To compare lobectomy and segmentectomy among different subtypes of stage I lung adenocarcinoma (ADC).

Bronchopulmonary sequestration is a rare disease in which a non-functional region of pulmonary tissue receives an aberrant vascular supply and lacks normal communication with the tracheobronchial tree. We present the case of a 30-year-old female with a primary complaint of unexplained weight loss and no other additional signs or symptoms. In view of this, computed tomography imaging was ordered, showing a 33HU mass in the right upper lobe. A specialist radiologist reviewed the images and concluded that the most likely differentials were mediastinal lymphoma or thymic malignancy. Video-assisted thoracoscopic surgery was performed, when it was seen that no malignancy was present, but rather a bronchopulmonary sequestration. Histology confirmed the diagnosis; the patient fared well post-operatively. Bronchopulmonary sequestration is a rare pathology, with most cases occurring in the lower lung lobes. This case is highly atypical, due to the lack of clinical features and the lesion radiologically mimicking the appearance of malignancy.

Background: Heterogeneous emphysema patients treated with Zephyr Valves (EBV) in the TRANSFORM Study showed clinically meaningful benefits across multiple outcomes at 3- and 6-months compared to the Control group (AJRCCM.2017;196:1535). Longer-term data are now presented. Aims and Objectives: Evaluate durability of benefit and safety of EBV treatment out to 24-months. Methods: 97 patients (58M/39F; age, 64.3±7.4yrs; FEV1, 30.5±8.9%pred.; RV, 247±49%pred.; TLC, 138±17%pred.), with no collateral ventilation (Chartis) were randomized (2:1) to EBV treatment and optimal medical management (n=65) or optimal medical management (n=32). Data at 3- and 6-months has been previously reported. The EBV group was followed beyond 6-months out to 24-months. Results: EBV group showed clinically and statistically significant improvements over baseline in RV, FEV1, SGRQ, 6MWD and BODE Index at 18-months (Figure below; values are means±SEM). At 24-months, improvements in RV, FEV1 (%change), and SGRQ remained clinically and statistically significant. Over this period, the most common adverse event was COPD exacerbation. Conclusions: Zephyr Valve treatment in patients with severe heterogeneous emphysema provides durable benefit in lung function and quality of life to at least 24-months with an acceptable safety profile. These improvements are contrasted by an expected decrease in these measures over 24 months given the disease progression.

It is a well-described phenomenon in the literature that a thymoma can lead to aplastic anemia, and that a thymectomy can be curative for to aplastic anemia. However, the opposite is extremely rare. We present an unusual case of a 60-year-old woman with myasthenia gravis, who was diagnosed with an incidental thymoma found on computerized tomography. Resection of the thymoma treated her myasthenia gravis but led to an aplastic anemia resistant to granulocyte colony-stimulating factor, cyclosporin, and horse antithymocyte globulin treatment. The patient received an allogenic stem cell transplant but unfortunately passed away because of complications.

Background: Giant nerve sheath tumours (GNST) are rare and literature on their management is scant. Spinal GNST present as a surgical challenge due to the involvement of anatomical regions often outside the ?comfort zone? of a spinal surgeon. This case series aims to identify challenges in the surgical management of GNSTs. Methods: Retrospective case note review of all spinal GNST cases from 2010 to 2016 managed in Sheffield Teaching Hospitals identified 8 patients, 3 of whom were incidental findings (kept under surveillance) and were excluded. 5 cases were treated surgically. Data collected included patient demographic, presenting symptom(s), radiological data, surgical approach to the tumour and challenges encountered, histopathology report and follow up. Results: Our cohort consisted entirely of females (N?=?5) with a mean age of 56.4 years (range 45?70). Imaging studies and histopathological diagnoses confirmed 5 GNSTs (four benign schwannomas and one ganglioneuroma). A Single-stage anterior approach was adopted for three patients while a combined anterior-posterior approach was adopted for the remaining two. In one patient, a posterior approach was initially planned, but this was abandoned and converted to an anterior approach following onset of acute superior vena cava (SVC) syndrome secondary to SVC compression by the giant tumour on prone positioning of the patient. PET imaging of case 3 showed intense tracer uptake consistent with malignancy, however histology confirmed WHO grade 1 Schwannoma. The other three non-operated GNSTs are kept under yearly radiological and clinical surveillance. Conclusions: GNSTs are surgically challenging as they often invade territories that are beyond the comfort zone of one single specialty. A multidisciplinary approach with careful pre-operative surgical planning is recommended. Patients in whom a posterior approach is planned should have a trial of prone positioning pre-operatively. Careful interpretation of FDG-PET imaging is recommended due to the possibility of false positive result.

