Background: Minimally invasive surgeries for non-small cell lung cancers (NSCLCs) such as video-assisted thoracoscopic surgeries (VATSs) and robotic-assisted thoracoscopic surgeries (RATSs) have become standard of care for patients needing surgical resection in early stages. The role for neoadjuvant systemic therapy has increased with patients receiving neoadjuvant systemic chemotherapy and immunotherapy. However, there has been some equipoise over the intraoperative and overall outcomes for these patients. Here, we review the current data regarding outcomes of patients undergoing minimally invasive thoracic surgical resection after systemic chemotherapy, immunotherapy, or both. Methods: A systematic literature review of randomized controlled trials and observational studies presenting data on patients with NSCLC that underwent neoadjuvant systemic therapy followed by minimally invasive surgery was performed assessing complications, conversion rates, and lymph node yield. Results: Our search strategy and review of references resulted in 239 publications to screen with 88 full texts assessed and 21 studies included in our final review. VATS had a statistically significant higher lymph node yield in five studies. The reported conversion rates ranged from 0 to 54%. Dense adhesions, bleeding, and difficult anatomy were the most common reported reasons for conversion to open surgeries. The most common complications between both groups were prolonged air leak, arrythmia, and pneumonia. VATS was found to have significantly fewer complications in three papers. Conclusions: The current literature supports VATS as safe and feasible for patients with NSCLC after neoadjuvant systemic treatment. Surgeons should remain prepared to convert to open surgeries in those patients with dense adhesions and bleeding risk.

Purpose: Despite advances in systemic therapy, outcomes of patients with gastric cancer (GC) peritoneal carcinomatosis (PC) remain poor, in part because of poor penetrance of systemic therapy into peritoneal metastasis due to the plasma-peritoneal barrier and anarchic intra-tumoral circulation. Hence, regional treatment approach with administration of chemotherapy directly into the peritoneal cavity (intraperitoneal, IP) under various conditions, combined with or without cytoreductive surgery (CRS) has remained an area of significant research interest. The purpose of this review is to provide high-level evidence for regional treatment approaches in the management of GCPC with limited peritoneal disease. Methods: A review of the current literature and ongoing clinical trials for regional IP therapies for GCPC was performed. Studies included in this review comprise of phase III randomized controlled trials, non-randomized phase II studies, high-impact retrospective studies, and active ongoing clinical trials for each available IP modality. Results: The three common IP approaches are heated intraperitoneal chemotherapy (HIPEC), normothermic intraperitoneal chemotherapy (NIPEC) and more recently introduced, pressurized intraperitoneal aerosolized chemotherapy (PIPAC). These IP approaches have been combined with systemic therapy and/or CRS with varying degrees of promising results, demonstrating evidence of improvements in survival rates and peritoneal disease control. Patient selection, optimization of systemic therapy, and completeness of cytoreduction have emerged as major factors influencing the design of contemporary and ongoing trials. Conclusion: IP chemotherapy has a clear role in the management of patients with GCPC, and when combined with CRS in appropriately selected patients has the potential to significantly improve survival. Ongoing and upcoming IP therapy clinical trials hold great promise to shape the treatment paradigm for GCPC.

Both Orthopedic Surgery (OS) and Neurosurgery (NS) perform spine surgery in the setting of trauma. However, it is unknown whether outcomes differ between these specialties. This study compares management and outcomes for vertebral fractures between NS and OS, hypothesizing similar operation rate, length of stay (LOS), and readmission. Do outcomes differ between NS and OS in the management of vertebral fractures following trauma? A retrospective single-center study was conducted on adult patients with cervical, thoracic, lumbar, and sacral fractures treated at a single trauma center, where no standardized pathway exists across NS and OS. Patients were compared for injury profile, diagnostic imaging, and operative techniques as well as LOS, mortality, and complications. A total of 630 vertebral fracture patients (OS:350 (55.6%); NS:280 (44.4%)) were included. NS utilized magnetic resonance imaging (MRI) more commonly (36.4% vs. 22.6%, p < 0.001). NS patients more often underwent operation (13.2% vs. 7.4%, p = 0.016) despite similar fracture number and severity (p > 0.05). Post-operative complications, LOS, and readmission rates were similar between cohorts (p > 0.05). Despite similar injury profiles, NS had higher rates of MRI usage and operative interventions in the context of traumatic spine fractures. Despite differences in management, major clinical outcomes were similar between NS and OS. However, we do call for further standardization of evaluation and treatment of patients based on established algorithms from such as the AOSpine Thoracolumbar Spine Injury Classification System (ATLICS).

Prior studies have demonstrated improved outcomes for admitted children at pediatric-only hospitals (POHs) (e.g. children's hospitals) versus combined pediatric-adult trauma centers (CPACs). However, there is a paucity of data regarding disparities of overall and intensive care unit (ICU) admissions between POHs and CPACs. This study compared POHs versus CPACs, hypothesizing increased overall and ICU admissions at CPACs. A retrospective (2017-2021) analysis of the Trauma Quality Improvement Program database was performed, comparing 1-14-y-old patients treated at POHs versus CPACs. The primary outcomes were overall and ICU admissions rates. Secondary outcomes include inpatient complications and mortality. Two separate multivariable logistic regression analyses evaluated associated risk of mortality and risk of complications for those admitted, controlling for age, injury severity score, mechanism of injury, and brain injury. Of 199,414 children, 110,041 (55.2%) were treated at POHs and 89,373 (44.8%) at CPACs. Patients admitted to POHs were slightly younger (median 7 versus 8 y-old, P < 0.001) and had a decreased yet statistically different median injury severity score (POH: 4 versus CPAC: 5, P < 0.001). CPAC patients had increased overall (77.8% versus 66.2% P < 0.001) and ICU admissions (13.6% versus 6.3%, P < 0.001). POH patients had statistically decreased complications (1.2% versus 1.3%, P = 0.041) and mortality (0.7% versus 0.9%, P < 0.001). However, these findings did not persist on multivariable analysis (complications: P = 0.99; mortality: P = 0.12). This national analysis demonstrated differences in admission patterns between POHs and CPACs. The higher admission rates at CPACs yet similar associated risk of complications and mortality suggest a potential opportunity for improvement efforts at these centers.

Purpose: This study aimed to identify associated risk factors for mortality in octogenarian trauma patients undergoing urgent or emergent laparotomy (UEL). Methods: Trauma patients ages 80–89 years-old undergoing UEL within 6-hours of arrival were included. A multivariable logistic regression analysis was performed to determine associated risk of mortality. Results: From 701 octogenarians undergoing UEL, 324 (46.2%) died. Compared to survivors, UEL octogenarians who died had higher rates of cirrhosis (3.5% vs. 1.1%, p = 0.028), injuries to the brain (17.3% vs. 5.6%, p < 0.001), heart (8.6% vs. 1.6%, p < 0.001), and lung (57.4% vs. 23.9%, p < 0.001) and lower rates of functional independence (6.4% vs. 12.6%, p = 0.007). The strongest independent associated patient-related risk factor for death was cirrhosis (OR 8.28, CI 2.25–30.46, p = 0.001). However, undergoing concurrent thoracotomy increased risk of death significantly (OR 16.59, CI 2.07-132.76, p = 0.008). Functional independence was not associated with mortality (p > 0.05). Conclusion: This national analysis emphasizes the need to identify and manage pre-existing conditions like cirrhosis and not determine futility based on pre-trauma functional status alone. Concurrent thoracotomy for hemorrhage control increases risk of death over 16-fold.