Search

OBJECTIVE To update the recommendations for the structural characteristics of general thoracic surgery (GTS) in Europe in order to provide a document that can be used as a guide for harmonizing the general thoracic surgical practice in Europe. METHODS A task force was created to set the structural, procedural and qualification characteristics of a European GTS unit. These criteria were endorsed by the Executive Committee of the European Society of Thoracic Surgeons and by the Thoracic Domain of the European Association for Cardio-Thoracic Surgery and were validated by the European Board of Thoracic Surgery at European Union of Medical Specialists. RESULTS Criteria regarding definition and scope of GTS, structure and qualification of GTS unit, training and education and recommendations for subjects of particular interest (lung transplant, oesophageal surgery, minimally invasive thoracic surgery, quality surveillance) were developed. CONCLUSIONS This document will hopefully represent the first step of a process of revision of the modern thoracic surgeons' curricula, which need to be qualitatively rethought in the setting of the qualification process. The structural criteria highlighted in the present document are meant to help and tackle the challenge of cultural and language barriers as well as of widely varying national training programmes

We report data-simple descriptions of patient characteristics, cancer categories, and non-risk-adjusted survival-for patients with pathologically staged cancer of the esophagus and esophagogastric junction after resection or ablation with no preoperative therapy from the Worldwide Esophageal Cancer Collaboration (WECC). Thirty-three institutions from six continents submitted de-identified data using standard definitions: demographics, comorbidities, clinical cancer categories, and all-cause mortality from first management decision. Of 13,300 patients, 5,631 had squamous cell carcinoma, 7,558 adenocarcinoma, 85 adenosquamous carcinoma, and 26 undifferentiated carcinoma. Patients were older (62 years) men (80%) with normal body mass index (51%), little weight loss (1.8 kg), 0-2 ECOG performance status (83%), and a history of smoking (70%). Cancers were pT1 (24%), pT2 (15%), pT3 (50%), pN0 (52%), pM0 (93%), and pG2-G3 (78%); most involved distal esophagus (71%). Non-risk-adjusted survival for both squamous cell carcinoma and adenocarcinoma was monotonic and distinctive across pTNM. Survival was more distinctive for adenocarcinoma than squamous cell carcinoma when pT was ordered by pN. Survival for pTis-1 adenocarcinoma was better than for squamous cell carcinoma, although monotonic and distinctive for both. WECC pathologic staging data is improved over that of the 7th edition, with more patients studied and patient and cancer variables collected. These data will be the basis for the 8th edition cancer staging manuals following risk adjustment for patient, cancer, and treatment characteristics, and should direct 9th edition data collection. However, the role of pure pathologic staging as the principal point of reference for esophageal cancer staging is waning.

Background: Little is known about recurrence patterns in patients with a pathologically complete response (pCR) or an incomplete response after neoadjuvant chemoradiotherapy (CRT) followed by resection for oesophageal cancer. This study was performed to determine the pattern of recurrence in patients with a pCR after neoadjuvant CRT followed by surgery. Methods: All patients who received neoadjuvant CRT followed by oesophagectomy between 1993 and 2009 were identified from a database, and categorized according to pathological tumour response. Recurrences were classified as locoregional or distant. Results: One hundred and eighty-eight patients were included. Median potential follow-up was 71.6 months. A pCR was achieved in 62 (33.0 per cent) of 188 patients. Recurrence developed in 24 (39 per cent) of 62 patients with a pCR and 70 (55.6 per cent) of 126 without a pCR (P = 0.044). Locoregional recurrence with or without synchronous distant metastases occurred in eight patients (13 per cent) in the pCR group and 31 (24.6 per cent) in the non-pCR group (P = 0.095). Locoregional recurrences without synchronous distant metastases occurred four (6 per cent) and ten (7.9 per cent) patients respectively (P = 0.945). The overall 5-year survival rate was significantly higher in the pCR group than in the non-pCR group (52 versus 33.9 per cent respectively; P = 0.019). Conclusion: Of patients with a pCR, 13 per cent still developed a locoregional recurrence. Although pCR is more favourable for survival, it is not synonymous with cure or complete locoregional disease control. Copyright (C) 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Video-endoscopic surgical treatment of the fetus may, in the future, become an alternative to open fetal operation. Six 95-day-old fetal lambs were examined through intrauterine endoscopy using amnioinfusion and specially designed balloon-tipped cannulas. The fetuses were monitored endoscopically for oxygen saturation, heart rate and temperature throughout the procedure. With a rigid 5 millimeter telescope and a flexible 3 millimeter endoscope, the respiratory and upper gastrointestinal tracts could be examined. No mucosal or other trauma was noted upon completion of the endoscopy; all lambs survived the procedure. While the applications of fetal endosurgery are likely to be similar to those of open fetal operation, fetal endoscopy (looking in the fetus) is a new entity for which clinical relevance (rather than mere feasibility) remains to be demonstrated. This technique, however, could become a valuable research tool to study fetal gastrointestinal and pulmonary physiologic factors in situ.

