Postoperative pulmonary venous obstruction after the repair of total anomalous pulmonary venous connection is a challenging complication, especially when it occurs in the upstream pulmonary vein outside the pericardial sac. Here, we report such a case that was resolved successfully by a novel, modified, sutureless technique that repositioned the pericardial reflection to expand the pericardial sac.
{"title":"Modified Technique for Repairing Recurrent Pulmonary Venous Obstruction","authors":"Kazunari Fujisawa BSc , Hideyuki Kato MD , Bryan J. Mathis PhD , Yuji Hiramatsu MD","doi":"10.1016/j.atssr.2024.09.004","DOIUrl":"10.1016/j.atssr.2024.09.004","url":null,"abstract":"<div><div>Postoperative pulmonary venous obstruction after the repair of total anomalous pulmonary venous connection is a challenging complication, especially when it occurs in the upstream pulmonary vein outside the pericardial sac. Here, we report such a case that was resolved successfully by a novel, modified, sutureless technique that repositioned the pericardial reflection to expand the pericardial sac.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 1","pages":"Pages 99-101"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143508426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.atssr.2024.09.006
Timothy R. Harris MD , Joiliana Lecointe BS , Thomas P. Doyle MD , Nhue L. Do MD , Dana R. Janssen MD , Garrett N. Coyan MD, MS
A 25-week preterm neonate was born with complete left-sided partial anomalous pulmonary venous drainage with a confluence draining into a vertical vein to the innominate vein. The ostium was stenotic, resulting in pulmonary hypertension requiring palliation by serial stent placement because of prematurity and comorbidities. The patient subsequently underwent successful surgical left anomalous pulmonary venous confluence reimplantation to the left atrium with vertical vein ligation at 12 months of age. This report highlights the unique multidisciplinary management strategy required for the rarely encountered obstructed complete left-sided anomalous pulmonary venous return in a preterm neonate.
{"title":"Management of Obstructed Complete Left Partial Anomalous Pulmonary Venous Return in a Preterm Infant","authors":"Timothy R. Harris MD , Joiliana Lecointe BS , Thomas P. Doyle MD , Nhue L. Do MD , Dana R. Janssen MD , Garrett N. Coyan MD, MS","doi":"10.1016/j.atssr.2024.09.006","DOIUrl":"10.1016/j.atssr.2024.09.006","url":null,"abstract":"<div><div>A 25-week preterm neonate was born with complete left-sided partial anomalous pulmonary venous drainage with a confluence draining into a vertical vein to the innominate vein. The ostium was stenotic, resulting in pulmonary hypertension requiring palliation by serial stent placement because of prematurity and comorbidities. The patient subsequently underwent successful surgical left anomalous pulmonary venous confluence reimplantation to the left atrium with vertical vein ligation at 12 months of age. This report highlights the unique multidisciplinary management strategy required for the rarely encountered obstructed complete left-sided anomalous pulmonary venous return in a preterm neonate.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 1","pages":"Pages 106-108"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143511804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A 70-year-old man was referred to our hospital for mediastinal malignant neoplasm. Chest computed tomography revealed a 20-cm mass in the middle mediastinum with displacement of the superior vena cava, left innominate vein, and right upper lobe. Tumor resection, right upper lobectomy, combined resection of the left brachiocephalic vein and superior vena cava, and revascularization were performed. It was pathologically diagnosed as an undifferentiated pleomorphic sarcoma, and the patient experienced no recurrence for 4 years. Although the prognosis of mediastinal pleomorphic sarcoma cases is poor, complete surgical resection may lead to long-term survival.
