Seminars in Thoracic and Cardiovascular Surgery RSS feed: Current Issue. Seminars in Thoracic and Cardiovascular Surgery is devoted to keeping the practicing surgeon current. Each issue includes two topics, one on cardiac surgery and one on general thoracic surgery. Each topic is explored in approximately five articles that present detailed descriptions and sound evaluations of developments in diagnosis and treatment, new techniques, and scientific and technologic advances. 2009 Topics , Volume 21 January Imaging advances for surgery of the thoracic aorta Therapeutic options for the treatment of advanced lung cancer April Ethical, legal, and health policy challenges in contemporary cardiothoracic surgery July Contemporary management of mesothelioma October Endovascular options for cardiac surgeons Current status of tracheal surgery http://www.semthorcardiovascsurg.com/?rss=yesElsevier Inc.en © 2009 Published by Elsevier Inc. All rights reserved. Seminars in Thoracic and Cardiovascular Surgery1043-0679214Winter 2009 © 2009 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.semthorcardiovascsurg.com/article/PIIS1043067910000043/abstract?rss=yesMasthead10.1053/S1043-0679(10)00004-3Seminars in Thoracic and Cardiovascular Surgery 21, 4 (2009)Seminars in Thoracic and Cardiovascular Surgery214S1043-0679(09)X0006-7iihttp://www.semthorcardiovascsurg.com/article/PIIS1043067910000067/abstract?rss=yesOfficers10.1053/S1043-0679(10)00006-7Seminars in Thoracic and Cardiovascular Surgery 21, 4 (2009)Seminars in Thoracic and Cardiovascular Surgery214S1043-0679(09)X0006-7iiiiiihttp://www.semthorcardiovascsurg.com/article/PIIS1043067910000079/abstract?rss=yesTable of Contents10.1053/S1043-0679(10)00007-9Seminars in Thoracic and Cardiovascular Surgery 21, 4 (2009)Seminars in Thoracic and Cardiovascular Surgery214S1043-0679(09)X0006-7ivvhttp://www.semthorcardiovascsurg.com/article/PIIS1043067910000080/abstract?rss=yesForthcoming/Previous Topics10.1053/S1043-0679(10)00008-0Seminars in Thoracic and Cardiovascular Surgery 21, 4 (2009)Seminars in Thoracic and Cardiovascular Surgery214S1043-0679(09)X0006-7vivihttp://www.semthorcardiovascsurg.com/article/PIIS1043067909001476/abstract?rss=yesLymph node metastasis is the most important prognostic factor in localized non-small cell lung cancer. In case of nodal involvement, the survival rate can be expected to be approximately half of that for a patient with N0 status. Currently, adjuvant chemotherapy is recommended for all patients with histologically positive lymph nodes after resection.Sentinel Node Mapping in Lung Cancer: IntroductionMichael J. Liptay10.1053/j.semtcvs.2009.12.001Seminars in Thoracic and Cardiovascular Surgery 21, 4 (2009)Seminars in Thoracic and Cardiovascular Surgery214S1043-0679(09)X0006-7Sentinel Node Mapping in Lung Cancer- Michael J. Liptay, MD, FACS, Guest Editor297297http://www.semthorcardiovascsurg.com/article/PIIS1043067909001373/abstract?rss=yesThe basic anatomic lymph node drainage patterns from lung cancers have remained relatively constant since their early descriptions. Sentinel lymph node mapping and other reviews of anatomic resections have provided additional information regarding drainage patterns of lymphatic metastases. In light of these efforts, topics related to lymphatic metastases, such as skip metastasis and micrometastasis, still remain the subject of investigation. A review of the recent literature shows that the incidence of macroscopic skip metastasis is approximately 25%. Despite the occurrence of skip metastases, a generalized lymphatic drainage pattern is observed and is consistent with the drainage patterns that are observed among nonskip metastases to the mediastinum. Direct mediastinal drainage or the inability to detect micrometastatic disease due to observational errors or technical inadequacies may explain the presence of skip metastasis. This is supported by the fact that a review of the recent literature also shows that the incidence of micrometastasis is approximately 19%. The similarities