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D'Amico, Thomas Anthony

Overview:

Lung Cancer

1.Role of molecular markers in the prognosis and therapy of lung cancer
2.Genomic analysis lung cancer mutations


Esophageal Cancer

1.Role of molecular markers in the prognosis and therapy of esophageal cancer
2.Genomic analysis esophageal cancer mutations

Positions:

Gary Hock Professor of Surgery

Surgery, Cardiovascular and Thoracic Surgery
School of Medicine

Professor of Surgery

Surgery, Cardiovascular and Thoracic Surgery
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1987

M.D. — Columbia University

Grants:

Phase I/II Trial of ZD1839 and Celecoxib in Ex-Smokers

Administered By
Medicine, Medical Oncology
AwardedBy
National Institutes of Health
Role
Co Investigator
Start Date
September 26, 2002
End Date
August 31, 2007

Genetics, Inflammation & Post-op Cognitive Dysfunction

Administered By
Anesthesiology, Cardiothoracic
AwardedBy
National Institutes of Health
Role
Co Investigator
Start Date
September 01, 1999
End Date
July 31, 2006

Measurement of Hypoxia in Non-Small Cell Lung Carcinoma

Administered By
Medicine, Medical Oncology
AwardedBy
National Institutes of Health
Role
Investigator
Start Date
April 01, 2002
End Date
March 31, 2006

Publications:

The Role of Extent of Surgical Resection and Lymph Node Assessment for Clinical Stage I Pulmonary Lepidic Adenocarcinoma: An Analysis of 1991 Patients.

This study examined the association of extent of lung resection, pathologic nodal evaluation, and survival for patients with clinical stage I (cT1-2N0M0) adenocarcinoma with lepidic histologic features in the National Cancer Data Base.The association between extent of surgical resection and long-term survival for patients in the National Cancer Data Base with clinical stage I lepidic adenocarcinoma who underwent lobectomy or sublobar resection was evaluated using Kaplan-Meier and Cox proportional hazards regression analyses.Of the 1991 patients with cT1-2N0M0 lepidic adenocarcinoma who met the study criteria, 1544 underwent lobectomy and 447 underwent sublobar resection. Patients treated with sublobar resection were older, more likely to be female, and had higher Charlson/Deyo comorbidity scores, but they had smaller tumors and lower T status. Of the patients treated with lobectomy, 6% (n = 92) were upstaged because of positive nodal disease, with a median of seven lymph nodes sampled (interquartile range 4-10). In an analysis of the entire cohort, lobectomy was associated with a significant survival advantage over sublobar resection in univariate analysis (median survival 9.2 versus 7.5 years, p = 0.022, 5-year survival 70.5% versus 67.8%) and after multivariable adjustment (hazard ratio = 0.81, 95% confidence interval: 0.68-0.95, p = 0.011). However, lobectomy was no longer independently associated with improved survival when compared with sublobar resection (hazard ratio = 0.99, 95% confidence interval: 0.77-1.27, p = 0.905) in a multivariable analysis of a subset of patients in which only those patients who had undergone a sublobar resection including lymph node sampling were compared with patients treated with lobectomy.Surgeons treating patients with stage I lung adenocarcinoma with lepidic features should cautiously utilize sublobar resection rather than lobectomy, and they must always perform adequate pathologic lymph node evaluation.

Authors
Cox, ML; Yang, C-FJ; Speicher, PJ; Anderson, KL; Fitch, ZW; Gu, L; Davis, RP; Wang, X; D'Amico, TA; Hartwig, MG; Harpole, DH; Berry, MF
MLA Citation
Cox, ML, Yang, C-FJ, Speicher, PJ, Anderson, KL, Fitch, ZW, Gu, L, Davis, RP, Wang, X, D'Amico, TA, Hartwig, MG, Harpole, DH, and Berry, MF. "The Role of Extent of Surgical Resection and Lymph Node Assessment for Clinical Stage I Pulmonary Lepidic Adenocarcinoma: An Analysis of 1991 Patients." Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer 12.4 (April 2017): 689-696.
PMID
28082103
Source
epmc
Published In
Journal of Thoracic Oncology
Volume
12
Issue
4
Publish Date
2017
Start Page
689
End Page
696
DOI
10.1016/j.jtho.2017.01.003

Traveling to a High-volume Center is Associated With Improved Survival for Patients With Esophageal Cancer.

An association between volume and outcomes has been observed for esophagectomy, though little is known about why or how patients choose low- or high-volume centers. The purpose of this study was to evaluate how travel burden and hospital volume influence treatment and outcomes of patients with locally advanced esophageal cancer.Predictors of receiving esophagectomy for patients with T1-3N1M0 mid or distal esophageal cancer in the National Cancer Data Base from 2006 to 2011 were identified using multivariable logistic regression. Survival was compared using propensity score-matched groups: patients in the bottom quartile of travel distance who underwent treatment at low-volume facilities (Local) and patients in the top quartile of travel distance who underwent treatment at high-volume facilities (Travel).Of 4979 patients who met inclusion criteria, we identified 867 Local patients who traveled 2.7 [interquartile range (IQR): 1.6-4 miles] miles to centers that treated 2.6 (IQR: 1.9-3.3) esophageal cancers per year, and 317 Travel patients who traveled 107.1 (IQR: 65-247) miles to centers treating 31.9 (IQR: 30.9-38.5) cases. Travel patients were more likely to undergo esophagectomy (67.8% vs 42.9%, P < 0.001) and had significantly better 5-year survival (39.8% vs 20.6%, P < 0.001) than Local patients.Patients who travel longer distances to high-volume centers have significantly different treatment and better outcomes than patients who stay close to home at low-volume centers. Strategies that support patient travel for treatment at high-volume centers may improve esophageal cancer outcomes.

Authors
Speicher, PJ; Englum, BR; Ganapathi, AM; Wang, X; Hartwig, MG; D'Amico, TA; Berry, MF
MLA Citation
Speicher, PJ, Englum, BR, Ganapathi, AM, Wang, X, Hartwig, MG, D'Amico, TA, and Berry, MF. "Traveling to a High-volume Center is Associated With Improved Survival for Patients With Esophageal Cancer." Annals of surgery 265.4 (April 2017): 743-749.
PMID
28266965
Source
epmc
Published In
Annals of Surgery
Volume
265
Issue
4
Publish Date
2017
Start Page
743
End Page
749
DOI
10.1097/sla.0000000000001702

Don't look back.

Authors
D'Amico, TA
MLA Citation
D'Amico, TA. "Don't look back." The Journal of thoracic and cardiovascular surgery 153.3 (March 2017): 636-637.
PMID
27817954
Source
epmc
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
153
Issue
3
Publish Date
2017
Start Page
636
End Page
637
DOI
10.1016/j.jtcvs.2016.10.005

Recommendations from the European Society of Thoracic Surgeons (ESTS) regarding computed tomography screening for lung cancer in Europe.

In order to provide recommendations regarding implementation of computed tomography (CT) screening in Europe the ESTS established a working group with eight experts in the field. On a background of the current situation regarding CT screening in Europe and the available evidence, ten recommendations have been prepared that cover the essential aspects to be taken into account when considering implementation of CT screening in Europe. These issues are: (i) Implementation of CT screening in Europe, (ii) Participation of thoracic surgeons in CT screening programs, (iii) Training and clinical profile for surgeons participating in screening programs, (iv) the use of minimally invasive thoracic surgery and other relevant surgical issues and (v) Associated elements of CT screening programs (i.e. smoking cessation programs, radiological interpretation, nodule evaluation algorithms and pathology reports). Thoracic Surgeons will play a key role in this process and therefore the ESTS is committed to providing guidance and facilitating this process for the benefit of patients and surgeons.

Authors
Pedersen, JH; Rzyman, W; Veronesi, G; D'Amico, TA; Van Schil, P; Molins, L; Massard, G; Rocco, G
MLA Citation
Pedersen, JH, Rzyman, W, Veronesi, G, D'Amico, TA, Van Schil, P, Molins, L, Massard, G, and Rocco, G. "Recommendations from the European Society of Thoracic Surgeons (ESTS) regarding computed tomography screening for lung cancer in Europe." European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 51.3 (March 2017): 411-420.
PMID
28137752
Source
epmc
Published In
European Journal of Cardio-Thoracic Surgery
Volume
51
Issue
3
Publish Date
2017
Start Page
411
End Page
420
DOI
10.1093/ejcts/ezw418

Reply to D.A. Palma

Authors
Yang, C-FJ; Chan, DY; D’Amico, TA; Berry, MF; Harpole, DH
MLA Citation
Yang, C-FJ, Chan, DY, D’Amico, TA, Berry, MF, and Harpole, DH. "Reply to D.A. Palma." Journal of Clinical Oncology 35.5 (February 10, 2017): 572-572.
Source
crossref
Published In
Journal of Clinical Oncology
Volume
35
Issue
5
Publish Date
2017
Start Page
572
End Page
572
DOI
10.1200/JCO.2016.70.2787

Invited Commentary.

Authors
D'Amico, TA
MLA Citation
D'Amico, TA. "Invited Commentary." The Annals of thoracic surgery 103.2 (February 2017): 460-461.
PMID
28109349
Source
epmc
Published In
The Annals of Thoracic Surgery
Volume
103
Issue
2
Publish Date
2017
Start Page
460
End Page
461
DOI
10.1016/j.athoracsur.2016.08.095

Reply to Perna et al.

Authors
Gonzalez-Rivas, D; D'Amico, TA; Jiang, G; Sihoe, A
MLA Citation
Gonzalez-Rivas, D, D'Amico, TA, Jiang, G, and Sihoe, A. "Reply to Perna et al." European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 51.2 (February 2017): 397-398.
PMID
28186246
Source
epmc
Published In
European Journal of Cardio-Thoracic Surgery
Volume
51
Issue
2
Publish Date
2017
Start Page
397
End Page
398
DOI
10.1093/ejcts/ezw270

Reply to T.-H. Wang et al.

Authors
Yang, C-FJ; Chan, DY; Wang, X; D'Amico, TA; Harpole, DH; Berry, MF
MLA Citation
Yang, C-FJ, Chan, DY, Wang, X, D'Amico, TA, Harpole, DH, and Berry, MF. "Reply to T.-H. Wang et al." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 35.1 (January 2017): 118-120.
PMID
28034078
Source
epmc
Published In
Journal of Clinical Oncology
Volume
35
Issue
1
Publish Date
2017
Start Page
118
End Page
120

Keep moving forward.

Authors
D'Amico, TA
MLA Citation
D'Amico, TA. "Keep moving forward." The Journal of thoracic and cardiovascular surgery (December 8, 2016).
PMID
28087111
Source
epmc
Published In
Journal of Thoracic and Cardiovascular Surgery
Publish Date
2016
DOI
10.1016/j.jtcvs.2016.11.047

A Risk Score to Assist Selecting Lobectomy Versus Sublobar Resection for Early Stage Non-Small Cell Lung Cancer.

The long-term survival benefit of lobectomy over sublobar resection for early-stage non-small cell lung cancer must be weighed against a potentially increased risk of perioperative mortality. The objective of the current study was to create a risk score to identify patients with favorable short-term outcomes following lobectomy.The 2005-2012 American College of Surgeons National Surgical Quality Improvement Program database was queried for patients undergoing a lobectomy or sublobar resection (either segmentectomy or wedge resection) for lung cancer. A multivariable logistic regression model was utilized to determine factors associated with 30-day mortality among the lobectomy group and to develop an associated risk score to predict perioperative mortality.Of the 5,749 patients who met study criteria, 4,424 (77%) underwent lobectomy, 1,098 (19%) underwent wedge resection, and 227 (4%) underwent segmentectomy. Age, chronic obstructive pulmonary disease, previous cerebrovascular event, functional status, recent smoking status, and surgical approach (minimally invasive versus open) were utilized to develop the risk score. Patients with a risk score of 5 or lower had no significant difference in perioperative mortality by surgical procedure. Patients with a risk score greater than 5 had significantly higher perioperative mortality after lobectomy (4.9%) as compared to segmentectomy (3.6%) or wedge resection (0.8%, p < 0.01).In this study, we have developed a risk model that predicts relative operative mortality from a sublobar resection as compared to a lobectomy. Among patients with a risk score of 5 or less, lobectomy confers no additional perioperative risk over sublobar resection.

Authors
Gulack, BC; Yang, C-FJ; Speicher, PJ; Yerokun, BA; Tong, BC; Onaitis, MW; D'Amico, TA; Harpole, DH; Hartwig, MG; Berry, MF
MLA Citation
Gulack, BC, Yang, C-FJ, Speicher, PJ, Yerokun, BA, Tong, BC, Onaitis, MW, D'Amico, TA, Harpole, DH, Hartwig, MG, and Berry, MF. "A Risk Score to Assist Selecting Lobectomy Versus Sublobar Resection for Early Stage Non-Small Cell Lung Cancer." The Annals of thoracic surgery 102.6 (December 2016): 1814-1820.
PMID
27592602
Source
epmc
Published In
The Annals of Thoracic Surgery
Volume
102
Issue
6
Publish Date
2016
Start Page
1814
End Page
1820
DOI
10.1016/j.athoracsur.2016.06.032

Patient Preferences in Treatment Choices for Early-Stage Lung Cancer.

Decision-making for lung cancer treatment can be complex because it involves both provider recommendations based on the patient's clinical condition and patient preferences. This study describes the relative importance of several considerations in lung cancer treatment from the patient's perspective.A conjoint preference experiment began by asking respondents to imagine that they had just been diagnosed with lung cancer. Respondents then chose among procedures that differed regarding treatment modalities, the potential for treatment-related complications, the likelihood of recurrence, provider case volume, and distance needed to travel for treatment. Conjoint analysis derived relative weights for these attributes.A total of 225 responses were analyzed. Respondents were most willing to accept minimally invasive operations for treatment of their hypothetical lung cancer, followed by stereotactic body radiation therapy (SBRT); they were least willing to accept thoracotomy. Treatment type and risk of recurrence were the most important attributes from the conjoint experiment (each with a relative weight of 0.23), followed by provider volume (relative weight of 0.21), risk of major complications (relative weight of 0.18), and distance needed to travel for treatment (relative weight of 0.15). Procedural and treatment preferences did not vary with demographics, self-reported health status, or familiarity with the procedures.Survey respondents preferred minimally invasive operations over SBRT or thoracotomy for treatment of early-stage non-small cell lung cancer. Treatment modality and risk of cancer recurrence were the most important factors associated with treatment preferences. Provider experience outweighed the potential need to travel for lung cancer treatment.

Authors
Tong, BC; Wallace, S; Hartwig, MG; D'Amico, TA; Huber, JC
MLA Citation
Tong, BC, Wallace, S, Hartwig, MG, D'Amico, TA, and Huber, JC. "Patient Preferences in Treatment Choices for Early-Stage Lung Cancer." The Annals of thoracic surgery 102.6 (December 2016): 1837-1844.
PMID
27623277
Source
epmc
Published In
The Annals of Thoracic Surgery
Volume
102
Issue
6
Publish Date
2016
Start Page
1837
End Page
1844
DOI
10.1016/j.athoracsur.2016.06.031

Frozen section of N2 nodes is invaluable whenever unexpected suspicious operative findings are encountered.

Authors
Yang, C-FJ; D'Amico, TA; Berry, MF
MLA Citation
Yang, C-FJ, D'Amico, TA, and Berry, MF. "Frozen section of N2 nodes is invaluable whenever unexpected suspicious operative findings are encountered." The Journal of thoracic and cardiovascular surgery 152.6 (December 2016): 1643-1644.
PMID
27842692
Source
epmc
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
152
Issue
6
Publish Date
2016
Start Page
1643
End Page
1644
DOI
10.1016/j.jtcvs.2016.08.048

Reply to D.A. Palma.

Authors
Yang, C-FJ; Chan, DY; D'Amico, TA; Berry, MF; Harpole, DH
MLA Citation
Yang, C-FJ, Chan, DY, D'Amico, TA, Berry, MF, and Harpole, DH. "Reply to D.A. Palma." Journal of clinical oncology : official journal of the American Society of Clinical Oncology (November 21, 2016): JCO2016702787-.
PMID
27870575
Source
epmc
Published In
Journal of Clinical Oncology
Publish Date
2016
Start Page
JCO2016702787

Patterns of Failure After Surgery for Non-Small-cell Lung Cancer Invading the Chest Wall.

The patterns of failure after resection of non-small-cell lung cancer (NSCLC) invading the chest wall are not well documented, and the role of adjuvant radiation therapy (RT) is unclear, prompting the present analysis.The present institutional review board-approved study evaluated patients who had undergone surgery from 1995 to 2014 for localized NSCLC invading the chest wall. Patients with superior sulcus tumors were excluded. The clinical outcomes were estimated using the Kaplan-Meier method and compared using a log-rank test. The prognostic factors were assessed using a multivariate analysis, and the patterns of failure were scored.Seventy-four patients were evaluated. Most patients had undergone lobectomy or pneumonectomy (85%) with en bloc chest wall resection (80%) and had pathologically node negative findings (81%). The surgical margins were positive in 10 patients (14%) and most commonly involved the chest wall (7 of 10). Adjuvant treatment included RT in 21 (28%) and chemotherapy in 28 (38%). A total of 24 local recurrences developed. The chest wall was a component of local disease recurrence in 19 of 24 cases (79%). The local control rate at 5 years for the entire population was 60% (95% confidence interval, 46%-74%). The local control rate was 74% with adjuvant RT versus 55% without RT (P = .43). On multivariate analysis, only resection less than lobectomy or pneumonectomy was associated with worse local control. The overall survival rate was 38% with RT versus 34% without RT (P = .59).Positive surgical margins and local disease recurrence were common after resection of NSCLC invading the chest wall. The primary pattern of failure was local recurrence in the chest wall. Adjuvant RT was not associated with improved local control or survival.

Authors
Tandberg, DJ; Kelsey, CR; D'Amico, TA; Crawford, J; Chino, JP; Tong, BC; Ready, NE; Wright, A
MLA Citation
Tandberg, DJ, Kelsey, CR, D'Amico, TA, Crawford, J, Chino, JP, Tong, BC, Ready, NE, and Wright, A. "Patterns of Failure After Surgery for Non-Small-cell Lung Cancer Invading the Chest Wall." Clinical lung cancer (November 21, 2016).
PMID
27965012
Source
epmc
Published In
Clinical lung cancer
Publish Date
2016
DOI
10.1016/j.cllc.2016.11.008

Gastric Cancer, Version 3.2016; Clinical Practice Guidelines in Oncology

© National Comprehensive Cancer Network, Inc. 2016, All rights reserved.Gastric cancer is the fifth most frequently diagnosed cancer and the third leading cause of death from cancer in the world. Several advances have been made in the staging procedures, imaging techniques, and treatment approaches. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Gastric Cancer provide an evidence- and consensus-based treatment approach for the management of patients with gastric cancer. This manuscript discusses the recommendations outlined in the NCCN Guidelines for staging, assessment of HER2 overexpression, systemic therapy for locally advanced or metastatic disease, and best supportive care for the prevention and management of symptoms due to advanced disease.

Authors
Ajani, JA; D'Amico, TA; Almhanna, K; Bentrem, DJ; Chao, J; Das, P; Denlinger, CS; Fanta, P; Farjah, F; Fuchs, CS; Gerdes, H; Gibson, M; Glasgow, RE; Hayman, JA; Hochwald, S; Hofstetter, WL; Ilson, DH; Jaroszewski, D; Johung, KL; Keswani, RN; Kleinberg, LR; Korn, WM; Leong, S; Linn, C; Lockhart, AC; Ly, QP; Mulcahy, MF; Orringer, MB; Perry, KA; Poultsides, GA; Scott, WJ; Strong, VE; Washington, MK; Weksler, B; Willett, CG; Wright, CD; Zelman, D; McMillian, N; Sundar, H
MLA Citation
Ajani, JA, D'Amico, TA, Almhanna, K, Bentrem, DJ, Chao, J, Das, P, Denlinger, CS, Fanta, P, Farjah, F, Fuchs, CS, Gerdes, H, Gibson, M, Glasgow, RE, Hayman, JA, Hochwald, S, Hofstetter, WL, Ilson, DH, Jaroszewski, D, Johung, KL, Keswani, RN, Kleinberg, LR, Korn, WM, Leong, S, Linn, C, Lockhart, AC, Ly, QP, Mulcahy, MF, Orringer, MB, Perry, KA, Poultsides, GA, Scott, WJ, Strong, VE, Washington, MK, Weksler, B, Willett, CG, Wright, CD, Zelman, D, McMillian, N, and Sundar, H. "Gastric Cancer, Version 3.2016; Clinical Practice Guidelines in Oncology." JNCCN Journal of the National Comprehensive Cancer Network 14.10 (October 1, 2016): 1286-1312. (Review)
Source
scopus
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
14
Issue
10
Publish Date
2016
Start Page
1286
End Page
1312

Personalized and targeted therapy of esophageal squamous cell carcinoma: an update.

Esophageal squamous cell carcinoma (ESCC) is a deadly disease that requires extensive research. In this review, we update recent progress in the research area of targeted therapy for ESCC. SOX2 and its associated proteins (e.g., ΔNP63α), which regulate lineage survival of ESCC cells, are proposed as therapeutic targets. It is believed that targeting the lineage-survival mechanism may be more effective than targeting other mechanisms. With the advent of a new era of personalized targeted therapy, there is a need to move from the tumor-centric model into an organismic model.

Authors
Liu, Y; Xiong, Z; Beasley, A; D'Amico, T; Chen, XL
MLA Citation
Liu, Y, Xiong, Z, Beasley, A, D'Amico, T, and Chen, XL. "Personalized and targeted therapy of esophageal squamous cell carcinoma: an update." Annals of the New York Academy of Sciences 1381.1 (October 2016): 66-73.
PMID
27399176
Source
epmc
Published In
Annals of the New York Academy of Sciences
Volume
1381
Issue
1
Publish Date
2016
Start Page
66
End Page
73
DOI
10.1111/nyas.13144

Gastric Cancer, Version 3.2016, NCCN Clinical Practice Guidelines in Oncology.

Gastric cancer is the fifth most frequently diagnosed cancer and the third leading cause of death from cancer in the world. Several advances have been made in the staging procedures, imaging techniques, and treatment approaches. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Gastric Cancer provide an evidence- and consensus-based treatment approach for the management of patients with gastric cancer. This manuscript discusses the recommendations outlined in the NCCN Guidelines for staging, assessment of HER2 overexpression, systemic therapy for locally advanced or metastatic disease, and best supportive care for the prevention and management of symptoms due to advanced disease.

Authors
Ajani, JA; D'Amico, TA; Almhanna, K; Bentrem, DJ; Chao, J; Das, P; Denlinger, CS; Fanta, P; Farjah, F; Fuchs, CS; Gerdes, H; Gibson, M; Glasgow, RE; Hayman, JA; Hochwald, S; Hofstetter, WL; Ilson, DH; Jaroszewski, D; Johung, KL; Keswani, RN; Kleinberg, LR; Korn, WM; Leong, S; Linn, C; Lockhart, AC; Ly, QP; Mulcahy, MF; Orringer, MB; Perry, KA; Poultsides, GA; Scott, WJ; Strong, VE; Washington, MK; Weksler, B; Willett, CG; Wright, CD; Zelman, D; McMillian, N; Sundar, H
MLA Citation
Ajani, JA, D'Amico, TA, Almhanna, K, Bentrem, DJ, Chao, J, Das, P, Denlinger, CS, Fanta, P, Farjah, F, Fuchs, CS, Gerdes, H, Gibson, M, Glasgow, RE, Hayman, JA, Hochwald, S, Hofstetter, WL, Ilson, DH, Jaroszewski, D, Johung, KL, Keswani, RN, Kleinberg, LR, Korn, WM, Leong, S, Linn, C, Lockhart, AC, Ly, QP, Mulcahy, MF, Orringer, MB, Perry, KA, Poultsides, GA, Scott, WJ, Strong, VE, Washington, MK, Weksler, B, Willett, CG, Wright, CD, Zelman, D, McMillian, N, and Sundar, H. "Gastric Cancer, Version 3.2016, NCCN Clinical Practice Guidelines in Oncology." Journal of the National Comprehensive Cancer Network : JNCCN 14.10 (October 2016): 1286-1312.
PMID
27697982
Source
epmc
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
14
Issue
10
Publish Date
2016
Start Page
1286
End Page
1312

Outcomes of Major Lung Resection After Induction Therapy for Non-Small Cell Lung Cancer in Elderly Patients.

This study analyzes the impact of age on perioperative outcomes and long-term survival of patients undergoing surgery after induction chemotherapy for non-small cell lung cancer.Short- and long-term outcomes of patients with non-small cell lung cancer who were at least 70 years and received induction chemotherapy followed by major lung resection (lobectomy or pneumonectomy) from 1996 to 2012 were assessed using multivariable logistic regression, Kaplan-Meier, and Cox proportional hazard analysis. The outcomes of these elderly patients were compared with those of patients younger than 70 years who underwent the same treatment from 1996 to 2012.Of the 317 patients who met the study criteria, 53 patients were at least 70 years. The median age was 74 years (range, 70 to 82 years) in the elderly group, and induction chemoradiation was used in 24 (45%) patients. Thirty-day mortality was similar between the younger (n = 12) and elderly (n = 3) patients (5% versus 6%; p = 0.52). There were no significant differences in the incidence of postoperative complications between younger and elderly patients (49% versus 57%; p = 0.30). Patients younger than 70 years had a median overall survival (30 months; 95% confidence interval [CI], 24 to 43) and a 5-year survival (39%; 95% CI, 33 to 45) that was not significantly different from patients at least 70 years (median overall survival, 30 months; 95% CI, 18 to 68; and 5-year overall survival, 36%; 95% CI, 21 to 51). However, there was a trend toward worse survival in the elderly group after multivariable adjustment (hazard ratio, 1.43; 95% CI, 0.97 to 2.12; p = 0.071).Major lung resection after induction chemotherapy can be performed with acceptable short- and long-term results in appropriately selected patients at least 70 years, with outcomes that are comparable to those of younger patients.

Authors
Yang, C-FJ; Mayne, NR; Wang, H; Meyerhoff, RR; Hirji, S; Tong, BC; Hartwig, M; Harpole, D; D'Amico, TA; Berry, M
MLA Citation
Yang, C-FJ, Mayne, NR, Wang, H, Meyerhoff, RR, Hirji, S, Tong, BC, Hartwig, M, Harpole, D, D'Amico, TA, and Berry, M. "Outcomes of Major Lung Resection After Induction Therapy for Non-Small Cell Lung Cancer in Elderly Patients." The Annals of thoracic surgery 102.3 (September 2016): 962-970.
PMID
27234579
Source
epmc
Published In
The Annals of Thoracic Surgery
Volume
102
Issue
3
Publish Date
2016
Start Page
962
End Page
970
DOI
10.1016/j.athoracsur.2016.03.088

Impact of Age on Long-Term Outcomes of Surgery for Malignant Pleural Mesothelioma.

Although malignant pleural mesothelioma (MPM) is generally a disease associated with more advanced age, the association of age, treatment, and outcomes has not been well-characterized. We evaluated the impact of age on outcomes in patients with MPM to provide data for use in the treatment selection process for elderly patients with potentially resectable disease.Overall survival (OS) of patients younger than 70 and 70 years or older with Stage I to III MPM who underwent cancer-directed surgery or nonoperative management in the Surveillance, Epidemiology, and End Results database (2004-2010) was evaluated using multivariable Cox proportional hazard models and propensity score-matched analysis.Cancer-directed surgery was used in 284 of 879 (32%) patients who met inclusion criteria, and was associated with improved OS in multivariable analysis (hazard ratio, 0.71; P = .001). Cancer-directed surgery was used much less commonly in patients 70 years and older compared with patients younger than 70 years (22% [109/497] vs. 46% [175/382]; P < .001), but patients 70 years and older had improved 1-year (59.4% vs. 37.9%) and 3-year (15.4% vs. 8.0%) OS compared with nonoperative management. The benefit of surgery in patients 70 years and older was observed even after propensity score-matched analysis was used to control for selection bias.Surgical treatment is associated with improved survival compared with nonoperative management for both patients younger than 70 years and patients aged 70 years or older.

Authors
Yang, C-FJ; Yan, BW; Meyerhoff, RR; Saud, SM; Gulack, BC; Speicher, PJ; Hartwig, MG; D'Amico, TA; Harpole, DH; Berry, MF
MLA Citation
Yang, C-FJ, Yan, BW, Meyerhoff, RR, Saud, SM, Gulack, BC, Speicher, PJ, Hartwig, MG, D'Amico, TA, Harpole, DH, and Berry, MF. "Impact of Age on Long-Term Outcomes of Surgery for Malignant Pleural Mesothelioma." Clinical lung cancer 17.5 (September 2016): 419-426.
PMID
27236386
Source
epmc
Published In
Clinical lung cancer
Volume
17
Issue
5
Publish Date
2016
Start Page
419
End Page
426
DOI
10.1016/j.cllc.2016.03.002

Induction Chemotherapy is Not Superior to a Surgery-First Strategy for Clinical N1 Non-Small Cell Lung Cancer.

Guidelines recommend primary surgical resection for non-small cell lung cancer (NSCLC) patients with clinical N1 disease and adjuvant chemotherapy if nodal disease is confirmed after resection. We tested the hypothesis that induction chemotherapy for clinical N1 (cN1) disease improves survival.Patients treated with lobectomy or pneumonectomy for cT1-3 N1 M0 NSCLC from 2006 to 2011 in the National Cancer Data Base were stratified by treatment strategy: surgery first vs induction chemotherapy. Propensity scores were developed and matched with a 2:1 nearest neighbor algorithm. Survival analyses using Kaplan-Meier methods were performed on the unadjusted and propensity-matched cohorts.A total of 5,364 cN1 patients were identified for inclusion, of which 565 (10.5%) were treated with induction chemotherapy. Clinical nodal staging was accurate in 68.6% (n = 3,292) of patients treated with surgical resection first, whereas 16.3% (n = 780) were pN0 and 10.7% (n = 514) were pN2-3. Adjuvant chemotherapy was given to 60.9% of the surgery-first patients who were pN1-3 after resection. Before adjustment, patients treated with induction chemotherapy were younger, with lower comorbidity burden, were more likely to be treated at an academic center and to have private insurance (all p < 0.001), but were significantly more likely to have T3 tumors (28.7% vs 9.9%, p < 0.001) and to require pneumonectomy (23.5% vs 18.5%, p = 0.005). The unadjusted and propensity-matched analyses found no differences in short-term outcomes or survival between groups.Induction chemotherapy for cN1 NSCLC is not associated with improved survival. This finding supports the currently recommended treatment paradigm of surgery first for cN1 NSCLC.

Authors
Speicher, PJ; Fitch, ZW; Gulack, BC; Yang, C-FJ; Tong, BC; Harpole, DH; D'Amico, TA; Berry, MF; Hartwig, MG
MLA Citation
Speicher, PJ, Fitch, ZW, Gulack, BC, Yang, C-FJ, Tong, BC, Harpole, DH, D'Amico, TA, Berry, MF, and Hartwig, MG. "Induction Chemotherapy is Not Superior to a Surgery-First Strategy for Clinical N1 Non-Small Cell Lung Cancer." The Annals of thoracic surgery 102.3 (September 2016): 884-894.
PMID
27476819
Source
epmc
Published In
The Annals of Thoracic Surgery
Volume
102
Issue
3
Publish Date
2016
Start Page
884
End Page
894
DOI
10.1016/j.athoracsur.2016.05.065

Early feeding after esophagectomy may be too early.

Authors
D'Amico, TA
MLA Citation
D'Amico, TA. "Early feeding after esophagectomy may be too early." Journal of thoracic disease 8.9 (September 2016): E1067-.
PMID
27747065
Source
epmc
Published In
Journal of Thoracic Disease
Volume
8
Issue
9
Publish Date
2016
Start Page
E1067

Reply to Perna et al.

Authors
Gonzalez-Rivas, D; D'Amico, TA; Jiang, G; Sihoe, A
MLA Citation
Gonzalez-Rivas, D, D'Amico, TA, Jiang, G, and Sihoe, A. "Reply to Perna et al." European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery (August 29, 2016).
PMID
27572241
Source
epmc
Published In
European Journal of Cardio-Thoracic Surgery
Publish Date
2016

Multidisciplinary approach to treatment of radiation-induced chest wall sarcoma.

Radiation-induced sarcoma (RIS) is a rare complication following therapeutic external irradiation for lung cancer patients. Patients with RIS may develop recurrence or metastasis of the previous disease and also at high risk for early chest wall complications following operation, which requires close follow-up and multidisciplinary approach. We present a challenging case of RIS with a multidisciplinary teamwork in the decision-making and successful management.

Authors
Kara, HV; Gandolfi, BM; Williams, JB; D'Amico, TA; Zenn, MR
MLA Citation
Kara, HV, Gandolfi, BM, Williams, JB, D'Amico, TA, and Zenn, MR. "Multidisciplinary approach to treatment of radiation-induced chest wall sarcoma." General thoracic and cardiovascular surgery 64.8 (August 2016): 492-495.
PMID
25663293
Source
epmc
Published In
General Thoracic and Cardiovascular Surgery
Volume
64
Issue
8
Publish Date
2016
Start Page
492
End Page
495
DOI
10.1007/s11748-015-0527-x

Minimally Invasive Versus Open Esophagectomy for Esophageal Cancer: A Population-Based Analysis.

The objective of this study was to evaluate outcomes of minimally invasive approaches to esophagectomy using population-level data.Multivariable regression modeling was used to determine predictors associated with the use of minimally invasive approaches for patients in the National Cancer Data Base who underwent resection of middle and distal clinical T13N03M0 esophageal cancers from 2010 to 2012. Perioperative outcomes and 3-year survival were compared between propensity-matched groups of patients with esophageal cancer who underwent minimally invasive esophagectomy (MIE) or open esophagectomy (OE). A subgroup analysis was performed to evaluate the impact of using robotic-assisted operations as part of the minimally invasive approach.Among 4,266 patients included, 1,308 (30.6%) underwent MIE. It was more likely to be used in patients treated at academic (adjusted odds ratio [OR], 10.1; 95% confidence interval [CI], 4.2-33.1) or comprehensive cancer facilities (adjusted OR, 6.4; 95% CI, 2.6-21.1). Compared with propensity-matched patients who underwent OE, patients who underwent MIE had significantly more lymph nodes examined (15 versus 13; p = 0.016) and shorter hospital lengths of stay (10 days versus 11 days; p = 0.046) but similar resection margin positivity, readmission, and 30-day mortality (all p > 0.05). Survival was similar between the matched groups at 3 years for both adenocarcinoma and squamous cell carcinoma (p > 0.05). Compared with MIE without robotic assistance, use of a robotic approach was not associated with any significant differences in perioperative outcomes (p > 0.05).The use of minimally invasive techniques to perform esophagectomy for esophageal cancer is associated with modestly improved perioperative outcomes without compromising survival.

Authors
Yerokun, BA; Sun, Z; Yang, C-FJ; Gulack, BC; Speicher, PJ; Adam, MA; D'Amico, TA; Onaitis, MW; Harpole, DH; Berry, MF; Hartwig, MG
MLA Citation
Yerokun, BA, Sun, Z, Yang, C-FJ, Gulack, BC, Speicher, PJ, Adam, MA, D'Amico, TA, Onaitis, MW, Harpole, DH, Berry, MF, and Hartwig, MG. "Minimally Invasive Versus Open Esophagectomy for Esophageal Cancer: A Population-Based Analysis." The Annals of thoracic surgery 102.2 (August 2016): 416-423.
PMID
27157326
Source
epmc
Published In
The Annals of Thoracic Surgery
Volume
102
Issue
2
Publish Date
2016
Start Page
416
End Page
423
DOI
10.1016/j.athoracsur.2016.02.078

Recent randomized trials on stage III lung cancer treatment

Authors
Yang, C-FJ; D’Amico, TA
MLA Citation
Yang, C-FJ, and D’Amico, TA. "Recent randomized trials on stage III lung cancer treatment." Translational Cancer Research 5.S2 (August 2016): S170-S173.
Source
crossref
Published In
Translational cancer research
Volume
5
Issue
S2
Publish Date
2016
Start Page
S170
End Page
S173
DOI
10.21037/tcr.2016.07.24

NCCN Guidelines (R) Insights Malignant Pleural Mesothelioma, Version 3.2016 Featured Updates to the NCCN Guidelines

Authors
Ettinger, DS; Wood, DE; Akerley, W; Bazhenova, LA; Borghaei, H; Camidge, DR; Cheney, RT; Chirieac, LR; D'Amico, TA; Dilling, T; Dobelbower, M; Govindan, R; Hennon, M; Horn, L; Jahan, TM; Komaki, R; Lackner, RP; Lanuti, M; Lilenbaum, R; Lin, J; Jr, LBW; Martins, R; Otterson, GA; Patel, JD; Pisters, KM; Reckamp, K; Riely, GJ; Schild, SE; Shapiro, TA; Sharma, N; Swanson, SJ; Stevenson, J; Tauer, K; Yang, SC; Gregory, K; Hughes, M
MLA Citation
Ettinger, DS, Wood, DE, Akerley, W, Bazhenova, LA, Borghaei, H, Camidge, DR, Cheney, RT, Chirieac, LR, D'Amico, TA, Dilling, T, Dobelbower, M, Govindan, R, Hennon, M, Horn, L, Jahan, TM, Komaki, R, Lackner, RP, Lanuti, M, Lilenbaum, R, Lin, J, Jr, LBW, Martins, R, Otterson, GA, Patel, JD, Pisters, KM, Reckamp, K, Riely, GJ, Schild, SE, Shapiro, TA, Sharma, N, Swanson, SJ, Stevenson, J, Tauer, K, Yang, SC, Gregory, K, and Hughes, M. "NCCN Guidelines (R) Insights Malignant Pleural Mesothelioma, Version 3.2016 Featured Updates to the NCCN Guidelines." JOURNAL OF THE NATIONAL COMPREHENSIVE CANCER NETWORK 14.7 (July 1, 2016): 825-836.
Source
wos-lite
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
14
Issue
7
Publish Date
2016
Start Page
825
End Page
836

Comparative effectiveness of stereotactic radiosurgery versus whole-brain radiation therapy for patients with brain metastases from breast or non-small cell lung cancer

Authors
Halasz, LM; Uno, H; Hughes, M; D'Amico, T; Dexter, EU; Edge, SB; Hayman, JA; Niland, JC; Otterson, GA; Pisters, KMW; Theriault, R; Weeks, JC; Punglia, RS
MLA Citation
Halasz, LM, Uno, H, Hughes, M, D'Amico, T, Dexter, EU, Edge, SB, Hayman, JA, Niland, JC, Otterson, GA, Pisters, KMW, Theriault, R, Weeks, JC, and Punglia, RS. "Comparative effectiveness of stereotactic radiosurgery versus whole-brain radiation therapy for patients with brain metastases from breast or non-small cell lung cancer." Cancer 122.13 (July 1, 2016): 2091-100.
Source
crossref
Published In
Cancer
Volume
122
Issue
13
Publish Date
2016
Start Page
2091
End Page
100
DOI
10.1002/cncr.30009

Thoracoscopic Lobectomy for Non-small Cell Lung Cancer.

Lobectomy is the gold standard treatment in operable patients with surgically resectable non-small cell lung cancer. Thoracoscopic lobectomy has emerged as an option for surgeons facile with the technique. Video-assisted thoracoscopic surgery (VATS) is used for a variety of indications, but its efficacy as a reliable oncologic procedure makes it appealing in the treatment of non-small cell lung cancer. Fewer postoperative complications and decreased postoperative pain associated with VATS procedures can lead to shorter lengths of stay and lower overall costs. Thoracoscopic surgery continues to evolve, and uniportal, robot-assisted, and awake thoracoscopic procedures have all shown promising results.

Authors
Gaudet, MA; D'Amico, TA
MLA Citation
Gaudet, MA, and D'Amico, TA. "Thoracoscopic Lobectomy for Non-small Cell Lung Cancer." Surgical oncology clinics of North America 25.3 (July 2016): 503-513.
PMID
27261912
Source
epmc
Published In
Surgical Oncology Clinics of North America
Volume
25
Issue
3
Publish Date
2016
Start Page
503
End Page
513
DOI
10.1016/j.soc.2016.02.005

NCCN Guidelines Insights: Malignant Pleural Mesothelioma, Version 3.2016.

These NCCN Guidelines Insights focus on recent updates to the NCCN Guidelines for Malignant Pleural Mesothelioma (MPM). These NCCN Guidelines Insights discuss systemic therapy regimens and surgical controversies for MPM. The NCCN panel recommends cisplatin/pemetrexed (category 1) for patients with MPM. The NCCN panel also now recommends bevacizumab/cisplatin/pemetrexed as a first-line therapy option for patients with unresectable MPM who are candidates for bevacizumab. The complete version of the NCCN Guidelines for MPM, available at NCCN.org, addresses all aspects of management for MPM including diagnosis, evaluation, staging, treatment, surveillance, and therapy for recurrence and metastasis; NCCN Guidelines are intended to assist with clinical decision-making.

Authors
Ettinger, DS; Wood, DE; Akerley, W; Bazhenova, LA; Borghaei, H; Camidge, DR; Cheney, RT; Chirieac, LR; D'Amico, TA; Dilling, T; Dobelbower, M; Govindan, R; Hennon, M; Horn, L; Jahan, TM; Komaki, R; Lackner, RP; Lanuti, M; Lilenbaum, R; Lin, J; Loo, BW; Martins, R; Otterson, GA; Patel, JD; Pisters, KM; Reckamp, K; Riely, GJ; Schild, SE; Shapiro, TA; Sharma, N; Swanson, SJ; Stevenson, J; Tauer, K; Yang, SC; Gregory, K; Hughes, M
MLA Citation
Ettinger, DS, Wood, DE, Akerley, W, Bazhenova, LA, Borghaei, H, Camidge, DR, Cheney, RT, Chirieac, LR, D'Amico, TA, Dilling, T, Dobelbower, M, Govindan, R, Hennon, M, Horn, L, Jahan, TM, Komaki, R, Lackner, RP, Lanuti, M, Lilenbaum, R, Lin, J, Loo, BW, Martins, R, Otterson, GA, Patel, JD, Pisters, KM, Reckamp, K, Riely, GJ, Schild, SE, Shapiro, TA, Sharma, N, Swanson, SJ, Stevenson, J, Tauer, K, Yang, SC, Gregory, K, and Hughes, M. "NCCN Guidelines Insights: Malignant Pleural Mesothelioma, Version 3.2016." Journal of the National Comprehensive Cancer Network : JNCCN 14.7 (July 2016): 825-836.
PMID
27407123
Source
epmc
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
14
Issue
7
Publish Date
2016
Start Page
825
End Page
836

Location of the Tumor is a “Central” Predictor of Nodal (N1) Upstaging

Authors
Decaluwé, H; De Ruysscher, D; D’Amico, T
MLA Citation
Decaluwé, H, De Ruysscher, D, and D’Amico, T. "Location of the Tumor is a “Central” Predictor of Nodal (N1) Upstaging." Journal of Thoracic Oncology 11.7 (July 2016): e89-e90.
Source
crossref
Published In
Journal of Thoracic Oncology
Volume
11
Issue
7
Publish Date
2016
Start Page
e89
End Page
e90
DOI
10.1016/j.jtho.2016.02.022

Long-term survival following open versus thoracoscopic lobectomy after preoperative chemotherapy for non-small cell lung cancer.

Video-assisted thoracoscopic (VATS) lobectomy is increasingly accepted for the management of early-stage non-small cell lung cancer (NSCLC), but its role for locally advanced cancers has not been as well characterized. We compared outcomes of patients who received induction therapy followed by lobectomy, via VATS or thoracotomy.Perioperative complications and long-term survival of all patients with NSCLC who received induction chemotherapy (ICT) (with or without induction radiation therapy) followed by lobectomy from 1996-2012 were assessed using Kaplan-Meier and Cox proportional hazard analysis. Propensity score-matched comparisons were used to assess the potential impact of selection bias.From 1996 to 2012, 272 patients met inclusion criteria and underwent lobectomy after ICT: 69 (25%) by VATS and 203 (75%) by thoracotomy. An 'intent-to-treat' analysis was performed. Compared with thoracotomy patients, VATS patients had a higher clinical stage, were older, had greater body mass index, and were more likely to have coronary disease and chronic obstructive pulmonary disease. Induction radiation was used more commonly in thoracotomy patients [VATS 28% (n = 19) vs open 72% (n = 146), P < 0.001]. Thirty-day mortality was similar between the VATS [3% (n = 2)] and open [4% (n = 8)] groups (P = 0.69). Seven (10%) of the VATS cases were converted to thoracotomy due to difficulty in dissection from fibrotic tissue and adhesions (n = 5) or bleeding (n = 2); none of these conversions led to perioperative deaths. In univariate analysis, VATS patients had improved 3-year survival compared with thoracotomy (61% vs 43%, P = 0.010). In multivariable analysis, the VATS approach showed a trend towards improved survival, but this did not reach statistical significance (hazard ratio, 0.56; 95% confidence interval, 0.32-1.01; P = 0.053). Moreover, a propensity score-matched analysis balancing patient characteristics demonstrated that the VATS approach had similar survival to an open approach (P = 0.56).VATS lobectomy in patients treated with induction therapy for locally advanced NSCLC is feasible and effective and does not appear to compromise oncologic outcomes.

Authors
Yang, C-FJ; Meyerhoff, RR; Mayne, NR; Singhapricha, T; Toomey, CB; Speicher, PJ; Hartwig, MG; Tong, BC; Onaitis, MW; Harpole, DH; D'Amico, TA; Berry, MF
MLA Citation
Yang, C-FJ, Meyerhoff, RR, Mayne, NR, Singhapricha, T, Toomey, CB, Speicher, PJ, Hartwig, MG, Tong, BC, Onaitis, MW, Harpole, DH, D'Amico, TA, and Berry, MF. "Long-term survival following open versus thoracoscopic lobectomy after preoperative chemotherapy for non-small cell lung cancer." European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 49.6 (June 2016): 1615-1623.
PMID
26719408
Source
epmc
Published In
European Journal of Cardio-Thoracic Surgery
Volume
49
Issue
6
Publish Date
2016
Start Page
1615
End Page
1623
DOI
10.1093/ejcts/ezv428

Impact of patient selection and treatment strategies on outcomes after lobectomy for biopsy-proven stage IIIA pN2 non-small cell lung cancer.

We evaluated the impact of patient selection and treatment strategies on long-term outcomes of patients who had lobectomy after induction therapy for stage IIIA pN2 non-small cell lung cancer (NSCLC).The impact of various patient selection, induction therapy and operative strategies on survival of patients with biopsy-proven stage IIIA pN2 NSCLC who received induction chemotherapy ± radiation followed by lobectomy from 1995 to 2012 was assessed using Cox proportional hazards analysis.From 1995 to 2012, 111 patients had lobectomy for stage IIIA pN2 NSCLC after chemotherapy ± radiation with an overall 5-year survival of 39%. The use of induction chemoradiation decreased over time; from 1996 to 2007, 46/65 (71%) patients underwent induction chemoradiation, whereas from 2007 to 2012, 36/46 (78%) patients underwent induction chemotherapy. The use of video-assisted thoracoscopic surgery (VATS) increased over the time period of the study, from 0/26 (0%) in 1996-2001, to 4/39 (10%) in 2002-07 to 33/46 (72%) in 2008-12. Compared with patients given induction chemotherapy alone, patients given additional induction radiation were more likely to have complete pathologic response (30 vs 11%, P = 0.01) but had worse 5-year survival in univariable analysis (31 vs 48%, log-rank P = 0.021). Patients who underwent pathologic mediastinal restaging following induction therapy but prior to resection had an improved overall survival compared with patients who did not undergo pathologic mediastinal restaging {5-year survival: 45.2 [95% confidence interval (CI): 33.9-55.9] vs 13.9% (95% CI: 2.5-34.7); log-rank, P = 0.004}. In multivariable analysis, the particular induction therapy strategy and the surgical approach used, as well as the extent of mediastinal disease were not important predictors of survival. However, pathologic mediastinal restaging was associated with improved survival (HR 0.39; 95% CI: 0.21-0.72; P = 0.003).For patients with stage IIIA pN2 NSCLC, the VATS approach or the addition of radiation to induction therapy can be selectively employed without compromising survival. The strategy of assessing response to induction therapy with pathologic mediastinal restaging allows one to select appropriate patients for complete resection and is associated with a 5-year overall survival of 39% in this population.

Authors
Yang, C-FJ; Adil, SM; Anderson, KL; Meyerhoff, RR; Turley, RS; Hartwig, MG; Harpole, DH; Tong, BC; Onaitis, MW; D'Amico, TA; Berry, MF
MLA Citation
Yang, C-FJ, Adil, SM, Anderson, KL, Meyerhoff, RR, Turley, RS, Hartwig, MG, Harpole, DH, Tong, BC, Onaitis, MW, D'Amico, TA, and Berry, MF. "Impact of patient selection and treatment strategies on outcomes after lobectomy for biopsy-proven stage IIIA pN2 non-small cell lung cancer." European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 49.6 (June 2016): 1607-1613.
PMID
26719403
Source
epmc
Published In
European Journal of Cardio-Thoracic Surgery
Volume
49
Issue
6
Publish Date
2016
Start Page
1607
End Page
1613
DOI
10.1093/ejcts/ezv431

"Early" thoracic duct ligation for chylothorax after esophagectomy means "now".

Authors
D'Amico, TA
MLA Citation
D'Amico, TA. ""Early" thoracic duct ligation for chylothorax after esophagectomy means "now"." The Journal of thoracic and cardiovascular surgery 151.5 (May 2016): 1405-1406.
PMID
26882982
Source
epmc
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
151
Issue
5
Publish Date
2016
Start Page
1405
End Page
1406
DOI
10.1016/j.jtcvs.2016.01.032

Long-term outcomes after lobectomy for non-small cell lung cancer when unsuspected pN2 disease is found: A National Cancer Data Base analysis.

There are few studies evaluating whether to proceed with planned resection when a patient with non-small cell lung cancer (NSCLC) unexpectedly is found to have N2 disease at the time of thoracoscopy or thoracotomy. To help guide management of this clinical scenario, we evaluated outcomes for patients who were upstaged to pN2 after lobectomy without induction therapy using the National Cancer Data Base (NCDB).Survival of NSCLC patients treated with lobectomy for clinically unsuspected mediastinal nodal disease (cT1-cT3 cN0-cN1, pN2 disease) from 1998-2006 in the NCDB was compared with "suspected" N2 disease patients (cT1-cT3 cN2) who were treated with chemotherapy with or without radiation followed by lobectomy, using matched analysis based on propensity scores.Unsuspected pN2 disease was found in 4.4% of patients (2047 out of 46,691) who underwent lobectomy as primary therapy for cT1-cT3 cN0-cN1 NSCLC. The 5-year survival was 42%, 36%, 21%, and 28% for patients who underwent adjuvant chemotherapy (n = 385), chemoradiation (n = 504), radiation (n = 300), and no adjuvant therapy (n = 858), respectively. Five-year survival of the entire unsuspected pN2 cohort was worse than survival of 2302 patients who were treated with lobectomy after induction therapy for clinical N2 disease (30% vs 40%; P < .001), although no significant difference in 5-year survival was found in a matched-analysis of 655 patients from each group (37% vs 37%; P = .95).This population-based analysis suggests that, in the setting of unsuspected pN2 NSCLC, proceeding with lobectomy does not appear to compromise outcomes if adjuvant chemotherapy with or without radiation therapy can be administered following surgery.

Authors
Yang, C-FJ; Kumar, A; Gulack, BC; Mulvihill, MS; Hartwig, MG; Wang, X; D'Amico, TA; Berry, MF
MLA Citation
Yang, C-FJ, Kumar, A, Gulack, BC, Mulvihill, MS, Hartwig, MG, Wang, X, D'Amico, TA, and Berry, MF. "Long-term outcomes after lobectomy for non-small cell lung cancer when unsuspected pN2 disease is found: A National Cancer Data Base analysis." The Journal of thoracic and cardiovascular surgery 151.5 (May 2016): 1380-1388.
PMID
26874598
Source
epmc
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
151
Issue
5
Publish Date
2016
Start Page
1380
End Page
1388
DOI
10.1016/j.jtcvs.2015.12.028

Role of Adjuvant Therapy in a Population-Based Cohort of Patients With Early-Stage Small-Cell Lung Cancer.

Data on optimal adjuvant therapy after complete resection of small-cell lung cancer (SCLC) are limited, and in particular, there have been no studies evaluating the role of adjuvant chemotherapy, with or without prophylactic cranial irradiation, relative to no adjuvant therapy for stage T1-2N0M0 SCLC. This National Cancer Data Base analysis was performed to determine the potential benefits of adjuvant chemotherapy with and without prophylactic cranial irradiation in patients who undergo complete resection for early-stage small-cell lung cancer.Overall survival of patients with pathologic T1-2N0M0 SCLC who underwent complete resection in the National Cancer Data Base from 2003 to 2011, stratified by adjuvant therapy regimen, was evaluated using Kaplan-Meier and Cox proportional hazards analysis. Patients treated with induction therapy and those who died within 30 days of surgery were excluded from analysis.Of 1,574 patients who had pT1-2N0M0 SCLC during the study period, 954 patients (61%) underwent complete R0 resection with a 5-year survival of 47%. Adjuvant therapy was administered to 59% of patients (n = 566), including chemotherapy alone (n = 354), chemoradiation (n = 190, including 99 patients who underwent cranial irradiation), and radiation alone (n = 22). Compared with surgery alone, adjuvant chemotherapy with or without radiation was associated with significantly improved survival. In addition, multivariable Cox modeling demonstrated that treatment with adjuvant chemotherapy (hazard ratio [HR], 0.78; 95% CI, 0.63 to 0.95) or chemotherapy with radiation directed at the brain (HR, 0.52; 95% CI, 0.36 to 0.75) was associated with improved survival when compared with no adjuvant therapy.Patients with pT1-2N0M0 SCLC treated with surgical resection alone have worse outcomes than those who undergo resection with adjuvant chemotherapy alone or chemotherapy with cranial irradiation.

Authors
Yang, C-FJ; Chan, DY; Speicher, PJ; Gulack, BC; Wang, X; Hartwig, MG; Onaitis, MW; Tong, BC; D'Amico, TA; Berry, MF; Harpole, DH
MLA Citation
Yang, C-FJ, Chan, DY, Speicher, PJ, Gulack, BC, Wang, X, Hartwig, MG, Onaitis, MW, Tong, BC, D'Amico, TA, Berry, MF, and Harpole, DH. "Role of Adjuvant Therapy in a Population-Based Cohort of Patients With Early-Stage Small-Cell Lung Cancer." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 34.10 (April 2016): 1057-1064.
PMID
26786925
Source
epmc
Published In
Journal of Clinical Oncology
Volume
34
Issue
10
Publish Date
2016
Start Page
1057
End Page
1064
DOI
10.1200/jco.2015.63.8171

Traveling to a High-volume Center is Associated With Improved Survival for Patients With Esophageal Cancer.

An association between volume and outcomes has been observed for esophagectomy, though little is known about why or how patients choose low- or high-volume centers. The purpose of this study was to evaluate how travel burden and hospital volume influence treatment and outcomes of patients with locally advanced esophageal cancer.Predictors of receiving esophagectomy for patients with T1-3N1M0 mid or distal esophageal cancer in the National Cancer Data Base from 2006 to 2011 were identified using multivariable logistic regression. Survival was compared using propensity score-matched groups: patients in the bottom quartile of travel distance who underwent treatment at low-volume facilities (Local) and patients in the top quartile of travel distance who underwent treatment at high-volume facilities (Travel).Of 4979 patients who met inclusion criteria, we identified 867 Local patients who traveled 2.7 [interquartile range (IQR): 1.6-4 miles] miles to centers that treated 2.6 (IQR: 1.9-3.3) esophageal cancers per year, and 317 Travel patients who traveled 107.1 (IQR: 65-247) miles to centers treating 31.9 (IQR: 30.9-38.5) cases. Travel patients were more likely to undergo esophagectomy (67.8% vs 42.9%, P < 0.001) and had significantly better 5-year survival (39.8% vs 20.6%, P < 0.001) than Local patients.Patients who travel longer distances to high-volume centers have significantly different treatment and better outcomes than patients who stay close to home at low-volume centers. Strategies that support patient travel for treatment at high-volume centers may improve esophageal cancer outcomes.

Authors
Speicher, PJ; Englum, BR; Ganapathi, AM; Wang, X; Hartwig, MG; D'Amico, TA; Berry, MF
MLA Citation
Speicher, PJ, Englum, BR, Ganapathi, AM, Wang, X, Hartwig, MG, D'Amico, TA, and Berry, MF. "Traveling to a High-volume Center is Associated With Improved Survival for Patients With Esophageal Cancer." Annals of surgery (March 15, 2016).
PMID
26982688
Source
epmc
Published In
Annals of Surgery
Publish Date
2016

NCCN guidelines® Insights: Non-small cell lung cancer, version 4.2016 Featured updates to the NCCN guidelines

These NCCN Guidelines Insights focus on recent updates in the 2016 NCCN Guidelines for Non-Small Cell Lung Cancer (NSCLC; Versions 1-4). These NCCN Guidelines Insights will discuss new immunotherapeutic agents, such as nivolumab and pembrolizumab, for patients with metastatic NSCLC. For the 2016 update, the NCCN panel recommends immune checkpoint inhibitors as preferred agents (in the absence of contraindications) for second-line and beyond (subsequent) therapy in patients with metastatic NSCLC (both squamous and nonsquamous histologies). Nivolumab and pembrolizumab are preferred based on improved overall survival rates, higher response rates, longer duration of response, and fewer adverse events when compared with docetaxel therapy.

Authors
Ettinger, DS; Wood, DE; Akerley, W; Bazhenova, LA; Borghaei, H; Camidge, DR; Cheney, RT; Chirieac, LR; D'Amico, TA; Dilling, TJ; Chris Dobelbower, M; Govindan, R; Hennon, M; Horn, L; Jahan, TM; Komaki, R; Lackner, RP; Lanuti, M; Lilenbaum, R; Lin, J; Loo, BW; Martins, R; Otterson, GA; Patel, JD; Pisters, KM; Reckamp, K; Riely, GJ; Schild, SE; Shapiro, TA; Sharma, N; Stevenson, J; Swanson, SJ; Tauer, K; Yang, SC; Gregory, K; Hughes, M
MLA Citation
Ettinger, DS, Wood, DE, Akerley, W, Bazhenova, LA, Borghaei, H, Camidge, DR, Cheney, RT, Chirieac, LR, D'Amico, TA, Dilling, TJ, Chris Dobelbower, M, Govindan, R, Hennon, M, Horn, L, Jahan, TM, Komaki, R, Lackner, RP, Lanuti, M, Lilenbaum, R, Lin, J, Loo, BW, Martins, R, Otterson, GA, Patel, JD, Pisters, KM, Reckamp, K, Riely, GJ, Schild, SE, Shapiro, TA, Sharma, N, Stevenson, J, Swanson, SJ, Tauer, K, Yang, SC, Gregory, K, and Hughes, M. "NCCN guidelines® Insights: Non-small cell lung cancer, version 4.2016 Featured updates to the NCCN guidelines." JNCCN Journal of the National Comprehensive Cancer Network 14.3 (March 1, 2016): 255-264. (Review)
Source
scopus
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
14
Issue
3
Publish Date
2016
Start Page
255
End Page
264

Large clinical databases for the study of lung cancer: Making up for the failure of randomized trials.

Authors
Yang, C-FJ; Hartwig, MG; D'Amico, TA; Berry, MF
MLA Citation
Yang, C-FJ, Hartwig, MG, D'Amico, TA, and Berry, MF. "Large clinical databases for the study of lung cancer: Making up for the failure of randomized trials." The Journal of thoracic and cardiovascular surgery 151.3 (March 2016): 626-628.
PMID
26432720
Source
epmc
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
151
Issue
3
Publish Date
2016
Start Page
626
End Page
628
DOI
10.1016/j.jtcvs.2015.08.110

Impact of Positive Margins on Survival in Patients Undergoing Esophagogastrectomy for Esophageal Cancer.

Multimodality treatment that includes esophagogastrectomy may represent the best option for curing accurately staged patients with esophageal cancer. We analyzed the impact of incomplete resection on outcomes after esophagogastrectomy for esophageal cancer.The incidence of positive margins for patients who underwent esophagogastrectomy without induction therapy for pathologic T1-3N0-1M0 esophageal cancer of the mid and lower esophagus from 2003 to 2006 in the National Cancer Database was analyzed with multivariate logistic regression. The impact of positive margins on survival was assessed using Kaplan-Meier and Cox proportional hazards analysis.Positive margins occurred in 342 of 3,125 patients (10.9%) who met study criteria. Increasing clinical T status was an independent predictor of positive margins in multivariate analysis, but the chance of positive margins decreased with larger facility case volumes. The presence of clinical nodal disease was not predictive of an incomplete resection. The 5-year survival of patients with positive margins (13.8%, 95% confidence interval [CI]: 10.5% to 18.1%) was significantly worse than that for patients with negative margins (46.3%, 95% CI: 44.4% to 48.3%, p < 0.001). Both microscopic residual disease (hazard ratio 1.37, 95% CI: 1.16 to 1.60, p < 0.001) and gross residual disease (hazard ratio 1.98, 95% CI: 1.62 to 2.42, p < 0.001) predicted worse survival in multivariate analysis of the entire cohort. Receiving adjuvant chemoradiation therapy slightly improved 5-year survival of patients with positive margins (16.9%, 95% CI: 11.3% to 23.6%, versus 13.5%, 95% CI: 9% to 20.3%, p < 0.001).Positive margins are associated with poor survival, and adjuvant therapy only marginally improved prognosis. Future studies are needed to better evaluate whether induction therapy can lower the incidence of positive margins.

Authors
Javidfar, J; Speicher, PJ; Hartwig, MG; D'Amico, TA; Berry, MF
MLA Citation
Javidfar, J, Speicher, PJ, Hartwig, MG, D'Amico, TA, and Berry, MF. "Impact of Positive Margins on Survival in Patients Undergoing Esophagogastrectomy for Esophageal Cancer." The Annals of thoracic surgery 101.3 (March 2016): 1060-1067.
PMID
26576752
Source
epmc
Published In
The Annals of Thoracic Surgery
Volume
101
Issue
3
Publish Date
2016
Start Page
1060
End Page
1067
DOI
10.1016/j.athoracsur.2015.09.005

Use and Outcomes of Minimally Invasive Lobectomy for Stage I Non-Small Cell Lung Cancer in the National Cancer Data Base.

Previous studies have raised concerns that video-assisted thoracoscopic (VATS) lobectomy may compromise nodal evaluation. The advantages or limitations of robotic lobectomy have not been thoroughly evaluated.Perioperative outcomes and survival of patients who underwent open versus minimally-invasive surgery (MIS [VATS and robotic]) lobectomy and VATS versus robotic lobectomy for clinical T1-2, N0 non-small cell lung cancer from 2010 to 2012 in the National Cancer Data Base were evaluated using propensity score matching.Of 30,040 lobectomies, 7,824 were VATS and 2,025 were robotic. After propensity score matching, when compared with the open approach (n = 9,390), MIS (n = 9,390) was found to have increased 30-day readmission rates (5% versus 4%, p < 0.01), shorter median hospital length of stay (5 versus 6 days, p < 0.01), and improved 2-year survival (87% versus 86%, p = 0.04). There were no significant differences in nodal upstaging and 30-day mortality between the two groups. After propensity score matching, when compared with the robotic group (n = 1,938), VATS (n = 1,938) was not significantly different from robotics with regard to nodal upstaging, 30-day mortality, and 2-year survival.In this population-based analysis, MIS (VATS and robotic) lobectomy was used in the minority of patients for stage I non-small cell lung cancer. MIS lobectomy was associated with shorter length of hospital stay and was not associated with increased perioperative mortality, compromised nodal evaluation, or reduced short-term survival when compared with the open approach. These results suggest the need for broader implementation of MIS techniques.

Authors
Yang, C-FJ; Sun, Z; Speicher, PJ; Saud, SM; Gulack, BC; Hartwig, MG; Harpole, DH; Onaitis, MW; Tong, BC; D'Amico, TA; Berry, MF
MLA Citation
Yang, C-FJ, Sun, Z, Speicher, PJ, Saud, SM, Gulack, BC, Hartwig, MG, Harpole, DH, Onaitis, MW, Tong, BC, D'Amico, TA, and Berry, MF. "Use and Outcomes of Minimally Invasive Lobectomy for Stage I Non-Small Cell Lung Cancer in the National Cancer Data Base." The Annals of thoracic surgery 101.3 (March 2016): 1037-1042.
PMID
26822346
Source
epmc
Published In
The Annals of Thoracic Surgery
Volume
101
Issue
3
Publish Date
2016
Start Page
1037
End Page
1042
DOI
10.1016/j.athoracsur.2015.11.018

How I Teach a Thoracoscopic Lobectomy.

Authors
Zwischenberger, BA; D'Amico, TA; Tong, BC
MLA Citation
Zwischenberger, BA, D'Amico, TA, and Tong, BC. "How I Teach a Thoracoscopic Lobectomy." The Annals of thoracic surgery 101.3 (March 2016): 846-849.
PMID
26897185
Source
epmc
Published In
The Annals of Thoracic Surgery
Volume
101
Issue
3
Publish Date
2016
Start Page
846
End Page
849
DOI
10.1016/j.athoracsur.2015.12.033

NCCN Guidelines Insights: Non-Small Cell Lung Cancer, Version 4.2016.

These NCCN Guidelines Insights focus on recent updates in the 2016 NCCN Guidelines for Non-Small Cell Lung Cancer (NSCLC; Versions 1-4). These NCCN Guidelines Insights will discuss new immunotherapeutic agents, such as nivolumab and pembrolizumab, for patients with metastatic NSCLC. For the 2016 update, the NCCN panel recommends immune checkpoint inhibitors as preferred agents (in the absence of contraindications) for second-line and beyond (subsequent) therapy in patients with metastatic NSCLC (both squamous and nonsquamous histologies). Nivolumab and pembrolizumab are preferred based on improved overall survival rates, higher response rates, longer duration of response, and fewer adverse events when compared with docetaxel therapy.

Authors
Ettinger, DS; Wood, DE; Akerley, W; Bazhenova, LA; Borghaei, H; Camidge, DR; Cheney, RT; Chirieac, LR; D'Amico, TA; Dilling, TJ; Dobelbower, MC; Govindan, R; Hennon, M; Horn, L; Jahan, TM; Komaki, R; Lackner, RP; Lanuti, M; Lilenbaum, R; Lin, J; Loo, BW; Martins, R; Otterson, GA; Patel, JD; Pisters, KM; Reckamp, K; Riely, GJ; Schild, SE; Shapiro, TA; Sharma, N; Stevenson, J; Swanson, SJ; Tauer, K; Yang, SC; Gregory, K; Hughes, M
MLA Citation
Ettinger, DS, Wood, DE, Akerley, W, Bazhenova, LA, Borghaei, H, Camidge, DR, Cheney, RT, Chirieac, LR, D'Amico, TA, Dilling, TJ, Dobelbower, MC, Govindan, R, Hennon, M, Horn, L, Jahan, TM, Komaki, R, Lackner, RP, Lanuti, M, Lilenbaum, R, Lin, J, Loo, BW, Martins, R, Otterson, GA, Patel, JD, Pisters, KM, Reckamp, K, Riely, GJ, Schild, SE, Shapiro, TA, Sharma, N, Stevenson, J, Swanson, SJ, Tauer, K, Yang, SC, Gregory, K, and Hughes, M. "NCCN Guidelines Insights: Non-Small Cell Lung Cancer, Version 4.2016." Journal of the National Comprehensive Cancer Network : JNCCN 14.3 (March 2016): 255-264.
PMID
26957612
Source
epmc
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
14
Issue
3
Publish Date
2016
Start Page
255
End Page
264

VATS lobectomy facilitates the delivery of adjuvant docetaxel-carboplatin chemotherapy in patients with non-small cell lung cancer.

Authors
D'Amico, TA
MLA Citation
D'Amico, TA. "VATS lobectomy facilitates the delivery of adjuvant docetaxel-carboplatin chemotherapy in patients with non-small cell lung cancer." Journal of thoracic disease 8.3 (March 2016): 296-297.
PMID
27076920
Source
epmc
Published In
Journal of Thoracic Disease
Volume
8
Issue
3
Publish Date
2016
Start Page
296
End Page
297
DOI
10.21037/jtd.2016.02.36

Modified uniportal video-assisted thoracoscopic surgery (VATS).

Video-assisted thoracoscopic surgery (VATS) for resectable lung cancer patients has been frequently used in the past decades. The potential beneficial advantages and safety of VATS has been shown in large patient series and meta-analyses. The strategy of limiting access to one incision in one intercostal space (uniportal VATS) has been adopted by some thoracic surgeons in recent years. We have described a modified uniportal VATS technique with its potential advantages. Modified uniportal VATS potentially offers better exposure, beneficial opportunities for education and improved comfort for the thoracic surgery team in clinical usage.

