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Simple Summary: Subxiphoid single-port robotic-assisted thoracic surgery thymectomy using the single-port robotic system is currently being developed for minimally invasive surgery. This retrospective multi-institutional study is the largest study of its kind on this technique and is the first to compare the perioperative outcomes of this technique to those of subxiphoid single-port video-assisted thoracic surgery thymectomy. This novel technique was associated with a lower conversion rate to multi-port surgery, shorter chest tube drainage duration, and shorter postoperative hospital stays, demonstrating its potential as a surgical treatment option for selected patients. Subxiphoid thymectomy is a novel alternative to the transthoracic approach and sternotomy, with potential benefits, such as reduced postoperative pain and faster recovery. We previously reported the initial experience with subxiphoid single-port robotic-assisted thoracic surgery (SRATS) thymectomy using the single-port robotic system (SPS). However, the efficacy of this technique remains unknown. Thus, this study examined the multi-institutional experience with SRATS thymectomy and compared the perioperative outcomes of this technique to those of subxiphoid single-port video-assisted thoracic surgery (SVATS) thymectomy. The data of patients who underwent subxiphoid SRATS and SVATS thymectomy, performed by three thoracic surgeons at three institutions between September 2018 and May 2024, were retrospectively collected. In total, 110 patients were included, with 85 and 25 undergoing SRATS and SVATS thymectomy, respectively. After propensity score matching, 25 patients were included in each group. The SRATS group was associated with a lower conversion rate to multi-port surgery (0% vs. 20%, p = 0.05), shorter chest tube drainage duration (1.32 ± 0.75 vs. 2.00 ± 1.29 days, p = 0.003), and a shorter postoperative hospital stay (2.52 ± 1.00 vs. 5.08 ± 5.20 days, p = 0.003). Subxiphoid SRATS thymectomy using the SPS is feasible and is a good alternative to conventional thymectomy. Further studies are necessary to confirm its benefits. [ABSTRACT FROM AUTHOR]

Simple Summary: This study explored how lung cancer spreads through air spaces in small tumors (up to 2 cm) and its impact on patient outcomes. Focusing on small-size and early-stage lung adenocarcinomas, the researchers analyzed medical records of patients treated between 2012 and 2022. We measured the distance of floating cancer cells spread from the main tumor through alveolar spaces and categorized patients based on whether this spread was present and its extent. Interestingly, while overall survival rates were similar across groups, patients with more extensive spread (2 mm or more) experienced a higher chance of cancer recurrence even in this very early cancer. This suggests that understanding the extent of spread through air spaces is crucial in predicting cancer recurrence in small lung tumors. Further research with a larger group of patients is needed to confirm these risk factors and improve treatment strategies. This study aimed to identify the clinical manifestation and implications according to the grading of tumor spread through air spaces in early-stage small (≤2 cm) pathological stage I non-mucinous lung adenocarcinomas. Medical records of patients with pathological stage I tumors sized ≤2 cm were retrospectively reviewed and analyzed. The furthest distance of the spread through air spaces from the tumor margin was measured on a standard-length scale (mm). Enrolled patients were categorized into spread through air spaces (STAS) (−) and STAS (+), and STAS (+) was subdivided according to its furthest distance as follows: STAS (+)-L (<2 mm) and STAS (+)-H (≥2 mm). Risk factors for STAS (+) included papillary predominant subtype (p = 0.027), presence of micropapillary patterns (p < 0.001), and EGFR (p = 0.039). The overall survival of the three groups did not differ significantly (p = 0.565). The recurrence-free survival of STAS (+)-H groups was significantly lower than those of STAS (−) and STAS (+)-L (p < 0.001 and p = 0.039, respectively). A number of alveolar spaces were definite risk factors for STAS (+)-H groups (p < 0.001), and male gender could be one (p = 0.054). In the patient group with small (≤2 cm) pathological stage I lung adenocarcinomas, the presence of STAS ≥ 2 mm was related to significantly lower recurrence-free survival. For identifying definite risk factors for the presence of farther STAS, more precise analysis from a larger study population should be undertaken. [ABSTRACT FROM AUTHOR]

