The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Aug 2017
Survival impact of postoperative therapy modalities according to margin status in non-small cell lung cancer patients in the United States.
Unlike complete (R0) resection guidelines, current National Comprehensive Cancer Network (NCCN) adjuvant therapy guidelines after incomplete (R1/R2) resection of non-small cell lung cancer (NSCLC) are based on low-level evidence. We attempted to validate them. ⋯ NCCN adjuvant therapy guidelines after complete resection, based on high-level evidence, are validated, but not guidelines for patients with incompletely resected early-stage NSCLC, which are based on low-level evidence. Monomodality postoperative radiotherapy was not validated for any stage. Specific studies are needed to determine optimal management after incomplete resection.
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J. Thorac. Cardiovasc. Surg. · Aug 2017
Evaluation of acute and chronic pain outcomes after robotic, video-assisted thoracoscopic surgery, or open anatomic pulmonary resection.
Although robotic-assisted thoracic surgery (RATS) provides improved dexterity, the effect of RATS on pain compared with video-assisted thoracoscopic surgery (VATS) or open lobectomy is poorly understood. This study evaluated acute and chronic pain following RATS, VATS, and open anatomic pulmonary resection. ⋯ Although minimally invasive approaches resulted in less acute pain and chronic numbness, there were no significant differences between RATS and VATS. In contrast, more RATS patients believed the approach affected their pain, suggesting a difference between reality and perception.
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J. Thorac. Cardiovasc. Surg. · Aug 2017
Outcomes following thoracotomy or thoracoscopic vascular ring division in children and young adults.
To determine the short- and intermediate-term outcomes following vascular ring division by video-assisted thoracoscopic (VATS) or thoracotomy approach. ⋯ Vascular ring division by either thoracotomy or VATS can be performed with low rates of complication and need for reintervention. Compared with thoracotomy, VATS is associated with shorter operative duration and hospital LOS among patients with RAA with LSCA/LL.
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J. Thorac. Cardiovasc. Surg. · Aug 2017
Salvage pulmonary resection after stereotactic body radiotherapy: A feasible and safe option for local failure in selected patients.
For inoperable patients with pulmonary malignancy, stereotactic body radiotherapy is a reasonable therapeutic option. Despite good early tumor control, local failure occurs in up to 10% of patients by 3 years. Because management of local recurrence after stereotactic body radiotherapy is unclear, we evaluated use of surgery as a salvage option. ⋯ After local failure of stereotactic body radiotherapy, salvage resection remains a viable option for operable patients, with acceptable morbidity and survival. As use of stereotactic body radiotherapy continues to expand, further studies to evaluate the optimal management for local failure are needed.
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J. Thorac. Cardiovasc. Surg. · Aug 2017
Open repair of chronic thoracic and thoracoabdominal aortic dissection using deep hypothermia and circulatory arrest.
Chronic dissection of the thoracic and thoracoabdominal aorta as sequela of a prior type A or B dissection is a challenging problem that requires close radiographic surveillance and prompt operative intervention in the presence of symptoms or aneurysm formation. Open repair of chronic thoracic and thoracoabdominal aortic dissection using deep hypothermia has been our preferred method to treat this complex pathology. The advantages of this technique include organ and spinal cord protection, the flexibility to extend the repair proximally into the arch, and the ability to limit ischemia to all vascular beds. ⋯ Open repair of chronic thoracic and thoracoabdominal aortic dissection using deep hypothermia and circulatory arrest has low morbidity and mortality. The need for reintervention is low, and long-term survival is excellent. We believe that open repair continues to be the gold standard in patients who are suitable candidates for surgery.