Pub Date : 2025-12-01DOI: 10.1016/j.atssr.2025.05.005
Gongmin Rim MD, PhD , Deog Gon Cho MD, PhD , Kwanyong Hyun MD, PhD , Yong Jin Chang MD , Min Seop Jo MD, PhD , Sung-Ho Her MD, PhD
Background
Bronchopleural fistula (BPF) is a severe postoperative complication in thoracic surgery with high morbidity and mortality. Traditional surgical treatments are effective but invasive, highlighting the need for minimally invasive alternatives. The Amplatzer vascular plug (AVP), typically used for the embolization of targeted vessels, has been highlighted for its potential use in BPF closure.
Methods
This study evaluated the use of AVPs II and IV for bronchoscopic closure of BPFs in 3 male patients after lobectomy or pneumonectomy. AVP II was used for fistulas >6 mm and AVP IV for those <6 mm. Procedures were performed under general anesthesia in the hybrid operating room using flexible bronchoscopy with fluoroscopic guidance.
Results
Successful fistula closure was achieved in all cases without complications. Follow-up during 11 months (range, 3-22 months) confirmed stable device positioning, clinical improvement, and no 90-day mortality.
Conclusions
AVP closure is a safe, effective, and minimally invasive approach for managing BPF, offering a promising first-line treatment option for patients unsuitable for traditional surgery. Further studies are required to validate these findings.
{"title":"Precision Closure of Postsurgical Bronchopleural Fistulas Using Vascular Plugs","authors":"Gongmin Rim MD, PhD , Deog Gon Cho MD, PhD , Kwanyong Hyun MD, PhD , Yong Jin Chang MD , Min Seop Jo MD, PhD , Sung-Ho Her MD, PhD","doi":"10.1016/j.atssr.2025.05.005","DOIUrl":"10.1016/j.atssr.2025.05.005","url":null,"abstract":"<div><h3>Background</h3><div>Bronchopleural fistula (BPF) is a severe postoperative complication in thoracic surgery with high morbidity and mortality. Traditional surgical treatments are effective but invasive, highlighting the need for minimally invasive alternatives. The Amplatzer vascular plug (AVP), typically used for the embolization of targeted vessels, has been highlighted for its potential use in BPF closure.</div></div><div><h3>Methods</h3><div>This study evaluated the use of AVPs II and IV for bronchoscopic closure of BPFs in 3 male patients after lobectomy or pneumonectomy. AVP II was used for fistulas >6 mm and AVP IV for those <6 mm. Procedures were performed under general anesthesia in the hybrid operating room using flexible bronchoscopy with fluoroscopic guidance.</div></div><div><h3>Results</h3><div>Successful fistula closure was achieved in all cases without complications. Follow-up during 11 months (range, 3-22 months) confirmed stable device positioning, clinical improvement, and no 90-day mortality.</div></div><div><h3>Conclusions</h3><div>AVP closure is a safe, effective, and minimally invasive approach for managing BPF, offering a promising first-line treatment option for patients unsuitable for traditional surgery. Further studies are required to validate these findings.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 4","pages":"Pages 850-855"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145645976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.atssr.2025.06.007
Angelo Federico DO , John Hilu MD , Alexander Restum MS , Danielle Garcia DO
Deliberate foreign body ingestion (DFBI) is a psychopathologic disorder that involves the ingestion of nonnutritive objects to cause self-harm. Depending on the object, the subsequent injuries can be life-threatening if not managed promptly. Whereas the use of video-assisted thoracoscopic surgery (VATS) for the treatment of various lung diseases is well established, the efficacy for retrieval of intrathoracic foreign bodies is unclear and available literature is limited. We report the case of a patient who underwent a VATS for retrieval of an intrathoracic knife after ingestion. This report discusses the use of open thoracotomy vs VATS for intrathoracic foreign body retrieval.
