When Is It Safe to Operate for Lung Cancer? Selection of Fiscally Responsible Cardiopulmonary Function Tests for Limited Resection (Wedge Resection and Segmentectomy), Standard Lobectomy, Sleeve Lobectomy, and Pneumonectomy
Pulmonary function testing remains the central determinant of candidacy for pulmonary resection and indicator of perioperative risk. For patients with borderline pulmonary function, exercise testing can help determine surgical candidacy either via stair climbing or by obtaining a maximum oxygen consumption. The Thoracic Revised Cardiac Risk Index should be used to select patients for further cardiac testing. Patient comorbidities, medications, functional limitations, and smoking status are also requisite assessments of the preoperative evaluation that influence perioperative outcomes. A minimally invasive approach to pulmo...
Source: Thoracic Surgery Clinics - June 8, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Travis C. Geraci, Thomas Ng Source Type: research
Constants and Currents in the Education and Training of General Thoracic Surgeons
Teaching multiple, evolving surgical approaches to thoracic surgical residents at a time of decreasing surgeon volume, increasing scrutiny of quality, greater demands on surgical efficiency, and reduced resident work hours requires a new mindset and new methods of education. The challenge presented to general thoracic surgeon educators and residents is explained, and encouragement is drawn from the examples of previous educational crises and their solutions. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - June 8, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Henning A. Gaissert Source Type: research
Implications of Adverse Biological Factors and Management of Solitary Fibrous Tumors of the Pleura
Solitary fibrous tumors arise in many locations throughout the body and are genetically and histologically considered a single disease. Solitary fibrous tumors of the pleura (SFTP) are the most common tumor of this disease. Most of the SFTPs are treated with surgery alone, and chemotherapy and radiotherapy do not seem to play a role in treatment. Tumor size and unfavorable histology are risk factors for malignant potential. Incomplete resection is an important risk factor for recurrence. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - June 8, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Weston G. Andrews, Eric Valli ères Source Type: research
Life Expectancy and Rate of Decline After Lung Volume Reduction Surgery
Lung volume reduction surgery (LVRS) patient selection guidelines are based on the National Emphysema Treatment Trial. Because of increased mortality and poor improvement in functional outcomes, patients with non –upper lobe emphysema and low baseline exercise capacity are determined as poor candidates for LVRS. In well-selected patients with heterogeneous emphysema, LVRS has a durable long-term outcome at up to 5-years of follow-up. Five-year survival rates in patients range between 63% and 78%. LVRS seem s a durable alternative for end-stage heterogeneous emphysema in patients not eligible for lung transplantation. Fut...
Source: Thoracic Surgery Clinics - April 27, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Sowmyanarayanan Thuppal, Nicholas Lanzotti, Bradley Vost, Traves Crabtree, Stephen Markwell, Benjamin Seadler, Nisha Rizvi, Justin Sawyer, Kyle McCullough, Stephen R. Hazelrigg Source Type: research
Bronchoscopic Valve Treatment of End-Stage Chronic Obstructive Pulmonary Disease
Endobronchial valve therapy has evolved over the past decade, with demonstration of significant improvements in pulmonary function, 6-minute walk distance, and quality of life in patients with end-stage chronic obstructive lung disease. Appropriate patient selection is crucial, with identification of the most diseased lobe and of a target lobe with minimal to no collateral ventilation. Endobronchial valve therapy typically is utilized in patients with heterogeneous disease but may be indicated in select patients with homogeneous disease. Morbidity and mortality have been lower than historically reported with lung volume re...
Source: Thoracic Surgery Clinics - April 27, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Traves D. Crabtree Source Type: research
Analysis of Recent Literature on Lung Volume Reduction Surgery
This article reviews recent literature generated since the original NETT publication, focusing on physiologic implications of LVRS, recent data regarding the safety and durability of LVRS, and patient selection and extension of NETT criteria to other patient populations. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - April 27, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Daniel P. McCarthy, Lauren J. Taylor, Malcolm M. DeCamp Source Type: research
Critical Analysis of the National Emphysema Treatment Trial Results for Lung-Volume-Reduction Surgery
The National Emphysema Treatment Trial compared medical treatment of severe pulmonary emphysema with lung-volume-reduction surgery in a multiinstitutional randomized prospective fashion. Two decades later, this trial remains one of the key sources of information we have on the treatment of advanced emphysematous lung disease. The trial demonstrated the short- and long-term effectiveness of surgical intervention as well as the need for strict patient selection and preoperative workup. Despite these findings, the key failure of the trial was an inability to convince the medical community of the value of surgical resection in...
