Background The Society of Thoracic Surgeons (STS) creates risk adjustment models for common cardiothoracic operations for quality improvement purposes. Our aim was to update the lung cancer resection risk model utilizing the STS General Thoracic Surgery Database (GTSD) with a larger and more contemporary cohort. Methods We queried the STS GTSD for all surgical resections of lung cancers from January 1, 2012 through December 31, 2014 Logistic regression was used to create three risk models for adverse events: operative mortality, major morbidity and composite mortality and major morbidity. Results 27,844 lung cancer resections were performed at 231 centers. 62% (n=17,153) were performed via thoracoscopy. The mortality rate was 1.4% (n=401), major morbidity rate was 9.1% (n=2,545) and the composite rate was 9.5% (2,654). Predictors of mortality included age, male gender, FEV1, body mass index, cerebrovascular disease, steroids, coronary disease, peripheral vascular disease, renal dysfunction, Zubrod score, American Society of Anesthesiologists rating, thoracotomy approach, induction therapy, reoperation, tumor stage, and greater extent of resection. (all p<0.05). For major morbidity and the composite measure, cigarette smoking becomes a risk factor while stage, renal dysfunction, congestive heart failure, and cerebrovascular disease lose significance. Conclusions Operative mortality and complication rates are low for lung cancer resection among surgeons participating in the GTSD. Risk factors from the prior lung cancer resection model are refined and new risk factors such as prior thoracic surgery are identified. The GTSD risk models continue to evolve as more centers report and data is audited for quality assurance.

We performed a phase I trial of FANG vaccine, an autologous tumor-based product incorporating a plasmid encoding granulocyte-macrophage colony-stimulating factor (GMCSF) and a novel bifunctional short hairpin RNAi (bi-shRNAi) targeting furin convertase, thereby downregulating endogenous immunosuppressive transforming growth factors (TGF) β1 and β2. Patients with advanced cancer received up to 12 monthly intradermal injections of FANG vaccine (1 × 10(7) or 2.5 × 10(7) cells/ml injection). GMCSF, TGFβ1, TGFβ2, and furin proteins were quantified by enzyme-linked immunosorbent assay (ELISA). Safety and response were monitored. Vaccine manufacturing was successful in 42 of 46 patients of whom 27 received ≥1 vaccine. There were no treatment-related serious adverse events. Most common grade 1, 2 adverse events included local induration (n = 14) and local erythema (n = 11) at injection site. Post-transfection mean product expression GMCSF increased from 7.3 to 1,108 pg/10(6) cells/ml. Mean TGFβ1 and β2 effective target knockdown was 93.5 and 92.5% from baseline, respectively. Positive enzyme-linked immunospot (ELISPOT) response at month 4 was demonstrated in 9 of 18 patients serially assessed and correlated with survival duration from time of treatment (P = 0.025). Neither dose-adverse event nor dose-response relationship was noted. In conclusion, FANG vaccine was safe and elicited an immune response correlating with prolonged survival. Phase II assessment is justified.

Background To revise the model for perioperative risk for esophagectomy for cancer utilizing the Society of Thoracic Surgeons General Thoracic Surgery Database in order to provide enhanced risk stratification and quality improvement measures for contributing centers. Methods The Society of Thoracic Surgeons General Thoracic Surgery Database was queried for all patients treated for esophageal cancer with esophagectomy between July 1, 2011 and June 30, 2014. Multivariable risk models for major morbidity, perioperative mortality and combined morbidity and mortality were created with the inclusion of surgical approach as a risk factor. Results 4321 esophagectomies were performed by 164 participating centers. The most common procedures included: Ivor Lewis (32.5%), Transhiatal (21.7%), Minimally Invasive esophagectomy, Ivor Lewis type (21.4%) and McKeown (10.0%). Sixty-nine percent of patients received induction therapy. Perioperative mortality (inpatient and 30-day) was 135/4321 (3.4%). Major morbidity occurred in 1429 patients (33.1%). Major morbidities include unexpected return to OR (15.6%), anastomotic leak (12.9%), reintubation (12.2%), initial ventilation beyond 48 hours (3.5%), pneumonia (12.2%), renal failure (2.0%), recurrent laryngeal nerve paresis (2.0%). Statistically significant predictors of combined major morbidity or mortality included: age >65, BMI ≥35, preoperative congestive heart failure, Zubrod score >1, McKeown Esophagectomy, current or former smoker and squamous cell histology. Conclusion Thoracic surgeons participating in the Society of Thoracic Surgeons General Thoracic Surgery Database perform esophagectomy with low morbidity and mortality. McKeown esophagectomy is an independent predictor of combined postoperative morbidity or mortality. Revised predictors for perioperative outcome were identified to facilitate quality improvement processes and hospital comparisons.

In 4 centers with beating-heart operation experience, there is an overall early benefit in off-pump surgery, especially in patients traditionally considered at high risk for coronary artery bypass grafting.