Spread through air spaces has been defined by the WHO as a new pattern of invasion in non-small cell lung cancer (NSCLC). The possible role of surgical manipulation in generating this pattern has recently been discussed. The aim of this study is to review the presence of STAS in patients with lung cancer undergoing video-assisted thoracic surgery (VATS) compared to robotic surgery (RATS). 248 resectable stage I-II adenocarcinoma and squamous cell carcinoma who underwent either VATS or RATS between January 2022 and March 2024 were included. We evaluated the association between STAS and the surgical technique, tumour histology and pathological staging. STAS was found in 45 (29

Background: Hematological indices such as the neutrophil-lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), and systemic immune inflammation index (SII) have been proposed as markers of inflammatory disease and prognostic indicators in some tumors, but their role remains controversial. This study aims to evaluate the relationship between these indices and postoperative complications in patients undergoing robotic-assisted anatomic lung resection for oncological purposes. Methods: This retrospective, single-center study included patients who underwent anatomical lung resection from January 2022 to June 2023 using robotic-assisted surgery. The data collected included hematological variables, demographic information, body mass index (BMI) data, information about pulmonary function, medical history, postoperative outcomes, and survival data. Results: A total of 96 patients were included, with a median BMI of 26.10. The data distribution across demographic and clinical variables was homogeneous. Univariate and multivariate analyses revealed no significant association between preoperative or postoperative inflammatory indices and postoperative complications, persistent air leak (PAL), or 1-year mortality. Conclusions: This small, retrospective study with short-term follow-up found no significant relationship between inflammatory indices and postoperative outcomes. These findings suggest that SII and similar indices are not reliable predictors of complications, PAL, or mortality in patients undergoing robotic-assisted anatomic lung resection.

Introduction: The robotic-assisted (RATS) lobectomy learning curve is usually measured compared to an established videothoracoscopic (VATS) surgery program. The objective of our study is to compare the learning curves of both techniques. Methods: We performed an intention-to-treat analysis comparing the RATS vs. VATS lobectomies. Surgical time, conversions, complications, number of lymph nodes (LNs) and lymph node stations harvested, chest drainage duration, length of stay, readmissions, and 90-day mortality were compared between both groups. The learning curve was assessed using the CUSUM method. Results: RATS cases (30) and VATS cases (35) displayed no significant differences. The RATS learning curve was completed after 23 procedures while the VATS curve required 28 interventions. Complications appeared in four RATS procedures and in eight VATS patients. No differences in the number of LNs and harvested LN stations were reported. Four patients were readmitted in the RATS group, and eight in the VATS group. No 90-day postoperative mortality was observed in either group. The RATS group reported fewer chest tube days (3 (2–5) vs. 5 (4–5.8), p = 0.005) and hospital days (4 (3–6) vs. 5 (4–6), p = 0.023). Conclusions: The RATS curve appears shorter than the VATS curve. RATS lobectomies resulted in reduced chest tube duration and length of stay during the learning time period.

The current treatment for mesothelioma, in selected cases, consists of extended pleurodecortication and intrathoracic hyperthermic chemotherapy. This technique is laborious and detailed and must be followed step by step to achieve good results. We present the case of a patient with epithelioid mesothelioma meeting surgical criteria who underwent the mentioned technique, experiencing an adequate postoperative period and an early discharge. This experience demonstrates that the technique is safe when performed in centres with experience and the means to address this complex pathology.

The pulmonary microbiome has emerged as a significant factor in respiratory health and diseases. Despite the sterile conditions maintained during ex vivo lung perfusion (EVLP), the use of antibiotics in the perfuse liquid can lead to dynamic changes in the lung microbiome. Here, we present the design of a study that aims to investigate the hypothesis that EVLP alters the lung microbiome and induces tissue inflammation. This pilot, prospective, controlled study will be conducted in two Spanish donor centers and will include seven organ donors after brain death or after controlled cardiac death. After standardized retrieval, the left lung will be preserved in cold storage and the right lung will be perfused with EVLP. Samples from bronchoalveolar lavage, perfusion and preservation solutions, and lung biopsies will be collected from both lungs and changes in lung microbiome and inflammatory response will be compared.

This clinical case shows the repercussions of acute exposure to cement dust in the respiratory tract and other mucous membranes. Following a cement dust pipe explosion, the patient endured a severe inhalation of dust. A combination of rigid bronchoscopy and a mechanical insufflation-exsufflation system was employed to remove cement debris from the airways. Respiratory physiotherapy sessions were implemented for effective secretion clearance, contributing to a successful short-term recovery. While this remains an isolated case, the unconventional techniques employed provide valuable insights for potential similar scenarios in the future.

