Imperial College London

Eric Lim

Faculty of MedicineNational Heart & Lung Institute

Professor of Thoracic Surgery
 
 
 
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Contact

 

+44 (0)20 7351 8591eric.lim

 
 
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Location

 

Sydney StreetRoyal Brompton Campus

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Summary

 

Publications

Publication Type
Year
to

242 results found

Fraser S, Baranowski R, Patrini D, Nandi J, Al-Sahaf M, Smelt J, Hoffman R, Santhirakumaran G, Lee M, Wali A, Dickinson H, Jadoon M, Harrison-Phipps K, King J, Pilling J, Bille A, Okiror L, Stamenkovic S, Waller D, Wilson H, Jordan S, Begum S, Buderi S, Tan C, Hunt I, Vaughan P, Jenkins M, Hayward M, Lawrence D, Beddow E, Anikin V, Mani A, Finch J, Maheswaran H, Lim E, Routledge T, Lau K, Harling Let al., 2021, Maintaining safe lung cancer surgery during the COVID-19 pandemic in a global city, EClinicalMedicine, Vol: 39, Pages: 1-8, ISSN: 2589-5370

Background: SARS-CoV-2 has challenged health service provision worldwide. This work evaluates safe surgical pathways and standard operating procedures implemented in the high volume, global city of London during the first wave of SARS-CoV-2 infection. We also assess the safety of minimally invasive surgery(MIS) for anatomical lung resection. Methods: This multicentre cohort study was conducted across all London thoracic surgical units, covering a catchment area of approximately 14.8 Million. A Pan-London Collaborative was created for data sharing and dissemination of protocols. All patients undergoing anatomical lung resection 1st March-1st June 2020 were included. Primary outcomes were SARS-CoV-2 infection, access to minimally invasive surgery, post-operative complication, length of intensive care and hospital stay (LOS), and death during follow up. Findings: 352 patients underwent anatomical lung resection with a median age of 69 (IQR: 35-86) years. Self-isolation and pre-operative screening were implemented following the UK national lockdown. Pre-operative SARS-CoV-2 swabs were performed in 63.1% and CT imaging in 54.8%. 61.7% of cases were performed minimally invasively (MIS), compared to 59.9% pre pandemic. Median LOS was 6 days with a 30-day survival of 98.3% (comparable to a median LOS of 6 days and 30-day survival of 98.4% pre-pandemic). Significant complications developed in 7.3% of patients (Clavien-Dindo Grade 3-4) and 12 there were re-admissions(3.4%). Seven patients(2.0%) were diagnosed with SARS-CoV-2 infection, two of whom died (28.5%). Interpretation: SARS-CoV-2 infection significantly increases morbidity and mortality in patients undergoing elective anatomical pulmonary resection. However, surgery can be safely undertaken via open and MIS approaches at the peak of a viral pandemic if precautionary measures are implemented. High volume surgery should continue during further viral peaks to minimise health service burden and potential harm to cancer pa

Journal article

Loizidou A, Lim E, 2021, Is Small Cell Lung Cancer a Surgical Disease at the Present Time?, THORACIC SURGERY CLINICS, Vol: 31, Pages: 317-321, ISSN: 1547-4127

Journal article

Domingo-Sabugo C, Willis-Owen SAG, Mandal A, Nastase A, Dwyer S, Brambilla C, Gálvez JH, Zhuang Q, Popat S, Eveleigh R, Munter M, Lim E, Nicholson AG, Lathrop M, Cookson WOC, Moffatt MFet al., 2021, Distinct pancreatic and neuronal Lung Carcinoid molecular subtypes revealed by integrative omic analysis

<jats:title>Summary</jats:title><jats:p>Lung Carcinoids (L-CDs) are uncommon low-grade neuroendocrine tumours that are only recently becoming characterised at the molecular level. Notably data on the molecular events that precipitate altered gene expression programmes are very limited. Here we have identified two discrete L-CD subtypes from transcriptomic and whole-genome DNA methylation data, and comprehensively defined their molecular profiles using Whole-Exome Sequencing (WES) and Single Nucleotide Polymorphism (SNP) genotyping. Subtype (Group) 1 features upregulation of neuronal markers (L-CD-NeU) and is characterised by focal spindle cell morphology, peripheral location (71%), high mutational load (<jats:italic>P</jats:italic>=3.4×10<jats:sup>−4</jats:sup>), recurrent copy number alterations and is enriched for Atypical Lung Carcinoids. Group 2 (L-CD-PanC) are centrally located and feature upregulation of pancreatic and metabolic pathway genes concordant with promoter hypomethylation of beta cell and genes related to insulin secretion (<jats:italic>P</jats:italic>&lt;1×10<jats:sup>−6</jats:sup>). L-CD-NeU tumours harbour mutations in chromatin remodelling and in SWI/SNF complex members, while L-CD-PanC tumours show aflatoxin mutational signatures and significant DNA methylation loss genome-wide, particularly enriched in repetitive elements (<jats:italic>P</jats:italic>&lt;2.2 × 10<jats:sup>−16</jats:sup>). Our findings provide novel insights into the distinct mechanisms of epigenetic dysregulation in these lung malignancies, potentially opening new avenues for biomarker selection and treatment in L-CD patients.</jats:p>

