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Chest wall pain syndromes can emerge following local therapies for lung cancer and can adversely affect patients quality-of-life. This can occur after lung surgery, radiation therapy, or percutaneous image-guided thermal ablation. This review describes the multifactorial pathophysiology of chest wall pain syndromes that develop following surgical and non-surgical local therapies for lung cancer and summarizes evidence-based management strategies for inflammatory, neuropathic, myofascial, and osseous pain. It discusses a step-wise approach to treating chest wall pain that begins with non-opioid oral analgesics and includes additional pharmacologic treatments as clinically indicated, such as anticonvulsants, serotonin and norepinephrine reuptake inhibitors, tricyclic antidepressants, and various topical treatments. For myofascial pain, physical medicine techniques, such as acupuncture, trigger point injections, deep tissue massage, and intercostal myofascial release can also offer pain relief. For severe or refractory cases, opioid analgesics, intercostal nerve blocks, or intercostal nerve ablations may be indicated. Fortunately, palliation of treatment-related chest wall pain syndromes can be managed by most clinical providers, regardless of the type of local therapy utilized for a patients lung cancer treatment. In cases where a patients pain fails to respond to initial medical management, clinicians can consider referring to a pain specialist who can tailor a more specific pharmacologic approach or perform a procedural intervention to relieve pain.

BackgroundIntraoperative opioid use has a positive relationship with postoperative nausea and vomiting (PONV), and opioid-free anaesthesia (OFA) might reduce PONV. We investigated whether OFA compared with opioid-based anaesthesia would reduce PONV during the first 2 postoperative days among patients undergoing thoracoscopic lung resection.MethodsIn this randomised controlled trial, 120 adult patients were randomly assigned (1:1, stratified by sex) to receive either OFA with esketamine, dexmedetomidine, and sevoflurane, or opioid-based anaesthesia with sufentanil and sevoflurane. A surgical pleth index (SPI) of 20-50 was applied for intraoperative analgesia provision. All subjects received PONV prophylaxis (dexamethasone and ondansetron) and multimodal analgesia (flurbiprofen axetil, ropivacaine wound infiltration, and patient-controlled sufentanil). The primary outcome was the occurrence of PONV during the first 48 h after surgery.ResultsThe median age was 53 yr and 66.7% were female. Compared with opioid-based anaesthesia, OFA significantly reduced the incidence of PONV (15% vs 31.7%; odds ratio [OR]=0.38, 95% confidence interval [CI], 0.16-0.91; number needed to treat, 6; P=0.031). Secondary and safety outcomes were comparable between groups, except that OFA led to a lower rate of vomiting (OR=0.23, 95% CI, 0.08-0.77) and a longer length of PACU stay (median difference=15.5 min, 95% CI, 10-20 min). The effects of OFA on PONV did not differ in the prespecified subgroups of sex, smoking status, and PONV risk scores.ConclusionsIn the context of PONV prophylaxis and multimodal analgesia, SPI-guided opioid-free anaesthesia halved the incidence of PONV after thoracoscopic lung resection, although it was associated with a longer stay in the PACU.Clinical trial registrationChinese Clinical Trial Registry (ChiCTR2200059710).

Background: Non-small cell lung cancer (NSCLC) is the leading cause of death from malignancies, and surgical resection is the most effective form of treatment. Coronary artery disease (CAD) is a common comorbidity in patients with NSCLC. A coronary artery calcium (CAC) score correlates with the extent of CAD. We aimed to test whether an automated assessment of CAC scores helps to identify the population of patients with a higher risk of postoperative complications and worse overall survival (OS) after the surgical treatment of NSCLC. Methods: In this retrospective cohort study, the data of the patients who were surgically treated for NSCLC were matched with the reassessed preoperative CT images. The postoperative complication rates and overall survival were analyzed. The CAC score was evaluated automatically using the Syngo.via Siemens Healthcare software. Cardiac age was assessed according to Hoff et al. 2001. The prognosticators of postoperative complications and of OS were tested. Results: The data of 193 patients with complete data, an adherence to the inclusion and exclusion criteria, and that were operated between 2018 and 2019, were included. Cardiac age was a predictor of the cardiovascular and pulmonary complications rate (95%CI −0.007–0.203, p = 0.066, beta coefficient 0.098). In a multivariable stepwise regression analysis, operative access was a predictor of cardiovascular and pulmonary complications (95%CI −0.290–−0.111, p < 0.001, beta coefficient −0.200), cardiovascular complications (95%CI −0.161–−0.022, p = 0.011, beta coefficient −0.036), and the general complication rate (95%CI −0.370–−0.194, p < 0.001, beta coefficient −0.286). Kaplan–Meier curves were separated in the survival analysis of groups of patients with a cardiac age 0–69 years vs. an age of 70+ (92 vs. 92 patients) (in Cox regression analysis, HR = 1.678, 95%CI 0.847–3.292 p = 0.138). Conclusions: An automated CAC score assessment may be a potential and clinically meaningful prognosticator of both postoperative complications and OS in patients that are operated on due to NSCLC. Further studies are required. [ABSTRACT FROM AUTHOR]

Objectives: The choice of the best Video-Assisted Thoracic Surgery (VATS) surgical approach is still debated. Surgeons are often faced with the choice between innovation and self-confidence. The present study reports the experience of a high-volume single institute, comparing data of uni-portal, bi-portal and tri-portal VATS, to find out the safest and most effective mini-invasive approach, leading surgeon's choice. Methods: Between 2015 and 2022, a total of 210 matched patients underwent VATS lobectomy for early-stage cancer, using uni-portal (fifth intercostal space), bi-portal (seventh space for optic and the fifth), and tri-portal (seventh and the fifth/four) access. Patients were matched for age, BPCO, smoke, comorbidities, lesions (size and staging) to obtain three homogenous groups (A: uni-portal; B: bi-portal; C: tri-portal). The surgeons had comparable expertise. Data were retrospectively collected from institutional database and analyzed. Results: No differences were detected considering time of surgery, length of hospital stay, complications, conversion rate, specific survival, and days of chest tube length of stay. Better results on chest tube removal were described in group A (mean 1.1 days) compared to B (mean 2.6 days) and C (mean 4.7 days); nevertheless, they not statistically significant (p = 0.106). Conclusions: No significant differences among the groups were described, except for the reduction in chest tube permanence in group A. This allows to hypothesize an enhanced recovery after surgery in this group but the different approaches in this series seem to guarantee comparable safety and effectiveness. Considering no superiority of one method above the others, the best suggested approach should be the one for which the surgeon feels more confident. [ABSTRACT FROM AUTHOR]

The pathology of primary hemostasis is a common complication of extracorporeal membrane oxygenation (ECMO) support. Scientific data describing its changes in patients on short-term ECMO support and the ability and speed of the restoration of its functions are limited. The aim of this study was to describe the pathology of primary hemostasis induced by short-term ECMO support and its development over time using PFA-200, ROTEM platelet, and von Willebrand factor (vWF) analyses. In patients undergoing lung transplantation surgery using intraoperative veno-arterial ECMO support, blood samples were analyzed using the following tests: PFA-200, ROTEM platelet tests, vWF antigen, ristocetin cofactor (RCo), and collagen-binding protein (CB) before, during, and after ECMO support. Blood samples from 32 patients were analyzed. All 3 PFA-200 tests (COL/EPI, COL/ADP, and COL/P2Y) showed significant deterioration during ECMO support with rapid restoration after ECMO cessation (p < 0.05), suggesting an ECMO-induced primary hemostasis disorder. A significant increase of vWF antigen after ECMO cessation (p < 0.05) was found with an increase of RCo and CB levels, although it was not significant (p > 0.05). Short-term ECMO support induces primary hemostasis pathology. It occurs immediately after initiation but is rapidly restored after ECMO cessation, which is detectable by PFA-200. Despite there being persistent platelet dysfunction after ECMO cessation, as seen with the ROTEM platelet results, the increased levels of vWF antigen might explain the normal results of primary hemostasis detected by PFA-200. [ABSTRACT FROM AUTHOR]

Limited data exist to guide oxygen administration during one-lung ventilation for thoracic surgery. We hypothesised that high intraoperative inspired oxygen fraction during lung resection surgery requiring one-lung ventilation is independently associated with postoperative pulmonary complications (PPCs). We performed this retrospective multicentre study using two integrated perioperative databases (Multicenter Perioperative Outcomes Group and Society of Thoracic Surgeons General Thoracic Surgery Database) to study adult thoracic surgical procedures using one-lung ventilation. The primary outcome was a composite of PPCs (atelectasis, acute respiratory distress syndrome, pneumonia, respiratory failure, reintubation, and prolonged ventilation >48 h). The exposure of interest was high inspired oxygen fraction (FiO 2), defined by area under the curve of a FiO 2 threshold > 80%. Univariate analysis and logistic regression modelling assessed the association between intraoperative FiO 2 and PPCs. Across four US medical centres, 141/2733 (5.2%) procedures conducted in 2716 patients (55% female; mean age 66 yr) resulted in PPCs. FiO 2 was univariately associated with PPCs (adjusted OR [aOR]: 1.17, 95% confidence interval [CI]: 1.04–1.33, P =0.012). Logistic regression modelling showed that duration of one-lung ventilation (aOR: 1.20, 95% CI: 1.03–1.41, P =0.022), but not the time-weighted average FiO 2 (aOR: 1.01, 95% CI: 1.00–1.02, P =0.165), was associated with PPCs. Our results do not support limiting the inspired oxygen fraction for the purpose of reducing postoperative pulmonary complications in thoracic surgery involving one-lung ventilation. [ABSTRACT FROM AUTHOR]

