Journal of Chest Surgery最新文献

Background: Salvage resection after radiotherapy is technically challenging, and patients are vulnerable to postoperative complications. Outcomes of salvage lung resection after stereotactic ablative radiotherapy (SABR) are not well established. We aimed to assess the feasibility and safety of salvage resection for local failure after SABR.

Methods: We identified patients treated with SABR for primary or secondary lung malignancies from 2012 to 2018 who subsequently underwent salvage resection for local recurrence at the SABR-treated site. Detailed patient data were retrospectively collected. Short-term postoperative outcomes and mid-term recurrence rates were evaluated.

Results: Of 741 patients who received SABR, 16 underwent 17 salvage procedures for local failure. Pulmonary metastasis from colorectal cancer (n=12; 71%) was the most common pathology. The median time from SABR to local recurrence was 15.9 months (interquartile range [IQR], 8.6-21.5 months). Video-assisted thoracoscopic surgery was performed in 13 of 17 operations, and R0 resection was achieved in all cases. Eight lesions required anatomic resection to achieve complete removal. Postoperative bleeding requiring surgical intervention occurred in 1 patient (6%) and was unrelated to prior radiation. No 30- or 90-day mortality was recorded. The median hospital stay was 4 days (IQR, 4-6 days), and the median follow-up duration was 58.1 months (IQR, 31.5-72.1 months). Although 4 patients developed distant metastases after salvage resection, none experienced local failure.

Conclusion: Salvage resection can be a safe and effective treatment for local failure after SABR. Careful selection of eligible patients is essential.

A 70-year-old man with severe aortic stenosis was referred to our department for surgery. Echocardiography revealed a peak/mean pressure gradient of 101/61 mm Hg and a membranous ventricular septal aneurysm protruding into the right ventricular outflow tract without shunt flow. Right heart catheterization demonstrated right ventricular outflow tract obstruction with a peak pressure gradient of 11 mm Hg. Aortic valve replacement using a bioprosthetic valve and enfolding repair of the membranous ventricular septal aneurysm were performed. The folded aneurysmal tissue was compressed and reinforced with double-applied patches from both the left and right ventricular sides via aortotomy and right atriotomy, respectively. The postoperative course was uneventful. This novel Bi-Patch Enfolding Repair, termed the "egg muffin technique," provides a simple and effective method for volume reduction of aneurysmal tissue. Unlike aneurysm resection with defect closure, it mitigates the risk of iatrogenic shunt formation and atrioventricular block.

The preferred treatment for non-small cell lung cancer is surgical resection, and pneumonectomy may be necessary for centrally located tumors. Adequate pulmonary reserve is critical for pneumonectomy; otherwise, nonsurgical treatment options should be considered. Some patients who are initially inoperable due to insufficient pulmonary function may become surgical candidates after rehabilitation interventions. Here, we present a case of right bullectomy followed by left pneumonectomy successfully performed in a patient with bilateral giant bullous lung disease and a left hilar mass. The patient has remained complication- and recurrence-free for 2 years.

Background: EGFR exon 20 insertions account for 1% to 10% of EGFR mutations in non-small-cell lung cancer (NSCLC) and are known to confer resistance to traditional tyrosine kinase inhibitors. However, the prognostic significance of these mutations in early-stage resected NSCLC remains unclear. This study assesses outcomes in patients with resected NSCLC harboring EGFR exon 20 insertions, comparing them to patients with common EGFR mutations and those with wild-type EGFR.

Methods: We retrospectively reviewed 3,235 patients who underwent resection for NSCLC at Tri-Service Hospital between 2008 and 2021. After excluding cases lacking EGFR testing, incomplete data, or advanced-stage disease, 44 patients with exon 20 insertions were matched to 602 patients with common EGFR mutations and 729 with wild-type EGFR. Clinical characteristics, disease-free survival (DFS), and overall survival (OS) were analyzed using the Kaplan-Meier method, with statistical comparisons performed using the log-rank test. Cox proportional hazards models were used to identify independent prognostic factors.

