Biomedical subjects

Linda W Martin

Publications and source records attributed to Linda W Martin.

4 recordsLinked to original sources

PubMed2006

Management of intrathoracic leaks following esophagectomy.

Mortality from esophageal anastomotic leaks has declined dramatically in contemporary practice, which seems to be caused by a management strategy that includes observation of contained, asymptomatic leaks, operation on uncontained leaks using muscle flaps to reinforce the leak repair, and percutaneous drainage of contained, symptomatic leaks. With further advances in surgical technique, critical care, and multimodality treatment, this trend is likely to continue.

Algorithms↗

PubMed2005

The evolution of treatment outcomes for resected stage IIIA non-small cell lung cancer over 16 years at a single institution.

OBJECTIVES: The effect of multimodality treatment including surgical intervention, chemotherapy, and radiation for potentially resectable stage IIIA non-small cell lung cancer in a practice setting remains to be defined. To determine which treatment factors are associated with improved survival, we evaluated outcomes for these patients at our institution over a 16-year period. METHODS: We surveyed our institutional pathology database from 1986 through 2001 for patients with resected pathologic stage IIIA (N2) non-small cell lung cancer. Three hundred fifty-three patients were confirmed to have appropriate pathologic staging and attempted complete resection. These patients were assessed by means of univariate and multivariable analysis for factors associated with long-term survival. Stage migration was estimated by using a classification based on nodal station involvement. RESULTS: Median potential follow-up was 132 months. During the study period, 3- and 5-year survival increased; preoperative staging improved, relatively more lobectomies and fewer pneumonectomies were performed, and multimodality treatment was used more frequently. The number of positive N2 nodal stations did not change over time (P = .14). Surgical intervention alone resulted in 3-year survival of 30%, and perioperative chemotherapy, radiation, or both increased 3-year survival to 38% (P = .004). Multivariable analysis showed that male sex (hazard ratio, 1.44; 95% confidence interval, 1.13-1.84; P = .003), more than 2 positive mediastinal nodal stations (hazard ratio, 1.73; 95% confidence interval, 1.16-2.57; P = .007), R1 or R2 resection (hazard ratio, 1.72; 95% confidence interval, 1.22-2.41; P = .002), lower or middle lobe tumor location (hazard ratio, 1.63; 95% confidence interval, 1.28-2.08; P < .001), and surgical intervention alone (hazard ratio, 1.59; 95% confidence interval, 1.23-2.04; P < .001) were independent predictors of poor survival. CONCLUSIONS: The use of multimodality therapy appears to contribute to improved outcomes over time in patients with resected stage IIIA (N2) non-small cell lung cancer.

Carcinoma, Non-Small-Cell Lung↗

PubMed2005

Intrathoracic leaks following esophagectomy are no longer associated with increased mortality.

OBJECTIVES: Assess outcomes following intrathoracic leaks after esophagectomy from 1970 to 2004 to evaluate the impact of evolving surgical and perioperative techniques on leak-associated mortality (LAM). SUMMARY BACKGROUND DATA: An intrathoracic leak following esophagectomy has historically been considered a catastrophic event, with mortality as high as 71%. Concerns about this complication often affect choice of surgical approach for esophagectomy. METHODS: A retrospective review of all esophagectomies for cancer from 1970 to 2004 (n = 1223) was performed. Outcomes following intrathoracic anastomoses (n = 621) were analyzed by era: historical 1970-1986 (n = 145) and modern 1987-2004 (n = 476). RESULTS: There was no difference in the frequency of leak between the time intervals (4.8% versus 6.3%, P = 0.5). Despite a significant increase in the use of preoperative chemoradiation (1% versus 42%, P < 0.001) in the historical versus modern era, the overall mortality decreased from 11% to 2.5% (P < 0.001). The LAM was markedly reduced from 43% to 3.3% (P = 0.016). Factors associated with LAM included failure to use enteral nutrition (HR 13.22, CI 1.8-96.8) and era in which the surgery was performed (HR 18.3, 1.9-180). Other differences included an increased proportion of successful reoperations for leak control (11/30 versus 0/7, P = 0.08) and use of reinforcing muscle flaps (7/11). In the modern era, perioperative mortality is not significantly different for patients with or without intrathoracic leaks (3.3% versus 2.5%, P = 0.55), nor is long-term survival (P = 0.16). CONCLUSIONS: Modern surgical management of intrathoracic leaks results in no increased mortality and has no impact on long-term survival. Clinical decisions regarding the use of intrathoracic anastomoses should not be affected by concerns of increased mortality from leak.

Adult↗

PubMed2004

Vertebral body resection.

Vertebral body resection for locally advanced lung cancer can be performed with acceptable morbidity and mortality rates, and with improved long-term survival, when combined with chemotherapy and radiation. A consensus has not been reached on either the optimal extent of vertebral resection or the optimal treatment regimen. Should total vertebrectomies be the standard of care for all patients, even those with minimal spine involvement? Can the extended operative times and multiple incisions and anatomic limitations that place some of the mediastinal organs at risk be justified for potential improvement in local control, or are the quicker and potentially safer endolesional resections appropriate for these tumors? Is local control, and ultimately survival, improved when additional chemotherapy and radiation therapy is given up front, or is an uninterrupted course of a higher dose of concurrent chemotherapy and radiation therapy following surgery preferred? Ideally, these questions will be answered by means of prospective randomized trials; however, because of the small number of patients who actually present with vertebral body involvement by lung cancer, physicians may have to rely on phase 2 studies and series reports from high-volume institutions to guide their treatment algorithms in the future.

Bone Neoplasms↗