Journal of thoracic disease最新文献

Background: Minimally invasive thoracic surgery is the most frequently used approach for lung resection to minimize surgical stress on the patient. To further reduce invasiveness, the non-intubated spontaneous ventilation method is applied on the anesthesia side. However, due to the unsafe airway associated with this procedure, this method is not widely adopted. This study analyzes the surgical results of our method, which involves spontaneous ventilation with double lumen tube intubation and uniportal video-assisted thoracic surgery (VATS) lung lobectomies.

Methods: Between 2015 and 2023, 302 patients underwent uniportal VATS lobectomy in two different periods, depending on the type of anesthesia. Between 2015 and 2019, traditional relaxation, double lumen tube intubation, and general anesthesia (GA) with mechanical one-lung ventilation were used for lobectomies in 210 patients (93 males, 117 females, mean age 64.3 years) (GA-VATS group). Between 2021 and 2023, 92 cases (44 males, 48 females, mean age 66.3 years) underwent lobectomy with spontaneous ventilation after a short relaxation period, double lumen intubation, and vagus nerve blockade (SVI-VATS group). Perioperative data from 66 patients in each group were analyzed after 1:1 sample propensity score matching (caliper 0.1).

Results: Respecting all patients, in the GA-VATS and SVI-VATS groups, the mortality and morbidity rates were 1 (0.47%) and 0 (0%), and 52 (24.7%) (P=0.050) and 19 (20.6%) (P=0.32), respectively. The rate of grade IIIB complications was 13 (6.1%) in the GA-VATS group and 0 (0%) in the SVI-VATS group (P=0.01). The length of surgery was 91.1 vs. 86.4 min (P=0.10), duration of chest drainage was 4.64±4.58 vs. 3.39±3.39 days (P=0.02), the rate of permanent air leak was 43 (20.4%) vs. 8 (8.7%) (P=0.001), reoperation rate was 11 (5.2%) vs. 0 (0%) (P=0.02), and the number of removed mediastinal lymph nodes was 12.7 vs. 12.7 (P=0.97) in the GA-VATS and SVI-VATS groups, respectively. After propensity score-matched analysis, there were no cases of mortality in either group. Morbidity rates were 19 (28.8%) and 15 (22.7%) (P=0.55), length of surgery was 99 vs. 86.7 min (P=0.003), duration of chest drainage was 5.1 vs. 3.8 days (P=0.02), the rate of permanent air leak was 15 (22.7%) vs. 8 (12.1%) (P=0.10), and the reoperation rate was 5 (7.57%) vs. 0 (0%) (P=0.058) in the GA-VATS and SVI-VATS groups, respectively.

Conclusions: SVI-VATS lobectomy resulted in fewer complications, particularly those requiring correction under anesthesia (IIIb) and a shorter postoperative period than GA-VATS. The number of removed mediastinal lymph nodes was similar between the groups.

Background: Positional indications for sublobar resection have been increasingly focused by clinical surgeons while the surgical strategies for cases involving inter-multisegmental veins (IMSVs) remain underreported. We want to further clarify the positional indications for sublobar resection in patients with clinical T1a-bN0 non-small cell lung cancer (NSCLC).

Methods: The clinical data of 686 patients from August 2021 to July 2022 were retrospectively analyzed. In the three-dimensional (3D) reconstruction images, we analyzed the prevalence and drainage patterns of typical IMSVs, specifically focusing on the lateral vein (Vl) in the upper lobes and the branches of the superior segmental vein (V⁶b) in the lower lobes. The potential association between lesion locations and surgical strategy was also analyzed.

Results: The prevalence of Vl, V⁶b2, and V⁶b3 was 58.5% (231/395), 98.3% (286/291), and 25.1% (73/291), respectively. Vl mainly drained into V²a+b (70/110, 63.6%) on the right and into V¹⁺²b+c (72/121, 59.5%) on the left. V⁶b2 and V⁶b3 mainly converged with other branches of the superior segmental vein. Limited resection was more feasible when the 2 cm simulated cutting margin of nodules did not involve IMSVs, or when lesions were located in the outer region. Multivariable logistic regression analyses identified four independent predictors for surgical procedure selection: (I) whether the 2 cm simulated cutting margin involves IMSVs; (II) diameter; (III) consolidation-to-tumour ratio (CTR); and (IV) depth ratio.

