European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery最新文献

{"title":"EACTS Expert Consensus Document on Lung Volume Reduction for Emphysema.","authors":"David Waller, Vasileios Kouritas, Ben Shanahan, Claudio Caviezel, Ruxandra-Iulia Milos, Sara Buttery, Paula Browne, Samuel V Kemp, Thomas Egenod, Laurens J Ceulemans, Korkut Bostanci","doi":"10.1093/ejcts/ezag226","DOIUrl":"https://doi.org/10.1093/ejcts/ezag226","url":null,"abstract":"<p><p>Emphysema is a major burden for health care, both in terms of use of hospital resources and of community services. Medical therapies are limited and may only palliate symptoms, whereas lung volume reduction (LVR) has been shown to provide further benefit for those on maximal medical therapy who meet the selection criteria. However, LVR remains a considerably underutilized intervention partly due to a paucity of practice guidelines. Lung volume reduction can be obtained by 2 main methods: Lung volume reduction surgery (LVRS) and endobronchial lung volume reduction (EBLVR). There have been expert statements on EBLVR, but this is the first multidisciplinary statement also to consider lung volume reduction surgery (LVRS). In a comprehensive, literature-based review, all aspects of LVR are considered. Selection criteria for both LVR methods are simplified as far as possible, and advice is given to aid multidisciplinary decision-making. Each technique is individually examined with technical points and practice advice, and the factors determining when either is used are explained. Where no clear comparative evidence is available, the pros and cons of each debate are clearly illustrated. The inter-relationship with a lung transplant is explored in a constructive, collaborative way. The benefits of LVR are detailed, but importantly, so are the perioperative risks. Clear management plans are outlined utilizing the multidisciplinary team. Finally, the importance of and recommendations for follow-up protocols are stated. This unique initiative brings together experts from across the disciplines involved in offering lung volume reduction, and a consensus has been achieved in all aspects, indicating the widespread implications for the statements.</p>","PeriodicalId":520617,"journal":{"name":"European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122750","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":"EACTS Expert Consensus Document on Iatrogenic Aortic Dissection.","authors":"Maximilian Luehr, Gaik Nersesian, Leonard Pitts, Luca Di Marco, Julia Dumfarth, Christoph A Nienaber, Maciej K Kolowca, Marie Elisabeth Stelzmüller, Milan Milojevic, Martin Czerny, Florian Schoenhoff, Evgenij Potapov","doi":"10.1093/ejcts/ezag221","DOIUrl":"https://doi.org/10.1093/ejcts/ezag221","url":null,"abstract":"<p><p>Iatrogenic aortic dissection (IAD) is a rare but life-threatening complication of open cardiac surgical procedures and catheter-based interventions, associated with high morbidity and mortality. With an ageing population and increasing procedural complexity, the absolute burden of IAD is expected to rise. Unlike spontaneous aortic dissection, IAD typically results from direct intimal injury during cannulation, clamping, catheter manipulation, or device deployment-while its clinical course is strongly influenced by the procedural context and the speed of recognition. Evidence to guide the management of IAD remains limited and is largely derived from registries and observational reports, contributing to substantial variation in diagnostic and therapeutic strategies. This European Association for Cardio-Thoracic Surgery Expert Consensus Document provides the first dedicated, multidisciplinary guidance on IAD, covering definitions and classification, risk factors, prevention, early diagnosis, acute management pathways, and post-discharge surveillance. The document synthesizes available evidence in the literature and expert opinions to offer practical, procedure-specific guidance and algorithms for IAD treatment. The guidance and algorithms include recommendations for rapid identification, containment, and timely surgical or endovascular repair of IAD, as well as conservative management strategies when appropriate, with the aim of supporting clinical decision-making and ultimately improving patient outcomes.