Journal of thoracic disease
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Esophagectomy remains the mainstay treatment of esophageal cancer (EC). Combined with neoadjuvant therapies, the management of EC has deleterious effects on body composition, functional capacity and psychological well-being. Preoperative patient optimisation known as prehabilitation is a novel intervention aimed at reducing morbidity and mortality associated with the trajectory of EC care. ⋯ Nutritional and psychological interventions are less well evaluated. Furthermore, no convincing relationship between prehabilitation and oncological outcomes has been demonstrated. Early studies evaluating prehabilitation are promising however further large scale research is required in order to assess the clinical effectiveness.
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There is no doubt that in recent years our profession has witnessed a steady increase in the number of complaints it receives regarding patient treatment. Patients and families raise such complaints having considered that the treatment offered by clinicians was substandard. Although many of these are resolved with direct correspondence from the hospital and meetings, several others lead to legal proceedings. ⋯ It is then obvious that the role of clinicians as medical expects becomes vital. In fact, their true role is of paramount importance not so much for the successful outcome of a case but mainly for the provision of justice for both claimants and defendants. The article will try and identify the challenges that medical experts face in the current litigation climate and with the opinion of a thoracic surgery expert, will tease out important elements which are necessary to drive a modern and safe clinical and medico legal practice.
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Brain metastases are a major cause of mortality in patients with small cell lung cancer (SCLC). Prophylactic cranial irradiation (PCI) may improve survival among patients that respond to chemotherapy. Less is known about the outcomes of PCI following surgical resection of SCLC. The purpose of this study was to determine if patients who underwent initial surgical resection of SCLC benefit from PCI. ⋯ PCI is associated with increased survival for patients following surgical resection of SCLC. Patients with positive lymph nodes appear to benefit the most, while it remains unclear if patients with negative lymph nodes derive a benefit. Further study is warranted to clarify which subsets of patients should be treated with PCI.
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Improving surgical outcomes is important to patients, providers, and healthcare systems. Understanding best methods to ensure evidence based practices are successfully implemented and sustained in clinical practices leads to improved care. Dissemination and implementation (D&I) science facilitates the successful pathway from clinical trials to sustained implementation. ⋯ Systematically identifying constructs from the beginning of the design through the implementation process can guide design of a multi-component strategy for future large-scale implementation by assessing the relative impact of factors on implementation using the CFIR framework. In the example studied, this allows key stakeholders to ensure success of D&I of SURPAS at multiple levels and times, continuously optimizing the process.
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Robotic thoracoscopic surgery was first done in mainland China in 2009 and has gained popularity in the past few years. Here, we present the largest Chinese series of robotic lobectomy for early-stage non-small cell lung cancer (NSCLC) to date. We aimed to compare the perioperative outcomes of our three-arm robotic-assisted lobectomy (RAL3) and video-assisted lobectomy (VAL) for p-stage I NSCLC and report the approach of the robotic anatomic lobar resections of our center. ⋯ This study confirms that RAL3 is a safer and more effective technique than VAL for the treatment of early-stage NSCLC.