JTCVS open最新文献

{"title":"Randomized controlled trials in lung cancer surgery: How are we doing?","authors":"Lye-Yeng Wong MD ,&nbsp;Yanli Li PhD ,&nbsp;Irmina A. Elliott MD ,&nbsp;Leah M. Backhus MD ,&nbsp;Mark F. Berry MD ,&nbsp;Joseph B. Shrager MD ,&nbsp;Daniel S. Oh MD","doi":"10.1016/j.xjon.2024.01.008","DOIUrl":"10.1016/j.xjon.2024.01.008","url":null,"abstract":"<div><h3>Objective</h3><p>Randomized control trials are considered the highest level of evidence, yet the scalability and practicality of implementing randomized control trials in the thoracic surgical oncology space are not well described. The aim of this study is to understand what types of randomized control trials have been conducted in thoracic surgical oncology and ascertain their success rate in completing them as originally planned.</p></div><div><h3>Methods</h3><p>The <span>ClinicalTrials.gov</span><svg><path></path></svg> database was queried in April 2023 to identify registered randomized control trials performed in patients with lung cancer who underwent surgery (by any technique) as part of their treatment.</p></div><div><h3>Results</h3><p>There were 68 eligible randomized control trials; 33 (48.5%) were intended to examine different perioperative patient management strategies (eg, analgesia, ventilation, drainage) or to examine different intraoperative technical aspects (eg, stapling, number of ports, port placement, ligation). The number of randomized control trials was relatively stable over time until a large increase in randomized control trials starting in 2016. Forty-four of the randomized control trials (64.7%) were open-label studies, 43 (63.2%) were conducted in a single facility, 66 (97.1%) had 2 arms, and the mean number of patients enrolled per randomized control trial was 236 (SD, 187). Of 21 completed randomized control trials (31%), the average time to complete accrual was 1605 days (4.4 years) and average time to complete primary/secondary outcomes and adverse events collection was 2125 days (5.82 years).</p></div><div><h3>Conclusions</h3><p>Given the immense investment of resources that randomized control trials require, these findings suggest the need to scrutinize future randomized control trial proposals to assess the likelihood of successful completion. Future study is needed to understand the various contributing factors to randomized control trial success or failure.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624000093/pdfft?md5=31a0bb0c6d8ebbd26fb3317ddee71848&pid=1-s2.0-S2666273624000093-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139537376","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}

{"title":"Impact of maximum phonation time on postoperative dysphagia and prognosis after cardiac surgery","authors":"Masato Ogawa PT, PhD ,&nbsp;Seimi Satomi-Kobayashi MD, PhD ,&nbsp;Mari Hamaguchi MD ,&nbsp;Kodai Komaki PT ,&nbsp;Hifumi Kusu PT ,&nbsp;Kazuhiro P. Izawa PT, PhD ,&nbsp;Shunsuke Miyahara MD, PhD ,&nbsp;Yoshitada Sakai MD, PhD ,&nbsp;Ken-ichi Hirata MD, PhD ,&nbsp;Kenji Okada MD, PhD","doi":"10.1016/j.xjon.2024.02.002","DOIUrl":"10.1016/j.xjon.2024.02.002","url":null,"abstract":"<div><h3>Objective</h3><p>The incidence of postoperative complications, including dysphagia, increases as the population undergoing cardiovascular surgery ages. This study aimed to explore the potential of maximum phonation time (MPT) as a simple tool for predicting postextubation dysphagia (PED) and major adverse cardiac and cerebrovascular events (MACCEs).</p></div><div><h3>Methods</h3><p>This retrospective study included 442 patients who underwent elective cardiac surgery at a university hospital. MPT was measured before surgery, and patients were stratified into 2 groups based on normal and abnormal MPTs. Postoperative complications, including PED and MACCEs, were also investigated. Swallowing status was assessed using the Food Intake Level Scale.</p></div><div><h3>Results</h3><p>MPT predicted PED with prevalence of 11.0% and 18.0% in the normal and abnormal MPT groups, respectively (<em>P</em> = .01). During the follow-up period, MACCEs developed in 17.0% of patients. Frailty, European System for Cardiac Operative Risk Evaluation II score, PED, and MPT were markedly associated with MACCEs (adjusted hazard ratios: 2.25, 1.08, 1.96, and 0.96, respectively). Mediation analysis revealed that MPT positively influenced PED and MACCEs, whereas PED positively influenced MACCEs. The trend in restricted cubic spline analysis indicated that the hazard ratio for MACCEs increased sharply when MPT was &lt;10 seconds.</p></div><div><h3>Conclusions</h3><p>These findings underscore the potential of MPT as a valuable tool in the preoperative assessment and management of patients undergoing cardiac surgery. By incorporating MPT into routine preoperative evaluations, clinicians can identify patients at a higher risk of PED and MACCEs, allowing for targeted interventions and closer postoperative monitoring. This may improve patient outcomes and reduce the health care costs associated with these complications.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624000378/pdfft?md5=550203ce332b1a31041f922e1f490cc0&pid=1-s2.0-S2666273624000378-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139881582","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}