Results: Patients with exon 20 insertions were younger and more frequently presented with stage IA disease. The 5-year DFS was 79% in the exon 20 insertion group, compared to 81% in the common mutation group and 83.9% in the wild-type group. The 5-year OS was 78.5% for exon 20, 91.9% for common mutations, and 91% for wild-type. While no significant differences in DFS or OS were observed between groups, the exon 20 insertion group had a higher incidence of secondary cancers. Multivariable analysis indicated that exon 20 insertion was independently associated with worse OS, but not with DFS.

Conclusion: EGFR exon 20 insertions do not significantly shorten DFS, but are associated with inferior OS in early-stage resected NSCLC. Given the limited treatment options, the role of adjuvant therapy warrants further investigation.

Background: The coronavirus disease 2019 (COVID-19) pandemic disrupted healthcare and worsened quality of life (QOL). Advanced esophageal cancer is often accompanied by malnutrition and poor QOL; chemoradiotherapy (CRT) remains the mainstay of treatment. We evaluated nutrition and QOL pre- and post-CRT immediately before and during the pandemic.

Methods: Patients with esophageal cancer who underwent neoadjuvant or definitive CRT between April 2019 and December 2020 were enrolled. Disease severity, treatment timing, and outcomes were compared for cohorts treated pre-COVID-19 and during COVID-19. Nutritional status was measured with the Patient-Generated Subjective Global Assessment (PG-SGA). QOL was measured with the Mandarin Chinese version of the European Organization for Research and Treatment of Cancer core questionnaire (EORTC QLQ-C30) and the esophageal site-specific module (QLQ-OES18). In the pandemic cohort, pre-/post-CRT paired analyses were performed.

Results: Eighty-four patients were enrolled. The median diagnosis to treatment interval lengthened during COVID-19 (17.8 days vs. 24.2 days, p=0.04). Among the patients treated during the COVID-19 pandemic, nutritional status improved significantly following CRT (p=0.003). In the EORTC QLQ-C30, post-CRT scores for global health status (p<0.01) and emotional functioning (p<0.01) showed significant improvement. Additionally, symptom scores, including fatigue (p=0.02) and nausea and vomiting (p=0.02), decreased. However, financial difficulties worsened after CRT (p=0.02). In the EORTC QLQ-OES18, post-CRT symptom scores for eating (p<0.01), reflux (p=0.03), and pain (p<0.01) showed significant improvement.

Conclusion: Despite COVID-19-related delays, CRT enhanced nutrition, global health, and symptom control in esophageal cancer, although financial burdens increased. Integrating socioeconomic support with oncologic care is vital during health crises.

Background: Chemoradiotherapy is the standard treatment for esophageal cancer, but the optimal radiation dose remains undetermined. A dose of 50.4 Gy is commonly used in both neoadjuvant and definitive settings. This study evaluates the outcomes of using 50.4 Gy in neoadjuvant chemoradiotherapy (nCRT).

Methods: Patients with esophageal cancer who underwent nCRT with 50.4 Gy radiation followed by surgery between 2010 and 2023 were retrospectively analyzed. They were categorized as achieving pathological complete response (pCR patients) or not (non-pCR patients). Oncological outcomes, including overall survival (OS) and recurrence-free survival (RFS), were assessed.

Results: Among 258 patients treated with nCRT, 96.5% completed the treatment protocol, and 74.4% (n=192) proceeded to surgery. These 192 patients formed the analysis cohort. The overall complication rate was 70.3%, with 19.3% classified as major complications. The 30-day and 90-day postoperative mortality rates were both 0.5%. The pCR rate was 45%. Patients with pCR had a 3-year OS rate of 72.7% and a median survival of 125 months, whereas non-pCR patients had a 3-year OS rate of 49.6% and a median survival of 35 months (p=0.002). Additionally, pCR patients had a 3-year RFS rate of 62.0% and a median RFS of 68 months, compared to 33.6% and 20 months, respectively, for non-pCR patients (p<0.001).

Conclusion: This study reports the outcomes of using 50.4 Gy in nCRT for locally advanced esophageal cancer. The findings affirm the efficacy of 50.4 Gy neoadjuvant chemoradiotherapy in achieving favorable long-term outcomes, particularly among patients with complete pathological response.