JTCVS open最新文献

{"title":"Association between postoperative iliopsoas muscle cross-sectional area changes and prognosis in elderly patients with lung cancer","authors":"Shoko Kubota MD ,&nbsp;Joji Samejima MD, PhD ,&nbsp;Makoto Tada MD, PhD ,&nbsp;Tomohiro Miyoshi MD, PhD ,&nbsp;Kenta Tane MD, PhD ,&nbsp;Yuki Matsumura MD, PhD ,&nbsp;Keiju Aokage MD, PhD ,&nbsp;Masahiro Tsuboi MD, PhD","doi":"10.1016/j.xjon.2026.101579","DOIUrl":"10.1016/j.xjon.2026.101579","url":null,"abstract":"<div><h3>Background</h3><div>The cross-sectional area (CSA) of the iliopsoas muscle on computed tomography is associated with sarcopenia, but its perioperative changes and prognostic significance in lung cancer remain unclear. This study aimed to clarify postoperative changes in the iliopsoas CSA and their prognostic correlation in the perioperative period of lung cancer.</div></div><div><h3>Methods</h3><div>We analyzed 270 patients with lung cancer age ≥70 years who underwent lobectomy between January 2016 and December 2020. Iliopsoas CSA at the L3 vertebral level was measured preoperatively and at 6 and 12 months postoperatively and analyzed with ImageJ software. Patients were grouped based on whether their CSA decreased or increased between 6 months and 12 months postoperatively. Recurrence-free survival (RFS) and overall survival (OS) were compared between groups.</div></div><div><h3>Results</h3><div>Compared with preoperatively, the iliopsoas CSA was decreased significantly at 6 months (23.2 mm²; <em>P</em> &lt; .01) and 12 months (15.5 mm²; <em>P</em> = .03). Patients in the decreasing CSA were older (<em>P</em> = .02), more often male (<em>P</em> = .02), and had poorer lung function (<em>P</em> = .04). Decreased CSA was linked to poorer 5-year RFS (<em>P</em> = .07) and significantly worse OS (<em>P</em> = .04). The multivariate analysis revealed that a decrease in iliopsoas muscle CSA between 6 months and 12 months postoperatively was an independent poor prognostic factor for RFS (<em>P</em> &lt; .01) and OS (<em>P</em> = .05).</div></div><div><h3>Conclusions</h3><div>In elderly patients with primary lung cancer, decreased iliopsoas CSA from 6 months to 12 months postoperatively was at least an independent poor prognostic factor for OS.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"30 ","pages":"Article 101579"},"PeriodicalIF":1.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147720241","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":"The impact of perioperative outcomes on long-term survival after esophageal cancer resection","authors":"Carolyn C. Chang MD ,&nbsp;Ntemena Kapula MAS ,&nbsp;Irmina A. Elliott MD ,&nbsp;Brandon Guenthart MD ,&nbsp;Douglas Z. Liou MD ,&nbsp;Natalie S. Lui MD ,&nbsp;Leah Backhus MD ,&nbsp;Joseph B. Shrager MD ,&nbsp;Mark F. Berry MD","doi":"10.1016/j.xjon.2026.101615","DOIUrl":"10.1016/j.xjon.2026.101615","url":null,"abstract":"<div><h3>Objective</h3><div>Current metrics for quality of care after esophagectomy rely on short-term perioperative outcomes. We aimed to evaluate the relationship of perioperative outcomes and long-term survival after esophagectomy for esophageal cancer.</div></div><div><h3>Methods</h3><div>Institutions in the National Cancer Database performing ≥20 esophagectomies (2010-2019) were ranked by a weighted composite score of major perioperative events—length of stay &gt;20 days, unplanned readmissions, and 30-day mortality—and stratified into quintiles. Survival between centers with the least perioperative morbidity (quintile 1) and all other centers (quintiles 2-5) was compared using Kaplan-Meier, Cox proportional hazard, and landmark analyses.