A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was: Is sub-lobar resection equivalent to lobectomy in terms of operative morbidity and mortality, long-term survival and disease recurrence in patients with peripheral carcinoid lung cancer? A total of 342 papers were identified using the search as described below. Of these, 10 papers presented the best evidence to answer the clinical question as they presented sufficient data to reach conclusions regarding the issues of interest for this review. Long-term survival, disease recurrence and operative morbidity were included in the assessment. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of the papers are tabulated. A literature search showed that there is a good prognosis after resection of lung carcinoid with the 10-year disease-free survival rate ranging between 77 and 94%, and suggested that sub-lobar resection of a typical carcinoid did not compromise the long-term survival. The proportion of peripheral tumours ranged between 22.6 and 100% and the proportion of patients with a preoperative diagnosis of carcinoid ranged between 51.9 and 86.7%, with many series not providing either or both of these data. As a result, a lobectomy or greater resection was necessary on anatomical or diagnostic grounds and led to a low number of sub-lobar resections. Owing to the high heterogeneity within and between series and small numbers of cases included, it is difficult to draw conclusions on disease recurrence and postoperative morbidity. All studies available retrospectively compared heterogeneous groups of non-matched group of patients, which can bias the outcomes reported. There is a lack of comprehensive randomized studies to compare a lobectomy or greater resection and sub-lobar resection. We conclude that there is little objective evidence to show the equivalence or superiority of lobectomy over sub-lobar resection.
Background: Primary mitral regurgitation (PMR) results in adverse remodeling changes and left ventricular (LV) dysfunction. Assessing LV function has prognostic value in predicting morbidity and mortality. Indications for surgery include parameters such as LV ejection fraction (LVEF) and systolic dimensions. Current guidelines are limited in identifying patients at optimal time for surgery. Impaired postoperative LVEF indicates poor prognostic outcomes and subsequent heart failure. Global longitudinal strain (GLS) via speckle tracking echocardiography (STE) presents as a promising parameter to detect subclinical dysfunction in asymptomatic patients.Methods: Following PRISMA guidelines, a literature search was conducted with Cochrane Library, PudMed, SCOPUS, and Web of Science. Key MeSH terms included "mitral regurgitation," "mitral valve insufficiency," "global longitudinal strain," "deformation," "LV-GLS," and "GLS." Inclusion criteria included (1) patients with severe PMR, (2) mixed population of symptomatic and asymptomatic patients, (3) standardized methods in assessing LV systolic function using 2D-STE, (4) valve repair or replacement surgery, and (5) patient outcomes measured after surgery.Search returned 234 papers, 12 of which met the inclusion criteria and were subsequently reviewed.Results: Baseline GLS is an independent predictor of postoperative outcomes, ranging from −17.9 to −21.7% GLS. A significant negative correlation was observed between preoperative GLS and postoperative LVEF. Impaired baseline GLS was associated with higher mortality rates. Better long-term survival rates were seen in patients who underwent early surgery. Conclusion: GLS shows sensitivity in predicting long-term postoperative outcomes.Further analysis is required to determine preoperative GLS threshold to identify asymptomatic patients at the optimal time for mitral valve surgery.
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