{"title":"Video-Assisted Thoracoscopic Surgery for Retrieval of an Intrathoracic Knife","authors":"Angelo Federico DO , John Hilu MD , Alexander Restum MS , Danielle Garcia DO","doi":"10.1016/j.atssr.2025.06.007","DOIUrl":"10.1016/j.atssr.2025.06.007","url":null,"abstract":"<div><div>Deliberate foreign body ingestion (DFBI) is a psychopathologic disorder that involves the ingestion of nonnutritive objects to cause self-harm. Depending on the object, the subsequent injuries can be life-threatening if not managed promptly. Whereas the use of video-assisted thoracoscopic surgery (VATS) for the treatment of various lung diseases is well established, the efficacy for retrieval of intrathoracic foreign bodies is unclear and available literature is limited. We report the case of a patient who underwent a VATS for retrieval of an intrathoracic knife after ingestion. This report discusses the use of open thoracotomy vs VATS for intrathoracic foreign body retrieval.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 4","pages":"Pages 879-882"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145645979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.atssr.2025.05.006
Omar A. Jarral MD, PhD , Stevan S. Pupovac MD , Renee Cholyway MD , Patricia Nicolato DO , Mei Chau MD , Chad Kliger MD , Nirav C. Patel MD, FRCS , S. Jacob Scheinerman MD , Alan R. Hartman MD , Derek R. Brinster MD
Background
The objective of this study was to assess the number of root procedures performed for a newly graduated surgeon to overcome the learning curve.
Methods
An institutional database was used to obtain details for patients undergoing root surgery during a 10-year period for a newly graduated surgeon. To assess learning curve, strucchange R package (engineering method to objectively identify structural changes in data) was used to analyze operative efficiency. A cumulative sum failure analysis curve was plotted to indicate the magnitude and direction of changes in efficiency for this single surgeon. A composite of adverse outcome was assessed across learning curve phases.
Results
Strucchange identified 3 segments to the learning curve. These occurred at 38 (95% CI, 25-54) and 148 (95% CI, 135-152) cases. Based on this, there were 3 segments to the learning curve: after the first 25 to 50 cases, 50 to 150 cases, and then 150 cases onward. The composite of adverse outcome was compared across the phases of the learning curve. In phase 1, 44.0% experienced the outcome, which was reduced to 20.0% in phase 2 and 21.1% in phase 3 (P = .029).
Conclusions
There appear to be 3 segments of the learning curve for the new surgeon when performing root replacement. The first occurs after around 25 to 50 cases, after which there is a rapid decline in operative time and complications. The second phase occurs between cases 50 and 150, during which advanced proficiency is developed. Aortic fellowship programs should aim to graduate fellows with at least 50 root procedures as first operator.
{"title":"Learning Curve for Aortic Root Replacement","authors":"Omar A. Jarral MD, PhD , Stevan S. Pupovac MD , Renee Cholyway MD , Patricia Nicolato DO , Mei Chau MD , Chad Kliger MD , Nirav C. Patel MD, FRCS , S. Jacob Scheinerman MD , Alan R. Hartman MD , Derek R. Brinster MD","doi":"10.1016/j.atssr.2025.05.006","DOIUrl":"10.1016/j.atssr.2025.05.006","url":null,"abstract":"<div><h3>Background</h3><div>The objective of this study was to assess the number of root procedures performed for a newly graduated surgeon to overcome the learning curve.</div></div><div><h3>Methods</h3><div>An institutional database was used to obtain details for patients undergoing root surgery during a 10-year period for a newly graduated surgeon. To assess learning curve, strucchange R package (engineering method to objectively identify structural changes in data) was used to analyze operative efficiency. A cumulative sum failure analysis curve was plotted to indicate the magnitude and direction of changes in efficiency for this single surgeon. A composite of adverse outcome was assessed across learning curve phases.</div></div><div><h3>Results</h3><div>Strucchange identified 3 segments to the learning curve. These occurred at 38 (95% CI, 25-54) and 148 (95% CI, 135-152) cases. Based on this, there were 3 segments to the learning curve: after the first 25 to 50 cases, 50 to 150 cases, and then 150 cases onward. The composite of adverse outcome was compared across the phases of the learning curve. In phase 1, 44.0% experienced the outcome, which was reduced to 20.0% in phase 2 and 21.1% in phase 3 (<em>P</em> = .029).</div></div><div><h3>Conclusions</h3><div>There appear to be 3 segments of the learning curve for the new surgeon when performing root replacement. The first occurs after around 25 to 50 cases, after which there is a rapid decline in operative time and complications. The second phase occurs between cases 50 and 150, during which advanced proficiency is developed. Aortic fellowship programs should aim to graduate fellows with at least 50 root procedures as first operator.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 4","pages":"Pages 1154-1158"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145645997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Unifocalization of pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries is technically challenging because of the differing embryological development of the central pulmonary artery, major aortopulmonary collateral arteries, and parenchymal pulmonary arteries. We performed unifocalization using a saline “inflation test” not only to prevent kinking of the vessels, but also to identify differences in extensibility to intergrade uniform vessels. Moreover, right ventricular outflow tract reconstruction using a handmade valved conduit was performed to facilitate easy access to the catheter intervention to maintain a uniform vascular network. This approach offers a potential solution for the treatment of complex conditions.
