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Journal and News Scan

Source: The Lancet Oncology
Author(s): O Raaschou-Nielson and others

The authors surveyed the effects of particulate air pollution on the development of lung cancer and the adenocarcinoma subtype in 17 European cohorts totalling over 300,000 members and over 4 million person-years at risk.  Over 2,000 lung cancers were diagnosed during the follow-up period.  Particulate pollution was associated with a 20% increase in the risk of lung cancer and a 50% increase in the risk of adenocarcinoma.

Source: Endoscopy
Author(s): Corina Sie, Tim Bright, Mark Schoeman, Philip Game, William Tam, Peter Devitt, David Watson

129 pts with Barrett's esophagus with either no or low grade dysplasia were randomized to ablation with the argon plasma coagulator (APC) or observation.  Ablation of >95% of Barrett's mucosa was initially achieved in 61 of 63 in the APC group.  This decreased to 21 of 32 at long-term follow-up (>84 mos).  The length of Barrett's decreased in the surveillance group from 4.2 cm at presentation to 2.7 cm at long-term follow-up.   Sporadic low grade and high grade dysplasia developed in both groups, indicating that persistent surveillance is required.

Source: Annals of Thoracic Surgery
Author(s): Michael Kent, Rodney Landreneau, Sumithra Mandrekar, Shauna Hillman, Francis Nichols, David Jones, Sandra Starnes, Angelina Tan, Joe Putnam, Brian Meyers, Benedict Daly, Hiran C. Fernando

The ACOSOG Z4032 trial compared sublobar resection alone to sublobar resection with brachytherapy.   This study compared surgical outcomes for wedge resection vs segmental resection, which were surgical options as part of the  trial.  Wedge resection was associated with a closer resection margin (8mm vs 15mm), a lower rate of nodal upstaging (1% vs 9%), fewer nodal stations sampled (1 vs 3), and a higher rate of no nodal sampling/dissection (41% vs 2%). 

Source: Annals of Thoracic Surgery
Author(s): Jeffrey A. Poynter, Pirooz Eghtesady, Brian W. McCrindle, Henry L. Walters,Paul M. Kirshbom, Eugene H. Blackstone, S. Adil Husain, David M. Overman, Erle H. Austin, Tara Karamlou, Andrew J. Lodge, James D. St. Louis, Peter J. Gruber, Gerhard Ziemer, Ryan R. Davies, Jeffrey P. Jacobs, John W. Brown, William G. Williams, Christo I. Tchervenkov, Marshall L. Jacobs, Christopher A. Caldarone, Congenital Heart Surgeons' Society

Factors affecting RV to PA conduit durability were investigated in a multi-institution study involving 429 infants <2 years old.  Conduit durability at a median f/u of 6 years was 63%.  Earlier replacement was associated with a smaller z-score, and durability was reduced with implantation of allografts from aorta or PA compared to use of a valved bovine jugular vein. 

Source: Annals of Thoracic Surgery
Author(s): Katherine H. Chau, Tamir Friedman, Maryann Tranquilli, John A. Elefteriades

The efficacy of deep hypothermic circulatory arrest (DHCA) on preserving neurocognitive function is uncertain.  This study compared 29 pts undergoing aortic surgery with DHCA to 33 who did not require DHCA.  Cognitive scores preop and postop were similar for both groups. A similar number of pts (11 vs 13) experienced neurocognitive deficits postoperatively, including a decline in types of memory function.  Time under DHCA was not associated with the incidence of neurocognitive deficits.  Overall, cardiac surgery caused some problems with memory.  DHCA, when required, preserved neurocognitive function. 

Source: Annals of Thoracic Surgery
Author(s): Damien J. LaPar, Ivan K. Crosby, Irving L. Kron, John A. Kern, Edwin Fonner, Jeffrey B. Rich, Alan M. Speir, Gorav Ailawadi

In the US, preoperative beta-blockade is a hospital quality metric that must be addressed at the time of each operation.  This study reviewed STS Database data for isolated CABG in nearly 44,000 pts.  After risk adjustment, beta-blockade had no effect on mortality, morbidity, or hospital resource utilization.  The authors suggest that beta-blockade is not a useful quality metric for CABG. 

Source: Seminars in Thoracic and Cardiovascular Surgery
Author(s): GE Darling, NK Altorki, JD Luketich, MB Orringer

This article is a transcription of a roundtable discussion on surgical management of esophageal cancer involving recognized experts in the field.  Topics include conduit preparation, pyloric drainage, conduit preconditioning, postoperative reflux, the role of surgery in multimodality therapy, and the choice of incisions for esophagectomy.

Source: Annals of Oncology
Author(s): A. Suzuki, L. Xiao, T. Taketa, K. Sudo, R. Wadhwa, M. A. Blum, H. Skinner, R. Komaki, B. Weston, J. H. Lee, M. S. Bhutani, D. C. Rice, D. M. Maru, J. Erasmus, S. G. Swisher, W. L. Hofstetter, and J. A. Ajani

This single-center study analyzed outcomes for 323 pts with esophageal adenocarcinoma who achieved a clinical CR after chemoradiotherapy to determine the prognostic value of pretreatment PET.  Patients with an SUV >6 faired better with induction therapy and resection compared to definitive chemoradiotherapy.  Those with an SUV <6 did equally well with either treatment regimen.  PET SUV may facilitate determining whether bimodality or trimodality is optimal for patients with esophageal adenocarcinoma. 

Source: New England Journal of Medicine
Author(s): Philippe Gabriel Steg, Arnoud van 't Hof, Christian W. Hamm, Peter Clemmensen, Frédéric Lapostolle, Pierre Coste, Jurrien Ten Berg, Pierre Van Grunsven, Gerrit Jan Eggink, Lutz Nibbe, Uwe Zeymer, Marco Campo dell' Orto, Holger Nef, Jacob Steinmetz, Louis Soulat, Kurt Huber, Efthymios N. Deliargyris, Debra Bernstein, Diana Schuette, Jayne Prats, Tim Clayton, Stuart Pocock, Martial Hamon, and Patrick Goldstein for the EUROMAX Investigators

This trial of 2218 pts with STEMI being transported for PCI randomized pts to bivalirudin or standard therapy (LMW heparin with optional glycoprotein IIb/IIIa inhibitors).  The primary outcome was death or major bleeding.   Bivalirudin was associated with a significant reduction (40%) in the primary outcome incidence but had a 6-fold increase in the incidence of acute stent thrombosis.  Death and reinfarction rates were similar.

Source: Thorax
Author(s): HJ Kang, B Hwangbo, G-K Lee, B-H Nam, H-S Lee, MS Kim, JM Lee, JI Z, HS Lee, J-Y Han

This randomized trial included 148 pts with potentially resectable NSLCL.  Mediastinal staging was randomized to EBUS-centered (EBUS possibly followed by EUS) or EUS-centered (EUS possibly followed by EBUS).  Diagnostic accuracy and sensitivity were similar for both groups.  Adding EBUS after initial EUS improved accuracy and sensitivity significantly, whereas adding EUS after initial EBUS did not significantly improve outcomes.  The authors suggest that EBUS is the best first procedure in endoscopic mediastinal staging for potentially resectable lung cancer.

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