Seminars in Thoracic and Cardiovascular Surgery最新文献

{"title":"Systematic Review of Sublobar Resection for Treatment of High-Risk Patients with Stage I Non-Small Cell Lung Cancer: The American Association for Thoracic Surgery Expert Consensus Document.","authors":"Robert E Merritt, Alessandro Brunelli, Garrett Walsh, Sudish Murthy, Matthew J Schuchert, Thomas K Varghese, Michael Lanuti, Andrea Wolf, Homa Keshavarz, Billy W Loo, Robert D Suh, Raymond H Mak, Gerard J Criner, Peter J Mazzone, Michael Liptay, Q Eileen Wafford, M Blair Marshall, Betty Tong, Brian Pettiford, Gaetano Rocco, James Luketich, Thomas A D'Amico, Scott J Swanson, Arjun Pennathur","doi":"10.1053/j.semtcvs.2024.11.002","DOIUrl":"10.1053/j.semtcvs.2024.11.002","url":null,"abstract":"<p><p>Sublobar resection offers a parenchymal-sparing surgical alternative to lobectomy and includes wedge resection and segmentectomy. Sublobar resection has been historically utilized in high-risk patients with compromised lung function; however, the technique is becoming more prevalent for normal-risk patients with peripheral stage IA non-small cell lung cancer (NSCLC) <2 cm. In this article, we summarize the technique of sublobar resection, the importance of surgical margins and lymph node sampling, patient selection, perioperative complications, outcomes, and the impact of sublobar resection on the quality of life. There is limited data on short-term and long-term outcomes after sublobar resection for stage I NSCLC in high-risk patients. Results from randomized clinical trials (RCTs) of sublobar resection have been variable. We have summarized the results of the ACOSOG Z4032 RCT, which compared outcomes in high-risk patients who underwent sublobar resection alone versus sublobar resection with brachytherapy for stage I NSCLC. In addition, we have summarized recent findings of the CALGB/Alliance 140503 RCT comparing sublobar resection and lobectomy, which suggested that disease-free survival after sublobar resection in patients with small (<2 cm) peripheral stage IA NSCLC was non-inferior to lobectomy, and another RCT (JCOG 0802) of segmentectomy vs. lobectomy for small peripheral clinical stage IA NSCLC, where segmentectomy was associated with better overall survival despite a higher local recurrence rate. Sublobar resection is primarily performed with minimally invasive approaches, including robotic-assisted and video-assisted thoracoscopic techniques. From an oncologic perspective, obtaining adequate surgical margins and performing an adequate lymph node evaluation are critical for good outcomes after sublobar resection.</p>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aortic Valve Replacement for Moderate and Asymptomatic Severe Aortic Stenosis.","authors":"Ross Michael Reul, Alexander P Nissen, Kendra J Grubb","doi":"10.1053/j.semtcvs.2024.11.008","DOIUrl":"10.1053/j.semtcvs.2024.11.008","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concomitant Procedures in Robotic Mitral Valve Surgery.","authors":"Christina Waldron, Makoto Mori, Michael LaLonde, Arnar Geirsson","doi":"10.1053/j.semtcvs.2024.11.007","DOIUrl":"10.1053/j.semtcvs.2024.11.007","url":null,"abstract":"<p><p>The robotic platform may provide advantages over sternotomy including improved visualization and greater dexterity. With emerging evidence increasingly supporting the importance of concomitantly addressing tricuspid regurgitation and atrial fibrillation, robotic surgeons should be encouraged to perform appropriate concomitant procedures where indicated.</p>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New Directions in Coronary Revascularization for Refractory Angina: Gene Therapy and the Lizard Heart.","authors":"Ahmed H Aly, Nahush A Mokadam","doi":"10.1053/j.semtcvs.2024.11.009","DOIUrl":"10.1053/j.semtcvs.2024.11.009","url":null,"abstract":"<p><p>Refractory angina is a debilitating disease with limited therapeutic options that is primarily caused by microvascular dysfunction and desertification. Toward addressing this unmet need, microvascular revascularization therapy has progressively evolved from the lizard heart-inspired transmyocardial revascularization to precisely inducing vascular endothelial growth factor with gene therapy. Gene therapy with adenoviral vehicles or naked modified ribonucleic acid is safe and shows early signs of clinical promise but has not yet been proven effective due to gaps in optimization.