Lobectomy for Suspected Lung Cancer Without Prior Diagnosis.

Background: We describe use, patients, and outcome of diagnostic lobectomy for suspected lung cancer without pathologic confirmation.

Methods: A retrospective review of consecutive lobectomy or bilobectomy for suspected or confirmed primary pulmonary malignancy was conducted using our participant's sample of The Society of Thoracic Surgeons database. Surgeons performed lobectomy based on clinical diagnosis or confirmation on a biopsy specimen.

E-Cigarette Use, Small Airway Fibrosis, and Constrictive Bronchiolitis.

Background: Vaping, including the use of electronic cigarettes (e-cigarettes), has become increasingly prevalent, yet the associated long-term health risks are largely unknown. Given the prevalence of use, particularly among adolescents early in their lifespan, it is vital to understand the potential chronic pathologic sequelae of vaping.

Methods: We present the cases of four patients with chronic lung disease associated with e-cigarette use characterized by clinical evaluation, with pulmonary function tests (PFTs), chest high-resolution computed tomography (HRCT), endobronchial optical coherence tomography (EB-OCT) imaging, and histopathologic assessment.

Contributing factors to lymph node recovery with esophagectomy by thoracic surgeons: an analysis of the Society of Thoracic Surgeons General Thoracic Surgery Database.

Given the association between lymphadenectomy and survival after esophagectomy, and the ongoing development of effective adjuvant protocols for identified residual disease, we determined factors contributing to lymph node yield and effects on postoperative morbidity following esophagectomy by thoracic surgeons. Using the Society of Thoracic Surgeons General Thoracic Surgery Database, all patients who underwent esophagectomy for primary esophageal cancer with gastric conduit reconstruction from 2012 to 2016 were identified. Patient demographics, technical factors, and tumor characteristics associated with lymph node yield were determined using a multivariable multilevel mixed-effects regression model.

Management of Air Leaks and Residual Spaces Following Lung Resection.

Air leaks and residual airspaces following lung resection are common problems in thoracic surgery. Prolonged air leaks frequently necessitate extended hospitalization. This is true whether the surgery was done in an open fashion or with video-/robot-assisted thoracic surgery.

Surgical intervention for late gastric conduit obstruction.

Objectives: Gastric emptying delay after oesophagectomy may occur in conduits exposed to pleural forces of respiration or anatomic obstruction. Remedial operations addressing both causes are rarely reported. The study aim was to categorize severe gastric conduit obstruction (GCO) and report the outcome of surgical revision.

Management and outcomes of esophageal perforation.

Background: Esophageal perforation is a morbid condition and remains a therapeutic challenge. We report the outcomes of a large institutional experience with esophageal perforation and identify risk factors for morbidity and mortality.

Methods: A retrospective analysis was conducted on 142 patients who presented with a thoracic or gastroesophageal junction esophageal perforation from 1995 to 2020.

Risk factors for recurrent spontaneous pneumothorax: A population level analysis.

Background: We sought to determine the rate and risk factors of recurrent spontaneous pneumothorax in a diverse population.

Methods: Cohort study using the California Public Discharge Data file (1995-2010). We identified patients with first-time spontaneous pneumothorax.

Evaluation of Release Maneuvers After Airway Reconstruction.

Background: Airway release (AR) maneuvers performed during airway resection to reduce anastomotic tension have not been thoroughly studied.

Methods: This study retrospectively analyzed consecutive resections for postintubation stenosis (PITS) and primary tracheal neoplasms (PTNs) at Massachusetts General Hospital (Boston, MA). Anastomotic complications were defined as stenosis, separation, necrosis, granulation tissue, and air leak.

Programmed Death Ligand 1 and Immune Cell Infiltrates in Solitary Fibrous Tumors of the Pleura.

Background: Approximately 10% to 15% of patients with solitary fibrous tumors of the pleura (SFTP) have recurrence after resection. Many are not candidates for reresection and lack effective treatments. We explored the expression of programmed death ligand 1 (PD-L1) as a biomarker for candidacy for treatment with immune checkpoint inhibitors.

Pregnancy-associated idiopathic laryngotracheal stenosis: presentation, management and results of surgical treatment.

Objectives: Idiopathic laryngotracheal stenosis (ILTS) is an uncommon problem arising mostly in women. In some, it arises during or is exacerbated by pregnancy. Experience with management of patients with this rare association is limited.

