General Thoracic Surgery Database at 17 institutions in Michigan.

Long-term outcomes after robotic-assisted Ivor Lewis esophagectomy.

Robotic assistance has gained acceptance in thoracic procedures, including esophagectomy. There is a paucity of data regarding long-term outcomes for robotic esophagectomy. We previously reported our initial series of robot-assisted Ivor Lewis (RAIL) esophagectomy.

Hemolysis following wrap aortoplasty for Type A aortic dissection repair: Case report and review of the literature.

A Dacron wrap aortoplasty has been described as an adjunct to reduction ascending aortoplasty for the repair of Type A aortic dissections. We report a case of an uncomplicated hemiarch repair with wrap aortoplasty of the distal anastomosis which resulted in severe acute hemolysis. Despite only minimal focal graft deformation on imaging, the patient was found to have a flow gradient across the distal anastomosis, which was reduced by > 50% following release of the outer graft wrap.

Is Esophagectomy for Benign Conditions Benign?

Background: Outcomes data on esophagectomy performed for benign conditions is scarce. Using the National Surgical Quality Improvement Program database, we sought to analyze outcomes of esophagectomy performed for benign conditions.

Methods: The National Surgical Quality Improvement Program database was queried for all esophagectomies performed from 2005 to 2015.

Minimally invasive technique leads to decreased morbidity and mortality in small bowel resections compared to an open technique: an ACS-NSQIP identified target for improvement.

Background: We hypothesize that currently minimally invasive techniques are underutilized, leading to unnecessary morbidity and mortality. The objective of the study was to compare morbidity and mortality rates in patients receiving a minimally invasive (MIS) small bowel resection to patients receiving an open (OP) small bowel resection.

Methods: Patients in the National Surgical Quality Improvement Program (NSQIP) database who underwent a small bowel resection between 2007 and 2011 were enrolled in the study and grouped whether they received a MIS procedure (n = 1,780) or an OP procedure (n = 17,701).

Long-term symptom relief and patient satisfaction after Heller myotomy and Toupet fundoplication for achalasia.

Background: The goal of this study was to review the results, symptom relief, and patient satisfaction after laparoscopic Heller myotomy and Toupet fundoplication.

Methods: A cohort of patients who underwent laparoscopic esophagomyotomy and a Toupet fundoplication was identified. A retrospective chart review was conducted and patients then were interviewed by telephone using a modified 5-point Likert scale.