elcome to the 2019 SCTS Annual Meeting and Cardiothoracic Forum in London. This year’s programme covers the many different aspects of cardio-thoracic surgery, emphasising areas that are important in your daily clinical work. As ever, we are hoping to create an interactive meeting with the exchange of knowledge and ideas, facilitating discussions and debates between delegates. With a wide range of educational formats presenting the latest and the best information on new technologies and techniques in cardio-thoracic surgery, the presentations will be of interest to surgeons, anaesthetists, nurses, surgical care practitioners, physiotherapists, child governance leads, database managers and allied health professionals. This year’s meeting will include presentations of the highest quality from surgical and masterclass presentations to the latest clinical updates and technical innovations. As ever, the meeting will also witness some outstanding debates presented by some of the foremost experts in their field. Away from the scientific programme, all delegates are reminded that this year’s SCTS Annual Dinner will be held on Monday 11 March at the UnderGlobe. Some spaces are still available, please ask at the registration desk for further details. The organisers would like to extend their thanks to industry for their continued support of the meeting, and all the presenters who have taken the time to contribute to this year’s SCTS Conference News newspaper. It is a great pleasure to welcome you to London and the organisers are honoured and delighted with your presence at this meeting. We hope the information presented will be of great interest. London is one of the world’s great cities and we hope you enjoy the meeting and all this wonderful city has to offer... and remember to make in note in your diaries for next year’s meeting that will be held in Cardiff, 22-24 March 2020!

BACKGROUND:We aim to evaluate the transition process from open to video-assisted thoracoscopic surgery (VATS) anatomical segmentectomies in a regional thoracic surgical unit.METHODS:In a retrospective study from January 2013 to December 2015, we identified all anatomical segmentectomies performed in our unit. Pre, peri and postoperative data were compared between the three years (2013, 2014 and 2015) and according to operative approach. Thoracotomy after VATS intraoperative biopsy was considered a conversion for the purposes of the study.RESULTS:A total of 86 consecutive cases [56 females and 30 males, median age 70 years (range, 43 to 83 years); median FEV1 of 78% predicted (range, 41% to 126%)] were included. There was a significant change in the surgical approach with time. Fifty-two cases underwent VATS (73% via single-port) and 34 open surgeries, including nine conversions. There were no postoperative deaths in the VATS group and one in the open group. Operative outcomes were similar over time with no haemorrhagic events, equivalent R1 resection and nodal stations explored in all lymph node positive patients. In node negative cases however, open surgery was associated with more extensive mediastinal exploration. Patients in 2015 had a shorter hospital stay in comparison to those in previous years [median 4 days (range, 1-15 days) vs. median 6 days (range, 3-27 days), P=0.01]. There were no differences in the incidence of complications or readmissions to hospital over time.CONCLUSIONS:The transition over a short period of time from open to single-port VATS segmentectomy has allowed us to significantly reduce postoperative hospital stay without compromising operative or postoperative outcomes.

Clear resection margins and appropriate lymph node dissection are fundamental aspects of complete lung cancer resection, as defined by the International Association for the Study of Lung Cancer (IASLC). However, no reports to date have compared these outcomes in uniportal versus multiportal approaches to video-assisted thoracoscopic surgery (VATS).