Journal article

Willis-Owen S, Domingo Sabugo C, Starren E, Liang L, Freidin M, Arseneault M, Zhang Y, Kiong Lu S, Popat S, Lim E, Nicholson A, Riazalhosseini Y, Lathrop M, Cookson W, Moffatt Met al., 2021, Y disruption, autosomal hypomethylation and poor male lung cancer survival, Scientific Reports, Vol: 11, ISSN: 2045-2322

Lung cancer is the most frequent cause of cancer death worldwide. It affects more men than women, and men generally have worse survival outcomes. We compared gene co-expression networks in affected and unaffected lung tissue from 126 consecutive patients with Stage IA–IV lung cancer undergoing surgery with curative intent. We observed marked degradation of a sex-associated transcription network in tumour tissue. This disturbance, detected in 27.7% of male tumours in the discovery dataset and 27.3% of male tumours in a further 123-sample replication dataset, was coincident with partial losses of the Y chromosome and extensive autosomal DNA hypomethylation. Central to this network was the epigenetic modifier and regulator of sexually dimorphic gene expression, KDM5D. After accounting for prognostic and epidemiological covariates including stage and histology, male patients with tumour KDM5D deficiency showed a significantly increased risk of death (Hazard Ratio [HR] 3.80, 95% CI 1.40–10.3, P = 0.009). KDM5D deficiency was confirmed as a negative prognostic indicator in a further 1100 male lung tumours (HR 1.67, 95% CI 1.4–2.0, P = 1.2 × 10–10). Our findings identify tumour deficiency of KDM5D as a prognostic marker and credible mechanism underlying sex disparity in lung cancer.

Journal article

Baudin E, Caplin M, Garcia-Carbonero R, Fazio N, Ferolla P, Filosso PL, Frilling A, de Herder WW, Hoersch D, Knigge U, Korse CM, Lim E, Lombard-Bohas C, Pavel M, Scoazec JY, Sundin A, Berruti Aet al., 2021, Lung and thymic carcinoids: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up, ANNALS OF ONCOLOGY, Vol: 32, Pages: 439-451, ISSN: 0923-7534

Journal article

Domingo-Sabugo C, Starren E, Mandal A, Nastase A, Hoang L, Edwards M, Morris-Rosendahl D, Lim E, Nicholson AG, Lathrop M, Cookson W, Moffatt Met al., 2020, Distinct Landscapes of Genomic Alterations between Lung Carcinoids and Non-Small Cell Lung Cancers, Publisher: SPRINGERNATURE, Pages: 528-528, ISSN: 1018-4813

Conference paper

Lim E, 2020, What Is the Optimum Lymph Node Management in Patients Undergoing Surgery for Lung Cancer?, JOURNAL OF THORACIC ONCOLOGY, Vol: 15, Pages: 1565-1566, ISSN: 1556-0864

Journal article

Bartlett EC, Kemp S, Ridge CA, Desai SR, Mirsadraee S, Morjaria JB, Shah PL, Popat S, Nicholson AG, Rice AJ, Jordan S, Begum S, Mani A, Derbyshire J, Morris K, Chen M, Peacock C, Addis J, Martins M, Kaye SB, Padley SPG, Devaraj A, McDonald F, Robertus JL, Lim E, Barnett J, Finch J, Dalal P, Yousaf N, Jamali A, Ivashniova N, Phillips C, Newsom-Davies T, Lee R, Vaghani P, Whiteside S, Vaughan-Smith Set al., 2020, Baseline Results of the West London lung cancer screening pilot study - Impact of mobile scanners and dual risk model utilisation, LUNG CANCER, Vol: 148, Pages: 12-19, ISSN: 0169-5002

Journal article

Zhang YZ, Brambilla C, Molyneaux PL, Rice A, Robertus JL, Jordan S, Lim E, Lang-Lazdunski L, Begum S, Dusmet M, Anikin V, Beddow E, Finch J, Asadi N, Popat S, Le Quesne J, Husain AN, Cookson WO, Moffatt MF, Nicholson AGet al., 2020, Presence of pleomorphic features but not growth patterns improves prognostic stratification of epithelioid malignant pleural mesothelioma by 2-tier nuclear grade, Histopathology, Vol: 77, Pages: 423-436, ISSN: 0309-0167

