Lung Resection Research Articles (Page 1)

To analyze the influencing factors of postoperative hypotension (POH) following video-assisted thoracoscopic lung resection (VATS) and evaluate a predictive model combining non-invasive hemodynamic parameters with the inferior vena cava collapsibility index (IVCCI). A prospective study enrolled 100 VATS patients (September 2024-March 2025). Patients were stratified into POH (n = 36) and Non-POH (n = 64) groups based on mean arterial pressure (MAP ≤ 65 mmHg or ≥ 30% reduction from baseline) within 24hours postoperatively. Hemodynamic parameters (cardiac output [CO], systemic vascular resistance [SVR], stroke volume [SV], stroke volume variation [SVV], left ventricular stroke work [LVSW]) were monitored using the Non-invasive Continuous Arterial Blood Pressure And Cardiac Output Monitoring System. IVCCI was ultrasonographically measured post-extubation. Linear regression analyzed correlations between post-anesthetic emergence period hemodynamic parameters and POH, while multivariable logistic regression analysis was employed to identify predictive factors, leading to the development and validation of a clinical prediction model. The incidence of early POH was 36%. Multivariate analysis demonstrated that a model combining post-anesthesia emergence period left ventricular stroke work (PA_LVSW, OR = 0.880, P < 0.01), IVCCI (OR = 1.095, P = 0.01), baseline MAP, and ASA achieved an AUC of 0.940 (95% CI: 0.895-0.985), with 83.3% sensitivity and 89.1% specificity, outperforming individual predictors (IVCCI: AUC = 0.65; PA_LVSW༚AUC = 0.84). Early POH after VATS is closely associated with cardiac function suppression and volume status imbalance. The multiparameter model integrating PA_LVSW, IVCCI, ASA physical status, and baseline MAP effectively predicts POH. Chinese Clinical Trial Register, ChiCTR2500100275. Registered 7 April 2025 Retrospectively registered, https//www.chictr.org.cn/showprojEN.html? proj=259,898.

Background: Recent landmark clinical trials have introduced the role of targeted therapy with surgery for resectable non-small cell lung cancers (NSCLCs). Methods: This narrative review summarizes data from recent clinical trials and retrospective studies to highlight the evolving interplay between targeted therapy and resectable NSCLC. Results: For patients with epidermal growth factor receptor (EGFR) mutations, the ADAURA trial demonstrated significant improvements in disease-free and overall survival with adjuvant osimertinib after complete resection. The NeoADAURA trial expanded the role of osimertinib to neoadjuvant treatment as it showed benefit in major pathologic response rates when compared to chemotherapy alone. Neoadjuvant osimertinib may facilitate surgical resection, especially for patients with lymph node involvement. Furthermore, the ALINA trial established the role of adjuvant alectinib, another targeted therapy, for patients with anaplastic lymphoma kinase (ALK) positive resectable NSCLC. Given the evidence for use of these novel targeted therapies in patients with resectable lung cancer, early molecular profiling is critical for patients with NSCLC to help guide pre- and postoperative treatment. The use of targeted therapies may even expand to stage IV NSCLC as clinical trials are ongoing and could possibly redefine the role of surgery in advanced disease. Conclusions: While there are ongoing trials to clarify the optimal timing of targeted therapies and surgical resection, current data supports the use of targeted therapies as part of multimodality care in surgically resectable NSCLC.

EGFR exon 20 insertions account for 1% to 10% of EGFR mutations in non-small-cell lung cancer (NSCLC) and are known to confer resistance to traditional tyrosine kinase inhibitors. However, the prognostic significance of these mutations in early-stage resected NSCLC remains unclear. This study assesses outcomes in patients with resected NSCLC harboring EGFR exon 20 insertions, comparing them to patients with common EGFR mutations and those with wild-type EGFR. We retrospectively reviewed 3,235 patients who underwent resection for NSCLC at Tri-Service Hospital between 2008 and 2021. After excluding cases lacking EGFR testing, incomplete data, or advanced-stage disease, 44 patients with exon 20 insertions were matched to 602 patients with common EGFR mutations and 729 with wild-type EGFR. Clinical characteristics, disease-free survival (DFS), and overall survival (OS) were analyzed using the Kaplan-Meier method, with statistical comparisons performed using the log-rank test. Cox proportional hazards models were used to identify independent prognostic factors. Patients with exon 20 insertions were younger and more frequently presented with stage IA disease. The 5-year DFS was 79% in the exon 20 insertion group, compared to 81% in the common mutation group and 83.9% in the wild-type group. The 5-year OS was 78.5% for exon 20, 91.9% for common mutations, and 91% for wild-type. While no significant differences in DFS or OS were observed between groups, the exon 20 insertion group had a higher incidence of secondary cancers. Multivariable analysis indicated that exon 20 insertion was independently associated with worse OS, but not with DFS. EGFR exon 20 insertions do not significantly shorten DFS, but are associated with inferior OS in early-stage resected NSCLC. Given the limited treatment options, the role of adjuvant therapy warrants further investigation.

