Samina Park

Serial improvement of quality metrics in pediatric thoracoscopic lobectomy for congenital lung malformation: an analysis of learning curve

AbstractBackgroundVideo-assisted thoracic surgery (VATS) pulmonary resection in children is a technically demanding procedure that requires a relatively long learning period. This study aimed to evaluate the serial improvement of quality metrics according to case volume experience in pediatric VATS pulmonary resection of congenital lung malformation (CLM).n Methods VATS anatomical resection in CLM was attempted in 200 consecutive patients. The learning curve for the operative time was modeled by cumulative sum analysis. Quality metrics were used to measure technical achievement and efficiency outcomes.n Results The median operative time was 95xa0min. The median length of hospital stay and chest tube indwelling time was 4 and 2 days, respectively. The improvement of operation time was observed persistently until 200 cases. However, two cut-off points, the 50th case and 110th case, were identified in the learning curve for operative time, and the 110th case was the turning point for stable outcomes with short operation time. Significant reduction of length of hospital stay and chest tube indwelling time was observed after 50 cases (pu2009=u2009.002 and pu2009=u2009.021, respectively). The complication rate decreased but continued at a low rate for entire study period and the interval decrease was not statistically significant. Conversion rate decreased significantly (pu2009=u2009.001), and technically challenging procedures were performed more frequently in later cases.n Conclusions Improvements of quality metrics in operation time, conversion rate, length of hospital stay, and chest tube indwelling time were observed in proportion to case volume. Minimum experience of 50 is necessary for stable outcomes of pediatric VATS pulmonary resection.

Comparison of neoadjuvant chemotherapy followed by surgery to upfront surgery for thymic malignancy

BACKGROUNDnThe oncologic benefit of neoadjuvant chemotherapy in thymic malignancies remains unclear. Postoperative oncologic outcomes of curative resection after neoadjuvant chemotherapy were compared with those of upfront surgery.nnnMETHODSnBased on records from a multicenter database, 1,486 patients with surgically resected thymic malignancies between 2000 and 2013 were included in thexa0final study cohort. Of these, 110 patients (7.4%) underwent surgical resection after neoadjuvant chemotherapy, and 1,376 patients (92.6%) underwent upfront surgery. A propensity score-matched analysis was performed to minimize differences in preoperative and intraoperative variables. Postoperative outcomes and survivals were compared between the two groups.nnnRESULTSnIn the matched cohort, there were no significant differences in postoperative mortality (p value not calculated), postoperative complications (pxa0= 0.405), and hospital length of stay (pxa0= 0.821) between the two groups. However, the neoadjuvant chemotherapy group showed significantly higher transfusion rates (pxa0= 0.003) and longer operation times (p < 0.001) than the upfront surgery group. Pathologically complete resection rates (pxa0= 0.382) and tumor sizes (pxa0= 0.286) were similar between the two groups. The 5-year overall survival ratesxa0were 77.4% and 76.7%, respectively (pxa0= 0.596). The 3-year recurrence-free survival rates were 62.9% and 71.5%, respectively (pxa0= 0.070).nnnCONCLUSIONSnNeoadjuvant chemotherapy, followed by resection, obtained similar resectability and long-term survival rates to those of upfront surgery. Therefore, the role of neoadjuvant chemotherapy should be refined in randomized controlled trials.

Thymic carcinoma vs . thymic neuroendocrine tumor

Thymic neoplasm is a rare disease, accounting for <1% of all cancers. Among the thymic malignancies, thymic carcinoma (TC) including thymic neuroendocrine tumor (TNET) rarely occurs (1,2). Both TC and TNET appear to have an aggressive behavior (3). Interestingly, TNET develops distant metastasis and recurrence more frequently than neuroendocrine tumors originating from other organs (4). Although the incidence of TNET is increasing, which may be due to increased awareness of this disease among clinicians, information on TNET is limited due to the small number of cases (4,5).