AIMS: Nuclear grade has been recently validated as a powerful prognostic tool in epithelioid malignant pleural mesothelioma (E-MPM). In other studies histological parameters including pleomorphic features and growth patterns were also shown to exert prognostic impact. The primary aims of our study are (1) externally validate the prognostic role of pleomorphic features in E-MPM and (2) investigate if evaluating growth pattern in addition to 2-tier nuclear grade improves prognostication. METHODS AND RESULTS: 614 consecutive cases of E-MPM from our institution over a period of 15 years were retrospectively reviewed, of which 51 showed pleomorphic features. E-MPM with pleomorphic features showed significantly worse overall survival compared those without (5.4 months vs 14.7 months). Tumours with predominantly micropapillary pattern showed the worst survival (6.2 months) followed by solid (10.5 months), microcystic (15.3 months), discohesive (16.1 months), trabecular (17.6 months) and tubulo-papillary (18.6 months). Sub-classification of growth patterns into high grade (solid, micropapillary) and low grade (all others) led to good separation of overall survival (10.5 months vs. 18.0 months) but did not predict survival independent of 2-tier nuclear grade. A composite score comprised of growth pattern and 2-tier nuclear grade did not improve prognostication compared with nuclear grade alone. Intra-tumoural heterogeneity in growth patterns is ubiquitous. CONCLUSIONS: Our findings support the incorporation of E-MPM with pleomorphic features in the epithelioid subtype as a highly aggressive variant distinct from 2-tier nuclear grade. E-MPM demonstrates extensive heterogeneity in growth pattern but its evaluation does not offer additional prognostic utility to 2-tier nuclear grade.

Journal article

Lim E, Darlison L, Edwards J, Elliott D, Fennell DA, Popat S, Rintoul RC, Waller D, Ali C, Bille A, Fuller L, Ionescu A, Keni M, Kirk A, Koh P, Lau K, Mansy T, Maskell NA, Milton R, Muthukumar D, Pope T, Roy A, Shah R, Shamash J, Tasigiannopoulos Z, Taylor P, Treece S, Ashton K, Harris R, Joyce K, Warnes B, Mills N, Stokes EA, Rogers C, MARS 2 Trialistset al., 2020, Mesothelioma and Radical Surgery 2 (MARS 2): protocol for a multicentre randomised trial comparing (extended) pleurectomy decortication versus no (extended) pleurectomy decortication for patients with malignant pleural mesothelioma., BMJ Open, Vol: 10, Pages: 1-9, ISSN: 2044-6055

INTRODUCTION: Mesothelioma remains a lethal cancer. To date, systemic therapy with pemetrexed and a platinum drug remains the only licensed standard of care. As the median survival for patients with mesothelioma is 12.1 months, surgery is an important consideration to improve survival and/or quality of life. Currently, only two surgical trials have been performed which found that neither extensive (extra-pleural pneumonectomy) or limited (partial pleurectomy) surgery improved survival (although there was some evidence of improved quality of life). Therefore, clinicians are now looking to evaluate pleurectomy decortication, the only radical treatment option left. METHODS AND ANALYSIS: The MARS 2 study is a UK multicentre open parallel group randomised controlled trial comparing the effectiveness and cost-effectiveness of surgery-(extended) pleurectomy decortication-versus no surgery for the treatment of pleural mesothelioma. The study will test the hypothesis that surgery and chemotherapy is superior to chemotherapy alone with respect to overall survival. Secondary outcomes include health-related quality of life, progression-free survival, measures of safety (adverse events) and resource use to 2 years. The QuinteT Recruitment Intervention is integrated into the trial to optimise recruitment. ETHICS AND DISSEMINATION: Research ethics approval was granted by London - Camberwell St. Giles Research Ethics Committee (reference 13/LO/1481) on 7 November 2013. We will submit the results for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBERS: ISRCTN-ISRCTN44351742 and ClinicalTrials.gov-NCT02040272.

Journal article

Edwards JG, Chansky K, Van Schil P, Nicholson AG, Boubia S, Brambilla E, Donington J, Galateau-Salle F, Hoffmann H, Infante M, Marino M, Marom EM, Nakajima J, Ostrowski M, Travis WD, Tsao M-S, Yatabe Y, Giroux DJ, Shemanski L, Crowley J, Krasnik M, Asamura H, Rami-Porta Ret al., 2020, The IASLC Lung Cancer Staging Project: Analysis of Resection Margin Status and Proposals for Residual Tumor Descriptors for Non-Small Cell Lung Cancer, JOURNAL OF THEORETICAL BIOLOGY, Vol: 492, Pages: 344-359, ISSN: 0022-5193

