[Delphi Expert Consensus of the German Society for Thoracic Surgery on Segmentectomy for Non-small Cell Lung Cancer].

Background: Findings from two recently published randomised controlled trials have shown favourable oncological results of segmentectomy for early-stage NSCLC < 2 cm. This has generated a growing interest in this procedure, which is however considered technically more challenging than lobectomy. The aim of the working group of the German Society for Thoracic Surgery (DGT) was to address, via an expert consensus project, topics concerning implementation of segmentectomy in lung cancer surgery.

Survival outcomes in a prospective randomized multicenter Phase III trial comparing patients undergoing anatomical segmentectomy versus standard lobectomy for non-small cell lung cancer up to 2 cm.

Objectives: The oncological equivalence of anatomical segmentectomy for early stage non-small cell lung cancer (NSCLC) is still controversial. Primary aim of this study was survival outcomes in combination with improved quality of life after segmentectomy compared with lobectomy in patients with pathological stage Ia NSCLC (up to 2 cm, 7th edition) MATERIALS AND METHODS: We conducted a prospective, randomized, multicenter phase III trial to confirm the non-inferiority of segmentectomy to lobectomy in regard to prognosis (trial No. DRKS00004897).

The impact of gender bias in cardiothoracic surgery in Europe: a European Society of Thoracic Surgeons and European Association for Cardio-Thoracic Surgery survey.

Objectives: The European Society of Thoracic Surgeons and the European Association for Cardio-Thoracic Surgery designed a questionnaire to assess the impact of gender bias on a cardiothoracic surgery career.

Methods: A 46-item survey investigating gender bias was designed using online survey software from December 2020 to January 2021. All European Society of Thoracic Surgeons and European Association for Cardio-Thoracic Surgery members and non-members included in the mailing lists were invited to complete an electronic survey.

["Tissue Handling" in Thoracic Surgery - Results of a Delphi Expert Consensus Conference of the German Society for Thoracic Surgery].

Background: The aim of this working group of the German Society for Thoracic Surgery (DGT) was to develop an expert consensus based on the Delphi method to define "tissue handling" and depict intraoperative handling of specific anatomical structures during thoracic surgery.

Methods: Invited experts (thoracic surgery specialists; n = 93) completed two consecutive rounds of electronic Delphi questions on four main topics: transection of lung parenchyma, dissection/separation of pulmonary vessels, angioplasty/vascular anastomoses, and bronchus settling closure/plasty/anastomosis. Consensus was set at ≥ 75% agreement.

From female surgical resident to academic leaders: challenges and pathways forward.

Despite an increasing number of female surgeons it is still very difficult for them to get into high rank positions. What are the obstacles for women to achieve a professional level where they can lead teams, departments or organisations or be invited as speakers in meetings or for editorial comments? Besides the general attitude still existing in many societies that women are responsible for child care there is a clear difference in self-presentation of women compared to their male counterparts. Women tend to underestimate their competence and skills whereas (often male) decision makers expect candidates to present themselves in a rather self-confident way.

Endoscopic lung volume reduction with endobronchial valves in very low patients: results from the German Registry - Lungenemphysemregister e.V.

Background: Endoscopic lung volume reduction (ELVR) with valves has been suggested to be the key strategy for patients with severe emphysema and concomitant low diffusing capacity of the lung for carbon monoxide ( ). However, robust evidence is still missing. We therefore aim to compare clinical outcomes in relation to for patients treated with ELVR.

[Delphi Expert Consensus of the German Thoracic Surgery Society on Perioperative Management of Oncological Anatomical Lung Resections].

Background: Anatomical lung resection for curative treatment of a tumour disease is the most common selective procedure in oncological thoracic surgery. The goal of the working group of the German Thoracic Surgery Society (DGT) was to achieve a consensus on the perioperative management of selective oncological lung resection procedures.

Methods: The assigned group of the DGT designed and conducted two electronic rounds of questions in all major thoracic and lung centres.

[Lymphadenectomy during Potentially Curative Pulmonary Metastasectomy - Recommendations of an Expert Consensus Panel using the Delphi Process].

Background: The aim of the consensus approach was to improve the quality of care by agreement on definitions and standards, in order to harmonise lymphadenectomy during lung metastasectomy.

Methods: The Delphi process consisted of two rounds of anonymous voting before discussion at a consensus meeting to reach final consensus within a group of experts. Consensus was assumed when > 75% of the panel agreed.

Perioperative course and quality of life in a prospective randomized multicenter phase III trial, comparing standard lobectomy versus anatomical segmentectomy in patients with non-small cell lung cancer up to 2 cm, stage IA (7th edition of TNM staging system).

Objectives: For early stage non-small cell lung cancer (NSCLC) retrospective data of functionally compromised patients undergoing segmentectomy showed equal outcomes for perioperative complications and quality of life (QoL) compared with lobectomy patients. However no prospectively randomized data comparing patients eligible for both procedures are available.

Materials And Methods: We conducted a prospective, randomized, multicenter phase III trial and investigated perioperative complications and QoL in patients with NSCLC stage IA (7th edition) undergoing segmentectomy versus lobectomy.

[Delphi Expert Consensus of the German Thoracic Surgery Society on the Management of Chest Tube Drainage].

Background: Chest tubes are a valuable instrument and are used on a daily basis - not only by thoracic surgeons but also by a variety of medical specialists who treat pneumothorax or pleural effusions. The goal of the working group of the German Thoracic Society (DGT) was to achieve a consensus on the management of chest tube/drainage using the Delphi process.

