IntroductionMyxoid liposarcoma is a soft tissue sarcoma with a high tendency for lung metastasis. Its aggressive nature necessitates accurate diagnosis and treatment planning to improve outcomes.Case ReportA 31‐year‐old man presented with a three‐year history of an asymptomatic, progressively enlarging mass in his right thigh. Magnetic resonance imaging indicated a soft tissue tumor within the sartorius muscle, and an incisional biopsy suggested myxoid liposarcoma. Staging computed tomography scans revealed two nodules in the right lung, leading to an initial diagnosis of Stage IV myxoid liposarcoma. Given his overall health and the presumed resectability of the lesions, the patient underwent three courses of preoperative chemotherapy with doxorubicin and ifosfamide. Follow‐up imaging showed no change in the size of the tumor or lung nodules. A wide resection of the thigh tumor was performed, including part of the vastus medialis, sartorius, and gracilis muscles. Postoperatively, 65 gray (relative biological effectiveness) of proton radiation therapy was administered. Subsequently, a robot‐assisted thoracoscopic right lower lobectomy and lymph node dissection were performed to resect the lung nodules. Histological examination of the lung lesions revealed necrotizing granulomas with numerous round‐shaped yeasts. The special stains confirmed pulmonary cryptococcosis, ruling out metastasis and revising the tumor staging to Stage Ib. Consequently, postoperative chemotherapy was canceled, and the patient showed no recurrence over 3 years of follow‐up.DiscussionThis case emphasizes the need for histopathological evaluation of lung lesions in sarcoma patients, as not only cryptococcosis but also various fungal infections can mimic metastasis, potentially altering the treatment plan and prognosis.

The improvements from minimally invasive surgery and Enhanced Recovery After Surgery (ERAS) protocols have enabled more octogenarians to be considered for curative treatment of early-stage lung cancer. However, evidence on short-term outcomes after ERAS-guided Video-Assisted Thoracoscopic Surgery (VATS) lobectomy in this age group remains limited. The aim was to evaluate perioperative outcomes and assess specific challenges in octogenarians undergoing VATS lobectomy following a well-established ERAS-protocol. We conducted a retrospective observational study of consecutive adults undergoing VATS lobectomy within an ERAS program from 2009 to 2024. All patients followed standardized care and followed an ERAS protocol. Patients aged ≥80years underwent an additional preoperative risk assessment. Among 4,602 patients, 335 (7.3%) were octogenarians (median age 82years, IQR 81-83). Median length of stay was one day longer among octogenarians (4 (IQR: 2-7) vs 3days (IQR: 2-6), p=0.004). Overall complication rates were comparable between octogenarians and younger patients, except for postoperative atrial fibrillation (octogenarians 12% vs 7.6%, p=0.012). Within 30days, 40 octogenarians (11.9%) were readmitted, most commonly for pneumonia (30%), pneumothorax (25%), and pleural effusion (20%). 30-day mortality was not statistically different between octogenarians and younger patients (octogenarians 1.8% vs 1.2%, p=0.29). The number of octogenarians undergoing VATS lobectomy has increased from 2.5% of all patients in 2009 to 11.7% in 2024. VATS lobectomy within an ERAS framework appears safe and feasible in carefully selected octogenarians, yielding acceptable short-term outcomes. Chronological age alone should not preclude surgical treatment.

Abstract Background Uniportal thoracoscopic sleeve lobectomy is being increasingly performed as a less invasive option than equivalent procedures carried out through thoracotomy. The addition of non-intubated anesthesia with maintenance of spontaneous ventilation is reported as a further step ahead within advanced minimally invasive thoracic surgery options. Main text. In this editorial commentary, the recently published paper titled “Surgical technique and outcome analysis of nonintubated uniportal VATS sleeve lobectomy: A cohort study”, by Drs Qu and Jiang is discussed in detail. Conclusion We don’t know yet if excellent results do mean that it is worth doing non-intubated uniportal thoracoscopic sleeve resection. Rather, further investigation is warranted to confirm general applicability.

