ABSTRACTObjectivesRadiological surveillance after curative‐intent lung cancer resection is essential for early detection of recurrence and second primary tumors. Large‐scale health emergencies can compromise oncologic follow‐up. This study quantifies the impact of a health crisis on radiological surveillance in a national cohort of resected lung cancer patients.MethodsA time‐segmented observational cohort study was performed using data from the prospective, multicenter GEVATS registry. Surveillance density (CT/month) was evaluated across three predefined periods: pre‐pandemic (baseline), state of alarm (maximum healthcare restrictions), and post‐alarm (recovery phase). The population at risk was updated for each period. Subgroup analyses during the post‐alarm phase assessed prioritization according to neoadjuvant treatment, pathological stage, age, and comorbidity.ResultsAmong 2382 eligible patients, surveillance density declined progressively from the pre‐pandemic period (0.157 ± 0.079 CT/month) to the state of alarm (0.098 ± 0.071 CT/month). In the post‐alarm phase, density dropped sharply to 0.023 ± 0.018 CT/month (equivalent to one CT every 3.6 years), representing a 76.5% reduction compared with the state‐of‐alarm period (p < 0.001). This under‐surveillance was generalized, with no significant differences by pathological stage (p = 0.084), age (p = 0.564), or comorbidity (p = 0.872). Only prior neoadjuvant therapy was associated with a slightly higher density (p = 0.040).ConclusionsA prolonged health crisis resulted in a profound and persistent reduction in radiological surveillance after lung cancer resection, without evidence of risk‐based prioritization. These findings support the need for contingency frameworks within clinical guidelines to preserve continuity of oncologic follow‐up during future health emergencies.

Central airway obstruction (CAO) involves the narrowing of the trachea, carina, and main bronchi. This study describes a technique for placing a self-expanding metallic Y-stent using a single guidewire for the palliative management of inoperable malignant stenosis near the carina, evaluating its efficacy and safety. We conducted a retrospective analysis of all patients with severe malignant carinal stenosis who were treated with a customized self-expanding metallic Y-stent at our institution between January 2020 and December 2024. In all cases, the left bronchial branch of the stent was positioned using the Seldinger technique with a single guidewire. The single-guidewire Seldinger technique simplified the procedure, resulting in a significantly shorter stent placement time (38 vs. 51 min; p < 0.0001) and reduced general anesthesia time (53 vs. 71 min; p ≤ 0.0001) compared to a double-guidewire approach. Furthermore, it minimized the number of required X-ray exposures (0-1 vs. 4-5 images; p < 0.0001) and lowered the risk of guidewire dislodgement. No immediate complications were reported. The placement of a self-expanding Y-stent using a single left-sided guidewire is an efficacious and feasible approach for maintaining airway patency in patients with severe malignant carinal stenosis, offering a simpler and more efficient procedural alternative.

The increasing detection of pulmonary nodules has made accurate preoperative localization clinically urgent. Although electromagnetic navigation bronchoscopy (ENB)-guided dye marking is effective, evidence is limited, and the optimal dye remains unclear. This study compared methylene blue (MB) and indocyanine green (ICG) to determine the more efficient option for pulmonary nodule localization. A total of 101 patients who underwent preoperative ENB localization between 2015 and 2021 were included. Patients were divided into two groups according to the dye used (MB or ICG) for comparative analysis. The primary outcomes were localization success rate and ENB-related complications. Secondary outcomes included the impact of different dyes on operative efficiency, assessed by the time from the beginning of the operation to submission of the specimen for frozen section analysis (target time), concordance between intraoperative freezing and postoperative paraffin results, and 5-year overall survival (OS) and disease-free survival (DFS). Among 101 patients (ICG: 58 patients, 71 nodules; MB: 43 patients, 47 nodules), all nodules were successfully localized using both dyes, with no serious ENB-related complications. Compared with the MB group, ICG use was associated with a shorter target time. Consistency of intraoperative freezing and postoperative paraffin results was comparable between the two groups (p = 0.96). Five-year DFS and OS were also comparable between the two groups. ENB-guided dye localization enables accurate and safe minimally invasive resection of pulmonary nodules. Both MB and ICG are effective, while ICG was associated with a shorter operative time and may offer a potential efficiency benefit.

