Journal of Chest Surgery最新文献

{"title":"Efficacy and Safety of Combined Autologous Blood Patch and Doxycycline Pleurodesis for the Management of Persistent Air Leaks in Secondary Spontaneous Pneumothorax: A Randomized Controlled Trial.","authors":"Mohamed Ahmed, Mohammed Y Alamassi, Ayman F Yousef, Mohammed S Ishaq, Ahmed Gamal Elkhouly","doi":"10.5090/jcs.26.076","DOIUrl":"10.5090/jcs.26.076","url":null,"abstract":"<p><strong>Background: </strong>Persistent air leak (PAL) is a frequent and challenging complication of secondary spontaneous pneumothorax (SSP) and often prolongs hospitalization. We compared the efficacy and safety of autologous blood patch pleurodesis (ABPP) plus doxycycline with those of ABPP alone for managing PAL in patients with SSP who were considered unfit for surgery.</p><p><strong>Methods: </strong>This prospective, randomized controlled trial enrolled 121 patients with SSP and PAL lasting ≥7 days. Participants were randomized to receive ABPP alone (n=62) or ABPP plus intrapleural doxycycline (n=59). The primary outcome was time to air leak cessation. Secondary outcomes included the 7-day success rate, time to drain removal, length of hospital stay, pain score, complications, and recurrence at 1 and 3 months.</p><p><strong>Results: </strong>Kaplan-Meier analysis showed significantly faster air leak cessation in the ABPP plus doxycycline group than in the ABPP-alone group (median, 4 days vs. 6 days; log-rank p<0.001). This was accompanied by earlier intercostal drain removal (median, 5 days vs. 7 days; p<0.001) and a shorter hospital stay (median, 12 days vs. 14 days; p<0.001). The 7-day success rate was 81% in the combination group and 74% in the ABPP group (p=0.34). Post-procedural pain scores were higher in the combination group (p<0.001). However, overall complication rates (36% vs. 40%, p=0.6) and 3-month recurrence rates (3.8% vs. 7%, p=0.68) were statistically comparable between groups.</p><p><strong>Conclusion: </strong>Combining doxycycline with ABPP appears to be a safe and effective bedside intervention. Compared with ABPP alone, the combination significantly accelerated air leak cessation and shortened hospitalization, while achieving pleural symphysis without increasing major complications (trial registration number: Pan African Clinical Trials Registry, PACTR202505753650802).</p>","PeriodicalId":34499,"journal":{"name":"Journal of Chest Surgery","volume":" ","pages":"221-230"},"PeriodicalIF":1.5,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13542692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Salvage Repair Using an Esophagus-Conduit Segment In Situ as a Neo-Posterior Tracheal Wall for Multiple Tracheoesophageal and Trachea-Conduit Fistulas: A Case Report.","authors":"Ying Jie Cui, Hyunjin Cho","doi":"10.5090/jcs.26.058","DOIUrl":"10.5090/jcs.26.058","url":null,"abstract":"<p><p>Tracheoesophageal fistula (TEF) and trachea-conduit fistula (TCF) after esophagectomy are rare but life-threatening complications. Large or multiple fistulas are difficult to treat when standard resection and tracheal reconstruction are not feasible. A 70-year-old man developed an anastomotic stricture after Ivor-Lewis esophagectomy for squamous cell carcinoma and underwent repeated balloon dilatations and stent placement. Progressive tissue injury resulted in 1 TCF and 2 large TEFs. Salvage surgery included stent removal, distal conduit takedown, proximal conduit closure, substernal colon interposition, and esophagocolostomy. The esophagus-proximal gastric conduit segment containing the fistulas was preserved in situ as a neo-posterior tracheal wall. Oral intake was resumed after esophagography on postoperative day 6, and bronchoscopy confirmed a viable blind pouch. Preserving the esophagus-conduit segment in situ may provide effective airway-alimentary separation in selected patients with extensive multifocal TEF/TCF. In highly selected patients, this salvage option for airway-alimentary separation when standard resection and reconstruction carry prohibitive risk. Given the limited survival in this case, it is not intended as a definitive or broadly generalizable reconstruction.