Interdisciplinary cardiovascular and thoracic surgery最新文献

{"title":"The ethical considerations of integrating artificial intelligence into surgery: a review.","authors":"Arian Arjomandi Rad, Robert Vardanyan, Thanos Athanasiou, Jos Maessen, Peyman Sardari Nia","doi":"10.1093/icvts/ivae192","DOIUrl":"10.1093/icvts/ivae192","url":null,"abstract":"<p><p>The integration of artificial intelligence (AI) into surgery raises significant ethical concerns, including the impact on autonomy, human authority and the patient-doctor relationship. This study underscores the need for a multidisciplinary approach to navigate these ethical dilemmas, involving stakeholders from various fields. A comprehensive literature review up to March 2024 was conducted to assess the ethical implications of AI applications in surgery. This included an examination of data privacy, informed consent, algorithmic bias, the role of advanced robotics, and the impact on surgeons' decision-making. The study also considered the development of autonomous surgical robots and their ethical implications. The review highlights that while AI can enhance surgical precision and improve clinical decision-making, it also poses several ethical challenges. AI's ability to support decision-making risks undermining surgeons' autonomy and judgement, raising concerns about over-reliance on technology. Issues such as data privacy, algorithmic bias and equitable access to AI-driven tools were identified as key ethical concerns. Autonomous surgical robots, while promising, introduce complex questions about accountability and liability, particularly when unexpected outcomes occur. Effective integration of AI into surgical practices demands the development of ethical frameworks that respect both the capabilities of AI and the irreplaceable value of human judgement. Balancing technological advancement with ethical integrity is essential to safeguard patient-centred care and ensure equitable access to AI benefits in healthcare.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11904299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143506540","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":"Impact of non-significant right coronary ostial involvement on coronary events in type A aortic dissection surgery.","authors":"Ling-Chen Huang, Xiang-Min Hu, Ai-Kai Zhang, Ze-Hua Shao, Yang-Xue Sun, Dong Zhao, Yi Chang, Xiang-Yang Qian, Hong-Wei Guo","doi":"10.1093/icvts/ivaf035","DOIUrl":"10.1093/icvts/ivaf035","url":null,"abstract":"<p><strong>Objectives: </strong>Coronary-related technical complications constantly occur during type A aortic dissection surgical repair and are potentially fatal, yet their risk factors require further investigation. The intricate morphology of coronary ostial involvement may have a substantial impact.</p><p><strong>Methods: </strong>From June 2019 to January 2024, consecutive type A aortic dissection patients who underwent open surgery were included. Patients were divided into the coronary involvement group (non-significant involvement: Neri A-dissected intima involving the margin of the coronary ostium; significant involvement: Neri B and Neri C) and the non-involvement group. Coronary events were defined as coronary-related technical complications necessitating bailout coronary revascularization or coronary ostial repair. Logistic regression analysis identified risk factors associated with coronary events. Overall survival was estimated using Kaplan-Meier method and Cox regression analysis.</p><p><strong>Results: </strong>Of 1168 patients, 660 patients had coronary involvement, while 508 did not. Coronary events occurred in 58 patients (4.97%), including 53 (4.54%) who required bailout coronary revascularization. Patients with coronary involvement had a higher incidence of coronary events (8.18% vs 0.79%, P < 0.001). Logistic regression analysis revealed that significant right coronary involvement was associated with coronary events (odds ratio: 20.58, 95% confidence interval: 7.37-57.50, P < 0.001). Notably, non-significant right coronary involvement, accounting for 44.61% of patients, was also associated with coronary events compared to those without involvement (odds ratio: 7.05, 95% confidence interval: 2.69-18.50, P < 0.001).