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Journal and News Scan

Source: New England Journal of Medicine
Author(s): LB Holst and others for the TRISS Trial Group and the Scandinavian Critical Care Trials Group

This randomized trial investigated two different thresholds for triggering transfusion in patients with septic shock: 9 g/dL or 7 g/dL.  The lower threshold group received a median of 1 unit of blood compared to 4 in the higher threshold group.  90 day mortality rates and other morbidity were similar between the groups.  

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Hickey GL, Grant SW, Bridgewater B, Kendall S, Bryan AJ, Kuo J, Dunning J

This study utilised data form the UK National Adult Cardiac Surgery Audit to compare re-intervention free survival between porcine and bovine pericardial aortic valves. All elective or urgent aortic valve replacements with or without coronary artery surgery between 2003 and 2013 were included with a median follow-up time of 3.6 years. There was no difference in in-hospital mortality, survival (10-year survival of 49.0% and 50.3% in the bovine pericardial and porcine groups respectively) or re-intervention free survival between the groups. After adjustment there was a trend towards improved re-intervention free survival in younger patients (<60) who received porcine valves. 

Source: Annals of Surgery
Author(s): Gronnier, Caroline; Tréchot, Boris; Duhamel, Alain; Mabrut, Jean-Yves; Bail, Jean-Pierre; Carrere, Nicolas; Lefevre, Jérémie H.; Brigand, Cécile; Vaillant, Jean-Christophe; Adham, Mustapha; Msika, Simon; Demartines, Nicolas; El Nakadi, Issam; Piessen, Guillaume; Meunier, Bernard; Collet, Denis; Mariette, Christophe; On behalf of the FREGAT Working GroupFRENCHAFC

This multicenter prospective trial evaluated the impact of induction therapy on anastomotic leak (AL) and other complications after esophagectomy.  Of 2944 included pts, 593 had induction chemoradiotherapy.  AL occurred in 8.8% of induction therapy pts compared to 10.6% of surgery only patients.  90 day postoperative morbidity and mortality rates were similar between the groups. Chylothorax, cardiovascular complications, and VTE events were more common after induction therapy.

Source: Annals of Surgery
Author(s): Mc Cormack, Orla; Zaborowski, Alex; King, Sinead; Healy, Laura; Daly, Caroline; O'Farrell, Naoimh; Donohoe, Claire L.; Ravi, Narayanasamy; Reynolds, John V.

The authors investigated the impact of new onset a-fib after esophagectomy in 437 pts.  Risk factors included age, diabetes, induction therapy, and cardiac history.  A-fib was associated with postoperative pneumonia, symptomatic pleural effusions, and an increase in C-reactive protein.  It was not associated with anastomotic leak or mortality.  92% of affected pts were discharged in sinus rhythm.  Long-term survival was not related to the development of a-fib.

Source: Annals of Surgery
Author(s): Hölscher, Arnulf H.; Drebber, Uta; Schmidt, Henner; Bollschweiler, Efriede

The histologic response to induction therapy is usually a binary function.  In the current study, the authors explored methods of refining the histologic response classification to improve prediction of prognosis for patients with esophageal adenocarcinoma.  They identified 3 unique groups: major response in the primary tumor with ypN0; either major response with ypN+ or minor response with ypN0; minor response and ypN+.  The 5-yr survivals were 64%, 42%, and 18%, respectively.

Source: Annals of Surgery
Author(s): Koen Talsma, A.; Shapiro, Joel; Looman, Caspar W. N.; van Hagen, Pieter; Steyerberg, Ewout W.; van der Gaast, Ate; van Berge Henegouwen, Mark I.; Wijnhoven, Bas P. L.; van Lanschot, J. Jan B.; On behalf of CROSS Study Group

It has recently been reported that the number of lymph nodes resected during esophagectomy is related to long-term survival, leading to recommendations for the proper extent of nodal dissection.  The current study used data from the CROSS trial to investigate this relationship in groups of esophagectomy patients with and without induction chemoradiotherapy.  The median number of resected nodes in those without and with induction therapy was 18 and 14.  Involved nodes had a much greater negative impact on survival in those undergoing induction therapy than in those who had surgery alone.  The total number of resected nodes was related to survival in the surgery only group, but had no relationship to survival in the multimodality group.

Source: Annals of Surgery
Author(s): Shapiro, Joel; van Hagen, Pieter; Lingsma, Hester F.; Wijnhoven, Bas P. L.; Biermann, Katharina; ten Kate, Fiebo J. W.; Steyerberg, Ewout W.; van der Gaast, Ate; van Lanschot, J. Jan B.; On behalf of the CROSS Study Group

It has recently been reported that a longer interval to esophagectomy following induction therapy results in higher pathologic response rates.  The current study used data from the CROSS trial to determine whether a longer interval to esophagectomy following induction therapy results in improved survival.  Time to surgery (TTS) was a median of 48 days, and was primarily determined by logistic constraints.  Increasing TTS after 45 days was associated with improved pCR and an increased risk of postoperative complications.  There was no survival advantage associated with increasing TTS.

Source: Annals of Surgery
Author(s): Slankamenac, Ksenija; Nederlof, Nina; Pessaux, Patrick; de Jonge, Jeroen; Wijnhoven, Bas PL; Breitenstein, Stefan; Oberkofler, Christian E; Graf, Rolf; Puhan, Milo A; Clavien, Pierre-Alain

The Comprehensive Complication Index (CCI) was compared to more standard methods of categorizing complications for their utility in assessing outcomes after randomized surgical trials.  The CCI outperformed standard methods in 2 of 3 published randomized trials (pancreatic and esophageal surgery), demonstrating significant differences in outcomes whereas none was reported in the original trials.  The sample sizes needed to demonstrate differences using CCI are an order of magnitude lower than for traditional endpoints.

Author(s): Diego Gonzalez-Rivas

A right upper lobe sleeve lobectomy, uniportally. 

Source: DG News Cardiology
Author(s): Yuting P. Chiang,

CHICAGO -- September 30, 3014 -- Among patients aged 50 to 69 years who underwent aortic valve replacement with bioprosthetic or mechanical prosthetic valves, there was no significant difference in 15-year survival or stroke, although patients in the bioprosthetic valve group had a greater likelihood of re-operation but a lower likelihood of major bleeding.

The findings are published in the October 1 issue of JAMA.

In older patients, bioprosthetic valves pose a low lifetime risk of reoperation for structural degeneration and avoid many of the complications associated with mechanical prostheses. Bioprosthetic valves are therefore recommended in patients aged older than 70 years. However, the optimal prosthesis type for younger patients is less clear.

Yuting P. Chiang, Mount Sinai Hospital, New York, New York, and colleagues used a state-wide administrative database to quantify differences in long-term survival, stroke, re-operation, and major bleeding episodes after aortic valve replacement according to prosthesis type.