Publications by authors named "Brian Whang"

11 Publications

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Corrigendum to "Surgical evaluation of lymph nodes in esophageal adenocarcinoma: Standardized approach or personalized medicine?" [European Journal of Surgical Oncology (2018) 1177-1180].

Eur J Surg Oncol 2018 12 14;44(12):2003. Epub 2018 Sep 14.

Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA; VA Boston Healthcare System, Boston, MA, USA.

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http://dx.doi.org/10.1016/j.ejso.2018.08.008DOI Listing
December 2018

Surgical evaluation of lymph nodes in esophageal adenocarcinoma: Standardized approach or personalized medicine?

Eur J Surg Oncol 2018 08 19;44(8):1177-1180. Epub 2018 Apr 19.

Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA; VA Boston Healthcare System, Boston, MA, USA.

The extent of lymphadenectomy for esophageal adenocarcinoma remains controversial. Outstanding issues include the appropriate technical approach such as transthoracic versus transhiatal, or open versus minimally invasive, both of which have implications on overall lymph node harvest numbers and morbidity. Recent data on the relationship of total number of lymph nodes harvested and oncologic survival have been conflicting, due in part to a likely differential impact of lymphadenectomy on survival based on tumor stage and response to neoadjuvant therapy. While standardizing the extent of lymphadenectomy may be desirable, a more useful approach might be to tailor lymphadenectomy considering the multidimensional impact of surgical technique and multimodal treatment strategy.
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http://dx.doi.org/10.1016/j.ejso.2018.03.007DOI Listing
August 2018

Long-term outcomes after near-infrared sentinel lymph node mapping in non-small cell lung cancer.

J Thorac Cardiovasc Surg 2018 03 14;155(3):1280-1291. Epub 2017 Dec 14.

Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass. Electronic address:

Objective: To report the first analysis of long-term outcomes using near-infrared (NIR) image-guided sentinel lymph node (SLN) mapping in non-small cell lung cancer (NSCLC).

Methods: Retrospective analysis of patients with NSCLC enrolled in 2 prospective phase 1 NIR-guided SLN mapping trials, including an indocyanine green (ICG) dose-escalation trial, was performed. All patients underwent NIR imaging for SLN identification followed by multistation mediastinal lymph node sampling (MLNS) and pathologic assessment. Disease-free (DFS) and overall survival (OS) were compared between patients with NIR SLN (SLN group) and those without (non-SLN group).

Results: SLN detection, recurrence, DFS, and OS were assessed in 42 patients with NSCLC who underwent intraoperative peritumoral ICG injection, NIR imaging, and MLNS. NIR SLNs were identified in 23 patients (SLN group), whereas SLNs were not identified in 19 patients enrolled before ICG dose and camera optimization (non-SLN group). Median follow-up was 44.5 months. Pathology from NIR SLNs was concordant with overall nodal status in all 23 patients. Sixteen patients with SLN were deemed pN0 and no recurrences were, whereas 4 of 15 pN0 non-SLN patients developed nodal or distant recurrent disease. Comparing SLN versus non-SLN pN0 patients, the probability of 5-year OS is 100% versus 70.0% (P = .062) and 5-year DFS is statistically significantly improved at 100% versus 66.1% (P = .036), respectively. Among the 11 pN+ patients, 7 were in the SLN group, with >40% showing metastases in the SLN alone.

Conclusions: Patients with pN0 SLNs showed favorable disease-free and overall survival. This preliminary review of NIR SLN mapping in NSCLC suggests that pN0 SLNs may better represent true N0 status. A larger clinical trial is planned to validate these findings.
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http://dx.doi.org/10.1016/j.jtcvs.2017.09.150DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5816699PMC
March 2018

Thoracic Surgery in the Pregnant Patient.

Authors:
Brian Whang

Thorac Surg Clin 2018 Feb 18;28(1):1-7. Epub 2017 Oct 18.

