Gastric cancer is the fifth leading cause of cancer-related deaths worldwide. Over 95% of gastric cancers are adenocarcinomas, which are typically classified based on anatomic location and histologic type. Gastric cancer generally carries a poor prognosis because it is often diagnosed at an advanced stage. Systemic therapy can provide palliation, improve survival, and enhance the quality of life in patients with locally advanced or metastatic disease. The implementation of biomarker testing has had a significant impact on clinical practice and patient care. Targeted therapies have demonstrated encouraging results in clinical trials for the treatment of patients with locally advanced or metastatic disease. This selection from the NCCN Clinical Practice Guidelines in Oncology for Gastric Cancer highlights recommendations for biomarker testing and discusses updates for the treatment of advanced disease, including peritoneal carcinoma as only disease and unresectable locally advanced, recurrent, or metastatic disease.

Gastric cancer is the fifth leading cause of cancer-related deaths worldwide. Over 95% of gastric cancers are adenocarcinomas, which are typically classified based on anatomic location and histologic type. Gastric cancer generally carries a poor prognosis because it is often diagnosed at an advanced stage. Systemic therapy can provide palliation, improve survival, and enhance the quality of life in patients with locally advanced or metastatic disease. The implementation of biomarker testing has had a significant impact on clinical practice and patient care. Targeted therapies have demonstrated encouraging results in clinical trials for the treatment of patients with locally advanced or metastatic disease. This selection from the NCCN Clinical Practice Guidelines in Oncology for Gastric Cancer highlights recommendations for biomarker testing and discusses updates for the treatment of advanced disease, including peritoneal carcinoma as only disease and unresectable locally advanced, recurrent, or metastatic disease.

Background:Lung cancer with metastatic spread to the breast is a rare entity that is not commonly considered on the differential of diagnoses in the clinical context of new breast masses. The aim of our study is to provide a comprehensive literature review to highlight key clinical and histological features. Methods:A comprehensive review of literature from 1962 to 2024 regarding lung cancer with breast metastasis using PubMed was performed alongside an exemplary patient description. Data collection consisted of variables categorized as patient demographics, clinical disease characteristics, tumor immunohistochemistry and biomarker profile, and disease management and clinical outcomes. Results:Eighty-three studies consisting of case reports and case series were used for data collection and analysis, which consisted of 145 unique patient profiles. Of the included patients, 65.5% had adenocarcinoma, which was consistent with the reported chemical staining and molecular profiles; 49.6% had metachronous metastatic and primary disease with an average time to breast diagnosis of 24.2 months; 66.2% presented with an additional site of metastatic disease; 24.5% were initially misdiagnosed as having primary breast cancer. The overall mortality was 62.5% of those with reported survival outcomes, with an average follow-up of 15.0 months. Conclusions:Patients with lung cancer who have metastasized to the breast are at elevated risk for being misdiagnosed with primary breast cancer and may receive unnecessary surgery and incorrect treatment regimens.

Post-pneumonectomy empyema (PPE) is an uncommon but serious complication that carries significant therapeutic challenges. We present a late-onset PPE due to Nocardia nova in an immunocompetent individual. Nine years after a right pneumonectomy for non-small cell lung cancer, surveillance scans revealed new right pleural thickening and FDG avidity concerning for recurrence. Thoracoscopic pleural biopsies were negative for malignancy, but tissue cultures grew N. nova. Nocardia empyema is rare with few reported cases. Most occur in immunocompromised hosts, and all were associated with pulmonary or disseminated nocardiosis. Our case describes the first report of a PPE secondary to Nocardia.

Actinomyces israelii (AI) is a Gram-positive, rod-shaped bacterium that lives commensally on and within humans as a typical colonizer within the gastrointestinal tract, including the mouth. As an opportunistic pathogen, infection often results from tissue injury or breach of the mucosal barrier (ie, during various dental or GI procedures, aspiration, or specific pathologies such as diverticulitis). Symptoms generally present slowly as a non-tender, indurated mass that evolves into multiple abscesses, fistulae, or draining sinus tracts without regard for anatomical barriers, including fascial planes or lymphatic drainage. However, it may also present as an acute suppurative infection with pain and rapid progression to abscess formation.

