Publications by authors named "Pascal-Alexandre Thomas"
Outcomes of non-small cell lung cancer resection in patients with synchronous brain metastases.
Eur J Cardiothorac Surg
September 2025
Objectives: To report on the outcomes in a single centre cohort of patients who underwent resection of their primary lung tumour along with radical treatment of their synchronous brain metastases.
Materials And Methods: Between 2005 and 2024, 86 patients (35 females and 51 males) with 113 events with a median age of 59 years (range: 52-67) were treated. The most common histological subtype was adenocarcinoma (71 patients, 82.
Introduction: Unlike most malignancies, increased adiposity, as expressed by a higher body mass index (BMI), is associated with improved prognosis after lung cancer surgery at the population level. Height, one of the determinants of BMI, is associated with better survival, independent of other confounders, even though BMI is calculated as weight divided by height squared. The association of weight with survival is difficult to assess because, at the individual level, weight is closely linked to height and does not directly reflect adiposity.
View Article and Find Full Text PDFObjectives: Acute kidney injury (AKI) requiring dialysis after lung transplantation is a significant source of morbidity. This study investigates the incidence, mortality, and variables associated with the need for dialysis.
Methods: This retrospective analysis included patients aged ≥15 years who underwent lung transplantation between 2014 and 2019 at 3 French institutions.
Background: Lung cancer remains the leading cause of cancer-related mortality worldwide. In resected stage II-III Non-Small Cell Lung Cancer (NSCLC), adjuvant chemotherapy (ACT) improves survival, but its benefit in elderly patients remains unclear due to the lack of dedicated studies. We conducted a retrospective study to assess benefit and predictive factors of ACT in NSCLC patients over 75-years-old.
View Article and Find Full Text PDFBeyond 2025: Projections of cardiothoracic surgeon demographics in France.
Arch Cardiovasc Dis
June 2025
Background: Cardiothoracic surgeons are essential healthcare practitioners but there are demographic challenges and training complexities. Understanding workforce trends is critical to ensure future capacity and adaptability in France.
Aims: This study assessed the current state of the cardiothoracic surgery workforce in France and projected demographic trends through 2040.
Objective: To assess the predictive performance of Predicthor, an artificial intelligence model, for 30-day mortality and complications following major pulmonary resections.
Background: The significance of predicting postoperative complications in thoracic surgery lies in the impact on patient outcomes and the efficient allocation of healthcare resources. The longstanding use of the Thoracoscore for over 15 years in hospital settings emphasizes the opportune moment for an update, leveraging new artificial intelligence methodologies to enhance predictive precision and relevance.
The use of the robotic approach is rapidly increasing in thoracic surgery worldwide. Mastering this new technique is challenging and teaching robotic surgery is difficult. Nevertheless, to date, no academic certified training program including a standardized approach is available for robotic lobectomy and no objective assessment scale has been proposed.
View Article and Find Full Text PDFIntroduction: Lobectomy with lymph node dissection is the gold standard treatment for stage IA-IIA Non-Small Cell Lung Cancer (NSCLC). Surgery is responsible for higher early mortality but offers better overall long-term survival. The patient population concerned is often elderly and combines the comorbidities of smoking and age.
View Article and Find Full Text PDFPreoperative planning programme in minimally invasive lung surgery reduces intraoperative adverse events.
Eur J Cardiothorac Surg
December 2024
Objectives: While minimally invasive surgery (MIS) is the preferred approach in patients with early-stage lung cancer, intraoperative adverse events (IOAE) may still occur. The objective of this study was to assess the impact of a dedicated preoperative planning program on adverse event occurrence.
Methods: A single-centre cross-sectional comparative study was conducted, including all patients with proven/suspected lung cancer undergoing curative MIS, prior (September 2021-October 2022) and after (November 2022-January 2024) the implementation of a preoperative planning program.
A pilot quality improvement initiative for lymph node dissection during lung cancer surgery.
Eur J Cardiothorac Surg
November 2024
Objectives: To evaluate the impact of a quality improvement initiative on intraoperative lymph node (LN) dissection adequacy.
Methods: A single-centre cohort of 781 naïve patients who underwent resection of non-small cell lung cancer with pathological LN involvement and survived beyond 90 days was reviewed. LN dissection metrics were compared before and after the implementation of a quality improvement initiative.
Article Synopsis
- A multicenter study investigated the frequency of Patient Safety Incidents (PSI) during lung surgeries in France and their effects on postoperative outcomes within 90 days.
- Out of 1919 surgeries screened, 953 were included, revealing a 32% PSI incidence, which was mostly attributed to human factors, organizational issues, and technology problems.
- The severity of PSI significantly increased the risk of complications, readmission, and mortality at 90 days, highlighting the importance of addressing human factors in surgical settings.
Article Synopsis
- Interstitial lung disease (ILD) is associated with an increased risk of lung cancer (LC), but the surgical risks for patients with both conditions remained uncertain, prompting a study analyzing outcomes for LC patients with and without ILD.
- The study included data from 4,073 patients who underwent LC surgery between January 2006 and June 2023, with 30 identified as having ILD. Key findings showed no significant difference in overall survival between LC-ILD and LC-non-ILD groups, although the LC-ILD group faced specific complications like prolonged air leaks and pneumonia.