Authors
Kara, HV; Balderson, SS; D'Amico, TA
MLA Citation
Kara, HV, Balderson, SS, and D'Amico, TA. "Modified uniportal video-assisted thoracoscopic surgery (VATS)." Annals of cardiothoracic surgery 5.2 (March 2016): 123-126.
PMID
27134839
Source
epmc
Published In
Annals of cardiothoracic surgery
Volume
5
Issue
2
Publish Date
2016
Start Page
123
End Page
126
DOI
10.21037/acs.2016.03.09

Less is more: a shift in the surgical approach to non-small-cell lung cancer

Authors
Cao, C; D'Amico, T; Demmy, T; Dunning, J; Gossot, D; Hansen, H; He, J; Jheon, S; Petersen, RH; Sihoe, A; Swanson, S; Walker, W; Yan, TD
MLA Citation
Cao, C, D'Amico, T, Demmy, T, Dunning, J, Gossot, D, Hansen, H, He, J, Jheon, S, Petersen, RH, Sihoe, A, Swanson, S, Walker, W, and Yan, TD. "Less is more: a shift in the surgical approach to non-small-cell lung cancer." The Lancet Respiratory Medicine 4.3 (March 2016): e11-e12.
Source
crossref
Published In
The Lancet Respiratory Medicine
Volume
4
Issue
3
Publish Date
2016
Start Page
e11
End Page
e12
DOI
10.1016/S2213-2600(16)00024-2

Modern Management of Pulmonary Metastases.

Authors
Onaitis, MW; D'Amico, TA
MLA Citation
Onaitis, MW, and D'Amico, TA. "Modern Management of Pulmonary Metastases." Thoracic surgery clinics 26.1 (February 2016): xi-.
PMID
26611517
Source
epmc
Published In
Thoracic Surgery Clinics
Volume
26
Issue
1
Publish Date
2016
Start Page
xi
DOI
10.1016/j.thorsurg.2015.10.001

Variation in Definitive Therapy for Localized Non-Small Cell Lung Cancer Among National Comprehensive Cancer Network Institutions.

This study determined practice patterns in the staging and treatment of patients with stage I non-small cell lung cancer (NSCLC) among National Comprehensive Cancer Network (NCCN) member institutions. Secondary aims were to determine trends in the use of definitive therapy, predictors of treatment type, and acute adverse events associated with primary modalities of treatment.Data from the National Comprehensive Cancer Network Oncology Outcomes Database from 2007 to 2011 for US patients with stage I NSCLC were used. Main outcome measures included patterns of care, predictors of treatment, acute morbidity, and acute mortality.Seventy-nine percent of patients received surgery, 16% received definitive radiation therapy (RT), and 3% were not treated. Seventy-four percent of the RT patients received stereotactic body RT (SBRT), and the remainder received nonstereotactic RT (NSRT). Among participating NCCN member institutions, the number of surgeries-to-RT course ratios varied between 1.6 and 34.7 (P<.01), and the SBRT-to-NSRT ratio varied between 0 and 13 (P=.01). Significant variations were also observed in staging practices, with brain imaging 0.33 (0.25-0.43) times as likely and mediastinoscopy 31.26 (21.84-44.76) times more likely for surgical patients than for RT patients. Toxicity rates for surgical and for SBRT patients were similar, although the rates were double for NSRT patients.The variations in treatment observed among NCCN institutions reflects the lack of level I evidence directing the use of surgery or SBRT for stage I NSCLC. In this setting, research of patient and physician preferences may help to guide future decision making.

Authors
Valle, LF; Jagsi, R; Bobiak, SN; Zornosa, C; D'Amico, TA; Pisters, KM; Dexter, EU; Niland, JC; Hayman, JA; Kapadia, NS
MLA Citation
Valle, LF, Jagsi, R, Bobiak, SN, Zornosa, C, D'Amico, TA, Pisters, KM, Dexter, EU, Niland, JC, Hayman, JA, and Kapadia, NS. "Variation in Definitive Therapy for Localized Non-Small Cell Lung Cancer Among National Comprehensive Cancer Network Institutions." International journal of radiation oncology, biology, physics 94.2 (February 2016): 360-367.
PMID
26853344
Source
epmc
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
94
Issue
2
Publish Date
2016
Start Page
360
End Page
367
DOI
10.1016/j.ijrobp.2015.10.030

Historical perspectives of The American Association for Thoracic Surgery: Dr David B. Skinner (1935-2003)--a surgeon and something more.

Authors
Southerland, KW; D'Amico, TA
MLA Citation
Southerland, KW, and D'Amico, TA. "Historical perspectives of The American Association for Thoracic Surgery: Dr David B. Skinner (1935-2003)--a surgeon and something more." The Journal of thoracic and cardiovascular surgery 151.1 (January 2016): 1-3.
PMID
26242837
Source
epmc
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
151
Issue
1
Publish Date
2016
Start Page
1
End Page
3
DOI
10.1016/j.jtcvs.2015.07.002

Sublobar Resection for Clinical Stage IA Non-small-cell Lung Cancer in the United States.

This study evaluated the use of lobectomy and sublobar resection for clinical stage IA non-small-cell lung cancer (NSCLC) in the National Cancer Data Base (NCDB).The NCDB from 2003 to 2011 was analyzed to determine factors associated with the use of a sublobar resection versus a lobectomy for the treatment of clinical stage IA NSCLC. Overall survival was assessed using the Kaplan-Meier method and Cox proportional hazard modeling.Among 39,403 patients included for analysis, 29,736 (75.5%) received a lobectomy and 9667 (24.5%) received a sublobar resection: 84.7% wedge resection (n = 8192) and 15.3% segmental resection (n = 1475). Lymph node evaluation was not performed in 2788 (28.8%) of sublobar resection patients, and 7298 (75.5%) of sublobar resections were for tumors ≤ 2 cm. After multivariable logistic regression, older age, higher Charlson-Deyo comorbidity scores, smaller tumor size, and treatment at lower-volume institutions were associated with sublobar resection (all P < .001). Overall, lobectomy was associated with significantly improved 5-year survival compared to sublobar resection (66.2% vs. 51.2%; P < .001, adjusted hazard ratio 0.66; P < .001). However among sublobar resection patients, nodal sampling was associated with significantly better 5-year survival (58.2% vs. 46.4%; P < .001).Despite adjustment for patient and tumor related characteristics, a sublobar resection is associated with significantly reduced long-term survival compared to a formal surgical lobectomy among patients with NSCLC, even for stage 1A tumors. For patients who cannot tolerate lobectomy and who are treated with sublobar resection, lymph node evaluation is essential to help guide further treatment.

Authors
Speicher, PJ; Gu, L; Gulack, BC; Wang, X; D'Amico, TA; Hartwig, MG; Berry, MF
MLA Citation
Speicher, PJ, Gu, L, Gulack, BC, Wang, X, D'Amico, TA, Hartwig, MG, and Berry, MF. "Sublobar Resection for Clinical Stage IA Non-small-cell Lung Cancer in the United States." Clinical lung cancer 17.1 (January 2016): 47-55.
PMID
26602547
Source
epmc
Published In
Clinical lung cancer
Volume
17
Issue
1
Publish Date
2016
Start Page
47
End Page
55
DOI
10.1016/j.cllc.2015.07.005

Video assisted transaxillary first rib resection in treatment of thoracic outlet syndrome (TOS).

Authors
Kara, HV; Balderson, SS; Tong, BC; D'Amico, TA
MLA Citation
Kara, HV, Balderson, SS, Tong, BC, and D'Amico, TA. "Video assisted transaxillary first rib resection in treatment of thoracic outlet syndrome (TOS)." Annals of cardiothoracic surgery 5.1 (January 2016): 67-69. (Review)
PMID
26904437
Source
epmc
Published In
Annals of cardiothoracic surgery
Volume
5
Issue
1
Publish Date
2016
Start Page
67
End Page
69
DOI
10.3978/j.issn.2225-319x.2015.08.09

Historical perspectives of The American Association for Thoracic Surgery: Paul A. Ebert (1932-2009).

Authors
McCoy, CC; D'Amico, TA
MLA Citation
McCoy, CC, and D'Amico, TA. "Historical perspectives of The American Association for Thoracic Surgery: Paul A. Ebert (1932-2009)." The Journal of thoracic and cardiovascular surgery 150.6 (December 2015): 1389-1392.
PMID
26073689
Source
epmc
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
150
Issue
6
Publish Date
2015
Start Page
1389
End Page
1392
DOI
10.1016/j.jtcvs.2015.05.043

Adding radiation to induction chemotherapy does not improve survival of patients with operable clinical N2 non-small cell lung cancer.

Radiotherapy is commonly used in induction regimens for patients with non-small cell lung cancer with operable mediastinal nodal disease, although evidence has not shown a benefit over induction chemotherapy alone. We compared outcomes between induction chemotherapy and induction chemoradiation using the National Cancer Data Base.Induction radiation use and survival of patients who underwent lobectomy or pneumonectomy after induction chemotherapy for clinical T1-3N2M0 non-small cell lung cancer in the National Cancer Data Base from 2003 to 2006 were assessed using logistic regression, general linear regression, Kaplan-Meier, and Cox proportional hazard analysis.Of 1362 patients who met study criteria, 834 (61%) underwent induction chemoradiation and 528 (39%) underwent induction chemotherapy. Lobectomy was performed in 82% of patients (n = 1111), and pneumonectomy was performed in 18% of patients (n = 251). Pneumonectomy was performed more often after induction chemoradiation than after induction chemotherapy (20% vs 16%, P = .04). Downstaging from N2 to N0/N1 was more common with induction chemoradiation compared with induction chemotherapy (58% vs 46%, P < .01), but 5-year survival of patients receiving induction chemoradiation and patients receiving induction chemotherapy was similar in unadjusted analysis (41% vs 41%, P = .41). In multivariable analysis, the addition of radiation to induction chemotherapy also was not associated with a survival benefit (hazard ratio, 1.03; 95% confidence interval, 0.89-1.18; P = .73).Induction chemoradiation is used in the majority of patients with non-small cell lung cancer with N2 disease who undergo induction therapy before surgical resection, but it is not associated with improved survival compared with induction chemotherapy.

Authors
Yang, C-FJ; Gulack, BC; Gu, L; Speicher, PJ; Wang, X; Harpole, DH; Onaitis, MW; D'Amico, TA; Berry, MF; Hartwig, MG
MLA Citation
Yang, C-FJ, Gulack, BC, Gu, L, Speicher, PJ, Wang, X, Harpole, DH, Onaitis, MW, D'Amico, TA, Berry, MF, and Hartwig, MG. "Adding radiation to induction chemotherapy does not improve survival of patients with operable clinical N2 non-small cell lung cancer." The Journal of thoracic and cardiovascular surgery 150.6 (December 2015): 1484-1492.
PMID
26259994
Source
epmc
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
150
Issue
6
Publish Date
2015
Start Page
1484
End Page
1492
DOI
10.1016/j.jtcvs.2015.06.062

The impact of tumor size on the association of the extent of lymph node resection and survival in clinical stage I non-small cell lung cancer.

Lymph node evaluation for node-negative non-small cell lung cancer (NSCLC) is associated with long-term survival but it is not clear if smaller tumors require as extensive a pathologic nodal assessment as larger tumors. This study evaluated the relationship of tumor size and optimal extent of lymph node resection using the National Cancer Data Base (NCDB).The incremental survival benefit of each additional lymph node that was evaluated for patients in the NCDB who underwent lobectomy for clinical Stage I NSCLC from 2003 to 2006 was evaluated using Cox multivariable proportional hazards regression modeling. The impact of tumor size was assessed by repeating the Cox analysis with patients stratified by tumor size ≥2 cm vs <2 cm.A median of 7 [interquartile range: 4,11] lymph nodes were examined in 13,827 patients who met study criteria. Following adjustment, the evaluation of each additional lymph node demonstrated a significant survival benefit through 11 lymph nodes. After grouping patients by tumor size, patients with tumors <2 cm demonstrated a significant survival benefit for the incremental resection of each additional lymph node through 4 lymph nodes while patients with tumors ≥2 cm had a significant survival benefit through 14 lymph nodes.Pathologic lymph node evaluation is associated with improved survival for clinically node-negative NSCLC, but the extent of the necessary evaluation varies by tumor size. These results have implications for guidelines for lymph node assessment as well as the choice of surgery vs other ablative techniques for clinical stage I NSCLC.

Authors
Gulack, BC; Yang, C-FJ; Speicher, PJ; Meza, JM; Gu, L; Wang, X; D'Amico, TA; Hartwig, MG; Berry, MF
MLA Citation
Gulack, BC, Yang, C-FJ, Speicher, PJ, Meza, JM, Gu, L, Wang, X, D'Amico, TA, Hartwig, MG, and Berry, MF. "The impact of tumor size on the association of the extent of lymph node resection and survival in clinical stage I non-small cell lung cancer." Lung cancer (Amsterdam, Netherlands) 90.3 (December 2015): 554-560.
PMID
26519122
Source
epmc
Published In
Lung Cancer
Volume
90
Issue
3
Publish Date
2015
Start Page
554
End Page
560
DOI
10.1016/j.lungcan.2015.10.011

Invited Commentary.

Authors
D'Amico, TA
MLA Citation
D'Amico, TA. "Invited Commentary." The Annals of thoracic surgery 100.6 (December 2015): 2053-2054.
PMID
26652514
Source
epmc
Published In
The Annals of Thoracic Surgery
Volume
100
Issue
6
Publish Date
2015
Start Page
2053
End Page
2054
DOI
10.1016/j.athoracsur.2015.06.002

The History of Duke Thoracic Surgery.

Since 1931, Duke Thoracic Surgery has been defined by excellence in patient care, research, and the education of leaders in surgery. In this work, the history, contributions, historic figures, and current structure of the program are reviewed. The program has cultivated a commitment to surgical investigation and training that persists to the present day. This commitment is manifest by the program's contributions to the field of cardiothoracic surgery, from the fundamental investigation of the coronary circulation and the development of the heat exchanger for myocardial preservation, to large-scale clinical trials in cardiac and thoracic surgery.

Authors
Smith, PK; Mulvihill, MS; D'Amico, TA
MLA Citation
Smith, PK, Mulvihill, MS, and D'Amico, TA. "The History of Duke Thoracic Surgery." Seminars in thoracic and cardiovascular surgery 27.4 (December 2015): 360-369.
PMID
26811042
Source
epmc
Published In
Seminars in Thoracic and Cardiovascular Surgery
Volume
27
Issue
4
Publish Date
2015
Start Page
360
End Page
369
DOI
10.1053/j.semtcvs.2015.10.009

Induction chemoradiation therapy prior to esophagectomy is associated with superior long-term survival for esophageal cancer.

The purpose of this study was to examine the role of induction chemoradiation in the treatment of potentially resectable locally advanced (T2-3N0 and T1-3N+) esophageal cancer utilizing a large national database. The National Cancer Data Base (NCDB) was queried for all patients undergoing esophagectomy for clinical T2-3N0 and T1-3N+ esophageal cancer of the mid- or lower esophagus. Patients were stratified by the use of induction chemoradiation therapy versus surgery-first. Trends were assessed with the Cochran-Armitage test. Predictors of receiving induction therapy were evaluated with multivariable logistic regression. A propensity-matched analysis was conducted to compare outcomes between groups, and the Kaplan-Meier method was used to estimate long-term survival. Within the NCDB, 7921 patients were identified, of which 6103 (77.0%) were treated with chemoradiation prior to esophagectomy, while the remaining 1818 (23.0%) were managed with surgery-first. Use of induction therapy increased over time, with an absolute increase of 11.8% from 2003-2011 (P < 0.001). As revealed by the propensity model, induction therapy was associated with higher rates of negative margins and shorter hospital length of stay, but no differences in unplanned readmission and 30-day mortality rates. In unadjusted survival analysis, induction therapy was associated with better long-term survival compared to a strategy of surgery-first, with 5-year survival rates of 37.2% versus 28.6%, P < 0.001. Following propensity score matching analysis, the use of induction therapy maintained a significant survival advantage over surgery-first (5-year survival: 37.9% vs. 28.7%, P < 0.001). Treatment with induction chemoradiation therapy prior to surgical resection is associated with significant improvement in long-term survival, even after adjusting for confounders with a propensity model. Induction therapy should be considered in all medically appropriate patients with resectable cT2-3N0 and cT1-3N+ esophageal cancer, prior to esophagectomy.

Authors
Speicher, PJ; Wang, X; Englum, BR; Ganapathi, AM; Yerokun, B; Hartwig, MG; D'Amico, TA; Berry, MF
MLA Citation
Speicher, PJ, Wang, X, Englum, BR, Ganapathi, AM, Yerokun, B, Hartwig, MG, D'Amico, TA, and Berry, MF. "Induction chemoradiation therapy prior to esophagectomy is associated with superior long-term survival for esophageal cancer." Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus 28.8 (November 2015): 788-796.
PMID
25212528
Source
epmc
Published In
Diseases of the Esophagus
Volume
28
Issue
8
Publish Date
2015
Start Page
788
End Page
796
DOI
10.1111/dote.12285

Invited Commentary.

Authors
D'Amico, TA
MLA Citation
D'Amico, TA. "Invited Commentary." The Annals of thoracic surgery 100.5 (November 2015): 1802-1803.
PMID
26522526
Source
epmc
Published In
The Annals of Thoracic Surgery
Volume
100
Issue
5
Publish Date
2015
Start Page
1802
End Page
1803
DOI
10.1016/j.athoracsur.2015.04.067

Thoracoscopic diaphragm plication.

Authors
Kara, HV; Roach, MJ; Balderson, SS; D'Amico, TA
MLA Citation
Kara, HV, Roach, MJ, Balderson, SS, and D'Amico, TA. "Thoracoscopic diaphragm plication." Annals of cardiothoracic surgery 4.6 (November 2015): 573-575. (Review)
PMID
26693159
Source
epmc
Published In
Annals of cardiothoracic surgery
Volume
4
Issue
6
Publish Date
2015
Start Page
573
End Page
575
DOI
10.3978/j.issn.2225-319x.2015.08.11

Troubleshooting thoracoscopic anterior mediastinal surgery: lessons learned from thoracoscopic lobectomy.

Video-assisted thoracoscopic surgery (VATS) lobectomy is safe, oncologically effective, and increasingly utilized for lung cancer resection. Lessons from VATS lobectomy experience can guide the use of a VATS approach to resect mediastinal masses. Exposure and dissection when using VATS to resect anterior mediastinal masses has unique challenges. Several maneuvers acquired from experience with VATS lobectomy can reduce the technical difficulty and often prevent conversion to an open approach. In this troubleshooting guide, we offer 'tips' to both avoid and manage numerous intra-operative technical difficulties that commonly arise during VATS anterior mediastinal procedures. Avoiding an open approach may improve outcomes, although conversion for safety or complete resection can be necessary. Techniques and experiences derived from VATS lobectomy can facilitate VATS resection of mediastinal masses.

Authors
Hirji, SA; Balderson, SS; Berry, MF; D'Amico, TA
MLA Citation
Hirji, SA, Balderson, SS, Berry, MF, and D'Amico, TA. "Troubleshooting thoracoscopic anterior mediastinal surgery: lessons learned from thoracoscopic lobectomy." Annals of cardiothoracic surgery 4.6 (November 2015): 545-549.
PMID
26693151
Source
epmc
Published In
Annals of cardiothoracic surgery
Volume
4
Issue
6
Publish Date
2015
Start Page
545
End Page
549
DOI
10.3978/j.issn.2225-319x.2015.07.04

Racial and Ethnic Differences in Lung Cancer Surgical Stage: An STS Database Study.

Racial and ethnic differences in lung cancer care have been previously documented. These differences may be related to access to care, cultural differences, or fewer patients presenting with operable lung cancer. The relationship between race and pathologic stage of patients who undergo lung cancer resection has not been defined. This study estimates racial disparities in lung cancer stage among patients who undergo surgical resection.The Society of Thoracic Surgeons (STS) database was queried for patients who underwent resection of non-small cell lung cancer and had complete pathologic staging and racial identification. Univariate and multivariate analyses were performed. Study end point was the pathologic stage and we evaluated its association with the racial and ethnic origins of the patients.Of 19,173 eligible patients with non-small cell lung cancer of known pathological stage who underwent surgery between 2002 and 2008, the majority were Caucasian (17,148, 89.4%), 1,502 (7.8%) were African-American, 273 (1.4%) were Asian, and 250 (1.3%) were Hispanic. In univariate analysis, significantly more Caucasian and African-American patients underwent resection of stage I/II lung cancer (13,929, 81.2% and 1,217, 81%, respectively) as compared with the Asian (207, 75.2%) and Hispanic (188, 75.8%) patients (p = 0.007). Stage at operation did not differ between Caucasians and African-Americans. Multivariate analysis confirmed these findings (p = 0.03) after adjustment for age, gender, tobacco use, diabetes, and year of surgery.Within the STS database, patients identified as Asian or Hispanic had a significantly higher pathologic stage at the time of resection than Caucasian or African-American patients. The causes of these differences in the treatment of potentially curable lung cancer are unknown and require further investigation.

Authors
Weksler, B; Kosinski, AS; Burfeind, WR; Silvestry, SC; Sullivan, J; D'Amico, TA
MLA Citation
Weksler, B, Kosinski, AS, Burfeind, WR, Silvestry, SC, Sullivan, J, and D'Amico, TA. "Racial and Ethnic Differences in Lung Cancer Surgical Stage: An STS Database Study." The Thoracic and cardiovascular surgeon 63.7 (October 2015): 538-543.
PMID
25984780
Source
epmc
Published In
The Thoracic and Cardiovascular Surgeon
Volume
63
Issue
7
Publish Date
2015
Start Page
538
End Page
543
DOI
10.1055/s-0035-1546295

An e-score is born.

Authors
D'Amico, TA
MLA Citation
D'Amico, TA. "An e-score is born." The Journal of thoracic and cardiovascular surgery 150.4 (October 2015): 813-.
PMID
26242839
Source
epmc
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
150
Issue
4
Publish Date
2015
Start Page
813
DOI
10.1016/j.jtcvs.2015.07.030

Right-Sided vs. Left-Sided Pneumonectomy after Induction Therapy for Non-Small Cell Lung Cancer

Authors
Yang, C-FJ; Chan, DY; Gulack, BC; Ranney, DN; Tong, BC; Onaitis, MW; Harpole, D; D'Amico, TA; Hartwig, MG; Berry, MF
MLA Citation
Yang, C-FJ, Chan, DY, Gulack, BC, Ranney, DN, Tong, BC, Onaitis, MW, Harpole, D, D'Amico, TA, Hartwig, MG, and Berry, MF. "Right-Sided vs. Left-Sided Pneumonectomy after Induction Therapy for Non-Small Cell Lung Cancer." JOURNAL OF THORACIC ONCOLOGY 10.9 (September 2015): S335-S336.
Source
wos-lite
Published In
Journal of Thoracic Oncology
Volume
10
Issue
9
Publish Date
2015
Start Page
S335
End Page
S336

Survival after Surgery for pN1 and pN2 Small Cell Lung Cancer: A Comparison with Surgical Treatment of Non-Small Cell Lung Cancer

Authors
Yang, C-FJ; Chan, DY; Gulack, BC; Speicher, PJ; Hartwig, MG; Berry, MF; Tong, BC; Onaitis, MW; D'Amico, TA; Harpole, D
MLA Citation
Yang, C-FJ, Chan, DY, Gulack, BC, Speicher, PJ, Hartwig, MG, Berry, MF, Tong, BC, Onaitis, MW, D'Amico, TA, and Harpole, D. "Survival after Surgery for pN1 and pN2 Small Cell Lung Cancer: A Comparison with Surgical Treatment of Non-Small Cell Lung Cancer." JOURNAL OF THORACIC ONCOLOGY 10.9 (September 2015): S399-S400.
Source
wos-lite
Published In
Journal of Thoracic Oncology
Volume
10
Issue
9
Publish Date
2015
Start Page
S399
End Page
S400

Long-Term Survival after Surgery for Pathologic N1 and N2 Small Cell Lung Cancer: A Comparison with Nonoperative Management

Authors
Yang, C-FJ; Chan, DY; Speicher, PJ; Gulack, BC; Onaitis, MW; Hartwig, MG; Tong, BC; Berry, MF; D'Amico, TA; Harpole, D
MLA Citation
Yang, C-FJ, Chan, DY, Speicher, PJ, Gulack, BC, Onaitis, MW, Hartwig, MG, Tong, BC, Berry, MF, D'Amico, TA, and Harpole, D. "Long-Term Survival after Surgery for Pathologic N1 and N2 Small Cell Lung Cancer: A Comparison with Nonoperative Management." JOURNAL OF THORACIC ONCOLOGY 10.9 (September 2015): S193-S194.
Source
wos-lite
Published In
Journal of Thoracic Oncology
Volume
10
Issue
9
Publish Date
2015
Start Page
S193
End Page
S194

Wedge Resection vs Segmentectomy for Patients with T1A N0 Non-Small Cell Lung Cancer

Authors
Yang, C-FJ; Chan, DY; Gulack, BC; Speicher, PJ; Onaitis, MW; Tong, BC; D'Amico, TA; Harpole, D; Berry, MF; Hartwig, MG
MLA Citation
Yang, C-FJ, Chan, DY, Gulack, BC, Speicher, PJ, Onaitis, MW, Tong, BC, D'Amico, TA, Harpole, D, Berry, MF, and Hartwig, MG. "Wedge Resection vs Segmentectomy for Patients with T1A N0 Non-Small Cell Lung Cancer." JOURNAL OF THORACIC ONCOLOGY 10.9 (September 2015): S242-S242.
Source
wos-lite
Published In
Journal of Thoracic Oncology
Volume
10
Issue
9
Publish Date
2015
Start Page
S242
End Page
S242

Impact of Radiation on Recurrence Patterns and Survival for Patients Undergoing Lobectomy for Stage IIIA-pN2 Non-Small Cell Lung Cancer

Authors
Yang, C-FJ; Adil, SM; Meyerhoff, RR; Anderson, KL; Hirji, SA; Harpole, D; Tong, BC; Onaitis, MW; Hartwig, MG; D'Amico, TA; Berry, MF
MLA Citation
Yang, C-FJ, Adil, SM, Meyerhoff, RR, Anderson, KL, Hirji, SA, Harpole, D, Tong, BC, Onaitis, MW, Hartwig, MG, D'Amico, TA, and Berry, MF. "Impact of Radiation on Recurrence Patterns and Survival for Patients Undergoing Lobectomy for Stage IIIA-pN2 Non-Small Cell Lung Cancer." JOURNAL OF THORACIC ONCOLOGY 10.9 (September 2015): S573-S573.
Source
wos-lite
Published In
Journal of Thoracic Oncology
Volume
10
Issue
9
Publish Date
2015
Start Page
S573
End Page
S573

Historical perspectives of The American Association for Thoracic Surgery: David C. Sabiston, Jr (1924-2009).

Authors
D'Amico, TA
MLA Citation
D'Amico, TA. "Historical perspectives of The American Association for Thoracic Surgery: David C. Sabiston, Jr (1924-2009)." The Journal of thoracic and cardiovascular surgery 150.2 (August 2015): 275-278.
PMID
25135240
Source
epmc
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
150
Issue
2
Publish Date
2015
Start Page
275
End Page
278
DOI
10.1016/j.jtcvs.2014.07.010

Training Assistants Improves the Process of Adoption of Video-Assisted Thoracic Surgery Lobectomy.

Despite overwhelming evidence of decreased pain, fewer complications, and shorter length of stay with equivalent oncologic outcomes, video-assisted thoracic surgery (VATS) lobectomy has been slow to be adopted in the community. This study evaluates the role of training surgical assistants to ease the transition to VATS lobectomy.A half-day training course for physician assistants in the specific skills needed to assist with VATS lobectomy was developed to be offered annually in conjunction with a national meeting. Each participant completed a needs assessment before the course and a course assessment afterward. One-year follow-up data were obtained from the first cohort to determine the effects of the course on their practice.Forty-four physician assistants participated in the course in either 2013 or 2014. Participant-identified educational needs included enhanced camera navigation skills, use of specialized instruments, and knowledge of the steps of the operation to provide proactive assistance. After completing the course, 90% (n = 39) felt more confident in their ability to provide optimal visualization for the operating surgeon, and 93% (n = 40) felt more confident in their ability to recognize and anticipate the steps of a VATS lobectomy. These changes persisted at 1 year.Specific training directed at surgical assistants may improve the adoption of new technology by mechanisms including improved visualization and better understanding of methods to facilitate the operation and avoid frustration. This type of training should be made available to assistants of surgeons learning new operations.

Authors
Meyerson, SL; Balderson, SS; D'Amico, TA
MLA Citation
Meyerson, SL, Balderson, SS, and D'Amico, TA. "Training Assistants Improves the Process of Adoption of Video-Assisted Thoracic Surgery Lobectomy." The Annals of thoracic surgery 100.2 (August 2015): 401-406.
PMID
26116475
Source
epmc
Published In
The Annals of Thoracic Surgery
Volume
100
Issue
2
Publish Date
2015
Start Page
401
End Page
406
DOI
10.1016/j.athoracsur.2015.03.087

Growth and Change at NCCN.

Authors
D'Amico, TA
MLA Citation
D'Amico, TA. "Growth and Change at NCCN." Journal of the National Comprehensive Cancer Network : JNCCN 13.8 (August 2015): 946-.
PMID
26285239
Source
epmc
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
13
Issue
8
Publish Date
2015
Start Page
946

Uniportal VATS-a new era in lung cancer surgery.

Authors
Ng, CSH; Gonzalez-Rivas, D; D'Amico, TA; Rocco, G
MLA Citation
Ng, CSH, Gonzalez-Rivas, D, D'Amico, TA, and Rocco, G. "Uniportal VATS-a new era in lung cancer surgery." Journal of thoracic disease 7.8 (August 2015): 1489-1491.
PMID
26380777
Source
epmc
Published In
Journal of Thoracic Disease
Volume
7
Issue
8
Publish Date
2015
Start Page
1489
End Page
1491
DOI
10.3978/j.issn.2072-1439.2015.08.19

Improving lung cancer outcomes by improving the quality of surgical care.

Surgical resection remains the most important curative treatment modality for non-small cell lung cancer, but variations in short- and long-term surgical outcomes jeopardize the benefit of surgery for certain patients, operated on by certain types of surgeons, at certain types of institutions. We discuss current understanding of surgical quality measures, and their role in promoting understanding of the causes of outcome disparities after lung cancer surgery. We also discuss the use of minimally invasive surgical resection approaches to expand the playing field for surgery in lung cancer care, and end with a discussion of the future role of surgery in a world of alternative treatment possibilities.

Authors
Osarogiagbon, RU; D'Amico, TA
MLA Citation
Osarogiagbon, RU, and D'Amico, TA. "Improving lung cancer outcomes by improving the quality of surgical care." Translational lung cancer research 4.4 (August 2015): 424-431.
PMID
26380183
Source
epmc
Published In
Translational lung cancer research
Volume
4
Issue
4
Publish Date
2015
Start Page
424
End Page
431
DOI
10.3978/j.issn.2218-6751.2015.08.01

Surgery versus SABR for resectable non-small-cell lung cancer.

Authors
Cao, C; D'Amico, T; Demmy, T; Dunning, J; Gossot, D; Hansen, H; He, J; Jheon, S; Petersen, RH; Sihoe, A; Swanson, S; Walker, W; Yan, TD
MLA Citation
Cao, C, D'Amico, T, Demmy, T, Dunning, J, Gossot, D, Hansen, H, He, J, Jheon, S, Petersen, RH, Sihoe, A, Swanson, S, Walker, W, and Yan, TD. "Surgery versus SABR for resectable non-small-cell lung cancer." The Lancet. Oncology 16.8 (August 2015): e370-e371.
PMID
26248836
Source
epmc
Published In
The Lancet Oncology
Volume
16
Issue
8
Publish Date
2015
Start Page
e370
End Page
e371
DOI
10.1016/s1470-2045(15)00036-4

Impact of Pulmonary Function Measurements on Long-Term Survival After Lobectomy for Stage I Non-Small Cell Lung Cancer.

Pulmonary function tests predict respiratory complications after lobectomy. We evaluated the impact of pulmonary function measurements on long-term survival after lobectomy for stage I non-small cell lung cancer.The relationship between percent predicted forced expiratory volume in 1 second (FEV1) and percent predicted diffusing capacity of the lung for carbon monoxide (Dlco) and overall survival for patients who underwent lobectomy without induction therapy for stage I (T1-2N0M0) non-small cell lung cancer from 1996 to 2012 was evaluated using the Kaplan-Meier approach and a multivariable Cox proportional hazard model.During the study period, 972 patients (mean Dlco 76 ± 21, mean FEV1 73 ± 21) met inclusion criteria. Perioperative mortality was 2.6% (n = 25). The 5-year survival of the entire cohort was 60.1%, with a median follow-up of 43 months. The 5-year survival for patients with percent predicted FEV1 stratified by more than 80%, 61% to 80%, 41% to 60%, and 40% or less was 70.1%, 59.3%, 52.5%, and 53.4%, respectively. The 5-year survival for patients with percent predicted Dlco stratified by more than 80%, 61% to 80%, 41% to 60%, and 40% or less was 70.2%, 63.4%, 44.2%, and 33.1%, respectively. In multivariable survival analysis, both larger tumor size (hazard ratio 1.15, p = 0.01) and lower Dlco (hazard ratio 0.986, p < 0.0001) were significant predictors of worse survival. The association of FEV1 and survival was not statistically significant (p = 0.18).Survival after lobectomy for patients with stage I non-small cell lung cancer is impacted by lower Dlco, which can be used in the risk and benefit assessment when choosing therapy.

Authors
Berry, MF; Yang, C-FJ; Hartwig, MG; Tong, BC; Harpole, DH; D'Amico, TA; Onaitis, MW
MLA Citation
Berry, MF, Yang, C-FJ, Hartwig, MG, Tong, BC, Harpole, DH, D'Amico, TA, and Onaitis, MW. "Impact of Pulmonary Function Measurements on Long-Term Survival After Lobectomy for Stage I Non-Small Cell Lung Cancer." The Annals of thoracic surgery 100.1 (July 2015): 271-276.
PMID
25986099
Source
epmc
Published In
The Annals of Thoracic Surgery
Volume
100
Issue
1
Publish Date
2015
Start Page
271
End Page
276
DOI
10.1016/j.athoracsur.2015.02.076

Personalized targeted therapy for esophageal squamous cell carcinoma.

Esophageal squamous cell carcinoma continues to heavily burden clinicians worldwide. Researchers have discovered the genomic landscape of esophageal squamous cell carcinoma, which holds promise for an era of personalized oncology care. One of the most pressing problems facing this issue is to improve the understanding of the newly available genomic data, and identify the driver-gene mutations, pathways, and networks. The emergence of a legion of novel targeted agents has generated much hope and hype regarding more potent treatment regimens, but the accuracy of drug selection is still arguable. Other problems, such as cancer heterogeneity, drug resistance, exceptional responders, and side effects, have to be surmounted. Evolving topics in personalized oncology, such as interpretation of genomics data, issues in targeted therapy, research approaches for targeted therapy, and future perspectives, will be discussed in this editorial.

Authors
Kang, X; Chen, K; Li, Y; Li, J; D'Amico, TA; Chen, X
MLA Citation
Kang, X, Chen, K, Li, Y, Li, J, D'Amico, TA, and Chen, X. "Personalized targeted therapy for esophageal squamous cell carcinoma." World journal of gastroenterology 21.25 (July 2015): 7648-7658. (Review)
PMID
26167067
Source
epmc
Published In
World journal of gastroenterology : WJG
Volume
21
Issue
25
Publish Date
2015
Start Page
7648
End Page
7658
DOI
10.3748/wjg.v21.i25.7648

Impact of mesothelioma histologic subtype on outcomes in the Surveillance, Epidemiology, and End Results database.

This study was conducted to determine how malignant pleural mesothelioma (MPM) histology was associated with the use of surgery and survival.Overall survival of patients with stage I-III epithelioid, sarcomatoid, and biphasic MPM in the Surveillance, Epidemiology, and End Results database from 2004-2010 was evaluated using multivariate Cox proportional hazards models.Of 1183 patients who met inclusion criteria, histologic subtype was epithelioid in 811 patients (69%), biphasic in 148 patients (12%), and sarcomatoid in 224 patients (19%). Median survival was 14 mo in the epithelioid group, 10 mo in the biphasic group, and 4 mo in the sarcomatoid group (P < 0.01). Cancer-directed surgery was used more often in patients with epithelioid (37%, 299/811) and biphasic (44%, 65/148) histologies as compared with patients with sarcomatoid histology (26%, 58/224; P < 0.01). Among patients who underwent surgery, median survival was 19 mo in the epithelioid group, 12 mo in the biphasic group, and 4 mo in the sarcomatoid group (P < 0.01). In multivariate analysis, surgery was associated with improved survival in the epithelioid group (hazard ratio [HR] 0.72; P < 0.01) but not in biphasic (HR 0.73; P = 0.19) or sarcomatoid (HR 0.79; P = 0.18) groups.Cancer-directed surgery is associated with significantly improved survival for MPM patients with epithelioid histology, but patients with sarcomatoid and biphasic histologies have poor prognoses that may not be favored by operative treatment. The specific histology should be identified before treatment, so that surgery can be offered to patients with epithelioid histology, as these patients are most likely to benefit.

Authors
Meyerhoff, RR; Yang, C-FJ; Speicher, PJ; Gulack, BC; Hartwig, MG; D'Amico, TA; Harpole, DH; Berry, MF
MLA Citation
Meyerhoff, RR, Yang, C-FJ, Speicher, PJ, Gulack, BC, Hartwig, MG, D'Amico, TA, Harpole, DH, and Berry, MF. "Impact of mesothelioma histologic subtype on outcomes in the Surveillance, Epidemiology, and End Results database." The Journal of surgical research 196.1 (June 2015): 23-32.
PMID
25791825
Source
epmc
Published In
Journal of Surgical Research
Volume
196
Issue
1
Publish Date
2015
Start Page
23
End Page
32
DOI
10.1016/j.jss.2015.01.043

Long-Term Outcomes of Lobectomy for Non-Small Cell Lung Cancer After Definitive Radiation Treatment.

Salvage surgical resection for non-small cell lung cancer (NSCLC) patients initially treated with definitive chemotherapy and radiotherapy can be performed safely, but the long-term benefits are not well characterized.Perioperative complications and long-term survival of all patients with NSCLC who received curative-intent definitive radiotherapy, with or without chemotherapy, followed by lobectomy from 1995 to 2012 were evaluated.During the study period, 31 patients met the inclusion criteria. Clinical stage distribution was stage I in 2 (6%), stage II in 5 (16%), stage IIIA in 15 (48%), stage IIIB in 5 (16%), stage IV in 3 (10%), and unknown in 1 (3%). The reasons surgical resection was initially not considered were: patients deemed medically inoperable (5 [16%]); extent of disease was considered unresectable (21 [68%]); small cell lung cancer misdiagnosis (1 [3%]), and unknown (4 [13%]). Definitive therapy was irradiation alone in 2 (6%), concurrent chemoradiotherapy in 28 (90%), and sequential chemoradiotherapy in 1 (3%). The median radiation dose was 60 Gy. Patients were subsequently referred for resection because of obvious local relapse, medical tolerance of surgical intervention, or posttherapy imaging suggesting residual disease. The median time from radiation to lobectomy was 17.7 weeks. There were no perioperative deaths, and morbidity occurred in 15 patients (48%). None of the 3 patients with residual pathologic nodal disease survived longer than 37 months, but the 5-year survival of pN0 patients was 36%. Patients who underwent lobectomy for obvious relapse (n = 3) also did poorly, with a median overall survival of 9 months.Lobectomy after definitive radiotherapy can be done safely and is associated with reasonable long-term survival, particularly when patients do not have residual nodal disease.

Authors
Yang, C-FJ; Meyerhoff, RR; Stephens, SJ; Singhapricha, T; Toomey, CB; Anderson, KL; Kelsey, C; Harpole, D; D'Amico, TA; Berry, MF
MLA Citation
Yang, C-FJ, Meyerhoff, RR, Stephens, SJ, Singhapricha, T, Toomey, CB, Anderson, KL, Kelsey, C, Harpole, D, D'Amico, TA, and Berry, MF. "Long-Term Outcomes of Lobectomy for Non-Small Cell Lung Cancer After Definitive Radiation Treatment." The Annals of thoracic surgery 99.6 (June 2015): 1914-1920.
PMID
25886806
Source
epmc
Published In
The Annals of Thoracic Surgery
Volume
99
Issue
6
Publish Date
2015
Start Page
1914
End Page
1920
DOI
10.1016/j.athoracsur.2015.01.064

Adjuvant Chemotherapy After Lobectomy for T1-2N0 Non-Small Cell Lung Cancer: Are the Guidelines Supported?

Evidence guiding adjuvant chemotherapy (AC) use after lobectomy for stage I non-small cell lung cancer (NSCLC) is limited. This study evaluated the impact of AC use and tumor size on outcomes using a large, nationwide cancer database.The effect of AC on long-term survival among patients who underwent lobectomy for margin-negative pathologic T1-2N0M0 NSCLC in the National Cancer Data Base from 2003 to 2006 was estimated using the Kaplan-Meier method. The specific tumor size threshold at which AC began providing benefit was estimated with multivariable Cox proportional hazards modeling.Overall 3,496 of 34,360 patients (10.2%) who met inclusion criteria were treated with AC, although AC use increased over time from 2003, when only 2.7% of patients with tumors less than 4 cm and 6.2% of patients with tumors of 4 cm or larger received AC. In unadjusted survival analysis, AC was associated with a significant 5-year survival benefit for patients with tumors less than 4 cm (74.3% vs 66.9%; P<.0001) and 4 cm or greater (64.8% vs 49.8%; P<.0001). In subanalyses of patients grouped by strata of 0.5-cm increments in tumor size, AC was associated with a survival advantage for tumor sizes ranging from 3.0 to 8.5 cm.Use of AC among patients with stage I NSCLC has increased over time but remains uncommon. The results of this study support current treatment guidelines that recommend AC use after lobectomy for stage I NSCLC tumors larger than 4 cm. These results also suggest that AC use is associated with superior survival for patients with tumors ranging from 3.0 to 8.5 cm in diameter.

Authors
Speicher, PJ; Gu, L; Wang, X; Hartwig, MG; D'Amico, TA; Berry, MF
MLA Citation
Speicher, PJ, Gu, L, Wang, X, Hartwig, MG, D'Amico, TA, and Berry, MF. "Adjuvant Chemotherapy After Lobectomy for T1-2N0 Non-Small Cell Lung Cancer: Are the Guidelines Supported?." Journal of the National Comprehensive Cancer Network : JNCCN 13.6 (June 2015): 755-761.
PMID
26085391
Source
epmc
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
13
Issue
6
Publish Date
2015
Start Page
755
End Page
761

Non-Small Cell Lung Cancer, Version 6.2015.

These NCCN Guidelines Insights focus on recent updates to the 2015 NCCN Guidelines for Non-Small Cell Lung Cancer (NSCLC). Appropriate targeted therapy is very effective in patients with advanced NSCLC who have specific genetic alterations. Therefore, it is important to test tumor tissue from patients with advanced NSCLC to determine whether they have genetic alterations that make them candidates for specific targeted therapies. These NCCN Guidelines Insights describe the different testing methods currently available for determining whether patients have genetic alterations in the 2 most commonly actionable genetic alterations, notably anaplastic lymphoma kinase (ALK) gene rearrangements and sensitizing epidermal growth factor receptor (EGFR) mutations.

Authors
Ettinger, DS; Wood, DE; Akerley, W; Bazhenova, LA; Borghaei, H; Camidge, DR; Cheney, RT; Chirieac, LR; D'Amico, TA; Demmy, TL; Dilling, TJ; Dobelbower, MC; Govindan, R; Grannis, FW; Horn, L; Jahan, TM; Komaki, R; Krug, LM; Lackner, RP; Lanuti, M; Lilenbaum, R; Lin, J; Loo, BW; Martins, R; Otterson, GA; Patel, JD; Pisters, KM; Reckamp, K; Riely, GJ; Rohren, E; Schild, SE; Shapiro, TA; Swanson, SJ; Tauer, K; Yang, SC; Gregory, K; Hughes, M
MLA Citation
Ettinger, DS, Wood, DE, Akerley, W, Bazhenova, LA, Borghaei, H, Camidge, DR, Cheney, RT, Chirieac, LR, D'Amico, TA, Demmy, TL, Dilling, TJ, Dobelbower, MC, Govindan, R, Grannis, FW, Horn, L, Jahan, TM, Komaki, R, Krug, LM, Lackner, RP, Lanuti, M, Lilenbaum, R, Lin, J, Loo, BW, Martins, R, Otterson, GA, Patel, JD, Pisters, KM, Reckamp, K, Riely, GJ, Rohren, E, Schild, SE, Shapiro, TA, Swanson, SJ, Tauer, K, Yang, SC, Gregory, K, and Hughes, M. "Non-Small Cell Lung Cancer, Version 6.2015." Journal of the National Comprehensive Cancer Network : JNCCN 13.5 (May 2015): 515-524.
PMID
25964637
Source
epmc
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
13
Issue
5
Publish Date
2015
Start Page
515
End Page
524

Outcomes after treatment of 17,378 patients with locally advanced (T3N0-2) non-small-cell lung cancer.

Treatment patterns and outcomes in a population-based database were examined to identify patients likely to benefit from surgical resection of locally advanced (T3N0-2) non-small-cell lung cancer (NSCLC).Factors predicting the use of surgery for patients with T3N0-2M0 NSCLC in the Surveillance, Epidemiology and End Results (SEER) database from 1988 to 2010 were assessed using a multivariable logistic regression model. Survival was analysed using the Kaplan-Meier approach and Cox proportional hazard models. Propensity matching was used to compare outcomes after surgery and outcomes in patients who refused surgery and underwent radiation therapy (RT).Of 17 378 patients identified for study inclusion [8597 (50%) T3N0, 2304 (13%) T3N1 and 6477 (37%) T3N2], surgery was used in 7120 (41%). Only female sex and being married predicted the use of surgery, while older age, black race and N2 nodal disease predicted non-surgical management. Surgical patients overall had better long-term survival than non-surgical patients [odds ratio (OR) 0.42, 95% confidence interval (CI): 0.41-0.45, P < 0.001]. After propensity adjustment, patients who refused surgery and instead were treated with RT had significantly worse long-term survival than matched surgery patients (OR 0.65, 95% CI: 0.48-0.89, P = 0.0074). Sublobar resection and pneumonectomy predicted worse survival in patients who had surgery. Nodal disease also predicted worse survival after surgery, but surgery maintained an association with better overall survival compared with non-operative therapy among patients with both N1 (OR 0.53, P < 0.001) and N2 disease (OR 0.50, P < 0.001) in separate analyses stratified by nodal status. Older age also predicted worse survival after surgery, but patients older than 75 who were treated with surgery had significantly better long-term survival than non-operative patients (OR 0.49, 95% CI: 0.45-0.53, P < 0.001).Surgery is used in a minority of patients with locally advanced NSCLC, but is associated with better survival than non-surgical treatment, even for patients older than 75 and patients with nodal disease. Given the very poor outcomes observed with non-operative management, surgical resection should be carefully considered in all patients with locally advanced NSCLC and should not necessarily be denied because of patient age or nodal disease.

Authors
Speicher, PJ; Englum, BR; Ganapathi, AM; Onaitis, MW; D'Amico, TA; Berry, MF
MLA Citation
Speicher, PJ, Englum, BR, Ganapathi, AM, Onaitis, MW, D'Amico, TA, and Berry, MF. "Outcomes after treatment of 17,378 patients with locally advanced (T3N0-2) non-small-cell lung cancer." European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 47.4 (April 2015): 636-641.
PMID
25005840
Source
epmc
Published In
European Journal of Cardio-Thoracic Surgery
Volume
47
Issue
4
Publish Date
2015
Start Page
636
End Page
641
DOI
10.1093/ejcts/ezu270

Accuracy of positron emission tomography in identifying hilar (N1) lymph node involvement in non-small cell lung cancer: Implications for stereotactic body radiation therapy.

To assess the efficacy of preoperative positron emission tomography (PET) to stage the ipsilateral hilum in resected non-small cell lung cancer (NSCLC).All patients who underwent surgery for NSCLC between 1995 and 2008 were evaluated. Patients who underwent preoperative PET imaging at our institution and had hilar nodal sampling were included. Those whose primary tumors extended to the hilum or who received preoperative chemotherapy or radiation therapy were excluded. All PET studies were interpreted by an attending nuclear medicine radiologist and were scored as positive or negative in the hilum or peribronchial area based on visual analysis alone. A 2-sided Fisher exact test compared patient subgroups.During the time interval, 1558 patients underwent surgery for NSCLC, of whom 484 were eligible for this analysis. The ipsilateral hilum was positive on preoperative PET in 107 patients. The median number of N1 lymph nodes sampled was 4 (range, 1-31). Positive ipsilateral N1 lymph nodes were identified pathologically in 91 patients (19%). Among the 91 patients with involved N1 lymph nodes, 40 were PET positive resulting in a sensitivity of 44%. Among 393 patients without pathologic involvement of hilar lymph nodes, 326 were PET negative resulting in a specificity of 83%. The positive predictive and negative predictive values were 37% and 86%, respectively.Positron emission tomography appears to have limitations in staging the ipsilateral hilar lymph nodes. Invasive sampling is appropriate if treatment would differ based on the nodal status.

Authors
Pepek, JM; Marks, LB; Berry, MF; Ready, NE; Gee, NG; Coleman, RE; D'Amico, TA; Crawford, J; Kelsey, CR
MLA Citation
Pepek, JM, Marks, LB, Berry, MF, Ready, NE, Gee, NG, Coleman, RE, D'Amico, TA, Crawford, J, and Kelsey, CR. "Accuracy of positron emission tomography in identifying hilar (N1) lymph node involvement in non-small cell lung cancer: Implications for stereotactic body radiation therapy." Practical radiation oncology 5.2 (March 2015): 79-84.
PMID
25413417
Source
epmc
Published In
Practical Radiation Oncology
Volume
5
Issue
2
Publish Date
2015
Start Page
79
End Page
84
DOI
10.1016/j.prro.2014.05.002

Impact of pretreatment imaging on survival of esophagectomy after induction therapy for esophageal cancer: who should be given the benefit of the doubt?: esophagectomy outcomes of patients with suspicious metastatic lesions.

We examined survival of patients who underwent esophagectomy for locally advanced esophageal cancer with foci that were suspicious for metastatic disease on initial imaging but whose disease did not progress after induction chemoradiation treatment (CRT).The impact of pre- and posttherapy staging characteristics on survival of patients who underwent esophagectomy after CRT between 2003 and 2009 was evaluated using multivariable logistic regression. Survival of patients with and without possible metastatic disease on initial imaging was compared with the log-rank test.During the study period, 71 (32%) of 220 patients who underwent CRT followed by esophagectomy had possible distant metastatic disease on initial imaging. Patients with initial suspicion of metastases had a 5-year survival of 24.8%. Overall survival of patients with and without possible metastatic disease on initial imaging was not significantly different (p = 0.4), but pretreatment positron emission tomography (PET) suggesting a liver lesion (hazard ratio [HR] 3.2, p = 0.003) predicted worse survival. Additional predictors of worse survival were clinical T4 status (HR 3.1, p = 0.001), post-CRT pathologic nodal status (HR 1.6, p = 0.04), and pathologically confirmed metastatic disease at or before resection (HR 3.1, p = 0.01). None of 10 patients with pathologic metastatic disease at resection lived longer than 2.5 years.Patients with possible liver metastases on pretreatment PET and patients with confirmed metastatic disease at the time of surgery do not benefit from resection. However, patients with pretreatment imaging that shows possible metastatic disease in sites other than the liver still have reasonable long-term survival after resection.

Authors
Erhunmwunsee, L; Englum, BR; Onaitis, MW; D'Amico, TA; Berry, MF
MLA Citation
Erhunmwunsee, L, Englum, BR, Onaitis, MW, D'Amico, TA, and Berry, MF. "Impact of pretreatment imaging on survival of esophagectomy after induction therapy for esophageal cancer: who should be given the benefit of the doubt?: esophagectomy outcomes of patients with suspicious metastatic lesions." Annals of surgical oncology 22.3 (March 2015): 1020-1025.
PMID
25234017
Source
epmc
Published In
Annals of Surgical Oncology
Volume
22
Issue
3
Publish Date
2015
Start Page
1020
End Page
1025
DOI
10.1245/s10434-014-4079-6

Minimally invasive surgery for “tumor mimicking” foreign body aspiration in an adult

Authors
Kara, HV; D’Amico, TA
MLA Citation
Kara, HV, and D’Amico, TA. "Minimally invasive surgery for “tumor mimicking” foreign body aspiration in an adult." Indian Journal of Thoracic and Cardiovascular Surgery 31.1 (March 2015): 45-46.
Source
crossref
Published In
Indian Journal of Thoracic and Cardiovascular Surgery
Volume
31
Issue
1
Publish Date
2015
Start Page
45
End Page
46
DOI
10.1007/s12055-014-0319-4

Adjuvant chemotherapy after resection of N1 non-small cell lung cancer: differential impact of new evidence on physician and patient decisions.

Adjuvant cisplatin-based chemotherapy (ACT) after resection of stages II-IIIA non-small cell lung cancer (NSCLC) modestly increased survival in several clinical trials. This study evaluated the subsequent impact of those trials on ACT use in clinical practice.Patients who underwent lobectomy or more extensive lung resection without induction chemotherapy for pathologically confirmed N1 positive NSCLC between 2000 and 2012 were reviewed. Referrals to medical oncology, oncologist recommendations for ACT, and initiation of ACT were evaluated. Because major trials supporting ACT were published in 2004 and 2005, analysis was stratified into two eras: 2000-2005 and 2006-2012.During the study period, 272 patients met inclusion criteria (110 in the 2000-2005 cohort, 162 in the 2006-2012 cohort). Referrals to medical oncology increased from 74.5% (n=82) in the 2000-2005 cohort to 90.1% (n=146) in the 2006-2012 cohort (P=0.002). Due to lack of referral or missed appointments, 35.5% (n=39) of the 2000-2005 patients and 17.9% (n=32) of the 2006-2012 patients did not have a documented conversation with an oncologist regarding ACT. The proportion of patients recommended for ACT increased from 61% (n=50) to 81.5% (n=119) between the eras (P<0.001). Of patients recommended for chemotherapy, 14% (7/50) in 2000-2005 and 13.4% (16/119) in 2006-2012 declined ACT (P=0.666).Publication of supporting evidence increased recommendations for ACT but did not change the percentage of patients who ultimately agreed to receive ACT. Additional research is needed to better understand patient decision-making in this situation.

Authors
Coleman, BK; Curtis, LH; Onaitis, MW; D'Amico, TA; Berry, MF
MLA Citation
Coleman, BK, Curtis, LH, Onaitis, MW, D'Amico, TA, and Berry, MF. "Adjuvant chemotherapy after resection of N1 non-small cell lung cancer: differential impact of new evidence on physician and patient decisions." Journal of thoracic disease 7.3 (March 2015): 243-251.
PMID
25922700
Source
epmc
Published In
Journal of Thoracic Disease
Volume
7
Issue
3
Publish Date
2015
Start Page
243
End Page
251
DOI
10.3978/j.issn.2072-1439.2015.01.42

Benefit of adjuvant chemotherapy after resection of stage II (T1-2N1M0) non-small cell lung cancer in elderly patients.

We evaluated the use and efficacy of adjuvant chemotherapy after resection of T1-2N1M0 non-small cell lung cancer (NSCLC) in elderly patients.Factors associated with the use of adjuvant chemotherapy in patients older than 65 years of age who underwent surgical resection of T1-2N1M0 NSCLC without induction chemotherapy or radiation in the Surveillance, Epidemiology, and End Results-Medicare database from 1992 to 2006 were assessed using a multivariable logistic regression model that included treatment, patient, tumor, and census tract characteristics. Overall survival (OS) was analyzed using the Kaplan-Meier approach and inverse probability weight-adjusted Cox proportional hazard models.Overall, 2,781 patients who underwent surgical resection as the initial treatment for T1-2N1M0 NSCLC and survived at least 31 days after surgery were identified, with adjuvant chemotherapy given to 784 patients (28.2 %). Factors that predicted adjuvant chemotherapy use were younger age and higher T status. The 5-year OS was significantly better for patients who received adjuvant chemotherapy compared with patients not given adjuvant chemotherapy: 35.8 % (95 % confidence interval [CI] 31.9-39.6) vs. 28.0 % (95 % CI 25.9-30.0) (p = 0.008). In the inverse probability weight-adjusted Cox proportional hazard regression model, adjuvant chemotherapy use predicted significantly improved survival (hazard ratio 0.84; 95 % CI 0.76-0.92; p = 0.0002).Adjuvant chemotherapy after resection of T1-2N1M0 NSCLC is associated with significantly improved survival in patients older than 65 years. These data can be used to provide elderly patients with realistic expectations of the potential benefits when considering adjuvant chemotherapy in this setting.

Authors
Berry, MF; Coleman, BK; Curtis, LH; Worni, M; D'Amico, TA; Akushevich, I
MLA Citation
Berry, MF, Coleman, BK, Curtis, LH, Worni, M, D'Amico, TA, and Akushevich, I. "Benefit of adjuvant chemotherapy after resection of stage II (T1-2N1M0) non-small cell lung cancer in elderly patients." Annals of surgical oncology 22.2 (February 2015): 642-648.
PMID
25192680
Source
epmc
Published In
Annals of Surgical Oncology
Volume
22
Issue
2
Publish Date
2015
Start Page
642
End Page
648
DOI
10.1245/s10434-014-4056-0

Smoking history predicts for increased risk of second primary lung cancer: a comprehensive analysis.

BACKGROUND: Tobacco use is the most important risk factor for the development of lung cancer. The objective of the current study was to determine the effect of smoking on the development of second primary lung cancers (SPLCs) and other clinical outcomes after surgery for non-small cell lung cancer (NSCLC). METHODS: All patients who underwent surgery for NSCLC at the study institution from 1995 through 2008 were identified. Rates of SPLC were analyzed based on smoking status and pack-year exposure. Multivariate analysis was performed to determine risk factors for SPLC. Overall survival, local control, distant metastases, and postoperative mortality were also examined. RESULTS: A total of 1484 patients were identified, including 98 never-smokers. The incidence of SPLC at 3 years, 5 years, and 8 years was 5%, 8%, and 16%, respectively. Only 1 never-smoker developed an SPLC. On multivariate analysis, which was restricted to ever-smokers with pack-years as a continuous variable, smoking history was found to be the only independent risk factor for SPLC (hazard ratio, 1.08; 95% confidence interval, 1.02-1.16 [P = .031]), corresponding to an 8% increased risk per 10 pack-year exposure. There were no differences in rates of local control or distant metastases based on smoking status. There was a trend toward lower postoperative mortality in never-smokers compared with ever-smokers (0% vs 3.3%; P = .069). Overall survival was found to be significantly worse for current smokers compared with former and never-smokers. CONCLUSIONS: SPLCs are rare in never-smokers. Increasing tobacco exposure is associated with a higher risk of SPLC in patients with a history of smoking. Current smokers have an increased risk of mortality whereas former and never-smokers have comparable survival.

Authors
Boyle, JM; Tandberg, DJ; Chino, JP; D'Amico, TA; Ready, NE; Kelsey, CR
MLA Citation
Boyle, JM, Tandberg, DJ, Chino, JP, D'Amico, TA, Ready, NE, and Kelsey, CR. "Smoking history predicts for increased risk of second primary lung cancer: a comprehensive analysis." Cancer 121.4 (February 2015): 598-604.
PMID
25283893
Source
epmc
Published In
Cancer
Volume
121
Issue
4
Publish Date
2015
Start Page
598
End Page
604
DOI
10.1002/cncr.29095

Defining the role of adjuvant chemotherapy after lobectomy for typical bronchopulmonary carcinoid tumors.

BACKGROUND: Treatment guidelines for typical bronchopulmonary carcinoid tumors recommend observation alone after resection of stage I-IIIA disease, but there are limited data related to the use of adjuvant chemotherapy in the setting of nodal metastases found at operation. METHODS: Patients in the National Cancer Data Base (NDCB) who underwent lobectomy for typical carcinoid and had metastatic nodal disease were stratified by the use of adjuvant chemotherapy. Baseline characteristics and outcomes were compared between groups. Next, patients were propensity matched using a 3:1 nearest-neighbor algorithm, and adjusted outcomes were compared. Finally, long-term survival was evaluated using the Kaplan-Meier method with comparisons based on the log-rank test. RESULTS: Overall, 4,612 patients were identified, among whom 629 (13.6%) had positive lymph nodes at the time of operation. Of them, adjuvant chemotherapy was used in 37 patients (5.9%). There were no baseline differences between patients who did and those who did not receive adjuvant chemotherapy. Patients treated with chemotherapy demonstrated a survival disadvantage at 5 years (69.7% versus 81.9%; p = 0.042). After propensity matching, all baseline characteristics between groups were highly similar. There remained a trend toward inferior 5-year survival for patients who received adjuvant chemotherapy, although the difference no longer met statistical significance (69.7% versus 80.9%; p = 0.096). CONCLUSIONS: Adjuvant chemotherapy is not associated with improved survival among patients who undergo lobectomy for typical carcinoids and nodal metastases. These data support current treatment guidelines.

Authors
Nussbaum, DP; Speicher, PJ; Gulack, BC; Hartwig, MG; Onaitis, MW; D'Amico, TA; Berry, MF
MLA Citation
Nussbaum, DP, Speicher, PJ, Gulack, BC, Hartwig, MG, Onaitis, MW, D'Amico, TA, and Berry, MF. "Defining the role of adjuvant chemotherapy after lobectomy for typical bronchopulmonary carcinoid tumors." The Annals of thoracic surgery 99.2 (February 2015): 428-434.
PMID
25499480
Source
epmc
Published In
The Annals of Thoracic Surgery
Volume
99
Issue
2
Publish Date
2015
Start Page
428
End Page
434
DOI
10.1016/j.athoracsur.2014.08.030

Esophageal and esophagogastric junction cancers, version 1.2015.

Esophageal cancer is the sixth most common cause of cancer deaths worldwide. Adenocarcinoma is more common in North America and Western European countries, originating mostly in the lower third of the esophagus, which often involves the esophagogastric junction (EGJ). Recent randomized trials have shown that the addition of preoperative chemoradiation or perioperative chemotherapy to surgery significantly improves survival in patients with resectable cancer. Targeted therapies with trastuzumab and ramucirumab have produced encouraging results in the treatment of advanced or metastatic EGJ adenocarcinomas. Multidisciplinary team management is essential for patients with esophageal and EGJ cancers. This portion of the NCCN Guidelines for Esophageal and EGJ Cancers discusses management of locally advanced adenocarcinoma of the esophagus and EGJ.

Authors
Ajani, JA; D'Amico, TA; Almhanna, K; Bentrem, DJ; Besh, S; Chao, J; Das, P; Denlinger, C; Fanta, P; Fuchs, CS; Gerdes, H; Glasgow, RE; Hayman, JA; Hochwald, S; Hofstetter, WL; Ilson, DH; Jaroszewski, D; Jasperson, K; Keswani, RN; Kleinberg, LR; Korn, WM; Leong, S; Lockhart, AC; Mulcahy, MF; Orringer, MB; Posey, JA; Poultsides, GA; Sasson, AR; Scott, WJ; Strong, VE; Varghese, TK; Washington, MK; Willett, CG; Wright, CD; Zelman, D; McMillian, N; Sundar, H
MLA Citation
Ajani, JA, D'Amico, TA, Almhanna, K, Bentrem, DJ, Besh, S, Chao, J, Das, P, Denlinger, C, Fanta, P, Fuchs, CS, Gerdes, H, Glasgow, RE, Hayman, JA, Hochwald, S, Hofstetter, WL, Ilson, DH, Jaroszewski, D, Jasperson, K, Keswani, RN, Kleinberg, LR, Korn, WM, Leong, S, Lockhart, AC, Mulcahy, MF, Orringer, MB, Posey, JA, Poultsides, GA, Sasson, AR, Scott, WJ, Strong, VE, Varghese, TK, Washington, MK, Willett, CG, Wright, CD, Zelman, D, McMillian, N, and Sundar, H. "Esophageal and esophagogastric junction cancers, version 1.2015." Journal of the National Comprehensive Cancer Network : JNCCN 13.2 (February 2015): 194-227.
PMID
25691612
Source
epmc
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
13
Issue
2
Publish Date
2015
Start Page
194
End Page
227

VATS versus open surgery for lung cancer resection: moving toward a minimally invasive approach.

The use of video-assisted thoracoscopic surgery (VATS) has become the standard approach for the surgical resection of early-stage lung cancer. Although no large prospective, randomized, controlled trial has compared VATS lobectomy with thoracotomy, well-designed retrospective studies have consistently shown that VATS has comparable oncologic outcomes and is associated with fewer complications, reduced length of hospital stay, improvement in patient quality of life, and superior tolerance of adjuvant therapies.

Authors
Klapper, J; D'Amico, TA
MLA Citation
Klapper, J, and D'Amico, TA. "VATS versus open surgery for lung cancer resection: moving toward a minimally invasive approach." Journal of the National Comprehensive Cancer Network : JNCCN 13.2 (February 2015): 162-164.
PMID
25691607
Source
epmc
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
13
Issue
2
Publish Date
2015
Start Page
162
End Page
164

Esophageal cancer

© Cambridge University Press 2014.Introduction The incidence of esophageal carcinoma is increasing, with the incidence of esophageal adenocarcinoma increasing faster than any other malignancy in the United States (1). Estimates for 2013 predict 17990 new cases of esophageal carcinoma, accounting for 15210 deaths (2). While the incidence of squamous cell carcinoma of the esophagus is decreasing by 3.6% per year, the incidence of adenocarcinoma of the esophagus is increasing by 2.1% per year (3). Adenocarcinoma of the esophagus The most important risk factor for the development of adenocarcinoma of the esophagus is the presence of columnar-lined esophagus (CLE), or Barrett's esophagus (4). CLE is present in approximately 10% of patients with gastroesophageal reflux (5) and it is estimated that up to 90% of all esophageal adenocarcinomas arise from CLE. The presence of CLE is associated with an increased risk of adenocarcinoma by a factor of between 30 and 125 (4,6). LOH data Loss-of-heterozygosity (LOH) studies of specific oncogenes involved in the neoplastic progression of the esophagus have identiied important loss of function atmultiple sites (7–11). In a study performed on 23 cases of adenocarcinoma of the esophagus the chromosomal abnormalitieswith the highest incidence of LOH were 3p (64%), 5q (45%), 9p (52%), 11p (61%), 13q (50%), 17p (96%), 17q (55%), and 18q (70%; 71).

Authors
Ceppa, DKP; D Amico, TA
MLA Citation
Ceppa, DKP, and D Amico, TA. "Esophageal cancer." Molecular Oncology: Causes of Cancer and Targets for Treatment. January 1, 2015. 526-531.
Source
scopus
Publish Date
2015
Start Page
526
End Page
531
DOI
10.1017/CBO9781139046947.045

Adjuvant chemotherapy is associated with improved survival after esophagectomy without induction therapy for node-positive adenocarcinoma.

This study investigated adjuvant chemotherapy (AC) use after esophagectomy without induction therapy for node-positive (pN+) adenocarcinoma using the National Cancer Database, including the impact of complications related to surgery (CRS) on outcomes.Predictors of AC use in 1694 patients in the National Cancer Data Base who underwent R0 esophagectomy from 2003-2011 without induction therapy for pN+ adenocarcinoma of the middle or lower esophagus and survived more than 30 days were identified with multivariable logistic regression. The impact of AC on survival was estimated using Kaplan-Meier and Cox-proportional hazards methods.AC was given to 874 of 1694 (51.6%) patients; 618 (70.7%) AC patients received radiation. Older age (adjusted odds ratio [AOR] 0.58/decade, p < 0.001), longer travel distance (AOR 0.78 per 100 miles, p = 0.03) and CRS (AOR 0.45, p < 0.001) predicted that AC was not used. Patients given AC had better 5-year survival than patients not given AC (24.2% versus 14.9%, p < 0.001), and AC use predicted improved survival in multivariate analysis (hazard ratio 0.67, p = 0.008). Receiving radiation in addition to AC did not improve survival (p = 0.35). Although CRS was associated with worse survival, patients who had CRS but received AC had superior survival compared to patients who did not have CRS or get AC (p = 0.016).AC after esophagectomy is associated with improved survival but was only used in half of patients with pN+ esophageal adenocarcinoma. We also found that the addition of radiation to AC was not associated with a survival benefit. CRS predict worse long-term survival and lower the chance of getting AC, but even patients with CRS had improved survival when given AC.

Authors
Speicher, PJ; Englum, BR; Ganapathi, AM; Mulvihill, MS; Hartwig, MG; Onaitis, MW; D'Amico, TA; Berry, MF
MLA Citation
Speicher, PJ, Englum, BR, Ganapathi, AM, Mulvihill, MS, Hartwig, MG, Onaitis, MW, D'Amico, TA, and Berry, MF. "Adjuvant chemotherapy is associated with improved survival after esophagectomy without induction therapy for node-positive adenocarcinoma." Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer 10.1 (January 2015): 181-188.
PMID
25490005
Source
epmc
Published In
Journal of Thoracic Oncology
Volume
10
Issue
1
Publish Date
2015
Start Page
181
End Page
188
DOI
10.1097/jto.0000000000000384

Spontaneous herniation of the lung and diaphragm treated with surgical repair.

