Background: Robotic thymectomy is a highly precise, minimally-invasive procedure with rapid postoperative recovery, which is why it has become treatment of choice. In this study, we describe our experience with robotic thymectomy performed on an outpatient basis to better understand the feasibility of an ambulatory robotic thymectomy program. Methods: Retrospective, descriptive study of 18 patients who underwent thymectomy via robot-assisted thoracic surgery on an outpatient basis at Bellvitge University Hospital in Barcelona, between June 2019 and December 2022. We describe the following: outpatient surgery rate with inclusion criteria; surgical technique; drain removal criteria; postoperative complications; and return visits to the emergency department. Results: Of a total of 54 patients that underwent robotic thymectomy, 17 were not eligible for ambulatory surgery due to myasthenia gravis. Of the remaining 37 patients, 19 required scheduled admission prior to surgery. Consequently, only 18 patients met previously established criteria for ambulatory surgery. Of the 18 individuals who underwent outpatient intervention, two were readmitted within 30 days (11.1%), one for removal of a foreign body at 24 hours. Four patients (22.2%) presented to the emergency room for pain control. Conclusions: This is the first study to evaluate treatment outcomes and complications in patients undergoing ambulatory thymectomy. The results suggest that this procedure could be both feasible and safe. However, large prospective studies are needed to confirm these findings.

Patients with familial fibrotic interstitial lung disease (ILD) experience worse survival than patients with sporadic disease. Current guidelines do not consider family aggregation or genetic information in the diagnostic algorithm for idiopathic pulmonary fibrosis or other fibrotic ILDs. Better characterizing familial cases could help in diagnostic and treatment decision-making. This retrospective cohort study included 222 patients with fibrotic ILD (104 familial and 118 sporadic) from Bellvitge University Hospital. Clinical, radiological, pulmonary functional tests (PFT), and histological evaluations were performed at diagnosis and follow-up. Telomere shortening and disease-associated variants (DAVs) in telomerase-related genes were analysed in familial patients and sporadic patients with telomeric clinical signs. Primary outcomes were the presence of a UIP histological pattern and disease progression. Patients with idiopathic pulmonary fibrosis (IPF) (52

Background: Lung cancer remains the leading cause of cancer-related mortality worldwide with non-small cell lung cancer (NSCLC) accounting for the majority of cases. The stage of detection significantly influences survival rates with early-stage diagnosis offering the best prognosis. This study investigates the prognostic impact of the omega-6/omega-3 ratio and tumor infiltration by CD8+ lymphocytes and CD68+ macrophages on overall survival (OS) and disease-free survival (DFS) in NSCLC patients undergoing pulmonary resection. Methods: We conducted a retrospective analysis of 53 patients with early-stage NSCLC who underwent pulmonary resection between September 2017 and January 2020. The omega-6/omega-3 ratio was quantified using gas chromatography and spectrometry. Tumor infiltration by CD8 and CD68 was assessed through immunohistochemistry. Survival outcomes were evaluated using Kaplan-Meier and Cox regression analyses. Results: An increased omega-6/omega-3 ratio and higher CD68+ macrophage infiltration were associated with a trend towards worse OS and DFS in NSCLC patients, though these results did not reach statistical significance. CD8+ T-cell infiltration was associated with improved survival outcomes, confirming its role as a favorable prognostic marker. Comparative analysis with existing datasets revealed similar demographic and clinical characteristics, reinforcing the generalizability of our findings. Conclusions: The omega-6/omega-3 ratio and CD68+ macrophage infiltration serve as important factors potentially influencing prognosis in NSCLC patients undergoing pulmonary resection. These findings highlight the need for further research to refine the prognostic utility of these biomarkers and to explore therapeutic strategies targeting inflammation and immune cell infiltration.

Background: Nutrition is an important factor in the outcome of any disease process. We evaluated the relationship of nutritional status and inflammatory status of non-small cell lung cancer (NSCLC) patients undergoing robotic-assisted thoracic surgery (RATS) with postoperative complications. Methods: This prospective cohort study included 107 NSCLC patients undergoing surgical treatment, between 2019 and 2021. Nutritional status and inflammatory status were assessed before pulmonary resection using anthropometric assessment, blood tests, and body mass index (BMI). Results: The BMI was 27.5 ± 4.4. Based on BMI, 29% (n = 31) were classified as normal weight, 43% (n = 46) as overweight, and 28% (n = 30) as obese. The mean neutrophil/lymphocyte ratio (NLR) was 2.16 ± 0.85, the platelet/lymphocyte ratio (PLR) was 121.59 ± 44.21, and the lymphocyte/monocyte ratio (LMR) was 3.52 ± 1.17. There was no increase in the number of intraoperative complications or bleeding (p = 0.696), postoperative complications (p = 0.569), mean hospital stay (p = 0.258) or duration of chest drain (p = 0.369). Higher inflammatory status, with an NLR > 1.84, was associated with more overall postoperative complications (p = 0.028), only in univariate analysis, but this significance was not maintained on multivariate analysis. Conclusions: BMI was not a predictor of increased postoperative risk in this cohort; therefore, weight should not deter surgeons from using RATS for pulmonary resection.

