Regardless of the underlying pathology, valve-sparing David I procedure has acceptable long-term results. Valve-related complications such as stroke or major bleeding is exceedingly low.

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Our results encourage the application of CPB in extended pulmonary resections to achieve complete resections. In carefully selected patients, especially those with sarcomas, the radical surgical procedure associated with increased pulmonary complications allows for significantly prolonged survival and quality of life.

Background/Aim: Sarcopenia describes the loss of skeletal muscle mass. While this condition is associated with a high mortality in cancer patients, its influence on survival is still underestimated. Patients and Methods: A systematic review for articles was performed using the PubMed database, Cochrane Library, Biomed Central, Science Direct and by manual search. We used data of overall survival in sarcopenic patients for assessing the death risk. We extracted hazard ratio estimates from univariate and multivariate Cox proportional hazards models for meta-analysis. Results: A total of 15 studies were eligible for meta-analysis including a total of 2,521 lung cancer patients. Univariate meta-analysis revealed a twofold increased death risk in sarcopenic patients; multivariate meta-analysis yielded a significant, threefold elevated risk of death. This higher mortality is independent of tumour stage. Conclusion: Muscle loss is an independent risk factor for increased death risk in lung cancer patients independent of cancer stage. This argues for implementing screening for sarcopenia into cancer care. Sarcopenia describes the age-related loss of muscle mass and strength starting during the fourth to fifth decade of life. It is defined as a muscle mass of at least two standard deviations below the mean muscle mass found in young healthy adults (1-3). While often reported in the elderly, loss of muscle mass does also manifest in patients suffering from a chronical disease like congestive heart failure, chronical obstructive pulmonary disease, chronical renal failure or cancer. Muscle loss has a relevant impact on survival, especially in the latter group. The prevalence of sarcopenia in cancer patients depends on cancer entity, which is why a prevalence of 16% is described in breast cancer patients, whereas 71% of lung cancer patients under palliative therapy suffer from sarcopenia (4-6). Muscle wasting is an unfavourable prognostic factor for cancer specific survival of rectum, liver, oesophagus, stomach or kidney cancer patients (1, 7). If muscle mass is maintained or increased, patients show a longer overall survival (5). Sarcopenia may be caused by several different factors; cancer, chemotherapy or locoregional impairment caused by surgery or radiation therapy, comorbidities, malnutrition or physical inactivity (8). Sarcopenia itself is also a risk factor for an increase in chemotoxicity and a decrease in therapy response (1). Physical activity prevents muscle wasting; a small pilot study showed that smartphones are a good tool to implement personalized physical activity programs and to increase physical activity of patients (9, 10). Sarcopenia is assessed by using Dual-energy X-ray absorptiometry scan (DEXA), bioelectrical impedance analysis (BIA) or computed tomography (2). Especially computed tomography is used routinely for investigations 4603 This article is freely accessible online.