The clinical benefit of dividing the inferior pulmonary ligament (IPL) during video-assisted thoracoscopic upper lobectomy (TUL) for early-stage lung cancer remains controversial. This study aimed to evaluate the association between IPL division during TUL and postoperative clinical outcomes. We retrospectively analyzed 95 patients who underwent TUL between December 2020 and June 2025. Patients were assigned to an IPL-preservation group (Group P) or an IPL-division group (Group D). Group P included 50 patients (31 right-sided and 19 left-sided procedures), and Group D included 45 (29 right-sided and 16 left-sided procedures). Postoperative outcomes-including operative time, intraoperative blood loss, duration of postoperative air leak, chest tube duration, length of postoperative hospital stay, and changes in bronchial angle, lung volume, pulmonary function, and cough severity-were compared between groups. Bronchial angle and lung volume were measured using three-dimensional (3D) reconstructed chest computed tomography (CT) images. Cough severity and cough-related quality of life before and after surgery were assessed using the Mandarin Chinese version of the Leicester Cough Questionnaire (LCQ-MC). Baseline characteristics were comparable between groups, with no statistically significant differences (all P > 0.05). IPL division was associated with a greater degree of postoperative bronchial angle change after left-sided surgery, reaching borderline significance at 3 months (68.1 ± 7.2° vs. 78.1 ± 7.8°, P = 0.046) and poorer 6-month outcomes, including smaller lung volume (3615 ± 475 mL vs. 3392 ± 489 mL, P = 0.027), a trend towards lower FEV1% (73.04 ± 9.36 vs. 69.06 ± 10.11, P = 0.049), lower DLCO (80.82 ± 10.35 vs. 76.06 ± 11.08, P = 0.033), and lower total LCQ-MC score (17.70 ± 1.72 vs. 16.98 ± 1.69, P = 0.042). No significant between-group differences were observed for other endpoints. IPL division did not demonstrate a clear benefit over IPL preservation. The findings suggest that IPL division may be associated with reduced postoperative lung volume, impaired recovery of diffusing capacity, greater displacement of the residual bronchus, and more severe chronic cough. However, particularly for outcomes with marginally significant P values, these results should be interpreted with caution due to multiple comparisons. These conclusions are hypothesis-generating and require confirmation in larger, prospective studies.

Postoperative anastomotic embolism and elusive chronic nausea following pulmonary artery tear during single-port thoracoscopic lobectomy: a case report and examination of potential mechanisms

Uniportal thoracoscopic surgery has gained popularity as a minimally invasive approach for anatomical lung resection. While outcomes from high-volume centers have been reported, evidence describing nationwide real-world practice across institutions with varying experience is scarce. This study aimed to evaluate the current status and perioperative outcomes of uniportal thoracoscopic anatomical pulmonary resections in Japan. We conducted a multicenter retrospective study under the Japanese Uniportal Video-assisted Thoracoscopic Surgery Interest Group. Patients with primary lung cancer who underwent uniportal thoracoscopic lobectomy or segmentectomy in Japan between April 2018 and March 2023 were included. Clinical information was collected from participating institutions, and patient characteristics, operative variables, and perioperative outcomes were evaluated. The primary outcome was the incidence of procedure-related complications, with secondary outcomes including operative time and other perioperative parameters. A total of 3,546 patients were analyzed, comprising 2,780 lobectomies and 766 segmentectomies. The proportion of segmentectomies gradually increased during the study period. In the lobectomy group, the median operative time was 170 min, with prolonged air leak in 7.6% and significant vessel injury in 3.4%. In the segmentectomy group, the median operative time was 154 min, with prolonged air leak in 4.6% and significant vessel injury in 3.5%. Thirty-day mortality was 0.3% in both groups, and conversion to multiport or thoracotomy occurred in 1.8-3.6% of cases. This nationwide analysis indicates that uniportal thoracoscopic anatomical pulmonary resection is performed safely in Japan, with perioperative outcomes comparable to those reported internationally. Although operative times were slightly longer than those in single-institution series, complication rates remained low, indicating that uniportal thoracoscopic anatomical pulmonary resection is being conducted with acceptable perioperative outcomes in real-world practice.

