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Journal and News Scan

Source: Annals of Surgery
Author(s): de la Motte, Louise; Kehlet, Henrik; Vogt, Katja; Nielsen, Claus H.; Groenvall, John B.; Nielsen, Henning B.; Andersen, Andreas; Schroeder, Torben V.; Lönn, Lars

This double-blind placebo-controlled trial involved 153 pts undergoing elective endovascular aortic aneurysm repair, of whom half received methylprednisolone preoperatively.  The intervention reduced the systemic inflammatory response from 92% to 27%, plasma IL-6 was decreased by 90%, and CRP, body temperature, IL-8, and TNF were also reduced.  MMP-9, D-dimer, and myeloperoxidase were unchanged.  Medical and surgical morbidity were similar between the groups.  The intervention reduced time to meet discharge criteria from 3 to 2 days.

Source: Annals of Surgery
Author(s): Estrera, Anthony L.; Sandhu, Harleen K.; Miller, Charles C.; Charlton-Ouw, Kristofer; Nguyen, Tom C.; Afifi, Rana O.; Azizzadeh, Ali; Safi, Hazim J.

This retrospective review reports on single-institution results for management of aneurysms involving the entire aorta using a 2-stage elephant trunk technique.  288 pts had only a first stage operation, and 157 pts underwent a complete 2 stage repair.  Mortality was 9.1% and stroke rate after stage 1 was 3.4%.   Mortality prior to 2nd stage repair was 18%.

Source: European Heart Journal
Author(s): Geske JB, Konecny T, Ommen SR, Nishimura RA, Sorajja P, Schaff HV, Ackerman MJ, Gersh BJ.

The authors of this study investigated the effect of myectomy on pulmonary hypertension in patients with hypertrophic cardiomyopathy (HCM). In a retrospective study of 306 HCM patients, they found that myectomy was associated with an evident reduction in right ventricular systolic pressure (RVSP), both in patients with moderate/severe PH and in all patients with PH (RVSP>35mmHg). Their findings can help to guide therapeutic expectations and provide insight into pulmonary haemodynamics following obstruction relief.

Source: Thorax
Author(s): A Reid, N H de Klerk, C Magnani, D Ferrante, G Berry, A W Musk, E Merler

Data from 6 cohort studies were evaluated to assess the ongoing risk of mesothelioma more than 40 years after initial environmental exposure to asbestos.  Among over 22,000 of those exposed, 707 cases of pleural mesothelioma were diagnosed.  The rate and risk increased until 45 years after exposure, then the rate of increase tapered off somewhat.

Source: Thorax
Author(s): Christopher Kabrhel, Ikenna Okechukwu, Praveen Hariharan, James Kimo Takayesu, Peter MacMahon, Faris Haddad, Yuchiao Chang

In an effort to identify clinical findings associated with deterioration and mortality after PE, the authors prospectively monitored 298 pts admitted through the ED with documented PE.  34% of pts experienced clinical deterioration, which was associated with hypotension, hypoxia, residual DVT, CAD, and right heart strain on echocardiogram.  In contrast, 30-day mortality was associated with malignancy and CHF.

Source: Journal of Clincial Oncology
Author(s): Hiran C. Fernando, Rodney J. Landreneau, Sumithra J. Mandrekar, Francis C. Nichols, Shauna L. Hillman, Dwight E. Heron, Bryan F. Meyers, Thomas A. DiPetrillo, David R. Jones, Sandra L. Starnes, Angelina D. Tan, Benedict D.T. Daly and Joe B. Putnam Jr

This multiinstitutional randomized trial compared sublobar resection alone to sublobar resection with adjuvant brachytherapy in high risk patients with peripheral NSCLC <3cm.  Time to and type of local recurrence were similar between the groups.  Brachytherapy did not importantly improve local control in patients with potentially compromised margins.  The 3-year suvival rate in both groups was 71%.

Source: Journal of Clinical Oncology
Author(s): Rodney J. Landreneau, Daniel P. Normolle, Neil A. Christie, Omar Awais, Joseph J. Wizorek, Ghulam Abbas, Arjun Pennathur, Manisha Shende, Benny Weksler, James D. Luketich and Matthew J. Schuchert

This single-institution retrospective study used propensity score matching to compare long-term outcomes of anatomic segmentectomy vs lobectomy for early stage non-small cell lung cancer.   A total of 312 pts were matched in each group.  Locoregional and overall recurrence rates were similar between the groups.  Freedom from recurrence (70% for segmentectomy vs 71% for lobectomy) at 5 years was similar.  5-year survival was also similar (54% vs 60%). 

Source: Journal of Clinical Oncology
Author(s): Christophe Mariette, Laetitia Dahan, Françoise Mornex, Emilie Maillard, Pascal-Alexandre Thomas, Bernard Meunier, Valérie Boige, Denis Pezet, William B. Robb, Valérie Le Brun-Ly, Jean-François Bosset, Jean-Yves Mabrut, Jean-Pierre Triboulet, Laurent Bedenne and Jean-François Seitz

This randomized trial involving 30 centers in France compared outcomes after induction chemoradiotherapy followed by resection to resection alone for stage I or II esophageal cancer.  The R0 resection rate was similar between the groups.  Postoperative mortality was higher in the induction therapy group (11.1% vs 3.4%).  Long-term survival was similar between the groups. 

Source: Circulation
Author(s): Cohen DJ, Osnabrugge RL, Magnuson EA, Wang K, Li H, Chinnakondepalli K, Pinto D, Abdallah MS, Vilain KA, Morice MC, Dawkins KD, Kappetein AP, Mohr FW, Serruys PW.

In this study the cost-effectiveness of CABG vs. DES-PCI was analysed from a U.S. Healthcare perspective. Using 5-year cost and quality-of-life data from the SYNTAX trial and lifetime extrapolations, the authors found that CABG was an economically attractive treatment option for most patients with 3-VD or left main CAD disease. 

Source: Thorax
Author(s): Amelia O Clive, Brennan C Kahan, Clare E Hooper, Rahul Bhatnagar, Anna J Morley, Natalie Zahan-Evans, Oliver J Bintcliffe, Rogier C Boshuizen, Edward T H Fysh, Claire L Tobin, Andrew R L Medford, John E Harvey, Michel M van den Heuvel, Y C Gary Lee, Nick A Maskell

The authors developed and validated a survival predictive score for patients with malignant pleural effusion using 3 large international cohorts of patients.  The LENT score is based on LDH level, ECOG performance status, neutrophil to lymphocyte ratio, and tumor type.  Low risk patients had a median survival of 319 days, moderate risk group survival was 130 days, and median survival in the high risk group was 44 days.  Among the high risk patients, mortality at 1 month was 35% and at 6 months was 97%.  Use of this score may help in selecting appropriate interventions for this patient population.

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