Management of Complications After Esophagectomy
Esophagectomy is a complex operation with many potential complications. Early recognition of postoperative complications allows for the best chance for patient survival. Diagnosis and management of conduit complications, including leak, necrosis, and conduit-airway fistulae, are reviewed. Other common complications, such as chylothorax and recurrent laryngeal nerve injury, also are discussed. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - May 22, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Jonathan C. Yeung Source Type: research

Preoperative Evaluation for Thoracic Surgery
Preoperative evaluation before thoracic surgery aims to separate those patients who will tolerate surgery and those who are not surgical candidates. Predicted postoperative pulmonary function testing helps make this distinction. The preoperative period represents a time for patient engagement and physical optimization to improve postoperative outcomes. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - May 22, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Theofilos Matheos, Lakshmi Ram, Robert Canelli Source Type: research

Prehabilitation of the Thoracic Surgery Patient
Outcomes after thoracic surgery are better predicted by preoperative evaluation of patients ’ physiologic reserve (also known as personal biologic age rather than chronologic age), using validated assessment tools in multidisciplinary collaboration with geriatricians. Targetable risk factors should be identified, and methods should be utilized to minimize these risks. Prehabilitation has been validated as a tool to increase functional and nutritional status of patients undergoing surgery in other specialties and improve outcomes. Although research is still limited in thoracic surgery, early results are promising. (So...
Source: Thoracic Surgery Clinics - May 22, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Aaron R. Dezube, Lisa Cooper, Michael T. Jaklitsch Source Type: research

Intraoperative Anesthetic and Surgical Concerns for Robotic Thoracic Surgery
Robotic thoracic surgery continues to gain momentum and is emerging as the optimal method for minimally invasive thoracic surgery. As a rapidly advancing field, continued review of the surgical and anesthetic concerns unique to robotic thoracic operations is necessary to maintain safe and efficient practice. In this review, we discuss the intraoperative concerns as they pertain to pulmonary, esophageal, and mediastinal thoracic robotic operations. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - May 22, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Travis C. Geraci, Prabhu Sasankan, Brent Luria, Robert J. Cerfolio Source Type: research

Prevention of Postoperative Prolonged Air Leak After Pulmonary Resection
This article discusses the prophylactic measures that have been studied for the prevention of PALs following lung surgery. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - May 22, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Praveen Sridhar, Virginia R. Litle, Morihito Okada, Kei Suzuki Source Type: research

Surgical Adjuncts During Esophagectomy
Esophagectomy is a major operation whereby intraoperative technique and postoperative care must be optimal. Even in expert hands, the complication rate is as high as 59%. Here the authors discuss the role of surgical adjuncts, including enteral access, nasogastric decompression, pyloric drainage procedures, and anastomotic buttressing as adjuncts to esophagectomy and whether they reduce perioperative complications. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - May 22, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Ammara A. Watkins, Michael S. Kent, Jennifer L. Wilson Source Type: research

Perioperative Management of the Thoracic Patient Continues to Evolve
We are excited to bring you this focused issue for the Thoracic Surgery Clinics on “Perioperative Management of the Thoracic Patient.” In contrast to other surgical specialties, general thoracic surgery in particular requires deliberate coordination between all members of the operative team. To optimize patient safety and operative efficiency, anesthesiologists and surgeons mu st communicate not only intraoperatively but also preoperatively as well. General thoracic surgeons and anesthesiologists need to know how to take an evidence-based approach to manage perioperative problems. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - May 22, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Robert J. Canelli, Virginia R. Litle Tags: Preface Source Type: research

Pain Management in Thoracic Surgery
Thoracic surgery is considered one of the most painful surgical procedures performed. Pain is mediated via several mechanisms and is affected by the surgical approach as well as patient factors. Pain after thoracic surgery can be debilitating and lead to poor outcomes, such as respiratory complications, longer hospital stays, poor quality of life, and chronic post-thoracotomy pain syndrome. A multimodal approach to postoperative pain that combines systemic and regional anesthesia has been shown to be the most effective in optimizing analgesia in these patients. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - April 29, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Kyle Marshall, Keleigh McLaughlin Source Type: research

