Junguo Dong, D. González-Rivas, Pengcheng Lv, Zhexin Wang, Jiaxi He, F. Yao, Shuben Li
Abstract OBJECTIVES The paediatric tracheobronchial inflammatory myofibroblastic tumour (IMT) is a rare disease. Whether limited surgical resection is a feasible surgical approach for these patients remains controversial. The objectives of this study were to report the long-term prognosis after limited surgical resections on paediatric tracheobronchial IMT and provide a surgical management strategy for this rare disease. METHODS Paediatric tracheobronchial IMT patients who underwent limited surgical resection from 2012 to 2020 were enrolled in this study. The clinical characteristics, course of treatment and long-term outcomes of all participants were collated. We presented the accumulated data and analysed the feasibility of limited surgical resection on the paediatric tracheobronchial IMT. RESULTS A total of 9 children with tracheobronchial IMTs were enrolled in our study. Cough and shortness of breath were the most common symptoms. All 9 participants underwent surgical treatment, including 2 tracheal reconstructions, 4 carinal reconstructions and 3 bronchial sleeve resections. Among the participants, 6/9 (66%) were positive for the anaplastic lymphoma receptor tyrosine kinase gene in terms of immunohistochemistry. None of the participants died of short-term complications. The follow-up period was 5.4 (range, 1.1–9.3) years, during which all participants remained well. CONCLUSIONS Limited surgical resection is preferred for paediatrics with tracheobronchial IMTs. Meanwhile, patients with complete resection have an excellent long-term prognosis.
{"title":"Limited airway resection and reconstruction for paediatric tracheobronchial inflammatory myofibroblastic tumour","authors":"Junguo Dong, D. González-Rivas, Pengcheng Lv, Zhexin Wang, Jiaxi He, F. Yao, Shuben Li","doi":"10.1093/icvts/ivac117","DOIUrl":"https://doi.org/10.1093/icvts/ivac117","url":null,"abstract":"Abstract OBJECTIVES The paediatric tracheobronchial inflammatory myofibroblastic tumour (IMT) is a rare disease. Whether limited surgical resection is a feasible surgical approach for these patients remains controversial. The objectives of this study were to report the long-term prognosis after limited surgical resections on paediatric tracheobronchial IMT and provide a surgical management strategy for this rare disease. METHODS Paediatric tracheobronchial IMT patients who underwent limited surgical resection from 2012 to 2020 were enrolled in this study. The clinical characteristics, course of treatment and long-term outcomes of all participants were collated. We presented the accumulated data and analysed the feasibility of limited surgical resection on the paediatric tracheobronchial IMT. RESULTS A total of 9 children with tracheobronchial IMTs were enrolled in our study. Cough and shortness of breath were the most common symptoms. All 9 participants underwent surgical treatment, including 2 tracheal reconstructions, 4 carinal reconstructions and 3 bronchial sleeve resections. Among the participants, 6/9 (66%) were positive for the anaplastic lymphoma receptor tyrosine kinase gene in terms of immunohistochemistry. None of the participants died of short-term complications. The follow-up period was 5.4 (range, 1.1–9.3) years, during which all participants remained well. CONCLUSIONS Limited surgical resection is preferred for paediatrics with tracheobronchial IMTs. Meanwhile, patients with complete resection have an excellent long-term prognosis.","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":"48 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80982400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Intraoperative risk factors for major complications after oesophagectomy: the surgical Apgar score","authors":"L. Cagini, S. Ceccarelli, U. Bracale, V. Tassi","doi":"10.1093/icvts/ivac111","DOIUrl":"https://doi.org/10.1093/icvts/ivac111","url":null,"abstract":"","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86051713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The burden of non-rheumatic valvular heart disease has increased rapidly due to the worldwide ageing population [1]. More than 24 million people suffer from degenerative mitral valve disease, while calcific aortic disease steadily rises, reaching 9 million cases before the pandemic [1, 2]. Repair or replacement of the diseased valve by either mechanical or biological prosthesis remains the only definitive treatment for patients with valvular heart disease. Over 200 000 heart valve replacement surgeries are performed annually worldwide, with a predicted increment to 850 000 per year by 2050 [3]. Over the last 2 decades, a massive shift from mechanical to bioprosthetic heart valve (BHV) replacements has been