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Open in new tab Download slide OBJECTIVES Anastomotic leak (AL) is one of the most serious complications after oesophageal cancer surgery. A high cervical anastomosis using a narrow gastric tube based on optimized procedures has the potential to reduce the AL after a McKeown oesophagectomy. METHODS A narrow gastric tube was defined as 2–2.5 cm in diameter. Meanwhile, we defined a high anastomosis (HA) and a normal anastomosis (NA) based on the position of the intraoperative cervical anastomosis above or below the level of the inferior thyroid artery, respectively. A total of 533 patients who had a McKeown oesophagectomy from March 2018 to March 2023 were included in this study, including 281 patients in the NA group and 252 patients in the HA group. Potential confounding factors in baseline characteristics were balanced by propensity score matching. RESULTS After matching, 190 patients remained in both groups. When comparing the pathological and surgical results, we found that more lymph nodes, both in total number (21.1 ± 10.0 vs 15.8 ± 7.7, P  = 0.001) and thoracic part (13.5 ± 7.8 vs10.8 ± 6.1, P  = 0.005), were harvested from the HA group. The pathological T and TNM stages of patients in the HA group were earlier than those in the NA group (P  = 0.001). Overall postoperative complications (P  = 0.001), including pulmonary infection (P  = 0.001), AL (P  < 0.001), leakage-related pyothorax (P  < 0.001), recurrent laryngeal nerve palsy (P  = 0.031) and pleural effusion (P  < 0.001), were all significantly lower in the HA group. Finally, multivariable logistic regression analysis indicated that HA was an independent protective factor for AL (odds ratio = 0.331, 95% confidence interval: 0.166–0.658; P  = 0.002). CONCLUSIONS For patients undergoing a McKeown oesophagectomy, a high cervical anastomosis using a narrow gastric tube can effectively reduce leakage-related complications. [ABSTRACT FROM AUTHOR]

Simple Summary: The superior vena cava (SVC)'s involvement in non-small-cell lung cancer (NSCLC) has been considered a technical and oncological contraindication for surgery. In recent decades, different studies have demonstrated that surgery should not be contraindicated per se, but in highly selected cases and specialized centers, it could be curative with acceptable risks. Nevertheless, the tangential resection of the SVC or patch reconstruction have different surgical risks from prosthetic replacement. Moreover, the percentage of SVC involvement may influence the prognoses of these selected patients. Our intention was to investigate the relation between the rate of SVC involvement and surgical and oncological outcomes. The conclusions of our retrospective study may improve the management of patients with T4 NSCLC and SVC invasion. Background: Surgery for non-small-cell lung cancers (NSCLCs) invading the superior vena cava (SVC) is rarely performed due to surgical complexities and reported poor prognoses. Different methods have been described to reconstruct the SVC, such as direct suture, patch use or prosthesis, according to its circumferential involvement. The aim of our study was to analyze the short- and long-term results of different types of SVC resection and reconstruction for T4 NSCLCs. Methods: Between January 2000 and December 2019, 80 patients received an anatomical lung resection with SVC surgery in this multicenter retrospective study. The partial resection and direct suture or patch reconstruction group included 64 patients, while the complete resection and prosthesis reconstruction group included 16 patients. The primary endpoints were as follows: long-term survival and disease-free survival. The secondary endpoints were as follows: perioperative complications and 30- and 90-day mortality. Unpaired t-tests or Mann–Whitney U tests for non-parametric variables were applied to discrete or continuous data, and the chi-square test was applied to dichotomous or categorical data. Survival rates were calculated using the Kaplan–Meier method and compared using the log-rank test. Results: No differences were found between the two groups in terms of general characteristics and surgical, oncological and survival outcomes. In particular, there were no differences in terms of early (50.0% vs. 68.8%, p = 0.178) and late complication frequency (12.5% vs. 12.5%, p = 1.000), 30- and 90-day mortality, R status, recurrence, overall survival (33.89 ± 40.35 vs. 35.70 ± 51.43 months, p = 0.432) and disease-free survival (27.56 ± 40.36 vs. 31.28 ± 53.08 months, p = 0.668). The multivariate analysis demonstrated that age was the only independent predictive factor for overall survival. Conclusions: According to our results, SVC resection has good oncological and survival outcomes, regardless of the proportion of circumferential involvement and the type of reconstruction. [ABSTRACT FROM AUTHOR]

