Journal of thoracic disease最新文献

Background: Patients surviving the coronavirus disease 2019 (COVID-19) are reported to explore pulmonary sequelae. It is challenging to provide pulmonary function tests (PFTs) during the pandemic of this contagious diseases because of the difficulty related to infection control risks. This study aims to identify important predictors of lung diffusion capacity impairment in COVID-19 survivors after hospital discharge.

Methods: The retrospective cohort study included 341 patients after COVID-19. The parameters of spirometry, body plethysmography, lung diffusion capacity for carbon monoxide (DLco), and the worst chest computed tomography (CT) scan in the acute phase of COVID-19 (CT_max, %) were assessed. Multivariable logistic regression analysis for exploring risk factors associated with lung diffusion capacity impairment was used. The receiver operating characteristic (ROC) curve of multivariate observation and the area under the curve (AUC) were used to assess the performance of a model.

Results: At the time of the analysis, 64.8% (221/341) patients participated in follow-up visits on 90 days, 23.5% (80/341) on 90-180 days, and 11.7% (40/341) on more than 180 days after the onset of COVID-19 symptoms. The median CT_max was 50% (50% of the lung area was involved in a pathological process according to a semi-quantitative CT score). Abnormal DLco (<80% of predicted) was recorded in 60.4% cases. The predictors such as age, gender, body mass index (BMI), CT_max, and the time interval between the COVID-19 symptoms onset and follow-up PFTs were encapsulated in the logistic regression analysis to explore the prediction of reduced DLco. Backward stepwise regression was applied to eliminate insignificant predictors. It was found that CT_max was important predictor of impaired DLco. AUC value was 0.780 [95% confidential interval (CI): 0.723-0.837, P<0.001]. The sensitivity and specificity in the training group were 80% and 67%, respectively. The odds ratio (OR) showed that CT_max =45% and more in the acute phase of COVID-19 was significantly associated with reduced DLco during 6 months after COVID-19 (OR 1.21, 95% CI: 1.095-1.334; P<0.05).

Conclusions: Pulmonary interstitial damage caused by severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) definitely contributes to reduced DLco after hospital discharge. This indicates that analysis of CT scans during the acute phase of COVID-19 may have prognostic relevance for abnormal DLco.

Background: The impact of post-surgical same day ambulation in lung resection patients is relatively unstudied. We sought to determine the relationship between day of surgery ambulation and postoperative outcomes after lung resection.

Methods: This was a prospective cohort study at one healthcare system with six hospitals (1/2019-3/2023). Patients undergoing segmentectomy and lobectomy were targeted for inclusion. Patients who had missing ambulation data were excluded. Patients were divided into two cohorts based on whether or not they ambulated postoperatively on the day of surgery. Postoperative outcomes were compared using chi-square, Fisher's exact, or Mann-Whitney-U tests. Multivariable logistic regression controlling for pertinent perioperative confounders was performed to identify the independent effect of ambulation on complication rates.

Results: Of 1,056 patients included in the analytic cohort, 443 patients (42.0%) ambulated postoperatively on the day of surgery. Patients who ambulated day of surgery had significantly lower rates of morbidity, including respiratory complications, surgical site infection, bleeding, cardiac complications, cardiac arrhythmias, infectious complications, and opioid use, and had shorter length of stay, shorter chest tube duration, and lower total hospital cost. After risk-adjustment, patients who ambulated day of surgery had lower odds of overall morbidity, less opioid consumption, shorter length of stay, and shorter chest tube duration.

Conclusions: Patients who ambulated postoperatively on the day of surgery had better surgical recovery and outcomes after lung resection than those who did not. Day of surgery ambulation is an excellent quality metric and associated with avoidance of postoperative complications.