{"title":"Patient-specific tissue engineered vascular graft for aortic arch reconstruction","authors":"Hidenori Hayashi MD ,&nbsp;Jacqueline Contento BSE ,&nbsp;Hiroshi Matsushita MD ,&nbsp;Paige Mass MS ,&nbsp;Vincent Cleveland MS ,&nbsp;Seda Aslan MS ,&nbsp;Amartya Dave BS ,&nbsp;Raquel dos Santos ,&nbsp;Angie Zhu ,&nbsp;Emmett Reid ,&nbsp;Tatsuya Watanabe MD, PhD ,&nbsp;Nora Lee MPAP, PA-C ,&nbsp;Tyler Dunn BS ,&nbsp;Umar Siddiqi ,&nbsp;Katherine Nurminsky BS ,&nbsp;Vivian Nguyen BA ,&nbsp;Keigo Kawaji PhD ,&nbsp;Joey Huddle MS ,&nbsp;Luka Pocivavsek MD, PhD ,&nbsp;Jed Johnson PhD ,&nbsp;Narutoshi Hibino MD, PhD","doi":"10.1016/j.xjon.2024.02.012","DOIUrl":"10.1016/j.xjon.2024.02.012","url":null,"abstract":"<div><h3>Objective(s)</h3><p>The complexity of aortic arch reconstruction due to diverse 3-dimensional geometrical abnormalities is a major challenge. This study introduces 3-dimensional printed tissue-engineered vascular grafts, which can fit patient-specific dimensions, optimize hemodynamics, exhibit antithrombotic and anti-infective properties, and accommodate growth.</p></div><div><h3>Methods</h3><p>We procured cardiac magnetic resonance imaging with 4-dimensional flow for native porcine anatomy (n = 10), from which we designed tissue-engineered vascular grafts for the distal aortic arch, 4 weeks before surgery. An optimal shape of the curved vascular graft was designed using computer-aided design informed by computational fluid dynamics analysis. Grafts were manufactured and implanted into the distal aortic arch of porcine models, and postoperative cardiac magnetic resonance imaging data were collected. Pre- and postimplant hemodynamic data and histology were analyzed.</p></div><div><h3>Results</h3><p>Postoperative magnetic resonance imaging of all pigs with 1:1 ratio of polycaprolactone and poly-L-lactide-co-ε-caprolactone demonstrated no specific dilatation or stenosis of the graft, revealing a positive growth trend in the graft area from the day after surgery to 3 months later, with maintaining a similar shape. The peak wall shear stress of the polycaprolactone/poly-L-lactide-co-ε-caprolactone graft portion did not change significantly between the day after surgery and 3 months later. Immunohistochemistry showed endothelization and smooth muscle layer formation without calcification of the polycaprolactone/poly-L-lactide-co-ε-caprolactone graft.</p></div><div><h3>Conclusions</h3><p>Our patient-specific polycaprolactone/poly-L-lactide-co-ε-caprolactone tissue-engineered vascular grafts demonstrated optimal anatomical fit maintaining ideal hemodynamics and neotissue formation in a porcine model. This study provides a proof of concept of patient-specific tissue-engineered vascular grafts for aortic arch reconstruction.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624000470/pdfft?md5=83578d921ec116ef7b7a1810d2355980&pid=1-s2.0-S2666273624000470-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140464429","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}

