Intraoperative 125I brachytherapy for high-risk stage I non-small cell lung carcinoma.

Purpose: Preliminary assessment of feasibility, efficacy, acute and chronic side effects associated with permanent intraoperative placement of 125I vicryl mesh brachytherapy in a select group of high-risk Stage I NSCLC who have undergone video-assisted thoracoscopic resection (VATR).

Methods And Materials: From January 8, 1997 to March 16, 1998, 23 patients with Stage I NSCLC at high risk for conventional surgery due to cardiopulmonary compromise underwent combined VATR and intraoperative placement of 125I seeds embedded in vicryl mesh. Seeds embedded in vicryl suture were attached with surgical clips to a sheet of vicryl mesh, and thoracoscopically inserted over the target area (tumor bed and staple line) with nonabsorbable suture or surgical clips.

Computed tomography-guided wire localization of pulmonary lesions before thoracoscopic resection: results in 101 cases.

The authors determine the success rate, safety, and potential complications of computed tomography-guided preoperative hookwire localization of small peripheral pulmonary nodules. One hundred one consecutive wire localizations with addition of methylene blue injection were performed in 94 patients immediately before thoracoscopic resection of small lung lesions. Sixty-two patients had a known primary malignancy, whereas 32 had an asymptomatic nodule.

Fine-needle aspiration cytology of a mediastinal seminoma associated with multilocular thymic cyst.

Multiloculated thymic cysts are uncommon lesions that can be either acquired or associated with malignancies. This report describes the fine-needle aspiration (FNA) cytology of a mediastinal seminoma with prominent cystic change, confirmed by surgical pathology examination and ancillary studies performed on both the cytology and tissue specimens. The FNA cytology revealed clusters of malignant oval-to-polygonal-shaped cells with large oval nuclei possessing prominent nucleoli set in a pale-to-eosinophilic cytoplasm.

Expression of the Cell Adhesion Molecule CD44 in Human Lung Tumors and Cell Lines.

Background: The purpose of this study was to examine the expression of the cell adhesion molecule CD44 in normal lung, primary and metastatic lung tumors, and cell lines derived from primary lung carcinomas. Methods and Results: A total of 68 lung specimens including normal tissue and primary and metastatic tumors, as well as 28 cell lines cultured from primary lung tumors with high recurrence, were examined for CD44 expression by semiquantitative reverse transcription polymerase chain reaction. Variant exon expression was confirmed by Southern blotting and hybridization of particular samples.

The clinical significance of hepatocyte growth factor for non-small cell lung cancer.

Background: Hepatocyte growth factor (HGF) is a cytokine that is released after injury. It is a paracrine factor that is produced by mesenchymal cells; epithelial and endothelial cells respond to HGF through its receptor, the c-met protein. Hepatocyte growth factor induces cell growth and cell movement and is also highly angiogenic.

Success of laparoscopic fundoplication for gastroesophageal reflux disease.

Background: We explored the efficacy of laparoscopic fundoplication (LF) in patients with uncomplicated, medically recalcitrant pathologic gastroesophageal reflux disease (GERD) for whom we previously would have recommended open surgical repair.

Methods: From January 1994 to January 1998, we performed LF on 150 patients (80 men and 70 women) with GERD recalcitrant to maximal medical therapy. No patient suffered from esophageal stricture or epithelial dysplasia; however 16% (24 of 150) had benign Barrett's mucosa.

Effect of minimally invasive thoracic surgical approaches on acute and chronic postoperative pain.

Acute postthoracotomy pain and chronic postthoracotomy pain are significant problems leading to increased length of hospital stay and medical costs, reduction in patient quality of life and patient productivity, and potential immunologic derangement that may compromise oncologic surgical results. Minimally invasive surgical approaches can potentially benefit the patient by reducing postoperative pain-related morbidity. Objective data supporting our inclination that these VATS approaches are superior to open thoracic surgical techniques is accumulating.

Thoracoscopic lung biopsy or open lung biopsy for interstitial lung disease.