between these 2 values suggest that an improved ability to detect micrometastatic disease is needed. This manuscript reviews the patterns of lymph node drainage from a historical and current perspective to facilitate an understanding of the existing knowledge with respect to skip metastasis and micrometastasis.Lymph Node Drainage Patterns and Micrometastasis in Lung CancerAnthony W. Kim10.1053/j.semtcvs.2009.11.001Seminars in Thoracic and Cardiovascular Surgery 21, 4 (2009)Seminars in Thoracic and Cardiovascular Surgery214S1043-0679(09)X0006-7Sentinel Node Mapping in Lung Cancer- Michael J. Liptay, MD, FACS, Guest Editor298308http://www.semthorcardiovascsurg.com/article/PIIS1043067909001452/abstract?rss=yesCurrent methods for sentinel lymph node (SLN) mapping and nodal treatment in lung cancer remain inadequate for routine clinical use. In this study, we discuss the potential for using the combination of invisible near-infrared (NIR) fluorescent light and nanotechnology for these applications. NIR fluorescence imaging has recently received significant attention for in vivo imaging applications because of its low tissue autofluorescence, high photon penetration into living tissue, and high signal-to-background ratio. Our large animal in vivo studies have been able to successfully identify SLNs in lung tissue, and several clinical studies have examined the use of NIR fluorescence imaging systems for SLN mapping in breast and gastric cancer. Promising new nanoparticle technologies, when combined with NIR fluorescence imaging, offer the potential for image-guided treatment of lymph nodes at high risk for tumor recurrence. This review provides a theoretic and empiric framework for developing the next generation of diagnostic and therapeutic agents for lung cancer.Image-Guided Sentinel Lymph Node Mapping and Nanotechnology-Based Nodal Treatment in Lung Cancer Using Invisible Near-Infrared Fluorescent LightOnkar Khullar, John V. Frangioni, Mark Grinstaff, Yolonda Lorig Colson10.1053/j.semtcvs.2009.11.009Seminars in Thoracic and Cardiovascular Surgery 21, 4 (2009)Seminars in Thoracic and Cardiovascular Surgery214S1043-0679(09)X0006-7Sentinel Node Mapping in Lung Cancer- Michael J. Liptay, MD, FACS, Guest Editor309315http://www.semthorcardiovascsurg.com/article/PIIS1043067909001427/abstract?rss=yesThe reduction in lymph node dissection using sentinel node (SN) identification in patients with lung cancer is associated with several difficulties, compared with similar procedures in patients with breast cancer or melanoma. To overcome the difficulties of SN identification in lung cancer, several topics have been reported in Japan. In this study, the following topics regarding SN identification in lung cancer patients will be introduced: (1) devices for SN identification using a radioisotope tracer; (2) movement of Tc-99 tin colloid after injection; (3) characteristics of patients in whom SNs could not be identified; (4) results of ex vivo SN identification; (5) reliability of in vivo SN identification; (6) algorithm for reducing mediastinal lymph node dissection; (7) SN identification using SPECT/CT; (8) differences in SN identification between large and small radioisotope particles; (9) size of metastatic and nonmetastatic mediastinal lymph nodes in non-small cell lung cancer; (10) SN navigation segmentectomy for clinical stage IA non-small cell lung cancer; and (11) lymphatic flow at segmental lymph nodes.Sentinel Node Mapping in Lung Cancer: The Japanese ExperienceHiroaki Nomori10.1053/j.semtcvs.2009.11.006Seminars in Thoracic and Cardiovascular Surgery 21, 4 (2009)Seminars in Thoracic and Cardiovascular Surgery214S1043-0679(09)X0006-7Sentinel Node Mapping in Lung Cancer- Michael J. Liptay, MD, FACS, Guest Editor316322http://www.semthorcardiovascsurg.com/article/PIIS1043067909001403/abstract?rss=yesRadioguided lymph node mapping can potentially improve staging in locoregional non-small cell lung cancer. This is accomplished by using advanced pathologic techniques to detect