Publications by authors named "Biniam Kidane"

90 Publications

Commentary: Less is maybe more: Sublobar resection in screen-detected lung cancers.

J Thorac Cardiovasc Surg 2021 Aug 14. Epub 2021 Aug 14.

Section of Thoracic Surgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; CancerCare Manitoba Research Institute, Cancer Care Manitoba, Winnipeg, Manitoba, Canada; Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. Electronic address:

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http://dx.doi.org/10.1016/j.jtcvs.2021.08.028DOI Listing
August 2021

Commentary: Toward precision surgery: Advances in defining sublobar resection candidacy.

J Thorac Cardiovasc Surg 2021 Jul 17. Epub 2021 Jul 17.

Section of Thoracic Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Research Institute in Oncology & Hematology, Cancer Care Manitoba, Winnipeg, Manitoba, Canada.

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http://dx.doi.org/10.1016/j.jtcvs.2021.07.021DOI Listing
July 2021

Province-Wide Analysis of Patient-Reported Outcomes for Stage IV Non-Small Cell Lung Cancer.

Oncologist 2021 Jul 3. Epub 2021 Jul 3.

Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.

Background: In Ontario, Canada, patient-reported outcome (PRO) evaluation through the Edmonton Symptom Assessment System (ESAS) has been integrated into clinical workflow since 2007. As stage IV non-small cell lung cancer (NSCLC) is associated with substantial disease and treatment-related morbidity, this province-wide study investigated moderate to severe symptom burden in this population.

Materials And Methods: ESAS collected from patients with stage IV NSCLC diagnosed between 2007 and 2018 linked to the Ontario provincial health care system database were studied. ESAS acquired within 12 months following diagnosis were analyzed and the proportion reporting moderate to severe scores (ESAS ≥4) in each domain was calculated. Predictors of moderate to severe scores were identified using multivariable Poisson regression models with robust error variance.

Results: Of 22,799 patients, 13,289 (58.3%) completed ESAS (84,373 assessments) in the year following diagnosis. Patients with older age, with high comorbidity, and not receiving active cancer therapy had lower ESAS completion. The majority (94.4%) reported at least one moderate to severe symptom. The most prevalent were tiredness (84.1%), low well-being (80.7%), low appetite (71.7%), and shortness of breath (67.8%). Most symptoms peaked at diagnosis and, while declining, remained high in the following year. On multivariable analyses, comorbidity, low income, nonimmigrants, and urban residency were associated with moderate to severe symptoms. Moderate to severe scores in all ESAS domains aside from anxiety were associated with radiotherapy within 2 weeks prior, whereas drowsiness, low appetite and well-being, nausea, and tiredness were associated with systemic therapy within 2 weeks prior.

Conclusion: This province-wide PRO analysis showed moderate to severe symptoms were prevalent and persistent among patients with metastatic NSCLC, underscoring the need to address supportive measures in this population especially around treatments.

Implications For Practice: In this largest study of lung cancer patient-reported outcomes (PROs), stage IV non-small cell lung cancer patients had worse moderate-to-severe symptoms than other metastatic malignancies such as breast or gastrointestinal cancers when assessed with similar methodology. Prevalence of moderate-to-severe symptoms peaked early and remained high during the first year of follow-up. Symptom burden was associated with recent radiation and systemic treatments. Early and sustained PRO collection is important to detect actionable symptom progression, especially around treatments. Vulnerable patients (e.g., older, high comorbidity) who face barriers in attending in-person clinic visits had lower PRO completion. Virtual PRO collection may improve completion.
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http://dx.doi.org/10.1002/onco.13890DOI Listing
July 2021

Metabolic Changes in Early-Stage Non-Small Cell Lung Cancer Patients after Surgical Resection.

Cancers (Basel) 2021 Jun 16;13(12). Epub 2021 Jun 16.

St. Boniface Hospital Albrechtsen Research Centre, Winnipeg, MB R2H 2A6, Canada.

Metabolic alterations in malignant cells play a vital role in tumor initiation, proliferation, and metastasis. Biofluids from patients with non-small cell lung cancer (NSCLC) harbor metabolic biomarkers with potential clinical applications. In this study, we assessed the changes in the metabolic profile of patients with early-stage NSCLC using mass spectrometry and nuclear magnetic resonance spectroscopy before and after surgical resection. A single cohort of 35 patients provided a total of 29 and 32 pairs of urine and serum samples, respectively, pre-and post-surgery. We identified a profile of 48 metabolites that were significantly different pre- and post-surgery: 17 in urine and 31 in serum. A higher proportion of metabolites were upregulated than downregulated post-surgery ( < 0.01); however, the median fold change (FC) was higher for downregulated than upregulated metabolites ( < 0.05). Purines/pyrimidines and proteins had a larger dysregulation than other classes of metabolites ( < 0.05 for each class). Several of the dysregulated metabolites have been previously associated with cancer, including leucyl proline, asymmetric dimethylarginine, isopentenyladenine, fumaric acid (all downregulated post-surgery), as well as N6-methyladenosine and several deoxycholic acid moieties, which were upregulated post-surgery. This study establishes metabolomic analysis of biofluids as a path to non-invasive diagnostics, screening, and monitoring in NSCLC.
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http://dx.doi.org/10.3390/cancers13123012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8234274PMC
June 2021

Administrative and clinical databases: General thoracic surgery perspective on approaches and pitfalls.