</p>","PeriodicalId":520617,"journal":{"name":"European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122734","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":"Cardiac Surgery Training in Europe: Time for a Common Pathway.","authors":"Salvatore Poddi, Lucrezia Puglisi, Cynthia L Lefter, Hussam Al Hussein, Alessio Rungatscher","doi":"10.1093/ejcts/ezag220","DOIUrl":"https://doi.org/10.1093/ejcts/ezag220","url":null,"abstract":"","PeriodicalId":520617,"journal":{"name":"European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery","volume":"68 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148429","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":"Outcomes and Prognostic Factors in Primary Thoracic Malignant Peripheral Nerve Sheath Tumours: A Multicentre Study.","authors":"Giovanni Leuzzi, Federica Sabia, Clarissa Uslenghi, Elena Palassini, Alessandro Gronchi, Stefano Margaritora, Filippo Lococo, Giuseppe Marulli, Emanuela Re Cecconi, Enrico Ruffini, Francesco Guerrera, Francesco Leo, Federico Vaisitti, Ivan Lomangino, Giacomo Grisorio, Alberto Terminella, Giacomo Cusumano, Edoardo Mercadante, Felicita Corzani, Andrea Dell'Amore, Giorgio Cannone, Marco Lucchi, Vittorio Aprile, Erino Angelo Rendina, Giulio Maurizi, Giuseppe Cardillo, Sara Ricciardi, Francesco Petrella, Andrea Cara, Piergiorgio Solli","doi":"10.1093/ejcts/ezag222","DOIUrl":"https://doi.org/10.1093/ejcts/ezag222","url":null,"abstract":"","PeriodicalId":520617,"journal":{"name":"European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery","volume":"68 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149140343","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":"Minimally-invasive tricuspid valve operations: three decades of Leipzig experience.","authors":"Piotr Mazur, Konstantinos Papakonstantinou, Jagdip Kang, Sergey Leontyev, Alexey Dashkevich, Thomas Schröter, David Holzhey, Thilo Noack, Philipp Kiefer, Mateo Marin-Cuartas, Michael A Borger","doi":"10.1093/ejcts/ezag238","DOIUrl":"https://doi.org/10.1093/ejcts/ezag238","url":null,"abstract":"<p><strong>Objectives: </strong>Data on minimally invasive tricuspid valve surgery for severe tricuspid regurgitation remain limited, particularly regarding long-term outcomes.</p><p><strong>Methods: </strong>This retrospective single-center study included adult patients who underwent minimally invasive tricuspid valve surgery through right mini-thoracotomy for severe tricuspid regurgitation as the primary indication between 1996 and 2024. Patients with endocarditis or tricuspid stenosis, as well as those undergoing left-sided valve surgery, were excluded. The primary endpoint was all-cause mortality during follow-up.</p><p><strong>Results: </strong>A total of 199 patients with a median age of 70.0 years, including 110 (55%) women, were analyzed. Sixty-four (32%) had previous cardiac surgery. Median EuroSCORE II was 3.6% (1.8-6.0) and median TRI-SCORE-predicted mortality was 5.0% (3.0-14.0). Three patients (1.5%) required conversion to sternotomy. Tricuspid valve repair was performed in 108 patients (54%). In-hospital mortality was 6% for the entire cohort (12/199). Discharge echocardiography demonstrated no or mild residual tricuspid regurgitation in 176/194 patients (91%). Estimated overall survival was 85% (95% confidence interval, 80-90%) at 1 year, 69% (62-75%) at 5 years, and 53% (46-61%) at 10 years. Repeat tricuspid valve surgery was recorded in 7 patients (4%). In multivariable analysis, older age, male sex, urgent/emergent operation, atrial fibrillation/flutter, diabetes mellitus, signs of right heart failure, lower glomerular filtration rate and lower preoperative hemoglobin independently predicted mortality.</p><p><strong>Conclusions: </strong>Minimally invasive tricuspid valve surgery for severe tricuspid regurgitation was associated with low conversion rates and provided good early and late outcomes. Repair was performed in over half of patients.