</div></div><div><h3>Results</h3><div>Overall, 11,036 patients with esophageal cancer who underwent esophagectomy at 209 institutions were included. Of those, 1825 (17%) patients were treated at 42 quintile 1 centers and 9211 (83%) were treated at 167 quintiles 2-5 centers. Prolonged length of stay (15% vs 7.9%, <em>P</em> &lt; .001), unplanned readmissions (7.1% vs 4.1%, <em>P</em> &lt; .001) and 30-day mortality (3.1% vs 0.5%) were all significantly greater at the quintile 2-5 centers. Five-year overall survival was better at quintile 1 centers in both univariable (51.9% vs 47.7%, <em>P</em> &lt; .001), and in multivariable analysis (hazard ratio 0.89, <em>P</em> = .004). Significantly better survival continued to be observed at quintile 1 centers on landmark analysis that excluded patients who died within 6 months (55.8% vs 47.7%, <em>P</em> = .036).</div></div><div><h3>Conclusions</h3><div>Our study demonstrates that patients undergoing esophagectomy for esophageal cancer at centers with lower rates of major perioperative events had improved long-term survival, suggesting that short-term metrics can serve as indicators of long-term performance and oncologic efficacy.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"30 ","pages":"Article 101615"},"PeriodicalIF":1.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147720247","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":"Transformers in surgical artificial intelligence: A domain-stratified, study-level narrative review","authors":"Andres Bravo MBI, BScH,&nbsp;Sara Razzaq MD,&nbsp;Mohan Murari MS,&nbsp;Aditya Ahuja BSc,&nbsp;Danielle Birchett BS,&nbsp;Lana Schumacher MD","doi":"10.1016/j.xjon.2026.101597","DOIUrl":"10.1016/j.xjon.2026.101597","url":null,"abstract":"<div><h3>Objective</h3><div>The objective was to synthesize study-reported outcomes of transformer-based artificial intelligence systems in surgical domains and describe settings where they appear advantageous relative to nontransformer models and human benchmarks.</div></div><div><h3>Methods</h3><div>We searched major databases: PubMed, Embase, IEEE Xplore, ScienceDirect, Google Scholar, arXiv, and Cochrane Library. Eligible studies evaluated transformer architectures in surgical/perioperative contexts (medical imaging, workflow recognition, prognosis-related modeling, or education) and reported quantitative outcomes. Because of heterogeneous tasks/metrics, we performed a domain-organized narrative synthesis. Where the same study reported transformers and nontransformers on the same dataset/metrics, we computed within-study deltas (Δ = Transformers – Nontransformers) and summarized medians and interquartile ranges alongside vote counts (T&gt;NT/tie/T&lt;NT). No cross-study pooling or hypothesis testing was performed.</div></div><div><h3>Results</h3><div>Paired comparisons favored transformers in medical imaging for 15 of 20 (75.0%) with median Δ +1.13 percentage points (interquartile range, 3.70) and in workflow recognition for 28 of 34 (82.4%) with median Δ +1.75 percentage points (interquartile range, 3.28). Prognosis had sparse paired data (n = 1; Δ +3.0 percentage points; illustrative). Education favored transformers overall in 5 of 6 (83.3%) paired comparisons, driven by surgery time prediction; diagnostic education tasks were mixed. Reported advantages were task dependent and dataset specific; gains were typically single-digit percentage points in like-for-like settings.</div></div><div><h3>Conclusions</h3><div>Transformers frequently match or exceed nontransformer baselines in surgical imaging and workflow tasks, with promising, yet heterogeneously reported, signals in prognosis and education. Translation to dependable clinical/educational impact will require standardized benchmarks, external/prospective validation, transparent comparator reporting (including human baselines), and deployment studies that address real-time operating room constraints and fairness across patient and learner groups.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"30 ","pages":"Article 101597"},"PeriodicalIF":1.