Journal of thoracic disease最新文献

{"title":"Artificial intelligence and radiomics in small cell lung cancer: a narrative review of imaging and multisource data integration.","authors":"Yue Yang, Jialu Sun, Jiayi Liu, Jiaxu Liu, Shiyang Deng, Jiang Du","doi":"10.21037/jtd-2026-1693","DOIUrl":"https://doi.org/10.21037/jtd-2026-1693","url":null,"abstract":"<p><strong>Background and objective: </strong>Artificial intelligence (AI) and radiomics are increasingly used to analyze imaging and multisource data in small cell lung cancer (SCLC), but the directness and clinical maturity of the available evidence remain uncertain. This narrative review aimed to summarize and critically evaluate SCLC-specific, mixed-cohort, and indirect evidence across diagnostic classification, prognostic prediction, treatment-associated outcomes, and lesion segmentation.</p><p><strong>Methods: </strong>A structured literature search was conducted to identify human studies evaluating AI, deep learning (DL), radiomics, or machine learning within imaging-based or imaging-integrated workflows. Studies were selected according to clinical relevance, directness of SCLC evidence, methodological strength, and reporting completeness, and were classified as SCLC-specific, mixed-cohort, or indirect/transferable evidence.</p><p><strong>Key content and findings: </strong>Direct SCLC-specific evidence was strongest for multicenter computed tomography (CT)-based prognostic models and lesion segmentation, whereas diagnostic classification relied mainly on mixed cohorts or public image-level datasets. Treatment-response models showed preliminary value but were predominantly retrospective and lacked prospective clinical validation. Retrospective studies suggested associations between model-derived risk scores and outcomes following prophylactic cranial irradiation (PCI), but did not establish treatment-benefit prediction. Pathomic and radiogenomic analyses also identified associations between quantitative features, immune-cell infiltration, genomic alterations, and treatment response; these findings remain hypothesis-generating. Interpretation is limited by small SCLC cohorts, retrospective single-center designs, non-independent image-level analyses, and limited external validation and interpretability.</p><p><strong>Conclusions: </strong>AI and radiomics show potential in SCLC, particularly for CT-based prognosis and segmentation. However, treatment-response prediction, non-invasive subtype classification, and clinical decision support remain investigational and require prospective multicenter validation and patient-level external evaluation before clinical implementation.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1060"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655832/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182724","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":"Beyond diagnosis and antibiotic stewardship: a hypothesized additional role for procalcitonin in patients with suspected sepsis.","authors":"Guillaume Monneret, Morgane Gossez, Fabienne Venet","doi":"10.21037/jtd-2026-2232","DOIUrl":"https://doi.org/10.21037/jtd-2026-2232","url":null,"abstract":"","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1075"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182805","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":"Less complexity, not less protection: reconsidering cerebral protection during short circulatory arrest in aortic arch surgery.","authors":"Shingo Kunioka, Hayato Ise, Hiroyuki Kamiya","doi":"10.21037/jtd-2026-2203","DOIUrl":"https://doi.org/10.21037/jtd-2026-2203","url":null,"abstract":"","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1080"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182826","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":"Landiolol for preventing postoperative atrial fibrillation: lessons from Japan for all?","authors":"Isabelle Frei, David Santer, Eckhard Mauermann","doi":"10.21037/jtd-2026-1107","DOIUrl":"https://doi.org/10.21037/jtd-2026-1107","url":null,"abstract":"","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1079"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656044/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182840","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":"Non-intubated uniportal video-assisted minor and major pulmonary resections: a single-center European experience in 163 selected patients.","authors":"Hayan Merhej, Alaa Selman, Daniel Benjamin Jaeger, Jan Karsten, Alina Meininger, Dietmar Boethig, Akylbek Saipbaev, Mihail Magdei, Tomoyuki Nakagiri, Norman Zinne, Arjang Ruhparwar, Ruoyu Zhang, Felix Lennartz, Heiko Golpon, Patrick Zardo","doi":"10.21037/jtd-2026-1579","DOIUrl":"https://doi.org/10.21037/jtd-2026-1579","url":null,"abstract":"<p><strong>Background: </strong>Non-intubated video-assisted thoracoscopic surgery (niVATS) avoids endotracheal intubation and one-lung mechanical ventilation. Whether this translates into clinically meaningful benefits compared with intubated video-assisted thoracoscopic surgery (VATS) requires comparative studies. Evidence from European centers, particularly for major pulmonary resections, remains limited. We evaluated technical feasibility and perioperative outcomes in a selected European niVATS cohort.