Image-guided Radiofrequency Ablation for Treatment of Stage I Non-Small Cell Lung Cancer in 111 High-risk Patients: Analysis of Prognostic Variables.

Objective: Surgical resection is the standard treatment for stage 1 non-small-cell lung cancer (NSCLC). Radiofrequency ablation (RFA) is an option in high-risk patients who cannot undergo surgical resection of stage I NSCLC, but prognostic factors and long-term oncologic results have not been fully evaluated. We evaluated outcomes after image-guided RFA in high-risk patients with stage I NSCLC, and factors associated with survival.

Robotic-assisted minimally invasive esophagectomy: experience at the University of Pittsburgh Medical Center.

Robotic-assisted minimally invasive esophagectomy (RAMIE) is increasingly used in the treatment of resectable esophageal cancer. This is a report on the current technique of RAMIE at University of Pittsburgh Medical Center (UPMC), including a summary of early data on 65 patient outcomes reported in an ongoing esophageal cancer database. To date, we have performed over 200 cases of RAMIE at UPMC from September 2013 to July 2024, and the analysis of the data will be presented soon.

Occult Node Detection With Lobectomy Versus Segmentectomy for Stage IA NSCLC.

Objective: Besides the discussion on parenchymal margin, data on the extent of lymph node (LN) dissection are scarce, especially in segmentectomy. This study aimed to investigate the extent of LN dissection and detection of occult disease in segmentectomy compared with lobar resection.

Methods: We performed a single-institution, retrospective analysis for patients who underwent segmentectomy or lobectomy for clinical T1N0M0 (≤3 cm) NSCLC from 2012 to 2022.

Long-Term Follow-Up of Giant Paraesophageal Hernia Repair With Restoration of Normal Anatomy Without Fundoplication.

Background: While some have reported performing gastropexy after paraesophageal hernia repair, the risk for development of severe reflux is being defined. Although we have observed good short-term outcomes after restoration of normal anatomy in patients with predominantly obstructive symptoms, long-term outcomes are unknown.

Methods: Retrospective review of patients without significant reflux (heartburn, regurgitation, pulmonary symptoms) who underwent normal anatomy restoration was performed.

Restoration of normal anatomy without fundoplication in non-elective incarcerated giant paraesophageal hernia repair.

Background: The purpose of our study was to examine outcomes following a novel approach to management of incarcerated giant paraesophageal hernia in a non-elective setting. Surgical dogma has dictated performing a fundoplication, but we have hypothesized that this is unnecessary in patients without significant reflux presenting with predominantly obstructive symptoms.

Methods: Patients who presented to the emergency room between January 2010 and June 2024 with symptomatic giant incarcerated paraesophageal hernia with operative repair performed during the same hospitalization were included.

Anastomotic leakage following robot-assisted minimally invasive esophagectomy (RAMIE): which anastomosis should be preferred?

Background: The optimal technique for intrathoracic esophagogastric anastomosis in esophagectomy remains undetermined. This study evaluates different anastomotic techniques in robot-assisted minimally invasive esophagectomy (RAMIE) and their impact on anastomotic leakage rates.

Materials And Methods: This observational, retrospective, comparative cohort study analyzed data obtained from the Upper GI International Robotic Association (UGIRA) Esophageal Registry.

Outcomes of esophageal diversion and long-term prognosis: A single-institution experience.

Objective: Esophageal diversion of the esophagus is a last resort but effective procedure to control esophageal crises. Existing reports on this procedure are sporadic, and the prognosis is difficult to predict.

Methods: We performed a single-institution, retrospective study of patients who underwent esophageal diversion with cervical esophagostomy from 2014 to 2023.

Outcomes with Sublobar Resection vs Lobectomy in Patients With cT1N0M0 Large-cell Neuroendocrine Cancer.

Background: Large-cell neuroendocrine cancer (LCNEC) is a rare tumor histology associated with poor prognosis. This study aimed to analyze outcomes with sublobar resection in patients with clinical T1N0M0 LCNEC (<3 cm) compared with lobectomy.

