Esophageal cancer is one of the most common gastrointestinal malignancies in China. Surgery remains the cornerstone of curative-intent treatment for patients with resectable disease. However, postoperative recurrence and metastasis remain major causes of poor long-term survival. As an essential component of multidisciplinary treatment, postoperative adjuvant therapy aims to eradicate potential minimal residual disease (MRD), reduce the risk of recurrence, and improve survival outcomes. In recent years, perioperative treatment strategies for esophageal cancer, including chemoradiotherapy and immunotherapy, have evolved rapidly. Nevertheless, considerable controversy remains regarding the indications, treatment regimens, and management strategies for postoperative adjuvant therapy across different clinical settings, and standardized clinical practice is still lacking. To further standardize the clinical practice of postoperative adjuvant therapy for esophageal cancer in China, the Esophageal Cancer Committee of the Chinese Anti-Cancer Association convened a multidisciplinary panel of experts to develop the Chinese Expert Consensus on Postoperative Adjuvant Therapy for Esophageal Cancer (2026 Edition). This consensus addresses key issues, including the fundamental principles and management of postoperative adjuvant therapy, treatment strategies across different clinical scenarios, the application of biomarkers, and the management of special populations. A total of 18 recommendations are proposed to provide standardized and individualized guidance for clinical decision-making and to identify priorities for future clinical research.

To analyze the perioperative and long-term survival outcomes of robotic-assisted thoracoscopic surgery (RATS) in the treatment of patients with non-small cell lung cancer (NSCLC) based on the 13-year clinical practice at Shanghai Chest Hospital.

Consecutive patients with NSCLC who underwent RATS lung surgery at Shanghai Chest Hospital from May 2009 to May 2022 were retrospectively enrolled. Baseline demographic characteristics, perioperative parameters, and long-term survival outcomes were analyzed.

A total of 1 798 patients were included, consisting of 786 males (43.7%) and 1 012 females (56.3%), with a mean age of (59.4±9.1) years. There were 1 557 cases (86.6%) of lobectomy, 112 cases (6.2%) of segmentectomy, and 129 cases (7.2%) of wedge resection. The mean tumor diameter was (2.4±1.1) cm, and adenocarcinoma accounted for the predominant pathological type (90.3%). The mean operative duration was (101.9±28.5) minutes. 80.9% of patients had intraoperative blood loss ≤100 mL, the conversion rate to thoracotomy was 3.8%, and 99.2% of patients achieved negative surgical margins. The mean number of dissected lymph node stations was 5.5±1.6, with a mean of 11.2±5.2 lymph nodes retrieved. The mean postoperative chest tube drainage volume was (710.5±268.3) mL over a mean drainage duration of (3.2±1.8) days, and the mean postoperative hospital stay was (4.5±2.1) days. Postoperative complications occurred in 332 patients (18.5%), among whom 23 cases (1.3%) had severe complications. Survival analysis revealed that the 5-year recurrence-free survival (RFS) rate and overall survival (OS) rate were 82.5% and 88.8%, respectively. Further multivariable Cox regression analyses showed that age, histological subtype, pathological TNM stage, and neoadjuvant therapy were independent prognostic factors for RFS and OS.

RATS is associated with limited intraoperative blood loss, a low conversion rate to thoracotomy, a low postoperative complication rate, and favorable long-term survival outcomes. In our center’s clinical experience, RATS demonstrates favorable perioperative safety profiles and acceptable long-term oncological outcomes, making it a viable surgical approach for NSCLC.

To retrospectively evaluate the perioperative outcomes and safety of port-only four-arm robotic-assisted precision pulmonary segmentectomy performed under artificial pneumothorax in a single-center cohort, and to explore the technical value of this approach in improving exposure of the deep operative field and facilitating complex segmental resections.

Clinical data were retrospectively collected from patients who underwent totally portal four-arm robotic-assisted pulmonary segmentectomy at our center between May 2022 and December 2025. All procedures were performed using the da Vinci Xi robotic system under a fully closed artificial pneumothorax. Preoperative individualized planning was based on thin-section computed tomography (CT) and three-dimensional CT bronchography and angiography (3D-CTBA). Intraoperatively, coordinated four-arm traction, meticulous dissection using Maryland bipolar forceps, and indocyanine green (ICG) near-infrared fluorescence imaging were applied to assist in identifying the intersegmental plane. Primary outcomes included operative time, estimated blood loss, conversion to thoracotomy, postoperative drainage parameters, chest tube duration, length of postoperative hospital stay, and postoperative complications.

