An analysis, systematic review, and meta-analysis of the perioperative mortality after neoadjuvant therapy and pneumonectomy for non-small cell lung cancer.

Objective: Pneumonectomy after neoadjuvant therapy remains controversial.

Methods: A systematic PubMed search was performed for original articles from 1990 through 2010 describing pneumonectomy after neoadjuvant therapy. Specific data on 30-day and 90-day perioperative mortalities were abstracted from these articles.

Approach to the ground-glass nodule.

The detection of ground-glass opacity (GGO) is increasingly common. Sufficient data have been accumulated to formulate recommendations for observation, intervention, and treatment modalities. However, an understanding of many nuances and uncertainties in the available data is needed to avoid making management errors.

Molecular classification of nonsmall cell lung cancer using a 4-protein quantitative assay.

Background: The importance of definitive histological subclassification has increased as drug trials have shown benefit associated with histology in nonsmall-cell lung cancer (NSCLC). The acuity of this problem is further exacerbated by the use of minimally invasive cytology samples. Here we describe the development and validation of a 4-protein classifier that differentiates primary lung adenocarcinomas (AC) from squamous cell carcinomas (SCC).

Impact of hospital volume of thoracoscopic lobectomy on primary lung cancer outcomes.

Background: This study evaluated hospital operative volume of video-assisted thoracoscopic surgery (VATS) lobectomy in primary lung cancer as a predictor of short-term outcomes after pulmonary lobectomy on a national scale. Some previous analyses comparing VATS vs open lobectomy outcomes have been limited by inaccuracies in patient cohort identification.

Methods: The 2008 Healthcare Utilization Project-Nationwide Inpatient Sample database was culled using the International Classification of Diseases (9th Clinical Modification) procedure codes specifically distinguishing VATS vs open lobectomies (32.

Long-term survival after lung resection for non-small cell lung cancer with circulatory bypass: a systematic review.

Objective: Resection of locally advanced non-small cell lung cancer using circulatory bypass is not frequently performed. The objective of this study was to systematically review the long-term survival associated with the published studies dealing with the performance of lung resections for non-small cell lung cancer using circulatory bypass.

Methods: A systematic review of publications dealing with lung resections for non-small cell lung cancer under circulatory bypass spanning from January 1, 1990, to December, 31 2010, was performed using a PubMed search with specific inclusion and exclusion criteria.

Stage classification and prognosis: an intersection of medicine, quantum physics and religion?

Estimating prognosis is an important part of caring for patients with cancer. However, predicting prognosis is complicated and depends on many factors. Simply amassing more data alone is not the answer; we have to learn to intellectually manage the inherent complexity and uncertainty if we are to make progress.

Management of thymic tumors: a survey of current practice among members of the European Society of Thoracic Surgeons.

Introduction: Management of thymoma has largely been based on single-institution retrospective, observational studies. The European Society of Thoracic Surgeons (ESTS) Thymic Working Group has investigated the current practice among ESTS members.

Methods: A questionnaire divided into seven sections with 24 questions was designed, and it was delivered to ESTS members.

Correction of postpneumonectomy syndrome using a custom implant.

The authors describe a patient who underwent a right pneumonectomy for removal of a bronchial carcinoid tumour. Over time she developed recurrent infections, dyspnoea and wheeze despite no evidence of tumour recurrence. A marked mediastinal shift caused severe narrowing of the left main-stem bronchus as it was draped over the vertebral column consistent with a diagnosis of postpneumonectomy syndrome.

Management of stage I and II thymoma.

With a knowledgeable assessment of the clinical presentation and demographic and radiologic characteristics, most thymomas can be reliably identified preoperatively without the need for a biopsy. Surgery is the mainstay of treatment for stage I and II thymoma. The rate of complete resection is essentially 100% by open techniques, and recurrences are rare.

Standard outcome measures for thymic malignancies.

Thymic malignancies present particular issues due to the pace of disease progression, patterns of recurrence, and causes of death that make nuances of how outcomes are reported particularly important. The relatively limited number of patients also creates a challenge to glean as much as possible from the available experience, but risks over-interpretation and potentially misleading conclusions. Therefore the International Thymic Malignancy Interest Group has developed a set of standards for reporting of outcome measures of clinical studies, which have been adopted for collaborative projects undertaken by the organization.

Should the 7th edition of the lung cancer stage classification system change treatment algorithms in non-small cell lung cancer?

Introduction: Approximately 10 to 15% of non-small cell lung cancer patients will be assigned a stage classification according to the 7th edition of TNM that differs from that assigned by the 6th edition (the "stage shifters"). This apparent upstaging or downstaging of tumors may affect patient management, as many clinicians formulate stage-based management strategies. However, the staging system revision was not designed to evaluate treatment, and attempts to make parallel adjustments in treatment plans may not be justified.

Transient brachial plexus palsy: an unusual complication of paravertebral infusion of local anesthetic.

A continuous infusion of 0.25% bupivaciane into the parevertebral space was used for postoperative pain relief after a lung resection. On postoperative day 1, a brachial plexus palsy developed, which resolved on discontinuation of the infusion.