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Pneumonectomy is associated with high mortality. Knowledge of the cause and timing of death is critically important to reduce mortality. This study aimed to compare long-term nononcologic mortality between pneumonectomy and lobectomy patients and investigate factors associated with nononcologic mortality. Medical records of 337 patients who underwent pneumonectomy and 7545 patients who underwent lobectomy from 2009 to 2018 were reviewed. Postoperative morbidity, mortality, and cause of death were investigated. Competing risk analysis was performed to compare nononcologic mortality between pneumonectomy and lobectomy patients. Independent prognostic factors of nononcologic death were analyzed. The 90 day, 1 year, and 5 year mortality rates after pneumonectomy were 7.1%, 20.8%, and 49.3%, respectively. The respective nononcologic mortality rates after pneumonectomy were 6.5%, 11.6%, and 14.5%. The most common nononcologic cause of death was pneumonia. The 5 year cumulative incidence of nononcologic mortality was higher after pneumonectomy than after lobectomy (14.5% vs. 2.1%; p < 0.001). Risk of nononcologic death was higher after pneumonectomy (hazard ratio 1.54; p = 0.038). Older age (hazard ratio 1.09; p < 0.001) was an independent prognostic factor associated with nononcologic death after pneumonectomy. Higher predicted postoperative diffusion capacity for carbon monoxide (PPO DLCO) approached significance (hazard ratio 0.97; p = 0.054) as a protective factor. Long-term nononcologic mortality was higher after pneumonectomy than lobectomy and the main cause of nononcologic death was pneumonia. Clinicians should prevent and aggressively treat pneumonia after surgery, particularly in older patients and those with low PPO DLCO. [ABSTRACT FROM AUTHOR]

We evaluated the feasibility of video-assisted thoracoscopic surgery (VATS) following neoadjuvant concurrent chemoradiotherapy (nCCRT) for N2 non-small-cell lung cancer (NSCLC). We retrospectively reviewed patients with clinical N2 NSCLC who underwent lobectomy and lymph node dissection after nCCRT. The patients were matched using a propensity score based on age, sex, pulmonary function test, histologic type, clinical T factor, and method of N-staging. A total of 385 patients were enrolled between June 2012 and July 2017 (35 VATS, 350 open). After propensity matching (31 VATS, 112 open), the VATS group showed a significantly lower major complication rate (≥ grade II Clavien-Dindo classification; 9.7% vs 30.4%, P = 0.036). No significant differences were found between 2 group of 5-year survival rates (77.1% for the VATS group, 59.9% for the open group; P = 0.276) and recurrence-free survival rates (66.3% for the VATS group, 54.6% for the open group; P = 0.354). In multivariable analysis, VATS did not affect overall survival and recurrence-free survival. VATS was comparable to open thoracotomy in patients with clinical N2 NSCLC after nCCRT without compromising oncologic efficacy. [ABSTRACT FROM AUTHOR]

Background and Aims Endoscopic submucosal dissection (ESD) has been widely accepted for treating superficial esophageal squamous cell carcinoma (SESCC). However, long-term outcomes of ESD and esophagectomy for SESCC have not been compared. We compared the clinical outcomes of ESD and esophagectomy in a matched cohort. Methods Patients who underwent ESD and esophagectomy for SESCC were included. We selected SESCCs without obvious submucosal invasion from the surgical database by reviewing endoscopic images. To minimize the effect of selection bias, propensity score matching was performed. Overall survival (OS), disease-specific survival (DSS), recurrence-free survival (RFS), and metachronous RFS were compared between the 2 groups. Adverse event rates were also compared. Results In a matched cohort of 120 pairs, OS, DSS, and RFS were comparable between the 2 groups. The 5-year OS, DSS, and RFS rates were 93.9% versus 91.2%, 100% versus 97.4%, and 92.8% versus 95.3% for the ESD and esophagectomy groups, respectively. The metachronous RFS was worse in the ESD group than in the esophagectomy group (P =.004). The 5-year metachronous RFS rates were 90.3% versus 100% for the ESD and esophagectomy groups, respectively. The esophagectomy group showed a higher overall adverse event rate than the ESD group (55.5% vs 18.5%, P <.0001). In each subgroup of mucosal and submucosal cancer, OS, DSS, and RFS were also comparable between the 2 groups. Conclusions ESD provides long-term outcomes comparable with esophagectomy in patients with SESCC without endoscopic evidence of obvious submucosal invasion. ESD should be considered as the first-line treatment for these patients. [ABSTRACT FROM AUTHOR]

