Journal and News Scan

Retrospective study of surgery versus SBRT for clinical stage I NSCLC using the National Cancer Data Base (NCDB). Propensity score matching was used to create 5355 matched pairs. In that analysis, median survival for those undergoing surgery was 62.3 months versus 33.1 months in those undergoing SBRT. The 3-year survival was 68.5% in the surgery group and 46.0% in the SBRT group. An additional propensity score matching was used to create 4555 matched pairs of patients undergoing sublobar resection (wedge or segmentectomy) versus SBRT. In that analysis, median survival for those undergoing sublobar resection was 48.3 months versus 33.9 months in those undergoing SBRT. The 3-year survival was 61.7% in the surgery group and 47.0% in the SBRT group. The main finding of this study was that patients undergoing surgery for clinical stage I NSCLC have longer overall survival than those undergoing SBRT. The authors state that a limitation of the study is that despite propensity matching, there are unmeasured variables that contributed to treatment allocation. 

This systematic review assessed outcomes of surgery for thymomas treated with open vs minimally invasive approaches.  The vast majority of tumors were Masaoka I and II.  Minimally invasive approaches were associated with shorter LOS and less blood loss.  Complication rates were similar between  the groups, as were rates of R0 resection and recurrence. 

The authors of this paper aimed to study the frequency and predictors of internal mammary artery (IMA) failure in 1539 patients who underwent IMA revascularization of the left anterior descending (LAD) artery. IMA failure was defined as >75% stenosis at a follow-up of 12-18 months.  They found that IMA failure occured in 8.6%. IMA failure was associated with LAD stenosis <75% (odds ratio 1.76), not having diabetes mellitus (OR 1.82) and an additional bypass graft to the diagonal branch (OR 1.92). IMA failure was associated with higher rates of acute clinical events after follow-up angiography.   The investigators conclude that these findings suggest that the benefit of CABG in moderate LAD stenosis without functional ischemia could be matter of debate. 

The authors performed a randomized control study of 178 patients with heart failure and systolic dyssynchrony who were accepted for CABG, randomizing the participants into two groups:  CABG alone (n=87) and CABG + concomitant epicardial CRT (n=91).  CRT was activated postoperatively.  At a mean follow-up period of 55 months, the mortality rate of the CABG group was 36% and that of the CABG + CRT group was 15%.  Moreover, all-cause mortality, cardiac death, and hospital readmissions were significantly lower for the CABG + CRT group.

It is known that not all patients with potential indications for CRT undergoing CABG will meet the criteria for CRT postoperatively.  The question is whether performing CRT at the time of CABG in all such patients is a cost-effective strategy.