Patients with lung cancer have a high incidence of tumor recurrence even after curative surgical resection. Some reports indicated that immunosuppressive cells induced by surgical stress could contribute to tumor recurrence after surgery; however, the underlying mechanisms are not fully understood. In this study, we found that increased postoperative blood monocytes served as a risk factor for tumor recurrence in 192 patients with non-small cell lung cancer (NSCLC). We established the lung cancer recurrent mouse model after tumor resection and showed that the surgical stress immediately increased the level of serum monocyte chemoattractant protein-1 (MCP-1), which subsequently increased blood monocytes. These blood monocytes were rapidly recruited into distant micrometastases and became tumor growth-promoting tumor associated macrophages (TAMs). Furthermore, even after the blood MCP-1 and monocytes decreased enough 72 h after tumor resection, TAMs in micrometastases remained rich because the MCP-1 secreted by micrometastases themselves continued to recruit monocytes around the tumor. Consequently, tumor resection triggered the outgrowth of distant metastases via the MCP-1–Monocyte–TAM axis. When we administered the MCP-1 inhibitor to the lung cancer recurrent model mice, blood monocytes decreased after tumor resection, and TAMs in micrometastases also dramatically decreased. Finally, peri- and postoperative treatment with the MCP-1 inhibitor suppressed distant metastases after surgery. Targeting the MCP-1–Monocyte–TAM axis may inhibit surgical stress-induced NSCLC recurrence by attenuating postoperative immunosuppressive monocytes in micrometastases. [ABSTRACT FROM AUTHOR]

The optimal surgical approach for elderly patients with early-stage non-small cell lung cancer (NSCLC) remains a topic of debate. A retrospective analysis was conducted on patients who underwent pulmonary resection for early-stage NSCLC at our single institution between January 2018 and December 2022. Propensity score matching was used to balance baseline characteristics between the sublobar resection and lobectomy groups. Perioperative outcomes, pulmonary function recovery, postoperative quality of life, and survival were compared between the two groups. A total of 151 patients were included, with 42 undergoing sublobar resection and 109 undergoing lobectomy. After propensity score matching, baseline characteristics were well-balanced between the two groups. Sublobar resection was associated with shorter operative time (125.83 ± 33.56 min vs. 161.14 ± 61.54 min, p = 0.048), less intraoperative blood loss [65 (30, 75) ml vs. 120 (70, 170) ml, p < 0.001], shorter drainage duration [3 (2, 5) days vs. 5 (3, 6) days, p < 0.001], shorter hospital stay [6 (4, 8) days vs. 10 (7, 13) days, p < 0.001], and fewer postoperative complications (11.9% vs. 47.6%, p < 0.001), compared to lobectomy. Moreover, sublobar resection led to better pulmonary function recovery and higher postoperative quality of life scores, with no significant difference in overall and disease-free survival between the groups. Sublobar resection in patients aged 80 and above with early-stage NSCLC offered comparable oncological outcomes to lobectomy while preserving more lung function and providing better postoperative recovery and long-term quality of life. These findings have important implications for treatment decision-making in elderly NSCLC patients. [ABSTRACT FROM AUTHOR]

Background: Despite the implementation of enhanced recovery programs, the reported average postoperative length of stay after robotic lobectomy remains as 4 days. In this prospective study, we present the outcomes of early discharge (on day 2) with telehealth home monitoring device after robotic lobectomy for lung cancer in selected patients. Methods: All patients with a caregiver were discharged on postoperative day 2 (POD 2) with a telemonitoring device provided they met the specific discharge criteria. Inclusion criteria: <75 years old, stage I-II NSCLC, with caregiver, ECOG 0–2, scheduled for lobectomy, logistic proximity to hospital (<60 km); intra-postoperative exclusion criteria: conversion to open surgery, early complications needing hospital monitoring or redo-operation, difficult pain management, <92 HbO2% saturation on room air or need for O2 supplementation, altered vital or laboratory parameters. Teleconsultations were scheduled as follows: the first one in afternoon of POD2, two on POD3, then once a day until chest tube removal. After discharge, patients recorded their vital signs at least four times a day using the device, which allowed two surgeons to monitor them via a mobile application. In the event of sudden changes in vital signs or the occurrence of adverse events, patients had access to a direct phone line and a dedicated re-hospitalization pathway. The primary outcome was safety, assessed by the occurrence of post-discharge complications or readmissions, as well as feasibility. Secondary outcomes: comparison of safety profile with a matched control group in which the standard of care and the evaluation of resource optimization were maintained and economic evaluation. Results: Between July 2022 and February 2024, 48 patients were enrolled in the present study. Six patients (12.5%) dropped out due to unsatisfied discharge criteria on POD2. Exclusion causes were: significant air leaks (n:2) requiring monitoring and the use of suction device, uncontrolled pain (n:2), atrial fibrillation, and occurrence of cerebral ischemia (n:1 each). The adherence rate to vital signs monitoring by patients was 100%. A mean number of four measurements per day was performed by each patient. During telehealth home monitoring, a total of 71/2163 (1.4%) vital sign measurements violated the established acceptable threshold in 22 (52%) patients. All critical violations were managed at home. During the surveillance period (defined as the time from POD 2 to the day of chest tube removal), a persistent air leak was recorded in one patient requiring readmission to the hospital (on POD 13) and re-intervention with placement of a second thoracic drainage due to unsatisfactory lung expansion. No other postoperative complication occurred nor was there any readmission needed. Compared to the control group, the discharge gain was 2.5 days, with an economic benefit of 528 €/day (55.440 € on the total enrolled population). Conclusions: Our results confirm that the adoption of telehealth home monitoring is feasible and allows a safe discharge on postoperative day two after robotic surgery for stage I-II NSCLC in selected patients. A potential economic benefit (141 days of hospitalizations avoided) for the healthcare system could result from the adoption of this protocol. [ABSTRACT FROM AUTHOR]

Background: Preoperative prediction of postoperative pulmonary function after anatomical resection for lung cancer is essential to prevent long-term morbidity and mortality. Here, we compared the accuracy of hybrid single-photon emission computed tomography/computed tomography (SPECT/CT) with traditional anatomical and planar scintigraphy approaches in predicting postoperative pulmonary function in patients with impaired lung function. Methods: We analyzed the predicted postoperative pulmonary function in patients undergoing major anatomical lung resection, applying a segment counting approach, planar perfusion scintigraphy (PPS), and SPECT/CT-based lung function quantification. Results: In total, 120 patients were evaluated, of whom 82 were included in the study. Postoperative lung function tests were obtained in 21 of 82 patients. The preoperative SPECT/CT-based quantification yielded very accurate results compared to the actual postoperative FEV1 and DLCO values. The linear regression analysis showed that the SPECT/CT-based analysis predicted postoperative FEV1 (%) and DLCO values more accurately than the segment counting approach or PPS. Accordingly, 58/82 patients would qualify for anatomical lung resection according to the SPECT-based quantification, 56/82 qualified according to the PPS (Mende), and only 47/82 qualified according to the segment counting method. Moreover, we noted that the SPECT-predicted FEV1 values were very close to the actual postoperative values in emphysema patients, and selected patients even showed improved lung function after surgery. Conclusions: Anatomically driven methods such as SPECT/CT yielded a very accurate prediction of the postoperative pulmonary function. Accordingly, applying SPECT/CT revealed more patients who would formally qualify for lung resection. We suggest SPECT/CT as the preferred method to evaluate eligibility for lung surgery in selected patients with impaired pulmonary reserve. [ABSTRACT FROM AUTHOR]

Multiple primary lung cancer (MPLC), can be categorized as synchronous multiple primary lung cancer (sMPLC) and metachronous multiple primary lung cancer (mMPLC), which are becoming increasingly common in clinical practice. A precise differential diagnosis between MPLC and intrapulmonary metastases (IPM) is essential for determining the appropriate management strategy. MPLC is primarily diagnosed through histology, imaging, and molecular methods. Imaging serves as an essential foundation for preoperative diagnosis, while histology is a critical tool for establishing a definitive diagnosis. As molecular biology advances, the diagnosis of MPLC has stepped into the era of molecular precision. Surgery is the preferred treatment approach, with stereotactic radiotherapy and ablation being viable options for unresectable lesions. Targeted therapy and immunotherapy can be considered for specific patients. A multidisciplinary team approach to evaluation and the application of combination therapy can benefit more patients. Looking ahead, the development of more authoritative guidelines will be instrumental in streamlining the diagnosis and management of MPLC. [ABSTRACT FROM AUTHOR]

Background Methods Result Conclusion The clinical characteristics and management of late‐onset chylothorax after lung cancer surgery remained unknown. Here we aimed to provide evidence on the management of late‐onset chylothorax by analysis of several cases with the largest sample size.We retrospectively collected clinical data of patients who developed late‐onset chylothorax after lung cancer surgery and were re‐admitted by a single surgeon in our center from 2016 to 2022. The clinical characteristics and management for these patients were analysed. The role of Hem‐o‐lok clipping after lymphadenectomy in preventing late‐onset chylothorax was further explored by comparing the surgical outcomes between treated group and control group.A total of six patients who were re‐admitted for late‐onset chylothorax after lung cancer surgery were included for analysis. The mean age of them was 60.7 years old. The symptom of late‐onset chylothorax was mainly dyspnea and cough and the diagnosis was all made by Sudan III staining between postoperative day 17 to 42. All patients were firstly treated with thoracocentesis and low‐fat diet with intravenous nutrition. Four patients were successfully managed with low‐fat diet and thoracocentesis, while the other two patients were further managed with pleurodesis with 50% glucose fluid solution. We found a significantly decreased risk of late‐onset chylothorax in the treated group with improved procedure of applying Hem‐o‐lok clipping after lymphadenectomy than in the control group (0% versus 2.6%, P < 0.01).Late‐onset chylothorax after lung cancer surgery was a rare and negligible complication, which may usually be managed by non‐surgical methods. Hem‐o‐lok clipping during lymphadenectomy seemed to be an effective method to prevent late‐onset chylothorax after lung cancer surgery. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusions The reliability of data‐driven predictions in real‐world scenarios remains uncertain. This study aimed to develop and validate a machine‐learning‐based model for predicting clinical outcomes using real‐world data from an electronic clinical pathway (ePath) system.All available data were collected from patients with lung cancer who underwent video‐assisted thoracoscopic surgery at two independent hospitals utilizing the ePath system. The primary clinical outcome of interest was prolonged air leak (PAL), defined as drainage removal more than 2 days post‐surgery. Data‐driven prediction models were developed in a cohort of 314 patients from a university hospital applying sparse linear regression models (least absolute shrinkage and selection operator, ridge, and elastic net) and decision tree ensemble models (random forest and extreme gradient boosting). Model performance was then validated in a cohort of 154 patients from a tertiary hospital using the area under the receiver operating characteristic curve (AUROC) and calibration plots.To mitigate bias, variables with missing data related to PAL or those with high rates of missing data were excluded from the dataset. Fivefold cross‐validation indicated improved AUROCs when utilizing key variables, even post‐imputation of missing data. Dichotomizing continuous variables enhanced performance, particularly when fewer variables were employed in the decision tree ensemble models. Consequently, regression models incorporating seven key variables in complete case analysis demonstrated superior discriminatory ability for both internal (AUROCs: 0.77–0.84) and external cohorts (AUROCs: 0.75–0.84). These models exhibited satisfactory calibration in both cohorts.The data‐driven prediction model implementing the ePath system exhibited adequate performance in predicting PAL post‐video‐assisted thoracoscopic surgery, optimizing variables and considering population characteristics in a real‐world setting. [ABSTRACT FROM AUTHOR]

