Comparison of standard and penalized logistic regression in risk model development.

Objective: Regression models are ubiquitous in thoracic surgical research. We aimed to compare the value of standard logistic regression with the more complex but increasingly used penalized regression models using a recently published risk model as an example.

Methods: Using a standardized data set of clinical T1-3N0 esophageal cancer patients, we created models to predict the likelihood of unexpected pathologic nodal disease after surgical resection.

Minimum Volume Standards for Surgical Care of Early-Stage Lung Cancer: A Cost-Effectiveness Analysis.

Background: Multiple stakeholders have advocated for minimum volume standards for complex surgical procedures. The Leapfrog Group recommends that patients with non-small cell lung cancer (NSCLC) receive surgical resection at hospitals that perform at least 40 lung resections annually. However, the cost-effectiveness of this paradigm is unknown.

Assessment of Preoperative Opioid Use Prevalence and Clinical Outcomes in Pulmonary Resection.

Background: Preoperative opioid use is associated with increased health care use after elective abdominal surgery. However, the scope of preoperative opioid use and its association with outcomes have not been described in elective pulmonary resection. This study aimed to characterize prevalent preoperative opioid use in patients undergoing elective pulmonary resection and compare clinical outcomes between patients with and without preoperative opioid exposure.

Utilization Trends, Outcomes, and Cost in Minimally Invasive Lobectomy.

Background: Minimally invasive lobectomy is associated with decreased morbidity and length of stay. However, there have been few published analyses using recent, population-level data to compare clinical outcomes and cost by surgical approach, inclusive of robotic-assisted thoracoscopic surgery (RATS). The objective of this study was to compare outcomes and hospitalization costs among patients undergoing open, video-assisted thoracoscopic surgery (VATS) and RATS lobectomy.

Trends in Treatment of T1N0 Esophageal Cancer.

Objective: The purpose of this study was to explore nationwide trends in treatment and outcomes of T1N0 esophageal cancer.

Background: Endoscopic treatment has become an accepted option for early-stage esophageal cancer, but nationwide utilization rates and outcomes are unknown.

Methods: T1N0 esophageal cancers were identified in the National Cancer Database from 2004 to 2014.

A Clinical Nomogram for Predicting Node-positive Disease in Esophageal Cancer.

Objective: We developed and validated a nomogram predicting the likelihood of occult lymph node metastases in surgically resectable esophageal cancers.

Background: Patients with esophageal cancer with positive lymph nodes benefit from neoadjuvant therapy, but limitations in current clinical staging techniques mean nodal metastases often go undetected preoperatively.

Methods: The National Cancer Database was queried for patients with clinical T1-3N0M0 cancer undergoing upfront esophagectomy from 2004 to 2014.

Adjuvant Therapy for Node-Positive Esophageal Cancer After Induction and Surgery: A Multisite Study.

Background: The benefit of adjuvant treatment for esophageal cancer patients with positive lymph nodes after induction therapy and esophagectomy is uncertain. This in-depth multicenter study assessed the benefit of adjuvant therapy in this population.

Methods: A retrospective cohort study from 9 institutions included patients who received neoadjuvant treatment, underwent esophagectomy from 2000 to 2014, and had positive lymph nodes on pathology.

The role of small or single-institution prospective studies in thoracic research.

Interventional studies are designed specifically to test the impact of a treatment or management strategy on an outcome of interest. In this article, we will highlight two viewpoints regarding the role of small or single-institution prospective interventional studies within the field of thoracic surgery: first, that these studies are beneficial and can positively impact the field, and second, that these studies can have such significant limitations that they may have no meaningful impact. We will also review elements that can make for successful design and execution of small prospective interventional studies.

Unintended consequences of changes to lung allocation policy.

Organ allocation for transplantation aims to balance the principles of justice and medical utility to optimally utilize a scarce resource. To address practical considerations, the United States is divided into 58 donor service areas (DSA), each constituting the first unit of allocation. In November 2017, in response to a lawsuit in New York, an emergency action change to lung allocation policy replaced the DSA level of allocation for donor lungs with a 250 nautical mile circle around the donor hospital.

Induction Radiation Therapy for Esophageal Cancer: Does Dose Affect Outcomes?

Background: Wide variation is seen in the dosage of preoperative induction radiation therapy for esophageal cancer. We investigated associations between outcomes after esophagectomy and dosage of induction radiation therapy.

Methods: Patients undergoing induction radiation therapy (30 to 70 Gy), followed by esophagectomy, were identified from the National Cancer Database and classified as low (<40 Gy), standard (40 to 50.

Postoperative Pneumonia Prevention in Pulmonary Resections: A Feasibility Pilot Study.

Background: Pneumonia after pulmonary resection occurs in 5% to 12% of patients and causes substantial morbidity. Oral hygiene regimens lower the incidence of ventilator-associated pneumonias; however, the impact in patients undergoing elective pulmonary resection is unknown. We conducted a prospective pilot study to assess the feasibility of an oral hygiene intervention in this patient cohort.

Enhanced Recovery After Surgery (ERAS) in Thoracic Surgery.

Enhanced Recovery After Surgery (ERAS) pathways are protocolled collections of perioperative decisions designed to improve outcomes that are becoming increasingly popular across surgical subspecialties. In this article, we review 5 recent manuscripts focused on ERAS for elective pulmonary resections, focusing on the components of the pathways and the resultant outcomes. Overall, we observed that ERAS protocols can be safely implemented without increasing hospital readmission or mortality.

Surveillance versus esophagectomy in esophageal cancer patients with a clinical complete response after induction chemoradiation.

There currently exists an area of controversy in treatment of esophageal cancer for patients who have an apparent clinical complete response (cCR) after induction chemoradiation. A standard treatment is to offer these patients an esophagectomy, but increasingly there is interest from both the patient and provider for active surveillance with so-called "salvage" esophagectomies for local recurrence as an alternative treatment paradigm. In this article, we review the existing evidence that stakeholders should consider for clinical decision-making in this specific patient population, including: the accuracy of post-induction clinical restaging, the reliability of operative risk assessment, the feasibility and adherence to surveillance strategies, and the observed outcomes in these patients after salvage esophagectomy or continued active surveillance.

Current State of Empyema Management.

Background: Empyema affects up to 65,000 patients annually in the United States. Recent consensus guidelines demonstrate ambiguity about optimal treatment. We examined current treatment practices and outcomes for inpatient treatment of empyema using a comprehensive, longitudinal data set that encompasses an entire state cohort of hospitalized patients.