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Tak Kyu Oh,1 Kwhanmien Kim,2 Sanghoon Jheon,2 Sang-Hwan Do,1 Jung-Won Hwang,1 Jin Hee Kim,1 Young-Tae Jeon,1 In-Ae Song1 1Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea; 2Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam, Korea Purpose: The relationship between chronic smoking history and postoperative pain remains controversial. This study aimed to elucidate this relationship in non-small cell lung cancer (NSCLC) patients who underwent video-assisted thoracic surgery (VATS) lobectomy.Patients and methods: This retrospective observational study included NSCLC patients treated with VATS lobectomy between January 2011 and July 2017. Demographic and clinical information, including preoperative smoking history, was collected. The primary goal was to investigate the relationship between smoking history and postoperative pain outcomes (oral morphine equivalent [OME] consumption and pain score). Multivariate linear regression analysis was performed, and P0.05). However, patients who had never smoked consumed less morphine equivalent analgesics (mg) on postoperative days 0–2 (coefficient: −17.48, 95% CI [−33.83, −1.13], P=0.036) compared to patients who had a history of smoking.Conclusion: Patients who had never smoked had lower opioid analgesics consumption on the days immediately following surgery, while being a current smoker or the total amount of smoking in packs did not affect postoperative pain outcomes after VATS lung lobectomy. Keywords: anesthesia, analgesia, opioid, postoperative pain, smoking

Miyoung Choi,1 Worl Suk Lee,1 Min Lee,1 Kyeongman Jeon,2 Seungsoo Sheen,3 Sanghoon Jheon,4 Young Sam Kim5 1National Evidence-Based Healthcare Collaborating Agency, Seoul, Republic of Korea; 2Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; 3Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, Republic of Korea; 4Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea; 5Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea Background: Bronchoscopic lung volume reduction (BLVR) can be suggested as an alternative for surgical lung volume reduction surgery for severe emphysema patients. This article intends to evaluate by systematic review the safety and effectiveness of BLVR using a one-way endobronchial valve.Methods: A systematic search of electronic databases, including MEDLINE, EMBASE, and the Cochrane Library, as well as eight domestic databases up to December 2013, was performed. Two reviewers independently screened all references according to selection criteria. The Scottish Intercollegiate Guidelines Network criterion was used to assess quality of literature. Data from randomized controlled trials were combined and meta-analysis was performed. Results: This review included 15 studies. Forced expiratory volume in 1 second (FEV1) improved in the intervention group compared with the control group (mean difference [MD]=6.71, 95% confidence interval [CI]: 3.31–10.11). Six-minute walking distance (MD=15.66, 95% CI: 1.69–29.64) and cycle workload (MD=4.43, 95% CI: 1.80–7.07) also improved. In addition, St George’s Respiratory Questionnaire score decreased (MD=4.29, 95% CI: -6.87 to -1.71) in the intervention group. In a subgroup analysis of patients with complete fissure, the FEV1 change from baseline was higher in the BLVR group than in the control group for both 6 months (MD=15.28, P

Abstract Background An association between innate immunity including Toll-like receptors (TLRs) and COPD is reported recently; TLR4 deficiency in lung can cause emphysema in animals, which is not evident in humans. We analyzed the association of TLR4 expression, airflow limitation and emphysema in smokers. Methods We enrolled patients of ≥40years old with smoking histories of ≥10 pack-years and who had undergone lung resection. We measured TLR4 expression in lung lysates. The severity of emphysema was evaluated on computed tomography. TLR4 expression was also evaluated immunohistochemically. Results In total, 53 patients were enrolled. Forced expiratory volume in one second per forced vital capacity (FEV1/FVC) increased (P=0.03) and emphysema score decreased (P=0.01) as TLR4 expression increased. These were still significant, in multiple regression analysis including sex, age, tuberculosis history, smoking history and inhaled corticosteroid (ICS) usage. We also classified patients as high, intermediate, and low expressers according to TLR4 expression. Although no differences in age, gender, tuberculosis, or smoking history were observed among the groups, emphysema severity increased significantly (P = 0.02) and FEV1/FVC decreased significantly (P = 0.006) in TLR4 low expresser. The difference in TLR4 expression based on immunohistochemistry was most prominent in bronchial and alveolar epithelial cells. Conclusion Down-regulated TLR4 expression in lung was associated with emphysema and airflow limitation in smokers.