Journal article

Lim E, Sousa I, Shah PL, Diggle P, Goldstraw Pet al., 2020, Lung Volume Reduction Surgery: Reinterpreted With Longitudinal Data Analyses Methodology, ANNALS OF THORACIC SURGERY, Vol: 109, Pages: 1496-1501, ISSN: 0003-4975

Journal article

Zhang YZ, Brambilla C, Molyneaux PL, Rice A, Robertus JL, Jordan S, Lim E, Lang-Lazdunski L, Begum S, Dusmet M, Anikin V, Beddow E, Finch J, Asadi N, Popat S, Cookson WOC, Moffatt MF, Nicholson AGet al., 2020, Utility of nuclear grading system in epithelioid malignant pleural mesothelioma in biopsy-heavy setting, The American Journal of Surgical Pathology, Vol: 44, Pages: 347-356, ISSN: 0147-5185

Nuclear grading systems for epithelioid malignant pleural mesothelioma (MPM) have been proposed but it remains uncertain if they could be applied in a biopsy-heavy setting. Using the proposed system, we conducted an independent, external validation study using 563 consecutive cases of epithelioid MPM diagnosed at our institution between 2003 and 2017, of which 87% of patients underwent biopsies only. The median number of sites sampled was 1, with a median maximum tissue dimension of 17 mm (biopsy) and 150 mm (resection). The median overall survival (OS) was 14.7 months. The frequencies of grade I, II, and III tumors were 31% (132/563), 52% (292/563), and 17% (94/563). Grade I tumors were associated with the most favorable median OS (24.7 mo) followed by grades II (12.7 mo) and III (7.2 mo). The 2-tier nuclear grade separated tumors into low grade (19.3 mo) and high grade (8.9 mo). In multivariate analysis, 3-tier nuclear grade, 2-tier nuclear grade, and mitosis-necrosis score predicted OS independent of age, procedural type, solid-predominant growth pattern, necrosis, and atypical mitosis (all P<0.001 except 2-tier nuclear grade, P=0.001). In the scenario of a single- site biopsy with tissue dimension ≤10 mm, none but age (P=0.002) were independently predictive. Our data also suggested sampling 3 sites or a maximum tissue dimension of at least 20 mm from a single site is optimal for nuclear grade assessment. In conclusion our study confirmed the utility of nuclear grade in epithelioid MPM using a biopsy-heavy cohort provided the tissue sample met minimum dimensional criteria.

Journal article

Zang R, Shi J-F, Lerut TE, Wang L, Liu C-C, Brunelli A, Petersen RH, Ng CSH, Lim E, Gao Set al., 2020, Ten-Year Trends of Clinicopathologic Features and Surgical Treatment of Lung Cancer in China, ANNALS OF THORACIC SURGERY, Vol: 109, Pages: 389-395, ISSN: 0003-4975

Journal article

Leung M, Freidin MB, Freydina D, Von Crease C, De Sousa P, Barbosa MT, Nicholson AG, Lim Eet al., 2020, Blood-based circulating tumor DNA mutations as a diagnostic and prognostic biomarker for lung cancer, CANCER, Vol: 126, Pages: 1804-1809, ISSN: 0008-543X

Journal article

Lim E, Begum S, Batchelor T, Krishnadas R, Shackcloth M, Dunning J, Paul I, Anikin V, McGonigle N, Naidu B, Fallouh H, Belcher E, Stavroulias D, Loubani M, Qadri S, Zamvar V, Mckeon H, Harris R, Blazeby JM, Nicholson AG, Rogers CAet al., 2019, OPTIMUM DIAGNOSTIC PATHWAY AND PATHOLOGIC CONFIRMATION RATE OF EARLY STAGE LUNG CANCER: RESULTS FROM VIOLET, Winter Meeting of the British-Thoracic-Society, Publisher: BMJ PUBLISHING GROUP, Pages: A15-A15, ISSN: 0040-6376

Conference paper

Lim E, Batchelor T, Dunning J, Shackcloth M, Anikin V, Naidu B, Belcher E, Loubani M, Zamvar V, Brush T, Dabner L, Harris R, Phillips D, Beard C, Mckeon H, Paramasivan S, Elliott D, Rojas AR, Stokes E, Wordsworth S, Blazeby J, Rogers C, Trialists TVet al., 2019, In Hospital Clinical Efficacy, Safety and Oncologic Outcomes from VIOLET: A UK Multi-Centre RCT of VATS Versus Open Lobectomy for Lung Cancer, Publisher: ELSEVIER SCIENCE INC, Pages: S6-S6, ISSN: 1556-0864

Conference paper

De Sousa P, Mansour F, Barbosa M, Booth S, Klein H, Mani A, Nizami M, Von Crease C, Ladas G, Finch J, Asadi N, Beddow E, Mcgonigle N, Anikin V, Begum S, Jordan S, Montero-Fernandez A, Robertus J, Rice A, Nicholson A, Lim Eet al., 2019, An Audit on IASLC Compliance of Lymph Nodes Dissection and Impact on Survival After Surgery for Non-Small Cell Lung Cancer, Publisher: ELSEVIER SCIENCE INC, Pages: S550-S550, ISSN: 1556-0864

