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Successful perioperative management of congenital cystic adenomatoid malformation of the lung by high frequency oscillatory ventilation--report of two cases.

BACKGROUND: Comparable to congenital diaphragmatic hernia, patients with congenital cystic adenomatoid malformation of the lung (CCAM) may develop life-threatening mediastinal shift and persistent pulmonary hypertension. In patients with diaphragmatic hernia, high frequency oscillatory ventilation (HFOV) has been shown to allow perioperative stabilisation. PATIENTS: One term and one premature newborn of 30 gestational weeks with CCAM. Both patients developed massive mediastinal shift and intermittend pulmonary hypertension. METHOD: Retrospective chart review. RESULTS: In both patients perio

The role of surgery in the multimodality management of non-small cell lung cancer.

The majority of patients with lung cancer have disseminated disease at the time of presentation. For the minority of patients with disease localized to the chest, the concept of staging becomes particularly important because it has a major impact on the treatment plan. Guided by findings on the computed tomographic scan, mediastinoscopy remains the definitive invasive staging procedure to document unequivocally the involvement of the mediastinal lymph nodes. Equally as important is the documentation of absence of disease in contralateral lymph nodes. Patients with locally advanced non-small ce

Advances in the use of ECMO in oncology patient.

BackgroundOver the past decade, ECMO has provided temporary cardiopulmonary support to an increasing number of patients, but the use of extracorporeal membrane oxygenation (ECMO) to provide temporary respiratory and circulatory support to adult patients with malignancy remains controversial.ObjectivesThis paper reviews the specific use of extracorporeal membrane oxygenation (ECMO) in oncology patients.MethodsWe searched PubMed, CINAHL, Cochrane Library, and Embase databases for studies on the use of ECMO in cancer patients between 1998 and 2022. Twenty-four retrospective, prospective, and case

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… ECMO can also be used to support conventional lung ventilation, according to the authors. 63 Six patients underwent pneumonectomy using both high‐ and low‐flow modes. … Preliminary results of extracorporeal membrane oxygenation assisted tracheal sleeve pneumonectomy for cancer. Thorac Cardiovasc Surg. 2021;69(3):240‐245. 31. Schiff JH, Köninger J, Teschner J, et al. …

To Study the Correlation Between the Anatomical Variation of Bronchial Vessels Identified by Preoperative Three-Dimensional CT Reconstruction and the Clinical Outcome After Complex Segmentectomy.

AIM: All enrolled patients with non-small cell lung cancer (NSCLC) undergoing complex pulmonary segmentectomy received standardized preoperative three-dimensional (3D) computed tomography (CT) reconstruction. This study aimed to classify bronchovascular anatomical variations identified on preoperative 3D CT reconstruction and to examine their associations with postoperative complications (POCs), exploratory technical surrogate measures, and short-term postoperative rehabilitation. METHODS: From May 2022 to June 2025, a total of 170 patients with primary NSCLC who underwent thoracoscopic compl

Skip N2 Metastasis in Resected Lung Cancer: Prognostic Subclassification by Lymphatic Drainage and Histology.

PURPOSE: Skip N2 metastasis in non-small-cell lung cancer (NSCLC) confers a favorable prognosis, yet the biological determinants remain poorly defined. We investigated lymphatic drainage patterns and histological characteristics to develop a novel pN2 subclassification. METHODS: We retrospectively analyzed 180 consecutive pN2 patients (2015-2022); 50 exhibited skip metastasis. Lymphatic drainage was classified as direct, indirect, or mixed, and a composite score incorporating drainage, histology, grade, and lymphovascular invasion stratified patients into 3 risk groups. Survival was assessed

Lymphovascular Invasion is a Predictor of Postoperative Recurrence or Death in Stage I Non-small-cell Lung Cancer (NSCLC).

BACKGROUND: Histopathological features can be valuable prognostic tools in risk stratification of early-stage nonsmall cell lung cancers (NSCLC). This study evaluates the correlation between lymphovascular invasion (LVI), visceral pleural invasion (VPI), micropapillary pattern, and spread through airspaces (STAS) with outcomes in stage I NSCLC. METHODS: Retrospective chart review was conducted on patients who underwent lung resection at a single academic center between 2015 and 2019 with pathology confirming NSCLC. Patients treated with neoadjuvant chemotherapy or with stage II or above cance

Predicting the Risk of Postoperative Delirium in Patients Undergoing Lobectomy: Development and Assessment of a Novel Nomogram.

To construct and internally validate a nomogram predicting postoperative delirium (POD) in patients with pulmonary malignancies undergoing lobectomy.Clinical electronic medical record data were retrospectively collected from 1,066 patients who underwent lobectomy, divided into a training cohort (746) and a validation cohort (320) using a 7:3 temporal split. A nomogram for POD was developed using Lasso regression and multivariable logistic regression analysis according to the TRIPOD statement. Performance was assessed through receiver operating characteristic curves (ROC) and calibration plots.

Correlation Between the Number of Pathological Risk Factors and Postoperative Prognosis in Patients with Stage I Lung Adenocarcinoma.

BACKGROUND: Although visceral pleural invasion, lymphovascular invasion, tumor spread through air spaces, and poor differentiation are pathological risk factors associated with unfavorable prognosis in patients with lung adenocarcinoma, the cumulative impact of these factors on prognosis remains unclear. METHODS: We enrolled 1532 patients with stage I lung adenocarcinoma. Patients were divided according to the number of risk factors as follows: Group A (without risk factors), Group B (one risk factor), and Group C (multiple risk factors). Moreover, we stratified patients into two subgroups ba

Effect of Resected Lung Volume on Pulmonary Function and Residual Lung Volume in Patients Undergoing Segmentectomy: A Retrospective Study.