Molecular profiling of lung tumors is crucial for guiding targeted therapeutic strategies and identifying potential resistance mechanisms to specific therapies, such as epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs). During this profiling, mutations with uncertain treatment implications can be identified. This case study represents a 69-year-old female with a co-occurring EGFR mutation profile that presents a unique therapeutic challenge. Tumor DNA was used for next-generation sequencing (NGS) of a custom 275 cancer-related QIAseq Human Comprehensive Cancer Panel (Qiagen). Next-generation RNA sequencing was performed using the Illumina TruSight panel. FISH analysis and PD-L1 22C3 immunohistochemical testing were also performed. Microscopic analysis revealed an invasive adenocarcinoma with papillary, acinar, and focal micropapillary features with a 6 mm invasive component. The final pathology stage was determined to be pT1aN0M0. NGS for DNA variant detection identified two mutations in EGFR, an EGFR G719A and EGFR L833_V834delinsFL with a variant allele frequency (VAF) of 22.2% and 21.1%, respectively. Targeted NGS RNA fusion analysis was also performed, which came back negative. PD-L1 22C3 immunohistochemical testing showed only 1% of the tumor cells expression. FISH analysis revealed one copy of MET and D7Z1 in 27% of cells, indicating an aneuploid neoplastic clone with monosomy 7. EGFR TKIs are universally accepted as a first-line treatment for advanced non-small cell lung cancer (NSCLC) patients with a sensitizing EGFR mutation. While mutations such as G719A are sensitive to all generations of EGFR-TKI, the effects are unknown for rare compound mutations in EGFR, such as EGFR L833_V834delinsFL. There are no reports in the literature with any mention of an algorithm of treatment for such a case. The patient had two metachronous lung primary cancers resected in 2022 and 2024. Due to the complete surgical resection, the sensitivity of this mutation of TKIs could not be established. This unique mutation profile still remains of paramount importance to understand if the patient relapses or presents with a new tumor with the same genetic profile.

BACKGROUND:The continued rise in healthcare expenditures has not produced commensurate improvements in patient outcomes, leading US healthcare stakeholders to emphasize value-based care. Transition to such a model requires all team members to adopt a new strategic and organizational framework. OBJECTIVE:To describe and report a strategy for the implementation of a novel patient-centered value-based "optimal surgical care" (OSC) framework, with validation and cost analysis in kidney surgery. DESIGN, SETTING, AND PARTICIPANTS:An observational study of care episodes at a single institution from 2014 to 2019 was conducted. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS:Multidisciplinary teams defined OSC by core and procedure-specific metrics using a combination of provider-based ("bottom-up") and "clinical leadership"-based ("top-down") strategies. Baseline OSC rates across were established, while identifying proportions of OSC achieved by coefficient of variation (CV) in total direct costs. Multivariable linear regression comparing cost between OSC and non-OSC encounters was performed, adjusting for patient characteristics. RESULTS AND LIMITATIONS:An analysis of 30 261 perioperative care episodes was performed. Following the implementation of an OSC framework, there was an increase in OSC rates across all procedure buckets using core (25%) and procedure-specific (26%) metrics. Among the tumors tested, kidney cancer surgical episodes held the highest OSC rate improvement (67%) with lowest variability in cost (CV 0.5). OSC was associated with significant total cost savings across all tumor types after adjusting for inflation (p < 0.05). Compared with non-OSC episodes, a significant reduction in the cost ratio of OSC was noted for renal surgery (p < 0.01), with estimated costs savings of $2445.87 per OSC encounter. CONCLUSIONS:Institutional change directing efforts toward optimizing surgical care and emphasizing value rather than focusing solely on expense reduction is associated with improved outcomes, while potentially reducing costs. The strategy for implementation requires serial performance analyses, engaging and educating providers, and continuous ongoing adjustments to achieve durable results. PATIENT SUMMARY:In this study, we report our strategy and outcomes for transitioning to a value-based healthcare model using a novel "optimal surgical care" framework at a National Cancer Institute-designated comprehensive cancer center. We observed an increase in optimal surgical care episodes across all specialties after 5 yr, with a potential associated reduction in cost expenditure. We conclude that the key to a successful and sustained transition is the implementation strategy, focusing on continual review and provider engagement.