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147720360","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":"Crystalloid cardioplegia versus cold blood cardioplegia in aortic arch surgery: A noninferiority randomized trial","authors":"Shota Hasegawa MD,&nbsp;Katsuhiro Yamanaka MD, PhD,&nbsp;Ryo Kawabata MD,&nbsp;Hironaga Shiraki MD,&nbsp;Shunya Chomei MD,&nbsp;Noriko Ohyama MD,&nbsp;Taishi Inoue MD, PhD,&nbsp;Soichiro Henmi MD, PhD,&nbsp;Hiroaki Takahashi MD, PhD,&nbsp;Kenji Okada MD, PhD","doi":"10.1016/j.xjon.2026.101578","DOIUrl":"10.1016/j.xjon.2026.101578","url":null,"abstract":"<div><h3>Background</h3><div>The optimal cardioplegic solution to use during aortic surgery remains unclear. While cold blood cardioplegia (BCP) has metabolic advantages, crystalloid cardioplegia (CCP) offers practical benefits. This trial investigated whether cold CCP is noninferior to cold BCP in preserving postoperative left ventricular ejection fraction (LVEF).</div></div><div><h3>Methods</h3><div>In this single-center, patient- and assessor-blinded, parallel-group noninferiority randomized trial, 52 adult patients undergoing elective aortic arch replacement were randomized 1:1 to receive cold BCP or CCP. The primary endpoint was LVEF on postoperative day 7. The noninferiority margin was set at −7%. Secondary endpoints included change in LVEF, mortality, low-output syndrome, myocardial infarction (MI), creatine kinase MB isotype (CK-MB) release, left ventricular diastolic dysfunction, right ventricular systolic dysfunction, stroke, atrial fibrillation, pacemaker implantation, mediastinal drainage, reexploration for bleeding, and acute kidney injury.</div></div><div><h3>Results</h3><div>The median aortic cross-clamp time was 96 minutes. Baseline LVEF was similar in the 2 groups (BCP, 61.1 ± 5%; CCP, 61.7 ± 5%; <em>P</em> = .66). The mean difference in postoperative LVEF (CCP – BCP) was 1.23%, with a 95% confidence interval of −5.48% to 2.69%, exceeding the noninferiority margin and confirming noninferiority (<em>P</em> = .0041). Peak CK-MB levels were comparable in the 2 groups (BCP, 35.0 ± 15 U/L; CCP, 41.6 ± 22 U/L; <em>P</em> = .22), although levels at 7 hours and 24 hours were lower in the BCP group (<em>P</em> = .034 and .046, respectively). One in-hospital death occurred in the BCP group, and 1 case of low output syndrome occurred in the CCP group. Postoperative MI occurred in 4 patients (2 per group), with no significant differences in other secondary endpoints.</div></div><div><h3>Conclusions</h3><div>Cold CCP appeared to be noninferior to cold BCP for myocardial protection in elective aortic arch replacement, as suggested by comparable postoperative LVEF.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"30 ","pages":"Article 101578"},"PeriodicalIF":1.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147720457","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":"Redo total arch replacement with frozen elephant trunk for patients with previous proximal aortic replacement for acute type A dissection","authors":"Markian Bojko MD, MPH,&nbsp;Maylis Basturk BA,&nbsp;Valerie Huang MD,&nbsp;Serge Kobsa MD, PhD,&nbsp;Fernando Fleischman MD","doi":"10.1016/j.xjon.2026.101588","DOIUrl":"10.1016/j.xjon.2026.101588","url":null,"abstract":"<div><h3>Objectives</h3><div>The extent of arch replacement for aortic dissection remains controversial. The natural history of a residually dissected arch remains unknown, and the morbidity of arch reintervention in these settings is understudied. Therefore, the aim of this study was to investigate outcomes of redo total arch replacement in patients who had previous proximal aortic repair for acute type A dissection.