</p><p><strong>Conclusions: </strong>Coronary events occurred in 4.97% patients. Significant right coronary involvement is strongly associated with coronary events; non-significant right coronary involvement, which is relatively common in surgical patients, also poses a substantial risk for coronary events and warrants attention.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11922551/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484641","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":"Impact of annulus-cusp mismatch on mid-term outcomes of aortic valve repair with valve-sparing aortic root replacement.","authors":"Go Yamashita, Atsushi Sugaya, Jiro Sakai, Shingo Hirao, Tatsuhiko Komiya","doi":"10.1093/icvts/ivaf048","DOIUrl":"10.1093/icvts/ivaf048","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to investigate mid-term outcomes of aortic valve repair with valve-sparing aortic root replacement based on different grades of annulus-cusp mismatch and identify optimal aortic root geometries for this procedure.</p><p><strong>Methods: </strong>A retrospective analysis was conducted between October 2011 and July 2022. Patients were stratified into three groups based on predicted coaptation length calculated using an annulus-cusp mismatch formula: no-mismatch (coaptation length > 4 mm, n = 52), mild-mismatch (2 mm ≤ coaptation length ≤ 4 mm, n = 28) and severe-mismatch (coaptation length < 2 mm, n = 25), and mid-term outcomes were compared.</p><p><strong>Results: </strong>We included 105 patients who underwent valve-sparing root replacement using the reimplantation technique. During the median follow-up of 6.0 years, 21 moderate aortic valve regurgitation events and 6 reoperation events were observed. No significant inter-group differences in overall survival or cumulative incidence of cardiac death or hospitalization for heart failure were observed. However, the groups significantly differed in the cumulative incidence of moderate aortic regurgitation at 5 years (2.0%, 14.8% and 60.1% for no-mismatch, mild-mismatch and severe-mismatch groups, respectively; P < 0.001) and cumulative incidence of reoperation at 5 years (0%, 0% and 11.8%, respectively; P = 0.002).</p><p><strong>Conclusions: </strong>Our findings suggest that severe annulus-cusp mismatch is associated with higher rates of valve regurgitation and reoperation following aortic valve repair with valve-sparing aortic root replacement; however, larger studies are needed for confirmation. Preoperative computed tomography-based assessment of annulus-cusp mismatch shows promise in surgical planning and patient selection for aortic valve repair procedures.</p><p><strong>Clinical registration number: </strong>4392.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11906396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560256","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":"Relationship of pulmonary artery size and venovenous collaterals during staged single ventricle reconstruction and their impact on outcomes after Fontan procedure.","authors":"Teresa Lemmen, Thibault Schaeffer, Takuya Osawa, Carolin Niedermaier, Jonas Palm, Nicole Piber, Muneaki Matsubara, Paul Philipp Heinisch, Stanimir Georgiev, Alfred Hager, Peter Ewert, Jürgen Hörer, Masamichi Ono","doi":"10.1093/icvts/ivaf070","DOIUrl":"10.1093/icvts/ivaf070","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to evaluate the relationship between pulmonary artery size and venovenous collaterals (VVCs) during staged single ventricle reconstruction.</p><p><strong>Methods: </strong>Patients who underwent staged Fontan palliation between 2003 and 2023 were reviewed. The relationship between the pulmonary artery index and the development of VVCs was determined. Furthermore, the impact of pulmonary artery index and VVCs on in-hospital morbidities after the Fontan procedure was evaluated.</p><p><strong>Results: </strong>A total of 377 patients were included. Median age at bidirectional cavopulmonary shunt (BCPS) and total cavopulmonary connection (TCPC) were 4.2 (3.3-6.2) months and 2.1 (1.7-2.6) years, respectively. VVCs were observed in 51 (13.5%) of the patients. Patients who developed VVCs showed higher pulmonary artery pressure (P = 0.024), higher transpulmonary gradient (P = 0.042), lower pulmonary artery index (P = 0.016) and lower right pulmonary artery index (P = 0.011) at the time of BCPS, compared to those without. However, the pulmonary artery index was similar in patients with and without VVCs at the time of TCPC. Higher transpulmonary gradient (P = 0.007) and lower pulmonary artery symmetry index (P = 0.032) at BCPS were identified as independent risks for developing VVCs. The existence of VVCs did not influence the postoperative course after TCPC. Notably, pulmonary artery symmetry index at BCPS was identified as an independent risk for prolonged pleural effusion (P = 0.018) and for chylothorax (P = 0.021).