Thoracic surgery clinics
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Thoracic surgery clinics · May 2015
ReviewLong-term Oncologic and financial implications of lung cancer screening.
Benefits and risks of computed tomography lung cancer screening are discussed with specific focus on oncologic and financial issues. Earlier disease stage at diagnosis implies that more patients are treated surgically, but the changes in oncologic treatment will not be dramatic. ⋯ Preliminary data from the National Lung Screening Trial indicate that it is cost effective and comparable to screening for other major malignancies. Some future modifications in the computed tomography screening methodology are discussed.
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Results of the recent National Lung Cancer Screening Trial show a significant survival benefit for annual screening with a low-dose computed tomographic (CT) scan in high-risk individuals. This result has led the US Preventive Services Task Force to recommend annual low-dose CT scans for this at-risk population. ⋯ The primary risks from screening are radiation exposure, false-positive results and unnecessary diagnostic and therapeutic procedures, overdiagnosis and overtreatment, and increased psychological distress. This article reviews these risks, which must be considered and weighed against the benefits when discussing enrollment with patients.
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Lung transplantation (LTx) is the definitive treatment of patients with end-stage lung disease. Availability of donor lungs remains the primary limitation and leads to substantial wait-list mortality. ⋯ Unique in its physiology, lung viability seems more tolerant to the variable durations of ischemia that occur in DCD donors. Initial experience with DCD LTx is promising and, in combination with ex vivo lung perfusion systems, seems a valuable opportunity to expand the lung donor pool.
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The number of patients listed for lung transplantation exceeds the number of available transplantable organs because of a shortage of organ donors and a low utilization rate of donated lungs. A novel strategy of donor lung management, called ex vivo lung perfusion (EVLP) can keep the organ in a physiologic protective condition, and promises to increase lung utilization by reevaluating, treating, and repairing donor lungs before transplantation. Preclinical studies have shown great potential for EVLP as a platform for the delivery of novel therapies to repair injured organs ex vivo and improve the success of lung transplantation.
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Airway complications after lung transplantation present a formidable challenge to the lung transplant team, ranging from mere unusual images to fatal events. The exact incidence of complications is wide-ranging depending on the type of event, and there is still evolution of a universal characterization of the airway findings. ⋯ Simple observation or simple balloon bronchoplasty is sufficient in many cases, but vigilance following more severe necrosis is required for late development of both anastomotic and nonanastomotic airway strictures. Furthermore, the impact of coexisting infection, rejection, and medical disease associated with high-level immunosuppression further complicates care.