OBJECTIVES Postoperative pain remains a burden for patients after minimally invasive anatomic lung resection. Current guidelines recommend the intraoperative placement of intercostal catheters to promote faster recovery. This trial aimed to determine the analgesic efficacy of continuous loco-regional ropivacaine application via intercostal catheter and establish this method as a possible standard of care. METHODS Between December 2021 and October 2023, patients were randomly assigned to receive ropivacaine 0.2% or a placebo through an intercostal catheter with a flow rate of 6–8 ml/h for 72 h after surgery. Patients were undergoing anatomic VATS lung resection under general anaesthesia for confirmed or suspected stage I lung cancer (UICC, 8th edition). The sample size was calculated to assess a difference in numerical rating scale associated with pain reduction of 1.5 points. RESULTS Fourteen patients were included in the ropivacaine group, whereas the placebo group comprised 18 participants. Patient characteristics and preoperative pain scores were similar in both groups. There was no statistically significant difference in postoperative pain scores and morphine consumption between the 2 groups. The mean numerical rating scale when coughing during the first 24 h postoperatively was 4.9 (SD: 2.2) in the ropivacaine group and 4.3 (SD: 2.4); P  = 0.47 in the placebo group. We were unable to determine any effect of administered ropivacaine on the postoperative pulmonary function (FEV1, PEF). CONCLUSIONS Our preliminary results suggest that continuous loco-regional ropivacaine administration via surgically placed intercostal catheter has no positive effect on postoperative pain scores or morphine requirements. CLINICAL REGISTRATION NUMBER NCT04939545 [ABSTRACT FROM AUTHOR]

Background: This study aimed to identify a specific SCLC population that would benefit from surgery. Methods: This study utilized patient data retrieved from the Surveillance, Epidemiology, and End Results (SEER) database spanning 2010 to 2017. To mitigate clinical biases, the propensity score matching (PSM) technique was employed. Separate cohorts were aligned using PSM according to the AJCC 8th edition TNM classification. The Kaplan–Meier method and a competing risk model were applied to evaluate overall survival (OS) and lung cancer–specific survival (LCSS), respectively. Outcomes: Among the 3394 patients with potentially resectable SCLC included in the study, 3062 underwent chemoradiotherapy and 332 underwent surgical treatment with adjuvant chemotherapy. Surgery was associated with better OS (median OS: 49 months; 95% CI: 35–63 months vs. 27 months; 95% CI: 21–33 months, p < 0.001) and LCSS (SHR, 0.578; 95% CI: 0.411–0.815, p < 0.001) in stage I patients after PSM. However, there was no significant difference in OS and LCSS between the surgery and nonsurgery groups in stage II and III patients after PSM. In the entire cohort, lobectomy was associated with improved OS (median OS: 48.6 vs. 28.7 months, p < 0.0001), but not LCSS (SHR, 0.696; 95% CI: 0.466–1.040, p = 0.078) compared with sublobar resection after PSM. Conclusion: Surgery with adjuvant chemotherapy significantly improved the survival prognosis of patients with early‐stage SCLC. However, surgical treatment should be carefully considered in patients with stage II/III disease. Lobectomy is oncologically equal to sublobar resection. [ABSTRACT FROM AUTHOR]

Background: There is a paucity of data concerning the feasibility and value of thoracic aortic stent graft implantation (TEVAR) applications for removing tumors infiltrating the aortic wall. This analysis aimed to demonstrate the feasibility of TEVAR and monitor the perioperative risks of morbidity and mortality. Additionally, a literature review was performed. Methods: A retrospective data analysis was performed on patients who received TEVAR prior to thoracic malignancy resection between January 2010 and April 2024. The primary endpoint was technical success. Results: A total of 15 patients (median age: 67 years; range: 23–75; 66.7% female) received TEVAR prior to thoracic surgery of different tumor entities. In 80% of cases (n = 12), the proximal landing zone was in aortic zone 3. In three cases, the supra-aortic debranching of LSA and/or LCCA via bypass implantation or in situ laser fenestration was necessary. No postoperative endograft-related complications were observed. In eight patients, aortic wall infiltration was confirmed intraoperatively. In total, R0 resection was achieved in seven patients (46.7%). The 30-day mortality rate was 6.7% (n = 1). Technical success was achieved in all patients (100%), while procedural success was achieved in 80% due to incomplete tumor resection in three patients. Conclusions: To the best of our knowledge, this is the largest analysis to date that confirms the results of previous smaller studies. Aortic stent grafting prior to thoracic tumor resection allows for extensive resection while maintaining low morbidity and a low 30-day mortality risk. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to examine the utility of a combination of the modified Caprini score and D-dimer levels for the evaluation and management of lower extremity venous thrombosis following lung cancer surgery. The purpose was to offer insights for developing clinical intervention programs. Methods: The study sample consisted of 224 patients who underwent surgery for lung cancer at the First Central Hospital of Baoding City. General patient data and D-dimer levels on the first day post-surgery were collected. The modified Caprini risk assessment score was calculated. All patients underwent ultrasonography of the lower limb veins before and after surgery to identify venous thrombosis in the lower limb veins. Differences in lower extremity venous thrombosis and D-dimer levels among patients in various modified Caprini score groups were compared and analyzed. Results: Based on the modified Caprini risk assessment score, all patients were categorized into three groups: the low-risk, medium-risk, and high-risk groups. The groups did not differ significantly in terms of age, but the differences in the rates of lower extremity venous thrombosis in the low, intermediate, and high-risk Caprini risk groups (16.5%, 19.2%, and 37.1%, respectively) were statistically significant. Out of the total 224 patients, 47 (21%) were diagnosed with venous thromboembolisms post-surgery, and all of them had thrombosis of the intermuscular veins of the lower extremity. The difference in the modified Caprini risk assessment score between patients with and without lower extremity venous thrombosis was statistically significant (P = 0.035), as were the postoperative D-dimer levels (1.28 ± 1.64 vs. 2.69 ± 2.77, respectively; P < 0.05) between these two groups of patients. The modified Caprini risk assessment score showed an association with lower extremity venous thrombosis (r = 0.15, P = 0.56) with an area under the receiver operating characteristic curve (AUC) of 0.59. Conclusion: In this study, we found that combining the modified Caprini risk assessment score with D-dimer measurements enhanced the accuracy of assessing the severity of deep vein thrombosis (DVT). This combination can be beneficial in evaluating thrombosis risk post-lung cancer surgery and holds significant clinical utility. [ABSTRACT FROM AUTHOR]

Background: The incidence of secondary tracheal tumours following lung cancer surgery is notably low. Patients with tracheal tumours typically present with symptoms such as coughing, sputum production, haemoptysis, wheezing, stridor, and dyspnoea. In cases of peripheral structure invasion, symptoms may further extend to hoarseness and dysphagia. Initial symptoms may be notably non-distinct. However, the development of pronounced airway symptoms often signifies a critical condition. Case presentation: A 70-year-old male with severe chest tightness and asthma was transferred to our hospital for emergency treatment. He had undergone left pneumonectomy for non-small cell carcinoma of the left upper lobe of the lung 3 years prior. The examination confirmed that a secondary tumour originated from the left main bronchus and extended to the carina, occupying 90% of the diameter of the tracheal lumen. To relieve the patient's emergency airway, we chose right thoracoscopic resection of the tracheal tumour assisted by cardiopulmonary bypass (CPB), which provides extracorporeal lung support and a good surgical field. Conclusion: In patients with secondary tracheal tumours after left pneumonectomy for lung cancer, perioperative airway management is challenging for anaesthesiologists, and patients' oxygenation should receive close attention. This article describes the airway management process of this patient for reference. [ABSTRACT FROM AUTHOR]

Purpose: Single lung transplantation (SLT) is a viable option for patients with end-stage pulmonary parenchymal and vascular diseases. However, various diseases can occur in native lungs after SLT. Methods: Between January 2000 and December 2021, 35 patients underwent cadaveric SLT and survived for more than 30 days in our hospital. Among these 35 patients, 10 required surgery for diseases that developed in their native lungs. The clinical characteristics of these 10 patients and the outcomes of native lung surgery (NLS) were investigated. Results: Among these ten patients, the indications for lung transplantation were chronic obstructive pulmonary disease and idiopathic interstitial pneumonia in three patients each, and lymphangioleiomyomatosis and collagen vascular disease-related interstitial pneumoniain two patients each. The causes of NLS included pneumothorax (n = 4), primary lung cancer (n = 2), native lung hyperinflation (n = 2), and pulmonary aspergilloma (n = 2). The surgical procedures were pneumonectomy (n = 7), lobectomy (n = 2), and alveolar-pleural fistula repair (n = 1). Only one postoperative complication, empyema, was treated with antibiotics. The 5-year overall survival rates after transplantation with and without NLS were 70.0% and 80.0%, respectively, and did not differ to a statistically extent (p = 0.56). Conclusion: NLS is an effective treatment option for diseases that develop in the native lungs after SLT. [ABSTRACT FROM AUTHOR]

