The Annals of thoracic surgery
-
There is growing interest in aortic valve-sparing and valve repair operations, but the ideal operation and timing of intervention in these generally younger patients undergoing operations for aortic insufficiency (AI) and dilated ascending aorta remains controversial. ⋯ Elective root replacement operations in patients younger than 70 are associated with low rates of mortality and reoperation, which should be considered the benchmark operation for aortic valve-sparing or repair operations in similar patients. Worse survival was associated with severe AI and older age, suggesting earlier intervention may be an appropriate therapeutic strategy in selected patients.
-
Comparative Study
Recurrence and Survival After Segmentectomy in Patients With Prior Lung Resection for Early-Stage Non-Small Cell Lung Cancer.
Lobectomy is the standard of care for patients with early-stage non-small cell lung cancer (NSCLC). However, the treatment of choice for patients with prior lung resection and a second primary NSCLC has not been established. We compared rates and patterns of recurrence and survival in patients with and without prior lung resection treated by segmentectomy and determined predictors of recurrence. ⋯ Segmentectomy is a reasonable option for patients with early-stage NSCLC who have had a prior lung resection. It results in similar survival but trends toward lower recurrence-free survival compared with patients undergoing primary resection.
-
Quantitative analysis of specific exhaled carbonyl compounds (ECCs) has shown promise for the detection of lung cancer. The purpose of this study is to demonstrate the normalization of ECCs in patients after lung cancer resection. ⋯ The analysis of ECCs demonstrates reduction to the level of control patients after surgical resection for lung cancer. This technology has the potential to be a useful tool to detect disease after lung cancer resection. Continued follow-up will determine whether subsequent elevation of ECCs is indicative of recurrent disease.
-
A highly selected subset of patients with oligometastatic non-small cell lung cancer (NSCLC) will be cured after all sites of established disease (primary and metastases) have been eliminated by surgery or radiation (ie, "curative intent" approach). Mediastinal lymph node metastases (N2) have been found retrospectively to predict a poor prognosis in this setting (5-year survival of 4% for N2-positive versus 31% for N2-negative). Hence, our institution has programmatically limited the use of curative intent local therapy to oligometastatic NSCLC patients confirmed to be free of N2 disease. However, it is unclear whether the exclusion of N2-positive patients is an effective prospective selection step to aggressively treat oligometastatic NSCLC. ⋯ Using invasive mediastinal staging to exclude N2 disease has a role in surgical decision making and achieving long-term survival among oligometastatic NSCLC patients. Further study is warranted to determine whether a subset of patients with N2 disease also have the potential for long-term survival with local therapy.