Department Of Thoracic Surgery Research Articles

Place of robotic surgery in completion lobectomy after anatomical segmentectomy.

Although segmentectomy is steadily increasing in early-stage non-small-cell lung cancer, recurrence in the ipsilateral lobe is also increasing. Completion lobectomy (CL) is a challenging procedure that has already been described in a few studies using video-assisted thoracic surgery or thoracotomy. In this study, we aimed to show the feasibility and safety of robot-assisted thoracic surgery in cases of CL. Among 2073 major resections performed between January 2018 and september 2022 in the Department of Thoracic Surgery at Nancy University Regional Hospital, we retrospectively included patients who underwent CL by robot-assisted thoracic surgery after previous segmentectomy for non-small-cell lung cancer. Data and perioperative results were described and analysed. Seventeen patients underwent CL with a median recurrence time after previous segmentectomy of 18 months [interquartile range (IQR): 12]. Four patients (23.5%) had a pulmonary artery injury that was controlled, and no conversion to open thoracotomy was needed. The operative time was 150 min (IQR: 20), and blood loss was 300 ml (IQR: 150). The median postoperative chest tube duration was 2 days (IQR: 1), and the length of hospital stay was 3 days (IQR: 3), with no postoperative deaths. Completion lobectomy is a challenging procedure due to severe adhesions surrounding vessels, which potentially could cause higher rate of PA bleeding than conventional surgeries. With experienced team and surgeons, CL with robotic surgery may be reported as a safe and feasible procedure.

Prevalence, diagnosis, and treatment of chronic obstructive pulmonary disease in a hospitalized lung cancer population: a single center study.

Chronic obstructive pulmonary disease (COPD) often coexists with lung cancer (LC) and has a detrimental effect on the prognosis of LC patients. Presently, there is a lack of adequate assessment regarding the management of COPD in LC patients. This study assessed the screening, prevalence, diagnosis and treatment of COPD in hospitalized LC patients and compared the management practices between two departments at our hospital. We retrospectively assessed the data of 3,578 patients diagnosed with primary LC in the Department of Respiratory and Critical Care Medicine and the Department of Thoracic Surgery from January 2019 to December 2020. We also compared the rate of spirometry, COPD diagnosis and COPD inhalation treatment between the LC patients from both departments, the proportion of patients aware of their COPD diagnosis and adhered to inhaled therapy, and analyzed factors influencing COPD diagnosis and inhalation treatment. A total of 2,762 (77.2%) LC patients underwent spirometry, and the observed spirometry-defined COPD prevalence was 25.0% (690/2,762). The proportion of spirometry performed in the Department of Thoracic Surgery was significantly higher than in the Department of Respiratory and Critical Care Medicine (90.5% vs. 62.9%; P<0.001). The overall COPD diagnosis rate recorded in the discharge diagnosis in the 690 spirometry-defined COPD patients was 46.5% (321/690), and the COPD treatment rate during hospitalization was 45.2% (312/690). In addition, physicians from the Department of Respiratory and Critical Care Medicine had a higher diagnostic rate than surgeons from the Department of Thoracic Surgery (69.1% vs. 7.5%; P<0.001), as well as a better-standardized COPD treatment rate (60.6% vs. 18.6%; P<0.001). Further, the proportion of COPD inhalation treatment was higher among LC patients with COPD recorded in discharge diagnosis (74.8% vs. 19.5%; P<0.001), and multivariate logistic regression analysis showed that COPD recorded in discharge diagnosis significantly increased the proportion of COPD awareness post-hospitalization (P<0.001). This study showed that COPD could be a frequently undiagnosed and undertreated condition among LC patients, especially those hospitalized in a surgical ward. Additionally, a discharge diagnosis of COPD may increase the rate of inhalation treatment and awareness of the condition in LC patients.

