Thoracic surgery clinics
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Lobectomy with systematic lymph node sampling or dissection remains the mainstay of treatment of early stage non-small cell lung cancer. The use of video-assisted thoracic surgery (VATS) to perform lobectomy was first reported in 1992. ⋯ To overcome these limitations, robotic systems were developed during the last decades. This article reviews the technical aspects of robotic lobectomy using a VATS-based approach.
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Robotic surgery is safe and efficient, with similar survival rates to the open and video-assisted thoracoscopic surgery (VATS) approaches. The surgeon can provide an R0 resection in patients with cancer. ⋯ The capital cost, service contract costs, and equipment costs have to be carefully considered and studied, and patient selection is critical. There are few achievable benefits of using a robotic system compared with VATS when performing a sympathotomy for patients with hyperhidrosis or a pulmonary wedge resection for tissue diagnosis for patients with interstitial lung disease.
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Carinal resection and sleeve pneumonectomy are rare procedures and challenging issues in thoracic surgery. In spite of the knowledge of the technique, the incidence of postoperative complications is higher compared with standard resections. Adequate patient selection, improved anesthetic management and surgical technique, and better postoperative management might reduce the rate of postoperative morbidity and mortality.
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Esophageal cancer management is based on baseline clinical stage, location of the tumor, and associated comorbid conditions. In patients with localized esophageal cancer (LEC) with technically resectable tumors and who are medically fit for surgery, the current recommendation is trimodality therapy (chemoradiation followed by surgery). Bimodality therapy (definitive chemoradiation) is reserved for patients with cervical esophageal tumors, technically unresectable tumors, for patients who cannot be recommended surgery due to medical comorbidities, or those who decline surgery. Prospective data from 2 studies suggest that definitive chemoradiation may be sufficient for LEC with squamous cell histology; a definite answer, however, is unclear.
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Thoracic surgery clinics · Aug 2013
ReviewRole of induction therapy: surgical resection of non-small cell lung cancer after induction therapy.
Patients with Stage III non-small cell lung cancer are best managed by multimodality therapy. Patients with N2 disease can be treated with induction therapy (usually chemotherapy) followed by surgical resection. Patients whose medical comorbidities preclude surgery should be treated with definitive chemoradiotherapy. T3 or T4 tumors involving the superior sulcus or spine are best managed with induction chemoradiotherapy and surgical resection.