OBJECTIVE:Surgical repair of paraesophageal hernias in patients with hostile abdomen is challenging. Despite its utility as an open procedure, the adoption of the minimally invasive Belsey Mark IV procedure has been limited because of the complexity of using traditional video-assisted thoracoscopic instrumentation. The robotic platform offers additional degrees of freedom, which enables minimally invasive transthoracic approach despite challenging anatomy. The purpose of this article is to describe a technique of robotic approach for the Belsey Mark IV operation.METHODS:We retrospectively reviewed 5 cases of the robotic Belsey Mark IV procedure completed at a single institution between June 2018 and November 2021. Data were collected from a review of the medical records, including operative reports, anesthesia records, imaging, and clinical notes. The operative technique is described in the present article. There were 4 men and 1 woman. The average age of the patients was 64.4 ± 13.6 years, with an average body mass index of 24.5 kg/m2. Three patients had undergone previous transabdominal hiatal hernia repair, and 2 of them had 2 prior repairs. One patient underwent simultaneous pulmonary left lower lobectomy for cancer with the Belsey Mark IV procedure.RESULTS:The average operative time was 209 ± 95 min (110 to 360 min). The average postoperative length of stay was 4.2 days, and 2 patients experienced complications including bleeding and persistent air leak (after lobectomy). The average blood loss was 67 ± 25 mL.CONCLUSIONS:The robotic platform enables a transthoracic minimally invasive approach to the Belsey Mark IV operation.

Cancers originating in the esophagus or esophagogastric junction constitute a major global health problem. Esophageal cancers are histologically classified as squamous cell carcinoma (SCC) or adenocarcinoma, which differ in their etiology, pathology, tumor location, therapeutics, and prognosis. In contrast to esophageal adenocarcinoma, which usually affects the lower esophagus, esophageal SCC is more likely to localize at or higher than the tracheal bifurcation. Systemic therapy can provide palliation, improved survival, and enhanced quality of life in patients with locally advanced or metastatic disease. The implementation of biomarker testing, especially analysis of HER2 status, microsatellite instability status, and the expression of programmed death-ligand 1, has had a significant impact on clinical practice and patient care. Targeted therapies including trastuzumab, nivolumab, ipilimumab, and pembrolizumab have produced encouraging results in clinical trials for the treatment of patients with locally advanced or metastatic disease. Palliative management, which may include systemic therapy, chemoradiation, and/or best supportive care, is recommended for all patients with unresectable or metastatic cancer. Multidisciplinary team management is essential for all patients with locally advanced esophageal or esophagogastric junction cancers. This selection from the NCCN Guidelines for Esophageal and Esophagogastric Junction Cancers focuses on the management of recurrent or metastatic disease.

Gastric cancer is the third leading cause of cancer-related deaths worldwide. Over 95% of gastric cancers are adenocarcinomas, which are typically classified based on anatomic location and histologic type. Gastric cancer generally carries a poor prognosis because it is often diagnosed at an advanced stage. Systemic therapy can provide palliation, improved survival, and enhanced quality of life in patients with locally advanced or metastatic disease. The implementation of biomarker testing, especially analysis of HER2 status, microsatellite instability (MSI) status, and the expression of programmed deathligand 1 (PD-L1), has had a significant impact on clinical practice and patient care. Targeted therapies including trastuzumab, nivolumab, and pembrolizumab have produced encouraging results in clinical trials for the treatment of patients with locally advanced or metastatic disease. Palliative management, which may include systemic therapy, chemoradiation, and/or best supportive care, is recommended for all patients with unresectable or metastatic cancer. Multidisciplinary team management is essential for all patients with localized gastric cancer. This selection from the NCCN Guidelines for Gastric Cancer focuses on the management of unresectable locally advanced, recurrent, or metastatic disease.

