Wedge resection plus adequate lymph nodes resection is comparable to lobectomy for small-sized non-small cell lung cancer.

Objectives: The study investigated whether wedge resection plus adequate lymph nodes resection conferred comparable survival to lobectomy for node-negative non-small cell lung cancer (NSCLC) ≤2 cm. Methods: The Surveillance, Epidemiology, and End Results database was used to identify patients diagnosed with node-negative NSCLC ≤2 cm and underwent wedge resection or lobectomy (2004-2015). Patients were stratified by the procedure (wedge resection, lobectomy) and the size of NSCLC (≤1 cm, 1-2 cm). We assessed survival between patients undergoing wedge resection and lobectomy. The optimal number of lymph nodes resected which made those two procedures comparable was explored by using Kaplan-Meier analysis and Cox regression analysis. Propensity score matching was performed to minimize the effect of confounding factors. Results: 7893 patients with lobectomy and 2536 patients with wedge resection were identified. Wedge resection was associated with worse survival either in the ≤1 cm or 1-2 cm NSCLC before and after matching. For lesions 1-2 cm and receiving lobectomy, more lymph nodes resected conferred statistically significant increase on survival and six nodes were optimal. For lesions ≤1 cm and receiving lobectomy, lymph nodes resection had no impact on survival. Wedge resection and lobectomy were comparable when one or more nodes for lesions ≤1 cm and six or more nodes for lesions 1-2 cm were resected. Conclusions: Wedge resection was inferior to lobectomy for NSCLC ≤1 cm and 1-2 cm. Wedge resection plus adequate lymph nodes resection was comparable to lobectomy.

Memantine Alleviates Acute Lung Injury Via Inhibiting Macrophage Pyroptosis.

ABSTRACT: Acute lung injury (ALI) is caused by direct pulmonary insults and indirect systemic inflammatory responses that result from conditions such as sepsis and trauma. Alveolar macrophages are the main and critical leukocytes in the airspace, and through the synthesis and release of various inflammatory mediators critically influence the development of ALI following infection and non-infectious stimuli. There is increasing recognition that inflammation and cell death reciprocally affect each other, which forms an auto-amplification loop of these two factors, and in turn, exaggerates inflammation. Therefore, pharmacological manipulation of alveolar macrophage death signals may serve as a logical therapeutic strategy for ALI. In this study, we demonstrate that memantine, a N-methyl-D-aspartic acid receptor (NMDAR) antagonist, through suppressing Ca2+ influx and subsequent ASC oligomerization inhibits macrophage Nlrp3 inflammasome activation and pyroptosis, therefore, alleviates ALI in septic mice. This finding explores a novel application of memantine, an FDA already approved medication, in the treatment of ALI, which is currently lacking effective therapy.

Survival and Resected Lymph Node Number During Sublobar Resection for N0 Non-Small Cell Lung Cancer 2 cm or Less.

BACKGROUND: We investigated the association between survival and the number of examined lymph nodes after sublobar resection for node-negative non-small cell lung cancer with size of 2 cm or less. METHODS: The Surveillance, Epidemiology, and End Results database was used to identify patients diagnosed with non-small cell lung cancer 2 cm or less from 2004 to 2014 and underwent wedge resection or segmentectomy. Patients were stratified by the procedure (wedge resection, segmentectomy), the size of tumors (≤1 cm, 1 to 2 cm), and the number of lymph nodes examined (0, 1 to 3, 4 to 9, ≥10). The relationship between the number of resected lymph nodes and overall survival (OS)/lung cancer-specific survival (LCSS) was analyzed. RESULTS: A total of 2,298 patients with wedge resection and 566 patients with segmentectomy were identified. Segmentectomy was performed for bigger tumors (1.43 cm versus 1.38 cm) and was associated with more lymph nodes resected (median number: 3 versus 1). Multivariable analysis after propensity score matching revealed that lymph node resection improved survival for patients undergoing wedge resection while not for patients undergoing segmentectomy. In the wedge resection group, 1 to 3 nodes resected improved OS and 4 to 9 nodes improved OS and LCSS compared with patients without nodes evaluated for lesions 1 cm or less. No survival benefit was observed when 10 or more nodes were resected. For lesions 1 to 2 cm, incremental improvement in survival appeared with the increase of examined lymph node number. More than 16 nodes resected conferred no additional survival benefit compared with patients with 10 to 16 nodes resected. CONCLUSIONS: In wedge resection, 4 to 9 and 10 to 16 lymph nodes should be examined for lesions 1 cm or less and 1 to 2 cm, respectively. In segmentectomy, lymph node resection did not confer survival benefits for lesions 2 cm or less.

Prognostic factors of lung adenocarcinoma manifesting as ground glass nodules larger than 3 cm.

