Background: The National Emphysema Treatment Trial (NETT) demonstrated that lung volume reduction surgery (LVRS) is an effective treatment for emphysema in select patients. With chronic lower respiratory disease being the third leading cause of death in the US, this study sought to assess practice patterns and outcomes for LVRS on a national level since the NETT. Methods: Aggregate statistics on LVRS reported in the Society of Thoracic Surgeons (STS) Database from January 2003 to June 2011 were analyzed to assess procedure volume, pre-operative and operative characteristics, and outcomes. Comparisons to published data from the NETT were made using chi-squared and two sided t-tests. Results: In 8.5 years, 538 patients underwent LVRS, with 20 to 118 cases reported in the STS database per year. When compared to NETT subjects, STS patients were younger (p<0.001), a larger proportion underwent the procedure thoracoscopically (p<0.001), and FEV1 was 31% vs. 28% of predicted (p<0.001). When mortality was compared between STS patients and all NETT subjects randomized to surgery, there were no significant differences. However, mortality was 3% higher in STS patients when compared to the non-high risk NETT subset (p=0.005). Conclusions: This study demonstrates the importance of patient selection and the need to develop consensus on appropriate benchmarks for mortality rates after lung volume reduction surgery. It underscores the need for dedicated centers to increasingly address the heavy burden of chronic lower respiratory disease in the US in a multi-disciplinary fashion, particularly for preoperative evaluation and postoperative management of emphysema.

HighlightsWe discuss a case of isolated splenic tuberculosis.Extra-pulmonary tuberculosis can present in the immunocompetent patient.Splenectomy is indicated when GI bleeding due to portal hypertension and splenomegaly occurs, as well as failure of medical therapy, cytopenia and multiple splenic abscess.

Single lung transplants (SLTs) leave in place a diseased lung, a potential source of complications. Native lung pneumonectomy is occasionally indicated. We present 2 cases of native lung complications (NLCs) managed with video-assisted thoracoscopic surgery (VATS) pneumonectomy at our institution, a procedure never reported in this context before. Case 1 involves a 59-year old gentleman with refractory, invasive pulmonary aspergillosis of the native lung, 5 years after SLT for idiopathic pulmonary fibrosis. Case 2 involves a 66-year old gentleman with α-1 antitrypsin deficiency who developed severe haemoptysis and intraparenchymal haemorrhage in the native lung 12 years after SLT. A VATS pneumonectomy was performed in both cases because we believed it would facilitate wound healing and hasten recovery in immunosuppressed patients. Our short-term results align with this hypothesis. We conclude that VATS pneumonectomy is a feasible, adequate and safe procedure in this patient population; larger series are needed to draw definitive conclusions.

A 66 year old female was found to have an ampullary mass on endoscopic examination. A pancreaticoduodenectomy was performed and the pathology was consistent with carcinoid tumor. Carcinoid tumors of the ampulla of Vater are rare tumors of the gastrointestinal tract, accounting for 0.3-1% of gastrointestinal carcinoids. Management of ampullary carcinoid tumor with pancreaticoduodenectomy is in accordance with current recommendations.

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