The Landmark Series: Role of Curative Intent Treatment for Oligometastatic Disease of the Lung.

The management of oligometastatic lung cancer represents a treatment challenge for most academic programs, with varied best practice recommendations and limited, inconsistent quality in available evidence and clinical trials. As migration toward focused systemic and local multimodal treatment strategies continues, the dogma of "old fashioned" care for all stage 4 lung cancer patients has been revisited and modernized. Through this lens, the authors draw upon a growing body of experience during the last two decades that justifies curative-intent strategies for select lung cancer patients who present with or at times progress to oligometastatic disease.

Lymphatic Metastasis of Esophageal Squamous Cell Carcinoma: The Role of NRF2 and Therapeutic Strategies.

The lethality of esophageal squamous cell carcinoma (ESCC), and other epithelial cancers, is primarily due to its aggressive nature and frequent lymphatic metastasis, both of which impact prognosis. In this review, we explore the underlying molecular mechanisms of ESCC lymphatic metastasis, specifically, the functional role of NRF2 and therapeutic strategies. Current data suggest that NRF2 hyperactivation (NRF2) may promote lymphatic metastasis of ESCC by affecting the extracellular matrix (ECM), epithelial-mesenchymal transition (EMT), lymphangiogenesis, immune evasion, metabolic programming, and Hippo signaling.

Variable Presentations of Sclerosing Pneumocytoma: Two Cases Highlighting Divergent Fluorodeoxyglucose Metabolism and Carcinoid Tumorlet Association.

Pulmonary sclerosing pneumocytomas are rare benign tumors, with some cases demonstrating potential for aggressive metastasis. Patients typically are asymptomatic with a nodule/mass seen on incidental imaging; however, they can present with nonspecific symptoms such as cough, shortness of breath, and chest pain. Diagnosis can only be confirmed with biopsy, and computed tomography-guided or fluoroscopy-guided needle biopsies are routinely used.

Open mesh repair of an iatrogenic post-nephrectomy Bochdalek hernia in an adult: a case study.

Bochdalek hernias arise from a developmental failure of the pleuroperitoneal canal to close, allowing abdominal contents to herniate into the thorax and compress the developing lung parenchyma. In rare cases, Bochdalek hernias may arise in adults and usually present with symptoms related to the hernia. Treatment consists of either open, laparoscopic, or robotic repair to close the defect.

Optimizing outcomes in paraesophageal hernia repair: a novel critical view.

Background: The recurrence rate of paraesophageal hernia repair (PEHR) is high with reported rates of recurrence varying between 25 and 42%. We present a novel approach to PEHR that involves the visualization of a critical view to decrease recurrence rate. Our study aims to investigate the outcomes of PEHR following the implementation of a critical view.

Liposomal Bupivacaine Versus Bupivacaine and Dexamethasone Intercostal Nerve Blocks for Robotic Thoracic Surgery: A Randomized Clinical Trial.

Introduction For peripheral nerve blocks, using either the liposomal formulation of bupivacaine or plain bupivacaine with epinephrine and dexamethasone as an adjuvant has been shown to improve postoperative pain scores. In a single-blinded, randomized controlled study of patients undergoing robotic-assisted thoracoscopic surgery, we determined if bupivacaine with epinephrine and dexamethasone was noninferior to liposomal bupivacaine mixed with plain bupivacaine when administered intraoperatively as an intercostal nerve block (INB). Methods A total of 34 patients undergoing robotic-assisted thoracoscopic surgery were randomized to receive one of two injectate mixtures during their intraoperative INB.

A real-world study evaluating the safety and utility of a two-row stapler reload on pulmonary vasculature.

Background: Endoscopic staplers are common surgical devices used for the ligation and division of vasculature in thoracic procedures. When a stapler ligates and divides pulmonary vasculature, potentially catastrophic intraoperative bleeding at the staple-line may occur. The aim of this study was to confirm the safety and discuss the utility of a two-row stapler reload, by assessing the incidence of clinically necessary intraoperative hemostatic intervention when applied to pulmonary vasculature in real-world applications.

Diagnostic Workup and Therapeutic Intervention of Hiatal Hernias Discovered as Incidental Findings on Computed Tomography.

Background: Computed tomography imaging routinely detects incidental findings; most research focuses on malignant findings. However, benign diseases such as hiatal hernia also require identification and follow-up. Natural language algorithms can help identify these non-malignant findings.