Lymphocele and lymphatic fistulae are relatively benign complications in renal transplantation. The incidence in our series of 248 renal transplants was 8%. The origin and pathogenesis of lymph collection and augmented lymph flow are discussed. The main importance of this complication lies in its differential diagnosis with urinary fistula and acute rejection episode or deep phlebothrombosis with all its therapeutic implications. Important lymph accumulations should be drained. We prefer as initial treatment a percutaneous closed aspiration which most successfully solves the problem. In case this method should fail, one can choose between external or internal drainage. As in literature, we actually prefer an internal marsupialisation, but completed by an omentoplasty if the leakage originates from the kidney.

Spontaneous haemopneumothorax (SHP) is a rare, potential life-threatening emergency. Patients suffering from spontaneous haemopneumothorax can present at the emergency department with dyspnoea and unexplained signs of significant hypovolemia. Discussion about patient selection, timing and technique of operation is still alive. Standard chest roentgenogram is the most useful way to diagnose spontaneous haemopneumothorax, although false negative results exist. In most cases, initial conservative treatment requires later surgical intervention. So early surgical management is needed. In haemodynamic stable patients without any contra-indications, VATS is the preferred treatment method. However there's still discussion about the timing of surgery in hemodynamically instable patients.

BACKGROUND: The reporting of surgical techniques is of mixed quality, with most at a very minimal level. Reporting guidelines that could be applied to guide surgical technique reporting vary in methodology for development, discipline coverage, dimension coverage and detail requested. However, a scoping review that could indicate the gaps and efforts needed in surgical technique reporting guidelines is lacking and warranted. This study aims to design a methodological rigour protocol to guide the development of a scoping review of surgical technique reporting guidelines. METHODS: This protocol is designed following the 2020 manual proposed by the Joanna Briggs Institute. To further ensure the soundness of the protocol, we also included multidisciplinary professionals (including methodologists, clinicians, and journal editors) to refine the protocol. DISCUSSION: Seven key steps for developing the scoping review are identified and presented in detail, including (I) identifying the research questions; (II) inclusion criteria; (III) search strategy; (IV) source of evidence selection; (V) data extraction; (VI) analysis of the evidence; and (VII) presentation of the results. Guided by this protocol, the subsequent scoping review will inform us the overview of surgical technique reporting guidelines and precisely guide our direction and next steps in improving surgical technique reporting guidelines. TRIAL REGISTRATION: This protocol is not registered as the PROSPERO database only accepts registration of systematic review protocols while does not accept registration of scoping review protocols. ispartof: GLAND SURGERY vol:10 issue:7 pages:2325-2333 ispartof: location:China (Republic : 1949- ) status: published

