Paul C Lee

Weill Cornell Medical College, New York, New York, United States

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Publications (71)275.08 Total impact

  • Journal of the American College of Surgeons 09/2011; 213(3):S42-S43. DOI:10.1016/j.jamcollsurg.2011.06.087 · 4.45 Impact Factor
  • Journal of the American College of Surgeons 09/2011; 213(3):S42. DOI:10.1016/j.jamcollsurg.2011.06.086 · 4.45 Impact Factor
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    ABSTRACT: Current practice is to repair uncomplicated diaphragmatic hernias (UDHs) to avoid complications such as obstruction or gangrene. However, practice patterns are based on limited data. We analyzed the National Inpatient Sample to compare outcomes of patients with obstructed (ODH) or gangrenous (GDH) diaphragmatic hernias and those who underwent repair of UDHs to perform a risk-benefit analysis of observation versus elective repair. We queried the National Inpatient Sample for hospitalized patients who underwent a UDH repair as the principal procedure during their admission. To this repair group, we compared the outcomes of those patients who had a diagnosis of GDH or ODH. A risk-benefit analysis of observation versus elective repair was performed based on these data. Over a 10-year period, 193,554 admissions for the diagnosis of diaphragmatic hernia were identified. A UDH was the diagnosis in 161,777 (83.6%) admissions with 38,764 (24.0%) admissions for elective repair. ODH or GDH was the reason for admission in 31,127 (16.1%) and 651 (0.3%), respectively. Compared with patients who underwent elective repair, mortality was higher in patients with ODH or GDH (1% vs 4.5%; P < .001; and 1% vs 27.5%; P < .001). Risk-benefit analysis suggested a small but real benefit to elective repair in patients aged 50 to 70 years or if the operative mortality is 1% or less. Elective UDH repair is associated with better outcomes than admissions for ODH or GDH with a favorable risk-benefit profile than observation if the operative mortality is low.
    The Journal of thoracic and cardiovascular surgery 07/2011; 142(4):747-54. DOI:10.1016/j.jtcvs.2011.06.038 · 3.99 Impact Factor
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    ABSTRACT: Radiation dose from diagnostic imaging procedures is not monitored in patients undergoing surgery for lung cancer. Evidence suggests an increased lifetime risk of malignancy of 1.0% per 100 millisieverts (mSv). As such, recommendations are to restrict healthcare and radiation workers to a maximum dose of 50 mSv per year or to 100 mSv over a three-year period. The purpose of this study was to estimate cumulative effective doses of radiation in patients undergoing lung cancer resection and to determine predictors of increased exposure. We identified 94 consecutive patients undergoing resection for non-small cell lung cancer. Radiologic procedures performed from one year prior to resection until two years postresection were recorded. Estimates of effective doses (mSv) were obtained from published literature and institutional records. Predictors of dose greater than 50 mSv per year and greater than 100 mSv per three years were examined statistically. The majority of patients (median age = 67 years) had stage IA cancer (52%). In the three-year period, patients had 1,958 radiologic studies (20.8/patient) including 398 computed tomographic (CT) scans (4.23/patient) and 211 positron emission tomography (PET) scans (2.24 per patient). The three-year median estimated radiation dose was 84.0 mSv (interquartile range, 44.1 to 123.2 mSv). The highest dose was in the preoperative year. In any one year, 66% of patients received more than 50 mSv, while 19% received over 100 mSv. Over the three-year period, 43.6% of patients exceeded 100 mSv. The majority of the radiation (89.8%) was from CT or PET scans. On multivariate analysis, a history of previous malignancy (odds ratio [OR] 3.8; confidence interval [CI] 1.14 to 12.7), postoperative complications (OR 6.16; CI 1.42 to 26.6), and postoperative surveillance with PET-CT (OR 13.2; CI 4.34 to 40.3) predicted exposure greater than 100 mSv over the three-year period. This study demonstrates that lung cancer patients often receive a higher dose of radiation than that considered safe for healthcare and radiation workers. The median cumulative dose reported in this study could potentially increase the individual estimated lifetime cancer risk by as much as 0.8%. Although risk-benefit considerations are clearly different between these groups, strategies should be in place to decrease radiation doses during the preoperative workup and postoperative period.
