Our data indicate that a complete AXLND can be performed with minimal long-term morbidity. The lower the morbidity of AXLND, the less acceptable are the unique complications of the SLN technique.

Although modern techniques in anesthesia and surgery have reduced morbidity and mortality for pulmonary resection, some physicians still consider advanced age a contraindication to resection of lung cancer. We examined our experience with VATS lobectomy in octogenarians at Cedars-Sinai Medical Center over 12 years (1992–2004). There were 159 patients. Mean age was 83 years (range, 80–94 years) consisting of 61 males (38%) and 96 females (62%). Operations included 153 lobectomies (96%), 3 bilobectomies (2%), and 3 pneumonectomies (2%). Two operations were converted to thoracotomy (1%), one due to bleeding, and one due to poor visualization. Median hospital stay was 4.00 ± 6.39 days. One hundred thirty-one patients (82%) had no complications. The most common complication was arrhythmias occurring in 8/159 (5%) patients. There were three perioperative deaths (1.8%). Pathology revealed 104 adenocarcinomas (65%), 25 squamous cell carcinomas (16%), 5 adeno-squamous carcinomas (3%), 7 bronchoalveolar carcinomas (4%), 7 large cell carcinomas (4%), 4 carcinoid tumors (3%), 4 non-small cell lung cancer (NSCLC) (3%), 1 mucoepidermoid carcinoma (<1%), 1 lymphoma (<1%), and 1 pulmonary metastasis (<1%). Median follow-up was 29 months. The results of this series show that age alone is not a contraindication to the surgical treatment of lung cancer.

The surgical treatment of small bowel obstruction is evolving. Laparoscopic exploration and adhesiolysis is increasingly being utilized. We conducted a retrospective chart review of all patients who were operated on and discharged with the diagnosis of adhesiolysis for small bowel obstruction (SBO) from July 1999 to October 2000 at Cedars-Sinai Medical Center. There were a total of 75 patients. Patients were grouped based on the type of operation: laparoscopic (lap), open, and converted. Thirty-four patients were attempted laparoscopically, 11 of those requiring conversion to open. Fifty-two patients were treated with a laparotomy. Complications contributing to morbidity were significantly lower in the lap group ( P < 0.01). There was no difference in morbidity between the converted and open groups. There were fewer pneumonias and wound infections in the lap group when compared to the open group, although it did not reach statistical difference. The reduction of post-op ileus in the lap group was statistically significant ( P < 0.01). Statistically significant differences between the lap and open groups were also found in estimated blood loss (EBL) ( P < 0.004), length of stay (LOS) ( P < 0.01), bowel resection ( P < 0.01) and op-time ( P < 0.003). Laparoscopic release of adhesions is a viable option in the surgical management of small bowel obstruction. A prospective randomized trial comparing both surgical techniques is needed to further validate the laparoscopic approach to small bowel obstruction.

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There are few cases of splenic infarction associated with antiphospholipid antibody reported in the literature. We present two cases of splenic infarction associated with anticardiolipin antibody, one complicated by the development of a splenic pseudocyst. Clinical diagnostic features of splenic infarction are described. In addition, a review of the literature on thrombotic manifestations of antiphospholipid syndrome is presented.

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In selected patients, large paraesophageal hernias can safely be managed via a laparoscopic antireflux procedure with the hepatic shoulder technique. Although no long-term follow-up is available, this technique has shown good early postoperative results and may be used as an alternative to a laparoscopic Mesh reinforced fundoplication or difficult crural closure.

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