New or enlarging hiatal hernias after thoracic surgery for early lung cancer

Initiative for Early Lung Cancer Research on Treatment and International Early Lung Cancer Action Program Investigators

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2 Scopus citations


Objective: The study objective was to determine the relationship between lung resection and the development of postoperative hiatal hernia. Methods: Preoperative and postoperative computed tomography imaging from 373 patients from the International Early Lung Cancer Action Program and the Initiative for Early Lung Cancer Research on Treatment were compared at a median of 31.1 months of follow-up after resection of clinical early-stage non–small cell lung cancer. Incidence of new hiatal hernia or changes to preexisting hernias were recorded and evaluated by patient demographics, surgical approach, extent of resection, and resection site. Results: New hiatal hernias were seen in 9.6% of patients after lung resection (5.6% after wedge or segmentectomy and 12.4% after lobectomy; P = .047). The median size of new hernias was 21 mm, and the most commonly associated resection site was the left lower lobe (24.2%; P = .04). In patients with preexisting hernias, 53.5% demonstrated a small but significant increase in size from 21 to 22 mm (P < .0001). All hernias persisted through the latest postoperative computed tomography scan. When 110 surgical patients without preexisting hernia were matched by sex, age, and smoking to nonoperative controls, the incidence of new hernia at follow-up was significantly higher among those who underwent surgery (17.3% vs 2.7%, P = .0003). Conclusions: Both open and minimally invasive lung resection for clinical early-stage lung cancer are associated with new or enlarging postoperative hiatal hernia, especially after resections involving the left lower lobe.

Original languageAmerican English
Pages (from-to)415-423
Number of pages9
JournalJTCVS Open
StatePublished - Jun 2022