    The Annals of thoracic surgery 07/2011; 92(4):1170-8; discussion 1178-9. DOI:10.1016/j.athoracsur.2011.03.096 · 3.65 Impact Factor
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    ABSTRACT: Myoepitheliomas have been described most commonly in salivary glands and have been reported elsewhere but are rare in the lung, with only six previously reported cases. To our knowledge, this represents the first endotracheal myoepithelioma. These tumors have characteristic features that distinguish them from other tumors, and the diagnosis is a pathologic one, based on the morphology and supported by immunohistochemistry. Myoepitheliomas should be considered in the diagnosis of any pulmonary nodule.
    Chest 07/2011; 140(1):242-4. DOI:10.1378/chest.10-2976 · 7.13 Impact Factor
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    ABSTRACT: No consensus exists on the optimal treatment strategy for clinical T2-T3N0M0 esophageal cancer. This study was conducted to determine rates of nodal positivity (N+) and to evaluate results of treatment strategies in this cohort. Surgically treated patients with cT2-T3N0M0 esophageal cancer were reviewed. Adequacy of lymph node dissection was assessed by guidelines applied to clinical stage. Survival was determined by Kaplan-Meier analysis. Univariate and multivariate analyses were done for predictors of N+ and survival. We identified 102 patients, 51 cT2N0 and 51 cT3N0, 39 (38%) of whom had induction therapy. Despite being clinically node negative, 61 patients (60%) had nodal metastases. Applied to cT classification, adequate nodal dissection was achieved in 64 patients (63%). Transthoracic esophagectomy was more likely than transhiatal esophagectomy to achieve adequate nodal dissection (69% versus 31%, p=0.005). Adequate nodal dissection was more likely to document pN+ disease in both the surgery alone group (70% versus 50%, p=0.13) and induction therapy group (71% versus 33%, p=0.02). Five-year overall survival was 44% with surgery alone and 55% with induction therapy. On multivariate analysis, pN+ was the strongest predictor of overall survival (relative risk 2.73, confidence interval: 1.29 to 5.78). Most cT2-T3N0M0 patients have pN+ disease. Despite induction therapy, more than 50% have persistent nodal disease. Transthoracic esophagectomy is more likely to detect pN+ disease and more likely to meet criteria of adequate nodal dissection than is transhiatal esophagectomy. Therefore, the majority of patients with cT2-T3N0M0 should be considered for neoadjuvant protocols and should be treated by transthoracic resection whenever possible.
    The Annals of thoracic surgery 06/2011; 92(2):491-6; discussion 496-8. DOI:10.1016/j.athoracsur.2011.04.004 · 3.65 Impact Factor
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    ABSTRACT: Cesium-131 ((131)Cs) radioactive seed is Food and Drug Administration approved for permanent seed implant for all cancers, including lung and head and neck (HN) cancers. We describe the first clinical report of (131)Cs dosimetry and exposure rates to treating physicians and staff. Twenty-eight patients received (131)Cs implant for early stage lung and recurrent HN cancers. A nomogram was developed to calculate the number of seeds needed to cover the wedge line with the prescription dose (80 Gy). Final dosimetry was obtained after CT planning a few days following the surgical procedure. Radiation exposure to the treating physicians and staff was measured at the completion of the procedure. A nomogram was developed using the variseed software with source data from American Association of Physicists in Medicine TG-43 report. The total volume covered by the prescription isodose line of (131)Cs was measured and compared with (125)I. The prescription volume was smaller for (131)Cs. In addition, the exposure rate with (131)Cs was found to be acceptable. Our preliminary experience with (131)Cs lung and HN brachytherapy has been very encouraging with excellent dosimetric coverage and acceptable exposure to the treating physicians and staff.