{"title":"Complete Resection of Mediastinal Undifferentiated Pleomorphic Sarcoma","authors":"Ryusuke Sumiya MD, PhD , Takeshi Matsunaga MD, PhD , Mariko Fukui MD, PhD , Takuo Hayashi MD, PhD , Yukio Watanabe MD, PhD , Aritoshi Hattori MD, PhD , Kazuya Takamochi MD, PhD , Kenji Suzuki MD, PhD","doi":"10.1016/j.atssr.2024.09.019","DOIUrl":"10.1016/j.atssr.2024.09.019","url":null,"abstract":"<div><div>A 70-year-old man was referred to our hospital for mediastinal malignant neoplasm. Chest computed tomography revealed a 20-cm mass in the middle mediastinum with displacement of the superior vena cava, left innominate vein, and right upper lobe. Tumor resection, right upper lobectomy, combined resection of the left brachiocephalic vein and superior vena cava, and revascularization were performed. It was pathologically diagnosed as an undifferentiated pleomorphic sarcoma, and the patient experienced no recurrence for 4 years. Although the prognosis of mediastinal pleomorphic sarcoma cases is poor, complete surgical resection may lead to long-term survival.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 1","pages":"Pages 225-228"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143512556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.atssr.2024.08.009
Nida S. Bham MD , Jess D. Schwartz MD, FACS
Inflammatory myoblastic tumors of the lung are rare benign lesions. Here we present the case of a 15-year-old boy with postobstructive pneumonia. Computed tomography of the chest revealed a mass in the left mainstem bronchus that was confirmed on bronchoscopy. A rigid bronchoscopy with core resection was performed. Findings on pathologic examination were consistent with an inflammatory myoblastic tumor. The initial core resection relieved his postobstructive pneumonia; however, repeat bronchoscopy a month later demonstrated recurrence of the lesion. The tumor was removed with a parenchymal-sparing sleeve resection. At 80 months of follow-up, the patient is without evidence of recurrence or stenosis.
{"title":"Endobronchial Inflammatory Myoblastic Tumor (IMT)—A Sleeve to Solve the Issue","authors":"Nida S. Bham MD , Jess D. Schwartz MD, FACS","doi":"10.1016/j.atssr.2024.08.009","DOIUrl":"10.1016/j.atssr.2024.08.009","url":null,"abstract":"<div><div>Inflammatory myoblastic tumors of the lung are rare benign lesions. Here we present the case of a 15-year-old boy with postobstructive pneumonia. Computed tomography of the chest revealed a mass in the left mainstem bronchus that was confirmed on bronchoscopy. A rigid bronchoscopy with core resection was performed. Findings on pathologic examination were consistent with an inflammatory myoblastic tumor. The initial core resection relieved his postobstructive pneumonia; however, repeat bronchoscopy a month later demonstrated recurrence of the lesion. The tumor was removed with a parenchymal-sparing sleeve resection. At 80 months of follow-up, the patient is without evidence of recurrence or stenosis.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 1","pages":"Pages 167-170"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143511694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.atssr.2024.09.007
Andre Y. Son MD, MS , Abigail S. Baldridge DrPH , Andrei Churyla MD , Duc Thinh Pham MD , Christopher K. Mehta MD , Douglas R. Johnston MD , Patrick M. McCarthy MD , S. Christopher Malaisrie MD
Background
Aortic root enlargement (ARE) during aortic valve replacement (AVR) mitigates prosthesis-patient mismatch, but its use has been low. Transcatheter aortic valve-in-valve (VIV) as a treatment for failing bioprosthetic valves is limited by small surgical valves, renewing interest in ARE during the index AVR. This study demonstrates trends and outcomes of ARE after commercial approval of VIV in 2015.
Methods
This retrospective cohort study analyzed 2182 patients undergoing nonemergent AVR between August 2007 and December 2022. Endocarditis, aortic dissection, and concomitant root replacement or ventricular assist device placement were excluded. Trends in ARE use, valve size, and types were compared. Outcome measures included 30-day mortality and gradients and were compared between patients with and without ARE.
