Surgical Approach to Esophagectomy Post CheckMate 577
Following the results of the CheckMate 577 trial, the Food and Drug Administration approved adjuvant immune checkpoint inhibitor therapy for patients with locally advanced esophageal cancer without a pathologic complete response following neoadjuvant chemoradiotherapy and esophagectomy. This innovation in systemic therapy has rekindled the debate around the clinical value of an extended lymphadenectomy at the time of esophagectomy. In this article, we provide a review of the oncologic principles and potential risks and benefits of extended lymphadenectomy at the time of esophagectomy with acknowledgments to current and for...
Source: Thoracic Surgery Clinics - February 26, 2023 Category: Cardiovascular & Thoracic Surgery Authors: Nikhil Panda, Lana Schumacher Source Type: research
Stereotactic Body Radiation Therapy Versus Ablation Versus Surgery for Early-Stage Lung Cancer in High-Risk Patients
Current treatment for early-stage lung cancer focuses on surgical intervention as the mainstay of treatment; however, this poses issues in patients that are high-risk or unable to tolerate any operation. In this case, sublobar resection or radiation therapy has been the primary treatment for these subsets of patients. Alternative approaches include stereotactic body radiation therapy (SBRT) and thermal ablation. In this article, we focus on treatment strategies using SBRT, thermal ablation, or surgery as it pertains to high-risk patients with early-stage lung cancer. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - February 26, 2023 Category: Cardiovascular & Thoracic Surgery Authors: Conor M. Maxwell, Calvin Ng, Hiran C. Fernando Source Type: research
Pulmonary Metastasectomy
The lung represents the most common site for metastatic spread of extrathoracic primary malignancies. Pulmonary metastatic disease occurs in a wide breadth of cancers with a multitude of histologies, and, historically, has been managed predominantly with systemic therapy. However, in appropriately selected patients, pulmonary metastasectomy can provide extended disease-free intervals, relief from systemic therapy, and prolonged survival. Thus, pulmonary metastasectomy serves a vital role in the armamentarium against a multitude of primary malignancies. Moreover, as systemic agents improve and more patients live longer with...
Source: Thoracic Surgery Clinics - February 26, 2023 Category: Cardiovascular & Thoracic Surgery Authors: Michael Eisenberg, Nathaniel Deboever, Mara B. Antonoff Source Type: research
Esophageal Perforation
Esophageal perforation is a rare but fatal disease process that requires prompt diagnosis and treatment. Surgery has historically been required for treatment; however, there is currently a shift toward endoscopic management. Although no randomized controlled trials exist to compare patient outcomes, many case series and systematic analyses describe their indications, efficacy, and safety profile. Endoscopic stenting and endoscopic vacuum therapy are the 2 therapies most widely described across a diverse patient population and appear to be safe and effective when treating esophageal perforation, in the proper clinical setti...
Source: Thoracic Surgery Clinics - February 26, 2023 Category: Cardiovascular & Thoracic Surgery Authors: Kelly Fairbairn, Stephanie G. Worrell Source Type: research
Current Management of Stage IIIA (N2) Non-Small-Cell Lung Cancer
There have been numerous recent advances in the treatmetn of stage IIIA non-small cell lung cancer. The most significant involve the addition of targeted therapies adn immune checkpoint inhibitors into perioperative care. These exciting advances are improving survival in this challenging patient population, but some-decade old controveries around the definition of resectability, prognositic importance of tumor response to induction therapy, and the role of pneumonectomy persist. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - February 26, 2023 Category: Cardiovascular & Thoracic Surgery Authors: Darren S. Bryan, Jessica S. Donington Source Type: research
Achalasia
Approaches to achalasia include non-operative and operative techniques with Heller Myotomy and Per-Oral Endoscopic Myotomy (POEM) at the forefront of palliative strategies. Given the diverse subtypes and the time-dependent failure pattern for achalasia, there is no standard approach. We elect for a POEM for type III achalasia, poor functional status, hostile abdomen, and salvage after the previous myotomy. A Heller myotomy is elected over a POEM for type II achalasia, presence of diverticulum, and hiatal hernia. As long-term outcomes become available, an optimal customized strategy will become clearer. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - February 26, 2023 Category: Cardiovascular & Thoracic Surgery Authors: Sadia Tasnim, Siva Raja, Monisha Sudarshan Source Type: research
Current Management of Carcinoid Tumor
Bronchopulmonary carcinoid tumors are rare, well-differentiated neuroendocrine neoplasms. They can be categorized as typical or atypical lesions and are low-to-intermediate-grade, respectively. The cornerstone of therapy for carcinoid tumors is surgical resection and current consensus guidelines recommend anatomic resection for stage I to IIIA disease. The renewed interest in sublobar resections for the treatment of lung malignancies has sparked debate over the degree of resection necessary for these indolent lesions. Segmentectomy provides an oncologic resection while preserving as much lung parenchyma as possible, and is...
