Abstract Background Patient-reported outcome measures (PROMs) offer the potential for enhancing treatment quality and supporting patient-centered care. However, it remains uncertain how effectively these measures correlate with clinical outcomes. Methods This prospective observational cohort study included 107 adult patients undergoing elective thoracic surgery. PROMs assessing anxiety, depression, and pain perception were collected preoperatively and at 6–12 months postoperatively using the Hospital Anxiety and Depression Scale (HADS), the State–Trait Anxiety Inventory (STAI), the Pain Sensitivity Questionnaire (PSQ), and the Pain Catastrophizing Scale (PCS). Postoperative pain was assessed using the Numeric Rating Scale (NRS), and persistent pain at follow-up was defined as post-thoracotomy pain syndrome (PTPS). The primary endpoint was the longitudinal change in PROMs between preoperative assessment and follow-up. Secondary endpoints included subgroup analyses according to the type of surgical access (open and minimally-invasive), the type of locoregional anesthetic technique (epidural anesthesia, intercostal nerve block, local anesthetic infiltration), and the presence of acute and chronic postoperative pain (PTPS). Results Patients showed elevated scores at postoperative follow-up, with the exception of the HADS overall score, HADS-anxiety, and STAI, the latter of which demonstrated a significant decrease. No significant differences were found across subgroups based on procedure type, anesthesia method, or PTPS status, with the exception of a significant difference in HADS-depression scores in patients without PTPS. Conclusions A decline in physical and psychological well-being was observed 6 to 12 months post-surgery, reflected in increased levels of pain, depression, and anxiety. Our study did not find evidence of an association between the PROMs assessed and variations in surgical procedures, anesthesia methods, or the presence of acute and chronic pain in this cohort. Trial registration DRKS: DRKS00017798.

Lung cancer, the leading cause of cancer-related mortality, presents major challenges for both standard therapies and chimeric antigen receptor (CAR) T cell therapy due to tumour heterogeneity and resistance. Preclinical models that capture patient-specific factors are essential for personalizing treatment decisions. Here we show that matched lung tumouroids and healthy lung organoids derived from patients provide a robust platform for studying therapy responses. The tumouroids faithfully retained the molecular and histological identity of the original tumours, as confirmed by genomic, epigenomic and proteomic analyses, and accurately replicated individual patient responses to standard-of-care therapies. Importantly, the platform also revealed patient-specific CAR T cell responses, uncovering a complex interplay between target antigen density and broader, tumour-intrinsic resistance programmes. By capturing these individualized factors, our model supports rational patient selection for CAR T cell therapy in lung cancer and provides a framework for designing CAR T cells tailored to overcome resistance mechanisms in solid tumours. A platform using matched patient-derived lung tumouroids and healthy lung organoids enables accurate examination of patient responses to CAR T therapy and offers a faithful framework for improved CAR T design.

BACKGROUND:The safety and feasibility of robotic-assisted (RATS) thymectomy for myasthenia gravis (MG) with onset age ≥ 50 years remain unverified, particularly in very late-onset MG (V-LOMG). METHODS:Patients were classified into late-onset MG (LOMG, 50-64) and very late-onset MG (V-LOMG ≥ 65) based on age of onset. Composite neurological remission (CNR) included complete stable remission (CSR), pharmacologic remission (PR), and minimal manifestations-0 (MM-0), while favorable outcomes comprised CNR and MM1-3. RESULTS:Among 1041 patients, 172 with MG onset at ≥ 50 years who underwent RATS extended thymectomy were included in the final analysis. The LOMG group comprised 104 patients (45.2% male), while the V-LOMG group included 68 patients (60.3% male). V-LOMG patients had more preoperative MG crises, shorter onset-to-thymectomy intervals, heavier thymic specimens, and less hyperplasia. In ocular-onset MG, generalization was more frequent in LOMG than in V-LOMG. No significant differences were found in other baseline characteristics, perioperative parameters, postoperative complications, and adverse composite outcomes. At a 5.1-year mean follow-up, the V-LOMG group had slightly higher CSR (7.4% vs. 6.7%), CNR (16.2% vs. 11.5%), and favorable outcome rates (52.9% vs. 45.2%) than the LOMG group, with no statistical significance. Both groups, especially V-LOMG (16.0 mg vs. 2.1 mg, p < 0.001), showed a significant corticosteroid dose reduction at the last follow-up, confirming the steroid-sparing effect of thymectomy. CONCLUSIONS:RATS extended thymectomy appears to be a safe and feasible treatment for patients with MG of onset at age ≥ 50 years, including those with V-LOMG, demonstrating a significant steroid-sparing effect while maintaining favorable neurological outcomes.

