Difficult Decisions in Thoracic Surgery: An Evidence-Based Approach

Front Cover
Mark K Ferguson
Springer Science & Business Media, Mar 12, 2007 - Medical - 526 pages
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Why do thoracic surgeons need training in decision making? Many of us who have weathered harrowing residencies in surgery feel that, after such experiences, decision making is a natural extension of our selves. While this is no doubt true, correct de- sion making is something that many of us have yet to master. The impetus to develop a text on evidence-based decision making in thoracic surgery was stimulated by a conference for cardiothoracic surgical trainees developed in 2004 and sponsored by the American College of Chest Physicians. During that conference it became clear that we as thoracic surgeons are operating from a very limited fund of true evidence-based information. What was also clear was the fact that many of the decisions we make in our everyday practices are not only uninformed by evidence-based medicine, but often are contradictory to existing guidelines or evidence-based recommendations. The objectives of this book are to explain the process of decision making, both on the part of the physician and on the part of the patient, and to discuss speci? c clinical problems in thoracic surgery and provide recommendations regarding their mana- ment using evidence-based methodology. Producing a text that will purportedly guide experienced, practicing surgeons in the decision-making process that they are acc- tomed to observe on a daily basis is a daunting task.
 

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Contents

Introduction
3
EvidenceBased Medicine Levels of Evidence and Grades of Recommendation
13
Decision Analytic Techniques
21
Nonclinical Components of Surgical Decision Making
36
How Patients Make Decisions with Their Surgeons The Role of Counseling and Patient Decision Aids
44
Lung
58
Radiographic Staging of Lung Cancer Computed Tomography and Positron Emission Tomography
59
Routine Mediastinoscopy for Clinical Stage I Lung Cancer
68
Botox Balloon or Myotomy Optimal Treatment for Achalasia
285
Fundoplication after Laparoscopic Myotomy for Achalasia
292
Primary Repair for Delayed Recognition of Esophageal Perforation
298
Lengthening Gastroplasty for Managing Gastroesophageal Reflux Disease and Stricture
305
Lengthening Gastroplasty for Managing Giant Paraesophageal Hernia
318
Management of Zenkers Diverticulum Open Versus Transoral Approaches
323
Management of Minimally Symptomatic Pulsion Diverticula of the Esophagus
332
Diaphragm
340

Management of Unexpected N2 Disease Discovered at Thoracotomy
75
Induction Therapy for Clinical Stage I Lung Cancer
82
Induction Therapy for Stage IIIA N2 Lung Cancer
88
Adjuvant Postoperative Therapy for Completely Resected Stage I Lung Cancer
94
Sleeve Lobectomy Versus Pneumonectomy for Lung Cancer Patients with Good Pulmonary Function
103
Lesser Resection Versus Lobectomy for Stage I Lung Cancer in Patients with Good Pulmonary Function
110
Lesser Resection Versus Radiotherapy for Patients with Compromised Lung Function and Stage I Lung Cancer
119
Resection for Patients Initially Diagnosed with N3 Lung Cancer after Response to Induction Therapy
128
VideoAssisted Thorascopic Surgery Major Lung Resections
140
Surgery for NonSmall Cell Lung Cancer with Solitary M1 Disease
147
Thoracoscopy Versus the Open Approach for Resection of Solitary Pulmonary Metastases
151
Unilateral or Bilateral Approach for Unilateral Pulmonary Metastatic Disease
158
Surgery for Bronchoalveolar Lung Cancer
165
Lung Volume Reduction Surgery in the Candidate for Lung Transplantation
175
Pleural Sclerosis for the Management of Initial Pneumothorax
186
Esophagus
193
Staging for Esophageal Cancer Positron Emission Tomography Endoscopic Ultrasonography
195
Induction Therapy for Resectable Esophageal Cancer
200
Transthoracic Versus Transhiatal Resection for Carcinoma of the Esophagus
208
Minimally Invasive Versus Open Esophagectomy for Cancer
218
Lymph Node Dissection for Carcinoma of the Esophagus
225
Intrathoracic Versus Cervical Anastomosis in Esophageal Replacement
234
Jejunostomy after Esophagectomy
242
Gastric Emptying Procedures after Esophagectomy
250
Posterior Mediastinal or Retrosternal Reconstruction Following Esophagectomy for Cancer
258
Postoperative Adjuvant Therapy for Completely Resected Esophageal Cancer
265
Celiac Lymph Nodes and Esophageal Cancer
271
Partial or Total Fundoplication for Gastroesophageal Reflux Disease in the Presence of Impaired Esophageal Motility
279
Giant Paraesophageal Hernia Thoracic Open Abdominal or Laparoscopic Approach
343
Management of Minimally Symptomatic Giant Paraesophageal Hernias
350
Plication for Diaphragmatic Eventration
356
Pacing for Unilateral Diaphragm Paralysis
365
Optimal Crural Closure Techniques for Repair of Large Hiatal Hernias
371
Management of Acute Diaphragmatic Rupture Thoracotomy Versus Laparotomy
379
Airway
386
Stenting for Benign Airway Obstruction
387
Tracheal Resection for Thyroid or Esophageal Cancer
398
Pleura and Pleural Space
408
Pleural Sclerosis for Malignant Pleural Effusion Optimal Sclerosing Agent
409
Management of Malignant Pleural Effusion Sclerosis or Chronic Tube Drainage
414
Initial Spontaneous Pneumothorax Role of Thoracoscopic Therapy
424
Intrapleural Fibrinolytics
433
Diffuse Malignant Pleural Mesothelioma The Role of Pleurectomy
442
Treatment of Malignant Pleural Mesothelioma Is There a Benefit to Pleuropneumonectomy?
451
Mediastinum
461
Management of Myasthenia Gravis Does Thymectomy Provide Benefit over Medical Therapy Alone?
463
Thymectomy for Myasthenia Gravis Optimal Approach
469
Management of Residual Disease after Therapy for Mediastinal Germ Cell Tumor and Normal Serum Markers
474
Management of Malignant Pericardial Effusions
482
Asymptomatic Pericardial Cyst Observe or Resect?
488
Chest Wall
494
Optimal Approach to Thoracic Outlet Syndrome Transaxillary Supraclavicular or Infraclavicular
495
Pectus Excavatum in Adults
503
Index
509
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