Thoracic surgery clinics
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Thoracic surgery clinics · Aug 2020
ReviewManagement of Complications After Lung Resection: Prolonged Air Leak and Bronchopleural Fistula.
Prolonged air leak or alveolar-pleural fistula is common after lung resection and can usually be managed with continued pleural drainage until resolution. Further management options include blood patch administration, chemical pleurodesis, and 1-way endobronchial valve placement. Bronchopleural fistula is rare but is associated with high mortality, often caused by development of concomitant empyema. Bronchopleural fistula should be confirmed with bronchoscopy, which may allow bronchoscopic intervention; however, transthoracic stump revision or window thoracostomy may be required.
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Enhanced recovery pathways (ERPs), used across multiple surgical subspecialties, is a multidisciplinary delivery of perioperative care designed to lessen the psychological stress of patients undergoing surgery. Thoracic ERP has been implemented but is not widespread, and variations exist between programs. Evidence of the benefit of thoracic ERP is emerging. This article presents common components of a thoracic surgery ERP and reviews contemporary outcomes.
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Thoracic surgery clinics · May 2020
ReviewAdjuvant and Neoadjuvant Immunotherapy in Non-small Cell Lung Cancer.
The advent of immune checkpoint blockade has revolutionized the management of advanced non-small cell lung cancer (NSCLC). Impressive results in the metastatic setting have prompted substantial interest in the application of these agents in earlier-stage disease. ⋯ Resection specimens demonstrate encouraging rates of pathologic response. There are several ongoing phase 3 studies comparing neoadjuvant combination chemotherapy and checkpoint blockade to chemotherapy alone in patients with resectable NSCLC.
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Five-year survival rates for patients with early-stage non-small cell lung cancer have room for improvement. Adjuvant chemotherapy results in a small but significant increase in overall survival at 5 years. Efforts to improve outcomes by intensifying adjuvant treatment, utilizing cancer-specific vaccines or tyrosine kinase inhibitors in unselected patients, have been unsuccessful. In addition to research with immune checkpoint inhibitors that are addressed in a separate article, ongoing studies to personalize adjuvant therapy either by selecting only patients with evidence of minimal residual disease or targeting tumor driver mutations are promising.
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Thoracic surgery clinics · Feb 2020
ReviewTreatment of Pleural Effusions with Nonintubated Video-Assisted Thoracoscopic Surgery.
Video-assisted thoracic surgery has considerably improved the care of the thoracic surgical patient. Patients are able to leave the hospital sooner and experience less pain with equal oncologic outcomes when compared with open surgery. ⋯ This article provides the general thoracic surgeon a detailed description on how to manage pleural effusions using video-assisted thoracoscopic surgery in a nonintubated patient. Surgical techniques and pearls are also presented.