Accurate localization of pulmonary nodules is crucial for successful video-assisted thoracoscopic surgery (VATS) resection. Electromagnetic navigation bronchoscopy (ENB) combined with indocyanine green (ICG) fluorescence has emerged as a promising technique for precise pulmonary nodule marking. This study aims to evaluate the efficacy and safety of four ENB-guided ICG marking techniques: direct lesion marking, superficial marking, resection boundary marking, and margin sphere marking. We prospectively enrolled 80 patients with deep lung nodules and evaluated the procedural outcomes, accuracy, complications, and postoperative results of each ENB-guided strategy. The overall success rate of ENB-guided ICG marking was 97.5%, with no significant differences among the four techniques. The superficial marking and resection boundary marking methods achieved 100% fluorescence visibility and superior consistency in marking. The visibility of fluorescence varied among the four marking methods. No severe complications occurred during the ENB procedures, while 1 patient had minor bleeding at the dye injection site. Our study demonstrates that ENB-guided localization using ICG dye and fluorescence thoracoscopy is a safe and effective technique for the preoperative marking of deep lung nodules. Among the four localization strategies investigated, we recommend prioritizing the superficial marking and resection boundary marking methods in clinical practice when feasible, as they provide reliable and precise guidance for the resection of deep lung nodules.

Background: According to a large-scale clinical trial in Japan, segmentectomy for small peripheral non-small cell lung cancer has an advantage over lobectomy in terms of overall survival, while it could also increase the incidence of local recurrence. In ipsilateral reoperations, intrathoracic adhesions from a previous surgery increase the risk of lung injury and bleeding, which may result in intraoperative and postoperative complications. The ability of oxidized regenerated cellulose (ORC) sheets to prevent postoperative adhesions has been demonstrated in the abdomen, and the same effect is expected in the thoracic region. The purpose of this study is to provide evidence supporting the application of ORC sheets to the parietal pleura of an open chest wounds to prevent postoperative adhesions in the thoracic region.

Methods: This phase II prospective open-label, randomized, parallel-group study will validate adhesion prevention by applying ORC sheets to the parietal pleura of open chest wounds at the time of surgical closure. In the control group, the chest is closed by the usual procedure without ORC sheets. The primary endpoint is the presence rate of pleural adhesion findings on chest echography performed 4-20 weeks postoperatively. Data analysis will be performed in 2025-2026.

Discussion: This study will provide evidence to the adhesion prevention effect of ORC sheet in the thoracic region, with the aim of establishing a strategy to prevent postoperative intrapleural adhesions.

Trial registration: This trial has been registered on the Japan Registry of Clinical Trials 1032230271 (https://jrct.niph.go.jp/latest-detail/jRCT1032230271).

Developed by Pierre F. Denoix in the mid-20th century as a clinical classification of anatomic tumour extent, the tumour, node, and metastasis (TNM) classification was adopted by the Union for International Cancer Control (UICC) and the American Joint Committee on Cancer (AJCC). The first lung cancer classification was published as a brochure in 1966 by the UICC, and 2 years later, the UICC published the first edition of the TNM Classification of Malignant Tumours, which was followed 9 years later by the first edition of the AJCC Manual for Staging of Cancer. The 2^nd to 6^th editions of the lung cancer classification were based on a North American database managed by Clifton F. Mountain, who also introduced the pathologic classification for tumours undergoing resection. Most descriptors used today originated in the second edition of the classification. To address the limitation of the North American database being restricted to a single geographic region, Peter Goldstraw proposed the creation of a larger, international database within the International Association for the Study of Lung Cancer (IASLC). The IASLC Staging Project, developed by the members of the IASLC Staging and Prognostic Factors Committee (SPFC) and the statisticians of Cancer Research and Biostatistics (CRAB), has already compiled three databases, which informed the analyses for the 7^th, the 8^th, and the 9^th editions of the lung cancer TNM classification. This classification has stood the test of time and will remain valuable as long as the anatomic extent of lung cancer continues to play a role in therapy and research.

Background: The American College of Surgeons Commission on Cancer (CoC) revised operative quality standards recommending resection of lymph nodes from at least one hilar station and three different mediastinal stations in all curative-intent pulmonary resections. This study evaluated the prognostic value and factors associated with adherence to this new CoC standard in patients with resected clinical stage IA non-small cell lung cancer (NSCLC).