Starting a robotic thoracic surgery program: From wedge resection to sleeve lobectomy in six months. Initial conclusions

IntroductionRobot-assisted thoracic surgery (RATS) is a rapidly expanding technique. In our study, we aimed to analyze the results of the process to adopt robotic surgery in our Department of Thoracic Surgery. MethodsThis is an intention-to-treat analysis of a series of consecutive patients operated on using the RATS approach in our hospital from January 2021 to March 2022. Data were registered for patient characteristics, type of surgery, operative times, conversion rate, chest tube duration, length of hospital stay and complications.The IBM SPSS® statistical software was used for the statistical analysis. A cumulative sum analysis of the operating time was performed to define the learning curve. ResultsDuring the study period, 51 patients underwent robotic surgery, including pulmonary and non-pulmonary interventions. In addition, 15 patients (29.4%) underwent non-pulmonary interventions: one pleural (2%), 2 diaphragmatic (3.9%), and 12 mediastinal (23.5%). Among the mediastinal surgeries, one conversion was necessary (8.3%) for a complex vascular malformation, and 11 were completed by RATS, including 7 (58.3%) thymomas, 3 (25%) pleuro-pericardial cysts, and one (8.3%) neurogenic tumor. Mean operative time was 141 min (104–178), mean chest tube duration was 0.9 days (0–2), and mean length of stay was 1.45 days (1–2).Thirty-six patients underwent lung surgery (70.6%). The complete RATS resections (34; 94.4%) included: 3 wedge resections (11.1%), 2 segmentectomies (3.7%), 28 lobectomies (81.5%), and one sleeve lobectomy (3.7%). Mean surgery time was 194.56 min (141–247), chest tube duration was 3.92 days (1–8), and length of stay was 4.6 days (1–8). Complications occurred in 4 patients (11.1%). No 90-day mortalities were registered. ConclusionsThe implementation of RATS was achieved with good clinical results and operative times for all indications. A rapid learning curve was accomplished in short time. Previous VATS experience, patient selection, team training and program continuity are fundamental to successfully develop a RATS program.

[Uniportal thoracoscopic thorough debridement for tubercular empyema with abscess of the chest wall].

Objective: To examine the feasibility and technical considerations of thorough debridement using uniportal thoracoscopic surgery for tuberculous empyema complicated by chest wall tuberculosis. Methods: A retrospective analysis was conducted on 38 patients who underwent comprehensive uniportal thoracoscopy debridement for empyema complicated by chest wall tuberculosis in the Department of Thoracic Surgery, Shanghai Pulmonary Hospital, from March 2019 to August 2021. There were 23 males and 15 females, aged (M(IQR)) 30 (25) years (range: 18 to 78 years). The patients were cleared of chest wall tuberculosis under general anesthesia and underwent an incision through the intercostal sinus, followed by the whole fiberboard decortication method. Chest tube drainage was used for pleural cavity disease and negative pressure drainage for chest wall tuberculosis with SB tube, and without muscle flap filling and pressure bandaging. If there was no air leakage, the chest tube was removed first, followed by the removal of the SB tube after 2 to 7 days if there was no obvious residual cavity on the CT scan. The patients were followed up in outpatient clinics and by telephone until October 2022. Results: The operation time was 2.0 (1.5) h (range: 1 to 5 h), and blood loss during the operation was 100 (175) ml (range: 100 to 1 200 ml). The most common postoperative complication was prolonged air leak, with an incidence rate of 81.6% (31/38). The postoperative drainage time of the chest tube was 14 (12) days (range: 2 to 31 days) and the postoperative drainage time of the SB tube was 21 (14) days (range: 4 to 40 days). The follow-up time was 25 (11) months (range: 13 to 42 months). All patients had primary healing of their incisions and there was no tuberculosis recurrence during the follow-up period. Conclusion: Uniportal thoracoscopic thorough debridement combined with postoperative standardized antituberculosis treatment is safe and feasible for the treatment of tuberculous empyema with chest wall tuberculosis, which could achieve a good long-term recovery effect.

Improving Thoracic Surgery Ward Round Quality and Enhancing Patient Safety in a Referral Centre.

