Journal of Chest Surgery最新文献

Background: The CheckMate 577 trial demonstrated that adjuvant nivolumab improves disease-free survival in patients with resected esophageal cancer following neoadjuvant chemoradiotherapy. This study aimed to evaluate real-world outcomes associated with adjuvant immunotherapy.

Methods: Patients with esophageal cancer and residual pathological disease who underwent neoadjuvant therapy followed by surgical resection between January 2019 and February 2024 were retrospectively analyzed. Participants were grouped by adjuvant treatment received: no adjuvant therapy, adjuvant immunotherapy (AI), or adjuvant chemotherapy (AC). Primary outcomes included overall survival (OS) and recurrence-free survival (RFS). Subgroup analyses were performed for patients meeting CheckMate 577 eligibility criteria and those with pathological node-positive (ypN+) status.

Results: The study included 127 patients (mean age: 60 years; male: 86%): 23 received AI, 36 AC, and 68 received no adjuvant therapy. There were no significant differences in OS between AI and AC groups (median OS [mOS]: 34 months vs. 34 months; p=0.81), nor in RFS (median RFS [mRFS]: 15 months vs. 16 months; p=0.94). In the CheckMate 577-eligible subgroup (n=68), OS and RFS were similar between AI and AC groups (mOS: 25 months vs. 47 months; p=0.16; mRFS: 19 months vs. 20 months; p=0.74). Likewise, among ypN+ patients (n=54), no significant differences in OS or RFS were noted between AI and AC (mOS: 34 months vs. 31 months; p=0.74; mRFS: 9.5 months vs. 14 months; p=0.89).

Conclusion: AI did not demonstrate a significant survival advantage compared to AC, even in patients meeting CheckMate 577 criteria or those with ypN+ status. Identifying the optimal adjuvant treatment for esophageal cancer remains a challenging and evolving issue.

Date: May 29-30, 2025.

Location: Seoul Dragon City Hotel, Seoul, Korea.

We describe the treatment of a 54-year-old man with a history of methicillin-resistant Staphylococcus aureus pericarditis who presented with left ventricular pseudoaneurysm following prior left anterior thoracotomy pericardial window. Surgical intervention included pseudoaneurysm repair using a wide patch. Additionally, an attempted mitral valve repair was converted to replacement due to intraoperative findings of significant calcification of the mitral anterior leaflet and annulus, along with suspected rheumatic changes. Our report highlights the management of concurrent cardiac pseudoaneurysm and mitral annular calcification, emphasizing the role of comprehensive imaging both perioperatively and intraoperatively in achieving durable outcomes.

A patient in her early 20s presented with a cough and elevated inflammatory markers. A chest radiograph revealed an abnormal opacity in the right lower zone. Subsequent computed tomography showed an abscess in the right lower lobe that was fed by an anomalous vessel arising from the aorta. These findings were consistent with intralobar sequestration complicated by abscess formation. The patient was treated with antibiotics and discharged home, with plans for elective embolization and lobectomy under the care of the cardiothoracic surgeons. A literature review revealed a limited body of work on pulmonary sequestrations, with very few reported cases involving similar presentations. Thus, our case represents a rare and important addition to the literature.

Background: Pectus excavatum (PE), the most common congenital chest wall deformity, is increasingly treated with minimally invasive repair (MIRPE). However, postoperative complications such as bar displacement remain a significant challenge, occurring in approximately 9.5% of cases. While surgical modifications and stabilization techniques aim to reduce risks, bar displacement persists as a critical concern.

Methods: This PROSPERO-registered systematic review followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A search of PubMed, Scopus, and CINAHL through October 2024 identified studies evaluating bar displacement in PE patients undergoing MIRPE or alternative surgical approaches. The inclusion criteria focused on risk factors, stabilization techniques, and reoperation strategies. Data extraction and risk-of-bias assessments were independently conducted by multiple reviewers to ensure accuracy and quality.

Results: Thirteen studies spanning 23 years were included. Bar displacement rates varied widely (0.9%-33.3%), with key risk factors including patient age, chest wall rigidity, bar length, and placement technique. Advanced stabilization methods-such as bridge fixation, shorter bars, multipoint fixation, and adjunct stabilizers-significantly reduced displacement rates. Common postoperative complications included wound infections, seromas, pleural effusions, and bar re-dislocation. Imaging modalities like chest X-rays and 3-dimensional computed tomography scans proved critical for early detection. Heterogeneity in stabilization approaches underscores a shift toward patient-specific strategies to optimize outcomes.