    Brachytherapy 06/2011; 10(6):508-13. DOI:10.1016/j.brachy.2011.04.002 · 1.99 Impact Factor
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    ABSTRACT: The primary objective of this study was to determine the rate of pathological response after preoperative celecoxib and concurrent taxane-based chemotherapy in patients with cancer of the esophagus and gastroesophageal junction. Thirty-nine patients were enrolled in this single-arm, phase II clinical trial. Patients were administered daily celecoxib in combination with two to three cycles of carboplatin and paclitaxel with preoperative intent. Levels of cyclooxygenase (COX)-2 expression in resected tumors were analyzed by immunohistochemistry and correlated with clinical outcome measures. Postoperatively, patients were administered daily celecoxib for 1 year or until documented tumor recurrence. All patients received two to three cycles of chemotherapy plus celecoxib 800 mg/d. Toxicities were as expected. A major clinical response (complete response + partial response) was noted in 22 patients (56%); six patients (15%) had a complete clinical response. Thirty-seven patients underwent esophagectomy. Five patients had a major pathological response (12.8%). Four-year overall and disease-free survivals were 40.9% and 30.3%, respectively. Patients with tumors expressing COX-2 demonstrated a higher likelihood of a major clinical response response (62% versus 50%) and an improved overall survival, compared with patients with COX-2-negative tumors. Preoperative celecoxib with concurrent chemotherapy demonstrated sufficient effect on pathologic response to warrant further study. Patients with tumors expressing COX-2 demonstrated trends toward improved response to preoperative therapy and improved overall survival compared with nonexpressors.
    Journal of thoracic oncology: official publication of the International Association for the Study of Lung Cancer 06/2011; 6(6):1121-7. DOI:10.1097/JTO.0b013e31821529a9 · 5.80 Impact Factor
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    ABSTRACT: The prognosis for patients with esophageal cancer is poor, even among those who undergo potentially curative esophagectomy. The neutrophil:lymphocyte ratio (NLR) is hypothesized to reflect the systemic inflammatory response created by a tumor and is possibly predictive of tumor aggressiveness and propensity for metastasis. We performed a single-center retrospective analysis of esophageal cancer patients who underwent attempted curative esophagectomy at Weill Cornell Medical Center between 1996 and 2009. We collected data on patient demographics, clinical characteristics, and receipt of neoadjuvant treatment. Preoperative blood tests were used to calculate NLR. Elevated NLR was defined a priori as ≥5.0. Logistic regression modeling was performed to analyze characteristics associated with elevated NLR. We conducted Kaplan-Meier analyses and Cox regression modeling to determine estimates and predictors of disease-free and overall survival. We identified a total of 295 patients who underwent esophagectomy. The median duration of follow-up was 31 months (interquartile range [IQR] 13-61). There were 56 patients (18.9%) who had elevated NLR preoperatively. Receipt of neoadjuvant therapy was independently associated with high NLR (odds ratio [OR] 2.14, 95% confidence interval [95% CI] 1.02-4.51). In multivariable analyses, elevated NLR was associated with significantly worse disease-free (hazard ratio [HR] 2.26, 95% CI 1.43-3.55) and overall survival (HR 2.31, 95% CI 1.53-3.50). Preoperative NLR is a potential prognostic marker for recurrence and death after esophagectomy. It is unclear whether NLR reflects the degree of inflammatory response to the primary tumor or other patient-specific or tumor characteristics that predispose to recurrence. Further investigation is warranted to clarify the mechanisms explaining the observed associations between elevated NLR and poor outcomes in esophageal cancer.
