A decade of surgical outcomes in a structured lung cancer screening program.

OBJECTIVE: Lung cancer screening can decrease mortality. The majority of screen-detected cancers are early stage and undergo surgical resection. However, there are little data regarding the outcomes of surgical treatment outside of clinical trials. The purpose of this study was to compare the outcomes of curative resection for screen-detected lung cancers with nonscreened, incidentally detected cancers at an institution with a structured screening program. METHODS: Patients undergoing lung cancer curative resection from January 2012 to June 2021 were identified from a prospective database. Baseline patient characteristics, tumor characteristics, and outcomes were compared between cancer detected from screening and cancer detected incidentally. RESULTS: There were 199 patients in the incidental group and 82 patients in the screened group. Mean follow-up was 33.3 ± 25 months. The screened group had more African Americans (P = .04), a higher incidence of emphysema (P = .02), less prior cancers (P < .01), and more pack-years smoked (P < .01). The screened group had a smaller size (1.74 vs 2.31 cm, P < .01); however, pathologic stage was similar, with the majority being stage I. Postoperative morbidity, 30-day mortality, and overall and recurrence-free survival were similar between groups. Only 48.7% of the incidental group met current US Preventative Services Task Force screening criteria (age 50-80 years, ≥20 pack-year smoking history). CONCLUSIONS: Screen-detected lung cancers have excellent postoperative and long-term outcomes with curative resection, similar to incidentally detected cancers. A large portion of incidentally detected lung cancers do not meet current screening guidelines, which is an opportunity for further refinement of eligibility.

Mediastinal thymic cysts: a narrative review.

Background and Objective: Mediastinal thymic cysts are a relatively rare pathology. With the expansion of eligible individuals screened with cross-sectional imaging for lung cancer, it is likely that there will be an increase in the number of individuals presenting with these cysts. Understanding this rare pathology will become more important when this incidental pathology is encountered. Methods: Search of PubMed was undertaken using keywords "mediastinal", "mediastinum", "thymic", "thymus", "cyst". Relevant literature was reviewed and selected for this comprehensive narrative review, including case reports, case series, and retrospective reviews. Key Content and Findings: Thymic cysts in the mediastinum can be classified into two broad categories, congenital and inflammatory. Accurate diagnosis by imaging is challenging and the majority of patients are asymptomatic. Literature suggests that the majority of cysts are benign, however an unknown percentage may harbor neoplastic processes and over time can cause significant compressive symptoms. Definitive treatment and diagnosis is surgical, with overall excellent outcomes. The decision to pursue surgical treatment versus surveillance requires a shared decision making approach with patients. Conclusions: Given the scarcity of available high quality evidence regarding the management of mediastinal thymic cysts, this review provides practitioners a broad knowledge base to guide patients to make informed decisions.

Central venous catheter placement leading to an emergent paramedian sternotomy: a case report.

Perioperative cardiac tamponade during central venous catheter placement is rare. We present a case of tamponade from pulmonary artery injury during dialysis catheter placement resulting in complicated sternotomy and hospital course. A 52-year-old female experienced intraoperative hypotension, rapidly identified as tamponade, that was treated with an emergent paramedian sternotomy. Patient experienced postdischarge dehiscence and osteomyelitis requiring multiple reoperations. This case is the first report of a deviated paramedian sternotomy performed mainly through ribs. The complications experienced outline the importance of effective multidisciplinary knowledge of best practices to stabilize tamponade pathology, mitigating morbidity and mortality.

Rare pathology leading to a diagnostic challenge: A subarachnoid spinal hematoma after catheter cryoablation for atrial fibrillation.

Catheter ablation for atrial fibrillation is associated with a low rate of complications, with few reports of intracranial hemorrhage in the literature. Additionally, subarachnoid hemorrhage with spinal hematoma is also an uncommon pathology with less than 200 total cases to date described. A 78-year-old female with hypertension and atrial fibrillation on warfarin presented for catheter cryoablation and experienced periprocedural hypertension. Subsequently, post-procedure, the patient developed severe back pain, nausea, vomiting, altered consciousness, and paraplegia. Imaging demonstrated subarachnoid hemorrhage with hematoma compressing cord at the T4/5 level and infarction inferior to this level. The rare nature as well as presentation of this pathology, in the setting of a safe procedure, emphasizes the importance to re-evaluate diagnostic plans when patient presentation is inconsistent with expected post procedural course. 〈Learning objective: The rare nature as well as presentation of subarachnoid hemorrhage with spinal hematoma, in the setting of a safe catheter cryoablation for atrial fibrillation, emphasizes the importance to re-evaluate diagnostic plans when patient presentation is inconsistent with expected post procedural course.〉.