Source: Thoracic Surgery Clinics - February 26, 2023 Category: Cardiovascular & Thoracic Surgery Authors: Micaela Langille Collins, Olugbenga Okusanya Source Type: research
Neoadjuvant Strategies for Esophageal Cancer
Neoadjuvant strategies with multimodal therapy including chemotherapy and radiation are the standard of care in locally advanced esophageal cancer. The role of immunotherapy in the perioperative management of esophageal cancer is expanding, and adjuvant nivolumab for patients with residual disease following trimodality therapy has been shown to improve disease-free survival. Applications of checkpoint blockade and positron emission tomography (PET)-directed therapy in the neoadjuvant setting are under investigation in several clinical trials. We review the perioperative management of locally advanced esophageal cancer and ...
Source: Thoracic Surgery Clinics - February 26, 2023 Category: Cardiovascular & Thoracic Surgery Authors: Carly C. Barron, Xin Wang, Elena Elimova Source Type: research
Sublobar Resections
Sublobar resections are commonly performed operations that have seen an increase in applicability. The sublobar approach, comprising segmentectomy and wedge resections, can provide lung preservation and thus is better tolerated in select patients in comparison to lobectomy. These operations are offered for a variety of benign and malignant lesions. Understanding the indications and technical aspects of these approaches is paramount as improvements in lung cancer screening protocols and the imaging modalities has led to an increase in the detection of early-stage cancer. In this article, we discuss the anatomy, indications,...
Source: Thoracic Surgery Clinics - February 26, 2023 Category: Cardiovascular & Thoracic Surgery Authors: Benjamin Wei, Frank Gleason Source Type: research
Starting and Developing a Robotic Thoracic Surgery Program
Robotic-assisted surgery has been widely adopted in the field of thoracic surgery as a safe, minimally invasive approach with distinct technical advantages. With increased utilization, it has become an integral part of training pathways for the next generation of thoracic surgeons. This review article highlights key steps in implementing a robotic thoracic surgery program at an academic center based on institutional experience and the available surgical literature. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - November 11, 2022 Category: Cardiovascular & Thoracic Surgery Authors: Eliza D. Hompe, Paul W. Furlow, Lana Y. Schumacher Source Type: research
Resident Training in Robotic Thoracic Surgery
The use of a robotic surgical platform has become common place in thoracic surgery programs throughout the United States. Formal training paradigms need to be reevaluated to allow for effective and efficient training of thoracic surgery residents and fellows. The utilization of video-based coaching and simulation are effective adjuncts in robotics training. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - November 11, 2022 Category: Cardiovascular & Thoracic Surgery Authors: Brian Mitzman, Brigitte K. Smith, Thomas K. Varghese Source Type: research
A Review of Robotic Thoracic Surgery Adoption and Future Innovations
The embracing of new technology and surgical innovation has been one of the hallmarks of cardiothoracic surgery. The adoption of video-assisted thoracoscopic surgery was the paradigm-changing perspective shift that has enabled an entire culture of minimally invasive cardiothoracic surgery. From this foundation robotically assisted thoracic surgery has developed into mainstream practice. The aim of this review is to recount the technological and academic milestones of the past as well as describe future technological innovations that will shape the future of thoracic robotic surgery. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - November 11, 2022 Category: Cardiovascular & Thoracic Surgery Authors: John F. Lazar, Ann E. Hwalek Source Type: research
Robotic Lobectomy
Robotic lobectomy volume in the United States has increased dramatically in the past 10 years. Improved perioperative outcomes and increased public demand for minimally invasive techniques continue to drive its popularity. Preoperative workup is similar to VATs lobectomy and includes appropriate tumor staging, pulmonary function tests, and imaging. Severe intraoperative complications are rare but can be catastrophic; individualized response to each is required. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - November 11, 2022 Category: Cardiovascular & Thoracic Surgery Authors: Kelly Fairbairn, Jonathan Rice, Stephanie G. Worrell Source Type: research
Management of Complications in Robotic Thoracic Surgery
The rapid adoption of robotic-assisted thoracic surgery has led to increased interest in the management of complications. Overall rates of complication during robotic-assisted thoracic surgery are low. Reported complications include pulmonary vascular injury; great vessel injury; thoracic duct injury; erroneous transection; tracheobronchial injury; and esophageal, diaphragmatic, and abdominal organ injury. A robotic thoracic surgeon should understand and have a management plan for any potential complication. When a complication occurs, the priority is to stabilize the patient. Then, after stabilization, an assessment of th...
Source: Thoracic Surgery Clinics - November 11, 2022 Category: Cardiovascular & Thoracic Surgery Authors: Matthew D. Stanley, Manu S. Sancheti Source Type: research
Robotic First Rib Resection and Robotic Chest Wall Resection
Robot-assisted thoracoscopic surgery for the treatment of thoracic outlet syndrome and chest wall lesions are burgeoning topics on thoracic surgery. Following publication of the Society of Vascular Surgeons expert statement in 2016, the diagnosis and management of thoracic outlet syndrome is favorably evolving. Robot-assisted first rib resection is a novel approach to the surgical management of thoracic outlet syndrome that may have advantages compared with traditional open surgical approaches. Robot-assisted chest wall resection is technically feasible for a variety of chest wall conditions and may also have advantages co...
Source: Thoracic Surgery Clinics - November 11, 2022 Category: Cardiovascular & Thoracic Surgery Authors: Matthew R.L. Egyud, Bryan M. Burt Source Type: research
