Reconstruction of Oncologic Sternectomy Defects: Lessons Learned from 60 Cases at a Single Institution.

Unlabelled: Oncologic sternectomy results in complex defects where preoperative planning is paramount to achieve best reconstructive outcomes. Although pectoralis major muscle flap (PMF) is the workhorse for sternal soft tissue coverage, additional flaps can be required. Our purpose is to evaluate defects in which other flaps beside PMF were required to achieve optimal reconstruction.

Fibrosing mediastinitis: clinical presentation, therapeutic outcomes, and adaptive immune response.

Fibrosing mediastinitis (FM) is a rare disorder characterized by the invasive proliferation of fibrous tissue within the mediastinum. FM frequently results in the compression of vital mediastinal structures and has been associated with substantial morbidity and mortality. Its pathogenesis remains unknown.

Solitary fibrous tumors of the pleura: results of surgical treatment and long-term prognosis.

Objective: We sought to define the long-term outcome of surgically treated solitary fibrous tumors of the pleura.

Methods: We performed a retrospective review from December 1972 through December 2002.

Results: There were 84 patients (39 men and 45 women) with a median age of 57 years (range, 34-83 years).

Patient-centered quality indicators for pulmonary resection.

Background: Quality of care is increasingly scrutinized. However, no standard quality measures exist for surgical care of patients undergoing pulmonary resection.

Methods: Our thoracic surgical team developed a set of patient-centered quality of care measures specific to patients undergoing pulmonary resection.

Combined transabdominal gastroplasty and fundoplication for shortened esophagus: impact on reflux-related and overall quality of life.

Background: Transabdominal gastroplasty for shortened esophagus at the time of fundoplication results in a segment of aperistaltic, acid-secreting neoesophagus above the fundoplication. We hypothesized that transabdominal gastroplasty impairs quality of life (QOL).

Methods: This was a matched paired analysis with retrospective chart review and follow-up questionnaire of 116 patients undergoing transabdominal fundoplication with gastroplasty with 116 matched controls undergoing transabdominal fundoplication alone from January 1997 to June 2005.

Malignant pleural mesothelioma: surgical management in 285 patients.

Background: Malignant pleural mesothelioma is a rare, aggressive, and deadly malignancy. Despite increasing incidence, no treatment modality is accepted standard of care. This report analyzes our experience with surgical management of mesothelioma.

Thoracic surgery certification in the United States of America.

As we enter the 21st century, thoracic surgeons can look back with pride and gratitude to their predecessors who placed a high premium on clinical practice and certification. Thoracic surgery, however, is dynamic, not static. So, too, should be thoracic surgery recertification.

Lung cancer in octogenarians: factors affecting long-term survival following resection.

Objective: To identify factors associated with long-term survival following pulmonary resection for lung cancer in patients 80 years of age or older.

Methods: The medical records of all patients >or=80 years, who underwent pulmonary resection for lung cancer from 1985 to 2002, were reviewed.

Results: There were 294 patients (192 men, 102 women).

The influence of transabdominal gastroplasty: early outcomes of hiatal hernia repair.

Objective: The aim of our study was to review our experience with transabdominal gastroplasty to determine the safety and short-term efficacy of the procedure.

Methods: Retrospective review of all patients that underwent transabdominal hiatal hernia repair with concurrent gastroplasty for shortened esophagus between October 1999 and May 2004.

Results: There were 63 patients, 27 men and 36 women.

Survival after recurrent nonsmall-cell lung cancer after complete pulmonary resection.

Background: Survival characteristics of patients who have recurrent nonsmall-cell lung cancer after surgical resection are not well understood. Little objective evidence exists to justify treatment for these patients.

Methods: We prospectively followed 1,361 consecutive patients with nonsmall-cell lung cancer who underwent complete surgical resection at our institution from January 1997 to December 2001.

Conventional resection of pulmonary metastases.

We present an overview of surgical technique for the resection of secondary tumor metastases to the lungs. Issues addressed include the optimal surgical approach, the requirement to remove all lesions while preserving unaffected lung parenchyma and the advantages of the available surgical staplers and devices. In selected patients, resection of metastatic lesions to the lung or chest wall offers a survival benefit.

Surgical treatment of tumors of the proximal stomach with involvement of the distal esophagus: a 26-year experience with Siewert type III tumors.

Objective: A paucity of outcome data exists regarding patients with proximal stomach cancer involving the distal esophagus (Siewert type III tumors). This is especially true with regard to long-term survival rates after surgical intervention.

Methods: Medical records were reviewed of all patients who underwent total gastrectomy and distal esophagectomy with Roux-en-Y esophagojejunostomy for Siewert type III tumors from January 1975 through December 2000.

Lung cancer in octogenarians: factors affecting morbidity and mortality after pulmonary resection.

