Pulmonary Division Research Articles

Evaluation of the post-COVID multidisciplinary outpatient clinic at the Pulmonary Division of the Cantonal Hospital Winterthur from the patient's perspective: a mixed-methods study.

This prospective study, conducted with patients from the multidisciplinary post-COVID outpatient clinic at the Pulmonary Division of the Cantonal Hospital Winterthur, aimed to investigate changes in patients' main symptoms, elements that aided in coping with the condition and satisfaction with the consulting and therapeutic interventions. After obtaining ethical approval, fifty patients were consecutively included in this longitudinal study, which incorporated three survey times post-consultation: t1 (0-7 days), t2 (4-8 weeks) and t3 (4-6 months). The survey comprised standardised questionnaires, including the Hospital Anxiety and Depression Scale, the Post-COVID-19 Functional Status scale and the Chalder Fatigue scale, along with study-specific questions regarding symptoms and reasons for consulting the post-COVID outpatient clinic. Additionally, ten patients were invited to participate in qualitative individual interviews at t2 and t3. The study was conducted between November 2021 and February 2023. The median age of the 50 participants was 47 years (IQR: 36-55), with 66% (33/50) being female. Most participants (66% or 33/50) reported no pre-existing conditions prior to COVID-19 infection, and only six patients required hospitalisation during the acute phase of their infection. Visits to the multidisciplinary post-COVID clinic occurred approximately eight months post-infection, with referrals primarily made by primary care physicians (82% or 41/50). The majority of patients experienced persistent tiredness, exhaustion and fatigue (94% or 47/50), along with reduced physical performance (82% or 41/50), while pain or breathing difficulties were less frequently mentioned. At t1, around half of the patients were fully or partially unable to work, a proportion that reduced to around a third by t3. Symptoms generally decreased over time, with significant improvements observed between t2 and t3. However, subjectively perceived cognitive limitations worsened or were reported more frequently over time. Most patients (96% or 48/50) felt well cared for throughout their consultations. In qualitative interviews, patients highlighted the medical staff's attentiveness and the time dedicated to consultations, which made them feel that their complaints were taken seriously and that they received appropriate information. The results confirmed that the multidisciplinary post-COVID outpatient clinic met most respondents' expectations. Patients found that the attentive interprofessional coaching was most helpful in coping with their illness. However, participants also noted long waiting times and expressed a desire for earlier admission to the clinic.

The impact of vascular division sequence and epithelial-mesenchymal transition status on postoperative recurrence in lung adenocarcinoma.

The vascular division sequence in video-assisted thoracic surgery (VATS) lung resection is usually determined by the handling difficulty due to the limited surgical view through the scope. However, upfront pulmonary vein division is theoretically desirable to avoid tumor cells spreading by surgical manipulation. Epithelial-mesenchymal transition (EMT) is associated with poor prognosis and an increased number of circulating tumor cells. The purpose of this study is to evaluate the effect of vascular division sequence and EMT on postoperative recurrence. We retrospectively investigated tissue microarrays of 282 lung adenocarcinomas surgically resected between 2001 and 2007. We excluded the cases with segmentectomy, wedge resection, dissemination, insufficient material for staining, or lack of medical records. The effect of vascular division sequence and clinicopathologic factors on recurrence was evaluated in 195 cases. The upfront pulmonary vein division (V-first) was performed in 60 patients, and the upfront pulmonary artery division (A-first) was performed in 135 patients. The recurrence was observed in 67 patients (13 in V-first and 54 in A-first). Epithelial-mesenchymal transition activation was observed in 104 patients. Multivariable analysis with 195 patients revealed that lymph node metastasis and pleural invasion were risk factors for the recurrence. The stratified multivariable analysis showed that vascular division sequence (A-first) was a risk factor only in the EMT-negative group (91 patients). In the EMT-negative subset, the 5-year relapse-free survival rate was significantly lower in the A-first group than the V-first group (72.6% vs. 92.2%, p = 0.0136). The upfront pulmonary artery division might be a risk factor in patients without EMT activation.

The long-term impact of COVID-19 pneumonia on pulmonary function and exercise capacity.

