Eric Lim's research while affiliated with Imperial College London and other places
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Publications (212)
Background:
Chest drain management is a variable aspect of postoperative care in thoracic surgery, with different opinion for air and drain volume output. We aim to study if acceptable safety was maintained using air leak criteria alone.
Methods:
A 9-year retrospective analysis of protocolised chest drain management using digital drain air leak...
Lung cancer is the leading cause of cancer-associated mortality worldwide1. Here we analysed 1,644 tumour regions sampled at surgery or during follow-up from the first 421 patients with non-small cell lung cancer prospectively enrolled into the TRACERx study. This project aims to decipher lung cancer evolution and address the primary study endpoint...
Background
Lung cancer is the leading cause of cancer death. Surgery remains the main method of managing early-stage disease. Minimal-access video-assisted thoracoscopic surgery results in less tissue trauma than open surgery; however, it is not known if it improves patient outcomes.
Objective
To compare the clinical effectiveness and cost-effecti...
The status of lymph node involvement is a major component of the tumor, node, metastasis (TNM) staging system. The N categories for lung cancer have remained unchanged since the 4th edition of the TNM staging system, partly because of differences in nodal mapping nomenclature, partly because of insufficient details to verify possible alternative ap...
Background
This review describes a new therapeutic landscape in the adjuvant treatment of resectable non-small cell lung cancer (NSCLC) and discusses the role of the surgeon in ensuring best outcomes within this treatment paradigm.
Methods
We conducted a narrative literature review using the search terms “non-small cell lung cancer” AND “adjuvant”...
Background:
Reinforced staple lines are less susceptible to leaks or bleeding and may consequently reduce morbidity and complications during or after surgery. However, their safety and benefits as well as the best form of reinforcement are still under debate. This study evaluates the safety of a stapler with pre-attached buttressing material based...
Background:
We sought to evaluate the impact of different national clinical guidelines (with consistent and conflicting recommendations) on clinician's practice in the UK.
Methods:
In this cohort study we analysed data from National Lung Cancer Audit comprising all patients diagnosed with lung cancer between 2008 to 2013 within England and Wales...
Introduction:
Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is considered to be a rare condition associated with lung neuroendocrine tumours (NET), and its natural history is poorly described. We aimed to assess the prevalence and clinicopathologic characteristics of DIPNECH in the lung NET population, and to investigate p...
Murine tissues harbor signature γδ T cell compartments with profound yet differential impacts on carcinogenesis. Conversely, human tissue-resident γδ cells are less well defined. In the present study, we show that human lung tissues harbor a resident Vδ1 γδ T cell population. Moreover, we demonstrate that Vδ1 T cells with resident memory and effect...
SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients.Since surgical patients are already at higher risk of venous thromboembolism than general populations, thisstudy aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk ofvenous thromboembolism. We...
Pleural mesothelioma is an aggressive malignancy with limited effective therapies. In order to identify therapeutic targets, we integrated SNP genotyping, sequencing and transcriptomics from tumours and low-passage patient-derived cells. Previously unrecognised deletions of SUFU locus (10q24.32), observed in 21% of 118 tumours, resulted in disorder...
The immune microenvironment influences tumour evolution and can be both prognostic and predict response to immunotherapy1,2. However, measurements of tumour infiltrating lymphocytes (TILs) are limited by a shortage of appropriate data. Whole-exome sequencing (WES) of DNA is frequently performed to calculate tumour mutational burden and identify act...
Background
SARS-CoV-2 has challenged health service provision worldwide. This work evaluates safe surgical pathways and standard operating procedures implemented in the high volume, global city of London during the first wave of SARS-CoV-2 infection. We also assess the safety of minimally invasive surgery(MIS) for anatomical lung resection.
Method...
Small cell lung cancer is an aggressive form of cancer. Previously, surgery was rarely considered because most patients present at the advanced stages of the disease. New research and the advances in medical imaging has challenged this notion proving that, as part of a multimodal treatment pathway, surgery has a key role to play in the management o...
Lung Carcinoids (L-CDs) are uncommon low-grade neuroendocrine tumours that are only recently becoming characterised at the molecular level. Notably data on the molecular events that precipitate altered gene expression programmes are very limited. Here we have identified two discrete L-CD subtypes from transcriptomic and whole-genome DNA methylation...
Lung cancer is the most frequent cause of cancer death worldwide. It affects more men than women, and men generally have worse survival outcomes. We compared gene co-expression networks in affected and unaffected lung tissue from 126 consecutive patients with Stage IA–IV lung cancer undergoing surgery with curative intent. We observed marked degrad...
Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Su...
Introduction
Mesothelioma remains a lethal cancer. To date, systemic therapy with pemetrexed and a platinum drug remains the only licensed standard of care. As the median survival for patients with mesothelioma is 12.1 months, surgery is an important consideration to improve survival and/or quality of life. Currently, only two surgical trials have...
An amendment to this paper has been published and can be accessed via a link at the top of the paper.
Remarkable progress in molecular analyses has improved our understanding of the evolution of cancer cells toward immune escape1–5. However, the spatial configurations of immune and stromal cells, which may shed light on the evolution of immune escape across tumor geographical locations, remain unaddressed. We integrated multiregion exome and RNA-se...
Objectives
The West London lung screening pilot aimed to identify early-stage lung cancer by targeting low-dose CT (LDCT) to high risk participants. Successful implementation of screening requires maximising participant uptake and identifying those at highest risk. As well as reporting pre-specified baseline screening metrics, additional objectives...
An amendment to this paper has been published and can be accessed via a link at the top of the paper.
Lung cancer is the most frequent cause of cancer death worldwide1. It is male predominant and for reasons that are unknown also associated with significantly worse outcomes in men2. Here we compared gene co-expression networks in affected and unaffected pulmonary tissue derived from 126 patients with Stage IA-IV lung cancer. We observed marked degr...
Aims
Nuclear grade has been recently validated as a powerful prognostic tool in epithelioid malignant pleural mesothelioma (E‐MPM). In other studies histological parameters including pleomorphic features and growth patterns were also shown to exert prognostic impact. The primary aims of our study are (1) externally validate the prognostic role of p...
Objectives:
The prognostic significance of pathologic features and invasive size has not been well studied for invasive mucinous adenocarcinoma (IMA). This study evaluates the significance of pathologic features and invasive size in relation to clinical outcome.
Methods:
We reviewed the pathologic features in 84 IMAs, including histologic patter...
Background:
The objectives of the current study were to develop an initial blood-based circulating tumor DNA (ctDNA) gene signature and to validate the clinical test performance in patients with early primary and secondary lung cancer.
Methods:
Between January 2009 and October 2014, a total of 211 patients with known or suspected lung cancer don...
Malignant pleural mesothelioma (MPM) is an aggressive malignancy that lacks effective therapy. To identify therapeutic targets we integrated SNP genotyping, sequencing and transcriptomics from tumours and low-passage patient-derived cells. Previously unrecognised losses of SUFU , observed in 21% of 118 tumours, resulted in disordered expression of...
Background:
Lung metastasectomy in the treatment of advanced colorectal cancer has been widely adopted without good evidence of survival or palliative benefit. We aimed to test its effectiveness in a randomised controlled trial (RCT).
Methods:
Multidisciplinary teams in 13 hospitals recruited participants with potentially resectable lung metasta...
Background:
The largest randomised controlled trial evaluating results of lung volume reduction surgery (LVRS) was conducted by the National Emphysema Treatment Trial (NETT) that published a series of reports for outcomes up to 24 months. However, patient outcomes were difficult to interpret due to limitations in and the presentation of convention...
Nuclear grading systems for epithelioid malignant pleural mesothelioma (MPM) have been proposed but it remains uncertain if they could be applied in a biopsy-heavy setting. Using the proposed system, we conducted an independent, external validation study using 563 consecutive cases of epithelioid MPM diagnosed at our institution between 2003 and 20...
Approximately 50% of patients with early-stage non-small-cell lung cancer (NSCLC) who undergo surgery with curative intent will relapse within 5 years1,2. Detection of circulating tumor cells (CTCs) at the time of surgery may represent a tool to identify patients at higher risk of recurrence for whom more frequent monitoring is advised. Here we ask...
Introduction
Lung cancer is a leading cause of cancer deaths worldwide and surgery remains the main treatment for early stage disease. Prior to the introduction of video-assisted thoracoscopic surgery (VATS), lung resection for cancer was undertaken through an open thoracotomy. To date, the evidence base supporting the different surgical approaches...
Background:
Lung cancer has changed significantly during the past two decades in its epidemiology and treatment. We conducted a retrospective analysis using data from seven major areas of China over ten years to evaluate clinicopathologic and surgical treatment trends of lung cancer in China during the past decade METHODS: Data from 7184 primary l...