</p>","PeriodicalId":34499,"journal":{"name":"Journal of Chest Surgery","volume":" ","pages":"239-242"},"PeriodicalIF":1.5,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13542682/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Blunt Thoracic Trauma Prognosis: Validation of the Study of the Management of Blunt Chest Wall Trauma Score against Injury Severity Score in an Indonesian Tertiary Hospital.","authors":"Artono Isharanto, Eric Yayang Suhanda, Imam Suseno Bayuadi, Koernia Kusuma Wardhana, Gracelia Ruth Elisabeth Damanik, Chaidar Muttaqin","doi":"10.5090/jcs.25.143","DOIUrl":"10.5090/jcs.25.143","url":null,"abstract":"<p><strong>Background: </strong>Blunt thoracic trauma is a leading cause of trauma-related morbidity and mortality worldwide. Although the Injury Severity Score (ISS) is widely used to assess overall trauma severity, it lacks specificity for thoracic injuries. The Study of the Management of Blunt Chest Wall Trauma (STUMBL) score, which incorporates age, number of rib fractures, chronic lung disease, oxygen saturation, and pre-injury anticoagulant use, has not been validated in the Indonesian clinical setting.</p><p><strong>Methods: </strong>A prospective cohort study was conducted at Dr. Saiful Anwar General Hospital, Malang, Indonesia, between February 2024 and April 2025. Adult patients (≥18 years) with confirmed blunt thoracic trauma and a Glasgow Coma Scale score of 14-15 were included. Demographic, clinical, and radiologic variables were recorded, and ISS and STUMBL scores were calculated at admission. Outcomes included prolonged hospitalization (≥7 days), intensive care unit (ICU) admission, and in-hospital mortality. Statistical analyses included the Mann-Whitney U test and receiver operating characteristic curve analysis.</p><p><strong>Results: </strong>Among 371 patients, 75.7% were male, with a median age of 43 years. Road traffic accidents accounted for 69.5% of cases. ICU admission occurred in 18.3% of patients, and in-hospital mortality was 5.4%. Both ISS and STUMBL scores were significantly higher among patients with adverse outcomes (p<0.001 for all comparisons). The STUMBL score demonstrated superior predictive accuracy, with area under the curve (AUC) values of 0.896 for prolonged hospitalization, 0.894 for ICU admission, and 0.859 for in-hospital mortality. A cut-off >10.5 yielded sensitivities ranging from 70.0% to 74.1% and specificities ranging from 80.6% to 92.4%. In contrast, ISS demonstrated lower AUC values (0.753-0.802) and reduced discriminatory ability.</p><p><strong>Conclusion: </strong>The STUMBL score outperformed ISS in predicting prolonged hospitalization, ICU admission, and in-hospital mortality among patients with blunt thoracic trauma. Its application may improve early risk stratification and support clinical decision-making in Indonesian tertiary hospitals.</p>","PeriodicalId":34499,"journal":{"name":"Journal of Chest Surgery","volume":" ","pages":"202-210"},"PeriodicalIF":1.5,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13546859/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147724016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Thoracic Computed Tomography Imaging Sufficient for Evaluating a Solitary Pulmonary Nodule?","authors":"Tayfun Kermenli","doi":"10.5090/jcs.26.065","DOIUrl":"10.5090/jcs.26.065","url":null,"abstract":"","PeriodicalId":34499,"journal":{"name":"Journal of Chest Surgery","volume":" ","pages":"243-244"},"PeriodicalIF":1.5,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13542688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Management of Congenital Lung Malformations: Indications, Timing, and Outcomes.","authors":"Chang Hyun Kang","doi":"10.5090/jcs.26.066","DOIUrl":"10.5090/jcs.26.066","url":null,"abstract":"<p><p>Congenital lung malformations (CLMs) represent a heterogeneous group of developmental anomalies increasingly detected through prenatal imaging. The optimal management of asymptomatic patients remains controversial. This review summarizes current evidence regarding surgical indications, timing, techniques, and outcomes. Although some studies report low rates of symptom development, longer-term data suggest that many initially asymptomatic patients eventually become symptomatic and require surgery. Delayed intervention after infection is associated with increased operative difficulty and morbidity. Additionally, the potential risk of malignant transformation, though rare, supports consideration of early resection. Minimally invasive approaches, particularly thoracoscopic surgery, have demonstrated superior postoperative recovery, musculoskeletal outcomes, and pulmonary function compared with thoracotomy. While lung-sparing procedures are increasingly utilized, careful patient selection is essential to minimize residual disease. Overall, early elective resection using minimally invasive techniques appears safe and may optimize long-term outcomes in patients with CLMs.