Stephen D Cassivi

Mayo Clinic - Rochester · Department of Thoracic Surgery

Introduction As interest in metastasis-directed therapy (MDT) for prostate cancer (PCa) grows, exploring indications and patient selection is increasingly more important. Thus far, few studies have described long-term outcomes after surgical MDT in those with disease recurrence involving the lung. The objective of our study was to compare the cumul...

e20646 Background: Thymic carcinomas tend to be aggressive malignancies with variable patterns of immunostaining. We aimed to assess whether the outcome of patients with thymic carcinomas was associated with immunoreactivity for conventional and emerging immunohistochemical markers of thymic carcinoma versus thymoma. Methods: Scoring of CD5, CD117,...

Background: Long-term survival in esophagectomy patients with esophageal cancer is low due to tumor-related characteristics, with few reports of modifiable variable influencing outcome. We aim to identify determinants of Overall Survival, Time to Recurrence, and Disease-Free Survival in this patients' cohort. Methods: Adult patients who underwen...

Objective: Lobar torsion is a rare occurrence in which a portion of the lung is twisted on its bronchovascular pedicle. The vast majority are observed in the acute postoperative period often following right upper lobectomy. Spontaneous middle lobe torsion independent of pulmonary resection is exceptionally rarer; fewer than 15 cases have been reco...

Background: A significant proportion of patients with clinical stage IA non-small cell lung cancer (NSCLC) experience recurrence and decreased survival after surgery. We examined the impact of preoperative primary tumor positron emission tomography (PET) scan maximum standardized uptake value (SUVmax) on oncologic outcomes after surgery. Methods:...

The objective of the present study was to characterize the difference in 10-year carcinoid-specific survival (CSS) and disease-free survival (DFS) among patients with resected pulmonary typical carcinoid (TC) and atypical carcinoid (AC). Patients diagnosed with pulmonary carcinoid tumors (PCT) between January 1, 1997, and December 31, 2016, were id...

Thymic neuroendocrine tumors (TNET) are rare anterior mediastinal neoplasms often associated with paraneoplastic syndromes. A patient presented with intractable hyponatremia and a Dotatate-avid mediastinal mass. Following medical optimization, she underwent thoracoscopic thymectomy with en-bloc thymic small cell carcinoma resection. Her symptoms re...

Background: A preoperative type and screen (T&S) is traditionally routinely obtained prior to noncardiac thoracic surgery; however, an intraoperative blood transfusion is rare. This practice is overly cautious and expensive. Methods: We included adult patients undergoing major thoracic surgery at Mayo Clinic from 2007-2016. Receipt of a T&S bloo...

Background: The morphologic distinction between thymic carcinomas and thymomas, specifically types B3, A, and occasionally micronodular thymomas with lymphoid stroma (MNTLS) can be challenging, as has also been shown in interobserver reproducibility studies. Since thymic carcinomas have a worse prognosis than thymomas, the diagnosis is important f...

Background Despite demonstration of its clear benefits relative to open approaches, a video-assisted thoracic surgery (VATS) technique for pulmonary lobectomy has not been universally adopted. This study aims to overcome potential barriers by establishing the essential components of the operation as well as determining which steps would be most use...

Background: A prolonged air leak (PAL) is the most frequent complication after pulmonary resection. This study aimed to assess the safety and efficacy of autologous blood patch pleurodesis (ABPP) to treat PAL. Methods: A prospectively maintained database identified patients with a PAL after pulmonary resection for lung cancer between 2015-2019....

Objectives To evaluate SATB2 expression and prognostic implications in a large cohort of thoracic neuroendocrine tumors. Methods Surgical pathology files (1995-2017) and an institutional thymic epithelial tumor database (2010-2020) were searched for resected neuroendocrine tumors. Cases were stained with SATB2 (clone EP281). Percent SATB2-positive...

