Evaluation of high-risk pulmonary nodules and pathologic correlation in patients enrolled in a low-dose computed tomography (LDCT) program.

Background: The American Cancer Society estimates that lung cancer is responsible for 155,870 deaths: 84,590 in men and 71,280 in women. In an effort to reduce lung cancer mortality, many major medical societies have recommended annual low-dose CT screenings for high-risk individuals. The Centers for Disease Control and Prevention (CDC) has recommended yearly lung cancer screening with LDCT for people who are classified as high-risk individuals.

50 Patients with Malignant Mesothelioma of Both the Pleura and Peritoneum: A Single-Institution Experience.

Background: The most common sites of malignant mesothelioma are the pleura and peritoneum, but little is known about the incidence, prognosis, or treatment of patients with disease in both cavities. Previous series suggest that multimodality treatment improves overall survival for pleural or peritoneal disease, but studies typically exclude patients with disease in both cavities. Despite limitations, this investigation is the only study to broadly examine outcomes for patients with malignant mesothelioma in both the pleural and peritoneal cavities.

Novel Treatment for Anastomotic Leak After Ivor-Lewis Esophagectomy.

Intrathoracic anastomotic leaks after esophagogastrostomy occur frequently, often resulting in prolonged hospitalization and delays in advancing oral nutrition and hydration. Management of anastomotic esophageal leaks vary based on time of occurrence to time of intervention, condition of the patient, and location. Conservative approaches such as endovascular clips and endovascular stents have gained momentum in addressing esophageal leaks and fistulas, replacing the original paradigm of surgical approach as initial management.

Less Common Side Effects of Sympathetic Surgery.

Because of video-assisted thoracic technology and increased patient awareness of treatment options for palmar hyperhidrosis, endoscopic thoracic sympathectomy (ETS) has become a well-accepted treatment for this disorder. Video assistance affords excellent visualization of thoracic anatomy, which allows the procedure to be done quickly with few complications. However, despite the ease of performing ETS, complications can occur unless thoracic anatomy and physiology are well-understood.

Pulmonary Kirsten Rat Sarcoma Virus Mutation Positive Mucinous Adenocarcinoma Arising in a Congenital Pulmonary Airway Malformation, Mixed Type 1 and 2.

Congenital pulmonary airway malformation (CPAM) is a developmental abnormality of the lung, which results from an abnormality of branching during fetal development of the lung. We report the case of an 18 year-old woman who developed Kirsten rat sarcoma virus (KRAS) mutation positive mucinous adenocarcinoma of the lung (AC) in association with mixed CPAM type 1 and 2. This case is unique as KRAS mutation positive AC is present in a setting of both CPAM 1 and 2 in the same lesion.

The efficacy of EBUS-guided transbronchial needle aspiration for molecular testing in lung adenocarcinoma.

Background: The purpose of the study was to assess the efficacy of obtaining adequate cytologic specimens by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for molecular testing of lung adenocarcinomas.

Methods: This was an institutional review board-approved study of all patients who had undergone EBUS-TBNA from April 2010 through March 2012 for the diagnosis, staging, or both of lung cancer. Patients with a diagnosis of adenocarcinoma were reflexively tested for molecular markers by polymerase chain reaction, sequencing, and fluorescence in situ hybridization (FISH).

Minimally invasive thymectomy and open thymectomy: outcome analysis of 263 patients.

Background: An open thymectomy is a morbid procedure. If a minimally invasive thymectomy is performed without compromising the tenets of thymic surgery, it has the potential for decreasing morbidity and may offer similar clinical and oncologic results.

Methods: This is an institutional review board-approved, retrospective study of a single center's experience with both open (transsternal) and minimally invasive (video-assisted thoracoscopic surgery) thymectomy.

Social anxiety and functional impairment in patients seeking surgical evaluation for hyperhidrosis.

Primary hyperhidrosis is characterized by excessive sweating and often accompanied by social avoidance. Social anxiety disorder (SAD) is characterized by fear and avoidance of social situations, often partly related to fears of showing signs of excessive autonomic nervous system activation, such as sweating. To clarify the relationship of hyperhidrosis and SAD, this study assessed severity of sweating, overall social anxiety and social anxiety due to sweating, and disability in 2 groups: patients seeking surgical treatment for hyperhidrosis (n = 40) and patients seeking treatment for SAD (n = 64).

The use of a tailored surgical technique for minimally invasive esophagectomy.

Objective: Uncertainty exists among surgeons as to whether minimally invasive esophagectomy (MIE) is a comparable operation to open esophagectomy (OE). The surgical technique and oncologic dissection should not be degraded when using a minimally invasive approach.

Methods: We reviewed a single hospital's experience with both OE and MIE.

The surgical management of stage I and stage II lung cancer.

There have been recent advances in the treatment of non-small cell lung cancer (NSCLC). Surgical resection remains the cornerstone in the treatment of patients with stages I and II NSCLC. Anatomic lobectomy combined with hilar and mediastinal lymphadenectomy constitutes the oncologic basis of surgical resection.

Lysyl oxidase: a lung adenocarcinoma biomarker of invasion and survival.

Background: Lung adenocarcinoma invasion and metastasis arises from autocrine and paracrine signaling events between tumor epithelial cells and the stromal microenvironment that is mediated in part by transforming growth factor-β (TGF-β) signaling. The copper-dependent amine oxidase lysyl oxidase (LOX) plays a role in extracellular matrix structure and is up-regulated in invasive type II TGF-β receptor-deficient cells. The authors hypothesized that LOX expression is associated with extent of invasion and survival in patients with lung adenocarcinoma.