Results
Overall, 74 patients (3.4%) underwent ARE, 14 (1.0%) before 2015 and 60 (7.6%, P < .0001) after 2015. Use of smaller valves (19-21 mm) decreased from 372 (26.8%) before 2015 to 85 (10.7%, P < .0001) after 2015. ARE group was younger than the AVR-alone group (64 vs 68 years, P = .001) but had similar predicted risk of mortality (median, 1.7%). Both groups had comparable postoperative mean gradients (ARE: 11 vs AVR-alone: 10 mm Hg, P = .42). ARE had higher 30-day mortality (5 [7%] vs 48 [2%], P = .014); however, no difference was found in elective patients (2 of 65 [3%] vs 39 of 1898 [2%], P = .57).
Conclusions
ARE use has increased since commercial approval of VIV. The addition of ARE to AVR did not affect early safety in elective cases, and postoperative gradients were similar to those in patients not requiring ARE. Further studies are required to determine long-term outcomes after ARE, including VIV candidacy.
{"title":"Trends and Outcomes of Aortic Root Enlargement During Bioprosthetic Aortic Valve Replacement","authors":"Andre Y. Son MD, MS , Abigail S. Baldridge DrPH , Andrei Churyla MD , Duc Thinh Pham MD , Christopher K. Mehta MD , Douglas R. Johnston MD , Patrick M. McCarthy MD , S. Christopher Malaisrie MD","doi":"10.1016/j.atssr.2024.09.007","DOIUrl":"10.1016/j.atssr.2024.09.007","url":null,"abstract":"<div><h3>Background</h3><div>Aortic root enlargement (ARE) during aortic valve replacement (AVR) mitigates prosthesis-patient mismatch, but its use has been low. Transcatheter aortic valve-in-valve (VIV) as a treatment for failing bioprosthetic valves is limited by small surgical valves, renewing interest in ARE during the index AVR. This study demonstrates trends and outcomes of ARE after commercial approval of VIV in 2015.</div></div><div><h3>Methods</h3><div>This retrospective cohort study analyzed 2182 patients undergoing nonemergent AVR between August 2007 and December 2022. Endocarditis, aortic dissection, and concomitant root replacement or ventricular assist device placement were excluded. Trends in ARE use, valve size, and types were compared. Outcome measures included 30-day mortality and gradients and were compared between patients with and without ARE.</div></div><div><h3>Results</h3><div>Overall, 74 patients (3.4%) underwent ARE, 14 (1.0%) before 2015 and 60 (7.6%, <em>P</em> < .0001) after 2015. Use of smaller valves (19-21 mm) decreased from 372 (26.8%) before 2015 to 85 (10.7%, <em>P</em> < .0001) after 2015. ARE group was younger than the AVR-alone group (64 vs 68 years, <em>P</em> = .001) but had similar predicted risk of mortality (median, 1.7%). Both groups had comparable postoperative mean gradients (ARE: 11 vs AVR-alone: 10 mm Hg, <em>P</em> = .42). ARE had higher 30-day mortality (5 [7%] vs 48 [2%], <em>P</em> = .014); however, no difference was found in elective patients (2 of 65 [3%] vs 39 of 1898 [2%], <em>P</em> = .57).</div></div><div><h3>Conclusions</h3><div>ARE use has increased since commercial approval of VIV. The addition of ARE to AVR did not affect early safety in elective cases, and postoperative gradients were similar to those in patients not requiring ARE. Further studies are required to determine long-term outcomes after ARE, including VIV candidacy.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 1","pages":"Pages 1-5"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143512359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Thoracic endovascular aortic repair is a key treatment of acute type B aortic dissection. We recognized the importance of managing type B aortic dissections from their onset and established our strategy in 2013. Here, we report the early and late outcomes of our comprehensive strategy for the management of type B aortic dissections.
Methods
This was a single-institution, observational, retrospective study. Between April 2013 and March 2024, 227 consecutive patients with acute type B aortic dissection were admitted to our institute and treated by our strategy. Early and late outcomes were also assessed for all patients.
Results
Thoracic endovascular aortic repair plus optimal medical treatment was performed to close the primary entry tear in 90 patients (40%) in the acute (12%), subacute (14%), and chronic (14%) phases. Optimal medical treatment alone was performed in 137 patients (60%). The early and late outcomes showed significant improvement.
