No abstract

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: 'Does lobectomy achieve better survival and recurrence rates than limited pulmonary resection for T1N0M0 non-small cell lung cancer patients?' Altogether 225 papers were found using the reported search, of which nineteen represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. A meta-analysis published in 2005 showed a 0.7% (P=0.3659) survival difference at one year, 1.9% (P=0.5088) at three years and 3.6% (P=0.3603) at five years. The largest study prior to the meta-analysis was a randomized controlled study of 247 patients with T1N0 tumors that showed eight locoregional recurrences in the lobectomy group compared to 21 in the sublobar group, which was statistically significant. Since the meta-analysis we identified three studies, two of which showed no difference in survival and recurrence between wedge resection and lobectomy for T1N0 tumors and one that showed improved survival after lobectomy compared to wedge resection for T1N0 tumors. We conclude that wedge resection is not comparable to lobectomy for stage IA NSCLC. The increased long-term mortality associated with wedge resection is mainly due to non-cancer deaths, reflecting a higher risk patient group with many comorbid conditions. Segmental resection is comparable to lobectomy for small peripheral tumors. Sublobar resection is associated with shorter hospital stay. For bronchioalveolar carcinoma sublobar resection is recommended provided intra-operative pathologic consultation confirms pure bronchioalveolar histology without evidence of invasion, and surgical margins are free of disease.

Informed consent prior to any surgical intervention should include in-hospital survival estimation after the procedure performed. The recently developed Thoracoscore predicts well the postoperative mortality possibility. The purpose of our study was to test the modified Thoracoscore performance in our new thoracic program. One hundred and fifty-five consecutive patients underwent thoracic surgery procedure within two years. The procedures performed were: 62 lung resections, 10 open tumor biopsies, 21 neck and mediastinal procedures, 33 chest wall and pleural procedures, 8 tracheal procedures, 3 esophageal procedures, 13 minor cardiac procedures, and 5 chest trauma cases. The modified Thoracoscore was calculated based on the following variables: age, gender, priority of the procedure, malignancy, type of procedure, Zubrod score, ASA class, and number of co-morbidities. The observed mortality was 5.2% (eight deaths) while the predicted one based on the modified Thoracoscore was 4.9%. The scoring system we used had excellent discriminatory ability with a C statistic (0.95, 95% CIs 0.91-0.99). The Hosmer-Lemeshow goodness-of-fit was not statistically significant (P=0.82), indicating acceptable calibration of the model for the present series. The modified Thoracoscore's ability to predict postoperative survival in the whole context of thoracic surgery performs well in our program. Application of any risk scoring system requires external validation and provides comparison of the actual outcomes with other programs.