Lung herniation is rare and is usually caused by blunt trauma, congenital abnormalities of the ribs, or previous thoracic operations. We report a rare case of spontaneous lung herniation in a 72-year-old woman and describe the operative repair.

Authors
Kara, HV; Javidfar, J; D'Amico, TA
MLA Citation
Kara, HV, Javidfar, J, and D'Amico, TA. "Spontaneous herniation of the lung and diaphragm treated with surgical repair." The Annals of thoracic surgery 99.5 (January 2015): 1821-1823.
PMID
25952221
Source
epmc
Published In
The Annals of Thoracic Surgery
Volume
99
Issue
5
Publish Date
2015
Start Page
1821
End Page
1823
DOI
10.1016/j.athoracsur.2014.06.105

The prognostic importance of the number of dissected lymph nodes after induction chemoradiotherapy for esophageal cancer.

BACKGROUND: Analyses of adequacy of lymph node dissection during resection of esophageal cancer are based on patients who have not undergone induction chemoradiotherapy. We sought to determine the minimum number of dissected lymph nodes necessary to ensure adequate staging after induction chemoradiotherapy. METHODS: A prospectively maintained thoracic surgery database was queried to identify consecutive patients undergoing postinduction esophagectomy from 1996 to 2010. Cox proportional hazard and recursive partitioning survival analyses were performed. RESULTS: Complete lymph node data were available for 395 patients. Mean age was 59.5 years, and 64 patients (16%) were female. The median number of dissected lymph nodes was 8 (range, 0 to 63). When pathologic (p)T stage, pN stage, and the number of dissected lymph nodes were used as predictors, only pN stage (odds ratio, 1.3; 95% confidence interval, 1.2 to 1.7) and age (odds ratio, 1.03; 95% confidence interval, 1.01 to 1.04) independently predicted survival. Recursive partitioning was performed on 262 pN0 patients using T stage and the number of dissected lymph nodes as predictors. No pN0 patient with 28 lymph nodes dissected died during follow-up. For patients with fewer than 28 lymph nodes dissected, the next prognostic factor was T stage. For pT1-2 N0 patients, the number of lymph nodes dissected did not affect survival. For pT3-4 N0 patients, a significant survival decrement was noted for patients with fewer than 7 lymph nodes dissected compared with those with more than 7 lymph nodes dissected. CONCLUSIONS: T stage determines prognosis in postinduction pN0 patients with fewer than 28 lymph nodes evaluated. Postinduction pT3N0 patients with fewer than 7 lymph nodes evaluated are understaged.

Authors
Hanna, JM; Erhunmwunsee, L; Berry, M; D'Amico, T; Onaitis, M
MLA Citation
Hanna, JM, Erhunmwunsee, L, Berry, M, D'Amico, T, and Onaitis, M. "The prognostic importance of the number of dissected lymph nodes after induction chemoradiotherapy for esophageal cancer." The Annals of thoracic surgery 99.1 (January 2015): 265-269.
PMID
25440285
Source
epmc
Published In
The Annals of Thoracic Surgery
Volume
99
Issue
1
Publish Date
2015
Start Page
265
End Page
269
DOI
10.1016/j.athoracsur.2014.08.073

Historical perspectives of The American Association for Thoracic Surgery: G. Alexander Patterson.

Authors
Chang, SH; D'Amico, TA
MLA Citation
Chang, SH, and D'Amico, TA. "Historical perspectives of The American Association for Thoracic Surgery: G. Alexander Patterson." The Journal of thoracic and cardiovascular surgery 148.6 (December 2014): 2455-2457.
PMID
24485961
Source
epmc
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
148
Issue
6
Publish Date
2014
Start Page
2455
End Page
2457
DOI
10.1016/j.jtcvs.2013.11.061

Modified uniportal video-assisted thoracoscopic lobectomy: Duke approach.

Traditional thoracoscopic strategies using two to four ports has been demonstrated to be oncologically successful for patients with resectable lung cancer, with numerous advantageous over thoracotomy. A single-incision approach has been described, but it is associated with potential disadvantages. The modified uniportal approach described may address those disadvantageous, with retention of the potential advantages of using a single incision.

Authors
Kara, HV; Balderson, SS; D'Amico, TA
MLA Citation
Kara, HV, Balderson, SS, and D'Amico, TA. "Modified uniportal video-assisted thoracoscopic lobectomy: Duke approach." The Annals of thoracic surgery 98.6 (December 2014): 2239-2241.
PMID
25468108
Source
epmc
Published In
The Annals of Thoracic Surgery
Volume
98
Issue
6
Publish Date
2014
Start Page
2239
End Page
2241
DOI
10.1016/j.athoracsur.2014.06.086

Non-small cell lung cancer, version 1.2015.

This selection from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Non-Small Cell Lung Cancer (NSCLC) focuses on the principles of radiation therapy (RT), which include the following: (1) general principles for early-stage, locally advanced, and advanced/metastatic NSCLC; (2) target volumes, prescription doses, and normal tissue dose constraints for early-stage, locally advanced, and advanced/palliative RT; and (3) RT simulation, planning, and delivery. Treatment recommendations should be made by a multidisciplinary team, including board-certified radiation oncologists who perform lung cancer RT as a prominent part of their practice.

Authors
Ettinger, DS; Wood, DE; Akerley, W; Bazhenova, LA; Borghaei, H; Camidge, DR; Cheney, RT; Chirieac, LR; D'Amico, TA; Demmy, TL; Dilling, TJ; Govindan, R; Grannis, FW; Horn, L; Jahan, TM; Komaki, R; Kris, MG; Krug, LM; Lackner, RP; Lanuti, M; Lilenbaum, R; Lin, J; Loo, BW; Martins, R; Otterson, GA; Patel, JD; Pisters, KM; Reckamp, K; Riely, GJ; Rohren, E; Schild, S; Shapiro, TA; Swanson, SJ; Tauer, K; Yang, SC; Gregory, K; Hughes, M
MLA Citation
Ettinger, DS, Wood, DE, Akerley, W, Bazhenova, LA, Borghaei, H, Camidge, DR, Cheney, RT, Chirieac, LR, D'Amico, TA, Demmy, TL, Dilling, TJ, Govindan, R, Grannis, FW, Horn, L, Jahan, TM, Komaki, R, Kris, MG, Krug, LM, Lackner, RP, Lanuti, M, Lilenbaum, R, Lin, J, Loo, BW, Martins, R, Otterson, GA, Patel, JD, Pisters, KM, Reckamp, K, Riely, GJ, Rohren, E, Schild, S, Shapiro, TA, Swanson, SJ, Tauer, K, Yang, SC, Gregory, K, and Hughes, M. "Non-small cell lung cancer, version 1.2015." Journal of the National Comprehensive Cancer Network : JNCCN 12.12 (December 2014): 1738-1761.
PMID
25505215
Source
epmc
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
12
Issue
12
Publish Date
2014
Start Page
1738
End Page
1761

Quantifying the safety benefits of wedge resection: a society of thoracic surgery database propensity-matched analysis.

BACKGROUND: Wedge resection is often used instead of anatomic resection in an attempt to mitigate perioperative risk. In propensity-matched populations, we sought to compare the perioperative outcomes of patients undergoing wedge resection with those undergoing anatomic resection. METHODS: The Society of Thoracic Surgery database was reviewed for stage I and II non-small cell lung cancer patients undergoing wedge resection and anatomic resection to analyze postoperative morbidity and mortality. Propensity scores were estimated using a logistic model adjusted for a variety of risk factors. Patients were then matched by propensity score using a greedy 5- to 1-digit matching algorithm, and compared using McNemar's test. RESULTS: Between 2009 and 2011, 3,733 wedge resection and 3,733 anatomic resection patients were matched. The operative mortality was 1.21% for wedge resection versus 1.93% for anatomic resection (p=0.0118). Major morbidity occurred in 4.53% of wedge resection patients versus 8.97% of anatomic resection patients (p<0.0001). A reduction was noted in the incidence of pulmonary complications, but not cardiovascular or neurologic complications. There was a consistent reduction in major morbidity regardless of age, lung function, or type of incision. Mortality was reduced in patients with preoperative forced expiratory volume in 1 second less than 85% predicted. CONCLUSIONS: Wedge resection has a 37% lower mortality and 50% lower major morbidity rate than anatomic resection in these propensity-matched populations. The mortality benefit is most apparent in patients with forced expiratory volume in 1 second less than 85% predicted. These perioperative benefits must be carefully weighed against the increase in locoregional recurrence and possible decrease in long-term survival associated with the use of wedge resection for primary lung cancers.

Authors
Linden, PA; D'Amico, TA; Perry, Y; Saha-Chaudhuri, P; Sheng, S; Kim, S; Onaitis, M
MLA Citation
Linden, PA, D'Amico, TA, Perry, Y, Saha-Chaudhuri, P, Sheng, S, Kim, S, and Onaitis, M. "Quantifying the safety benefits of wedge resection: a society of thoracic surgery database propensity-matched analysis." The Annals of thoracic surgery 98.5 (November 2014): 1705-1711.
PMID
25201723
Source
epmc
Published In
The Annals of Thoracic Surgery
Volume
98
Issue
5
Publish Date
2014
Start Page
1705
End Page
1711
DOI
10.1016/j.athoracsur.2014.06.017

Defining and improving postoperative care.

Although much is known regarding the importance of postoperative care, the surveillance of patients after 30 days from the surgical procedure can be improved. It must be recognized that mortality between 30 and 90 days exceeds what is commonly considered "operative mortality"—death within 30 days of surgery. Significant effort should be dedicated to the design of predictive models to prevent readmission. More importantly, surgeons must develop better models to manage the complications that arise after readmission to prevent mortality in readmitted patients. Finally, current guidelines for oncologic surveillance are an area of controversy, and future studies are needed for better direction of resources.

Authors
D'Amico, TA
MLA Citation
D'Amico, TA. "Defining and improving postoperative care." The Journal of thoracic and cardiovascular surgery 148.5 (November 2014): 1792-1793.
PMID
25444180
Source
epmc
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
148
Issue
5
Publish Date
2014
Start Page
1792
End Page
1793
DOI
10.1016/j.jtcvs.2014.09.095

Thoracoscopic left upper lobectomy in patients with internal mammary artery coronary bypass grafts.

This study examined outcomes of a technique for performing thoracoscopic left upper lobectomy (LUL) in patients with a previous left internal mammary artery (LIMA) coronary artery bypass graft, where a small wedge of lung parenchyma adjacent to the graft is left to avoid injury.All patients undergoing thoracoscopic LUL from 1999 to 2010 at a single institution were reviewed. Perioperative morbidity, cancer recurrence, and long-term survival were compared between patients who had (LIMA group) or did not have (control group) a previous LIMA graft.During the study period, 290 patients underwent thoracoscopic LUL; 14 (5%) had previous LIMA grafts. There was no perioperative mortality in the LIMA group versus 4 (1%) in the control group (p = 0.65). One patient (7%) in the LIMA group required conversion to thoracotomy, which was similar to the control group (n = 16, 6%; p = 0.83). Overall perioperative morbidity was also not different between the groups (LIMA 36% [5 of 14] versus control 29% [81 of 276], p = 0.61). No patient in the LIMA group had perioperative cardiac ischemia. For patients with lung cancer, 5-year survival (LIMA 50% vs control 63%, p = 0.23) and cancer recurrence rates (LIMA 27% (3 of 11) versus control 15% (36 of 242), p = 0.27) were not different between the groups. Only 1 LIMA recurrence was local, and it was not related to the parenchyma left on the LIMA graft.Thoracoscopic LUL can be performed safely in patients with LIMA bypass grafts. Leaving lung parenchyma on the graft may prevent injury and does not compromise oncologic outcomes in appropriately selected patients.

Authors
Shah, AA; Worni, M; Onaitis, MW; Balderson, SS; Harpole, DH; D'Amico, TA; Berry, MF
MLA Citation
Shah, AA, Worni, M, Onaitis, MW, Balderson, SS, Harpole, DH, D'Amico, TA, and Berry, MF. "Thoracoscopic left upper lobectomy in patients with internal mammary artery coronary bypass grafts." The Annals of thoracic surgery 98.4 (October 2014): 1207-1212.
PMID
25110335
Source
epmc
Published In
The Annals of Thoracic Surgery
Volume
98
Issue
4
Publish Date
2014
Start Page
1207
End Page
1212
DOI
10.1016/j.athoracsur.2014.05.068

Use of amiodarone after major lung resection.

We evaluated the association of respiratory complications and amiodarone use in patients with atrial fibrillation (AF) after major lung resection.Outcomes of patients who had postoperative AF treated with or without amiodarone after lobectomy, bilobectomy, or pneumonectomy at a single institution between 2003 and 2010 were evaluated using multivariable logistic modeling.Of 1,412 patients who underwent lobectomy, bilobectomy, or pneumonectomy, AF occurred in 232 (16%). Atrial fibrillation developed after a respiratory complication in 31 patients, who were excluded from subsequent analysis. The remaining 201 patients who had AF without an antecedent respiratory complication had similar mortality (3.0% [6 of 201] vs 2.5% [30 of 1,180], p = 0.6) and respiratory morbidity (10% [20 of 201] vs 9% [101 of 1,180], p = 0.5) but longer hospital stays (5 [4 to 7] vs 4 days [3 to 6], p < 0.0001) compared with the 1,180 patients who did not have AF. Amiodarone was used in 101 (50%) of these 201 patients, including 5 patients who had a pneumonectomy. Age, pulmonary function, and operative resection were similar between the patients treated with and without amiodarone. Amiodarone use was not associated with a significant difference in the incidence of subsequent respiratory complications (12% [12 of 101 amiodarone patients] vs 8% [8 of 100 non-amiodarone patients], p = 0.5).Atrial fibrillation that occurs without an antecedent respiratory complication in patients after major lung resection results in longer hospital stay but not increased mortality or respiratory morbidity. Using amiodarone to treat atrial fibrillation after major lung resection is not associated with an increased incidence of respiratory complications.

Authors
Berry, MF; D'Amico, TA; Onaitis, MW
MLA Citation
Berry, MF, D'Amico, TA, and Onaitis, MW. "Use of amiodarone after major lung resection." The Annals of thoracic surgery 98.4 (October 2014): 1199-1206.
PMID
25106684
Source
epmc
Published In
The Annals of Thoracic Surgery
Volume
98
Issue
4
Publish Date
2014
Start Page
1199
End Page
1206
DOI
10.1016/j.athoracsur.2014.05.038

Thoracoscopic pneumonectomy in management of histoplasmosis and fibrosing mediastinitis.

Pulmonary histoplasmosis is generally a self-limited respiratory illness in endemic areas. Fibrosing mediastinitis is a severe chronic complication of pulmonary histoplasmosis in which pulmonary vessels and airways can be compressed with the potential for life-threatening implications. We present a 50-year-old male patient who presented with a total occlusion of the left pulmonary artery due to fibrosing mediastinitis.

Authors
Kara, HV; Javidfar, J; Hirji, SA; Balderson, SS; D'Amico, TA
MLA Citation
Kara, HV, Javidfar, J, Hirji, SA, Balderson, SS, and D'Amico, TA. "Thoracoscopic pneumonectomy in management of histoplasmosis and fibrosing mediastinitis." The Annals of thoracic surgery 98.4 (October 2014): e95-e96.
PMID
25282249
Source
epmc
Published In
The Annals of Thoracic Surgery
Volume
98
Issue
4
Publish Date
2014
Start Page
e95
End Page
e96
DOI
10.1016/j.athoracsur.2014.06.093

Challenging cases: thoracoscopic lobectomy with chest wall resection and sleeve lobectomy-Duke experience.

Video-assisted thoracoscopic surgery (VATS) had recent advances in both equipment and technique so has been applied to more complex conditions in some thoracic surgery centers. We have adopted our VATS lobectomy experience for patients with chest wall invasion and endobronchial localized tumor requiring bronchial sleeve resection. We are describing our decision-making and surgical methods for these patients which we believe will be decreasing the number of contraindications for VATS and offering this surgical method for more patients.

Authors
Kara, HV; Balderson, SS; D'Amico, TA
MLA Citation
Kara, HV, Balderson, SS, and D'Amico, TA. "Challenging cases: thoracoscopic lobectomy with chest wall resection and sleeve lobectomy-Duke experience." Journal of thoracic disease 6.Suppl 6 (October 2014): S637-S640. (letter)
PMID
25379202
Source
epmc
Published In
Journal of Thoracic Disease
Volume
6
Issue
Suppl 6
Publish Date
2014
Start Page
S637
End Page
S640
DOI
10.3978/j.issn.2072-1439.2014.07.40

Modern impact of video assisted thoracic surgery.

With advancement in technology, experience and training over the last two decades, video assisted thoracic surgery (VATS) has become widely accepted and utilized all over the world. VATS started as a diagnostic tool in the early 1990s, technique of VATS lobectomy evolved and became safer over the next 10-15 years and now it is being used for more advanced and hybrid operations. VATS has contributed to the development of minimally invasive surgical interventions for other thoracic disorders like mediastinal tumors and esophageal cancer as well. This article looks at the advantages of VATS, technique advancements and its applications in other thoracic operations and its influence on the present and future of thoracic surgery.

Authors
Shah, RD; D'Amico, TA
MLA Citation
Shah, RD, and D'Amico, TA. "Modern impact of video assisted thoracic surgery." Journal of thoracic disease 6.Suppl 6 (October 2014): S631-S636. (Review)
PMID
25379201
Source
epmc
Published In
Journal of Thoracic Disease
Volume
6
Issue
Suppl 6
Publish Date
2014
Start Page
S631
End Page
S636
DOI
10.3978/j.issn.2072-1439.2014.08.02

Outcomes for locally advanced T1-T3N1M0 esophageal cancer: the impact of traveling to a high volume center for treatment

Authors
Speicher, PJ; Englum, BR; Ganapathi, A; D'Amico, TA; Berry, MF
MLA Citation
Speicher, PJ, Englum, BR, Ganapathi, A, D'Amico, TA, and Berry, MF. "Outcomes for locally advanced T1-T3N1M0 esophageal cancer: the impact of traveling to a high volume center for treatment." October 2014.
Source
wos-lite
Published In
Journal of The American College of Surgeons
Volume
219
Issue
4
Publish Date
2014
Start Page
E5
End Page
E6

Outcomes after pneumonectomy for benign disease: the impact of urgent resection.

Pneumonectomy for benign disease is often complicated by inflammatory processes that obscure operative planes. We reviewed our experience to evaluate the impact of requiring urgent or emergent pneumonectomy on outcomes.All pneumonectomies for benign conditions from 1997 to 2012 at a single institution were retrospectively reviewed. Mortality was assessed using multivariable logistic regression that included laterality, age, and surgery status, which was emergent if performed within 24 hours of initial evaluation, urgent if performed after 24 hours but within the same hospital stay, and otherwise elective.Among 42 pneumonectomies, completion pneumonectomy after previous ipsilateral lung resection was performed in 14 patients (33%). Resection was elective in 22 patients (52%), urgent in 12 (28%), and emergent in 8 (19%). The most common indication was for necrotic lung (n = 12; 29%). Muscle flaps were used in 26 patients (62%). Perioperative mortality for the entire cohort was 29% (n = 12) and was significantly higher when surgery was urgent (5 of 12; 42%) or emergent (5 of 8; 62.5%) compared with elective (2 of 22; 9.1%) (p = 0.03). Requiring urgent or emergent surgery remained a significant predictor of mortality in multivariable analysis (odds ratio 10.4, p = 0.01).Pneumonectomy for benign disease has significant risk for mortality, particularly when not performed electively. Although surgery cannot be planned in the setting of trauma or some situations of acute infection, patients known to have conditions that are likely to require pneumonectomy should be considered for surgery earlier in their disease course, before developing an acute problem that requires urgent or emergent resection.

Authors
Klapper, J; Hirji, S; Hartwig, MG; D'Amico, TA; Harpole, DH; Onaitis, MW; Berry, MF
MLA Citation
Klapper, J, Hirji, S, Hartwig, MG, D'Amico, TA, Harpole, DH, Onaitis, MW, and Berry, MF. "Outcomes after pneumonectomy for benign disease: the impact of urgent resection." Journal of the American College of Surgeons 219.3 (September 2014): 518-524.
PMID
24862885
Source
epmc
Published In
Journal of The American College of Surgeons
Volume
219
Issue
3
Publish Date
2014
Start Page
518
End Page
524
DOI
10.1016/j.jamcollsurg.2014.01.062

Issues with implementing a high-quality lung cancer screening program.

After a comprehensive review of the evidence, the United States Preventive Services Task Force recently endorsed screening with low-dose computed tomography as an early detection approach that has the potential to significantly reduce deaths due to lung cancer. Prudent implementation of lung cancer screening as a high-quality preventive health service is a complex challenge. The clinical evaluation and management of high-risk cohorts in the absence of symptoms mandates an approach that differs significantly from that of symptom-detected lung cancer. As with other cancer screenings, it is essential to provide to informed at-risk individuals a safe, high-quality, cost-effective, and accessible service. In this review, the components of a successful screening program are discussed as we begin to disseminate lung cancer screening as a national resource to improve outcomes with this lethal cancer. This information about lung cancer screening will assist clinicians with communications about the potential benefits and harms of this service for high-risk individuals considering participation in the screening process.

Authors
Mulshine, JL; D'Amico, TA
MLA Citation
Mulshine, JL, and D'Amico, TA. "Issues with implementing a high-quality lung cancer screening program." CA: a cancer journal for clinicians 64.5 (September 2014): 352-363.
PMID
24976072
Source
epmc
Published In
Ca: A Cancer Journal for Clinicians
Volume
64
Issue
5
Publish Date
2014
Start Page
352
End Page
363
DOI
10.3322/caac.21239

Surgical excision for mediastinal synovial sarcoma with limited response to chemoradiotherapy.

Primary synovial sarcoma of the mediastinum is an exceedingly rare neoplasm. We describe a 31-year-old woman who had an incidental diagnosis of mediastinal mass. Histopathology and immunohistochemistry analysis confirmed the diagnosis of primary mediastinal synovial sarcoma. The patient underwent concurrent chemotherapy and radiotherapy, with minimal response radiologically. Resection was subsequently performed, with negative margins. The histopathologic examination revealed the diagnosis with a limited pathologic response. Because of the rarity of primary mediastinal synovial sarcoma, the optimal therapy is still unclear. We report this case of induction therapy followed by en bloc surgical resection.

Authors
Kara, HV; Javidfar, J; D'Amico, TA
MLA Citation
Kara, HV, Javidfar, J, and D'Amico, TA. "Surgical excision for mediastinal synovial sarcoma with limited response to chemoradiotherapy." The Annals of thoracic surgery 98.3 (September 2014): e69-e70.
PMID
25193225
Source
epmc
Published In
The Annals of Thoracic Surgery
Volume
98
Issue
3
Publish Date
2014
Start Page
e69
End Page
e70
DOI
10.1016/j.athoracsur.2014.05.039

Trends and outcomes in the use of surgery and radiation for the treatment of locally advanced esophageal cancer: a propensity score adjusted analysis of the surveillance, epidemiology, and end results registry from 1998 to 2008.

We examined outcomes and trends in surgery and radiation use for patients with locally advanced esophageal cancer, for whom optimal treatment isn't clear. Trends in surgery and radiation for patients with T1-T3N1M0 squamous cell or adenocarcinoma of the mid or distal esophagus in the Surveillance, Epidemiology, and End Results database from 1998 to 2008 were analyzed using generalized linear models including year as predictor; Surveillance, Epidemiology, and End Results doesn't record chemotherapy data. Local treatment was unimodal if patients had only surgery or radiation and bimodal if they had both. Five-year cancer-specific survival (CSS) and overall survival (OS) were analyzed using propensity-score adjusted Cox proportional-hazard models. Overall 5-year survival for the 3295 patients identified (mean age 65.1 years, standard deviation 11.0) was 18.9% (95% confidence interval: 17.3-20.7). Local treatment was bimodal for 1274 (38.7%) and unimodal for 2021 (61.3%) patients; 1325 (40.2%) had radiation alone and 696 (21.1%) underwent only surgery. The use of bimodal therapy (32.8-42.5%, P = 0.01) and radiation alone (29.3-44.5%, P < 0.001) increased significantly from 1998 to 2008. Bimodal therapy predicted improved CSS (hazard ratios [HR]: 0.68, P < 0.001) and OS (HR: 0.58, P < 0.001) compared with unimodal therapy. For the first 7 months (before survival curve crossing), CSS after radiation therapy alone was similar to surgery alone (HR: 0.86, P = 0.12) while OS was worse for surgery only (HR: 0.70, P = 0.001). However, worse CSS (HR: 1.43, P < 0.001) and OS (HR: 1.46, P < 0.001) after that initial timeframe were found for radiation therapy only. The use of radiation to treat locally advanced mid and distal esophageal cancers increased from 1998 to 2008. Survival was best when both surgery and radiation were used.

Authors
Worni, M; Castleberry, AW; Gloor, B; Pietrobon, R; Haney, JC; D'Amico, TA; Akushevich, I; Berry, MF
MLA Citation
Worni, M, Castleberry, AW, Gloor, B, Pietrobon, R, Haney, JC, D'Amico, TA, Akushevich, I, and Berry, MF. "Trends and outcomes in the use of surgery and radiation for the treatment of locally advanced esophageal cancer: a propensity score adjusted analysis of the surveillance, epidemiology, and end results registry from 1998 to 2008." Dis Esophagus 27.7 (September 2014): 662-669.
PMID
23937253
Source
pubmed
Published In
Diseases of the Esophagus
Volume
27
Issue
7
Publish Date
2014
Start Page
662
End Page
669
DOI
10.1111/dote.12123

Induction therapy does not improve survival for clinical stage T2N0 esophageal cancer.

This study compared survival after initial treatment with esophagectomy as primary therapy to induction therapy followed by esophagectomy for patients with clinical T2N0 (cT2N0) esophageal cancer in the National Cancer Database (NCDB).Predictors of therapy selection for patients with cT2N0 esophageal cancer in the NCDB from 1998 to 2011 were identified with multivariable logistic regression. Survival was evaluated using Kaplan-Meier and Cox proportional hazards methods.Surgery was used in 42.9% (2057 of 4799) of cT2N0 patients. Of 1599 esophagectomy patients for whom treatment timing was recorded, induction therapy was used in 44.1% (688). Pretreatment staging was proven accurate in only 26.7% of patients (210 of 786) who underwent initial surgery without induction treatment and had complete pathologic data available: 41.6% (n = 327) were upstaged and 31.7% (n = 249) were downstaged. Adjuvant therapy (chemotherapy or radiation therapy) was given to 50.2% of patients treated initially with surgery who were found after resection to have nodal disease. There was no significant difference in long-term survival between strategies of primary surgery and induction therapy followed by surgery (median 41.1 versus 41.9 months, p = 0.51). In multivariable analysis, induction therapy was not independently associated with risk of death (hazard ratio [HR], 1.16, p = 0.32).Current clinical staging for early-stage esophageal cancer is highly inaccurate, with only a quarter of surgically resected cT2N0 patients found to have had accurate pretreatment staging. Induction therapy for patients with cT2N0 esophageal cancer in the NCDB is not associated with improved survival.

Authors
Speicher, PJ; Ganapathi, AM; Englum, BR; Hartwig, MG; Onaitis, MW; D'Amico, TA; Berry, MF
MLA Citation
Speicher, PJ, Ganapathi, AM, Englum, BR, Hartwig, MG, Onaitis, MW, D'Amico, TA, and Berry, MF. "Induction therapy does not improve survival for clinical stage T2N0 esophageal cancer." Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer 9.8 (August 2014): 1195-1201.
PMID
25157773
Source
epmc
Published In
Journal of Thoracic Oncology
Volume
9
Issue
8
Publish Date
2014
Start Page
1195
End Page
1201
DOI
10.1097/jto.0000000000000228

Patterns of recurrence after trimodality therapy for esophageal cancer.

Patterns of failure after neoadjuvant chemoradiotherapy and surgery for esophageal cancer are poorly defined.All patients in the current study were treated with trimodality therapy for nonmetastatic esophageal cancer from 1995 to 2009. Locoregional failure included lymph node failure (NF), anastomotic failure, or both. Abdominal paraaortic failure (PAF) was defined as disease recurrence at or below the superior mesenteric artery.Among 155 patients, the primary tumor location was the upper/middle esophagus in 18%, the lower esophagus in 32%, and the gastroesophageal junction in 50% (adenocarcinoma in 79% and squamous cell carcinoma in 21%) of patients. Staging methods included endoscopic ultrasound (73%), computed tomography (46%), and positron emission tomography/computed tomography (54%). Approximately 40% of patients had American Joint Committee on Cancer stage II disease and 60% had stage III disease. The median follow-up was 1.3 years. The 2-year locoregional control, event-free survival, and overall survival rates were 86%, 36%, and 48%, respectively. The 2-year NF rate was 14%, the isolated NF rate was 3%, and the anastomotic failure rate was 6%. The 2-year PAF rate was 9% and the isolated PAF rate was 5%. PAF was found to be increased among patients with gastroesophageal junction tumors (12% vs 6%), especially for the subset with ≥ 2 clinically involved lymph nodes at the time of diagnosis (19% vs 4%).Few patients experience isolated NF or PAF as their first disease recurrence. Therefore, it is unlikely that targeting additional regional lymph node basins with radiotherapy would significantly improve clinical outcomes.

Authors
Dorth, JA; Pura, JA; Palta, M; Willett, CG; Uronis, HE; D'Amico, TA; Czito, BG
MLA Citation
Dorth, JA, Pura, JA, Palta, M, Willett, CG, Uronis, HE, D'Amico, TA, and Czito, BG. "Patterns of recurrence after trimodality therapy for esophageal cancer." Cancer 120.14 (July 2014): 2099-2105.
PMID
24711267
Source
epmc
Published In
Cancer
Volume
120
Issue
14
Publish Date
2014
Start Page
2099
End Page
2105
DOI
10.1002/cncr.28703

Sex differences in early outcomes after lung cancer resection: analysis of the Society of Thoracic Surgeons General Thoracic Database.

Women with lung cancer have superior long-term survival outcomes compared with men, independent of stage. The cause of this disparity is unknown. For patients undergoing lung cancer resection, these survival differences could be due, in part, to relatively better perioperative outcomes for women. This study was undertaken to determine differences in perioperative outcomes after lung cancer surgery on the basis of sex.The Society of Thoracic Surgeons' General Thoracic Database was queried for all patients undergoing resection of lung cancer between 2002 and 2010. Postoperative complications were analyzed with respect to sex. Univariable analysis was performed, followed by multivariable modeling to determine significant risk factors for postoperative morbidity and mortality.A total of 34,188 patients (16,643 men and 17,545 women) were considered. Univariable analysis demonstrated statistically significant differences in postoperative complications favoring women in all categories of postoperative complications. Women also had lower in-hospital and 30-day mortality (odds ratio, 0.56; 95% confidence interval, 0.44-0.71; P < .001). Multivariable analysis demonstrated that several preoperative conditions independently predicted 30-day mortality: male sex, increasing age, lower diffusion capacity, renal insufficiency, preoperative radiation therapy, cancer stage, extent of resection, and thoracotomy as surgical approach. Coronary artery disease was an independent predictor of mortality in women but not in men. Thoracotomy as the surgical approach and preoperative radiation therapy were predictive of mortality for men but not for women. Postoperative prolonged air leak and empyema predicted mortality in men but not in women.Women have lower postoperative morbidity and mortality after lung cancer surgery. Some risk factors are sex-specific with regard to mortality. Further study is warranted to determine the cause of these differences and to determine their effect on survival.

Authors
Tong, BC; Kosinski, AS; Burfeind, WR; Onaitis, MW; Berry, MF; Harpole, DH; D'Amico, TA
MLA Citation
Tong, BC, Kosinski, AS, Burfeind, WR, Onaitis, MW, Berry, MF, Harpole, DH, and D'Amico, TA. "Sex differences in early outcomes after lung cancer resection: analysis of the Society of Thoracic Surgeons General Thoracic Database." The Journal of thoracic and cardiovascular surgery 148.1 (July 2014): 13-18.
PMID
24726742
Source
epmc
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
148
Issue
1
Publish Date
2014
Start Page
13
End Page
18
DOI
10.1016/j.jtcvs.2014.03.012

Tumor acquisition for biomarker research in lung cancer.

The biopsy collection data from two lung cancer trials that required fresh tumor samples be obtained for microarray analysis were reviewed. In the trial for advanced disease, microarray data were obtained on 50 patient samples, giving an overall success rate of 60.2%. The majority of the specimens were obtained through CT-guided lung biopsies (N = 30). In the trial for early-stage patients, 28 tissue specimens were collected from excess tumor after surgical resection with a success rate of 85.7%. This tissue procurement program documents the feasibility in obtaining fresh tumor specimens prospectively that could be used for molecular testing.

Authors
Stevenson, M; Christensen, J; Shoemaker, D; Foster, T; Barry, WT; Tong, BC; Wahidi, M; Shofer, S; Datto, M; Ginsburg, G; Crawford, J; D'Amico, T; Ready, N
MLA Citation
Stevenson, M, Christensen, J, Shoemaker, D, Foster, T, Barry, WT, Tong, BC, Wahidi, M, Shofer, S, Datto, M, Ginsburg, G, Crawford, J, D'Amico, T, and Ready, N. "Tumor acquisition for biomarker research in lung cancer." Cancer investigation 32.6 (July 2014): 291-298.
PMID
24810245
Source
epmc
Published In
Cancer Investigation (Informa)
Volume
32
Issue
6
Publish Date
2014
Start Page
291
End Page
298
DOI
10.3109/07357907.2014.911880

Thoracoscopic approach to lobectomy for lung cancer does not compromise oncologic efficacy.

We compared survival between video-assisted thoracoscopic surgery (VATS) and thoracotomy approaches to lobectomy for non-small cell lung cancer.Overall survival of patients who had lobectomy for any stage non-small cell lung cancer without previous chemotherapy or radiation from 1996 to 2008 was evaluated using the Kaplan-Meier method and multivariate Cox analysis. Propensity scoring was used to assess the impact of selection bias.Overall, 1,087 patients met inclusion criteria (610 VATS, 477 thoracotomy). Median follow-up was not significantly different between VATS and thoracotomy patients overall (53.4 versus 45.4 months, respectively; p=0.06) but was longer for thoracotomy for surviving patients (102.4 versus 67.9 months, p<0.0001). Thoracotomy patients had larger tumors (3.9±2.3 versus 2.8±1.5 cm, p<0.0001), and more often had higher stage cancers (50% [n=237] versus 71% [n=435] stage I, p<0.0001) compared with VATS patients. In multivariate analysis of all patients, thoracotomy approach (hazard ratio [HR] 1.22, p=0.01), increasing age (HR 1.02 per year, p<0.0001), pathologic stage (HR 1.45 per stage, p<0.0001), and male sex (HR 1.35, p=0.0001) predicted worse survival. In a cohort of 560 patients (311 VATS, 249 thoracotomy) who were assembled using propensity scoring and were similar in age, stage, tumor size, and sex, the operative approach did not impact survival (p=0.5), whereas increasing age (HR 1.02 per year, p=0.01), pathologic stage (HR 1.44 per stage, p<0.0001), and male sex (HR 1.29, p=0.01) predicted worse survival.The thoracoscopic approach to lobectomy for non-small cell lung cancer does not result in worse long-term survival compared with thoracotomy.

Authors
Berry, MF; D'Amico, TA; Onaitis, MW; Kelsey, CR
MLA Citation
Berry, MF, D'Amico, TA, Onaitis, MW, and Kelsey, CR. "Thoracoscopic approach to lobectomy for lung cancer does not compromise oncologic efficacy." The Annals of thoracic surgery 98.1 (July 2014): 197-202.
PMID
24820392
Source
epmc
Published In
The Annals of Thoracic Surgery
Volume
98
Issue
1
Publish Date
2014
Start Page
197
End Page
202
DOI
10.1016/j.athoracsur.2014.03.018

Interinstitutional variation in management decisions for treatment of 4 common types of cancer: A multi-institutional cohort study.

When clinical practice is governed by evidence-based guidelines and there is consensus about their validity, practice variation should be minimal. For areas in which evidence gaps exist, greater variation is expected.To systematically assess interinstitutional variation in management decisions for 4 common types of cancer.Multi-institutional, observational cohort study of patients with cancer diagnosed between July 2006 through May 2011 and observed through 31 December 2011.18 cancer centers participating in the formulation of treatment guidelines and systematic outcomes assessment through the National Comprehensive Cancer Network.25 589 patients with incident breast cancer, colorectal cancer, lung cancer, or non-Hodgkin lymphoma.Interinstitutional variation for 171 binary management decisions with varying levels of supporting evidence. For each decision, variation was characterized by the median absolute deviation of the center-specific proportions.Interinstitutional variation was high (median absolute deviation >10%) for 35 of 171 (20%) oncology management decisions, including 9 of 22 (41%) decisions for non-Hodgkin lymphoma, 16 of 76 (21%) for breast cancer, 7 of 47 (15%) for lung cancer, and 3 of 26 (12%) for colorectal cancer. Forty-six percent of high-variance decisions involved imaging or diagnostic procedures and 37% involved choice of chemotherapy regimen. The evidence grade underpinning the 35 high-variance decisions was category 1 for 0%, 2A for 49%, and 2B/other for 51%.Physician identifiers were unavailable, and results may not generalize outside of major cancer centers.The substantial variation in institutional practice manifest among cancer centers reveals a lack of consensus about optimal management for common clinical scenarios. For clinicians, awareness of management decisions with high variation should prompt attention to patient preferences. For health systems, high variation can be used to prioritize comparative effectiveness research, patient-provider education, or pathway development.National Cancer Institute and National Comprehensive Cancer Network.

Authors
Weeks, JC; Uno, H; Taback, N; Ting, G; Cronin, A; D'Amico, TA; Friedberg, JW; Schrag, D
MLA Citation
Weeks, JC, Uno, H, Taback, N, Ting, G, Cronin, A, D'Amico, TA, Friedberg, JW, and Schrag, D. "Interinstitutional variation in management decisions for treatment of 4 common types of cancer: A multi-institutional cohort study." Annals of internal medicine 161.1 (July 2014): 20-30.
PMID
24979447
Source
epmc
Published In
Annals of internal medicine
Volume
161
Issue
1
Publish Date
2014
Start Page
20
End Page
30
DOI
10.7326/m13-2231

Surgical Aspects of Thoracic Malignancies

© 2014 John Wiley and Sons, Inc.This chapter presents a series of case studies related to surgical aspects of thoracic malignancies. The first case study is about a 65-year-old smoker with a spiculated, peripheral 2.5 cm right upper lobe mass. Other case studies include a 72-year-old smoker with large, right infrahilar mass, a 66-year-old smoker with an apical lung mass, and a 56-year-old female reported with peripheral solitary pulmonary nodule in the right upper lobe. Finally, the chapter discusses the case study of 62-year-old female presented with a history of a T2N1 left breast cancer (ER and PR positive).

Authors
Chang, ASY; D'Amico, TA; White, DC
MLA Citation
Chang, ASY, D'Amico, TA, and White, DC. "Surgical Aspects of Thoracic Malignancies." Cancer Consult: Expertise for Clinical Practice. June 20, 2014. 711-718.
Source
scopus
Publish Date
2014
Start Page
711
End Page
718
DOI
10.1002/9781118589199.ch108

Surgical management of congenital pulmonary malformations after the first decade of life.

BACKGROUND: Most congenital pulmonary malformations are discovered early in life, but some are diagnosed in adulthood. We evaluated patients treated surgically after the first decade of life. METHODS: All patients who underwent surgical treatment for a congenital pulmonary malformation diagnosed after 10 years of age at a single institution from 1997 to 2012 were evaluated for presenting symptoms, surgical management, perioperative outcomes, and symptom resolution. RESULTS: Twenty-two patients met the inclusion criteria. The most common malformations were pulmonary sequestration (n = 12, 55%), congenital cystic adenomatoid malformation (n = 2, 9%), and bronchial agenesis (n = 2, 9%). The median age at diagnosis was 36 years (range, 10-66 years). The most common presenting symptoms were dyspnea (n = 6, 27%) and hemoptysis (n = 4; 18%); 4 (18%) asymptomatic patients received diagnoses. The median duration of symptoms before operation was 14 months. An emergency room visit or hospitalization occurred in 11 patients (50%) before their referral for surgical evaluation. The surgical approach was thoracotomy for 7 patients (32%) and thoracoscopy for 15 patients (68%). All vascular anomalies requiring a pneumonectomy (n = 3, 14%) were done by a thoracotomy, and 83% (10/12) of pulmonary sequestrations were treated thoracoscopically. The median hospital stay was 3 days. There were no perioperative deaths, and minor morbidity occurred in 4 patients (18%). Complete resolution of symptoms after operation occurred in 94% (16/17) of patients, with a median follow-up time of 3 weeks. CONCLUSIONS: Early surgical management of congenital pulmonary malformations found after the first decade of life is recommended to control symptoms and avoid hospitalizations. Most adult pulmonary sequestrations can be treated with minimally invasive techniques.

Authors
Wang, A; D'Amico, TA; Berry, MF
MLA Citation
Wang, A, D'Amico, TA, and Berry, MF. "Surgical management of congenital pulmonary malformations after the first decade of life." The Annals of thoracic surgery 97.6 (June 2014): 1933-1938.
PMID
24681038
Source
epmc
Published In
The Annals of Thoracic Surgery
Volume
97
Issue
6
Publish Date
2014
Start Page
1933
End Page
1938
DOI
10.1016/j.athoracsur.2014.01.053

The impact of pulmonary hypertension on morbidity and mortality following major lung resection.

OBJECTIVES: Pulmonary hypertension is considered a poor prognostic factor for or even a contraindication to major lung resection, but evidence for this claim is lacking. This study evaluates the impact of pulmonary hypertension on morbidity and mortality following pulmonary lobectomy. METHODS: Adult patients who underwent a lobectomy for cancer and had a transthoracic echocardiogram (TTE) performed within the year prior to the operation were included. Pulmonary hypertension was defined as an estimated right ventricular systolic pressure (RVSP) of ≥36 mmHg by TTE. The preoperative characteristics, intraoperative data and postoperative outcomes of patients with and those without pulmonary hypertension based on TTE were compared. A model for morbidity including published risk factors as well as pulmonary hypertension was developed by multivariable logistic regression. RESULTS: There were 279 patients without pulmonary hypertension and 19 patients with pulmonary hypertension. Patients with pulmonary hypertension had a lower preoperative forced expiratory volume in 1 s and diffusing capacity of the lung for carbon monoxide than patients without pulmonary hypertension and a higher incidence of tricuspid regurgitation and mitral regurgitation, but the groups were otherwise similar. The mean RVSP in the group of patients with pulmonary hypertension was 47 mmHg. Perioperative mortality (0.0 vs 2.9%; P = 1.0) and postoperative complications (57.9 vs 47.7%; P = 0.48) were not significantly different between patients with and those without pulmonary hypertension. The presence of pulmonary hypertension was not a predictor of adverse outcomes in either univariate or multivariate analysis. CONCLUSIONS: Lobectomy may be performed safely in selected patients with pulmonary hypertension, with complication rates comparable with those experienced by patients without pulmonary hypertension.

Authors
Wei, B; D'Amico, T; Samad, Z; Hasan, R; Berry, MF
MLA Citation
Wei, B, D'Amico, T, Samad, Z, Hasan, R, and Berry, MF. "The impact of pulmonary hypertension on morbidity and mortality following major lung resection." European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 45.6 (June 2014): 1028-1033.
PMID
24132298
Source
epmc
Published In
European Journal of Cardio-Thoracic Surgery
Volume
45
Issue
6
Publish Date
2014
Start Page
1028
End Page
1033
DOI
10.1093/ejcts/ezt495

When should surgeons begin surveillance with CT scans after lobectomy for stage 1A non-small cell lung cancer?

Authors
Mallipeddi, MK; Eltaraboulsi, WR; Shoffner, AR; Naqvi, IA; D'Amico, TA; Onaitis, MW; Berry, MF
MLA Citation
Mallipeddi, MK, Eltaraboulsi, WR, Shoffner, AR, Naqvi, IA, D'Amico, TA, Onaitis, MW, and Berry, MF. "When should surgeons begin surveillance with CT scans after lobectomy for stage 1A non-small cell lung cancer?." May 20, 2014.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
32
Issue
15
Publish Date
2014

Association of adjuvant chemotherapy with improved survival after esophagectomy without induction therapy for node-positive adenocarinoma.

Authors
Speicher, PJ; Englum, BR; Ganapathi, AM; Onaitis, MW; D'Amico, TA; Berry, MF
MLA Citation
Speicher, PJ, Englum, BR, Ganapathi, AM, Onaitis, MW, D'Amico, TA, and Berry, MF. "Association of adjuvant chemotherapy with improved survival after esophagectomy without induction therapy for node-positive adenocarinoma." May 20, 2014.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
32
Issue
15
Publish Date
2014

Thoracoscopic versus robotic approaches: advantages and disadvantages.

The overall advantages of thoracoscopy over thoracotomy in terms of patient recovery have been fairly well established. The use of robotics, however, is a newer and less proven modality in the realm of thoracic surgery. Robotics offers distinct advantages and disadvantages in comparison with video-assisted thoracoscopic surgery. Robotic technology is now used for a variety of complex cardiac, urologic, and gynecologic procedures including mitral valve repair and microsurgical treatment of male infertility. This article addresses the potential benefits and limitations of using the robotic platform for the performance of a variety of thoracic operations.

Authors
Wei, B; D'Amico, TA
MLA Citation
Wei, B, and D'Amico, TA. "Thoracoscopic versus robotic approaches: advantages and disadvantages." Thoracic surgery clinics 24.2 (May 2014): 177-vi.
PMID
24780422
Source
epmc
Published In
Thoracic Surgery Clinics
Volume
24
Issue
2
Publish Date
2014
Start Page
177
End Page
vi
DOI
10.1016/j.thorsurg.2014.02.001

The biomolecular era for thoracic surgeons: the example of the ESTS Biology Club.

Understanding basic mechanisms of lung disease may help to move forward the management of our patients. Molecular biology has affected our diagnostic and therapeutic pathways in the direction of personalized medicine not only for thoracic malignancies. Accordingly, thoracic surgeons are becoming increasingly aware that specific knowledge of genetic and epigenetic alterations may influence their clinical behavior-from the ward to the operating room (OR). In this continuously evolving scenario, surgical societies have perceived the increasing relevance of biomolecular medicine in the practice of modern thoracic surgery. More recently, in the spirit of mutual collaboration between sister societies, the European Society of Thoracic Surgeons (ESTS) has adopted the concept of the American Association for Thoracic Surgery (AATS) incorporating one session dedicated to the Biology Club within the Annual Meeting Program. The aim of the ESTS Biology Club is to outline and sponsor the new profile of the surgeon scientist during the only world meeting exclusively focused on general thoracic surgery. The following article will summarize the significance of this and give an update on molecular biology tools for thoracic malignancies.

Authors
Opitz, I; D'Amico, TA; Rocco, G
MLA Citation
Opitz, I, D'Amico, TA, and Rocco, G. "The biomolecular era for thoracic surgeons: the example of the ESTS Biology Club." Journal of thoracic disease 6 Suppl 2 (May 2014): S265-S271. (Review)
PMID
24868444
Source
epmc
Published In
Journal of Thoracic Disease
Volume
6 Suppl 2
Publish Date
2014
Start Page
S265
End Page
S271
DOI
10.3978/j.issn.2072-1439.2014.05.01

Mckeown esophagogastrectomy.

Esophageal cancer is increasing in incidence faster than other cancers in the US. Outcomes after esophagectomy may be related to many factors, including the age of the patient, the stage of the tumor, the operative approach, and the incidence of postoperative morbidity. Pulmonary complications are the major source of morbidity and mortality following esophageal resection, and numerous studies have identified various factors associated with these complications. Various operative approaches have been applied to the management of esophageal cancer, with the goal of optimal oncologic results with the lowest possible morbidity and mortality. The McKeown esophagogastrectomy is applicable for most patients with esophageal cancer, and the technique and results are reviewed.

Authors
D'Amico, TA
MLA Citation
D'Amico, TA. "Mckeown esophagogastrectomy." Journal of thoracic disease 6 Suppl 3 (May 2014): S322-S324. (Review)
PMID
24876937
Source
epmc
Published In
Journal of Thoracic Disease
Volume
6 Suppl 3
Publish Date
2014
Start Page
S322
End Page
S324
DOI
10.3978/j.issn.2072-1439.2014.03.28

European guidelines on structure and qualification of general thoracic surgery.

OBJECTIVE: To update the recommendations for the structural characteristics of general thoracic surgery (GTS) in Europe in order to provide a document that can be used as a guide for harmonizing the general thoracic surgical practice in Europe. METHODS: A task force was created to set the structural, procedural and qualification characteristics of a European GTS unit. These criteria were endorsed by the Executive Committee of the European Society of Thoracic Surgeons and by the Thoracic Domain of the European Association for Cardio-Thoracic Surgery and were validated by the European Board of Thoracic Surgery at European Union of Medical Specialists. RESULTS: Criteria regarding definition and scope of GTS, structure and qualification of GTS unit, training and education and recommendations for subjects of particular interest (lung transplant, oesophageal surgery, minimally invasive thoracic surgery, quality surveillance) were developed. CONCLUSIONS: This document will hopefully represent the first step of a process of revision of the modern thoracic surgeons' curricula, which need to be qualitatively rethought in the setting of the qualification process. The structural criteria highlighted in the present document are meant to help and tackle the challenge of cultural and language barriers as well as of widely varying national training programmes.

Authors
Brunelli, A; Falcoz, PE; D'Amico, T; Hansen, H; Lim, E; Massard, G; Rice, TW; Rocco, G; Thomas, P; Van Raemdonck, D; Congregado, M; Decaluwe, H; Grodzki, T; Lerut, T; Molnar, T; Salati, M; Scarci, M; Van Schil, P; Varela, G; Venuta, F; Melfi, F; Gebitekin, C; Kuzdzal, J; Leschber, G; Opitz, I; Papagiannopoulos, K; Patterson, A; Ruffini, E; Klepetko, W; Toker, A
MLA Citation
Brunelli, A, Falcoz, PE, D'Amico, T, Hansen, H, Lim, E, Massard, G, Rice, TW, Rocco, G, Thomas, P, Van Raemdonck, D, Congregado, M, Decaluwe, H, Grodzki, T, Lerut, T, Molnar, T, Salati, M, Scarci, M, Van Schil, P, Varela, G, Venuta, F, Melfi, F, Gebitekin, C, Kuzdzal, J, Leschber, G, Opitz, I, Papagiannopoulos, K, Patterson, A, Ruffini, E, Klepetko, W, and Toker, A. "European guidelines on structure and qualification of general thoracic surgery." European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 45.5 (May 2014): 779-786.
PMID
24562007
Source
epmc
Published In
European Journal of Cardio-Thoracic Surgery
Volume
45
Issue
5
Publish Date
2014
Start Page
779
End Page
786
DOI
10.1093/ejcts/ezu016

Differential prognostic significance of extralobar and intralobar nodal metastases in patients with surgically resected stage II non-small cell lung cancer.

We sought to determine the prognostic significance of extralobar nodal metastases versus intralobar nodal metastases in patients with lung cancer and pathologic stage N1 disease.A retrospective review of a prospectively maintained lung resection database identified 230 patients with pathologic stage II, N1 non-small cell lung cancer from 1997 to 2011. The surgical pathology reports were reviewed to identify the involved N1 stations. The outcome variables included recurrence and death. Univariate and multivariate analyses were performed using the R statistical software package.A total of 122 patients had extralobar nodal metastases (level 10 or 11); 108 patients were identified with intralobar nodal disease (levels 12-14). The median follow-up was 111 months. The baseline characteristics were similar in both groups. No significant differences were noted in the surgical approach, anatomic resections performed, or adjuvant therapy rates between the 2 groups. Overall, 80 patients developed recurrence during follow-up: 33 (30%) of 108 in the intralobar and 47 (38%) of 122 in the extralobar cohort. The median overall survival was 46.9 months for the intralobar cohort and 24.4 months for the extralobar cohort (P < .001). In a multivariate Cox proportional hazard model that included the presence of extralobar nodal disease, age, tumor size, tumor histologic type, and number of positive lymph nodes, extralobar nodal disease independently predicted both recurrence-free and overall survival (hazard ratio, 1.96; 95% confidence interval, 1.36-2.81; P = .001).In patients who underwent surgical resection for stage II non-small cell lung cancer, the presence of extralobar nodal metastases at level 10 or 11 predicted significantly poorer outcomes than did nodal metastases at stations 12 to 14. This finding has prognostic importance and implications for adjuvant therapy and surveillance strategies for patients within the heterogeneous stage II (N1) category.

Authors
Haney, JC; Hanna, JM; Berry, MF; Harpole, DH; D'Amico, TA; Tong, BC; Onaitis, MW
MLA Citation
Haney, JC, Hanna, JM, Berry, MF, Harpole, DH, D'Amico, TA, Tong, BC, and Onaitis, MW. "Differential prognostic significance of extralobar and intralobar nodal metastases in patients with surgically resected stage II non-small cell lung cancer." The Journal of thoracic and cardiovascular surgery 147.4 (April 2014): 1164-1168.
PMID
24507984
Source
epmc
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
147
Issue
4
Publish Date
2014
Start Page
1164
End Page
1168
DOI
10.1016/j.jtcvs.2013.12.015

Accuracy of fluorodeoxyglucose-positron emission tomography within the clinical practice of the American College of Surgeons Oncology Group Z4031 trial to diagnose clinical stage I non-small cell lung cancer.

Fluorodeoxyglucose-positron emission tomography (FDG-PET) is recommended for diagnosis and staging of non-small cell lung cancer (NSCLC). Meta-analyses of FDG-PET diagnostic accuracy demonstrated sensitivity of 96% and specificity of 78% but were performed in select centers, introducing potential bias. This study evaluates the accuracy of FDG-PET to diagnose NSCLC and examines differences across enrolling sites in the national American College of Surgeons Oncology Group (ACOSOG) Z4031 trial.Between 2004 and 2006, 959 eligible patients with clinical stage I (cT1-2 N0 M0) known or suspected NSCLC were enrolled in the Z4031 trial, and with a baseline FDG-PET available for 682. Final diagnosis was determined by pathologic examination. FDG-PET avidity was categorized into avid or not avid by radiologist description or reported maximum standard uptake value. FDG-PET diagnostic accuracy was calculated for the entire cohort. Accuracy differences based on preoperative size and by enrolling site were examined.Preoperative FDG-PET results were available for 682 participants enrolled at 51 sites in 39 cities. Lung cancer prevalence was 83%. FDG-PET sensitivity was 82% (95% confidence interval, 79 to 85) and specificity was 31% (95% confidence interval, 23% to 40%). Positive and negative predictive values were 85% and 26%, respectively. Accuracy improved with lesion size. Of 80 false-positive scans, 69% were granulomas. False-negative scans occurred in 101 patients, with adenocarcinoma being the most frequent (64%), and 11 were 10 mm or less. The sensitivity varied from 68% to 91% (p=0.03), and the specificity ranged from 15% to 44% (p=0.72) across cities with more than 25 participants.In a national surgical population with clinical stage I NSCLC, FDG-PET to diagnose lung cancer performed poorly compared with published studies.

Authors
Grogan, EL; Deppen, SA; Ballman, KV; Andrade, GM; Verdial, FC; Aldrich, MC; Chen, CL; Decker, PA; Harpole, DH; Cerfolio, RJ; Keenan, RJ; Jones, DR; D'Amico, TA; Shrager, JB; Meyers, BF; Putnam, JB
MLA Citation
Grogan, EL, Deppen, SA, Ballman, KV, Andrade, GM, Verdial, FC, Aldrich, MC, Chen, CL, Decker, PA, Harpole, DH, Cerfolio, RJ, Keenan, RJ, Jones, DR, D'Amico, TA, Shrager, JB, Meyers, BF, and Putnam, JB. "Accuracy of fluorodeoxyglucose-positron emission tomography within the clinical practice of the American College of Surgeons Oncology Group Z4031 trial to diagnose clinical stage I non-small cell lung cancer." The Annals of thoracic surgery 97.4 (April 2014): 1142-1148.
PMID
24576597
Source
epmc
Published In
The Annals of Thoracic Surgery
Volume
97
Issue
4
Publish Date
2014
Start Page
1142
End Page
1148
DOI
10.1016/j.athoracsur.2013.12.043

Video-assisted thoracoscopic surgery lobectomy at 20 years: a consensus statement.

OBJECTIVE: Video-assisted thoracoscopic surgery (VATS) lobectomy has been gradually accepted as an alternative surgical approach to open thoracotomy for selected patients with non-small-cell lung cancer (NSCLC) over the past 20 years. The aim of this project was to standardize the perioperative management of VATS lobectomy patients through expert consensus and to provide insightful guidance to clinical practice. METHODS: A panel of 55 experts on VATS lobectomy was identified by the Scientific Secretariat and the International Scientific Committee of the '20th Anniversary of VATS Lobectomy Conference-The Consensus Meeting'. The Delphi methodology consisting of two rounds of voting was implemented to facilitate the development of consensus. Results from the second-round voting formed the basis of the current Consensus Statement. Consensus was defined a priori as more than 50% agreement among the panel of experts. Clinical practice was deemed 'recommended' if 50-74% of the experts reached agreement and 'highly recommended' if 75% or more of the experts reached agreement. RESULTS: Fifty VATS lobectomy experts (91%) from 16 countries completed both rounds of standardized questionnaires. No statistically significant differences in the responses between the two rounds of questioning were identified. Consensus was reached on 21 controversial points, outlining the current accepted definition of VATS lobectomy, its indications and contraindications, perioperative clinical management and recommendations for training and future research directions. CONCLUSION: The present Consensus Statement represents a collective agreement among 50 international experts to establish a standardized practice of VATS lobectomy for the thoracic surgical community after 20 years of clinical experience.

Authors
Yan, TD; Cao, C; D'Amico, TA; Demmy, TL; He, J; Hansen, H; Swanson, SJ; Walker, WS; International VATS Lobectomy Consensus Group,
MLA Citation
Yan, TD, Cao, C, D'Amico, TA, Demmy, TL, He, J, Hansen, H, Swanson, SJ, Walker, WS, and International VATS Lobectomy Consensus Group, . "Video-assisted thoracoscopic surgery lobectomy at 20 years: a consensus statement." Eur J Cardiothorac Surg 45.4 (April 2014): 633-639.
PMID
24130372
Source
pubmed
Published In
European Journal of Cardio-Thoracic Surgery
Volume
45
Issue
4
Publish Date
2014
Start Page
633
End Page
639
DOI
10.1093/ejcts/ezt463

Survival in the elderly after pneumonectomy for early-stage non-small cell lung cancer: a comparison with nonoperative management.

Short-term outcomes of morbidity, mortality, and quality of life after pneumonectomy worsen with increasing age. The impact of age on long-term outcomes has not been well described. The purpose of this study was to quantify the impact of patient age on long-term survival after pneumonectomy for early-stage non-small cell lung cancer.Overall survival (OS) of patients who had a pneumonectomy for stage I to II non-small cell lung cancer in the Surveillance Epidemiology and End Results program registry from 1988 through 2010 was evaluated using multivariable and propensity score adjusted Cox proportional hazard models. Age was stratified as younger than 50 years, 50 to 69 years, 70 to 79 years, and 80 years and older. Pneumonectomy patients' OS was compared with matched patients who refused surgery and underwent radiation therapy (RT).Pneumonectomies comprised 10.8% of non-small cell lung cancer resections in 1988, but only 2.9% in 2010. Overall, 5-year OS of 5,701 pneumonectomy patients was 49.8% (95% CI, 45.3-54.8%) for patients younger than 50 years, 40.5% (95% CI, 38.8-42.2%) for patients 50 to 69 years, 28.9% (95% CI, 26.6-31.5%) for patients 70 to 79 years, and 18.8% (95% CI, 14.2-24.8%) for patients 80 and older (p < 0.001). Increasing patient age was the most important predictor of worse OS (hazard ratio = 1.34 per decade; p < 0.001). For patients younger than 70 years, 5-year OS was 46.3% (95% CI, 36.2-59.2%) after pneumonectomy vs 18.4% (95% CI, 11.9-28.3%) for matched RT patients (p < 0.001). In matched groups of patients 70 years and older, 5-year OS for pneumonectomy was 25.8% (95% CI, 20.8-32.0%) vs 12.2% for RT (95% CI, 8.6-17.4%; p = 0.02).Survival after pneumonectomy for stage I to II non-small cell lung cancer decreases steadily with patient age. The incremental benefit of pneumonectomy vs RT in matched patients is less in patients older than 70 years than in younger patients, although outcomes with pneumonectomy are superior to RT in all age groups. Patients should not be denied pneumonectomy based on age alone, but careful patient selection in elderly patients is essential to optimize survival.

Authors
Speicher, PJ; Ganapathi, AM; Englum, BR; Onaitis, MW; D'Amico, TA; Berry, MF
MLA Citation
Speicher, PJ, Ganapathi, AM, Englum, BR, Onaitis, MW, D'Amico, TA, and Berry, MF. "Survival in the elderly after pneumonectomy for early-stage non-small cell lung cancer: a comparison with nonoperative management." Journal of the American College of Surgeons 218.3 (March 2014): 439-449.
PMID
24559956
Source
epmc
Published In
Journal of The American College of Surgeons
Volume
218
Issue
3
Publish Date
2014
Start Page
439
End Page
449
DOI
10.1016/j.jamcollsurg.2013.12.005

Open, thoracoscopic and robotic segmentectomy for lung cancer.

While lobectomy is the standard procedure for early stage lung cancer, the role of sublobar resection is currently under investigation for selected patients with small tumors. In this review, studies reporting outcomes on open, thoracoscopic and robotic segmentectomy were analyzed. In patients with stage I lung cancer, with tumors <2 cm in diameter and within segmental anatomic boundaries, segmentectomy appears to have equivalent rates of morbidity, recurrence and survival when compared to lobectomy. Segmentectomy also resulted in greater preservation of lung function and exercise capacity than lobectomy. It appears reasonable to consider segmentectomy for patients with stage I lung cancer (particularly in air-containing tumors with ground glass opacities) where tumors are <2 cm in diameter and acceptable segmental margins are obtainable, especially in patients with advanced age, poor performance status, or poor cardiopulmonary reserve. The results of two ongoing randomized controlled trials (CALGB 140503 and JCOG0802/WJOG4607L) and additional well-designed studies on open, thoracoscopic, and robotic segmentectomy will be important for clarifying the role of segmentectomy for lung cancer.

Authors
Yang, C-FJ; D'Amico, TA
MLA Citation
Yang, C-FJ, and D'Amico, TA. "Open, thoracoscopic and robotic segmentectomy for lung cancer." Annals of cardiothoracic surgery 3.2 (March 2014): 142-152.
PMID
24790837
Source
epmc
Published In
Annals of cardiothoracic surgery
Volume
3
Issue
2
Publish Date
2014
Start Page
142
End Page
152
DOI
10.3978/j.issn.2225-319x.2014.02.05

Impact of Pre-treatment Imaging on Survival of Esophagectomy after Induction Therapy for Esophageal Cancer: Who Should be Given the Benefit of Doubt?

Authors
Erhunmwunsee, L; Englum, BR; D'Amico, TA; Onaitis, MW; Berry, MF
MLA Citation
Erhunmwunsee, L, Englum, BR, D'Amico, TA, Onaitis, MW, and Berry, MF. "Impact of Pre-treatment Imaging on Survival of Esophagectomy after Induction Therapy for Esophageal Cancer: Who Should be Given the Benefit of Doubt?." February 2014.
Source
wos-lite
Published In
Annals of Surgical Oncology
Volume
21
Publish Date
2014
Start Page
S151
End Page
S151

The Impact of Surveillance after Lobectomy for Stage IA Non-small Cell Lung Cancer

Authors
Mallipeddi, MK; Eltaraboulsi, WR; Shoffner, AR; Naqvi, IA; D'Amico, TA; Onaitis, MW; Berry, MF
MLA Citation
Mallipeddi, MK, Eltaraboulsi, WR, Shoffner, AR, Naqvi, IA, D'Amico, TA, Onaitis, MW, and Berry, MF. "The Impact of Surveillance after Lobectomy for Stage IA Non-small Cell Lung Cancer." February 2014.
Source
wos-lite
Published In
Annals of Surgical Oncology
Volume
21
Publish Date
2014
Start Page
S153
End Page
S154

Issues with implementing a high-quality lung cancer screening program

© 2014 American Cancer Society.After a comprehensive review of the evidence, the United States Preventive Services Task Force recently endorsed screening with low-dose computed tomography as an early detection approach that has the potential to significantly reduce deaths due to lung cancer. Prudent implementation of lung cancer screening as a high-quality preventive health service is a complex challenge. The clinical evaluation and management of high-risk cohorts in the absence of symptoms mandates an approach that differs significantly from that of symptom-detected lung cancer. As with other cancer screenings, it is essential to provide to informed at-risk individuals a safe, high-quality, cost-effective, and accessible service. In this review, the components of a successful screening program are discussed as we begin to disseminate lung cancer screening as a national resource to improve outcomes with this lethal cancer. This information about lung cancer screening will assist clinicians with communications about the potential benefits and harms of this service for high-risk individuals considering participation in the screening process.

Authors
Mulshine, JL; D'Amico, TA
MLA Citation
Mulshine, JL, and D'Amico, TA. "Issues with implementing a high-quality lung cancer screening program." CA Cancer Journal for Clinicians 64.5 (January 1, 2014): 351-363. (Review)
Source
scopus
Published In
Ca: A Cancer Journal for Clinicians
Volume
64
Issue
5
Publish Date
2014
Start Page
351
End Page
363
DOI
10.3322/caac.21239

Reply: To PMID 23545195.

Authors
Shah, AA; D'Amico, TA; Berry, MF
MLA Citation
Shah, AA, D'Amico, TA, and Berry, MF. "Reply: To PMID 23545195." Ann Thorac Surg 97.1 (January 2014): 382-383. (Letter)
PMID
24384211
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
97
Issue
1
Publish Date
2014
Start Page
382
End Page
383
DOI
10.1016/j.athoracsur.2013.09.056

Pneumonectomy for Stage IIIA NSCLC: A Chance, Not a Calamity Reply

Authors
Shah, AA; D'Amico, TA; Berry, MF
MLA Citation
Shah, AA, D'Amico, TA, and Berry, MF. "Pneumonectomy for Stage IIIA NSCLC: A Chance, Not a Calamity Reply." ANNALS OF THORACIC SURGERY 97.1 (January 2014): 382-383.
Source
wos-lite
Published In
The Annals of Thoracic Surgery
Volume
97
Issue
1
Publish Date
2014
Start Page
382
End Page
383

Sleeve lobectomy for non-small cell lung cancer with N1 nodal disease does not compromise survival.

BACKGROUND: We evaluated if sleeve lobectomy had worse survival compared with pneumonectomy for non-small cell lung cancer (NSCLC) with N1 disease, which may be a risk factor for locoregional recurrence. METHODS: Patients who underwent pneumonectomy or sleeve lobectomy without induction treatment for T2-3 N1 M0 NSCLC at a single institution from 1999 to 2011 were reviewed. Survival distribution was estimated with the Kaplan-Meier method, and multivariable Cox proportional hazards regression was used to evaluate the effect of resection extent on survival. RESULTS: During the study period, 87 patients underwent pneumonectomy (52 [60%]) or sleeve lobectomy (35 [40%]) for T2-3 N1 M0 NSCLC. Pneumonectomy and sleeve lobectomy patients had similar mean ages (60.9 ± 10.7 vs 63.5 ± 12.7 years, p = 0.30), gender distribution (69.2% [36 of 52] vs 60.0% [21 of 35] male, p = 0.37), mean forced expiratory volume in 1 second (66.3 ± 15.9 vs 63.5 ± 17.6, p = 0.47), stage (61.5% [32 of 52] vs 62.9% [22 of 35] stage II, p = 0.90), and tumor grade (51.9% [27 of 52] vs 31.4% [11 of 35] well/moderately differentiated, p = 0.17). Postoperative mortality (3.8% [2 of 52] vs 5.7% [2 of 35], p = 0.68) and median (interquartile range) length of stay (5 [4 to 7] vs 5 [4 to 7] days, p = 0.68) were similar between the two groups. The 3-year survival after pneumonectomy (46.8% [95% CI, 31.8% to 60.4%]) and sleeve lobectomy (65.2% [95% CI, 45.5% to 79.3%]) was not significantly different (p = 0.23). In multivariable survival analysis that included resection extent, age, stage, and grade, only increasing age predicted worse survival (hazard ratio, 1.03/year; p = 0.03). CONCLUSIONS: Performing sleeve lobectomy instead of pneumonectomy for NSCLC with N1 nodal disease does not compromise long-term survival.