Source: Thoracic Surgery Clinics - April 27, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Joseph J. Platz, Keith S. Naunheim Source Type: research
Technical Aspects of Lung Volume Reduction Surgery Including Anesthetic Management and Surgical Approaches
As palliative treatment, lung volume reduction surgery can be offered to a selected subset of chronic obstructive pulmonary disease patients. Careful adherence to established inclusion and exclusion criteria is critical to achieve good outcomes. The evolution of surgical techniques toward minimally invasive approaches has improved outcomes. The fully extrathoracic access combining a subxiphoid incision with subcostal port placement allowed a further decrease in perioperative pain, which favors spontaneous respiratory drive and early postoperative mobilization. Less aggressive resections and better match for size of the hem...
Source: Thoracic Surgery Clinics - April 27, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Philippe H. Lemaitre, Bryan Payne Stanifer, Joshua R. Sonett, Mark E. Ginsburg Source Type: research
Alpha1-antitrypsin Disease, Treatment and Role for Lung Volume Reduction Surgery
This article analyzes multiple published series where lung volume reduction surgery has been used in individuals with alpha1-antitrypsin deficiency and their overall outcomes. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - April 27, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Nathalie Foray, Taylor Stone, Peter White Source Type: research
Future Treatment of Emphysema with Roles for Valves, Novel Strategies and Lung Volume Reduction Surgery
This article discusses more recent developments in bronchoscopic and novel interventions and speculates on how these novel strategies may impact the future of lung reduction interventions. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - April 27, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Simran Randhawa, Bryan Meyers Source Type: research
Value of a Multidisciplinary Team Approach to Treatment of Emphysema
Lung volume reduction surgery can significantly improve quality of life for properly selected patients who are symptomatic despite maximal medical management for emphysema. This requires a well-constructed multidisciplinary team (including transplant) to evaluate and treat these patients (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - April 27, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Sean C. Wightman, Robert J. McKenna Source Type: research
Postoperative Air Leaks After Lung Surgery
Postoperative air leak is one of the most common complications after pulmonary resection and contributes to postoperative pain, complications, and increased hospital length of stay. Several risk factors, including both patient and surgical characteristics, increase the frequency of air leaks. Appropriate intraoperative tissue handling is the most important surgical technique to reduce air leaks. Digital drainage systems have improved the management of postoperative air leak via objective data, portability, and ease of use in the outpatient setting. Several treatment strategies have been used to address prolonged air leak, ...
Source: Thoracic Surgery Clinics - April 27, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Travis C. Geraci, Stephanie H. Chang, Savan K. Shah, Amie Kent, Robert J. Cerfolio Source Type: research
Economic Considerations of Lung Volume Reduction Surgery and Bronchoscopic Valves
This article reviews the medical literature on cost-effectiveness of lung volume reduction surgery and bronchoscopic valve placement for lung volume reduction. It discusses the anticipated costs and economic impact in the future as technique is perfected and outcomes are improved. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - April 27, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Janani Vigneswaran, Seth Krantz, John Howington Source Type: research
Lung Volume Reduction Surgery in Patients with Homogeneous Emphysema
Randomized controlled trials have demonstrated that lung volume reduction surgery (LVRS) improves exercise capacity, lung function, and quality of life in patients with heterogenous emphysema on computed tomographic and perfusion scan. However, most patients have a nonheterogenous type of destruction. These patients, summarized under “homogeneous emphysema,” may also benefit from LVRS as long they are severely hyperinflated, and adequate function is remaining with a diffusing capacity of the lungs for carbon monoxide greater than 20% and no pulmonary hypertension. Surgical mortality is low when patients are well select...
Source: Thoracic Surgery Clinics - April 27, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Walter Weder, Laurens J. Ceulemans, Isabelle Opitz, Didier Schneiter, Claudio Caviezel Source Type: research
Systemic Medications in Chronic Obstructive Pulmonary Disease
Inhaled therapy remains the cornerstone of chronic obstructive pulmonary disease pharmacologic care, but some systemic treatments can be of help when the burden of the disease remains high. Azithromycin, phosphodiesterase-4 inhibitors, and mucoactive agents can be used in such situations. The major difficulty remains in the identification of the optimal target populations. Another difficulty is to determine how these treatments should be positioned in the global treatment algorithm. For instance, should they be prescribed in addition to other antiinflammatory agents or should they replace them in some cases? Research is on...
Source: Thoracic Surgery Clinics - April 27, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Nicolas Roche Source Type: research
