To evaluate the efficacy of indocyanine green （ICG） fluorescence imaging of the thoracic duct in preventing chylothorax after minimally invasive McKeown esophagectomy（MIME）.
Methods
A retrospective analysis was conducted on 174 patients who underwent MIME for esophageal cancer at the Department of Thoracic Surgery，The First Affiliated Hospital of the University of Science and Technology of China （January to December 2024）.Patients were divided into two groups： the ICG imaging of the thoracic duct（ITD）group（n＝61）and the non-ICG imaging of the thoracic duct（NITD）group（n＝113）.Clinical data，perioperative parameters and postoperative complications were compared.Univariate and multivariate analyses were performed to identify risk factors for chylothorax.
Results
A total of 174 patients were included，including 141 males and 33 females with a mean age of 68.56±12.02 years.No significant differences were observed between the ITD and NITD groups in age，sex，tumor location，pathological type，differentiation grade，preoperative comorbidities，neoadjuvant therapies（chemotherapy，chemoradiotherapy，or chemoradiotherapy with immunotherapy），operative time，intraoperative blood loss，hospital stay，or lymph node dissection（P＞0.05）.Significant differences were noted in preoperative neoadjuvant chemotherapy combined with immunotherapy，intraoperative thoracic duct ligation，thoracic duct injury，pT stage，pN stage，and pTNM stage（P＜0.05）.The incidence of chylothorax was significantly lower in the ITD group compared to the NITD group（P＜0.05）.No differences were observed in other minor complications（atelectasis，anastomotic leakage，pleural effusion，pneumonia，hoarseness，arrhythmia）or major complications（pleural effusion，hemorrhage，anastomotic leakage，arrhythmia）（P＞0.05）.Univariate and multivariate analysis confirmed that intraoperative thoracic duct imaging was an independent protective factor against chylothorax（P＝0.048）.
Conclusion
ICG fluorescence imaging of the thoracic duct effectively reduces the incidence of chylothorax after minimally invasive McKeown esophagectomy.
To clarify the influence of the tumor-lateral nature （left/right） of second lung cancer（SLC） and its interaction with the extent of previous lung resection on the 5-year overall survival rate of patients.
Methods
Using data in the Surveillance， Epidemiology， and End Results（SEER）database from 1975 to 2018，the study enrolled the SLC patients with a history of surgery for lung malignancy.Kaplan-Meier survival analysis and Cox proportional risk model were used to investigate the effect of malignancy on 5-year overall survival in SLC patients.
Results
A total of 4 693 patients with SLC were screened，including 2 587 patients with right-sided SLC and 2 106 patients with left-sided SLC.The results of multivariate analysis showed that the SLC on the right side was an independent risk factor for poor prognosis of subjects［hazard ratio（HR）：1.115，95% confidence interval（CI）：1.036～1.200，P＝0.004］，and the position of the two lung cancers on the opposite laterality was also associated with the lower 5-year overall survival rate（HR：1.086，95% CI：1.006～1.172，P＝0.034）.
Conclusion
Tumor laterality is a key factor affecting the prognosis of SLC and may have a synergistic effect with the anatomical changes after previous lung resection.The survival disadvantage of patients with right SLC suggests that in the selection of surgical methods and postoperative follow-up，the risk assessment and individualized intervention of the right lung should be strengthened in order to improve the long-term prognosis.
To analyze the research status，hotspots，and future development trends in the field of bronchopleural fistula （BPF） by using bibliometric methods.
Methods
Based on the Web of Science Core Collection database，English literature related to BPF published between 1995 and 2024 was retrieved.CiteSpace and VOSviewer were employed to conduct a visual analysis of annual publication volume，countries，institutions，authors，journals，highly cited literature，and keywords.
Results
A total of 1 503 articles were included，showing a steady increase in publication volume over the past thirty decades. Research on BPF is primarily concentrated in the United States （403 articles），China （218 articles），Japan （167 articles），and Italy （100 articles）.Mayo Clinic is the most prolific institution in this field （27 articles），while Lorenzo Spaggiari ranks first among authors（19 articles）.The journal with the highest number of publications is Annals of Thoracic Surgery （184 articles）.The most cited article is “Bronchopleural fistulas：an overview of the problem with special focus on endoscopic management” （290 citations）. High-frequency keywords include pulmonary resection （347 occurrences），bronchopleural fistula （312 occurrences），lung cancer （194 occurrences），and empyema （170 occurrences）.Keyword analysis reveals that risk factors，BPF complications，diagnostic techniques，surgical treatment，bronchoscopic intervention，and prevention are the current research hotspots.Early studies primarily focused on risk factors and treatment methods，while recent research has shifted toward prevention，long-term survival rates，and the accumulation of evidence-based medical evidence.
Conclusion
This study summarizes the research status and hotspots in the field of BPF through bibliometric analysis and explores potential future development trends，providing a valuable reference for scholars engaged in this field worldwide.
Esophageal cancer is a highly aggressive digestive tract malignancy with a poor prognosis.Its treatment strategies require individualization and precision.Recent advances in artificial intelligence （AI） have enhanced various aspects of esophageal cancer treatment， significantly improving the accuracy of treatment outcome prediction，treatment plan formulation，and dynamic intervention.This article systematically reviews the core applications and recent progress of AI in the treatment of esophageal cancer，and discusses the challenges and future directions for its clinical application.
Current therapeutic strategies for lung cancer remain suboptimal， underscoring the urgent need for novel treatment approaches and targets of clinical relevance.In recent years，a growing body of evidence has highlighted the pivotal role of tumor microenvironment （TME） abnormalities in the initiation and progression of lung cancer.Among the various stromal components，cancer-associated fibroblasts （CAFs） have emerged as key regulators of the malignant phenotype，significantly influencing tumor cell proliferation，invasion，and metastasis.As integral constituents of the TME，CAFs are essential for maintaining normal cellular physiology.However，when aberrantly activated within the tumor milieu，CAFs are closely associated with the aggressive biological behavior of cancer cells.Elucidating the mechanistic roles of CAFs in lung cancer and evaluating their potential as therapeutic targets hold considerable promise for advancing treatment outcomes.