Gastric cancer is the third leading cause of cancer-related deaths worldwide. Over 95% of gastric cancers are adenocarcinomas, which are typically classi fi ed based on anatomic location and histologic type. Gastric cancer generally carries a poor prognosis because it is often diagnosed at an advanced stage. Systemic therapy can provide palliation, improved survival, and enhanced quality of life in patients with locally advanced or metastatic

Central MessageThere are conflicting descriptions in the literature for the approach to a lung-sparing left main stem bronchus resection. We provide a detailed description of a robotic technique from the right side.See Commentaries on pages 575 and 577. There are conflicting descriptions in the literature for the approach to a lung-sparing left main stem bronchus resection. We provide a detailed description of a robotic technique from the right side. See Commentaries on pages 575 and 577. A 43-year-old female patient had a proximal left main stem bronchus (LMSB) lesion identified 2 years previously on a computed tomography scan of the chest (Figure 1) during workup for severe asthma. The lesion was debrided via rigid bronchoscopy by a pulmonologist before surgical referral. Pathology revealed a well-differentiated neuroendocrine tumor. A gallium dotatate scan reported uptake in a subcarinal lymph node with a standardized uptake value of 13.8. Flexible bronchoscopy with endobronchial ultrasound was performed 3 weeks before surgical resection, and the base of the tumor was tattooed at the time with vital blue dye to facilitate its identification at the time of resection and allow visible margin assessment. Endobronchial ultrasound–guided biopsy confirmed isolated subcarinal lymph node involvement. We planned a right robotic thoracoscopic approach. Intraoperative ventilation to the left lung was accomplished with 6-mm single lumen wire-reinforced tube (Fuji Systems Corporation. Tokyo, Japan). A similar tube was available at the bedside for cross-field ventilation through a separate thoracoscopic port but was not needed. Two venous central catheters were placed in the right internal jugular vein and the right femoral vein in case extra corporeal membrane oxygenation (ECMO) was required. The patient was placed in the left lateral decubitus position. Four 8-mm intercostal robotic ports were placed in the seventh to eighth intercostal space and one 12-mm assistant port at the tenth intercostal space mid-axillary line. Robotic instruments included bipolar Maryland (right arm), bipolar grasper (left arm), and tip-up grasper (retracting arm) for the dissection. The bronchus was divided with robotic scissors, and robotic needle driver was used for the anastomosis. The surgical field was controlled with a remotely operated surgical irrigator system. The procedure was completed by the da Vinci Xi robot (Intuitive Surgical, Sunnyvale, Calif). A capnothorax of 10 mm Hg was achieved. After division of the mediastinal pleural reflection along the posterior hilum, the esophagus was mobilized posteriorly, exposing the distal trachea and mainstem bronchi. Subcarinal lymph node package was completely resected. Both the carina and the proximal 3 cm of the LMSB were circumferentially dissected. It is important to protect the cuff of the endobronchial tube by pushing it as far as possible distally before dividing the bronchus. Based on the endobronchial appearance, we divided the proximal LMSB flush with the carina. We then resected the carinal end as a 5-mm ring for proximal margin. Two stay sutures were placed in the distal LMSB bilaterally to prevent left intrathoracic retraction of the bronchus. After identifying the tattooed base of the tumor, we proceeded to resect a similar 5-mm ring for distal margin, about 3 cm from the carina and 1 cm proximal to the secondary carina. After removing the margins for frozen section, we completed the dissection and removal of the main bronchial segment. After confirming negative margins, a primary bronchial carinal end-to-end anastomosis was performed with 2 running absorbable 3-0 barbed sutures. The sutures were placed at the left membranous–cartilaginous junction, and the anastomosis was performed in a running fashion first anteriorly then posteriorly. After