Pulmonary metastasectomy (PM) is a well-established treatment that is able to contribute to the cure of oligometastatic cancer. Surgery should adopt the most lung-sparing approach possible to preserve pulmonary function (and, consequently, the quality of life) and to spare the lung for potential additional lung resections. In this framework, laser technology has been introduced in recent decades, but only few experiences combining laser technology with VATS approaches have been reported till now. The main focus of this manuscript is to report our institutional experience in performing lung-sparing laser-assisted PM by uniportal VATS (uniportal laser-assisted VATS: U-LA-VATS). The surgical technique and peri-operative results from our series of patients were herein presented and compared with the pertinent literature. Methods: Between March 2021 and November 2023, among 98 patients who underwent PM, a total of 24 patients (18 men (75%); 6 women (25%); mean age 61.4 years; age range 13–83 years) were treated with laser-assisted PM at our institution. Patients who underwent anatomical resection were excluded for the purpose of the analysis. The U-LA-VATS procedure adopted a modified laser-assisted lung resection technique for performing PM via VATS. Dedicated instruments are used, characterized by a long shape and a curved shape, with distal and proximal articulations. A surgical laser system (Thulium + Diodo OUTPUT 30–10 W, Quanta System S.p.a., Solbiate Olona, Italy) was used, and a 550-μm sterile optical fibre conducted through a specific thoracoscopic handpiece was introduced in the lowest part of the incision. Peri-operative results were analysed in all cohort and compared according to the surgical technique. Moreover, these results were compared with those reported in the literature. Comprehensive research of the literature was conducted on PubMed from 2000 to 2024. A review was performed and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results: In 12 cases (50%), thulium laser-assisted resection was performed using uniportal video-assisted thoracic surgery (VATS), and in the other cases (12, 50%), a (mini)thoracotomy access was adopted. In the thoracotomy group, the mean duration of surgery was 95 ± 57.7 min; meanwhile, it was 73.5 ± 35.5 in the uniportal VATS group. At the univariate analysis, this difference resulted to be statistically significant (p value 0.025). We did not observe intra-operative complications or remarkable malfunction of the laser system. We also did not report major complications after surgery; also the air-leak rate was 8.3% and 0% after thoracotomic and VATS procedures, respectively. Surgical margins were free from disease in all cases. Major and minor post-op complication rates were similar in both groups. The mean hospitalization after surgery was 2.9 ± 0.3 days for the uniportal VATS group and 3.7 ± 0.9 days for the thoracotomy group, this difference being statistically significant at the univariate analysis (p value = 0.015). Conclusions: U-LA-VATS is a safe and effective procedure, able to combine a parenchymal sparing exeresis with a mini-invasive approach. This procedure is associated with a shorter hospital stay compared with PM performed by a thoracotomic approach. Compared with the selected works for the review, our series is the only one describing the use of laser resection combined with a uniportal VATS approach. [ABSTRACT FROM AUTHOR]

A reply to a previous study on propofol anesthesia for thyroid and parathyroid surgery was published in the journal Anaesthesia. The authors of the reply thanked the previous authors for their interest and discussed the findings of their own study. They found that opioid-free propofol anesthesia reduced the incidence of postoperative nausea and vomiting (PONV) and improved patient satisfaction. They disagreed with the suggestion to analyze nausea, retching, and vomiting separately and provided data on the severity of PONV. The authors also discussed adverse effects and recovery time, concluding that opioid-free propofol anesthesia did not prolong recovery or increase resource utilization. [Extracted from the article]

Background: Some pulmonary tuberculosis patients may require lung resection surgery. Postoperative pulmonary rehabilitation is essential to restore the lung function and maintain quality of life. We aimed to study the pulmonary rehabilitation outcomes and complications of step-by-step Baduanjin exercise under a doctor-nurse-patient integration mode in patients after lobectomy due to pulmonary tuberculosis. Methods: We performed a randomized controlled clinical trial in patients undergoing lobectomy due to pulmonary tuberculosis between September 2017 and August 2021. Eligible patients were randomly assigned into the control group or interventional group. The control group received routine postoperative care. The interventional group received step-by-step Baduanjin exercise based on the doctor-nurse-patient integration mode in addition to the routine care. The primary outcomes were the pulmonary functions, including forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and FEV1/FVC. The secondary outcomes were the maximum walking distance in a 6-min walk test and postoperative pulmonary complications, including atelectasis, pneumonia, and respiratory failure. Results: A total of 100 patients were enrolled into the study, with 50 patients in the control and interventional groups. There were 60 female patients (60%). The mean patient age was 37.9 (± 2.8) years old. At the one- and two-month postoperative follow-ups, pulmonary function tests showed statistically significantly better performances in FEV1/prediction, FVC/prediction, and FEV1/FVC in the interventional group than the control group. The 6-min walk test also revealed longer walking distances in the interventional group than the control group. There were no statistically significant differences in postoperative complications between the two groups. Conclusions: A step-by-step Baduanjin exercise regimen under the doctor-nurse-patient integration mode could safely improve pulmonary rehabilitation in patients after lobectomy due to pulmonary tuberculosis. [ABSTRACT FROM AUTHOR]

Background and Purpose: Ineffective esophageal motility (IEM) is the most frequently diagnosed esophageal motility abnormality and characterized by diminished esophageal peristaltic vigor and frequent weak, absent, and/or fragmented peristalsis on high‐resolution esophageal manometry. Despite its commonplace occurrence, this condition can often provoke uncertainty for both patients and clinicians. Although the diagnostic criteria used to define this condition has generally become more stringent over time, it is unclear whether the updated criteria result in a more precise clinical diagnosis. While IEM is often implicated with symptoms of dysphagia and gastroesophageal reflux disease, the strength of these associations remains unclear. In this review, we share a practical approach to IEM highlighting its definition and evolution over time, commonly associated clinical symptoms, and important management and treatment considerations. We also share the significance of this condition in patients undergoing evaluation for anti‐reflux surgery and consideration for lung transplantation. [ABSTRACT FROM AUTHOR]

Background: The use of sublobar resection has increased with advances in imaging technologies. However, it is difficult for thoracic surgeons to identify small lung tumours intraoperatively. Radiofrequency identification (RFID) lung-marking systems are useful for overcoming this difficulty; however, accurate placement is essential for maximum effectiveness. Methods: We retrospectively reviewed patients who underwent RFID tag placement via fluoroscopic bronchoscopy under virtual bronchoscopic navigation (VBN) guidance before our institution's sublobar resection of lung lesions. Thirty-one patients with 31 lung lesions underwent RFID lung-marking with fluoroscopic bronchoscopy under VBN guidance. Results: Of the 31 procedures, 26 tags were placed within 10 mm of the target site, 2 were placed more than 10 mm away from the target site, and 3 were placed in a different area from the target bronchus. No clinical complications were associated with RFID tag placement, such as pneumothorax or bleeding. The contribution of the RFID lung-marking system to surgery was high, particularly when the RFID tag was placed at the target site and tumour was located in the intermediate hilar zone. Conclusions: An RFID tag can be placed near the target site using fluoroscopic bronchoscopy in combination with VBN guidance. RFID tag placement under fluoroscopic bronchoscopy with VBN guidance is useful for certain segmentectomies. [ABSTRACT FROM AUTHOR]

Studies of adults undergoing lung resection indicated that selective omission of pleural drains is safe and advantageous. Significant practice variation exists for pleural drainage practices for children undergoing lung resection. We surveyed pediatric surgeons in a 10-hospital research consortium to understand decision-making for placement of pleural drains following lung resection in children. Faculty surgeons at the 10 member institutions of the Western Pediatric Surgery Research Consortium completed questionnaires using a REDCap survey platform. Descriptive statistics and bivariate analyses were used to characterize responses regarding indications and management of pleural drains following lung resection in pediatric patients. We received 96 responses from 109 surgeons (88 %). Most surgeons agreed that use of a pleural drain after lung resection contributes to post-operative pain, increases narcotic use, and prolongs hospitalization. Opinions varied around the immediate use of suction compared to water seal, and half routinely completed a water seal trial prior to drain removal. Surgeons who completed fellowship within the past 10 years left a pleural drain after wedge resection in 45 % of cases versus 78 % in those who completed fellowship more than 10 years ago (p = 0.001). The mean acceptable rate of unplanned post-operative pleural drain placement when pleural drainage was omitted at index operation was 6.3 % (±4.6 %). Most pediatric surgeons use pleural drainage following lung resection, with recent fellowship graduates more often omitting it. Future studies of pleural drain omission demonstrating low rates of unplanned postoperative pleural drain placement may motivate practice changes for children undergoing lung resection. V. • What is currently known about this topic? Although adult trials have shown the safety and benefits of pleural drain omission following resectional lung surgery, few such trials exist in children. • What new information is contained in this article? Wide practice variations exist in pleural drain utilization and management, providing an opportunity for standardization of care and elimination of drains in a majority of patients. [ABSTRACT FROM AUTHOR]