</p><p><strong>Conclusions: </strong>A small and unbalanced pulmonary artery at BCPS is associated with the postoperative development of VVCs.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143635012","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":"A three-dimensional model of aortic dissection for hybrid surgical simulation and training.","authors":"Mamoru Arakawa, Koji Kawahito","doi":"10.1093/icvts/ivaf044","DOIUrl":"10.1093/icvts/ivaf044","url":null,"abstract":"<p><p>Thoracic endovascular aortic repair is widely performed in complicated and uncomplicated type B aortic dissection cases. After the introduction of a stent graft, the use of several types of hybrid approaches has been reported for patients with type A aortic dissection. The procedure is advanced because the complications are fatal; therefore, training is required. However, the surgical simulation of aortic dissection is challenging because no favourable animal model is available. This study aimed to simulate hybrid surgical simulation using a novel three-dimensional aortic dissection model. Three-dimensional polyurethane models of type A and B aortic dissection, both of which have true and false lumens, were manufactured based on computed tomography data. Under fluoroscopy, the entry tear and false lumen flows were visualized using a contrast medium. A stent graft was delivered and deployed under pulsatile conditions in the type B aortic dissection model. Total arch replacement was performed in the type A and B aortic dissection models after thoracic endovascular aortic repair as a hybrid approach. In conclusion, a model with a mock circuit is a useful tool to simulate both open and endovascular aortic repair for aortic dissections as a hybrid approach.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560267","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":"Validation of the German registry of acute aortic dissection type A score for predicting 30-day mortality after acute type A aortic dissection surgery in a single Japanese aortic centre.","authors":"Shinsuke Kotani, Genichi Sakaguchi","doi":"10.1093/icvts/ivaf037","DOIUrl":"10.1093/icvts/ivaf037","url":null,"abstract":"<p><strong>Objectives: </strong>This study evaluated the applicability of the German Registry of Acute Aortic Dissection Type A (GERAADA) score in predicting 30-day mortality in Japanese patients undergoing surgery for acute type A aortic dissection (ATAAD) and compared its predictive performance with that of the European System for Cardiac Operative Risk Evaluation II (EuroSCORE II).</p><p><strong>Methods: </strong>This single-centre retrospective study involved 154 patients who underwent emergency surgery for ATAAD between January 2019 and April 2024. The GERAADA and EuroSCORE II were calculated for each patient. Predictive accuracy for 30-day mortality was assessed using the area under the receiver operating characteristic curve (AUC). A multivariate logistic regression identified independent predictors of mortality, and long-term outcomes were evaluated using Kaplan-Meier analysis.</p><p><strong>Results: </strong>The 30-day mortality rate was 11.0%. The GERAADA score showed an AUC of 0.80, indicating good discriminatory ability, while the EuroSCORE II demonstrated moderate performance with an AUC of 0.67 (P = 0.07). The GERAADA score significantly overestimated mortality in this cohort, whereas the EuroSCORE II underestimated it. Independent predictors of mortality included the use of catecholamines at referral. Kaplan-Meier analysis revealed a 1-year survival rate of 79.4% with an AUC of 0.72, demonstrating the GERAADA score's utility as a predictor of long-term survival.</p><p><strong>Conclusions: </strong>The GERAADA score provides accurate predictions of 30-day mortality in Japanese patients undergoing ATAAD surgery, comparable to the EuroSCORE II. This score demonstrates robust predictive ability for short- and long-term outcomes and may serve as a practical tool for risk stratification in ATAAD surgery.