Objective We aimed to investigate the accuracy of a circulating exosome-based gene panel for predicting spread through air spaces (STAS). Methods A training cohort of 700 patients with stage I LUAD and a validation cohort of 178 patients were evaluated. Multivariable logistic regression was performed to identify exosome-derived genes and computed tomography (CT) features associated with STAS. The predictive performance of the gene panel, frozen sections (FS), and CT features was compared. Combined prediction models incorporating multiple diagnostic modalities were subsequently constructed and validated. Results STAS-positive tumors exhibited distinct exosome-derived gene signatures, including ALK rearrangement and elevated expression of MTA1, Twist, Slug, and β-Catenin. In the training cohort, the five-gene panel achieved an AUC of 0.802 (95 % CI: 0.770–0.834), with a sensitivity of 0.847 and a specificity of 0.666—superior to both FS (P < 0.001) and CT imaging features (P < 0.001). The AUC of the combined model integrating the gene panel with FS was 0.856 (95 % CI: 0.827–0.884), comparable to the model integrating the gene panel with radiology (AUC 0.846, 95 % CI 0.817–0.875; P = 0.471), and significantly higher than the combination of FS with radiology (AUC 0.803, 95 % CI: 0.767–0.840; P = 0.008 and P = 0.043, respectively). Similar results were also observed in the validation cohort. Conclusion ALK rearrangement and elevated expression of MTA1, Twist, Slug and β-Catenin in circulating exosomes were independent predictors of STAS. The five-gene panel serves as a promising adjunct to radiology and frozen sections for preoperative identification of STAS, potentially guiding optimal surgical decision-making.

Objective: To evaluate a simplified surgical approach for Acute Type A Aortic Dissection (ATAAD). Methods: A retrospective analysis (Jan 2021–Oct 2025) compared 50 patients: an observation group undergoing Fontus stent graft with "MUSIC" strategy (Moderate hypothermia, Unilateral Selective antegrade cerebral perfusion, Ice Cap) versus a control group receiving Sun's procedure under deep hypothermic circulatory arrest (DHCA). Results: The Fontus/MUSIC group showed shorter circulatory arrest time, less postoperative drainage, faster recovery of coagulation and liver enzymes, better early renal and pulmonary function, and shorter ventilation. A graft bend >70.79° improved true lumen expansion. No differences were found in ECMO, renal replacement, stay, or 30-day mortality. Conclusion: The Fontus graft with “MUSIC” reduces technical complexity and perioperative risk, supporting its routine use in regional centers.

Fibrous dysplasia (FD) is the most common benign tumor of the ribs, with surgical resection being the preferred treatment modality for rib FD, leading to enhanced quality of life and favorable outcomes. The complexity of surgical intervention varies depending on the location of costal FD, presenting challenges for both open surgical and thoracoscopic approaches. In this study, we present a novel technique for three-port robotic-assisted costectomy utilizing a Gigli saw, detailing our initial findings and outcomes. We reviewed five patients with benign rib tumors who underwent three-port robotic-assisted rib resection using a Gigli saw between May 2021 and December 2022. Data on patient characteristics, relevant short-term surgical outcomes and clinical long-term treatment effects were collected. The surgery was successful in all five patients without any need for an additional port and emergency conversion to open surgery. Median operative time was 76.8 min (range, 73–116 min), and the median intraoperative blood loss volumes was 75 ml (range, 40– 105 mL). On average, chest tubes were removed 1.2 days postoperatively (range, 1–2 days), with a mean drainage volume of 93 ml on postoperative day 1 (range, 70–135 ml). Patients were discharged between the 2nd and 4th postoperative day. During 1-year follow-up period, no recurrence was observed in either patient. The utilization of a three-port robotic-assisted costectomy in conjunction with a Gigli saw represents a viable, secure, and efficient approach for treating isolated benign rib lesions. Our aim is to provide clinical guidance on this technique and promote its broader application.

Lung cancer is a leading cause of cancer-related mortality globally, with a five-year survival rate lower than many other cancers. Surgery remains the most effective treatment; however, fewer than 50

Desmoid fibromatosis (DF) is a rare low-grade benign myofibroblastic neoplasm that originates from fascia and muscle striae. For giant chest wall DF, surgical resection offer a radical form of treatment and the causing defects usually need repair and reconstruction, which can restore the structural integrity and rigidity of the thoracic cage. The past decade witnessed rapid advances in the application of various prosthetic material in thoracic surgery. However, three-dimensional (3D)-printed custom-made titanium ribs have never been reported for chest wall reconstruction post-DF resection. Here, we report a successful implantation of individualized 3D-printed titanium ribs to repair the chest wall defect in a patient with DF.