J Thorac Cardiovasc Surg 2021 Mar 19. Epub 2021 Mar 19.

Department of Surgery, Surgical Outcomes and Quality Improvement Center, Northwestern University Feinberg School of Medicine, Chicago, Ill.

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http://dx.doi.org/10.1016/j.jtcvs.2021.03.057DOI Listing
March 2021

Comparative metabolomics studies of blood collected in streck and heparin tubes from lung cancer patients.

PLoS One 2021 23;16(4):e0249648. Epub 2021 Apr 23.

Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, MB, Canada.

Metabolomics analysis of blood from patients (n = 42) undergoing surgery for suspected lung cancer was performed in this study. Venous and arterial blood was collected in both Streck and Heparin tubes. A total of 96 metabolites were detected, affected by sex (n = 56), collection tube (n = 33), and blood location (n = 8). These metabolites belonged to a wide array of compound classes including lipids, acids, pharmaceutical agents, signalling molecules, vitamins, among others. Phospholipids and carboxylic acids accounted for 28% of all detected compounds. Out of the 33 compounds significantly affected by collection tube, 18 compounds were higher in the Streck tubes, including allantoin and ketoleucine, and 15 were higher in the Heparin tubes, including LysoPC(P-16:0), PS 40:6, and chenodeoxycholic acid glycine conjugate. Based on our results, it is recommended that replicate blood samples from each patient should be collected in different types of blood collection tubes for a broader range of the metabolome. Several metabolites were found at higher concentrations in cancer patients such as lactic acid in Squamous Cell Carcinoma, and lysoPCs in Adenocarcinoma and Acinar Cell Carcinoma, which may be used to detect early onset and/or to monitor the progress of the cancer patients.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0249648PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8064553PMC
April 2021

Deus ex machina? Demystifying rather than deifying machine learning.

J Thorac Cardiovasc Surg 2021 Mar 11. Epub 2021 Mar 11.

Section of Thoracic Surgery, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada; Research Institute in Oncology and Hematology, Cancer Care Manitoba, Winnipeg, Manitoba, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. Electronic address:

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http://dx.doi.org/10.1016/j.jtcvs.2021.02.095DOI Listing
March 2021

A simple "passive awareness" intervention to decrease the cost of thoracoscopic lobectomy.

Updates Surg 2021 Apr 3. Epub 2021 Apr 3.

Section of Thoracic Surgery, University of Manitoba, GH604 - 820 Sherbrook Street, Winnipeg, MB, R3A 1R9, Canada.

In thoracic surgery, disposable instruments are significant drivers of cost. There is variation in disposable instrument use among surgeons. It was hypothesized that a "passive awareness" intervention (displaying a pricing list of disposable instruments in the operating theater) would decrease operative costs. A current price list of disposable instruments used in thoracoscopic lobectomy was displayed in the thoracic surgery operating theater. Consecutive patients who underwent thoracoscopic lobectomy 6 months prior to price list display (Period 1) and 6 months following price list display (Period 2) were analyzed. Descriptive statistics were used to describe case distribution and lobectomy costs. T test and linear regression were used to examine the impact of surgeon, lobe removed, and time period. Over the study period, 71 patients underwent thoracoscopic lobectomy (Period 1: n = 36, Period 2: n = 35). Median per-lobectomy disposables cost decreased from $2063.22 (Interquartile range [IQR] $788.49) in Period 1 to $1885.92 (IQR $552.26) in Period 2; p = 0.03. There was a significant reduction in the median number of "high cost disposables" between Periods 1 and 2 (5.5-5.0, respectively; p = 0.04). In multiple linear regression, there was a decrease in total per-lobectomy cost of $286.21 (p = 0.03) and a decrease in stapler cartridge cost of $266.89 (p = 0.03) when controlling for surgeon and lobe. There was a significant reduction in disposable instrument expenditure per thoracoscopic lobectomy following posting of instrument costs in the operating theater. These findings suggest that a simple passive awareness intervention is effective in influencing surgeon behavior to reduce disposable instrument costs.
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http://dx.doi.org/10.1007/s13304-021-01048-wDOI Listing
April 2021

Lung Resection Without Tissue Diagnosis: A Pragmatic Perspective on the Indeterminate Pulmonary Nodule.

Clin Lung Cancer 2021 Feb 19. Epub 2021 Feb 19.

Section of Thoracic Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada. Electronic address:

Background: The indeterminate pulmonary nodule is a common clinical problem. Preoperative tissue diagnosis is not always possible, despite all attempts. The objectives of this study were to determine the frequency of a malignant diagnosis in this scenario and whether attempted preoperative biopsy impacted estimation of the risk of malignancy.