Background: This retrospective observational study aimed to examine whether clinical inflammatory parameters were associated with the requirement dosage of unfractionated heparin (UFH) to maintain the range of ACT in veno-arterial extracorporeal membrane oxygenation (V-A ECMO) during lung transplantation surgery. Methods: Among all patients who underwent lung transplantation using V-A ECMO from January 2021 to May 2022, 27 patients were included. These patients were divided into two groups based on whether the infusion rate of UFH was increased from the initial infusion rate (7-8 units/kg/h) (increased group, n = 10) or the infusion rate was maintained or decreased (non-increased group, n = 17). The infusion rate was adjusted with an activated clotting time (ACT) target of 160-200 s. Results: At 1-2 h after starting ECMO, ACT was significantly lower (179.0 (166.5-188.5) versus 224.0 (193.0-242.0) sec, p = 0.006) and white blood cell (WBC) counts were higher in the increased group (12.6 ± 3.3 versus 9.5 ± 4.0 x 103/lL, p = 0.046). The UFH infusion rates were higher in the increased group during the surgery. The cutoff value of WBC count at 1-2 h after starting ECMO for discriminating the need for increasing the UFH dosage was determined as 10.2 x 103/lL (sensitivity 90.0%, specificity 58.8%, area under the curve 0.712) and discrimination of this cut-off value was confirmed as statistically significant (p = 0.018). Conclusion: These data suggested that WBC count was associated with the requirement of an increase in the UFH infusion rate of V-A ECMO during lung transplantation surgery. Further evaluation is necessary to clarify the role of WBC count in determining the optimal UFH dosage. [ABSTRACT FROM AUTHOR]

Background: Extensive surgical procedures play a key role in treatment of various lung diseases. Nevertheless, these complex procedures are associated with a high risk of early postoperative complications.Objective: To evaluate outcomes of the early postoperative period in patients with various lung diseases and determine risk factors for postoperative complications.Material and methods: We analyzed postoperative complications in 377 patients who underwent extensive lung surgery. The mean age was 45.7 ± 5.2 years. The majority of patients (56.0%) had malignant or benign lung tumors. Lobectomy was the most common type of surgery. Pneumonectomy accounted for 26.5%.Results: The overall rate of cardiovascular complications was 8.2%. The highest number of complications was observed after right-sided pneumonectomy (21.7%). Respiratory complications after right-sided pneumonectomy accounted for 34.8%. Lobectomy and bilobectomy had lower rates of complications (4.4% and 6.3%, respectively). The highest number of systemic complications was also recorded after right-sided pneumonectomy (23.9%), whereas lobectomy had a lower risk (4.4%). Patients with primary lung tumors had significantly more complications (32.2%) compared with patients without cancer (10.8%). The main risk factors were male gender (odds ratio [OR], 1.6; 95% CI, 1.1-2.2; P = .032), age ≥60 years (OR, 1.9; 95% CI, 1.5-2.6; P = .001), smoking (OR, 1.7; 95% CI, 1.2-2.5; P = .019), C-reactive protein level >3 mg/dL (OR, 1.8; 95% CI, 1.1-2.7; P = .015) and forced expiratory volume in the first second of expiration (FEV1)

Background: Despite increasing sub-specialization, general surgeons continue to perform oncologic thoracic surgeries. Our objective was to determine whether general surgery resident participation in thoracic surgery affects surgical quality or oncologic outcomes. We hypothesized that patient outcomes with and without resident participation would be similar. Methods: We retrospectively reviewed the electronic health records of patients with stage 0-IV lung cancer undergoing oncologic pulmonary resection at BLINDED FOR REVIEW during an 11-year period (2012-2022). Patients younger than 18 years or older than 85 years were excluded, as were those who had incomplete follow-up data or were unregistered in our institutional cancer registry. Patients were divided into groups based on whether residents or staff surgeons completed >50% of the critical portions of the operation. We compared 30-day morbidity outcomes, overall survival (OS), and disease-free survival (DFS). Results: Three hundred thirteen patients met inclusion criteria. Demographic and clinical characteristics were similar between groups, as were types of surgical resection and median operative times. A statistical difference was found in the distribution of surgical approach. The odds of morbidity were 65% higher in the Staff group (OR=1.65; 95% CI, 1.007-2.71). Resident participation was not significantly associated with OS or DFS (P =.32 and P =.54, respectively). Discussion: General surgery resident involvement in lung cancer operations is not associated with longer operative times but is associated with a higher likelihood of a thoracotomy. General surgery resident involvement was associated with decreased postoperative morbidity and did not significantly affect OS or DFS. [ABSTRACT FROM AUTHOR]

Background: The goal of the research was to examine the value of peripheral blood indicators in forecasting survival and recurrence among people suffering central‐type non‐small cell lung cancer (NSCLC) undergoing sleeve lobectomy (SL). Methods: Clinical information was gathered from 146 individuals suffering from NSCLC who had SL at our facility between January 2014 and May 2023. Peripheral blood neutrophil lymphocyte ratio (NLR), monocyte lymphocyte ratio (MLR), and platelet lymphocyte ratio (PLR) levels were determined by receiver operating characteristic (ROC) curve to establish the threshold points. Kaplan–Meier survival analysis was employed to evaluate the prognostic value of different groupings, and both univariate and multivariate Cox proportional hazards model (referred to as COX) were performed. Results: The disease‐free survival (DFS) and overall survival (OS) cutoff values were carried out via ROC analysis. Kaplan–Meier survival analysis revealed notable differences in OS for NLR (≥2.196 vs. <2.196, p = 0.0009), MLR (≥0.2763 vs. <0.2763, p = 0.0018), and PLR (≥126.11 vs. <126.11, p = 0.0354). Similarly, significant differences in DFS were observed for NLR (≥3.010 vs. <3.010, p = 0.0005), MLR (≥0.2708 vs. <0.2708, p = 0.0046), and PLR (≥126.11 vs. <126.11, p = 0.0028). Univariate Cox analysis showed that NLR (hazard ratio [HR]: 2.469; 95% confidence interval [CI]: 1.416–4.306, p < 0.001), MLR (HR: 2.192, 95% CI: 1.319–3.643, p = 0.002) and PLR (HR: 1.696, 95% CI: 1.029–2.795, p = 0.038) were correlated alongside OS. Multivariate Cox analysis showed that NLR (HR: 2.036, 95% CI: 1.072–3.864, p = 0.030) was a separate OS risk variable. Additionally, the pN stage (HR: 3.163, 95% CI: 1.660–6.027, p < 0.001), NLR (HR: 2.530, 95% CI: 1.468–4.360, p < 0.001), MLR (HR: 2.229, 95% CI: 1.260–3.944, p = 0.006) and PLR (HR: 2.249, 95% CI: 1.300–3.889, p = 0.004) were connected to DFS. Multivariate Cox analysis showed that pN stage (HR: 3.098, 95% CI: 1.619–5.928, p < 0.001) was a separate DFS risk variable. Conclusion: The study demonstrates that NLR, MLR, and PLR play a convenient and cost‐effective role in predicting survival and recurrence among individuals alongside central‐type NSCLC having SL. [ABSTRACT FROM AUTHOR]

Respiratory failure occurs more frequently after thoracic surgery than abdominal surgery. Although the etiology for this complication is frequently attributed to underlying lung disease present in patients undergoing thoracic surgery, this notion is often unfounded because many patients with normal preoperative pulmonary function often require prolonged oxygen supplementation even after minimal resection of lung tissue. Using a murine model of pulmonary resection and peripheral blood samples from patients undergoing resection of the lung or abdominal organs, we demonstrated that lung surgery initiates a proinflammatory loop that results in damage to the remaining lung tissue, noncardiogenic pulmonary edema, hypoxia, and even death. Specifically, we demonstrated that resection of murine lung tissue increased concentrations of the homeostatic cytokine interleukin-7, which led to local and systemic activation of type 2 innate lymphoid cells. This process activated lung-resident eosinophils and facilitated stress-induced eosinophil maturation in the bone marrow in a granulocyte-macrophage colony-stimulating factor–dependent manner, resulting in systemic eosinophilia in both mice and humans. Up-regulation of inducible nitric oxide synthase in lung-resident eosinophils led to tissue nitrosylation, pulmonary edema, hypoxia, and, at times, death. Disrupting this activation cascade at any stage ameliorated deleterious outcomes and improved survival after lung resection in the mouse model. Our data suggest that repurposing US Food and Drug Administration–approved eosinophil-targeting strategies may potentially offer a therapeutic intervention to improve outcomes for patients who require lung resection for benign or malignant etiology. Editor's summary: Respiratory failure frequently occurs after lung resection and may not be fully explained by underlying respiratory disease or the size of the resection. Here, Mei and colleagues used patient samples and mouse models of pneumonectomy to show that lung resection specifically leads to increased percentages of eosinophils through a mechanism involving production of IL-7 by γδ T cells, leading to granulocyte-macrophage colony-stimulating factor production by type 2 innate lymphoid cells, ultimately resulting in increased eosinophil maturation, activation, and production of reactive oxygen species that injure the remaining lung. Targeting different points in this pathway reduced lung damage and improved survival of mice after lung resection, suggesting that perioperative administration of agents that target eosinophils or neutralize nitric oxide synthase could potentially reduce the risk of respiratory failure after lung resection. —Melissa L. Norton [ABSTRACT FROM AUTHOR]

Introduction: Bronchiectasis, characterized by airway dilation, mucus hypersecretion, and recurrent exacerbations, is increasingly recognized in children and adolescents. Recent guidelines from the European Respiratory Society (ERS) and Thoracic Society of Australia and New Zealand (TSANZ) emphasize early diagnosis and optimized management. This review explores therapeutic strategies for pediatric bronchiectasis. Materials and methods: Our review involved a comprehensive search of English-language literature in the PubMed and EMBASE databases until December 2023, focusing on observational studies, interventions, reviews, and guidelines in pediatric bronchiectasis. Results: Management strategies encompass airway clearance techniques, mucoactive agents, pulmonary rehabilitation, bronchodilators and inhaled corticosteroids tailored to individual needs and age-appropriate techniques. Antibiotics play key roles in preventing exacerbations, eradicating pathogens, and managing acute exacerbations, which are guided by culture sensitivities and symptoms. Long-term antibiotic prophylaxis, particularly macrolides, aims to reduce exacerbations, although concerns about antibiotic resistance persist. Vaccinations, including pneumococcal and influenza vaccines, are crucial for preventing infections and complications. Surgery and lung transplantation are reserved to severe, refractory cases after failure of medical therapies. Conclusions: The optimal management of pediatric bronchiectasis requires a multidisciplinary approach, including physiotherapy, pharmacotherapy, and vaccinations, tailored to individual needs and guided by evidence-based guidelines. Further research is needed to refine diagnostic and therapeutic strategies and improve outcomes for affected children and adolescents. [ABSTRACT FROM AUTHOR]

