The metabolic and inflammatory burden of cardiac surgery results in increased protein catabolism, elevated energy expenditure and thereby a consequent increased risk of postoperative complications. Therefore, it is imperative to optimise nutritional status preoperatively and postoperatively to ameliorate these effects on wound healing, immune function, and recovery of the myocardium, in addition to other clinical outcomes. Despite its benefits, structured perioperative nutritional care is rarely undertaken. In this narrative review, we will summarise contemporary literature (2017-2026) and international guideline recommendations to outline phase-specific nutritional strategies for patients undergoing cardiac surgery. In the early postoperative period, early initiation of enteral nutrition, adequate protein provision (1.2-2.0 g/kg/day), and careful fluid and glycaemic management are critical to attenuate catabolic stress and reduce complications. During hospital recovery and discharge to home, emphasis should shift towards caloric adequacy, micronutrient optimisation-particularly vitamins C and D, zinc, and iron-and management of medication-related gastrointestinal effects. In the long-term phase, adoption of cardioprotective dietary patterns such as the Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets supports secondary prevention and cardiovascular risk reduction. Elderly patients who are sarcopenic, individuals with diabetes mellitus or chronic kidney disease (CKD), overweight individuals and people on anticoagulation warrant special consideration. Integrating nutritional assessment and intervention into Enhanced Recovery After Cardiac Surgery (ERACS) pathways may help improve recovery trajectories and reduce morbidity. Further high-quality research should be conducted to define procedure-specific and individualised nutritional protocols in the cardiac surgical population.

Non-small cell lung cancer (NSCLC) accounts for nearly 85% of lung cancer cases and remains a leading cause of cancer-related mortality worldwide. Advances in molecular diagnostics and targeted therapies have transformed treatment paradigms, yet the integration of molecular testing into routine care for resected NSCLC specimens continues to face significant challenges. This review outlines the technical, clinical, and systemic barriers that limit the effectiveness of molecular testing. Key considerations include tissue quality, the limitations of formalin-fixed paraffin-embedded (FFPE) samples, and the comparative roles of conventional methods—such as immunohistochemistry (IHC), fluorescence in situ hybridization (FISH), and reverse transcription polymerase chain reaction (RT-PCR)—versus next-generation sequencing (NGS). We also discuss the prevalence and clinical relevance of common genomic alterations, including TP53, KRAS, EGFR, and ALK, as well as their impact on prognosis and treatment selection. Real-world obstacles such as accessibility, reimbursement, delays in testing, interdisciplinary coordination, and sample adequacy are critically examined. Emerging innovations—including multi-omics integration, spatial profiling, liquid biopsy, artificial intelligence, and novel targeted therapies—offer opportunities to overcome current limitations and improve patient outcomes. Finally, practical recommendations are proposed to optimize tissue handling, testing algorithms, and access to precision-guided therapies. By addressing these challenges, molecular testing in NSCLC can be more effectively leveraged to personalize treatment strategies and enhance survival outcomes.

Preoperative sarcopenia has emerged as an important determinant of adverse postoperative and long-term outcomes in patients with resectable non-small cell lung cancer (NSCLC). Its frequent coexistence with systemic inflammation may further worsen survival outcomes. At the same time, neoadjuvant chemotherapy and chemoimmunotherapy have substantially improved pathological response and survival in resectable NSCLC. However, their interaction with host-related factors such as sarcopenia and systemic inflammatory status remains insufficiently characterized. This narrative review aims to synthesize current evidence regarding the interplay between preoperative sarcopenia, systemic inflammation, and neoadjuvant therapy in resectable NSCLC and evaluates their potential combined impact on surgical and oncological outcomes. A narrative synthesis of 20 studies involving patients undergoing lung cancer resection was performed. Sarcopenia was primarily assessed using computed tomography or PET-CT-derived skeletal muscle indices, most commonly the skeletal muscle index, whereas systemic inflammation was evaluated using biochemical inflammatory markers. The available evidence consistently indicates that preoperative sarcopenia is associated with poorer long-term survival, and this adverse effect appears to be amplified in the presence of systemic inflammation. Although neoadjuvant chemoimmunotherapy has improved tumor response and survival outcomes, it may also act as a systemic stressor capable of aggravating muscle loss. Importantly, no study to date has simultaneously evaluated sarcopenia, systemic inflammation, and neoadjuvant therapy within a unified analytical framework. Most available studies focus primarily on sarcopenia, while inflammatory or treatment-related parameters are typically analyzed separately. Overall, while sarcopenia and systemic inflammation are recognized predictors of adverse outcomes in resectable NSCLC, robust evidence integrating them with neoadjuvant therapy is lacking. Clarifying their potential interaction may improve risk stratification and help to optimize perioperative management strategies in the era of neoadjuvant therapy.

