Sleeve Lobectomy as an Alternative Procedure to Pneumonectomy for Non-small Cell Lung Cancer

IntroductionThe aim of this study is to compare the outcomes of sleeve lobectomy (SL) and pneumonectomy (PN) and to determine which one is more acceptable standard procedure for patients with non-small cell lung cancer.MethodsFrom 1996 to 2005, 424 patients underwent SL (n = 157) and PN (n = 267) in our institution. Propensity score matching analysis was performed to compare these two groups for mortality, morbidity, survival, recurrence, and postoperative pulmonary function.ResultsIn each group, 105 patients were eligible for analysis. The operative mortality was lower in the SL group (1.0%) than the PN group (8.6%), (p < 0.0001). The morbidity was similar (33.4% versus 29.5%, p = 0.376). The 5-year survival was lower in the PN group (PN, 32.14% versus SL, 58.43%, p = 0.0002). The recurrence pattern (locoregional versus distant) did not differ between two groups (p = 0.180). The mean actual postoperative first second forced expiratory volume in the patients underwent SL was 2.05 ± 0.55 liter, which increased by 7.9% compared with the predicted-postoperative first second forced expiratory volume.ConclusionsOur results showed that the SL can be performed with low operative risk and may offer superior survival and better postoperative pulmonary function compared with the PN in selected patients. If anatomically feasible, a SL must be considered as a favorable alternative to PN in patients with non-small cell lung cancer

Pattern of Recurrence after Curative Resection of Local (Stage I and II) Non-Small Cell Lung Cancer: Difference According to the Histologic Type

The aim of the present study was to evaluate the pattern of recurrence after complete resection of pathological stage I, II non-small cell lung cancer, especially according to the cell type. We reviewed the clinical records of 525 patients operated on for pathologic stage I and II lung cancer. The histologic type was found to be squamous in 253 and non-squamous in 229 patients. Median follow-up period was 40 months. Recurrences were identified in 173 (36%) of 482 enrolled patients; distant metastasis in 70%, distant and local recurrence in 11%, and local recurrence in 19%. Distant metastasis was more common in non-squamous than in squamous cell carcinoma (p=0.044). Brain metastasis was more frequently identified in non-squamous mthan in squamous cell carcinoma (24.2% vs. 7.3%. p=0.005). Multivariate analyses showed that cell type is the significant risk factor for recurrence-free survival in stage I and stage II non-small cell lung cancer. Recurrence-free survival curves showed that non-squamous cell carcinoma had similar risks during early periods of follow-up and more risks after 2 yr from the operation compared to squamous cell carcinoma. Pathological stage and histologic type significantly influence recurrence-free survival

Prognosis After Surgical Resection of M1a/M1b Esophageal Squamous Cell Carcinoma

This study was undertaken to examine prognosis after resection for M1 disease in squamous cell esophageal carcinoma. Fifty-six patients with M1 esophageal cancer underwent esophageal resection with two or three-field nodal dissection from 1994 to 2001. Operative mortality occurred in 3 patients. Primary tumor sites were as follows; 10 upper, 23 middle, and 20 lower thoracic esophagus. They were found to have M1 disease by pathologic examination of dissected nodes, 24 M1a and 29 M1b. Forty-two patients (79%) were considered to have undergone curative resection. Chemotherapy and/or radiation therapy was given to 38 patients perioperatively. Recurrence was identified in 35 patients (66%) during a mean follow-up of 23 months. Overall median and 5-yr survivals were 19 months and 12.7%. Five-year survivals for M1a and M1b disease were 23.9% and 6.1%, respectively (p=0.0488). Curative resection tended to show better survival (p=0.3846). Chemotherapy and/or radiation therapy provided no advantage (p=0.5370). Multivariate analysis showed that M1b was significant risk factor over M1a disease. Our conclusion is that surgical resection can provide acceptable survival in thoracic squamous esophageal cancer with M1a disease. Survival differences between M1a and M1b disease support the current subclassification staging system

Epidermal growth factor receptor mutations and anaplastic lymphoma kinase rearrangements in lung cancer with nodular ground-glass opacity