Video-assisted thoracoscopic surgery (VATS) lobectomy has emerged as the standard surgical procedure for early-stage non-small cell lung cancer (NSCLC). This article presents the initial experience of a newly established thoracic surgery department with a residency program, evaluating surgical, oncologic and safety outcomes while implementing a learning environment. This single-center retrospective study analyzed medical records of patients who underwent VATS lobectomy for early-stage NSCLC between 2019 and 2024. Inclusion criteria were age over 18 years, NSCLC pathology, and clinical stage IA-IIB. The patient population was divided into two subgroups, the first consisting of procedures performed exclusively by senior surgeons and the second consisting of those performed by residents under direct supervision. Key outcomes were mortality, overall complication, and overall survival rates. A total of 460 patients were evaluated, with a mean age of 69.7 years; the cohort was predominantly male. Adenocarcinoma was the most common pathology (81.1%), with right upper lobe resection being the most frequent procedure. The conversion rate to thoracotomy was 4.1%, with senior surgeons reporting a rate of 8.7% compared to 0.7% among residents. Thirty-day mortality was 1.73%, with senior surgeons at 1.02% and residents at 2.26%. Overall complication rate reached 26.7% without a difference in the subgroups. Prolonged hospitalization occurred in 26.9% of cases. Five-year overall survival was 90.42% among the 94 patients with adequate follow-up, demonstrating favorable outcomes for minimally invasive surgery in early-stage lung cancer. This single-center experience demonstrates that VATS lobectomy is a safe and effective treatment for early-stage NSCLC, yielding outcomes comparable to those reported globally. The study findings reaffirm VATS as a current standard of care, providing robust postoperative survival and manageable complication rates. Furthermore, study indicates that VATS lobectomy is also a safe procedure for training surgical residents, supporting its role in surgical education.

Retrospective analyses have associated elevated mechanical power (MP) during one-lung ventilation (OLV) with reintubation rates and emergent non-invasive ventilation. Nonetheless, the study design and chosen outcomes may limit the generalizability of these findings to postoperative pulmonary complications (PPCs) in patients undergoing thoracoscopic lobectomy. The aim of this study was to evaluate whether this association remained robust under a standardized anesthesia protocol. A prospective cohort study was conducted at a tertiary hospital among adults aged 50-80 years. Respiratory signals, chest computed tomography, and blood sampling were routinely measured. MP was defined as the sum of the energy transferred to overcome airway resistance and temporarily stored in the elastic lung tissue in one minute. The primary endpoint was the association of MP and PPCs. The secondary endpoints were the occurrence of impaired postoperative oxygenation, changes in lung aeration compartments, and systemic inflammatory factors during the perioperative period. Patient recruitment lasted from August 1st 2022 to July 19th 2024 and included 118 participants. The incidence of PPCs was 33.9 %. MP during OLV and normalization to lung volume in non-surgical lungs, as well as the elastic and resistive components of MP, were independently associated with PPCs (ORadj =1.67 [1.01, 2.76], p =0.044; 1.68 [1.04, 2.71], p =0.033; 1.81 [1.16, 3.11], p =0.046; and 2.61 [1.09, 6.27], p =0.031, respectively). Compared with resistive components, dynamic elastic component of MP had a stronger dominance on PPCs (contribution to pseudo-R2 0.029 vs. 0.015). The relationship between MP and PPCs was non-linear (p =0.047), with a reflection point at MP of 3.7 J.min-1. Compared to those without PPCs, patients with PPCs exhibited higher perioperative IL-10 levels and consistently poor lung aeration—both preoperatively in the non-dependent region and postoperatively in the mid-ventral region. Changes in biomarkers did not differ between patients; however, IL-8 levels showed consistent associations with PPCs during the perioperative observation period. Under lung-protective ventilation, MP during OLV was independently and non-linearly associated with PPCs, driven predominantly by its dynamic elastic component and accompanied by specific inflammatory and aeration changes. Number ChiCTR2200062173 (restarted on July 27th 2022). •Question: In the complex setting of performing thoracoscopic lobectomy in patients receiving OLV, does the association between MP and PPCs remain robust? •Findings: A higher MP during OLV, mainly driven by ∆P, was independently and non-linearly associated with an increased risk of PPCs. •Meaning: In adults undergoing thoracoscopic lobectomy with lung-protective ventilation, clinical measures to minimize mechanical power may reduce the risk of PPCs.

The right top pulmonary vein (RTPV) is a rare venous anomaly arising from the posterior segmental vein, which runs dorsal to the bronchus intermedius. This anatomy increases the risk of vascular injury during right lower lobectomy, particularly during subcarinal lymph node dissection and fissure division. We describe thoracoscopic right lower lobectomy with subcarinal lymph node dissection in a patient with RTPV. Key techniques include circumferential dissection of the RTPV and a fissure-last technique. This approach enabled safe preservation of the anomalous vein and adequate exposure of the subcarinal space for complete lymph node dissection. This case highlights practical strategies for preserving anomalous veins and enabling safe subcarinal lymph node dissection, contributing to reproducible thoracoscopic surgery.

