This guideline is jointly developed by the Chinese Society of Esophageal Diseases and the Guangdong Thoracic Diseases Society. Based on existing literature and the clinical experience of the participating experts, the guideline summarizes the application of non-intubation anesthesia technique in thoracoabdominal laparoscopic esophagectomy (the McKeown procedure), aiming to provide practical references for medical centers that intend to implement the McKeown. The guideline systematically outlines the indications and contraindications of non-intubated anesthesia, emphasizing patient selection criteria such as American Society of Anesthesiologists (ASA) class ≤2 and good cardiopulmonary function, while excluding severe comorbidities or airway abnormalities. Preoperative preparation includes comprehensive evaluation, nutritional support, cardiopulmonary exercise, and dietary adjustments. Anesthetic techniques involve epidural anesthesia, thoracic paravertebral nerve block, and laryngeal mask airway placement, with two recommended anesthesia protocols for optimized intraoperative management. The surgical workflow details patient positioning, incision design, and key steps in thoracic, abdominal, and cervical operations, highlighting the advantages of minimally invasive techniques and spontaneous ventilation management. Anesthesia management focuses on preventing and addressing complications such as hypercapnia, hypoxemia, and laryngeal mask displacement, with clear criteria for conversion to tracheal intubation. Postoperative analgesia adopts a multimodal strategy to enhance recovery. The guideline concludes that non-intubated anesthesia offers advantages of reduced trauma and faster recovery but requires individualized management to ensure safety. With technological advancements, this approach is expected to further promote minimally invasive esophageal cancer surgery.

To compare the safety and advantages of uniportal thoracoscopic thymectomy by different approaches.

One hundred and ninety-two patients with thymoma who underwent uniportal thoracoscopic thymectomy from January 2018 to September 2022 in Department of Cardiothoracic Surgery of Sanya Central Hospital (The Third People’s Hospital of Hainan) were retrospectively collected. An lateral group (LASP) with 65 cases and a subxiphoid group (SASP) with 127 cases were assigned, and finally 53 cases were matched in each group by propensity score matching. The indicators, including operative time, intraoperative blood loss, number of conversions to open surgery, postoperative drainage volume, chest tube indwelling time, and postoperative wound pain VAS scores at different time points, were compared and analyzed in the SASP and LASP groups.

A total of 106 patients were successfully matched. There was no significant difference in baseline data after matching (P>0.05). The operation time for the LASP group was shorter than that for the SASP group [ (103.453±25.992) min vs (114.509±25.142) min, P<0.05]. There was no statistical significance between the two groups in terms of intraoperative blood loss [60 (45~90) mL vs 55 (45~65) mL] and VAS score [5 (5~6) vs 5 (4~5) ] on the first day after surgery. The VAS score after extubation [4 (3~5) vs 4 (3~4) ], one week after the operation [2 (1~3) vs 1 (0~2) ], and the need for analgesic drugs in the first week after surgery were better in the SASP group than in the LASP group (P<0.05). There was no significant difference between the two groups in the data of postoperative drainage volume, drainage time, and the need for analgesic drugs after extubation (P>0.05) .

Both the lateral thorax and the subxiphoid approach are safe and effective. The subxiphoid approach has a longer operation time, but it has the advantage of less postoperative pain.

To evaluate the correlation between clinical complete response (cCR) judged by enhanced computed tomography (CT) and pathological complete response (pCR) after neoadjuvant chemotherapy combined with immunotherapy for esophageal squamous cell carcinoma (ESCC), and analyze its clinical application value in predicting prognosis.

We retrospectively analyzed the clinical data of 266 patients who received neoadjuvant chemotherapy combined with immunotherapy and surgery at The Fourth Hospital of Hebei Medical University from November 2019 to May 2024. Two physicians judged whether cCR was achieved based on enhanced CT images. Then, we analyzed the relationship between cCR and pCR and compared the survival differences of patients.

Among 266 patients, 53 (19.9%) achieved cCR. Among cCR patients, 39 (73.6%) achieved pCR. The sensitivity of cCR for predicting pCR is 50.7% and the specificity is 92.6%. The receiver operating characteristic (ROC) curve demonstrated that cCR had a certain predictive value for pCR [area under the curve (AUC) =0.716, 95% confidence interval (CI) : 0.641–0.792, P<0.001]. Survival curve analysis shows that there is a significant association between pCR and both overall survival (OS; χ²=7.82, P=0.005) and recurrence-free survival (RFS; χ²=6.28, P=0.012). cCR predicted by enhanced CT is also significantly correlated with OS (χ²=5.38, P=0.020) and RFS (χ²=8.39, P=0.004). Multivariate Cox regression analysis revealed that N stage was an independent prognostic factor for both OS and RFS.

Enhanced CT has a certain predictive efficacy for pCR based on cCR in ESCC after neoadjuvant chemotherapy combined with immunotherapy, with low sensitivity and high specificity. It holds certain clinical value in assessing the efficacy of neoadjuvant therapy and predicting prognosis. Multivariate analysis identified N stage as an independent prognostic factor for both OS and RFS.

To investigate the association between stromal CD68⁺ macrophage infiltration and disease-free survival (DFS) in patients with stage ⅠB lung squamous cell carcinoma (LUSC) after surgery, and to evaluate its potential as a prognostic biomarker.

Sixty patients with stage ⅠB LUSC who underwent surgery in 2014 in Cancer Hospital of Chinese Academy of Medical Sciences were retrospectively analyzed. CD68⁺ macrophages in the tumor stroma were quantified by immunohistochemistry and HALO digital pathology. Based on the optimal cutoff value (12.01) from ROC analysis, patients were divided into high- and low-expression groups. Kaplan-Meier survival analysis and Cox regression models were used to assess DFS and prognostic factors.