noticed [4], despite unresolved durability issues. The change to a BHV strategy could be partially explained by the preference of younger individuals to avoid lifelong treatment with a vitamin K antagonist (VKA), which mechanical heart valves warrant, and more elderly patients at higher bleeding risk being treated. Surgical replacement of a diseased valve aims to improve symptoms and prolong life but exposes the patient to potential prosthesis-related complications. Although less thrombogenic than mechanical heart valves, tissue valves are also prone to cause thromboembolic complications, and the risk is exceptionally high during the first 3 months after the operation [5]. Despite the frequency of BHV usage, the optimal postoperative anticoagulation strategy remains unclear. This is especially true for decision-making in cardiac surgery patients with incremental risk of thromboembolic complications, such as prolonged immobility, stroke, malignancy, prior and de novo atrial fibrillation (AF), congestive heart failure, history of major venous and pulmonary thromboembolism and hypercoagulable conditions. Focused research on these clinical scenarios was considered less important, and the academic community has concentrated chiefly on assessing structural failure. Consequently, postsurgical antithrombotic management is based not on valuable research findings but rather on local habits. Recently, however, surgical and transcatheter BHV thrombosis and the prevention of thromboembolic complications have attracted significant attention due to better imaging surveillance [3]. The lack of robust data on the efficacy and safety of different anticoagulation regimens is reflected by seeing lower levels of evidence (LOEs) behind the recommendations in the recently released European Society of Cardiology (ESC)/European Association for Cardio-Thoracic Surgery (EACTS) Guidelines for the management of valvular heart disease [6]. For patients with no baseline indication for oral anticoagulation (OAC), the ESC/ EACTS guidelines recommend either low-dose aspirin (75– 100 mg/day) or a VKA for the first 3 months after surgical implantation of an aortic BHV [class of recommendation (COR) IIa, LOE B]. For those who received a BVH in the mitral or tricuspid position, a V
{"title":"Oral anticoagulation following bioprosthetic SAVR in patients with atrial fibrillation: what’s the current status of NOACs?","authors":"M. Milojevic, A. Nikolić, S. Mićović, A. Jeppsson","doi":"10.1093/icvts/ivac112","DOIUrl":"https://doi.org/10.1093/icvts/ivac112","url":null,"abstract":"The burden of non-rheumatic valvular heart disease has increased rapidly due to the worldwide ageing population [1]. More than 24 million people suffer from degenerative mitral valve disease, while calcific aortic disease steadily rises, reaching 9 million cases before the pandemic [1, 2]. Repair or replacement of the diseased valve by either mechanical or biological prosthesis remains the only definitive treatment for patients with valvular heart disease. Over 200 000 heart valve replacement surgeries are performed annually worldwide, with a predicted increment to 850 000 per year by 2050 [3]. Over the last 2 decades, a massive shift from mechanical to bioprosthetic heart valve (BHV) replacements has been noticed [4], despite unresolved durability issues. The change to a BHV strategy could be partially explained by the preference of younger individuals to avoid lifelong treatment with a vitamin K antagonist (VKA), which mechanical heart valves warrant, and more elderly patients at higher bleeding risk being treated. Surgical replacement of a diseased valve aims to improve symptoms and prolong life but exposes the patient to potential prosthesis-related complications. Although less thrombogenic than mechanical heart valves, tissue valves are also prone to cause thromboembolic complications, and the risk is exceptionally high during the first 3 months after the operation [5]. Despite the frequency of BHV usage, the optimal postoperative anticoagulation strategy remains unclear. This is especially true for decision-making in cardiac surgery patients with incremental risk of thromboembolic complications, such as prolonged immobility, stroke, malignancy, prior and de novo atrial fibrillation (AF), congestive heart failure, history of major venous and pulmonary thromboembolism and hypercoagulable conditions. Focused research on these clinical scenarios was considered less important, and the academic community has concentrated chiefly on assessing structural failure. Consequently, postsurgical antithrombotic management is based not on valuable research findings but rather on local habits. Recently, however, surgical and transcatheter BHV thrombosis and the prevention of thromboembolic complications have