Non-small cell lung cancer (NSCLC) represents a prevalent malignant neoplasm, with surgical resection serving as its primary therapeutic modality. Following a pivotal randomized trial released by the North American Lung Cancer Study Group in 1995, which demonstrated a heightened local recurrence rate and diminished survival in T1N0 stage lung cancer patients undergoing segmentectomy compared to lobectomy, the latter has since been acknowledged as the established surgical approach for achieving curative outcomes in early-stage NSCLC. Nevertheless, during the latter part of the 20th century, segmentectomy, renowned for its optimization of lung function preservation, progressively gained traction in the landscape of lung cancer treatment. Furthermore, the exploration of thoracoscopic techniques and robot-assisted surgery has emerged as a focal point in research. Substantial advancements have been witnessed in the realm of surgical treatment for NSCLC in recent years. This article endeavors to expound upon the surgical section of the 2024 first edition of the National Comprehensive Cancer Network (NCCN) guidelines for NSCLC, offering intricate elucidations pertaining to surgical indications, methodologies, lymph node dissection strategies, etc. Its overarching objective is to facilitate a nuanced comprehension among surgeons regarding the underlying principles and methodologies governing NSCLC surgical interventions.
Cervicothoracic junction tumors are rare but rather intractable clinical diseases. This article focuses on its surgical methods and strategies, and briefly summarizes its anatomy, pathological classification, diagnoses, etc., to share with readers some relevant experience and thoughts in the surgical treatment of cervicothoracic junction tumors in our department.
The Grillo procedure, involving a laterally bipedicled flap and sternum removal, has historically served as the standard approach for airway reconstruction following salvage resection of cervical esophageal cancer. However, the creation of an anterior mediastinal stoma can result in significant trauma, and subsequent infection may precipitate catastrophic bleeding. The study aimed to evaluate the safety and effectiveness of modified tracheal reconstruction.
Methods
We retrospectively analyzed 12 patients with cervical esophageal cancer involving the trachea who underwent chemoradiotherapy at the Shanghai Chest Hospital Esophageal Surgery Department. We developed a novel technique utilizing unilateral pectoralis major myocutaneous flap for tracheal defect reconstruction. Wedge resection of the involved tracheal membrane was conducted to preserve the sternum, opting for a pedicled pectoralis major myocutaneous flap for airway repair. The perioperative clinical data and prognosis of all patients were statistically analyzed.
Results
Twelve patients underwent reconstruction of the posterior tracheal wall using the pectoralis major muscle flap and underwent tracheostomy. Among them, 10 were male and 2 were female, with an average age of 62.6 years. The surgical duration was (5.5±75.7) min, blood loss volume (231.8±44.1) mL, hspitalization stay (23.8 ± 14.1) days, ICU stay (6.7±9.8) days. Four patients experienced severe postoperative complications, including two cases of residual necrosis of the anterior tracheal wall, one case of pharyngogastric anastomotic fistula, and one case of sudden cervical vascular bleeding resulting in death 21 days post-surgery. The remaining patients experienced long-term survival without stoma stenosis or related tracheal stenosis. During follow-up, the Karnofsky Performance Status (KPS) scores at 1-, 3-, and 6-months post-surgery were statistically analyzed. Six patients (50%) scored ≥60 at 3 months post-surgery, and nine patients (75%) scored ≥60 at 6 months post-surgery.
Conclusions
Utilizing a unilateral pectoralis major pedicled myocutaneous flap to reconstruct the posterior tracheal wall proves effective in salvage surgery for cervical esophageal cancer. This improved technique effectively avoids damage to the sternum and surrounding tissues caused by Grillo’s mediastinal stoma, while the rich blood supply of the pectoralis major flap can effectively prevent mediastinal infection and catastrophic bleeding. Unilateral pectoralis major pedicled myocutaneous flap to reconstruct the posterior wall of the trachea is an effective technical in salvage surgery for cervical esophageal cancer.
To analyze the characteristics, diagnostic points, differential diagnosis and surgical methods of saddle chest, and summarize the surgical treatment experience, so as to provide reference for the clinical diagnosis and treatment of saddle chest.
Methods
A retrospective analysis was performed on the patients with saddle chest who underwent surgery in the Department of Chest Wall Surgery of Guangdong Second Provincial General Hospital from January 2022 to September 2023. The diagnosis and treatment data of the patients were collected, including age, gender, clinical symptoms, characteristics of thoracic deformity, imaging examination results, operation time, intraoperative blood loss, postoperative hospital stay, and postoperative complications. Through the analysis of the above indicators, the deformity characteristics and surgical outcomes of saddle chest were discussed.
Results
A total of 48 patients were enrolled, including 44 males and 4 females, aged from 5–35 (14.0±4.97) years. There were 45 cases and 3 cases of primary saddle chest and secondary saddle chest. Five patients complained of discomfort and 18 patients had abnormal electrocardiogram before the operation. All patients underwent surgical treatment successfully, and the correction effect was satisfactory. Among them, 38 cases were treated with Wenlin + Wung operation, 8 cases with Wenlin + Wang operation, and 2 cases with Wung operation. The operation time was 20–130 (52.50±23.97) min, the intraoperative blood loss was 1–100 (5.0±16.80) mL, and the postoperative hospital stay was 3–24 (6.0±11.90) days. Poor wound healing occurred in 4 patients, who were cured after debridement and suture.
Conclusions
Saddle chest is unique and should be differentiated from other thoracic deformities. After surgeons have a full understanding of saddle chest, through the use of appropriate surgical methods, they usually can achieve satisfactory results.
In the post-COVID era, the application of chest CT has become increasingly widespread, leading to a higher detection rate of pulmonary nodules. Given the substantial variability in treatment and prognosis among different types of nodules, accurate identification and diagnosis are of paramount importance. Traditional clinical features and radiographic assessments for nodule differentiation still bear a significant risk of error. However, the field of radiomics has emerged in the past decade, utilizing computer algorithms to seek high-throughput data from images to aid clinical decision-making, thus enhancing diagnostic efficacy and benefiting patients. This article presents an overview of CT radiomics and its value in the differential diagnosis of pulmonary nodules. It also discusses the advantages, challenges, and limitations of this approach and looks forward to the future directions in the development of radiomics.
In recent years, subxiphoid video-assisted thoracoscopic surgery has been increasingly applied as a new approach for anterior mediastinal disease in China due to its excellent clinical outcomes. However, subxiphoid thoracoscopic mediastinal surgery is a technique that is still being developed and promoted, and requires users to have a comprehensive understanding of the technique in order to better apply it. Herein, we provide a review of the technique and its latest advancements for a more comprehensive understanding for the users.