</div></div><div><h3>Methods</h3><div>In total, 79 consecutive patients underwent redo total arch replacement with frozen elephant trunk after previous type A dissection repair. Surgical outcomes were obtained from the institutional database and the electronic medical record was reviewed for follow-up outcomes.</div></div><div><h3>Results</h3><div>The median time between type A repair and redo total arch replacement with frozen elephant trunk was 4.25 [2.05, 7.78] years. The most common comorbidity was hypertension in 76 of 79 (96.2%), and 14 of 79 (17.7%) had previous cerebrovascular disease. The median crossclamp and circulatory arrest times (minutes) were 78 [61, 108] and 18 [14, 25], respectively. The operative mortality rate was 3 in 79 (3.8%), the postoperative stroke rate was 7 of in (8.9%), and the paraplegia rate was 4 in 79 (5.1%). The 1-year survival was 93.5% (88.1%-99.2%), and the 3-year cumulative incidence of aortic reintervention was 53.1% (38.3%-65.8%). In total, 35 patients required distal aortic reintervention, including 19 distal thoracic endovascular aortic repair extensions, and 5 open thoracoabdominal aneurysm repairs.</div></div><div><h3>Conclusions</h3><div>Redo total arch replacement after previous proximal aortic repair for acute type A dissection can be performed safely at an experienced aortic referral center.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"30 ","pages":"Article 101588"},"PeriodicalIF":1.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147720460","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":"Impact of prolonged microaxial flow pump support on outcomes in heart transplantation: A single-center experience","authors":"Muhammad F. Masood MD ,&nbsp;Mehran Rahimi MD ,&nbsp;Ryan Mikami BS ,&nbsp;Mary Kate Freyaldenhoven BS ,&nbsp;R.J. Waken PhD ,&nbsp;Irene Fischer MPH ,&nbsp;Maxwell Braasch MD ,&nbsp;Maya Weerasooriya BS ,&nbsp;Jackson Haynes BS ,&nbsp;Nguyen Huyen Tran Nguyen BS ,&nbsp;Kunal Kotkar MD ,&nbsp;Ralph J. Damiano Jr. MD ,&nbsp;Tsuyoshi Kaneko MD ,&nbsp;Amit Pawale MD","doi":"10.1016/j.xjon.2026.101616","DOIUrl":"10.1016/j.xjon.2026.101616","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate whether patients receiving prolonged Impella 5.5 support (greater than 30 days) as a bridge to heart transplantation experience comparable outcomes with those receiving shorter-term support (up to 30 days).</div></div><div><h3>Methods</h3><div>Institutional data were queried between December 2020 and December 2024 for adult patients who were bridged to heart transplantation with the Impella 5.5 device. Patients were stratified into 2 cohorts on the basis of the duration of Impella support (30 days or less vs more than 30 days). Key end points including in-hospital mortality rate and Impella-related complications were compared.</div></div><div><h3>Results</h3><div>Of 359 patients who received an Impella 5.5 at our institution, a total of 66 patients were bridged to heart transplantation, which included 45 patients receiving short-term support and 21 patients receiving prolonged support. The proportion of listed patients on short-term and prolonged Impella support who received a HeartMate 3 was 6.7% and 0%, respectively (0.546). The waitlist mortality rate for patients with short-term and prolonged Impella 5.5 support was 8.9% and 14.3%, respectively (<em>P</em> = .645). There was no 90-day posttransplantation mortality in both groups. The rate of Impella-related complications for patients receiving short-term and prolonged Impella 5.5 support was comparable between the 2 groups except for bleeding and ventricular tachyarrhythmia, which occurred more frequently in prolonged group (<em>P</em> &lt; .05).</div></div><div><h3>Conclusions</h3><div>Prolonged Impella 5.5 support was associated with comparable waitlist mortality and greater device-related complications. Our data suggest that prolonged Impella 5.5 support is a viable strategy for bridge to heart transplantation.