Conclusions
Our strategy provided excellent early and late outcomes of acute type B aortic dissection, avoided postoperative paraplegia, and completely prevented thoracoabdominal aortic replacement.
{"title":"Expert Management of Type B Aortic Dissection From Onset With Thoracic Endovascular Aortic Repair","authors":"Katsuhiko Oda MD, PhD , Makoto Takahashi MD, PhD , Ryuichi Taketomi MD, PhD , Rina Akanuma MD , Takahiko Hasegawa MD , Satoshi Kawatsu MD, PhD","doi":"10.1016/j.atssr.2024.09.002","DOIUrl":"10.1016/j.atssr.2024.09.002","url":null,"abstract":"<div><h3>Background</h3><div>Thoracic endovascular aortic repair is a key treatment of acute type B aortic dissection. We recognized the importance of managing type B aortic dissections from their onset and established our strategy in 2013. Here, we report the early and late outcomes of our comprehensive strategy for the management of type B aortic dissections.</div></div><div><h3>Methods</h3><div>This was a single-institution, observational, retrospective study. Between April 2013 and March 2024, 227 consecutive patients with acute type B aortic dissection were admitted to our institute and treated by our strategy. Early and late outcomes were also assessed for all patients.</div></div><div><h3>Results</h3><div>Thoracic endovascular aortic repair plus optimal medical treatment was performed to close the primary entry tear in 90 patients (40%) in the acute (12%), subacute (14%), and chronic (14%) phases. Optimal medical treatment alone was performed in 137 patients (60%). The early and late outcomes showed significant improvement.</div></div><div><h3>Conclusions</h3><div>Our strategy provided excellent early and late outcomes of acute type B aortic dissection, avoided postoperative paraplegia, and completely prevented thoracoabdominal aortic replacement.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 1","pages":"Pages 6-10"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143512360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study assessed the possibility of a bridge to recovery using the Berlin Heart EXCOR and the histologic characteristics of pediatric patients with dilated cardiomyopathy accompanied by a left ventricular noncompaction phenotype.
Methods
Of the 17 pediatric patients with dilated cardiomyopathy who underwent Berlin Heart EXCOR implantation between 2013 and 2020, 6 were diagnosed with left ventricular noncompaction association. The patients were classified into 2 groups: the dilated cardiomyopathy group and dilated cardiomyopathy with the left ventricular noncompaction phenotype group. The histologic characteristics of the left ventricular myocardium and left ventricular function after Berlin Heart EXCOR implantation were compared.
Results
Cardiac recovery was not observed in the dilated cardiomyopathy with left ventricular noncompaction group. In contrast, 6 patients (55%) in the dilated cardiomyopathy group achieved cardiac recovery, and the Berlin Heart EXCOR was explanted. The degree of myocardial fibrosis was significantly higher in the dilated cardiomyopathy with the left ventricular noncompaction phenotype group than in the dilated cardiomyopathy group (P < .05). The final follow-up left ventricular ejection fraction and end-diastolic diameter during Berlin Heart EXCOR support improved significantly compared with the preimplantation variables in the dilated cardiomyopathy group (both P < .001); the dilated cardiomyopathy with left ventricular noncompaction phenotype group showed no improvements (P = .84 and P = .37, respectively).
Conclusions
The left ventricular noncompaction phenotype associated with dilated cardiomyopathy may adversely affect the rate of cardiac recovery with Berlin Heart EXCOR.