The sequelae of post-coronavirus disease 2019 (COVID-19) have been widely reported. However, the time point of the follow-up time in the previous studies varied ranging from 3-24 months and the interval time of the follow-up time was too long (6 or 12 months). Thus, a shorter interval time during recovery for assessment of the sequelae of post COVID-19 on lung function and exercise capacity is still required. Therefore, this study aims to explore the long-term impact of COVID-19 pneumonia on pulmonary function and exercise capacity. A prospective observational study was conducted on post COVID-19 pneumonia at the Lung Health Center, Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand between May 2021 and April 2022. Spirometry, impulse oscillometry (IOS), and fractional exhaled nitric oxide (FeNO) were assessed at 1-, 6-, 9-, and 12-month post-hospital discharge when compared to healthy controls. The six-minute walk test (6-MWT) was also assessed. Thirty-eight post COVID-19 pneumonia with ages 41.1±14.8 years (52.6% male) and twenty-five healthy controls were enrolled. The %predicted of forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1) were significantly lower in post COVID-19 pneumonia compared to healthy controls at month 1 and month 9. The improvement of %predicted FVC and FEV1 was observed in post COVID-19 pneumonia. The six-minute walk distance (6-MWD) was significantly lower in post COVID-19 pneumonia compared to healthy controls in all visits, while the 6-MWD improved overtime in post COVID-19 pneumonia. The long term sequelae of post COVID-19 pneumonia on lung function and exercise capacity were observed. Pulmonary function tests and six-minutes walk test are useful tools for detection of long term sequelae of post COVID-19 pneumonia.

Therapy With Inhaled Treprostinil, Macitentan, and Tadalafil/Riociguat in High-Risk Pulmonary Arterial Hypertension.

Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Nebraska Medical Center, Omaha, NE K. El-Kersh provided consultative services to Acceleron, served on advisory boards for J&J Actelion, and United Therapeutics, received institutional research funding from J&J Actelion and United Therapeutics and participated in United Therapeutics speaker bureau (2018–2021).

Building Career Paths for Ph.D., Basic and Translational Scientists in Clinical Departments in the United States: An Official American Thoracic Society Workshop Report.

Rationale: To identify barriers and opportunities for Ph.D., basic and translational scientists to be fully integrated into clinical units. Objectives: In 2022, an ad hoc committee of the American Thoracic Society developed a project proposal and workshop to identify opportunities and barriers for scientists who do not practice medicine to develop successful careers and achieve tenure-track faculty positions in clinical departments and divisions within academic medical centers (AMCs) in the United States. Methods: This document focuses on results from a survey of adult and pediatric pulmonary, critical care, and sleep medicine division chiefs as well as a survey of workshop participants, including faculty in departmental and school leadership roles in both basic science and clinical units within U.S. AMCs. Results: We conclude that full integration of non-clinically practicing basic and translational scientists into the clinical units, in addition to their traditional placements in basic science units, best serves the tripartite mission of AMCs to provide care, perform research, and educate the next generation. Evidence suggests clinical units do employ Ph.D. scientists in large numbers, but these faculty are often hired into non-tenure track positions, which do not provide the salary support, start-up funds, research independence, or space often associated with hiring in basic science units within the same institution. These barriers to success of Ph.D. faculty in clinical units are largely financial. Conclusions: Our recommendation is for AMCs to consider and explore some of our proposed strategies to accomplish the goal of integrating basic and translational scientists into clinical units in a meaningful way.

Editorial introductions.