In recent years, robot-assisted thoracoscopic surgery has seen major advances. The feasibility and safety of this new surgical procedure have been widely recognized. However, only a few studies have investigated the short-term postoperative outcomes of lobectomy in early-stage non-small cell lung cancer (NSCLC) patients using different numbers of ports in Da Vinci robot-assisted surgery. This study aimed to evaluate the clinical value of robot-assisted lobectomy by comparing the perioperative data of NSCLC patients who underwent three-port and four-port surgical methods. The data of 121 consecutive patients who were admitted to our hospital for NSCLC and underwent Da Vinci robot-assisted thoracic surgery (RATS) for radical resection from January 2020 to October 2021 were retrospectively collected and analyzed. The cases that did not meet the inclusion criteria were removed, and the patients were divided into the three-port group (76 cases) and the four-port group (45 cases). The general clinical data, perioperative data, and postoperative pain were individually compared to determine the different clinical effectiveness of the two approaches. All 121 patients in the 2 groups successfully underwent lobectomy and systemic lymph node dissection. No significant difference in age, sex, tumor location, tumor size, history of chronic disease, pathological type, pathological tumor-node-metastasis (pTNM) staging, postoperative complications, and number or stations of total lymph nodes dissected was observed between the two groups (P > 0.05). The operation time [(117.32 ± 36.55) min vs. (136.83 ± 40.63) min], the console time [(90 ± 19.35) min vs. (103 ± 15.65) min], the intraoperative blood loss [(94.34 ± 32.16) mL vs. (102.73 ± 33.67) mL], the chest tube drainage time [(2.43 ± 0.65) d vs. (2.79 ± 1.42) d], and the postoperative hospitalization time [(4.55 ± 1.43) d vs. (5.14 ± 1.66) d] were lower in the three-port group compared to the four-port group but showed no statistically significant difference (P > 0.05). However, the three-port group demonstrated significantly superior visual analogue scale pain scores compared to the four-port group at 24, 48, and 72 h postoperatively (all p < 0.001). Compared to four-port RATS, the three-port robotic-assisted lobectomy is safe, practicable and effective. Operative incision optimization leads to less postoperative pain and appears to be more acceptable for patients with NSCLC.

Background:Younger and older patients with breast cancer often present with different clinicopathological characteristics and exhibit different risk factors for recurrence. This study sought to evaluate the biological characteristics and identify the recurrence risk factors in patients with operable breast cancer who were ≤40 years of age. Methods:This retrospective study investigated the biological characteristics and clinical outcomes of young patients (aged ≤40 years) with operable breast cancer who had been admitted to the Second Affiliated Hospital of Soochow University for treatment from January 2015 to December 2019. Clinicopathological and follow-up data were collected and statistically analyzed using IBM SPSS 27.0 software. The disease-free survival (DFS) rates were evaluated, and regression analyses were conducted to identify risk factors associated with adverse outcomes. Results:A total of 154 young patients (aged ≤40 years) with operable breast cancer were included in this study, of whom 68 (44.2%) were aged ≤35 years. In terms of breast cancer subtypes, there were 19 (12.3%) patients with luminal A-like disease, 74 (48.1%) patients with luminal B-like disease, 17 (11.0%) patients with human epidermal growth factor receptor 2 (HER2)-positive (non-luminal) disease, and 44 (28.6%) patients with triple-negative breast cancer (TNBC). The 5-year DFS rate of all the patients was 88%; among those with TNBC, the rate was slightly lower at 76%. According to the results of the log-rank test, tumor (T) stage, node (N) status (N0 or N+), the biological subtype, and the Ki-67 index (with a 14% cut-off value between high and low expression levels) were risk factors for recurrence. The Cox regression analysis showed that the biological subtype was the only risk factor for recurrence. The multiple linear regression analysis demonstrated that the pathological type, tumor grade, estrogen receptor (ER) labeling intensity, and progesterone receptor (PR) expression level significantly affected the level of Ki-67 expression. Conclusions:This retrospective study showed that biological subtype was the most important risk factor for recurrence in operable breast cancer patients ≤40 years. The Ki-67 index is influenced by the pathological type, primary tumor grade, ER labeling intensity, and PR expression level. Fourteen percent is recommended as the cut-off value for the high and low expression of Ki-67 in clinical practice.

