Monday - Thoracic Surgery News

14 AATS 93 RD ANNUAL MEETING MINNEAPOLIS CONVENTION CENTER • MINNEAPOLIS, MN • MAY 4 – 8, 2013
Continued from page 13
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Experts Featured in General Thoracic Symposium
The General Thoracic Surgery
Symposium featured talks on
topics ranging from stage 1
non–small cell lung cancer
(NSCLC), to esophageal anastomosis,
to the use of VAC negative pressure
wound therapy for complicated
infections.
With tuberculosis an increasing
problem in the modern world, John
Mitchell, MD, reviewed treatment
strategies for tuberculosis patients,
mainly those with multi-drug-resistant
infection, who are referred for
surgery. Dr. Mitchell, of the University
of Colorado, said that surgical
resection as an adjunct to medical
therapy has shown benefits in multiple
studies. Surgery is favored in
patients with localized lung damage,
including cavitation and destroyed
tissue, that might be a focus
of persistent disease in those who
do not have access to or are intolerant
of chemotherapy.
“Lobectomy and pneumonectomy
by means of a thoracotomy are
the most commonly performed
procedures, although a minimally
Dr. Mitchell addressed the role of
minimially invasive approaches to TB.
invasive approach is feasible in
some patients,” Dr. Mitchell said,
pointing out that results can be
good, with relatively low mortality
rates (0%-5%) and greater than 90%
sputum conversion being achievable.
He also discussed the potential
role of surgery in treating the rarer
“nontuberculous mycobacteria”
(NTM), ubiquitous environmental
MARTIN ALLRED
Dr. Lanuti pointed out the value of RFA
for select, high-risk NSCLC patients.
pathogens that can attack patients
with damaged lungs or compromised
immune systems and is often
drug resistant. “Lung resection has
been found to reduce relapse rates
and to improve eradication of the
infection by removing damaged areas
of lung parenchyma,” Dr.
Mitchell said.
“Untreated stage I NSCLC has a 1-
year survival rate of around 75% but
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survival rapidly declines to 50% by 9
months, with very few patients alive
5 years after the diagnosis,” said
Massachusetts General Hospital’s
Michael Lanuti, MD.
Dr. Lanuti stressed the need for
alternative treatments for those
20%-30% of patients deemed ineligible
or at high risk for the “gold
standard” treatment, lobectomy. He
discussed the role of radiofrequency
ablation (RFA) and stereotactic
body radiotherapy (SBRT) in their
treatment.
“RFA is a reasonable treatment for
high risk stage I NSCLC patients
who have peripheral lesions less than
3 cm, but not for those patients who
have lesions adjacent to major bronchovascular
structures, or the esophagus,”
he advised. Despite the lack of
phase III trial data, SBRT is preferred
for medically inoperable patients
with peripheral T1/2N0 (less than 5
cm) NSCLC, with a modified treatment
for patients with tumors close
to the bronchial tree,” Dr. Lanuti
said.
“Navigational bronchoscopy will
continue to play a major role in diagnostics,
especially with the development
of improved biopsy instrumentation
and catheters,” said Douglas
Minnich, MD, of the University
of Alabama, in his discussion of the
foundations of the technique, its inerpretation
and value.
5” modified chest spreader retractor
for either a proximal or distal
mini-sternotomy procedure
The universal lift is attached to the
sternal retractor arm and is used to
lift the patient’s left chest one to
two inches
Navigational broncoscopy has a firm
future, said Douglas Minnich, MD.
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