</p>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of High-Risk Patients with Stage I Non-Small Cell Lung Cancer: The American Association for Thoracic Surgery Expert Consensus Document.","authors":"Arjun Pennathur, Michael Lanuti, Robert E Merritt, Andrea Wolf, Homa Keshavarz, Billy W Loo, Robert D Suh, Raymond H Mak, Alessandro Brunelli, Gerard J Criner, Peter J Mazzone, Garrett Walsh, Michael Liptay, Q Eileen Wafford, Sudish Murthy, M Blair Marshall, Betty Tong, Brian Pettiford, Gaetano Rocco, James Luketich, Matthew J Schuchert, Thomas K Varghese, Thomas A D'Amico, Scott J Swanson","doi":"10.1053/j.semtcvs.2024.10.002","DOIUrl":"10.1053/j.semtcvs.2024.10.002","url":null,"abstract":"<p><strong>Objectives: </strong>A significant proportion of patients with stage I non-small cell lung cancer (NSCLC) are considered at high risk for complications or mortality after lobectomy. The American Association for Thoracic Surgery (AATS) previously published important considerations in determining which patients are considered high risk. The current objective was to evaluate treatment options and important factors to consider during treatment selection for these high-risk patients.</p><p><strong>Methods: </strong>The AATS Clinical Practice Standards Committee assembled an expert panel to review treatment options for high-risk patients with stage I NSCLC. After a systematic search of the literature identification of lung-nodule-related factors to consider in treatment selection, the panel developed expert consensus statements and vignettes using a modified Delphi method. A 75% consensus was required for approval.</p><p><strong>Results: </strong>The expert panel identified sublobar resection, image-guided thermal ablation (IGTA), and stereotactic ablative radiotherapy (SABR), which is also known as stereotactic body radiation therapy (SBRT) or stereotactic radiosurgery (SRS), as modalities applicable in the treatment of high-risk patients with stage I NSCLC. Fourteen statements and 5 vignettes illustrating clinical scenarios were formulated, revised, and ultimately approved.</p><p><strong>Conclusion: </strong>The choice of which modality (sublobar resection, SABR, or IGTA) is optimal in high-risk patients with stage I NSCLC is complex, but a surgical approach is generally favored when deemed safe. SABR and IGTA are reasonable options in select patients, with SABR being the likely next choice in nonsurgical patients. If possible, obtaining a biopsy is very important prior non-surgical treatment. A multi-disciplinary review of patient and tumor characteristics is essential for achieving an optimal decision. The clinical treatment decision should also take patient perspectives, preferences, and quality of life into consideration.</p>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of the Continuous Allocation Score (CAS) on Lung Transplant in the United States.","authors":"Chadrick E Denlinger","doi":"10.1053/j.semtcvs.2024.11.004","DOIUrl":"10.1053/j.semtcvs.2024.11.004","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Importance of Pulmonary Nodule Features in the Selection of Treatment for the High-Risk Patient with Stage I Non-Small Cell Lung Cancer: The American Association For Thoracic Surgery Expert Consensus Document.","authors":"Arjun Pennathur, Michael Lanuti, Robert E Merritt, Andrea Wolf, Homa Keshavarz, Billy W Loo, Robert D Suh, Raymond H Mak, Alessandro Brunelli, Gerard J Criner, Peter J Mazzone, Garrett Walsh, Michael Liptay, Q Eileen Wafford, Sudish Murthy, M Blair Marshall, Betty Tong, Brian Pettiford, Gaetano Rocco, James Luketich, Matthew J Schuchert, Thomas K Varghese, Thomas A D'Amico, Scott J Swanson","doi":"10.1053/j.semtcvs.2024.10.003","DOIUrl":"10.1053/j.semtcvs.2024.10.003","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment Selection for the High-Risk Patient with Stage I Non-Small Cell Lung Cancer: Sublobar Resection, Stereotactic Ablative Radiotherapy or Image-Guided Thermal Ablation? The American Association for Thoracic Surgery Expert Consensus Document.","authors":"Arjun Pennathur, Michael Lanuti, Robert E Merritt, Andrea Wolf, Homa Keshavarz, Billy W Loo, Robert D Suh, Raymond H Mak, Alessandro Brunelli, Gerard J Criner, Peter J Mazzone, Garrett Walsh, Michael Liptay, Q Eileen Wafford, Sudish Murthy, M Blair Marshall, Betty Tong, Brian Pettiford, Gaetano Rocco, James Luketich, Matthew J Schuchert, Thomas K Varghese, Thomas A D'Amico, Scott J Swanson","doi":"10.1053/j.semtcvs.2024.10.004","DOIUrl":"10.1053/j.semtcvs.2024.10.004","url":null,"abstract":"<p><p>A significant proportion of patients with stage I non-small cell lung cancer (NSCLC) are considered at high risk for complications or mortality after lobectomy. The American Association for Thoracic Surgery (AATS) previously published an expert consensus document detailing important considerations in determining who is at high risk. The current objective was to evaluate treatment options and important factors to consider during treatment selection