Journal of Chest Surgery最新文献

Restrictive cardiomyopathy (RCM) is associated with a high mortality rate among patients awaiting heart transplantation, largely due to the challenges inherent in mechanical circulatory support device implantation and the limited effectiveness of pharmacologic therapies. The small size of the left ventricular cavity in RCM patients can cause significant complications, such as inflow cannula obstruction, impaired diastolic filling, and an increased risk of suction events. Here, we present 2 cases, each rare individually, both of which posed unique surgical challenges. Our aim was to evaluate the preoperative conditions, clinical characteristics, surgical approaches, and early outcomes in 2 RCM patients: one who received a left ventricular assist device (LVAD) as a bridge to heart transplantation, and the other as a bridge to candidacy. For the first patient, LVAD implantation with mitral valve resection was performed under emergency conditions due to the presence of a left atrial thrombus; subsequent heart transplantation was later achieved. For the second patient, LVAD implantation with mitral valve replacement was conducted as a bridge to candidacy in the setting of high pulmonary vascular resistance.

Despite growing interest, comparative data on the minimally invasive David procedure (MI-DP) versus the traditional complete sternotomy approach (CS-DP) remain scarce, largely due to the inherent complexity of the operation. The present meta-analysis compared the perioperative outcomes of MI-DP and CS-DP. We systematically searched MEDLINE, Scopus, and the Cochrane Library for studies comparing MI-DP and CS-DP. Pooled odds ratios and mean differences (MDs) with 95% confidence intervals (CIs) were calculated using RevMan ver. 8.13.0 (The Cochrane Collaboration). A subgroup analysis of exclusively propensity-matched data was also performed. Seven studies comprising 1,124 patients were included, with 394 (35%) in the MI-DP group. MI-DP was associated with reduced blood loss (MD, -123.1 mL; 95% CI, -150.1 to -96.1 mL; p<0.0001), intensive care unit (ICU) stay (MD, -0.5 days; 95% CI, -0.6 to -0.4 days; p<0.00001), and hospital stay (MD, -2.8 days; 95% CI, -4.9 to -0.7 days; p=0.01), albeit with a longer cross-clamp time (MD, 13.3 minutes; 95% CI, 2.8 to 23.9 minutes; p=0.01). Thirty-day mortality and complications, including neurological deficits and reoperation for bleeding, were similar between groups. The subgroup analysis restricted to propensity-matched data confirmed these benefits and revealed additional reductions in mechanical ventilation time (MD, -6.3 hours; 95% CI, -7.2 to -5.4 hours; p<0.00001) and red blood cell transfusion requirements (MD, -85.6 mL; 95% CI, -114.6 to -56.5 mL; p<0.00001). MI-DP offers reduced ventilation time, blood loss, and ICU and hospital stays without compromising safety. However, our findings should be interpreted cautiously pending validation by future prospective studies (PROSPERO CRD42025631006).

Background: In February 2024, South Korea experienced a major healthcare disruption following the mass resignation of approximately 86% of resident physicians in protest of a government-led medical reform. In response, the government introduced a policy that centralized high-complexity operations in tertiary hospitals and redirected low-complexity procedures to general hospitals and clinics. However, the nationwide impact of this policy on surgical distribution and volume remains unclear.

Methods: A retrospective analysis was performed using nationwide claims data from the Korean National Health Insurance Service, accessed via the Health Insurance Review and Assessment Service (HIRA). General thoracic surgery volumes from February to July 2023 (pre-crisis) were compared to the same period in 2024 (post-crisis) across tertiary hospitals (n=47), general hospitals (n=331), and smaller hospitals/clinics (n=37,888). Surgical complexity was categorized using relative value units (RVUs), which reflect procedural intensity and resource requirements.

Results: Overall thoracic surgery volume declined by 15% during the crisis. Tertiary hospitals reported a 22% reduction in procedures, while general hospitals and clinics recorded increases of 9% and 92%, respectively. High-complexity operations (≥30,000 RVUs) at tertiary hospitals fell by 22%, with only partial compensation by general hospitals. Low-complexity procedures (<30,000 RVUs) also decreased at tertiary hospitals but were not adequately redistributed.

Conclusion: The 2024 healthcare crisis caused significant disruption to surgical capacity in South Korea. Although some redistribution occurred, the government's reallocation strategy did not fully achieve its intended goals. Recovery of pre-crisis surgical capacity, especially for high-complexity procedures, remains incomplete.

Background: Although there is general agreement on performing concomitant ablation of atrial fibrillation (AF) during left-sided heart valve surgery in low-risk patients due to its proven long-term clinical benefits, its role in reoperative cases remains debated because of perceived high risks.