{"title":"Enhanced Recovery After Surgery Cardiac Society turnkey order set for prevention and management of postoperative atrial fibrillation after cardiac surgery: Proceedings from the American Association for Thoracic Surgery ERAS Conclave 2023","authors":"Subhasis Chatterjee MD ,&nbsp;Busra Cangut MD ,&nbsp;Amanda Rea DNP, CRNP, AGACNP-BC, CCRN, CMC, CSC, E-AEC ,&nbsp;Rawn Salenger MD ,&nbsp;Rakesh C. Arora MD ,&nbsp;Michael C. Grant MD ,&nbsp;Vicki Morton-Bailey DNP, MSN, AGNP-BC ,&nbsp;Sameer Hirji MD, MPH ,&nbsp;Daniel T. Engelman MD","doi":"10.1016/j.xjon.2024.02.008","DOIUrl":"10.1016/j.xjon.2024.02.008","url":null,"abstract":"<div><h3>Background</h3><p>Postoperative atrial fibrillation (POAF) is a prevalent complication following cardiac surgery that is associated with increased adverse events. Several guidelines and expert consensus documents have been published addressing the prevention and management of POAF. We aimed to develop an order set to facilitate widespread implementation and adoption of evidence-based practices for POAF following cardiac surgery.</p></div><div><h3>Methods</h3><p>Subject matter experts were consulted to translate existing guidelines and literature into a sample turnkey order set (TKO) for POAF. Orders derived from consistent class I or IIA or equivalent recommendations across referenced guidelines and consensus manuscripts appear in the TKO in bold type. Selected orders that were inconsistently class I or IIA, class IIB, or supported by published evidence appear in italic type.</p></div><div><h3>Results</h3><p>Preoperatively, the recommendation is to screen patients for paroxysmal or chronic atrial fibrillation and initiate appropriate treatment based on individual risk stratification for the development of POAF. This may include the administration of beta-blockers or amiodarone, tailored to the patient's specific risk profile. Intraoperatively, surgical interventions such as posterior pericardiotomy should be considered in selected patients. Postoperatively, it is crucial to focus on electrolyte normalization, implementation strategies for rate or rhythm control, and anticoagulation management. These comprehensive measures aim to optimize patient outcomes and reduce the occurrence of POAF following cardiac surgery.</p></div><div><h3>Conclusions</h3><p>Despite the well-established benefits of implementing a multidisciplinary care pathway for POAF in cardiac surgery, its adoption and implementation remain inconsistent. We have developed a readily applicable order set that incorporates recommendations from existing guidelines.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624000433/pdfft?md5=2b7e73572aa7010d90b03e490b35ee9d&pid=1-s2.0-S2666273624000433-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140463874","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}

{"title":"The high-risk features among patients undergoing mitral valve operation for ischemic mitral regurgitation: The 3-strike score","authors":"Makoto Mori MD, PhD ,&nbsp;Christina Waldron BS ,&nbsp;Sigurdur Ragnarsson MD ,&nbsp;Markus Krane MD ,&nbsp;Arnar Geirsson MD","doi":"10.1016/j.xjon.2024.02.017","DOIUrl":"10.1016/j.xjon.2024.02.017","url":null,"abstract":"<div><h3>Objective</h3><p>Ischemic mitral regurgitation is prevalent and associated with high surgical risk. With the less-invasive option of transcatheter edge-to-edge repair, the optimal patient selection for mitral valve operation for ischemic mitral regurgitation remains unclear. We sought to identify high-risk features in this group to guide patient selection.</p></div><div><h3>Methods</h3><p>Using the Cardiothoracic Surgery Trial Network's severe ischemic mitral regurgitation trial data, we identified patient and echocardiographic characteristics associated with an increased risk of 2-year mortality using the support vector classifier and Cox proportional hazards model. We identified 6 high-risk features associated with 2-year survival. Patients were categorized into 3 groups, each having 1 or less, 2, or 3 or more of the 6 identified high-risk features.</p></div><div><h3>Results</h3><p>Among the 251 patients, the median age was 69 (Q1 62, Q3 75) years, and 96 (38%) were female. Two-year mortality was 21% (n = 53). We identified 6 high-risk preoperative features: age 75 years or more (n = 69, 28%), prior sternotomy (n = 49, 20%), renal insufficiency (n = 69, 28%), gastrointestinal bleeding (n = 15, 6%), left ventricular ejection fraction less than 40% (n = 131, 52%), and ventricular end-systolic volume index less than 50 mL/m² (n = 93, 37%). In patients who had 1 or less, 2, and 3 or more high-risk features, 90-day mortality was 4.2% (n = 5), 9.9% (n = 4), and 20.0% (n = 10), respectively (<em>P = .</em>006), and 2-year mortality was 10% (n = 12), 22% (n = 18), and 46% (n = 23) (<em>P &lt; .</em>001), respectively.</p></div><div><h3>Conclusions</h3><p>We developed the 3-strike score by identifying high-risk preoperative features for mitral valve surgery for ischemic mitral regurgitation. Patients having 3 or more of such high-risk features should undergo careful evaluation for surgical candidacy given the high early and late mortality after mitral valve operations.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624000524/pdfft?md5=f8fb24ecd9911e001228e2a1b94e72bf&pid=1-s2.0-S2666273624000524-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140084340","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}

