Postinduction therapy pulmonary function retesting is necessary before surgical resection for non-small cell lung cancer.

OBJECTIVE: Pretreatment-predicted postoperative diffusing capacity of the lung for carbon monoxide (DLCO) has been associated with operative mortality in patients who receive induction therapy for resectable non-small cell lung cancer (NSCLC). It is unknown whether a reduction in pulmonary function after induction therapy and before surgery affects the risk of morbidity or mortality. We sought to determine the relationship between induction therapy and perioperative outcomes as a function of postinduction pulmonary status in patients who underwent surgical resection for NSCLC. METHODS: We retrospectively reviewed data for 1001 patients with pathologic stage I, II, or III NSCLC who received induction therapy before lung resection. Pulmonary function was defined according to American College of Surgeons Oncology Group major criteria: DLCO ≥50% = normal; DLCO <50% = impaired. Patients were categorized into 5 subgroups according to combined pre- and postinduction DLCO status: normal-normal, normal-impaired, impaired-normal, impaired-impaired, and preinduction only (without postinduction pulmonary function test measurements). Multivariable logistic regression was used to quantify the relationship between DLCO categories and dichotomous end points. RESULTS: In multivariable analysis, normal-impaired DLCO status was associated with an increased risk of respiratory complications (odds ratio, 2.29 [95% CI, 1.12-4.49]; P = .02) and in-hospital complications (odds ratio, 2.83 [95% CI, 1.55-5.26]; P < .001). Type of neoadjuvant therapy was not associated with an increased risk of complications, compared with conventional chemotherapy. CONCLUSIONS: Reduced postinduction DLCO might predict perioperative outcomes. The use of repeat pulmonary function testing might identify patients at higher risk of morbidity or mortality.

Robotic Resection of Ectopic Parathyroid Glands in the Superior Posterior Mediastinum.

Background: Ectopic parathyroid glands can present in a challenging location in the superior posterior mediastinum. Methods: Two patients with primary hyperparathyroidism were operated on for ectopic paraesophageal parathyroid glands in the superior posterior mediastinum. Sestamibi scan, computed tomography (CT) scan, and photon emission CT were used to identify the exact location of these glands. We describe a minimally invasive resection using a three-arm robotic-assisted thoracoscopic technique. Results: Both lesions were completely resected with using the port-based robotic approach with expedited recovery. There was no perioperative morbidity. Patient had low postoperative pain scores and improved symptomatically. Conclusion: Robotic approach for resection of superior posterior mediastinal parathyroids is safe and effective in this challenging operative location.