A 73-year-old man with hereditary multiple exostoses (HMEs) presented with a 2-year history of a progressively enlarging mass over his left anterior chest wall (Fig 1A) causing discomfort, deformity, and significant functional impairment. Physical examination revealed a very large, hard, immobile mass that displaced the left nipple superiorly. Computed tomographic scanning (Fig 1B) demonstrated a 35 × 20 × 15-cm, partially calcified mass with a predominant extrathoracic component, extending into the left anterior mediastinum and abutting the right ventricle. There was no radiologic evidence of metastatic disease. Wide local excision of the mass (Figure 2) was performed with resection of the left fifth rib from which the mass arose. The resultant small chest wall defect did not give rise to a flail segment, and satisfactory reconstruction was achieved with a double-layered polypropylene mesh. Histologic analysis confirmed a low-grade chondrosarcoma with clear rib resection margins. The patient was discharged on the seventh postoperative day following uneventful recovery. Malignant transformation to chondrosarcoma can develop in 0.5% to 10% of patients with HME [1Hennekam R.C. Hereditary multiple exostoses.J Med Genet. 1991; 28: 262-266Crossref PubMed Scopus (186) Google Scholar]. To our knowledge, the occurrence of a giant costal chondrosarcoma arising in a patient with HME is rare, having been reported only once before [2Liu W. Kong D. Tang J. Yu F. Giant costal osteochondroma in a man with multiple exostoses.Ann Thorac Surg. 2013; 96: 675-677Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar].

Peripheral arterial injuries after blunt or penetrating trauma commonly follow injuries to adjacent soft tissue and bone. The traditional approach to these injuries is by open exploration, with identification and ligation of the bleeding vessel. We describe the case of a type II respiratory failure patient who had an enormous pectoral muscle haematoma following chest drain insertion, in whom the bleeding was only controlled by angiographic embolisation following failure of surgical exploration.

BACKGROUND:The 1997 non-small cell lung cancer staging revisions assigned a T4 descriptor to satellite nodules in the primary tumor lobe. We reviewed our experience of satellite-nodule T4 non-small cell lung cancer following these revisions and evaluated prognostic factors for this group.METHODS:All patients who underwent resection of non-small cell lung cancer between April 1997 and June 2005 with satellite nodule(s) confirmed at pathologic examination were identified from our institutional Lung Tumor Registry. Case notes and pathology reports were reviewed and data collected on possible prognostic factors. Survival was modeled using the Kaplan-Meier method, and survival differences between groups were analyzed using the log-rank test.RESULTS:From 1,276 non-small cell lung cancer patients who underwent resection, 137 were staged pT4, and 35 were T4-satellite nodules. Median follow-up was 25 months (range, 1 to 102 months). Median main tumor size was 3.0 cm (range, 1 to 9.8 cm). Adenocarcinoma or bronchioloalveolar carcinoma was the predominant histologic diagnosis (n = 28; 80%). One-, 3- and 5-year survival was 86%, 69%, and 57%, respectively; median survival was 68 months. During the same period, 137 patients undergoing resection for all T4 lesions had a 1-, 3-, and 5-year survival of 68%, 53%, and 18%, respectively. Adenocarcinoma or bronchioloalveolar carcinoma histologic diagnosis (adenocarcinoma or bronchioloalveolar carcinoma versus squamous, 75% versus 67% 3-year survival; p = 0.0026), female gender (66% versus 49% for males, 5-year survival; p = 0.041), and absence of vascular invasion (no invasion versus vascular invasion, 74% versus 20% 5-year survival; p = 0.0101) were significant predictors of better survival.CONCLUSIONS:Survival for resected T4 non-small cell lung cancer with satellite nodule(s) in the primary lobe is better than for other T4 lesions, and the T4 descriptor may unduly upstage these cases. The current T4 descriptor represents a heterogeneous population.

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether treatment with magnesium in addition to an anti-arrhythmic is beneficial to patients who have gone into atrial fibrillation after cardiac surgery. Altogether 466 papers were identified using the below mentioned search, of which 8 papers presented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group, relevant outcomes and weaknesses were tabulated. We conclude that while the literature on magnesium prophylaxis and non-cardiac surgical studies on magnesium therapy for atrial fibrillation suggest that magnesium may be of benefit, there are currently no studies in post-cardiac surgery atrial fibrillation to support the use of magnesium therapy for these patients.

Peripheral arterial injuries after blunt or penetrating trauma commonly follow injuries to adjacent soft tissue and bone. The traditional approach to these injuries is by open exploration, with identification and ligation of the bleeding vessel. We describe the case of a type II respiratory failure patient who had an enormous pectoral muscle haematoma following chest drain insertion, in whom the bleeding was only controlled by angiographic embolisation following failure of surgical exploration. 2009 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.