A guide for managing patients with stage I NSCLC: Deciding between lobectomy, segmentectomy, wedge, SBRT and ablation-part 2: Systematic review of evidence regarding resection extent in generally healthy patients

Background: Clinical decision-making for patients with stage I lung cancer is complex. It involves multiple options (lobectomy, segmentectomy, wedge, stereotactic body radiotherapy, thermal ablation), weighing multiple outcomes (e.g., short-, intermediate-, long-term) and multiple aspects of each (e.g., magnitude of a difference, the degree of confidence in the evidence, and the applicability to the patient and setting at hand). A structure is needed to summarize the relevant evidence for an individual patient and to identify which outcomes have the greatest impact on the decision-making. Methods: A PubMed systematic review from 2000-2021 of outcomes after lobectomy, segmentectomy and wedge resection in generally healthy patients is the focus of this paper. Evidence was abstracted from randomized trials and non-randomized comparisons with at least some adjustment for confounders. The analysis involved careful assessment, including characteristics of patients, settings, residual confounding etc. to expose degrees of uncertainty and applicability to individual patients. Evidence is summarized that provides an at-a-glance overall impression as well as the ability to delve into layers of details of the patients, settings and treatments involved. Results: In healthy patients there is no short-term benefit to sublobar resection Conclusions: A systematic, comprehensive summary of evidence regarding resection extent in healthy patients with attention to aspects of applicability, uncertainty and effect modifiers provides a foundation on which to build a framework for individualized clinical decision-making

A guide for managing patients with stage I NSCLC: Deciding between lobectomy, segmentectomy, wedge, SBRT and ablation-part 3: Systematic review of evidence regarding surgery in compromised patients or specific tumors

Background: Clinical decision-making for patients with stage I lung cancer is complex. It involves multiple options [lobectomy, segmentectomy, wedge, stereotactic body radiotherapy (SBRT), thermal ablation], weighing multiple outcomes (e.g., short-, intermediate-, long-term) and multiple aspects of each (e.g., magnitude of a difference, the degree of confidence in the evidence, and the applicability to the patient and setting at hand). A structure is needed to summarize the relevant evidence for an individual patient and to identify which outcomes have the greatest impact on the decision-making. Methods: A PubMed systematic review from 2000-2021 of outcomes after lobectomy, segmentectomy and wedge resection in older patients, patients with limited pulmonary reserve and favorable tumors is the focus of this paper. Evidence was abstracted from randomized trials and non-randomized comparisons (NRCs) with adjustment for confounders. The analysis involved careful assessment, including characteristics of patients, settings, residual confounding etc. to expose degrees of uncertainty and applicability to individual patients. Evidence is summarized that provides an at-a-glance overall impression as well as the ability to delve into layers of details of the patients, settings and treatments involved. Results: In older patients, perioperative mortality is minimally altered by resection extent and only slightly affected by increasing age; sublobar resection may slightly decrease morbidity. Long-term outcomes are worse after lesser resection; the difference is slightly attenuated with increasing age. Reported short-term outcomes are quite acceptable in (selected) patients with severely limited pulmonary reserve, not clearly altered by resection extent but substantially improved by a minimally invasive approach. Quality-of-life (QOL) and impact on pulmonary function hasn\u27t been well studied, but there appears to be little difference by resection extent in older or compromised patients. Patient selection is paramount but not well defined. Ground-glass and screen-detected tumors exhibit favorable long-term outcomes regardless of resection extent; however solid tumors \u3c1 cm are not a reliably favorable group. Conclusions: A systematic, comprehensive summary of evidence regarding resection extent in compromised patients and favorable tumors with attention to aspects of applicability, uncertainty and effect modifiers provides a foundation for a framework for individualized decision-making

A guide for managing patients with stage I NSCLC: Deciding between lobectomy, segmentectomy, wedge, SBRT and ablation-part 4: Systematic review of evidence involving SBRT and ablation

Background: Clinical decision-making for patients with stage I lung cancer is complex. It involves multiple options [lobectomy, segmentectomy, wedge, stereotactic body radiotherapy (SBRT), thermal ablation], weighing multiple outcomes (e.g., short-, intermediate-, long-term) and multiple aspects of each (e.g., magnitude of a difference, the degree of confidence in the evidence, and the applicability to the patient and setting at hand). A structure is needed to summarize the relevant evidence for an individual patient and to identify which outcomes have the greatest impact on the decision-making. Methods: A PubMed systematic review from 2000-2021 of outcomes after SBRT or thermal ablation Results: Short-term outcomes are meaningfully better after SBRT than resection. SBRT doesn\u27t affect quality-of-life (QOL), on average pulmonary function is not altered, but a minority of patients may experience gradual late toxicity. Adjusted non-randomized comparisons demonstrate a clinically relevant detriment in long-term outcomes after SBRT Conclusions: A systematic, comprehensive summary of evidence regarding Stereotactic Body Radiotherapy or thermal ablatio

Pulmonary Thromboendarterectomy in Pediatric Patients: Report of Three Cases

Chronic thromboembolic pulmonary hypertension (CTEPH), which occurs due to impartial resolution of the pulmonary thrombus, is a rare type of pulmonary hypertension. However, most patients have an excellent long-term survival following pulmonary thromboendarterectomy (PTE). Pulmonary emboli and associated CTEPH is unusual in the pediatric population and is mostly reveals an underlying thrombophilic state. PTE is also recognized as the best therapeutic option in this subgroup of patients. In this case series, we report three young patients who had successfully undergone PTE due to pulmonary emboli and associated CTEPH.WoSScopu