Background: It remains undetermined whether preoperative computed tomography (CT)-guided hookwire localization would result in elevated risk of tumor spread through air spaces (STAS) in stage IA lung adenocarcinoma. Methods: A total of 1836 patients who underwent lobectomy were included. To eliminate the potential impact of confounding factors on producing STAS, propensity score–matching (PSM) was used to create two balanced subgroups stratified by implementation of hookwire localization. We also introduced an external cohort including 1486 patients to explore the effect of hookwire localization on the incidence of STAS and patient survival after sublobar resection (SR). For proactive simulation of hookwire localization, 20 consecutive lobectomy specimens of p-stage IA lung adenocarcinoma were selected. Results: Ex vivo tests revealed that mechanical artifacts presenting as spreading through a localizer surface (STALS) could be induced by hookwire localization but be distinguished by CD68 and AE1/3 antibody-based immunohistochemistry. The distance of STALS dissemination tended to be shorter compared with real STAS (P = 0.000). After PSM, implementation of hookwire localization was not associated with elevated STAS incidence, nor worse survival in p-stage IA patients undergoing lobectomy irrespective of STAS. Conclusions: CT-guided hookwire localization might induce mechanical artifacts presenting as STALS which could be distinguished by immunohistochemistry, but would not affect survival in p-stage IA disease. Surgeons can be less apprehensive about performing hookwire localization in relation to STAS on stage IA disease suitable for SR.

Jianxing He, Hengrui Liang, Wei Wang, Andrey Akopov, Alberto Aiolfi, Keng-Leong Ang, Luca Bertolaccini, Kaican Cai, Qingdong Cao, Baojun Chen, Chang Chen, Chun Chen, Donglai Chen, Fengxia Chen, Jun Chen, Lei Chen, Mingwu Chen, Yongbing Chen, Zhuxing Chen, Chao Cheng, Dong Cui, Fei Cui, Tianyang Dai, Qinglong Dong, Paolo A. Ferrari, Raja M. Flores, Junke Fu, Soichiro Funaki, Marios E. Froudarakis, Xiangfeng Gan, Mingfei Geng, Jialong Guo, Qiang Guo, Yongtao Han, Jintao He, Kaiming He, Kyoji Hirai, Jian Hu, Shuqiao Hu, Jian Huang, Jun Huang, Wenfa Jiang, Kyung Soo Kim, Gabor Kiss, Fanyi Kong, Lan Lan, Xuefeng Leng, Bin Li, Gaofeng Li, Hecheng Li, Hefei Li, Heng Li, Jiwei Li, Xiaoqiang Li, Shuben Li, Yinfen Li, Zhuoyi Li, Yi Liang, Lixia Liang, Wenhua Liang, Yongde Liao, Wanli Lin, Xu Lin, Hongxu Liu, Hui Liu, Jixian Liu, Jun Liu, Xiang Liu, Zihao Liu, Xingzhao Lu, Qingquan Luo, Naiquan Mao, Qi Pan, Dazhi Pang, Jun Peng, Jun Peng, Eugenio Pompeo, Rulin Qian, Kun Qiao, Bassam Redwan, Zi Sang, Wenlong Shao, Jianfei Shen, Weiyu Shen, Sook-Whan Sung, Wenfang Tang, Tianhu Wang, Guangsuo Wang, Haitao Wang, Huien Wang, Jiyong Wang, Wen Wang, Yongyong Wang, Zhenyuan Wang, Li Wei, Wei Wei, Hao Wu, Jie Wu, Zhaohua Xia, Chenyang Xu, Enwu Xu, Hai Xu, Ning Xu, Quan Xu, Rongyu Xu, Shun Xu, Chaokun Yang, Hanyu Yang, Shengli Yang, Jun Yi, Guangjian Zhang, Hao Zhang, Jia Zhang, Man Zhang, Xiao Zhang, Yajie Zhang, Zhe Zhang, Zhifeng Zhang, Honglin Zhao, Jian Zhao, Xiaodong Zhao, Jianping Zhou, Yanran Zhou, Chengchu Zhu, Shaojin Zhu, Xinhai Zhu, Jian Cui, Yubo Yan, Ke-Neng Chen