PDF file 103K, Cisplatin chemosensitivity in SK-LU-1 miR-34b/c transfected cells

Background: Robotic-assisted thoracic surgery (RATS) is used increasingly frequently in major lung resection for early stage non-small-cell lung cancer (NSCLC) but has not yet been fully evaluated. The aim of this study was to compare the surgical outcomes of lymph node dissection (LND) performed via RATS with those from totally thoracoscopic (TT) four-port videothoracoscopy. Methods: Clinical and pathological data were collected retrospectively from patients with clinical stage N0 NSCLC who underwent pulmonary resection in the form of lobectomy or segmental resection between June 2010 and November 2022. The assessment criteria were number of mediastinal lymph nodes and number of mediastinal stations dissected via the RATS approach compared with the four-port TT approach. Results: A total of 246 pulmonary resections with LND for clinical stages I–II NSCLC were performed: 85 via TT and 161 via RATS. The clinical characteristics of the patients were similar in both groups. The number of mediastinal nodes dissected and mediastinal stations dissected was significantly higher in the RATS group (TT: mean ± SD, 10.72 ± 3.7; RATS, 14.74 ± 6.3 [p < 0.001]), except in the inferior mediastinal stations. There was no difference in terms of postoperative complications. Conclusions: In patients with early stage NSCLC undergoing major lung resection, the quality of hilomediastinal LND performed using RATS was superior to that performed using TT.

PDF file 160K, Characterization of miR-34b/c transfectants

PDF file 74K, Kaplan-Meier plot of DFS according to miR-34b/c methylation level in 97 stage I lung AC patients

PDF file 193K, Analytical sensitivity of Melting Curve Analysis for assessing miR-34b/c methylation

PDF file 263K, Representative examples of invasion assay in SK-LU-1 cells

PDF file 88K, Kaplan-Meier plots of DFS and OS according to miR-34b/c methylation in 140 early stage lung AC patients

PDF file 68K, Frequency of miR-34b/c promoter methylation and correlation of tumors miR-34b/c expression with methylation status

PDF file115K, Suppl.Table S1. Patient characteristics. Suppl.Table S2. Lung AC lines with TP53 mutation. Suppl.Table S3. Primers used for qRT-PCR. Suppl.Table S4. Correlation between tumors miR-34b/c expression and clinical and molecular variables. Suppl.Table S5. Multivariate Cox model for DFS based upon miR-34b/c methylation (continuous). Suppl.Table S6. Multivariate Cox model for OS in 140 patients

PDF file 167K, Restoration of miR-34b/c expression by treating lung AC cell lines with 5-Aza-2'-Deoxycytidine

The numerous causes underlying mediastinal lesions require different diagnostic and therapeutic approaches, including conservative, minimally invasive, and surgical interventions. Solid lesions of a malignant nature, mostly located in the anterior mediastinum, are properly treated with surgical resection either with or without adjuvant schemes. In contrast, a surveillance program is usually recommended with solid benign tumors, depending on their size and related symptomatology. In the management of mediastinal collections, when a drainage intervention is required (suspicion of infection and symptomatology), a minimally invasive nonsurgical procedure or thoracic surgery is considered. The minimally invasive nonsurgical procedures that can be available are percutaneous radiology-guided imaging (abdominal ultrasound (US) or computed tomography (CT) scan), complete single-aspiration guided by endoscopic ultrasound (EUS) or endobronchial ultrasound (EBUS), and transmural drainage guided by EUS. Surgical debridement is feasible to treat collections, but as this entails considerable risk of postoperative complications, it is chosen only when other minimally invasive therapies are not possible. The published literature related to the interventional endoscopic approach to mediastinal lesions is scarce. Nevertheless, reports in this field reveal that interventional EUS may have a role in both the diagnosis of and therapeutic approach to mediastinal lesions, mainly in the management of mediastinal collections.

Introducción: El abordaje del nódulo pulmonar solitario tiene como objetivo la detección temprana del cáncer de pulmón en donde la resección quirúrgica es la piedra angular del tratamiento. La tecnología de imagen por fluorescencia combina un agente excitable en el espectro de luz cercano al infrarrojo y un sistema para visualizar selectivamente un tejido diana que permite su localización intraoperatoria. Caso clínico: Varón de 72 años fumador con un nódulo pulmonar de 9 milímetros con patrón en vidrio deslustrado en el lóbulo inferior derecho localizado bajo guía tomográfica con verde de indocianina y tratado mediante resección sublobar con linfadenectomía sistemática asistida por robot con abordaje uniportal. Conclusión: La técnica de marcaje preoperatorio con verde de indocianina y tecnología de imagen por fluorescencia es un método seguro y preciso que permite la identificación intraoperatoria de un nódulo pulmonar solitario durante la cirugía de mínima invasión.

