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Introduction: Recent trials have reported promising results with the addition of immunotherapy to chemotherapy for patients with locally advanced NSCLC, but in practice, the proportion of patients who receive systemic therapy (ST) has historically been low. Underutilization of ST may be particularly apparent in patients undergoing pneumonectomy, in whom the physiologic insult and surgical complications may preclude adjuvant therapy (ADJ). We, therefore, evaluated the use of ST for patients with NSCLC undergoing pneumonectomy. Methods: We queried the National Cancer Database, including all patients with NSCLC who underwent pneumonectomy between 2006 and 2018. Logistic regression was used to identify associations with ST and neo-ADJ (NEO). Overall survival was compared after propensity score matching (1:1) patients undergoing ST to those undergoing surgery alone using Kaplan-Meier and Cox regression methods. Results: A total of 2619 patients were identified. Among these, 12% received NEO, 43% received ADJ, and 45% surgery alone. Age younger than 65 years (adjusted odds ratio [aOR] = 1.53, 95% confidence interval; [CI]: 1.10–2.11), Asian ethnicity (aOR = 2.68, 95% CI: 1.37–5.23), treatment at a high-volume center (aOR = 1.39, 95% CI: 1.06–1.81), and private insurance (aOR = 1.42, 95% CI: 1.05–1.94) were associated with NEO, whereas age younger than 65 years (aOR = 1.95, 95% CI: 1.61–2.38), comorbidity index less than or equal to 1 (aOR = 1.66, 95% CI: 1.29–2.16), and private insurance (aOR = 1.47, 95% CI: 1.20–1.80) were associated with any ST. In the matched cohort, ST was associated with better survival than surgery (adjusted hazard ratio = 0.67, 95% CI: 0.58–0.78). Conclusions: A high proportion of patients who undergo pneumonectomy do not receive ST. Patient and socioeconomic factors are associated with the receipt of ST. Given its survival benefit, emphasis should be placed on multimodal treatment strategies, perhaps with greater consideration given to neoadjuvant approaches.

Background: To cope with COVID-19 pandemic control precautions, many surgical residency programs have adopted a Declared Health Emergency rotation to minimize exposure to the COVID-19. We evaluated the experience and educational value of virtual education activities by reviewing the perceptions of the Declared Health Emergency rotation participants through survey questionnaire analysis. Methods: Participants of the Declared Health Emergency rotation virtual educational activities were asked to complete a survey questionnaire describing their perception and experience. Results: The survey response rate was 100% (faculty, n = 13; residents, n = 8; nurse practitioners/physician assistants, n = 4). The majority reported that virtual activities required minimal technical skills (n = 17, 68%). Compared to the traditional in-person conferences before the pandemic, the majority reported that they participated in virtual rounds more often or the same (n = 22, 88%), that the overall level and quality of interactions were the same or better (n = 19, 76%), and that the knowledge gained was the same or more (n = 22, 88%). All respondents reported that virtual conferences educational objectives were met. Conclusion: The quality of education and the knowledge gain during the virtual educational activities are equivalent or better than in the traditional face-to-face activities. The use of technology in virtual educational activities is a practical and convenient approach to achieve the desired educational objectives during and potentially after the COVID-19 pandemic.

Background There remains uncertainty regarding the second‐best conduit after the internal thoracic artery in coronary artery bypass grafting. Few studies directly compared the clinical results of the radial artery (RA), right internal thoracic artery (RITA), and saphenous vein (SV). No network meta‐analysis has compared these 3 strategies. Methods and Results MEDLINE and EMBASE were searched for adjusted observational studies and randomized controlled trials comparing the RA, SV, and/or RITA as the second conduit for coronary artery bypass grafting. The primary end point was all‐cause long‐term mortality. Secondary end points were operative mortality, perioperative stroke, perioperative myocardial infarction, and deep sternal wound infection (DSWI). Pairwise and network meta‐analyses were performed. A total of 149 902 patients (4 randomized, 31 observational studies) were included (RA, 16 201, SV, 112 018, RITA, 21 683). At NMA, the use of SV was associated with higher long‐term mortality compared with the RA (incidence rate ratio, 1.23; 95% CI, 1.12–1.34) and RITA (incidence rate ratio, 1.26; 95% CI, 1.17–1.35). The risk of DSWI for SV was similar to RA but lower than RITA (odds ratio, 0.71; 95% CI, 0.55–0.91). There were no differences for any outcome between RITA and RA, although DSWI trended higher with RITA (odds ratio, 1.39; 95% CI, 0.92–2.1). The risk of DSWI in bilateral internal thoracic artery studies was higher when the skeletonization technique was not used. Conclusions The use of the RA or the RITA is associated with a similar and statistically significant long‐term clinical benefit compared with the SV. There are no differences in operative risk or complications between the 2 arterial conduits, but DSWI remains a concern with bilateral ITA when skeletonization is not used.