Authors
Berry, MF; Worni, M; Wang, X; Harpole, DH; D'Amico, TA; Onaitis, MW
MLA Citation
Berry, MF, Worni, M, Wang, X, Harpole, DH, D'Amico, TA, and Onaitis, MW. "Sleeve lobectomy for non-small cell lung cancer with N1 nodal disease does not compromise survival." Ann Thorac Surg 97.1 (January 2014): 230-235.
PMID
24206972
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
97
Issue
1
Publish Date
2014
Start Page
230
End Page
235
DOI
10.1016/j.athoracsur.2013.09.016

Surgical techniques and results of the pulmonary artery reconstruction for patients with central non-small cell lung cancer

Background: It is difficult to achieve a margin-negative resection (R0) for non-small cell lung cancer (NSCLC) patients with infiltration of the pulmonary artery. We report our experience of the pulmonary artery reconstruction with regard to long-term survival.Methods: Clinical records of 118 patients with NSCLC who underwent partial or circumferential pulmonary artery resection during a 21-year period were reviewed retrospectively. Techniques and survival outcomes were analyzed.Results: We performed 22 pulmonary artery sleeve resections, 51 reconstructions by autologous pericardial patch, 36 tangential resections, 3 left main pulmonary artery (PA) angioplasties during pneumonectomy without cardiopulmonary bypass, and 6 by only preserving the apical and anterior (1st) branch of pulmonary arterial trunk. In 41 patients, bronchial sleeve resection was associated; in 7 cases, superior vena cava reconstruction was also required. Thirty-one patients received induction therapy. Thirteen patients had stage IB disease, 41 stage II, 53 IIIA, and 11 IIIB. Ninety-three patients had squamous cell carcinoma, 22 adenocarcinoma, 2 mixed and 1 large cell carcinoma. Negative vascular margins were achieved in all. 5 positive bronchial margins were due to limited lung function. The analysis of 118 cases yielded follow-up data in 94 cases. The mean follow-up was 70 months (range 1-156 months). There was no in hospital death, and the overall 5-year survival was 50.2%. Five-year survivals for stages I and II versus III were 63.9% versus 37.0% (p = 0.0059). Multivariate analysis yielded non-squamous cell carcinoma, stage III and patch pulmonary arterioplasty as negative prognosis factors. PA reconstruction associated with bronchial sleeve resection was the positive prognostic factor.Conclusions: Pulmonary artery resection and reconstruction is feasible and safe, with favorable long-term survival. Our results support this technique as an effective alternative to selected patients with infiltration of the pulmonary artery, such as stage I and II and those who proved down-staged from stage III. Accurate preoperative evaluation, precise and suitable surgical techniques are crucial to achieve good results. Only preserving the anterior and apical pulmonary arteries and reconstruction of the main pulmonary artery by using the artery conduit technique without cardiopulmonary bypass in association with left pneumonectomy can be performed successfully. Postoperative anticoagulation is unnecessary. © 2013 Ma et al.; licensee BioMed Central Ltd.

Authors
Ma, Q; Liu, D; Guo, Y; Shi, B; Tian, Y; Song, Z; Zhang, Z; Ge, B; Wang, X; D'Amico, TA
MLA Citation
Ma, Q, Liu, D, Guo, Y, Shi, B, Tian, Y, Song, Z, Zhang, Z, Ge, B, Wang, X, and D'Amico, TA. "Surgical techniques and results of the pulmonary artery reconstruction for patients with central non-small cell lung cancer." Journal of Cardiothoracic Surgery 8.1 (December 1, 2013).
PMID
24289720
Source
scopus
Published In
Journal of Cardiothoracic Surgery
Volume
8
Issue
1
Publish Date
2013
DOI
10.1186/1749-8090-8-219

Management of T2N0 Esophageal Cancer Reply

Authors
Berry, MF; Martin, JT; D'Amico, TA
MLA Citation
Berry, MF, Martin, JT, and D'Amico, TA. "Management of T2N0 Esophageal Cancer Reply." ANNALS OF THORACIC SURGERY 96.5 (November 2013): 1911-1911.
Source
wos-lite
Published In
The Annals of Thoracic Surgery
Volume
96
Issue
5
Publish Date
2013
Start Page
1911
End Page
1911

A CASE OF LUNG ADENOCARCINOMA HARBORING BOTH A KRAS MUTATION AND AN EML4-ALK FUSION GENE WITH RESPONSE TO CRIZOTINIB

Authors
Menefee, ME; D'Amico, TA
MLA Citation
Menefee, ME, and D'Amico, TA. "A CASE OF LUNG ADENOCARCINOMA HARBORING BOTH A KRAS MUTATION AND AN EML4-ALK FUSION GENE WITH RESPONSE TO CRIZOTINIB." November 2013.
Source
wos-lite
Published In
Journal of Thoracic Oncology
Volume
8
Publish Date
2013
Start Page
S1315
End Page
S1316

Reply: To PMID 23063200.

Authors
Berry, MF; Martin, JT; D'Amico, TA
MLA Citation
Berry, MF, Martin, JT, and D'Amico, TA. "Reply: To PMID 23063200." Ann Thorac Surg 96.5 (November 2013): 1911-. (Letter)
PMID
24182495
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
96
Issue
5
Publish Date
2013
Start Page
1911
DOI
10.1016/j.athoracsur.2013.07.041

Comparative Effectiveness of Stereotactic Radiosurgery (SRS) Versus Whole Brain Radiation Therapy (WBRT) for Patients With Brain Metastases From Non-Small Cell Lung Cancer (NSCLC)

Authors
Halasz, LM; Uno, H; Zornosa, C; D'Amico, TA; Dexter, EU; Hayman, JA; Otterson, GA; Pisters, KM; Weeks, JC; Punglia, RS
MLA Citation
Halasz, LM, Uno, H, Zornosa, C, D'Amico, TA, Dexter, EU, Hayman, JA, Otterson, GA, Pisters, KM, Weeks, JC, and Punglia, RS. "Comparative Effectiveness of Stereotactic Radiosurgery (SRS) Versus Whole Brain Radiation Therapy (WBRT) for Patients With Brain Metastases From Non-Small Cell Lung Cancer (NSCLC)." October 1, 2013.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
87
Issue
2
Publish Date
2013
Start Page
S41
End Page
S41

Local recurrence after surgery for non-small cell lung cancer: a recursive partitioning analysis of multi-institutional data.

OBJECTIVE: To define subgroups at high risk of local recurrence (LR) after surgery for non-small cell lung cancer using a recursive partitioning analysis (RPA). METHODS: This Institutional Review Board-approved study included patients who underwent upfront surgery for I-IIIA non-small cell lung cancer at Duke Cancer Institute (primary set) or at other participating institutions (validation set). The 2 data sets were analyzed separately and identically. Disease recurrence at the surgical margin, ipsilateral hilum, and/or mediastinum was considered an LR. Recursive partitioning was used to build regression trees for the prediction of local recurrence-free survival (LRFS) from standard clinical and pathological factors. LRFS distributions were estimated with the Kaplan-Meier method. RESULTS: The 1411 patients in the primary set had a 5-year LRFS rate of 77% (95% confidence interval [CI], 0.74-0.81), and the 889 patients in the validation set had a 5-year LRFS rate of 76% (95% CI, 0.72-0.80). The RPA of the primary data set identified 3 terminal nodes based on stage and histology. These nodes and their 5-year LRFS rates were as follows: (1) stage I/adenocarcinoma, 87% (95% CI, 0.83-0.90); (2) stage I/squamous or large cell, 72% (95% CI, 0.65-0.79); and (3) stage II-IIIA, 62% (95% CI, 0.55-0.69). The validation RPA identified 3 terminal nodes based on lymphovascular invasion (LVI) and stage: (1) no LVI/stage IA, 82% (95% CI, 0.76-0.88); (2) no LVI/stage IB-IIIA, 73% (95% CI, 0.69-0.80); and (3) LVI, 58% (95% CI, 0.47-0.69). CONCLUSIONS: The risk of LR was similar in the primary and validation patient data sets. There was discordance between the 2 data sets regarding the clinical factors that best segregate patients into risk groups.

Authors
Kelsey, CR; Higgins, KA; Peterson, BL; Chino, JP; Marks, LB; D'Amico, TA; Varlotto, JM
MLA Citation
Kelsey, CR, Higgins, KA, Peterson, BL, Chino, JP, Marks, LB, D'Amico, TA, and Varlotto, JM. "Local recurrence after surgery for non-small cell lung cancer: a recursive partitioning analysis of multi-institutional data." J Thorac Cardiovasc Surg 146.4 (October 2013): 768-773.e1.
PMID
23856204
Source
pubmed
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
146
Issue
4
Publish Date
2013
Start Page
768
End Page
773.e1
DOI
10.1016/j.jtcvs.2013.05.041

Are discordant positron emission tomography and pathological assessments of the mediastinum in non-small cell lung cancer significant?

OBJECTIVE: Many patients with non-small cell lung cancer have positive mediastinal lymph nodes on preoperative positron emission tomography (PET) but do not have mediastinal involvement after surgery. The prognostic significance of this discordance was assessed. METHODS: This Institutional Review Board-approved study evaluated patients treated with upfront surgery at Duke Cancer Institute (Durham, NC) for non-small cell lung cancer from 1995 to 2008. Those staged with PET with pN0-1 disease after negative invasive mediastinal assessment were included. Mediastinal lymph nodes were scored as positive or negative based on visual analysis of the preoperative PET. Clinical outcomes of the PET-positive and PET-negative cohorts were estimated using the Kaplan-Meier method and compared using a log-rank test. Prognostic factors were assessed using a multivariate analysis. RESULTS: A total of 547 patients were assessed, of whom 105 (19%) were PET positive in the mediastinum. The median number of mediastinal lymph node stations sampled was 4 (range, 1-9). The 5-year risk of local recurrence was 26% in PET-positive versus 21% in PET-negative patients (P = .50). Patterns of local failure were similar between the 2 groups. Distant recurrence (35% vs 29%; P = .63) and overall survival (44% vs 54%; P = .52) were comparable for PET-positive and PET-negative patients. On multivariate analysis, a positive PET was not significant for local recurrence (hazard ratio [HR], 1; P = 1), distant recurrence (HR, 0.82; P = .42), or overall survival (HR, 1.08; P = .62). CONCLUSIONS: Patients with positive mediastinal lymph nodes on preoperative PET, but negative on histologic analysis, are not at increased risk of disease recurrence. Pathologic staging remains the standard.

Authors
Tandberg, DJ; Gee, NG; Chino, JP; D'Amico, TA; Ready, NE; Coleman, RE; Kelsey, CR
MLA Citation
Tandberg, DJ, Gee, NG, Chino, JP, D'Amico, TA, Ready, NE, Coleman, RE, and Kelsey, CR. "Are discordant positron emission tomography and pathological assessments of the mediastinum in non-small cell lung cancer significant?." J Thorac Cardiovasc Surg 146.4 (October 2013): 796-801.
PMID
23870158
Source
pubmed
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
146
Issue
4
Publish Date
2013
Start Page
796
End Page
801
DOI
10.1016/j.jtcvs.2013.05.027

Partial anomalous pulmonary venous return to azygos vein with absent segmental bronchus.

Authors
Kavakli, K; Gaudet, M; Balderson, SS; Wahidi, M; D'Amico, TA
MLA Citation
Kavakli, K, Gaudet, M, Balderson, SS, Wahidi, M, and D'Amico, TA. "Partial anomalous pulmonary venous return to azygos vein with absent segmental bronchus." Ann Thorac Surg 96.4 (October 2013): 1486-.
PMID
24088473
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
96
Issue
4
Publish Date
2013
Start Page
1486
DOI
10.1016/j.athoracsur.2013.03.041

Extensive invasion of the left atrium by lung cancer.

A 52-year-old man complained of cough and hemoptysis for 1 month. Chest computed tomography scan revealed a 9 cm × 7 cm right lung mass invading the right inferior pulmonary vein and left atrium extensively, and the inferior pulmonary vein was completely occluded. Transsternal echocardiogram confirmed that the lesion invaded the apex of left atrium adjacent to the right pulmonary inferior vein. Positron emission tomography scan showed no other metastatic disease. Bronchoscopy with endobronchial biopsy demonstrated a low-grade squamous cell carcinoma. After 2 cycles of induction chemotherapy, he underwent resection with cardiopulmonary bypass. Postoperative pathology was sarcoma mixed with squamous carcinoma (10%), without lymph node metastasis. Both the bronchial and atrial margins were negative, pathology stage T4N0M0, IIIA. He recovered without postoperative complications, and went back to work 20 days after surgery. He received four cycles of subsequent chemotherapy, but a solitary brain metastasis was discovered 7 months later, and he died 9 months after surgery.

Authors
Ma, Q; Liu, D; Liu, P; Chen, J; Xie, Z; D'Amico, TA
MLA Citation
Ma, Q, Liu, D, Liu, P, Chen, J, Xie, Z, and D'Amico, TA. "Extensive invasion of the left atrium by lung cancer." Ann Thorac Surg 96.2 (August 2013): 685-687.
PMID
23910112
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
96
Issue
2
Publish Date
2013
Start Page
685
End Page
687
DOI
10.1016/j.athoracsur.2012.12.050

Contraindications of video-assisted thoracoscopic surgical lobectomy and determinants of conversion to open.

Since the introduction of anatomic lung resection by video-assisted thoracoscopic surgery (VATS) was introduced 20 years ago, VATS has experienced major advances in both equipment and technique, introducing a technical challenge in the surgical treatment of both benign and malignant lung disease. The demonstrated safety, decreased morbidity, and equivalent efficacy of this minimally invasive technique has led to the acceptance of VATS as a standard surgical modality for early-stage lung cancer and increasing application to more advanced disease. However, only a minority of lobectomies are performed using the VATS technique, likely owing to concern for intraoperative complications. Optimal operative planning, including obtaining baseline pulmonary function tests with diffusion measurements, positron emission tomography and/or computed tomography scans, bronchoscopy, and endobronchial ultrasound or mediastinoscopy, can be used to anticipate and potentially prevent the occurrence of complications. With increasing focus on operative planning, as well as comfort and experience with the VATS technique, the indications for which this technique is used has grown. As such, the absolute contraindications have narrowed to inability to tolerate single lung ventilation, inability to achieve complete resection with lobectomy, T3 or T4 tumors, and N2 or N3 disease. However, as VATS lobectomy has been applied to more advanced stage disease, the rate of conversion to open thoracotomy has increased, particularly early in the surgeon's learning curve. Causes of conversion are generally classified into four categories: intraoperative complications, technical problems, anatomical problems, and oncological conditions. Though it is difficult to anticipate which patients may require conversion, it appears that these patients do not suffer from increased morbidity or mortality as a result of conversion to open thoracotomy. Therefore, with a focus on a safe and complete resection, conversion should be regarded as a means of completing resections in a traditional manner rather than as a surgical failure.

Authors
Hanna, JM; Berry, MF; D'Amico, TA
MLA Citation
Hanna, JM, Berry, MF, and D'Amico, TA. "Contraindications of video-assisted thoracoscopic surgical lobectomy and determinants of conversion to open." J Thorac Dis 5 Suppl 3 (August 2013): S182-S189. (Review)
PMID
24040521
Source
pubmed
Published In
Journal of Thoracic Disease
Volume
5 Suppl 3
Publish Date
2013
Start Page
S182
End Page
S189
DOI
10.3978/j.issn.2072-1439.2013.07.08

Prospective phase II trial of preresection thoracoscopic mediastinal restaging after neoadjuvant therapy for IIIA (N2) non-small cell lung cancer: results of CALGB Protocol 39803.

OBJECTIVE: Accurate pathologic restaging of N2 stations after neoadjuvant therapy in stage IIIA (N2) non-small cell lung cancer is needed. METHODS: A prospective multi-institutional trial was designed to judge the feasibility of videothoracoscopy to restage the ipsilateral nodes in mediastinoscopy-proven stage IIIA (N2) non-small cell lung cancer after 2 cycles of platinum-based chemotherapy and/or 40 Gy or more of radiotherapy. The goals included biopsy of 3 negative N2 node stations or to identify 1 positive N2 node or pleural carcinomatosis. RESULTS: Ten institutions accrued 68 subjects. Of the 68 subjects, 46 (68%) underwent radiotherapy and 66 (97%) underwent chemotherapy. Videothoracoscopy successfully met the prestudy feasibility in 27 patients (40%): 3 negative stations confirmed at thoracotomy in 7, persistent stage N2 disease in 16, and pleural carcinomatosis in 4. In 20 procedures (29%), no N2 disease was found, 3 stations were not biopsied because of unanticipated nodal obliteration. Thus, 47 videothoracoscopy procedures (69%, 95% confidence interval, 57%-80%) restaged the mediastinum. Videothoracoscopy was unsuccessful in 21 patients (31%) because the procedure had to be aborted (n = 11) or because of false-negative stations (n = 10). Of the 21 failures, 15 were right-sided, and 10 had a positive 4R node. The sensitivity of videothoracoscopy was 67% (95% confidence interval, 47%-83%), and the negative predictive value was 73% (95% confidence interval, 56%-86%) if patients with obliterated nodal tissue were included. The sensitivity was 83% (95% confidence interval, 63%-95%) and the negative predictive value was 64% (95% confidence interval, 31%-89%) if those patients were excluded. The specificity was 100%. One death occurred after thoracotomy. CONCLUSIONS: Videothoracoscopy restaging was "feasible" in this prospective multi-institutional trial and provided pathologic specimens of the ipsilateral nodes. Videothoracoscopy restaging was limited by radiation and the 4R nodal station.

Authors
Jaklitsch, MT; Gu, L; Demmy, T; Harpole, DH; D'Amico, TA; McKenna, RJ; Krasna, MJ; Kohman, LJ; Swanson, SJ; DeCamp, MM; Wang, X; Barry, S; Sugarbaker, DJ; CALGB Thoracic Surgeons,
MLA Citation
Jaklitsch, MT, Gu, L, Demmy, T, Harpole, DH, D'Amico, TA, McKenna, RJ, Krasna, MJ, Kohman, LJ, Swanson, SJ, DeCamp, MM, Wang, X, Barry, S, Sugarbaker, DJ, and CALGB Thoracic Surgeons, . "Prospective phase II trial of preresection thoracoscopic mediastinal restaging after neoadjuvant therapy for IIIA (N2) non-small cell lung cancer: results of CALGB Protocol 39803." J Thorac Cardiovasc Surg 146.1 (July 2013): 9-16.
PMID
23768804
Source
pubmed
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
146
Issue
1
Publish Date
2013
Start Page
9
End Page
16
DOI
10.1016/j.jtcvs.2012.12.069

Variability in the treatment of elderly patients with stage IIIA (N2) non-small-cell lung cancer.

: We evaluated treatment patterns of elderly patients with stage IIIA (N2) non-small-cell lung cancer (NSCLC).: The use of surgery, chemotherapy, and radiation for patients with stage IIIA (T1-T3N2M0) NSCLC in the Surveillance, Epidemiology, and End Results-Medicare database from 2004 to 2007 was analyzed. Treatment variability was assessed using a multivariable logistic regression model that included treatment, patient, tumor, and census track variables. Overall survival was analyzed using the Kaplan-Meier approach and Cox proportional hazard models.: The most common treatments for 2958 patients with stage IIIA (N2) NSCLC were radiation with chemotherapy (n = 1065, 36%), no treatment (n = 534, 18%), and radiation alone (n = 383, 13%). Surgery was performed in 709 patients (24%): 235 patients (8%) had surgery alone, 40 patients (1%) had surgery with radiation, 222 patients had surgery with chemotherapy (8%), and 212 patients (7%) had surgery, chemotherapy, and radiation. Younger age (p < 0.0001), lower T-status (p < 0.0001), female sex (p = 0.04), and living in a census track with a higher median income (p = 0.03) predicted surgery use. Older age (p < 0.0001) was the only factor that predicted that patients did not get any therapy. The 3-year overall survival was 21.8 ± 1.5% for all patients, 42.1 ± 3.8% for patients that had surgery, and 15.4 ± 1.5% for patients that did not have surgery. Increasing age, higher T-stage and Charlson Comorbidity Index, and not having surgery, radiation, or chemotherapy were all risk factors for worse survival (all p values < 0.001).: Treatment of elderly patients with stage IIIA (N2) NSCLC is highly variable and varies not only with specific patient and tumor characteristics but also with regional income level.

Authors
Berry, MF; Worni, M; Pietrobon, R; D'Amico, TA; Akushevich, I
MLA Citation
Berry, MF, Worni, M, Pietrobon, R, D'Amico, TA, and Akushevich, I. "Variability in the treatment of elderly patients with stage IIIA (N2) non-small-cell lung cancer." Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer 8.6 (June 2013): 744-752.
PMID
23571473
Source
epmc
Published In
Journal of Thoracic Oncology
Volume
8
Issue
6
Publish Date
2013
Start Page
744
End Page
752
DOI
10.1097/jto.0b013e31828916aa

Treatment Modalities for T1N0 Esophageal Cancers A Comparative Analysis of Local Therapy Versus Surgical Resection

Authors
Berry, MF; Zeyer-Brunner, J; Castleberry, AW; Martin, JT; Gloor, B; Pietrobon, R; D'Amico, TA; Worni, M
MLA Citation
Berry, MF, Zeyer-Brunner, J, Castleberry, AW, Martin, JT, Gloor, B, Pietrobon, R, D'Amico, TA, and Worni, M. "Treatment Modalities for T1N0 Esophageal Cancers A Comparative Analysis of Local Therapy Versus Surgical Resection." JOURNAL OF THORACIC ONCOLOGY 8.6 (June 2013): 796-802.
PMID
24614244
Source
wos-lite
Published In
Journal of Thoracic Oncology
Volume
8
Issue
6
Publish Date
2013
Start Page
796
End Page
802
DOI
10.1097/JTO.0b013e3182897bf1

Non-Small Cell Lung Cancer, Version 2.2013 Featured Updates to the NCCN Guidelines

Authors
Ettinger, DS; Akerley, W; Borghaei, H; Chang, AC; Cheney, RT; Chirieac, LR; D'Amico, TA; Demmy, TL; Govindan, R; Jr, GFW; Grant, SC; Horn, L; Jahan, TM; Komaki, R; Kong, F-MS; Kris, MG; Krug, LM; Lackner, RP; Lennes, IT; Jr, LBW; Martins, R; Otterson, GA; Patel, JD; Pinder-Schenck, MC; Pisters, KM; Reckamp, K; Riely, GJ; Rohren, E; Shapiro, TA; Swanson, SJ; Tauer, K; Wood, DE; Yang, SC; Gregory, K; Hughes, M
MLA Citation
Ettinger, DS, Akerley, W, Borghaei, H, Chang, AC, Cheney, RT, Chirieac, LR, D'Amico, TA, Demmy, TL, Govindan, R, Jr, GFW, Grant, SC, Horn, L, Jahan, TM, Komaki, R, Kong, F-MS, Kris, MG, Krug, LM, Lackner, RP, Lennes, IT, Jr, LBW, Martins, R, Otterson, GA, Patel, JD, Pinder-Schenck, MC, Pisters, KM, Reckamp, K, Riely, GJ, Rohren, E, Shapiro, TA, Swanson, SJ, Tauer, K, Wood, DE, Yang, SC, Gregory, K, and Hughes, M. "Non-Small Cell Lung Cancer, Version 2.2013 Featured Updates to the NCCN Guidelines." JOURNAL OF THE NATIONAL COMPREHENSIVE CANCER NETWORK 11.6 (June 2013): 645-653.
PMID
23744864
Source
wos-lite
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
11
Issue
6
Publish Date
2013
Start Page
645
End Page
653

Thymomas and thymic carcinomas: Clinical Practice Guidelines in Oncology.

Masses in the anterior mediastinum can be neoplasms (eg, thymomas, thymic carcinomas, or lung metastases) or non-neoplastic conditions (eg, intrathoracic goiter). Thymomas are the most common primary tumor in the anterior mediastinum, although they are rare. Thymic carcinomas are very rare. Thymomas and thymic carcinomas originate in the thymus. Although thymomas can spread locally, they are much less invasive than thymic carcinomas. Patients with thymomas have 5-year survival rates of approximately 78%. However, 5-year survival rates for thymic carcinomas are only approximately 40%. These guidelines outline the evaluation, treatment, and management of these mediastinal tumors.

Authors
Ettinger, DS; Riely, GJ; Akerley, W; Borghaei, H; Chang, AC; Cheney, RT; Chirieac, LR; D'Amico, TA; Demmy, TL; Govindan, R; Grannis, FW; Grant, SC; Horn, L; Jahan, TM; Komaki, R; Kong, F-MS; Kris, MG; Krug, LM; Lackner, RP; Lennes, IT; Loo, BW; Martins, R; Otterson, GA; Patel, JD; Pinder-Schenck, MC; Pisters, KM; Reckamp, K; Rohren, E; Shapiro, TA; Swanson, SJ; Tauer, K; Wood, DE; Yang, SC; Gregory, K; Hughes, M; National Comprehensive Cancer Network,
MLA Citation
Ettinger, DS, Riely, GJ, Akerley, W, Borghaei, H, Chang, AC, Cheney, RT, Chirieac, LR, D'Amico, TA, Demmy, TL, Govindan, R, Grannis, FW, Grant, SC, Horn, L, Jahan, TM, Komaki, R, Kong, F-MS, Kris, MG, Krug, LM, Lackner, RP, Lennes, IT, Loo, BW, Martins, R, Otterson, GA, Patel, JD, Pinder-Schenck, MC, Pisters, KM, Reckamp, K, Rohren, E, Shapiro, TA, Swanson, SJ, Tauer, K, Wood, DE, Yang, SC, Gregory, K, Hughes, M, and National Comprehensive Cancer Network, . "Thymomas and thymic carcinomas: Clinical Practice Guidelines in Oncology." J Natl Compr Canc Netw 11.5 (May 1, 2013): 562-576.
PMID
23667206
Source
pubmed
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
11
Issue
5
Publish Date
2013
Start Page
562
End Page
576

Gastric cancer, version 2.2013: featured updates to the NCCN Guidelines.

The NCCN Clinical Practice Guidelines in Oncology for Gastric Cancer provide evidence- and consensus-based recommendations for a multidisciplinary approach for the management of patients with gastric cancer. For patients with resectable locoregional cancer, the guidelines recommend gastrectomy with a D1+ or a modified D2 lymph node dissection (performed by experienced surgeons in high-volume centers). Postoperative chemoradiation is the preferred option after complete gastric resection for patients with T3-T4 tumors and node-positive T1-T2 tumors. Postoperative chemotherapy is included as an option after a modified D2 lymph node dissection for this group of patients. Trastuzumab with chemotherapy is recommended as first-line therapy for patients with HER2-positive advanced or metastatic cancer, confirmed by immunohistochemistry and, if needed, by fluorescence in situ hybridization for IHC 2+.

Authors
Ajani, JA; Bentrem, DJ; Besh, S; D'Amico, TA; Das, P; Denlinger, C; Fakih, MG; Fuchs, CS; Gerdes, H; Glasgow, RE; Hayman, JA; Hofstetter, WL; Ilson, DH; Keswani, RN; Kleinberg, LR; Korn, WM; Lockhart, AC; Meredith, K; Mulcahy, MF; Orringer, MB; Posey, JA; Sasson, AR; Scott, WJ; Strong, VE; Varghese, TK; Warren, G; Washington, MK; Willett, C; Wright, CD; McMillian, NR; Sundar, H; National Comprehensive Cancer Network,
MLA Citation
Ajani, JA, Bentrem, DJ, Besh, S, D'Amico, TA, Das, P, Denlinger, C, Fakih, MG, Fuchs, CS, Gerdes, H, Glasgow, RE, Hayman, JA, Hofstetter, WL, Ilson, DH, Keswani, RN, Kleinberg, LR, Korn, WM, Lockhart, AC, Meredith, K, Mulcahy, MF, Orringer, MB, Posey, JA, Sasson, AR, Scott, WJ, Strong, VE, Varghese, TK, Warren, G, Washington, MK, Willett, C, Wright, CD, McMillian, NR, Sundar, H, and National Comprehensive Cancer Network, . "Gastric cancer, version 2.2013: featured updates to the NCCN Guidelines." J Natl Compr Canc Netw 11.5 (May 1, 2013): 531-546.
PMID
23667204
Source
pubmed
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
11
Issue
5
Publish Date
2013
Start Page
531
End Page
546

Does pneumonectomy have a role in the treatment of stage IIIA non-small cell lung cancer?

BACKGROUND: The role of surgical resection for stage IIIA non-small cell lung cancer (NSCLC) is unclear. We sought to examine outcomes after pneumonectomy for patients with stage IIIA disease. METHODS: All patients with stage IIIA NSCLC who had pneumonectomy at a single institution between 1999 and 2010 were reviewed. The Kaplan-Meier method was used to estimate long-term survival and multivariable Cox proportional hazards regression was used to identify clinical characteristics associated with survival. RESULTS: During the study period, 324 patients had surgical resection of stage IIIA NSCLC. Pneumonectomy was performed in 55 patients, 23 (42%) of whom had N2 disease. Induction treatment was used in 17 patients (31%) overall and in 11 of the patients (48%) with N2 disease. Perioperative mortality was 9% (n = 5) overall and 18% (n = 3) in patients that had received induction therapy (p = 0.17). Complications occurred in 32 patients (58%). Three-year survival was 36% and 5-year survival was 29% for all patients. Three-year survival was 40% for N0-1 patients and 29% for N2 patients (p = 0.59). In multivariable analysis, age over 60 years (hazard ratio [HR] 3.65, p = 0.001), renal insufficiency (HR 5.80, p = 0.007), and induction therapy (HR 2.17, p = 0.05) predicted worse survival, and adjuvant therapy (HR 0.35, p = 0.007) predicted improved survival. CONCLUSIONS: Long-term survival after pneumonectomy for stage IIIA NSCLC is within an acceptable range, but pneumonectomy may not be appropriate after induction therapy or in patients with renal insufficiency. Patient selection and operative technique that limit perioperative morbidity and facilitate the use of adjuvant chemotherapy are critical to optimizing outcomes.

Authors
Shah, AA; Worni, M; Kelsey, CR; Onaitis, MW; D'Amico, TA; Berry, MF
MLA Citation
Shah, AA, Worni, M, Kelsey, CR, Onaitis, MW, D'Amico, TA, and Berry, MF. "Does pneumonectomy have a role in the treatment of stage IIIA non-small cell lung cancer?." Ann Thorac Surg 95.5 (May 2013): 1700-1707.
PMID
23545195
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
95
Issue
5
Publish Date
2013
Start Page
1700
End Page
1707
DOI
10.1016/j.athoracsur.2013.02.044

Diabetes mellitus: A significant co-morbidity in the setting of lung cancer?

Authors
Washington, I; Chino, JP; Marks, LB; D'Amico, TA; Berry, MF; Ready, NE; Higgins, KA; Yoo, DS; Kelsey, CR
MLA Citation
Washington, I, Chino, JP, Marks, LB, D'Amico, TA, Berry, MF, Ready, NE, Higgins, KA, Yoo, DS, and Kelsey, CR. "Diabetes mellitus: A significant co-morbidity in the setting of lung cancer?." THORACIC CANCER 4.2 (May 2013): 123-130.
Source
wos-lite
Published In
Thoracic Cancer
Volume
4
Issue
2
Publish Date
2013
Start Page
123
End Page
130
DOI
10.1111/j.1759-7714.2012.00162.x

Thymomas and Thymic Carcinomas Clinical Practice Guidelines in Oncology

Authors
Ettinger, DS; Riely, GJ; Akerley, W; Borghaei, H; Chang, AC; Cheney, RT; Chirieac, LR; D'Amico, TA; Demmy, TL; Govindan, R; Jr, GFW; Grant, SC; Horn, L; Jahan, TM; Komaki, R; Spring Kong, F-M; Kris, MG; Krug, LM; Lackner, RP; Lennes, IT; Jr, LBW; Martins, R; Otterson, GA; Patel, JD; Pinder-Schenck, MC; Pisters, KM; Reckamp, K; Rohren, E; Shapiro, TA; Swanson, SJ; Tauer, K; Wood, DE; Yang, SC; Gregory, K; Hughes, M
MLA Citation
Ettinger, DS, Riely, GJ, Akerley, W, Borghaei, H, Chang, AC, Cheney, RT, Chirieac, LR, D'Amico, TA, Demmy, TL, Govindan, R, Jr, GFW, Grant, SC, Horn, L, Jahan, TM, Komaki, R, Spring Kong, F-M, Kris, MG, Krug, LM, Lackner, RP, Lennes, IT, Jr, LBW, Martins, R, Otterson, GA, Patel, JD, Pinder-Schenck, MC, Pisters, KM, Reckamp, K, Rohren, E, Shapiro, TA, Swanson, SJ, Tauer, K, Wood, DE, Yang, SC, Gregory, K, and Hughes, M. "Thymomas and Thymic Carcinomas Clinical Practice Guidelines in Oncology." JOURNAL OF THE NATIONAL COMPREHENSIVE CANCER NETWORK 11.5 (May 2013): 562-576.
Source
wos-lite
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
11
Issue
5
Publish Date
2013
Start Page
562
End Page
576

Abstract LB-296: FDG-PET avidity negatively impacts survival in pStage I NSCLC in the ACOSOG Z4031 trial.

Authors
Grogan, EL; Deppen, SA; Chen, H; Ballman, KV; Verdial, FC; Aldrich, MC; Decker, PA; Harpole, DH; Cerfolio, RJ; Keenan, RJ; Jones, DR; D'Amico, TA; Shrager, JB; Meyers, BF; Putnam, JB
MLA Citation
Grogan, EL, Deppen, SA, Chen, H, Ballman, KV, Verdial, FC, Aldrich, MC, Decker, PA, Harpole, DH, Cerfolio, RJ, Keenan, RJ, Jones, DR, D'Amico, TA, Shrager, JB, Meyers, BF, and Putnam, JB. "Abstract LB-296: FDG-PET avidity negatively impacts survival in pStage I NSCLC in the ACOSOG Z4031 trial." April 15, 2013.
Source
crossref
Published In
Cancer Research
Volume
73
Issue
8 Supplement
Publish Date
2013
Start Page
LB-296
End Page
LB-296
DOI
10.1158/1538-7445.AM2013-LB-296

The best that surgery has to offer.

Authors
D'Amico, TA
MLA Citation
D'Amico, TA. "The best that surgery has to offer." J Thorac Cardiovasc Surg 145.3 (March 2013): 699-701.
PMID
23312096
Source
pubmed
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
145
Issue
3
Publish Date
2013
Start Page
699
End Page
701
DOI
10.1016/j.jtcvs.2012.12.020

Smoking status and survival in the national comprehensive cancer network non-small cell lung cancer cohort.

BACKGROUND: The objectives of this study were to evaluate survival among current smokers, former smokers, and never smokers who are diagnosed with non-small cell lung cancer (NSCLC). METHODS: The study included patients who participated in the National Comprehensive Cancer Network's NSCLC Database Project. Current, former, and never smokers were compared with respect to overall survival by fitting Cox regression models. RESULTS: Data from 4200 patients were examined, including 618 never smokers, 1483 current smokers, 380 former smokers who quit 1 to 12 months before diagnosis, and 1719 former smokers who quit >12 months before diagnosis. Among patients with stage I, II, and III disease, only never smokers had better survival than current smokers (hazard ratio, 0.47 [95% confidence interval, 0.26-0.85] vs 0.51 [95% confidence interval, 0.38-0.68], respectively). Among patients with stage IV disease, the impact of smoking depended on age: Among younger patients (aged ≤55 years), being a never smoker and a former smoker for ≥12 months increased survival. After age 85 years, smoking status did not have a significant impact on overall survival. CONCLUSIONS: Patients who were smoking at the time of diagnosis had worse survival compared with never smokers. Among younger patients with stage IV disease, current smokers also had worse survival compared with former smokers who quit >12 months before diagnosis. It is likely that tumor biology plays a major role in the differences observed; however, to improve survival, it is prudent to encourage all smokers to quit smoking if they are diagnosed with NSCLC.

Authors
Ferketich, AK; Niland, JC; Mamet, R; Zornosa, C; D'Amico, TA; Ettinger, DS; Kalemkerian, GP; Pisters, KM; Reid, ME; Otterson, GA
MLA Citation
Ferketich, AK, Niland, JC, Mamet, R, Zornosa, C, D'Amico, TA, Ettinger, DS, Kalemkerian, GP, Pisters, KM, Reid, ME, and Otterson, GA. "Smoking status and survival in the national comprehensive cancer network non-small cell lung cancer cohort." Cancer 119.4 (February 15, 2013): 847-853.
PMID
23023590
Source
pubmed
Published In
Cancer
Volume
119
Issue
4
Publish Date
2013
Start Page
847
End Page
853
DOI
10.1002/cncr.27824

Historical perspectives of The American Association for Thoracic Surgery: Henry T. Bahnson (1920-2003).

Authors
D'Amico, TA; American Association for Thoracic Surgery Centennial Committee,
MLA Citation
D'Amico, TA, and American Association for Thoracic Surgery Centennial Committee, . "Historical perspectives of The American Association for Thoracic Surgery: Henry T. Bahnson (1920-2003)." J Thorac Cardiovasc Surg 145.2 (February 2013): 326-327.
PMID
23141035
Source
pubmed
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
145
Issue
2
Publish Date
2013
Start Page
326
End Page
327
DOI
10.1016/j.jtcvs.2012.10.024

Impact of T status and N status on perioperative outcomes after thoracoscopic lobectomy for lung cancer.

OBJECTIVE: We sought to evaluate the effect of tumor size, location, and clinical nodal status on outcomes after thoracoscopic lobectomy for lung cancer. METHODS: All patients who underwent attempted thoracoscopic lobectomy for lung cancer between June 1999 and October 2010 at a single institution were reviewed. A model for morbidity including published risk factors as well as tumor size, location, and clinical N status was developed by multivariable logistic regression. RESULTS: During the study period, 916 thoracoscopic lobectomies met study criteria: 329 for peripheral, clinical N0 tumors ≤ 3 cm and 504 for tumors that were central, clinical node positive, or >3 cm. Tumor location could not be documented for 83 patients. Conversions to thoracotomy occurred in 36 patients (4%); patients with clinically node-positive disease had higher conversion rates (11 conversions in 153 clinical N1 to N3 patients [7.2%] vs 25 in 763 clinical N0 patients [3.3%, P = .03]. Overall operative mortality was 1.6% (14 patients) and morbidity was 32% (296 patients). Although patients with larger tumors (P = .006) and central tumors (P = .01) had increased complications by univariate analysis, tumor size >3 cm (P = .17) and central location (P = .5) did not predict significantly overall morbidity in multivariate analysis. Clinical node status did not predict increased complications by univariate or multivariate analysis. Significant predictors of morbidity in multivariable analysis were increasing age, decreasing forced expiratory volume in 1 second, prior chemotherapy, and congestive heart failure. CONCLUSIONS: Thoracoscopic lobectomy for lung cancers that are central, clinically node positive, or >3 cm does not confer increased morbidity compared with peripheral, clinical N0 cancers that are <3 cm.

Authors
Villamizar, NR; Darrabie, M; Hanna, J; Onaitis, MW; Tong, BC; D'Amico, TA; Berry, MF
MLA Citation
Villamizar, NR, Darrabie, M, Hanna, J, Onaitis, MW, Tong, BC, D'Amico, TA, and Berry, MF. "Impact of T status and N status on perioperative outcomes after thoracoscopic lobectomy for lung cancer." J Thorac Cardiovasc Surg 145.2 (February 2013): 514-520.
PMID
23177123
Source
pubmed
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
145
Issue
2
Publish Date
2013
Start Page
514
End Page
520
DOI
10.1016/j.jtcvs.2012.10.039

The role of radiation therapy in resected T2 N0 esophageal cancer: a population-based analysis.

BACKGROUND: The prognosis of even early-stage esophageal cancer is poor. Because there is not a consensus on how to manage T2 N0 disease, we examined survival after resection of T2 N0 esophageal cancer, with or without radiation therapy. METHODS: Patients who underwent resection for T2 N0 squamous cell carcinoma or adenocarcinoma of the mid or distal esophagus, with or without radiation therapy, were identified using the Surveillance, Epidemiology and End Results cancer registry from 1998 to 2008. The 5-year cancer-specific survival (CSS) and overall survival (OS) after resection alone and combined resection with radiation therapy were compared using the Kaplan-Meier approach, risk-adjusted Cox proportional hazard models, and competing risk models. RESULTS: The 5-year OS of 490 T2 N0 patients was 40.3% (95% confidence interval [CI], 35.2% to 45.4%). Surgical resection alone was used in 267 patients (54%) and combined therapy in 223 (46%). The 5-year OS was 38.6% (95% CI, 31.7% to 45.5%) in patients undergoing resection only and 42.3% (95% CI, 34.7% to 49.6%) for combined therapy (p = 0.48). No difference in OS was found, even after risk adjustment (hazard ratio [HR], 1.14; 95% CI, 0.87 to 1.48; p = 0.35). However, in landmark studies with left truncation for 3 and 6 months, resection only showed better OS than combined therapy (HR, 1.33; 95% CI, 1.01 to 1.75; p = 0.04 vs HR, 1.36; 95% CI, 1.01 to 1.83; p = 0.04, respectively). No such difference for CSS was detected, even for the landmark study after 6 months (HR, 1.16; 95% CI, 0.98 to 1.39, p = 0.09). CONCLUSIONS: Combining radiation therapy with esophagectomy did not result in improved outcomes compared with esophagectomy alone for patients with T2 N0 esophageal cancer in the Surveillance, Epidemiology and End Results database.

Authors
Martin, JT; Worni, M; Zwischenberger, JB; Gloor, B; Pietrobon, R; D'Amico, TA; Berry, MF
MLA Citation
Martin, JT, Worni, M, Zwischenberger, JB, Gloor, B, Pietrobon, R, D'Amico, TA, and Berry, MF. "The role of radiation therapy in resected T2 N0 esophageal cancer: a population-based analysis." Ann Thorac Surg 95.2 (February 2013): 453-458.
PMID
23063200
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
95
Issue
2
Publish Date
2013
Start Page
453
End Page
458
DOI
10.1016/j.athoracsur.2012.08.049

Impact of the 7th Edition AJCC staging classification on the NCCN clinical practice guidelines in oncology for gastric and esophageal cancers.

The 7th edition of the AJCC Cancer Staging Manual has attempted to harmonize gastric and esophageal cancers, including management of gastroesophageal junction (GEJ)-type tumors. The treatment of complex tumor types is best guided by a staging classification that reliably groups patients according to prognosis and therapy. This article reviews and discusses these changes with the goal of elucidating key features of the staging system and outlining how these changes relate to the NCCN Clinical Practice Guidelines in Oncology with regard to the care and treatment of patients. The 7th edition of the AJCC Cancer Staging Manual has certainly improved harmonization of gastric and distal esophageal/GEJ-type adenocarcinomas, although issues persist, particularly regarding the optimal neoadjuvant treatment for the management of GEJ carcinomas.

Authors
Strong, VE; D'Amico, TA; Kleinberg, L; Ajani, J
MLA Citation
Strong, VE, D'Amico, TA, Kleinberg, L, and Ajani, J. "Impact of the 7th Edition AJCC staging classification on the NCCN clinical practice guidelines in oncology for gastric and esophageal cancers." J Natl Compr Canc Netw 11.1 (January 1, 2013): 60-66. (Review)
PMID
23307982
Source
pubmed
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
11
Issue
1
Publish Date
2013
Start Page
60
End Page
66

Framing for success: nocebo effects in thoracic surgery.

Authors
Williams, JB; Sade, RM; D'Amico, TA
MLA Citation
Williams, JB, Sade, RM, and D'Amico, TA. "Framing for success: nocebo effects in thoracic surgery." Ann Thorac Surg 95.1 (January 2013): 9-11.
PMID
23272824
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
95
Issue
1
Publish Date
2013
Start Page
9
End Page
11
DOI
10.1016/j.athoracsur.2012.10.048

Erratum: Smoking status and survival in the national comprehensive cancer network nonsmall cell lung cancer cohort (Cancer (doi: 10.1002/cncr.27824))

Authors
Ferketich, AK; Niland, JC; Mamet, R; Zornosa, C; DAmico, TA; Ettinger, DS; Kalemkerian, GP; Pisters, KM; Reid, ME; Otterson, GA
MLA Citation
Ferketich, AK, Niland, JC, Mamet, R, Zornosa, C, DAmico, TA, Ettinger, DS, Kalemkerian, GP, Pisters, KM, Reid, ME, and Otterson, GA. "Erratum: Smoking status and survival in the national comprehensive cancer network nonsmall cell lung cancer cohort (Cancer (doi: 10.1002/cncr.27824))." Cancer 119.6 (2013): 1289-1290.
Source
scival
Published In
Cancer
Volume
119
Issue
6
Publish Date
2013
Start Page
1289
End Page
1290
DOI
10.1002/cncr.27796

Does surgery improve outcomes for esophageal squamous cell carcinoma? An analysis using the surveillance epidemiology and end results registry from 1998 to 2008.

We examined survival associated with locally advanced esophageal squamous cell cancer (SCC) to evaluate if treatment without surgery could be considered adequate.Patients in the Surveillance, Epidemiology and End Results Registry (SEER) registry with stage II-III SCC of the mid or distal esophagus from 1998-2008 were grouped by treatment with definitive radiation versus esophagectomy with or without radiation. Information on chemotherapy is not recorded in SEER. Tumor stage was defined as first clinical tumor stage in case of neo-adjuvant therapy and pathological report if no neo-adjuvant therapy was performed. Cancer-specific (CSS) and overall survival (OS) were analyzed using the Kaplan-Meier approach and propensity-score adjusted Cox proportional hazard models.Of the 2,431 patients analyzed, there were 844 stage IIA (34.7%), 428 stage IIB (17.6%), 1,159 stage III (47.7%) patients. Most were treated with definitive radiation (n = 1,426, 58.7%). Of the 1,005 (41.3%) patients who underwent surgery, 369 (36.7%) had preoperative radiation, 160 (15.9%) had postoperative radiation, and 476 (47.4%) had no radiation. Five-year survival was 17.9% for all patients, and 22.1%, 18.5%, and 14.5% for stages IIA, IIB, and stage III, respectively. Compared to treatment that included surgery, definitive radiation alone predicted worse propensity-score adjusted survival for all patients (CSS Hazard Ratio [HR] 1.48, p < 0.001; OS HR 1.46, p < 0.001) and for stage IIA, IIB, and III patients individually (all p values ≤ 0.01). Compared to surgery alone, surgery with radiation predicted improved survival for stage III patients (CSS HR 0.62, p = 0.001, OS HR 0.62, p < 0.001) but not stage IIA or IIB (all p values > 0.18).Esophagectomy is associated with improved survival for patients with locally advanced SCC and should be considered as an integral component of the treatment algorithm if feasible.

Authors
Worni, M; Martin, J; Gloor, B; Pietrobon, R; D'Amico, TA; Akushevich, I; Berry, MF
MLA Citation
Worni, M, Martin, J, Gloor, B, Pietrobon, R, D'Amico, TA, Akushevich, I, and Berry, MF. "Does surgery improve outcomes for esophageal squamous cell carcinoma? An analysis using the surveillance epidemiology and end results registry from 1998 to 2008." Journal of the American College of Surgeons 215.5 (November 2012): 643-651.
PMID
23084493
Source
epmc
Published In
Journal of The American College of Surgeons
Volume
215
Issue
5
Publish Date
2012
Start Page
643
End Page
651
DOI
10.1016/j.jamcollsurg.2012.07.006

Radiation therapy at the end of life in patients with incurable nonsmall cell lung cancer.

BACKGROUND: Receipt of chemotherapy at the end of life (EOL) is considered an indicator of poor quality of care for medical oncology. The objective of this study was to characterize the use of radiotherapy (RT) in patients with nonsmall cell lung cancer (NSCLC) during the same period. METHODS: Treatment characteristics of patients with incurable NSCLC who received RT at the EOL, defined as within 14 days of death, were analyzed from the National Comprehensive Cancer Network NSCLC Outcomes Database. RESULTS: Among 1098 patients who died, 10% had received EOL RT. Patients who did and did not receive EOL RT were similar in terms of sex, race, comorbid disease, and Eastern Cooperative Oncology Group performance status. On multivariable logistic regression analysis, independent predictors of receiving EOL RT included stage IV disease (odds ratio [OR], 2.04; 95% confidence interval [CI], 1.09-3.83) or multiorgan involvement (OR, 1.75; 95% CI, 1.08-2.84) at diagnosis, age <65 years at diagnosis (OR, 1.85; 95% CI, 1.21-2.83), and treating institution (OR, 1.24-5.94; P = .02). Nearly 50% of EOL RT recipients did not complete it, most commonly because of death or patient preference. CONCLUSIONS: In general, EOL RT was received infrequently, was delivered more commonly to younger patients with more advanced disease, and often was not completed as planned. There also was considerable variation in its use among National Comprehensive Cancer Network institutions. Next steps include expanding this research to other cancers and settings and investigating the clinical benefit of such treatment.

Authors
Kapadia, NS; Mamet, R; Zornosa, C; Niland, JC; D'Amico, TA; Hayman, JA
MLA Citation
Kapadia, NS, Mamet, R, Zornosa, C, Niland, JC, D'Amico, TA, and Hayman, JA. "Radiation therapy at the end of life in patients with incurable nonsmall cell lung cancer." Cancer 118.17 (September 1, 2012): 4339-4345.
PMID
22252390
Source
pubmed
Published In
Cancer
Volume
118
Issue
17
Publish Date
2012
Start Page
4339
End Page
4345
DOI
10.1002/cncr.27401

Thoracoscopic lobectomy has increasing benefit in patients with poor pulmonary function: a Society of Thoracic Surgeons Database analysis.

OBJECTIVE: Using a national database, we asked whether video-assisted thoracoscopic surgery (VATS) lobectomy is beneficial in high-risk pulmonary patients. BACKGROUND: Single-institution series demonstrated benefit of VATS lobectomy over lobectomy via thoracotomy in poor pulmonary function patients [FEV1 (forced expiratory volume in 1 second) or DLCO (diffusion capacity of the lung to carbon monoxide) <60% predicted]. METHODS: The STS General Thoracic Database was queried for patients having undergone lobectomy by either thoracotomy or VATS between 2000 and 2010. Postoperative pulmonary complications included those defined by the STS database. RESULTS: In the STS database, 12,970 patients underwent lobectomy (thoracotomy, n = 8439; VATS, n = 4531) and met inclusion criteria. The overall rate of pulmonary complications was 21.7% (1832/8439) and 17.8% (806/4531) in patients undergoing lobectomy with thoracotomy and VATS, respectively (P < 0.0001). In a multivariable model of pulmonary complications, thoracotomy approach (OR = 1.25, P < 0.001), decreasing FEV1% predicted (OR = 1.01 per unit, P < 0.001) and DLCO% predicted (OR = 1.01 per unit, P < 0.001), and increasing age (1.02 per year, P < 0.001) independently predicted pulmonary complications. When examining pulmonary complications in patients with FEV1 less than 60% predicted, thoracotomy patients have markedly increased pulmonary complications when compared with VATS patients (P = 0.023). No significant difference is noted with FEV1 more than 60% predicted. CONCLUSIONS: Poor pulmonary function predicts respiratory complications regardless of approach. Respiratory complications increase at a significantly greater rate in lobectomy patients with poor pulmonary function after thoracotomy compared with VATS. Planned surgical approach should be considered while determining whether a high-risk patient is an appropriate resection candidate.

Authors
Ceppa, DP; Kosinski, AS; Berry, MF; Tong, BC; Harpole, DH; Mitchell, JD; D'Amico, TA; Onaitis, MW
MLA Citation
Ceppa, DP, Kosinski, AS, Berry, MF, Tong, BC, Harpole, DH, Mitchell, JD, D'Amico, TA, and Onaitis, MW. "Thoracoscopic lobectomy has increasing benefit in patients with poor pulmonary function: a Society of Thoracic Surgeons Database analysis." Ann Surg 256.3 (September 2012): 487-493.
PMID
22868367
Source
pubmed
Published In
Annals of Surgery
Volume
256
Issue
3
Publish Date
2012
Start Page
487
End Page
493
DOI
10.1097/SLA.0b013e318265819c

Invited commentary.

Authors
D'Amico, TA
MLA Citation
D'Amico, TA. "Invited commentary." Ann Thorac Surg 94.3 (September 2012): 920-921.
PMID
22916752
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
94
Issue
3
Publish Date
2012
Start Page
920
End Page
921
DOI
10.1016/j.athoracsur.2012.05.076

Retrospective Analysis Of The Impact Of Age On Overall Survival In Patients With Non-small Cell Lung Cancer

Authors
Luu, DC; D'Amico, TA; Kalemkerian, G; Koczywas, M; Rabin, MS; Mamet, R; Zornosa, C; Pisters, K; Niland, J; Otterson, GA
MLA Citation
Luu, DC, D'Amico, TA, Kalemkerian, G, Koczywas, M, Rabin, MS, Mamet, R, Zornosa, C, Pisters, K, Niland, J, and Otterson, GA. "Retrospective Analysis Of The Impact Of Age On Overall Survival In Patients With Non-small Cell Lung Cancer." September 2012.
Source
wos-lite
Published In
Journal of Thoracic Oncology
Volume
7
Issue
9
Publish Date
2012
Start Page
S271
End Page
S272

Optimal management of malignant pleural effusions (results of CALGB 30102).

The optimal strategy to achieve palliation of malignant pleural effusions (MPEs) is unknown. This multi-institutional, prospective, randomized trial compares 2 established methods for controlling symptomatic unilateral MPEs. Patients with unilateral MPEs were randomized to either daily tunneled catheter drainage (TCD) or bedside talc pleurodesis (TP). This trial is patterned after a previous randomized trial that showed that bedside TP was equivalent to thoracoscopic TP (CALGB 9334). The primary end point of the current study was combined success: consistent/reliable drainage/pleurodesis, lung expansion, and 30-day survival. A secondary end point, survival with effusion control, was added retrospectively. This trial randomized 57 patients who were similar in terms of age (62 years), active chemotherapy (28%), and histologic diagnosis (lung, 63%; breast, 12%; other/unknown cancers, 25%) to either bedside TP or TCD. Combined success was higher with TCD (62%) than with TP (46%; odds ratio, 5.0; P = .064). Multivariate regression analysis revealed that patients treated with TCD had better 30-day activity without dyspnea scores (8.7 vs. 5.9; P = .036), especially in the subgroup with impaired expansion (9.1 vs. 4.6; P = .042). Patients who underwent TCD had better survival with effusion control at 30 days compared with those who underwent TP (82% vs. 52%, respectively; P = .024). In this prospective randomized trial, TCD achieved superior palliation of unilateral MPEs than TP, particularly in patients with trapped lungs.

Authors
Demmy, TL; Gu, L; Burkhalter, JE; Toloza, EM; D'Amico, TA; Sutherland, S; Wang, X; Archer, L; Veit, LJ; Kohman, L; Cancer and Leukemia Group B,
MLA Citation
Demmy, TL, Gu, L, Burkhalter, JE, Toloza, EM, D'Amico, TA, Sutherland, S, Wang, X, Archer, L, Veit, LJ, Kohman, L, and Cancer and Leukemia Group B, . "Optimal management of malignant pleural effusions (results of CALGB 30102)." J Natl Compr Canc Netw 10.8 (August 2012): 975-982.
PMID
22878823
Source
pubmed
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
10
Issue
8
Publish Date
2012
Start Page
975
End Page
982

Needs assessment for an errors-based curriculum on thoracoscopic lobectomy.

BACKGROUND: Research suggests a benefit from a skills curriculum emphasizing error prevention, identification, and management. Our purpose was to identify common errors committed by trainees during simulated thoracoscopic lobectomy for use in developing an error-based curriculum. METHODS: Twenty-one residents (postgraduate years 1 to 8) performed a thoracoscopic left upper lobectomy on a previously validated simulator. Videos of the procedure were reviewed in a blinded fashion using a checklist listing 66 possible cognitive and technical errors. RESULTS: Of the 21 residents, 15 (71%) self-reported completing the anatomic lobectomy; however, only 7 (33%) had actually divided all of the necessary structures correctly. While dissecting the superior pulmonary vein, 16 residents (76%) made at least one error. The most common (n=13, 62%) was dissecting individual branches rather than the entire vein. On the bronchus, 14 (67%) made at least one error. Again, the most common (n=9, 43%) was dissecting branches. During these tasks, cognitive errors were more common than technical errors. While dissecting arterial branches, 18 residents (86%) made at least one error. Technical and cognitive errors occurred with equal frequency during arterial dissection. The most common arterial error was excess tension on the vessel (n=10, 48%). CONCLUSIONS: Curriculum developers should identify skill-specific technical and judgment errors to verify the scope of errors typically committed. For a thoracoscopic lobectomy curriculum, emphasis should be placed on correct identification of anatomic landmarks during dissection of the vein and airway and on proper tissue handling technique during arterial dissection.

Authors
Meyerson, SL; Tong, BC; Balderson, SS; D'Amico, TA; Phillips, JD; DeCamp, MM; DaRosa, DA
MLA Citation
Meyerson, SL, Tong, BC, Balderson, SS, D'Amico, TA, Phillips, JD, DeCamp, MM, and DaRosa, DA. "Needs assessment for an errors-based curriculum on thoracoscopic lobectomy." Ann Thorac Surg 94.2 (August 2012): 368-373.
PMID
22633499
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
94
Issue
2
Publish Date
2012
Start Page
368
End Page
373
DOI
10.1016/j.athoracsur.2012.04.023

Thoracoscopic segmentectomy for lung cancer.

Lobectomy has long been considered the standard procedure for early-stage lung cancer, and minimally invasive techniques have been demonstrated to be associated with superior outcomes compared with lobectomy by thoracotomy. The use of segmentectomy is under investigation for selected patients with small tumors, and the use of minimally invasive strategies is applicable as well. In this review, we analyzed studies that have compared (1) thoracoscopic segmentectomy versus the open approach, (2) thoracoscopic segmentectomy versus thoracoscopic lobectomy, and (3) thoracoscopic segmentectomy versus thoracoscopic lobectomy versus thoracoscopic wedge resection. When compared with open segmentectomy, preliminarily, thoracoscopic segmentectomy was found to have equivalent oncologic results, with shorter hospital length of stay, reduced rates of morbidity, and lower cost. When compared with thoracoscopic lobectomy, thoracoscopic segmentectomy had equivalent rates of morbidity, recurrence, and survival. Preliminarily, thoracoscopic segmentectomy was found to result in greater preservation of lung function and exercise capacity than the thoracoscopic lobectomy.

Authors
Yang, C-FJ; D'Amico, TA
MLA Citation
Yang, C-FJ, and D'Amico, TA. "Thoracoscopic segmentectomy for lung cancer." The Annals of thoracic surgery 94.2 (August 2012): 668-681.
PMID
22748648
Source
epmc
Published In
The Annals of Thoracic Surgery
Volume
94
Issue
2
Publish Date
2012
Start Page
668
End Page
681
DOI
10.1016/j.athoracsur.2012.03.080

Validation of a thoracoscopic lobectomy simulator.

OBJECTIVES: Although simulation is considered integral to general surgery training, its role has only recently been recognized in thoracic surgical education, perhaps due to a lack of widely available, validated simulators for advanced thoracic procedures. This study evaluates the construct, content and face validity of an inexpensive, easily reproducible simulator for teaching thoracoscopic lobectomy. METHODS: Construct validity (ability of the simulator to discriminate between users of different skill levels) was assessed by having surgical trainees perform a lobectomy on the simulator. Participants were divided into three groups (experienced, intermediate and novice) based on self-reported experience with minimally invasive surgery. After instruction and practice time to limit the effect of any simulator-specific learning curve, each performed a left upper lobectomy that was scored using a standardized assessment tool incorporating total time plus weighted penalty minutes assigned for errors. Content validity (simulator requires same steps and decision-making as a clinical lobectomy) was assessed using a Likert scale by those participants who had previously seen a thoracoscopic lobectomy in a patient. RESULTS: Thirty-one residents participated in the study (12 experienced, 6 intermediate and 13 novice). All 12 experienced participants completed the lobectomy. The other groups were less successful with 4 of 6 in the intermediate group and 5 of 13 in the novice group completing the lobectomy (P = 0.004). The mean times for lobectomy + penalty minutes were 35 + 6.8 (experienced), 50 + 13 (intermediate) and 54 + 20 (novice). Differences between groups were statistically significant for experienced vs. novice (P < 0.001) and experienced vs. intermediate (P < 0.04). Content validity was assessed by the 18 participants who had previously seen a thoracoscopic lobectomy with a mean of 9.2 of 10 possible points. CONCLUSIONS: The thoracoscopic lobectomy simulator used in this study demonstrates acceptable validity and can be a useful tool for teaching thoracoscopic lobectomy to trainees or experienced surgeons.

Authors
Tong, BC; Gustafson, MR; Balderson, SS; D'Amico, TA; Meyerson, SL
MLA Citation
Tong, BC, Gustafson, MR, Balderson, SS, D'Amico, TA, and Meyerson, SL. "Validation of a thoracoscopic lobectomy simulator." Eur J Cardiothorac Surg 42.2 (August 2012): 364-369.
PMID
22315356
Source
pubmed
Published In
European Journal of Cardio-Thoracic Surgery
Volume
42
Issue
2
Publish Date
2012
Start Page
364
End Page
369
DOI
10.1093/ejcts/ezs012

First-line systemic therapy practice patterns and concordance with NCCN guidelines for patients diagnosed with metastatic NSCLC treated at NCCN institutions.

The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) allow many systemic therapy options for patients with metastatic non-small cell lung cancer (NSCLC). This analysis uses the NCCN NSCLC Outcomes Database to report on first-line therapy practice patterns and concordance with NCCN Guidelines. The analysis was limited to patients diagnosed with metastatic NSCLC between September 2006 and November 2009 at 1 of 8 participating NCCN Member Institutions. Patient characteristics, regimens used, and guidelines concordance were analyzed. Institutional variation and changes in practice over time were also measured. A total of 1717 patients were included in the analysis. Of these, 1375 (80%) were treated with systemic therapy, most often in the form of a carboplatin-based doublet (51%) or carboplatin-based doublet with targeted therapy (17%). Overall, 76% of patients received care that was concordant with NCCN Guidelines. Among patients with good performance status (n = 167), the most common reasons for not receiving first-line therapy were that therapy was not recommended (39%) or death occurred before treatment (33%). The most common reason for receiving nonconcordant drug therapy was the administration of pemetrexed or erlotinib before its incorporation into the NCCN Guidelines for first-line therapy (53%). Most patients in this cohort received care that was concordant with NCCN Guidelines. The NSCLC Outcomes Database is a valuable resource for evaluating practice patterns and concordance with NCCN Guidelines among patients with NSCLC.

Authors
Zornosa, C; Vandergrift, JL; Kalemkerian, GP; Ettinger, DS; Rabin, MS; Reid, M; Otterson, GA; Koczywas, M; D'Amico, TA; Niland, JC; Mamet, R; Pisters, KM
MLA Citation
Zornosa, C, Vandergrift, JL, Kalemkerian, GP, Ettinger, DS, Rabin, MS, Reid, M, Otterson, GA, Koczywas, M, D'Amico, TA, Niland, JC, Mamet, R, and Pisters, KM. "First-line systemic therapy practice patterns and concordance with NCCN guidelines for patients diagnosed with metastatic NSCLC treated at NCCN institutions." J Natl Compr Canc Netw 10.7 (July 1, 2012): 847-856.
PMID
22773800
Source
pubmed
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
10
Issue
7
Publish Date
2012
Start Page
847
End Page
856

Lymphovascular invasion in non-small-cell lung cancer: implications for staging and adjuvant therapy.

BACKGROUND: Lymphovascular space invasion (LVI) is an established negative prognostic factor and an indication for postoperative radiation therapy in many malignancies. The purpose of this study was to evaluate LVI in patients with early-stage non-small-cell lung cancer, undergoing surgical resection. METHODS: All patients who underwent initial surgery for pT1-3N0-2 non-small-cell lung cancer at Duke University Medical Center from 1995 to 2008 were identified. A multivariate ordinal regression was used to assess the relationship between LVI and pathologic hilar and/or mediastinal lymph node (LN) involvement. A multivariate Cox regression analysis was used to evaluate the relationship of LVI and other clinical and pathologic factors on local failure (LF), freedom from distant metastasis (FFDM), and overall survival (OS). Kaplan-Meier methods were used to generate estimates of LF, FFDM, and OS in patients with and without LVI. RESULTS: One thousand five hundred and fifty-nine patients were identified. LVI was independently associated with the presence of regional LN involvement (p < 0.001) along with lobar (versus sublobar) resections (p < 0.001), and an open thoracotomy (versus video-assisted thoracoscopic surgery). LVI was not independently associated with LF on multivariate analysis (hazard ratio [HR] = 1.23, p = 0.25), but was associated with a lower FFDM (HR 1.52, p = 0.005) and OS (HR 1.26, p = 0.015). In addition, multivariate analysis showed that LVI was strongly associated with increased risk of developing distant metastases (HR = 1.75, p = 0.006) and death (HR = 1.53, p = 0.003) in adenocarcinomas but not in squamous carcinomas. CONCLUSIONS: LVI is associated with an increased risk of harboring regional LN involvement. LVI is also an adverse prognostic factor for the development of distant metastases and long-term survival.

Authors
Higgins, KA; Chino, JP; Ready, N; D'Amico, TA; Berry, MF; Sporn, T; Boyd, J; Kelsey, CR
MLA Citation
Higgins, KA, Chino, JP, Ready, N, D'Amico, TA, Berry, MF, Sporn, T, Boyd, J, and Kelsey, CR. "Lymphovascular invasion in non-small-cell lung cancer: implications for staging and adjuvant therapy." J Thorac Oncol 7.7 (July 2012): 1141-1147.
PMID
22617241
Source
pubmed
Published In
Journal of Thoracic Oncology
Volume
7
Issue
7
Publish Date
2012
Start Page
1141
End Page
1147
DOI
10.1097/JTO.0b013e3182519a42

Historical perspectives of The American Association for Thoracic Surgery: Hiram T. Langston (1912-1992).

Authors
Faber, LP; D'Amico, TA; American Association for Thoracic Surgery Centennial Committee,
MLA Citation
Faber, LP, D'Amico, TA, and American Association for Thoracic Surgery Centennial Committee, . "Historical perspectives of The American Association for Thoracic Surgery: Hiram T. Langston (1912-1992)." J Thorac Cardiovasc Surg 144.1 (July 2012): 4-6.
PMID
22710037
Source
pubmed
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
144
Issue
1
Publish Date
2012
Start Page
4
End Page
6
DOI
10.1016/j.jtcvs.2011.12.007

Induction chemoradiation is not superior to induction chemotherapy alone in stage IIIA lung cancer.

BACKGROUND: The optimal treatment strategy for patients with operable stage IIIA (N2) non-small cell lung cancer is uncertain. We performed a systematic review and meta-analysis to test the hypothesis that the addition of radiotherapy to induction chemotherapy prior to surgical resection does not improve survival compared with induction chemotherapy alone. METHODS: A comprehensive search of PubMed for relevant studies comparing patients with stage IIIA (N2) non-small cell lung cancer undergoing resection after treatment with induction chemotherapy alone or induction chemoradiotherapy was conducted using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standards. Hazard ratios were extracted from these studies to give pooled estimates of the effect of induction therapy on overall survival. RESULTS: There were 7 studies that met criteria for analysis, including 1 randomized control trial, 1 phase II study, 3 retrospective reviews, and 2 published abstracts of randomized controlled trials. None of the studies demonstrated a survival benefit to adding induction radiation to induction chemotherapy versus induction chemotherapy alone. The meta-analysis performed on randomized studies (n=156 patients) demonstrated no benefit in survival from adding radiation (hazard ratio 0.93, 95% confidence interval 0.54 to 1.62, p=0.81), nor did the meta-analysis performed on retrospective studies (n=183 patients, hazard ratio 0.77, 95% confidence interval 0.50 to 1.19, p=0.24). CONCLUSIONS: Published evidence is sparse but does not support the use of radiation therapy in induction regimens for stage IIIA (N2). Given the potential disadvantages of adding radiation preoperatively, clinicians should consider using this treatment strategy only in the context of a clinical trial to allow better assessment of its effectiveness.

