Lung lobectomy surgical approach and resource utilization differ by anatomic lobe in a statewide discharge registry.

Background: Anatomic lobe-specific differences with respect to pulmonary lobectomy have been suggested in the thoracic surgery literature but hard data has been lacking in larger population studies in part due to coding systems that do not distinguish pulmonary lobectomy by anatomic lobe. International Classification of Diseases, Tenth Revision (ICD-10) procedure codes, adopted in the United States in 2015, may provide novel methodologic accessibility for pulmonary lobectomy studies as they classify lobectomy operations by specific anatomic lobe. We queried the Texas Inpatient Public Use Data File (TPUDF) ICD-10 codes for both open and endoscopic approach lobectomy with a specific view to differences based on anatomic lobes. Methods: Between fourth fiscal quarter (Q4) 2015 and Q4 2017, all pulmonary lobectomy operations performed in Texas state-licensed hospitals were identified by querying the TPUDF for ICD-10 procedure codes for pulmonary lobectomy as classified by anatomic lobe. Surgical approach, additional procedures and diagnosis codes, length of hospital stay (LOS), and discharge status were recorded with aggregate values undergoing statistical analysis. Results: Right and left upper versus lower lobe resections were more prevalent however minimally invasive surgery was less commonly performed for upper than right lower lobectomy. LOS, irrespective of surgical approach, was longer for upper versus lower lobe resection as was need for transfer to additional inpatient facilities. LOS was longer and need for additional surgical or procedural interventions days after the primary procedure of lobectomy was greater for right versus left upper lobe resection, suggesting some differential properties of the right versus left pleural space. Conclusions: The marked clinical differences between anatomic lobes in the setting of pulmonary lobectomy observed in this study have the potential to translate to differences in expected hospital and health system costs and surgeon time-expenditure and experience premium that currently have no mechanism for their accounting. These findings highlight the value of ICD-10 coding for analysis of pulmonary lobectomy in administrative databases and suggest a possible path to more informed patient counseling and equitable hospital and surgeon reimbursement based on payment adjustment by anatomic lobe in pulmonary lobectomy operations.

Review of donor and recipient surgical procedures in lung transplantation.

Lung transplant remains the only durable treatment of end stage lung disease. Efficient surgical technique and preservation strategy are of critical importance in avoiding ischemia reperfusion injury and primary graft dysfunction (PGD), both associated with poorer outcomes. We present our surgical and preservation strategy for both donor and recipient procedures, including endobronchial and intracorporeal lung assessment, mediastinal dissection, lung preservation, donor pneumonectomy, back bench preparation, recipient approach, pneumonectomy, along with the bronchial, pulmonary artery, and pulmonary venous anastomoses.

Giant Mediastinal Liposarcoma: A Rare Yet Distinct Clinical Entity.

Mediastinal liposarcomas are rare tumors that occasionally present as unusually large and rapidly growing mediastinal masses resulting in compressive symptoms. We present a case of a 48-year-old woman undergoing resection of a mediastinal liposarcoma of massive proportion and propose that "giant mediastinal liposarcomas" be identified as a distinct clinical entity.

Demographic risk factors impacting timely radiation therapy completion after breast conserving surgery.

BACKGROUND: Radiotherapy completion (RTC) is critical to successful breast conserving treatment. Our aim was to identify patient groups at greatest risk of not achieving timely radiotherapy completion (TRTC) in an urban setting. METHODS: This observational cohort study used hospital registry data from 2004 to 2010 for female stage I and II breast conserving treatment patients to assess predictors of RTC and TRTC, defined as RTC of 35 to 49 days. RESULTS: Two hundred sixty-one patients were analyzed. There was no difference in mean days to RTC by ethnicity (black 46.8, white 46.4, Hispanic 48.1 days, P = .75) or total RTC (black 88.2%, white 97.9%, Hispanic 93.3%, P = .09). However, a substantial difference was seen in TRTC by ethnicity (black 51.8%, white 79.2%, Hispanic 57.8%, P = .03). Multivariate logistic regression analysis of failure to achieve TRTC found associations with black race (odds ratio [OR] 2.67), Medicare (OR 3.46), Medicaid (OR 2.19), and age less than 50 years (OR 4.13). CONCLUSIONS: This study demonstrates high overall percentage RTC but demonstrates disparities in TRTC. Those at greatest risk of unsuccessful TRTC were younger, Medicare or Medicaid insured, and black race.

Robotic resection of a superior sulcus neurogenic tumor.

Neurogenic tumors do not often occur in the superior sulcus or apex of the chest cavity. Historically, surgical approaches have been dictated by the location of the tumor and its relation to the contiguous structures such as the vertebral bodies, subclavian vessels, and chest wall. Resection is hampered by difficulties with visualization and access within a narrow working space. The shortcomings associated with the traditional surgical approaches create a potential of injury to nearby structures. We present a case of a 43-year-old woman with a superior sulcus neurogenic tumor impinging on the left subclavian vein, who underwent a successful resection without injury to nearby structures. We found that a robotic approach improved visualization of the tumor and nearby structures and increased instrument maneuverability relative to a thoracoscopic approach, along with less pain and recovery time compared with a thoracotomy. This experience suggests that robotics provides a promising alternative for excision of superior sulcus neurogenic tumors, which may reduce associated morbidity.