Pulmonary carcinoids (PCs) display the common features of all well-differentiated neuroendocrine neoplasms (NEN) and are classified as low- and intermediate-grade malignant tumours (i.e. typical (TC) and atypical carcinoid (AC), respectively). There is a paucity of randomised studies dedicated to advanced PCs and management principles are drawn fro...
Objectives:
Video-assisted thoracoscopic surgery (VATS) has emerged as a safe and efficacious alternative approach to conventional thoracotomy for selected patients with non-small-cell lung cancer. The aim of the present study was to assess the current clinical practice of VATS among the European Society of Thoracic Surgeons (ESTS) members.
Metho...
Abstract
Objectives
The aim of this study is to collate multi-institutional data to determine the value by defining the diagnostic performance of fluorodeoxyglucose positron emission tomography (FDG PET)/CT for malignancy in patients undergoing surgery with an anterior mediastinal mass in order to ascertain the clinical utility of PET/CT to diffe...
Background:
Never-smokers with lung cancer often present late as there are no established aetiological risk factors. The aim of the study is to define the frequency over time and characterise clinical features of never-smokers presenting sufficiently early to determine if it is possible to identify patients at risk.
Methods:
We retrospectively a...
Immune evasion is a hallmark of cancer. Losing the ability to present neoantigens through human leukocyte antigen (HLA) loss may facilitate immune evasion. However, the polymorphic nature of the locus has precluded accurate HLA copy-number analysis. Here, we present loss of heterozygosity in human leukocyte antigen (LOHHLA), a computational tool to...
Background:
Tissue thickness at the site of ablation is a determinant of lesion transmurality. We reported the feasibility, safety and efficacy of long-standing persistent atrial fibrillation (PsAF) ablation, incorporating deliberate LAA isolation and occlusion and identified systematic differences in ostial LAA tissue thickness in a matched cohor...
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...
Lung cancer care is rapidly changing with advances in genomic testing, the development of next-generation targeted kinase inhibitors, and the continued broad study of immunotherapy in new settings and potential combinations. The IASLC and the Journal of Thoracic Oncology publish this annual update to help readers keep pace with these important deve...
Background: Endocardial left ventricular (LV) lead placement is
an alternative for delivering cardiac resynchronisation therapy in
patients whom coronary sinus lead placement has failed. Lead
navigation guided by 2D fluoroscopy, however, is not without
limitations.
Objective: LV lead manipulation in real time using a 3D mapping
system may offer an...
Objectives:
Large-cell neuroendocrine carcinoma (LCNC) is a rare tumour characterized by aggressive biological behaviour and poor prognosis. Due to its rarity and the lack of randomized clinical trials, the best treatment is still under debate. Some recent reports indicate that adjuvant chemotherapy (CT) may have a beneficial effect on survival. O...
The early detection of relapse following primary surgery for non-small cell lung cancer and the characterization of emerging subclones seeding metastatic sites might offer new therapeutic approaches to limit tumor recurrence. The potential to non-invasively track tumor evolutionary dynamics in ctDNA of early-stage lung cancer is not established. He...
CD25 is expressed at high levels on regulatory T (Treg) cells and was initially proposed as a target for cancer immunotherapy. However, anti-CD25 antibodies have displayed limited activity against established tumors. We demonstrated that CD25 expression is largely restricted to tumor-infiltrating Treg cells in mice and humans. While existing anti-C...
CD25 is expressed at high levels on regulatory T (Treg) cells and was initially proposed as a target for cancer immunotherapy. However, anti-CD25 antibodies have displayed limited activity against established tumors. We demonstrated that CD25 expression is largely restricted to tumor-infiltrating Treg cells in mice and humans. While existing anti-C...
The aim of this study is to survey healthcare professionals’ perspectives regarding methods of transfer for patients undergoing thoracic surgery.
INTRODUCTION
LVRS is recommended by NICE for selected patients with severe emphysema.
At the Royal Brompton Hospital (RBH), patients undergoing LVRS are admitted after surgery to HDU before discharge to the surgical ward. In order to reduce readmissions to HDU, a two-day elective stay policy was introduced. The aim of this audit is to assess the ef...
Introduction
Post drain removal pneumothorax is common in thoracic surgery and the complication strongly influences length of stay. Currently, no consensus exists on the acceptable frequency nor have any drain removal protocol been validated. The aim of this audit is to determine the expected standard to which nursing staff would consider acceptab...
