Current management guidelines in thoracic surgery:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
2012
|
| Schriftenreihe: | Thoracic surgery clinics
22,1 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XII, 137 S. Ill., graph. Darst. |
| ISBN: | 9781455739431 |
Internformat
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Datensatz im Suchindex
| _version_ | 1804148772471570432 |
|---|---|
| adam_text | Titel: Current management guidelines in thoracic surgery
Autor: Marshall, M. Blair
Jahr: 2012
Current Management Guidelines in Thoracic Surgery
Contents
Preface: Current Management Guidelines in Thoracic Surgery xi
M. Blair Marshall
Perioperative Smoking Cessation
Alberto de Hoyos, Carol Southard, and Malcolm M. DeCamp
Smoking is the leading cause of preventable death worldwide. Smoking cessation
programs that include counseling and pharmacotherapy have been proved to be ef-
fective in achieving long-standing abstinence. Smoking cessation is associated with
significant improvements in quality of life, mortality, life expectancy, and postsurgical
complication rates. Contrary to general belief, smoking cessation close to the time of
elective surgery does not increase the risk of pulmonary complications. Longer-
term quit rates are generally higher in cohorts who quit in anticipation of surgery com-
pared with those quitting for general health considerations. A team approach and
adherence to the guidelines for smoking cessation improves long-term chances of
success.
Prophylaxis and Management of Atrial Fibrillation After General Thoracic Surgery 13
Robert E. Merritt and Joseph B. Shrager
Atrial fibrillation (AF) commonly affects patients after general thoracic surgery. Post-
operative AF increases hospital stay and charges. Effective prophylaxis and treat-
ment is the goal. Calcium channel blockers prevent postoperative AF. Beta
blockers are a less viable choice. Amiodarone prophylaxis should be avoided in pa-
tients with pulmonary dysfunction or who require pneumonectomy. In management
of AF, a brief trial of rate-control agents is appropriate; however, chemical cardiover-
sion with rhythm-control agents should be instituted after 24 hours. High-risk patients
with history of stroke or transient ischemic attack, or with two or more risk factors for
thromboembolism should receive anticoagulation therapy.
DeepVeinThrombosis/Pulmonary Embolism: Prophylaxis, Diagnosis, and Management 25
AlessandroBrunelli
Thoracic surgery patients should be regarded at high risk for postoperative venous
thromboembolism (VTE). VTE mechanical and pharmacologic prophylaxis with low
molecular weight heparin, or low-dose unfractionated heparin orfondaparinux (Arix-
tra) is therefore strongly recommended. Pharmacologic prophylaxis should be ex-
tended to 4 weeks after major cancer surgery. Pulmonary embolism should be
always managed with anticoagulation, in addition to thrombolytic therapy, in patients
presenting with cardiogenic shock or persistent arterial hypotension.
The Management of Anticoagulants Perioperatively 29
Robert J. Cerfolio and Ayesha S. Bryant
Perioperative management of anticoagulants requires one to balance the patient s
risk factors for operative bleeding, the type of operation to be performed, and the
patient s risk of thromboembolism. At present, no set algorithm exists for the
Contents
perioperative management of all the anticoagulants. In this article, we address the
perioperative management of the most commonly used anticoagulants seen in prac-
tice today, such as warfarin, heparin, dabigatran, Clopidogrel, and aspirin, for the
most commonly performed general thoracic operations.
Perioperative Antibiotics in Thoracic Surgery 35
Stephanie H. Chang and Alexander S. Krupnick
No official guidelines exist for perioperative antibiotic use in noncardiac thoracic sur-
gery. Despite some conflicting data and few randomized clinical trials there exists
strong evidence supporting the use of perioperative antibiotic prophylaxis in pulmo-
nary resection. This article discusses the evidence-based indications for antibiotic
prophylaxis after lung resection, esophageal surgery, and lung transplantation.
Physiologic Evaluation of Lung Resection Candidates 47
Elizabeth A. David and M. Blair Marshall
This article reviews an evidence-based approach to the physiologic evaluation of
patients under consideration for surgical resection of lung cancer. Adequate physi-
ologic evaluation often includes a multidisciplinary evaluation, with complete identi-
fication of risk factors for perioperative complications and long-term disability
including cardiovascular risk, assessment of pulmonary function, and smoking ces-
sation counseling. Consideration of tumor-related anatomic obstruction, atelectasis,
or vascular occlusion may alter measurements. Careful preoperative physiologic as-
sessment helps to identify patients at increased risk of morbidity and mortality after
lung resection. These evaluations are helpful in identifying patients who may not
benefit from surgical management of their lung cancer.
Management of Early Stage Non-Small Cell Lung Cancer in High-Risk Patients 55
Jessica S. Donington and Justin D. Blasberg
The preferred treatment of stage I non-small cell lung cancer (NSCLC) is anatomic
resection with systematic mediastinal lymph node evaluation. However, 20% of pa-
tients with operable lung cancer are not candidates for this type of resection. Recent
advancements in radiology-guided technologies have expanded the treatment op-
tions for high-risk patients with early-stage NSCLC. There has simultaneously
been resurgence in interest and refinement of indications and techniques for sublo-
bar resection in this population. While these treatments appear to have decreased
peri-procedural morbidity and mortality, their oncologic efficacy compared to that of
lobectomy remains to be determined.