Objectives To evaluate clinical presentations, treatment modalities, and outcomes of pulmonary mucosa–associated lymphoid tissue (MALT) lymphoma by stage strata. Methods We retrospectively reviewed 51 patients diagnosed with pulmonary MALT lymphoma between January 2003 and December 2015. To compare treatment modalities and outcomes, we stratified the patients into low-stage (IE/IIE) and high-stage (IIIE/IVE) groups using modified Ann Arbor staging. Progression-free survival was estimated using Kaplan-Meier curves, and differences were compared using the log-rank test. A hazard ratio of progression by stage strata, adjusted for other clinical variables, was determined using a Cox adjusted proportional hazards model. Results The majority of patients had stage IE disease (76.5%; 39 of 51). With advancing stage, patients were more likely to have respiratory and B symptoms and higher International Prognostic Index scores. The most common treatment modality was surgical resection in low-stage patients (33 of 43) and chemotherapy in high-stage patients (7 of 8). At a median follow-up of 40.7 months, progression-free survival was longer for low-stage patients (median, 40.7 months vs 24.9 months; P < .001), and high-stage patients were 9.2 times more likely to progress (hazard ratio, 9.24; 95% confidence interval, 1.93-44.36). Among 30 patients with surgically resected stage IE disease, 8 with central lesions were treated via lobectomy and 22 with peripheral lesions were treated via lobectomy (n = 8) or limited resection (n = 14). One of these patients, with a central lesion, experienced disease recurrence. Conclusions Our findings suggest that the clinical course of low-stage pulmonary MALT lymphoma, for which the mainstay of treatment is surgical resection, might be indolent. [ABSTRACT FROM AUTHOR]

Background We aimed to characterize ground-glass opacity (GGO) nodules and evaluate the prognosis of clinical stage IA lung adenocarcinoma with GGO nodules after wedge resection. Methods Patients who underwent wedge resection for early stage lung cancer and proven adenocarcinoma on postoperative pathologic report were enrolled in the study between 2004 and 2010. Radiologic findings of the main tumor were evaluated for ground-glass opacities with chest computed tomography (CT). We divided patients into two groups based on the consolidation-to-tumor ratio (C/T ratio ≤0.25, pure GGO group; C/T ratio >0.25, mixed GGO group). Overall survival and recurrence-free survival were analyzed for all patients. Results A total of 97 patients were included in our study. Among these, 71 patients were categorized into the pure GGO group and 26 patients into the mixed GGO group. The 5-year overall survival rate was 98.6% in the pure GGO group and 95.5% in the mixed GGO group ( p = 0.663). Five patients (5.1%) experienced recurrences; only 1 patient (1/71, 1.4%) in the pure GGO group and 4 patients (4/26, 15.3%) in the mixed GGO group had recurrence. Conclusions GGO-dominant clinical stage IA lung adenocarcinoma (pure GGO group) showed an excellent prognosis. Wedge resection should be carefully considered for patients with mixed GGO nodules (C/T ratio >0.25) because of the high recurrence rate. Radiologic noninvasiveness (C/T ratio ≤0.25) might be a good indicator for candidates for sublobar resection in cases of early stage lung adenocarcinoma. [ABSTRACT FROM AUTHOR]

Objectives: MicroRNAs (miRNAs) are widely known for their function as regulators of gene expression via translational repression. Polymorphisms in miRNAs have been shown to affect the regulatory capacity of miRNAs by influencing miRNA processing and/or miRNA-mRNA interactions. The purpose of this study was to investigate the association between 7 single nucleotide polymorphisms (SNPs) commonly found in precursor miRNA (pre-miRNA) and primary miRNA (pri-miRNA) sequences and the recurrence of disease in patients who underwent a complete resection of non–small cell lung cancer (NSCLC). Methods: Five SNPs found in pre-miRNAs (rs11614913/miR-196a2, rs2910164/miR-146a, rs6505162/miR-423, rs2289030/miR-492, and rs895819/miR-27a) and 2 SNPs found in pri-miRNAs (rs7372209/miR-26a-1 and rs213210/miR-219-1) were genotyped in 388 patients with NSCLC. Results: Among 388 patients, variants of the rs2910164 SNP were significantly associated with recurrence-free survival (RFS) (P = .016, log–rank test). When the results were subdivided by the tumor stage, variants of the rs2910164 and rs11614913 SNPs positively correlated with a better RFS (adjusted hazard ratio [HR], 0.48; 95% confidence interval [CI], 0.28-0.80; adjusted HR, 0.60; 95% CI, 0.38-0.94, respectively) in patients with stage II and stage III disease. Moreover, RFS significantly improved in patients with higher numbers of variant alleles in the rs2910164 and rs11614913 SNPs. Conclusions: Our findings suggest that polymorphisms in the rs2910164 of miR-146a and the rs11614913 of miR-196a2 are associated with prognosis in patients with completely resected NSCLC. [ABSTRACT FROM AUTHOR]