BACKGROUND:At present, an ultrafine chest tube combined with a traditional thick tube were often used after pulmonary uniportal video-assisted thoracoscopic surgery (U-VATS). However, the thick tube was often placed in the incision, which increased the risk of poor wound healing and postoperative pain. The aim of this study is to investigate the feasibility and safety of using two ultrafine chest tubes (10 F pigtail tube) for drainage after pulmonary U-VATS.METHODS:The medical records of patients who underwent pulmonary U-VATS during June 2018 and June 2020 in the department of cardiothoracic surgery of the second affiliated hospital of Soochow university were retrospectively reviewed to compare two different drainage strategies, receiving two 10 F pigtail tubes as chest tube (group A) or one 10 F pigtail tube as lower chest tube combined with one 24 F tube as upper chest tube (group B).RESULTS:106 patients in group A receiving two 10 F pigtail tubes during June 2019 and June 2020 and 183 patients in group B receiving one 10 F pigtail tube as lower chest tube combined with one 24 F tube as upper chest tube during June 2018 and June 2019 were included. There was no significant difference between two groups in terms of the postoperative thoracic drainage (mL) (1st: 199.54±126.56 vs 203.59±139.32, P=0.84; 2nd: 340.30±205.47 vs 349.74±230.92, P=0.76; 3rd: 435.19±311.51 vs 451.37±317.03, P=0.70; 4th: 492.58±377.33 vs 512.57±382.94, P=0.69; Total: 604.57±547.24 vs 614.64±546.08, P=0.88), drainage time (d) (upper chest tube: 2.54±2.20 vs 3.40±2.07, P=0.21; lower chest tube: (2.24±2.43 vs 3.82±2.12, P=0.10), postoperative hospital stays (d) (6.87±3.17 vs 7.06±3.21, P=0.63), poor wound healing (0 vs 3.28%, P=0.09), replacement of lower chest tube (0.94% vs 2.19%, P=0.66) and the VAS1 (3.00±0.24 vs 2.99±0.15, P=0.63). Notably, there were significant differences between two groups in terms of the VAS₂ (2.28±0.63 vs 2.92±0.59, P<0.01) and VAS₃ (2.50±1.58 vs 2.79±1.53, P=0.02), as well as the frequency of using additional analgesics (25.47% vs 38.25%, P=0.03) and replacement of the upper chest tube (0 vs 4.37%, P=0.03).CONCLUSIONS:It's feasible and safe to use two 10 F pigtail tubes for drainage after pulmonary U-VATS, which can achieve less postoperative pain and lower frequency of replacement of the upper chest tube on some specific patients.

BACKGROUND:Anatomical segmentectomy by uniportal video-assisted thoracoscopic surgery (U-VATS) is a delicate surgical procedure. Hitherto, only few studies have assessed the learning curves of anatomical segmentectomy by U-VATS, with varying data available. The present study aimed to investigate the learning curve and clinical advantages for U-VATS segmentectomy.METHODS:The medical records of patients who underwent U-VATS or non-U-VATS segmentectomy between August 2017 and May 2020 were retrospectively reviewed. Cumulative sum (CUSUM) analysis was employed to illustrate the learning curve of U-VATS segmentectomy. Perioperative parameters were used to determine the structural intervals of the learning curve, and to compare U-VATS and non-U-VATS segmentectomy.RESULTS:In total, 122 patients receiving U-VATS segmentectomy and 98 patients receiving non-VATS segmentectomy were included. Of these, 116 patients underwent successful U-VATS segmentectomy, while the other six patients underwent conversions. The structural intervals of 20-29 cases and 58-63 cases were determined as the threshold according to the CUSUM analyses. The learning process of U-VATS segmentectomy was therefore divided into three phases. Interestingly, the perioperative parameters differed significantly between Phases 1 and 3, including operative time (Op-T), postoperative hospital stays (Po-Hst), postoperative thoracic drainage (Po-D), and operative failure (Po-F) rates (P<0.05). Moreover, U-VATS segmentectomy in Phase 3 was associated with significantly shorter Po-Hst and Op-T, less Po-D, and reduced postoperative pain compared with non-U-VATS (P<0.05).CONCLUSIONS:U-VATS segmentectomy is an ideal alternative to non-U-VATS segmentectomy. Surgeons can preliminarily complete U-VATS anatomical segmentectomy after performing 20-29 cases, and can master the surgical techniques after completing 58-63 cases.

A stomach was considered ineligible to be an ideal conduit conventionally if its right gastroepiploic artery (RGEA) were injured. However, both sufficient blood flow and good venous return are crucial to the success of reconstruction. And there lacks robust evidence regarding the surgical techniques of reconstructing RGEA and right gastroepiploic vein (RGEV) and performing cervical anastomosis with gastric conduit simultaneously. Herein, we summarized the key surgical techniques for simultaneous vascular reconstruction and gastric conduit anastomosis in McKeown esophagectomy.