attracted significant attention due to better imaging surveillance [3]. The lack of robust data on the efficacy and safety of different anticoagulation regimens is reflected by seeing lower levels of evidence (LOEs) behind the recommendations in the recently released European Society of Cardiology (ESC)/European Association for Cardio-Thoracic Surgery (EACTS) Guidelines for the management of valvular heart disease [6]. For patients with no baseline indication for oral anticoagulation (OAC), the ESC/ EACTS guidelines recommend either low-dose aspirin (75– 100 mg/day) or a VKA for the first 3 months after surgical implantation of an aortic BHV [class of recommendation (COR) IIa, LOE B]. For those who received a BVH in the mitral or tricuspid position, a V","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":"49 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84735609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Kapetanakis, Nikolaos L Korodimos, Thrasyvoulos P Michos, P. Tomos
{"title":"Challenging conventional dogma in chest drain placement following lung resection surgery: is there a best position?","authors":"E. Kapetanakis, Nikolaos L Korodimos, Thrasyvoulos P Michos, P. Tomos","doi":"10.1093/icvts/ivac131","DOIUrl":"https://doi.org/10.1093/icvts/ivac131","url":null,"abstract":"","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85425814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Vukovic, P. Milačić, Igor S Zivkovic, D. Kosevic, S. Mićović
Abstract The progeroid syndrome includes a group of rare, severe genetic disorders clinically characterized by premature physical ageing. Severe aortic stenosis has been described in progeria patients, but no previous surgical aortic valve replacement was reported. We describe a successful surgical aortic valve replacement combined with coronary artery bypass grafting in a progeria patient with severe aortic stenosis and a small aortic annulus.
{"title":"Successful surgical aortic valve replacement in a patient with progeria","authors":"P. Vukovic, P. Milačić, Igor S Zivkovic, D. Kosevic, S. Mićović","doi":"10.1093/icvts/ivac115","DOIUrl":"https://doi.org/10.1093/icvts/ivac115","url":null,"abstract":"Abstract The progeroid syndrome includes a group of rare, severe genetic disorders clinically characterized by premature physical ageing. Severe aortic stenosis has been described in progeria patients, but no previous surgical aortic valve replacement was reported. We describe a successful surgical aortic valve replacement combined with coronary artery bypass grafting in a progeria patient with severe aortic stenosis and a small aortic annulus.","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82626838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. H. Lee, Joon Chul Jung, Bongyeon Sohn, H. Chang, Dong Jung Kim, J. S. Kim, C. Lim, Kay-Hyun Park
Abstract OBJECTIVES The aim of this study was to evaluate changes in aortic growth rate and factors influencing aneurysmal dilatation after uncomplicated acute type B aortic dissection (ABAD). METHODS Medically treated patients with uncomplicated ABAD between September 2004 and January 2020 were retrospectively reviewed. Diameters of 6 different sites in the descending aorta were measured and aortic growth rate was calculated according to the time interval. Factors associated with aneurysmal changes were also investigated. RESULTS This study enrolled a total of 105 patients who underwent >2 serial computed tomography with a mean follow-up duration of 35.4 (12.1–77.4) months. The mean overall growth rates of the proximal descending thoracic aorta (DTA), mid-DTA, distal DTA, proximal abdominal aorta, maximal DTA and maximal abdominal aorta were 0.6 (1.9), 2.9 (5.2), 2.1 (4.0), 1.2 (2.2), 3.3 (5.6) and 1.4 (2.5) mm/year, respectively. The growth rate was higher at the early stage. It decreased over time. Growth rates of proximal DTA, mid-DTA, distal DTA, proximal abdominal aorta, maximal DTA, and maximal abdominal aorta within 3 months after dissection were 1.3 (9.6), 12.6 (18.2), 7.6 (11.7), 5.9 (7.5), 16.7 (19.8) and 6.8 (8.9) mm/year, respectively. More than 2 years later, they were 0.2 (0.6), 1.6 (1.6), 1.2 (1.3), 0.9 (1.4), 1.7 (1.9) and 1.2 (1.7) mm/year, respectively. Factors associated with aneurysmal changes after uncomplicated ABAD included an elliptical true lumen (odds ratio = 3.16; 95% confidence interval: 1.19–8.41; P = 0.021) and a proximal entry >10 mm (odds ratio = 3.08; 95% confidence interval: 1.09–8.69; P = 0.034) on initial computed tomography imaging. CONCLUSIONS The aortic growth rate was higher immediately after uncomplicated ABAD but declined eventually. Patients with an elliptical true lumen and a large proximal entry might be good candidates for early endovascular intervention after uncomplicated ABAD.