Conclusions: IMSVs exhibited high prevalences, with Vl showing diverse drainage patterns, while V⁶b2 and V⁶b3 displayed little variation. Depth ratio and the lesion's relative location to the IMSVs were identified as longitudinal and transverse positional indications, respectively, for sublobar resection in patients with clinical T1a-bN0 NSCLC.

Background: Chronic obstructive pulmonary disease (COPD) remains a leading cause of morbidity and mortality worldwide. Bronchoscopic lung volume reduction (BLVR) using endobronchial valves (EBV) offers a minimally invasive treatment for severe emphysema. Traditionally performed under general anesthesia (GA), this study evaluates whether BLVR performed under moderate sedation (MS) potentially has less adverse events as compared to ones done under GA.

Methods: This retrospective analysis included 65 patients who underwent BLVR with EBV placement at the University of Florida between January 2020 and June 2022. All procedures were performed under MS. Primary outcomes assessed included the incidence of pneumothorax (PTX), while secondary outcomes comprised valve removal rates, need for revision bronchoscopy, and other procedural complications.

Results: The incidence of PTX was 16.9%, lower than the previously reported rate of 26% in studies combining GA and MS. No major complications or deaths were reported. Procedures were successfully completed in all patients, with valves deployed as planned. Revision bronchoscopy was required in 21.5% of cases.

Conclusions: BLVR under MS is demonstrated to be safe and feasible, with a lower rate of complications compared to GA. These findings suggest that MS may be a preferred sedation method for BLVR, though further research is warranted to confirm these results and explore the long-term outcomes and cost implications.

Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide, largely driven by the accumulation of senescent bronchial epithelial cells, which contribute to inflammation and tissue remodeling. This study investigates the therapeutic potential of nuclear factor erythroid 2-related factor 2 (Nrf2) activation in targeting senescence-related changes to alleviate COPD progression.

Methods: Single-cell transcriptome analysis, in vitro COPD cell models, and a COPD mouse model were utilized to examine the effects of Nrf2 activation. Specifically, the study focused on the impact of Nrf2 on senescent ciliated epithelial cells and the associated secretory phenotype. Respiratory function tests and lung pathology assessments were conducted to evaluate the intervention's efficacy in the mouse model.

Results: The study identified a significant presence of senescent ciliated epithelial cells in COPD patients, contributing to disease progression. Nrf2 activation in vitro reduced senescence markers, enhanced cell proliferation, and decreased inflammatory cytokines. In vivo, Nrf2 activation significantly improved lung function and reduced pathological damage in the COPD mouse model.

Conclusions: The findings underscore the potential of Nrf2 activation as a therapeutic strategy to mitigate COPD progression by modulating the senescence-associated secretory phenotype (SASP). This study suggests that Nrf2 activators could offer a promising approach to improving clinical outcomes for COPD patients.

Background: Cone-beam computed tomography (CBCT)-guided bronchoscopy is increasingly utilized for diagnosing peripheral pulmonary lesions (PPLs). We carried out the meta-analysis for assessing the efficacy and safety of CBCT-guided bronchoscopy for PPLs.

Methods: An extensive search in several databases was conducted to identify relevant articles. We evaluated the quality of studies with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. The pooled diagnostic yield (DY) and adverse event rate with the 95% confidence interval (CI) were computed. Subgroup analyses were performed according to additional use of navigation, use of radial endobronchial ultrasound (rEBUS), use of fixed or mobile CBCT, whether computed tomography (CT) spin was performed before biopsy to affirm tool-in-lesion, use of rapid onsite cytologic examination (ROSE), strictness of the definition of DY, and study design. Further analysis was performed to explore the association between odds of diagnosis with CBCT guided bronchoscopy and PPLs characteristics (>20 vs. ≤20 mm, non-upper lobe vs. upper lobe, with bronchus sign vs. without bronchus sign, and solid vs. non-solid) as well as sampling methods (forceps vs. fine needle aspiration, forceps vs. cryoprobe sampling). The pooled odds ratio (OR) and 95% CI were calculated. The significance level was set at 0.05. All analyses were performed by using meta package in R version 4.3.2.

Results: We included 23 studies involving 1,769 patients and 1,863 PPLs in the meta-analysis. The overall pooled DY of CBCT-guided bronchoscopy was 80.2% (95% CI: 76.0-84.1%). Subgroup analysis showed that the DY was highest when CBCT was used with robotic-assisted navigation bronchoscopy (pooled DY 87.5%; 95% CI: 81.5-92.4%), the DY was 78.9% (95% CI: 70.8-85.9%) when CBCT was used alone without other navigation techniques. Lesion size >20 mm, presence of bronchus sign and solid lesions were associated with significant increase in the odds of diagnosis with CBCT-guided bronchoscopy. Pooled adverse event rate was 2.3% (95% CI: 1.2-3.6%).

