Christopher Harris

Systematic review and meta-analysis of uniportal versus multiportal video-assisted thoracoscopic lobectomy for lung cancer

BACKGROUND Uniportal video-assisted thoracoscopic surgery (VATS) has emerged as a less invasive alternative to the conventional multiportal approach in the treatment of lung cancer. The benefits of this uniportal technique have not yet been characterized in patients undergoing VATS lobectomy. This meta-analysis aimed to compare the clinical outcomes of uniportal and multiportal VATS lobectomy for patients with lung cancer. METHODS A systematic review was conducted using seven electronic databases. Endpoints for analysis included perioperative mortality and morbidity, operative time, length of hospital stay, perioperative blood loss, duration of postoperative drainage and rates of conversion to open thoracotomy. RESULTS Eight relevant observational studies were identified and included for meta-analysis. Results demonstrated a statistically significant reduction in the overall rate of complications, length of hospital stay and duration of postoperative drainage for patients who underwent uniportal VATS lobectomy. There were no significant differences between the two treatment groups in regard to mortality, operative time, perioperative blood loss and rate of conversion to open thoracotomy. CONCLUSIONS The present meta-analysis demonstrated favourable outcomes for uniportal VATS lobectomy in the treatment of lung cancer compared to the conventional multiportal approach. However, long-term follow-up data is still needed to further characterize the benefits of the uniportal approach.

Screening for aortic aneurysms

Ann Cardiothorac Surg 2018 www.annalscts.com Background The aorta supplies oxygen-rich blood to the body’s organs and tissues travelling from the heart. An aortic aneurysm is an abnormal widening of the aorta, resulting from weakening of its wall. This may occur in the chest near its origin from the heart, known as a thoracic aortic aneurysm, or lower down in the abdomen, known as an abdominal aortic aneurysm. Aortic aneurysms may expand over time without causing symptoms, but may eventually rupture, resulting in death unless emergency surgery or a repair procedure is performed immediately. Screening, surveillance and early intervention for highrisk individuals are critical to prevent this life-threatening scenario. Screening for aortic aneurysms ACS Patient Page

Ventricular assist devices.

Heart failure occurs in 1% of the UK adult population yet represents 5% of all hospital admissions, according to the 2008/09 National Heart Failure audit (http://www.ic.nhs.uk/ webfiles/publications/002_Audits/NHS_IC_ HEART_FAILURE_AUDIT_13-12-10.pdf ). The 3 month readmission rate is as high as 30% and 30% of patients admitted will die within 1 yr of discharge. Medical therapies, such as angiotensin-converting enzyme inhibitors, b-blockers, diuretics, inotropic agents, and anti-arrhythmics represent the usual care, but for patients with end-stage heart failure the only effective treatment is surgical intervention. In addition, cardiogenic shock associated with acute myocardial infarction, postcardiotomy and cardiomyopathies carries a high mortality if treated by conservative means alone. Ventricular assist devices (VADs) are mechanical systems that reduce the workload of the heart, permitting the ventricle to rest, whilst maintaining cardiac output and perfusion of vital organs. They have subsequently gained popularity in both acute and chronic heart failure as potentially life-saving treatment modalities.