Journal of thoracic disease最新文献

{"title":"Buffalo chest after minimally invasive repair of pectus excavatum (MIRPE).","authors":"Francesco Donati, Marcelo Martinez-Ferro, Manuel Lopez, Michele Torre","doi":"10.21037/jtd-2026-1-0344","DOIUrl":"https://doi.org/10.21037/jtd-2026-1-0344","url":null,"abstract":"","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 3","pages":"266"},"PeriodicalIF":1.9,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077425/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147690718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing perioperative care in esophagectomy: a narrative review.","authors":"Tessa C M Geraedts, Misha D P Luyer","doi":"10.21037/jtd-2025-aw-2175","DOIUrl":"https://doi.org/10.21037/jtd-2025-aw-2175","url":null,"abstract":"<p><strong>Background and objective: </strong>Perioperative management of esophageal cancer surgery is continuously evolving. Advances in patient preparation, surgical techniques, and the implementation of enhanced recovery after surgery (ERAS) protocols have collectively improved postoperative outcomes and recovery. Minimally invasive esophagectomy has been widely adopted due to its association with reduced surgical trauma, less blood loss, shorter hospital stay, and, in some studies, lower complication rates. Despite these advances, esophagectomy remains a high-risk procedure with substantial morbidity, underscoring the need for continued optimization of perioperative care. This review focuses on recent developments in perioperative care and their impact on outcomes in esophageal cancer surgery.</p><p><strong>Methods: </strong>This narrative review provides an overview of the literature on perioperative optimization in esophageal cancer surgery, with emphasis on developments from the past several years, and is structured around key domains including prehabilitation, surgical techniques, ERAS protocols, and emerging experimental strategies.</p><p><strong>Key content and findings: </strong>Structured prehabilitation programs combining physical training, psychological support, and nutritional optimization have demonstrated complementary benefits in enhancing functional reserve and surgical tolerance. Current clinical practice increasingly focuses on technical refinement of minimally invasive esophagectomy, with growing adoption of robot-assisted techniques to enhance surgical precision and postoperative outcomes. Within ERAS, postoperative nutritional management is one of the least consistently implemented components, although direct oral feeding after minimally invasive esophagectomy has been shown to be safe and feasible and may enhance recovery and even long-term outcomes. In parallel with these advances, experimental strategies have been explored to further attenuate perioperative inflammation. Neuromodulation of the sympathetic nervous system has shown potential to modulate the postoperative immune response and holds promise for further improving postoperative outcomes.</p><p><strong>Conclusions: </strong>Perioperative care for esophagectomy has evolved towards a multimodal and patient-centered approach. Optimization of prehabilitation, minimally invasive (including robotic) techniques and ERAS-based perioperative care may further improve postoperative outcomes. Neuromodulation may represent a promising adjunct but requires further clinical validation. Continued refinement of perioperative pathways may contribute not only to faster recovery, but also to improved long-term outcomes.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 3","pages":"251"},"PeriodicalIF":1.9,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147690835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for treatment failure of drug-resistant pulmonary tuberculosis: results from a two-decade data analysis.","authors":"Karolina Kėvelaitienė, Roma Puronaitė, Valerija Edita Davidavičienė, Birutė Nakčerienė, Edvardas Danila","doi":"10.21037/jtd-2025-1-2548","DOIUrl":"https://doi.org/10.21037/jtd-2025-1-2548","url":null,"abstract":"<p><strong>Background: </strong>Drug-resistant tuberculosis (DR-TB) remains a major public health challenge worldwide, particularly in Eastern Europe, where high disease burden and complex treatment regimens contribute to suboptimal outcomes. Lithuania has historically reported high rates of pulmonary DR-TB; however, data on long-term treatment outcomes and their determinants over extended periods are limited. This study evaluated long-term treatment outcomes among adults with pulmonary DR-TB in Lithuania over a 22-year period and assessed associations between treatment outcomes, individual risk factors, and temporal trends.</p><p><strong>Methods: </strong>A retrospective cohort analysis was conducted using data from the National Tuberculosis Information System for 2000-2021. The study included 5,761 adults with DR-TB, categorized into three periods: Period I (2000-2007), Period II (2008-2015), and Period III (2016-2021). Treatment outcomes were classified as successful (treatment completion with recovery) or unsuccessful [treatment failure, progression to chronic TB, death before completion, or transition from multidrug-resistant tuberculosis (MDR-TB) to extensively drug-resistant tuberculosis (XDR-TB)]. Associations between outcomes and risk factors such as smoking, alcohol and substance use, comorbidities, and sociodemographic variables were examined using multivariate analysis.