Division of Thoracic Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA. Electronic address:

Thoracic surgeons are sometimes asked to consult on the management of a patient who is pregnant. Conditions commonly encountered are empyema, spontaneous pneumothorax, and diaphragmatic hernia. Lung cancer is rarely seen in pregnancy, but its incidence is rising. Diagnostic imaging and perioperative management involve the navigation of fetal risks and nuances in maternal physiology. Shared decision making within a multidisciplinary framework will optimally guide the course of management.
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http://dx.doi.org/10.1016/j.thorsurg.2017.08.002DOI Listing
February 2018

A novel technique for tumor localization and targeted lymphatic mapping in early-stage lung cancer.

J Thorac Cardiovasc Surg 2017 09 10;154(3):1110-1118. Epub 2017 Feb 10.

Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass. Electronic address:

Objective: To investigate safety and feasibility of navigational bronchoscopy (NB)-guided near-infrared (NIR) localization of small, ill-defined lung lesions and sentinel lymph nodes (SLN) for accurate staging in patients with non-small cell lung cancer (NSCLC).

Methods: Patients with known or suspected stage I NSCLC were enrolled in a prospective pilot trial for lesion localization and SLN mapping via NB-guided NIR marking. Successful localization, SLN detection rates, histopathologic status of SLN versus overall nodes, and concordance to initial clinical stage were measured. Ex vivo confirmation of NIR SLNs and adverse events were recorded.

Results: Twelve patients underwent NB-guided marking with indocyanine green of lung lesions ranging in size from 0.4 to 2.2 cm and located 0.1 to 3 cm from the pleural surface. An NIR "tattoo" was identified in all cases. Ten patients were diagnosed with NSCLC and 9 SLNs were identified in 8 of the 10 patients, resulting in an 80% SLN detection rate. SLN pathologic status was 100% sensitive and specific for overall nodal status with no false-negative results. Despite previous nodal sampling, one patient was found to have metastatic disease in the SLN alone, a 12.5% rate of disease upstaging with NIR SLN mapping. SLN were detectable for up to 3 hours, allowing time for obtaining a tissue diagnosis and surgical resection. There were no adverse events associated with NB-labeling or indocyanine green dye itself.

Conclusions: NB-guided NIR lesion localization and SLN identification was safe and feasible. This minimally invasive image-guided technique may permit the accurate localization and nodal staging of early stage lung cancers.
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http://dx.doi.org/10.1016/j.jtcvs.2016.12.058DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5552457PMC
September 2017

Minimally Invasive Esophagectomy for Adenocarcinomas of the Gastroesophageal Junction and Distal Esophagus: Notes on Technique.

J Laparoendosc Adv Surg Tech A 2017 Feb 18;27(2):162-169. Epub 2016 Nov 18.

2 Department of Surgery, Brigham and Women's Hospital , Veterans Health Administration, Boston Healthcare System, Boston, Massachusetts.

In the last three decades, with the advancement of laparoscopic and thoracoscopic surgery, minimally invasive approaches for benign and malignant diseases of the esophagus have been developed and more experience is starting to accumulate across the world. Minimally invasive esophagectomy (MIE) has demonstrated acceptable lymph node retrieval, good postoperative outcomes, and low mortality. In this article, we review our preferred technique of MIE for adenocarcinomas of the gastroesophageal junction and distal esophagus.
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http://dx.doi.org/10.1089/lap.2016.0430DOI Listing
February 2017

Perventricular device closure of post-myocardial infarction ventricular septal defect on the beating heart.

J Thorac Cardiovasc Surg 2011 Jul 17;142(1):230-2. Epub 2011 Jan 17.

Division of Pediatric Cardiology, Mount Sinai School of Medicine, New York, NY 10029, USA.

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http://dx.doi.org/10.1016/j.jtcvs.2010.10.039DOI Listing
July 2011

The left thoracotomy approach for reoperative cardiac surgery: considerations for the surgeon and anesthesiologist.

J Cardiothorac Vasc Anesth 2011 Feb 9;25(1):134-9. Epub 2010 Apr 9.

Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, New York, NY, USA. 10029-1028

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http://dx.doi.org/10.1053/j.jvca.2010.01.016DOI Listing
February 2011

Transatrial lead implantation using the 4-Fr lumenless pacing lead and delivery system in young adults with congenital heart disease.

Pacing Clin Electrophysiol 2009 Dec 10;32(12):e40-2. Epub 2009 Sep 10.

Division of Pediatric Cardiology, Yale University School of Medicine, New Haven, Connecticut, USA.