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"30 ","pages":"Article 101616"},"PeriodicalIF":1.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147720624","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":"Evaluation of dual-lumen pulmonary artery cannulation in extracorporeal right ventricular support","authors":"Valeria Lo Coco MD ,&nbsp;Michele Di Mauro MD, PhD ,&nbsp;Silvia Mariani MD, PhD ,&nbsp;Elham Bidar MD, PhD ,&nbsp;Kasia Hryniewicz MD, PhD ,&nbsp;Antonio Loforte MD, PhD ,&nbsp;Thomas Fux MD, PhD ,&nbsp;Sam Heuts MD, PhD ,&nbsp;Dominik Wiedemann MD, PhD ,&nbsp;Michal Kawcynsky MD, PhD ,&nbsp;Tom Verbelen MD, PhD ,&nbsp;Lars Mikael Broman MD, PhD ,&nbsp;Jamila Kremer MD, PhD ,&nbsp;Matteo Pozzi MD, PhD ,&nbsp;Koji Takeda MD, PhD ,&nbsp;Udo Boeken MD, PhD ,&nbsp;Yih-Sharng Chen MD, PhD ,&nbsp;Paolo Masiello MD, PhD ,&nbsp;Dominik J. Vogel MD, PhD ,&nbsp;Jacinta J. Maas MD, PhD ,&nbsp;Stephanie Bertolin MD","doi":"10.1016/j.xjon.2026.101699","DOIUrl":"10.1016/j.xjon.2026.101699","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate whether dual-lumen (DL) versus single-lumen (SL) pulmonary artery cannulation improves outcomes in patients with refractory right ventricular failure (RVF) supported with extracorporeal life support and to identify which patients benefit most.</div></div><div><h3>Methods</h3><div>We conducted a multicenter retrospective cohort study using the international PLACE registry (2000-2020). Adults undergoing pulmonary artery cannulation for isolated RVF were included. Outcomes were in-hospital and 30-day mortality, bleeding, thromboembolic events, continuous renal-replacement therapy, and length of stay. Propensity score weighting was applied to adjust for baseline differences. Prespecified analyses tested effect modification by hypoxemia, renal function, platelet count, cannulation site, and oxygenator use. Mediation and clustering were used to explore physiological pathways and phenotypes.</div></div><div><h3>Results</h3><div>Among 345 patients, DL cannulation was associated with lower postoperative lactate and creatinine and with fewer bleeding events. In weighted multivariable models, DL reduced the risk of bleeding and the composite of bleeding or thromboembolism (weighted odds ratio, 0.50; 95% CI 0.32-0.77; <em>P</em> = .0017 and weighted odds ratio, 0.57; 95% CI 0.39-0.84; <em>P</em> = .004). Hypoxemia significantly strengthened the survival benefit of DL, whereas cannulation site and oxygenator use did not modify outcomes. Mediation analyses indicated that the effect of DL on survival was indirect, operating through early improvement in perfusion and renal function. Unsupervised clustering identified distinct postoperative biochemical phenotypes with markedly different prognoses; DL was associated with a shift toward favorable profiles.</div></div><div><h3>Conclusions</h3><div>In extracorporeal life support for RVF, DL pulmonary artery cannulation improves outcomes primarily by enhancing early organ function and reducing complications. Patients with baseline hypoxemia appear to benefit most, supporting a physiology-guided approach to cannulation strategy.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"30 ","pages":"Article 101699"},"PeriodicalIF":1.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147720619","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":"Mapping surgical deserts of cardiovascular training in Latin America: A geospatial and structural analysis","authors":"Wildor Samir Cubas MD, MSc ,&nbsp;Joaquín Gundelach MD ,&nbsp;Lorena Montes MD ,&nbsp;Maximiliano Hernández MD ,&nbsp;Santiago Cubas MD ,&nbsp;Carolina Sosa Vota MD ,&nbsp;Juan Andrés Montero MD ,&nbsp;Gerardo Soca MD, MSc ,&nbsp;Víctor Dayan MD, PhD ,&nbsp;Michael W.A. Chu MD, MEd","doi":"10.1016/j.xjon.2026.101675","DOIUrl":"10.1016/j.xjon.2026.101675","url":null,"abstract":"<div><h3>Objective</h3><div>Latin America faces significant disparities in cardiovascular surgery training access. We used a driven geospatial analysis to map surgical deserts—underserved regions to surgical education—and quantified disparities through population-adjusted density metrics and structural variables.