Patients And Methods: We reviewed 500 consecutive cases of pulmonary resection without a preoperative tissue diagnosis at a tertiary care center from 2009 to 2013. Age, sex, smoking status, prior malignancy, tumor size, and whether or not tissue diagnosis had been attempted were recorded. Logistic regression models were constructed to determine factors associated with a malignant diagnosis.

Results: There were 297 males (59.4%), the mean age was 64.9 years, and 412 had a smoking history (82.4%). Also, 203 patients (40.6%) had a malignancy history, and 36 patients (7.2%) had previous lung cancer. Biopsy was attempted for 102 patients (20.5%). The final diagnosis was lung cancer in 336 patients (67.2%), metastatic cancer in 93 patients (18.6%), and benign tumour in 71 patients (14.2%). Male sex, increasing age, smoking history, and prior lung cancer were positive predictors of lung cancer. Model discrimination was good (c-statistic, 0.83). Attempted biopsy did not alter model discrimination.

Conclusion: In this cohort, 86% of resected lesions were malignant. The decision to pursue preoperative tissue diagnosis did not change the predictive ability offered by clinical factors. These findings are reassuring in the scenario when a patient is operable but the diagnosis remains unknown.
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http://dx.doi.org/10.1016/j.cllc.2021.02.011DOI Listing
February 2021

The Primary Spontaneous Pneumothorax trial: A critical appraisal from the surgeon's perspective.

J Thorac Cardiovasc Surg 2021 Feb 24. Epub 2021 Feb 24.

Department of Surgery, University of Calgary, Calgary, Alberta, Canada.

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http://dx.doi.org/10.1016/j.jtcvs.2021.02.070DOI Listing
February 2021

Symptom Assessment Following Surgery for Lung Cancer: A Canadian Population-Based Retrospective Cohort Study.

Ann Surg 2021 Feb 10. Epub 2021 Feb 10.

Department of Surgery, University of Toronto, Toronto, Ontario, Canada Division of Surgical Oncology, Odette Cancer Centre - Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada Division of Thoracic Surgery, Department of Surgery, University Health Network, Toronto, Ontario, Canada Section of Thoracic Surgery, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada Research Institute in Oncology and Hematology, Cancer Care Manitoba, Winnipeg, Manitoba, Canada Department of Thoracic Surgery, University of Montréal, Montréal, Québec, Canada Division of Medical Oncology, Odette Cancer Centre - Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.

Objective: To conduct a population-level analysis of temporal trends and risk factors for high symptom burden in patients receiving surgery for non-small-cell lung cancer (NSCLC).

Summary Background Data: A population-level overview of symptoms after curative intent surgery is necessary to inform decision making and supportive care for patients with lung cancer.

Methods: Retrospective cohort study of patients receiving surgery for stage I-III NSCLC between January 2007-September 2018. Prospectively collection Edmonton Symptom Assessment System (ESAS) scores, linked to provincial administrative data, were used to describe the prevalence, trajectory and predictors of moderate-to-severe symptoms in the year following surgery.

Results: A total of 5,350 patients, with 28,490 unique ESAS assessments, were included in the analysis. Moderate-to-severe tiredness (68%), poor wellbeing (63%) and shortness of breath (60%) were the most common symptoms reported. The rise and fall in the proportion of patients experiencing moderate-to-severe symptoms after surgery coincided with the median time to first (58 days, IQR: 47-72) and last cycle of chemotherapy (140 days, IQR: 118-168), respectively. There was eventual stabilization, albeit above the pre-operative baseline, within 6-7 months after surgery. Female sex (RR 1.09-1.26), lower income (RR 1.08-1.23), stage III disease (RR 1.15-1.43), adjuvant therapy (RR 1.09-1.42), chemotherapy within two weeks of an ESAS assessment (RR 1.14-1.73), and pneumonectomy (RR 1.05-1.15) were associated with moderate-to-severe symptoms following surgery.

Conclusions: Knowledge of population-level prevalence, trajectory and predictors of moderate-to-severe symptoms after surgery for NSCLC can be used to facilitate shared decision making and improve symptom management throughout the course of illness.
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http://dx.doi.org/10.1097/SLA.0000000000004802DOI Listing
February 2021

Statins in patients with COVID-19: a retrospective cohort study in Iranian COVID-19 patients.

Transl Med Commun 2021 25;6(1). Epub 2021 Jan 25.

Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has profoundly affected the lives of millions of people. To date, there is no approved vaccine or specific drug to prevent or treat COVID-19, while the infection is globally spreading at an alarming rate. Because the development of effective vaccines or novel drugs could take several months (if not years), repurposing existing drugs is considered a more efficient strategy that could save lives now. Statins constitute a class of lipid-lowering drugs with proven safety profiles and various known beneficial pleiotropic effects. Our previous investigations showed that statins have antiviral effects and are involved in the process of wound healing in the lung. This triggered us to evaluate if statin use reduces mortality in COVID-19 patients.