Current Opinion in Pulmonary Medicine was launched in 1995. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of pulmonary medicine is divided into nine sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Alan FeinAlan FeinAlan Fein, MD received his medical degree from the State University of New York Downstate Medical Center in Brooklyn, USA in 1973. He completed his internship and residency in internal medicine at Albert Einstein College of Medicine, Bronx Municipal Hospital, New York, USA. From there, Dr Fein moved on to a fellowship in Pulmonary Disease at the University of California, San Francisco Cardiovascular Research Institute, USA. He served as Division Chief for Sleep, Pulmonary & Critical Care Medicine at Winthrop Hospital and then for the North Shore Long Island Jewish Health System. Dr Fein is a member of the American Academy of Sleep Medicine, the American College of Chest Physicians, the American College of Physicians, and the American College of Critical Care Medicine. He is the former President of the American Lung Association of Nassau/Suffolk and served on the national boards of the American Thoracic Society and the American College of Chest Physicians. Dr Fein is a Clinical Professor of Medicine at New York University, USA and Zucker School of Medicine, USA. He was Chief of the Pulmonary, Critical and Sleep Division of Prohealthcare Associates Optum Health. He is currently Medical director of the Post Covid Recovery Center for Optum Health. Dr Fein is on the editorial boards of Current Opinion in Pulmonary Medicine and the American Journal of Respiratory & Critical Care Medicine. Dr Fein has authored almost 100 peer-reviewed manuscripts, over 100 review articles, and book chapters on topics such as diagnosis and treatment of lung cancer, pneumonia, asthma, and chronic obstructive pulmonary diseases. David OstDavid OstDavid Ost, MD, MPH is Professor of Medicine at The University of Texas M. D. Anderson Cancer Center, Department of Pulmonary Medicine, USA. Dr Ost is a Fellow of the American College of Chest Physicians and the American College of Physicians and has served on the board of directors of the American Association of Bronchology and Interventional Pulmonology. Dr Ost is currently editor of the Journal of Bronchology and Interventional Pulmonology. He is a reviewer for many journals including Annals of Internal Medicine, the American Journal of Respiratory and Critical Care Medicine, Chest and the Journal of the American Medical Association. Dr Ost has authored over 100 manuscripts and book chapters on such topics as interventional pulmonology, lung cancer, pulmonary embolism, and ventilator associated pneumonia. Dr Ost received his medical degree from the Thomas Jefferson University, Jefferson Medical College in Philadelphia, USA. He completed his internship and residency in internal medicine at Northwestern University in Chicago, USA. Additionally, Dr Ost was a fellow in pulmonary and critical care at Northwestern. He is board certified in interventional pulmonology. He received his Masters in Public Health from Harvard University, USA, with a focus in quantitative methods. Marlies WijsenbeekMarlies WijsenbeekMarlies Wijsenbeek is pulmonary physician and Professor of Interstitial Lung Diseases at the Erasmus University Medical Centre in Rotterdam, a national expert centre for interstitial lung diseases (ILD) in the Netherlands and member of the European Reference Network for Rare Lung Diseases (ERN-Lung). She is chair of the multidisciplinary ILD centre. Her research interests include e-health, patient centred outcome measures in ILD, cough in ILD and new therapies in ILD and sarcoidosis. She is chair of group 12.01 (Idiopathic Interstitial Pneumonia) of the European Respiratory Society, chair of the functional committee for continued education of the ERN-Lung, member of the scientific advisory boards of different patient associations, Associate Editor of the European Respiratory Journal, and member of the international advisory board of The Lancet Respiratory Medicine. Catharina C. MoorCatharina C. MoorKaren Moor, M.D. Ph.D. is a pulmonologist in training and postdoctoral researcher at the Erasmus Medical Center, Rotterdam, the Netherlands. She is the current Early Career Representative for the ILD assembly within the European Respiratory Society (ERS). Her research focuses on innovative approaches for patient-centered care in interstitial lung disease (ILD), especially digital health care and home monitoring. She coordinated the first-ever randomized controlled trial on home monitoring in ILD (Am J Respir Crit Care Med Vol 202, Iss 3, pp 393–401, Aug 1, 2020). Together with Prof. Dr Marlies Wijsenbeek she is co-leading various home monitoring studies, including a large international patient-led registry study, and a nationwide implementation study.

Sleep medicine advocacy matters for public health and safety.

Subscription RequiredLetters to the editorSleep medicine advocacy matters for public health and safety Shannon S. Sullivan, MD, Muhammad Adeel Rishi, MD, for the Public Safety Committee of the American Academy of Sleep Medicine Shannon S. Sullivan, MD Division of Pulmonary, Asthma, and Sleep Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California Search for more papers by this author , Muhammad Adeel Rishi, MD Indiana University School of Medicine, Indianapolis, Indiana Search for more papers by this author , for the Public Safety Committee of the American Academy of Sleep Medicine Search for more papers by this author Published Online:June 21, 2023https://doi.org/10.5664/jcsm.10692

Doing more with less.

Subscription RequiredCommentaryDoing more with less Ann M. Romaker, MD, Jennifer L. Cook, MD Ann M. Romaker, MD Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati, Cincinnati, OH Search for more papers by this author , Jennifer L. Cook, MD Division of Cardiology, University of Cincinnati, Cincinnati, OH Search for more papers by this author Published Online:March 31, 2023https://doi.org/10.5664/jcsm.10602

Sleep Neurology: Is It a Ready for Prime Time Player?

