Clinical Decision-Making

In this short video, STS members exchange viewpoints on a new study that found patients with postoperative PE had increased 30-day mortality, reintubation, and readmission rates, which was presented at the 2024 STS Annual Meeting.

Robbin Cohen, MD, Cedars-Sinai at Huntington Hospital, is joined by the study’s lead author, Andrea L. Axtell, MD, MPH, an assistant professor of surgery at the University of Wisconsin School of Medicine and Public Health, Michael Smith, MD, Norton Thoracic Institute, St. Joseph’s Hospital & Medical Center, and John Mitchell, MD, University of Colorado Health, to discuss the research methodology, findings and impact on improving patient care. 

Overall survival rates of esophageal cancer have risen in the past 50-plus years, from 5% in 1970 to 22% in 2023. Yet, no comprehensive guidelines addressing multidisciplinary management of esophageal cancer that incorporate input from surgeons, radiation oncologists, and medical oncologists have been available, until now. 

The Society of Thoracic Surgeons, American Society for Radiation Oncology, and American Society of Clinical Oncology have co-authored the first comprehensive guideline on the management of esophageal cancer. Published today in The Annals of Thoracic Surgery, the guideline addresses key clinical subject areas pertinent to the care of patients with locally advanced, resectable thoracic esophageal cancer. 

The guideline delivers recommendations for the use of induction chemotherapy, optimal radiation dose, value and timing of esophagectomy, use of chemotherapy vs. chemoradiotherapy before surgery, approach and extent of lymphadenectomy, and the value of adjuvant therapy after resection.

“These comprehensive guidelines address areas critical for standardizing and improving care and outcomes for esophageal cancer patients,” says study investigator Stephanie Worrell, MD, clinical associate professor and thoracic section chief at the University of Arizona in Tucson. “The recommendations are based on a comprehensive review of innovations and advancements in the most recent literature.”

For the first time, The Society of Thoracic Surgeons joined the Korean Society for Thoracic and Cardiovascular Surgery (KSTCVS) in their presentation of the Heart Valve Disease Forum (HVDF), an annual conference that delivers the latest developments on the basis, cause, diagnosis, treatment, and future of valve disease.

Image

The forum, held September 15-16, 2023, in Dragon City, Yongsan, Seoul, was led by the President of the HVDF, Dr. Kyung Hwan Kim, and organized by co-program directors Dr. Joon Bum Kim of Asan Medical Center of Ulsan College of Medicine and Dr. S. Chris Malaisrie of Northwestern University, who commented “STS was thrilled to partner with the KSTCVS on this international event, highlighting transpacific expertise on valves.”

Dr. Kim remarked, “By co-hosting the forum with STS, we brought together the world’s top scholars in related fields for discussion and achieved the best conference experience.”

More than 300 surgeons, residents, and other medical students attending the conference heard from luminary surgeons and professors on today’s hottest topics impacting the specialty, including TAVI, innovative SAVR, and endocarditis, and trained on surgical techniques in wet labs. “The dynamic, case-based discussions and interactive wet labs with skilled faculty inspired the next generation of cardiac surgeons," said Dr. Malaisrie.

Dr. Thomas MacGillivray, president of STS, delivered several talks, including one on “Crisis Management in the Operating Room and Surgeon Leadership.”

At this year’s conference, particular emphasis was placed on connecting young surgeons responsible for the future of heart valve surgery with proven STS surgeon leaders through a mentor-mentee program. It was an exclusive opportunity for early career attendees to gain invaluable guidance on navigating their career paths and overcoming challenges from leaders.

“The heart valve symposium was a wonderful success and a historical event that stands out among the meeting’s 30-year history,” said Dr. Kim. “Our Korean colleagues agreed that collaborating with STS was the best thing in terms of excellence of lectures, one-to-one teaching in the wet lab, an exciting mentorship program, and beautiful times spent outside of the conference room.”

​

In 2022, the cardiothoracic surgical community turned to The Annals of Thoracic Surgery for insights on best practices for patient care, quality metrics from the STS National Database™, a glimpse at the future of surgical techniques, and much more. 

Among the top articles in 2022—in both usage and citations—were the STS/AATS Clinical Practice Guidelines on the Management of Type B Aortic Dissection, as well as an article elucidating why STS and the American Association for Thoracic Surgery did not endorse the 2021 ACC/AHA/SCAI coronary revascularization guidelines. The latter, as explored in the cover story of this issue of STS News, informed new analyses that account for the increased risks in patients with multivessel coronary artery disease, and that support coronary artery bypass grafting as the best first approach in these patients. 

The second most-viewed and most-cited article was “Current and Future Applications of Virtual, Augmented, and Mixed Reality in Cardiothoracic Surgery,” a topic that reinforces the STS community’s interest in adopting promising new techniques and technologies to further enhance their skills. 

Image

COVID-19 is still very much a relevant topic, as surgeons continue to discover the toll COVID infections—and delays in care exacerbated by lockdown—have taken on their patients in the long term. “Pulmonary Parenchymal Changes in COVID-19 Survivors,” “The Effect of COVID-19 on Adult Cardiac Surgery in the United States in 717,103 Patients,” and “One-Year Outcomes with Veno-venous Extracorporeal Membrane Oxygenation Support” appeared among The Annals’ 10 most popular articles in usage, citations, and overall views.  

STS National Database-driven research graced the top 10 in citations. “Concordance of Treatment Effect,” “Sex Differences in Coronary Artery Bypass Grafting Techniques,” and the unveiling of the new Failure to Rescue quality metric provided guidance for evidence-based quality improvement.  

Novel, condition-specific applications and their implications for surgeons appeared among highly-read topics, including the surgical perspective on neoadjuvant immunotherapy in non-small cell lung cancer, rescue blanket as a provisional seal for penetrating chest wounds, lymphatic disorders and their management in patients with congenital heart disease, and topical vancomycin for reducing the incidence of deep sternal wound complications after sternotomy. 

Image

STS Members have complimentary access to the journal. Read the latest at annalsthoracicsurgery.org.