    Annals of Surgical Oncology 05/2011; 18(12):3362-9. DOI:10.1245/s10434-011-1754-8 · 3.94 Impact Factor
  • The Annals of thoracic surgery 04/2011; 91(4):e63. DOI:10.1016/j.athoracsur.2011.01.031 · 3.65 Impact Factor
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    ABSTRACT: The goal of this study was to analyze factors predictive of recurrence and disease-free survival in patients with completely resected esophageal carcinoma. We conducted a retrospective review of a prospective database to identify patients with completely resected esophageal carcinoma. Medical records were reviewed. Recurrence rates, time to recurrence, and disease-free survival were analyzed. The Kaplan-Meier method was used for time to event estimation, and multivariate Cox regression models were constructed to analyze factors thought to be significant in determining both freedom from recurrence and disease-free survival. From 1988 to 2009, 465 of 500 patients underwent complete resection for esophageal carcinoma. Median follow-up for living patients was 49 months; 197 patients (42.4%) had recurrence, leading to 175 patients dying of cancer and 22 patients living with recurrent disease. Multivariate regression adjusted for P stage identified the following variables as independent predictors of freedom from recurrence: performance status greater than 0 (hazard ratio [HR], 1.84; 95 confidence interval [CI], 1.35-2.49]; P < .001), poor differentiation (HR, 1.50; CI, 1.12-2.01; P = .006), induction therapy (HR, 1.65; CI, 1.21-2.25]; P = .002), en bloc resection (HR, 0.61; CI, 0.43-0.88; P = .007), and advanced pathologic stages (II/III/IV) (HR, 5.46; CI, 3.05-9.78; P < .001). Independent predictors of disease-free survival adjusted for P stage were performance status greater than 0 (HR, 1.73; CI, 1.34-2.23; P < .001), en bloc resection (HR, 0.63; CI, 0.47-0.84; P = .002), induction therapy (HR, 1.34; CI, 1.02-1.76; P = .033), and advanced pathologic stages (II/III/IV) (HR, 3.16; CI, 2.15-4.65; P < .001). For patients with completely resected esophageal cancer, independent predictors of improved freedom from recurrence and disease-free survival include good performance status, en bloc resection, and early pathologic stage.
    The Journal of thoracic and cardiovascular surgery 03/2011; 141(5):1196-206. DOI:10.1016/j.jtcvs.2011.01.053 · 3.99 Impact Factor
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    ABSTRACT: In clinical stage IIIA non-small cell lung cancer, the role of surgical resection, particularly pneumonectomy, after induction therapy remains controversial. Our objective was to determine factors predictive of survival after postinduction surgical resection. We retrospectively reviewed a prospectively collected database of 136 patients who underwent surgical resection after induction chemotherapy (n = 119) or chemoradiation (n = 17) from June 1990 to January 2010. One hundred five lobectomies or bilobectomies and 31 pneumonectomies were performed. There was 1 perioperative death (pneumonectomy). Seventy-one patients had downstaging to N0 or N1 nodal status (52%). There were 2 complete pathologic responses. Median follow-up was 42 months (range, 0.69-136 months). Overall 5-year survival for entire cohort was 33% (36% lobectomy, 22% pneumonectomy, P = .001). Patients with pathologic downstaging to pN0 or pN1 had improved 5-year survival (45% vs 20%, P = .003). For patients with pN0 or pN1 disease, survival after lobectomy was better than after pneumonectomy (48% vs 27%, P = .011). In patients with residual N2 disease, there was no statistically significant survival difference between lobectomy and pneumonectomy (5-year survival, 21% vs 19%; P = .136). Multivariate analysis showed as independent predictors of survival age (hazard ratio, 1.05; P = .002), extent of resection (hazard ratio, 2.01; P = .026), and presence of residual pN2 (hazard ratio, 1.60; P = .047). After induction therapy for patients with clinical stage IIIA disease, both pneumonectomy and lobectomy can be safely performed. Although survival after lobectomy is better, long-term survival can be accomplished after pneumonectomy for appropriately selected patients. Nodal downstaging is important determinant of survival, particularly after lobectomy.
    The Journal of thoracic and cardiovascular surgery 01/2011; 141(1):48-58. DOI:10.1016/j.jtcvs.2010.07.092 · 3.99 Impact Factor
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    ABSTRACT: Although patients with esophageal cancer (EC) often develop lymph node metastases in the cervical and recurrent laryngeal (CRL) distribution, lymphadenectomy in this field is rarely performed. The purpose of this study was to determine factors associated with CRL node positivity and to determine the appropriate indications to perform a "three field" lymphadenectomy. In a retrospective review, EC patients who underwent three-field lymphadenectomy were analyzed. Predictors of positive CRL nodes were examined univariately, then selected for inclusion in a multivariate logistic regression model. From 1994 to 2009, 185 patients had a three-field lymphadenectomy, of whom 46 patients (24.9%) had positive CRL nodes. Final pathology stages (seventh edition) were I in 24 patients, II in 43, III in 109, and IV in 1 patient. Eight patients had a major pathologic response after induction therapy. On univariate analysis, variables significantly associated with positive CRL nodes included squamous cell histology, proximal location, advanced clinical presentation, the presence of clinical nodal disease, higher pT classification, and higher pN classification. There was no reduction in the rate of positive CRL nodes after induction chemotherapy. On multivariate analysis, higher pN classification (adjusted odds ratio 16.25, 95% confidence interval: 5.40 to 48.87; p < 0.0001) and squamous histology (adjusted odds ratio 6.04, 95% confidence interval: 2.21 to 16.56; p < 0.0001) predicted positive CRL nodes. Complete lymphadenectomy is necessary in esophageal cancer to appropriately stage patients. Low rates of positive CRL nodes are present with early clinical stage, with pT0-2 tumors, and with pN0 classification, particularly in patients with adenocarcinoma and gastroesophageal junction tumors. Dissection of the CRL field should be considered with advanced disease for adenocarcinoma and in all patients with squamous cell cancer.