{"title":"Lack of Bridge to Recovery in Pediatric Dilated Cardiomyopathy With Left Ventricular Noncompaction","authors":"Moyu Hasegawa MD , Masaki Taira MD , Yuji Tominaga MD , Takuji Watanabe MD , Yosuke Kugo MD , Toshiaki Nagashima MD , Akima Harada BS , Takayoshi Ueno MD, PhD , Shigeru Miyagawa MD, PhD","doi":"10.1016/j.atssr.2024.02.021","DOIUrl":"10.1016/j.atssr.2024.02.021","url":null,"abstract":"<div><h3>Background</h3><div>This study assessed the possibility of a bridge to recovery using the Berlin Heart EXCOR and the histologic characteristics of pediatric patients with dilated cardiomyopathy accompanied by a left ventricular noncompaction phenotype.</div></div><div><h3>Methods</h3><div>Of the 17 pediatric patients with dilated cardiomyopathy who underwent Berlin Heart EXCOR implantation between 2013 and 2020, 6 were diagnosed with left ventricular noncompaction association. The patients were classified into 2 groups: the dilated cardiomyopathy group and dilated cardiomyopathy with the left ventricular noncompaction phenotype group. The histologic characteristics of the left ventricular myocardium and left ventricular function after Berlin Heart EXCOR implantation were compared.</div></div><div><h3>Results</h3><div>Cardiac recovery was not observed in the dilated cardiomyopathy with left ventricular noncompaction group. In contrast, 6 patients (55%) in the dilated cardiomyopathy group achieved cardiac recovery, and the Berlin Heart EXCOR was explanted. The degree of myocardial fibrosis was significantly higher in the dilated cardiomyopathy with the left ventricular noncompaction phenotype group than in the dilated cardiomyopathy group (<em>P</em> < .05). The final follow-up left ventricular ejection fraction and end-diastolic diameter during Berlin Heart EXCOR support improved significantly compared with the preimplantation variables in the dilated cardiomyopathy group (both <em>P</em> < .001); the dilated cardiomyopathy with left ventricular noncompaction phenotype group showed no improvements (<em>P</em> = .84 and <em>P</em> = .37, respectively).</div></div><div><h3>Conclusions</h3><div>The left ventricular noncompaction phenotype associated with dilated cardiomyopathy may adversely affect the rate of cardiac recovery with Berlin Heart EXCOR.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 1","pages":"Pages 241-246"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143512419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.atssr.2024.08.002
Koji Kawaguchi MD , Shinji Kaneda MD , Daisuke Ito MD , Akira Shimamoto MD , Motoshi Takao MD
This report describes our technical methods of robotic-assisted chest wall resection concomitant with lobectomy, which did not require the division of major extrathoracic muscles and spreading of the ribs. In both cases, the patients were able to raise their arms on the affected side immediately after surgery, without any shoulder dysfunction. This robotic-assisted muscle-sparing chest wall resection without thoracotomy technique enables preservation of the extrathoracic muscles and allows patients to maintain their quality of life, thus making it possible for patients to promptly receive adjuvant therapy.
{"title":"Robotic-Assisted Muscle-Sparing Chest Wall Resection Without Thoracotomy: Tips and Benefits for Lung Cancer Patients With Chest Wall Invasion","authors":"Koji Kawaguchi MD , Shinji Kaneda MD , Daisuke Ito MD , Akira Shimamoto MD , Motoshi Takao MD","doi":"10.1016/j.atssr.2024.08.002","DOIUrl":"10.1016/j.atssr.2024.08.002","url":null,"abstract":"<div><div>This report describes our technical methods of robotic-assisted chest wall resection concomitant with lobectomy, which did not require the division of major extrathoracic muscles and spreading of the ribs. In both cases, the patients were able to raise their arms on the affected side immediately after surgery, without any shoulder dysfunction. This robotic-assisted muscle-sparing chest wall resection without thoracotomy technique enables preservation of the extrathoracic muscles and allows patients to maintain their quality of life, thus making it possible for patients to promptly receive adjuvant therapy.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 1","pages":"Pages 190-192"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143512506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.atssr.2024.07.007
Devanish N. Kamtam MBBS, MS , Joseph B. Shrager MD , Irmina A. Elliott MD , Henry H. Guo MD, PhD , Brandon A. Guenthart MD , Douglas Z. Liou MD , Natalie S. Lui MD , Leah M. Backhus MD , Mark F. Berry MD
Background
Positron emission tomography (PET) is the standard of care for non-small cell lung cancer (NSCLC) clinical staging, but it may have limited utility in evaluating subsolid lung adenocarcinomas that can have relatively indolent behavior without hypermetabolic activity.