{"title":"Changes in aortic growth rate and factors influencing aneurysmal dilatation after uncomplicated acute type B aortic dissection","authors":"J. H. Lee, Joon Chul Jung, Bongyeon Sohn, H. Chang, Dong Jung Kim, J. S. Kim, C. Lim, Kay-Hyun Park","doi":"10.1093/icvts/ivac126","DOIUrl":"https://doi.org/10.1093/icvts/ivac126","url":null,"abstract":"Abstract OBJECTIVES The aim of this study was to evaluate changes in aortic growth rate and factors influencing aneurysmal dilatation after uncomplicated acute type B aortic dissection (ABAD). METHODS Medically treated patients with uncomplicated ABAD between September 2004 and January 2020 were retrospectively reviewed. Diameters of 6 different sites in the descending aorta were measured and aortic growth rate was calculated according to the time interval. Factors associated with aneurysmal changes were also investigated. RESULTS This study enrolled a total of 105 patients who underwent >2 serial computed tomography with a mean follow-up duration of 35.4 (12.1–77.4) months. The mean overall growth rates of the proximal descending thoracic aorta (DTA), mid-DTA, distal DTA, proximal abdominal aorta, maximal DTA and maximal abdominal aorta were 0.6 (1.9), 2.9 (5.2), 2.1 (4.0), 1.2 (2.2), 3.3 (5.6) and 1.4 (2.5) mm/year, respectively. The growth rate was higher at the early stage. It decreased over time. Growth rates of proximal DTA, mid-DTA, distal DTA, proximal abdominal aorta, maximal DTA, and maximal abdominal aorta within 3 months after dissection were 1.3 (9.6), 12.6 (18.2), 7.6 (11.7), 5.9 (7.5), 16.7 (19.8) and 6.8 (8.9) mm/year, respectively. More than 2 years later, they were 0.2 (0.6), 1.6 (1.6), 1.2 (1.3), 0.9 (1.4), 1.7 (1.9) and 1.2 (1.7) mm/year, respectively. Factors associated with aneurysmal changes after uncomplicated ABAD included an elliptical true lumen (odds ratio = 3.16; 95% confidence interval: 1.19–8.41; P = 0.021) and a proximal entry >10 mm (odds ratio = 3.08; 95% confidence interval: 1.09–8.69; P = 0.034) on initial computed tomography imaging. CONCLUSIONS The aortic growth rate was higher immediately after uncomplicated ABAD but declined eventually. Patients with an elliptical true lumen and a large proximal entry might be good candidates for early endovascular intervention after uncomplicated ABAD.","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89127738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anne Maria Beukers, Jamy Adriana Catharina de Ruijter, S. Loer, A. Vonk, Carolien Suzanna Enna Bulte
Abstract OBJECTIVES Colloid oncotic pressure (COP) is an important factor in cardiac surgery, owing to its role in haemodilution. The effect of cardiopulmonary bypass prime fluids on the COP is unknown. In this study, the effect of crystalloid and colloid prime fluids, with or without retrograde autologous priming (RAP), on the COP during elective cardiac surgery was evaluated. METHODS Randomized controlled trials and prospective clinical trials comparing crystalloid and colloid priming fluids or with RAP were selected. The primary outcome was the COP; secondary outcomes were fluid balance, fluid requirements, weight gain, blood loss, platelet count and transfusion requirements. RESULTS From 1582 records, 29 eligible studies were identified. COPs were comparable between gelofusine and hydroxyethyl starch (HES) during bypass [mean difference (MD): 0.69; 95% confidence interval (CI): −2.05, 3.43; P = 0.621], after bypass (MD: −0.11; 95% CI: −2.54, 2.32; P = 0.930) and postoperative (MD: −0.61; 95% CI: −1.60, 0.38; P = 0.228). Fluid balance was lower with HES than with crystalloids. RAP reduced transfusion requirements compared with crystalloids. Blood loss was comparable between groups. CONCLUSIONS COPs did not differ between crystalloids and colloids. As a result of increased transcapillary fluid movement, fluid balance was lower with HES than with crystalloids. Haematocrit and transfusion requirements were comparable between groups. However, the latter was lower when RAP was applied to crystalloid priming compared with crystalloids alone. Finally, no differences in blood loss were observed between the groups.