Solitary fibrous tumors (SFTs) are rare mesenchymal neoplasms that typically arise from the pleura but may occur in various extrathoracic sites. Primary intraparenchymal pulmonary SFTs without pleural attachment are exceptionally uncommon and often pose diagnostic and therapeutic challenges. We report the case of a middle-aged female patient presenting with progressive dyspnea and a large mass in the left lower lobe on imaging. Computed tomography revealed a well-circumscribed, hypervascular mass occupying the left lower lobe. Bronchoscopic and percutaneous biopsies were nondiagnostic, and surgical resection was pursued. Intraoperatively, the tumor was found to arise from the lung parenchyma without pleural involvement. Histopathological examination demonstrated a spindle-cell neoplasm with the typical “patternless pattern,” and immunohistochemistry confirmed nuclear STAT6 positivity, establishing the diagnosis of SFT. The postoperative course was uneventful apart from a transient pulmonary embolism, which was successfully treated. The patient was discharged in good condition and is under regular radiologic surveillance. SFTs of the lung are rare and often mimic more common pulmonary tumors radiologically. Histologic confirmation with STAT6 immunohistochemistry is crucial for accurate diagnosis. Complete surgical excision remains the mainstay of treatment. Given the risk of late recurrence—especially in large tumors—long-term imaging follow-up is mandatory. This case highlights the importance of considering SFT in the differential diagnosis of large pulmonary masses, the critical role of STAT6-based histopathologic confirmation, and the necessity for prolonged surveillance even after complete resection.

INTRODUCTION:Postoperative pain remains a major challenge after lung cancer surgery and may negatively affect recovery, functional status, and quality of life. Structured perioperative educational interventions may improve symptom management and postoperative outcomes. This study evaluated the effect of a structured educational intervention on postoperative pain outcomes in patients undergoing lung cancer surgery. METHODS:This prospective, single-center, non-randomized interventional study included 160 patients undergoing surgical treatment for lung cancer between October 2021 and March 2024. Participants were allocated to either an intervention group (n=80), which received structured perioperative education in addition to usual care, or a control group (n=80), which received usual care alone. The educational intervention was delivered preoperatively and reinforced during the first three postoperative days, with caregiver participation encouraged. Pain outcomes were assessed preoperatively and at 1, 6, and 12 months postoperatively using the Greek-language Pain Rating Scale. The primary outcome was current pain intensity. Secondary outcomes included average pain intensity during the previous week, pain distress, and pain-related interference with daily activities. Longitudinal analyses were performed using linear mixed-effects models. RESULTS:Significant group, time, and group × time interaction effects were observed for all pain-related outcomes (all p<0.001). Compared with the control group, patients receiving the educational intervention demonstrated significantly lower postoperative pain intensity, reduced pain distress, and less pain-related interference with daily activities across follow-up assessments. The largest between-group differences were generally observed at six months postoperatively. Sensitivity analyses adjusting for baseline pain scores, length of hospital stay, and immunotherapy confirmed the robustness of the findings. CONCLUSION:Structured perioperative education was associated with improved postoperative pain outcomes following lung cancer surgery. Educational interventions incorporating caregiver involvement and reinforcement during the early postoperative period may represent a feasible and low-risk supportive strategy to improve postoperative recovery and pain management in patients undergoing thoracic surgery. Further randomized multicenter studies are warranted to confirm these findings.

