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Journal and News Scan
The National Cancer Database was queried regarding esophageal squamous cancer cases from 2004-2013, and over 11,000 patients were identified. Definitive chemoradiotherapy was used in 79%, whereas resection was employed in 21% at some phase of therapy. Resection alone and definitive chemoradiotherapy were associated with increased mortality compared to neoadjuvant therapy followed by resection. Higher volume centers (>20/year) had better survival than other centers regardless of therapy.
This multiinstitutional study including advocates of robotic lung resection identified a 1.9% incidence of intraoperative castrophes, most commonly pulmonary arterial bleeding. Patients at risk had lower FEV1%, higher clinical stage, and more frequent preoperative radiation therapy. Interestingly, they were also undergoing a different surgical approach than what the authors normally used. The hospital mortality in these patients was 10-fold higher than among patients who did not suffer catastrophes.
This analysis of data from the JCOG0201 trial identified factors that place patients at increased risk for recurrence after lobectomy for stage I adenocarcinoma. They include visceral pleural invasion, vascular invasion, or an invasive component measuring >2 cm.
A federal court in Minnesota has dismissed over 5000 lawsuits against 3M Bair Hugger, disagreeing with assertions by plaintiffs that forced-air warming contributes to surgical site infections (SSI). A fallout between the inventor and the company he founded contributed to the acrimony and disparate recommendations surrounding this therapy. Ultimately, the judge agreed with a preponderance of published evidence, the FDA, and independent organizations such as ECRI in concluding the benefits of forced-air warming systems outweigh potential but unproven risks of SSI due to disruption of air currents.
A new multidisciplinary guideline for surgical attire has been issued that replaces controversial 2014 recommendations from the Association of periOperative Registered Nurses (AORN). The new standard, written by the American Society of Anesthesiologists (ASA), American College of Surgeons (ACS), AORN, and others has reversed prior mandates regarding head and arm covering, and clothing worn under scrubs, due to lack of evidence. It is anticipated that The Joint Commission and other regulatory bodies will follow these new guidelines which state, “No recommendation can be made” for the type of head covering worn, wearing long sleeves, or clothing worn underneath scrubs. The author notes significant cost savings from elimination of disposable jackets, and encourages anesthesiologists to have greater input in future policy decisions. A resurgence of the skull cap is warranted based on evidence. A key lesson from this 5-year distraction is the need for multidisciplinary collaboration by ALL stakeholders impacted by a national policy of this scope.
Better cardiorespiratory fitness as quantified by treadmill exercise testing was associated with a substantially decreased likelihood of lung cancer in former smokers (77% reduction in very fit) and reduced mortality in smokers who subsequently developed lung cancer (85% reduction in very fit).
Quite interesting to see that the incidence of revascularisation after multivessel PCA (the additional element on the second co-primary outcome) appears to have occured in more than 1% of the patients within three years...
Using data from the FREEDOM (Future Revascularizaiton Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease) trial, the authors developed an 8 variable model that predicts individual risk of major acute cardiovascular events in diabetic patients with multivessel disease. Percutaneous coronary intervention (PCI) never outperformed CABG; the latter was superior to PCI in 54% of patients overall and in 100% of those who smoked.
This review offers data suggesting that intermediate-term outcomes for saphenous vein grafting are similar to those for radial artery grafts used for CABG.
A coalition of international organizations dealing with cancer and sports medicine have updated recommendations, stating that exercise may help prevent cancer and can improve survival in patients with cancer. Methods of implementation are discussed.