{"title":"Enhancing Unifocalization With Saline Inflation Testing and a Handmade Valved Conduit in Major Aortopulmonary Collateral Arteries","authors":"Akio Ikai MD, PhD , Keiichi Hirose MD, PhD , Mizuhiko Ishigaki MD , Sung-Hae Kim MD , Kisaburo Sakamoto MD , Hiroki Ito MD","doi":"10.1016/j.atssr.2025.04.019","DOIUrl":"10.1016/j.atssr.2025.04.019","url":null,"abstract":"<div><div>Unifocalization of pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries is technically challenging because of the differing embryological development of the central pulmonary artery, major aortopulmonary collateral arteries, and parenchymal pulmonary arteries. We performed unifocalization using a saline “inflation test” not only to prevent kinking of the vessels, but also to identify differences in extensibility to intergrade uniform vessels. Moreover, right ventricular outflow tract reconstruction using a handmade valved conduit was performed to facilitate easy access to the catheter intervention to maintain a uniform vascular network. This approach offers a potential solution for the treatment of complex conditions.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 4","pages":"Pages 1108-1110"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145646013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.atssr.2025.05.013
Ahmed J. AlAraibi , Ammar Shaaban MBBS , Muhammad Ashfaq MD , Husam Noor MD , Martin Maresch MD, PhD , Nazar Bukamal MBBch , Zaid Arekat MD , Habib Al-Tareif MD
Descending necrotizing mediastinitis is a life-threatening infection, and in extremely rare instances it can erode into the aortic wall and lead to mycotic pseudoaneurysms. A 50-year-old man presented with chest pain, hoarseness, and dysphagia. Imaging revealed an aortic arch pseudoaneurysm and a mediastinal abscess containing multidrug-resistant Salmonella. Urgent surgical repair using deep hypothermic circulatory arrest allowed thorough debridement and patch closure. Two months later, suture line dehiscence was successfully managed by thoracic endovascular aortic repair. He recovered under prolonged antibiotic therapy. This case underscores the importance of early recognition and a multidisciplinary, staged approach to overcome both immediate and delayed complications.
{"title":"Combined Surgical Management and Endovascular Repair of Aortic Arch Mycotic Pseudoaneurysm Secondary to Descending Necrotizing Mediastinitis","authors":"Ahmed J. AlAraibi , Ammar Shaaban MBBS , Muhammad Ashfaq MD , Husam Noor MD , Martin Maresch MD, PhD , Nazar Bukamal MBBch , Zaid Arekat MD , Habib Al-Tareif MD","doi":"10.1016/j.atssr.2025.05.013","DOIUrl":"10.1016/j.atssr.2025.05.013","url":null,"abstract":"<div><div>Descending necrotizing mediastinitis is a life-threatening infection, and in extremely rare instances it can erode into the aortic wall and lead to mycotic pseudoaneurysms. A 50-year-old man presented with chest pain, hoarseness, and dysphagia. Imaging revealed an aortic arch pseudoaneurysm and a mediastinal abscess containing multidrug-resistant <em>Salmonella.</em> Urgent surgical repair using deep hypothermic circulatory arrest allowed thorough debridement and patch closure. Two months later, suture line dehiscence was successfully managed by thoracic endovascular aortic repair. He recovered under prolonged antibiotic therapy. This case underscores the importance of early recognition and a multidisciplinary, staged approach to overcome both immediate and delayed complications.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 4","pages":"Pages 989-992"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145646025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Owing to the proximity of vital organs, apical lung cancer requires a surgical approach distinct from that used for conventional radical lung cancer surgery. Various techniques have been developed to address this challenge. The open chest approach involves extensive muscle dissection, often leading to an unexpected degree of respiratory function loss. This report outlines a surgical technique performed on a patient with reduced pulmonary function who underwent left upper division segmentectomy combined with resection of the first and third ribs. The procedure was conducted by a combination of uniportal video-assisted thoracic surgery and a localized high posterolateral incision.
