Prediction of survival after a lung transplant at 1 year (SALTO cohort) using information available at different key time points.

OBJECTIVES: A lung transplant is the final treatment option for end-stage lung disease. We evaluated the individual risk of 1-year mortality at each stage of the lung transplant process. METHODS: This study was a retrospective analysis of patients undergoing bilateral lung transplants between January 2014 and December 2019 in 3 French academic centres. Patients were randomly divided into development and validation cohorts. Three multivariable logistic regression models of 1-year mortality were applied (i) at recipient registration, (ii) the graft allocation and (iii) after the operation. The 1-year mortality was predicted for individual patients assigned to 3 risk groups at time points A to C. RESULTS: The study population consisted of 478 patients with a mean (standard deviation) age of 49.0 (14.3) years. The 1-year mortality rate was 23.0%. There were no significant differences in patient characteristics between the development (n = 319) and validation (n = 159) cohorts. The models analysed recipient, donor and intraoperative variables. The discriminatory power (area under the receiver operating characteristic curve) was 0.67 (0.62-0.73), 0.70 (0.63-0.77) and 0.82 (0.77-0.88), respectively, in the development cohort and 0.74 (0.64-0.85), 0.76 (0.66-0.86) and 0.87 (0.79 - 0.95), respectively, in the validation cohort. Survival rates were significantly different among the low- (< 15%), intermediate- (15%-45%) and high-risk (> 45%) groups in both cohorts. CONCLUSIONS: Risk prediction models allow estimation of the 1-year mortality risk of individual patients during the lung transplant process. These models may help caregivers identify high-risk patients at times A to C and reduce the risk at subsequent time points.

Immersive Three-dimensional Computed Tomography to Plan Chest Wall Resection for Lung Cancer.

PURPOSE: Chest wall resections for lung cancer treatment remain difficult to plan using standard 2-dimensional computed tomography. Although virtual reality headsets have been used in many medical contexts, they have not been used in chest wall resection planning. DESCRIPTION: We compared preoperative planning of a chest wall surgical resection for lung cancer treatment between senior and resident surgeons who used an immersive virtual reality device and a 2-dimensional computed tomography. EVALUATION: Chest wall resection planning was more accurate when surgeons used virtual reality vs computed tomography analysis (28.6% vs 18.3%, P = .018), and this was particularly true in the resident surgeon group (27.4% vs 8.3%, P = .0025). Predictions regarding the need for chest wall substitutes were also more accurate when they were made using virtual reality vs computed tomography analysis in all groups (96% vs 68.5%, P < .0001). Other studied parameters were not affected by the use of the virtual reality tool. CONCLUSIONS: Virtual reality may offer enhanced accuracy for chest wall resection and reconstruction planning for lung cancer treatment.

Pulmonary metastatic chondrosarcoma with massive extension into left atrium and left ventricle: outcome of surgical management in emergency.

We report a case of metastatic chondrosarcoma to the lung that invaded the right inferior pulmonary vein with massive cardiac extension and presented with an acute heart failure. CT scan showed a large mass of the right lower lobe which invaded and filled almost all the left atrium with an extension into left ventricle through the mitral valve. Surgical resection was performed in emergency. The patient is still alive 4 months after development of cardiac symptoms and surgery.

Video-axillaroscopy: a new mini-invasive technique for surgical exploration of the axillary region.

Subclavicular lymph nodes are one of the deeper lymph node groups of the lymphatic network located in the axillary region. As its location is surrounded by vessels and nerves, biopsy of subclavicular lymph nodes is not possible without eye control. We describe a new, mini-invasive technique for accessing the thoracic outlet region. Video-axillaroscopy is a reliable mini-invasive technique for targeting biopsies of lymph nodes in the axillary region. It is safer and more accurate than radio-guided techniques. Exploration of this region might benefit treatment of lymphoma and breast cancer and applications might emerge for thoracic outlet syndromes.

Is there a place for video-associated thoracoscopy for dissecting intramural haematoma of the oesophagus?

Spontaneous haematoma of the oesophagus is a rare cause of chest pain. We report the case of a 63-year-old female in whom spontaneous rupture of the oesophagus was suspected, but who was subsequently, found to have a dissecting intramural haematoma of the oesophagus. She successfully underwent mediastinal and thoracic drainage by right video-assisted thoracoscopy. Although conservative treatment is widely described in the literature, surgical treatment by right video-associated thoracoscopy may be a suitable alternative if there is a diagnostic doubt.

Multi-segmental reverse loops for long-segment, supercharged pedicled ileum graft for total oesophageal reconstruction: an alternative for anisoperistaltic ileum graft.

In this article, a new technique for turn-over jejunal graft without kinking of its mesenteric vessels is described. Graft necrosis occurred on a left colon oesophageal reconstruction performed for a 56-year-old-woman. A salvage oesophageal reconstruction was performed by a long-segment, supercharged, pedicled anisoperistaltic ileum. Regurgitations were permanent in spite of medical treatment. Segmental reverse of ileum loops was used to turn over the direction of peristaltism without mesenteric twisting. The technique has never been described previously.