Background: Pharyngo-esophageal reconstruction using free jejunal grafts (FJGs) has been widely used, but the procedure is technically demanding and requires the involvement of multiple departments. We performed simplified reconstruction with FJGs using end-to-side vascular anastomosis and extended pharyngo-jejunostomy. Methods: The jejunal artery and vein were anastomosed to the neck vessels in an end-to-side fashion without microvascular anastomosis. Pharyngo-jejunostomy with extended end-to-end anastomosis was performed to reduce size mismatch. We retrospectively analyzed the medical records of 32 patients diagnosed with pharyngeal, esophageal, or pyriform sinus cancer who received a FJG. Results: The mean age was 61.5 ± 9.4 years, and there were 25 male patients. Jejunal vessels were commonly anastomosed to the right common carotid artery and the right internal jugular vein (22, 68.8%). The mean ischemic times of the FJG and carotid artery clamping time were 46.5 ± 8.1 and 15.8 ± 4.4 minutes, respectively. During the procedure, 3 patients suffered from inadequate reperfusion of the FJG requiring removal of the initial graft and replacement with another FJG. There were no neurologic complications, postoperative deaths, or adverse events directly related to FJG except for leakage of the pharyngo-jejunostomy site in 1 patient, which was primarily repaired. During the follow-up period, 5 patients (15.6%) suffered from dysphagia, but only 3 patients had evidence of anastomotic strictures at the jejuno-esophagostomy site. Thirteen patients (40.6%) received postoperative adjuvant radiotherapy. Conclusions: Our technique of FJG with end-to-side vascular anastomosis and extended pharyngo-jejunostomy is simple and safe. [ABSTRACT FROM AUTHOR]

Background: This study evaluated the clinical results, nodal metastatic patterns, and overall efficacy of esophagectomy with three-field lymph node dissection for upper esophageal squamous cell carcinoma (SCC). Methods: Between 2001 and 2008, esophagectomy was performed in 497 esophageal cancer patients, of whom 93 underwent esophagectomy with three-field lymph node dissection, without neoadjuvant treatment for upper esophageal SCC. Results: Of these 93 patients, 91 (97.8%) were men, the median age was 65.0 years, and 82 (88.2%) underwent R0 resection with curative intent. In-hospital mortality was 4.3%. Pathologic T N M stages were stage I, 8.6%; stage II, 16.1%; stage III, 75.3%; and stage IV, 0%. The mean numbers of total lymph nodes dissected and, of those, total metastatic lymph nodes per patient were 61.7 ± 18.2 and 4.7 ± 7.0, respectively. Metastases occurred to the recurrent laryngeal lymph nodes in 43.3%, to the cervical lymph nodes in 46.2%, and to abdominal lymph nodes in 24.7% of patients. Overall 5-year and disease-free survival rates were 43.5% and 34.3%, respectively, and were 50.1% and 37.6%, respectively, for R0 resection. Conclusions: Recurrent laryngeal lymph node chains are those most commonly affected by nodal metastasis, and the prevalence of cervical lymph node involvement is high, at more than 40%. Esophagectomy with three-field lymph node dissection in patients with upper esophageal SCC can be performed with acceptable morbidity and mortality. Curative R0 resection for upper esophageal SCC achieved a satisfactory 5-year survival rate. [ABSTRACT FROM AUTHOR]

Background: In stage IA non-small cell lung cancer (NSCLC), lobectomy and mediastinal lymph node dissection is considered the standard treatment. However, 20% to 30% of patients have cancer recurrences. The purpose of this study was to determine the patterns and risk factors for recurrence in patients with stage IA NSCLC. Methods: We retrospectively reviewed the medical records of 201 patients who had confirmed stage IA NSCLC by lobectomy and complete lymph node dissection. Results: There were 131 male patients with a mean age of 60.68 ± 9.26 years. The median follow-up period was 41.4 months. Recurrences were reported in 16 patients. One hundred fourteen and 87 patients were T1a (≤2 cm) and T1b (>2 cm to ≤3 cm), respectively. The pathologic results were as follows: adenocarcinomas and bronchioloalveolar carcinomas (n = 134); squamous cell carcinomas (n = 57); and other diagnoses (n = 10). Tumor necrosis and lymphatic invasion were significant adverse risk factors for recurrence based on univariate analysis. Multivariate analysis showed that tumor necrosis was the only significant risk factor to predict cancer recurrence (hazard ratio, 4.336; p = 0.032). The 5-year overall survival was 94.8% for necrosis-negative patients and 86.2% for necrosis-positive patients (p = 0.04). The 5-year disease-free survival was 92.1% for necrosis-negative patients and 78.9% for necrosis-positive patients (p = 0.016). Conclusions: Tumor necrosis was shown to be an adverse risk factor for survival and recurrence in patients with stage IA NSCLC. Thus, close observation and individualized adjuvant therapy might be helpful for patients with stage IA NSCLC with tumor necrosis. [Copyright &y& Elsevier]

Background: Early intrapulmonary recurrence is a major problem after pulmonary metastasectomy related to colorectal cancer. However, the risk factors for early intrapulmonary recurrence are not clear. Methods: Between August 2001 and December 2007, 125 patients underwent pulmonary metastasectomy after colorectal cancer. The prognostic factors for overall survival were evaluated, including early (within 6 months) intrapulmonary recurrence. The factors related to early intrapulmonary recurrence were also analyzed. Results: Thirteen patients (10.4%) had early intrapulmonary recurrence. The median follow-up was 46 months (range, 21 to 99). Early intrapulmonary recurrence (hazard ratio 2.716; 95% confidence interval: 1.027 to 7.182; p = 0.044), extrapulmonary metastasectomy, metastatic hilar or mediastinal lymph nodes, and high prethoracotomy carcinoembryonic antigen levels were independent prognostic factors on multivariate analysis. Extrapulmonary metastasectomy (odds ratio 4.840; 95% confidence interval: 1.314 to 17.821; p = 0.018) and bilateral pulmonary metastasis (odds ratio 6.228; 95% confidence interval: 1.689 to 22.960; p = 0.006) were independent risk factors for early intrapulmonary recurrence. Conclusions: Early intrapulmonary recurrence after pulmonary metastasectomy related to colorectal cancer is a prognostic factor for poor overall survival. Extrapulmonary metastasectomy and bilateral pulmonary metastasis are risk factors for early intrapulmonary recurrence. Pulmonary metastasectomy in patients with these risk factors should be considered carefully. [Copyright &y& Elsevier]