Pediatric Case Report on an Interstitial Lung Disease with a Novel Mutation of SFTPC Successfully Treated with Lung Transplantation

Mutations of the surfactant protein (SP)-C gene (SFTPC) have been associated with neonatal respiratory distress syndrome (RDS) and childhood interstitial lung disease (ILD). If accurate diagnosis and proper management are delayed, irreversible respiratory failure demanding lung transplantation may ensue. A girl was born at term but was intubated and given exogenous surfactant due to RDS. Cough and tachypnea persisted, and symptoms rapidly progressed at 16 months of age despite treatment with antibiotics, oral prednisolone, methylprednisolone pulse therapy, and intravenous immunoglobulin. At 20 months, she visited our hospital for a second opinion. A computed tomography scan showed a diffuse mosaic pattern with ground-glass opacity and subpleural cysts compatible with ILD. A video-assisted thoracoscopic lung biopsy revealed ILD with eosinophilic proteinaceous material and macrophages in the alveolar space. Bilateral lung transplant from a 30-month-old child was done, and she was discharged in room air without acute complications. Genetic analysis revealed a novel c.203T>A, p.Val68Asp mutation of SP-C, based on the same exon as a known pathogenic mutation, p.Glu66Lys.

The prognostic effect of the epidermal growth factor receptor gene mutation on recurrence dynamics of lung adenocarcinoma

OBJECTIVESnThe prognostic effects of epidermal growth factor receptor (EGFR) gene mutation on lung adenocarcinoma recurrence have not been well established. The relationship between EGFR gene mutation and recurrence dynamics of lung adenocarcinoma was investigated.nnnMETHODSnA total of 527 patients with complete resection for adenocarcinoma were reviewed retrospectively. EGFR gene mutation was analysed by polymerase chain reaction followed by bidirectional direct sequencing in recurred patients. Patients were divided into the EGFR gene mutation group (M) or the wild-type EGFR gene group (W). Recurrence types and disease-free intervals (DFIs) of the 2 groups were compared. DFIs were calculated by the Kaplan-Meier method and compared using the log-rank test and Cox proportional hazard model.nnnRESULTSnEGFR gene sequencing was performed in 115 recurrent adenocarcinoma patients. Sixty-six patients had EGFR mutations and 49 patients had wild-type EGFR. The median DFI of the 2 groups were significantly different (M: 20.3u2009months, W: 15.1u2009months, Pu2009=u20090.012). EGFR gene mutation was the only prognostic factor for DFI [hazard ratio (HR)u2009=u20090.639, 95% confidence interval (CI)u2009=u20090.428-0.954, Pu2009=u20090.029]. The proportion of loco-regional recurrences and distant metastases of both groups were similar (Pu2009=u20090.50). In subgroup analysis, EGFR gene mutation (HRu2009=u20090.534, 95% CIu2009=u20090.339-0.839, Pu2009=u20090.007) was a significant prognostic factor for DFI of distant metastases.nnnCONCLUSIONSnLung adenocarcinoma with EGFR gene mutations had longer DFI than those with wild-type EGFR gene, especially with regard to distant metastasis. EGFR gene mutation was a prognostic factor for lung adenocarcinoma.

Successful Lung Transplantation in a Patient with Myasthenia Gravis

A 47-year-old man with myasthenia gravis (MG) was admitted for a lung transplant. He had bronchiolitis obliterans after allogeneic hematopoietic stem cell transplantation due to acute myeloid leukemia. MG developed after stem cell transplantation. Bilateral sequential lung transplantations and a total thymectomy were performed. The patient underwent right diaphragmatic plication simultaneously due to preoperatively diagnosed right diaphragmatic paralysis. A tracheostomy was performed and bilevel positive airway pressure (BiPAP) was applied on postoperative days 8 and 9, respectively. The patient was transferred to the general ward on postoperative day 12, successfully weaned off BiPAP on postoperative day 18, and finally discharged on postoperative day 62.

Oral 3.04. The extent of lymph node dissection in thymic malignancies

Background nThe proper extent of lymph node dissection (LND) is unclear in thymic malignancies. We investigated the pattern of lymph node metastasis in thymic malignancies based on new ITMIG proposal for lymph node map for thymic malignancies.