Background: Non-small-cell lung cancer (NSCLC) is driven by distinct oncogenic alterations with important therapeutic and prognostic implications. Noninvasive biomarkers that predict molecular status in surgically resectable disease may aid in their management. We investigated the association of preoperative primary-tumor SUVmax on PET/CT, smoking history, and corrected serum calcium levels with driver oncogenic alterations and PD-L1 expression in surgically resected NSCLC. Methods: We retrospectively studied 170 patients with surgically resected NSCLC at a single tertiary center. Resected tumors were assessed for EGFR, KRAS, and BRAF mutations, ALK and ROS1 rearrangements, and PD-L1 expression. Associations between molecular status, PD-L1 expression, and clinicometabolic parameters were evaluated using univariate analyses and multivariable regression models. Results: A driver alteration was detected in 51.2% of tumors, and 30% of evaluable cases showed high PD-L1 expression (≥50%). Corrected serum calcium was positively correlated with SUVmax and emerged as the strongest independent predictor retained in the final linear regression model, with pack-years also contributing independently. Most molecular subgroups did not show significant differences in SUVmax. EGFR-mutated tumors showed a trend toward a lower SUVmax compared with EGFR wild-type tumors, although this did not reach statistical significance. Smoking history was not significantly associated with PD-L1 expression, and pack-years did not differ significantly across the molecular groups examined. Conclusions: In this cohort of surgically resected NSCLC, preoperative corrected serum calcium and smoking exposure were more closely associated with tumor metabolic activity than with specific molecular alterations. These findings suggest that simple clinical and biochemical parameters may provide complementary information, although their utility for discriminating individual molecular subgroups appears limited.

Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is an extremely uncommon and incompletely elucidated pulmonary condition arising from neuroendocrine cells within the airway epithelium. We report the case of a 65-year-old woman who presented to our thoracic surgery department with a history of hemoptysis following the incidental discovery of a solitary pulmonary nodule in the right middle lobe, highly suspicious for lung cancer. After a thorough diagnostic workup, including positron emission tomography-computed tomography (PET-CT), our multidisciplinary team recommended a right middle lobectomy. The histopathological examination of the resected specimen confirmed DIPNECH without evidence of an associated carcinoid tumor. Given the potential for progression to neuroendocrine neoplasm, the development of evidence-based management protocols for DIPNECH remains essential. This case highlights the atypical and often silent presentation of this rare lung pathology and emphasizes the importance of considering DIPNECH in the differential diagnosis of asymptomatic patients presenting with solitary pulmonary nodules.

3D printing is an additive manufacturing technology. The methodology involves designing the object in a digital environment, in a CAD (Computer-Aided Design) computer program, which then converts the 3D image file into an STL (Standard Triangulation Language) file to be loaded and read by the printer. In the first two decades of the twentieth century, the main technology that caused intense discussions, since the first stereolithography technique used by Charles Hull in 1983, has been the conversion of digital models into physical objects. 3D printers became commercially available in the 1980s, with the market growing exponentially in the 1990s and 2000s. Medical applications for 3D printing have been reported since 1990. Stereolithographic modeling of cardiac structures was described by Binder in 2000 for better diagnostic access and surgical planning. In improving healthcare, 3D printing, i.e. the conversion of digital models into physical objects, plays an important and multiple/multifaceted role.