239 Background: After trastuzumab (T) approval for advanced HER2-positive E/GEJ-AC, HER2 testing has increased in patients (pts) with resectable disease. Neoadjuvant carboplatin/paclitaxel chemoradiation (nCP-CRT) is a common therapy approach. We performed the largest evaluation, to our knowledge, of the prognostic impact of HER2 in E/GEJ-AC pts tr...

Objective : Esophagectomy is associated with significant morbidity and mortality. We assessed the relationship between intraoperative fluid (IOF) administration and postoperative pulmonary outcomes in patients undergoing a transthoracic, transhiatal, or tri-incisional esophagectomy. Design : Retrospective cohort study (Level 3 evidence) Setting :...

BACKGROUND Contemporary data on LVRS is sparse, particularly in regards to utilization and surgical outcomes. In this context, we analyze the practice patterns and outcomes of LVRS nationally. METHODS We identified all patients (n=1617) undergoing LVRS at 165 hospitals between 2001 and 2017 from the STS General Thoracic Database. Practice patterns...

Abstract Importance: A postoperative video telemedicine follow-up program was introduced by the Mayo Clinic. An attempt was made to understand the potential cost savings to patients before contemplating full-scale expansion across all potentially eligible surgical patients and practices. Objective: The primary purpose was to estimate potential co...

Epiphrenic diverticulum is a rare and benign condition with significant surgical morbidity and evolving surgical management. The objective of this study was to analyze short term clinical outcomes after surgery for epiphrenic diverticula. We conducted a retrospective cohort study in a single tertiary care center of all patients who underwent treatm...

Background Patient-reported reflux is one of the most common complaints after esophagectomy. This study aimed to determine predictors of patient-reported reflux and if a preserved pylorus would protect from symptomatic reflux. Methods A prospective clinical study recorded patient-reported reflux after esophagectomy from August 2015 to July 2018. E...

Objective: To collect patient-reported outcomes after esophagectomy to establish a set of preliminary normative standards to aid in symptom-score interpretation. Patients and methods: Patients undergoing esophagectomy often have little understanding about postoperative symptom management. The Mayo Clinic esophageal CONDUIT tool is a validated qu...

Background: The object of this initiative was to perform a prospective, multi-center survey of patients following lung resection to assess the amount of opioids consumed and disposition of unused opioids to inform the development of evidence-based prescribing guidelines. Methods: Adults undergoing lung resection via minimally invasive (MIS, n=10...

Background The relationship between individual complications and esophagectomy mortality is unclear. The influence of comorbidities on the impact of complications on operative mortality is also unknown. We sought to assess the impact of individual complications and the effect of coexisting comorbidities on operative mortality following esophagectom...

OBJECTIVES The aim of this study is to evaluate the efficacy of chest computed tomography (CT) to predict the pathological stage of thymic epithelial tumours (TET) using the recently introduced tumour, node and metastasis (TNM) staging with comparison to the modified Masaoka staging. METHODS Preoperative chest CT examinations in cases of resected...

Background: Despite the current strategies aimed at avoiding opioid overprescription by implementing institutional guidelines, the use of opioids after surgical procedures remains highly variable. It is well known that opioids are activated by the cytochrome p450 CYP2D6 enzyme to exert pharmacologic effect. Individual variation in CYP2D6 activity...

Background: The benefit of adjuvant treatment for esophageal cancer patients with positive lymph nodes after induction therapy and esophagectomy is uncertain. This in-depth multicenter study assessed the benefit of adjuvant therapy in this population. Methods: A retrospective cohort study from 9 institutions included patients who received neoadj...

Objectives: Paragangliomas have unique features in the mediastinum, in part due to their location. Because of their paucity, they have not been thoroughly investigated. We studied the clinical, pathological, immunohistochemical and molecular features of mediastinal paragangliomas. Methods: Immunohistochemistry, next-generation sequencing mutatio...

Background The Thymectomy Trial in Non-Thymomatous Myasthenia Gravis Patients Receiving Prednisone (MGTX) showed that thymectomy combined with prednisone was superior to prednisone alone in improving clinical status as measured by the Quantitative Myasthenia Gravis (QMG) score in patients with generalised non-thymomatous myasthenia gravis at 3 year...