micrometastases in selected thoracic lymph nodes. The use of isosulfan blue, technetium-99m and 18F-fluorodeoxyglucose (FDG) as mapping agents have been reported. Despite several limitations in this technique, it may facilitate the selection of patients for novel therapies, resulting in improved outcomes for lung cancer patients.Sentinel Node and Positron Emission Tomography Mapping in Lung CancerChukwumere Nwogu10.1053/j.semtcvs.2009.11.004Seminars in Thoracic and Cardiovascular Surgery 21, 4 (2009)Seminars in Thoracic and Cardiovascular Surgery214S1043-0679(09)X0006-7Sentinel Node Mapping in Lung Cancer- Michael J. Liptay, MD, FACS, Guest Editor323326http://www.semthorcardiovascsurg.com/article/PIIS1043067909001385/abstract?rss=yesImproving existing means of sentinel lymph node identification in non-small cell lung cancer will allow for molecular detection of occult micrometastases that may cause recurrence in early stage non-small cell lung cancer. Furthermore, targeted application of chemical and biological cytotoxic agents can potentially improve outcomes in patients with lymph node (LN) metastases. “Therapeutic Sentinel Lymph Node Imaging” incorporates these modalities into a single agent thereby identifying which LNs harbor tumor cells and simultaneously eradicating metastatic disease. In this review, we summarize the novel preclinical agents for identification and treatment of tumor bearing LNs and discuss their potential for clinical translation.Therapeutic Sentinel Lymph Node ImagingStefan S. Kachala, Elliot L. Servais, Bernard J. Park, Valerie W. Rusch, Prasad S. Adusumilli10.1053/j.semtcvs.2009.11.002Seminars in Thoracic and Cardiovascular Surgery 21, 4 (2009)Seminars in Thoracic and Cardiovascular Surgery214S1043-0679(09)X0006-7Sentinel Node Mapping in Lung Cancer- Michael J. Liptay, MD, FACS, Guest Editor327338http://www.semthorcardiovascsurg.com/article/PIIS1043067909001506/abstract?rss=yesSince US Food and Drug Administration approval in 2005 for the treatment of descending thoracic aortic aneurysms, thoracic endovascular aortic repair (TEVAR) has revolutionized the field of thoracic aortic surgery. Although no randomized studies exist to this point, accumulating clinical experience from around the world has confirmed the feasibility and the safety of this new treatment paradigm, with results comparable to conventional open repair. Furthermore, TEVAR provides patients previously considered prohibitively high risk for conventional repair an alternative surgical option. With its widespread acceptance in the treatment of aneurysmal disease, innovative investigators have further expanded the indications of use with off-label application of TEVAR in various other thoracic aortic pathologies, including dissections, traumatic injuries, aortic arch, and thoracoabdominal aortic aneurysms. Perhaps, many have argued that this technology may have its most significant clinical contribution in these highest risk categories of thoracic aortic pathologies.Advances in Thoracic Endovascular Aortic Repair: IntroductionWilson Y. Szeto, Joseph E. Bavaria10.1053/j.semtcvs.2009.12.004Seminars in Thoracic and Cardiovascular Surgery 21, 4 (2009)Seminars in Thoracic and Cardiovascular Surgery214S1043-0679(09)X0006-7Advances in Thoracic Endovascular Aortic Repair- Wilson Y. Szeto, MD, and Joseph E. Bavaria, MD, Guest Editors339340http://www.semthorcardiovascsurg.com/article/PIIS1043067909001488/abstract?rss=yesDescending thoracic aortic aneurysmal disease is associated with poor 5-year survival rates as low as 10%-15% if untreated. This is probable because of a combination of the aneurysmal disease, comorbidities, and in many patients advanced age. In the search for better outcomes and newer techniques, the endovascular approach for the treatment of these aneurysms has developed over the last 20 years. Many advances in the materials and techniques have been made since the first reports of abdominal and thoracic aortic endovascular repair in the early 1990s. Currently, clinical trials have