European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Jul 2014
Observational StudyAdopting a standardized anterior approach significantly increases video-assisted thoracoscopic surgery lobectomy rates.
Video-assisted thoracoscopic surgery (VATS) lobectomy is associated with improved short-term outcomes compared with thoracotomy. Definition of the hilar structures is crucial to safe VATS lobectomy. Several VATS approaches have been described. We report the effect of three surgeons in our institution undertaking standardized anterior approach (SAA) training on the proportion of isolated lobectomies subsequently completed by VATS. Predictors of successful VATS lobectomy were analysed. ⋯ Formal training and adoption of the SAA approach were associated with a more than 3-fold increase in our VATS lobectomy rate. The effect was immediate and sustained. This may reflect easier identification of the major structures from the anterior view. In addition, standardization of surgical techniques and perioperative protocols may facilitate efficient team working. VATS lobectomy was associated with a shorter median hospital stay. Units seeking to increase their VATS lobectomy rate should consider group adoption of the SAA approach.
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Eur J Cardiothorac Surg · Jul 2014
Time to refine N2 staging? cN2α and cN2β based on local regional involvement provide a more accurate prognosis in surgically treated IIIA non-small-cell lung cancer than N2 alone or the number of node stations involved.
The number of stations of N2 nodes involved has been considered to be one of the most important prognostic factors for lung cancer. However, most reports have dealt with the pathological nodal status rather than with the clinical nodal status. We investigated the relationship between the prognosis and the location of the primary tumour and nodes involved. ⋯ Clinical mediastinal lymph node status based on the location of the primary tumour and the node involved was an important preoperative prognostic factor. Thus, this factor should be considered when planning and evaluating clinical trials. Another important finding was that clinical single-station N2 is not always pathological single-station N2 disease.
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Eur J Cardiothorac Surg · Jul 2014
Safety and feasibility of concomitant surgical ablation of atrial fibrillation in patients with severely reduced left ventricular ejection fraction.
Concomitant surgical ablation of atrial fibrillation (AF) is a safe and feasible procedure. However, many surgeons are reluctant to perform it in patients with heart failure. We investigated the safety and efficacy of AF ablation in patients with a severely reduced left ventricular ejection fraction (LVEF <35%). ⋯ Surgical AF ablation was safe and feasible in patients with severely reduced LVEF. The restoration of SR led to a significantly higher improvement in LVEF and alleviation of clinical heart failure symptoms, not observed if AF persisted postoperatively.
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Eur J Cardiothorac Surg · Jul 2014
Randomized Controlled TrialPerioperative gabapentin for the prevention of persistent pain after thoracotomy: a randomized controlled trial.
To evaluate the effect of perioperative gabapentin treatment for the prevention of persistent post-thoracotomy pain and to establish whether gabapentin has a significant therapeutic impact on acute postoperative pain. ⋯ We found no evidence for the superiority of gabapentin over placebo for the treatment of acute pain following thoracotomy or for the prevention of persistent post-thoracotomy pain.
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Eur J Cardiothorac Surg · Jul 2014
Outcomes in patients requiring mechanical ventilation following pneumonectomy.
The aim of this study was to clarify the outcomes of patients who require post-pneumonectomy mechanical ventilation (PPMV). ⋯ Our findings suggest that continued PPMV patients may have a rate of weaning at hospital dismissal and OS comparable to reintubated PPMV patients. A lower fraction of inhaled oxygen and less positive fluid balance may be favoured managements in reintubated PPMV patients.