Abstract:
:The role of surgery in the treatment of patients with stage IIIa non-small cell lung cancer (NSCLC) and mediastinal node involvement is examined in this best evidence topic according to a structured protocol. A total of 579 papers were identified using the outlined search, 12 of which were deemed to represent the best available evidence. From the data summarized, we conclude that surgery, as part of a multimodality therapeutic approach, offers a survival benefit for patients with resectable N2 NSCLC. Overall five-year survival rates following primary resection ranged from 17% to 20% (four studies). Improved five-year survival was demonstrated with multimodality therapy (19-45%; 13 studies). Subgroup analysis demonstrates a five-year survival of 30.5% with postoperative chemo-radiotherapy, 22.2% with chemotherapy alone, and 27% with radiotherapy alone. In our review, we address three major issues regarding the management of stage IIIa NSCLC, the first of which is primary vs. postinduction surgery. The largest cohort series to date is the International Association for the Study of Lung Cancer Staging Committee paper on nodal disease, which reports that patients with single-zone N2 disease had the same survival outcome as patients with multizone N1 disease. The second issue is that of randomized vs. cohort studies: there have been five randomized trials reporting similar outcomes and hence equipoise. The third issue is postinduction staging. All studies evaluated reported a better outcome in patients with ypN0 (i.e. postinduction N0 disease). However, surgery should not be denied to patients with ypN1-N2, as there is evidence to demonstrate a significant improvement in survival time in all patients able to undergo surgery after induction chemo-radiotherapy. In conclusion, although some of the evidence available is equivocal regarding the survival benefit of resection for stage IIIa N2 disease, the authors believe surgery should be considered as part of a multimodality therapeutic strategy for patients with advanced nodal disease.
journal_name
Interact Cardiovasc Thorac Surgjournal_title
Interactive cardiovascular and thoracic surgeryauthors
Bakir M,Fraser S,Routledge T,Scarci Mdoi
10.1510/icvts.2011.267872subject
Has Abstractpub_date
2011-09-01 00:00:00pages
303-10issue
3eissn
1569-9293issn
1569-9285pii
icvts.2011.267872journal_volume
13pub_type
杂志文章,评审abstract::Miniaturized cardiopulmonary bypass (CPB) systems, though more biocompatible, are limited by not being adaptable to all cardiac surgical operations. We evaluate a versatile CPB system [extracorporeal vacuum-assisted device optimized (EVADO)] based on the elimination of roller pumps, separation of extracavitary suction...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章,随机对照试验
doi:10.1510/icvts.2010.258921
更新日期:2011-04-01 00:00:00
abstract:OBJECTIVES:To analyse the factors associated with in-hospital mortality and mid-term significant neoaortic valve regurgitation (AR) after truncal valve (TV) repair. METHODS:Eleven children underwent TV repair at our institution from July 1999 to March 2012. All children presented significant preoperative TV regurgitat...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1093/icvts/ivt098
更新日期:2013-06-01 00:00:00
abstract::Video-assisted thoracoscopy (VATS) is gaining on thoracic surgery, having newly developed devices next to endostaplers for haemostatic and airtight sealing of lung parenchyma. Though the bipolar electrothermal Ligasure has good results for pulmonary wedge resection, its literature is small in numbers. Authors compared...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1510/icvts.2008.199307
更新日期:2009-07-01 00:00:00
abstract::For the CryoLife-O'Brien valve (CryoLife Inc, Kennesaw, GA, USA), implanted with a single suture line, we aimed to analyze the surgical requests and the hemodynamic results compared to stented bioprostheses. Two groups of patients requiring isolated aortic valve replacement from this population were compared retrospec...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1510/icvts.2006.133967
更新日期:2006-10-01 00:00:00
abstract::Endocarditis involving the aortic root and intervalvular fibrous skeleton presents a reconstructive dilemma. We report a case of endocarditis involving the aortic root and tricuspid valve with extensive destruction of the atrioventricular septum. Debridement necessitated resection of the aortic root, aortic valve, tri...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1510/icvts.2008.181966
更新日期:2009-02-01 00:00:00
abstract::The rotary blood pump (the HeartWare® Ventricular Assist Device) from HeartWare® (Medtronic) is an established left ventricular assist device and usually implanted via sternotomy. To reduce the invasiveness of the implant procedure and to optimize the position of the inflow cannula, we propose an alternative implant t...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1093/icvts/ivy183
更新日期:2018-12-01 00:00:00
