General Thoracic and Cardiovascular Surgery最新文献

{"title":"Clinical predictors of pathological response after immunotherapy in salvage surgery for non-small cell lung cancer: a supplementary analysis of the CReGYT-05 immune checkpoint inhibitor-salvage study.","authors":"Satoshi Takamori, Shinya Tane, Megumi Nishikubo, Takuya Watanabe, Kotaro Nomura, Akira Hamada, Shinkichi Takamori, Shinya Katsumata, Satoshi Shiono","doi":"10.1007/s11748-026-02319-2","DOIUrl":"10.1007/s11748-026-02319-2","url":null,"abstract":"<p><strong>Objectives: </strong>Radiological responses based on tumor size reduction are often unreliable after immune checkpoint inhibitor (ICI) therapy for non-small cell lung cancer (NSCLC), particularly in salvage surgery. The aim of this study was to evaluate the association between MPR and prognosis, and to determine whether changes in metabolic response on positron emission tomography/computed tomography (PET/CT) and tumor marker levels can identify patients who achieve a major pathological response (MPR) despite residual disease.</p><p><strong>Methods: </strong>This multicenter retrospective study (CReGYT-05 ICI-Salvage study) included patients with NSCLC who underwent salvage lung resection after ICI therapy at 14 institutions in Japan. Metabolic response was evaluated by changes in maximum standardized uptake value (SUVmax). Pathological response was classified as MPR (≦10% viable tumor cells). Associations among metabolic response, tumor markers, pathological response, and survival were analyzed.</p><p><strong>Results: </strong>Among 31 evaluable patients, 11 (35%) achieved MPR. Patients with MPR had improved 5-year overall survival compared with those without MPR (100% vs. 40.3%; p = 0.017). In univariate analysis, serum CEA decreased (odds ratio [OR], 16.000; 95% confidence interval [CI], 2.105-343.167; p = 0.005), SUVmax decreased ≧60% (OR, 25.000; 95% CI, 2.441-661.493; p = 0.005), and cStage IV (OR, 0.125; 95% CI, 0.020-0.608; p = 0.009) were suggested to be associated with MPR.</p><p><strong>Conclusions: </strong>Radiologic response alone is insufficient to identify major pathological responders after ICI therapy. PET/CT metabolic response combined with tumor marker changes provides clinically meaningful information for selecting candidates for salvage surgery.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":"1013-1021"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148005258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on, \"Women in Japanese cardiovascular surgery: 21 years trends (2004-2025), current status and future perspectives\".","authors":"Hussnain Bilal, Waseem Sajjad Shah","doi":"10.1007/s11748-026-02322-7","DOIUrl":"10.1007/s11748-026-02322-7","url":null,"abstract":"","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":"1034-1035"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148014899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Women in Japanese cardiovascular surgery: 21-year trends (2004-2025), current status and future perspectives.","authors":"Zaina Mudassar, Muhammad Khaldoon Mirza","doi":"10.1007/s11748-026-02320-9","DOIUrl":"10.1007/s11748-026-02320-9","url":null,"abstract":"","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":"1036-1037"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148029190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic utility of serum albumin in underweight patients who underwent isolated surgical aortic valve replacement.","authors":"Takahiro Ohmori, Koichi Maeda, Kyongsun Pak, Akinobu Ohtani, Yusuke Yanagino, Kazuma Handa, Takura Taguchi, Koichi Inoue, Ai Kawamura, Shigeru Miyagawa","doi":"10.1007/s11748-026-02299-3","DOIUrl":"10.1007/s11748-026-02299-3","url":null,"abstract":"<p><strong>Objective: </strong>The clinical impact of underweight on outcomes in patients undergoing surgical aortic valve replacement (SAVR) remains unclear. This study aimed to investigate the prognostic significance of underweight status in patients undergoing SAVR and to identify key determinants of adverse outcomes within this population.</p><p><strong>Methods: </strong>805 patients underwent SAVR between January 2016 and December 2021 at eight Japanese centers. After excluding 31 patients with missing laboratory data, a total of 774 patients were included. Patients were categorized into underweight group (Body mass index [BMI] < 18.5 kg/m², 79 patients), normal-weight group (BMI 18.5-25 kg/m², 464 patients), and overweight group (BMI　≥25 kg/m², 231 patients). The primary endpoint was all-cause mortality.