Background: Little has been published regarding outcomes subsequent to complications after thoracic surgery. The present study investigated outcomes and risk factors associated with mortality in patients admitted to an intensive care unit (ICU) after initial recovery from thoracic oncology surgery. Methods: From March 2001 to August 2005, 1,087 patients underwent major resection for lung or esophageal cancer. Ninety-four (8.6%) of those patients required ICU care after initial recovery, and were the subject of the present retrospective review. Results: The patient group included 85 males (90.4%), of mean age 66 years. Patients were classified as either survivors (n = 63, 67%) or nonsurvivors (n = 31, 33%). The most common reason for ICU readmission was pulmonary complication (n = 73, 77.7%). Sixty-four patients (68.1%) required mechanical ventilation and 42 (43.3%) required renal support. Multivariate analysis showed that the initial acute physiological assessment and chronic health evaluation (APACHE) III score at readmission to ICU, duration of mechanical ventilation, and renal support were risk factors for in-hospital mortality. The overall three-year survival was 50.6%. Cox analysis showed that survivors who underwent tracheostomy had a poor prognosis (p = 0.011). Of 12 late mortalities in survivors who underwent tracheostomy, 9 (75%) were due to cancer-unrelated causes. Conclusions: The ICU readmission after thoracic oncology surgery was associated with high in-hospital mortality. Identification of patients with a high APACHE score and (or) prolonged ventilation at readmission may help predict the risk of mortality. Preemptive strategies designed to optimize treatment of such high-risk patients may improve outcomes. Survivors from ICU readmission after thoracic oncology surgery require meticulous and frequent follow-up due to a high risk of deterioration after discharge. [Copyright &y& Elsevier]

Background: Patients undergoing pulmonary resection are thought to be at high risk for the development of postoperative pulmonary complications (PPCs), and these complications may lead to serious morbidity. The purpose of this study was to identify the factors associated with postoperative pulmonary complications in patients undergoing lung cancer resection and to determine the effect of PPCs on survival. Methods: The study involved a retrospective review of 635 patients who had undergone curative resection for lung cancer. The patient group included 504 males (79.4%), and the overall mean age was 61.3 years. Patients were classified as those who had experienced PPCs (PPCs group, n = 105, 16.5%) or those who had not (no-PPCs group, n = 530, 83.5%). Results: The surgical procedures performed were 101 pneumonectomies (15.9%), 505 lobectomies (79.5%), and 29 lesser resections (4.6%). Cancer types comprised 330 squamous cell carcinomas (52.0%), 255 adenocarcinomas (40.2%) and 50 others (7.8%). Univariate analysis showed that the following factors were predictors for PPCs: male sex, erythrocyte sedimentation rate, preoperative serum fibrinogen level, pulmonary function, chronic obstructive pulmonary disease, smoking, double primary cancer, and surgical duration. Multivariate logistic regression showed that preoperative serum fibrinogen level (p < 0.001), surgical duration (p < 0.0001) and being male (p = 0.02) were significant predictors of PPCs. Overall survival 3 years after surgery was 68.2% in no-PPCs group and 38.8% in PPCs group (p < 0.0001). Regardless of tumor staging, overall survival differed significantly between PPCs and no-PPCs groups, whereas disease-free survival did not. Conclusions: Higher preoperative serum fibrinogen levels, longer surgical duration, and being male were the predictive factors for PPCs in surgical candidates. The development of PPCs was linked to a shortened overall survival. [Copyright &y& Elsevier]

Background: Information on the function of the intrathoracic stomach after esophageal resection for esophageal cancer is limited. This study evaluated the factors affecting intrathoracic gastric emptying of solid food in patients who had undergone this surgery. Methods: Between February 2003 and August 2003, intrathoracic gastric emptying of solid food was evaluated by radioisotope in 56 of the patients who underwent esophageal replacement surgery with the stomach for esophageal cancer. The 50% gastric emptying time was categorized into three ranges: over 180 minutes was defined as delayed, within 180 minutes as intermediate, and when all the radioisotopes were dumped into the jejunum as rapid. The factors affecting the gastric emptying were analyzed. Results: In 6 out of 56 (10.7%) patients the radioisotope removal was too rapid to check the gastric-emptying time, and hence the analysis was performed in 50 patients. Twenty-one (37.5%) patients showed significantly delayed gastric emptying. The 50% gastric emptying time calculated by an exponential fitting method was 422 and 109 minutes in the delayed and intermediate groups, respectively. Age, the method of gastric drainage, and the stomach shape used did not affect the intrathoracic gastric emptying. Only the follow-up interval after surgery was a significant factor on gastric emptying (p = 0.024). The intrathoracic gastric emptying of solid food was more and more increased over time after surgery by regression analysis (p = 0.03). Conclusions: The use of the intrathoracic stomach as an esophageal substitute had a significant effect on gastric emptying, with intrathoracic gastric emptying of solid foods immediately after esophagectomy being markedly prolonged in about 50% of patients. However, the intrathoracic gastric emptying significantly increased over time. Research is required into improving intrathoracic gastric emptying in the early period after esophagectomy. [Copyright &y& Elsevier]