abstract::The aim of the study was to assess the feasibility, efficacy and safety of the use of a conical self-expandable stent for the treatment of post-pneumonectomy bronchopleural fistula (PPBPF). Between April 2008 and November 2010, six patients underwent treatment for the PPBPF by the introduction of a tracheobronchial co...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1093/icvts/ivr077
更新日期:2012-04-01 00:00:00
abstract:OBJECTIVES:Dividing the intersegmental planes with a stapler during pulmonary segmentectomy leads to volume loss in the remnant segment. The aim of this study was to assess the influence of segment division methods on preserved lung volume and pulmonary function after segmentectomy. METHODS:Using image analysis softwa...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1093/icvts/ivw188
更新日期:2016-10-01 00:00:00
abstract::Various forms of renal replacement therapies are available to treat acute renal failure (ARF) after cardiac surgery. The objective of this study was to assess the incidence of ARF developing postoperatively necessitating continuous veno-venous hemofiltration (CVVH) in adult patients requiring cardiopulmonary bypass (C...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1016/j.icvts.2004.03.002
更新日期:2004-09-01 00:00:00
abstract::Aprotinin reduces bleeding and transfusion rates in patients undergoing coronary surgery while on clopidogrel. However, safety studies have indicated that aprotinin may have a possible adverse effect related to an increased incidence of thromboembolic events. We therefore studied the adenosinediphosphate (ADP) mediate...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1510/icvts.2009.206342
更新日期:2009-08-01 00:00:00
abstract:OBJECTIVE:To report a rare case of fatal early acute thrombosis of mechanical mitral prosthesis. METHODS:A 62-year-old lady, who underwent closed mitral valvotomy for rheumatic heart disease 19 years ago, presented with Canadian Cardiovascular Society Class II angina and New York Heart Association Class III dyspnoea. ...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1510/icvts.2005.125757
更新日期:2006-08-01 00:00:00
abstract::Endothelin (ET-1) is a potent vasoconstrictor. We compared patterns of ET-1 in percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) and correlated it with markers of inflammation. Patients with multivessel disease were enrolled in a prospective randomized study of PCI vs. on-pump CABG. Pr...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章,随机对照试验
doi:10.1510/icvts.2011.278192
更新日期:2011-12-01 00:00:00
abstract::The latissimus dorsi and serratus anterior muscles are available for reconstruction coverage of thoracic defects. We performed extended latissimus dorsi-serratus anterior chimeric thoraco-myoplasty with a vascular supercharge to maintain sufficient blood supply to the flaps because of a deficiency in the distal blood ...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1093/icvts/ivz280
更新日期:2020-03-01 00:00:00
abstract::A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was: is it safe to stop anticoagulants after successful surgery for atrial fibrillation? Altogether, 177 papers were found using the reported search, of which 14 were selected that represented the bes...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章,评审
doi:10.1510/icvts.2011.282319
更新日期:2011-12-01 00:00:00
abstract::Left ventricular papillary muscle geometry is distorted in dilated non-ischemic hearts, and following anterior infarction caused by a wrap around left anterior descending artery occlusion. Loss of the apex creates a spherical left ventricular (LV) chamber, and subsequent dilation causes secondary mitral insufficiency ...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1510/icvts.2005.109868
更新日期:2005-10-01 00:00:00
abstract::A 65-year old man who had undergone right pneumonectomy for lung cancer presented with superior vena cava (SVC) syndrome due to recurrent bulky disease on follow-up after 14 months. Complete resection of the tumour was achieved, and the SVC system was reconstructed with separated double grafts. The right graft was ana...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1093/icvts/ivv188
更新日期:2015-10-01 00:00:00
abstract:OBJECTIVES:The differences in clinical features, surgical outcome and long-term prognosis between men and women who undergo surgery for Type A aortic dissection are not well known. METHODS:From January 2004 to December 2016, 303 patients, consisting of 147 women and 156 men, underwent surgery for acute Type A aortic d...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1093/icvts/ivy005
更新日期:2018-06-01 00:00:00
abstract:OBJECTIVES:The best surgical strategy for acute Stanford Type A aortic dissection (aTAAD) involving the arch remains controversial. Here, we report on the satisfactory results following aTAAD repair using a novel arch fenestrated stent graft. METHODS:From December 2014 to December 2015, 42 aTAAD patients (27 male and ...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1093/icvts/ivx335
更新日期:2018-03-01 00:00:00