PurposeTo investigate the efficacy and safety of oliceridine for anesthesia induction, maintenance and analgesia in patients undergoing thoracoscopic lobectomy.Patients and MethodsIn this single-center, prospective, double-blind, randomized controlled trial, patients scheduled for surgery between October 2024 and August 2025 were divided into two groups: oliceridine group (Group O) and sufentanil group (Group S). Study drugs were used for anesthesia induction, maintenance and postoperative analgesia. The primary outcome was the incidence of postoperative opioid-related adverse events within the first 48 hours, including PONV, respiratory depression, dizziness, pruritus, and constipation. Secondary outcomes included hemodynamic parameters, NRS and Ramsay Sedation Scale at multiple time points of post-surgery (2h, 6h, 12h, 24h, and 48h), the usage of postoperative analgesia drugs, rescue treatments, and Quality of Recovery-15 (QoR-15) scores.ResultsA total of 166 patients were enrolled (Group O: n=83, Group S: n=83). Compared to Group S, Group O showed significantly lower rates of PONV and respiratory depression (P<0.05) and higher QoR-15 scores at 24h and 48h (P<0.05). No significant differences were found in hemodynamics, NRS scores, or Ramsay scores between the two groups (P > 0.05).ConclusionOliceridine provides safe and effective perioperative analgesia for patients undergoing thoracoscopic lobectomy. It maintains stable hemodynamics, achieves analgesic efficacy comparable to sufentanil, and demonstrates a superior profile in reducing opioid-related adverse events while promoting postoperative recovery.

Dear Editor, We read with great interest the report on the POPPER randomized controlled trial, which evaluated a smartphone-based application for home symptom management and rehabilitation following thoracoscopic lobectomy[1]. The authors proposed an innovative digital intervention integrating a symptom alert system, exercise modules, and educational content, demonstrating statistically significant improvements in pulmonary function recovery and patient-reported outcomes. We commend the investigators for their timely contribution to postoperative digital care; however, several methodological and interpretative issues merit further discussion. Although the difference in pulmonary function recovery rate (PFRR) between the app group and the standard care group reached statistical significance (79.32% vs. 75.73%; P = 0.04), the absolute improvement of approximately 3.6% may not translate into a clinically meaningful benefit. The study did not define the minimal clinically important difference for PFRR, nor did it report outcomes beyond 30 days. Given the natural recovery trajectory after thoracoscopic surgery, the short-term improvement observed may reflect an early motivational effect rather than sustained physiological gains. In addition, the single-blind design, in which clinicians and nurses were aware of group allocation, introduces potential performance bias. Participants in the app group received more frequent guidance, monitoring, and contact through the alert system, which may have enhanced adherence and engagement independently of the app’s intrinsic efficacy. Thus, the observed effects might largely represent an attention or engagement bias rather than the true functional value of the digital platform itself. The inclusion criteria limited enrollment to relatively healthy individuals (ECOG 0–1, capable of performing spirometry and exercise), restricting generalizability to older, frail, or less tech-savvy patients – who in fact constitute a substantial proportion of the post-lobectomy population. The mean age of 61 years and the very high satisfaction rate (95.5%) suggest participants had a good level of digital literacy, a feature that may not be easily replicated in real-world practice, where many elderly patients still face barriers to smartphone use. Furthermore, excluding patients with prolonged hospital stays or postoperative complications may underestimate the challenges of implementing this intervention in more complex recovery scenarios. The authors reported that participants who triggered alerts exhibited higher exercise intensity and greater pulmonary recovery. However, this finding may be confounded, as more motivated individuals are naturally inclined to report symptoms and adhere to exercise regimens more diligently. The causal direction between symptom monitoring and rehabilitation remains unclear, whether monitoring promotes recovery or recovery itself encourages more reporting. Without time-series analysis, attributing functional improvement directly to the alert mechanism remains speculative. Although no app-related adverse events were reported, the app group showed a numerically higher rate of emergency department visits (8.8% vs. 2.9%), which, despite lacking statistical significance, warrants attention. Heightened symptom awareness could lead to unnecessary consultations, reflecting potential hypersensitivity rather than improved self-management. Moreover, the study did not assess cost-effectiveness, caregiver burden, or healthcare resource utilization – key dimensions for evaluating digital health interventions. The recovery trajectory after pulmonary lobectomy typically extends beyond 1 month, with pulmonary function and quality of life continuing to improve over 3–6 months[2]. Without long-term follow-up data, it remains uncertain whether the observed benefits persist, plateau, or diminish once the intervention ceases. Extending follow-up with repeated assessments of lung function and quality of life would greatly enhance the clinical validity of the findings. In summary, the POPPER trial represents a valuable step toward digital-assisted postoperative rehabilitation in thoracic surgery. Nevertheless, its short-term effects, methodological limitations, and interpretive ambiguities temper the strength of its conclusions. Future research should incorporate clinically meaningful endpoints, ensure blinded assessment and balanced follow-up, include more diverse patient populations, and evaluate cost-effectiveness and long-term outcomes to establish the sustained value of such digital interventions. Consistent with the 2025 TITAN Guidelines[3], our review fully adheres to these guidelines.