Authors
Shah, AA; Berry, MF; Tzao, C; Gandhi, M; Worni, M; Pietrobon, R; D'Amico, TA
MLA Citation
Shah, AA, Berry, MF, Tzao, C, Gandhi, M, Worni, M, Pietrobon, R, and D'Amico, TA. "Induction chemoradiation is not superior to induction chemotherapy alone in stage IIIA lung cancer." Ann Thorac Surg 93.6 (June 2012): 1807-1812. (Review)
PMID
22632486
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
93
Issue
6
Publish Date
2012
Start Page
1807
End Page
1812
DOI
10.1016/j.athoracsur.2012.03.018

Is radiation without surgery the adequate therapy for potentially resectable esophageal squamous cell carcinoma? An analysis using the Surveillance Epidemiology, and End Results Registry from 1998 to 2008

Authors
Worni, M; Gloor, B; Pietrobon, R; D'Amico, TA; Akushevich, I; Berry, MF
MLA Citation
Worni, M, Gloor, B, Pietrobon, R, D'Amico, TA, Akushevich, I, and Berry, MF. "Is radiation without surgery the adequate therapy for potentially resectable esophageal squamous cell carcinoma? An analysis using the Surveillance Epidemiology, and End Results Registry from 1998 to 2008." June 2012.
Source
wos-lite
Published In
British Journal of Surgery
Volume
99
Publish Date
2012
Start Page
8
End Page
8

Outcomes after treatment of resectable, node-negative esophageal cancer: A risk-adjusted analysis of the Surveillance, Epidemiology, and End Results registry

Authors
Martin, JT; Worni, M; Zwischenberger, JB; Pietrobon, R; D'Amico, TA; Berry, MF
MLA Citation
Martin, JT, Worni, M, Zwischenberger, JB, Pietrobon, R, D'Amico, TA, and Berry, MF. "Outcomes after treatment of resectable, node-negative esophageal cancer: A risk-adjusted analysis of the Surveillance, Epidemiology, and End Results registry." May 20, 2012.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
30
Issue
15
Publish Date
2012

Accuracy of FDG-PET to diagnose lung cancer in the ACOSOG Z4031 trial.

Authors
Grogan, EL; Deppen, SA; Ballman, KV; Andrade, GM; Verdail, FC; Aldrich, MC; Chen, H; Decker, PA; Harpole, D; Cerfolio, R; Keenan, R; Jones, DR; D'Amico, TA; Shrager, JB; Meyers, BF; Putnam, JB
MLA Citation
Grogan, EL, Deppen, SA, Ballman, KV, Andrade, GM, Verdail, FC, Aldrich, MC, Chen, H, Decker, PA, Harpole, D, Cerfolio, R, Keenan, R, Jones, DR, D'Amico, TA, Shrager, JB, Meyers, BF, and Putnam, JB. "Accuracy of FDG-PET to diagnose lung cancer in the ACOSOG Z4031 trial." May 20, 2012.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
30
Issue
15
Publish Date
2012

Retrospective analysis of the impact of age on overall survival in patients with non-small cell lung cancer.

Authors
Luu, DCN; Mamet, R; Zornosa, CC; Niland, JC; D'Amico, TA; Kalemkerian, GP; Koczywas, M; Pisters, K; Rabin, MS; Otterson, GA
MLA Citation
Luu, DCN, Mamet, R, Zornosa, CC, Niland, JC, D'Amico, TA, Kalemkerian, GP, Koczywas, M, Pisters, K, Rabin, MS, and Otterson, GA. "Retrospective analysis of the impact of age on overall survival in patients with non-small cell lung cancer." May 20, 2012.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
30
Issue
15
Publish Date
2012

The management of patients with stage IIIA non-small cell lung cancer with N2 mediastinal node involvement.

Patients with stage IIIA non-small cell lung cancer, determined based on involvement of ipsilateral mediastinal lymph nodes, represent the most challenging management problem in this disease. Patients with this stage disease may have very different degrees of lymph node involvement. The pathologic confirmation of this involvement is a key step in the therapeutic decision. The difference in the degree of lymph node compromise has prognostic and treatment implications. Based on multiple considerations, patients can be treated with induction chemotherapy, chemoradiotherapy followed by surgery, or definitive chemoradiotherapy without surgery. Data derived from clinical trials have provided incomplete guidance for physicians and their patients. The best therapeutic plan is achieved through the multidisciplinary cooperation of a team specialized in lung cancer.

Authors
Martins, RG; D'Amico, TA; Loo, BW; Pinder-Schenck, M; Borghaei, H; Chaft, JE; Ganti, AKP; Kong, F-MS; Kris, MG; Lennes, IT; Wood, DE
MLA Citation
Martins, RG, D'Amico, TA, Loo, BW, Pinder-Schenck, M, Borghaei, H, Chaft, JE, Ganti, AKP, Kong, F-MS, Kris, MG, Lennes, IT, and Wood, DE. "The management of patients with stage IIIA non-small cell lung cancer with N2 mediastinal node involvement." J Natl Compr Canc Netw 10.5 (May 2012): 599-613. (Review)
PMID
22570291
Source
pubmed
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
10
Issue
5
Publish Date
2012
Start Page
599
End Page
613

Efficacy of mediastinal lymph node dissection during thoracoscopic lobectomy.

Authors
Wang, H; D'Amico, TA
MLA Citation
Wang, H, and D'Amico, TA. "Efficacy of mediastinal lymph node dissection during thoracoscopic lobectomy." Ann Cardiothorac Surg 1.1 (May 2012): 27-32.
PMID
23977461
Source
pubmed
Published In
Annals of cardiothoracic surgery
Volume
1
Issue
1
Publish Date
2012
Start Page
27
End Page
32
DOI
10.3978/j.issn.2225-319X.2012.04.02

Outcomes after surgical management of synchronous bilateral primary lung cancers.

BACKGROUND: Distinguishing between synchronous primary lung cancers and metastatic disease in patients with bilateral lung masses is often difficult. The objective of this study is to examine outcomes associated with a strategy of performing staged bilateral resections in patients without N2 disease based on invasive mediastinal staging and without distant metastases. METHODS: Patients undergoing resections of bilateral synchronous primary lung cancer at our institution between 1997 and 2010 were reviewed. Perioperative complications were graded according to National Cancer Institute guidelines. Survival was estimated using the Kaplan-Meier method and compared using a log-rank test. End points included overall survival, disease-free survival, operative death, cancer recurrence, and postoperative complications. RESULTS: Resections of bilateral synchronous primary lung cancers were performed in 47 patients. Forty-five patients (96%) had at least a unilateral thoracoscopic approach; 28 (60%) had bilateral thoracoscopic approaches. The median postresection length of stay was 3 days. Thirteen patients (28%) had a postoperative complication; only 3 (6%) were grade 3 or higher. There was 1 perioperative death (2%). Eleven patients received adjuvant therapy; only 3 patients in whom adjuvant therapy was indicated did not receive the recommended treatment. The overall 3-year survival was 35%. Survival of patients whose bilateral tumors had identical histology did not differ from patients whose histology was different (p = 0.57). Three-year disease-free survival was 24%. CONCLUSIONS: Aggressive surgical treatment of apparent synchronous bilateral primary lung cancer can be performed with low morbidity. Most patients tolerate the bilateral surgeries and adjuvant therapy. Overall survival is sufficiently high to support this aggressive approach.

Authors
Shah, AA; Barfield, ME; Kelsey, CR; Onaitis, MW; Tong, B; Harpole, D; D'Amico, TA; Berry, MF
MLA Citation
Shah, AA, Barfield, ME, Kelsey, CR, Onaitis, MW, Tong, B, Harpole, D, D'Amico, TA, and Berry, MF. "Outcomes after surgical management of synchronous bilateral primary lung cancers." Ann Thorac Surg 93.4 (April 2012): 1055-1060.
PMID
22381451
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
93
Issue
4
Publish Date
2012
Start Page
1055
End Page
1060
DOI
10.1016/j.athoracsur.2011.12.070

Feasibility of hybrid thoracoscopic lobectomy and en-bloc chest wall resection.

OBJECTIVES: Lobectomy with an en-bloc chest wall resection is an effective but potentially morbid treatment of lung cancer invading the chest wall. Minimally invasive approaches to lobectomy have reduced morbidity compared with thoracotomy for early stage lung cancer, but there is insufficient evidence regarding the feasibility of hybrid thoracoscopic lobectomy chest wall resection. We reviewed our experience with an en-bloc chest wall resection and lobectomy to evaluate the outcomes of a hybrid approach using thoracoscopic lobectomy combined with the chest wall resection where rib spreading is avoided. METHODS: All patients who underwent lobectomy and en-bloc chest wall resection with ribs for primary non-small cell lung cancer from January 2000 to July 2010 were reviewed. Starting in April 2003, a hybrid approach was introduced where thoracoscopic techniques were utilized to accomplish the pulmonary resection and a limited counter incision was used to perform the en-bloc resection of the chest wall, avoiding scapular mobilization and rib spreading. Preoperative, perioperative and outcome variables were assessed using the standard descriptive statistics. RESULTS: During the study period, 105 patients underwent en-bloc lobectomy and chest wall resection, including 93 patients with resection via thoracotomy and 12 patients with resection via the hybrid thoracoscopic approach. Complete resection was achieved in all patients in both groups. Tumour size and the extent of resection were similar in the two groups. There were no conversions and no perioperative mortality in the hybrid group. Post-operative outcomes were similar, although patients who underwent the hybrid approach had a shorter length of stay (P = 0.03). CONCLUSIONS: A hybrid approach that combines thoracoscopic lobectomy and chest wall resection is feasible and effective in selected patients. The use of a limited counter incision without rib spreading does not compromise oncologic efficacy. Further experience is needed to determine if this approach provides any advantage in outcomes, including post-operative morbidity.

Authors
Berry, MF; Onaitis, MW; Tong, BC; Balderson, SS; Harpole, DH; D'Amico, TA
MLA Citation
Berry, MF, Onaitis, MW, Tong, BC, Balderson, SS, Harpole, DH, and D'Amico, TA. "Feasibility of hybrid thoracoscopic lobectomy and en-bloc chest wall resection." Eur J Cardiothorac Surg 41.4 (April 2012): 888-892.
PMID
22219441
Source
pubmed
Published In
European Journal of Cardio-Thoracic Surgery
Volume
41
Issue
4
Publish Date
2012
Start Page
888
End Page
892
DOI
10.1093/ejcts/ezr150

Molecular biology of lung cancer

Authors
Onaitis, MW; D'amico, TA
MLA Citation
Onaitis, MW, and D'amico, TA. "Molecular biology of lung cancer." Cardiothoracic Surgery Review. January 5, 2012. 984-986.
Source
scopus
Publish Date
2012
Start Page
984
End Page
986

Diaphragmatic pacing

Authors
Berry, MF; D'Amico, TA
MLA Citation
Berry, MF, and D'Amico, TA. "Diaphragmatic pacing." Cardiothoracic Surgery Review. January 5, 2012. 1355-1357.
Source
scopus
Publish Date
2012
Start Page
1355
End Page
1357

Malignant pleural mesothelioma.

Authors
Ettinger, DS; Akerley, W; Borghaei, H; Chang, A; Cheney, RT; Chirieac, LR; D'Amico, TA; Demmy, TL; Ganti, AKP; Govindan, R; Grannis, FW; Horn, L; Jahan, TM; Jahanzeb, M; Kessinger, A; Komaki, R; Kong, F-MS; Kris, MG; Krug, LM; Lennes, IT; Loo, BW; Martins, R; O'Malley, J; Osarogiagbon, RU; Otterson, GA; Patel, JD; Schenck, MP; Pisters, KM; Reckamp, K; Riely, GJ; Rohren, E; Swanson, SJ; Wood, DE; Yang, SC; National Comprehensive Cancer Network,
MLA Citation
Ettinger, DS, Akerley, W, Borghaei, H, Chang, A, Cheney, RT, Chirieac, LR, D'Amico, TA, Demmy, TL, Ganti, AKP, Govindan, R, Grannis, FW, Horn, L, Jahan, TM, Jahanzeb, M, Kessinger, A, Komaki, R, Kong, F-MS, Kris, MG, Krug, LM, Lennes, IT, Loo, BW, Martins, R, O'Malley, J, Osarogiagbon, RU, Otterson, GA, Patel, JD, Schenck, MP, Pisters, KM, Reckamp, K, Riely, GJ, Rohren, E, Swanson, SJ, Wood, DE, Yang, SC, and National Comprehensive Cancer Network, . "Malignant pleural mesothelioma." J Natl Compr Canc Netw 10.1 (January 2012): 26-41.
PMID
22223867
Source
pubmed
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
10
Issue
1
Publish Date
2012
Start Page
26
End Page
41

Discussion

Authors
D'Amico, TA
MLA Citation
D'Amico, TA. "Discussion." Journal of Thoracic and Cardiovascular Surgery 143.2 (2012): 387-389.
Source
scival
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
143
Issue
2
Publish Date
2012
Start Page
387
End Page
389
DOI
10.1016/j.jtcvs.2011.10.065

Message from the chair of the NCCN Board of Directors

Authors
D'Amico, TA
MLA Citation
D'Amico, TA. "Message from the chair of the NCCN Board of Directors." JNCCN Journal of the National Comprehensive Cancer Network 10.4 (2012): 565-566.
Source
scival
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
10
Issue
4
Publish Date
2012
Start Page
565
End Page
566

Effect of increasing experience on dosimetric and clinical outcomes in the management of malignant pleural mesothelioma with intensity-modulated radiation therapy

Purpose: To assess the impact of increasing experience with intensity-modulated radiation therapy (IMRT) after extrapleural pneumonectomy (EPP) for malignant pleural mesothelioma (MPM). Methods and Materials: The records of all patients who received IMRT following EPP at Duke University Medical Center between 2005 and 2010 were reviewed. Target volumes included the preoperative extent of the pleural space, chest wall incisions, involved nodal stations, and a boost to close/positive surgical margins if applicable. Patients were typically treated with 9-11 beams with gantry angles, collimator rotations, and beam apertures manually fixed to avoid the contalateral lung and to optimize target coverage. Toxicity was graded retrospectively using National Cancer Institute common toxicity criteria version 4.0. Target coverage and contralateral lung irradiation were evaluated over time by using linear regression. Local control, disease-free survival, and overall survival rates were estimated using the Kaplan-Meier method. Results: Thirty patients received IMRT following EPP; 21 patients also received systemic chemotherapy. Median follow-up was 15 months. The median dose prescribed to the entire ipsilateral hemithorax was 45 Gy (range, 40-50.4 Gy) with a boost of 8-25 Gy in 9 patients. Median survival was 23.2 months. Two-year local control, disease-free survival, and overall survival rates were 47%, 34%, and 50%, respectively. Increasing experience planning MPM cases was associated with improved coverage of planning target volumes (P=.04). Similarly, mean lung dose (P<.01) and lung V5 (volume receiving 5 Gy or more; P<.01) values decreased with increasing experience. Lung toxicity developed after IMRT in 4 (13%) patients at a median of 2.2 months after RT (three grade 3-4 and one grade 5). Lung toxicity developed in 4 of the initial 15 patients vs none of the last 15 patients treated. Conclusions: With increasing experience, target volume coverage improved and dose to the contralateral lung decreased. Rates of pulmonary toxicity were relatively low. However, both local and distant control rates remained suboptimal. © 2012 Elsevier Inc. All rights reserved.

Authors
Patel, PR; Yoo, S; Broadwater, G; Marks, LB; Miles, EF; D'Amico, TA; Harpole, D; Kelsey, CR
MLA Citation
Patel, PR, Yoo, S, Broadwater, G, Marks, LB, Miles, EF, D'Amico, TA, Harpole, D, and Kelsey, CR. "Effect of increasing experience on dosimetric and clinical outcomes in the management of malignant pleural mesothelioma with intensity-modulated radiation therapy." International Journal of Radiation Oncology Biology Physics 83.1 (2012): 362-368.
PMID
22516382
Source
scival
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
83
Issue
1
Publish Date
2012
Start Page
362
End Page
368
DOI
10.1016/j.ijrobp.2011.11.057

Non-small cell lung cancer: Clinical practice guidelines in oncology

Most patients with non-small cell lung cancer (NSCLC) are diagnosed with advanced cancer. These guidelines only include information about stage IV NSCLC. Patients with widespread metastatic disease (stage IV) are candidates for systemic therapy, clinical trials, and/or palliative treatment. The goal is to identify patients with metastatic disease before initiating aggressive treatment, thus sparing these patients from unnecessary futile treatment. If metastatic disease is discovered during surgery, then extensive surgery is often aborted. Decisions about treatment should be based on multidisciplinary discussion. © JNCCN-Journal of the National Comprehensive Cancer Network.

Authors
Ettinger, DS; Akerley, W; Borghaei, H; Chang, AC; Cheney, RT; Chirieac, LR; D'Amico, TA; Demmy, TL; Ganti, AKP; Govindan, R; Jr, FWG; Horn, L; Jahan, TM; Jahanzeb, M; Kessinger, A; Komaki, R; Kong, F-M; Kris, MG; Krug, LM; Lennes, IT; Jr, BWL; Martins, R; O'Malley, J; Osarogiagbon, RU; Otterson, GA; Patel, JD; Pinder-Schenck, MC; Pisters, KM; Reckamp, K; Riely, GJ; Rohren, E; Swanson, SJ; Wood, DE; Yang, SC; Hughes, M; Gregory, KM
MLA Citation
Ettinger, DS, Akerley, W, Borghaei, H, Chang, AC, Cheney, RT, Chirieac, LR, D'Amico, TA, Demmy, TL, Ganti, AKP, Govindan, R, Jr, FWG, Horn, L, Jahan, TM, Jahanzeb, M, Kessinger, A, Komaki, R, Kong, F-M, Kris, MG, Krug, LM, Lennes, IT, Jr, BWL, Martins, R, O'Malley, J, Osarogiagbon, RU, Otterson, GA, Patel, JD, Pinder-Schenck, MC, Pisters, KM, Reckamp, K, Riely, GJ, Rohren, E, Swanson, SJ, Wood, DE, Yang, SC, Hughes, M, and Gregory, KM. "Non-small cell lung cancer: Clinical practice guidelines in oncology." JNCCN Journal of the National Comprehensive Cancer Network 10.10 (2012): 1236-1271.
PMID
23054877
Source
scival
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
10
Issue
10
Publish Date
2012
Start Page
1236
End Page
1271

Foreword

Authors
D'Amico, TA
MLA Citation
D'Amico, TA. "Foreword." Awake Thoracic Surgery (2012): i-.
Source
scival
Published In
Awake Thoracic Surgery
Publish Date
2012
Start Page
i
DOI
10.2174/97816080528821120101000i

VATS versus thoracotomy for major lung resection after induction therapy

Induction therapy has been considered a risk factor for morbidity and mortality after major lung resection via thoracotomy, but has been demonstrated to be feasible and effective in both prospective trials and retrospective studies. Induction therapy was initially felt to be a contraindication to performing major lung resection with video-assisted thoracoscopic surgery (VATS), but VATS resection after induction therapy has now also been shown to be feasible in small retrospective studies. Although the use of thoracotomy and VATS after induction therapy has never been prospectively directly compared in the literature, both approaches can be appropriate options depending on the specific circumstances. This chapter will review the significant published studies of major lung resection with both approaches after induction therapy. © Springer-Verlag London Limited 2011.

Authors
Berry, MF; D'Amico, TA
MLA Citation
Berry, MF, and D'Amico, TA. "VATS versus thoracotomy for major lung resection after induction therapy." Difficult Decisions in Thoracic Surgery (Second Edition): An Evidence-Based Approach. December 1, 2011. 145-153.
Source
scopus
Publish Date
2011
Start Page
145
End Page
153
DOI
10.1007/978-1-84996-492-0_15

Perioperative management of patients on clopidogrel (Plavix) undergoing major lung resection.

BACKGROUND: Management of patients requiring antiplatelet therapy with clopidogrel (Plavix) and major lung resection must balance the risks of bleeding and cardiovascular events. We reviewed our experience with patients treated with clopidogrel perioperatively to examine outcomes, including results of a new strategy for high-risk patients. METHODS: Patients who underwent major lung resection and received perioperative clopidogrel between January 2005 and September 2010 were reviewed. Initially, clopidogrel management consisted of discontinuation approximately 5 days before surgery and resumption immediately after surgery. After July 2010, high-risk patients (drug-eluting coronary stent placement within prior year or previous coronary event after clopidogrel discontinuation) were admitted 2 to 3 days preoperatively and bridged with the intravenous glycoprotein IIb/IIIa receptor inhibitor eptifibatide (Integrilin) according to a multidisciplinary cardiology/anesthesiology/thoracic surgery protocol. Outcomes were compared with control patients (matched for preoperative risk factors and extent of pulmonary resection) who did not receive perioperative clopidogrel. RESULTS: Fifty-four patients who had major lung resection between January 2005 and September 2010 and received clopidogrel perioperatively were matched with 108 control subjects. Both groups had similar mortality, postoperative length of stay, and no differences in the rates of perioperative transfusions, reoperations for bleeding, myocardial infarctions, and strokes. Seven of the 54 clopidogrel patients were admitted preoperatively for an eptifibatide bridge. Two of these patients received perioperative transfusions, but there were no deaths, reoperations, myocardial infarctions, or stroke. CONCLUSIONS: Patients taking clopidogrel can safely undergo major lung resection. Treatment with an eptifibatide bridge may minimize the risk of cardiovascular events in higher risk patients.

Authors
Ceppa, DP; Welsby, IJ; Wang, TY; Onaitis, MW; Tong, BC; Harpole, DH; D'Amico, TA; Berry, MF
MLA Citation
Ceppa, DP, Welsby, IJ, Wang, TY, Onaitis, MW, Tong, BC, Harpole, DH, D'Amico, TA, and Berry, MF. "Perioperative management of patients on clopidogrel (Plavix) undergoing major lung resection." Ann Thorac Surg 92.6 (December 2011): 1971-1976.
PMID
21978871
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
92
Issue
6
Publish Date
2011
Start Page
1971
End Page
1976
DOI
10.1016/j.athoracsur.2011.07.052

Editorial comment: Clinical pathways: mediastinoscopy and mediastinal lymph node dissection.

Authors
D'Amico, TA
MLA Citation
D'Amico, TA. "Editorial comment: Clinical pathways: mediastinoscopy and mediastinal lymph node dissection." Eur J Cardiothorac Surg 40.6 (December 2011): 1481-1482.
PMID
21439845
Source
pubmed
Published In
European Journal of Cardio-Thoracic Surgery
Volume
40
Issue
6
Publish Date
2011
Start Page
1481
End Page
1482
DOI
10.1016/j.ejcts.2011.02.025

Persistent N2 disease after neoadjuvant chemotherapy for non-small-cell lung cancer.

OBJECTIVES: Patients achieving a mediastinal pathologic complete response with neoadjuvant chemotherapy have improved outcomes compared with patients with persistent N2 disease. How to best manage this latter group of patients is unknown, prompting a review of our institutional experience. METHODS: All patients who initiated neoadjuvant therapy for non-small-cell lung cancer from 1995 to 2008 were evaluated. The patients were excluded if they had received preoperative radiotherapy, had had a mediastinal pathologic complete response, or had evidence of disease progression after neoadjuvant chemotherapy. The clinical endpoints were calculated using the Kaplan-Meier product-limit method and compared using a log-rank test. RESULTS: A total of 28 patients were identified. The median follow-up period was 24 months. Several neoadjuvant chemotherapy regimens were used, most commonly carboplatin with vinorelbine (36%) or paclitaxel (32%). A partial response to chemotherapy was noted in 23 (82%) and stable disease was noted in 5 (18%) on postchemotherapy imaging. Resection was performed in 22 of 28 patients, consisting of lobectomy in 14, pneumonectomy in 2, and wedge/segmentectomy in 6 (21/22 R0, 1/22 R1). There were no postoperative deaths. Postoperative therapy (radiotherapy and/or additional chemotherapy) was administered to 12 patients (55%). The remaining 6 patients generally received definitive radiotherapy with or without additional chemotherapy. The overall and disease-free survival rate at 1, 3, and 5 years was 75%, 37%, and 37% and 50%, 23%, and 19%, respectively. The survival rate at 5 years was similar between patients undergoing resection (34%) and those receiving definitive radiotherapy with or without chemotherapy (40%; P = .73). CONCLUSIONS: Disease-free and overall survival was sufficiently high to warrant aggressive local therapy (surgery or radiotherapy) in patients with persistent N2 disease after neoadjuvant chemotherapy.

Authors
Higgins, KA; Chino, JP; Ready, N; Onaitis, MW; Berry, MF; D'Amico, TA; Kelsey, CR
MLA Citation
Higgins, KA, Chino, JP, Ready, N, Onaitis, MW, Berry, MF, D'Amico, TA, and Kelsey, CR. "Persistent N2 disease after neoadjuvant chemotherapy for non-small-cell lung cancer." J Thorac Cardiovasc Surg 142.5 (November 2011): 1175-1179.
PMID
22014344
Source
pubmed
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
142
Issue
5
Publish Date
2011
Start Page
1175
End Page
1179
DOI
10.1016/j.jtcvs.2011.07.059

Bayesian probit regression model for the diagnosis of pulmonary fibrosis: proof-of-principle.

BACKGROUND: The accurate diagnosis of idiopathic pulmonary fibrosis (IPF) is a major clinical challenge. We developed a model to diagnose IPF by applying Bayesian probit regression (BPR) modelling to gene expression profiles of whole lung tissue. METHODS: Whole lung tissue was obtained from patients with idiopathic pulmonary fibrosis (IPF) undergoing surgical lung biopsy or lung transplantation. Controls were obtained from normal organ donors. We performed cluster analyses to explore differences in our dataset. No significant difference was found between samples obtained from different lobes of the same patient. A significant difference was found between samples obtained at biopsy versus explant. Following preliminary analysis of the complete dataset, we selected three subsets for the development of diagnostic gene signatures: the first signature was developed from all IPF samples (as compared to controls); the second signature was developed from the subset of IPF samples obtained at biopsy; the third signature was developed from IPF explants. To assess the validity of each signature, we used an independent cohort of IPF and normal samples. Each signature was used to predict phenotype (IPF versus normal) in samples from the validation cohort. We compared the models' predictions to the true phenotype of each validation sample, and then calculated sensitivity, specificity and accuracy. RESULTS: Surprisingly, we found that all three signatures were reasonably valid predictors of diagnosis, with small differences in test sensitivity, specificity and overall accuracy. CONCLUSIONS: This study represents the first use of BPR on whole lung tissue; previously, BPR was primarily used to develop predictive models for cancer. This also represents the first report of an independently validated IPF gene expression signature. In summary, BPR is a promising tool for the development of gene expression signatures from non-neoplastic lung tissue. In the future, BPR might be used to develop definitive diagnostic gene signatures for IPF, prognostic gene signatures for IPF or gene signatures for other non-neoplastic lung disorders such as bronchiolitis obliterans.

Authors
Meltzer, EB; Barry, WT; D'Amico, TA; Davis, RD; Lin, SS; Onaitis, MW; Morrison, LD; Sporn, TA; Steele, MP; Noble, PW
MLA Citation
Meltzer, EB, Barry, WT, D'Amico, TA, Davis, RD, Lin, SS, Onaitis, MW, Morrison, LD, Sporn, TA, Steele, MP, and Noble, PW. "Bayesian probit regression model for the diagnosis of pulmonary fibrosis: proof-of-principle. (Published online)" BMC Med Genomics 4 (October 5, 2011): 70-.
PMID
21974901
Source
pubmed
Published In
BMC Medical Genomics
Volume
4
Publish Date
2011
Start Page
70
DOI
10.1186/1755-8794-4-70

A randomized, double blind, placebo controlled clinical trial of the preoperative use of ketamine for reducing inflammation and pain after thoracic surgery.

PURPOSE: We hypothesized that patients who received ketamine during thoracic surgery would benefit from suppression of the inflammatory cascade, represented by lower interleukin (IL)-6 and C-reactive protein (CRP) plasma levels. METHODS: This study was a randomized, double blind, placebo controlled clinical trial of ketamine in patients undergoing thoracic surgery. The setting was a single university teaching hospital. Forty patients who presented to the preoperative clinic prior to thoracic surgery (20 control, 20 treatment) were randomized to receive either a 0.5 mg/kg ketamine bolus or an equivalent volume of normal saline intravenously prior to chest wall incision. Plasma samples taken prior to induction of anesthesia and at 24 h following surgery were assayed for IL-6 and CRP levels. Verbal pain scores were reported at 4 and 24 h following surgery and at discharge. RESULTS: IL-6 plasma levels did not differ significantly at 24 h for patients receiving ketamine (245 ± 287 pg/ml, mean ± SD) compared to patients who received placebo (269 ± 210 pg/ml), p = 0.39. Additionally, CRP levels at 24 h were not significantly different (8.8 ± 4.5 mg/dl for ketamine, 9.3 ± 5.6 mg/dl for placebo patients), p = 0.37. Finally, verbal pain scores were not significantly different between patient groups at 4 or 24 h, or at discharge. CONCLUSIONS: These findings suggest that the routine use of a single dose of ketamine prior to chest wall incision is not effective at reducing pain or inflammation in thoracic surgery patients at 24 h postoperatively.

Authors
D'Alonzo, RC; Bennett-Guerrero, E; Podgoreanu, M; D'Amico, TA; Harpole, DH; Shaw, AD
MLA Citation
D'Alonzo, RC, Bennett-Guerrero, E, Podgoreanu, M, D'Amico, TA, Harpole, DH, and Shaw, AD. "A randomized, double blind, placebo controlled clinical trial of the preoperative use of ketamine for reducing inflammation and pain after thoracic surgery." J Anesth 25.5 (October 2011): 672-678.
PMID
21809148
Source
pubmed
Published In
Journal of Anesthesia
Volume
25
Issue
5
Publish Date
2011
Start Page
672
End Page
678
DOI
10.1007/s00540-011-1206-4

Historical perspectives of The American Association for Thoracic Surgery: Evarts A. Graham (1883-1957).

Authors
D'Amico, TA
MLA Citation
D'Amico, TA. "Historical perspectives of The American Association for Thoracic Surgery: Evarts A. Graham (1883-1957)." J Thorac Cardiovasc Surg 142.4 (October 2011): 735-739.
PMID
21820677
Source
pubmed
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
142
Issue
4
Publish Date
2011
Start Page
735
End Page
739
DOI
10.1016/j.jtcvs.2011.06.028

Invited commentary.

Authors
D'Amico, TA
MLA Citation
D'Amico, TA. "Invited commentary." Ann Thorac Surg 92.3 (September 2011): 1050-.
PMID
21871298
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
92
Issue
3
Publish Date
2011
Start Page
1050
DOI
10.1016/j.athoracsur.2011.04.075

Improving outcomes after esophagectomy: the importance of preventing postoperative pneumonia.

Outcomes after esophagectomy may be related to many factors, including the age of the patient, the stage of the tumor, the operative approach, and the incidence of postoperative morbidity. Pulmonary complications are the major source of morbidity and mortality following esophageal resection, and numerous studies have identified various factors associated with these complications. Preoperative factors affecting pulmonary complications include advanced age, poor nutritional status, and poor cardiopulmonary reserve, whereas preoperative chemoradiation therapy is not clearly associated with increased pulmonary complications. Intraoperative factors associated with increased rates of pulmonary complications include increased blood loss, prolonged operative times, advanced or proximal esophageal tumors, and more extensive operations, including the McKeown resection with three-field lymph node dissection. Postoperative factors associated with pulmonary complications include the development of atrial fibrillation, recurrent laryngeal nerve injury, and aspiration or other abnormality of deglutition. Potential maneuvers to limit the severity of pulmonary complications include smoking cessation prior to surgery, aggressive pulmonary toilet, and documentation of intact swallowing mechanisms prior to the resumption of oral intake after surgery.

Authors
D'Amico, TA
MLA Citation
D'Amico, TA. "Improving outcomes after esophagectomy: the importance of preventing postoperative pneumonia." Zhonghua Wei Chang Wai Ke Za Zhi 14.9 (September 2011): 660-666.
PMID
21948529
Source
pubmed
Published In
Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery
Volume
14
Issue
9
Publish Date
2011
Start Page
660
End Page
666

Esophageal and esophagogastric junction cancers.

Authors
Ajani, JA; Barthel, JS; Bentrem, DJ; D'Amico, TA; Das, P; Denlinger, CS; Fuchs, CS; Gerdes, H; Glasgow, RE; Hayman, JA; Hofstetter, WL; Ilson, DH; Keswani, RN; Kleinberg, LR; Korn, WM; Lockhart, AC; Mulcahy, MF; Orringer, MB; Osarogiagbon, RU; Posey, JA; Sasson, AR; Scott, WJ; Shibata, S; Strong, VEM; Varghese, TK; Warren, G; Washington, MK; Willett, C; Wright, CD; National Comprehensive Cancer Network,
MLA Citation
Ajani, JA, Barthel, JS, Bentrem, DJ, D'Amico, TA, Das, P, Denlinger, CS, Fuchs, CS, Gerdes, H, Glasgow, RE, Hayman, JA, Hofstetter, WL, Ilson, DH, Keswani, RN, Kleinberg, LR, Korn, WM, Lockhart, AC, Mulcahy, MF, Orringer, MB, Osarogiagbon, RU, Posey, JA, Sasson, AR, Scott, WJ, Shibata, S, Strong, VEM, Varghese, TK, Warren, G, Washington, MK, Willett, C, Wright, CD, and National Comprehensive Cancer Network, . "Esophageal and esophagogastric junction cancers." J Natl Compr Canc Netw 9.8 (August 1, 2011): 830-887.
PMID
21900218
Source
pubmed
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
9
Issue
8
Publish Date
2011
Start Page
830
End Page
887

Incorporating research into thoracic surgery practice.

The incorporation of research into a career in thoracic surgery is a complex process. Ideally, the preparation for a career in academic thoracic surgery begins with a research fellowship during training. In the academic setting, a research portfolio might include clinical research, translational research, or basic research. Using strategies for developing collaboration, thoracic surgeons in community-based programs may also be successful clinical investigators. In addition to the rigors of conducting research, strategies for reserving protected time and obtaining grant support must be considered to be successful in academic surgery.

Authors
D'Amico, TA; Tong, BC; Berry, MF; Burfeind, WR; Onaitis, MW
MLA Citation
D'Amico, TA, Tong, BC, Berry, MF, Burfeind, WR, and Onaitis, MW. "Incorporating research into thoracic surgery practice." Thorac Surg Clin 21.3 (August 2011): 369-377.
PMID
21762860
Source
pubmed
Published In
Thoracic Surgery Clinics
Volume
21
Issue
3
Publish Date
2011
Start Page
369
End Page
377
DOI
10.1016/j.thorsurg.2011.04.004

Efficacy of mediastinal lymph node dissection during lobectomy for lung cancer by thoracoscopy and thoracotomy.

BACKGROUND: Mediastinal lymph node dissection (MLND) is an integral component of complete resection for non-small cell lung cancer (NSCLC). This study analyzed the National Comprehensive Cancer Network's (NCCN) NSCLC Database to compare the efficacy of MLND during lobectomy by video-assisted thoracoscopy surgery (VATS) and thoracotomy (open). METHODS: The NCCN NSCLC Database was queried to identify patients who underwent lobectomy to analyze the adequacy of MLND by the number of LN stations. The percentage of patients with at least three N2 stations, the number of N2 LN stations, and the total number of LN stations (N1+N2) resected was compared by approach. RESULTS: Of 4215 patients with NSCLC (January 2007 to September 2010), 388 patients underwent lobectomy (199 VATS and 189 open) and met entry criteria. The groups were similar in age, sex, comorbidities, performance status, and histology. MLN assessment was similar in both groups as measured by number of N2 stations (median, 3 stations; p=0.12). At least three MLN stations were assessed in 130 patients (66%) in the VATS group vs 107 patients (58%) in the open group (p=0.12). The total number of N1+N2 stations resected for each group was also similar (median, 4 in both groups (p=0.06). CONCLUSIONS: The NCCN database indicates at least three MLN stations were assessed in most patients who underwent lobectomy by either approach. As evaluated by the number of LN stations, there was no difference in the efficacy of MLN dissection by approach.

Authors
D'Amico, TA; Niland, J; Mamet, R; Zornosa, C; Dexter, EU; Onaitis, MW
MLA Citation
D'Amico, TA, Niland, J, Mamet, R, Zornosa, C, Dexter, EU, and Onaitis, MW. "Efficacy of mediastinal lymph node dissection during lobectomy for lung cancer by thoracoscopy and thoracotomy." Ann Thorac Surg 92.1 (July 2011): 226-231.
PMID
21718849
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
92
Issue
1
Publish Date
2011
Start Page
226
End Page
231
DOI
10.1016/j.athoracsur.2011.03.134

Utility of a simple algorithm to grade diastolic dysfunction and predict outcome after coronary artery bypass graft surgery.

BACKGROUND: Inclusion of a measure of left ventricular diastolic dysfunction (LVDD) may improve risk prediction after cardiac surgery. Current LVDD grading guidelines rely on echocardiographic variables that are not always available or aligned to allow grading. We hypothesized that a simplified algorithm involving fewer variables would enable more patients to be assigned a LVDD grade compared with a comprehensive algorithm, and also be valid in identifying patients at risk of long-term major adverse cardiac events (MACE). METHODS: Intraoperative transesophageal echocardiography data were gathered on 905 patients undergoing coronary artery bypass graft surgery, including flow and tissue Doppler-based measurements. Two algorithms were constructed to categorize LVDD: a comprehensive four-variable algorithm, A, was compared with a simplified version, B, with only two variables-transmitral early flow velocity and early mitral annular tissue velocity-for ease of grading and association with MACE. RESULTS: Using algorithm A, only 563 patients (62%) could be graded, whereas 895 patients (99%) received a grade with algorithm B. Over the median follow-up period of 1,468 days, Cox modeling showed that LVDD was significantly associated with MACE when graded with algorithm B (p=0.013), but not algorithm A (p=0.79). Patients with the highest incidence of MACE could not be graded with algorithm A. CONCLUSIONS: We found that an LVDD algorithm with fewer variables enabled grading of a significantly greater number of coronary artery bypass graft patients, and was valid, as evidenced by worsening grades being associated with MACE. This simplified algorithm could be extended to similar populations as a valid method of characterizing LVDD.

Authors
Swaminathan, M; Nicoara, A; Phillips-Bute, BG; Aeschlimann, N; Milano, CA; Mackensen, GB; Podgoreanu, MV; Velazquez, EJ; Stafford-Smith, M; Mathew, JP; Cardiothoracic Anesthesia Research Endeavors (CARE) Group,
MLA Citation
Swaminathan, M, Nicoara, A, Phillips-Bute, BG, Aeschlimann, N, Milano, CA, Mackensen, GB, Podgoreanu, MV, Velazquez, EJ, Stafford-Smith, M, Mathew, JP, and Cardiothoracic Anesthesia Research Endeavors (CARE) Group, . "Utility of a simple algorithm to grade diastolic dysfunction and predict outcome after coronary artery bypass graft surgery." Ann Thorac Surg 91.6 (June 2011): 1844-1850.
PMID
21492828
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
91
Issue
6
Publish Date
2011
Start Page
1844
End Page
1850
DOI
10.1016/j.athoracsur.2011.02.008

A model for morbidity after lung resection in octogenarians.

OBJECTIVE: Age is an important risk factor for morbidity after lung resection. This study was performed to identify specific risk factors for complications after lung resection in octogenarians. METHODS: A prospective database containing patients aged 80 years or older, who underwent lung resection at a single institution between January 2000 and June 2009, was reviewed. Preoperative, histopathologic, perioperative, and outcome variables were assessed. Morbidity was measured as a patient having any perioperative event as defined by the Society of Thoracic Surgeons General Thoracic Surgery Database. A multivariable risk model for morbidity was developed using a panel of established preoperative and operative variables. Survival was calculated using the Kaplan-Meier method. RESULTS: During the study period, 193 patients aged 80 years or older (median age 82 years) underwent lung resection: wedge resection in 77, segmentectomy in 13, lobectomy in 96, bilobectomy in four, and pneumonectomy in three. Resection was accomplished via thoracoscopy in 149 patients (77%). Operative mortality was 3.6% (seven patients) and morbidity was 46% (89 patients). A total of 181 (94%) patients were discharged directly home. Postoperative events included atrial arrhythmia in 38 patients (20%), prolonged air leak in 24 patients (12%), postoperative transfusion in 22 patients (11%), delirium in 16 patients (8%), need for bronchoscopy in 14 patients (7%), and pneumonia in 10 patients (5%). Significant predictors of morbidity by multivariable analysis included resection greater than wedge (odds ratio 2.98, p=0.006), thoracotomy as operative approach (odds ratio 2.6, p=0.03), and % predicted forced expiratory volume in 1s (odds ratio 1.28 for each 10% decrement, p=0.01). CONCLUSIONS: Octogenarians can undergo lung resection with low mortality. Extent of resection, use of a thoracotomy, and impaired lung function increase the risk of complications. Careful evaluation is necessary to select the most appropriate approach in octogenarians being considered for lung resection.

Authors
Berry, MF; Onaitis, MW; Tong, BC; Harpole, DH; D'Amico, TA
MLA Citation
Berry, MF, Onaitis, MW, Tong, BC, Harpole, DH, and D'Amico, TA. "A model for morbidity after lung resection in octogenarians." Eur J Cardiothorac Surg 39.6 (June 2011): 989-994.
PMID
21276728
Source
pubmed
Published In
European Journal of Cardio-Thoracic Surgery
Volume
39
Issue
6
Publish Date
2011
Start Page
989
End Page
994
DOI
10.1016/j.ejcts.2010.09.038

PERSISTENT N2 DISEASE AFTER NEOADJUVANT CHEMOTHERAPY-NOW WHAT?

Authors
Higgins, KA; Ready, NE; D'amico, TA; Onaitis, MW; Crawford, J; Clough, R; Berry, MF; Yoo, D; Harpole, DH; Dunphy, F; Kelsey, CR
MLA Citation
Higgins, KA, Ready, NE, D'amico, TA, Onaitis, MW, Crawford, J, Clough, R, Berry, MF, Yoo, D, Harpole, DH, Dunphy, F, and Kelsey, CR. "PERSISTENT N2 DISEASE AFTER NEOADJUVANT CHEMOTHERAPY-NOW WHAT?." June 2011.
Source
wos-lite
Published In
Journal of Thoracic Oncology
Volume
6
Issue
6
Publish Date
2011
Start Page
S1572
End Page
S1572

INDUCTION CHEMORADIOTHERAPY IS NOT SUPERIOR TO INDUCTION CHEMOTHERAPY ALONE IN PATIENTS WITH STAGE IIIA(N2) NON-SMALL CELL LUNG CANCER: A SYSTEMATIC REVIEW AND META-ANALYSIS

Authors
Shah, AA; Berry, MF; Tzao, C; Rajgor, D; Pietrobon, R; D'Amico, TA
MLA Citation
Shah, AA, Berry, MF, Tzao, C, Rajgor, D, Pietrobon, R, and D'Amico, TA. "INDUCTION CHEMORADIOTHERAPY IS NOT SUPERIOR TO INDUCTION CHEMOTHERAPY ALONE IN PATIENTS WITH STAGE IIIA(N2) NON-SMALL CELL LUNG CANCER: A SYSTEMATIC REVIEW AND META-ANALYSIS." June 2011.
Source
wos-lite
Published In
Journal of Thoracic Oncology
Volume
6
Issue
6
Publish Date
2011
Start Page
S1578
End Page
S1579

Aggressive end-of-life (EOL) chemotherapy (CT) use in metastatic non-small cell lung cancer (mNSCLC): A National Comprehensive Cancer Network (NCCN) outcomes database analysis.

Authors
Bickel, KE; Niland, JC; Mamet, R; Zornosa, CC; Ettinger, DS; Pisters, K; Otterson, GA; Koczywas, M; Reid, ME; Rabin, MS; D'Amico, TA; Earle, C; Pini, TM; Kalemkerian, GP
MLA Citation
Bickel, KE, Niland, JC, Mamet, R, Zornosa, CC, Ettinger, DS, Pisters, K, Otterson, GA, Koczywas, M, Reid, ME, Rabin, MS, D'Amico, TA, Earle, C, Pini, TM, and Kalemkerian, GP. "Aggressive end-of-life (EOL) chemotherapy (CT) use in metastatic non-small cell lung cancer (mNSCLC): A National Comprehensive Cancer Network (NCCN) outcomes database analysis." May 20, 2011.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
29
Issue
15
Publish Date
2011

Proteomic analysis for detection of NSCLC: Results of ACOSOG Z4031.

Authors
Harpole, D; Ballman, KV; Oberg, AL; Whiteley, G; Cerfolio, R; Keenan, R; Jones, DR; D'Amico, TA; Shrager, J; Putnam, JB; Grp, ACSO
MLA Citation
Harpole, D, Ballman, KV, Oberg, AL, Whiteley, G, Cerfolio, R, Keenan, R, Jones, DR, D'Amico, TA, Shrager, J, Putnam, JB, and Grp, ACSO. "Proteomic analysis for detection of NSCLC: Results of ACOSOG Z4031." May 20, 2011.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
29
Issue
15
Publish Date
2011

Proteomic analysis for detection of NSCLC: Results of ACOSOG Z4031.

7003 Background: NCI CT Screening Trial demonstrated a significant decrease in lung cancer mortality. This will dramatically increase the number of suspicious nodules discovered by CT. Unfortunately CT scans have a high false-positive rate for lung cancer requiring invasive diagnostic intervention. This study aim was to prospectively determine whether the serum proteomic profile can predict the presence of primary NSCLC in patients with CT suspicious lung lesions.One-thousand seventy-four patients with a clinically suspicious stage I (cT1-2 N0 M0) lung lesion were enrolled in Z4031 between 02/2004 and 05/2006. Fresh-frozen and FFPE tumor with pre- and post-operatively blood were collected prospectively after informed consent. Ciba Chrome Blue was used to capture low molecular weight proteins in pre-operative serum (un-digested) followed by mass analysis on a prOTOF 2000 MALDI-TOF mass spectrometer (MS) in duplicate. The spectra were normalized and the maximum and sum amplitudes within a m/z bin were used as abundance values. Features were identified by m/z values.913 patients were eligible: 723 patients with NSCLC and 190 patients with benign nodules. Patients with NSCLC were older (median 67.2 yrs vs 59.7 yrs, p < 0.0001) and had larger nodules (57.9% vs. 29.3% ≥ 2.0 cm, p < 0.0001). Of patients with NSCLC, 28% were squamous, 61.3% were adenocarcinoma, and 10% were other NSCLC. 690 eligible patients had at least one analyzable spectra. The MS proteomic profiles failed to discriminate between the groups. The spectra contained only a handful of proteins per patient and bins that had statistically significant different abundance values were in the noise region of the data and did not contain proteins.The proteomic platform did not have sufficient sensitivity to detect low abundance proteins. Furthermore, the limit of detection for the newest MS platforms are not sufficient for discovering discriminate protein profiles due to the dynamic range of the human proteome. A targeted approach beginning with analysis of gene expression in tissue followed by confirmation of corresponding proteins in tissue, and then assessing these proteins in serum will likely be much more fruitful and is underway.

Authors
Harpole, D; Ballman, KV; Oberg, AL; Whiteley, G; Cerfolio, R; Keenan, R; Jones, DR; D'Amico, TA; Shrager, J; Putnam, JB
MLA Citation
Harpole, D, Ballman, KV, Oberg, AL, Whiteley, G, Cerfolio, R, Keenan, R, Jones, DR, D'Amico, TA, Shrager, J, and Putnam, JB. "Proteomic analysis for detection of NSCLC: Results of ACOSOG Z4031." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 29.15_suppl (May 2011): 7003-.
PMID
28020088
Source
epmc
Published In
Journal of Clinical Oncology
Volume
29
Issue
15_suppl
Publish Date
2011
Start Page
7003

Aggressive end-of-life (EOL) chemotherapy (CT) use in metastatic non-small cell lung cancer (mNSCLC): A National Comprehensive Cancer Network (NCCN) outcomes database analysis.

7537 Background: Aggressive EOL cancer care is a health care quality and cost issue. As lung cancer is the leading cause of cancer-related death in the U.S., and NCCN member institutions are considered to offer high-quality, evidence-based care, we examined the aggressiveness of mNSCLC EOL care at NCCN institutions.The NCCN database was queried to identify all deceased mNSCLC patients (pts) actively treated at 8 NCCN institutions from January 2007-June 2010. Aggressive EOL care was defined as 1) Starting a new CT regimen within 30 days of death (30d New), 2) Receipt of CT within 14 days of death (14d Any), or 3) Any ICU admission within the last 30 days of life (30d ICU). Among pts receiving CT, multivariate logistic regression was used to investigate associations between pt factors and aggressive CT use, controlling for age, NCCN institution, performance status (PS), and comorbidity. Multivariate analysis was not possible for the ICU model due to small sample size.Among 1,092 eligible pts, 18.9% had 1 or more aggressive EOL events: 10.7% 30d New, 11.8% 14d Any, and 3.2% 30d ICU. Forty (34%) of 30d New pts started first line CT. Median age overall was 63 (range 25-91) and was 61 for all pts in the aggressive CT analyses. Initial overall PS was 57% 0-1 and was still predominantly 0-1 (23-38%) at the last CT in all groups. The multivariate results are listed below; an odds ratio > 1 indicating aggressive care more likely.While typical pt factors, such as age and PS, are used to determine fitness for CT receipt in mNSCLC, our analysis suggests that aggressive EOL CT receipt in mNSCLC at NCCN institutions is associated with other pt or clinical factors. [Table: see text].

Authors
Bickel, KE; Niland, JC; Mamet, R; Zornosa, CC; Ettinger, DS; Pisters, K; Otterson, GA; Koczywas, M; Reid, ME; Rabin, MS; D'Amico, TA; Earle, C; Pini, TM; Kalemkerian, GP
MLA Citation
Bickel, KE, Niland, JC, Mamet, R, Zornosa, CC, Ettinger, DS, Pisters, K, Otterson, GA, Koczywas, M, Reid, ME, Rabin, MS, D'Amico, TA, Earle, C, Pini, TM, and Kalemkerian, GP. "Aggressive end-of-life (EOL) chemotherapy (CT) use in metastatic non-small cell lung cancer (mNSCLC): A National Comprehensive Cancer Network (NCCN) outcomes database analysis." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 29.15_suppl (May 2011): 7537-.
PMID
28023230
Source
epmc
Published In
Journal of Clinical Oncology
Volume
29
Issue
15_suppl
Publish Date
2011
Start Page
7537

How well does the new lung cancer staging system predict for local/regional recurrence after surgery?: A comparison of the TNM 6 and 7 systems.

INTRODUCTION: To evaluate how well the tumor, node, metastasis (TNM) 6 and TNM 7 staging systems predict rates of local/regional recurrence (LRR) after surgery alone for non-small cell lung cancer. METHODS: All patients who underwent surgery for non-small cell lung cancer at Duke between 1995 and 2005 were reviewed. Those undergoing sublobar resections, with positive margins or involvement of the chest wall, or those who received any chemotherapy or radiation therapy (RT) were excluded. Disease recurrence at the surgical margin, or within ipsilateral hilar and/or mediastinal lymph nodes, was considered as a LRR. Stage was assigned based on both TNM 6 and TNM 7. Rates of LRR were estimated using the Kaplan-Meier method. A Cox regression analysis evaluated the hazard ratio of LRR by stage within TNM 6 and TNM 7. RESULTS: A total of 709 patients were eligible for the analysis. Median follow-up was 32 months. For all patients, the 5-year actuarial risk of LRR was 23%. Conversion from TNM 6 to TNM 7 resulted in 21% stage migration (upstaging in 13%; downstaging in 8%). Five-year rates of LRR for stages IA, IB, IIA, IIB, and IIIA disease using TNM 6 were 16%, 26%, 43%, 35%, and 40%, respectively. Using TNM 7, corresponding rates were 16%, 23%, 37%, 39%, and 30%, respectively. The hazard ratios for LRR were statistically different for IA and IB in both TNM 6 and 7 but were also different for IB and IIA in TNM 7. CONCLUSIONS: LRR risk increases monotonically for stages IA to IIB in the new TNM 7 system. This information might be valuable when designing future studies of postoperative RT.

Authors
Pepek, JM; Chino, JP; Marks, LB; D'amico, TA; Yoo, DS; Onaitis, MW; Ready, NE; Hubbs, JL; Boyd, J; Kelsey, CR
MLA Citation
Pepek, JM, Chino, JP, Marks, LB, D'amico, TA, Yoo, DS, Onaitis, MW, Ready, NE, Hubbs, JL, Boyd, J, and Kelsey, CR. "How well does the new lung cancer staging system predict for local/regional recurrence after surgery?: A comparison of the TNM 6 and 7 systems." J Thorac Oncol 6.4 (April 2011): 757-761.
PMID
21325975
Source
pubmed
Published In
Journal of Thoracic Oncology
Volume
6
Issue
4
Publish Date
2011
Start Page
757
End Page
761
DOI
10.1097/JTO.0b013e31821038c0

A 10-gene progenitor cell signature predicts poor prognosis in lung adenocarcinoma.

BACKGROUND: One aspect of the cancer stem cell hypothesis is that patients with tumors that exhibit stem-like phenotypes have poor prognoses. Distal epithelial progenitors from lungs early in development demonstrate both self-renewal and potential to differentiate into all bronchial and alveolar epithelial cell types. By contrast, late progenitors are only able to produce alveolar cells. We sought to create a lung-specific progenitor cell signature for possible prognosis prediction in human lung cancer. METHODS: A transgenic mouse was created in which embryonic distal epithelial progenitor cells express green fluorescent protein when tamoxifen is administered. Lung progenitor cells were harvested after tamoxifen injection at either embryonic day 11.5 (E11.5) or 17.5 (E17.5). The RNA extracted from these cells was hybridized to Affymetrix 430.2 mouse chips (Affymetrix, Santa Clara, CA). A genomic signature was created by comparing the cell types using L1 logistic regression and applied to transcriptome datasets of resected patients from our tumor bank and the National Institutes of Health Director's Challenge Consortium. RESULTS: When a 10-gene genomic signature was applied to resected human adenocarcinoma datasets, tumors that were transcriptionally similar to the early progenitors had a significantly worse prognosis than those similar to the late progenitors. Using a Cox model in which age and stage were included, the predicted score from the logistic regression model was an independent predictor of survival. CONCLUSIONS: A lung progenitor cell signature predicts poor prognosis in lung adenocarcinoma. Modulation of these genes or their signaling pathways may be effective therapeutic strategies in the future.

Authors
Onaitis, M; D'Amico, TA; Clark, CP; Guinney, J; Harpole, DH; Rawlins, EL
MLA Citation
Onaitis, M, D'Amico, TA, Clark, CP, Guinney, J, Harpole, DH, and Rawlins, EL. "A 10-gene progenitor cell signature predicts poor prognosis in lung adenocarcinoma." Ann Thorac Surg 91.4 (April 2011): 1046-1050.
PMID
21353202
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
91
Issue
4
Publish Date
2011
Start Page
1046
End Page
1050
DOI
10.1016/j.athoracsur.2010.12.054

Invited commentary.

Authors
D'Amico, TA
MLA Citation
D'Amico, TA. "Invited commentary." Ann Thorac Surg 91.2 (February 2011): 348-349.
PMID
21256265
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
91
Issue
2
Publish Date
2011
Start Page
348
End Page
349
DOI
10.1016/j.athoracsur.2010.09.051

"Reality surgery"--a research ethics perspective on the live broadcast of surgical procedures.

In recent years, the live broadcasting of medical and surgical procedures has gained worldwide popularity. While the practice has appropriately been met with concerns for patient safety and privacy, many physicians tout the merits of real time viewing as a form of investigation, accelerating the process leading to adoption or abolition of newer techniques or technologies. This view introduces a new series of ethical considerations that need to be addressed. As such, this article considers, from a research ethics perspective, the use of live surgical procedure broadcast for investigative purposes.

Authors
Williams, JB; Mathews, R; D'Amico, TA
MLA Citation
Williams, JB, Mathews, R, and D'Amico, TA. ""Reality surgery"--a research ethics perspective on the live broadcast of surgical procedures." J Surg Educ 68.1 (January 2011): 58-61. (Review)
PMID
21292217
Source
pubmed
Published In
Journal of Surgical Education
Volume
68
Issue
1
Publish Date
2011
Start Page
58
End Page
61
DOI
10.1016/j.jsurg.2010.08.009

A comprehensive evaluation for aspiration after esophagectomy reduces the incidence of postoperative pneumonia

Authors
Berry, MF; Atkins, Z; Tong, BC; Harpole, DH; D'Amico, TA; Onaitis, MW
MLA Citation
Berry, MF, Atkins, Z, Tong, BC, Harpole, DH, D'Amico, TA, and Onaitis, MW. "A comprehensive evaluation for aspiration after esophagectomy reduces the incidence of postoperative pneumonia." Dysphagia 26.3 (2011): 326--.
Source
scival
Published In
Dysphagia
Volume
26
Issue
3
Publish Date
2011
Start Page
326-
DOI
10.1007/s00455-011-9343-3

Discussion

Authors
Shrager, J; Darling, ; D'Amico, T; Zielinski, M; Leyn, PD
MLA Citation
Shrager, J, Darling, , D'Amico, T, Zielinski, M, and Leyn, PD. "Discussion." Journal of Thoracic and Cardiovascular Surgery 141.3 (2011): 668-670.
Source
scival
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
141
Issue
3
Publish Date
2011
Start Page
668
End Page
670
DOI
10.1016/j.jtcvs.2010.11.009

Technique of thoracoscopic basilar segmentectomy.

Authors
Ceppa, DP; Balderson, S; D'Amico, TA
MLA Citation
Ceppa, DP, Balderson, S, and D'Amico, TA. "Technique of thoracoscopic basilar segmentectomy." Semin Thorac Cardiovasc Surg 23.1 (2011): 64-66.
PMID
21807302
Source
pubmed
Published In
Seminars in Thoracic and Cardiovascular Surgery
Volume
23
Issue
1
Publish Date
2011
Start Page
64
End Page
66
DOI
10.1053/j.semtcvs.2011.04.009

Preface

Authors
Magedanz, T; Chase, J; Gavras, A; Thanh, NH
MLA Citation
Magedanz, T, Chase, J, Gavras, A, and Thanh, NH. "Preface." Lecture Notes of the Institute for Computer Sciences, Social-Informatics and Telecommunications Engineering, LNICST 46 (2011): v-vi.
Source
scival
Published In
Lecture Notes of the Institute for Computer Sciences, Social-Informatics and Telecommunications Engineering
Volume
46
Publish Date
2011
Start Page
v
End Page
vi

Survival Among Smokers and Nonsmokers in the National Comprehensive Cancer Network (NCCN) Non-small Cell Lung Cancer (NSCLC) Cohort

Authors
Ferketich, AK; Niland, JC; Mamet, R; Zornosa, C; D'Amico, TA; Ettinger, DS; Kalemkerian, GP; Pisters, KM; Reid, ME; Otterson, GA
MLA Citation
Ferketich, AK, Niland, JC, Mamet, R, Zornosa, C, D'Amico, TA, Ettinger, DS, Kalemkerian, GP, Pisters, KM, Reid, ME, and Otterson, GA. "Survival Among Smokers and Nonsmokers in the National Comprehensive Cancer Network (NCCN) Non-small Cell Lung Cancer (NSCLC) Cohort." December 2010.
Source
wos-lite
Published In
Journal of Thoracic Oncology
Volume
5
Issue
12
Publish Date
2010
Start Page
S513
End Page
S513

A comprehensive evaluation for aspiration after esophagectomy reduces the incidence of postoperative pneumonia.

OBJECTIVE: This study assesses the effect of using a comprehensive swallowing evaluation before starting oral feedings on aspiration detection and pneumonia occurrence after esophagectomy. METHODS: The records of all patients undergoing esophagectomy between January 1996 and June 2009 were reviewed. Multivariable logistic regression analysis assessed the effect of preoperative and operative variables on the incidence of aspiration and pneumonia. Separate analyses were performed on patients before (early era, 1996-2002) and after (later era, 2003-2009) a rigorous swallowing evaluation was used routinely before starting oral feedings. RESULTS: During the study period, 799 patients (379 from the early era and 420 from the later era) underwent esophagectomy; 30-day mortality was 3.5% (28 patients). Cervical anastomoses were performed in 76% of patients in the later era compared with 40% of patients in the early era. Overall, 96 (12%) patients had evidence of aspiration postoperatively, and the pneumonia incidence was 14% (113 patients). Age (odds ratio, 1.05 per year; P < .0001) and later era (odds ratio, 1.90; P = .0001) predicted aspiration in all patients in a multivariable model. In the early era, cervical anastomosis and aspiration independently predicted pneumonia. With a comprehensive swallowing evaluation in the later era, the detected incidence of aspiration increased (16% vs 7%, P < .0001), whereas the incidence of pneumonia decreased (11% vs 18%, P = .004) compared with the early era, such that neither anastomotic location nor aspiration predicted pneumonia in the later era. CONCLUSIONS: Esophagectomy is often associated with occult aspiration. A comprehensive swallowing evaluation for aspiration before initiating oral feedings significantly decreases the occurrence of pneumonia.

Authors
Berry, MF; Atkins, BZ; Tong, BC; Harpole, DH; D'Amico, TA; Onaitis, MW
MLA Citation
Berry, MF, Atkins, BZ, Tong, BC, Harpole, DH, D'Amico, TA, and Onaitis, MW. "A comprehensive evaluation for aspiration after esophagectomy reduces the incidence of postoperative pneumonia." J Thorac Cardiovasc Surg 140.6 (December 2010): 1266-1271.
PMID
20884018
Source
pubmed
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
140
Issue
6
Publish Date
2010
Start Page
1266
End Page
1271
DOI
10.1016/j.jtcvs.2010.08.038

Thymic malignancies.

Authors
Ettinger, DS; Akerley, W; Bepler, G; Blum, MG; Chang, A; Cheney, RT; Chirieac, LR; D'Amico, TA; Demmy, TL; Govindan, R; Grannis, FW; Jahan, T; Johnson, DH; Kessinger, A; Komaki, R; Kong, F-M; Kris, MG; Krug, LM; Le, Q-T; Lennes, IT; Martins, R; O'Malley, J; Osarogiagbon, RU; Otterson, GA; Patel, JD; Pisters, KM; Reckamp, K; Riely, GJ; Rohren, E; Swanson, SJ; Wood, DE; Yang, SC; National Comprehensive Cancer Network,
MLA Citation
Ettinger, DS, Akerley, W, Bepler, G, Blum, MG, Chang, A, Cheney, RT, Chirieac, LR, D'Amico, TA, Demmy, TL, Govindan, R, Grannis, FW, Jahan, T, Johnson, DH, Kessinger, A, Komaki, R, Kong, F-M, Kris, MG, Krug, LM, Le, Q-T, Lennes, IT, Martins, R, O'Malley, J, Osarogiagbon, RU, Otterson, GA, Patel, JD, Pisters, KM, Reckamp, K, Riely, GJ, Rohren, E, Swanson, SJ, Wood, DE, Yang, SC, and National Comprehensive Cancer Network, . "Thymic malignancies." J Natl Compr Canc Netw 8.11 (November 2010): 1302-1315.
PMID
21081786
Source
pubmed
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
8
Issue
11
Publish Date
2010
Start Page
1302
End Page
1315

Surgical techniques to avoid parenchymal injury during lung resection (fissureless lobectomy).

Thoracoscopic lobectomy has become an accepted, safe, and oncologically sound procedure compared with open lobectomy. Several studies have reported that it reduces the length of stay, postoperative pain, and postoperative complications, including air leaks. Although there are specific technical considerations that must be taken into account, it is increasingly becoming the preferred method of anatomic lobectomy. Surgeons should be encouraged to embrace the minimally invasive strategy, which may be learned in courses using novel simulation techniques. Future directions suggest that this technique will be expanded to address even the most challenging thoracic procedures.

Authors
Balsara, KR; Balderson, SS; D'Amico, TA
MLA Citation
Balsara, KR, Balderson, SS, and D'Amico, TA. "Surgical techniques to avoid parenchymal injury during lung resection (fissureless lobectomy)." Thorac Surg Clin 20.3 (August 2010): 365-369. (Review)
PMID
20619227
Source
pubmed
Published In
Thoracic Surgery Clinics
Volume
20
Issue
3
Publish Date
2010
Start Page
365
End Page
369
DOI
10.1016/j.thorsurg.2010.04.002

Risk factors for atrial fibrillation after lung cancer surgery: analysis of the Society of Thoracic Surgeons general thoracic surgery database.

BACKGROUND: Atrial fibrillation is responsible for significant morbidity after lung cancer surgery, and preoperative and perioperative risk factors are not well described. METHODS: The Society of Thoracic Surgeons (STS) database was queried for all lobectomy and pneumonectomy patients with a diagnosis of lung cancer. A multivariable logistic regression model was developed to predict the risk of atrial arrhythmia as a function of preoperative and perioperative factors. Generalized estimating equations methodology was used to account for correlation among observations from the same institution. Missing data were handled using the method of chained equations with 10 randomly imputed data sets. RESULTS: A total of 13,906 patients who underwent resection for lung cancer at participating institutions had complete information for postoperative atrial arrhythmia, of whom 1,755 (12.6%) experienced the outcome. Multivariable logistic analysis indentified increasing age, increasing extent of operation, male sex, nonblack race, and stage II or greater tumors as predictors of postoperative atrial fibrillation. CONCLUSIONS: Analysis of the STS database has identified five variables that predict postoperative atrial fibrillation. This predictive model may be useful to develop strategies for risk stratification, prophylaxis, and treatment.

Authors
Onaitis, M; D'Amico, T; Zhao, Y; O'Brien, S; Harpole, D
MLA Citation
Onaitis, M, D'Amico, T, Zhao, Y, O'Brien, S, and Harpole, D. "Risk factors for atrial fibrillation after lung cancer surgery: analysis of the Society of Thoracic Surgeons general thoracic surgery database." Ann Thorac Surg 90.2 (August 2010): 368-374.
PMID
20667313
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
90
Issue
2
Publish Date
2010
Start Page
368
End Page
374
DOI
10.1016/j.athoracsur.2010.03.100

Ethics in cardiothoracic surgery: a survey of surgeons' views.

BACKGROUND: Cardiothoracic surgeons are frequently confronted with complex ethical issues. Educational efforts to help surgeons navigate such issues have been undertaken in recent years, but their effectiveness is uncertain. METHODS: A survey instrument exploring the effects of ethics educational sessions at annual meetings and publications in cardiothoracic surgery journals was sent electronically to cardiothoracic surgeons who belong to The Society of Thoracic Surgeons and the American Association for Thoracic Surgery. RESULTS: Of 3,705 surgeons, 578 responded (15.6%). The majority of respondents practice in an academic setting (55%), attended at least two of the last five Society annual meetings (66%), and at least one of the last five Association annual meetings (68%). A majority of respondents agreed that their own practices would be improved (69%) and that cardiothoracic surgeons in general would benefit (83%) from better understanding of ethical issues. Respondents also believed that demonstration of an adequate understanding of ethical issues should be part of both American Board of Thoracic Surgery certification and maintenance of certification processes (61% and 60%, respectively). Among respondents who attended ethics presentations at annual meetings, only 4% believed that the sessions did not improve their understanding of complex ethical issues, and only 10% believed that the sessions did not affect their surgical practices. CONCLUSIONS: The survey suggested that efforts toward ethics education for cardiothoracic surgeons might be both relevant and important; the results encourage continuation and further improvement of such efforts.

Authors
D'Amico, TA; McKneally, MF; Sade, RM
MLA Citation
D'Amico, TA, McKneally, MF, and Sade, RM. "Ethics in cardiothoracic surgery: a survey of surgeons' views." Ann Thorac Surg 90.1 (July 2010): 11-13.e1-4-.
PMID
20609739
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
90
Issue
1
Publish Date
2010
Start Page
11-13.e1-4
DOI
10.1016/j.athoracsur.2010.03.061

Operative techniques in early-stage lung cancer.

Lung cancer is the most common cause of death by malignancy, responsible for more deaths than the next 4 causes combined and predicted to account for nearly 220,000 new cancer diagnoses and 160,000 deaths in 2009. The cornerstone of therapy for early-stage lung cancer is lobectomy and mediastinal lymph node dissection. Although lobectomy is considered the standard procedure, segmentectomy may be appropriate for selected patients. Conventional approaches to resection may be used, including posterolateral and muscle-sparing thoracotomy. However, minimally invasive lobectomy and segmentectomy procedures are now commonly used with superior outcomes.

Authors
D'Amico, TA
MLA Citation
D'Amico, TA. "Operative techniques in early-stage lung cancer." J Natl Compr Canc Netw 8.7 (July 2010): 807-813.
PMID
20679539
Source
pubmed
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
8
Issue
7
Publish Date
2010
Start Page
807
End Page
813

Thoracoscopic lobectomy: the gold standard for early-stage lung cancer?

Primary lung cancers remain the most lethal of all the malignancies, predicted to account for nearly 160,000 deaths and 220,000 new diagnoses in 2009. The cornerstone of therapy for early-stage lung cancer is surgical resection by lobectomy with concomitant removal of the draining nodal basin. Minimally invasive lobectomy with the use of a thoracoscope has been established as an alternative to standard thoracotomy approaches. Thoracoscopic lobectomy provides advantages over a traditional thoracotomy, including less pain, shorter hospitalization, decreased overall costs, superior chemotherapy compliance, and fewer overall complications. In light of these advantages and with evidence of oncologic equivalence, thoracoscopic lobectomy should be considered the gold standard for the treatment of early-stage lung cancer. This article details the technical strategies for performing thoracoscopic lobectomy and highlights the published evidence demonstrating its advantages over a traditional thoracotomy approach.

