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
Time-varying analysis of readmission and mortality during the first year after pneumonectomy
Gregory D. Jones, MD, Kay See Tan, PhD, Raul Caso, MD, Joseph Dycoco, BA, Bernard J. Park, MD, Matthew J. Bott, MD, Daniela Molena, MD, James Huang, MD, James M. Isbell, MD, Manjit S. Bains, MD, David R. Jones, MD, Gaetano Rocco, MD
The risk of readmission and death varies during the first year after pneumonectomy. Nononcologic causes predominate in the first 90 days, after which oncologic causes prevail.
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Commentary: Are we home yet?
Thomas A. D'Amico, MD
Readmission after pneumonectomy confers significant risk of mortality until 90 days after surgery. Failure to rescue is a result of delayed readmission or ineffective care after readmission.
Commentary: John Snow, pneumonectomy, and complication epidemiology
Elliot Wakeam, MD, MPH
John Snow used epidemiology to solve a cholera outbreak in London in 1856. We need similar efforts to solve a difficult problem in 2020—that of complications after pneumonectomy.
Commentary: What's past is prologue: The story of pneumonectomy
Ashok Muniappan, MD
Pneumonectomy remains a high-risk procedure in general thoracic surgery. Outcomes from postoperative day 90 and onwards suggest additional targets for quality improvement.
Disparities in guideline-concordant treatment for node-positive, non–small cell lung cancer following surgery
Norma E. Farrow, MD, Selena J. An, MD, MSPH, MA, Paul J. Speicher, MD, MHS, David H. Harpole Jr., MD, Thomas A. D'Amico, MD, Jacob A. Klapper, MD, Matthew G. Hartwig, MD, Betty C. Tong, MD, MS, MHS
Socioeconomic factors, including lack of insurance and geographic region, are associated with disparities in adjuvant therapy use for node-positive non–small cell lung cancer. These disparities have significant impact on outcomes and survival.
Commentary: The majority of minorities
Michelle C. Salazar, MD, Daniel J. Boffa, MD
Some sociodemographic strata were more likely to receive nonguideline-concordant care; however, many strata classically at risk to be undertreated were not.
Commentary: Chemo if you can—disparities in receipt of guideline-concordant adjuvant therapy in patients with locoregional non–small cell lung cancer
Alexis Chidi, MD, PhD, MSPH, Stephen R. Broderick, MD, MPHS
Within the limitations of the National Cancer Database, the study identifies inequities in care of patients with locoregional NSCLC and presents opportunities for further study and practice change.
Commentary: Despair and disparity
Zane T. Hammoud, MD, FACS
Insurance status is a leading factor in guideline discordant therapy for completely resected pN1 and pN2 non–small cell lung cancer.
ESOPHAGEAL CANCER
The effect of age on survival after endoscopic resection versus surgery for T1a esophageal cancer
Vignesh Raman, MD, Oliver K. Jawitz, MD, Soraya L. Voigt, MD, Chi-Fu J. Yang, MD, David H. Harpole, MD, Thomas A. D'Amico, MD, Matthew G. Hartwig, MD
ER is associated with comparable survival to surgery in patients with cT1a esophageal cancer regardless of age.
Commentary: Endoscopic resection versus surgery for superficial esophageal cancer: Ageless or timeless?
Jules Lin, MD
Endoscopic resection is an option across all ages for T1a cancer, but esophagectomy remains important in patients with a greater risk of nodal disease.
Commentary: Age is just a number: Let's give endoscopy a chance in the treatment of early esophageal cancer
Jesse Rappaport, MD, Siva Raja, MD, PhD
Endoscopic resection for very early esophageal cancer may be the right first-line choice for all patients, especially elderly patients, who may be at greater risk for conventional surgery.
TRANSPLANT
Bilateral lung transplantation on intraoperative extracorporeal membrane oxygenator: An observational study
Konrad Hoetzenecker, MD, PhD, Alberto Benazzo, MD, Theresa Stork, MD, Katharina Sinn, MD, Stefan Schwarz, MD, Thomas Schweiger, MD, PhD, Walter Klepetko, MD, the Vienna Lung Transplant Group
Lung transplantation should be routinely performed on intraoperative ECMO support. VA-ECMO provides optimal reperfusion conditions that translate into superior primary graft function.
Commentary: Adding fuel to the fire for mechanical support during lung transplantation—More might be better
Sara Najmeh, MD, Matthew G. Hartwig, MD, MHS
Routine VA ECMO in lung transplant is safe and demonstrates excellent short-term outcomes, including low PGD. Additional studies are needed before advocating this approach as a new standard of care.
Commentary: Taking matters into your own hands: Venoarterial extracorporeal membrane oxygenation for controlled reperfusion during lung transplantation
Brian Mitzman, MD
Many times, less is more. In this case, using venoarterial extracorporeal membrane oxygenation to alter reperfusion can significantly improve primary graft dysfunction rates and overall survival.
Commentary: Central defense on trial
Ankit Dhamija, MD, Heather K. Hayanga, MD, MPH, Kelsey Musgrove, MD, J.W. Awori Hayanga, MD, MPH
Extracorporeal support is a growing strategy of choice for intraoperative support in lung transplantation.
TRANSPLANT FEATURED VIDEO
How to achieve controlled reperfusion.
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LUNG CANCER: PERIOPERATIVE MANAGEMENT
The prognostic nutritional index and postoperative complications after curative lung cancer resection: A retrospective cohort study
Sukhee Park, MD, Hyun Joo Ahn, MD, PhD, Mikyung Yang, MD, PhD, Jie Ae Kim, MD, PhD, Jin Kyoung Kim, MD, PhD, Soo Jung Park, MD
The preoperative prognostic nutritional index was associated with postoperative complications and long-term outcomes after curative resection of non–small cell lung cancer.
Commentary: Beyond the eyeball test
Lorraine D. Cornwell, MD, R. Taylor Ripley, MD
Although surgeons use the “eyeball test” to advise patients about surgical risk, nutritional indices such as the PNI may help quantify risks beyond the VASQIP, performance status, and frailty scoring.
Commentary: Soft prognosticators following radical treatment of lung cancer: The time has come for a more integrated approach
Alessandro Brunelli, MD
TNM staging system should be integrated by cancer- and patient-related biologic, immunologic, and metabolic characteristics to allow a targeted and personalized cancer treatment.