Pleural mesothelioma is a highly aggressive malignancy with a poor prognosis due to the limited efficacy of currently available therapies. Macroautophagy (hereafter "autophagy") is a lysosome-mediated degradation pathway involved in cellular homeostasis that can either support or inhibit cancer progression depending on context. In this study, we investigated the effects of SAR405, an inhibitor of vacuolar protein-sorting 34 (VPS34), which is important for regulating the early stage of autophagy, on pleural mesothelioma. Human pleural mesothelioma cell lines H28, H2452, and 211H were cultured with SAR405. The effects of SAR405 on protein expression, cell viability, colony formation, cell invasion, and the cell cycle were investigated, as were its synergistic effects with cisplatin. Autophagy induction was evaluated in mesothelioma cells transfected with the pMRX-IP-GFP-LC3-RFP-LC3ΔG plasmid, which was developed for the quantitative and statistical estimation of autophagy. SAR405 treatment alone significantly reduced cell viability, colony formation, and cell invasion, and increased G2/M cell cycle arrest. In addition, SAR405 induced apoptosis in the H2452 cell line. Although cisplatin weakly induced autophagy in mesothelioma cells, its combination with SAR405 did not result in additive or synergistic effects on cell viability. Based on these results, inhibition of VPS34 by SAR405 effectively suppressed cell viability in all mesothelioma cell lines and induced apoptosis in H2452 cells. The findings of this study indicate the potential for VPS34 inhibition as a new strategy for the treatment of mesothelioma and provide insights into the complex role of autophagy in this malignancy.

Improving patient-centered outcomes is a core aim of value-based healthcare (VBHC). Integrating patient-reported outcome and experience measures (PROMs/PREMs) into clinical quality registries may provide insight into health-related quality of life (HRQL) and variation in care. We piloted PROMs/PREMs collection in an Australian Lung Cancer Registry to evaluate associations between HRQL, clinical outcomes and treatment value. Individuals newly diagnosed with lung cancer across five metropolitan health services were invited to complete electronic PROMs (EORTC QLQ-C30 and QLQ-LC29) and PREMs at baseline and follow-up. Preference-based utilities (QLU-C10D) and quality-adjusted life-years (QALYs) were derived and linked with registry clinical data. Stage-specific Australian health system cost estimates for guideline concordant treatment (GCT) provided context for value-based reporting. Multivariable regression examined associations between HRQL and clinical variables. Baseline PROMs/PREMs were completed by 241/490 (49%) participants. HRQL was associated with cancer stage, ECOG performance status ≥ 2, comorbidities, weight loss, and receipt of GCT (p = 0.041). HRQL remained stable among ongoing respondents over time. Estimated health system costs increased with advancing stage, while earlier stage disease was associated with better HRQL and survival. A registry-level VBHC dashboard integrating HRQL, patient experience, clinical quality indicators and cost context was developed to support health service performance review. PROMs/PREMs linked with clinical and cost data provided meaningful insight into patient-centered outcomes and drivers of value in lung cancer care. This VBHC framework highlights the importance of early diagnosis and access to evidence-based treatment and offers a scalable approach to support patient-centered quality improvement at the health system level.

ABSTRACTBackgroundIn robot‐assisted thoracoscopic (RATS) bronchial sleeve lobectomy, despite the continuous suturing (CS) technique's widespread adoption, the safety and advantages of the semi‐continuous suturing (SCS) technique remain inconclusive.MethodsPatients undergoing RATS bronchial sleeve lobectomy for central Non‐Small Cell Lung Cancer (NSCLC) between January 2020 and December 2024 were retrospectively enrolled and stratified into two cohorts based on anastomotic technique: the CS group and the SCS group. Perioperative outcomes were compared between the two groups.ResultsThe SCS group (n = 18) demonstrated significantly shorter anastomotic time than the CS group (n = 14) (median 28 min [24–33] vs. 45 min [32–52]; p < 0.001), with a 21‐min reduction in operative time (median 135 min [110–185] vs. 156 min [138–212]; p = 0.040). No statistically significant differences were observed in: overall complication rates (anastomosis‐specific: 11.1% vs. 21.4%, p = 0.425; systemic: 22.2% vs. 42.9%, p = 0.212); 90‐day mortality (0% vs. 7.1%, p = 0.467); late stenosis rate (0% vs. 7.1%, p = 0.249) or reoperation rate (5.6% vs. 14.3%, p = 0.401); postoperative recovery metrics (extubation time and hospital stay, p > 0.05).ConclusionsSCS can safely reduce bronchial anastomosis time in RATS sleeve resection and is recommended as the preferred technique for optimizing operative efficiency.