Intraoperative Anesthetic Management of the Thoracic Patient
The intraoperative anesthetic management for thoracic surgery can impact a patient ’s postoperative course, especially in patients with significant lung disease. One lung ventilation poses inherent risk to patients including hypoxemia, acute lung injury, and right ventricular dysfunction. Patient-specific ventilator management strategies during one lung ventilation can reduce po stoperative morbidity. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - April 27, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Melina Shoni, Gerardo Rodriguez Source Type: research

Adjuvant and Neoadjuvant Immunotherapy in Non –small Cell Lung Cancer
The advent of immune checkpoint blockade has revolutionized the management of advanced non –small cell lung cancer (NSCLC). Impressive results in the metastatic setting have prompted substantial interest in the application of these agents in earlier-stage disease. Applications of checkpoint blockade in the adjuvant setting are under investigation in several clinical trials. Early trials have demonstrated the safety and feasibility of the administration of checkpoint inhibitors in the neoadjuvant setting. Resection specimens demonstrate encouraging rates of pathologic response. There are several ongoing phase 3 studie...
Source: Thoracic Surgery Clinics - April 21, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Stephen R. Broderick Source Type: research

Liquid Biopsies Using Circulating Tumor DNA in Non-Small Cell Lung Cancer
Liquid biopsies for the diagnosis and treatment of lung cancer have developed rapidly, driven primarily by technical advances in sensitivity to detect circulating tumor DNA (ctDNA). Still, technical limitations such as the challenge of detecting low-level ctDNA variants and distinguishing tumor-related variants from clonal hematopoiesis remain. With further technical advancements, new applications for ctDNA analysis are emerging including detection of post-treatment molecular residual disease (MRD), clinical trial selection, and early cancer detection. This chapter reviews the current state of ctDNA testing in NSCLC, the u...
Source: Thoracic Surgery Clinics - April 21, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Bruna Pellini, Jeffrey Szymanski, Re-I. Chin, Paul A. Jones, Aadel A. Chaudhuri Source Type: research

ROS1-rearranged Non –small Cell Lung Cancer
ROS1-rearranged non –small cell lung cancer (NSCLC) makes up approximately 1% to 2% of all NSCLC, is oncogenically driven by a constitutively activated ROS1 kinase paired with certain fusion partners, and can be detected by several different assays. These patients are initially treated with tyrosine kinase inhibitors (TKIs), which target the activated ROS1 kinase. Eventually these tumors develop resistance to initial TKI treatment through secondary kinase mutations that block TKI binding or activation of bypass signaling pathways, which subvert ROS1 as the driver of the malignancy. Investigation of several TKIs that ...
Source: Thoracic Surgery Clinics - April 21, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Nicholas P. Giustini, Lyudmila Bazhenova Source Type: research

Epidermal Growth Factor Receptor Mutations
Up to 20% of lung adenocarcinomas in the United States and Europe and 50% in Asia have activating mutations of the tyrosine kinase domain of the epidermal growth factor receptor (EGFR). The identification and subsequent targeting of mutations with EGFR –tyrosine kinase inhibitors (TKIs) led to significant advances in treatment of EGFR-mutant lung cancer. Newer-generation EGFR-TKIs resulted in improvement in outcomes, with less toxic side effects and better tolerability. Resistance to EGFR-TKIs remains a significant barrier, and better understand ing of resistance mechanisms is needed. Efforts are ongoing to incorpora...
Source: Thoracic Surgery Clinics - April 21, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Erin M. McLoughlin, Ryan D. Gentzler Source Type: research

Principles of Immunotherapy in Non-Small Cell Lung Cancer
Immunotherapy has transformed the treatment of many tumors. Robust data demonstrating improved overall survival and progression-free survival in patients treated with monoclonal antibodies have established immune checkpoint inhibitors as standard of care in stages III and IV non-small cell lung cancer. Nivolumab is effective in previously treated patients with metastatic non-small cell lung cancer. Pembrolizumab and atezolizumab are approved as monotherapy and in combination with other therapies. Ongoing trials investigate the potential role of immunotherapy in earlier disease settings. Identifying predictive biomarkers of...
Source: Thoracic Surgery Clinics - April 21, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Melinda L. Hsu, Jarushka Naidoo Source Type: research

