Mathias H. Aazami Torkel Aberg Clemens Aigner Cary W. Akins Nawwar Al-Attar Johannes M. Albes Ivan Aleksic Joseph Alex Vladimir Alexi-Meskishvili Christos Alexiou Ottavio R. Alfieri Zohair Y. Al-Halees Cem H. Alhan Imtiaz S. Ali Marco Alifano Nelson Alphonso Sharif Al-Ruzzeh Muhammad Muneer Amanullah Joseph J. Amato Vincenzo Ambrogi Marcello Carlo Ambrogi Gabriel Amir Luca Ampollini Robert H. Anderson Udo Christian Anegg Gianni D. Angelini Marco Anile Martine Antoine Carlo Antona Manuel J. Antunes Anelechi Anyanwu Jose I. Aramendi Jose Luis Aranda Olgun Kadir Aribas Kitipan V. Arom Hisao Asamura Athanasios C. Athanasiou Kalliopi Athanassiadi Tim Attmann Stephane Aubert Adel Khader Ayed Omer Aziz Jacques F. Azorin Jean Bachet Akin Eraslan Balci Xavier Baldo Yaron Bar-El Hendrick B. Barner David J. Barron Murat Basaran Cristina Basso Roberto Rafael Battellini Eugene Baudet Erwin P. Bauer Robert Bauernschmitt Urs Bauersfeld Yusuf Bayrak Matthias Bechtel David F. Beggs Ion P. Bellenis Jaroslav Benedik Federico Jose Benetti John R. Benfield Stefano Benussi Pascal A. Berdat Marius Berman Jose M. Bernal Marc-Andre Bernath Richard G. Berrisford Antoine A. Beuchat Friedhelm Beyersdorf Olivier Michel Bical Benjamin Bidstrup Paolo Biglioli Dietrich E. Birnbaum Gianluigi Bisleri Hartmuth B. Bittner Edward Black Antonio Bobbio Massimo Bonacchi Johannes Bonatti Pramod Bonde Philipp Bonhoeffer Andreas A. Boning Damien Bonnet Robert Stuart Bonser Michael A. Borger Ahmad Boseila Torsten Bossert Wolfgang Bothe Dietmar Bothig Tomaso Bottio Denis Bouchard Edward Thomas Brackenbury Michael Brandt William J. Brawn Pierre-Yves Brichon Christian Pierre Brizard Ivan Bruschweiler Alan J. Bryan Eric E. Buchser Gerald D. Buckberg Eric Gordon Butchart Jose M. Caffarena Antonio M. Calafiore Ayten K. Cangir Massimo Caputo Paolo Carbognani John Alfred Carr Thierry Carrel Angelo Carretta Raymond Cartier Aaron R. Casha Thierry Caus Alfredo Giuseppe Cerillo Stepan Cerny Alfredo Cesario Juan C. Chachques David J. Chambers Dominique Chapelle Pierre-Guy Chassot Nilanjan Chaudhuri Sylvain Chauvaud Olivier Chavanon Massimo Chello Yih-Sharng Chen Rene Chiolero Ray Chu-Jeng Chiu Cliff K. Choong Emmanuel Choukroun Thomas Decker Christensen Jan T. Christenson Paola Ciriaco Ali Civelek Massimiliano Codispoti Dennis V. Cokkinos Juan V. Comas John V. Conte Massimo Conti Graham J. Cooper Antonio F. Corno Joseph S. Coselli Maurizio Cotrufo Jacques Cotting Elvio Covino Jeremiah N. Cox Jochen T. Cremer John C. Criscione Martin Czerny Sabine H. Dabritz Willem Daenen Mark H.D. Danton Otto E. Dapunt John Dark Hiroshi Date Tirone E. David Michele De Bonis Tiziano De Giacomo Marc R. de Leval Sergio A. de Oliveira Ruggero De Paulis Marc de Perrot Raffaele De Simone Marek Andrzej Deja Alain Francois Delabays Dominique Delay Roland G. Demaria Murat M. Demirtas Thomas Deneke Joseph J. DeRose Paola D’Errigo Mohan P. Devbhandari Roberto Di Bartolomeo Duccio Di Carlo Roberto Di Donato Marco Di Eusanio Verdi J. Di Sesa Giovanni Dialetto Interactive CardioVascular and Thoracic Surgery 6 (2007) 143–146