Introduction Ward rounds are vitalclinical processes that facilitate an opportunity for daily review and management of thoracic surgery inpatients. The aim of this study was to comparethoracic surgery ward round documentationagainst locally agreedstandards and design a template to improve the detail and uniformity of this process to enhance patient care. Materials and methods Data for this audit was collected retrospectively and prospectively. Data was collected during three auditing periods and managed on Microsoft Excel. Descriptive statistics were used for its analysis. Chi-square and Fisher's Exact tests were used to test for differences in reporting rates. Results and discussion Initially, a total of 199 ward round notes were reviewed. Imaging results (19%) and discharge planning (23%) were not reported. eCARE (electronic Clinical Assessment for Round Evaluation) was developed to ensure that all aspects of patient evaluation recommended by the guidelines were included. Reporting rates significantly improved after such changes. We analysed the effect of the new ward round note on discharge planning (23.3 vs 41%, p<0.001), complication rates (32.6 vs 21.9%, p=0.03), post-surgical length of stay (LOS) (7.0 vs 5.0, p<0.001). Conclusion Over a year, we auditedthe Thoracic Surgery Department's ward round documentation against locally agreed standards in line with national recommendations. Several important items were not regularly reported. Using closed-ended questions improved reporting rates, and patient care was optimised. Further research should explore the impact of this new documentation method on patient care and postoperative outcomes in our Trust as well as other cardiothoracic centres.

[Chinese Medical Association guideline for clinical diagnosis and treatment of lung cancer (2023 edition)].

To standardize the prevention and clinical management of lung cancer, improve patients' survival outcomes, and offer professional insight for clinicians, the Oncology Society of Chinese Medical Association has summoned experts from departments of pulmonary medicine, oncology, thoracic surgery, radiotherapy, imaging, and pathology to formulate the Oncology Society of Chinese Medical Association guideline for clinical diagnosis and treatment of lung cancer in China (2023 edition) through consensus meetings. Updates in this edition include 1) cancer screening: deletion of high-risk traits of lung cancer based on epidemiological investigations in the Caucasian population, while preserving features confirmed by research on the Chinese population. Advice on screening institutions is also added to raise awareness of the merits and demerits of lung cancer screening through detailed illustrations. 2) Principles of histopathologic evaluation: characteristics of four types of neuroendocrine tumors (typical carcinoid, atypical carcinoid, large cell carcinoma, and small cell carcinoma) are reviewed. 3) Surgical intervention: more options of resection are available for certain peripheral lesions based on several clinical studies (CALGB140503, JCOG0802, JCOG1211). 4) neoadjuvant/adjuvant therapy: marked improvement in the prognosis of non-small cell lung cancer (NSCLC) patients receiving neoadjuvant immunotherapy are reviewed; more options for consolidation immunotherapy after radiochemotherapy have also emerged. 5) Targeted and immune therapy: tyrosine kinase inhibitors of sensitive driver mutations such as EGFR and ALK as well as rare targets such as MET exon 14 skipping, RET fusion, ROS1 fusion, and NTRK fusion have been approved, offering more treatment options for clinicians and patients. Furthermore, multiple immune checkpoint inhibitors have been granted for the treatment of NSCLC and SCLC, resulting in prolonged survival of late-stage lung cancer patients. This guideline is established based on the current availability of domestically approved medications, recommendations of international guidelines, and present clinical practice in China as well as integration of the latest medical evidence of pathology, genetic testing, immune molecular biomarker detection, and treatment methods of lung cancer in recent years, to provide recommendations for professionals in clinical oncology, radiology, laboratory, and rehabilitation.

Male Breast Cancer: About 05 Cases

Male breast cancer is a rare disease (about 1% of breast cancers) with a poor prognosis. The diagnosis is most often late and lesions are treated in advanced stages. The aim of this study was to analyze the clinical, histological, therapeutic and prognostic characteristics of male breast cancer. This was a retrospective study of 05 patients collected in the thoracic surgery department of the Marrakech military hospital. The average age of our patients was 66.2 years. The average consultation time was 11.8 months, and self-care of a breast nodule was the main reason for consultation in 60% of cases. Invasive ductal carcinoma was the predominant histological type in 66.7% of cases. Multimodal therapeutic management consisted of mastectomy followed by adjuvant treatment with chemotherapy, radiotherapy and/or hormone therapy depending on the stage of the tumor and histological characteristics. The hormone dependence of these tumors is proven in 60% of cases. Five-year survival is currently being evaluated. Node invasion, invasion of the dermis and the TNM, clinical stage are factors that significantly influence the occurrence of metastases. None of these risk factors were found to be significant in terms of overall survival.

[Application Value of Artificial Intelligence-assisted Three-dimensional Reconstruction in Planning Thoracoscopic Segmentectomy].

