Invited commentary.

Department of Thoracic Surgery, Shanghai Chest Hospital, 241 Huaihai Rd W, Shanghai, China 200030.
The Annals of thoracic surgery (Impact Factor: 3.65). 07/2012; 94(1):198. DOI: 10.1016/j.athoracsur.2012.04.031
Source: PubMed
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    ABSTRACT: From 1974 to 1981, 1598 patients with non-oat cell carcinoma of the lung were seen and treated. All were staged according to the AJC staging system. Of these, 706 patients had evidence of mediastinal lymph node metastases (N2). There were 151 patients (21%) who had complete, potentially curative resection of their primary tumor and all accessible mediastinal lymph nodes. The histologic type of tumor was adenocarcinoma in 94 patients, epidermoid carcinoma in 46 patients, and large-cell carcinoma in 11 patients. The extent of pulmonary resection consisted of a lobectomy in 119 patients, pneumonectomy in 26 patients, and wedge resection or segmentectomy in six patients. Almost all patients also received radiation therapy to the mediastinum. Clinical staging of the primary tumor and the mediastinum was based on the radiographic presentation of the chest and on bronchoscopy. Before treatment, 104 of 151 patients (69%) were believed to have had stage I (90 patients) or II (14 patients) disease, and 47 patients had stage III disease, of whom only 33 had evidence of mediastinal lymph node involvement. Excluding deaths from unrelated causes, the overall survival rate was 74% at 1 year, 43% at 3 years and 29% at 5 years. Survival in patients with clinical stage I or II disease treated by resection was favorable despite the presence of N2 nodes (50% at 3 years). Survival in obvious clinical N2 disease was poor (8% at 3 years). There was no difference in survival between patients with adenocarcinoma and those with epidermoid carcinoma. However, survival was poorer in patients with N2 nodes in the inferior mediastinum compared to those without lymph node involvement at that level.
    Annals of Surgery 10/1983; 198(3):386-97. DOI:10.1097/00000658-198309000-00015 · 7.19 Impact Factor
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    ABSTRACT: Risk factors of postoperative atrial fibrillation (AF) in patients undergoing general thoracic operations have been extensively studied. This study investigated risk factors for intraoperative AF. Identification of patients vulnerable for intraoperative AF during lung operations will benefit from improved preoperative and intraoperative management that will ultimately decrease intraoperative complications. This study retrospectively evaluated the risk factors for intraoperative AF during lung operations. Medical records of 10,638 patients who underwent lung operations from January 1, 2006, to May 20, 2011, at the Shanghai Chest Hospital were reviewed. The analysis excluded 75 patients with preoperative AF or nonsinus rhythm or who were taking antiarrhythmic drugs before the operation. The final analysis included 10,563 patients. Univariate and multivariate analyses were performed to identify risk factors for intraoperative AF. The overall incidence of intraoperative AF was 3.27% (346 of 10,563). Multivariable logistic analysis identified increasing age, male sex, lung cancer, general anesthesia plus paravertebral block, open operation, resection of one or more lobes, and increased operation time as risk factors of intraoperative AF. In 40.73% of patients, intraoperative AF occurred during lymph node dissection. We identified seven risk factors for intraoperative AF in patients receiving lung operations. These findings may eventually help us to improve preoperative and intraoperative management to minimize intraoperative AF.
    The Annals of thoracic surgery 05/2012; 94(1):193-7. DOI:10.1016/j.athoracsur.2012.03.057 · 3.65 Impact Factor
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    ABSTRACT: The American College of Surgery Oncology Group Z0030 study was a prospective randomized study that showed that mediastinal lymph node sampling (MLNS) offered similar results to mediastinal lymph node dissection (MLND) in patients with non-small cell lung cancer (NSCLC). However, that study only randomized patients after thorough samplings that were negative on frozen section in several N2 and N1 nodal stations. The purpose of this study was to evaluate the effect of MLND to the more common practice of ruling out N2 disease preoperatively and then resection without sending lymph nodes for frozen section. This is a retrospective study of patients clinically staged as N0 with NSCLC. The incidence of pathologic N2 disease reported by the Society of Thoracic Surgeons (STS) database was considered to represent MLNS and it was compared with our patients who underwent complete MLND. Between January 2002 and December 2009, 1,358 patients clinically staged as N0 underwent lobectomy or segmentectomy and MLND (not MLNS). Our incidence of pathologic N2 disease in 1,107 patients who underwent lobectomy was 10.6% compared with 9.4% in the 24,896 STS lobectomy patients (p=0.196). Our incidence of pathologic N2 disease in 251 patients who underwent segmentectomy was 13.0% compared with 5.3% in the 2,150 STS segmentectomy patients (p<0.001). When complete MLND is performed in patients during pulmonary resection who are clinically node negative (have benign N2 nodes after selective endobronchial or esophageal ultrasound or mediastinoscopy) without using intraoperative frozen section of N2 or N1, more patients are pathologically staged with N2 disease; thus, more are considered for adjuvant chemotherapy. The impact on survival in these patients is unproven.
    The Annals of thoracic surgery 07/2012; 94(3):902-6. DOI:10.1016/j.athoracsur.2012.05.034 · 3.65 Impact Factor