The Annals of thoracic surgery
-
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.
-
Comparative Study
Pulmonary Artery Sealing With an Ultrasonic Energy Device in Video-Assisted Thoracoscopic Surgery Lobectomy: An Animal Survival Study.
Pulmonary artery (PA) sealing in video-assisted thoracoscopic surgery (VATS) lobectomy is typically accomplished using vascular endostaplers. Endostaplers may be associated with iatrogenic PA branch injury, especially in short, small PA branches. We evaluated PA branch sealing with the HARMONIC ACE +7 (ACE) shears (Ethicon, Cincinnati, OH) in VATS lobectomy in a canine survival model. ⋯ The use of the ACE for PA branch sealing in VATS lobectomy is safe and effective in an animal survival model. Human studies are needed to determine the clinical safety of ultrasonic PA branch sealing before widespread clinical use.
-
Data from selected centers show that robotic lobectomy is safe and effective and has 30-day mortality comparable to that of video-assisted thoracoscopic surgery (VATS). However, widespread adoption of robotic lobectomy is controversial. We used The Society of Thoracic Surgeons General Thoracic Surgery (STS-GTS) Database to evaluate quality metrics for these 2 minimally invasive lobectomy techniques. ⋯ Patients undergoing robotic lobectomy had more comorbidities and robotic lobectomy operative times were longer, but quality outcome measures, including complications, hospital stay, 30-day mortality, and nodal upstaging, suggest that robotic lobectomy and VATS are equivalent.
-
The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS CHSD) is the largest congenital and pediatric cardiac surgical clinical data registry in the world. With more than 400,000 total operations from nearly all centers performing pediatric and congenital heart operations in North America, the STS CHSD is an unparalleled platform for clinical investigation, outcomes research, and quality improvement activities in this subspecialty. ⋯ This use of the STS CHSD for outcomes research and for quality measurement continues to expand as database participation and the available wealth of data in it continue to grow. This article reviews outcomes research and quality improvement articles published in 2015 based on STS CHSD data.