The three-dimensional (3D) can assist in planning lung segmentectomy. 3D reconstruction software based on artificial intelligence algorithm is gradually applied in clinic. The aim of this study was to evaluate the accuracy and safety of 3D reconstruction assisted planning of thoracoscopic segmentectomy. A total of 90 patients admitted to Department of Thoracic Surgery of Lanzhou University Second Hospital were evaluated for thoracoscopic segmentectomy. Before operation, artificial intelligence 3D reconstruction software was used to make 3D lung images and conduct preoperative planning. Surgical videos were saved during the operation and perioperative data were recorded. Video recordings of 38 patients were selected to explore the effectiveness of artificial intelligence 3D reconstruction for surgical planning. The results of artificial intelligence 3D reconstruction and Mimics 21 software reconstruction were compared with the actual results in the operation, and the detection and classification ability of bronchus and blood vessels of the two reconstruction methods were compared. All the 90 patients underwent artificial intelligence 3D reconstruction planning, including 57 patients (63.3%) with single lung segmentectomy and 33 patients (36.7%) with combined sub-segmentectomy. The accuracy of artificial intelligence 3D reconstruction for lesion localization was 100.0%, and the accuracy of computed tomography (CT) was 94.4% (85/90). The detection accuracy of artificial intelligence 3D reconstruction and Mimics 21 software was 92.1% (35/38) and 89.5% (34/38), and the anatomic typing accuracy was 89.5% (34/38) and 84.2% (32/38), and the total accuracy was 76.3% (29/38) and 71.1% (27/38). In the comparative observation of 38 surgical videos and reconstructed images, the consistent rates of target segment planning, surgical approach, artery dissection, vein dissection and bronchial dissection for preoperative planning using artificial intelligence 3D reconstruction were 92.1% (35/38), 92.1% (35/38), 89.5% (34/38), 86.8% (33/38) and 94.7% (36/38). The overall planning operational consistency rate was 68.4% (26/38). It is accurate and safe to use artificial intelligence 3D reconstruction to assist planning thoracoscopic segmentectomy.

[Risk Factors and Sampling Range Evaluation of Lymph node Metastasis for 
Non-small Cell Lung Cancer with Diameter ≤2 cm].

More early-stage non-small cell lung cancer (NSCLC) are diagnosed in time and treated surgically, but systematic lymph node dissection can not bring enough survival benefits for them, and even increase the probability of postoperative complications. This study aims to analyze the risk factors and evaluate mediastinal lymph node metastasis sites in different lung lobes for NSCLC with diameter ≤2 cm, so as to provide reference for surgery. We collected 1051 patients with pulmonary nodule diameter ≤2 cm who were treated by pulmonary lobectomy with lymph node sampling/dissection in Department of Thoracic Surgery of the First Affiliated Hospital with Nanjing Medical University from December 2009 to December 2019. SPSS 26.0 statistical software was used for statistical analysis, to explore the risk factors and evaluate mediastinal lymph node metastasis sites in different lung lobes. 95 of 1051 (9.04%) patients presented lymph node metastasis. Male, pathological non-adenocarcinoma, 1 cm<tumor diameter≤2 cm, spread through air spaces (STAS), visceral pleural invasion (VPI), vascular invasion, low differentiation of adenocarcinoma, and micropapillary or solid adenocarcinoma subtype were the risk factors for lymph node metastasis (P<0.01). Male, 1 cm<tumor diameter≤2 cm, STAS, VPI and vascular invasion were independent risk factors for lymph node metastasis (P<0.05). Lymph node metastasis of #2R, #4R, #9 appeared in upper and middle lobe of right lung (P<0.05), and #7 appeared in right lower lobe (P<0.05). Lymph node metastasis of #5 and #6 in the left upper lobe was more common (P<0.05), while metastasis of #7 and #9 had no significant difference (P>0.05). Lymph nodes in group N1 were significantly correlated with lymph node metastasis in groups #2R, #4R, #5, #6, #7 and #9 (P<0.01). Lobe-specific lymph node dissection (LSND) can be performed for early-stage NSCLC. Male, pathological non-adenocarcinoma, 1 cm<tumor diameter≤2 cm, STAS, VPI, vascular invasion, low differentiation of adenocarcinoma, and micropapillary or solid adenocarcinoma subtype would increase the risk of lymph node metastasis.

