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Journal and News Scan
September 16, 2015
Submitted by: Mark Ferguson
The 6th and 7th versions of the AJCC staging system were compared for their prognostic accuracy for patients with esophagogastric adenocarcinomas using an institutional database. The 7th edition system was significantly more accurate in groups undergoing MIE, induction therapy, and overall.
September 12, 2015
Submitted by: Mark Ferguson
This randomized trial compared induction therapy for pathologically-proven N2/IIIA NSCLC with 3 cycles of cisplatinum and docetaxel chemotherapy alone to chemotherapy combined with 44 Gy of radiation therapy. 232 pts in 23 centers were enrolled over a 12 year period. No differences were identified in the chemotherapy vs chemoradiotherapy groups for event-free survival (11.6 vs 12.8 mos) or median survival (26.2 vs 37.1).
Comparative Histology of Aortic Dilatation Associated With Bileaflet Versus Trileaflet Aortic Valves
September 9, 2015
Submitted by: Arie Blitz
Resected aortas associated with a bicuspid aortic valve (BAV,n = 60) and trileaflet aortic valve (n = 24) in patients with aortic valve disease were compared with normal diameter aortas from patients undergoing cardiac transplantation (n = 16) by five histologic criteria. The extent of elastic fiber loss, smooth muscle cell loss, medial fibrosis, and atherosclerosis was more severe in trileaflet aortic valve than BAV when considered across all diameters and when stratified to those between 4 and 5 cm. This finding begs the question: Should the guideline-recommended more aggressive threshold for replacing the aorta in BAV patients as compared to trileaflet aortic valve patients be revisited?
September 8, 2015
Submitted by: Mark Ferguson
This single institution study involving 606 patients operated 2000-2012 examined the influence of the extent of lymphadenectomy on survival. The number of nodes resected was not related to all-cause mortality, even comparing the highest and lowest quartiles. The number of metastatic nodes and an increasing ratio of positive to negative nodes were each related to increasing mortality rates in a dose-response relationship.
September 5, 2015
Submitted by: Mark Ferguson
The consequences of the flawed process of investigation of scientific misconduct and premature conclusions of the outcomes are discussed.
September 4, 2015
Submitted by: Mark Ferguson
Changes in risk profile and outcomes over 40 years were assessed from the Stanford experience with heart transplant in children. Age at transplant decreased in the most recent time period from about 10 to 5.6 years. The use of mechnical support as bridge increased dramatically over the time of the study. Long-term survival increased dramatically, and patients with cardiomyopathy had a survival advantage over those with congenital heart disease.
September 4, 2015
Submitted by: Mark Ferguson
This study used a multicenter cohort in Italy to identify prognostic indicators for 3-year survival in patients who had undergone extrapleural pneumonectomy (EPP) for mesothelioma. 23% lived 3 years or longer. This survival was related to age, epitheliod histology, lack of asbestos exposure, and involved LN ratio. A risk score for survival was developed based on these factors.
September 4, 2015
Submitted by: Mark Ferguson
This study from the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative evaluated outcomes of CABG in 33 hospitals 2011-2013, assessing the association of blood transfusion (39.9% of pts) and the incidence of postoperative pneumonia (3.6% of pts). Blood transfusion was associated with an increased risk of pneumonia (OR 3.4), and there was a dose-response relationship between the number of units transfused and pneumonia risk.
September 4, 2015
Submitted by: Mark Ferguson
Short- and mid-term outcomes of TAVR for nonagenarian (>90 years) patients in the PARTNER-1 trial were assessed for 531 pts. MACE occurred in 35% including stroke in 3.6%. Important paravalvular leak occurred in 1.4%. 30-day mortality was 4% and 3-year mortality was 48%, which compared to 44% in a matched population. QOL stabilized at 6 months and was better than preop. A trans-apical approach had a higher risk of 30-day and 3-year mortality.
September 4, 2015
Submitted by: Mark Ferguson
Long-term outcomes of endovascular (EVAR) and open repair of abdominal aortic aneurysm (AAA) were compared using a California-based dataset including more than 23,000 pts. Postoperative outcomes were better with EVAR, and survival at 3 years was better with EVAR. After 3 years, mortality was higher for EVAR, and EVAR was associated with higher rates of reintervention and of late AAA rupture.