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Journal and News Scan

Source: Annals of Thoracic Surgery
Author(s): Jeffrey L. Port, Bhupesh Parashar, Nonso Osakwe, Abu Nasar, Paul C. Lee, Subroto Paul, Brendon M. Stiles, Nasser K. Altorki

Using a single institution database, the authors propensity score matched patients receiving wedge resection, wedge resection plus brachytherapy, or SBRT for early stage NSCLC.  Survival was assessed at a median of 35 mos.  Overall recurrence was higher for SBRT vs wedge (30% vs 9%), and recurrence-free and disease-free survival were better after wedge than SBRT.  Male sex and SBRT were significant predictors of mortality and recurrence.

Source: JAMA
Author(s): Yuting P. Chiang; Joanna Chikwe; Alan J. Moskowitz; Shinobu Itagaki; David H. Adams; Natalia N. Egorova

The New York State database was used to perform a retrospective analysis of outcomes for isolated AVR comparing bioprosthetic to mechanical valves.  Propensity matching was used to create 1001 patient pairs.  Survival  and stroke rates were similar between the groups at an average of 10.8 years follow-up.  The cumulative incidence of reoperation  was higher in the bioprosthetic group (12.1% vs 6.9%) but the cumulative incidence of major bleeding was lower in that group (6.6% vs 13.0%). 

Source: JAMA
Author(s): Tiziana Bove and others

This randomized double-blind multicenter study involving 667 pts evaluated the utility of IV fenoldopam in reducing the rate of renal replacement therapy for patients undergoing cardiac surgery who exhibit postoperative acute kidney injury.  Fenoldopam did not importantly reduce the need for renal replacement therapy or 30 day mortality.  Its use was asssociated with an increase in postoperative hypotension.

Source: DG News Cardiology
Author(s): Walter Alexander

WASHINGTON D.C. -- September 16, 2014 -- Use of a dual-filter cerebral protection system reduces the number and volume of cerebral lesions in patients with severe aortic stenosis undergoing transaortic valve replacement (TAVR), according to prospective research presented at the 2014 Transcatheter Cardiovascular Therapeutics meeting (TCT).

“In patients with severe aortic stenosis who are at increased surgical risk, the use of [a] dual-filter cerebral protection system during TAVR significantly reduces the number and volume of cerebral lesions as determined by DW-MRI [diffusion-weighted magnetic resonance imaging] subtraction at 2 and 7 days after TAVR,” explained presenter Axel Linke, MD, University of Leipzig Heart Center, Leipzig, Germany, speaking here at a plenary session on September 13.

“Although results with TAVR have improved considerably over the last decade, stroke remains a major issue, and increases mortality by threefold,” Dr. Linke noted. He said also that neuro-imaging studies are revealing ischaemic brain lesions in more than two-thirds of these patients. “We know that those lesions are associated with a poorer neurocognitive outcome,” he added.

Source: Journal of Thoracic Oncology
Author(s): Cressman, Sonya and others

Costs of lung cancer screening were determined for individuals with a 2% or greater risk of lung cancer over 3 years for 2059 subjects participating in the Pan-Canadian Early Detection of Lung Cancer Study.  During the first 18 mos of screening the per-person cost was $453.  Surgical therapy cost $33,344 over 2 years compared to costs of treating advanced stage cancers of $47,792. 

Source: Journal of Thoracic Oncology
Author(s): den Hengst, Willem A.; Hendriks, Jeroen M.H.; Balduyck, Bram; Rodrigus, Inez; Vermorken, Jan B.; Lardon, Filip; Versteegh, Michel I.M.; Braun, Jerry; Gelderblom, Hans; Schramel, Franz M.N.H.; Van Boven, Wim-Jan; Van Putte, Bart P.; Birim, Özcan; Maat, Alexander P.W.M.; Van Schil, Paul E.Y.

This phase II trial evaluated outcomes of isolated lung perfusion with Melphalan and complete surgical resection for pulmonary metastases from colorectal cancer or sarcoma in 50 pts.  Surgical mortality was 0%, but morbidity (primarily grade 3 or 4 pulmonary morbidity) was 44%.  30 patients suffered local recurrence.  3-year survival was 57% and recurrence-free survival was 36%. 

Source: Journal of Thoracic Oncology
Author(s): Deppen, Stephen A.; Blume, Jeffrey D.; Aldrich, Melinda C.; Fletcher, Sarah A.; Massion, Pierre P.; Walker, Ronald C.; Chen, Heidi C.; Speroff, Theodore; Degesys, Catherine A.; Pinkerman, Rhonda; Lambright, Eric S.; Nesbitt, Jonathan C.; Putnam, Joe B.; Grogan, Eric L.

A model for predicting lung cancer in patients with suspicious lung nodules (TREAT) was developed using single institutional data (Vanderbilt), validated using data from another institution, and compared to the Mayo Clinic predictive model.  The model accuracy was 87% in the development cohort and 89% in the validation cohort, compared to 80% in the Mayo Clinic model. 

Source: The Lancet
Author(s): Robert C Rintoul, Andrew J Ritchie, John G Edwards, David A Waller, Aman S Coonar, Maxine Bennett, Eleonora Lovato, Victoria Hughes, Julia A Fox-Rushby, Linda D Sharples, on behalf of the MesoVATS Collaborators

This randomized controlled trial compared VATS partial pleurectomy (VAT-PP) to talc pleurodesis in patients with malignant mesothelioma and a pleural effusion, evaluating overall survival.  VAT-PP was associated with significantly greater surgical complications, a higher rate of respiratory complications and prolonged air leak, and a significantly longer median hospital length of stay.  Survival at 1 year was similar to the talc pleurodesis group (52% vs 57%).  VAT-PP is not recommended for improving survival in patients with malignant mesothelioma and a pleural effusion.

Source: Journal of Clinical Oncology
Author(s): Andrew R. Davies, James A. Gossage, Janine Zylstra, Fredrik Mattsson, Jesper Lagergren, Nick Maisey, Elizabeth C. Smyth, David Cunningham, William H. Allum and Robert C. Mason

This retrospective review evaluated the relationship of pretreatment vs post-induction therapy stage to survival in patients undergoing surgery for esophageal adenocarcinoma in 2 centers in London.  Among 584 pts, 400 underwent induction therapy.  Downstaging predicted improved survival (HR 0.43).  Downstaging was associated with decreased rates of local and distant recurrence.  Survival was more closely associated with stage after induction therapy than initial stage.

Source: JAMA
Author(s): Stephen A. Deppen; Jeffrey D. Blume; Clark D. Kensinger; Ashley M. Morgan; Melinda C. Aldrich; Pierre P. Massion; Ronald C. Walker; Melissa L. McPheeters; Joe B. Putnam Jr; Eric L. Grogan

This meta-analysis of 70 studies evaluated the utility of PET in assessing over 8,511 lung nodules, comparing regions in which infectious lung disease is endemic to other regions.  Specificity was lower in regions with endemic infectious diseases, 61% vs 77%.  Overall, the accuracy of PET was extremely heterogeneous.

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