Biomarkers for Immunotherapy
This article reviews the data supporting the use of these biomarkers to optimize patient selection for these therapies and explores biomarkers that are the focus of ongoing research. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - April 21, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Jean G. Bustamante-Alvarez, Dwight H. Owen Source Type: research

Current Landscape of Personalized Therapy
Almost a half of patients diagnosed with nonesmall-cell lung cancer (NSCLC) present with incurable disease, and a significant number of patients who are treated with curative intent for early-stage disease will eventually recur. Systemic therapy is selected based on tumor histology, squamous versus nonsquamous NSCLC, molecular testing, and PD-L1 score. Depending on PD-L1 score, patients are eligible for immunotherapy alone or in combination with chemotherapy in the first-line setting. Oncogenic driver mutations can be detected in approximately 50% of patients with nonsquamous NSCLC of which several can be targeted therapeu...
Source: Thoracic Surgery Clinics - April 21, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Leora Horn, Amanda S. Cass Source Type: research

The Rapidly Changing World of Thoracic Oncology
The landscape of care in advanced stage non –small cell lung cancer (NSCLC) is changing at lightning speed. Rarely in oncology have we seen the kind of rapid advancements and broad sweeping changes that are occurring currently in lung cancer. No patient with stage IV NSCLC in 2020 is approached the same way that they would have been 5 years ago. There are entirely new classes of medications, multiple new molecular targets, greater understanding of resistances mechanisms, novel biomarkers, and better tools to track disease response and progression. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - April 21, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Jessica S. Donington, Jyoti D. Patel Tags: Preface Source Type: research

Erratum
In the article “Results of the National Lung Cancer Screening Trial: Where Are We Now” by Neel P. Chudgar, Peter R. Bucciarelli, Elizabeth M. Jeffries, Nabil P. Rizk, Bernard J. Park, Prasad S. Adusumilli, and David R. Jones, published in the May 2015 issue (Volume 25, Number 2, pages 145–153), under the “ Results” section on page 147, the following sentence is incorrect: “False-positive rates were 96.4% in the LDCT group and 95.4% in the CXR group.” (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - April 21, 2020 Category: Cardiovascular & Thoracic Surgery Source Type: research

Advances in Systemic Therapy for Non-Small Cell Lung Cancer
THORACIC SURGERY CLINICS (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - April 21, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Jessica S. Donington, Jyoti D. Patel Source Type: research

Copyright
ELSEVIER (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - April 21, 2020 Category: Cardiovascular & Thoracic Surgery Source Type: research

Contributors
M. BLAIR MARSHALL, MD, FACS (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - April 21, 2020 Category: Cardiovascular & Thoracic Surgery Source Type: research

Contents
Jessica S. Donington and Jyoti D. Patel (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - April 21, 2020 Category: Cardiovascular & Thoracic Surgery Source Type: research

Forthcoming Issues
Peri-operative Management of the Thoracic Patient (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - April 21, 2020 Category: Cardiovascular & Thoracic Surgery Source Type: research

Enhanced recovery after thoracic surgery
This article presents common components of a thoracic surgery ERP and reviews contemporary outcomes. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - April 17, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Nathan Haywood, Ian Nickel, Aimee Zhang, Matthew Byler, Erik Scott, Walker Julliard, Randal S. Blank, Linda W. Martin Source Type: research

Management of Complications after Lung Resection: Prolonged Air Leak and Bronchopleural Fistula
Prolonged air leak or alveolar-pleural fistula is common after lung resection and can usually be managed with continued pleural drainage until resolution. Further management options include blood patch administration, chemical pleurodesis, and one-way endobronchial valve placement. Bronchopleural fistula is rare but is associated with high mortality, often due to development of concomitant empyema. Bronchopleural fistula should be confirmed with bronchoscopy, which may allow for bronchoscopic intervention; however, transthoracic stump revision or window thoracostomy may be required. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - April 17, 2020 Category: Cardiovascular & Thoracic Surgery Authors: James M. Clark, David T. Cooke, Lisa M. Brown Source Type: research

