In this episode our team reviews the two groundbreaking RCTs which challenged the long-held dogma that a lobectomy is the only acceptable oncologic procedure for NSCLC. Listen as we compare and contrast the North American CALGB trial and Japanese JCOG trial which were both designed to investigate survival and recurrence outcomes by randomizing stage 1A patients to lobectomy versus a sublobar resection.

-Compare and contrast the patient characteristics of the CALGB and JCOG trials

-Understand the methodology each trial and be able to explain their nuanced differences

-Analyze the results of the CALGB and JCOG trials and how they apply to patients today

Kelly Daus MD, Peter White MD, Eric Vallieres, MD and Brian Louie MD

https://pubmed.ncbi.nlm.nih.gov/36780674/

Altorki N, et al. Lobar or Sublobar Resection for Peripheral Stage IA Non-Small-Cell Lung Cancer. N Engl J Med. 2023 Feb 9;388(6):489-498. doi: 10.1056/NEJMoa2212083. PMID: 36780674; PMCID: PMC10036605.

https://pubmed.ncbi.nlm.nih.gov/35461558/’

Saji H, et al. West Japan Oncology Group and Japan Clinical Oncology Group. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): a multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet. 2022 Apr 23;399(10335):1607-1617. doi: 10.1016/S0140-6736(21)02333-3. PMID: 35461558.

https://pubmed.ncbi.nlm.nih.gov/37473998/

Altorki N, et al. Lobectomy, segmentectomy, or wedge resection for peripheral clinical T1aN0 non-small cell lung cancer: A post hoc analysis of CALGB 140503 (Alliance). J Thorac Cardiovasc Surg. 2023 Jul 18:S0022-5223(23)00612-8. doi: 10.1016/j.jtcvs.2023.07.008. Epub ahead of print. PMID: 37473998.

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If you liked this episode, check out our other Cardiothoracic episodes: https://behindtheknife.org/podcast-category/cardiothoracic/

Behind the Knife ABSITE 2024 – Brand new, up-to-date, high yield learning to help you DOMINATE the exam.

Don’t forget to check out our NEW ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet

Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2024 ABSITE podcast series.  Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife.  Learn more at https://www.medtronic.com/

If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.  

Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Behind the Knife ABSITE 2024 – Brand new, up-to-date, high yield learning to help you DOMINATE the exam.

Don’t forget to check out our NEW ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet

Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2024 ABSITE podcast series.  Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife.  Learn more at https://www.medtronic.com/

If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.  

Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Behind the Knife ABSITE 2024 – Brand new, up-to-date, high yield learning to help you DOMINATE the exam.

Don’t forget to check out our NEW ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet

Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2024 ABSITE podcast series.  Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife.  Learn more at https://www.medtronic.com/

If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.  

Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Behind the Knife ABSITE 2024 – Brand new, up-to-date, high yield learning to help you DOMINATE the exam.

Don’t forget to check out our NEW ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet

Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2024 ABSITE podcast series.  Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife.  Learn more at https://www.medtronic.com/

If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.  

Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Behind the Knife ABSITE 2024 – Brand new, up-to-date, high yield learning to help you DOMINATE the exam.

Don’t forget to check out our NEW ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet

Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2024 ABSITE podcast series.  Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife.  Learn more at https://www.medtronic.com/

If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.  

Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Behind the Knife ABSITE 2024 – Brand new, up-to-date, high yield learning to help you DOMINATE the exam.

Don’t forget to check out our NEW ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet

Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2024 ABSITE podcast series.  Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife.  Learn more at https://www.medtronic.com/

If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.  

Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Behind the Knife ABSITE 2024 – Brand new, up-to-date, high yield learning to help you DOMINATE the exam.

Don’t forget to check out our NEW ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet

Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2024 ABSITE podcast series.  Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife.  Learn more at https://www.medtronic.com/

If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.  

Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Behind the Knife ABSITE 2024 – Brand new, up-to-date, high yield learning to help you DOMINATE the exam.

Don’t forget to check out our NEW ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet

Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2024 ABSITE podcast series.  Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife.  Learn more at https://www.medtronic.com/

If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.  

Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Making a discovery that changes how we practice is one of the most exciting things about the fields of medicine and surgery. In this episode, join endocrine surgeons Drs. Barb Miller, John Phay, Priya Dedhia, and Surgical Oncology Fellow Dr. Samantha Ruff from The Ohio State University. Hear Dr. Phay tell the story of how parathyroid autofluorescence was discovered and the work that has gone on since that day. The group discusses several articles focusing on intraoperative adjuncts used to identify parathyroid tissue during thyroid and parathyroid surgery. 

Hosts: Barbra S. Miller, MD (Moderator), Clinical Professor of Surgery, John Phay, MD, Clinical Professor of Surgery, Priya H. Dedhia, MD, PhD, Assistant Professor of Surgery, Samantha Ruff, MD, Surgical Oncology Fellow, Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.

Twitter handles: 

Barbra Miller - @OSUEndosurgBSM

John Phay – @JohnPhayMD

Priya Dedhia – @priyaknows 

Samantha Ruff - @SamRuff_MD

Learning objectives: 

1) Understand the background of the discovery of parathyroid autofluorescence

2) Describe various intraoperative adjuncts utilized to identify parathyroid tissue

3) Compare and contrast the advantages and disadvantages of using autofluorescence versus indocyanine green for identification of parathyroid tissue  

4) Recognize the impact of use of intraoperative imaging adjuncts on postoperative hypocalcemia (short and long-term)

5) Understand the general safety issues for the parathyroid imaging techniques discussed

References:

1. Benmiloud, F., G. Godiris-Petit, R. Gras, et al., Association of Autofluorescence-Based Detection of the Parathyroid Glands During Total Thyroidectomy With Postoperative Hypocalcemia Risk: Results of the PARAFLUO Multicenter Randomized Clinical Trial. JAMA Surg, 2020. 155(2): p. 106-12 DOI: 10.1001/jamasurg.2019.4613. https://pubmed.ncbi.nlm.nih.gov/31693081/

2. Kahramangil, B. and E. Berber, Comparison of indocyanine green fluorescence and parathyroid autofluorescence imaging in the identification of parathyroid glands during thyroidectomy. Gland Surg, 2017. 6(6): p. 644-8 DOI: 10.21037/gs.2017.09.04. https://pubmed.ncbi.nlm.nih.gov/29302480/

3. Paras, C., M. Keller, L. White, et al., Near-infrared autofluorescence for the detection of parathyroid glands. J Biomed Opt, 2011. 16(6): p. 067012 DOI: 10.1117/1.3583571. https://pubmed.ncbi.nlm.nih.gov/21721833/

4. Vidal Fortuny, J., V. Belfontali, S.M. Sadowski, et al., Parathyroid gland angiography with indocyanine green fluorescence to predict parathyroid function after thyroid surgery. Br J Surg, 2016. 103(5): p. 537-43 DOI: 10.1002/bjs.10101. https://pubmed.ncbi.nlm.nih.gov/26864909/

Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

If you liked this episode, check out other Behind the Knife endocrine episodes: https://behindtheknife.org/podcast-category/endocrine/