</p><p><strong>Methods: </strong>This retrospective single-center observational study included consecutive patients selected to undergo niVATS between May 2018 and February 2025. The primary endpoint was intraoperative conversion to intubated anesthesia. Secondary endpoints included postoperative complications, chest tube duration, length of stay, reoperation, and 30-day mortality.</p><p><strong>Results: </strong>A total of 163 patients were included. Median age was 67 years and median body mass index (BMI) was 24 kg/m². Anatomical lung resections were performed in 77 patients (47.2%), including 50 lobectomies and 27 segmentectomies. Conversion to intubated anesthesia occurred in 6 patients (3.7%). Prolonged air leak was observed in 21 patients (12.9%), pneumonia in 5 (3.1%), and reoperation in 6 (3.7%). Thirty-day mortality was 1.2%. Median chest tube duration and hospital stay were 3 and 5 days, respectively. Conversion was more frequently observed among patients undergoing lobectomy and among those with a higher BMI.</p><p><strong>Conclusions: </strong>niVATS is feasible in selected patients across a broad spectrum of thoracic procedures in a high-volume European center. Lobectomy and increasing BMI are associated with a higher likelihood of conversion and should be considered during patient selection and perioperative planning. These descriptive findings do not establish comparative safety or clinical benefit versus intubated VATS; prospective comparative studies are required.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1007"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655830/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182856","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":"Symptoms improvement and lung function benefits of fixed triple therapy with beclomethasone/formoterol/glycopyrronium inhalation powder in patients with moderate-to-severe COPD: outcomes of the Bulgarian arm of the RESPONSE study.","authors":"Rosen E Petkov, Andrey N Kenderov, Neli L Rodopska, Evgeni V Mekov, Krassimir Kalinov","doi":"10.21037/jtd-2026-1487","DOIUrl":"10.21037/jtd-2026-1487","url":null,"abstract":"<p><strong>Background: </strong>The fixed triple beclomethasone dipropionate/formoterol fumarate/glycopyrronium (BDP/FF/GB) therapy is available in both pressurized metered-dose inhaler (pMDI) and dry powder inhaler (DPI) formulations for chronic obstructive pulmonary disease (COPD) treatment. While the pMDI form has been extensively investigated in pivotal trials and real-world studies, real-world data on the DPI (88/5/9 μg) formulation remain limited. The RESPONSE study assessed the real-world effectiveness of BDP/FF/GB inhalation powder in a cohort of moderate-to-severe COPD patients uncontrolled with dual combinations.</p><p><strong>Methods: </strong>This non-interventional, prospective, multicenter study was conducted across 21 Bulgarian sites. COPD patients (≥35 years) with persistent symptoms [COPD Assessment Tool (CAT) ≥10 and/or modified Medical Research Council (mMRC) ≥2] and moderate or severe pulmonary obstruction [30%≤ forced expiratory volume in 1 second as a percentage of predicted value (FEV₁%) <80%] despite dual therapies were switched to BDP/FF/GB DPI and followed for 6 months. The primary endpoint was improvement in CAT scores. Secondary endpoints included lung function, treatment adherence, dyspnea and the percentage of patients achieving CAT score reduction ≥2 from baseline.</p><p><strong>Results: </strong>A total of 363 patients completed the study. Mean CAT scores improved significantly from 23.0 at baseline to 16.9 (P<0.001), regardless of prior dual therapy or inhaler type. Mean (± SD) FEV₁% increased from 47.6%±11.9% to 53.2%±15.75% (P<0.001). Treatment adherence and dyspnea also showed significant improvement. Notably, 87.9% of participants achieved a CAT score reduction ≥2 points.</p><p><strong>Conclusions: </strong>The RESPONSE study showed that switching to BDP/FF/GB DPI was associated with clinically meaningful improvements in symptoms, lung function, and adherence in COPD patients inadequately controlled on dual therapy, supporting its role as a practical escalation option in routine care.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1039"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655834/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165224","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":"Treatment patterns and prognostic factors of radiation-associated esophageal fistula in patients with esophageal squamous cell carcinoma: a retrospective cohort study.","authors":"Han-Yu Si, Qiu-Ying An, Hong-Shan Ji, Ya-Jing Wang, Ya-Ge Jia, Yu-Hao Su, Meng-Lu Liu, Jin Yan, Zi-Han Zhang, Chan-Jun Zhen, Wen-Wen Bai, Rui Zhang, Li-Yuan Fu, Yu-Zhi Song, Ping Zhang, Zhi-Guo Zhou","doi":"10.21037/jtd-2026-1519","DOIUrl":"https://doi.org/10.21037/jtd-2026-1519","url":null,"abstract":"<p><strong>Background: </strong>Most previous studies have focused on exploring the formation mechanism of esophageal fistula (EF) and predicting its risk of occurrence. However, few studies have reported the treatment and prognosis of EF after radiotherapy (RT) in patients with esophageal cancer (EC). This study aimed to explore treatment patterns and prognostic factors of radiation-associated esophageal fistula (RAEF) in esophageal squamous cell carcinoma (ESCC).