To compare the clinical efficacy of the progressive suspension method and conventional thoracoscopic pulmonary resection in right upper lobectomy. A prospective cohort study was conducted involving 60 patients admitted to the Department of Thoracic Surgery at Cangzhou Central Hospital from January 2024 to March 2025. Patients were randomly divided into the observation group (n = 30, using the progressive suspension method, including 15 cases of trans-thoracic puncture fixation and 15 cases of intra-thoracic suture fixation) and the control group (n = 30, conventional thoracoscopic pulmonary resection). Surgical field exposure, operative fluency, lymph node dissection, perioperative indicators, and hospitalization costs were compared between the two groups. The observation group demonstrated significantly superior surgical field exposure (83.3% vs. 50.0%, p = 0.008) and operative fluency (73.3% vs. 33.3%, p = 0.002). The operative time [(87.5 ± 23.2) min vs. (112.4 ± 35.6) min, p < 0.001], intraoperative blood loss [50 (20, 50) mL vs. 80 (50, 120) mL, p < 0.001], postoperative drainage [150 (100, 200) mL vs. 250 (180, 300) mL, p = 0.003], VAS pain score [(3.2 ± 1.1) vs. (4.8 ± 1.5), p < 0.001], and hospitalization costs [(4.5 ± 0.8) vs. (5.2 ± 1.1) ten thousand yuan, p = 0.009] were all significantly better in the observation group. The number of lymph nodes dissected [(10.3 ± 3.1) vs. (8.5 ± 2.8), p = 0.021] showed a statistically significant difference, while the complete lymph node resection rate (93.3% vs. 80.0%, p = 0.143) and complication rate (16.7% vs. 33.3%, p = 0.132) showed no significant difference. No statistical differences were observed between the two suspension subgroups (p > 0.05). The progressive suspension method in thoracoscopic right upper lobectomy provides superior surgical field exposure, improved operative fluency, higher surgical efficiency, and better postoperative recovery compared to the conventional method, making it a safe and effective surgical approach.

ObjectiveTo evaluate outcomes of different doses of esketamine in postoperative patient-controlled intravenous analgesia (PCIA) combined with preoperative intercostal nerve block (ICNB) analgesia protocol for acute postoperative pain (APP) relief in patients undergoing thoracoscopic lobectomy.Materials and methodsA total of 360 patients scheduled for thoracoscopic lobectomy at Xuzhou Central Hospital between October 2021 and July 2023 were enrolled and randomly assigned into three groups using the random envelope method. Before anesthesia induction, all patients received ICNB, followed by general anesthesia. Group C received PCIA using sufentanil at 0.03 μg/kg/h, Group K1 received a low dose of esketamine at 0.015 mg/kg/h in PCIA, and Group K2 received a moderate dose of esketamine at 0.03 mg/kg/h in PCIA. Numerical Rating Scale (NRS) pain scores were recorded at 2, 4, 24, 48, and 72 h postoperatively. The incidence of APP within 72 h post-surgery, the requirement for rescue analgesia and the occurrence of adverse reactions, were assessed and recorded for the three groups.ResultsThere were significantly lower NRS scores in Group K2 at 2, 4, 24, 48, and 72 h postoperatively, compared to Groups C and K1 (P < 0.01). However, there were no statistically significant differences in NRS scores between Group C and Group K1 (P > 0.05). The incidence of APP within 72 h postoperatively was significantly lower in Group K2, compared to Group C and Group K1 (P < 0.05). Additionally, Group C exhibited a significantly higher the incidence of postoperative nausea and vomiting (PONV) than the other two groups (P < 0.05). Group K2 demonstrated superior postoperative analgesic efficacy, including reduced rescue analgesia needs and lower opioid consumption, without affecting hospital stay length compared to Groups C and K1.ConclusionA dose of 0.03 mg/kg/h esketamine in PCIA combined with preoperative ICNB significantly alleviates APP in patients undergoing thoracoscopic lobectomy, reducing resting pain scores by approximately 30% at 24 h compared to sufentanil-based analgesia.Clinical Trial Registrationhttps://www.chictr.org.cn/, Identifier ChiCTR2100051000.