ABSTRACTRadiation recall dermatitis (RRD) is an inflammatory skin reaction confined to areas previously exposed to radiation, triggered by subsequent systemic therapy. This case report describes a female patient with hormone receptor‐positive, human epidermal growth factor receptor 2‐negative breast cancer. She received 6 cycles of neoadjuvant chemotherapy, followed by mastectomy with immediate tissue expander implantation and axillary lymph node dissection. Adjuvant radiotherapy and intensive endocrine therapy (endocrine therapy and abemaciclib) were administered postoperatively. After radiotherapy, the patient developed small, coin‐sized skin flap necrosis. Two months after completing radiotherapy, she initiated abemaciclib treatment, which was followed by rapid progression of flap necrosis and increased exposure of the tissue expander. This flap necrosis was suggestive of RRD. This report details the clinical course, management strategies, and a review of relevant literature, aiming to provide valuable insights for clinicians in handling similar cases and enhance awareness of potential risks associated with this treatment combination.

Postoperative pulmonary complications (PPC) are linked to higher morbidity and healthcare costs. High-flow nasal cannula (HFNC) oxygen therapy may mitigate PPC by enhancing oxygenation and easing respiratory effort. This study assessed HFNC's efficacy versus conventional oxygen therapy in reducing PPC during anesthetic induction and extubation in elective thoracic surgery for lung resection. In a single-center randomized clinical trial, 90 patients undergoing elective thoracic surgery were randomized (1:1) to HFNC or conventional oxygen therapy during induction and extubation. The primary outcome was in-hospital PPC incidence within 30 days. Secondary outcomes included intubation hypoxemia, 30-day mortality, and ICU admission. Poisson regression identified PPC predictors. PPC rates were 20.0% in the HFNC group and 26.7% in controls (relative risk [RR] 0.75, 95% CI 0.35-1.60, p = 0.455), with no significant difference. Poisson regression revealed independent predictors: chronic obstructive pulmonary disease, preoperative SpO2 ≤ 94%, surgery > 2 h, and left lung ventilation (p < 0.05). No differences occurred in intubation hypoxemia (0% both groups), 30-day mortality (2.22% HFNC vs. 4.44% controls, p = 0.553), or ICU admission (13.33% HFNC vs. 17.78% controls, p = 0.526). HFNC was well-tolerated without device issues. HFNC, applied during intubation and extubation, did not significantly reduce the incidence of PPC or secondary outcomes compared to conventional oxygen therapy in patients undergoing elective thoracic surgery. Further research is needed to explore HFNC's potential in high-risk populations or with optimized protocols, such as extended application periods or varied flow rates, to enhance perioperative respiratory management.

ABSTRACTBackgroundEpidermal growth factor receptor‐mutated (EGFRm) non‐small cell lung cancer (NSCLC) responds well to EGFR tyrosine kinase inhibitors (EGFR‐TKIs), yet optimal therapy after resistance remains uncertain. Although immune checkpoint inhibitors (ICIs) show limited overall efficacy, heterogeneity in response by programmed cell death ligand 1 (PD‐L1) expression exists.MethodsWe retrospectively evaluated 90 patients with advanced/recurrent EGFRm NSCLC treated with first‐line EGFR‐TKIs (October 2018–October 2023). Clinicopathological and radiologic features were compared by PD‐L1 tumor proportion score (< 50% vs. ≥ 50%). The primary analysis evaluated overall survival from first progression (post‐progression OS/PPS) using a time‐varying Cox model with start–stop intervals, modeling ICI as a time‐dependent exposure ICI(t) and testing the ICI(t) × PD‐L1 interaction.ResultsThe PD‐L1 ≥ 50% group (n = 26) more often had solid histology (62% vs. 8%), solid nodules on computed tomography (96% vs. 52%), and larger tumors (median 42.0 vs. 27.5 mm). Among 68 patients evaluable from t0, the ICI(t) × PD‐L1 interaction was significant (Wald p = 0.015; likelihood‐ratio p = 0.036). Stratum‐specific adjusted ICI effects suggested a detrimental association in PD‐L1 < 50% (hazard ratio [HR]: 3.11, 95% confidence interval [CI]: 0.94–10.30) but favorable association in PD‐L1 ≥ 50% (HR: 0.457, 95% CI: 0.138–1.512). In exploratory analyses of 22 ICI‐treated patients, PD‐L1 ≥ 50% showed higher response rates (64% vs. 9%) and longer time to treatment failure (3.4 vs. 1.4 months).ConclusionsHigh PD‐L1 expression in EGFRm NSCLC is associated with more aggressive morphologic features and modifies the association between post‐progression ICI and survival. These findings support PD‐L1‐informed selection after EGFR‐TKI failure, while prospective confirmation is needed.