Publications by authors named "Pascal A Thomas"
Objectives: While minimally invasive surgery (MIS) is the preferred approach in patients with early-stage lung cancer, intraoperative adverse events (IOAE) may still occur. The objective of this study was to assess the impact of a dedicated preoperative planning program on adverse event occurrence.
Methods: A single-centre cross-sectional comparative study was conducted, including all patients with proven/suspected lung cancer undergoing curative MIS, prior (September 2021-October 2022) and after (November 2022-January 2024) the implementation of a preoperative planning program.
Objectives: To evaluate the impact of a quality improvement initiative on intraoperative lymph node (LN) dissection adequacy.
Methods: A single-centre cohort of 781 naïve patients who underwent resection of non-small cell lung cancer with pathological LN involvement and survived beyond 90 days was reviewed. LN dissection metrics were compared before and after the implementation of a quality improvement initiative.
Article Synopsis
- Interstitial lung disease (ILD) is associated with an increased risk of lung cancer (LC), but the surgical risks for patients with both conditions remained uncertain, prompting a study analyzing outcomes for LC patients with and without ILD.
- The study included data from 4,073 patients who underwent LC surgery between January 2006 and June 2023, with 30 identified as having ILD. Key findings showed no significant difference in overall survival between LC-ILD and LC-non-ILD groups, although the LC-ILD group faced specific complications like prolonged air leaks and pneumonia.
- Overall, the research illustrates that while patients with LC-ILD experience certain challenges, surgical outcomes, including post-operative complications, are not significantly worse
Article Synopsis
- The study aimed to evaluate safety and survival outcomes of lobectomy, segmentectomy, and wedge resection for early-stage lung cancer using data from the French EPITHOR registry between 2016 and 2022.
- A total of 19,452 patients were analyzed, finding that lobectomy was the most common procedure (72.2%), and while short-term 90-day mortality rates were similar across the three methods, significant differences emerged in 5-year overall survival.
- The results indicated that wedge resection was linked to worse long-term survival compared to lobectomy, suggesting that all types of sublobar resections may not provide equal effectiveness in treating lung cancer.
Article Synopsis
- The study analyzes the effects of lung transplant allocation policies in the USA and France, focusing on urgent lung transplants and their impact on patient outcomes.
- Using data from 2007 to 2017, the research found that urgent lung transplants had a higher risk of death, with survival rates significantly better in the US compared to France.
- The conclusion suggests that while urgent lung transplants are risky in both countries, the US score-based allocation system leads to better post-transplant survival rates, indicating a complex interplay of factors influencing outcomes.
Objectives: To assess the current practice of pulmonary metastasectomy at 15 European Centres. Short- and long-term outcomes were analysed.
Methods: Retrospective analysis on patients ≥18 years who underwent curative-intent pulmonary metastasectomy (January 2010 to December 2018).
Article Synopsis
- The study investigates the impact of the number of involved structures (NIS) on the prognosis of patients with thymic epithelial tumors (TETs) who underwent surgery, using data from the European Society of Thoracic Surgeons (ESTS) thymic database.
- Out of 303 patients analyzed, those with more than two involved structures had significantly worse cancer-specific survival (CSS) compared to those with two or fewer, with 5-year CSS rates of 9.5% versus 93.2%, respectively.
- Factors such as neoadjuvant therapy, complete resection, and thymoma histology were associated with better prognosis, highlighting the importance of NIS in determining patient outcomes.
Introduction: Unlike most malignancies, higher body mass index (BMI) is associated with a reduced risk of lung cancer and improved prognosis after surgery. However, it remains controversial whether height, one of determinants of BMI, is associated with survival independently of BMI and other confounders.
Methods: We extracted data on all consecutive patients with resectable non-small cell lung cancer included in Epithor, the French Society of Thoracic and Cardiovascular Surgery database, over a 16-year period.
Milestones in the History of Esophagectomy: From Torek to Minimally Invasive Approaches.
Medicina (Kaunas)
October 2023
Article Synopsis
- The history of esophagectomy showcases a progress marked by dedication and technical improvements, transitioning from early risky procedures to modern minimally invasive techniques aimed at enhancing patient outcomes.
- Milestones include Franz J. A. Torek's 1913 esophageal resection, which opened doors for esophageal cancer treatment, but faced high mortality rates that prompted ongoing evolution of surgical methods like thoracotomy and transhiatal approaches.
- Recent advancements, such as robot-assisted surgeries and collaborative initiatives, have improved survival rates, yet complications like anastomotic leaks continue to pose challenges, necessitating innovative prevention strategies.
Article Synopsis
- In minimally invasive thoracic surgery, paravertebral block (PVB) is a common technique for postoperative pain relief but relies heavily on the surgeon's skill and available resources, prompting a search for better methods when pain control fails.
- The study aimed to compare the effectiveness of PVB performed by surgeons during video-assisted thoracoscopic surgery (PVB-VATS) against the traditional PVB technique done by anesthesiologists (PVB-US) to see if they produce similar pain management outcomes.