Results: After initial recruitment of 459 patients with COVID-19 (Shiraz province, Iran) and careful consideration of the exclusion criteria, a total of 150 patients, of which 75 received statins, were included in our retrospective study. Cox proportional-hazards regression models were used to estimate the association between statin use and rate of death. After propensity score matching, we found that statin use appeared to be associated with a lower risk of morbidity [HR = 0.85, 95% CI = (0.02, 3.93),  = 0.762] and lower risk of death [(HR = 0.76; 95% CI = (0.16, 3.72),  = 0.735)]; however, these associations did not reach statistical significance. Furthermore, statin use reduced the chance of being subjected to mechanical ventilation [OR = 0.96, 95% CI = (0.61-2.99),  = 0.942] and patients on statins showed a more normal computed tomography (CT) scan result [OR = 0.41, 95% CI = (0.07-2.33),  = 0.312].

Conclusions: Although we could not demonstrate a significant association between statin use and a reduction in mortality in patients with COVID19, we do feel that our results are promising and of clinical relevance and warrant the need for prospective randomized controlled trials and extensive retrospective studies to further evaluate and validate the potential beneficial effects of statin treatment on clinical symptoms and mortality rates associated with COVID-19.
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http://dx.doi.org/10.1186/s41231-021-00082-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7829327PMC
January 2021

Tidal volume during 1-lung ventilation: A systematic review and meta-analysis.

J Thorac Cardiovasc Surg 2020 Dec 25. Epub 2020 Dec 25.

Section of Thoracic Surgery, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Research Institute in Oncology and Hematology, Winnipeg, Manitoba, Canada. Electronic address:

Background: The selection of tidal volumes for 1-lung ventilation remains unclear, because there exists a trade-off between oxygenation and risk of lung injury. We conducted a systematic review and meta-analysis to determine how oxygenation, compliance, and clinical outcomes are affected by tidal volume during 1-lung ventilation.

Methods: A systematic search of MEDLINE and EMBASE was performed. A systematic review and random-effects meta-analysis was conducted. Pooled mean difference estimated arterial oxygen tension, compliance, and length of stay; pooled odds ratio was calculated for composite postoperative pulmonary complications. Risk of bias was determined using the Cochrane risk of bias and Newcastle-Ottawa tools.

Results: Eighteen studies were identified, comprising 3693 total patients. Low tidal volumes (5.6 [±0.9] mL/kg) were not associated with significant differences in partial pressure of oxygen (-15.64 [-88.53-57.26] mm Hg; P = .67), arterial oxygen tension to fractional intake of oxygen ratio (14.71 [-7.83-37.24]; P = .20), or compliance (2.03 [-5.22-9.27] mL/cmH2O; P = .58) versus conventional tidal volume ventilation (8.1 [±3.1] mL/kg). Low versus conventional tidal volume ventilation had no significant impact on hospital length of stay (-0.42 [-1.60-0.77] days; P = .49). Low tidal volumes are associated with significantly decreased odds of pulmonary complications (pooled odds ratio, 0.40 [0.29-0.57]; P < .0001).

Conclusions: Low tidal volumes during 1-lung ventilation do not worsen oxygenation or compliance. A low tidal volume ventilation strategy during 1-lung ventilation was associated with a significant reduction in postoperative pulmonary complications.
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http://dx.doi.org/10.1016/j.jtcvs.2020.12.054DOI Listing
December 2020

Endobronchial Ultrasound Staging of Operable Non-small Cell Lung Cancer: Do Triple-Normal Lymph Nodes Require Routine Biopsy?

Chest 2021 Jun 9;159(6):2470-2476. Epub 2021 Jan 9.

Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Division of Thoracic Surgery, Department of Surgery, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada. Electronic address:

Background: Staging guidelines for lung cancer recommend endobronchial ultrasound (EBUS) and systematic biopsy of at least three mediastinal lymph node (LN) stations for accurate staging. A four-point ultrasonographic score (Canada Lymph Node Score [CLNS]) was developed to determine the probability of malignancy in each LN. A LN with a CLNS of < 2 is considered low probability for malignancy. We hypothesized that, in patients with cN0 non-small cell lung cancer, LNs with CLNS of < 2 may not require routine biopsy because they represent true node-negative disease.

Research Question: Do LNs considered triple normal on CT scanning, PET scanning, and CLNS evaluation require routine biopsy?

Study Design And Methods: LNs were evaluated for ultrasonographic features at the time of EBUS and the CLNS was applied. Triple-normal LNs were defined as cN0 on CT scanning (short axis, < 1 cm), PET scanning (no hypermetabolic activity), and EBUS (CLNS, < 2). Specificity and negative predictive value (NPV) were calculated against the gold standard pathologic diagnosis from surgically excised specimens.