{"title":"Effects of crystalloid and colloid priming strategies for cardiopulmonary bypass on colloid oncotic pressure and haemostasis: a meta-analysis","authors":"Anne Maria Beukers, Jamy Adriana Catharina de Ruijter, S. Loer, A. Vonk, Carolien Suzanna Enna Bulte","doi":"10.1093/icvts/ivac127","DOIUrl":"https://doi.org/10.1093/icvts/ivac127","url":null,"abstract":"Abstract OBJECTIVES Colloid oncotic pressure (COP) is an important factor in cardiac surgery, owing to its role in haemodilution. The effect of cardiopulmonary bypass prime fluids on the COP is unknown. In this study, the effect of crystalloid and colloid prime fluids, with or without retrograde autologous priming (RAP), on the COP during elective cardiac surgery was evaluated. METHODS Randomized controlled trials and prospective clinical trials comparing crystalloid and colloid priming fluids or with RAP were selected. The primary outcome was the COP; secondary outcomes were fluid balance, fluid requirements, weight gain, blood loss, platelet count and transfusion requirements. RESULTS From 1582 records, 29 eligible studies were identified. COPs were comparable between gelofusine and hydroxyethyl starch (HES) during bypass [mean difference (MD): 0.69; 95% confidence interval (CI): −2.05, 3.43; P = 0.621], after bypass (MD: −0.11; 95% CI: −2.54, 2.32; P = 0.930) and postoperative (MD: −0.61; 95% CI: −1.60, 0.38; P = 0.228). Fluid balance was lower with HES than with crystalloids. RAP reduced transfusion requirements compared with crystalloids. Blood loss was comparable between groups. CONCLUSIONS COPs did not differ between crystalloids and colloids. As a result of increased transcapillary fluid movement, fluid balance was lower with HES than with crystalloids. Haematocrit and transfusion requirements were comparable between groups. However, the latter was lower when RAP was applied to crystalloid priming compared with crystalloids alone. Finally, no differences in blood loss were observed between the groups.","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":"70 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78100214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Summary A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was ‘In patients undergoing oesophagectomy does postoperative home enteral nutrition have any impact on nutritional status?’ Altogether, 50 articles were found using the reported search, of which 5 studies represented the best evidence to answer the clinical question. This consisted of 1 systematic review including a meta-analysis of 9 randomized controlled trials (RCTs), 3 RCTs and 1 cohort study. Main outcomes included loss of body weight and body mass index (BMI), change of serum albumin, haemoglobin, total protein and prealbumin, rates of nutritional risk patients and score value of patient-generated subjective global assessment. The meta-analysis concluded that there were significant differences in the loss of body weight and BMI between 2 groups, with higher values observed in the HEN group than that in the control group. One RCT showed that patients receiving HEN had a significantly lower weight loss compared with the control group. However, in another RCT, there was no significant difference between 2 groups in the loss of weight and body BMI. The available evidence shows that patients receiving home enteral nutrition yielded a significantly better BMI and lower decrease in body weight than those without after surgical resection of oesophageal cancer. We conclude that HEN could serve as an effective intervention for patients undergoing oesophagectomy. Moreover, the optimal time for patients receiving HEN could be 4–8 weeks after discharge. Feeding via jejunostomy and nasointestinal tube are feasible and safety approaches for HEN.