Future OncologyVol. 16, No. 18 CommentaryTubeless video-assisted thoracic surgery for lung cancer: is it ready for prime time?Yaokai Wen, Yu Jiang, Hengrui Liang, Long Jiang, Zhihua Guo, Clive Musonza, R. Lucas Thomas, Chenglin Yang, Jiaxi He, Jianfei Shen, Lei Chen, Haibo Sun, Gavin M. Wright, Jian Zhang, Qintai Yang, Shengyi Zhong, Wenhua Liang, Shuben Li, Jianrong Zhang & Jianxing HeYaokai WenDepartment of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, PR ChinaState Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou, Guangdong 510120, PR ChinaNanshan School, Guangzhou Medical University, Guangzhou, Guangdong 511436, PR China, Yu JiangDepartment of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, PR ChinaState Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou, Guangdong 510120, PR ChinaNanshan School, Guangzhou Medical University, Guangzhou, Guangdong 511436, PR China, Hengrui LiangDepartment of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, PR ChinaState Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou, Guangdong 510120, PR China, Long JiangDepartment of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, PR ChinaState Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou, Guangdong 510120, PR China, Zhihua GuoDepartment of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, PR ChinaState Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou, Guangdong 510120, PR China, Clive Musonza https://orcid.org/0000-0002-0773-9209Brown School at Washington University in St. Louis, St. Louis, Missouri 63130, USA, R. Lucas ThomasWashington University School of Medicine, St. Louis, Missouri 63110, USAUniversity of Washington, Seattle, Washington 98195, USA, Chenglin YangDepartment of Thoracic Surgery, Shenzhen Center, Cancer Hospital Chinese Academy of Medical Sciences, Shenzhen, Guangdong 518116, PR China, Jiaxi HeUniversity of Maryland School of Medicine, Baltimore, Maryland 21201, USA, Jianfei ShenDepartment of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang 317000, PR China, Lei ChenState Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou, Guangdong 510120, PR ChinaDepartment of Anesthesia, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, PR China, Haibo SunDepartment of Thoracic Surgery, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan 450008, PR China, Gavin M. WrightDepartment of Surgery, University of Melbourne; Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, AustraliaDepartment of Cardiothoracic Surgery, St. Vincent's Hospital, Melbourne, Victoria 3065, AustraliaVictorian Comprehensive Cancer Center, Melbourne, Victoria 3000, Australia, Jian ZhangThoracic Surgery Department, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510630, PR China, Qintai YangDepartment of Otorhinolaryngology-Head & Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510630, PR China, Shengyi ZhongDepartment of Cardiothoracic Surgery, Xianning Central Hospital, Xianning, Wuhan 437100, PR China, Wenhua LiangDepartment of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, PR China, Shuben LiDepartment of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, PR China, Jianrong Zhang *Author for correspondence: E-mail Address: jianrong.zhang@unimelb.edu.auhttps://orcid.org/0000-0003-4688-5222Brown School at Washington University in St. Louis, St. Louis, Missouri 63130, USAVictorian Comprehensive Cancer Center, Melbourne, Victoria 3000, AustraliaDepartment of General Practice, Melbourne Medical School; Cancer in Primary Care Research Group, Centre for Cancer Research, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Melbourne, Victoria 3010, Australia & Jianxing He**Author for correspondence: E-mail Address: drjianxing.he@gmail.comDepartment of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, PR ChinaState Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou, Guangdong 510120, PR ChinaPublished Online:7 May 2020https://doi.org/10.2217/fon-2020-0278AboutSectionsView ArticleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinkedInReddit View articleKeywords: chest tubelocoregional anesthesialung cancerspontaneous ventilationtubeless VATSurinary tubevideo-assisted thoracic surgeryReferences1. Global Burden of Disease Cancer Collaboration, Fitzmaurice C, Abate D et al. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 29 cancer groups, 1990 to 2017: a systematic analysis for the global burden of disease study. JAMA. Oncol. 5(12), 1749–1768 (2019).Crossref, Medline, Google Scholar2. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J. Clin. 70(1), 7–30 (2020).Crossref, Medline, Google Scholar3. Dhanasopon AP, Kim AW. Lung cancer screening and its impact on surgical volume. Surg. Clin. North Am. 97(4), 751–762 (2017).Crossref, Medline, Google Scholar4. Bulgarelli Maqueda L, García-Pérez A, Minasyan A, Gonzalez-Rivas D. Uniportal VATS for non-small cell lung cancer. Gen. Thorac. Cardiovasc. Surg. (2019).Crossref, Google Scholar5. Ikeda N. Updates on minimally invasive surgery in non-small cell lung cancer. Curr. Treat. Options. Oncol. 20(2), 16 (2019).Crossref, Medline, Google Scholar6. Lim E, Batchelor T, Dunning J et al. PL02.06 in hospital clinical efficacy, safety and oncologic outcomes from VIOLET: a UK multi-centre RCT of VATS versus open lobectomy for lung cancer. J. Thorac. Oncol. 14(10), S6 (2019).Crossref, Google Scholar7. Situ D, Long H, Tan Q et al. OA13.02 video-assisted thoracoscopic surgery vs. thoracotomy for non-small cell lung cancer: survival outcome of a randomized trial. J. Thorac. Oncol. 14(10), S240 (2019).Crossref, Google Scholar8. Bendixen M, Kronborg C, Jørgensen OD, Andersen C, Licht PB. Cost-utility analysis of minimally invasive surgery for lung cancer: a randomized controlled trial. Eur. J. Cardiothorac. Surg. 56(4), 754–761 (2019).Crossref, Medline, Google Scholar9. Hung WT, Cheng YJ, Chen JS. Video-assisted thoracoscopic surgery lobectomy for lung cancer in nonintubated anesthesia. Thorac. Surg. Clin. 30(1), 73–82 (2020).Crossref, Medline, Google Scholar10. Liu J, Cui F, Pompeo E et al. The impact of non-intubated versus intubated anaesthesia on early outcomes of video-assisted thoracoscopic anatomical resection in non-small-cell lung cancer: a propensity score matching analysis. Eur. J. Cardiothorac. Surg. 50(5), 920–925 (2016).Crossref, Medline, Google Scholar11. Al Ghamdi ZM, Lynhiavu L, Moon YK et al. Comparison of non-intubated versus intubated video-assisted thoracoscopic lobectomy for lung cancer. J. Thorac. Dis. 10(7), 4236–4243 (2018).Crossref, Medline, Google