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uvant radiotherapy in completely resected lung ASC.

Current preoperative staging for lymph nodal status remains inaccurate. The purpose of this study was to build an artificial neural network (ANN) model to predict pathologic nodal involvement in clinical stage I-II esophageal squamous cell carcinoma (ESCC) patients and then validated the performance of the model.

A total of 523 patients (training set 350; test set 173) with clinical staging I-II ESCC who underwent esophagectomy and reconstruction were enrolled in this study. Their post-surgical pathological results were assessed and analysed. An ANN model was established for predicting pathologic nodal positive patients in the training set, which was validated in the test set. A receiver operating characteristic (ROC) curve was also created to illustrate the performance of the predictive model.

Of the enrolled 523 patients with ESCC, 41.3% of the patients were confirmed pathologic nodal positive (216/523). The ANN staging system identified the tumour invasion depth, tumour length, dysphagia, tumour differentiation and lymphovascular invasion (LVI) as predictors for pathologic lymph node metastases. The C-index for the ANN model verified in the test set was 0.852, which demonstrated that the ANN model had a good predictive performance.

The ANN model presented good performance for predicting pathologic lymph node metastasis and added indicators not included in current staging criteria and might help improve the staging strategies.

The ANN model presented good performance for predicting pathologic lymph node metastasis and added indicators not included in current staging criteria and might help improve the staging strategies.

Tracheobronchopathia osteochondroplastica (TPO) is characterized by the presence of diffuse cartilaginous or bony submucosal nodules that lead to airway lumen narrowing. So far, there was no study in South Korea analysing a large number of TPO patients. We aimed to elucidate its treatment strategy and clinical course by analysing the characteristics of TPO patients.

In this retrospective study, we reviewed the clinical data of 40 patients diagnosed with TPO by bronchoscopy between October 1997 and April 2019 at a single referral hospital.

Of the 40 patients, 26 (65.0%) were male and the median age was 63.0 years. The most common symptom was cough (n=12, 30%). Pulmonary function test (PFT) revealed an obstructive pattern in 10 (25.7%) patients. Chest computed tomography (CT) scan showed 23 (62.6%) patients with diffuse narrowing and calcified nodules. In bronchoscopy, the entire trachea was found to be involved in 30 (75.0%) patients and airway narrowing was identified in 6 (15.0%) patients. Endobronchial biopsies were obtained from 15 patients and the most common findings included typical cartilaginous and bony tissues (n=14, 93.3%). Since most patients were asymptomatic or had mild symptoms, they did not undergo any specific treatment. Of the 19 symptomatic patients, 2 (5.0%) patients received laser therapy for treating tracheal stenosis.

TPO is a slowly progressing disease and is well managed with conservative therapies. Although TPO shows a distinctive pattern by bronchoscopy, it follows a benign clinical course.

TPO is a slowly progressing disease and is well managed with conservative therapies. Although TPO shows a distinctive pattern by bronchoscopy, it follows a benign clinical course.

Left heart involvement might be a differential factor in the physiopathology and prognosis of severe tricuspid regurgitation (TR) following cardiac surgery. We aimed to compare the outcomes of isolated tricuspid valve surgery (ITVS) after congenital versus left heart-disease surgery.

We retrospectively studied and followed up 58 patients who underwent ITVS for TR following cardiac surgery in our center from January 2012 to December 2017. According to the different etiologies of TR, the participants were divided into one group of TR following surgery for congenital heart diseases (CHD) (pCHD group, n=24), and another group of TR following surgery for left heart disease (pVHD group, n=34).

Compared to the pCHD group, the pVHD group presented with a more advanced age (P<0.001), higher model for end-stage liver disease (MELD) score calculation (P=0.04), and higher EuroSCORE II calculation (P=0.01). In the post-operative course, the pVHD group showed a longer mechanical ventilation time (P<0.001) and longer intensive care unit stay (P=0.001). However, there was no significant difference between the two groups in in-hospital mortality (8.8%

0, P=0.26), or the incidence of major adverse cardiac and cerebrovascular events (MACCE) (20.6%

12.5%, P=0.47) at follow-up.

Severe TR following surgery for left heart disease is associated with higher surgical risks and a remarkable frailty as compared to that following surgery for CHDs; however, with the development of surgical techniques and peri-operative management, ITVS can be safely performed in both conditions with promising contemporary mid-term outcomes.

Severe TR following surgery for left heart disease is associated with higher surgical risks and a remarkable frailty as compared to that following surgery for CHDs; however, with the development of surgical techniques and peri-operative management, ITVS can be safely performed in both conditions with promising contemporary mid-term outcomes.

This study evaluated the lymph node ratio (LNR) defined as the ratio of the number of metastatic lymph nodes to the number of dissected lymph nodes as a prognostic factor for survival in patients with pT1-2N1M0 non-small cell lung cancer (NSCLC).

We retrospectively reviewed 413 patients with pathologic T1-2N1M0 NSCLC after complete surgical resection and mediastinal LN dissection between January 2004 and December 2012. The cut-off value for LNR was determined using χ

tests, which were calculated using Cox proportional hazards regression model. Based on this model, the optimal cut-off value for LNR was 0.1.