Methods: This study included 338 consecutive patients with AF who underwent redo surgery for left-sided valve disease between 2000 and 2015 at 2 tertiary referral centers. Among them, 143 patients underwent concomitant surgical ablation for AF (ablation group), while 195 did not (no-ablation group). To evaluate comparative long-term clinical outcomes between the 2 groups, inverse probability of treatment weighting was applied.

Results: Early mortality rates were 3.5% (4/143) in the ablation group and 9.2% (18/195) in the no-ablation group (p=0.064). At 5 years, the cumulative incidence of AF recurrence was 12.3%±0.1% in the ablation group and 85.2%±0.1% in the no-ablation group (p<0.001). During follow-up (median, 103 months), the ablation group demonstrated significantly lower risks of death (adjusted hazard ratio [aHR], 0.495; 95% confidence interval [CI], 0.312-0.784; p=0.003) and thromboembolic events (aHR, 0.212; 95% CI, 0.058-0.771; p=0.019) compared with the no-ablation group.

Conclusions: Concomitant AF ablation during redo valve surgery was associated with improved rhythm outcomes, survival, and freedom from thromboembolic events, supporting its consideration as a reasonable option even in this high-risk group.

Traumatic pneumatocele (TP) is a rare, benign pulmonary lesion that primarily affects children and young adults following blunt chest trauma. We present the case of a 16-year-old male judo athlete who developed persistent hemoptysis. Imaging identified a large hydropneumothorax. During video-assisted thoracoscopic surgery, a cystic lesion was discovered in the left lower lobe, and intraoperative bronchofibroscopy revealed a minor bronchopleural fistula. A wedge resection was performed, resulting in an uncomplicated recovery; the patient was discharged on postoperative day 2. This case underscores the rarity of complicated TP necessitating surgical intervention and highlights the importance of considering TP in young patients with blunt chest trauma.

Low-dose computed tomography (LDCT) screening is widely recognized as an effective tool for the early detection of lung cancer. However, its efficacy among individuals without a history of smoking continues to attract interest. Currently, nearly all lung cancer screening guidelines provide recommendations exclusively for individuals who currently smoke or have a history of smoking. Emerging research indicates that LDCT screening may also benefit individuals who have never smoked but are genetically predisposed to lung cancer or have been exposed to certain environmental risk factors. This underscores the need to consider expanding LDCT screening eligibility criteria to include carefully selected never-smokers at high risk, potentially preventing lung cancer-related deaths.

Technological advances have led to significant progress in minimally invasive surgery in the field of general thoracic surgery. Thymectomy, which has traditionally been performed via an open approach through a median sternotomy, is now entering a new era because of the advantages offered by robot-assisted thoracic surgery. Robotic thymectomy using the single-port robotic system via the subxiphoid approach has recently been introduced. This innovative technique offers several potential benefits, including reduced postoperative pain, faster recovery, and improved cosmetic outcomes. However, it can be technically challenging during the early phase, especially for less experienced robotic surgeons. In this study, we present our surgical technique in detail, providing tips and highlighting potential pitfalls to aid in overcoming these technical challenges.

Elastofibroma dorsi (ED) is a rare, benign, slowly growing soft tissue neoplasm characterized by abnormal elastic fiber proliferation. There is a marked female predominance; bilateral presentation occurs in only 10% of cases. ED is usually located in the infra-scapular area, adherent to the posterior chest wall and ribs. Although many theories have been proposed regarding its pathogenesis, the exact cause remains uncertain. Preoperative diagnosis is established based on clinical picture and radiological imaging. We present a case of a 49-year-old man with bilateral ED who complained of back pain and limited shoulder movement, and who underwent simultaneous bilateral surgical removal; histopathological examination confirmed the diagnosis.

Surgical approaches for thoracic esophageal cancer have evolved from invasive open procedures to minimally invasive techniques such as thoracoscopic and robot-assisted surgery. While robotic surgery offers improved precision and visualization, it still relies on single-lung ventilation and may not significantly reduce postoperative complications. Recently, transcervical esophagectomy (TCE) using a mediastinoscope has emerged as a promising alternative, enabling esophageal resection and lymphadenectomy via the neck without thoracic incisions. However, challenges such as recurrent laryngeal nerve palsy and limited reproducibility persist. Robot-assisted TCE addresses these issues by improving precision and reducing interference in the narrow mediastinum. Early studies, including the authors' pilot work, have shown encouraging results. Despite its potential, comprehensive data on the short-term outcomes and safety of this technique remain limited. This study aims to introduce robot-assisted TCE for patients with thoracic esophageal carcinoma and compare its clinical benefits with those of transthoracic robot-assisted esophagectomy, thereby clarifying its role in the evolving field of esophageal cancer surgery.