[Chinese Medical Association guideline for clinical diagnosis and treatment of lung cancer (2023 edition)].

To standardize the prevention and clinical management of lung cancer, improve patients' survival outcomes, and offer professional insight for clinicians, the Oncology Society of Chinese Medical Association has summoned experts from departments of pulmonary medicine, oncology, thoracic surgery, radiotherapy, imaging, and pathology to formulate the Chinese Medical Association Guideline for Clinical Diagnosis and Treatment of Lung Cancer in China (2023 edition) through consensus meetings. Updates in this edition include 1) cancer screening: deletion of high-risk traits of lung cancer based on epidemiological investigations in the Caucasian population, while preserving features confirmed by research on the Chinese population. Advice on screening institutions is also added to raise awareness of the merits and demerits of lung cancer screening through detailed illustrations. 2) Principles of histopathologic evaluation: characteristics of four types of neuroendocrine tumors (typical carcinoid, atypical carcinoid, large cell carcinoma, and small cell carcinoma) are reviewed. 3) Surgical intervention: more options of resection are available for certain peripheral lesions based on several clinical studies (CALGB140503, JCOG0802, JCOG1211). 4) neoadjuvant/adjuvant therapy: marked improvement in the prognosis of non-small cell lung cancer (NSCLC) patients receiving neoadjuvant immunotherapy are reviewed; more options for consolidation immunotherapy after radiochemotherapy have also emerged. 5) Targeted and immune therapy: tyrosine kinase inhibitors of sensitive driver mutations such as EGFR and ALK as well as rare targets such as MET exon 14 skipping, RET fusion, ROS1 fusion, and NTRK fusion have been approved, offering more treatment options for clinicians and patients. Furthermore, multiple immune checkpoint inhibitors have been granted for the treatment of NSCLC and SCLC, resulting in prolonged survival of late-stage lung cancer patients. This guideline is established based on the current availability of domestically approved medications, recommendations of international guidelines, and present clinical practice in China as well as integration of the latest medical evidence of pathology, genetic testing, immune molecular biomarker detection, and treatment methods of lung cancer in recent years, to provide recommendations for professionals in clinical oncology, radiology, laboratory, and rehabilitation.

Surgical management of descending necrotizing mediastinitis: strategy for thoracic interference

BackgroundThe present descriptive study shares the overall experience of treating all these patients where different surgical process was adopted depending on the treatment required after carefully evaluating the risk factors and comorbidities.MethodsThe present study was conducted at the Department of Thoracic Surgery, Choray Hospital, Vietnam between the period of 2010 to 2020. We have treated 95 patients altogether in this duration.ResultsWe were able to save most of the patients by applying thoracotomy and thoracic irrigation for most of the patients based on the observed indications that were identified immediately after the compulsory standard cervicotomy. The indication for thoracic interference was considered when the infection was deeply spread into the mediastinum and cannot get out through cervicotomy, although the most effective method of drainage was applied.ConclusionOur statistical investigation of the patient data suggested the possible association and influence of comorbidity such as diabetes. Therefore, we recommend that in specific cases thoracotomy along with thoracic irrigation and repetitive surgical draining could be a better option to reduce the infection and the mortality rate.Trial registrationRetrospectively registered.

Utility of methylene blue mixed with autologous blood in preoperative localization of pulmonary nodules and masses.

The value of CT-guided puncture with methylene blue mixed with autologous blood in preoperative localization of pulmonary nodules and masses was explored. A total of 113 patients with 146 nodules and masses were treated with methylene blue mixed with autologous blood for preoperative localization and thoracoscopic surgery in the Department of Thoracic Surgery, the First Affiliated Hospital of Fujian Medical University between October 2021 and October 2022. The localization effect, complications, and pathological conditions were observed. The localization success rate was 98.63% (144/146). The localization failed nodules and masses could still be located by looking for needle eyes and reading films. The whole group successfully completed thoracoscopic surgery. The average interval of operation after puncture was 22.16 ± 6.22 h. There was a small amount of suspicious hemothorax after puncture. There was no pneumothorax after puncture in the whole group. There were no hemoptysis, irritating dry cough, and other reactions. The overall complication rate was 2.65%, and no special treatment was given. It is safe and effective to use methylene blue mixed with autologous blood for CT-guided preoperative puncture and localization of small pulmonary nodules and masses.