A total of 271 patients were included. The mean age was (58.3±10.3) years; 186 patients (68.6%) were female, and 69 (25.5%) had a history of smoking. Postoperative pathology revealed invasive adenocarcinoma as the predominant histological type (65.3%), followed by minimally invasive adenocarcinoma (21.4%). The mean operative time was (117.8±31.0) min, and the median estimated blood loss was 40 mL (range, 0–200 mL). One patient (0.4%) required conversion to thoracotomy. The mean postoperative drainage volume was (485.2±440.2) mL, the mean chest tube duration was (2.9±1.3) days, and the mean postoperative hospital stay was (4.3±1.5) days. Chest tube drainage lasting >7 days occurred in 4 patients (1.5%). The mean number of dissected lymph node stations was 4.34±2.03, with a mean of 7.07±4.92 lymph nodes retrieved. R0 resection was achieved in all patients (271/271, 100%). 244 (90.0%) experienced no postoperative complications. Clavien-Dindo grade Ⅰ and grade Ⅱ complications occurred in 23 (8.5%) and 3 (1.1%) patients, respectively, while persistent postoperative air leak was observed in 1 patient (0.4%).

Port-only four-arm robotic-assisted precision pulmonary segmentectomy under artificial pneumothorax is feasible and demonstrates favorable perioperative outcomes and safety in a single-center retrospective cohort. Beyond minimizing surgical incisions, this approach enables centralized control of the camera and traction by the primary surgeon, thereby reducing exposure-related variability associated with assistant-dependent maneuvers. Coupled with wristed robotic instruments, it may improve the precision of deep small-vessel dissection and intersegmental plane management, providing a practical technical strategy for complex precision pulmonary segmentectomy.

To illustrate a R language-based method for the extraction of data from thoracic surgery-based electronic medical records.

The information on lymph node metastasis among patients, who consecutively received surgery for primary lung or bronchial malignant disease between Aug 2019 and Aug 2022, was extracted from the pathological report. Initially, the pathological text was loaded on the EXCEL sheet. The total sample was evenly divided into four groups, which were managed by four independent researchers. The primary data were initially treated manually, then by regular expression under R language (version 4.2.2) environment, between which the time-consumed and the accuracy rate was compared, respectively. Additionally, the overall sample was managed by another independent researcher and the time consumed as well as accuracy was recorded.

During the study period, a total of 9 154 patients received surgery in our hospital, of which 8 579 (93.7%) patients underwent systematic lymph node dissection or sampling. Among the four independent researchers, one each treated data of approximately 2 288 patients. The time consumed by hand was 100, 120, 115 and 130 hours, respectively (average: 116.25 hours) with the corresponding accuracy rate of 96%, 94%, 97% and 95%, respectively, (average: 95.5%). Upon switching to the R language-based method, the time consumed was reflected by 60, 30, 50 and 75 min, respectively, (average: 55 min) with the accuracy rate calculated as 99%, 100%, 100% and 98%, respectively (average: 99.25%). There was a statistical significance observed not only in time consumed but also in accuracy rate with the R language-based method favored by both P values of less than 0.001. When all sample were processed by another researcher under R language environment, the total time consumed was 45 min with an accuracy rate of 99%.

R language-based method is an effective method for handling text materials derived from electronic medical records, by which the efficiency and quality for constructing database of specific thoracic disease are improved.

This paper systematically reviews the evolution and future prospects of thoracoscopic minimally invasive esophagectomy (MIE) in China over the past three decades. The developmental trajectory of MIE in China from the early 1990s to the present was analyzed, focusing on instrument innovation, surgical approach evolution, breakthroughs in key techniques, and the shift in comprehensive treatment paradigms. In the early 1990s, in response to the significant trauma and high morbidity associated with traditional open transthoracic esophagectomy, Chinese thoracic surgeons initiated minimally invasive exploration despite challenges such as reliance on imported instruments, lack of technical precedents, and conservative mindsets. Over the past thirty years, the field has achieved a comprehensive leap: surgical instruments have evolved from "homemade adaptations" to sophisticated domestic manufacturing and intelligent systems; surgical approaches have diversified from video-assisted thoracoscopic surgery to totally thoracoscopic, robot-assisted, uniportal, and mediastinoscopic techniques. Critical breakthroughs have been made in the semi-prone position approach, tubular gastric conduit reconstruction, and the innovative anastomosis techniques. The treatment paradigm has shifted from surgery alone to perioperative multidisciplinary comprehensive therapy. Notably, several high-impact clinical trials led by Chinese researchers have been incorporated into international guidelines, signifying a shift from "following" to "leading" in the global arena. Overall, a standardized and mature technical system for MIE has been established in China. Future developments will focus on greater precision through imaging planning, intelligent robotic platforms, organ preservation strategies, and the standardization of care across regions, aiming to optimize outcomes for esophageal cancer patients with "Chinese solutions" .