Division of Sleep Neurology, Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Departments of Medicine and Neurology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, U.S.A. The author has no funding or conflicts of interest to disclose.

Inferior pulmonary ligament division during left upper lobectomy causes pulmonary dysfunction.

The division of inferior pulmonary ligament (IPL) during upper lobectomy (UL) was believed to be mandatory to dilate the remaining lung sufficiently. However, the benefits, especially postoperative pulmonary function, remain controversial. This study aimed to evaluate whether IPL division leads to pulmonary dysfunction. This retrospective study included 213 patients who underwent UL between 2005 and 2018. They were categorized into an IPL division group (D group, n = 106) and a preservation group (P group, n = 107). Postoperative dead space at the lung apex, pulmonary function and complications were assessed using chest X-rays and spirometry. Changes in bronchial angle, cross-sectional area and circumference of the narrowed bronchus on the excised side were measured on three-dimensional computed tomography. There was no significant difference in the postoperative complication rate, the dead space area, forced vital capacity (FVC), or forced expiratory volume in 1 s (FEV1) between the 2 groups after right UL (FVC; P = 0.838, FEV1; P = 0.693). By contrast, after left UL pulmonary function was significantly better in the P than in the D group (FVC; P = 0.038, FEV1; P = 0.027). Changes in bronchial angle did not significantly differ between the 2 groups. The narrowed bronchus's cross-sectional area (P = 0.021) and circumference (P = 0.009) were significantly smaller in the D group than in the P group after left UL. IPL division during left UL caused postoperative pulmonary dysfunction and airflow limitation due to bronchial kinking. IPL preservation may have a beneficial impact on postoperative pulmonary function.

COVID-19 and ophthalmic herpes zoster co-infection in immunocompetent patient

Background: Varicella-zoster virus (VZV) is a virus of human neurotropic that remains within ganglionic neurons in a latent state after the primary infection throughout the entire neuroaxis.
 Case: A male patient, 32 years old Javanese, consulted from the pulmonary division with complaints of vesicular eruption in the facial area on September 27, 2020. The patient was diagnosed with ophthalmic herpes zoster and a mild COVID-19 infection since 2 days ago and was hospitalized. Management in patients was acyclovir, methylprednisolone, with analgesics and vitamins. COVID-19 as co-infection and other viruses has been known, but infrequently affect the respiratory tract.
 Conclusion: Herpes zoster patient should ruled out the COVID-19 and maximize the precaution for personal safety equipment until the SARS-CoV-2 is excluded.

The most common pulmonary diseases length of stay, and characteristics of patients admitted to pulmonary service.

Although chronic respiratory diseases are prevalent in Saudi Arabia, there are limited data on the patient burden and associated factors. The aim of this study is to identify the chronic respiratory diseases frequently admitted to pulmonary services and to determine the patient's characteristics, associated comorbidities readmission rate, and reason for a more extended stay in hospital. A prospective study was conducted over a 5-year period at King Abdulaziz Medical City-Riyadh, Saudi Arabia, in the Pulmonary Division, between March 2015 and December 2019. Data on demographics, comorbidities, and chronic respiratory diseases were collected. Total patients admitted were 1315 patients, female 54.2%, the mean age was 62.4 (SD±17.6), and the ages ranged from 14 to 98 years. Overall, chronic obstructive pulmonary disease was the most common respiratory disease requiring admission (17.9%), followed by interstitial lung disease (15.8%), bronchiectasis (11.9%), and obesity hypoventilation syndrome (10.8%). The most common comorbidities were obesity (42.5%), diabetes 49.1%, and hypertension 54.9%. Only 135 (10.3%) were readmitted within 30 days posthospital discharge. Among the patients who were readmitted, 103 (76.3%) were readmitted due to issues related to previous admission diagnosis, noncompliance 75 (55.5%), social reasons, and premature discharges in 51 (37.8%) and 29 (21.5%) of the cases, respectively. The respiratory disease varied significantly by gender, age, obesity status, comorbidities, length of stay (LOS), and admissions. Chronic respiratory diseases are prevalent in our population and are mainly influenced by gender, age, obesity status, comorbidities, LOS, and admissions. Policymakers and health professionals need to recognize the burden of chronic respiratory diseases on patients and health systems and implement effective prevention programs.