{"title":"Uniportal Video-Assisted Left Upper Segmentectomy With a Minimally Invasive Chest Wall Resection Technique for Pancoast Lung Cancer","authors":"Fumiaki Watanabe MD, PhD , Teruhisa Kawaguchi MD , Yasuhisa Urata MD , Iwao Hioki MD, PhD , Katsutoshi Adachi MD, PhD , Tomoaki Sato MD, PhD","doi":"10.1016/j.atssr.2025.06.018","DOIUrl":"10.1016/j.atssr.2025.06.018","url":null,"abstract":"<div><div>Owing to the proximity of vital organs, apical lung cancer requires a surgical approach distinct from that used for conventional radical lung cancer surgery. Various techniques have been developed to address this challenge. The open chest approach involves extensive muscle dissection, often leading to an unexpected degree of respiratory function loss. This report outlines a surgical technique performed on a patient with reduced pulmonary function who underwent left upper division segmentectomy combined with resection of the first and third ribs. The procedure was conducted by a combination of uniportal video-assisted thoracic surgery and a localized high posterolateral incision.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 4","pages":"Pages 908-911"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145646057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.atssr.2025.06.003
Kathryne Holmes MD , Mouchammed Agko MD , John Kuckelman DO , Daniel Miller MD
Postpneumonectomy syndrome (PPS) is a rare postoperative condition. We report a patient with cardiac PPS caused by unique cardiac-related anatomic changes. A 56-year-old man with atypical carcinoid of the right lung underwent a right intrapericardial pneumonectomy. At the 12-month follow-up, the patient complained of progressive dyspnea. Imaging demonstrated the right diaphragm elevation with significant mass effect on the right side of the heart without tracheobronchial abnormalities. A redo right thoracotomy was performed with reduction of intrathoracic contents, diaphragmatic plication, and placement of an intrathoracic tissue expander with complete correction of the anatomical abnormality and resolution of symptoms.
{"title":"Cardiac Postpneumonectomy Syndrome","authors":"Kathryne Holmes MD , Mouchammed Agko MD , John Kuckelman DO , Daniel Miller MD","doi":"10.1016/j.atssr.2025.06.003","DOIUrl":"10.1016/j.atssr.2025.06.003","url":null,"abstract":"<div><div>Postpneumonectomy syndrome (PPS) is a rare postoperative condition. We report a patient with cardiac PPS caused by unique cardiac-related anatomic changes. A 56-year-old man with atypical carcinoid of the right lung underwent a right intrapericardial pneumonectomy. At the 12-month follow-up, the patient complained of progressive dyspnea. Imaging demonstrated the right diaphragm elevation with significant mass effect on the right side of the heart without tracheobronchial abnormalities. A redo right thoracotomy was performed with reduction of intrathoracic contents, diaphragmatic plication, and placement of an intrathoracic tissue expander with complete correction of the anatomical abnormality and resolution of symptoms.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 4","pages":"Pages 886-888"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145646051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.atssr.2025.06.031
AlleaBelle Bradshaw MD , Ifeanyi Chinedozi MD , Jace C. Bradshaw MD , Jonathan D. Mathews BS , Anson Y. Lee BS , Emily L. Larson BS , Hanghang Wang MD, PhD , Puja Kachroo MD , Zachary Darby MD , Jessica B. Briscoe MD , Jennifer S. Lawton MD
Background
Use of the radial artery (RA) as a conduit during coronary artery bypass grafting is associated with better outcomes compared with vein. However, data on the RA as a sequential graft are limited. This study assessed the safety and efficiency of using sequential RA grafting.
Methods
Patients with sequential vs nonsequential RA grafting by 1 surgeon from 2 hospitals from 2001 to 2022 were compared using propensity matching. Primary outcomes were total artery revascularization (TAR) and incomplete revascularization. Secondary outcomes included cardiopulmonary bypass and cross-clamp times, total number of arterial grafts, 30-day mortality, and complications. The Mann-Whitney U test, χ2 test, and propensity matching were used.
Results
Of 517 patients who received RA grafting, 107 (20.7%) were sequential. After matching, there were 107 patients in the sequential group and 321 in the nonsequential group. Sequential RA use was associated with more TAR (P < .001) and less incomplete revascularization (P = .002). Matched patients with sequential RA grafting and 4 grafts had shorter bypass and cross-clamp times (P < .001). No differences were observed in clinical outcomes between matched groups.
Conclusions
Patients with sequential RA grafting had more TAR with equivalent outcomes compared with those with single RA. These findings support the safety and efficiency of sequential RA grafting.