    The Annals of thoracic surgery 12/2010; 90(6):1805-11; discussion 1811. DOI:10.1016/j.athoracsur.2010.06.085 · 3.65 Impact Factor
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    ABSTRACT: Patients with early-stage, resectable, non-small-cell lung cancer (NSCLC) are at risk for recurrent disease, and 5-year survival rates do not exceed 75%. Angiogenesis inhibitors have shown clinical activity in patients with late-stage NSCLC, raising the possibility that targeting the vascular endothelial growth factor pathway in earlier-stage disease may be beneficial. This proof-of-concept study examined safety and efficacy of short-term, preoperative pazopanib monotherapy in patients with operable stage I/II NSCLC. Patients scheduled for resection received oral pazopanib 800 mg/d for 2 to 6 weeks preoperatively. Tumor response was measured by high-resolution computed tomography, permitting estimation of change in tumor volume and diameter. Gene-expression profiling was performed on 77 pre- and post-treatment lung samples from 34 patients. Of 35 patients enrolled, 33 (94%) had clinical stage I NSCLC and two (6%) had clinical stage II NSCLC. Median treatment duration was 16 days (range, 3 to 29 days). Thirty patients (86%) achieved tumor-volume reduction after pazopanib treatment. Two patients achieved tumor-volume reduction > or = 50%, and three patients had partial response according to Response Evaluation Criteria in Solid Tumors. Pazopanib was generally well tolerated. The most common adverse events included grade 2 hypertension, diarrhea, and fatigue. One patient developed pulmonary embolism 11 days after surgery. Several pazopanib target genes and other angiogenic factors were dysregulated post-treatment. Short-duration pazopanib was generally well tolerated and demonstrated single-agent activity in patients with early-stage NSCLC. Several target genes were dysregulated after pazopanib treatment, validating target-specific response and indicating a persistent pazopanib effect on lung cancer tissue. Further clinical evaluation of pazopanib in NSCLC is planned.
    Journal of Clinical Oncology 07/2010; 28(19):3131-7. DOI:10.1200/JCO.2009.23.9749 · 17.88 Impact Factor
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    ABSTRACT: We report an unusual clinical presentation of renal leiomyosarcoma. A woman, who received renal transplant from her mother, was diagnosed to have leiomyosarcoma in the donated kidney. The mother was found to have a right upper lobe lung mass 10 years later, which was diagnosed as leiomyosarcoma. It is possible that the mother had primary leiomyosarcoma of the donated kidney with micrometastases to the lung 10 years previously, which developed into a lesion in the donated kidney in her daughter. Ten years later, the slow-growing metastatic leiomyosarcoma developed into a lung mass.