Interactive CardioVascular and Thoracic Surgery - 2006 Reviewers

Background: In recent years, many factors have revamped the interest in segmentectomies as preferred procedure for stage I non-small cell lung cancer (NSCLC). The aim of this systematic review and meta-analysis is to compare the outcomes of segmentectomy versus lobectomy regarding overall survival (OS) in the surgical treatment of stage I NSCLC, as stated in the conclusions of the largest studies conducted in this field and reported to date. Methods: The searching strategy was developed in EMBASE, MEDLINE and Cochrane CENTRAL from 1990 until December 2016. The meta-analysis was performed with the combination of the reported survival outcomes of the individual studies using a random effect model. The OS of the lobectomy group was compared with the segmentectomy group alone. The hazard ratio (HR) and standard error were extracted or calculated for each study using the Kaplan-Meier method. Results: Regarding the results, most of these studies were based on the retrospective data. The size of the cohorts varied from 17 to 11,520, with a total number of 24,542 patients. The pooled HR was 1.04 [95% confidence interval (CI), 0.92–1.18; P=0.50]. Conclusions: The survival in the segmentectomy group was not inferior to patients treated with lobectomy. In conclusion, the current meta-analysis disclosed that segmentectomies produce similar survival compared to lobectomy for patients with stage I NSCLC. To establish the role of segmentectomy in early NSCLC, more evidence is needed, in particular, a large numbered, prospective, randomised trials, which should dissolve the uncertainties and the questions raised by retrospective data.

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Segmentectomy versus lobectomy for stage I non-small cell lung cancer: a systematic review and meta-analysis

Chest tube insertion is a common procedure usually done for the purpose of draining accumulated air or fluid in the pleural cavity. Small-bore chest tubes (≤14F) are generally recommended as the first-line therapy for spontaneous pneumothorax in non-ventilated patients and pleural effusions in general, with the possible exception of hemothoraces and malignant effusions (for which an immediate pleurodesis is planned). Large-bore chest drains may be useful for very large air leaks, as well as post-ineffective trial with small-bore drains. Chest tube insertion should be guided by imaging, either bedside ultrasonography or, less commonly, computed tomography. The so-called trocar technique must be avoided. Instead, blunt dissection (for tubes >24F) or the Seldinger technique should be used. All chest tubes are connected to a drainage system device: flutter valve, underwater seal, electronic systems or, for indwelling pleural catheters (IPC), vacuum bottles. The classic, three-bottle drainage system requires either (external) wall suction or gravity (“water seal”) drainage (the former not being routinely recommended unless the latter is not effective). The optimal timing for tube removal is still a matter of controversy; however, the use of digital drainage systems facilitates informed and prudent decision-making in that area. A drain-clamping test before tube withdrawal is generally not advocated. Pain, drain blockage and accidental dislodgment are common complications of small-bore drains; the most dreaded complications include organ injury, hemothorax, infections, and re-expansion pulmonary edema. IPC represent a first-line palliative therapy of malignant pleural effusions in many centers. The optimal frequency of drainage, for IPC, has not been formally agreed upon or otherwise officially established.

/pdf/chest-tube-drainage-of-the-pleural-space-a-concise-review-59yxqfh87d.pdf

Chest Tube Drainage of the Pleural Space: A Concise Review for Pulmonologists

Does Lymph Node Count Influence Survival in Surgically Resected Non-Small Cell Lung Cancer?