We report the technique of transatrial delivery of the Medtronic 3830 SelectSecure lead (Medtronic Inc., Minneapolis, MN, USA) for right ventricular endocardial pacing in two young adults with congenital heart disease who had multiple pacing lead failures and superior vena cava occlusion. The deflectable catheter delivery system used to position the SelectSecure lead provided the opportunity to map the right ventricular endocardial surface and determine the best available pacing site. At midterm follow-up, both systems are functioning well.
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http://dx.doi.org/10.1111/j.1540-8159.2009.02539.xDOI Listing
December 2009

Cardiac stem cells delivered intravascularly traverse the vessel barrier, regenerate infarcted myocardium, and improve cardiac function.

Proc Natl Acad Sci U S A 2005 Mar 25;102(10):3766-71. Epub 2005 Feb 25.

Institute of Molecular Cardiology, University of Louisville, Louisville, KY 40202, USA.

The ability of cardiac stem cells (CSCs) to promote myocardial repair under clinically relevant conditions (i.e., when delivered intravascularly after reperfusion) is unknown. Thus, rats were subjected to a 90-min coronary occlusion; at 4 h after reperfusion, CSCs were delivered to the coronary arteries via a catheter positioned into the aortic root. Echocardiographic analysis showed that injection of CSCs attenuated the increase in left ventricular (LV) end-diastolic dimensions and impairment in LV systolic performance at 5 weeks after myocardial infarction. Pathologic analysis showed that treated hearts exhibited a smaller increase in LV chamber diameter and volume and a higher wall thickness-to-chamber radius ratio and LV mass-to-chamber volume ratio. CSCs induced myocardial regeneration, decreasing infarct size by 29%. A diploid DNA content and only two chromosomes 12 were found in new cardiomyocytes, indicating that cell fusion did not contribute to tissue reconstitution. In conclusion, intravascular injection of CSCs after reperfusion limits infarct size, attenuates LV remodeling, and ameliorates LV function. This study demonstrates that CSCs are effective when delivered in a clinically relevant manner, a clear prerequisite for clinical translation, and that these beneficial effects are independent of cell fusion. The results establish CSCs as candidates for cardiac regeneration and support an approach in which the heart's own stem cells could be collected, expanded, and stored for subsequent therapeutic repair.
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http://dx.doi.org/10.1073/pnas.0405957102DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC553298PMC
March 2005

Bone marrow cells differentiate in cardiac cell lineages after infarction independently of cell fusion.

Circ Res 2005 Jan 29;96(1):127-37. Epub 2004 Nov 29.

Cardiovascular Research Institute, Department of Medicine, New York Medical College, Valhalla, NY 10595, USA.

Recent studies in mice have challenged the ability of bone marrow cells (BMCs) to differentiate into myocytes and coronary vessels. The claim has also been made that BMCs acquire a cell phenotype different from the blood lineages only by fusing with resident cells. Technical problems exist in the induction of myocardial infarction and the successful injection of BMCs in the mouse heart. Similarly, the accurate analysis of the cell populations implicated in the regeneration of the dead tissue is complex and these factors together may account for the negative findings. In this study, we have implemented a simple protocol that can easily be reproduced and have reevaluated whether injection of BMCs restores the infarcted myocardium in mice and whether cell fusion is involved in tissue reconstitution. For this purpose, c-kit-positive BMCs were obtained from male transgenic mice expressing enhanced green fluorescence protein (EGFP). EGFP and the Y-chromosome were used as markers of the progeny of the transplanted cells in the recipient heart. By this approach, we have demonstrated that BMCs, when properly administrated in the infarcted heart, efficiently differentiate into myocytes and coronary vessels with no detectable differentiation into hemopoietic lineages. However, BMCs have no apparent paracrine effect on the growth behavior of the surviving myocardium. Within the infarct, in 10 days, nearly 4.5 million biochemically and morphologically differentiated myocytes together with coronary arterioles and capillary structures were generated independently of cell fusion. In conclusion, BMCs adopt the cardiac cell lineages and have an important therapeutic impact on ischemic heart failure.
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http://dx.doi.org/10.1161/01.RES.0000151843.79801.60DOI Listing
January 2005