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BACKGROUND:To compare nodal upstaging and morbidity and mortality (M&M) rates for Operative Standard 5.8 vs other nodal sampling guidelines. METHODS:Patients who underwent clinical stage I-IIIA non-small cell lung cancer resection between July 1, 2021 and December 31, 2024, were identified in the Society of Thoracic Surgeons General Thoracic Surgery Database. We evaluated nodal upstaging and M&M rates for Operative Standard 5.8, a modified European Society for Thoracic Surgery (ESTS) lobe-specific guideline, a lobe-specific guideline based on work from Japan ("modified Japanese guideline"), and a hypothetical "2+1" guideline (≥2 mediastinal and ≥1 hilar station sampled). Odds of nodal upstaging and M&M for patients who met each guideline vs no guideline were compared using multivariable logistic regression. RESULTS:Of 46,954 patients, 68.7% met Operative Standard 5.8, 32.4% met the modified ESTS guideline, 25.9% met the modified Japanese guideline, 83.9% met the 2+1 guideline, and 16.1% met no guideline. Nodal upstaging rates were 11.6% for Operative Standard 5.8, 11.7% for the modified ESTS guideline, 11.5% for the modified Japanese guideline, 11.5% for the 2+1 guideline, and 7.6% for patients who met no guideline. M&M rates were nearly identical across the 4 guidelines (5.2%-5.3%) and similar to those among patients who met no guideline (4.9%). Findings were consistent in multivariable-adjusted analyses. CONCLUSIONS:In the Society of Thoracic Surgeons General Thoracic Surgery Database, nodal upstaging and M&M rates were comparable between Operative Standard 5.8 and the modified ESTS, modified Japanese, and 2+1 guidelines, supporting similar performance of these nodal sampling strategies. Upstaging rates were higher for patients who met any guideline vs none.
The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database (ACSD) is one of the largest and most comprehensive clinical databases, containing data from >8.6 million cardiac operations performed in the United States. The ACSD provides a platform for quality through risk modeling and performance metrics, scientific inquiry through robust outcomes research, and health policy through broad hospital participation. The ACSD is a dynamic, continuously evolving tool for the specialty, with recent initiatives including linkage to longitudinal health data as well as refinement and expansion of existing risk models. This report summarizes the current status of the ACSD and major trends in the specialty. Specifically, data on procedural volumes, surgical practices, and outcomes as well as ACSD research are discussed.
BACKGROUND Esophageal perforation is an uncommon but life-threatening condition that occurs spontaneously or as an iatrogenic injury following endoscopic intervention. The aim of this document was to provide a multi-disciplinary consensus on the diagnosis, treatment and follow-up for patients with suspected esophageal perforation. METHODS A multidisciplinary panel from the Society of Thoracic Surgeons (STS) convened to develop consensus recommendations for the diagnosis and management of esophageal perforation. Evidence was identified through systematic searches of PubMed and Embase (2010–2024) using the the Population-Intervention-Comparator-Outcome (PICO) framework, and statements were finalized through a modified Delphi process requiring greater than 75% agreement among experts. RESULTS Ten distinct recommendation statements were developed based on available literature. The statements all achieved greater than 75% consensus from all authors. The recommendations endorse the use of CT esophagram over fluoroscopic esophagram for diagnosis and the option of omitting imaging altogether in the event of spontaneous pneumomediastinum. There is a paucity of randomized control trials comparing endoscopic approaches for therapeutic management. However, current literature supports an array of endoscopic approaches based on technical aspects of the perforation and individual experience and skill. CONCLUSIONS Early diagnosis with CT esophagram and individualized management emphasizing endoscopic approaches such as stenting or vacuum therapy optimize outcomes in esophageal perforation. Multidisciplinary, patient tailored decision making guided by available evidence and expert consensus remains essential given the limited high quality data.
BACKGROUND:Management of atrial fibrillation (AF) at the time of coronary artery bypass grafting (CABG) is a class 1 recommendation. This study evaluated trends in AF management and their association with long-term survival. METHODS:Patients with paroxysmal or persistent AF who underwent isolated CABG were identified from The Society of Thoracic Surgeons Adult Cardiac Surgery Database (2011-2022) with linkage to Medicare claims for long-term outcomes. Patients were stratified by AF treatment: none, left atrial appendage occlusion (LAAO) only, epicardial ablation (EA), or intracardiac ablation (IA). The primary end point was all-cause mortality; secondary end points included permanent pacemaker placement, stroke, and readmission for AF, bleeding, or heart failure. Long-term mortality was assessed using Kaplan-Meier methods and Cox regression. Nonfatal outcomes were assessed using competing-risk regression with death as the competing event. RESULTS:Among 59,331 patients, 71.0% had paroxysmal AF, increasing from 56.6% (2011) to 79.6% (2022). AF treatment included none (51.0%), LAAO only (15.3%), EA (25.4%), and IA (8.2%). AF treatment increased from 31.8% to 68.8%, driven by LAAO (1.2%-30.8%). Patients with persistent AF had higher mortality than patients with paroxysmal AF (P < .001). EA showed lower mortality compared with no treatment. IA was associated with higher pacemaker implantation (6.0% vs 3.2%-3.4% in other groups; P < .001). Compared with no treatment, all treatment groups had lower stroke risk (subdistribution hazard ratio, 0.64-0.79; P < .001) and lower AF readmission (subdistribution hazard ratio, 0.85-0.89; P < .05). CONCLUSIONS:Nearly one-half of patients with AF who underwent CABG receive no treatment. Epicardial ablation was associated with superior long-term survival, and all strategies with were associated lower stroke risk.
Background Two recent randomized clinical trials have shown sublobar resection to be noninferior to lobectomy in node-negative non-small cell lung cancer ≤2 cm. As a result, the use of sublobar resection in early lung cancer patients has significantly increased. Consensus recommendations are needed to guide its appropriate use. Methods The Society of Thoracic Surgeons Workforce on Evidence-Based Surgery assembled a panel of thoracic surgeons with clinical and methodological expertise to review the existing literature on this topic. A modified Delphi method, with boundaries and thresholds determined a priori, was used until 75% agreement on the statements was reached. Results The panel identified 7 key areas of controversy. Three rounds of voting were required to reach >75% agreement on 21 statements to help guide appropriate use of sublobar resection in early-stage lung cancer. Conclusions Despite results of recent randomized clinical trials, several key questions remain regarding sublobar resection for early-stage non-small cell lung cancer. These statements will provide further guidance for clinicians considering the different surgical options.
