The Annals of thoracic surgery
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Rectal cancer has a higher risk of developing lung metastasis compared with colon cancer. It is unclear whether the prognosis after pulmonary metastasectomy for these distinct tumors is different. ⋯ Disease-free survival and site of recurrence after pulmonary metastasectomy for colorectal carcinoma are dependent on the site of the primary tumor. Lung metastases from rectal cancer have a worse disease-free survival compared with colon cancer. This may influence treatment and follow-up strategies.
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Readmissions are a common problem in cardiac surgery. The goal of this study was to examine the frequency, timing, and associated risk factors for readmission after cardiac operations. ⋯ Nearly 1 of 5 patients who undergo cardiac operations require readmission, an outcome with significant health and economic implications. Management practices to avert in-hospital infections, reduce postoperative arrhythmias, and avoid volume overload offer important targets for quality improvement.
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Transesophageal echocardiography (TEE) is often performed during cardiac operations. The need to repeat TEE to exclude left atrial or left atrial appendage thrombus before direct current cardioversion (DCCV) in patients with a recent intraoperative TEE showing no thrombus is unclear. We sought to determine the incidence of and risk factors for new thrombus in patients undergoing TEE-guided DCCV after cardiac operations. ⋯ Development of new thrombus in patients with atrial arrhythmias early after cardiac operations is not uncommon, especially in patients with heart failure. Patients at high risk for thromboembolic events should undergo TEE before DCCV, even if a recent intraoperative TEE showed no thrombus.
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Many studies have demonstrated that patients with metachronous second primary lung cancer (MSPLC) benefit from surgery. Owing to the lack of uniform criteria and prospective randomized trials, the extent of resection remains controversial, and prognostic factors are still not fully clear. The present study aimed to assess surgical treatment of MSPLC and identify prognostic factors of outcome. ⋯ Surgical treatment of MSPLC is safe and effective. TNM stage I, tumor size 2 cm or less, or less than 20 pack-years smoking are predictors of improved survival. Sublobar resection is acceptable. For stage I disease, lobectomy tends to be associated with better survival than sublobar resection, although the difference is not significant, and completion pneumonectomy is not recommended. Long-term follow-up is necessary even after curative resection of lung cancer.