Arrhythmogenic right ventricular dysplasia (ARVD) is an inheritable heart muscle disease that predominantly affects the right ventricle (RV) and predisposes to ventricular arrhythmias and sudden cardiac death (SCD)¹. The natural history is predominantly related to ventricular electric instability which may lead to arrhythmic SCD, mostly in young pe...
Both physicians and surgeons insert chest drains by various techniques—including Seldinger and “wide-bore” methods. The indications include hemothorax, pneumothorax, pleural effusion, and postoperative care in thoracic surgery. Given their invasive nature, there is significant potential for complications; however, this can be minimized by following...
Background:
The mapping of ventricular arrhythmias in humans using a mini-basket 64-electrode catheter paired with a novel automatIc mapping system (RhythmiaTM) has not been evaluated.
Objective:
To evaluate the safety and efficacy of mapping ventricular arrhythmias and clinical outcomes after ablation using this system.
Methods:
Electroanatomi...
Aims: Characterizing the differences in substrate and clinical outcome between heart failure (HF) and non-heart failure (non-HF) patients undergoing persistent atrial fibrillation (AF) ablation.
Methods and results: Using complex fractionated electrograms (CFE) as a surrogate marker of substrate complexity, we compared the bi-atrial substrate in pa...
Introduction
Across the UK, patients are commonly wheeled in a bed to theatre. With the introduction of day case cancer surgery and shorter stays in general, leads to the need to change patient perception in the gravity of the cancer surgery experience. However little is known on healthcare professional’s willingness to support a new patient centre...
Diagnostic Performance of PET-CT for Anterior Mediastinal Lesions – the DECiMaL study
C. Proli (1), P. De Sousa (1), S. Jordan (1), V. Anikin (1), S.M. Love (2), M. Shackcloth (2), N. Kostoulas (3), K. Papagiannopoulos (3), Y. Haqzad (4), M. Loubani (4), F. Sellitri (5), F. Granato (5), A. Bush (6), A. Marchbank (6), S. Iyer (7), M. Scarci (7), E...
Background:
Routine clinical application of circulating tumour cells (CTCs) for blood based diagnostics is yet to be established. Despite growing evidence of their clinical utility for diagnosis, prognosis and treatment monitoring, the efficacy of a robust platform and universally accepted diagnostic criteria remain uncertain. We evaluate the diag...
We thank Vroomen et al1 for their letter detailing the benefits of hybrid atrial fibrillation ablation, involving thoracoscopic epicardial ablation combined with endocardial catheter ablation followed by an epicardial left atrial appendage (LAA) clip procedure, performed in an experienced center.2
However, wider adoption of this approach as routin...
Introduction: Contact force sensing (CF) catheters have improved acute outcomes and medium-term recurrence rates following AF ablation, however data supporting the use of CF in ventricular tachycardia (VT) ablation is limited. To evaluate outcome following VT ablation with and without CF at a large tertiary referral hospital in London, UK.
Methods...
Background:
Left atrial appendage (LAA) electric isolation is reported to improve persistent atrial fibrillation (AF) ablation outcomes. However, loss of LAA mechanical function may increase thromboembolic risk. Concomitant LAA electric isolation and occlusion as part of conventional AF ablation has never been tested in humans. We therefore evalua...
Objective:
This study aims to assess the international practice of management of bronchial carcinoids.
Materials & methods:
A survey designed by the Neuroendocrine Tumors of the Lung Working Group, was conducted among the members of the European Society of Thoracic Surgeons.
Results:
A total of 172 centers worldwide replied to the questionnair...
Introduction
The ARC-HF study previously showed 1-year benefit of catheter ablation (CA) over rate control (RC) on symptomatic and functional endpoints. We investigated the longer term effect of CA on clinical outcomes in this cohort.
Methods
In 52 patients with persistent AF and systolic heart failure, originally randomised 1:1 for CA versus RC,...
Introduction:
The presence of ROS proto-oncogene 1, receptor tyrosine kinase gene (ROS1) rearrangements in lung cancers confers sensitivity to ROS kinase inhibitors, including crizotinib. However, they are rare abnormalities (in ∼1% of non-small cell lung carcinomas) that are typically identified by fluorescence in situ hybridization (FISH), and s...
Background:
Myocardial injury after non-cardiac surgery (MINS) is defined as troponin elevation of ≥0.03 ng/mL associated with 3.87-fold increase in early mortality. We sought to determine the impact of cardiology intervention on mortality in patients who developed MINS after general thoracic surgery.
Methods:
A retrospective review was performe...