Malnutrition in patients with head and neck cancer undergoing radiotherapy: A cross-sectional study

ObjectiveIn this study, we investigated the prevalence of malnutrition and analyzed the related factors among patients with head and neck cancer (HNC) undergoing radiotherapy. MethodsWe included 108 patients with head and neck cancer undergoing radiotherapy from the oncology and thoracic surgery departments of a comprehensive medical center in Qingdao between January 2019 and June 2020. We used the Nutritional Risk Screening-2002 tool (NRS-2002) to evaluate their nutritional status during radiotherapy. We analyzed the basic sociodemographic information and laboratory indicators of the respondents to examine the impact of these factors on nutritional status. ResultsIn the 108 patients that we studied, those aged ≥65 years had a significantly higher nutritional risk when compared to patients <65 years of age (P < 0.05). Univariate analysis revealed that a late tumor stage (P = 0.039), the neck being the site of radiotherapy (P = 0.009), the presence of diabetes (P < 0.001), and the presence of anxiety and depression (P = 0.002) were associated with nutritional risks for patients with head and neck cancer undergoing radiotherapy. Multivariate logistic regression analysis identified a late tumor stage, the neck being the radiotherapy site, and combined anxiety and depression as nutritional risk factors in such patients. ConclusionWe found a high incidence of malnutrition in patients undergoing radiotherapy for HNC; this highlights the importance of early identification of patients at risk and evaluation of related risk factors to enhance the efficacy of nutritional interventions.

The prognostic value of the preoperative albumin/globulin and monocyte ratio in resected early-stage non-small cell lung cancer

ObjectiveThis study investigated the prognostic value of the preoperative albumin/globulin to monocyte ratio (AGMR) in patients with resected non-small cell lung cancer (NSCLC). MethodsThe study retrospectively enrolled patients with resected NSCLC from the Department of Thoracic Surgery, China–Japan Union Hospital of Jilin University from January 2016 to December 2017. Baseline demographic and clinicopathological data were collected. The preoperative AGMR was calculated. Propensity score matching (PSM) analysis was applied. The receiver operating characteristic curve was used to determine the optimal AGMR cut-off value. The Kaplan–Meier method was used to calculate the overall survival (OS) and disease-free survival (DFS). The Cox proportional hazards regression model was used to evaluate the prognostic value of the AGMR. ResultsA total of 305 NSCLC patients were included. The optimal AGMR value was 2.80. Before PSM. The high AGMR (>2.80) group had a significantly longer OS (41.34 + 11.32 vs. 32.03 + 17.01 months; P < 0.01) and DFS (39.00 + 14.49 vs. 28.78 + 19.13 months; P < 0.01) compared with the low AGMR (≤2.80) group. Multivariate analyses showed that AGMR (P < 0.01) in addition to sex (P < 0.05), body mass index (P < 0.01), history of respiratory diseases (P < 0.01), lymph node metastasis (P < 0.01), and tumor size (P < 0.01) were associated with OS and DFS. After PSM, AGMR remained as an independent prognostic factor for OS (hazard ratio [HR] 2.572, 95% confidence interval [CI]: 1.470–4.502; P = 0.001) and DFS (HR 2.110, 95% CI: 1.228–3.626; P = 0.007). ConclusionThe preoperative AGMR is a potential prognostic indicator for OS and DFS in resected early-stage NSCLC.

Prognostic Value of 18F-Fluorodeoxyglucose Uptake of Bone Marrow on PET/CT in Patients with Limited Disease Small Cell Lung Cancer

