Seminars in thoracic and cardiovascular surgery
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Semin. Thorac. Cardiovasc. Surg. · Jan 2012
Cerebral protection for aortic arch surgery: mild hypothermia with selective cerebral perfusion.
Historically, reconstruction of the aortic arch has been exclusively performed during deep hypothermic circulatory arrest. Antegrade cerebral perfusion (ACP) has been popularized, offering a more physiologic method of perfusion and extending the safe limits for arch repair. ⋯ To our best knowledge we have been one of the pioneering centers to start such an aggressive temperature management in aortic arch surgery back in 2000. To date 426 patients underwent aortic arch replacement in our unit employing the standardized surgical protocol described herein.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2012
What is the optimal interval between chemoradiation and esophagectomy?
Locally advanced esophageal cancer requires multimodality therapy-most commonly induction chemoradiation followed by esophagectomy. There is a paucity of literature on the optimal time interval between induction treatment and resection. Patient readiness and healthy tissue, as well as tumor responses to radiation, are factors to consider. Two recent retrospective large-center studies on this topic are reviewed.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2012
ReviewLung cancer resection volume: is procedure volume really an indicator of quality?
The majority of lung cancer resection studies indicate that hospital and surgeon procedure volume are inversely associated with mortality. It makes intuitive sense that performing large numbers of these procedures leads to better outcomes. ⋯ This review will examine the methodology used in the volume-outcome relationship literature and highlight important areas of concern. Careful examination of the literature demonstrates that lung cancer resection volume is not strongly associated with mortality and should not be used as a proxy measure for quality.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2012
ReviewSpecialty matters in the treatment of lung cancer.
The effect of surgeon volume, hospital volume, and surgeon specialty on operative outcomes has been reported in numerous studies. Short-term and long-term outcome comparisons for pulmonary resection for lung cancer have been performed between general surgeons (GS), cardiothoracic surgeons (CTS), and general thoracic surgeons (TS), using large administrative and inpatient databases. ⋯ Some specific processes of care that account for these improved economic, operative, and oncological outcomes have been identified. Others are not yet specifically known and associated with specialization in thoracic surgery.