for these high-risk patients. After systematic review of the literature, treatment options for high-risk patients with stage I NSCLC were reviewed by an AATS expert panel. Expert consensus statements and vignettes pertaining to treatment selection were then developed using discussion and a modified Delphi method. The expert panel identified sublobar resection, stereotactic ablative radiotherapy (SABR), and image-guided thermal ablation (IGTA) as modalities applicable in the treatment of high-risk patients with stage I NSCLC. The panel also identified lung-nodule-related factors that are important to consider in treatment selection. Using this information, the panel formulated 14 consensus statements and 5 vignettes illustrating clinical scenarios. This article summarizes important factors to consider in treatment selection using these modalities, which are applicable in high-risk patients with stage I NSCLC. The choice of which modality (sublobar resection, SABR, or IGTA) is optimal in high-risk patients with stage I NSCLC is complex, but a surgical approach is generally favored when deemed safe. SABR and IGTA are reasonable options in select patients. SABR is more commonly used than IGTA and is likely the next-best choice. A multi-disciplinary review of patient and tumor characteristics is essential for achieving an optimal decision. The clinical treatment decision should also take patient perspectives, preferences, and quality of life into consideration.</p>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic Review of Image-Guided Thermal Ablation for Treatment of High-Risk Patients with Stage I Non-Small Cell Lung Cancer: The American Association for Thoracic Surgery Expert Consensus Document.","authors":"Michael Lanuti, Robert D Suh, Gerard J Criner, Peter J Mazzone, M Blair Marshall, Betty Tong, Robert E Merritt, Andrea Wolf, Homa Keshavarz, Billy W Loo, Raymond H Mak, Alessandro Brunelli, Garrett Walsh, Michael Liptay, Q Eileen Wafford, Sudish Murthy, Brian Pettiford, Gaetano Rocco, James Luketich, Matthew J Schuchert, Thomas K Varghese, Thomas A D'Amico, Scott J Swanson, Arjun Pennathur","doi":"10.1053/j.semtcvs.2024.11.001","DOIUrl":"10.1053/j.semtcvs.2024.11.001","url":null,"abstract":"<p><p>Image-guided thermal ablation (IGTA) applied to pulmonary pathology is an alternative to surgery in high-risk patients with stage I non-small cell lung cancer (NSCLC). Its application to lung neoplasm was first introduced in 2001 and has been implemented to treat metastatic disease to the lung or in select medically inoperable patients with peripheral stage I NSCLC. IGTA may also be an alternative to treat stage I NSCLC in non-operable patients with interstitial lung disease in whom a radiation modality is deemed too high risk. There are 3 methods of delivery: radiofrequency ablation (RFA), microwave ablation and cryoablation. Observational series and some prospective trials have shown safety and efficacy across all three modalities. Despite accumulating experience, there are no large randomized clinical trials comparing the outcomes of lung IGTA to alternative locoregional therapies (eg, stereotactic body radiotherapy or sublobar pulmonary resection) for the treatment of stage I NSCLC. Because IGTA is a local therapy, a higher risk of locoregional recurrence is inherently understood as compared with anatomic resection. In the literature, primary tumor control after RFA ranges from 47 to 90% and is dependent on tumor size and proximity to bronchovascular structures. Local failure ranges from 10 to 47%, and tumors ≥3 cm have the highest rate of local recurrence. The most prevalent side effects are pneumothorax and reactive pleural effusion; hemorrhage is uncommon. Of note, observational series show no significant loss of lung function after IGTA. This expert review contextualizes limitations, complications and outcomes of IGTA in patients with stage I NSCLC.</p>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Malperfusion, Malperfusion Syndrome, and Mesenteric Ischemia in Aortic Dissection.","authors":"Gardner Yost, Bo Yang","doi":"10.1053/j.semtcvs.2024.11.005","DOIUrl":"10.1053/j.semtcvs.2024.11.005","url":null,"abstract":"<p><p>Aortic malperfusion occurs in a significant percentage of patients with acute aortic dissection, and causes malperfusion syndrome, the clinical entity defined by end organ ischemia, in 10-33% of patients. Malperfusion syndrome can be rapidly lethal and can involve the coronary, cerebral, visceral, or lower extremity vessels. Depending on presentation, it may be appropriately and well treated with endovascular fenestration prior to definitive central aortic repair.</p>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}