</p><p><strong>Methods: </strong>A total of 91 EF patients were retrospectively enrolled from January 2016 to July 2023. Based on the fistula type, 39 patients presented with tracheoesophageal fistula (TEF) and 52 with esophagomediastinal fistula (EMF). Survival analyses utilized the Kaplan-Meier method. Multivariable Cox regression analysis was employed to ascertain prognosis.</p><p><strong>Results: </strong>By the last follow-up date on June 30, 2025, all patients had died. The cohort had a median post-fistula survival time of 3.1 months, and their 3-month, 6-month, and 12-month survival rates were 51.6%, 18.7%, and 5.5%, respectively. All patients received nutritional support therapy, including nasal feeding (n=61), esophageal stenting (n=10), gastrostomy/jejunostomy (n=12), and simple fluid infusion therapy (n=8). Gastrostomy/jejunostomy was associated with the highest post-fistula survival rates (3-month: 83.3%, 6-month: 41.7%, 12-month: 25.0%). In TEF, esophageal stenting provided comparable 3-month post-fistula survival rates to gastrostomy/jejunostomy (71.4% <i>vs.</i> 75.0%). Among 21 patients who had EF during primary RT, those completing the planned RT after receiving nutritional support therapy achieved superior fistula closure rates compared to treatment discontinuation (77.8% <i>vs.</i> 25.0%). Multivariable Cox analysis identified reirradiation, simple fluid infusion therapy, persistent fistula, and hemoglobin <120 g/L as independent unfavorable prognostic factors.</p><p><strong>Conclusions: </strong>Gastrostomy/jejunostomy is associated with improved survival in patients with RAEF. Esophageal stenting represents a viable short-term palliative option for TEF patients. Completing planned RT may promote fistula healing for EF during primary RT. Hemoglobin level serves as an accessible prognostic biomarker.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1042"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655807/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182756","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":"Parallel-bar versus cross-bar configurations in the Nuss procedure: addressing cohort overlap and morphology-based selection criteria.","authors":"Paula Duarte D'Ambrosio, Lucas Monteiro Delgado, Rachid Eduardo Noleto da Nóbrega Oliveira, Enzo Campedelli Borges, Mathias de Souza Ribeiro, Giulia Moraes Piazzi, Gustavo Campos Sabino, Patrícia Viana, Rafael Rodrigues Lourencini, Bernardo Mazzini Ketzer, José Ribas Milanez de Campos","doi":"10.21037/jtd-2026-2306","DOIUrl":"https://doi.org/10.21037/jtd-2026-2306","url":null,"abstract":"","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1067"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656061/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182885","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 neoadjuvant therapy and nomogram development in early-stage and locally advanced Siewert type II adenocarcinoma of the esophagogastric junction based on the SEER database.","authors":"Pubo Shi, Pengjie Yang, Xingfu Ban, Yong Li, Benben Zhu","doi":"10.21037/jtd-2026-2069","DOIUrl":"https://doi.org/10.21037/jtd-2026-2069","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Despite the rising global incidence of adenocarcinoma of the esophagogastric junction (AEG), treatment for Siewert type II AEG remains controversial, particularly regarding whether neoadjuvant therapy confers differential benefit according to stage. Locally advanced patients may benefit from neoadjuvant therapy, yet the benefit of additional adjuvant therapy remains unclear. This study therefore aimed to evaluate the stage-specific efficacy of neoadjuvant therapy and to explore the value of adjuvant therapy following neoadjuvant treatment in locally advanced disease.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients diagnosed with Siewert type II AEG were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. Survival differences among patients were assessed using the Kaplan-Meier method and log‑rank test. To minimize baseline imbalances, propensity score matching (PSM) was performed, and multivariable Cox regression analyses were conducted before and after PSM to adjust for potential confounders. Univariate and multivariate Cox regression analyses were employed to identify independent prognostic factors. A nomogram predicting overall survival (OS) was constructed based on the variables selected by Cox regression. The predictive performance of the nomogram was evaluated by the concordance index (C‑index), receiver operating characteristic (ROC) curves with area under the curve (AUC) values, calibration plots, and decision curve analysis (DCA).