- Conducted as a randomized clinical trial with 196 patients, the primary focus was on the differences in opioid consumption post-surgery, along with secondary measures such as pain scores
Article Synopsis
- The study investigates how lung disease affects diaphragm structure, particularly after single-lung transplantation (SLTx), using CT scans to measure diaphragm characteristics.
- Researchers analyzed CT scans of 31 patients from Marseille, France, who had undergone SLTx between 2009 and 2022 and compared the transplanted lung's diaphragm to the native lung's.
- Results showed that after SLTx, the transplanted lung's diaphragm thickness increased significantly while its height decreased, indicating recovery potential, while there were no notable changes in the diaphragm related to the native lung.
Article Synopsis
- The study aimed to analyze lung cancer patients who had surgery for tumors invading the chest wall, comparing outcomes based on whether they received induction chemotherapy, induction radiochemotherapy, or no induction therapy.
- Out of 688 patients studied, those who received induction radiochemotherapy had the best long-term survival rates, while postoperative mortality and incomplete resection rates varied among the groups.
- The findings suggest that induction radiochemotherapy could improve survival outcomes, indicating a need for further research through a prospective randomized trial.
Article Synopsis
- - Primary ciliary dyskinesia (PCD) is a rare lung disease that can cause permanent lung damage and may lead to respiratory failure, with lung transplant being a possible solution in advanced cases.
- - This study analyzed data from 36 PCD patients who received lung transplants between 1995 and 2020, focusing on their survival rates and the incidence of lung dysfunction after the transplant.
- - Overall survival was about 5.9 years, with similar outcomes for patients with and without situs abnormalities; however, those with situs abnormalities had a higher rate of rejection in the first year, highlighting the feasibility and challenges of lung transplantation in PCD patients.
Prognostic score and sex-specific nomograms to predict survival in resectable lung cancer: A French nationwide study from the Epithor cohort database.
Lancet Reg Health Eur
March 2023
Article Synopsis
- The study aims to create a user-friendly nomogram to predict long-term outcomes for patients with resectable non-small cell lung cancer (NSCLC), helping to identify those at high risk during cancer treatment planning.
- Researchers analyzed clinical data from over 62,000 patients treated between 2003 and 2020, utilizing Cox modeling to identify key prognostic factors, leading to the development of sex-specific nomograms.
- Results showed a median survival of 9.2 years, with significant differences in overall survival rates based on the prognostic scoring system, confirming that this composite score can effectively predict survival after NSCLC surgery.
Article Synopsis
- A trauma system was established in the PACA region in 2014 to improve the care of bleeding trauma patients according to European guidelines.
- A study analyzed the compliance with these guidelines in penetrating thoracic trauma cases before and after the trauma system's implementation, focusing on morbidity and mortality outcomes.
- The results showed that compliance rates improved significantly post-implementation, correlated with a decrease in morbidity and mortality, highlighting the benefits of following established trauma protocols.
Until recently, thoracic surgery in France was associated with vascular or cardiac surgery. It is now increasingly performed as a specific activity. Training of a thoracic surgeon has a common part with cardiovascular surgery during a 6-year curriculum including theory and practical practice acquired both by simulation and clinical fellowship.
View Article and Find Full Text PDFBackground: Thymic carcinoma is a rare and highly malignant tumor with a dismal prognosis, which occasionally coexists with myasthenia gravis (MG). This study aims to investigate the MG incidence on a surgical cohort of patients with thymic carcinoma and to explore its influence on long-term survival. Methods: the prospectively collected data from the ESTS database on thymic epithelial tumors were reviewed.
View Article and Find Full Text PDFCommentary: Challenging the final frontier of lung transplantation.
J Thorac Cardiovasc Surg
February 2023
Background: In lung transplantation (LT), the actual surgical practice is to cut the donor bronchus as short as possible in order to reduce anastomotic complications (AC). Consequently, the anastomosis is very close to the secondary carina. If AC occur, regular straight stents may be unsatisfactory and on-site modified bifurcated stents may represent an alternative.
View Article and Find Full Text PDFVideo-assisted thoracic surgery versus stereotactic ablative radiotherapy: is the game over?
Eur J Cardiothorac Surg
August 2022
Article Synopsis
- Ex vivo lung perfusion (EVLP) is a method that helps increase the number of usable lungs for transplant by improving their condition after retrieval from donors.
- A study in France analyzed brain-dead donors from 2012 to 2019 to compare lungs transplanted after EVLP to those that were rejected or transplanted without EVLP, using statistical methods to identify donor profiles.
- Results showed that while many factors, like donor age and smoking history, affected lung use, EVLP significantly improved the chances of utilizing lungs from donors with poorer initial health indicators.
Objectives: Pulmonary retransplant (ReTx) is considered a controversial procedure. Despite literature reporting outcomes following ReTx, limited data exist in recipients bridged to their ReTx on extracorporeal life support (ECLS). The goal of this study was to investigate the outcomes of recipients bridged to a first-time ReTx by ECLS.
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