Left-sided partial anomalous pulmonary venous return (PAPVR) may remain clinically silent and undiagnosed until incidentally identified, potentially introducing complexity in perioperative assessment and management, particularly in patients with significant comorbidities. We report the case of a 77-year-old male with metastatic colorectal adenocarcinoma and a history of multiple right-sided pulmonary metastasectomies. He underwent a right completion upper bilobectomy. Postoperatively, placement of a central venous line in the left internal jugular vein (selected due to intraoperative accessibility, although the right side is generally preferred for central access) revealed unexpectedly high oxygen saturation levels, prompting an urgent computed tomography angiogram. Imaging confirmed a previously undiagnosed left-sided PAPVR, with drainage of the left upper pulmonary vein into the left jugular vein. The central line was removed and replaced on the contralateral side. No surgical correction was required due to the asymptomatic nature and contralateral location of the anomaly. The patient recovered uneventfully, aside from a brief episode of atrial fibrillation managed conservatively. This case highlights the importance of maintaining clinical awareness of vascular anomalies such as PAPVR in thoracic surgical patients. Incidental findings may have significant implications for central venous access, anesthetic management, and postoperative care. Thorough imaging review and effective interdisciplinary communication are essential to ensure optimal outcomes.

Lymphoepithelial or lymphoepithelioma-like carcinoma is a poorly differentiated carcinoma located outside the nasopharynx with similar morphologic characteristics to its nasopharyngeal counterpart. Lymphoepithelial carcinoma of the lung is a rare subtype of squamous cell lung carcinoma frequently associated with Epstein-Barr virus (EBV) infection, accounting for approximately 1% of non-small cell lung carcinomas (NSCLC). We herewith present a case of a 78-year-old female patient who was diagnosed with lymphoepithelial carcinoma of the lung, emphasizing its distinct epidemiological features, clinical workup, and histopathological characteristics. Furthermore, we discuss its histologic differential diagnosis. Finally, we refer to this tumor's unique molecular and immunological profile and its treatment modalities, and we review the literature.

Background:Esophageal perforation is a rare but life-threatening condition associated with a high mortality rate and often presents with nonspecific clinical manifestations that can lead to delayed diagnosis and treatment. When combined with ST-segment elevation on electrocardiography (ECG), it can be particularly challenging to distinguish esophageal perforation from acute inferior myocardial infarction, as the two conditions may share similar ECG findings. Case Description:We report the case of a 65-year-old man with a significant history of long-term alcohol consumption who presented to our hospital (the Affiliated Hospital of Liaoning University of Traditional Chinese Medicine) with persistent oppressive pain in the anterior and posterior left chest. Initially, the patient was diagnosed with acute coronary syndrome based on the ECG findings, which showed Q-wave and ST-segment elevation in the inferior leads. However, further dynamic monitoring of myocardial necrosis markers, including myoglobin and troponin I, yielded negative results inconsistent with acute myocardial infarction. Subsequent enhanced computed tomography revealed thickening and discontinuity of the wall of the thoracic esophagus with an irregular, mixed-density shadowing of the surrounding soft tissue confirming the diagnosis of esophageal rupture. Despite prompt recognition and transfer to a hospital with surgical capabilities, the patient tragically succumbed to esophageal rupture and hemorrhage while awaiting surgery. Conclusions:This case highlights the importance of maintaining a broad differential, including esophageal rupture, in patients exhibiting necrotic Q waves and ST-segment elevation in the inferior wall of the ECG, especially in the absence of reciprocal changes in the lateral leads and the lack of abnormal markers of myocardial necrosis. Prompt recognition of this rare but potentially fatal condition is crucial for initiating appropriate treatment and improving patient outcomes. Emergency physicians should be aware of this atypical presentation of esophageal perforation mimicking an acute myocardial infarction and consider this differential diagnosis when faced with discordant clinical and diagnostic findings.