Traumatic esophageal perforations are rare but diffcult to treat injuries. We review the principles of work-up, anatomy and treatment of cervical, thoracic and abdominal traumatic esophageal perforations. Management is dictated by location of the perforation and any concurrent injuries. The majority of cases are amenable to primary repair with flap...

Objective: The purpose of this retrospective cohort study was to evaluate resource consumption of clinically significant esophageal anastomotic leaks. Methods: Between September 1, 2008, to December 31, 2014, a prospectively maintained database was queried to identify patients with grade III to IV anastomotic leaks after esophagectomy for esopha...

Background: Morgagni hernias are rare congenital diaphragmatic hernias that often do not become clinically significant until adulthood. The purpose of this study was to characterize the preoperative findings and describe surgical outcomes of Morgagni hernia repair based on operative approach. Methods: Charts of patients who underwent repair of a...

Background The objective of this study was to analyze the induction therapy regimens employed since publication of CROSS Trial in patients treated with locally advanced EGJ cancer in terms of toxicity, complications, survival and recurrence. Methods Retrospective chart review all patients in single institution prospective database who had neoadjuv...

Background The purpose of this study was to evaluate the survival difference in clinical T2N0 esophageal cancer patients receiving neoadjuvant chemoradiotherapy (CRT) vs. upfront surgery. Methods Between 1/1/1995 to 12/31/2012, a prospectively maintained database was used to identify patients with cT2N0 esophageal adeno- and squamous cell carcinom...

Background Pneumatosis intestinalis has long been a marker of advanced bowel ischemia and prompts urgent laparotomy. In post-operative settings, the presence of pneumatosis represents a significant management dilemma. We share a case-series of post-esophagectomy patients with pneumatosis intestinalis and no corollary intra-abdominal pathologic find...

Introduction: Solitary fibrous tumors (SFT) are rare mesenchymal neoplasms. Most follow a benign course, but a subset will recur or metastasize. Various risk stratification schemes have been proposed for SFT, but none have been universally endorsed and few have focused on pleuropulmonary SFT. Methods: Histologic sections were examined from surgi...

Adolescent idiopathic scoliosis affects children aged 11-18 years. Severe disease may necessitate spinal fusion. Vertebral body tethering gradually corrects scoliosis as the patients grow. The application of video-assisted thoracic surgery to the thoracic spine is a new area for further development.

Purpose of review: To highlight the various applications of 3D printing in cardiovascular disease and discuss its limitations and future direction. Recent findings: Use of handheld 3D printed models of cardiovascular structures has emerged as a facile modality in procedural and surgical planning as well as education and communication. Three-dime...

Background: Persistent air leak can complicate pulmonary resection, and one management option is dismissal with a chest tube in place. This study evaluated the rate of empyema and readmission after dismissal with a chest tube. Methods: A retrospective review of our prospective database from January 2004 to December 2013 identified 236 patients w...

Background: Intrathoracic paragangliomas (PGLs) are rare tumors. Approximately 50% originate from and around cardiac structures. Methods: A retrospective review was made of the perioperative course of patients with intrathoracic PGL resection from 2000 through 2015 at Mayo Clinic in Rochester, Minnesota. Results: Twenty-two patients underwent...

Objectives: Laparoscopic Nissen fundoplication is the most commonly performed operation for the repair of large hiatal hernias. We compared outcomes between the Belsey Mark IV fundoplication and the laparoscopic Nissen fundoplication. Methods: A retrospective review was performed over a 10-year period on patients who had repair of large paraesop...

Visiting scholarships to other institutions have a rich history in medicine and are an exciting opportunity to exchange ideas, learn new clinical techniques and form collaborative relationships for research advancements. Such experiences are also important in fostering a well-rounded surgical education. In this article we reflect on the valuable na...