Simple Summary: The imaging method called refraction-contrast computed tomography using synchrotron radiation can achieve detailed images almost similar to those from a microscope. This study examined its ability to recognize lung cancer. We took pictures of lung cancer samples in Japan using this imaging method. These pictures showed the insides of the samples precisely, making it easy to distinguish healthy tissue from cancerous spots. They even allowed us to tell the difference between a main lung cancer and one that started somewhere else, like the colon. Fundamentally, this method could be a way to check for lung cancer without cutting into tissue. However, before doctors can use it, the machines involved need some major changes. Refraction-contrast computed tomography based on X-ray dark-field imaging (XDFI) using synchrotron radiation (SR) has shown superior resolution compared to conventional absorption-based methods and is often comparable to pathologic examination under light microscopy. This study aimed to investigate the potential of the XDFI technique for clinical application in lung cancer diagnosis. Two types of lung specimens, primary and secondary malignancies, were investigated using an XDFI optic system at beamline BL14B of the High-Energy Accelerator Research Organization Photon Factory, Tsukuba, Japan. Three-dimensional reconstruction and segmentation were performed on each specimen. Refraction-contrast computed tomographic images were compared with those obtained from pathological examinations. Pulmonary microstructures including arterioles, venules, bronchioles, alveolar sacs, and interalveolar septa were identified in SR images. Malignant lesions could be distinguished from the borders of normal structures. The lepidic pattern was defined as the invasive component of the same primary lung adenocarcinoma. The SR images of secondary lung adenocarcinomas of colorectal origin were distinct from those of primary lung adenocarcinomas. Refraction-contrast images based on XDFI optics of lung tissues correlated well with those of pathological examinations under light microscopy. This imaging method may have the potential for use in lung cancer diagnosis without tissue damage. Considerable equipment modifications are crucial before implementing them from the lab to the hospital in the near future. [ABSTRACT FROM AUTHOR]

Synchrotron radiation microcomputed tomography (SR‐μCT) can provide non‐destructive three‐dimensional investigation for soft tissue with high resolution. The aim of this study is to evaluate technical improvements in microcomputed tomographic imaging of human lung tissue using a synchrotron radiation source at the 6C biomedical beamline. SR‐μCT images of excised human lung tissue (6 mm vertically and 10 mm horizontally sized) were explored at the 6C biomedical beamline in the Pohang accelerator laboratory (Pohang, Republic of Korea) using phase retrieval methods with a modified Bronnikov algorithm. Experimental data collection was performed with changes in the following conditions: the presence of a graphite attenuator, sample to detector distance, the presence of different scintillators and increasing pixel sizes. We identified that the resolution of lung tissue images was sufficiently enhanced when the graphite attenuator was not applied, 550 mm of sample to detector distance, with Cadmium tungsten (CdWO4) scintillator and twice binning of the pixel data and could be comparable with images from pathologic examination. Refinement of SR‐μCT techniques for soft tissue originating from the human body would advance the potential clinical application of synchrotron radiation in the near future. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to evaluate mortality and morbidity after surgical lung biopsy in patients with interstitial lung diseases and to investigate perioperative risk factors for complications. Methods: A total of 132 enrolled patients were divided into three groups: group 1 (70), patients with operation scheduled before admission; group 2 (48), patients with operation determined after medical therapy; and group 3 (14), patients with emergent operation followed by steroid therapy. Complications were classified according to the Clavien–Dindo system. The 30‐ and 90‐day mortality and complication rates were evaluated, and perioperative risk factors were investigated. Results: Overall complication rate was 19.7%. The 30‐ and 90‐day in‐hospital mortality rates were 1.5% and 3.0%, respectively. Complication rates more than grade II were significantly different between the three groups (P = 0.045). Patients in group 1 revealed only class I or II complications and no mortalities. Elevated oxygen demand after operation was an independent risk factor for any complications, complications more than class II and any events (P < 0.001, P = 0.042 and P < 0.001, respectively). The New York Heart Association Functional Classification (NYHA) class IV was a statistically significant risk factor for any complications (P = 0.036, odds ratio 7.93). Higher NYHA class (III and IV) showed significantly higher risk in occurrence of any events after lung biopsy. Conclusion: Prepared surgical lung biopsy for interstitial lung disease is feasible with reasonable morbidity. Higher NYHA class and elevated oxygen demand after the surgery could imply post‐operative outcomes. Alternative diagnostic methods such as transbronchial biopsy or bronchoalveolar lavage should be considered prior to surgical lung biopsy especially in high‐risk patients. [ABSTRACT FROM AUTHOR]