Background:The main difficulty of minimally invasive Ivor Lewis (IL) procedure for adenocarcinoma of the esophagogastric junction (AEGJ) is the intrathoracic esophagogastric anastomosis (IEA). We aimed to assess the safety and feasibility of the IL procedure with the da Vinci surgical system for treatment of AEGJ with semi-mechanical intrathoracic IEA.Methods:The cohort included 72 patients with AEGJ who received treatment at the Department of Minimally Invasive Esophagus Surgery of the Tianjin Medical University Cancer Institute and Hospital from August 2020 to March 2023. Of these 72 patients, 17 received neoadjuvant chemo-immunotherapy. The robot-assisted minimally invasive IL procedure was performed using a linear stapler for overlap side-to-side intrathoracic anastomosis and the stapler defect was closed with double full-layer continuous sutures by robotic hand-sewn (semi-mechanical) IEA.Results:Of the 72 AEGJ patients, 2 were converted to exploration, 7 were converted to laparotomy and thoracotomy for circular-stapled intrathoracic anastomosis, and 6 were converted to thoracotomy for circular-stapled anastomosis, which included 2 cases of extensive pleural adhesion and 4 cases of overlap anastomosis failure, whereas 57 underwent the robot-assisted minimally invasive IL procedure with semi-mechanical IEA. Among the 9 patients converted to laparotomy, the laparotomy rate was closely related to the Siewert classification (P<0.005) and preoperative use of neoadjuvant therapy (P<0.05). Among the 57 patients who underwent the robot-assisted minimally invasive IL procedure with semi-mechanical IEA, there were 2 cases of anastomotic leakages (2/57, 3.5%), no case of anastomotic stricture, 5 cases of postoperative pneumonia (5/57, 8.77%), 2 cases of intensive care unit admission (2/57, 3.5%), and 1 case of readmission within 30 days (1/57, 1.75%). None of the patients died within 30 days after surgery.Conclusions:The robot-assisted minimally invasive IL procedure with semi-mechanical IEA is both safe and feasible for AEGJ. However, caution is advised for patients with Siewert type III AEGJ and those who have already received preoperative neoadjuvant therapy.

Teratomas are a type of germ cell tumor that may contain several different types of tissue. Neurofibroma is a benign peripheral nerve sheath tumor with the plexiform type being pathognomonic for neurofibromatosis type 1. We report a case of a 33-year-old woman with a background of Neurofibromatosis type 1 who presented with left-sided chest pain and shortness of breath. She was diagnosed with a large mediastinal mass which was confirmed from a CT-guided biopsy as neurofibroma. Following a multidisciplinary team discussion, she underwent mediastinal mass resection and the final histopathology report revealed mediastinal mature teratoma.

Background: The prognostic value of the existing 8th edition post-neoadjuvant treatment (ypTNM) appears to be limited, and necessary reassessment and modification should be carried out as needed. This study aimed to compare the prognosis prediction accuracy of modified and unmodified versions of the 8th edition ypTNM. Methods: Esophageal cancer patients who had received neoadjuvant therapy from the Surveillance, Epidemiology, and End Results (SEER) database were included in this observational longitudinal study. The median follow-up time was 26 months. All-cause mortality was the outcome variable. Demographic and clinical variables were collected as covariates. Kaplan-Meier (log-rank test) and Cox proportional hazards models were conducted for developing modified ypTNM staging. The concordance index (C-index) was calculated to analyze the discriminative ability of modified ypTNM staging. Results: Overall, 3,595 patients met inclusion criteria. The 8th edition staging was not able to significantly discriminate between patients with ypT1- and ypT2-, ypT3- and ypT4-, ypN2- and ypN3- disease, respectively. Using the modified staging, we found that patients with ypT0-2 [hazard ratio (HR) =1.232; 95% confidence interval (CI): 1.053-1.441] and ypT3-4 (HR =1.257; 95% CI: 1.136-1.390) with grade III + IV had a significant risk of death compared to those with grade I + II. As was the case for the ypN0 (HR =1.295; 95% CI: 1.073-1.562) group with middle and upper tumor locations compared to those with low tumor location. The modified staging possessed better homogeneity in terms of the chi-square likelihood ratio (143.443 vs. 102.044), Akaike information criterion (AIC) (32,683.716 vs. 32,719.115), and Schwarz's Bayesian criterion (SBC) (32,723.496 vs. 32,741.847), as well as better discriminatory ability (C-index of 0.577 vs. 0.560, P=0.045) compared to the 8th edition staging. Conclusions: Although the modified ypTNM staging system we created by incorporating tumor grade and location to the original T and N displayed certain prognosis prediction accuracy compared with the 8thedition ypTNM staging, a larger sample size and prospective studies are needed to explore.

