Journal and News Scan

This article presents guidelines on the diagnosis and management of advanced stage lung cancer developed by the 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.

Methods

• 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.

Results

• 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.

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. 

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.