Methods: The assigned group of the DGT designed and conducted two electronic rounds of questions in all major thoracic and lung cancer centres.

Contribution of CAD to the Sensitivity for Detecting Lung Metastases on Thin-Section CT - A Prospective Study with Surgical and Histopathological Correlation.

Purpose:  To assess the sensitivity of radiologists and a CAD system for the detection of lung metastases on thin-section computed tomographic (CT) scans prior to pulmonary metastasectomy.

Materials And Methods:  All patients scheduled for resection of lung metastases were eligible for this prospective single-center trial. 95 patients with 115 surgical procedures (pulmonary metastasectomy using thoracotomy) were included.

Epigenomic profiling of non-small cell lung cancer xenografts uncover LRP12 DNA methylation as predictive biomarker for carboplatin resistance.

Background: Non-small cell lung cancer (NSCLC) is the most common cause of cancer-related deaths worldwide and is primarily treated with radiation, surgery, and platinum-based drugs like cisplatin and carboplatin. The major challenge in the treatment of NSCLC patients is intrinsic or acquired resistance to chemotherapy. Molecular markers predicting the outcome of the patients are urgently needed.

QSEA-modelling of genome-wide DNA methylation from sequencing enrichment experiments.

Genome-wide enrichment of methylated DNA followed by sequencing (MeDIP-seq) offers a reasonable compromise between experimental costs and genomic coverage. However, the computational analysis of these experiments is complex, and quantification of the enrichment signals in terms of absolute levels of methylation requires specific transformation. In this work, we present QSEA, Quantitative Sequence Enrichment Analysis, a comprehensive workflow for the modelling and subsequent quantification of MeDIP-seq data.

Transoral endoscopic mediastinal surgery (TOEMS)-results of a first clinical study for scarless mediastinal lymph node biopsies.

Background: Video-assisted mediastinoscopy (VAM) represents the standard procedure for mediastinal lymph node biopsies. This operation results in a scar at prominent position at the anterior neck. Since there is a trend to less invasive procedures, natural orifice transluminal endoscopic surgery (NOTES) was introduced to different fields of surgery.

Comparison of volatile organic compounds from lung cancer patients and healthy controls-challenges and limitations of an observational study.

This paper outlines the design and performance of an observational study on the profiles of volatile organic compounds (VOCs) in the breath of 37 lung cancer patients and 23 healthy controls of similar age. The need to quantify each VOC considered as a potential disease marker on the basis of individual calibration is elaborated, and the quality control measures required to maintain reproducibility in breath sampling and subsequent instrumental trace VOC analysis using solid phase microextraction-gas chromatography-mass spectrometry over a study period of 14 months are described. Twenty-four VOCs were quantified on the basis of their previously suggested potential as cancer markers.

European guidelines on structure and qualification of general thoracic surgery.

Objective: To update the recommendations for the structural characteristics of general thoracic surgery (GTS) in Europe in order to provide a document that can be used as a guide for harmonizing the general thoracic surgical practice in Europe.

Methods: A task force was created to set the structural, procedural and qualification characteristics of a European GTS unit. These criteria were endorsed by the Executive Committee of the European Society of Thoracic Surgeons and by the Thoracic Domain of the European Association for Cardio-Thoracic Surgery and were validated by the European Board of Thoracic Surgery at European Union of Medical Specialists.

Management of tracheal surgery complications.

Complications in tracheal surgery are not uncommon but generally do not influence the final result. Most patients benefit from tracheal resections and mortality is low. Risk factors for complications are reoperations, preoperative tracheostomy, and lengthy resections.

Correlation of SHOX2 gene amplification and DNA methylation in lung cancer tumors.

Background: DNA methylation in the SHOX2 locus was previously used to reliably detect lung cancer in a group of critical controls, including 'cytologically negative' samples with no visible tumor cell content, at a high specificity based on the analysis of bronchial lavage samples. This study aimed to investigate, if the methylation correlates with SHOX2 gene expression and/or copy number alterations. An amplification of the SHOX2 gene locus together with the observed tumor-specific hypermethylation might explain the good performance of this marker in bronchial lavage samples.

Chemoresistance in non-small-cell lung cancer: can multidrug resistance markers predict the response of xenograft lung cancer models to chemotherapy?

Objective: In chemotherapy for non-small-cell lung cancer (NSCLC), some patients seem to exhibit an intrinsic resistance or develop an acquired resistance under treatment. Results on resistance markers for possible treatment failure as shown in studies on selected lung cancer cell lines could not be completely confirmed in clinical trials. As these conflicting data require further research, we created a model between cell culture and the clinical need to study this problem.

Development of a new trans-oral endoscopic approach for mediastinal surgery based on 'natural orifice surgery': preclinical studies on surgical technique, feasibility, and safety.

Objective: In recent years, several surgical disciplines adopted endoscopic techniques. Presently, natural orifice approaches are under exploration to reduce surgical access trauma. We have developed a trans-oral endoscopic approach for endoscopic mediastinal surgery and have tested this new technique in preclinical studies for feasibility and safety.

Reliability of a computer-aided detection system in detecting lung metastases compared to manual palpation during surgery.

For resection of lung metastases computed tomography (CT) is needed to determine the operative strategy. A computer-aided detection (CAD) system, a software tool for automated detection of lung nodules, analyses the CT scans in addition to the radiologists and clearly marks lesions. The aim of this feasibility study was to evaluate the reliability of CAD in detecting lung metastases.