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
Resection following concurrent chemotherapy and high-dose radiation for stage IIIA non–small cell lung cancer
Jessica S. Donington, MD, Rebecca Paulus, BS, Martin J. Edelman, MD, Mark J. Krasna, MD, Quynh-Thu Le, MD, PhD, Mohan Suntharalingam, MD, Billy W. Loo Jr., MD, PhD, Chen Hu, PhD, Jeffrey D. Bradley, MD, for the NRG Oncology Lung Group
Lobectomy was performed safely following full-dose concurrent chemoradiotherapy in these multi-institutional prospective trials.
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Commentary: High-dose induction chemoradiation for lung cancer: The past is prologue
Nasser Altorki, MD, Brendon Stiles, MD
Important data from 2 phase 2 trials with chemotherapy plus high-dose radiation before stage IIIA NSCLC surgery show that lobar resection can be done safely but complex resections carry 20% mortality.
Commentary: Burn, baby, burn
Joanna Sesti, MD, Subroto Paul, MD, MPH
Full-dose preoperative radiation (60 Gy) can be given to patients with stage IIIA non–small cell lung cancer with acceptable mortality at selected centers.
Sublobar resection compared with stereotactic body radiation therapy and ablation for early stage non–small cell lung cancer: A National Cancer Database study
Jing Wu, MD, Harrison X. Bai, MD, Lilian Chan, MS, Chang Su, MS, Paul J. Zhang, MD, Li Yang, MD, Zishu Zhang, MD
Our results suggest SLR may be associated with increased OS in patients with early-stage NSCLC compared with SBRT or ablation.
Commentary: The wizard of OS: Is overall survival better after sublobar resection versus stereotactic radiation or ablation?
Jules Lin, MD, FACS, FCCP
The authors report better survival with sublobar resection versus stereotactic radiation or ablation, although data in the National Cancer Database are limited and future prospective studies are needed.
Commentary: To wedge or not to wedge
Chadrick E. Denlinger, MD
A retrospective review of a large administrative database suggests that the most effective alternative to lobectomy for early-stage lung cancer is a sublobar resection followed by SBRT and thermal ablation.
Commentary: Can big data effectively answer important clinical questions?
Michael Lanuti, MD
Comparisons of sublobar resection, SBRT, or percutaneous thermal ablation for treatment of early stage NSCLC are difficult in a nonrandomized setting.
FEATURE VIDEO
Segmental resection for the non–small cell lung cancer in the posterior segment of left upper lobe.
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Early outcomes of robotic versus thoracoscopic segmentectomy for early-stage lung cancer: A multi-institutional propensity score-matched analysis
Yajie Zhang, MD, PhD, Chun Chen, MD, PhD, Jian Hu, MD, PhD, Yu Han, MD, Maosheng Huang, MD, Jie Xiang, MD, Hecheng Li, MD, PhD
Robotic segmentectomy resulted in comparable short-term outcomes compared with VATS segmentectomy for early NSCLC. A potential benefit of robotics might relate to an improved N1 lymph node retrieval.
Commentary: Robot-assisted segmentectomy is safe and expensive—What is the debate?
Kimberly J. Song, MD, Raja M. Flores, MD
Robot-assisted segmentectomy is safe but expensive and has not been shown to provide clinical benefits relative to video-assisted thoracoscopic surgery.
Commentary: Video-assisted thoracoscopic surgery versus robotic assisted surgery: Are we asking the right question?
Samuel S. Kim, MD, FACS, Ankit Bharat, MD, FACS
Both video-assisted thoracoscopic and robotic segmentectomy are effective and safe in the hands of expert surgeons in treating early lung cancer.
LUNG CANCER: INVITED EXPERT OPINION
Perioperative considerations for neoadjuvant immunotherapy in non–small cell lung cancer
Brendon M. Stiles, MD, Boris Sepesi, MD, Stephen R. Broderick, MD, Matthew J. Bott, MD
Intense interest exists in preoperative immunotherapy for patients with surgically resectable lung cancer. Surgeons should be actively involved in trial design, patient selection, and outcome evaluation.
Commentary: Why does neoadjuvant therapy suddenly make sense for early stage non–small cell lung cancer?
Jessica Donington, MD, MSCR
Trials of neoadjuvant immune checkpoint inhibitors have generated great enthusiasm, but we must be cognizant of the potential for negative influence on short-term surgical outcomes in early-stage patients.
LUNG TRANSPLANT
Improved survival after lung transplantation for adults requiring preoperative invasive mechanical ventilation: A national cohort study
Barbara C.S. Hamilton, MD, MAS, Gabriela R. Dincheva, BS, Michael A. Matthay, MD, Steven Hays, MD, Jonathan P. Singer, MD, MS, Marek Brzezinski, MD, Jasleen Kukreja, MD, MPH
The last decade has shown significant improvements in survival for lung transplantation in mechanically ventilated recipients.
Commentary: Survival of the fittest: Survival improved in patients on mechanical ventilation pretransplant, but frailty still matters
While survival has improved in patients on mechanical ventilation pre-lung transplant, assessing frailty is critical, as these patients continue to have worse survival than nonventilated patients.
Commentary: Rage against the machine (ventilator that is)
David B. Erasmus, MB, ChB, MD, Si M. Pham, MD, Kevin P. Landolfo, MD
Despite improvements in recipient survival following lung transplant with pretransplant mechanical ventilation, the quest for better bridging strategies continues.