Background: The acute respiratory distress syndrome (ARDS) that develops after thoracic surgery is usually lethal. The use of corticosteroids to treat ARDS has been the subject of great controversy. Methods: Therefore we compared conventional therapy with early low-dose steroid therapy in the treatment of postoperative ARDS. Methylprednisolone was given daily as an intravenous push every 6 hours and was changed to a single oral dose or discontinued, with a loading dose of 2 mg/kg followed by 2 mg/kg per day. Results: Over 2.5 years, 523 major thoracic operations were performed with postoperative ARDS developing in 20 patients (3.8%), of which 8 were treated with conventional therapy and 12 with early low-dose steroid therapy. Early low-dose steroid therapy significantly reduced postoperative mortality, with 7 patients (58.3%) recovering without mechanical ventilation. Conclusions: We believe this is the first clinical study of low-dose methylprednisolone at an early phase of postoperative ARDS. The beneficial effects of the use of early low-dose steroids in ARDS are consistent with the hypothesis that fibroproliferation is an early response to lung injury, which is inhibited by early low-dose steroid therapy without disturbing operative wound healing. [Copyright &y& Elsevier]

To evaluate the significance of microscopic residual disease (MRD) at the bronchial resection margin after bronchial sleeve resection in non–small cell lung cancer. We retrospectively reviewed 536 consecutive patients who underwent bronchial sleeve resection between 1995 and 2015. Clinical outcomes, including recurrence and long-term survival, were analyzed according to the bronchial resection margin status (R0 = complete resection and R1 = microscopic residual tumor). Forty patients (7.5%) were identified to have MRD. During a 52.4-month follow-up (range, 0.1-261.0 months), there was no significant difference in 5-year overall survival (61.8% vs 61.5%; P =.550) and 5-year recurrence-free survival (53.7% vs 59.0%; P =.390) between groups R1 and R0. Multivariable cox regression analysis demonstrated that the margin status (group R1) was not associated with significantly decreased overall survival and recurrence-free survival. In group R1, 3 patients (7.5%) showed locoregional recurrence, including 1 patient (2.5%) with anastomotic recurrence. There were no significant differences between both groups in anastomotic recurrence (2.5% vs 2.6%; P = 1.000), locoregional recurrence (7.5% vs 12.7%; P =.476), and distant recurrence (25.0% vs 23.2%; P =.947) rates. Subgroup analysis of group R1 revealed a significant trend toward an increasing recurrence rate as the pathological extent of MRD advanced toward invasive extramucosal carcinoma (P for trend =.015). In our experience of bronchial sleeve resection, the oncologic outcome of MRD was not jeopardized. Furthermore, the pathological extent of MRD might be helpful for recurrence prediction and treatment planning. [ABSTRACT FROM AUTHOR]

Here, we report a thirteen years' survivor of initial primary lung cancer, who successfully diagnosed with second primary lung cancer(SPLC). It was arising from the pneumonectomy cavity of a non-small cell lung cancer(NSCLC). Few cases of SPLC associated with the post-pneumonectomy cavity have been reported in the literature. The histologic results of SPLC was metastatic pleomorphic carcinoma. It is a rare type of lung cancer; which incidence has been reported to range from 0.1% to 0.4% among all lung cancers. Based on regular follow-up with chest computed tomography(CT) and an understanding of post-pneumonectomy changes, the second primary pleomorphic carcinoma was correctly diagnosed and appropriately treated. [ABSTRACT FROM AUTHOR]

Objectives: Sleeve lobectomy was introduced for patients with lung cancer whose pulmonary reserve was inadequate for pneumonectomy. However, the safety and survival benefits of wedge bronchoplastic lobectomy as an alternative to sleeve lobectomy have not been thoroughly studied. This study was performed to evaluate the safety and oncologic results of wedge bronchoplastic lobectomy for lung cancer. Methods: We retrospectively analyzed 191 patients who underwent wedge bronchoplastic lobectomy and mediastinal lymph node dissection from 2001 to 2009. Results: There were 174 male patients with a mean age of 61.8 ± 8.2 years. The median follow-up duration was 28 months. Nine patients showed severe postoperative complications: bronchopleural fistulas (n = 3), necrosis at the bronchoplasty site (n = 1), or obstruction (n = 5). The operative mortality rate was 3.7%. Local and regional recurrences were reported in 17 and 12 patients, respectively. The 5-year overall survival was 62.8%. The 5-year overall survival was 68.6% in N0, 64.4% in N1, and 52.6% in N2 (P = .09). The 5-year overall freedoms from local recurrence and locoregional recurrence were 85.3% and 78.9%, respectively, which did not differ by nodal status. A multivariate analysis showed that positive N1 and N2 nodes were risk factors (P = .036 and P = .042, respectively) for overall survival after wedge bronchoplastic lobectomy. Conclusions: Wedge bronchoplastic lobectomy for lung cancer is a safe and feasible procedure that does not compromise oncologic principles. It can be considered an appropriate alternative to sleeve lobectomy and pneumonectomy, regardless of nodal status. [ABSTRACT FROM AUTHOR]

