Impact of preoperative chemotherapy on pulmonary function tests in resectable early-stage non-small cell lung cancer.

Background: Several chemotherapy agents, including gemcitabine and paclitaxel, have been reported to cause interstitial pneumonitis. The incidence of pulmonary toxicity from the combination of gemcitabine and paclitaxel is reported to be approximately 5%. In this report, pulmonary function test (PFT) results were analyzed from two similar randomized phase 2 trials that tested platinum and nonplatinum regimens preoperatively in patients with stage I or II non-small cell lung cancer (NSCLC).

Should endobronchial ultrasonography be part of the thoracic surgeon's armamentarium?

Objective: The study objective was to determine the clinical usefulness and accuracy of endobronchial ultrasound-guided needle aspiration of mediastinal and hilar lymph nodes.

Methods: A retrospective analysis of a thoracic surgery unit's experience was performed.

Results: In a period of 19 months, 75 patients underwent the procedure (mean age = 65.

Spontaneous bronchopleural fistula following lung volume reduction surgery for emphysema.

Five days following bilateral thoracoscopic lung volume reduction surgery for emphysema, a 63-year-old man underwent reoperation for closure of a massive bronchopleural fistula. It was discovered intraoperatively that the fistula was located distant from prior staple lines or resection sites from his surgery. This case is an example of what may be a unique pathophysiologic mechanism of bronchopleural fistula formation--a 'stress rupture' of the lung parenchyma following lung volume reduction surgery.

Impact of obesity on perioperative outcomes of minimally invasive esophagectomy.

Background: Abnormal body mass index has been targeted as a predictor of complications after major surgery. The aim of this study was to review the impact of obesity on perioperative outcomes after minimally invasive esophagectomy.

Methods: This study was a single-institution retrospective review of patients undergoing minimally invasive esophagectomy for high-grade dysplasia or cancer of the esophagus between 1999 and 2004.

Efficacy of signal pathway inhibitors alone and in combination with Cisplatin varies between human non-small cell lung cancer lines.

Background: Signal pathway inhibitors (SPI) are designed to act synergistically with conventional cytotoxic drugs to control cancer progression. The objective of this study was to evaluate the effect of various SPI, both alone and in combination with cisplatin, on three different non-small cell lung cancer (NSCLC) cell lines.

Materials And Methods: Cell lines (A549, 201T, 273T) representing NSCLC were treated for 72 h in the presence or absence of inhibitors to PI3K (LY-294002; Tocris Bioscience, Ellisville, MO), BCL-2 (Gossypol; Sigma-Aldrich, St.

Association between CCND1 G/A870 polymorphism, allele-specific amplification, cyclin D1 expression, and survival in esophageal and lung carcinoma.

Purpose: Cyclin D1 is found on 11q13, which is a region frequently amplified in several tumor types. The CCND1 locus gives rise to at least two protein isoforms of D1 (D1a and D1b). A common G/A polymorphism (G/A870) is thought to influence the expression levels of D1a and D1b.

Technical challenges and utility of anterior exposure for thoracic spine pathology.

Background: Thoracic surgeons are frequently called upon to provide exposure to the anterior cervicothoracic, thoracic, and proximal lumbar spine. We reviewed our surgical experience and the perioperative outcomes of these spinal approaches. Relevant technical and anatomic considerations of each procedure are highlighted.

Whole genome exon arrays identify differential expression of alternatively spliced, cancer-related genes in lung cancer.

Alternative processing of pre-mRNA transcripts is a major source of protein diversity in eukaryotes and has been implicated in several disease processes including cancer. In this study we have performed a genome wide analysis of alternative splicing events in lung adenocarcinoma. We found that 2369 of the 17 800 core Refseq genes appear to have alternative transcripts that are differentially expressed in lung adenocarcinoma versus normal.

Laparoscopic repair of giant paraesophageal hernia results in long-term patient satisfaction and a durable repair.

