Annals of Thoracic and Cardiovascular Surgery 

About: Annals of Thoracic and Cardiovascular Surgery is an academic journal published by Editorial Committee of Annals of Thoracic and Cardiovascular Surgery. The journal publishes majorly in the area(s): Lung cancer & Medicine. It has an ISSN identifier of 1341-1098. It is also open access. Over the lifetime, 2263 publications have been published receiving 23746 citations.

The revised TNM staging system for lung cancer.

Abstract: The International Staging Committee (ISC) of the International Association for the Study of Lung Cancer (IASLC) collected 68,463 patients with nonsmall cell lung cancer and 13,032 patients with small cell lung cancer, registered or diagnosed from 1990 to 2000, whose records had adequate information for analyzing the tumor, node, metastasis (TNM) classification. The T, N, and M descriptors were analyzed, and recommendations for changes in the seventh edition of the TNM classification were proposed based on differences in survival. For the T component, tumor size was found to have prognostic relevance, and its analysis led to recommendations to subclassify T1 tumors into T1a (≤ 2 cm) and T1b (>2 ‐ ≤ 3 cm) and T2 tumors into T2a (>3 ‐ ≤ 5 cm) and T2b (>5 ‐ ≤ 7 cm), and to reclassify T2 tumors > 7 cm into T3. Furthermore, with additional nodules in the same lobe as the primary tumors, T4 tumors would be reclassified as T3; with additional nodules in another ipsilateral lobe, M1 as T4; and with pleural dissemination, T4 as M1. There were no changes in the N category. In the M category, M1 was recommended to be subclassified into M1a (contralateral lung nodules and pleural dissemination) and M1b (distant metastasis). The proposed changes for the new stage grouping were to upstage T2bN0M0 from stage IB to stage IIA, and to downstage T2aN1M0 from stage IIB to stage IIA and T4N0-N1M0 from stage IIIB to stage IIIA. The proposed changes better differentiate tumors of different prognoses. (Ann Thorac Cardiovasc Surg 2009; 15: 4‐9)

Mortality secondary to esophageal anastomotic leak.

Abstract: Background: Esophageal anastomotic leak is a potentially life threatening complication of esophagectomy and esophagogastrectomy. We reviewed our experience with this complication and tried to identify factors predictive of mortality after esophageal anastomotic leak. Methods: Records of patients undergoing esophagectomy and esophagogastrectomy for benign or malignant disease over a 10-year period (1989-1999), who developed esophageal anastomotic leaks, were reviewed. Results: Three-hundred and seven patients underwent esophagectomy or esophagogastrectomy. Twenty-three (7.5%) developed esophageal anastomotic leaks. Eight of these patients (35%) died. Four of 23 (17%) patients had seemingly normal postoperative contrast studies. Factors potentially predictive of death included age (died, 72.8 ±8.3 years; survived, 65.3±8.8 years; p=0.063), location of anastomosis (cervical, 3/9 died; thoracic, 5/14 died; p=0.91), leak presentation (clinical, 6/12 died; contrast study, 2/11 died; p=0.11), time of leak (<7 days, 3/5 died; ≥7 days, 5/18 died; p=0.18), presence of gastric necrosis (necrosis, 3/3 died; no necrosis, 5/20 died; p=0.019), and treatment (surgical, 4/4 died; conservative, 4/19 died; p=0.005). Conclusions: Postoperative esophageal anastomotic leaks prove fatal in a significant number of cases. The lethal potential of cervical anastomotic leaks should not be underestimated. Gastric necrosis is an important predictor of subsequent death. Advanced age, early postoperative (<7 days) leakage, and clinically apparent signs of leakage may be predictive of death but these factors did not reach statistical significance in our study. Surgical treatment of esophageal anastomotic leaks is associated with subsequent death, but this relationship is unlikely to be causal; severely ill patients tend to be treated surgically. (Ann Thorac Cardiovasc Surg 2004; 10: 71‐5)

Bronchopleural fistula in the surgery of non-small cell lung cancer: incidence, risk factors, and management.

