Lymphovascular invasion is associated with a worse overall survival in patients with resected non-small cell lung cancer regardless of tumor stage. Parietal pleural involvement, N2 nodal disease, and advanced age independently predict poor overall survival.

A best evidence topic was written according to a structured protocol. The question addressed was whether the extent of pulmonary resection affects survival in patients with synchronous multiple primary lung cancers undergoing curative surgery. A total of 724 papers were identified using the reported searches, of which 14 represented the best evidence to answer the clinical question. The authors, date, journal, country, study type, population, outcomes and key results are tabulated. All studies were retrospective. Eight of 14 studies found no difference in terms of median, overall or progression-free survival when a sublobar resection in the form of a wedge resection or segmentectomy was performed for at least one of the synchronous lesions. Two studies demonstrated a negative impact on survival when lobectomy or bilobectomy was not performed for each lesion. Five papers reviewed the role of pneumonectomy in this category of patients and four of them demonstrated that such an extended resection has a significantly negative impact on survival, while, in one study, although pneumonectomy when compared with sublobar resections and photodynamic therapy had decreased long-term survival, this difference did not reach statistical significance. The use of lung-sparing resections (wedge resection or segmentectomy) of at least one lesion (if technically feasible) is advised for patients with synchronous multiple primary lung cancers. Most studies do not demonstrate any differences in immediate or long-term survival with two anatomical resections. Embarking for anatomical lung resections in the form of lobectomies should be done only in those cases where there are no concerns about postoperative pulmonary reserve. The performance of a pneumonectomy should be avoided, especially for bilateral synchronous lesions, unless it is absolutely necessary.

Increasing age and postoperative infection are most strongly associated with POAF. Adoption of enhanced recovery protocols, along with more rigorous monitoring and early treatment of postoperative infection may help reduce POAF and its associated morbidity. Rhythm assessment is crucial to identify persistent AF after discharge, and clinicians should be vigilant for recurrence of AF at follow-up.

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was 'in patients with primary lung carcinoma, does the sequence of pulmonary vasculature ligation during anatomical lung resection influence the oncological outcomes?' A total of 48 papers were found using the reported search, of which 7 represented the best evidence to answer the question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Among six prospective studies included, five of them randomized patients to either pulmonary vein or artery occlusion first during anatomical lung resection, while one study was retrospective. Two reports did not find any difference between pulmonary vein and artery occlusion first during long-term follow-up in terms of either disease recurrence (51 vs 53%, P = 0.7), or 5-year overall survival (54 vs 50%, P = 0.82). One report did not find any difference with regard to circulating tumour cells either after thoracotomy (5.0 vs 3.9, P = 0.4), or after the completion of lobectomy (38.0 vs 70.0, P = 0.23). One report found a higher expression of CD44v6 (P = 0.008) and CK19 (P = 0.05) in patients undergoing pulmonary arterial occlusion first. One report found that pulmonary vein occlusion before that of the pulmonary arterial branches has a favourable outcome on circulating carcino-embryonic antigen (CEA) mRNA in the peripheral blood, while another one did not find a significant difference in circulating levels of CEA mRNA (P = 0.075) and CK19 mRNA (P = 0.086) with either method. Another study reported no correlation between circulating pin1 mRNA levels in peripheral blood after the completion of the resection and the sequence of ligation of pulmonary vessels (9.95 ± 0.91 vs 14.71 ± 1.64, P > 0.05). Based on the two studies assessing the long-term outcome of patients with primary lung cancer undergoing anatomical curative resection, the sequence of ligation of pulmonary vessels does not seem to influence the oncological outcomes or survival. However, the other studies focusing on the influence of these techniques on circulating tumour cells or their molecular products report conflicting results the clinical consequences of which cannot be predicted.