Current challenges in thoracic surgery最新文献

{"title":"A narrative review of the social determinants of lung cancer screening: knowledge gaps and controversies","authors":"Sakib M. Adnan, Kristine Chin, G. Ma, C. Erkmen","doi":"10.21037/ccts-22-4","DOIUrl":"https://doi.org/10.21037/ccts-22-4","url":null,"abstract":"","PeriodicalId":72729,"journal":{"name":"Current challenges in thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46404930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient perspectives on open vs. minimally invasive thoracic surgery (PPOMITS): survey and experience from a single academic institution","authors":"Daniel Jones, U. Bhattacharyya, Ching Yeung, A. Martel, M. Hanna, Ameera Moledina, Andrew J. E. Seely, D. Maziak, S. Sundaresan, P. Villeneuve, S. Gilbert","doi":"10.21037/ccts-22-10","DOIUrl":"https://doi.org/10.21037/ccts-22-10","url":null,"abstract":"Background: Despite the widespread acceptance of safety and oncologic equivalence of minimally invasive thoracic surgery, adoption by thoracic surgeons is lagging. Patient perspectives on minimally invasive thoracic surgery versus open surgical approaches has not been well studied. The aim of this survey was to document patient perspective on pain, complication risks, cosmesis, travel burden, and functional outcomes and their relationship to surgical approach. Methods: From 2012–2017, 201 thoracic surgical patients were prospectively enrolled in this observational cohort study. Participants completed a RAND36 short form health survey and a PPOMITS (patient perspectives on open vs. minimally invasive thoracic surgery) questionnaire. Variables of interest were measured on a continuous visual analog scale. PPOMITS questions were classified into three anatomic regions (neck, chest, and abdomen). Surveys were completed preoperatively, then at 1 and 6 months postoperatively. Chi-squared, Fisher’s, and independent t -test were used as appropriate. Results: A total of 201 patients were surveyed. Recovery of indices was similar in both MIS and open surgery patients. On average, patients placed greater importance on postoperative pain (6.93; 95% CI: 6.69–7.17) than incision size (4.31; 95% CI: 4.0–4.63, P<0.001) and travel burden (4.35; 95% CI: 4.04–4.66, P<0.001). Risk of complications (7.36; 95% CI: 7.14–7.58) was also given more importance than incision size (P<0.001) and travel burden (P<0.001). Findings were similar at each time point and across body regions. Importance of postoperative pain was similar between both groups regardless of surgical site and timing. RAND SF-36 results indicated a significant decline in physical functioning, role limitations due to physical health, energy level, pain, and social functioning at 1 month. All indices recovered to baseline at 6 months. Conclusions: Early deterioration with recovery of functional outcomes at 6 months were similar regardless of surgical approach. Risk of complications was more important to patients than incision size, pain, and distance traveled for treatment. Our results suggest that patients may be willing to enter randomized trials comparing minimally invasive and open approaches, in regionalized cancer care models.","PeriodicalId":72729,"journal":{"name":"Current challenges in thoracic surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68326912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomarkers in Lung Cancer Screening: a Narrative Review.","authors":"Hannah N Marmor,&nbsp;J Tyler Zorn,&nbsp;Stephen A Deppen,&nbsp;Pierre P Massion,&nbsp;Eric L Grogan","doi":"10.21037/ccts-20-171","DOIUrl":"https://doi.org/10.21037/ccts-20-171","url":null,"abstract":"<p><p>Although when used as a lung cancer screening tool low-dose computed tomography (LDCT) has demonstrated a significant reduction in lung cancer related mortality, it is not without pitfalls. The associated high false positive rate, inability to distinguish between benign and malignant nodules, cumulative radiation exposure, and resulting patient anxiety have all demonstrated the need for adjunctive testing in lung cancer screening. Current research focuses on developing liquid biomarkers to complement imaging as non-invasive lung cancer diagnostics. Biomarkers can be useful for both the early detection and diagnosis of disease, thereby decreasing the number of unnecessary radiologic tests performed. Biomarkers can stratify cancer risk to further enrich the screening population and augment existing risk prediction. Finally, biomarkers can be used to distinguish benign from malignant nodules in lung cancer screening. While many biomarkers require further validation studies, several, including autoantibodies and blood protein profiling, are available for clinical use. This paper describes the need for biomarkers as a lung cancer screening tool, both in terms of diagnosis and risk assessment. Additionally, this paper will discuss the goals of biomarker use, describe properties of a good biomarker, and review several of the most promising biomarkers currently being studied including autoantibodies, complement fragments, microRNA, blood proteins, circulating tumor DNA, and DNA methylation. Finally, we will describe future directions in the field of biomarker development.</p>","PeriodicalId":72729,"journal":{"name":"Current challenges in thoracic surgery","volume":"5 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10069480/pdf/nihms-1882324.