Scholar12. Wen Y, Liang H, Qiu G et al. Non-intubated spontaneous ventilation in video-assisted thoracoscopic surgery: a meta-analysis. Eur. J. Cardiothorac. Surg. 57(3), 428–437 (2020).Medline, Google Scholar13. Holbek BL, Hansen HJ, Kehlet H, Petersen RH. Thoracoscopic pulmonary wedge resection without post-operative chest drain: an observational study. Gen. Thorac. Cardiovasc. Surg. 64(10), 612–617 (2016).Crossref, Medline, Google Scholar14. Murakami J, Ueda K, Tanaka T, Kobayashi T, Kunihiro Y, Hamano K. The validation of a no-drain policy after thoracoscopic major lung resection. Ann. Thorac. Surg. 104(3), 1005–1011 (2017).Crossref, Medline, Google Scholar15. Ueda K, Haruki T, Murakami J, Tanaka T, Hayashi M, Hamano K. No drain after thoracoscopic major lung resection for cancer helps preserve the physical function. Ann. Thorac. Surg. 108(2), 399–404 (2019).Crossref, Medline, Google Scholar16. Deng B, Qian K, Zhou JH, Tan QY, Wang RW. Optimization of chest tube management to expedite rehabilitation of lung cancer patients after video-assisted thoracic surgery: a meta-analysis and systematic review. World J. Surg. 41(8), 2039–2045 (2017).Crossref, Medline, Google Scholar17. Li P, Shen C, Wu Y, Lai Y, Zhou K, Che G. It is safe and feasible to omit the chest tube postoperatively for selected patients receiving thoracoscopic pulmonary resection: a meta-analysis. J. Thorac. Dis. 10(5), 2712–2721 (2018).Crossref, Medline, Google Scholar18. Feneley RC, Hopley IB, Wells PN. Urinary catheters: history, current status, adverse events and research agenda. J. Med. Eng. Technol. 39(8), 459–470 (2015).Crossref, Medline, Google Scholar19. Lai Y, Wang X, Zhou K, Su J, Che G. The feasibility and safety of no placement of urinary catheter following lung cancer surgery: a retrospective cohort study with 2,495 cases. J. Invest. Surg. 1–8 (2019).Crossref, Medline, Google Scholar20. Li S, Jiang L, Ang K-L et al. New tubeless video-assisted thoracoscopic surgery for small pulmonary nodules. Eur. J. Cardiothorac. Surg. 51(4), 689–693 (2017).Medline, Google Scholar21. Cui F, Liu J, Li S et al. Tubeless video-assisted thoracoscopic surgery (VATS) under non-intubated, intravenous anesthesia with spontaneous ventilation and no placement of chest tube postoperatively. J. Thorac. Dis. 8(8), 2226–2232 (2016).Crossref, Medline, Google Scholar22. Mineo TC, Tamburrini A, Perroni G, Ambrogi V. 1000 cases of tubeless video-assisted thoracic surgery at the Rome Tor Vergata University. Future. Oncol. 12(23s), 13–18 (2016).Link, CAS, Google Scholar23. Yang SM, Wang ML, Hung MH, Hsu HH, Cheng YJ, Chen JS. Tubeless uniportal thoracoscopic wedge resection for peripheral lung nodules. Ann. Thorac. Surg. 103(2), 462–468 (2017).Crossref, Medline, Google Scholar24. Peng G, Liu M, Luo Q et al. Spontaneous ventilation anesthesia combined with uniportal and tubeless thoracoscopic lung biopsy in selected patients with interstitial lung diseases. J. Thorac. Dis. 9(11), 4494–4501 (2017).Crossref, Medline, Google Scholar25. Liu CY, Hsu PK, Chien HC, Hsieh CC, Ting CK, Tsou MY. Tubeless single-port thoracoscopic sublobar resection: indication and safety. J. Thorac. Dis. 10(6), 3729–3737 (2018).Crossref, Medline, Google Scholar26. Lirio F, Galvez C, Bolufer S, Corcoles JM, Gonzalez-Rivas D. Tubeless major pulmonary resections. J. Thorac. Dis. 10(Suppl. 22), S2664–S2670 (2018).Crossref, Medline, Google Scholar27. Li X, Wang X, Zhang H, Cheng H, Cao Q. Unilateral single-port thoracoscopic surgery for bilateral pneumothorax or pulmonary bullae. J. Cardiothorac. Surg. 14(1), 71 (2019).Crossref, Medline, CAS, Google Scholar28. Zhang JT, Dong S, Chu XP et al. Randomized trial of an improved drainage strategy vs routine chest tube after lung wedge resection. Ann. Thorac. Surg. 109(4), 1040–1046 (2020).Crossref, Medline, Google Scholar29. Irons JF, Martinez G. Anaesthetic considerations for non-intubated thoracic surgery. J. Vis. Surg. 2, 61 (2016).Crossref, Medline, Google Scholar30. Galvez C, Navarro-Martinez J, Bolufer S, Lirio F, Sesma J, Corcoles JM. Nonintubated uniportal VATS pulmonary anatomical resections. J. Vis. Surg. 3, 120 (2017).Crossref, Medline, Google Scholar31. Guo Z, Yin W, Pan H et al. Video-assisted thoracoscopic surgery segmentectomy by non-intubated or intubated anesthesia: a comparative analysis of short-term outcome. J. Thorac. Dis. 8(3), 359–368 (2016).Crossref, Medline, Google Scholar32. Lu TY, Chen JX, Chen PR et al. Evaluation of the necessity for chest drain placement following thoracoscopic wedge resection. Surg. Today 47(5), 606–610 (2017).Crossref, Medline, Google Scholar33. Gonzalez-Rivas D, Bonome C, Fieira E et al. Non-intubated video-assisted thoracoscopic lung resections: the future of thoracic surgery? Eur. J. Cardiothorac. Surg. 49(3), 721–731 (2016).Crossref, Medline, Google Scholar34. Kiss G, Castillo M. Non-intubated anesthesia in thoracic surgery-technical issues. Ann. Transl. Med. 3(8), 109 (2015).Medline, Google Scholar35. Hung MH, Chan KC, Liu YJ et al. Nonintubated thoracoscopic lobectomy for lung cancer using epidural anesthesia and intercostal blockade: a retrospective cohort study of 238 cases. Medicine 94(13), e727 (2015).Crossref, Medline, Google Scholar36. Rivedal DD, Nayar HS, Israel JS et al. Paravertebral block associated with decreased opioid use and less nausea and vomiting after reduction mammaplasty. J. Surg. Res. 228, 307–313 (2018).Crossref, Medline, Google ScholarFiguresReferencesRelatedDetailsCited ByClinical application of preserving spontaneous breathing non‐intubation anesthesia in thoracoscopic surgery for lung cancer under ERAS concept24 November 2021 | Asia-Pacific Journal of Clinical Oncology, Vol. 18, No. 5 Vol. 16, No. 18 eToC Sign up Follow us on social media for the latest updates Metrics Downloaded 193 times History Received 31 March 2020 Accepted 21 April 2020 Published online 7 May 2020 Published in print June 2020 Information© 2020 Future Medicine LtdKeywordschest tubelocoregional anesthesialung cancerspontaneous ventilationtubeless VATSurinary tubevideo-assisted thoracic surgeryAcknowledgmentsThe conceptualization of the content in this editorial was established by J Zhang, C Musonza and L Thomas in a course 'Randomized Controlled Trials' lectured by Graham Colditz and Jingxia Lu at Washington University in St Louis, USA.Financial & competing interests disclosureThe authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.No writing assistance was utilized in the production of this manuscript.PDF download