Anaplastic Lymphoma Kinase Mutation –Positive Non–Small Cell Lung Cancer
The treatment of patients with advanced non –small cell lung cancer with anaplastic lymphoma kinase chromosomal rearrangements has been revolutionized by the development of tyrosine kinase inhibitors (TKIs). Excellent progress has been made over the past decade, with 4 TKIs now approved in the front-line setting. Alectinib is the preferred first-line option based on its efficacy and side-effect profile. The central nervous system (CNS) activity of alectinib and brigatinib has allowed for treatment of CNS metastases with TKI therapy. Once resistance inevitably develops, newer therapies such as lorlatinib can be consid...
Source: Thoracic Surgery Clinics - March 2, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Anthony V. Serritella, Christine M. Bestvina Source Type: research

Combining Immunotherapy with Radiation Therapy in Non –Small Cell Lung Cancer
Immune checkpoint inhibitors have recently been demonstrated to improve survival in metastatic and locally advanced non-small cell lung cancer (NSCLC). Radiation therapy has a well-established role in the treatment of NSCLC and has more recently been shown to be immunostimulatory, with the potential to enhance the efficacy of immunotherapy. This comprehensive review details the current roles of radiation therapy and immune checkpoint inhibitors in NSCLC, discusses the intersection of these two modalities and their potential to have combined synergistic responses, and highlights existing preclinical and clinical data and on...
Source: Thoracic Surgery Clinics - March 2, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Kelly Fitzgerald, Charles B. Simone Source Type: research

Adjuvant Chemotherapy
Five-year survival rates for patients with early-stage non –small cell lung cancer have room for improvement. Adjuvant chemotherapy results in a small but significant increase in overall survival at 5 years. Efforts to improve outcomes by intensifying adjuvant treatment, utilizing cancer-specific vaccines or tyrosine kinase inhibitors in unselected patie nts, have been unsuccessful. In addition to research with immune checkpoint inhibitors that are addressed in a separate article, ongoing studies to personalize adjuvant therapy either by selecting only patients with evidence of minimal residual disease or target...
Source: Thoracic Surgery Clinics - March 2, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Jessica A. Hellyer, Heather A. Wakelee Source Type: research

Molecular Targets Beyond the Big 3
This article covers genetic targets beyond EGFR, ALK and ROS1, their novel agents, challenges, and future directions. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - March 2, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Terrence C. Tsou, Haley C. Allen, Karen L. Reckamp Source Type: research

Combining Immunotherapy and Chemotherapy for Non –Small Cell Lung Cancer
Over the past year, the combination of platinum-based chemotherapy and immunotherapy has become the standard of care for patients with metastatic non –small-cell lung cancer with any programmed death ligand 1 tumor proportion score. There is preclinical evidence demonstrating potential synergistic immunomodulation with combination therapy by enhancing immune-mediated tumor death and by disrupting the immunosuppressive tumor microenvironment tha t prevents immune detection. This potential synergy or complementary activity has been demonstrated in clinical trials showing improved and durable responses with chemo-immuno...
Source: Thoracic Surgery Clinics - March 2, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Julia Judd, Hossein Borghaei Source Type: research

Nonintubated Video-Assisted Thoracic Surgery for the Management of Primary and Secondary Spontaneous Pneumothorax
This study provides information pertaining to the physiologic, surgical, and anesthetic aspects and describes the potential benefits of nonintubated thoracoscopic surgery for the management of primary and secondary spontaneous pneumothorax. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - November 22, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Pei-Hsing Chen, Wan-Ting Hung, Jin-Shing Chen Source Type: research

Treatment of Pleural Effusions with Nonintubated Video-Assisted Thoracoscopic Surgery
This article provides the general thoracic surgeon a detailed description on how to manage pleural effusions using video-assisted thoracoscopic surgery in a nonintubated patient. Surgical techniques and pearls are also presented. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - November 22, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Thamer Robert Qaqish, Solange Cox, Rebecca Carr, Mark Katlic Source Type: research

Nonintubated Uniportal Video-Assisted Thoracic Surgery for Chest Infections
Chest infection is a health care problem in many regions of the world, and pleural empyema is the most common type of surgical chest infection. In the past decennium, the introduction of nonintubated surgery and uniportal video-assisted thoracic surgery changed considerably surgical treatment of pleural empyema. Although the advantages seem evident, the need for randomized controlled trials is necessary to confirm the usefulness. Moreover, in the future, an education and training program for thoracic surgeons and anesthesiologists would allow increasing the number of awake surgical options in caring for patients with stage...
Source: Thoracic Surgery Clinics - November 22, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Marcello Migliore Source Type: research