• Long-term oncological outcome of VATS lobectomy is limited in clinical N1 NSCLC. • Compared to open thoracotomy, VATS lobectomy showed a shorter hospitalization. • VATS lobectomy had similar perioperative outcomes and long-term survival outcomes. • VATS lobectomy is feasible and safe approach in clinically suspected N1 NSCLC. Although the video-assisted thoracic surgery (VATS) approach has been accepted as a safe and effective alternative to lobectomy, its advantage remains unclear in advanced-stage lung cancer. This study is aimed to evaluate the feasibility and long-term outcomes of VATS in lung cancer with clinical N1 (cN1) disease. We retrospectively reviewed the records of 1149 consecutive patients who underwent lobectomy for cN1 disease from 2006 to 2016. Perioperative outcomes and long-term survival rates were compared using a propensity score-based inverse probability of treatment weighting (IPTW) technique. We performed VATS and open thoracotomy for 500 and 649 patients, respectively. All preoperative characteristics became similar between the two groups after IPTW adjustment. Compared to thoracotomy, VATS was associated with shorter hospitalization (7.7 days vs. 9.2 days, p < 0.001), earlier adjuvant chemotherapy (41.7 days vs. 46.6 days, p = 0.028), similar complete resection rates (95.2 % vs. 94.0 %, p = 0.583), and equivalent dissected lymph nodes (27.5 vs. 27.8, p = 0.704). On IPTW-adjusted analysis, overall survival (OS) (59.4 % vs. 60.3 %, p = 0.588) and recurrence-free survival (RFS) (59.2 % vs. 56.9 %, p = 0.651) at 5 years were also similar between the two groups. Multivariable Cox analysis revealed that VATS was not a significant prognostic factor for cN1 disease (p = 0.764 for OS and p = 0.879 for RFS). VATS lobectomy is feasible for patients with cN1 disease, providing comparable perioperative outcomes, oncologic efficacy, and long-term outcomes as open thoracotomy. [ABSTRACT FROM AUTHOR]

Highlights • Brain metastasis (BM) occurred in approximately 16% of lung adenocarcinoma (ADC) patients. • BM were found in 3% of stage I lung ADC. • Large tumor size, LN involvement, and distant metastases were associated with BM. • EGFR mutations were risk factors for BM among never-smokers, K-RAS mutations were risk factors among males. Abstract Objective Patients with lung adenocarcinoma (ADC) are at higher risk of the development of brain metastasis (BM), and genetic alterations are associated with BM. Patients and methods A total of 598 patients with lung ADC in our institution between January 2014 and December 2014 were reviewed retrospectively. We evaluated the incidence of BM by stage and genetic alterations. Results Of the 598 patients, 97 (16.2%) had BM, which occurred across all stages. The incidence of BM showed a tendency to increase as the stage increased (p < 0.001, trend test). Although patients with EGFR mutations had BM across all stages, those with ALK or K- mutations had BM only in stage III and IV diseases. Regardless of types of mutations, the incidence of BM showed a tendency to increase as the T or N staging increased (p < 0.001 for each of EGFR, ALK, and K-RAS mutations, trend test). Whereas BM incidence showed a tendency to increase as the M staging increased in patients with EGFR-mutant lung ADC (p < 0.001, trend test), there was no linear trend between M staging and ALK (p = 0.469, trend test) or K-RAS mutations (p = 0.066, trend test). After adjusting covariables, EGFR mutations were associated with BM in never-smokers (adjusted OR = 2.07, 95% CI = 1.02–4.34) and K-RAS mutations were risk factors for BM in males (adjusted OR = 3.86, 95% CI = 1.01–14.43). Conclusions BM occurred in approximately 16% of lung ADC patients, including 3% with stage I diseases. Whereas EGFR-mutant lung ADC had BM across all stages, ALK- or K-RAS-mutant lung ADC had BM only in advanced stages. EGFR mutations were risk factors for BM among never-smokers and K-RAS mutations were risk factors among males. [ABSTRACT FROM AUTHOR]