OBJECTIVE: Focal endoscopic resection (ER) followed by radiofrequency ablation (RFA) safely and effectively eradicates Barrett's oesophagus (BO) containing high-grade dysplasia (HGD) and/or early cancer (EC) in smaller studies with limited follow-up. Herein, we report long-term outcomes of combined ER and RFA for BO (HGD and/or EC) from a single-arm multicentre interventional study.DESIGN: In 13 European centres, patients with BO ≤ 12 cm with HGD and/or EC on 2 separate endoscopies were eligible for inclusion. Visible lesions (OUTCOMES: complete eradication of neoplasia (CE-neo) and intestinal metaplasia (CE-IM); durability of CE-neo and CE-IM (once achieved) during follow-up. Biopsy and resection specimens underwent centralised pathology review.RESULTS: 132 patients with median BO length C3M6 were included. After entry-ER in 119 patients (90%) and a median of 3 RFA (IQR 3-4) treatments, CE-neo was achieved in 121/132 (92%) and CE-IM in 115/132 patients (87%), per intention-to-treat analysis. Per-protocol analysis, CE-neo and CE-IM were achieved in 98% and 93%, respectively. After a median of 27 months following the first negative post-treatment endoscopic control, neoplasia and IM recurred in 4% and 8%, respectively. Mild-to-moderate adverse events occurred in 25 patients (19%); all managed conservatively or endoscopically.CONCLUSIONS: In patients with early Barrett's neoplasia, intensive multimodality endotherapy consisting of ER combined with RFA is safe and highly effective, and the treatment effect appears to be durable during mid-term follow-up.TRIAL REGISTRATION NUMBER: NTR 1211, http://www.trialregister.nl.

plantation for cystic fibrosis. Proc Am Thorac Soc 2009;6:619–633 [13] Bech B, Pressler T, Iversen M, Carlsen J, Milman N, Eliasen K, Perko M, Arendrup H. Long-term outcome of lung transplantation for cystic fibrosis—Danish results. Eur J Cardiothorac Surg 2004;26:1180–1186 [14] Algar FJ, Cano JR, Moreno P, Espinosa D, Cerezo F, Alvarez A, Baamonde C, Santos F, Vaquero JM, Salvatierra A. Results of lung transplantation in patients with cystic fibrosis. Transplant Proc 2008;40:3085–3087 [15] Quattrucci S, Rolla M, Cimino G, Bertasi S, Cingolani S, Scalercio F, Venuta F, Midulla F. Lung transplantation for cystic fibrosis: 6-year follow-up. J Cyst Fibros 2005;4:107–114 [16] Wiebe K, Wahlers T, Harringer W, vd Hardt H, Fabel H, Haverich A. Lung transplantation for cystic fibrosis—a single center experience over 8 years. Eur J Cardiothorac Surg 1998;14:191–196 [17] Spahr JE, Love RB, Francois M, Radford K, Meyer KC. Lung transplantation for cystic fibrosis: current concepts and one center’s experience. J Cyst Fibros 2007;6:334–350 [18] Egan TM, Detterbeck FC, Mill MR, Bleiweis MS, Aris R, Paradowski L, Retsch-Bogart G, Mueller BS. Long term results of lung transplantation for cystic fibrosis. Eur J Cardiothorac Surg 2002;22: 602–609 [19] Chaparro C, Maurer J, Gutierrez C, Krajden M, Chan C, Winton T, Keshavjee S, Scavuzzo M, Tullis E, Hutcheon M, Kesten S. Infection with Burkholderia cepacia in cystic fibrosis: outcome following lung transplantation. Am J Respir Crit Care Med 2001;163:43–48 [20] Aris RM, Routh JC, LiPuma JJ, Heath DG, Gilligan PH. Lung transplantation for cystic fibrosis patients with Burkholderia cepacia complex. Survival linked to genomovar type. Am J Respir Crit Care Med 2001;164: 2102–2106 [21] Mendeloff EN. Lung transplantation for cystic fibrosis. Semin Thorac Cardiovasc Surg 1998;10:202–212 [22] Van De Wauwer C, Van Raemdonck D, Verleden GM, Dupont L, De Leyn P, Coosemans W, Nafteux P, Lerut T. Risk factors for airway complications within the first year after lung transplantation. Eur J Cardiothorac Surg 2007;31:703–710 [23] Wittwer T, Fehrenbach A, Meyer D, Brandes H, Albes J, Richter J, Wahlers T. Retrograde flush perfusion with low-potassium solutions for improvement of experimental pulmonary preservation. J Heart Lung Transplant 2000;19:976–983 [24] Kofidis T, Struber M, Warnecke G, Sommer S, Leyh RG, Balsam LB, Robbins RC, Haverich A. Antegrade versus retrograde perfusion of the donor lung: impact on the early reperfusion phase. Transpl Int 2003;16: 801–805 [25] Curtis HJ, Bourke SJ, Dark JH, Corris PA. Lung transplantation outcome in cystic fibrosis patients with previous pneumothorax. J Heart Lung Transplant 2005;24:865–869