Conclusions: CBCT-guided bronchoscopy is a safe technique with high DY in diagnosing PPLs.

Background: Chest drains are routinely used after video-assisted thoracoscopic surgery (VATS) lung resections to evacuate fluid and air from the pleural space. We compared the impact of coaxial silicone (SIL) drains vs. standard polyvinyl chloride (PVC) drains on postoperative pain, drainage efficacy, and short-term treatment outcome following VATS lobectomy.

Methods: The prospective randomized study included 80 patients who underwent VATS lobectomy for lung cancer between September 2020 and June 2023. Patients were randomized into two groups based on the type of chest drain used postoperatively: 40 in the experimental group (coaxial SIL drain Fr 24) and 40 in the control group (standard PVC drain Fr 24). The researchers collecting the data and the caregivers were not blinded to the group allocation. The primary objective was to evaluate pain over the initial 2 postoperative days by assessing analgesic consumption, respiratory muscle strength [measured as maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP)], and pain intensity using the visual analog scale (VAS). MIP, MEP, and VAS were measured both at rest and during physical activity.

Results: Sixty-nine patients were included in the final analysis: 35 in the experimental group and 34 in the control group. The groups were comparable in terms of drainage efficacy and short-term treatment outcome, but pain was significantly lower in the experimental group (coaxial SIL drain). Diclofenac consumption was significantly lower in the experimental group (P=0.004), with a trend toward lower consumption of other analgesics. All respiratory muscle strength measurements were higher in the experimental group, with significant differences in static MIP on the second postoperative day (P=0.046), both static (P=0.02) and dynamic (P=0.050) MEP on the first postoperative day, and static MEP on the second postoperative day (P=0.02). Static VAS (S-VAS) on the first postoperative day was statistically significantly lower in the experimental group (P=0.003). Dynamic VAS (D-VAS) was comparable between the groups.

Conclusions: This study confirmed the hypothesis that coaxial SIL drains, owing to their softer material, cause less pain while maintaining efficacy comparable to standard PVC drains.

Trial registration: The study was registered at ClinicalTrial.gov (NCT06425601).

Background: Silicosis, an occupational disease caused by chronic silica exposure, has a high global burden and limited treatment options. This study analyzed the epidemiological trends and future projections of silicosis based on data from the Global Burden of Disease (GBD), aiming to provide data support for public health interventions.

Methods: We extracted and analyzed the data on the incidence, mortality, and disability-adjusted life years (DALYs) of silicosis, as well as the age-standardized rate (ASR) of silicosis from the GBD Study 2021. Using these data, we describe the trends in five dimensions: global, regional, national, age, and sex. We used Joinpoint regression software (V.5.2.0) to calculate the average annual percent changes (AAPCs) in the ASRs from 1990 to 2021. Silicosis trends from 2022 to 2050 were predicted using Bayesian Age-Period-Cohort (BAPC) and Autoregressive Integrated Moving Average (ARIMA) models.

Results: From 1990 to 2021, the global incidence of silicosis, number of deaths, and DALYs showed an upward trend. However, the corresponding ASRs all showed decreasing trends, with AAPC values of -1.1% (-1.1% to -1.0%), -2.5% (-2.7% to -2.3%), and -2.5% (-2.7% to -2.3%), respectively. However, the burden of silicosis varied significantly across countries and regions, with China, South Africa, and Chile having a silicosis age-standardized incidence rate (ASIR) and age-standardized DALYs rate (ASDR) well above the global average. In addition, the ASIR and ASDR of silicosis were generally higher among men. There were also differences between regions at different socioeconomic levels, with the DALYs burden of silicosis being lowest among males and females in low social demographic index (SDI) regions and highest among males in medium and high SDI regions. The BAPC model projected a gradual decrease in the silicosis burden from 2022 to 2050.

Conclusions: Although the disease burden of silicosis showed a decreasing global trend from 1990 to 2021, it is still a global public health concern. Effective preventive and curative measures should be taken to address the challenges posed by silicosis and to protect the lives and health of workers.