Results: In total, 143 LNs from 57 cN0 patients were assessed. Triple-normal LNs showed a specificity and NPV of 60% (95% CI, 51.2%-68.3%) and 93.1% (95% CI, 85.6%-97.4%), respectively. After pathologic assessment, only 5.6% (n = 8/143) of triple-normal nodes were proven to be malignant.

Interpretation: At the time of staging for lung cancer, combining CT scanning, PET scanning, and CLNS criteria can identify triple-normal LNs that have a high NPV for malignancy. This raises the question of whether triple-normal LNs require routine sampling during EBUS and transbronchial needle aspiration. A prospective trial is required to confirm these findings.
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http://dx.doi.org/10.1016/j.chest.2020.12.050DOI Listing
June 2021

From Emergency Department Visit to Readmission After Esophagectomy: Analysis of Burden and Risk Factors.

Ann Thorac Surg 2021 08 11;112(2):379-386. Epub 2020 Dec 11.

Division of Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Thoracic Surgery, Toronto General Hospital, Toronto, Ontario, Canada.

Background: Frequent emergency department (ED) visits occur after esophagectomy. We aimed to identify the incidence of and risk factors for conversion from ED visit to inpatient admission.

Methods: A retrospective cohort study was performed of consecutive esophagectomies at a tertiary Canadian center (1999 to 2014). Multivariable regression analyses identified factors associated with conversion from ED visit to admission.

Results: There were 520 esophagectomies with 6% inhospital mortality (n = 31). Of those discharged, 29.7% (n = 145) had one or more emergency visit and 43.4% (n = 63) of these patients were readmitted to the hospital. First-time ED visits resulted in inpatient conversion 23.4% of the time (n = 34); successive ED visits resulted in increasing conversion. On multivariable analysis, anastomotic leak (adjusted odds ratio 2.45; 95% confidence interval, 1 to 6.01; P = .05) was independently associated with higher odds of conversion to admission. Sensitivity analysis using Poisson regression to model conversion as a rate identified that living in regions further away was associated with lower conversion rate to admission (risk ratio 0.35; 95% confidence interval, 0.13 to 0.94; P = .04).

Conclusions: Although postesophagectomy ED utilization is high, the majority of visits do not convert to admission. With each increasing ED visit, likelihood of converting to admission increases. Anastomotic leakage was associated with higher odds of conversion to admission, possibly related to development of strictures. Access to urgent outpatient endoscopy may help reduce the incidence of ED visits and admission. Although living in regions further away is associated with lower conversion rates to admission at the index hospital, that may be due to patients utilizing closer local hospitals.
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http://dx.doi.org/10.1016/j.athoracsur.2020.11.020DOI Listing
August 2021

Choosing the right survey-patient reported outcomes in esophageal surgery.

J Thorac Dis 2020 Nov;12(11):6902-6912

College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.

Patient reported outcomes (PROs) fulfill a crucial and unique niche in patient management, providing health-care providers a glimpse into their patients' health experience. This is of utmost importance in patients with benign and malignant disorders of esophagus requiring surgery, which carries significant morbidity, in part due to a high burden of symptoms affecting health-related quality of life (HRQOL). There are a variety of generic and disease-specific patient reported outcome measures (PROMs) available for use in esophageal surgery. This article provides a broad overview of commonly used HRQOL instruments in esophageal surgery, including their utility in comparative effectiveness research, prognostication and shared decision-making for patients undergoing surgery for benign and malignant disorders of the esophagus.
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http://dx.doi.org/10.21037/jtd.2020.03.58DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7711431PMC
November 2020

Does it matter how we evaluate HRQOL? Longitudinal comparison of the EORTC QLQ-C30/QLQ-OG25 and FACT-E.

J Cancer Surviv 2021 Aug 26;15(4):641-650. Epub 2020 Oct 26.

Department of Surgery, Section of Thoracic Surgery, University of Manitoba and the Research Institute in Oncology & Hematology, 820 Sherbrook Street, Winnipeg, Manitoba, R3A 1R9, Canada.

Purpose: To determine whether EORTC QLQ-C30/QLQ-OG25 and FACT-E compared longitudinally provide similar reflections of health-related quality of life (HRQOL).

Methods: Eighty-six esophageal cancer patients treated with curative intent, scheduled to complete both questionnaires at baseline and post-treatment time points until 36 months. A generalized estimating equation model utilizing a Gaussian family compared instruments longitudinally. The two-one-sided-test (TOST) method assessed equivalence between the instruments.

Results: Trajectories for social domain and overall quality of life differed significantly between instruments. Also, FACT-G's functional well-being post-treatment returns to baseline 3-6 months earlier than the EORTC QLQ-C30's role functioning subscale, suggesting measurement of different components. Trajectories for physical and esophageal symptom subscales are similar and are deemed equivalent. Emotional domains are comparable and bear little resemblance to the physical domain trajectories indicating reflection of emotional experience rather than a physical proxy. EORTC QLQ-C30 subscales have a trajectory similar to its physical functioning scale except for the emotional and esophageal symptoms scales. Overall HRQOL in both instruments showed a consistent return to baseline/pre-treatment levels by 6 months post-treatment.