Background: Laparoscopic repair of giant paraesophageal hernia (LRGPEH) is routinely performed in many centers, but high recurrence rates have led to concerns regarding this approach. We evaluate long-term recurrence rates, symptom improvement and correlation with radiographic recurrence, and risk factors for recurrence in our cohort of patients.

Methods: A cohort of consecutive patients with a minimum of 5 years potential follow-up (1997-2003) post-LRGPEH was identified from a prospective database.

Radiofrequency ablation for the treatment of lung neoplasm.

Lung cancer is the most common cause of cancer-related mortality in the USA. Surgical resection is the standard treatment for resectable disease; however, a significant percentage of patients with otherwise resectable lung cancer may have other comorbidities, precluding surgical resection. In patients with Stage I non-small-cell lung cancer, conventional external-beam radiotherapy is typically offered as treatment in medically inoperable, high-risk patients with reported 5-year survival rates of 10-30%.

Is minimally invasive esophagectomy indicated for cancer?

Esophagectomy is an important component in the comprehensive treatment of esophageal cancer. The 5-year survival in patients who are treated with esophagectomy is approximately 35% compared with approximately 16% for all patients. However, esophagectomy is a complex operation with high (40-60%) morbidity and 5-20% mortality rates reported by many centers.

Revisional surgery after esophagectomy: an analysis of 43 patients.

Background: Reflux and postprandial fullness are common after esophagectomy. On occasion, these symptoms have an anatomic basis that requires operative correction. Two such conditions are the following: (1) a diaphragmatic hernia in which bowel herniates into the chest; and (2) a redundant conduit that impairs gastric emptying.

The integrity of esophagogastric junction anatomy in patients with isolated laryngopharyngeal reflux symptoms.

Background: Distortion of esophagogastric junction anatomy in patients with gastroesophageal reflux disease produces permanent dilation of the gastric cardia proportional to disease severity, but it remains unclear whether this mechanism underlies reflux in patients with isolated laryngopharyngeal reflux symptoms.

Method: In a prospective study, 113 patients were stratified into three populations based on symptom complex: laryngopharyngeal reflux symptoms, typical reflux symptoms, and both laryngopharyngeal and typical symptoms. Subjects underwent small-caliber upper endoscopy in the upright position.

An extracellular matrix scaffold for esophageal stricture prevention after circumferential EMR.

Background: EMR is an accepted treatment for early esophageal cancer and high-grade dysplasia. One of the limitations of this technique is that extensive mucosal resection and endoscopic submucosal dissection may be required to obtain complete removal of the neoplasm, which may result in significant stricture formation.

Objective: The objective of the current study was to evaluate the efficacy of an endoscopically deployed extracellular matrix (ECM) scaffold material for prevention of esophageal stenosis after circumferential EMR.

Cervical pharyngostomy: an old technique revisited.

Objective: To review our experience with pharyngostomy tubes used to manage complications following foregut surgery and to discuss technical aspects of insertion.

Summary Background Data: Cervical pharyngostomy tubes are percutaneously placed through the hypopharynx and directed into the stomach or small bowel. Historically, these tubes were placed during resection of head and neck cancer for postoperative nutrition.

The Pittsburgh Lung Screening Study (PLuSS): outcomes within 3 years of a first computed tomography scan.

Rationale: The role of computed tomography (CT) screening for lung cancer is controversial, currently under study, and not yet fully elucidated.

Objectives: To report findings from initial and 1-year repeat screening low-radiation-dose CT of the chest and 3-year outcomes for 50- to 79-year-old current and ex-smokers in the Pittsburgh Lung Screening Study (PLuSS).

Methods: Notified of findings on screening CT, subjects received diagnostic advice from both study and personal physicians.

Use of novel autoantibody and cancer-related protein arrays for the detection of esophageal adenocarcinoma in serum.

Objective: The aim of this study was to evaluate the feasibility of using novel autoantibody and cancer-related protein arrays to identify potential biomarkers for the early detection of esophageal adenocarcinoma in serum.