Methods
The sensitivity and specificity of PET for determining pathologic lymph node status and disease-free survival were assessed in patients operated on for cT1 N0 subsolid lung adenocarcinoma from January 2006 to June 2022 (at Stanford University School of Medicine, Stanford, CA). Patients with clinical or pathologic tumor size >30 mm, hilar or mediastinal lymph node size >1cm, and purely solid tumors were excluded.
Results
PET was available in 498 of 534 (93.2%) patients and more often was used in older patients with larger and more solid tumors. The overall pathologic lymph node–positive rate was 8.4% (45 of 534). PET specificity was 95.1%, but sensitivity was only 20.0%. A tumor diameter of 18.5 mm and a solid component percentage of 62.5% had the maximum predictive accuracy for pathologic lymph node positivity, with a 0% and 1.5% rate of pathologic and PET lymph node positivity, respectively, for tumors with values lower than those thresholds. There was no significant difference in 5-year disease-free survival between individuals who did and did not undergo PET scanning (76.6% vs 96.8%; P = .07). Conversely, 134 (26.9%) patients who underwent PET scanning had 171 incidentally detected hypermetabolic lesions unrelated to lung cancer, with only 13 of 134 (9.7%) patients identified as having non-NSCLC premalignant or malignant conditions requiring further therapy.
Conclusions
PET scan use for subsolid lung adenocarcinoma has high specificity but limited sensitivity for predicting pathologic lymph node positivity. PET also has no association with disease-free survival and often detects clinically unimportant findings rather than changing lung cancer management, particularly for patients with smaller and less solid tumors.
{"title":"Utility of PET for Nodal Staging in Subsolid Clinical Stage IA (T1 N0) Lung Adenocarcinoma","authors":"Devanish N. Kamtam MBBS, MS , Joseph B. Shrager MD , Irmina A. Elliott MD , Henry H. Guo MD, PhD , Brandon A. Guenthart MD , Douglas Z. Liou MD , Natalie S. Lui MD , Leah M. Backhus MD , Mark F. Berry MD","doi":"10.1016/j.atssr.2024.07.007","DOIUrl":"10.1016/j.atssr.2024.07.007","url":null,"abstract":"<div><h3>Background</h3><div>Positron emission tomography (PET) is the standard of care for non-small cell lung cancer (NSCLC) clinical staging, but it may have limited utility in evaluating subsolid lung adenocarcinomas that can have relatively indolent behavior without hypermetabolic activity.</div></div><div><h3>Methods</h3><div>The sensitivity and specificity of PET for determining pathologic lymph node status and disease-free survival were assessed in patients operated on for cT1 N0 subsolid lung adenocarcinoma from January 2006 to June 2022 (at Stanford University School of Medicine, Stanford, CA). Patients with clinical or pathologic tumor size >30 mm, hilar or mediastinal lymph node size >1cm, and purely solid tumors were excluded.</div></div><div><h3>Results</h3><div>PET was available in 498 of 534 (93.2%) patients and more often was used in older patients with larger and more solid tumors. The overall pathologic lymph node–positive rate was 8.4% (45 of 534). PET specificity was 95.1%, but sensitivity was only 20.0%. A tumor diameter of 18.5 mm and a solid component percentage of 62.5% had the maximum predictive accuracy for pathologic lymph node positivity, with a 0% and 1.5% rate of pathologic and PET lymph node positivity, respectively, for tumors with values lower than those thresholds. There was no significant difference in 5-year disease-free survival between individuals who did and did not undergo PET scanning (76.6% vs 96.8%; <em>P</em> = .07). Conversely, 134 (26.9%) patients who underwent PET scanning had 171 incidentally detected hypermetabolic lesions unrelated to lung cancer, with only 13 of 134 (9.7%) patients identified as having non-NSCLC premalignant or malignant conditions requiring further therapy.</div></div><div><h3>Conclusions</h3><div>PET scan use for subsolid lung adenocarcinoma has high specificity but limited sensitivity for predicting pathologic lymph node positivity. PET also has no association with disease-free survival and often detects clinically unimportant findings rather than changing lung cancer management, particularly for patients with smaller and less solid tumors.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 1","pages":"Pages 118-122"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141846155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.atssr.2024.09.018
Jennifer L. Keen MD , Pranav Modi MBBS , Maria M. Crespo MD , Christian Bermudez MD , Andrew Courtwright MD, PhD
Background
Extracorporeal membrane oxygenation (ECMO) is increasingly used as a bridge to lung transplantation. Despite success in select populations, candidates requiring ECMO bridge to retransplantation have historically had poor 1-year survival. This study aimed to examine the characteristics of the recipient, donor, and transplant procedure type to guide selection of candidates for ECMO bridge to retransplantation.