The study included 337 males and 76 females with a mean age of 62 years (range, 34-83 years). Patients with a high LNR (≥0.1) were more likely to be female and have more adenocarcinomas compared with patients with a low LNR (<0.1). The overall survival (OS) and disease-free survival (DFS) rates were significantly worse in the high LNR group than the low LNR group (OS, 55.4%

69.8%, respectively P=0.003; DFS, 33.2%

61.7%, P<0.001). In the multivariate analysis, a high LNR was associated with significantly worse OS [adjusted hazard ratio (aHR), 2.69; 95% confidence interval (CI), 1.74-4.17] and DFS (aHR, 2.41; 95% CI, 1.57-3.68).

LNR is an independent prognostic factor for survival in patients with pT1-2N1M0 NSCLC. These findings may provide useful prognostic information to allow the selection of patients for more aggressive postoperative therapy or follow-up strategies.

LNR is an independent prognostic factor for survival in patients with pT1-2N1M0 NSCLC. These findings may provide useful prognostic information to allow the selection of patients for more aggressive postoperative therapy or follow-up strategies.

Pulmonary vein (PV) stump thrombus, a known source of cerebral infarction, develops almost exclusively after left upper lobectomy; however, the mechanism remains unclear. We therefore evaluated the hemodynamics in the left atrium with four-dimensional flow magnetic resonance imaging (4D-flow MRI), which enables the simultaneous depiction of blood flow at three locations and the evaluation of hemodynamics.

4D-flow MRI was basically performed 7 days after lobectomy for cancer arising in the right upper lobe (n=11), right lower lobe (n=8), left upper lobe (n=13), or left lower lobe (n=8). We evaluated dynamic blood movement from the ipsilateral remaining PV, the resected PV stump, and the contralateral PVs into the left atrium using 4D-flow MRI.

There were some characteristic blood flow patterns that seemed to either promote or prevent PV stump thrombus. Promotive flow patterns were significantly more frequent and preventive flow patterns were significantly less frequent in patients who had undergone left upper lobectomy than in those who had undergone other lobectomy. Accordingly, the degree of blood turbulence near the vein stump, as measured by the extent of change in the blood movement, was significantly higher in patients who had undergone left upper lobectomy than in patients who had undergone other lobectomy.

Our study revealed that left upper lobectomy likely causes blood turbulence near the vein stump through complicated blood streams in the left atrium, which can play a part in the development of vein stump thrombus. Further study to identify patients at high risk of vein stump thrombus is warranted.

Our study revealed that left upper lobectomy likely causes blood turbulence near the vein stump through complicated blood streams in the left atrium, which can play a part in the development of vein stump thrombus. Further study to identify patients at high risk of vein stump thrombus is warranted.

Ligation of the thoracic duct (LTD) is known to be a useful way to prevent postoperative chylothorax, but its impact on long-term survival is rare to be assessed.

Data from 609 patients with esophageal cancer who underwent esophagectomy from September, 2012, to January, 2014, were retrospectively collected. Tetramisole The study cohort was classified into two groups the thoracic duct ligation group (LG) and the non-ligation group (NLG). Propensity score matching (PSM) was performed to control confounding factors between the two groups. Postoperative complications and length of stay were compared between the two groups. Overall survival was estimated using the Kaplan-Meier method, and compared using the log-rank test. Independent prognostic factors were determined using Cox regression analysis.

After PSM, there were 185 patients in each of the two groups. LTD had no significant impact on chylothorax, anastomotic leak, recurrent nerve palsy, pneumonia and length of stay (P>0.05). The 1-, 3- and 5-year survival rates were 87.0%, 64.1%, and 50.9% in the LG, respectively, compared to 85.4%, 59.9%, and 42.3%, respectively, in the NLG. The differences between the 2 groups were not statistically significant (P=0.156). In the multivariable analysis, LTD was not an independent prognostic factor, neither before nor after PSM.

Our study demonstrated that LTD had no significant impact on postoperative complications or long-term survival in patients with esophageal cancer.

Our study demonstrated that LTD had no significant impact on postoperative complications or long-term survival in patients with esophageal cancer.

The surgical strategy for acute type A aortic dissection (AADA) usually consists of reconstruction of the tear-lesion in the affected part of the ascending aorta. The optimal strategy either to replace the ascending aorta (AAR) or to replace the ascending aorta and the total aortic arch (TAAR) is still under debate. Our study compares the 30-day mortality between AAR and TAAR in AADA surgery.

In this retrospective observational study, we analysed a total patient cohort of 339 patients who underwent surgery for AADA from January 2001 until December 2016. A propensity score-matched analysis between the AAR- and the TAAR-group with 43 patients for each subgroup was subsequently carried out. A multivariable analysis was performed to identify risk-factors for the 30-d-mortality. The 30-day mortality was defined as the primary end-point and long-term survival was the secondary endpoint.

In 292 (86.1%) patients AAR and in 47 (13.9%) patients TAAR was performed for emergent AADA. Patients were older (P=0.049) in the AAR group.