OBJECTIVES: The aim of the study was to investigate prognostic factors of lung adenocarcinomas manifesting as ground glass nodules larger than 3 cm on thin-section computed tomography scans, especially comparing the prognostic role of the whole size and the solid size. METHODS: We included 195 patients with lung adenocarcinomas manifesting as ground glass nodules larger than 3 cm who underwent surgical resection. We identified clinical factors associated with lymph node metastases by binary logistics regression analysis. Kaplan-Meier analysis was performed to determine the association between the whole size or the solid size and overall survival (OS). Multivariable Cox regression analysis was used to identify prognostic factors of OS. RESULTS: The median follow-up time was 62 months. The median values of the whole size and the solid size were 3.5 cm and 2.3 cm, respectively. The 3-year and 5-year OS rates were 95.5% and 86.2%, respectively. Patients with lesions <2.3 cm had markedly better OS than those with lesions ≥2.3 cm. No significant differences existed between the survival of patients with lesions <3.5 cm and ≥3.5 cm. Multivariable analysis showed that bigger solid size was significantly associated with the presence of lymph node metastases and inferior OS, whereas larger whole size was not. Adjuvant chemotherapy improved the OS of patients with stage Ib and II-IIIa disease, but not that of patients with stage Ia disease. CONCLUSIONS: Solid size was a better predictor of lymph node metastases and prognosis than whole size in ground glass nodules larger than 3 cm. Clinical T staging should be based on the solid size rather than on the whole size of these lesions.

The 100 most-cited papers in general thoracic surgery: A bibliography analysis.

BACKGROUND: The status of citations can reflect the impact of a paper and its contribution to surgical practice. The aim of our study was to identify and review the 100 most-cited papers in general thoracic surgery. MATERIALS AND METHODS: Relevant papers on general thoracic surgery were searched through Thomson Reuters Web of Science in the last week of November 2017. Results were returned in descending order of total citations. Their titles and abstracts were reviewed to identify whether they met our inclusion criteria by two thoracic surgeons independently. Characteristics of the first 100 papers, including title, journal name, country, first author, year of publication, total citations, citations in latest 5 years and average citation per year (ACY) were extracted and analyzed. RESULTS: Of the 100 papers, the mean number of citations was 322 with a range from 184 to 921. 19 journals published the papers from 1956 to 2012. Annals of Surgery had the largest number (29), followed by Journal of Thoracic and Cardiovascular Surgery (22) and Annals of Thoracic Surgery (21). The majority of the papers were published in 2000s (48) and originated from United States of America (62). There were 65 retrospective studies, 13 RCTs and 11 prospective studies. Orringer MB and Grillo HC contributed 4 first-author articles respectively. There were 53 papers on esophagus, 36 on lung, 6 on pleura and 5 on trachea. CONCLUSIONS: Our study identified the most-cited papers in the past several decades and offered insights into the development and advances of general thoracic surgery. It can help us understand the evidential basis of clinical decision-making today in the area.

Value of CT Characteristics in Predicting Invasiveness of Adenocarcinoma Presented as Pulmonary Ground-Glass Nodules.

Background Less invasive adenocarcinomas (LIAs) of the lung, including adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA), are indications of sublobar resection and has a 5-year disease-free survival rate of almost 100% after surgery. By distinguishing invasive adenocarcinoma from LIA with computed tomography (CT) characteristics, it is possible to determine the extent of resection and prognosis for patients with ground-glass nodules (GGNs) before surgery. Methods We reviewed CT and pathological findings of 728 GGNs in 645 consecutive patients who received curative lung resection in a single center. Only AIS, MIA, and invasive adenocarcinoma were included. Characteristics of CT, including maximum diameter of the lesion (Lmax) and maximum diameter of the consolidation (Cmax), were assessed thoroughly. Results Multivariate logistic regression showed that larger Lmax (p < 0.001) and nonsmooth margin (p = 0.001) were independent factors for invasive adenocarcinoma in pure GGNs (pGGNs). The optimal cut-off value of Lmax was 12.0 mm. In mixed GGNs (mGGNs), multivariate analysis revealed that larger Lmax (p < 0.001), larger Cmax (p = 0.032), and vacuole sign (p = 0.007) were predictive factors for invasive adenocarcinoma, and the area under curve of regression model was 0.866. The optimal cut-off values of Lmax and Cmax were 15.4 and 5.8 mm, respectively. No node metastasis was found in 295 patients who had at least three stations of mediastinal lymph nodes dissected. Conclusion In pGGNs, larger Lmax (>12.0 mm) and nonsmooth margin were reliable predictors for invasive adenocarcinoma. In mGGNs, lesions with larger Lmax (>15.4 mm), larger Cmax (>5.8 mm), and vacuole sign were more likely to be invasive adenocarcinoma.

Uniportal video-assisted thoracic surgery-the experiences of Shanghai Pulmonary Hospital.

Uniportal video-assisted thoracic surgery (VATS) is getting recognized in thoracic surgery, especially in China. Although surgeons from some part of the world are still skeptic, those in China have witnessed its breathtaking growth, along with the development of the specialty of thoracic surgery. By introducing the history and experiences of one specialty hospital-Shanghai Pulmonary Hospital (SPH), we show the feasibility and safety of uniportal VATS, and illustrate the technical details of this procedure with the example of right middle lobectomy (RML).