Background: Fluorine 18-labeled fibroblast activation protein inhibitor (¹⁸F-FAPI-04) positron emission tomography/computed tomography (PET/CT) has shown promise for the visualization of advanced stage lung cancer. The accuracy of ¹⁸F-FAPI-04 compared with that of fluorine-18 labeled-fluorodeoxyglucose (¹⁸F-FDG) in detecting early lung adenocarcinoma (LUAD) remains unknown. Taking the surgical pathology of pulmonary nodule as the gold standard, the diagnostic performance of stage IA LUAD were compared between ¹⁸F-FAPI-04 PET/CT and ¹⁸F-FDG PET/CT, and the correlation between ¹⁸F-FAPI-04 uptake and pathological characteristics of stage IA LUAD.

Methods: This prospective study from February 2023 to October 2023 analyzed patients with stage IA LUAD who underwent simultaneous examinations with ¹⁸F-FAPI-04 and ¹⁸F-FDG PET/CT. Semi-quantitative parameters such as maximum standardized uptake value (SUVmax), tumor-to-background ratio (TBR), metabolic tumor volume (MTV), total lesion glycolysis (TLG), FAPI avid tumor volume (FTV), and total lesion FAP expression (TLF) were calculated. The two patterns were compared using either a paired Student's t-test or a Wilcoxon signed-rank test. Immunohistochemical (IHC) staining for detecting fibroblast activating protein (FAP) expression was performed in all resected tumor specimens. Correlation analysis was performed between ¹⁸F-FAPI-04 uptake and pathological features of stage IA LUAD.

Results: A total of 20 patients diagnosed with stage IA LUAD were included in this study. A total of 24 pulmonary nodules were identified in these 20 patients, all of whom were confirmed to have stage IA LUAD through operation and pathology. Of them, 17 nodules were stained by FAP immunohistochemistry. Compared with ¹⁸F-FDG, ¹⁸F-FAPI-04 PET/CT showed a statistically significant increase in SUVmax and TBR for stage IA LUAD, both in the overall and stratified analyses (adenocarcinoma in situ + minimally invasive adenocarcinoma groups vs. invasive adenocarcinoma groups; moderately vs. well-differentiated lesions; stage IA1 vs. IA2+3; P<0.05). The SUVmax of the intense FAP expression group was significantly higher than that of the mild FAP expression group, demonstrating a statistically significant difference (P=0.005). The FAP-IHC score was positively correlated with the SUVmax of ¹⁸F-FAPI-04 (r=0.64, P=0.005).

Conclusions: ¹⁸F-FAPI-04 PET/CT demonstrates higher SUVmax and TBR than ¹⁸F-FDG PET/CT in the detection of stage IA LUAD. It was re-assured that the ¹⁸F-FAPI-04 uptake of stage IA LUAD was positively correlated with the expression of FAP in vitro.

Background: Thoracic autonomic nervous system surgery is mainly used for hyperhidrosis/facial flushing, whereas cardiac and vascular indications are limited. The literature remains controversial regarding the correct indications and surgical technique, with the lack of homogeneous data being a major limitation. We designed a survey to investigate current practice among members of the European Society of Thoracic Surgeons (ESTS).

Methods: A 29-question ad hoc questionnaire was available to all ESTS members from December 2022 to February 2023. It included questions on demographics, indications, preoperative evaluation, technique, complications and follow-up. A descriptive analysis of the data is presented.

Results: The response rate was 7% and 121 of 123 valid responses were analysed. Sympathetic surgery was performed for hyperhidrosis/facial flushing, cardiac and vascular disease in 99%, 29% and 29% of respondents respectively. Palmar hyperhidrosis was the most common, followed by axillary, facial flushing and craniofacial hyperhidrosis. Catecholaminergic ventricular tachycardia was more common than long QT syndrome and Raynaud's over Buerger's disease. Data analysis showed that members preferred nerve cutting to clipping (66%, 64% and 58% for hyperhidrosis/facial flushing, cardiac and vascular disease respectively). Preference for the target level of nerve block varied significantly depending on the condition addressed. For most responders (65%), severe compensatory sweating was an adverse event, occurring in less than 10% of treated cases. Only 52% used a database for follow-up.

Conclusions: Current practice in sympathetic surgery in ESTS responders is consistent with the available evidence, although it is characterized by great heterogeneity in almost all aspects. A database could help to standardize patient selection, surgical techniques and follow-up, and provide the basis for future multi-institutional trials.