Both traditional open lung biopsy through a limited thoracotomy and VATS lung biopsy are effective methods for obtaining parenchymal samples in patients who have respiratory insufficiency and radiographic pulmonary infiltrates. For patients with slowly progressive disease processes, who require an elective biopsy, VATS biopsy is the procedure of choice because of the ability to visualize and sample multiple areas of the lung, and because of the decreased postoperative pain. On the other hand, when patients are critically ill and already on high-level ventilatory support, the VATS method offers no advantages over the standard minimal thoracotomy.

Early chest tube removal after video-assisted thoracoscopic wedge resection of the lung.

Background: Traditional management of chest tubes after a wedge resection of peripheral pulmonary tissue often lasts several days. We evaluated the safety and efficacy of early chest tube removal in the recovery room after uncomplicated video-assisted thoracoscopic surgical wedge resections of the lung.

Methods: From December 1995 to July 1997, 59 patients underwent video-assisted thoracoscopic surgical wedge resection for indeterminate pulmonary nodules (n = 33) or interstitial lung disease (n = 26).

A comparison of techniques for placement of double-lumen endobronchial tubes.

Study Objective: To compare two methods of double-lumen endobronchial tube placement for thoracic surgery and to identify factors that provide a rational basis for placement method selection.

Design: Prospective, randomized study.

Setting: Teaching hospital.

Morbidity, cost, and six-month outcome of minimally invasive direct coronary artery bypass grafting.

Background: Minimally invasive direct coronary artery bypass grafting (MIDCABG) promises to reduce the morbidity of coronary bypass, but this has not been proved.

Methods: This retrospective study compares the morbidity, mortality, cost, and 6-month outcome of patients less than 80 years old undergoing elective left internal mammary artery to left anterior descending artery bypass grafting via MIDCABG (n = 60) or sternotomy (n = 55) between January 1995 and December 1996. There were no differences between the groups in mean age, sex distribution, or preoperative risk level.

Is video-assisted thoracoscopic lobectomy a unified approach?

Background: Few surgeons worldwide currently perform video-assisted thoracoscopic (VAT) lobectomy. We conducted a questionnaire survey of this selected group of surgeons to gain insight into their current practice.

Methods: A survey with 25 questions on VAT lobectomy including operative approaches, techniques, its role in their practice, and limitations were mailed to 45 thoracic surgeons worldwide who are believed to perform this operation.

Intraoperative brachytherapy following thoracoscopic wedge resection of stage I lung cancer.

Study Objectives: Local recurrence is high when sublobar resection is chosen as primary management of stage I non-small cell lung carcinoma. Postoperative external-beam radiotherapy may reduce this local recurrence problem. A technique of intraoperative brachyradiotherapy following thoracoscopic wedge resection is described as an alternative to adjuvant external-beam radiotherapy for high-risk patients who are not candidates for pulmonary lobectomy.

Differentiation and programmed cell death-related intermediate biomarkers for the development of non-small cell lung cancer: a pilot study.

Fifty samples of lung tissue from patients with non-small cell lung cancer were analyzed for the expression and localization of biomarkers related to squamous differentiation and programmed cell death. These markers include tissue transglutaminase (tTG), keratinocyte transglutaminase (kTG), involucrin, loricrin, and Bcl-2. We found that all of these markers are overexpressed in tumors as compared with histologically normal lung epithelium, where expression is minimal.

Preoperative chemoradiotherapy for carcinoma of the esophagus and gastroesophageal junction.

Purpose: To determine whether combination 5-fluorouracil, cisplatin, and interferon alfa, an active regimen in advanced esophageal cancer, is efficacious as induction therapy before esophagectomy.