we tested for an air leak, a pedicled pericardial thymic flap was developed and used to encircle the anastomosis (Video 1). Final pathology revealed a 6-mm well-differentiated neuroendocrine tumor with negative resection margins. The patient was discharged after 2 days. The Fox Chase Cancer Center Institutional Review Board approved this study as IRB: 21-9916 on April 26, 2021. Informed consent was obtained before surgery. Due to its location adjacent to the aortic arch and main pulmonary artery, exposing the proximal LMSB is extremely challenging. It is well known that carinal exposure is easier from the right chest. However, for this operation, a right thoracic approach requires isolation of the right lung while operating on the left bronchus. Exposure from the left chest would require major dissection and retraction of the aorta and pulmonary artery with division of the ligamentum arteriosum.1Ragusa M. Vannucci J. Cagini L. Daddi N. Pecoriello R. Puma F. Left main bronchus resection and reconstruction. A single institution experience.J Cardiothorac Surg. 2012; 7: 29Crossref PubMed Scopus (13) Google Scholar,2Caviezel C. Koersgen F. Weder W. Inci I. Left main bronchus sleeve resection with reconstruction of neolobar carina.J Thorac Cardiovasc Surg. 2017; 154: 370-372Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar LMSB resection has also been described trans-sternally, on cardiopulmonary bypass.3Kang M.K. Kang D.K. Hwang Y.H. Successful sleeve resection of bronchial carcinoid under veno-venous ECMO.Thorac Cancer. 2019; 10: 2319-2321Crossref PubMed Scopus (1) Google Scholar In addition, reports with or without ECMO for right-sided exposure have been described.4Newton J.R. Grillo H.C. Mathisen D.J. Main bronchial sleeve resection with pulmonary conservation.Ann Thorac Surg. 1991; 52: 1272-1280Abstract Full Text PDF PubMed Scopus (43) Google Scholar,5Cerfolio R.J. Deschamps C. Allen M.S. Trastek V.F. Pairolero P.C. Mainstem bronchial sleeve resection with pulmonary preservation.Ann Thorac Surg. 1996; 61 (discussion 1462-1463): 1458-1462Abstract Full Text PDF PubMed Scopus (52) Google Scholar However, to our knowledge, this is the first report of right thoracoscopic LMSB resection without ECMO. Regarding ECMO for airway procedures, we believe it can be a valuable resource but that it does not come without potential downsides and risks. These include technical complications related to cannulation, flow problems that may necessitate reventilation at an importune time of the procedure, and the small but real increased risk of bleeding. In addition, of course, it requires extra time, personnel, and cost. The technical approach is essentially the same as that with thoracotomy. We prefer to use barbed suture to facilitate the anastomosis and have found no increased risk of anastomotic complications with this material in more than 22 sleeve resections.6Mazzei M. Abbas A.E. Why comprehensive adoption of robotic assisted thoracic surgery is ideal for both simple and complex lung resections.J Thorac Dis. 2020; 12: 70-81Crossref PubMed Scopus (7) Google Scholar Some surgeons advocate a mediastinoscopy before tracheal or carinal resections as a “release maneuver” of the trachea and main stem bronchi to help reduce tension at the anastomosis. However, one benefit of the robotic platform is the ability to use bimanual wristed dissection to replicate this same anterior airway dissection internally, thus avoiding an extra neck incision and procedure. In fact, we find that the robotic approach using the left bronchial intubation technique allows excellent exposure of the carina and LMSB while avoiding the potential disadvantages of ECMO. We provide a detailed description of the surgical technique with anesthesia considerations for right robotic-assisted lung-sparing LMSB resection. This may be of value for the thoracic surgery community when planning a similar approach.

Esophageal cancer is the eighth most common cancer worldwide, and its incidence has been increasing over the past several decades. Esophagectomy currently is the standard of care for more advanced early esophageal cancer and should be performed at centers of excellence with high volumes, appropriate supportive staff, and multidisciplinary expertise.