</p>","PeriodicalId":34499,"journal":{"name":"Journal of Chest Surgery","volume":" ","pages":"191-201"},"PeriodicalIF":1.5,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13542683/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Endothelial-Lined Blood Cyst Arising from the Tricuspid Papillary Muscle: A Case Report.","authors":"Do Hui Lee, Jong Pil Jung, Chang Ryul Park, Yong Jik Lee, Gwan Sic Kim","doi":"10.5090/jcs.26.069","DOIUrl":"https://doi.org/10.5090/jcs.26.069","url":null,"abstract":"<p><p>Cardiac blood cysts are rare benign lesions typically observed in neonates and infants; persistence into adulthood is uncommon. Involvement of the tricuspid subvalvular apparatus is particularly rare. We report the case of a 47-year-old woman with a cardiac blood cyst arising from the tricuspid subvalvular apparatus. This case underscores the need to consider cardiac blood cysts in the differential diagnosis of right-sided intracardiac masses in patients with nonspecific symptoms and demonstrates the feasibility of valve- and subvalvular apparatus-preserving surgical excision.</p>","PeriodicalId":34499,"journal":{"name":"Journal of Chest Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Outcomes between Valve-Sparing Root Replacement and the Bentall Procedure in Acute Stanford Type A Aortic Dissection: A Single-Center Retrospective Cohort Study in South Korea.","authors":"Saori Oshiro, Kitae Kim, Hong Rae Kim, Ho Jin Kim, Joon Bum Kim","doi":"10.5090/jcs.26.031","DOIUrl":"https://doi.org/10.5090/jcs.26.031","url":null,"abstract":"<p><strong>Background: </strong>Comparative evidence for valve-sparing root replacement (VSRR) versus the Bentall procedure in acute Stanford type A aortic dissection (ATAAD) remains limited. We compared early and long-term outcomes between these procedures.</p><p><strong>Methods: </strong>We retrospectively analyzed patients with ATAAD who underwent emergency aortic root intervention at Asan Medical Center (1994-2022), comparing VSRR with the Bentall procedure. Stabilized inverse probability of treatment weighting (IPTW) was applied using 6 prespecified clinically relevant covariates. Cox models analyzed all-cause mortality and the composite outcome, and Fine-Gray competing risk models analyzed stroke, infective endocarditis (IE), hemorrhagic events, and reoperation.</p><p><strong>Results: </strong>Among 82 patients undergoing aortic root intervention (VSRR, n=17; Bentall procedure, n=65), covariate balance improved after IPTW, with standardized mean differences <0.20 for prespecified covariates. Early outcomes showed no clear between-group differences. During a median follow-up of 6.02 years (interquartile range, 1.22-15.42 years), no significant between-group differences were found in all-cause mortality (hazard ratio [HR], 0.83; 95% confidence interval [CI], 0.29-2.33; p=0.718) or the composite outcome (HR, 0.70; 95% CI, 0.32-1.53; p=0.368). Competing risk analyses showed no clear differences in stroke (subdistribution HR [sHR], 0.90; 95% CI, 0.15-5.37; p=0.908), IE (sHR, 0.30; 95% CI, 0.004-21.34; p=0.582), hemorrhagic events (sHR, 0.68; 95% CI, 0.07-6.61; p=0.743), or reoperation (sHR, 0.13; 95% CI, 0.004-4.80; p=0.269).</p><p><strong>Conclusion: </strong>In this single-center ATAAD cohort requiring aortic root intervention, VSRR and the Bentall procedure showed no clear differences in adjusted outcomes. Longer follow-up and larger multicenter studies exploring anatomic and operative variables are warranted.