{"title":"In patients undergoing oesophagectomy does postoperative home enteral nutrition have any impact on nutritional status?","authors":"Xiaokun Li, Jianrong Hu, Jianfeng Zhou, Pinhao Fang, Yong Yuan","doi":"10.1093/icvts/ivac120","DOIUrl":"https://doi.org/10.1093/icvts/ivac120","url":null,"abstract":"Summary A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was ‘In patients undergoing oesophagectomy does postoperative home enteral nutrition have any impact on nutritional status?’ Altogether, 50 articles were found using the reported search, of which 5 studies represented the best evidence to answer the clinical question. This consisted of 1 systematic review including a meta-analysis of 9 randomized controlled trials (RCTs), 3 RCTs and 1 cohort study. Main outcomes included loss of body weight and body mass index (BMI), change of serum albumin, haemoglobin, total protein and prealbumin, rates of nutritional risk patients and score value of patient-generated subjective global assessment. The meta-analysis concluded that there were significant differences in the loss of body weight and BMI between 2 groups, with higher values observed in the HEN group than that in the control group. One RCT showed that patients receiving HEN had a significantly lower weight loss compared with the control group. However, in another RCT, there was no significant difference between 2 groups in the loss of weight and body BMI. The available evidence shows that patients receiving home enteral nutrition yielded a significantly better BMI and lower decrease in body weight than those without after surgical resection of oesophageal cancer. We conclude that HEN could serve as an effective intervention for patients undergoing oesophagectomy. Moreover, the optimal time for patients receiving HEN could be 4–8 weeks after discharge. Feeding via jejunostomy and nasointestinal tube are feasible and safety approaches for HEN.","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80337474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jon Pedro Timane, Henrik Jessen Hansen, R. Petersen
Abstract This report presents the case of a woman successfully treated with thoracoscopic detorsion of the right lung after she was diagnosed with a 180-degree torsion, 6 months after a video-assisted thoracoscopic right upper lobectomy for a stage 1 adenocarcinoma.
{"title":"Right lung torsion diagnosed 6 months after a thoracoscopic right upper lobectomy","authors":"Jon Pedro Timane, Henrik Jessen Hansen, R. Petersen","doi":"10.1093/icvts/ivac116","DOIUrl":"https://doi.org/10.1093/icvts/ivac116","url":null,"abstract":"Abstract This report presents the case of a woman successfully treated with thoracoscopic detorsion of the right lung after she was diagnosed with a 180-degree torsion, 6 months after a video-assisted thoracoscopic right upper lobectomy for a stage 1 adenocarcinoma.","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75691243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract OBJECTIVES It is widely accepted that surgical resection of localized pulmonary typical carcinoid (TC) tumours remains the primary curative modality. However, the optimal extent of resection remains controversial. This study aimed to investigate the survival rates of patients with stage T1-2N0M0 TC tumours who underwent sublobar resection or lobectomy. METHODS We queried the Surveillance, Epidemiology, and End Results database for patients who underwent surgery after being diagnosed with stage T1-2N0M0 TCs from 2004 to 2016. Propensity score matching (PSM) analysis was used to equalize the baseline characteristics between the sublobar resection group and the lobectomy group. Kaplan–Meier analysis and the Cox proportional hazard model were performed for survival analysis. RESULTS Of the 2469 patients included, 658 (26.65%) underwent sublobar resection and 1811 (73.35%) underwent lobectomy. All 2469 patients were analysed with PSM and, following PSM, 812 patients were included in the final analysis and divided into 2 groups of 406 patients. In the matched cohort, Kaplan–Meier analysis demonstrated no significant difference in survival curves between the sublobar resection and lobectomy groups in patients with stage T1-2N0M0 TC tumours [5-year overall survival (OS) = 90.78% vs 93.30%; hazard ratio 1.18, 95% confidence interval: 0.77–1.80; P = 0.505]. Subgroup analysis by tumour size showed that the sublobar resection group was identical to the lobectomy group in OS for tumours ≤3.0 cm. In addition, no difference in OS between surgical groups was observed in any subgroups. In the multivariable Cox analysis, age ≤65 years, female sex, married status and adequate lymph node assessment (≥5) were associated with improved OS, whereas the extent of resection was not. CONCLUSIONS Sublobar resection seems to be associated with similar survival to lobectomy for stage T1-2N0M0 TC tumours if lymph node assessment is performed adequately. This analysis suggests that sublobar resection should be considered an appropriate alternative for stage T1-2N0M0 TC tumours. However, further validations are needed in large, multicentre prospective studies.