Abstract: Background: The incidence of a bronchopleural fistula (BPF) as a major complication after non-small cell lung carcinoma (NSCLC) surgery has decreased in recent years, due to new surgical refinements and a better understanding of the bronchial healing process. We reviewed our most recent experience with BPFs and tried to determine methods which may effectively reduce its occurrence. Methods: Data on 490 patients with lung resections for NSCLC over a period from 1990 to 1999 were retrospectively reviewed. Details regarding surgery and the subsequent treatment were carefully reviewed. Particular attention was paid to factors possibly affecting the occurrence of BPFs: the technique of the initial bronchial closure, previous radiation and/ or chemotherapy, need for postoperative ventilation and presence of residual carcinomatous tissue at the bronchial suture line. Information about age, sex, clinical diagnosis, associated conditions, TNM stage, period between primary operation and rethoracotomy and postoperative outcome was also recorded. Results: The overall BPF incidence was 4.4% (22/490). There were 21 (95.5%) males and 1 (4.5%) female, mean age was 57.8 years. BPFs occurred after pneumonectomy in 12 (54.6%), after lobectomy in 9 (40.9%) patients and after sleeve resections in 1 (4.5%) patient. Mortality rate was 27.2% (6/22). Right-sided pneumonectomy and postoperative mechanical ventilation were identified as risk factors for BPFs (p<0.05). Initial chest re-exploration was performed in 20 (90.9%) patients. After debridement, the bronchial stump was reclosed by hand suture in 10 (45.4%) patients. All 10 (45.4%) patients with a post-lobectomy- and sleeve resection BPF necessitated completion surgery. The BPF was additionally covered with a vascularized flap in 20 (90.9%) patients. In 2 (9%) patients with small BPFs and poor overall condition the initial treatment was endoscopic. In both the fistula persisted and the stump had to be surgically resutured. Conclusions: A BPF remains a major complication in the surgery of NSCLC because of its high mortality and morbidity rate. A BPF is more common after right-sided pneumonectomy and is frequently associated with postoperative mechanical ventilation. The management varies according to the initial type of surgery, the size of the BPF, the overall patient condition and that of the remaining lung. Endoscopic treatment is reserved only for small fistulas associated with poor general condition. (Ann Thorac Cardiovasc Surg 2001; 7: 330‐6)

Technique and outcomes of pulmonary endarterectomy surgery.

Abstract: Pulmonary endarterectomy (PTE) is the definitive treatment for chronic pulmonary hypertension resulting from thromboembolic disease. Chronic thromboembolic pulmonary hypertension is estimated to occur in approximately 4% of patients who have developed an acute pulmonary embolism, though the true prevalence is suspected to be much higher. Chronic thromboembolic pulmonary hypertension is characterized by intraluminal thrombus organization, fibrous stenosis, and vascular remodeling of pulmonary vessels. PTE is an operation considered to be a curative for this affliction and is therefore superior to transplantation. The procedure involves the removal of organized and incorporated fibrous obstructive tissue from the pulmonary arterial tree and is a true endarterectomy, not an embolectomy. Surgical outcomes with respect to functional status, quality of life, hemodynamics, right ventricular function, and gas exchange are favorable. Preoperative hemodynamic severity and site of anatomical obstruction are key predictors of postoperative outcome. This article focuses on the surgical techniques and outcomes of patients undergoing PTE for chronic thromboembolic pulmonary hypertension and discusses the currently known factors that affect survival after this operation. (Ann Thorac Cardiovasc Surg 2008; 14: 274‐282)

Current Status and Future Prospects for Esophageal Cancer Treatment.

Abstract: The local control effect of esophagectomy with three-field lymph node dissection (3FLD) is reaching its limit pending technical advancement. Minimally invasive esophagectomy (MIE) by thoracotomy is slowly gaining acceptance due to advantages in short-term outcomes. Although the evidence is slowly increasing, MIE is still controversial. Also, the results of treatment by surgery alone are limiting, and multimodality therapy, which includes surgical and non-surgical treatment options including chemotherapy, radiotherapy, and endoscopic treatment, has become the mainstream therapy. Esophagectomy after neoadjuvant chemotherapy (NAC) is the standard treatment for clinical stages II/III (except for T4) esophageal cancer, whereas chemoradiotherapy (CRT) is regarded as the standard treatment for patients who wish to preserve their esophagus, those who refuse surgery, and those with inoperable disease. CRT is also usually selected for clinical stage IV esophageal cancer. On the other hand, with the spread of CRT, salvage esophagectomy has traditionally been recognized as a feasible option; however, many clinicians oppose the use of surgery due to the associated unfavorable morbidity and mortality profile. In the future, the improvement of each treatment result and the establishment of individual strategies are important although esophageal cancer has many treatment options.