Comparative study on Various Tube Voltages and Contrast Media Doses in CT Pulmonary Angiography to detect Pulmonary Thromboembolism

Background: Lowering the amount of iodinated contrast material and tube voltage may increase pulmonary artery opacification and thrombus identification without compromising picture quality. Objectives: To explore the efficiency of using lower tube voltage and a lower contrast medium dose for conducting computed tomography for pulmonary angiography (CTPA) aiming to increase its accuracy in detecting pulmonary thromboembolism (PTE). Subjects and Methods:100 patients scheduled for CTPA with a preoperative diagnosis of PTE were grouped into two: group A, (50 patients) got 1 mL/kg at 120 kV and group B, (50 patients) received 0.5 mL/kg at 80 kV.The technique of bolus tracking was implemented.Values of midpoint of multiple pulmonary artery divisions were used to assess attenuation.Significant values are those that exceed 300 Hounsfield units (HU). The dosage of radiation received by the patient, defined as the effective dose, was compared between groups. Results: Total mean attenuationdata for the pulmonary arteries have shown to be substantially greater in group-B compared to group-A (39110.4HU vs. 335.97.9HU, P=0.001). Moreover, total dose length product (DLP) values were substantially lower in group-B (934.9 mGy.cm vs. 384.443 mGy.cm, P=0.001). While effective dose values have shown to be significantly lower in group-B (2.90.3 mSv vs. 13.21.8 mSv, P 0.001). Conclusion: Low-kilovoltage technique and low quantity of iodinated contrast are useful in conducting (CTPA) with high accuracy in detection of pulmonary thromboembolism.

Feasibility of an Antiracism Curriculum in an Academic Pulmonary, Critical Care, and Sleep Medicine Division.

BackgroundStructural health inequities and racism adversely affect patient health and the culture of academic medicine. Formal training to educate fellows and faculty on antiracism is lacking.ObjectiveOur objective was to design, implement, and assess the feasibility and preliminary efficacy of a year-long antiracism curriculum within a pulmonary, critical care, and sleep medicine division.MethodsThis was a pre- and postintervention observational study conducted between July 2020 and June 2021. The curriculum was offered during an allotted educational meeting time slot at a single-center pulmonary, critical care, and sleep medicine division at a large academic institution to fellows and faculty. The curriculum consisted of 13 1-hour virtual interactive workshops delivered by local experts in diversity, equity, and inclusion topics. Surveys assessed knowledge on racism in medicine; opinions, understanding, and comfort surrounding race and racism in medicine; as well as additional questions to solicit feedback on the curriculum itself via visual analog scale and write-in comments.ResultsBefore initiating the curriculum, 74% (n = 28) of respondents reported interest in an antiracism curriculum, and the majority (95%, n = 36) believed that discrimination affects medical staff and patients. Respondents reported only moderate comfort in talking about race (median, 58; interquartile range 41–70 on visual analog scale 0–100, where 100 is strongly agree with “I feel comfortable talking about race”). The postintervention survey demonstrated stability of the belief of the presence of racial discrimination and a 15% increase in self-directed learning about related topics. Although knowledge related to the use of race in medical algorithms improved, 14% fewer participants reported interest in continuing to engage in a division-wide structured antiracism curriculum.ConclusionImplementation of a curriculum on justice, equity, diversity, and inclusion within a fellowship program is feasible and addresses an unmet need within graduate medical education.

A Decision-Support System to Schedule Rotations for Trainees.

BackgroundEach training program has its own internal policies and restrictions, which must be considered while developing trainee schedules. Designing these schedules is complex and time consuming, and the final schedules often contain undesirable aspects for trainees.ObjectiveWe developed a decision-support system (DSS) to optimally schedule daily assignments and monthly rotations for trainees. The proposed DSS aims to 1) reduce the schedule development time, 2) maximize trainee preferences for desired rotations and vacation times, and 3) ensure adaptability of the DSS across multiple graduate medical programs through a flexible design and intuitive graphical user interface.MethodsUsing mixed-integer linear programming, we developed a scheduling model that 1) maximized trainees’ preferences on specific rotations and vacation times and 2) ensured fairness by assigning equal numbers of vacation days and a balanced schedule of difficult versus easy rotations among trainees. The model was successfully implemented in the Mayo Clinic Division of Pulmonary and Critical Care for the academic year 2018–2019.ResultsUsing the DSS, it took only a few minutes to produce a schedule versus several days of preparation time required by the manual process. Compared with the manually developed schedule, the DSS schedule satisfied 11% more rotation preferences and improved fairness by 19%. All trainees met duty hours in the DSS schedule compared with 83% in the manually developed schedule.ConclusionThe proposed DSS can dramatically reduce the schedule preparation time, accommodate more of trainees’ preferences, and improve fairness in assigning rotations.