Nonintubated Video-Assisted Thoracoscopic Surgery Lung Biopsy for Interstitial Lung Disease
Interstitial lung diseases are a heterogeneous group with diffuse parenchymal lung disease. Because most patients with interstitial lung diseases have impaired pulmonary function, the risks of thoracic surgery are an important issue when considering surgical lung biopsy. The nonintubated video-assisted thoracoscopic surgery lung biopsy for interstitial lung disease is a safe and feasible option in carefully selected patients with interstitial lung disease. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - November 22, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Tae Ho Kim, Jong Ho Cho Source Type: research

Nonintubated Video-Assisted Wedge Resections in Peripheral Lung Cancer
Wedge resection in peripheral lung cancer is considered a suboptimal procedure. However, in elderly and/or frail patients it is a reliable and safer alternative. This procedure can be easily performed under nonintubated anesthesia, allowing the recruitment of patients considered otherwise marginal for a surgical treatment. Nonintubated anesthesia can reduce lung trauma, operative time, postoperative morbidity, hospital stay, and global expenses. Furthermore, nonintubated anesthesia produces less immunologic impairment and this may affect postoperative oncological long-term results. Wedge lung resection through nonintubated...
Source: Thoracic Surgery Clinics - November 22, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Vincenzo Ambrogi, Riccardo Taj è, Tommaso Claudio Mineo Source Type: research

Nonintubated Anesthesia for Tracheal/Carinal Resection and Reconstruction
Nonintubated anesthesia is feasible and might be associated with shorter surgery time and shorter hospitalization for tracheal/carinal resection and reconstruction. Only case reports and a few small retrospective series study were conducted to evaluate nonintubated anesthesia for tracheal/carinal resection and reconstruction; no randomized control trials exist. Further exploration should focus on selection of optimal candidates and prospective validation. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - November 22, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Hengrui Liang, Diego Gonzalez-Rivas, Yanran Zhou, Jun Liu, Xi Wu, Jianxing He, Shuben Li Source Type: research

Nonintubated Tracheal Surgery
The article describes an anesthetic management strategy for resection of the cervical trachea due to benign stenosis without using an endotracheal tube. The strategy includes: (1) insertion of an airway stent in the stenotic area, (2) insertion of a supraglottic airway device (SGAD), and (3) advancing a jet ventilation catheter through the SGAD. The stent is removed during surgery together with the resected part of the trachea. The technique of nonintubated tracheal resection allows the surgeon to work most comfortably and helps the anesthesiologist properly maintain the patient ’s vital functions in the operating ro...
Source: Thoracic Surgery Clinics - November 22, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Andrey Akopov, Mikhail Kovalev Source Type: research

Management of Intraoperative Crisis During Nonintubated Thoracic Surgery
Nonintubated video-assisted thoracoscopic surgery programs have gradually spread all over the world. The benefits are based on less invasiveness and earlier recovery. However, complications may appear. For the correct prevention and management of all these potentially critical situations, the principles of crisis resource management (CRM) must be followed. They should also include clinical simulation as a tool to generate different scenarios to improve teamwork. The purpose of this special issue is to appraise and summarize the design, implementation, and efficacy of simulation-based CRM training programs for a specific su...
Source: Thoracic Surgery Clinics - November 22, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Jose Navarro-Mart ínez, Maria Galiana-Ivars, María Jesús Rivera-Cogollos, Carlos Gálvez, Sergio Bolufer Nadal, Marta Ortega Lamaignère, Elena Díez Mazo Source Type: research

Team Training for Nonintubated Thoracic Surgery
Nonintubated thoracic surgery arose as supplemental evolution of minimally invasive surgery and is gaining popularity. A proper nonintubated thoracic surgery unit is mandatory and should involve surgeons, anesthesiologists, intensive care physicians, physiotherapists, psychologists, and scrub and ward nurses. Surgical training should involve experienced and young surgeons. It deserves a step-by-step approach and consolidated experience on video-assisted thoracic surgery. Due to difficulty in reproducing lung and diaphragm movements, training with simulation systems may be of scant value; instead, preceptorships and invited...
Source: Thoracic Surgery Clinics - November 22, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Federico Tacconi, Tommaso Claudio Mineo, Vincenzo Ambrogi Source Type: research

