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Journal and News Scan

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.

Source: JAMA Intern Med.
Author(s): Du DT, McKean S, Kelman JA, Laschinger J, Johnson C, Warnock R, Worrall CM, Sedrakyan A, Encinosa W, MaCurdy TE, Izurieta HS.

In this manuscript, the authors describe their findings of a cohort analysis of 66 453 Medicare beneficiaries over the age of 65, who underwent aortic valve replacement (AVR) ± CABG and compare date of surgery, 30-day and one-year mortality between those receiving biological and mechanical prosthesis.

The mortality rate for the date of surgery and the first 30 days after the date of surgery was statistically higher among mechanical valve recipients than biological valve recipients. The unadjusted OR for death between recipients of mechanical and biological prosthesis was highest on the date of surgery. The difference in mortality rate between both groups was not statistically significant for the first 30 days after the date of hospital discharge and within 31 to 365 days after the date of surgery. Subgroup analyses suggest that the mortality difference between recipients of biological and mechanical valves in the overall population is primarily driven by high-risk patients who underwent concurrent CABG. Patients undergoing isolated AVR may have little or no increased risk for early death after mechanical AVR when

compared with bioprosthetic AVR.

Source: Circulation
Author(s): De Bonis M, Lapenna E, Maisano F, Barili F, La Canna G, Buzzatti N, Pappalardo F, Calabrese M, Nisi T, Alfieri O.

In this retrospective review, the authors evaluate the long-term outcome of 61 patients undergoing edge-to-edge mitral valve repair without annuloplasty ring for degenerative mitral regurgitation (MR). The reasons for not performing annuloplasty were either severe annular calcification or absence of significant annular dilatation. Follow up was 100%. Overall survival at 12 years was 51±7%, and freedom from MR ≥3+ was 43±7.6%. Twenty-one patients required reoperation during the follow up period. These findings lead the authors to conclude that in degenerative MR, the overall long-term results of the surgical edge-to edge technique without annuloplasty are not satisfactory. The authors underscore the relevance this may have in transcatheter mitral valve repair procedures.

Source: Annals of Surgery
Author(s): Patel, Himanshu J; Williams, David M; Drews, Joseph D; Dasika, Narasimham L; Eliason, Jonathan L; Passow, Mary C; Deeb, G Michael

This retrospective review summarizes a single institution experience with thoracic aortic endovascular stenting in 420 pts over 20 years.  Indications were aneurysm (238), dissection (100) and trauma (39).  78% of pts were deemed to be at high risk for open repair.  Mortality was 4.8%, stroke incidence was 5%, and cord ischemia was temporary in 7.9% and permanent in 1.7%.  10 year freedom from failure was 63%; failure was predicted by pre-existing renal failure, presentation with rupture, or need for arch intervention. 15 year survival was 32%. 

Source: Annals of Surgery
Author(s): Sugarbaker, David J; Richards, William G; Bueno, Raphael

This retrospective review of pts undergoing complete resection by extrapleural pneumonectomy 1998-2011 for malignant mesothelioma focused on stage predictors of survival.  Surgical mortality was 5%.  Overall survival at 5 years was 14%, and median survival was 18 mos.   Median survival for N1 or N2 disease was 17 and 13 mos, respectively.  Nodal staging is important for estimating prognosis and for patient selection.

Source: Journal of Clinical Oncology
Author(s): Kazuki Sudo, Lianchun Xiao, Roopma Wadhwa, Hironori Shiozaki, Elena Elimova, Takashi Taketa, Mariela A. Blum, Jeffrey H. Lee, Manoop S. Bhutani, Brian Weston, William A. Ross, Ritsuko Komaki, David C. Rice, Stephen G. Swisher, Wayne L. Hofstetter, Dipen M. Maru, Heath D. Skinner and Jaffer A. Ajani

This retrospective study evaluated recurrence patterns and management of recurrence after bimodality (chemoradiotherapy) for esophageal cancer in 276 pts.  Local relapse alone developed in 23%, and 36% of those patients had salvage esophagectomy.  Median survival for those undergoing salvage esophagectomy was 59 mos, whereas pts who were not offered salvage esophagectomy had a median survival of 9.5 mos.  Over 90% of isolated relapses occured during the first 2 years. 

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Taggart DP, Altman DG, Gray AM, Lees B, Nugara F, Yu L-M and Flather M on behalf of the ART Investigators.

This descriptive study presents the peri-operative and 1-year results of on-pump and off-pump surgery performed in patients enrolled in the Arterial Revascularization Trial (ART). Out of the 3102 patients randomised in the ART trial to undergo either single or bilateral mammary artery grafting, 41% had their surgery performed off-pump. The decision to perform on or off-pump surgery was at the discretion of the surgeon. A similar number of grafts were performed in off-pump and on-pump procedures. Both operative time and ventilation time were shorter in patients who had off-pump surgery. Blood loss and platelet transfusion requirements were also lower in the off-pump surgery group. There was no clinically significant difference in 30-day mortality, stroke, peri-operative myocardial infarction, need for repeat revascularization or 1-year mortality between the off-pump and on-pump groups (formal statistical hypothesis testing was not performed due to the study design).

Source: Journal of the National Cancer Institute
Author(s): Patrick Cheung, Sergio Faria, Shahida Ahmed, Pierre Chabot, Jonathan Greenland, Elizabeth Kurien, Islam Mohamed, James R. Wright, Helmut Hollenhorst, Catherine de Metz, Holly Campbell, Thi Toni Vu, Anand Karvat, Elaine S. Wai, Yee C. Ung, Glenwood Goss, Frances A. Shepherd, Patti O’Brien, Keyue Ding and Chris O’Callaghan

This multi-institutional phase II trial (80 patients from 17 Canadian institutions) was performed to assess if a hypofractionated accelerated radiotherapy regimen for cytohistological-proven early stage NSCLC (peripherally located T1 to T3 N0 M0) has a good local control rate. They concluded that delivering 60 Gy in 15 fractions using a simple three-dimensional conformal radiotherapy technique resulted in favorable outcomes in patients with NSCLC who were medically inoperable or refused surgery.  The actuarial rate of primary tumor control was 87.4%  and overall survival was 68.7% at 2 years. This approach may be a good option for those centers that do not have SBRT/SABR capability.