Objective: To compare the costs and length of hospital stay among patients with a confirmed diagnosis of lung cancer (LC) prior to surgery versus those without confirmation. Methods: This retrospective, single-center study was conducted in patients who underwent a surgical procedure for LC, with or without a pathologically confirmed LC diagnosis prior to surgery, between March 2017 and December 2019. The main outcomes were costs and length of hospital stay (LOS). Results: Among the 269 patients who underwent surgery for lung cancer between March 2017 and December 2019, 203 (75.5%) patients underwent surgery due to a histopathological diagnosis, and 66 (24.5%) because of a Multidisciplinary Cancer Committee indication. The unadjusted mean cost was significantly lower in Group II (patients with surgery based on Multidisciplinary Cancer Committee criteria) ((sic)2,581.80 +/- (sic)1,002.50) than in Group I (patients with histopathological diagnosis) ((sic)4,244.60 +/- (sic)2,008.80), P < 0.0001. Once adjusted for covariables, there was a mean difference of -(sic)1,437.20 in the costs of Group II, P < 0.0001. Unadjusted mean hospital stay was significantly longer in Group I (5.6 days) than in Group II (3.5 days). Conclusions: The results suggest that indicating surgical resection of lung cancer based on Multidisciplinary Cancer Committee criteria, rather than performing CT-guided percutaneous lung biopsy, may result in a significant decrease in cost and length of hospital stay. (C) 2023 AEC. Published by Elsevier Espana, S.L.U. All rights reserved.

Robot-assisted thoracic surgery (RATS) is a rapidly expanding technique. In our study, we aimed to analyze the results of the process to adopt robotic surgery in our Department of Thoracic Surgery. This is an intention-to-treat analysis of a series of consecutive patients operated on using the RATS approach in our hospital from January 2021 to March 2022. Data were registered for patient characteristics, type of surgery, operative times, conversion rate, chest tube duration, length of hospital stay and complications. The IBM SPSS® statistical software was used for the statistical analysis. A cumulative sum analysis of the operating time was performed to define the learning curve. During the study period, 51 patients underwent robotic surgery, including pulmonary and non-pulmonary interventions. In addition, 15 patients (29.4%) underwent non-pulmonary interventions: one pleural (2%), 2 diaphragmatic (3.9%), and 12 mediastinal (23.5%). Among the mediastinal surgeries, one conversion was necessary (8.3%) for a complex vascular malformation, and 11 were completed by RATS, including 7 (58.3%) thymomas, 3 (25%) pleuro-pericardial cysts, and one (8.3%) neurogenic tumor. Mean operative time was 141 min (104–178), mean chest tube duration was 0.9 days (0–2), and mean length of stay was 1.45 days (1–2). Thirty-six patients underwent lung surgery (70.6%). The complete RATS resections (34; 94.4%) included: 3 wedge resections (11.1%), 2 segmentectomies (3.7%), 28 lobectomies (81.5%), and one sleeve lobectomy (3.7%). Mean surgery time was 194.56 min (141–247), chest tube duration was 3.92 days (1–8), and length of stay was 4.6 days (1–8). Complications occurred in 4 patients (11.1%). No 90-day mortalities were registered. The implementation of RATS was achieved with good clinical results and operative times for all indications. A rapid learning curve was accomplished in short time. Previous VATS experience, patient selection, team training and program continuity are fundamental to successfully develop a RATS program. La cirugía torácica asistida por robot (RATS) es una técnica en rápida expansión. Nuestro objetivo fue analizar el resultado del proceso de adopción de la cirugía robótica en nuestro Departamento de Cirugía Torácica. Este es un análisis por intención de tratamiento de una serie de pacientes consecutivos operados mediante el método RATS en nuestro centro desde enero de 2021 a marzo de 2022. Se registraron las características de los pacientes, tipo de cirugía, tiempos operatorios, tasa de conversión, duración del drenaje torácico, estancia hospitalaria y complicaciones. Para el análisis estadístico se utilizó el software IBM SPSS®. Se realizó un análisis de suma acumulada del tiempo de operación para definir la curva de aprendizaje. Durante el periodo de estudio, 51 pacientes fueron sometidos a cirugía robótica.15 pacientes (29,4%) fueron sometidos a intervenciones no pulmonares: 1 pleural (2%), 2 diafragmáticas (3,9%) y 12 mediastínicas (23,5%). Entre las cirugías mediastínicas, fue necesaria una conversión (8,3%) por malformación vascular compleja y 11 fueron completadas por RATS, incluidos 7 (58,3%) timomas, 3 (25%) quistes pleuro-pericárdicos y 1 (8,3%) tumores neurogénicos. El tiempo operatorio medio fue de 141 minutos [104–178], la duración media del tubo torácico fue de 0,9 días [0–2] y la estancia media fue de 1,45 días [1–2]. 36 pacientes tuvieron cirugías pulmonares (70,6%). Las resecciones RATS completas (34; 94,4%) incluyeron: 3 resecciones en cuña (11,1%), 2 segmentectomías (3,7%), 28 lobectomías (81,5%) y 1 lobectomía con broncoplastia (3,7%). El tiempo medio de cirugía fue de 194,56 minutos [141–247], la duración del tubo torácico fue de 3,92 días [1–8] y la estancia hospitalaria fue de 4,6 días [1–8]. No se registró mortalidad a los 90 días. La implementación de RATS se logró con buenos resultados clínicos y tiempos operatorios en todas las indicaciones. Se completó una rápida curva de aprendizaje en poco tiempo. La experiencia previa en VATS, la selección de pacientes, la capacitación del equipo y la continuidad del programa son fundamentales para desarrollar con éxito un programa RATS.