Objective: This study aims to evaluate the perioperative and midterm oncological outcomes of robotic-assisted thoracic surgery extended thymectomy for patients with large resectable thymomas compared with small thymomas. Methods: This retrospective single-center study included 204 patients with thymomas who underwent robotic-assisted thoracic surgery extended thymectomy between January 2003 and February 2024. Patients were divided into 2 groups based on the thymoma size (5-cm threshold). Results: The study comprised 114 patients (55.9%) in the small thymoma group and 90 patients (44.1%) in the large thymoma group. No significant differences were found between the groups regarding gender, age, proportion of elderly patients, or pathologic high-risk classifications. Apart from a longer operative time (P = .009) in the large thymoma group, no differences were observed between the 2 groups regarding surgical parameters and postoperative outcomes. No deaths occurred within 30 days in either group. During a median follow-up of 61.0 months (95% CI, 48.96-73.04), 4 patients experienced recurrence (1.96%). No significant differences in the 5-year overall survival (P = .25) or recurrence-free survival (P = .43) were observed between groups. Conclusions: Robotic-assisted thoracic surgery extended thymectomy is technically feasible, safe, and effective for treating large resectable thymomas. Moreover, midterm outcomes for patients with completely resected large thymomas were comparable to those with small thymomas during a median follow-up period of up to 5 years. (J Thorac Cardiovasc Surg 2025;169:469-83)

ZusammenfassungDieses Manuskript gibt einen Überblick über die Prinzipien und Voraussetzungen zur Implementierung eines ERAS-Programms in der Thoraxchirurgie.Basierend auf den ERAS-Guidelines für Thorachirurgie der ERAS Society wird das ERAS-Programm mit seinen einzelnen Maßnahmen bei elektiven Lungenoperationen dargestellt. Mit besonderem Augenmerk auf das postoperative Outcome werden die klinischen Maßnahmen anhand einer aktuellen Literaturübersicht beschrieben. Das ERAS-Programm zum optimierten perioperativen Management für elektive lungenresezierende Eingriffe besteht derzeit aus 45 Maßnahmen, die sich auf 4 perioperative Phasen verteilen. Diese Maßnahmen umfassen von der Zeit vor der Krankenhausaufnahme (Patientenaufklärung, Screening und Behandlung möglicher Risikofaktoren wie Anämie, Mangelernährung, Beendigung des Nikotin- oder Alkoholmissbrauchs, Prähabilitation, Kohlenhydratbelastung) über die unmittelbare präoperative Phase (verkürzte Nüchternheitsphase, nicht sedative Prämedikation, Prophylaxe von PONV und thromboembolischen Komplikationen), die intraoperativen Maßnahmen (Antibiotikaprophylaxe, standardisierte Anästhesie, Normothermie, zielgerichtete Flüssigkeitstherapie, minimalinvasive Chirurgie, Vermeidung von Kathetern und Sonden) und die postoperativen Maßnahmen (frühzeitige Mobilisierung, frühzeitige Ernährung, Entfernung eines Blasenkatheters, Hyperglykämiekontrolle). Die meisten dieser Maßnahmen beruhen auf wissenschaftlichen Studien mit hohem Evidenzlevel und führen zu einer Reduktion postoperativer allgemeiner Komplikationen.Das ERAS-Programm ist ein optimiertes perioperatives Behandlungsverfahren und kann die postoperative Genesung von Patienten bei elektiven Lungenresektionen durch eine Verringerung der allgemeinen Komplikationsrate und der Gesamtmorbidität verbessern.