Introduction We investigated the timing and patterns of recurrence after the treatment of stage IIIA (N2) non-small cell lung cancer via neoadjuvant concurrent chemoradiotherapy followed by surgery. Materials and methods An institutional database was reviewed retrospectively between 1997 and 2013 (N = 570). Eligible patients had pathologically proven N2 disease, and they completed the planned trimodality therapy with curative intent. The hazard rate function and competing risk analysis were used to evaluate the recurrence dynamics. Results Among the included patients, 76% had single station N2 involvement and 95% had complete resection. The 5-year overall and recurrence-free survival rates were 47% and 29%, respectively. Of the 290 patients who experienced recurrence, 25 (8.4%) experienced loco-regional recurrence, whereas 238 (80.4%) had distant metastases. The hazard rate function for overall recurrence revealed a peak at approximately 8 months after surgery and a marked decline after 2 years. The peak recurrence frequency of distant metastasis differed at each site, with isolated brain metastases exhibiting the earliest peak (6 months) and a narrow recurrence interval (15 months). A histological comparison revealed a higher recurrence hazard rate for adenocarcinoma than for squamous cell carcinoma but similar pattern of recurrences. Patients with complete responses had a lower cumulative incidence rate of recurrence but a slightly earlier peak of recurrence. Nodal responses to induction therapy demonstrated that patents with ypN0 had the lowest recurrence risk, whereas patients with ypN1 and ypN2 had similar hazard rates and cumulative incidence rates of recurrence. Conclusions The dynamics of recurrence after trimodality therapy is organ-specific and varies according to pathologic factors. Our finding provides information on selection patients with risk of recurrence and timing of surveillance study. [ABSTRACT FROM AUTHOR]

Objectives The objective of this study was to evaluate the treatment outcomes and prognostic factors of neoadjuvant concurrent chemoradiotherapy (CCRT) followed by surgical resection for non-small cell lung cancer (NSCLC) with N2 disease. Materials and methods A retrospective review of patients with N2 disease who underwent neoadjuvant CCRT followed by surgery at our institution was performed and multivariate Cox regression analysis was used to determine the factors associated with survival outcomes. Results From 1997 to 2013, 574 patients underwent curative-intent surgery after neoadjuvant CCRT for NSCLC with N2 disease. The mean age was 59 years (444 men, 77%). The extent of surgery included lobectomy in 418 patients (73%), pneumonectomy in 73 (13%), and sleeve resection in 25 (4.3%). Complete resection was obtained in 543 patients (95%). Postoperative complications and in-hospital mortality occurred in 199 patients (35%) and 21 (3.7%), respectively. Pathologic complete response was achieved in 72 patients (13%) and 304 (53%) experienced mediastinal clearance. With a mean follow-up of 36 months, median overall survival (OS) and recurrence-free survival (RFS) were 56 months and 18 months, respectively. The 5-year OS rates were 61% in ypN0, 49% in ypN1, and 35% in ypN2 ( p = 0.001). The 5-year RFS rates were 45% in ypN0, 23% in ypN1, and 17% in ypN2 ( p < 0.001). Older age, advanced pT stage, persistent N2, large cell carcinoma, and pneumonectomy were independent prognostic factors associated with worse OS and poorer RFS. Conclusion Neoadjuvant CCRT followed by surgery could be performed with acceptable early postoperative outcomes, satisfactory local control, and encouraging long-term survival. Care should be taken in selecting patients when necessitating pneumonectomy after neoadjuvant CCRT. Further efforts to improve outcomes in patients with persistent N2 disease are required. [ABSTRACT FROM AUTHOR]

Abstract: We investigated whether direct tissue matrix-assisted laser desorption/ionization (MALDI) mass spectrometry (MS) analysis on lipid may assist with the histopathologic diagnosis of non-small cell lung cancers (NSCLCs). Twenty-one pairs of frozen, resected NSCLCs and adjacent normal tissue samples were initially analyzed using histology-directed, MALDI MS. 2,5-dihydroxybenzoic acid/α-cyano-4-hydroxycinnamic acid were manually deposited on areas of each tissue section enriched in epithelial cells to identify lipid profiles, and mass spectra were acquired using a MALDI-time of flight instrument. A lipid profile that could differentiate cancer and adjacent normal samples with a median accuracy of 92.9% was discovered. Several phospholipids including phosphatidylcholines (PC) {34:1} were overexpressed in lung cancer. Squamous cell carcinomas and adenocarcinomas were found to have different lipid profiles. Discriminatory lipids correctly classified the histology of 80.4% of independent NSCLC surgical tissue samples (41 out of 51) in validation set. MALDI MS image of 11 discriminatory lipids validated their differential expression according to the histologic type in cancer cells of bronchoscopic biopsy samples. PC {32:0} [M+Na]+ (m/z 756.68) and ST-OH {42:1} [M−H]− (m/z 906.89) were overexpressed in adenocarcinomas. Thus, lipid profiles accurately distinguish tumor from adjacent normal tissue and classify non-small cell lung cancers according to the histologic type. [Copyright &y& Elsevier]

