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Journal and News Scan
February 21, 2015
Submitted by: Mark Ferguson
Indications for postoperative radiation therapy (PORT) for resected lung cancer are unclear. This study evaluated outcomes from the National Cancer Data Base 2004-2006, including 2115 patients resected with pathologic N2 NSCLC, of whom 918 (43%) received PORT. PORT was associated with better median survival (42 vs 38 mos, p=0.048) and was associated with improved survival on multivariable analysis.
February 21, 2015
Submitted by: Mark Ferguson
SEER outcomes from 1973-2010 were evaluated, including a total of over 947,000 pts, of whom only 441 had atypical carcinoid tumors of the lung. 69% were women and 87% were white. 20% had stage IV disease at diagnosis. 78% of the patients underwent resection. 3-year survival was 85% for N0, 69% for N1-2, and 26% for stage IV.
February 21, 2015
Submitted by: Arie Blitz
The meta-analysis by Kowalewski et al found that implantable gentamicin collagen sponges significantly reduced the incidence of sternal wound infections by nearly 40%.
February 21, 2015
Submitted by: Mark Ferguson
Beautiful video. The background music is also beautiful, but I think something with more of a beat would have been appropriate.
February 16, 2015
Submitted by: Marcelo Jimenez
Usually patients with prior cancer are excluded in lung cancer trials, but the impact on survival in lung cancer is not known. In a cohort of 102929 patients older than 65 with stage IV lung cancer, a propensity score analysis were performed and found that patients with prior cancer had better survival (all-cause and lung cancer-specific). Therefore these patients with prior cancer should be considered candidates for clinical trials for advanced lung cancer.
February 16, 2015
Submitted by: Mark Ferguson
This trial randomized 61 pts to a program of endurance and strength training or no training beginning 5-7 weeks after lung resection for cancer and lasting 20 weeks. Compared to controls, treatment group patients demonstrated significant improvements in peak O2 uptake, DLCO, leg and arm strength, muscle mass, and QOL.
February 14, 2015
Submitted by: Mark Ferguson
The author presents credible (and enticing) evidence for eating dark chocolate for health reasons, including managing hypertension and cardiovascular disease.
February 13, 2015
Submitted by: Ruben Osnabrugge
The authors evaluated the change in risk profile of 65097 patients who underwent CABG between 1997 and 2011 in the Veterans Affairs Surgical Quality Improvement Program (VASQIP). They found that there was a marked increase in the prevalence of obesity, diabetes, left main coronary artery disease and NYHA class. Prevalences of previous myocardial infarction, low ejection fraction and advanced angina decreased. Importantly, operative mortality decreased over time. The trends confirm the general perception of ongoing improvement in outcomes, despite a sicker and older population.
February 11, 2015
Submitted by: Arie Blitz
The authors analyzed all patients greater than age 18 in the National Inpatient Sample from 1998-2011 to evaluate trends and outcomes of tissue vs. mechanical aortic valve replacements. Implantation of tissue valves increased overall from 38% to 64% when comparing the earlier era to the later one. The patients undergoing tissue AVR had a greater presence of comorbidites and concomitant operations. Whereas the complication rate was higher in the tissue valve population, the mortality rate was lower. Interestingly, lower volume facilities tended to favor mechanical AVR and higher volume facilities tended to favor tissue AVR.
February 10, 2015
Submitted by: Arie Blitz
Dr. Reed et al from the Cleveland Clinic conducted this prospective study to assess whether VerifyNow point-of-care platelet testing could predict bleeding in 39 patients receiving Plavix and undergoing CABG. Patients in higher PRU quartiles experienced smaller decreases in hematocrit and less bleeding. By ROC analysis, a PRU threshold of ≤207 was the optimal threshold for discrimination of major bleeding during surgery, with 85% sensitivity and an 89% NPV.
Question: Should VerifyNow platelet testing be used as a discriminator for timing of CABG rather than waiting the guideline-recommended 5 days for patients who have received Plavix?