BackgroundNeoadjuvant chemoimmunotherapy does not benefit all non-small cell lung cancer (NSCLC) patients, and reliable biomarkers are urgently needed. We conducted this prospective phase II trial of neoadjuvant chemoimmunotherapy to explore the role of cell-free DNA (cfDNA) features in pathological response assessment.MethodsTotally, 100 patients with stage IIB-IIIB NSCLC were enrolled and treated with neoadjuvant toripalimab plus chemotherapy for at least 2 cycles. Targeted methylation panel sequencing and whole methylome sequencing were conducted on 195 cfDNA samples collected from 60 patients before each treatment cycle (C0, C1) and before surgery (BS), with subsequent calculations of methylation fragment ratio (MFR) and chromosome aneuploid of featured fragment (CAFF) scores, respectively. The correlations between MFR or CAFF and pathological response were evaluated.ResultsFinally, 83 patients underwent surgery, and 54 (65.1%) patients achieved major pathological response (MPR), including 38 (45.8%) with complete pathological response (pCR). The median MFR and CAFF scores in both the MPR and non-MPR groups significantly decreased after the first cycle, and the MPR group maintained low levels before surgery (P < 0.001). According to pre-defined cut-off values, the MFR and CAFF scores were recategorized as low or high status. Patients with low MFR status at BS (74.5% vs. 11.1%, P < 0.001) or low CAFF status at C1 (73.9% vs. 36.4%, P = 0.031) and BS (76.2% vs. 38.9%, P = 0.008) were more likely to achieve MPR than those with high status. Three dynamic patterns were identified: C0 low, C0 high/C1 low, and C0 high/C1 high. These patterns were further divided by BS low or high status, which indicated distinctive MPR rate (C0 low: BS low vs. high 78.9% vs 0%; C0 high/C1 low: BS low vs. high 73.9% vs. 25%; C0 high/C1 high: BS low vs. high 83.3% vs. 0%). An integrative model was constructed by incorporating immune parameters (PD-L1 and CD8 + CD28- T lymphocytes) and cfDNA features (MFR and CAFF) at C1 and BS, achieving an AUC of 0.86 (95% CI 0.80–0.92).ConclusionsDynamic monitoring of cfDNA methylation has potential to predict pathological response of neoadjuvant chemoimmunotherapy in NSCLC.Trial registrationRENAISSANCE study, NCT04606303, initiated on October 27, 2020.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12916-025-04419-x.

Commentary: Prognostic Implications of EGFR Exon 20 Insertions in Resected Non-Small Cell Lung Cancer.

BACKGROUND. Habitat imaging provides a novel approach to capture spatial heterogeneity within lesions. OBJECTIVE. The purpose of this study was to develop a ternary-classification habitat model to characterize lung adenocarcinoma presenting as a subsolid nodule (SSN) on CT and to test the model's diagnostic performance compared with 2D and radiomic models. METHODS. This retrospective study included 747 patients (median age, 56 years; 241 men, 506 women) with 834 resected lung adenocarcinomas that presented as SSNs on low-dose CT between July 2018 and July 2023. Adenocarcinomas from one center were divided into training (n = 440) and internal test (n = 189) sets; adenocarcinomas from three other centers formed an external test set (n = 205). Adenocarcinomas were classified as noninvasive adenocarcinoma, grade 1 invasive adenocarcinoma (IAC), or grade 2 or 3 (hereafter, grade 2/3) IAC. Ternary-classification models were built in the training set using multivariable multinomial logistic regression analyses (2D model: diameter and consolidation-to-tumor ratio; habitat model: volume and volume ratio of attenuation-based subregions; radiomic model: extracted radiomic features; combined model: habitat and radiomic features). Performance was evaluated using macroaveraged and class-specific AUCs. RESULTS. The optimal number of habitats was four. The 2D, habitat, radiomic, and combined models had macroaveraged AUCs in the internal test set of 0.857, 0.909, 0.914, and 0.912 and in the external test set of 0.871, 0.919, 0.924, and 0.926, respectively. Those four models had class-specific AUCs in the external test set for noninvasive adenocarcinoma of 0.945, 0.956, 0.961, and 0.955; for grade 1 IAC of 0.792, 0.858, 0.857, and 0.862; and for grade 2/3 IAC of 0.875, 0.940, 0.952, and 0.961, respectively. In the external test set, macroaveraged AUCs and class-specific AUCs for grades 1 and 2/3 IAC were significantly higher for habitat, radiomic, and combined models versus the 2D model, but not for other model comparisons; class-specific AUCs for noninvasive adenocarcinoma were not significantly different for any model comparisons. CONCLUSION. The habitat model performed significantly better than the 2D model in ternary adenocarcinoma classification; its performance was not significantly different from the radiomic and combined models. CLINICAL IMPACT. The habitat model's combination of interpretability and diagnostic performance supports its utility for noninvasive risk stratification of SSNs encountered during lung cancer screening.