Authors
Hartwig, MG; D'Amico, TA
MLA Citation
Hartwig, MG, and D'Amico, TA. "Thoracoscopic lobectomy: the gold standard for early-stage lung cancer?." Ann Thorac Surg 89.6 (June 2010): S2098-S2101.
PMID
20493989
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
89
Issue
6
Publish Date
2010
Start Page
S2098
End Page
S2101
DOI
10.1016/j.athoracsur.2010.02.102

Does the revised TNM staging system for lung cancer better estimate actuarial rates of local/regional recurrence after surgery?

Authors
Pepek, JM; Chino, JP; Onaitis, MW; Marks, LB; Ready, N; Crawford, J; D'Amico, TA; Hubbs, JL; Kelsey, CR
MLA Citation
Pepek, JM, Chino, JP, Onaitis, MW, Marks, LB, Ready, N, Crawford, J, D'Amico, TA, Hubbs, JL, and Kelsey, CR. "Does the revised TNM staging system for lung cancer better estimate actuarial rates of local/regional recurrence after surgery?." May 20, 2010.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
28
Issue
15
Publish Date
2010

Implementing genomically-guided trials in non-small cell lung carcinoma (NSCLC)

Authors
Potti, A; Vlahovic, G; Dunphy, F; Barry, W; Datto, MB; D'Amico, TA; Crawford, J; Ginsburg, GS; Nevins, JR; Ready, N
MLA Citation
Potti, A, Vlahovic, G, Dunphy, F, Barry, W, Datto, MB, D'Amico, TA, Crawford, J, Ginsburg, GS, Nevins, JR, and Ready, N. "Implementing genomically-guided trials in non-small cell lung carcinoma (NSCLC)." May 20, 2010.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
28
Issue
15
Publish Date
2010

Comparison of in-dwelling catheters and talc pleurodesis in the management of malignant pleural effusions

Authors
Demmy, TL; Gu, L; Burkhalter, JE; Toloza, EM; D'Amico, TA; Sutherland, S; Wang, XF; Archer, L; Veit, LJ; Kohman, L; Canc, LGB
MLA Citation
Demmy, TL, Gu, L, Burkhalter, JE, Toloza, EM, D'Amico, TA, Sutherland, S, Wang, XF, Archer, L, Veit, LJ, Kohman, L, and Canc, LGB. "Comparison of in-dwelling catheters and talc pleurodesis in the management of malignant pleural effusions." May 20, 2010.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
28
Issue
15
Publish Date
2010

Videothoracoscopic mediastinal lymphadenectomy.

Mediastinal lymph node dissection improves the staging of patients who have non-small cell lung cancer at the time of resection. Thoracoscopic lobectomy is seen as an effective strategy for patients who have early-stage lung cancer. Videothoracoscopic lymphadenectomy performed during thoracoscopic lobectomy achieves complete mediastinal lymph node dissection.

Authors
D'Amico, TA
MLA Citation
D'Amico, TA. "Videothoracoscopic mediastinal lymphadenectomy." Thorac Surg Clin 20.2 (May 2010): 207-213. (Review)
PMID
20451131
Source
pubmed
Published In
Thoracic Surgery Clinics
Volume
20
Issue
2
Publish Date
2010
Start Page
207
End Page
213
DOI
10.1016/j.thorsurg.2010.02.001

A cost-minimisation analysis of lobectomy: thoracoscopic versus posterolateral thoracotomy.

OBJECTIVE: Recent evidence suggests that lobectomy performed either through thoracoscopy (TL) or via a posterolateral thoracotomy (PLT) produces equivalent oncologic outcomes in appropriately selected patients. Advantages of thoracoscopic lobectomy include decreased postoperative pain, shorter length of stay, fewer postoperative complications and better compliance with adjuvant chemotherapy. This study evaluates the costs associated with lobectomy performed thoracoscopically or via thoracotomy. METHODS: This is a retrospective analysis of actual costing and prospectively collected health-related quality of life (QOL) outcomes. Between 2002 and 2004, 113 patients underwent lobectomy (PLT: n=37; TL: n=76) and completed QOL assessments both preoperatively and 1-year postoperatively. Actual fixed and variable direct costs from the preoperative, hospitalisation and 30-day postoperative phases were captured using a T1 cost accounting system and were combined with actual professional collections. Cost-utility analysis was performed by transforming a global QOL measurement to an estimate of utility and calculating a quality-adjusted life year (QALY) for each patient. RESULTS: Baseline characteristics were similar in the two groups. Total costs (USD) were significantly greater for the strategy of PLT (USD 12,119) than for TL (USD 10,084; p=0.0012). Even when only stage I and II lung cancers were included (n=32 PLT, n=69 TL), total costs for PLT were still higher than that for TL (USD 11,998 vs USD 10,120; p=0.005). The mean QALY for the PLT group was 0.74+/-0.22 and for the TL group was 0.72+/-0.18 (p=0.68). CONCLUSIONS: In this retrospective analysis, TL was significantly less expensive than PLT from the preoperative evaluation through 30 days postoperatively, with overall savings of approximately USD 2000 per patient. In light of equivalent QALY outcomes, this cost-utility analysis supports increased adoption of TL as a cost-minimisation strategy. The use of TL for the 50,000 lobectomies performed in the United States each year would represent a savings of approximately USD 100 million.

Authors
Burfeind, WR; Jaik, NP; Villamizar, N; Toloza, EM; Harpole, DH; D'Amico, TA
MLA Citation
Burfeind, WR, Jaik, NP, Villamizar, N, Toloza, EM, Harpole, DH, and D'Amico, TA. "A cost-minimisation analysis of lobectomy: thoracoscopic versus posterolateral thoracotomy." Eur J Cardiothorac Surg 37.4 (April 2010): 827-832.
PMID
19939695
Source
pubmed
Published In
European Journal of Cardio-Thoracic Surgery
Volume
37
Issue
4
Publish Date
2010
Start Page
827
End Page
832
DOI
10.1016/j.ejcts.2009.10.017

Gastric cancer.

Authors
Ajani, JA; Barthel, JS; Bekaii-Saab, T; Bentrem, DJ; D'Amico, TA; Das, P; Denlinger, C; Fuchs, CS; Gerdes, H; Hayman, JA; Hazard, L; Hofstetter, WL; Ilson, DH; Keswani, RN; Kleinberg, LR; Korn, M; Meredith, K; Mulcahy, MF; Orringer, MB; Osarogiagbon, RU; Posey, JA; Sasson, AR; Scott, WJ; Shibata, S; Strong, VEM; Washington, MK; Willett, C; Wood, DE; Wright, CD; Yang, G; NCCN Gastric Cancer Panel,
MLA Citation
Ajani, JA, Barthel, JS, Bekaii-Saab, T, Bentrem, DJ, D'Amico, TA, Das, P, Denlinger, C, Fuchs, CS, Gerdes, H, Hayman, JA, Hazard, L, Hofstetter, WL, Ilson, DH, Keswani, RN, Kleinberg, LR, Korn, M, Meredith, K, Mulcahy, MF, Orringer, MB, Osarogiagbon, RU, Posey, JA, Sasson, AR, Scott, WJ, Shibata, S, Strong, VEM, Washington, MK, Willett, C, Wood, DE, Wright, CD, Yang, G, and NCCN Gastric Cancer Panel, . "Gastric cancer." J Natl Compr Canc Netw 8.4 (April 2010): 378-409.
PMID
20410333
Source
pubmed
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
8
Issue
4
Publish Date
2010
Start Page
378
End Page
409

Pulmonary function tests do not predict pulmonary complications after thoracoscopic lobectomy.

BACKGROUND: Pulmonary function tests predict respiratory complications and mortality after lung resection through thoracotomy. We sought to determine the impact of pulmonary function tests upon complications after thoracoscopic lobectomy. METHODS: A model for morbidity, including published preoperative risk factors and surgical approach, was developed by multivariable logistic regression. All patients who underwent lobectomy for primary lung cancer between December 1999 and October 2007 with preoperative forced expiratory volume in 1 second (FEV1) or diffusion capacity to carbon monoxide (Dlco) 60% or less predicted were reviewed. Preoperative, histopathologic, perioperative, and outcome variables were assessed using standard descriptive statistics. Pulmonary complications were defined as atelectasis requiring bronchoscopy, pneumonia, reintubation, and tracheostomy. RESULTS: During the study period, 340 patients (median age 67) with Dlco or FEV1 60% or less (mean % predicted FEV1, 55+/-1; mean % predicted Dlco, 61+/-1) underwent lobectomy (173 thoracoscopy, 167 thoracotomy). Operative mortality was 5% (17 patients) and overall morbidity was 48% (164 patients). At least one pulmonary complication occurred in 57 patients (17%). Significant predictors of pulmonary complications by multivariable analysis for all patients included Dlco (odds ratio 1.03, p=0.003), FEV1 (odds ratio 1.04, p=0.003), and thoracotomy as surgical approach (odds ratio 3.46, p=0.0007). When patients were analyzed according to operative approach, Dlco and FEV1 remained significant predictors of pulmonary morbidity for patients undergoing thoracotomy but not thoracoscopy. CONCLUSIONS: In patients with impaired pulmonary function, preoperative pulmonary function tests are predictors of pulmonary complications when lobectomy for lung cancer is performed through thoracotomy but not through thoracoscopy.

Authors
Berry, MF; Villamizar-Ortiz, NR; Tong, BC; Burfeind, WR; Harpole, DH; D'Amico, TA; Onaitis, MW
MLA Citation
Berry, MF, Villamizar-Ortiz, NR, Tong, BC, Burfeind, WR, Harpole, DH, D'Amico, TA, and Onaitis, MW. "Pulmonary function tests do not predict pulmonary complications after thoracoscopic lobectomy." Ann Thorac Surg 89.4 (April 2010): 1044-1051.
PMID
20338305
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
89
Issue
4
Publish Date
2010
Start Page
1044
End Page
1051
DOI
10.1016/j.athoracsur.2009.12.065

Primary chest wall tumors.

Authors
Shah, AA; D'Amico, TA
MLA Citation
Shah, AA, and D'Amico, TA. "Primary chest wall tumors." J Am Coll Surg 210.3 (March 2010): 360-366. (Review)
PMID
20193901
Source
pubmed
Published In
Journal of the American College of Surgeons
Volume
210
Issue
3
Publish Date
2010
Start Page
360
End Page
366
DOI
10.1016/j.jamcollsurg.2009.11.012

An inexpensive, reproducible tissue simulator for teaching thoracoscopic lobectomy.

PURPOSE: Simulation is rapidly becoming an integral part of surgical education at all levels including the education of practicing surgeons in new techniques such as thoracoscopic lobectomy. Current thoracoscopic lobectomy simulator models have significant limitations including expense and requirement for specialized facilities. This study describes a novel low-cost, easily reproducible, bench top simulator. DESCRIPTION: Tissue blocks consisting of a porcine heart and bilateral lungs with intact pericardium were secured from a commercially available source. The pulmonary artery and veins were statically distended with ketchup to more realistically mimic the technique of dissection and allow for simultaneous identification of technical errors. EVALUATION: This simulator has been used at seven different industry and society sponsored thoracoscopic lobectomy training programs by more than 100 participants. Qualitative data on the performance of the model was collected from faculty and course participants. CONCLUSIONS: A low-cost porcine heart-lung block statically perfused with ketchup provides an inexpensive, easily reproducible model for teaching thoracoscopic lobectomy, which reasonably and accurately simulates a clinical experience.

Authors
Meyerson, SL; LoCascio, F; Balderson, SS; D'Amico, TA
MLA Citation
Meyerson, SL, LoCascio, F, Balderson, SS, and D'Amico, TA. "An inexpensive, reproducible tissue simulator for teaching thoracoscopic lobectomy." Ann Thorac Surg 89.2 (February 2010): 594-597.
PMID
20103349
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
89
Issue
2
Publish Date
2010
Start Page
594
End Page
597
DOI
10.1016/j.athoracsur.2009.07.067

Preoperative radiation therapy and chemotherapy for pulmonary blastoma: a case report.

Authors
Zagar, TM; Blackwell, S; Crawford, J; D'Amico, T; Christensen, JD; Sporn, TA; Kelsey, CR
MLA Citation
Zagar, TM, Blackwell, S, Crawford, J, D'Amico, T, Christensen, JD, Sporn, TA, and Kelsey, CR. "Preoperative radiation therapy and chemotherapy for pulmonary blastoma: a case report." J Thorac Oncol 5.2 (February 2010): 282-283.
PMID
20101153
Source
pubmed
Published In
Journal of Thoracic Oncology
Volume
5
Issue
2
Publish Date
2010
Start Page
282
End Page
283
DOI
10.1097/JTO.0b013e3181c420e1

Thoracoscopic lobectomy is associated with lower morbidity than open lobectomy: a propensity-matched analysis from the STS database.

BACKGROUND: Several single-institution series have demonstrated that compared with open thoracotomy, video-assisted thoracoscopic lobectomy may be associated with fewer postoperative complications. In the absence of randomized trials, we queried the Society of Thoracic Surgeons database to compare postoperative mortality and morbidity following open and video-assisted thoracoscopic lobectomy. A propensity-matched analysis using a large national database may enable a more comprehensive comparison of postoperative outcomes. METHODS: All patients having lobectomy as the primary procedure via thoracoscopy or thoracotomy were identified in the Society of Thoracic Surgeons database from 2002 to 2007. After exclusions, 6323 patients were identified: 5042 having thoracotomy, 1281 having thoracoscopy. A propensity analysis was performed, incorporating preoperative variables, and the incidence of postoperative complications was compared. RESULTS: Matching based on propensity scores produced 1281 patients in each group for analysis of postoperative outcomes. After video-assisted thoracoscopic lobectomy, 945 patients (73.8%) had no complications, compared with 847 patients (65.3%) who had lobectomy via thoracotomy (P < .0001). Compared with open lobectomy, video-assisted thoracoscopic lobectomy was associated with a lower incidence of arrhythmias [n = 93 (7.3%) vs 147 (11.5%); P = .0004], reintubation [n = 18 (1.4%) vs 40 (3.1%); P = .0046], and blood transfusion [n = 31 (2.4%) vs n = 60 (4.7%); P = .0028], as well as a shorter length of stay (4.0 vs 6.0 days; P < .0001) and chest tube duration (3.0 vs 4.0 days; P < .0001). There was no difference in operative mortality between the 2 groups. CONCLUSIONS: Video-assisted thoracoscopic lobectomy is associated with a lower incidence of complications compared with lobectomy via thoracotomy. For appropriate candidates, video-assisted thoracoscopic lobectomy may be the preferred strategy for appropriately selected patients with lung cancer.

Authors
Paul, S; Altorki, NK; Sheng, S; Lee, PC; Harpole, DH; Onaitis, MW; Stiles, BM; Port, JL; D'Amico, TA
MLA Citation
Paul, S, Altorki, NK, Sheng, S, Lee, PC, Harpole, DH, Onaitis, MW, Stiles, BM, Port, JL, and D'Amico, TA. "Thoracoscopic lobectomy is associated with lower morbidity than open lobectomy: a propensity-matched analysis from the STS database." J Thorac Cardiovasc Surg 139.2 (February 2010): 366-378.
PMID
20106398
Source
pubmed
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
139
Issue
2
Publish Date
2010
Start Page
366
End Page
378
DOI
10.1016/j.jtcvs.2009.08.026

Outcomes of video-assisted thoracoscopic decortication.

BACKGROUND: Video-assisted thoracoscopic surgical decortication (VATSD) is widely used for treatment of early empyema and hemothorax, but conversion to open thoracotomy for decortication (OD) is more frequent in the setting of complex, chronic empyema. This study compared indications for and outcomes associated with VATSD and OD. METHODS: The outcomes of 420 consecutive patients undergoing VATSD or OD for benign conditions from 1996 to 2006 were reviewed and compared with respect to baseline characteristics, preoperative management, and operative and postoperative course. Patients were analyzed on an intention-to-treat basis. RESULTS: The cohort consisted of 326 VATSD and 94 OD patients. The conversion rate from VATSD to OD was 11.4%. The operative time and median in-hospital length of stay were shorter for the VATSD group: 97 vs 155 minutes (p < 0.001), and 15 vs 21 days (p = 0.03), respectively. The median postoperative length of stay was 7 days for the VATSD group vs 10 days for the OD group (p < 0.001). Significantly fewer postoperative complications occurred in the VATSD group in the following categories: atelectasis, prolonged air leak, reintubation, ventilator dependence, need for tracheostomy, blood transfusion, sepsis, and 30-day mortality. CONCLUSIONS: Thoracoscopic decortication for empyema, complex pleural effusion, and hemothorax yields results that are at least equivalent to open decortication. Patients undergoing VATSD have fewer postoperative complications. The conversion and reoperation rates are low, suggesting that a thoracoscopic approach is an effective and reasonable first option for most patients with complex pleural effusions and empyema.

Authors
Tong, BC; Hanna, J; Toloza, EM; Onaitis, MW; D'Amico, TA; Harpole, DH; Burfeind, WR
MLA Citation
Tong, BC, Hanna, J, Toloza, EM, Onaitis, MW, D'Amico, TA, Harpole, DH, and Burfeind, WR. "Outcomes of video-assisted thoracoscopic decortication." Ann Thorac Surg 89.1 (January 2010): 220-225.
PMID
20103240
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
89
Issue
1
Publish Date
2010
Start Page
220
End Page
225
DOI
10.1016/j.athoracsur.2009.09.021

Discussion

Authors
Andrade, RS; Cooke, DT; Hofstetter, W; D'Amico, TA; Freeman, R
MLA Citation
Andrade, RS, Cooke, DT, Hofstetter, W, D'Amico, TA, and Freeman, R. "Discussion." Annals of Thoracic Surgery 90.3 (2010): 919--.
Source
scival
Published In
The Annals of Thoracic Surgery
Volume
90
Issue
3
Publish Date
2010
Start Page
919-
DOI
10.1016/j.athoracsur.2010.05.061

Non-small cell lung cancer: Clinical practice guidelines in oncology

Lung cancer is the leading cause of cancer-related death in the United States. The primary risk factor for lung cancer is smoking, which accounts for more than 85% of all lung cancer-related deaths. Radon gas, a radioactive gas that is produced by the decay of radium 226, is the second leading cause of lung cancer. The decay of this isotope leads to the production of substances that emit alpha-particles, which may cause cell damage and therefore increase the potential for malignant transformation. Furthermore, data suggest that postmenopausal women who smoke or are former smokers should not undergo hormone replacement therapy, because it increases the risk for death from non-small cell lung cancer. Important changes in these NCCN Guidelines for 2010 include updates to the Principles of Surgical Therapy and Radiation Therapy, and the addition of a section on maintenance therapy for advanced or metastatic disease. In addition, recommendations for a number of chemotherapy regimens were modified, including the addition of erlotinib as a first-line treatment option for patients who are positive for the EGFR mutation, and staging was updated per the IASLC recommendations. © Journal of the National Comprehensive Cancer Network.

Authors
Ettinger, DS; Akerley, W; Bepler, G; Blum, MG; Chang, A; Cheney, RT; Chirieac, LR; D'Amico, TA; Demmy, TL; Ganti, AKP; Govindan, R; Jr, FWG; Jahan, T; Jahanzeb, M; Johnson, DH; Kessinger, A; Komaki, R; Kong, F-M; Kris, MG; Krug, LM; Le, Q-T; Lennes, IT; Martins, R; O'Malley, J; Osarogiagbon, RU; Otterson, GA; Patel, JD; Pisters, KM; Reckamp, K; Riely, GJ; Rohren, E; Simon, GR; Swanson, SJ; Wood, DE; Yang, SC
MLA Citation
Ettinger, DS, Akerley, W, Bepler, G, Blum, MG, Chang, A, Cheney, RT, Chirieac, LR, D'Amico, TA, Demmy, TL, Ganti, AKP, Govindan, R, Jr, FWG, Jahan, T, Jahanzeb, M, Johnson, DH, Kessinger, A, Komaki, R, Kong, F-M, Kris, MG, Krug, LM, Le, Q-T, Lennes, IT, Martins, R, O'Malley, J, Osarogiagbon, RU, Otterson, GA, Patel, JD, Pisters, KM, Reckamp, K, Riely, GJ, Rohren, E, Simon, GR, Swanson, SJ, Wood, DE, and Yang, SC. "Non-small cell lung cancer: Clinical practice guidelines in oncology." JNCCN Journal of the National Comprehensive Cancer Network 8.7 (2010): 740-741+771-801-.
PMID
20679538
Source
scival
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
8
Issue
7
Publish Date
2010
Start Page
740-741+771-801

The Effect of Increasing Experience with Intensity Modulated Radiation Therapy for Resected Malignant Pleural Mesothelioma

Authors
Patel, PR; Yoo, S; Marks, L; Miles, E; D'Amico, TA; Harpole, DH; Kelsey, C
MLA Citation
Patel, PR, Yoo, S, Marks, L, Miles, E, D'Amico, TA, Harpole, DH, and Kelsey, C. "The Effect of Increasing Experience with Intensity Modulated Radiation Therapy for Resected Malignant Pleural Mesothelioma." 2010.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
78
Issue
3
Publish Date
2010
Start Page
S505
End Page
S506

Preoperative chemotherapy versus preoperative chemoradiotherapy for stage III (N2) non-small-cell lung cancer.

PURPOSE: To compare preoperative chemotherapy (ChT) and preoperative chemoradiotherapy (ChT-RT) in operable Stage III non-small-cell lung cancer. METHODS AND MATERIALS: This retrospective study analyzed all patients with pathologically confirmed Stage III (N2) non-small-cell lung cancer who initiated preoperative ChT or ChT-RT at Duke University between 1995 and 2006. Mediastinal pathologic complete response (pCR) rates were compared using a chi-square test. The actuarial overall survival, disease-free survival, and local control were estimated using the Kaplan-Meier method and compared using the log-rank test. Multivariate Cox regression analysis was also performed. RESULTS: A total of 101 patients who initiated preoperative therapy with planned resection were identified. The median follow-up was 20 months for all patients and 38 months for survivors. The mediastinal lymph nodes were reassessed after preoperative therapy in 88 patients (87%). Within this group, a mediastinal pCR was achieved in 35% after preoperative ChT vs. 65% after preoperative ChT-RT (p = 0.01). Resection was performed in 69% after ChT and 84% after ChT-RT (p = 0.1). For all patients, the overall survival, disease-free survival, and local control rate at 3 years was 40%, 27%, and 66%, respectively. No statistically significant differences were found in the clinical endpoints between the ChT and ChT-RT subgroups. On multivariate analysis, a mediastinal pCR was associated with improved disease-free survival (p = 0.03) and local control (p = 0.03), but not overall survival (p = 0.86). CONCLUSION: Preoperative ChT-RT was associated with higher mediastinal pCR rates but not improved survival.

Authors
Higgins, K; Chino, JP; Marks, LB; Ready, N; D'Amico, TA; Clough, RW; Kelsey, CR
MLA Citation
Higgins, K, Chino, JP, Marks, LB, Ready, N, D'Amico, TA, Clough, RW, and Kelsey, CR. "Preoperative chemotherapy versus preoperative chemoradiotherapy for stage III (N2) non-small-cell lung cancer." Int J Radiat Oncol Biol Phys 75.5 (December 1, 2009): 1462-1467.
PMID
19467798
Source
pubmed
Published In
International Journal of Radiation: Oncology - Biology - Physics
Volume
75
Issue
5
Publish Date
2009
Start Page
1462
End Page
1467
DOI
10.1016/j.ijrobp.2009.01.069

Surgical management of pulmonary metastases.

Metastasectomy is the only curative option for some patients with secondary pulmonary malignancy. Many studies suggest a survival benefit in selected patients if complete resection of pulmonary metastases is accomplished. There are several operative approaches that may be used, with the goal of complete resection and with minimal parenchymal loss. Evaluation for resection must include ascertainment of control of the primary tumor and assessment of the ability to achieve complete resection. Minimally invasive approaches may offer advantages in quality of life outcomes, with equivalent oncologic outcomes.

Authors
Erhunmwunsee, L; D'Amico, TA
MLA Citation
Erhunmwunsee, L, and D'Amico, TA. "Surgical management of pulmonary metastases." Ann Thorac Surg 88.6 (December 2009): 2052-2060. (Review)
PMID
19932302
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
88
Issue
6
Publish Date
2009
Start Page
2052
End Page
2060
DOI
10.1016/j.athoracsur.2009.08.033

Local recurrence after surgery for early stage lung cancer: an 11-year experience with 975 patients.

BACKGROUND: The objective of the current study was to evaluate the actuarial risk of local failure (LF) after surgery for stage I to II nonsmall cell lung cancer (NSCLC) and assess surgical and pathologic factors affecting this risk. METHODS: The records, including pertinent radiologic studies, of all patients who underwent surgery for T1 to T2, N0 to N1 NSCLC at Duke University between 1995 and 2005 were reviewed. Risks of disease recurrence were estimated using the Kaplan-Meier method. A multivariate Cox regression analysis assessed factors associated with LF in the entire cohort and a subgroup undergoing optimal surgery for stage IB to II disease. RESULTS: For all 975 consecutive patients, the 5-year actuarial risk of local and/or distant disease recurrence was 36%. First sites of failure were local only (25%), local and distant (29%), and distant only (46%). The 5-year actuarial risk of LF was 23%. On multivariate analysis, squamous/large cell histology (hazards ratio [HR], 1.98), stage > IA (HR, 2.02), and sublobar resections (HR, 1.99) were found to be independently associated with a higher risk of LF. For the subset of patients (n = 445) undergoing at least a lobectomy with negative surgical margins and currently considered for adjuvant chemotherapy (stage IB-II disease), the 5-year actuarial risk of LF was 27%. Within this subgroup, squamous/large cell histology (HR, 2.5) and lymphovascular space invasion (HR, 1.74) were associated with a higher risk of LF. The 5-year rate of LF was 13%, 32%, and 47%, respectively, with 0, 1, or 2 risk factors. CONCLUSIONS: Greater than half of disease recurrences after surgery for early stage NSCLC involved local sites. Pathologic factors may help to distinguish those patients at highest risk.

Authors
Kelsey, CR; Marks, LB; Hollis, D; Hubbs, JL; Ready, NE; D'Amico, TA; Boyd, JA
MLA Citation
Kelsey, CR, Marks, LB, Hollis, D, Hubbs, JL, Ready, NE, D'Amico, TA, and Boyd, JA. "Local recurrence after surgery for early stage lung cancer: an 11-year experience with 975 patients." Cancer 115.22 (November 15, 2009): 5218-5227.
PMID
19672942
Source
pubmed
Published In
Cancer
Volume
115
Issue
22
Publish Date
2009
Start Page
5218
End Page
5227
DOI
10.1002/cncr.24625

Complications after Pulmonary Resection: Lobectomy and Pneumonectomy

Authors
Berry, MF; D'Amico, TA
MLA Citation
Berry, MF, and D'Amico, TA. "Complications after Pulmonary Resection: Lobectomy and Pneumonectomy." Complications in Cardiothoracic Surgery: Avoidance and Treatment: Second Edition. October 5, 2009. 158-181.
Source
scopus
Publish Date
2009
Start Page
158
End Page
181
DOI
10.1002/9781444307580.ch6

Risk factors for morbidity after lobectomy for lung cancer in elderly patients.

BACKGROUND: Studies evaluating risk factors for complications after lobectomy in elderly patients have not adequately analyzed the effect of using minimally invasive approaches. METHODS: A model for morbidity including published preoperative risk factors and surgical approach was developed by multivariable logistic regression. All patients aged 70 years or older who underwent lobectomy for primary lung cancer without chest wall resection or airway procedure between December 1999 and October 2007 at a single institution were reviewed. Preoperative, histopathologic, perioperative, and outcome variables were assessed using standard descriptive statistics. Morbidity was measured as a patient having any perioperative complication. The impact of bias in the selection of surgical approach was assessed using propensity scoring. RESULTS: During the study period, 338 patients older than 70 years (mean age, 75.7 +/- 0.2) underwent lobectomy (219 thoracoscopy, 119 thoracotomy). Operative mortality was 3.8% (13 patients) and morbidity was 47% (159 patients). Patients with at least one complication had increased length of stay (8.3 +/- 0.6 versus 3.8 +/- 0.1 days; p < 0.0001) and mortality (6.9% [11 of 159] versus 1.1% [2 of 179]; p = 0.008). Significant predictors of morbidity by multivariable analysis included age (odds ratio, 1.09 per year; p = 0.01) and thoracotomy as surgical approach (odds ratio, 2.21; p = 0.004). Thoracotomy remained a significant predictor of morbidity when the propensity to undergo thoracoscopy was considered (odds ratio, 4.9; p= 0.002). CONCLUSIONS: Patients older than 70 years of age can undergo lobectomy for lung cancer with low morbidity and mortality. Advanced age and the use of a thoracotomy increased the risk of complications in this patient population.

Authors
Berry, MF; Hanna, J; Tong, BC; Burfeind, WR; Harpole, DH; D'Amico, TA; Onaitis, MW
MLA Citation
Berry, MF, Hanna, J, Tong, BC, Burfeind, WR, Harpole, DH, D'Amico, TA, and Onaitis, MW. "Risk factors for morbidity after lobectomy for lung cancer in elderly patients." Ann Thorac Surg 88.4 (October 2009): 1093-1099.
PMID
19766786
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
88
Issue
4
Publish Date
2009
Start Page
1093
End Page
1099
DOI
10.1016/j.athoracsur.2009.06.012

Techniques of VATS resections for lobectomy, segmentectomies, and lymph node dissections and their results in 2009: who are the candidates, when do you not do this?

Authors
D'Amico, TA
MLA Citation
D'Amico, TA. "Techniques of VATS resections for lobectomy, segmentectomies, and lymph node dissections and their results in 2009: who are the candidates, when do you not do this?." September 2009.
Source
wos-lite
Published In
Journal of Thoracic Oncology
Volume
4
Issue
9
Publish Date
2009
Start Page
S58
End Page
S60

Thoracoscopic lobectomy is associated with lower morbidity compared with thoracotomy.

OBJECTIVES: Advantages of thoracoscopic lobectomy include less postoperative pain, shorter hospitalization, and improved delivery of adjuvant chemotherapy. The incidence of postoperative complications has not been thoroughly assessed. This study analyzes morbidity after lobectomy to compare the thoracoscopic approach and thoracotomy. METHODS: By using a prospective database, the outcomes of patients who underwent lobectomy from 1999-2009 were analyzed with respect to postoperative complications. Propensity-matched groups were analyzed based on preoperative variables and stage. RESULTS: Of the 1079 patients in the study, 697 underwent thoracoscopic lobectomy, and 382 underwent lobectomy by means of thoracotomy. In the overall analysis thoracoscopic lobectomy was associated with a lower incidence of atrial fibrillation (P = .01), atelectasis (P = .0001), prolonged air leak (P = .0004), transfusion (P = .0001), pneumonia (P = .001), sepsis (P = .008), renal failure (P = .003), and death (P = .003). In the propensity-matched analysis based on preoperative variables, when comparing 284 patients in each group, 196 (69%) patients who underwent thoracoscopic lobectomy had no complications versus 144 (51%) patients who underwent thoracotomy (P = .0001). In addition, thoracoscopic lobectomy was associated with a lower incidence of atrial fibrillation (13% vs 21%, P = .01), less atelectasis (5% vs 12%, P = .006), fewer prolonged air leaks (13% vs 19%, P = .05), fewer transfusions (4% vs 13%, P = .002), less pneumonia (5% vs 10%, P = .05), less renal failure (1.4% vs 5%, P = .02), shorter chest tube duration (median of 3 vs 4 days, P < .0001), and shorter length of hospital stay (median of 4 vs 5 days, P < .0001). CONCLUSIONS: Thoracoscopic lobectomy is associated with a lower incidence of major complications, including atrial fibrillation, compared with lobectomy by means of thoracotomy. The underlying factors responsible for this advantage should be analyzed to improve the safety and outcomes of other thoracic procedures.

Authors
Villamizar, NR; Darrabie, MD; Burfeind, WR; Petersen, RP; Onaitis, MW; Toloza, E; Harpole, DH; D'Amico, TA
MLA Citation
Villamizar, NR, Darrabie, MD, Burfeind, WR, Petersen, RP, Onaitis, MW, Toloza, E, Harpole, DH, and D'Amico, TA. "Thoracoscopic lobectomy is associated with lower morbidity compared with thoracotomy." J Thorac Cardiovasc Surg 138.2 (August 2009): 419-425.
PMID
19619789
Source
pubmed
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
138
Issue
2
Publish Date
2009
Start Page
419
End Page
425
DOI
10.1016/j.jtcvs.2009.04.026

[Thoracic wall defect reconstruction and dead space obliteration with an intra-/extrathoracic free flap].

Presented is the case of a 61-year-old male patient with a chronic thoracic wall defect, including a bronchopleural fistula, after multiple resections of a desmoid tumor. After partial lung resection to remove the bronchopleural fistula, dead space was partially obliterated and the thoracic wall reconstructed with a free combined intra- and extrathoracic rectus abdominis muscle flap.

Authors
Harenberg, PS; Viol, AW; D'Amico, TA; Levin, LS; Erdmann, D
MLA Citation
Harenberg, PS, Viol, AW, D'Amico, TA, Levin, LS, and Erdmann, D. "[Thoracic wall defect reconstruction and dead space obliteration with an intra-/extrathoracic free flap]." Chirurg 80.7 (July 2009): 641-644.
PMID
19280081
Source
pubmed
Published In
Der Chirurg
Volume
80
Issue
7
Publish Date
2009
Start Page
641
End Page
644
DOI
10.1007/s00104-009-1695-y

Lung volume reduction surgery for the management of refractory dyspnea in chronic obstructive pulmonary disease.

PURPOSE OF REVIEW: This review describes the role of lung volume reduction surgery (LVRS) for the management of refractory dyspnea and other debilitating conditions in patients with chronic obstructive pulmonary disease. Recent studies, including a randomized trial comparing LVRS to medical therapy, are analyzed. RECENT FINDINGS: LVRS plus optimal medical therapy is superior to medical therapy alone in treating certain subsets of patients with severe emphysema. In patients with predominantly upper lobe emphysema and low-exercise capacity, LVRS not only improves symptoms of dyspnea and exercise intolerance, but also is associated with improved survival. Furthermore, LVRS has recently been shown to be superior to medical therapy in improving other quality of life parameters, such as nutritional status, sleep quality, and the frequency of chronic obstructive pulmonary disease (COPD) exacerbations in patients with severe emphysema. SUMMARY: LVRS is an effective strategy in the treatment of properly selected patients with COPD, improving survival and quality of life, including exercise tolerance, dyspnea, oxygen requirement and functional status.

Authors
Shah, AA; D'Amico, TA
MLA Citation
Shah, AA, and D'Amico, TA. "Lung volume reduction surgery for the management of refractory dyspnea in chronic obstructive pulmonary disease." Curr Opin Support Palliat Care 3.2 (June 2009): 107-111. (Review)
PMID
19436210
Source
pubmed
Published In
Current Opinion in Supportive and Palliative Care
Volume
3
Issue
2
Publish Date
2009
Start Page
107
End Page
111
DOI
10.1097/SPC.0b013e32832ad5e1

Giant thoracic liposarcoma treated with induction chemotherapy followed by surgical resection.

Authors
Berry, MF; Sporn, TA; Moore, JO; D'Amico, TA
MLA Citation
Berry, MF, Sporn, TA, Moore, JO, and D'Amico, TA. "Giant thoracic liposarcoma treated with induction chemotherapy followed by surgical resection." J Thorac Oncol 4.6 (June 2009): 768-769.
PMID
19461403
Source
pubmed
Published In
Journal of Thoracic Oncology
Volume
4
Issue
6
Publish Date
2009
Start Page
768
End Page
769
DOI
10.1097/JTO.0b013e31819e77ff

Prognostic factors for recurrence after pulmonary resection of colorectal cancer metastases.

BACKGROUND: This study was undertaken to review a large series of resections of colorectal pulmonary metastases in the era of modern chemotherapy. METHODS: A retrospective chart review of prospectively maintained thoracic surgery databases identified 378 patients who underwent pulmonary resection for colorectal cancer metastases with curative intent from 1998 to 2007. RESULTS: The primary site of disease was rectum (52%), left colon (26%), right colon (16%), and unknown (6%). Before thoracic recurrence, 166 patients (44%) had previously undergone resection of extrathoracic metastases. Median disease-free interval (DFI) was 24 months from the time of the primary operation. The number of metastatic deposits resected was one in 60%, two in 20%, three in 10%, and four or more in 10%. Chemotherapy was administered to 87 patients (23%) before resection and to 169 patients (45%) after resection. Three-year recurrence-free survival was 28%, and 3-year overall survival was 78%. Multivariable analysis revealed age younger than 65 years, female sex, DFI less than 1 year, and number of metastases greater than three as independent predictors of recurrence. Of 44 patients with three or more lesions and less than 1 year DFI, none was cured by operation. By contrast, recurrence-free survival was 49% at 3 years for those with one lesion and DFI greater than 1 year. CONCLUSIONS: Age younger than 65 years, female sex, DFI less than 1 year, and number of metastases greater than three predict recurrence. Medical management alone should be considered standard for patients who have both three or more pulmonary metastases and less than 1 year DFI.

Authors
Onaitis, MW; Petersen, RP; Haney, JC; Saltz, L; Park, B; Flores, R; Rizk, N; Bains, MS; Dycoco, J; D'Amico, TA; Harpole, DH; Kemeny, N; Rusch, VW; Downey, R
MLA Citation
Onaitis, MW, Petersen, RP, Haney, JC, Saltz, L, Park, B, Flores, R, Rizk, N, Bains, MS, Dycoco, J, D'Amico, TA, Harpole, DH, Kemeny, N, Rusch, VW, and Downey, R. "Prognostic factors for recurrence after pulmonary resection of colorectal cancer metastases." Ann Thorac Surg 87.6 (June 2009): 1684-1688.
PMID
19463577
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
87
Issue
6
Publish Date
2009
Start Page
1684
End Page
1688
DOI
10.1016/j.athoracsur.2009.03.034

Intraoperative sentinel node mapping with technitium-99 in lung cancer: results of CALGB 140203 multicenter phase II trial.

INTRODUCTION: Sentinel node mapping with radioactive technetium in non-small cell lung cancer has been shown to be feasible in several single institution reports. The Cancer and Leukemia Group B designed a phase II trial to test a standardized method of this technique in a multi-institutional setting. If validated, the technique could provide a more accurate and sensitive way to identify lymph node metastases. METHODS: Patients with clinical stage I non-small cell lung cancer amenable to resection were candidates for this trial. Intraoperatively, tumors were injected with technetium sulfur colloid (0.25 mCi). The tumor and lymph nodes were measured in vivo with a hand held Geiger counter and resection of the tumor and nodes was carried out. Sentinel nodes, all other nodes and the tumor were analyzed with standard histologic assessment. Negative sentinel nodes were also evaluated with immunohistochemistry. RESULTS: In this phase II trial, 8 surgeons participated (1-13 patients enrolled per surgeon), and 46 patients (out of a planned 150) were enrolled. Of these, 43 patients had cancer and an attempted complete resection, and 39 patients underwent sentinel node mapping. One or more sentinel nodes were identified in 24 of the 39 patients (61.5%). The sentinel node(s) were found to be accurate (no other nodes were positive for cancer if the sentinel node was negative) in 20/24 patients (83.3%). In the overall group the sentinel node mapping procedure was found to be accurate in 20/39 patients (51.2%). CONCLUSIONS: Intraoperative sentinel node mapping in lung cancer with radioisotope yielded lower accrual and worse accuracy than expected. The multi-institutional attempt at validating this technique was unsuccessful.

Authors
Liptay, MJ; D'amico, TA; Nwogu, C; Demmy, TL; Wang, XF; Gu, L; Litle, VR; Swanson, SJ; Kohman, LJ; Thoracic Surgery Subcommittee of the Cancer and Leukemia Group B,
MLA Citation
Liptay, MJ, D'amico, TA, Nwogu, C, Demmy, TL, Wang, XF, Gu, L, Litle, VR, Swanson, SJ, Kohman, LJ, and Thoracic Surgery Subcommittee of the Cancer and Leukemia Group B, . "Intraoperative sentinel node mapping with technitium-99 in lung cancer: results of CALGB 140203 multicenter phase II trial." J Thorac Oncol 4.2 (February 2009): 198-202.
PMID
19179896
Source
pubmed
Published In
Journal of Thoracic Oncology
Volume
4
Issue
2
Publish Date
2009
Start Page
198
End Page
202
DOI
10.1097/JTO.0b013e318194a2c3

No heroic measures: how soon is too soon to stop?

Authors
D'Amico, TA; Krasna, MJ; Krasna, DM; Sade, RM
MLA Citation
D'Amico, TA, Krasna, MJ, Krasna, DM, and Sade, RM. "No heroic measures: how soon is too soon to stop?." Ann Thorac Surg 87.1 (January 2009): 11-18.
PMID
19101261
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
87
Issue
1
Publish Date
2009
Start Page
11
End Page
18
DOI
10.1016/j.athoracsur.2008.09.075

Reply

Authors
D'Amico, T; Krasna, MJ; Krasna, D; Sade, RM
MLA Citation
D'Amico, T, Krasna, MJ, Krasna, D, and Sade, RM. "Reply." Annals of Thoracic Surgery 88.5 (2009): 1723-1724.
Source
scival
Published In
The Annals of Thoracic Surgery
Volume
88
Issue
5
Publish Date
2009
Start Page
1723
End Page
1724
DOI
10.1016/j.athoracsur.2009.06.111

Detection of occult N2 disease with molecular techniques.

Lymph node involvement is the most important factor affecting the prognosis and treatment of patients with potentially resectable NSCLC. Radiographic imaging is inadequate to ascertain lymph node involvement accurately. Currently, lymph nodes are histologically examined with standard histopathologic techniques, such as H&E staining; however, lymph node micrometastases (occult N2 disease) may be missed, leading to inaccurate staging and suboptimal treatment. More accurate strategies, using molecular biologic techniques, are currently being studied. IHC using antibodies to cytokeratins improves the sensitivity of lymph node assessment. Other techniques, such as RT-PCR, may be superior to IHC, and the detection of various cancer-specific gene transcripts by RT-PCR is being evaluated. Many transcripts with high sensitivity also demonstrate low specificity, either because of their presence in non-neoplastic tissue or (as is the case of CK-19) because of the existence of associated pseudogenes. At the present time, the most promising molecular detector may be KS1/4, which is infrequently present in noncancerous cells but has a high sensitivity in metastatic nodes. Genomic analysis of lymph nodes, which may be used to improve the detection of micrometastases and to improve risk stratification, is currently being studied. Genomic signatures have the potential to guide therapeutic decision making as well.

Authors
Erhunmwunsee, L; D'Amico, TA
MLA Citation
Erhunmwunsee, L, and D'Amico, TA. "Detection of occult N2 disease with molecular techniques." Thorac Surg Clin 18.4 (November 2008): 339-347. (Review)
PMID
19086604
Source
pubmed
Published In
Thoracic Surgery Clinics
Volume
18
Issue
4
Publish Date
2008
Start Page
339
End Page
347
DOI
10.1016/j.thorsurg.2008.07.001

Esophageal cancer.

Authors
Ajani, JA; Barthel, JS; Bekaii-Saab, T; Bentrem, DJ; D'Amico, TA; Fuchs, CS; Gerdes, H; Hayman, JA; Hazard, L; Ilson, DH; Kleinberg, LR; McAleer, MF; Meropol, NJ; Mulcahy, MF; Orringer, MB; Osarogiagbon, RU; Posey, JA; Sasson, AR; Scott, WJ; Shibata, S; Strong, VEM; Swisher, SG; Washington, MK; Willett, C; Wood, DE; Wright, CD; Yang, G; NCCN Esophageal Cancer Panel,
MLA Citation
Ajani, JA, Barthel, JS, Bekaii-Saab, T, Bentrem, DJ, D'Amico, TA, Fuchs, CS, Gerdes, H, Hayman, JA, Hazard, L, Ilson, DH, Kleinberg, LR, McAleer, MF, Meropol, NJ, Mulcahy, MF, Orringer, MB, Osarogiagbon, RU, Posey, JA, Sasson, AR, Scott, WJ, Shibata, S, Strong, VEM, Swisher, SG, Washington, MK, Willett, C, Wood, DE, Wright, CD, Yang, G, and NCCN Esophageal Cancer Panel, . "Esophageal cancer." J Natl Compr Canc Netw 6.9 (October 2008): 818-849.
PMID
18926093
Source
pubmed
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
6
Issue
9
Publish Date
2008
Start Page
818
End Page
849

Quality of life outcomes are equivalent after lobectomy in the elderly.

OBJECTIVE: Prospective analyses of quality of life in elderly patients after lobectomy are limited, yet surgeons often recommend suboptimal therapy to these patients on the basis of the belief that lobectomy is poorly tolerated. Surgical decision making in elderly patients with lung cancer is better informed when the benefits to survival and quality of life after lobectomy are understood. METHODS: By using a validated quality of life instrument, 422 patients were prospectively assessed preoperatively and 3, 6, and 12 months after lobectomy. Outcomes were analyzed with respect to age (group 1: < 70 years and group 2: > or = 70 years). The outcome domains of physical functioning, role functioning, emotional functioning, cognitive functioning, social functioning, global health, and pain in the chest were analyzed using a mixed model. The trend in quality of life was determined according to age. The Kaplan-Meier method was used for analysis of overall survival. RESULTS: The mean age was 60.1 years in group 1 (N = 256) and 74.7 years in group 2 (N = 166). Baseline demographics and quality of life were similar except that group 2 had better emotional functioning scores and worse pain in the chest scores. Postoperatively, both groups demonstrated significant decreases in quality of life at 3 months. However, at 6 and 12 months, all domains had returned to baseline except physical functioning, which remained below baseline in group 2. Emotional functioning improved postoperatively for both groups. Overall survival at 5 years was not different between groups. CONCLUSION: By using a validated quality of life assessment tool with measurements at baseline and serially after resection in a large patient population, this analysis quantifies the degree of impairment of quality of life after lobectomy and documents time to full recovery for both age groups.

Authors
Burfeind, WR; Tong, BC; O'Branski, E; Herndon, JE; Toloza, EM; D'Amico, TA; Harpole, LH; Harpole, DH
MLA Citation
Burfeind, WR, Tong, BC, O'Branski, E, Herndon, JE, Toloza, EM, D'Amico, TA, Harpole, LH, and Harpole, DH. "Quality of life outcomes are equivalent after lobectomy in the elderly." J Thorac Cardiovasc Surg 136.3 (September 2008): 597-604.
PMID
18805257
Source
pubmed
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
136
Issue
3
Publish Date
2008
Start Page
597
End Page
604
DOI
10.1016/j.jtcvs.2008.02.093

Long-term outcomes of thoracoscopic lobectomy.

Thoracoscopic lobectomy is emerging as the procedure of choice for patients with early stage non-small cell lung cancer, based on advantages in quality of life as well as long-term outcomes. In addition, thoracoscopic lobectomy has been demonstrated to be safe and effective for selected patients with locally advanced disease and for those after induction therapy. Concerns relating to oncologic efficacy, as measured by complete resection rate, ability to perform complete mediastinal lymph node dissection, or cancer-specific survival, have not been supported by evidence in the literature. In addition there is increasing evidence that thoracoscopic lobectomy may actually have superior outcomes, based on advantages in morbidity and mortality after resection and in the delivery of adjuvant chemotherapy.

Authors
D'Amico, TA
MLA Citation
D'Amico, TA. "Long-term outcomes of thoracoscopic lobectomy." Thorac Surg Clin 18.3 (August 2008): 259-262. (Review)
PMID
18831500
Source
pubmed
Published In
Thoracic Surgery Clinics
Volume
18
Issue
3
Publish Date
2008
Start Page
259
End Page
262
DOI
10.1016/j.thorsurg.2008.04.002

Thoracoscopic lobectomy for the management of non-small cell lung cancer.

Surgical resection is the primary treatment for early-stage non-small cell lung cancer (NSCLC). While open thoracotomy is the most frequently performed approach for lobectomy, minimally invasive surgical resection is a safe and viable alternative. Thoracoscopic lobectomy, also termed video-assisted thoracoscopic surgery lobectomy, is defined as the anatomic resection of an entire lobe of the lung-including mediastinal lymph node dissection-using a thoracoscope and an access incision without using a mechanical retractor and spreading of the ribs. As the procedure has evolved and been studied, thoracoscopic lobectomy has been demonstrated to be a safe and oncologically effective strategy in the surgical management of patients with stage I or II NSCLC, as well as selected patients with stage III NSCLC after induction therapy. Advantages of this approach include less postoperative pain, shorter chest tube duration and subsequent length of stay, fewer overall complications, better compliance with adjuvant chemotherapy, faster return to full activity, and greater preservation of pulmonary function.

Authors
Balderson, SS; D'Amico, TA
MLA Citation
Balderson, SS, and D'Amico, TA. "Thoracoscopic lobectomy for the management of non-small cell lung cancer." Curr Oncol Rep 10.4 (July 2008): 283-286. (Review)
PMID
18778552
Source
pubmed
Published In
Current Oncology Reports
Volume
10
Issue
4
Publish Date
2008
Start Page
283
End Page
286

Surgery for esophageal cancer.

Management of patients with esophageal cancer requires local therapy (surgery or radiation therapy) and systemic therapy, following evidence-based guidelines and stage-specific approaches. Esophagogastrectomy is associated with considerable morbidity and mortality. Various surgical approaches may be used, depending on the disease stage, tumor location, patient-related factors, and surgeon preference. Careful patient selection and preparation, with strict attention to the management of postoperative complications, particularly pneumonia, will optimize patient outcome. There has been a trend toward increased use of induction chemotherapy or chemoradiotherapy, which may confer a modest survival advantage but at the cost of increased treatment-related mortality, particularly in patients receiving induction chemotherapy and radiotherapy. Biomarkers that can predict outcome and help select therapy for patients with esophageal cancer are needed; several potential markers of treatment resistance/sensitivity in patients receiving trimodality therapy with cisplatin/5-fluorouracil, radiation therapy, and surgery have been identified in studies from our laboratory and others.

Authors
D'Amico, TA
MLA Citation
D'Amico, TA. "Surgery for esophageal cancer." Gastrointest Cancer Res 2.4 Suppl (July 2008): S6-S9.
PMID
19343153
Source
pubmed
Published In
Gastrointestinal Cancer Research
Volume
2
Issue
4 Suppl
Publish Date
2008
Start Page
S6
End Page
S9

Intrathoracic desmoid tumor: brief report and review of literature.

INTRODUCTION: The chest wall is the most common extraabdominal site for desmoid tumors. However, true intrathoracic desmoid tumors are exceedingly rare with most cases actually representing intrathoracic extension of chest wall tumors. A comprehensive review of the literature was undertaken to identify the prevalence and characteristics of true intrathoracic desmoid tumors. METHODS: A case of surgical treatment of a true intrapleural desmoid tumor in a 42-year-old woman is reported. A comprehensive MEDLINE search was performed to identify all previously reported cases of intrathoracic desmoid tumor. RESULTS: Twenty-two reported cases of true intrathoracic desmoid tumor were identified including the case presented in this report. Of these, 12 were intrapleural in origin. Patient age ranged from 5 to 66 years. Average tumor size was 9.2 cm. All patients underwent surgical resection with negative margins in two-thirds. Twenty-five percent of those patients developed local recurrence. CONCLUSIONS: Unlike superficial chest wall desmoid tumors which will create a palpable mass, intrapleural tumors will not cause symptoms until they grow large enough to locally invade chest wall or surrounding structures or compress pulmonary parenchyma. Wide local excision (as is generally recommended for most desmoid tumors) is often impossible because of surrounding vascular and neural structures. Therefore, it may be advisable to consider adjuvant therapy, either radiation directed at known positive margins or antiestrogen therapy.

Authors
Meyerson, SL; D'Amico, TA
MLA Citation
Meyerson, SL, and D'Amico, TA. "Intrathoracic desmoid tumor: brief report and review of literature." J Thorac Oncol 3.6 (June 2008): 656-659.
PMID
18520808
Source
pubmed
Published In
Journal of Thoracic Oncology
Volume
3
Issue
6
Publish Date
2008
Start Page
656
End Page
659
DOI
10.1097/JTO.0b013e3181757aa6

A phase I study of UFT/leucovorin, carboplatin, and paclitaxel in combination with external beam radiation therapy for advanced esophageal carcinoma.

PURPOSE: Concurrent chemotherapy and radiation therapy (RT) are used to treat patients with esophageal cancer. The optimal combination of chemotherapeutic agents with RT is not well established. We evaluated the safety and preliminary efficacy of a combination of UFT/leucovorin, carboplatin, and paclitaxel with RT in a Phase I study of patients with advanced esophageal cancer. METHODS AND MATERIALS: Patients with squamous cell carcinoma or adenocarcinoma of the esophagus initially received UFT/leucovorin, carboplatin, and paclitaxel with RT (1.8 Gy daily to 45 Gy). After completion, the disease was restaged and patients were evaluated for surgery. Primary end points included determination of dose-limiting toxicities (DLTs) and a recommended Phase II dose. Secondary objectives included determination of non-DLTs, as well as preliminary radiographic and pathologic response rates. RESULTS: Twelve patients were enrolled (11 men, 1 woman). All were assessable for toxicity and efficacy. One of 6 patients at Dose Level 1 (UFT/leucovorin, 200/30 mg twice daily on RT days; carboplatin, area under the curve [AUC] 5, Weeks 1 and 4; paclitaxel, 175 mg/m2 Weeks 1 and 4) had a DLT (febrile neutropenia). Of these 6 patients, 4 underwent esophagectomy and none achieved a pathologic complete response. Six patients were then enrolled at Dose Level 2 (UFT/leucovorin, 300/30 mg in the morning and 200/30 mg in the evening on RT days; carboplatin, AUC 5, Weeks 1 and 4; paclitaxel, 175 mg/m2 Weeks 1 and 4). Two of 6 patients at Dose Level 2 developed DLTs (febrile neutropenia in both). Esophagectomy was performed in 3 patients, with 2 achieving a pathologic complete response. CONCLUSIONS: Maximum tolerated doses in this study were UFT/leucovorin, 200/30 mg twice daily on RT days; carboplatin, AUC 5, Weeks 1 and 4; and paclitaxel, 175 mg/m2 Weeks 1 and 4 when delivered with external RT. In this small study, this regimen appears active, but toxic.

Authors
Czito, BG; Cohen, DP; Kelsey, CR; Lockhart, AC; Bendell, JC; Willett, CG; Petros, WP; D'Amico, TA; Truax, R; Hurwitz, HI
MLA Citation
Czito, BG, Cohen, DP, Kelsey, CR, Lockhart, AC, Bendell, JC, Willett, CG, Petros, WP, D'Amico, TA, Truax, R, and Hurwitz, HI. "A phase I study of UFT/leucovorin, carboplatin, and paclitaxel in combination with external beam radiation therapy for advanced esophageal carcinoma." Int J Radiat Oncol Biol Phys 70.4 (March 15, 2008): 1066-1072.
PMID
17881149
Source
pubmed
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
70
Issue
4
Publish Date
2008
Start Page
1066
End Page
1072
DOI
10.1016/j.ijrobp.2007.07.2347

Non-small cell lung cancer.

Authors
Ettinger, DS; Akerley, W; Bepler, G; Chang, A; Cheney, RT; Chirieac, LR; D'Amico, TA; Demmy, TL; Feigenberg, SJ; Figlin, RA; Govindan, R; Grannis, FW; Jahan, T; Jahanzeb, M; Kessinger, A; Komaki, R; Kris, MG; Langer, CJ; Le, Q-T; Martins, R; Otterson, GA; Patel, JD; Robert, F; Sugarbaker, DJ; Wood, DE
MLA Citation
Ettinger, DS, Akerley, W, Bepler, G, Chang, A, Cheney, RT, Chirieac, LR, D'Amico, TA, Demmy, TL, Feigenberg, SJ, Figlin, RA, Govindan, R, Grannis, FW, Jahan, T, Jahanzeb, M, Kessinger, A, Komaki, R, Kris, MG, Langer, CJ, Le, Q-T, Martins, R, Otterson, GA, Patel, JD, Robert, F, Sugarbaker, DJ, and Wood, DE. "Non-small cell lung cancer." J Natl Compr Canc Netw 6.3 (March 2008): 228-269.
PMID
18377844
Source
pubmed
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
6
Issue
3
Publish Date
2008
Start Page
228
End Page
269

Molecular biologic staging of lung cancer.

Clinical and pathologic staging of lung cancer is suboptimal in achieving the goals of assessing prognosis and selecting therapy. Although the technologic developments that allow the generalized use of proteomic and genomic analyses are relatively recent, major progress in understanding the molecular basis of lung cancer has been made. Predicting survival is only the first step in the use of genomics and proteomics. If a reliable gene array or protein profile can be identified that is associated with poor prognosis, these profiles can then be identified and become potential therapeutic targets. It is not difficult to envision the development of a simple serum test that will diagnose a lung cancer perhaps even before it is clinically apparent and at the same time identify the chemotherapeutic agents to which the tumor is sensitive, allowing individually directed treatment. Eventually, a comprehensive staging system should incorporate the prognostic information of biologic variables.

Authors
D'Amico, TA
MLA Citation
D'Amico, TA. "Molecular biologic staging of lung cancer." Ann Thorac Surg 85.2 (February 2008): S737-S742. (Review)
PMID
18222207
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
85
Issue
2
Publish Date
2008
Start Page
S737
End Page
S742
DOI
10.1016/j.athoracsur.2007.11.047

Thoracoscopic segmentectomy: technical considerations and outcomes.

Authors
D'Amico, TA
MLA Citation
D'Amico, TA. "Thoracoscopic segmentectomy: technical considerations and outcomes." Ann Thorac Surg 85.2 (February 2008): S716-S718. (Review)
PMID
18222203
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
85
Issue
2
Publish Date
2008
Start Page
S716
End Page
S718
DOI
10.1016/j.athoracsur.2007.11.050

Positron emission tomography in esophageal cancer.

Authors
D'Amico, TA
MLA Citation
D'Amico, TA. "Positron emission tomography in esophageal cancer." Gastrointest Cancer Res 2.1 (January 2008): 35-36.
PMID
19259320
Source
pubmed
Published In
Gastrointestinal Cancer Research
Volume
2
Issue
1
Publish Date
2008
Start Page
35
End Page
36

Radiofrequency ablation for primary lung cancer and pulmonary metastases.

Lung cancer remains one of the leading causes of death throughout the world. Although surgery is the gold standard treatment for lung cancer, the majority of patients are not resectable at the time of diagnosis. Even among patients who are potentially resectable, many are treated nonoperatively because of inadequate pulmonary reserve or advanced comorbidities. Despite aggressive multiple-drug regimens and the addition of radiation treatment, survival remains poor without surgery, and recurrence is the rule regardless of the initial treatment. Radiofrequency ablation can be performed via a percutaneous approach under conscious sedation, and side effects are generally mild and self limited, primarily consisting of pneumothorax. Radiofrequency ablation can be applied to primary pulmonary malignancies and metastatic lesions and is reported to achieve excellent local control in limited clinical series. Human and animal studies supporting the use of radiofrequency ablation for pulmonary malignancy are reviewed, and the current application of radiofrequency ablation and its limitations are described herein.

Authors
White, DC; D'Amico, TA
MLA Citation
White, DC, and D'Amico, TA. "Radiofrequency ablation for primary lung cancer and pulmonary metastases." Clin Lung Cancer 9.1 (January 2008): 16-23. (Review)
PMID
18282353
Source
pubmed
Published In
Clinical lung cancer
Volume
9
Issue
1
Publish Date
2008
Start Page
16
End Page
23
DOI
10.3816/CLC.2008.n.003

Review and recent development of angle-resolved low-coherence interferometry for detection of precancerous cells in human esophageal epithelium

The combination of low-coherence interferometry with angle-resolved light scattering measurements has been shown to be a powerful method for determining the structure of cell nuclei within intact tissue samples. The nuclear morphology data have been used as a biomarker of neoplastic change in a wide range of settings. Here, we review the development of angle-resolved lowcoherence interferometry (a/LCI) for assessing the health status of human esophageal epithelial tissues based on depth-resolved measurements of the morphology of cell nuclei. The design and implementation of clinical instrumentation are reviewed, and results from ex vivo human tissue measurements are presented to validate the capabilities of the technique. In addition to the review of earlier papers, new results are presented, which demonstrate the first application of a portable a/LCI system with a flexible endoscopic probe to assessing depth-resolved nuclear morphology in a clinical setting. High sensitivity for the detection of precancerous tissues is demonstrated. © 2008 IEEE.

Authors
Brown, WJ; Pyhtila, JW; Terry, NG; Chalut, KJ; D'Amico, TA; Sporn, TA; Obando, JV; Wax, A
MLA Citation
Brown, WJ, Pyhtila, JW, Terry, NG, Chalut, KJ, D'Amico, TA, Sporn, TA, Obando, JV, and Wax, A. "Review and recent development of angle-resolved low-coherence interferometry for detection of precancerous cells in human esophageal epithelium." IEEE Journal on Selected Topics in Quantum Electronics 14.1 (2008): 88-96.
Source
scival
Published In
IEEE Journal of Selected Topics in Quantum Electronics
Volume
14
Issue
1
Publish Date
2008
Start Page
88
End Page
96
DOI
10.1109/JSTQE.2007.913969

Technique of Thoracoscopic Segmentectomy

Authors
Pham, D; Balderson, S; D'Amico, TA
MLA Citation
Pham, D, Balderson, S, and D'Amico, TA. "Technique of Thoracoscopic Segmentectomy." Operative Techniques in Thoracic and Cardiovascular Surgery 13.3 (2008): 188-203.
Source
scival
Published In
Operative Techniques in Thoracic and Cardiovascular Surgery
Volume
13
Issue
3
Publish Date
2008
Start Page
188
End Page
203
DOI
10.1053/j.optechstcvs.2008.10.002

Adult tracheoesophageal fistula: A multidisciplinary approach

Fistulization between the respiratory and gastrointestinal tracts is an uncommon problem that results from a spectrum of disease processes. Tracheoesophageal fistula (TEF) formation can be either acquired or congenital; the congenital variety is a rare problem of early infancy and will not be discussed in this review article. Acquired TEFs usually result from malignancy, with the primary tumor location being the esophagus, but many nonmalignant entities can also result in TEF formation. The timely diagnosis of TEF is of vital importance to avoid serious complications such as malnutrition, chronic pulmonary infection, and ultimately overwhelming sepsis and death. In this article, we review the approach to TEFs in regards to etiology, fistula anatomy, diagnosis, and management. We place particular emphasis on a multimodality approach to this complex entity while highlighting important recent medical and surgical developments. © 2008 Lippincott Williams & Wilkins, Inc.

Authors
Singh, J; Olcese, VA; D'Amico, TA; Wahidi, MM
MLA Citation
Singh, J, Olcese, VA, D'Amico, TA, and Wahidi, MM. "Adult tracheoesophageal fistula: A multidisciplinary approach." Clinical Pulmonary Medicine 15.3 (2008): 145-152.
Source
scival
Published In
Clinical Pulmonary Medicine
Volume
15
Issue
3
Publish Date
2008
Start Page
145
End Page
152
DOI
10.1097/CPM.0b013e3181728336

Induction therapy for clinical stage i lung cancer

Non-small cell lung cancer (NSCLC) remains a leading cause of death and will cause approximately 163,500 deaths in the United States in 2005. While patients presenting with localized disease have the best chance of being cured, they represent a minority of patients and unfortunately have a significant likelihood of developing recurrent disease after treatment and ultimately dying of their disease. The 5-year survival for patients presenting with clinical stage I lung cancer ranges from 38% to 61%; for those with pathological stage IA disease, the survival is 67%. © 2007 Springer-Verlag London Limited.

Authors
White, DC; D'Amico, TA
MLA Citation
White, DC, and D'Amico, TA. "Induction therapy for clinical stage i lung cancer." Difficult Decisions in Thoracic Surgery: An Evidence-Based Approach. December 1, 2007. 82-87.
Source
scopus
Publish Date
2007
Start Page
82
End Page
87
DOI
10.1007/978-1-84628-474-8_9

Video-assisted thoracic surgery lobectomy: report of CALGB 39802--a prospective, multi-institution feasibility study.

PURPOSE: To evaluate the technical feasibility and safety of video-assisted thoracic surgery (VATS) lobectomy for small lung cancers. PATIENTS AND METHODS: The Cancer and Leukemia Group B 39802 trial was a prospective, multi-institutional study designed to elucidate the technical feasibility of VATS in early non-small-cell lung cancer (NSCLC) using a standard definition for VATS lobectomy (one 4- to 8-cm access and two 0.5-cm port incisions) that mandated videoscopic guidance and a traditional hilar dissection without rib spreading. Between 1998 and 2001, 128 patients with peripheral lung nodules < or = 3 cm in size with suspected NSCLC were prospectively registered for VATS lobectomy. RESULTS: One hundred twenty-seven patients (66 males and 61 females; median age, 66 years; range, 37 to 86 years), with a performance status of 0 (74%) or 1 (26%), underwent surgery. Patients with lymph nodes more than 1 cm by computed tomography scan underwent mediastinal lymph node sampling to rule out N2 disease. One hundred eleven patients (87%) had stage I lung cancer, and 96 (86.5%) of these 111 patients underwent successful VATS lobectomies. The median procedure length was 130 minutes (range, 47 to 428 minutes), and median chest tube duration was 3 days (range, 1 to 14 days). Fifty-eight (60%) of 97 patients underwent diagnostic biopsy at lobectomy. Within 30 days, three (2.7%) of 111 patient deaths occurred, none of which were directly related to VATS technique; seven (7.4%) of 95 patients had grade 3 or greater complications, with only one case of bleeding. CONCLUSION: A standardized approach to VATS lobectomy as specifically defined with avoidance of rib spreading is feasible.

Authors
Swanson, SJ; Herndon, JE; D'Amico, TA; Demmy, TL; McKenna, RJ; Green, MR; Sugarbaker, DJ
MLA Citation
Swanson, SJ, Herndon, JE, D'Amico, TA, Demmy, TL, McKenna, RJ, Green, MR, and Sugarbaker, DJ. "Video-assisted thoracic surgery lobectomy: report of CALGB 39802--a prospective, multi-institution feasibility study." J Clin Oncol 25.31 (November 1, 2007): 4993-4997.
PMID
17971599
Source
pubmed
Published In
Journal of Clinical Oncology
Volume
25
Issue
31
Publish Date
2007
Start Page
4993
End Page
4997
DOI
10.1200/JCO.2007.12.6649

Paclitaxel-based chemoradiotherapy in the treatment of patients with operable esophageal cancer.

PURPOSE: To compare a neoadjuvant regimen of cisplatin/5-fluorouracil (5-FU) and concurrent radiation therapy (RT) with paclitaxel-based regimens and RT in the management of operable esophageal (EC)/gastroesophageal junction (GEJ) cancer. METHODS AND MATERIALS: All patients receiving neoadjuvant chemotherapy (CT) and RT for EC/GEJ cancer at Duke University between January 1995 and December 2004 were included. Clinical end points were compared for patients receiving paclitaxel-based regimens (TAX) vs. alternative regimens (non-TAX). Local control (LC), disease-free survival (DFS), and overall survival (OS) were estimated using the Kaplan-Meier method. Chi-square analysis was performed to test the effect of TAX on pathologic complete response (pCR) rates and toxicity. RESULTS: A total of 109 patients received CT-RT followed by esophagectomy (95 M; 14 F). Median RT dose was 45 Gy (range, 36-66 Gy). The TAX and non-TAX groups comprised 47% and 53% of patients, respectively. Most (83%) TAX patients received three drug regimens including platinum and a fluoropyrimidine. In the non-TAX group, 89% of the patients received cisplatin and 5-FU. The remainder received 5-FU or capecitabine alone. Grade 3-4 toxicity occurred in 41% of patients receiving TAX vs. 24% of those receiving non-TAX (p = 0.19). Overall pCR rate was 39% (39% with TAX vs. 40% with non-TAX, p = 0.9). Overall LC, DFS, and OS at 3 years were 80%, 34%, and 37%, respectively. At 3 years, there were no differences in LC (75% vs. 85%, p = 0.33) or OS (37% vs. 37%, p = 0.32) between TAX and non-TAX groups. CONCLUSIONS: In this large experience, paclitaxel-containing regimens did not improve pCR rates or clinical end points compared to non-paclitaxel-containing regimens.

Authors
Kelsey, CR; Chino, JP; Willett, CG; Clough, RW; Hurwitz, HI; Morse, MA; Bendell, JC; D'Amico, TA; Czito, BG
MLA Citation
Kelsey, CR, Chino, JP, Willett, CG, Clough, RW, Hurwitz, HI, Morse, MA, Bendell, JC, D'Amico, TA, and Czito, BG. "Paclitaxel-based chemoradiotherapy in the treatment of patients with operable esophageal cancer." Int J Radiat Oncol Biol Phys 69.3 (November 1, 2007): 770-776.
PMID
17889266
Source
pubmed
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
69
Issue
3
Publish Date
2007
Start Page
770
End Page
776
DOI
10.1016/j.ijrobp.2007.03.035

Pulmonary segmentectomy by thoracotomy or thoracoscopy: reduced hospital length of stay with a minimally-invasive approach.