After a median follow-up of 82 months, 21 (35%) patients experienced recurrence or metastasis. High CD68 expression was significantly associated with longer DFS (P<0.05). Multivariate Cox regression showed that high CD68 expression was an independent protective factor [hazard ratio (HR) =0.179, 95% confidence interval (CI) : 0.041–0.775, P=0.021], whereas visceral pleural invasion was associated with poorer prognosis (HR=2.865, 95%CI: 1.18–6.95, P=0.018) .

High stromal infiltration of CD68⁺ macrophages is associated with improved DFS in patients with stage ⅠB LUSC. CD68 may serve as a novel prognostic biomarker, and its integration with traditional pathological factors may enhance postoperative risk stratification and personalized treatment.

To explore the current status and potential of mainstream large language models (LLMs) in lung cancer auxiliary diagnosis and treatment.

A multidisciplinary team from Zhongshan Hospital Affiliated to Fudan University designed 40 questions based on domestic and international guidelines and long-term clinical experience. The questions covered five modules of lung cancer diagnosis and treatment: basic concepts, lung cancer screening, diagnosis, treatment, and pathology. The questions were posed to five mainstream LLMs: DeepSeek-V3, DeepSeek-R1, Doubao, Kimi, and GPT-4o. The models’ outputs were evaluated by two experienced thoracic surgeons using a five-point Likert scale to assess accuracy and emotional support.

GPT-4o, DeepSeek-V3, and DeepSeek-R1 performed similarly, with a median [interquartile range (IQR) ] of 5.00 (4.50–5.00), significantly outperforming Kimi [4.25 (3.50–4.50) ] and Doubao [4.50 (3.88–4.50) ]. Subgroup analysis showed that DeepSeek-R1 excelled in basic concepts, diagnosis, treatment, and pathology modules. DeepSeek-V3 performed excellently overall, particularly in the diagnosis module. GPT-4o was best suited for the screening module. The emotional support assessment revealed that all LLMs scored notably lower in this dimension, around 3.00, compared to their accuracy scores. Among the models, DeepSeek-R1 provided the highest level of emotional support, with a median (IQR) of 3.50 (3.00–4.50). GPT-4o [2.50 (2.50–3.12) ], DeepSeek-V3 [3.25 (2.50–3.50) ], and Doubao [3.00 (2.50–3.50) ] demonstrated comparable performance, while Kimi showed the lowest scores [2.50 (2.50–3.00) ]. Subgroup analysis further indicated that emotional support ratings were consistently lower across all modules, highlighting a critical limitation of current LLMs in patient-centered communication.

LLMs show initial application potential in lung cancer diagnosis and treatment, but shortcomings remain in handling complex clinical scenarios and patient communication. With ongoing development and improvement, LLMs are expected to have broad application prospects in the field of lung cancer diagnosis and treatment. To the best of our knowledge, our study is the first systematic evaluation of domestic LLMs in the context of lung cancer care in China.

The results of the randomized controlled trials, Japan Clinical Oncology Group (JCOG) 0802 and Cancer and Leukemia Group B (CALGB) 140503, have demonstrated that sublobar resection offers comparable prognosis to lobectomy for patients with early-stage non-small cell lung cancer (NSCLC) with tumors ≤2 cm in diameter. However, the application of sublobar resection in clinical practice remains controversial. This review summarizes these controversies into four key points: the impact of high-risk pathological factors on the safety of sublobar resection, lymph node dissection during sublobar resection, factors influencing local recurrence in sublobar resection, and the benefits to quality of life from sublobar resection. We summarize the research progress on these controversies to provide insights for the clinical application of sublobar resection.

Esophageal cancer and esophagogastric junction cancer are highly prevalent malignant tumors in China, and most patients are diagnosed at an advanced stage. Neoadjuvant therapy has become the standard treatment for locally advanced patients. However, although traditional neoadjuvant chemoradiotherapy (nCRT) can improve the surgical resection rate, the distant metastasis rate remains high, indicating that the treatment strategy needs further optimization. Total neoadjuvant therapy (TNT) overcomes the drug resistance caused by tumor heterogeneity from the spatiotemporal dimension through early intensive systemic therapy, multidrug sequential combination, and dynamic adaptive adjustment, showing good prospects in both esophageal adenocarcinoma and squamous cell carcinoma. Existing studies have shown that the TNT strategy can improve the R0 resection rate in esophageal adenocarcinoma [for example, the pathological complete response rate (pCR) of the FLOT regimen (docetaxel + oxaliplatin + leucovorin + 5-fluorouracil) reaches 20%], and nCRT combined with immunotherapy (such as atezolizumab) can further improve survival [the 2-year overall survival (OS) rate in the PERFECT trial reaches 92%]. In esophageal squamous cell carcinoma, immunotherapy combined with nCRT significantly increases the pCR rate (55.6% in the PALACE-1 study and 63.2% in the CRIS study), and specific biomarkers (such as TCF-1⁺ T cells) may predict therapeutic efficacy. However, the toxicity management of TNT (such as lymphopenia) and the optimal treatment sequence still need further optimization. Future research directions include: developing a dynamic monitoring system for ctDNA to guide individualized treatment; exploring innovative combinations such as dual immunotherapy blockade and antibody-drug conjugates; and verifying long-term survival benefits through phase Ⅲ clinical trials (such as KEYNOTE-975 and EA2174). Multidisciplinary collaboration and precision immunotherapy will drive the innovation of neoadjuvant therapy for esophageal cancer.