Merve AYIK TURK1, Berna KOMURCUOGLU2, Ahmet YANARTAS3, Ozgur BATUM2, Yunus TURK4, Mehmet Ufuk YILMAZ5 1Izmir Bozyaka Training and Research Hospital, Department of Pulmonology, İzmir 2Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Department of Pulmonology, İzmir 3Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Department of Nuclear Medicine, İzmir 4Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Department of Thoracic Surgery, İzmir 5Medicana Health Groups, Department of Pulmonology, İzmir Keywords: Small cell lung cancer, Prognostic factors, Limited stage, Bone marrow FDG uptake Small cell lung cancer (SCLC) is a malignancy from the neuroendocrine tumor family, which has a poor prognosis and presents with metastases at the time of the diagnosis. The present study investigated the relationship between bone marrow fluorodeoxy-D-glucose (FDG) uptake and survival to evaluate prognosis in limited-stage SCLC. This single-center retrospective study examined a total of 220 patients diagnosed with limited-stage SCLC between January 2010 and June 2019. Bone marrow FDG uptake, serum inflammatory markers, and other factors used to determine the prognosis, as well as overall survival (OS) and progression-free survival (PFS), were recorded and retrospectively analyzed. Within physiological limits, bone marrow standardized uptake value (SUV) mean of &gt; 1.95 was identified as a good prognostic factor for PFS (p= 0.03). The multivariate analysis of OS and PFS revealed that the Eastern Cooperative Oncology Group (ECOG) performance scale (p= 0.001) was a common independent prognostic factor. Stages of the disease, albumin levels and bone marrow-to-liver ratio (BLR) [one of the positron emission tomography/computed tomography (PET/CT) parameters] of &lt; 0.8 were prognostic factors for OS. The bone marrow SUV mean was positively correlated with the primary tumor SUV max and SUV mean. The bone marrow SUV mean is a parameter that can be used to predict PFS in limited-stage SCLC. For OS, in turn, the BLR was identified as an independent factor.

Evaluation of the Efficacy of a Digital Chest Drainage System in Traumatic Pneumothorax.

Pneumothorax is the major complication in patients with chest trauma. Thoracic injury is a major cause oftrauma-related deaths, with up to half of these patients developing pneumothorax. The initial primary management of pneumothorax is intercostal chest drainage (ICD). Chest drainage systems are used to resolve pleural air leakage (PAL), lymphatic or exudative effusion, blood accumulation after chest surgery or trauma, and other disease conditions such as pneumothorax. This study evaluates the efficacy of a digital chest drainage system (Thopaz+, Medela AG, Baar, Switzerland) in patients with pneumothorax following chest trauma and analyzes the satisfaction score by patients. A hospital-based cross-sectional study was conducted in a tertiary care centre at the Department of Cardiovascular and Thoracic Surgery (CTVS). All patients with a diagnosis of traumatic pneumothorax/hemopneumothorax from January 2021 to June 2022, aged more than 15 years, were enrolled for the study. A total of 102 patientsrequired chest drainage systems and were selected for the study. We analysed demographic data, clinical profiles, and routine investigations with chest X-rays and computed tomography (CT) scans. All patients were connected with digital drainage devices and monitored for air leaks and other complications. Patient satisfaction was evaluated by a purposefully developed survey questionnaire. Most of our study subjects were male (84.3%) and the mean age was 42.38±15.75 years. The total duration of chest tube, post-operative air leak and duration of hospital stay were noted. The mean chest tube duration was 4.39±1.18 days. Twelve patients were found to have air leaks with digital drainage devices. The mean duration of hospital stay was 5.75±1.49 days. All subjects were provided with a survey questionnaire to assess their response to digital drainage devices. We found that patients were comfortable and had positive responses for the Thopaz+ device. We found that Thopaz+ digital drainage system is useful in reducing chest tube duration and hospital stay. It also helps in the early resolution of air leaks and minimises complications. Most of our patients showed a positive attitude. With regard to Thopaz+ digital device, our study concludes that Thopaz+ should be considered for patients who need chest tube drain for pneumothorax.