BACKGROUND: Previous studies have discouraged limited pulmonary resection for primary lung cancer, but pulmonary segmentectomy has advantages for some patients. Furthermore, while thoracoscopic lobectomy has been increasingly applied with well-demonstrated advantages compared with thoracotomy, few data exist regarding thoracoscopic approaches to pulmonary segmentectomy. This study compares thoracoscopic segmentectomy (TS) with open segmentectomy (OS). METHODS: This is a retrospective review of prospectively collected data for 77 consecutive segmentectomy patients treated between 2000 and 2006 at a single center. Preoperative, intraoperative, and postoperative variables for patients undergoing TS (n = 48) were compared with those undergoing OS (n = 29). Student's t tests were used for continuous data and Fisher's exact tests for dichotomous data. RESULTS: Baseline demographics were similar between groups. Indications for pulmonary resection included non-small cell lung cancer (n = 39), metastatic disease (n = 30), and other diagnoses (n = 8). All common segmentectomies were represented. No thoracoscopic cases required conversion to open procedures. Operative times, estimated blood loss, and chest tube duration were similar between groups. Outcomes were similar except that hospital length of stay was significantly less among TS patients (length of stay 6.8 +/- 6 days OS versus 4.3 +/- 3 days TS; p = 0.03). Thirty-day mortality was 6.9% (2 of 29) for the OS group compared with 0% for the TS group. Long-term survival rates were significantly better in the TS group (p = 0.0007). CONCLUSIONS: Thoracoscopic segmentectomy is a safe and feasible procedure, comparing favorably with OS by reducing hospital length of stay. For experienced thoracoscopic surgeons, TS appears to be a sound option for lung-sparing, anatomic pulmonary resections.

Authors
Atkins, BZ; Harpole, DH; Mangum, JH; Toloza, EM; D'Amico, TA; Burfeind, WR
MLA Citation
Atkins, BZ, Harpole, DH, Mangum, JH, Toloza, EM, D'Amico, TA, and Burfeind, WR. "Pulmonary segmentectomy by thoracotomy or thoracoscopy: reduced hospital length of stay with a minimally-invasive approach." Ann Thorac Surg 84.4 (October 2007): 1107-1112.
PMID
17888955
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
84
Issue
4
Publish Date
2007
Start Page
1107
End Page
1112
DOI
10.1016/j.athoracsur.2007.05.013

Outcomes after surgery for esophageal cancer.

Esophageal cancer is a virulent malignancy associated with a 5-year overall survival of approximately 5%. Treatment remains controversial-despite the results of prospective, randomized trials of combined-modality therapy-because results are poor with all strategies. The role of surgical resection in patients with esophageal cancer is controversial. The fact that most patients have advanced disease at the time of diagnosis makes surgery futile in the majority of cases. Nevertheless, surgery is the best option for cure in early-stage esophageal cancer and remains the superior modality for local control in locally advanced disease. The benefits and drawbacks of several surgical approaches are discussed in this review. Multiple factors are implicated in the etiology of postesophagectomy complications, the rate of which is quite high. Perhaps the most important contributor to morbidity and mortality after esophagectomy is the development of pulmonary complications. Over the past decade, there has been a trend toward the increased use of trimodality therapy in potentially operable patients-induction chemotherapy and radiation therapy, followed by surgery. The rationale for using induction therapy is that it allows simultaneous delivery of local (radiation therapy) and systemic (chemotherapy) modalities, provides for early tumor regression and symptom control, results in improved subsequent local control, and identifies responding patients who might benefit from adjuvant therapy. Thus, on the basis of recent studies and meta-analyses, there may be a modest survival advantage for patients who receive induction chemotherapy followed by surgery, compared with surgery alone. There is also an apparent increase in treatment-related mortality, mainly for patients receiving induction chemotherapy and radiotherapy. Currently, National Comprehensive Cancer Network guidelines support the use of induction therapy only in established clinical trial protocols.

Authors
D'Amico, TA
MLA Citation
D'Amico, TA. "Outcomes after surgery for esophageal cancer." Gastrointest Cancer Res 1.5 (September 2007): 188-196.
PMID
19262708
Source
pubmed
Published In
Gastrointestinal Cancer Research
Volume
1
Issue
5
Publish Date
2007
Start Page
188
End Page
196

Thoracoscopic lobectomy facilitates the delivery of chemotherapy after resection for lung cancer.

BACKGROUND: We conducted a study of patients who underwent anatomic resection with adjuvant chemotherapy to determine if thoracoscopic lobectomy enables more effective administration of adjuvant chemotherapy than lobectomy by thoracotomy. METHODS: We reviewed the outcomes of 100 consecutive patients with non-small cell lung cancer (NSCLC) who underwent lobectomy and received adjuvant chemotherapy (1999 to 2004). The variables analyzed were time to initiation of chemotherapy, percentage of planned regimen received, number of delayed or reduced chemotherapy doses, toxicity grade, length of hospitalization, chest tube duration, 30-day mortality, and major complications (pneumonia, respiratory failure, atrial fibrillation). The chi2 test and Student t test were used to compare dichotomous and continuous variables, respectively. RESULTS: Complete resection was performed by thoracotomy in 43 patients and by thoracoscopy in 57 (no conversions). All patients received adjuvant chemotherapy, and 20 (20%) received adjuvant radiation therapy: 13 (30%) of 43 in the thoracotomy group and 7 (12%) of 57 in the thoracoscopy group (p = 0.04). Patients undergoing thoracoscopic lobectomy had significantly fewer delayed (18% versus 58%, p < 0.001) and reduced (26% versus 49%, p = 0.02) chemotherapy doses. A higher percentage of patients undergoing thoracoscopic resection received 75% or more of their planned adjuvant regimen without delayed or reduced doses (61% versus 40%, p = 0.03). There were no significant differences in time to initiation of chemotherapy or toxicity. Patients undergoing a thoracoscopic lobectomy had a shorter median length of hospitalization (4 days versus 5 days, p = 0.02). CONCLUSIONS: Thoracoscopy was associated with an overall higher compliance rate and fewer delayed or reduced doses of chemotherapy in patients receiving adjuvant chemotherapy.

Authors
Petersen, RP; Pham, D; Burfeind, WR; Hanish, SI; Toloza, EM; Harpole, DH; D'Amico, TA
MLA Citation
Petersen, RP, Pham, D, Burfeind, WR, Hanish, SI, Toloza, EM, Harpole, DH, and D'Amico, TA. "Thoracoscopic lobectomy facilitates the delivery of chemotherapy after resection for lung cancer." Ann Thorac Surg 83.4 (April 2007): 1245-1249.
PMID
17383320
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
83
Issue
4
Publish Date
2007
Start Page
1245
End Page
1249
DOI
10.1016/j.athoracsur.2006.12.029

A Phase I study of capecitabine, carboplatin, and paclitaxel with external beam radiation therapy for esophageal carcinoma.

PURPOSE: Concurrent chemotherapy and radiation therapy (RT) are used to treat patients with esophageal cancer. The optimal combination of chemotherapeutic agents with RT is undefined. We evaluated a combination of capecitabine, carboplatin, and paclitaxel with RT in a phase I study. METHODS AND MATERIALS: Patients with squamous cell carcinoma or adenocarcinoma of the esophagus initially received capecitabine, carboplatin, and paclitaxel with RT (1.8 Gy daily to 50.4 Gy). After completion, patients were restaged and evaluated for surgery. Primary endpoints included determination of dose-limiting toxicities (DLT) and a recommended phase II dose, non-DLT, and preliminary radiographic and pathologic response rates. RESULTS: Thirteen patients were enrolled (10 men, 3 women). All were evaluable for toxicity and efficacy. Two of 3 patients at dose level 1 (capecitabine 825 mg/m(2) twice daily on RT days, carboplatin area under the curve (AUC) 2 weekly, paclitaxel 60 mg/m(2) weekly) had DLT (both Grade 4 esophagitis). Of these 3, 2 underwent esophagectomy and had pathologic complete response (pCR). Ten patients were then enrolled at dose level -1 (capecitabine 600 mg/m(2) twice daily, carboplatin AUC 1.5, paclitaxel 45 mg/m(2)). Overall, 3 of 10 patients at dose level -1 developed DLT (2 Grade 3 esophagitis, 1 Grade 3 hypotension). Esophagectomy was performed in 6 of 10 patients. All patients had pathologic downstaging and 2 of 6 had pCR. CONCLUSIONS: The maximally tolerated/recommended phase II doses were capecitabine 600 mg/m(2) twice daily, carboplatin AUC 1.5 weekly, and paclitaxel 45 mg/m(2) weekly with RT to 50.4 Gy. In our small study, this regimen appears active but is accompanied by significant toxicities, primarily esophagitis.

Authors
Czito, BG; Kelsey, CR; Hurwitz, HI; Willett, CG; Morse, MA; Blobe, GC; Fernando, NH; D'Amico, TA; Harpole, DH; Honeycutt, W; Yu, D; Bendell, JC
MLA Citation
Czito, BG, Kelsey, CR, Hurwitz, HI, Willett, CG, Morse, MA, Blobe, GC, Fernando, NH, D'Amico, TA, Harpole, DH, Honeycutt, W, Yu, D, and Bendell, JC. "A Phase I study of capecitabine, carboplatin, and paclitaxel with external beam radiation therapy for esophageal carcinoma." Int J Radiat Oncol Biol Phys 67.4 (March 15, 2007): 1002-1007.
PMID
17197129
Source
pubmed
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
67
Issue
4
Publish Date
2007
Start Page
1002
End Page
1007
DOI
10.1016/j.ijrobp.2006.10.027

Improved survival with pulmonary metastasectomy: an analysis of 1720 patients with pulmonary metastatic melanoma.

OBJECTIVES: The outcomes of patients with metastatic melanoma are poor. Although prognostic models have been developed to predict the occurrence of pulmonary metastasis from cutaneous melanoma, few data exist to define the outcomes of these patients once metastasis has occurred. The objective of this study was to discriminate predictors of survival for patients with pulmonary metastatic melanoma. METHODS: We found 1720 patients with pulmonary metastasis listed in a prospective comprehensive cancer center database of 14,057 consecutive patients with melanoma (Jan 1, 1970-June 1, 2004). Demographic and histopathologic data, time and location of recurrences, number of pulmonary nodules, and subsequent therapies were collected. Univariate and multivariate Cox proportional hazards models were used to identify predictors of survival for patients with pulmonary metastatic melanoma. RESULTS: The median survival was 7.3 months after development of pulmonary metastasis. Significant predictors of survival from the multivariate model included nodular histologic type (P = .033), disease-free interval (P < .001), number of pulmonary metastases (P = .012), presence of extrathoracic metastasis (P < .001), and performance of pulmonary metastasectomy (P < .001). Interactions were identified between metastasectomy and disease-free interval and presence of extrathoracic metastasis. Surgery was associated with a survival advantage of 12 months for patients with a disease-free interval longer than 5 years (19 vs 7 months, P < .01) and of 10 months for patients without extrathoracic metastasis (18 vs 8 months, P < .01). CONCLUSIONS: When all other identified risk factors were controlled for mathematically, metastasectomy maintained a significant survival advantage for patients with pulmonary metastatic melanoma. These data support the role of surgery for a select subset of patients with pulmonary metastasis.

Authors
Petersen, RP; Hanish, SI; Haney, JC; Miller, CC; Burfeind, WR; Tyler, DS; Seigler, HF; Wolfe, W; D'Amico, TA; Harpole, DH
MLA Citation
Petersen, RP, Hanish, SI, Haney, JC, Miller, CC, Burfeind, WR, Tyler, DS, Seigler, HF, Wolfe, W, D'Amico, TA, and Harpole, DH. "Improved survival with pulmonary metastasectomy: an analysis of 1720 patients with pulmonary metastatic melanoma." J Thorac Cardiovasc Surg 133.1 (January 2007): 104-110.
PMID
17198792
Source
pubmed
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
133
Issue
1
Publish Date
2007
Start Page
104
End Page
110
DOI
10.1016/j.jtcvs.2006.08.065

In situ detection of nuclear atypia in Barrett's esophagus by using angle-resolved low-coherence interferometry

Background: Monitoring of patients with Barrett's esophagus (BE) for dysplasia, currently done by systematic biopsy, can be improved through increasing the proportion of at-risk tissue examined. Objective: Optical biopsy techniques, which do not remove the tissue but interrogate the tissue with light, offer a potential method to improve the monitoring of BE. Frequency-domain angle resolved low-coherence interferometry (fa/LCI) is an optical spectroscopic technique applied through an endoscopic fiber bundle and measures the depth-resolved nuclear morphology of tissue, a key biomarker for identifying dysplasia. The aim of the study was to assess the diagnostic capability of fa/LCI for differentiating healthy and dysplastic tissue in patients with BE. Methods: Depth-resolved angular scattering data are acquired by using fa/LCI from tissue excised from 3 patients who had esophagogastrectomy. The data are processed to determine the average nuclear size and density as a function of depth beneath the tissue surface. These data are compared with the pathologic classification of the tissue. Main Outcome Measurements: Average of depth-resolved nuclear diameter and nuclear density measurements in tissue samples. Results: Upon comparison to pathologic diagnosis, the fa/LCI data results report the nuclear atypia characteristic of dysplasia in the epithelial tissue. Examination of the average nuclear morphology over the superficial 150 μm results in complete separation between healthy columnar and BE dysplastic tissues. Limitations: Lack of in vivo data; lack of nondysplastic BE data because of limited sample size. Conclusions: In complicated tissue structures, such as BE, depth-resolved nuclear morphology measurements provided an excellent means to identify dysplasia. The preliminary results demonstrate the great potential for the in vivo application of fa/LCI as a targeting mechanism for physical biopsy in patients with BE. © 2007 American Society for Gastrointestinal Endoscopy.

Authors
Pyhtila, JW; Chalut, KJ; Boyer, JD; Keener, J; D'Amico, T; Gottfried, M; Gress, F; Wax, A
MLA Citation
Pyhtila, JW, Chalut, KJ, Boyer, JD, Keener, J, D'Amico, T, Gottfried, M, Gress, F, and Wax, A. "In situ detection of nuclear atypia in Barrett's esophagus by using angle-resolved low-coherence interferometry." Gastrointestinal Endoscopy 65.3 (2007): 487-491.
PMID
17321252
Source
scival
Published In
Gastrointestinal Endoscopy
Volume
65
Issue
3
Publish Date
2007
Start Page
487
End Page
491
DOI
10.1016/j.gie.2006.10.016

Complications of thoracoscopic pulmonary resection.

Thoracoscopic strategies are becoming increasingly utilized in the management of patients with thoracic disease processes, including primary pulmonary malignancy, secondary pulmonary malignancy, granulomatous lung disease, and pleural processes. Although minimally invasive approaches have been demonstrated to improve outcomes and reduce complications, as compared to the conventional approach, the prevention, early recognition, and effective management of complications after thoracoscopic pulmonary resection are still critical factors in optimizing outcomes.

Authors
Berry, MF; D'Amico, TA
MLA Citation
Berry, MF, and D'Amico, TA. "Complications of thoracoscopic pulmonary resection." Semin Thorac Cardiovasc Surg 19.4 (2007): 350-354. (Review)
PMID
18395637
Source
pubmed
Published In
Seminars in Thoracic and Cardiovascular Surgery
Volume
19
Issue
4
Publish Date
2007
Start Page
350
End Page
354
DOI
10.1053/j.semtcvs.2007.10.001

Thoracoscopic lobectomy

The surgical approach in the management of patients with lung cancer is evolving. Conventional surgical approaches utilizing thoracotomy remain the standard for the majority of patients with resectable lung cancer. Minimally invasive procedures, however, may be employed in selected patients with early-stage lung cancer, in order to minimize operative morbidity without sacrificing oncologic efficacy. Copyright © 2007 JMS.

Authors
D'Amico, TA
MLA Citation
D'Amico, TA. "Thoracoscopic lobectomy." Journal of Medical Sciences 27.3 (2007): 95-100.
Source
scival
Published In
Journal of Medical Sciences
Volume
27
Issue
3
Publish Date
2007
Start Page
95
End Page
100

Molecular biologic staging and selection of therapy for non-small cell lung cancer

The optimal staging system achieves accurate assessment of extent of disease, effective prognostic stratification, and selection of appropriate therapy. The staging system for non-small cell lung cancer (NSCLC) provides a framework for the assessment of prognosis and the assignment of therapy for all patients with a new diagnosis of lung cancer, the most common cause of death by malignancy1. The most recent revision of the lung cancer staging system, which considers the size and location of the primary tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastases (M), is based on the analysis of a collected database representing all clinical, surgical-pathologic, and follow-up information for 5,319 patients treated for primary lung cancer2. Similar results have been reported among a population of 6,670 patients treated in Japan3. The power of these large databases in predicting prognosis is self-evident. Nevertheless, there is an inherent inaccuracy of this staging process. According to the TNM system, the predicted 5-year survival after complete resection for T1N0M0 NSCLC (stage IA) is only 67%2. Therefore, 33% of patients with stage IA NSCLC are incorrectly staged at presentation. Even with optimal therapy, these patients will succumb to their disease, predominately from the development of metastatic disease not detected at the time of diagnosis and initial therapy, despite the use of standard staging procedures4. Similarly, a significant fraction of all patients with Stage Ib or II disease are incorrectly staged, resulting in inaccurate assessment of extent of disease, prognostic stratification, and selection of therapy. Currently, adjuvant chemotherapy has been established as beneficial for selected patients with after complete resection5-7; however, the majority of patients will not benefit, from its administration: substantial fractions will die despite chemotherapy or would have survived even without chemotherapy. Molecular biologic staging refers to the assessment tumor markers associated with various oncogenic mechanisms in order to improve the risk stratification provided by conventional TNM staging. Biologic staging may target oncogenes, oncogenic protein products, growth factors, or receptors. The biologic techniques utilized include analysis of DNA, RNA, or protein products. Molecular biologic staging may potentially be applied to the primary tumor, lymph nodes, bone marrow, or serum, in order to establish the diagnosis of malignancy at earlier stage, to assess prognosis, to detect occult metastases, to select therapy, and to predict chemotherapy sensitivity or resistance. The purpose of the assessment of prognostic markers in the primary tumor is to identify patients, or groups of patients, with early stage disease, whose risk of recurrence is sufficiently high enough to justify adjuvant therapy. In addition, the assessment of the primary tumor may also enable more accurate selection of adjuvant therapy, either cytotoxic chemotherapy or targeted therapy. Assessment of lymph nodes may allow identification of micrometastatic disease: occult metastases not identified on routine pathologic examination. Correct assessment of micrometastatic lymph node involvement improves assessment of extent of disease, prognostic stratification, and choice of adjuvant therapy8. Assessment of bone marrow and serum may identify evidence of occult distant metastatic disease (Stage IV). Identification of these patients would prevent unnecessary surgical resection and allow patients to receive systemic therapy sooner. Copyright © 2007 JMS.

Authors
D'Amico, TA
MLA Citation
D'Amico, TA. "Molecular biologic staging and selection of therapy for non-small cell lung cancer." Journal of Medical Sciences 27.1 (2007): 1-7.
Source
scival
Published In
Journal of Medical Sciences
Volume
27
Issue
1
Publish Date
2007
Start Page
1
End Page
7

Invited commentary

Authors
D'Amico, T
MLA Citation
D'Amico, T. "Invited commentary." Annals of Thoracic Surgery 83.1 (2007): 221-222.
PMID
17184667
Source
scival
Published In
The Annals of Thoracic Surgery
Volume
83
Issue
1
Publish Date
2007
Start Page
221
End Page
222
DOI
10.1016/j.athoracsur.2006.10.025

Stage and treatment migration in patients with stage III non-small cell lung cancer

Authors
Hubbs, JL; Fatunase, T; Hollis, DR; Clough, RW; Kelsey, CR; D'Amico, TA; Marks, LB
MLA Citation
Hubbs, JL, Fatunase, T, Hollis, DR, Clough, RW, Kelsey, CR, D'Amico, TA, and Marks, LB. "Stage and treatment migration in patients with stage III non-small cell lung cancer." 2007.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
69
Issue
3
Publish Date
2007
Start Page
S159
End Page
S160
DOI
10.1016/j.ijrobp.2007.07.288

Molecular and genetic markers in thoracic surgery.

Authors
Petersen, RP; D'Amico, TA
MLA Citation
Petersen, RP, and D'Amico, TA. "Molecular and genetic markers in thoracic surgery." Ann Thorac Surg 82.6 (December 2006): 2335-2336.
PMID
17131544
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
82
Issue
6
Publish Date
2006
Start Page
2335
End Page
2336

Molecular biologic staging of esophageal cancer.

The molecular biology of esophageal cancer is characterized by a series of genetic mutations that occur throughout the progression from normal squamous epithelium to carcinoma. The most important risk factor for the development of adenocarcinoma, which is increasing in incidence, is the presence of CLE. The pathophysiology of CLE appears to be related to duodenogastroesophageal reflux, also increasing in incidence. The genetic mutations that are responsible for tumorigenesis have been described, although the precise sequence of mutations is variable. Analysis of molecular biologic factors that are important in tumorigenesis may be used in clinical applications: establishing diagnosis, assessing prognosis, and assigning therapy. The development of molecular biologic substaging of patients with CLE may potentially identify patients with elevated malignant potential and expedite therapy. The ability of molecular markers to predict resistance to chemotherapy and radiation therapy represents an important potential advantage, with two possible applications. Predictable resistance to a particular chemotherapeutic agent would allow the selection of a alternative agent, with a greater potential for efficacy. Furthermore, known mechanisms of resistance, which have been analyzed using molecular markers, may be inhibited or reversed. The molecular biology of esophageal cancer requires further study. The molecular events and factors that are involved may be important in the diagnosis, staging, and treatment of esophageal cancer, in addition to the description of tumorigenesis.

Authors
D'Amico, TA
MLA Citation
D'Amico, TA. "Molecular biologic staging of esophageal cancer." Thorac Surg Clin 16.4 (November 2006): 317-327. (Review)
PMID
17240819
Source
pubmed
Published In
Thoracic Surgery Clinics
Volume
16
Issue
4
Publish Date
2006
Start Page
317
End Page
327
DOI
10.1016/j.thorsurg.2006.09.001

Suitability of the lumbar test dose for the thoracic epidural space.

Authors
Homi, HM; Sulzer, C; Lappas, G; D'Amico, T; Stafford-Smith, M
MLA Citation
Homi, HM, Sulzer, C, Lappas, G, D'Amico, T, and Stafford-Smith, M. "Suitability of the lumbar test dose for the thoracic epidural space." J Cardiothorac Vasc Anesth 20.5 (October 2006): 700-703.
PMID
17023292
Source
pubmed
Published In
Journal of Cardiothoracic and Vascular Anesthesia
Volume
20
Issue
5
Publish Date
2006
Start Page
700
End Page
703
DOI
10.1053/j.jvca.2006.01.027

Nine-year single center experience with cervical mediastinoscopy: complications and false negative rate.

BACKGROUND: Mediastinoscopy is a valuable tool for evaluating mediastinal pathology and is essential for establishing treatment strategies in most patients with lung cancer. We sought to determine the complication and false negative rate for mediastinoscopy in an institution that routinely performs this procedure. METHODS: We performed a retrospective review of 2,145 consecutive mediastinoscopies at a single institution between April 1996 and April 2005. Demographics and complications were analyzed. In patients with lung cancer who underwent subsequent resection, the false negative rate was calculated. RESULTS: Mean patient age was 61 +/- 0.4 years, and 58% (n = 1,253) were male. Pathology included lung cancer (n = 1,459), metastatic disease (n = 78), lymphoma (n = 51), and other benign disease (n = 557). Twenty-three patients (1.07%) experienced complications including hemorrhage (n = 7, 0.33%), vocal cord dysfunction (n = 12, 0.55%), tracheal injury (n = 2, 0.09%), and pneumothorax (n = 2, 0.09%). There was 1 death (0.05%) after pulmonary artery injury. Five of the 7 vascular injuries occurred during biopsy of level 4R. Three hundred and forty-three patients (23.5%) with lung cancer had positive mediastinoscopies. The false negative rate was 56 of 1,019 (5.5%) among lung cancer patients undergoing resection. Thirty-two (57%) of the false negatives were due to metastatic disease in lymph nodes not normally biopsied during cervical mediastinoscopy (levels 5, 6, 8, or 9). CONCLUSIONS: Although invasive, mediastinoscopy identified locally advanced disease in a significant percentage of this lung cancer population and was associated with a low false negative rate. Complications after mediastinoscopy were uncommon. These results support the continued routine use of mediastinoscopy.

Authors
Lemaire, A; Nikolic, I; Petersen, T; Haney, JC; Toloza, EM; Harpole, DH; D'Amico, TA; Burfeind, WR
MLA Citation
Lemaire, A, Nikolic, I, Petersen, T, Haney, JC, Toloza, EM, Harpole, DH, D'Amico, TA, and Burfeind, WR. "Nine-year single center experience with cervical mediastinoscopy: complications and false negative rate." Ann Thorac Surg 82.4 (October 2006): 1185-1189.
PMID
16996905
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
82
Issue
4
Publish Date
2006
Start Page
1185
End Page
1189
DOI
10.1016/j.athoracsur.2006.05.023

Thoracoscopic lobectomy: evolving and improving.

Authors
D'Amico, TA
MLA Citation
D'Amico, TA. "Thoracoscopic lobectomy: evolving and improving." J Thorac Cardiovasc Surg 132.3 (September 2006): 464-465.
PMID
16935095
Source
pubmed
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
132
Issue
3
Publish Date
2006
Start Page
464
End Page
465
DOI
10.1016/j.jtcvs.2006.04.026

Thoracoscopic lobectomy is a safe and versatile procedure: experience with 500 consecutive patients.

OBJECTIVE: Advantages of thoracoscopic lobectomy for early stage non-small cell lung cancer (NSCLC), as compared with lobectomy by conventional thoracotomy, include less postoperative pain and shorter length of hospitalization. The outcomes after thoracoscopic lobectomy in patients with more complex pulmonary conditions are analyzed to determine safety, efficacy, and versatility. METHODS: A prospective database of 500 consecutive patients who underwent thoracoscopic lobectomy between June 1999 and January 2006 was queried. Demographic, histopathologic, perioperative, and outcome variables were assessed using standard descriptive statistics and Kaplan-Meier survival analyses. RESULTS: Thoracoscopic lobectomy was successfully performed in 492 patients (conversion rate, 1.6%). Pathologic analysis included primary NSCLC in 416 patients (83.2%), centrally located secondary pulmonary malignancy in 37 patients (7.4%), and a variety of benign conditions in 45 patients (9%). Among the 416 patients with NSCLC, pathologic analysis demonstrated stage I in 330 patients (55.3%), stage II in 40 patients (9.6%), and stage III or greater NSCLC in 44 patients (10.6%). The operative and perioperative (30-day) mortality was 0% and 1%, respectively. The overall 2-year survival rate for the entire cohort was 80%, and the 2-year overall survival rates for stage I NSCLC, stage II or greater NSCLC, secondary pulmonary malignancy, and granulomatous disease patients were 85%, 77%, 73%, and 89%, respectively. CONCLUSIONS: Thoracoscopic lobectomy is applicable to a spectrum of malignant and benign pulmonary disease and is associated with a low perioperative morbidity and mortality rate. Survival rates are comparable to those for lobectomy with thoracotomy.

Authors
Onaitis, MW; Petersen, RP; Balderson, SS; Toloza, E; Burfeind, WR; Harpole, DH; D'Amico, TA
MLA Citation
Onaitis, MW, Petersen, RP, Balderson, SS, Toloza, E, Burfeind, WR, Harpole, DH, and D'Amico, TA. "Thoracoscopic lobectomy is a safe and versatile procedure: experience with 500 consecutive patients." Ann Surg 244.3 (September 2006): 420-425.
PMID
16926568
Source
pubmed
Published In
Annals of Surgery
Volume
244
Issue
3
Publish Date
2006
Start Page
420
End Page
425
DOI
10.1097/01.sla.0000234892.79056.63

Non-small cell lung cancer clinical practice guidelines in oncology.

Authors
Ettinger, DS; Bepler, G; Bueno, R; Chang, A; Chang, JY; Chirieac, LR; D'Amico, TA; Demmy, TL; Feigenberg, SJ; Grannis, FW; Jahan, T; Jahanzeb, M; Kessinger, A; Komaki, R; Kris, MG; Langer, CJ; Le, Q-T; Martins, R; Otterson, GA; Robert, F; Sugarbaker, DJ; Wood, DE; National Comprehensive Cancer Network (NCCN),
MLA Citation
Ettinger, DS, Bepler, G, Bueno, R, Chang, A, Chang, JY, Chirieac, LR, D'Amico, TA, Demmy, TL, Feigenberg, SJ, Grannis, FW, Jahan, T, Jahanzeb, M, Kessinger, A, Komaki, R, Kris, MG, Langer, CJ, Le, Q-T, Martins, R, Otterson, GA, Robert, F, Sugarbaker, DJ, Wood, DE, and National Comprehensive Cancer Network (NCCN), . "Non-small cell lung cancer clinical practice guidelines in oncology." J Natl Compr Canc Netw 4.6 (July 2006): 548-582.
PMID
16813724
Source
pubmed
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
4
Issue
6
Publish Date
2006
Start Page
548
End Page
582

Thoracoscopic lobectomy: a safe and effective strategy for patients receiving induction therapy for non-small cell lung cancer.

BACKGROUND: Thoracoscopic lobectomy is an accepted oncologic approach for early stage non-small cell lung cancer (NSCLC). We conducted a retrospective study of patients who underwent lobectomy after induction therapy to determine the feasibility of thoracoscopic lobectomy compared with conventional thoracotomy lobectomy. METHODS: The outcomes of 97 consecutive patients with NSCLC who received induction therapy followed by lobectomy from 1996 to 2005 were reviewed. Outcome variables analyzed included complete resection, chest tube duration, length of hospitalization, 30-day mortality, hemorrhage, pneumonia, respiratory failure, and other major complications. The Student t test and chi2 or RxC contingency tables were used to compare continuous and categoric variables, respectively. RESULTS: Lobectomy was performed by thoracotomy in 85 patients and thoracoscopically in 12 patients (1 conversion), with complete resection in all patients. All patients received induction chemotherapy, and 74 (76%) received induction radiotherapy as well: 66 of 85 (78%) in the thoracotomy group and 8 of 12 (67%) in the thoracoscopy group. The overall median survival was 2.3 years, with no difference between the groups. Patients undergoing a thoracoscopic lobectomy had a shorter median hospital stay (3.5 vs 5 days, p = 0.0024) and chest tube duration (2 vs 4 days, p < 0.001). There were no significant differences in 30-day mortality, hemorrhage, pneumonia, or respiratory failure. CONCLUSIONS: Thoracoscopic lobectomy is a feasible approach for selected patients undergoing resection after induction therapy, and is associated with shorter hospital stay and chest tube duration. Long-term follow-up of survival will determine the role of thoracoscopic lobectomy in the management of patients after induction therapy.

Authors
Petersen, RP; Pham, D; Toloza, EM; Burfeind, WR; Harpole, DH; Hanish, SI; D'Amico, TA
MLA Citation
Petersen, RP, Pham, D, Toloza, EM, Burfeind, WR, Harpole, DH, Hanish, SI, and D'Amico, TA. "Thoracoscopic lobectomy: a safe and effective strategy for patients receiving induction therapy for non-small cell lung cancer." Ann Thorac Surg 82.1 (July 2006): 214-218.
PMID
16798217
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
82
Issue
1
Publish Date
2006
Start Page
214
End Page
218
DOI
10.1016/j.athoracsur.2006.02.051

A phase I study of capecitabine (CAP), carboplatin (CARB), paclitaxel (TAX) and external beam radiation therapy (EBRT) for patients with esophageal carcinoma (EC).

14044 Background: Chemoradiotherapy is used to treat esophageal cancer with curative intent or local symptom control. A phase I study of 5-FU + CARB + TAX + EBRT showed 100% RR and 50% pCR rate. CAP allows for fluoropyrimidine treatment without the inconvenience of an infusion pump. CARB allows for platinum treatment with less toxicity than cisplatin. We evaluated this combination of agents in a phase I study.Patients with squamous cell carcinoma or adenocarcinoma of the esophagus requiring local therapy received CAP (825 mg/m2 bid on radiation days) + CARB (AUC 2 qweek) + TAX (60 mg/m2 qweek) + EBRT (1.8 Gy qd to 50.4 Gy). DLT was defined as any grade 4 heme toxicity, grade 3 heme toxicity lasting ≥ 7 days, ≥ grade 3 N/V, diarrhea, or esophagitis lasting ≥ 4 days despite optimal medical management, grade 3 other toxicity, inability to deliver 75% of scheduled CAP dose, or treatment delay > 3 days.13 pts were enrolled (10M, 3F). Median age was 62 (R- 48-78). EUS stage was uT3N0 (n=1), uT2N1 (n=1), or T3N1 (n=11). 2/3 pts had DLT at dose level 1 (both grade 4 esophagitis). Esophagectomy was performed in 2/3 patients, both pCR. Three pts were then enrolled at dose level -1 (CAP 600 mg/m2 bid + CARB AUC 1.5 + TAX 45 mg/m2). One patient developed DLT (grade 3 esophagitis) so 7 more pts were added at this dose level. Overall, 3/10 patients at dose level -1 developed DLT (two grade 3 esophagitis, one grade 3 hypotension). Esophagectomy was performed in 6/10 pts - 2/6 had pCR; 6/6 had pathologic downstaging.MTD for this regimen was CAP 625 mg/m2 bid + CARB AUC 1.5 + TAX 45 mg/m2 with EBRT to 50.4 Gy. However, at the MTD, this regimen is relatively toxic with no significant improvement in rate of pCR. [Table: see text].

Authors
Kelsey, CR; Czito, BG; Bendell, JC; Willett, CG; Morse, MA; D'Amico, TA; Honeycutt, W; Franklin, A; Yu, D; Hurwitz, HI
MLA Citation
Kelsey, CR, Czito, BG, Bendell, JC, Willett, CG, Morse, MA, D'Amico, TA, Honeycutt, W, Franklin, A, Yu, D, and Hurwitz, HI. "A phase I study of capecitabine (CAP), carboplatin (CARB), paclitaxel (TAX) and external beam radiation therapy (EBRT) for patients with esophageal carcinoma (EC)." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 24.18_suppl (June 2006): 14044-.
PMID
27952282
Source
epmc
Published In
Journal of Clinical Oncology
Volume
24
Issue
18_suppl
Publish Date
2006
Start Page
14044

Serum protein expression predicts recurrence in patients with early-stage lung cancer after resection.

BACKGROUND: Patients with early stage nonsmall-cell lung cancer who have undergone complete resection have a recurrence rate of approximately 50%, predominately due to the development of systemic metastases. This study is a prospective analysis of the expression of seven serum protein markers of invasion and metastasis, collected preoperatively (baseline) and serially after resection, to determine the relationship between marker expression and recurrence. METHODS: Serum was collected from 196 patients with clinical stage I nonsmall-cell lung cancer who underwent resection over a 5-year period (1996 to 2000). Samples were drawn before resection and 1, 4, 6, 12, 18, and 24 months postoperatively. All patients were followed for at least 24 months or until death. Serum protein levels of vascular endothelial growth factor, hepatocyte growth factor), E-selectin, CD44, basic fibroblast growth factor, urokinase plasminogen activator, and urokinase plasminogen activator receptor were determined using enzyme-linked immunosorbent assay. RESULTS: To date, 73 patients (37%) have demonstrated recurrence. Baseline levels of only 1 marker (CD44) correlated with pathologic stage (p = 0.02). Analysis of the serial samples demonstrated that recurrence was predicted (before clinical or radiographic determination) by decreasing levels of E-selectin (p = 0.002), increasing levels of CD44 (p = 0.001), and increasing levels of urokinase plasminogen activator receptor (p = 0.03). CONCLUSIONS: This study demonstrates the potential to predict recurrence after resection in patients with early-stage nonsmall-cell lung cancer using a panel of serum protein markers. Early identification of patients with recurrence may improve the efficacy of systemic therapy.

Authors
D'Amico, TA; Brooks, KR; Joshi, M-BM; Conlon, D; Herndon, J; Petersen, RP; Harpole, DH
MLA Citation
D'Amico, TA, Brooks, KR, Joshi, M-BM, Conlon, D, Herndon, J, Petersen, RP, and Harpole, DH. "Serum protein expression predicts recurrence in patients with early-stage lung cancer after resection." Ann Thorac Surg 81.6 (June 2006): 1982-1987.
PMID
16731117
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
81
Issue
6
Publish Date
2006
Start Page
1982
End Page
1987
DOI
10.1016/j.athoracsur.2006.01.042

Efficacy of single-dose, multilevel paravertebral nerve blockade for analgesia after thoracoscopic procedures.

BACKGROUND: Although video-assisted thoracoscopic surgery for pulmonary resection is increasingly chosen over thoracotomy, the optimal analgesia regimen for thoracoscopy is unknown. The purpose of this trial was to compare the efficacy of analgesia from preoperative bupivacaine paravertebral nerve blockade with that from placebo injections. METHODS: Eighty adult patients undergoing unilateral thoracoscopic procedures were enrolled in a prospective, double-blinded, randomized clinical trial of preoperative, multilevel, single-dose paravertebral nerve blockade. Patients received six paravertebral injections with 5 ml of either 0.5% bupivacaine with 0.0005% epinephrine (treated, n = 40) or preservative-free saline (control, n = 40). Cumulative weight-adjusted intraoperative fentanyl and postoperative patient-controlled morphine usage, visual analog pain scores, and spirometry were used to compare efficacy of analgesia between groups. RESULTS: The treated group received significantly less intraoperative fentanyl compared with the control group (P = 0.003) and had a 31% smaller cumulative patient-controlled morphine dose (P = 0.03) in the 6 h after block placement. Within 6 h, treated patients also reported lower maximum pain scores (P = 0.02) and demonstrated less pain score variability (P = 0.01). No statistically significant difference in cumulative morphine usage existed at 12 or 18 h after block placement. No significant difference in spirometry, cortisol levels, or cytokine production was found between treatments. CONCLUSIONS: Single-dose paravertebral nerve blockade with bupivacaine is effective in reducing pain after thoracoscopic surgery, but only during the first 6 h after nerve blockade. Because of the limited duration of effect with currently available local anesthetic agents, the current data suggest that, at present, this technique is not indicated in the setting of thoracoscopic surgery.

Authors
Hill, SE; Keller, RA; Stafford-Smith, M; Grichnik, K; White, WD; D'Amico, TA; Newman, MF
MLA Citation
Hill, SE, Keller, RA, Stafford-Smith, M, Grichnik, K, White, WD, D'Amico, TA, and Newman, MF. "Efficacy of single-dose, multilevel paravertebral nerve blockade for analgesia after thoracoscopic procedures." Anesthesiology 104.5 (May 2006): 1047-1053.
PMID
16645458
Source
pubmed
Published In
Anesthesiology
Volume
104
Issue
5
Publish Date
2006
Start Page
1047
End Page
1053

Gastric Cancer Clinical Practice Guidelines.

Authors
Ajani, J; Bekaii-Saab, T; D'Amico, TA; Fuchs, C; Gibson, MK; Goldberg, M; Hayman, JA; Ilson, DH; Javle, M; Kelley, S; Kurtz, RC; Locker, GY; Meropol, NJ; Minsky, BD; Orringer, MB; Osarogiagbon, RU; Posey, JA; Roth, J; Sasson, AR; Swisher, SG; Wood, DE; Yen, Y
MLA Citation
Ajani, J, Bekaii-Saab, T, D'Amico, TA, Fuchs, C, Gibson, MK, Goldberg, M, Hayman, JA, Ilson, DH, Javle, M, Kelley, S, Kurtz, RC, Locker, GY, Meropol, NJ, Minsky, BD, Orringer, MB, Osarogiagbon, RU, Posey, JA, Roth, J, Sasson, AR, Swisher, SG, Wood, DE, and Yen, Y. "Gastric Cancer Clinical Practice Guidelines." J Natl Compr Canc Netw 4.4 (April 2006): 350-366.
PMID
16569388
Source
pubmed
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
4
Issue
4
Publish Date
2006
Start Page
350
End Page
366

Esophageal Cancer Clinical Practice Guidelines.

Authors
Ajani, J; Bekaii-Saab, T; D'Amico, TA; Fuchs, C; Gibson, MK; Goldberg, M; Hayman, JA; Ilson, DH; Javle, M; Kelley, S; Kurtz, RC; Locker, GY; Meropol, NJ; Minsky, BD; Orringer, MB; Osarogiagbon, RU; Posey, JA; Roth, J; Sasson, AR; Swisher, SG; Wood, DE; Yen, Y
MLA Citation
Ajani, J, Bekaii-Saab, T, D'Amico, TA, Fuchs, C, Gibson, MK, Goldberg, M, Hayman, JA, Ilson, DH, Javle, M, Kelley, S, Kurtz, RC, Locker, GY, Meropol, NJ, Minsky, BD, Orringer, MB, Osarogiagbon, RU, Posey, JA, Roth, J, Sasson, AR, Swisher, SG, Wood, DE, and Yen, Y. "Esophageal Cancer Clinical Practice Guidelines." J Natl Compr Canc Netw 4.4 (April 2006): 328-347.
PMID
16569387
Source
pubmed
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
4
Issue
4
Publish Date
2006
Start Page
328
End Page
347

Pathologic nodal status predicts disease-free survival after neoadjuvant chemoradiation for gastroesophageal junction carcinoma.

BACKGROUND: The incidence of carcinoma of the gastroesophageal junction (GEJ) is rapidly increasing, and the prognosis remains poor. We examined outcomes in patients who received neoadjuvant chemoradiation for GEJ tumors to identify factors that predict disease-free (DFS) and overall (OS) survival. METHODS: A retrospective analysis was performed of 101 consecutive patients who received chemoradiation and surgery for GEJ carcinoma between 1992 and 2001. RESULTS: The median DFS and OS of all patients were 16 and 25 months, respectively. Twenty-eight patients with a complete histological response (T0N0) experienced greater DFS compared with all others (P = .02). Node-negative patients, regardless of T stage, experienced improved median DFS (24 months) compared with N1 patients (9 months; P = .01). Preoperative stage, age, tumor location, or Barrett's esophagus did not independently predict OS by univariate analysis. Multivariate analysis demonstrated that only posttreatment nodal status (P = .03)-not the degree of primary tumor response-predicted DFS. CONCLUSIONS: The nodal status of patients with GEJ tumors after neoadjuvant therapy is predictive of DFS after resection. The poor outcome in node-positive patients supports postneoadjuvant therapy nodal staging, because surgical aggressiveness should be tempered by the realization that cure is unlikely and median survival is short.

Authors
Gaca, JG; Petersen, RP; Peterson, BL; Harpole, DH; D'Amico, TA; Pappas, TN; Seigler, HF; Wolfe, WG; Tyler, DS
MLA Citation
Gaca, JG, Petersen, RP, Peterson, BL, Harpole, DH, D'Amico, TA, Pappas, TN, Seigler, HF, Wolfe, WG, and Tyler, DS. "Pathologic nodal status predicts disease-free survival after neoadjuvant chemoradiation for gastroesophageal junction carcinoma." Ann Surg Oncol 13.3 (March 2006): 340-346.
PMID
16485154
Source
pubmed
Published In
Annals of Surgical Oncology
Volume
13
Issue
3
Publish Date
2006
Start Page
340
End Page
346
DOI
10.1245/ASO.2006.02.023

Invited commentary.

Authors
D'Amico, TA
MLA Citation
D'Amico, TA. "Invited commentary." Ann Thorac Surg 81.3 (March 2006): 1027-.
PMID
16488714
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
81
Issue
3
Publish Date
2006
Start Page
1027
DOI
10.1016/j.athoracsur.2005.09.038

Respiratory complications after esophagectomy.

Pulmonary complications are the major source of morbidity and mortality after esophageal resection, and numerous studies have identified various associated with these complications. This article discusses preoperative, intraoperative, and postoperative factors affecting pulmonary complications and strategies to reduce these complications after esophagectomy.

Authors
Atkins, BZ; D'Amico, TA
MLA Citation
Atkins, BZ, and D'Amico, TA. "Respiratory complications after esophagectomy." Thorac Surg Clin 16.1 (February 2006): 35-vi. (Review)
PMID
16696281
Source
pubmed
Published In
Thoracic Surgery Clinics
Volume
16
Issue
1
Publish Date
2006
Start Page
35
End Page
vi
DOI
10.1016/j.thorsurg.2006.01.007

Robotics in thoracic surgery: applications and outcomes.

Authors
D'Amico, TA
MLA Citation
D'Amico, TA. "Robotics in thoracic surgery: applications and outcomes." J Thorac Cardiovasc Surg 131.1 (January 2006): 19-20.
PMID
16399289
Source
pubmed
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
131
Issue
1
Publish Date
2006
Start Page
19
End Page
20
DOI
10.1016/j.jtcvs.2005.09.007

Improved hemodynamics and outcome after modified Norwood operation on the beating heart: Invited commentary

Authors
D'Amico, TA
MLA Citation
D'Amico, TA. "Improved hemodynamics and outcome after modified Norwood operation on the beating heart: Invited commentary." Annals of Thoracic Surgery 81.3 (2006): 1027--.
Source
scival
Published In
Annals of Thoracic Surgery
Volume
81
Issue
3
Publish Date
2006
Start Page
1027-
DOI
10.1016/j.athoracsur.2005.09.038

Preface

Authors
D'Amico, TA
MLA Citation
D'Amico, TA. "Preface." Thoracic Surgery Clinics 16.4 (2006): ix-.
Source
scival
Published In
Thoracic Surgery Clinics
Volume
16
Issue
4
Publish Date
2006
Start Page
ix
DOI
10.1016/j.thorsurg.2006.10.002

Outcomes of tracheobronchial stents in patients with malignant airway disease.

BACKGROUND: Malignant central airway obstruction is difficult to manage and is associated with poor outcome. We sought to identify the short (< 30 days) and intermediate (> 30 days) benefits and risks of tracheobronchial stents in patients with malignant airway disease. METHODS: Two hundred and twenty-five tracheobronchial stents were placed in 172 patients for benign (n = 32) and malignant (n = 140) disease from January 1, 1997, to May 31, 2003. The records of the patients with malignant disease were retrospectively analyzed to determine complication rate, reintervention rate, and survival. The malignant diagnoses included nonsmall cell cancer, small cell cancer, esophageal cancer, and metastatic disease. RESULTS: There were 172 stents placed in 140 patients with malignant disease, with no intraoperative mortality. The mean follow-up period was 142 +/- 12 days. There were 23 complications, including tumor ingrowth (n = 9), excessive granulation tissue (n = 7), stent migration (n = 5), and restenosis (n = 2). Five of the complications occurred during the short-term period (< 30 days) with the remaining complications (n = 18) occurring after 30 days. The complications required interventions including laser debridement (n = 14), dilation (n = 4), and stent removal (n = 5). CONCLUSIONS: Tracheobronchial stents offer minimally invasive palliative therapy for patients with unresectable malignant central airway obstruction. The benefit of airway stents is particularly seen in the short-term period where they provide symptomatic improvement and have low complication risk. The major impediment is excessive granulation tissue and tumor ingrowth, which occur primarily after 30 days.

Authors
Lemaire, A; Burfeind, WR; Toloza, E; Balderson, S; Petersen, RP; Harpole, DH; D'Amico, TA
MLA Citation
Lemaire, A, Burfeind, WR, Toloza, E, Balderson, S, Petersen, RP, Harpole, DH, and D'Amico, TA. "Outcomes of tracheobronchial stents in patients with malignant airway disease." Ann Thorac Surg 80.2 (August 2005): 434-437.
PMID
16039180
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
80
Issue
2
Publish Date
2005
Start Page
434
End Page
437
DOI
10.1016/j.athoracsur.2005.02.071

Low morbidity and mortality for bronchoplastic procedures with and without induction therapy.

BACKGROUND: The safety of bronchoplastic procedures after induction chemoradiotherapy is uncertain. This study examines short- and long-term outcomes after bronchoplastic procedures with and without induction therapy. METHODS: Between January 1997 and September 2004, more than 1,300 anatomic pulmonary resections for cancer were performed at a single institution. Of these, 73 patients required either sleeve lobectomy (57) or bronchoplasty (16), and were retrospectively analyzed. Nineteen patients (26%) received induction therapy; 15 received chemotherapy and radiation therapy and 4 received chemotherapy alone. Fifty-four patients underwent the bronchoplastic procedure without induction therapy. Mortality and early and late morbidity were analyzed. RESULTS: Mean follow-up was 25 months. Histology was nonsmall cell cancer in 62 (85%), carcinoid in 8 (11%), and renal cell cancer, schwannoma, and mucoepidermoid cancer in 1 patient each. There were 2 (2.7%) 30-day deaths, both in the group not receiving induction therapy. Of the surviving 71 patients, 70 had functional reconstructions at last follow-up. The overall 30-day complication rate was 30% (19 of 54) in patients not receiving induction therapy (no bronchopleural fistulas) and 42% (8 of 19) occurring in those receiving induction therapy (1 bronchopleural fistula). The long-term complication rate was 20% (11 of 54) among patients not receiving induction therapy and 5% (1 of 19) among those receiving induction therapy (completion pneumonectomy). There were no bronchovascular complications. Interventional bronchoscopy was required in 7 patients not receiving induction therapy, and was required in none of the patients receiving induction therapy. CONCLUSIONS: Anatomic pulmonary resections utilizing bronchoplastic techniques can be performed with low morbidity and mortality rates even after induction therapy.

Authors
Burfeind, WR; D'Amico, TA; Toloza, EM; Wolfe, WG; Harpole, DH
MLA Citation
Burfeind, WR, D'Amico, TA, Toloza, EM, Wolfe, WG, and Harpole, DH. "Low morbidity and mortality for bronchoplastic procedures with and without induction therapy." Ann Thorac Surg 80.2 (August 2005): 418-421.
PMID
16039176
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
80
Issue
2
Publish Date
2005
Start Page
418
End Page
421
DOI
10.1016/j.athoracsur.2005.02.058

"Anatomically-correct" dosimetric parameters may be better predictors for esophageal toxicity than are traditional CT-based metrics.

PURPOSE: Incidental esophageal irradiation during lung cancer therapy often causes morbidity. There is interest in trying to relate esophageal dosimetric parameters to the risk of injury. These parameters typically rely on CT-defined esophageal contours, and thus systematic limitations in esophageal contouring will influence these parameters. We herein assess the ability of a correction method, based on physiologic principles, to improve the predictive power of dosimetric parameters for radiation-induced esophageal injury. METHODS AND MATERIALS: Esophageal contours for 236 patients treated for lung cancer were quantitatively analyzed. All patients received three-dimensional planning, and all contours were generated by the same physician on axial CT images. Traditional dose-volume histogram (DVH)-based dosimetric parameters were extracted from the three-dimensional data set. A second set of "anatomically correct" dosimetric parameters was derived by adjusting the contours to reflect the known shape of the esophagus. Each patient was scored for acute and late toxicity using ROTG criteria. Univariate analysis was used to assess the predictive power of corrected and uncorrected dosimetric parameters (e.g., mean dose, V(50), and V(60)) for toxicity. The p values were taken as a measure of their significance. RESULTS: The univariate results indicate that both corrected and uncorrected dosimetric parameters are generally predictors for toxicity. The corrected parameters are more highly correlated (lower p value) with outcomes than the uncorrected metrics. CONCLUSIONS: The inclusion of corrections, based on anatomic realities, to DVH-based dosimetric parameters may provide dosimetric parameters that are better correlated with clinical outcomes than are traditional DVH-based metrics.

Authors
Kahn, D; Zhou, S; Ahn, S-J; Hollis, D; Yu, X; D'Amico, TA; Shafman, TD; Marks, LB
MLA Citation
Kahn, D, Zhou, S, Ahn, S-J, Hollis, D, Yu, X, D'Amico, TA, Shafman, TD, and Marks, LB. ""Anatomically-correct" dosimetric parameters may be better predictors for esophageal toxicity than are traditional CT-based metrics." Int J Radiat Oncol Biol Phys 62.3 (July 1, 2005): 645-651.
PMID
15936540
Source
pubmed
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
62
Issue
3
Publish Date
2005
Start Page
645
End Page
651
DOI
10.1016/j.ijrobp.2004.10.042

Monitoring tumor markers in serial sera predicts disease failure in lung cancer patients following surgery.

Authors
Harpole, D; Joshi, MBM; Petersen, RP; Miller, CC; Conlon, D; Brooks, KR; D'Amico, TA
MLA Citation
Harpole, D, Joshi, MBM, Petersen, RP, Miller, CC, Conlon, D, Brooks, KR, and D'Amico, TA. "Monitoring tumor markers in serial sera predicts disease failure in lung cancer patients following surgery." June 1, 2005.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
23
Issue
16
Publish Date
2005
Start Page
630S
End Page
630S

Prospective phase II trial of pre-resection thoracoscopic (VATS) restaging following neoadjuvant therapy for IIIA(N2) non-small cell lung cancer (NSCLC): Results of CALGB 39803.

Authors
Jaklitsch, MT; Gu, L; Harpole, DH; D'Amico, TA; McKenna, RJ; Krasna, MJ; Kohman, LJ; Swanson, SJ; Decamp, MM; Sugarbaker, DJ; Surg, CALGBT
MLA Citation
Jaklitsch, MT, Gu, L, Harpole, DH, D'Amico, TA, McKenna, RJ, Krasna, MJ, Kohman, LJ, Swanson, SJ, Decamp, MM, Sugarbaker, DJ, and Surg, CALGBT. "Prospective phase II trial of pre-resection thoracoscopic (VATS) restaging following neoadjuvant therapy for IIIA(N2) non-small cell lung cancer (NSCLC): Results of CALGB 39803." June 1, 2005.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
23
Issue
16
Publish Date
2005
Start Page
636S
End Page
636S

The impact of pre-radiotherapy surgery on radiation-induced lung injury.

AIMS: The use of postoperative radiation therapy (PORT) is predicated by an assessment of the potential benefits and risks, including radiation-induced lung injury. In this study, the risk of radiation-induced lung injury is assessed in patients who received PORT, and compared with a group of patients who received radiation without prior surgery, to determine if surgery increases the risk of radiation pneumonitis. MATERIALS AND METHODS: From 1991 to 2003, 251 patients with lung cancer were enrolled into a prospective study to assess radiation-induced lung injury. All patients received three-dimensional-planned, external-beam radiotherapy. One hundred and seventy-seven patients with over 6-months follow-up were eligible. For the current analysis, 49 patients (28%) had surgical intervention before radiotherapy. The rates of Grade 2 symptomatic pneumonitis in subgroups, based on the type of pre-radiation surgery, were computed and compared using Fisher's Exact Test. To consider the confounding factor of irradiated lung volume, patient subgroups were further defined on the basis of the mean lung dose. RESULTS: Surgical procedures included pneumonectomy (n=9), lobectomy (n=16), wedge resection (n=8) and exploration without resection (n=16). Radiation-induced lung injury occurred in 33 out of 177 (19%) patients, including 18% of the surgical group and 19% of the non-surgical group. Additionally, no statistically significant difference was found in the rate of radiation-induced lung injury based on the extent of resection. CONCLUSIONS: The incidence of pneumonitis is similar in the surgical and non-surgical groups. Thus, PORT may be safely given to selected patients after surgical exploration or resection.

Authors
Kocak, Z; Yu, X; Zhou, SM; D'Amico, TA; Hollis, D; Kahn, D; Tisch, A; Shafman, TD; Marks, LB
MLA Citation
Kocak, Z, Yu, X, Zhou, SM, D'Amico, TA, Hollis, D, Kahn, D, Tisch, A, Shafman, TD, and Marks, LB. "The impact of pre-radiotherapy surgery on radiation-induced lung injury." Clin Oncol (R Coll Radiol) 17.4 (June 2005): 210-216.
PMID
15999420
Source
pubmed
Published In
Clinical Oncology
Volume
17
Issue
4
Publish Date
2005
Start Page
210
End Page
216

Troubleshooting video-assisted thoracic surgery lobectomy.

PURPOSE: Surgeons converting their open lobectomy skills to video-assisted thoracic surgery (VATS) techniques have sought traditional technical courses, publications, and physician mentoring. While these are useful in teaching basic principles, it is more difficult to promulgate the numerous advanced techniques or technical "tricks" that deal with anatomical variations or pathologic changes in the lung tissue. DESCRIPTION: Engineers have simplified the process of rolling out complex technology by using troubleshooting guides. Accordingly, helpful video-assisted lobectomy maneuvers have been categorized according to the specific problems occasionally encountered at different points in the operation. EVALUATION: These maneuvers were compiled and reviewed by a panel of thoracic surgeons experienced in video-assisted lobectomies and have been active in teaching and mentoring of thoracic surgeons, residents and fellows. The techniques described have been used successfully by the authors to overcome exposure and instrumentation limitations, to achieve the outcomes reported in their series, and to guide trainees. CONCLUSIONS: Troubleshooting guides offer an organized means for surgeons to improve the parts of the video-assisted lobectomy procedure that they find tedious or challenging.

Authors
Demmy, TL; James, TA; Swanson, SJ; McKenna, RJ; D'Amico, TA
MLA Citation
Demmy, TL, James, TA, Swanson, SJ, McKenna, RJ, and D'Amico, TA. "Troubleshooting video-assisted thoracic surgery lobectomy." Ann Thorac Surg 79.5 (May 2005): 1744-1752.
PMID
15854969
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
79
Issue
5
Publish Date
2005
Start Page
1744
End Page
1752
DOI
10.1016/j.athoracsur.2004.05.015

Adjuvant chemotherapy for non-small cell lung cancer.

The survival after complete resection for non-small cell lung cancer (NSCLC) is unsatisfactory. Until recently, the use of adjuvant therapy after resection for early stage disease has not been proven to improve survival. However, the efficacy of adjuvant therapy has been demonstrated in phase III prospective randomized trials. The appropriate use of adjuvant therapy, including biologic therapy, is currently under investigation.

Authors
D'Amico, TA
MLA Citation
D'Amico, TA. "Adjuvant chemotherapy for non-small cell lung cancer." Semin Thorac Cardiovasc Surg 17.3 (2005): 195-198. (Review)
PMID
16253822
Source
pubmed
Published In
Seminars in Thoracic and Cardiovascular Surgery
Volume
17
Issue
3
Publish Date
2005
Start Page
195
End Page
198
DOI
10.1053/j.semtcvs.2005.06.010

Molecular staging and the selection of therapy for non-small cell lung cancer.

The stage-specific selection of therapy is the standard for patients with non-small cell lung cancer. Investigation of the molecular biology of lung cancer has provided pathways and targets that may be used to improve the efficacy of therapy and improve the survival for patients with lung cancer.

Authors
D'Amico, TA
MLA Citation
D'Amico, TA. "Molecular staging and the selection of therapy for non-small cell lung cancer." Semin Thorac Cardiovasc Surg 17.3 (2005): 180-185. (Review)
PMID
16253819
Source
pubmed
Published In
Seminars in Thoracic and Cardiovascular Surgery
Volume
17
Issue
3
Publish Date
2005
Start Page
180
End Page
185
DOI
10.1053/j.semtcvs.2005.06.011

Controversial issues regarding the use of induction chemotherapy for lung cancer.

Induction chemotherapy has been proven to improve survival in patients with Stage IIIA non-small cell lung cancer, and is under investigation for early stage disease. Controversy still exists regarding the choice of chemotherapy regimens, patient selection, and inclusion of radiation therapy.

Authors
Atkins, BZ; D'Amico, TA
MLA Citation
Atkins, BZ, and D'Amico, TA. "Controversial issues regarding the use of induction chemotherapy for lung cancer." Semin Thorac Cardiovasc Surg 17.3 (2005): 191-194. (Review)
PMID
16253821
Source
pubmed
Published In
Seminars in Thoracic and Cardiovascular Surgery
Volume
17
Issue
3
Publish Date
2005
Start Page
191
End Page
194
DOI
10.1053/j.semtcvs.2005.06.012

Targeted therapy for non-small cell lung cancer.

The overall survival for the treatment of lung cancer patients is less than 15%, despite advances in chemotherapy, radiation therapy, and surgery, due to the inability to control metastatic disease. Over the past three decades, the genetics of lung cancer has been progressively delineated. Small molecule drugs or monoclonal antibodies have been developed that target and inactivate specific cancer-related proteins, such as growth factor receptors or their kinases. This article will review the therapeutic implications of molecular changes associated with non-small cell lung cancer and the status of targeted therapies in its treatment.

Authors
Toloza, EM; D'Amico, TA
MLA Citation
Toloza, EM, and D'Amico, TA. "Targeted therapy for non-small cell lung cancer." Semin Thorac Cardiovasc Surg 17.3 (2005): 199-204. (Review)
PMID
16253823
Source
pubmed
Published In
Seminars in Thoracic and Cardiovascular Surgery
Volume
17
Issue
3
Publish Date
2005
Start Page
199
End Page
204
DOI
10.1053/j.semtcvs.2005.08.001

Adjuvant therapies for non-small cell lung cancer: introduction.

Authors
D'Amico, TA
MLA Citation
D'Amico, TA. "Adjuvant therapies for non-small cell lung cancer: introduction." Semin Thorac Cardiovasc Surg 17.3 (2005): 179-.
PMID
16253818
Source
pubmed
Published In
Seminars in Thoracic and Cardiovascular Surgery
Volume
17
Issue
3
Publish Date
2005
Start Page
179
DOI
10.1053/j.semtcvs.2005.06.009

Acute lung injury and acute respiratory distress syndrome after pulmonary resection.

The occurrence of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) after thoracic surgery are perplexing and persistent problems. Variously described as postpneumonectomy pulmonary edema, noncardiogenic pulmonary edema, and postlung resection pulmonary edema, ALI and ARDS may be considered a single entity, with ALI being the less severe form of ARDS. It is characterized by the acute onset of hypoxemia with radiographic infiltrates consistent with pulmonary edema, without elevations in the pulmonary capillary wedge pressure. Although this syndrome does not occur frequently and is usually without identifiable cause, the mortality is high. However, the phenomenon has not been rigorously studied owing to the low incidence, with primarily retrospective case series reported. Thus, the nomenclature, risks, and pathogenesis are not well defined. Interest in this syndrome has recently been renewed as the rate of other perioperative complications has declined. ALI/ARDS is reviewed with a focus on potential etiologies and the spectrum of available interventions.

Authors
Grichnik, KP; D'Amico, TA
MLA Citation
Grichnik, KP, and D'Amico, TA. "Acute lung injury and acute respiratory distress syndrome after pulmonary resection." Semin Cardiothorac Vasc Anesth 8.4 (December 2004): 317-334. (Review)
PMID
15583792
Source
pubmed
Published In
Seminars in Cardiothoracic and Vascular Anesthesia
Volume
8
Issue
4
Publish Date
2004
Start Page
317
End Page
334
DOI
10.1177/108925320400800405

Mediastinal Tumor

Authors
Pham, DT; D'Amico, TA
MLA Citation
Pham, DT, and D'Amico, TA. "Mediastinal Tumor." Surgical Decision Making: Fifth Edition. October 1, 2004. 88-91.
Source
scopus
Publish Date
2004
Start Page
88
End Page
91
DOI
10.1016/B978-0-7216-0290-5.50029-1

Reducing hospital morbidity and mortality following esophagectomy.

BACKGROUND: Esophagogastrectomy (EG) is a formidable operation with significant morbidity and mortality rates. Risk factor analyses have been performed, but few studies have produced strategies that have improved operative results. This study was performed in order to identify prognostic variables that might be used to develop a strategy for optimizing outcomes after EG. METHODS: The records of all patients (n = 379) who underwent EG patients at a tertiary medical center between 1996 and 2002 were retrospectively reviewed. Thirty-day morbidity and mortality were determined, and multivariable logistical regression analysis assessed the effect of preoperative and postoperative variables on early mortality. RESULTS: Operations included Ivor Lewis (n = 179), transhiatal (n = 130), and other approaches (n = 70). Operative mortality was 5.8%; 64% experienced complications, including respiratory complications (28.5%), anastamotic strictures (25%), and leak (14%). Increasing age, anastomotic leak, Charlson comorbidity index 3, worse swallowing scores, and pneumonia were associated with increased risk of mortality by univariate analysis. However, only age (p = 0.002) and pneumonia (p = 0.0008) were independently associated with mortality by multivariable analysis. Pneumonia was associated with a 20% incidence of death. Patients with pneumonia had significantly worse deglutition and anastomotic integrity on barium esophagogram compared with patients without pneumonia (p < 0.001, Mann-Whitney rank sum test). CONCLUSIONS: Morbidity and mortality of EG are significant, but most complications, including anastomotic leak, are not independent predictors of mortality. The most important complication after EG is pneumonia. Strategies to decrease postoperative mortality should include careful assessment of swallowing abnormalities and predisposition to aspiration by cineradiography or fiberoptic endoscopy. After EG, acceptable pharyngeal function and airway protection should be verified before resuming oral intake.

Authors
Atkins, BZ; Shah, AS; Hutcheson, KA; Mangum, JH; Pappas, TN; Harpole, DH; D'Amico, TA
MLA Citation
Atkins, BZ, Shah, AS, Hutcheson, KA, Mangum, JH, Pappas, TN, Harpole, DH, and D'Amico, TA. "Reducing hospital morbidity and mortality following esophagectomy." Ann Thorac Surg 78.4 (October 2004): 1170-1176. (Review)
PMID
15464465
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
78
Issue
4
Publish Date
2004
Start Page
1170
End Page
1176
DOI
10.1016/j.athoracsur.2004.02.034

Tracheobronchial stents in selected patients with benign airway disease

Authors
Lemaire, A; Burfeind, WR; Balderson, SS; Harpole, DH; D'Amico, TA
MLA Citation
Lemaire, A, Burfeind, WR, Balderson, SS, Harpole, DH, and D'Amico, TA. "Tracheobronchial stents in selected patients with benign airway disease." October 2004.
Source
wos-lite
Published In
Chest
Volume
126
Issue
4
Publish Date
2004
Start Page
801S
End Page
801S

Transhiatal esophagogastrectomy for an isolated ovarian cancer metastasis to the esophagus.

Authors
Haney, JC; D'Amico, TA
MLA Citation
Haney, JC, and D'Amico, TA. "Transhiatal esophagogastrectomy for an isolated ovarian cancer metastasis to the esophagus." J Thorac Cardiovasc Surg 127.6 (June 2004): 1835-1836.
PMID
15173754
Source
pubmed
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
127
Issue
6
Publish Date
2004
Start Page
1835
End Page
1836
DOI
10.1016/j.jtcvs.2004.01.018

Value of intraoperative pleural lavage in staging non-small cell lung cancer.

Authors
D'Amico, TA
MLA Citation
D'Amico, TA. "Value of intraoperative pleural lavage in staging non-small cell lung cancer." J Thorac Cardiovasc Surg 127.4 (April 2004): 947-948.
PMID
15052187
Source
pubmed
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
127
Issue
4
Publish Date
2004
Start Page
947
End Page
948
DOI
10.1016/j.jtcvs.2003.12.015

Angiogenesis in non-small cell lung cancer.

Two processes are necessary for a tumor colony to grow and become invasive: angiogenesis and basement membrane degradation. Angiogenesis is the formation of new blood vessels from the endothelium of existing vasculature, in response to the metabolic demand of the tumor. Assessment of the degree of tumor angiogenesis may improve risk stratification in patients with lung cancer, especially those with early-stage disease. In addition, the strategy of blocking the mechanism of angiogenesis may prove to be an effective therapeutic alternative for patients with nonsmall cell lung cancer. Clinical trials evaluating novel antiangiogenic agents, including antibodies to vascular endothelial growth factor (VEGF) and compounds directed at the tyrosine kinase receptor, are ongoing.

Authors
D'Amico, TA
MLA Citation
D'Amico, TA. "Angiogenesis in non-small cell lung cancer." Semin Thorac Cardiovasc Surg 16.1 (2004): 13-18. (Review)
PMID
15366683
Source
pubmed
Published In
Seminars in Thoracic and Cardiovascular Surgery
Volume
16
Issue
1
Publish Date
2004
Start Page
13
End Page
18

Preoperative pulmonary function as a prognostic factor for stage I non-small cell lung carcinoma: Invited commentary

Authors
D'Amico, TA
MLA Citation
D'Amico, TA. "Preoperative pulmonary function as a prognostic factor for stage I non-small cell lung carcinoma: Invited commentary." Annals of Thoracic Surgery 77.6 (2004): 1902-1903.
Source
scival
Published In
Annals of Thoracic Surgery
Volume
77
Issue
6
Publish Date
2004
Start Page
1902
End Page
1903
DOI
10.1016/j.athoracsur.2003.12.109

Thoracoscopic lobectomy

Minimally invasive approaches to lung cancer treatment have been demonstrated to be safe and effective for patients with early-stage lung cancer. Thoracoscopic lobectomy is designed to achieve the same oncologic result as conventional lobectomy: Complete hilar dissection and individual vessel control. The recognized advantages of thoracoscopic anatomic resection include less short-term postoperative pain, shorter hospital stay, and preserved pulmonary function. Although there are no prospective randomized studies comparing the thoracoscopic approach to conventional thoracotomy, there is no data from published series to suggest any difference in oncologic efficacy. © 2004 Elsevier Inc. All rights reserved.