Methods: We performed a single-institution, retrospective study comparing patients undergoing lobectomy vs sublobar resection (segmentectomy or wedge resection) for clinical T1N0M0 LCNEC from 2002 2022.

Hyperthermic Intrathoracic Chemoperfusion and the Role of Adjunct Immunotherapy for the Treatment of Pleural Mesothelioma.

Pleural mesothelioma (PM) is an aggressive cancer originating from the mesothelial lining of the pleura, with a rising global incidence since the mid-20th century due to asbestos and erionite exposure. PM accounts for 80-90% of all mesothelioma cases and is histologically classified into three subtypes-epithelioid, sarcomatoid, and biphasic- with epithelioid carrying the most favorable prognosis. Despite advances in surgery, chemotherapy, radiotherapy, and immunotherapy, PM prognosis remains poor, necessitating more effective, multimodal strategies.

Comparison of Robot-Assisted Versus Video-Assisted Thoracoscopic Segmentectomy: A Single-Institution Propensity-Matched Study.

Objective: Previous studies have evaluated the feasibility of robot-assisted thoracoscopic segmentectomy (RVATS) in comparison with video-assisted thoracoscopic segmentectomy (VATS). We report both short-term and long-term outcomes comparing RVATS and VATS at a single institution.

Methods: This is a retrospective propensity-matched cohort study reviewing RVATS and VATS for primary non-small cell lung cancer (NSCLC) performed from 2013 to 2021 at our institution; 1:2 propensity matching was performed.

A common secretomic signature across epithelial cancers metastatic to the pleura supports IL-6 axis therapeutic targeting.

Background: Many cancers metastasize to the pleura, resulting in effusions that cause dyspnea and discomfort. Regardless of the tissue of origin, pleural malignancies are aggressive and uniformly fatal, with no treatment shown to prolong life. The pleural mesothelial monolayer is joined by tight junctions forming a contained bioreactor-like space, concentrating cytokines and chemokines secreted by the mesothelium, tumor, and infiltrating immune cells.

Integrated BATF transcriptional network regulates suppressive intratumoral regulatory T cells.

Human regulatory T cells (T) are crucial regulators of tissue repair, autoimmune diseases, and cancer. However, it is challenging to inhibit the suppressive function of T for cancer therapy without affecting immune homeostasis. Identifying pathways that may distinguish tumor-restricted T is important, yet the transcriptional programs that control intratumoral T gene expression, and that are distinct from T in healthy tissues, remain largely unknown.

A maladaptive pleural environment suppresses preexisting anti-tumor activity of pleural infiltrating T cells.

Introduction: Treatment options for patients with malignant pleural effusions (MPE) are limited due, at least in part, to the unique environment of the pleural space, which drives an aggressive tumor state and governs the behavior of infiltrating immune cells. Modulation of the pleural environment may be a necessary step toward the development of effective treatments. We examine immune checkpoint molecule (ICM) expression on pleural T cells, the secretomes of pleural fluid, pleural infiltrating T cells (PIT), and ability to activate PIT

Methods: ICM expression was determined on freshly drained and activated PIT from breast, lung and renal cell cancer.

Evaluation of electromagnetic navigational bronchoscopic biopsy of lung lesions performed by a thoracic surgical service.

Background: With the increasing use of computed tomography scans for lung cancer screening and surveillance of other cancers, thoracic surgeons are being referred patients with lung lesions for biopsies. Electromagnetic navigational bronchoscopy-guided lung biopsy is a relatively new technique for bronchoscopic biopsy. Our objective was to evaluate the diagnostic yields and safety of electromagnetic navigational bronchoscopy-guided lung biopsy.

Comparison of robotic-assisted minimally invasive esophagectomy versus minimally invasive esophagectomy: A propensity-matched study from a single high-volume institution.