Conclusions: Overall HRQOL recovers earlier after curative-intent treatment than previously reported despite persistence of physical symptoms, with a consistent return to pre-treatment levels by 6 months after treatment. This supports the concept that HRQOL is not primarily defined by physical function. Based on this longitudinal comparison, FACT-E provides a more multidimensional assessment of HRQOL.

Implications For Cancer Survivors: Curative intent treatment for esophageal cancer has adverse effects on HRQOL but despite intense treatment, overall HRQOL recovers within 6 months.
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http://dx.doi.org/10.1007/s11764-020-00957-wDOI Listing
August 2021

SABR-BRIDGE: tereotactic lative adiotherapy efore esection to Avod elay for Early-Stage Lun Cancer or Oligomts During the COVID-19 Pandemic.

Front Oncol 2020 25;10:580189. Epub 2020 Sep 25.

Lawson Health Research Institute, London, ON, Canada.

Surgical resection is the standard-of-care approach for early-stage non-small cell lung cancer (NSCLC). Surgery is also considered an acceptable standard infit patients with oligometastatic lesions in the lungs. The COVID-19 pandemic has led to worldwide issues with access to operating room time, with patients and physicians facing uncertainty as to when surgical resection will be available, with likely delays of months. Further compounding this are concerns about increased risks of respiratory complications with lung cancer surgery during active phases of the pandemic. In this setting, many thoracic oncology teams are embracing a paradigm where stereotactic ablative radiotherapy (SABR) is used as a bridge, to provide radical-intent treatment based on a combination of immediate SABR followed by planned surgery in 3-6 months. This pragmatic approach to treatment has been named SABR-BRIDGE (Stereotactic ABlative Radiotherapy Before Resection to avoId Delay for early-stage lunG cancer or oligomEts). This term has also been applied to the pragmatic study of the outcomes of this approach. In this paper, we discuss the standards of care in treatment of early-stage (NSCLC) and pulmonary oligometastases, the impetus for the SABR-BRIDGE approach, and the controversies surrounding assessment of pathological response to neo-adjuvant radiation therapy.
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http://dx.doi.org/10.3389/fonc.2020.580189DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7544973PMC
September 2020

Allergen inhalation generates pro-inflammatory oxidised phosphatidylcholine associated with airway dysfunction.

Eur Respir J 2021 02 17;57(2). Epub 2021 Feb 17.

Dept of Medicine, University of British Columbia, Vancouver, BC, Canada.

Oxidised phosphatidylcholines (OxPCs) are produced under conditions of elevated oxidative stress and can contribute to human disease pathobiology. However, their role in allergic asthma is unexplored. The aim of this study was to characterise the OxPC profile in the airways after allergen challenge of people with airway hyperresponsiveness (AHR) or mild asthma. The capacity of OxPCs to contribute to pathobiology associated with asthma was also to be determined.Using bronchoalveolar lavage fluid from two human cohorts, OxPC species were quantified using ultra-high performance liquid chromatography-tandem mass spectrometry. Murine thin-cut lung slices were used to measure airway narrowing caused by OxPCs. Human airway smooth muscle (HASM) cells were exposed to OxPCs to assess concentration-associated changes in inflammatory phenotype and activation of signalling networks.OxPC profiles in the airways were different between people with and without AHR and correlated with methacholine responsiveness. Exposing patients with mild asthma to allergens produced unique OxPC signatures that associated with the severity of the late asthma response. OxPCs dose-dependently induced 15% airway narrowing in murine thin-cut lung slices. In HASM cells, OxPCs dose-dependently increased the biosynthesis of cyclooxygenase-2, interleukin (IL)-6, IL-8, granulocyte-macrophage colony-stimulating factor and the production of oxylipins protein kinase C-dependent pathways.Data from human cohorts and primary HASM cell culture show that OxPCs are present in the airways, increase after allergen challenge and correlate with metrics of airway dysfunction. Furthermore, OxPCs may contribute to asthma pathobiology by promoting airway narrowing and inducing a pro-inflammatory phenotype and contraction of airway smooth muscle. OxPCs represent a potential novel target for treating oxidative stress-associated pathobiology in asthma.
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http://dx.doi.org/10.1183/13993003.00839-2020DOI Listing
February 2021

Commentary: VATS, RATS, stats, and some caveats.

J Thorac Cardiovasc Surg 2021 07 30;162(1):269-270. Epub 2020 Jun 30.

Section of Thoracic Surgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Research Institute in Oncology and Hematology, Cancer Care Manitoba, Winnipeg, Manitoba, Canada. Electronic address:

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http://dx.doi.org/10.1016/j.jtcvs.2020.06.072DOI Listing
July 2021

Early Worsening of Quality of Life after Treatment of Stage I Lung Cancer.

Ann Am Thorac Soc 2020 08;17(8):935-936

Section of Thoracic Surgery, Department of Surgery, Rady Faculty of Health Sciences, and.