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11882300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484653","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":"Neonatal enlargement of the aortic arch roof without cardiopulmonary bypass using ductal patency for lower body perfusion: impact on long-term growth, function and shape of the aortic arch†.","authors":"Luigi Di Pasquale, Barbara Burkhardt, Julia Selena Beck, Martin Schweiger, Robert Cesnjevar, Hitendu Dave","doi":"10.1093/icvts/ivaf042","DOIUrl":"10.1093/icvts/ivaf042","url":null,"abstract":"<p><strong>Objectives: </strong>This study evaluates the long-term outcome of neonatal aortic arch roof enlargement using ductal patency in the context of coarctation associated with aortic arch hypoplasia.</p><p><strong>Methods: </strong>Retrospective single-centre analysis of children undergoing roof enlargement of the distal arch (left common carotid artery-left subclavian artery) without cardiopulmonary bypass (utilizing ductal patency for lower body perfusion); followed by resection and extended end-to-end anastomosis, through a left posterior thoracotomy. This study evaluates the long-term outcome with emphasis on arch growth and shape.</p><p><strong>Results: </strong>Thirty consecutive patients were included (2006-24). Median age and weight were 6.0 [interquartile range: 4.0-7.8)] days and 3.1 (2.7-3.5) kg, respectively. Simple congenital heart disease with simple intracardiac shunts (n = 17) and complex congenital heart disease (Complete Atrioventricular Septal Defect (AVSD), interrupted aortic arch and univentricular hearts) (n = 13) constituted the cohort. Non-ischaemic clamp time for roof enlargement was 43 (36-50) min. Ischaemic clamp time for coarctation resection was 23 (21-25) min. Pulmonary artery banding was performed in 19 (63.3%) patients. Twenty-seven (90%) successfully underwent staged repair at 6.1 (4.5-8.2) months age. Follow-up was complete at a median duration of 46.9 (21.7-159.9) months. All patients survived the operation and are in good health at follow-up. Median ventilation time, ICU and hospital stay were 1 (1-2), 3 (2-5) and 23.5 (14-40) days, respectively. No patient developed any neurological complication. Three developed left subclavian artery thrombosis, one requiring surgical revision. With one unrelated late accidental death 14 years after neonatal repair, Kaplan-Meier survival was 90.9 [50.8-98.7]% at 15 years. Two patients underwent arch re-enlargement at the inner curvature to accommodate the DKS during stage 2, resulting in freedom from reoperation of 93.3[75.9-98.3]% at 10 years. All survivors enjoy subjective normal exercise tolerance with no relevant gradient. No patient is on anti-hypertensive medication. Median Z value of the proximal, transverse and distal arch was normalized to -0.88 (-2.19 to -0.12), -0.66(-1.33 to 0.08) and 0.34 (-0.10 to 1.33), respectively, at the last follow-up. Twenty-three (76.7%) arches achieved Romanesque shape at follow-up.</p><p><strong>Conclusions: </strong>Long-term results of this minimally invasive approach show proportional growth without relevant gradient, freedom from hypertension and a Roman arch form, thus making it the preferred approach.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560276","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":"Full-root aortic valve replacement using Medtronic Freestyle bioroots for infective endocarditis.","authors":"Emilien Philippe Ruchonnet, Laura Didisheim, Matthaios Papadimitriou-Olivgeris, Pierre Monney, Lars Niclauss, René Prêtre, Matthias Kirsch, Ziyad Gunga","doi":"10.1093/icvts/ivaf034","DOIUrl":"10.1093/icvts/ivaf034","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to explore the potential efficacy of the Freestyle Medtronic bioroot in the treatment of aortic endocarditis, based on our single-centre experience.</p><p><strong>Methods: </strong>In this retrospective study conducted between 2015 and 2023, adult patients who underwent aortic root replacement with coronary arteries reimplantation using the modified Bentall technique with a Medtronic Freestyle bioroot in our centre for infective endocarditis were included.