Induction Therapy for Lung Cancer: Sailing Across the Pillars of Hercules 67
Gaetano Rocco, Alessandro Morabito, and Paolo Muto
In spite of numerous clinical trials, the jury is still out on the value of induction therapy
for locally advanced lung cancer. We elected to address this topic from the multifac-
eted views of the clinicians often involved in lung cancer management and accord-
ing the most recent views on locally advanced NSCLC. The concept of a prognostic
stratification of N2 disease subsets, especially single vs multiple zone, has been in-
troduced and this may lead to a new interpretation of locally advanced NSCLC. Ten
crucial issues were identified that may have an impact on the approach to patients
with locally advanced lung cancer in everyday practice.
Contents
Chest Wall Sarcomas and Induction Therapy 77
John C. Kucharczuk
Chest wall sarcomas are uncommon tumors. The best patient outcomes likely result
from a formalized multidisciplinary treatment plan in a specialized center. No clear
guidelines exist to determine whether patients with chest wall sarcomas benefit
from preoperative adjuvant therapy. Most decisions are made on a case-by-case
basis with little available evidence. It is unclear whether established guidelines for
the more commonly occurring extremity sarcomas can be appropriately extrapo-
lated to the care of patients with chest wall disease. The single most important factor
in local control and long-term survival is a wide, complete, RO resection.
Induction Therapy for Thymic Malignancies 83
Avedis Meneshian and Stephen C.Yang
Thymic malignancies are rare tumors of the chest that express a broad range of bi-
ological behaviors. Surgery remains the mainstay of therapy, and complete surgical
resection is the primary predictor of long-term survival. Although there is a paucity of
clinical trials assessing the role of induction/adjuvant chemotherapy and/or radiation
therapy in the treatment of thymic malignancies, existing data suggest that induction
therapy should be offered for the treatment of advanced-stage disease, and post-
operative radiation for specific stages.
Pulmonary Metastasectomy 91
Francis C.Nichols
The most common cause of cancer death is the development of metastatic disease.
Thirty percent of patients eventually develop pulmonary metastases. Randomized
control data supporting the commonly accepted practice of surgical pulmonary
metastasectomy are lacking. This article focuses on the current surgical manage-
ment of pulmonary metastases providing the reader with reasonable guidance
from the vast literature that exists.
Management of Barrett Esophagus with High-grade Dysplasia 101
Thomas W. Rice and John R. Goldblum
High-grade dysplasia in Barrett esophagus is a marker for future development of
cancer and for the existence of synchronous cancer. A significant problem in man-
agement is intraobserver and interobserver variation in the diagnosis of high-grade
dysplasia in Barrett esophagus, the natural history of which is poorly understood;
thus, treatment decisions are problematic. The ability to preserve the esophagus
with endoscopic mucosal ablation or resection and reduce morbidity of treatment
has made endoscopic treatment the mainstay of therapy. Esophagectomy is re-
served for treatment failures and for high-grade dysplasia not amenable to less ag-
gressive therapies. This article outlines the data supporting current management
strategies.
Evidence-Based Review of the Management of Cancers of the Gastroesophageal Junction 109
Chaitan K. Narsule, Marissa M. Montgomery, and Hiran C. Fernando
The management of localized esophageal cancer has traditionally been surgical re-
section; yet, despite improvements in outcomes and techniques, survival for patients
with esophageal cancer, especially those with evidence of nodal involvement,
Contents
remains poor. In this article, we have used an evidence-based approach to define op-
timal therapy based on clinical stage for esophageal cancer. We review the currently
available evidence supporting the use of neoadjuvant and adjuvant therapies for lo-
cally advanced esophageal cancer. Additionally, we review the evidence supporting
the role of endoscopic therapies, rather than resection, for early-stage esophageal
cancer.
Follow-up of Patients with Resected Thoracic Malignancies 123
Paul M. Claiborne, Clara S. Fowler, and Ara A. Vaporciyan
The authors have systematically performed a literature search using 8 databases
identifying established guidelines for follow-up after resected thoracic malignancies.
Seven different societies (found to have published recommendations for non-small
cell lung cancer, esophageal cancer, thymoma, or mesothelioma) guidelines are re-
viewed in this article. High-quality evidence leading to consistent, strong recommen-
dations among societies has not been found. With the subsequent advancements in
surgical treatment and other curative modalities, the ability to detect and intervene
with curative therapy at earlier stages of disease in a growing portion of the current
patient population will benefit from higher-quality evidence.
Index 133
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| spelling | Current management guidelines in thoracic surgery guest ed. M. Blair Marshall Philadelphia [u.a.] Saunders 2012 XII, 137 S. Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Thoracic surgery clinics 22,1 Thoraxchirurgie (DE-588)4059934-6 gnd rswk-swf Thoraxchirurgie (DE-588)4059934-6 s DE-604 Marshall, M. Blair Sonstige oth Thoracic surgery clinics 22,1 (DE-604)BV019335438 22,1 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=024700665&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
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| title | Current management guidelines in thoracic surgery |
| title_auth | Current management guidelines in thoracic surgery |
| title_exact_search | Current management guidelines in thoracic surgery |
| title_full | Current management guidelines in thoracic surgery guest ed. M. Blair Marshall |
| title_fullStr | Current management guidelines in thoracic surgery guest ed. M. Blair Marshall |
| title_full_unstemmed | Current management guidelines in thoracic surgery guest ed. M. Blair Marshall |
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