High-resolution tomographic images using synchrotron X-rays are expected to provide detailed reflection of microstructures, thereby allowing for the examination of histologic structures without destruction of the specimen. This study aims to evaluate the synchrotron tomographic images of mixed ground-glass opacity excised on 5-mm sections in comparison to pathologic examination. The Institutional Review Board of our institute approved this retrospective study, and written informed consent was obtained from each patient whose lung tissue would be used. Obtained lung cancer specimens were brought to the multiple Wiggler 6C beam line at the Pohang Light Source (PLS-II) in Korea, and phase contrast X-ray images were obtained in November 2016. The X-ray emanated from a bending magnet of the electron storage ring with electron energy of 3 GeV, and a typical beam current was 320 mA. Reconstructed tomographic images were compared with images from histologic slides obtained from the same samples. Pulmonary microstructures including terminal bronchioles, alveolar sacs, and vasculature were identified with phase contrast X-ray images. Images from normal lung tissue and mixed ground-glass opacity were clearly distinguishable. Hyperplasia of the interalveolar septum and dysplasia of microstructure were clearly identified. The imaging findings correlated well with hematoxylin-eosin stained specimens. Tomographic images using synchrotron radiation have the potential for clinical applications. With refinement, this technique may become a diagnostic tool for detection of lung cancer. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the clinical implication of synchrotron radiation imaging techniques for human lung adenocarcinoma in comparison with pathologic examination. A refraction-based tomographic imaging technique called the X-ray dark-field imaging (XDFI) method was used to obtain computed tomographic images of human lung adenocarcinoma at the beam line at Photon Factory BL 14B at the High Energy Accelerator Research Organization (KEK) in Tsukuba, Japan. Images of normal lung tissue were also obtained using the same methods and reconstructed as 3D images. Both reconstructed images were compared with pathologic examinations from histologic slides which were made with identical samples. Pulmonary alveolar structure including terminal bronchioles, alveolar sacs, and vasculatures could be identified in synchrotron radiation images of normal lung. Hyperplasia of interstitial tissue and dysplasia of alveolar structures were noticed in images of lung adenocarcinoma. Both synchrotron radiation images were considerably correlated with images from histologic slides. Lepidic patterns of cancer tissue were distinguished from the invasive area in synchrotron radiation images of lung adenocarcinoma. Refraction-contrast tomographic techniques using synchrotron radiation could provide high-resolution images of lung adenocarcinoma which are compatible with those from pathologic examinations. [ABSTRACT FROM AUTHOR]

Background Although surgical resection is the best way for curing cancer, there has been a certain portion of patients who could not undergo surgery because of various reasons. We experienced 9 cases of photodynamic therapy for esophageal cancer patients with inoperable conditions, and investigated the feasibility and safety of photodynamic therapy. Methods Medical records of patients of esophageal cancers who received photodynamic therapies in Korea University Anam Hospital were reviewed retrospectively. Survival, complication rates and treatment results were evaluated. Results A total of 9 patients (all men) with esophageal cancer had been received photodynamic therapy between 2007 and 2015. Average age at the time of treatment was 70.9 (± 4.62, ranging 64 to 78) and average follow-up periods were 18.2 (± 16.59, ranging 3.8 to 53.6). The average Charlson Comorbidity Index (CCI) were 7.3 (± 2.29, ranging 4 to 10). During the follow-up periods, 5 patients died, and only one death was related with the distant metastasis progression. There was one case of skin reaction and no other complications were appeared. There were no complication related deaths. Complete remission of esophageal cancer showed in 6 patients (66.7%) and partial remission showed in 3 patients (33.3%). Two patients with partial remission showed loco-recurrence. One patient with complete remission had to undergo surgery because of preexisting esophageal stenosis. In patients with complete remission, no recurrence was observed. Conclusion Photodynamic therapy is feasible and safe with acceptable rates of complications. For esophageal cancer patients with inoperable condition or refusal of surgery, photodynamic therapy could provide alternative way to treatment. Disclosure All authors have declared no conflicts of interest. [ABSTRACT FROM AUTHOR]

CT guided biopsy of the retroperitoneal mass showed lymphoplasmacytic infiltrate with IgG4 positive plasma cells and IgG4:IgG ratio averaging up to 40%. B CONCLUSIONS: b In histoplasma associated FM and IgG4-RD overlap, serum IgG4 levels should be obtained not as a diagnostic test, but marker of disease activity and treatment response. [Extracted from the article]