A man in his 60s presented with an abnormal shadow on chest radiography. Computed tomography (CT) showed a tumor, measuring 6.1 cm, in the right upper lobe and an anomalous bronchus arising from the trachea. Following transbronchial biopsy and examinations, the patient was diagnosed with stageⅡB lung adenocarcinoma. The patient underwent a multiport thoracoscopic right upper lobectomy and lymph node dissection. Preoperatively, the information of the tracheal bronchus was shared in the surgical team. During the procedure, the tracheal bronchus was detected behind the azygos arch. The azygos arch and tracheal bronchus were dissected by a stapler. The tracheal bronchus stump was covered by a pedicled pericardial fat pad. No complications were observed perioperatively. Information of anomalies should be shared in the surgical team, including anesthesiologists preoperatively.

Comparative Analysis of Thoracic Paravertebral Block and Erector Spinae Plane Block on Respiratory Function and Quality of Recovery in Thoracoscopic Surgery: A Randomized Controlled Trial.

We report a case of synchronous double cancer involving the left lung and esophagus treated with a minimally invasive one-stage procedure combining thoracoscopic lobectomy and mediastinoscopic esophagectomy. Although a two-stage approach is often selected due to the technical complexity and invasiveness of simultaneous surgery, both tumors in this case were advanced, and a single-stage resection was considered the most appropriate option to avoid losing the opportunity for curative treatment. The postoperative course was complicated by anastomotic leakage, which was managed conservatively;however, early recurrence of esophageal cancer occurred, followed by multiple brain metastases from small cell lung carcinoma. These recurrences may have been related to limited mediastinal lymph node dissection, performed to preserve bronchial blood flow, and to the delayed initiation of adjuvant therapy due to treatment for esophageal recurrence. This case demonstrates not only the feasibility and advantage of a less invasive simultaneous approach but also emphasizes the need to optimize lymph node dissection strategies and the timing of postoperative therapy in complex synchronous malignancies.

Effect of Remimazolam or Propofol Combined With Esketamine on Anesthesia and Early Perioperative Neurocognitive Disorders in Patients Undergoing Thoracoscopic Partial Lung Resection: A Randomized Clinical Trial.

Hypoxemia is a common and clinically significant problem during one-lung ventilation (OLV). Prophylactic ventilation strategies to prevent OLV-associated hypoxemia and lung injury remain insufficiently defined. Patients scheduled for elective video-assisted thoracoscopic lung lobectomy or segmentectomy were enrolled and randomly assigned into a preconditioning group or a control group. After anesthesia induction, a visual double-lumen endotracheal tube was inserted. The preconditioning group underwent three cycles of OLV preconditioning protocol before surgery: 2min OLV → 2min two-lung ventilation (TLV) → 4min OLV → 4min TLV → 6min OLV → 6min TLV. The control group received conventional OLV only. Ventilation parameters: the tidal volume was set at 6 mL/kg during OLV and 8 mL/kg during TLV. Respiratory rate was adjusted to maintain an end-tidal carbon dioxide partial pressure of 35-45 mmHg. The primary outcome was the oxygenation index (arterial partial pressure of oxygen/fraction of inspired oxygen, PaO2/FiO2). Secondary outcomes included perioperative oxidative stress markers and the incidence of postoperative pulmonary complications (PPCs) within 7 days after surgery. Seventy-four patients were included in the final analysis. The oxygenation index decreased in both groups after initiation of OLV, reaching its lowest value at 30min. At this time point, the preconditioning group showed a significantly higher oxygenation index than the control group (209 ± 64 vs. 145 ± 43 mmHg, P < 0.001). No significant differences were observed between the two groups in perioperative superoxide dismutase (SOD) levels [168 ± 16 vs. 160 ± 21 U/mL, P = 0.302] or in the incidence of PPCs (10/38 vs. 16/36, P = 0.105). OLV preconditioning improved intraoperative oxygenation during thoracic surgery, but did not significantly affect perioperative oxidative stress or the incidence of PPCs. The study was retrospectively registered in the Chinese Clinical Trial Registry on April 8, 2021, ( http://www.chictr.org.cn , ChiCTR2100045203).