PURPOSE: We elucidated the effects of planned resection volume on postoperative pulmonary function and changes in residual lung volume during segmentectomy. METHODS: This study included patients who underwent thoracoscopic segmentectomy between January 2017 and December 2022 and met eligibility criteria. Pre- and post-resection spirometry and computed tomography were performed. Three-dimensional reconstructions were performed by using computed tomography images to calculate the volumes of the resected, remaining, and nonoperative side regions. Based on the resected region volume, patients wer

Clinical impact of preoperative sarcopenia and immunonutritional impairment on postoperative outcomes in non-small cell lung cancer surgery.

OBJECTIVES: This study aimed to clarify the relationship between preoperative sarcopenia and prognostic nutritional index (PNI) statuses and clinicopathological factors in patients with non-small cell lung cancer (NSCLC) who underwent surgical resection, and to evaluate short- and long-term outcomes by stratifying groups according to sarcopenia and PNI status as prognostic predictors. MATERIALS AND METHODS: This study included 300 patients with p-Stage I-IIIA NSCLC who underwent complete resection with lobectomy. Sarcopenia was assessed using the skeletal muscle index (SMI) and the immunonutr

Lymph node dissection in small peripheral lung cancer: Supplemental analysis of JCOG0802/WJOG4607L.

OBJECTIVE: The optimal region of lymph node dissection (LND) during segmentectomy in patients with small peripheral non-small cell lung cancer requires clarification. Through a supplemental analysis of the Japan Clinical Oncology Group (JCOG) 0802/West Japan Oncology Group (WJOG) 4607L, we investigated the associated factors, distribution, and recurrence pattern of lymph node metastases (LNMs) and proposed the optimal LND region. METHODS: Of the 1106 patients included in the JCOG0802/WJOG4607L, 1056 patients with LNDs were included in this supplemental analysis. We investigated the distributi

Endobronchial Ultrasound Staging of Operable Non-small Cell Lung Cancer: Do Triple-Normal Lymph Nodes Require Routine Biopsy?

BACKGROUND: Staging guidelines for lung cancer recommend endobronchial ultrasound (EBUS) and systematic biopsy of at least three mediastinal lymph node (LN) stations for accurate staging. A four-point ultrasonographic score (Canada Lymph Node Score [CLNS]) was developed to determine the probability of malignancy in each LN. A LN with a CLNS of < 2 is considered low probability for malignancy. We hypothesized that, in patients with cN0 non-small cell lung cancer, LNs with CLNS of < 2 may not require routine biopsy because they represent true node-negative disease. RESEARCH QUESTION: Do LNs con

Endobronchial Valve Treatment in Emphysema Patients with a Very Low DLCO.

BACKGROUND: For selected patients with severe emphysema, bronchoscopic lung volume reduction with endobronchial valves (EBV) is recognized as an additional treatment option. In most trials investigating EBV treatment, patients with a very low diffusing capacity (DLCO) were excluded from participation. OBJECTIVES: Our goal was to investigate whether EBV treatment in patients with emphysema with a very low DLCO is safe and effective. METHODS: This was a single-center retrospective analysis including patients with emphysema and a DLCO ≤20%pred who underwent EBV treatment. Follow-up was performe

Single-direction thoracoscopic basal segmentectomy.

OBJECTIVE: Thoracoscopic anatomic single or combined basal segmentectomy is technically challenging because of the variation and deep location of vessels and bronchi in the parenchyma. This study aimed to describe thoracoscopic segmentectomy of basal segments using a single-direction method. METHODS: This retrospective study included 137 patients who underwent single or combined thoracoscopic basal segmentectomy between April 2015 and August 2019. All procedures were performed via the preferred inferior pulmonary ligament approach or an interlobar fissure approach following a single-direction

Postoperative intensity-modulated radiation therapy reduces local recurrence and improves overall survival in III-N2 non-small-cell lung cancer: A single-center, retrospective study.

PURPOSE: To determine the postoperative effects of radiotherapy (PORT) on the local recurrence-free survival (LRFS) and overall survival (OS) of stage III-N2 non-small-cell lung cancer (NSCLC). MATERIALS AND METHODS: 183 patients with resected stage III-pN2 NSCLC from Hunan Cancer Hospital between 2013 and 2016 were divided into two groups for postoperative chemotherapy (POCT) (n = 105) or combination chemotherapy and radiotherapy (POCRT) (n = 78). The LRFS and OS were compared and the factors affecting local recurrence were illustrated in these two groups. The sites of failure based on the l

Resection Process Map: A novel dynamic simulation system for pulmonary resection.

OBJECTIVE: Use of 3-dimensional computed tomography for preoperative and intraoperative simulation has been introduced in the field of thoracic surgery. However, 3-dimensional computed tomography provides only static simulation, which is a significant limitation of surgical simulation. Dynamic simulation, reflecting the intraoperative deformation of the lung, has not been developed. The aim of this study was to develop a novel simulation system that generates dynamic images based on patient-specific computed tomography data. METHODS: We developed an original software, the Resection Process Ma

[Severe COPD can benefit from endobronchial valves].

Lung volume reduction using endobronchial one-way valves (EBV) have been introduced as a new treatment for end-stage COPD and emphysema. They cause the lung parenchyma distal to the valve to collapse by causing an atelectasis. Nine randomized controlled trials (RCTs) studying the effects of insertion of EBVs in patients with severe emphysema were identified. In two of the RCTs both lungs were treated whereas in seven a unilateral approach was used. In comparison with optimal medical therapy, unilateral placement of EBVs resulted in clinically and statistically significant improvements in lung