The surgical treatment of advanced non-small-cell-lung-cancer (NSCLC) invading mediastinal organs and great vessels is still controversial. The aim of this multicentre study is to analyse oncological outcomes, surgical outcomes and prognostic factors of patients with NSCLC involving heart and great vessels. 362 patients treated surgically for locally advanced T4-NCSLC between 1990 and 2020 were retrospectively reviewed. Patients were divided into five subgroups: pulmonary artery(n = 129), left atrium(n = 82), superior vena cava(n = 80), aorta(n = 43), and multiple vascular structures(n = 28). Resection was complete in 327(90%) patients. Overall 90-day mortality was 8.8%, influenced by poly-transfusions, pneumonectomy, bronchopleural fistula and previous cardiovascular disease (4.5HR.p = 0.03, 3.7HR p = 0.01, 14.0HR.p < 0.001 and 3.0HR p < 0.01). One-, 3- and 5-year survival rates were 75%, 43%, 33%, respectively and there were significant differences among the five groups(p < 0.001). Survival was significantly affected by induction radiotherapy, nodal status, pTNM-stage and radicality (3.8HR p = 0.03, 2.6HR p = 0.001, 1.6HR p < 0.05 and 1.6HR p < 0.05). Surgery provided acceptable results in selected patients with T4-NSCLC with major vascular infiltration in expert centres. Nodal-status and radicality influenced the overall-survival and disease-free survival. Neoadjuvant chemotherapy appears to have a positive effect on long-term results, particularly in N2-patients. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide Open in new tab Download slide OBJECTIVES Our goal was to assess the influence of working hours and working at night on intraoperative complications on surgeons conducting video-assisted pulmonary resections. METHODS We identified all patients who underwent video-assisted thoracoscopic surgery (VATS) in Shanghai Chest Hospital from January 2015 to April 2017. Univariable and multivariable logistic analyses were used to analyse independent risk factors for intraoperative complications. A 1:4 propensity score matching analysis was conducted to verify those results. RESULTS A total of 15 767 patients who underwent VATS pulmonary resection were included in this study. Among them, 15 280 patients (96.1%) were operated on during daytime working hours and 487 (3.1%) at night. A total of 203 (1.3%) intraoperative complications occurred. Vascular injury was the main cause of intraoperative complications, accounting for 92.1% (187/203). Multivariable logistic regression indicated that age [odds ratio (OR) = 1.68, 95% confidence interval (CI) 1.43–1.98; P  < 0.001], gender (OR = 1.71, 95% CI 1.26–2.32; P  = 0.001), surgical experience (OR = 2.07, 95% CI 1.56–2.75; P  < 0.001), type of surgery (OR = 0.31, 95% CI 0.20–0.49; P  < 0.001) and operative periods (OR = 2.69, 95% CI 1.61–4.86; P  < 0.001) were independent predictors for intraoperative complications. The incidence of intraoperative complications during night-time surgery was significantly higher than that during daytime working hours. A 1:4 propensity score matching-based results verification showed that night-time surgery was still an independent risk factor after propensity score matching (OR = 2.76, 95% CI 1.47–5.15; P  = 0.002). CONCLUSIONS The incidence of intraoperative complications from VATS pulmonary resection performed during night hours was significantly higher than that performed during working hours. In the present labour environment, thoracic surgeons should avoid night-time surgery whenever possible. [ABSTRACT FROM AUTHOR]

Background: Accurate preoperative prediction of the invasiveness of lung nodules on computed tomography (CT) can avoid unnecessary invasive procedures and costs for low-risk patients. While previous studies approached this task using cross-sectional data, this study aimed to utilize the commonly available longitudinal data of lung nodules through sequential modelling based on long short-term memory (LSTM) networks., Methods: We retrospectively included 171 patients with lung nodules that were followed-up at least once and pathologically diagnosed with adenocarcinoma for model development. Pathological diagnosis was the gold standard for deciding lung nodule invasiveness. For each nodule, a handful of semantic features, including size intensity and interval since first discovery, were obtained from an arbitrary number of CT scans available to individual patients and used as input variables to pre-operatively predict nodule invasiveness. The LSTM-based classifier was optimized by extensive experiments and compared to logistic regression (LR) as baseline with five-fold cross-validation., Results: The best LSTM-based classifier, capable of receiving data from an arbitrary number of time points, achieved better preoperative prediction of lung nodule invasiveness [area under the curve (AUC), 0.982; accuracy, 0.924; sensitivity, 0.946; specificity, 0.881] than the best LR (AUC, 0.947; accuracy, 0.906; sensitivity, 0.938; specificity, 0.847) classifier., Conclusions: The longitudinal data of lung nodules, though unevenly spaced and varying in length, can be well modeled by the LSTM, allowing for the accurate prediction of nodule invasiveness. Given that the input variables of the sequential modelling consist of a few semantic features that are easily obtained and interpreted by clinicians, our approach is worthy further investigation for the optimal management of lung nodules., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tlcr.amegroups.com/article/view/10.21037/tlcr-22-319/coif). DS is an employee of Keya Medical Technology Co. Ltd. The company provided the computer with GPU cards that were used to conduct the model training, testing and data analysis for this study. The other authors have no conflicts of interest to declare., (2022 Translational Lung Cancer Research. All rights reserved.)