Surgeons have shifted away from the practice of en bloc esophagectomy, particularly in the era of neoadjuvant therapies. While some still advocate for this radical approach, contemporary data which establish its superiority are sparse. We hypothesized that a more complete, radical resection could be completed in the setting of chemoradiation without adding morbidity.

Patients undergoing esophagectomy following neoadjuvant chemoradiation for esophageal adenocarcinoma from 2006-2018 were evaluated. Outcomes following right transthoracic en bloc esophagectomy were compared to standard esophagectomy to determine the impact on outcomes. A Cox proportional hazard model was evaluated, and logistic regression was performed to determine the impact of en bloc resection on postoperative morbidity.

604 patients were identified, including 133 (22%) who underwent modified en bloc esophagectomy. Positive margins were most likely to occur in standard esophagectomy (35/471, 7%) versus en bloc (3/133, 2%) (p=0.026). En bcrometastases, this approach is safe and feasible.

Previous studies of decortication for empyema have demonstrated that patient characteristics are associated with mortality, but the relationship of infectious pathogen to outcome has not been described. Our objective was to analyze the association of microbiology and antibiotic resistance with post-operative mortality following decortication for empyema. We hypothesized that bacterial pathogens, antibiotic resistance and patient characteristics would all contribute to perioperative morbidity and mortality.

Patients undergoing pulmonary decortication for empyema from 1/1/2010-10/1/2017 were reviewed retrospectively. Cases were matched to microbiology cultures. The outcomes of interest was a composite of death, tracheostomy, initial ventilator support > 48 hours or unexpected ICU readmission. Antibiotic resistance was categorized as present or absent, and the number of antibiotics with resistance was counted for each patient. We describe the relationship of patient characteristics, antibiotic resistance, are associated with morbidity and mortality among patients with empyema.

As academic cardiothoracic surgeons focus on producing a new generation of successful surgeon leaders, mentorship has emerged as one of the most important variables influencing professional and personal success and satisfaction. We explore the literature to determine the benefits, qualities and features of the mentor relationship.

A comprehensive review was performed in February for 2020 of Ovid MEDLINE, Cochrane Central Register of Controlled Trials, and the SCOPUS Database using ‘mentor’ as a primary search term. The titles and abstracts of these publications were then reviewed by 2 of the authors to identify relevant sources addressing topics related to mentorship in cardiothoracic surgery and identify 4 specific areas of focus (1) the value of mentorship, (2) the skills needed to be an effective mentor, (3) effective approaches for identifying and receiving mentorship, and (4) the unique considerations associated with mentorship for traditionally underrepresented populations in surgery.

Of 16,469 articles reviewed, 167 relevant manuscripts were identified and 62 were included.

There is undeniable value in mentorship when navigating a career in cardiothoracic surgery. By sharing the most significant features and skills of both ideal mentors and mentees, we hope to provide a framework to improve the quality of mentorship from both sides.

There is undeniable value in mentorship when navigating a career in cardiothoracic surgery. find more By sharing the most significant features and skills of both ideal mentors and mentees, we hope to provide a framework to improve the quality of mentorship from both sides.

Although the use of the uniportal thoracoscopic technique has spread exponentially recently, the comparison of nonintubated and intubated uniportal thoracoscopic segmentectomies for lung tumors has not been reported. We aimed to compare the feasibility, safety, and short-term postoperative outcomes between the two methods.

From January 2014 to June 2019, we retrospectively reviewed 185 consecutive patients with lung tumors who underwent uniportal thoracoscopic segmentectomy at our institute. A body mass index (BMI) of ≥25 kg/m

was considered as contraindication for the nonintubated anesthetic approach. For the remaining cases, the anesthetic approach was made at the discretion of each individual anesthesiologist. A propensity-matched analysis incorporating sex and BMI was used to compare the clinical outcomes of the nonintubated and intubated groups.

Fifty (27.0%) patients underwent the procedure with the nonintubated anesthetic approach. The nonintubated group was more likely to be female (p<0.001) and had lower BMI (p<0.001). The other clinical features showed no significant difference. There was no significant difference between the two groups in the type of segmentectomy according to the difficulty classification system. After propensity matching, 43 matched patients in each group were included. Anesthetic induction duration (12.0 versus 15.3 min, p=0.014) was shorter in the nonintubated group. No other significant differences in perioperative, postoperative, and anesthetic results were noted between the two matched groups.

The nonintubated anesthetic approach can be a safe and feasible alternative to intubated uniportal thoracoscopic segmentectomy.

The nonintubated anesthetic approach can be a safe and feasible alternative to intubated uniportal thoracoscopic segmentectomy.

Routine childhood immunisation with pneumococcal conjugate vaccine (PCV) has changed the epidemiology of pneumococcal disease across age groups, providing an opportunity to reconsider PCV dosing schedules. We aimed to evaluate the post-booster dose immunogenicity of ten-valent (PCV10) and 13-valent (PCV13) PCVs between infants randomly assigned to receive a single-dose compared with a two-dose primary series.

We did an open-label, non-inferiority, randomised study in HIV-unexposed infants at a single centre in Soweto, South Africa. Infants were randomly assigned to receive one priming dose of PCV10 or PCV13 at ages 6 weeks (6w + 1 PCV10 and 6w + 1 PCV13 groups) or 14 weeks (14w + 1 PCV10 and 14w + 1 PCV13 groups) or two priming doses of PCV10 or PCV13, one each at ages 6 weeks and 14 weeks (2 + 1 PCV10 and 2 + 1 PCV13 groups); all participants then received a booster dose of PCV10 or PCV13 at 40 weeks of age. The primary endpoint was geometric mean concentrations (GMCs) of serotype-specific IgG 1 month after the booster dose, which was assessed in all participants who received PCV10 or PCV13 as per the assigned randomisation group and for whom laboratory results were available at that timepoint.