</p><p><strong>Results: </strong>The median age was 76 years (interquartile range [IQR]: 71-79), and the median BMI was 23.3 kg/m² (IQR: 20.9-25.8). Underweight patients had the highest 5-year mortality, followed by normal-weight and overweight patients (23.5%, 11.9%, and 7.4%; p = 0.001). In multivariable analysis, BMI was an independent predictor of mortality (1.0 kg/m² increase, adjusted hazard ratio: 0.92; 95% confidence interval: 0.86 to 0.99; p = 0.020). Among underweight patients, serum albumin was independently associated with all-cause mortality (p = 0.002). Underweight patients were stratified by median albumin into low (< 4.0 g/dL, n = 43) and normal (≥ 4.0 g/dL, n = 36) groups, and 5-year mortality was higher in the low albumin group (34.1% vs. 12.6%, p = 0.015).</p><p><strong>Conclusions: </strong>Low BMI was associated with higher mortality after SAVR, and serum albumin provided additional risk stratification within underweight group.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":"939-949"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633306/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147768533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Women in Japanese cardiovascular surgery: 21-year trends (2004-2025), current status and future perspectives.","authors":"Osamu Ishida, Shotaro Yoshida, Koji Tsutsumi","doi":"10.1007/s11748-026-02306-7","DOIUrl":"10.1007/s11748-026-02306-7","url":null,"abstract":"<p><strong>Background: </strong>Despite the increasing number of female medical graduates in Japan, women remain underrepresented in cardiovascular surgery.</p><p><strong>Methods: </strong>Using complete registry data from the Japanese Board of Cardiovascular Surgery (2004-2025), we examined annual proportions of female board-certified cardiovascular surgeons and newly certified surgeons. Linear regression was performed to assess trends and extrapolate future proportions. International benchmarking utilized published data from the United States, Europe, and global surveys.</p><p><strong>Results: </strong>The proportion of female board-certified cardiovascular surgeons increased from 0.7% in 2004 to 4.8% in 2025 (annual increase 0.202 percentage points; 95% CI 0.18-0.23; R² = 0.973; P < 0.001). Among newly certified surgeons, the proportion was more variable, reaching 9.0% in 2025. Linear extrapolation projected the overall proportion to reach 5.6% in 2030 (95% prediction interval 5.0-6.1%) and 7.6% in 2040 (95% prediction interval 7.0-8.2%). The current Japanese proportion of 4.8% is approximately half the global average of 8.0% (from the 2024 EACTS global workforce analysis based on CTSNet data across 146 countries) and 42-47% of the United States (11.5%) and Europe (10.3%) in the same report.</p><p><strong>Conclusions: </strong>Over two decades, female representation in Japanese cardiovascular surgery has risen steadily to 4.8%, driven by increasing female new certifications. Japan's current level corresponds to Western proportions from the mid-2000s, reflecting a persistent international disparity. The recent physician work-style reform and ongoing efforts to improve retention may influence future trends, but longitudinal data are needed to evaluate their impact.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":"963-969"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147768475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on: \"Complex lung segmentectomy: comparative perioperative outcomes of robotic and video-assisted approaches\".","authors":"Kashf Younas","doi":"10.1007/s11748-026-02321-8","DOIUrl":"10.1007/s11748-026-02321-8","url":null,"abstract":"<p><p>This commentary evaluates a propensity-matched study by Nakamura et al. comparing robotic-assisted (RATS) versus video-assisted complex segmentectomy. The original study demonstrated that despite longer operative times, RATS achieved comparable perioperative outcomes with significantly fewer postoperative arrhythmias. While methodologically robust, limitations include the retrospective design, the absence of long-term oncologic data, and a lack of cost-effectiveness analysis. Furthermore, the potential influence of surgeon proficiency on outcomes was not assessed. Future multicenter prospective registries with comprehensive outcome measures are needed to validate these findings.