Background The radial artery (RA) is increasingly being used for coronary artery bypass grafting (CABG). Endoscopic thoracic sympathectomy (ETS) has been shown to block innervation of sympathetic nerves of upper limbs, which reduces sweating of hands and dilates blood vessels. The modified Allen’s test (MAT) is one of the commonest methods of assessing collateral arm flow prior to RA harvest, though it has limitations. However, the reliability of MAT after ETS remains unclear. We therefore investigated the effects of ETS on the results of MAT. Methods A retrospective cohort study was conducted on 164 consecutive Chinese patients with palmar hyperhidrosis who underwent ETS between January 2016 and January 2019. The medical records were reviewed concerning the ultrasound examination and MAT results of their RAs and ulnar arteries (UAs) in both forearms before and after ETS. Results The performance of ETS significantly increased the diameter of the right RA from 2.731±0.122 to 3.102±0.114 mm in men and from 2.347±0.074 to 2.915±0.162 mm in women. Similar effects of ETS were observed in expanding the diameters of the left RA and the UA. Meanwhile, there was no significant effect of ETS on systolic blood pressure (BP) and heart rate (HR). Overall, retesting of patients following ETS with a preoperative positive MAT result revealed a transition to a negative result. Conclusions ETS was effective in dilating RA in both men and women, which could lead to a false negative preoperative MAT result. Patients should be questioned about their history of ETS if their RAs are to be harvested for CABG. More studies are warranted to evaluate the safety of RA as a coronary artery graft after ETS.

