Lung cancer mortality reduction by LDCT screening: UKLS randomised trial results and international meta-analysis.

Background: The NLST reported a significant 20% reduction in lung cancer mortality with three annual low-dose CT (LDCT) screens and the Dutch-Belgian NELSON trial indicates a similar reduction. We present the results of the UKLS trial.

Methods: From October 2011 to February 2013, we randomly allocated 4 055 participants to either a single invitation to screening with LDCT or to no screening (usual care).

Does neoadjuvant chemoradiotherapy increase survival in patients with resectable oesophageal cancer?

A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was whether trimodal therapy [neoadjuvant chemoradiotherapy (nCRT) in addition to surgery] improves survival in patients with resectable oesophageal cancer. Altogether 565 studies were identified using the below-mentioned search.

The UK Lung Cancer Screening Trial: a pilot randomised controlled trial of low-dose computed tomography screening for the early detection of lung cancer.

Background: Lung cancer kills more people than any other cancer in the UK (5-year survival < 13%). Early diagnosis can save lives. The USA-based National Lung Cancer Screening Trial reported a 20% relative reduction in lung cancer mortality and 6.

Giant pulmonary hamartoma causing acute right heart failure.

Giant pulmonary hamartomas are rare. We describe a case of a 59-year-old female patient with a giant chondroid hamartoma in the lower lobe of the right lung presenting with acute right heart failure. To the best of our knowledge such a unique presentation has not been previously described in the literature.

The impact of positive circumferential margin on survival following oesophagectomy using the new 7th TNM classification.

Objectives: Previous studies looking at the influence of positive circumferential margin (CRM) on survival after oesophagectomy are conflicting. This may be due to the fact that older versions of the TNM classification were used, which do not predict survival as accurately as the new 7th edition. We examine whether CRM involvement has an impact on survival when the 7th TNM classification is used.

Phenylephrine infusion improves blood flow to the stomach during oesophagectomy in the presence of a thoracic epidural analgesia.

Objectives: Gastric tube necrosis is a major cause of mortality after oesophagectomy. The construction of the gastric tube used for oesophageal reconstruction involves a division of several arteries leading to a reduction in the blood supply at the fundus, which is used for the oesophageal anastomosis. This study was undertaken to determine the effect of thoracic epidural anaesthesia and intravenous phenylephrine on haemodynamics and blood flow in the tubularized stomach.

Routine endoscopy to detect anastomotic leakage after esophagectomy.

Background: This study evaluated the safety and efficacy of endoscopy in diagnosing anastomotic leaks after esophagectomy.

Methods: One hundred consecutive postesophagectomy patients, all having reconstruction using the stomach, underwent endoscopy in the first week after operation. The anastomosis and gastric mucosa were examined for evidence of ischemia, necrosis, and leak.

Tumour budding and a low host inflammatory response are associated with a poor prognosis in oesophageal and gastro-oesophageal junction cancers.

Aims: Tumour budding and host inflammatory response are parameters easily assessed histologically that have prognostic significance in many cancers. There have been few studies examining these parameters in oesophageal or gastro-oesophageal cancers. This study aims to address that deficiency.

Splenic injury following diaphragmatic plication: an avoidable life-threatening complication.

We report an unusual complication of left-sided diaphragmatic plication, namely bleeding from the spleen due to tearing of adhesions between the spleen and the abdominal aspect of the diaphragm. We believe that making a small incision in the diaphragm prior to the plication to identify and divide the adhesions could have prevented the complication, and that this manoeuvre should be a standard part of the operation.

Cardiac comorbidity is not a risk factor for mortality and morbidity following surgery for primary non-small cell lung cancer.

Objective: We examined the effect of cardiac comorbidity on mortality and postoperative complications following surgery for primary non-small cell lung cancer.

Methods: Between October 2001 to December 2005, 1067 consecutive patients underwent lung resection for primary cancer within a single centre; patient data was collected prospectively. Two hundred and seventy-one patients had a history of cardiac comorbidity, which included 196 angina, 118 myocardial infarction, 36 revascularisation, 10 congestive cardiac failure and 19 rhythm disorders (numbers not mutually exclusive).

Spontaneous infection of a stable mediastinal cystic mass: A case report.