- Overall, the research illustrates that while patients with LC-ILD experience certain challenges, surgical outcomes, including post-operative complications, are not significantly worse
Article Synopsis
- The study aimed to evaluate safety and survival outcomes of lobectomy, segmentectomy, and wedge resection for early-stage lung cancer using data from the French EPITHOR registry between 2016 and 2022.
- A total of 19,452 patients were analyzed, finding that lobectomy was the most common procedure (72.2%), and while short-term 90-day mortality rates were similar across the three methods, significant differences emerged in 5-year overall survival.
- The results indicated that wedge resection was linked to worse long-term survival compared to lobectomy, suggesting that all types of sublobar resections may not provide equal effectiveness in treating lung cancer.
Article Synopsis
- The study analyzes the effects of lung transplant allocation policies in the USA and France, focusing on urgent lung transplants and their impact on patient outcomes.
- Using data from 2007 to 2017, the research found that urgent lung transplants had a higher risk of death, with survival rates significantly better in the US compared to France.
- The conclusion suggests that while urgent lung transplants are risky in both countries, the US score-based allocation system leads to better post-transplant survival rates, indicating a complex interplay of factors influencing outcomes.
Article Synopsis
- The study investigates the impact of the number of involved structures (NIS) on the prognosis of patients with thymic epithelial tumors (TETs) who underwent surgery, using data from the European Society of Thoracic Surgeons (ESTS) thymic database.
- Out of 303 patients analyzed, those with more than two involved structures had significantly worse cancer-specific survival (CSS) compared to those with two or fewer, with 5-year CSS rates of 9.5% versus 93.2%, respectively.
- Factors such as neoadjuvant therapy, complete resection, and thymoma histology were associated with better prognosis, highlighting the importance of NIS in determining patient outcomes.
Background: Few epidemiological data are available on surgically treated Caucasian patients with non-small-cell lung cancers (NSCLCs) harboring epidermal growth factor receptor () mutations. The main objective of this study was to describe, in the real-world setting, these patients' incidence, clinical, and tumoral characteristics.
Methods: The participating centers included all consecutive localized non-squamous NSCLC patients undergoing surgery between January 2018 and December 2019 in France.
Introduction: Unlike most malignancies, higher body mass index (BMI) is associated with a reduced risk of lung cancer and improved prognosis after surgery. However, it remains controversial whether height, one of determinants of BMI, is associated with survival independently of BMI and other confounders.
Methods: We extracted data on all consecutive patients with resectable non-small cell lung cancer included in Epithor, the French Society of Thoracic and Cardiovascular Surgery database, over a 16-year period.
Article Synopsis
- Non-small cell lung cancer (NSCLC) often leads to compromised lung function, and this study focuses on the effects of surgical methods, specifically minimally invasive surgery (MIS), on 90-day post-operative mortality in high-risk patients.
- The research analyzed data from over 46,000 patients, identifying high-risk individuals with poor lung function, and found a significantly higher mortality rate in this group compared to low-risk patients.
- Results indicated that high-risk patients undergoing MIS had lower mortality rates than those undergoing traditional open surgery, even matching the mortality rates of low-risk patients.
Background: Interstitial lung disease associated with genetic disorders of the surfactant system is a rare entity in adults that can lead to lung transplantation. Our objective was to describe the outcome of these patients after lung transplantation.
Methods: We conducted a retrospective, multicentre study, on adults who underwent lung transplantation for such disease in the French lung transplant centres network, from 1997 to 2018.
Milestones in the History of Esophagectomy: From Torek to Minimally Invasive Approaches.
Medicina (Kaunas)
October 2023
Article Synopsis
- The history of esophagectomy showcases a progress marked by dedication and technical improvements, transitioning from early risky procedures to modern minimally invasive techniques aimed at enhancing patient outcomes.
- Milestones include Franz J. A. Torek's 1913 esophageal resection, which opened doors for esophageal cancer treatment, but faced high mortality rates that prompted ongoing evolution of surgical methods like thoracotomy and transhiatal approaches.
- Recent advancements, such as robot-assisted surgeries and collaborative initiatives, have improved survival rates, yet complications like anastomotic leaks continue to pose challenges, necessitating innovative prevention strategies.
Article Synopsis
- In minimally invasive thoracic surgery, paravertebral block (PVB) is a common technique for postoperative pain relief but relies heavily on the surgeon's skill and available resources, prompting a search for better methods when pain control fails.
- The study aimed to compare the effectiveness of PVB performed by surgeons during video-assisted thoracoscopic surgery (PVB-VATS) against the traditional PVB technique done by anesthesiologists (PVB-US) to see if they produce similar pain management outcomes.
- Conducted as a randomized clinical trial with 196 patients, the primary focus was on the differences in opioid consumption post-surgery, along with secondary measures such as pain scores
Article Synopsis
- The study investigates how lung disease affects diaphragm structure, particularly after single-lung transplantation (SLTx), using CT scans to measure diaphragm characteristics.
- Researchers analyzed CT scans of 31 patients from Marseille, France, who had undergone SLTx between 2009 and 2022 and compared the transplanted lung's diaphragm to the native lung's.
- Results showed that after SLTx, the transplanted lung's diaphragm thickness increased significantly while its height decreased, indicating recovery potential, while there were no notable changes in the diaphragm related to the native lung.