proven that several different commercially available endovascular grafts can be deployed safely, with early results equal to or better than conventional open repairs. Most of the data reported have been on early and midterm results. Now with continued observation, the long-term outcomes of these novel techniques can be determined over the next decade.Endovascular Repair of Descending Thoracic Aortic Aneurysm: Review of LiteratureJames E. Davies10.1053/j.semtcvs.2009.12.002Seminars in Thoracic and Cardiovascular Surgery 21, 4 (2009)Seminars in Thoracic and Cardiovascular Surgery214S1043-0679(09)X0006-7Advances in Thoracic Endovascular Aortic Repair- Wilson Y. Szeto, MD, and Joseph E. Bavaria, MD, Guest Editors341346http://www.semthorcardiovascsurg.com/article/PIIS1043067909001439/abstract?rss=yesSurgical management of aortic arch aneurysms remains a clinical challenge associated with significant perioperative morbidity and mortality. For the increasingly aging population with significant comorbidities, innovative hybrid aortic arch reconstructive techniques using thoracic endograft technology have been developed in an attempt to improve surgical outcome. With these hybrid arch reconstructive techniques, surgeons have extended the indications and provided an alternative surgical option to patients previously considered prohibitively high risk for conventional open repair of aortic arch aneurysms. Multiple techniques have been described in the literature. In this section, we will present: (1) the current results of hybrid aortic arch repair and (2) a new classification based on the anatomic extent of the aneurysm and the suitability of the landing zones.Hybrid Repair of Aortic Arch Aneurysms: Combined Open Arch Reconstruction and Endovascular RepairWilson Y. Szeto, Joseph E. Bavaria10.1053/j.semtcvs.2009.11.007Seminars in Thoracic and Cardiovascular Surgery 21, 4 (2009)Seminars in Thoracic and Cardiovascular Surgery214S1043-0679(09)X0006-7Advances in Thoracic Endovascular Aortic Repair- Wilson Y. Szeto, MD, and Joseph E. Bavaria, MD, Guest Editors347354http://www.semthorcardiovascsurg.com/article/PIIS1043067909001464/abstract?rss=yesThoracoabdominal aortic aneurysms (TAAA) remain a formidable surgical challenge, with conventional open repair associated with significant rates of mortality and morbidity. Furthermore, many of these patients are elderly with significant comorbidities and may not be candidates for repair. Consequently, the availability of a “hybrid” option, including open visceral debranching with concomitant endovascular aneurysm exclusion, may have advantages in these high-risk patients, including the potential to offer therapy to those ineligible for conventional repair. Our technique for hybrid TAAA repair is performed by means of midline laparotomy. A commercially manufactured custom multibranched Dacron graft is used to sequentially bypass, in extranatomic manner, the left renal artery, superior mesenteric artery, celiac axis, and right renal artery. Inflow is through a single proximal anastomosis to the iliac system, infrarenal aorta, or an existing infrarenal aortic graft. In all cases, endovascular exclusion of the aneurysm has been performed at the same operation. The procedure is applicable to all types of TAAA (Extent I-V), although a bifurcated abdominal aortic endograft may be required if inadequate distal landing zone for a tube endograft exists above the aortic bifurcation. Results to date suggest this technique of “hybrid” TAAA repair to be a safe alternative to conventional repair for TAAA in older patients with significant comorbidity, with results in our institution similar to those previously published for younger patients undergoing conventional repair in high-volume centers.Hybrid Thoracoabdominal Aortic Aneurysm Repair: Concomitant Visceral Revascularization and Endovascular Aneurysm ExclusionG. Chad Hughes, Richard L. McCann10.1053/j.semtcvs.2009.11.010Seminars in Thoracic and Cardiovascular Surgery 21, 4 (2009)Seminars in Thoracic and