Simple Summary: Lung cancer continues to be the leading cause of cancer-related deaths worldwide. Many patients present advanced disease at the time of the diagnosis. Neoadjuvant therapy aims to reduce the tumor stage and improve the operability of patients, and simultaneously leads to tumor regression. The tumor regression grade reflects the degree of pathological response to therapy. Thus, we conducted this study to identify the predictors for pathologic response after neoadjuvant treatment followed by surgery. The second goal of our research was to find the relationship between survival and tumor regression. Our study revealed that the histology of the primary tumor, lymph node size in the preoperative CT scan (>1.7 cm), and absolute tumor size reduction after neoadjuvant treatment (>2.6 cm) independently predict the effectiveness of tumor regression. Age > 70 years, extended resection > one lobe, and tumor recurrence or metastasis were identified as significant independent predictors of reduced overall survival. Our study aimed to identify predictors for the effectiveness of tumor regression in lung cancer patients undergoing neoadjuvant treatment and cancer resections. Patients admitted between 2016 and 2022 were included in the study. Based on the histology of the tumor, patients were categorized into a lung adenocarcinoma group (LUAD) and squamous cell carcinoma group (SQCA). Ninety-five patients with non-small-cell lung cancer were included in the study. A total of 58 (61.1%) and 37 (38.9%) patients were included in the LUAD and SQCA groups, respectively. Additionally, 9 (9.5%), 56 (58.9%), and 30 (31.6%) patients were categorized with a tumor regression score of I, II, and III, respectively. In multivariable analyses, histology of the primary tumor (SQCA), lymph node size in the preoperative CT scan (>1.7 cm), and absolute tumor size reduction after neoadjuvant treatment (>2.6 cm) independently predict effectiveness of tumor regression (OR [95% confidence interval, p-value] of 6.88 [2.40–19.77, p < 0.0001], 3.13 [1.11–8.83, p = 0.0310], and 3.76 [1.20–11.81, p = 0.0233], respectively). Age > 70 years, extended resection > one lobe, and tumor recurrence or metastasis were identified as significant independent predictors of reduced overall survival. Assessment of tumor size before and after neoadjuvant treatment might help to identify high-risk patients with decreased survival and to improve patient management and care. [ABSTRACT FROM AUTHOR]

Simple Summary: Lung-resected patients experience physical deterioration that limits their quality of life, but there are important gaps in the knowledge of the evolution of this deterioration. The aim of this study was to assess physical deterioration in lung cancer survivors in the short and medium term, using self-administered functional measures that would allow us to obtain information about patients' perceptions. These results can facilitate the future management of lung cancer patients after resection, reducing the sequelae they suffer and improving their quality of life. Background. Lung resection represents the main curative treatment modality for lung cancer. These patients present with physical deterioration that has been studied previously using objective variables; however, no previous studies have evaluated the self-perceived physical fitness of these patients. For these reasons, to increase the current knowledge on lung cancer patients' impairment, the aim of this study was to characterize the self-perceived physical deconditioning of lung cancer patients undergoing lung resection in the short and medium term after surgery. Methods. A longitudinal, observational, prospective cohort study was performed in the Thoracic Surgery Service of the Hospital Virgen de las Nieves (Granada). Symptoms (pain, fatigue, cough and dyspnea) and physical fitness (upper and lower limbs) were assessed before surgery, at discharge and at one month after discharge. Results. Among the total of 88 patients that we included in our study, significant differences were found at discharge in symptoms (p < 0.05) and physical fitness (p < 0.05). One month after surgery, higher levels of pain (p = 0,002) and dyspnea (p = 0.007) were observed, as well as poorer results in the upper (p = 0.023) and lower limbs' physical fitness, with regard to the initial values. Conclusions. Patients undergoing lung resection present an increase in symptoms and physical fitness deterioration at discharge, which is maintained one month after surgery. [ABSTRACT FROM AUTHOR]

Purpose: Saliva is often used as a tool for identifying systemic diseases because of the noninvasive nature of its collection. Moreover, salivary metabolites can be potential predictive factors for postoperative survival. We conducted the present study to establish whether salivary metabolites can function as predictive biomarkers for lung surgery complications. Methods: Unstimulated salivary samples were collected from 412 patients before lung surgery. Salivary metabolites were analyzed comprehensively by capillary electrophoresis mass spectrometry. Clinical data with the discriminatory ability of biomarkers were assessed to predict lung surgery complications using multivariate logistic regression analysis. The primary endpoint was the risk factors for postoperative complications of Clavien–Dindo grade ≥ III. Results: Postoperative complications of Clavien–Dindo grade ≥ III developed in 36 patients (8.7%). There was no postoperative 30-day mortality. Male sex (odds ratio [OR], 3.852; 95% confidence interval CI 1.455–10.199; p = 0.007) and salivary gamma-butyrobetaine (OR, 0.809; 95% CI 0.694–0.943; p = 0.007) were identified as significant risk factors for postoperative complications of Clavien–Dindo grade ≥ III. Conclusion: Salivary metabolites are potential noninvasive biomarkers for predicting postoperative complications of lung surgery. [ABSTRACT FROM AUTHOR]

Purpose: Robotic-assisted thoracoscopic surgery (RATS) is a relatively new approach to lung cancer surgery. To promote the development of RATS procedures, we investigated the factors related to short-term postoperative outcomes. Methods: We analyzed the records of patients who underwent RATS lobectomy for primary lung cancer at our institution between June, 2018 and January, 2023. The primary outcome was operative time, and the estimated value of surgery-related factors was calculated by linear regression analysis. The secondary outcome was surgical morbidity and the risk was assessed by logistic regression analysis. Results: The study cohort comprised 238 patients. Left upper lobectomy had the longest mean operative time, followed by right upper lobectomy. Postoperative complications occurred in 13.0% of the patients. Multivariate analysis revealed that upper lobectomy, the number of staples used for interlobular fissures, and the number of cases experienced by the surgeon were significantly associated with a longer operative time. The only significant risk factor for postoperative complications was heavy smoking. Conclusion: Patients with well-lobulated middle or lower lobe lung cancer who are not heavy smokers are recommended for the introductory period of RATS lobectomy. Improving the procedures for upper lobectomy and dividing incomplete interlobular fissures will promote the further development of RATS. [ABSTRACT FROM AUTHOR]

Background: Securing the airway in the emergency department (ED) is a high-stakes procedure; however, the primary success and complication rate are largely unknown in Germany. The aim of this study was a retrospective analysis of prospectively collected resuscitation room data for endotracheal intubation (ETI) regarding indications, performance and complications. Method: Between 1 January 2020 and 30 June 2023 all ETIs conducted in the ED (Kliniken Maria Hilf, Moenchengladbach, Germany) were analyzed following approval by the ethics committee (EK 23-369). Primary intubations performed by the anesthesiology department were excluded. The core medical team of the ED underwent a six-week training program including a two-week anesthesia rotation prior to performing ETI in the ED. There were standard operating procedures (SOP) for both rapid sequence induction (RSI) and airway exchange with a placed laryngeal tube (LT) utilizing video laryngoscopy (C-Mac, Storz), rocuronium for relaxation and primary intubation with an elastic bougie. The primary success rate, overall success rate and intubation-related complications were analyzed. Additionally, the factor of consultant ED staff and residents was evaluated with respect to the primary success rate. Results: During the study period 499 patients were intubated by the core ED team and 28 patients underwent airway exchange from LT to ETI. Primary success could be achieved in 489/499 (98.0%) ETI and in 25/28 (89.3%) LT exchange patients. Surgically achieved securing of the airway was carried out in 5/527 (0.9%) patients in a cannot intubate situation and 11/527 (2.2%) patients suffered cardiac arrest minutes after the ETI. The overall first pass success rate of endotracheal tube placement was 514/527 (97.4%). The comparison of the primary success of consultants (168/175; 96.0%) vs. residents 320/325 (98.5%) yielded no significant differences (p = 0.08). Conclusion: In clinical acute and emergency medicine, a standardized approach utilizing video laryngoscopy and a bougie following a structured training concept, can achieve an above-average high primary success rate with simultaneous low severe complications in the high-risk collective of critically ill emergency patients in an intrahospital setting. [ABSTRACT FROM AUTHOR]

Purpose: Prior studies have described complications of radiofrequency ablation (RFA) of liver tumours. The aim of this study was to identify risk factors for hospitalization duration longer than 24 hours following RFA of liver tumours. Methods: This retrospective, single-centre study included patients with liver tumours undergoing RFA between October 2017 and July 2020. Medical records were reviewed to collect patient, tumours, and procedure characteristics for each RFA session. The association between potential risk factors and duration of hospitalization (less than or more than 24 hours) was analyzed using univariate and multivariate logistic regressions. Results: Our study included 291 patients (mean age: 65.2 ± 11.2 [standard deviation]; 201 men) undergoing 324 RFA sessions. Sixty-eight sessions (21.0%) resulted in hospitalization of more than 24 hours. Multivariate analysis identified each additional needle insertion per session (OR 1.4; 95% CI [1.1-1.9]; P =.02), RFA performed in segment V (OR 2.8; 95% CI [1.4-5.7]; P =.004), and use of artificial pneumothorax (OR 14.5; 95% CI [1.4-146.0]; P =.02) as potential risk factors. A history of hepatic encephalopathy (OR 2.6; 95% CI [1.1-6.0]; P =.03) was only significant in univariate analysis. Post-hoc, subgroup analysis of patients with hepatocellular carcinoma (69.8%) did not identify other risk factors. Conclusion: Risk factors for a hospitalization duration longer than 24 hours include a higher number of needle insertions per session, radiofrequency ablation in segment V, and use of an artificial pneumothorax. [ABSTRACT FROM AUTHOR]