Background: Postoperative chylothorax can be managed by any or all of observation, parenteral nutrition, surgical duct ligation, pleurodesis, or thoracic duct embolization. The objective of this study was to determine the efficacy of standard therapies, such as surgical duct ligation and observation, compared with newer treatment methods (thoracic...

Background: The current national trends, practice patterns, and outcomes after sleeve resection compared with pneumonectomy in the United States are not known. In addition, whether hospital sleeve-to-pneumonectomy (S:P) ratios are a valid marker of hospital quality is unclear. We describe practice patterns and evaluate the utility of the S:P ratio...

The Society for Translational Medicine and The Chinese Society for Thoracic and Cardiovascular Surgery conducted a systematic review of the literature in an attempt to improve our understanding in the postoperative management of chest tubes of patients undergoing pulmonary lobectomy. Recommendations were produced and classified based on an internat...

Patients undergoing lobectomy are at significantly increased risk of lung injury. One-lung ventilation is the most commonly used technique to maintain ventilation and oxygenation during the operation. It is a challenge to choose an appropriate mechanical ventilation strategy to minimize the lung injury and other adverse clinical outcomes. In order...

Introduction Multifocal lung cancer (MFLC) is an increasingly common clinical scenario but there is lack of high-level evidence for its optimal treatment. Thus, we surveyed members of the interdisciplinary International Association for the Study of Lung Cancer (IASLC) on their therapeutic approaches and analyzed the resultant practice patterns. Me...

Background: The Society of Thoracic Surgeons (STS) has developed composite quality measures for cardiac surgical procedures and lobectomy for lung cancer. This study sought to develop a composite measure for esophagectomy for esophageal cancer. Methods: The STS esophagectomy composite score is derived from two risk-adjusted outcomes: mortality a...

Background To assess the pulmonary function and quality of life (QOL) after chest wall resection for non-small cell lung cancer. Material and methods One hundred and thirty-five patients (cases) who underwent pulmonary resection with chest wall removal were identified from January 1997 to December 2015. Propensity score matching (1:3) was applied...

Background: Unplanned readmissions are adverse clinical events that negatively impact patients and affect the use of health care resources. Identifying risk factors that can predict readmissions might permit individualized patient management. We compiled a complete account of readmissions after all lung resections over a year to identify potential...

BackgroundA biodegradable polymeric sealant has been previously shown to reduce postoperative air leaks after open pulmonary resection. The aim of this study was to evaluate safety and efficacy during minimally invasive pulmonary resection. Methods In a multicenter prospective single-arm trial, 112 patients with a median age of 69 years (range 34–8...

Background: Endoscopic mucosal resection (EMR) and esophagectomy are treatment options for cT1 esophageal adenocarcinoma. Our aim was to study outcomes for patients undergoing EMR then esophagectomy. Methods: We identified patients undergoing EMR and esophagectomy for cT1 esophageal adenocarcinoma over 10 years. EMR histology was used to predict...

Background/aims: The optimal intervention for Boerhaave perforation has not been determined. Options include surgical repair with/without a pedicled muscle flap, T tube placement, esophageal resection or diversion, or an endoscopic approach. All management strategies require adequate drainage and nutritional support. Our aim was to evaluate outcome...

Background: This study examined the variation in the adoption of video-assisted thoracoscopic surgery (VATS) for lobectomy across United States hospitals from a population-based national database. Methods: We used the National Cancer Data Base to identify patients undergoing lobectomy between 2010 and 2012 and used hierarchical regression to est...

Background: Five-year survival of stage IV esophageal cancer is rare. The treatment of advanced esophageal cancer is typically palliative and the role of surgery remains controversial. We sought to understand the impact of curative surgery on survival and identify any favorable tumor or patient characteristics that might make surgical resection ap...

Introduction: Neoadjuvant treatment might increase resectability of thymic epithelial tumors (TET). No standardized pathologic grading scheme for tumor response is available. Also, it is unclear whether radiologic treatment response can predict pathologic response. Methods: Patients with unresectable TET who underwent neoadjuvant treatment befor...