Consensus for Thoracoscopic Lower Lobectomy: Essential Components and Targets for Simulation

BackgroundDespite demonstration of its clear benefits relative to open approaches, a video-assisted thoracic surgery technique for pulmonary lobectomy has not been universally adopted. This study aims to overcome potential barriers by establishing the essential components of the operation and determining which steps are most useful for simulation training. MethodsAfter randomly selecting experienced thoracic surgeons to participate, an initial list of components to a lower lobectomy was distributed. Feedback was provided by the participants, and modifications were made based on anonymous responses in a Delphi process. Components were declared essential once at least 80% of participants came to an agreement. The steps were then rated based on cognitive and technical difficulty followed by listing the components most appropriate for simulation. ResultsAfter 3 rounds of voting 18 components were identified as essential to performance of a video-assisted thoracic surgery for lower lobectomy. The components deemed the most difficult were isolation and division of the basilar and superior segmental branches of the pulmonary artery, isolation and division of the lower lobe bronchus, and dissection of lymphovascular tissue to expose the target bronchus. The steps determined to be most amenable for simulation were isolation and division of the branches of the pulmonary artery, the lower lobe bronchus, and the inferior pulmonary vein. ConclusionsUsing a Delphi process a list of essential components for a video-assisted thoracic surgery for lower lobectomy was established. Furthermore 3 components were identified as most appropriate for simulation-based training, providing insights for future simulation development.

Vein step. Description: Pulmonary ligament division. The common basal vein is dissected, encircled with a tape and divided using an angled vascular endostapler.

Vein step. Description: Pulmonary ligament division. The common basal vein is dissected, encircled with a tape and divided using an angled vascular endostapler.

Patient Satisfaction with Telehealth During the COVID-19 Pandemic in a Pediatric Pulmonary Clinic.

IntroductionThe coronavirus disease 2019 (COVID-19) pandemic has drastically impacted health care delivery systems and has resulted in the rapid implementation of telehealth services across many health care specialties. As the COVID-19 pandemic highlighted the need to leverage digital mediums to increase patient access to health care, our pediatric pulmonary division sought to measure patient satisfaction with a new telehealth platform.MethodA survey was sent to 281 pediatric pulmonary patients from March 2020 to April 2020. Parents were asked to rate their overall experience with telemedicine.ResultsFifty surveys were completed, and results indicated that overall initial satisfaction with care was high. Eighty-two percent of participants either strongly agreed or agreed that they would use telehealth services again.DiscussionThe positive outcome measures may reflect increased patient comfort with integrating telehealth into routine pediatric pulmonary care services. Given high patient satisfaction ratings, we believe that the telehealth platform should be considered for use in routine practice after the COVID-19 pandemic has resolved.

The impact of dissection of station 9 on survival and the necessity of pulmonary ligament division during upper lobectomy for lung cancer

Background We conducted this study to investigate the need for dissection of station 9 lymph nodes during upper lobectomy for non-small-cell lung cancer (NSCLC) and to find out the operative results of inferior pulmonary ligament division. Methods A total of 840 patients who underwent upper lobectomy for NSCLC between January 2007 and June 2020 were evaluated retrospectively. The patients were separated into two groups – those having undergone lymph node dissection of station 9 and inferior pulmonary ligament dissection (Group I) and those who did not (Group II). In these groups, the prognostic value of station 9 lymph nodes and postoperative effects (drainage time, prolonged air leak, dead space and length of hospital stay) of ligament division or preservation were analyzed. Results The number of patients with station 9 lymph node metastasis was only one (0.1%) and that was multi-station pN2 disease. Station 9 lymph nodes were found in 675 (80.4%) patients, while 22 (2.6%) patients had no lymph nodes in the dissected material. In the other 143 (17%) patients, the inferior pulmonary ligament and station 9 were not dissected. While 5-year survival was 64.9% in 697 patients of Group I, it was 61.3% in 143 patients of Group II (p = 0.56). There was no statistically significant difference between the groups in postoperative effects of ligament division or preservation. Conclusions In upper lobectomies, status of station 9 does not have a significant impact on patients' survival and lymph node staging. Additionally, preservation or division of the inferior pulmonary ligament has no significant advantage or disadvantage.

