MicroAbstractThis study spanned six Chinese medical centers and included 143 resectable stage III non-small cell lung cancer (NSCLC) patients with induction immunochemotherapy with a median follow-up of 29.5 months, demonstrating that video-assisted thoracoscopic surgery (VATS) led to decreased surgical-related pain, earlier chest tube removal, fewer postoperative complications, and comparable two-year survival outcomes to thoracotomy. Even when converted, VATS achieved perioperative outcomes equivalent to thoracotomy. Therefore, VATS could be considered feasible and oncologically effective for resectable stage III NSCLC after neoadjuvant immunochemotherapy.BackgroundImmune checkpoint inhibitors have revolutionized non-small cell lung cancer (NSCLC) treatment but may pose greater technical challenges for surgery. This study aims to assess the feasibility and oncological effectiveness of video-assisted thoracoscopic surgery (VATS) for resectable stage III NSCLC after neoadjuvant immunochemotherapy.MethodsInitial stage IIIA-IIIB NSCLC patients with neoadjuvant immunochemotherapy undergoing either VATS or open lobectomy at six medical centers during 2019-2023 were retrospectively identified. Perioperative outcomes and two-year survival were analyzed. Propensity-score matching (PSM) was employed to balance patient baseline characteristics.ResultsAmong the total 143 patients, PSM yielded 62 cases each for VATS and OPEN groups. Induction-related adverse events were comparable between the two groups. VATS showed a 14.5% conversion rate. Notably, VATS decreased numeric rating scales for postoperative pain, shortened chest tube duration (5[4-7] vs. 6[5-8] days, P=0.021), reduced postoperative comorbidities (21.0% vs. 37.1%, P=0.048), and dissected less N1 lymph nodes (5[4-6] vs. 7[5-9], P=0.005) compared with thoracotomy. Even when converted, VATS achieves perioperative outcomes equivalent to thoracotomy. Additionally, over a median follow-up of 29.5 months, VATS and thoracotomy demonstrated comparable two-year recurrence-free survival (77.20% vs. 73.73%, P=0.640), overall survival (87.22% vs. 88.00%, P=0.738), cumulative incidences of cancer-related death, and recurrence patterns. Subsequent subgroup comparisons and multivariate Cox analysis likewise revealed no statistical difference between VATS and thoracotomy.ConclusionVATS is a viable and effective option for resectable stage III NSCLC patients following neoadjuvant immunochemotherapy, leading to decreased surgical-related pain, earlier chest tube removal, reduced postoperative complications, and similar survival outcomes compared to thoracotomy.

2018年3月至2019年3月期间采用剑突下切口胸腔镜全胸腺切除术治疗9例胸腺肿瘤患者,其中男6例,女3例；年龄24～83岁,平均(54.8±15.2)岁。患者术前均常规行胸部增强CT检查明确诊断,了解胸腺肿物与周围组织、血管关系,术前均未行肿物穿刺活检。全组手术过程顺利,无围手术期死亡,无输血、加用肋间切口和中转开胸。术后无迟发出血、肺部感染、肺不张、胸腔积液、胸腔或纵隔积气、重症肌无力等并发症。全组随访1～12个月,期间无肿瘤复发及特殊不适,疗效满意。经剑突下切口胸腔镜全胸腺切除术治疗胸腺肿瘤安全有效,创伤小,痛苦少,患者恢复快,值得临床推广应用。

对2018年8月至2019年3月上海交通大学医学院附属同仁医院诊治的4例气管憩室导致慢性咳嗽患者的临床和病理资料进行分析，胸部高分辨HRCT检查显示，胸廓入口处气管旁右侧后壁的类圆形或不规则囊状或柱状气体影，连续横断薄层扫描或多平面重建等后处理技术发现气囊与气管之间无或有一较细的管道相连，气管镜检查均未见明显异常通道，术后病理报告示气管憩室。经颈部沿皮纹横弧形切口顺利切除气管憩室，术后慢性咳嗽症状消退，随访2～8个月，疗效满意。

Objective:To compare the clinical effect of anterior mediastinal tumor resection with video assisted thoracoscopic surgery(VATS) through approach of trans-subsagittal incision and trans-intercostal incision.Methods:The clinical data of 118 patients including 67 males and 51 females with anterior mediastinal tumors using VATS resection from January 2013 to October 2020 in Tongren Hospital, Shanghai Jiao Tong University School of Medicine were analyzed retrospectively. According to different incisional approach, these patients were divided into two groups of trans-subsagittal incision group including 45 cases with 25 males and 20 females, and trans-intercostal incision group including 73 cases with 42 males and 31 females. The sternal incision group was treated with the sub xiphoid incision plus the subcostal arch incision and the sternal retractor traction sternum, and the intercostal incision group was treated with the traditional intercostal space incision. Subsagittal incision combined subcostal arch incision and sternum traction with sternal retractor was used in the approach of trans-subsagittal incision group, and the traditional thoracotomy was used in the intercostal incision group. The clinical data of operation time, volume of intraoperative blood loss, rate of transfer to open thoracotomy, duration of postoperative chest tube drainage, visual analogy score(VAS)assessed on the 1st and 3rd days after surgery, hospitalization time, average cost of hospitalization, and incidence of postoperative complications, were compared between the two groups.Results:The operative time, volume of intraoperative blood loss, the number of cases of transfer to open thoracotomy, duration of postoperative chest tube drainage, VAS score of the first and third days after operation, length of hospitalization, average hospitalization cost and the incidence of postoperative complications were lower than those in the transcostal incision group( P<0.05). Conclusion:Compared to the group of trans-intercostal incision VATS resection of anterior mediastinal tumor, the trans-subsagittal incision group has many advantages as follows, shorter operation time, less intraoperative blood loss, no transfer to open thoracotomy, much simpler and safer operative procedure, less body trauma, lighter postoperative pain, less postoperation complications, shorter hospitalization time, less average hospitalization cost, and rapid rehabilitation after surgery.