Mediastinal cysts have an unpredictable course but can cause complications such as infection or local pressure effects. Persons with mediastinal cysts can be asymptomatic for many years or can develop symptoms as a result of complications of the cyst. There is a lack of consensus on the best approach to managing those patients without symptoms.

The utility of intrapleural instillation of autologous blood for prolonged air leak after lobectomy.

Purpose Of Review: Air leak after pulmonary lobectomy is a relatively common problem, which when persistent can be a cause of other postoperative morbidity as well as contributing to extended hospitalization. A number of methods have been proposed to prevent and treat air leakage, but none have proved incontrovertibly effective. This article reviews the practice of using autologous blood as an effective technique to treat postoperative air leaks after lobectomy.

The effect of thoracic epidural bupivacaine and an intravenous adrenaline infusion on gastric tube blood flow during esophagectomy.

Background: Gastric tube necrosis is a major cause of anastomotic leak after esophagectomy. A correlation has been shown between reduced flux at the anastomotic end of the gastric tube and anastomotic leaks.

Methods: We prospectively studied the effect of intraoperative thoracic epidural bupivacaine and subsequent adrenaline infusion on hemodynamics and flux in the gastric tube.

Ectopic thymoma of the chest wall.

A case of ectopic thymoma arising from the chest wall is reported. A chest wall tumour involving the third and fourth ribs and extending extrapleurally and subpectorally was resected following a histopathological diagnosis of hemangioendothelioma obtained at initial incision biopsy. Pathological examination of the excised mass, revealed appearances consistent with a malignant thymoma.

Late presentation of congenital Bochdalek hernia: a case report.

A 23-year-old man presented with a long history of dyspnea and wheezing thought to be due to asthma. Abnormal appearance of the left hemithorax was an incidental finding on a chest X-Ray. On further investigations he was found to have congenital Bochdalek hernia which was repaired surgically.

Colo-pleural fistula following pneumonectomy.

Following pneumonectomy and diaphragmatic reconstruction for carcinoid tumour, a fistula developed between the pneumonectomy space and the splenic flexure of the colon. The problem was successfully treated by colon resection and thoracoplasty.

Intrapleural instillation of autologous blood in the treatment of prolonged air leak after lobectomy: a prospective randomized controlled trial.

Background: The aim of this study was to assess the value of instilling autologous blood into the pleural cavity to seal prolonged air leaks after lobectomy.

Methods: Of 319 lobectomies performed over an 18-month period, 22 patients (6.9%) experienced prolonged air leak (more than 5 days after surgery).

Aorto-bronchial fistula following aortic and bronchial stenting of a thoracic aneurysm.

A 66-year-old man underwent repair of an abdominal aortic aneurysm and synchronous stenting of a thoracic aneurysm compressing his left main bronchus. This resulted in further bronchial compression which was also stented. An aorto-bronchial fistula resulting in severe haemoptysis occurred a few weeks later.

Surgical treatment of anastomotic leaks after oesophagectomy.

Objective: To determine the optimum management of anastomotic leaks after oesophagectomy.

Methods: We undertook a retrospective review of 23 patients who developed anastomotic leakage, out of 389 patients undergoing oesophagectomy with gastric interposition. The presentation, diagnosis, and treatment of the leaks, and patient outcomes are analysed.

Two cases of rounded atelectasis presenting after coronary artery surgery.

Rounded atelectasis developed in two patients after coronary artery bypass grafting. Although both lesions led to the suspicion of a primary pulmonary tumor on initial assessment, malignancy was excluded by biopsy and radiologic observation in the first patient and excision biopsy in the second.

Intravenous hydration versus naso-jejunal enteral feeding after esophagectomy: a randomised study.

Objective: Patients undergoing esophagectomy are typically nutritionally depleted and cannot establish oral feeding for up to a week after surgery. We have investigated the routine use of enteral feeding via a naso-jejunal tube.

Methods: Forty consecutive patients undergoing a transthoracic esophagectomy for cancer were randomised to receive enteral feeding or intravenous crystalloid fluids after surgery.

Does lung biopsy help patients with interstitial lung disease?

Objectives: The decision to perform lung biopsy in the evaluation of interstitial lung disease (ILD) is based on the probability that this examination will yield a specific diagnosis, leading to a change in treatment. The purpose of this study was to identify factors that influence the diagnostic yield of lung biopsy for ILD.

Methods: One hundred patients underwent lung biopsy for ILD over a 5-year period.