</p><p><strong>Results: </strong>Treatment success rates increased steadily across periods (66.2%, 68.5%, and 79.5%), while mortality rates declined (30.7%, 29.5%, and 20.1%). Non-lethal treatment failure rates decreased markedly (3.0%, 2.0%, and 0.3%). Treatment failure was significantly associated with low body mass index, male gender, unemployment, homelessness, tobacco and alcohol use, substance abuse, and comorbidities including cancer, cardiovascular and chronic lung disease, diabetes mellitus, human immunodeficiency virus (HIV) infection, and renal failure.</p><p><strong>Conclusions: </strong>Treatment outcomes of DR-TB in Lithuania have shown improvement over a 22-year period. Successful treatment outcomes were strongly influenced by a combination of clinical, behavioral, and socioeconomic factors, underscoring the complexity of DR-TB management. The relative importance of these components may vary for each individual patient. Incorporating multifaceted strategies, such as psychological support, social assistance (including access to food and shelter), and employment opportunities, into the national DR-TB control framework could enhance health system responsiveness and reduce inequities in care.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 3","pages":"201"},"PeriodicalIF":1.9,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077367/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147690841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic impact of treatment modalities and examined lymph nodes count on survival in T3-4 esophageal cancer: a retrospective cohort and predictive modeling study from the Surveillance, Epidemiology, and End Results database.","authors":"Yu Wu, Pubo Shi, Pengjie Yang, Ting Yang, Jingjing Zhang, Shaobo Li, Li Feng, Benben Zhu, Zhifang Wu","doi":"10.21037/jtd-2025-1-2675","DOIUrl":"https://doi.org/10.21037/jtd-2025-1-2675","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Esophageal carcinoma (EC) is a malignancy of significant global burden, characterized by high incidence and mortality rates. The majority of patients are diagnosed with advanced disease. While surgery-based multimodality therapy is standard for resectable disease at this stage, the optimal strategy requires further definition. Concurrently, the impact of the number of examined lymph nodes (ELNs) on patient prognosis across different treatment modalities remains to be further explored. This study aimed to investigate the prognostic impacts of different treatment modalities and the corresponding number of ELNs in patients with T3-4 EC.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective cohort study analyzed patients with pT3-4 EC from the Surveillance, Epidemiology, and End Results (SEER) database who underwent radical esophagectomy. Participants were categorized into four treatment groups: neoadjuvant therapy plus surgery (NS), adjuvant therapy plus surgery (AT), surgery alone (SA), and perioperative therapy (PT). Overall survival (OS) was compared using Kaplan-Meier analysis. Propensity score matching (PSM) was applied to balance baseline characteristics across treatment groups and across subgroups stratified by the number of ELNs. For prognostic modeling, patients were randomly divided into training and validation sets (7:3 ratio). The variables ultimately used to construct the nomogram were progressively refined through univariate Cox analysis, least absolute shrinkage and selection operator (LASSO) regression, and multivariable Cox analysis. Model performance was assessed using the concordance index (C-index), receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 4,485 eligible patients were included in the study. With a median follow-up of 24 months, 2,796 deaths were recorded. After PSM, OS was significantly better in the NS and PT groups than in the SA and AT groups (P&lt;0.05), while no significant difference was found between NS and PT (P=0.21). The AT group also showed superior OS compared to SA (P&lt;0.001). ELNs demonstrated treatment-specific prognostic value, with optimal thresholds identified at 9 for NS, 16 for AT, 17 for SA, and 19 for PT. Exceeding these thresholds was associated with significantly improved OS, and this association remained robust in sensitivity analyses. A nomogram was developed using independent prognostic factors from multivariate Cox analysis, including age, node (N) stage, metastasis (M) stage, ELNs, and treatment modality. The model showed good discrimination, with a C-index of 0.608 in the training set and 0.616 in the validation set. The areas under the curves (AUCs) for predicting 1-, 3-, and 5-year OS were 0.645, 0.620, and 0.618 in the training set, and 0.658, 0.619, and 0.631 in the validation set. Calibration plots and DCA confirmed good model fit and clinical utility.