30-Second Takeaway
- In dialysis CABG, LIMA plus veins improves 5-year survival over veins alone; multiarterial strategies show no clear benefit.
- For F/BEVAR, 30-day mortality is lower when hospitals and surgeons exceed about 9 and 7 cases annually, respectively.
- Non-anatomical lung metastasectomy offers survival comparable to anatomical resection with less morbidity, at the cost of more locoregional recurrence.
Week ending April 4, 2026
Concise evidence updates for CABG in dialysis, complex aortic repair, thoracic oncology, esophagectomy, transplant, and infection imaging
In dialysis CABG, LIMA plus veins outperforms vein-only in both sexes
Among 15,215 hemodialysis patients undergoing isolated CABG in USRDS, both men and women had better 5-year survival with LIMA+SVG vs SVG only. Adjusted 5-year survival was about 32% vs 27% in men and 31% vs 25% in women for LIMA versus vein-only grafting. LIMA grafting conferred no clear 5-year survival advantage compared with multiarterial grafting in either sex. Men had slightly better 5-year survival than women after LIMA grafting, including among hospital survivors, indicating persistent sex-based survival gaps. These data support routine LIMA use in dialysis CABG, while multiarterial grafting appears non-superior and should be individualized, especially in women.
Specific volume thresholds linked to safer fenestrated/branched aortic repair
In 8,015 Medicare patients undergoing F/BEVAR from 2016–2023, 30-day mortality was 4.4%. LOESS analyses identified ≥9 cases/year per hospital and ≥7 cases/year per surgeon as inflection points for lower 30-day mortality. Hospitals performing ≤9 annual F/BEVARs had higher mortality (adjusted OR 1.43, 95% CI 1.02–1.99), independent of case mix. Surgeons performing ≤7 annual cases also had higher mortality (adjusted OR 1.51, 95% CI 1.04–2.18). These data support concentrating F/BEVAR within programs and operators achieving at least these modest annual case volumes.
Non-anatomical pulmonary metastasectomy preserves parenchyma without sacrificing survival
This multicenter European study matched 324 anatomical to 830 non-anatomical pulmonary metastasectomies performed with curative intent. Five-year overall survival was 62%, with no significant long-term survival difference between anatomical and non-anatomical resections. Early after surgery, anatomical resection showed worse overall survival despite similar long-term outcomes. Locoregional recurrence-free survival favored anatomical resections, while any-site recurrence-free survival was similar between groups. Thirty-day morbidity was higher with anatomical resections (22.2% vs 13.7%), supporting parenchyma-sparing resections when margins and biology permit.
Segmentectomy can match lobectomy if nodal dissection is rigorous
This narrative review pooled 12 studies including over 175,000 early-stage NSCLC patients undergoing segmentectomy or lobectomy. Lobectomy showed higher overall nodal upstaging than segmentectomy (14.5% vs 6.6%), mainly via better N1 detection (13.3% vs 3.7%). Despite less N1 detection, adjusted survival for occult pN1/pN2 patients receiving adjuvant therapy was comparable between procedures. Segmentectomy achieved survival similar to lobectomy, while wedge resection had worse survival (HR 1.23). Completion lobectomy after segmentectomy showed no consistent survival benefit and appreciable morbidity, arguing for selective rather than routine use. High-quality segmentectomy requires systematic nodal dissection, adequate margins, and integrated adjuvant therapy planning.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.