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9275429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Narrative review of radiomics for classifying pulmonary nodules and potential impact on lung cancer screening","authors":"Matthew J. Stephens","doi":"10.21037/ccts-20-168","DOIUrl":"https://doi.org/10.21037/ccts-20-168","url":null,"abstract":": Lung cancer screening has proven to be a useful tool for identifying early stage lung cancers, however, the overall accuracy can sometimes lead to false positive and negatives that have potential adverse effects on patient outcomes. Advancement in computational methods have allowed for quantification of pulmonary nodule imaging features, referred to as radiomics, which have the potential to increase lung cancer screening accuracy and improve patient management. The initial part of this review covers common radiomic features and the challenges in deriving them. The second part of this review systematically evaluates literature relating to radiomics and lung cancer finding articles in areas that might have the potential to change management in lung cancer screening. Pertinent literature included initial nodule classification as benign or malignant, classifying subsolid nodules as invasive or noninvasive, and prediction of tumor recurrence after surgical resection. The reviewed articles evaluating use of radiomics are mostly limited due to small sample sizes and lack of a validation cohort. These studies show potential for radiomic features to improve pulmonary nodule classification and change the way patients are managed, however, comparison between studies is limited due to variabilities in the way these features are derived. To make these features useful will require further research and standardization of the workflows that derive these features.","PeriodicalId":72729,"journal":{"name":"Current challenges in thoracic surgery","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134942329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A narrative review of lung cancer screening implementation: increasing utilization of evidence-based practice","authors":"James A. Miller, Robert M. Van Haren","doi":"10.21037/ccts-20-162","DOIUrl":"https://doi.org/10.21037/ccts-20-162","url":null,"abstract":": Cancer is the second leading cause of death in the United States, with lung cancer causing more cancer deaths annually than any other primary site. The high mortality is, in part, due to the lack of symptoms during early stage disease. There is therefore a resultant delay in diagnosis until lung cancer has progressed to later stages, when fewer if any potentially curative options exist. Low-dose computed tomography (LDCT) scanning for screening of high-risk patients has been found to identify lung cancer at earlier stages, and this has corresponded both with an increase in curative intervention and a decrease in lung cancer mortality. Although lung cancer screening carries a relatively low risk of harm, it remains underutilized. The rates of eligible patients that undergo lung cancer screening varies regionally, with rates of screening ranging from less than 4% of eligible patients up to 18% in some states. This low rate of screening has persisted over the past few years despite recommendations for lung cancer screening from national and international organizations. Improving utilization rates requires identification of barriers to screening and strategies to resolve these barriers. As screening utilization rates increase, continued improvement in rates of early diagnosis and mortality from lung cancer would then be expected to follow.","PeriodicalId":72729,"journal":{"name":"Current challenges in thoracic surgery","volume":"100 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134942334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A narrative review of risk prediction models for lung cancer screening","authors":"Aaron R. Dezube, Michael T. Jaklitsch","doi":"10.21037/ccts-20-165","DOIUrl":"https://doi.org/10.21037/ccts-20-165","url":null,"abstract":": Lung cancer is the leading cause of cancer-death worldwide. The U.S. Preventative Services Task Force (USPTSF) approved screening for current or former smokers aged 55–80 based on the results of the National Lung Screening trial (NLST). Current guidelines use rigid inclusion criteria, therefore new attention has turned to use of risk-prediction models for lung cancer to reduce the number needed to screen as well as identify high-risk patients who don’t meet current screening guidelines. Our paper serves as an expert narrative review of new literature pertaining to lung cancer risk prediction models for screening based on review of articles from PubMed and Cochrane database from date of inception through June 11, 2020. We used the MeSH search terms: “lung cancer”; “screening”; “low dose CT”, and “risk prediction model” to identify any new relevant articles for inclusion in our review. We reviewed multiple risk-prediction models including recent updates and systematic reviews. Our results suggest risk projection models may reduce false positive rates and identify high risk patients not currently eligible for screening. However, most studies were heterogenous in both their variables and risk threshold cutoffs for screening. Furthermore, a lack of prospective validation continues to limit