{"title":"Assessing the Safety of Sequential Radial Artery Grafting in Coronary Revascularization","authors":"AlleaBelle Bradshaw MD , Ifeanyi Chinedozi MD , Jace C. Bradshaw MD , Jonathan D. Mathews BS , Anson Y. Lee BS , Emily L. Larson BS , Hanghang Wang MD, PhD , Puja Kachroo MD , Zachary Darby MD , Jessica B. Briscoe MD , Jennifer S. Lawton MD","doi":"10.1016/j.atssr.2025.06.031","DOIUrl":"10.1016/j.atssr.2025.06.031","url":null,"abstract":"<div><h3>Background</h3><div>Use of the radial artery (RA) as a conduit during coronary artery bypass grafting is associated with better outcomes compared with vein. However, data on the RA as a sequential graft are limited. This study assessed the safety and efficiency of using sequential RA grafting.</div></div><div><h3>Methods</h3><div>Patients with sequential vs nonsequential RA grafting by 1 surgeon from 2 hospitals from 2001 to 2022 were compared using propensity matching. Primary outcomes were total artery revascularization (TAR) and incomplete revascularization. Secondary outcomes included cardiopulmonary bypass and cross-clamp times, total number of arterial grafts, 30-day mortality, and complications. The Mann-Whitney <em>U</em> test, χ<sup>2</sup> test, and propensity matching were used.</div></div><div><h3>Results</h3><div>Of 517 patients who received RA grafting, 107 (20.7%) were sequential. After matching, there were 107 patients in the sequential group and 321 in the nonsequential group. Sequential RA use was associated with more TAR (<em>P</em> < .001) and less incomplete revascularization (<em>P</em> = .002). Matched patients with sequential RA grafting and 4 grafts had shorter bypass and cross-clamp times (<em>P</em> < .001). No differences were observed in clinical outcomes between matched groups.</div></div><div><h3>Conclusions</h3><div>Patients with sequential RA grafting had more TAR with equivalent outcomes compared with those with single RA. These findings support the safety and efficiency of sequential RA grafting.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 4","pages":"Pages 1000-1004"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145645723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.atssr.2025.04.004
Clayton J. Agler BA , Catherine G. Pratt MD, MS , Jenna N. Whitrock MD, MS , Jianmin Pan PhD , Jayesh P. Rai MS , Shesh N. Rai PhD , Shimul A. Shah MD, MHCM , Sandra L. Starnes MD , Robert M. Van Haren MD, MSPH
Background
Surgery provides curative-intent treatment for early-stage non-small cell lung cancer (NSCLC). Some patients decline recommend lung cancer resection and have worse overall survival (OS). The details of what treatment or palliative care is received among those who decline recommend surgery have not been described. We aimed to identify factors associated with declining all treatment among patients who decline recommended surgery for NSCLC.
Methods
The National Cancer Database was utilized to identify stage I and II patients with NSCLC age ≤70 years diagnosed from 2004-2020. Patients were assigned to 2 cohorts: declined recommended surgery but received alternative treatment (alternative treatment cohort) and declined recommended surgery and declined all other treatment modalities (no treatment cohort). Cox regression analysis was performed to identify variables independently associated with OS.
Results
A total of 67,454 adult patients met inclusion criteria. Among patients who did not receive surgery (n = 923), 70.6% of patients received no treatment (n = 652). Patients who declined surgery were more likely of Black race. Compared with alternative treatment, patients who received no treatment were more likely to have stage I cancer and nongovernment insurance. Multivariable Cox regression demonstrated that residence in areas with higher income and receiving alternative treatment were associated with improved OS; while increased comorbidities was associated with worse OS.
Conclusions
Most patients who decline recommended surgery receive no treatment, and declining all treatment for early-stage NSCLC is associated with worse OS. Targeted interventions to mitigate socioeconomic barriers for lung cancer treatment are necessary.
