The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Sep 2021
Prognostic value of epidermal growth factor receptor gene mutation in resected lung adenocarcinoma.
Mutation of the EGFR gene is known as a predictor for the response to EGFR tyrosine kinase inhibitor. Although EGFR mutation status is proposed to be incorporated in the Ninth Edition of the Lung Cancer Staging system, its prognostic value for surgically resected lung adenocarcinoma remains controversial. ⋯ EGFR mutation was a strong poor prognostic factor in patients with radiologic solid, histologic acinar pattern-predominant adenocarcinoma/papillary pattern-predominant adenocarcinoma/invasive mucinous adenocarcinoma, and pathologic stage II and III lung adenocarcinomas. After surgery, distinct metastatic patterns were revealed according to EGFR mutation status. These findings have implications for the upcoming new lung cancer staging system.
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J. Thorac. Cardiovasc. Surg. · Sep 2021
Multicenter StudyInstitutional factors associated with adherence to quality measures for stage I and II non-small cell lung cancer.
Although previous studies have identified variation in quality lung cancer care, existing quality metrics may not fully capture the complexity of cancer care. The Thoracic Surgery Outcomes Research Network recently developed quality measures to address this. We evaluated baseline adherence to these measures and identified factors associated with adherence. ⋯ Significant gaps continue to exist in the delivery of quality care to patients with early-stage lung cancer. High-volume academic hospitals had higher adherence for surgical care measures, but lower rates for coordination of care measures. This requires further investigation, but suggests targets for quality improvement may vary by institution type.
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J. Thorac. Cardiovasc. Surg. · Sep 2021
Comparative StudySupercharged cervical anastomosis for esophagectomy and gastric pull-up.
Esophagectomy has high rates of morbidity and mortality. Anastomotic leakage is the most frequent complication and is likely caused by diminished anastomotic perfusion. Supercharged microvascular anastomosis has previously been performed in select patients to supplement the blood supply to the graft and anastomosis after esophagectomy. This study aimed to evaluate complications that may arise after performing the supercharged cervical anastomosis for esophagectomy procedure. ⋯ The supercharged cervical anastomosis for esophagectomy procedure may reduce the occurrence of anastomotic leakage and improve perfusion in the anastomotic area via vein and arterial microanastomoses.
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J. Thorac. Cardiovasc. Surg. · Sep 2021
Preoperative plasma biomarkers associated with atrial fibrillation after coronary artery bypass surgery.
Postoperative atrial fibrillation (POAF) is a common complication in coronary artery bypass grafting (CABG) procedures. This prospective study aimed to investigate predisposition of proteins and metabolites correlated to POAF after CABG and related cellular pathways. ⋯ The present study for first time at multi-omics levels explored the mechanism of POAF and validated the results in a new cohort of patients, suggesting preexisting differential proteins and differential metabolites in the plasma of patients prone to POAF after CABG. Dysregulation of peroxisome proliferators-activated receptor α and glutathione metabolism pathways related to metabolic remodeling and redox imbalance-associated electrical remodeling may play a key role in the pathogenesis of POAF. Lower plasma phospholipid transfer protein, apolipoprotein-C3, higher cholesteryl ester transfer protein and glutathione peroxidase 3 levels are linked with POAF. These proteins/metabolites may be developed as biomarkers to predict POAF.