    Nephrology Dialysis Transplantation 05/2010; 25(5):1713-5. DOI:10.1093/ndt/gfp736 · 3.49 Impact Factor
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    ABSTRACT: Several single-institution series have demonstrated that compared with open thoracotomy, video-assisted thoracoscopic lobectomy may be associated with fewer postoperative complications. In the absence of randomized trials, we queried the Society of Thoracic Surgeons database to compare postoperative mortality and morbidity following open and video-assisted thoracoscopic lobectomy. A propensity-matched analysis using a large national database may enable a more comprehensive comparison of postoperative outcomes. All patients having lobectomy as the primary procedure via thoracoscopy or thoracotomy were identified in the Society of Thoracic Surgeons database from 2002 to 2007. After exclusions, 6323 patients were identified: 5042 having thoracotomy, 1281 having thoracoscopy. A propensity analysis was performed, incorporating preoperative variables, and the incidence of postoperative complications was compared. Matching based on propensity scores produced 1281 patients in each group for analysis of postoperative outcomes. After video-assisted thoracoscopic lobectomy, 945 patients (73.8%) had no complications, compared with 847 patients (65.3%) who had lobectomy via thoracotomy (P < .0001). Compared with open lobectomy, video-assisted thoracoscopic lobectomy was associated with a lower incidence of arrhythmias [n = 93 (7.3%) vs 147 (11.5%); P = .0004], reintubation [n = 18 (1.4%) vs 40 (3.1%); P = .0046], and blood transfusion [n = 31 (2.4%) vs n = 60 (4.7%); P = .0028], as well as a shorter length of stay (4.0 vs 6.0 days; P < .0001) and chest tube duration (3.0 vs 4.0 days; P < .0001). There was no difference in operative mortality between the 2 groups. Video-assisted thoracoscopic lobectomy is associated with a lower incidence of complications compared with lobectomy via thoracotomy. For appropriate candidates, video-assisted thoracoscopic lobectomy may be the preferred strategy for appropriately selected patients with lung cancer.
    The Journal of thoracic and cardiovascular surgery 02/2010; 139(2):366-78. DOI:10.1016/j.jtcvs.2009.08.026 · 3.99 Impact Factor
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    ABSTRACT: In patients with esophageal cancer, a complete pathologic response after preoperative therapy is universally regarded as a favorable prognostic factor. However, less is known about factors predictive of outcome in patients with persistent nodal disease. The purpose of this study is to determine which variables affect survival in this patient population. We reviewed a prospectively maintained esophageal cancer database. Patients with positive lymph nodes after preoperative therapy and surgery were selected. Predictors of survival were examined univariately using the log-rank test. Factors identified at P < .20 by univariate analysis were selected for inclusion in a multivariate model. Ninety-six patients with 1 or more positive nodes received preoperative therapy. Pathologic T classification was 0 to 2 in 25 (26%) patients and 3 to 4 in 71 (74%) patients. In 29 (30%) patients, nonregional nodal disease was present (M1). Final pathologic stages were IIB in 18 (19%), III in 49 (51%), and IV in 29 (30%). Postoperatively, 44 (46%) patients received additional chemotherapy. On univariate analysis, pathologic stage, pathologic T classification, and number of positive nodes significantly affected overall survival. On multivariate analysis, clinical stage (hazard ratio [HR], 2.25; P = .05), pathologic T classification (HR, 3.06; P = .006), and number of positive nodes (HR 1.03 per node, P = .09) were significant predictors of overall survival. Long-term survival can be achieved in patients with esophageal cancer who have persistent nodal disease after neoadjuvant therapy and surgical resection. Clinical stage, pathologic T classification, and number of positive nodes best predict survival. Nonregional nodal disease does not adversely affect outcome. Postoperative chemotherapy conferred no additional survival benefit in this patient population.
    The Journal of thoracic and cardiovascular surgery 12/2009; 139(2):387-94. DOI:10.1016/j.jtcvs.2009.10.003 · 3.99 Impact Factor
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    ABSTRACT: Distinguishing a metachronous lung cancer from a metastatic or recurrent lesion in patients with a prior history of non-small cell lung cancer is a challenging task. Previous studies have suggested histologic type and disease-free interval as criteria for diagnosing metachronous lung cancer. These factors may not be as relevant now that current imaging allows for earlier detection of tumors and with the rising incidence of adenocarcinoma. The purpose of this study was to reexamine the factors that determine outcomes in patients with a second primary lung cancer. A retrospective review of a prospective lung cancer database was performed to identify patients with metachronous lung cancer. Metachronous lung cancer was defined as any non-small cell lung cancer occurring after a prior resection regardless of disease-free interval or histologic type. The Kaplan-Meier method was used for survival analysis. The Mantel-Cox method was used to compare overall survival. Cox regression was used for multivariate analysis. Fifty-eight patients had metachronous lung cancer. Overall survival at 5 years was 66% (stage IA, 74%; IB, 59%; all other stages, 0%; p = 0.01). Seventy-two percent (42 of 58 patients) had similar histologic type. There was no difference in overall survival based on similar versus different histologic type (65% versus 73%; p = 0.77). Median disease-free interval was 42 months (range, 8 to 312 months). Disease-free interval was not a significant predictor of overall survival (p = 0.24). The extent of resection included wedge (36%, 21 of 58 patients), segmentectomy (24%, 14 of 58 patients), and lobectomy (40%, 23 of 58 patients), with no difference in overall survival (58% versus 60% versus 75%, respectively; p = 0.32). These data suggest that early tumor stage is the only significant determinant of survival after surgical treatment of metachronous lung cancer. Neither histologic type nor disease-free interval was of prognostic value. Limited resections may be adequate treatment.