Interventricular hydatid cyst imitating pulmonary stenosis

Cardiac hydatid cyst is known to be a rarely occurring disease. The appearance of large cysts in the interventricular septum in childhood is even more rare. Although such cysts are usually asymptomatic, they can behave like valvular disorders, depending on their location. In addition, cardiac hydatid cysts originating from the interventricular septum carry the risk of rupturing into both ventricular cavities, which may lead to fatal complications. Thus, early surgical treatment is of extreme importance. We describe the case of a 7-year-old girl with a cardiac hydatid cyst that originated in the interventricular septum

The Impact Of Red Cell Distribution Width And Neutrophil/Lymphocyte Ratio On Long-Term Survival After Pulmonary Resection For Non-Small Cell Lung Cancer

Red cell distribution width (RDW) and Neutrophil/Lymphocyte Ratio (NLR) are widely available blood tests which can be used to reflect patients' inflammatory status. We investigated the effects of RDW and NLR levels on long-term survival after pulmonary resection for non-small cell lung cancers. Data were compiled retrospectively from 249 patients. We found a significant correlation between higher RDW and NLR levels and poorer prognosis. Overall survival rates of patients with high and normal RDW levels were 42 +/- 7 and 84 +/- 12 months, respectively (p= 0.019). In addition, disease free survival rates of patients with high and normal RDW levels were 62 +/- 6 and 76 +/- 4 months (p= 0.047), respectively. When NLR levels were divided into tertiles we observed significantly poorer overall and disease free survival in ascending tertiles. The overall and disease free survival rates in the lower through upper tertiles were; 88 +/- 6, 80 +/- 6, 50 +/- 5 months for overall and 87 +/- 6, 77 +/- 6, 47 +/- 5 months for disease free survival (p< 0.001). In conclusion, the ability to accurately predict sub-sets with poorer outcomes among patients who had undergone pulmonary resection for non-small cell lung cancers is important. RDW and NLR are biomarkers which could influence patients categorization in this regard. Preoperative measurement of these potential markers are simple, adds no additional cost to routine preoperative workup and can be used to identify patients with poorer prognosis.WoSScopu

External Validation Of The Thoracic Revised Cardiac Risk Index In Patients Undergoing Lung Resection For Non-Small-Cell Lung Cancer Cardiac Risk Index In Lung Resections

Aim: The Thoracic Revised Cardiac Risk Index (ThRCRI) is a cardiac risk stratification tool specific to patients undergoing thoracic surgery. However, its usage is not accepted in routine practice yet. In this study, we aimed to validate the reliability of ThRCRI for predicting cardiac complications in an independent cohort undergoing lung resections for non-small-cell lung cancer (NSCLC). Material and Method: Data of 249 patients were analyzed according to ThRCRI scores and cardiovascular complication rate. ROC analyses were also carried out to evaluate the reliability of ThRCRI categories. Results: Higher ThRCRI risk scores were found to be associated with higher overall cardiac complication rates (p<0.0001) with a moderate-to-high reliability. Discussion: This study externally validated the discriminative ability of ThRCRI to differentiate high-risk patients for major cardiac complications following major lung resections. We advocate its use as a cardiac screening tool for patients who are candidates for lung resection.Wo

Prognostic Significance of the Glasgow Prognostic Score in Patients Undergoing Pulmonary Metastasectomy

Pulmonary metastasectomy is considered the standard treatment for various cancer types when the primary tumour is under control. The Glasgow Prognostic Score (GPS), which is determined by serum levels of C-reactive protein (CRP) and albumin, is found to be a potential prognostic tool for variable primary cancer types. The aim of this study is to evaluate the prognostic role of the GPS in patients undergoing pulmonary metastasectomy for different subgroups of cancer types. Data of 142 patients who underwent pulmonary metastasectomy at in a single institution were retrospectively analyzed from a prospectively collected database. Primary tumour histologic subtypes were classified into five categories: Gastrointestinal tumours (Colorectal, gastric and colangiocellular carcinomas, n= 43), sarcomas (osteosarcoma, chondrosarcoma and synovial sarcoma, n= 38), breast carcinoma (n= 16), genitourinary system carcinomas (Cervix and endometrium carcinomas, n= 10) and miscellaneous (n= 35). High GPS is found to be correlated with worse survival rates in the subgroups of pulmonary metastasectomy for gastrointestinal, genitourinary and miscellaneous cancers (p= 0.050, p= 0.046 and p= 0.003, respectively). Although there is an evident decline of mean survival in breast cancer and sarcoma patients, the effect of GPS score on overall survival was statistically insignificant (p= 0.081 and p= 0.056, respectively). In conclusion, GPS appears to be a useful predictor of overall survival in pulmonary metastases for the majority of cancer types.WoSScopu

Epicardial Cysts: Report of Two Rare Cases

WOS: 000300736100012PubMed ID: 22360907Epicardial cysts originating directly from the epicardium are seen very rarely. Complete surgical excision is recommended when these cysts are detected. If cysts compress surrounding vital structures, cardiopulmonary bypass (CPB) should also be considered. We report herein 2 cases of multiloculated epicardial cysts, both of which were successfully excised, 1 with CPB

Epicardial Cysts: Report of Two Rare Cases

Epicardial cysts originating directly from the epicardium are seen very rarely. Complete surgical excision is recommended when these cysts are detected. If cysts compress surrounding vital structures, cardiopulmonary bypass (CPB) should also be considered. We report herein 2 cases of multiloculated epicardial cysts, both of which were successfully excised, 1 with CPB