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 1,847 patients were enrolled. In the overall cohort, no significant OS difference was observed between surgery alone (SA) and neoadjuvant-based therapy combined with surgery (NS) groups after PSM (P=0.14). Stage‑stratified analysis showed that neoadjuvant therapy significantly improved OS in locally advanced patients (P&lt;0.001), but not in early‑stage patients (P=0.06). Among locally advanced patients receiving neoadjuvant therapy, adding adjuvant therapy provided no additional OS benefit (P=0.87). Prognostic nomograms were constructed for early‑stage and locally advanced patients. For the early‑stage model, the C‑index was 0.696 in the training set and 0.669 in the testing set, with AUC values for 1‑, 3‑, and 5‑year OS of 0.653, 0.730, and 0.748 in the training set, and 0.698, 0.702, and 0.692 in the testing set. For the locally advanced model, the C‑index was 0.671 and 0.635 in the training and testing sets, respectively, with AUC values of 0.741, 0.723, and 0.725 in the training set, and 0.693, 0.684, and 0.690 in the testing set. Calibration and DCA confirmed satisfactory predictive performance and clinical utility for both models.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Neoadjuvant therapy, predominantly chemoradiotherapy, significantly improved OS in locally advanced Siewert type II AEG but not in early-stage disease. In locally advanced patients, adding adjuvant therapy after neoadjuvant therapy did not provide addi","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1014"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655897/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181842","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":"Liposomal bupivacaine versus ropivacaine thoracic paravertebral block for thoracoscopic atrial septal defect repair: analgesic efficacy and cardiac biomarker outcomes in a single-center, assessor-blinded, randomized trial.","authors":"Bingqian Li, Yuxin Gao, Jingjing Han, Yan Li, Yu Chen","doi":"10.21037/jtd-2026-1135","DOIUrl":"10.21037/jtd-2026-1135","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Thoracoscopic atrial septal defect (ASD) repair, although minimally invasive, can cause substantial postoperative pain. Thoracic paravertebral block (TPVB) provides effective chest wall analgesia, and liposomal bupivacaine (LB), a long-acting local anesthetic with sustained release, may prolong analgesic duration. We investigated whether ultrasound-guided TPVB using long-acting LB improves postoperative analgesia without compromising cardiovascular safety compared with ropivacaine (RP).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This randomized, assessor-blinded trial enrolled 94 patients undergoing thoracoscopic ASD repair, who were randomly assigned (1:1) to receive ultrasound-guided TPVB with either LB or RP. Eligibility criteria included age 18-55 years, American Society of Anesthesiologists (ASA) II-III, New York Heart Association (NYHA) II-III, and ejection fraction (EF) &gt;50%. Randomization was computer-generated with sealed envelopes. Safety monitoring included continuous electrocardiography (ECG) for arrhythmias, with Clavien-Dindo grading and Naranjo causality assessment. The primary endpoint was the numerical rating scale (NRS, 0-10) pain score during coughing at 24 h postoperatively. Secondary outcomes included NRS scores at other time points, 72-h opioid consumption (morphine milligram equivalents, MME), time to first rescue analgesia, extended analgesia outcomes [postoperative days 4-7 (POD4-POD7)], perioperative hemodynamics, postoperative recovery, cardiac/inflammatory biomarker trajectories, and adverse events (with postoperative arrhythmias analyzed separately).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Baseline demographic, clinical, and intraoperative variables were well-balanced between groups (all P&gt;0.05). Compared with RP, LB was associated with lower NRS pain scores at rest and during coughing from extubation through 72 h (all P&lt;0.05), including the primary endpoint at 24 h. LB significantly reduced 72-h opioid consumption [median interquartile range (IQR) 7.5 (0, 42) mg &lt;i&gt;vs.&lt;/i&gt; 45 (30, 67.5) mg; P&lt;0.001] and increased the proportion of patients requiring no rescue analgesia within 72 h (72.4% &lt;i&gt;vs.&lt;/i&gt; 27.6%; P=0.003). Time to first rescue analgesia was numerically longer with LB (20.5 h &lt;i&gt;vs.&lt;/i&gt; 12.0 h; P=0.10), and opioid-sparing effects persisted on POD4-POD7 (both P&lt;0.001). Mechanical ventilation duration was shorter in the LB group [5 (3, 6) h &lt;i&gt;vs.&lt;/i&gt; 6 (4, 7.5) h; P=0.03]. Cardiac and inflammatory biomarker trajectories did not differ between groups. Non-arrhythmic adverse events were comparable, and postoperative arrhythmia incidence within 30 days was similar between groups (13.3% &lt;i&gt;vs.&lt;/i&gt; 15.6%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In adults undergoing thoracoscopic ASD repair, LB-based TPVB provides superior early analgesia with sustained opioid sparing and shorter mechanical ventilation duration, without signals of increased cardiovascular risk, including postoperative arrhythmias. These fi","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1049"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169663","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}