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Co","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 3","pages":"230"},"PeriodicalIF":1.9,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147690848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of perfusate filtration or exchange on lung function during ex vivo lung perfusion (EVLP): a systematic review.","authors":"Maira Machhiwala, Ryaan El-Andari, Parham Hassanzadeh, Adrien Lam, Daniel Gutierrez, Max Buchko, Darren H Freed, Jayan Nagendran","doi":"10.21037/jtd-2025-1-2756","DOIUrl":"https://doi.org/10.21037/jtd-2025-1-2756","url":null,"abstract":"<p><strong>Background: </strong>Ex vivo lung perfusion (EVLP) supports assessment and rehabilitation of donor lungs. It runs as a closed circuit, so electrolytes and metabolites accumulate over the duration of perfusion. This systematic review investigates the impact of various dialysis or perfusate exchange (PE) techniques on electrolyte balance, inflammation and lung function during EVLP.</p><p><strong>Methods: </strong>A literature search of PubMed and Embase was conducted from database inception to September 17, 2025. We included all articles describing human or animal studies that tested dialysis or PE during EVLP. Outcomes included electrolytes, lactate, pH, edema formation, lung performance characteristics, and inflammatory markers.</p><p><strong>Results: </strong>Five studies met the inclusion criteria, one human and four porcine models, with a total of 57 subjects. Across studies, dialysis consistently improved solute clearance, lowering sodium, potassium, and chloride, while increasing calcium and glucose, reducing lactate accumulation, and maintaining physiologic pH. PE did not sustain physiologic pH and had limited impact on electrolyte homeostasis, with only transient effects on lactate. No differences were observed in lung function parameters including oxygenation, compliance, and airway pressure. Pro-inflammatory cytokine production was largely unchanged, however, interleukin (IL)-10 was elevated with dialysis in several studies.</p><p><strong>Conclusion: </strong>During EVLP, dialysis stabilized acid-base status and metabolites. These biochemical gains did not translate into consistent improvements in oxygenation or compliance. Smaller dialysis membranes were associated with higher pulmonary artery pressure (PAP) and increased cytokine profile. Future studies should extend EVLP duration with perfusate clearance to evaluate whether perfusate clearance strategies provide additional benefits with longer duration preservation.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 3","pages":"248"},"PeriodicalIF":1.9,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077377/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147690868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of a LASSO-derived prognostic model predicting postoperative cognitive dysfunction risk in off-pump coronary artery bypass grafting patients.","authors":"Zehua Zhang, Xiaoyu Xu, Wenxing Peng, Yifan Wang, Yang Lin","doi":"10.21037/jtd-2025-1-2673","DOIUrl":"https://doi.org/10.21037/jtd-2025-1-2673","url":null,"abstract":"<p><strong>Background: </strong>Middle-aged and elderly patients face an elevated risk of postoperative cognitive dysfunction (POCD) after coronary artery bypass grafting (CABG), a complication that worsens prognosis. While off-pump CABG (OPCABG) reduces some injury mechanisms, no prediction model has been developed for predicting POCD in this surgical population. This study aimed to develop a predictive model for POCD following OPCABG to facilitate the earlier and more precise identification of high-risk patients.</p><p><strong>Methods: </strong>This prospective single-center study enrolled 412 patients who underwent elective OPCABG at Beijing Anzhen Hospital between March 2024 and March 2025. Patients were randomly allocated in a 7:3 ratio to a training set (n=288) and a testing set (n=124). Variable selection was performed using least absolute shrinkage and selection operator (LASSO) regression and multivariable logistic regression on the training set. A nomogram was subsequently developed using the chosen variables. The predictive performance of the model was assessed in both sets using the area under the receiver operating characteristic (ROC) curve, sensitivity, specificity, calibration curves, and decision curve analysis (DCA).</p><p><strong>Results: </strong>POCD was observed in 174 out of 412 patients (42.2%). Predictive factors included age, body mass index (BMI), blood glucose, total cholesterol (TC), smoking history, and history of prior silent cerebrovascular disease (SCVD). The model demonstrated good diagnostic performance, with area under the curve (AUC) values of 0.722 [95% confidence interval (CI): 0.663-0.780] in the training set and 0.704 (95% CI: 0.609-0.800) in the testing set. Calibration curves showed close agreement between the predictions of the nomogram and the observed outcomes. DCA for both datasets suggested favorable clinical utility of the model.</p><p><strong>Conclusions: </strong>This study presents a LASSO-derived predictive model for the estimation of the risk of POCD in patients undergoing OPCABG.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 3","pages":"220"},"PeriodicalIF":1.9,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147690890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examined lymph node counts ≤6 are correlated with an unfavorable prognosis in stage IA NSCLC patients following sublobar resection: a retrospective study employing propensity score matching analysis.","authors":"Yufeng Tang, Min Luo","doi":"10.21037/jtd-2025-aw-2137","DOIUrl":"https://doi.org/10.21037/jtd-2025-aw-2137","url":null,"abstract":"<p><strong>Background: </strong>Complete lymph node dissection improves staging accuracy in non-small cell lung cancer (NSCLC) patients and may improve outcomes in select patients. However, the benefit of increased lymph node examination in patients with stage IA NSCLC remains unclear. Therefore, this study aimed to explore the relationship between the examined lymph node (ELN) counts and the prognosis of patients with stage IA NSCLC following sublobar resection.