Introduction: The aim of this study was to determine whether preoperative nutritional status and inflammatory status, specifically polyunsaturated acids and the omega 6/3 ratio, would affect postoperative outcomes and complications in patients with lung cancer undergoing lung resection. Methods: This prospective observational study included 68 patients with early-stage non-small-cell lung cancer who were candidates for radical surgery. A complete nutritional assessment was performed. The primary study variable was postoperative complications and mortality in the first 30 days. Descriptive, bivariate, and logistic regression analyses were carried out. Results: A total of 50 men (73.53%) and 18 women (26.47%) underwent surgery, with a median age of 64.2 (±9.74) years. The mean omega 6/3 ratio was 17.39 (±9.45). A complication occurred in 39.7% of the study sample (n = 27), the most common being persistent air leak in 23.53% (n = 16). After performing the bivariate analysis, the only variable that remained significant was the omega 6/3 ratio; we observed that it had a prognostic value for persistent air leak (p = 0.001) independent of age, sex, comorbidity, preoperative respiratory function, and approach or type of surgery. The remaining nutritional and inflammatory markers did not have a statistically significant association (p > 0.05) with postoperative complications. However, this significance was not maintained in the multivariate analysis by a small margin (p = 0.052; 95% CI: 0.77–1.41). Conclusions: Omega 6/3 ratio may be a prognostic factor for air leak, independent of the patient’s clinical and pathological characteristics.

Background: Despite evidence supports worse outcomes in familial cases of fibrotic interstitial lung diseases (ILDs), they are managed indistinctly from sporadic cases. Aims And Objectives: To assess if family history and telomeric dysfunction can have implications in the diagnosis and follow-up. Methods: 222 patients from Bellvitge University Hospital (Spain) with fibrotic-ILD, were included, 104 familial and 118 sporadic. ILD diagnosis and follow-up [pulmonary function tests (PFT) and high-resolution CT (HRCT) scans] were performed according to international guidelines. Results: Idiopathic Pulmonary Fibrosis (IPF) (52%), fibrotic hypersensitivity pneumonitis (23%), and other non-IPF fibrotic ILD (25%) patients were included, mean age at diagnosis was 67±10 years, 27% referred smoking history. Familial cases were less likely to show consistent or probable usual interstitial pneumonia (UIP) pattern on HRCT (familial 30% vs sporadic 66%; p<0.001; OR 0.22; CI95% 0.13-0.39), still more biopsies were performed in the sporadic group (familial 33% vs sporadic 41%). Familial cases were more likely to have progressive disease (familial 67% vs sporadic 31%; OR 4.5; CI95% 2.5-8.2; p<0.001), despite similar PFT values at diagnosis. All indeterminate UIP radiological pattern biopsies showed UIP on pathology. Among those with non-UIP radiological pattern, familial cases more frequently showed consistent or probable UIP on pathology (familial 54% vs sporadic 10%; OR 10.5; CI95% 2.5-43.5; p<0.001). Conclusions: Family history could be a relevant information for the multidisciplinary committee in diagnostic approach and in anticipating the probability of fibrotic progression.

BACKGROUND:Pleurodesis is a common technique for treating the accumulation of air or liquid in the pleural space caused by pneumothorax or pleural effusion, it is based on the bounding of pleural layers through induced inflammatory lesions. There are several pleurodesis procedures.OBJECTIVES:To test and describe the inflammatory effect of hyperthermia on the pleural and peritoneal mesothelia of rats, with the aim of testing the effectiveness of this process for inducing pleurodesis.METHODS:35 Sprague-Dawley (male/female) rats were randomized into four treatment groups: Group A (Talc, 10 individuals); group B (control, 5 individuals); group C (hyperthermic isotonic saline, 10 individuals); and group D (filtrate air at 50°, 10 individuals). Inflammatory effect of hyperthermia was the primary outcome parameter.RESULTS:In the talc group, minimal adhesions between both pleural and peritoneal layers were observed in seven rats. Talc produced peritoneal mesothelium inflammation and fibrosis associated to foreign body giant cells in 80% (8/10) of the sample. Furthermore, clear evidence of a granulomatous foreign-body reaction was detected. No macroscopic and/or microscopic damage was registered in the remaining three groups (control, hyperthermic, and filtrate air).CONCLUSIONS:Talc is an excellent method for producing pleuro-peritoneal inflammatory lesions. On the contrary, hyperthermia apparently does not induce the macroscopic and microscopic damage that is required for efficient pleurodesis. Therefore, hyperthermia should not be used for pleurodesis procedures.