Background Body mass index (BMI) has been shown to be an independent predictor of survival following lung resection surgery. This study aimed to quantify the short- to midterm impact of abnormal BMI on postoperative outcomes. Methods Lung resections at a single institution were examined between 2012 and 2021. Patients were divided into low BMI (<18.5), normal/high BMI (18.5–29.9), and obese BMI (>30). Postoperative complications, length of stay, and 30- and 90-day mortality were examined. Results A total of 2,424 patients were identified. Of these patients, 2.6% (n = 62) had a low BMI, 67.4% (n = 1,634) had a normal/high BMI, and 30.0% (n = 728) had an obese BMI. Overall postoperative complications were higher in the low BMI group (43.5%) when compared with normal/high (30.9%) and obese BMI group (24.3%) (p = 0.0002). Median length of stay was significantly higher in the low BMI group (8.3 days) compared with 5.2 days in the normal/high and obese BMI groups (p < 0.0001). Ninety-day mortality was higher in the low (16.1%) compared with the normal/high (4.5%) and obese BMI groups (3.7%) (p = 0.0006). Subgroup analysis of the obese cohort did not elucidate any statistically significant differences in overall complications in the morbidly obese. Multivariate analysis determined that BMI is an independent predictor of reduced postoperative complications (odds ratio [OR], 0.96; 95% confidence interval [CI], 0.94–0.97; p < 0.0001) and 90-day mortality (OR, 0.96; 95% CI, 0.92–0.99; p = 0.02). Conclusion Low BMI is associated with significantly worse postoperative outcomes and an approximate fourfold increase in mortality. In our cohort, obesity is associated with reduced morbidity and mortality following lung resection surgery, confirming the existence of the obesity paradox. [ABSTRACT FROM AUTHOR]

Background The aim of this study was to evaluate the safety and feasibility of simultaneous surgery for patients with primary esophageal and lung cancers. Methods Patients with primary esophageal and lung cancers who underwent simultaneous surgical procedures between January 2016 and January 2022 were retrospectively analyzed. The data of patients who underwent esophagectomy and lobectomy (group EL) were compared with those of patients who underwent esophagectomy and sublobar resection (group ES). Results A total of 21 patients were included with an average age of 64.62 ± 5.24 years. Group EL contained 8 patients and group ES contained 13 patients. All procedures were completed uneventfully with a mean operative time of 251.19 ± 66.93 minutes. Pulmonary complications occurred in six (28.57%) patients. Other complications included anastomotic leakage in 1 patient, pleural effusion requiring drainage in 8 patients, atrial fibrillation in 2 patients, and incision infection in 1 patient. All patients were followed up for 30.23 ± 21.82 months. During the follow-up period, nine patients had a recurrence of cancer and died of tumor progression, and one patient died of a tracheothoracogastric fistula. Complications and mortality in group EL did not increase when compared to those in group ES. Conclusion It is safe and feasible to perform a single-stage surgical procedure for patients with primary esophageal and lung cancers. Simultaneous esophagectomy and lobectomy did not increase postoperative complications or mortality compared with esophagectomy and sublobar resection. [ABSTRACT FROM AUTHOR]

Purpose: The potential of uniportal video-assisted thoracic surgery (U-VATS) to reduce chronic pain after thoracic surgery (CPTS) compared to open thoracotomy (OT) remains unexplored. This prospective study aims to assess the incidence of CPTS following U-VATS or OT and identify associated risk factors. Methods: Patients undergoing thoracic surgery were recruited from March 2021 to March 2022, categorized by surgical approach (U-VATS vs. OT). Standard clinical protocols for surgery, anesthesia, and analgesia were followed. Pain symptoms were assessed using the Short-form McGill Pain Questionnaire, with follow-ups up to 6 months. Perioperative factors influencing CPTS at 3 months were analyzed through univariate and multivariate methods. Results: A total of 694 patients were analyzed. Acute pain after thoracic surgery (APTS) was significantly less severe in the U-VATS group (p < 0.001). U-VATS patients exhibited a lower incidence of CPTS at 3 months (63.4% vs. 80.1%, p < 0.001), with reduced severity among those experiencing CPTS (p = 0.007) and a decreased occurrence of neuropathic pain (p = 0.014). Multivariate analysis identified OT incision, moderate to severe APTS (excluding moderate static pain at 24 h postoperative), nocturnal surgery, and lung surgery as risk factors for CPTS. Conclusion: This study underscores the potential of U-VATS to reduce both the incidence and severity of CPTS at 3 months compared to OT. Furthermore, it highlights risk factors for CPTS, including OT incision, inadequately managed APTS, lung surgery, and nocturnal surgery. These findings emphasize the importance of considering surgical approach and perioperative pain management strategies to mitigate the burden of CPTS. [ABSTRACT FROM AUTHOR]

Introduction: Atrial fibrillation (AF) represents the most common arrhythmia in the postoperative setting. We aimed to investigate the incidence of postoperative AF (POAF) and determine its predictors, with a specific focus on inflammation markers. Methods: We performed a retrospective single tertiary center cohort study including consecutive adult patients who underwent a major surgical procedure between January 2016 and January 2020. Patients were divided into four subgroups according to the type of surgery. Results: Among 53,387 included patients (79.4% male, age 64.5 ± 9.5 years), POAF occurred in 570 (1.1%) with a mean latency after surgery of 3.4 ± 2.6 days. Ninety patients died (0.17%) after a mean of 13.7 ± 8.4 days. The 28‐day arrhythmia‐free survival was lower in patients undergoing lung and cardiovascular surgery (p <.001). Patients who developed POAF had higher levels of C‐reactive protein (CRP) (0.70 ± 0.03 vs. 0.40 ± 0.01 log10 mg/dl; p <.001). In the multivariable Cox regression analysis, adjusting for confounding factors, CRP was an independent predictor of POAF [HR per 1 mg/dL increase in log‐scale = 1.81 (95% CI 1.18–2.79); p =.007]. Moreover, independent predictors of POAF were also age (HR/1 year increase = 1.06 (95% CI 1.04–1.08); I <.001), lung and cardiovascular surgery (HR 23.62; (95% CI 5.65–98.73); p <.001), and abdominal and esophageal surgery (HR 6.26; 95% CI 1.48–26.49; p =.013). Conclusions: Lung and cardiovascular surgery had the highest risk of POAF in the presented cohort. CRP was an independent predictor of POAF and postsurgery inflammation may represent a major driver in the pathophysiology of the arrhythmia. [ABSTRACT FROM AUTHOR]

Background: Inhibition of 5-HT3 (5-Hydroxyl Tryptamine) receptors is known to enhance morphine analgesia in animal models. We tested the efficacy of azasetron, a 5-HT3 receptor antagonist, on postoperative chronic pain after pulmonary surgery in a randomized triple-blind controlled study. Methods: A total of 250 patients who were scheduled to receive pulmonary surgery were randomized to patient-controlled analgesia (PCA) using 200 µg sufentanil with normal saline or 200 µg sufentanil with 20 mg azasetron. The numerical rating scale of pain (NRS) was recorded at baseline, postoperative day (POD) 1, 2, 3, 90, and 180. Negative binomial regression was used to identify associated factors for postoperative NRS six months after surgery. Results: The results showed that azasetron did not affect the primary outcomes: the incidence of postoperative chronic pain on POD90 and 180. However, azasetron decreased postoperative NRS at rest and activity on POD1, 2, and 3. Furthermore, azasetron decreased postoperative nausea and vomiting on POD1 and 2. Univariate and multivariate negative binomial regression analysis identified preoperative pain, smoking, drinking and open surgery are risk factors of chronic pain six months after surgery. Conclusions: Azasetron did not affect the incidence of chronic pain after pulmonary surgery. The presence of preoperative pain, smoking, drinking, and open surgery were found to be associated with chronic pain six months after surgery. Clinical trial registration: The trial was registered prior to patient enrollment at the Chinese Clinical Trial Registry (ChiCTR2200060139), 20/05/2022; the site url is https://www.chictr.org.cn/. [ABSTRACT FROM AUTHOR]

Objective The evaluation of lymph node properties before lung cancer surgery has a great impact with the choice of surgical methods. Although there are various examination methods, many methods have invasive or accuracy problems. In order to improve the accuracy of diagnosis, we mainly discuss the value of wide- body spectral CT in the differential diagnosis of mediastinal metastatic lymph nodes, non-metastatic lymph nodes in lung cancer patients and reactive hyperplastic lymph nodes. Methods The clinical and imaging data of 64 patients with lung cancer and 28 patients with pulmonary inflammatory lesions were retrospectively analyzed. All patients underwent plain scan and enhanced dual-phase spectral CT scan. The size, density, three-phase IC, NIC, and λHU of lymph nodes in metastatic, non-metastatic and inflammatory reactive hyperplasia groups were measured on 70 keV single-energy images and iodine-based images, respectively. The single-factor variance and Kruskal-Wallis H rank sum test were used to analyze and compare the differences. Results The short diameter of metastatic lymph nodes was larger than that of non-metastatic lymph nodes and reactive hyperplastic lymph nodes (P < 0.001) . The plain scan density of reactive hyperplastic lymph nodes was higher than that of metastatic lymph nodes (P < 0.001), but there was no significant difference between non-metastatic lymph nodes (P = 0.325) . The CT values of reactive hyperplastic lymph nodes in arterial phase and venous phase were higher than those of metastatic and non-metastatic lymph nodes (P < 0.05) . Except for NIC in arterial phase, IC, NIC and λHU in plain scan, IC and λHU in arterial phase, IC, NIC and λHU in venous phase of reactive hyperplastic lymph nodes and metastatic lymph nodes were statistically significant (all P < 0.05) . There was no significant difference in IC, NIC and λHU between reactive hyperplastic lymph nodes and non-metastatic lymph nodes in plain scan, arterial phase and venous phase (all P > 0.05) . Conclusion The quantitative and spectral curve slope of iodine in mediastinal metastatic lymph nodes of lung cancer were basically lower than those in reactive hyperplastic lymph nodes. The quantitative parameters of spectral CT had certain diagnostic efficacy in differentiating metastatic lymph nodes and reactive hyperplastic lymph nodes, while the spectral parameters of non-metastatic lymph nodes and reactive hyperplastic lymph nodes were not statistically significant. [ABSTRACT FROM AUTHOR]

