No abstract

Considering the evidence available to date, the Comité de l'évolution des pratiques en oncologie recommends the following: (1) for medically operable patients with stage T1-2N0M0 NSCLC, surgery remains the standard treatment because comparative data regarding the efficacy of SABR and surgery are currently insufficient for SABR to be considered an equivalent alternative to surgery for these patients; (2) for medically inoperable patients with stage T1-2N0M0 NSCLC or medically operable patients who refuse surgery, SABR should be preferred to standard EBRT (grade B recommendation); (3) the biological equivalent dose (BED(10)) used for SABR treatment should be at least 100 Gy (grade B recommendation); (4) for patients with a central tumor, a large-volume tumor (large planning target volume) or severe pulmonary comorbidity, a risk-adaptive schedule should be used (dose reduction or increase in the number of fractions; grade B recommendation); (5) the choice of using SABR to treat NSCLC should be discussed within tumor boards; treatment with SABR (or with standard EBRT) should not be considered for patients whose life expectancy is very limited because of comorbidities (grade D recommendation).

Background: In the setting of the COVID-19 pandemic, the conduct of elective cancer surgery has become an issue because of the need to balance the requirement to treat patients with the possibility of transmission of the virus by asymptomatic carriers. A particular concern is the potential for viral transmission by way of aerosol which may be generated during perioperative care. There are currently no guidelines for the conduct of elective lung resection surgery in this context. Methods: A working group composed of 1 thoracic surgeon, 2 anesthesiologists and 1 critical care specialist assessed the risk for aerosol during lung resection surgery and proposed steps for mitigation. After external review, a final draft was approved by the Committee for the Governance of Perioperative and Surgical Activities of the Hôpital Maisonneuve-Rosemont, in Montreal, Canada. Results: The working group divided the risk for aerosol into 6 time-points: (1) intubation and extubation; (2) Lung isolation and patient positioning; (3) access to the chest; (4) conduct of the surgical procedure; (5) procedure termination and lung re-expansion; (6) chest drainage. Mitigating strategies were proposed for each time-point. Conclusions: The situation with COVID-19 is an opportunity to re-evaluate operating room protocols both for the purposes of this pandemic and similar situations in the future. In the context of lung resection surgery, specific time points during the procedure seem to pose specific risks for the genesis of aerosol and thus should be the focus of attention.

Cumulative sum (CUSUM) plots and methods have wide‐ranging applications in healthcare. We review and discuss some issues related to the analysis of surgical learning curve (LC) data with a focus on three types of CUSUM statistical approaches. The underlying assumptions, benefits, and weaknesses of each approach are given. Our primary conclusion is that two types of CUSUM methods are useful in providing visual aids, but are subject to overinterpretation due to the lack of well‐defined decision rules and performance metrics. The third type is based on plotting the CUSUM of the differences between observations and their average value. We show that this commonly applied retrospective method is frequently interpreted incorrectly and is thus unhelpful in the LC application. Curve‐fitting methods are more suitable for meeting many of the goals associated with the study of surgical LCs.

Inflammatory pseudotumours of the lung are extremely rare. Their pathogenesis is controversial, their diagnosis is often difficult and their clinical behaviour may be unpredictable - ranging from benign to locally invasive, to metastatic in spite of an apparently 'benign' histology. A patient who presented with multiple recurrent lesions in the contralateral lung almost two years after the resection of a large primary tumour of the left upper lobe is reported.

No abstract

A case of azygos lobe is presented. An azygos lobe is an accessory lobe of the lung that may occasionally be confused with a pathological process such as a bulla, lung abscess or neoplasm. Its pathogenesis is discussed, as are the characteristic x-ray features that enable an accurate diagnosis.

Postpneumonectomy syndrome is a rare postoperative complication whereby mediastinal shifting toward the pneumonectomy space results in bronchial compression between the pulmonary artery, aorta, and vertebral column. This syndrome is more common after right pneumonectomy; other risk factors include young age and female sex. Imaging studies consistently reveal massive mediastinal shifting and document airway compromise. Bronchoscopy and flow-volume loops are helpful in confirming the diagnosis. Other causes of dyspnea, including cancer recurrence, should be excluded. Definitive treatment involves surgical repositioning of the mediastinum in the midline, as well as insertion of a saline-filled silicone prosthesis into the pneumonectomy space in order to prevent recurrence.