    The Annals of thoracic surgery 10/2009; 88(4):1100-5. DOI:10.1016/j.athoracsur.2009.06.098 · 3.65 Impact Factor
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    ABSTRACT: Postpneumonectomy bronchopleural fistulas (BPFs) remain difficult management problems associated with considerable morbidity and mortality. Traditional therapies have included primary repair or delayed closure with the creation of an Eloesser cavity and tissue flap reinforcement. New bronchoscopic modalities have included the use of bioglues, stents, and coils. We describe another additional, less invasive bronchoscopic modality - the use of an atrial septal closure device.
    Interactive Cardiovascular and Thoracic Surgery 09/2009; 9(5):901-2. DOI:10.1510/icvts.2009.215202 · 1.11 Impact Factor
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    ABSTRACT: Patients with esophageal carcinoma and celiac, cervical, or other nonregional nodal metastases generally have a poor prognosis after surgical resection. Factors predicting long-term survival are unclear. The goal of this study was to analyze factors predicting long-term survival in this subset of patients. We conducted a retrospective review of a prospective database over a 20-year period to identify patients with resected esophageal carcinoma with nonregional lymph node metastases. Medical records were reviewed and risk factors were analyzed. Sixty-seven patients underwent esophagectomy for M1a or M1b disease from 1987 to 2007. Esophagectomy was transthoracic in 62 patients and transhiatal in 5. The median number of lymph nodes harvested was 36. Sites of nodal metastases were the following: recurrent nodal chain in 42 patients, celiac in 20, both recurrent and celiac in 4, and paratracheal in 1. Median length of follow-up was 66 months. The 5-year overall survival for the entire cohort was 25%. The 5-year overall survival was significantly higher with earlier T-status, (pathologic tumor [pT]1/T2 vs pT3/T4; 62% vs 15%, p = 0.006). Thirteen patients who had nonregional nodal metastases without involvement of regional nodes (pN0) had a significant improvement in 5-year survival (67% vs 15%; p < 0.001). Patients with squamous cell carcinomas had higher 5-year survival compared with those with adenocarcinomas (42% vs 14%; p = 0.009). Patients treated with induction chemotherapy had prolonged 5-year survival (41%, p = 0.06) compared with those treated with adjuvant chemotherapy (11%) or no therapy (20%). Multivariate analysis demonstrated that chemotherapy treatment, squamous cell type, and early T stage (pT1/T2) are significant positive predictors of survival. Surgical resection for patients with esophageal cancer associated with nonregional nodal metastases results in 25% survival at five years. Squamous histology, earlier T status, and perioperative chemotherapy are independent positive predictors of long-term survival.
    The Annals of thoracic surgery 07/2009; 88(1):186-92; discussion 192-3. DOI:10.1016/j.athoracsur.2009.03.079 · 3.65 Impact Factor

Publication Stats

1k Citations
275.08 Total Impact Points

Institutions

  • 2005–2015
    • Weill Cornell Medical College
      • • Department of Cardiothoracic Surgery
      • • Department of Public Health
      • • Department of Genetic Medicine
      New York, New York, United States
  • 2008–2014
    • New York Hospital Queens
      New York, New York, United States
  • 2007–2014
    • New York Presbyterian Hospital
      • Department of Thoracic Surgery
      New York, New York, United States
  • 2005–2012
    • Cornell University
      Итак, New York, United States