Lung cancer is a malignant tumor with the highest morbidity and mortality both in China and even in the world.Accurate diagnosis and treatment of this disease are crucial to improving the survival and quality of life of patients.Computed tomography （CT）-guided percutaneous lung puncture is an important method for the diagnosis and treatment of lung diseases，but heavily relies on doctors' professional skills and surgical experience in practices.The robot-assisted percutaneous surgery system integrates a series of emerging technologies to improve the accuracy and safety of percutaneous lung puncture，reduce the difficulty of operation，and reduce the occurrence of complications through puncture path planning，respiratory movement monitoring，robot-assisted positioning，etc.This technology has been increasingly used in clinical scenarios，such as lung biopsy，ablation，and preoperative localization for thoracoscopic surgery.In order to standardize the operating procedures of CT-guided percutaneous lung puncture for diagnosis，treatment and localization with the robot-assisted percutaneous surgery system and to summarize key points，Guangdong Association of Thoracic Diseases organized experts from various fields （thoracic surgery，respiratory medicine，oncology，interventional therapy，etc.） to develop this expert consensus.

Lung nodules are a common chest imaging manifestation，which has received extensive attention from the clinic and society.In recent years， artificial intelligence （AI） technology based on computed tomography （CT） images has matured and has been widely applied in the classification of lung nodule detection，pathologic typing，malignancy degree and gene mutation prediction.The aim of this paper is to sort out and analyze the relevant studies of AI in the field of lung nodule diagnosis and treatment.

Objective

To summarize the clinical data of bronchopleural fistula （BPF） patients，analyze the causes， and explore the treatment methods and efficacy.

Methods

From April 2021 to June 2024 in Department of Thoracic Surgery，Affiliated Zhongshan Hospital of Dalian Uninersity，6 patients with BPF after lung resection were treated with bronchoscopy （injection of polidocanol around the bronchial fistula） and surgical intervention after the failure of conservative treatment.

Results

Among the 6 patients，4 were males and 2 were females，aged 60 years on average；5 patients underwent right lower lobe resection；3 patients had a long history of smoking；1 patient had diabetes mellitus；3 patients had combined anemia and hypoproteinemia.The mean length of the bronchial stump was （0.8±0.4） cm.The median time to postoperative BPF was 71.5 days.One patient underwent thoracoscopic BPF repair.Five patients were treated with endoscopic injection of sclerosing agent，and one of them had R1 resection，failed endoscopic treatment，and was transferred to surgical repair，with a success rate of interventional therapy of 80%.After follow-up of 3 to 40 months，BPF was healed.

Conclusion

Combining a large amount of relevant research，our group found that BPF after lung resection is related to smoking，malnutrition，right lower lobe surgery，and R1 resection.Endoscopic sclerotherapy is effective，yet surgery remains the final treatment.

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.

Objective

To estimate the impact of adjuvant chemotherapy on survival in T2bN0M0 nonsmall cell lung cancer（NSCLC）patients.

Methods

The clinicopathological data of patients with stage T2bN0M0 NSCLC who underwent lobectomy and mediastinal lymph node dissection between 2010 and 2015 were retrospectively analyzed in the Surveillance，Epidemiology，and End Results（SEER）database.The risk factors were identified by Cox regression.Propensity score matching（PSM）analysis and Kaplan-Meier curves were used to compare the cancerspecific survival（CSS）and overall survival（OS）of T2bN0M0 NSCLC patients between the non-adjuvant chemotherapy and adjuvant chemotherapy groups.

Results

A total of 538 patients with completely resected stage T2bN0M0 NSCLC were enrolled in this study，including 285 males and 253 females，with a median age of 69（62-75）years.Patients with younger，grade III-IV were more likely to receive chemotherapy（P＜0.05）.In Cox regression，adjuvant chemotherapy was significantly associated with OS in completely resected stage T2N0M0 NSCLC（hazard ratio =0.52，95% confidence interval 0.36-0.74，P＜0.05）.In the total population，patients treated with adjuvant chemotherapy had a better OS than those not treated with adjuvant chemotherapy before and after PSM（P＜0.05）.In addition，adjuvant chemotherapy can bring a survival benefit for patients ＜70 years old，but does not improve OS for patients≥70 years old.Similarly，for poor-to-undifferentiated patients，adjuvant chemotherapy can improve the OS of patients，but for moderate-to-well differentiated patients，adjuvant chemotherapy cannot bring survival benefit.

Conclusion

Adjuvant chemotherapy contribute to a survival benefit in completely resected stage T2bN0M0 NSCLC patients，especially in patients ＜70 years and poor-to-undifferentiated NSCLC patients.Adjuvant chemotherapy should be considered in completely resected stage T2bN0M0 NSCLC patients.

Objective

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.

Objective

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.

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.

Objective

To explore the effects of different surgical methods on chronic cough after lung surgery in patients with peripheral lung adenocarcinoma with maximum tumor diameter ≤2 cm.

Methods

Earlystage lung adenocarcinoma patients who underwent thoracoscopic surgery at the Department of Thoracic Surgery of Provincial Hospital of Anhui Medical University from January 2021 to December 2021 were retrospectively analysed and divided into lobectomy，segmentectomy and wedge groups according to the surgical methods to analyse the effects of lobectomy，segmentectomy and wedge resection on the chronic cough of early-stage lung adenocarcinoma patients in the postoperative period.Logistic regression analysis was used to analyse the risk factors of postoperative chronic cough in patients with early-stage lung adenocarcinoma.

Results

The maximum diameter of tumor in the lobectomy group were larger than that in the segmentectomy and wedge resection groups，and the difference was statistically significant（P＜0.001）.The lung lobe group had more thoracic adhesions than the lung segment and wedge groups（P=0.015）.Patients in the lung lobe group underwent more systematic lymph node dissection（P＜0.001），more upper mediastinal lymph node dissection（P＜0.001），and more subluxation lymph node dissection（P＜0.001） than patients in the lung segment group and wedge group.Patients in the lung lobe group had longer anesthesia time and postoperative banding time than those in the lung segment and wedge groups，with significant differences（P＜0.001，P＜0.001）.Univariate and multifactorial analyses revealed that the tumor was located in the upper lung lobe（P=0.002），lobectomy（P=0.047），systematic lymph node dissection（P＜0.001），upper mediastinal lymph node dissection（P＜0.001），and subglottic lymph node dissection were performed（P＜0.001），and the longer the duration of anesthesia and the duration of post-operative tube banding（P＜0.001，P=0.013） were independent risk influences for chronic cough after lung surgery in patients with early stage lung adenocarcinoma.

Conclusion

Early-stage lung adenocarcinoma patients who underwent lobectomy were more likely to develop postoperative chronic cough after lung surgery than early-stage lung adenocarcinoma patients who underwent sublobar lobectomy.In addition，when the tumor is located in the upper lobe of the lung，mediastinal lymph node dissection is performed，anesthesia time and postoperative time with tubes are long，more attention should be paid to prevent the occurrence of chronic cough after lung surgery after surgery.

Objective

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.