Background: This study aimed to evaluate the long-term impact of postoperative prolonged air leak (PAL) on pulmonary function., Methods: We enrolled 1,316 patients with pathologic stage I-III lung cancer who underwent lobectomy. The cohort was divided into 2 groups: those who experienced PAL (n=55) and those who did not (n=1,261). Propensity score matching was conducted at a 1:4 ratio, resulting in 49 patients in the PAL group and 189 in the non-PAL group. Changes in pulmonary function were compared among preoperative, 6-month postoperative, and 12-month postoperative measurements between the 2 groups., Results: The variables used for propensity score matching included age, sex, smoking history, body mass index, baseline pulmonary function, pathologic stage, and surgical approach. All standardized mean differences were less than 0.1. Six months postoperatively, the PAL group showed a greater reduction in both forced expiratory volume in 1 second (FEV 1 ) (-13.0% vs. -10.0%, p=0.041) and forced vital capacity (FVC) (-15.0% vs. -9.0%, p<0.001) than the non-PAL group. In cases of upper lobectomy, there were no significant differences in FEV 1 changes between the PAL and non-PAL groups at both 6 and 12 months. However, in lower lobectomy, the PAL group demonstrated a more pronounced decrease in FEV 1 (-14.0% vs. -11.0%, p=0.057) and FVC (-20.0% vs. -13.0%, p=0.006) than the non-PAL group at 6 months postoperatively., Conclusion: Postoperative PAL delayed the recovery of pulmonary function after lobectomy. These effects were markedly more pronounced after lower lobectomy than after upper lobectomy.

Purpose: Primary tumor resection and metastasectomy are curative for metastatic colorectal cancer. However, there is still a paucity of data regarding the clinical outcomes and risk factors after disease recurrence and second metastasectomy., Materials and Methods: We retrospectively evaluated the clinical outcomes of patients who underwent the second metastasectomy. In addition, risk factors for the outcomes were analyzed., Results: A total of 94 patients (39 females and 55 males) received a second metastasectomy after the recurrence. Recurrent sites included the lung (47 patients), liver (36 patients), both lung and liver (four patients), and non-lung/non-liver (seven patients). Among them, 89 (94.7 %) patients achieved R0 resection, while three (3.2 %) and two (2.1 %) patients achieved R1 and R2 resections, respectively. The 5-year disease-free survival (DFS) and overall survival (OS) were 42.8±5.3 % and 67.2±4.9 %, respectively. Multivariable analysis for DFS identified that primary rectal cancer (hazard ratio [HR] 0.45, P=0.033) and disease-free interval after the first metastasectomy of ≥12 months (HR 0.39, P=0.002) were good predictive factors; in contrast, non-lung/non-liver metastasis (HR 3.32, P=0.020) was a poor predictive factor. Multivariable analysis for OS showed that age ≥70 years (HR 3.27, P=0.011), non-lung/non-liver metastasis (HR 4.04, P=0.024), and lesion number ≥2 (HR 2.25, P=0.023) were poor prognostic factors., Conclusion: Patients who underwent a second metastasectomy had a long-term disease-free state and good OS. Our data suggest that a second metastasectomy should be considered if a patient has a limited number of metastases confined to the liver and/or lung and long DFS after the first metastasectomy., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: This study investigated the prognostic impact of non-predominant lepidic components in invasive nonmucinous adenocarcinoma., Methods: Patients who underwent lobectomy and were diagnosed with stage I nonmucinous, non-lepidic-predominant invasive adenocarcinoma based on pathologic findings were included. Tumors were staged according to the eighth edition of TNM classification and categorized on the basis of the presence of lepidic components in the final pathologic findings. Overall survival (OS) and recurrence-free survival (RFS) were analyzed before and after applying inverse probability of treatment weighting. Competing risk analyses for recurrence were also compared in the two groups., Results: Of the 1270 patients, 858 (67.6%) had lepidic components (+). The pathologic stage and histologic grade were higher in the lepidic (-) group (p < 0.001, respectively). The 5-year OS and RFS were significantly worse in the lepidic (-) group than in the lepidic (+) group (OS: 88.2% versus 94.9%, p < 0.001; RFS: 79.4% versus 91.9%, p < 0.001). These trends were consistent after weighted analysis (OS: 92.4% versus 96.4%, p = 0.029; RFS: 85.6% versus 92.3%, p = 0.007). The 5-year cumulative incidence of any recurrence was 14.0% in the lepidic (-) group and 4.1% in the lepidic (+) group (p < 0.001). Multivariable Fine-Gray regression analysis found that the lepidic (+) group exhibited a lower risk of recurrence than did the lepidic (-) group (hazard ratio = 0.52, 95% confidence interval: 0.29-0.93, p = 0.031)., Conclusions: In pathologic stage I invasive nonmucinous adenocarcinoma, the presence of histologically diagnosed non-predominant lepidic components might be associated with a better prognosis after curative surgery., Competing Interests: Disclosure The authors declare no conflict of interest., (Copyright © 2024 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.)