{"title":"Donor heart refusal after circulatory death: An analysis of United Network for Organ Sharing refusal codes","authors":"Tyler M. Dann BS ,&nbsp;Brianna L. Spencer MD ,&nbsp;Spencer K. Wilhelm MD ,&nbsp;Sarah K. Drake MA, MLIS ,&nbsp;Robert H. Bartlett MD ,&nbsp;Alvaro Rojas-Pena MD ,&nbsp;Daniel H. Drake MD","doi":"10.1016/j.xjon.2024.02.010","DOIUrl":"10.1016/j.xjon.2024.02.010","url":null,"abstract":"<div><h3>Objective</h3><p>Donor hearts procured after circulatory death (DCD) may significantly increase the number of hearts available for transplantation. The purpose of this study was to analyze current DCD and brain-dead donor (DBD) heart transplantation rates and characterize organ refusal using the most up-to-date United Network for Organ Sharing (UNOS) and Organ Procurement and Transplantation Network data.</p></div><div><h3>Methods</h3><p>We analyzed UNOS and Organ Procurement and Transplantation Network DBD and DCD candidate, transplantation, and demographic data from 2020 through 2022 and 2022 refusal code data to characterize DCD heart use and refusal. Subanalyses were performed to characterize DCD donor demographics and regional transplantation rate variance.</p></div><div><h3>Results</h3><p>DCD hearts were declined 3.37 times more often than DBD hearts. The most frequently used code for DCD refusal was neurologic function, related to concerns of a prolonged dying process and organ preservation. In 2022, 92% (1329/1452) of all DCD refusals were attributed to neurologic function. When compared with DBD, DCD donor hearts were more frequently declined as the result of prolonged warm ischemic time (odds ratio, 5.65; 95% confidence interval, 4.07-7.86) and other concerns over organ preservation (odds ratio, 4.06; 95% confidence interval, 3.33-4.94). Transplantation rate variation was observed between demographic groups and UNOS regions. DCD transplantation rates are currently experiencing second order polynomial growth.</p></div><div><h3>Conclusions</h3><p>DCD donor hearts are declined more frequently than DBD. DCD heart refusals result from concerns over a prolonged dying process and organ preservation. Heart transplantation rates may be substantially improved by ex situ hemodynamic assessment, adoption of normothermic regional perfusion guidelines, and quality initiatives.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624000457/pdfft?md5=bb2b93ebb5efa998e7bc72b3d3a075f1&pid=1-s2.0-S2666273624000457-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140466789","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}

{"title":"Determining optimal air leak resolution criteria when using digital pleural drainage device after lung resection","authors":"Mohsen Alayche BSc ,&nbsp;Justen Choueiry BSc ,&nbsp;Adnan Mekdachi BMSc ,&nbsp;Donna E. Maziak MD ,&nbsp;Andrew J.E. Seely MD, PhD ,&nbsp;Sudhir R. Sundaresan MD ,&nbsp;Patrick J. Villeneuve MD, PhD ,&nbsp;Daniel Jones MD, MPH ,&nbsp;William Klement PhD ,&nbsp;Sebastien Gilbert MD","doi":"10.1016/j.xjon.2024.01.016","DOIUrl":"10.1016/j.xjon.2024.01.016","url":null,"abstract":"<div><h3>Objective</h3><p>There is limited clinical evidence to support any specific parenchymal air leak resolution criteria when using digital pleural drainage devices following lung resection. The aim of this study is to determine an optimal air leak resolution criteria, where duration of chest tube drainage is minimized while avoiding complications from premature chest tube removal.</p></div><div><h3>Methods</h3><p>Airflow data averaged at 10-minute intervals was collected prospectively using a digital pleural drainage device (Thopaz; Medela) in 400 patients from 2015 to 2019. All permutations of air leak resolution criteria from &lt;10 to 100 mL/minute for 4 to 12 hours were applied retrospectively to the pleural drainage data to determine air leak duration, and air leak recurrence frequency and volume. Air leak recurrence indicates potential for rather than occurrence of adverse events. Descriptive statistics were used to identify the optimal criteria based on patient safety (low frequency and volume of air leak recurrences), and efficiency (shortest initial air leak duration).</p></div><div><h3>Results</h3><p>The majority of the 400 patients underwent lobectomy (57% [227 out of 400]), wedge resections (29% [115 out of 400]), or segmentectomies (8% [32 out of 400]) for lung cancer (90% [360 out of 400]). An airflow threshold &lt;50 mL/minute resulted in longer air leak duration before meeting the criteria for air leak resolution (<em>P</em> &lt; .0001). Air leak recurrence frequency and volume were greater in patients with a monitoring period &lt;8 consecutive hours (<em>P</em> &lt; .0001).</p></div><div><h3>Conclusions</h3><p>When using a digital pleural drainage device, a postoperative air leak resolution criteria &lt;50 mL/minute for 8 consecutive hours was associated with the best safety and efficiency profile.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624000330/pdfft?md5=ea58eb0f1085961471ff727a2f683353&pid=1-s2.0-S2666273624000330-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139890541","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}