手术是早期非小细胞肺癌（NSCLC）的有效治疗方法。一些患者不推荐肺癌切除，总生存期（OS）较差。那些拒绝推荐手术的患者接受何种治疗或姑息治疗的细节尚未被描述。我们的目的是确定在非小细胞肺癌患者中拒绝推荐手术治疗的相关因素。方法利用美国国家癌症数据库（National Cancer Database）对2004-2020年诊断的年龄≤70岁的I期和II期NSCLC患者进行识别。患者被分配到2个队列：拒绝推荐手术但接受替代治疗（替代治疗队列）和拒绝推荐手术并拒绝所有其他治疗方式（无治疗队列）。采用Cox回归分析确定与OS独立相关的变量。结果67,454例成人患者符合纳入标准。在未接受手术的患者中（n = 923）， 70.6%的患者未接受治疗（n = 652）。拒绝手术的患者更有可能是黑人。与替代治疗相比，未接受治疗的患者更有可能患上I期癌症和非政府保险。多变量Cox回归分析表明，居住在高收入地区和接受替代治疗与OS改善相关；而合并症的增加与更差的OS相关。结论大多数拒绝推荐手术的患者没有接受任何治疗，拒绝所有早期NSCLC治疗与更差的OS相关。有针对性的干预措施以减轻肺癌治疗的社会经济障碍是必要的。
{"title":"What Happens After Declining Recommended Surgery? Analysis of Early-Stage Non-Small Cell Lung Cancer","authors":"Clayton J. Agler BA , Catherine G. Pratt MD, MS , Jenna N. Whitrock MD, MS , Jianmin Pan PhD , Jayesh P. Rai MS , Shesh N. Rai PhD , Shimul A. Shah MD, MHCM , Sandra L. Starnes MD , Robert M. Van Haren MD, MSPH","doi":"10.1016/j.atssr.2025.04.004","DOIUrl":"10.1016/j.atssr.2025.04.004","url":null,"abstract":"<div><h3>Background</h3><div>Surgery provides curative-intent treatment for early-stage non-small cell lung cancer (NSCLC). Some patients decline recommend lung cancer resection and have worse overall survival (OS). The details of what treatment or palliative care is received among those who decline recommend surgery have not been described. We aimed to identify factors associated with declining all treatment among patients who decline recommended surgery for NSCLC.</div></div><div><h3>Methods</h3><div>The National Cancer Database was utilized to identify stage I and II patients with NSCLC age ≤70 years diagnosed from 2004-2020. Patients were assigned to 2 cohorts: declined recommended surgery but received alternative treatment (alternative treatment cohort) and declined recommended surgery and declined all other treatment modalities (no treatment cohort). Cox regression analysis was performed to identify variables independently associated with OS.</div></div><div><h3>Results</h3><div>A total of 67,454 adult patients met inclusion criteria. Among patients who did not receive surgery (n = 923), 70.6% of patients received no treatment (n = 652). Patients who declined surgery were more likely of Black race. Compared with alternative treatment, patients who received no treatment were more likely to have stage I cancer and nongovernment insurance. Multivariable Cox regression demonstrated that residence in areas with higher income and receiving alternative treatment were associated with improved OS; while increased comorbidities was associated with worse OS.</div></div><div><h3>Conclusions</h3><div>Most patients who decline recommended surgery receive no treatment, and declining all treatment for early-stage NSCLC is associated with worse OS. Targeted interventions to mitigate socioeconomic barriers for lung cancer treatment are necessary.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 4","pages":"Pages 829-833"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145645966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.atssr.2025.05.003
Ayham M. Odeh MD , Raymond A. Verm MD , Marshall S. Baker MD, MBA , Wissam Raad MD , Richard Freeman MD, MBA , Zaid M. Abdelsattar MD, MS
Background
Blood transfusions are rare during elective thoracic surgery, yet routine ordering of preoperative type and screens (pre-T&S) is common. In this context, an international survey was conducted to assess thoracic surgeons’ practice patterns.
Methods
A 42-question, internet-based survey was sent to all thoracic surgeons registered in CTSNet. Responses were collected from April to July, 2023. We collected data on surgeon demographics, description of clinical practice, preoperative routines, and their approach to hypothetical clinical vignettes. These sections were compared between surgeons who routinely order a pre-T&S and those who do not by using the Pearson χ2 test for categorical variables, and the Student t test or Mann-Whitney U test for continuous variables.
Results
Surveys were sent to 2499 thoracic surgeons, 173 of whom filled out the survey; 129 (74.6%) surveys were fully completed. Most respondents were male (88.4%), with a mean age of 52.6 (SD 9.5) years (n = 127) and an average of 18.4 (9.5) years in practice. Most were from North America (54.0%). A total of 78.8% of surgeons routinely order a pre-T&S; however, the average estimated bleeding incidence was 4.0%, with an intraoperative transfusion rate of 2.0%. Despite routine pre-T&S ordering, 57.5% of surgeons were willing to use a decision aid tool, if available. Surgeons reported that institutional policy affected their practice.
Conclusions
Largely because of institutional policy, most surgeons worldwide still order a routine pre-T&S despite acknowledging a low bleeding risk and the rarity of intraoperative transfusions. Most surgeons are open to changing this practice.
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