Conference paper

De Sousa P, Gallina F, Tamburrini A, Nizami M, Igwe C, Amer K, Lim E, Ambrogi Vet al., 2019, Neutrophil to Lymphocyte Ratio Is an Independent Prognostic Predictor in Thymoma, Publisher: ELSEVIER SCIENCE INC, Pages: S332-S332, ISSN: 1556-0864

Conference paper

Domingo-Sabugo C, Starren E, Mandal A, Nastase A, Hoang L, Edwards M, Morris-Rosendahl D, Lim E, Nicholson A, Lathrop M, Cookson W, Moffatt Met al., 2019, Comprehensive Molecular Profiling and Comparison of Common and Rarer Subtypes of Lung Cancer, Publisher: ELSEVIER SCIENCE INC, Pages: S686-S686, ISSN: 1556-0864

Conference paper

Lim E, Batchelor T, Shackcloth M, Dunning J, McGonigle N, Brush T, Dabner L, Harris R, Mckeon HE, Paramasivan S, Elliott D, Stokes EA, Wordsworth S, Blazeby J, Rogers CA, Lim E, Rogers C, Brush T, Dabner L, Phillips D, Mckeon H, Beard C, Harris R, Elliott D, Paramasivan S, Rojas AR, Wordsworth S, Stokes E, Blazeby J, Nicholson AG, Lim E, Begum S, Jordan S, De Sousa P, Barbosa MT, Batchelor T, Internullo E, Krishnadas R, Casali G, West D, Bobruk K, O'Donovan C, Lowe A, Nicklin J, Heron E, Chambers J, Houlihan B, Beacham L, Hudson H, Tucker K, Farmery T, Davis D, Shackcloth M, Asante-Siaw J, Love S, Feeney S, Murphy L, Rosas AD, Young A, Cook J, Dunning J, Paul I, Latif H, Jacobs C, Chilvers A, Stephenson E, Cain M, Iqbal N, Anikin V, McGonigle N, Prendergast C, Jones L, Rogers P, Naidu B, Fallouh H, Hernandez L, Kalkat M, Steyn R, Oswald N, Kerr A, Ferris C, Webb J, Taylor J, Bancroft H, Kadiri S, Jalal Z, Belcher E, Stavroulias D, Di Chiara F, Saunders K, Havinden-Williams M, Ainsworth M, Loubani M, Qadri S, Dobbs K, Atkin P, Fellowes D, Cox L, Zamvar V, Marshall L, Strachan F, Stewart S, Langley R, Adamson J, Hunt I, Licht P, Nair A, Hall C, Cowen M, Dutton SJ, Kirk A, Kerr K, Shah R, Qureshi N, Treasure Tet al., 2019, Study protocol for VIdeo assisted thoracoscopic lobectomy versus conventional Open LobEcTomy for lung cancer, a UK multicentre randomised controlled trial with an internal pilot (the VIOLET study), BMJ OPEN, Vol: 9, ISSN: 2044-6055