Methods: Sera from 18 patients with esophageal adenocarcinoma and 14 with gastroesophageal reflux disease were added to microarrays designed to detect circulating autoantibodies to 51 tumor-associated antigens. Sera from the same patients were also added to a 53-plex assay for various cancer-related proteins.

Transcervical gastric tube drainage facilitates patient mobility and reduces the risk of pulmonary complications after esophagectomy.

Background: Standard nasogastric decompression following esophagectomy is associated with reduced patient comfort and mobility and impaired hypopharyngeal function--predisposing the patient to sinusitis, pharyngitis, and the risk of aspiration. In this study, we evaluate the results of the transcervical gastric tube drainage in the setting of esophagectomy.

Methods: Transcervical gastric tube decompression was performed on 145 consecutive patients undergoing open esophagectomy between 2003 and 2007.

Endoscopic thoracic sympathectomy: at what level should you perform surgery?

Several interventions are possible on the sympathetic chain and the nomenclature has been confusing. The authors propose a uniform nomenclature for each procedure, mainly, sympathectomy for resection or ablation of the ganglion, sympathicotomy for the transaction of the chain, ramicotomy for the procedure preserving the chain and ganglia and severing the rami, and finally, sympathetic block for clipping above and below the ganglia. They recommend intervention on the T2 ganglia for facial hyperhidrosis and rubor, on the T3 ganglia for palmar hyperhidrosis, and on the T3 and T4 ganglia for axillary hyperhidrosis.

Polyflex expandable stents in the treatment of esophageal disease: initial experience.

Background: The new generation of expandable plastic esophageal stents (Polyflex; Boston Scientific, Natick, MA), combine the features of plastic and self-expanding metallic stents. The main objective of this study is to evaluate our initial experience with Polyflex expandable stents in the treatment of esophageal disease from two institutions.

Methods: A total of 58 Polyflex stents were placed in 38 patients over a two-year period.

Roux-en-Y near esophagojejunostomy for intractable gastroesophageal reflux after antireflux surgery.

Background: Intractable gastroesophageal reflux disease (GERD) after prior antireflux operation presents a difficult challenge. Our objective was to investigate the role of Roux-en-Y near esophagojejunostomy (RNYNEJ) in the management of intractable reflux symptoms after prior antireflux surgery.

Methods: Between June 2000 and October 2005, 25 patients with GERD after antireflux surgery underwent RNYNEJ.

Long-term results of a phase II trial of neoadjuvant chemotherapy followed by esophagectomy for locally advanced esophageal neoplasm.

Background: Effective systemic therapy is considered essential to improve the outcome for patients with surgically resectable locally advanced esophageal carcinoma. We report the long-term results of our phase II study of neoadjuvant chemotherapy, followed by esophagectomy and adjuvant chemotherapy for potentially resectable esophageal carcinoma.

Methods: Patients were staged with computed tomography scan (n = 70), endoscopic ultrasonography (n = 63), and laparoscopy with or without thoracoscopy (n = 70).

Minimally-invasive esophagomyotomy in 200 consecutive patients: factors influencing postoperative outcomes.

Background: The primary objective of this study was to review our experience with minimally-invasive esophagomyotomy as primary therapy for achalasia, and to identify those clinical variables most predictive of myotomy failure.

Methods: We reviewed our experience with all patients who underwent minimally-invasive Heller myotomy from 1992 to 2005. Outcome variables analyzed included perioperative morbidity and mortality, symptomatic improvement, and requirement for postoperative interventions.

Parenchymal-sparing resections: why, when, and how.

Although lobectomy should continue to be regarded as the procedure of choice for NSCLC, certain subsets of patients who have favorable characteristics may be treated appropriately with segmentectomy without adversely affecting oncologic outcome as long as an adequate assessment of intraoperative nodal status and surgical margin is performed. The use of anatomic segmentectomy may be particularly useful for small, peripheral tumors less than 2 cm in diameter located within anatomic segmental boundaries, as well as for elderly patients who have impaired cardiopulmonary function. Ground-glass opacities and lesions displaying bronchoalveolar histology also may be appropriate target lesions for segmentectomy because of their low metastatic potential.