Robotic-assisted thoracoscopy is a procedure that allows certain improvements over the traditionally used thoracoscopic procedures but still has disadvantages. Its association with dissection techniques such as the tunnel technique allows an approach to lungs with incomplete or fused fissures. We present the case of a 65-year-old female smoker with a 33-mm mass with a 13.7 SUVmax on positron emission tomography-computed tomography scans accompanied by biopsies that confirmed the diagnosis of small-cell lung cancer. After confirming that it was stage N0 and M0, surgical treatment was chosen. We performed a left upper lobectomy and thoracoscopic lymphadenectomy with robotic assistance; due to the presence of incomplete fissures, we used the fissure tunneling technique. This procedure ensured a safe dissection technique with the correct identification of the vascular and bronchial structures and reduced the risk of air leakage.

Background: Locally advanced lung cancer represents a surgical challenge in terms of adding years of good quality of life to patients while avoiding the complications of surgery, which is why new techniques are developed despite its complexity. Case Description: We present this case where a possible therapeutic diagnostic process with good outcomes is exposed, which adds it as a valid treatment in centers that have experience. We present a patient, former smoker, that consults with pleuritic pain and cough for 2 weeks of evolution, those were initially interpreted as a pneumonia/empyema, resistant to antibiotic treatment. However, a positron emission tomography-computed tomography (PET-CT) scan found a mass in the posterior segment of the right upper lobe (RUL) and bullae, a negative mediastinoscopy and CT scan were obtained, which reported an invasion of T6 and the costovertebral joint, a needle biopsy was performed that reported: undifferentiated carcinoma with necrosis. It was decided to perform a resection of the spinous processes and transverse processes plus a laminectomy and a vertebrectomy of T6 and T7 and an upper right lobectomy, and a resection of posterior rib arches 5, 6, 7 and 8. The pathological anatomy results obtained were: large cell carcinoma. The patient was recovered and pending on oncological treatment. Conclusions: Vertebral and pulmonary resections are technically possible, although they must be performed in centers with experience in those procedures, thus reducing the possibility of residual disease or post-surgical complications.

Abstract Objective: To compare the costs and length of hospital stay between patients with a confirmed lung cancer (LC) diagnosis before surgery versus those without confirmed diagnosis. Methods: Retrospective and single center study conducted on consecutive patients who underwent a LC surgical procedure, with or without a pathologically confirmed LC diagnosis before surgery, between March 2017 and December 2019. The main outcomes were costs and length of hospital stay (LOHS). Results: Among the 269 screened patients, 254 met the inclusion/exclusion criteria and were included in the analysis, 196 (77.2%) with confirmed LC diagnosis before surgery and 58 (22.8%) without it. Unadjusted cost was significantly lower in patients who underwent surgery without histopathological diagnosis before surgery than in those who underwent surgery with a histopathological diagnosis before surgery (Hodges-Lehmann median difference: -1,280.5 €; 95% confidence interval [CI]: -1,682.1 to -899.4 €, p<0.0001). LOHS was significantly shorter in patients without a previous diagnosis of LC before surgery (4.0 [95%CI: 3.0 - 4.0] vs. 5.0 [95% CI: 5.0 - 6.0] days, p<0.0001). Median (95% CI) LOHS was significantly lower in patients who underwent video-assisted thoracoscopy (4.0 [95% CI 4.0 -4.0] days) than in those who underwent open-surgery (6.0 [95% CI 5.0 - 6.0] days, p<0.0001). Conclusions: Patients who went into the operating-room without a previous confirmed diagnosis of LC resulted in lower direct costs, shorter LOHS, and increased use of VATS.