BackgroundPreoperative characterization of solitary pulmonary nodules is critical yet challenging, as distinguishing early-stage neoplasms from benign lesions is essential to prevent unwarranted anatomical resections. The study aimed to analyze the impact of preoperative positron emission tomography-computed tomography (PET-CT) on the incidence of video-assisted thoracoscopic surgery (VATS) lobectomy for unsuspected benign disease, in patients without preoperative diagnosis.MethodsThe study included 864 patients, after VATS lobectomy, without the preoperative diagnosis, between January 1, 2014 and December 31, 2020, with 654 receiving preoperative PET-CT and 210 without it. The propensity score matching analysis was done, calculating the predicted probability using: age, sex, cardiovascular comorbidities, previous malignancy, chronic obstructive pulmonary disease (COPD), diabetes, and T category, obtaining equal groups of 210 patients with preoperative PET-CT (PET group) and without preoperative PET-CT (non-PET group). Univariate and multivariate analyses assessed the impact of the various factors on the incidence of benign postoperative diagnosis.ResultsNo significant difference was found in benign postoperative diagnosis between the PET and non-PET groups [n=6 (2.9%) vs. n=10 (4.8%), P=0.31; risk difference (RD): −0.019, 95% confidence interval (CI): −0.060 to 0.022] In the univariate analysis, younger age [60.75 vs. 65.5 years, P=0.02] and absence of COPD (4.6% vs. 0%, P=0.046), significantly influenced the risk of the postoperative unsuspected benign diagnosis. The younger age emerged as the sole significant risk factor for VATS lobectomy for benign lesions [P=0.042, odds ratio (OR) =1.062; 95% CI: 1.002–1.127].ConclusionsThe use of preoperative PET-CT did not decrease the risk of performing VATS lobectomy on unsuspected benign tumors. That risk should be considered when qualifying for VATS lobectomy, especially in younger patients.

The limited duration of action of bupivacaine hydrochloride in thoracic paravertebral nerve block (TPVB) contributes to high rates of acute and chronic postsurgical pain (CPSP) following video-assisted thoracoscopic surgery (VATS). The efficacy of long-acting liposomal bupivacaine (LB) in VATS remains inconclusive. This randomized, double-blind trial involved 146 patients undergoing elective VATS, who received TPVB with either 20 ml of 0.887% liposomal bupivacaine (LB group) or 20 ml of 0.25% bupivacaine hydrochloride (B group). This study was registered with the Chinese Clinical Trial Registry on July 31, 2024. The primary outcome was the area under the curve (AUC) of numerical rating scale (NRS) pain scores over the first 72 h postoperatively. Secondary outcomes included NRS scores at 72 h and at 1, 3, and 6 months postoperatively; concentrations of inflammatory markers within 48 h postoperatively; analgesic consumption; patient-controlled intravenous analgesia (PCIA) presses; postoperative hospitalization duration; and the incidence of postoperative adverse reactions and complications. The AUC of NRS scores at rest and during movement was significantly lower in the LB group compared to the B group during the first 72 h postoperatively (P < 0.05). At 1 and 3 months postoperatively, the LB group showed significantly lower NRS scores and a 58% reduction in CPSP incidence (28.6% vs. 48.6%; P < 0.001). The LB group required fewer effective and total PCIA presses, as well as reduced supplemental analgesic doses during the first 48 postoperative hours (P < 0.01). Fewer complications, including subcutaneous emphysema and pneumonia, were observed in the LB group (P < 0.01). Additionally, inflammatory responses were attenuated, as indicated by decreased interleukin-1β levels within 48 h and lower C-reactive protein levels at 24 h (P < 0.05). No significant differences were observed between the groups in other secondary outcomes. Liposomal bupivacaine for TPVB significantly alleviated both acute and chronic postsurgical pain, reduced analgesic requirements, and did not increase pulmonary complications.