Esophageal cancer is one of the most common malignant tumors of the digestive tract worldwide. In China, esophageal squamous cell carcinoma represents the predominant histological subtype, and most patients are diagnosed at a locally advanced stage. In recent years, immune checkpoint inhibitors (ICIs) have significantly improved survival outcomes in patients with advanced or unresectable esophageal cancer and have gradually been incorporated into adjuvant and neoadjuvant settings, profoundly reshaping the overall therapeutic landscape of this disease. With the breakthrough progress of immunotherapy in esophageal cancer and its emergence as a core component of comprehensive treatment, perioperative management of esophageal cancer has entered a new paradigm founded on immunotherapy-the "post-immunotherapy era". This era not only signifies a shift in treatment strategy from merely validating efficacy to optimizing integration and individualized application, but also profoundly reshapes perioperative management models, multidisciplinary team (MDT) decision-making processes, and long-term prognostic assessment standards for patients. This review aims to summarize the major clinical evidence for immunotherapy in esophageal cancer, focusing on the current status and practical considerations of perioperative immunotherapy. It delves into key issues such as multidisciplinary collaboration, surgical timing, management of immune-related adverse events (irAEs), attention to primary and acquired non-response, and pathological response assessment. Furthermore, this article explores future directions, including novel immune targets, combined treatment strategies, and biomarker-guided precision immunotherapy, aiming to provide a comprehensive reference for the standardized application and future research of perioperative immunotherapy.

This study provides an in-depth interpretation of the ALTER-L043 phase II randomized trial, focusing on the efficacy and safety of perioperative penpulimab plus anlotinib with or without chemotherapy in resectable non-small cell lung cancer (NSCLC). The investigation was motivated by the need to optimize combination strategies beyond current immunotherapy-chemotherapy regimens, including the potential of "chemotherapy-free" approaches. The analysis encompassed the design, patient characteristics, pathological response rates, and safety profile of the trial, with comparisons to recent phase III studies. Results demonstrated that the triplet regimen achieved a major pathological response rate of 76.0% (19/25), surpassing the doublet regimens [57.7% (15/26) vs. 52.4% (11/21)], with notable benefits in squamous cell carcinoma [79.0% (15/19) vs. 55.0% (11/20) vs. 50.0% (9/18)] and stage ⅢA/ⅢB disease [82.4% (14/17) vs. 55.6% (5/9) vs. 50.0% (6/12)]. The chemotherapy-free doublet also showed promising efficacy. Safety profiles were manageable across groups. In conclusion, penpulimab plus anlotinib-based therapy offers a viable perioperative option, with the triplet regimen potentially suited for high-burden disease and the doublet providing an alternative for chemotherapy-ineligible patients, though phase Ⅲ confirmation is warranted.

This paper reports the diagnosis and management of two elderly male patients with recurrent pneumothorax who developed the rare complication of chest tube misplacement into lung tissue after insertion of a 24-Fr chest tube. Both patients presented with poor drainage and subcutaneous emphysema following tube placement, and the diagnosis was confirmed by chest computed tomography (CT). As conservative management, we adopted a strategy of reinserting a new chest tube at an alternative site to promote lung re-expansion. Both patients were discharged uneventfully, with good lung re-expansion observed during follow-up. These cases suggest that for elderly patients with recurrent pneumothorax and those at high risk of pleural adhesions who require chest tube drainage, preoperative chest CT evaluation, selection of an appropriate insertion site, digital exploration of the pleural cavity during the procedure, and avoidance of chest tubes with an introducer stylet are crucial for preventing this complication. When chest tube misplacement into the lung tissue occurs, leaving the original tube in place to provide a partial tamponade effect while simultaneously inserting a new chest tube may serve as a safe and effective first-line conservative strategy.

Primary pulmonary choriocarcinoma (PPC) is an extremely rare, highly malignant extragonadal epithelial neoplasm of non-gestational origin. As an aggressive trophoblastic tumor, it can secrete β-human chorionic gonadotropin (β-hCG). By reviewing domestic and foreign literature as well as recent research advances, this article analyzes the clinical manifestations, laboratory and imaging findings, pathological features, diagnosis and treatment regimens of one PPC case, and summarizes the characteristics of the disease. The aim is to improve clinicians’ understanding of PPC, reduce misdiagnosis and missed diagnosis, and standardize the diagnostic and therapeutic workflows for this disease.