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STS 2023, SAN DIEGO — Patients who undergo lobectomy for primary incidence of lung cancer often die from the same cancer recurrence, prompting researchers from Massachusetts General Hospital in Boston to advocate for adjuvant therapies at the time of surgery or following procedures. Research coordinator Alexandra Potter, BSE, presented “Incidence, Timing and Causes of Death Among Patients Who Underwent Lobectomy for Stage IA Lung Cancer in the National Lung Screening Trial (NLST),” an analysis of long-term survival of patients from the National Lung Screening Trial.  The randomized NLST included 53,454 patients. The team at Massachusetts General delved into the NLST data and developed a cohort of 433 patients whose cancers were identified by low-dose computed tomography or Xray and met other study inclusion criteria. They found that: ·       Five-year cancer-specific survival was 80%, 10-year was 70%. ·       Five-year overall survival was 72%, 10-year overall survival was 55%. ·       Five-year overall survival for patients under age 65 at time of diagnosis was 79% and 10-year overall survival was 62%. ·       Five-year overall survival for patients 65 and older at time of diagnosis was 62% and 10-year overall survival was 48% . ·       The leading cause of death for all patients in the cohort was lung cancer, either primary or at recurrence, accounting for 59% of all deaths. The longer patients lived following resection surgery, the more likely they were to die from other causes—the top ones being heart disease, COPD, and other types of cancers. “These findings highlight the importance of developing strategies to reduce the risk of lung cancer death among early-stage lung cancer patients undergoing surgery,” Potter said. This includes patients at high risk for lung cancer recurrence. Potter offered several suggestions: identifying remaining tumor cells in the blood post-surgery, which may indicate increased risk for cancer recurrence. These patients may benefit from adjuvant therapies.

STS 2023, SAN DIEGO — The best practices for tricuspid valve surgery gained definition Sunday at STS 2023 as experts took the first steps to end the tricuspid’s undeserved reputation as the “forgotten valve.” Qiudong (Kevin) Chen, MD, MS, research resident at Cedars-Sinai Medical Center Smidt Heart Institute in Los Angeles, California, presented the Richard E. Clark Memorial Paper, which demonstrated that: ·       For non-endocarditis-related tricuspid regurgitation (TR), isolated tricuspid valve repair is associated with a lower risk of operative mortality (in-hospital or 30-days post-operative) than valve replacement. ·       In the same population, beating heart surgery (repair or replacement) is associated with a lower risk of pacemaker implant, renal failure, and post-operative blood transfusions than surgery under cardioplegic arrest. However, no mortality benefit was identified. ·       Higher pre-operative Model for End-Stage Liver Disease (MELD) scores were associated with higher operative mortality, especially for patients with MELD scores 20 or above. Increased levels of tricuspid valve regurgitation are associated with worse survival rates, and operative mortality can be up to 11% in patients undergoing isolated surgery. Both these factors contributed to the need for this analysis on a larger population level in order to start uncovering optimal surgical strategies. Senior authors for this study were Dr. Michael Bowdish and Dr. Joanna Chikwe. Dr. Chen and his surgeon colleagues conducted their review using the STS National Database™, which he called a “powerful, comprehensive tool” that allowed his team to review procedural trends and volumes from 2012 to 2019 across the US. He noted several limitations in the analysis, including lack of long-term outcomes and incomplete etiology. From the Adult Cardiac Surgery Database, physician-scientists initially identified 14,704 patients who underwent isolated tricuspid valve surgery and further narrowed this to 6,507 patients with non-endocarditis-related tricuspid regurgitation, who were assessed in the study. Although tricuspid regurgitation is common, the study confirmed that this disorder is extremely undertreated. Tricuspid repair and replacement remain rare surgeries nationwide: the investigators found that 93% of US medical centers performed five or fewer of these procedures annually. A majority of procedures were conducted with patients under cardiac arrest, followed by surgeries on patients with beating hearts and a small minority performed on patients with fibrillating hearts. “I believe these findings suggest that in this patient population, tricuspid repair may be a safer option when feasible,” Dr. Chen said. He was joined by senior co-authors Michael E. Bowdish, MD, MS, Jad Malas, MD, and Amy Roach, MD, all also from Cedars-Sinai, in this study. “Surgical outcomes for isolated TR are poor, and we can do better by generating additional clinical evidence by identifying those patients with TR and operating on them early,” added James Gammie, MD, professor of surgery at Johns Hopkins Medicine, who served as discussant. Putting tricuspid regurgitation in perspective, Dr. Gammie noted that about 1.6 million people in the US have significant TR, making the disease almost as prevalent as aortic stenosis.