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Journal and News Scan
October 31, 2013
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129 pts with Barrett's esophagus with either no or low grade dysplasia were randomized to ablation with the argon plasma coagulator (APC) or observation. Ablation of >95% of Barrett's mucosa was initially achieved in 61 of 63 in the APC group. This decreased to 21 of 32 at long-term follow-up (>84 mos). The length of Barrett's decreased in the surveillance group from 4.2 cm at presentation to 2.7 cm at long-term follow-up. Sporadic low grade and high grade dysplasia developed in both groups, indicating that persistent surveillance is required.
October 31, 2013
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The ACOSOG Z4032 trial compared sublobar resection alone to sublobar resection with brachytherapy. This study compared surgical outcomes for wedge resection vs segmental resection, which were surgical options as part of the trial. Wedge resection was associated with a closer resection margin (8mm vs 15mm), a lower rate of nodal upstaging (1% vs 9%), fewer nodal stations sampled (1 vs 3), and a higher rate of no nodal sampling/dissection (41% vs 2%).
October 31, 2013
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Factors affecting RV to PA conduit durability were investigated in a multi-institution study involving 429 infants <2 years old. Conduit durability at a median f/u of 6 years was 63%. Earlier replacement was associated with a smaller z-score, and durability was reduced with implantation of allografts from aorta or PA compared to use of a valved bovine jugular vein.
October 31, 2013
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The efficacy of deep hypothermic circulatory arrest (DHCA) on preserving neurocognitive function is uncertain. This study compared 29 pts undergoing aortic surgery with DHCA to 33 who did not require DHCA. Cognitive scores preop and postop were similar for both groups. A similar number of pts (11 vs 13) experienced neurocognitive deficits postoperatively, including a decline in types of memory function. Time under DHCA was not associated with the incidence of neurocognitive deficits. Overall, cardiac surgery caused some problems with memory. DHCA, when required, preserved neurocognitive function.
October 31, 2013
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In the US, preoperative beta-blockade is a hospital quality metric that must be addressed at the time of each operation. This study reviewed STS Database data for isolated CABG in nearly 44,000 pts. After risk adjustment, beta-blockade had no effect on mortality, morbidity, or hospital resource utilization. The authors suggest that beta-blockade is not a useful quality metric for CABG.
October 31, 2013
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This article is a transcription of a roundtable discussion on surgical management of esophageal cancer involving recognized experts in the field. Topics include conduit preparation, pyloric drainage, conduit preconditioning, postoperative reflux, the role of surgery in multimodality therapy, and the choice of incisions for esophagectomy.
October 30, 2013
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This single-center study analyzed outcomes for 323 pts with esophageal adenocarcinoma who achieved a clinical CR after chemoradiotherapy to determine the prognostic value of pretreatment PET. Patients with an SUV >6 faired better with induction therapy and resection compared to definitive chemoradiotherapy. Those with an SUV <6 did equally well with either treatment regimen. PET SUV may facilitate determining whether bimodality or trimodality is optimal for patients with esophageal adenocarcinoma.
October 30, 2013
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This trial of 2218 pts with STEMI being transported for PCI randomized pts to bivalirudin or standard therapy (LMW heparin with optional glycoprotein IIb/IIIa inhibitors). The primary outcome was death or major bleeding. Bivalirudin was associated with a significant reduction (40%) in the primary outcome incidence but had a 6-fold increase in the incidence of acute stent thrombosis. Death and reinfarction rates were similar.
October 30, 2013
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This randomized trial included 148 pts with potentially resectable NSLCL. Mediastinal staging was randomized to EBUS-centered (EBUS possibly followed by EUS) or EUS-centered (EUS possibly followed by EBUS). Diagnostic accuracy and sensitivity were similar for both groups. Adding EBUS after initial EUS improved accuracy and sensitivity significantly, whereas adding EUS after initial EBUS did not significantly improve outcomes. The authors suggest that EBUS is the best first procedure in endoscopic mediastinal staging for potentially resectable lung cancer.
October 30, 2013
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Of nearly 360,000 pts in England diagnosed with a first primary lung cancer, outcomes were assessed for 465 patients who underwent resection for small cell cancer. 5-year survival was 45% for resected NSCLC, 31% for resected SCLC, and was 3% for patients who didn't have resection. Survival was better for patients who had a resection for known SCLC compared to those whose histologic diagnosis wasn't made until after surgery. The authors conclude that resection should be offered to selected patients with SCLC.