Night work is frequently associated with sleep deprivation and is associated with greater surgical and medical complications. Lung transplantation (LT) is carried out both at night and during the day and involves many medical healthcare workers. The goal of the study was to compare morbidity and mortality between LT recipients according to LT operative time. We performed a retrospective, observational, single-center study. When the procedure started between 6 AM and 6 PM, the patient was allocated to the Daytime group. If the procedure started between 6 PM and 6 AM, the patient was allocated to the Nighttime group. Between January 2015 and December 2020, 253 patients were included. A total of 168 (66%) patients were classified into the Day group, and 85 (34%) patients were classified into the Night group. Lung Donors' general characteristics were similar between the groups. The 90-day and one-year mortality rates were similar between the groups (90-days: n = 13 (15%) vs. n = 26 (15%), p = 0.970; 1 year: n = 18 (21%) vs. n = 42 (25%), p = 0.499). Daytime LT was associated with more one-year airway dehiscence (n = 36 (21%) vs. n = 6 (7.1%), p = 0.004). In conclusion, among patients who underwent LT, there was no significant association between operative time and survival. [ABSTRACT FROM AUTHOR]

Background: The ultrasonic scalpel is widely used during surgery. It is safe and effective to close the pulmonary artery branch vessels of 7 mm or below with an ultrasonic energy device as reported. However, there have been no multicenter randomized clinical trial to assess the safety and effectiveness of using ultrasonic scalpel to coagulate 5–7 mm blood vessels in thoracic surgery. Methods: This is a prospective, multicenter, randomized, parallel controlled, non-inferiority clinical trial. A total of 144 eligible patients planning to undergo lung or esophageal surgery will be randomly allocated to the experimental group and the control group. The investigational product (Disposable Ultrasonic Shears manufactured by Reach Surgical, Inc.) and the control product (Harmonic Ace + 7, 5 mm Diameter Shears with Advanced Hemostasis) will be used in each group. The primary endpoint is the success rate of coagulating target blood vessels during surgery. Secondary endpoints include postoperative rebleeding, intraoperative bleeding volume, drainage volume, surgical duration, etc. Postoperative follow-up before and after discharge will be performed. Discussion: This clinical trial aims to evaluate the safety and effectiveness of using the investigational product (Disposable Ultrasonic Shears manufactured by Reach Surgical, Inc.) and that of the control product (Harmonic Ace + 7, 5 mm Diameter Shears with Advanced Hemostasis) to coagulate 5–7 mm blood vessels in thoracic surgery. Trial registration: ClinicalTrials.gov: NCT06002737. The trial was prospectively registered on 16 August 2023, https://www.clinicaltrials.gov/study/NCT06002737. [ABSTRACT FROM AUTHOR]

Purpose: Radical surgery is the primary treatment for early-stage resectable lung cancer, yet recurrence after curative surgery is not uncommon. Identifying patients at high risk of recurrence using preoperative computed tomography (CT) images could enable more aggressive surgical approaches, shorter surveillance intervals, and intensified adjuvant treatments. This study aims to analyze lung cancer sites in CT images to predict potential recurrences in high-risk individuals. Methods: We retrieved anonymized imaging and clinical data from an institutional database, focusing on patients who underwent curative pulmonary resections for non-small cell lung cancers. Our study used a deep learning model, the Mask Region-based Convolutional Neural Network (MRCNN), to predict cancer locations and assign recurrence classification scores. To find optimized trained weighted values in the model, we developed preprocessing python codes, adjusted dynamic learning rate, and modifying hyper parameter in the model. Results: The model training completed; we performed classifications using the validation dataset. The results, including the confusion matrix, demonstrated performance metrics: bounding box (0.390), classification (0.034), mask (0.266), Region Proposal Network (RPN) bounding box (0.341), and RPN classification (0.054). The model successfully identified lung cancer recurrence sites, which were then accurately mapped onto chest CT images to highlight areas of primary concern. Conclusion: The trained model allows clinicians to focus on lung regions where cancer recurrence is more likely, acting as a significant aid in the detection and diagnosis of lung cancer. Serving as a clinical decision support system, it offers substantial support in managing lung cancer patients. [ABSTRACT FROM AUTHOR]

Objective: Unusual clinical course Background: Guillain-Barré syndrome (GBS) is a rare immune-mediated peripheral nerve disorder. Among non-infectious factors, surgery has been identified as a potential trigger of the disease. This report presents the case of a 74-yearold man who developed GBS 15 days after a right lower lobectomy for lung adenocarcinoma. Case Report: We present a case of a patient who was a former smoker who underwent uniportal video-assisted (U-VATS) right lower lobectomy for localized lung adenocarcinoma. Fifteen days after surgery, he exhibited bilateral lower- limb weakness, widespread paresthesia, and postural instability. Comprehensive diagnostic workup, including clinical assessment, serological tests, cerebrospinal fluid (CSF) analysis, and nerve conduction studies (NCS), confirmed the diagnosis. Notably, CSF analysis revealed albumin-cytological dissociation, with albumin 453.2 mg/L, protein 757 mg/L, glucose 67 mg/dl, 3 white blood cells (WBC)/uL, and polymorphonucleates (PMN) 33%. NCS demonstrated motor and sensory abnormalities. Prompt administration of intravenous immunoglobulins (IVIG) 2 g/kg daily for 5 days resulted in complete recovery within 3 months. Conclusions: This case emphasizes the importance of prompt recognition and management of GBS as a postoperative complication. Neurological examination, neuroimaging, and electrophysiological studies are essential for accurate diagnosis. IVIG therapy remains a cornerstone in GBS management, with favorable outcomes observed in this case. Enhanced awareness among clinicians about the potential association between surgery and GBS is vital to prevent more serious complications and ensure optimal patient management. Further research is crucial to determine the precise pathogenesis and mechanisms of GBS following lung surgery. [ABSTRACT FROM AUTHOR]

Introduction. Several studies have shown the survival benefit of bilateral lymph node dissection as part of curative- -intent surgery for lung cancer. The pilot BML-1 study was the first randomized trial comparing bilateral with the standard (unilateral) systematic lymph node dissection. Material and methods. Patients with non-small cell lung cancer stage I–IIIA, who underwent anatomical lung resection were randomised 1:1 to receive a bilateral or standard, unilateral lymphadenectomy. Data regarding the type of recurrence and time to recurrence were analysed. Results. The rate of locoregional recurrence in the bilateral lymphadenectomy and the standard lymphadenectomy were 2.7% and 5.3% and those of distant relapse were 24.3% and 23.7% respectively (p = 0.99). The follow-up time was 87 months. The mean time from surgery to recurrence was 35.0 months and 22.8 months, respectively (p = 0.83). Conclusions. There is no firm evidence that bilateral mediastinal lymphadenectomy (BML) is associated with a recurrence pattern that is different than that following the systematic lymph node dissection (SLND). We found a trend towards lower incidence of local recurrence and longer time to recurrence in the BML group, but the differences were statistically not significant. A large randomised study is warranted to further analyse this matter. [ABSTRACT FROM AUTHOR]

Objective: In this study, we compared the analgesic effects of intercostal nerve block (ICNB), ultrasound-guided paravertebral nerve block (PVB), and epidural block (EB) following single-port thoracoscopic lung surgery. Method: A total of 120 patients who underwent single-hole thoracoscopic lung surgery were randomly and equally divided into three groups: ICNB group, the PVB group, and the EB group. ICNB was performed under direct thoracoscopic visualization before the conclusion of the surgery in the ICNB group, while PVB and EB were performed after general anesthesia in the PVB and EB groups, respectively. Patient-controlled intravenous analgesia (PCIA) was used following the surgery in all the groups. The following indicators were recorded: Intraoperative sufentanil dosage, anesthesia awakening time, postoperative intubation time, nerve block operation time, postoperative visual analog scale (VAS) pain scores during resting and coughing at regular intervals of 0, 2, 4, 8, 24, and 48 h, the time until first PCIA, number of effective compressions within 24 h postoperatively, number of rescue analgesia interventions, and the side effects. Results: In comparison to the ICNB group, the PVB and EB groups had a lower intraoperative sufentanil dosage, significantly shorter anesthesia awakening time, and postoperative intubation time, but longer nerve block operation time, lower VAS scores when resting and coughing within 24 h postoperatively (all p-values less than 0.05). Conversely, there were no statistically significant differences in VAS scores during resting and coughing after 24 h (all p-values greater than 0.05). Time to first PCIA, number of effective compressions and number of rescue analgesia at the 24-hour mark postoperatively were significantly better in the PVB and EB groups than that in the ICNB group (P < 0.05). However, there was a higher incidence of side effects observed in the EB group (P < 0.05). Conclusion: The analgesic effect of PVB and EB following single-port thoracoscopic lung surgery is better than that of ICNB. PVB causes fewer side effects and complications and is safer and more effective. [ABSTRACT FROM AUTHOR]