Bibliographical note

Funding Information:
This study was sponsored in part by the Simons Foundation. Number and date of IRB approval: I-ELCAP: Western IRB #0325, February 5, 2021. IELCART: Mount Sinai IRB HS #:15-01021, January 25, 2021.This effort was made possible by generous grants from the Simons Foundation International, Ltd. IELCART Investigators, Icahn School of Medicine, New York, NY: Raja Flores, MD, Andrew Kaufman, MD, Dong-Seok Lee, MD, Daniel Nicastri, MD, Andrea Wolf, MD, Kimberly Song, MD, Kenneth Rosenzweig, MD, Jorge Gomez, MD, Mary Beth Beasley, MD, Maureen Zakowski, MD, Michael Chung, MD, David F. Yankelevitz, MD, Claudia I. Henschke, PhD, MD, Emanuela Taioli, MD, PhD, Rebecca Schwartz, MD, Huiwen Chan, Jeffrey Zhu, Sydney Kantor, Shana Adler, Mount Sinai West, New York, NY: Daniel Nicastri, MD, Wissam Raad, MD, Pathology: Zrzu Buyuk, MD, Adie Friedman, MD, Ronald Dreifuss, MD, Stacey Verzosa, MD, Mariya Yakubox, NP, Karina Aloferdova, NP, Patricia Stacey, Simone De Nobrega, Jeffrey Zhu, Sydney Kantor, Shana Adler, Mount Sinai Brooklyn, Brooklyn, NY: Ardeshir Hakami, MD, Shana Adler, Jeffrey Zhu, New York University Medical Center, New York, NY: Harvey Pass, MD, Berne Crawford, MD, Jessica Donnington, MD, Benjamin Cooper, MD, Andre Moreirea, MD, Audrey Sorensen, RN, State University of New York, Syracuse, NY: Leslie Kohman, MD, Robert Dunton, MD, Jason Wallen, MD, Christopher Curtiss, MD, Ernest Scalzetti, MD, Linda Ellinwood, RN, Vassar Brothers, Poughkeepsie, NY: Clifford P. Connery, MD, Emilo Torres, MD, Dan Cruzer, MD, Bruce Gendron, MD, Sonya Alyea, NP, Daniel Lackaye, Lauren Studer, IELCART Coordinating Center: PIs: Raja Flores, MD, Claudia Henschke, PhD, MD, Co-PIs: Emanuela Taioli, MD, PhD, David Yankelevitz, MD, Investigators: Rebecca Schwartz, PhD, Betsy Becker, PhD, Artit Jirapatnakul, PhD, Rowena Yip, MPH, Nan You MS, Huiwen Chan, MPH, MBA, I-ELCAP Investigators, Mount Sinai School of Medicine, New York, NY: Claudia I. Henschke, Principal Investigator, David F. Yankelevitz, Rowena Yip, Artit Jirapatnakul, Raja Flores, Andrea Wolf; Weill Cornell Medical College: Daniel M. Libby, James P. Smith, Mark Pasmantier; Cornell University: A. P. Reeves; CBNS, City University of New York at Queens College, Queens, NY; Steven Markowitz, Albert Miller; Fundacion Instituto Valenciano de Oncologia, Valencia, Spain: Jose Cervera Deval; University of Toronto, Princess Margaret Hospital, Toronto, Canada: Heidi Roberts, Demetris Patsios; Azumi General Hospital, Nagano, Japan: Shusuke Sone, Takaomi Hanaoka; Clinica Universitaria de Navarra, Pamplona, Spain: Javier Zulueta, Juan P. de-Torres, Maria D. Lozano; Swedish Medical Center, Seattle, Wash: Ralph Aye, Kristin Manning; Christiana Care, Helen F. Graham Cancer Center, Newark, Del: Thomas Bauer; National Cancer Institute Regina Elena, Rome, Italy: Stefano Canitano, Salvatore Giunta; St Agnes Cancer Center, Baltimore, Md: Enser Cole; LungenZentrum Hirslanden, Zurich, Switzerland: Karl Klingler; Columbia University Medical Center, New York, NY: John H. M. Austin, Gregory D. N. Pearson; Hadassah Medical Organization, Jerusalem, Israel: Dorith Shaham; Holy Cross Hospital Cancer Institute, Silver Spring, Md: Cheryl Aylesworth; Nebraska Methodist Hospital, Omaha, Neb: Patrick Meyers; South Nassau Communities Hospital, Long Island, NY: Shahriyour Andaz; Eisenhower Lucy Curci Cancer Center, Rancho Mirage, Calif; Davood Vafai; New York University Medical Center, New York, NY: David Naidich, Georgeann McGuinness; Dorothy E. Schneider Cancer Center, Mills-Peninsula Health Services, San Mateo, Calif: Barry Sheppard; State University of New York at Stony Brook, Stony Brook, NY: Matthew Rifkin; ProHealth Care Regional Cancer Center, Waukesha & Oconomowoc Memorial Hospitals, Oconomowoc, Wis: M. Kristin Thorsen, Richard Hansen; Maimonides Medical Center, Brooklyn, NY: Samuel Kopel; Wellstar Health System, Marietta, Ga: William Mayfield; St Joseph Health Center, St Charles, Mo: Dan Luedke; Roswell Park Cancer Institute, Buffalo, NY: Donald Klippenstein, Alan Litwin, Peter A. Loud; Upstate Medical Center, Syracuse, NY: Leslie J. Kohman, Ernest M. Scalzetti; Jackson Memorial Hospital, University of Miami, Miami, Fla; Richard Thurer, Nestor Villamizar; State University of New York, North Shore-Long Island Jewish Health System, New Hyde Park, NY: Arfa Khan, Rakesh Shah; The 5th Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China: Xueguo Liu; Mercy Medical Center, Rockville Center, NY: Gary Herzog; Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan: Diana Yeh; National Cancer Institute of China, Beijing, China: Ning Wu; Staten Island University Hospital, Staten Island, NY: Joseph Lowry, Mary Salvatore; Central Main Medical Center: Carmine Frumiento; Mount Sinai School of Medicine, New York, NY: David S. Mendelson; Georgia Institute for Lung Cancer Research, Atlanta, Ga: Michael V. Smith; The Valley Hospital Cancer Center, Paramus, NJ: Robert Korst; Health Group Physimed/McGill University, Montreal, Canada: Jana Taylor; Memorial Sloan-Kettering Cancer Center, New York, NY: Michelle S. Ginsberg; John Muir Cancer Institute, Concord, Calif: Michaela Straznicka; Atlantic Health Morristown Memorial Hospital, Morristown, NJ: Mark Widmann; Alta Bates Summit Medical Center, Berkeley, Calif: Gary Cecchi; New York Medical College, Valhalla, NY: Terence A.S. Matalon; St Joseph's Hospital, Atlanta, Ga: Paul Scheinberg; Mount Sinai Comprehensive Cancer Center, Miami Beach, Fla: Shari-Lynn Odzer; Aurora St Luke's Medical Center, Milwaukee, Wis: David Olsen; City of Hope National Medical Center, Duarte, Calif: Fred Grannis, Arnold Rotter; Evanston Northwestern Healthcare Medical Group, Evanston, Ill: Daniel Ray; Greenwich Hospital, Greenwich, Conn: David Mullen; Our Lady of Mercy Medical Center, Bronx, NY: Peter H. Wiernik; Baylor University Medical Center, Dallas Tex: Edson H. Cheung; Sequoia Hospital, Redwood City, Calif: Melissa Lim; Glens Falls Hospital, Glens Falls, NY: Louis DeCunzo; Atlantic Medical Imaging, Atlantic City, NJ: Robert Glassberg; Karmanos Cancer Institute, Detroit, Mich: Harvey Pass, Carmen Endress; Rush University, Chicago, Ill: Mark Yoder, Palmi Shah; Building Trades, Oak Ridge, Tenn: Laura Welch; Sharp Memorial Hospital, San Diego, Calif: Michael Kalafer; Newark Beth Israel Medical Center, Newark NJ Jeremy Green; Guthrie Cancer Center, Sayre, Pa: James Walsh, David Bertsch; Comprehensive Cancer Centers of the Desert, Palm Springs, Calif: Elmer Camacho; Dickstein Cancer Treatment Center, White Plains Hospital, White Plains, NY: Cynthia Chin; Presbyterian Healthcare, Charlotte, NC: James O'Brien; University of Toledo, Toledo, Ohio: James C. Willey

Funding Information:
This study was sponsored in part by the Simons Foundation . Number and date of IRB approval: I-ELCAP: Western IRB #0325, February 5, 2021. IELCART: Mount Sinai IRB HS #:15-01021, January 25, 2021.

Funding Information:
This effort was made possible by generous grants from the Simons Foundation International, Ltd .

Publisher Copyright:
© 2022 The Authors


  • hiatal hernia
  • lung cancer
  • paraesophageal hernia
  • postoperative complications
  • thoracic surgery morbidity


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