{"title":"En bloc chest wall resection in locally advanced cT3N2 (stage IIIB) lung cancer involving the chest wall: Revisiting guidelines","authors":"Joseph F. Zywiciel BS ,&nbsp;Raymond A. Verm MD ,&nbsp;Wissam Raad MD ,&nbsp;Marshall Baker MD, FACS ,&nbsp;Richard Freeman MD, MBA ,&nbsp;Zaid M. Abdelsattar MD, MS, FACS","doi":"10.1016/j.xjon.2023.12.007","DOIUrl":"10.1016/j.xjon.2023.12.007","url":null,"abstract":"<div><h3>Objectives</h3><p>Current National Comprehensive Cancer Network guidelines recommend definitive chemoradiation rather than surgery for patients with locally advanced clinical stage T3 and N2 (stage IIIB) lung cancer involving the chest wall. The data supporting this recommendation are controversial. We studied whether surgery confers a survival advantage over definitive chemoradiation in the National Cancer Database.</p></div><div><h3>Methods</h3><p>We identified all patients with clinical stage T3 and N2 lung cancer in the National Cancer Database from 2004 to 2017 who underwent a lobectomy with en bloc chest wall resection and compared them with patients with clinical stage T3 and N2 lung cancer who had definitive chemoradiation. We used propensity score matching to minimize confounding by indication while excluding patients with tumors in the upper lobes to exclude Pancoast tumors. We used 1:1 propensity score matching and Kaplan–Meir survival analyses to estimate associations.</p></div><div><h3>Results</h3><p>Of 4467 patients meeting all inclusion/exclusion criteria, 210 (4.49%) had an en bloc chest wall resection. Patients undergoing surgical resection were younger (mean age = 60.3 ± 10.3 years vs 67.5 ± 10.4 years; <em>P</em> &lt; .001) and had more adenocarcinoma (59.0% vs 44.5%; <em>P</em> &lt; .001) but were otherwise similar in terms of sex (37.1% female vs 42.0%; <em>P</em> = .167) and race (Whites 84.3% vs 84.0%; <em>P</em> = .276) compared with the definitive chemoradiation group. After resection, there was an unadjusted 30- and 90-day mortality rate of 3.3% and 9.5%, respectively. A substantial survival benefit with surgical resection persisted after propensity score matching (log-rank <em>P</em> &lt; .001).</p></div><div><h3>Conclusions</h3><p>In this large observational study, we found that in select patients, en bloc chest wall resection for locally advanced clinical stage T3 and N2 lung cancer was associated with improved survival compared with definitive chemoradiation. National Comprehensive Cancer Network guidelines should be revisited.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273623004242/pdfft?md5=3293b1306bd400e9ba025f2cadfbe7ce&pid=1-s2.0-S2666273623004242-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139190811","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}

{"title":"Shouldn’t we first follow the guidelines before implementing alternative mechanical circulatory support modalities?","authors":"Maximillian Vondran MD ,&nbsp;Alexander Kaminski MD ,&nbsp;Simon Schemke MD ,&nbsp;Matthias Heringlake MD","doi":"10.1016/j.xjon.2024.01.001","DOIUrl":"10.1016/j.xjon.2024.01.001","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624000019/pdfft?md5=f239520bbde4eaf2f5dfa015c1448749&pid=1-s2.0-S2666273624000019-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139392321","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}

{"title":"The necessity of preoperative planning and nodule localization in the modern era of thoracic surgery","authors":"Stijn Vanstraelen MD ,&nbsp;Gaetano Rocco MD ,&nbsp;Bernard J. Park MD ,&nbsp;David R. Jones MD","doi":"10.1016/j.xjon.2024.01.004","DOIUrl":"10.1016/j.xjon.2024.01.004","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624000056/pdfft?md5=846793516aab17c41026581dccc63b10&pid=1-s2.0-S2666273624000056-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139457481","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}