</p><p><strong>Methods: </strong>We obtained data from the Surveillance, Epidemiology, and End Results (SEER) 17 registry study database (2010-2019), including patients with stage IA NSCLC who underwent sublobar resection. Patients with missing ELN counts were excluded. Cox regression analysis showed a correlation between ELN count and cancer-specific survival (CSS). Propensity score matching (PSM) compared survival between ELN ≤6 and ELN >6 groups. Analysis used Empower Stats and R software.</p><p><strong>Results: </strong>In this study, 5,851 patients with NSCLC and pathological stage IA disease were included. Patients with more than 6 ELNs were older, more likely to be Caucasian, and more likely to have lung adenocarcinoma. After PSM, baseline characteristics were balanced between ELN groups. Univariate analysis showed better survival in the ELN >6 group, with a hazard ratio (HR) of 0.75 [95% confidence interval (CI): 0.64-0.88, P=0.0004], which was consistent in multivariate analysis (HR: 0.76, 95% CI: 0.64-0.89, P=0.0008). Kaplan-Meier survival curves indicated significantly better survival in the ELN >6 group, consistent across wedge and segmental resection subgroups.</p><p><strong>Conclusions: </strong>In conclusion, our findings indicate that an ELN count of ≤6 following sublobar resection in patients with stage IA NSCLC is linked to an unfavorable prognosis. We recommend dissecting more than 6 nodes during sublobar resections in stage 1A NSCLC patients.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 3","pages":"210"},"PeriodicalIF":1.9,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077378/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147690923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electrodes of radiofrequency ablation for malignant lung tumors: a narrative review of advances, applications, and prospects.","authors":"Haowei Zhang, Xueqi Qin, Yueyang Sun, Ying Liu","doi":"10.21037/jtd-2025-1975","DOIUrl":"https://doi.org/10.21037/jtd-2025-1975","url":null,"abstract":"<p><strong>Background and objective: </strong>Radiofrequency ablation (RFA) is one of the most widely adopted thermal ablation modalities for patients with inoperable malignant lung tumors, including primary lung cancer and pulmonary metastases. Compared with other ablation techniques such as microwave and cryoablation, RFA has a longer clinical accumulation and technical evolution, and its therapeutic effect relies primarily on the delivery of thermal energy within tissues, placing higher demands on thermal field distribution. As the core energy-conducting component of RFA system, the radiofrequency (RF) electrode significantly affects the morphology and extent of the ablation zone. Notably, owing to the lungs' unique anatomical architecture, precise deployment of such devices is crucial to ensure effective ablation and minimize potential complications. This study focuses on the application and challenges of RF electrodes in pulmonary ablation and highlights the prospective development of RF electrode technology.</p><p><strong>Methods: </strong>This study conducted a review by searching through databases including PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), and Google Scholar. Studies focusing on the structure, design, or ablation performance of RF electrodes in malignant lung tumors were selected. Based on these findings, a narrative review was generated.</p><p><strong>Key content and findings: </strong>RF electrodes available for pulmonary ablation can be mainly classified into monopolar, bipolar, and multipolar electrodes. And the optimized electrode designs-such as cooling, expandable, or bipolar configurations-can better adapt to tumors of different morphologies and sizes by improving the tissue-electrode coupling and energy deposition, enabling larger, more controllable ablation zone than conventional designs. In the future, RF electrode technology will be further integrated with structural and functional optimization, combination therapy strategies (such as targeted drug delivery), and precise intelligent control system to offer stronger effectiveness and personalized minimally invasive treatment strategies to lung tumor patients.</p><p><strong>Conclusions: </strong>The geometric and conductive characteristics of RF electrodes have been proven to significantly influence the effectiveness and safety of RFA for lung tumors. Future developments should focus on optimizing electrode configuration and refining energy delivery strategies, which are crucial for achieving controllable and uniform ablation zones in lung tumors.