The Annals of thoracic surgery
-
Video-assisted thoracic surgery lobectomy has controversial advantages over traditional open surgical approaches. Subjective concerns such as pain, dyspnea, physical functioning, and overall satisfaction generally favor VATS but vary depending on survey timing. ⋯ Video-assisted thoracic surgery often hastens return to work and facilitates adjuvant chemotherapy or subsequent urgent surgical procedures. Video-assisted thoracic surgery-related quality of life benefits are amplified by advanced age (or other frailties) and reduced by advanced cancer stage or comorbid illness.
-
Thoracoscopic lobectomy is performed with increasing frequency for early-stage lung cancer. Several published reports suggest thoracoscopic resection is safe, with the potential advantage of shorter hospital stay, quicker recovery, and comparable oncologic results. ⋯ Thoracoscopic lung resection can be performed safely in selected patients aged 80 years and older, in those with marginal pulmonary function, and in those with pathologic response to neoadjuvant therapy.
-
It is not obvious to visualize and expose the main trunk of the pulmonary artery through a port access approach. We describe surgical and anesthesiology measures necessary to perform the removal of an atrial septal defect closure device safely and adequately.
-
Although single-center series evaluating esophagectomy for cancer have demonstrated that this operation can be performed safely and with excellent outcomes, controversy remains regarding the comparable oncologic efficacy of the transhiatal and transthoracic approaches. This study was performed to determine outcomes after transhiatal and transthoracic esophagectomy for patients undergoing resection nationwide. ⋯ In the largest population-based study to date assessing long-term outcome after esophagectomy for esophageal cancer, transhiatal esophagectomy confers an early survival advantage, but long-term survival does not appear to differ according to surgical approach.
-
Although the neurologic status of patients undergoing cardiac operations has been well studied at other times, there are few studies of neurologic status in the immediate postoperative state. This study used standardized nursing neurologic evaluations to describe the sequence of neurologic changes during the first few hours after cardiac operations and the factors that influence them. ⋯ Standardized, serial nursing neurologic assessments of postoperative cardiac patients provide insight into the immediate postoperative period and may be a useful tool for early identification of patients at risk for adverse outcomes.