Conclusion: Tailored stabilization techniques are essential for successful PE correction. Although advancements in fixation methods have reduced displacement risks, standardized postoperative protocols and multicenter studies are needed to validate these innovations and improve long-term outcomes (PROSPERO: CRD42024595337).

Lung cancer surgery has advanced significantly over the decades, profoundly impacting patient outcomes and surgical practices. This review examines the major historical milestones in lung cancer surgery-from early pneumonectomies to the establishment of lobectomy as the standard treatment for resectable non-small cell lung cancer (NSCLC) and the subsequent evolution toward sublobar resections (including segmentectomy and wedge resection) for early-stage NSCLC. Growing evidence for the efficacy of sublobar resections has redefined the surgical approach for early-stage lung cancer by shifting the focus from lobectomy to less invasive procedures. However, despite the demonstrated non-inferiority of sublobar resections, concerns about locoregional recurrence continue to pose a major challenge. Addressing this issue is essential for optimizing surgical outcomes in early-stage NSCLC. One promising innovation to mitigate recurrence is the novel asymmetrical linear stapler (NALS), which represents a significant advancement in stapling technology for minimally invasive lung cancer surgery. This review traces the evolution of lung cancer surgery from the 1960s to 2024, focusing on key milestones and the role of NALS in addressing current challenges.

Background: The predictive value of creatine kinase-myocardial band (CK-MB) and high-sensitivity troponin T (hs-TnT) for adverse outcomes in coronary artery bypass grafting (CABG) has been well established in previous studies. However, most of these investigations have focused on perioperative complications. The present study assessed the preoperative and postoperative prognostic value of hs-TnT and CK-MB in individuals undergoing on-pump CABG.

Methods: This cohort study included patients who underwent isolated on-pump CABG at a tertiary hospital, Tehran Heart Center, between November 2018 and March 2021. We evaluated the associations of preoperative and postoperative hs-TnT and CK-MB levels with the incidence of major adverse cardiovascular events (MACE) within 1 year after surgery.

Results: Of the 3,188 participants, 231 (7.2%) experienced MACE. Factors associated with a higher incidence of MACE included older age, diabetes mellitus, history of peripheral vascular disease, lower left ventricular ejection fraction, and the occurrence of acute kidney injury after surgery. The adjusted hazard ratios (HRs) for the association between hs-TnT levels and 1-year MACE were 1.17 (95% confidence interval [CI], 1.07-1.29; p<0.001) for preoperative levels, 1.22 (95% CI, 1.02-1.47; p=0.044) at 8 hours post-surgery, and 1.38 (95% CI, 1.17-1.62; p<0.001) at 24 hours post-surgery. CK-MB levels at 8 hours (HR, 1.05; 95% CI, 1.01-1.10; p=0.023) and 24 hours (HR, 1.07; 95% CI, 1.04-1.10; p<0.001) after surgery were also associated with adverse events.

Conclusion: Preoperative and postoperative serum levels of hs-TnT and CK-MB may be considered significant predictors of MACE within 1 year after on-pump CABG.

Background: Currently, clinical T staging in non-small cell lung cancer (NSCLC) is based on the largest radiological diameter observed on computed tomography (CT). Under this system, tumors with varying shapes-such as spherical, amorphous, or spiculated tumors- can be assigned the same T stage even with different volumes. We aimed to propose a 3-dimensional (3D) volumetric staging system for NSCLC as an alternative to diameter- based T staging and to conduct comparative survival analyses between these methods.

Methods: We retrospectively analyzed data from patients who underwent surgery for pT1-4N0M0 primary NSCLC between January 2018 and May 2022. Digital Imaging and Communications in Medicine data from patient CT scans were uploaded to 3D Slicer software for volumetric tumor measurement. Using the paired samples t-test or the Wilcoxon test, we compared the expected tumor volumes, calculated by tumor diameter, with the actual volumes measured by 3D Slicer. Receiver operating characteristic analysis was employed to determine the cut-off value for tumor volume. Kaplan-Meier analysis was utilized to assess overall survival, while the log-rank method was applied to compare survival differences between groups. The significance of changes in T stage was evaluated using the marginal homogeneity test.

Results: The study included 136 patients. Significant differences were observed between expected and actual tumor volumes (p=0.01), and associated changes in T stage were also significant (p=0.04). The survival analysis performed using tumor volume (p=0.009) yielded superior results compared to that based on diameter (p=0.04) in paients with early tumor stage.

Conclusion: T-factor staging based on tumor volume could represent an alternative staging method for NSCLC.