Materials And Methods: Forty-four patients with potentially resectable esophageal/gastroesophageal junction adenocarcinoma or squamous cell carcinoma were entered into a phase I/II study of this chemotherapeutic regimen and concurrent external-beam radiotherapy before resection. The initial 16 patients were treated with prolonged-infusion 5-fluorouracil (300 mg/m2 on days 1 to 28), cisplatin (20 mg/m2 on days 1 to 5 and 24 to 28), interferon alfa (3 x 10(6) U/m2 intravenously on days 1 to 5 and 24 to 28; subcutaneous injection every other day on days 6 to 23), and radiation (4000 cGy).

p53 sequence analysis predicts treatment response and outcome of patients with esophageal carcinoma.

Background: The ability to predict biologic behavior and treatment responsiveness would be a valuable asset in the multimodality approach to esophageal carcinoma. The authors examined whether alterations of the p53 gene correlate with clinicopathologic parameters, response to preoperative chemotherapy/radiotherapy, and outcome in patients with esophageal carcinoma. METHODS.

Preliminary results of thoracoscopic Belsey Mark IV antireflux procedure.

Laparoscopic Nissen fundoplication has replaced open approaches for refractory gastroesophageal reflux disease (GERD) in many major medical centers. Here we report our preliminary results of the Belsey Mark IV antireflux procedure performed by video-assisted thoracoscopy (VATS-Belsey). Fifteen patients underwent VATS-Belsey.

Thoracoscopic techniques for the management of intrathoracic metastases. Results.

Background: The authors reviewed a series of 74 patients with cancer metastatic to the chest cavity undergoing thoracoscopic procedures. Indications, feasibility, and outcome of thoracoscopy were analyzed.

Methods: Perioperative and survival data on patients undergoing 89 operative thoracoscopic procedures between January 1991 and August 1993 were retrieved from a prospective database.

Future directions in esophageal cancer.

The incidence of esophageal cancer in the United States has been increasing in recent years. Since multimodality therapy for esophageal cancer has produced discouraging results, recent approaches have focused on molecular biological techniques, positron emission tomography, and minimally invasive surgery to improve pretreatment staging which will facilitate a more accurate assessment of new treatment. This article summarizes the results of studies investigating these approaches and outlines the strategy currently used at the University of Pittsburgh Medical Center.

The role of thoracoscopy in lung cancer management.

Video-assisted thoracic surgery (VATS) has enabled more complex procedures previously requiring thoracotomy to be accomplished in lung cancer management. VATS today can be employed in the evaluation of idiopathic (and known) malignant pleural effusions, mediastinal adenopathy, indeterminate pulmonary nodules, and compromise resection and lobectomy of peripheral stage I non-small cell lung cancer. Thus, VATS is becoming an accepted approach to a variety of intrathoracic problems, although its absolute indications for patients with lung cancer have yet to be firmly defined.

Video-assisted thoracoscopic surgery for resection of lung metastases.

Resection of indeterminate pulmonary lesions in patients with a history of malignancy is indicated, as the presence of metastases will provide prognostic information and often dictate further therapy. Pulmonary metastasectomy also improves survival in select patients with favorable tumor histologies. We reported the results of video-assisted thoracoscopic surgery (VATS) resection of indeterminate lung nodules in 72 patients with a history of malignancy.

Role of nutrition support during induction chemoradiation therapy in esophageal cancer.

Background: Preoperative chemoradiation therapy (CRT) potentially benefits a subgroup of patients with esophageal cancer. The ability to administer aggressive CRT may depend on the initial nutritional status and the ability to sustain nutrition during therapy. Parenteral nutrition support during CRT may lead to complications that limit its usefulness and negate any potential benefit.

Minimally invasive surgical staging is superior to endoscopic ultrasound in detecting lymph node metastases in esophageal cancer.

Objective: Endoscopic ultrasonography is frequently used to locally stage esophageal cancer, but few studies exist to validate its accuracy for lymph node metastases. Our objective was to compare endoscopic ultrasonography with video-assisted thoracoscopic and laparoscopic staging in evaluating lymph node metastases in esophageal cancer.

Methods: Twenty-six patients with potentially resectable esophageal cancer were identified by conventional imaging.