Exploring cell competition for the prevention and therapy of esophageal squamous cell carcinoma.

Esophageal squamous cell carcinoma (ESCC) is characterized by the development of cancer in the esophageal squamous epithelium through a step-by-step accumulation of genetic, epigenetic, and histopathological alterations. Recent studies have demonstrated that cancer-associated gene mutations exist in histologically normal or precancerous clones of the human esophageal epithelium. However, only a small proportion of such mutant clones will develop ESCC, and most ESCC patients develop only one cancer.

Minimally Invasive Treatment of Tunneled Central Venous Catheter-Associated Venobronchial Fistula.

Venobronchial fistula (VBF) is a rare complication of central venous access. We describe a 30-year-old woman with VBF associated with a tunneled venous catheter. She presented with a drowning sensation associated with infusions.

The Early Impact of the COVID-19 Pandemic on Lung, Colorectal, and Breast Cancer Screening and Treatment at a Tertiary Cancer Center.

Objectives: During the coronavirus-19 pandemic, experts recommended delaying routine cancer screening and modifying treatment strategies. We sought to understand the sequalae of these recommendations.

Materials And Methods: We performed a retrospective single-center analysis of screening, diagnosis, and treatment of lung, colorectal, and breast cancer.

Utilization Large Animal Research as an Adjunct for Surgical Education Increases Perceived Resident Confidence.

Surgical education has evolved over time to incorporate supplemental modalities of training beyond the operating room. Even with the utility of simulation software and didactic education, there is still a need to provide surgical residents with experience in live tissue dissection and tissue handling while maintaining patient safety. In our program, after two clinical years, residents participate in a year of translational research which uses porcine models for complex open abdominal procedures.

The State of Racial and Gender Diversity in Cardiothoracic Surgery Training.

Background: The field of cardiothoracic surgery has been striving to increase its gender and racial diversity. We sought to examine changes in gender and racial diversity in cardiothoracic fellowships and integrated residencies in the past decade.

Methods: Accreditation Council for Graduate Medical Education data were obtained from 2011 to 2019.

Liposomal Bupivacaine Versus Bupivacaine for Intercostal Nerve Blocks in Thoracic Surgery: A Retrospective Analysis.

Background: Liposomal bupivacaine (LipoB), delivered via intercostal nerve blocks (ICNBs), is increasingly being used for postoperative pain control in thoracic surgery patients, but there is limited data on its effectiveness when compared to standard bupivacaine.

Objective: We sought to compare postoperative opioid use, pain control, and length of stay (LOS) in patients undergoing thoracic surgery with LipoB ICNBs vs patients undergoing thoracic surgery with ICNBs using standard bupivacaine.

Study Design: A retrospective analysis.

Status of sentinel lymph node mapping in non-small cell lung cancer.

Sentinel lymph node mapping has become the standard of care in melanoma and breast cancer, contributing to marked improvements in accurate staging and targeted treatment, while decreasing morbidity of aggressive nodal bed dissections. Since 1999, several groups have proposed similar mapping in lung cancer models with mixed success. This article reviews the research up to date and discusses opportunities to improve accuracy of sentinel lymph node biopsy in non-small cell lung cancer.

Value of circulating insulin-like growth factor-associated proteins for the detection of stage I non-small cell lung cancer.

Objective: Circulating biomarkers related to insulin-like growth factor (IGF) signaling are associated with disease progression in multiple carcinomas, but their potential diagnostic value for lung cancer screening has been inadequately examined. We evaluated 9 circulating IGF-related factors for their ability to assign clinical significance to indeterminate pulmonary nodules identified via computed tomography-based radiologic studies.

Methods: Patients (n = 224 stage I non-small cell lung cancer; n = 123 benign) were enrolled by Rush University and the Mayo Clinic and had pretreatment serum evaluated for levels of IGF-1, IGF-2, and insulin-like growth factor binding proteins (IGFBPs) 1-7.

Multimodality treatment of pleural mesothelioma.

Although the treatment of malignant pleural mesothelioma has been refined during the past two decades, overall survival from this rather uncommon disease is still extremely poor. Here we review the current multimodal diagnostic and treatment options for patients with mesothelioma and discuss promising new experimental concepts in this disease.