Thoracic Surgery
RCT: Serratus anterior plane block reduces pain and opioid use in rib fracture patients – JAMA Surgery
2 May, 2024 | 23:20h | UTCStudy Design and Population:
This study was a multicenter, open-label, pragmatic randomized clinical trial conducted across eight emergency departments in New South Wales, Australia. The trial included 210 patients aged 16 years or older who had clinically suspected or radiologically confirmed rib fractures. Patients intubated, transferred for urgent surgical intervention, or with major concomitant nonthoracic injuries were excluded.
Main Findings:
In the trial, patients were randomized to receive either a serratus anterior plane block (SAPB) along with standard rib fracture management or standard care alone. The primary outcome was a composite pain score measured 4 hours post-enrollment. The SAPB group showed a significant increase in patients achieving the desired pain score reduction (41% in SAPB group vs. 19.6% in control; RR 0.73, 95% CI 0.60-0.89, P = 0.001). Additionally, SAPB recipients had significantly lower opioid consumption at 24 hours compared to the control group.
Implications for Practice:
The trial’s results support the addition of a serratus anterior plane block (SAPB) to standard rib fracture management for providing effective early pain relief and reducing opioid use. However, it’s important to note that this study did not include a sham group, and patients were aware of whether they received the intervention. This lack of blinding could influence patient-reported outcomes due to placebo effects. Despite this limitation, the reduction in pain and opioid consumption suggests that SAPB is a beneficial component of care for patients with rib fractures.
Reference (link to abstract – $ for full-text):
M-A: Neoadjuvant chemoimmunotherapy enhances event-free survival in resectable NSCLC with low PD-L1 expression
28 Apr, 2024 | 20:20h | UTCThis meta-analysis evaluated the impact of neoadjuvant chemoimmunotherapy versus chemotherapy on resectable non-small cell lung cancer (NSCLC) patients, particularly focusing on those with tumor PD-L1 levels below 1%. The study synthesized data from 43 trials, encompassing 5431 patients, to assess clinical outcomes such as overall and event-free survival, alongside major and complete pathological responses. Findings highlighted that neoadjuvant chemoimmunotherapy significantly improved event-free survival (hazard ratio, 0.74; 95% CI, 0.62-0.89) compared to chemotherapy alone, particularly in patients with low PD-L1 expression, though overall survival benefits were not observed. The pooled analysis from randomized clinical trials showed favorable outcomes across all examined endpoints, supporting the superiority of neoadjuvant chemoimmunotherapy in these settings.
Reference (link to free full-text):
Consensus Paper | Surgical video data use, structure, and exploration (for research in AI, quality improvement, and education)
9 Aug, 2023 | 15:20h | UTC
Pictorial Review | Watch out for the early killers: imaging diagnosis of thoracic trauma
9 Aug, 2023 | 15:02h | UTCWatch Out for the Early Killers: Imaging Diagnosis of Thoracic Trauma – Korean Journal of Radiology
Study | Removal of thymus in adults linked to increased death, cancer incidence
4 Aug, 2023 | 12:09h | UTCHealth Consequences of Thymus Removal in Adults – New England Journal of Medicine (link to abstract – $ for full-text)
Commentaries:
Doctors have long considered the thymus expendable. But could removing it be fatal? – Science
The thymus withers away after puberty. But it may be important for adults – Science News
Thymus gland critical for adult health, study finds – News Medical
Commentary on Twitter
In a study by Kooshesh et al., mortality, the risk of cancer, and levels of proinflammatory cytokines were higher among adults whose thymus had been removed than among control patients. Read the full study results: https://t.co/poaAiELsKG
— NEJM (@NEJM) August 2, 2023
NICE Updated Guideline | Diagnosis and management of lung cancer
4 Aug, 2023 | 12:05h | UTCLung cancer: diagnosis and management – National Institute for Health and Care Excellence
Study | AI use in lung cancer screening enhances prediction of lung cancer death, CVD death, and all-cause death
1 Aug, 2023 | 14:31h | UTCAI Body Composition in Lung Cancer Screening: Added Value Beyond Lung Cancer Detection – Radiology (free for a limited period)
Commentary: Study: AI Assessment of Chest CT May Predict Multiple Mortality Risks – Diagnostic Imaging
BTS Guideline for pleural disease
31 Jul, 2023 | 14:44h | UTCBritish Thoracic Society Guideline for pleural disease – Thorax
BTS Clinical Statement on pleural procedures
31 Jul, 2023 | 14:42h | UTCBritish Thoracic Society Clinical Statement on pleural procedures – Thorax