Background: Predictors of morbidity and mortality after pulmonary resection for lung cancer in patients 80 years of age or older are unknown.

Methods: The medical records of all patients 80 years of age or older who had pulmonary resection for lung cancer from January 1985 through September 2004 were reviewed.

Results: There were 379 patients (248 men, 131 women).

Completely resected N1 non-small cell lung cancer: factors affecting recurrence and long-term survival.

Objective: N1 disease in non-small cell lung cancer represents a heterogeneous patient subgroup with a 5-year survival of approximately 40%. Few reports have evaluated the correlation between N1 disease and tumor recurrence or which subgroup of patients would most benefit from adjuvant chemotherapy.

Methods: From 1997 through 2002, all patients with pathologic T1-4 N1 M0 non-small cell lung cancer who had a complete resection with systematic mediastinal lymphadenectomy were retrospectively analyzed and evaluated for factors associated with recurrence and long-term survival.

Percutaneous endoscopic gastrostomy risks rendering the gastric conduit unusable for esophagectomy.

Surgical treatment for cancer of the esophagus most often involves replacement of the esophagus with a gastric conduit. This gastric tube relies upon the continuity of the gastroepiploic artery for its blood supply. This case report involves a patient whose gastroepiploic artery became thrombosed by a percutaneous endoscopic gastrostomy, rendering his gastric conduit unusable.

Postpneumonectomy empyema: results after the Clagett procedure.

Background: The purpose of this study was to analyze our experience with the management of patients with postpneumonectomy empyema treated by the Clagett procedure.

Methods: Data were analyzed from our prospective database on 84 consecutive patients with postpneumonectomy empyema from July 1988 to June 2004.

Results: There were 73 men and 11 women.

Failed antireflux surgery: results after reoperation.

Background: Since laparoscopy has become a common surgical approach for antireflux surgery, little is known regarding reoperation for failed antireflux surgery.

Methods: Records of all patients who underwent reoperation without esophageal resection for symptoms of recurrent gastroesophageal reflux disease or hiatal hernia between July 1, 1995 and April 1, 2004 were reviewed. There were 126 patients.

Gynecologic cancers: factors affecting survival after pulmonary metastasectomy.

Background: Little information is available regarding long-term survival after pulmonary metastasectomy for gynecologic malignancies.

Methods: All patients who underwent pulmonary resection for gynecologic malignancies at our institution between January 1985 and June 2001 were reviewed. Factors affecting long-term survival were analyzed.

The role of pulmonary resection in small cell lung cancer.

Objective: To analyze the outcome of surgical resection for patients with small cell lung cancer (SCLC).

Patients And Methods: We identified all patients who underwent thoracotomy for SCLC at our institution from January 1985 to July 2002. All patients were staged using the American Joint Committee on Cancer TNM system.

Predicting postrecurrence survival among completely resected nonsmall-cell lung cancer patients.

Background: Survival after recurrence subsequent to complete resection of nonsmall-cell lung cancer (NSCLC) has been considered a multifactorial process dependent on demographic, clinical, biological, and treatment characteristics. This study sought to quantify the prognostic effects of these characteristics on postrecurrence survival.

Methods: Three hundred ninety NSCLC patients who underwent complete resection and subsequently had recurrent cancer were studied.

Esophagogastrectomy: the influence of stapled versus hand-sewn anastomosis on outcome.

Successful anastomosis is essential for favorable esophagogastrectomy outcomes. Before July 2002, almost all esophagogastric anastomoses at our institution were hand-sewn. We then began using linear stapled anastomotic techniques.

Pulmonary resection for metastatic malignant fibrous histiocytoma: an analysis of prognostic factors.

Background: Factors affecting recurrence and survival after pulmonary resection for metastatic malignant fibrous histiocytoma (MFH) are not well known.

Methods: Records of patients undergoing pulmonary metastasectomy for MFH between January 1976 and January 2000 were analyzed.

Results: There were 103 patients (46 men and 57 women).

Laparoscopic esophageal myotomy for achalasia: factors affecting functional results.

Background: We reviewed our experience and analyzed factors affecting functional results after laparoscopic esophageal myotomy (LEM) for achalasia.

Methods: From January 1996 through October 2003, the records of 211 patients (110 men and 101 women) who had LEM for achalasia were reviewed, and factors affecting morbidity and functional results were analyzed.

Results: Median age was 47 years (range, 12 to 85).

Locally recurrent esophageal carcinoma: when is re-resection indicated?

Background: Limited locally recurrent esophageal carcinoma is rare, and little is known regarding effectiveness of re-resection.

Methods: Medical records of 27 consecutive patients with locally recurrent esophageal carcinoma who underwent reoperation at our institution between February 1974 and January 2003 were analyzed.

Results: The original and recurrent cancer cell types were identical in all patients.