Methods
This was a retrospective cohort study of all US adult lung retransplant recipients between May 5, 2005, and December 31, 2022. We evaluated 1-year survival of ECMO-bridged retransplant patients, stratified by time from initial transplant, procedure type (single or bilateral retransplant), and ECMO era (2005-2017 vs 2018-2022).
Results
In this national cohort, 111 of 1296 (8.6%) retransplant recipients underwent ECMO bridge. One-year survival was worse for ECMO bridge retransplant recipients (52.2% vs 74.0%; P < .001) and has worsened in the contemporary era (2018-2022) of ECMO bridge to retransplantation compared with prior years (P = .03). Time from initial transplantation and use of bilateral retransplant after an initial bilateral transplant were most strongly associated with improved 1-year survival of ECMO-bridged retransplant recipients. Of bilateral recipients bridged to bilateral transplant more than 1 year after primary transplantation, survival was 65.9% in ECMO-bridged patients as opposed to 77.2% in nonbridged patients.
Conclusions
Careful selection of candidates and surgical procedure type remains essential in determining candidacy for ECMO bridge to retransplantation.
{"title":"Survival After Extracorporeal Membrane Oxygenation Bridge to Lung Retransplantation","authors":"Jennifer L. Keen MD , Pranav Modi MBBS , Maria M. Crespo MD , Christian Bermudez MD , Andrew Courtwright MD, PhD","doi":"10.1016/j.atssr.2024.09.018","DOIUrl":"10.1016/j.atssr.2024.09.018","url":null,"abstract":"<div><h3>Background</h3><div>Extracorporeal membrane oxygenation (ECMO) is increasingly used as a bridge to lung transplantation. Despite success in select populations, candidates requiring ECMO bridge to retransplantation have historically had poor 1-year survival. This study aimed to examine the characteristics of the recipient, donor, and transplant procedure type to guide selection of candidates for ECMO bridge to retransplantation.</div></div><div><h3>Methods</h3><div>This was a retrospective cohort study of all US adult lung retransplant recipients between May 5, 2005, and December 31, 2022. We evaluated 1-year survival of ECMO-bridged retransplant patients, stratified by time from initial transplant, procedure type (single or bilateral retransplant), and ECMO era (2005-2017 vs 2018-2022).</div></div><div><h3>Results</h3><div>In this national cohort, 111 of 1296 (8.6%) retransplant recipients underwent ECMO bridge. One-year survival was worse for ECMO bridge retransplant recipients (52.2% vs 74.0%; <em>P</em> < .001) and has worsened in the contemporary era (2018-2022) of ECMO bridge to retransplantation compared with prior years (<em>P</em> = .03). Time from initial transplantation and use of bilateral retransplant after an initial bilateral transplant were most strongly associated with improved 1-year survival of ECMO-bridged retransplant recipients. Of bilateral recipients bridged to bilateral transplant more than 1 year after primary transplantation, survival was 65.9% in ECMO-bridged patients as opposed to 77.2% in nonbridged patients.</div></div><div><h3>Conclusions</h3><div>Careful selection of candidates and surgical procedure type remains essential in determining candidacy for ECMO bridge to retransplantation.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 1","pages":"Pages 150-155"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143511698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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