Seminars in thoracic and cardiovascular surgery
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Semin. Thorac. Cardiovasc. Surg. · Jan 2013
ReviewCoronary artery bypass graft surgery remains the standard of care for patients with diabetes.
Coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI) are proven effective treatments of coronary artery disease (CAD), however, the optimal revascularization strategy remains unclear in certain patient subsets. The recently published "Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease (FREEDOM)" trial is a randomized study evaluating the use of CABG vs PCI in diabetic patients with multivessel coronary disease. The purpose of this editorial is to review the FREEDOM trial and the available literature guiding clinicians to make evidence-based decisions when treating diabetic patients with multivessel coronary disease. The current evidence suggests that CABG should remain the standard of care for this patient population.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2013
ReviewHow to follow up patients after curative resection of lung cancer.
Survivors of lung cancer surgery are among the highest-risk patients for developing another lung cancer, yet there is no clear consensus on the method of surveillance for patients after curative surgical resection. Surveillance is no longer futile because the emergence of computed tomography screening has allowed the detection of recurrences and new metachronous cancers at an early stage. In selected patients, lung cancer identified recently on routine computed tomography scan is amenable to curative treatment and is associated with longer survival.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2013
ReviewSurgical management of tetralogy of fallot: in defense of the infundibulum.
Surgical treatment of the Tetralogy of Fallot (ToF) is one of the great successes of medicine and also a topic of controversy. Different strategies have been proposed, including age-based (neonatal) management strategies as well as anatomic-based management strategies. ⋯ The goals of current surgical therapy should be to mitigate the late right ventricular (RV) dysfunction that may occur by minimizing the extent of surgical injury during the intial repair. As the surgical techniques continue to advance, the outcomes will continue to improve.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2013
ReviewCurrent readings: sublobar resection for non-small-cell lung cancer.
The Lung Cancer Study Group consensus recommending lobectomy for stage I non-small-cell lung cancer (NSCLC) to reduce local recurrence associated with sublobar resections has directed NSCLC care since its 1995 publication. However, enhancements in imaging technology and in our understanding of the molecular biology of NSCLC over the past 2 decades have produced large cohorts of patients with smaller, better staged, and more indolent tumors than evaluated by the Lung Cancer Study Group. Numerous single-institution trials have demonstrated that in well-selected patients, sublobar resection can afford comparable survival and recurrence rates with lobectomy with a more favorable risk profile. This review of recent literature will focus on 2 separate issues with regard to the use of sublobar resections for stage I NSCLC: (1) a comparison to nonoperative ablative therapies in medically unfit patients, and (2) identifying in which subset of the noncompromised standard-risk population, sublobar resections provide equivalent outcome to lobectomy.