Objective: Robotic-assisted minimally invasive esophagectomy accounts for a growing proportion of esophagectomies, potentially due to improved technical capabilities simplifying the challenging aspects of standard minimally invasive esophagectomy. However, there is limited evidence directly comparing both operations. The objective is to evaluate the short-term and long-term outcomes of robotic-assisted minimally invasive esophagectomy in comparison with the minimally invasive esophagectomy approach for patients with esophageal cancer over a 7-year period at a high-volume center.

Effects of Intraoperative Support Strategies on Endothelial Injury and Clinical Lung Transplant Outcomes.

In lung transplantation, postoperative outcomes favor intraoperative use of extracorporeal membrane oxygenation (ECMO) over cardiopulmonary bypass (CBP). We investigated the effect of intraoperative support strategies on endothelial injury biomarkers and short-term posttransplant outcomes. Adults undergoing bilateral lung transplantation with No-Support, venoarterial (V-A) ECMO, or CPB were included.

Oesophagectomy following noncurative endoscopic resection for oesophageal carcinoma: does interval matter?

Objectives: Oesophagectomy was always recommended after noncurative endoscopic resection (ER). And the optimal time interval from ER to oesophagectomy remains unclear. This study was to explore the effect of interval on pathologic stage and prognosis.

Single-center experience of ex vivo lung perfusion and subsequent lung transplantation.

Background: The safety of lung transplantation using ex vivo lung perfusion (EVLP) has been confirmed in multiple clinical studies; however, limited evidence is currently available regarding the potential effects of EVLP on posttransplant graft complications and survival with mid- to long-term follow-up. In this study, we reviewed our institutional data to better understand the impact of EVLP.

Methods: Lungs placed on EVLP from 2014 through 2020 and transplant outcomes were retrospectively analyzed.

Right middle lobe syndrome after upper lobectomy: Role of the bronchial angle.

Background: Right middle lobe syndrome is part of a spectrum of relatively rare but serious conditions that may occur following right upper lobectomy. We aimed to assess whether the preoperative middle lobe bronchial angle on CT predicted patients at risk of developing middle lobe syndrome.

Method: All patients who had a complete upper lobectomy over 4 years were retrospectively reviewed for clinical and imaging findings of middle lobe syndrome.

Colon Interposition for Esophageal Cancer.

Esophagectomy and colon interposition in the adult patient, either for primary alimentary reconstruction or as a secondary replacement after initial resection/reconstruction for malignant or benign disease, remains a valuable tool in the thoracic surgeon's armamentarium. It is important for surgeons to remain versed in the complexities of the operation, including preoperative preparation and decision making, operative procedural and technical variations, and recognition and timely treatment of postoperative complications. In this article, we present technical details of the procedure, a review of selected published studies, long-term results, and indications and outcomes for revisional surgery.

The effect of receiving an award from the American Association for Thoracic Surgery Foundation.

Objective: This study's objective was to evaluate the scholastic and career effects of receiving either the American Association for Thoracic Surgery (AATS) Foundation research scholarship or surgical investigator program.

Methods: AATS annual reports and recipient listings were used to generate the awardees. MEDLINE and SCOPUS were used to assess publications, citations, and H-Index for awardees.

The Use of Extracorporeal Support to Rescue Patients With Acute Respiratory Distress Syndrome Following Thoracic Surgery.

Postoperative acute respiratory distress syndrome (ARDS) following a general thoracic procedure is associated with high morbidity and mortality. Extracorporeal membrane oxygenation (ECMO) offers an alternate means of cardiopulmonary support in the setting of refractory respiratory failure. We report indications and outcomes patients who after complex general thoracic surgery developed ARDS requiring ECMO support.

Intraoperative Support for Primary Bilateral Lung Transplantation: A Propensity-Matched Analysis.

Background: Single-center studies support benefits of venoarterial extracorporeal membrane oxygenation (VA-ECMO) as a method of intraoperative support. Propensity-matched data from a large cohort, however, are currently lacking. Therefore, our goal was to compare outcomes of intraoperative VA-ECMO and cardiopulmonary bypass (CPB) during bilateral lung transplantation (LTx) with a propensity analysis.