Annals of Thoracic Surgery最新文献

Background: The Mesothelioma and Radical Surgery 2 (MARS2) trial has drawn into question pleurectomy/decortication (PD) for the treatment of pleural mesothelioma. This trial's evaluation of resectability (poor PET-CT utilization, patients with non-epithelioid subtypes, etc.) and preference for extended PD (89% patients underwent this) may have led to the high in-hospital and 30-day mortality (both 4%) and 90-day mortality (9%). Many argue that surgical treatment for mesothelioma offers better outcomes in appropriately identified patients. The argument is based on case series prior to 2015 with limited discussion of surgical details. We present our institutional outcomes in carefully-characterized pleural mesothelioma during the time MARS2 was completed, highlighting management and outcomes in the same period.

Methods: Our database was screened for patients from 2015-2021 treated with PD for pleural mesothelioma. Patients undergoing extrapleural pneumonectomy were excluded. Electronic medical records were queried for dates of surgery, last follow-up, and death; preoperative tests; operative details; and postoperative outcomes. Electronically available obituaries were reviewed to supplement survival data. Descriptive variables and post-surgical survival were analyzed.

Results: Seventy-one patients underwent PD for pleural mesothelioma. Histological diagnosis demonstrated 56 (78.9%) epithelioid, 13 (18.3%) biphasic, and 2 (2.8%) sarcomatoid PM. All 71 (100%) had pulmonary function tests and PET-CT. In-hospital and 30-day mortality were 0 and 90-day mortality was 3/71 (4.2%).

Conclusions: PD can be done safely, with low post-operative mortality. With strict selection criteria and resection focused on balancing cytoreduction with patients' tolerance for aggressive surgery, short-term complications and mortality of PD in pleural mesothelioma can be limited.

Background: Computed tomographic (CT) lung cancer screening (LCS) reduces lung cancer-specific mortality and improves survival. We reviewed contemporary literature to develop consensus recommendations on perioperative quality standards for LCS programs to optimize outcomes.

Methods: The Society of Thoracic Surgeons (STS) Task Force on Lung Cancer Screening and STS Workforce on Evidence Based Surgery convened a multidisciplinary panel of thoracic surgeons, radiation oncologists, and interventional pulmonologists. A comprehensive literature review was conducted using the PICO (Population, Intervention, Comparisons, Outcome) framework. Consensus statements were developed through a modified Delphi process addressing: (1) preoperative biopsy and diagnostic surgical procedures, (2) acceptable rates of complications from diagnostic and therapeutic procedures, and (3) timing of intervention after a suspicious LCS finding, and the role of the multidisciplinary team in patient management. Consensus required ≥75% agreement.

Results: The panel developed 23 consensus statements after 3 Delphi rounds; 20 achieved consensus in the first round. Surgery without tissue diagnosis was acceptable for carefully selected patients, favoring minimally invasive, parenchymal-sparing approaches. Pneumonectomy without diagnosis was unanimously rejected. Programs should track benign resection rates. Acceptable complication benchmarks included pneumothorax <5%, hemoptysis <2%, and mortality <1% for bronchoscopic biopsy; and surgical morbidity <10% and 30-day mortality <1%, per STS database standards. Definitive resection should occur within 12 weeks of the inciting imaging study. Multidisciplinary teams should include thoracic surgery, oncology, pulmonology, and radiology. Preoperative pulmonary rehabilitation and smoking cessation were emphasized.

Conclusions: This STS consensus defines perioperative quality standards for CT LCS programs, supporting shared decision-making, multidisciplinary care, and quality improvement.

Primary cardiac spindle cell sarcoma is a rare, aggressive tumor with poor prognosis. An 82-year-old woman presented with dizziness and was found to have two left atrial masses. After resection and no initial metastasis, she developed widespread delayed metastases and died 279 days post-op. Even after successful resection with clear margins and no metastasis, vigilant follow-up and multidisciplinary care are crucial for management.