Postoperative air leak is among the most common complications in thoracic surgery. Current management strategies are often suboptimal. Intrapleural administration of a glucose solution has emerged as a novel therapeutic approach; however, its clinical value has not been thoroughly investigated. This study aimed to compare the effectiveness of intrapleural 40% glucose solution versus autologous blood patch pleurodesis in managing postoperative air leak. This prospective, randomized, controlled study enrolled patients who underwent anatomical lung resections (segmentectomy, lobectomy, or bilobectomy) at the Department of Thoracic Surgery, Poznan University of Medical Sciences, between November 2023 and December 2024. Patients with postoperative air leak were randomized to receive either 40% glucose (study group) or autologous blood (control group). The primary end-point was cessation of postoperative air leak. Secondary end-points included incidence of residual air space, chest pain, and reoperation. A total of 110 patients were included: 47 in the glucose group and 63 in the blood group. Glucose administration resulted in a higher rate of postoperative air leak resolution (95.7% vs 82.5%, p = 0.033; 95% CI: 2.2% to 24.2%). The glucose group had a shorter postoperative hospital stay(7 vs 9 days, p = 0.036). Chest pain occurred more frequently in the glucose group, but the difference was not statistically significant(10.6% vs 4.8%, p = 0.24). No major infectious complications were observed. Residual air space occurence and reoperation rates were comparable. Intrapleural 40% glucose solution achieved a higher resolution rate of postoperative air leak compared to autologous blood patch pleurodesis, with a comparable safety profile.

In minimally invasive surgeries such as video-assisted thoracic surgery (VATS) and robot-assisted thoracic surgery (RATS), unexpected complications may necessitate conversion to thoracotomy. This study aimed to compare the rates, causes, and implications of conversion to thoracotomy between VATS and RATS. We retrospectively reviewed data from 1135 patients who underwent anatomical lung resection for primary lung cancer via VATS (n = 580) or RATS (n = 555) from 2011 to 2024. Conversion causes were categorized using the Vascular, Anatomy, Lymph node, Technical (VALT) system. Perioperative outcomes and independent predictors of conversion were analyzed via multivariate logistic regression. The overall conversion rate was significantly lower in the RATS group than in the VATS group (2.0% vs. 7.8%, p < 0.001). RATS was associated with fewer anatomical (0.9% vs. 3.1%, p = 0.010) and lymph node-related (0.2% vs. 2.6%, p < 0.001), with no significant difference in vascular-related conversions (0.9% vs. 2.1%, p = 0.142). Multivariate analysis identified age ≥ 75year, clinical T2-4, and N1-2 stage as independent risk factors, while RATS use was protective. Emergency conversions were uncommon in both groups, whereas RATS appeared advantageous in technically demanding settings. RATS significantly reduces the risk of conversion, particularly in anatomically or nodally complex cases, without increasing vascular complications.

Current Status of Immunotherapy in Resectable Lung Cancer

Effect of intraoperative paravertebral or intravenous lidocaine infusion on postoperative complications and inflammation after lung resection surgery: a randomised controlled trial.

Prognostic nutritional index predicts survival in older patients with resectable invasive lung adenocarcinoma.

Outcomes with neoadjuvant osimertinib and/or chemotherapy in patients with EGFR-mutant resectable non-small cell lung cancers.

Assessment of Postoperative Chylothorax Volume Threshold Associated with Failed Conservative Management.

Association of lung silica deposition with epidermal growth factor receptor-mutant lung cancer.

Prognostic impact of pleural lavage cytology in EGFR-stratified resected non-small cell lung cancer.

Translated article] Network meta-analysis of perioperative immunotherapies in non-small-cell lung cancer according to tumor programmed death ligand 1 expression.

Impact of lung resections on lung transplant grafts due to size discrepancy.

Association Between Early Postoperative Hypoxia and Postoperative Pulmonary Complications in Lung Resection Surgery: A Retrospective Cohort Study.

Chylothorax after partial lung resection in a patient with lung cancer and lymphoma

Molecular Therapy and Targeted Treatment for Cancer (with Surgical Lenses).