Authors
Burfeind, WR; D'Amico, TA
MLA Citation
Burfeind, WR, and D'Amico, TA. "Thoracoscopic lobectomy." Operative Techniques in Thoracic and Cardiovascular Surgery 9.2 (2004): 98-114.
Source
scival
Published In
Operative Techniques in Thoracic and Cardiovascular Surgery
Volume
9
Issue
2
Publish Date
2004
Start Page
98
End Page
114
DOI
10.1053/j.optechstcvs.2004.05.002

A comparative analysis of positron emission tomography and mediastinoscopy in staging non-small cell lung cancer.

OBJECTIVES: Positron emission tomography has been demonstrated to improve the detection of distant metastases in patients with lung cancer. This study compares the efficacy of PET to mediastinoscopy in mediastinal staging of patients with non-small cell lung cancer. METHODS: Between May 1995 and May 2000, positron emission tomography was performed on 1988 patients with known or suspected non-small cell lung cancer at Duke University Medical Center. Cervical mediastinoscopy was subsequently performed in patients without demonstrable evidence of distant metastases. The efficacy of mediastinal staging was analyzed by comparing the prospective results of positron emission tomography with the histopathologic results of mediastinoscopy by nodal station. RESULTS: In this study 202 patients with non-small cell lung cancer (116 of whom were male) underwent mediastinoscopy after positron emission tomography. Of the 65 patients with positive results of positron emission tomography, only 29 patients had positive results of mediastinoscopy in the corresponding nodal station. Of the 137 patients with negative results of positron emission tomography, 16 patients were demonstrated to have N2 or N3 disease. The sensitivity, specificity, positive and negative predictive values, and accuracy for positron emission tomography were 64.4%, 77.1%, 44.6%, 88.3%, and 74.3%, respectively. Histologic findings in patients with non-small cell lung cancer and false-positive results of mediastinal positron emission tomography included granulomatous inflammation, sinus histiocytosis, and silicosis. CONCLUSIONS: Positron emission tomography neither confirms nor excludes involvement of the mediastinum in patients with non-small cell lung cancer. Cervical mediastinoscopy with lymph node biopsy remains the criterion standard for mediastinal staging.

Authors
Gonzalez-Stawinski, GV; Lemaire, A; Merchant, F; O'Halloran, E; Coleman, RE; Harpole, DH; D'Amico, TA
MLA Citation
Gonzalez-Stawinski, GV, Lemaire, A, Merchant, F, O'Halloran, E, Coleman, RE, Harpole, DH, and D'Amico, TA. "A comparative analysis of positron emission tomography and mediastinoscopy in staging non-small cell lung cancer." J Thorac Cardiovasc Surg 126.6 (December 2003): 1900-1905.
PMID
14688703
Source
pubmed
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
126
Issue
6
Publish Date
2003
Start Page
1900
End Page
1905
DOI
10.1016/S0022

Cerebral embolization during cardiac surgery: impact of aortic atheroma burden.

BACKGROUND: Aortic atheromatous disease is known to be associated with an increased risk of perioperative stroke in the setting of cardiac surgery. In this study, we sought to determine the relationship between cerebral microemboli and aortic atheroma burden in patients undergoing cardiac surgery. METHODS: Transoesophageal echocardiographic images of the ascending, arch and descending aorta were evaluated in 128 patients to determine the aortic atheroma burden. Transcranial Doppler (TCD) of the right middle cerebral artery was performed in order to measure cerebral embolic load during surgery. Using multivariate linear regression, the numbers of emboli were compared with the atheroma burden. RESULTS: After controlling for age, cardiopulmonary bypass time and the number of bypass grafts, cerebral emboli were significantly associated with atheroma in the ascending aorta (R2=0.11, P=0.02) and aortic arch (P=0.013). However, there was no association between emboli and descending aortic atheroma burden (R2=0.05, P=0.20). CONCLUSIONS: We demonstrate a positive relationship between TCD-detected cerebral emboli and the atheromatous burden of the ascending aorta and aortic arch. Previously demonstrated associations between TCD-detectable cerebral emboli and adverse cerebral outcome may be related to the presence of significant aortic atheromatous disease.

Authors
Mackensen, GB; Ti, LK; Phillips-Bute, BG; Mathew, JP; Newman, MF; Grocott, HP; Neurologic Outcome Research Group (NORG),
MLA Citation
Mackensen, GB, Ti, LK, Phillips-Bute, BG, Mathew, JP, Newman, MF, Grocott, HP, and Neurologic Outcome Research Group (NORG), . "Cerebral embolization during cardiac surgery: impact of aortic atheroma burden." Br J Anaesth 91.5 (November 2003): 656-661.
PMID
14570786
Source
pubmed
Published In
BJA: British Journal of Anaesthesia
Volume
91
Issue
5
Publish Date
2003
Start Page
656
End Page
661

Measurement of chemoresistance markers in patients with stage III non-small cell lung cancer: a novel approach for patient selection.

BACKGROUND: The long-term survival of patients with stage III non-small cell lung cancer treated with a combination of chemotherapy and radiation is 10% to 20%. Survival could potentially be increased and toxicity limited if one could identify patients most likely to respond to a particular treatment regimen. This project prospectively evaluated a panel of potential immunohistochemical markers of chemoresistance in a population of patients with pathology-confirmed stage III non-small cell lung cancer in order to determine the prognostic value of each marker in relation to response to chemotherapy or survival. METHODS: Immunohistochemical staining was performed on histologically positive mediastinal nodal specimens obtained from 59 patients (mean age, 62 years; range, 41 to 79 years) without evidence of distant metastatic disease treated with navelbine-based chemotherapy and external beam radiation therapy between 1996 and 2001. Included were markers for apoptosis (p53, bcl-2), drug efflux/degradation (MDR, GST-pi), growth factors (EGFr, Her2-neu), and mismatch repair (hMLH1, hMSH2). After chemotherapy, patients underwent radiologic evaluation for response measured by standard criteria. RESULTS: After a median 41 months of follow-up (range, 17 to 55 months), 43 patients had recurrent disease and 38 of these patients were dead of cancer (median cancer-free survival of 10 months and overall survival of 18 months). Patients who demonstrated a complete or partial response (n = 38) had a significantly improved survival (p = 0.002) compared with those with stable or progressive cancer (n = 21). Multivariable Cox step-wise regression analysis of marker expression associated overexpression of p53 and low expression of hMSH2 with poor treatment response and cancer death. CONCLUSIONS: These preliminary data suggest that marker expression may allow the separation of patients into low- and high-risk groups with respect to survival after combined navelbine-based chemotherapy and XRT. This could represent a novel method of selecting patients for a particular treatment regimen if these data are reproduced in a larger prospective trial.

Authors
Brooks, KR; To, K; Joshi, M-BM; Conlon, DH; Herndon, JE; D'Amico, TA; Harpole, DH
MLA Citation
Brooks, KR, To, K, Joshi, M-BM, Conlon, DH, Herndon, JE, D'Amico, TA, and Harpole, DH. "Measurement of chemoresistance markers in patients with stage III non-small cell lung cancer: a novel approach for patient selection." Ann Thorac Surg 76.1 (July 2003): 187-193.
PMID
12842538
Source
pubmed
Published In
The Annals of Thoracic Surgery
Volume
76
Issue
1
Publish Date
2003
Start Page
187
End Page
193

Local control without resection.

Authors
D'Amico, TA
MLA Citation
D'Amico, TA. "Local control without resection." J Thorac Cardiovasc Surg 125.4 (April 2003): 787-788.
PMID
12698140
Source
pubmed
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
125
Issue
4
Publish Date
2003
Start Page
787
End Page
788
DOI
10.1067/mtc.2003.258

Gastric cancer. Clinical practice guidelines in oncology.

Gastric cancer is rampant in several countries around the world. Its incidence in the West has been on the decline for more than 40 years; however, the location of gastric cancer has shifted proximally in the past 15 years. The reason for this shift is not clear. Diffuse histology is also more common now than intestinal type of histology. Advances have been made in staging procedures such as laparoscopy and endoscopic ultrasonography and in possible functional imaging techniques. The current TNM classification requires an examination of at least 15 lymph nodes; therefore, at least a D1 dissection is recommended. Patients with locoregional gastric carcinoma should also be referred to high-volume treatment centers. Combination chemotherapy and radiotherapy in the adjuvant setting for select group of patients is considered the new standard in the United States. The NCCN Gastric Cancer Guidelines portray uniformity in the systemic approach to cancer in the United States. We look forward to the results of investigations of a number of new chemotherapeutic agents, including antireceptor agents, vaccines, gene therapy, and antiangiogenic agents. The panel anticipates many advances in the treatment of esophageal carcinoma in the future.

Authors
Ajani, J; D'Amico, TA; Hayman, JA; Meropol, NJ; Minsky, B; National Comprehensive Cancer Network,
MLA Citation
Ajani, J, D'Amico, TA, Hayman, JA, Meropol, NJ, Minsky, B, and National Comprehensive Cancer Network, . "Gastric cancer. Clinical practice guidelines in oncology." J Natl Compr Canc Netw 1.1 (January 2003): 28-39.
PMID
19764148
Source
pubmed
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
1
Issue
1
Publish Date
2003
Start Page
28
End Page
39

Esophageal cancer. Clinical practice guidelines in oncology.

Esophageal cancer is a major health hazard in many parts of the world. The incidence of adenocarcinoma is rising in white men, particularly in the nonendemic areas, such as the West. Barrett's metaplasia, gastroesophageal reflux, hiatal hernia, and obesity are thought to play a role in these cases. In addition, the most common location of esophageal carcinoma has shifted to the lower third of the esophagus. Unfortunately, esophageal carcinoma is often diagnosed late; therefore, most therapeutic approaches are palliative. Advances have been made in staging procedures and in therapeutic approaches. The NCCN Esophageal Cancer Guidelines emphasize that palpable advances have been made in the treatment of locoregional esophageal carcinoma. Similarly, endoscopic palliation of esophageal carcinoma has improved substantially due to improving technology. A number of new chemotherapeutic agents are on the horizon including antireceptor agents, vaccines, gene therapy, and antiangiogenic agents. The panel expects numerous advances in the treatment of esophageal carcinoma in the future.

Authors
Ajani, J; D'Amico, TA; Hayman, JA; Meropol, NJ; Minsky, B; National Comprehensive Cancer Network,
MLA Citation
Ajani, J, D'Amico, TA, Hayman, JA, Meropol, NJ, Minsky, B, and National Comprehensive Cancer Network, . "Esophageal cancer. Clinical practice guidelines in oncology." J Natl Compr Canc Netw 1.1 (January 2003): 14-27.
PMID
19764147
Source
pubmed
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
1
Issue
1
Publish Date
2003
Start Page
14
End Page
27

Molecular biologic substaging of stage I NSCLC through immunohistochemistry performed on formalin-fixed, paraffin-embedded tissue.

Authors
Joshi, M-BM; D'Amico, TA; Harpole, DH
MLA Citation
Joshi, M-BM, D'Amico, TA, and Harpole, DH. "Molecular biologic substaging of stage I NSCLC through immunohistochemistry performed on formalin-fixed, paraffin-embedded tissue." Methods Mol Med 75 (2003): 369-388.
PMID
12407753
Source
pubmed
Published In
Methods in Molecular Medicine
Volume
75
Publish Date
2003
Start Page
369
End Page
388

Thoracoscopic lobectomy: a safe and effective strategy for patients with stage I lung cancer.

BACKGROUND: Thoracoscopic lobectomy is emerging as a potential alternative to thoracotomy for early stage lung cancer. The issues of safety and oncologic efficacy should be analyzed before recommending this procedure for widespread use. METHODS: Thoracoscopic lobectomy was attempted in 110 consecutive patients (age, 35 to 81 years) with tumors that were judged to be amenable to lobectomy over a 26-month period. Exclusion criteria included tumors greater than 5 cm in diameter, T3 tumors, endobronchial tumors visible at bronchoscopy, the use of induction therapy, extensive N1 disease on computed tomographic scan, and N2 disease at mediastinoscopy. The procedures were performed without rib spreading using two ports and included anatomic hilar dissection and individual vessel stapling. RESULTS: Thoracoscopic lobectomy and mediastinal lymph dissection was successfully performed in 108 patients (98.2%); 2 patients required conversion to thoracotomy to control bleeding in the setting of dense hilar adenopathy. There were no intraoperative deaths and 4 perioperative deaths (3.6%) caused by pneumonia and associated adult respiratory distress syndrome (3 patients) and stroke (1 patient). Major complications included pneumonia (5 patients), stroke (1 patient), and return to the operating room to revise the bronchial closure (1 patient). Minor complications included prolonged air leak (6 patients), atrial fibrillation (4 patients), blood transfusion (2 patients) and ileus (1 patient). Median time to chest tube removal was 3 days, and median length of stay was 3 days. CONCLUSIONS: Thoracoscopic lobectomy is a safe and effective strategy for patients with early stage lung cancer. Long-term follow-up is required to determine if recurrence rate and 5-year survival are comparable with thoracotomy for lobectomy.

Authors
Daniels, LJ; Balderson, SS; Onaitis, MW; D'Amico, TA
MLA Citation
Daniels, LJ, Balderson, SS, Onaitis, MW, and D'Amico, TA. "Thoracoscopic lobectomy: a safe and effective strategy for patients with stage I lung cancer." Ann Thorac Surg 74.3 (September 2002): 860-864.
PMID
12238851
Source
pubmed
Published In
The Annals of Thoracic Surgery
Volume
74
Issue
3
Publish Date
2002
Start Page
860
End Page
864

Serum creatinine patterns in coronary bypass surgery patients with and without postoperative cognitive dysfunction.

UNLABELLED: Renal dysfunction is common after coronary artery bypass graft (CABG) surgery. We have previously shown that CABG procedures complicated by stroke have a threefold greater peak serum creatinine level relative to uncomplicated surgery. However, postoperative creatinine patterns for procedures complicated by cognitive dysfunction are unknown. Therefore, we tested the hypothesis that postoperative cognitive dysfunction is associated with acute perioperative renal injury after CABG surgery. Data were prospectively gathered for 282 elective CABG surgery patients. Psychometric tests were performed at baseline and 6 wk after surgery. Cognitive dysfunction was defined both as a dichotomous variable (cognitive deficit [CD]) and as a continuous variable (cognitive index). Forty percent of patients had CD at 6 wk. However, the association between peak percentage change in postoperative creatinine and CD (parameter estimate = -0.41; P = 0.91) or cognitive index (parameter estimate = -1.29; P = 0.46) was not significant. These data indicate that postcardiac surgery cognitive dysfunction, unlike stroke, is not associated with major increases in postoperative renal dysfunction. IMPLICATIONS: We previously noted that patients with postcardiac surgery stroke also have greater acute renal injury than unaffected patients. However, in the same setting, we found no difference in renal injury between patients with and without cognitive dysfunction. Factors responsible for subtle postoperative cognitive dysfunction do not appear to be associated with clinically important renal effects.

Authors
Swaminathan, M; McCreath, BJ; Phillips-Bute, BG; Newman, MF; Mathew, JP; Smith, PK; Blumenthal, JA; Stafford-Smith, M; Perioperative Outcomes Research Group,
MLA Citation
Swaminathan, M, McCreath, BJ, Phillips-Bute, BG, Newman, MF, Mathew, JP, Smith, PK, Blumenthal, JA, Stafford-Smith, M, and Perioperative Outcomes Research Group, . "Serum creatinine patterns in coronary bypass surgery patients with and without postoperative cognitive dysfunction." Anesth Analg 95.1 (July 2002): 1-8.
PMID
12088934
Source
pubmed
Published In
Anesthesia and Analgesia
Volume
95
Issue
1
Publish Date
2002
Start Page
1
End Page
8

Impact of computed tomography-positron emission tomography fusion in staging patients with thoracic malignancies.

BACKGROUND: Positron emission tomography (PET) has been demonstrated to improve staging in patients with thoracic malignancies. This study evaluates the ability of a new imaging technique to improve the spatial resolution and accuracy of PET. METHODS: Patients with known or suspected malignancy (n = 21) who were referred for a dedicated PET scan were also evaluated with a new camera-based PET system, which uniquely allows simultaneous computed tomography (CT) and fusion of the camera-based PET images with the CT images. The dedicated PET scan was obtained 1 hour after intravenous injection of fluorodeoxyglucose. The camera-based PET imaging was fused with the CT images at approximately 2 hours after injection. The camera-based PET and CT-PET fusion images were read independently and blindly by 2 experienced observers and the presence and location of abnormalities was compared with dedicated PET scans. RESULTS: Dedicated PET identified 18 sites in the chest as abnormal. The CT-PET fusion was superior to the camera-based PET alone, concordant with the dedicated PET in 16 of 21 patients compared with 13 of 21 by camera-based PET. The lesions missed by the camera-based PET were less than 1 cm in diameter. Fused CT-PET images provided superior anatomic localization and spatial resolution compared with dedicated PET and camera-based PET. CONCLUSIONS: CT-PET fusion images were more accurate than camera-based PET alone. CT-PET fusion improves the spatial resolution compared with dedicated PET and may improve the availability and efficacy of staging of patients with thoracic malignancies.

Authors
D'Amico, TA; Wong, TZ; Harpole, DH; Brown, SD; Coleman, RE
MLA Citation
D'Amico, TA, Wong, TZ, Harpole, DH, Brown, SD, and Coleman, RE. "Impact of computed tomography-positron emission tomography fusion in staging patients with thoracic malignancies." Ann Thorac Surg 74.1 (July 2002): 160-163.
PMID
12118750
Source
pubmed
Published In
The Annals of Thoracic Surgery
Volume
74
Issue
1
Publish Date
2002
Start Page
160
End Page
163

Pathologic nodal status predicts disease-free survival after neoadjuvant chemoradiation for gastroesophageal junction carcinoma

Authors
Gaca, JG; Harpole, DH; D'Amico, TA; Pappas, T; Seigler, HF; Wolfe, WG; Tyler, S
MLA Citation
Gaca, JG, Harpole, DH, D'Amico, TA, Pappas, T, Seigler, HF, Wolfe, WG, and Tyler, S. "Pathologic nodal status predicts disease-free survival after neoadjuvant chemoradiation for gastroesophageal junction carcinoma." July 2002.
Source
wos-lite
Published In
Gastroenterology
Volume
123
Issue
1
Publish Date
2002
Start Page
1
End Page
2

Molecular staging of lung and esophageal cancer.

In both esophageal and NSCLC, the TNM stage at diagnosis remains the most important determinant of survival. Significant research to investigate the biology of NSCLC and esophageal carcinoma is ongoing, and the roles of proto-oncogenes, tumor suppressor genes, angiogenic factors, extracellular matrix proteases, and adhesion molecules are being elucidated. While evidence is accumulating that various markers are involved in NSCLC and esophageal tumor virulence, the current studies are compromised by small sample sizes, heterogeneous populations, and variations in techniques. Large prospective studies with homogenous groups designed to evaluate the role of these various markers should clarify their potential involvement in NSCLC and esophageal cancer. Identification of occult micrometastases in lymph nodes and bone marrow using immunohistochemical techniques and rt-PCR is intriguing. These techniques are promising as a method to more accurately stage patients, and therefore to predict outcomes and to determine therapies. Perhaps the most promising area of research is the development of novel drugs whose mechanism of action targets the pathways of various molecular markers. Molecular biologic substaging offers an opportunity to individualize a chemotherapeutic regimen based on the molecular profile of the tumor, thus providing the potential for improved outcomes with less morbidity in patients with both NSCLC and esophageal cancer.

Authors
Lau, CL; Moore, M-BH; Brooks, KR; D'Amico, TA; Harpole, DH
MLA Citation
Lau, CL, Moore, M-BH, Brooks, KR, D'Amico, TA, and Harpole, DH. "Molecular staging of lung and esophageal cancer." Surg Clin North Am 82.3 (June 2002): 497-523. (Review)
PMID
12371582
Source
pubmed
Published In
Surgical Clinics of North America
Volume
82
Issue
3
Publish Date
2002
Start Page
497
End Page
523

Molecular biologic substaging of non-small cell lung cancer.

Authors
D'Amico, TA
MLA Citation
D'Amico, TA. "Molecular biologic substaging of non-small cell lung cancer." J Thorac Cardiovasc Surg 123.3 (March 2002): 409-410.
PMID
11882809
Source
pubmed
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
123
Issue
3
Publish Date
2002
Start Page
409
End Page
410

The rewarming rate and increased peak temperature alter neurocognitive outcome after cardiac surgery.

UNLABELLED: Neurocognitive dysfunction is a common complication after cardiac surgery. We evaluated in this prospective study the effect of rewarming rate on neurocognitive outcome after hypothermic cardiopulmonary bypass (CPB). After IRB approval and informed consent, 165 coronary artery bypass graft surgery patients were studied. Patients received similar surgical and anesthetic management until rewarming from hypothermic (28 degrees -32 degrees C) CPB. Group 1 (control; n = 100) was warmed in a conventional manner (4 degrees -6 degrees C gradient between nasopharyngeal and CPB perfusate temperature) whereas Group 2 (slow rewarm; n = 65) was warmed at a slower rate, maintaining no more than 2 degrees C difference between nasopharyngeal and CPB perfusate temperature. Neurocognitive function was assessed at baseline and 6 wk after coronary artery bypass graft surgery. Univariable analysis revealed no significant differences between the Control and Slow Rewarming groups in the stroke rate. Multivariable linear regression analysis, examining treatment group, diabetes, baseline cognitive function, and cross-clamp time revealed a significant association between change in cognitive function and rate of rewarming (P = 0.05). IMPLICATIONS: Slower rewarming during cardiopulmonary bypass (CPB) was associated with better cognitive performance at 6 wk. These results suggest that a slower rewarming rate with lower peak temperatures during CPB may be an important factor in the prevention of neurocognitive decline after hypothermic CPB.

Authors
Grigore, AM; Grocott, HP; Mathew, JP; Phillips-Bute, B; Stanley, TO; Butler, A; Landolfo, KP; Reves, JG; Blumenthal, JA; Newman, MF; Neurologic Outcome Research Group of the Duke Heart Center,
MLA Citation
Grigore, AM, Grocott, HP, Mathew, JP, Phillips-Bute, B, Stanley, TO, Butler, A, Landolfo, KP, Reves, JG, Blumenthal, JA, Newman, MF, and Neurologic Outcome Research Group of the Duke Heart Center, . "The rewarming rate and increased peak temperature alter neurocognitive outcome after cardiac surgery." Anesth Analg 94.1 (January 2002): 4-10.
PMID
11772792
Source
pubmed
Published In
Anesthesia and Analgesia
Volume
94
Issue
1
Publish Date
2002
Start Page
4
End Page
10

Thymopoiesis in HIV-infected adults after highly active antiretroviral therapy.

The thymus of HIV-seropositive patients can enlarge as CD4+ T cell counts increase on highly active anti-retroviral therapy (HAART). This may indicate development of new T cells or represent mature peripheral T cells recirculating to the thymus. To define the etiology of the enlargement, the thymuses of two HIV-infected individuals on HAART were biopsied. For more than 3 years before initiation of HAART, both patients (38 and 41 years of age) had documented CD4+ T lymphopenia. Peripheral blood samples were obtained to assess circulating CD4+ CD45RA+ CD62L+ T cells, which were thought to have recently developed in the thymus. Peripheral blood T cells from both patients and thymocytes from the second patient were also tested for levels of DNA episomes formed during T cell receptor gene rearrangement (T cell receptor rearrangement excision circles, TRECs). With HAART, peripheral blood CD4+ T cell counts increased from approximately 60/mm(3) to 552/mm(3) and 750/mm(3) for patients 1 and 2, respectively. Thymic biopsies from both patients showed normal thymus histology with active thymopoiesis. Percentages of peripheral blood CD4+ CD45RA+ CD62L+ T cells and quantitation of T cell TRECs also reflected active thymopoiesis in both patients. Thus, in these two HIV-seropositive adults examined after initiation of HAART, thymic enlargement represented active thymopoiesis. Thymopoiesis in adult AIDS patients may contribute to immune reconstitution even after prolonged CD4+ T lymphopenia.

Authors
Markert, ML; Alvarez-McLeod, AP; Sempowski, GD; Hale, LP; Horvatinovich, JM; Weinhold, KJ; Bartlett, JA; D'Amico, TA; Haynes, BF
MLA Citation
Markert, ML, Alvarez-McLeod, AP, Sempowski, GD, Hale, LP, Horvatinovich, JM, Weinhold, KJ, Bartlett, JA, D'Amico, TA, and Haynes, BF. "Thymopoiesis in HIV-infected adults after highly active antiretroviral therapy." AIDS Res Hum Retroviruses 17.17 (November 20, 2001): 1635-1643.
PMID
11779351
Source
pubmed
Published In
AIDS Research and Human Retroviruses
Volume
17
Issue
17
Publish Date
2001
Start Page
1635
End Page
1643
DOI
10.1089/088922201753342040

Predicting the sites of metastases from lung cancer using molecular biologic markers.

BACKGROUND: The use of molecular markers in staging non-small cell lung cancer (NSCLC) has been supported in retrospective prognostic models but has not been evaluated in predicting sites of metastases. METHODS: Pathologic specimens were collected from 202 patients after complete resection for stage I NSCLC, who were subsequently found to have no metastases at 5 years (n = 108), isolated brain metastases (n = 25), or other distant metastases (n = 69). A panel of eight molecular markers of metastatic potential was chosen for immunohistochemical analysis of the tumor: p53, erbB2, angiogenesis factor viii, EphA2, E-cadherin, urokinase plasminogen activator (UPA), UPA receptor, and plasminogen activator inhibitor. RESULTS: Patients with isolated brain relapse had significantly higher expression of p53 (p = 0.02) and UPA (p = 0.002). The quantitative expression of E-cadherin was used to predict the site of metastases using recursive partitioning: 0 of 92 patients with E-cadherin expression of 0, 1, or 2 developed isolated cerebral metastases; 0 of 33 patients with E-cadherin expression of 3 with UPA of 1 or 2 and ErbB2 of 0 developed brain metastases. Of the remaining patients at risk (UPA = 3), the risk of isolated cerebral metastases was 21 of 57 patients (37%). CONCLUSIONS: This study demonstrates that molecular markers may predict the site of relapse in early stage NSCLC. If validated in an ongoing prospective study, these results could be used to select patients with isolated brain metastases for adjuvant therapy, such as prophylactic cranial irradiation.

Authors
D'Amico, TA; Aloia, TA; Moore, MB; Conlon, DH; Herndon, JE; Kinch, MS; Harpole, DH
MLA Citation
D'Amico, TA, Aloia, TA, Moore, MB, Conlon, DH, Herndon, JE, Kinch, MS, and Harpole, DH. "Predicting the sites of metastases from lung cancer using molecular biologic markers." Ann Thorac Surg 72.4 (October 2001): 1144-1148.
PMID
11603427
Source
pubmed
Published In
The Annals of Thoracic Surgery
Volume
72
Issue
4
Publish Date
2001
Start Page
1144
End Page
1148

Tumor marker expression is predictive of survival in patients with esophageal cancer.

BACKGROUND: This study was designed to determine the prognostic value of immunohistochemical tumor marker expression in a population of patients with node-negative esophageal cancer treated with complete resection alone. METHODS: Resection specimens were collected from 61 patients with node-negative T1 (n = 31), T2 (n = 14), and T3 (n = 16) esophageal cancer. A panel of 10 tumor markers was chosen for immunohistochemical analysis, based on associations with differing oncologic mechanisms: apoptosis (p53), growth regulation (transforming growth factor-alpha, epidermal growth factor receptor, and Her2-neu), angiogenesis (factor VIII), metastatic potential (CD44), platinum resistance (p-glycoprotein and metallothionein), 5-fluorouracil resistance (thymidylate synthetase), and carcinogenic detoxification (glutathione S-transferase-pi). RESULTS: Complete resection was performed in all patients (44 adenocarcinoma, 17 squamous cell carcinoma), with no operative deaths. Multivariable analysis demonstrated a significant relationship between cancer-specific death and the following variables: low-level P-gp expression (p = 0.004), high-level expression of p53 (p = 0.04), and low-level expression of transforming growth factor-alpha (p = 0.03). In addition, the number of involved tumor markers present was strongly predictive of negative outcome (p = 0.0001). CONCLUSIONS: This study supports the prognostic value of immunohistochemical tumor markers, specifically the expression pattern of P-gp, p53, and transforming growth factor-alpha, in patients with esophageal carcinoma treated with complete resection alone.

Authors
Aloia, TA; Harpole, DH; Reed, CE; Allegra, C; Moore, MB; Herndon, JE; D'Amico, TA
MLA Citation
Aloia, TA, Harpole, DH, Reed, CE, Allegra, C, Moore, MB, Herndon, JE, and D'Amico, TA. "Tumor marker expression is predictive of survival in patients with esophageal cancer." Ann Thorac Surg 72.3 (September 2001): 859-866.
PMID
11565671
Source
pubmed
Published In
The Annals of Thoracic Surgery
Volume
72
Issue
3
Publish Date
2001
Start Page
859
End Page
866

The prognostic value of molecular marker analysis in patients treated with trimodality therapy for esophageal cancer.

The purpose of this study was to define the prognostic value of a group of molecular tumor markers in a well-staged population of patients treated with trimodality therapy for esophageal cancer. The original pretreatment paraffin-embedded endoscopic esophageal tumor biopsy material was obtained from 118 patients treated with concurrent cisplatin + 5-fluorouracil (5-FU) + 45 Gy radiation followed by resection from 1986 until 1997 at the Duke University Comprehensive Cancer Center. Three markers of possible platinum chemotherapy association [metallothionein (MT), glutathione S-transferase-pi (GST-pi), P-glycoprotein (P-gp or multidrug resistance)] and one marker of possible 5-FU association [thymidylate synthase (TS)] were measured using immunohistochemistry. The median cancer-free survival was 25.0 months, with a significantly improved survival for the 38 patients who had a complete response (P < 0.001). High-level expression of GST-pi, P-gp, and TS were associated with a decreased survival. MT was not significant in this population. Multivariate analysis identified high-level expression in two of the platinum markers (GST-pi and P-gp) and the 5-FU marker TS as independent predictors of early recurrence and death. In conclusion, this investigation measured three possible markers associated with platinum and one possible marker associated with 5-FU in a cohort of esophageal cancer patients. Independent prognostic significance was observed, which suggests that it may be possible to predict which patients may benefit most from trimodality therapy. These data need to be reproduced in a prospective investigation.

Authors
Harpole, DH; Moore, MB; Herndon, JE; Aloia, T; D'Amico, TA; Sporn, T; Parr, A; Linoila, I; Allegra, C
MLA Citation
Harpole, DH, Moore, MB, Herndon, JE, Aloia, T, D'Amico, TA, Sporn, T, Parr, A, Linoila, I, and Allegra, C. "The prognostic value of molecular marker analysis in patients treated with trimodality therapy for esophageal cancer." Clin Cancer Res 7.3 (March 2001): 562-569.
PMID
11297249
Source
pubmed
Published In
Clinical cancer research : an official journal of the American Association for Cancer Research
Volume
7
Issue
3
Publish Date
2001
Start Page
562
End Page
569

Molecular biology of esophageal cancer.

Several mechanisms of resistance to chemotherapy have been identified among the agents that are commonly used in the systemic treatment of patients with esophageal cancer: paclitaxel, platinum, and 5-FU. A recent study from our laboratory evaluated the initial endoscopic biopsy material from patients who subsequently underwent trimodality therapy, including chemotherapy with cisplatin and 5-FU, radiation therapy, and surgery. IHC analysis was performed on seven markers of chemotherapy or radiation therapy resistance: P-gp, GST-pi, MT (platinum inhibitors); EGF-R, TGF-alpha, erb-B2 (activation of cell growth cascade); and p53 (interferes with chemotherapy-induced apoptosis). In this study, elevated expression of GST-pi and P-gp were associated with decreased survival and may be markers of treatment resistance. Expression of erb-B2 was associated with enhanced survival and may be a marker of treatment sensitivity. Assessment of the probability of chemoresistance of a particular tumor using the expression of molecular biologic markers may allow for the selection of a more favorable chemotherapeutic agent. Furthermore, understanding the mechanisms of resistance, including the mechanisms of DNA repair, may provide insight into mechanisms to reverse or to inhibit resistance to chemotherapy. DNA repair mechanisms are used by cells to protect themselves against mutagens and carcinogens. DNA repair inhibitors may increase the mutagenicity associated with DNA damage and may prove to be an ineffective oncologic treatment strategy; however, the possibility exists that DNA repair inhibition may improve the efficacy of anticancer agents, and this should be tested. The value of this strategy may be in allowing treatment doses to be decreased and lessening side effects while maintaining therapeutic efficacy.

Authors
D'Amico, TA; Harpole, DH
MLA Citation
D'Amico, TA, and Harpole, DH. "Molecular biology of esophageal cancer." Chest Surg Clin N Am 10.3 (August 2000): 451-469. (Review)
PMID
10967750
Source
pubmed
Published In
Chest surgery clinics of North America
Volume
10
Issue
3
Publish Date
2000
Start Page
451
End Page
469

Emergent thoracotomy for airway control after intrathoracic tracheal injury.

Authors
Shah, AS; Forbess, JM; Skaryak, LA; Lilly, RE; Vaslef, SN; D'Amico, TA
MLA Citation
Shah, AS, Forbess, JM, Skaryak, LA, Lilly, RE, Vaslef, SN, and D'Amico, TA. "Emergent thoracotomy for airway control after intrathoracic tracheal injury." J Trauma 48.6 (June 2000): 1163-1164.
PMID
10866268
Source
pubmed
Published In
Journal of Trauma - Injury, Infection and Critical Care
Volume
48
Issue
6
Publish Date
2000
Start Page
1163
End Page
1164

Myxoid liposarcoma of the supraclavicular fossa.

Liposarcomas generally originate most often in the extremities or retroperitoneum, less frequently in the head and neck, and rarely in the thorax. We describe a particularly rare presentation of myxoid liposarcoma originating in the supraclavicular fossa. The mass was resected and has not recurred. We searched our pathology database for other soft-tissue tumors of the supraclavicular fossa and found no other case of sarcoma originating in this site. In addition, we performed a literature review of thoracic and neck liposarcomas to identify similar cases and discuss their clinical course.

Authors
Morse, MA; Bossen, E; D'Amico, TA; Williamson, W; Johnson, R
MLA Citation
Morse, MA, Bossen, E, D'Amico, TA, Williamson, W, and Johnson, R. "Myxoid liposarcoma of the supraclavicular fossa." Chest 117.5 (May 2000): 1518-1520.
PMID
10807849
Source
pubmed
Published In
Chest
Volume
117
Issue
5
Publish Date
2000
Start Page
1518
End Page
1520

Influence of panel-reactive antibodies on posttransplant outcomes in lung transplant recipients.

BACKGROUND: Panel-reactive antibody (PRA) is used to estimate the degree of humoral sensitization in the recipient before transplantation. Although pretransplant sensitization is associated with increased complications in other solid organ transplant recipients, less is known about the outcome of sensitized lung transplant recipients. Therefore, we sought to determine the impact of elevated pretransplant PRA on clinical outcomes after lung transplantation. METHODS: The records of the first 200 lung transplant operations performed at Duke University Medical Center were reviewed. The outcomes of sensitized patients, PRA greater than 10% before transplantation (n = 18), were compared with the outcomes of nonsensitized patients. RESULTS: Sensitized patients experienced a significantly greater number of median ventilator days posttransplant (9 +/- 8) as compared with nonsensitized recipients (1 +/- 11; p = 0.0008). There were no significant differences between the number of episodes of acute rejection; however, there was a significantly increased incidence of bronchiolitis obliterans syndrome occurring in untreated sensitized recipients (56%) versus nonsensitized (23%; p = 0.044). In addition, there was a trend towards decreased survival in the sensitized recipients, with a 2-year survival of 58% in sensitized recipients as compared with 73% in the nonsensitized patients (p = 0.31). CONCLUSIONS: Sensitized lung transplant recipients experience more acute and chronic complications after transplantation. These patients probably warrant alternative management strategies.

Authors
Lau, CL; Palmer, SM; Posther, KE; Howell, DN; Reinsmoen, NL; Massey, HT; Tapson, VF; Jaggers, JJ; D'Amico, TA; Davis, RD
MLA Citation
Lau, CL, Palmer, SM, Posther, KE, Howell, DN, Reinsmoen, NL, Massey, HT, Tapson, VF, Jaggers, JJ, D'Amico, TA, and Davis, RD. "Influence of panel-reactive antibodies on posttransplant outcomes in lung transplant recipients." Ann Thorac Surg 69.5 (May 2000): 1520-1524.
PMID
10881834
Source
pubmed
Published In
The Annals of Thoracic Surgery
Volume
69
Issue
5
Publish Date
2000
Start Page
1520
End Page
1524

Molecular biologic substaging of stage I lung cancer according to gender and histology.

BACKGROUND: This study is designed to assess molecular biologic substaging according to gender and histology in patients with stage I non-small cell lung cancer (NSCLC). METHODS: Pathologic specimens were collected from 408 consecutive patients after complete resection for stage I NSCLC, with follow-up of at least 5 years. A panel of nine molecular markers was chosen for immunohistochemical analysis of the tumor: recessive oncogenes p53 and bcl-2, the protooncogene erbB-2, KI-67 proliferation index, retinoblastoma oncogene (Rb), epidermal growth factor receptor (EGFr), angiogenesis factor viii, sialyl-Tn antigen (STN), and CD-44. Cox proportional hazards regression analysis was used to construct a risk model for cancer-specific survival according to marker status, gender, and histologic subtype. RESULTS: Among men, the only molecular marker associated with decreased cancer-specific survival is erbB-2; among women, there are four markers: p53, Rb, CD-44, and factor viii. Among patients with squamous cell carcinoma, the only molecular marker associated with decreased cancer-specific survival is erbB-2; among patients with adenocarcinoma (AC), there are three markers: p53, CD-44, and factor viii. Multivariable analysis of interactions among molecular markers, gender, and histology demonstrates two important relationships (hazard ratio): p53+/women (2.269) and CD-44+/AC (2.266). CONCLUSIONS: Molecular biologic substaging of patients with stage I NSCLC demonstrates differential cancer-specific survival according to marker expression, gender, and histologic subtype.

Authors
D'Amico, TA; Aloia, TA; Moore, MB; Herndon, JE; Brooks, KR; Lau, CL; Harpole, DH
MLA Citation
D'Amico, TA, Aloia, TA, Moore, MB, Herndon, JE, Brooks, KR, Lau, CL, and Harpole, DH. "Molecular biologic substaging of stage I lung cancer according to gender and histology." Ann Thorac Surg 69.3 (March 2000): 882-886.
PMID
10750777
Source
pubmed
Published In
The Annals of Thoracic Surgery
Volume
69
Issue
3
Publish Date
2000
Start Page
882
End Page
886

Gene therapy for lung cancer.

Gene therapy is emerging as a promising modality for the treatment of lung cancer. Diverse strategies employing gene therapy for lung cancer have been investigated in vitro and in animal models, and a number of these approaches have met with promising results. Several phase I and II clinical trials have been undertaken, and early results suggest that it may be safe to administer gene therapy to lung cancer patients. It remains to be determined whether this modality will be efficacious as primary or adjunctive therapy in the setting of lung cancer.

Authors
Mosca, PJ; Morse, MA; D'Amico, TA; Crawford, J; Lyerly, HK
MLA Citation
Mosca, PJ, Morse, MA, D'Amico, TA, Crawford, J, and Lyerly, HK. "Gene therapy for lung cancer." Clin Lung Cancer 1.3 (February 2000): 218-226.
PMID
14733649
Source
pubmed
Published In
Clinical lung cancer
Volume
1
Issue
3
Publish Date
2000
Start Page
218
End Page
226

Cognitive decline after major noncardiac operations: a preliminary prospective study.

BACKGROUND: Cardiac operations frequently are complicated by postoperative cognitive decline. Less common and less studied is postoperative cognitive decline after noncardiac surgery, so we determined its incidence, severity, and possible predictors. METHODS: Twenty-nine patients who had thoracic and vascular procedures were studied. A neurocognitive test battery was administered preoperatively and 6 to 12 weeks postoperatively. A change score (preoperative minus postoperative) was calculated for each measure in each individual. Cognitive deficit (a measure of incidence) was defined as a 20% decrement in 20% or more of the completed tests. The average scores of all tests and the average decline (a measure of severity) were determined. RESULTS: The incidence of cognitive deficit was 44.8%. Overall the severity of the decline was an average of 15% decline. In the 44.8% of patients who had cognitive deficit, the severity was 24.7%. Multivariable predictors of cognitive decline were age (for incidence and severity) and years of education (for severity). CONCLUSIONS: Cognitive decline after noncardiac operations is a frequent complication of surgical procedures. The severity could preclude successful return to a preoperative lifestyle.

Authors
Grichnik, KP; Ijsselmuiden, AJ; D'Amico, TA; Harpole, DH; White, WD; Blumenthal, JA; Newman, MF
MLA Citation
Grichnik, KP, Ijsselmuiden, AJ, D'Amico, TA, Harpole, DH, White, WD, Blumenthal, JA, and Newman, MF. "Cognitive decline after major noncardiac operations: a preliminary prospective study." Ann Thorac Surg 68.5 (November 1999): 1786-1791.
PMID
10585059
Source
pubmed
Published In
The Annals of Thoracic Surgery
Volume
68
Issue
5
Publish Date
1999
Start Page
1786
End Page
1791

A biologic risk model for stage I lung cancer: immunohistochemical analysis of 408 patients with the use of ten molecular markers.

OBJECTIVE: The standard treatment of patients with stage I non-small cell lung cancer is resection of the primary tumor; however, the recurrence rate is 28% to 45%. This study evaluates a panel of molecular markers in a large population of patients with stage I non-small cell lung cancer to determine the prognostic value of each marker and to create a biologic risk model. METHODS: Pathologic specimens were collected from 408 consecutive patients after complete resection for stage I non-small cell lung cancer at a single institution, with follow-up of at least 5 years. A panel of 10 molecular markers was chosen for immunohistochemical analysis of the primary tumor on the basis of differing oncogenic mechanisms. Local tumor expansion requires growth regulating proteins (epidermal growth factor receptor, the protooncogene erb-b2); apoptosis proteins (p53, bcl-2); and cell cycle regulating proteins (retinoblastoma recessive oncogene, KI-67). Local tumor invasion requires angiogenesis (factor viii). The development of distant metastases involves the expression of adhesion proteins (CD-44, sialyl-Tn, blood group A). Cox proportional hazards regression analysis was used to construct an independent risk model for cancer recurrence and death. RESULTS: Multivariable analysis demonstrated significantly elevated risk for the following molecular markers: p53 (hazard ratio, 1.68; P =.004); factor viii (hazard ratio, 1.47 P =. 033); erb-b2 (hazard ratio, 1.43; P =.044); CD-44 (hazard ratio, 1. 40; P =.050); and retinoblastoma recessive oncogene (hazard ratio, 0. 747; P =.084). CONCLUSIONS: Five molecular markers were associated with the risk of recurrence and death, representing independent metastatic pathways: apoptosis (p53), angiogenesis (factor viii), growth regulation (erb-b2), adhesion (CD-44), and cell cycle regulation (retinoblastoma recessive oncogene). This study demonstrates the validity of this molecular biologic risk model in patients with stage I non- small cell lung cancer.

Authors
D'Amico, TA; Massey, M; Herndon, JE; Moore, MB; Harpole, DH
MLA Citation
D'Amico, TA, Massey, M, Herndon, JE, Moore, MB, and Harpole, DH. "A biologic risk model for stage I lung cancer: immunohistochemical analysis of 408 patients with the use of ten molecular markers." J Thorac Cardiovasc Surg 117.4 (April 1999): 736-743.
PMID
10096969
Source
pubmed
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
117
Issue
4
Publish Date
1999
Start Page
736
End Page
743

Malignant melanoma presenting as a mediastinal mass.

A case of malignant melanoma presenting as a mediastinal mass without an extrathoracic primary is reported. Microscopically the tumor appeared consistent with malignant melanoma, with the presence of focal melanin pigment in large epithelioid cells. Fontana stain confirmed the presence of melanin pigment. Immunohistochemical staining further suggested melanoma, with the tumor cells expressing a HMB45+, S100+ and cytokeratin-phenotype. Electron microscopy showed an abundance of melanosomes confirming the diagnosis of malignant melanoma.

Authors
Lau, CL; Bentley, RC; Gockerman, JP; Que, LG; D'Amico, TA
MLA Citation
Lau, CL, Bentley, RC, Gockerman, JP, Que, LG, and D'Amico, TA. "Malignant melanoma presenting as a mediastinal mass." Ann Thorac Surg 67.3 (March 1999): 851-852.
PMID
10215250
Source
pubmed
Published In
The Annals of Thoracic Surgery
Volume
67
Issue
3
Publish Date
1999
Start Page
851
End Page
852

Outcomes of lung transplant recipients with respiratory failure requiring mechanical ventilation

Authors
Wood, KA; Palmer, SM; Govert, J; Baz, MA; Steele, MP; Davis, RD; D'Amico, TA; Tapson, VF
MLA Citation
Wood, KA, Palmer, SM, Govert, J, Baz, MA, Steele, MP, Davis, RD, D'Amico, TA, and Tapson, VF. "Outcomes of lung transplant recipients with respiratory failure requiring mechanical ventilation." March 1999.
Source
wos-lite
Published In
American journal of respiratory and critical care medicine
Volume
159
Issue
3
Publish Date
1999
Start Page
A54
End Page
A54

Lung transplantation at Duke University Medical Center.

Lung transplantation is a viable therapy for patients with a variety of end-stage lung diseases. Our active program now includes over 200 lung transplant operations with acceptable one- and 3-year survival rates of 78% and 61%. A major focus of clinical research at this institution is to design strategies to prevent the development of chronic allograft dysfunction. Our preliminary work in this regard has been encouraging. In addition, a major research focus has been to design protocols to prevent the development of posttransplant infections. Our work with aerosolized ABLC represents a major advance at our center, and additional randomized prospective studies are ongoing to define the optimal antifungal prophylaxis after transplantation. Ongoing clinical and basic research at Duke and elsewhere should continue to advance the field of clinical transplantation and ultimately lead to more acceptable long-term outcomes for lung allograft recipients.

Authors
Lau, CL; Palmer, SM; D'Amico, TA; Tapson, VF; Davis, RD
MLA Citation
Lau, CL, Palmer, SM, D'Amico, TA, Tapson, VF, and Davis, RD. "Lung transplantation at Duke University Medical Center." Clin Transpl (1998): 327-340.
PMID
10503111
Source
pubmed
Published In
Clinical transplants
Publish Date
1998
Start Page
327
End Page
340

Right Upper Lobe Sleeve Resection

Authors
D'Amico, TA
MLA Citation
D'Amico, TA. "Right Upper Lobe Sleeve Resection." Operative Techniques in Thoracic and Cardiovascular Surgery 3.3 (1998): 178-182.
Source
scival
Published In
Operative Techniques in Thoracic and Cardiovascular Surgery
Volume
3
Issue
3
Publish Date
1998
Start Page
178
End Page
182
DOI
10.1016/S1522-2942(07)70088-0

Desensitization of myocardial beta-adrenergic receptors and deterioration of left ventricular function after brain death.

Brain death often results in a series of hemodynamic alterations that complicate the treatment of potential organ donors before transplantation. The deterioration of myocardial performance after brain death has been described; however, the pathophysiologic process of the myocardial dysfunction that occurs after brain death has not been elucidated. This study was designed to analyze the function of the myocardial beta-adrenergic receptor and the development of left ventricular dysfunction in a porcine model of experimental brain death. Analysis of the beta-receptor included determination of receptor density and adenylate cyclase activity after stimulation independently at the receptor protein, the G protein, and the adenylate cyclase moiety. Myocardial beta-receptor density did not change after the induction of brain death. A decrease in stimulated adenylate cyclase activity was observed within the first hour after brain death at the level of the beta-receptor, the G protein, and the adenylate cyclase moiety, which suggests the occurrence of rapid desensitization of beta-receptor function. Significant deterioration of myocardial performance also occurred within the first hour after brain death, represented by a decrease in preload-recruitable stroke work compared with the baseline value. The deterioration of myocardial performance after brain death correlates temporally with desensitization of the myocardial beta-receptor signal transduction system. The mechanism of impairment appears to be localized to the adenylate cyclase moiety itself.

Authors
D'Amico, TA; Meyers, CH; Koutlas, TC; Peterseim, DS; Sabiston, DC; Van Trigt, P; Schwinn, DA
MLA Citation
D'Amico, TA, Meyers, CH, Koutlas, TC, Peterseim, DS, Sabiston, DC, Van Trigt, P, and Schwinn, DA. "Desensitization of myocardial beta-adrenergic receptors and deterioration of left ventricular function after brain death." J Thorac Cardiovasc Surg 110.3 (September 1995): 746-751.
PMID
7564442
Source
pubmed
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
110
Issue
3
Publish Date
1995
Start Page
746
End Page
751

Effects of cardiac glycosides on myocardial function and energetics in conscious dogs.

The physiological effects of intravenous ouabain on left ventricular (LV) systolic function and metabolic-to-mechanical energy transfer were examined in eight conscious dogs. LV pressure and volume were measured using micromanometers and ultrasonic dimension transducers during transient vena caval occlusions under control conditions and after increasing doses of ouabain. Doppler coronary flow and coronary sinus O2 saturations were used to determine arterial-to-coronary sinus O2 content difference and thereby to calculate LV O2 consumption; total mechanical energy was computed as the sum of LV stroke work and the product of end-diastolic volume and LV mean ejection pressure, neglecting LV unstressed cavitary volume. The slope (10(4) erg/ml) of the stroke work vs. end-diastolic volume relationship increased progressively with rising doses of ouabain from 7.0 +/- 1.6 at control to 9.6 +/- 1.7 after ouabain 0.75 mg (P = 0.0002). Regression analysis of LV O2 consumption (mW/cm3) vs. total mechanical energy (mW/cm3) yielded a linear relationship that did not change with 0.75 mg of ouabain (P > 0.4). These data indicate that ouabain possesses a significant positive inotropic effect on the intact left ventricle without a change in energy transfer efficiency or O2 wasting.

Authors
Lucke, JC; Elbeery, JR; Koutlas, TC; Gall, SA; D'Amico, TA; Maier, GW; Rankin, JS; Glower, DD
MLA Citation
Lucke, JC, Elbeery, JR, Koutlas, TC, Gall, SA, D'Amico, TA, Maier, GW, Rankin, JS, and Glower, DD. "Effects of cardiac glycosides on myocardial function and energetics in conscious dogs." Am J Physiol 267.5 Pt 2 (November 1994): H2042-H2049.
PMID
7977836
Source
pubmed
Published In
The American journal of physiology
Volume
267
Issue
5 Pt 2
Publish Date
1994
Start Page
H2042
End Page
H2049

Stability of the beta-adrenergic receptor/adenylyl cyclase pathway of pediatric myocardium after brain death.

Our previous work in the adult porcine model shows that brain death results in a rapid decline in left ventricular systolic function as measured by the preload recruitable stroke work method to 8% of the baseline slope within 6 hours; this process is accompanied by functional uncoupling of the beta-adrenergic receptor at the level of the adenylyl cyclase moiety within 1 hour. In contrast, the pediatric porcine myocardium displays no change in left ventricular systolic function from baseline within 6 hours of brain death. This work investigates whether the beta-adrenergic receptor/adenylyl cyclase pathway remains intact after induction of brain death in the pediatric porcine model. Thirteen 1-month-old swine (7 to 10 kg) were anesthetized and underwent median sternotomy, and baseline transmural left ventricular biopsy specimens were obtained before ligation of head vessels to induce brain death in six piglets, with the remaining seven serving as controls. Baseline left ventricular biopsy specimens were obtained just before and 1 and 3 hours after brain death or at matched time points without brain death in the control group. Myocardial tissue was then analyzed for beta-adrenergic receptor density with the use of saturation [125I]-iodocyanopindolol binding in the absence and presence of propranolol 1 mumol/L. Coupling of the beta-adrenergic receptor to its signal transduction system (stimulation of adenylyl cyclase) was tested at three levels: beta-adrenergic receptor (isoproterenol 100 mumol/L), stimulatory G protein Gs (sodium fluoride 10 mmol/L), and the adenylyl cyclase moiety itself (forskolin 100 mumol/L).(ABSTRACT TRUNCATED AT 250 WORDS)

Authors
Peterseim, DS; Chesnut, LC; Meyers, CH; D'Amico, TA; Van Trigt, P; Schwinn, DA
MLA Citation
Peterseim, DS, Chesnut, LC, Meyers, CH, D'Amico, TA, Van Trigt, P, and Schwinn, DA. "Stability of the beta-adrenergic receptor/adenylyl cyclase pathway of pediatric myocardium after brain death." J Heart Lung Transplant 13.4 (July 1994): 635-640.
PMID
7947880
Source
pubmed
Published In
The Journal of Heart and Lung Transplantation
Volume
13
Issue
4
Publish Date
1994
Start Page
635
End Page
640

Improved tolerance of the pediatric myocardium to brain death.

The occurrence of brain death has been shown to significantly diminish left ventricular function in the adult porcine model. This study examined whether the pediatric myocardium is as sensitive as the adult myocardium to the detrimental effects of brain death in the porcine model. Left ventricular intracavitary pressure and major and minor axis epicardial dimensions were measured in eleven 1-month old pigs (7.5 to 10 kg) during a vena caval occlusion. Brain death was induced in six pigs by acutely ligating the brachiocephalic and left subclavian arteries. The remaining five pigs served as controls. Data were then collected every hour for 6 hours. The plot of the stroke work versus the end diastolic volume, called the preload recruitable stroke work relationship, was determined from the measured pressure and calculated intracavitary volume data. The slope of this linear relationship is an index of contractility, and the x intercept (Vo) is an index of diastolic mechanics. At each hour after instrumentation two vena caval occlusions were performed, and the mean slope of the preload recruitable stroke work line was calculated as a percentage of the baseline slope in both the brain-dead and control group. The mean values from the brain-dead pigs were 118%, 138%, 126%, 154%, 123%, and 87% of the baseline value for the 6 hours after brain death. The mean control values were 128%, 117%, 133%, 123%, 114%, and 111% of baseline for the 6 hours after instrumentation alone.(ABSTRACT TRUNCATED AT 250 WORDS)

Authors
Peterseim, DS; Meyers, CH; Craig, DM; Davis, JW; Campbell, KA; D'Amico, TA; Van Trigt, P
MLA Citation
Peterseim, DS, Meyers, CH, Craig, DM, Davis, JW, Campbell, KA, D'Amico, TA, and Van Trigt, P. "Improved tolerance of the pediatric myocardium to brain death." J Heart Lung Transplant 12.6 Pt 2 (November 1993): S236-S240.
PMID
8312342
Source
pubmed
Published In
The Journal of Heart and Lung Transplantation
Volume
12
Issue
6 Pt 2
Publish Date
1993
Start Page
S236
End Page
S240

The efficiency of pulmonary blood transport following single lung transplantation.

Perioperative right ventricular (RV) dysfunction remains a significant problem following single lung transplantation (SLT), especially in patients with pulmonary hypertension. Total RV power (Wt), a determinant of RV function, is the sum of the mean component (Wm) which contributes to actual blood flow and the oscillatory component (Wo) which is the energy expended on arterial pulsation. Calculation of Wo is possible only through harmonic analysis of pulmonary arterial (PA) pressure and flow waveforms, and as much as 33% of RV power is attributed to it. The purpose of this study was to precisely quantify changes in RV power output using Fourier analysis of PA pressure and flow waveforms after SLT. Fourteen dogs (donors) were instrumented with a PA ultrasonic flow probe, PA and left atrial (LA) micromanometers, and LA epicardial pacing leads. Control (Pre-Tx) pressure-flow data were acquired during transient occlusion of the right PA at a heart rate of 140. The PA was cannulated, the lungs were flushed with 1 liter of modified Euro-Collins solution at 4 degrees C, and the left lung was harvested and transplanted to 14 recipient dogs in a standard manner. After 1 hr of reperfusion, PA (Post-Tx) pressure-flow data were acquired as above. All recipient animals survived SLT with a mean ischemic time of 183 +/- 3 min. Following SLT, both the mean, Wm, (69 +/- 9 to 161 +/- 23 mW) and oscillatory, Wo, (23 +/- 3 to 46 +/- 10 mW) components of RV power output increased significantly after SLT (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Authors
Meyers, CH; D'Amico, TA; Peterseim, DS; Uppal, R; Purut, CM; Smith, PK; Sabiston, DC; Van Trigt, P
MLA Citation
Meyers, CH, D'Amico, TA, Peterseim, DS, Uppal, R, Purut, CM, Smith, PK, Sabiston, DC, and Van Trigt, P. "The efficiency of pulmonary blood transport following single lung transplantation." J Surg Res 54.4 (April 1993): 286-292.
PMID
8331922
Source
pubmed
Published In
Journal of Surgical Research
Volume
54
Issue
4
Publish Date
1993
Start Page
286
End Page
292
DOI
10.1006/jsre.1993.1045

Effects of triiodothyronine and vasopressin on cardiac function and myocardial blood flow after brain death.

Previous studies have documented decreases in serum-free triiodothyronine (T3) after brain death and improved hemodynamics with its replacement, suggesting its controversial, but promising, clinical utility for managing potential organ donors. Vasopressin is also commonly used clinically as a pressor agent after brain death. A load-independent analysis of cardiac function and an assessment of myocardial blood flow (MBF) with these agents have not been reported, however. Eighteen pigs were instrumented with left ventricular epicardial dimension transducers and a left ventricular micromanometer. MBF was assessed by standard microsphere techniques. Baseline left ventricular pressure-dimension data were collected, and brain death was induced by ligating the innominate and left subclavian arteries. Left ventricular function data were collected every 30 minutes after brain death to 6 hours or until the animal died. Microsphere injections were performed before brain death and hourly thereafter to 4 hours. At 90 minutes after brain death, animals were assigned to a vasopressin (2 units/hr, intravenously, n = 6), T3 (0.05 microgram/kg/hr, intravenously, n = 6), or control (n = 6) treatment group. Preload recruitable stroke work (PRSW), a load-independent index of left ventricular function, was derived from the pressure-dimension data. MBF was calculated by conventional methods. At 4 hours after brain death, PRSW and MBF decreased significantly in the control, vasopressin, and T3 groups relative to the baseline, pre-brain dead state (PRSW: -36% +/- 12%, -48 +/- 7%, -52% +/- 5%; MBF: -27% +/- 15%, -38% +/- 5%, -78% +/- 2%, respectively). Neither vasopressin nor T3, however, showed any advantage over the control group in terms of preserving left ventricular function or prolonging survival. Furthermore, these data show a marked decrease in MBF in the T3 group (p < 0.01 versus control and vasopressin groups) without a significant change in cardiac function. Analysis of endocardial to epicardial flow ratios disclosed no significant differences between groups at any time. In summary, animals treated with T3 had a greater decline in MBF than the control group at 4 hours, without any benefit to cardiac function. Further studies examining the mechanism responsible for the deterioration of MBF and cardiac dysfunction will be necessary to optimally manage the brain dead patient before organ harvest, especially regarding the precise role of T3.

Authors
Meyers, CH; D'Amico, TA; Peterseim, DS; Jayawant, AM; Steenbergen, C; Sabiston, DC; Van Trigt, P
MLA Citation
Meyers, CH, D'Amico, TA, Peterseim, DS, Jayawant, AM, Steenbergen, C, Sabiston, DC, and Van Trigt, P. "Effects of triiodothyronine and vasopressin on cardiac function and myocardial blood flow after brain death." J Heart Lung Transplant 12.1 Pt 1 (January 1993): 68-79.
PMID
8443205
Source
pubmed
Published In
The Journal of Heart and Lung Transplantation
Volume
12
Issue
1 Pt 1
Publish Date
1993
Start Page
68
End Page
79

Improved tolerance of the pediatric myocardium to brain death

The occurrence of brain death has been shown to significantly diminish left ventricular function in the adult porcine model. This study examined whether the pediatric myocardium is as sensitive as the adult myocardium to the detrimental effects of brain death in the porcine model. Left ventricular intracavitary pressure and major and minor axis epicardial dimensions were measured in eleven 1-month old pigs (7.5 to 10 kg) during a vena caval occlusion. Brain death was induced in six pigs by acutely ligating the brachiocephalic and left subclavian arteries. The remaining five pigs served as controls. Data were then collected every hour for 6 hours. The plot of the stroke work versus the end diastolic volume, called the preload recruitable stroke work relationship, was determined from the measured pressure and calculated intracavitary volume data. The slope of this linear relationship is an index of contractility, and the x intercept (V(o)) is an index of diastolic mechanics. At each hour after instrumentation two vena caval occlusions were performed, and the mean slope of the preload recruitable stroke work line was calculated as a percentage of the baseline slope in both the brain-dead and control group. The mean values from the brain-dead pigs were 118%, 138%, 126%, 154%, 123%, and 87% of the baseline value for the 6 hours after brain death. The mean control values were 128%, 117%, 133%, 123%, 114%, and 111% of baseline for the 6 hours after instrumentation alone. There was no statistical difference between groups with the rank sum test. The shift in the x intercept was calculated for each group at each hour as well. The mean group shifts from the baseline V(o) in the brain-dead pigs were 0.97, 2.40, 2.63, 4.86, 5.00, and 5.00 ml. The mean control group shifts from the baseline V(o) were -0.63, 2.85, 3.29, 2.76, 2.96, and 2.69 ml. Only at the fourth and fifth hours were there any statistically significant differences between the groups with the rank sum test (p < 0.03). During acute brain death, the pediatric porcine myocardium is significantly more stable than the adult porcine myocardium, which rapidly declines to 8% of the baseline slope within 6 hours of brain death. If the mechanism for this tolerance is determined, perhaps it could be applied to the adult population of brain-dead donors to expand the organ supply. We conclude that in the porcine model of brain death, the pediatric myocardium demonstrates no decremental decline in left ventricular systolic function in contrast to the adult myocardium.

Authors
Peterseim, DS; Meyers, CH; Craig, DM; Davis, JW; Campbell, KA; D'Amico, TA; Trigt, PV
MLA Citation
Peterseim, DS, Meyers, CH, Craig, DM, Davis, JW, Campbell, KA, D'Amico, TA, and Trigt, PV. "Improved tolerance of the pediatric myocardium to brain death." Journal of Heart and Lung Transplantation 12.6 II (1993): S236-S240.
Source
scival
Published In
Journal of Heart and Lung Transplantation
Volume
12
Issue
6 II
Publish Date
1993
Start Page
S236
End Page
S240

Effects of triiodothyronine and vasopressin on cardiac function and myocardial blood flow after brain death

Previous studies have documented decreases in serum-free triiodothyronine (T3) after brain death and improved hemodynamics with its replacement, suggesting its controversial, but promising, clinical utility for managing potential organ donors. Vasopressin is also commonly used clinically as a pressor agent after brain death. A load-independent analysis of cardiac function and an assessment of myocardial blood flow (MBF) with these agents have not been reported, however. Eighteen pigs were instrumented with left ventricular epicardial dimension transducers and a left ventricular micromanometer. MBF was assessed by standard microsphere techniques. Baseline left ventricular pressure-dimension data were collected, and brain death was induced by ligating the innominate and left subclavian arteries. Left ventricular function data were collected every 30 minutes after brain death to 6 hours or until the animal died. Microsphere injections were performed before brain death and hourly thereafter to 4 hours. At 90 minutes after brain death, animals were assigned to a vasopressin (2 units/hr, intravenously, n = 6), T3 (0.05 μg/kg/hr, intravenously, n = 6), or control (n = 6) treatment group. Preload recruitable stroke work (PRSW), a load-independent index of left ventricular function, was derived from the pressure-dimension data. MBF was calculated by conventional methods. At 4 hours after brain death, PRSW and MBF decreased significantly in the control, vasopressin, and T3 groups relative to the baseline, pre-brain dead state (PRSW: -36% ± 12%, -48% ± 7%, -52% ± 5%; MBF: -27% ± 15%, -38% ± 5%, -78% ± 2%, respectively). Neither vasopressin nor T3, however, showed any advantage over the control group in terms of preserving left ventricular function or prolonging survival. Furthermore, these data show a marked decrease in MBF in the T3 group (p < 0.01 versus control and vasopressin groups) without a significant change in cardiac function. Analysis of endocardial to epicardial flow ratios disclosed no significant differences between groups at any time. In summary, animals treated with T3 had a greater decline in MBF than the control group at 4 hours, without any benefit to cardiac function. Further studies examining the mechanism responsible for the deterioration of MBF and cardiac dysfunction will be necessary to optimally manage the brain dead patient before organ harvest, especially regarding the precise role of T3.

Authors
Meyers, CH; D'Amico, TA; Peterseim, DS; Jayawant, AM; Steenbergen, C; Jr, DCS; Trigt, PV; Young, J; Egan, T; McKeown, P
MLA Citation
Meyers, CH, D'Amico, TA, Peterseim, DS, Jayawant, AM, Steenbergen, C, Jr, DCS, Trigt, PV, Young, J, Egan, T, and McKeown, P. "Effects of triiodothyronine and vasopressin on cardiac function and myocardial blood flow after brain death." Journal of Heart and Lung Transplantation 12.1 I (1993): 68-80.
Source
scival
Published In
Journal of Heart and Lung Transplantation
Volume
12
Issue
1 I
Publish Date
1993
Start Page
68
End Page
80

Pulmonary arterial impedance after single lung transplantation.

Single lung transplantation (SLT) is emerging as definitive therapy for end-stage pulmonary disease of varying etiology, yet a complete description of the hemodynamic properties of the transplanted lung has not been reported. In this study, Fourier analysis was used to calculate the pulmonary arterial (PA) impedance spectrum before and immediately after SLT to define precisely the pulmonary pressure-flow relationship. Median sternotomies were performed in 18 dogs (donors): an ultrasonic flow probe was placed around the PA and micromanometers were placed in the PA and left atrium (LA). Control PA pressure and flow (PAQ) and LA pressure were measured during transient occlusion of the right PA. The lungs were harvested using cold modified Euro-Collins solution for preservation. After thoracotomy and pneumonectomy, left SLT was performed in 18 recipient dogs with a mean ischemic time of 179 +/- 6 min. After reperfusion for 1 hr, PA pressure and flow data were again collected. Characteristic impedance (Z0), a measure of resistance to pulsatile flow, was compared to input resistance (Rin), a measure of resistance to mean flow, and pulmonary vascular resistance (PVR), the conventional index. Rin is defined as the zeroth harmonic of the impedance spectrum and Z0 as the mean of impedance moduli from 2-12 Hz. All recipients survived transplantation. Both PVR and Rin increased significantly after transplantation (11 +/- 1 vs 19 +/- 3 Wood U, P less than 0.05, and 1352 +/- 121 vs 1964 +/- 244 dyne.sec.cm-5, P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Authors
Meyers, CH; Purut, CM; D'Amico, TA; Smith, PK; Sabiston, DC; Van Trigt, P
MLA Citation
Meyers, CH, Purut, CM, D'Amico, TA, Smith, PK, Sabiston, DC, and Van Trigt, P. "Pulmonary arterial impedance after single lung transplantation." J Surg Res 52.5 (May 1992): 459-465.
PMID
1619914
Source
pubmed
Published In
Journal of Surgical Research
Volume
52
Issue
5
Publish Date
1992
Start Page
459
End Page
465

The preservation of cardiac function after brain death: A myocardial pressure-dimension analysis

Authors
D'Amico, TA; Buchanan, SA; Lucke, JC; Koutlas, TC; Soto, PF; Gall, SA; Trigt, PV
MLA Citation
D'Amico, TA, Buchanan, SA, Lucke, JC, Koutlas, TC, Soto, PF, Gall, SA, and Trigt, PV. "The preservation of cardiac function after brain death: A myocardial pressure-dimension analysis." Surgical Forum 41 (1990): 277-279.
Source
scival
Published In
Surgical Forum
Volume
41
Publish Date
1990
Start Page
277
End Page
279

Effects of global ischemia on the metabolic to mechanical energy transfer characteristics of the left ventricle

Authors
Lucke, JC; Koutlas, TC; Jr, SAG; D'Amico, TA; Glower, DD; Rankin, JS
MLA Citation
Lucke, JC, Koutlas, TC, Jr, SAG, D'Amico, TA, Glower, DD, and Rankin, JS. "Effects of global ischemia on the metabolic to mechanical energy transfer characteristics of the left ventricle." Surgical Forum 41 (1990): 254-257.
Source
scival
Published In
Surgical Forum
Volume
41
Publish Date
1990
Start Page
254
End Page
257

Effect of blood cardioplegia reperfusion on recovery of ventricular function after global myocardial ischemia

Authors
Koutlas, TC; Lucke, JC; Jr, SAG; D'Amico, TA; Rankin, JS; Glower, DD
MLA Citation
Koutlas, TC, Lucke, JC, Jr, SAG, D'Amico, TA, Rankin, JS, and Glower, DD. "Effect of blood cardioplegia reperfusion on recovery of ventricular function after global myocardial ischemia." Surgical Forum 41 (1990): 230-233.
Source
scival
Published In
Surgical Forum
Volume
41
Publish Date
1990
Start Page
230
End Page
233
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