the generalizability. Therefore, we acknowledge the need for further prospective data collection regarding use of risk-prediction modeling to refine lung cancer screening.","PeriodicalId":72729,"journal":{"name":"Current challenges in thoracic surgery","volume":"66 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134942333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Opportunities and challenges in lung cancer screening implementation: a narrative review","authors":"Eduardo R. Nunez, Katrina A. Steiling, Virginia R. Litle","doi":"10.21037/ccts-20-160","DOIUrl":"https://doi.org/10.21037/ccts-20-160","url":null,"abstract":": The U.S. Preventive Services Task Force and the Centers for Medicare and Medicaid Services (CMS) recommend lung cancer screening (LCS) for high risk current and former smokers. Developing a comprehensive LCS program requires coordinated planning from program conception through implementation and maintenance that address both pragmatic and regulatory matters. In this review article, we discuss the available evidence, guideline recommendations, and practical considerations for implementing a high-quality LCS program. Key factors in the initial planning phase include engagement of stakeholders with a particular focus on support from providers, patients and healthcare organizations. Additionally, it is important to consider the infrastructure and program design that will best serve local needs, and implement mandatory components such as a data registry and smoking cessation. We also discuss the implementation phase including strategies for optimizing the eligible patient population to be screened as well as the processes of shared decision making (SDM), standardization of screening results and communication of findings to patients. Once patients have been screened, maintenance of a successful LCS program requires iterative multidisciplinary reviews of key quality metrics and establishing systematic mechanisms to track evaluation, minimizing loss to follow-up. We also review other recommended components that contribute to maintaining a high-quality screening program such as a clinical screening coordinator, patient navigator, and tools to improve the uptake of and adherence to LCS.","PeriodicalId":72729,"journal":{"name":"Current challenges in thoracic surgery","volume":"73 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134942332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A narrative review of lung cancer screening: risks of lung cancer screening","authors":"Natthaya Triphuridet, David F. Yankelevitz, Andrea Wolf","doi":"10.21037/ccts-20-176","DOIUrl":"https://doi.org/10.21037/ccts-20-176","url":null,"abstract":": Low-dose chest computed tomography (LDCT) screening for lung cancer in high-risk individuals is the current standard of care in the United States and European countries. LDCT has been shown to reduce lung cancer mortality. However, potential “side effects” and “risks” of lung cancer screening should be concerned and weighed against its benefits. To provide a summary of the risk of lung cancer screening as performed with LDCT. The potential risks of LDCT screening are generally considered to be outweighed by the benefit of reducing the risk of lung cancer death in the high-risk population. The studies on harm of LDCT screening varied on definition of positive test and study protocol. However, using current nodule protocols guidelines defining positive nodule based on consistency, size, and round of screening with certain management protocol as Lung-RADS would have reduced in the false positive rate in baseline and subsequent rounds, prevented invasive procedures and complications associated with false positive exams and decreased the overdiagnosis rate. Currently, there are no epidemiological evidence supporting increased cancer incidence or mortality from radiation dose of the LDCT screening for lung cancer which below 100 mSv. While the risks are generally considered to be outweighed by the benefit of reducing the risk of lung cancer death in the screening-eligible population, it is important to understand these potential risks, especially given the requirements for shared decision making.","PeriodicalId":72729,"journal":{"name":"Current challenges in thoracic surgery","volume":"66 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134942330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endotracheal repair of an iatrogenic tracheal laceration in a COVID-19 patient scheduled for surgical tracheostomy: a case report","authors":"Kenan Öztürk, Michael Westhoff, Stefan Welter","doi":"10.21037/ccts-21-27","DOIUrl":"https://doi.org/10.21037/ccts-21-27","url":null,"abstract":"Background: To the best of our knowledge, this is the first report of a tracheal membrane laceration (TML) repair in a frail COVID-19 patient requiring long term ventilation.","PeriodicalId":72729,"journal":{"name":"Current challenges in thoracic surgery","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136019490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic right upper lobe segmentectomy","authors":"","doi":"10.21037/ccts-20-177","DOIUrl":"https://doi.org/10.21037/ccts-20-177","url":null,"abstract":"","PeriodicalId":72729,"journal":{"name":"Current challenges in thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45482889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}