Whether stereotactic ablative radiotherapy (SABR) is comparable to surgery in treating stage I non-small-cell lung cancer (NSCLC) is unknown. Therefore, we conducted this meta-analysis to compare the efficacy of SABR with that of surgery in treating stage I NSCLC. A systematic literature search in PubMed, Embase, Cochrane Library databases and Google Scholar as well as the American Society of Clinical Oncology was conducted to identify relevant studies dated through 31 December 2015. Data including 3-year survival rate, overall survival (OS) and 3-year loco-regional control (LRC) rates were extracted and analysed. No complete randomized controlled trials but 12 cohort studies were included with a total of 13 598 patients. Meta-analysis showed a significantly lower 3-year survival rate (risk ratio = 0.78; 95% confidence interval [CI] = [0.68, 0.90]; P = 0.001) and shorter OS (hazard ratio =1.60; 95% CI = [1.24, 2.06]; P < 0.001) for patients treated with SABR compared with surgery. No difference in the 3-year LRC rate was observed between SABR and surgery (risk ratio = 0.95; 95% CI = [0.82, 1.09]; P = 0.453). Subgroup analysis was conducted on the basis of surgical procedures. In the subgroup analysis, SABR was found to yield significantly shorter OS than lobectomy (hazard ratio = 1.68; 95% CI = [1.09, 2.60]; P = 0.018), whereas SABR was comparable to sublobar resection in terms of 3-year survival rate, OS and 3-year LRC rate. Our meta-analysis found that lobectomy yielded better survival outcomes than SABR, whereas SABR yielded comparable rates when compared with sublobar resection. Lobectomy is still the preferred method for treating earlystage NSCLC. Well-designed and multicentred randomized controlled trials with large sample sizes, however, are needed to confirm and update our conclusions.

Radiotherapy, lobectomy or sublobar resection? A meta-analysis of the choices for treating stage I non-small-cell lung cancer.

Sublobar resection is equivalent to lobectomy for T1a non–small cell lung cancer in the elderly: a Surveillance, Epidemiology, and End Results database analysis

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was, 'in adult patients who require a tube thoracostomy, is the trocar technique comparable to blunt dissection in terms of rate of tube malposition or complications?' Altogether more than 258 papers were found using the reported search, of which 7 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers were tabulated. The articles included two retrospective reviews, three prospective observational studies and two prospective randomized studies. Of these, four papers concluded that the trocar technique was associated with a significantly higher rate of tube malposition and complications. One retrospective review found that the rate of tube malposition was similar in both groups; however, the trocar technique was abandoned due to the occurrence of severe complications like lung and stomach injury. Another study found that blunt dissection into the pleural space followed by the use of a trocar to direct the chest tube was as safe as and even more effective than blunt dissection alone. A randomized prospective study in cadavers comparing blunt vs sharp tip trocars reported that the use of blunt tip trocars resulted in less complications. We conclude that the trocar technique for chest tube placement should be avoided in adult patients as it is associated with a higher incidence of malposition and complications. The blunt dissection technique with digital exploration of the pleural cavity prior to chest tube placement is the safest technique and should be considered standard practice.

Is the trocar technique for tube thoracostomy safe in the current era

Spindle cell hemangioma (SCH) is an uncommon tumor that usually presents as a subcutaneous or deep dermal nodule affecting the extremities of young people. It is primarily a benign vascular neoplasm with a tendency to recur locally. Reports describing SCH diagnosed in muscles, retroperitoneum, mediastinum, and even in the spinal cord occasionally surface in the literature. We report a very rare case of SCH diagnosed in the lung.

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Christos Stavropoulos

Papers

Sublobar resection is equivalent to lobectomy for T1a non–small cell lung cancer in the elderly: a Surveillance, Epidemiology, and End Results database analysis

Is the trocar technique for tube thoracostomy safe in the current era

Spindle Cell Hemangioma of the Lung: A Case Report