</p>","PeriodicalId":520617,"journal":{"name":"European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122891","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":"Autologous blood pleurodesis for postoperative air leakage following video-assisted thoracoscopic surgery-a randomized controlled trial.","authors":"Finn Amundsen Dittberner, Thomas Decker Christensen, Peter Bjørn Licht","doi":"10.1093/ejcts/ezag235","DOIUrl":"https://doi.org/10.1093/ejcts/ezag235","url":null,"abstract":"<p><strong>Objectives: </strong>Postoperative air leakage following lung surgery prolongs chest drainage duration and length of hospitalization and the evidence regarding treatment with autologous blood pleurodesis (ABP) is scarce. We decided to investigate if ABP would influence postoperative air leakage when used on the first postoperative day following elective video-assisted thoracoscopic surgery (VATS).</p><p><strong>Methods: </strong>In this multicenter randomized controlled trial, patients with an air leakage greater than 40 ml/min during cough and mobilization on their first postoperative day following elective VATS were randomized 1:1 to standard chest drain management with or without ABP (stratified by lobectomy or wedge resection). The chest drain was removed after standardized digital drainage criteria, and the primary endpoint was time to chest drain removal. Patients with persistent air leakage beyond postoperative day 7 were censored to allow for individualized management.</p><p><strong>Results: </strong>A total of 268 patients were randomized (134 in each group), after lobectomy (n = 238) or wedge (n = 30). Median chest drain duration was 3.4 days (95% CI 3.0-4.9) in the ABP group versus 5.0 days (95% CI 4.0-6.8) in the control group (p = 0.007). By postoperative day 7, chest drains had been removed in 74% versus 62% of patients, respectively. ABP significantly increased the rate of chest drain removal (HR 1.49, 95% CI 1.11-2.01; p = 0.007). The treatment effect was consistent across both participating centers.</p><p><strong>Conclusion: </strong>Early autologous blood pleurodesis significantly shortens chest drain duration in patients with postoperative air leakage following VATS. This simple and low-cost intervention should be considered in Enhanced Recovery After Surgery protocols after thoracic surgery.</p>","PeriodicalId":520617,"journal":{"name":"European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122745","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 tumour size: Integrating tumour biology and technical quality to select the extent of resection in early-stage NSCLC.","authors":"Alessandro Brunelli","doi":"10.1093/ejcts/ezag228","DOIUrl":"https://doi.org/10.1093/ejcts/ezag228","url":null,"abstract":"<p><strong>Objective: </strong>Randomized trials have established anatomical segmentectomy as an acceptable alternative to lobectomy for selected patients with peripheral, node-negative NSCLC ≤2 cm. However, trial populations were highly selected, and tumour diameter alone does not capture the biological heterogeneity of early-stage disease.</p><p><strong>Methods: </strong>A structured search of Undermind and PubMed identified comparative studies, randomized trials, meta-analyses and consensus evidence available through 10 August 2026. Evidence was critically appraised and synthesized narratively, with emphasis on recurrence, survival, staging and technical quality.</p><p><strong>Results: </strong>Segmentectomy provides excellent outcomes when adequate margins, anatomical completeness and rigorous nodal assessment are achieved. GGO-dominant tumours, particularly those with low consolidation-to-tumour ratio, represent the strongest candidates for parenchymal preservation. Increasing CTR, pure-solid morphology, larger size, high FDG uptake, micropapillary or solid histology, STAS, VPI and LVI identify progressively higher-risk phenotypes, but none alone consistently proves that lobectomy improves survival. Micropapillary components exceeding approximately 5%, STAS, inadequate margins, incomplete staging and multiple coexisting adverse features strengthen the rationale for lobectomy. Segmentectomy is generally preferable to wedge resection for solid, deeper or biologically aggressive lesions, whereas wedge resection remains reasonable for carefully selected small, peripheral, GGO-dominant tumours. The favourable results of randomized trials depend on accurate preoperative and intraoperative staging and should not be generalized to unselected cT1c or biologically aggressive tumours.