Journal article

Rosenthal R, Cadieux EL, Salgado R, Al Bakir M, Moore DA, Hiley CT, Lund T, Tanic M, Reading JL, Joshi K, Henry JY, Ghorani E, Wilson GA, Birkbak NJ, Jamal-Hanjani M, Veeriah S, Szallasi Z, Loi S, Hellmann MD, Feber A, Chain B, Herrero J, Quezada SA, Demeulemeester J, Van Loo P, Beck S, McGranahan N, Swanton C, Swanton C, Jamal-Hanjani M, Veeriah S, Czyzewska-Khan J, Johnson D, Laycock J, Rosenthal R, Gorman P, Hynds RE, Wilson G, Birkbak NJ, Watkins TBK, McGranahan N, Escudero M, Stewart A, Van Loo P, Rowan A, Hiley C, Abbosh C, Goldman J, Stone RK, Denner T, Ward S, Nye E, Joshi K, Ben Aissa A, Wong YNS, Georgiou A, Quezada S, Hartley JA, Lowe HL, Herrero J, Lawrence D, Hayward M, Panagiotopoulos N, Falzon M, Borg E, Marafioti T, Janes SM, Forster M, Ahmad T, Lee SM, Papadatos-Pastos D, Carnell D, Mendes R, George J, Ahmed A, Taylor M, Choudhary J, Summers Y, Califano R, Taylor P, Shah R, Krysiak P, Rammohan K, Fontaine E, Booton R, Evison M, Crosbie P, Moss S, Joseph L, Bishop P, Quinn AM, Doran H, Leek A, Harrison P, Moore K, Waddington R, Novasio J, Blackhall F, Rogan J, Smith E, Dive C, Tugwood J, Brady G, Rothwell DG, Pierce J, Gulati S, Naidu B, Langman G, Trotter S, Bancroft H, Kerr A, Kadiri S, Middleton G, Djearaman M, Fennell D, Shaw JA, Le Quesne J, Moore DA, Nakas A, Rathinam S, Monteiro W, Marshall H, Nelson L, Riley J, Primrose L, Martinson L, Anand G, Khan S, Nicolson M, Kerr K, Palmer S, Remmen H, Miller J, Buchan K, Chetty M, Gomersall L, Lester J, Morgan F, Adams H, Davies H, Kornaszewska M, Attanoos R, Lock S, MacKenzie M, Wilcox M, Bell H, Hackshaw A, Ngai Y, Smith S, Gower N, Ottensmeier C, Chee S, Johnson B, Alzetani A, Shaw E, Lim E, De Sousa P, Barbosa MT, Bowman A, Jordan S, Rice A, Raubenheimer H, Bhayani H, Hamilton M, Mensah N, Ambrose L, Devaraj A, Chavan H, Nicholson AG, Lau K, Sheaff M, Schmid P, Conibear J, Ezhil V, Prakash V, Russell P, Light T, Horey T, Danson S, Bury J, Edwards J, Hill J, Matthews S, Kitsanta Y, Suvarna K, Fisheret al., 2019, Neoantigen-directed immune escape in lung cancer evolution, NATURE, Vol: 567, Pages: 479-+, ISSN: 0028-0836

Journal article

Filosso PL, Guerrera F, Falco NR, Thomas P, Garcia Yuste M, Rocco G, Welter S, Moreno Casado P, Rendina EA, Venuta F, Ampollini L, Nosotti M, Raveglia F, Rena O, Stella F, Larocca V, Ardissone F, Brunelli A, Margaritora S, Travis WD, Sagan D, Sarkaria I, Evangelista A, ESTS NETs-WG steering committeeet al., 2019, Anatomical resections are superior to wedge resections for overall survival in patients with Stage 1 typical carcinoids., Eur J Cardiothorac Surg, Vol: 55, Pages: 273-279

OBJECTIVES: Typical carcinoids (TCs) are rare, slow-growing neoplasms, usually characterized by satisfactory surgical outcomes. Due to the rarity of TCs, international guidelines for the management of particular clinical presentations currently do not exist. In particular, non-anatomical resections (wedges) are sometimes advocated for Stage 1 TCs because of their indolent behaviour. The aim of this paper was to evaluate the most effective type of surgery for Stage 1 TCs, using the European Society of Thoracic Surgeons retrospective database of the Neuroendocrine Tumors of the Lung Working Group. METHODS: We analysed the effect of surgical procedure on the survival of patients with Stage 1 TCs. Overall survival (OS) was calculated from the date of intervention. The cumulative incidence of cause-specific death (tumour- and non-tumour-related) was also estimated. The impact of the surgical procedure (i.e. lobectomy vs segmentectomy vs wedge resection) on survival was investigated using the Cox model with shared frailty (for OS, accounting for the within-centre correlation) and the Fine and Gray model (for cause-specific mortality) using the approach based on the multinomial propensity score. Effects were estimated including in the model the logit-transformed propensity scores of segmentectomy and wedge resection as covariates. RESULTS: A total of 876 patients with Stage 1 TCs (569 women, 65%) were included in this study. The median age was 60 years (interquartile range 47-69). At the last follow-up, 66 patients had died: The 5-year OS rate was 94.3% [95% confidence interval (CI) 92.2-95.9]. The 5-year cumulative incidences of tumour- and non-tumour-related deaths were 2.4% (95% CI 1.4-3.9) and 3.9% (95% CI 2.5-5.6%), respectively. The analysis performed using the multinomial propensity score approach confirmed the significantly worse survival of patients treated with a wedge resection compared to those treated with a lobectomy (hazard ratio 2.01, 95% CI 1.09-3.6

Journal article

De Sousa P, Mansour F, Barbosa M, Booth S, Klein H, Mani A, Nizami M, Von Crease C, Kyparissopoulos D, Townsend E, Ladas G, Redmond K, Anastasiou N, Finch J, Kuppuswamy MK, Asadi N, Beddow E, Mcgonigle N, Anikin V, Begum S, Dusmet M, Jordan S, Montero-Fernandez A, Robertus JL, Rice A, Nicholson AG, Lim Eet al., 2019, An audit on IASLC compliance of lymph nodes dissection and impact on survival after surgery for non-small cell lung cancer, Publisher: ELSEVIER IRELAND LTD, Pages: S66-S66, ISSN: 0169-5002