Background The prevalence gastro-tracheal fistula following esophagectomy is rare, however, very difficult to cure, and often results in fatal outcomes. We experienced surgical repair of gastro-tracheal fistula after minimally invasive esophagectomy, thereby reported here. Methods A 66 year-old male patient had undergone VATS esophagectomy combined with cervical esophagogastrostomy through posteromediastinal route for his esophageal cancer (pT2N2M0). After concurrent chemo-radiation therapy for local recurrence in subcarinal area, gastro-tracheal fistula was developed between the posterior membranous wall of trachea just above carina and gastric conduit. Surgical correction was performed through right posterolateral thoracotomy. After longitudinal incision on the gastric conduit near the location of gastro-esophageal fistula, the fistula tract was exposed, and closed using three layer sutures with vicryl 3–0. Results The patient stayed at intensive care unit for only one day. During the periods of nil per os, the nutrition had supported by intravenous administration and jejunostomy. After 2 weeks of nil per os, postoperative bronchoscopy and endoscopy was performed. No remnant fistula was noted on both examinations suggesting successful fistula closure. And, the patient was discharged without any complications on postoperative day 28. Conclusion Conduit-airway fistula could be caused by diverse risk factors such as thermal injury during the dissection, external beam irradiation, and severe malnutrition. Less invasive procedures including endoscopic interventions could be amenable, however, direct surgical repairs might be required for prompt closure of fistula and minimizing further complications. Disclosure All authors have declared no conflicts of interest. [ABSTRACT FROM AUTHOR]

Background: Histological heterogeneity is thought to be important for prognosis of lung adenocarcinoma. We investigated to determine pathological features with prognostic value for recurrence of early stage lung cancer. Methods: A total of 368 patients who underwent curative surgical resection for early stage lung adenocarcinoma between 2009 and 2012 were enrolled. Pathologic characteristics including the presence of visceral pleural invasion, micropapillary patterns, aerogenous spread, lymphovascular invasion, perineural invasion and necrosis were examined. The correlations between pathological factors and clinical outcomes were analysed to determine prognostic significance. Results: Mean follow‐up was 43.0 months (±14.56, ranging from 0.0 to 73.9 months). Three‐year overall survival was 95.2% and disease‐free survival was 89.8%. The recurrence rate was 9.0% (33 patients) and the mortality rate was 6.0% (22 patients). The presence of a micropapillary pattern (P < 0.002), lymphatic invasion (P < 0.000), aerogenous spread (P < 0.000), vascular invasion (P = 0.036) and necrosis (P < 0.000) were negative prognostic factors of recurrence in univariate analysis. In multivariate analysis, only aerogenous spread had prognostic value (P = 0.020). The recurrence hazard ratio for the presence of aerogenous spread was 3.2 (95% confidence interval 1.20–8.47). Conclusion: The presence of aerogenous spread was an independent pathological risk factor of recurrence in stage I lung adenocarcinoma. Micropapillary pattern had prognostic importance for recurrence in univariate analysis, but not in multivariate analysis. [ABSTRACT FROM AUTHOR]

The article presents the case study of a 63-year-old man with aspiration symptom that occur after swallowing liquid, dealing with topics including the patient's medical history and laboratory results that led to the diagnosis of bronchoesophageal fistula secondary to middle esophageal diverticulum.

Objectives: Accurate prediction of pathological N2 metastasis is crucial for choosing the best therapeutic strategy for non-small cell lung cancer (NSCLC) patients. The aim of this study is to evaluate the usefulness of metabolic heterogeneity assessed by the positron emission tomography combined with computed tomography (PET/CT) using F-18 fluorodeoxyglucose (FDG) in primary NSCLC with clinically suspected N2 metastasis in predicting pathological mediastinal lymph node metastasis.Materials and Methods: Fifty patients with newly diagnosed NSCLC and clinically suspected N2 on preoperative CT and F-18 FDG PET/CT were included. Pathological results were confirmed by surgical specimens and the coefficient of variation (COV) was used to evaluate the metabolic heterogeneity of primary tumor mass by using F-18 FDG PET/CT.Results: Among the 50 patients with clinically suspected N2, 23 patients were pathologically confirmed as positive mediastinal lymph node metastasis and 27 patients were negative. Pathologically confirmed positive mediastinal lymph node metastasis group presented higher COV than the negative metastasis group (p < 0.001). An optimal cut-off value of 41.9 was proposed for discriminating metastasis from non-metastasis group. The sensitivity and specificity were 65.2% and 88.9%, respectively (AUC: 0.84; p < 0.0001). In addition, compared with other metabolic parameters, metabolic heterogeneity defined as COV showed the superior predictability of the mediastinal metastasis. (p = 0.001) CONCLUSION: Metabolic heterogeneity which was defined as COV of primary tumor could predict pathological mediastinal lymph node metastasis in NSCLC patients with clinically suspected N2. Therefore, COV of primary tumor may play a complementary role to conventional imaging in providing nodal information before taking biopsy. [ABSTRACT FROM AUTHOR]