Cardiovascular Surgery214S1043-0679(09)X0006-7Advances in Thoracic Endovascular Aortic Repair- Wilson Y. Szeto, MD, and Joseph E. Bavaria, MD, Guest Editors355362http://www.semthorcardiovascsurg.com/article/PIIS1043067909001415/abstract?rss=yesEndoleaks and endotension remain the primary limitation of endovascular aortic repair with stent-grafts. Consequently, all endovascular surgeons performing thoracic or abdominal endovascular aortic repairs require a comprehensive knowledge and understanding of how to survey and manage endoleaks. The derivation of the current endoleak classification scheme, the clinical impact of endoleaks, the diagnostic tools relevant to endoleak detection, an endoleak surveillance protocol, and the strategies in use for their management are outlined in this review.Endoleaks After Endovascular Aortic Stent-Grafting: Impact, Diagnosis, and ManagementThomas G. Gleason10.1053/j.semtcvs.2009.11.005Seminars in Thoracic and Cardiovascular Surgery 21, 4 (2009)Seminars in Thoracic and Cardiovascular Surgery214S1043-0679(09)X0006-7Advances in Thoracic Endovascular Aortic Repair- Wilson Y. Szeto, MD, and Joseph E. Bavaria, MD, Guest Editors363372http://www.semthorcardiovascsurg.com/article/PIIS1043067909001440/abstract?rss=yesType III aortic dissection is associated with high morbidity and mortality. There is a shifting paradigm in the treatment of complicated and uncomplicated acute type III aortic dissection toward earlier endovascular repair. In this review, the authors present the current perspective on the endovascular management of acute complicated and uncomplicated type III aortic dissection.Acute Complicated and Uncomplicated Type III Aortic Dissection: An Endovascular PerspectiveCastigliano M. Bhamidipati, Gorav Ailawadi10.1053/j.semtcvs.2009.11.008Seminars in Thoracic and Cardiovascular Surgery 21, 4 (2009)Seminars in Thoracic and Cardiovascular Surgery214S1043-0679(09)X0006-7Advances in Thoracic Endovascular Aortic Repair- Wilson Y. Szeto, MD, and Joseph E. Bavaria, MD, Guest Editors373386http://www.semthorcardiovascsurg.com/article/PIIS104306790900149X/abstract?rss=yesDeBakey type I aortic dissections pose significant challenges in operative and long-term management of the arch and distal thoracic aorta. Concerns regarding management of complex tears extending to the arch and descending thoracic aorta, malperfusion syndromes, and late aortic dilatation have provided an impetus to explore aortic repairs that involve stent-graft placement into the descending thoracic aorta in combination with conventional hemi-arch or total arch repairs. Early results with these techniques are promising but further study is warranted.Distal Aortic Remodeling Using Endovascular Repair in Acute DeBakey I Aortic DissectionNimesh D. Desai, Alberto Pochettino10.1053/j.semtcvs.2009.12.003Seminars in Thoracic and Cardiovascular Surgery 21, 4 (2009)Seminars in Thoracic and Cardiovascular Surgery214S1043-0679(09)X0006-7Advances in Thoracic Endovascular Aortic Repair- Wilson Y. Szeto, MD, and Joseph E. Bavaria, MD, Guest Editors387392http://www.semthorcardiovascsurg.com/article/PIIS1043067909001397/abstract?rss=yesBlunt traumatic aortic injury is a highly fatal injury caused from rapid deceleration of the thorax. Most victims do not survive to obtain emergency medical care. Immediate open surgical repair had been the standard of care for decades, but more recent strategies and the emergence of thoracic aortic endografting have changed protocols for the treatment of this highly lethal lesion. This article reviews the current treatment of blunt thoracic aortic injury and the use of thoracic aortic stent grafting for this patient population.Endovascular Repair of Blunt Thoracic Aortic InjuriesDerek R. Brinster10.1053/j.semtcvs.2009.11.003Seminars in Thoracic and Cardiovascular Surgery 21, 4 (2009)Seminars in Thoracic and Cardiovascular Surgery214S1043-0679(09)X0006-7Advances in Thoracic Endovascular Aortic Repair- Wilson Y. Szeto, MD, and Joseph E. Bavaria, MD, Guest Editors393398