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http://dx.doi.org/10.1513/AnnalsATS.202005-523EDDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7393789PMC
August 2020

COVID-19 guidance for triage of operations for thoracic malignancies: A consensus statement from Thoracic Surgery Outcomes Research Network.

J Thorac Cardiovasc Surg 2020 Aug 9;160(2):601-605. Epub 2020 Apr 9.

The extraordinary demands of managing the COVID-19 pandemic has disrupted the world's ability to care for patients with thoracic malignancies. As a hospital's COVID-19 population increases and hospital resources are depleted, the ability to provide surgical care is progressively restricted, forcing surgeons to prioritize among their cancer populations. Representatives from multiple cancer, surgical, and research organizations have come together to provide a guide for triaging patients with thoracic malignancies as the impact of COVID-19 evolves as each hospital.
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http://dx.doi.org/10.1016/j.jtcvs.2020.03.061DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7146695PMC
August 2020

Does Tweeting Improve Citations? One-Year Results From the TSSMN Prospective Randomized Trial.

Ann Thorac Surg 2021 01 3;111(1):296-300. Epub 2020 Jun 3.

Department of Thoracic and Cardiovascular Surgery, MD Anderson Cancer Center, Houston, Texas. Electronic address:

Background: The Thoracic Surgery Social Media Network (TSSMN) is a collaborative effort of leading journals in cardiothoracic surgery to highlight publications via social media. This study aims to evaluate the 1-year results of a prospective randomized social media trial to determine the effect of tweeting on subsequent citations and nontraditional bibliometrics.

Methods: A total of 112 representative original articles were randomized 1:1 to be tweeted via TSSMN or a control (non-tweeted) group. Measured endpoints included citations at 1 year compared with baseline, as well as article-level metrics (Altmetric score) and Twitter analytics. Independent predictors of citations were identified through univariable and multivariable regression analyses.

Results: When compared with control articles, tweeted articles achieved significantly greater increase in Altmetric scores (Tweeted 9.4 ± 5.8 vs Non-tweeted 1.0 ± 1.8, P < .001), Altmetric score percentiles relative to articles of similar age from each respective journal (Tweeted 76.0 ± 9.1 percentile vs Non-tweeted 13.8 ± 22.7 percentile, P < .001), with greater change in citations at 1 year (Tweeted +3.1 ± 2.4 vs Non-Tweeted +0.7 ± 1.3, P < .001). Multivariable analysis showed that independent predictors of citations were randomization to tweeting (odds ratio [OR] 9.50; 95% confidence interval [CI] 3.30-27.35, P < .001), Altmetric score (OR 1.32; 95% CI 1.15-1.50, P < .001), open-access status (OR 1.56; 95% CI 1.21-1.78, P < .001), and exposure to a larger number of Twitter followers as quantified by impressions (OR 1.30, 95% CI 1.10-1.49, P < .001).

Conclusions: One-year follow-up of this TSSMN prospective randomized trial importantly demonstrates that tweeting results in significantly more article citations over time, highlighting the durable scholarly impact of social media activity.
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http://dx.doi.org/10.1016/j.athoracsur.2020.04.065DOI Listing
January 2021

Commentary: Are we confident in abandoning P values, or is this just the interval?

J Thorac Cardiovasc Surg 2020 Apr 12. Epub 2020 Apr 12.

Section of Thoracic Surgery, Department of Surgery, Rady Faculty of Health Sciences; Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada; Research Institute in Oncology and Hematology, Cancer Care Manitoba, Winnipeg, Canada. Electronic address:

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http://dx.doi.org/10.1016/j.jtcvs.2020.03.131DOI Listing
April 2020

FDG PET/CT Findings in an Asymptomatic Case of Confirmed COVID-19.

Clin Nucl Med 2020 Aug;45(8):647-648

In the current and rapidly worsening pandemic, patients with COVID-19 may undergo imaging with FDG PET/CT. Because a significant proportion of infected patients may be asymptomatic, incidental discovery on a PET/CT scan performed for unrelated reasons can occur. Because of the highly infectious nature of this agent, it is important that interpreting physicians be aware of the typical imaging findings to identify potentially affected patients. We present the case of an asymptomatic patient referred for FDG PET/CT imaging of a lung nodule who demonstrated the typical CT findings of COVID-19 infection and was subsequently found to be positive on testing.
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http://dx.doi.org/10.1097/RLU.0000000000003145DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7268853PMC
August 2020

Postoperative but not intraoperative transfusions are associated with respiratory failure after pneumonectomy.

Eur J Cardiothorac Surg 2020 11;58(5):1004-1009

Department of Surgery, Division of Thoracic Surgery, University of Toronto, Toronto General Hospital, Toronto, ON, Canada.

Objectives: Transfusion of blood products has been associated with increased risk of post-pneumonectomy respiratory failure. It is unclear whether intraoperative or postoperative transfusions confer a higher risk of respiratory failure. Our objective was to assess the role of transfusions in developing post-pneumonectomy respiratory failure.