Methods: Retrospective review of 654 patients who underwent pulmonary resection for clinical IA NSCLC. The study population was divided into patients that met and did not meet the CoC standard.

Results: The CoC standard was met in only 254 (38.8%) patients. Factors associated with meeting the CoC standard included left-sided resections, open technique, and type of pulmonary resection. CoC standard was met in 51.6% of lobectomies, 29.9% of segmentectomies, and 17.1% of wedge resections (P<0.001). Nodal upstaging was more frequent in patients meeting the CoC standard (21.3% vs. 12.5% when standard not met; P=0.004). Time to recurrence [adjusted hazard ratio (aHR): 0.86, 95% confidence interval (CI): 0.63-1.17, P=0.33] and overall survival (aHR: 0.78, 95% CI: 0.58-1.05, P=0.10) were not different between CoC standard groups. However, patients not meeting the CoC standard and classified as pN0 exhibited an overall survival that resembled that of patients with pN1 disease.

Conclusions: Left-sided resections, open technique and lobectomy were associated with meeting the CoC standard. However, this standard did not have a significant impact on long-term outcomes. Larger studies with longer follow-up are needed to clarify the role of the CoC standard in patients with resected stage IA NSCLC.

Background: Complex segmentectomy for uniportal video-assisted thoracoscopic surgery (VATS) remains controversial due to procedural complexity and the risk of increased complications, unlike multiportal VATS. Demonstrating the perioperative results and proficiency of individual surgeon is believed to influence future dissemination for uniportal VATS. In this study, we aimed to compare the perioperative outcomes and learning curves of complex versus simple segmentectomy for uniportal VATS.

Methods: This retrospective cohort study included all patients who had an elective uniportal VATS segmentectomy between July 2018 and June 2023. We documented our initial experience with 100 consecutive segmentectomy cases. A single board-certified experienced surgeon performed all procedures. The perioperative outcomes of the complex (n=45) and simple (n=55) segmentectomy groups were compared using propensity score matching and the cumulative sum technique.

Results: Using propensity score matching, 29 patients were chosen from each group. There was no statistically significant difference between the two groups in perioperative outcomes. The initial learning curve for simple segmentectomy was completed after 20 cases, while that for complex segmentectomy was completed after 11 cases.

Conclusions: Uniportal VATS complex segmentectomy was safe and comparable to simple segmentectomy in terms of perioperative outcomes and learning curves in an experienced surgeon. Uniportal VATS complex segmentectomy should be considered a viable surgical option.

The scarcity of viable donor lungs is a formidable obstacle in lung transplantation (LTx) surgery. This issue significantly hinders the availability of this life-saving procedure for patients in need. To alleviate this shortage, researchers have turned to ex vivo lung perfusion (EVLP) technology as a means to evaluate and potentially repair marginal donor lungs, thereby increasing the donor pool and improving access to transplantation. However, it is important to note that the current capabilities of EVLP technology are still somewhat limited, and further research, development, and optimization are necessary to maximize its potential. To advance this field of study, animal experiments play a crucial role in providing a controlled environment for exploring the possibilities and limitations of EVLP. Among the various animal models available, the small animal EVLP platform for rats stands out by virtue of its simplicity, convenience, and cost-effectiveness. This platform offers researchers a unique opportunity to gain valuable insights into the workings of EVLP and its potential applications in LTx. However, conducting these experiments is not without its challenges. The complexity of the procedure requires a deep understanding of the relevant considerations and operational skills. To ensure the success of these experiments, it is essential that researchers have a comprehensive grasp of the intricacies involved. Drawing upon our practical experience over the past 3 years, our Jiangxi team has systematically refined and summarized the specific details of a rat EVLP experiment in this paper. It encompasses a comprehensive overview of the experimental setup, procedural steps, and potential pitfalls that should be kept in mind. We believe that this information will serve as a valuable resource for researchers in the field, providing them with a solid foundation upon which to build their own experiments and further advance the study of EVLP in LTx.