BACKGROUND, OBJECTIVES:In recent years, ERAS treatment pathways have found their way into many surgical fields, as they reduce complications and accelerate postoperative recovery. For thoracic surgery, the first ERAS guidelines were published by the ERAS Society and the European Society of Thoracic Surgeons (ESTS) in 2019. We have now evaluated how ERAS-items are implemented in clinical practice by using an online survey.MATERIAL AND METHODS:An online survey was conducted from 12/5/2021 until 1/6/2021. The survey consisted of 22 questions focusing on the key elements of an ERAS program according to the published ERAS guidelines. Results were summarised, descriptively analysed and put into context with the current literature.RESULTS:Of 155 thoracic surgeons, 32 responded to the survey. In 28.1% (n = 9) of the hospitals, an ERAS core unit was established, and a database to record the ERAS items existed in 15.6% (n = 5). Only 3.1% (n = 1) kept an ERAS-diary preoperatively. A so-called Carboloading was conducted at 15.6% (n = 5) of surgeons. Standard PONV prophylaxis was administered to 59.4% (n = 19) of the patients. In most cases (84.4%, n = 29), a single drain was inserted into the pleural cavity during anatomic resections. In 3% (n = 1) of the centres two drains, in 12.5% (n = 4) no drainage was placed. The most commonly applied initial suction was -10 cmH2O (75%, n = 24). Suction ≤ 2 cmH2O was used by only two of those interviewed. Drainage removal took place in 50% (n = 16) of cases between the 1st or 2nd POD, in 34.4% of cases (n = 11) between the 3rd and 4th POD and in 9.4% (n = 3) the drain remained longer than the 4th POD. The first postoperative mobilisation took place in 71.9% (n = 23) of the centres on the day of the operation.CONCLUSIONS:The implementation of ERAS guidelines varies in Germany between centres. Certain perioperative processes are covered sufficiently, but the implementation of key features of ERAS is yet to be fully established in clinical practice. The first steps in this direction have already been taken and lay the foundation for cooperation across centres.

Background and Objective:The development of early screening for lung cancer has led to improved overall survival in patients with non-small cell lung cancer (NSCLC). However, the management of NSCLC patients with resectable and potentially resectable chest wall invasion (CWI) requires attention. The purpose of this review is to summarize the role of surgery (chest wall resections) in NSCLC patients with CWI. Methods:A literature search and review from three databases (PubMed, Embase, and ScienceDirect) comprised the last 39 years. This review was focused on the treatment of NSCLC patients with CWI, mainly including the preoperative evaluation, principles of treatment and strategic decision-making, surgical complications, and prognostic factors. Key Content and Findings:Through the collection of relevant literature on NSCLC that invades the chest wall, this narrative review describes the actual role in clinical practice and future developments of chest wall resections. Preoperative treatment requires the multidisciplinary team (MDT) team to conduct accurate clinical staging of the patient and pay attention to the patient's lymph node status and rib invasion status. The successful implementation of chest wall resection and possible chest wall reconstruction requires refined individualized treatment based on the patient's clinical characteristics, supplemented by possible postoperative systemic treatment. Conclusions:Surgery plays an important role in treating NSCLC patients with CWI, and a collaborative, experienced MDT is an essential component of the successful treatment of CWI with lung cancer. In the future, more high-quality clinical research is needed to focus on CWI patients so that patients can receive more effective treatment options and better clinical prognosis.

Background: Surgical procedures need to be performed safely on every day and night of the week.Operations on certain weekdays have recently been shown to be associated with increased risk.Patient concerns about their safety have to be taken seriously when surgery needs to be planned.Many patients also believe in negative effects of lunar constellations or Friday 13 th .To establish a scientific basis for reassurement, we retrospectively analyzed surgical complications at a maximum care center, addressing these issues.Methods: All surgical procedures and their complications from 2007-2014 were registered in the departmental morbidity registry.Complications resulting in the necessity for reoperations were analyzed and matched with the day of the week of the primary procedure, the day the complication occurred, the lunar cycle and Friday 13 th .Results: Over 25.000 procedures were performed, resulting in a total of 635 registered surgical complications requiring reoperations.Male and female patients were equally affected.Weekdays of the primary procedure did not show a difference in subsequent complications (P = 0.227), but weekdays of revision surgery reached statistical difference of P = 0.05, with most reoperations taking place on Fridays.No correlation with any lunar constellation or Friday 13 th could be found, P = 0.763 and P = 0.144, respectively.Discussion: This retrospective analysis could not show a heightened risk for reoperations due to the primary procedure being performed on certain weekdays.Patients can also be reassured that there is sufficient evidence that lunar cycles do not affect the occurrence of complications and reoperations, nor does Friday 13 th .

Acute secondary peritonitis is afflicted with a high morbidity. The treatment of the disease should be interdisciplinary. The combination of intensive care therapy, antibiotics and surgical procedures for source control are mandatory. The patients often need relaparotomies and open abdominal lavages. Continuous negative pressure therapy seems to be beneficial. There are several different treatment options for example concerning right point of time, on-demand versus planned, amount of lavage solution used, which solution used, CNP system yes or no, which CNP system, which pressure and many more. We would like to describe the treatment in our clinic and compare it with the existing literature.