Lung volume reduction surgery using the NETT selection criteria.

Background: The National Emphysema Treatment Trial (NETT) proved that lung volume reduction surgery (LVRS) was safe and effective in patients with certain clinical characteristics and using defined inclusion-exclusion criteria. Based on the selection criteria developed in that trial, we performed bilateral LVRS on 49 patients during the period of February 2004 until May 2009.

Methods: Forty-nine patients underwent lung volume reduction by either median sternotomy (10) or video-assisted thoracoscopic surgery (39) selected according to NETT described parameters.

Intrathoracic linear stapled esophagogastric anastomosis: an alternative to the end to end anastomosis.

Minimally invasive esophagectomy (MIE) is gradually gaining acceptance as an oncological sound procedure. The advantages of MIE arise from avoidance of a thoracotomy or laparotomy, resulting in decreased pulmonary morbidity and generally a faster recovery, yet not compromising the surgical benefit of esophagectomy in patients with cancer of the esophagus. No single technique of esophagectomy has proven itself superior to another from either an oncologic or survival perspective.

Analysis of clamping versus cutting of T3 sympathetic nerve for severe palmar hyperhidrosis.

Objectives: Endoscopic thoracic sympathectomy can predictably eliminate the disabling symptoms of palmar hyperhidrosis. Debate has ensued over competing techniques, in particular, cutting versus clamping of the sympathetic chain. We subjectively assessed the sweat severity in different areas of the body and evaluated changes in the quality of life in patients undergoing either the cutting or clamping technique.

Invasive size is an independent predictor of survival in pulmonary adenocarcinoma.

Current classification of pulmonary adenocarcinoma includes noninvasive bronchioloalveolar carcinoma, mixed subtype adenocarcinoma, and several patterns of invasive carcinoma. The extent of invasion in mixed subtype adenocarcinoma is variable, and prior studies suggest that estimates of extent of desmoplasia or invasion and gross tumor size are predictors of survival. Pathologic review of 178 consecutive primary lung adenocarcinoma resections from 1997 to 2000 was performed blinded to outcome.

Lung-volume reduction surgery for pulmonary emphysema: Improvement in body mass index, airflow obstruction, dyspnea, and exercise capacity index after 1 year.

Objectives: We hypothesized that lung-volume reduction surgery for pulmonary emphysema would improve body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index, a multidimensional predictor of survival in chronic obstructive pulmonary disease. We also aimed to identify preoperative predictors of improvement in the BODE index.

Methods: In a prospective cohort study of patients undergoing lung-volume reduction surgery at our center, with the methodology of the National Emphysema Treatment Trial, we compared clinical characteristics before and 1 year after surgery with the Wilcoxon signed rank test.

Adhesiolysis is facilitated by robotic technology in reoperative cardiac surgery.

Over a 2-year period, 5 patients who required reoperative chest surgery underwent robotic adhesiolysis with the da Vinci (Intuitive, Sunnyvale, CA) system. Resternotomy was performed under direct visualization for coronary revascularization (n = 2) or valve replacement (n = 1). A fourth patient required coronary revascularization after a previous axilloaxillary bypass.

Expression of syndecan-1 and expression of epidermal growth factor receptor are associated with survival in patients with nonsmall cell lung carcinoma.

Background: Recently, the authors identified molecular signatures and pathways associated with nonsmall cell lung carcinoma histology and lung development. They hypothesized that genetic classifiers of histology would provide insight into lung tumorigenesis and would be associated with clinical outcome when evaluated in a broader set of specimens.

Methods: Associations between patient survival and immunostaining for 11 representative histologic classifiers (epidermal growth factor receptor [EGFR], CDK4, syndecan-1, singed-like, TTF-1, keratin 5, HDAC2, docking protein 1, integrin alpha3, P63, and cyclin D1) were examined using a tissue microarray constructed from nonsmall cell lung carcinoma specimens.

Histologic assessment of non-small cell lung carcinoma after neoadjuvant therapy.

Chemotherapy or chemoradiation is often used in Stage IIIA non-small cell lung carcinoma before surgical resection (neoadjuvant therapy). In reviewing the histopathology of such tumors after resection, the recognition that the pathologic changes are related to prior therapy and the assessment of tumor regression are both of importance. To refine histologic parameters for tumor regression and describe patterns of tumor reaction to therapy, we identified 30 lobectomy or pneumonectomy specimens from 1996-2000 in which neoadjuvant therapy was received before surgical resection.

Non-small-cell lung cancer molecular signatures recapitulate lung developmental pathways.

Current paradigms hold that lung carcinomas arise from pleuripotent stem cells capable of differentiation into one or several histological types. These paradigms suggest lung tumor cell ontogeny is determined by consequences of gene expression that recapitulate events important in embryonic lung development. Using oligonucleotide microarrays, we acquired gene profiles from 32 microdissected non-small-cell lung tumors.

Advanced thoracoscopic procedures are facilitated by computer-aided robotic technology.

Objective: Computer (robotic) enhancement has been used to facilitate simple thoracoscopic procedures such as internal mammary artery (IMA) mobilization. This report describes the use of robotic technology in advanced thoracoscopic procedures.

Methods: Ten patients underwent advanced thoracoscopic procedures utilizing the Da Vinci robotic surgical system (Intuitive Surgical, Mountain View, CA) at our institution.