Intralobar pulmonary sequestration with a rare source of arterial supply

BACKGROUND: Pulmonary sequestration is one of the most common malformations of the lungs in clinical practice. However, difficulties are possible in the interpretation of the radiological data, which leads to a violation of the examination technique in such patients and, accordingly, to the lack of success of the therapy and proper routing.&#x0D; AIM: To demonstrate the clinical case of a patient with intralobar pulmonary sequestration, describing the characteristic radiographic picture, and suggesting research methodology for the identified features of the aberrant vessel.&#x0D; METHODS: Clinical and radiological data of a 27-year-old patient with acute respiratory symptoms and suspected abscessed pneumonia based on X-ray and computed tomography (CT) findings were presented. Due to the absence of clinical and radiological dynamics, atypical CT semiotics of abscesses, CT angiography of the thoracic aorta was performed after intravenous contrast enhancement with 80 ml of iodine-containing preparation (350 mg/mL).&#x0D; RESULTS: A pulmonary tissue thickening was revealed in the lower left lobe with lumpy clear contours, which consisted of a system of cystic cavities with contents, particularly well differentiated after contrast enhancement. On the native study, an additional vascular structure following from the subdiaphragmatic space was traced paravertebrally, which was the reason for extending the CT angiography scanning area to the epigastric region of the abdomen. A large-caliber arterial vessel was detected, which departed as a branch from the celiac trunk and passed to the above-described thickening of the pulmonary tissue. The combination of these signs is typical for intrapulmonary sequestration.&#x0D; CONCLUSIONS: The correct interpretation of the identified changes allowed the patient to be routed to a hospital with a thoracic surgery department, since the sequestration must be removed in the vast majority of cases to prevent recurrent inflammatory episodes. Extension of the scanning area below the diaphragm may be useful, since part of the sequesters is supplied with blood from the abdominal aorta and its visceral branches. This will prevent the need for repeat CT angiography, and information about the source of the blood supply is extremely important for surgeons.

Efficacy of using Maryland forceps versus electrocoagulation hooks in da Vinci robot-assisted thoracoscopic mediastinal tumor resection

BackgroundTo compare the difference of short-term curative effect between the use of Maryland forceps (MF) and electrocoagulation hooks (EH) in da Vinci robot-assisted thoracoscopic mediastinal tumor resection.MethodsRetrospectively analyze 84 patients with mediastinal tumors who underwent robot-assisted thoracoscopic surgery (RATS) at the Department of Thoracic Surgery in Gansu Provincial Hospital from February 2019 to February 2023. Two groups were divided according to the intraoperative use of energy devices, including 41 cases in the MF group and 43 cases in the EH group. Perioperative clinical data was gathered to compare the short-term efficacy of patients in both groups.ResultsThere were no significant differences in baseline characteristics such as sex (P = 0.685), age (P = 0.165), and tumor size (P = 0.339) between the two groups. Compared with the EH group, patients in the MF group have shorter operative time (P = 0.030), less intraoperative bleeding (P = 0.010), less total postoperative drainage volume (P = 0.001), shorter postoperative drainage time (P = 0.022), shorter hospital stay (P = 0.019), and lower levels of interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor-alpha (TNF-α), and cortisol. No statistically significant differences were found between the two groups in terms of total hospitalization costs (P = 0.123), postoperative visual analog scale (VAS) pain scores (P = 0.064), and postoperative complications (P = 0.431).ConclusionUsing MF in RATS for mediastinal tumor is safe and effective, which can reduce the amount of bleeding, reduce the degree of inflammatory reaction, and conducive to the quick recovery of patients.

Intrathymic Localization of Melanoma: A Brief Report of Two Cases and a Review of the Literature

Intrathymic localizations of melanoma represent a very rare entity, with fewer than ten cases of intrathymic melanoma described in the literature. Herein, we describe two cases of patients who underwent surgical removal of a thymic mass at our thoracic surgery department between 2015 and 2022. The final pathological examination revealed a malignant melanoma in both cases; we therefore carried out a literature review to identify such rare and similar cases. In the first case, the intrathymic localization of melanoma was the first manifestation of the disease, posing a dilemma regarding the metastatic and primitive nature of the neoplasm. The second case described a thymic metastasis from a known previous cutaneous melanoma, for which the patient had successfully been treated six years earlier. After carefully reviewing the literature, we identified only six cases of verified primary intrathymic melanomas and one case of intrathymic metastasis resulting from melanoma previously described. Pathologists should be aware of the occurrence of this rare entity and mindful of the differential diagnoses. Several tools, including immunostaining of melanocytic markers and molecular investigations, are mandatory for final pathological diagnosis.

Comment on 'Plasma metabolomics study in screening and differential diagnosis of multiple primary lung cancer'.

Department of Thoracic Surgery, The First Affiliated Hospital of Ningbo University, Zhejiang, 315020, China Running Title: Plasma metabolomics and multiple primary lung cancer. Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. Published online ■ ■ *Corresponding author. Address: Department of Thoracic Surgery, The First Affiliated Hospital of Ningbo University, Zhejiang, 315020, China. E-mail address: [email protected] (C. Zhou). This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0/