Journal of Surgical OncologyVolume 119, Issue 6 p. 667-667 ISSUE INFORMATIONFree Access Issue Information - Ed Board First published: 09 April 2019 https://doi.org/10.1002/jso.25466AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume119, Issue6May 1, 2019Pages 667-667 RelatedInformation

Paraesophageal hernia represents a complex surgical problem involving significant distortion of the anatomy and function of the esophagus, stomach, gastroesophageal junction, mediastinum, lungs, and heart. Surgeons operating in the area must have deep understanding of the normal anatomy and pathologic derangements in patients with paraesophageal hernias. This article describes the normal anatomy and anatomic abnormalities in application to the various approaches used in the surgical repair of a paraesophageal hernia.

e18520 Background: The comparative survival impact of increasing TTI for United States patients with different curable tumors is unknown. Methods: We queried the National Cancer Database for the TTI of patients treated with curative therapy for the following non-metastatic solid tumors (2003 – 2006): bladder, breast, cervix, colon, esophagus, gastric, head and neck (H&N), lung (NSCLC), pancreas, prostate, rectosigmoid, rectum, connective tissue, and uterus. Exclusion criteria included patients with unknown TTI, TTI > 365 days (d), distant metastases at diagnosis, in situ cancer, stage I bladder cancer, and palliative treatment. Overall survival (OS) was analyzed in each site using multivariable cox proportional hazards models. Adjustments were made for patient characteristics, stage of disease, and treatment modality. Additional site-specific variables were incorporated for some tumors (breast, cervix, pancreas, H&N) where appropriate. TTI was evaluated in discrete intervals with 0-7d evaluated as a separate interval to account for curative treatment started emergently. Results: 952,415 patients were included. Breast cancer was most common (n = 326,556, 34%). Esophagus (66%) and H&N (52%) cancer patients commonly began treatment with (chemo)radiation. All other sites most commonly began with an operation. Patients with prostate (44%), bladder (30%), cervix (21%), NSCLC (17%), and esophagus (16%) cancers commonly started treatment more than 60d after diagnosis. By contrast emergent treatment was most common (44%) in the lower GI tract (colon, rectosigmoid, rectum). This was associated with worse survival (HR 1.34, 95% CI 1.32 – 1.36) whether on day 0 or days 1-7. Bladder, breast, gastric, lower GI, H&N, and uterine cancers demonstrated worse OS for increasing TTI beyond 60 days on MVA, with the largest effect demonstrated for lower GI (HR 1.31, 95% CI 1.27-1.36) and uterine cancer (HR 1.23, 95% CI 1.16-1.30). Increasing TTI did not result in significantly worse outcomes for connective tissue, cervix, esophagus, NSCLC, pancreas, and prostate cancers. Conclusions: The impact of TTI on survival is not uniform. Some patients may benefit more than others from expeditious treatment initiation – most commonly from an operation.

Background: Standard treatment for locally advanced esophageal cancer includes neoadjuvant therapy followed by surgical resection. However, many patients experience a period of decreased oral intake during neoadjuvant treatment and are at risk for malnutrition. We hypothesize that use of jejunostomy tube (j-tube) feedings during neoadjuvant therapy in selected patients may be associated with better perioperative outcomes. Methods: A prospectively collected database at a single institution was retrospectively analyzed. The study period was from 2005 to 2015. Patients who underwent j-tube placement before neoadjuvant therapy before definitive resection for esophageal cancer were included in the analysis. Perioperative outcomes were compared between patients who adhered to recommended tube feeds during neoadjuvant therapy (users) and patients who did not adhere (nonusers). Results: During the study period, 94/301 patients received a j-tube before or during neoadjuvant therapy for esophageal cancer. Seventy-three patients utilized tube feeds regularly during the neoadjuvant phase, while 21 patients did not. The groups did not differ significantly with respect to clinical factors such as dysphagia on presentation, postneoadjuvant therapy performance status, or Charlson Comorbidity Index. Perioperative pneumonia rates were lower in j-tube users compared to nonusers (6.8% [5 of 73] versus 23.8% [5 of 21]), respectively, P=.036); this difference remained significant with adjustment for type of surgery (odds ratio=0.16, P=.018). Conclusions: j-Tube users had a significantly lower incidence of pneumonia within 30 days of curative resection when compared to nonusers. j-Tube feedings during neoadjuvant therapy for selected patients with locally advanced esophageal cancer should be encouraged.