</p><p><strong>Results: </strong>Thirty patients, with five deaths, no cases of relapse and two cases of reinfection, were included, and prosthetic valve endocarditis represented 73.3% of cases. The median age was 66 years (IQR 14.5 years), and 24/30 (80%) were male. Median EuroSCORE II was 12.2% (IQR 13.9%). The most commonly identified pathogen was Staphylococcus aureus (eight cases; 23.3%). Fourteen additional procedures were performed on 12 patients. Annular abscess was present in 73.3% of cases and required annulus patch repair in 13/22 (59%). Early reoperation rate was 20%, mostly for surgical bleeding. One- and 5-year actuarial survival rates were 90.0 and 82.2%, respectively. There were no cases of relapse, and reinfection-free survival was 86.7% at 1 year and 75.5% at 5 years. Postoperative mean and maximal transvalvular gradients were 7 (IQR 3.3 mmHg) and 14.6 mmHg (IQR 4.6 mmHg), respectively.</p><p><strong>Conclusions: </strong>The Medtronic Freestyle bioroot could be a valid alternative to homografts for the treatment of infective endocarditis, particularly in cases necessitating aortic root reconstruction after extensive debridement of annular abscesses, with comparable outcomes and potential advantages in terms of durability and availability.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11913326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560253","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":"Subclinical leaflet thrombosis in Ozaki procedure.","authors":"Mathieu van Steenberghe, Francois Perret, Patrick O Myers, Gregory Khatchatourov","doi":"10.1093/icvts/ivaf051","DOIUrl":"10.1093/icvts/ivaf051","url":null,"abstract":"<p><p>Aortic valve reconstruction with autologous glutaraldehyde-fixed pericardium (Ozaki procedure) represents an alternative to conventional prosthetic valve replacement, allowing excellent haemodynamic outcomes. We report two cases of subclinical leaflet thrombosis (SLT) at 12 and 23 months of follow-up. Anticoagulation was initiated, and later echocardiography showed haemodynamic and mobility improvement. SLT is well documented for bioprosthetic valve. To our knowledge, this is the first report for Ozaki procedure in an adult population. Glutaraldehyde is known for cytotoxicity, and partial endothelialization can be responsible for thrombosis, creating favourable conditions for later endocarditis and degeneration. Anticoagulation should be recommended postoperatively for the first 3 months with control at 6 months. Finally, alternative treatment to glutaraldehyde should be investigated.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11913325/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560287","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":"Initial single-institutional experience with salvage surgery for stage IV non-small-cell lung cancer.","authors":"Tomoyuki Hishida, Naoyuki Oka, Kaito Yano, Seiji Omura, Yu Okubo, Kyohei Masai, Kaoru Kaseda, Keiko Ohgino, Hideki Terai, Hiroyuki Yasuda, Keisuke Asakura","doi":"10.1093/icvts/ivaf029","DOIUrl":"10.1093/icvts/ivaf029","url":null,"abstract":"<p><p>The purpose of this study was to assess surgical outcomes of salvage surgery for clinical stage IV non-small-cell lung cancer. A total of 14 patients who underwent lung resection following systemic therapy between 2010 and 2022 were included in this study. Systemic therapy prior to surgery included agents including epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) in eight patients and non-TKI agents in six (chemotherapy alone: four, chemotherapy plus immune checkpoint inhibitors: two). During a median follow-up of 5.2 years, the EGFR-TKI group showed a favourable 5-year overall survival of 83%; however, it was due to treatment after relapse, and there were no 4-year relapse-free survivors. The non-EGFR-TKI group showed a 5-year relapse-free survival of 33%, and 2 patients have survived more than 3 years without any relapse and further treatment. When considering the role of surgery in multimodal treatment for initial c-stage IV non-small-cell lung cancer, salvage surgery following non-TKI therapy (chemotherapy with or without immune checkpoint inhibitor) can be regarded as genuine salvage surgery.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11906397/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416420","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}