OBJECTIVES: Length of stay (LOS) is an important measure of quality and healthcare costs. Variation occurs due to individual and institutional practices, case complexity and patient/social factors. Identification of variables affecting LOS may help develop enhanced recovery protocols. This study aims to identify factors influencing LOS following su...

Significance: Bronchopleural fistula is a severe complication of pulmonary resection. Current management is not reliably successful. This work describes the first-in-human application of an autologous mesenchymal stem cell (MSC)-seeded matrix graft to the repair of a large, multiply recurrent postpneumonectomy BPF. Clinical follow-up of 1.5 years...

Background: There are very few randomized trials confirming the belief that prolonged urinary catheterization increases urinary tract infections, and none of these have included a comparative analysis of patients with an epidural catheter in place. The aim of this prospective randomized trial was to determine if removal of the urinary catheter wit...

Background: The purpose of this analysis was to revise the model for perioperative risk for esophagectomy for cancer utilizing The Society of Thoracic Surgeons General Thoracic Surgery Database to provide enhanced risk stratification and quality improvement measures for contributing centers. Methods: The Society of Thoracic Surgeons General Thor...

Background: The prevalence of minimally invasive thymectomy (MIT) is increasing and may have significant benefit to patients in terms of morbidity and post-operative recovery. Our aim was to review the Mayo Clinic experience of MIT. Methods: We reviewed data from all MIT cases collected in a prospectively maintained database from January 1995 to...

SESSION TITLE: Cardiovascular Disease Case Report Posters SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM INTRODUCTION: Incidence of bronchopleural fistula (BPF) after pneumonectomy is reported to be 1-5% for cancer resections, with a reported mortality of 30-50%. It is more common after rig...

Improving the quality of surgical care through accurate measurement of outcomes is an important endeavor. The purpose of this study was to compare data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) and The Society of Thoracic Surgeons (STS) general thoracic surgery database to determine if a samplin...

Background: Although surgical resection of adenocarcinoma or squamous cell carcinoma of the esophagus is standard practice, the treatment strategy for other malignant rare esophageal cancers is still under debate. The aim of this study was to examine the treatment of rare malignant esophageal cancers and to evaluate the survival of these patients....

In complex esophageal cases, conventional two-dimensional imaging is limited in demonstrating anatomic relationships. We describe the utility of three-dimensional (3D) printed models for complex patients to individualize care. Oral effervescent agents, with positive enteric contrast, distended the esophagus during computed tomography (CT) scanning...

Objectives: Length of stay (LOS) is an important measure of quality and healthcare costs. Variation occurs due to individual and institutional practices, case complexity and patient/social factors. Identification of variables affecting LOS may help develop enhanced recovery protocols. This study aims to identify factors influencing LOS following s...

The clinical features of thymic carcinoid (TC) and bronchial carcinoid (BC) tumors as part of multiple endocrine neoplasia type 1 (MEN1) have been rarely described and their importance in clinical practice is debated. The objective of this study was to describe the clinical presentation and outcome of this uncommon manifestation of MEN1 in a tertia...

We aimed to compare long-term survival and quality of life (QOL) outcomes after bilobectomy and lobectomy for non-small cell lung cancer patients. A cohort of 951 consecutive patients was identified from a single treatment institution, of whom 128 underwent bilobectomy and 823, lobectomy. Propensity score matching (1:3) was applied to balance known...

Buttressing of the bronchial stump after pulmonary resection has been reported to decrease the prevalence of bronchopleural fistula. This adjuvant maneuver is most commonly performed in patients undergoing resection for infection or in those who have received preoperative radiation. The anatomic location of the upper lobe bronchus often makes it di...

Objectives: Pulmonary complications remain a frequent cause of morbidity following oesophagectomy. Risk screening tools assist in patient stratification. Ferguson proposed a risk score to predict major pulmonary complications after oesophagectomy. Our objective was to validate this score externally. Methods: We analysed our institutional database f...