Editorial introductions.

Current Opinion in Pulmonary Medicine was launched in 1995. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of pulmonary medicine is divided into nine sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Alan FeinAlan FeinAlan Fein, MD received his medical degree from the State University of New York Downstate Medical Center in Brooklyn, USA in 1973. He completed his internship and residency in internal medicine at Albert Einstein College of Medicine, Bronx Municipal Hospital, New York, USA. From there, Dr Fein moved on to a fellowship in Pulmonary Disease at the University of California, San Francisco Cardiovascular Research Institute, USA. He served as Division Chief for Sleep, Pulmonary & Critical Care Medicine at Winthrop Hospital and then for the North Shore Long Island Jewish Health System. Dr Fein is a member of the American Academy of Sleep Medicine, the American College of Chest Physicians, the American College of Physicians, and the American College of Critical Care Medicine. He is the former President of the American Lung Association of Nassau/Suffolk and served on the national boards of the American Thoracic Society and the American College of Chest Physicians. Dr Fein is a Clinical Professor of Medicine at New York University, USA and Zucker School of Medicine, USA. He was Chief of the Pulmonary, Critical and Sleep Division of Prohealthcare Associates Optum Health. He is currently Medical director of the Post Covid Recovery Center for Optum Health. Dr Fein is on the editorial boards of Current Opinion in Pulmonary Medicine and the American Journal of Respiratory & Critical Care Medicine. Dr Fein has authored almost 100 peer-reviewed manuscripts, over 100 review articles, and book chapters on topics such as diagnosis and treatment of lung cancer, pneumonia, asthma, and chronic obstructive pulmonary diseases. David E. OstDavid E. OstDavid E. Ost, MD, MPH is Professor of Medicine at The University of Texas M. D. Anderson Cancer Center, Department of Pulmonary Medicine, USA. Dr Ost is a Fellow of the American College of Chest Physicians and the American College of Physicians and has served on the board of directors of the American Association of Bronchology and Interventional Pulmonology. Dr Ost is currently editor of the Journal of Bronchology and Interventional Pulmonology. He is a reviewer for many journals including Annals of Internal Medicine, the American Journal of Respiratory and Critical Care Medicine, Chest and the Journal of the American Medical Association. Dr Ost has authored over 100 manuscripts and book chapters on such topics as interventional pulmonology, lung cancer, pulmonary embolism, and ventilator associated pneumonia. Dr Ost received his medical degree from the Thomas Jefferson University, Jefferson Medical College in Philadelphia, USA. He completed his internship and residency in internal medicine at Northwestern University in Chicago, USA. Additionally, Dr Ost was a fellow in pulmonary and critical care at Northwestern. He is board certified in interventional pulmonology. He received his Masters in Public Health from Harvard University, USA, with a focus in quantitative methods. Aalt BastAalt BastProf. Aalt Bast studied chemistry at the Free University in Amsterdam, the Netherlands. His PhD study (on biotransformation enzymes) was conducted at the Erasmus University of Rotterdam (Faculty of Medicine), the Netherlands, and at the University of Utrecht (Faculty of Pharmacy), Netherlands. He was Professor of Molecular Pharmacology at the Department of Pharmacochemistry at the Free University in Amsterdam in 1988. In 1998, he started to work as professor of Human Toxicology at the Maastricht University, the Netherlands. His main field of interest is the role of free radicals in drug toxicity and pathologies of the lung and the cardiovascular system. Moreover, the possibilities for therapeutic intervention with antioxidants (from food or as drugs) are explored. His current position is Dean of the Campus Venlo, a satellite of Maastricht University. He is registered in the Netherlands as an experimental pharmacologist and toxicologist. He (co-) authored over 650 papers and book chapters. He was chairman of the Dutch Toxicological Society, member of the Concilium Toxicologicum and member of the National Health Council.