</div></div><div><h3>Methods</h3><div>Geospatial analysis mapped all cardiovascular surgery training programs in Latin America. A Composite Access Index (density, travel time, economics, structure) was developed. Hierarchical clustering and regression were used to identify surgical deserts and structural impacts, revealing 3 types: geographic, structural, and economic.</div></div><div><h3>Results</h3><div>A total of 243 cardiovascular surgery programs across 19 Latin American countries provided 454 annual positions. Brazil leads with 170 programs and 280 positions, whereas Guatemala, Honduras, and Nicaragua each have 1 program offering 2 positions. Program density is greatest in Cuba (3.39 positions/million), followed by Uruguay (0.88), Peru (0.73), and Panama (0.67), and lowest in Guatemala (0.11), Argentina (0.13), and Venezuela (0.14). Integrated residency models exist in Cuba, Panama, Peru, and Ecuador; only Brazil, Chile, Mexico, and Venezuela require board examinations. Health spending per capita ranges from $934 in Chile to $35 in Haiti. The Composite Access Index highlights high-access countries (Cuba 1.00, Uruguay 0.95, Chile 0.85), moderate-access (Brazil 0.69, Peru 0.75, Colombia 0.64), and limited-access “surgical deserts” (Bolivia 0.31, Guatemala 0.27). Regression analyses showed no significant effect of structure requirements on access (<em>P</em> &gt; .77). Funding, decentralization, and geography are primary determinants of equitable training.</div></div><div><h3>Conclusions</h3><div>This comprehensive mapped study exposes that cardiovascular surgery training in Latin America is highly unequal; surgical deserts persist as a result of limited funding, geographic isolation, and program decentralization, whereas structural requirements minimally influence access.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"30 ","pages":"Article 101675"},"PeriodicalIF":1.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147720774","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":"Surgical nodal sampling established by Commission on Cancer Standard 5.8 is essential for accurate lung cancer staging","authors":"Raheem Bell MD, MS ,&nbsp;Amanda B. Francescatti MS ,&nbsp;Daniel Boffa MD ,&nbsp;Timothy W. Mullett MD ,&nbsp;Matthew A. Facktor MD ,&nbsp;Nirmal K. Veeramachaneni MD ,&nbsp;Ryan C. Jacobs MD, MS ,&nbsp;Frank Schneider MD ,&nbsp;Tina J. Hieken MD ,&nbsp;David D. Odell MD, MMSc ,&nbsp;Ronald J. Weigel MD, PhD, MBA","doi":"10.1016/j.xjon.2026.101685","DOIUrl":"10.1016/j.xjon.2026.101685","url":null,"abstract":"<div><h3>Objective</h3><div>Accurate mediastinal staging is critical for the effective treatment of non–small cell lung cancer because lymph node involvement significantly influences prognosis and therapeutic decisions. We sought to evaluate the diagnostic accuracy, limitations, and complementary roles of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), cervical mediastinoscopy, and surgical lymph node sampling in mediastinal staging of non–small cell lung cancer.</div></div><div><h3>Methods</h3><div>A systematized literature review was performed using PubMed and national guideline repositories. Studies were included if they reported or provided sufficient data to calculate the negative predictive value (NPV) for EBUS-TBNA, mediastinoscopy, or surgical lymph node sampling. Data were synthesized qualitatively across different clinical scenarios.