Conference paper

Baudin E, Hayes A, Scoazec J-Y, Filosso PL, Lim E, Kaltsas G, Frilling A, Chen J, Kos-Kudla B, Gorbounova V, Wiedenmann B, Nieveen van Dijkum E, Cwikla J, Falkerby J, Valle JW, Kulke MH, Caplin Met al., 2019, Unmet medical needs in pulmonary neuroendocrine (carcinoid) neoplasms, Neuroendocrinology, Vol: 108, Pages: 7-17, ISSN: 0028-3835

Pulmonary carcinoids (PCs) display the common features of all well-differentiated neuroendocrine neoplasms (NEN) and are classified as low- and intermediate-grade malignant tumours (i.e. typical (TC) and atypical carcinoid (AC), respectively). There is a paucity of randomised studies dedicated to advanced PCs and management principles are drawn from the larger gastroenteropancreatic (GEP) NEN experience. There is growing evidence that NEN anatomic subgroups have different biology and different responses to treatment and, therefore, should be investigated as separate entities in clinical trials. In this review, we discuss the existing evidence and limitations of tumour classification, diagnostics and staging, prognostication and treatment in the setting of PC with focus on unmet medical needs and directions for the future.

Journal article

Asemota N, Rouhani MJ, Harling L, Raubenheimer H, De Souza AC, Lim Eet al., 2018, Minimally invasive bilateral lung resections and CABG through 5 ports, Case Reports in Surgery, Vol: 2018, Pages: 1-3, ISSN: 2090-6900

Minimal access surgery is increasingly popular to reduce postoperative morbidity and enhance recovery. We present a case of a patient who underwent bilateral minimally invasive thoracic and cardiac surgery. An 81-year-old woman was diagnosed with T1aN0M0 left upper lobe small-cell lung cancer and underwent single-port left video-assisted thoracoscopic surgery (VATS) upper lobectomy in 2016. She developed a contralateral right lower lobe nodule and underwent a single-port right VATS wedge resection of the lower lobe nodule, subsequently confirmed as necrotising granulomatous inflammation with acid-fast bacilli, consistent with previous tuberculosis (TB) infection. On postoperative day 1, she had an episode of self-reverting ventricular tachycardia and bradycardia. Subsequent myocardial perfusion scan and coronary angiogram showed significant LV dysfunction and severe coronary artery disease with a left main stem (LMS) lesion. After agreement at MDT, an Endo-ACAB (endoscopic atraumatic coronary artery bypass grafting) was performed, via 3 ports, with the left internal mammary artery anastomosed to left anterior descending artery. She recovered well postoperatively and was discharged. Multiple sequential minimally invasive procedures are now routine and can be performed safely in patients with a complex combination of pathologies. In this case, bilateral single-port (anatomic and nonanatomic) lung resections were undertaken followed by coronary revascularisation with a total of 5 minimal access ports.

Journal article

Gilham C, Rake C, Hodgson J, Darnton A, Burdett G, Wild JP, Newton M, Nicholson AG, Davidson L, Shires M, Treasure T, Peto J, Duncan A, Dusmet M, Edwards JG, Lim E, Milton R, Morgan I, O'Keefe P, Power D, Rajesh PB, Rathinam S, Rassl DM, Routledge T, Shackcloth M, De Soyza Aet al., 2018, Past and current asbestos exposure and future mesothelioma risks in Britain: The Inhaled Particles Study (TIPS), International Journal of Epidemiology, Vol: 47, Pages: 1745-1756, ISSN: 0300-5771

BackgroundOccupational and environmental airborne asbestos concentrations are too low and variable for lifetime exposures to be estimated reliably, and building workers and occupants may suffer higher exposure when asbestos in older buildings is disturbed or removed. Mesothelioma risks from current asbestos exposures are therefore not known.MethodsWe interviewed and measured asbestos levels in lung samples from 257 patients treated for pneumothorax and 262 with resected lung cancer, recruited in England and Wales. Average lung burdens in British birth cohorts from 1940 to 1992 were estimated for asbestos-exposed workers and the general population.ResultsRegression analysis of British mesothelioma death rates and average lung burdens in birth cohorts born before 1965 suggests a lifetime mesothelioma risk of approximately 0.01% per fibre/mg of amphiboles in the lung. In those born since 1965, the average lung burden is ∼1 fibre/mg among those with no occupational exposure.ConclusionsThe average lifetime mesothelioma risk caused by recent environmental asbestos exposure in Britain will be about 1 in 10 000. The risk is an order of magnitude higher in a subgroup of exposed workers and probably in occupants in the most contaminated buildings. Further data are needed to discover whether asbestos still present in buildings, particularly schools, is a persistent or decreasing hazard to workers who disturb it and to the general population, and whether environmental exposure occurs predominantly in childhood or after beginning work. Similar studies are needed in other countries to estimate continuing environmental and occupational mesothelioma hazards worldwide, including the contribution from chrysotile.