INTRODUCTION:Minimally invasive thymectomy (MIT) is a surgical approach to thymectomy that has more favorable short-term outcomes for myasthenia gravis than open thymectomy (OT). The oncologic outcomes of MIT performed for thymoma have not been rigorously evaluated. We analyzed determinants of complete (R0) resection among patients undergoing MIT and OT in a large international database. METHODS:The retrospective database of the International Thymic Malignancy Interest Group was queried. Chi-square and Wilcoxon rank sum tests, multivariate logistic regression models, and propensity matching were performed. RESULTS:A total of 2514 patients underwent thymectomy for thymoma between 1997 and 2012; 2053 of them (82%) underwent OT and 461 (18%) underwent MIT, with the use of MIT increasing significantly in recent years. The rate of R0 resection among patients undergoing OT was 86%, and among those undergoing MIT it was 94% (p < 0.0001). In propensity-matched MIT and OT groups (n = 266 in each group); however, the rate of R0 resection did not differ significantly (96% in both the MIT and OT groups, p = 0.7). Multivariate analyses were performed to identify determinants of R0 resection. Factors independently associated with R0 resection were geographical region, later time period, less advanced Masaoka stage, total thymectomy, and the absence of radiotherapy. Surgical approach, whether minimally invasive or open, was not associated with completeness of resection. CONCLUSIONS:The use of MIT for resection of thymoma has been increasing substantially over time, and MIT can achieve rates of R0 resection for thymoma similar to those achieved with OT.

e15574 Background: Standard treatment for locally advanced esophageal cancer includes neoadjuvant therapy followed by curative resection. Patients are at risk for malnutrition prior to and during neoadjuvant treatment. Therefore, these patients may derive benefit from preoperative jejunostomy tube (j-tube) placement. We hypothesize that usage of pre-operative j-tubes may be associated with better perioperative outcomes. Methods: A prospectively collected database at a single institution was retrospectively analyzed. Study period was from 2005 to 2015. Patients that underwent j-tube placement beforeinduction therapy prior to definitive resection for esophageal cancer were included in the analysis. Perioperative outcomes were compared between patients who adhered to recommended tube feeds during induction (users) and patients who did not adhere (non-users). P-values were calculated using Fisher’s exact test. Logistic regression was used to estimate odds ratios and confidence intervals. Multivariate analysis was performed controlling for age, clinical stage and open surgery. Results: During the study period, 94 patients received a j-tube prior to or during induction therapy for esophageal cancer. Seventy-three patients utilized tube feeds regularly during the induction phase while 21 patients did not. The groups did not differ significantly in dysphagia on presentation, post induction treatment performance status, or Charlson Comorbidity Index. Results for perioperative pneumonia are shown in Table 1. The trend toward lower rates of all complications also favored j-tube users (85.7% vs. 64.4%, p=0.1056). Conclusions: J-tube users had significantly decreased risk for pneumonia within 30 days of curative resection when compared to non-users. Use of j-tube nutrition preoperatively may decrease perioperative risk in esophagectomy patients. Perioperative pneumonia: Users vs non-users. Effect Odds Ratio Estimates OR 95% CI P-value Model 1, Univariate J-tube (user vs non- user) J-tube user vs non-user 0.24 0.06 0.91 0.036 Model 2, Adjusted J-tube (user vs non- user) J-tube user vs non-user 0.11 0.02 0.62 0.013 Sex (M vs F) 3.26 0.27 39.86 0.355 log (LOS) 1.95 0.68 5.58 0.213 Wound Infection (Y vs N) 30.74 3.05 309.57 0.004