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":"1038-1039"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148257969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neoadjuvant immunotherapy and the stepwise risk of postoperative atrial fibrillation: a propensity score-matched analysis isolating surgical and biological triggers.","authors":"Ersin Kaya, Tarık Şimşek, İnan Mutlu","doi":"10.1007/s11748-026-02313-8","DOIUrl":"10.1007/s11748-026-02313-8","url":null,"abstract":"<p><strong>Background: </strong>Neoadjuvant immunotherapy has transformed the management of resectable non-squamous cell lung cancer (NSCLC). However, the specific arrhythmogenic potential of immune checkpoint inhibitors (ICIs) in the postoperative setting remains poorly characterized. This study aimed to isolate the independent impact of neoadjuvant immunotherapy on postoperative atrial fibrillation (POAF) and quantify its clinical consequences.</p><p><strong>Methods: </strong>We analyzed 1,610 patients undergoing anatomic lung resection for Stage II-III NSCLC between 2020 and 2025. To decouple the ICI effect from chemotherapy and eliminate selection bias, a 1:1:1 propensity score-matched (PSM) analysis based on baseline clinical and demographic characteristics was performed to create three balanced cohorts (n = 400 each, Total N = 1,200): (1) upfront surgery (Control), (2) isolated neoadjuvant chemotherapy (nCT), and (3) neoadjuvant chemo-immunotherapy (nCIT).</p><p><strong>Results: </strong>Following PSM, all baseline cardiac risk factors achieved statistical parity (p > 0.05). A significant stepwise escalation in POAF incidence was observed: 11.5% in the Control group, 15.1% in the nCT group, and 23.5% in the nCIT group (p < 0.001). Multivariable analysis isolated the specific immunotherapy effect, revealing that the addition of ICIs independently increased POAF odds by 2.28-fold (95% CI: 1.45-3.65, p < 0.001) compared to chemotherapy alone. Clinically, POAF development in the immunotherapy cohort resulted in a significant extension of the median hospital stay (10.4 vs. 5.6 days, p < 0.001) and ICU stay (3.2 vs. 1.4 days, p < 0.001). This specific ICI effect appeared to correlate with an enhanced systemic inflammatory response and increased surgical complexity observed during hilar dissection.</p><p><strong>Conclusion: </strong>Modern neoadjuvant protocols suggest that the immunotherapy component contributes to a higher likelihood of POAF. Consequently, integrating careful perioperative cardiac monitoring and tailored management approaches for these patients could be beneficial in improving clinical outcomes and optimizing the use of hospital resources.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":"1004-1012"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148101336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mitral annular disjunction and high-risk profiles: a conceptual approach to risk stratification and surgical implications.","authors":"Koji Furukawa, Hirohito Ishii, Shuhei Sakaguchi, Kousuke Mori, Ayaka Iwasaki, Risa Meiri","doi":"10.1007/s11748-026-02336-1","DOIUrl":"10.1007/s11748-026-02336-1","url":null,"abstract":"<p><strong>Objective: </strong>Mitral annular disjunction (MAD), frequently associated with Barlow's disease, links degenerative mitral regurgitation to postoperative ventricular arrhythmias and sudden cardiac death, even after technically successful valve repair. However, despite advances in mitral repair, the arrhythmic substrate associated with MAD remains insufficiently addressed in current surgical paradigms.</p><p><strong>Methods: </strong>A systematic search of PubMed and Google Scholar (2000-2025) was conducted using keywords including \"mitral annular disjunction,\" \"mitral regurgitation,\" \"arrhythmic mitral valve prolapse,\" and \"mitral valve surgery.\" Of 264 records screened, 41 peer‑reviewed articles, prioritizing high‑impact registries and surgical cohorts, were selected for synthesis.</p><p><strong>Results: </strong>MAD is associated with paradoxical annular curling and traction‑related myocardial remodeling, which may contribute to fibrosis through pathological stretch. Observational studies suggest that higher‑risk features-such as extensive MAD (≥ 5 mm, particularly ≥ 8.5 mm), late gadolinium enhancement, or syncope-are linked to increased arrhythmic vulnerability. Although modern repair techniques can eliminate anatomical MAD, pre‑existing substrate abnormalities may persist, and ventricular arrhythmias can still occur after technically successful repair.</p><p><strong>Conclusions: </strong>The extent of disjunction and the presence of associated substrate abnormalities appear to influence long‑term rhythm stability. A conceptual, hypothesis‑generating framework that integrates structural, electrical, imaging, and clinical information may help inform risk stratification. Prospective studies are needed to determine whether a risk‑stratified approach or optimized intervention timing can modify arrhythmic risk or potentially affect long‑term outcomes.