Is it valuable and safe to perform reoperation for XXXX ?

@entity1 @entity1737 @entity704
UNASSIGNED: A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether it is valuable and safe to perform reoperation for @entity704 . Altogether, more than 500 papers were found using the reported search, of which 15 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, @entity1 group studied, study type, relevant outcomes and results of these papers are tabulated. This paper includes 1 level 1a study and 15 level 2b studies. The operative mortality was reported in six studies, ranging from 0 to 13.3%, and the operative morbidity in five studies, ranging from 0 to 32.1%. Most @entity1 suffering from operative mortality (5/5) and morbidity (16/19) had @entity1737 . One meta-analysis demonstrated improved rates of long-term overall survival in @entity1 with @entity704 who were treated surgically compared with those treated non-surgically. Ten studies showed better survival after surgical treatment than after non-surgical treatment with the difference being statistically significant in 4 of them. Two studies reported that the prognosis in @entity1 with complete reresection was comparable with that of @entity1 without recurrence. One study found that @entity1 with a thymus-related syndrome improved after re-resection. Another two studies revealed that debulking surgery for @entity704 was associated with poorer survival and worse outcomes than both complete resection and non-surgical therapy. From the papers identified in our search, we can conclude that reoperation can be performed with acceptable morbidity and low mortality in appropriately selected @entity1 with locally and/or regionally @entity704 . Both survival and thymus-related syndromes are improved if the recurrence is surgically resected when compared with other medical treatments. Debulking surgery should be limited to those few selected @entity1 in whom other treatment options are not available. In addition, morbidity and mortality most commonly occur in association with @entity1737 , and hence medical control of this should be optimized prior to reoperation.