Background: Numerous studies have investigated methods of predicting postoperative pulmonary complications (PPCs) in lung cancer surgery, with chronic obstructive pulmonary disease (COPD) and low forced expiratory volume in 1 second (FEV 1 ) being recognized as risk factors. However, predicting complications in COPD patients with preserved FEV 1 poses challenges. This study considered various diffusing capacity of the lung for carbon monoxide (DL CO ) parameters as predictors of pulmonary complication risks in mild COPD patients undergoing lung resection., Methods: From January 2011 to December 2019, 2,798 patients undergoing segmentectomy or lobectomy for non-small cell lung cancer (NSCLC) were evaluated. Focusing on 709 mild COPD patients, excluding no COPD and moderate/severe cases, 3 models incorporating DL CO , predicted postoperative DL CO (ppoDL CO ), and DL CO divided by the alveolar volume (DL CO /VA) were created for logistic regression. The Akaike information criterion and Bayes information criterion were analyzed to assess model fit, with lower values considered more consistent with actual data., Results: Significantly higher proportions of men, current smokers, and patients who underwent an open approach were observed in the PPC group. In multivariable regression, male sex, an open approach, DL CO <80%, ppoDL CO <60%, and DL CO /VA <80% significantly influenced PPC occurrence. The model using DL CO /VA had the best fit., Conclusion: Different DL CO parameters can predict PPCs in mild COPD patients after lung resection for NSCLC. The assessment of these factors using a multivariable logistic regression model suggested DL CO /VA as the most valuable predictor.

Introduction: The purpose of this study is to investigate the prognostic impact of spread through air spaces (STAS) in invasive mucinous adenocarcinoma (IMA)., Materials and Methods: From 2015 to 2019, patients who underwent complete resection of IMA were extracted from the prospective database. Multivariable Cox-regression analysis and inverse probability of treatment weight (IPTW) - adjusted log-rank test for 5-year recurrence-free survival (RFS) were performed., Results: STAS was observed in 39.1% (53 out of 133). The STAS (+) group shows larger tumor size (2.9 ± 2.4 cm vs 3.8 ± 2.4 cm, p = 0.031) and higher incidence of lympho-vascular invasion (6 [7.5%] vs 18 [34.0%], p < 00.001) compared to the STAS (-) group. The 5-year RFS was 66.1% in the STAS (+) group and 91.8% in the STAS (-) group (p < 00.001), and the incidence of locoregional recurrence was significantly higher in the STAS (+) group than the STAS (-) group (1 [1.2%] vs 12 [22.6%], p < 00.001). Multivariable analysis revealed that STAS was associated with poor prognosis for all-recurrence (hazard ratio 2.81, 95% confidence interval 1.01-7.81, p = 0.048). After IPTW adjustment, 5-year RFS was 66.3% in the STAS (+) group and 92.9% in the STAS (-) group (p = 0.007), and risk for locoregional recurrence was greater in the STAS (+) group than the STAS (-) group (1.1 [0.9%] vs 20.8 [16.6%], p < 00.001)., Conclusions: STAS showed negative prognostic impact on all-recurrence, especially due to locoregional recurrence, after curative resection of IMA., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare., (© 2024 Published by Elsevier Ltd.)