Ramponi F, Wilson MK, Vedelago J, Bayfield MS
ANZ J Surg 2011 Nov;81(11):843-4
PMID: 22295336
True video-assisted thoracic surgery for early-stage non-small cell lung cancer
Cao CQ, Stine ML, Yan TD
J Thorac Dis 2009 Dec;1(1):34-8
PMID: 22263000
Abstract
Since its inception, minimally invasive surgery has made a dramatic impact on all branches of surgery. Video-assisted thoracic surgery (VATS) lobectomy for early-stage non-small cell lung cancer (NSCLC) was first described in the early 1990s and has since become popular in a number of tertiary referral centers. Proponents of this relatively new procedure cite a number of potentially favorable perioperative outcomes, possibly due to reduced surgical trauma and stress. However, a significant proportion of the cardiothoracic community remains skeptical, as there is still a paucity of robust clinical data on long-term survival and recurrence rates.The definition of ‘true’ VATS has also been under scrutiny, with a number of previous studies being considered ‘mini-thoracotomy lobectomy’ rather than VATS lobectomy. We hereby examine the literature on true VATS lobectomy, with a particular focus on comparative studies that directly compared VATS lobectomy with conventional open lobectomy.
Treatment failure after extrapleural pneumonectomy for malignant pleural mesothelioma
Yan TD, Tin M, Boyer M, McLean J, G Bannon P, McCaughan BC
J Thorac Dis 2009 Dec;1(1):23-8
PMID: 22262998
Abstract
BACKGROUND: Extrapleural pneumonectomy (EPP) has been used as a treatment option for selected patients with malignant pleural mesothelioma (MPM). The primary end-point of this study was disease-free survival (DFS). Prognostic indicators for local and overall DFS were statistically analyzed.
METHODS: Between October 1994 to April 2008, 59 patients who had complete macroscopic cytoreduction after EPP formed the basis of this report. In recent years, selected patients received adjuvant radiotherapy and pemetrexed combined with cisplatin or carboplatin. The clinicopathologic data of all patients were prospectively collected in a computerized database. Statistical analysis was performed by using Kaplan-Meier method and compared using the log-rank test. Cox-regression model was used for multivariate analysis.
RESULTS: The mean age at the time of EPP was 59 (S.D. = 8) years. Nineteen patients (32%) experienced perioperative complications. The median survival was 21 months (range 2 to 104). The local disease recurrence rate was 51%. The median local DFS was 22 months (0 to 73). The overall disease recurrence rate was 64%. The median overall DFS was 18 months (range 0 to 73). In multivariate analysis, epithelial subtype (p = 0.026) and adjuvant radiotherapy (p = 0.023) were independently associated with an improved local DFS. Adjuvant radiotherapy (p = 0.011) was also independently associated with an improved overall DFS.
CONCLUSIONS: This study demonstrated that that local disease failure was still a considerable clinical problem following complete EPP. The data also showed that patients with epithelial histology and receiving adjuvant radiotherapy were associated with an improved disease control.
Management of the proximal anastomosis in open, hybrid repair of thoracoabdominal aortic aneurysm
Ramponi F, Leslie A, Stephen MS, White GH, Jeremy R, Wilson MK
Ann. Thorac. Surg. 2012 Jan;93(1):358-9; author reply 359-60
PMID: 22186475
Abstract
Anaortic off-pump coronary artery bypass grafting: The criterion standard for minimization of neurologic injury
Edelman JJ, Yan TD, Vallely MP
J. Thorac. Cardiovasc. Surg. 2012 Jan;143(1):251-2; author reply 252
PMID: 22172760
Abstract
Pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension : a systematic review
Rahnavardi M, Yan TD, Cao C, Vallely MP, Bannon PG, Wilson MK
Ann Thorac Cardiovasc Surg 2011;17(5):435-45
PMID: 21881372
Abstract
PURPOSE: Pulmonary thromboendarterectomy (PTE) is a treatment option for patients with chronic thromboembolic pulmonary hypertension (CTEPH). The present systematic review was performed to assess the safety and efficacy of PTE for CTEPH.
METHODS: A systematic review was performed, and six electronic databases were searched for published studies from January 1999 to February 2010. All articles that presented morbidity and mortality data, survival data or preoperative and postoperative pulmonary hemodynamic indices were included. The primary outcome measures extracted were early morbidity and mortality, pulmonary hemodynamic and functional outcome indices prior to and after the operation, and survival data.
RESULTS: Of the 654 publications retrieved, 19 relevant papers (total number of 2729 patients) representing the most recent and complete data set from each institute, were included for appraisal and data extraction. No randomized controlled trials or matched comparative studies were identified. Thirty-day mortality ranged from 1.3% to 24% (median 8%). Residual pulmonary hypertension was reported in 11%-35% of patients after PTE. Pulmonary artery pressure and pulmonary vascular resistance significantly decreased after PTE in all studies. Before PTE, 60%-100% of patients were in NYHA functional class III or IV. This percentage decreased to 0%-21% after PTE. Five-year survival ranged from 74% to 89%.
CONCLUSIONS: The current literature suggests that PTE for patients with CTEPH is associated with acceptable perioperative morbidity and mortality rates and improved hemodynamic indices and survival when viewed against the prognosis associated with historical controls using medical therapy.
