ABSTRACT
BACKGROUND: Management of stage-III-N2 non-small-cell lung cancer (NSCLC) based on a multimodal strategy (surgery or radiotherapycombined with systemic drugs) remains controversial. Patients are treated with a curative intent, and available data suggestprolonged survival after complete resection. However, no consensual definition of "tumor resectability" exists. This study aimed to analyze the concordanceamong French tumor board meeting (TBM)-emittedtherapeutic decisions forstage-III-N2 NSCLC. METHODS: Six patients with stage-III-N2 NSCLC discussed at Saint-Etienne University Hospital'sthoracic TBMs were selected, anonymouslyreported, and submitted to the participating TBMs. The primary goal of this multicenter, prospective, observational study was to assess the consistency of TBMpanel decisions for each case. The secondary endpointwas identifying the demographic or technical factors that potentiallyaffected decision-making. RESULTS: Twenty-seven TBMs from university hospitals, a cancer center, general hospitals, and a private hospitalparticipated in this study. None of their decisions for the six cases were unanimous.The decisions were homogenous for three cases (78%, 85%, and 88% TBMs opted for medical treatment, respectively),andmore ambivalent for the other three (medical versus surgical strategies were favored by 44%/56%, 46%/54%, and 58%/42% TBMs, respectively). Interestingly, decisions regarding chemoradiationand perioperative chemotherapyinthe medical and surgical strategies, respectively, were also discordant. Hospital type, specialist participation in TBMs, and activity volumes were not significantly associated with therapeutic decisions. CONCLUSION: The results of this study highlight substantial disparities amongFrench TBMs regarding therapeutic management of stage-III-N2 NSCLC. The decisions were not associated with local conditions.
ABSTRACT
OBJECTIVE: To define the role of suture closure of the subcutaneous dead space in preventing wound complications after cesarean delivery. DATA SOURCES: We searched MEDLINE, the Cochrane Database of Systematic Reviews, and the bibliographies of major texts and review articles. METHODS OF STUDY SELECTION: Only studies in which patients undergoing cesarean delivery were randomly assigned to closure of the subcutaneous space or to no closure were included. Each study was required to report on at least 1 of the following outcomes: wound infection, hematoma, seroma, or separation. The studies also reported "wound disruption," a combination of these outcomes which either explicitly stated or strongly implied the need for further wound care. Six studies meeting criteria were identified. TABULATION, INTEGRATION, AND RESULTS: Three studies included 875 patients with any subcutaneous thickness and noted a decrease in wound disruption with closure (relative risk [RR] 0.56; 95% confidence interval [CI] 0.36, 0.86). Two studies reported results from 181 patients with incision depth of 2 cm or less and noted no difference (RR 1.01; 95% CI 0.46, 2.20). Five studies reported results on 887 patients with wound thickness greater than 2 cm. Although only 1 study had a significant effect by itself, when results were combined, there was a significant decrease in wound disruption (RR 0.66; 95% CI 0.48, 0.91). This reduction seems to be largely a result of decreased wound seromas (4 studies, 852 patients, RR 0.42; 95% CI 0.24, 0.75). In women with wound thickness greater than 2 cm, subcutaneous closure resulted in a risk reduction of 6.2%, and 16.2 women would need subcutaneous closure to prevent 1 wound disruption (number needed to treat). CONCLUSION: Suture closure of subcutaneous fat during cesarean delivery results in a 34% decrease in risk of wound disruption in women with fat thickness greater than 2 cm.