</p>","PeriodicalId":34499,"journal":{"name":"Journal of Chest Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond Resectability: Molecular Selection for Salvage Surgery after Epidermal Growth Factor Receptor-Tyrosine Kinase Inhibitor Therapy in Non-Small Cell Lung Cancer.","authors":"Zurui Liu","doi":"10.5090/jcs.26.115","DOIUrl":"https://doi.org/10.5090/jcs.26.115","url":null,"abstract":"","PeriodicalId":34499,"journal":{"name":"Journal of Chest Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unexpected Coronary Malperfusion Requiring Bailout Coronary Artery Bypass Grafting after Valve-Sparing Aortic Root Replacement in a Patient with Anomalous Aortic Origin of a Coronary Artery: A Case Report.","authors":"Yoshiharu Mori, Shinji Kamiya, Mikako Yoshikawa, Hideki Sasaki","doi":"10.5090/jcs.26.077","DOIUrl":"https://doi.org/10.5090/jcs.26.077","url":null,"abstract":"<p><p>Valve-sparing aortic root replacement (VSRR) requires coronary button reimplantation, and anomalous coronary anatomy may increase the risk of unexpected coronary malperfusion. A 38-year-old man with Marfan syndrome underwent VSRR for aortic root aneurysm and severe aortic regurgitation. The right coronary artery arose anomalously from the left sinus of Valsalva. Despite apparently satisfactory reconstruction, severe myocardial ischemia developed after coronary reimplantation during weaning from cardiopulmonary bypass. Intraoperative reassessment revealed no obvious kinking or obstruction of the right coronary artery, and bougie passage confirmed luminal patency. Because the mechanism of malperfusion remained unclear, bailout coronary artery bypass grafting (CABG) was performed. Hemodynamics stabilized promptly, and postoperative imaging confirmed graft patency. Geometric alteration of a reimplanted coronary artery may result in dynamic malperfusion even when reconstruction appears technically satisfactory. When persistent ischemia occurs without an identifiable anatomical cause, early bailout CABG may provide a practical treatment option.</p>","PeriodicalId":34499,"journal":{"name":"Journal of Chest Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time-Dependent Associations of Structural and Electrical Failure with Survival after Mitral Valve Repair and Concomitant Atrial Fibrillation Ablation for Degenerative Mitral Valve Disease: A Single-Center Retrospective Cohort Study in South Korea.","authors":"Jeesoo Lee, Kitae Kim, Hong Rae Kim, Ho Jin Kim, Jae Suk Yoo, Sung-Ho Jung, Joon Bum Kim","doi":"10.5090/jcs.26.053","DOIUrl":"https://doi.org/10.5090/jcs.26.053","url":null,"abstract":"<p><strong>Background: </strong>We examined associations of structural and electrical failure with long-term survival after mitral repair with atrial fibrillation (AF) ablation for degenerative mitral prolapse, using time-dependent modeling.</p><p><strong>Methods: </strong>We analyzed 300 consecutive patients (age, 59.4±11.9 years; 34.7% female) undergoing degenerative mitral prolapse repair with surgical ablation. Structural failure was defined as postoperative severe mitral regurgitation (MR); electrical failure was defined as AF recurrence beyond a 3-month blanking period. Structural and electrical failures were modeled as time-varying covariates in Cox proportional hazards models evaluating mortality. Bidirectional time-dependent and landmark analyses assessed temporal interdependence.</p><p><strong>Results: </strong>During follow-up (median, 6.3 years), structural and electrical failures occurred at 4.1% and 5.7% per patient-year, respectively; death occurred at 1.1%/patient-year. Structural failure was independently associated with tricuspid regurgitation (TR) velocity (adjusted hazard ratio [aHR], 2.94; 95% confidence interval [CI], 1.79-4.83) and anterior leaflet prolapse (aHR, 3.10; 95% CI, 1.18-8.12). Electrical failure was independently associated with age (aHR, 1.53; 95% CI, 1.19-1.98), left atrial diameter (aHR, 1.06; 95% CI, 1.04-1.08), and severe TR (aHR, 6.24; 95% CI, 2.15-18.11). In the time-dependent analysis, severe MR independently predicted mortality (aHR, 2.54; 95% CI, 1.01-6.38), whereas AF recurrence did not (aHR, 0.97; 95% CI, 0.24-3.97). Bidirectional analyses showed no significant temporal association between structural and electrical failures.</p><p><strong>Conclusion: </strong>Among patients with degenerative mitral prolapse undergoing mitral repair with concomitant AF ablation, structural valve failure, but not electrical recurrence, was associated with increased long-term mortality. Structural and electrical failures showed no significant temporal association.</p>","PeriodicalId":34499,"journal":{"name":"Journal of Chest Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}