摘要目的手术切除局限性肺典型类癌(TC)肿瘤是目前公认的主要治疗方式。然而，最佳切除范围仍有争议。本研究旨在探讨T1-2N0M0期TC肿瘤患者行叶下切除术或肺叶切除术后的生存率。方法:我们查询了2004年至2016年诊断为T1-2N0M0期tc后接受手术的患者的监测、流行病学和最终结果数据库。倾向评分匹配(PSM)分析用于平衡叶下切除术组和叶下切除术组之间的基线特征。生存率分析采用Kaplan-Meier分析和Cox比例风险模型。结果纳入的2469例患者中，658例(26.65%)行肺叶下切除术，1811例(73.35%)行肺叶切除术。所有2469例患者进行PSM分析，在PSM之后，812例患者被纳入最终分析，分为2组406例患者。在匹配的队列中，Kaplan-Meier分析显示，在T1-2N0M0期TC肿瘤患者中，叶下切除术组和叶下切除术组的生存曲线无显著差异[5年总生存率(OS) = 90.78% vs 93.30%;风险比1.18,95%置信区间:0.77-1.80;p = 0.505]。肿瘤大小的亚组分析显示，肿瘤≤3.0 cm的OS，叶下切除术组与叶下切除术组相同。此外，在任何亚组中，手术组之间的OS均无差异。在多变量Cox分析中，年龄≤65岁、女性、婚姻状况和足够的淋巴结评估(≥5)与OS改善相关，而切除程度与OS改善无关。结论:如果淋巴结评估充分，对于T1-2N0M0期TC肿瘤，叶下切除术与叶下切除术的生存率相似。该分析表明，对于T1-2N0M0期TC肿瘤，应考虑采用叶下切除术。然而，需要在大型、多中心的前瞻性研究中进一步验证。
{"title":"Sublobar resection versus lobectomy for patients with stage T1-2N0M0 pulmonary typical carcinoid tumours: a population-based propensity score matching analysis","authors":"Hao Yang, Tong-hua Mei","doi":"10.1093/icvts/ivac125","DOIUrl":"https://doi.org/10.1093/icvts/ivac125","url":null,"abstract":"Abstract OBJECTIVES It is widely accepted that surgical resection of localized pulmonary typical carcinoid (TC) tumours remains the primary curative modality. However, the optimal extent of resection remains controversial. This study aimed to investigate the survival rates of patients with stage T1-2N0M0 TC tumours who underwent sublobar resection or lobectomy. METHODS We queried the Surveillance, Epidemiology, and End Results database for patients who underwent surgery after being diagnosed with stage T1-2N0M0 TCs from 2004 to 2016. Propensity score matching (PSM) analysis was used to equalize the baseline characteristics between the sublobar resection group and the lobectomy group. Kaplan–Meier analysis and the Cox proportional hazard model were performed for survival analysis. RESULTS Of the 2469 patients included, 658 (26.65%) underwent sublobar resection and 1811 (73.35%) underwent lobectomy. All 2469 patients were analysed with PSM and, following PSM, 812 patients were included in the final analysis and divided into 2 groups of 406 patients. In the matched cohort, Kaplan–Meier analysis demonstrated no significant difference in survival curves between the sublobar resection and lobectomy groups in patients with stage T1-2N0M0 TC tumours [5-year overall survival (OS) = 90.78% vs 93.30%; hazard ratio 1.18, 95% confidence interval: 0.77–1.80; P = 0.505]. Subgroup analysis by tumour size showed that the sublobar resection group was identical to the lobectomy group in OS for tumours ≤3.0 cm. In addition, no difference in OS between surgical groups was observed in any subgroups. In the multivariable Cox analysis, age ≤65 years, female sex, married status and adequate lymph node assessment (≥5) were associated with improved OS, whereas the extent of resection was not. CONCLUSIONS Sublobar resection seems to be associated with similar survival to lobectomy for stage T1-2N0M0 TC tumours if lymph node assessment is performed adequately. This analysis suggests that sublobar resection should be considered an appropriate alternative for stage T1-2N0M0 TC tumours. However, further validations are needed in large, multicentre prospective studies.","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76356386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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