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Journal and News Scan
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.
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.
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.
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.
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.
A right upper lobe sleeve lobectomy, uniportally.
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.
Optimal management of a VSD at the time of coarctation repair is controversial. The retrospective review of the Pediatric Cardiac Care Consortium 1982-2007 evaluated outcomes for 2,022 patients. The presence of a VSD increased operative mortality 4-fold to 8.3%. Patients underwent coarct repair and VSD closure at an older age (87 days) than for coarct repair and PA banding (22 days). Discharge mortality was about 9% for each group. Hospital mortality for patients who underwent coarct repair but no surgical VSD management had a discharge mortality of 7.9%.
This study assessed risk factors, frequency, and timing associated with readmission after cardiac surgery using data for 5,158 pts from 10 participating centers. The overall readmission rate was 19%, and was highest for combined CABG and valve operations. Readmissions were more common in the first 30 days after discharge (80% of total), and were most often due to fluid overload, infection, and arrhythmia. Baseline conditions associated with readmission were female sex, AKI, COPD, diabetes, anemia, and prolonged operating time.
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.