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Compared with VATE, RATE resulted in a higher lymph node yield along the left RLN without increasing morbidity.

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ObjectiveTo review the surgical and clinical results of minimally invasive resection of intrathoracic neurogenic tumors using a videoassisted thoracoscopic technique. Summary Background DataThoracoscopy has emerged as a possible means for diagnosing and managing various intrathoracic disorders. Benign intrathoracic tumors often are ideal lesions for resection using a video-assisted technique. The authors report on their combined experience with the thoracoscopic resection of 143 intrathoracic neurogenic tumors. MethodsBetween March 1992 and February 1999, 143 patients with intrathoracic neurogenic tumors were diagnosed and underwent resection using video-assisted thoracoscopic techniques in three teaching centers. Case selection, surgical technique, and clinical results were reviewed. ResultsThe average age of the patients was 40.8 years; 57.3% were male. Thirty-eight patients (27%) had symptoms attributable to the masses. Seventy-two masses were neurofibromas, 33 were neurilemmomas, 7 were paragangliomas, and 31 were ganglioneuromas. All but seven tumors were located in the posterior mediastinum. The masses were on average 3.5 cm in greatest diameter. The mean surgical time was 40 minutes, and the average hospital stay was 4.1 days. There were no major postoperative complications or recurrences to date. Nine patients reported paresthesias over the chest wall during a mean follow-up of 29 months. ConclusionsResection of intrathoracic neurogenic tumors using a thoracoscopic technique based on standard surgical indications would seem to be appropriate. Most of these masses are benign and readily removed. For dumbbell tumors, a combined thoracic and neurosurgical approach is mandatory.Intrathoracic neurogenic tumors are neoplasms that arise from any of the neural elements in the thorax. These tumors are derived from the various neural elements (nerve sheath, ganglion, or neurite) of the peripheral, autonomic, or paraganglionic nervous systems. Nerves and ganglia of both the somatic and autonomic nervous systems are found throughout the thorax but are concentrated in the paravertebral sulcus region, commonly designated as the posterior mediastinum. Intercostal nerve rami and the sympathetic chain found in this region account for 95% of intrathoracic neurogenic tumors.1 Before the advent of video-thoracoscopy, most nerve sheath and autonomic system tumors were best approached by a standard posterolateral thoracotomy. 2-6More recently, attempts have been made to resect these tumors thoracoscopically in a minimally invasive manner. [7][8][9] Given the advantages shown by the efficacy of these techniques and their less invasive nature, we have chosen video-thoracoscopy as the procedure of choice to remove intrathoracic neurogenic tumors in recent years. This report reviews our combined experiences and clinical results.

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BackgroundAlthough the outcomes of caustic ingestion differ between children and adults, it is unclear whether such outcomes differ among adults as a function of their age. This retrospective study was performed to ascertain whether the clinical outcomes of caustic ingestion differ significantly between elderly and non-elderly adults.MethodsMedical records of patients hospitalized for caustic ingestion between June 1999 and July 2009 were reviewed retrospectively. Three hundred eighty nine patients between the ages of 17 and 107 years were divided into two groups: non-elderly (< 65 years) and elderly (≥ 65 years). Mucosal damage was graded using esophagogastroduodenoscopy (EGD). Parameters examined in this study included gender, intent of ingestion, substance ingested, systemic and gastrointestinal complications, psychological and systemic comorbidities, severity of mucosal injury, and time to expiration.ResultsThe incidence of psychological comorbidities was higher for the non-elderly group. By contrast, the incidence of systemic comorbidities, the grade of severity of mucosal damage, and the incidence of systemic complications were higher for the elderly group. The percentages of ICU admissions and deaths in the ICU were higher and the cumulative survival rate was lower for the elderly group. Elderly subjects, those with systemic complications had the greatest mortality risk due to caustic ingestion.ConclusionsCaustic ingestion by subjects ≥65 years of age is associated with poorer clinical outcomes as compared to subjects < 65 years of age; elderly subjects with systemic complications have the poorest clinical outcomes. The severity of gastrointestinal tract injury appears to have no impact on the survival of elderly subjects.

After nCRT, esophagectomy should be performed within 8 weeks, especially in patients with good response.

Background: Effective postoperative pain control for thoracic surgery is very important, not only because it reduces pulmonary complications but also because it accelerates the pace of recovery. Moreover, it increases patients' satisfaction with the surgery. In this study, we present a simple approach involving the safe placement of intercostal catheter (ICC) after single port video-assisted thoracoscopic surgery (VATS) anatomic resection and we evaluate postoperative analgesic function with and without it.Methods: We identified patients who underwent single port anatomic resection with ICC placed intraoperatively as a route for continuous postoperative levobupivacaine (0.5%) administration and retrospectively compared them with a group of single port anatomic resection patients without ICC.The operation time, postoperative day 0, 1, 2, 3 and discharge day pain score, triflow numbers, narcotic requirements, drainage duration and post-operative hospital stay were compared.Results: In total, 78 patients were enrolled in the final analysis (39 patients with ICC and 39 without).We found patients with ICC had less pain sensation numerical rating scale (NRS) on postoperative day 0, 1 (P=0.023, <0.001) and better triflow performance on postoperative day 1 and 2 (P=0.015, 0.032). In addition, lower IV form morphine usage frequency and dosage (P=0.009, 0.017), shorter chest tube drainage duration (P=0.001) and postoperative stay (P=0.005) were observed in the ICC group.Conclusions: Continuous intercostal nerve blockade by placing an ICC intraoperatively provides effective analgesia for patients undergoing single port VATS anatomic resection. This may be considered a viable alternative for postoperative pain management.