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 3","pages":"253"},"PeriodicalIF":1.9,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077353/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147690925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experience with H anastomosis and its perioperative management protocol in minimally invasive esophagectomy: a propensity score-matched comparison with stapled non-enhanced recovery after surgery pathway.","authors":"Zhenzhong Zhang, Derong Tang, Yang Hu, Jianqing Zhao, Zhiyun Xu","doi":"10.21037/jtd-2025-1-2589","DOIUrl":"https://doi.org/10.21037/jtd-2025-1-2589","url":null,"abstract":"<p><strong>Background: </strong>H anastomosis is an emerging esophagogastric reconstruction technique that has shown promising perioperative results. However, real-world comparative evidence, particularly from rigorously matched cohorts, remains limited. Therefore, the present study aimed to compare short-term postoperative recovery metrics between the H anastomosis pathway and a stapled anastomosis pathway using propensity score matching (PSM).</p><p><strong>Methods: </strong>This single-center retrospective study compared patients who underwent H anastomosis pathway between October 2024 and July 2025 (n=100) with those who received stapled anastomosis pathway between October 2023 and July 2024 (n=102). PSM was applied in a 1:1 ratio (75 matched pairs) based on age, sex, body mass index (BMI), and neoadjuvant therapy (NAT). Postoperative hospital stay (PHS) and postoperative fasting duration (PFD), modeled as overdispersed count variables, were analyzed using negative binomial regression. For low-frequency events-including severe pulmonary infection (SPI), reinsertion, and anastomotic leakage (AL)-Firth's penalized logistic regression was used to reduce small-sample bias. Binary postoperative outcomes-including hypoalbuminemia, fever, high-grade fever, tachycardia, and atrial fibrillation (AF)-were evaluated using standard logistic regression.</p><p><strong>Results: </strong>The H anastomosis pathway group demonstrated significantly shorter PHS and PFD (PHS: 10.27±4.19 <i>vs</i>. 17.29±6.95 days, P<0.001; PFD: 1.64±1.29 <i>vs</i>. 9.99±6.02 days, P<0.001) and lower incidences of postoperative fever, high-grade fever, AF, and hypoalbuminemia compared with the stapled anastomosis pathway group. These associations remained robust after adjustment for smoking and alcohol history and major comorbidities.</p><p><strong>Conclusions: </strong>Although superiority cannot yet be claimed, our findings indicate that H anastomosis, when implemented together with its coordinated perioperative management protocol, provides a stable and feasible enhanced recovery after surgery (ERAS) oriented pathway for minimally invasive esophagectomy (MIE).</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 3","pages":"224"},"PeriodicalIF":1.9,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077397/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147690828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic value of 3D mean CT attenuation in the solid component of resected part-solid lung adenocarcinomas.","authors":"Ryohei Miyazaki, Masaya Tamura, Takashi Sakai, Naoki Furukawa, Yujiro Bunno, Marino Yamamoto, Hironobu Okada","doi":"10.21037/jtd-2025-1790","DOIUrl":"https://doi.org/10.21037/jtd-2025-1790","url":null,"abstract":"<p><strong>Background: </strong>Preoperative prediction of recurrence in non-small cell lung cancer (NSCLC) remains limited using conventional imaging parameters such as tumor size, consolidation-to-tumor (C/T) ratio, and 2D mean computed tomography attenuation (mCT) value. This study aimed to evaluate the prognostic utility of the 3D-solid mCT value in patients with surgically resected NSCLC.</p><p><strong>Methods: </strong>A total of 138 patients with part-solid adenocarcinomas who underwent complete resection between 2012 and 2018 were retrospectively analyzed. Preoperative CT data were processed using a 3D workstation to measure tumor volume and calculate the 3D-solid mCT value. Recurrence-free survival (RFS) was the primary outcome. Receiver operating characteristic (ROC) analysis was used to identify optimal cut-off values. Survival was analyzed using Kaplan-Meier and Cox proportional hazards models.</p><p><strong>Results: </strong>Patients were divided into high (≥-106.0 HU) and low (<-106.0 HU) 3D-solid mCT value groups. The high value group showed significantly worse 5-year RFS (65.8% <i>vs.</i> 98.4%, P<0.001). The 3D-solid mCT value had the highest predictive accuracy for recurrence [area under the curve (AUC) =0.724] compared to the 2D-mCT value (AUC =0.643, P=0.02) and C/T ratio (AUC =0.598). Multivariate analysis identified high 3D-solid mCT value (hazard ratio: 9.22, P=0.02) and lymphatic invasion (P=0.002) as independent predictors of recurrence.</p><p><strong>Conclusions: </strong>The 3D-solid mCT value is a strong, independent predictor of postoperative recurrence in NSCLC and showed better predictive performance than conventional 2D imaging parameters in ROC analysis. Preoperative assessment of this value may help identify high-risk patients and support personalized postoperative management. However, further studies with formal model comparison are warranted to confirm its superiority.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 3","pages":"208"},"PeriodicalIF":1.9,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077412/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147690845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}