Review | Regional analgesia for acute pain relief after open thoracotomy and video-assisted thoracoscopic surgery
31 Jul, 2023 | 14:03h | UTC
Systematic Review | Ethical perspectives on surgical video recording for patients, surgeons and society
11 Jul, 2023 | 13:44h | UTC
RCT | Perioperative nivolumab plus chemotherapy increases pathological response vs. chemotherapy alone in stage III NSCLC
10 Jul, 2023 | 13:27h | UTCPerioperative Nivolumab and Chemotherapy in Stage III Non–Small-Cell Lung Cancer – New England Journal of Medicine (link to abstract – $ for full-text)
Commentary: Addition of Neoadjuvant Nivolumab to Platinum-Based Chemotherapy in Stage III NSCLC – The ASCO Post
Commentary on Twitter
Original Article: Perioperative Nivolumab and Chemotherapy in Stage III Non–Small-Cell Lung Cancer https://t.co/DCcs0tkyPN #oncology pic.twitter.com/0zG9SUbqQj
— NEJM (@NEJM) June 30, 2023
Editorial | How to become a good surgeon
22 Jun, 2023 | 15:12h | UTCHow to become a good surgeon – Advances in Ophthalmology Practice and Research
Guideline | Management of patients with primary spontaneous pneumothorax
20 Jun, 2023 | 12:46h | UTC
Practice advisory for preoperative and intraoperative pain management of thoracic surgical patients
19 Jun, 2023 | 14:05h | UTCPart 1: Practice Advisory for Preoperative and Intraoperative Pain Management of Thoracic Surgical Patients – Anesthesia and Analgesia (free for a limited period)
Part 2: Practice Advisory for Preoperative and Intraoperative Pain Management of Cardiac Surgical Patients – Anesthesia and Analgesia (free for a limited period)
See also: Prevalence and Characteristics of Persistent Postoperative Pain After Thoracic Surgery: A Systematic Review and Meta-Analysis – Anesthesia and Analgesia (free for a limited period)
Infographic: Persistent Pain After Thoracic Surgery—What Works, What Doesn’t – Anesthesia and Analgesia (free for a limited period)
RCT | Perioperative pembrolizumab improves pathological outcomes, event-free survival in early-stage NSCLC
6 Jun, 2023 | 14:36h | UTCPerioperative Pembrolizumab for Early-Stage Non–Small-Cell Lung Cancer – New England Journal of Medicine (link to abstract – $ for full-text)
Commentary on Twitter
Presented at #ASCO23: In the KEYNOTE-671 trial, pts with resectable lung cancer were assigned to neoadjuvant pembrolizumab or placebo plus chemotherapy followed by adjuvant pembrolizumab or placebo. Two-year event-free survival was 62.4% with pembrolizumab & 40.6% with placebo.
— NEJM (@NEJM) June 3, 2023
M-A | Comparison of intercostal block and epidural analgesia for post-thoracotomy
5 Jun, 2023 | 13:04h | UTC
Post-pneumonectomy syndrome: a systematic review of the current evidence and treatment options
15 May, 2023 | 12:45h | UTC
RCT | Early NIV and HFNO therapy for preventing endotracheal intubation in hypoxemic blunt chest trauma patients
10 May, 2023 | 15:48h | UTC
RCT | Lung volume reduction surgery vs. endobronchial valves in patients with emphysema
2 May, 2023 | 13:29h | UTC
Commentary on Twitter
ERJ: In this first randomised study to compare lung volume reduction surgery and endobronchial valve placement in people who are suitable for both treatments, surgery did not produce substantially superior outcomes at 1 year post-procedure https://t.co/cFIVZijSJg pic.twitter.com/ZqRCgxYwLS
— ERS publications (@ERSpublications) May 1, 2023
RCT | Ventilation approaches in one-lung ventilation and pulmonary complications after major lung resection surgery
2 May, 2023 | 13:23h | UTC
Commentary on Twitter
One of the largest #RCTs on the management of one lung ventilation in #thoracicanesthesia (880 pts). https://t.co/ZVhTP5sv4o pic.twitter.com/KyLu4BE2yd
— Journal of Cardiothoracic and Vascular Anesthesia (@JCVAonline) April 30, 2023
RCT | The effectiveness of early surgical stabilization for multiple rib fractures
26 Apr, 2023 | 14:01h | UTCRelated:
RCT | Operative vs. nonoperative treatment of acute unstable chest wall injuries.
RCT | Rib fixation is not beneficial for non–ventilator-dependent chest wall injuries.
RCT | Endosonography with or without confirmatory mediastinoscopy for resectable lung cancer
26 Apr, 2023 | 13:56h | UTC
Cold static preservation at 10°C shows promising results for safely extending lung transplantation timeframes
24 Apr, 2023 | 13:38h | UTCExtension of Cold Static Donor Lung Preservation at 10°C – NEJM Evidence
Commentary on Twitter
Donor lungs for transplantation are stored on ice and transplanted as rapidly as possible. In an advance that may ease transplant logistics, Ali et al. now report that prolonged storage of donor lungs at 10°C may lead to equivalent outcomes.
Read the Original Article:
— NEJM Evidence (@NEJMEvidence) April 22, 2023
Review | Lung transplantation for COPD/pulmonary emphysema
27 Mar, 2023 | 12:58h | UTCLung transplantation for COPD/pulmonary emphysema – European Respiratory Review