New research was presented at AATS 2015, the annual meeting of the American Association for Thoracic Surgery, from April 25 to 29 in Seattle. The features below highlight some of the studies emerging from the conference.
Pneumonectomy for NSCLC After Chemo-Radiation Therapy
The Particulars: Previous research has shown that locally advanced non-small-cell lung cancer (NSCLC) is associated with a poor prognosis, meaning that effective treatment strategies are needed for the disease. Pneumonectomy after neoadjuvant concurrent chemo-radiation therapy may be beneficial in NSCLC patients, but research is lacking on this treatment strategy.
Data Breakdown: For a study, researchers performed retrospective analyses of 16 patients who underwent pneumonectomy after neoadjuvant concurrent chemo-radiation therapy to treat NSCLC. Nearly 40% of patients obtained a pathologically complete response. Following treatment, all abnormal blood tumor marker levels were normal. At an average follow-up of about 40 months, all patients were alive and only two had recurrent tumors. Toxicity was manageable, and no serious complications were observed.
Take Home Pearl: Pneumonectomy after neoadjuvant concurrent chemo-radiation therapy appears to be a feasible and effective treatment strategy for NSCLC.
Supraventricular Tachycardia Following Pulmonary Lobectomy
The Particulars: Few studies have assessed the rate of supraventricular tachycardia (SVT) in patients undergoing pulmonary lobectomy. Research is needed to determine if SVT is associated with length of stay (LOS) and to establish the incidence of stroke, mortality, and readmission in these patients.
Data Breakdown: Researchers reviewed the cases of more than 20,000 lobectomies performed in 2009 to 2011. They found that 11.8% of patients had postoperative SVT. Clinical predictors of SVT included being 75 or older, male, and having COPD, congestive heart failure, and thoracotomy. Patients with isolated SVT had increased LOS and stroke and readmission rates when compared with those who had no complications. However, no differences were observed for in-hospital mortality or readmission with stroke. Patients with SVT and other complications had increased LOS and rates of stroke, mortality, and readmission when compared with others.
Take Home Pearls: Postoperative SVT appears to be common in patients undergoing pulmonary lobectomy. In this patient population, SVT appears to be associated with increased rates of stroke, prolonged LOS, and higher rates of readmission.
Comparing Approaches in Early Stage Lung Cancer
The Particulars: Anecdotal evidence suggests that clinicians are increasingly interested in the potential of performing limited resections in early stage lung cancer. However, the extent to which limited resection may preserve pulmonary function when compared with standard lobectomy has not been well defined, particularly in the setting of minimally invasive surgery.
Data Breakdown: Spirometry tests were obtained prospectively before and 6 months after patients in a study underwent video-assisted thoracoscopic surgery (VATS) lobectomy, VATS segmentectomy, VATS wedge resection, or VATS mediastinal procedures without lung resection (control). Forced vital capacity loss was significantly greater after lobectomy than after segmentectomy or wedge resection. Forced expiratory volume in 1 second loss after both lobectomy and segmentectomy was significantly higher than what was observed after wedge resection. Diffusing capacity was similar among all groups.
Take Home Pearl: VATS wedge resection appears to preserve pulmonary function better than other minimally invasive surgical options for early stage lung cancer.
Early Oral Feeding After Esophagectomy
The Particulars: Following resection and reconstruction of esophageal cancer, it is common for patients to be put on enteral tube feeding for several days. It has yet to be determined in studies if no nasogastric intubation and early oral feeding after thoracolaparoscopic esophagectomy is safe and feasible.
Data Breakdown: For a study, adults with esophageal squamous cell carcinoma who received thoracolaparoscopic esophagectomy were randomized to start oral feeding on postoperative day 1 or to receive no food by mouth until 7 days after surgery. Rates of anastomotic leak were below 3.0% in both groups. Overall complication rates were 22.2% in the early oral feeding group and 25.0% in the late oral feeding group. However, time to first flatus, bowel movement, and length of postoperative stay was significantly shorter in the early oral feeding group.
Take Home Pearls: No nasogastric intubation and early oral feeding following thoracolaparoscopic esophagectomy appears to be safe and feasible. This strategy also appears to shorten length of stay and time to bowel function recovery.
LVRS: Assessing Safety & Durability
The Particulars: Despite prior research that has validated the efficacy of lung volume reduction surgery (LVRS) in select patients with advanced emphysema, concerns about the safety and durability of the surgery have limited its use.
Data Breakdown: Investigators at Columbia University conducted a study to assess surgical morbidity and mortality, early and late functional outcomes, and long-term survival among patients who underwent bilateral LVRS. No all-cause surgical deaths were observed at 6 months. Forced expiratory volume in 1 second and maximal workload measurements improved at 1, 2, and 5 years postoperatively. Overall survival rates seen among LVRS recipients were:
♦ 99% at 1 year
♦ 97% at 2 years
♦ 80% at 5 years
Take Home Pearls: In select patients, LVRS appears to be safe and durable with regard to long-term functional improvements. The procedure also appears to yield high long-term survival rates.