Vår uppsats handlar om formativ bedömning och vad det innebär att arbeta så i undervisningen. Vi tolkar att rådande läroplaner beskriver ett uppdrag som ligger i linje med ett formativt arbetssätt. Syftet var att ta reda på om lärare i samhällskunskap som arbetar på gymnasiet arbetar formativt och hur de gör det. Ett annat vanligt namn för formativ bedömning är bedömning för lärande (BFL). Genom kvalitativa intervjuer har vi frågat gymnasielärare i samhällskunskap hur de arbetar med bedömning, om de arbetar formativt och om det finns någon samsyn på deras respektive gymnasieskolor kring bedömning. Vi ville också veta vad formativt arbete innebär. Bedömning för lärande fokuserar på lärandet och hur eleven kan utvecklas och nå framgång i lärandet. Genom att konkretisera mål, syfte och kunskapskvaliteter så att eleven förstår dessa kan eleven få syn på sitt eget lärande. När eleven ges makt över sitt eget lärande leder det till ökad motivation. I formativ bedömning arbetar läraren bland annat med feedback och kamrat- och självvärdering. Vårt resultat visar att lärarna vi intervjuat i stor utsträckning arbetar summativt med formativa inslag i varierande grad, förutom en av lärarna som arbetar på en gymnasieskola i Borås som arbetar enligt bedömning för lärande. Studien visar att det råder brist på samsyn kring bedömning på gymnasie-skolorna, förutom på skolan i Borås där det finns tid avsatt för möten och samtal kring formativ bedömning. Litteraturen visar på de positiva effekterna av bedömning för lärande vilket också styrks av intervjun med läraren i Borås

Surgical Resection of Recurrent Lung Cancer in Patients Following Curative Resection

We reviewed our experience with resection of recurrent lung cancer to evaluate the benefit and risk of the procedure. From December 1994 to December 2003, 29 consecutive patients underwent pulmonary resections for recurrent lung cancer. The mean duration from the first resection to second surgery was 25.4±15.1 months for the definite 2nd primary lung cancer (n=20) and 8.9±5.7 months for metastatic lung cancer (n=9). The procedures at the second operations were completion-pneumonectomy in 11 patients, lobectomy in 5 patients, wedge resection in 12 patients and resection and anastomosis of trachea in 1 patient. Morbidity was observed in 6 (21%) of the patients and the in-hospital mortality was two patients (7%) after the repeated lung resection. Tumor recurrence after reoperation was observed in 14 patients (48%). The actuarial 5-yr survival rate was 69% and the 5-yr disease free rate following reoperation was 44%. No significant difference was found in overall survival and disease free survival between the 2nd primary lung cancer group and the metastatic lung cancer group. The recurrence rate following reoperation was significantly different between the wedge resection group and lobectomy/completion pneumonectomy group (p=0.008), but the survival rate was not significantly different (p=0.41). Surgical intervention for recurrent lung cancers can be performed with acceptable mortality and morbidity. If tolerable, completion pneumonectomy or lobectomy is recommended for resection of recurrent lung cancer

Video-assisted thoracic surgery sleeve resection and bronchoplasty using 3D imaging system: its safety and efficacy

Background Video-assisted thoracic surgery sleeve resection with bronchial anastomosis or bronchoplasty is a technically demanding procedure. Three-dimensional endoscopic surgery has been reported to be helpful in decreasing operation time and improving spatial perception with less surgical errors, but there have been rare reports about relatively difficult thoracoscopic procedures utilizing 3D thoracoscope. We performed this study to evaluate early clinical outcomes of thoracoscopic sleeve resection and bronchoplasty utilizing 3D thoracoscope. Methods Data from a total of 36 patients who underwent thoracoscopic sleeve lobectomy or bronchoplasty at our institution from December 2015 to October 2017 were retrospectively reviewed. Three-port approach with one utility incision was used with a 10 mm, 30° three-dimensional thoracoscope. Twenty-three patients (81%) were male, and mean age was 65.9 ± 9.4 years. Fourteen patients (38.9%) underwent sleeve resection with bronchial anastomosis, 22 (61.1%) underwent wedge or simple bronchoplasty, and one patient received concomitant PA procedure. Bronchial anastomosis sites were not covered with viable tissue flaps. Results There was no (0%) suture needle injury from spatial misperception during bronchoplasty or sleeve anastomosis. There was no (0%) operative mortality. The pathologic report revealed squamous cell carcinoma (63.9%), adenocarcinoma (19.4%), carcinoid (6.9%), adenosquamous carcinoma (3.4%), and sarcomatoid carcinoma (2.8%). One (2.8%) late mortality was due to systemic recurrence of sarcomatoid carcinoma. There was no (0.0%) anastomotic failure. The mean number of dissected lymph nodes were 27.4 ± 13.2, and mean operation time was 216.8 ± 60.0 min. Median postoperative 24-h drain amount was 315 mL. Median chest tube days and hospital days were 4 and 6, respectively. Two patients (5.6%) had complications greater than Clavien-Dindo grade II—one case of ARDS, and the other case of a delayed bronchopleural fistula. Conclusions Thoracoscopic sleeve resection and bronchoplasty utilizing HD 3D thoracoscope is a safe and effective procedure with excellent early clinical outcomes. Further investigation for long-term outcomes will be needed