</p><p><strong>Conclusions: </strong>Sublobar resection should be viewed as refined selection rather than replacement of lobectomy. Tumour size defines eligibility, but biology increasingly determines suitability. Precision surgery will require prospective validation of integrated models combining morphology, metabolism, pathology, molecular biomarkers, patient physiology and technical quality.</p>","PeriodicalId":520617,"journal":{"name":"European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042669","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":"Minimally invasive mitral valve surgery: Current evidence and best practice models.","authors":"Serdar Akansel, Markus Kofler, Joerg Kempfert, Volkmar Falk","doi":"10.1093/ejcts/ezag227","DOIUrl":"https://doi.org/10.1093/ejcts/ezag227","url":null,"abstract":"<p><strong>Objectives: </strong>Minimally invasive mitral valve surgery (MI-MVS) has evolved into a widely adopted surgical strategy for the treatment of mitral valve disease. This narrative review summarizes, the importance of preoperative diagnostic work-ups, contemporary surgical techniques, perioperative management, learning curve considerations, and future perspectives of MI-MVS.</p><p><strong>Methods: </strong>A review of currently available literature on MI-MVS was performed, focusing on direct-vision, video-assisted, fully endoscopic, and robotic-assisted approaches. Best practice models regarding preoperative imaging, cannulation strategies, myocardial protection, mitral valve repair techniques, perioperative management, and Enhanced Recovery After Surgery (ERAS) protocols as well as important clinical outcome measures are discussed.</p><p><strong>Results: </strong>MI-MVS provides reduced surgical trauma, shorter hospitalization, lower infection rates, and a faster recovery. Video-assisted right mini-thoracotomy remains the most commonly adopted approach, whereas fully endoscopic and robotic-assisted techniques continue to expand. Routine preoperative contrast-enhanced computed tomography improves patient selection as well as procedural planning and reduces the risk of stroke. Careful patient selection and structured mentorship are essential to overcome the learning curve.</p><p><strong>Conclusions: </strong>MI-MVS has become an established and effective treatment strategy for mitral valve disease in experienced centers. Ongoing advances in surgical technology, imaging tools, ERAS protocols, and robotic platforms are expected to further expand its global adoption. Standardized training pathways, careful patient selection, and experienced institutional mentorship remain critical for optimizing clinical outcomes.</p>","PeriodicalId":520617,"journal":{"name":"European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149032959","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":"TricValve system implantation in patients with cardiac implantable electronic devices: A multicentre observational study.","authors":"Kira Osipenko, Iuliana Coti, Paul Werner, Amila Kahrovic, Luis Nombela Franco, Ignacio J Amat Santos, Amir A Mahabadi, Christian Frerker, Federico De Marco, Jan Althoff, Antonio Mangieri, Javier Martín Moreiras, Nikola Pavlović, Joachim Schofer, Ulrich Schäfer, Eike Tigges, Christoph Wilde, Jörg Hausleiter, Omar Abdul-Jawad Altisent, Maurizio Taramasso, Luis Fernando Pajín Valbuena, Joško Bulum, Santiago Ordoñez, Martin Swaans, João Silva Marques, Boris Dickmann, Birgit Zirngast, Daniel Zimpfer, Martin Andreas","doi":"10.1093/ejcts/ezag224","DOIUrl":"https://doi.org/10.1093/ejcts/ezag224","url":null,"abstract":"<p><strong>Objectives: </strong>Tricuspid regurgitation (TR) is associated with high morbidity and mortality. The TricValve bicaval valve system has emerged as a transcatheter option for patients with severe symptomatic TR who are not candidates for surgery or orthotopic interventions. However, its safety in patients with pre-existing cardiac implantable electronic devices (CIED) remains uncertain due to potential lead-related complications. This study aims to evaluate the feasibility and safety of TricValve implantation in patients with pre-existing CIED, with particular focus on lead-related complications and the need for lead extraction or repositioning.