Journal article

Cao C, Frick AE, Ilonen I, McElnay P, Guerrera F, Tian DH, Lim E, Rocco Get al., 2018, European questionnaire on the clinical use of video-assisted thoracoscopic surgery., Interact Cardiovasc Thorac Surg, Vol: 27, Pages: 379-383

OBJECTIVES: Video-assisted thoracoscopic surgery (VATS) has emerged as a safe and efficacious alternative approach to conventional thoracotomy for selected patients with non-small-cell lung cancer. The aim of the present study was to assess the current clinical practice of VATS among the European Society of Thoracic Surgeons (ESTS) members. METHODS: A standardized questionnaire was sent to thoracic surgeons on the ESTS mailing list, with collection of data on demographics, use of multiportal or uniportal VATS, institutional experience with VATS procedures and proportion of operations performed by different approaches. Analysis was performed using SPSS statistical software. RESULTS: Complete questionnaire results were collected from 100 unique institutions in 31 countries, representing data on the clinical practice of 461 board-certified thoracic surgeons. Three hundred and twenty-four of the 461 (70%) surgeons claimed to perform anatomical VATS resections, with a total estimated caseload of 9519 resections per year. Two hundred and thirty-one (50%) surgeons reported to have performed lobectomies primarily through the VATS approach. The case volume was significantly correlated to the number (P = 0.019) and proportion (P = 0.001) of surgeons who performed VATS anatomical resections. Overall, 47% of the centres performing anatomical VATS resections reported some use of uniportal approach. There was no association between the number of thoracic surgeons within an institution and the likelihood of performing uniportal VATS lobectomy. CONCLUSIONS: Compared to previous surveys, results of the present European study suggested that there is a strong trend favouring VATS for a range of thoracic procedures in the current clinical setting. However, the use of uniportal VATS is still not yet widespread. The evolving adoption of VATS in Europe should be further assessed with regard to clinical outcomes in the form of large standardized registries.

Journal article

Giroux DJ, Van Schil P, Asamura H, Rami-Porta R, Chansky K, Crowley JJ, Rusch VW, Kernstine Ket al., 2018, The IASLC Lung Cancer Staging Project: A Renewed Call to Participation, JOURNAL OF THORACIC ONCOLOGY, Vol: 13, Pages: 801-809, ISSN: 1556-0864

Journal article

Proli C, De Sousa P, Jordan S, Anikin V, Devaraj A, Love SM, Shackcloth M, Kostoulas N, Papagiannopoulos K, Haqzad Y, Loubani M, Sellitri F, Granato F, Bush A, Marchbank A, Iyer S, Scarci M, Lim E, UK Thoracic Surgery Research Collaborativeet al., 2018, A diagnostic cohort study on the accuracy of 18-fluorodeoxyglucose (18FDG) positron emission tomography (PET)-CT for evaluation of malignancy in anterior mediastinal lesions: the DECiMaL study., BMJ Open, Vol: 8, ISSN: 2044-6055

OBJECTIVES: The aim of this study is to collate multi-institutional data to determine the value by defining the diagnostic performance of fluorodeoxyglucose positron emission tomography (FDG PET)/CT for malignancy in patients undergoing surgery with an anterior mediastinal mass in order to ascertain the clinical utility of PET/CT to differentiate malignant from benign aetiologies in patients presenting with an anterior mediastinal mass SETTING: DECiMaL Study is a multicentre, retrospective, collaborative cohort study in seven UK surgical sites. PARTICIPANTS: Between January 2002 and June 2015, a total of 134 patients were submitted with a mean age (SD) of 55 years (16) of which 69 (51%) were men. We included all patients undergoing surgery who presented with an anterior mediastinal mass and underwent PET/CT. PET/CT was considered positive for any reported avidity as stated in the official report and the reference was the resected specimen reported by histopathology using WHO criteria. PRIMARY AND SECONDARY OUTCOME MEASURES: Sensitivity, specificity, positive and negative predicted values of [18F]-FDG PET in determining malignant aetiology for an anterior mediastinal mass. RESULTS: The sensitivity and specificity of PET/CT to correctly classify malignant disease were 83% (95% CI 74 to 89) and 58% (95% CI 37 to 78). The positive and negative predictive values were 90% (95% CI 83% to 95%) and 42% (95% CI 26% to 61%). CONCLUSIONS: The results of our study suggest reasonable sensitivity but no specificity implying that a negative PET/CT is useful to rule out the diagnosis of malignant disease whereas a positive result has no value in the discrimination between malignant and benign diseases of the anterior mediastinum.

Journal article

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