Hyperbaric oxygen therapy in the prevention and management of tracheal and oesophageal anastomotic complications.

Objectives: Failure of anastomotic healing is a morbid complication after airway or oesophageal surgery. Hyperbaric oxygen therapy (HBOT) has been used extensively in the management of complex wound-healing problems. We demonstrate the use of HBOT to rescue at-risk anastomoses or manage anastomotic failures in thoracic surgery.

Multidisciplinary selection of pulmonary nodules for surgical resection: Diagnostic results and long-term outcomes.

Objective: Pulmonary nodules found incidentally or by lung cancer screening differ in prevalence, risk profile, and diagnostic intervention. The results of surgical intervention for incidental versus screening lung nodules during multidisciplinary Pulmonary Nodule and Lung Cancer Screening Clinic (PNLCSC) follow-up have not been reported.

Methods: All patients evaluated at a PNLCSC from 2012 to 2018 following referral by primary care physicians, specialist physicians, or self-referral after computed tomography (CT) identified nodules on routine diagnostic CT (incidental group) or lung cancer screening CT (screening group) were included.

The Importance of a Diverse Specialty: Introducing the STS Workforce on Diversity and Inclusion.

Despite an ever-diversifying United States population, women and underrepresented minorities lack proportionate membership in the cardiothoracic surgery workforce. Many Society of Thoracic Surgeons (STS) members view achieving a diverse cardiothoracic surgery workforce as important. To address the needs of our specialty to better reflect and understand (cultural competence) our evolving communities, the STS created the Workforce on Diversity and Inclusion.

Pulmonary Artery Resection During Lung Resection for Malignancy.

Background: Complete resection of central tumors invading the main pulmonary artery (PA) requires arterial reconstruction to avoid pneumonectomy. Oncologic equivalence with pneumonectomy has been suggested. We review clinical selection and outcome for these uncommon procedures in the context of candidacy for pneumonectomy.

Postintubation Tracheal Stenosis: Management and Results 1993 to 2017.

Background: To evaluate the management, complications of treatment, and outcomes of postintubation tracheal stenosis.

Methods: A retrospective review was performed of records from a prospective database of all patients undergoing tracheal or laryngotracheal resection from 1993 to 2017 for postintubation tracheal stenosis. Redo operations after failure of initial resection and reconstruction for postintubation tracheal stenosis were included.

Educational Challenges of the Operating Room.

Resident education in the operating room and surgical resident autonomy represent two enormous challenges within cardiothoracic (CT) training programs. The goal of surgical educators and CT trainees is to ensure the graduating resident's ability to safely operate independently at the completion of training. The field has come a long way from the notion of see one, do one, teach one, which was once the norm.

Impact of Radial Margin Status After Esophagectomy for Adenocarcinoma.

Introduction: The clinical impact of a positive radial margin after esophagectomy for cancer has not been clearly  identified. The goal of this study was to identify risk factors for a positive radial margin and determine the impact on recurrence and survival.

Methods: Retrospective review of 196 patients with pathological T3 N0-3 esophageal adenocarcinoma undergoing esophagectomy between 2002 and 2017.

Carinal surgery: A single-institution experience spanning 2 decades.

Objectives: Complete resection of neoplasms involving the carina are technically challenging and have high operative morbidity and mortality. This study examines the last 2 decades of clinical experience at our institution.

Methods: Medical records were retrospectively reviewed between 1997 and 2017 to identify all patients who underwent carinal resection.

Programmed death ligand 1 and CD8+ immune cell infiltrates in resected primary tracheal malignant neoplasms.

Objectives: Many patients with primary malignant tracheal neoplasms are not surgical candidates nor do they experience residual or recurrent disease after surgery and may benefit from alternative therapies. This study explores the expression of programmed death ligand 1 (PD-L1) in patients with primary tracheal malignancy as a biomarker for candidacy for treatment with immune checkpoint inhibitors.

Methods: We conducted a retrospective review of the medical records of 23 patients with resected primary tracheal malignant tumours from 2010 to 2016.

Relative Incremental Cost of Postoperative Complications of Esophagectomy.

The purpose of this study was to quantify the cost impact of complications of esophagectomy and identify opportunities for reducing costs while optimizing outcomes. Patients undergoing esophagectomy at a single institution between 2002 and 2017 were included. Complications were tabulated from clinical data.