</p><p><strong>Methods: </strong>We conducted a multicentre retrospective study including 65 patients with pre-implanted CIED who underwent TricValve implantation between May 2023 and November 2024 at 23 international centres. Pre-procedural computed tomography and echocardiography were analyzed to assess device interaction, lead positioning, and complications. The primary endpoint was procedural safety, including lead-related events and the need for lead extraction or repositioning during intervention. Secondary endpoints included echocardiographic outcomes, CIED/non-CIED-related complications and survival during follow-up of 159 days (IQR 60-358 days).</p><p><strong>Results: </strong>TricValve implantation was technically successful in all patients (100%). Periprocedural no lead extraction or repositioning was required. Lead-related complications occurred in 4 patients (6.2%). No procedural deaths or TricValve malfunctions were observed. Post-implantation imaging confirmed stable lead positioning in all remaining cases.</p><p><strong>Conclusions: </strong>TricValve implantation in patients with pre-existing CIED appears feasible. Lead-related complications during early follow-up were rare, manageable, and did not compromise device function or procedural success. Our data do not support routine prophylactic lead extraction before TricValve implantation.</p>","PeriodicalId":520617,"journal":{"name":"European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148979076","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":"Early recurrence patterns after neoadjuvant chemoradiotherapy and chemoimmunotherapy in esophageal squamous cell carcinoma: A multicenter study.","authors":"Cien Sun, Chunji Chen, Hua Sun, Hao Liu, Qianyi Chen, Zimin Wang, Jiawen Chen, William C Cho, Zhigang Li, Zhichao Liu, Dehua Ma, Minhua Ye, Chunguo Wang, QinYa Wang, Xuefeng Leng, Yongtao Han, Qifeng Wang, Jiahua Lv, Hainan Chen, Jinbo Zhao, Xiaolong Yan, Huilai Lv, Ziqiang Tian, Changchun Wang, Liwei Xu, Youhua Jiang, Zhengyang Zhang, Qihong Zhong, Jiangbo Lin, Xinyu Mei, Xiaoyang Li, Dong Qian, Chengchu Zhu, Xufeng Guo, Jianfei Shen","doi":"10.1093/ejcts/ezag219","DOIUrl":"https://doi.org/10.1093/ejcts/ezag219","url":null,"abstract":"<p><strong>Objective: </strong>To compare early recurrence patterns and survival outcomes between neoadjuvant chemoimmunotherapy (NCIT) and neoadjuvant chemoradiotherapy (NCRT) in patients with locally advanced esophageal squamous cell carcinoma (ESCC).</p><p><strong>Methods: </strong>This retrospective cohort study included 1428 patients with stage IIB-IVA ESCC who underwent NCIT or NCRT followed by radical surgery. Outcomes included overall survival (OS), recurrence-free survival (RFS), locoregional recurrence, distant metastasis, and post-recurrence survival (PRS). Propensity score matching (1:1 ratio, 0.1 caliper; balance threshold: standardized mean difference <0.10) and multivariable Cox regression were utilized.</p><p><strong>Results: </strong>After propensity score matching (532 patients per group), the NCIT group exhibited better 3-year OS (72.2% vs 60.9%; hazard ratio [HR], 0.69; 95% confidence interval [CI], 0.56-0.85; P < .001) and RFS (67.8% vs. 59.3%; HR, 0.70; 95% CI, 0.57-0.86; P < .001) than the NCRT group. The NCIT group also had lower rates of early overall recurrence (131 [24.6%] vs. 196 [36.8%]; P < .001) and early distant metastasis (73 [13.7%] vs. 125 [23.5%]; P < .001) than the NCRT group. Multivariable regression analysis identified NCRT (vs NCIT), higher ypN stage, and not achieving a major pathological response as independent risk factors for both early overall recurrence and early distant metastasis. Among patients who experienced early recurrence, PRS did not differ between the two modalities (HR, 0.81; 95% CI, 0.63-1.04; P = .086). Although the NCRT group had a higher major pathological response rate, NCIT was associated with better early recurrence control even among patients achieving major pathological response (HR, 0.61; 95% CI, 0.47-0.84; P < .001).</p><p><strong>Conclusions: </strong>Compared with NCRT, NCIT is associated with a lower incidence of early recurrence, particularly distant metastasis, which may contribute to the observed OS advantage. The poor prognosis after early recurrence highlights the need for intensified postoperative surveillance in high-risk patients.</p>","PeriodicalId":520617,"journal":{"name":"European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914620","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}