Technical Issues and Patient Safety in Nonintubated Thoracic Anesthesia
Nonintubated thoracic surgery (NITS) has a good safety record in experienced hands, but has pitfalls for beginners. The main aim of NITS is to keep the patient under spontaneous respiration, avoiding adverse effects, such as hypoxemia, hypercapnia, panic attacks, and finally conversion to general anesthesia. In this paper, the safety aspects of anesthesia for NITS is discussed based on data from the literature and personnel clinical experiences. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - November 22, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Gabor Kiss Source Type: research

Video-Assisted Thoracoscopic Surgery Lobectomy for Lung Cancer in Nonintubated Anesthesia
Nonintubated video-assisted thoracoscopic surgery (VATS) lobectomy to treat lung cancer has gained attention in recent decades, but there is very little literature on this topic. This review aims to explore the state-of-the-art, recent progress, and future prospects of this method. Its feasibility and safety have been demonstrated, and its potential benefits are faster postoperative recovery and fewer intubation-related complications. Nonintubated VATS lobectomy is a feasible and safe alternative for lung cancer treatment. This work provides information for those who would like to start using this technique and want a more...
Source: Thoracic Surgery Clinics - November 22, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Wan-Ting Hung, Ya-Jung Cheng, Jin-Shing Chen Source Type: research

Anatomic Segmentectomy in Nonintubated Video-Assisted Thoracoscopic Surgery
Thoracic surgery has evolved into minimally invasive surgery, in terms of not only surgical approach but also less aggressive anesthesia protocols and lung-sparing resections. Nonintubated anatomic segmentectomies are challenging procedures but can be safely performed if some essentials are considered. Strict selection criteria, previous experience in minor procedures, multidisciplinary cooperation, and the 4 cornerstones (deep sedation, regional analgesia, oxygenation support and vagal blockade) should be followed. Better outcomes in postoperative recovery, including resumption of oral intake, chest tube duration, and hos...
Source: Thoracic Surgery Clinics - November 22, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Carlos G álvez, Sergio Bolufer, Elisa Gálvez, Jose Navarro-Martínez, Maria Galiana-Ivars, Julio Sesma, María Jesús Rivera-Cogollos Source Type: research

Preface
In my life, all my efforts were, are and will be inspired by the passion for surgery and the devotion to university institutions. —Tommaso Claudio Mineo (1945-2018) (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - November 22, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Vincenzo Ambrogi Source Type: research

Nonintubated Thoracic Surgery
THORACIC SURGERY CLINICS (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - November 22, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Vincenzo Ambrogi, Tommaso Claudio Mineo Source Type: research

Copyright
ELSEVIER (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - November 22, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

Contributors
M. BLAIR MARSHALL, MD, FACS (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - November 22, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

Contents
Vincenzo Ambrogi (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - November 22, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

Forthcoming Issues
Advances in Systemic Therapy for Non-Small Cell Lung Cancer (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - November 22, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

Transthoracic Paraesophageal Hernia Repair
The transthoracic approach to PEH repair has been displaced by the laparoscopic methods of repair for valuable reasons. Despite the pressures of performing minimally invasive surgery, the experienced esophageal surgeon will appreciate the benefits of the transthoracic repair in select circumstances as outlined in this article. In this writing, we discussed our indications, the salient anatomy and important steps in performing a successful transthoracic PEH repair. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - September 27, 2019 Category: Cardiovascular & Thoracic Surgery Authors: James Matthew Reinersman, Subrato J. Deb Source Type: research

Technical Options and Approaches to Lengthen the Shortened Esophagus
Failure to recognize a short esophagus during paraesophageal hernia repair can lead to poor functional outcomes and increased recurrence rates. Diagnosis is usually done intraoperatively when less than 2 to 3  cm of esophagus lie in the intraabdominal position. If aggressive esophageal mediastinal mobilization is unable to lengthen the esophagus, the surgeon should perform an esophageal lengthening procedure. A modified Collis gastroplasty is most commonly used and can be performed through a variety of transabdominal or transthoracic approaches. These procedures are safe, durable, and associated with good long-term ou...
Source: Thoracic Surgery Clinics - September 27, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Matthew G. Hartwig, Sara Najmeh Source Type: research