abstract::A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'in patients with ascending aortic or aortic arch disease what are the outcomes with endovascular repair in terms of survival, complications and reintervention?' Altogether 585 papers were found using th...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1093/icvts/ivaa215
更新日期:2021-01-01 00:00:00
abstract::A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether adjuvant antifungal therapy is useful after pulmonary surgery for aspergilloma. One hundred and sixteen papers were identified using the search described below, of which 5 papers presented the b...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章,评审
doi:10.1093/icvts/ivu069
更新日期:2014-06-01 00:00:00
abstract:OBJECTIVES:Blood cardioplegia (BCP) can be used in different ways to protect the heart from ischaemia-reperfusion injury during cardiac surgery. Because there could be differences between warm and cold intermittent cardioplegia with or without warm reperfusion, we investigated the influence of 2 blood cardioplegia solu...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1093/icvts/ivy011
更新日期:2018-07-01 00:00:00
abstract::The ventricular assist device (VAD) is a life-saving option for patients in heart failure refractory for conventional therapy. The aim of study was to assess the influence of VAD on heart transplantation (HT) outcome in children <16 years. Between October 1988 and August 2008, 73 children underwent HT: Group 1 (n=9) w...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1510/icvts.2009.210518
更新日期:2009-11-01 00:00:00
abstract::We describe a treatment strategy for an aberrant arterial aneurysm associated with pulmonary sequestration. A 58-year-old man with impending aberrant arterial aneurysm rupture underwent a 2-stage surgery that included an emergency thoracic endovascular aortic repair (TEVAR) of the descending aorta to occlude the origi...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1093/icvts/ivz233
更新日期:2020-01-01 00:00:00
abstract::Although aortic sarcomas are extremely rare, they may arise in association with a Dacron graft. Here, we report a case of an intimal sarcoma in an ascending aortic Dacron graft implanted 17 years earlier. The patient presented with multiple cerebral infarctions; clinically, a thrombus was found to cause the embolic st...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1093/icvts/ivz192
更新日期:2019-12-01 00:00:00
abstract::Atrial septal defect (ASD) is a common congenital cardiac anomaly. Even though surgery is the gold standard, percutaneous device closure is gaining popularity because of the short learning curve, cosmetic advantage and relative safety. The long-term implications are open to question. We report here two cases where sur...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1510/icvts.2007.165647
更新日期:2008-02-01 00:00:00
abstract::The surgical management of the aortic arch pathologies is controversial. Primary anastomosis and patch aortoplasties combined with end-to-end anastomosis have some complications like recurrence and aneurysm formation. Surgical repair of apical muscular (Swiss-cheese) defects is also still under debate. A 6-year-old pa...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1016/S1569-9293(03)00260-3
更新日期:2004-03-01 00:00:00
abstract::Postoperative air-leak is a problem which is frequently encountered in thoracic surgery. We describe the utility of the Asherman chest seal, a device used in primary trauma care in the successful management of a complicated postoperative air-leak. The Asherman Chest Seal is a sterile occlusive dressing with a one-way ...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1510/icvts.2007.161497
更新日期:2007-12-01 00:00:00
abstract::A best evidence topic was written according to a structured protocol. The question addressed was 'In patients requiring an aortic valve replacement, are rapid deployment aortic valve systems better than conventional aortic valve prostheses in terms of mortality, morbidity and/or valve function?' A total of 508 papers ...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章,评审
doi:10.1093/icvts/ivw226
更新日期:2016-11-01 00:00:00
abstract::We describe the case history of a 43-year-old male with type 1 Brugada syndrome. He was fitted with an implantable cardioverter defibrillator (ICD) for primary prevention nine years ago. After admission for inappropriate shocks, an abnormal position of the lead was discovered. Further investigations (chest X-ray and t...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1510/icvts.2010.250209
更新日期:2011-03-01 00:00:00
abstract:OBJECTIVES:The totally thoracoscopic left atrial Maze (TT-Maze) is a relatively new surgical solution for the treatment of atrial fibrillation (AF). The procedure consists of a complete left atrial Maze, which is performed by video-assisted thoracoscopy with the use of radiofrequency ablation. We describe our rhythm re...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1093/icvts/ivv358
更新日期:2016-03-01 00:00:00