</div></div><div><h3>Results</h3><div>The pooled (unweighted) NPV of EBUS-TBNA was 93.2% (range, 84.7%-98%). Mediastinoscopy demonstrated a pooled NPV of 93.8% (range, 78.8%-97%), with most false negatives attributable to inaccessible stations. Surgical lymph node sampling yielded a pooled NPV of 92.2% (range, 83.6%-96%) for resected nodal stations, although assessment is limited by variability across studies with inconsistent surgical approaches. These data support the need for systematic intraoperative nodal evaluation to confirm pathologic stage and inform treatment selection.</div></div><div><h3>Conclusions</h3><div>Although EBUS-TBNA is the preferred initial staging modality due to its minimally invasive nature, its diagnostic limitations warrant a low threshold for additional nodal evaluation. Systematic intraoperative lymph node evaluation at the time of surgical resection is indispensable for definitive staging, providing clinically actionable data that influences treatment decisions. Optimal staging of non–small cell lung cancer requires a multidisciplinary, individualized approach that combines modalities based on pretest probability, imaging findings, and patient factors.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"30 ","pages":"Article 101685"},"PeriodicalIF":1.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147720862","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 contemporary nationwide analysis of neoadjuvant regimens for esophageal adenocarcinoma","authors":"Jorge Humberto Rodriguez-Quintero MD, MPH,&nbsp;Grace Ha MD,&nbsp;Rajika Jindani MD,&nbsp;Isaac Loh BS,&nbsp;Rolfy Perez-Holguin MD,&nbsp;Neel P. Chudgar MD,&nbsp;Brendon M. Stiles MD","doi":"10.1016/j.xjon.2026.101591","DOIUrl":"10.1016/j.xjon.2026.101591","url":null,"abstract":"<div><h3>Background</h3><div>In the United States, neoadjuvant chemoradiotherapy with CROSS (41.6 Gy, carboplatin/paclitaxel) has been the standard for patients with operable locally advanced esophageal adenocarcinoma (EAC). Recently, the ESOPEC multicenter phase III trial reported superior overall survival (OS) with perioperative FLOT (5-FU/leucovorin/oxaliplatin/docetaxel) compared to CROSS. We aimed to examine trends in neoadjuvant treatment strategies and compare outcomes in a contemporary real-world cohort.</div></div><div><h3>Methods</h3><div>Patients with clinical stage II-IVA (T2-4aN0-3M0 by the American Joint Committee on Cancer 8th Edition staging classification) EAC who underwent neoadjuvant chemoradiation (nCRT; ≥41.4 Gy) or neoadjuvant chemotherapy (nCT) followed by esophagectomy were identified in the National Cancer Database (2015-2022). Postoperative outcomes and overall survival (Kaplan-Meier) were compared in propensity-matched cohorts.</div></div><div><h3>Results</h3><div>A total of 9845 patients were identified, of whom 8955 (91.0%) received nCRT and 890 (9.0%) received nCT before esophagectomy. The median patient age was 65 years (interquartile range [IQR], 58-71 years), and 88.1% (n = 8674) of the patients were male. Over time, there was trend toward increasing use of nCT, from 6.7% of patients in 2015 to 9.6% in 2022 (<em>P</em> &lt; .001). In well-balanced matched cohorts (1:1, nCT vs nCRT; n = 106), despite an improved pathologic response with nCRT, nCT was associated with improved OS (median, 51.4 months vs 40.5 months; <em>P</em> = .029; hazard ratio, 0.82; 95% confidence interval, 0.68-0.98) and a better 5-year OS rate (49.8% vs 43.3%) at a median follow-up of 28.8 months (IQR, 17.2-42.5 months).</div></div><div><h3>Conclusions</h3><div>In a contemporary cohort of patients with locally advanced EAC, nCRT remained the predominant approach. However, consistent with ESOPEC, nCT alone was associated with improved OS.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"30 ","pages":"Article 101591"},"PeriodicalIF":1.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147720246","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}