BACKGROUND:Lack of robust evidence highlights the important need to address the controversy on the clinical safety and effectiveness between Ivor Lewis versus Sweet procedure for middle and lower esophageal squamous cell carcinoma (ESCC). METHODS:Search results were filtered according to certain criteria and were analyzed in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. FINDINGS:The inter-study heterogeneity was high. Ivor Lewis procedure might be associated with longer operation time (p < 0.01) and higher lymph node yield (p < 0.01) compared with Sweet procedure. There was no significant difference in the length of hospital stay and postoperative complications with similar reoperation rate between the two procedures (p > 0.05). As the combined analysis of survival data revealed, there was no statistical difference in the oncologic efficacy of them (p = 0.97). INTERPRETATION:The present study based on retrospective data with high heterogeneity indicated that Ivor Lewis esophagectomy might be associated with increased lymph node yield but longer operation time than Sweet. Prospective studies are warranted to compare the long-term survival of Ivor Lewis esophagectomy versus Sweet for middle and lower ESCC.

A solitary fibrous tumor (SFT) is a rare mediastinal neoplasm associated with a high recurrence rate. Total excision on initial surgery is an established indicator of a positive outcome. Here, we report the case of a 52‐year‐old man who was admitted to our hospital with symptoms of cough, chest pain, and dyspnea for two months. Chest computed tomography (CT) scan revealed a middle mediastinal mass which infiltrated adjacent vital structures, and surgery was performed with the assistance of cardiopulmonary bypass (CPB) and median sternotomy. The mass was completely removed and histopathology confirmed the presence of a mesenchymal tumor. The patient had an uneventful recovery without any perioperative symptoms, hoarseness, or dysfunction of the diaphragm. Sixty‐nine months after surgery, a CT scan confirmed that the patient remained disease‐free without necessitating the introduction of chemotherapy or radiotherapy. Here, to the best of our knowledge, we report the first case of a giant invasive mediastinal SFT that was completely resected during initial surgery under CPB with a remarkable outcome.

Background: The role of wound-edge protection devices (WEPDs) in wound infection prevention is still controversial. The aim of this meta-analysis was to assess the protective efficiency of WEPDs in gastrointestinal surgery in a pooled analysis of randomized controlled trials.Materials and methods: A variety of sources were searched for randomized controlled trials evaluating the protective efficiency of WEPDs in gastrointestinal surgery. Subgroup analysis and meta-regressions were conducted to investigate the possible influence of the type of WEPD on the size of intervention effect. This review was conducted in accordance with a prespecified protocol based on the guidance of the Cochrane Handbook and Preferred Reporting Items for Systematic Reviews and Meta-analyses statement.Results: Sixteen studies with 3663 patients were included. The WEPDs usage led to a significant decrease in surgical wound infection (risk ratio [RR] = 0.64; 95% confidence interval [CI]: 0.46-0.87; P = 0.005; I-2 = 63%), with the dual-ring design usage yielding a more significant reduction in surgical wound infection (RR = 0.24; 95% CI: 0.11-0.50; P = 0.0002; I-2 = 29%), whereas the single-ring design usage yielding a nonsignificant result (RR = 0.78; 95% CI: 0.58-1.04; P = 0.09; I-2 = 53%).Conclusions: Double-ring WEPD, but not single-ring design, reduces wound infection rate significantly in gastrointestinal surgery. Therefore, the use of single-ring WEPD should be reconsidered. (C) 2016 Elsevier Inc. All rights reserved.