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Journal and News Scan
This study tracked changes in management for and outcomes of T1a and T1b esophageal cancer using data from the National Cancer Data Base. Endoscopic resection increased nearly 3-fold to 53% for T1a lesions during the interval, and increased nearly 3-fold to 21% for T1b cancers. Nodal involvement was predicted by T status, tumor size >2cm, and tumor grade. The rate of nodal involvement in resected pts was 5% for T1a and 17% for T1b. Endoscopic therapy had a lower risk of procedure-related mortality (HR 0.33). 5-year survival was better after surgical resection (88% vs 77%).
Outcomes of lung adenocarcinoma classified according to the new IASLC/ATS/ERS system were evaluated in this retrospective single-institution study involving 573 pts who underwent surgical treatment. Histologic patterns were associated with sex and tumor TNM factors. Recurrence was higher in micropapillary and solid-predominant cancers. These subtypes were also associated with poorer overall and disease-specific survival compared to other types.
This article presents guidelines on the diagnosis and management of advanced stage lung cancer developed by the ESMO in 2013.
This article summarizes consensus guidelines for the diagnosis and management of early stage lung cancer developed by ESMO in 2013.
– The aim of this study was to evaluate the effect of vein graft preservation solutions on vein graft failure (VGF) and clinical outcomes in patients undergoing coronary artery bypass graft (CABG) surgery. These researchers concluded that patients undergoing CABG whose vein grafts were preserved in a buffered saline solution had lower VGF rates and showed trends toward better long–term clinical outcomes compared with patients whose grafts were preserved in saline– or blood–based solutions.
- Researchers used data from the Project of Ex–Vivo Vein Graft Engineering via Transfection IV (PREVENT IV) study, a phase 3, multicenter, randomized, double–blind, placebo–controlled trial that enrolled 3014 patients at 107 US sites from August 1, 2002, through October 22, 2003.
- Eligibility criteria for the trial included CABG surgery for coronary artery disease with at least 2 planned vein grafts.
- Interventions included preservation of vein grafts in saline, blood, or buffered saline solutions.
- Main outcomes measures included 1–year angiographic VGF and 5–year rates of death, myocardial infarction, and subsequent revascularization.
- Most patients had grafts preserved in saline (1339 [44.4%]), followed by blood (971 [32.2%]) and buffered saline (507 [16.8%]).
- Baseline characteristics were similar among groups.
- Researchers found that 1–year VGF rates were much lower in the buffered saline group than in the saline group (patient–level odds ratio [OR], 0.59 [95% CI, 0.45–0.78; P<0.001]; graft–level OR, 0.63 [95% CI, 0.49–0.79; P<0.001]) or the blood group (patient–level OR, 0.62 [95% CI, 0.46–0.83; P=0.001]; graft–level OR, 0.63 [95% CI, 0.48–0.81; P<0.001]).
- Use of buffered saline solution also tended to be associated with a lower 5–year risk for death, myocardial infarction, or subsequent revascularization compared with saline (hazard ratio, 0.81 [95% CI, 0.64–1.02; P=0.08]) and blood (0.81 [0.63–1.03; P=0.09]) solutions.
The timing of surgery in patients with asymptomatic severe aortic stenosis (AS) remains a matter of debate. In this study, the authors evaluate the prognostic value of plasma levels of B-type natriuretic peptide (BNP) during exercise in 211 patients with asymptomatic AS. In multivariate analysis, second and third tertiles of peak-exercise BNP were strong predictors of death or aortic valve replacement motivated by development of symptoms or LV dysfunction, compared with the first tertile. Patients with asymptomatic severe AS and a high peak BNP values may require closer follow up and may benefit from earlier surgery.
Volume-outcomes relationships for operative mortality were first identified more than a decade ago. This study updated the data using Medicare claims for more than 3 million patients. The inverse relationship between volume and outcomes was confirmed for all 8 procedures studied. The inverse ratio actually increased for 5 of 8 procedures despite overall improvements in outcomes. For esophagectomy mortality the OR for very low compared to very high volumes was 2.25 in 2000-2001 and 3.68 in 2008-2009.
This single institution study evaluated differences in 30-day and 90-day mortality after esophagectomy in nearly 1300 patients. 30-day mortality was 2.9%, hospital mortalit was 5.1%, and 90-day mortality was 7%. Late deaths were related to surgery (particularly the occurrence of anastomotic leakage), sudden death, and recurrent cancer. The sensitivity of 30-day mortality in detecting surgery-related deaths was only 33%.
A risk model of mortality associated with esophagectomy in Japan was developed using variables identified in the ACS NSQIP program. 30-day and overall surgical mortality rates were 1.2% and 3.4%, and the morbidity rate was 42%. Morbidity was higher after minimally invasive esophagectomy. Mortality was related to difficulty with ADLs, recent smoking, greater preoperative weight loss, male sex, and COPD.
This prospective multiinstitutional study evaluated outcomes of different devices used for endoscopic vein harvesting classified as open or closed tunnel devices. There was no difference in the incidence of early graft failure or late clinical outcomes. The poorer graft outcomes related to endoscopic vein harvesting are not attributable to device type.