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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cT3N1M0/IIIA non–small cell lung cancer and the risk of
underuse of surgery
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
Make surgery great again
Scott I. Reznik, MD
with adjuvant therapy remains the optimal therapy
for T3N1 non–small cell carcinoma of the lung in
Is surgery better than chemoradiation for T3N1M0
non–small cell lung cancer?
Chi-Fu Jeffrey Yang, MD
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.
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.
Positive bronchial section margin: How certain is R
Paul E. Van Schil, MD, PhD
positive bronchial section margin ranges from R
uncertain to R1 or R2 involvement with different
Absence of evidence is not evidence of absence
Vignesh Raman, MD, Oliver K. Jawitz,
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.
(vascular and bronchial) sleeve left upper lobectomy by
survival outcome after lobectomy in patients with
clinical T1 N0 lung cancer
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
A 10-year follow-up analysis showed
excellent prognosis after lobectomy in patients with
clinical T1 N0 lung cancer with dominant ground glass
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
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.
Is segmentectomy ready to be accepted as the standard
Wentao Fang, MD
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.
surgical treatment for primary malignant melanoma of the
esophagus: A multicenter retrospective study
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.
Pigmented spot during esophagoscopy—a mole or melanoma?
Tahsin M. Khan, MD, Chuong D. Hoang,
resection accompanied by systematic lymphadenectomy
and adjuvant therapy may improve survival for
primary malignant melanoma of the esophagus, which
remains a diagnostic dilemma.
All that glitters is not gold
John S. Young, MD, M. Blair Marshall,
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 patients have outcomes similar to those
of electively listed patients
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
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.
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
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.
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
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.
“To list, or not to list? That is the question”
Jing Yu Chen, MD, Michael K.Y. Hsin,
MD, FRCS, CTh
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.
POLICY: INVITED EXPERT OPINION
in thoracic surgery: The importance of the team
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
There is no “I” in team. Regionalization in thoracic
surgery, the interdependence of the team, and surgical
Moishe Liberman, MD, PhD
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?
Going beyond the volume–outcomes concept: The case for
regionalization in thoracic surgery
Yaron Shargall, MD
in thoracic surgery seems to be associated with
better patient outcomes, unrelated to increase in