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":"931-938"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148294246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A modified Cerfolio technique for robotic pulmonary resection: a retrospective comparison with the conventional approach.","authors":"Shintaro Tarumi, Yuka Takakuwa, Ryota Nagashima, Masahiro Abe","doi":"10.1007/s11748-026-02300-z","DOIUrl":"10.1007/s11748-026-02300-z","url":null,"abstract":"<p><strong>Objective(s): </strong>The Cerfolio-based technique is widely used for robotic pulmonary resection; however, multiple intercostal ports, particularly a posterior dorsal port, may increase invasiveness. We developed a modified Cerfolio technique (ModC) that integrates the retraction arm into the utility incision to reduce posterior intercostal ports while preserving independent four-arm manipulation.</p><p><strong>Methods: </strong>We retrospectively reviewed 72 consecutive robotic pulmonary resections at a single institution (April 2024-November 2025): conventional Cerfolio-based approach (C group, n = 41) or ModC (n = 31; introduced April 2025). Both approaches used four robotic arms, a 30° down scope, and no CO₂ insufflation. Console time, operative time, estimated blood loss, and perioperative complications were compared.</p><p><strong>Results: </strong>The distribution of lobectomy and segmentectomy was similar between groups (p = 0.635). Median console time was 134 min in the C group and 121 min in the ModC group (p = 0.096). Median operative time was 175 versus 156 min (p = 0.051), and median blood loss was 5 versus 3 mL (p = 0.172). Major complications (Clavien-Dindo grade ≥ III) occurred in 3 patients (7.3%) in the C group and 1 (3.2%) in the ModC group (p = 0.629). No reoperation, readmission within 30 days, or 30-day mortality occurred.</p><p><strong>Conclusions: </strong>ModC, a minimal modification of a Cerfolio-based workflow, can be introduced smoothly without compromising short-term outcomes.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":"977-981"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147672262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance of large language models on the Japanese cardiovascular surgery board examination: a comparative analysis of eight contemporary AI models with educational implications.","authors":"Kentaro Kasa, Daisuke Yoshimaru, Hiroki Ohta, Takao Ohki, Hirotaka James Okano","doi":"10.1007/s11748-026-02304-9","DOIUrl":"10.1007/s11748-026-02304-9","url":null,"abstract":"<p><strong>Objective: </strong>Large language models (LLMs) have shown strong performance on medical licensing and specialty examinations, but their utility in cardiovascular surgery certification and education remains unknown.</p><p><strong>Methods: </strong>We evaluated eight LLMs (GPT-5, GPT-4o [OpenAI], Gemini-2.5Pro, Gemini-2.0, Gemma-3 [12B] [Google DeepMind], Claude-4, Claude-3 [Anthropic], and Llama-4 [Scout] [Meta AI]) using their official application programming interfaces as of September 2025. Examination items were obtained from the Japanese Cardiovascular Surgery Board (2021-2024; 523 questions). Texts were extracted from PDFs, images converted to JPEGs, and each question presented with a standardized Japanese prompt. Models produced three responses per item; final answers were determined by majority voting. Accuracy with 95% confidence intervals was calculated, and pairwise comparisons performed using McNemar's test.</p><p><strong>Results: </strong>Across 523 items, GPT-5 achieved the highest accuracy (87.4%), followed by Gemini-2.5Pro (85.7%); their performance did not differ significantly. Claude-4 ranked third (80.3%), exceeding the passing threshold in some years. GPT-4o (65.6%) and Gemini-2.0 (58.5%) showed moderate accuracy, whereas Claude-3 (36.9%), Gemma-3 (40.9%), and Llama-4 (52.2%) scored lower. Pairwise testing confirmed a clear stratification: high (GPT-5, Gemini-2.5Pro), upper-intermediate (Claude-4), mid (GPT-4o, Gemini-2.0), and low (others). All models declined with image-based items, with top models reduced to around 70%. Accuracy remained stable across years, with GPT-5, Gemini-2.5Pro, and occasionally Claude-4, surpassing the pass threshold.</p><p><strong>Conclusions: </strong>Successive model generations, particularly GPT-5 and Gemini-2.5Pro, consistently achieved passing-level accuracy. These findings highlight substantial gains through model evolution and underscore the potential of LLMs as supplementary tools for specialty education, despite persistent limitations in image-based reasoning.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":"950-962"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147768514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}