Abstract: Among 1372 lung cancer patients without brain metastasis that underwent resection of lung cancer at our center from 2001 to 2007, brain metastases developed in 72 patients (5.2%) during their hospital course. We hypothesized that there were micro-metastases in the brain at the time of lung surgery in these patients, even though there were no detectable brain metastases on the MRI. The purpose of this study was to evaluate the growth rates of metastatic brain tumors in this unique subset of patients, and to compare the findings with our previous study that calculated the growth rate of brain metastases during chemotherapy. Among 72 patients, 23 with cystic or hemorrhagic metastases were excluded. Seventy-six metastatic brain tumors in 49 patients were reviewed. Twenty-five patients underwent adjuvant or neoadjuvant chemotherapy; however, for the rest of the patients, chemotherapy was not added after lung cancer surgery. The tumor volume was determined using V-works software (v. 4.0) (Cybermed, Seoul, Korea) and T1 gadolinium enhanced MR images. The overall median tumor growth rate was 11.7mm3/day (interquartile range, 4.9–26.8). There were no statistically significant differences in the tumor growth among the lung cancer stages and the growth rate was similar regardless of the use of chemotherapy. The growth rate reported in this study shows consistency with that of our previous report (12.1mm3/day). These findings may help optimize patient management during follow up. [ABSTRACT FROM AUTHOR]

Abstract: Purpose and methods: The outcomes of lung cancer patients who were asymptomatic at diagnosis have never been reported as part of a large-scale study. A national survey of lung cancer in South Korea registered a total of 8788 patients diagnosed in 2005. We report the results herein, with an emphasis on the prognosis of the asymptomatic lung cancer patients. Results: Adenocarcinoma was the most frequent (36.1%) histopathologic type, followed by squamous cell carcinoma (32.1%), large cell carcinoma (1.5%), and small cell carcinoma (13.5%). In most cases, lung cancer was detected with subjective symptoms, but 6.5% of cases had no symptoms indicative of lung cancer at the time of diagnosis. Compared to symptomatic patients, asymptomatic patients were younger, more often female, non-smokers, and more frequently presented with adenocarcinoma. Initial treatments were surgery (22.1%), radiation therapy (7.8%), chemo-radiation therapy (5.4%), and chemotherapy (38%), while 26.6% of patients were recorded to have supportive care only. Asymptomatic patients received surgery in 60.0% of cases, and they showed significantly longer survival times than symptomatic patients. Absence of symptoms at diagnosis significantly reduced the risk of death from non-small cell lung cancer, regardless of patient age, patient gender, stage at diagnosis, smoking history, or whether treatment was performed, but did not reduce the risk of death from small cell lung cancer. Conclusions: Adenocarcinoma has grown to be the leading histopathologic type of lung cancer in South Korea. Absence of symptom at diagnosis is a favorable prognostic factor for patients with non-small cell lung cancer. [Copyright &y& Elsevier]

Purpose: To retrospectively evaluate which dose-volumetric parameters are associated with the risk of ≥ Grade 3 acute esophageal toxicity (AET) in lung cancer patients treated with three-dimensional conformal radiotherapy (3D-CRT). Methods and Materials: One hundred twenty-four lung cancer patients treated curatively with 3D-CRT were retrospectively analyzed. All patients received conventionally fractionated radiotherapy (RT) with median dose of 60 Gy (range, 54–66 Gy) delivered in 30 fractions (range, 27–33 fractions). Thirty-one patients underwent curative surgery before RT. Ninety-two patients received chemotherapy (induction, 18; concurrent ± induction, 74). Acute esophageal toxicity was scored by Radiation Therapy Oncology Group criteria. The parameters analyzed included sex; age; Karnofsky performance score; weight loss; surgery; concurrent chemotherapy; the percentages of organ volume receiving ≥20 Gy (V20), ≥30 Gy (V30), ≥40 Gy (V40), ≥50 Gy (V50), ≥55 Gy (V55), ≥ 58 Gy (V58), ≥60 Gy (V60), and ≥63 Gy (V63); the percent and absolute length of the esophagus irradiated; the maximum and mean dose to the esophagus; and normal tissue complication probability. Results: Of the 124 patients, 15 patients (12.1%) had Grade 3 AET, and 1 (0.8%) patient had Grade 4 AET. There was no fatal Grade 5 AET. In univariate and multivariate logistic regression analyses, concurrent chemotherapy and V60 were significantly associated with the development of severe (≥ Grade 3) AET (p &#60; 0.05). Severe AET was observed in 15 of 74 patients (20.3%) who received concurrent chemotherapy, and in 1 of 50 patients (2.0%) who did not (p = 0.002). Severe AET was observed in 5 of 87 patients (5.7%) with V60 ≤ 30% and in 11 of 37 patients (29.7%) with V60 > 30% (p &#60; 0.001). Among 50 patients who did not receive concurrent chemotherapy, severe AET was observed in 0 of 43 patients (0%) with V60 ≤ 30% and in 1 of 7 patients (14.2%) with V60 > 30% (p = 0.140). Among 74 patients who received concurrent chemotherapy, severe AET was observed in 5 of 44 patients (11.4%) with V60 ≤ 30% and in 10 of 30 patients (33.3%) with V60 > 30% (p = 0.037). Conclusions: Concurrent chemotherapy and V60 were associated with the development of severe AET ≥ Grade 3. For patients being treated with concurrent chemotherapy, V60 is considered to be a useful parameter predicting the risk of severe AET after conventionally fractionated 3D-CRT for lung cancer. [Copyright &y& Elsevier]