Lung decortication for the treatment of chronic pleural empyema remains a technically challenging procedure that is associated with bleeding and air leak. The recent advent of pure argon plasma has provided thoracic surgeons with an electrically neutral energy source for dissection and coagulation of pulmonary tissue with minimal depth of necrosis. In this article, we describe the technique of lung decortication with argon plasma energy (PlasmaJet, Plasma Surgical, Roswell, GA, USA) for the treatment of chronic pleural empyema. With appropriate application, the PlasmaJet can facilitate the removal of fibrous cortex with satisfactory hemostasis and aerostasis. Argon plasma energy can potentially be a useful adjunct in lung decortication. Controlled trials are needed to determine its role in the surgical management of advanced pleural empyema.

Pectus Excavatum (PE) or "funnel chest," the most common deformity of the anterior chest wall characterized by sternal depression, can be repaired via either operative or non-invasive techniques. Vacuum Bell (VB) device is the most widespread of the latter one which can be applied either intraoperatively or as monotherapy. The present narrative review examines the efficacy of that innovative method. A thorough search of the literature resulted in 13 English-written articles concerning VB therapy from its first description to February 2019. The studies included patients with mild to moderate PE, mainly evaluated via Haller-Index and/or sternum depth prior to and following treatment. Concerning depth-improvement, 37-90% showed amelioration while 10-40% of them an excellent correction to normal. In 42%, Haller-Index also improved with a median decrease of 0.3 after VB application. A correlation was attempted to be found between the efficacy of VB and factors such as the frequency and duration of VB application, patient age, gender, PE severity and type, and differential pressure of the suction cup. Complications may be frequent yet mild and temporary. Intraoperatively, VB widows Minimally Invasive Repair of Pectus Excavatum (MIRPE) operation a safer procedure with greater results. VB as conservative treatment is an effective and well-tolerated alternative therapeutic option for selected patients with PE who meet specific criteria. It also constitutes a device of significant efficacy, appropriate for intraoperative use during MIRPE procedure.

Desmoid tumours are rare, locally aggressive neoplasms exhibiting high tendency for recurrence, even after complete resection. Only 1 in 5 of them originates from the chest wall, usually measuring less than 10 cm at diagnosis. Herein, we report the case of a woman presenting with symptoms of gradual lung compression by a giant desmoid tumour occupying the entire hemithorax. She underwent complete surgical resection of the tumour and chest wall reconstruction. She had disease recurrence 15 months later and currently remains under regular follow-up. The management of intrathoracic desmoid tumours is challenging because they are usually not diagnosed until they become large enough to cause compression symptoms. While medical management is the primary modality of treatment, surgery could be considered in selected cases where significant symptoms arise, and the functional status is impaired secondary to the tumour. Adjuvant radiotherapy to minimise the risk of local recurrence should also be considered.

Ameloblastoma is a rare odontogenic neoplasm of the jaw. It usually behaves as a benign, slow growing tumour of the oral cavity with a high recurrence rate, especially when it is inadequately resected. A small proportion of ameloblastomas metastasize to distant organs, with lungs representing the most common site of metastatic spread. In this report, we present the case of a middle-aged man with two pulmonary nodules and a history of mandibular ameloblastoma excised 10 years prior to this radiological finding. Following resection and histopathological analysis of the lung lesion, a diagnosis of metastatic ameloblastoma was confirmed. No local recurrence of the primary tumour was identified. At 1-year follow-up, the patient had no evidence of local or metastatic disease.