The following is a collection of featured thoracic articles from the Journal of Thoracic and Cardiovascular Surgery (JTCVS). To read the latest issue, or browse the feature video library and other journal highlights, please visit www.jtcvs.org.
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LUNG CANCER
Treatment of cT3N1M0/IIIA non–small cell lung cancer and the risk of underuse of surgery
Mohamed Rahouma, MD, Mohamed Kamel, MD, Abu Nasar, MS, Sebron Harrison, MD, Benjamin Lee, MD, Jeffrey Port, MD, Nasser Altorki, MD, Brendon M. Stiles, MD
In the NCDB, approximately half of patients with clinical T3N1M0 were treated with dCRT rather than surgery. This practice should be avoided in operable patients, because surgery is associated with better survival.
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Commentary: Make surgery great again
Scott I. Reznik, MD
Surgery with adjuvant therapy remains the optimal therapy for T3N1 non–small cell carcinoma of the lung in appropriate patients.
Commentary: Is surgery better than chemoradiation for T3N1M0 non–small cell lung cancer?
Chi-Fu Jeffrey Yang, MD
In appropriately selected patients, surgery for T3N1M0 lung cancer is likely associated with improved survival compared with definitive chemoradiation, but further research evaluating different types of T3 tumors is needed.
Clinical outcomes of microscopic residual disease after bronchial sleeve resection for non–small cell lung cancer
Tae Hee Hong, MD, Jhingook Kim, MD, Sumin Shin, MD, Hong Kwan Kim, MD, PhD, Yong Soo Choi, MD, PhD, Jae Il Zo, MD, PhD, Young Mog Shim, MD, PhD, Jong Ho Cho, MD, PhD
Long-term fate of bronchial sleeve resection was not severely hampered by microscopic residual disease alone, although its pathological extent could be considered for actual decision -making.
Commentary: Positive bronchial section margin: How certain is R uncertain?
Paul E. Van Schil, MD, PhD
A positive bronchial section margin ranges from R uncertain to R1 or R2 involvement with different prognosis.
Commentary: Absence of evidence is not evidence of absence
Vignesh Raman, MD, Oliver K. Jawitz, MD
Although microscopically positive bronchial margins were not associated with worse survival in this study, only 28 patients had invasion at the margin, making the data difficult to interpret.
FEATURE VIDEO
A double (vascular and bronchial) sleeve left upper lobectomy by thoracotomy.
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Long-term survival outcome after lobectomy in patients with clinical T1 N0 lung cancer
Hiroyuki Ito, MD, Kenji Suzuki, MD, Tomonori Mizutani, MD, Keiju Aokage, MD, Masashi Wakabayashi, MSc, Haruhiko Fukuda, MD, Shun-ichi Watanabe, MD, on behalf of the Japan Clinical Oncology Group Lung Cancer Surgical Study Group
A 10-year follow-up analysis showed excellent prognosis after lobectomy in patients with clinical T1 N0 lung cancer with dominant ground glass opacity.
Commentary: Through the looking glass: Is the consolidation/tumor ratio more important than size for clinical T1N0 lung cancer with a dominant ground-glass opacity?
Jules Lin, MD
As we await results of randomized trials on sublobar resection, the consolidation/tumor ratio may need to be considered in determining treatment for T1N0 nodules with a dominant ground-glass opacity.
Commentary: Is segmentectomy ready to be accepted as the standard of care?
Wentao Fang, MD
Even though the results of 2 ongoing trials are expected, it is still too early to consider segmentectomy as the standard of care for early stage lung cancers.
ESOPHAGEAL CANCER
Results of surgical treatment for primary malignant melanoma of the esophagus: A multicenter retrospective study
Liang Dai, MD, Zi-Ming Wang, MD, Zhi-Qiang Xue, MD, Ming He, MD, Yong Yuan, MD, Xue-Qian Shang, MD, Ke-Neng Chen, MD, PhD, FRCS, the Chinese Cooperative Primary Malignant Melanoma of the Esophagus Group (CCPMMEG)
Dissection of lymph nodes should be emphasized in the surgical treatment of patients with PMME. The use of postoperative adjuvant treatment may improve outcomes over surgery alone.
Commentary: Pigmented spot during esophagoscopy—a mole or melanoma?
Tahsin M. Khan, MD, Chuong D. Hoang, MD
Surgical resection accompanied by systematic lymphadenectomy and adjuvant therapy may improve survival for primary malignant melanoma of the esophagus, which remains a diagnostic dilemma.
Commentary: All that glitters is not gold
John S. Young, MD, M. Blair Marshall, MD
A retrospective study of patients treated by a variety of strategies is discussed. With recent knowledge gained in melanoma, the risk factors and optimal treatment strategies remain to be defined.
A video of McKeown minimally invasive esophagectomy.
LUNG TRANSPLANT
Urgently listed lung transplant patients have outcomes similar to those of electively listed patients
Andrew Tang, MD, Lucy Thuita, MS, Hafiz Umair Siddiqui, MD, Jesse Rappaport, MD, Eugene H. Blackstone, MD, Kenneth R. McCurry, MD, Usman Ahmad, MD, for the Lung Transplantation Center
Most urgently listed patients undergo lung transplant within 1 month. Morbidity, long-term survival, and allograft function after transplant are similar for urgently and electively listed patients.
Commentary: Does an expeditious evaluation for high-acuity lung transplant recipients make a difference?
Aakash Shah, MD, Chetan Pasrija, MD, Ronson J. Madathil, MD, Christine L. Lau, MD, MBA
Urgently listed lung transplant recipients may have equivalent outcomes to similar acuity electively listed patients in high-volume centers willing to perform transplantation in high-risk patients.
Commentary: Donor lungs allocated to critically ill patients listed urgently: No longer a waste of precious organs?
Dirk Van Raemdonck, MD, PhD, Laurens J. Ceulemans, MD, PhD, Arne Neyrinck, MD, PhD, Robin Vos, MD, PhD, Geert M. Verleden, MD, PhD
Well-selected patients urgently listed for LTx because of acute respiratory failure have similar outcomes as those of electively listed patients with comparable disease severity and urgency.
Commentary: “To list, or not to list? That is the question”
Jing Yu Chen, MD, Michael K.Y. Hsin, MD, FRCS, CTh
Lung transplantation for urgently listed patients is challenging and resource-intensive. Transplantation teams need to exercise good judgment in offering urgent listing to offset the risks of poor outcomes.
HEALTH POLICY: INVITED EXPERT OPINION
Regionalization in thoracic surgery: The importance of the team
Gail E. Darling, MD, FRCSC
Regionalization may optimize patient outcomes by allowing a critical mass of specialty providers to work together and gain expertise. Increasing volume alone does not guarantee optimal outcomes.
Commentary: There is no “I” in team. Regionalization in thoracic surgery, the interdependence of the team, and surgical volume
Moishe Liberman, MD, PhD
While an experienced team is probably more important than volume alone in thoracic surgery, if there is no volume, how do you build an experienced team?
Commentary: Going beyond the volume–outcomes concept: The case for regionalization in thoracic surgery
Yaron Shargall, MD
Regionalization in thoracic surgery seems to be associated with better patient outcomes, unrelated to increase in surgeon/hospital volumes.