Methods: We performed a retrospective cohort study using prospectively collected data on consecutive pneumonectomies between 2005 and 2015. Patient records were reviewed for intraoperative/postoperative exposures. Univariable and multivariable analyses were performed.

Results: Of the 251 pneumonectomies performed during the study period, 24 (9.6%) patients suffered respiratory failure. Ninety-day mortality was 5.6% (n = 14) and was more likely in patients with respiratory failure (7/24 vs 7/227, P < 0.001). Intraoperative and postoperative transfusions occurred in 42.2% (n = 106) and 44.6% (n = 112) of patients, respectively and were predominantly red blood cells. On univariable analysis, both intraoperative (P = 0.03) and postoperative transfusion (P = 0.004) were associated with a higher risk of respiratory failure. The multivariable model significantly predicted respiratory failure with an area under curve (AUC) = 0.88 (P = 0.001). On multivariable analysis, the only independent predictors of respiratory failure were postoperative transfusions [adjusted odds ratio (aOR) 6.54, 95% confidence interval (CI) 1.74-24.59; P = 0.005] and lower preoperative forced expiratory volume (adjusted OR 0.96, 95% CI 0.93-0.99; P = 0.03). Estimated blood loss was not significantly different (P = 0.91) between those with (median 800 ml, interquartile range 300-2000 ml) and without respiratory failure (median 800 ml, interquartile range 300-2000 ml).

Conclusions: Respiratory failure occurred in 9.6% of patients post-pneumonectomy and confers a higher risk of 90-day mortality. Postoperative (but not intraoperative) transfusion was the strongest independent predictor associated with respiratory failure. Intraoperative transfusion may be in reaction to active/unpredictable blood loss and may not be easily modifiable. However, postoperative transfusion may be modifiable and potentially avoidable. Transfusion thresholds should be assessed in light of potential cost-benefit trade-offs.
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http://dx.doi.org/10.1093/ejcts/ezaa107DOI Listing
November 2020

COVID-19 Guidance for Triage of Operations for Thoracic Malignancies: A Consensus Statement From Thoracic Surgery Outcomes Research Network.

Ann Thorac Surg 2020 08 9;110(2):692-696. Epub 2020 Apr 9.

The extraordinary demands of managing the COVID-19 pandemic has disrupted the world's ability to care for patients with thoracic malignancies. As a hospital's COVID-19 population increases and hospital resources are depleted, the ability to provide surgical care is progressively restricted, forcing surgeons to prioritize among their cancer populations. Representatives from multiple cancer, surgical, and research organizations have come together to provide a guide for triaging patients with thoracic malignancies as the impact of COVID-19 evolves as each hospital.
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http://dx.doi.org/10.1016/j.athoracsur.2020.03.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7146713PMC
August 2020

Positive end-expiratory pressure and recruitment maneuvers during one-lung ventilation: A systematic review and meta-analysis.

J Thorac Cardiovasc Surg 2020 Oct 29;160(4):1112-1122.e3. Epub 2020 Feb 29.

Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada. Electronic address:

Background: It is unclear how positive end-expiratory pressure (PEEP) and recruitment maneuvers impact patients during one-lung ventilation (OLV). We conducted a systematic review and meta-analysis of the effect of lung recruitment and PEEP on ventilation and oxygenation during OLV.

Methods: A systematic review and random-effects meta-analysis were performed. Mean difference with standard deviation was calculated. Included studies were evaluated for quality and risk of bias using the Cochrane Risk of Bias tool and the modified Newcastle-Ottawa Score where appropriate.

Results: In total, 926 articles were identified, of which 16 were included in meta-analysis. Recruitment maneuvers increased arterial oxygen tension (PaO) by 82 mm Hg [20, 144 mm Hg] and reduced dead-space by 5.9% [3.8, 8.0%]. PEEP increased PaO by 30.3 mm Hg [11.9, 48.6 mm Hg]. Subgroup analysis showed a significant increase in PaO (P = .0003; +35.4 mm Hg [16.2, 54.5 mm Hg]) with PEEP compared with no PEEP but no such difference in comparisons with PEEP-treated controls. No significant difference in PaO was observed between "high" and "low" PEEP-treated subgroups (P = .29). No significant improvement in PaO was observed for subgroups coadministered PEEP, lung recruitment, and low tidal volumes. PEEP was associated with a modest but statistically significant increase in compliance (P = .03; 4.33 mL/cmHO [0.33, 8.32]). High risk of bias was identified in the majority of studies. Considerable heterogeneity was observed.

Conclusions: Recruitment maneuvers and PEEP have physiologic advantages during OLV. The optimal use of PEEP is yet to be determined. The evidence is limited by heavy use of surrogate outcomes. Future studies with clinical outcomes are necessary to determine the impact of recruitment maneuvers and PEEP during OLV.
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http://dx.doi.org/10.1016/j.jtcvs.2020.02.077DOI Listing
October 2020
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